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Permit No. 18984 BUILDING ADDRESS: 1 13773 VISTA GRANDE DRIVE PERMIT NUMBER: 18984 BUILDING INFORMATION APPLICANT INFORMATION ` BUILDING PERMIT APPLICATION Address: 113773 VISTA GRANDE DRIVE I Name: (WEST COAST CUSTOM ROOMS -4- Community Development APN: 11024-103-06 Address: 1786 PINEFALLS AVE ... ,- 2001 Grand Avenue �, .;� Lot: 146 City,Zip Code: 'WALNUT,CA.91789 y„_ Chino Hills,CA 91709 Cross Streets: 1 Phone/Pager: 1(909)594-7547 1 ext. 1 ,,...,:;..%• "°'°""°""'S LICENSED CONTRACTOR DECLARATION Tract/Parcel: 113651-2 City Bus Lic#: 1 I hereby affirm that I'm licensed under the provisions of Chapter 9(commencing with Section Valuation: 1$1,500.00 ENGINEER/ARCHITECT INFORMATION 7000 of Division 3 of the Business and Professions Code)and my license is in full force and effect. OWNER INFORMATION Name: N/A OWNER BUILDER DECLARATION Name: STEPHEN WORCESTER Address: I hereby affirm that I'm exempt from the Contractor's License Law for the following reason: Address: 13773 VISTA GRANDE DRIVE City,Zip Code: property, g Ty,Zip Phone: ext. I,as the owner of theor myemployees with wages as their whole Ci Code: CHINO HILLS,CA 91709 ® compensation,will do the work,and the structure is not intended or offered for sale. Phone: (909)590-8171 1 ext. 1 Lic#: I,as owner of the property,am exclusively contracting with licensed contractors to Bus Lic#: City Bus Lic#: )construct the project. C) I am exempt under Section I I BPC for this reason Bus Exp: APPROVAL INFORMATION WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION Issued By: IYVE111,MARTINEZ I hereby affirm under penalty of perjury one of the following declarations: Contractor: WEST COAST CUSTOM ROOMS Date Issued: 19/12/01 Address: 1786 PINEFALLS AVE Finance Code: 1C4 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 City,Zip Code: WALNUT,CA.91789 I Census Code: which this permit is issued. Phone or Pager: (909)594-7547 1 ext. I 1 Final Date: /6/26-16 I Bus.Lic.#: 101-05750 Final By: y(Qd)-j —1t,..�A�c✓ I have and will maintain workers'compensation,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My Lic.#: 1471619 Extension: 1 f workers'compensation insurance carrier and policy number are: Exp Date: 14/30/02 1 Reviewed By: ILAURO BUGARIN Lic.Class: 1B,HIC 1 Approved By: 1LAURO BUGARIN INSURANCE INFORMATION Insurance Company: 1STATE FUND /' PROJECT INFORMATION Policy Number: 11620269 t PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date: 11/1/02 Structure: 0 Section need not be completed if permit is for one hundred dollars($100)or less Garage: 1 I I ( 1 I certify that in the performance of the work for which this permit is issued. I shall not employ Patio: 1 I I I any person in any manner so as to become subject to the Workers'Compensation Laws of Porch: 1 I I I Califomia and agree that if I should become subject to the workers'compensation provisions of Other: 1NEW DOOR Section 3700 of the Labor Code. I shall comply with those provisions. PROPOSED USE NEW DOOR INSTALLATION AND ELECTRICAL-(1)LIGHT AND(1)SWITCH Date: I I Signature: I EXISTING HEADER FOR DOOR I certify I have read this application and state that the above information is corr'ct. I agree to comply with all City Ordinances and state laws and hereby authorize represent tives of this City to COMMENTS enter upon the above mentioned property for inspection purp a /� Date: Ig// ie/ �►�42I Signature: � 40-1.,,Ls � , l OTHER FEES REQUIRED ,'iUIRED u PRIOR TO ACTUAL PERMIT PERMIT FEE INFORMATION ZONING SETBACKS G' l�ING ISSUANCE Zoning: 1PD Front Yard: 20 Over X: I 0 1 Issuance: 1 $29.00 1 Electrical: 1 $4.50 1 Land Use: FR-1 Side Yard: 5/5 School: 1 NO 1 Permit Fees:Cut: 0 I Development: 1 NO 1 Plan Check: I $27.30 I Plumbing: I $0.00 1 I $102.80 I Plan: STRUCT 1 Rear Yard: 20 Fill: 0 I SMIP: 1 $0.00 Occ: 1R3 SSY: Total: 0 I Sewer: 1 NO 1 Mechanical: 1 $0.00 1 Structural: 1 $42.00 I Type: IVN Water: 1 NO 1 Geo Review: 1 $0.00 1 Grading: 1 $0.00 1 Total Fee Due 1 $102.80 INSPECTION RECORD Permit Number Inspection Date Inspector Inspection Date Inspector Grading: Pregrade Meeting FINAL INSPECTIONS(Inspector verify following) Rough Grade NO OCCUPANCY PERMITTED WITHOUT FINAL Terraces County Environmental Sub Drains Health Dept Finish Grading Planning Dept Soils Certification Public Works Grading Certification Fire Rough Landscape As Built Approved Underground Site Inspections: ALL ABOVE MUST BE APPROVED BEFORE FINAL BLDG Building Sewer Final Grade U.G.Waste Plumbing Final Electric • Water Service Final Plumbing Storm Drain/Catch Basins Final Mechanical U/G Conduit/Electrical Final Building/Construction /%i/di `7�,+' Compaction Report Water Meter Number ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION Footings CERTIFICATE OF OCCUPANCY UFER Ground(Rebar/Copper) Hardware/Hold-Downs Piers/Caissons/Tendons OTHER: Slab Grade DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED Shear • Roof Nailing Exterior Walls • Interior Walls Hardware/Hold-Downs Rough Electric Rough Mechanical Rough Plumbing/Topout Framing COVER NO WORK UNTIL ABOVE IS APPROVED Insulation Drywall Interior/Exterior Lath Stucco Scratch Roof Covering Block Wall Inspections: Footing,ReBar 1st Lift Bond Beam 2nd Lift Bond Beam 3rd Lift Bond Beam Drain/Seal • SWIMMING POOLS: Location/Rebar/Bonding/Light Gr Conduit Ro Elect POOL NOT TO BE FILLED UNTIL FENCING IS COMPLETE Fence,Gate&Alarm Final Pool Temp Power Pole Electric Release Gas Test