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Permit No. 19984 BUILDING ADDRESS: 16254 VAN GOGH COURT PERMIT NUMBER: 19984 ... / BUILDING INFORMATION APPLICANT INFORMATION / \ '• BUILDING PERMIT APPLICATION Address: 16254 VAN GOGH COURT I Name !DESTINY POOLS 14-4 tt— ii;,w Community Development APN 11017-703-32 I Address 13429 BUNKERHILL .,"1 • 2001 Grand Avenue+ Lot 117 City,Zip Code !CHINO CA 91710 , :+�: Chino Hills,CA 91709 Cross Streets IWHISTER I Phone/Pager 1(909)627-8181 1 ext an OF CHINO LICENSED CONTRACTOR DECLARATION Tract/Parcel 114079 1 City Bus Lic# 1 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 N/A OWNER BUILDER DECLARATION Name GEORGE AND CANDICE FORTNER Address I hereby affirm that I'm exempt from the Contractor's License Law for the following reasonAddress 16254 VAN GOGH COURT 1 City,Zip Code 1,as the owner of the property,or my employees with wages as their whole City,Zip Code CHINO HILLS,CA 91709 Phone 1 ext 1 3compensation,will do the work,and the structure is not intended or offered for sale Phone (909)393-9227 1 ext I Lie# • 1,as owner of the property,am exclusively contracting with licensed contractors to Bus Lie# City Bus Lic# construct the project I Bus Exp APPROVAL INFORMATION I am exempt under Section 1 I BPC for this reason WORKERS'COMPENSATION DECLARATION CONTRACTOR INFORMATION Issued By !DAWN FORSHA I hereby affirm under penalty of perjury one of the following declarations Contractor GEORGE AND CANDICE FORTNER I Date Issued 15/21/02 Address 16254 VAN GOGH COURT Finance Code 1C4 I have and will maintain a certificate of consent to self-insure for workers'compensation as provided by Section 3700 of the Labor Code,for the performance of the work for City,Zip Code CHINO HILLS,CA 91709 Census Code which this permit is issued Phone or Pager (909)393-9227 1 ext 1 I Final Date Bus Lic# NEW Final ByAs. `-- I have and will maintain workers'compensation,as required by Section 3700 of the Lic # 805410 ® Labor Code,for the performance of the work for which this permit is issued My Extension workers'compensation insurance earner and policy number are Exp Date 3/31/04 Reviewed By !ANDY ZUMMO INSURANCE INFORMATION Lie Class C53 Approved By !ANDY ZUMMO Insurance Company !Exempt I PROJECT INFORMATION Policy Number 1 I PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date I I1 1 1 Structure © Section need not be completed if permit is for one hundred dollars($100)or less Garage 1 •I certify that in the performance of the work for which this permit is issued ,Il not employ Patio 1 1 ! 1 any person in any manner so as to become subject to the Workers'Compe•sation .ws of Porch 1 1 California and agree that if I should become subject to the workers'corn,-ns.tion provisions of Other !POOL AND SPA !REAR 1 535 Section 3700 of the Labor Code I shall comply wit 'se pro sions i / .. PROPOSED USE POOL AND SPA Date: 1 �/1// 67j 1 Signatu A Art_ ��� ` ( Al4..r /o/7O7O'T .cam /ACC,e..-5^..9 I certify I have read this application and state that the abs - • : ation is sorrec I agree to comply with all City Ordinances and state laws and = -.y autho•ze repress air es of this City to COMMENTS enter upon the above mentioned property for insp- ion purpose• Date: I C/W/(�7A Signatur:. I L�4LI�4_ . fit' ` OTHER FEES REQUIRED ZONING SETBACK S/ GRADING PRIOR TO ACTUAL PERMIT PERMIT FEE INFORMATION ISSUANCE Zoning 1PD Front Yard 25 1 SideCut Yard Over X School N I Issuance $29 00 Electrical I $90 00 $421.40 Land Use FR-1 5/5 Permit Fees: ! 0 Development N 1 Plan !POOL AND SPA Plan Check 1 $0 00 1 Plumbing 1 $0 00 Rear Yard 15 Fill 0 p SM IP I $0 00 1 Occ IRE 1 SSY Total 1 0 Sewer 1 N 1 Mechanical 1 $0 00 1 Structural 1 $302 40 Water N Total Fee Due I $421.40 I Type IVM Geo Review $0 00 1 Grading $0 00 SJSPECTION RECOIL 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 ,f_1 A_ 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 Interior/Exterior Lath Stucco Scratch Roof Covering Block Wall Inspections : Footing, ReBar 17- 1st Lift Bond Beam 2nd Lift Bond Beam 3rd Lift Bond Beam Drain/Seal SWIMMING POOLS : Location/Rebar/Bonding/Light t ��,��l I Gr Conduit f, "`""" Ro Elect d2r r POOL NOT TO BE FILLED UNTIL FENCING IS COMPLETE Fence, Gate&Alarm t o'- Final Pool �l , .,ti Temp Power Pole Electric Release Gas Test 11/ rinand TEsti AP EnginEE gn , Inc . 2603 Pomona Boulevard,Pomona,CA 91768 • (909)869-6316 • Fax(909)869-6318 GEOTECHNICAL INSPECTION REPORT Report No: DATE: 6/ / LIENT:i fN" 170 'L ' PROJECT NO. 1 _ TIME: 14 to JOB ADRESS: [ &2 JZ S4 N C%lCe.1, �' 1 5_214111 SOILS REPORT DATED / v v4 (/ I ' TYPE OF WORK: V/I I Nt� C F ON4 INSPECTION REPORT LEFT AT: p1-2-11‘&17"r A REPRESENTATIVE OF THIS FIRM HAS INSPECTED THE ABOVE WORK ITEMNAT THE SUBJECT SITE. APPROVED PER THE PLANS DISAPPROVED EE BELOW GENERAL COMMENTS AND CONDITIONS OF APPROVAL: -r--t te/ t.0Nfel t� i t&/ VV I DT 72`{ 5/ TZ' 7 N - I 01. 1(/ '• ter-A (2-:/- e) t 9 e2AA AND INDIL '77o \,/_ N4 . v ISt l�l._ vt�.c ISS �-V It i .STJT 'L -L2A4 A. . > Lt g.1:31SiV-/w1.s, fit2-OI A z F dT"-GNtI!�[� SNL Tl o N ,6..-r ' r7 v� L7 4 � GO�I���L - tel O N/, ACTION ITEMS: /,s\,/CT j ��,2 � C. /'// INSPECTED BY:V-- • )1.--,SIGNATURE: