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Permit No. 4327 - :^•N CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND -;e„ A CERTIFICATE OF USE & OCCUPANCY .-.,?- COMMUNITY DEVELOPMENT 2001 Grand Avenue -.. ` Chino Hills, CA 91709 ADILDINGDRESS n `' VI I S PROPOSEDUSE � CO ADDRESS !J(0 l �111A D `)O� v APN I 033' SG I nTHE FOJJ OWING WORK IS AUTHORIZED BY THIS PERMIT y LOT Q( . BLOCK TRACT/312/_< UOT 0 PLUMB , 0 MECH 0 ELECT 0 GRADING 00 73 I TYPE OF PERMIT /NEW 0 ALTER 0 ADDITION IT APPLICANT .t o , alma o NiL L-4 YYLt00AMlkk.+ 0 REPAIR 0 CONVERT ID DEMO 0 OCCUPANCY PMT ADDRESS g331)_ M I'' Cited( aR PROJECTLOCATION ON SIZE DESCRIPTION I PROPERTY I IN SO FEET 9J CITYLKIA• ., illl'S BP 5),5 S-3 PH 73-J061 1 " - \ I Ic98' / o u OWNER -QR//-"0 Ly LTV 2 I I s 1 ADDRESS !lSL W AS Kbit),' I I S 'V(-yl CITY ZIP PH I 4 ARCHITECT ENGINEER ^'dqJ1-1.4q„,_ yvi,r5k5 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 '\/1K._, IUU I- fl'^S c . ' LIC NO ///��� AS pb CEILING HEATING FIREPLACE ADDRESS SI1Mt R S A I METAL MASONRY CITY ZIP PH SEWER MIN DEPTH S/F/100I SIZE 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 of Chapter 9(commencing with Section 7000 of Division 3 of the Business and Professions Code,andel myli'ceensse is in full force and effect ' ,•R// .9p/� License Class rJq- I License Number SI/ a kI- ' W/ _ j / Date r'ontractor ADDRESS CITY AND ZIP 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 sole compensation will do the work,and the structure is not intended or offered for sale ❑ I as owner of the property,am exclusively contracting with licensed contractors to construct the protect ZONING I LAND USE ❑ I am exempt under Sec BAPC tor this reason I Date INITIAL SETBACKS I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY I SY I hereby affirm that I have•certificate of consent to self insure,ore certificate of Workers' Compensation JIns�uraance or a certified copy thereof /7)MAW �., // RY SSV COMPANY 11t/ b- S POLICY NO y ✓JJ A �TI1 rI GROUP DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES VALUATION J 337--o Certified copy is filed with the city CITY VERIFIED Dale APPLICANT PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE I certify that in performance of the work(or which this permit is issued,I shall not employ any ELECTRICAL I STRUCTURAL Coo person in any manner so as to become subject to the Workers'Compensation Law of California 1.1 3— Data -�3�'� APPLICANT ----, /F- U 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( jam/ 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 APP V TOTAL PERMIT FEE L ilie-A/1-.-,/ 3-23 —/-r' i oii '°° ,�Signature oOpplicant;rit ` Date . -71---"X" .Name L� DATE OF IS$U ( PERMITUMBER 966/44 Print Applicant's/Agentts Name 3 /a? 93a FINANCE CODE C_ILI Operator: WAIN Check #: 000000000 WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK- OWNER Date: 3/29/95 00 Receipt 1: 0001008 CHECK $104.60 GOLD•ASSESSOR/MANILA - INSPECTOR Rmount Terclered $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 ADDRFcc 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 0 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 019 015 NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY • • • a . 9.01i11 FS•o+ {r,r+c _ ...n+:, a•II*or" M,.e^,. - .. •,. r'� , f A .i .{,. rxM to • w ''ty -Iry r-' '10-•jd.ea .4., '.-r-.7.a,.9FA"4.r:trmt'a .v a. - .r u.- , 'I..>•0 CITY OF CHINO BILLS APPLICATION FOR A BUILDING PERMIT AND 1 A CERTIFICATE OF USE & OCCUPANCY .