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Permit No. 6021 City of Lino Hills APPLlt PION FOR BUILDING PERMIT Community Development 2001 Grand Avenue 1` Chino Hills,CA 91709 Building Address: Proposed Use - St No.2077 Street VISTA DEL SOL =00TINGS FOR FUTURE PATIO COVER/GASLINE APN 1032-561-50 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT 1 Lot 113 Block Tract1_3906-SN Strutt. N Plumb. 1 Applicant GREG MULLEN El Mech. ❑Elect. n Grarlinn St No. 2077 Street VISTA DEL Snl Type of ProjectN New 0 Alter 0 Addition i CityCHINO HILLS Zip91709 Phone 606-9753 0 Repair ❑Convert. 0 Demo 0 Occupancy Permit i '1 OwnerGEG MULLEN Project Location on Size Description Property in Sq.Feet i St No.2077 Streets TA DFI SOI I � Phone 1• FTGS CityCHINO HILLS Zipg170g 606-9753 FTGS I I Engr/Arch Lic No. 2. St No. Street 3. I I C City Zip Phone 4. I I J` Contractor Lic No. REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION Sewer I Min. Depth I S/F/100 I Size St No. Street i City Zip Phone Cubic Yards Excavation Fill Over Excavation (;`--) City Business License _ License No. Expiration Date 12 X 12X 16 FTGS. BASED ON 15 FT.SPAN AND 40 FT. Licensed Contractor's Declaration I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section 14111TH. .1Ig\ 7000 of Division 3 of the Business and Professions Code)and my license is in full force and effect. License Class License Number Date Contractor /" Address City and Zip Phone ' ---, \ - Owner Builder Declaration ` I I hereby affirm that I am exempt from the Contractor's License Law for the following reason: \ > / 1--i I, as the owner of the property, or my employees with wages as their whole 6.1 compensation, will do the work,and the structure is not intended or offered for sale. N''....-.... r-i Jae owner r of the property, am exclusively contracting with licensed contractors to construct the p•:'=•t. ❑ I am - . pt under, is reason Date// i���f� Initiar �L-- 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,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 Elb. I have and will maintain worker's compensation,as required by Section 3700 of the FY 25 I SY 5 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: 1S 15 I Ins. Co.: Group/Division/Type Policy No: Exp Date: . VALUATION (This deet�Dn not be completed if the permit is for one hundred doolars($100)or less). S 1,440.00 c.I certify that in_the performance of the work fo • ich this permit is issued. I shall not employ any person-in any manner so as to becom- ubj:t to the Workers' Compensation PERM- FEES Laws of Califr+�nd agree that if I should bec• e subj: t to the workers' compensation provision of Section 3700 of the Labor •.e. I s omply with those pro ' s�� +/ Electrical ( Structural $42.00 ,� Date/L �� c� •• .turn,. _�--��'f9Fltwwt#r-q / G - � . Warning: Failure to secure work, compensation coverage ' u wful, and shall subject an Plumbing $6.00 Grading employer to criminal penalties a,• civiI fines up to one hun red ousand dollars($100,000), in addition to the cost of compensation, damages as provid 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 I Plan Check and state an hereby authorize representatives of this City Issuance Approved I Total Permit Fee to en upon a above mentioned, property for inspection y DC 477 nn p I ��' 2ti° - /-1-././5-'/ ''' Date Issued Permit Number j-Signdiure of Applican gent p�'te G GG 03/19/96 6021 ' FINANCE CODE CENSUS CODE Print Applicant's/Agent's Name r4 0/S L,ONSTRUCTION LENDING AGENCN __ I HEREBY AFFIRM THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC.3037,CIV.C.). LENDER'S NAME LENDER'S ADDRFQ 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. 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. 0 AS OWNER/BUILDER1 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 DIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY. BUILDING INSPECTIONS RECORD DATE f INSPECTOR I DATE INSPECTOR Setback/Location I I Rough Plumbing Temporary Power I Shower Pan Test Foundation Reinforcing Steel_ 3//2--/149 Stucco Mesh or Exterior Siding I_ Excavation and Forms insulation Slab Grade I I Sewer Ground Plumbing Soil I interceptor Ground Plumbing Water Septic Tank Underslab Ducts J Leach Line or Seep Pit Undersiab Conduit Water Service Undersiab Gas I Lath or Drywall Nailing Fireplace Foundation Gas Line Air Test 4//9/640 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 J Final Electrical Rough Heating Final Gas Service and Ground Developer Fees Paid Rough Electrical J 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 ROCK N. W. E. • Inspector's Signature and Initials DATE OF ISSUANCE PERMIT NUMBER