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Permit No. 17117 BUILDING ADDRESS: 2253 HEDGEROW LANE PERMIT NUMBER: 17117 �- • --+ 'r BUILDING INFORMATION APPLICANT INFORMATION ' -. , b t1ILDING PERMIT APPLICATION Address: 2253 HEDGEROW LANE Name: (ELEGANT CUSTOM POOLS '_ Community Development APN• 1024-201-49 Address. 14195 CHINO HILLS PARKWAY#125 '';t"'-.1 2001 Grand Avenue Lot 48 I City,Zip Code: (CHINO HILLS,CA 91709 ' Chino Hills,CA 91709 ? ;: :: Cross Streets: AUTUMN HILL I Phone/Pager: 1(909)606-8470 I ext "°'°""°MILLS LICENSED CONTRACTOR DECLARATION Tract/Parcel: 13651-9 City Bus Lic#. 1NEW i hereby affirm that I'm licensed under the provisions of Chapter 9(commencing with Section Valuation: $500 00 ENGINEER/ARCHITECT INFORMATION 7000 of Division 3 of the Business and Professions Code)and my license is in full force and - effect. OWNER INFORMATION Name. IN/A OWNER BUILDER DECLARATION Name: MARK GARGONE Address: 1 1 I hereby affirm that I'm exempt from the Contractor's License Law for the following reason: Address: 2253 HEDGEROW LANE City,Zip Code. I,as the owner of the prp rt or my employees with wages as their whole City,Zip Code: CHINO HILLS,CA 91709 Phone: 1 ext. O compensation,will do the work,and the structure is not intended or offered for sale. Phone. (909)591-8842 I ext. I I Lie#: © 1,as owner of the property,am exclusively contracting with licensed contractors to Bus Lic#: N/A City Bus Lic#• construct the project. l am exempt under Section I BPC for this reason I Bus Exp. APPROVAL INFORMATION 1110 WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION Issued By: YVETTE MARTINEZ I hereby affirm under penalty of perjury one of the following declarations Contractor: ELEGANT CUSTOM POOLS Date Issued: 10/9/00 Address: 14754 VELVET STREET Finance Code: C4 I have and will maintain a certificate of consent to self-insure for workers'compensation © as provided by Section 3700 of the Labor Code,for the performance of the work for City,Zip Code. CHINO HILLS,CA 91709 Census Code- which this permit is issued. Phone or Pager: (909)606-8470 I ext. I Final Date. Bus.Lic.#: NEW Final By I have and will maintain workers'compensation,as required by Section 3700 of the ® Labor Code,for the performance of the work for which this permit is issued. My Lic.#: 590692 Extension: workers'compensation insurance carrier and policy number are: Exp Date: 8/11/01 Reviewed By. INSURANCE INFORMATION Lie.Class• C53 ...----N Approved By Insurance Company: 1CREDIT GENERAL INS. 1 PROJECT INFORMATION Policy Number. 1ART0015950 1 POJ CT ESCRIPTION LOCATION SQUARE FT. Expiration Date. 18-24-01 1 Structure. © Section need not be completed if permit is for one hundred dollars($100)or less Garage: 1 I 1 I 1 I certify that in the performance of the work for which this permit is issued I shall not employ Patio: 1 . any person in any manner so as to become subject to the Workers'Compensation Laws of Porch. I 1 1 1 1 1 California and agree that if I should become subject to the workers'compensation provisions of Other lA/C RELOCATE 1SIDE 1 Section 3700 of the Labor Code. I shall comply with those provisions. RELOCATE A/C UNIT PROPOSED USE Date: i i Signature: i i UNIT CAN ENCROACH NO CLOSER THAN 2'INTO THE REQUIRED SIDE YARD I certify I have read this application and state that the above information is correct. I agree to SETBACK. comply with all City Ordinances and state laws and hereby authonze representatives of this City to COMMENTS enter upon the above mentioned property for inspection purposes. 