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Permit No. 5921 City of CLno Hills APPLICk _,ON FOR BUILDING PERMIT Community Development 2001 Grand Avenue Chino Hills,CA 91709 (.0 Building Address: Proposed Use - St No. 1957 Street VISTA DEL SOL RETAINING WALL APN 1032-561-24 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot 87 Block Tract 13906-5 N Struct. ❑Plumb. ❑Mech. ❑Elect. ❑Gradino Applicant BROCK HOMES St No. 201 Street E SANDPOINTE STE #100 Type of Project ®New ❑Alter 0 Addition City SANTA ANA Zip 92707 Phone714-556-4663 ❑Repair ❑Convert. ❑Demo ❑occupancy Permit Owner BROCK HOMES Project I Location on I Size St No. '201 Street E SANDPOINTE STE #100 Description Property in Sq.Feet City SANTA ANA Zip 92707 Phone714-556-4663 1• RET WALL I 1110 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 I Size St No. 201 Street E SANDPOINTE STE #100 YES. City SANTA ANA Zip 92707 Phone 714-556-4663 Cubic Yards Excavation Fill Over Excavation 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 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: D1I,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--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 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' PD,IL1,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: R3/VN Exp Date: VALUATION (This dection need not be completed if the permit is for one hundred doolars($100)or less). $1,210.00 Elc.I certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation PERMIT FEES 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 $37.20 provisions.? L Electrical Structural Date J'���6 if- .L-` [a-as-- Warning: Failure to secure workers' compensatio II overage is unlawful/and shall subject an Plumbing 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 $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 Plan Check and state laws and hereby authorize representatives of this City Issuance Approved Total Permit Fee to enter upon the above mentioned property for inspection DC $66.20 purposes. /�6-11/6a1 / D,� 3-6-% Date Issued Permit Number Signature (f Applicant,gr Aant Date (�ff 03/07/96 5921 Print Applicant's/Agent's Name FINANCE CODE C4 CENSUS CODE 0/S 6 3NSTRUCTION LENDING AGENC"L 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 ADDRESC 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. ❑IS 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 q f I/(/q'7 3'176, Stucco Mesh or Exterior Siding Excavation and Forms Insulation Slab Grade Sewer Ground Plumbing Soil Interceptor • Ground Plumbing Water Septic Tank Undersiab 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 23//,,6 tel/ Final On Site Improvements Fireplace Bond Beam Final Off Site Improvements ! Roof Sheathing Final Dedication � fV• Framing and Ventilation Final Zoning �i,J Y I Roof Covering Final Electrical �/ II Rough Heating Final Gas (1/1(/ Service and Ground Developer Fees Paid , ,_� hIV Rough Electrical Fire Dept. Approval Verified / v I r Vim. Bonding Certificate of Occupancy I 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