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Permit No. 5015 City of Chihli Hills APPLICATION FOR BUILDING PERMIT Community Development 2001 Grand Avenue Chino Hills,CA 91709 Buildin (Address: Proposed Use - j St No. "-9 Street VISTA DEL SOL RESIDENCE 1032-561-31 APN THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot 94 Block Tract 13906-5 El Struct. ll Plumb. BROCK HOMES El Mech. El Elect. ®Grading Applicant ®New 0 Alter ❑Addition 23. i MILLCREEK Type of Project St No. Street City LAGUNA HILLSZip 92653 phone714-583-1061 ❑Repair 0 Convert. 0 Demo El Occupancy Permit Owner BROCK HOMES Project I Location on I Size 23382 MILLCREEK Description Property in Sq.Feet St No. Street 1 LIVABLE 145 City LHULINik HILLS Zip 92653 phone714-583-1061 Engr/Arch Lic No. Z GARAGE I I;10 St No. Street 3 PATIO I 1 I80 City Zip Phone 4. I I Contractor BROCK HOMES Lic No.54648 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION 23382 MILLCREEK - Sewer Min. Depth S/F/100 Size St No. Street YES City LAGUNA HILLS Zip 92653 phone714-583-106 --tubic Yards-Excavation' Fill Over Excavation City Business License . License No. 693 Expiration Date10/31/95 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 �' .�� City and Zip Phone /�` `a Owner Builder Declaration I hereby affirm that I am exempt from the Contractor's License Law for the following reason: 0 1--1 I, as the owner of the property, or my employees with wages as their whole compensation, will do the work, and the structure is not intended or offered for sale. 1'7 I, as owner of the property, am exclusively contracting with licensed contractors to 4111��-- mm-- 4.1 construct the project. T— ❑ 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,ILI,FR1 compensation as provided by Section 3700 of the Labor Code, for the performance of the 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 LaborCode, for the performance of the work fcr which this permit is issued. My worker's Ry I SY SSY I compensation insurance carrier and policy number are: Ins. Co.: Group/Division/Type Policy No: r 3/VN Exp Date: VALUATION (This dection need not be completed if the permit is for one hundred doolars($1 00)or less). ! 1 33,994.00 ❑ 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 Electrical $235.95 Structural $1,014.62 provisions. / Date S /r C-iJ Signature Warning: Failure to secure workers' compensation verage is unlawaw U, andahall subject an Plumbing $244.50 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 $88.80 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 $65.07 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 $1,752.94 purposes. f I 4✓ '. G ' : /Y iI qJ Date Issued Permit Number Signature . Applicant o eget/ Date 08/11/95 5 015 FINANCE CODE CENSUS CODE Print Applicant's/Agent's Name C4 101 • ..,ONSTRUCTION LENDING AGth1C' 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. ❑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 30 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 DATE I INSPECTOR Setback/Location I I I Rough Plumbing I I Temporary Power I I / I Shower Pan Test I I Foundation Reinforcing Steel c, /,c l I �,, - Stucco Mesh or Exterior Siding I I Excavation and Forms / /` ` " s+" i Insulation I I Slab Grade I ?//5/5't I - Sewer I I Ground Plumbing Soil I VorA S Interceptor Ground Plumbing Water I Septic Tank Underslab Ducts tl Leach Line or Seep Pit I Underslab Conduit Water Service I Underslab Gas I Lath or Drywall Nailing I I Fireplace Foundation I Gas Line Air Test I I Joists and Girders I Final Energy I I Electrical Ground 7//7/Ff Atel I Final Plumbing Mid-Height Bond Beam I Final Heating/A.C. 8-Foot Bond Beam Final Construction Final Bond Beam Final On Site Improvements Fireplace Bond Beam Final Off Site Improvements Roof Sheathing tsf/E17Z /O/2p/per I Final Dedication Framing and Ventilation Final Zoning Roof Covering Final Electrical Rough Heating Final Gas Service and Ground I Developer Fees Paid Rough Electrical I Fire Dept. Approval Verified Bonding I Certificate of Occupancy Over Head Electrical I Fence Height Gates Heater Pool Drainage I SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDE LONG X DEPTH OF ROCK N. W. E. S. Inspector's Signature and Initials geit DATE OF ISSUANCE PERMIT NUMBER g - --q5 50 (5 Io 3 y4 CITY OF CHINO HILLS COMMUNITY DEVELOPMENT DEPARTMENT BUILDING AND SAFETY DIVISION I PERMIT # SC) f S' 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 / eocx_ DATE 0—(7-45 LOCATION C70) Cr` V l S7/,1- 176-L S 'L- INSPECTION RECORD INSPECTION I DATE INSPECTOR Setback/Location Temporary Power Foundation/Reinforcing Steel Slab Grade ///7// I o<s•F Ground Plumbing c /rf3/f Underslab Copper Underslab Conduit/Ducts I J� Fireplace Foundation I Joists and Girders I Electrical Ground `l/l?/f.SI- DO NOT CONCEAL UNTIL ABOVE ARE SIGNED AND DATED First Bond Beam/Lilt I Final Bond Beam/Lift 51/40/9'S Fireplace Bond Beam ` Roof Sheathing _ Shear 1//0//-/- Framing and Ventilation I j A Rough Heating Electrical Service and Ground I /A Ir Rough Electrical I r/I Y le V/ Rough Plumbing Shower Pan/Tub Test l� Stucco Mesh or Exterior Siding I Fire Sprinklers I DO NOT CONCEAL UNTIL ABOVE ARE SIGNED AND DATED Insulation I /1/1/ Sewer I /O�,D/cj- ?� 04, Septic Tank " Leach Line or Seep Pit Water Service I /t747/F,r I �• / 7i DO NOT CONCEAL UNTIL ABOVE ARE SIGN AND DATED Interior LattrQf Diwali I///42/.9(-- Gas /c C Gas Line Air Test I !i 7v /9( 4 /--- Final Grading I - Final Electrical I log\e Final Plumbing I /MY Final Heating/A.C. Final Zoning/Conditions of Approvall Final Fire(Call Local Fire Dept.) I /Z- —qS -71Y- Final Building /iia/ZA1 Certificate of Occupancy r / 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.