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Permit No. 0359 • Ill . APPLICATION FOR A BUILDING PERMIT AND A CERTIFICATE OF USE & OCCUPANCY CITY OF CHINO HILLS ADDRESS g! / QRD I Q ( D CLEARED BY APPLICATION TYPE NO c 3 9�—� 2 LOT BLOCK PACT Z �/�` L7 ,1 OWNER �� I` I'v"��t/S THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMITo S n,� _ n ADDRESS, Y'�f ,V ' 0 STRUCT 0 PLUMB ( J MECH n ELECT cn /�) ll N cureF'? SZIP ..., TYPE OF PROJECT U NEW Li ALTER Ii ADDITION ARCHITECT/ LIC NO ENGINEER ❑REPAIR U CONVERT D DEMO [1 OCCUPANCY PMT ADDRESS PROJECT LOCATION ON SIZE -- DESCRIPTION I PROPERTY I IN SO FEET CITY U� l ZIP /I PH �y7 / CONTRACTOR PAZ!� H -).- C'/[{�„�LIC �NO\ t (J (L// I ADDRESS /j J—_rI[.V vcF-. Irl,,In+J KJ A I 2 I I CITY �A— -P_vvr-� ZIP Lb)l�� PH 79q-�ty ' I I CITY BUSINESS9LICENSE REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION LICENSE NO EXPIRATION DAT LICENSED CONTRACTOR S DECLARATION \ I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000 of I I I �- -h5,1‘ M.� WI Division 3 of theBusiness and Professions Code,and my license is in lull force and effect L------- / (11 i License ` . License Number q 3� q 1/ ., Dale "1—I-/f Conlraclor ADORESc 444s ri L-11--,MA--P MY AND ZIP PHONE 1 CONSTRUCTION LENDING AGENCY 1 f I hereby affirm That there is a construction lending agency for the performance of the work for which fly this permit is issued(Sec 1097 Civ C)Lender s Name Lenders Address OWNER BUILDER DECLARATION 1 I hereby affirm that I am exempt from the Contractor s License Law for the following reasonCn n as owner of the property or my employees with wages as their sole compensation,will do the V 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 the PrOtOCT ❑I am"kempl under Sec B&PC for this reason Dale INITIAL 4 WORKERS COMPENSATION DECLARATION I hereby affirm that I have a certificate o1 consent to self insure or l cert Iity�te/Qf�Wpr p� n Compenaaliiiirrooqqoo����iiii Insula/�teJ/�re cart' copy copy thereof POLICY NO �J L+ l.{i f[„ .�YL_/[ COMPANY �%'`���"YK/ OATS EXPIRE / 1 3 n Certified copy i!hereby furnished CITY IFIED ❑Cerlifttrfopy us Med with the city !jL. ) GROUP DIVISION TYPE Dale _ APPLICANT CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATI61I INSURANCE VALUATION I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become sublecl to the Workers Compensation Lawn of California Date APPLICANT PERMIT FEES NOTICE TO APPLICANT If alter making this Certificate of Exemption you should become subfec1 ELECTRICAL I STRUCTURAL to the Workers Compensation provisions of the Labor Code you must forthwith comply with such provision Or this permil shall be deemed revoked - PLUMBING I GRADING I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION //, I$CORK AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS,AND MECHANICAL / M ��' I ISSUANCE FEES HEREBY 01, 'O'IZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE GEO REVIEW LLL�S�� /` I PLAN CHECK ME Ir PR'PERT FOR INSPECTION PURPOSES //""�� lA__ Li_�,/ ISSUANCE APPROVED TOTAL PER FE�`�/, Signature of Applicant or�ent Date li l / ` rE V ���/'���I 1111` (( oaf OF ISSLIANp( iP1z,, Print Applicant s/Agents Name [(/ r CITY, OF CHINO ILLS 1 or-BUILDING ADDRESS —,, C'� / 6 ADDRESS J �� �O ..-.01 BLOCK TRALT )Z/ )...J BUILDING INSPECTIONS RECORD 4 D.VNER POST IN CONSPICUOUS PLACE ON THE JOB ADDRESS CITY ZIP PH PLUMBING DATE, APPROJED/1NSPR S SIGNATURE GROUND SOIL P1 I I GROUND WATER P2 I I REMARKS TOP OUT P3 I I SEWER P5 I I ' ••-• GAS TEST P6 I I I I FINAL PLUMBING P12 I I MECHANICAL DATE APPROVED/INSPR S SIGNATURE UNDERGROUNDIFLOOR Ml I ROUGH M2 I I AIR COND I I . FINAL MECHANICAL M12 I I ELECTRICAL DATE APPROVEDANSPR'S SIGNATURE TEMP CONSTN POWER E3 I I UNDERGROUND PVC METAL-0 B.0 El ROUGH WIRING RECEPT SPACING- SERVICE-CIRCUIT E2 I I FINAL ELECTRICAL E12 I I STRUCTURAL DATE APPROJED/INSPR S. SIGNATURE FOUNDATION LOCATION S1 I I REINFORCED 0 UFER 0 SLAB REINF 0 MEMBRANE 0 S3 I I UNDERPINNING 54 MASONRY S11 I I FIREPLACE S11 I I ROOF FRAMING i ROOF SHEATHING S5 FRAMING $6 I I INSULATION SOUND/ENERGY S7 LATH EXTERIOR 58 I I LATH INTERIORIGYPBOARD 59 I 1 1 I I APPRO NATURE R S DATE OF ISSUANCE PERMIT NUMBER SIGNATURE BUILDING FINAL S12 I I I