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Permit No. 5006 City of Grimo Hills APPLICmi ruvi FOR BUILDING PERMIT Community Development 2001 Grand Avenue Chino Hills,CA 91709 Building Address: Proposed Use - St No. 2037 Street VISTA DEL SOL RESIDENCE APN 1032-561-32 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot 95 Block Tract 13906-5 ®Struct. ®Plumb. Applicant BROCK HOMES ®Mech. ®Elect. ®Grading St No. 23382 Street MILLCREEK Type of Project New 0 Alter 0 Addition one714-583-1061 0 Repair ❑Convert. ❑Demo ❑Occupancy Permit City LAGUNA HILLS Zip 92653 ph Owner BROCK HOMES Project I Location on I Size St No. 23382 StreetMILLCREEK Description Property in Sq.Feet City LAGUNA HILLS Zip 92653 phone714-583-1061 1-LIVABLE I 11770 770 ' Engr/Arch Lic No. z.GARAGE I [17 St No. Street 3 PATIO I 123 City Zip Phone 4. I I Contractor BROCK HOMES Lic No.54648 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION . . Sewer Min. Depth S/F/100 Size St No. 23382 Street MILLCREEK YES City LAGUNA HILLS Zip 92653 Phone714-583-106 Cubic Yards Excavation' Fill Over Excavation City Business License License No. 693 Expiration Datel 0/31/95 Licensed Contractor's Declaration •••••-•---•••••--•----•---•------•••--••-••--•-•••••--••• ••--••-------•-----• I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 7000 of Division 3 of the Business and Professions Code)and my license is in full force and effect. License Class B License Number 54648 Date Contractor SAME AS ABOVE Address -„,..x•-•---,...,,, City and Zip Phone � Owner Builder Declaration - .,----"7) . I hereby affirm that I am exempt from the Contractor's License Law for the following reaso : r, I,as the owner of the property, or my employees with wages as their whole 1.....1 compensation, will do the work, and the structure is not intended or offered for sale. r7 I, as owner of the property, am exclusively contracting with licensed contractors to 4.J construct the project. ------..._..--.----_-_--- 1:11 ...........................-............ .-..................._.-...._............._❑ I am exempt under Sec.__,B&PC for this reason Date Initial Workers' Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations: ZoningI Land Use Ela. I have and will maintain a certificate of consent to self-insure for workers' CH/PD,IL1,FR1 compensation as provided by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. Setbacks I Model/Plan ab. I have and will maintain worker's compensation,as required by Section 3700 of the FY I SY I LaborCode, for the performance of the work fcr which this permit is issued. My worker's Ry I SSY compensation insurance carrier and policy number are: Ins. Co.: Group/Division/Type Policy No: F 3/VN Exp Date: VALUATION (This dection need not be completed if the permit is for one hundred doolars($100)or less). ' 1 13,1 38.00 13 c. I certify that In the performance of the work for which this permit is issued. I shall ` not employ any person in any manner so as to become subject to the Workers' Compensation PERMIT FEES Laws of California and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code. I shall forthwith comply with those provisions- Electrical $194.70 Structural $920.22 Date EL d l-5r Signature Ad's,. .1 PlumbingGrading Warning: Failure to secure workers' compensatio coverage is unawful,,nd shall subject an $222.00 $75.00 employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest, and attorney's fees. Mechanical $78.81 Issuance $29.00 I certify that I have read this application and state that the above information is correct. I agree to comply with all City Ordinances Geo Review Plan Check $59.07 and state laws and hereby authorize representatives of this City Issuance Approved I Total Permit Fee to enter upon the above mentioned property for inspection DC $1,578.80 purposes. IVKQ • Le'i/v//V V -d-1I~ Date Issued Permit Number Signature Q�f/Applicant oil iAgeni Date Vv 08/11/95 5006 FINANCE CODE CENSUS CODE Print Applicant's/Agent's Name .C4 101 • ,ONSTRUCTION LENDING AG _.