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Permit No. 3530 0 0 '•'• CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND y'r'a COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY 2001 Grand Avenue i_ase- EllOREM Chino Hills, CA 91709 ADDRESS 2,O C I OAK Ca-N- \a-. L n PROPOSED USE- CO C C X APN • + �� l THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT 0 LOT 4_ L.I. BLOCK TRACT 1 03 77....1 9 I Sp(STRUCT t$PLUMB 'IL MECH ELECT 0 GRADING D T TYPEOF PERMIT 'ANEW 0 ALTER 0 ADDITION m APPLICANT y'[/ fn ���fff 8 m 'ra w♦. I 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT JrQ co LOCATION �( ADDRESS it S A r^'l"•�ku'77✓ PROJECT I N I DESCRIPTION PROPERTY IN SO FEET CITY sh UJ// ZIP C1.7iaPwits )fr./3a OWNER a'1 )✓\ Imo. aAWl L 2 RTJ I �N�� ADDRESS 4. es A r l„r C-- . G .« I I �S ^ t 91 1 � o P81�' I I c(Tv (�'tlD ZIP H ii-CI Ix 4 ARCHITECT ENGINEER LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS NOSES I NO DWELLING UNITS I BWJROOMS CITY ZIP PH \ \ `\1 I FLOOR I EXT WALL I INT WALL CONTRACTOR LIC NO ADDRESS CEILING HEATING I FIREPLACE METAL MASONRY CITY ZIP PH c ��� SEWER MIN DEPTH S/F/100 I SIZE CITY BUSINESS LICENSE LICENSE NO EXPIRATION DATE LICENSED CONTRACTOR 5 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 Business and Professions Code,and my license to in lull force and effect License Class License Number \ \ \ Date Contractor t `�Q.=t't' *S \cl.1C., 0).C.``I L .2Q. ADDRESS �a0 CC..L\\AvC.. 0-4ts..F ell ,4.'tCVeh CITY AND ZIP PHONE n\-. � ` \ OWNER-BUILDING DECLARATION I hoe rm that I am exempt from the Contractors License Law for the following reason 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 far sale ❑ I as owner of the properly am exclusively contracting with licensed contractors to construct NsN, / the protect ZONING I LAND USE ❑ I am exempt under Sec / BAPC for this reason I Date lit 5/1 y- INITIAL A .19_, SETBACKS I MODEL/PLAN WORKERSCOMPENSATION DECLARATION FY I SY I I hereby affirm that I have a certificate of consent to self insure,ore certificate of Workers' Compensation Insurance,or a certified copy thereof RY I SSVI COMPANY POLICY NO GROUP DIVISION TYPE ❑ Certified copy is hereby furnished DATE EXPIRES VALUATION-"`e,.,.. .c:)\ -,-1-N\❑ Certified copy is filed with the city CITY VERIFIED Data APPLICANT PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS C• ON INSURANCE ` , I certify that in performance of the work for which ••rend• sued, shall not•employ any ELECTRICAL S -OOH, STRUCTURAL \` y�� person in any nner as to become sublet • he Workers y•ensation L%w of California , ` Date 9 5 / A-• CANT • v NOTIsubjeCEt oOhsWorkArs Compensation tioCeo11Mtea�Cadp Yn you stfouildwbeth oomply PLUMBING �( (t mak\ I GRADING — with such provisions or this permit shall be deemed revoked MECHANICAL b`� •w I ISSUANCE FEES I CER T •AVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA TION Pt•'R T I AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS, GEO REVIEW I PLAN CHECK ANs •BY -1 THORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE .. ...••.. ...••• D P OPERTY FOR INSPECTION PURPOSESNJ Il. Q . Date C! /f ISS�`�N APP VEB,\ I TOTAL PERMIT RMIT FEE i+re of Applicant or '•_ . ate \ \2JU^t1v DATE OF ISSUANCE AN. I MIT NUMBER Print Appliont'a/Agents Name �\� FINANCE CODE G\\ Swat or: fl4N Creech. A: 04010(!6 WHITE- FILE/GREEN- FINANCE/ YELLOW- OFFICE/PINK- OWNER Da-e: 9115!94 W Receipt B: 0000525WO( $1349. WO( GOLD-ASSESSOR/MANILA -INSPECTOR ',CONSTRUCTION LENDING AGEN• I HEREBY AFFIRM THAT THERE ISA CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 3097 CIV C) LENDER'S NAM' LENDER'S ADDREgq DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRESA DIVISION OF INDUStRIAL SAFETY PERMIT ASA PREFIEQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW \i/ ❑ I CERTIFY THAT NO EXCAVATION 5 FEET OR MORE FEET IN DEPTH,INTO WHICH A PERSON 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 HIGI-1 ❑AS OWNER/BUILDER I WILL NOT EMPLOY ANYONE TO DO WORK WHICH WOULD REQUIRE A PERMIT FROMTHE DIVISION OF INDUSTRIAL SAFETY,AS NOTED ABOVE UNLESS SUCH PERSON HAS A PERMIT FROM THAT DIVISION DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER I HAVE READJTHE HAZARDOUS MATERIALS QUESTIOj4A1141)AND THE WORK APPLIED FOR ON THIS PERMIT ❑IS CIS NOT SUBJECT TO THE APPLICABLE RTQUIREMENTS OF THE HEALTH,AND SAFETYrCODE AND THE LOCAL AIR QUALITY AGENCY C1 27 .r-if lYJ ; - - L , Co• lig 5 I Yom' r 11i a.11 2.1"<11-i (, . ..r9 0210 r . /° tri (eal4 1( // - -_- Ye /J ) ..., r T -q...,fir- ..