Loading...
Permit No. 4328 • . I CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY 2001 Grand Avenue ® Chino// Hills, CA 91709 ADDRESS /9 v/5719 Dec so L PROPOSED USE W �y COo APN I Dia-J bI'aI ,�E1' WA LL- LLTHHE/E FALL OWING WORK IS AUTHORIZED BY THIS PERMIT y LOT 8'/ BLOCK TRAC�35D6_�— ti'STRUCT 0 PLUMB ❑ MECH ❑ ELECT ❑ GRADING 0 o CJ 0 XI TYPE OF PERMIT CALPOr 0 ALTERU)O ADDITION IT n � APPLICANT Kock /moo -C Co ❑ REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS -3 3 M y )/ Cot at PROJECTLOCATION ON SIZE DESCRIPTION I PROPERTY I IN SO FEET DITY/ , /.,vfr /i,llc ZIP 9 61r 3 P" 573--Ag/ 0'p 3�Dd/ , (A,/,�11 I I 6/S-1 c OWNERR EIZoGiU [-10 'AA f 2 3 ADDRESS caMg At A&'lte_ a I I `v Ij.) CITY ZIP PH 4 I I ARCHITECT ENGINEER kbaafefilQ„ /Vt fc 5 LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION (((�-- ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS CITY ZIP PH31 ROOF I FLOOR I EXT WALL I INT WALL CONTRACTOR lJ'O LR-0 k �OwicI LIC NO CA I CEILING HEATING FIREPLACE ADDRESS A- )S IAyv i5 N�UVb' METAL MASONRY CITY MP PH LICENSE NO / EXPIRATIONITY BUSINESS DATELICENSECcJ, p SEWER I MIN DEPTH I S/F/100 I SIZE J /A LICENSEDineeunderd CONTRACTOR f ChCLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION I Mrebyonhrmt thtIam lessfproons provisionsof ter I3 my yl (eomman(commencingwith forceSecneffect 7000 of Division 3 of the Business and Professions Code,antl�m/y�b/canape p m full and etled ��,y� License Class 6- 1 License Number -�760/d R-bt W/'LL. /J5I Date Contractor 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 o I as owner of the properly,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 excluswaly contracting with licensed contractors to construct the project ZONING I LAND USE ❑ I am exempt under Seo B&PC for this reason I Oaf INITIAL SETBACKS I MODEL/PLAN WORKERS'COMPENSATION DECLARATION FY I SY I I hereby affirm that I have•certificate of consent to self insure ore certificate of Workers Compensation Insurance,� ra��- Corr�e certified copy thereof -TT'y�+y o��,.qRY SSY COMPANY rya)4U Z,t✓`- ) POLICY NO/I-r-tlzJes wT y7-7-y GROUP DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES VALUATION �/, c----- El Certified copy is filed with the city CITY VERIFIEDp� 73 0 Data 3'7-3-9 r APPLICANT }F.-- 11fu//f // I— AA /f PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS CNAPENSATION INS& ANCE I certify that in performance of the work for which this permit is issued,I shall not employ any ELECTRICAL I STRUCTURAL / is go person in any manner sou to become subject to the Workers'Compensation Law of California 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 FEES •�(J�/ �• 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 f. '//'�J'(�(/L\ 3 ISSUANCE APP ED I TOTAL� PERMIT FEE Signature of AOit ant or A(41t 0 Dat l�� _y 14. Ls (I: 166ACLY ( S /�/(•'f•DATE. sC)OF I fg I PER[A NUMBER CR Print Applicant s//Agent s Name /l IL•Jr' FINANCE CODE CV Operator: LAWN deck II: 000000000 WHITE- FILE/GREEN- FINANCE/ YELLOW- OFFICE/PINK- OWNER Date: 3!29!9 00 BecEiP1 C. 0001007 GOLD-ASSESSOR/MANILA - INSPECTOR pap{ 0147.80 gaunt Tendered (147.86 •CONSTRUCTION LENDING AGEN• ion 1 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 r tr THE CALIFORNIA HEALTH AND SAFETY CODE 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 A PERSON ISREQUIRED 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 015 ❑ISNOT ,SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY I, \ • • - • h - • r r�>a�, v r ,.n•.o r e • n -r. .. .t'. .