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Permit No. 3059 I • • fl CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY 2001 Grand Avenue IllillailaillChino Hills, CA 91709 /eR O n /Q Lai r m B UpILDI NO / Li/w )a /4,c�tt V4 1e /k ' PROPOSED USE ADRESS ! �/ o /�1 / I `THVOLLOWING WORK IS AUTHORIZED BY THIS PERMIT y LOT /0 BLOCK TRAC),4 ri-i LT STRUCT 0 PLUUMB� ❑ MECH ❑ ELECT ❑ GRADING 0 /� ,r �� TYPE OF PERMIT IW�EW ❑ ALTER ❑ ADDITION 11 APPLICANT f/Jlti n / ,{.,yam 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT A ADDRESS//O N �/ �`d/dV AA 00 PROJECT DESCRIPTION I PROPERTY LOCATION N I IN SO FEET �///(�y AAA�i� /J it/e/il VI' SIZE G r clrvl A/(47I/] ZIP d/7'g,O PH7�37-0:20 i L�j-,�L]/1 t I IaY/0�la .Y OWNER '7N _ 2 Co I I 1 aO ..-..��'����{{{ F ADDRESS i44 G I 1 CITY ZIP PH 4I I ARCHITECT �"� ENGINEER `on ,rYIfIAI�II,0C �f LIC No „2583 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESSWooCil.14,6 at' 'a 3a •,/]/��" 7.3-t- NO STORIES NO DWELLING UNITS I BEDROOMS CITY NGL/ /rvs./7rs�'�'l7\/ ZIP q^f 66o /n^ 7 -OgIR ROOF FLOOR ERT WALL INT WALL1. CONTRAVVVCTTO�VRII I�.(/�Vu DE At Fs_ LIC NO I I I ADDRESS ,-"'- -Ain j _i CEILING HEATING I ALFIREPLACEMASONRY METAL MASONRY rg.7 CITY ZIP PH / SEWER IMIN DEPTH S/F/100 SIZE CITY BUSINESS LICENSE4 NSSLICENSE/J3/ _%Y I '^ a-- LICENSE NO ,/ ^ g 7 EXPIRATION DATE LICENSED CONTRACTORS DECLARATION / CUBIC YARDS EXCAVATION FILL OVER EXCAVATION I hereby affirm that I am licensed under provisions of Chapter B(commencing with Section 7000 of Division 3 of theBB sines and Professions Code,and my license is in 1 force and effect License Clan ti/ License Number 479 1 1 Date 6-3o - q) Contractor 5y9--n ADDRESS — <4-I91' — CITY AND ZIP PHONE OWNER BUILDING DECLARATION I herby affirm that I am exempt from the Contractors 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,end the structure is not intended or offered for sale O I as owner of the property,em exclusively contracting with licensed contractors to construct the prolecl ZONING I LAND USE O I am exempt under Sec BAPC for this reason I Date INITIAL SETBACKS I MODEL/PLAN WORKERS'COMPENSATION DECLARATION FY I SY I hereby affirm that I have a cercifloats of consent to self insure,or a certificate of Workers Compensation Insurance,ore certified copy thereof //��--��//�� RY SSY COMPANY 4,677L/4 POLICY N00 7/634 353-5 GROUP DIVISION TYPE 0v Certified copy is hereby furnished DATE EXPIRES Y-73 �M7�yn JCC eddied copy is filed with the city CITY VERIFIED / VALUATION ' _l u/ / /U --- /Dale APPLICANT CJS II b PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE I certify that in performance of the work for which this permit a issued,I shall not employ any ELECTRICALa�'' 1 I ` I STRUCTURA? n r/Li person in any manner so as to become subject to the Workers'Compensation Law of California �L`/ U /p7� Dale APPLICANT PLUMBING�sz I GRADING NOTICE TO APPLICANT II after making this Certificate of Exemption,you should become C.J�.� subject to the Worker. Compensation provisions of the Labor Code you must forthwith comply with such provisions or this permit shall be deemed revoked MECHANICAL 9k7 ,� O ISSUANCE FEES�I9�- I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA- TION IS CORRECT I AGREE of OM- Y WIT. LL CITY ORDINANCES AND STATE LAWS, GEO REVIEW I PLAN CHECKA ra 7 AND HEREBY HORIZE ' E- AT eF THIS CITY TO ENTER UPON THE ABOVE M TIONEe f'OPERTYTPOSES II, . ISSUANCE APPROVEDTOTAL PERMIT FEE I w .4= -s7 l (4414* 14-a, FA!