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Permit No. 4086 �� • • i'• CITY OF CHINO HILLS i APPLICATION FOR A BUILDING PERMIT AND `e'- COMMUNITY DEVELOPMENT A CERTIFICATE OF USE &OCCUPANCY •�•ti 2001 Grand Avenue ISBNS Chino Hills, CA 91709 • BUILDING �AA� Vi 3 PROPOSED USE I r ADDRESS ^- J b�y �^I l.So1-. Sc& C :PIS - f2 j o APN Ia39 - J Z THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT a LOT �', 1 BLOCK TRACj3lot_� I]1STRUCT c17=PLUMB -b•MECH ❑•ELECT LY'GRADING a "I 1 ) / MI v TYPE OF PERMIT IS-NEW 0 ALTER 0 ADDITION n APPLICANT "e!)�- 1i MWIrkr _0 K ll\ t \ J (1 'j J 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT PROJECT LOCATION SIZE ADDRESS g'j��'� ml `1 cotnn/�--e'jtk ��'R, u(L`-I}�l�jQ IJ(�// DESCRIPTION I PROPERTY ON I IN SO FEET CITY! QSL,nc1 NMI /�c /�Z�I,P��,jgdb) l PH J A l,/00I 1 ` ''lf�1 I I 1031 i OWNER C-/,P^'tlri A\ r1VWt/ 2 �1Y\C I I 1IIl0 C I (� ADDRESS 3 Ppm*. I I 6U\\ �J / V // CITY ZIP PH 4 - I 161C ARCHITECT ENGINEER L.C. '16t-S LIC NO REMARKSTSPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS I cc—) Nvi t i �I-1c. NO STORIES NO DWELLING UNITS BEDROOMS ( ^ CITY C - I' ' Anti. ZIP q2 /I) PH se-s-0_."9.-1-) ROOF FLOOR EXT WALL INT WALL v�' CONTRACTOR `` ''tt'. , ,..OH-` v LIC NO I I I ADDRESS VIAMU` CEILING HEATING I METALMASONRY CITY ZIP PH SEWER MIN DEPTH S/F/l00I SIZE CITY BUSINESS LICENSE LICENSE NO EXPIRATION DATE LICENSED CONTRACTOR 5 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 lull force and effect IN License Close N 511641 License Number � 2 t� 3 V Dst• Contractor ADDRESC 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 ZONING I LAND USE the project ,7 O I em exempt under Sec WC for this reason I 1 1Z, I Data INITIAL SETBACKS I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY I sr I 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 y(��- 1/'T�.y/, L/ RY SSY COMPANY f 2141dI'x-Vaf POLICY NO ( wl/ V I�O"v/ l77- 1 GROUP• _-1 DIVISION TYPE. O Certified copy is hereby furnished DATE EXPIRES K UN) VALUATION I "3 (C.9L! %Fend copy is bled with the city CITY VERIFIED /�� �..7 Date I -43)J APPLICANT P� 672 �/ PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS CiL]MPENSATION INSURANCE I certify that in performance of the work for which this permit is issued,I shall not employ any ELECTRICAL^ S1� as �� I STRUCTURAIt 0 Ii person in any manner so to become subject to the Workers'Compensation Law of California CJ- Date APPLICANT PLUMBING /� Lci I GRADING '7{' NOTICE TO APPLICANT If,atter making this Certificate of Exemption,you should become `••�- iJ subtect to the Workers Compensation provisions of the Labor Code,you must forthwith comply �^J\ with such provisions or this permit shall be deemed revoked MECHANICAL sg SO ISSUANCE FEES "1] I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA ��aa TION IS CORRECT I AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS, GEO REVIEW I PLAN CHECK C/D/! S•0.4 AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES ISSUANCE ROVED TOTAL PERMIT FEE )iC 1-31-9J-" 1752 . �`� Signature of A6/icant or Agog/ Date (1-re-‘1 MEM/1Y DATE OF IS$U�N( I PERMIT ER� Print Applicant1t// as/Agent a Name I I FINANCE CODE / Operator: DAWN Check I: 000000000 Date: 2/01/95 00 Receipt 0: 0000010 WHITE- FILE/GREEN- FINANCE/ YELLOW- OFFICE/PINK- OWNER CHER( 51752.94 GOLD-ASSESSOR/MANILA - INSPECTORAmount Tendered $1752.94 CONSTRUCTION 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 ADD:'_: DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRES A DIVISION OF INDUSTRIAL SAFETY PERMIT ASA PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW ❑ 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 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 KNAVE 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 -- J \ _ 1 . z51ir ,.y -..x 4''yts 'v at't'C'`I' jf\.-' ' `— Y sir-ru :r-wv' ,I' j i., . ,4,+y..6Azi vee' 7. y�JIL:Ii iii Wrz ' CITY OF CHINO HILIs APP( (CATION FOR A BUILDING PERMIT AND 'se; A CERTIFICATE OF USE & OCCUPANCY COMMUNITY DEVELOPMENT r:-.- 2001 Grand Avenue ll _ i Chino Hills, CA 91709 BUILDINGrPROPOSED USE- CO ADDRESS aOOjJ/' V1 C�.h Its- L P v APN -2., THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT s LOT BLOCK TRACT ❑/STAUCT 0 PLUMB 0 MECH 0-ELECT 0 GRADING 00 I I'`i I t s TYPE OF PERMIT 0 NEW 0 ALTER 0 ADDITION m APPLICANT Tn I In 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PUT ADDRESS PROJECT I LOCATION ON I SIZE ` ` • DESCRIPTION PROPERTY IN SO FEET CITYI / ZIP • PH t" I I OW NEOI I t 03 ADDRESS I I J s 2 '1 3 t CITY ZIP PH 4 ARCHITECT ENGINEER / ( LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS INO 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 SEWER MIN DEPTH S/F/100 I SIZE \� 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 the Business end Profession.Code, and my license is in full force and effect License Class