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Permit No. 3077 r • • ct:. CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND COMMUNITY DEVELOPMENT A CERTIFICATE OF USE h OCCUPANCY 2001 Grand Avenue e Chino .Hills, CA 91709 ^ I ;lj b C.- L / 3 ABUILDINGDDRESS , 1/J90 /1Fi lt k'{y/t Ne ' PROPOSED USE s ,/� � C r. APN /0 4-7 3) //// ---«`OL ,✓ ILr/ VTHUM-LOWING WORK IS AUTHORIZED BY THIS PERMIT 64.- // a LOT /L BLOCK TRACT/ /L•.IQ1r LVSTRUCT 0 PLUMB 0 MECH 0 ELECT 0 GRADING a 73 TYPE OF PERMIT IDLNEW 0 ALTER 0 ADDITION N APPLICANT I ) DC_ �_� 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS//ill / 1 a !co/I/ - 0 DESCRIPTIONT PROJEC I LOCATION PROPERTY N I SIZE IN SO FEET �,_ �7 ll// VVV hI/V Z� Y0,4737-440 CITY(1%)4,0Am_ ZIP Ni n-0 737 / , L�l/jyn✓y1A�(�o I I a 9L^lam OWNER A��h /�I�/�/ 2 GC?r' lila I I �/ / (� ADDRESS _„..,,,,—(-7// '//C- 3 I I v 0X/ CITY ZIP PH I I \ 4 ARCHITECT ENGINEER//V/6,pe-f-�Jf6J LIC NOC()t2��3 REMARKS/SPECIAL CONDITIONS/PROJECTDESCRIPTION ADDRESS[//hl (q- oV5 r --Aa)._ 3r) NO STORIES NO DWELLING UNITS BEDROOMS wN 11//((// /J" �y �'y C I TYfI�Ci.�.M7 /S DP !/ 1 �L0 )1;a-o 1 ROOF I FLOOR I EXT WALL I INT WALL 1C CONTRACTOR t/VV il/J 0 .777 6101_(if LIC NO C ADDRESS c. -' C Aiv)g_ CEILING HEATING I METAL EMASONRY ..../..- (CI !l CITY �J /r�21�'P PH 1�' '] SEWER I MIN DEPTH I S/F/100 I SIZE /73/ EXPIRATION DATECENSE /L��Z a --1/L LICENSE NO £7 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 Buser ss and Profession.Code,and my licensen' isdin full force and effect License Class License Number 1 7�a�.&/r.-- Date 6 -30 -$--- Contractor -- 671711C ADDRES0 -- 6Arn CITY AND ZIP PHONP OWNER BUILDING DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason O I,as own.,of the property or my employees with wages as their sole compensation,will d- 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 conatruot ZONING I LAND USE the Protect O I am exempt under Sec B&PC for this reason I Date INITIAL SETBACKS I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY u I IIlY\- I I hereby affirm that I have a certificate of consent to self insure or a certificate of Workers Compensation Insurance,/� ora certified copy thereof RY 1 1I SSY /� COMPANY ��At- POLICY NO p7C4)/6363•5:)j GROUP DIVISION TYPE 0 Certified copy is hereby furnished DATE EXPIRES / VALUATION Ia7/ 9-o ,Certified copy a filed with the city CITY VERIFIED as- _ Date APPLICANT PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE a I certify that in performance of the work for which this permit is issued, shall not employ any ELECTRICALLI './ - ) I STRUCTURAL,(-vS so person in any manner so as to become•ublect to the Workers Compensation Law of Celdarnia .�� /l/J Date APPLICANT PLUMBING OOCC'_l C'.7O�1 ' I GRADING NOTICE TO APPLICANT If,alter making this Cerblmate of Exemption,you should become subject to the Workers Compensallon provisions of the Labor Code,you must lonhwith comply ///���, with such provisions or this permit shall be deemed revoked MECHANICALQX • /�/vxl ISSUANCE FEESa9' i' I CERTIFY THATI ••VE READ HIS APPLICATIO D STATE THAT THE ABOVE INFORMA 6 TION IS COR•-D>rI AG-'- s COM WIT CITY ORDINANCES AND STATE LAWS, GEO REVIEW PLAN CHECK AND HERE THOR PRE TATI F THIS CITY TO ENTER UPON THE ABOVE ME TIO,..