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Permit No. 4082 • • • �-'• CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND --i;=ei„... COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY --"4'4' 2001 Grand Avenue n-- Chino Hills, CA 91709 BUILDING '� �'/nPROPOSED USE J co c ADDRESS Ot QU VISTR DEL, SOL 3\ J �, x r 1� O APRC.IIP cI�.I 1033N-117.-.PS • THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT > LOT 69` BLOCK TRACT I�S� r 9.$T�RUCT .�P1UM8 �`MECH {G7-ELECT DI-GRADING 9 `/ITYPE OF PERMIT ANEW ID ALTER 0 ADDITION m APPLICANT I-1(1 R 0s. 1•1-6 4 CSCO CO 0 REPAIR 0 CONVERT 0 DEMO 0OCCUPANCY PMT ADDRESS g33a'a Iwo\ CAR.EEL lJR S1J1/t`Q (3 U PROJECT LOCATION ON SIZE I�II�I /' DESCRIPTION PROPERTY IN SO FEET (� CITY /1ZSIMLf LM�I` ZIP _/�I�� PH c b 3106 1 I'%r I 1102 J"-' nI I/1 1 OWNER SlJYt,G Al M.kI,E 2 d� I I Illk ADDRESS3 f1RIAc' I I Y By G CITY ZIP PH 4 6A.alI I ARCHITECT I b (01 ENGINEER L.. C. A\,„„e 5 LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ----�)/ V ADDRESS I n-I N, 9 lint Air NO STORIES NO DWELLING UNITS BEDROOMS37 CITY S$tAJ� Arts ZIP 1 o) PH 57-0 / ROOF I FLOOR I EXT WALL I INT WALL 2 CONTRACTOR Gl, . LIC NO r- ADDRESS `�M��-t` CEILING HEATING I METAL MASONRY I/l^ FIREPLACE CITY ZIP PH SEWER MIN DEPTH S/F/100 I SIZE -�l CITY BUSINESS LICENSE LICENSE NO EXPIRATION DATE LICENSED CONTRACTOR S DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000 of Division 3 of th /ee��B�usiiness and Professions Code,and myyllice /nse is In full force and effect ("� ^p License Class O� J License Number ✓'T 4'1 Ran 3 R. Date Contractor ADDRFCC CITY AND ZIP PHONC OWNER-BUILDING DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason O I as owner of the property or my employ..•with wages as their sole compensation,will do the work and the structure is not intended or offered for sale O I as owner of the property,am exclusively contracting with licensed contractors to construct ZONING I LAND USE the protect _ O I am exempt under Sec B&PC for this reason I \-Z. Dat. INITIAL SETBACKS I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY I SY I hereby affirm that I have a certificate of consent to self insure or a certificate of Workers Compensation n Insurance, .,o rrr a certdled copy thereof -}/� -y- '��T qty �/-y'7 RY I SSY I COMPANY LPA IdC POLICY NOY1JStl Ul73 Od'-c-7/Fy GROUP DIVISION TYPEj O Certified copy is hereby furnished DATE EXPIRES (K) Lit--1 VALUATION e")\-IN �.��'+ Certified'copy is filed(' with the oily CITY VERIFIEDE �, I "L� I `CI Date IR I '�-J APPLICANT L•- /t""`f�i`n_• PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COALPENSATIOfTINSQRANCE _ I certify that in performance of the work for which this permit is issued,I shall not employ any ELECTRICAL ale 1 l I STRUCTURAL l/ (,� person in any manner so a to become subject to the Workers Compensation Law of California OOJti IUh-`•`• Dat. APPLICANT PLUMBING qq v12T I GRADING ^'1( NOTICE TO APPLICANT II,alter making this Certificate of Exemption,you should become !