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Permit No. 1821 CITY OF CHINO HILLS . . GOMMi7NITY DEVELOPMENT , 2001 Grand Avenue APPLICATION FOR GRADING AND OTHER MISCELLANEOUS PERMITS Chino Hills, CA 91709 BUILDING i+ CLEARED BY I APCP- IfT�TYPE NO CO ADDRESS <'O 7 Oy4 _ �'d�vyv,J 1� �/ O APN 9 1 7-a61 -G 7 Fle----7 THE FOLL(SWING WORK IS AUTHORIZED BY THIS PERM E r �C�L /4 BLOCKTRACT /0370, ❑ STRUCT ❑ PLUMB 0 MECH 0 ELECT DING a /1 0 NEW ❑ ALTER ❑ ADDITION ❑ SUPERVISED GRADING m OWNER / / - ) SE�1A) (�[.� I�/ ❑ DUMP DEPOSIT REQUIRED ADDRESS /[`�,� L v Lr= DX_ ❑ REPAIR ❑ CONVERT ❑ DEMO /t.0 CUBIC YDS CITY 0` l0 1cLs ZIP 2r7 0 Q PH5 7/2 Yr( I DESCRIPTION OF WORK AND CONDITIONS O(CCF///APPROVAL J ARCHITECTINRI £7 — /d!I_A J LIC NO C �30 77 r ENGINEER / 7/ v / �QQ R �` ADDRESS 2 Zfo(f/S ' 4 07!($)(Z v CITY Pr671a1)/9 g ZIP 5[74 PH 7t 1 3/d'D 4 rz_ O CONTRACTOR /9�N�n /hv/LD fi LIC NO (� ADDRESS !J /L1�l � CITY ZIP PH CITY BUSINESS LICENSE LICENSE NO EXPIRATION DATE LICENSED CONTRACTORS 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 d effect "S License Class License Numb r 0 Dat. ntractor }t ADDRESS —/ CITY AND ZIP PHONF y� ..-� OWNER-BUILDING DECLARATION �' I hereby affirm that I am exempt from the Contractor's License Law for the following reason A ❑ 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 ------ / I,as owner of the property,am exclusively contracting with licensed contractors to construct the project I` +. - - - a ,°s. ' ` f; 1:-.,,,v ❑ I am exempt under Sec BSPC for this reason I PERMIT EXPIRED BY LIMITATION Date INITIAL I WORKERS COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure,or a certificate of Workers'Compensation , '..N. i I% 4,- ...\_...".4,-Insurance,or a certified copy thereof I Date\ — ''- ' ,Initial �� ) vt, COMPANY POLICY NO F ❑Certified copy is hereby furnished DATE EXPIRES ❑ Certified copy is filed with the city CITY VERIFIPn VALUATION Date APPLICANT PERMIT FEES 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 any manner so as to become subject to the Workers'Compensation Laws of California Date APPLICANT / v0 PLUMBING GRADING 1( ��_ NOTICE TO APPLICANT If,after malung 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 permit shall be deemed revoked MECHANICAL ISSUANCE FEES �° I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS G CORRECT I AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS AND HEREBY AUTHORIZE REPRESENTATIVES OF T IS CITY TO ENTER UPON THE ABOVE MENTIONED GEO REVIEW PLAN CHECK PROPER F SPECTIO RPOS ISSU E PROV TOTAL PERMIT FEE C- GI l ? co55(CT gnat a of Applicant or/!gent Date t�L4�� j � e1AE 6A se, PERMIT NUMB/�g�,� Print Applicant's/Agent s Name / {7 • 3 I / �'� / - -- 6......._e-- Operator: VIRGINIA Check II: 000003666 Date: 8/06/93 00 Receipt II: 0000179 WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR CHECK $194.00 • • BUILDING ADDRESS LOT ` BLOCK TRACT INSPECTIONS RECORD OWNER ~ . ADDRESS CITY ' > > ZIP PH SWIMMING POOL INSPECTIONS PLUMBING DATE APPROVED/INSPR'S _ SIGNATURE LOCATION/DIG SP1 REMARKS STEEUBONDING/PLUMBING TEST SP3 APPROVED TO GUNITE SP3 UNDERGROUNG ELECTRIC SP2 -GAS TEST SP3 FENCE ENCLOSURE SP5 FINAL SP12 - GRADING INSPECTIONS PLUMBING DATE APPROVED/INSPR'S SIGNATURE PRE GRADING MEETING GR1 s4.YW'wAh GIlIPR• ILOLT�SE"+•f^.N;,,. Lt J�"*l.—N..^[r rr— _.. _ TOE OF FILL GR2 I EXCA1ATION GR3 RET WALL FOOT GR4 MASONRY/FORMS...��.��-��,5. .E;•�a,7�<��-�.� _,�„�-'«•�, N DRAINAGE DEVICES GR6 ROUGH GRADING& BUILDING RELEASE GR7 w ` DATE OF ISSUANCE PERMIT NUMBER FINAL 'ti GR12 \ j • •