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Permit No. 4136 ill 1111 �• CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND COMMUNITY DEVELOPMENT --s :-.'rA CERTIFICATE OF USE & OCCUPANCY r :. "I •~ 2001 Grand Avenue Chino Hills, CA 91709 BUILDING ADDRESS 'j�O(�/S ^�VFS[(t ,SQL- PROPOSED USE�1 /(J� (-]e/-}/�, �i / a APN I t :W- t W.' 9 l�Vv/ti1-� _ I f(/ 2 THE Kat/WING WORK IS AUTHORIZED BY THIS PERMIT > LOT T/0 I BLOCK TRACTIrjiW_S" /- RUCT 0 PLUMB 0 MECH ❑ ELECT GRADING CI ` O � D APPLICANT TYPE OF PERMIT 4TNEW 0 ALTER 0 ADDITION fT 1')Rm<t� t4em� CO Co 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS 031)WO PAIR CAM ��k- %Fr_l3� ,v' / IZE DESCRC TION T I P OPERTY LOCATION N I SN SO FEET CI 1-1 lli/tk ItAk ] C /�ZIP ^j3.CS PHJ03`/Iol> 1 I OWNER 3�ML AS I mhos 2 I I ADDRESS G I CITY ZIP PH ARCHITECT 4 I I I— ENGINEER tyi ersr IfEbS LIC NO REMARKS/SPECIAL CONDIT1ONS/PROJECT DESCRIPTION ISL ADDRESS II DO (,�,NAi< NO STORIES I NO DWELLING UNITS I BEDROOMS .�.w7� CITY sail it,t ZIP I9“0 PH !ig- ClCJ7I r ROOF I FLOOR EXT WALL INT WALL CONTRACTOR VV LIC NO II ADDRESS CEILING HEATING I FIREPLACE METAL MASONRY CITY ZIP PH LICENSE NO ECITY BUSINESSXPIRATION DATELICENSE SEWER MIN DEPTH S/F/100 I SIZE 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'J�1(�•Business and Professions Code,andel mymlicense is in lull force and effect License Class Y ( License Number 52/g'6 di/•��tuttL bG Date Contractor a-%.- ) ADDRESS CITY AND ZIP PHONE OWNER BUILDING DECLARATION I hereby affirm that I am exempt Iron 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 elruclure is not intended or offered for sale 1i•s owner of the property am exclusively contracting with licensed contractors to construct �" the propat ZONING LAND USE O I am esempl under Sec B&PC for this reason I Date INITIAL SETBACKS I MODEUPLAN WORKERS COMPENSATION DECLARATION FY I SY I hereby affirm that I have a certificate of consent to sell insure,or a certificate of Workers' Compensation Insurance,r/nc ,�orr a(certified copy thereof �-t,,y]/���y,,�/�'�,j� RY SSY I COMPANY I rx F'S POLICY NO 7tt7Z/ QQ2tt7 I r I GROUP DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES O Certd/leeTTd copyco� is filed with the city CITY VERIFIEDFI (�,,, VALUATION a / — Dale 0"-Itif APPLICANT t'/v�.Atm, , (� PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURXNCE /� I certify that in performance of the work for which this permit is issued,I shall not employ any ELECTRICAL I STRUCTURAL( 4.2D person in any manner so as to become eublect to the Workers Compensation Law of California IW/7 a Date APPLICANT PLUMBING I GRADING 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 ISSUANCE FEESail 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, GED REVIEW I PLAN CHECK AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES ISSUANCE A OVER TOTAL PERMIT FEE `t-' fhrtmata/ D 4—sr /2 s Q els SigneofApphcantcAg4nt Date DATE SI �E / I PERT 1MBER am` f\ gtGsPnl(ApPlicant•/Agents Name' FINANCE CODE CM - Operator: VIRSINIA Check II: 000000000 Date: 2/09/95 00 Rece:Ot I: 0000343 WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK- OWNER CHECK $93.80 GOLD-ASSESSOR/MANILA - INSPECTOR Amount Tendered $93.80 .CONSTRUCTION LENDING AGEN• 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 ADOREF" DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRES A DIVISION OF INDUSTRIAL SAFETY PERMIT ASA PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APP41CANT SIGNS ONE OF`THE CERTIFICATES BELOW - I, o 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 "-_ 1 ❑ 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 ' 1 A - _ I HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT 015 015 NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY t i a . •Z , -N - �C , , l _- i r Li 1 •l / 4 ) II' - .. .. ._ . -.` ' ' ..m.-rp. .R..,,,n.wr-'r 1q.•rr-7?"4.•p .r.y.. -•a. 10 .;.''w CITY OF CHINO IS APPLICATION FOR A BUILDING PERMIT AND COMMUNITY DEVELOPMENT ' A CERTIFICATE OF USE & OCCUPANCY 2001 Grand Avenue Chum Hills, CA 91709 BUILDING ADDRESS afr)'3 tit\� '^ I\&L 'S ye PROPOSED USE / / C F APN 1 . ,r 4„)- s 1 'it,.."