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Permit No. 7567 City of CL:nO H• APPLICA—)N FOR BUILDING PERMIT Community Developm nt • • 2001 Grand Avenue Chino Huls,CA 91709 Building Address: Use - St No. 1976 Street VISTA DEL SOL - PATIO COVER APN 1032-561-17 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot 80 Block Tract 13906-5 0 Struct. LI Plumb. Applicant KEVIN KELLY THORSON ❑Mech. ❑Elect. CI Grading St No. 100 Street W CLOVE . Type of Project ❑New CIAlter N Addition City BREA Zip 92621 Phone 795-7077 CI Repair LI Convert. ❑Demo 0 Occupancy Permit Owner MARK HOUCK - Project I Location on I Size Description Property in Sq.Feet St No. 1976 Street VISTA DEL SOL I 240 City CHINO HILLS Zip 91709 Phone 597-285P 1. PATIO Engr/Arch Lic No. 2. I I St No. Street 3. I City Zip Phone 4. ( I Contractor KEVIN KELLY THORSON Lic No. 465807 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION Sewer I Min. Depth I S/F/100 I Size St No. 100 Street W CLOVE . City BREA Zip 92621 Phone 795-7077 Cubic Yards Excavation Fill Over Excavation City Business License License No. NEW 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 465807 ' Date 11/30/98 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: ('U I, as the owner of the property, or my employees with wages as their whole I..1 compensation, will do the work, and the structure is not intended or offered for sale. 1--1 I, as owner of the property, am exclusively contracting with licensed contractors to Im.1 construct the project. ElI am exempt under Sec.________,B&PC for this reason �•1 Date Initial orkers' Compensation Declaration I hereby affi nder penalty of perjury one of the following declarations: ZoningI Land Use ❑a. have and will maintain a certificate of consent to self-insure for workers' PD compe tion as provided by Section 3700 of the Labor Code, for the performance of the wo or 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 25 I SY 5,5. .I ' LaborCode, for the performance of the work for which this permit is issued. My worker's compensation insurance carrier and policy number are: RY 1 5 I SSY Ins. Co.: .Gj�Q'•' 6 ) 1/[•I7 Group/Division/Type • Policy No:.r )i >°Zr!, �j-G)e Exp.Date: . r •: • • : • VALUATION (This dection need not be completed if the permit is for one hundred doolars($100)or less). $2,880.00 ❑ 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 acre- that if I should become subject to the workers' compensa(ion provisions f Sectio, ►s-• of the Labor Code. I shall fo w' comply with those $ 480 provis ns. �w�ri � • Electrical Structural • to .—_,�_i.. _/_ - Signature - v • •'. • • Warning: Failure to sc�Ctfrelir.�rs' compensation coverage is unlawful, and shall subject an Plumbing Grading employer to criminal penalties and civil fines up to one hundred thousand dollars($100,000), ir additic^ to tF,. cost of compensation, damages as provided for in Sert',n 3706 of the Labor Code, interest, and attorney's fees. Mechanical Issuance $2900 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 laws and hereby authorize representatives of this City Issuance Approved Total Permit Fee to enter' pon he b. entioned property for inspection DC $93.80 pu se • / i2_9 �� Date Issued I Permit Number •=----- Signature of Appli t or Agent Date 12/9/96 I 7567 A)T/y- ,n FINANCE CODE C4 CENSUS CODE 0/S Print Applicant's/Agent's Name 1ONSTRUCTION LENDING AGENC . 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 ADDRESF 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. p 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 DATE INSPECTOR Setback/Location Rough Plumbing Temporary Power Shower Pan Test Foundation Reinforcing Steel Stucco Mesh or Exterior Siding• Excavation and Forms Insulation :Slab Grade._ • . . . . • - Sewer: Ground Plumbing Soil Interceptor Ground Plumbing Water Septic Tank Underslab 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 %.14) Final Bond Beam Final On Site Improvements Fireplace Bond Beam Final Off Site Improvements Rog t- Bathing , Final Dedication raming knd Ventilation Final Zoning overing Final Electrical Rough Heating Final Gas Service and Ground Developer Fees Paid Rough Electrical Fire Dept. Approval Verified Bonding Certificate of Occupancy Over Head Electrical Fence Height •- Gates Heater Pool Drainage - C/N Ft to 'L a130/gl6 U� , . • • SEPTIC TANK GALS. SEEP. PIT X • LEACH LINE WIDE • LONG X " J3EPTI{.OF RODK ,_ .•,. r- . .'•: • W. E. • S= Inspector's Signature and Initials. • DATE OF ISSUANCE PERMIT NUMBER