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Permit No. 3642 L4IUNO F HILLS • DEVELOPMEGrand Avenue • APPLICATION FOR A BUILDING PERMIT AND A CERTIFICATE OF USE&OCCUPANCY Chino Hills, CA 91709 BUILDING / CLEARED BY APPLICATION TYPE NO W ADDRESS Z163 3 Lr-1 ,\v\�\ F Apt;) o �APN D24 Zof ��j^o — o�p THE FOLLOWING WORK ISAUTHORIZED BY THIS PERMIT 0 i D LOT v BLOCK Cill, 71.11TRUCT ID PLUMB ❑ MECH ELECT 0 . TYPE OF PROJECT 115NEW ❑ALTER ❑ADDITION OWNER tvelEt_VlL ' ��p I (/)1�L�J ❑ REPAIR ❑ CONVERT ❑ DEMO I= OCCUPANCY PMT I ADDRESS PROJECT LOCATION ON I SIZE t','�• 2161 . V 1�n`,\v' LI-4- DESCRIPTION PROPERTY IN SO FEET T CITY C,111f`lQ USI S ZIP l pC� t� � PHg) o-r 1.GAreloe, I %-tc...c I `Sok,,, ()_..)_ ARCHITECT ENGINEER LIC NO 2.-N. vONt\k I N r 5--- ADDRESS ADDRESS 3' I I CITY ZIP PH REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION CONTRACTOR LIC NO ADDRESS , CITY ZIP PH - Tr CITY BUSINESS LICENSE LICENSE NO EXPIRATION DATF LICENSED CONTRACTORS DECLARATION 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 Class License NUMber Date Contractor ADDRESS • CITY AND ZIP PHONF OWNER-BUILDING DECLARATION ' _ I her,by affirm that I am exempt from the Contractor's License Law for the following reason 1, .. (� I,as owner of the property,or my employees with wages as their sole compensation,will do the work, ' rLRMIT EXPIRED BY LIMITATION and the structure is not intended or offered for sale I ❑ I,as owner of the property,am exclusively contracting with licensed contractors to construct the protect 1=1I am exempt under Sec B&PC for this reason k \ \` \ Date 9 - 4 --14-1rtINITIAI (------41 "N"N InfgutaV T t• WORKERS'COMPENSATION DECLARATI011`—J I hereby affirm that I have a certificate of consent to self insure,or a certificate of Workers'Compensation _ Insurance,or a certified copy thereof COMPANY POLICY NO GROt VISION TYPE ❑ Certified copy is hereby furnished DATE EXPIRES ❑Certified copy is filed with the city CITY VERIFIm VALUATION -...‹),...6‘...\•.,,2 • Date APPLICANT PERMIT FEES , CERTIFICATE OF EXEMPTIONIFROM WORKERS'COMPENSATION INSURANCE ' - I crtify that in the performance of the work for which this permit is issued, not employ any person in ELECTRICALyt'� �D I STRUCTURAL; �� anymanner s to beconyeG.ub ect to the Workers'Co ensat/i4a'�a Cali ma iii\ V I< Date — +� ` APPLICANT 7 PLUMBING I GRADING NOTICE TO APPLICANT If,after making this Certificate of Ex tion, u should become subject to the +.. ""' Workers'Compensation provisions of the Labor Code,you must fort with comply with such provisions or - this permit shall be deemed revoked . MECHANICAL , I ISSUANCE FEES .0,\..p. ^ I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS,AND HEREBY GEO REVIEW I PLAN CHECK ............ AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTI ED I. .—..' 441 PROPERTY FO•:r;-- •TION PURPOSES. IISS AP VED TOTAL PERMIT FEE 4- Signature of Applicant r Agent Date ``‘\44 ' r-->g ___S DATE OF ISSUANCE PERMIT NUMBER r-4 Ft Print Applicant's/Agent's Name 1�� (1\7'‘A--'12\t3\ C .....u\ Operator: VIRGINIA Check #: 000003410 ]late. 9/30/94 00 Receipt 41: 0001175 CHECK $114.10 WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR • • BUILDING ADDRESS ! , LOT BLOCK TRACT BUILDING'INSPECTIONS RECORD OWNER • �* ADDRESS I CITY r ZIP PH b F ! ., r PLUMBING: DATE APPROVED/INSPR'S + r SIGNATURE ; ' • GROUND SOIL/WATER P1 - TOP OUT ` ' P2 -• ' SHOWER PAN P3 REMARKS SEWER PS GAS TEST P6 FINAL PLUMBING P12 MECHANICAL - DATE APPROVED/INSPR'S SIGNATURE . UNDERGROUND FLOOR M1 ROUGH M2 I FAU/AC M4 I I FINAL MECHANICAL M12 I • ELECTRICAL DATE APPROVED/INSPR'S SIGNATURE TEMP.CONSTN.POWER E3 I UNDERGROUND PVC-METAL-D:8.G... :.ir+..:, Etv F,.x w.., -,.. 1r sic. nw•m. ROUGH WIRING RECEPT.SPACINGS e %--"i Y • "'' " ' a ' SERVICE"-CIRC-UIT„ *E2 .tet ; " "�'" 1,`it+•d:-i 4a i FINAL ELECTRICAL E12 ` 4LL sAPPROVEDIINSPR'S aSTRUCTURA .'"' ' ' D%1TE SIGNATURE , FOUNDATION"LO ATI J 1S1 _•.. w /e_V5 RI c/ &n'!5✓V / //4./c '`t —6L,/re°--" '— REINFORCED I5 j I.� O r5_ 7 SLAB REINFORCED U MEMBRANE S3.I � FLOOR FRAME/INSUL. -• ' S4 I - - I . MASONRY S11 I :.I • FIREPLACE S11 t ROOF FRAMING ROOF SHEATHING S5 _ .LY"1 FRAMING s .^ ''. S6 I U 4), i/ " • . , INSULATION . SOUND ENERGY S7 1 " " LATH EXTERIOR S8 I I ..-- LATH ._LATH INTERIOR/GYPBOARD S9 I APPROVED/INSPR'S SIGNATURE DATE OF ISSUANCE PERMIT NUMBER ` BUILDING FINAL •', , .' S12 . r ! _ •, /`" -