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Permit No. 1058802456 105 SAN BERNARDINO COUNTY-EPWA/LAND AGEMENT DEPT • OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 88 02456 225A 01 I PAGE 1 OF 1 THIS IS NOT A PERMIT IRITIL ISSUED AF?L DATE 07/14/88 ISSUE DATE 08/12/88 PARCEL NUMBER 1017-831-15-0000 PROPOSED USE: SWIMMING POOL AND SPA CURRENT USE: RESIDENCE TRAC LOT SEC IVITY : 126257 I 000 1342 I SE29 102S 10SW I PRCL 00AP I PRCL COTMMUNITY PLANL821 ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/PUD RES-4 LOT DIMENSION 55X125 CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER 4BLDGS ON LOT 1 GROUP R3 MALINS POOLS INC. 12345 MILLS AVE R31 *PLANS RECD 2 LAND USE PLOT 0 INDEX NBR 31-159 CHINO CA 91710-0000 STD PLAN/ICBO FHA (714) 628 - 8734 GRADING INITIAL ACTUAL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER CU.YDS. EXC. JONES, BILL CU.YDS. FILL 3126 OAKCREEK RD CHINO HILLS CA 91709-0000 ITEM CNT DESCRIPTION DETAIL TOTALS (714) 597 - 9666 POOL PRIVATE 198.80 MISC SUB-TOTAL 198.80 JOB SITE ADDRESS TOTAL AMOUNT 198.80 3126 OAKCREEK RD CHINO HILLS CA 91709-0000 CROSS STREET OAK HILL DR INSPECTN ACCESS CONTRACTOR NAME LICENSE NUMBER MALINS POOL CONST CONT000438874 MAILING ADDRESS, PHONE NUMBER 3857 SCHAEFER AVE UNIT (FC CHINO CA 91710-0000 (000) 000 - 0000 MINIMUM SETBACK DISTANCES 45 FRNT SETBACK/CENTRLINE OAKCREEK RD R/W 50 _ 20 REAR SETBACK/PROP LINE 40 SIDE SETBACK/CENTRLINE OAK HILL DR R/W 50 5 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES I NO. DWELLING I NO. BEDROOMS I FLOOR UNITS . EXT. WALLS I INT. WALLS CEILING ON TA 10 'ROOFHEATING FIREPLACES 1' 6 L T E D I METAL I MASRY Y /J fj PWAATER TIR I SEWER I MIN DEPTH' S.F./100IOSIZEI NEW/REPAIR 000COMMENTS STD POOL PLAN NO. 86-30088-225A. PRE-CONSTRUCTION INSPECTION REQUESTED 7/14/88. AMR WAIVED .00 AMT PAID 198.80 PAYOR NAME• MALINS POOL CONSTRUCTION, INC. PAID 07/14/88 RECEIPT 2395 EMPL: RICHARDS, GARY 4111 S 0ICENSED 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 OFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT /f/ �J LICENSE CLASS C--7—<1. (12,5LICENSE NUMBER � !7 ^? CONTRACTOR Al``�` (�5 DATF ~/! 16.— 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 [$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 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 (S) 8100, LAB C 1 POLICY NO F210 5c2g:1 COMPANY /7'26,il`` bl'i A ❑ CERTIFIED CAPY IS HEREBY FURNISHED IED COPY IS ILED WITH E COUNTY BUILDING INSPECTION DEPARTMENT r ` ' ..SE-- '/ APPLICANT `mss DATE r or / 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 DATE 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 I 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 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 TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTIO UR OSES sst ' SIGNATURE OF APPLICANT OR AGENT 'h "rA� DATE _ / .. / - // l I EXPIRATION NOTICE APPLICATIONS FOR WHICH NO PERMIT IS ISSUED WITHIN 180 DAYS FOLLOWING THE DATE OF APPLICATION SHAL PIRE,EVERY PERMIT SHALL EXPIRE IF WORK DOES NOT COMMENCE WITHIN 180 DAYS OF ISSUAN.SUCH PERMIT OR IF THE WORK IS SUSPENDED OR DONED FOR A PERIOD OF 180 DAYS, FEES PAID ARE NOT REFUNDABLE AFTER ONE YEAR FROM OF PAYMENT, ALL FEES PAID MAY NOT BE REFUND 12-17588-469 • Owner Name ares Permit NumbillIVQ� 2C Li5ID A-/ INSPECTION RECORD DATE INSPECTOR DATE I INSPECTOR Setback rr.rere- I ii-0 Rough Plumbing Temporary Power I Shower Pan Test Foundation Reinforcing Steel Stucco Mesh or Exterior Siding Excavation and Forms Insulation F.H A Foundation Req. Sewer Slab Grade Interceptor Ground Plumbing Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit ) lG44 r - I .7-Q*- Water Service Fireplace Foundation Lath or Drywall Nailing Joists and Girders Gas Line Air Test A g'->?-1X r Electrical P f-1 7-er 4.13 Final Energy ' Mid-Height Bond Beam Final Plumbing 8-Foot Bond Beam Final Heating/A C Final Bond Beam Final Construction C./'/c/ 161r Fireplace Bond Beam Final On Site Improvements J Roof Sheathing Final Off Site Improvements Framing and Ventilation Final Dedication Roof Covering Final Zoning Rough Heating Final Electrical Electrical Service and Ground Final Gas Rough Electrical 23e/ O Developer Fees Paid WC (Y/N) Ind Saf (YIN) Certificate of Occupancy //,1rE4e .t41 T, 47.9Avo.o o /c R.'sAo/ e Lrive5r .C. ./ / SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDE X LONG X DEPTH OF ROCK N W E Inspector's Signature and Initials 12-17589-469 Rev 3/88