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Permit No. 5703 City of Crr„d10 Hills / APPLICA—JN FOR BUILDING PERMIT Community Development 2001 Grand Avenue Chino Hills,CA 91709 Building Address: Proposed Use - St No. 2005 Street VISTA DEL SOL RESIDENCE APN 1032-561-30 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot 93 Block Tract 13906-5 IN Struct. El Plumb. Applicant BROCK HOMES 1J Ntech. ®Elect. ®Grading St No. 201 Street E SANDPOINTE Type of Project El New EI Alter 0 Addition City SANTA ANA Zip 92707 Phone 714-556-4663 El Repair 0 Convert. 0 Demo ❑ Occupancy Permit Owner BROCK HOMES Project I Location on I Size Q Description Property in Sq.Feet r St No. 201 Street E SANDPOINTE 1. LIVABLE I 11820 �J City SANTA ANA Zip 92707 Phone 714-556-4663 Engr/Arch Lic No. 2. GARAGE I 1565 St No. Street 3- PATIO I 148 City Zip Phone 4. 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 YES. City SANTA ANA Zip 92707 Phone 714-556-4663 Cubic Yards Excavation Fill Over Excavation ir City Business License 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 a License Number GdRdR Date Contractor CAMP AS sm-s F 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: ❑ 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. ❑ I, 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 affirm under penalty of perjury one of the following declarations: Zoning Land Use Ela. I have and will maintain a certificate of consent to self-insure for workers' PD,IL1,FR1 compensation as provided by Section 3700 of the Labor Code, for the performance of the work which this permit is issued. Setbacks I Model/Plan b. I have and will maintain worker's compensation,as required by Section 3700 of the FY I SY I LaborCode, for the performance of the work for which this permit is issued. My worker's compensation insurance carrier and policy number are: Ry I ssy Ins. Co.: Group/Division/Type Policy No: R3/VN Exp Date: VALUATION - (This dection need not be completed if the permit is for one hundred doolars($100)or less). $1 14,741.00 ❑ 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 provisions. �f �y v�, �, 14'46119'L-Q— i �J Electrical $200.20 Structural $924.94 para l I I 1 /-1 t Si ure toi' 6/ 94—Q_ i l Warning: Failure to secure workers' compensation coverage is unlawfu and shall subject an Plumbing $210.00 Grading $75.00 employer to criminal penalties and civil fines up to one hundred thousan 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 $68.82 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 I Plan Check $59.37 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 $1.567.33 purposes. --- ��A' W,1!e_-- /h 7/4 62 Date Issued Permit Number Signature of Applicaor Agent Date 01/17/96 5703 Print Applicant's/Agent's Name FINANCE CODE CENSUS CODE C4 101 (:wNSTRUCTION LENDING AGENCI I HEREBY AFFIRM THAT THERE ISA 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 REQUIRESA 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. ❑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 -IDS 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 DA!E INSPECTOR Setback/Location I Rough Plumbing I r li l .. i ', ^:1 ice,/ij Temporary Power I Shower Pan Test I L i( '— I 1./)‹ Foundation Reinforcing Steel I I Stucco Mesh or Exterior Siding I c.4f(1I C1A„ YI Ni Excavation and Forms , i Insulation G//�c/� 14 (/ Slab Grade �i IOC, / Sewer �j //// 1Lo ;1/,/4- Ground Plumbing Soil i I Z3I . , I t / Interceptor Ground Plumbing Water zls ilk_ v It!/' Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service / , Underslab Gas Lath or Drywall Nailing I/�( L \17 l/ Fireplace Foundation Gas Line Air Test � � .. \I!/' Joists and Girders Final Energy / / Electrical Ground Final Plumbing Mid-Height Bond Beam Final Heating/A.C. / 8-Foot Bond Beam Final Construction , 1 X Final Bond Beam ,Final On Site Improvements ��l(ni� / Fireplace Bond Begm /1 Final Off Site Improvements ,‘/i(A '�/ -T Roof Sheathing • /s ,,/ ��/1C(/ A Final Dedication ite.)iv Framing and Ventilation A' ,i/ Final Zoning ,/ ' / Ii V/ Roof Covering , / N I// Final Electrical / l) Rough Heating i I,/M0/ i V Final Gas / Service and Ground t(I 17 1 Developer Fees Paid / Rough Electrical +,' Fire Dept. Approval Verified Bonding L f/ Certificate of Occupancy / Over Head Electrical ,r / Fence Height I Gates Heater I Pool Drainage SEPTIC TANK GALS. SEEP. PIT X LEACH..LINE WIDE LONG X DEPTH OF ROCK N. • W. E. S. Inspector's Signature and.lnitials 436 93 DATE OF ISSUANCE PERMIT NUMBER L 0,- - ci 3 t3q to _ , p 4- . err( OF Ch,- 40 HILLS COMtuutr yGEANO SA ETY ©LVISIROM ENj BUI6Dlt, 1 PERiiiIIT # .- m.for next day tnsJOpecB.uvn Call X90$}590-151 i Ext.282 before 5:00 p • POST INA SAFE CONSPIVUDUS PLACE AT FRONT OF PROVIDE PERMIT NUM S ON J4B AT Y ME OFOINSPECTiOT10N. HAVE APPROVED I7 i,.6 j� _ .. 0ATE J • . OWNER f IJ J r ' c i t LOCATION INSPECTION RECORD INSPECTION DATE 9 INSPECTOR Setback/Location 1 . Temporary Power 1 Foundation/Reinforcing Steel I1 1, 3* Slab Grade t1 ii��0 �t -1� 1 .rf Ground Plumbing !i L#S I 7 4' t 9------- Underslab Copper 1.7—/Z-3/94- j ----- Underslab Conduit/Ducts , r Fireplace Foundation Joists and Girders ` Electrical Groundi I f DO NOT CONCEAL UNTIL ABOVE ARE SIGNED AND DATED - First Bond Beam/Lit 1 I •• Final Bond BeamtLlll i ! - Fireplace Bond Beam ' 1 Root Sheathing I shear 11 / . Framing and Ventilation ! 1i , i I Rough Healing I il II l ift Electrical SBNItig till Ii1Il(1 I.,i 1 Ti / ` f . ir 1 U Rough Electrical v ' 1.' Rough Plumbing t - Shower Pan/Tub Test 1 I Stucco Mesh or Exterior Siding 1 t Fire Sprinklers DO NOT ICONCEAL UNTi A8 YE ARE$Il,� ° ° Insulationfoal Ito I\-- ' . I tom- , Sewer i h7/h(r I \Jj. Septic Tank t - Leach Line or Seep Pit I I • Water Service 1 1 DO NOT CONCEAL UNTIL ii3OVE ARE SiGNED AND DATED = Interior Lath or al!Ipg I 50e FJ -76, Gas Line Air Tes'r--- - I r 7/7(.. . Final Grading 1 1 . _ Final Elecirical I I . Final Plumbing I 1 Final Heating/A.C. 1 I t 11 .. • Final ZoningiCondhtons of Approval Final Fire(Cali Local Fire Dept.) I c"-—/,5 ,96. 1' 1 i Final Building 1 1 Certificate of Occupancy i 1 • 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 I permit active. NO WORK SHALL BE COVERED WiTTHOUT INSPECTION. FILE THIS CARD WITH YOUR pEFilnAiflsitiT aEconvm I WHEN JOB IS COIIIPLA.TC.D.