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Permit No. 4059 a+• CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND s:N IIII A CERTIFICATE OF USE & OCCUPANCY �:-2� COMMUNITY DEVELOPMENT rLit. 2001 Grand Avenue Ill " ONus Chino Hills, CA 91709 ADDRESS /14/ /i � � I�'/hove_ L1F� � _`/L PROPOSED USE-s,/ F C o APN /Q• �l)V,fhl /0 V THHE,,FCLLOWIIN�G)YORK IS—AUUTJ1ORIZ—ED BY'HIS PEWIT D LOT9 A f BLOCK TRACT/10—i,0 LYSTRUCT L✓PLUI,MBB 1TAECH 0-ECECT et GRADING 8 APPLICANT33 I I�/r' J—I/'MAG^C jO.J ✓ TYPE OF PERMIT IY'NEW 0 ALTER 0 ADDITION y / 1 11 //ii//�'s'r'/L J 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS n/�1I Dn�I,LI , Li G 1�`0/I 7 Gl O DESCRIPTION PROPELOCATIRTY ONON I INZE I SO FEET CITY U.'/.�7V/f7 �t�ZIIP�/7QJ fl,,D % r3) -Y9�•�� , L-' pq )O I Ic of _ OWNER 1 IY�I- / ✓ r•/ /s-I ' 2 400, i1C/1 I Lian -6J ADDRESS lJ V _ oznOraj 33 I I CITY / yZL r PH 4 ARCHITECT y(y /^InI�7p ENGINEER A 1 7 / , I/L/D S LIC NO eo i a y-e 3 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS LIIQc e -i pv5 'd , a 3 /ate, {j� NO STORIES NO DWELLING UNITS BEDROOMS CITV/�'g Ram,- T/✓ • ZIP Gado a �/1't+7 c6-ag f/ ROOF FLOOR EXT WALL INT WALL CONTRACTOR„ \..)- f LIC NO I I I e t / J ADDRESS CEILING HEATING I FIREPLACE 444 METAL MASONRY ir CITY �, sZIP PH •�. / p SEWER I MIN DEPTH I S/F/100 I / SIZE LICENSE NO 2 O 2 EXPIRATION DATECENSE �:JI i, 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 Bus as and Professions Code,and my�licennse is in full force and effect License mli Class - L anse Number 6 7 ` • ✓”'[ c • Date se Contractor F.— ADDRESS ADDRESS 4 //_4 Q / 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 proleol ZONING y I LAND USE O I am exempt under Sec B&PC for this reason C A I P•V I]e \ I 3-4-1 Date INITIAI SETBAIK1S . j I I MODEL/PLAN WORKERS'COMPENSATION DECLARATION FY I SY n101T I hereby affirm that I have•certificate of consent to self insure,ora oertificate of Workers' Compensation L Insurance,/oorr.a certified copy thereof A, }}' I COMPANY/Alt/Al rT POLICY NO`r7et-' 7o?<Y 75- GROUP 7) DIVISItN TYPE un fl O Certified copy is hereby furnished DATE EXPIRES VALUATION ism cm — > Certified copy issjfiled with,the city CITY VERIFIED Y/� A.{/ryt,� y `i Date /9,�i� / _/ / APPLICANT H0 / /✓"II` C f I 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 ELECTRICALl7ll la I STRUCTURAq7).14 person in any manner so as to become subject to the Workers Compensation Law of California QQ // Date APPLICANT PLUMBING a3:-) -- I GRADING NOTICE TO APPLICANT If, eller making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code you must forthwith comply /]p�.,�(�i '�^ with such provisions or this permit shall be deemed revoked MECHANICAL `�//t,i �L ISSUANCE FEES ('�/ I CERTIFY THAT I VE REA S APP)4 ATI e. a STATE THAT THE ABOVE INFORMA CM ' 1 6...)