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Permit No. 1656 CITY OF CHINO HILLS • • COMMUNITY DEVELOPMENT 2001 Grand Avenue APPLICATION FOR A BUILDING PERMIT AND A CERTIFICATE OF USE &OCCUPANCY Chino Hills, CA 91709 kRi + Ib32_- BUILDING CLEARED BY//_,,,_ PPLICATI TYPE NO co ADDRESS F 0 APh1 L 7, ; Z /�/ / CP/197 -3_, CIS THE5 LLOWING WORK IS AUTHORIZED BY THIS PERMIT o D/LTOi �/yv/" TRAC 1,p RUCT ❑ PLUMB ❑ MECH. ❑ ELECT 37 • TYPE OF PROJECT el:+fQ�W ❑ ALTER DIm TION p "� (1) OWNER S� / .r ` .J�IfL'ri✓AIOC7 ❑ REPAIR LI ❑ DEMO ❑ OCCUPANCY PMT ADDRESS �J i /y f PROJECT LOCATION ON I SIZE 2 � %c[ (�/ _SG/re pa, 7 Lc Qeo DESCRIPTION PROPERTY// IN/SO, ,FFEEEETT CITY f/,,GiJ�() /'T�,6 ZIP 9/ 70 c7 PH cY2-/5 7 , r O I7Y- Y/ 7/6115 ,0( / 7'6 I 1 � ` ARCHITECT [ / / ENGINEER LIC NO 2 I I/�G/ f��SL -� ADDRESS 9 I I l \A CITY - ZIP PH REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION CONTRACTOR 42` ry,4v, e`.i.)srLIC NO 5.2 3/` ` ADDRESS ( 0 / .OS,ee / / ' v�sr _��/�//.e KtY 4ZIP ,,,,2,.ys-,71PH7p 'O�F5Q /(/,lC�� /�� - ,:,.5 \\1 CITY BUSINESS LICENSE 7`,.,LICENSE NO EXPIRATION DATF MVV_ LICENSED CONTRACTOR'S 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_ /? a License Number 5'Q-1/5 I Date .7" I —S3 Contractor 2' r' /L1�1/c �'G^'ST: Ct ADDRESS -7-3-5-'v r _Ly v - ZJ14 CITY AND ZIP Lon/4 (JO G 92 -C40NF 5i4 – 7 --6.56?? 1 OWNER-BUILDING DECLARATION ,( I hereby affirm that I am exempt from the Contractor's License Law for the following reason -_ r _(.--C / - /�/ . ❑ I,as owner of the property,or my employees with wages as their sole compensation,will do the work, ./J`S'i 5/ „y� /, fk:S and the structure is not intended or offered for sale 1s (/�n[�� ❑ I,as owner of the property,am exclusively contracting with licensed contractors to construct the protect (P e- Si v - ❑ I am exempt under Sec BBPC for this reason / C-/ CC/, • Date INITIAL WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certrficate of consent to self insure,or a certificateark s'Compensation Insurance,or a certified copy thereof 1 COMPANY ICY NO // / GROUP i/ DIVISION TYPe�/4 / ❑ Certified copy is hereby furnished DATE EXPIRES .-t L /" ❑ Certified copy is file the city CITY VERIFIEn VALUATION $//:/% ' Date APPLICANT PERMIT FEES 11 CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE I certify that in the performance of the work for which this permit is issued,I shall not employ any person in( ELECTRICAL I STRUCTURAL! —��U any manna o as to beton ssubtect to the Workers'Compensation Laws of California Date ✓/ _1� i /� APPLICANT r SS�// /L9 e04 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 with such provisions or this perm/shall be deemed revoked MECHANICAL I ISSUANCE FEE 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: PLAN CHECK AUTH•P. E REPRESENTATIVES OF THIS CITY TO,ENTER UPON THE ABOVE MENTIONED P•••."TY FOR INSPVTIONPURPOSES. ISSUANCE APP OVED TOTAL PERM FEE / Signature of plicant or Agent -,,a i f Date ` s SN.t'1 Fi S e0`� DATE�/OFf ISSUANCE'/�yPERMIT NUMBER Prim Applicant's/Agent's Name .... / ./ __,92„,�r ���� 6 /c/y r ,..,_______ 7 Dnerator: DAWN Check D: 000000000 Date: 7/02/93 00 Receipt 0: 0000075 CISH RECEIVED $83.00 WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR '4� s BUILDING • • ADDRESS .P. LOT BLOCK •LOT % BUILDING INSPECTIONS RECORD OWNER ADDRESS • CITY ZIP PH PLUMBING DATE APPROVED/INSPR'S SIGNATURE GROUND SOIL/WATER P1 TOP OUT P2 SHOWER PAN P3 REMARKS SEWER P5 GAS TEST P6 . FINAL PLUMBING P12 MECHANICAL DATE APPROVED/INSPR'S • SIGNATURE UNDERGROUND FLOOR Mt I -- ROUGH M2 FAU/AC M4I FINAL MECHANICAL M12 ELECTRICAL DATE APPROVED/INSPR'S • SIGNATURE TEMP.CONSTN POWER E3 UNDERGROUND PVC-METAL-D B C El ROUGH WIRING RECEPT SPACING- • 1' . SERVICE-CIRCUIT E2 FINAL ELECTRICAL E12 STRUCTURAL - DATE i APPROVED/INSPR'S SIGNATURE FOUNDATION LOCATION 51 REINFORCED ❑ UFER ❑ SLAB REINFORCED MEMBRANE S3 FLOOR FRAME/INSUL S4 I MASONRY Sttl • FIREPLACE Si ROOF FRAMING A ROOF SHEATHING S5 i / FRAMING S6 0//97T- j y'24 INSULATION SOUND ENERGY S7 LATH EXTERIOR SB LATH INTERIOR/GYPBOARD S9 APPROVED/INSPR'S SIGN, RE DATE OF ISSUANCE PERMIT NUMBER BUILDING FINAL S12 ?//1/././:?/. .g ��