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Permit No. 1623 ,. _ CITY OF CHINO HILLS . + I/ COMMUNITY DEVELOPMENT 2001 Grand Avenue APPLICATION FOR GRADING AND OTHER MISCELLANEOUS PERMITS Chino Hills, CA 91709 BUILDING l , / CLEARED� BY r APPLICATION TYPE NO ` ADDRESS `f ajAl 6 Vis /d/A F l� v - APN x// 5-4, 10 ' TH FOLLOWING RK IS AUTHORIZE HIS PERMIT 0 LOT w(J(,/ BLOCK TRACT 9� / TR PLUMB ❑ MECH ELECT 0 GRADING 8 Y/ Yom" v r m . NEW 0 ALTER 0 ADDITION 0 SUPERVISED GRADING w OWNER�Y7ls j n , CD �S CD T-+ �l ren ` , ( 4v ._ 0 DUMP DEPOSIT REQUIRED ADDRESS 1 /^ n"5 1 f is,, 4 1_ 0 REPAIR 0 CONVERT 0 DEMO CUBIC YDS CITY ` ZIP \/f " PHJ-97 �!, DESCRIPTION OF WORK AND CONDITIONS OF APPROVAL ARCHITECT .4� ...._ ENGINEER ' Oa/ clt,1 r+,4„,e 6 4,1. di,O IC NO j 97 l / /�f�/�//,( /c� / q ADDRESS 133,2_, xj 717i1 I1! cx ay. 2i0 I / U//iliL/CC�l/�!/!/��- �✓ l(V� CITY//Lp A.(.6..., ZIP 9z y0 W J PH fig,iz `� CONTRACTO /�. /` 11 ��� 3 �4''-- f�0 0, 1!'4(U� O � S r / ADDRESS /// �a .J.1 CCjj((J� CITY ZIP PH -.09e 7 rV CITY BUSINESS LICENSE LICENSE NO =XPIRATION DATE LICENSED CONTRACTOR'S DECLARATION r , I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000 of Division 3 of the Ru..ssiiness and Professions Code,and my license is in full force and effect /� %, - License Class �� License Numb 6/0 i �/ i,.Date�-2-5- 7� niracto . � y foo V�s ADDRESS CITY -�) \/� CITY AND ZIP 0)—�5�/� PHONE�Z - el/TO '( ' OWNER-BUILDING DECLARATION I hereby affirm that I am exempt from the Contractor's License Law tor 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 the project O I am exempt under Sec UPC for this reason Data INITIAl r WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure,or a certificate of Workers'Compensation Insurance,oorr cerhed copy theQ COMPAN "7 M0/LC 41V ;1/4— POLICY NO, �-w Z17 ,'i9 D9 ❑Ce ed copy is hereby furnisFedDATE EXPIRES /"J— 9/ Certified copy is filed with the city CITY Icn A VALUATION 9° i ; ,, -, d() Cf Datey��7g'- APPLICANT I r. .�►t�r.�i C� IT FEES C04TO CERTIFICATE OF EXEMPTION FROM WORKER OMPENSATION I NCE w I certify that in the performance of the work for which this per is issued,I shal of employ any perso in ELECTRICAL �0 J� I STRUCTURAL G, any manner so as to become subject to the Workers'Compensation Laws of Calrfo U /L, Date APPLICANT r /� PLUMBING .V, de 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 �// \I this permit shall be deemed revoked MECHANICAL I ISSUANCE FEES l� V I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS C••• CT I AGREE TO OMP WITH ALL CITY ORDINANCES AND STATE LAWS,AND HEREBY . •UTHO' ZE REPRESE ATI S OF THIS CITY TO ENTER UPON THE ABOVE MENTIONED GEO REVIEW PLAN CHECK PROPER FOR INSPE.L•N POSEY i -, 7 ■ ISSUANCE APPROVED TOTAL PERMIT FEE/',ii-,--.4.—' !ni si ' Olt 6-25—/3 Signet(of Applicanf'6r Agent Date (45;;;3427 ...L7 DATE OF ISSU// e9r5 bi I PERMIT NUMBER/ A3Print Applicant's/Agent's Name • d-/--,' ,0,_ 73, ‘ Y--- Operator: VIRGINIA Check #: 000002142 Date: 6/25/93 00 Receipt #: 0000900 DECK WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR $137'30 WHITE • , • BUILDING ADDRESS ' LOT BLOCK TRACT INSPECTIONS RECORD OWNER ADDRESS CITY ZIP PH SWIMMING POOL INSPECTIONS PLUMBING DATE APPROVED/INSPR'S SIGNATURE • LOCATION/DIG SP111//� ' ! I j "ti REMARKS )STEELBONDING/PLUMBING TEST SP3 I -7117121611 APPROVED TO GUNITE SP3, UNDERGROUNG ELECTRIC SP2 11(x"I \�`/J? GAS TEST SP3 I „� �A '/ FENCE ENCLOSURE SP5 IVSIVNOVim[ ' FINAL SP12 I/0//2 /177: • 1' GRADING INSPECTIONS PLUMBING DATE APPROVED/INSPR'S SIGNATURE PRE GRADING MEETING GRI TOE OF FILL GR2 EXCAVATION GR3 RET WALL FOOT GR4 MASONRY/FORMS GR5 • DRAINAGE DEVICES GR6 I ROUGH,GRADING 8 BUILDING RELEASE GR7 DATE OF ISSUANCE PERMIT NUMBER FINAL _ GR12 I ,t, . r • TRIAD TRIAD GEOTECHNICAL CONSULTANTS INC. Soils Engineering • Engineering Geology • Environmental Engineering ti 41: 17231 EAST RAILROAD STREET, SUITE 100, CITY OF INDUSTRY, CA 91748 TELEPHONE(818)964-2313 FAX (818) 810-0915 NOTICE OF c5-10.¢ rc,4V,4rjv,J INSPECTION JOB LOCATION ,-T3-2,L.5- VALta VA.5Ti4 Die. ( /hAin,'////J JOB NO. 93-6.3911-.7 DATE OF INSPECTION %-/-9,i CLIENT/OWNER e-cJieS L'G4S779/�- ,'OoIJ CLIENT'S ADDRESS • . .v,n ff-Ve DESCRIPTION OF AREA INSPECTED: 4"X(AV.1-77ON AeEEA/ A Sow A . /� '' , / S6//,S. cp,/, s//C/E,D 64.S � i�.� -.sz,CT. r e/yl aJ "2Av&;L Z,49A/7—ZrZ66..1/V ,a/144 . </10N/.0 .011 e t ,•4 .Lo C.J TO / OQ&-1 dre" '/?IA S/(Id .41701/77.41--. �X .4VI477iO4/ .. .9CE/19E4/T 4 [//yi7-6— ,4'w7 SPE/W, '"t7 F�7 - . �/YO//V� // , WL' ,�iPJi97�_.GDc,4,[j vvA-eW.WC A96-4/c/6--,s. , yd7 c ZL o&SE. c n,/r ,_WO749 ,7/4O M/C67/', JC Gf V.42 A' TO 9(�W/Tim . JOB SUPERINTENDENT: INSPECTED BY: SIGNATURE NATJd(E