..).a7 "" , TION IS COR- AGRE CO Y WIT CITY ORDINANCES AND STATE LAWS, GEO REVIEW PLAN CHECK /_'1 l �'7 AND HERE: HORIZ PRE ATI eF THIS CITY TO ENTER UPON THE ABOVE v� / MENTIO OPER RIN CTIO1 RPOSES ,r Q ISSUANCE APPROVED TOTAL PERMIT`F-E7E /yy Signature of App sit or Agent Date / DATED ISS�U"AN/yE PER TT NUMBER l fi/(/Gca �' sit ac-1 PA.v9 .,n V 0 i I atY//9,5� I 10:C Print Applicant's/Agent s Name FINANCE CODE /" \ 1 Operator: 0(01 Check II: 000000000 Date: 1/26/95 00 Receipt Y: 0000846 WHITE- FILE/GREEN- FINANCE/ YELLOW- OFFICE/PINK-OWNER CEng $1719.42 GOLD-ASSESSOR/MANILA - INSPECTOR Peount Tendered $1719.42 • ',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 NAM LENDER'S ADDU:^^_ (DIVISION OF INDUSTRIAL SAFETY PE9MIT CERTIFICATION `'_ 1 �` _: I1 •, r` i IT THE CALIFORNIA HEALTH AND SAFETYY CODE REQUIRES DIVISION OF INDUSTRIAL SAFETYPERMIT AS A PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW , n ❑ 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 I _ , ( r , ❑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 • ' ) 1� DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER I ( - •\ 1 , '• I HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORKCAPPLIED FOR ON THIS PERMIT ❑IS DIS NOT JSUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTHrANO SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY 1 \ 7 34k) N ' C��• -J?c � JJ�`� C , ' �r t,aIli IJ\ r', ' , r YO c ( �, lt ) c I,- 1 14 1 ,FAL... C'1'1 �. U ''zip r«r ) ( 3 ., . -v.fng4" •y,> wRA" pkat{• 4-T,.+^v'w. •?,-*y' m'q g 'crAv7re1/4^ .",ser-rt-r1-..:4(r4P- c -4;7-• .;�wa . x . fx:_4a-„.- •. , is,i. CO , �''•fy CITY OF HINHILLS APPLICATION FOR A BUILDING PERMIT AND _.a.ri '' A CERTIFICATE OF USE & OCCUPANCY COMMUNITY DEVELOPMENT 4'",- 2001 Grand Avenue `”1111111=1111111Chino Hills, CA 91709 BUILDING tq 2 h I I a��J, - g �_ rt r PROPOSED USE- v ADDRESS I 1V�71 it 'I,}IAV /`4 APN DO — ('/Q r- ID THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT G' LOT �I �/ BLOCK TRACT/ZI61j r 0' TRUCT 0-PLUMB D'MECH ❑-ELECT -O GRADING 5 ✓� %% %` I (` 7, TYPE OF PERMIT 0'NEW 0 ALTER 0 ADDITION m APPLICANT )fild T 11i f✓)� S N ( cn 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS j 111 A) • L ,' O t <f 11A 7 L) r i? PROJECT I LOCATION ON I SIZE `} } ) DESCRIPTION /� PROPERTY IN SO FEET FFEEET CITY (1- - 1 - `r11tJ/� t ) yyZIP 'i//I I ? ( PH)?) .Yiyau 1 Ligein I IseV% -) .T OWNER 1 •y ( fi'PJJ A'I — l sit J 2 ;� e,. l I , ADDRESS 1 0 A I f /JI' 3 I I CITY ,r /ZIP PH 4 I I ARCHITECENGINEER T/k%q l t/�t7„ , i 1/I',Ki, LIC NO ger 4 1':e 3 REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION -- ADDRESS Li Ir ._ fit/,r;,4) ' V • trt, 1 73 '0 NO STORIES NO DWELLING UNITS BEDROOMS ,• CITY J iIt• 2-.,7T-r_3 • ZIP4-I�� `H7c_;'Itsi) ROOF FLOOR EXT WALL INT WALL ' ` .L b I I I CONTRACTOR 5 ` � LIC NO FIRPLACE 1' ADDRESS in i CEI LINO HEATING I METAL MASONRY Irl r' ~ CITY ..~ yr ZIP PH •ti_ SEWER MIN DEPTH S/F/100 SIZE CENSE �1j 2 LICENSE NO } h EXPIRATION DATE 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 Cods, and my license is in full force end effect n y *@ S Lmenae Claes License Number f, ` I S / 1 I Date f' • ")- / Contractor fr ADDRESS ( 1 is CITY AND ZIP e..., J In PHONE OWNER-BUILDING DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason L 0 I,as owner of the property,or my employees with wagon 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 ZONING I LAND USE the project 0 I am exempt under Sec B&PC for this reason Imo`} l ♦ 1 ,rr L.; 1\ I f t Date -- INITIAI SETBACKS 11 I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY I SY nl .:)T'I I hereby affirm that I have a certificate of consent to sell insure or•certificate of Workers' CompensationInsurance or a certified copy thereof L/ RV I SSV 1..' I COMPANY 4h 7't•//' POLICY NO(nee`•��ii e H 70 )55!