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Permit No. 0365 • APPLICATION FOR A BUILDING PERMIT AND A'CERTIFICATE OF USE E OCCUPANCY I CITY OF CHINO HILLS ~� /9/' /623 -6d /- 2z ADDRESS I 1 L- �A/�J A�„ I CLEARED BY APPA TION TYPE NO F ,,// // LOT243 BLOCK TRACT 2 Ir D 0,,NER 1n/I n In/t e-S- Lo � I THE F J,LOWING WORK IS AUTHORIZED BY THIS PERMIT 0 4��1--- y' F ���� DO m ADDRESS �,, �STRUCT 0 PLUMB 0 MECH 0 ELECT m / e7APl14 I V) CITY/ 'L � ,`jII 5. ZIP PH $?3 9g 73 TYPE OF PROJECT NEW ❑ALTER O ADDITION ARCHITECT/ 1 t'1 = UC NO 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ENGINEER ADDRESS PROJECT LOCATION ON I SIZE DESCRIPTION PROPERTY IN SO FEET CITY ^ .."1 ZIP PH �` CONTRA,. / j 70Ja• y, NO $ , g/O 1 t I I /�/,e-�7s _yid ///J I _ I 0 ADDRESS J / (Od � :Q,,S /•.",,,, IZ GTY g/12/LllACI ZIP 9/7‘ PH 672r— Q / 9J 1 3 I CITY BUSINESS LICENSE REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION LICENSE NO EXPIRATION DATE C1_ UCENSED CONTRACTOR S DECLARATION I hereoy affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000 of rE,C3.‘ QcDADvsron 3 d the Business and Prolessons Code,and my license a m lull torte and edea cc33' a 'v13 License N 3,,?/19 , 4 / Dm . 7�S- `12Contraa .rh5 i�a ilv.•r- Ao rs �`ET/g4&,e6 ADDRESS ///n ,c A73:1" CTY AND ZIP Iptior-p.+./4 PHONE PHONE—4122--.n 970 FieoNT /f i ' CONSTRUCTION LENDING AGENCY f? jq-/L,. ZO I s.hereby affirm that there is a constructuon tending agency for the performance 01 the work for which /fie • this permit a issued(Sec 1097,Cry C)Lender's Name Lender s Address .5%476 to - \)/ ONNER.BLItLDER DECLARATION I hereby affirm trial I am exempt from the Contractor's License Law for the following reason ,J+/mow G/f} /��/P I.as owner of the property.or my employees with wages as they sole compensation,wdl do the /v./CP ee//a V e--- work,and the structure is ria intended or cowed for sale C I as owner of the property,am esdusrvely contracting with licensed Contractors to construct the prole= I am ecempt under Sec BS°C for this reason Dale INITIAL WORKERS COMPENSATION DECLARATION AA I hereby attain thtl I nave a cenRrcate of consent to self insure or a c R t of S!� CornTensai.on Insurance or a Riad copy thereof POJ_Y NO /,/ �t7 COMPANY �CA DATE EXPIRES /-�nJ-- 5'/'q L_ n Cenrfred copy rs hereby tumrshed CITY RIFTED 4....1b............. ___ rBICnBred Copy K nkd with the City .....9>P DIVISION TYPE Date 9-3- 9 2 APPLICANT CERTIFICATE OF EXEMPTION FROM WORKERSt.0MPENSITION RANCELUATION I certify that in the penormance of the work for which this R is issued, not emnInv any pe•son in any manner