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Permit No. 10061 .l ra \ . "tr CITY OF CHINO I APP.5,710N FOR A BUILDING PERMIT AND _ ay,. COMMUNITY DEVELO•NT CERTIFICATE OF USE & OCCUPANCY ? .:-1:rd. 2001 Grand Avenue -..,,�,. .,,,. Chino Hills, CA 91709 CO BUILDING d p�/n h/ /1 PROPOSED USE CO ADDRESS /) �'/l L 2 /J�//^� SIL/-� Gam/ /i //r/y/y/- /� ,l Fa APN 11) 7— /�l- r/ ) V��A / 1 A�-I 1UT �C' `'� Lel L°T THE FOLLOWING WORK IS AUTHORIZED BY DRIB PERMIT > LOT '� j BLOCK TRACT ^ p STRUDT ❑ PLUMB ❑ MECH LECT ❑ GRADING 0 r-7-, if.-- )ii ' • TYPE OF PERMIT 0 NEW 0 ALTER 0 ADDITION En APPLICANT G //�����jjj i'� //t'/I // ,y/ �')/f cn cn j r /� /JJJ / J `-�/ /r/ / r/ ' 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS //L-'-- `. /t 'V1. it /� PROJECT I LOCATION ON I SIZE C�� ( L, l l I/II �`-�! DESCRIPTION PROPERTY IN SO FEET „�_ CITY U11/7G1 �r ll�l ZIP L7 i7`/ P" ��' 7X IG 1 II I �� OWNER I ADDRESS I 3 ---- ,....-- CITY ---CITY ZIP PH I I ` 4 ARCHITECT ENGINEER LIC No ' REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION r— i..—. .. ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS CIA'--- ZIP PH ROOF I FLOOR EXT WALL INT WALL CONTRACTOR LIC NO ADDRESSCEILING I HEATING I METALMASONRY_ CITY _ ZIP PH SEWER MIN DEPTH SIF/100 ( SIZE CITY BUSINESS LICENSE LICENSE NO c,rirv.,,..,.oh,- • LICENSED CONTRACTOR S DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Secl ion 7000 of Division 3 of the Business end Professions Code and my license is in lull forte and•Ilett /���ttt���r (� // '/ // /. • �f License Class License Number ,'t�2�L//J/ --12:1. [`/ G- _/ into�4 i Dal- Contractor / [-T Cb57 / 4 z ki/ �/ ADDRESS (// -41/�_Ir 7J ,i7/ .i�J/t Loa CITY AND ZIP PHONE -i _2—/'t'�L -I[ 'l OWNER BUILDING DECLARATION / ;!--- n I herreepq&firm that I am exempt from the Coniraclor's License Law for the following reason If/4% /�„_J )_i r/1 as owner of the property oremployees with • s as their sole c sation will do /� /,//v r �f pi D Ymy non compensation the workiand the structure is not Intended or offered for sale ' O I as owner of the property am exclusively comrecling with lic•ns ed contractors to construct Ina projectZONING I LAND USE O I am exempt under Sect (UPC for this reason -e- I Date /_/_ JA/Y 7 INITIAL / / SETBACKS t MODEL/PLAN WORKERS COMPENSATION DECLARATION FY I SY "`— I I hereby affirm that I have a certificate of consent to sell Insure,or a certificate of Workers _ Compensation Insurance or a certified copy thereof RY I SSY I COMPANY POLICY NO GROUP DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES VALUATION // O Candied copy is filed with the city CITY VERIFIED / I ..�/7>. 727) Date APPLICANT r permit PERMIT MIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATIONINSURANCE I candy that on p or Enc•• of the work f which a NSAd I shall not employ any ELECTRICAL /2 41.; I STRUCTURAL ..-- r-24 eco, person in any manner so as to become aubiect to the Workers Compensation Law of California Dat• APPLICANT PLUMBING - I GRADING NOTICE TO APPLICANT If,after making this CenU¢ate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code you must forthwith complyLL with such provisions or this permit shall be deemed revoked MECHANICAL ISSUANCE FEES fi,/ ( 7 • I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA /� / '1/ TION IS CORRECT I AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS, GEO REVIEW PLAN CHECK AND HEREBY AUTHORIZE REPRESENT q-itVFC OF THIS CITY TO ENTER UPON THE ABOVE MEHTIpNE ROPERR VJSP t .eUPPO5 ES ��///�� ISSUANCETAPPROVED TOTA�P R r FEE /� Signere of Applicant or Agent / Date //1'LI1/Yr// DATE SSUAICE PERMIT NUMBER - cDli�tet . Gam. h.Y, Pnn Api-I fVt 16 1 /4/E-4/ s/ ants Name FINANCE CODE n i Operator: VELWI Date: 7/11/97 00 Receipt: 0000511 WHITE- FILE/GREEN- FINANCE/YELI OW- OFFICE/PINK- OWNER Total Payment $843,70 GOLD -ASSESSOR/MANILA - INSPECTOR