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Permit No. (40) W -ri dile L-- -. . - 105 SAN BERNARDINO COUNTY-EPWA/L.AND rr a AGEMENT DEPT .--. . --..-mm------.,..------ - ----- OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 90 01462 225A 01 f STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED -.._...__ --- ) --•- ••------' APPL DATE 06/08/90 J ISSUE DATE 06/14/90 1 PG 1 OF 1 PARCEL NUMBER 1017-022-14-0000 ---'-----•-•--- ' PROPOSED USE: SWIMMING POOL CURRENT USE: RESIDENCE W/GARAGE . TRACT LBLK LOT ISEC ! TWN I RNG I PRCL MAP PRCL ACTIVITY : 1.821 13295 000 01�+- SE32 1-02S 08W O�L _ COMMUNITY PLAN ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL N0 CHINO HILLS CH/PD,IL1,* LOT DIMENSION IRREG CONST TYPE APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER #BLDGS ON LOT 1 GROUP ' BLUE DOPHIN POOLS 12702 MAGNOLIA DR #PLANS RECD 2 LAND USE PLOT 0 INDEX NBR 40-160 RIVERSIDE CA 92503-0000 STD PLAN/ICBO FHA (714) 734 - 8878 ITEM CNT DESCRIPTION DETAIL TOTALS OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER POOL PRIVATE 251.68 KLOSTERMAN, WILLIAM P. t41SC SUB-TOTAL 251.68 BOX 1749 TOTAL AMOUNT 251..68 CHINO HILLS CA 91709-0000 (714) 597 - 1872 JOB SITE ADDRESS 16134 FIRESTONE LN CHINO CA 91710-0000 CROSS STREET WINGED FOOT WY INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER BLUE DOLPHIN POOLS CONT000522042 4044 CAPME( BROOKS WAY SAN DIEGO CA 92130-0000 1000) 000 - 0000 ACTIVE WORKERS COMP 0k1. OF TWO. 'SAFETY PERMIT: MINIMUM SETBACK DISTANCES 19 FRNT SETBACK/PROP LINE 15 REAR SETBACK/PROP LINE 11 SIDE SETBACK/PROP LINE S 5 SIDE SETBACK/PROP LINE N MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES I UNO.NIT DWELLING NO. BEDROOMS FLOOR EXT. WALLS INT. WALLS CEILING PJ. "" '-',.ii ROOF HEATING FIREPLACES .ir' �s METAL MASRY WATERSEWER MIN DEPTH S.F./100 SIZE NEPk /PUBLIC PUBLIC 000 000 1 W/REAIR - 0 V4.4.i);i:TA L,'a... fi 0 0000 r� L ?� 'L. Pet EL-® � COMMENTS 44(-4 / *MODERATE TO HIGH LANDSLIDE SUSCEPTIBILITY. AMT WAIVED .00 AMT PAID 251.68 PAYOR NAN(: OLE DOPHIN POOL PAID 06/08/90 RECEIPT 2527 EMPL: ADAMS, C PAID BY : CHECK NBR : 197 - S eICENSED CONTRACTORS DECLARATION• • I HEREBY AFFIRM THAT I AM LICENSED UNDER THE PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS LICENSE NUMBER CONTRACTOR DATF OWNER-BUILDER DECLARATION I HEREBY AFFIRM THAT I AM EXEMPT FROM THE CONTRACTORS LICENSE LAW FOR THE FOLLOWING REASON(SECTION 7031.5,BUSINESS AND PROFESSIONS CODE• ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONSTRUCT, ALTER, IMPROVE, DEMOLISH OR REPAIR ANY STRUCTURE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CONTRACTORS LICENSE LAW[CHAPTER 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE]OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMPTION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS [$5001.1: ❑ 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(SECTION 7044,BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR THROUGH HIS OR HER OWN EMPLOYEES,PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE; IF, HOWEVER,THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLETION, THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ❑ I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC.7044,BUSINESS AND PROFESSIONS CODE: THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRACTORS LICENSE LAW). ❑ I AM EXEMPT UNDER SEC. B. AND P. C. FOR THIS REASON OWNER DATE WORKERS' COMPENSATION DECLARATION 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 (SEC. 3800, LAB.C.I POLICY NO. COMPANY ❑ CERTIFIED COPY IS HEREBY FURNISHED ❑ CERTIFIED COPY IS FILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT APPLICANT DATE ADDITIONAL REVISION CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100]OR LESS). I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERS'COMPENSATION LAWS OF CALIFORNIA. APPLICANT DATE 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. CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C.). LENDER'S NAMF LENDER'S ADDRESS DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRES A DIVISION OF INDUSTRIAL SAFETY PERMIT AS A PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW. ❑ I CERTIFY THAT NO EXCAVATION 5 FEET OR MORE FEET IN DEPTH,INTO WHICH A PERSON IS REQUIRED TO DESCEND,WILL BE MADE IN CONNECTION WITH WORK AUTHORIZED BY THIS PERMIT,AND THAT NO BUILDING,STRUCTURE,SCAFFOLDING,FALSEWORK,OR DEMOLITION OR DISMANTLING THEREOF,WILL BE MORE THAN 36 FEET HIGH. ❑ AS OWNER/BUILDER I WILL NOT EMPLOY ANYONE TO DO WORK WHICH WOULD REQUIRE A PERMIT FROM THE DIVISION OF INDUSTRIAL SAFETY,AS NOTED ABOVE UNLESS SUCH PERSON,gHAS A PERMIT FROM THAT DIVISION. DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER I HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT ❑ IS ❑ IS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY. I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT, I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. SIGNATURE OF APPLICANT OR AGENT DATE EXPIRATION AND REFUND NOTICE APPLICATIONS FOR WHICH NO PERMIT IS ISSUED WITHIN 180 DAYS FROM THE DATE OF APPLICATION SHALL EXPIRE.PERMITS SHALL EXPIRE IF WORK DOES NOT COMMENCE WITHIN 180 DAYS OF ISSUANCE OF SUCH PERMIT OR IF THE WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS.FEES PAID ARE NOT REFUNDABLE AFTER 180 DAYS FROM DATE OF PAYMENT,EXCEPT FOR ERRORS IN ACCEPTANCE WHICH MAY BE REFUNDABLE UP TO ONE YEAR FROM DATE OF PAYMENT. ALL FEES PAID MAY NOT BE REFUNDABLE. 12-17588-469 Rev.4/90 4 Owner'Name R Ioc+ ,tillp •Permit Numtill -- 1-74®/7fo0 oo ADf INSPECTION RECORD . DATE INSPECTOR I I DATE INSPECTOR Setback tot--Z,-_9'O 1----,-440 Rough Plumbing Temporary Power •O''-g--P'd ,/fir, Foundation Reinforcing Steel (f.-ZS.-1'1'7> -74Stucco Mesh or Exterior Siding Excavation and Forms (i- -f dj Insulation F.H.A. Foundation Req. Sewer Slab Grade Interceptor Ground Plumbingpp'e.G'QS K.5,.5 „0 V Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Servicejt 4~414) 9. 4420 Fireplace Foundation Lath or Drywall Nailing Joists and Girders Gas Line Air Test Rxe. 3..9-Fe> .fx5 Electrical Ground £qyt) j1 x.27 -fa 11Q4' Final Energy Mid-Height Bond Beam Final Plumbing 8-Foot Bond Beam Final Heating/A.C. Final Bond Beam Final Construction (. 469e4 r( ''3 Fireplace Bond Beam Final On Site Improvements 1)'• Li. 9c, C Roof Sheathing Final Off Site Improvements Framing and Ventilation Final Dedication Roof Covering Final Zoning I Rough HeatinglAgogF" 'z' a -Ajd ,..c0', Final Electrical I _ Electrical Service and Ground / Final Gas 9 -4'.. ' 4.e7' Rough Electrical IT.4i- Afe-4 Developer Fees Paid I WC (Y/N) Ind Saf (Y/N) Certificate of Occupancy "- 4s -CG a-c 7-/33 -Q<? Cit) *V— C iv o le 3 SEPTIC TANK GALS. w a arr. P. /, a �g SEEP. PIT X t.. ` ;:- s', ; „ LEACH LINE WIDF 014 4"o w,,a '-r''n" tt X LONG X DEPTH OF ROCK ti,.5' F)VNti r Lr N. EPA «a "Yr R'' - brAq B C. V-1-7--Q, ......A- A,Wil, W. E. I .r n l 44 .7/ -----• S. Inspector's Signature and Initials ' , - e64"h51742./ 12-17589-469 Rev.3/88