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Permit No. 3862 r CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND COMMUNITY DEVELOPMENT A CERTIFICATE OF USE &OCCUPANCY -..:. 2001 Grand Avenue 'iT-- Chino Hills, CA 91709 BCD0 ADDRESSUILDING /�j� (..)0,��+ni.LG� C PROPOSED USE n r APN /0i1)— 3/ - 4/6 —0000 Ulf n /1/400-4 /Va ///'''''' THE FOL1LOWINd WORK IS AUTHORIZED BY THIS PERMIT > LOT 39 BLOCK /1 COCT/n / �S ` UCT 0 PLUMB ❑ MECH ❑ ELECT ❑ GRADING 0 I C/C/(../ �C/ O 9 TYPE OF PERMIT 0 NEW0 ALTER ADDITION m APPLICANT L/ wI Tri ?tin0 REPAIR 0 CONVERT 0 DEMO OCCUPANCY PMT en LOCATION ADDRESS 2 1 SIC oak If /,�j.- Q� (�''��(7,' DESCRIPTION om`}-T PROPERTY ON I IN SQ FEET t• CITY C „) /JfiIL� ZIP cf1170_/ PH5 I/ r3/3 1 YN / / I I r7 .W C r o T/ OWNER 5ol.{FYI /C-; L I I ADDRESS v 1 CITY ZIP PH I I 124 ARCHITECT ENGINEER LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS CITY ZIP PH ROOF I FLOOR EXT WALL INT WALL CONTRACTOR LIC NO ADDRESS CEILING I HEATING I FIREPLACE METAL MASONRY CITY ZIP PH SEWER I MIN DEPTH I S/F/100I SIZE CITY BUSINESS LICENSE LICENSE NO EXPIRATION DATc LICENSED CONTRACTORS 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 ., ` \,� ��' yyy'''��� '"�7^ License Clan License Number ((((��(1-0,--41,_ �i� Tt$y' S d �vh 0411) Oat. Contractor TLg ADDRESS I 4. r)-c fav&3(I 01S10' CITY AND ZIP PHONF OWNER BUILDING DECLARATION I here Ipm that I am exempt from the Contractor's License Law for the following reason I as owner of the properly,or my employees with wages as their sole compensation,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 ;ZONING)nI ,LAND USE Lha project C IiI N / I / I ❑ I am exempt under Sec BBPC�f or�Ihn mason � T I Fl YDate W�KERS COMPENSATION O INITIAL TI SETBACKS ,-- 'YSy L/IT_t ��7V� I MODEL/PLAN /` I hereby affirm Ihat I have a certificate of consent to sell insure or a certificate of Workers O I \J �Y" I Compensation Insurance,or a certified copy thereof RY I SSY COMPANY POLICY NO GROUP DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES VALUATIONIg�c o Certified copy is filed with the oily CITY VERIFIED C�J'/ '`^� Dat. APPLICANT l-r� P PERMIT FEES )St)T5 ( (J CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE ,tr� �r) I certify that in performance of the work for which this permit a issued I shall not employ any ELECTRICAL 4`�.J I STRUCTURAL 111 person in any manner/so as to become subject to the Workers'Compensa on Law of California l X Oats 7//” �`" APPLICANT j'") PLUMBING I GRADING NOTICE TO APPLICANT II,after making this Cornfield of emption, 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 153 ---- I 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 MENTIONED2- PROPERTY FOR INS-ECTION—./ /P PURPOSES I �� _ /� // /� �V ISSUANCE APPROVED TOTAL �'� /tis �JJ1��JJlI`Z'-._ I Sig erre f Apolioanl or ge Date '`' // DATE OF�B` U� .ID �/ / I PERMIT�J UE{7 „irk hie-h- Print Applicant's/Agents Name FINANCE CODE G LI Operator: VIRSINIA Chet:: C. O(3304133 Date: 11/16/94 00 Receipt 4: OCC0,5 2 WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK- OWNER CHECK $120.40 GOLD-ASSESSOR/MANILA - INSPECTOR CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 3097 CIV C) LENDER'S NAM LENDER'S ADORES° DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRESA DIVISION OF INDUSTRIAL SAFETY PERMIT AS A PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW ❑ I CERTIFY THAT NO EXCAVATION 5 FEET OR MORE FEET IN DEPTH,INTO WHICH A PERSON IS REQUIRED TO DESCEND,WILL BE MADE IN CONNECTION WITH WORK AUTHORIZED BY THIS PERMIT,AND THAT NO BUILDING STRUCTURE,SCAFFOLDING, FALSEWORK,OR DEMOLITION OR DISMANTLING THEREOF,WILL BE MORE THAN 36 FEET HIGH O AS OWNER/BUILDER,I WILL NOT EMPLOY ANYONE TO DO WORK WHICH WOULD REQUIRE A PERMIT FROM THE DIVISION OF INDUSTRIAL SAFETY,AS NOTED ABOVE UNLESS SUCH PERSON HAS A PERMIT FROM THAT DIVISION - DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER • I HAVE:READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT DS OS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY I I • • I • � f. I JI �4 • • 1 • • I� , J • t I a "ill • i I , 1 fie `•o" eyc`rd'^"a'kS4CPtiF"Zi✓'`?' .j, , fl$t9 t'll� t9.5:P--rrf1Afl' '+n,•r"tr'•1r.N'cn.