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Permit No. 3405 r �- e -�J•• CITY OF CHINO APPLICATION FOR A BUILDING PERMIT AND T - COMMUNITY DEVELOPMENT A CERTIFICATE OF USES OCCUPANCY .•:.(•>!--- 2001 Grand Avenue Chino Hills, CA 91709 }�' ��i ^,.__++ BUILDING / PROPOSED USE T-00.-)Cl n46 I--QR f—w- .1/'J' . ADDRESS ©9 i a e ��''' �� �-+ ot�1e•(Z Fo APN 33 t`I Z THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT s. LOT 38-a. BLOCK TRACT a a5- 1 0 ❑ MECH 0 ELECT CGRADING a DO TYPE OF PERMIT 0 NEW 0 ALTER 0 ADDITION 0 APPLICANT tc11kr i - -, w wcn M 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS T.T ^'.L7 �,`/ ,( � "�.R"'� DESLOCATION ON SIZE ,,n l[-lit-4 IL `JI'�F� DESCRIPTION PROPERTY IN SO FEET CITY/ t.�la V.. X5.11 1 t� ZIP/G ,oiAD�1 PH n- �'- 1 I 1 Li 2 OWNER._ '�li J tt.11 ii ia- '�.t aL�.l cs'�-O� I I 11 ��w// ��V' 2 ADDRESS I OA �czeie_..Qz 511 -p^^� '1713 S I I CI ARCHITECT LLS ZIP 1.70e1 Y PH u� i t- I 4 ClRCHITECT I I 1 `✓ ENGINEER LiC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION _.9 ADDRESS I NO STORIES NO DWELLING UNITS BEDROOMS CITY ZIP PH ROOF I FLOOR EXT WALL INT WALL .. METAL CONTRACTOR LIC NO i,.� ADDRESS CEILING HEATING I FIREPLACE ([`~' MASONRY NCITY ZIP PH s CITY BUSINESS LICENSE SEWEfl t MIN DEPTH S/F/to6 512E LICENSE NO EXPIRATION DATE LICENSED CONTRACTORS DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION I hereby Mhrm that I am licensed under provisions ei Chapter 0(commencing with Section 7000 of Orvisioc 3 of the Business and Professions Code,and my laena•is in full force and effect �' ,.., .L� (�j License Class License Number /r-ocfr j n 4 S I -z—e_ I Del. Contractor '?G Y. IE')C `i • ADDRESS CITY AND ZIP PHONE OWNER BUILDING DECLARATION t,..I[hereby affirm that I am exempt from the Contractor's License Law for the following reason }Sj 1,a owner of the property,or my employees with wages at then sole compensation,will do / the work,and the structure a not intended or offered lar sale 0 I,as owner of the property,em exclusively conlrectag with licensed contractors to construct the project ZONING I LAND USE 0 I em exempt under[Se /__r B&PC for this ninon O Date �L-�� - INITIAL PIA 0 4n SETBACKS I MODEL/PLAN a'� WORKERS'COMPENSATION DECLARATION FY s01 I SY`�tl 11 ) I I hereby affirm that I have a certificate of consent to sell insure,or a certificele of Workers ��` r Compensation Insurance or a certified copy thereof RY S \7��` COMPANY POLICY NO GROUP DIVISION TYPE 0Certified copy is hereby furnished DATE EXPIRES 0 Certified copy is filed with the city CITY VERIFIED VALUATION et, ' _.- Dale APPLICANT PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE I certify that in performance of the work Ior which this permit is issued,I not employ any ELECTRICAL I STRUCTURAL f\ 00 1..... pompon'any nnsr et as to become loth.Workers'Cori nisi -w of California l-7 OMe V ..i 414 APPLICANT •-+� Asa+aw II7 • i` 4 PLUMBING I GRADING NOTICE TO APPLICANT II after meting this Certificate of Exemon• you sh•+J' be-•me eubiect to the Workers Compensation provisions of the Labor Code you must tort wilts comply with such provisions or this permit shall be deemed revoked MECHANICAL I ISSUANCE FEES Vf' I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA TION IS CORRECT I ACRE. 0 COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS, GEO REVIEW I PLAN CHECK AND HEREBY A HO tyr,E •:PRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTI Q D P-•-E+ O IH URPOSES eD / ISSUANCE APPROVED TOTAL PERMIT E Spdatuie of Appli•ant or kilo t l J Date UMi C •a a 4. TAsDATE OF ISSUANCE/ FERMI Li `�)^ Print Applicant's/Agent's Name IS/ l ( H I t v I FINANCE CODE C.)-1 Operator: DAWN Check 8: o000CriOBo Date: 8/25/94 00 Receipt 8: 50009 80 WHITE-FILE/GREEN- FINANCE/ YELLOW- OFFICE/PINK-OWNER DECK GOLD-ASSESSOR/MANILA • INSPECTOR CONSTRUCTION I HEREBY AFFIRM THAT THERE ISA CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OFE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 3097 CIV C) LENDER'S NAME LENDER'S ADDRECC _ • DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRES A DIVISION OF INDUSTRIAL SAFETY PERMIT ASA PRREOUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW , I r o 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,FALSE WORK,OR DEMOLITION OR DISMANTLING THEREOF,WILL BE MORE THAN 38 FEET HIGH ,+ O AS OWNER/BUILDER I WILL NOT EMPLOY ANYONE TO DO WORK WHICH WOULD REQUIRE v ERMITJROMTHE DIVISJgI OF INDUSTRIAL SAFETY,AS NOTED ABOVE UNLESS SUCH PERSON HAS A PERMIT FROM THAT DIVISION DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER L ' �+ I y'\ j�.j. `) + ' +, - I HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE'WORK APPLIED FOR ON THIS PERMIT 01?)DS NOP SUBJECT TO THE APPLICABLEREQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY ti -+1 y<1 .1,I I y.tt 111 . . : 't 'I J J81 ' NA.). . T I11 1 . ) ` )t I i 1 dirt Y. t, ) • 4.4 I \ '$ItI t% t��•�•` •, i .,1 A', ;It\.