so as to become subject t0 the Workers Compensation Laws of CalRorma Dale APPLICANT PERMIT FEES C �-S NOTICE TO APPLICANT II aper making this Cenyrcate of Exemption you should become subject ELECTRICAL I STRUCTURAL3aCJ to me Workers Compensation provisions of the Labor Code you must lonhvnth comply with such Provision or this permit shall be deemed revoked PLUMBING I GRADING I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION 'S C.'RECT I AGREE • CO LY WITH ALL CITY ORDINANCES AND STATE LAWS AND MECHANICALISSUANCE FEES HE- i. AUTHORIZE R:-RE TATIVES OF THIS CITY TO ENTER UPON THE ABOVE GEO REVIEW I PLAN CHECK ME • ED PROPS- OR� SPE RPOSES S�g��atg■ 9—) —Q 7i ISSUANCE jPPROVED I TOTAL PERMIT FEE I.1!. w / `---f d. of Applicant or Date 'L✓Tlig'- 12,�j, DATE OF I„S AN EE Q PERMIT NUMBER//_`/ t Print Applicant s I Agent s Name �[J/I'L� 0 3 6 . ;ITY OK CHINO ILLS • . FUI,_DING .DDRESS _OT BLOCK TRACT INSPECTIONS RECORD :AVNER POST IN CONSPICUOUS � ' PLACE ON THE JOB -,DORESS CITY ZIP PH SWIMMING POOL INSPECTIONS INSPECTION DATE APPROVEDANSPR S SIGNATURE OC..TIONfOIG SP1 IL- I REMARKS STEEL/BONDING/PLUMBING TEST SP3 1 Z /�I x//7/9 C/ V I " ADDgp ED TO GUNITE SP3 1 I i I „DERGROUND ELECTRIC SP2 1 1/et 3 l,-L,1 4 e . I GAS TEST SP3 1 9t/ib/4 '� ` ( I 1 FENCE ENCLOSURE SPS I /0/14// 2/ I 4 -e.. I I FINAL SP12 I /0/X/9?/ I `/ IGI4ADING INSPECTIONS INSPECTION DATE APPROVED1INSPR'S SIGNATURE DRE GRADING MEETING GR1 ' ITOE OF FILL GR2 EXCA'ATION GR3 ' RET WALL FOOT GRA MASONRY i FORMS GRS DRAINAGE DEVICES ORE ROUGH GRADING 6 BUILDING RELEASE GR7 DATE Of ISSUANCE PERMIT NUMBER IrMAL GR12 • TRIAD GEOTECHNICAL CONSULTANTS-INC. " c 7 �j Soils Engineering • Engineering Geology • Envtronmental"Engmeenng 17231 EAST RAILROAD STREET, SUITE 100, CITY OF INDUSTRY, CA 91748 TELEPHONE(818)964-2313 FAX(818)810-0915 NOTICE OF INSPECTION JOB LOCATION o9. -SAN .P4 4 I, .D.� CA 4-)O .4//,lL�S JOB NO. 9Z-0 3-U DATE OF INSPECTION CLIENT/OWNER ,ao, . CLIENT'S ADDRESS //Xad ' - DESCRIPTION OF AREA INSPECTED: EXG)4v,477Oi ' /AS ,C - 4) f5OA) 2A /A) r°.a ix_,.47.a.�, A fO/J ,4e<s', ;&5 ��,�y� T� �s�,��s 7 c ? -.�.� - - L/r//T 7_ �IEV/az"- Z.2 0 e iN eo.C.b C//ou/e zcJJE- A �d r).4'-Q19TeX.6i9,0,,S//A .QTc vTiA� . "-xc 9!/r4TiON - -0;v7- f,�N,r'J /c'AJJr .*.tlbiMA A,0.O,GOd/4.� .€44 Z of a" csO/.4. .IA/o7.d .dam ,Q4-207.0 veal .�•€O•K- 9XtJfvoaTlo..J /D,e'o iP Ta /A—"il9Grrtlf ,- A 41A1,7? . . /r/O7 A = ..4>d.G /.1AA/ $ j//cU/ 2 AQe- cS7 Cd O/A> .<9/77-6 . ,c1cf o v 2.- ,T/ll f ,eee!!o��N�.oT,t,cs .t✓�4T�rJ: S o��r,C�E/1 / i99-Z� JOB SUPERINTENDENT: INSPECTED BY: SIGNATURE GNA RE