- .y;a•;r'._yan.. - - t - .i A _•..a''• CITY OF CHINoO�S APPLICATION FOR A BUILDING PERMIT AND y.rt ' COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY • 2001 Grand Avenue Chino Hills, CA 91709 BUILDING /Q^.A Z .Jt.{� (( � PROPOSED USE- co ADDRESS ` /J✓ rV'i s I' /V- t lw r—fc b r- d ' O AP I o 32- 56/ -2 toTHE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT LOT BLOCK TRACT0-STRUCT 0 PLUMB ❑ MECH ❑ ELECT ❑ GRADING 17 <I v " 1.' 31 TYPE OF PERMIT I„NEW 0 ALTER 0 ADDITION T APPLICANT In i1' 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT (n ADDRESS 2 t , A r' /• PROJECT LOCATION ON SIZE DESCRIPTION PROPERTY IN SO FEET CITY, ,,, ZIP • • PH , { 1 ++V--` J A r /'� (0,"-)- Qit) �i OWNER t 1' I I .� 2 ADDRESS yl, - 3 I I II,/� /p' CITY ZIP PH 4 r• ARCHITECT gi;-, `• _. ENGINEER i • LIC ND REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION t ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS t CITY ZIP PH CONTRACTOR LIC NO ROOF I FLOOR EXT WALL INT WALL ADDRESS CEILING HEATING I FIREPLACE ,• METAL MASONRY Sr-+� ZIP CITY CITY BUSINESS LICENSE- - I PH SEWER MIN DEPTH S/F/100 SIZE 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,and my license is in full force and effect License Class r License Number 1 ) I., Date Contractor ADDRESS CITY AND ZIP PHONE 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 employes with wages as their sole compensation,will do the work end the structure is not intended or offered for sale O I as owner of the property am exclusrvety contracting with licensed contractors to construct ZONING I •-LAND USE the protect O I am exempt under Sec BBPC for this reason Date INITIAI SETBACKS I MODEL/PLAN WORKERS COMPENSATION DECLARATION FY I SY I I hereby affirm that I have a certificate of consent to self insure,ora certificate of Workers' I I Compensation Insurance,or a certified copy thereof RY SSY COMPANY / i POLICY NO y: S • r • / GROUP DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES VALUATION - ......-- CI Certified copy is bled with the city CITY VERIFIED / I Date x 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 ) 0ELECTRICAL STRUCTURAL person in any manner so as to become subject to the Workers'Compensation Law of California '� i Deb 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 e. �/ 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 1,_ r - r Signature of Applicant or Agent ' Date f^ /47. •,�� _1- DATE.-OF ISSUANCE I PERMIT NUMBER / - -'e f// Print Applicant s/Agent's Name - •/)/7/1 q F_)Q FINANCE CODE CV Li 0 -CV WHITE- FILE/GREEN- FINANCE/ YELLOW- OFFICE/PINK- OWNER GOLD-ASSESSOR/MANILA - INSPECTOR •ONSTRUCTION LENDING AGENT 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 NAMF LENDER'S ADDRGcc 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 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 I DATE INSPECTOR Setback/Location I I Rough Plumbing Temporary Power Shower Pan Test Foundation Reinforcing Steel / Stucco Mesh or Exterior Siding Excavation and Forms 6/7/71 `y/d Insulation Slab Grade Sewer Ground Plumbing Soil Interceptor Ground Plumbing Water Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit I 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 i Final Construction Cy7,9/%' ----- Final Bond Beam 7,9/ff— g % Final On Site Improvements Fireplace Bond Beam _ Final Of/ 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