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Permit No. 2662 / 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 / CLEARED BY APPLICATION TYPE NO. C ADDRESS • ' - • ci 61 P /ail &f f/t 3/c2 1919O THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT 0 V CK . . ,A /� 0 STRUCT. 0 PLUMB. 0 MECH. 0 ELECT 0 D7 TYPE OF PROJECT- ❑ NEW -- 0-ALTER-- 0 ADDITION - -m 00 CD OWNER /,A,`,_AAA J ^ �HI` 6 1 0 REPAIR 0 CONVERT ❑ DEMO ❑ OCCUPANCY PMT. ADDRESS •sy/� 7 J lll�l [ .4.--A1:41-1.1 �/J7 PROJECT LOCATION ON SIZE /.._J,7�p72/1 j ,`r. %^0 L DESCRIPTION PROPERTY I IN SO.FEET CITY �/ 7 L/ ZIP 91 (�� .fc?75' PH "`'G ""- i�iru ���, ,�ifir? 59b 59"). 1�� -I /&2'/� Lw ARCHITECT u I I ENGINEER LIC.NO. 2. \\-\\, • ADDRESS 3.- I I *1/4.. CITY ZIP PH REMAA,RKS/SPPECCIIALL C�ONDDIITTIIO�N, ipJECT DESCRIPTION CONTRACTOR Lftf, /,rte /2 LIC.NO.5i(� . � 3 :)0 6 ..,,,. /:_7z,"6-**,,,,, ..,G.�� /:7z t f4 f; NN.* /159 /3 1101416.1 ADDRESS (,5,/ eil lid"jey fr., . . , S CITY`/m`,,� 4;A" ZIP 1'�/ /©`6I - PH-- 17.1ei 7- L / I CITY BUSINESS LICENSE '"-"T ' LICENSE NO • 4'l.� EXPIRATION DATE - - LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000 of Division 3 of the Business and Professions Code,and my license is in full force a and effect- - License Class ` 0 License Number 5]41_ `/7 Dates -9'--,;21 VContractor Ap `...emi�� N ADDRESSM -- ' J�'e it Li/,j l/ ty CITY AND ZIP 4-41710 #i//S lJ`/.76.1 HONE —'9 7 4j,,— / V?,,,,,‘ - -,OWNER-BUILDING DECLARATION, I hereby affirm that I am�exempt from the Contractor'sLicerise Law for the following reason: - - ❑ I,as owner of the property,or E,y employees with wages as-their side 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 - • e ❑ I am exempt under Sec. BBPC for this reason �. _ Date - INITIAL 7 f�4(j 'r ? /, e/! 6-. A WORKERS'COMPENSATION DECLARATION r-‹—el/ I hereby affirm that I have a certificate of consent to self insure,or a certificate of Workers'Compensation < < j Insurance,or a certified copy thereof - - <<_ C - ✓ ' i'(-9 - - COMPANY • POLICY NO. ' GROUP DIVISION -- TYPE/7z/' ❑ Certified copy is hereby furnished DATE EXPIRES �• ❑ Certified copy is filed with the city CITY VERIFIFn VALUATIONa"]'/( ,� -- 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,I shall not employ any person.in ELECTRICAL I STRUCTURAL: / q any manner so as to become subject to the Workers'Compensates Laws of Californr </Yi"/ Date: -7 =�I—94 APPLICANT -Meirr"Main. 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:Hz:7z_ 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 PROP RTY FOR INSPECTION PURPOSES. ISSUANCE APPROVED; '. TOTAL PERMIT FEE: 4' '. ,. ,,I °. 1 -.951 . . , e'� . So Signature of Applicant or Ag'&nt Date DATE OF /ISS NCE: PERMIT NUMBER: Xi-z//6A 4. fiV ii taj 7,V/ 2 I Print Applicant's/Agent's Name 1 r g.../ • Operator: DAWN Check II: 000002706 Date: 3/21/94 00 Receipt it: 0000762 • CIECK $93.80 WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR ��� . BUILDING ADDRESS LOT BLOCK TRACT ' BUILDING.INSPECTIONS RECORD OWNER _ ADDRESS - _ CITY ZIP PR - PLUMBING DATE APPROVED/INSPR'S SIGNATURE . - - GROUND SOIL/WATER P1 TOP OUT P2 _ . SHOWER PAN P3 REMARKS SEWER PG ' GAS TEST P6 FINAL PLUMBING P12 MECHANICAL DATE APPROVED/INSPR'S - _ - -' SIGNATURE UNDERGROUND FLOOR Ml ROUGH M2 I . FAU/AC M4 I I FINAL MECHANICAL M12 I ELECTRICAL DATE APPROVED/INSPR'S , SIGNATURE - • TEMP.CONSTN.POWER E3 I I . UNDERGROUND - . . PVC-METAL-D.B.C. E1 - ROUGH WIRING - • • RECEPT.SPACING- C ]] .`� �, • SERVICE-CIRCUIT E2 I-WIL �"lvi-Itt `f'Awr OP �+ I I i- it, _av -4,-,...1l!��2�;/yam ;7� FINAL ELECTRICAL E12 i r STRUCTURAL DATE APPROVED/INSPR'S SIGNATURE FOUNDATION:LOCATION Si • REINFORCED 0 UFER 0 , ' • SLAB REINFORCEDO MEMBRANE S3 I ' FLOOR FRAME/INSUL. S4 MASONRY S11 FIREPLACE S11 I ROOF FRAMING ROOF SHEATHING S5 FRAMING S6 I •I INSULATION SOUND ENERGY S7 1 ‘ 1%,"7-//0 j!/\i, n LATH EXTERIOR S8 I I _-.e,�r,0/e..;,7 <<"_17,.,,.�,/5) LATH INTERIOR/GYPBOARD S9 I ,- ` r i i i APPROVED/INSPR'S SIGNATURE DATE OF ISSUANCE PERMIT NUMBER j„ r BUILDING FINAL S12 ///t7� •:t ' • i