- COMMUNITY DEVELOPMENT Y'el -~ 2001 Grand Avenue • - ate'KINIENIChino Hills, CA 91709 BUILDING ADDRESS 201t5bNaA A tt, St _ PROPOSED c C APN t ' TC i , Ia 4 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT y LOT r BLOCK TRACT/ ' ❑ STRUCT 0 PLUMB ❑ MECH 0 ELECT 0 GRADING O .r 33 TYPE OF PERMIT O'NEW 0 ALTER 0 ADDITION m APPLICANTV)I II In 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS ,I I , PROJECT LOCATION ON SIZE DESCRIPTION PROPERTY IN SO FEET CITY i e ZIP PH \ L"11 � k I IGJjf OWNER I I S. f 2 ADDRESS * 3 I I Y CITY ZIP PH y I I ARCHITECT r ENGINEER a, �, , LIC NO REMARKS/SPECIAL CONDIT1ONS/PROJECT DESCRIPTION IC ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS73) CITY ZIP PH ROOF I FLOOR EXT WALL INT WALL CONTRACTOR ; LIC NO ' CEILING HEATING I FIREPLACE t.~ ADDRESS METAL MASONRY t`\ V0 CITY ZIP PH LICENSE NO EXPIRATION DATELICENSE SEWER MIN DEPTH S/F/100 I SIZE CLICENSED 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 the Business and Prolusions Code,and my license is in lull force and effect r r ry License Class Lrcens•Number 'Jr ' , I / , , t 1 f ' Date if ontractor ADDRESS CITY AND ZIP PHONE OWNER BUILDING DECLARATION 1 hereby affirm that I am exempt horn the Contractor I License Law for the following reason O I as owner of the property,or my employees with wages as their sole compsnaabon,will do the work,and the structure is not intended or offered for sale ❑ I as owner of the property,am exclusively contracting with licensed contractors to construct the project ZONING I LAND USE O I am exempt under Sec B&PC for this reason I Date INITIAI 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' I I Compensation Insurance or a certified copy thereof RY SSY COMPANY r POLICY NO 7. GROUP DIVISION TYPE ❑ Certified copy is hereby furnished DATE EXPIRES VALUATION 1 .,,....,"- O Certified copy is filed with the city CITY VERIFIED I 1 I. Date APPLICANT PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE I certify that in performance of the work for which this permit ra issued,I shall not employ any ELECTRICAL I STRUCTURAL s(",0 person in any manner so a to become subject to the Workers Compensation Law of California (L ri Date APPLICANT PLUMBING I GRADING I NOTICE TO APPLICANT If, after making this Cart,icat•of Exemption,you should become subject to the WorkCompensation provisions of the LADD,Code,you Muff forthwi h comply � ,..� with such provisionss o or ihu shall permit be deemed revoked MECHANICAL ISSUANCE FEES 'N,I. 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 10I - —"- DATE OF ISSUANCETom./ PERMIT NUMBER 1-7 Print Applicant s/Agents Nam* rr//tt �������,,,(((,,,,,,///��� "AArJvL�JL FINANCE CODE 6 Li WHITE- FILE/GREEN- FINANCE/ YELLOW- OFFICE/PINK- OWNER GOLD-ASSESSOR/MANILA - INSPECTOR SONSTRUCTION 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 ADDRFcc DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETYCODE 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 APERSON 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 36 FEET HIGH 0 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 BUILDING INSPECTIONS RECORD DATE INSPECTOR I DATE I INSPECTOR Setback/Location Rough Plumbing Temporary Power / Shower Pan Test Foundation Reinforcing Steel 6 V15", j/ 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 7/�/yam a 7' Final Bond Beam 74'a/9J / , 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