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Permit No. 5366 City of C.-1ino Hills APPLICA-._JN FOR BUILDING PERMIT Community Development 2001 Grand Avenue Chino Hills,CA 91709 • Building Address: Proposed Use - St No. 2037 Street VISTA DELL SOL RETAINING WALL APN 1032-561-32 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot 95 Block Tract 13906-5 Ei WM.. Ei ii4iiiii: Applicant BROCK HOMES ®Mee�` � �` CI %iiitin •St No. 201 Street E SANDPOINTE STE 100 Type of Project i�@�i AI �F A564i City SANTA ANA Zip 92707 Phone 714-556-4663 El hinif 0 t®111i@Ft: 0 Dom® 0 b ey t Owner BROCK HOMES Description Lon Size pt on Property in Sq.Feet St No. 201 • Street E SANDPOINTE STE 1001. RET WALLI 1384 City SANTA ANA Zip 92707 Phone 714-556-4663 Engr/Arch • Lic No. 2. I I St No. Street 3. I I City Zip Phone 4. I I Contractor BROCK HOMES Lic No. 54648 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION Sewer I 'Min.Depth I S/F/100 Size St No. 201 Street E SANDPOINTE STE 100 City SANTA ANA Zip 92707 Phone 714-556-4663 Cubic Yards Excavation Fill Over Excavation City Business License License No. 693 Expiration Date 10/31/95 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 R 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: DI, 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. DImDI, as owner of the property, am exclusively contracting with licensed contractors to , construct the project. ❑ I am exempt under Sec.__,B&PC for this reason Date Initial Workers' Compensation Declaration I hereby confirm that I have a certificate of consent to self insure, or a Zoning Land Use certificate of Workers Compensation Insurance, or a certified copy thereof, CH/PD Company POLICY IC. Setbacks I Model/Plan ❑ Certified copy is hereby furnished Date Expires FY I SY Certified copy is on file with the city City Verified RY I SSY I I �f ,�� / Group/Division/Type Date a�( '19C- AppJiearlf- / ,i Gam/ez9'i-Q—_ Certificate of Exemption from Workers' Compensation Insurance VALUATION I certify that in the performance of the work for which this permit is issued, I shall not employ $4,608.00 any person in any manner,so as to become subject to the Workers Compensation Laws of California. PERMIT FEES Date Applicant NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject Electrical Structural $86.40 to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. I certify that I have read this application and state that the above Plumbing I Grading information is correct. I agree to comply with all City Ordinances and state laws and hereby authorize representatives of this City Mechanical Issuance $29.00 to enter upon the above mentioned property for inspection purposes. Geo Review I Plan Check 444444 / A Issuance Approved Total Permit Fee 44444(aA i74- 6-6,--1—€_ e(4°/`7 i DC $115.40 Signature of Applicant or lent Date I T Date Issued Permit Number 11/02/95 5366 Print Applicant's/Agent's Name FINANCE CODE 1 CENSUS CODE C4 0/S e ,ONSTRUCTION LENDING AGENC1. ) 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 ODE 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 36 FEET HIGH. Li AS OWNER/BUILDER I WILL NOT EMPLOY ANYONE TO DO WORK WHICH WOULD HEQUIfIE 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 ANI) TILE WORK APPLIED FOR ON THIS PERMIT DIS HIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND I HE LOCAL AIR QUALITY AGENCY. BUILDING INSPECTIONS RECORD DATE INSPECTOR DATE INSPECTOR Setback/Location Rough Plumbing Temporary Power Shower Pan Test Foundation Reinforcing SteelC (q5-- L- Stucco Mesh or Exterior Siding Excavation and Forms Insulation • - --------- Slab Grade Sewer ---- --------- Ser Ground Plumbing Soil interceptor Ground PlumbingWater Septic Tank Undersiab Ducts Leach Line or Seep Pit UndersiabConduit Water Service Underslab Gas Lath or Drywall Nailing - - ---- ----- --Fireplace Foundation Foundation Gas Line Air Test Joists and Girders Final Energy Electrical Ground Final Plumbing Mid-Height Bond Beam Final Heating/A.C. 8-Foot Bond Beam _ Final Construction Final Bond Beam i 2/5 _ 3 Final On Site Improvements Fireplace Bond Beam Final Off Site Improvements Roof Sheathing Final Dedication / �� Framing and Ventilation Final Zoning RoofCovering_ Final Electrical Rough Heating Final Gas Service and Ground Developer Fees Pald -- ---------- Rough ElectricalDept. --v-- 9 Fire A -- - - ---- ------ ---------- __. Approval Verified Bonding Certificate of Occupancy Over Head Electrical - —— —Fence Height Gates Heater Pool Drainage -a-- SEPTIC TANK GALS. -- - ---- _ ----------------- ---- SEEP. PIT. - - X LEACH LINE WIDE - _ _ - . -. LONG X. DEPTII OF ROCK _ N. • W. E. S. Inspector's Signature and Initials DATE OF ISSUANCE PERMIT NUMBER !/- 02 - 95 53 C