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Permit No. 4090 I) • . • - +'• CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND -1%. A CERTIFICATE OF USE &OCCUPANCY .r..� COMMUNITY DEVELOPMENT -" J 2001 Grand Avenue Chino Hilts, CA 91709 BUILDING !^� }��� Q ) PROPOSED USE •� L�/y� Q j+ C ADDRESS vaon VISTA EL ..ML c . (APO ("d z APN �J t I o3a s 6 S THE FOLLOWING WORK ISL AUTHORIZED BY THIS PERMIT s LOT 111 BLOCK TRACT«G�r STRUCT ,�6-PLUMB 'L]•MECH ELECT AB-GRADING U�11 O 1�. �� �� 33 TYPE OF PERMIT LIYIEW 0 ALTER 0 ADDITION T APPLICANT A c y, �j/' 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS �]3�1bi'� m111 Oct . (�Q• LyLiL� IJV PROJECT DESCRIPTION I LOCATION PROPERTY ON IZE qtr FEET ',� CITY/OK F �-61II I ZIP !v/1 PH 1007 1 I I I qtc OWNER Car1'v5• Ai Abbu-L 2 as... I I poJ �'\1 r ADDRESS 3 /0'rR"2AfO I I H97 CITY ZIP PH llP I I go C PM-) 0 ARCHITECT ENGINEER LL, (\ATOP-S LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS i ¶5-I t1 Euro -3?0 NE NO STORIES NO DWELLING UNITS BEDROOMS CITY ekivr A/W ZIP •-'p ` PH c-•U 1 ` CEILINGROOI FLOOR HEATING I EXT WALL I INT WALL F CONTRACTOR Gw�-y� LIC NO ADDRESS IC I FIREPLACE METAL MASONRY CITY ZIP PH CITY BUSINESS LICENSE SEWER MIN DEPTH S/F/100 I SIZE 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 th/ee Business and Proleaoons Code, and my license n In lull force and affect {� 1 License Class IS I License Number 5H61/y RAY% Iia O'C'el t-J Date Contractor AODRESC CITY AND DP PHONd OWNER-BUILDING DECLARATION I hereby affirm that I am exempt from the Contractor•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 properly am exclusively contracting with licensed contractors to construct IM protect ZONING LAND USE O I am exempt under Sao B&PC for this reason I VI R. I Data INITIAI 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 Insurance,s( ora certified copy thereof .y(�s.-� -�y RY SSY I COMPANY I RAVL1 C POLICY NO/N•A�1Lvl ' I-ti GROUPK s DIVISION UT''PE O Certified copy is hereby furnished DATE EXPIRES (V VALUATION Or-Certified lfied copy filed with the city CITY VERIFIED I 0 X r 3 Dale )_ ' I-9t-- APPLICANT U L� IIsi PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS CO/I.PENSATION INSUAXNCE �I '1 I certify that in performance of the work for which this permit a issued,I shall not employ any ELECTRICAL Ir.." /U STRUCTURAL p(Ab Cs person in any manner so as to become subject to the Workers Compensation Law of Caldornu 1 O ( Dat- APPLICANT PLUMBING gaga, I GRADING 775 NOTICE TO APPLICANT If attar making this Certificate of Exemption,you should become gaga, I / 7 subject to the Worker. Compensation provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked MECHANICAL 78 U 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 57 51 AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES ISSUANCE APPROVED TOTAL PERMIT FEE �n �arfW (� /•31-9J-' 1- -- /553. S ignatme pplicant or t a Date DATE OF ISSANC PERMIT NUMBER firm /34644i,1* Print Applicant s/Agents Name r FINANCE CODE C LI Operator: DAWN Check 0: 000000000 WHITE- FILE/GREEN• FINANCE/YELLOW- OFFICE/PINK- OWNER Date: 2/01/95 00 Receipt 0: 0553070 pgC}t $1553.70 GOLD-ASSESSOR/MANILA - INSPECTOR Rmount Tendered 51553.70 IRONSTRUCTION LENDING AGENC• I HEREBY AFFIRM THAT THERE ISA CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED (SEC 3097, CIV C) LENDER'S NAME LENDER'S ADDREgc DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRES A DIVISION OF INDUSTRIAL SAFETY PERMIT AS A PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW ❑ I CERTIFY THAT NO EXCAVATIONS FEET OR MORE FEET IN DEPTH,INTO WHICH A PERSON IS REQUIRED TO DESCEND,WILL BE MADE IN CONNECTION WITH WORK AUTHORIZED BY THIS PERMIT,AND THAT NO BUILDING,STRUCTURE,SCAFFOLDING,FALSEWORK,OR DEMOLITION OR DISMANTLING THEREOF,WILL BE MORE THAN 36 FEET HIGH ❑AS OWNER/BUILDER I WILL NOT EMPLOY ANYONE TO DO WORK WHICH WOULD REQUIRE A PERMIT FROM THE DIVISION OF INDUSTRIAL SAFETY,AS NOTED ABOVE UNLESS SUCH PERSON HAS A PERMIT FROM THAT DIVISION DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER I HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT DIS DIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY • v. tie::,1'..:.:N-,`,*;;-- . - r• ---c+�"'0 1"--d-:•,;j;y;.i•E`a�+l.: "-R' .A(r 1•11., " J • \ _ R t^ '�,,i ...