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Permit No. 1059 UP(OF CHINO HILLS4- • COMMUNITY DEVELOPMENT } 2001 Grand Avenue APPLICATION FOR A BUILDING PERMIT AND A CERTIFICATE OF USE &OCCUPANCY Chino Hills, CA 91709 lei 4 l ,rte �ml� ( �.v BUILDING CLEARED BY APP ATION TYPE NO co ADDRESS _ CP/ - Fie ( IF //J g APN 1,r 1�1 �� L4� f r�/� / THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT E LOT 5� BLOCK TRACTIc�ITRUCT g'PCUMB C AECH ( ECT 0 1 JXV '�,�� 30 TYPE OF PROJECT Ly'NEW ❑ ALTER ❑ ADDITION m r ,OWNER ❑ REPAIR ❑ CONVERT ❑ DEMO ❑ OCCUPANCY PMT 1n PADDRESS /Th 1'{i /` 3 )J1 DR I IQN/PROPERTY ONLOCATION I SIZE _FE/ �J CITY r U 1/N �Y,//! 1 ZIP/9,0 Fj-1`/'rX PH� /'1 �(/.-yyC 3 1 I5...1i I bi lk A l ' g- ENGINEER3 . ARCHIT c` G Q LIC NO 2 „24,./e1,)- r I f I" / I RD7 ADDRESS 34* . I ,/ I /` 4.6 CITY ZIP - PH 4MARK 'ECIAL CONDITIONS/PROJECT DESCRIPTION • CONTRACTOR 61/yt LIC NO .01 ADDRESS • CITY ZIP PH - CITY BUSINESS D.._ - LICENSE NO -....)6 ( EXPIRATION DATE LICENSE / // l/wy/� LICENSED CONTRACTOR'S DECLARATION / tI W.,-.29/Y3 ,L I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000 of Division 3 of the Business and Professions Code,and my license n full for e a d e License Class- ( 5 License Number Date Contractor /) a/t ADDRESS IC'ern £ 4 _ rp i L/d 011r` 7r CIN AND ZIP (::ia29-4 PHONE( LL 4 ife•DOD , 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 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 protect ❑ I am exempt under Sec B&PC for the reason Date INITIAL T�A WORKERS'COMPENSATION DECLARATION C'�"V _/ _`I '"`CA.... • ,OC--/'� C I hereby affirm that I have a certdwate of consent to self insure,or a certificate of Workers'Compensation , Insurance,or a certified copy thereof I COMPANY thK/`ta /T2 p00NOVw?O/!1`/ '�9 - w , O Certified copy is hereby furnished DATE EXPIRES :T'l• 4 GROI�f/l DIVJN rid QJ Certified copy is filed with the city CITY VERIFIcn '�j VALUATION /n / ,5-6 Date APPLICANT 14:71/r�-`l'_/ /,/ rPIRMIT 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 • I STRUXQ7. `7 7 Q� - any manner so as to become subject to the Workers'Compensation Laws of California // Date 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 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 J PLAN CHECK AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTIONED i PROPER FO INSP C -N PPUU/P�SES A''' SSU ROVED TOTA PERMIT FEE Sgnatt"re'of Applicant ti Date �//" .,// /�,� irL� / r�) I r DATE OF ISSUANCEPERMIT NUMB'lER Print Applicant's/Agent's Name - .2,5 / d. %/� Operator: DAWN Check 41: 000000000 Date: 3/23/93 00 Receipt #: 0000712 WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR CHECK $1277.00 • III) 0 .. ..., I •, BUILDING ADDRESS LOT BLOCK •- TRACT ' BUILDING INSPECTIONS RECORD OWNER ' ADDRESS k V 1 CITY ZIP , PH ,PLU NG ;` Eny .A OVED/ PR'S !