-Sig run of Applic t or Arent Date /nN / i �a/ / DATE�ISSUANCE 30111-+ ,(� I PERMIT NUMBER r/Print Applicant s/Ageott''s�sNN_amLeU•• ✓✓ �'�” FINANCE CODE cI-1- Operator: VIRSINIA Check II: 000593037 Date: 6/30/94 00 Receipt $: 0001253 WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK-OWNER GCI( 51644,42 GOLD-ASSESSOR/MANILA - INSPECTOR r ` CONSTRUCTION LENDING AGEN• EBY AFFIRM THAT THERE ISA CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED RF� 3097 CIV C) ER'S NAMF LENDER'S AVDSe- t. 1.' DIVISION OF 16DUSTRIALSAFETY PERFMIT CERTIFICATION , THE CALIFORNIA HEALTH AND SAFETY,CODE REQUIRES A DIVISION OF-IND TRIAL A E P 4 AS IL-..1_, UTO ERS lies: L 0, tc,, 4:74, AS IL—.EOUISITE TO P`ER'MIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW \A \ \ r. 1 k )\ C I CERTIFY THAT NO EXCAVATION 5 FEET OR MORE FEET IN DEPTH,INTO WHICH APERSON IS REQUIRED TO DESCEND,WILL BE MADE IN CONNECTION WITH WORK AUTHORIZED BY THIS PERMIT,AND THAT NO BUILDU{,STRUCTURE,SCAFFOLDING,FALSEWORK,OR DEMOLITION OR DISMANTLING THEREOF,WILL BE MORE THAN 36 FEET HIGH (1\-- `` FF\\.• • C AS OWNER/BUILDER I WILL NOT EMPLOY ANYONE TO DO WORK WHICH WOULD REQUIRE A PERMIT FROM THE DIVISION OF INDUSTRIAL SAFETY,AS NOTED ABOVE UNLESS SUCH PERSON HAS A PERMIT FROM THAT DIVISION 1 \�,- \ t DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER t ' ` ± , '. I HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK:APPLIED FOR ON THIS PERMIT 015 CIS NOT, SUBJECT TO THE _ APPLICABLE-REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY \. ' . 1. 51, •\'' \ ,. 4 I 1 -I . 1 \\1 • . \- C s r --.._ 1 _ -"N. __ i I I— I • \ - , , • \I — N '• t' ' I , , .9') 1.3I,d I' ,%, i , ' i - 0 �._ •N CITY OF CHINO HILLS A KATION FOR A BUILDING PERMIT AND 'r<< COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY 11 •~ 2001 Grand Avenue Chum Hills, CA 91709 / el O A /R DINNk BUILDING ( ,y�, ��nl L PROPOSED USE- CO ADDRESS ///�I /Iii r 4� /4 -Adi)l7EIR/710/ff , cl r APN /Q 1/ % I/' •dy / / �M Z THEJOLLOWING WORK IS AUTHORIZED BY THIS PERMIT D LOT in BLOCK TRAC% `c/_/n ESSTRUCT 0 PLUMB 0 ❑ MECH ❑ ELECT ❑ GRADING 0 �1 A'YWfI � // v /n TYPE OF PERMIT IIYNEW 0 ALTER 0 ADDITION S APPLICANT t 1 c 6•/105 // 1 d (,r 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS//0 / - 1/ r�/G/��I 'f,f � PROJECT LOCATION ON SIZE //'J y 7 ��// DES/ICRIIPT'IIOO�Ni, // I PROPERTY I IN SO FEET/� CITY! e4.Cm/ aP f/flO �PH 737 el.In 1 W ✓n#/e- I I 920 4g. OWNER 2) �, rI l�W e I I 110-2'0) ADDRESS —r,>.... 3 CITY ZIP PH - I I ARCHITEC // 4 ENGINEER fl1L;; 7likl / ilk 1` Y� LIC NOt L/-c r 3 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION -55 ADDRESS WO te404 .k9 at --Sri 7o NO STORIES NO DWELLING UNITS BEDROOMS r j1� j� ( ^ 7 44 {I CITYIV6rllrx`jf tj DP g;IFC 7/P 7Y �..C'J /R �-,^ ROOF I FLOOR EXT WALL INT WALL CONTRACTOR I 1 j Cif t / ill C 5 LIC NO , C ^'„!E! CEILING HEATING FIREPLACE S AGGRESS r fT /! ... I METAL MASONRY �y CITY /�„ ^ EXPIRATION BUSINESS LICENSE /.9 j� y(�/1' SEWER I MIN DEPTH I S/F/100 I SIZE r{", LICENSE NO I 7 N• 7 V LICENSED CONTRACTOR'S DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000 of Division 3 of the Busineai and Professions Code, and my license is in full force and effect License Class t.) License Number 47 J 2.5rt r Date f s"` }� C. Contractor 'SAV' e. ADDRESS <A r1/F CITY AND ZIP PHONF OWNER BUILDING DECLARATION I hereby affirm that I am exempt from the Contractor s License Lew 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 properly am exclusively contracting with licensed contractors to construct ZONING I LAND USE the project 0 I am exempt under Sec B&PC for this reason I Date INITIAI SETBACKS I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY I SY I hereby affirm that I have a certificate of consent to self insure,ora certificate of Workers' Compensation Insurance,urcor a certified copy thereof y y}`� RY SSY IF COMPANY 4 t r'/•A POLICY NOr•� 147/63L4?,$S GROUP DIVISION TYPE -.Y is j 0 Certified copyhereby furnished DATE EXPIRES /- 5 � t VALUATION 1 ty l /) — rOrn