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Permit No. 4501 • 0 szN CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND t- COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY r 2001 Grand AvenuelliM _llilillil Chino Hills, CA 91709 - BUILDING ADDRESS I sq(�1n �.� C� ��� 17 I PROPOSED USE F F `' + 1 0-rV10 �t�4 The gen 177 0 1 APN W 17 Sl0 1 I . THE.FOLLOWING WORK IS AUTHORIZED B�HIS PERMIT D LOT 3/' ^- BLOCK TRACT I� EKTRUCT ❑ PLUMB ❑ MECH' LCT 0 GRADING 0 APPLICAANNTJ��y�m * ff F7+� �f 1 J JY 73 TYPE OF PERMIT 0 NEW R 0 ADDITION co V 1 l7lJ IT 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT LOCATION T ADDRESS '`lS/Cd1� �A� MA/ni A.,joy) I)R �`�'( DESCRIPTION I PROPERTY N I SIZE IN SO FEET CITY •hII/.aOY�y Mil\ 21P�P 4III10q I '/LLPH -5g 7-0 TSC 1 I I 15O -� `I OWNER♦ IAM t /�1I/,y(�/REA IQ�S, i/L-kity j� 2 I I ��VJI `(\�1' `(r ADDRESS I /--'YQ) OAK\` C'17i1 IIIQ)V�A 1 l /(�—/ /`�� 3 I I .X.// . CI `�11\V) 1-hill ZIP {i / Q /(/ PH 3-1 /-c./ 7t F/4 I I 5--/ ARCHITECT l ENGINEER LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS O CITY ZIP PH CONTRACTOR LIC NO ROOF I FLOOR EXT WALL INT WALL ADDRESS CEILING HEATING I FIREPLACE METAL MASONRY CITY DP PH SEWER MIN DEPTH S/F/100 SIZE CITY BUSINESS LICENSEI LICENSE NO EXPIRATION DATE 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 Business and Professions Code, and my license is in full force end effect License Class License Number Date Contractor ADDRESS CITY AND ZIP PHONE OWNER BUILDING DECLARATION I hereby affirm that I am exempt from the Contractor•License Law for the following reason ❑ I,as owner of the property,or my employees with wages as their sole compensation,will do t work end the structure a not intended or offered for said i i(YI ••owner o1 the property am ezduarvey contracting with licensed contractors to construct the protect ZONING LAND USE ❑ I em exempt under Sec BBPCJor this reason ^ �' C' I 5 Dat• '44"-al ..XV)... INITIA( SETBACKS I MODEL/PLAN WORKERSCOMPENSATION DECLARATION FY I SY I hereby affirm that I have a certificate of consent to self insure,ora certificate of Workers' I I Compensation Insurance,or•candied copy thereof RY SSY COMPANY POLICY NO GROUP -/f 7 DIVISION TY'E v J f{s' O Certified copy is hereby furnished DATE EXPIRES !►/1�`� ❑ Certified copy is filed with the city CITY VERIFIED VALUATION a,O DD_____ Dal. APPLICANT PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE I certify that in performance of the work for which this perms is issued I shall not employ any ELECTRICAL ab J STRUCTURA, - / personnu ina nnersoas coma subject to theWo re ••mp eh• Law of California 1/ r II( Oete v �� APPLICANT I A PLUMBING I GRADING f 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 perms 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 Wre ofApplicant; or Agen._LPECT PURPOSES Dat, ISSUANCE SAPPROVED I TOTAL PERMITFEE e `S . Lv T D619 5' f t //'7'/—_ I PERM /OT HUMBER ,`I J �nt�App�bcant•/Agent's Name `LyJyr /�� `'-yJ'1•[sY�—`l{J1 FINANCE COJDE GL\ Operator: VIRGINIA Chectt B: 000000000 Date: 5/04/95 00 Receipt 0: 0000317 WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK-OWNER CAH t Tender $94.75 RamatTendered (94.75 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 ADORES? DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION 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 • t •• — .� — , I CERTIFY THAT NOEXCAVATIONSFEET OR MORE FEET IN DEPTH,INTO WHICH A PERSON ISREQUIRED TO DESCEND,WILL BEMADE IN CONNECTION (.f WITH WORK AUTHORIZED BY THIS PERMIT,AND THAT NO BUILDING,STRUCTURE,SCAFFOLDING.FALSEWORK,OR DEMOLITION OR DISMANTLING 11 THEREOF WILL BE MORE THAN 36 FEET HIGH " — •, if 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 tj 1 .) DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER I HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT DIS DS NOT SUBJECT TO THE - APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE.LOCAL AIR QUALITY AGENCY , • • • • • I1 a 7' ,i 11, __. •« CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND to; .. COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY 2001 Grand Avenue Elliiiiii_ _ Chino Hills, CA 91709 ADDRESS 13 Qa�, l n-K C.n•/VCjInn 1� PROPOSED USE /� �.y / ( •� y,.y)} C APN II 11 V l'�a rift t'• +.r° i /h y r i—t-)J ' ) Z 1 U{ / ,' � 3 I THE,FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT a LOT y{ f "\ BLOCK TRACT "'}/ t•, 1 'S /DTRUCT 0 PLUMB 0 MECH O.EIFCT 0 GRADING 0 S S Rt. y • y IL rt I TYPE OF PERMIT 0 NEW `O,ALTER 0 ADDITION y APPLICANT I '' 1 I 1 .