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Permit No. 5370 City of L/vino Hills APPLIL_.fION FOR BUILDING P -MIT Community Development 2001 Grand Avenue Chino Hills,CA 01709 Building Address: r Proposed Use - St No.2061 StreetVlcTi nFl .cnl ETAINING WALL APN 1032 561-35 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot no Block Tract13906-5 ®L51tSuf let• OidtPrikrib. al3diedsch. OPEtect. D[ r®f atc1 Applicant BRnry unr<ncc Type of Project®L>q w ❑I�IAtfer DIA dit'ibn . . St No. 201 Street E sompnINTF cTF 1 nt1 CitycA,�„-A ANA Zipga7f)7 Phone/14-556-4663 Di'weirag atvtalart.DL�@ lo�[9�c�'9bg} fit Owner . ..... ,�..11!11 ACC B .. Project Location on Size .,0Description Property in Sq.Feet St No. V, StreetEpnl cTF 1 nn I i.RET WALL CitySANTA AM' : Zipg77 Phone/14-556-4663 Engr/Arch Lic No. 2. I I St No. Street 3. I I City Zip Phone 4. I I Contractor REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION EnCCK HOMES Lic No.5F46 Sewer I Min. Depth I S/F/100 I Size St No.`v, Street E SANDPO11'TE cTF 1.00 City5.ANTA ANA Zipa97n7 Phone714-556-4663 Cubic Yards Excavation Fill Over Excavation City Business License License No.Cf,2 Expiration Datel0/31/95 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 License Number -. 0 DatP Contractor sa ;��:.-,•;:: 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: D1, 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. f'-1 I, as owner of the property, am exclusively contracting with licensed contractors to 6..1 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 POKY NO. Setbacks I Model/Plan ❑ rtified copy is hereby furnished Date Expires FY I SY RY I SSY all Certified copy is on file with the city City Verified Group/Division/Type Date 1110/II- APP• n* Int c i14490-0-4-02—__ 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 $1,200.00 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 $34.80 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 I Issuance $29.00 to enter upon the above mentioned property for inspection purposes. Geo Review I Plan Check / Issuance Approved Total Permit Fee 14b-u (C� %ie.�-� ii/e 41' DC $63.80 Signature of Applicant or Agent Date ' I Date Issued Permit Number 11/02/95 5370 Print Applicant's/Agent's Name FINANCE CODE I CENSUS CODE C4 0/S '�;ONSTRUCTION LENDING AGENC1-.4 I HEREBY AFFIRM THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC.3097,CIV.C.). LENDER'S NAME LENDER'S ADDRESQ DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE AE:UIRES A DIVISION OF INDUSTRIAL SAFETY PERMIT AS A PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW. ❑I CERTIFY THAT NO EXCAVATION 5 FEET OR MORE FEET IN DEPTH,INTO WHICH A PERSON IS REQUIRED TO DESCEND,WILL BE MADE IN CONNECTION WITH WORK AUTHORIZED BY THIS PERMIT,AND THAT NO BUILDING,STRUCTURE,SCAFFOLDING,FALSEWORK,OR DEMOLITION OR DISMANTLING THEREOF,WILL BE MORE THAN 36 FEET HIGH. O AS OWNER/BUILDER I WILL NOT EMPLOY ANYONE TO DO WORK WHICH WOULD REQUIRE A PEUMII FROM THE DIVISION OF INDUSTRIAL SAFETY,AS NOTED ABOVE UNLESS SUCH PERSON HAS A PERMIT FROM THAT DIVISION. DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER ..... ___ _ ... _._. I HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT flIS [IIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF TIlE HEALTH AND SAFETY CODE AND I HE LOCAL Alla QUALITY AGENCY. BUILDING INSPECTIONS RECORD • DATE INSPECTOR - DATE INSPECTOR Setback/Location Rough Plumbing Temporary Power Shower Pan Test Foundation Reinforcing Steel .j J",3Q q$' Stucco Mesh or Exterior Siding Excavation and Forms Insulation Slab Grade Sewer Ground Plumbing Soil Interceptor GroundPlumbing Water Septic Tank Underslab Ducts Leach Line or Seep Pit UnderslabConduit Water Service Undersiab Gas Lath or Drywall Nailing Fireplace Foundation Gas Line Air Test Joists and Girders Final Energy Electrical Ground Final Plumbing Mid-Height Bond BeamFinal Heating/A.C. B-Foot Bond Beam Final Construction Final Bond Beam .. /5- Final On Site Improvements Fireplace Bond Beam Final Off Site Improvements Roof Sheathing Final Dedication ,(� Framing and Ventilation _ _ Final Zoning ,r Roof Covering Final Electrical Rough Heating Final Gas Service and Ground Developer Fees Pald -- --------- Rou 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 HOCK N. _.. • W. E. S. Inspector's Signature and Initials 96 • DATE OF ISSUANCE PERMIT NUMBER l/�- 60 - 95 53 '1