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Permit No. 1058802176 105 SAN BERNARDINO COUNTY-EPWA/LARD AGEMENT DEPT OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 88 02176 225A 01 I PAGE 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED APPI DATE 06/17/88 ISSUE DATE 06/27/88 PARCEL NUMBER 1017-841-13-0000 PROPOSED USE: SWIMMING POOL AND SPA CURRENT USE: RESIDENCE TRACT IBLK II SEC ITUI RUI PRCL MAP I PRCL COMMUNITY PLAN ZONE/ E DISTRICT( GENERAL PLAN 12625 000 313 SE29 G CHINOHILLS CH/PUD RES-4 SUBDIVISION NAME SUBDIVISION PARCEI NO LOT DIMENSION IRREGULAR (CONST TYPE VN 4BLDGS ON LOT 1 GROUP R3 APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 30-159 MALINS POOL CONSTRUCTION, INC. STD PLAN/ICBG FHA 12345 MILLS AVE *31 CHINO CA 91710-0000 GRADING INITIAL ACTUAL (714) 628 - 8734 CU.YDS EXC. CU.YDS. FILL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER KALITERNA, MIKE ITEM CNT DESCRIPTION DETAIL TOTALS 15985 OAK CANYON DR POOL PRIVATE 198.80 CHINO HILLS CA 91709-0000 MISC SUB-TOTAL 198.80 (714) 597 - 0129 TOTAL AMOUNT 198.80 JOB SITE ADDRESS COMPLETED 15985 OAK CANYON DR CHINO HILLS CA 91709-0000 Q_ CROSS STREET OAKCREEK RD DATE O 3Q- /9F� INSPECTN ACCESS �� CONTRACTOR NAME LICENSE NUMBER MALINS POOL CONST CONT0004388/4 MAILING ADDRESS, PHONE NUMBER 3857 SCHAEFER AVE UNIT #C CHINO CA 91710-0000 MINIMUM SETBACK DISTANCES 20 FRNT SETBACK/CENTRLINE P/L OAK CANYON DR FUN 50 20 REAR SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO STORIES I NO. DWELLING I NO. BEDROOMS I FLOOR UNIT EXT WALLS INT. WALLS CEILING ROOF I HEATING FIREPLACES METAL JMASRY PUBLIC WATER I SEWER I MIN NODEPTHI S•F./100IOSSIZZE! NEW/REPAIR 000COMMENTS STD POOL PLAN NO. 86-30088-225A. PRE-CONSTRUCTION INSPECTION REQUESTED. AMT WAIVED .00 AMT PAID 198.80 PAYOR NAME. MALINS POOL CONSTRUCTION. INC. PAID 06/17/88 RECETPT • 1970 EMPk_: RICHARDS, GARY •ICENSED CONTRACTORS DECLARATION• .... REBY AFFIRM THAT I AM LICENSED UNDER THE PROVISIONS OF CHAPTER 9 (COMMFwNCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND OFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE ANDEFFECT �f s � LIC SE CLASS C-g3 LICENSE NUMBER / 3 a` 741 . CONTRACTOR j4'-• 'w/ DATF g'`-��^ �" 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 [$500] I ❑ 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 (SEC 800, LAB (C_)C ('� _ POLICY NO // `L U P 1 COMPANY A ` . ❑ CERTIFIED COPY IS HEREBY FURNISHED TIFIED COPY IS F LED W THE COUNTY BUILDING INSPECTION DEPARTMENT APPLICANT �"\ DATF / // v a 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 DATF 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 ISA CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV C I 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 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 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 OVE-MENTIONED PROPERTY FOR INSPECTION PURP SES SIGNATURE OF APPLICANT OR AGENT r/-21 ---‘1" r DATE �� ^ / _ // EXPIRATION NOTICE APPLICATIONS FOR WHICH NO PERMIT IS ISSUED WITHIN 180 DAYS FOLLOWING THE DATE OF APPLICATION SHALL EXPIRE,EVERY PERMIT 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 ONE YEAR FROM DATE OF PAYMENT, ALL FEES PAID MAY NOT BE REFUNDABLE 12.17588-469 • • • INSPECTIaRECORD Permit Number /a '(9 f j S 3f, I DATE I INSPECTOR I I DATE I INSPECTOR Setback 16117 t2,44,. I 4,0 I Rough Plumbing Temporary Power I I Shower Pan Test Foundation Reinforcing Steel Lte_0 � I Stucco Mesh or Exterior Siding Excavation and Forms i I �J� I Insulation F.H A Foundation Req I I I Sewer Slab Grade ..47-'-Qtr- haa5 I Interceptor Ground Plumbing I I I Septic Tank Underslap DuctsI Leach Line or Seep Pit 7=-"IS.4. Underslab Conduit Water Service Fir oZya7 7- / 4 q , Lath or Drywall Nailing Joists and Girders Gas Line Air Test/rnb g-2-ref' /L' Electrical Ground 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 Roof Sheathing Final Off Site Improvements Framing and Ventilation Final Dedication Roof Covering Final Zoning Rough Heating Final Electrical 5- '-Er /COW Electrical Service and Ground •ar' 7JA Final Gas Igx--s'E If. ��Rooyugh��Electrical �� A, Developer Fees Paid TC/�e t - - ?-,X,3.17' afa Certificate of Occupancy I WORKERS' COMPENSATION INSURANCE (YIN) C U M N L E I F n DIVISION OF INDUSTRIAL SAFETY PERMIT (YIN) „Ifr cy J2,,-)_S // - SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDE X LONG X DEPTH OF ROCK N W A E i 7//( 7/1 10/ea-C 2-C,A 77-4/5. / AA - . _, S Inspector's 1r Signature and Initials �1 !� V 12-17559-489