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Permit No. 3863 =;to CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND A CERTIFICATE OF USE &OCCUPANCY COMMUNITY DEVELOPMENT •.;.• • 2001 Grand Avenue ®l Chino Hills, CA 91709 BUILDING q LL y. .Iy-�,A 1 PROPOSED USE0 CO ADDRESS 13 Ll I 1-koa-cf 5 'Nvei La tJ e� FA-(0,,��c.JJQ�I ..S ".1/4". �I4� C r 7 APN THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT L3 �/ D LOT Iry / BLOCK TRACT / 0 STRUCT 0 PLUMB ❑ MECH ❑ ELECT ❑ GRADING 0 `�`/ I O 9 1 / , TYPE OF PERMIT 0 NEW 0 ALTER 0 ADDITION N APPLICANT Y A-rl yl V Ni £ r 5A- III��\.. !� �{ I r' /�.�A/p 0 REPAIR 0 CONVERT' 0 DEMO 0 OCCUPANCY PMT y SIZE ADDRESS ♦3�T� +I IS A- 65ISy-R�y NPS (�(7 1v lj DESCRIPTION /� I PROPERTY I INNV SO FEETs CITY C Ft-llr/1./ I+ills ZIP q r 7/ b'9 PH 3-51-73671 �1e•✓R I I J /`--� OWNER Si!. ,nviilt p/ 2 I I ADDRESS lI I W 3 () CITY ZIP PH I I 4 ARCHITECT ENGINEER vkI -<jlc-bh/fl LaildSC�¢IitiNo 7REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS �j -1OrT,Vl NO STORIES NO DWELLING UNITS BEDROOMS CITY ZIP PHS [q ISO ROOF I FLOOR EXT WALL INT WALL CONTRACTOR LIC NO ADDRESS CEILING I HEATING I FIREPLACE METAL MASONRY ����(((((���� CITY ZIP PH SEWER I MIN DEPTH I S/F/100I SIZE CITY BUSINESS LICENSE LICENSE NO EXPIRATION DATF LICENSED CONTRACTORS DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION I hereby allirm that I am licensed under provisions of Chapter 9(commencing with Section 7000 /C'1 of Division 3 of the Business and Professions Code and my license is in full force and effect f License Class License Number lac. X. I �/^ /- +OO W Date Contractor 1 ADDRESS C CITY AND DP PHONF OWNER BUILDING DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason 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 II-`, r' 1Z/OYNING I LAND USE O I am exempt under See B&PC for this reason -' C I I /PO P11 1 7 ISI I / — Date �O/KERS/COMPENSATION DECLARATION INITIAL � FY IS E1TA�,A/1CCKSS SY I MODEL/PLAN I 1 hereby affirm that I have a certificate of consent to self insure,or a certificate of Workers' I^� Compensation Insurance,or a certified copy thereof RY A I / I SSY I COMPANY POLICY NO GROUP DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES O Certified copy is filed with the city CITY VERIFIED VALUATION go" Date APPLICANT PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE certify that in a ner so o as of become mework tor ct whichthe is permit is issued,I shall not employ an ELECTRICAL da�-rl I STRUCTURAL �fl L O I person in any rtpeforsanc tob h• k for subject the Workers'rmit' omuen all Cal nes �/ ``LJ l�J �I7t� Date /17��( 7y APPLICANT V PLUMBING /�,� I GRADING J I NOTICE TO APPLICANT II,after making this Certificate of Exemption you should become VJ 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 a I CERTIFY THAT 1 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 Q / - q ISSUANCE APPO I TOTAL PERMIZFEE • .�2ll (7, Y'��JGE-.Kip ////9`1! �/ , (SUr(8 Sign lure of Appli4ant or Agent v(�' Date / /V`-Me/Z yA/ y r c i4 R yr DATE\OF{Si UA E I PERMIT NUMBER Pnnt Applicants/Agents TION ` I I6(L\ 3 6S FINANCE CODE C--14 i.tOr: IAN [neck t,: 000001232 WHITE- FILE/GREEN- FINANCE/ YELLOW- OFFICE/PINK-OWNER :'-•e% 11/17194 CO REcefDt 8: 0000813 ;.Neck 888.CKt GOLD-ASSESSOR/MANILA - INSPECTOR CONSTRUCTION LENDING AGENCY 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 NAM' LENDER'S ADDREcc DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRESA DIVISION OF INDUSTRIAL SAFETY PERMIT AS A PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW D 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 O 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 DIS DIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY To -it>, CITY OF CHINO