�i t • - ����.,$"ICZf N" I .,,.y fi"JII.rt.i'^` �'n•->a a'w�,.F•dv,F• iF t •N CITY OF CHINO APPLCATION FOR A BUILDING PERMIT AND COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY 2001 Grand Avenue Chino Hills, CA 91709 BUILDING (/y/7 I PROPOSED USE ADDRESS • .0 l L r Vi 5-EA ` J • C ' APN ( , _ THE FOLLOWINGWORK IS AUTHORIZED BY THIS PERMIT > LOTBLOCK TRACT B STRUCT /O PLUMB b MECH 0 ELECT /0 GRADING is � 1 1 ` s TYPE OF PERMIT UkNEW 0 ALTER 0 ADDITION ynJ APPLICANT r A 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS PROJECT I LOCATION ON I SIZE i • DESCRIPTION PROPERTY IN SO FEET I, CITUI t ZIP PH . I I Cl 1 T' OWNER Z I I - ADDRESS G I I , CITY ZIP PH 4 y ARCHITECT ENGINEER LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS ' • NO STORIES NO DWELLING UNITS BEDROOMS �/ CITY S • , ZIP C PH ROOF I FLOOR EXT WALL INT WALL CONTRACTOR LIC NO ADDRESS CEILING HEATING I METALMASONRY CITY ZIP PH CITY BUSINESS LICENSE SEWER MIN DEPTH S/F/100 I SIZE V- . LICENSE NO EXPIRATION DATE LICENSED CONTRACTOR 5 DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION I hereby allirm that I am licensed under provisions of Chapter B(commencing with Section 7000 of Division 3 of the Business and Professions Cod.,and my License is in lull lorce and effect Linens Class License Number ' 1 t . Dat. Contractor ADDRCee CITY AND ZIP PHON: OWNER BUILDING DECLARATION I hereby affirm that I am exempt from the Contractor's Linens.Law for the following reason ❑ I,as owner of the property or my employees with wages as thsir sole compensation will d- the work and the structure is not intended or oH.red for sale ❑ I as owner of the property am exclusively contracting with licensed contractors to construct the protect ZONING LAND USE ❑ I am exempt under Sec B&PC for this reason I ` Oat. INITIAL SETBACKS I MODEL/P LAN WORKERS'COMPENSATION DECLARATION FY I SY I I hereby affirm that I have a certilicate of consent to sell insure,or•certificate of Workers Compensation Insurance,or a candied copy thereof RY SSY COMPANY i POLICY NO i ' GROUP, DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES VALUATION O Certified copy is filed with the city CITY VERIFIED I Data / APPLICANT - PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE I certify that in perlormance of the work for which this permit is issued,I shall not employ any ELECTRICAL •i I STRUCTURAL ",' person in any manner so as to become subject to the Workers Compensation Law of California I - Oats APPLICANT PLUMBING I GRADING - i ' NOTICE TO APPLICANT II 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 7 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 Dat. • DATE OF ISSUANCE PERMIT NUMBER 1 Print Applicant s/Agents Name v; i I I i'j , ( . /I i I FINANCE CODE l 'I 0 , WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK- OWNER GOLD-ASSESSOR/MANILA - INSPECTOR •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 ADDRFcc 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 D 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 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 INSPECTOR DATE INSPECTOR Setback/Location Rough Plumbing 7/,„ k-/ ,,. Temporary Power Shower Pan Test //'V/ ' _.• - `• r9' Foundation Reinforcing Steel Stucco Mesh or Exterior Siding 7/757' j" /./„. Excavation and Forms Insulation "7/2 079-C — Slab Grade e /7/P;) ,75,/, Sewer r/7/FS --Sof Ground Plumbing Soil f/7//4< Interceptor Ground Plumbing Water 4, /7/S is! Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service 7//7/f$ I -f,L<. Underslab Gas Lath or Drywall Nailing 7/75-/fX 7LV Fireplace Foundation Gas Line Air Test /////9 I .4:494 Joists and Girders Final Energy Electrical Ground 4 /7/ f ( Final Plumbing 9///‘-r--e›< Mid-Height Bond Beam v Final Heating/A C A- %%„-.-- _� /- B _ -Foot Bond Beam Final Construction //U/ 7- ' ✓� Final Bond Beam Final On Site Improvements Fireplace Bond Beam Final Off Site Improvements Roof Sheathing { fHei=2- 7 7/0/FS- .-Ats, Final Dedication Framing and Ventilation 7/Lp/S5- --id Final Zoning ..-- Roof Covering \ -- Final Electrical q/,o%.— Rough Heating ) Final Gas //"/ 7 - Service and Ground / / Developer Fees Paid Rough Electrical 7 , Fire Dept Approval Verified Bonding 7/2-0/f 5" Iyf/ 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 113 DATE OF ISSLIANCE PERMIT NUMBER aIleci-s b9() rt