` rLt ar-r %jJ ' --- r... w. - ., 7 fl CITY OF CHINO •LSAPPLICATION FOR A BUILDING PERMIT AND COMMUNITY DEVELOPMENT0A CERTIFICATE OF USE d OCCUPANCY _ 2001 Grand Avenue �' `e Chico Hills, CA 91709 W�` / BUILDING 'J I r / PROPOSED USE J CC ADDRESS [ 49 / CL /( 0 J + �1 2 APN - % .) _ THE FOULOWING WORK IS AUTHORIZED BY THIS PERMIT > LOT -! -I BLOCK C... TRACT/ •0 STRUCT 0 PLUMB ❑ MECH 0 ELECT 0 GRADING a O 11 DO TYPE OF PERMIT 0 NEW 0 ALTER pY ADDITION m APPLICANT r , r- f c F r \ CO -27 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT �� -k PROJECT LOCATION ON SIZE ADDRESS F...�. }' LT (• L A i� DESCRIPTION PROPERTY IN 50 FEET CITU LI ,., I j t h, ZIP .-/1 7 / • i•J j 1 [ r41 ' I I �/� OWNER _J I . , - 2 L(fLFI\ •rJC I I IvT'1 '�iC ADDRESS I 3 CITY ZIP PHI I 4 1' ARCHITECT ENGINEER LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS " r CITY ZIP PHsl ROOFFLOOR EXT WALL INT WALL ( CONTRACTOR LIC NO I ADDRESS CEILING HEATING I METAL MASONRY FIREPLACE CITY ZIP PH SEWER MIN DEPTH S/F/100I SIZE CITY BUSINESS LICENSE LICENSE NO EXPIRATION DATF 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 Profession,Code,and my license is in full force and effect p License Class License Number j1 `�r7' ,)f h L ). r r r 1 T•--/ ) Date Contractor 0 Y .C • /, • ! 111 4-Lie_ta Nt ADDRESS I P-A4::J \rc .SIO h -5'f.., CITY AND ZIP PHONE OWNER BUILDING DECLARATION I herebydllrm that I am exempt from the Contractor's License Law for the following reason 1_I V I as owner of the property or my employees with wage,as their sole compensation 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 I ZONING I LAND USE the project _ O I am exempt under Sec B&PC for this reason t:7,-he `'-"I2 —1„,/t I I 1- i1 ' \, Date /� ,t- /_/ INITIAi SETBACKS y I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY v I SY41 4-1L I I hereby affirm that I have a certificate of consent to self insure,ora certificate of Workers Compensation Insurance,or a certified copy thereof RY 7)—1 I SSY I COMPANY POLICY NO GROUP DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES v VALUATION � ^ e} ! — ( '- rb O Certified copy is filed with the city CITY VERIFIED Y 4 / t i Date APPLICANT PERMIT FEES ("7/)i9/ ,,V` CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE f) ppp I certify that in performance of the work for which this permit is issued,I shall not employ any ELECTRICAL( ` l� I STRUCTURA person in any manner so as to become subject to the Workers'Compensation Law of California "J 1 l ' r ye / Date ' APPLICANT PLUMBING I GRADING NOTICE TO APPLICANT If, after making this Certificate of Exemption,you should become subject to the Worker'Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be domed revoked MECHANICAL I ISSUANCE FEES``j 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 PLAN CHECK AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES ISSUANCE`PPR' 1p I TOTAL• E� 1 r ) /f/ Signature of Applicant or Agent , Dale / DATE OF ISSUANCE PERMILNUMBER f Print Applicant s/Agents Name 1 I l Li FINANCE CODE / +� WHITE- FILE/GREEN- FINANCE/ YELLOW- OFFICE/PINK- OWNER GOLD-ASSESSOR/MANILA - INSPECTOR CONSTRUCTION LENDING AGEN I HEREBY AFFIRM THAT THERE IS A CONSTR ION LENDING AGENCY FOR THE PERFORMANCE THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 3097,CIV C) LENDER'S NAME LENDER'S ADDRESS 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 D 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 38 FEET HIGH D 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 DIS 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 Rough Plumbing Temporary Power Shower Pan Test Foundation Reinforcing Steel I Stucco Mesh or Exterior Siding Excavation and Forms Insulation Slab Grade Sewer Ground Plumbing Soil Interceptor Ground Plumbing Water Septic Tank ti 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 I / Final Bond Beam Final On Site Improvements I / Fireplace Bond BeamFinal Off Site Improvements /1 I Roof Sheathing /L///9f' i`�//�-- Final Dedication I 1 V / Framing and Ventilation Final Zoning ,- 1 I /1 ^ L Roof Covering Final Electrical / `\ / / II CA /V Rough Heating Final Gas / In I v C' , .t Service and Ground Developer Fees Paid I I 1 II \ V/ 1 0 I Rough Electrical Fire Dept Approval Verifier /I It V . I_/ I Bonding Certificate of Occupancy \ 'I / : \V I T Over Head Electrical '\ X I v , \ N Fence Height 7 It.... \\t--' FYI' Gates / I 'l '\" H _ Heater / I I Pool Drainage / I 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