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Permit No. 3551 • • -.:►.•« CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND »l COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY ."t`~ 2001 Grand Avenue -1 Chino Hills, CA 91709 /0/ 7 /3 0 C / BUILDINGADDRESS / ! I 31 � 54 Vale l PROPOSE�USE C F 0 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT a LOT 7 BLOCK TRACT J /—ham ^TRUCT �.BLUMB ECH ELECT ❑ GRADING 0 AA / / =p �� D l.. / '/ec - TYPE OF PERMIT ❑ NEW ❑ ALTER ❑ ADDITION y APPLICANT -o 0 REPAIR 0 CONVERT 0 DEMO Oi OCCUPANCY PMT ADDRESS 110 /�,, ,( �iv�e�rt/ ��a PROJECT DESCRIPTION I PROPERTY N I IN SO FEET CITY An w /,ft' ZIP 9 7. 0917'212-SIM , C>4- ---. I ' , I c 3\ OWNER `�ilii / ±`iNss.� I I -\ `� ADDRESS I I 3 CITY ZIP PH I I 4 ARCHITECT ENGINEER. Min/9W/4{— f/j S LIC NOeo/acri REMARKS/SPECIAL CONDITIONS/PROJECTDESCRIPTION ADDRESS LI/CD /r 9'i c'+ s ZL 1 1// a ,5, NO STORIES NO DWELLING UNITS BEDROOMS CITY IICrx 1A.,- - /n, ZIP is 7'%H?`I —°g/� ROOF I FLOOR I EXT WALL I INT WALL U13 CONTRACTOR 1 'Q //V• LIC NO 67a.JaKs- W CEILING HEATING I FIREPLACE ADDRESS c Q�n /- METAL MASONRY r-..... ciry CITY ZIP PH SEWER I MIN DEPTH I S/F/100 I SIZE CITY BUSINESS I7 Q�j`7/ EXPIRATION DATE LICENSED `79 LICENSE NO 7 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 license iso in full force and effect License Class NnLicense Number h 7a oO s- Date 6-3—93 Contractor ADDRESS /�,/Ap/J,�,)s� CITY AND DP �_�v ' 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(heir 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 protect ZONING I LAND USE O I am exempt under Sec B&PC for this reasonI Date INITIAL SETBACKS I MODEL/PLAN WORKERS'COMPENSATION DECLARATION FY I SY I I hereby affirm that I have•certificate of consent to self insure,ore certificate of Workers' Compensation Insurance,or a<ertdied copy thereof / /.-�,���/ RY SSVI COMPANY flAZA- POLICY NO 071 (/C 74-1 QJ 7sc GROUP DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES 9---/-••99 ���,,,/// VALUATION \� IA�Candied copy is filed with the tilt' CITY VERIFIED \s,07 /Date APPLICANT PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE s.� I certify that in performance of the work for which this permit is issued,I shall not employ any ELECTRICAL\\...\\S>..\\ I STRUCTURAL\V��� person in any manner so as to become subject to the Workers Compensation Law of California �e v �V Date APPLICANT PLUMBING (�S:3 I GRADING NOTICE TO APPLICANT If after making this Certificate of Exemption,you should become \ subtect to the Workers Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked MECHANICAL \Q\^-1Lt� ISSUANCE FEES\�'V t♦v t ra I CERTIFY THAT HAVE READ THIS APPLICA •• AND STATE THATTHE ABOVE INFORMA `Yn TION IS COR• I AGRE 0 Geer-LY L CITY ORDINANCES AND STATE LAWS GEO REVIEW I PLAN CHECK (. —AN;T�R"_�PERR�;R • �C?a RPOSES CITYENTER UPON THE ABOVE ``K� 9 ISSUANCE APPROVED TOTAL PERMIT FEE Si. ature of App ant or Agent Date I \����� /n^ble, R anCA rw.'