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Permit No. 4085 • • CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND sip. COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY r-~ 2001 Grand Avenue Chino Hills, CA 91709 BUILDING /y D 11 "" PROPOSED USE CO ADDRESS a08Q VIS-n} Oa3p))� r APN SIR «IPG a a l lila—'_ OH -1 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT y LOT / y BLOCK TRACT D4TRUCT 6`PLUMB 9 MECH k1-ELECT '6 GRADING e lOi 139 -r al al APPLICANT RSD����(" TYPE OF PERMIT kit-NEW 0 ALTER 0 ADDITION Co """'�"� kb D REPAIR D CONVERT D DEMO D OCCUPANCY PMT ADDRESS alb& 1 - R /` A c-�k DR PROJECT LOCATION ON SIZE RAI 1./W�^ �J� d---D3 / DESCRIPTION I PROPERTY I IN SO FEET (� CIN I/aQIM` CL�1 1 c I�ZIP �I?61 1 P" ] a ,l Ub/ 1 1 I I I W—- /�(O/1" OWNER S R 1 Ry' _ 2 /1 y� liv d I I lira G ADDRESS I I GPat1h U CITY ZIP PH I 161 b �-- GARALK ENO NIEERT L c, I�Mt1UQS LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION Gy v -...n ADDRESS 1I1 N, T3371 ) ALE y��, NO STORIES NO DWELLING UNITS BEDROOMS �^ CITY St►� 014 ZIP 9a7o ) PH ca_7.yyI '_ ROOF I FLOOR I EXT WALL I INT WALL CONTRACTOR leiA C LIC NO ADDRESS CEILING HEATING I FIREPLACE METAL MASONRY ((I/\ CITY ZIP PH SEWER MIN DEPTH S/F/100 I SIZE VV ' CITY BUSINESS LICENSE 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 and Professions Code,and my license is in full force and effect thp License Class L3" I License Number '''cgs Ila.' SA R. Data Contractor ADORES° CITY AND ZIP PHONE OWNER-BUILDING DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason D I as owner of the property,or my employees with wages as Thur sole compensation,will do the work end the structure is not intended or offered for sale D I as owner of the property,am exclusively contracting with licensed contraclora to construct the protect ZONING LAND USE D I am exempt under Sac B&PC for this reason I ce- I Dab INITIAI SETBACKS I MODEL/PLAN WORKERSCOMPENSATION DECLARATION FY I SYI I hereby affirm that I have a certificate of consent to self insure,ora certificate of Worker' Compensation IIInssura since,,or a certified copy thereof C �-1�� `''-1 RY SSY COMPANY Platte ! POLICY Nd QS7VI"trt/0�'1 FI GROUZ .-s DIVISION TYPE D Certified copy is hereby furnished DATE EXPIRES (f '_J VALUATION I33, fl�t ei Certified copy is filed with the city CITY VERIFIED I/ Dale 1'31-9 s' APPLICANT }� xA / ! / ///111 PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE Q _ I certify that in performance of the work for which this permit is iaauetl,I shall not employ any ELECTRICAL /\'1C /I I STRUCTURALq oil( .G./- person in any manner so as to become subject to the Workers Compensation Law of California �I,.,,),J 1 Date APPLICANT PLUMBING atm/ TO I GRADING R.S—— NOTICE TO APPLICANT If,after making this Certificate of Exemption,you should become s.C_I"1 sublect to the Workers Compensation provisions of the Labor Code,you must forthwith comply py with such provisions or this permit shall be deemed revoked MECHANICAL 0 0. 0• ISSUANCE FEES fi, I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA X10 (JAI TION IS CORRECT I AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS, GEO REVIEW I PLAN CHECK L''J7( g-' in AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES ISSUANCE AP OVEO TOTAL PERMIT FEE . i-3A-e rJ /j` 1~L 175x .111 Signature of licent or Age6 Date J' �t Agri-- Y DATE . IyIA)C I PERMIT NUMBER 7R^ P�P/e�,et / � Print Applicant s/Agent•Name FINANCE CODE C-W liberator: DWI heck 6: 000000000 Date: 2/01/95 00 Receipt 1: 0000009 WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK• OWNER CAECA $1752.94 GOLD-ASSESSOR/MANILA - INSPECTOR recount Tendered $1752.94 •ONSTRUCTION LENDING AGENC• I HEREBY AFFIRM THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 3097,CIV C) LENDER'S NAME LENDER S ADDRE$C 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 C I CERTIFY THAT NO EXCAVATION 5 FEET OR MORE FEET IN DEPTH,INTO WHICH APERSON IS REOUIRED 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 3E 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 CIS CIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY 1 a :-V.