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Permit No. 3147 Ali I CITY OF CHINO HILLS - APPLICATION FOR A BUILDING PERMIT AND A CERTIFICATE OF USE & OCCUPANCY COMMUNITY DEVELOPMENT2001 Grand Avenue __ Chino Hills, CA 91709 �y CO BUILDING /�y/yaa���� ^r���-.-- ,jj _� nn PROPOSED USE- C ADDRESS I �'•15( / C�L�ISC`VC1 ` F 2 cJ nOrY?0 COt[21 s APN ' 011_ /�D Jif /) /� �y(� THF, FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT o LOT / nD BLOCK TRACT I`y/� $TRUCT 0 PLUMB ❑ MECH 0 ELECT 0 GRADING D \(/ �J / TYPE OF PERMIT ❑ NEW ❑ ALTER ADDITION m APPLICANT ' //,,���\ `--)n CO /-� `�� ` - = 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT CO ADDRESS LOCATION ZE /� !YJ L L, //o�l/n�1n/�l.�+.//-r��)`� •i./`�/� DESCRIPTION v�,,11 I PROPERTY N I NI SO FEET CITY/ 1 ncpc c )ZIP Ql /Il/la / PHHr..7 fl 1 �� Ocen vpr l M\ly// _ 1p1 v, (fivp.� I cA_'14 X kite' a8-1 U, OWNER t,■I --�1./�y4" �e 1`9ifl /'� I I r•(\ ADDRESS I �1�-/V ( ZI 1 I Cd-1;.1.�' i r 3 Tei\inn Ai11 ( ? -f( I I ARCHITECT ENGINEER LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ):1 � ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS O CITY ZIP PH \•, ' 1 ROOFI FLOOR EXT WALL INT WALL CONTRACTOR � \C 1 , o .aerith LIC NO gene/. ADDRESS PJ 1-���ll��.A�W/UJ iii��ff"'p sip„ ,L-�� genets CEILING HEATING FIREPLACE P NRY eine:LID ZIP S1 lA� PH s^ SEWER MIN DEPTH I/FHOOMETAL MASOSIZE Wh`149 EXPIRATION DATECE NSE / irc���/ I LICENSE NO 1 t'TdJ I LICENSED CONTRACTORS DECLARATION r CUBIC YARDS EXCAVATION FILL OVER EXCAVATION I hereby affirmthat I am licensed under provisions of Chapter 9(commencing with Section 7000 of Division 3 of . Business and Prof ns ions Code,and my license isinfull force and effect License Cla 1/ License Nu r 1L T_7_ /_(7\C TM7 Date -_ a ' e - Contractor neLLI �` tt ADDRESS `iiia -4 lit' �� I.1 C,- lr CITY AND ZIQ i1 ccr-n CI 1{3IONE[ 4CC7 OWNER-BUILDING DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason ❑ I,as owner of the properly,or my employee,with waon es their sole compensation,will do the work,and the structure is not intended or offered for sale ❑ I as owner of the property,em exclusively contracting with licensed contractors to construct the projectZONING I LAND USE ❑ I am exempt under Sec BAPC for this reason I Date INITIAL SETBACKS I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY Lag" I S'cS t I I hereby affirm that I have a certificate of consent to sell insure,or a certificate of Workers' Compensation Insurance,ora certified copy thereof RV ao, I SSY I COMPANY POLICY NO GROUP DIVISION TYPE ❑ Codified copy is hereby furnished DATE EXPIRES 1:1Certified copy is filed with the city CITY VERIFIED VALUATION 7/ 000 Dal. APPLICANT PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE I certify that in performance of the work for which this perry is issued I shall not employ any ELECTRICAL I STRUCTURAL ,y, O/� o person in any nneso as to become subject to the Wo a Compensation Law of Calif• i Date IPAPPLICA ,- - L:S M►+��/� PLUMBING I GRADING NOTICE TO APP LI ANT II,after making this Ce flcate of Exemption,you should become subject to the Workers Compensation provisions • (Labor Code you must forthwith comply with such provisions or this permit shall be deemed revoked MECHANICAL I ISSUANCE FEES Z 9- 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 I PLAN CHECK AND HEREBY AUTHOR! : REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MEhTIONED PROPE-TY 'OR INSPECTION PURPOSES ISSUANCE APPROVED TOTAL PERMIT FEE IUAea ISt_ _- , .. mit uil. igsDm '93- '&32 - Signature of App. nt or Agent �'T�,m � (� sate U �/j . �C l M 1 , 1 A.y r C"I\ DATE OF ISS I/�y/9 y PERMIT �'N I BER/ Print Applicant's%Agent's Name 7/ FINANCE CODE G / / ['aerator: VIRGINIA check d: 009(f0WJ WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK- OWNER Date: 7/MONEY ORDEE4/9M1 00 RBnapt D: 'dWR t�3.a 3u GOLD-ASSESSOR/MANILA -INSPECTOR , ,j< _u.tint Tendered $100.00 •CONSTRUCTION LENDING AGEN 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 ADDREcc DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRESA DIVISION OF INDUSTRIAL-SAFE 1'PERMIT ASA PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW Y l - ` " \ ;rJ 1 1' ❑ I 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,FALSEWORK,OR DEMOLITION OR DISMANTLING THEREOF WILL BE MORE THAN 36 FEET HIGH I ♦:-♦- • O AS OWNER/BUILDiER 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 f `C -- DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER I +. , I HAVE, READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK AI?PLIED FOR ON THIS PERMIT EIS •'❑IS NOT .SUBJECT TO THE APPLICABLE'REQUIREMENTS;OFTHE HEALTH'AND•SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY ! (' ,I, r r_, f I J �;^ _ I - j/f ) F > f , 'i ill I � r` 1Icy y �1 fin _ ) • 1301 -101 - -C> t -1 1 _{ • !