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Permit No. 4092 • • �^• CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND i e: '. • COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY 2001 Grand Avenue cti INE_ .ailiiiiiil Chino Hills, CA 91709 BUILDING ging T��; c PROPOSED USE- w ADDRESS �fil>� VITTMet UCL 5aLF 5F2 CA140 cti APN o3a_41fr_ 0 I THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT 11 D LOT /-q BLOCK TRACT1^gdg 5_ SLSTRUCT `PLUMB GeMECH 0 ELECT ::Nd GRADING S APPLICANT((((/ /��y �/yI� �`jj TYPE OF PERMIT 0 NEW C ALTER C ADDITION y `Jod� r'"-"1""c 1 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT N ADDRESS 0:3-5 )__Y MI Vl (Oa O'Q . Suitt 13 D PROJECT I LOCATION ON I SIZE V`1! X1-7/ F CC3.-.)0(:, l /�/ DESCRIPTION I PROPERTY I IN SO ET 9-3 Q CITY'L(g,,, K1V�I ZIP /d,+�� PH J03')aib ( 1 �S_r -� �A� as n ��1. OWNER SAS A] A�rkJt 2 I I s/r ]J 1_ ADDRESS I I �� 3 PM1U CITY ZIP PH I I ' 4 •�-- ARCHITECT M,, / ENGINEER �-C. t t 4-111/VCS LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION 1 V ADDRESSIst' itArtU rojeNO STORIES NO DWELLING UNITS BEDROOMS CITY 90nitA M44 ZIP e}lddqD) PH °''7743 ROOF I FLOOR I EXT WALL I INT WALL CONTRACTOR f 'may LIC NO ADDRESS CEILING HEATING I FIREPLACE METAL MASONRY /^, CITY ZIP PH SEWER MIN DEPTH S/F/100 I SIZE V CITY BUSINESS LICENSE 0 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 ofOp -ilthe Business end Professions Code,and my license is in full force and effect 1 License Class. r ' License Number 9-11.q 1, RAO QM_ Date Contractor ADDRFce CITY AND ZIP PHONF OWNER BUILDING DECLARATION I hereby affirm that I em exempt from the Contractor's License Law for the following reason O I,as owner of the property,or my employees with wages ss their sole compensation will do the work,and the structure is not intended or offered for sale O I ss owner of the property am exclusively contracting with licensed contractors to construct ZONING I LAND USE the protect O I am exempt under Sec BBPC for this reason I Date INITIAL SETBACKS I MODEL/PLAN WORKERS'COMPENSATION DECLARATION FY I SY I hereby affirm that I have a certificate of consent to self insure,ora certificate of Workers' Compensation Insurance,sa/ or a certified copy thereof ./� Icy RY SSY I COMPANY rAA-LR'H�Gc- POLICY NOIJtJ7//)Q&rT /14' ()MVP).VDIVISION -TYP,E O Certified copy is hereby furnished DATE EXPIRES C �� VALUATIOJx ,�_M 'Ili 1 1 O GrtiNetl)copy is filed with the city CITY VERIFIED /� I/ ) `t C. Dale /"71 'T APPLICANT 2L a - 1- PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE ���� t certifyI m that performance of the work for which this permit is issued, shall not employ any ELECTRICAL O�4J /��..•sI STRUCTURAL/Ott person in any manner so as to become subject to the Workers Compensation Law of California CCYY� Date APPLICANT CO PLUMBING /tin. I GRADING NOTICE TO APPLICANT If,after making this Certificate of Exemption,you should become a subject to the Workers Compensation provisions of the Labor Code,you must forthwith comply with such provmona or this permit shall be deemed revoked MECHANICAL 6r0( ISSUANCE FEES I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMA O TION IS CORRECT I AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS, GEO REVIEW I PLAN CHECK 99 34 AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE 1 MENTIONED PROPERTY FOR INSPECTION PURPOSES ISSUANCE APPROVEDi 567 TOTAL PERMIT FEE 33 F—`71— Sipnatur Applicant or t Q Date yDATE OFUPN�CE PERMIT UMB Print Applicant s/Agent a Name FINANCE CODE Cii Operator: IAN Check 9: 000000000 WHITE- FILE/GREEN- FINANCE/ YELLOW- OFFICE/PINK- OWNER Date: 2101/95 00 Receiot Y: 0000016 NEN 41567.33 GOLD-ASSESSOR/MANILA - INSPECTOR r, 51567.33 •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 ADDRESC 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 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 ❑IS ❑IS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY - • • , • • • , 1 K _ 9ra"" .'vr^ + -Av�.yYy,»S-rt -- "'w"ty`.1Lafit ir- "''rl� 'P.;04. NdWPI is r LIWT-,-''Vf-rCyfr"\ r.'L - _ -+?• ` CITY OF CHINO NILS AP CATION FOR A BUILDING PERMIT AND at% COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY Y• 2001 Grand Avenue - Chino Hills, CA 91709 - BUILDING PROPOSED USE / C ADDRESS i .r J t C P APN { 6* .