}`I`7 3 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 t �j Te ISSUANCE FEES /-TG; G O I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA TION IS CORRECT I AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS, GEO REVIEW I PLAN CHECK GSV'-F • n`T AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE C7 MENTIONED PROPERTY FOR INSPECTION PURPOSES ISSUANCE APPROVED TOTAL PERMIT FEE Lbl Signature o ppbcanf cr AgJi 0 Date DATE OF ISS ANC PERM T NUMBER 11+'11 ofieKnitti 11I /E1/9� Pnnt Applicants/Agents Name a 1 I I / 0?3 - _i FINANCE CODE C `J J D•Jerator: DAWN Check I: 000000000 Date: 2101195 00 Recent II: 0000005 WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK- OWNER FitCJt $1752.94 GOLD•ASSESSOR/MANILA - INSPECTOR Chount Tendered $1752.94 lIONSTRUCTION LENDING AGENC• I HEREBY AFFIRM THAT THERE ISA CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 3097,CIV C) LENDER'S NAME LENDER'S ADDRFQQ DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRESA DIVISION OF INDUSTRIAL SAFETY PERMIT AS A PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW O I CERTIFY THAT NO EXCAVATION 5 FEET OR MORE FEET IN DEPTH,INTO WHICH A PERSON ISREQUIREDTO DESCEND,WILL BE MADE IN CONNECTION WITH WORK AUTHORIZED BY THIS PERMIT,AND THAT NO BUILDING,STRUCTURE,SCAFFOLDING,FALSEWORK,OR DEMOLITION OR DISMANTLING THEREOF WILL BE MORE THAN 36 FEET HIGH • D AS OWNER/BUILDER I WILL NOT EMPLOY ANYONE TO DO WORK WHICH WOULD REQUIRE A PERMIT FROM THE DIVISION OF INDUSTRIAL SAFETY,AS NOTED ABOVE UNLESS SUCH PERSON HAS A PERMIT FROM THAT DIVISION DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER I HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT DIS DIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY -,i '-4.----',..._'..,-..ii, ,w7,77 ---Pg .,n, _-4e s _I •jh 14",-�1 --4 Call/Sari.2•' k_ "> , + ..y� 1 P l,4-"1 'si0' • t1 lige .,.e t7•t.Y11,4 xiii t• �.. ointEel:-,: i1.•;"1-1.411 / -•='^• " 1 CITY OF CHINO HILLS S APPLICIATION FOR A BUILDING PERMIT AND ••.-it COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY -. r.�, 2001 Grand Avenue , ..".-iik,' Chino Hills, CA 91709 BUILDING PROPOSED USE C ADDRESS t v - •� - v« ti. F - 0 APN " _ ` 1 ' Z ` THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT y LOT BLOCK TRACT 0 STRUCT 0 PLUMB 0 MECH 0 ELECT 0 GRADING O ( I -' - 73 TYPE OF PERMIT 0 NEW 0 ALTER 0 ADDITION fn APPLICANT N I I 0) 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESSI PROJECT I LOCATION ON I SIZE , t ' DESCRIPTION PROPERTY IN SO FEET CITY ZIP PH ' I I , i,"/ 1 '' OWNER I I 2 ADDRESS 3 I I ' - CITY ZIP PH 4 ' ARCHITECT ENGINEER t ;y LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION - , ADDRESS - ti O STORIES NO DWELLING UNITS BEDROOMS CITY ZIP PH r ROOF I FLOOR EXT WALL INT WALL ' CONTRACTOR LIC NO ADDRESS CEILING HEATING I FIREPLACE METAL MASONRY CITY ZIP PH CITY BUSINESS LICENSE SEWER MIN DEPTH S/F/100 I SIZE �— LICENSE NO EXPIRATION DATE LICENSED CONTRACTOR'S DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION 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 License Class License Number ` ' Date "ontractor ADDRESS CITY AND ZIP PHONE OWNER BUILDING DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason O 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 O I,as owner of the property am exclusively contracting with licensed contractors to construct the protect ZONING I LAND USE O I am exempt under Sec B&PC for this reason I { S- , Dale INITIAI SETBACKS I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY I SY I hereby affirm that I have a certificate of consent to self insure,or a certificate of Workers' Compensation Insurance,or a certified copy thereof RY I SSV COMPANY POLICY NO GROUP DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES VALUATION O Certified copy is filed with the city CITY VERIFIED ( ' , t Date APPLICANT •-- PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE I certify that in performance of the work for which this permit is issued,I chaff not employ any ELECTRICAL _ l t STRUCTURAL person in any manner so as to become a ublect to the Workers'Compensation Law of California l Date APPLICANT PLUMBING I GRADING NOTICE TO APPLICANT If,after making this Cartihute 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 — ISSUANCE FEES ' I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA- TION IS CORRECT I AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS, GEO REVIEW I PLAN CHECK ' AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES ISSUANCE APPROVED TOTAL PERMIT FEE ! 7 `- — I r Signature of Applicant or Agent Date ' tt DATE OF ISSUANCE PERMIT NUMBER ' i Print Applicant s/Agents Name 3 I I /s Y FINANCE CODE C t / WHITE- FILE/GREEN- FINANCE/ YELLOW- OFFICE/PINK- OWNER GOLD-ASSESSOR/MANILA - INSPECTOR .ONSTRUCTION LENDING AGENC• I HEREBY AFFIRM THAT THERE ISA CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 3097,CIV C) LENDER'S NAME LENDER'S ADDRESC DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRES A DIVISION OF INDUSTRIAL SAFETY PERMIT AS A PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW CI I CERTIFY THAT NO EXCAVATION 5 FEET OR MORE FEET IN DEPTH,INTO WHICH APERSON IS REQUIRED TO DESCEND,WILL BE MADE IN CONNECTION WITH WORK AUTHORIZED BY THIS PERMIT,AND THAT NO BUILDING,STRUCTURE,SCAFFOLDING,FALSEWORK,OR DEMOLITION OR DISMANTLING THEREOF,WILL BE MORE THAN 36 FEET HIGH ❑ AS OWNER/BUILDER I WILL NOT EMPLOY ANYONE TO DO WORK WHICH WOULD REQUIRE A PERMIT FROM THE DIVISION OF INDUSTRIAL SAFETY,AS NOTED ABOVE UNLESS SUCH PERSON HAS A PERMIT FROM THAT DIVISION DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER I HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT DS OS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY BUILDING INSPECTIONS RECORD DATE INSPECTOR DATE INSPECTOR Setback/Location Rough Plumbing t./A7 v/o 1. Temporary Power Shower Pan Test '' '/ i , •rr� Foundation Reinforcing Steel Stucco Mesh or Exterior Siding 572/;c15— a-1AX Excavation and Forms Insulation ri/%d'/fr Slab Grade L /z /Fr Sewer f/; Ground Plumbing Soil 2/2//1J .41b.' Interceptor Ground Plumbing Water A/2011/415—1 ,tea/ Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service y/1 6/l-r �y Underslab Gas Lath or Drywall Nailing .�i/fes Fireplace Foundation Gas Line Air Test o�fJ c./7- Joists and Girders Final Energy Electrical Ground Final Plumbing r /.,/4-- Mid-Height Bond Beam Final Heating/A C 8-Foot Bond Beam Final Construction 6///fr <0,e Final Bond Beam Final On Site Improvements Fireplace Bond Beam Final Off Site Improvements Roof Sheathing 3/j effs 'j0 Final Dedication Framing and Ventilation V/f..o/95 Tao t Final Zoning Roof Covering Final Electrical / /,c �-� Rough Heating y/;g''7s 0104 Final Gas / '/ ' Service and Ground Developer Fees Paid Rough Electrical / / Fire Dept Approval Verified Bonding r//2f/fs ,pL Certificate of Occupancy Over Head Electrical Fence Height Gates Heater Pool Drainage SEPTIC TANK ,ALS SEEP PIT X LEACH LINE WIDE LONG X DEPTH OF ROCK N W E S Inspector's Signature and Initials DATE pF I$SUA� PERMIT NUMBER a 9 ,y`\ a