-Lk .. t ✓'.,,"^ ' I Z THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT D LOT ( BLOCK TRACT l ❑ STRUCT 0 PLUMB 0 MECH 0 ELECT 0 GRADING 0 33 APPLICANT TYPE OF PERMIT 'p'NEW 0 ALTER 0 ADDITION y P': . 14,1\ t ` co ❑ REPAIR El CONVERT 0 DEMO El OCCUPANCY PMT ADDRESS 3 };vc 'sl C - (1 1 t r2> PROJECT I LOCATION ON I SIZE 'lT DESCRIPTION PROPERTY IN SO FEET / CITY ., r•♦ r•, ZIP 1,\ PH-\r 1-, , 1 I I .) 7 .1 � OWNER Rn/y ADDRESS 3 CITY ZIP PH I I 4 ARCHITECT ENGINEER E;r^',,{ r , r Ift_ . Sr LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION si y ADDRESS 41,i fr,rir, rt R { -( NO STORIES NO DWELLING UNITS BEDROOMS it CITY /KJ7(". ➢P 1%e :Le PH 1c C_.t ROOF I FLOOR EXT WALL INT WALL :. CONTRACTOR LIC NO ADDRESS CEILING HEATING I FIREPLACE METAL MASONRY CITY ZIP PH , CITY BUSINESS LICENSE SEWER MIN DEPTH S/F/100 I SIZE LICENSE NO EXPIRATION DATE ` LICENSED CONTRACTOR'S DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION ' "" I hereby affirm that lam licensed under provisions of Chapter 9(commencing with Section 7000 of Division 3 of{ d the Business and Professions Code,andis my licenseIn full force and effect License Class 1-'-1 License Number -"7t-r' / I(-W,j c. Date _ Contractor .r). 't;i ADDRESS CITY AND ZIP PHONE OWNER-BUILDING DECLARATION I hereby affirm that I am exempt from the Contractors License Law for the following reason El 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 {H.1 as owner of the property am exclusively contracting with licensed contractors to construct the protect ZONING I LAND USE p I am exempt under Sec BBPC for this reason I Gate INI TIAI 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 n�Insurance,ora certified copy thereof 4 RY I SSV COMPANY 7lcflv4 . �' S y+ POLICY NO + .) 1 y..-Ju+'� - t 7 ' i' GROUP DIVISION TYPE p Certified copy is hereby furnished DATE EXPIRES p Certified copy isfiled with the city CITY VERIFIED VALUATION .Th J /_ r, Data C‘'‘.." it APPLICANT \✓V'- rkh-t_' `r {�' r t A PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE I certify that in performance of the work for which this permit i•issued,I shall not employ any ELECTRICAL STRUCTURAL/ I I person in any manner so•s to become subject to the Workers Compensation Law of California `•I r r'S L 0( Date APPLICANT PLUMBING I GRADING NOTICE TO APPLICANT If, after making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of iha Labor Coda,you must forthwith comply with such provisions or this permit shall be deemed revoked MECHANICAL I 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 \ - Int , 1 ' ' -i,� ' ) aT :). SigneFre of Applicant or Agent Date I �` H DATE OISSUANCE_ PERMIT NUMBER Pnnl APphcant•/Agent•Name' ( lir 27 FINANCE CODE IT WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK- OWNER GOLD-ASSESSOR/MANILA - INSPECTOR t •ONSTRUCTION LENDING AGEN• 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 ADDREFq 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 I INSPECTOR Setback/Location � _ V J ' -{;1 j.Rtugh Plumbing Temporary Power J�ili'�� f'-/L// Shower Pan Test Foundation Reinforcing Steel °' '/ Stucco Mesh or Exterior Siding Excavation and Forms Insulation Slab Grade Sewer Ground Plumbing Soil Interceptor Ground Plumbing Water Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service Underslab Gas Lath or Drywall Nailing Fireplace Foundation Gas Line Air Test Joists and Girders Final Energy Electrical Ground Final Plumbing Mid-Height Bond Beam Final Heating/A C 8-Foot Bond BeamFinal Construction 6/7/747 -- Final Bond Beam Z/c ,✓'/f / I Final On Site Improvements Fireplace Bond Beam Final Off Site Improvements Roof Sheathing Final Dedication Framing and Ventilation Final Zoning Roof Covering Final Electrical Rough Heating Final Gas Service and Ground Developer Fees Paid Rough Electrical Fire Dept Approval Verified Bonding Certificate of Occupancy Over Head Electrical Fence Height Gates Heater Pool Drainage SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDF LONG X DEPTH OF ROCK N W E Inspector's Signature and Initials 67 DATE OF ISSUANCE PERMIT NUMBER