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Permit No. 6255 --_.— — .— City of C.-An° Hills APPLIC,--, ION FOR BUILDING PERMIT Community Development 2001 Grand Avenue Chino HIlle,CA 91709 Building Address: Proposed Use - St No. i941 Street VISTA DEL SOL IESIDENCE 1032-561-22 APN THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT 85 El Struct. 0 Plumb. Lot Block Tract 13906-5 E Mech. El Elect. 23 Grading Applicant BROCK HOMES , 0New 12 Alter ID Addition 201 St No. Street E SANDPOINTE STE 100 Type of Project• 0 Repair 0 Convert. 0 Demo 0 Occupancy Permit CitySANTA ANAZip92707 phone714-556-4663 OwnerBROCK HOMES Project I Location on 1 Size Description Property in Sq.Feet St No.201 StreetE SANDPOINTE STE 100 LIVABLE 11770 --..._ citySAN IA ANA Zip92707 Phone 4-556-4663 2.GARAGEI -t17 Engr/Arch . Lic No. z. St No. Street 3.PATIO I r City Zip Phone 4. I I .Z. • Contractor BROCK HOMES Lic No.54648 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION --- Sewer 1 Min. Depth 1 S/F/100 1 Size (p St No.201 Street E SANDPOINTE STE 100 YES. citySANTA ANA Zip92707 phone714-556-4663 Cubic Yards Excavation Fill Over Excavation City Business License License No.No. Expiration Date Licensed Contractor's Declaration R, I hereby affirm that I am licensed under the provisions of Chapter 9 (commencing with Section _....--- -... effect. 7000 of Division 3 of the Business and Professions Code)and my license is in full force and ., License Class B License Number 54648 AS Date ContractorSAME ABOVE Address 0-- ''.., 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. ------------— . DI, as owner of the property, am exclusively contracting with licensed contractors to construct the project. 1=1 I am exempt under Sec.______,B&PC for this reason ----- -- DatP Initial • Workers' Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations: Zoning I Land Use Da. 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 mit is issued. Setbacks I Model/Plan ave and will maintain workers compensation, as required by Section 3700 of the Pi' I SY LaborCode, for the performance of the work for which this permit is issued. My workers Ry 1 SSY 1 compensation insurance carrier and policy number are: Ins. Co.: '71b74-/1 Group/Division/Type ?3/VN Policy No: "C-0 SILAS 9 ii-y T- Exp Date: VALUATION (This dection need not be completed if the permit is for one hundred doolars($100) or less). 113,138.00 0 c. 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 workerscompensation provisions of Section 3700 of the Labor Code. I shall forthwith comply with those $194.70 $908.82 provisions Electrical Structural --- -'4 gna ure_Si t k _ A iI ------- Warning: Failure to secure workers' compensati,1 coverage- $222.00 Grading $75.00 is unlawful, and shall subject an Plumbing employer to criminal penalties and civil fines up t• 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 $78.81 Issuance $29.00 I certify that I have read this application and state that the above Geo Review I Plan Check $59.07 information is correct. I agree to comply with all City Ordinances 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 I $1,567.40 purposes. _.n ---------- k ' 7j0V1'Y- — .5 -/ -W„ - Date Issued Permit Number Signature of pplicint oil AIV Date 5/1/96 I 6255 b 6Avz,by FINANCE CODE CENSUS CODE Print Applicant's/Agent's Name C4 101 • • _ .• . __ - i. )NSTRUCTION LENDING AGENCI I HEREBY AFFIRM THAT THERE IS A CONSTRUCTICN LENDING AGENCY FOR THE PERFORMANCE OF'HE 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,FALSE WORK,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 DIS NOT SUBJECT.TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY. BUILDING INSPECTIONS RECORD DATE INSPECTOR I DATE I INSPECTOR Setback/Location I s-tki-/44 736 Rough Plumbing I /4,(/% I 41,�� Temporary Power Shower Pan Test (D� W-.%-"----- Foundation Reinforcing Steel I I 14. /T f---1 /1 Stucco Mesh or Exterior Siding �/ iZA Excavation and Forms I gIV 6)(// Insulation �Z� Y.X.-.-- Slab �_ Slab Grade I I/l `���, Sewer / Z � Ground PlumbingSoil ���-��. r1 z l/L,(II Interceptor Ground Plumbing Water I 'SAWil- /' ... Septic Tank Underslab Ducts I r Leach Line or Seep Pit I Underslab Conduit , Water Service Underslab Gas I Lath or Drywall Nailing -7/3/r ii::::?-14.-.-- Fireplace Foundation I Gas Line Air Test 7/23196 re.4 — Joists and Girders I _ Final Energy /,,/_ /I / ,� Electrical Ground I 'u/ZD/L)i,,, 1.AS Final Plumbing /,f/`/7 n /./G Mid-Height Bond Beam I Final Heating/A.C. Q I i2 1/)V 8-Foot Bond Beam I Final Construction (% Final Bond Beam I Final On Site Improvements I Fireplace Bond Beam, + / Final Off Site Improvements Roof Sheathing /Shit,/ //w41. Final Dedication Framing and Ventilation rJl /I Final Zoning Roof Covering I SZ 1 Z/ Final Electrical /„l/ - [ /3 /l Rough Heating ( /17 IV/ Final Gas F�, �``-- Service and Ground IV p Developer Fees Paid [ Rough Electrical 07/ / Fire Dept. Approval Verified R//519.6, ��Z.7- Bonding / V 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. S. Inspector's Signature and Initials --j ” P5 DATE OF ISSUANCE PERMIT NUMBER 5- t -q10 (C, 55