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Permit No. 0412 213/C APPLICATION FOR A .DING PERMIT AND A CERTIFICATE OF USE & r—^•UPANCY 0 01/411 • CITY OF CHINO HILLS .. A- ; / 4 /IQ -015 BUILDING 1 :LFJWEO BY APPLICATION TYPE NO. C ADDRESS /3J// Ursa,'.9 nde Zr. s LOT 0-:,, BLOCK TRACT 13651-2 or > OWNER The Fieldstone Company I THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT: 0 ADDRESS 145 S. State College Blvd. , #660 I ❑Srmumm. O PLUMB. C MECH. 0 ELECTrn �t rn 'TY Brea ZIP 92621 PH, 990-3006 TYPE OF PROJECT It NEW G ALTER 0 ADDITION ARCHITECT/ LIC.NO 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT. ENGINEER Hales—Langston \\, ADDRESS 3111 N . Tustin Ave. , #230 PROJECT 1 LOCATION ON SIZE v_ DESCR�I rION PROPERTY INE FEET CITY Orange nP 92665 PH. 283-1770 /'a&-c 1 90 �. coli Accton Same 'as Owner UC Nu 402826 ' 1'—1 51-br-v I I 1 ,355 ADDRESS z od IJ° STaae V I I 1 ,240- 'I. CITY ZIP PH. F' I I 564 CITY BUSINESS LICENSE REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTIONLICENSE NkC EXPIRATION �11 N h 4- ( 4.).d'4Q n ti..,-1 •T CO LICENSED CONTRACTOR'S DECLARATION I h '• "•i m licensed under provisions o1 Chapter 9(commencing with Seaton 7000 of i • . . Division of. ell ,, -; , a Cod..and my Ikons.Is n lull tofu and ifl.c1. .,ti,ii. :'•i t i /'/Y/ i 4/�� i � , Uces.Cam Jcen l'^. Data Contractor See L c 9. a CITY AND AND IIP PHONE Pea,t CONSTRUCTION LENDING AGENCY 1V 4,,..4,-• I hereby affirm Ihaf there II a e+:, ...,.':.,,..;,. ,I for the performance of the work for Which /his permit Is Issued(Sec.1097,Civ.CI Lender's Nam. _ 5, Lender's Address OWNER-BUILDER DECLARATION I hereby.' '' r.1,',l •I from the Connectors License Law for the following reason: S-k S f" C• 0 I,as owner d the property,o "' .. with wages as their sole compensation,will do the ,. n , work,and the structure Is nog Intended or :' "4. le. . t-fii ///� 0 I,as owner of the property,am exclusively contracting wit. '. , ,•nlreclors to construct the �`� (�-`-'� iFr `Q/� W°fed• 0 I am exempt under Sec. .B&PC for this reason Dale' INITIAL WORKERS'COMPENSATION DECLARATION rr�� kt I hereby affirm that I have I certificate of consent to sell Insure,oDWPI0ete 216(]1 7 1 Compensation Insurance,or a certified copy(hereof.POLICY NO COMPANY Fireman's Fund DATE EXPIRES: 5/1/93 0 GAllied copy Is hereby furnished CITY VERIFIFn• vCorlIlled copy Is flied with the oily GROUP DIVISION TYPE Daly APPLICANT ' CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE VALUATION I cart' I•: ,' ; •n once of the work for which this permit Is Issued,I shall not employ any person In any mann. • ,.• Wed to the Workers'Compensation Laws of California. • Mar .:•• ft' r PERMIT FEES NOTICE TO APPLICANT.II.atter making this Canllicat.01 Exemption, •.1. . •: ems sublect ELECTRICAL: I STRUCRIRAL /S3 to the Workers'Compensation provisions of the Labor Code,you must lonhwd .IIh such provision or this permit shall be deemed revoked. PLUMBING: I GRADING: I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT.I AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS,AND MECHANICAL I ISSUANCE FEES: HEREBY AUTHORIZE REPRESENTATIVES OF THIS CITY 10 ENTER UPON THE ABOVE GEO REVIEW I PLAN CHECK: MENTIONED PROPERTY FOR INSPECTION PURPOSES. ISSUANCE APPROVED: TLRAL PEAI.RT FEE: Stpnature o1 Applicant or Agent Dale 4 /c..i� DATE C-F ISSUAN E: PERMIT NUMBER: Print Applicant's I Ager.