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Permit No. 0846 I CITY OF CHINO HILLS . • COMMUNITY DEVELOPMENT l +,t 2001 Grand Avenue APPLICATION FOR A BUILDING PERMIT AND A CERTIFICATE OF USE&OCCUPANCY Chino Hills, CA 91709 / f BUILDING %et�^I f ^r� C�v CLEA�EDY APPLICATION TYPE NO CO ADDRESS US! t1,�7_I /// � _ 0 APN , ^� � r�;,, ., _ 11)3 —04-y-1$ z THIFr�OLLOWING V>1ORK IS AUTHORIZED BY THIS PERMIT > o LOT a BLOCK TRACT/ 1,5-. �STRUCT PLUMB. ❑ MECH ❑ ELECT 0 (64' T/ 31 / TYPE OF PROJECTEW 0 ALTER 0 ADDITION m n fn OWNER N/ © �,N � 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT - .� ADDRESS r y. / PROJECT LOCATION ON SIZE /£( 1tP7Q�S f-d�d_. DESCRIPTION PROPERTY I IN SC) FEET \ CITY `bl friF1� /'L;fft PH 14,ACs'C_ I /5/X / I &74'. ARCHITECTc_ , if ENGININEERRc jeco,,,,zak LIC NO 2. I I ADDRESS � \ e //Q2O Cd1 C'CO� �l.LLi"- ". 3. I I CIN l zIP 9a10 ��/ ��� REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION r d . e•-i-f`1—Pt11�r r 1 C—. '��`- /a� CONTRACTOR "--....Ale____ - GL-_.I1G LTC'tJ`/�OG<'vrpr`� iNitt �JVlR_ / ��©L,./ A � \\ ADDRESS 4.-- ,r-ex,_ CITY �0 3 ZIP C ( ! �� 6/PH 331115—It A r I / CITY BUSINESS LICE Sp 'i�^�✓ LICENSE NO L.-3,/ EXPIRATION DATE ���s` `t* ! CIf ' / LICENSED CONTRACTORS DECLARATION .r A(.i1 I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000 ofn nd �' / : k. Division 3 of the Business and ProfessionsonCode, and my license is in full force and effect S-- License Class. - c'TP mbar SQ v 7 (' c Data 5;;%''5;;%'' Q(7 3 Contractor�� ( _ ADDRESS 4- A) - ...1-..4 c..._ / �• Y AND ZIP CO CIC ^l' — e� PHONE�J CIT3--34. �fC-� /� _a/ 6`C 7-6 _s- _ OWNER-BUILDING DECLARATION 0� / I hereby affirm that I am exempt from the Contractor's License Law for the following reason rte_ i.",G__ O I,as 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 the project O I am exempt under Sec. UPC for this reason Date INITIAI / WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure,or a certificate of Workers'Compensation Insurance,or�cert�ifie_d rcopy thereof"� G COMPANY . . ?Z4C. \ "� O.. POLICY NO // 5 > D 4 I // /9'3 GROUP DIVISION TYPE 9/Ai ❑Certified copy is hereby furnished DATE EXPIRES / e^ ( ( 3 '� �/ 6ertrtreed copy is filed with the city CITY VER�c�tE65—'— VALUATION Date 1 (3 ' 3 APPLICANT (. _ . : PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURAtQZE i I certify that in the performance of the work for which this permit is issued,I shall not employ any person in ELECTRICAL I STRUCTURAL any manner so as to become subject to the Workers'Compensation Laws of California Date APPLICANT , V PLUMBING- ___ ) qq NOTICE TO APPLICANT.If,after making this Certificate of Exemption,you should become subject to the Q //D. v�� Workers'Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked MECHANICAL ISSUANCE FEES r/ I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS,AND HEREBY GEO REVIEW I PLAN CHECK AUTH IZE R ESENTATIVES 0011.IS CITY TO ENTER UPON THE ABOVE MENTIONED P E F INSP TIO PURPIV. ISSUANCE APPROVED TOTAL PE MIT FEE: L1rj3nature of Apti.tant 6.Afen( Date ./ 5- � c-c5 'OAT SUA Eve, PERMIT NUMBER' Print Applicant's/AgenYs ame / (1r I Operator: DAWN Check 8: 000003513 • Date: 1/13/93 00 Receipt 8: 0000182 CHECK WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR $445.00 • • • .S _ J BUILDING ADDRESS LOT BLOCK TRACT BUILDING INSPECTIONS RECORD - OWNER ADDRESS CITY ZIP PH. PLUMBING DATE APPROVED/INSPR'S SIGNATURE GROUND SOIL/WATER P1 TOP OUT P2 SHOWER PAN P3 REMARKS SEWER P5 GAS TEST P6 FINAL PLUMBING P12 MECHANICAL DATE APPROVED/INSPR'S SIGNATURE UNDERGROUND FLOOR Mi I • ; ROUGH M2 I FAU/AC M4 I FINAL MECHANICAL M12 ELECTRICAL DATE APPROVED/INSPR'S SIGNATURE TEMP CONSTN.POWER E3 UNDERGROUND PVC-METAL-D.B.C. El ROUGH WIRING \ RECEPT.SPACING- SERVICE-CIRCUIT E2 I FINAL ELECTRICAL E12 STRUCTURALAPPROVED/INSPR'S DATE SIGNATURE FOUNDATION:LOCATION S1 REINFORCED 0 UFER ❑ SLAB REINFORCED 13 MEMBRANE S3 FLOOR FRAME/INSUL. S4 I MASONRY S11 FIREPLACE S11 I I ROOF FRAMING ROOF SHEATHING S5 FRAMING S6 I INSULATION �� •��= SOUND ENERGY S7 LATH EXTERIOR 58 I LATH INTERIOR/GYPBOARD S9 I •I APPROVED/INSPR'S SIGNATURE DATE OF ISSUANCE PERMIT NUMBER BUILDING FINAL S12 vi