�1 ytlr�`\ J�`.:5',�1_ .�1h)J ),� r),) .1. -./'r r ,,,15u.,yt4-n-,>r v.dbrt.1.,..•rvr'-..srr-y,sys w''n._ -'r-- , . . , • .. . . .. n - t }• CITY OF CHINO LS A (CATION FORA BUILDING PERMIT AND -:97.;;;...4 COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY "t`� 2001 Grand Avenue n...„���, Chino Hills, CA 91709 0 BUILDING 1 I� PROPOSED USE a ADDRESS 5 )IL^ Cys we rvJ tvO J r O APN /JO S 2_ b.-q- 3 2 ' 1 n 111!!!, 1 / J' THE FOLLOW�'I/W/G WORK IS A��2 THIS PERMIT y LOT �© BLOCK D TRACT I �r/5 a r>TRUCT 0 PLUMB ❑ MECH ❑ ELECT ❑ GRADING C 9 i �'•� TYPE OF PERMIT 0 NEW 0 ALTER ADDITION fCO n APPLICANT Ar r 1•l n(c i 1 ) c 1 \ Cl, 1 U� 0 REPAIR 9 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS n 1 ,r - PROJECT LOCATION ON SIZE �`A I r i n n,. ^ • ��� .•� DESCRIPTION I PROPERTY I IN 50 FEET --(�' CITY( tanc I � Cm ZIP cif )fl 1[) PH -JwY .(-x.0 / t.Vn -it, L1 O(�� l' -1. ---R� h �l.,• w. ('sit,A r I i`}Y^K rf 'lf ) t `i OWNER 'Y /( ' I• )ITh{ 2‘ ADDRESS ' L`. j1....) ( 4 I elC i e 1 C1.( 3 I I —_ 1 (46.�I-4/4/41 I I _ . CITU 41 i nit: U• � •. LP 1 P 4 ^1,1 ARCHITECT r� ENGINEER LID NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION 1 r - ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS CITY ZIP PH , ROOF I FLOOR I EXT WALL I INT WALL CONTRACTOR CfrLIC NO -1 ..- • FIRPLACE ADDRESS v' , ; ::,-,Q ' I r n(', t� CEILING HEATING I METALE EMASONRY •` CITY( 1(•) ) ��r/ ZIP /Ar _Lr PH.2417A..)44,- 1 SEWER I MIN DEPTH I S/F/100I SIZE I 1 CITY BUSINESS LICENSE t' ICtx7 LICENSE NO kJ �� ryrG i 7 EXPIRATION DATE LICENSED CONTRACTORS DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION I hereby allirm that lam licensed under provisions of Chapter 9(commencing with Section 7000 of Division 3 off the Business and Professions Code,and my/license is in full lore*and effect License Classt7,-/- ! License Number 11'1 I/-X ) ) L.� Date_,(,-;1t •""1y3�•gContractor LI/ .'i 1 t!1(�•---• .)C.- • 1 r 1 ADDRESS I %' <i-'a _ `/rnel�rr T f CITY AND ZIP �U N. , Cid lr �h PHONE --.F:Y` ✓^iQC` 1 — It -- - OWNER BUILDING DECLARATION I hereby affirm that I em exempt from the Contractor's License Law for the following reason 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 O I as owner of the property am exclusively contracting with licensed contractors to construct the protect ZONING I LAND USE O I am exempt under Sec BAPC for this reason I Date INITIAI SETB`AC ST Y I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY CX`- I SY'S I I hereby affirm that I have a certificate of consent to sell insure,ora certificate of Workers Compensation Insurance,ora certified copy thereof RY CNl I SSV COMPANY POLICY NO GROUP DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES VALUATION ,..— o Certified copy 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 permiys issued I shall not employ any ELECTRICAL STRUCTURAL person in any manner so as to become subtect to the Workers CompensationmLaw of California Date /14 /L1z/ APPLICAN I kV/wit V//41-4,, / / r e' r - - 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 mutt lonhwith 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 INFORMA TION IS CORRECT I AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS, GEO REVIEW I PLAN CHECK AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES ISSUANCE APPROVED I TOTAL PERMIT FEE .�mf'rn i {«Lath.. f _, C1( di l4' Signature of Applicint or Agent / - Date / / / \ ` / DATE OF(SSU NCE PE TIB Print anti^g ' Nam f !)C me II r A)!' r--- \\ /1 ,/?y I T/ 7 ` FINANCE CODE ,��/ J WHITE FILE/GREEN- FINANCE/ YELLOW- OFFICE/PINK- OWNER - GOLD-ASSESSOR/MANILA - INSPECTOR fix; • - +. ,t- 1 CONSTRUCTION LENDING AGENC• 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 NAMF LENDER S ADDRGcc 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 O I 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, FALSEWORK,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 DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER • I HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT IDS IDS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY BUILDING INSPECTIONS RECORD DATE INSPECTOR I DATE INSPECTOR Setback/Location I Rough Plumbing Temporary Power / Shower Pan Test Foundation Reinforcing Steel -7//S/'9‘7 tucco 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 Final Bond Beam Final On Site Improvements Fireplace Bond Beam Final Off Site Improvements Roof Sheathing Final Dedication Framing and Ventilation Final Zoning Roof Covering 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 r- . , .n / -, / /.^ /A - [ ,O //!-� N 7 //- n ///3/ ' / / l J SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDF LONG X DEPTH OF ROCK N W E S Inspector's Signature and Initials DATE OF ISSUANCE PERMIT NUMBER