Loading...
Permit No. 1682 11111 0 CITY OF CHINO HILLS COMMUNITY DEVELOPMENT 2001 Grand Avenue APPLICATION FOR A BUILDING PERMIT AND A CERTIFICATE OF USE &OCCUPANCY Chino Hills, CA 91709 BUILDING f / .1/ / \ CLEARED/BYY.�/�/_ APPLICATION TYPE rs NO CO ADDRESSC V ABLE V/S 1 A 1��'1vC �// I` 0 APN / O / '7 y 54/ - D THE)eLLC4WING WORK IS AUTHORIZED BY THIS PERMIT 0 / D LOT BLOCK TRACT STRUCT ❑ PLUMB ❑ MECH ❑ ELECT 0�� ./ �-, 0 TYPE OF PROJECT Q NEW ❑ ALTER WADDITION m fn OWNER "f C ,,^�, iP'G` ❑ REPAIR ❑ CONVERT ❑ DEMO ❑ OCCUPANCY PMT ADDRESS _ PROJECT LOCATION ON I SIZE ,_-?..3—.23- ✓LLC si7 2)=— ,..21"� DESCRIPTION PROPERTY IN SO FEET CITY(7,44/i70 /74„.„ ZIP /77)9 PH.59 5-0/0 1 f)4_ fI 123 / A HRL� .�/ I I / GINEER '✓D L „:72._.... LIC NO 2 11 ADDRESSJ3 Qr A %:- /4# e 3 I I CITY4 -4/v ZIP 9i/�I/,� PH 6 2 g__0 y0( REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION CONTRACTORttLIC NO ADDRESS r / r � CITY ZIP PH v CITY BUSINESS LICENSE LICENSE NO EXPIRATION DATF LICENSED CONTRACTOR S 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 rs in full force and effect w A License Class License Number Ai/ 4 e-- f,'—/A'��- 451111rr Date Contractor . ADDRESS CITY AND ZIP PHONE 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 as owner of the property am exclusively contracting with licensed contractors to construct the project ❑ I am exempt under Sec B&PC for this reason Date 7-/2- - 73 INITIAL /+ /� WORKERS COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to sett insure or a certificate of Workers Compensation Insurance or a certified copy thereof COMPANY POLICY NO GROUP VISION / E_ ❑ Certified copy is hereby furnished DATE EXPIRES ��J ❑ Certified copy is filed with the city CITY VERIFIcf VALUATION .57 4(f Date APPLICANT PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE I certify that in the performance of the work for which this permit is issued I shall not employ any person in ELECTRICAL I STRUCTURAL ��r any manner so as to become subject to the Workers Corrpensa n La dorn ` Date 7- 12- - 9‘...? APPLICANT ' PLUMBING I GRADING NOTICE TO APPLICANT If after making this Certificate of Exemption you shout pa�Ome subject to the Workers'Compensation provisions of the Labor Code you must forthwith comply h such provisions or - the permit shall be deemed revoked MECHANICAL I ISSUANCE FEES G I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS / CORRECT I AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS AND HEREBY GEO REVIEW //^ I PLAN CHECK AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTIONED PROPERTY FOR INSPECT• PURPOSES ISSUAN ROVE TOTAL PERMIT FEE I Signature of Applicant or AgentJ Date / i 1"4 j 7o /s DATE OF ISSUANCB'I PERMIT NUMBER Pt d w. 4>rC Lf 7 /3.—513 I /(0' 2-- Pnnt Applicant siAgent s Name OOperator: VIR6INIR Check 8: 000002758 Date: 7/13/93 00 Receipt D: 0000341 CHECK $104.60 , WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR • S • BUILDING ADDRESS LOT BLOCK TRACT BUILDING INSPECTIONS RECORD OWNER ADDRESS CITY ZIP PH PLUMBING DATE APPROVED/INSPR'S SIGNATURE GROUND SOIL/WATEA P1 TOP OUT P2 • SHOWER PAN P3REMARKS 4 SEWER P5 9/47/S =? Cc)) PO-0%f a�Aii /7,- 41/x" • GAS TEST P6 //1 �Q <Y / ��,, I " -y FINAL PLUMBING P12 ') ov \ •W`i V, V a 6 MECHANICAL DATE APPROVED/INSPR'S o� SIGNATURE UNDERGROUND FLOOR Ml ROUGH M2 I - - FAU/AC M4 FINAL MECHANICAL M12 ELECTRICAL DATE APPROVED/INSPR'S SIGNATURE TEMP CONSTN POWER E3 UNDERGROUND PVC-METAL-D B C El ROUGH WIRING RECEPT SPACING- SERVICE-CIRCUIT E2 FINAL ELECTRICAL El 2 STRUCTURAL DATE APPROVED/INSPR'S SIGNATURE FOUNDATION LOCATION 51 REINFORCED ❑ UFER 0 SLAB REINFORCED❑MEMBRANE S3 FLOOR FRAME/INSUL S4 MASONRY S11 FIREPLACE S11 ROOF FRAMING ROOF SHEATHING S5 FRAMING S6 INSULATION, , SOUND ENERGY S7 LATH EXTERIOR S8 • LATH INTERIOR/GYPBOARD S9 APPROVED/INSPR'S /j J' SIGNATURE DATE OF ISSUANCE PERMIT NUMBER BUILDING FINAL S12 I/(6J/:nNor •