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Permit No. 20070 BUILDING ADDRESS: . 16254 VAN GOGH COURT PERMIT NUMBER: 20070 BUILDING INFORMATION APPLICANT INFORMATION �� • BUILDING PERMIT APPLICATION I Name (DESTINY POOLS •4 z',.41 Address: 16254 VAN GOGH COURT ,. Community Development APN 11017-703-32 I Address 113429 BUNKERHILL s'""`'=` 2001 Grand Avenue -1...,_ Lot 117 1 City,Zip Code ICHINO CA 91710 ••-•••• Chino Hills,CA 91709 Cross Streets IWHISTER 1 Phone/Pager 1(909)627-8181 I ext 1 CITY°`�°°"LI` 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 I$1,281 00 1ENGINEER/ARCHITECT INFORMATION 7000 of Division 3 of the Business and Professions Code)and my license is in full force and effect OWNER INFORMATION Name 1N/A OWNER BUILDER DECLARATION Name GEORGE AND CANDICE FORTNER I Address .1 I hereby affirm that I'm exempt from the Contractor's License Law for the following reason Address 16254 VAN GOGH COURT City,Zip Code 1 I,as the owner of the property,or my employees with wages as their whole City,Zip Code CHINO HILLS,CA 91709 1 Phone 1 1 ext O O compensation,will do the work,and the structure is not intended or offered for sale Phone (909)393-9227 1 ext I 1 Lie# 1 • I,as owner of the property,am exclusively contracting with licensed contractors to Bus Lie# City Bus Lie# construct the project I © I am exempt under Section i i BPC for this reason i Bus Exp APPROVAL INFORMATION 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 Date Issued 5/21/02 Address 16254 VAN GOGH COURT Finance Code C4 I have and will maintain a certificate of consent to self-insure for workers'compensation © as provided bySection 3700 of the Labor Code,for theperformance of the work for City,Zip Code CHINO HILLS,CA 91709 Census Code which this permit is issued Phone or Pager (909)393-9227 ext 1 Final Date /f/-r/`f���ii Bus Lie# NEW Final B ":3 S� I have and will maintainworkers'compensation,as required by Section 3700 of the y /I © Labor Code,for the performance of the work for which this permit is issued My Lie # 805410 Extension workers'compensation insurance carrier and policy number are Exp Date 3/31/04 I Reviewed By ANDY ZUMMO Lie Class C53 1 Approved By ANDY ZUMMO INSURANCE INFORMATION Insurance Company (Exempt PROJECT INFORMATION Policy Number 1PROJECT DESCRIPTION LOCATION SQUARE FT. Expiration Date 1 Structure OO 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 iss d I s all not employ Patio any person in any manner so as to become subject to the Workers'Com ensatio Laws of Porch 1 1I California and agree that if I should become subject to the workers'corfip sate n provisions of Other (FOOTINGS 1 (REAR PATIO FOOTINGS 427 Section 3700 of the Labor Code I shall comply wi • ose . ovisions I I . PROPOSED USE PATIO FOOTINGS ONLY Date: I'j/2//O I Signa ure: -_/SAI "� SM IP FEE TO BE PAID AT PATIO COVER PERMIT ISSUANCE I certify I have read this application and state that the.;ove information is orrect I agree to comply with all City Ordinances and state laws and hereb . : ze repre e• ativ s of this City to enter upon the above mentioned property for inspec : purpose COMMENTS r / -1. Date: j 2 Signatur.. if U )i -...\----4------ OTHER FEES REQUIRED ZONING SETBACK S GRADING PRIOR TO ACTUAL PERMIT PERMIT FEE INFORMATION ISSUANCE Zoning 1PD 1 Front Yard 25 Over X 1 0Issuance 1 $29 00 1 Electrical 1 $0 00 1 Land Use IFR-1 1 Side Yard 5/5 School N I Cut 0 Plan Check $24 $0 00 Permit Fees: $84.38 Plan PATIO FOOTIN 1 Rear Yard 15 Fill 1 0 1 Development N 18 Plumbing 1SMTP 1 $0 00 Occ 1R3 SSY Total 0 1 Sewer N 1 Mechanical $0 00 1 Structural $31 20 1 Type 1" 1Water 1N 1 Geo Review 1 $0 00 1 Grading 1 $0 00 I Total Fee Due $84.38 1 ��������^ ¶SJSPECTION 0�����������') 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 Storm Drain/Catch Basins Final Plumbing Final Mechanical U/GConduit/Beothoo| Compaction Report F/no/BuUding/ConetruoUon ABOVE IS REQUIRED PRIOR TO FOUNDATION INSPECTION Water Meter Number Footings CERTIFICATE OF OCCUPANCY UFER Ground (Rebar/Copper) Hardware/Hold-Downs Piers/Caissons/Tendons OTHER: Slab Grade Fa»7/�`'�./ 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 0.0 1st Lift Bond Beam 2nd Lift Bond Beam 3rd Lift Bond Beam Drain/Seal SWIMMING POOLS : Location/Rebar/Bonding/Light Gr Conduit Ro Elect POOL NOT TO BE FILLED UNTIL FENCING IS COMPLETE Fence, Gate&Alarm Final Pool Temp Power Pole Electric Release Gas Test