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Permit No. 2264 ) 1,_ ----_ CITY OF CHINO HILLS - COMMUNITY DEVELOPMENT 2001 Grand Avenue APPLICATION FOR A BUILDING PERMIT AND A CERTIFICATE OF USE&OCCUPANC Chino Hills, CA 91709 • - .-. • ,- - ---- .-- " • -- - - ' BUILDING .. •CLEARED Y. . APPLICATION TYPE .. . _._NO.. _ - . . . ._ .. CO . ADDRESS i 3-•:?.'' .' --3.. 05174. .42:-Mai.)L / 4/ c F ' o - - . . • .- • . . • -., •..,4 /4 -i- • /r ej • :-1 -- . : ‘ . . •• . TIF FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT 0 LOT 62_ BLOCK TRACT/3 4,67..-- 2_ y‘,STRUCT,- - 0 PLVI;f9. -- -0-MECH. - --0-ELECT. - -- -p, If TYPE OF PROJECT EW 0 ALTER 0 ADDITION • m OWNER••....jAc_)/..._,/ ..4 1 orz_e---54 1/.)0 vL(.1 0 REPAIR 0 CON ERT 0 DEMO 0 OCCUPANCY PMT. .. . .. PROJECT LOCATION ON . . ,SINIZsEo. ADDRESS I S.-7 c,,,4:2 il STA ‘..C.f2--,----01,.-e._ . DESCRIP,TION. . PR ERTY FEET Ns`c • ',;: ' crry C.I.A‘vto I ZIP PH 613'-(7521 . '1.-a:TC)- .-relu.4271- Q-'--- I igg'7-..- N),, . . ARCHITECT ENGINEER - -- - ---- -- - -- - -. .- , - ? f- :g--Lz6 - l-t-Ori--- - - .2 I - I 45- Ai_ . .N ADDRESS . . . .. .. . . . . . .3. I .,:1 . ....\-.....t, ., CITY ZIP' --PH. REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION - CONTRACTOR 6.4134 56L/ ' at63,11r10 (06-736. - , . ADDRESS .g_0 s•-2 _ g,,;,:i5-1 0.6:- P__01 • . . , . . . . . .. . I.'''. CITY4Li A 16.44.4" CITY BUSINESS LICENSE LOA/j/ V as, -LICENSE NO ...41/5/ EXPIRATION DATP 1 4" -"*".f/* i' . . LICENSED CONTRACTOR'S DECLARATION , c.i.%••:--•_ • I hereby-affirm that I am licensed-under provisions of-Chapter-9-(commencing with Section-7000 of 11- Division 3 of the Business and Professions Code,and my license is in full force and effect. , . . .. . .. .. License Class License Number . , . . ' ' Dat n Contractor ._ ...., ..... . . . . .._ . ,. . . . . ,.- ,-, . , ADDRFqq , CITY AND ZIP PHONF - -•P-6jZ-4,,a,,_ -0 , Z-, /: - --- OWNER-BUILDING DECLARATION / • • I hereby affirm that I am exempt from the Contractors License Law for the following reason . . O I,-as owner of the property,or my erriPloyees-with-virages as their sole compensation,will do the work, • and the structure is not intended or offered for sale - .::%7---.64; /6_ O I,as owner of the property,am exclusively contracting with licensed contractors to construct the Project. . O 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 . -- • - '<61.2)- :-.,6 •-."---5 t- . Insurance,ora•certified copy thereof . . ,. IA COMPAN-Y POLICY WI GROUP/e„ DIVISION '' , ' TYPE/4/, •-•1', 0 Certified copy is hereby furnished .. ._ DATEEXPIRES ' , . . . ., -,.. . 