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Permit No. 3061 • • no. CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY 2001 Grand Avenue J Chino Hills, CA 91709 / aO 9-IL / '1 BUILDING CD ADDRESS / 903'41 /#e acV4/g V J PROPOSED USE � v APN JO �n •••/ OC f/I�•f ��`THE fLLOWING WORK IS AUTHORIZED BY THIS PERMIT LOT t BLOCK TRACTR (�(J� prSETRUCT 0 PLUMB ❑ MECH 0 ELECT 0 GRADING 0 9 ATYPE OF PERMIT 11;HI_W 0 ALTER 0 ADDITION MI APPLICANT l ID — 4r7il� s N �I✓✓11,, CO 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESSPROJE LOCATION ZE (easy/ /7� 4) L;Ni•,, /� aO y�,.Z,/_1 DESCRIPTION TI`ON/ �/� ( I PROPERTY N I INI SO FEET -� CITY (�JJf ZIPLg1/) �n 297-1/VV 1 LVAIr1.YJ I I aO 1a S �l OWNER — 2 Coate I I Han cfcci � �� ADDRESS LI/�'l!' Y 3I I CITY V ZIP PH 4I I ARCHITECT /4u JA7 filthiJ,E,E S LIC NCeA , ,�3 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS///D O //d a..IV 03 De - .....tca 0 NO STORIES NO DWELLING UNITS BEDROOMS CITY�iC r.•///2. 1'7`—/l,Bv'yW ZIP qA O J'- 7/7 H9 _O V/ 7 ROOF FLOOR EXT WALL INT WALL CONTRACTJR 1 ) f3 l / SO LIC NO Q I I I [C •---� c 5q .- C CEILING HEATING I FIREPLACE SI ADDRESS /7-"//C / METAL MASONRY 1�(I CITY ZIP PH 1 n SEWER I MIN DEPTH I S/F/100 I SIZE \ LICENSE NO / 7 a EXPIRATION DATE NSE/1- I 3O _9 U LICENSED CONTRACTORS 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 Business and Professions Code,and my lice nse is in full roe and effect Lioansa/C/lass , J _Lwansa Number 4 7�2 d-U, Date /� -10 - 9_r_ Contractor S A-m/- ADDRESS 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 O I as owner of the property,or my employees with wages as this r sole compensalion will do the work,and the structure is not intended or offered for sale O I as owner of th•property,am exclusively contracting with licensed contractors to construct the project ZONING I LAND USE O I am exempt under Sac B&PC for this reason I Data INITIAI SETBACKS I MODEL/PLAN WORKERS'COMPENSATION DECLARATION FY I SY I hereby affirm that I have a certificate of consent to self insure or a certificate of Workers Compensation Iunnce,ora certified copy thereof RY I SSV I COMPANY j r a POLICY NOC 9ek71‘363 rIs- GROUP DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES /1 `9 i �/ VALUATION a 1 Certified copy is filed with the city CITY VERIFIED '— ) �7,g/Dat• APPLICANT CCCJJJCCC ' PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE ///'''��] I certify that in performance of the work for which this permit is issued,I shall not employ any ELECTRICAL ala / /Vt I STRUCTURAL`/ i `_1•/� person in any manner so as to become subject to the Workers Compensation Law of California ^V Dat� APPLICANT PLUMBING I GRADING NOTICE TO APPLICANT If,after making this Certificate of Exemption,you should become `-��� 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 9a7•'�7 ISSUANCE FEES�t]�/ I CERTIFY THAT I HAVE READ T- ' APPLICATION AND STATE THAT THE ABOVE INFORMA- TION IS CORA I AGREE '• ••MPLY • THA_. ITY ORDINANCES AND STATE LAWS, GEO REVIEW PLAN CHECK //T;�S' / AND HEREB HORIZE- • SEN's'�IVE r' HIS CITY TO ENTER UPON THE ABOVE \UUl/// / MENTION.• -••PERTY •- SP--.S•O%•r-OSES `,''"" ' -die / / ISSUANCE APPROVED TOTAL PERMIT FEE Ip eture of Appllce or Agent x y Data (// 111)49 . 