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Permit No. 4314 69 r 0 _.:+�• CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND ",°}��= COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY - 2001 Grand Avenue PL /�-l/� • filliffielliiiiiIiil,L.:. Chino Hills, CA 91709 4 F-1 Z 57� / • BUILDING --7 / Q �" - PROPOSED USE C ADDRESS / / L / ate Oe7� F APN /n��_3�I _OS THE FOLLOWIING WORK IS AUTH,ORZ�ED BBYY T PERMIT s LOT e BLOCK TRACT j 36e0-' fI1 STPtlCT RI-PLUMB CH LF-ECCT DING 0 y � // Ri /� TYPE OF PERMIT LTNEW 0 ALTER 0 ADDITION m APPLICANT (�r-•(T-cc_,,_ Ho kt-L s. TA Tn dd 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS .2z.L,o L�A b L-D1-J C,4t y-C S PROJECT LOCATION ON SIZE o� -'7 q01, ,q DESCRIPTIONP • I PROPERTY I IN SO FEET/T CITY Co 1-4-)/-4 Qr ZI•P,,'� [.ilJ PH Z�� 'J. 1 U,�/v�/}��'�fypW� I I /�( //Mr�C// {/ OWNER /V'✓�1� 2 ��1� �I`--, I I l//`� l [1� ADDRESS G I I _y CITY ZIP PH 4 I I ^1/-�_ ARCHITECT S + ENGINEER LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION !\C7 ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS CITY C CONTRACTOR / r�� l /-!P aJM�i S LIC NO PH / c6 sy ROOF I FLOOR I EXT WALL I INT WALL ^- l�`L L•x a�Cl V I CEILING HEATING FIREPLACE ADDRESS �_ C4-M,c,� I METAL MASONRY `, ✓ CITY ZIP PH SEWER I MIN DEPTH I S/F/100I SIZE CITY BUSINESS LICENSE //_ 30-S� s LICENSE NO in /�� EXPIRATION DATE L 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 lbs Business and Professions Code,and my license is In lull force red effect License Class 3' License Number y GeG Date /9{a Contractor "efeni r X ' � ' r ADDRESc —' .. ,47114r_ CITY AND ZIP PHONr OWNER-BUILDING DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason O I es owner of the property,or my employees with wager 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 ONING I LAND USE the project r O I am exempt under Sec BAPC for this reason c- t-tl 11-)/ (_-1, P,4c I pat• INITIAI SETBACKS 1 I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY I SI ) /11 I I hereby affirm that I have a certificate of consent to self insure,ora certificate of Workers' RY I re / V�� Compensation Insurance or a certified copy thereof COMPANY POLICY NO GROUP /�7 pIVISION TYPE (.41 ❑ Certified copy is hereby furnished DATE EXPIRES 1 ' 7 RI ] ''/ VALUATIONisG I 1 h -� ❑ Certified pY/ailed with the city CITY VERIFIED/0,1 `� Oat e 3 y''r < APPLICAN - •f / .= PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE `�•y I certify that in performance of the work for which this permit is issued,I shall not employ any ELECTRICAL36 I STRUCTURAL/ 1�,T ` .18 person in any manner to as to become subject to the Workers Compensation Law of California -,q STRUCTURAL/ ��/••--`---��1� Oat- APPLICANT PLUMBING �J/� ' I GRADING /��� NOTICE TO APPLICANT If,after making this Certificate of Exemption you should become N_JJ /- sublect to the Workers Compensation provisions of the Labor Code,you must forthwith comply i g Gig . I actwith such provisions or this permit shall be deemed revoked MECHANICAL ` `I ISSUANCE FEES rel I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMS I PLAN CHECK 17/�Qe TION IS CORRECT I AGREE TO COMPLY W LL CITY ORDINANCES AND STATE LAWS, `0000 AND HEREBY AUTHO-+ E REP SE. A OF THIS CITY TO ENTER UPeN THE ABOVE `=E=SON% � •P� RPOSES ISSUANCE APPROVED TOTAL PERMIT FEE Signature of A••lic I'•r Agent % Date Z �' " SSI UANCE Print�licafs/Agente Name, + DATE