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Permit No. 4087 • • ;•« CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND -e-r�t COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY "1'� 2001 Grand Avenue Naiikailla Chino Hills, CA 91709 BUILDING PROPOSED USE fC A ADDRESS Di9S- VISTA DEL SOL r SEI. C.p Po VAI O APN U3g—ta'i 1 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT a LOT Lis BLOCK TRACTy 30l/_� r STRUCT PLUMB ch MSE7 ECH ELECT ' GRADING ial 1 � 9 ` 1 TYPE OF PERMIT I..NEW 0 ALTER 0 ADDITION cn m APPLICANT l D Jf.v •I i I pgD j( Il6VYL S co n 11 /�/� 11 // /�� 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS d�7�� l e Ill i k-vK.fk U . suite_ i�Uri PROJECT DESCRIPTION I LOCATION PROPERTY ON I SIZE IN 50 FEET CITY La (ANC t4 \\ ZIP /�I,�Id�-tpn PH SJ"IO6 i 1 /I�5 I I ` c' OWNER '^'� ty'YI•,G t1� Ablptt-e 2 0,til. I I C‘Or ADDRESS 3 CMAS,A-. I I 6 n- /Sl CITY ZIP PH I I Q3 ° peer)d ARCHITECT ENGINEER L e Flak j LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION r------.- v b...... -..-• ADDRES/�,1—I tilt AVE- NO STORIES NO DWELLING UNITS BEDROOMS CITY sp0,4 Mm ZIP /'l , PH�-O ROOF I FLOOR I EXT WALL I INT WALL -37 CONTRACTOR 1 )tku.-R_/„��„ y`1 d -LIC NO ADDRESS 1 st(- (W4�1'LI YV CEILING HEATING I FIREPLACE METAL MASONRY CITY ZIP PH SEWER MIN DEPTH S/F/100I SIZE CITY BUSINESS LICENSE (' _ LICENSE NO EXPIRATION DATE 1 :6..\ 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,andt7m�y((li/c`ennsse is in full force end effect {y /� {� License Class IS- I License Number .]"Ib�C l.A,J )f,0+ /,-, tial Date 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 O I am exempt under Sec BAPC for this reason I GR. 1 Oat. 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 I�nsuur�annccce,or a certified copy thereof �.�I -T RY SSYI COMPANY s s`y�t—t,2S POLICY NOThJV"i�r'' GR P DIVISION 1TYP O Certified copy is hereby furnished DATE EXPIRES �fp� VALUATION ,f3afCertified copy is fled with the city CITY VERIFIED 13, 1 2)-re —� VOafe i-31-1\ APPLICANT \tip �x'4t—�/ 1 n rni rx PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COOPENSATION INSURAfTCE I certify that in performance of the work for which this permit is issued,I shall not employ any ELECTRICAL ""a ` STRUCTURAL person in any manner so as to become subject to the Workers Compensation Law of California ' t1/4i• 7..V Dale APPLICANT PLUMBING , I 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 pp�� with such provisions or this permit shall be deemed revoked MECHANICAL l�--Is U �,1 J ISSUANCE FEES 207I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA TION j5 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 itcvvvL /-3/-,r 1:r--_ 157s, &f Signator fffAApplicant cVugentV Data '11 M �RLName Y DATE OF I$iU/yNCE I PERLIDS NUMBER Print Applicant s/Agents Name r `-'T I Il//!L`"wJ D(/xJy FINANCE CODE• L( Onerator: DAWN Cneck I: 000000000 Date: 2/01/95 00 Receipt it: 0000011 WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK- OWNER CPECK $1578.80 GOLD-ASSESSOR/MANILA - INSPECTOR Ikeount Tendered $1578.80 •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 ADORES° 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 �.�«1:a r; 7 ryr"n�: v..n� s r a'• ; n� ♦ v ; �i,4r• : > W+w .:,7.4c. Tqd w dJ t' Y. V? pi e' i / "'^.•re CITY OF CHINO HI APPLICATION FOR A BUILDING PERMIT AND _ `it" COMMUNITY DEVELOPMENT A CERTIFICATE OF USE &OCCUPANCY " _ 2001 Grand Avenue lilliElliiiiill Chino Hills, CA 91709 BUILDING PROPOSED USE- 0 C ADDRESS rl • 1/ t F 0 APN � �r . . Z 1 ' THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT y LOT t4 BLOCK TRACT t '`4k — 0 STRUCT 0 PLUMB ❑'MECH 0 ELECT ❑ GRADING 0 l Y( • O S APPLICANT i .y..