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Permit No. 2984 • • CITY OF CHINO HILLS COMMUNITY DEVELOPMENT 2001 Grand Avenue APPLICATION FOP A BUILDING PERMIT AND A CERTIFICATE OF USE &OCCUPANCY Chino Hills, CA 91709 BUILDING ADDRESS I q l JC _�1 f ll i��n 1(� ' \g CLEA BV �LICATION TYPE NO CO \J 1 IC _ 1 f �l VVVI/ le ' ) / C O APN ti oaLl — 3 a I — 0 LP THE FOLLOWING WORK IS AUTHORIZED BY TIS PERMIT 0 > LOT \ (�I BLOCK TRACT �2J fl!/ _'r ❑ � ❑ STRUCT, PLUMB ❑ MECH ELECT, 0 4 x J 33 TYPE OF PROJECT ❑ NEW ❑ ALTER 0 ADDITION m OWNER \,....A .L1 1�� r11 1n e s ❑ REPAIR CICONVERT ❑ DEMO CIOCCUPANCY PMT PROJECT LOCATION ON I SIZE ADDRESS 0 , r r ) 1 n Co I� S- 'e ZOO DESCRIPTION I PROPERTY IN SO FEET �n m_ - //''�� `1a9) ala- 1 � /! CITY lX3`fnYl (� ZIP 1 1 1 alJ 0 I`� / I ARCHITECT I I �(� ENGINEER LIC NO 2 ��` ADDRESS - 3 I I CITY ZIP PH 1 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION k Sery lce� -Io/C-(91 / \ CONTRACTOR�em ,`rcir`I 1 '4-i t' -v LC.N Sa'3s90 ADDRESS l', `7 a-U Ea sA_X 1{{{777 as 1 1::::6,r k 1,v_ . — �PJh1l. I �'U 1�32.� CITY 4Ano �'lei✓ k ZIP e1 a gO Le PH7�LI—60a0 -L . Z. CITY BUSINESS LICENSE NO 1 ( EXPIRATION DATF LICENSE I) I L?U . W q LICENSED CONTRACTOR'S DECLARATION / / / / I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000 of / e C// /67� / Division 3 of the Business an Professions Code,and my license is in full forceoand(effect `! /U License Class C-40c -0' License Number Sa ?.'.5l .S-I U( , Date 1p-9 -9 Contractor 6Yy.UOYIXC\I U 1 l1 1 l+V --- YU ADDRESS 0. 7 O :as+ vRv (VI Ca 1 Poi- -lc c- . CITY AND ZIP Avg( h...9t 1M Zo°�PHONc — 141 !LLq,-0O Qn 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, r and the structure is not intended or offered for sale /,/� /�/ /(p`/�j/J�/� ❑ I,as owner of the property,am exclusively contracting wdh licensed contractors to construct the protect //��� /. ' /e- "�"' "' ❑ 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 set(insure,or a certificate of Workers'Compensation1 Insurance,or a certified copy thereof CI fAA" COMPANY ` #Q+e Eu n a POLICY NO 30( 3 a5PY .GROUP DIVISION TYPE Certified copy is hereby furnished DATE EXPIRES ��// '�� „ 12 Certified copy is filed wdh the city ClCI ERIFIED A s•••• �/�— AL-t1ATION Date (LI — 61-9 APPLICA / `J 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'/^s;? STRUCTURAL• any manner so as to become subject to the Workers'Compensation Laws of California Date APPLICANT PLUMBING I GRADING NOTICE TO APPLICANT II,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 f'�f the permit shall be deemed revoked MECHAN CAL I ISSUANCE FEE4'� „ 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 PUR OSES///J///fn ISSUANCE APPROVE ITOTALPE RMIT FEE \'/-- �/V/l�X� < Q X XF Date p - �� -- r 9V Signal ,fen Applicant or Agent 1 ` )en ri P,i 7 Ta d P_,� DATE O[F�ISSUANCE PERMIT NUMBER f//� Print Applicant's/Agent's Name . j / • - //�/�iL... 10/1:1 I 6.1? ._ uir.A _ V.I.P. i•o'!@=1: i,s y+viOtn:l::,t% .,. Je:J.,'/ is/ tI CEijtc .1: OOLIO'lir ai,_L::, $90.irk 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 135 GAS TEST P6 FINAL PLUMBING P12 4 i'*T MECHANICAL DATE APPROVED/INSPR'S SIGNATURE UNDERGROUND FLOOR Ml I - -- 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 SI REINFORCED ❑ UFER ❑ SLAB REINFORCED MEMBRANE❑S3 FLOOR FRAME/INSUL. S4 MASONRY S11 I . FIREPLACE S11 ROOF FRAMING ROOF SHEATHING S5 • - FRAMING S6 INSULATION SOUND ENERGY S7 LATH EXTERIOR S8 LATH INTERIOR/GYPBOARD S9 APPROVED/INS PR'S SIGNATURE DATE OF ISSUANCE PERMIT NUMBER BUILDING FINAL • S12