+ c •t 2 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT LOT ir BLOCK TRACT 0 STRUCT 0 PLUMB 0 MECH 0 ELECT 0 GRADING CI r /h4 S TYPE OF PERMIT 0 NEW 0 ALTER 0 ADDITION m APPLICANT fn cn 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PUT ADDRESS PROJECTLOCATION ON SIZE • • • DESCRIPTION I PROPERTY I IN SO FEET 9 CITY/ ZIP r PH + 1 I ' I ,, —I I OWNER I I ' l 2 \r ADDRESS I I �'"^ 3 CITY ZIP PH I I /— 4 ARCHITECT ENGINEER L ( LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION CI ADDRESS • r — NO STORIES NO DWELLING UNITS BEDROOMS I r CITY i ZIP r PH • 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/100I SIZE CITY BUSINESS LICENSE LICENSE NO EXPIRATION DATP LICENSED CONTRACTOR'S DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION t ___ 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 force and erect Licenee Class License Number • `j Dale Contractor ADDRESS CITY AND ZIP PHONF OWNER-BUILDING DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for ih•following reason 0 1,as owner of ih•property,or my employees with wages as their sole compensation,will do the work and the structure is not intended or offered for sal. O I as owner of the property am exclusrvsly contracting with licsns.d contractors to construct I the project ZONING LAND USE O I am exempt under Sac B&PC for this reason Dat. INITIAL SETBACKS I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY I SY I I hereby ellirm that I have a certificate of consent to self insure,ore certificate of Workers Compensation Insurance or a certified copy thereof RY I SSY COMPANY POLICY N^ GROUP DIVISION TYPE 0 Certified copy is hereby burnished DATE EXPIRES t I - o C.rtifled copy is filed with the city CITY VERIFIED VALUATION th t. Cr Date APPLICANT PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE I certify that in performance of the work for which this permit rs issued,I shall not employ any ELECTRICAL c STRUCTURAL r - person In any manner so as to become subject to the Workers Compensation Law of California I Date APPLICANT PLUMBING - I GRADING ` — NOTICE TO APPLICANT If,after making this Certif watt of Ex.mpbon you should become subject to the Workers Compensation provisions of the Labor Code,you must lorthw,th comply t with such provisions or this permit shall be deemed revoked MECHANICAL � '- ISSUANCE FEES V - 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 l ISSUANCE APPROVED TOTAL PERMIT FEE I` • t4 Signature of Applicant or Agent Date �' 1. t C 1; DATE OF ISSUANCE PERMIT NUMBER I ' Print Applicant s/Agents Name -'t t ) I 1 /1-; L FINANCE CODE 111 t,v I -) C r-r WHITE- FILE/GREEN--F NANCE/ YELLOW- OFFICE/PINK- OWNER GOLD-ASSESSOR/MANILA - INSPECTOR 0ONSTRUCTION LENDING AGENDA, 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) LENDERS NAME LENDER'S ADDRES° DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRES A D[VISION OF INDUSTRIAL SAFETY PERMIT AS A PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW 0 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 /..//, �/,-:- ,,,.1 Temporary Power Shower Pan Test //"----i/ , ' Foundation Reinforcing Steel Stucco Mesh or Exterior Siding f/i/yr -447L- Excavation and Forms Insulation V/2c/jam Axe Slab Grade Z/L7/jc iArs, Sewer S/T/rr --",/ Ground Plumbing Soil y/1.//y-r- ..--At/ Interceptor Ground Plumbing Water 2-/t7/4S Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service -J/s'/yr see Underslab Gas Lath or Drywall Nailing 7-7//t r -is/ Fireplace Foundation Gas Line Air Test .S/3oft i"-- ricS, Joists and Girders Final Energy Electrical Ground Final Plumbing / /,/r r s� Mid-Height Bond Beam Final Heating/A C cy // / — Y� 8-Foot Bond Beam Final Construction (y /7/9} 4,40‹ Final Bond Beam Final On Site Improvements Fireplace Bond Beam Final Off Site Improvements Root Sheathing S7.71/75— strol Final Dedication Framing and Ventilation x725/7S Final Zoning Roof Covering Final Electrical //>/- .' df-if Rough Heating viz C/95— --ArcFinal Gas ,' /— Service and Ground -� -- Developer Fees Paid Rough Electrical / Fire Dept Approval Verified Bonding V/z>/per --r r' 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 (i2 Lk DATE OF IS UANCE PERMIT NUMBER alp Igo gocia._