/ E GROUND SOIL4t0AT ` P1 • 3 % 11 I de//4444,-- TOP OUT P2 .4 - 1 1 .' ' I . SHOWER PAN - P3 , /� REMARKS SEWER P5 L4 -l. :q17 I fil5d2119.-eivs !/%j GAS TEST P6 Y 1. • FINAL PLUMBING P12 I -'; / • • MECHANICAL DATE APPROVED/INSPR'S SIGNATURE UNDERGROUND FLOOR M1 ROUGH M2 • FAU/AC M4 ' ' . FINAL MECHANICAL M12 ELECTRICAL DATE APPROVED/INSPR'S SIGNATURE TEMP.CONSTN.POWER E3 I UNDERGROUND PVC-METAL-D B C E1 ROUGH WIRING RECEPT.SPACING- SERVICE-CIRCUIT E2 FINAL ELECTRICAL E12 STRUCTURAL DATE APPROVED/INSPR'S • SIGNATURE FOUNDATION:LO TION SS REINFORCED UFER` n/ ti,, SLAB REINFORCED1MBRANE190I FLOORFRAME/INSUL. /• • 94 . . - MASONRY S11 FIREPLACE S11 I ROOF FRAMING 5;' ���/JJ} ROOF SHEATHING - S5 / '?) T/J C // ✓�3 �/ • FRAMING • .S6.1 I INSULATION b SOUND ENERGY S7 LATH EXTERIOR SB LATH INTERIORIGYPBOARD S9 I APPROVED/INSPR'S `i ' SIGNATURE DATE OF ISSUANCE P MIT NUMBER BUILDING FINAL S12 , /31 MY OF CHINO HILLS • • ., J. CAMUNITY DEVELOPMENT 2001 Grand Avenue Chino Hills, CA 91709 -t-t(:,I," tt-N, r-,t-r,,i t(", L ' LOT \--)n BLOCK TRACT 11)u,ij 1 BUILDING INSPECTIONS RECORD POST IN CONSPICUOUS PLACE ON THE JOB ADDRESS c- \- )1,_: ''''\, . t--)\,.\,:cr v\(,,._:: 0\:- -23:,, CITY ' ZIP PH 1 / - -L )/-j; Ls J6"), 41 C.-:,t- L.. FOR NEXT DAY INSPECTION CALL t , t eR N 'A' 590-1511 EXT.282 BEFORE 4:00 P.M. t agiv. 4y.iDIA A..6.1 _ APPVEDAS I GIVE JOB ADDRESS,PERMIT NUMBER, f GROUND SOIL/WAXER* P1 1-3 .,1 7/ AND TYPE OF INSPECTION. ,4 ..1 TOP OUT P2 f,-.,,cr - i REMARKS SHOWER PAN F13_ &.'--; __ .."::::---f (-- _ .,p, r ,...1 4 SEWER P5 Li- -2 -93 --/--, 5.1z,IZA- '7/..3 ,114 2//-- il GAS TEST P6 6 7-45 .---1 • _,-- /4 ,) \ q--.91 ,-9 -7.- ,. 1 FINAL PLUMBING P12 DATE MECHANICA "777R7L VED/INSPR'S -1 — 1)-4-0-- 7 -'5-'13 SIGNATURE t UNDERGROUND FLOOR M1 ---, ROUGH M2 .,. 7-Z, ,..4 FAU/AC M4 . FINAL MECHANICAL M12 I ELECTRICAL DATE APPROVED/INSPR'S SIGNATURE TEMP.CONSTN.POWER E3 - UNDERGROUND PVC-METAL-D.B.C. Et ROUGH WIRING / / - ... • , _.„-- RECEPT.SPACING- , , „.- ....- e......—, SERVICE-CIRCUIT E2 I i FINAL ELECTRICAL E12 APPROVED/INSPR'S STRUCTURAL DATE SIGNATURE i' - FOUNDATION:litpTION l,, 1 0•77.) REINFORCED UFER . . , - SLAB REINFORCEDIRKIMBRANE 16 a0. ./e -'4,-; // *.- Z2 (4— 7r1/47 FLOOR FRAME/INSUL. S4 j C MASONRY Si1 I - I FIREPLACE Si 1 ROOF FRAMING ''.— "7 79›. /1 5 .--7* -- .? ROOF SHEATHING ..._ S5 '> FRAMING S6 4/-) . ,: 7-- I / INSULATION 69 ( -7 .., (t...--- SOUND ENERGY S7 LATH EXTERIOR S8 I 6/S I '''?e__ F c /./.a/.,..,4 7-----("Al-e.-- LATH INTERIOR/GYPBOARD S97I 6,. 8 4 7 e_____ J f.."......"4.„4,-Z APPROVED/INSPR'S SIGNATURE DATEUANCPERMIT NUMBER BUILDING FINAL S12 7/:./.., '-. ).-( - s42. 43//3