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Permit No. 3067 Il 0 0 M ,N CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND es„ COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY -'r. 2001 Grand Avenue �t /1 Chino Hills, CA 91709 /3 o 6 /'r t7...._ . BUILDING ADDRESS ' J y� Mom", /Air PROPOSED USE ^ F L aa'/// /y cc,/ FR 0 APN /ba f 7// v� Z aTH LOWING WORK IS AUTHORIZED BY THIS PERMIT y LOT \( BLOCK TRACT��/ � �fJ STRUCT 0 PLUMB ❑ MECH ❑ ELECT ❑ GRADING 0 �) IY� - // DJ TYPE OF PERMIT F3'NEW 0 ALTER 0 ADDITION m APPLICANT 1 1 De GAS ccri o R/.1/ TT�/NVV ��'��,��„( 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS//f) /I/ Ne�/Al ' PROJECT LOCATION ON SIZE Iv I DESCRIPTION PROPERTY I IN SO FEET CITYI n/v-'/V/-T ZIP I% 710 ?P / ?7-717r%0 I LSI liAPGF2-.I ,1 I — vRa] — OWNER z I coctoyad I (- 0 S ADDRESS gAing3 _—C— CITY I I (r CITY ZIP PH I I 9) 4 ARCHITECT ENGINEER KWi ffn •-/--n , $ LIC NOy Jt_� 3 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ..q! ADDRESS Y�W / vs a3 'v/Jt/� NO STORIES NO DWELLING UNITS BEDROOMS �I' CITY^ E pdT 6 ! ZIP qrl(Co 7 -1,54—ogl( ROOF I FLOOR I EXT WALL INT WALL CONTRACTOR U a/I _ IlZ 7 , 5 LIC NO ADDRESS ` � 1-�M�L/� /�(/G,'.G7 CEILING HEATING I METAL MASONRY FIREPLACE CITY �yY ZIP PH LICENSE NO I 7 CCITY BUSINESS DATELICENSE (1�J IO_1 SEWER I MIN DEPTH I S/F/100 I SIZE r J� XPIRA LICENSED CONTRACTORS DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION _ 1 hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000 of Division 3 of the Bus nos and Professions Code,and my license a in lull force and effect License Class 4 License Number 672g-se S Qs / _ Date 4 -�� - / ] Contractor -054-ME-054-MEr ADDRESS ". S/4a,0 CITY AND DP 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 employe..wdh 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 ZONING I LAND USE the project O I am exempt under Sec BAPC tor 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 sell insure,or a certificate of Workers' Compensation Insurance ora certified copy thereof RY SSYI COMPANY 7�g I Aft POLICY NOO?Ck 7)6.563 SSS GROUP DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES y—gr / VALUATION I /v� IY �Cerldud copy is tiled with the city CITY VERIFIED Date APPLICANT PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE �1 I certify that in performance of the work for which this permit is issued I shall not employ any ELECTRICALat —p�% ) I STRUCTURAL��..Lj 90 person in any manner so as to become subject to the Workers Compensation Law of Cal dornia �� VVJ 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/08ISSUANCE FEEScit ! ..----• .47gI CERTIFY THAT I HAVE READ IS APPLICATI N AND STATE THAT THE ABOVE INFORMA TION IS CORK • I AGREE CO -LY WI ALL CITY ORDINANCES AND STATE LAWS, GEO REVIEW I PLAN CHECK/�-f1 I. `7t AND HERE ORIZE R • TATI OF THIS CITY TO ENTER UPON THE ABOVE (/k-�' / / MENTIONEc PERTY I • CTIO URPOSES i / ISSUANCE APPROVED TOTAL PERMIT FEE Sig Pure of Applman or Agent Date UO6 DATE OF y6SUANCE I PERMIT NUMBER '2.4.4 t Ae i :/ (`l-/IJ(,�J^//R 3O/�/„/7 Pont Applicant s/Agents Name FINANCE CODE c4 Operator: VIRGINIA Cheek t: 000593037 Date: 6/30/94 00 Receiot J: 0001231 WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK- OWNER