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Permit No. 1972 CITY OF CHINO HILLS -" — COMMUNITY DEVELOPMENT 2001 Grand Avenue APPLICATION FORA BUILDING PERMIT AND.A_CERTIFICATE OF USE&OCCUPANCY . . Chino Hills, CA 91709 z"iADDRESS (3�� r` l/) {� n /J / coCLEAREQ BY L TION TYPE NO f CCC Z L s C ,Gj Cr /l/Jl{�� ��/ r v APN ,t n 4,‘ (� / /� len 4 ��% THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT O LOT ` 7 BLOCK / J { i....._,. ..7 STRUCT. 0 PLUMB0 MECH. ❑ ELECT. 0 l J 4J:t�lh ��- 11 v I ���� TYPE OF PROJECT ANEW ❑ALTER ❑ADDITION m OWNERit/ 0 REPAIR 0 CONVERT 0 DEMO 0 OCCUPANCY PMT. ADDRESS �j� ^ i �n %��- PROJECT I PROPERTOCATION ON I SIZE l�"A'/ 'J 712/J�/ DESCRIPTION PROPERTY IN SO.FEET CITY ZIP PH. 'AA I at WI-- I ` ARCHITECT • p44-1-0- ENGINEER ` LIC.NO. 2. I s l I 4.0.)'' ADDRESSii CITY 61.74 / P ''PH. �+ REMARKS/SPACIAL CONDITIONS/PROJECT DESCRIPTION CONTRACTOR U /.� t f — • LIC.NO.6,?`` }� // �//� `h/ X L, r V' !/ fir"/ / C/�iL/ ECJ G (J 1.. )e././ ' `7_ e // ` ( i ' C t 4 D Y e% (V�J \\v ADDRESS !/J�f Jam' 'X?Ne [7L /6 Xi S-" ,GA-7.7i ct" /94=4 o Lotto.,, . CITY 11 O / o /i' ,d ZIP // �V 7' .02-9,573. / J6 vi K Ate,'1,,i__ - CITY BUSINESS LICENSE 4.4V 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 �Business andanProfessions Code,and my I nsse is in full force and effect. License Class_Ire//�/Ct�^__ License Number '��✓�i` ('// / ,C//�y�}�1 _ . Data q �`✓ 91 Contractor "`�/f .-;44�1'�N1 " 7 . .rADDRESS ° I �L 0 1/. +7 CITY AND ZIP UP'•J 1" PHONE9 `C l/S� - c OWNER-BUILDING p r G .1 (J r I hereby affirm that I am exempt from the Contractor's License Law for the following reason: J r/ "'C 0 I,as owner of the property,or my employees with wages as their sole compensation,will do the work, .1Cr ,/) � , and the structure is not intended or offered for sale. f r 0 I,as owner of the property,am exclusively contracting with licensed contractors to construct-the project. 0 I am exempt under Sec. B&PC 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,ora certified copy there COMPANY ''� F7441 POLICY NO. r _ GROUP�� _ _ _ DIV _ I TYPEAi 0 Certified copy is hereby furnished DATE EXPIRES f' , Certified/c^opy is tiled with the-city ' ' C ' ERIFI . - /VALUATION is-ii Date -�/ci 6 42 APPLIC•NT: Ji: , (Q 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' I STRUCTURAL:1� 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: I ISSUANCE FEESS9 ' .--.—,a 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 i7 PROPER R INSPE TION PURPOSES. ISSUAN PROVED: TOTAL PERMIT FEE: Sgnaturetf Applicant�J Agent Date i��-fid' /3 ? ---/---,. ge/L y1�0(� ` ATE OF I SUANC 42 PERMIT NUMBER: Print Ap$licant's/Agent'ss NamefJ /5 433 I / a-7 '72 e.::7--- cl • Operator: VIR6INIR Check #: 000002283 Date: 9/10/93 00 Receipt #: 0000293 CHECK $137.00 WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR • BUILDING ADDRESS LOT BLOCK TRACT BUILDING INSPECTIONS RECORD OWNER • • ADDRESS CITY ZIP PN. PLUMBING DATE APPROVED/INSPR'S SIGNATURE GROUND SOIL/WATER P1 TOP'OUT P2 SHOWER PAN P3 REMARKS SEWER P5 GAS TEST P6 P/',v / t'�' / / i `�/Z J c ( -DJ) FINAL PLUMBING P12 rr MECHANICAL DATE APPROVED/INSPR'S SIGNATURE UNDERGROUND FLOOR M1 ROUGH M2I FAU/AC M4I FINAL MECHANICAL M12 ELECTRICAL DATE APPROVED/INSPR'S SIGNATURE TEMP.CONSTN.POWER E3 UNDERGROUND PVC-METAL-D.B.C. E1 • - ROUGH WIRING RECEPT.SPACING- SERVICE-CIRCUIT E2 I I FINAL ELECTRICAL E12 STRUCTURAL DATE APPROVED/INSPR'S - SIGNATURE FOUNDATION:LOCATION 51 REINFORCED 0 UFER 0 SLAB REINFORCED❑MEMBRANE❑S3 • FLOOR FRAME/INSU L. S4 MASONRY S11I FIREPLACE S11 ROOF FRAMING ROOF SHEATHING S5 • FRAMING S6 INSULATION SOUND ENERGY S7 LATH EXTERIOR S8 LATH INTERIOR/GYPBOARD S9 • APPROVED/INSPR'S SIGNATURE DATE OF ISSUANCE • PERMIT NUMBER BUILDING FINAL _ S12 /�j�/* J"j