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Permit No. 3497 0 0 a+•N CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND A CERTIFICATE OF USE & OCCUPANCY .._ COMMUNITY DEVELOPMENT r-' 2001 Grand Avenue gliiiiSilagi Chino Hills, CA 91709 ADDRESS j ef✓ ( �/ "L 1.<:, (4/44 lO f 1$ A PROPOSED USE- ` C /pyo)2 rel N� I V perrho Covo/ v APN I a/ `Ji. &&l' ^ Z THU-GLOWING WORK IS AUTHORIZED BY THIS PERMIT `` // a LOT 2 mBLOCK TRACT 06:15..-. 'LVSTRUCT 0 PLUMB ❑ MECH ❑ ELECT ❑ GRADING � / O �1 �3 or. //�� 33 TYPE OF PERMIT 0 NEW 0 ALTER S.4 DITION CD m APPLICANT { IAKI/�A t f lUS I Qo`r- 1 1010 CO "^�11A�1t 1111/� ^n ^ 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS c$ 4(o ILD CAL( A. D� PROJECT CRIP LOCATION ON SIZE �/� t�//vv �,lllIIILLLLLL J /vI� �`-- a DE/�S/yCR�I`Py.TtII O^N I PROPERTYj/��1L�J(� I IN`SSO(j FEETS\,L (ci ��. CITU f 1-'1dfa �1 J clizir. . %c n 14H i-(/ll�? 1P4 I 'V I Pact I / ` r/� V(8� OWNER MEL• CLD 1^I /A'�I 2' I I Y U ADDRESS 1 _ I`c'-'1 31 04K ��rN /0 D 3 I I CITY/' 11100 NILS ZIP qI /OI gal-PH J /`�a•JS y I I 0 ARCHITECT ENGINEER LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS 7C CITY ZIP PH ROOF FLOOR EXT WALL INT WALL CONTRACTOR 'MALE L, 1 LIC NO / I Ciel` r� ADDRESS 24(,t'b �.)I co LL A b�O,�J I / CEILING HEATING I METALMASONRYCITY ZIP LICENSE NOL Ic CAO EXPIRATION BUSINESS DATELICENSE PH HT SEWER I MIN DEPTH I S/F/100 I SIZE CCCYYY7 LICENSED CONTRACTOR S DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000 of Division 3 of the BusinessQand Prolusions Code, end my license is in full force end effect License Class License Number I.5-5--)113 Det• G-9 O/—,C 11 Contractor/'1�/AL_ -_ & A/`-i/`--II ADDREcc 741.117 LJI ILl L ,T` IJ CITY AND ZIP PHONE OWNER BUILDING DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following ruson ❑ I as owner of the property,or my employees with wag..a their sole compensation,will do the work and the structure is not intended or offered for sale O I,as owner of the property,sm exclusively contracting with licensed contractors to construct ZONING I LAND USE the project ❑ I em exempt under Sec 88PC for this reason c-1-\—I t'P,�-•\ • I I_f-I Date INITIAL SETBACKS I MODEL/PLAN WORKERI hereby affirm that I haves s certtical of consent toCOMo self insRATor a certificate of Workers'ONFY I SYS.' I Compensation Insurance,or a certified copy thereof RY&p I SSY /. .-_ I COMPANY POLICY NO GROUP p DIVISION TYPE un O Certified copy is hereby furnished DATE EXPIRES ❑ Certified copy is filed with the city CITY VERIFIED VALUATION r DM.. APPLICANT PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE / I certify that in performance of the work for which this permit is issued,I shall not employ any ELECTRICAL I STRUCTURAL^ `�^ person In a manner W a,p become subject to the Wor o ten Law of California /X -V Dal.. Cl7 LJ•I APPLICA - PLUMBING I GRADING NOTICE TO APPLICANT If,after making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must forthwith comply •� ���iii with such provisions or this permit shall be deemed revoked MECHANICAL ISSUANCE FEES N — , I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA I TION IS CORRECT I AGREE TO OMPLY WITH ALL CITY ORDINANCES AND STATE LAWS, GEO REVIEW I PLAN CHECK •E 5 NTATI THIS CITY TO ENTER UPON THE ABOVE ENTIONED PROPER ,j 'EC�TION PURPOSES I ' / L ISSUANCE PROVED TOTAL PERMIT FEE ale / te- GI4,3a Signature of Applicant/aor Agent1lDate ///SUO/J///5 1 JALE A . NILI—I hi I OATS Of ISl • 7 ?c I PERMITNUMBERU9E1 Print Applicant s/Agent's Name C,!