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Permit No. 1058800963201A01 4111 105 SAN BERNARDINO COUNTY—EPWA/LAND i1AtJAGEMENT DEPT OFFICE OF BUILDING AND SAFETY PERMIT APPLICATION PERMIT NBR 105 88 00963 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 10 3 1_ ?.3 - c- PROPOSED USE: RESIDENCE PLAN D CURRENT USE: VACANT TRACTBLK LOT SEC TWN RNG PRCL MAP PRCL COMMUNITY PLAN ZONE/LAND USE DISTRICT GENERAL PLAN 13585 1000 1025 I SE29 102S 108W I 0 0 CHINO HILLS PUD RES-14 SUBDIVISION NAME SUBDIVISION PARCEL NO LOT DIMENSION IRREG CONST TYPE VN T13585 PLAN D 2/1/88 1017851010000 IIBLDGS 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 II 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 NINTH ST UPLAND CA 91786-0000 1 747 1.00 747.00 (714) 946 — 3773 2 842 1.00 842.00 GAR 473 .50 237.00 JOB SITE ADDRESS PORCH 54 .20 11.00 15861 CAMERON LN CHINO HILLS CA 91786-0000 CALC. VALU 77,154.00 I ADJUSTED AREA 1837 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 (000) 000 — 0000 MINIMUM SETBACK DISTANCES 24 FRNT SETBACK/CENTRLINE PROPERTY LINE R/W 20 15 PEAR SETBACK/PROP LIME MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS Ds E e NO. STORIES NO. DWELLING NO. BEDROOMS FLOOR o- 2 UNITS 1 3 CO D ' Tr a -- - F fir: ., EXT. WALLS INT. WALLS CEILING `' ST SH SH / ROOFHEATING FIREPLACES TI INA METAL 01 IMASRY PUWATER BLIC (PUBLIC SEWER I MIN 000EPTHI S'000100I0000I ENENEWEPAIR COMMENTS ZERO LOT LINE ON ONE SIDE WITH 10 FT BUILDING SEPARATION. C OF C ON FILE. CHINO VALLEY REGIONAL MGR LETTER ON FILE. AMT WAIVED .00 AMT PAID 696.60 PAYOR NAME: BRIMAR DEV. PAID 02/01/88 RECEIPT : 04936 EMPL: CASTRO, K •ICENSED CONTRACTQRS DECLARATION 9 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 [5500].): ❑ 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 DATF 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 [$100]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 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/O S"gg-0 09 10 3-10 i4-o DATE I INSPECTOR I I DAT I INSPECTOR Setback {---,Vq--S I i +g Rough Plumbing - I i Temporary Power II Shower Pan Test I - `ffw". Foundation Reinforcing Steel IC',s � Stucco Mesh or Exterior Sidin ��q� / e: 10- / ' Excavation and Forms ''� Insulation �'i�C�i 4 l 4 F.H.A. Foundation Req. I I Sewer le,7ZC '�� Slab Grade i9--- AP"--S/— AP"--S / I Ground Plumbing k'-791.i 4,' Septic Tank I I Underslap'.Bacts+ ', v Lc.. g `.d Leach Line or Seep Pit I I Underslab Conduit ' I Water Service /r�Y4 a../4-ifct I - /14 Fireplace F6A�1 I �,. / IA�► Lath or Drywall NailingdiesV • .� I / Joists and Girders I� v I Gas Line Air Test 13"30 .i . Electrical Ground 40,41. I9 C�fi 14.4' Final EnergyMid-Height Bond Beamf I Final Plumbing / 8-Foot Bond Beam I Final Heating/A.C. Final Bond Beam I Final Construction ( / A I Fireplace Bond Beam 1 Final On Site Improvements tryIN Roof Sheathing VI / Final Off Site Improvements A�! 111// Framing and Ventilation A I / 1 Final Dedication RI/ iit," Roof Covering A L7 I (-1 /, I Final Zoning tri/ Rough Heating a7 I n\I`1 / ' Final Electrical -.7 / Electrical Service and Ground jrI /B/4' Final Gas J 1 Rough Electrical V I / wry Developer Fees Paid ,, 7 r Certificate of Occupancy ,¢/t1 $'•f WORKERS' COMPENSATION INSURANCE IY/N) DIVISION OF INDUSTRIAL SAFETY PERMIT (YIN) ? —Z�2L/-r /,c,4_/ 5p.44.c`t Aier.T'i4 .4 -> 01.-/✓/rt/r - - --4;z: rvAkJ -017.81 civ ivFu..=- _-�r--- -_ 4:4,--/Y)7 /VTZ- 1- .S"-'- 3 'X- a Al • ANT PIA pF n �. .�.x .4 . &. SEPTIC TANK GALS. 1% �A ..w.11**SEEP. PIT X 1JM I t" " -41"-+-/Q - LEACH LINE WIDE /�7 X LONG X DEPTH OF ROCK I / ‘1 4s N. 41XCv ) / W. E. S. Inspector's Signature and Initials tie,V ��1Gf/t�"' \ 12-17589-469 \