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Permit No. 1649 QTY OF CHINO HELLS • COMMUNITY DEVELOPMENT 0 2001 Grand Avenue APPLICATION FOR GRADING AND OTHER MISCELLANEOUS PERMITS Chino Hills, CA 91709 BUILDINGC�� 1/4II CLEARED BY APPLICATION TYPE NO CO ADDRESS iQ\�� 1 APN .1-71'.. S NO \ Z0 ( 6 l C ICD / A/? //////������.� THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT D LOT BLOCK TRACT Of 7_3' Q STRUCT ❑ PLUMB ❑ MECH ❑ ELECT ❑ GRADING 8 I' `4..W ❑ ALTER ❑ ADDITION ❑ SUPERVISED GRADING M OWNERIci :34.44.,rift It /► ^ 1' yl q ❑ DUMP DEPOSIT REQUIRED Cl) ADDRESS a I-i` I I 3LJ �l`.11 ..//KK\.I iA‘ t,I (i ig ❑ REPAIR ❑ CONVERT ❑ DEMO CUBIC YDS CITY ZIP PH DESCRIPTION OF WORK AND CONDITIONS OF APPROVAL (� ARCHITECT f� f ENGINEER od/ 1,40IdtiLe✓1La...- LIC NO / 33 2 d� /��/�i,/L 3 Z/ n �3y7' ADDRESS /] i i q t d r j �� CITY ZIP %� t'U" 0 PH f (r�Qa ` -!' r \\„k, CONTRACTOR (.40C, 1 S /4-6140 0 t16/Q-7 c ADDRESS /(/_ v S �tdv. CITY/ VY�n,N/rF ZIP q1-14 v PH 4 z7.47?.0 _ _ CITY BUSINESS LICENSE i1/ ��/1"./� LICENSE NO EXPIRATION DATE /�7 V%�� / 205 v ) LICENSED CONTRACTORS 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 is in full force and effect n License/Class�l p n�3 License Number ( •(P I 0 •S I IV1/n, Date ip LJJ-[3 Contractor /��,(�/J,�fL4 5 '4'bn 146 I C ADDRESS /� S . 15 - CITY AND ZIP r '01✓A 9(71 C PHONE /� V2 -0 990 OWNER-BUILDING DECLARATION I hereby affirm that I am exempt from the Contractors 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 the project O I am exempt under Sec B&PC for this reason Dat, INITIAL WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure,or a certificate of Workers'Compensation - Insurance,or rtrf opyther COMPAN rQ /L/ q�i._, POLICY NO /`L� 2-t 2. 0 90) 0 Certified copy is hereby furnished DA'. EXPIRES 4 Z ?te-/ 7 _ _ 1,__l o.:(.-copy is filed with the city CI RIFIED '/ ' VALUATION D ateir �j 1A / � � i r —0/ APPLICAN 414 i ii / • PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKER OMPENSATO E '� I certrfy that in the performance of the work for which this per is issue all not employ any person in ELECTRICAL I STRUCTURAL Lit) any manner so as to become subject to the Workers'Corrpen tion Laws Date 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 with such provisions or this permit shall be deemed revoked MECHANICAL I ISSUANCE FEES21 .....--.. I CE• THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS / C•'• a I AGREE TO .OM:.LY WITH ALL CITY ORDINANCES AND STATE LAWS AND HEREBY - A ••IZE REPRESE A 11 ES OF THIS CITY TO ENTER UPON THE ABOVE MENTIONED GEO REVIEW PLAN CHECK •1 • FOR INSPEC .N;UR•e___ I. �� `n ISSUANCE APPROVED - TOTAL PERMIT FEE g. Sign.jR 4‘..f Applicant• Age .6-11....-- Date �i� , , r //5'qO ,,4 r •t'1 DATE OF IS NCE" PERMIT NUMBER Print Applicant's/Agent's Name "" 294 I ,�� / dt,__L. Operator: VIRGINIA Check #: 000002162 Date: 7/01/93 00 Receipt #: 0000006 F-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR CHECK $115.40 N` 1 i • BUILDING ADDRESS • LOT BLOCK TRACT INSPECTIONS RECORD OWNER ADDRESS • CITY ZIP PH SWIMMING POOL INSPECTIONS PLUMBING DATE APPROVED/INSPR'S SIGNATURE LOCATION/DIG SP1 REMARKS STEEL/BONDING/PLUMBING TEST SP3 APPROVED TO GUNITE SP3 UNDERGROUNG ELECTRIC SP2 GAS TEST SP3 FENCE ENCLOSURE SP5 FINAL SP12 GRADING INSPECTIONS PLUMBING DATE APPROVED/INSPR'S SIGNATURE PRE GRADING MEETING GR1 I TOE OF FILL GR2 I EXCAVATION GR3 A I RET WALL FOOT GR4 C 4 MASONRY/FORMS GR5 •-r. . . � 1 DRAINAGE DEVICES GR6 ROUGH GRADING& BUILDING RELEASE GR7 //�� ,,)I DATE OF ISSUANCEPERMIT NUMBER FINAL GR12 '61i-r( ICO