� -/L�/rDATE OF IgS'ghUANCE L PERMITI Print Applicant s/Agent s Name /T/Vl FINANCE CODE C--14 Operator: VIRGINIA Check t: 000611728 Gate: 9/19/94 00 Receipt #: 00006% WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK-OWNER CHECK $1734.97 GOLD-ASSESSOR/MANILA - INSPECTOR SONSTRUCTION LENDING AGEN• I HEREBY AFFIRM THAT THERE ISA CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 3097 CIV C) LENDER'S NAMF LENDER'S ADDRF cc - DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRES A DIVISION OF INDUSTRIAL SAFETY PERMIT ASA PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICAYESQELOW ❑ I CERTIFY THAT NO EXCAVATION 5 FEET OR MORE FEET IN DEPTH,INTO WHICH A PERSON IS REQUIRED TO DESCEND,WILL BE MADE IN CONNECTION WITH WORK AUTHORIZED BY THIS PERMIT,AND THAT NO BUILDING,STRUCTURE,SCAFFOLDING, FALSEWORK,OR DEMOLITION OR DISMANTLING THEREOF,WILL BE MORE THAN 36 FEET HIGH ❑ AS OWNER/BUILDER I WILL NOT EMPLOY ANYONE TO DO WORK WHICH WOULD REQUIRE A PERMIT FROM THE DIVISION OF INDUSTRIAL SAFETY,AS NOTED ABOVE UNLESS SUCH PERSON HAS A PERMIT FROM THAT DIVISION DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER - - I HAVE READ THE HAZARDOUS MATERIALS OUE$TIQNNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT ❑IS 015 NOT SUBJECT TO THE APPLICABCE'REOUIREMENTS OF THE HEALTH ANID SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY • -y _ -.) r •r , f • C \ • • y - % • /fir • • i e (-1' A • 9 C �.. .q.' 53r-7 'r4.`r"..,f°`r,,,,v' T„(.r""`.v-"r «tY I v.. ....»,hPR9•�rr+-n,.,e• _ ..`.'s,rr'r' ^ -.r+,., . ill , ;;y:;'n CITY OF CHINO HILLS it / APPLICATION FOR A BUILDING PERMIT AND COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY "` .r` 2001 Grand Avenue -�y BEEMBiliiiiiI I Chino Hills, CA 91709 r fr) .r, f 13 0 C BADDRESS /!.`� l 36 /4 I /�� I74J`, ` / PROPOSEDeU3E 03 //pi 4 2 111/�y {{{ ii,/((!,(/�/ /��'lll��r(((YYY V +` C F APN / D/Or. — 3/I —O . sn z THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT y LOT 17 BLOCK TRACT/745/K ,`TRUCT �O,PLUMB N.MECH ELECT ❑ GRADING 0 APPLICANT I (ti/t L_�„�,;q � MI TYPE OF PERMIT 0 NEW 0 ALTER 0 ADDITION N 1!C I—IIILLL ! N s ❑ REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRES S '.16 �, 4n,/ 1rr�'1 !� DESCRIPTION I PROPERTYON I SIZE IN SO FEET `� CITY i 1 .'nLL NU/7 ZIP .)1j 2)O ' 237- 7'X i SV I I 'I \ OWNER 2 lQ'✓+1✓w� I I t I' iti ADDRESS ....a. �14� ll/ Jr I 3I CITY ZIP PH I 4 ARCHITECT JA - ENGINEER Aril,4,/,‘,00,4/4 dieverA `LIC NO Coi ori REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESStL�Il/t00 ('i�MrA,n Ill' /,� ,4 9,.fr1 w�'r/ `� J� NO STORIES NO DWELLING UNITS I BEDROOMS CITVF/C itor -7 /T8 ar ZIP Ll]SNOiGr"//TT"'�, 9? PPH /) ✓ tS�D f� / ROOF I FLOOR I EXT WALL I INT WALL 1 CONTRACTOR ! i 0/. LIC NO /7'7 1 Kr ADDRESS ` {J t1 „wow � l! 9�^4 CEILING HEATING FIREPLACE c Ci. mil I METAL MASONRY ir• CITY + ZIP PH I 7 x 7 EXPIRATIONITY BUSINESS DATE pi,/ SEWER I MIN DEPTH I S/F/100 I SIZE LICENSE NO '7 T 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' license is in full force and effect License ffC��less 6 License Number ^ r 4 W S ' (i Date .- 3- /3 Contractor ADDRESS � 4 ..4 a-, '� , — 42/77//r CITY AND ZIP PHONE 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 properly or my employees with wages as their sole compensation will do the work end the structure is not intended or offered for sale ❑ I as owner of the property,am exclusively contracting with licensed contractors to construct the project ZONING I LAND USE ❑ I am exempt under Sec B&PC for this reasonI Date INITIAL SETBACKS I MODEUP LAN WORKERS COMPENSATION DECLARATION FY I SV I hereby affirm that I have a certificate of consent to self insure,ora certificate of Workers' Compensation Insura'n ncc 'e , or certified copy thereof ^.a� ((('��( I��(' RY I SSV I COMPANY 4P "v/4 POLICY NO trai rA'7o� arl�./.A.a GROUP DIVISION TYPE ❑ Certified copy is hereby furnished DATE EXPIRES 9s /.'9i �. 