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Permit No. 2384 - i---4711-F- 1111, C.4 CITY OF CHINO HILLS COMMUNITY DEVELOPMENT 2001 Grand Avenue APPLICATION FOR A BUILDING PERMIT AND A CERTIFICATE OF USE &OCCUPANCY Chino Hills, CA 91709 ---/VAeZ— — /._ e..9 b e --/?_______, . . ZZ BUILDING 4 r CLEARED BY APPLICATION TYPE NO ADDRESS / /�/ / I�iI /../.:4W6 ".2� c /, / F iC) 2 , l� d e rl, / r+-0 �TH�E FOLLOWING WORK IS AUTHORIZED BY TI-15 PERMIT D J LOT /// fBLOCF� TRA . -„,/ /5 7r TRUCT PLUMBCAECH ELECT0 / / 3I //I `11 'G/// TYPE OF PROJECT I rvEW ❑ ALTER 9 ADDITION m OWNER /'Z//�i / 'IJ/L. N (/� fn �� 9 ' ❑ REPAIR ❑j CONVERT 9 DEMO 9 OCCUPANCY PMT 7, J/ PRD,lEgfr N SIZE ADDRESS /W /l.1 L/, �i4L/ /i�) y�Li6! PROPERTY OII / / I N7 / . CITY / i{s'1/4_/,� ZIP /77:72Z/,' /:L.' P�H/7%/ ��J16,4 GNU/g I l,'v 1 I /G�// ENG NARCHI EER ,424 a%/ /,.11� NO! .W...2.512 f// 7 04/1, 1 I 'E/V V' I "' Q\ ADDRESS�T/ G� ( /r%///'`�ac�i�' C/' "^,� 3 / I //1 \ �(TY�/��,D�����/JzIP zia/,1//J �iT�ifj;/�Z j)A(1REMARKS/SREC4A CONDITIONS/PROJECT DESCRIPTION k......... CONTRACTOR / LIC NO /�-Cl/' /L / ^ Gt tD7� �� /—, // 2 / v°f e ADDRESS /A"/L/lM / /1'/7.7 , /3-1X-{' -' / i "/ , 1, !. , Z \ �(,Z'//C" £C vc,/6,,CITY / ZIP PHIlls /'7,d �Ja// CITY XPI BUSINESS LICENSE //9 /a�_ r- LICENSE NO /, j EXPIRATION DATF %' G - ciis engineer to Inspect excavation LICENSED CONTRACTOR'S DECLARATION Prior to Placement I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000 of �I ;%.,...,b VI 5(Qe4 Z. 3 of the Busmen and Professions Code,and my license is n full force and ect and provide Draper report on site for license icenseClass License Number /1./7/7 6 bUiidIng Inspector. Date_/IO - 3 __.r'/�J 2, .--.. A ADDRESS CITY AND ZIP PHONG OWNER-BUILDING DECLARATION , I hereby affirm that I am exempt from the Contractor's License Law for the following reason 9 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 9 I,as owner of the property,am exclusively contracting with licensed contractors to construct the protect 0 I am exempt under Sec B&PC for this reason Date !NITIA' WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure,or a certificate of Workers'Compensation Insurance,or as certifiede� copy thereof `1 �J �jy/�� ` �j'�j �L COMPANY i 1./4 POLICY NOLO�[./�0--y1746-eit6_`�J, GROUPe / DIVISION�j TYPE; ❑ edified copy is hereby furnished DATE EXPIRES /4� /`-/ f / !/� `I _Certified i copy is filed with they�� city CITY VEdRfIFIED �/1� � VALUATIONs /Date P 740 -t3 APPLICANT /'.V) /( �th// i/, -,,A 7 / /�/ 1 PERMIT FEES r CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE I crtify that in the performance of the work for which this permit is issued,I shall not employ any person in ELECTRICA, �J y—�/ STRUCTURAL/ j// �r anymanner so as to become subject to the Workers Compensation Laws of California lL` i� Lf i Date APPLICANT /f� PLUMBING / U vy GRADING NOTICE TO APPLICANT It,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/6,V '7(� I ISSUANCE FEES/ 67/V..) I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS /l 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 PRO •TY Fe-• • , •_••*-- _ ISSUANCE APPROVED TOTAL PERMIT FEE F.447,..1__ -� Z��� �''— i�-/• ''-4 c4.; /� /'&' -4' (2-- Signature of Appy Agent Date y/'a i ` ^r �,�✓�_ 1 DATE OF ISSUANCE PERMIT NUMBER Print Applicant's/Agent's Name /. / /1. I '_," WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR IP 0 • ILDING ADDRESS Ape/ 4.,4777,,kedoz6, ,, ADDRESS�///��g�/�6�" LOT �� BLOCK Re/64/5 „Ag INSPECTIONS RECORD OWNERtad, AMM/66 ADDRESS CITY l ZIP PIH • PLUMBING DATE APPROVED/INSPR'S SIGNARE GROUND SOIL/WATER P1 I //( I p.y. TOP OUT P2 _I SHOWER PAN 14 _ A REMARKS \ SEWER PS \,;% LAS ��\ GAS TEST P6 Sa5/ /L / d .• _ / - a✓,e..4 ,' FINAL L MBING \I r*f v1y� ' 11:16041/5.9e MECHANICAL DAT APPROVED/INSPR'S / �) SIGNATUREHyde 9 ce2 UNDERGROUND FLOOR M1 I v � ROUGH M2 Z L V` 0 w ,_ I FAU/AC ..., M4 I Acti ���"'_ 8y5 .4-4,i, FINAL MECHANICAL;': M1.2 I . �- A j A • ELECTRICAL DATE • • APPROVED/INSPR'S 1.741-.-%+ V-ir3-X;:f/L 1i # _ _ SIGNATURE JJ v / g/z � i /• TEMP CONSTN POWER E3 }aC S t / �'i UNDERGROUND - l s+ PVC-METAL-D B C El ROUGH WIRING 2.:44141RECEPT SPACING- SERVICE-CIRCUIT E2 2.1 0/ n2 Ei 641- 13/1%8 Art l ' e__- FINAL ELECTRICAL E12 STRUCTURAL DATE APPROVED/INSPR'S SIGNATURE FOUNDATION•LOC ION S1 y REINFORCED UFER`` / SLAB REINFORCED 0 MEMBRANE IOC `ik FLOOR FRAME/INSUL S4 MASONRY S11I FIREPLACE Sit • ROOF SHEAMT NGI _- S5 2.1k1 ' I. 106 / FRAMING S6 •��,/vim INSULATION n r J SOUND ENERGY S7 G` LATH EXTERIOR S8 12 L / •/L)_ LATH INTERIOR/GYPBOARD S9 V/2�(4(/ 4/�� I r APPROVED/INSPR'S / SIGNATURE DATE OF ISSUANCE PERMIT NUMBER BUILDING FINAL S12 .3/A /I 7'...,..-.._ / /49/931: • I