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Permit No. 1822 I , .` • • • CITY OF CHINO HILLS ' % ' COMMUNITY DEVELOPMENT 2001 Grand Avenue Chino Hills, CA 91709 APPLICATION FOR A BUILDING PERMIT AND A CERTIFICATE OF USE&OCCUPANCY BUILDING ^ e,e, ri,v,,, CLEARED BV PPLICATION TYPE NO CoADDRESS /1C�/1 //��(/^ /� (/� / _ A P N /0 V/ -' V V I ' v / `/ 1____ ELL- THE oZ 5U° NG WORK IS AUTHORIZED BY THIS PERMIT t7PAheacL ^ > _WF /6 BLOCK TRACT/ V3 -7,, RUCT ❑ PLUMB ❑ MECH ❑ ELECT 0 J / / ,�� 0 I1 E r TYPE OF PROJECT W ❑ ALTER ❑ ADDITION m /L�It)It) fn OWNER / � " C��/�� 0REPAIR ❑ CONVERT ❑ DEMO ❑ OCCUPANCY PMT CO ADDRESS /4/ pL0` PROJECT LOCATION ON PROPERTY I SIZE g.7 /t �'`L, j DESCRIPTION IN SO FEET CITY 7A,o CI t LCL ZIP -�l7�. 7 PH C77-4214' 1161KiVvvt_Lri I KJ1d // 1 /06 ENGEEI- )OG O�nQ C/3 ENGINEER v I� LIC NO Q 7 7 2 / I Ni ADDRESS 2.2 6 -(O 6--,o c-D(n} tSP4(,06.$ 8 3 I I J CITY Dr�rda^ R,r' ZIP 'y r 7/ e� PH 71y 39 152.• REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION CONTRACTOR''' t4 Yt ,i,g p /- L`G(�p lI ) LIC NO ADDRESS KJ PiF�/ !/^r1 7 CITY ZIP PH 1 CITY BUSINESS LICENSE LICENSE NO EXPIRATION DATF 1 LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000 of t S Division 3 of the Business and Professions Code,and my license is in full force and effect License Class License Nu ✓ Date ontractor ADDRESS CITY AND ZIP PHONE OWNER BUILDING DECLARATION ,w, a+rieego>biat,Ak^4,..3•04=x,t�yx,;': -;,, ' , j m I hereby affirm that I aexempt from the Contractor's License Law for the following reason I; _ �J ❑ I as owner of the property or my employees with wages as their sole compensation will do the work ." - wea..�,,-E- to `. , - and the structure is not intended or offered for sale ' \ ' /15( I as owner of the property am exclusively contracting with licensed contractors to construct the project \ {�``' ❑ I am exempt under Sec B&PC for this reason I Dat .\\-U 1. 1tN ..�'1". `\ _ Date INITIAI WORKERS COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure or a certificate of Workers'Compensation Insurance or a certified copy thereof COMPANY POLICY NO GROUP DIVISION TYPE ❑ Certified copy is hereby furnished DATE EXPIRES ❑ Certified copy is filed with the aty CITY VERIFIED 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..... 7 20 any manner so as to become subject to the Workers'Compensation Laws of California / Date APPLICANT PLUMBING I GRADING NOTICE TO APPLICANT If after making thy Certificate of Exemption you should become subject to the Workers'Compensation provsions of the Labor Code you must forthwith comply with such provisions or the permit shall be deemed revoked MECHANICAL I ISSUANCE FEES ? da 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 I PLAN CHECK AUTHORIZE REPRESENTATIVES OF THIS CITY TO O ENTER UPON THE ABOVE MENTIONED /1 PROPER INSPECTION PURPOSES eye" ISSUANC ROVE TOTAL PERMIT FE Signature of Applicant or Agifnt `f��// Date ///y/%� 2 �w' tsiAnt SQfLt�� SATE E- (0 / ✓ I PERMIT ER� Print Applicant s/Agent's Name ''' — CiDatee:ta8%05%993 00 Rece okf l: 0X0180 CHECK $66.20 WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR ry ; BUILDING ADDRESS LOT BLOCK TRAC; 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 I � GAS TEST P6 FINAL PLUMBING P12 MECHANICAL DATE APPROVED/INSPRS SIGNATURE UNDERGROUND FLOOR M1 ROUGH M2 FAU/AC M4 FINA(MECHANICAL M12 ELECTRICAL DATE APPROVED/INSPR'S SIGNATURE TEMP CONSTN POWER E3 UNDERGROUND .-PVC -METAL-DBC El ROUGHIWIRING awAm�ge: RECEPT SPACING- SERVICE-GI8CUIT,.a.t.ct rt r•t, \ f 9. 4 ;,14..,F 1 g v r.I.wi1�<�-1:4f .11; S.l.;4 A:4.1 4 FINAL ELECTRICAL E12 • STRUCTURAL - DATE - - APPROVED)INSPR'S „„ ,..,, ,.._t' , 'SIGNATURE FOUNDATION LOCATION S1 , I t j REINFORCED D UFER 0 SLAB REINFORCEDE MEMBRANE S3 FLOOR FRAME/INSUL S4 MASONRY Sll FIREPLACE 511 ROOF FRAMING ROOF SHEATHING S5 FRAMING S6 INSULATION --- SOUND ENERGY S7 LATH EXTERIOR SBI LATH INTERIOR/GYPBOARD S9 APPROVED/INSPR'S SIGNATURE DATE OF ISSUANCE PERMIT NUMBER BUILDING FINAL-, \ S12 ti moi,• • \ ,