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Permit No. 1058800943201A01 105 SAN BERNARDINO COUNTY—EPWA/LAND•AGEMENT DEPT o OFFICE OF BUILDING AND SAFETY PERMIT APPLICATION PERMIT NBR 105 88 00943 201A 01 I PAGE 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 02/01/88 ISSUE DATE 02/01/88 PARCEL NUMBER to 1(_ 333-- ).- PROPOSED USE: RESIDENCE PLAN C CURRENT USE: VACANT 13585T I BIK I LOTT I SE29SEC I p N I RNG I PRCL M8WMAP I PRCL 0COOMMMUUNIITY IYLPPLAN ZONE/LLANND USE DISTRICT GENERALS—LAAL N 000SUBDIVISION NAME SUBDIVISION PARCEL NO LOT DIMENSION IRREG (CONST TYPE VN T13585 PLAN C 2/1/88 1017851010000 *BUGS ON LOT GROUP R3 APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER (PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 30-158 BRIMAR DEVELOPMENT STD PLAN/ICBO FHA N 123 E 9TH ST UPLAND CA 91786-0000 GRADING INITIAL ACTUAL (714) 946 — 3773 CU.YDS. EXC. CU.YDS. FILL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER UPLAND VILLAGE OAKS TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN 123 E 9TH ST UPLAND CA 91786-0000 1 739 1.00 739.00 (714) 946 — 3773 2 872 1.00 872.00 GAR 480 .50 240.00 JOB SITE ADDRESS PORCH 94 .20 19.00 15849 CAMERON LN CHINO HILLS CA 91786-0000 CALC. VALU 78,540.00 I ADJUSTED AREA 1870 CROSS STREET BAYBERRY INSPECTN ACCESS ITEM CNT DESCRIPTION DETAIL TOTALS RESIDENTIAL CONSTRU 696.60 TOTAL AMOUNT 696.60 CONTRACTOR NAME LICENSE NUMBER BRIMAR DEVELOPMENT CONT000338533 MAILING ADDRESS, PHONE NUMBER 1312 WEST BROOKS STREET ONTARIO CA 91762-0000 74.30) OOC — COcCO MINIMUM SETBACK DISTANCES 15 FRNT SETBACK/CENTRLINE PROPERTY LINE R/W 32 15 REAR SETBACK/PROP LINE 31 SIDE SETBACK/CENTRLINE PAISLEY R/W 32 1 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES NO. DWELLING NO. BEDROOMS FLOOR 2 UNITS 1 3 CO OfIP EXT. WALLSINT. WALLS CEILING sal"i 8 ST ISH ISH '3f' �.;. R rY. I ROOF HEATING FIREPLACES }^ h ,- (I TI INA (METAL 01 IMASRY g ', ° ___s_5::_-_____5-- WATER �� PUBLIC (PUBLIC SEWER I MIN DEPTH( S•0000100IOOOOEI NEW/REPAIRW 0W 415 ' COMMENTS • SIDE SETBACKS ARE ZERO ON ONE SIDE WITH 10 FT BUILDING SEPARATION. CHINO VALLEY REGIONAL MANAGERS LETTER ' ON FILE. C OF C ON FILE. AMT WAIVED .00 AMT PAID 696.60 PAYOR NAME: BRIMAR DEVELOPMENT PAID 02/01/88 RECEIPT : 04933 EMPL: CASTRO, K •ICENSED 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 PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS LICENSE NUMBER CONTRACTOR DATE 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 155001.1: ❑ 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 (SEC. 3800, LAB.C.). POLICY NO. COMPANY ❑ CERTIFIED COPY IS HEREBY FURNISHED ❑ CERTIFIED COPY IS FILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT APPLICANT DATE CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [61001 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.). 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 INSPECTION PURPOSES. SIGNATURE OF APPLICANT OR AGENT DATE EXPIRATION NOTICE APPLICATIONS FOR WHICH NO PERMIT IS ISSUED WITHIN 180 DAYS FOLLOWING THE DATE OF APPLICATION SHALL EXPIRE,EVERY PERMIT 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 ONE YEAR FROM DATE OF PAYMENT, ALL FEES PAID MAY NOT BE REFUNDABLE. 12-17588-469 ) INSPECTION RECORD Permit Number/0 5-88-OV r7`f3- a 0 t. a I DATE INSPECTOR DATE INSPECTOR Setback ig". "- `I 49 Rough Plumbing .4 / Temporary Power I I I Shower Pan Test . :ANEW _s•e I tiA Foundation Reinforcing Steel frr ' Stucco Mesh or Exterior Siding -' • Z,.a Excavation and Forms InsulationT-3--- -3-e- --a3 /A F.H.A. Foundation Req. _ I _ Sewer /c�7Q � - Slab Grade 7— /'ff I ll1 Interceptor Ground Plumbing g Septic Tank Underslap�v[rt! CL) Leach Line or Seep Pit Underslab Conduit I Water Service /if, #'e, IA .. /*V I// Fireplaces �4 7 Lath or Drywall Nailing 1C _ -fes`fi. Joists and`Girders _ Gas Line Air Test F-{.,.V7 f s!�i Electrical Ground /JLFf�p_ f{',��f ��( Final Energy `�, Mid-Height Bond Beam . r Final Plumbing A, nP71v1 - 8-Foot Bond Beam I Final Heating/A.C. r ' Final Bond Beam I Final Construction ,. Fireplace Bond Beam Final On Site Improvementse,6WA .,.�.,'�.19 /ice Roof Sheathing n IT A Final Off Site Improvements i f Framing and Ventilation r/ I ,, / Final Dedication n Roof Covering ' j Final Zoning Rough Heating ,`��,0/ Final Electrical 4:1 AY'// Electrical Service and Ground I I v - Final Gas `#/ W Rough ElectricalDeveloper Fees Paid .1/ • Certificate of Occupancy / WORKERS' COMPENSATION INSURANCE (Y/N) DIVISION OF INDUSTRIAL SAFETY PERMIT (Y/N) 3-a-7-89 -D u? Aa. W6 3-9s -,e/A.1 .-ate-a -�diem P ` SEPTIC TANK GALS. )AT E q, I wV �d yk SEEP. PIT X i/I/') LEACH LINE WIDF IttG X LONG X DEPTH OF ROCK N. W. E. S. Inspector's Signature and Initials , Q 1?____ 12-17589-469