4 a, DAT OF ISSUANCE PERMIT NUMBER Pnnt App Kant a/Agent's Nis U / S9i 306) 1 FINANCE CODE G 1-71 Operator: VIRGINIA Check C: 000593037 Date: 6/30/94 00 Receipt t: f0�0011259 WHITE- FILE/GREEN- FINANCE/ YELLOW- OFFICE/PINK- OWNER CHECK GOLD-ASSESSOR/MANILA - INSPECTOR ',CONSTRUCTION LENDING AGEN• I HEREBY AFFIRM THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 3097, CIV C) 1 LENDER'S NAME LENDERS ADDRF9 9, a ` DIVISION OF INDUSTRIAL StA'VETY PERMIT CERTIFICATIONI'"� .LL THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRES A DIVISION OF INDUSTRIAL SAFETYIPERMITAS�A PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW '2-) , ,F t 4 U k ❑ I CERTIFY THAT NO EXCAVATION 5 FEET OR MORE FEET IN DEPTH,INTO WHICH A PERSON IS REQUIRED TO DESCEND,WILL BE MADE IN CONNECTION WITH WORK AUTHORIZED BY THIS PERMIT,AND THAT NO BUILDING,STRU TORE,SCAFFOLDING,FALSEWORK,OR DEMOLITION'QA DISMANTLING •� THEREOF WILL BE MORE THAN 36 FEET HIGH (X-Atis ` X t J ❑ AS OWNER/BUILDER I WILL NOT EMPLOY ANYONE TO DO WORK WHICH WOULD REQUIRE A PERMITFROM THE DIVISION OF INDUSTRIAL SAFETY,AS NOTED ABOVE UNLESS SUCH PERSON HAS A PERMIT FROM THAT DIVISION ` • - •--- 4, t DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER 5 , " • ,,.t, ' 1t '-.IN t I . _ I HAVE\READcTHE 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 d_- I t °f t 1 : I AJ•, ' %. CP, 1 \ _ c, 1 t —,, ,,,,•\ ;;•,- • 1} A , i • 1 \ ` l1 \ 1 ..s.. - CITY OF CHINO4LS r AAICATION FOR A BUILDING PERMIT AND a7r'e A CERTIFICATE OF USE & OCCUPANCY : COMMUNITY DEVELOPMENT "I 2001 Grand Avenue Chino Hills, CA 91709 /A 0 A IL I 1 Ise' //�I v .+L ADDRESS L ' —7 yA tg,1 -/r DA f PROPOSED USE g 07 AF APN l o� P� A�I�`'7 il O THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT > LOT /5.1.' }00 BLOCK TRACT/.ff("/rit S'STRUCT ❑ PLUMB 0 MECH 0 ELECT 0 GRADING 0 'IW 9 APPLICANT k 1 0e T) 1 —7,11 / TYPE OF PERMIT tGYNEW 0 ALTER 0 ADDITION CO / 1 11 ) n �y 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS,it i Al, ' .v(ii h "` ,yrs0 PROJECT SIZE DESCRIPTION I PROPEIRTY ONON I IN 50 FEET YSr CINE I-! 1' lirFll ZIP 4'f) .an / 73?- :7e92,eI, 1 L/��'144:..b 7C /r� Ui' I I ��.--y � r. +F- (- OWNER jft f . 2 1.r hGn(i I I /N "^"{ ADDRESS 4 IC/){I, I 4 3 CITY ZIP PH 4 I I ARCHITECT L, t .:Or/A/i i�/Cfi; LIC N9"r./) rCI REMARKS/SPECIAL CONDITIONS/PROJECTDESCRIPTION _� ADDRESS/4/?Q, f /1 1,170 0) 11/ ' 3 0 NO STORIES NO DWELLING UNITS BEDROOMS s ti J!/ y 7/117 �/ / y y I CIT' j/ 'Ofi91T J. ZIP€2((Q PH,1D- r , ROOF I FLOOR EXT WALL INT WALL CONTRACTOR k 1 .A /r' LIC NO - - n/ ADDRESS "^ .9I➢f� �' CEILING HEATING I LACE METALED MASONRY 1 CITY Q 7777/Iif ZIP PH SEWER MIN DEPTH S/F/100 SIZECITY BUSINESS w LICENSE NO /1 7 O EXPIRATION DATECENS E�1 }� r 9 L.../ I I I LICENSED CONTRACTOR 5 DECLARATION J 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 Business and Professions Code, and my license is in full force and effect License Class I"3 License Number t 7 2 I Q 1 Date r 30 - 9 r Contractor A111 r ADDRESS JIC 4 114 it CITY AND ZIP PHONE 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 tor sale O I as owner of the property am exclusively contracting with licensed contractors to construct the projectZONING I LAND USE O I am exempt under Sec B&PC for this reason I Date INITIAI SETBACKS ( MODEVPLAN WORKERI hereby affirm that have,certificate of consentnDECLARATIONN o self insure,FY I SV I r a certificate of Workers' Compensation I/nsurance,or a certified copy thereof a' RY I SSY A/ COMPANY e 7A/11 POLICY NO) ' `L 714063 0f ,- GROUP DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES q * y I ' ) Certis illed copyfiled with the city CITY VERIFIED VALUATION ^� .