License Number i \ Date Contractor AODRESn. \�/'^ CITY AND ZIP PHONc i ) OWNER BUILDING DECLARATION I/ I hereby affirm that I am exempt from the Contractors License Law for the following reason \ I / 0 I as owner of the property,or my employees with wages as their sole compensation will do � the work,and iM structure is not intended or offered for sale O I asowner of the properly am exclusively contracting with licensed contractors to construct the protect ZONING LAND USE O I am exempt under Sec BSPC for this reason I Date INITIAI SETBACKS I MODEUPLAN WORKERS'COMPENSATION DECLARATION FY I SV I hereby affirm that I have a certificate of consent to self insure ore certificate of Workers' I Compensation Insurance or a certified copy thereof RY SSYI COMPANY POLICY NO GROUP, DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES VALUATION I _ C. O Caddied copy a filed with the city CITY VERIFIED `j 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 subject to the Workers Compensation Law of California I Dab APPLICANT PLUMBING \ l,,, I GRADING - NOTICE TO APPLICANT If after making this Certificate of Exemption,you should become r 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 x - 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 tAND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE . MENTIONED PROPERTY FOR INSPECTION PURPOSES ISSUANCE APPROVED TOTAL PERMIT FEE r Signature of Applicant or Agent Date x l 1 / DATE OF ISSUANCE PERMIT NUMBER Pnnt Applicants/Agent s Name 1 ' r / jI FINANCE CODE 1 X WHITE• FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK- OWNER GOLD-ASSESSOR/MANILA - INSPECTOR CONSTRUCTION LENDING AGENC• I HEREBY AFFIRM THAT THERE ISA CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT Ig ISSUED (SEC nod7,CIV C) LENDER'S NAM LENDER'S ADDRESc 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 ID 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 DIS 018 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 7%,,/s.,� Temporary Power Shower Pan Test '/`7 Foundation Reinforcing Steel Stucco Mesh or Exterior Siding cP///9 C Excavation and Forms Insulation 2/z°/P•3--- Slab /zo/FrSlab Grade (y/7/Fr s Sewer //7/fi Ground Plumbing Soil /p///9 r .,n„ Interceptor Ground Plumbing Water (i)/7/9_5-- -i,(ol Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service 7//7/F)-- Underslab //7/jamUnderslab Gas -si-or Drywall Nailing 7/L9/Fx ?< Fireplace Foundation Gas Line Air Test d///A Joists and Girders Final Energy Electrical Ground t /7/ -"AO< Final Plumbing Mid-Height Bond Beam Final Heating/A C 8-Foot Bond Beam Final Construction Final Bond Beam G/9/f. Final On Site Improvements Fireplace Bond Beam Final Off Site Improvements Roof Sheathing 740/7-1— ^�, - Final Dedication Framing and Ventilation 7/1%r- Final Zoning Root Covering _ Final Electrical Rough Heating 7/24/Fr Final Gas Service and Ground Developer Fees Paid Rough Electrical / / Fire Dept Approval Verified Bonding 7/E /$-S— 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 Inspector's Signature and Ini als DATE OF ISS ANCE PERMIT NUMB R 1-4 102 — Lo T- 114 .CITY OF CHINO HILLS COMMUNITY DEVELOPMENT DEPARTMENT BUILDING AND SAFETY DIVISION PERMIT # L\ toS Call (909)590-1511 Ext 282 before 3 00 p m for next day inspection POST IN A SAFE, CONSPICUOUS PLACE AT FRONT OF JOB PROVIDE PERMIT NUMBER WHEN CALLING FOR INSPECTION HAVE APPROVED PLANS ON JOB AT TIME OF INSPECTION OWNER. It / `� -w DAT fIOx 1f/G S LOCATION �t8' I ) lar 't, INSPECTION RECORD INSPECTION I DATE I INSPECTOR Setback Temporary Power Foundation Reinforcing Steel Excavation and Forms Slab Grade 4//'/fS Ground Plumbing Nf•S' Underslab Ducts Underslab Conduit Fireplace Foundation Joists and Girders / A' Electridal Ground 4 /P/yr DO NOT CONCEAL UNTIL ABOVE ARE SIGNED AND DATED Mid-Height Bond Beam I 8-Foot Bond Beam I Final Bond Beam 0//7/7---f Fireplace Bond Beam Roof Sheathing 7//C/fsFraming and Ventilation 7,9,,/ r Roof Covering Rough Heating 7/10/22-J Electrical Service and Ground Rough Electrical 2 Rough Plumbing / Shower Pan/Tub Test 7/ /,/jrj Stucco Mesh or Exterior Siding 17///9i DO NOT CONCEAL UNTIL ABOVE ARE SIGNED AND D/TED Insulation J'j��f,� Sewer PAP 7/7-r interceptor Septic Tank Leach Line or Seep Pit i Water($ervice 7//9/15"-- C DO NOT CONCEAL UNTIL ABOVE ARE SIGNED AND MATED trek orfDrywail Nailing 7/2 y/7,! 4 .7'— Gas Line Alr Test (719/(p,/7-1-- i , Final Electrical 9/////j'r Final Plumbing Final Heating/A C //"' ' Final Zoning Final Fire(Call Local Flre Dept 1 I 5?-04-9 S a7 Certificate of Occupancy I I I I I I NOTICE TO OWNER' Call for FINAL inspection on every job This permit will expire if work is suspended or abandoned for a period of 180 days Call for inspection every 180 days to help keep permit active NO WORK SHALL BE COVERED WITHOUT INSPECTION FILE THIS CARD WITH YOUR PERMANENT RECORDS WHEN JOB IS COMPLETED