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Permit No. 4083 /1.3.,::‘\ CITY OF CHINO H• APPLICATION FOR A BUILDING PERMIT AND =d:gy A CERTIFICATE OF USE & OCCUPANCY COMMUNITY DEVELOPMENT 2001 Grand Avenue ---.,...0„ii, Chico Hills, CA 91709 J 03 BUILDING n �-1 PROPOSED USE-C L/P c ADDRESS d�17 Vl$Tp Dia_ SOL 5 \ Imo. °.PO al z APN )0i0-51s- ir0_N _ Oa J b O� THE FOLLOWING WORK IS AUTHORIZEED BY THIS PERMIT a LOT GIS BLOCK TRACTI3S`, L�(�STRUCT LUMB C�3-MECH f0 ELECT �RADINO 0 GIS Vb TYPE OF PERMIT a3-NEW 0 ALTER 0 ADDITION m N APPLICANT IS Rh/ �C ,.I.y1VhF S y APPLICANTS VU ❑ REPAIR ❑ CONVERT ❑ DEMO ❑ OCCUPANCY PMT ADDRESS a331�2- tVbjbl GRq^7< lJR Svi to 13b DESCRIPTION I PROPERTY ON I SIZE IN 50 FEET CITY LASIMA- ItU v !.�( ZII�P1_�� gag r3 PH t3iI blal 1 1 si: I I 1 L)ap�! OWNER Spm$ AS (4 bag_ 2 'd I 111\ ADDRESS B r -1-1a I CITY ZIP PH I I 61 U 4 ARCHITECT ENGINEER L.C, m ) J LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS fin--) N. I uyt, - P`/- NO STORIES NO DWELLING UNITS BEDROOMS CITY CIA W.r AA A- ZIP 12 3o) PH -•9�I7� ROOF I FLOOR I EXT WALL I INT WALL CONTRACTOR (` -,,.,1 I LIC NO /WV�- CEILING HEATING FIREPLACE ADDRESS I METAL MASONRY CITY ZIP PH SEWER MIN DEPTH S/F/100I SIZE CITY BUSINESS LICENSE LICENSE NO EXPIRATION DATF ((( LICENSED CONTRACTOR S DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION \ / ` I hereby affirm that I am licensed under provisions of Chapter 9(commencing writ,Section 7000 v of Division 3 of the Business and Professions Code,and my license is in full force and effect [� p fel r{ cl License Clan 6- 1 License Number 54 _pn 3 CR. Data Contractor ADDRESC CITY AND ZIP PHONF 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 - ZONING I LAND USE the protect /� O I am exempt under Sec B&PC for this reason I \-1L-, I Date INITIAI SETBACKS I MODEUPLAN WORKERS COMPENSATION DECLARATION FY I SY I I hereby affirm that I have a certificate of consent to sell insure,or a oertd,ute of Workers' Compensation •Wl n Insurance,or a certified copy thereof RY I SSY I _L COMPANY 1y .1/�.l POLICY Nn7"o til\/1U��'1/7- / GROUP �.v r DIVISION I TYPE O Certified copy is hereby furnished DATE EXPIRES K C� •'/h// VALUATION Y1 &Certifiedis copyfiled with the city CITY VERIFIED QQ 3 n a Dal. /..3 P-9 ' APPLICANT yL2 /d Xtilia � PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COX/IPENSATION INSURANCE I certify that In performance of the work for which this permit is issued,I shall not employ any ELECTRICAL 03S-- 33s qr I STRUCTURAL I U ly (20_ person in any manner so as to become subject to the Workers Compensation Law of California VL d Date APPLICANT PLUMBING t/u• S� I GRADING l5-- NOTICE TO APPLICANT If,after making this Certificate of Exemption you should become O11 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 �R'$2 ISSUANCE FEES �-I I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA VV 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 'n MENTIONED PROPERTY FOR INSPECTION PURPOSES ISSUANCE APPROVED TOTAL PERMIT FEE 0 artan fr 1-3/-51— 175x. " Signature pelican'or A t V Gab �L.JI}•Ia0166s�IC�V DATE OF ISS ANCI PERA/yuT)I NUMBER Print Applicant s/Agents Name / r 1 )///jjj 1 0 g3 FINANCE CODE CLi Okerator: DRHN Check II: 000O00UU0 WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK- OWNER DOOatte: 2/01/95 00 Receipt d: 0000006 GOLD HECK •ASSESSOR/MANILA - INSPECTOR - $1752.94 t•7c: 9,4 •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 LENDERS ADDREee 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 ❑ I CERTIFY THAT NO EXCAVATION 5 FEET OR MORE FEET IN DEPTH,INTO WHICH A PERSON 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 ❑IS ❑IS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY • '?y;y�. ,,,my,.J:-Dr'' .t,vrctA.r N>.av ,c 4 u• CITY OF CHINO HILLS ,i APPLICATION FOR A BUILDING PERMIT AND `r•' COMMUNITY DEVELOPMENT "� A CERTIFICATE OF USE & OCCUPANCY rY 2001 Grand Avenue ` - Chino Hills, CA 91709 BUILDING PROPOSED USE 03 ADDRESS - C �` v 4' F g APN IV 1 . Z THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT y LOTit c BLOCK TRACT _ p`BTRUCT 0 PLUMB0 MECH 0 ELECT 0 GRADING Q 21 TYPE OF PERMIT 0 NEW 0 ALTER 0 ADDITION n APPLICANTD (r. II' O 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS 11. / PROJECT I LOCATION ON I SIZE DESCRIPTION PROPERTY IN SO FEET CITY ZIP / PH , ' I I / OWNER I I 2 1, ADDRESS , I I L 3 CITY ZIP PH 4 I I `-4 ARCHITECT -- ENGINEER , ( II ` LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS ; NO STORIES NO DWELLING UNITS BEDROOMS . CITY ZIP PH 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/P/100 I SIZE LICENSE NO EXPIRATION DATE LICENSED CONTRACTORS 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 end Professions Code,and my license is in lull force end ell ect i / License Class License Number i li G ., 1 Data Contractor ^�- ADDRESC CITY AND ZIP PHONF 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 employees with wags 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 project O I em exempt under Sec B&PC for this reason I }- Dale INITIAL SETBACKS I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY I SY I I hereby affirm that I have•certificate of consent to sell insure,ore certificate of Workers I Compensation Insurance ore certified copy thereof RY SSY COMPANY / POLICY NO GROUP DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES IN ' tJ,v VALUATION 0 Certified copy is filed with the city CITY VERIFIED I ' - 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 shell not employ any ELECTRICAL • STRUCTURAL person in any manner so as to become subject to the Workers Compensation Law of California I it Dale APPLICANT PLUMBING )< L 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 ) 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 I MENTIONED PROPERTY FOR INSPECTION PURPOSES ISSUANCE APPROVED TOTAL PERMIT FEE J / / ! r Signature of Applicant or Agent Date / ts• DATE OF ISSUANCE PERMIT NUMBER • Print Applicants/Agents Name k t f /,...,) ir\ FINANCE CODE ( 'I\ , WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK- OWNER GOLD-ASSESSOR/MANILA - INSPECTOR •ONSTRUCTION LENDING AGENC. 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 NAMF LENDER'S ADDPccc 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 BEI OW ❑ 1 CERTIFY THAT NO EXCAVATIONS FEET OR MORE FEET IN DEPTH,INTO WHICH A PERSON 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 015 NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY BUILDING INSPECTIONS RECORD DATE INSPECTOR DATE I INSPECTOR Setback/Location Rough Plumbing rl/, a Temporary Power Shower Pan Test �io/ / a Foundation Reinforcing Steel Siueee-Mesh or Exterior Siding y/zic/FS Excavation and Forms Insulation V%j'4 5-- Slab Slab Grade Z/L7/jr ... L , Sewer j/j/fes Ground Plumbing Soil Z7+7/95- Interceptor Ground Plumbing Water r-/27/fir Septic Tank Underslab Ducts Leach Line or Seep Pit _ Underslab Conduit Water Service r//zb/A� _'40 Underslab Gas Lath pFDrywall Nailing S1/4/Sr Fireplace Foundation Gas Line Air Test S/Jo/t -0-,Z7C" Joists and Girders Final Energy Electrical Ground Final Plumbing ,. /., „47 Mid-Height Bond Beam Final HeatIng/A C yr 7— rw 8-Foot Bond Beam Final Construction /h/fr ,4, Z Final Bond Beam Final On Site Improvements Fireplace Bond Beam _ Final Off Site Improvements Roof Sheathing ?�j,//f i� sib Final Dedication Framing and Ventilation Y/aF/f_i— .,2,L Final Zoning Roof Covering Final Electrical , //t r— Rough Heating 1,2"/7 5- Final Gas W/ '7/ Service and Ground Developer Fees Paid Rough Electrical / / Fire Dept Approval Verified Bonding 3V/.re/fr -�,, Certificate of Occupancy Over Head Electrical Fence Height Gates Heater Pool Drainage SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDE LONG X 7EPTH OF ROCK N W E Inspector's Signature and Initials IDATE OV IS UANCE PERMIT NUMBER