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Permit No. 2110 CITY OF CHINO HILLS . i • 1110 COMMUNITY DEVELOPMENT 2001 Grand Avenue APPLICATION FOR GRADING AND OTHER MISCELLANEOUS PERMITS Chino Hills, CA 91709 BUILDINGDp CLEARED'Y/ APPLICATION TYPE NO CO ADDRESS D7U age C�I/�I ydnJ L/�, //JO �T/�/ ((//////%%�?II // //,/ F / /��/jj r APN 7 3/ 1a / /1o Z l /// �} / T HkFOLLOWING WORK IS AUTHORIZED BY THIS PERMIT E 'pal /� TRACT/G� 7//1� RUCT 0 PLUMB 0 MECH 0 ELECT 0 GRADING 0 II i 0 NEW 0 ALTER 0 ADDITION 0 SUPERVISED GRADING m fn OWNERN Er.) rn AG ` 4-..i ❑ DUMP DEPOSIT REQUIRED ...J ADDRESS 0 REPAIR 0 CONVERT 0 DEMO CUBIC YDS ;?0-78 OACn t.s yon LAI. CITY Cf7„;(6 1,,�/s ZIP q / 709 PHs�7-Os6 al I DESCRIPTION OF WORK AND CONDITIONS OF APPROVAL ARCHITECT / ^ \� ENGINEER LIC NO �/ V ADDRESS 'Z /C9 �// e1 0-. "r'/t-/ CITY ZIP PH //(/&! .L� i'L/ ,/ J CONTRACTOR LIC NO /2/U //� \_/ ADDRESS AO r )li�/L�!<"Z' % CITY ZIP PHr/, 4/ Cf' j�,/( /Z/ie 1 � CITY BUSINESS LICENSE 1` LICENSE NO EXPIRATION DATE ��JJ / LICENSED CONTRACTORS DECLARATION C//(//01�� //_ 4i>/� .— 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 _ ) \ �/ / N License Class License Number ///G� , z�8 � , � Date Contractor ���YYY r r ///7/ ' ADDRESS lc-,i,iC- .l.r ' r - CITY AND ZIP PHONE \ OWNER-BUILDING DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason 0 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 0 I am exempt under Sec B&PC for this reason —� //) Date INITIAL% 7t�� 'A / / WORKERS COMPENSATION DECLARATION / �/ I hereby affirm that I have a certificate of consent to self insure,or a certificate o orkers'Compensation Insurance,or a certified copy thereof COMPANY POLICY NO r 0 Certified copy is hereby furnished DATE EXPIRES /t/ 0 Certified copy is filed with the city CITY VERIFIED VALUATION (Xc/V 0 Data APPLICANT PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE /m r I certify that in the performance of the work for which this permit is issued,I sh I not employ any person in ELECTRICAL I STRUCTURAL//i� /// 1 any manner so as to a orrm�sjed to the Workers'Compensation L aldornia L o�/ Date l0 / ✓s APPLICANT ` � � PLUMBING I GRADING NOTICE TO APPLICANT If,atter making this Certificate of Exempt ,you should become subject to the Workers'Compensation provisions of the Labor Code,you must rthwith comply with such provisions or ((��� this permit shall be deemed revoked MECHANICAL I ISSUANCE F,E7 /// 1 I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS //�/, ((// v 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 ENTER UPON THE ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES ISSU 2PROVED TOTAL PERMIT��EjjE S e of Applicant Agent Date , 69 K&( /niq��r DATE OF/1�SpJA_ . /�jZ I PERMIT NUMBS /7/( / Print Applicant s/Agent's Na w J ` (C- -( 1 a5) - os-i - I sl glO lq Paz;,--)kc.. 1'4 kP D S- 6,0- 8- f , Operator: DRWN Check 8: 000005081 Date: 10/25/93 00 Receipt A: 0000678 CIECR $93.80 WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR i f S 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 ///5-793 //l � o UNDERGROUNG ELECTRIC SP2 /2//Gh3 4 / GAS TEST SP3 FENCE ENCLOSURE SP5 FINAL SP12 GRADING INSPECTIONS PLUMBING DATE APPROVED/INSPR'S SIGNATURE PRE GRADING MEETING GRI TOE OF FILL GR2 EXCAVATION GR3 RET WALL FOOT GR4 MASONRY/FORMS GR5 DRAINAGE DEVICES GR6 ROUGH GRADING& • BUILDING RELEASE GR7 DATE OF ISSUANCE PERMIT NUMBER FINAL GR12