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Permit No. 2724 0 OP CITY OF CHINO HILLS COMMUNITY DEVELOPMENT 2001 Grand Avenue APPLICATION FOR A BUILDING PERMIT AND A CERTIFICATE OF USE &OCCUPANCY Chino 7Hills, CA 91709 BUILDINGADDRESS i `4 i1 ID 14.1:40(#17-1,41,42-:\iffy -Ky —Y CLEARED8/V/�/A►( APPLIC`A/TI/�O//N�TYPE/) NO CD �/ J /� / F 0 P I;07-41 7,..ATHE FjOLLOWING WORK IS AUTHORIZED BY THIS PERMIT D 'et< 4111105 Y IXTRUCT ❑ PLUMB ❑ MECH ❑ ELECT0 TYPE OF PROJECTNEW ❑ ALTER ❑ ADDITION m y� U) OWNER 7 �,� I' e //�� (n �/ Cr ,y- / I9'`� ❑ REPAIR ❑ CONVERT ❑ DEMO ❑ OCCUPANCY PMT - p ti / /� PROJECT LOCATION ON SIZE ADDRESS 7 7 rrj 4� . !i)pJ(�v I_ J �. 0 DESCRIPTION PROPERTY IN SQ FEET �\ CITY &..-, t J,')IN '1)'1. ZIP 7`4.%1(, '/_/D PH 73.7 j p ARCHITECT I I ENGINEER LIC NO 2 ADDRESS 3 I I CITY ZIP PH REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION CONTRACTOR LIC NO ADDRESS CITY ZIP PH V"��� CITY BUSINESS LICENSE ( „.._"--5,,c_.) . e,kII� LICENSE NO EXPIRATION DATA LICENSED CONTRACTOR'S DECLARATION 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 License Class_ License Number 61."--/- 4)/—j-7-7; V Date Contractor h. ADDRESc Z:44-0 A 4- CITY AND ZIP PHONE 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 1 ructure is not intended or offered for sale y 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 certificate of consent to self insure,or a certificate of Workers'Compensation Insurance,or ace died copy thereof COMPANY `_✓ POLICY NO GROUP DIVISION TYPE ❑Certified copy is hereby furnished DATE EXPIRES ' y�I,--6.:...47-,..."---.., /,y/y'/r ❑Caddie.copy"s tiled with the city CITY VERIFIED - L�+J,y�/ VALUATION f Date (. (4fi, APPLICANT d>t-7-/.,,�./'*.i' - - / 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 I STRUCTURAL &7 ,61 any manner so as to become subject to the Workers'Compensation Laws of California 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 1,.� this permit shall be deemed revoked MECHANICAL I 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 PLAN CHECK AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTIONED 11 PROPERTY FOR INSPECTION PURPOSES f I;; I,•,.� ISSUANCE�ANAPPROVED //y TOTAL PERMITITFEE �/' Sghgrurksr,xpplie5,N-Bre ei1T - Date I, / III DATE OF ISSUANCE' PERMIT NUMBER Print Apjikcant'slAgent's Name dt Operator: DAWN Check #: 000588203 Date: 4/04/94 00 Receipt #: 0000211 CHECK $66.20 WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR 0 0 • ,r BUILDING A4,/j/ 1, ` ADDRESS ((77//ff// I�!� j%/01.01748/61. �•_�� LOT /�G BLOCK :s�L/frJs� [[[[f��� 1�� BUILDING INSPECTIONS RECORD OWNER 846 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 /I°,'�Y' ,(O 'J FINAL PLUMBING P12 MECHANICAL DATE APPROVED/INSPR'S SIGNATURE UNDERGROUND FLOOR Mi ROUGH M2 FAU/AC MaI FINAL MECHANICAL M12 ELECTRICAL DATE APPROVED/INSPR'S SIGNATURE TEMP CONSTN POWER E3 UNDERGROUND - PVC-METAL-D B C Ei ROUGH WIRING RECEPT SPACING- SERVICE-CIRCUIT E2 FINAL ELECTRICAL E12 STRUCTURAL DATE APPROVED/INSPR'S SIGNATURE FOUNDATION LOCATION Si /i /' �( ,� REINFORCED ❑ UFER ❑ l 2J ‹.ci d, f1 y i / SLAB REINFORCED ID MEMBRANE ID S3 FLOOR FRAMEJINSUL S4 MASONRY Si1I FIREPLACE Sit ROOF FRAMING ROOF SHEATHING S5 FRAMING S6 INSULATION SOUND ENERGY S7 LATH EXTERIOR S8 LATH INTERIOR/GYPBOARD S9 I J APPROVED/INSPR'S SIGNATURE DATE OF ISSUANCE PERMIT NUMBER� ER BUILDING FINAL S12 2/7,//'7 - /`// �' ��� ,=___�/ 1