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Permit No. 19881 (2) BUILDING ADDRESS: 2128 OAK CANYON LANE PERMIT NUMBER: 19881 J � � . " BUILDING INFORMATION APPLICANT INFORMATION' ' BUILDING PERMIT APPLICATION Address 2128 OAK CANYON LANE Name JENNIFER LINT 1.70 7;95„ Community Development APN 11031-051404 Address 13777 AMARILLO AVENUE 2001 Grand Avenue ~:r--.-- Lot 148 l City,Z,p Code CHINO,CA 91710 « . Chino Hills,CA 91709 z.'; Cross Streets 1CHINO HILLS PARKWAY Phone/Pager (909)628-8734 I ext I an Or 10 HILS .... ,.... LICENSED CONTRACTOR DECLARATION Tract/Parcel 110379-1 City Bus Lic# 02-02973 I hereby affirm that I'm licensed under the provisions of Chapter 9(commencing with Section Valuation 1$25,000 00 ENGINEER/ARCHITECT INFORMATION 7000 of Division 3 of the Business and Professions Code)and my license is in full force and effect OWNER INFORMATION Name RON LACHER OWNER BUILDER DECLARATION Name GORGONE Address 1201 N TUSTIN AVENUE I hereby affirm that I'm exempt from the Contractor's License Law for the following reason Address 2128 OAK CANYON LANE City,Zip Code ANAHEIM,CA 92807 I,as the owner of the property,or my employees with wages as their whole City,Zip Code CHINO HILLS,CA 91709 Phone 1 1 ext ® compensation,will do the work,and the structure is not intended or offered for sale Phone (909)393-9404 1 ext • Lic 4 1 r I,as owner of the property,am exclusively contracting with licensed contractors to0 City Bus Lic 4 construct the project Bus Lic# I am exempt under Section I BPC for this reason Bus Exp APPROVAL INFORMATION 111 WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION Issued By DAWN FORSHA Contractor MALINS POOLS I hereby affirm under penalty of perjury one of the following declarations Date Issued 4/23/02 Address 13777 AMARILLO AVE I have and will maintain a certificate of consent to self-insure for workers'compensation Finance Code C4 ® as provided by Section 3700 of the Labor Code,for the performance of the work for City,Zip Code 1CHINO,CA 91710 Census Code which this permit is issued Phone or Pager 1(909)628-8734 ext 1 Final Date /0/l7(y?` _ e /__H Bus Lic# 02-02478 Final By (_ /��„��J" I have and will maintain workers'compensation,as required by Section 3700 of the C) Labor Code,for the performance of the work for which this permit is issued My Lic # 438874 Extension workers'compensation insurance carrier and policy number are Exp Date 7/01/02 Reviewed By GREG MCNICOL INSURANCE INFORMATION Lic Clas C-53 J Approved By GREG MCNICOL Insurance Company STATE FUND PROJECT INFORMATION Policy Number 1649104-01 PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date 17/1/02 1 1 1 Structure 0 Section need not be completed if permit is for one hundred dollars($100)or less Garage 4,1 certify that in the performance of the work for which this permit is issued I shall not employ Patio ny person in any manner so as to become subject to the Workers'Compensation Laws of Porch California and agree that if I should become subject to the workers'compensation provisions of Other POOL/SPA REAR Section 3700 of the Labor Code I shall comply with those(nprovisions 11 D Lil PROPOSED USE POOL/SPA Date: I7A2///6 2-I Signature: I / _��1 �A tis application and state that the abtfve informatio is correct I agree to comply with all City Ordinances and state laws and hereby authonze r resentatives of this City to COMMENTS enter upon the above mentioned property for inspection purposes Date: I I Signature OTHER FEES REQUIRED ZONING SETBACKS GRADING PRIOR TO ACTUAL PERMIT PERMIT FEE INFORMATION ISSUANCE Zoning PD Front Yard 30 Over X 0 Issuance $29 00 1 Electrical $90 00 Land Use FR-1Side Yard 15/15 Plan Check $0 00 Plumbing $0 00 I $421.40 I Plan POOL Rear Yard 15 Fill 0 Development NO 1 Cut 0 School NO Permit Fees: SMTP Sewer NO 1 Mechanical $0 00 Sti uctural $302 40 $0 00 Occ 1R3 SSY Total 0 Type 1VN Water NO 1 Geo Review $0 00 Grading $0 00 Total Fee Due 1 $421.40 1 NISPECTION RECOR• ! Permit Number Inspection Date Inspector Inspection Date Inspector Grading: Pregrade Meeting FINAL INSPECTIONS(Inspector verify following) RQugh Grade NO OCCUPANCY PERMITTED WITHOUT FINAL! Terraces County Environmental Sub Drains Health Dept Finish Grading Planning Dept Soils Certification Public Works Grading Certification Fire Rough Landscape As Built Approved Underground Site Inspections: ALL ABOVE MUST BE APPROVED BEFORE FINAL BLDG Building Sewer Final Grade U G.Waste Plumbing Final Electnc Water Service Final Plumbing Storm Drain/Catch Basins Final Mechanical U/G Conduit/Electncal Final Building/Construction /tyro 7 elr Compaction Report Water Meter Number ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION Footings CERTIFICATE OF OCCUPANCY UFER Ground (Rebar/Copper) Hardware/Hold-Downs Piers/Caissons/Tendons OTHER: Slab Grade DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED Shear Roof Nailing • Exterior Walls Interior Walls Hardware/Hold-Downs Rough Electnc Rough Mechanical Rough Plumbing/Topout Framing COVER NO WORK UNTIL ABOVE IS APPROVED Insulation Drywall Intenor/Extenor Lath Stucco Scratch Roof Covenng Block Wall Inspections : Footing, ReBar 1st Lift Bond Beam 2nd Lift Bond Beam 3rd Lift Bond Beam Drain/Seal SWIMMING POOLS : Location/Rebar/Bonding/Light •Sfl¢/at- Gr Conduit Ro Elect POOL NOT TO BE FILLED UNTIL FENCING IS COMPLETE Fence, Gate&Alarm ; Final Pool • 170)- Temp Power Pole Electric Release Gas Test SIs'/v(,, . 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