( IC` tt �-./ I0 REPAIR 0 CONVERT 0 DEMO ❑ OCCUPANCY PMT " ADDRESS ' /I f {v'• / I 1 ` PROJECT LOCATION ON I SIZE 11 ! DESCRIPTION PROPERTY IN SO FEET CITY‘ ) I 1 : ,I ZIP I I PH ' /' 2 ,. 4` i. I I „ a. OWNER ` I f t } i ,L,, -I 2 I \\jj '{, ADDRESS ; f t r r . , ! ' '\ 3 I I e ! t CITY / 1 i • 1 ZIP : 1 1 !• / PH s 4 I I �/ �•• ARCHITECT ENGINEER LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION _ .0.---- ADDRESS ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS CITY ZIP PH f ROOF I FLOOR EXT WALL INT WALL CONTRACTOR LIC NO ADDRESS CEILING HEATING I FIREPLACE METAL MASONRY _ I CITY ZIP PH SEWER MIN DEPTH S/F/100 I SIZE } CITY BUSINESS LICENSE LICENSE NO EXPIRATION DATE 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 Business and Professions Code,and my license is in full force and effect License Class License Number • Date Contractor ••_ ADDRESS .1w• CITY AND ZIP PHONE I\ OWNER-BUILDING DECLARATION I hereby affirm that I em 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 sob compensation,will do the work and the structure is not intended or offered for sale Ar Oel as owner of the property am exclusively contracting with licensed contractors to construct ZONING I ( LAND USE the protect - 0 I am exempt under Sec B&PC for this reason - I `I Date "••• I -j INITIAI SETBACKS I MODEL/PLAN WORKERS'COMPENSATION DECLARATION FY I SY 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 COMPANY POLICY NO GROUP 1 / DIVISION TYPE JY I • 0 Certified copy is hereby furnished DATE EXPIRES VALUATION f LI Certified copy is filed with the city CITY VERIFIED i Dat• APPLICANT PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE ( ` ! I certify that m performance of the work for which this permit Is Issued I shall not employ any ELECTRICAL I1 r^ I STRUCTURAL Lf J3 �7j person In any manner so ae to become subject to the Workeri Compensation Law of California 1111 ✓ Date I APPLICANT PLUMBING GRADING t NOTICE TO APPLICANT 11,after making this f lcate of Exemption,you should become subject to the Workers'Compensation provisionsns of the Labor Code you must forthwith comply 7X- 1/4 - '-��� with such provisions or this permit.hall be deemed revoked MECHANICAL ISSUANCE FEES i NN/ 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 ' ISSUANCE APPROVED TOTAL PERMIT FEE -._ i• I Ci ILai / Signature of Applicant or Agent Date ` A-T DATE OF ISSUANCE .w,- PERMIT NUMBER( Pnnt Applicant a/Apenls Name 4✓ t i ' 1✓, �- FINANCE CODE fir.+/" L 1 11 ill WHITE• FILE/GREEN- FINANCE/ YELLOW- OFFICE/PINK- OWNER GOLD-ASSESSOR/MANILA - INSPECTOR ONSTRUCTION LENDING AGENC• 1c 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 NAMF LENDER'S ADDREcc DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION 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 0 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 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 EIS DIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY BUILDING INSPECTIONS RECORD I DATE I INSPECTOR I I DATE I INSPECTOR Setback/Location I I I Rough Plumbing I I Temporary Power Shower Pan Test Foundation Reinforcing Steel Stucco Mesh or Exterior Siding Excavation and Forms Insulation 476"/ S- —47f' 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 7/ct/ 5- _,46,7----- Fireplace ---- Fireplace Foundation Gas Line Air Test Joists and Girders Final Energy Electrical Ground Final Plumbing Mid-Height Bond Beam Final Heating/A C cr/, -r.05: - 8-Foot - 8-Foot Bond Beam Final Construction ;f/o/fS y.92a-- Final Bond Beam Final On Site Improvements Fireplace Bond Beam Final Off Site Improvements Roof Sheathing , , / Final Dedication Framing and Ventilation (j/,j/%S �y� Final Zoning Roof Covering Final Electrical d/6/y'S C � Rough Heating I Final Gas Service and Ground , , I Developer Fees Paid Rough Electrical 4//1/215— C- Fire Dept Approval Verified Bonding T' - Certificate of Occupancy Over Head Electrical I Fence Height I Gates I Heater I Pool Drainage I 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