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Permit No. 0536 CITY OF CHINO HILLS III • COMMUNITY DEVELOPMENT 2001 Grand Avenue APPLICATION FOR A BUILDING PERMIT AND A CERTIFICATE OF USE&OCCUPANCY Chino Hills, CA 91709 BUILDING CLEARED BY APPLICATION TYPE NO Op ADDRESS �V/r1.l bk . �rt-7�� �J r . 0 APN I Dai I I - r3 I E THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT 0 LOT BLOCK TRACT ❑ STRUCT ❑ PLUMB ❑ MECH C- CCT o 7),;(_.A. jTYPE OF PROJECT JEW ❑ ALTER ❑ ADDITION 0 OWNER O � j {. I,'Ejs D REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS l n PROJECT I LOCATION ON I SIZE 3 �V�-_ OAK- ( n,�-f- K- LA DESCRIPTION PROPERTY IN SO FEET CITYCf;„yb 1414 I 1 AN ZIP ! ` . 9 )1 I c) PH 3S-'/ is 1 I I ENGEECTT��-, IWA w, a ENGINEER LIC NO 2I I ADDRESS 3 I I Vv CITY ZIP PH REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION c\-) CONTRACTOR �I h i t J`c: n�� LIC NO k.4").. .:0-it �0 ^� oC � G4—✓�— (� ADDRESS I ,+-1� G!�C /'1�r1 u/.,Ii: ���i� i'lT�! �'(�(�� CITY (12l, 41 tsli Ire ZIP c� 2 bO 4_ P 1 OV1U16 4YJcf J + ' CITY BUSINESSv_LICENSE 1 LICENSE NO EXPIRATION DATE 1! l LICENSED CONTRACTORS DECLARATION (� 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 b� License Number Co cilfhv .d O l Date I Contractor ADDRESS Li( 6-0 E-64 11.C i it CITY AND ZIP *gt\/Gi��l DC°>PHONE-1--636-A6) ICC, - OWNER-BUILDING DECLARATION r I.1,D I hereby affirm that I am exempt from the Contractors License Law for the following reason 1 0 I,as owner of the property,or my employees with wages as their sole compensation,will do the work, I PERMIT EXPIRED BY LIMITATION and the structure is not intended or offered for sale I ` \ 0 I,as owner of the property,am exclusively contracting with licensed contractors to construct the project 0 I am exempt under Sec UPC for this reason I \ ' A 3,) Date INITIAL I Dat NN .Initial WORKERS'COMPENSATION DECLARATION I I hereby affirm that I have a certificate of consent to sell insure,or a certificate of Workers'Compensation Insurance,or a certified copy there f COMPANY 14471// I / b /kY4411.4 POLICY NO GROUP DIVISION TYPE 0 Certified copy is hereby furnished DATE EXPIRES ❑Certified copy is filed with the city CITY VERIFIEll VALUATION Data APPLICANT PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE I certify that in the performance of the work for which this permt a issued,I shall not employ any person in ELECTRICAL �� I STRUCTURAL any ma neer Psis i become Iybjesllo the Workers Compensation Laws of California —�— Date D 5 I "�`7 APPLICANT PLUMBING I GRADING NOTICE TO APPLICANT ff,after making the 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 I ISSUANCE FEES `l� / .� 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 REPRESENTATI.1 S OF THI -CITY • ENTER UPON THE ABOVE MENTIONED -------) PROP:RTY FOR INSPECTION•LL RP• I 4 � ISSUAN E PPROV TOTAL P IT FELE} 6,,0 A*" .t.41 i.J 4i:..1 ��l I Sr1C1�1 �D / tur-of Applicant or Agent /� Date / �' rA �tA D/// / FIS ANC PERMIT NUMBER (/ Print Applicant's/Agent's Name 7 I Q�� �.O WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR - . - II • BUILDING , ADDRESS - LOT BLOCK TRACT BUILDING INSPECTIONS RECORD. OWNER ADDRESS I- CITY ZIP PH - PLUMBING DATE APPROVED/INSPR'S SIGNATURE _ , GROUND SOILNVATER P1 TOP OUT P2 - - - - - SHOWER PAN P3 REMARKS SEWER P5 GAS TEST P6 r� ti FINAL PLUMBING .P12 - - - ' MECHANICAL • DATE' • , ' APPROVED/INSPR'S -- - - - ' - — - SIGNATURE I UNDERGROUND FLOOR M1 ., - ROUGH M2 • FAU/AC M4 FINAL MECHANICAL M12 - - - _- . ELECTRICAL DATE APPROVED/INSPR'S _- __ _ SIGNATURE , TEMP CONSTN POWER E3 I I - — UNDERGROUND - - — — — - PVC-METAL-D-B C --..mE1'- .,a -„ ..-, .o.....=sem.,.. ROUGH WIRING RECEPT SPACINGS a. 4 9 • d""'-•»p'"" " .7-.q"°'`'"it''�+�p SERVICE,CIRCUIT„,,,,L� .E2 .a_., '.ii 'dh b,, 14,iii A•.,., I If FINAL ELECTRICAL E12 1 -_STRUCTURAL r�--,....' -i• 4APPIOVED/INSPR'S DATE-, • SIGNATURE FOUNDATION LOCATION Si REINFORCED 0 UFER 0 I '� �I ` y`v V SLAB REINFORCED 0 MEMBRANE O S3 I _ ' , - FLOOR FRAME/INSUL S4 I MASONRY S11 I FIREPLACE S11 I ROOF FRAMING ROOF SHEATHING S5 1 - FRAMING S6 I I S - INSULATION__- _ SOUND ENERGY S7 LATH EXTERIOR SBI LATH INTERIOR/GYPBOARD S9 APPROVED/INSPR'S SIGNATURE DATE OF ISSUANCE PERMIT NUMBER i _ r, ` - BUILDING FINAL 81.2 . - - - - - -