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Permit No. 3023 ga CITY OF CHINO HILLS 1111/ COMMUNITY DEVELOPMENT -- 20)01 Grand Avenue APPLICATION FOR GRADING AND OTHER MISCELLANEOUS PERMITS Chino Hills, CA 91709 / BUILDING F--�D q I f� 1 n _^� CLEARED �BYI OP APPLICATION TYPE NO W ADDRESS 5 (% 1/ UM�K�� C 1 1 0 `? (� O APN 1. 31 /T-1 J-S THE FOLLOWING WORK IS AUT RIZED BY THIS PERMIT 0 ./ / 0 LOT ���(""') BLOCK TRACT ' �-5 ��11( RUCT L .7CGMB irMECH ELECT ❑ GRADING 8 �(�� 17 NEW ❑ ALTER D ADDITION ❑ SUPERVISED GRADING m OWNER —�✓'�,�/�� ��' id (1'j ❑ DUMP DEPOSIT REQUIRED ADDRESS � UREPAIR ❑ CONVERT ❑ DEMO CUBIC YDS w die CITY ZIP PH I DESCRIPTION OF WORK AND CONDITIONS OF APPROVAL 0 ENGNITERT LIC NO • SLA)i rn I 1 I I A 'P 00! %PPr �- I ADDRESS CITY ZIP PH / J^n /ID CONTRACTOR 0 � C LIC NO 1 (��7n� 14/1"S v/5s �V _ ( _ jS - &0 ADDRESS f;A / I Cc f J ,rrKp -PC' - CITY r(�I (QUO ZIP g()l D PH5 _s---c. -7 , LICENSE NO 476:/ CITY BUSINESS LICENSE J EXPIRATION DATE 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 rs in full force and effect License Class r v,nd13 License Number /7C474 2 Date krZZ--qy Contractor C tad r s ADDRESS CITY AND ZIP PHONF OWNER-BUILDING DECLARATION _ T I hereby affirm that I am exempt from the Contractor's License Law for the following reason 5- ❑ 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 ❑ I am exempt under Sec B&PC for this reason Date INITIAl , WORKERS'COMPENSATION DECLARATION 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 �^ COMPANY 9717-e--- -hr A~% POLICY NO // 8-74e)9 /Ii o/a�j/ ❑ Ce hired copy is hereby furnished DATE EXPIRES 1---- / Cerhfred copy is filed with the aty CITY VERIFIES VALUATION `1�! ,M ^ ("7"---2-' APPLICANT 41A-1 ^_ Qv(w _'DateU �� PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS'Cc APENSATION INSURANCE/ I certify that in the performance of the work for which the permt is issued,I shall not employ any person in ELECTRICAL I STRUCTURAL a 1 f LJ J 0 any manner so as to become subject to the Workers'Corrpensahon Laws of California N (f Date APPLICANT 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 INFORMATION IS CORRECT I AGREE • OMPLY WITH ALL CITY ORDINANCES AND STATE LAWS,AND HEREBY AUTHORIZE REP• TATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTIONED GED REVIEW PLAN CHECK PROPERTY FOR ION PURP•-ES r II /ii /�2ily ISSUANCE APPROVED TOTAL PERMIT FEE w a� �a Signature of App -�T!'��A�e � ..' Date �(� � �e�e% afi_� DATE 9F I? I nLi I PERMIT NUMBER & Print Applicant's/Agent's Name ((f "� �/ J i Cq s F , ., L_,.'ait:i i,),,,N C7,ech tti 4d(fX(C1224 1. ,,,, I:I tl jP 1,13 k.ilelig t tl a u WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR =iiE I $4E1.0 • 0 BUILDING ADDRESS I ' ' ' LOT BLOCK TRACT ` 'INSPECTIONS'RECORD OWNER . + ,\ ADDRESS tom.. .. ., CITY ZIP PH SWIMMING POOL INSPECTIONS PLUMBING', DATE ' APPROVED/INSPR'S SIGNATURE LOCATION/DIG SP1 I j%26`-7 /�/J� REMARKS STEELBONDING/PLUMBING TEST SP3 I �j//�r�/ /,I' f APPROVED TO GUNITE SP3 I ih/ -.7,e,' S , , / I ?h/ry C'/d " r7,-S 'iE.-4;04°, .4 I r ,- : :1, ' / 1 UNDERGROUNG ELECTRIC SP2 cf li�'j t _ : ,,\, r ..y , ; GAS TEST SP3 j0/4m/ FENCE ENCLOSURE SP5 f)14>4. FINAL SP12I Yzf/// _ GRADING INSPECTIONS PLUMBING DATE APPROVED/INSPR'S ,_..N. ._-,0\\ \,� , SIGNATURE \� \ .- �\1>\�- \',\- \t. \�')%'1.St 1 PRE GRADING MEETING GR1f _ - �^�� (f Z� ,' C-/(2PRb' 9'10,(1/71-6--- TOE OF FILL GR2 r EXCAVATION GR3 RET WALL FOOT GR4 MASONRY/FORMS GR5 1 , 5' S \ , J, r;'\, ; ` . ' DRAINAGE DEVICES GR6 1 ROUGH GRADING& BUILDING RELEASE GR7 \` DATE,OR ISSUANCE PERMIT NUMBERI,; FINAL % , ' GR12 I , ', ` 1 _ �) ),,11,,}' 1 d1 , _\ ' t -At , , I i