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Permit No. 3902 �'.• CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND ay COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY 2001 Grand Avenue nilliail Chino Hills, CA 91709 BUILDINGPROPOSED USE CD C ADDRESS K�5 szi Ln .St- 1114 , Q1 L� F APN loll- oc35--,5i) I cr11 Ge. o Cm (Aii K. z THKjFOLLOWING WORKIIS AUTHORIZED BY THIS PERMIT . a LOT n n q1 BLOCK TRACT I s-) O6TRUCT 0 PLUMB 0 MECH 0 ELECT". 0 GRADING a of � Do a TYPE OF PERMIT 0 NEW 0 ALTER t 4 OITION m (0 APPLICANT„1,3 1 /� 1-1 E q^i A A `^/'l_ 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT n ADDRESS Q scl rL vA SAA Lt._ M1/tV1 R` GL� PROJECT - LOCATION ON SIZE J 1 1`` C.q (�^ p DESCRIPTION� I PROPERTY I IN SO FEETFETo JI CITY C. -;.L/JD ItLAS ZIP 11 n 1 PH A-1,) 0 -11 1 TI' 'o, I 13 V J L /� OWNER Arnff_ 2 V I I �(/(, S1• ADDRESS I I W 3 CITY ZIP PH 4I I ARCHITECT ENGINEER LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS CITY ZIP PH ((�� CONTRACTOR LIC NO ROOF I FLOOR EXT WALL INT WALL �I ADDRESS CEILING HEATING I FIREPLACE METAL MASONRY 0 CITY ZIP PH CITY BUSINESS LICENSE SEWER I MIN DEPTH S/F/100 I SIZE LICENSE NO EXPIRATION DATE I LICENSED CONTRACTOR'S DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION TI— I hereby affirm that I am bcensad under provisions of Chapter 9(commencing with Section 7000 of Drvulon 3 of the Business and Profession.Code, and my license is in full force and effect License Class License Number Data contractor r ADDRESS CITY AND ZIP PHONE OWNER-BUILDING DECLARATION I hereby affirm that I am exempt from the Contractor'.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 Ix as owner of the property am exclusively contracting with licensed contractors to construct the protect J 1'tZ'ONIING` I yyy��' LAND USE O I am exempt under Sec B&PC for this reason C /t• k p-�� )/ [-' 1•I L� I / Date IA�-� ti' INITIAL��� SETBACKS 1/ IJ 1 I MODEL/PLAN 7 WORKERS COMPENSATION DECLARATION FY I SY ON-CO I I hereby affirm that I have a certificate of consent to self insure,or a certificate of Worker Compensation Insurance,or a certified copy thereof RVLb I SSV COMPANY POLICY NO GROUP �� DIVISION TYPEI ) r1 0 Certified copy is hereby furnished DATE EXPIRES 11 VALUATION O Certified copy is filed with the city CITY VERIFIED Date APPLICANT PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERSCOMPENSATION INSURANCE �//�//••s��sss���� I certify that in performance of the work for which this pe t is issued,I shall not employ any ELECTRICAL I STRUCTURAL ' person in any Jmanner so as to become subject to the Works Compensation Law of California Date ) / 2c4y APPLICANT _ `/ PLUMBING I GRADING NOTICE TO APPLICANT If,alter making this Certificate of Exel 11 you should become subject to the Workers Compensation provisions of the Labor Code,you must forthwith comply _ with such provisions or this permit shall be deemed revoked MECHANICAL ISSUANCE FEES &9 I CERTIFY THAT I HAVE READ THIS 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 D HEREBY AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE TONED PROPERTY FOR INSPECTION PURPOSES ISSUANCE APPROVED TOTAL PERMIT FEE [ 2 .9g LS•7 Sig Applicant or Apart! Date DATE2 OF 11SSSU C PERIT NUMBER Print Applicant s/Agent.Name Li `"� � VOa FINANCE CODE CH Ilparator: VIRGINIA Cheek 0: 000000944 WHITE- FILE/GREEN- FINANCE/ YELLOW- OFFICE/PINK-OWNER DCatq( 11/28/94 00 Receipt 0: 00"„0899 GOLD-ASSESSOR/MANILA - INSPECTOR $1=5.90 CONSTRUCTION LENDING AGENCY 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 ADDRF cc DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION vim ' THE CALIFORNIA HEALTH AND SAF,ETY CODE REOUIRESA DIVISION OF INDUSTRIAL SAFETY PERMIT ASA PREREQUISITE-TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW r r' - C L ,� ❑ I CERTIFY THAT NO EXCAVATION 5 FEET OR MORE FEET IN DEPTH,INTO WHICH A PERSON ISREQUIRED 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 REQUIRDIVISION E A PERMIT FROM THE OF INDUSTRIAL SAFETY,AS NOTED ABOVE UNLESS SUCH PERSON HAS A PERMIT FROM THAT DIVISION '� ` - - '1` • ' t ♦ / DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBERI r7 1_t, L f J 1 C I HAVE READ.,THE HAZARDOUS MATERIALS QUESTIONNAIRE ANDCTHErWORK APPLIED FOR ON THIS PERMIT ❑ISrJDIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY • 4 It IA 1^' J h - • r - \y.= w • c \' -y=am -- - , ' 1 wec Pci•-r -.: y,,,..,^ttx-4,.,... ..d,/.•..ro-t,WC,•,.,r..,..,--.,•,,r "7r%I-flaw'T:OMt'.!�%.s.^.Zeit''-H-w' r. - :-.:�- . ',:na. 