-/J FINANCE CODE G Operator: VIRGINIA Check 1: 000000971 Date: 9/09/94 00 Receipt 1: 0000321 WHITE- FILE/GREEN- FINANCE/ YELLOW- OFFICE/PINK- OWNER CHECK $94.30 GOLD-ASSESSOR/MANILA - INSPECTOR SONSTRUCTION LENDING AGENC• / I HEREBY AFFIRM THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 3097 CIV C) LENDER'S NAME LENDERS ADDRESF DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION C " Ll% n ^ . , n's , ✓I ( ' i r�' I c.1 THE CALIFORNIA HEALTH AND SAFETY CODE,REQUIRES A DIVISION OF INDUSTRIAL SAFETY PERMIT AS A PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF-THE CERTIFICATES BELOW It t` ❑ I CERTIFY THAT NO EXCAVATION 5 FEET OR MORE FEET IN DEPTH,INTO WHICH A PERSON ISREQUIRED TO DESCEN,WILLE MADE IN CONNECTION WITH WORK AUTHORIZED BY THIS PERMIT,AND THAT NO`BUILDING,STRUFTURE,SCAFFOLDING,FALSEWORK,OR DEMOLITIONCOR DISMANTLING THEREOF,WILL THAN 36 FEET HIGH � ,t'uf- t K. C ❑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 / / I. I HAVE READ,THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE,WORK APPLIED FOR ONS THIS PERMIT DIS DIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY 1 4 , C re • r lI A ( J , 4 / =f 1 4-j • �I�I j f1 'f 1 3e ftJ ` =1 l F. rpN 1 , \\-3 ) • ' r � /1anJ� l = •M CITY OF CHINO L3 A, 'CATION FOR A BUILDING PERMIT AND b..17:014.1. ici..)' A CERTIFICATE OF USE & OCCUPANCY - CdMMUNITY DEVELOPMENT 2001 Grand Avenue PIMIII_111111 Chino Hills, CA 91709 BUILDING r' ,' i 1 (--,1 AA /'� .[/�j V PROPOSED USE- CO ADDRESS �-� W� 1` !'VJ �! 1 f'�� -� \\j / U,10/4.(( APN I It Iz THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMITcs LOT BLOCK TRACT { \ ,� �.STRUCT ❑ PLUMB 0 MECH 0 ELECT 0 GRADING 0 / 0 X) A /y �p �p TYPE OF PERMIT 0 NEW 0 ALTER 0-ADDITION Dl APPLICANT k Itis Atf{6 I�f &vs.% _ye E V S� Co 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS = It 7 �� inA« PROJECT I LOCATION ON I SIZE S ^1 it " t r, DESCRIPTION PROPERTY IN SO FEET CITY 11 1 lillAi) V1"/1 t 7 1+P{ L-3 c 1 }PH .t'1 1- n i 1! , ..) 1_,A; ) I 1',"kt4 L I / 1 t.�., Cr, OWNER I'r 1C Lr. jt i&*) `f •—• 2 r I I , ADDRESS t `�] (1 '-l1 L (.}1 he, Ga ha..16� a�- yr 3 I I -- CITY IA IAJ� /4 it.11/2 ZIP li 7(J tIUPH ci7d02cS 4 I I 1 / ARCHITECT ENGINEER LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION _ ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS ' CITY ZIP PH ROOF I FLOOR I EXT WALL I INT WALL C. CONTRACTOR �1 `L M �I��1 L t LIC NO I f 1� -„a ADDRESS ^! .h('f j' S` I L r� f ri 1 1 ly l 1 7 / CEILING HEATING FIREPLACE ;j... .C..4 ' 1 l .4 t 7 1_ I METAL MASONRY C. CITY ZIP PH LICENSE NO r S CCITY P BUST N DATELICENSE t j^''��;,1ITT() SEWER I MIN DEPTH I S/F/100 I SIZE LICENSED CONTRACTORS DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION I hereby affirm that I am licensed under provisions of Chapter S(commencing with Section 7000 of Division 3 of the Business and Professions Code,and my license is in full force and effect License Class IA License Number 1r i v. 5 113 0 411_ t al 'lar- tit-in'.1 nL t I `v 0 C¢.