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Permit No. 1784 CITY OF CHINO HILLS -. -` COMMUNITY DEVELOPMENT 2001 Grand Avenue APPLICATION FOR A BUILDING PERMIT AND A CERTIFICATE OF USE&OCCUPANCY Chino Hills, CA 91709BUILDINGf / ADDRESS I 3 gi 0 v ic_ii4, 6,2 Ad� CLEARED BY APPLICATION TYPE NO. CO `U�' v ty C� „"I r . O_ APN Z �} I THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT D LOT l BLOCK a 6 f_7, TRACT ❑ STRUCT. 0PLUMB. 0 MECH. 0ELECT. 0 JJJ J IO /� ,� / TYPE OF PROJECT NEW- —❑ ALTER 0 ADDITION M !`tel [ 4 I/ CD m CD OWNER / 0REPAIR 0CONVERT 0DEMO 0OCCUPANCY PMT. ADDRESS �� /s { ^ ��� // __ /� PROJECT LOCATION ON I SIZE �f/ �/�Cl/ DESCRIPTION PROPERTY IN S0.FEET CITY r /I ZIP PH 613 -6399 3 9q 1. ,006.6) / I I ARCHITECT I I ENGINEER LIC.NO. 2. ADDRESS 3. I I CITY ZIP PH. /+ REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION 1 CONTRACTOR U / ,"7 , Ad a t.IC.NO O?// y • ADDRESS 4-,,/-v . I -7 C 6 . . . ------ ----7-----B, r// LA, - I ,!ITY Ill:/—I Lf I I.e.('I ZIP f 6 . P l) ./�J .I c/.0 , - 7 U / C CITY BUSINESS LICENSE _ LICENSE NO EXPIRATION DATF ' LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter.9(commencing with Section 7000 of Division 3 of the Businessusand Professions Code,and my ken,in full forcee/nd effect. License Class " ' CS ` .3 License Numbeer,J/ R/f +t y� Date_7 -- "7 -7- / 5 Contractor 6 V � `O /�`)1$ ADDRESS 'rZ V I [ L() _ CITY AND ZIP_ (s `2I ONE_Or.?.) J - 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. O I,as owner of the property,am exclusively contracting with licensed contractors to construct the project. ❑ I am exempt under Sec. UPC for this reason ' Date INITIAL WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure,or a certificate of Workers'Compensation Insurance,or a certifed copy thereof. - COMPANY 4-114/2/CL POLICY NO • • _ GROUP DIVISION TYPE. ❑ Certified copy is hereby furnished DATE EXPIRES ICartified copy is filed with the.city C" E13�% f�/ s//I-��,Jn VALUATION aQGy Date 2�' APPLIC NT:1 "- lll PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE - I certify that in the performance of the work for which this permit is issued,I shall not employ any person in ELECTRICAL: STRUCTURAL: any manner so as to become subject to the Workers'Compensation Laws 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: 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 HEREBY GEO REVIEW. I PLAN CHECK: AUTHORIZE REPRESENTATIVES OF THIS CITY TO ENTER UPON THE ABOVE MENTIONED PROPER.•T'(FOR INSPECTION PURPOSES. ISSUANCE APPROVED: TOTAL PERMIT FEE: 1,, . :7-27-4q ' /7 7. `LU Signatur of Applicant or Agent Date llc DATE OF ISSUANCE: PERMIT NUMBER: Print Applinn ss dent's Name ( /Z 7 / .3 /75 1 )I'd:/ ) . Operator: VIRGINIA Check il: 000002213 Date: 7/27/93 00 Receipt I: 0000770 CHECK $477.40 WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR BUILDING ADDRESS LOT BLOCK TRACT BUILDING INSPECTIONS RECORD OWNER ADDRESS CITY ZIP PH. PLUMBING DATE APPROVED/INSPR'S SIGNATURE GROUND SOIL/WATER P1 TOP OUT P2 • SHOWER PAN P3 REMARKS SEWER 135 GAS TEST P6 • FINAL PLUMBING P12 MECHANICAL DATE APPROVED/INSPR'S SIGNATURE UNDERGROUND FLOOR M1 tio ROUGH M2 (� /f FAU/AC M4 x / L Ii'1> . • FINAL MECHANICAL M12 teNciA a757/Trig- - ELECTRICAL DATE APPROVED/INSPR'S Uv SIGNATURE r_/ J_ TEMP.CONSTN.POWER E3 SCG ID '4y "41-fa. �fisrwi - UNDERGROUND LI - / tete-A(:24-e/ /-oh6'il-1 c)/-0 PVC-METAL-D.B.C. El I - -�- ROUGH WIRING RECEPT.SPACING- SERVICE-CIRCUIT E2 FINAL ELECTRICAL E12 STRUCTURAL DATE APPROVED/INSPR'S SIGNATURE FOUNDATION:LOCATION S1 REINFORCED 0 UFER 0 SLAB REINFORCED D MEMBRANE S3 FLOOR FRAME/INSUL. S4 I I • MASONRY S11I I - FIREPLACE S11 I I ROOF FRAMING ROOF SHEATHING S5 FRAMING S6 INSULATION SOUND ENERGY S7 LATH EXTERIOR Se I LATH INTERIOR/GYPBOARD S9 • • APPROVED/INSPR'S SIGNATURE DATE OF ISSUANCE PERMIT NUMBER BUILDING FINAL S12 /1)/i 6/4q ��