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Permit No. 1970 /' T a „.. . , • S v., q i• CITY OF CHINO HILLS COMMUNITY DEVELOPMENT 2001 Grand Avenue APPLICATION FOR A BUILDING PERMIT AND A CERTIFICATE OF USE &OCCUPANCY Chino Hills, CA 91709 {/��i i 1/l ,rl�� J 1/, / ADDRESS` 1 / V J�j V L5 � /1? 1 v v c;_y RED BY APPLICATION TYPE NO CO APN P 011 �1 V%10 //C_ F2 0 . THEJFOLLOWING WORK IS AUTHORIZED BY THIS PERMIT 0 D LOT BLOCK TRACT, 9Z3 1 ❑ RUCT ❑ PLUMB ❑ MECH ❑ ELECT o I • 31 g •( j)Uk , MI TYPE OF PROJECT ❑ NEW ❑ ALTER ❑ ADDITION 1OWNER ( J [(Y 1/ / /1 IS- ❑ REPAIR ❑ CONVERT ❑ DEMO ❑ OCCUPANCY PMT ADDRESS 1 1 ///' ,)1 .f142 PROJECT I LOCATION ONPROPERTY SIZE \ / DESCRIPTION IN SO FEET pppp 4 ��� /> I/nye' �/�'�" c:.......). � CITY cow I W ZIP C PH '/7o/ i/� //Jf1L - r •� ' I 7() ARCHITECT -1- I \/ ENGINEER LIC NO 2 (\1 ADDRESS 3 I I w CITY . _ .- ,ZIP, s-� - r PH REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION CONTRACTOl`Mn of Je gtUW 5 c C /J [ c r 130 ADDRESS (3 CITY 4 -JD ZIP /11/iv PH .,57t1 lj2 /i//Ii • CITY BUSINESS LICENSE LICENSE NO f K7 EXPIRATION DATF , LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000 of r, Division 3 of thesiryes d Pryers Code,and my he III Ind effect i" it License CI s � I Licens:7iw — o r ry ' )1A' tt"! ' ttm u i ADDRESS 11/1111 ��'" • d( , r• V v I .."--- I CITY AND ZIP ` 'VYIN° PHONE 59 ' \ , lw ` \\N.\ OWNER-BUILDING DECLARATION I Dligt"' Mk, • " 1� I hereby affirm that I am exempt from the Contractor's 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 r ! and the structure is not intended oroffered for sale ` ❑ I as owner of the property am exclusivelytkr ntbnsed contractors to construct the project /S i --__- ❑ I amexempt and UPC for this reason '9i& i /,/yam' //�� Date INITIAL _ l = , /�.// /� / WORKERS'COMPENSATION DECLARATION o '_ ,o Sir �'/7nl/�-�� /1i / I hereby affirm that I have a certificate of c sent to self insure or a certificate of Workers Compensation Insurance or a certified��co°�t)y they t COMPANY b.,/ I POLICY NO k � //'/r GROUPDIVISION n TYPE /� ❑ Certified copy is hereby furnished DA EXPI•ii. �Q ertifin n VALUATION 2 L — /C) •a op i led w��ty CI FL�� Date !/ APPLICANT Ai�1 �I� /I PERMIT FEESFZ,,N CERTIFICATE OF EXEMPTION FROM WORKER C MP, SATION INSURAN -m � ``` I certify that in the performance of the work for which this perissued I shall not eplo n in ELECTRICAL I STRUCTURAL7 64} ^'� any manner so as to become subject to the Workers Corrpensatan Laws of Calif • �' �'\ Date APPLICANT. PLUMBING I GRADING NOTICE TO APPLICANT If after es Certificate of Exerrphon you should become subject to the ` Workers'Co rovisions of the Labor Code you must forthwith comply with such provisions or is perm$shall be deemed revoked MECHANICAL ISSUANCE FEES I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT T ABOV,E INFORMATION IS .CORRECT I AGREE T COMPLY WITH ALL CITY ORDINANCES AND'TATE L AWS AND HEREBY GEO REVIEW I PLAN CHECK Mzgd ALIT���!!!111 ORIZE •.'•R SE ATIVES OF THIS CITY TO ENTER UP•• THE A30VE MENTIONED PR I'/�. •I• P 0 •UoISES 7 r m 0Wgs , "/� . 00 ISSUANCE APPROV TOTAL PERMIT FEE S. �r L nt or7Cg c f YL s l �kc ( i���I DATE OF ISSUANCE �/,)1 PERMIT NUMBER Pnn�A�Iicants/Agents lflarrie ,4` '9 l/a/( `'� I / , 7 6_ - _ d cy s— Operator: VIRGINIP Check #: 000007221 Date: 9/10/93 00 Receipt #: 0000288 CHECK $104.60 WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR • 1 1111, • a • BUILDING ADDRESS LOT BLOCK TRACT BUILDING INSPECTIONS RECORD OWNER ADDRESS CITY ZIP PH PLUMBING DATE APPROVED/INSPR'S SIGNATURE GROUND SOIL/WATER P1 TOP OUT P2 SHOWER PAN P3 REMARKS SEWER P5 GAS TEST P6 �—��� � ,6114L.,„ .■ - FINAL PLUMBING P12 MECHANICAL DATE APPROVED/INSPR S SIGNATURE UNDERGROUND FLOOR M1I ROUGH M2I FAU/AC M4 FINAL MEFNANI'C'gL` i'"""""^'M112=`+�^n+kc rrcerngavro m ELECTRICAL„ DATE APPROVED/INSPR'S T4. d 'Pu , s ,� ,y, Rm., ".5.1q-NATURE TEMP CONSTN POWER E3 I "'" Far, p, UNDERGROUND PVC-METAL-D B C El ROUGH WIRING RECEPT SPACING �"'`" v 7.,,1.,.? f;n,p: