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Permit No. 5016 City of Chino' Hills APPLICATIG-, FOR BUILDING PERMIT Community Development 2001 Grand Avenue Chino Hills,CA 91709 Building Address: Proposed Use - St No. 2045 Street VISTA DEL SOL RESIDENCE APN 1032-561-33 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot 96 Block Tract 13906-5 El Struct. ®Plumb. BROCK HOMES ®Mech. ®Elect. ®Grading Applicant El New 0 Alter El Addition St No. 23382 Street MILLCREEK Type of Project City LAGUNA HILLS Zip 92653 phone714-583-1061 0 Repair 0 Convert. ❑Demo 0 Occupancy Permit Owner BROCK HOMES Project I Location on I Size St No. 23382 Street MILLCREEK Description Property in Sq.Feet city LAGUNA HILLS Zip 92653 phone714-583-1061 1-LIVABLE I [145 Engr/Arch Lic No. Z.GARAGE I 110 St No. Street 3_PATIO I 130 City Zip Phone 4. I I Contractor BROCK HOMES Lic No.54648 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION Sewer 1 Min. DepthS/F/100 Size St No.23382 Street MILLCREEK :5 I I City LAGUNA HILLS Zip 92653 Phone714-583-106 cdiliF: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 / ..\,/,) City and Zip Phone , Owner Builder Declaration / 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 I.J compensation, will do the work, and the structure is not intended or offered for sale. I--1 I, as owner of the property, am exclusively contracting with licensed contractors to L.1 construct the project. _...._.- __ _. _. ❑ 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 ❑ a. 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 la' for which this permit is issued. Setbacks I Model/Plan 4th b. I have and will maintain worker's compensation,as required by Section 3700 of the FY I SY 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: I 3/VN Exp Date: VALUATION (This dection need not be completed if the permit is for one hundred doolars($1 00)or less). !.133,994.00 ❑ 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 $235.95 Structural $1,014.62 Dara /// Signature_ ) t7 ,I . - Warning: Failure to secure workers' compensatio ''EE//overage is unlawful, .nd shall 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 Total Permit Fee to enter upon the above mentioned property for inspection DC $1.752.94 purposes. p zocm�� Q�1/-q'- Date Issued Permit Number Signature ofhpplicant orOsgentU Date 08/11/95 501 6 FINANCE CODE CENSUS CODE Print Applicant's/Agent's Name C4 101 /- ' ,ONSTRUCTION LENDING AG . C1' , 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,FALSE WORK,OR DEMOLITION OR DISMANTLING THEREOF,WILL BE MORE THAN 38 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 I INSPECTOR Setback/Location I I Rough Plumbing I I Temporary Power I I Shower Pan Test I I Foundation Reinforcing Steel 0'ba /q ..--- �i� I Stucco Mesh or Exterior Siding I I Excavation and Forms hp' //! ' `fer I insulation I Slab Grade 7/ff/i ---Ar:' I Sewer Ground Plumbing Soil C//1/1( I %R., _ Interceptor I Ground Plumbing Water 5tA04 Septic Tank I Underslab Ducts Leach Line or Seep Pit I Underslab Conduit Water Service I Underslab Gas I Lath or Drywall Nailing I Fireplace Foundation I Gas Line Air Test I Joists and Girders , I Final Energy I Electrical Ground `j'/( 7'/7) moo/ _. I Final Plumbing I Mid-Height Bond Beam ` I Final Heating/A.C. I 8-Foot Bond Beam I Final Construction I Final Bond Beam Final On Site Improvements 1 Fireplace Bond Beam , Final Off Site Improvements Roof Sheathing 4'j/162_ /0//3/95 Final Dedication I Framing and Ventilation I Final Zoning I Roof Covering I Final Electrical I Rough Heating I Final Gas Service and Ground Developer Fees Paid Rough Electrical I Fire Dept. Approval Verified Bonding I Certificate of Occupancy I Over Head Electrical I I Fence Height I _I Gates I Heater Pool Drainage I` I SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDE LONG X DEPTH OF ROCK N. W. E. S. Inspector's Signature and Initials DATE OF ISSUANCE PERMIT NUMBER