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Permit No. 6261 •City of Chino Hills APPLICA•ION FOR BUILDING PERMIT Community Development 2001 Grand Avenue Chino Nile,CA 91709 Building Address: Propose CE Use - St No.2136 Street VISTA DEL SOL APN 1032-482-26 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT 13906-5 ®Struct. ®Plumb. Lot 60 Block Tract N Mech. El Elect. ®Grading Applicant BROCK HOMES El New U Alter U Addition 201 E SANDPOINTE STE 100 Type of Project St No. Street • 0 Repair ❑Convert. ❑Demo ❑Occupancy Permit CitySANTA ANA Zip 92707 Phone714-556-4663 OwnerBROCK HOMES ProjectLocation on Size E SANDPOINTE STE 100 Description I Property in Sq.Feet St No. 201 Street 1 LIVABLE I 8145 CitySANTA ANA Zip92707 Phone714-556-4663 I Lic No. 1 Z.GARAGE I �10 Engr/Arch I 13 PATIO I rSt No. Street City Zip Phone 1 4. I I REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION Contractor BROCK HOMES Lic No.54648 Sewer I Min. Depth I S/F/100 Size St No.201 Street E SANDPOINTE STE 100 YES. city SANTA ANA Zip92707 Phone714-556-4663 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 B License Number 54648 Date Contractor SAME ASABOVE 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: ' ❑ 1, 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. ^ ' E1 I am exempt under Sec.__,B&PC for this reason • .1 Date Initial _..w.__.. ... ... �... ....... . ...... ._........ _.. ... .. .. _.. Workers' Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations: Zoning I Land Use PD,ILI,FR1 Da. I have and will maintain a certificate of consent to self-insure for workers' 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 LaborCode, for the performance of the work for which this permit is issued. My worker's Ry I SSY compensation Insurance �caarrriierand-policy number are: Ins. Co.: 1724l��R..1Group/Division/Type • 13/VN Policy No: , S't(//3 1t/ t:l-t' Exp Date: VALUATION (This dection need not be completed if the permit is for one hundred doolars($100) or less). $133,994.00 Lic. 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 thoseElectrical $235.95 Structural $1,001.22 provision /J�6 Dah. S ! Signature __ _ IA ____ Plumbing $244.50 Grading $75.00 Warning: Failure to secure workers' compensati coverage is unla I, and shall subject an 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 $8s$0 $29.00 Labor Code, interest, and attorney's fees. Mechanical Issuance I certify that I have read this application and state that the above $65.07 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 $1,739.54 purposes. Irs.`_ <l I Date Issued Permit Number Signaturef pplicarit orUA�ent(/ Date 5/1/96 I 6261 �� / FINANCE CODE CENSUS CODE Print Applicant's/Agent's Name C4 101 DNSTRUCTION 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 P3EREQUISITE 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 ❑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 IDA7E � INSPECTOR Setback/Location („/y��(,, ( ) Rough Plumbing ,l Temporary Power Shower Pan Test !f r/ Foundation Reinforcing Steel , tucco Mesh or Exterior Siding 74/ 747 r �G `�� Excavation and Forms /11-/f l�� >',L Insulation 'ill//44 -Q/A.- Slab Grade Sewer, Ground Plumbing Soil 1-72,2/96, —Ex—) Interceptor Ground Plumbing Water /c//G/6 Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit I I Water Service I Underslab Gas LathrClarywall Nailin. Fireplace Foundation Gas Line Air Test Joists and Girders Final Energy Electrical Ground j_,-p 4/L//4'Jt,, 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 _ b Roof Sheathing /hs 7 S z-/CG �.��—� Final Dedication ' a Framing and Ventilation , /r � //' Final Zoning .,i II Roof Covering (// !! // Final Electrical lit tl �,1/ Rough Heating ! V `�! I V Final Gas V IA I VI 'o Service and Ground Ili I1•1 Developer Fees Paid V I14 r 1 Rough Electrical i!% 7/ Fire Dept. Approval Verified / i l II1 'V j,t1 t Bonding V / Certificate of Occupancy / I {� - Over Head Electrical ( !� Fence Height ! Gates • Heater Pool Drainage Cfiz,/i6. a g62.„..,, Z).er 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