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Permit No. 1058802964 105 SAN BERNARDINO COUNTY-EPWA/LAND AGEMENT DEPT • OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 88 02964 225A 01 I PAGE 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 09/16/88 ISSUE DATE 09/27/88 PARCEL NUMBER 1017-861-12-0000 PROPOSED USE: SWIMMING POOL AND SPA CURRENT USE: RESIDENCE TRAC LOT SEC RNG 12625T 1000 1297 I SE29 1025 1088W I PRCL 00AP I PRCL ACTIVITYCOMMUNITY PLANL821 N ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/PUD \ LOT DIMENSION IRREGULAR CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER TtBLDGS ON LOT 1 (GROUP R3 MALINS POOLS INC. 12345 MILLS AVE *31 *PLANS RECD 2 LAND USE PLOT 0 IINDFX NBR 30-]5O CHINO CA 91710-0000 STD PLAN/ICBO FHA (714) 628 - 8734 GRADING INITIAL ACTUAL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER CU YDS. EXC. BERG, DAVID CU.YDS. FILL 15904 OAK CANYON DR CHINO HILLS CA 91709-0000 ITEM CNT DESCRIPTION DETAIL TOTALS (714) 597 - 8494 POOL PRIVATE 251.68 MISC SUB-TOTAL 251.68 JOB_SITE ADDRESS , TOTAL AMOUNT 251.68 15904 OAK CANYON DR CHINO HILLS CA 91709-0000 COMPLETED CROSS STREET OAKCREST DR INSPECTN ACCESS DATE /O 3f-'' ''t' ')4 CONTRACTOR NAME LICENSE NUMBER MALINS POOL CONST CONT000438874 MAILING ADDRESS, PHONE NUMBER 3857 SCHAEFER AVE UNIT *C CHINO CA 91710-0000 MINIMUM SETBACK DISTANCES 45 FRNT SETBACK/CENTRLINE OAK CANYON DR R/W 50 20 REAR SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE 10 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES NO. OITDWELLING NO. BEDROOMS FLOOR UNEXT. WALLS INT. WALLS 1 CEILING ROOF HEATING FIREPLACES METAL IMASRY PUBLICWATER I SEWER I MINODEPTH' S.00O100IOOOOEI NEW/REPAIR COMMENTS STANDARD POOL PLAN NO. 86-30088-225A. PRE-CONSTRUCTION INSPECTION ORDERED. AM1 WAIVED .00 AMT PAID 251.68 PAYOR NAME: MALIKS POOL CONSTRUCTION, INC. PAID 09/16/88 RECEIPT 3494 EMPL: RICHARDS, GARY ',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 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 1$500] ) ❑ 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 3800, LAB C 1 t t,) POLICY NO '.. - COMPANY ❑ CERTIFIED COPY IS HEREBY FURNISHED ❑ CERTIFIED COPY IS FILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT APPLICANT DATF 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 ISA 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 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 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 DATF EXPIRATION NOT ICE 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 . - - - 7654- e31.2 6 ,,:z.2S-A 0/ Owner Name ._ ____ � Permit umb INSPECTION RECORD DATE I INSPECTOR I I DATE I INSPECTOR Setback 1/o. .. S4,- I Rough Plumbing Temporary Power I I Shower Pan Test Foundation Reinforcing Steel VP' -. Q - I Stucco Mesh or Exterior Siding Excavation and Forms J , -3 -SF r-r*/ eC) I Insulation F H A Foundation Req. I I Sewer Slab Grade I I Interceptor Ground Plumbing ( I Septic Tank Underslab Ducts _ I Leach Line or Seep Pit Underslab Conduit I `/4" e-•"" I Water Service Fireplace Foundation I Lath or Drywall Nailing n Joists and Girders Gas Line Air Test Alf «?1Pir " 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 ZoningCrd-PtE4111 n Rough Heating Final Electrical V Electrical Service and Ground ,� Final Gas T Rough Electrical X 4 Developer Fees Paid I E WC (YIN) Ind Saf (Y/NI Certificate of Occupancy I /o - /y-g �ivctc s Gi T= c:9/t" `'.5.- /--A/ -R8 tom, L PLI4L Ok SEPTIC TANK GALS SEEP PIT X LEACH LINF WIDF X LONG X DEPTH OF ROCK N W E - A v Inspector's Signature and Initials .r/Yl / G�ea��f !� I ' 12-17589.489 Rev 3/68