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Permit No. 646 CITY OF CHINO HILLS 4110 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 W ADDRESS 3j J 4i4/c, c,/esri— k0 . F F 0 APN E THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT 0 D LOT 3 9j BLOCK TRACT /:.1 , l'.as..—Z.-- ❑ STRUCT ❑ PLUMB 0 MECH 0 ELECT 0 4� : TYPE OF PROJECT 0 NEW 0 ALTER 0 ADDITION m co SQL[ / cO / OWNER I / 0 REPAIR ❑ CONVERT 0 DEMO 0 OCCUPANCY PMT ——ter /iS'I;OAF •/ PROJECT LOCATION ON I SIZE ADDRESS ,1 �f A y eDESCRIPTION PROPERTY IN SO FEET . - Nere \ n, ` CITY �.l� �'ft•LC t ZIP PH S9 �,J� /7' � 1 �'1 \I"'v ARCHITECT ENGINEER 'T.( • , „ LIC NO /0/dJ 2 ADDRESS //d?7 .4 4A-r/A 4ok I. 3 / I CITY /4kis ` /f. Act/c. yQ / PH ?� 25,116 -o SSS REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION M I CONTRACTOR - LIC NO e �-1 �r,n „ I SOC)t s l� r��'n(a�"/`j�� ADDRESS a Z 14. 7 n•n 54r�Voir% ; iv% r\1/4\ )) CITY �a1L 1/4413,...4 ZIP S"d" PH IS/. 9�/“/ / CITY BUSINESS LICENSE 7Y I LICENSE NO EXPIRATION DATE ' LICENSED CONTRACTOR'S 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 C2---S-3 License Number 4/S as '7/ . Date Contractor 1/lyi rt Jy At cf /.-->/u 4-,_,1-7-93 ADDRESS �/{� , 1Ws h- Bpi.% / 7 L „,„4.1/4,:_:,.CITY AND ZIP �•V• 9 �7 PHONE �`1 y`2S. / Y OWNER-BUILDING DECLARATION I hereby 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 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 project ' ❑ I am exempt under Sec UPC for the reason Date INITIAi WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to sell insure,or a certificate of Workers'Compensation Insurance,or a certified copy thereof COMPANY POLICY NO GROUP DIVISION TYPE 0 Certified copy is hereby furnished DATE EXPIRES 0 Certified copy is filed with the city CITY VERIFIcn VALUATION Date APPLICANT PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE I certify that in the performance of the work for which this permit a issued,I shall not employ any person in ELECTRICAL I STRUCTURAL any manner so as to become subject to the Workers'Compensation Laws of California 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 TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS,AND HEREBY GEO REVIEW I PLAN CHECK AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES ISSUANCE APPROVED TOTAL PERMIT FEE • XK..- Ice1/ ', -�'Z Q `� KCI —1f/ Sf or Agent '/ Date c J ff- tlC S 1`f c�t K DATE OF ISSU /CE / F PERMIT NUMBER c/ & , Pnnt Applicant's/Ageht's Name ( / ! (p fie . I WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR 4- .... • • BUILDING ADDRESS LOT BLOCK TRACT BUILDING INSPECTIONS RECORD OWNER • ADDRESS CITY ZIP PH PLUMBING DATE APPROVED/INSPR'S SIGNATURE 1 , GROUND SOIL/WATER P1 TOP OUT P2 - SHOWER PAN P3 REMARKS SEWER P5 GAS TEST P6 761 Gtr,7B /Z/// - _ _ FINAL PLUMBING P12 _ G^'�,� /6G -/52•/-1-04#9 -/Z/Z/ 7 MECHANICAL DATE APPROVED/INSPR'S �- UNDERGROUND FLOOR M1 SIGNATURE �•�e --To '�"/'-7/ T��_ 2/,y/.7,�� CJ r / , ROUGH M2 FAU/AC M4 F�~Ci GAT C /21/4" FINAL MECHANICAL M12 _ ELECTRICAL DATE APPROVED/INSPR'S SIGNATURE • TEMP CONSTN POWER E3 I - • UNDERGROUND ---- PVC-METAL-D B C El I ` ROUGH WIRING RECEPT SPACING- SERVICE-CIRCUIT E2 I I FINAL ELECTRICAL E12 STRUCTURAL DATE APPROVED/INSPR'S SIGNATURE • FOUNDATION LOCATION 51 REINFORCED 0 UFER 0 I i SLAB REINFORCED❑MEMBRANE❑S3 FLOOR FRAME/INSUL S4 I MASONRY S11 I FIREPLACE Si1 I I ROOF FRAMING ROOF SHEATHING S5 FRAMING S6 INSULATION SOUND ENERGY S7 • LATH EXTERIOR S8 I LATH INTERIOR/GYPBOARD S9 ,� /� pG SIGNATURE APPOVED/INSPR'S ��yvw� DATE OF ISSUANCE PERMIT NUMBER BUILDING FINAL S12 `/ .