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Permit No. 2665 • • _, . CITY OF CHINO HILLS COMMUNITY DEVELOPMENT 2001 Grand Avenue APPLICATION FOR A BUILDING PERMIT AND A CERTIFICATE OF USE &OCCUPANCY Chino Hills, CA 91709 i//1O BUILDING j 29/ /��,� „ ,& J& CLEARED APPLICATION TYPE NO CO ADDRESS `L�,f�2/'J/��2 C E/ ,^ ci 6'1/ /r- - 3CO ) -D VWW� E ///liE�P1LLOWING WORK IS AUTHORIZED BY THIS PERMIT D /(! .B�g ,..rrSi /3 5f (�r RUCT ❑ PLUMB _ 0 MECH 0 ELECaT J �Y�" a . 37 TYPE OF PROJECTlEW 0 ALTER 0 ADDITION m � (0 OWNER V b c J ®!viEaS 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT PROJECT LOCATION SIZE ADDRESS / J 0 f j NJ / _ ) -co DESCRIPTION PROPERTY N I IN SO FEET CITYf ,/.))9nAiA ZIPIP17 (�s/\/ PH*I /3V/ ALJ 11 far \ . \� SSI, ARCHITECT rx ENGINEER LIC NO 2. .....„). ADDRESS 3 I I CITY ZIP PH REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION CONTRACTOR 00Tha rePL. LIC NO 3015'©(: \''A. ADDRESS T55 N iv ii--s�o A CITY C7/2-6-7N:)6-0 ZIP 9 1GL_l PH 2i1 ‘37_36K. _3f'? CITY BUSINESS LICENSE ...----"1 LICENSE NO EXPIRATION DATE ' LICENSED CONTRACTOR'S DECLARATION \N\ 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 is in full force and effect t License Class G I -1'06 License Number 0 1/-m "')...71.7---- (: -"/1/:>1/ � 1 Dates �4755' ���a y, r Contractorct �` - ADDRESS / / /5�i�>y 1v �yl�/1�r--14° ' %, %),\.1:..:r." CITY AND ZIP (9/ i ( l/114(25 PHONE 7/41-43, 3 G I0 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 the project _ - ❑ 1 am exempt under Sec B&PC for this reason Date INITIAL WORKERS'COMPENSATION DECLARATION S I hereby affirm that I have a certificate of consent to self insure,or a certtficate of Workers'/A/C�ompe sate , i del Insurance,or a certified copy thereof nL.�C�C.!/ COMPANY 7L 3 it.-- 41/4A-.: POLICY NO JC ` r` � /� GgOUP DIVISION TYPE 0 Certified copy is hereby furnished DATE EXPIRES /-11'— _A 0 Certified copy is filed with the city CITY VERIFIED _ C� VALUATIONS k:60 Date �� Cr* APPLICANT ��f� _ • _�! PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INEMANCE / I certify that in the performance of the work for which this permit is issued,I shall not employ any person in ELECTRICAL I STRUCTURAL/75" GGGfff"' (((sss/) any manner so as to become subject to the Workers'Compensation Laws of California //J 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 y this permit shall be deemed revoked MECHANICAL I ISSUANCE FEES.et)a/ 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 F NSPECTION PURPOSE ISSUANCE APPROVED I TOTAL PERMIT FEE Sgnaturrot Applicant lir Agent/ Date b?�%==_ C0,te- tip DATE OF ISS NCE PERMIT PERMIT(N�UMBER Print Applicant's/Agent's Name v r -�,( G ¢ �v(z S J Operator: DAWN Check #: 000021153 Date: 3/22/94 00 Receipt #: 0000824 CHECK $104.60 WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR • BUILDING ADDRESS LOT BLOCK TRACT BUILDING INSPECTIONS RECORD OWNER ADDRESS CITY ZIP PH PLUMBING DATE APPROVED/INSPR'S SIGNATURE GROUND SOIL/WATER P1 TOP OUT • P2 ' • SHOWER PAN P3 REMARKS SEWER P5 GAS TEST P6 FINAL PLUMBING P12 MECHANICAL DATE APPROVED/INSPR'S SIGNATURE UNDERGROUND FLOOR M1I ROUGH M2 FAU/AC M4 FINAL MECHANICAL M12 ELECTRICAL DATE APPROVED/INSPR'S SIGNATURE TEMP.CONSTN POWER E3 UNDERGROUND PVC-METAL-D B C El ROUGH WIRING RECEPT SPACING- SERVICE-CIRCUIT E2 FINAL ELECTRICAL E12 STRUCTURAL DATE APPROVED/INSPR'S SIGNATURE FOUNDATION'LOCATION S1 ✓" REINFORCED 0 UFER 0 SLAB REINFORCED ID MEMBRANE S3 FLOOR FRAME/INSUL S4 MASONRY S11 FIREPLACE S11 I 1 ROOF FRAMING ROOF SHEATHING S5 FRAMING S6 INSULATION SOUND ENERGY S7 LATH EXTERIOR S8 LATH INTERIOR/GYPBOARD S9 APPROVED/INSPR'S SIGNATURE DATE OF ISSUANCE PERMIT NUMBER BUILDING FINAL S12 •'>•'?1'1 • •