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Permit No. 1058801451 4 105 SAN BERNARDINO COUNTY-EPWA/LAND M7IT4AGEMENT DEPT • OFFICE OF BUILDING AND SAFETY P E RMT T APPLICATION PERMIT NBR 105 88 01451 225A 01 I PAGE 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 04/06/88 ISSUE DATE 00/00/00 PARCEL NUMBER 1017-841-25-0000 PROPOSED USE: SWIMMING POOL CURRENT USE: RESIDENCE TRACT 1 BLK 1I SEC I � 0W PRCL MAP I PRCL MNOPLAN ZONE/ USE DISTRICT( GENERAN 12625 000 328 SE29 8CHIHILLSCH/PUD RES-4 SUBDIVISION NAME SUBDIVISION PARCEL NO LOT DIMENSION IRREGULAR (CONST TYPE #BLDGS ON LOT 1 GROUP APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER #PLANS RECD 2 LAND USE PLOT 0 (INDEX NBR 30-160 POOL PLANS INC STD PLAN/ICBO 8630088225A FHA 11022 E ACAICA PKWY GARDEN GROVE CA 92640 GRADING INITIAL ACTUAL (714) 636 - 0294 CU.YDS. EXC. CU.YDS. FILL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER REICH, ARTIE AND PATTI ITEM CNT DESCRIPTION DETAIL TOTALS 3038 OAKCREEK RD PRIVATE POOL STD PL 165 80 CHINO HILLS CA 91709-0000 MISC SUB-TOTAL 165.80 (714) 597 - 6056 TOTAL AMOUNT 165.80 JOB SITE ADDRESS 3038 OAKCREEK RD CHINO HILLS CA 91709-0000 CROSS STREET OAK CANYON DRIVE INSPECTN ACCESS CONTRACTOR NAME LICENSE NUMBER MAILING ADDRESS, PHONE NUMBER MINIMUM SETBACK DISTANCES 45 FRNT SETBACK/CENTRLINE OAKCREEK RD R/W 50 20 REAR SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE 10 SIDE SETBACK/PROP LINE N T 1 0 MECHANICAL EQUIP N01 PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES I NO. DWELLING ( NO. BEDROOMS ( FLOOR COMPLFTED UNITS DATE: IEXT. WALLS INT WALLS CEILING � ROOFHEATING FIREPLACES I (METAL IMASRY PUBLIC WATER I SEWER I MINNODDEPTH1 S F./l0O(III SIZE NEW/REPAIR 000 COMMENTS POOL CONTRACTOR: MALINS POOLS INC 2345 MILLS AVE #31 CHINO, CA 91710 CONTRACTOR LICENSE NO. 438874 LICENSE AND W/C VERIFIED AMT WAIVED .00 AMT PAID 165.80 PAYOR NAME. MALINS POOLS INC PAID 04/06/88 RECEIPT 689 EMPL: RICHARDS, GARY ., •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,/vYAND MY LICENSE IS IN FULL FORCE AND EFFECT / 01 l C. LICENSE CLASF - 3 LICENSE NUMBER 1 ,7 9 8 7` CONTRACTOR A `\N DATE 4--N-,E? 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 [$500]I ❑ 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 DATE 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 0,3800,'LLAB C(. 5. --(:5?‘ 1 `' POLICY NO \1 1r 1� 1 -- 1 COMPANY 1—A \ R i•Zo n + K\❑ CERTIFIED CbPY IS HEREBY FURNISHED ❑ CERTIFIED C�OPYY{IS FILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT V\ V APPLICANT v` `rSYP�A t -� DATF (1 I 1 cY CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$1001 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 IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV C 1 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 1 El 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 121MINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECT ON PURPOSES L�+ SIGNATURE OF APPLICANT OR AGENT V`^'! Q 1..-11 DATE ` -1 \ ----'\-1 `ZJC f7 EXPI4ATION 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 r • f S INSPECTION RECORD Permit Number /OS— 87-ONV- 2Zr-9-OJ DATE I INSPECTOR DATE I INSPECTOR Setback I4 Zco 8e ki/.O Rough Plumbing Temporary Power Shower Pan Test Foundation Reinforcing Steel 4,f(G 6 6 I ,0/;S Stucco Mesh or Exterior Siding Excavation and Forms 4.f.4 88 I , Insulation F.H A Foundation Req I Sewer Slab Grade I Interceptor Ground Plumbing I Septic Tank Underslap Dwell• �� - 4 20 S is 4/-A Leach Line or Seep Pit Underslab Conduit Water Service Fireplace Foundation I Lath or Drywall Nailing Joists and Girders I Gas Line Air Test 4.a 86 A06 Electrical Gretrr►d 1Q4/zD 4a t3ls x.,/43 Final Energy Mid-Height Bond Beam Final Plumbing 8-Foot Bond Beam Final Heating/A.0 oP'-'77.PrI Final Bond Beam Final Construction 45-220- Fireplace 5Z2i'rFireplace Bond Beam Final On Site Improvements r Roof Sheathing Final Off Site Improvements I Framing and Ventilation Final Dedication I Roof Covering Final Zoning I Rough Heating Final Electrical 1,42"-V,'"Crr &o." Electrical Service and Ground Final Gas 14,-� orr Rough Electrical Developer Fees Paid I Certificate of Occupancy I • WORKERS' COMPENSATION INSURANCE (YIN) DIVISION OF INDUSTRIAL SAFETY PERMIT (Y/N) - _ d. 13R c,v-)=7RE .U,v/T� ,cam4 xz0 le 7- 4"z ,e& .5"--/2- (:c-S" CAI - 006.. EQ ri iO/rl ENT -a-iv c eo A-cii i AtO i -c) ,QEA2 v/i€D SHAG. - �:f,.•- - G--/©- t/T t -F° ecII-47..-0.4.46 ... --,a, S'i(Gry 4 w1er 4- i3-fri e,,•13.x'do r PAvasibr -ZZ- .41-R,4,4- boo --r-e) c Li VAieD Z0L.7-61) d Ackw A aaP SEPTIC TANK GALS SEEP PIT X rwiarr iR ., a LEACH LINE WIDE kt.0it g ' X LONG X DEPTH OF ROCK Ir w? /" g"�A ir T'� �, N _ I A r LEg ° I 0 1A) k L ` r leit, W E i ,.....,-- , ,410 ilL.461...47 AileSesimairg.awr, 4::::; -- S Inspector's Signature and Initials .9/6 ..12-17589-469