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Permit No. 5007 City of Chines Hills APPLICAriO, FOR BUILDING PERMIT Community Development 2001 Grand Avenue Chino Hills,CA 91709 Building Address: Proposed Use - St No. 2061 Street VISTA DEL SOL RESIDENCE APN 1032-561-35 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot 98 Block Tract 13906-5 ®Struct. El Plumb. Applicant BROCK HOMES . ®Mech. l Elect. ®Grading St No. 23382 Street MILLCREEK Type of Project EI New ❑Alter ❑Addition City LAGUNA HILLS Zip 92653 Phone714-583-1061 0 Repair 0 Convert. 0 Demo 0 Occupancy Permit Owner BROCK HOMES Project I Location on I Size St No. 23382 Street MILLCREEK Description Property in Sq.Feet LAGUNA HILLS 1.LIVABLE I 1 770 City Zip 92653 Phone714-583-1061 IL� Engr/Arch Lic No. 2.GARAGE I 117 St No. Street 3.PATI O I 123 City Zip Phone 4. I I Contractor BROCK HOMES Lic No.54648REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION Sewer I Min. Depth I S/F/100 I Size St No. 23382 Street MILLCREEK 'SES City LAGUNA HILLS Zip 92653 Phone714-583-106 "caupic 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 !/ .lA 1 City and Zip Phone Owner Builder Declaration Y - I hereby affirm that I am exempt from the Contractor's License Law for the following reason: n I,as the owner of the property, or my employees with wages as their whole �J compensation, will do the work, and the structure is not intended or offered for sale. -ss:`J DI,as owner of the property, am exclusively contracting with licensed contractors toconstruct the project. 1..1 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 I Model/Plan work for which this permit is issued. Setbacks b. 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 arc: 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). V 113,138.00 c. I certify that in the performance of the work for which this permit is issued. I shall PERMIT FEES not employ any person in any manner so as to become subject to the Workers' Compensation 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 I Structural $920.22 Date_ ir`1) —IrSignature_f Warning: Failure to secure workers' compensa coverage is unlaw 4., and shall subject an Plumbing $222.00 Grading $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 1.57R.Rf1 purposes. / �t I 21, e,'Au—') .I� Date Issued Permit Number Sign 4re of AppliEint 0 Agent Date 08/11/95 5007 FINANCE CODE CENSUS CODE Print Applicant's/Agent's Name C4 101 `< .,ONSTRUCTION LENDING AG -141C-S- , • 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 ADDRESF 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. ❑ 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 36 FEET HIGH. ❑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 I Rough Plumbing Temporary Power I I Shower Pan Test Foundation Reinforcing Steel i 7/20/7c- / /� - 1_ i Stucco Mesh or Exterior Siding1 Excavation and Forms °2© �S I `�°'� Insulation Slab Grade '/L6/¢� I/ / Sewer Ground Plumbing Soil �f(/ Interceptor Ground Plumbing Water Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service Underslab Gas Lath or Drywall Nailing Fireplace Foundation Gas Line Air Test Joists and GirdersFinal Energy Electrical Ground %/moo Final Plumbing Mid-Height Bond Beam Final Heating/A.C. 8-Foot Bond Beam Final Construction Final Bond Beam I Final On Site Improvements Fireplace Bond Beam I Final Off Site Improvements • Roof Sheathing gSkle-tZ- to/<6/if Final Dedication Framing and Ventilation Final Zoning Roof Covering Final Electrical Rough Heating Final Gas Service and Ground I Developer Fees Paid Rough Electrical Fire Dept. Approval Verified Bonding 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 47/ 9E? DATE OF ISSUANCE PERMIT NUMBER () - 1 ( -15 5007 - 03 - `e3 CITY OF CHINO HILLS COMMUNITY DEVELOPMENT DEPARTMENT BUILDING AND SAFETY DIVISION I PERMIT # nsoc7 '7 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 8c. .c-Ie_ DATE f''-17-?5' LOCATION /X.O1) TA Del_ So 4_ INSPECTION RECORD INSPECTION DATE I INSPECTOR Setback/Location Temporary Power Foundation/Reinforcing Steel a, tsr Slab Grade tts-7!— Ground Plumbing Underslab Copper • Underslab Conduit/Ducts Fireplace Foundation Joists and Girders Electrical Ground IL-4/5r— mai/" • DO NOT CONCEAL UNTIL ABOVE ARE SIGNED AND DATED First Bond Beam/Lilt Final Bond Beam/Lift Fireplace Bond Beam Roof Sheathing Shear !U/%0/ Framing and Ventilation • Rough Heating �� Electrical Service and Ground Rough Electrical ) J Rough Plumbing Shower Pan/Tub Test to/r/Z7 Stucco Mesh or Exterior Siding Fire Sprinklers DO NOT CONCEAL UNTIL ABOVE ARE SIGNED ANDRATED insulation /O/-r/�7X Sewer Septic Tank Leach Line or Seep Pit Water Service /,2//J/7-t_ / DO NOT CONCEAL UNTIL ABOVE ARE SIGNED AND DATED Interior Lath or D—r=i Nailing Ij/y/gc ab.-- Gas Line Air Test I i;/t11/5- Final Grading I J.( ,' Final Electrical + / 401 Final Plumbing ( MAI /1 7/ Final Heating/A.C. I f 17 Final Zoning/Conditions of Approval Final Fire(Call Local Fire Dept.) . /2_ Final Building /7-Ail/1 41— , Certificate of Occupancy • v 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.