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Permit No. 3081 111 Ill e; : CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND A' COMMUNITY DEVELOPMENT A CERTIFICATE OF USE &OCCUPANCY •'a -dr 2001 Grand Avenue __ Chino Hills, CA 91709 - BUILDING ADDRESS 309/ O (74,4 rh/) PROPOSED USE COC APN /� 3/ 3-7,-/ si5 it � n —T/HE,OLLOWING WORK IS AUTHORIZED BY THIS PERMIT LOT // BLOCK TRACT /L,� t7 ISYSTRUCT PLUMB 0 MECH 0ELECT 0GRADING 0 JJ qqq TYPE OF PERMIT 0 NEW 0 ALTER 0 ADDITIONfil APPLICANT , ,�' sig /p p co n /r \ 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT LOCATION ADDRESS /��//�/ 1? f7( �9,(ldrrr/�1/J (17" �Q. DESCRIPTION I PROPERTY I SIZE INSO FEET �J I CITY 1 /7 ��d ZIP 9777///) `Jr PH !k Oat I I I `! �i 0 OWNER 4473 /r Ofrg !1�/ 2 I I ADDRESS 30Q I-L•I Db, e. r 3 I I CITY ry,/' ZIP Of 70 9 PH 5-97 97t 4 I I a ARCHITECT ENGINEER LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION r ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS 0 CITY �y ZIP PH "P CONTRACTOR /✓I/ /L`i��9 GS LIC NO / o> ROOF I FLOOR I EXT WALL I INT WALL ADDRESS �/ o .5._ n CEILING I HEATING c A. I FIREPLACE n. . u le, METAL MASONRY CITY ZIP PH SEWER MIN DEPTH S/F/100I 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 provision,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 se / LicenClass / ,c3 License Number / Xc-4 7.--- Date 7-/—c7 Contractor ADORES., / CITY AND ZIP PHONE OWNER BUILDING DECLARATION I hereby affirm that I am exempt from the Contractors License Lew for the following reason O I as owner of the properly or my employees with wages as their sole compensetion,will do the work and the structure is not intended or offered for sale O I as owner of the property,am exclusively contracting with licensed contractors to construct the protect ZONING I LAND USE O I am exempt under Sec B&PC for this reason I Date INI TIAI SETBACKS I MODEL/PLAN WI hereby affirm that havea cerh mate of consent to self insure, I SY I e,ori•certificate of Workers' Compensation Insurance or a certified copy thereof / �(//J� RY I SSYI COMPANY 65-7pre-yL- iCA�J POLICY NO //h l/ V/ GROUP DIVISION TYPE ❑ C died copy a hereby furnished DATE EXPIRES L ye Certified copy is filed with the city CITY VERIFIE%ry,////y'/�.{/�A VALUATION 670o Date ice - 4 se APPLICANT V tl//A (�1/U4 (� ,,,AAAIIIAA7g �" AAARRR PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COIJPENSATION INSGA%HCE I certify'het in performance of the work for which this permit is issued,I shalt not employ any ELECTRICAL I STRUCTURAL 90 person in any manner so as to become subject to the Workers Compensation Law of California �/ Date APPLICANT PLUMBING I GRADING NOTICE TO APPLICANT II,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 aZ7 00 I CERTIFY THATvI� VE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA TION IS AGREE TO COMPLY WITH ALL CITY NCES AND E LAWS AND MND HONE RR y RTY FOR REPRESENTATIVES E PURPOSES THIS TORE TER UPON THTE ABOVE GEO REVIEW PLAN CHECK ION it', I I /I J 1(/ ----W ISSUANCE APPROVED TOTAL PERMIT FEE(((���rrr Signature of •naen o Ag. I '7 Date / 9 91 / cit DATE ) S/C1 AI PERMIT T.NUMBER Print Applicant s/Agent e Name 7/I `�f)/�`'^J8 I FINANCE CODE /e LI WHITE- FILE/GREEN• FINANCE/ YELLOW- OFFICE/PINK- OWNER GOLD-ASSESSOR/MANILA - INSPECTOR Pk. a ZS '- CONSTRUCTION LENDING AGEN• 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 ADDREFF DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION ' I ; N\ ". L_\ 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 '``,� \ • \ Z \ ❑ 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 RIVISION OF INDUSTRIAL SAFETY,AS NOTED ABOVE UNLESS SUCH PERSON HAS A PERMIT FROM THAT DIVISION DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER \`t ' I HAVE'READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE`WORK APPLIED FOR ON TRIS PERMIT IDS ❑IS'NOT•, SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY vD:; ) I 1 k. , r \'\N \, '\• \ i. '1 \ \• �• , j�' 1 • • \J1J` • '1 • 1 } ) . . �. -.171.....L'• CITY OF CHINO LS A It FOR A BUILDING PERMIT AND eaCOMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY Ka;: --1:1;,;-": � 2001 Grand Avenue Chino Hills, CA 91709 BUILDINGPROPOSED USE w ADDRESS Y - Lit_ •.