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Permit No. 4088 S 0 +'N CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND T. C" COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY e....T74,'- 2001 Grand Avenue I„; ." , . Chino Hills, CA 91709 J m BUILDING �Y y- PROPOSED USE C ADDRESS DI IA VISTA O L SOL 5 \ 1 �(� �yy '� CF J IJ c( O /., /� ae (�q Z APN IU3a-C'D- n 1 0 THE FOLLOWING WORK ISy�AUTHORIZ�E/D BY THIS PERMIT > LOT (_3 BLOCK TRACTI3so6-s— r�STRUCT '-CI-PLUMB LI`MECH EYkLECT �GRADINO 0 VV// a TYPE OF PERMIT U.NEW 0 ALTER 0 ADDITION m fn APPLICANT 1(1 /Loci L Ll ei cn �1 K(J C.R. it 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS 0.71-3., M1i1 A I. (� G. q PROJECT LOCATION ON SIZE 1 v LY/C�E/E�-Cy op. OIA�� IJO DESCRIPTION PROPERTY IN SO FEET CITY^_/jQ'��h rt Ln'fu1,11r1 AS J PH 5�3-106/ 1 I.`,/- I - k r \T' / OWNER u^,u lirV1EG AJ ArbridG 2gbd 9) ADDRESS 3 /„rr_„- I I / M CITY ZIP PH 4 C71TR'OC- I I At; \(�C ARCHITECT ��� ENGINEER L.(„ �tI(>Q 3 LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION 'Tf� ADDRESS TJ1- t Pt-VC NO STORIES NO DWELLING UNITS BEDROOMS (/ CITY 1�v ZIP PH /� CONTRACTOR LIC NO ROOF I FLOOR I EXT WALL I INT WALL ()W$cJ ADDRESS CEILING HEATING I METALMASONRY (�^V�(�7�1 CITY ZIP PH SEWER MIN DEPTH S/F/100 SIZE V CITY BUSINESS LICENSE I I I LICENSE NO EXPIRATION DATc 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 and Professions Code,and my license is in lull bores and effect /� License Class Pty 1 License Number SH 6y/ 1'I.JA., I Pc R.+ 3 wt 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 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 probed' { O I am exempt under Sec BBPC for this reason I -q I pat. INITIAI SETBACKS I MODEL/PLAN WORKERS'COMPENSATION DECLARATION FY I SY I hereby affirm that I have a certificate ol consent to self insure or a oeridicale of Workers Compensation Insurance oar�•certified copy thereof �y .�I-h/ RY I SSY I COMPANY T e AtAEtbr,J POLICY NO rOv11 ISI gl 'l7?-V GROUP) DIVISION ' TYPE O Certified copy is hereby furnished DATE EXPIRES K VALUATION 2{. ' \ , i I lCMilied copy is bled with the cily CITY VERIFIED -,-' Dal. I �3 HSI APPLICANT /kip,/kip, /!/�Qy,�v�L - / J 1 - ii/I n PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSCIRANCE I certify that in performance ol the work for which this permit is issued,I shall not employ any ELECTRICAL 1 9 %..). � STRUCTURAL person in any manner so as to become subbect to the Workers Compensation Law of California ` Dat APPLICANT PLUMBING �1�17- I GRADING 7S NOTICE TO APPLICANT If after making this Certificate of Exemption,you should become !/Qo subleot to the Workers'Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked MECHANICAL 78-.5 I ISSUANCE FEES act 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 MENTIONED PROPERTY FOR INSPECTION PURPOSES ISSUANCEI APPROVED TOTAL PERMIT FEE �.{�elAn eaCrli (� /-3/ 5'r' I�J� &sO Signature of pbcent or Ap Dale ��� (l l$9 � ,net DATE OF I SUANCE PER{/k,1.I1�1T NUMBER R Print Applicant_ s/Agents Name / ; I I )Cig 1 0�'/ FINANCE CODEQ J Operator: DIM Check 9: 000000000 Date: 2/01/55 00 Receipt 14: 0000012 WHITE- FILE/GREEN- FINANCE/ YELLOW- OFFICE/PINK• OWNER DECK $1578,80 GOLD-ASSESSOR/MANILA - INSPECTOR 0'-In. Tc-deme, $1578.80 .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 ADDRESW 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 I7 I 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 O 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 • - 1, r - - .-w..., sy ,,,,,a, -, -o.-.rarr;rw 'NT-tic-Srwr <.., 'Vele •V9;7,7 igioni 'ATN: ,),7n-:i,GE'ira"• -a+"f0' tiro CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND s si �,• COMMUNITY DEVELOPMENT A CERTIFICATE OF USE &OCCUPANCY 2001 Grand Avenue .