Loading...
Permit No. 4329 0 0 ':•« CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY . I. .� 2001 Grand Avenue Chino Hills, CA 91709 BUILDING PROPOSED USE- to ADDRESS / 5 Visa+ DEL 5oL r RE-r- Mkl,L a APN -±-- a I 7; D THE F9LLOWING WORK IS AUTHORIZED BY THIS PERMIT y LOT ¶3 BLOCK TRAC%3�D6-SJ tlhSTAUCT 0 PLUMB 0 MECH 0 ELECT 0 GRADING o �� � O ' 1 TYPE OF PERMIT N_1.1tEW 0 ALTER 0 ADDITION TI APPLICANT B n o i( 4- ,c n K L-A IYY fit` I '\ 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT ADDRESS , 33r /7? i y// &eat Qtt 3y1? lit) PROJECT LOCATION ON SIZE / I ..,/ �-p DESCRIPTION I I PROPERTY I/IINN SOFEET CITYLi5(h'LC/{/!/f ZIP C/M r3 PH ' 3d/Obi 1 LJ A Y I I W J / •�� viV n . OWNER a IWii; 14-0/4 Er 'p 2 i I I ADDRESS 514"g: Fl) i]bwV` 3 I I ( N CITY ZIP PH v 1 4I I ARCHENGINEER KA / moa, ingetS LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION \� ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS CITY ZIP PH al ROOF I FLOOR I EXT WALL I INT WALL CONTRACTOR ✓✓t�v ac 14.0„,,x5 LIC NO ADDRESS 5 Aft E A( IGbk CEILING HEATING I FIREPLACE METAL MASONRY CITY ZIP PH LICENSE NO ECITY BUSINESS XPIRATION SS LICENSE SEWER MIN DEPTH S/F/100 I SIZE ` ^ O 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 Bushes and Professions Code,and my lisenxe Min full force and effect License Class S' i License Number 52/1044' Ker' !AA_ 673 ' Dale Contractor ADDRESS CITY AND ZIP PHONF 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 property or my employees with wages as their vole 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 LANG USE the prol.M O I am exempt under Sec B&PC for this reason I Data INITIAL SETBACKS I MODEUP LAN WORKERS COMPENSATION DECLARATION FY I SY I hereby affirm that I have a certificate of consent to self insure,ora certificate of Workers Compensation Insurance,or a certified copy thereof .�-y��-}-�/T1,,,�h �/ RY SSY COMPANY rPrrs'Ct.ac & POLICY NO/ ing..Pt297 ,/7J/ GROUP DIVISION TYPE 0 Certified copy is hereby furnished DATE EXPIRES O Certified copy is bled with the city CITY VERIFIED VALUATION 8/3 /_ Date 1/ /91 -APPLICANT 9 44-,r,/,Il / DA 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 / 1 /ylo person in any manner so as to become abject to the Workers'Compensation Law of California (1/ Data APPLICANT PLUMBING I GRADING NOTICE TO APPLICANT II,aper making this Certificate of Exemption,you should become subject to the Workers Compensation provisions of the Labor Code,you must forthwith comply A �t with such provisions or this permit shall be deemed revoked MECHANICAL ISSUANCE FEES ..:��k�/� 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 0- /36,0-,/ 3-.23-9J— 10-C - 158. 6° Signature e//Applicant 44 .6 Date ( M �46�Akt`V, DATE OF I)al I PER IT Print Applicant s/s/Agent a Name 3 9 FINANCE CODE eq Operator: DAWN Check 9t 000000000 WHITE- FILE/GREEN- FINANCE/ YELLOW- OFFICE/PINK• OWNER Cake: 3/29/35 00 FeceLpt A:Crag $151000 GOLD-ASSESSOR/MANILA - INSPECTOR Amount Tendered $158.60 ',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 NAMr LENDER'S ADDRGec DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRESA DIVISION OF INDUSTRIAL SAFETY PERMIT ASA PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW D 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 D 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 PERMfT NUMBER I I f 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 • ` J ol,.LrJeil'.' t) .Ir_r_ .J'7 1 c. _.. . Ifv • . •'. 4.121 . . un c.w_ v •4- -,' , I a • r • ._ _ r -M1r.,. . .• I r.