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Permit No. 4320 • Ai _ _ • CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND V'�A''• COMMUNITY DEVELOPMENT A CERTIFICATE OF USES OCCUPANCY 1 ti 2001 Grand Avenue - ' Chino Hills, CA 91709 ..I BUILDING _ I PSEDUSE / C ADDRESS 4/ e �^^ I `�JJ I // + � � 0F APN /nn6% /7q0 �y THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT LOT2•") ^^ BLOCKK1 ' RACTI�•••� / - 0 STRUCT 0 PLUMB ❑ MECH ELECT ❑ GRADING j APPLICANT / 1�-, A• i^//r/1, ^� mI r� / V TYPE OF PERMIT ❑ NEW ❑ ALTER ❑ ADDITION n FFF--- ( • fff��� (((nnn //111///11114' , 1 G' )(REPAIR 0 CONVERT 0 DEMO ❑ OCCUPANCY PMT ADDRESJ 5 /(6, :2,.. ti /+L ,)ri/w `�I op hi 1 k r DESCRIPTION [ I LOCATION PROPERTY ON I SIZE IN SO FEET CITY /' 11.I1.'7✓ \1 / \Vt— ZIP 9L l - )lC PH /') q-..fSC _1 ' _re (_ I F Y1' J A OWNER //,�o� /,q• I�J' .V — 2 I I ADDRESS /Ar'/�I` 71_I� L II' V � / r/n/'�/' /��ykr 3 I I CITY !1/VLS)Il\ l- ZIP /#4.5-0C-, PH Srre) Gf�f q I I ARCHITECT ENGINEER LID NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ^`` ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS '=1 CITY ZIP PH i ROOF I FLOOR EXT WALL INT WALL a `/� CONTRACTOR LIC NO ADDRESS CEILING HEATING I FIREPLACE METAL MASONRY CITY ZIP PH SEWER MIN DEPTH S/F/100I SIZE CITY BUSINESS LICENSE LICENSE NO EXPIRATION DATE LICENSED CONTRACTOR'S DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION I hereby affirm that I am licensed under provisions of Chapter B(commencing with Section 7000 of Division 3 of the Business and Professions Code,and my license Is In full force and effect License Class License Number Dat• Contractor ADDRESS CITY AND ZIP PHONC OWNER BUILDING DECLARATION I hue irm that I am exempt from the Contractor's License Law for the following reason as owner of the properly,or my employees with wages as their sole compensation,will do the work,and the structure is not intended or offered for sale 0 I as owner of the property am exclusively contracting with licensed contractors to construct ZONING I LAND USE the props ;),,am exempt under Sec BAPC for this reason n n `..., Dat• r..4 ^ 77.— INITIAL ii• + SETBACKS I MODEL/PLAN WORKERS'COMPENSATION DECLARATION FY I SY I hereby affirm that I have a certificate of oonsent to self insure,or a certificate of Workers' Compensation Insurance,or a coddled copy thereof RY I SSY I COMPANY POLICY NO GROUP DIVISION TYPE 0 Certified copy is hereby furnished DATE EXPIRES VALUATION /�l—\ 0 Certified copy is filed with the city CITY VERIFIED /(,/(•J Date APPLICANT PERMIT FEES ' CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANC I certify that in performance of the work for which this permit is sued,I shall t ploy any ELECTRICAL cu I STRUCTURAL person in 2any runner so aasto bec msublect to the Workers' nye etion w 'California I cu Dat' -.5 r- 7c? C.--N APPLICANT - PLUMBING I GRADING NOTICE TO APPLICANT If, after making this Certificate of Exemption you should become subject to the Workers'Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shell be deemed revoked MECHANICAL ISSUANCE FEES I1 s/v I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA TION IS CO''ECT I AGREE Te CnMPLY WITH ALL CITY ORDINANCES AND STATE LAWS, GEO REVIEW I PLAN CHECK AND HEREB AU 'ORIZE R --'SENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTIONE• -R•.•ERTY F•' I.SPECTION PUR-+SES a / 4 .1 -.2 7 r-� C ( ISSUANCE PROVED TOTAL P�//R/EMIT FEE 71/4S6 Si- attire of Aeolic. t•aM•ant Date �,(ra�t __ rr DAST ` pISSUA a-7r I PE TNyMBERo / Print Applietlicant s/Agents Name FINANCE CODE C- I Operator: VIRGINIA Check 9: 000000000 Date: 3/27/95 00 Receipt B: 0000910 WHITE- FILE/GREEN• FINANCE/ YELLOW- OFFICE/PINK- OWNER I ntT�� 1000.00 GOLD-ASSESSOR/MANILA - INSPECTOR oONSTRUCTION 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 NAM LENDER'S ADDRFcc 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 Ox THE CERTIFICATES BELOW ` F I o I CERTIFY THAT NO EXCAVATION 5 FEET OR MORE FEET IN DEPTH,INTO WHICH A PERSON ISREOUIRED TO DESCEND,WILL-BE MADE IN CONNECTION WITH WORK AUTHORIZED BY THIS PERMIT,AND THAT NO BUILDING STRUCTURE,SCAFFOLDING,FALSEWOIiK,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 'N A \ DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER .A ' I HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE-WORK APPLIED FOR ON THIS PERMIT 015 _DIS NOT SUBJECTTO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY A 1 _ _ _ • 1 • • • - 2" ,. 