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Permit No. 1816 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 gg / /'7 ' CLE ED BY APPLICATION TYPE NO. CO ADDRESS 13egg s7 ///////'�n���^777 F APN 602� //z L1J �� Z THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT > ��J r r❑STRUCT. ❑ PLUMB. 0 MECH. ❑ ELECT. 0 LOT /�. y BLOCK TRAC� �/ ✓!J TRACT/&967...... D• XI - r TYPE OF PROJECT ><NEW 0 ALTER ❑ ADDITION m C„w2N� 00 • OWNER ��/, 0 REPAIR '❑ CONVERT 0 DEMO '0 OCCUPANCY PMT ADDRESS �/[///� V PROJECT„.,. LOCATION ON SIZE ��Iv�'1/ DESCRIPTION PROPERTY I IN SQ.FEET N crryaibtbI7/ J ZIP q PH 62,-7 03g . 1. D&:j< . . I /- -I 1 -1 0 W ARCHITECT -!i � I P191/4..... ft4D Nj ENGINEER • LIC.NO. 2. j a f 6'4' ' (k. / , ADDRESS - 9 F/ ""'V 1L'- I -►�J'i V - I )J V V CITY r , (ZIP PH. REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION CONTRACTOR t/ ¢l^(LC/ LIC.NO.5/Lk)I � � � `\t 'l '. 7 `/'� }'-L,C) �J/�j �'[./ _ - P{ C—1 D t a ADDRESS 1/10 ►q/ 1 1p.0J�LYiLi_ l / V [�/� CITY o1 _l V .�WW VV" ZIP / v7RC� PH./ll/�lf�L/ � �r�.N�--, LAJII�„�.LY1W �/llJ� /� ' LICENSE NO 4.3.Gy EXPIRATION DATE LICENSE /j7/2�/�� '�' N bp GJC �'iJCj(�/% L16N;/�„��,� /LICENSED CONTRACTORS DECLARATIdN[ /J / • I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000 of Division 3 of the Bu 'Hess and Professions Code,and my license. in full force and effect. License Class /� License Number ` llTf T //) ,� Date ` ,C Contractor 4//�✓Y e:AC✓,e ADDRESS /1/4) 1•A" t;IV-!A✓ e-- CITY AND ZIP 4464.-2 ,-) PH NE -7s3., -756t/ i . . OWNER-BUILDING DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason: AP. 11e.+. P.,�* - r ❑ I,as owner of the property,or my employees with wages as their sole compensation,will do the work, J I-frn 11111 a EXPIRED B[`LLi i i ik i'UN and the structure is not intended or offered for sale. I ❑ I,as owner of the property,am exclusively contracting with licensed contractors to construct the project. ❑ I am exempt under Sec. B&PC for this reason I p� i\\�` � ``� \ Date INITIAL tiutm - - - .1•[I1UW—�-' �1�� q WORKERS'COMPENSATION DECLARATION 79 -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 GROUP /e......... DIVISION TYPE// ❑ Certified copy is hereby furnished DATE EXPIRES !•r f N �,/ ❑Certified copy is filed with the city CITY VERIFIED VALUATION 7� • /�/� e /fD Date • APPLICANT-' - ��/ / (/ PERMIT FEES. : . CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE /t I certify that in the performance of the work for which this permit is issued,I shall not employ any person in ELECTRICAL: /�) C/� I STRUCTURAL`//1/i /f�) any manner 50 as oecome ubject to the Workers'Compensation Laws of Ca,alifo�r 'a. o�/_ �J �/�/l�/� // v Date: �' L/ APPLICANT f+�—/v" ham+ Al" 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: I ISSUANCE Ft ! 'e�) V- 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 R INSPECTION�/JPURPOSES. ISSUANCE APPROVED: TOTAL PERMIT FEE: IVA Signature of Applicant or Agent l Date �w /``�� 1J55 ! DATE OF UANCE: 9PERMIT NUMBER: Print Applicant's/Agent's Name • Operator: VIRGINIA Check #: 000004875 Date: 8/04/93 00 Receipt #: 0000090 CHECK $139.25 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 P5 GAS TEST P6 FINAL PLUMBING P12 MECHANICAL DATE APPROVED/INSPR'S_ SIGNATURE UNDERGROUND FLOOR Ml ROUGH M2I FAU/AC M4 I • FINAL MECHANICAL M12 ELECTRICAL DATE APPROVED/INSPR'S SIGNATURE TEMP.CONSTN.POWER E3 UNDERGROUND PVC-METAL-D.B.C. El ROUGH WIFIING RECEPT.SPACING.:: .,,:......., ...- -., ..:.:A•T .�: ,.: ...;,,:..„..: - SERVICE-CIRCUIT E2 FINAL ELECTRICAL E12 STRUCTURAL DATE APPROVED/INSPR'S E,/,: SIGNATURE FOUNDATION:REINFORCED 0 LOCATIONUFER 0 I (J;` SLAB REINFORCED MEMBRANE❑S3 i I ✓ FLOOR FRAME/INSUL. S4 I I C MASONRY S11 I I 1.-C4 ja (1 i L Ci-L..C. .{..I�,c+ .;pt r r-.r+ FIREPLACE S11 I I p _ ROOF FRAMING - _ iVi t_t _ A� `f ( f / �1 ROOF SHEATHING S5 FRAMING S6 I INSULATION SOUND ENERGY S7 LATH EXTERIOR S8 I I LATH INTERIOR/GYPBOARD S9 I APPROVED/INSPR'S SIGNATURE DATE OF ISSUANCE PERMIT NUMBER BUILDING FINAL S12