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Permit No. 939 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 r �.- CLEARED/ BY APPLICATION TYPE NO. 03 ADDRESS �� %!w�A 0 (i e li / � i \ \ 'i 0 APN THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT o D LOT BLOCK TRACT 0 STRUCT. 0 PLUMB. 0 MECH. 0 ELECT. 0 II a p . TYPE OF PROJECT tvEW 0 ALTER 0 ADDITION m CO OWNER '37-eS I p,i' ❑ REPAIR ❑ CONVERT ❑ DEMO 0 OCCUPANCY PMT. ADDRESS , PR T LOCATION DESCRIP I PROPERTY ON I ZE IN SO.FEET /1 A . CIT ;N '� 'L� ZIP PH 1. I Y ARCHITECT I ENGINEER LIC.NO. 2. ‘,3 ADDRESS 3. I 1-..,..,,,,..... • CITY ZIP PH. REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION :c • CONTRACTOR /' .UC.NO. 1. l &j A/A , P- -t.- ADDRESS�1„3 7 5 E p!-+, ` 'U' sL, 7e__ \\ ZIP PH. C. _ It rf t L'''.CITY zP,A- � i `lZb q-7 � l - [77 .N ti IL, \-6 L l CITY BUSINESS LICENSE LICENSE NO. EXPIRATION DATF �� Q. ,� ` i i LICENSED CONTRACTOR'S DECLARATION -- /\' �n_\� /`NRC1 <1.- G K 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 a in full force and effect. ( J�5�1�,'4� `�'t�..C2 �j �} (30547 ��- ) License Class ' , License Number yt ��- 'NO y,;- 1A- ( Lr^���%K Date �1 Contractor f 4---- _ • \ 'C ADDRESS2:2--3 Zt 7J j i 1 e—/� Lill 4- / �. �1�1 '1- °.k I L v • CITY AND ZIP `• �Vi� Lt+'�Z,A PHONE �G� 1-7�- �� OWNER-BUILDING DECLARATION I hereby affirm that>-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. ❑J am exempt under Sec. B&PC for this reason Date INITIAI - WORKERS'COMPENSATION DECLARATION - - I hereby affirm that I have a certificate of consent to self insure,or a certificate of Workers'Compensation e - Insurance,or aaccertified copypythereof. ^r� COMPANY 7 t�` �-9i • POLICY NO. (Z3 q e 3 la v v` NK, ' ( ) deo` GROUP' - DIVISION TYPE 0 Certified copy is hereby furnished DATE EXPIRES ( 1 e IJ o Certified�fcopy is file with the city CITY VERIFIER VALUATIO��[I T� . 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:LI any manner so as to become subject to the Workers'Compensation Laws of California. c Date' APPLICANT PLUMBING: 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: - I CER ' T T I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CO"ECT. I .GREE TO COMPLY WITH ' L CITY ORDINANCES AND STATE LAWS,AND HEREBY. GEO REVIEW: I PLAN CHECK: AU HORIZE rEPRESENT S O' HIS CITY TO ENTER UPON THE ABOVE MENTIONED P•,•PARTY FIR INSPECT N 0 •' S. ISSUAN PPR ED: TOTAL PERMIT FEE: gna r e o-'p IT •r••ent `-� Date 6c)L� N, k • r- DATE OF ISSUANCE: PERMIT NUMBER: • 'l'ffirkpTcant's%Agent's Name /) G G-3 f - I i • C _ • Operator: DRWN Check #: 000002119 Date: 2/23/93 00 Receipt #: 0000511 WHITE-INSPECTOR/GREEN-FILE/YELLOW-FILE/PINK-OWNER/GOLD-ASSESSOR DECK X69' . . . , I 1 • - . . BUILDING ADDRESS . . LOT • BLOCK - TRACT . • BUILDING INSPECTIONS RECORD OWNER ADDRESS CITY ZIP PH. • PLUMBING DATE APPROVED/INSPR'S • SIGNATURE GROUND SOILJWATER P1 TOP OUT • P2 SHOWER PAN P3 REMARKS SEWER P5 GAS TEST P6 • • • FINAL PLUMBING P12 , MECHANICAL DATE APPROVED/INSPR .'S• . • • SIGNATURE UNDERGROUND FLOOR--.- M1 , • ROUGH M2 FAU/AC M4 . • - - • tpl-frve:.;,5 ie.- -To . . - FINAL MECHANICAL M12 _3 - 1.-3 • - ELECTRICAL • DATE APPROVED/INSPR'S SIGNATURE TEMP.CONSTN.POWER E3 • " - - • UNDERGROUND . • - • • PVC-METAL-D.B.C. • • E1 ROUGH WIRING RECEPT.SPACING- • SERVICE-CIRCUIT E2 • FINAL ELECTRICAL E12 APPROVED/INSPR'S STRUCTURAL DATE SIGNATURE • FOUNDATION:LOCATION Si REINFORCED 0 jUFER SLAB REINFORCEOD MEMBRANE S3 ••. • • • • . . FLOOR FRAME/INSUL S4I • MASONRY S11 • FIREPLACE S11 ROOF FRAMING ROOF SHEATHING 55 FRAMING S6 INSULATION SOUND ENERGY S7 LATH EXTERIOR S8 LATH INTERIORJGYPBOARD S9 . . APPROVED/INSPR'S •• SIGNATURE • DATE OF ISSUANCE PERMIT NUMBER BUILDING FINAL • S12 • •.,- . - • • •