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Permit No. 2012-25926 BUILDING DIVISION OF COMMUNRY DEVELOPMENT DEPARTMENT n . City of Chino Hills 14000 City Center Dr.,Chino Hills,CA91709 a . Counter Phone (909)364-2780 Building Permit 24-Hour inspection line (909)364-2790 (NOTE You must call before 3p.m.for a next business day inspection) City Hall Main Number (909)364-2600 <;.i •i,t,p MAI 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. (3)RETAINING WALLS TOTAL 103 LINEAR FEETx 4'HIGH(INCLUDING t'FOR FOOTING) 2012-25926 33570 BUILDING ADDRESS I APT./UNIT NO. ISSUED DATE ISSUED BY P 2069 OAK CANYON LN 5/11/2012 Heredia,Monica L/ APN 103106110 ITRACT10379-1 W/ I LLOT I FLOORS/UNITS I PROJECT PERMITS P.TYPE CENCUS CODES (CONST.TYPE (ZONING TYPE IRC UPANCY TYPE (VALUATION $700000 I TOTAL SOFT 0.001 SLOG.SOFT 434 Res Add/Alter V8 R-S Current Owners: Fees Name:GREG APOSTOLOU Fee Group/ Fee Description Fee Amount Payments Address. 2069 OAK CANYON CHNO HILLS CA 91709 Transaction Type Ph: 310366.9085 Retaining Wall- $239 21 Email: M@CH.ORG Residential Contractor SPLASH POOLS-SPLASH POOLS 8001 Permit Issuance Fee $53.00 53,00 Address' 14730 CENTRAL AVENUE CHINO CA 91710 8003 Residential Plan Check Fee $72.96 72.96 Ph' 909-816-1287 Email: m@ch.org tic.Information784292 Exo.Date:9/30/2012 B39-B53 Residential Structural Fee $112.25 112.25 UCENSED CONTRACTORS DECLARATIONLICENSED CONTRACTORS DECLARATION $61473 $100 1.00 I hereby affirm under penalty of pequry that I am licensed under provisions of Chapter 9(commencing with Sec.7000)of Division 3 of the Business and Professions Code,and my license is in full force and TOTAL FEES $239.21 effect. In secunng this permit I am acting with the knowledge of and on behalf of the owner of the Property. AMOUNT PAID $239.21 / " pate:c/I/ (2 Contractor. JR it. — BALANCE DUE c„..( $000 OWNER-BUILDER DECLARATION I hereby affirm under penalty of penury that I am exempt from the Contractors Licence Law for the following reason,(Sec,7031E,Business and Profesionai 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 DMsion 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 Sec 7031.5 by any applicant for a 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. lfhowever,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 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 article 3 of the Business and Professions Code. te: Permittee: Pnnt Full Name._ WORKERS COMPENSATION DECLARATION I hereby affirm under penalty of penury one of the following declarations: _ r .. 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 for which this permit is with all city and county ordinances and state laws relating to building construction,and hereby authorize issued. representatives of this city to enter upon the above-mentioned proptery for inspection purposes. I have and will maintain workers'compensation insurance,as required by Section 3700 of the Labor Code,for the performance of the work forwhich this permit is issued. My workers compensation Jr insurance careerand policy number are: / -/ S/r v I r 4 Cagle/CI' &fir 7a 407 IGC A/4.#. Policy APPLICANT SIGNATURE DATE (e ft 4-(Cl S— t LI--I I\— Applicant ELIZABETH COURTNEY I ceroty that in the performance of the work forwhich 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,and Address' 16011 BU i mRFIELD RANCH RD,#224 CHINO HILLS CA 91709 agree that if I should become subject to the workers compensation provisions of Section 3700 of the ph: 909-Bt6-1287 Labor Code,I shall forthwith comply with those provisions. Email: / Lie.Information Exp.Date: Date Si I'•ltE Applicant—.xtJ /90 w I certify that the user of this facility shall comply with sections 25506,25533 and 25534 of the Health and Safety Code,which regulate the storage,handling and use of hazardous matenals WARNING: Failure to secure workers compensation coverage is unlawful and shall subject an employer to cnminal penalities and civil fines up to one hundred thousand dollars($100,000),in addition to the cost of compensation,damages as proaded for in section 3706 of the Labor Code,interest,and attorney's fees