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Permit No. 1058901218 001 4v D S9-/ 4) 1(?, SAN BERNARDINO COUNTY-EPWA/LAND•AGEMENT DEPT - - ----� OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATIO'( PERMIT NBR 105 89 01218 225A 01 STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED - APP( DATE 04/25/89 I ISSUE DATE 05/10/89 I PG 1 OF 1 PARCEL NUMBER 1017-841-06-0000 PROPOSED USE: POOL AND SPA CURRENT USE: RESIDENCE W/GARAGE TRAC BLK LOT SEC NG 12625T ! 000 1306 I SE29 10802S `PRCL MOAP PORCACTIVITY •L COMMUNITY PlANL821 ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS PUD LOT DIMENSION 43 X 120 CONST TYPE APPLICANT NAME) MAILING ADDRESS, AND PHONE NUMBER *BOGS ON LOT 1 (GROUP SAHARA POOLS, INC. - JUDY JERKINS 550 CIENEGA AVE AB *PLANS RECD 0 LAND USE PLOT 0 INDEX NBR 30-159 SAN DIMAS CA 91773-0000 STD PLAN/ICBO 8630088225A FHA (714) 599 - 9333 ITEM CNT DESCRIPTION DETAIL TOTALS OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER POOL PRIVATE 251.68 IRVINE, GREG AND CONNIE MISC SUB-TOTAL 251.68 15974 OAK CANYON DR TOTAL AMOUNT 251.68 CHINO HILLS CA 91709-0000 (714) 597 - 2756 JOB SITE ADDRESS 15974 OAK CANYON DR CHINO HILLS CA 91709-0000 CROSS STREET OAKCREEK ROAD INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER SAHARA POOLS INC CONT000350250 5508 CIENEGA SAN DIMAS CA 91773-0000 (000) 000 - 0000 PTV. OF IND. SAFETY PERMIT: MINIMUM SETBACK DISTANCES 20 FRNT SETBACK/PROP LINE 20 REAR SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE ONTANO NO. STORIES I UUNNITSWELLING I NO. BEDROOMS I FLOOR T ED EXT. WALLS INT. WALLS I CEILING ROOF HEATING FIREPLACES Elf 7 METAL IMASRY PWATER IR IP SEWERR I MINODEPTHI S.F./100I000OSIZEI NEW/REPAIR COMMENTS AMT WAIVED .00 AMT PAID 251.68 PAYOR NAME. SAHARA POOLS, INC. PAID 04/25/89 RECEIPT 2199 EMPL: STACCATO-NYARI, M PAID BY : CHECK NBR : 14955 .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 AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT LICENSE CLASS d."S? LICENSE NUMBER SC-27 CONTRACTOR /ii 'f� DATF • 9 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 [$5001 ) ❑ 1,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 HAKE A CERTIFICATE OF CONSENT TO SELF-INSURE OR A CERTIFICATE OF WORKERS'COMPENSATION INSURANCE OR A CERTIFIED COPY THEREOF (SEC 3800, LAB C) POLICY NO 4 n,14&) -88 COMPANYS?-?•>' �d/CJ71 ❑ CERTIFIED COPY IS HEREBY FURNISHED CERTIFIED CO Y S FILL WITH THE COUNTY BUILDING INSPECTION DEPARTMENT APPLICANT /.7?' "77, �e� DATF •S' /�X/y9 CERTIFICATE OF EXEMPTION FROM WORKERS'COIOIPENSATION 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) 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 INSPECTI PURPOSES 77 � SIGNATURE OF APPLICANT OR AGENT .• /. �� 4:2 DATE S`�©rY1 EXPIRATION Af( 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 — Owner Name (VLA-e- 0- Permit Numbc60c 9 0/2 f k 0-.-.c,),6--4--0/ INSPECTION RECORD DATE INSPECTOR I DATE INSPECTOR A- _ Setback FiXf 1.... I $%1Q-f-0 I "-5 Rough Plumbing Temporary Power I I Shower Pan Test Foundation Reinforcing Steel167144.4-9 lStucco Mesh or Exterior Siding Excavation and Forms ./Q _9`' 4 Insulation F H A Foundation Req I I Sewer Slab Grade I I Interceptor Ground Plumbing A 11.5_ p4�5- f 4 I fj,��j Septic Tank Underslab'ea � c4.7-4, vC/` 'p ... Leach Line or Seep Pit Underslab ConduitafrT.. 06.oyf.1 r .Y 60 Water Service Fireplace Foundation Lath or Drywall Nailing Joists and Girders Gas Line Air Test .-( &, Electrical Ground Final Energy Mid-Height Bond Beam Final Plumbing 8-Foot Bond Beam Final Heating/A C Final Bond Beam Final Construction V-4(.31- Fireplace Bond Beam Final On Site Improvements Roof Sheathing Final Off Site Improvements Framing and Ventilation Final Dedication Roof Covering Final Zoning s Rough Heating Final Electrical R „� Electrical Service and Ground n Final Gas �,:r Rough Electrical (90.21,j. 9' `/A1 Developer Fees Paid I WC (YIN) Ind Saf (Y/Nj Certificate of Occupancy I I C- 2 2- 8C d iv /• 3 aIC Tb ZTivp p IVO ao a c..0.v ca.-P.-.44.4.- t.....4 ti., r- p )LY 10-ter A'A --Q,Y. 1LAA)i 1-06 GSM hlG: L'G#J-f 06.23. 9 .V. SEPTIC TANK GALS SEEP PIT X ... . ■ LEACH LINE WIDF M ,' ..1�� ' ';Is`t�L X LONG X DEPTH OF ROCK N ; rm F! "r II. /1 Of A1,9 W E _ ^„ ���I A n A S Inspector's Signature and Initials �t3G1/ --- 12 17589-469 Rev 3/88