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Permit No. 1051 CITY OF CHINO HILLS . • COMMUNITY DEVELOPMENT 2001 Gr nd Avenue APPLICATION FOR A BUILDING PERMIT AND A CERTIFICATE OF USE 8 OC Chino Hf >, CA 91709 • BUILDING CLEARED BY APPLICATION TYPE NO I Ce IuICI l C) tLc -/d ' _0 APN Z THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT 0 D LOT BLOCK TRACT ❑ STRUCT ❑ PLUMB ❑ MECH ❑ ELECT 0 O If TYPE OF PROJECT ❑ NEW ❑ ALTER ❑ ADDITION m / cn OWNER � IJif�^ SCREPAIR ❑ CONVERT ❑ DEMO ❑ OCCUPANCY PMT CO PROJECT I LOCATION ON I SIZE ADDRESS Q^ ()Pi— K- (_n,Z C j DESCRIPTION PROPERTY IN SO FEET 9 . - I ,/4-� I / ..Z.,CITY/' �14t -}- td ZIP �� PH51� 7L_6� , cT--�' ARCHITECT I ENGINEER LIC NO 2 ADDRESS 3 I I 1 CITY ZIP PH REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION • CONTRACTOR LIC NO ADDRESS y - CITY ZIP PH CITY BUSINESS LICENSE )441,4?----- /o//'/9_5 i 1— LICENSE NO EXPIRATION DATA V/' ----•-•, 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 es in full force and effect License Class License Number Date 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 ❑ I,as owner of the property or my employees with wages as their sob compensation will do the work and the structure is not intended or offered for sale XI as owner of the property am exclusively contracting with licensed contractors to construct the protect ❑ I am exerrpt under Sec B&PC for this reason I G -may Sc Date Z / / J INITIAL r�f i 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 ❑Certified copy is hereby furnished DATE EXPIRES ❑ Coddled copy is filed with the aty CITY VERIFIEn VALUATION ' • Date APPLICANT PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE I certify that in the performance of the work for which this pernwt is issued I shall r�pt�ertploy any person in ELECTRICAL STRUCTURAL any manner so a to beco subpct to the Workers'Compens/�/y o L��ws of Ca�hiya/S' Date -as,to APPLICANT / / "--- /7,,, • / L.,,,.---- v 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 PROP FO PEC�ION PURPOSES ISSUANCE APPROVED TOTAL PERMIT FEE �i �/�y�9 G7 7/ S-Fatima of'dpplrcant or Agent Date ' I Bat l-( I/fC� �l�� DATEOFISSUANCE PER/M/h/T(NUMBER Pnnt Applicant s/Agent ss Name ✓ — Z -.3 j'� / �/ _ _ _ _ _ _ _ _ _ _ __ __ ___ _ � y _ _ Operator: DAWN Check #: 000001010 Date: 3/22/93 00 Receipt #: 0000680 WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR DECK $71.00 • • BUILDING ADDRESS LOT BLOCK TRACT , BUILDING INSPECTIONS RECORD OWNER ADDRESS CITY ZIP PH PLUMBING DATE APPROVED/INSPR'S SIGNATURE GROUND SOIL/WATER P1 TOP OUT P2 SHOWER PAN P3 REMARKS SEWER P5 GAS TEST P6 FINAL PLUMBING P12 I -:D&,.1/b&k/Vt4 �A/1_4 �}ya -- �� MECHANICAL DATE APPROVED/INSPR'S f / !``� }`7 l /�/1_ %� It� SIGNATURE l` J UNDERGROUND FLOOR M1 1 ROUGH M2 I ' ,, ` FAU/AC M4 I 12 �' Vv 0-2,4-� O K 611 - I I T LiiA. i� v / FINAL MECHANICAL M12 I P4.4 -10•-k__... q%Y �U 1^-k_1 ELECTRICAL DATE APPROVED/INSPR'S Y SIGNATURE TEMP CONSTN POWER E3 I UNDERGROUND PVC-METAL-D B C El ROUGH WIRING RECEPT SPACING- SERVICE-CIRCUIT E2 t Ii_x1_l. FINAL ELECTRICAL E12 I p e/f lt'��l' 1 STRUCTURAL DATE APPROVED/INSPR'S At11" � SIGNATURE ,, FOUNDATION LOCATIONySi i�/� �� ��" / , ��L REINFORCED D UFER 0-, q 3 SLAB REINFORCED 0 MEMBRANE OS3 I I �R\ q"rY FLOOR FRAME/INSUL S4 1 I ` IL y 7\v' ' MASONRY S11 I V I r'� LTV- FIREPLACE Si 1 I ROOF FRAMING ROOF SHEATHING SS FRAMING S6 I • INSULATION SOUND ENERGY S7 LATH EXTERIOR S8 LATH INTERIOR/GYPBOARD S9 I r APPROVED/INSPR'S SIGNATURE DATE OF ISSUANCE PERMIT NUMBER BUILDING FINAL S12 i „ /2, W.',1.,'VI I - I i, fi . — L It: ' _ /1112'_ •-- -_