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Permit No. 2960 CITY OF CHINO HILLS dil S (1—:-.1 COMMUNITY DEVELOPMENT 2001 Grand Avenue APPLICATION FOP A BUILDING PERMIT AND A CERTIFICATE OF USE&OCCUPANCY Chino Hills, CA 91709 BUILDING CLEARED BY APPLICATION TYPE NO CO ADDRESS ecc � �I�-fa ;�her�c� (� �� / // F 1 APN 1 D a 44— 3 1 1_ 6 a TIJE FOLLOWING WORK IS AUTHORIZED BY THJ PERMIT D LOT Cl / BLOCK O� TRACT3�`� 1—,S �tiRUCT ❑ PLUMB ❑ MECH ELECT 0 J3 ` 1 TYPE OF PROJECT ❑ NEW ❑ ALTER ❑ ADDITION m OWNER U 1\ C )4orn c s W �J f1 __�`IIJJ � ❑ REPAIR ❑ CONVERT ❑ DEMO ❑ OCCUPANCY PMT ADDRESS PROJECT LOCATION ON SIZE 1 1 O N �''l� C�1 `�� , O/� DESCRIPTION PROPERTY I IN SO,FEET j\\"...... CITY C.Q`C0�(1 CL ZIP q I�0(1 ��"qa9 47o►� I I S vv 1. `' st ARCHITECTI I \. N ENGINEER LIC NO, 2 ADDRESS 9. I I '� CITY ZIP PH REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION . : CONTRACTOR rh-POYG'�U U4-i i I1 -�rvLIC NOsa 359 \„,,,. '-, f7 , /y�� }j�� /I/ -- Tem Po We'_12 Pc L,s t ADDRESS 1r2© Ea S4 U ACICLI !a/t!\ 1)Y' \ Ci {�/�v/ �i►y)t ' �� i , / 1�2a�hei-vale _ t',r • CIN �haIle.10 ZIP / a d 6 (0 PH�(7�7 020 Lo-i- i Sit LICENSE NOI ID -I EXPIRATIONITY BUSINESS UI DATE LICENSE Ci /- 'O/GY A-PN- I C3 a y - 3 )1 — C z4 • LICENSED CONTRACTORS 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 L.0.1-'1- la — 1914-01-0 �ea:1 her-Va l'ir b r u� Lnse Class_ C-to/c ( ) License Number s a 5 9 Lo A-p N - )o y-- 3 i i - o. Date LP-(p'9 / Contractor 1 J , Y� (-A-1-1'I f -hi ...__. Y V J�'s C� Q ADDRESS ;):7 n 0-1 S� f tkaa I l ro,k ' 1:)4 (is\ CITY AND ZIP PHONE LAt 1(I - I L/176 -I ea 4-1ie Va le 1)r. OWNER-BUILDING DECLARATION A /-- {' ^�3r I hereby affirm that I am exempt from the Contractor's License Law for the following reason IV' 1 0 a l-3 )-C) y ❑ 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 WORKE RS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure,or a certificate of Workers'Compensation Insurance,or a certified copy thereof I COMPANY SA-0-1--e FurtrJ POLICY NO 30(x) -9 /3-.D S0 - GROUP DIVISION TYPE ❑ Certified copy is hereby furnished DATE EXPIRES //-1' /)`rJ Certified copy is filed withyythe city CITY VERIFIED I1) —yam VALUATION Date Co'ip-`fit� Li APPLICANIC*4/VISI - .e, PERMIT FEES - CERTIFICATE OF EXEMPTION FROM WORKERS'` OMPENSATION INSURANCE I certify that in the performance of the work for which this perrrxt is issued,I shall not employ any person in ELECTRICAL //l /� I STRUCTURAL any manner so as to become subject to the Workers'Compensation Laws of California L 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 this permit shall be deemed revoked MECHANICAL I ISSUANCE FEESi4 6 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 PROPERTY FOR INSPECTION PURPOSES ISSUANCE APPROV 9 TOTAL PERMIT FEE p _A,iLP — lam -9y �.42,._ .: :::: -,.... 6.----- . Signature l Applicant or gent /I Date /� (.J DATE FIS UANCE PERMIT NU BER �PvsName 11 `Ql�e\/r so Applicant's/Agerit's Name I / L-�/ 4 �` Operator: VIRGINIA Cheek t#: 000002100 Date: 6/06/94 00 Receipt It 0000256 CHECK $225,00 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 M1 ROUGH M2 l l FAU/AC Mal l l FINAL MECHANICAL M12 ELECTRICAL DATE APPROVED/INSPR'S SIGNATURE TEMP.CONSTN POWER E3 UNDERGROUND PVC-METAL-D B C El ROUGH WIRING RECEPT.SPACING- //414//9 "7444 SERVICE-CIRCUIT E2 0 FINAL ELECTRICAL E12 6//x//,!',41 „i�:, i'/��.��'� STRUCTURAL DATE APPROVED/INSPR'S SIGNATURE ------- FOUNDATION LOCATION 51 REINFORCED ❑ UFER ❑ SLAB REINFORCEDO MEMBRANE S3 FLOOR FRAME/INSUL S4 MASONRY S11 - FIREPLACE Si 1 ROOF FRAMING • ROOF SHEATHING S5 FRAMING S6 l l INSULATION SOUND ENERGY S7 LATH EXTERIOR S8 LATH INTERIOR/GYPBOARD- S9 APPROVED/INSPR'S SIGNATURE DATE OF ISSUANCE PERMIT NUMBER BUILDING FINAL S12