-1 I HEREBY AFFIRM THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC.3097,CIV.C.). LENDER'S NAME LENDER'S ADDRESS DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRES A DIVISION OF INDUSTRIAL SAFETY PERMIT AS A PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW. 0 I CERTIFY THAT NO EXCAVATION 5 FEET OR MORE FEET IN DEPTH,INTO WHICH A PERSON IS REQUIRED TO DESCEND,WILL BE MADE IN CONNECTION WITH WORK AUTHORIZED BY THIS PERMIT,AND THAT NO BUILDING,STRUCTURE,SCAFFOLDING,FALSEWORK,OR DEMOLITION OR DISMANTLING THEREOF,WILL BE MORE THAN 38 FEET HIGH. 0 AS OWNER/BUILDER I WILL NOT EMPLOY ANYONE TO DO WORK WHICH WOULD REQUIRE A PERMIT FROM THE DIVISION OF INDUSTRIAL SAFETY,AS NOTED ABOVE UNLESS SUCH PERSON HAS A PERMIT FROM THAT DIVISION. DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER I HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT DIS DIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY. BUILDING INSPECTIONS RECORD DATE I INSPECTOR I I DATE INSPECTOR Setback/Location I I Rough Plumbing Temporary Power I Shower Pan Test Foundation Reinforcing Steel 77/?s/ C Stucco Mesh or Exterior Siding Excavation and Forms Insulation Slab Grade ?//F/, Sewer •1 Ground Plumbing Soil //WC— Interceptor Ground Plumbing Water Septic Tank Underslab Ducts I Leach Line or Seep Pit Underslab Conduit j Water Service Underslab Gas J Lath or Drywall Nailing Fireplace Foundation jI Gas Line Air Test Joists and Girders J I Final Energy Electrical Ground 77/ F/ S--- I I Final Plumbing Mid-Height Bond Beam J Final Heating/A.C. 8-Foot Bond Beam Final Construction Final Bond Beam J Final On Site Improvements I Fireplace Bond Beam Final Oft Site Improvements I • Roof Sheathing e (97,"7J Final Dedication Framing and Ventilation I Final Zoning Roof Covering I Final Electrical Rough Heating I Final Gas Service and Ground I Developer Fees Paid Rough Electrical I Fire Dept. Approval Verified 1 Bonding I Certificate of Occupancy Over Head Electrical Fence Height Gates Heater Pool Drainage • SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDE LONG X DEPTH OF ROCK N. W. E. S. Inspector's Signature and Initials -44 95 DATE OF ISSUANCE PERMIT NUMBER 1--1- 1 O 3 S- --CITY OF CHINO HILLS COMMUNITY DEVELOPMENT DEPARTMENT BUILDING AND SAFETY DIVISION I PERMIT # Call(909) 590-1511 Ext. 282 before 3:00 p.m. for next day inspection POST IN A SAFE, CONSPICUOUS PLACE AT FRONT OF JOB. PROVIDE PERMIT NUMBER WHEN CALLING FOR INSPECTION. HAVE APPROVED PLANS ON JOB AT TIME OF INSPECTION. OWNER ReocIL DATE g -95-- LOCATION 02.037 V L 674 D S c)4- INSPECTION )LINSPECTION RECORD INSPECTION I DATE I INSPECTOR Setback/Location Temporary Power Foundation/Reinforcing Steel Slab Grade /// � Ground Plumbing q I r�y( mfr Underslab Copper Underslab Conduit/Ducts Fireplace Foundation Joists and Girders Electrical Ground DO NOT CONCEAL UNTIL ABOVE ARE SIGNED AND DATED First Bond Beam/Lilt Final Bond Beam/Lift Fireplace Bond Beam Root Sheathing ///. /v r �� Shear �"/�/ ' <_ Framing and Ventilation / f Rough Heating t 1 S/ / Electrical Service and Ground 61 1 I/ Rough Electrical Rough Plumbing Shower Pan/Tub Test y , Stucco Mesh or Exterior Siding Fire Sprinklers DO NOT CONCEAL UNTIL ABOVE ARE SIGNED AND DATED Insulation 7/ Sewer /D 4oA-.f Septic Tank Leach Line or Seep Pit Water Service /07. /Sr DO NOT CONCEAL UNTIL ABOVE ARE SIGNED AND DATED Interloc r Nging 7.//4// Gas Line Air Test //1/7i7/ Final Grading , (. Final Electrical �''� A V7 Final Plumbing I Ls /j' Final Heating/A.C. I V r Final Zoning/Conditions of Approv,all7 7 Final Fire(Call Local Fire Dept.) JZ" 5 - 95- Final SFinal Building /i//g/cr 4 . Certificate of Occupancy NOTICE TO OWNER! Call for FINAL inspection on every job. This permit will expire if work is suspended or abandoned for a period of 180 days. Call for inspection every 180 days to help keep permit active. NO WORK SHALL BE COVERED WITHOUT INSPECTION. FILE THIS CARD WITH YOUR PERMANENT RECORDS WHEN JOB IS COMPLETED.