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Permit No. 4140 r • • '•'• CITY OF CHINO HILLS COMMUNITY DEVELOPMENT APPLICATION FOR A BUILDING PERMIT AND rtA CERTIFICATE OF USE & OCCUPANCY ., ?_ 'I •� 2001 Grand Avenue 14114161ingilChino Hills, CA 91709 BUILDING � PROPOSED USE EC U ADDRESS Q.96-s- u1 T� p a 131`k s(tL u ' 1 '- o APDL V { _ R 4 I THE�LOWING WORK IS AUTHORIZED BY THIS PERMIT D LV 1 ,� LOT I f l JJ BLOCK TRAC�'3 � LI S� TRUCT 0PLUMB ❑ MECH 0 ELECT "0 GRADING 0 r0 c� XI TYPE OF PERMIT 0 NEW 0 ALTER 0 ADDITION m APPLICANT 11n _.1� .1 _-�c co I_11LF7�1�- H'W'f� en ^ 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS 0,,en - nitsfizet,, nV PROJECTLOCATION ON SIZE �y ���Y// DESCRIPTION I PROPERTY I• IN SO FEETQ CITY/fit Ri1' c ZIP Igen PH S}aS 1 1 I I S/! J OWNER -, e7 M Naar; 2 I I ADDRESS 3 I I 0 CITY ➢P PH I I OIC 4 ! ARCHITECT (vim\,1 ENGINEER k „� S, LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS LlI ore ,wy% (1p_ NO STORIES NO DWELLING UNITS BEDROOMS CITY ff ZIP 9v1l�O PH`-t!7`Cs ROOF I FLOOR EXT WALL INT WALL ?• CONTRACTOR db LIC NO „b `V�^ ADDRESS CEILING I HEATING I FIREPLACE METAL MASONRY T CITY ZIP PH SEWER I MIN DEPTH S/F/100 I SIZE y/' CITY BUSINESS LICENSE LICENSE NO CITY BUSINESS EXPIRATION DATF LICENSED CONTRACTORS 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/e�B_uuneas end Professions Code,and my license/ is in full force and effect L License Class IJ I License Number 1l-f�.'7S (- fs/n ' Date Contractor 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 ll aowner of the property,am exclusively contracting with licensed contractors to construct the protect ZONING ' LAND USE O I am exempt under Sec BAPC for this reason I Date INITIAL SETBACKS I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY I SY I I hereby affirm that I have•certdioate of consent to self insure,or a certificate of Workers' Compensation 'RInsurance e.,or a caddied copy thereof �-F� •TJ ��f�y� �l-T / RY SSV I COMPANY L'` �'t'�LE" POLICY NO':is 3113 •acor-tl 1 /'�I GROUP DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES O Certified copy is filed with the city CITY VERIFIED VALUATION 37i / / w �- Date 0-9— � 5 r APPLICANT ---• pI WYw`-'. At IPERMITIY/// FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE }� I certify that in performance of the work for which this permit re issued,I shall not employ any ELECTRICAL I STRUCTURAL ` �� ni person in any manner so as to become aublect to the Workers Compensation Law of California 7... s 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 4R, �[y with such provisions or this permit shall be deemed revoked MECHANICAL ISSUANCE FEES 7 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 1�. ^ ��r ISSUANCE APPROVED TOTAL PERMIT EE %A .- hitti>f���In.-.A (CI l / p 40 Signetur ApplicanA Ag�l Date t DAT F I SUAf9� I PERMIT yUjAlE�D Print Ap cant s/Agent s Name • FINANCE CODE /l LI Operator: VIRGINIA Check t: 000000000 Date: 2/09/95 00 Receipt t: 0000344 WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK-OWNER CHECK $104.60 GOLD-ASSESSOR/MANILA - INSPECTOR Amount Tendered $104,60 "'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) LENDER'S NAME LENDER'S ADDRESS 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 ONEOF-THE CERTIFICATES BELOW T ' i (3t : r o 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 "JJ . I 1 11 CI 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 4-. - - y DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER '' � r 1 ' I,. VI ` afr 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 _. r 1 ' 71:''.I ' A i--. ,H .'Iiv it 'I - i ` ' I, • .1 (.Jv7 1 •til ( 1 .y - ' •,'— I ) -- \ L • 1 _ f a t �-1 r'' 1%,N a t:,, I Iv Pe,vapa-'A"x r Ya.yt. • . 4 � r . 3 V'c,e iF.tt .- i••41'... 1.,••-..Anni. pan X ^a' ..a a. . . = eVs • - ^,+1Wu4 o.H. ,Ne-- v ^R" ^" "' ' +-% arr',s' i.- a1.�. 4k, ' - - i • p Y - •K CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND .ts COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY �-'r 2001 Grand Avenue Tin ti»T...i... Chino Hills, CA 91709 BUILDING r. PROPOSED USE 03 ADDRESS 4C.