• PROPE- ORI ECTI RPOSES ' / ISSUANCE APPROVED TOTAL PERMIT FEE < t /734 , q7 •nature of Api want or Kent Date DAT OF ISSUAN E 1 1 PERMIT N BER Pnnt Applicant's/Agent s Name FINANCE CODE C. U Operator: VIRGINIA Check 0: 000593038 WHITE- FILE/GREEN• FINANCE/YELLOW- OFFICE/PINK• OWNERS 6/30/94 00 Receipt 0: 0001263 DE $1734.GOLD-ASSESSOR/MANILA - INSPECTOR ',CONSTRUCTION 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 ADDRCcc DIVISION OF INDUSTRIAL SAFETY PERMIT7 CERTIFICATION ER " ' 'P ff '115 THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRESADIVISION OFINDUSTRI�AL�S�.FETYP MI7"AS A� RE IS ETb PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW 33 ,ti C VA I l\ I7 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 BUILDINQ S+TRU,GTURE,SCAFFOLDING,FALSEWORK,OR DEMOLITION O�DISMANTLING THEREOF WILL BE MORE THAN 36 FEET HIGH L\"\ {.Jr,` ' ❑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 - I ." DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER t ''' \•\� • - _ \\‘\ t • I HAVE,READ THE HAZARDOUS MATERIALS QUESTIONNAIRE ANDCHE+WORK APPLIED FOR ON THIS PERMIT IDS ❑IS+NOT SUBJECT TO THE -�- APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY ^1 `\1/4 -I i • • ( - - 1 \ 1 \ l 1 f _ \ 1 • • - - ' ' - ;,\ , 1 - ' `1e. ti ' • 1 \� •,w` ' jfly 'ILS ' ,I 4 , . , I CITY OF CHINO HILLS _ A (CATION FOR A BUILDING PERMIT AND COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY 2001 Grand Avenue® Chino Hills, CA 91709 I ; 6 C ii, / 3 BUILDINGS I 4119261 ()9D /' Orni__n , /,s, /fr Da '7 PROPOSED USE G FF c ADDRESS r(�pJ riGH�ll sflfl�/J/f{v l'./Lr./ylfl/, F O APNIo,3,4 ;1.. / .03 Z THE.EOLLOWING WORK IS AUTHORIZED BY THIS PERMIT s LOT A BLOCK TRACT��Ijj/rr / sn/ arSTAUCT 0 PLUMB O MECH ❑ ELECT ❑ GRADINGSCI - // 9 APPLICANT f/ TYPE OF PERMIT LJJ4EW 0 ALTER 0 ADDITION y -I qC k" "nig 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ,n ADDRESS/IO I„ ! / 'ii ? !l PROJECT LOCATION ON I SIZE 1V I� I/V�f� N' 0 LJ DESCRIPTION PROPERTY IN SO FEET _ iff CITY( !/j WA 'Pi2111 G 96PH 237-J '9I) 1 Li ME I I IA,3'1 /1,n/� nn I(� D �✓ OWNER /'T1 1 �{ .�"" 2 les-I, W;VI I599 ADDRESS /�// '1� lY I I 3 .....--, CITY ZIP PH I I 4 4' ARCHITECT t vs ENGINEER in u FA 111 R./ I I I!FF ) LIC NO/)f1 ti"'S)3 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESSylIh11 iia 400) 0Ni J' 10 NO STORIES NO DWELLING UNITS BEDROOMS Y I . !!! fie r, CITY, ctu:77/ ` 1/7 f/ ZIP G4o i.40 ".7 Si,1 ..S is ROOF FLOOR EXT WALL INT WALL -I. CONTRACTOR 0e f 4f LIC NO I t- �^ ... CEILING HEATING FIREPLACE /'' ADDRESS �.r /l Ai I METAL MASONRY 7 C./ CITY ZIP PH , SEWER I MIN DEPTH I S/F/100 I SIZE '�" LICENSE NO l7nf7 EXPIRATION DATECE NSE �I ] _ ��/ __1.f 7 / N 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 2Business and Professions Code, and my license is in full'force and effect Lie.,, .Class I *�/ License Number C1 4 ,f cc 7 Date r+ - 3c - t li r' Contractor / ADDRESS 4/),/1/5 "'- CITY AND ZIP PHONE OWNER BUILDING DECLARATION I hereby affirm that I am exempt from the Contractors 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,and the structure is not intended or offered for sale ❑ I as owner of the property am exclusively contracting with licensed contractors to construct t the project ZONING I LAND USE .t ❑ I am exempt under Sec B&PC for this reasonI Date INITIAi SETBACKS I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY s II -S-;(.C, I I hereby affirm that I have a certificate of consent to self insure,ora certificate of Workers' t Compensations Insurance,lora certified copy thereof J�^��/` / ,( z�'` RY t I SSV I COMPANY eritthi POLICY NO t 1�CJ.S 2163E 3ccs GROUP DIVISION TYPE ❑ Certified copy is hereby furnished DATE EXPIRES Ay.,. VALUATION 1" Lt ;O Certified copy is filed with the city CITY VERIFIED I (j j /Det• APPLICANT 111 PERMIT FEES l CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE I certify that In performance of the work for which this permit is issued,I shell not employ any ELECTRICAL•`y'J L } I STRUCTURAL(.. 