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Permit No. 4091 h:,'^'� CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND -'Ki A CERTIFICATE OF USE&OCCUPANCY• COMMUNITY DEVELOPMENT • '~ 2001 Grand Avenue Chino Hills, CA 91709 BUILDING QI -S V IS'tw Sot- PROPOSED USE c CD .+ D C ADDRESSJt ,y (� F APN -L1 -2-1SL < -C'[ enct � z I "3� THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT O / y �,J a LOT {Q1 BLOCK TRACTRgc _ C3+STRUCT (PLUMB HJ`MECH `ELECT ,W GRADING C { 1 ,AA 9 TYPE OF PERMIT A NEW 0 ALTER 0 ADDITION FR APPLICANT fl ,'lb L Raines.C` vv �r CO tJ iC G.{r CtZ'iin J CO xT - - 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS anao... KmGluckDR suive 130 PROJECT I LOCATION ON I SIIE ' I I�/t^I ` DESCRIPTION PROPERTY iIN,.SO FEET CITYL cbtehe Pal% ZIP q,c J PH 543s/U/a/ 5 I I I O3O 9) OWNER Yvw bc Z vsro AS A Gf\ OCe I Sir ��^�CC���....")) ADDRESS tt `W 3 OAcT\ t) I I g CITY ZIP PH dI I ARCHITE /*" ENGINEE L. c. (VIA\& T LIC NO REMARKS/SPECIAL CONDLT1ONSIPROJECT DESCRIPTION �—.- ADDRESS:ST/ -iii a l A.‘„, //`� NO STORIES NO DWELLING UNITS BEDROOMS CITY l"e Vi R" yy.a�, ZIP 41:77 01 PN<i ] l/_7"���, ROOF I FLOOR EXT WALL INT WALL CONTRACTORI �1'91�'�rj 1,-•� _I LIC NO • ' ADDRESS CEILING I HEATING METAL FIREPLACE MASONRY CITY ZIP PH SEWER MIN DEPTH StAt60 I SIZE CITY BUSINESS LICENSE LICENSE NO EXPIRATION DATE f'"�� LICENSED CONTRACTOR'S DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION t„/ I hereby affirmthef t am licensed under provistons of Chapter 9(commenting with Seclion 7000 of Division Sol the Business and Professions Code,and my Cleatlicenseora In full force and angel [� LicenseCleatr.t" } _License Number St#4W t A,Ain.QAR • Date Contractor ADDRESS CITY AND DP PHONP OWNER BUILDING DECLARATION I hereby etlum that I am exempt from the Contractor•License Law for the following reason C I,al owner of the properly,or my employees with wages es their sole compensation,will do the work and the structure is not intended or ollered for sale 0 I as owner of the property am exclusively contracting with licensed contractors to construct the prolate ZONING ` LAND USE 0 tam exempt under Seo_ B3PC for this reason i 1"/.. i Dale INI TIAI SETBACKS I MODELJPLAN WORKERS'COMPENSATION DECLARATION FY I SY ' I hereby affirm that I have a certificate of coneenl to self Insure or a certificate of Worker. Compensation Insurance,or a certified copy thereof RY ' SSY COMPANY J )aIAZTIZtI POLICY NO rim T(/1?dnor477- / GROUPt 3 DIVISION ,TYRE 0 Certified copy is hereby furnished DATE EXPIRES (` (�^•+ VALUATION 1 d Certified copy aided with the city CITY VERIFIED (U,L ICIJ 1 /-3 r— 4 ale1—cAPPLICANT stJM� PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS'CC?4PENSATION INSURANCE n I certify that in performance of the work for which this permit is issued,I shall not employ any ELECTRICAL 'N,a,� �`� I STRUCTURAL 9('t person in sty manner Co as to become subject to the Workers Compensation Law of California c�o/ti.) + Date APPLICANT PLUMBING �• (V I GRADING /Sr-"•- NOTICE TO APPLICANT If alter making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Codeyou must forthwith comply with such provisions or this permit shall be deemed revoked MECHANICAL / '}r $9 ISSUANCE FEES �Y' ..- I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA bo CYC TION IS CORRECT I AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS, GEO REVIEW 1 PLAN CHECK 51 3"}' AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE J / MENTIONED PROPERTY FOR INSPECTION PURPOSES - / /_51-7,C ISSUANCE APPROVE TOT R 1 1567.P- ad; Signetur Applicant o enta Date ��/' A�G� DATE OF'SSC NCE (//J',•�� PERMIT}L7U,r�(1BER Print Applicant s/Agent la Name !`� fO FINANCE CODE p Cnerator: DM Check 0: 000000000 WHITE- FILE/GREEN• FINANCE/ YELLOW- OFFICE I PINK•OWNER Oate: 2/01/55 00 AeceJot is 507. 3 MEM $11567.33 GOLD•ASSESSOR/MANILA •INSPECTOR e-.,,t-k "'rand $1567.33 liONSTRUCTION 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 ADDRF cc 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 REOUIRED 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 38 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 MIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY :.