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Permit No. 1073 CITY OF CHINO HELLS411P • "`COMMUNITY DEVELOPMENT L r 2001 Grand Avenue APPLICATION FOR A BUILDING PERMIT AND A CERTIFICATE OF USE &OCCUPANCY Chino Hills, CA 91709 BUILDING f J ' r Chyve / CLEARED BY APPLICATION TYPE NO CO ADDRESS J/'"�C, 1\ / /� /� ��/9 C APN ' �.d-- Z ��— —V� OD THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT 2 / > LOT 151 BLOCK TRACT 0/ „/F O. RUCT ❑<f'�UMB ❑•larCH 0,-,EL-ECT 00 (fl f 0 33 yf y�/ [ {/ /�f'j TYPE OF PROJECT fW ❑ ALTER ❑ ADDITION m OWNER`Irl "rl� 4t-6 ✓V-/` l ❑ REPAIR ❑ CONVERT ❑ DEMO ❑ OCCUPANCY PMT ADDRESS . ` 1 ��, /- / D� / ., �/1 PROJECT LOCATION ON SIZE n� ( ' �(`'�✓ v, `�l/x]{/1 D IPTION PROPERTY IN SO FEE /� /� F //�� � �,� ,tee CITY f-1! 1.M7 V l�.rfi'� ZI d(� Itv,D PL�r.IJ/J'L400D ,. /,T/''f I 7� '�// I /�/9 ENGINEER <1 Aiv/Y`-�_ LIC NO 2 j9' I / I g",5 ADDRESS 3 c� f I/ I ,1' CITY ZIP PH. REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION :� CONTRACTORC`cv/ LIC NO • ADDRESS tsG/tyVC C • CITY ZIP PH /� - LICENSE NO. 1 EXPIRATION DATE CITY BUSINESS LICENSE ��/�/ / 1 � - 1 ! �f� /�J ,�0 LICENSED CONTRACTOR'S DECLARATION / ''"�'' //2i/ ,� . /} 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 mull to c n effect License Class_ n License Number /l ,,./C/.,( v// Date / )/�^Contractor,E I I ►-tl[..2-13-1-- .(i t- __tr .r'/�/�� /��ti/y� ADDRESS /�f�_1 c-)/j"t(/' e{�r�r7„ [2 L-/ -moor- i CITY AND ZIP �_ p qlP� PHONEI6.41 3— 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 project !` ❑ I am exempt under Sec B&PC for this reason _ ,��y `� �rj Date INITIAL /7- .4 /� LG4: �,,/, /, WORKERS'COMPENSATION DECLARATION L' I hereby affirm that I have a certificate of consent to self insure,or a certificate of Workers'Compensation • Insurance,araa certified copy thereof r �?�� ��n r� '^7 r COMPAN YI + 'IE S ri`vl i �7 O$6LICY NOG�I:IC'GO l CI(--K7�Y57 �' / GROUP DIVISION.-f, - TVPE��p / ❑ Certified copy is hereby furnished DATE EXPIRES ri "Illi .rtdied copy is filed with the city CITY VEERI�FIEn - VALUATION /1 / /`T�T/ Tate APPLICANT 05 i PEF(MIT 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 /367 04?