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Permit No. 2012-26107 BUILDING DIVISION OF COMMUNftV DEVELOPMENT DE•/ /'i City of Chino Hills �'lij 14000 City Center Dr,Chino Hills,CA91709 i'a ';4 @li Counter Phone (909)364-2760 Building Permit 24-Hour Inspection Line (909)364-2790 (NOTE'You must call before 3p.m.fora next business day inspection) City Hall Main Number (909)364-2600 ��o-x� _ *ts, - lU-�_ NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK IS NOT COMMENCED WITHIN PLEASE USE PERMIT NUMBER 180 DAYS FROM DATE OF ISSUANCE,OR IF WORK IS SUSPENDED AT ANY TIME FOR MORE BELOW WHEN MAKING INQUIRIES THAN 180 DAYS OR IF WORK IS DONE IN VIOLATION OF ANY CITY OR STATE LAWS OR REQUESTING INSPECTIONS RELATING THERETO. PROJECT DESCRIPTION PROJECT No. I PERMIT No. HVAC C/0,SAME LOCATION 2012-26107 33757 BUILDING ADDRESS I APT./UNIT NO. ISSUED DATE ISSUED BY 2467 LIMESTONE CT 7/3/2012 Heredia,Monica APN IT CTB MAPA I LOT I FLOORS!UNITS I PROJECT PERMITS IP.TYPE 103115122 CE Res CODES Add/Alter COONST.TYPE I ZONING TYPE I OCCUPANCY TYPE 'VALUATION $10,000.00 I TOTAL SQFT 0.001 BLDG.SQFT 434 Current Owners: Fees Name:KGH INVESTMENTS LLC Fee Group/ Fee Description Fee Amount Payments Address. 4195 CHINO HILLS PKWY#124 CHINO HILLS CA 91709 Transaction Type Ph, 111-111-1111 _ Mechanical C/O - - - $121.85 Email: M@CH.ORG Contractor. ECONO AIR-ECONO AIR 6001 Permit Issuance Fee $54.00 54.00 Address. 4915 HUNTER AVE ANAHEIM CA 92807 8111 FAU/A-C>100,0008TU $53.00 53.00 Ph 800-503-2666 Email: M@CH ORG Mc.Information445220 Exp.Date:2282014 581473 $1.00 1.00 LICENSED CONTRACTORS DECLARATIONUCENSED CONTRACTORS DECLARATION 8150 Gas Pipe Syst-Up to 4 Outlets $6.50 650 I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter9(commencing with Sec 7000)of O'mision 3 of the Business and Professions Code,and my license is in full force and 13084 Elect Outlets(1-20) $4.90 490 effect. In securing this permit I am acting with the knowledge of and on behalf of the owner of the property 8086 Lighting Fixtures(1-20) $2.45 2.45 bate r 12- Contractor / TOTAL FEES sines ` ot AMOUNT PATO $121.85 OWNER-BUILDER DECLARATION BALANCE DUE $0.00 1 hereby affirm under penalty of penury that I am exempt from the Contractors Licence Law for the following reason,(Sec,7031.5,Business and Pmfesional Code: Any city or county which requires a permit to construct alter,improve,demolish or repair any structure,pnor to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9 commencing with Section 7000 of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption, Any violation of Sec.7031.5 by any applicant fora permit subjects the applicant to a civil penalty of not more that five hundred dollars($500.00) 1,as owner of the propterty,or my employees with wages as their sole compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale. If however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he she did not build or improve for the purpose of sale) I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Sec 7044,Business and Professions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who contacts for such projects with a contractor (s)licensed pursuant to the Contactors License Law). I am exempt under article 3 of the Business and Professions Code. Date: Permittee Print Full Name WORKERS COMPENSATION DECLARATION 1 hereby affirm under penalty of perjury one of the following declarations: I have and wilt maintain a certificate of consent to self-insure for workers'compensation,as I certify that I have read this application and state that the above information is correct. I agree to comply provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is with all city and county ordinances and state laws relating to building construction,and hereby authorize issued. /' representatives of this city to enter upon the above-mentioned proptery for inspection purposes. - I/ham and will maintain workers'compensation insurance,as required by Section 3700 of the r� Labor Code,for the performance of the work for which this permit is issued. My worker's compensation [' 7-3 - f insurance carrier and policy number are, 4� /� ,, /� jn / �c.�r,.�go �y # /4J _!` P'amer 0-/ / kms-h�x�-✓ Policy ( LICANTSIGNATGRE v DATE vY / Appfcant ADOLFO IBANEZ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the worker's compensation laws of California,and Address: 4915 E.HUNTER AVE ANAHEIM CA 92807 agree that if I should become subject to the worker's compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with those provisions Ph: 800503-2666 Email. " Dap (d7p r 3- / 2-- Lie.Information EN).Date: Applicant:- /. 'r-a...-a-L /7L-, I certify that the user of this facility shall comply with sections 25506,25533 and 25534 of the Health and /��J V Safety Code,which regulate the storage,handling and use of hazardous materials v/WARNING: Failure to s@'cure workermpensation coverage is unlawful,and shall subject an employer to cnminat penalities and civil fines up to one hundred thousand dollars($100,000),in addition to the cost of compensation,damages as provided for in section 3705 of the Labor Code,interest,and ' attorneys fees.