-. . CITY OF CHINO ILS A KATION FOR A BUILDING PERMIT AND „ r ,COMMUNITY DEVELOPMENT A CERTIFICATE OF USE &OCCUPANCY 2001 Grand Avenue allailiillil Chtno Hills, CA 91709 BUILDING ” / y i ���,1 ,K /'�� ��n PROPOSED USE a' ADDRESS Com. ' t /^' 1 h`__ v APN 'fir THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT or a LOT } BLOCK TRACT 1 't3 STRUCT INPLUMB N' MECH sQ ELECT 0 GRADING I MI TYPE OF PERMIT yi,NEW 0 ALTER 0 ADDITION y APPLICANT y , , t I - r' r• • Pf 1 W 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS f{, .; v 1 s I.1 I / r PROJECT LOCATION ON SIZE DESCRIPTION I PROPERTY I IN SO FEET + h / CITY }t , , ZIP / y 1 .,) PH ,a r t OWNER 1.1 i r t y*; N I !, , 2 ADDRESS , l d.1 ' / y K, ,f 3 i 1 I I 1 iL DV .� ,, i CITYI' t a a ZIP (f 1 1 ,-f PH I I •� 4 ARCHITECT ENGINEER 00 NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS NOSES I NO DWELLING UNITS I BEDROOMS CITY ZIP PH `\` " TC ROOF I FLOOR I EXT WALL I INT WALL CONTRACTOR LIC NO S 4 ADDRESS CEILING HEATING!C, y I FIREPLACE ♦ METAL MASONRY 7 tj f CITY CITY BUSINESS LICENSE ZIP PH SEWER I MIN DEPTH I S/F/100 I 512E r LICENSE NO EXPIRATION DATE LICENSED CONTRACTOR 5 DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION ' ""h. 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 linens•is in full force and effect 1 License Class License Number I Dat• ronlractor A . Q C ", `-`c,,! „,- II ,, •4 ++= ADDRESS ♦ I.• $— v, n 1-<-. tz ,_ )CITY AND ZIP PHONE *t (NI....it") I ' OWNER BUILDING DECLARATION 1 -R j hereby affirm that I em exempt from the Contractors 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 O I as owner of the property am exclusively contracting with licensed contractors to construct the protect ZONING I LAND USE ❑ I am exempt under Sec B&PC for this reason I el s Date yl' f 1 ♦} INITIAI • f SETBACKS I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY I SY I I hereby affirm that I have•certificate of consent to self insure,or a certificate of Workers Compensation Insurance or a certified copy thereof RY I SSY I COMPANY POLICY NO GROUP DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES ❑ Certified copy is filed with the city CITY VERIFIED VALUATIONS\ 4Nc\ \ Date 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 /t I STRUCTURAL W..\\%>r, person in any manner so as to become subject to the Workers Compensation Law of California � ) t" ` Det- 7 1 ' APPLICANT -,; PLUMBING k c. c\ `., I GRADING y_ \1P NOTICE TO APPLICANT If, alter 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 \\'>.y ISSUANCE FEES i,Vv , I CERTIFY THAT]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 / ,� } ll ISSUANCE APPROVED TOTAL PERMIT FEE gr ( 1 \Sy \ \ � Signature of Applicant or Agent Date `\� - _~�`' , ) A fVZ DATE OF ISSUANCE PERMIT ,,\ S V Print Applicant s/Agent e Name � ,. \ ..1, FINANCE CODE .t WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK- OWNER GOLD-ASSESSOR/MANILA - INSPECTOR •ONSTRUCTION LENDING AGENCO . . �---.,„ 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 AnnfF cc 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 ❑ 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 0 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 015 IDS 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 /a/2 s/fy 161. Temporary Power Shower Pan Test / z/LF/7r -ifac1, Foundation Reinforcing Steel Stucco Mesh or Exterior Siding 77/7/70 -ay. Excavation and Forms Insulation / /j 9/fsr Slab Grade Sewer Ground Plumbing Soil Interceptor Ground Plumbing Water Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service /10/fS a` Underslab Gas Lath or Drywall Nailing //io/7S Fireplace Foundation Gas Line Air Test to- 17-54C- Joists and Girders Final Energy Electrical Ground Final Plumbing 7- 3- 96- Iitt Mid-Height Bond Beam Final Heating/A C 8-Foot Bond Beam Final Construction 7-3-45 Aft Final Bond Beam Final On Site Improvements Fireplace Bond Beam Final Off Site Improvements Roof Sheathing q//6i/7`J Final Dedication Framing and Ventilation /2-/)'9/9y �� Final Zoning Roof Covering Final Electrical 7-3 -9 S /{/2... Rough Heating /2,77 p/F% --rgeT Final Gas Service and Ground /z/t p/7 y i Developer Fees Pa -. I.-----, Rough Electrical /o/„o% <51. Fire Dept Approt(aI Verified) (p_, 3_C7$ ( 00 Bonding Y/`/`//" "ay y Certificate of Occupancy r— Over Head Electrical Fence Height Gates Heater Pool Drainage ///j7/9Y c%rd crrrSo ate--- ///hin 10/0e- n9o- r ��L /- / ?-9'c au /,/A /r%iP/7y c%i •c---.4 -_ //�>%r r c/- / ii//F'/9/! cat/ co ,3 C 'f//c/rs c/✓ i/5/9- .vc /c«rs r-o 7/f e i�L'. %/G9�! r/ Waft =/,v U/.tit/- �CGX , SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDE LONG X DEPTH OF ROCK N W E S Inspector's Signature and Initials DATE OF ISSUANCE PERMIT NUMBER e