'ICa -., serw a - '- n / COMMUNITY CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND DEVELOPMENTA CERTIFICATE OF USE & OCCUPANCY 2001 Grand Avenue IIIMENiiiiil Chino Hills, CA 91709 BG PROPOSED USE C ADDRESSUILDINI Lou 5SA:w, ,Pr L ti a-f-h c� t�afi o <�1UQ-f�- APN f(�� =�I�;a- . I '1 THE FOLLOWING WORKS AUTHORIZED BY THIS PERMIT D LOT O�^ 1(h I BLOCK TRACT 13 n q O/STRUCT 0 PLUMB ❑ MECH ❑ E�LE�CT� O GRADING 0 �rrJ I 33 TYPE OF PERMIT 0 NEW 0 ALTER L-4 DITION n APPLICANT` s1 i \ , i 1 `r\1 A*',3,` C ❑ REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT A ADDRESS/ t‘i ,,_ AS1Ll)�L� �l k L([.! PROJECT ry DESCRIPTION I LOCATION PROPERTY ON I INI SO FE/ET') CITY\�{ l' .J.) t. LkS ZIP �I 1 / U 4 PH CI 1 jly 1 1 1 +0� I I �' K•( I{ OWNER ,J t l'I\'Ls VI I I t (( � • 1 ADDRESS fI I .0 3 CITY ZIP PH I I —` 4 ARCHITECT ENGINEER LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ~' .r \, ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS 17 CITY ZIP PH CONTRACTOR LIC NO ROOF I FLOOR EXT WALL INT WALL _ 1 ADDRESS CEILING HEATING I FIREPLACE �-- METAL MASONRY CITY ZIP PH SEWER MIN DEPTH S/F/100 SIZE CITY BUSINESS LICENSE I , LICENSE NO EXPIRATION DATE Y` ' LICENSED CONTRACTOR'S DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION I hereby affirm that 1 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 Dat• Contractor 3 ADDRESC . CITY AND ZIP PHONP OWNER-BUILDING DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason ❑ I,as owner of the properly or my employees with wages as their sole compensation,will do the work,and the structure is not intended or offered for rule Xthaswof the property em exclusively contracting with licensed contractors to construct t ZONING . I LAND USE projectCM L ❑ I am exempt under Sec B&PC for this reason I r 11J;� l_ u I 1 t . I I Det• r y r t~I INITIAL t� SETBACKS t I MODEL/PLAN I/` WORKERS COMPENSATION DECLARATION FY I SY C).240 I I hereby affirm that I have•certificate of consent to self insure,ora certificate of Workers Compensation Insurance or a certified copy thereof RY IS I SSY COMPANY POLICY NO GROUP(! i DIVISION TYPE / f I ❑ Certified copy is hereby furnished DATE EXPIRES li ..� VALUATIONI I o Certified copy liled with the city CITY VERIFIED -l �(' es Date APPLICANT PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE I certify that in perlormance of the work for which this permit is issued,I shall not employ any ELECTRICAL I STRUCTURAL1 . fC Jperson In any manner so as to become subject to the Workers Compensation Law of California 1 i+ Date • / L APPLICANT �_ V - PLUMBING I GRADING NOTICE TO APPLICANT II after making this Certificate of Exemption,you should become eublect to the Workers Compensation provisions of the Labor Code,you must forthwith comply • C with such provisions or this permit shall be deemed revoked MECHANICAL ISSUANCE FEES I CERTIFY THAT I HAVE READ THIS 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 AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES ISSUANCE APPROVED TOTAL PERMIT FEE \, I I `�r t-,?s-- 115 r`/ Q Signature'ol Applicant or Agent Dale DAT OF SS UaA"N � PERMIT NUMBER Print Applicant s/Agent s Name � I If C/ ? o L FINANCE CODE L l WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK-OWNER GOLD-ASSESSOR/MANILA ,INSPECTOR SONSTRUCTION LENDING AGENC I HEREBY AFFIRM THAT THERE ISA CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE 0 HE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 3097, CIV C) LENDER S NAME LENDER'S ADDPcce DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRES A DIVISION OF INDUSTRIAL SAFETY PERMIT ASA PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW O I CERTIFY THAT NO EXCAVATIONS 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,FALSE WORK,OR DEMOLITION OR DISMANTLING THEREOF,WILL BE MORE THAN 36 FEET HIGH 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 OIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY BUILDING INSPECTIONS RECORD DATE I INSPECTOR I DATE INSPECTOR Setback/Location Rough Plumbing Temporary Power Shower Pan Test Foundation Reinforcing Steel Stucco Mesh or Exterior Siding Excavation and Forms Insulation Slab Grade Sewer Ground Plumbing Soil Interceptor Ground Plumbing Water Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit I I Water Service Underslab Gas Lath or Drywall Nailing Fireplace Foundation Gas Line Air Test Joists and Girders Final Energy Electrical Ground Final Plumbing Mid-Height Bond Beam Final Heating/A C 8-Foot Bond Beam Final Construction Final Bond Beam Final On Site Improvements Fireplace Bond Beam Final Off Site Improvements Roof Sheathing ,/ Final Dedication Framing and Va dation- //20/A-C cls=1Y7 I Final Zoning Roof Covering Final Electrical Rough Heating Final Gas Service and Ground Developer Fees Paid Rough Electrical Fire Dept Approval Verified Bonding Certificate of Occupancy / , Over Head Electrical . 'z-4Z DIno //Zc'/q-�1--,40C_ _ Fence Height Gates Heater Pool Drainage SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDE LONG X DEPTH OF ROCK _ N W E S Inspector's Signature and Initials DATE OF ISSUANCE PERMIT NUMBER