\ r3'3•2"-- CITY OF CHINO HILLS APPLICATION FOR A BUILDING PERMIT AND 't"� COMMUNITY DEVELOPMENT A CERTIFICATE OF USE & OCCUPANCY 2001 Grand Avenue ...- .6. Chino Hills, CA 91709 / m ADDRESS I ry'��.Ty f n,3 L ,'V1 I t ek sob PROPOSED USE q APNIA 3 ^ ii I -? 0 THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT D' D LOT 'j- BLOCK TRACT O.STRUCT 0 PLUMB 0 MECH 0 ELECT 0 GRADING 0 y TYPE OF PERMIT IO„ W NE0 ALTER 0 ADDITION y APPLICANT1. 4 I co 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PUT • ADDRESS yI, /j ( • I ,. , , I PROJECT I LOCATION ON I SIZE DESCRIPTION PROPERTY `/IN SO FEET CITY ZIP PH 4 1 ttj t I 1 I 16713 / �•�. OWNER ( 2 ADDRESS .1 r- 1 y I 3 rsr I CITY ZIP PH 4II ARCHITECT -- ENGINEER , , I , , LIC NO REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION , -.. ADDRESS NO STORIES NO DWELLING UNITS BEDROOMS CITY ZIP PH P CONTRACTOR I] LIC NO ROOF I FLOOR EXT WALL INT WALL ,1/4._,J ADDRESS CEILING HEATING I FIREPLACE METAL MASONRY CITY ZIP PH SEWER MIN DEPTH S/F/100I SIZE CITY BUSINESS LICENSE LICENSE NO EXPIRATION DATE C) LICENSED CONTRACTOR'S DECLARATION CUBIC YARDS EXCAVATION FILL OVER EXCAVATION I hereby affirm that I am licensed under provisions of Chapter S(commencing with Section 7000 of Division 3 al the Business and Professions Code,and my license Is In full Imes and effect 11 License Class f License Number '/ P. / / I 1 i , Date fontracto' 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 property,or my employees with wages as their sole compensation will do the work and the structure is not intended or oflered for sale 0 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 'HIRAI 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 Insurance,or a certified copy thereof RY I SSV I COMPANY / • POLICY NO' GROUP DIVISION TYPE O Certified copy is hereby furnished DATE EXPIRES O Certified copy is filed with the city CITY VERIFIED VALUATION 3 , .—, Dal. 'r APPLICANT '""' trid — a + 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 it G �`/ )/ person in any manner so to become subject to the Workers'Compensation Law of California as Dan. APPLICANT ' PLUMBING I GRADING NOTICE TO APPLICANT If,alter making this Ceridmale of Exemption,you should become subject to the Workers Compensation provisions of the Labor Coda you must forthwith comply with such provisions or this permit shall be deemed revoked MECHANICAL ISSUANCE FEES. ./;:/-..., 1 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 APPROVED TOTAL PERMIT FEE r` ' ice 1CC (-- Signature _-Signeture of Applicant or Agent Date DATE OAF?ISSUANCE PERMIT NUMBER Print Applicants/Agents Name / � �rl �� rT�t_� FINANCE CODE C U 4 WHITE- FILE/GREEN- FINANCE/YELLOW- OFFICE/PINK- OWNER GOLD-ASSESSOR/MANILA - INSPECTOR aONSTRUCTION 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 NAMF LENDERS ADDRGcc DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRESA DIVISION OF INDUSTRIAL SAFETY PERMIT ASA PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW D 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 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 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 INSPECTOR Setback/Location Rough Plumbing Temporary Power a-- Shower Pan Test Foundation Reinforcing Steel of/}/f CI-----S Stucco Mesh or Exterior Siding Excavation and Forms lr 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/dV,–S— -4i,c---- Final Bond Beam 77/9//r� iy.7� Final On Site Improvements Fireplace Bond Beam Final Off Site Improvements Root 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