}� GROUP ,) •) DIVISION TYPE � fl 0 Certified copy is hereby furnished DATE EXPIRES i,, 13 VALUATION 1•^ D• Certified copy is filed with the city CITY VERIFIED (.,,/ I J14 r' Date / -: - t" I l 5' APPLICANT Hoe F 17)I7 S I PERMIT FEES 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 j } �r I STRUCTURAL I :� person in any manner so as to become subject to the Workers Compensation Law of California -� ,7 { -& I 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 ! 1.,-�^, with such provisions or this permit shall be deemed revoked MECHANICAL r\ / ! ISSUANCE FEES -1/2,,,;(/1� I CERTIFY THAT I HAVE READTHI. S 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 , ., `'f AND HEREBY AUTHORIZEREPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE ti " MENTIONED PROPERTY/FOR INSPECTION PURPOSES • r ISSUANCE APPROVED TOTAL PERMIT FEE Signature of Applicant or Agent Date V T-+J i i f ' ! ' /4/ �, ; r/didJr., UDC. 1 DATE OF ISS'UAN/C//E PERMIT NUMBER / �/y� Print Applicant s/Agents Name ( •I o / 15 i t0.� / FINANCE CODE L...-\-1 WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK- OWNER GOLD-ASSESSOR/MANILA - INSPECTOR •ONSTRUCTION LENDING AGENC• 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 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 o 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 QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT DIS 015 NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY BUILDING INSPECTIONS RECORD DATE INSPECTOR I DATE INSPECTOR Setback/Location , n HP/ Z / Rough Plumbing -,/h ./.1C A--------"-- Temporary ---/Temporary Power WI' -A "/' Shower Pan Test I '/ ' ✓ , ' I `1' Foundation Reinforcing Steel /' Stucco Mesh or Exterior Siding Excavation and Forms V V- Insulation ^//'L///r i L(-_- Slab Grade ,S/Z7/9C /nff Sewer I </t/`/r I C-1- Ground Plumbing Soil Interceptor I Ground Plumbing Water Septic Tank Underslab Ducts Leach Line or Seep Pit I .n Underslab Conduit Water Serval_ _ f /G 91 Underslab Gas 1-17P)r Drywall Ng)W44 I II 9t S,..---- Fireplace Foundation Gas Line Air Test 6//7/9.' . Joists and Girders Final Energy / I Electrical Ground ,V/7l frC /" ,? Final Plumbing I / / Mid-Height Bond Beam Final Heating/A C As/ 8-Foot Bond Beam Final Construction I / 4 // Final Bond Beam Final On Site Improvements i/l I / n y// Fireplace Bond Beam Final Off Site Improvements a I / IA Roof Sheathing G//G/9r C--AC Final Dedication "I I r / Framing and Ventilation / / Final Zoning / Roof Covering _( / a / Final Electrical / / Rough Heating 1`)// A S/// Final Gas / / Service and Ground O r/ (/` / Developer Fees Paid Rough Electrical Ill / / Fire Dept Approval Verified Bonding / / Certificate of Occupancy Over Head Electrical / / Fence Height Gates Heater Pool Drainage 00/461E 1`-' 5-//6/q`S .....--- F-4,6A". C /ZZ/9 r c-4-, 2)/c//ear-- 6//C-/93.- Cf SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDE LONG X DEPTH OF ROCK N W E S Inspector's Signature and Initials 9S DATE OF ISSUp NCE PERMIT NUMBER