DECK $1709.86 GOLD•ASSESSOR/MANILA - INSPECTOR SONSTRUCTION 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 NAMG LENDER'S ADdREee DIVISION OF INDUSTRIAL SAFETY P^E-�RMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRES DIVISION OF INDUSTRIAL SAFETIPERIY MASA PREREQUISRE TD PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW 4 111 it: j 0 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,S t UCTURE,SCAFFOLDING,FALSEWORK,OR DEMOLITION'OR>DISMANTLING THEREOF,WILL BE MORE THAN 36 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 BEAD THE HAZARDOUS MATERIALS gUESTIONNAIRE AND THEtWORK APPLIED FOR ON THIS PERMIT IDS EIS NOT, SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY / - - • 1 <• • ,•''' eSs A , •r • •` \' - ')� F_ • K' • • • �• ; •,\ \ )' - 1•. • `1 -- 1 - 1 _—, t J- _ C ,. -tt • ,ld'1.) .\07•,r I • 1 t,i • • ran eo�LSltlrarv-...<a.•...- of/- ."3# ••-•IA ,rP r+r-c...-7is•-wpw 5w-- • r i ,1v+natya6w'--.,.,..•,.-...._,... , • - 1 1 n CITY OF CHINO itS A IICATION FOR A BUILDING PERMIT AND A CERTIFICATE OF USE & OCCUPANCY COMMUNITY DEVELOPMENT2001 Grand Avenue 111ill Chino Hills, CA 91709 130 A BUILDINGS / e11 Ai rovers- 14,/, `/, PROPOSED USE _ F F ADDRESS (�"rIJ�',/r E'll4�g1 f/ /{ !7 /M.�e�y /[-71 C APN /p��'(//// THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT 0y LOT ir BLOCK TRACT/AAkby /,yr .. -STRUCT 0 PLUMB 0 MECH 0 ELECT 0 GRADING a 'Y ''DD�, j� IT TYPE OF PERMIT I W 0 ALTER 0 ADDITION (EIT APPLICANT t r)( 4 -)11kr S N 1 I ` f J 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS//n it/ I -g rl,en/A/ .2„,/,:, PROJECT DESCRIPTION I LOCATION PROPERTY ON I INSIZE SO FEET (n f is CITY/ /.r tcAI A ZIP to " 10 PA gi• v4. o 1 �L.�It 1Y �t311e1 I .a.,�a/ _ OWNER — 2 (oaforI I u Q>, s ADDRESS C f)Mc3 I I CITY ZIP PH I I 4 ARCHITECT, (,nA,v•- ,i'k A LIC NO at,/ CQ 3 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION —1'` ADDRESS Q,hl 1'*".10 , he . -if e 3O NO STORIES NO DWELLING UNITS BEDROOMS ,./ SS ''L�JJ ('/i/gis'1{I/V 1^/ Z� Vq^f 1 ••„ CITYAi/l I telt i7 CJ LP �'I!?D�l.' ��ll ti'L' - ,e ROOF I FLOOR I EXT WALL I INT WALL Y CONTRACTORA ( j f , . I.,11 y4 LIC NO s- • ADDRESS "t''''''"t'''''' us.� .�- CEILING HEATING I FIREPLACEC spit FJj,F METAL MASONRY �� CITY �J ZIP PH SEWER I MIN DEPTH I S/F/700 I SIZE CI' I + Sr ) EXPIRATION DATECITY BUSINESS LICENSE C) 30_ 6� �/ LICENSE NO / LICENSED CONTRACTOR'S DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION I hereby affirm that I am licensed under provisions of Chapter9(commencing with Section 7000 of Division 3 of the Business'�siqand Professions Code, and my license is in full force and effect oe License Class !/ License Number 4 7;1s; 7 )� - ( T'� Date 4 ' 36 � Contractor ' '+sOntr r ADDRESS ' .A I`/144 CITY AND ZIP PHONF Cr OWNER-BUILDING DECLARATION I hereby 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,and the structure is not intended or offered for sale 0 I as owner of the property am exclusively contracting with licensed contractors to construct the protect ZONING I LAND USE O 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,ore certificate of Workers Compensation Insurance,or•certified copy thereof y�y�/ FlySSV COMPANY a, t /lfl4 POLICY NOOfs /y 7,1•3‘3 SSS GROUP DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES S./ • g r (},Certified copy is filed with the city CITY VERIFIED VALUATION I 12-a 5 9 ^ / Dal. APPLICANT PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE l I certify that in performance of the work for which this permit is issued,I shall not employ any ELECTRICALL95 jf, ) I STRUCTURAL r•-1-,G`�O person in any manner so as to become subject to the Workers'Compensation Law of California -i ' :./✓f Date APPLICANT PLUMBING r& ' 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 /03e, with such.provisions or this permit shall be deemed revoked MECHANICAL /03e /1� ISSUANCE FEES •�ll '^ .r I CERTIFY THAT I HAVE READTHIS APPLICATION AND STATE THATTHE ABOVE INFORMA Ill , TION IS CORRECT I AGREE/TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS, GEO REVIEW PLAN CHECK// J,41 7 AND HEREByIAUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE CHECK( I • / ! MENTIONED PROPERTY5OR INSPECTION PURPOSES ( e / . / A i ISSUANCE APPROVED TOTAL PERMIT FEE % 47. Signature of Applicant'or Agint Date Ly �Z r y DAT /J Ho I PERMIT NUMBER 7 ,L s,C 7 f• 'r n,vr /1't%/ Loy /l/Y// 3,0(7) �7D 0IW/n Pnnt Applicant s/Agents Name / 1 FINANCE CODE C Li WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK- OWNER GOLD-ASSESSOR/MANILA - INSPECTOR S ONSTRUCTION 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) LENDER'S NAME LENDER'S ADDRGcc DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRESA DIVISION OF INDUSTRIAL SAFETY PERMIT ASA PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW D 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,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 IDIS DIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY BUILDING INSPECTIONS RECORD DATE I INSPECW5 DATE I INSPECTOR Setback/Location 7///Sj q- I �-7if� Rough Plumbing —2/i‘7'-1,(<14tJ Temporary Power I/ Shower Pan Test <r._2%_G/q/ Yie -, Foundation Reinforcing Steel „b{ Stucco Mesh or Exterior Siding Excavation and Forms n /J.� I , ?j— // Insulation I,!j �r Slab Grade t2if , 17 I ° n Sewer ����Gff� rr--2/- Ground Plumbing Soil 7///5c7 I C7/y Interceptor r Ground Plumbing Water Septic Tank Underslab Ducts Leach Line or Seep Pit I Underslab Conduit Water Service (' /re ?qv' Underslab Gas Lath or Drywall Nailing (7/.;0%// de-6.(r Fireplace Foundation Gas Line Air Test 9WC/ Joists and Girders / ,, Final Energy Electrical Ground LULU 7—/L(—G/c( /,e--7 1/r Final Plumbing In(4 / Mid-Height Bond Bearfi Final Heating/A C /40) nIVZ 8-Foot Bond Beam Final Construction v Final Bond Beam Final On Site Improvements I Fireplace Bond Beam , /f Final Off Site Improvements Roof Sheathing r{-",qy// Final Dedication Framing and Ventilation C.(ter Final Zoning Roof Covering v1/ /f Final Electrical /. Rough Heating q� � /�/�� Final Gas 149%;'-- Service and Ground y('/ 44\ / Developer Fees Paid Rough Electrical Fire Dept Approval Verified I in/>. //___�_ Bonding Certificate of Occupancy Over Head Electrical Fence Height Gates Heater Pool Drainage _ X9/2(/49— SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDE LONG X DEPTH OF ROCK N W E S Inspector's Signature and Initials DATEIF ISSUANCE PERMIT NUMBER