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Permit No. 3056 rI , • • _ CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND a•• COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY -.:.N 2001 Grand Avenue L_"Miiiiiiiia Chino Hills, CA 91709 CO BUILDING /s� //x�%57, PRO�zED USE - / F ADDRESS 30 As l,"C.ti7/ ',(,/)4 v/G� F l v APN Z THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT o a LOT BLOCK TRACT 0 STRUCT 0 PLUMB ❑ MECH 0 ELECT 0 GRADING 0 v s APPLICANT TYPE OF PERMIT 0 NEW 0 ALTER 0 ADDITION M / D CorlS�acc1��/� v, 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS .e23 z t°'9/4 YC PROJECT I LOCATION ON I SIZE ),, � T'Y� 9 DESCRIPTION PROPERTY IN SO FEET CY4f} ,L-fI ITZIP //737 PH ,0-9/73 OWNER *JZ a /fro,L/fCS/O 2 I I ADDRESS 3O,r{ C?'k'ct&S2,,e I u 3 CITY Cotdn,,/C) ,4715 ZIP PH 4 I I ARCHITECT ENGINEER LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS NO STORIES NO DWELLING .UNITS I BEDROOMS CITYZIP PH ........•••""' J �f ROOF FLOOR EXT WALL INT WALL CONTRACTOR l�P .j .N . A I 7.5L,c LIC NO 5734/J� — —_ ADDRESS 81,23 �C1-�4 i pc ! CEILING HEATING I FIREPLACE cJ CX-f� 71/737 METAL MASONRY CITY /4 4y'-'f/� CITY BUSINESS LICENSE PH �d"�-S>?3 SEWER MIN _EPTH S/F—F100 I LICENSE NO EXPIRATION DATE 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 Professions Cods, and my license is in lull Zorn and effect /' ^ 4 513 '7 Sr License Class �� T License Number < 1 < Date / �r - onntractor_ '—. ('e S7VLr A_Tc1'll ADDRESS �13 en ( -1 4 fit o, pp CITY AND ZIP PHONE 9C/— >/23 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 ❑ I as owner of the property am exclusively contracting with licensed contractors to construct ZONING I LAND USE the project o I am exempt under Sec B&PC for this reason I Date INITIAI SETBACKS I MODEUP LAN WORKERS COMPENSATION DECLARATION FY I SY I hereby affirm that I have•certificate of consent to self insure,ora oeridieste of Workers Compensation Insurance or•certified copy thereof RY I SSVI COMPANY POLICY NO GROUP DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES -(.eddied copy is filed with the city CITY VERIFIED VALUATION // / �/ - t Date APPLICANT l!/ (� (�J 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/D8''''''' person in any manner so as to become subject to the Workers'Compensation Law of California Date APPLICANT PLUMBING I GRADING NOTICE TO APPLICANT If alto making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must forthwith comply �y �` with such provisions or this permit shall be deemed revoked MECHANICAL ISSUANCE FEES G 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 REP SENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE �L ItsIONED PROPE TY FO N ECTION PURPOSES Q(� ISSUANCE �APP RROOVED TOT-al-PERMIT FEE J Sr nature of Applicant or Agett Dat / / f&) C ep\E��/5 ' DATE/ a/ � L/ PERMIT NUMBER Pnnt Applicant's/Agent s Name //f 0 FINANCE CODE g / Laera>:Gr: liddh they: 0: 00VQtl3nn WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK- OWNER vat el blad9n OO 3Ere:pt 2: $13 0 ;'SG; ,1371.UO GOLD-ASSESSOR/MANILA - INSPECTOR • 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 NAME LENDER'S ADDRESC DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION �. - THE CALIFORNIA HEALTH AND SAFETY CODEJREQUIRESA 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 38 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 F1EAD•THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT OIS ❑IS NOT SUBJECT TO THE APPLICABCE'REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY • t�� 1 ~� S rz\ � �, "r"' 1yt•B`rttR^'\4-v"r',c--..+- •v.,•., ._ ,,,,. .. - ..,. ?�•N CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND -1 ':xs�„ A CERTIFICATE OF USE S OCCUPANCY .'