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Permit No. 1058803522 15:10041-1.:_647> 3S a,p, 105-SAN BERNARDINO COUNTY—EPWA/LAND RANAGEMENT DEPT • t OS • OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 88 03522 225A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 11/21/88 I ISSUE DATE 11/21/88 I PG 1 OF 1 PARCEL NUMBER 1017-861-16-0000 PROPOSED USE: POOL CURRENT USE: RESIDENCE W/GARAGE TRACT 1000 13LOT 24 I SSEC E29 I O S 10SW PRCL MAP I PW 0ORCL ACTIVITY : L821 COMMUNITY PLAN ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS PUD RES 4 LOT DIMENSION IRREGULAR CONST TYPE APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER SMOGS ON LOT 1 GROUP DOLPHIN POOLS 12105 MENDOCINO PL *PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 30-159 CHINO CA 91710-0000 STD PLAN/ICBG 8630088225A FHA (714) 627 — 0756 E ITEM CNT DESCRIPTION DETAIL TOTALS OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER POOL PRIVATE 251.68 HICKS, SKIP AND BEVERLY MISC SUB—TOTAL 251.68 15919 OAK CANYON DR TOTAL AMOUNT 251.68 CHINO HILLS CA 91709-0000 (714) 597 — 0556 JOB SITE ADDRESS / 15919 OAK CANYON DR: CHINO HILLS CA 91709-0000 CROSS STREET OAKCREEK ROAD INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER DOLPHIN POOLS T SPAS CONT000353940 12105 MENDOCINO PL CHINO CA 91710-0000 (000) 000 — 0000 DTV. Or IND SAFPIY PERMIT: ��y MINIMUM SETBACK DISTANCES 45 FRNT SETBACK/CENTRLINE OAK CANYON DRIVE R/W 50 20 REAR SETBACl/PROP LINE 5 SIDE SETBACK/PROP LINE N 10 SIDE SETBACK/PROP LINE S MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES ( NO. DWELLING I NO. BEDROOMS I FLOOR UNITP � v; EXT. WALLS I INT. WALLS CEILING � �� 4 ' d9 a n 5.w zY it -o tr,Z r.. ROOF HEATING FIREPLACES �11Y '' ura P,,; METAL IMASRY F+£� L WATERN DEPTH F./100 SIZE NEW/REPAIR DAT PUBLIC I SEWER I MI'000 I S.000 10000 I COMMENTS ""'a3 AMT WAIVED .00 AMT PAID 251.68 PAYOR NAME: DOLPHIN POOLS PAID 11/21/88 RECEIPT 4707 EMPL: STACCATO—NYARI, M PAID BY : CHECK NBR : 1835 • •ICENSED 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 ASID PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT l/ 1126 /71/ /� L/ q !CENSE CLASS /3--/ L 5-3LICENSENUMBER 35-57 7 G CONTRACTOR "� /71' DATF /0? — /./ 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 ❑ 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 DATE 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 I POLICY NO COMPANY ❑ CERTIFIED COPY IS HEREBY FURNISHED ❑ CE 1E-0 COP i FILEDLWI T C NTY-BUILDING INSPECTION DEPARTMENT .7 per, PLICANT fila` 1 J/'L��\v DATE //6SO 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 WHICHJHIS_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 TE THAT THE A OVE INFORMATION IS CORRECT, I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANC AND STATE LAWS RELATING TO BUILDIN C NSTRUCTIO1J AND II EREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOV ENTIONED PROPERTY FOR INSPECTION PUR SE / /,�� / IGNATURE OF APPLICANT OR AGENT / DATE J --e/�� V // f V E)H'IRATION 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 /per - 0 3S-Z-7--- aa-S-A o/ tiwner'Name F I e_x_SIII— Permit Num /INSPECTION RECORD DATE INSPECTOR I DATE I INSPECTOR Setback /•.27$ct eebe Rough Plumbing Temporary Power Shower Pan Test Foundation Reinforcing Steel /•2 7, K:/Sri Stucco Mesh or Exterior Siding Excavation and Forms /•Q,. 9' d.i.<0 Insulation F.H A Foundation Req Sewer Slab Grade I Interceptor Ground Plumbing I Septic Tank Underslab Ducts I Leach Line or Seep Pit Underslab Conduit V.a7 Water Service -P--2._ cr-A3-8Y AAP Fireplace Foundation Lath or Drywall Nailing Joists and Girders Gas Line Air Test /$ V .P.249 4,2511 Electrical Ground 1 t•a7.410 029C Final Energy Mid-Height Bond Beam Final Plumbing 1 8-Foot Bond Beam Final Heating. S 3eri`��- Final Bond Beam Final Construction Fireplace Bond Beam Final On Site Improvements Roof Sheathing Final Off Site Improvements Framing and Ventilation Final Dedication ?<-fleet CovornigAar rer 4.-'15- `jr3 Final Zoning Rough Heating Final Electrical Electrical Service and Ground I Final Gas e _ -4., Rough Electrical L/�S, E.�.."I'' 1401 Developer Fees Paid WC (Y/N) Ind Saf (Y/N1"' Certificate of Occupancy a- *7-,P 9 YT-/ file.3-015d.o117,___ ri*1 Z-1-g9 G N i' "ovove-..off 44. , it.ri �G =` es?-Wit'C-K-M f'ati De'• '-i - - 4/$-Alec,r.,,,...._,L),,i.,,.,,es r -r-�c©y \--- --- Xy )-A-5-6-9* is, ...FL., .r.,tv a,..", V.17- 'mac e" SEPTIC TANK GALS in eft Ni :t+•. w ,ti. SEEP PIT X %OWE �?xti F 9 j LEACH LINF WIDE E.y X LONG X DEPTH OF ROCK Z+ N. /- 7 W E ko?N6?1 44 III: Ilioll 10 WI— S Inspector's Signature and Initials _-.iL ..- _ :/-"�"� 12-17589 469 Rev 3/88 /