>>,� } • j; 1.-‘ p I A'of . ) ) i 44'4 1 1 1 7 — -- r^ .' ..ryyn.yxy„acann„r+1/A011- •.,sr-Yo,.. 7'T - ' i.1 ; / F : • :L•N CITY OF CHINOILS 4 APPLICATION FOR A BUILDING PERMIT 11AND .-.1.%,...- A CERTIFICATE OF USE & OCCUPANCY rte. COMMUNITY DEVELOPMENT 0 ) r ...I. '- 2001 Grand Avenue Chino Hills, CA 91709 BUILDING �/ ryry PROPOSED USE F 0,,A , Ai- r I- JR., r1N}7,c - I ADDRESS 7C \I` oiLg. ..Uretic, 1vie r APN /02s) / J^ { THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT 0 LOT 7 C� BLOCK TRACT/Re ❑ STRUCT 0 PLUMB 0 MECH 0 ELECT 0 GRADING 0 !!! IY. XI TYPE OF PERMIT 0 NEW 0 ALTER 0 ADDITION m , APPLICANT HI 1c - A � /r ` ' A CO l �'TL fr.,'Z.l�L 1 I-h, y ❑ REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS wt( -r11 c- ;..V ...v_A t. k t PROJECT LOCATION ON SIZE / t (_1�-[ K•� D may'''] �'/ jam, DESCRIPTION PROPERTY IN SO FEET CITY(, 1M.,.�'� C'ILI A VP r 1 1%L r} PH Sri I •�f /1r i I I L4 \\. l A U OWNER 14 4(- f kA L•/ (L ZrZ/v�'VC? •�``. 2 I I �1 ADDRESS :_fcj/'i I ttt G.-CifL F- IC 3 I I �� CITY itC0i 11 at j ZIP C (7t isI PHe11 I'ITC; 4 I I •• ARCHITECT 1 ENGINEER LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS CITY ZIP PH fm ROOF I FLOOR EXT WALL INT WALL CONTRACTOR LIC NO 3 ADDRESS CEILING HEATING I FIREPLACE METAL MASONRY CITY ZIP PH \ CITY BUSINESS LICENSE I SEWER MIN DEPTH S/F/100 SIZE ' LICENSE NO EXPIRATION DATF v LICENSED CONTRACTOR'S DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION ...• I hereby affirm that I am licensed under provisions of Chapter 0(commencing with Section 7000 of Division 3 of the Business and Prof anions Code,and my license is in full force and effect License CClassT License Number r.33-k �/t,[n CyC 12-Qi-Date _ -_—Contractor IC X (h 1 ADDRESS CITY AND ZIP PHONE OWNER BUILDING DECLARATION I ereby affirm that I am exempt from the Contractor's License Law for the following reason I,as owner of the property or my employees with wages as their sole compensation will d_ the work,and the structure is not intended or offered for sale C I as owner of the property am exclusively contracting with licensed contractors to construct the protect ZONING ` LANG USE O I am exempt under Sec B&PC for this reasonI II � Date (-12.5h4 F�hINITIAL u y t Irt 47 SETBACKS I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY ao, I SY hi/n ) I I hereby affirm that I have a certificate of consent to self insure,or a certificate of Worker r Compensation Insurance,or a certified copy thereof RY 1 tit% I §S; CV:. \ I COMPANY POLICY NO GROUP / DIVISION' ' TYPE O Certified copy is hereby furnished DATE EXPIRES O Certified copy is filed with the city CITY VERIFIED VALUATION i' ,...._ 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 I STRUCTURAL 4/'t CO �` Deperson in any manner ec as to become subjAPPLICANT ct oI CAN Token'Compensati Law of California 1.1 111 S- I"a.�11 f` 4 tel, .4,-1;1 ' PLUMBING I GRADING NOTICE TO APPLICANT If,alter making this Certificate of Exempt' ,you should become subject to the Workers'Compensation provisions of the Labor Code you must forthwith comply ..t Ci '---.with such provisions or this pound shall be deemed revoked MECHANICAL ISSUANCE FEES -1r I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA TION 15 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 INSREOTION PURPOSES C //(: I / It. �•f ' 2 6/25/(141/2 f f(1 1 SSUANCE APPROVED TOTAL PERMIT FEE / 44Signature of Appli ant or Agent 'I Date / Tic ,� I DATE OF ISSUANCE PERMIT.NUMBER 1 �1,c• ., 6I ""i- -4ar '\ l� Kitt �Cf i Print Applicant s/Agents Name 1 / A / FINANCE CODE CH WHITE- FILE/GREEN• FINANCE/YELLOW- OFFICE/PINK- OWNER GOLD-ASSESSOR/MANILA - INSPECTOR CONSTRUCTION LENDING AGENCO 1 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 ADDRFcc 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 ❑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 DIS 015 NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY BUILDING INSPECTIONS RECORD DATE INSPECTOR I DATE INSPECTOR Setback/Location I 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 Final Construction Final Bond Beam 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 / _ /_ s ,i , Al '�, /1711 t t I1Ar U, r,y ) 1 - -- 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