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Permit No. 1969 t:TY OF c.HINO.HILLS III COMMUNIW DEVELOPMENT 2001 Grand Avenue APPLICATION FOR GRADING AND OTHER MISCELLANEOUS PERMITS Chino Hills, CA 91709 I ._ L. 'I�/ ��� CO ADDRESSG d 1(l ] yi Vi ykd lI)V V l! CLE //Y APPLICATION TYPE NO F /7 ///5,---iii �J ��.//Ire !/ 0 APN !O� I V��� Z TIKFOLLOWING WORK IS AUTHORIZED BY THIS PERMIT O .`�23 f LOT BLOCK TRACT RUCT ❑ PLUMB ❑ MECH ❑ ELECT ❑GRADING 8O { 70 1OWNER F/1 � V1S D p i '/ 4 1._015 EW ❑ ALTER ❑ ADDITION ❑ SUPERVISED GRADING (/)❑ DUMP DEPOSIT REQUIRED rN ADDRESS 3 L/3$ ' Aug visit, Dt ' ❑ REPAIR 0 CONVERT ❑ DEMO CUBIC YDS CITY CA/JO iri- j "V-II/i PH 1 Og I DES^RIPTION OF WORK AND CONDITIONS OF APPROVAL , ARCHITECT / ,D� ve,, J ENGINEER LIC NO �/ ' ADDRESS , - y CITY - •Z,E! PH _ :-)• 47/ 7-7� )-(/ . 1/d.1 CONTRACTOR rl/I���NW 1 V 0•(i L//"_"7 v"i „S St / //'-i`r" /_i�� [�%(-// i/ ADDRESS lt/ / [lvdWu , 4+.6.....4� I `w/,-i�fa (//�/Cii,/�z-�4 / 2 :"....\ CITY �/ 1V V ZIP ciIyrio PH i li/ 7-V/5, //N / ��I-t /. / /I /f./ CITY BUSINESS LICENSE / LICENSE NO Oki Pill /�/ EXPIRATION DATE �'/ / j // �� LICENSED CONTRACTORS DECLARATION P/-, --4//'1(717 - A,/' -7Z)V \v/ I hereby affirm that I am licensed under provisions of Chapter 9(commen�cl9g with Section 7000 of -Division 3 o the�usi es Pot ns Code and my he f• o�add effect 11. / • 1111/ e.7-.--, �� �(N� License Cla b+P/� License Nu •• ,.'Ir , !( �� ,��r•t 7�i/ / i tel/ / "7•e. .• ' iL i 1 7- �,. ) Date a14,3 C�onttra1ctt ,, �� ADDRESS I/// I She j itCr— -i v 1,,,,.....,- �.r;i•5 C . .• CITY AND ZIP v 14-11\16 1 116 PHONE 76 Yr/WI IK) pERM� I EXPIRED BY LIMITATION a OWNER-BUILDING DECLARATION I I hereby affirm that I am exempt from the Contractor's License Law for the following reason I 0 I,as owner of the property,or my employees with wages as their sole c• - ,wi do the work, ' \ `\ ` ` \A \ C \ and the structure is not intended or offered for sale � � .. 7� 1:1 �a'I,as owner of the property,am -••y contracting with licensed contractors to construct the project 1 Da{`e`// �Q� `'n" � � 1 T./"..-Y/Cr r /if'- ❑ I am exe . . •er Sec B&PC for this reason / ./Z�� -.." �j�f�J j� Date INITIAL • I 677 .7 .r ."6/ WQRKERS'COMPENSATION DECLARATION I hereby affirm t t I have a q�tdicate of consent to sell insure,or a certificate of Workers'Compensation ,,--# i /:&.-/• Insurance,or if t snot /f\� --//1 COMPANY Vi POLICY NO - tt�j /, ' ✓ T / ❑ Ce copy iereby furnished D• E PIRE• ) Ce rifr3h the sty •TY VE'IFIE• -. VALUATION ��ry) Date 0 APPLICANT A_a. AIWA PERMIT FEES • CERTIFICATE OF EXEMPTION FROM WORKER ENS TION INSURANCE..------.- I NSURANC5� )1) 1 I certify that in the performance of the work for which this per t r ami not employ any person in ELECTRICAL ,i �/.) I STRUCTURAL V2 9 any manner so as to become subject to the Workers' anon of California U(/ _�/7 Y//Z/// Date APPLICANT PLUMBING I GRADING NOTICE TO APPLI f,after making the Certificate of Exemption,you should become subject to the Workers' nsation provisions of the Labor Code,you must forthwith comply with such provisions or permit shall be deemed revoked MECHANICAL I ISSUANCE FEE(/% r4 I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS te__/_/////► �//1J CORRECT I AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS AND HEREBY GEO REVIEW I PLAN CHECK/ � 'f�V AUTHORI REP NTATIVES OF THIS CITY TO ENTER UPO THBOVE MENTIONED ER I P T POSE 16 Jr ISSUANCE APPROVED TOTAL PERMIT FEE S..nat r. •f ••••lic- •or A• DAte d/ �� I/77. '1(9 `�i�! • , ... DATE SSUfr�Jj/, n PERMIT/NU(f�BE/R •• Applicant's/Agent's Name �[.�" C/' I / i ,, J _ _ _ ._ _... __ ___ _-- -d_A-/:..6 _ Dnerator: VIRGINIA Check #: 000007221 Date: 9/10/93 00 Receipt #: 0000287 CHECK WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR $477.40 - - ,- ' • • , H j ,t 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/PLUMBINGTEST SP3 I \CI OWI 1(25Sif AN-N 41121"Ii APPROVED TO GUNITE SP3 I/ /O7Z-6/4r `O �/ v65zze2uLret6 A 6itz 265T .,1�-�� UNDERGROUNG ELECTRIC SP2 I ' - GAS TEST SP3 I FENCE ENCLOSURE SP5 /okay/6 ►moi - FINAL SP12 l✓f GRADING INSPECTIONS " "«.s* r'' -`t"'rt ," L+T„ati "rAPPROVED/INSPR'S 1 PLUMBING DATE SIGNATURE PRE GRADING MEETING GR1 4 TOE OF FILL ' GR2 EXCAVATION GR3 RET WALL FOOT GR4 MASONRY/FORMS GR5 • DRAINAGE DEVICES GR6 ROUGH GRADING& BUILDING RELEASE GR7 DATE OF ISSUANCE PERMIT NUMBER FINAL GR12 `. I