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Permit No. 1058900159 105 SAN BERNARDINO COUNTY-EPWA/LAND MIANAGEMENT DEPT • OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 89 00159 225A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 01/24/89 I ISSUE DATE 02/07/89 I PG 1 OF 1 PARCEL NUMBER 1017-841-34-0000 PROPOSED USE: SWIMMING POOL AND SPA CURRENT USE: RESIDENCE 12625TRAC BLK LOT SEC WN NG T 1000 337 I NE29 I 0 S 08W PRCL 00AP ( PRCLOCCTOMIhNJITY COMMUNITY PLAN ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/PUD LOT DIMENSION IRREGULAR CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *BLDGS ON LOT 1 (GROUP R3' CALIFORNIA POOLS/DUNCAN EDWARDS 1382 BOUQUET AVE 1 *PLANS RECD 2 LAND USE PLOT 0 (INDEX NBR 30-159 UPLAND CA 97186-0000 STD PLAN/ICBO 8630079225A FHA (714) 597 - 8048 ITEM CNT DESCRIPTION DETAIL TOTALS OVNER NAME, MAILING ADDRESS, AND PHONE NUMBER POOL PRIVATE 251.68 HOLTMEIER, CURTIS AND CARLA MISC SUB-TOTAL 251.68 3088 OAKCREEK RD TOTAL AMOUNT 251.68 CHINO HILLS CA 91709-0000 (714) 597 - 8048 JOB SITE ADDRESS 3088 OAKCREEK RD CHINO HILLS CA 91709-0000 CROSS STREET OAK HILL DRIVE INSPEC1N ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER CALIFORNIA POOLS T SPA CONT000185102 4600 NO SANTA ANITA AVE *200 EL MONTE CA 91731-0000 (000) 000 - 0000 -DIV. OF JN . SAF-EY" PER°'1'f - _ _ - - - MINIMUM SETBACK DISTANCES 45 FRNT SETBACK/CENTRLINE OAKCREEK RD R/W 50 20 REAR SE-MACK/PROP LINE 5 SIDE SETBACK/PROP LINE S 10 SIDE SETBACK/PROP LINE N MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIPE SETBACKS NO. STORIES I NO. DWELLING I NO. BEDROOMS I FLOOR UNITEXT. WALLS I INT. WALLS I CEILING ROOF I HEATINGI FIRELACES METAL IMASRY PWAATER TIR I SEWER I MINODEPTHI S.F./1OO SIZE( NEW/REPAIR ONTARIO 000 0000 COMMENTS COMPLETED DATE: , • AMT WAIVED .00 AMT PAID 251.68 PAYOR NAME: EDWARDS, DUNCAN PAID 01/24/89 RECEIPT 340 EMPL: RICHARDS, GARY PAID BY : CHECK NBR : 856 "'LICENSED CONTRACTORS DECLARATION. . I HEREBY AFFIRM THAT I AM LICENSED UNDER THE PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISI 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT LI E CLASS , LICENSE NUMBER l0 LS-7U2___- CONTRACTOR DA 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 I$5001 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 3800, LAB C I POLICY NO COMPANY ❑ CERTIFIED COPY IS HEREBY FURNISHED ❑ CERT FiED C Y IS FILED WITH THE C NT BgUILDING I SPECTION DEPARTMENT ' LICANT I�CiY/6-A siC C I%[�t/� ✓ l �}�}CDAf7 T e 4 , CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1$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 ISA CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV C) LENDER'S NAMF LENDER'S ADDRESc 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 .'�r 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-M ZONED PROPERTY FOR INSPECT! PURPOSES� J �� y �j ATURE OF APPLICANT OR AGENT �- './ X "`"' ' 'ice / DATE % 7(I// EXPIRATION AND REFUND NOTICE APPLICATIONS FOR WHICH NO PERMIT IS ISSUED WITHIN 180 DAYS FROM THE DATE OF APPLICATION SHALL EXPIRE PERMITS 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 180 DAYS FROM DATE OF PAYMENT, EXCEPT FOR ERRORS IN ACCEPTANCE WHICH MAY BE REFUNDABLE UP TO ONE YEAR FROM DATE OF PAYMENT ALL FEES PAID MAY NOT BE REFUNDABLE 12-17588-469 Rev 10/88 .� ... /as -&i59 zz cA o/ Owner Name f,`IDOL%j(�fif'�% Permi Numb.) INSPECTION RECORD DATE INSPECTOR I DATE INSPECTOR Setback f2. 'L,4i'J �s-�cS��j' /`I Rough Plumbing Temporary Power I Shower Pan Test Foundation Reinforcing Steel Atir Stucco Mesh or Exterior Siding Excavation and Forms -/3 -$q Insulation F.H.A. Foundation Req. I Sewer Slab Grade i Interceptor Ground Plumbing I Septic Tank Underslab Ducts I Leach Line or Seep Pit Underslab Conduit ,a3 VP, I7 Water Service iRoot_ Fireplace Foundation Lath or Drywall Nailing Joists and Girders I Gas Line Air TestST1164/`• .2"c2 6-r <43 Electrical Ground-341100✓4:za "f�.�e.'j iAP, Final Energy Mid-Height Bond Beam I Final Plumbing 8-Foot Bond Beam I Final Heating/A.C. Final Bond Beam I Final Construction Fireplace Bond BeamI Final On Site Improvements R9rehle61 L5'-3/ _� Final Off Site Improvements Framing and Ve tilation — Final 9,8140410a 14e4-f,. 2-4-929 Roof Covering I Final Zoning Heating dC,odlarr'IDr✓ p—11 4 4 Ikeit Final Electrical )X /Z'- -rw Electrical Service and Ground I Final Gas Rough Electrical S•3/ 9 1147 Developer Fees Paid WC WIN) - - Ind Saf (YIN) Certificate of Occupancy .V -.13 49 elf Ld -Fob ?'ga!r2. L`—i.t tgr J c ICDA--Tw o-r Z-L-gn FiMa/ 4,',o/'ov . C SEPTIC TANK GALS. SEEP PIT X LEACH LINF WIDE X LONG X DEPTH OF ROCK N. oa n it..!P 171. Aft, M ASU .sA Ia ki aR►v r i'r lid UV . yiAioliar. o Lai) W E tfik it 9"_ , / _ w t / S Inspector's Signature and Initials 12-17589-469 Rev 3/88