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Permit No. 4084 ^•''•N CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY 2001 Grand Avenue " m` Chino Hills, CA 91709 BUILDING ^ �� 1 I`T� PROPOSED USE- C ADDRESS `049 V/ i Del, SUI Srn APN r-- 1'J` cam co z 1 b32 6 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT > LOT '1 l BLOCK TRACT �$7RUCT UUMB [U`ECH IEI.ELECT �RADINO D "J TYPE OF PERMIT Iy`EW 0 ALTER 0 ADDITION m APPLICANT pifLoc - r 1 O0 p f'OCII C'C ) a t murk. ❑ REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS 0_31)11 f-1� ('1n 1t1 gI/ Of - SLI L� i3 PROJECT DESCRIPTION I LOCATION PROPERTY ON I INZE I SO FEET �1 CITY A51MR Nk•1111` ZIP 166 PH 583106 J1 -w2 OWNER SAW*". M 14 2 /Y TY I I f/ 1118 ADDRESS 3 ()Al l JI I CC) CITY ZIP PH I I �_ 4 (-X4�`aC e l D ARCHITECT ENGINEER / ( , rAq�uR,s LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS IS"S') N ` MIT 4.j AVS NO STORIES NO DWELLING UNITS BEDROOMS CITY \A ydr. fY ZIP 133 �\ PH S- o- 12:4—iROOF I FLOOR I EXT WALL I INT WALL -37 CONTRACTOR 'fan, LIC NO E ADDRESS CEILING HEATING I FIREPLACE METAL MASONRY CITY ZIP PH SEWER MIN DEPTH S/F/100I 512E \ CITY BUSINESS LICENSE LICENSE NO EXPIRATION DATE LICENSED CONTRACTORS DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION I hereby allure that I am licensed under provisions of Chapter 9(commencing with Section 7000 of Division 3 of the Business and Professions Coda,andmy license a in full fora and effect Ltoenn Class A- I License Number A-/6YL1 I"L,/1„ ss Date Contractor ADDRESe 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 wagss es their sole compensslion,will do the work,and the structure is not intended or offered for sale O I as owner of the properly am exclusively contracting with licensed contractors to construct the proles ZONING I LAND USE O I am exempt under Sec B&PC for this reason I I CI Dale INITIAi SETBACKS I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY I SY I hereby affirm that I have•certificate of consent to salt insure,or a certificate of Workers Compensation IIns�urrance,or a certified copy thereof �7�7 / RY SSYI COMPANY rig L I POLICY NO TD3-}-/7i !/ /-! GROU DIVISION I, ' vlvlTYPE O Coddled copy is herby furnished DATE EXPIRES �_� VALUATION 1 33tc tH 02 Coddled copy is filed with the city CITY VERIFIED // J Dale /-31-9Y 3 APPLICANT L`-- ottiK Y y PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS CIEMPENSATION INSUIdANCE I certify that in performance of the work for which this permit ie issued I shell not employ any ELECTRICAL ear 3r- STRUCTURAL• Yl id parson In any manner so as to become subject to the Workers'Compensation Law of California 1011 `- Dale APPLICANT PLUMBING OO/�L 11 I GRADING /� NOTICE TO APPLICANT If,altar making this Cedilicate of Exemption,you should become 9.__l II r subject to the Workers Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be doomed revoked MECHANICAL Qp ISSUANCE FEES /1Q _ I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA oo �J• I TION IS CORRECT I AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS, GEO REVIEW I PLAN CHECK //ele T AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE 1t)5 MENTIONED PROPERTY FOR INSPECTION PURPOSES ISSUANCE APPROVEDTAL PERMIT FEE ii0An /-3/-51--- / / 75 Signature ApPlica nl or A l Dale /y, n,�/ DATE OF IA NCE I PER IT T NUMBERV l I /Vt'1 ��l‘c/4I(.xy R Ti11 1/-ti/�J(}.J�v Pnn1 Applicant•/Agent's Name FINANCE CODE e_L/ Operator: DAMN Check II: 000000000 Dace: 2/01/95 00 Receipt II: 0000007 WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK- OWNER Ca{ 41752.94 GOLD-ASSESSOR/MANILA - INSPECTOR Amount Tendered 41752.94 41ONSTRUCTION LENDING AGENCO I HEREBY AFFIRM THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 3097,CIV C) LENDER'S NAM' LENDER'S ADORES° 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 0 I CERTIFY THAT NO EXCAVATIONS 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 DIS 015 NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY - _ • CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY ..:-.7-r.,21+r., 2001 Grand Avenue -OK_IMIEZElialChino Hills, CA 91709 BUILDING PROPOSED USE- ADDRESS i , - 1` \ F --1 ' C. 0 APN } , 1 CI THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT D LOT BLOCK TRACT , 0 STRUCT 0 PLUMB MECH ❑ ELECT ❑ GRADING 0 I I 1 1 31 TYPE OF PERMIT 0 NEW 0 ALTER 0 ADDITION m APPLICANTN r co 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESSPROJECT I LOCATION ON SIZE f ' I DESCRIPTION PROPERTY I IN SO FEET ( t CITY ZIP f PH , I I - %--/ 1 ty OWNER I 2 ADDRESS 3 CITY ZIP PH 4 ARCHITECT ENGINEER LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS `! t CITY ZIP PH c 0 •''' ‘ l` i ROOF I FLOOR EXT WALL INT WALL CONTRACTOR LIC NO ADDRESS CEILING HEATING FIREPLACE METAL MASONRY y- P CITY CITY BUSINESS LICENSE PH SEWER MIN DEPTH S/F/100 I SIZEC =VJ LICENSE NO EXPIRATION DATE LICENSED CONTRACTOR'S DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION I hereby affirm that lam licensed under provisions of Chapter S(commencing with Section 7000 of Division 3 of ih•Business and Professions Code,and, my license is In full force and all set Class AAR License License Number i. Dale Contractor 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 conslrucl the protect ZONING I LAND USE O I am exempl under Sec BBPC for this reason Gate INITIAL SETBACKS I MODEL/PLAN WORKERS'COMPENSATION DECLARATION FY I SY I I hereby affirm that I have a certificate of consent to self insure or a certificate of Workers Compensation Insurance ora certified copy thereof RY I SSY COMPANY POLICY NO '. GROUP DIVISION TYPE 0 Certified copy is hereby furnished DATE EXPIRES l VALUATION 0 Certified copy is filed with the cityCITY VERIFIED I - ' / c Date APPLICANT I PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE I certify that in performance of the work for which this permit is issued,I shall not employ any ELECTRICAL l ` STRUCTURAL I person in any manner so as to become subject to the Workers Compensation Law of California , Data APPLICANT PLUMBING )‘•• I T I GRADING NOTICE TO APPLICANT If alley making this Certificate of Exemption,you should become I 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 ' ' C. 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 PLAN CHECK ) r • AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES ISSUANCE APPROVED TOTAL PERMIT FEE Signature of Applicant of Agent Date '- DATE OF ISSUANCE PERM T NUMBER Pnnt Applicant s/Agents Name .\\ ' I I i r/-3 -3 -n (71 FINANCE CODE C.. k ' I WHITE:FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK- OWNER GOLD-ASSESSOR/MANILA - INSPECTOR •ONSTRUCTION LENDING AGENC• I HEREBY AFFIRM THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 3097, CIV C) LENDERS NAMG LENDERS ADDRcce DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRESA DIVISION OF INDUSTRIAL SAFETY PERMIT ASA 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 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 ❑IS ❑IS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY BUILDING INSPECTIONS RECORD DATE INSPECTOR I I DATE INSPECTOR Setback/Location I I Rough Plumbing I - 4/2/ Temporary Power Shower Pan Test r. / / - s/e Foundation Reinforcing Steel Stucco Mesh or Exterior Siding .575-775- Excavation / -775Excavation and FormsInsulation ,s/z/j}- Slab Grade 3///%S i,{de Sewer "1/447.5-- Ground 1/4/7fGround Plumbing Soil '-/L//,r -"eV& Interceptor Ground Plumbing Water 3///F1.- Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service 4,/s6/ft Underslab Gas Lath or Drywall Nailing T,je Fireplace Foundation Gas Line Air Test 513 D/F ys/ Joists and Girders Final Energy Electrical Ground Final Plumbing / /q/G Mid-Height Bond Beam Final Heating/A C r/ / 8-Foot Bond Beam Final Construction of/S/,rte I z ' Final Bond Beam Final On Site Improvements Fireplace Bond Beam Final Off Site Improvements Roof Sheathing V./We-eV- '/l C15 Final Dedication Framing and Ventilation fiat- Final Zoning Roof Covering Final Electrical ,/C 4„l _zee' Rough Heating 517/Tr- --ere Final Gas Service and Ground \ — Developer Fees Paid Rough Electrical / / Fire Dept Approval Verified Bonding S/2/9"5 -tree Certificate of Occupancy Over Head Electrical Fence Height Gates I Heater Pool Drainage SEPTIC TANK GALS SEEP PIT X - LEACH LINE WIDE LONG X DEPTH OF ROCK N W E S Inspector's Signature and Initials DATE O ISSANNNC�_, PERMIT NUMBER rr1S I v