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Permit No. 5341 City of ..-tllino Hills APPLI.:ATION FOR BUILDING PERMIT Community Development 2001 Grand Avenue Chino Hills,CA 91709 • Building Address: Proposed Use - St No.2080 Street VISTA DEL SOL ELECT LINE FOR FUTURE SPA APN THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot 67 Block Tract 13906-5 Q Strew_ El Plumb.. Applicant SUNSET FENCE AND PATIO CI Mme. ISS.©ect. ❑Gradino. St No. 3220 Street WILLOW Type of Projects New a Alter ❑Addition CitySIGNAL HILL Zip90806 phon&10-424-0771 CI Repair ['Convert. ❑Dema D Occupancy Permit Ownetl-INDA COLTON Project I Location on I Size St No.2080 Street VISTA DEL SOL Description Property in Sq.Feet CitIgHINO HILLS Zip91709 Phone 1 ELECT LINE II Engr/Arch Lic No. 2. I I St No. Street 3. I I City Zip Phone 4. I I ContractorSUNSET FENCE AND PATIOREMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION Lic No. Sewer I Min. Depth I S/F/100 I Size (� St N0.3220 Street WILLOW CitySIGNAL HILL Zip90806 phon10-424-0771 Cubic Yards Excavation Fill Over Excavation O 00 gi City Business License a License No. Expiration Date 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-1 License Number 126230 -0---- Date ContractorME AS ABOVE �^ Address ( \ City and Zip Phone \ •.• 1 (0 Owner Builder Declaration _._./ I hereby affirm that I am exempt from the Contractor's License Law for the following reason: f7 I, as the owner of the property, or my employees with wages as their whole ‘ 1 compensation, will do the work, and the structure is not intended or offered for sale. ..... ------- � � 0 rl l, as owner ofthe property, am exclusively contracting with licensed contractors to construct the project. DiI 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 13 CH/PD,FR1 a. I have and will maintain a certificate of consent..to .self-insure-for-•workere compensation as provided by Section 3700 of the Labor Code;•for the performance of the work for whi his permit is issued. Setbacks I Model/Plan b. I have and will maintain worker's compensation,as required by Section 3700 of the FY 20 ' SY 5,5 LaborCode, for the performance of the work for which this permit is issued. My worker's Ry 15 I ssy I compensation insurance carrier and policy number are: Ins. Co.: ( � •�llAi iGroup/Division/Type Policy No: 17 e,4©g Exp Date: ///S—G) : VALUATION (This dection need not be completed if the permit is for one hundred doolars($100).or less). 1100.00 (C] • c.I certify that'in the performance of the wo fZf which this permitis issued. I shall not employ any person in any manner so as to beco.e syojectrto.th''e'Morkers'.Compensation PERMIT FEES Laws of California and agree that if I'should beco'e s bj- . the workers' coo pensation provisions of Section 3700 of the(signatu; ' / abor Cod-. s ort "ith/c.-pl lth those $22.50 prows• s. �^—�_i e• Electrical Structural Date ,� ' \ �/ � Warning: Failu - to s- re workers' compensation coverage issuunla ul, and shall subject an Plumbing Grading employer to criminal penalties and civil fines up to one hundred tho sand dollars($100,000), in addition to the cost of compensation, damages as provided r in Section 3706 of the Labor Code, interest,and attorney's fees. Mechanical Issuance $45.00 I certify that I have read this application and state that the above I information is correct. I agree to comply with all City Ordinances Geo Review Plan Check and stat laws and hereby authorize representatives of this City Issuance Approved Total Permit Fee to ent ,up n the ,above mentioned property for inspection DC I $67.50 ,purp s ' / ... _ & 1/ - /I/v7 ' I //i. Date Issued Permit Number Signa ure of Applican or Agent Date / 10/26/95 I 5341 /.]/f `1l-.. a FINANCE CODE C4 CENSUS CODE 0/S Print Applicant's/Agent's Name ,,:-.-i-NSTRUCTION LENDING AGENCN I HEREBY AFFIRM THAT THERE ISA CONSTRUCTION LENDING AGENCY FOR I IF PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC.3697..CM/.C.). LENDER'S NAME LENDER'S ADDRESS DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY C6DE REQUIRES A DIVISION OF INDUSTRIAL SAFETY PERMIT AS A PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW. 0 ICEFITIFY 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. . . 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 UNLESSSUCH 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 -:01S DIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY. . . . BUILDING INSPECTIONS RECORD ,t • . _ DATE INSPECTOR I DATE INSPECTOR Setback/Location I Rough Plumbing Temporary Power I Shower Pan Test Foundation Reinforcing Steel I Stucco Mesh or Exterior Siding_ Excavali,on and Forms Insulation I . Slab Grade Sewer Ground Plumbing Soil _ . Interceptor _ . Ground PlUmbing Water Septic Tank Underslab Ducts Leach Line or Seep Pit I , Underslab Conduit 2Z2 Water Service Underslab Gas I Lath or Drywall Nailing Fireplace Foundation Gas Line Air Test Joists and Girders I Final Energy Electrical Ground ' Final Plumbing Mid-Height Bond Beam Final Heating/A.C. 8-Foot Bond Beam Final Construction Final Bond Beam J Final On Site Improvements Fireplace Bond Beam Final Off Site Improvements Root Sheathing ._ Final Dedication Framing and Ventilation Final Zoning Roof Covering I Final Electrical Rough Heating Final Gas Service and Ground Developer Fees Paid Rough Electrical Fire Dept. Approval Verified _ 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 . - _ DATE OF ISSUANCE PERMIT NUMBER . :