7.70 I / i n Date: /q/Z I Signature: /// /-•p/,/ / ,t U�1�i� OTHER FEES REQUIRED ZONING SETBACKS 1 GRADING PRIOR TO ACTUAL PERMIT PERMIT FEE INFORMATION ISSUANCE Zoning PD 1 Front Yard 18 Over X: 1 0 1 Issuance. 1 $33.30 I Electrical: 1 $0.00 Land Use: 1FR-1 1 Side Yard: 5 Cut. 1 0 1 School- I NO Permit Fees: $53.28 NO Plan Check: I $0.00 1 Plumbing: I $0 00 1 Plan: 1POOL 1 Rear Yard: 20Development: 1 Fill: I 0 SMTP• $0.00 I Occ: ACCESSORY 1 SSY: 15 Total. I 0 I Sewer: 1 NO Mechanical: 1 $19.98 I Structural: I $0.00 1 Type: ITO R3 VN 1 Water: 1 NO Geo Review: 1 $0.00 1 Grading: 1 $0.00Total Fee Due I $53.28 1 INSPECTION RECORD 4 � r. INSPECTION DATE INSPECTOR :,-, Grading: INSPECTION DATE INSPECTOR Block wmUkapecUon� � p�o�d� meohng � Rough Grade Footing, ReBar Tenaban 1st Lift Bond Beam Sub Drains 2nd Lift Bond Beam 3rd Li�Bond Beam Finish Grading �rain/5ao| Soils Certification � GnmingC��nc�nReRoof� Certification Rough Tear-off, Existing Conditions As Built Approved , Sheath Nailing Underground Site Inspections: Roof Final Building Sewer Line Swimming Pools : Supply Water Line Location/Rebar/Bonding/Light Storm Drain/Catch Basins Gas Test G,�unUux/RoE|ec| U/GCondu/ueseo�c� DO NOT BACKFILL UNTIL ABOVE IS APPROVED. Pre-Deck Verify Soils Engineering: POOL NOT TO BE FILLED UNTIL FENCING IS COMPLETE Compaction, moisture,conditioning,,uFence� ' Gate&Alarm unuomoor/unueo|uu /nspectmn: Final Pool U/F Waste Plumbing Fire Protection Equipment: U/F Water UG Pipe U/F Mechanical Thrust Blocks U/F Electrical Hydro U/F Framing Flush vve|d0vne\msp Insulation . Subfloor Overhead Hydro ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION Foundation Inspection: Temp Power Pole Electric Release Semacx/�oonng . UFER Ground (Rebar/Copper) Gas Test Hardware/Hold-Downs FINAL INSPECTIONS Piers/Caissons/Tendons DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED NO OCCUPANCY PERMITTED WITHOUT FINAL,/ Shear InspectiCounty Environmental HealDept (JS1'r57O) Roof Nailing Exterior Walls Planning Dept (3s4'275O) Interior Walls Public Works (3a4'2T70) Fire <393-3888) Hardware/Hold-Downs Landscape (JO4'2787) Combo Inspection: — Trust Accoun�..'(as*'276g) .7rammo ALL ABOVE MUST BE APPROVED BEFORE FINAL BLDG sough Electric Final Electric sough Mechanical Final Grade sough Plumbing/Topout Final Plumbing :OVER woWORK UNTIL ABOVE IS APPROVED nsulation Final Mechanical ^ Fina|ovimingxCvnoou�mn �~---� �nnwaxmspo�oon� ���,�~-_ nterior Water Meter Number Extenor 'atx CERTIFICATE OF OCCUPANCY. itucco Scratch OK TO ISSUE AISCELLANEOUS INSPECTIONS o^sonr/pimOTHER:p/a�e 'r�� � wtx� «�� \o���'�� 'late Ties, Fire Block, L�`^E°� �~~~= � - `auv/Deck : . • rooting kcce,s/Light/Switch 'mio Final . •