-..L.�. _; I / 11 TYPE OF PERMIT NEW ❑ ALTER ❑ ADDITION N 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESSf- s ( PROJECT I LOCATION ON I SIZE DESCRIPTION PROPERTY IN SO FEET CITYZIP PH .• I I C f1 1 . r OWNER w I 2 -i ADDRESS I I 3 1 r. CITY ZIP PH I I U l 4 ARCHITECT ENGINEER LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS\ NO STORIES NO DWELLING UNITS BEDROOMS CITY , ZIP PH • ' 'e-- CONTRACTOR LIC NO ROOF I FLOOR EXT WALL INT WALL - + 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 B(commencing with Section 7000 of Division 3 of the Business and Professions Code,and my license is in full force and effect - r" License Class I\- License Number I '• r 1)i, ) ' ' Date Contractor ADDRES° CITY AND ZIP PHONE OWNER BUILDING DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason ❑ I as owner o1 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 ❑ I as owner of the property am exclusively contracting with licensed contractors to construct ZONING ' LAND USE the protect ❑ I em exempt under Sec BBPC for this reason I t Date INITIAL SETBACKS I MODEUP4AN WORKERS'COMPENSATION DECLARATION FY I SV I ' I hereby affirm that I have a certificate of consent to self insure,ora certificate of Workers I Compensation Insurance or a certified copy thereof RY I SSY COMPANY POLICY NO • . ' GROUP DIVISION TYPE ❑ Certified copy is hereby furnished DATE EXPIRES ❑ Certified copy is filed with the city CITY VERIFIED VALUATION Date 4 APPLICANT n- A 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 't I STRUCTURAL person in any manner so as to become subject to the Workers Compensation Law of California 1 1�' Date APPLICANT PLUMBING I GRADING T. NOTICE TO APPLICANT If after making this Certificate of Exemption you should become / ' subiect to the WorkeCompensation provisions of the Labor Code you must forthwith comply with such provisions or this permit shall be deemed revoked MECHANICAL ' ISSUANCE FEES •rt y r, I CERTIFY THAT]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 Signature of Applicant or Agent Date DATE OF ISSUANCE PERMIT NUMBER y Print Applicant s/Agent a Name A tt I 1• / FINANCE CODE • ci 0 WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK-OWNER GOLD•ASSESSOR/MANILA - INSPECTOR 4DONSTRUCTION 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 LENDER'S ADDREce 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 0 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 015 DS 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 Plumbingc— Temporary Power Shower Pan Test ✓' / / Foundation Reinforcing Steel Stucco Mash or Exterior Siding i/1/2"1es staZ Excavation and Forms Insulation S///yam Slab Grade s'///f_ Sewer S/3/plC -yam Ground Plumbing Soil a-/z/yam _4/, Interceptor Ground Plumbing Water ,7///5'f' Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service Y/ZL/5r Underslab Gas Lath or Drywall Nailing 5/1/fr n� Fireplace Foundation Gas Line Air Test r/30,4r 1,� Joists and Girders Final Energy Electrical Ground Final Plumbing / /47/G c-- ,...1 Mid-Height Bond Beam Final Heating/A C I`/ // ' --- 8-Foot 8-Foot Bond Beam Final Construction 0/1/Yr Final Bond Beam Final On Site Improvements Fireplace Bond Beam Final Off Site Improvements Roof Sheathing (igen_ -1/.74-4 ,-24.24; Final Dedication Framing and Ventilation S/'/`yam Final Zoning Roof Covering Final Electrical //0/9 er Rough Heating Sy//Fr" � � Final Gas `/ // / Service and Ground *Th Developer Fees Paid Rough Electrical / Fire Dept Approval Verified Bonding .S1/4/7Certificate 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 wS DATE Ok IS UANCE PERMIT NUMBER