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Permit No. 3063 0 0 CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND _-2,r^y COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY 1::::-..:t-.7.•`"I • 2001 Grand Avenue Chino Hills, CA 91709 S _/Jo A /` ADDRESS 7 /s � 1k,_ F BUILDING ' /1 rj ��/I� a ^ PROPOSED USE 03C O APN /04'41 3 , / `� � THEJOLLOWING WORK IS AUTHORIZED BY THIS PERMIT sp LOT 9 BLOCK TRACTl.36s/�r-��UCT 0 PLUMB 0 MECH 0 ELECT 0 GRADING Cl ni ,/� / TYPE OF PERMIT ClaNE /C 0 ALTER 0 ADDITION m APPLICANT '/r //�i /4 GG y ///// I✓I Ill/ !/J ,/,, 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT N ADDRESS// Iv/r /, A/w�//f�-*-,900 PROJECT LOCATION ON S1ZE //h/�� �ZI Lv Tri T/ v DESCRIPTION O )a I PROPERTY I 119(16, CITV�n,Qon�A /J Ar�P�rg17� y9 �12-efi� , /fit—W �^y /`` � OWNER �•i K///.� 2 llINoLa I I -1a V �� ADDRESS I I 3 -13.0 CITY DP PH I 4 ARCHITECT// L ENOINEERJr�`��7 ��,� f LIC Ny(lo/3��3 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS'9t/OO ,•4p'vj2 vs / // �1 ?T NO STORIES NO DWELLING UNITS BEDROOMS CIT`(I�/r�49c7 ,art'/ DP 4✓FoJIo 0�7�V���,� -O�/� ROOF FLOOR it EXT WALL INT WALL CONTRACT&R lint � ✓/ ,/ LIC NO I I I ADDRESS �/LMg - CEILING HEATING I FIREPLACE �r//������ METAL MASONRY CITY ZIP PH SEWER IMIN DEPTHI S/F/700 SIZE CENSEy 10,- i/ ILICENSE NOJp 7 EXPIRATION DATE - LICENSED CONTRACTOR'S DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION I hereby affirm that I am bcenaad under provisions of Chapter 9(commencing with Section 7000 of Division 3 of the By[►Jreefs end Profession*Code,and my license'ynl 5 Inlull lfforce and effect License Class ♦ 1 Licenv Number/4 7 f% A f / _ Dab 6-30 -" Contractor •�>9nC ADDRESS 4A'YNIC CITY AND ZIP PHONF 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 for sale O I as owner of the property am exclusively contracting with licensed contractors to construct the project ZONING I LAND USE O I am exempt under Sec BAPC for this reason I Date INITIA' SETBACKS I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY I SV I I hereby affirm that I have a certificate of consent to self insure,or a certificate of Workers Compensation suurnce,ora certified copy thereof RY I SSVI 7 COMPANY , /70A POLICY NOD 70((-2/‘ 31i 3555- GROUP DIVISION TYPE O Caddied copy is hereby furnished DATE EXPIRES 4'9 3' VALUATION 11 k--7 I Certified copy is filed with the city CITY VERIFIED Date APPLICANT PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION is INSURANCE 111 I`y--� I certify that in performance of the work for which this permitissued,I shall not employ any ELECTRICAL/ ' I &O I STRUCTURALSv / I v0 9 person in any manner sot to become subject to the Workers Compensation Law of California v1 O at^ APPLICANT PLUMBING ""1aa � I GRADING O� NOTICE TO APPLICANT If, alto 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 shell be deemed revoked MECHANICAL ci tel I`� ISSUANCE FEESa9 !CERTIFY THAT I HAVE REAe HIS APPLICATIO AND STATE THAT THE ABOVE INFORMA J i TION IS CORREC •ACRE- • CO Y W L CITY ORDINANCES AND STATE LAWS, GEO REVIEW I PLAN CHECK / o r7 a' AND HEREBY ORIZ- R TA OF THIS CITY TO ENTER UPON THE ABOVE ( • / MENTIONEe.- PER • e I CT URPOSES S ' S ' 9,6 ISSUANCE APPROVED TOTAL PERMIT FEE Sig elute of Applic nt or Agent//n// // Dale • 575171& I ✓ r / (Jfw / � DATE OF ISSUANCE� I PERMIT '� C vyy��ttt��/ , Oc�1 flil4>•/ 7�Nyrme, k//.