0 Certified copy is filed with the city -- : CITY VERIFI - FIl• .' • „_..' - ' VALUATION .-2(:),V eV ' 'Date APPLICANT: PERMIT FEES . , , , • CERTIFICATE,OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE I certify that in the performance of the work for which this permit is issued,',shall-not employ any.,rson in ELECTRICAL- „,=9 , .. .---- I STRUCTURAL- any manner so as to becowtiject to the Workers'Corrponsat, La of•alyci ., ,,; 'Date: II-1 62--.1 APPLICAN Ale.,../ • ANKL.-,..41( Ai( • -2; . .- , 4 . . PLUMBING: _ ._ I GRADING:.. .. NOTICE TO APPLICANT:If,Ofter making this Certificate of femption,you shoul.become subject to the . Workers'Compensation provisions of the Labor Code,you ust forthwith comply with such provisions or _ this permit shall be deemed revoked MECHANICAL: _ . ISSUANCE FEES 'ir(.) *.• , -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 . - 1 J PROP RTY FOR INSPECTIO PURPOSES. 4 ISSUANCE APPROVEV.- ---e,-/< TOTAL PERMIT FEE. ..-... • ••••”"/24/e, „.„.------ • ature of Applicant-or Aggt :- A1)2270'c../4.1— 7 DATE OF ISSUANCE- PERMIT NUMBER: 464e) ia -:,(-e.z.,-t I).e_r p 6,/ 3 Print A- ' ////pplicant's/Agent's Name .... "- ,......,-, , . (7.1 • Ig2ratr! VIRGIN1f-1 Check iii 00)00207 lifiG/TS fiji Recein;; ,h 30OLL -IITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR _____ II • BUILDING • ADDRESS - • - LOT BLOCK TRACT ,�1 ,• . - BUILDING FNECTIONS RECORD OWNE •R ADDRESS. 1 J .,7 /, i r•"' �' •moi^.�j+i. ' CITY ZIP - - - PH. rt • PLUMBING DATE APPROVED/INSPR'S SIGNATURE I GROUND SOIL/1 ATER', P1 -IP - "; ', _I,. , r_ \ TOP OUT • P2 11 SHOWER PAN- P3 REMARKS - • SEWER P5 GAS TEST .P6' ' FINAL PLUMBING -P12 \ • '1 • 1 `. 1 fi, .. ,:'.ti1, ',- . ROVED/INSPR'S •,. k. ,,, \ ) MECHANICAL DATE APPSIGNATURE -'"�-,, -' '�`- ,; _1 `' •� UNDERGROUND FLOOR Ml I , ROUGH M2 • FAU/'AC M4 . FINAL MECHANICAL M12 - -- -I ' ELECTRICAL DATE -._ APPROVED/INSPR'S SIGNATURE TEMP.CONSTN.POWER E3-I UNDERGROUND _ PVC-METAL-D.B.C. .E1 ROUGH WIRING RECEPT.SPACING- SERVICE-CIRCUIT E2 - FINAL ELECTRICAL E12 , -_ . . STRUCTURAL DATE APPROVED/INSPR'S SIGNATURE FOUNDATION.LOBATION Si REINFORCE ////9/ '3 D UFER ❑ - SLAB REINFORCED MEMBRANE S3 FLOOR FRAME/INSUL. S4 • MASONRY • Sii SFT 6oit./1— /x/8/93 �' • '--(. - ., . FIREPLACE :11. ROOF FRAMING• ROOF SHEATHING S5 Lee-A `'G�J��� .orci?iv.") ,�.I`- FRAMING S6 . r -- -- _ IO-I V�'JM •DO - INSULATION- _ .l`_. . �,:,•-• \ _, - ' ' - \ SOUND ENERGY S7 - _Ni " "`� ' LATH-EXTERIOR S8 \\ LATH INTERIOR/GYPBOARD S9..I APPROVED/INSPR'S ' SIGNATURE DATE OF ISSUANCE PERMIT NUMBER ' BUILDING FINALS12 ////74/ C?.. p9,v. "' ` i \.-,.y:r,, • I • • ' • , Wf