II , ALICATION FOR A BUILDING PERMIT AND .rt.... COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY • - 2001 Grand Avenue tit'`ligaigiiiiiiiii Chino Hills, CA 91709 co ADDRESS I mot lY I , 1 sit N, t v PROPOSED US . ci /`^ , l i / O APN oz,C'. I 'ill THE FOLLOWING WORK IS AUTHORIZED BY THIS PERT D LOT BLOCK TRACT/2461 0 STRUCT 0 PLUMB 0O tt / ,e TYPE OF PERMIT 0 NEW 0 ALTER 0 ADDITION CD T APPLICANT , I .1- • ,y Co 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS ' t I t I r ".'l.,r PROJECT I LOCATION ON I SIZE DESCRIPTION PROPERTY IN 80 FEET CITY • ZIP t ( PH / 1 Cr.A7d0, I I'�t�-•(y OWNER 1i 1 ,/ 2 I I I` ADDRESS 3 i CITY ZIP PH 4 -- ENGINEERT ! t 0 LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS CITY ZIP PH r . ' ROOF I FLOOR EXT WALL INT WALL CONTRACTOR - - LIC NO 4. ADDRESS CEILING HEATING I METALMASONRY CITY ZIP PH SEWER MIN DEPTH S/F/100 I SIZE CITY BUSINESS LICENSE LICENSE NO EXPIRATION DATF LICENSED CONTRACTOR'S DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION I hereby affirm that I em licensed under provisions of Chapter 9(commencing with Section 7000 of Division 3 of the Business and Professions Code,and my license is in full force and effect ` 1[ //-. License Class License Number 1 4 l $ I I[ /- - ' /.-_r+ ' Date Contractor AODRESC CITY AND ZIP PHONE -J OWNER BUILDING DECLARATION I hereby affirm that I am 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 ZONING I LAND USE the protect O f 1 am exempt under Sec B&PC for this reason � T i: . _, L..-1 r I .�, Det• o. i INITIAL - SETBACKS I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY 1I SY I I hereby affirm that I have a certificate of consent to self insure,or a certificate of Workers' Compensation Insurance,ore certified copy thereof RY t ) I SSY 1-5 I COMPANY POLICY NO GROUP DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES VALUATION 1 i^ O Certified copy is filed with the city CITY VERIFIED Det• APPLICANT PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE I certify that in performance of the work for which this permit is issued,I shall not employ any ELECTRICAL —NI' •C I) I STRUCTURAL-Th d " � 0 as in any manner so to become subject to the Workers Compensation Law of CAbfornie y . �. 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 i with such provisions or this permit shall be deemed revoked MECHANICAL ISSUANCE FEES 1 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 PLAN CHECK AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES ISSUANCE APPROVED TOTAL PERMIT FEE Signature of Applicant or Agent Date DATE OFI S 1 I PET M�R y / • s ' Print Applicant s/Agents Name FINANCE CODE WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK- OWNER GOLD-ASSESSOR/MANILA :INSPECTOR ONSTRUCTIDN LENDING AGENC I HEREBY AFFIRM THAT THERE IS A CONSTRUCON LENDING AGENCY FOR THE PERFORMANCE allIFHE WORK FOR WHICH THIS PERMIT IS ISSUED ilikit (SEC 3097 CIV C) LENDER'S NAME LENDER S ADORE cc DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRESA DIVISION OF INDUSTRIAL SAFETY PERMIT AS A PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW ❑ I CERTIFY THAT NO EXCAVATION 5 FEET OR MORE FEET IN DEPTH,INTO WHICH A PERSON 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 3e 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 OS CBS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY BUILDING INSPECTIONS RECORD DATE INSPECTOR DATE INSPECTOR Setback/Location Rough Plumbing Temporary Power Shower Pan Test Foundation Reinforcing Steel Stucco 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 i i /1/771W CN a ler,../ T.r f big v/ / / 4- erS a /L //Z.PO/9 41 Cil e° / ii - i7) i '7 /crC- f—(iv -- -i 4-1/ • // — SEPTIC TANK GALS v 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