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Permit No. 2548 CITY OF CHINO HILLS COMMUNITY DEVELOPMENT 2001 Grand Avenue APPLICATION FOR A BUILDING PERMIT AND A CERTIFICATE OF USE&OCCUPANCY Chino Hills, CA 91709 , BUILDIN CLEARED BY APPLICATION TYPE NO. . .- ' - C ADDRES .5114 Via Loreto F CH PD FRlz APN 1017-5 1 2-0 8 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT D LOT 0 8 BLOCK TgA T9 0 6—3 � STRUCT. n�PLUMB. :::-";'n. MECH. L11❑ELECT. O 1l Do TYPE OF PROJECT NEW ❑ ALTER O ADDITION trf Brock Coral Ridge X� (J' OWNER CO O REPAIR ❑CONVERT ❑ DEMO ❑ OCCUPANCY PMT. - 3382 Mill Creek Drive #130 PROJECT LOCATION ON SIZE N ADDRE DE PROPERTY IN SQ. EET V, CITY Laguna Hi1lea, 92653 F483-1061 ARCHITEIOT. C. Majors & A s s o c i a1 2. it+ /- ENGINE g2; . ,41/2 1( 1 90 ADDRES1551 North - Tustin Avenue #640 3. <. I . CITY Santa . Ana, ZIP 92701. X50-9777 P - -- REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION /// - CONTRACTOR LIC.NO. - I - L O ��e0- - • k c.,,,, M. J . Brock -& Sons ,.r,•lan '•Lax-f- ADDRESS Oli)it engineer t;; inspect 6 �' f"2b flt�rl 233£2 •M411 Creek _n,-,_=;c #130 { iii,}° 4" ....1:-....^...,.........i. I r , ,., p.,:•w•,,,,rcrGI #Guth) ut piue1 CITY Laguna H i 11 sZIP 9 2653 P883-10 61 1 and provide Proper rennrt nn cite fn. �j CITY BUSINESS LICENSE j / j - b nclinspector. LICENSE NO �/ EXPIRATION DATE �..y�� 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 is in full force and effect. „ .' B-1 - 54648 - -- - - - License Class License Number - Date , Contra's,.. . - . ADDRESS CITY AND ZIP PRONG • _ - 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 project. , 0 I am exempt under Sec. B&PC for this reason 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 certified copy thereof. - - _-- .- .- ` - Alexander & Alexander TASJUBT477-4-94 . COMPANY. - , POLICY NO 1-1—y5 GROUP R DIVISION 3 TYPE V N ❑Certified copy is hereby furnished DATE EXPIRES ' VALUATION /I 2' ❑�'e�'fied co y is fled with tth�e city CITY VE/` ED .7 000 Q Date r APPLICANT: / 'i♦ _ - PERMIT FEES .. . CERTIFICATE OF EXEMPTION FROM WORKE4R6`COMPENSYOr7ION INSURANCE . I certify that in the performance of the work for which this permit is issued,I shall not employ any person in ELECTRICAL. �.�,/wJ '/y ,h/ y'�3 STRUCTURAL: 9 [� �y any manner so as to become subject to the Workers'Compensation Laws of California. V-”c•I.a_U - �/ /,)-i 5z) Date: APPLICANT youI PLUMBING: 4 n� v I GRADING: NOTICE TO APPLICANT:If,after makingthis Certificate of Exemption, should become subject to the if Workers'Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked MECHANICAL:' Q 7 - ISSUANCE FEES: - �� 7 f a . 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 J`v 7 - 7 AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTIONED . 'PROPERTY FOR INSPECTION PURPOSES, . ISSUANCE APPROVED' TOTAL PERMIT FEE: 6;7 Spaieeo g Dat /1 5 g7 .3V DATE OF ISS ANCE: PERMIT NUMBER:Jim Tim yn»ng, Prnjert Manager r/i• I !J Print Applicant's/Agent's Name f ( /...- . Operator: VIRGINIA Check *: 000619473 Date: 2/24/94 00 Receipt #: 0000744 CHECK $1527.34 WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR — ...,...., .,. . .- .. . , . .. . „_____, ----', • • . . . . - . . . . . 9ADu Du_pi tsGs/67/1 A/4 i i 4 e tate' x 9 f I . LOT . BLOCK /31 - . . • BUILDING INSPECTIONS RECORD . OWNER ADDRESS • CITY ZIP PH. ..7 _. .. i - PLUMBING '----i„ DATE AP,PROV.414JS PR'S ,,-.: 'SIG/NATURE GROUND SCilL‘WitktkR 'PIT 11-.AT-sly?Y-T-•-•!- ,i.,44.. TOP OUT •y .-, P2 ..'i-/4...2.34 • , '1' r. . . . . ., . „ , . • • " 5-14.0WER PAN * P3 /1 c..-V. 1 ' --'''''''' * - ''''' REMARKS - • . , . ... . . . , SgWER 'I'L-** •::',..\ , P5 S72-/fV I ';i4ris;X'''; , G_Ap TEST - • . P6• ...)-t?0/CW I :4.1"--- i 3 if/F( flfe a OPRele- 4 '474 7-..;;• I -.7 " I . FOL.PLUMBING. ..... ...P12 4 //YAW I ' ?7,----- ,/ //..,,,,. -MECHANICAL : _ ..••-.,., 3::..,.DATE ,....::. ' APPROVEDINSPR'S "7/1°/7 7 1--)/7 ---€7:g. w 4-1/3 04 SIGNATURE UNDEFIGFgOWILOOk• :•'•Mi. ROUGH '-''--- ' ' "'' 4.vi?'.' 477 ....FAU/AG M4 ..,//7-",,:::,/ g..:,v:.. --;....5" .-:Ai,'..,.. .'.):'• .0, ., FINAL MECHANICAL Mi 2. 61,//ry y yr ELECTRICAL DATE AP01:16VED/INSPR'S SIGNATURE TEMP.CONSTN.POWER E3 UNDERGROUND PVC-METAL-D.B.C. El ROUGH WIRING RECEPT.SPACING- E2 YA 0 SERVICE-CIRCUIT , , ."- • FINAL ELECTRICAL El 2 APPROVED/INSPR'S STRUCTURAL DATE SIGNATURE FOUNDATION:LOCATION 51 REINFORCED ...Er UFER SLAB REINFORCECLO-MEMBRANUR*51- 3 /f/' .y I - FLOOR FRAMEANSUL. S4 MASONRY Si 1 . r . .I FIREPLACE Si 1 - i,--\ - -- -•,.\ '-,T-..i, '..'-\.....-, ROCIF-FRAMAIG ROOF SHEATHING - S5 1.1%Y4K 1 eAP'X., •,..1 -',,,.,) FRAMING ...:-.--, ---*, ,. S6 1-ihriAtz• 1, -- • INSULATION '--..,%'---• ' '•, //4-*(77-7•q.:-I *27.‘ SOUND ENERGY S7 .1 ... LATH EXTERIOR. seI 4//9 LATH INTEQpRiGY,PBOARD S9.I al P- (7,-.-1/ez,;1 I,"? „. . . . APPROVEDANSPR'S -- SIGNATURE DATE OF ISSUANCE PERMIT NUMBER BUILDING TA7„.1 v i ..„ Si2 ‘/ --/c --- - / - ., . .., . , _ .. _ • • • • -.:7;11'..'.I..ii./I:I0 -ii- •:pil'.1 I) A r•.-1(V ric.liFx)El 00