-'LCA •COMMUNITY DEVELOPMENT 2001 Grand Avenue WilaSilail_ Chino Hills, CA 91709 . BULDN II �n PROPOSED USE / co ADDRE55GDIUP ,I�Gtk' ,eS� vt C �C_ C APNZ THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT a LOT BLOCK TRACT 0 STRUCT 0 PLUMB ❑ MECH 0 ELECT 0 GRADING 0 co y TYPE OF PERMIT 0 NEW 0 ALTER 0 ADDITION CO APPLICANT y 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS _ • '1 ` PROJECT I LOCATION ON I SIZE DESCRIPTION PROPERTY IN SO FEET CITY ZIP / / PH ' • 1/.c e� ,+�'re I I '-•9" i J • OWNER t'J .+ - '• 2 K3I I I 3 ADDRESS > ' 3 „._-.J CITY , ZIP PH 4 ARCHITECT ENGINEER LIC NO REMARKS/SPECIAL CONDMONS/PROJECT DESCRIPTION ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS ..fir �' 1 CITY ZIP PH ^ ROOF I FLOOR EXT WALL INT WALL C - CONTRACTOR I 1 LIC NO 5,. b. ,.. � � .../-"--- .../-"-- ___ ' ADDRESS ". l ' FIREPLACE -n + CEILING HEATING (V/ty, L. I I METAL MASONRY CITY ' - J ZIP ) • . J PH /.1 f y y SEWER MIN DEPTH S/F/100 SIZE 2 CITY BUSINESS LICENSE .. I f~ LICENSE NO EXPIRATION DATc 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 Professions Code,and my license is In full force and enact License Class License Number > / I Sr Date Contractor ADDRESC ' L CITY AND ZIP PHONE S OWNER BUILDING DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason - O 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 ZONING I LAND USE the project O I am exempt under Sec B8PC for this reason I Date INITIAI SETBACKS I MODEUP LAN WORKERS COMPENSATION DECLARATION FY I SY I I hereby affirm that I have a certificate of consent to self insure,or a certificate of Workers' Compensation Insurance,or a certified copy thereof RY I SSV COMPANY POLICY NO GROUP DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES / VALUATION ( l /--C • O.Cerldud copy is filed with the city CITY VERIFIED ' / / Dale 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 1/ ' ' person in any manner so as to become subject to the Workers Compensation Law of California Data 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 I 7 �•� 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 INFORMA TION IS CORRECT I AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS GEO REVIEW I PLANCHECKKV��• AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES .. / ISSUANCE APPROVED TOTAL PERMIT FEE - Signelun of Applicant or Agent Date C P —f 'C—' ` / S- ,-�, 1 DATE OF ISSUANCE I�,PPEER•MIT NUMBER ...+ • Print Applicant s/Agent s Name Z.-. , / '3 C / --_ - ,- , / FINANCECODE C..� V / F ..Q WHITE- FILE/GREEN- FINANCE/ YELLOW- OFFICE/PINK- OWNER GOLD-ASSESSOR/MANILA - INSPECTOR CONSTRUCTION LENDING AGENLO 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) LENDERS NAMF LENDERS ADDREee 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 39 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 DIS OIS 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 I Temporary Power I Shower Pan Test Foundation Reinforcing Steel —7/,/a t, IStucco Mesh or Exterior Siding Excavation and Forms ,%,/ '/ ' Insulation Slab Grade I Sewer Ground Plumbing Soil I Interceptor Ground Plumbing Water I Septic Tank Underslab Ducts I 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 /0/4;-7l, r 2. Final Bond Beam Final On Site Improvements / ' Fireplace Bond Beam Final Off Site Improvements Roof Sheathing _ / / Final Dedication Framing antlV/fikaY{aNen WA;/ 1/ /9. ) Final Zoning Roof Covering -/+( v 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 R,...\0,....Ci.a kg N.*N X I'-?7SIAJ I i', 1 CMS-7-l " �J I b' --A.—) !1 / i/ / / /12 -- r —4' 41 —A-m/ /f/c/d -1 /Yff,'/CCS .U�1L/ I I ( . , SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDF LONG X DEPTH OF ROCK N W E S Inspector's Signature and Initials 1 DATE OF ISSUANCE PERMIT NUMBER