- 4:r x C P k-:p �I 1u L -1 I APN /t1 / l =, / THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT o /2/1-,1 II � / D LOT -, .. BLOCK TRACT / 2 l furSITRUCT ❑ PLUMB 0 MECH 0 ELECT 0 GRADING iO 33 ! TYPE OF PERMIT 0 NEW 0 ALTER 0 ADDITION cn APPLICANT ��I •'/ r tom' G ( rF ^J I/ r cn ! 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS 1 (' - 1/ ( r 5 . v ` ' 7 PROJECT LOCATION ON SIZE y /_ DESCRIPTION I PROPERTY I IN SO FEET • CIN 1•• /.1 . f ZIP // ll PH �T , is, >( -1 1 I I T , J/ OWNER rte ' 'V 7 I './--) 2 I I ....-- ---- ADDRESS -"ADDRESS ,t / / „ 1r . ( ' t i I`-�-.-. 3 I I • CITY % }r ZIP // r/ PH 'J/ / 7/? I I �� 4 ARCHITECT ENGINEER LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION rs ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS r CITY ZIP PH ,1( // t / r /r ROOF I FLOOR EXT WALL INT WALL }..' / CONTRACTOR 1 LIC NO 1t l I`jt/��- ADDRESS CEILING HEATING I FIREPLACE METAL MASONRY CITY ZIP PH SEWER MIN DEPTH S/F/100 SIZE CITY BUSINESS LICENSE LICENSE NO EXPIRATION DATE LICENSED CONTRACTOR 5 DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION -I hereby album that I am licensed under provisions of Chapter 9(commencing with Station 7000 of Division 3 of the Business and Professions Code,and my license is in full force and&tact License `r Class l " License Number / I Z- // •/- Oaf• 17` 2 , //(11 Contractor ADDRESS CITY AND ZIP PHONE OWNER BUILDING DECLARATION I hereby affirm that I am 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 solo compensation will do the work,and the structure is not intended or oflered for sale 0 I 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 Date INITIAI SETBACKS I MODEL/PLAN WORKERS'COMPENSATION DECLARATION FY I SY I hereby Minn)that I have a whitest&of consent to sell Insure,or a certlticate of Workers • Compensation Insurance,or a certified copy thereof RY I SSY I ♦f ) COMPANY POLICY NO I/ 't /1 / GROUP DIVISION TYPE 0 Certified copy is hereby furnished DATE EXPIRES r, / V / VALUATION ' '\ ,i _ J Certified copy is filed with the city CITY VERIFIED) G'i• ( Ile • Data /- I '/ /APPLICANT I ' / t 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 STRUCTURAL ' ' 9-`\ person in any manner so as to become subject to the Workers Compensation Law of California •'1 Date APPLICANT PLUMBING I GRADING NOTICE TO APPLICANT II,alter making this Cerlif mate of Exemption,you should become subject to the Workan Compensation provisions of the Labor Code you must forthwith comply - with such provisions or this permit shell ba doomed revoked MECHANICAL ISSUANCE FEES ;l Li`) 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 l ISSUANCE APPROVED TOTAL PERMIT FEE I I / r , Signature of Applicant or Agent Data /DATE OF ISSUANCE PERMIT NUMBER Pnnt Applicant s/Agonl a Nems ( "------- C --/! I f LI - • Y I \ r. eIN NCE CODE `— Li / 0 WHITE- FILE/GREEN- FINANCE/ YELLOW- OFFICE/PINK- OWNER GOLD-ASSESSOR/MANILA - INSPECTOR 1 CONSTRUCTION LENDING AGENS 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 NAME LENDER'S ADDRGcc 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 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 O 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 OIS OIS 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 Foundation 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 7/20/s' 1-f/CcJ dell Final Construction (2/7y � Final Bond Beam 1 / 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 -/C 7/74%, a/i.- Pito?:- - .4_e# f///r/5lcJ� Foo rr� 3, ;_au. d\;-._ '. r....„i< „\\_ !w \\,J 7/)//sr' c/.✓ F,;.-.JG SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDE LONG X DEPTH OF ROCK •N • W E I S Inspector's Signature and Initials DATE OF ISSUANCE PERMIT NUMBER