�. D at• APPLICANT �/ PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE I certify that in performance of the work for which this permit is personLI issued,I shall not employ any ELECTRICAL 1. I�! I STRUCTURAL/7 „UCTURAL�,('Y %�rj in anyas manner so to become subject to the Workers Comp ensation Law of California f r Date APPLICANT PLUMBING � & ”" I GRADING NOTICE TO APPLICANT It,alter 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 9(11 rj �� ISSUANCE FEES^`r/ www. I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA ; Lw / TION IS CORRECT I AGREE1TO COMPLY,WITH ALL-CITY ORDINANCES AND STATE LAWS GEO REVIEW PLAN CHECK ly-' 2 j AND HEREBY AUTHORIZE REPRESENTATIVES,OF THIS CITY TO ENTER UPON THE ABOVE 4V' MENTIONED PROPERTY FOR INSPECTION JJ,CRPOSES ..1-- / f _ 91 ISSUANCE APPROVED I TOT L PERMIT FEE / iiiLow Signature of Applicant or Ageelntp /` Date ,S. 94 1" f A Ail (` )� � DA 50/i��//SUANCE I PERMIT NUMBER& I 1� Lyf.� f C gal, !(/ /l ./ r lJ`,/): 3 Print Applicant s/Agents Name FINANCE CODE 6— U 4. WHITE- FILE/GREEN- FINANCE a rr - OFFICE/PINK- OWNER GOLD-ASSESSOR/MANILA - INSPECTOR , 1ONSTRUCTION LENDING AGENG� 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 ADDRFee DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRES A DIVISION OF INDUSTRIAL SAFETY PERMIT AS A PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW ❑ I CERTIFY THAT NO EXCAVATIONS 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 BUILDING,STRUCTURE,SCAFFOLDING,FALSEWORK,OR DEMOLITION OR DISMANTLING THEREOF,WILL BE MORE THAN 36 FEET HIGH O 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 OIS OIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY BUILDING INSPECTIONS RECORD DATE I INSPECTJy1 DATE c 1 INSPFTO)i Setback/Location b///4l7 ,o("-'77 Rough Plumbing I ,-,/04,7 I .l Temporary Power ' r I' r ` Shower Pan Test {CI'//e}7 I Foundation Reinforcing Steel / ,C171 , /f Stucco Mesh or Exterior Siding L11/, , L., , Excavation and Forms A ,141 °- IV-if Insulation 2T/ 7,f 7/ Slab Grade rr- , II •r_ ,3 Sewer J/4 , /�� 17,/:z9 Slab Ground Plumbing Soil 'c//j/9q "7/ Interceptor Ground Plumbing Water 1-1 o_B,lk *'\m.II> Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service /641(c 2' /Ls-- Underslab Gas bath-or Drywall Nailing 7(se G,�,l„Z� ' Fireplace Foundation Gas Line Air Test 9/2 /¢c" - ,414„c----- Joists and Girdersn Final Energy J Electrical Ground ,//j/A "7-"f41—'5`/ ."7 Y Final Plumbing 7 / /4f-- / ..--,7 Mid-Height Bond Beam p Final Heating/A C ,friLt2--- Al Airs 8-Foot Bond Beam Final Construction I.% Final Bond Beam Final On Site Improvements Fireplace Bond Beam ,� Final Off Site Improvements Roof Sheathing ed--er-N S /t I SL/ K-7d' Final Dedication Framing and Ventilation ' r', I/ . A Final Zoning Roof Covering , r I h Y n j' Final Electrical /le/l..-- -- - ,7,4- Rough Heating I ).-1/4‘,/ %/All7 Final Gas /°/ ,41.1---- Service and Ground 44j f, I/ Developer Fees Paid Rough Electrical /' V Fire Dept Approval Verified /p/¢p (fr e e ,g.1r-- Bonding Certificate of Occupancy /1 /z& /4 4 -4. //L,_— Over Head Electrical Fence Height Gates Heater Pool Drainpge „ - • A �. C • ., F • 7v A' !4/tP -N---4-- - /pi/ o" h _/o%t/(Y — 2<,Pos.e_ tOtl _ ...0./L--- SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDE LONG X DEPTH OF ROCK N W E S Inspector's Signature and Initials 16-- DATE OF ISSUANCE PERMIT NUMBER ����� y 1306t.