Loading...
Permit No. 2402 CITY OF CHINO HILLS10 COMMUNITY DEVELOPMENT 2001 Grand Avenue APPLICATION FOR GRADING AND OTHER MISCELLANEOUS PERMITS Chino Hills, CA 91709 BUILDING ADDRESS , )1 Q,,,+ tl HN gi�Ir+" V e- o- CLEARED BY APPLICATION TYPE NO co C 44//)A APN �' 77„,14. r- 0 p ,� O'' "-7 Z f 11 / ' ' THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT 0 .5 / > LOT ,c._0044,94 BLOCK TRACT 136St ❑ STRUCT ❑ PLUMB ❑ MECH ❑ ELECT L(GRADING 8 33 I ❑ NEW ❑ ALTER ❑ ADDITION ❑ SUPERVISED GRADING - m Cube,be i_ret wi ' ❑ DUMP DEPOSIT REQUIRED w ADDRESS P ,0 t 1��,�1 4•A ! ,1,41_ zoo ❑ REPAIR ❑ CONVERT C] DEMO CUBIC YDS CITY 6,4,,,,,,s-,4_ zIP 9/7-2_0 PH 737 9Ltc9 DESCRIPTION OF WORK AND CONDITIONS OF APPROVAL I '`{�\ ARCHITECT /� ,' tk ENGINEER LIC NO ADDRESS - /g CITY ZIP PH. 4:21' CONTRACTOR ///)J/ ,Z,47&---..‹, LIC NO/,/'//� $5 ' // c f�C /%/(//- Z/>y /tet/// .t.k ADDRESS 27//!n A i /d 4- X 1i /i/ i�l� CITY / U�//ZP`� 66;J Xi LICENSE NO /7/9 EXPIRATION DATE LICENSECITY BUSINESS ///�;�`// - , - LICENSEDCONTRACTOR'SDECLARATIIOONN /(�/ \\ I hereby affirm that I am licensed,under provisions of Chapter 9(commencing with Section 7000 of Division 3 of the Business d Professions Code,and my licensec', is in full force and effect ` License Class License Number 6 7 --� ,J \-cQ Date .7.72..); Contractor ADDRESS q - `\v CITY AND ZIP PHONF 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 Date INITIAL WORKERS'COMPENSATION DECLARATION - I hereby affirm that I have a certdicate of consent to self insure,ora•certdicate of Workers'Compensation Insurance,or a certified copy thereof pa��t�/ �//�J COMPANY/7 y J POLICY NO[, /ee//%y✓�o�-7_, ❑Certified copy is hereby furnished DATE EXPIRES /- ertihed copy is filed with the city CITY VERIFIES A /�r VALUATION Date / /r/'�1/a'4 APPLICANT //A/ thr77/ ? 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 PLUMBING I GRADING 01:7512). 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 I ISSUANCE FEES.... .W - 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 L�i AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTIONED �� ❑ OJPERTY FFk ISINSPPEpioN PURPOSES V� -(41/20"1 "-- r..!). b 7l ISSUANCE APPROVED PERMIT FEE - Signature of Applicafntoror'Agent Date/ O /j///? ;2 [TOTAL i1� 0 '//�,,,�TtA -- 1 -SCIJ DATE OF,l�4SUANNC€L-jf///�//,7x/(:teli JP'ERMIT NUMBER , r Print Applicant's/Agent's Name /,'/ (/Gf /t 04/1' :: C r% - WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR , BUILDING ADDRESS 14.2.7W / i'f7 ���� LOT BLOCK TRACT , INSPECTIONS RECORD OWNER /��& 74/72z ? ADDRESS �y(r CITY ZIP PH SWIMMING POOL INSPECTIONS PLUMBING DATE APPROVED/INSPR'S • SIGNATURE • LOCATION/DIG SP1 REMARKS STEEUBONDING/PLUMBING TEST SP3 APPROVED TO GUNITE . SP3 ,4 j(,f 57 Z '7 1?- " UNDERGROUNG ELECTRIC SP2 J9 GAS TEST SP3 /dal /S� FENCE ENCLOSURE SP5 4 ,,�� FINAL SP12 i /i . . €116 Mir Mar GRADING INSPECTIONS �'� PLUMBING DATE APPROVED/INSPR'S • SIGNATURE . PRE GRADING MEETING GR1 TOE OF FILL GR2 E)(ICAVATION GR3 RET WALL FOOT GR4 MASONRY/FORMS GRS .3/z 3/ = ‘- DRAINAGE DRAINAGE DEVICES GR6 ROUGH GRADING& BUILDING RELEASE GR7 DATE OF ISSUANCE PERMIT NUMBER FINAL GR12 //O/9 :/•j I -94