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Permit No. 1803 • CITY OF CHINO HILLS COMMUNITY DEVELOPMENT 2001 Grand Avenue APPLICATION FOR A BUILDING PERMIT AND A CERTIFICATE OF USE&OCCUPANCY Chino Hills, CA 91709 BUILDING Cb,ADDRESS f e6 //, /J / v� A,�L CLEARED BY PPLICAT N TYPE NO./ef .co APN LO $ L 1Z THE/OLLOWING WORK IS AUTHORIZED BY THIS PERMIT LOT 5-- BLOCK TRACT (� L7�, STRUCT. ❑ PLUMB. ❑ MECH. ❑ ELECT. 0 i J3 TYPE OF PROJECT �]�(EW- 0 ALTER ❑ ADDITION - • / m OWNER Ad (gyp ,„4,,,,,, ❑ REPAIR ❑CONVERT ❑ DEMO ❑ OCCUPANCY PMT. ADDRESS / I PROJECT I LOCATION ON I SIZE ONSPROPERTY IN SO:FEET' CITY C(.411,... ) Hjug ZIP PH 61 -014 11•- .8Au_bdVY - -I !L At12_ I P-i-(/ ARCHENGINEER ERT "/V Y LIC.NO. 2. LA , I /2 f f n I / ! / ) ADDRESS / _ 3. '` - I �[y^ U i(� I Lf \\ CITY ZIP PH. REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION CONTRACTOR (l A kec jp '1 e„ LIC.NO. 5{ . (`7) ��� AIL 'a - :/l 1 ji/V �� J� /{(�j'� '1 'n\1 �1���yj/�"j �dis'-S <. v ADDRESS( 1 -\I D �'`� , Gal ii LL _J t.�/{+/ r CITY u1 �J>rI"D ZIP qJ 1 l , PH l0 1•')(IDcy CITY BUSINESS LICENSE LICENSE NO ' EXPIRATION DATE LICENSED CONTRACTORS DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000 of Division 3 of the B�usjneessAand Professions Code,and my license is in full force and effect. License Class r�yv'�/3 t License Number 1 62 42 i - _ Dat. 2 f✓^a� 53 Contractor �-1A,Ai�F F PA1)6)Fl t- ADDRESS 1I /) 10 ��/(J� . ,---)/D J -J)L— .3LVD- hL/ CITY AND ZIP J)PL ti`rr J c i'706 PHONE 70(1 °'�5` 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 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 certified copy thereof. COMPANY • POLICY NO. GROU .. OYP N r Ev�„� ❑ Certified copy is hereby furnished DATE EXPIRES /(J ❑ Certified copy is filed with the city CITY VERIFIED . VALUATION ,air,g7 r Date ' - APPLICANT . PERMIT FEES CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE A I certify that in the performance of the work for which this permit is issued,I shall not employ any person in ELECTRICAL: I ` anymanner so as to become subect to the Workers'Co /� STRUCTURAL: rrpensat on aws�of/Cali o a Date .1 �Q � APPLICANT A//7 ;€4"7-.1 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:Z'7 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 PROPERTY FOR INSPECTIO PURPOSES. ISSUANCROV TOTAL PERMIT FEE: ,- ? 3053 i Signature of Applicant or Agent Date / L`/ a(, �. C U 2:r Rv�� DATE OF'I UANCE.� PERMIT NUMBER:� EIL Print Applicant's/Agent's Name 7?I / I /(]6b / 0 Cel • Operator: VIRGINIA Check #: 000004866 • Date: 7/30/93 00 Receipt #: 00887 CHECK $126.20 WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR N 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 PS GAS TEST P6 • FINAL PLUMBING P12' • --" • MECHANICAL, DATE • • APPROVED/INSPR'S SIGNATURE UN!ERGROUNDFLOOR M1 ROUGH M2 FAU/AC M4 FINAL MECHANICAL M12 ELECTRICAL DATE APPROVED/INSPR'S SIGNATURE TEMP.CONSTN.POWER E3 UNDERGROUND PVC.-METAL-D.B.C. El ROUGH WIRING RECEPT.SPACING- SERVICE-CIRCUIT E2 FINAL ELECTRICAL E12 STRUCTURAL DATE APPROVED/INSPR'S SIGNATURE FOUNDATION:LOCATION SI REINFORCED 0 UFER 0 SLAB REINFORCED❑MEMBRANE S3 I FLOOR FRAME/INSUL. S4 I MASONRY Si1 I FIREPLACE S11 , - ROOF FRAMING f ROOFSHEATHING S5 I 1� t•Do ,kfOv' j� 17•s'1' FRAMING S6 I I � -- INSULATION_• SOUND ENERGY • S7 LATH EXTERIOR S8 I I LATH INTERIOR/GYPBOARD S9 I I APPROVED/INSPR'S SIGNATURE DATE OF ISSUANCE PERMIT NUMBER BUILDING FINAL S12 IDI 44