2 2 person in any manner sou to become subject to the Workers Compensation Law of California OS_(+7 4 /'t V r Dab APPLICANT PLUMBING �,•�1 C 1'� I GRADING NOTICE TO APPLICANT If after making this Certificate of Exemption,you should become _jam 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 1 ly / ISSUANCE FEES�V� "� I CERTIFY THATI HAVE READITHIS APPLICATION AND STATE THAT THE ABOVE INFORMA f TION IS CORRECT I AGREE TO COMPLY WITH'ALL CITY ORDINANCES AND STATE LAWS, GEO REVIEW PLAN CHECK(6 6 AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE 1( MENTIONED PROPERTY FOR INSPECTION PURPOSES e*CJ J 24 �- 9 , l ISSUANCE APPROVED TOTALtPERMIT FEE / `� !1GIfc'y// �� t LTY IrI 3 I 1 / Signature of Applicant or Apert Date "'� y DAT OF ISSSUANC�] PERMIT N�/q,+BER1 � 4./1 Pc, r T 1 i, A,"i9•Ls f. d iv( (*to l q I l0 Print Applicant s/Agent 5 Nem* + FINANCE CODE C Li 1 lc- . . \---___} WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK-OWNER GOLD-ASSESSOR/MANILA - INSPECTOR CONSTRUCTION LENDING AGENG4 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 REQUIRESA DIVISION OF INDUSTRIAL SAFETY PERMIT AS A 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 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 D 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 DIS DIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY BUILDING INSPECTIONS RECORD p4TE I INSPECTD9 I DATEI INSPE, TOF Setback/Location Wil Gj'7 I .5('-77- Rough Plumbing I I_ / 149r..I . , il 7 Temporary Power ' ' '„ ., I / Shower Pan Test IQ/Gjl" IF TO Foundation Reinforcing Steel oy-`721 , / _ 7f Stucco Mesh or Exterior Siding V1I N.' II Excavation and Forms ,- I>% I 4'If Insulation I Rte./5/5C( re; Grade y , I f,i Sewer �7 / 7cr Ground Plumbing Soil 7///Q// `� Interceptor Ii ' Ground Plumbing Water '114 f''C7[(1 ' .1e---)a-4, Septic Tank I Underslab Ducts y 1 ` ' v Leach Line or Seep Pit / // /6 Underslab Conduit I Water Service I /4/,z'i .i &' ' Underslab Gas I Sor Drywall Nailing I9/17f 6( — /Y..--"21 Fireplace Foundation I Gas Line Air Test 19/zz1/ / 2/.-h— Joists and Girders eI Final Energy I Electrical Ground //4,44 7/ 'k— y ice-2(C Final Plumbing I . In, /e1 Mid-Height Bond Beam u Final Heating/A C ,,, /1455 j, 8-Foot Bond Beam Final Construction /_� _5---' Final Bond Beam Final On Site Improvements F I Fireplace Bond Beam , Final Off Site Improvements Roof Sheathing -4g(N.,•-•- ,e-(6 ¢ A4-7)/ Final Dedication Framing and Ventilation ' ,,,,( / G ' '4 A Final Zoning Roof Covering I kIJY J/ Y. Final Electrical /e7/2-(14( ..-‘•Lc-4C- Rough Heating I/t43t t/ll IV Final Gas Service and Ground XI7 1\- Developer Fees Paid Rough Electrical 7 i Fire Dept Approval Verified Bonding Certificate of Occupancy Over Head Electrical Fence Height Gates Heater Pool Drainage ell ( q Cf Cbt' -- ,A - or SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDE LONG X DEPTH OF ROCK N W E S Inspector's Signature and Initials ( (0 DATE F ISSU NCE PERMIT NUMBER