41 N. ` ' ,� ) a - ref yu• p - •a - •` - _-.:''"•«"� CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND .e-r "--4-4-.1.. COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY • •r. 2001 Grand Avenue "2,„2„.„....., c��yChino {�/Hills, CA 91709BUILDING /(��J /1 J/SIA/ MVP- ADDRESS •Y)_�/4T xq1 1.1 i ll' " al J M� P- PRO 1Zt`USE i / `� Z APN ///IJ V I 7� — 0/ �(1/`IN //� /� ! THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMITo Y LOT r207, BLOCK Y TRACTG C 7 L/ 0 STRUCT ❑ PLUMB 0g ` II TYPE OF PERMIT 0 NEW ❑ ALTER ❑ ADDITION m APPLICANT J. 1 CO •- t $ , 'r�`� -�, O REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS ( I ' J1 Ie PROJECT LOCATION ON SIZE /1' i' f Ir'."' J•!• A. • DESCRIPTION I PROPERTY I IN SO FEET t ' CITYZIP �r t -1 PH Z!`• • j„ I I I L I, I Lf- P l 1 1 / C 1 t+ OWNER )I )/ j I ri!i 17.-. .f" e' 2 I I --- ADDRESS s/. 5 J L JI�1'•, 1 .4/ // /ll .L - I 3 CITY i { ZIP / <-- PH : 'F` I I ARCHITECT ENGINEER LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS NO STORIES NO DWELLING UNITS I BEDROOMS "` f CITY ZIP PH L ROOF I FLOOR EXT WALL INT WALL , v CONTRACTOR LIC NO CEILING HEATING I FIREPLACE ;' ADDRESS METAL MASONRY ..stet. CITY ZIP PH i '-.- SEWER MIN DEPTH S/F/100I SIZE • CITY BUSINESS LICENSE LICENSE NO EXPIRATION DATE LICENSED CONTRACTOR 5 DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION I hereby affirm that l am licensed under 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 License Number Date Contractor ADDRESS CITY AND ZIP PHONE • OWNER-BUILDING DECLARATION ( I hereebry,affirm that I am exempt from the Contractors License Law for the following reason t•t'ae owner of the property,or my employees with wages as their sole 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 ZONING I LAND USE 1 the protect I C am exempt under Sec B&PC for this reason I / Date ') rL INITIALf 1/-- " SETBACKSI MODEUP LAN WORKERS COMPENSATION DECLARATION FY I SY I hereby affirm that I have a cerlaical*of consent to self insure or a certificate of Workers Compensation Insurance,ora certified copy thereof RY I SSY COMPANY POLICY NO GROUP DIVISION TYPE • Certified copy is hereby furnished DATE EXPIRES tified copyVALUATION ' ❑ Corgi is filed with the city CITY VERIFIED / . Dale APPLICANT PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE I certify that in performance of the work for which this permit is issued,I shall not employ any ELECTRICAL 74 ,) ( '\ STRUCTURAL I person in any manner so sato become sublwt to the Worker= Compensation Law of Calif �� lorma . 11 / ' ktA.?' i Date APPLICANT , t' PLUMBING I GRADING NOTICE TO APPLICANT If atter making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must forthwith complyI t (�,.r r �• with such provuiona or this permit shall be deemed revoked MECHANICAL ISSUANCE FEES `-ly "ti I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA TION IS CORRECT I AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS, GEO REVIEW PLAN CHECK AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES I c ISSUANCE APPROVED TOTAL PERMIT FEE J, \ t Signature of Applicant or Agent Date ++ DAT F/SSUANC �j PER I N BaER 1c ` r / ��/✓ � D t t �_, i 'x t �'• Print Applicant s/Agents Neme FINANCE CODE LA WHITE- FILE/GREEN- FINANCE/ YELLOW- OFFICE/PINK- OWNER SOLD-ASSESSOR/MANILA - INSPECTOR _ _- —_ – - - - - - v ••••••gb , • t.)ONSTRUCTION LENDING AGENC`J I HEREBY AFFIRM THAT THERE ISA CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 3097,CIV C) LENDER'S NAME LENDER'S ADORE cc DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRESA DIVISION OF INDUSTRIAL SAFETY PERMIT AS A PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW - - - ❑ 1 CERTIFY THAT NO EXCAVATION 5 FEET OR MORE FEET IN DEPTH,INTO WHICH APERSON 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 . I O 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 - •• ,I 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 - . ^. \ , 1 • I , I ' • • ' • - i sit , I • • • r- • II • • • ., J, E =U :{J.bJ r • 313,7 :,, 1