S �� ] PERMIT` 1 FINANCE CODE /' H Operator: VIRGINIA Check 8: 000000000 Date: 3/24/95 00 Receipt 8: QOM.51 WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK- OWNER GEM Tendered .51 GOLD-ASSESSOR/MANILA - INSPECTORI SONSTRUCTION LENDING AGENC• 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 NAMF LENDER'S ADDRFcc DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH ANO SAFETY CODE REQUIRES A 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 REQUIREDTO 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 IGH-O 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 OIS 015 NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY,CODE AND THE LOCAL AIR QUALITY AGENCY •_ t • ..1 I '1 ` I • I • • 11 1 " ..-1.4-.c; r^n+Ni1;^,n,y' n P— " try, dtt ." ' . . --r't,r°.-yr v-rw" -4`4"*"..f%''k'4"' r-, CITY OF CHINO HILLS v APPLICATION FOR A BUILDING PERMIT AND I A CERTIFICATE OF USE & OCCUPANCY COMMUNITY DEVELOPMENT 2001 Grand Avenue �;����i. Chino Hills, CA 91709 f(k. r r r./ Z 57ee 47) BUILDING �'7 �//� 1�C/ p G/, / �/�, PROPOSED USE /-Y 2 ADDRESS / /r�al ! P( .G Lit r[/'N�Y [/]�� ` � �// F APN A I I-NI, _��// V'� 91 THE FOLLOWING\WORK ISAAUTHORIZED BY THIS PERMIT D LOT BLOCK TRACT ,;7; Df 0 STRUCT O-PLUMB A'MECH ❑'ELECT ❑'GRADING 0 0 L(' 1, ' y APPLICANT /16 r•- . Y it 1.1 A- r TYPE OF PERMIT ❑NEW 0 ALTER 0 ADDITION Ca L 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS 2 L 0 / 1• a &I.>I.i"Ov` i , Lice e r -" PROJECT I LOCATION ON I SIZE DESCRIPTION PROPERTY IN SO FEET J n CITY l .f_ Li ...I d ZIP I / V PH ['f`r `!IC Gpn 1 L�4 Vf- -h t, I 1251% „"--r OWNER _... ---. 'l., rL ',�_ -" 2 r0s ,e I I too9. ADDRESS I I • 1 3 N. CITY ZIP PH 4I ARCHITECT ti ENGINEER LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ce ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS CITY ZIP PH ,V , ROOF I FLOOR I EXT WALL I INT WALL f CONTRACTOR f' 4A ;l ,, f l .1,, LIC NO S." I r t al �n V fr' 7 CEILING HEATING FIREPLACE ADDRESS ... f'~1 f ` ,r„ METAL MASONRY �—' CITY ZIP PH C g SEWER MIN DEPTH S/F/100 SIZE -r CITY BUSINESS LICENSE I I I 1 A /` LICENSE NO id al EXPIRATION DATE II 3L,. r J LICENSED CONTRACTORS DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION I hereby affirm That I am bc.naed under provisions of Chapter 9(commencing with Section 7000 of Division 3 of the Bu.m and Professions Code, and my license la In lull force/and effect License Class ',so License Number 1 Date /— r !- fC Contractor r u ADDROcc -!- CITY AND ZIP PHONE OWNER-BUILDING DECLARATION I hereby affirm that I am exempt from the Contractors License Lawlor the following reason O I as owner of the property or my employees with tenon as their sole compensation,will do the work,end the structure is not intended or offered for sale O I as owner of the property am excluuN.ly contracting with licensed contractors to construct the project 8 for this reason •.�.r♦ (ZONING I LAND USE O I am exempt under Sec &PC I t ✓ I r i• w.t', It t< I `\, s.. Date 'I.