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Permit No. 5751 - City of Cho Hills APPLICAI N FOR BUILDING PERMIT Community Development 2001 Grand Avenue i Chino Hills,CA 91709 • Building Address: ‘-------/. Proposed Use - St No. 1950 Street VISTA DEL SOL ELECT METER PEDESTAL APN THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot Z Block Tract 13906-5 ❑Struct. ❑Plumb. Applicant MABRY ELECTRIC ❑Mech. Elect. ❑Gradin a St No. Street P 0 BOX 1047 Type of Project lEl New 0 Alter 0 Addition City CHINO Zip 91708 Phone 628-7681 0 Repair 0 Convert. 0 Demo 0 Occupancy Permi: Owner BROCK HOMES Project I Location on I Size .4 Description Property in Sq.Feet if St No. 201 Street E SANDPOINTE 1. METER PED I I 0 City SANTA ANA Zip 92707 Phone 714-556-466 Engr/Arch Lie No. 2. I I G_ St No. Street 3. I I N City Zip Phone 4. I I U Contractor REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION MABRY ELECTRIC Lic No. 322163 Sewer I Min. Depth I S/F/100 I Size St No. Street P 0 BOX 1047 City CHINO Zip 91708 Phone 62g_7687Fubic Yards Excavation Fill Over Excavation Cr)City Business License O 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 r_,,, License Number z,,, ? Date Contractor cAFAF Ac AarA/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: 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. W_____ — Y- I-li I, as owner of the property, am exclusively contracting with licensed contractors to 1....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 Ela. I have and will maintain a certificate of consent to self-insure for workers' CH/PD,FR1 compensation as provided by Section 3700 of the Labor Code, for the performance of the work for 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 Ry I SSY compensation insurance carrier and policy number are: Ins. Co.: Group/Division/Type Policy No: Exp Date: VALUATION (Ths,eeeetion need not be completed if the permit is for one hundred doolars($100)or less). $200.00 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.rovisions of Section 3700 of the Labor Code. shall forthwith comply with those Electrical $45.00) Structural Date 9 - 1---/�9e Signature Plumbing i'e -.4f, __62,,,04,,,,...-- Warning: Failure to secure workers' compensation coverage is unlawful, and shall subject an Grading 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 Issuance $45.00 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 and state laws and hereby authorize representatives of this City Issuance Approved I Total Permit Fee to enter upon the above mmentioned property for inspection DC $90.00 pUo 0( � a F 47)92(11-4, 9- -i--- 4" Date Issued Permit Number Signature of Appfcant`oF Agent - Date 02/02/96 5751 FINANCE CODE CENSUS CODE Print Applicant's/Agent's Name C4 0/S )NSTRUCTION LENDING AGENCI,\-, 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. ❑ 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 OIS DIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY. BUILDING INSPECTIONS RECORD DATE INSPECTOR DATE INSPECTOR Setback/Location Rough Plumbing Temporary Power Shower Pan Test Foundation Reinforcing Steel Stucco Mesh or Exterior Siding Excavation and Forms Insulation Slab Grade Sewer Ground Plumbing Soil Interceptor Ground Plumbing Water Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service Underslab Gas Lath or Drywall Nailing Fireplace 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 Final On Site Improvements Fireplace Bond Beam Final Off Site Improvements Roof Sheathing• Final Dedication Framing and Ventilation Final Zoning Roof Covering Final Electrical /` zg; Rough Heating Final Gas g Service and Ground Developer Fees Paid Rough Electrical Fire Dept. Approval Verified Bonding Certificate of Occupancy Over Head Electrical Fence Height Gates Heater Pool Drainage i , / C//1/ �/4 9 ) / _ . " - / /S / 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