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Permit No. (48) 1 j 4111 + ' 411 105 SAN BERNARDINO COUNTY-EPWA/LAND MANAGEMENT DEPT OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NRR 105 89 03021 225A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APP( DATE 09/07/89 I ISSUE DATE 09/26/89 I PG 1 OF 1 PARCEL NUMBER 1017-022-20-0000 PROPOSED USE: POOL AND SPA CURRENT USE: RESIDENCE W/GARAGE TRACT 1 BLK 000 LOT 020 I SSEC E32 1025 RNG 08W PRCL 00AP I ORC1_ ACTIV7TY 1821 COMMUNITY PLAN ZONE/LAND USE DISTRICT( GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL. NO CHINO HILLS CH/PD LOT DIMENSION IRREG CONST TYPE APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *BLDGS ON LOT 1 GROUP CALIFORNIA POOLS 1950 BREA CANYON RD *B-5 *PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 40-160 DIAMOND BAR CA 91765-0000 STD PLAN/ICBO 8630079225A FHA 1714) 861 - 0095 ITEM CNT DESCRIPTION DETAIL TOTALS OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER POOL PRIVATE 251.68 BERGSTROM, STEPHANIE A. MISC SUB-TOTAL 251.68 BOX 1749 TOTAL AMOUNT 251.68 CHINO HILLS CA 91709-0000 (714) 597 - 7699 r JOB SITE ADDRESS C O M P L E T E D HIFIRESTONE LN CDATE -/�- �J CHINONO CA 91710-0000 j_ CROSS STREET WINGED FOOT WY INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER CALIFORNIA POOLS T SPA CONT000185102 4600 NO SANTA ANITA AVE *200 EL MONTE CA 91731-0000 (000) 000 - 0000 OW. OF IND. SAFETY PERMIT: MINIMUM SETBACK DISTANCES 21 FRNT SETBACK/PROP LINE 15 REAR SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES I NO. OITDWELLING I NO. BEDROOMS I FLOOR UNEXT. WALLS INT. WALLS CEILING ROOF HEATING FIREPLACES METAL IMASRY WATER PUBLIC (PUBLIC SEWER WIN 000EPTHI S.000 0000F./1001 SIZ000EI NEW/REPAIR COMMENTS 0' AND 10' SIDE YARD SETBACK OR 5' AND 5' SIDES • AMT WAIVED .00 AMT PAID 251.68 (1\1 PAYOR NAME: AARON R. GARNER PAID 09/07/89 RECEIPT 5149 EMPL: STACCATO-NYARI, M PAID BY : CHECK NBR : 1393 U � 1 •- I 1, LICENSED 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 C 7 LICENSE NUMBER /85/b2. CONTRACTOR Kfiln/S DATE 2- zB- q 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 195001.1' ❑ 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 DATF 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 (SE 8 0, LAB.C.). r J } ,� POLICY NO g 32-40 I COMPANY l/ (` /��"^'1 _,,C' ❑ CERTIFIED COPY IS HEREBY FURNISHED K CERTIFIED COPY : FILED ' TH COU Y BUILD[ G INSPECT DEPARTMENT APPLICANT ►/1�-�j• / _ YA/�- DATF 1` 1 '7o ... v I CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$1001 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 1 LENDER'S NAME (-1_.,.A-_II LEN (Dnto., 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 HAS A PERMIT FROM THAT DIVISION. DIVISION OF INDUSTRIAL SAFETY PERMIT NUMBER I CERTIFY THAT I HAVE READ THIS APPLICATION AND S ATE TH• HE ABOVE INFORMATION IS CORRECT, I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATI ILD G CO).,aCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COU TY TO NTER UPON THE ABOVE-MENTIONED PROPERTY FOR INS ECTION P OSES� /(-y ? P� SIGNATURE OF APPLICANT OR AGENT /� i\I 1 I/ �� DATE ,Y. VXE PIRATION 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 10/88 _ /60,1t)3oZ/ as -A a/ Owner Name ?�i STr � , Permmb INSPECTION RECORD DATE I INSPECTOR , DATE INSPECTOR Setback I 0?919 I ljY'- Rough Plumbing .12ewer ;jgc/; „1'4,,,1” 'J-.2 289 4,W. Shower Pan Test Foundation Reinforcing Steel Itg1,61 it 1 / Stucco Mesh or Exterior Siding Excavation and Forms Insulation Sewer Slab Grade - _ Interceptor Ground Plumbin VA ill-ccj WO,- Septic Tank Underslab Ducts _ Leach Line or Seep Pit Underslab Conduit )/�T` Ve Water Service Fireplace Foundation Lath or Drywall Nailing Joists and GirdersGas Line Air Test Pjit. VA/947' Electrical Ground /\.(1) y•a7 -Tf (1...W.} Final Energy __ Mid-Height Bond Beam ' Final Plumbing 8-Foot Bond Beam Final Heating/A.C. Final Bond Beam Final Construction Fireplace Bond Beam , Final On Site Improvements R .;. 0.,ua.: ••gi'CiApOjef'4j /2 —/'W //,, Final Off Site Improvements Framing and Ventilation / Final Dedication Roof Covering / Final Zoning Rough Heating Final Electrical Electrical Service and Ground Final Gas Rough Electrical Developer Fees Paid WC (Y/N) Ind Saf (Y/N) Certificate of Occupancy /40-Y-110 wi:- ? //` 7'�t &1r�d C RS '4G, 7-2.4/ti. >/em. •=/7t/A 6S c' // •20-� 0 LL Fort.'Pie �EC�'�(', /4t'f'kt/CO,Bs/•, ///d f- ' 1?-�Z_ , Booz. /:i#1/ 6A-= 1 UUIVIa s. t. I S. 6,+ A SATE -/ d SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDF X LONG X DEPTH OF ROCK N. W. E. p® w t S. .��� v 4`-r 5/e//l��r�'i�!`�`-- In�peor's Signature and • als 12-17589-469 Rev 3/88