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 this 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 I PLAN CHECK AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES ii/-%.1- g,.A / ISSUA E ROVED TOTA�RMIT FEE �� 40,P.Sgnkure of t Agent Date / eec. DATE OF ISSUANCE PERMIT NUMBER Print Applicant's/Agent's Name ---,( 23— 0 /o10 Operator: DAWN Check #: 000000000 Date: 3/23/93 00 Receipt #: 0000696 WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR CHECK $1351.00 • • • 3- -to. BUILDING ADDRESS LOT BLOCK TRACT BUILDING INSPECTIONS RECORD OWNER ADDRESS CITY ZIP PH few ING ,�}/ jp 113 JA"Val D/ RE R'S GROUND SOI LIOMl4!ER* P1 13-A(b/ei3 TOP OUT P2 / V -- SHOWER PAN P3 REMARKS -1--41-€11) SEWER STEST P6 "I, •4i1 .7/ 6/_ '95 A7/' v LI" 2!"74f1 44 FINAL PLUMBING P12 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 UNDERGROUND PVC-METAL-D.B C E1 ROUGH WIRING RECEPT.SPACING- SERVICE-CIRCUIT E2 FINAL ELECTRICAL E12 STRUCTURAL DATE APPROVED/INSPR'S SIGNATURE • FOUNDATION.LOcATION S1/. REINFORCED � UFER�L�� SLAB REINFORCED LYAAE/MBRANEC5:3 FLOOR FRAME/INSUL. S4 MASONRY 5111 FIREPLACE S11 ROOF FRAMING " � ROOF S5 .c---1(1913 FRAMING S6 INSULATION SOUND ENERGY S7 LATH EXTERIOR S8 LATH INTERIORIGYPBOARD S9 I 7.2 7 ,�/ PL Z APPROVED/INSPR'S . ° C Sr"SIGNATURE ATE OF ISSUANCE jPERMNUMBER S. BUILDING FINAL S12 ,• - • . . , . • :,� ,� -J:7 :��t. • QTY OF CHINO HILLS 0 -,,' COMMUNITY DEVELOPMENT 2001 Grand Avenue Chino Hills, CA 91709 BUILDING / � / / ,f� 4...._..72„.... .,,,,,,,,,,,,,,„ ADDRESS / /`-"J /`�fGi��L,,,,./ // LO•T / 7 BLOCK TRACT/3,7 BUILDING INSPECTIONS RECORD OWNER //- C-7'—� POST IN CONSPICUOUS ADDRESS PLACE ON THE JOB • CITY ZIP PH FOR L APPR VED/IN S 590-1511 EXT.XT 282BEFORE 4:00 P.M.Y INSPECTION �PLU' M��IG 4/5//6� �' GIVE JOB ADDRESS, PERMIT NUMBER, GROUND SOTt ATEC R P1 �* X--209' AND TYPE OF INSPECTION. TOP OUT P2 i SHOWER PAN P3 (0/7, •C-.;1'i REMARKS SEWER P5 L-/2.Z_ —/� /,�'x �/ ., GAS TEST P6 _5e/ (0464 3 3 V/& T l 7�� *FINA6"77 / l t,^ 4'.27- 93 ,,/- FINAL L PLUMBING P12 MECHANICAL DATE APPROVED/INSPR'S ro-Q �„.7 /I 7-i -c"; /./la-,/'1 SIGNATURE / ' - 7- UNDERGROUND UNDERGROUND FLOOR Mt ROUGH M2 I C,/7JI C(L.- FAU/AC M4 I I FINAL MECHANICAL M12 I I ELECTRICAL DATE APPROVED/INSPR'S SIGNATURE TEMP.CONSTN.POWER E3 UNDERGROUND PVC-METAL-D.B.C. E1 ROUGH WIHiNI. RECEPT.SPACING- r �'7 p SERVICE-CIRCUIT E2 c r — l_____ FINAL ELECTRICAL E12 1 1 STRUCTURAL DATE APPROVED/INSPR'S SIGNATURE FOUNDATION:LOC9TION S1 , REINFORCED E UFER [� /� SLAB REINFORCEDMBRANECS3 I /i FLOOR FRAME/INSUL S4 MASONRY St1 FIREPLACE Si iROOF FRAMING I I ROOF SHEATHING �- S5 1 5'l ( -7� / f . ../.,..„2._,„.t....-\ - l FRAMING 86 ( /-Z- /� -�� / INSULATION L SOUND ENERGY S7 -7 I �� LATH EXTERIOR SB 6/e I4 LATH INTERIORIGYPBOARD Sg 6-4,, I 7p APPROVED/INSPR'S SIGNATURE DATE OF I ANCE PERMIT NUMBER BUILDING FINAL St2 11 3 1 1 1 e lR, I 5 -/,3 /o 73 ! 4 li' '