\ /00...1.X.-/00...1.X.- Lia.+, Neth .el Date i' n- -t contractor ! `� ADDRESS ' 1 1 i_1,L �i 1,+4 1 t 14- I.) •-•,\ ►a„ !'.A Nasi\..J, CITY AND DP PHONE N. ._ e. OWNER BUILDING DECLARATION ‘13 I hereby affirm that I am exempt from the Contractor's License Lew for the following reason O I as owner of the property,or my smploysss with wages as their sola compensation will do the work,and the structure is not intended or offered for sale O I as owner of the properly em exclusively contracting with licensed contractors to construct the protect ZONING .L.G I LAND USE O I am exempt under Sec B&PC for this reason C IA I i'IIr) \ I I- it I Date INITIAL SETBACKS I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY AD I SY 3 I 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 RY �`• I SSV LAN I COMPANY POLICY NO GROUP 1 • J DIVISION TYPE 11;1 0 Certified copy is hereby furnished DATE EXPIRES O Certified copy is filed with the city CITY VERIFIED VALUATION ' `` t ' .' "' DateAPPLICANT .. PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE r I certify that in performance of the work for which this permit Is issued,I shell not employ any ELECTRICAL I STRUCTURAL// � person in any manner so as to become subject to the Workers Compensation Law of California �(�-�. t '9 • Date �'� APPLICANT 4t's ""�" PLUMBING I GRADING NOTICE TO APPLICANT If,after making 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 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 ` .���/ 1_ 5. C- 5 P♦, ISSUANCE APPROVED TOTAL PERMIT FEE � 9 ? Signature of Applicant Or Agent Date 1\i 0 DATE OF ISSUANCE PERMIT NUMBER i ALS A 11At tit I ( 'i/ rrq 3yCI1 Prim Applicant's/Agent s Name r FINANCE CODE C `I WHITE- FILE/GREEN-- FINANCE/ YELLOW- OFFICE/PINK- OWNER GOLD-ASSFSSOR/MANILA - INSPECTOR i\ CONSTRUCTION LENDING AGENC, I HEREBY AFFIRM THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FORWHICH THIS PERMIT IS ISSUED (SEC 3097,CIV C) LENDER'S NAMF LENDER'S ADDRESC DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRESA DIVISION OF INDUSTRIAL SAFETY PERMIT AS A PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW o I CERTIFY THAT NO EXCAVATION 5 FEET OR MORE FEET IN DEPTH,INTO WHICH APERSON IS REQUIRED 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 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 DIS 015 NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY BUILDING INSPECTIONS RECORD DATE INSPECTOR DATE INSPECTOR Setback/Location Rough Plumbing Temporary Power Shower Pan Test Foundabon 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 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 Ventilation 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 Fence Height Gates Heater Pool Drainage I .i 91757M/ 74/o f'Z't4 / 1�k , ) - -, SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDE LONG X DEPTH OF ROCK N 0 W E S Inspector's Signature and Initials DATE OF ISSUANCE PERMIT NUMBER