�/� 3 t7 Pnnt Applicant's/Agent's Name / FINANCE CODE Dperater: VIRGINIA Check t: 000593037 Date: 6/30/95 00 Receipt 4: 0001252 WHITE• FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK-OWNER CHEM $19,21 / GOLD-ASSESSOR/MANILA -INSPECTOR - •ONSTRUCTION LENDING AGEN• 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 ADDRFt a\ DIVISION OF INDUSTRIAL SAr6TY PEIrR,M, IT CERTIFICATION 1 1 LC tier, ib��.i �', - THECALIFORNIAHEALTHANDSAFETYCODEREQUIRESADIVISIONOFIINATRIAL'SAF PERMIT AS A PREREQUISITE T PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW r J , \ F ?4 3\ ❑ 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,STRU TORE,SCAFFOLDING,FALSEWORK,OR DEMOLITION OR DISMANTLING THEREOF,WILL BE MORE THAN 36 FEET HIGH t' \t Jc` 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 .11t`t I HAVE,READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT DIS ❑IS NOT SUBJECT TO THE __ APPLICABLE REQUIREMENTS OF THE HEALTH AND'SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY 1 , • \' •„ \ . 1 , 1 \ ` • — , • - f ' • • • , \ N • �‘:‘� _ t - • ,V • [L , Ih'+•- ,Wtt ea a.,refs. -• •. ra.,,L 4 r •Ea.-kW:42 r--:' .Y iNtsrk•Ra..' yr-7'rv+r-,- V t 415 CITY OF CHINO A (CATION FOR A BUILDING PERMIT AND .'s`' COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY -`I 2001 Grand Avenue f ,4,,„,,,,,,„,,,,,, Cho Hills, CA 91709 //t) / L. �. BUILDINS 19 t/ /i�� E.a v4/ Aa It•� PROPOSEDU`SE- I P ff Ijll/Sgj/ �//j CF CO ADDRESS �/ _ / `/I r� O APN /044,A lit / ! ~ C THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT D' �- a LOT BLOCK TRACT(-,/ 2/Jg711y�'• L-r'STRUCT 0 PLUMB 0 MECH 0 ELECT 0 GRADING is 7(Q=( /7 C n • TYPE OF PERMIT U.NE ! 0ALTER 0ADDITION m APPLICANT !/Q !{tip1Cl Co cn 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT PROJECT LOCATION ADDR{/E'SS]/`/�/�} tj�U• //tm(tv'��v ir ��} 9 �/// DESCRIPTIIONN/�Q, /JI PROPERTY N I SIZEN SOS/jFEET vi CITY( etOM) ZIP 4/)J0 fPH 71747 )0 1 AiYT�//l'C�I I I '/ O ._ OWNER <4 fils ....- 2 Idoc I 11 D ADDRESS I I 3 CITY ZIP PH 4 I I ARCHITECT ENGINEERnt/F/7btX f/J,,{t f LIC NO4n,4 1 t 3 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS I 141p riliNO STORIES NO DWELLING UNITS BEDROOMS CI`,VEMJ L$i K r ZIP 4? 110 7/PH7)6 -og`Or ROOFWALL INT WALL- C' CONTRACTOR 1 /n 717ff LIC NO ! d I FLOOR EXT- II t" ADDRESSADDRESS ."...17/14/7/R: "...17/<j}�/7I . . CEILING HEATING I FIREPLACE/ METAL MASONRY . SEWER I MIN DEPTH I S/F/100 I SIZE CITY r/ 7 7 ECITY BUSINESS XPIRATION DATE PH 1 ib C ENSE((J�• *7^• (�/LI LICENSE NO 7V /7 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 Business and Professions Code,and my license is in full force and effect License/Glee- / License Number 47 - -w /1 L a!Date - 3D 9.+' Contraactor/ ,t'S4IV ADDRESS ""+ A 1n n CITY AND ZIP PHONF 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,end the structure is not intended or offered for sale O I as owner of the property am exclusively contracting with licensed contractors to construct the project ZONING I LAND USE O I am exempt under Sec BIPC to this reason I Oat., INITIAI SETBACKS I MODEUPLAN WORKERS'COMPENSATION DECLARATION FY I SY I I hereby affirm that I have a certificate of consent to self insure,ora certificate of Workers' Compensation.I{Insur�a)nnce or•certified copy thereof }�} f/�7/ �j/3-555 �r RY SSV COMPANY •/r `�/ POLICY NO•y 1,'J)r