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Permit No. 6262 City of C.-vino Hills APPLICE-:"i ION FOR BUILDING PERMIT Community Development 2001 Grand Avenue Chino H111e,CA 91709 Building Address: Proposed Use - St No. 1960 Street VISTA DEL SOL RESIDENCE 1032-561-19 APN THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot 82 Block Tract 13906-5 ®Struct. El Plumb. Applicant BROCK HOMES I I Mech. I I Elect. ®Grading St No. 201 Street E SANDPOINTE STE 100 Type of Project El New U Alter U Addition CitySANTA ANA Zip 92707 Phone714-556-4663 ❑Repair ❑Convert. ❑ Demo ❑Occupancy Permit ownerBROCK HOMES Project 1 Location on Size 201 E SANDPOINTE STE 100 Description Property I in Sq.Feet St No. Street LIVABLE I r145 CitySANTA ANA Zip 92707 Phone714-556-4663 1 Z GARAGE I 110 Engr/Arch Lic No. St No. Street 3.PATI O I 180 City Zip Phone 4. I I • Contractor BROCK HOMES Lic No.54648 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION 201 E SANDPOINTE STE 100 Sewer I Min. Depth I S/F/100 I Size —� St No, Street YES. CP City SANTA ANA Zip 92707 Phone714-556-4663 Cubic Yards Excavation Fill Over Excavation '-37 City Business License License No. Expiration Date Licensed Contractor's Declaration2 -•-- 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 DatP Contractor SAME ASABOVE0 Address ...-----/'1: City and Zip Phone ' Owner Builder Declaration /f I hereby affirm that I am exempt from the Contractor's License Law for the following reason: I--1 1, as the owner of the property, or my employees with wages as their whole l V/1) I1 compensation, will do the work, and the structure is not intended or offered for sale. UI, I, as owner of the property, am exclusively contracting with licensed contractors to i 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 PD,ILI,FR1 a. 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 I LaborCode, for the performance of the work for which this permit is issued. My worker's Ry I SSY Ii compensation insurance_ JcJcarrier and policy number are: Ins. Co.: / �'t L f Group/Division/Type -L rI ci-ta NS- Z3/VN PolicyNo: Exp Date: VALUATION (This dection need not be completed if the permit is for one hundred doolars($100)or less). $133,994.00 ❑ 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 workers' compensation provisions of Section 3700 of the Labor Cod . I shall forthwith comply with those $235.95 I $1,001.22 provisions. Date S `I/-1 tv Signature —-P3i1: 1 Electrical Structural Warning: Failure to secure workers' compensatio coverage is unla and shall subject an Plumbing $244.50 Grading $75.00 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 $88.80 Issuance $29.00 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 I $1,739.54 purposes. .L1 i --c- S-/-9-b. Date Issued Permit Number SignatureAp lican1i f/r 4 ent Date 5/1/96 6262 I JM a��b 14 4_0_ FINANCE CODE CENSUS CODE Print Applicant's/Agent's Name C4 101 �.,.. NSTRUCTION LENDING AGENCI.,,; , I HEREBY AFFIRM THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC.3097,CIV.C.). LENDER'S NAME LENDER'S ADDRESS DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRES A•DIVISION OF INDUSTRIAL SAFETY PERMIT AS A PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW. ❑I CERTIFY THAT NO EXCAVATION 5 FEET OR MORE FEET IN DEPTH,INTO WHICH A PERSON IS REQUIRED TO DESCEND,WILL BE MADE IN CONNECTION WITH WORK AUTHORIZED BY THIS PERMIT,AND THAT NO BUILDING,STRUCTURE',SCAFFOLDING,FALSE WORK,OR DEMOLITION OR DISMANTLING THEREOF,WILL BE MORE THAN 36 FEET HIGH. ❑AS OWNER/BUILDER I WILL NOT EMPLOY ANYONE TO DO WORK WHICH WOULD REQUIRE A PERMIT FROM TUE_DIVISION OF INDUSTRIAL SAFETY,AS NOTED ABOVE UNLESS SUCH PERSON HAS A PERMIT FROM THAT DIVISION. • DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER -' I HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT. IDI S . DIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY. ' BUILDING INSPECTIONS RECORD DAT I INSPECTOR DATE INSPECTOR Setback/Location rc/26A7., I 7/ ) Rough Plumbing h2/ - A _ Temporary Power L Shower Pan Test Foundation Reinforcing Steel t `...I A 'Stucco•Mesh or Exterior Siding 7/E/4'd ,a Excavation and Forms j')film'/ TT).....--- Insulation ' . ' -7 fk /y` /. _ Slab Grade jt '/ L.,70 . Sewer ''j.—A-`5---96) 4-7.,) Ground Plumbing Soil 0 .57$(/,9.{, _ (//,-- Interceptor Ground Plumbing Water 51Zb M,(. ZiG Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service , Underslab Gas Lath or Drywall Nailing -7/,p%G / 2 .'��/� Fireplace Foundation Gas Line Air Test 7/ 2 ,/q J 1L `, Joists and GirdersFinal Energy : .. . , I„/_. - / /,, Electrical Ground /«i"L 4/Y261‘14, c/.)A Final Plumbing • - I,Ld A/1„// Mid-Height Bond Beam Final Heating/A.C. Q I% //17 8-Foot Bond Beam _, Final Construction 12 Final Bond Beam 5/241/41(.. WO Final On Site Improvements Fireplace Bond Beam / _ Final Off Site Improvements Roof Sheathing / S-'%e.:..,,,- (,1 ' X141 v Final Dedication Framing and Ventilation A f .7 Final Zoning Roof Covering . 1 A(1/ II,/4 Final Electrical BAc/Fe �ll�— •Rough Heating I/1/1Z /I,17 Final Gas �j c-/aa. .,�27,—.Service and Ground /V y Developer Fees Paid Rough Electrical / 1/ I Fire Dept. Approval Verified I.Sc/iC;/r_� I L/ • Bonding 77g/sa, ia/��_ Certificate of Occupancy Over Head Electrical Fence Height Gates Heater I • . Pool Drainage i a- i2' ih4«rel / - SEPTIC TANK GALS. SEEP. PIT X LEACH LINE . WIDE - LONG X DEPTH OF ROCK N. W. E. S' Inspector's Signature and Initials 8a DATE OF ISSUANCE PERMIT NUMBER