- INITIAI SETBACKS I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY I SV, % J i_ I I hereby affirm that I have a certificate of consent to self Insure,or a certificate of Worker I SSY 4r - Compensation Insurance,ora certified copy thereof RY COMPANY POLICY NO GROUP " DIVISION TYPE titf 0 Certified copy is hereby furnished DATE EXPIRES VALUATION ' ❑ Certified copy is filed with the city CITY VERIFIED Jr)([ 1 i' �-� Dal• r 1 'S c"� APPLICANT Ivr VVV 1 PERMIT FEES' CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE k I certify That in performance of the work for which this permit issued,I shall not employ any ELECTRICAL ' � is �'''7 j" STRUCTURAL •%;1„, 'I}} `I person in any manner so as to become subject to the Workers Compensation Law of California tiA y i ! Dale APPLICANT `s' —" I 1 -- PLUMBING -1.:E GRADING -+., NOTICE TO APPLICANT If,after making this Cartihcele of Exemption you should become 1. subject to the Workers'Compensation provisions of the Labor Code,you must forthwith comply --- with with such provisions or this permit shall be deemed revoked MECHANICAL ) ! f I ISSUANCE FEES - I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA ` l}_ ' a w}ly ( I 1— y TION IS CORRECT I AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS GEO REVIEW 1 ,. ` PLAN CHECK .0" `/4' AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE " . I s" 1 MENTIONED PROPERTY FOR INSPECTION PURPOSES / /" ISSUANCE APPROVED TOTAL PERMIT FEE r 1 f-' f ` f� . `i -. }`'-� Signature of Applicant or Agent — Date , 1 -t. ...•�_ - ` LA.., /i`•/- �✓ I / v DATE OF ISS �, NCEE ( PERMIT NUMBER - lei Print Applicant s/Agent a Name FINANCE CODE (..•• WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK-OWNER GOLD-ASSESSOR/MANILA - INSPECTOR OONSTRUCTION LENDING AGENCS 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 ADDRES° DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRES A DIVISION OF INDUSTRIAL SAFETY PERMIT AS A PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW ❑ 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 38 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 OIS ❑IS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY BUILDING INSPECTIONS RECORD I DATE INSPECTORlyyI I DATE INSPECTOR Setback/Location IO/Z/C/> YAC/ I Rough Plumbing I c/L7 c�� Temporary Power Shower Pan Test I `7'/1 — ,n / Foundation Reinforcing Steel , /_ /.......- i i',om' Stucco Mesh or Exterior Siding 9/7/ 5 Excavation and Forms V/4/77 / Ci:7/ Insulation ///9r /761 / Slab Grade �/f,/4 al Sewer 7//G/cii , ,ZZ-------- Ground 7 cGround Plumbing Soil e/j/y4-- -teietInterceptor Ground Plumbing Water (o//2/Qs''' _ii90- Septic Tank Underslab Ducts Leach Line or Seep Pit v / -----x—m Underslab Conduit Water Service II3//$'/`7$ 2 Underslab Gas Lath or Drywall Nailing / / - 1742, ) Fireplace Foundation Gas Line Air Test Cf/I J9s rW/ Joists and Girders Final Energy 1/ Electrical Ground//a/ /7/45/- SLIz7 Final Plumbing x Mid-Height Bond Beam Final Heating/A C / I 8-Foot Bond Beam Final Construction / / If / Final Bond Beam Final On Site Improvements d 1 / Fireplace Bond Beam / / /X'� Final Off Site Improvements I .4V 1 // Roof Sheathing 1/2.,M4 r Final Dedication YAW"v/ lV / Framing and Ventilation IC'///ys Mele Final Zoning '' / I / Roof Covering A1t Ic (441& Final Electrical / V Rough Heating ,I ^/y /) / AFinal Gas I Service and Ground ((/��� ,� v vDeveloper Fees Paid /, i ) Rough Electrical (' '% r/ Fire Dept Approval Verified G1IP1 JOS 7—,_ Bonding Certificate of Occupancy Over Head Electrical Fence Height Gates Heater Pool Drainage, -7//'7C—' — C—a—IC-faae--s/- i2- — -----< / `WW'2/9,K' /1/R ft/ _ / / 02/ Z/416" (741- /kIL/ Or/C43 ( SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDF LONG X DEPTH OF ROCK N W E S Inspector's Signature and Initials F DATE OF IS UANCE PERMIT NUMBER