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Permit No. 2012-25748 hBUILDING DIVISION OF COMMUNITY DEVELOPMENT DEPARTMENT 4,�Ii City of Chino Hills .„ 14000 City Center Dr.,Chino Hills,CA91709 {+ • "'= Counter Phone (909)364-2780 a ' ' Building Permit 24-Hour Inspection Line (909)364-2790 (NOTE.You must call before 3p.m.for a next business day inspection) City Halt Main Number (909)364-2600 NOTICE: THIS PERMIT BECOMES NULL AND VOID IF WORK IS NOT COMMENCED WITHIN PLEASE USE PERMIT NUMBER 180 DAYS FROM DATE OF ISSUANCE,OR IF WORK IS SUSPENDED AT ANY TIME FOR MORE BELOW WHEN MAKING INQUIRIES THAN 180 DAYS OR IF WORK IS DONE IN VIOLATION OF ANY CITY OR STATE LAWS OR REQUESTING INSPECTIONS RELATING THERETO. PROJECT DESCRIPTION PROJECT No. I PERMIT No. POOL&SPA 2012-25748 33393 BUILDING ADDRESS I APT.I UNIT NO. ISSUED DATE ISSUED BY 0 2069 OAK CANYON LN 4/1212012 Beeler,Melissa / 103106110APN I TRAC MAP,/ IL T I FLOORS/UNITS I PROJECT PERMITS P.TYPE 43 / CENCUS CODrAdd/Alter CONST.TYPE 'ZONING TYPE I OCCUPANCY TYPE I VALUATION $28000.00 I TOTAL SOFT 0001 BLDG.SOFT 434_ -3 Current Owners: Fees Name:GREG APOSTOLOU Fee Group l Fee Description Fee Amount Payments Address. 2069 OAK CANYON CHINO HILLS CA 91709 Transaction Type Ph. 310-385-9085 Pool&Spa $723.65 Email: M@CH ORG - Contractor SPLASH POOLS-SPLASH POOLS 8001 Permit Issuance Fee $53.00 53.00 Address: 14730 CENTRAL AVENUE CHINO CA 91710 8078 Private Swimming Pool $96.00 9600 Ph- 909-815-1287 Email- m@ch.org Lit Intormation784292 EKG.Date:9/30/2012 8143 Water Piping System New/Repair $6.40 6.40 LICENSED CONTRACTORS DECLARATIONLICENSED CONTRACTORS DECLARATION 8150 Gas Pipe Syst-Up to 4 Outlets $6.40 6.40 I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9(commenting with Sec.7000)of Division 3 of the Business and Professions Code,and my license is in full force and 839-853 Residential Structural Fee $339.30 339.30 effect. In securing this permit I am acting with the knowledge of and on behalf of the owner of the property 8003 Residential Plan Check Fee $220.55 220.55 Nee Date. II/1 / Contractor. Cil / (�� �/ ` '/� (�/ S81473 82.00 2.00 �(' 11 TOTAL FEES $723.65 OWNER-BUILDER DECLARATION AMOUNT PAID $723.65 I hereby affirm under penalty of perjury that I am exempt from the Contractors Licence Law for the following reason,(Sec,7031.5,Business and Profesional Code: Any dty or county which requires a permit to construct,alter,Improve,demolish or repair any structure,prior to its issuance,also requires the BALANCE DUE $0.00 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)orthat he or she is exempt therefrom and the basis for the alleged exemption Any potation of Sec 7031.5 by any applicant fora permit subjects the applicant to a civil penalty of not more that five hundred dollars($500.00) I,as owner of the propterty,or my employees with wages as their sole compensation,will do the work,and the structure is not intended or offered for sale(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 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 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 Contractor's 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 underartide 3 of the Business and Professions Code. Date Permittee' Print Full Name' WORKERS COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations. I have and will maintain a certificate of consent to self-insure for workers'compensation,as I certify that I have read this application and state that the above information is correct. I agree to comply provided for by section 3700 of the Labor Code,for the performance of the work farwhrch this permit is with all dty and county ordinances and state laws relating to building construction,and hereby authonze issued. representatives of this city to enter upon the above-mentioned proptery for inspection purposes. C-.4. /v �7-/'�I have and will maintain workers'compensation insurance,as required by Section 3700 of the L' [ I Labor Code,for performance the work forwhich this permit i issued. My workers compensation ,y}VV) ( //jj, vJ_ // ti f tfo/+ - insuance carrierantl policy nu �are(n/ PIS jUf ) /(J (�/f/ M . �� t•4 `-7 / / -n ff Caper to Y 31 c .J Policy L el#APPLICANT SIGNATURE DATE )(l Applicant. BRIAN TADEO ( t I certify that in the performance of the work for which this permit is issued,!Shall not employ any \ l person in any manner so as to become subject to the workers compensation laws of California,and Address: 14730 CENTRAL AVE CHINO CA 91710 agree that if I should become subject to the worker's compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with those provisions. Ph. 951-235-9605 Email: 'I Lie.Information Exp.Date: Da'-: Si, L� r Applicant. {7 A )19aMa I certify that the user of this facility shall comply with sections 25506,25533 and 25534 of the Health and W' j' /j Safety Code,which regulate the storage,handling and use of hazardous matenals WARNING: Failure to min ire - s co War ...n coverage is ands , subject an employer to cnminal penaires and civil fines up to one hundred ousand*Mars($100,000),in addition to the cost of compensation,damages as provided for In section 06 of, -Labor Code,interest,and attorney's fees.