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Permit No. 18851 BUILDING ADDRESS: 2508 PASEO TORTUGA 1 PERKIT NUMBER: 18851 � BUILDING INFORMATION APPLICANT INFORMATION 1---- ./ .? - BUILDING PERMIT APPLICATION Address 12508 PASEO TORTUGA Name BARRY REGIMBAL 7�^'�W,d '' "R+r Community Development APN 11032-431-03 ( Address 115670 PINTO WAY � "'w 2001 Grand Avenue Lot 12 I City,Zip Code 'CHINO HILLS,CA 91709 ' • . Chino Hills,CA 91709 : :•- Phone/Pager 909 393-6733 ext gra Cross Streets i ( g �( ) to'"°•'�°""•"'s, LICENSED CONTRACTOR DECLARATION Tract/Parcel 114924 { City Bus Lic# 101-02985 I hereby affirm that I'm licensed under the provisions of Chapter 9(commencing with Section Valuation 1$25,000 00 1 ENGINEER/ARCHITECT INFORMATION 7000 of Division 3 of the Business and Professions Code)and my license is in full force and ' effect OWNER INFORMATION Name 1DAWN PASOL OWNER BUILDER DECLARATIONName 'EVE1 1 &MIGl1AL LANERAS Address 1201 N TUSTiN AVENUE 1 hereby affirm that I'm exempt from the Contractor's License Law for the following reasonAddress 12508 PASEO TORTUGA 1 City,Zip Code 'ANAHEIM,CA 92807 I,as the owner of theproperty,or em to employees with wages as their whole City,ZipCode ',CHINO HILLS,CA 91709 Phone 1(714)630-6100 1 ext 1 Cr my P Y g O compensation,will do the work,and the structure is not intended or offered for sale Phone 1(909)930-1740 1 ext 1 Lie# 161 183 ® I,as owner of the property,am exclusively contracting with licensed contractors to Bus Lic# City Bus Lic# 1 Samonstruct the project Bus Exp APPROVAL INFORMATION exempt under Section I I BPC for this reason i WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION issued By IYVETTE MARTINEZ I hereby affirm under penalty of perjury one of the following declarations Contractor 1BARRY REGIMBAL I Date issued 19/6/01 Address 115670 PINTO WAY Finance Code 1C4 I have and will maintain a certificate of consent to self-insure for workers'compensation City,ZipCode (CHINO HILLS,CA 91709 ® as provided by Section 3700 of the Labor Code,for the performance of the work for 1 Census Code 1 P i which this permit is issued Phone or Pager 1(909)393-6733 1 ext 1 1 Final Date Bus Lie# 101-02985Final By ae I have and will maintain workers'compensation,as required by Section 3700 of the Labor Code,for the performance of the work for which this permit is issued My Lic # 1317090 Extension workers'compensation insurance earner and policy number are Exp Date 2/28/02 Reviewed By ILAURO BUGARiN Lie CIa 1B,C53 Approved By ILAURO BUGARIN I INSURANCE INFORMATION Insurance Company 1STATE FUND I '/ PROJECT INFORMATION Policy Number 121426-2001 I PROJECT DESCRIPTION LOCATION SQUARE FT. L.,piration Date01/01/02 1Structure 1 i 1 © Section need not be completed if permit is for one hundred dollars($100)or less 1 1 I i certify that in the performance of the work for which this permit is issued I shall not employ Patio 1I 1 I Sperson in any manner so as to become subject to the Workers'Compensation Laws of Porch I I ifomia and agree that ill should become subject to the workers'compensation provisions of Other 'POOL AND SPA ( 'REAR Section 3700 of the Labor Code I shall comply with those provisions POOL AND SPA PROPOSED USE Date: I i Signature: i I I certify I have read this application and state that the above information is correct I agree to comply with all City Ordinances and state laws and hereby authorize represen Ives o is City to .,- ' enter upon the above mentioned property for inspection pu 5' / 7 �7 COMMENTS I - , / Date: Signature �. /,/ — — , E REQUIRED ZONIN SETBACKS GIIADI / PRIOR OACTUAL PERMIT PERMIT FEE INFORMATION ISSUANCE. Zoning 1PD 1 Front Yard 27 Over X 1 0 1 Issuance I $29 00 1 Electncal 1 $90 00 1 Land Use IFR-1 I Side Yard 5/5 Cut 0 School 1 NO Permit Fees: i $421.40 1 1 1 Development ' NO I Plan Check 1 $0 00 1 Plumbing 1 $0 00 I Plan 1POOL Rear Yard 15 Fill 1 0 1 SMIP 1 $0 00 l Occ R3 SSY Sewer 1 NO 1 Mechanical { $0 00 1 Structural 1 $302 40 1 I _ Total 0 Total Fee Due 1 $421.40 I Type IvN Water 1 NO 1 Geo Review $0 00 Grading 1 $0 00 1 • • I 1 • • INSPECTION RECORD Permit Number Inspection Date Inspector Inspection Date Inspector Grading: Pregrade Meeting FINAL INSPECTIONS(Inspector verify following) Rough Grade NO OCCUPANCY PERMITTED WITHOUT FINAL.I Terraces County Environmental Sub Drains Health Dept Finish Grading Planning Dept Soils Certification Public Works Grading Certification Fire Rough Landscape As Built Approved Underground Site Inspections: ALL ABOVE MUST BE APPROVED BEFORE FINAL BLDG, Building Sewer Final Grade U.G.Waste Plumbing Final Electric Water Service Final Plumbing Storm Drain/Catch Basins Final Mechanical U/G Conduit/Electrical Final Building/Construction;-;fir// ��! 1. .•s Compaction Report Water Meter Number / / ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION, Footings CERTIFICATE OF OCCUPANCY UFER Ground(Rebar/Copper) Hardware/Hold-Downs Piers/Caissons/Tendons OTHER: Slab Grade DO NOT POUR CONCRETE UNTIL ABOVE IS APPROVED, Shear Roof Nailing Exterior Walls Interior Walls Hardware/Hold-Downs Rough Electric Rough Mechanical Rough Plumbing/Topout Framing COVER NO WORK UNTIL ABOVE IS APPROVED, Insulation Drywall Intenor/Extenor Lath Stucco Scratch Roof Covering Block Wall Inspections: Footing,ReBar 1st Lift Bond Beam 2nd Lift Bond Beam 3rd Lift Bond Beam Drain/Seal SWIMMING POOLS: Location/Rebar/Bonding/Light \ Gr Conduit \. • Ro Elect 07171t) I-- POOL NOT TO BE FILLED UNTIL FENCING IS COMPLETE, Fence,Gate&Alarm 'Ott Q.4 Final Pool , �r 1 Temp Power Pole Electric Release Gas Test 7/j/c)J