Cadis ied copyfiled with the city CITY VERIFIED J /O Date APPLICANT PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE f I certify that in performance of the work for which this permit is issued,I shall not employ any ELECTRICAL 7 iI STRUCTURAL/! -/D )Li.1 / person in any manner so as to become subject to the Workers'Compensation Law of California !! s� Date APPLICANT PLUMBING 5& 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 `ky '� I n with such provisions or this permit shall be deemed revoked MECHANICAL r+/- • ISSUANCE FEES I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA I / TION IS CORRECT I AGREE]TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS, GEO REVIEW PLAN CHECK/. --2 �J AND HEREBYAUTHORIZEREPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE F� / MENTIONED•PROPERTY FOR INSPECTION PURPOSES te `- /yam e'' - / ISSUANCE APPROVED TOTAL PERMIT FEE /f I y i t///A. V I / '/414 1#a. Signature of Applicant or Agent Date A DATE f!� la —i: ErOF ISS ANCE PERMIT NUMBER �AO ,' lam, �l i:�c f/ we s (o I�3 044 ate 9 Print Applicant s/Agent•Name FINANCE CODE WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK- OWNER , GOLD-ASSESSOR/MANILA - INSPECTOR CONSTRUCTION LENDING AGENC4 I HEREBY AFFIRM THAT THERE ISA CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 3097,CIV C) LENDER'S NAME LENDER'S ADDRFcc DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRESA DIVISION OF INDUSTRIAL SAFETY PERMIT AS A PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW ❑ I CERTIFY THAT NO EXCAVATION 5 FEET OR MORE FEET IN DEPTH,INTO WHICH A PERSON ISREQUIRED TO DESCEND,WILL BE MADE IN CONNECTION WITH WORK AUTHORIZED BY THIS PERMIT,AND THAT NO BUILDING,STRUCTURE,SCAFFOLDING,FALSEWORK,OR DEMOLITION OR DISMANTLING THEREOF,WILL BE MORE THAN 36 FEET HIGH 0 AS OWNER/BUILDER I WILL NOT EMPLOY ANYONE TO DO WORK WHICH WOULD REQUIRE A PERMIT FROM THE DIVISION OF INDUSTRIAL SAFETY,AS NOTED ABOVE UNLESS SUCH PERSON HAS A PERMIT FROM THAT DIVISION DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER • I HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT 015 ❑IS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY BUILDING INSPECTIONS RECORD I pA)TE INS, CNR DATE / j INSPECTDR Setback/Location 17/t/5 V 4 {' Rough Plumbing -, SL/' /-, it------- Temporary Power I ', - Shower Pan Test /,4.2.- .% Foundation Reinforcing Steel I ,_qfri----- 7/ Stucco Mesh or Exterior Siding _ Excavation and Forms VV /J.-,bb' Insulation 5S/Z-47/V`( 1, //'.' ----) Slab Grade , ( I v Sewer 47// / Sc/ •Ar2'f— Ground Plumbing Soil 17/j/g c/ (-77 ' Interceptor ? Ground Plumbing Water I-__b L-q(s, N=--. .) Septic Tank Underslab Ducts I Leach Line or Seep Pit Underslab Conduit Water Service Underslab Gas Lath or Drywall Nailing $/?i/�Q.,.9' Fireplace Foundation Gas Line Air Test 7/LG/057 2.l - Joists and Girders _ Final Energy ,�/,/ Electrical Ground L&4,- —2-_(cf-G/y .<<—i177- Final Plumbing /p 1V' 'f�i.," Mid-Height Bond Beaml) Final Heating/A C /If)Y //r� 8-Foot Bond Beam Final Construction Final Bond Beam Final On Site Improvements Fireplace Bond Beam „ Final Off Site Improvements Roof Sheathing'j-SjCoc-., a raj`/ r71"- Final Dedication _ Framing and Ventilation ,J /1 A /I Final Zoning . M i"r J_// Roof Covering `1 f , ,'_ y/ Final Electrical ,/I V' 4j{ Rough Heating n 91:/ CK V Final Gas Service and Ground b • V Developer Fees Paid Rough Electrical / f/ Fire Dept Approval Verified ///4/9 y -11.--- Bonding Certificate of Occupancy /,/it P9'T a•�/_----- Over Head Electrical Fence Height Gates Heater Pool Drainage /D/ho%s - .t'eZ tfSa--- L5-/ Ty.!:c /_i/ / SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDF LONG X DEPTH OF ROCK N W E S Inspector's Signature and Initials IDDATE T ISSU�NCE PERMIT NUMBER -.