(;)) ,j• t- "C. )t 1. [ 1 I F APN 1 ., THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT > LOT it� BLOCK TRACT!'' ; 0 STRUCT 0 PLUMB 0 MECH 0 ELECT 0 GRADING tzi i 1• l• l y TYPE OF PERMIT 0 NEW 0 ALTER 0 ADDITION fn APPLICANT 0 I,t" a • "` W 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS rr ( \2 ii i>Sy t 1 '.. -• , I. PROJECT I LOCATION ON I SIZE DESCRIPTION PROPERTY IN SO FEET i{ C r CITY L F\b .. lA lith ZIP -E'I, t 1 PH S 1 r.,$ 1 1 I r I ��� OWNER 1i., i \\ 'L•+ 2 I I ADDRESSI I >,:e 3 4 CITY `. ZIP PH I I , / 4 ARCHITECT ENGINEER , c ,y,. , t LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS �(t �L ^p , • I NO STORIES NO DWELLING UNITS BEDROOMS CITY t IL +.L� ZIP • •(Lb, PH j`t ROOF I FLOOR N.,.. EXT WALL INT WALL _- - CONTRACTOR LIC NO • ADDRESS CEILING HEATING I FIREPLACE METAL MASONRY A CITY ZIP PH SEWER MIN DEPTH S/F/700 I SIZE of CITY BUSINESS LICENSE LICENSE NO EXPIRATION DATE LICENSED CONTRACTORS DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION I hereby affirm that I am licensed under provisions o1 Chapter 0(commencing with Section 7000 of Division 3 of the Business and Professions Code, and my license is in full force and effect 2. e Licena•Class t • 1 License Number G f•' •• it't , \ :e rli • t Date Contractor v ADDRESS ...–..-- CITY AND ZIP PHONE - OWNER-BUILDING DECLARATION I hereby affirm that I am exempt from the Contractor•License Law for the following reason ❑ I,as owner of the property,or my employees with wages as their sole compensation,will do Or the work,and the structure is not intended or offered for sale I as owner of the property •m exclusively contracting with licensed contractors to construct • the projectZONING I LAND USE ❑ I am exempt under Sec BBPC for this reason Date INITIAI SETBACKS I MODEL/PLAN WI hereby affirm that I haOa certificate of consent to DECLARATIONself e •certificate of Workers FY I SY I Compensation Insurance,or a certified copy thereof RY I SSY lit• a fl 'VI'xt YL} POLICY NO } iv GROUP DIVISION TYPE ❑ Certified copy is hereby furnished DATE EXPIRES / ❑ Certified copy is filed with the city CITY VERIFIED VALUATION 7., ` ` ', �.. Date /–'4'•'' + APPLICANT ` -- ' . ` P`ERMM•IT FEES CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE I certify that in performance of the work for which this permit is issued, shall not employ any ELECTRICAL I STRUCTURAL fP� person in any manner so as to become aublect lathe Worker Compensation Law of Calilcrma Date APPLICANT PLUMBING I GRADING NOTICE TO APPLICANT If,after making this Certificate of Exemption,you should become subject to the Worker, compensation provisions of the Labor Code,you must forthwith comply – .–.e ^.ti with such provisions or this permit shall be deemed revoked MECHANICAL ISSUANCE FEES t;/ 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 /+w, ISSUANCE APPROVED TOTAL PERMIT FEE Siyneture',ol Applicant or Agent Dat• — 1SaL DATE OF ISSUANCE PERMIT NUMBER Ips/ :it'eNa '0 ( I .� I 1/75 � � , VI) Print Applicant•/Agent•Nem• FINANCE CODE 1.- I • WHITE- FILE/GREEN- FINANCE/ YELLOW- OFFICE/PINK- OWNER • GOLD-ASSESSOR/MANILA - INSPECTOR N, • CONSTRUCTION LENDING AGENCO 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 NAMF LENDER'S ADOREcc 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 • 0 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,FALSE WORK,OR DEMOLITION OR DISMANTLING THEREOF,WILL BE MORE THAN 38 FEET HIGH O 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 OIS OIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY BUILDING INSPECTIONS RECORD DATE I INSPECTOR DATE INSPECTOR Setback/Location c,CX 7 Rough Plumbing Temporary Power 2/I 7 `z/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 Beam Final Construction 6j/,"CS- Final Bond Beam L/ZV/9r _d, � 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 WIDE LONG X DEPTH OF ROCK 1p N W E Inspector's Signature and Initials /747 DATE OF ISSUANCE PERMIT NUMBER