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Permit No. 1055 CITY OF CHINO HILLS COMMUNITY DEVELOPMENT /IIIP 2001 Grand Avenue APPLICATION FOR A BUILDING PERMIT AND A CERTIFICATE OF USE &OCCUPANCY Chino Hills, CA 91709 BUILDING i ,) _I 4€ I��� / CLEAREDBY APPLICATION NO O ADDRESS IOJy�'/�lW/� %F//�(/l� / l/ C APN / Oh/fig 9�I�. iL THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT D LOT —I )p -6 BLOCK�1 TRACT6�CY /I RUCT LUMB �'A�ECH ELECT 0 33 !� / TYPE OF PROJECTW D ALTER ❑ ADDITION m OWNER �:/► / CO �• O /�_...6r.. .,.,500� ❑ REPAIR ❑ CONVERT ❑ DEMO ❑ OCCUPANCY PMT � ADDRESS �/� f—/�� \ PROJECT LOCATION ON SIZE v (/� �/ (/I/L� DESCRIPTION PROPERTY INSO FEET CITY(/ Wf / 1 Zl /T /\ PH 1 1M:04/ di I 7 I /��! 1. ENG ARCHI g,g; NI ERT LIC NO24,,,,,. ..zi7a... �. ADDRESS 3724.1-g /"/�9 6 I/ I /�/ V CITY ZIP PH, REMARRKKS//SPECIAL CONDITIONS/PROJECT DESCRIPTION I t CONTRACTO5 .�/D LIC NO ADDRESS CITY ZIP PH • CITY BUSINESS __ LICENSE NO 1(C► EXPIRATION DATE LICENSE �_/__;.„3/ 6/-3. //� ' LICENSED CONTRACTOR'S DECLARATION L / /�`/,J"/�+/j"/v�,///y/9 !� I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000 of N. Division 3 of the Business and Professions Code,and my license is in full��force(and effect g I License Class c6 License Number `—ter r ' ,6 /,� ,k ji. Date /� �,{ CContrra�ctor +""�7/�,r��^�"/^" ��r\}T' n !riW ADDRESS /t 71 "�}`(��/(Lc/)`l(�� - I ( 1 I�y/' .. J 1/b, . \l I'1 1 CITY AND ZIP Lor o 69�—""6 ' PHONE t gib r� — w I N k\(V r OWNER-BUILDING DECLARATION I \ v`l I hereby affirm that I am exempt from the Contractor's License Law for the following reason tf� ` ❑ I,as owner of the property,or my employees with wages as their sole compensation,will do the work, t/1` and the structure is not intended or offered for sale 1\ ❑ I,as owner of the property,am exclusively contracting with licensed contractors to construct the project 1 ❑ I am exempt under Sec B&PC for this reason Date INITIAL WORKERS'COMPENSATION DECLARATION ad-ii'v— " �y /775'7 7� I hereby affirm that I have a certificate of consent to self insure,or a certificate of Workers'Compensation c.w Insurance,or a certified copy thereof (/�� COMPANY I Y NO kr ��Li(76:21-.1 �'�'�_ / GROUPiteDIVISION TYPE //� ❑Certified copy is hereby furnished DATE EXPIRES 4 ���/// v ,v (t 7;ertified copy is filed with the city CITY VERIF�IEn r VALUATION 4',/ ���Ji f a? /�� Date APPLICANT /1 1 /�/3 PERMIT FEES (, CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE I certify that in the performance of the work for which this permit is issued,I shall not employ any person in ELECTRICAL' STRUCTURAL any manner so as to become subject to the Workers'Compensation Laws of California Date APPLICANT / / I V 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 the permit shall be deemed revoked MECHANICAL , ISSUANCE FEES 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 PLAN CHECK. AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTIONED 1 _ PROPER OR INSP C + "oSES ISSU PROVED TOTAL PERMIT I'et SignatJre of Apel t ga{ 0-6—F5 `}�/-�- \ Date/ / or-- - ,t" .."40111r A‘Z4 3 -.3A.3 /i ! / J Mall �V1 I(. DATE OF ISSUANCE PERMIT NUUMBER PrintApplicant's/Agent's Name t � �o I ! 65 • Operator: DAWN Check #: 000000000 Date: 3/23/93 00 Receipt #: 0000704 WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR CHECK $1113.00 I 1dr 4111/ k BUILDING ADDRESS LOT BLOCK 'TRACT BUILDING INSPECTIONS RECORD OWNER ADDRESS CITY ZIP PH a 10'T 3 �RERS GROUND SI L 4194 ' P1 Iffy I /ii' 7/ TOP OUT - w P2 I 0,1 - SHOWER PAN P3 REMARKS SEWER P5 L1 ).2• CP) I -1-vl i 4104 4 ,. J AW" GAS TEST P6 6/2•1 ' I Q.VJA a FINAL PLUMBING P12 /64 .�� / MECHANICAL ' / DA E .1' APPROVED/INSPR'S SIGNATURE UNDERGROUND FLOOR Ml I I ROUGH M2 I ('•/. I V -09- FAU/AC M4 I ' I 1I , FINAL MECHANICAL M12 I/ I ,r"."7,04°.°- ELECTRICAL DATE APPROVED/INSPRS SIGNATURE TEMP CONSTN POWER E3 I UNDERGROUND PVC-METAL-D B.C. El ROUGH WIRING (2.,RECEPT.SPACING- G It. SERVICE-CIRCUIT E2 1" _ FINAL ELECTRICAL E12 /64,y/s, I+7, STRUCTURAL ' SATE 71 AP/PROVED/INSPR'S , SIGNATURE FOUNDATION LO,fd., U •S1 , 41 '`Z 4I^ REINFORCED Cr,��' UFER v SLAB REINFORCEDPMEMBRANE 3 (4 Ifs: l0l FLOOR FRAME/INSUL. S4 1 I 11YY MASONRY ' S11 / FIREPLACE S11 I Ali 0 ! , ,fieri /l X/ 1___5 ROOF FRAMING /� / i ROOF SHEATHING--.N.... S5 //� o���vlK�it/ 1 > T7 N7 �/ FRAMING- S6 I -4/ZJ I • SOUND EONERGY N S7 I foh C/ LATH EXTERIOR S8 ( i LATH INTERIOR/GYPBOARD S9 I I . //J7 /``4 / /7 • . 4 � �w APPROVED/INSPR'S / L 4--e, //�/0Y l / SIGNATURE 'DATE OF ISSUANCE PERM?NUMBER BUILDING FINAL S12 /44y/f3 •• /06/r." r . / ' al /V