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Permit No. 6099 • %;ity o-f no Hiles 1 APPLAIPION FOR BUILDING PERMIT Community Development `r . , . 2001 Grand Avenue - , Chino Hills,CA 91709 4 Buildtric¢Address: h ./ Proposed Use - 1 St No. 17419 Street KELSIE/WAY 'OOL AND SPA/GAS LINE APN 1� �- ��`_�3 . THE FOLLOWING WORK IS AUTHORIZED BY THIS PERMIT Lot : Block Tract 13 6 0` I m Struct. M Plumb. Applicant SAHARA POOLS E1 Mech. lA Elect. E l Grading St No. 1768 Street ARROW HWY Type of Project New 117 Alter 117 Addition CityLAVERNE Zip 91750 Phone 392-0281 ❑Repair Li Convert. n Demo ❑ Occupancy Permit OwnerMIKE HEINZ ProjectLocation onI Size Description I Property in Sq.Feet St No.17419 StreetKELSIE WAY I Cit HINO HILLS 1.POOL yC Zip91709 Phone Engr/Arch Lic No. 2. St No. Street 3. I I City Zip Phone 4. 1 I ` REMARKS/SPECIAL CONDITIONS/PROJECT DESCRIPTION Contractor SAHARA POOLS Lic No350250 Sewer I Min. Depth I S/F/100 I Size St No.1768 Street ARROW HWY tilh CityCHINO HILLS Zip91709 Phone 392-0281 Cubic Yards Excavation Fill Over Excavation t City Business License L License No. Expiration Date Licensed Contractor's 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-s3 License Number 3s02sn Date ContractorsAMEASABOVE Address • City and Zip Phone Owner Builder Declaration .--_----__ ___-_-. -_-._ ___.. . -_W__. I hereby affirm that I am exempt from the Contractor's License Law for the following reason: r-1 I, as the owner of the property, or my empwith not wages as their whole compensation, will do the work, and the structureloyees is intended or offered for sale. 0 D1 I, as owner of the property, am exclusively contracting with licensed contractors to --------------------- m��m^� ^^ �^ �^^�^^ �. construct the project. ❑ I am exempt under Sec._____, B&PC for this reason_ Date Initial Workers' Compensation Declaration I hereby affirm under penalty of perjury one of the following declarations Zoning I Land Use ❑ a. -a--v-e---and will maintain a certificate of consent to self-insure for workers' PD,IL1,FR1 compen on as provided by Section 3700 of the Labor Code, for the performance of the I wor r which this permit is issued. Setbacks Model/Plan b. I have and will maintain worker's compensation,as required by Section 3700 of the FY 25 I SY 5,5 I LaborCode, for the performance of the work for which this permit is issued. My worker's RY15 I SSY compensation insurance earner and policy number are: /� Ins. Co.: S'77177 , / ,' Group/Division/Type Policy No: O4f7S O—F,-- Exp Date: 1279. VALUATION (This dection need not be completed if the permit is for one hundred doolars($100)or less). $!,500,000.00 LI c..1-Certify that in the performance of the work for which this permit is issued. I shall PERMIT FEES not employ any person in any manner so as to become subject to the Workers' Compensation Law. of California and agree that if I should become subject to the workers' co...-nsation visions of Sectio 3700 of the Labor Code. I all forthwi�� �i e Electrical Structural P f $90.00 $302.40 rovisions /� /�� //� Date , � Signature Warning: FailjSre to sefure workers' compensation coverage is unlawful, and shall subject an Plumbing $6.00 Grading employer to criminal penalties and civil fines up to one hundred thousand dollars ($100,000), in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest,and attorney's fees. Mechanical Issuance $29.00 I certify that I have read this application and state that the above/ Geo Review I Plan Check inform tion is correct. I agree to comply with all City Ordinances and fate laws and hereby authorize representatives of this City Issuance :approved Total Permit Fee to enter upon the ab. ,- -/' Toned property for inspection c I ?4?7.40 rposes A Xj I / 1 // 7..fir' Date Issued Permit Number Signature 'o rApplicaf"itt6r14gent bate �d� ,//1eCC 4/5/96 6099 I �(, FINANCE CODE CENSUS CODE Print Applicant's/Agent's Name C4 329 CONSTRUCTION LENDING AGENCI 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 NAME 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 UI LESS 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,FALSE WORK,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 HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT DIS. DIS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY. • BUILDING INSPECTIONS RECORD DATE^ INSPECTOR I I DATE INSPECTOR Setback/Location I `1/ //'-'1(• CY.. ) it Rough Plumbing I Temporary Power I Shower Pan Test I Foundation Reinforcing Steel G//G/ / ,--x---, Stucco Mesh or Exterior Siding I Excavation and Forms I // i/ "`P• (- C) • �) Insulation Slab Grade I Sewer I , Ground Plumbing Soil Interceptor I Ground Plumbing Water Septic Tank I Underslab Ducts Leach Line or Seep Pit I Underslab Conduit t/i a / may, Water Service I - Underslab Gas // vr._. ----- Lath or Drywall Nailing _ Fireplace Foundation • Gas Line Air Test I . /67--746 �/-6 Joists and Girders Final Energy I Electrical Ground Final Plumbing I Mid-Height Bond Beam Final Heating/A.C. II 8-Foot Bond Beam Final Construction I Final Bond Beam Final On Site Improvements Fireplace Bond Beam Final Off Site Improvements Roof Sheathing Final Dedication I Framing and Ventilation Final Zoning I ,- Roof Covering Final Electrical I i/�,//ci'7. ;.7)7Rough Heating Final Gas r/ '/ ,7 Service and Ground Developer Fees Paid I Rough Electrical , / Fire Dept. Approval Verified I Bonding G/M/1r!o Certificate of Occupancy I Over Head Electrical _ / I Fence Height '//2, / /1"---7 ) /I' I Gates I // , taw l Heater ' I Pool Drainage I I I //'2/7& ()7 (r/.,/74z --- r 1 z / 4 .•,t/ '-/':)% C//ll' /i,-tc. /` l-',, //( //'i Fin4 / />,e_ f) SEPTIC TANK GALS. SEEP. PIT X - LEACH LINE WIDE -- LONG X DEPTH OF ROCK N. W. E. S. Inspector's Signature and Initials DATE OF ISSUANCE PERMIT NUMBER '