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Permit No. 1058801051 101, SAN BERNARDINO COUNTY-EPWA/LAND NAGEMENT DEi'i OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 88 01051 225A 01 ! PAGE 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 02/04/88 ISSUE DATE 02/09/88 PARCEL NUMBEP 1017-841-26-0000 PROPOSED USE: POOL AND SPA CURRENT USE: RESIDENCE AND GARAGE 12625T I BLK I 329LOT I SE29SEC I p NS I USW I PRCL MMAP I PRCL 0CCOMMUNITY O HILLS RES ZONE/LLANND USE DISTRICT( GENERAL PLAN 000SUBDIVISION NAME SUBDIVISION PARCEL NO LOT DIMENSION IRREGULAR (CONST TYPE #BLDGS ON LOT 1 GROUP APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER #PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 30-159 POOL PLANS INC STD PLAN/ICBO 8630088225A FHA 11022 E ACAICA PKWY GAROLN GROVE CA 92640 GRADING INITIAL ACTUAL (7341 636 - 0294 CU.YDS. EXC. CU.YDS. FILL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER STOVALL, ROBERT ITEM CN1 DESCRIPTION DETAIL TOTALS 3044 OAKCREEK ROAD PRIVATE POOL STD PL 165.80 CHINO HILLS CA 91709-0000 MISC SUB-TOTAL 165.80 1 ) - TOTAL AMOUNT 165.80 JOB SITE ADDRESS 3044 OAKCREEK ROAD CHINO HILLS CA 91709-0000 CROSS STREET OAK CANYON DRIVE INSPECTN ACCESS CONTRACTOR NAME LICENSE NUMBER MAILING ADDRESS, PHONE NUMBER , MI1iU17 SETBACK DISTANCES TNoN TA20 FRNT SETBACK/CENTRLINE P/L OAKCRFEK ROAD R/W 50 RI 1[) 1 5 REAR SETBACK/PROs' LINE n k..?0/4 PL ETED 5 SIDE SETBACK/PROP LIIJE N DA �°, l0 SIQE SETBACK/PROP LINE S �+e / f Ai.0 !!;; '-''' MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIESI NO. DWELLING \ NO. BEDROOMS FLOOR UNITEXT. WALLS I INT. WALLS I CEILING ROOF I HEATINGI FIRELACES METAL IMASRY WATER PUBLIC (PUBLIC SEWER I MI000EPTHI S 000100I0000EI NEW/REPAIR COMMENTS 5' REAR P/L SETBACK FOR POOL AND SPA ONLY POOL VALUATION 512,000 AlIT WAIVED .00 AMT PAID 165.80 PAYOR NAME: MALINS POOL CONST. INC. PAID 02/04/88 RECEIPT 212 EMPL: STACCATO-NYRI, M • •ICENSED CONTRACTORS DECLARATIONS e" s I HEREBY AFFIRM THAT I AM LICENSED UNDER THE PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND OFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT x C� / ? �{ CENSE CLASS C. 3 LICENSE NUMBER 'C v 7 I CONTRACTOR /4/i /5 ��` DATE_&;;•-• -` ir- 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$5001 1 ❑ 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 DATF 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 1 0 / POLICY NO 1 /ra.*S.0 / COMPANY / 'l2rel( , + ❑ CERTIFIED COPY IS HEREBY FURNISHED CI CERTIFIED COP I ILED THE COUNTY BUILDING INSPECTION DEPARTMENT APPLICANT / ."""1 �/DATF 9-- (5).......5....... / r • t CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [5100] 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 i 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 IS A 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 kr.-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 T BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECT,JN P POSES r- �� SIGNATURE OF APPLICANT OR AGENT // .-9 �v / DATE 7"--//L/ / L // / / EXPIRATION NOTICE APPLICATIONS FOR WHICH NO PERMIT IS ISSUED WITHIN 180 DAYS FOLLOWING THE DATE OF APPLICATION SHALL EXPIRE,EVERY PERMIT 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 ONE YEAR FROM DATE OF PAYMENT, ALL FEES PAID MAY NOT BE REFUNDABLE 12-17588-489 ♦, • • ^ • INSPECTION RECORD Permit Num berjQ6 /'0S 1 aI,S6c)l DATE I INSPECTOR I DATE INSPECTOR Setback 212,80 �j Rough Plumbing Temporary Power Shower Pan Test Foundation Reinforcing Steel /�88 /$ Stucco Mesh or Exterior Siding Excavation and Forms ,[/,�g 8 Dei Insulation F H A Foundation Req Sewer Slab Grade Interceptor Ground Plumbing I I S pt c T5flk rkAl6E 8 s3 Q L07.6 Underslap Daets (ytL'S I,7� sLeach Line or Seep Pit Underslab Conduit It Water Service Fireplace Foundation Lath or Drywall Nailing _ Joists and Girders I Gas Line Air Test 2'L t /j Electrical 6s ward Oa IN fl voce Final Energy Mid-Height Bond Beam Final Plumbing 8-Foot Bond Beam Final Heating/A.0 I A Final Bond Beam Final Construction 11] i7 �e, Fireplace Bond Beam Final On Site Improvements Roof Sheathing Final Off Site Improvements Framing and Ventilation Final Dedication Roof Covering Final Zoning Rough Heating Final Electrical f"J..t2.--Scr4V-2 Electrical Service and Ground Final Gas Rough Electrical 2)7 3 ���l�j Developer Fees Paid Certificate of Occupancy WORKERS' COMPENSATION INSURANCE (YIN) DIVISION OF INDUSTRIAL SAFETY PERMIT (YIN) E A/ I1Q /447. rEr A /488 LQ A YYA'x A 46 .Zitles ' /4363,'Q8a C J w� ac. OTARgO COMPLETEP Ate.r' -' SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDF X LONG X DEPTH OF ROCK N. W E 4/ 7/ /7 S ' Inspector's Signature and Initials -/�—.4 1 ,' / - 12-17589-489