ll���••'5 JN c GROUP DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES F/-V /�A VALUATION 11'`i C 3 1 _ CB Certified copy is filed with the city CITY VERIFIED r C / Date APPLICANT 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 ' I L !0 I STRUCTURAL r'� in f person in any manner so as to become subject to the Workers'Compensation Law of California J V Dal., APPLICANT PLUMBING C`\ -+ I GRADING NOTICE TO APPLICANT If,alter making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must forthwith comply W}/ 1 with such provisions or this permit shall be deemed revoked MECHANICAL I v 1 c f ISSUANCE FEES... % seeti I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA- TION IS CORRECT'PAGREE'TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS GEO REVIEW I PLAN CHECK / t M f 1 AND HEREBY AUTHORIZErREPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE i r t%I Ck MENTIONEDjPROPERTY'FOR INSPECTION PURPOSES /C-72 1-1,•e / J� c, ' 2�/ ISSUANCE APPROVED TOTAL PERMIT FEE /1 Signal saes-of Applicant or Agent +� Lt9l Date / cc g•& 1 / DATE OF ISSUANCE PERMIT M ER .--a ii Print Applicant s/Agents Name 111FINANCE CODE �� WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK- OWNER y GOLD-ASSESSOR/MANILA - INSPECTOR CONSTRUCTION LENDING AGENGli 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) LENDER'S NAME LENDER'S ADDRFcc 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 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 BUILDING,STRUCTURE,SCAFFOLDING,FALSEWORK,OR DEMOLITION OR DISMANTLING THEREOF,WILL BE MORE THAN 30 FEET HIGH ❑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 ❑IS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY BUILDING INSPECTIONS RECORD DAJE IINSPECTAR I DAT I INSPECTOR Setback/Location 771/ 1,1-7' Rough Plumbing I0`/ 4Gfy/ L /' c Temporary Power I I ' Shower Pan Test lei/474 C/ I Ki_/1-,T— Foundahon Reinforcing Steel gq .1 4 n Stucco Mesh or Exterior Siding Ic- 2,1 a/ 4,----2,4 U _ Excavation and Forms n rc i- I YenY IvInsulation c/77y�L7 I X7 Slab Grade lex _ I'I)j /J Sewer r7/, /l-ja% _, 1/Y Ground Plumbing Soil r2/(/ C c/ 14 ?/' Interceptor ' - . ' r Ground Plumbing Water '_Q _O' I\..: � Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service Underslab Gas Lath or Drywall Nailing 8/ ,/,cam .��„z..----- Fireplace Foundation Gas Line Air Test fr/Z,1/c r c-/2 a. Joists and Girders , „ Final Energy j Electrical Ground tart --(1(._4 4 K'7, Final Plumbing / /5c---- / -o--- Mid-Height Bond Beal Final Heating/A C } ,fil1� 7) r 8-Foot Bond Beam Final Construction Final Bond Beam Final On Site Improvements Fireplace Bond BeamFinal Off Site Improvements Roof Sheathing.},z$(ty-- r-41-fj c' 1C�7//3`i Final Dedication Framing and Ventilation --gna 1, V�G.7---V Final Zoning Roof CoveringI Final Electrical /0//2.,M1 / � Rough Heating cgl/f�4(j I , / Final Gas to /j2-4.4/ - ,t __ Service and Ground ej//Gl%fit% I de/L75" j Developer Fees Paid / , Rough Electrical If/jg/ r-/ C2,-/,‘,5-- -I Fire Dept Approval Verified 1/0/,,,jai.- ,d,,. ,77----____ Bonding 87(4/41/ /'4,40–S—I Certificate of Occupancy Over Head Electrical Fence Height I Gates I Heater I Pool Drainage viz/ /.i — e o «G. — -l/ 5 SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDF LONG X DEPTH OF ROCK N W E S Inspector's Signature and Initials q DATE OF ISSUTNNC(E� PERMIT NUMBER jl 1 3��3 1