-."ZIEM _ Chino Hills, CA 91709 BUILDING PROPOSED USE w ADDRESS 1 Y • .. C APN / ( t1 1 Z L THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT y LOT BLOCK TRACT t ❑ STRUCT 0 PLUMB ��MECH ❑'ELECT ❑ GRADING 0 tr 3) APPLICANT TYPE OF PERMIT 0 NEW 0 ALTER 0 ADDITION co M ca • 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS r PROJECT I LOCATION ONSIZE DESCRIPTION PROPERTY I IN SO FEET CITY ZIP PH ( 1- I I ......-- OWNER I I p - el--" ADDRESS I I 3 1 CITY ZIP PH I I � 4 ARCHITECT ' ENGINEER ( LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION A ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS CITY ZIP PH - CONTRACTOR LIC NO ROOF I FLOOR EXT WALL + INT WALL ADDRESS` CEILING HEATING I FIREPLACE METAL MASONRY CITY ZIP PH CITY BUSINESS LICENSE I SEWER MIN DEPTH S/F/100 SIZE .......---- 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 License Class License Number , I I s , Dab Contractor ADDRESS CITY AND ZIP PHONE - -_ OWNER-BUILDING DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason ❑ 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 ❑ I as owner of the property am exclusively contracting with licensed contractors to construct the project ZONING I LAND USE ❑ I am exempt under Sec B&PC for this reason Dal. INITIM SETBACKS I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY I SY I hereby affirm that I have a certificate of consent to self insure, or•certificate of Workers' Compensation Insurance,ora certified copy thereof RY I SSY I COMPANY - POLICY NO GROUP DIVISION TYPE 11Certified copy is hereby furnished DATE EXPIRES f ❑ Certified copy is filed with the city CITY VERIFIED VALUATION Data 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 I• 'j, STRUCTURAL person in any manner so as to become subject to the Workers Compensation Law of California Dal- APPLICANT PLUMBING I GRADING /-1 subject NOTICE APPLICANT If after making this ns Nhctl L b Exemption,you should beer oma with act to the sohs Compensationmit be eem 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 MENTIONED PROPERTY FOR INSPECTION PURPOSES ISSUANCE APPROVED TOTAL PERMIT FEE Signature of Applicant or Agent Date r A FF g DATE UA�CE-J PERMIT NUMBER / ) 7 Pent A hcant 8/Agent•Name I � FINANCE CODE 1 t 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) LENDER'S NAME LENDER'S ADDRESS 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 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 ITIS ITIS 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 „//, o%, Temporary Power Shower Pan Test "-', V/ • V �w Foundation Reinforcing Steel Stucco Mesh or Exterior Siding 11/4/1.5-- -Pt/ Excavation and Forms Insulation V4 t/5i iI Slab Grade 1727/,5 - 'Z Sewer .77)/15— Ground f/3/frGround Plumbing Soil L/z//vy' 194�/ Interceptor Ground Plumbing Water -z./f_7/ti "4' Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service f/zb/rc �. Underslab Gas Lath or Drywall Nailing 5///7 5 Fireplace Foundation Gas Line Air Test J/70/55 Joists and Girders Final Energy Electrical Ground Final Plumbing / /, /r,--- ,moi L Mid-Height Bond Beam Final Heating/A C v/ ./ 8-Foot Bond Beam Final Construction F /7/fes Final Bond Beam Final On Site Improvements Fireplace Bond Beam Final Off Site Improvements Roof Sheathing S/7_d'/fr . Final Dedication Framing and Ventilation y/,-TA/f.5— -- Final Zoning Roof Covering Final Electrical , /7 /C— ar7Q Rough Heatingao0/7- Final Gas (°////—' I Art."0- Service and Ground \ Developer Fees Paid Rough Electrical /, / Fire Dept Approval Verified Bonding V/ZOO//rte I Certificate of Occupancy Over Head Electrical Fence Height Gates Heater Pool Drainage I I SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDE LONG X DEPTH OF ROCK N W E S Inspector's Signature and Initials DATE I;$U�✓� PERMIT NUMBERg 1 I � 41^V\