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Permit No. 3437 t �,L CITY OF CHINO HILLS IP ii COMMUNITY DEVELOPMENT 2001 Grand Avenue APPLICATION FOR A BUILDING PERMIT AND A"CERTIFICATE OF USE &OCCUPANCY Chino Hills, CA 91709 BUILDING ADDRESS 37�� /iC ,/,‘',414 /�� , / `� CLEARED BY APPLICATION TYPE NO C i` 4- //// , fY F L> z O APN r /2 J THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT D. LOT 07it BLOCK er 2 TRACT 9950 W�RUCT U PLUMB CIMECH ❑ ELECT 0 / O ' TYPE OF PROJECT ❑ NEW ❑ ALTER ❑ ADDITION m OWNER d /2 0 ©AY _ i / CDCD / / EPAIR ❑ CONVERT ❑ DEMO ❑ OCCUPANCYPMT ADDRESS 2 �7,� J ,e �j J/,�/ PROJECT LOCATION ON SIZE CJC / ` /�//// �? �41.<,..., // DESCRIPTION I PROPERTY I IN SO FEET #//7� t; he?"/8"' 4/ // /// ZIP / /! `�" 9 � f2 Ci , �� /t Q-o 1„'I /1/4 'e" I l 8 0 >� JV ARCHITECT ENGINEER • LIC NO 2 I ADDRESS I 3 .r cCIIITYY��y�gi� // ZIP PH R/E°MARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION -"'� / // i TqA// , 1/'y, gar I IC NO y�n4Fgf I 0 C (leh C9/✓$ 2 �cep�— ADDRESS', /�/YL Gtr'/ i/ 7G 11� lL fP. jjCl/ ft/Y 3® Q /J/We tl n/ / 94.>126,;. /�� /` /� �G/ 1P c 4 /lam¢/✓49 / d` V/2 151-1< 1 %1-1< 1 CIIT//L pi, tj �i/�/ ZIP / // J+-� P ////�7 i.e. 8�lel # .-\ i,;AV /J� I�. 61)/4 h_ . c_ LICENSE NO !�� EXPIRATIONNGINECITY BUSINESS E /.. I(,�7'� Ai", (' �� rne ii LICENSED CONTRACTOR'S DECLARATION' r' ") I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000 of I Division 3 of the Business and Pro sans Code and my laen /s in full force and effect//' License Class_ e License Numb�efr s J , eF 9.'J, _ Data Contractor /Number er J .... ADDRESS` /Y ) Q.`Le Pte. ,I = Calf 4.191/ 99/64 >„ , 'd CITY AND ZIP PHONE , OWNER-BUILDING DECLARATION ', 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 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 protect - y\, ❑ I am exempt under Sec B&PC for this reason ��e .1`'\ \ \��\ r.;.., 1".....l Date 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 certifiedtficopy thereof,/ _ COMPANY if*"" /� e//D/!"/ POLICY NO las-.r.7,4_ D _ �f GROUP DIVISION TYPE ❑ Certified copy is hereby furnished DATE EXPIRES "AS " E Certifred opy is filed with the city CITY VERT DD�j�� /�_ /, VALUATION d A E��O/ — (1)--- Date 1 D— Date / — I APPLICANT�� % (��$ a 1 PERMIT FEES (�V 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 STRUCTURAL ��L,!/j� any manner so as to become subject to the Workers'Compensation Laws of California ! /f Date APPLICANT / 1 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 FEES a . _ / ;1 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 PROP RTY FOR INSP TION PURPOSES ISSUANCE�dAPPROVEDI TOTAL PER IT FEE 9-e�>r— 9-/-- Y 10510 Signature of Applicant or Agent Date 4_/ ' e ` A g'/2/_/' DATEO1ISSIIA F I PERMIT N � Print Applicant s/Agents Name ci, C- 1-1 Operator: VIRGINIA Check #: 000006972 Date: 9/01/94 00 Receipt #: 0000025 CHECK $105.10 WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR 111 P 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 FINAL PLUMBING P12 MECHANICAL DATE APPROVED/INSPRS SIGNATURE UNDERGROUND FLOOR M1 ROUGH , M2 FAU/AC M4 FINAL MECHANICAL M12 I I ELECTRICAL DATE APPROVED/INSPR'S SIGNATURE TEMP CONSTN POWER E3 • UNDERGROUND PVC-METAL-D B C El ROUGIi'WIR1NG""'.. :".�. RECEPT SPACING- Il SERVICE- PRCUIT .mss ao k Ei2R1 Re"_a $+ +d 9r itlt"'.`u r 'a4"r aP 46, 1.Jr. eT an•.0�, 4a ,rr Ia 1,7 v.r. I FINAL ELECTRICAL E12 Mer+�wva -A !PSRIIVNEA(/UINRSEPR'S STRUCTURAL :a-`rIrATE FOUNDATIOa LOCATION.rwaSd_ �r1.s�..nt4m��+ur»,.�. « w1-,•^f++.+•++�`s"^,C REINFORCED 0 UFER ❑� .m SLAB REINFORCED ID MEMBRANE I7 S3 FLOOR FRAME/INSUL S4 MASONRY S11 FIREPLACE S11 I - ROOF FRAMING ROOF SHEATHING S5 FRAMING S6 INSULATION SOUND ENERGY S7 LATH EXTERIOR S8 LATH INTERIOR/GYPBOARD S9 APPROVED/INSPR'S. SIGNATURE DATE OF ISSUANCE PERMIT NUMBER BUILDING FINAL S12 ti'