*'.c i P h xi:u1:s;,�.L ', ,'.' '{,i id'�:%;ri'K•' K\ 7,•- moi..y.IP.,^,krYif`lST? ✓' .n{c-4q' :"4ry "r-�'v„4^F.-4rt+.' .rn • CITY OF CHINO HILL'S 4 APPLICATION FOR A BUILDING PERMIT AND '.e�ti COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY 2001 Grand Avenue Chino Hills, CA 91709 BUILDING PROPOSED USE ADDRESS y, ' if ty- tiw C., LF l' ti0 APN I L - THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT > LOTBLOCK TRACT r O'STRUCT 17 PLUMB 0 MECH 41 ELECT 0 GRADING is (UI TRACT. t DJ TYPE OF PERMIT 0 NEW 0 ALTER 0 ADDITION m APPLICANTIn I' . , CO 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS I PROJECT LOCATION ON SIZE ' ` DESCRIPTION PROPERTY IN SO FEET CITY, ZIP PH 4, I I t OWNER 2 II I -i ADDRESS G I I ~� /J CITY ZIP PH 4 ARCHITECTS - ENGINEERt'C I l j: LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION - ADDRESS i ;. NO STORIES NO DWELLING UNITS BEDROOMS • 5 CITY ZIP PH �'- ROOF I FLOOR EXT WALL INT WALL y/ CONTRACTOR LIC NO ADDRESS CEILING HEATING I FIREPLACE METAL MASONRY CITU ZIP PH SEWER MIN DEPTH S/F/100I SIZE T CITY BUSINESS LICENSE LICENSE NO EXPIRATION DATE LICENSED CONTRACTOR'S DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION r 1 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 ,fleet License Class License Number 1 Dal. Contractor ADDRESC 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 d.. the work end the structure is not nfsnded or offered for sale O 1 as owner of tris property am exclusively contracting with licensed contractors to construct ZONINGI LAND USE the project O I am exempt under Sec B&PC for this reason I } 5 Dale INITIAL SETBACKS I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY I SY I hereby affirm that I have a certificate of consent to call insure, ora certificate of Workers I Compensation Insurance,or a certified copy thereof RY SSY COMPANY POLICY NO GROUP- DIVISION TYPEP O Certified copy is hereby furnished DATE EXPIRES VALUATION - O Certified copy is filed with the city CITY VERIFIED , 4 V 1 i'1 I Dal• 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 STRUCTURAL - person in any manner so as to become subject to the Workers Compensation Law of California - -� Oat. APPLICANT - PLUMBING 't, I GRADING J - NOTICE TO APPLICANT If after making this Certificate of Exemption you should become aubract to the Workers Compensation provisions of the Labor Code,you must forthwith comply , with such provisions or this puma shall be deemed revoked MECHANICAL Ir 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 t i, u L J 4 t - kr: DATE OF ISSUANCE PERMIT NUMBER t r - C. Li 0 / I Print Applicant s/Agents Name 1, 1 I t r FINANCE CODE � Li a 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) LENDERS NAME LENDER S ADDRFec 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 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 � /„ Temporary Power Shower Pan Test '- - " ' Foundation Reinforcing Steel Stucco Mesh or Exterior Siding 51/4/F,C Excavation and FormsInsulation Slab Grade L/2/4J Sewer _r7/75•15— Ground 7i7-rGround Plumbing Soil 4/1-J/9r i Interceptor Ground Plumbing Water 2-/z f/qs Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service .,,,/2G/y,i syr,[ Underslab Gas Lath or Drywall Nailing 5///7r- Fireplace ///7fFireplace Foundation Gas Line Air Test _��p"c r or-LEre Joists and Girders Final Energy Electrical Ground 2-12 f/fes -7ft' Final Plumbing //.,/2 Mid-HeIght Bond Beam / Final Heating/A C '7 '/ / `�� 8-Foot Bond Beam Final Construction /,/f/fes Gl/ Final Bond Beam Final On Site Improvements Fireplace Bond Beam Final Off Site Improvements Roof Sheathing 3/2A/9-f Final Dedication Framing and Ventilation '1/zFinal Zoning Roof Covering - Final Electrical / /Y ,--,-- Rough Heating y/z6/f , qy Final Gas P/ /7J Service and Ground Developer Fees Paid Rough Electrical / Fire Dept Approval Verified Bonding (/16/ffCertificate 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 Inspector's Signature and Initialsials ni ` DATE O1 ISI PE D91 � JII