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Permit No. 4089 I/ //, \ / 4— •M ` CITY OF CHINO H•- AP•ATION FOR A BUILDING PERMIT AND _ . �`' COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY 12- 2001 Grand Avenue -'..,11.I,1111 I, Chino Hills, CA 91709 BUILDING PROPOSED USE- ' C ADDRESS teIV I Vi3TYDEL S6� S PP\ c- ((o rh O APN I o30--K S - 3 U , THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT 0 D LOT i110 'jI/BLOCK TRACT,w�A'o c CRSTRUCT l'PLUMMB (D-MECH 1)I.ELECT `GRADING 9 TYPE OF PERMIT 14 NEW 0 ALTER 0 ADDITION m APPLICANT Bla_cjc r lacf y lJl.l IT 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS '2323 m;tl CJ�xk 'P PROJECTLOCATION ON SIZE 9-')1 7 PH �] DESCRIPTION I PROPERTY I IN SO FEET (/y1J/ CITY i.�t41Mu itIII ZIP --Lr3 -3•tob! 1 I I I q� U CA�-�� ( 0j OWNER Jr�� IIS Rhtil 2 �1 I I 7 OS' ADDRESS /1n I�,,,,,, )� G •-+I^"� Q7l C CITY ZIP PHnI I �� I / a 1 4TH» ARCHITECT ENGINEER L. c. m41.*& f LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADOR4'3-1 rUStnTJ Rte. NO STORIES NO DWELLING UNITS BEDROOMS17 CITY-tri,, pew} ZIP 1�j��-Ul PH 3 ) V-1117 ROOF I FLOOR I EXT WALL I INT WALL CONTRACTOR bt,,,I -fi LIC NO ADDRESS 15.5 Ili Th.NRUE CEILING HEATING I METALMASONRY \(//�\ CITY Sp,�- /�,_� ZIP C0..-1„,„‘ PH��J-9�.� SEWER MIN DEPTH S/F/100 I SIZEV ,+r- ` 1�-, CITY BUSINESS LICENSE v LICENSE NO EXPIRATION DATE LICENSED CONTRACTORS DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION I hereby affirm that I am licensed under provisions of Chapter ft(commencing with Section 7000 of Division 3 of the Business and Professions Code,andi IC license'is in full force and effect ComlJ Comae Class - I License Number ✓ SL_I T+/'1 n �] ,, Dabs Contractor rL-{T.'N I ( - I cmR ADDRESS CITY AND ZIP PHONE 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 contraoting with licensed contractors to construct the protect ZONING I (J LAND USE LII am exempt under Sec BBPC for this reason C CV f ILI I V2 1 Dat• INITIAL SETBACKS I MODEVPLAN WORKERS COMPENSATION DECLARATION FY I SY I I hereby affirm that I have a certificate of consent to self insure,ora certificate of Workers' Compensation Insurance, {o/r..a�cerldied copy thereof ^ -y.� RY SSY I COMPANY TR�etEt POLICY NOI t)5TUI3acOt'LI / '1 GRDUP. DIVISIONT�'PE U❑ Certified copy is hereby furnished DATE EXPIRES I( (\/ ❑ Certified copy 1is wbled with the city CITY VERIF D &I-PW-V- .14 � VALUATION I0�y,5a3 Dat• /-3 J/r' APPLICANT t_Y�• /I14-1'�GLI lJ $PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS'Cd*APENSATION INSUCIANCE I certify that in perlwmenca of the work for which this permit is issued,I shall not employ any ELECTRICAL- 11�, -le I STRUCTURAL p l/ - person in any manner so as to become subject to the Workers Compensation Law of California o 1 LD pale APPLICANT PLUMBING �'U��Drl'l — I GRADING - kic-- NOTICE TO APPLICANT If after making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked MECHANICAL IYt, -7g J p ISSUANCE FEES x I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA U ��yy TION IS CORRECT I AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWST , GEO REVIEW PLAN CHECK J AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE ` MENTIONED PROPERTY FOR INSPECTION PURPOSES ISSUANCE APPROVED TOTAL PERMIT FEE _ itiLet %3/-g1- Signetur Applicant gent° Date i S'3, DATES$�A�C PERMIT NU MBElir vnat"(Y Print Applicant s/Agentt sss Name IC LVR9 FINANCE CODE CL( Operator: DINH Check 1: 000000010 Date: 2/01/95 00 Heceipt e: 0000013 WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK- OWNER DECK $155170 GOLD-ASSESSOR/MANILA - INSPECTOR {Sunt Tendered $1553.70 P 7(nP x .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 ADDRES° 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 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 ❑IS ❑IS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY - Z.O. ~ it' 7�' ' 47' ;' ,d %f ,;,;Y,e: #•.iy ' ';�d :f- (Ertl i1"`'Jh•• ia? 'CV•*'L':' Jy4rr .n1': •aYfY, CiCe, .slheed.+'h 7w Ili; 'z•« CITY OF CHINO HILLS APP :ICATION FOR A BUILDING PERMIT AND .• s« COMMUNITY DEVELOPMENT A CERTIFICATE OF USE &OCCUPANCY I'� 2001 Grand Avenue „_ 'i.11Ealligillia Chino Hills, CA 91709 BUILDING PROPOSED USE • 03 ADDRESS C v 1 — , , (, O APN E THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT y LOT BLOCK TRACT 0 STRUCT ❑ PLUMB ❑ MECH O.ELECT 0 GRADING tr tr TYPE OF PERMIT 0 NEW 0 ALTER 0 ADDITION m APPLICANT ' Ni ' Jit ❑ REPAIR ❑ CONVERT ❑ DEMO ❑ OCCUPANCY PMT ADDRESS PROJECT I LOCATION ON I SIZE ' DESCRIPTION PROPERTY IN SO FEET CITY ZIP / - PH • I I -J... i { OWNER --I I 2 ADDRESS I I ' 3 CITY ZIP PHI I 4 ARCHITECT ENGINEER / • LIC NO REMARKS/SPECIAL CONDITIONSIPROJECT DESCRIPTION ADDRESS , NO STORIES NO DWELLING UNITS BEDROOMS e CITY . ZIP PH 'LROOF I FLOOR EXT WALL INT WALL CONTRACTOR LIC NO ADDRESS r - CEILING HEATING I FIREPLACE J METAL MASONRY CLICENSE NO EXPIRATIONITY BUSINESS DATELICENSE PH SEWER MIN DEPTH S/F/100 SIZE LICENSED CONTRACTORS 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 License Class License Number - tt Dat. Contractor t 4., , 1 t- ADORES° 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 ❑ I as owner of the property am exclusively contracting with licensed contractors to construct ZONING I LAND USE the protect O I am exempt under Sec B&PC for this reason I Del. INITIAL SETBACKS I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY I SY I hereby affirm that I have a certificate of consent to sell insure,ora certificate of Workers I I Compensation Insurance or a certified copy thereof RY SSV COMPANY POLICY NO ' GROUP DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES VALUATION f O Certified copy is I filed with the city CITY VERIFIED w / Dat. I APPLICANT i" 1 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 STRUCTURAL • , person in any manner so as to become subject to the Workers Compensation Law of California f LI , Dat• APPLICANT — F PLUMBING ) I GRADING , NOTICE TO APPLICANT 11 after making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must forthwith comply v with such provisions or this permshall be deemed revoked MECHANICAL ISSUANCE FEES it I `- I CERTIFY THAT I HAVE READ THIS APPLICATION ANO STATE THAT THE ABOVE INFORMA TION IS CORRECT I AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS GEO REVIEW PLAN CHECK C— 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 Ii v /)/ Print Applicant s/Agents Name ' I 1 f i-,_ Li FINANCE CODE l 0, 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 LENDERS ADDRFRg 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 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 ❑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 DATE INSPECTOR Setback/Location Rough Plumbing c/ Temporary Power Shower Pan Test —"/ /' //''r Foundation Reinforcing Steel Stucco-Meeh or Exterior Siding V/x'/r.3- slot- Excavation and Forms / Insulation X///9s---- Slab ///qs—Slab Grade 3///71- ..41P4 Sewer 5/3/95— j Ground Plumbing Soil z-/z//tr Interceptor Ground Plumbing Water 3///9a Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service 9/2 j/ Underslab Gas Lath or Drywall Nailing Fireplace Foundation Gas Line Air Test 5/3o/Pr -Ac( Joists and Girders Final Energy Electrical Ground Final Plumbing //0 `e Mid-Height Bond Beam Final Heating/A C n/ Y" — 8-Foot Bond Beam Final Construction 617/7-3— Final p17/7-SFinal Bond Beam Final On Site Improvements Fireplace Bond Beam Final Off Site Improvements Roof Sheathing f$r/ci72 y/�S/p,;� �,�` Final Dedication Framing and Ventilation 5///YS _i4 Final Zoning Roof Covering Final Electrical //q 4 r- Rough Heating -57//,-C -y. Final Gas " — Service and Ground Developer Fees Paid Rough Electrical / / Fire Dept Approval Verified Bonding 3—////173— ape Certificate of Occupancy Over Head Electrical Fence Height Gates Heater Pool Drainage SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDE LONG X nEPTH OF ROCK N W E S Inspector's Signature and Initials IlJ DATE ISS ANCA PERMIT NUMBER