1 VALUATION ��s D,,CMdrsd copy is filed with the city CITY VERIFIED 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\W \, I STRUCTURAL`�'k �`... person in any manner so as to become subject to the Workers'Compensation Law of Caldornla ` -1111-1. ... V Date APPLICANT PLUMBING `y,. ` GRADING NOTICE TO APPLICANT If,after making this Certificate of Exemption you should become � 1 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 ` i' ''\,T ISSUANCE FEES-% 1,,, ‘ ` 1 eT 'u i-- I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA- TION IS CORRECT I AGREE{TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS, GEO REVIEW I PLAN CHECK `• AND HEREBY AUTHORIZE'REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTIONED PROPERTY'FOR INSPECTION PURPOSES ISSUANCE APPROVED TOTAL PERMIT FEE g',�rfA-� g e * 3— a6 99 tb-- \1,-‘:.;,,,,,\--,c Signature of AppbA cent or Agent Daatee - Jr DATE OF I SUANCE PERMIT NUMBER Print Applicant s/Agent s Name 7 Ilk I-4 355 I (.) FINANCE CODE C.....H WHITE- FILE/GREEN- FINANCE/ YELLOW- OFFICE/PINK- OWNER GOLD-ASSESSOR/MANILA - INSPECTOR IkONSTRUCTION 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 NAMF LENDER'S ADDRF99 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 0 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 38 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 ❑IS DIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY BUILDING INSPECTIONS RECORD JDATJ INSPEC/T9R DATE INSPECTOR Setback/Location ifZ 9/41 le-9 f , Rough Plumbing ni(� a Temporary Power '` Shower Pan Test - Foundation Reinforcing Steel /_/¢Y ,/, Stucco Mesh or Exterior Siding ///2'R /474-7 ..a.c..- Excavation and Forms _///� /,//j Insulation /L/(o/4 ti '-4 f/ /a Slab Grade -41/2A/ ;/ Q Sewer 7/3,-,/qy it9 -5 Ground Plumbing Soil 6jZ9/!7'/ K"-,7, Interceptor Ground Plumbing Water le/7/14( D�/4„,-----1 Septic Tank Underslab DuctsLeach Line or Seep Pit Underslab Conduit /o/74-ci I., .44e....—..r---t Water Service I /0/7/94/ I /2- //,.......--c— Underslab Gas I Lath or Drywall Nailing If 2/n-/f `1 I a-e/ Fireplace Foundation Gas Line Air Test !L/Lg/9'/ 74/ Joists and Girders Final Energy • Electrical Ground Final Plumbing / i Mid-Height Bond Beam Final Heating/A C / / 8-Foot Bond Beam Final Construction / / Final Bond Beam Final On Site Improvements / / , // Fireplace Bond Beam Final Off Site Improvements ,-L/ ,r// Roof Sheathing a/ 7/ffs, Fnal Dedication \I^/ /\ / Framing and Ventilation A /1 / Final Zoning tk..X/ (/' / Roof Covering I iltivY ) / Final Electrical X v/ V / Rough Heating 10/ /AL./ Final Gas A I1/ / Service and Ground 11/I/ V ",' Developer Fees Paid V/ / Rough Electrical ` / / Fire Dept Approval Verified / V Bonding {/ / Certificate of Occupancy Jfq,/i MI /I Q Over Head Electrical / / " Fence Height I Gates I Heater I Pool Drainage I 67eCc rt /cy L a-etc-A-$a ///1/4-6-- S{ 'e �L SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDE i . /. /- LONG X DEPTH OF ROCK /7/51/N4 _7/c' QO Ci/ . ///"nit , N W E S Inspector's Signature and Initials DATE or ISSUANCE PERMIT NUMBER