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Permit No. 4326 0 0 .« CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND -I) '-` COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY f � 2001 Grand Avenue alaiigiggia Chico Hills, CA 91709 BUILDING "40,(/^ // / �p Tv / I PROPOSED USE- 03 ADDRESS 31r, 17/Pt' II�.I� SO(� �n} MILL F APN / .) I0�,y �) THE`FQI LLOWII'NIG WORK IS AUTHORIZED BY THIS PERMIT a LOT /_0 BLOCK TRACT nl•^y 3- �J�W UCT 0 PLUMB` ❑ MECH ❑ ELECT ❑ GRADING 0 L[/V 1 /J (VO TYPE OF PERMIT cJJIEw 0 ALTER 0 ADDITION m APPLICANT 't),J) t' c {Eos-e-r CO , I/�LN Yl, ) 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS 0U3 Af'Y, I I a t AR /IA k.. '7L U PROJECT DESCCRTION I I LOCATION PROPERTY OH I ZE NI(SO FEET CITY I/1'1M;y'tA)IS -11-ZIP a� s--3 PH 503 106/ 1 (AlA 'L I I I s !(l , (� OWNER B 061( 1+001E..1 J I I 2 ADDRESS ./eVIA Al Q,6bVt3 I I CITY DP PH I I ARCHITECT ENGINEER ff4vt MEtk5 LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS CITY ZIP PH ROOF I FLOOR I EXT WALL I INT WALLE CONTRACTOR s3 R D a_ I7 i e LIC NO ADDRESS f - Ac Ala MVI' CEILING HEATING I FIR METALEPLACE MASONRY CITY JJZIP PH SEWER MIN DEPTH S/F/I00I SIZE CITY BUSINESS LICENSE LICENSE NO EXPIRATION DATF 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 the Business and Professions Code,andel my//lice/nse is in lull force and effect �r License Class 13'I License Number `/`7b'7 ii g I- t4L 390 D 1 Dale Contractor ADDRESS CITY AND ZIP PHONE OWNER BUILDING DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for IM 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 property am exclusively contracting with licensed contractors to construct the protect ZONING LAND USE O I em exempt under Sec BSPC for this reason I Date INITIA' SETBACKS I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY I SY I hereby affirm that I have a certilicate of consent to self insure,or a certificate of Workers Compensation Insurance, ��or,,aa//Jcertified copy thereof 'Jt p�Ja }yJ RY SSY COMPANY U4l tb%"7 POLICY NO/ )//12'6 -2 -17�V GROUP DIVISION TYPE O Certified copy is hereby lurnished DATE EXPIRES VALUATION ( 10 O Certified ed copy filed with the city CITY VERIFIED y0 G Date .73-sr- APPLICANT 3,--. A`t/1/K vy 4n I I PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE I certify that in performance of the work for which this perm]a issued,I shall not employ any ELECTRICAL I STRUCTURALg I/O person in any manner so as to become subject to the Workers Compensation Law of California 7 Date APPLICANT PLUMBING I GRADING NOTICE TO APPLICANT If after making this Certificate of Exemption,you should become sublact to Lha Workers Compensation provisions of the Labor Coda,you must forthwith comply �/-•� --dwith such provisions or this permit shall be deemed revoked MECHANICAL 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 3 a3 sr , e--- 1/5- yv Signature ol/Mpplicant o�BaJ Dale VDATE OF ISSr ANCE PERMIT NUMBER i~ /3A(3011.1.--V 3 ALL, 1 Print Applicants/Agents Name r 3/a9/t . 'ab FINANCE CODE I C , L/ Operator: DAWN Check t: 000000000 WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK- OWNER Date: 3/29/95 00 Receipt is $ ICY, 3115.4115.40 0 GOLD-ASSESSOR/MANILA - INSPECTOR Amount Tendered $115.40 - "'CONSTRUCTION LENDING AGEN• 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 ADDRFce 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 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 DIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY • • , 'N i - '- `il'''"• ' at' • . .w`Y;,n.• f:ti,n.l".- v-,..q..e,.r,---+"bl tn>arto.4 ++1,0AV -slIGJ1/4,04,Me'Y[s.N.,r-.Apar,- %,, t ='�•N CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND 4 A CERTIFICATE OF USE & OCCUPANCY r--..-- � COMMUNITY DEVELOPMENT " 2001 Grand Avenue Chino Hills, CA 91709 BUILDING ADDRESS2I3o ....VI,SUf '-- ``' t /v PROPOSED USE CD Ml C APN -�,_'t ` { I E THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Dy D LOT BLOCK TRACT ELSIRUCT ❑ PLUMB 0 MECH 0 ELECT 0 GRADING v TYPE OF PERMIT kg,..K4 ALTER 0 ADDITION n APPLICANT Cr q 1 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS ) I ( i . I PROJECT I LOCATION ON I SIZE DESCRIPTION PROPERTY IN SO FEET CITY • ZIP / PH 4 1 V j I I hrO I OWNER ( 2 I I ADDRESS + 3 CITY ZIP PH C 4 ARCHITECT ENGINEER !\J , , , t, LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS 4 CITY ZIP PH a ROOF I FLOOR I EXT WALL I INT WALL .- CONTRACTOR LIC NO ADDRESS , CEILING HEATING I FIREPLACE t , METAL MASONRY 1, CITY ZIP PH SEWER I MIN DEPTH I S/F/100 - I SIZE •—� CITY BUSINESS LICENSE ' LICENSE NO 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 the Business and Professions Code,and my license is In full force and effect License Class " License Number L', 1 h . Date Contractor ADDRESq CITY AND DP PHONE OWNER BUILDING DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason • I as owner of the property,or my employees with wages as their sob compensation,will do the work and the structure is not intended or offered for sale O I as owner of the property am exclusively contracting with licensed contractors to construct ZONING I LAND USE the project O I am exempt under Seo B&PC for this reason I Datr INITIAI SETBACKS I MODEL/P LAN WORKERS'COMPENSATION DECLARATION FY I SY I I hereby affirm that I have a certificate of consent to self insure,or a certificate of Workers I Compensation Insurance,or a certified copy thereof RY SSYI COMPANY POLICY NO/ ' a GROUP DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES rtifies copyVALUATION O Coddled is filed with the city CITY VERIFIED 11, I • Date )' 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 S % person in any manner so as to become subject to the Workers Compensation Law of California yo T Gate 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 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 - P, Signature of Applicant or Agent Date R.--_/ .r !!5. `IL DATE OF ISSUANCE PERMIT NUMBER / ' Pont Applicant s/Agent s Name b y '/ / j' ~CJ4J 1 FINANCE CODE f • to , 01 WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK-OWNER GOLD-ASSESSOR/MANILA - INSPECTOR •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 LENDERS ADDRFcc DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETYCODE 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 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 PIS Pis 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 I Rough Plumbing Temporary Power - Shower Pan Test Foundation Reinforcing Steel G/>/ ._.5-- /,V Stucco Mesh or Exterior Siding Excavation and Forms r v 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 9/1/.f dir------ Final Bond Beam 741;/sr 4,r'�i7' 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 N W E S Inspector's Signature and Initials DATE OF ISSUANCE PERMIT NUMBER