-,i''WC2rr .E+ 3'f 'r'S. -4WX'+ - P *!'+i'Ir «~re. 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A •« CITY OF CHINO AI AP LIGATION FOR A BUILDING PERMIT AND ":��i„ A CERTIFICATE OF USE &OCCUPANCY 2001 Grand Avenue INE COMMUNITY DEVELOPMENT Chino Hills, CA 91709 liUil BUILDING n�/'� ]'�J PROPOSED USE c ADDRESS �( /Vt-/ I��'Q ) ( , F r _ \ . / O APN Z THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT s LOT BLOCK TRACT 0 STRUCT 0 PLUMB 0 MECH 0 ELECT 0 GRADING D (1 t 1 ''' t TYPE OF PERMIT O NEW 0 ALTER 0 ADDITION r APPLICANT , n V) ' 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS PROJECT I LOCATION ON I SIZE DESCRIPTION PROPERTY IN SO FEET CITY r ZIP PH 1 I I I (/'� OWNER I I `-' 2 ADDRESS I I t " - 3 CITY ZIP PH 4 -- 5 ARCHITECT ENGINEER LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ,d-- 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 DP CITY CITY BUSINESS LICENSE PH a SEWER MIN DEPTH S/F/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 and Professions Code, and my license is in full force end effect License Clay! License Number ' , Date Contractor ADDRESS 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 em excluvrvaty contracting with licensed contractors to construct the protect ZONING I LAND USE O I am exempt under Sec B&PC for this reason I Date INITIAI SETBACKS I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY I SY I I hereby affirm that I have•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 I 1 't • O Certified copy is hereby furnished DATE EXPIRES ' VALUATION r . O Certified copy is bled 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 shall not employ any ELECTRICAL , STRUCTURAL person in any manner so as to become a ublect to the Workers Compensation Law of California t I't Date APPLICANT PLUMBING � , I GRADING 7 t - 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 r AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES ISSUANCE APPROVED TOTAL PERMIT FEE Stgneture of Applicant or Agent Date j , / + - DATE OF ISSUANCE PERMIT NUMBER `ry '{ t. Print Applicant's/Agent a Name ' I / / is...) ft - ``� FINANCE CODE ` f WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK- OWNER GOLD-ASSESSOR/MANILA - INSPECTOR •ONSTRUCTION LENDING AGENCI• 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 ADDRFgc 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 D 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 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 BUILDING INSPECTIONS RECORD DATE I INSPECTOR DATE INSPECTOR Setback/Location I Rough Plumbing / / Temporary Power Shower Pan Test /// '' Foundation Reinforcing Steel Stucco Mash or Exterior Siding I • Excavation and Forms Insulation 7//7fr� Slab Grade 6/7/Fr Sewer 677/fr I Ground Plumbing Soil (, ///7$ n Interceptor I Ground Plumbing Water 6 /7/?)- ,,j ( Septic Tank I Underslab Ducts Leach Line or Seep Pit I Underslab Conduit Water Service 7//F/fes Underslab Gas beth or Drywall Nailing 7/y y/Fs .� Fireplace Foundation Gas Line Air Test S////f5 7� Joists and Girders Final Energy Electrical Ground G/>/ys- Final Plumbing 2'4 -"iC Mid-Height Bond Beam Final Heating/A C o 8-Foot Bond Beam Final Construction /J/' Final Bond Beam G//p/fes -at/ Final On Site Improvements Fireplace Bond Beam , Final Oft Site Improvements Roof Sheathing k Piet-IL %//0/3.5 Final Dedication Framing and Ventilation 7//51/411-- --1•110( Final Zoning Roof Covering Final Electrical Rough Heating 7//I/73--- Final Gas //v/ / v Service and Ground - Developer Fees Paid Rough Electrical / / Fire Dept Approval Verified Bonding 7//,77y -aye Certificate of Occupancy Over Head Electrical Fence Height Gates 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 l:/ l D 0 SA PERMIT NUNJ�E� �