�a Name /i61 7 0 Yl v . CITY OF, CtIINO '-TILLS • cry(.?P.., n �f/// /7��y ADDRESS I vIv/1 Vista , ' /de d'/ L ��' ' ` BLOCK TRACT /31p51- 2 BUILDING INSPECTIONS RECORD OWNER THE FIELDSTONE COMPANY POST IN CONSPICUOUS 145 5.b 1 Ait-COLLEGE-13LVD. PLACE ON THE JOB ADDRESS SUITE 660 �Q� SREA-CAU ORN 1 CITY ZIP PH.7/II.' cm 1),300to PLUMBING . DATE APPROVEDIINSPR'S - SIGNATURE GROUND SOIL P1 I c1 AC(/c1 4 €_- GROUNDWATER P2 I /OA I C-4 _C___ REMARKS TOP OUT P3 I �/ i'i /� I -�– K R SEWER "5 I AMI141/1 F:ell.. . W 4ltil Y I%l�.�)�- 44 7 -J� GAS TEST P8 I , - (f--(3 I `71� I �/�sFiw/mac: Ilal ze �, I 1 FINAL PLUMBING P12 MECHANICAL DATE APPROVEDIINSPR'S i SIGNATURE UNDERGROUNDIFLOOR M1 ROUGH M2 I Z-/7„/9,,5 I 7e • AIR COND. T`'1! I ' I I I FINAL MECHANICAL M12 I I ELECTRICAL DATE APPROVEDANSPR'S SIGNATURE TEMP.CONSTN.POWER E3 I I I I UNDERGROUND PVC•METAL-D.B.0 El ROUGH WIRING RECEPT.SPACING- . /7.Z/7 V /7 /7V I -l•e__- SERVICE-CIRCUIT E2 I FINAL ELECTRICAL E12 I I STRUCTURAL DATE APPRCNE URE SPR'S. SIGFOUNDATION:LOCATIONI • REINFORCED 0 UFER ❑ I T/zrz- �� - SLAB:REINF MEMBRANE 0 S3 I /0/4j�I 7 A p • UNDERPINNING 54 I . I 6:"1C7- /! /T' ie-Vt aX-E cz' 5-1./CA-"- 2 CA-"- ,3/93 MASONRY 511 I I 7-e..- FIREPLACE S11 I/O/li/9 I • •ROOF EfAMING �7 RpOF SHtATIING S5 I -7./3/1 3 �j I `47 6' FRAMING S6 I z///z/9 J I . INSULATION SiI !1 fi /l' J I G—t1 1L-- SOUND/ENERGY ' LATH EXTERIOR S8 •Z-/z�jy/T3 1"[a LATH INTERIORIGYPBOARD S9 T I I APPROVEDIINSPR'S SIGNATURE DATE OF ISSUANCE PERMIT.NUM R /[� BUILDING FINAL S12 I L// /2// j I .'�(, I 1/N 1 V 'Z i 1 CITY QLCHINO IT-'LLS . b� �i ADDRESS /5_?// yf sta. amd-& Pr. LOT 5 BLOCK TRACT I3 fp51 2 BUILDING INSPECTIONS RECORD CANNER TME FIELDSTONE COMPANY POST IN CONSPICUOUS 145 5.5IA1t E'BLVD• PLACE ON THE JOB ADDRESS SUITE 680 i CITY ZIP PH.7/171.-9q v- �.,, , PLUMBING DATE APPPROVED1INSSPPR'•S+ • • SIGNATURE GROUND 5011 P1 I /ZS,9,j,k "./-C... ' GROUND WATER P2 I rD./S I Q . I REMARKS TOP OUT P3 SEWER P5 I/o/Z.l_ I q- GAS TEST P6 I I I I FINAL PLUMBING P12 MECHANICAL DATE APPROVEDANSPR'S SIGNATURE UNDERGROUND/FLOOR Mt ROUGH 162 I I AIR COND. M/ I I I FINAL MECHANICAL 1.112 I I ELECTRICAL DATE APPROVEDANSPR'S SIGNATURE TEMP.CONSTN.POWER E3 I I UNDERGROUNDI I PVC•METAL-0.B.0 El ROUGH WIRING RECEPT.SPACING. I SERVICE-CIRCUIT E2 • I I FINAL ELECTRICAL E12 I I STRUCTURAL DATE APPROVEDANSPR'S. SIGNATURE NDATION:LSI REIN O UFER ❑ I 9/z A2— ,1/ , SLAB:REINF. 0 MEMBRANE 0 S3 I /10/6/ I 4:1 e • UNDERPINNING SI I I MASONRY S11 I I FIREPLACE Sil I/4//3// l.� 4:1 '� ROOF FRAMING I CCCC.////1IIII ROOF SHEATHING S5 FRAMING S6 + I INSULATION I i SOUND/ENERGY S) LATH EXTERIOR S6 I I LATH INTERIOR,GYPBOARD S9 I I 0 I I APPROVEDANSPR'S DATE OF ISSUANCE SIGNATUREPERMIT NUMBER BUILDING FINAL 512 I