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Permit No. 1058802633230A02 l .. -105 SAN BERNARDINO COUNTY-EPWA/LAND•AGEMENT DEPT I OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 88 02633 230A 02 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 03/14/90 I ISSUE DATE 03/14/90 I PG 1 OF 1 PARCEL NUMBER 1000-271-01-0000 PROPOSED USE: RETAINING WALL EXTENSION IICURRENT USE: HOUSE UNDER CONSTRUCTION 10556TRAC7 I 000 1018 I SE25 SEC 1025 1 09W I PRCL MAP I PR CL CL COPLAN ACTIVITY ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISIONIPARCEL NO CHINO HILLS CH/PUD LOT DIMENSION IRREGULAR CONST TYPE APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER #BLDGS ON LOT 1 GROUP TO, HA VAN AND MONICA 3002 S DEEGAN ST *PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 12-160 SANTA ANA CA 91789-0000 STD PLAN/ICBO FHA N (714) 531 - 3965 TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER TO, HA VAN AND MONICA FENCE 49 .20 10.00 3002 S DEEGAN ST SANTA ANA CA 91789-0000 CALC. VALU 450.00 I ADJUSTED AREA 10 (714) 531 - 3965 ITEM CNT DESCRIPTION DETAIL TOTALS JOB SITE ADDRESS RESIDENTIAL CONSTRU 35.45 16059 CANYON HILLS RD ISSUANCE FEE 16.96 CHINO HILLS CA 91709-8000 TOTAL AMOUNT 52.41 CROSS STREET CARBON CANYON RD INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER DIV. OF IND. SAFETY PERMIT: MINIMUM SETBACK DISTANCES *** EXISTING *** MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIESI NO. DWELLING NO. BEDROOMS FLOOR ONTARIO UNITS EXT. WALLSI it INT. WALLS I CEILING COMPLETDATE3'EDZ S_S L J ROOF I HEATING FIREPLACES METAL IMASRY PWAATER TIR I SEWER I MIN DEPT)] S.000 0000F./1001 SIZE1 NEW/REPAIR COMMENTS (III REFER TO 1058802633230A01, EXTENSION TO RETAINING WALL AMT WAIVED .00 AMT PAID 52.41 PAYOR NAME: HA VAN TO PAID 03/14/90 RECEIPT 951 EMPL: STEVENS, BETTY PAID BY : CHECK NBR : 597 • 0 • . LICENSED CONTRACTORS DECLARATION I HEREBY AFGIRM THAT I AM LICENSED UNDER THE PROVISIONS OF CHAPTER 9 ICOMMENCING 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 ❑ 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 4CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTORIS) LICENSED PURSUANT TO THE CONTRACTORS LICENSE LAW). A IAM EXEMPT/Uy ER SEC. 7,C-, //�. -,, B. AND P. C. FOR THIS REASON / NER `\\'� i1 /"•- /A.A .C-, DATE ////716 / ( 7 I 1 / 7 WORKERS' COMPENSATION DECLARATION (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 ($1001 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. O 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. O 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 BUIL G CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO EN R UPON THE AOVE•MENTIONED PROPERTY FOR INSPECTION P POSES. f! IGNATURE OF APPLICANT OR AGENT ,-e e-'7-/0-L- I DATE .-3// /c//- (/� / 9 EXPIRATION AND REFUND NOTICE APPLICATIONS FOR WHICH NO PERMIT IS ISSUED WITHIN 180 DAYS FROM THE DATE OF APPLICATION SHALL EXPIRE.PERMITS E PIRE 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 180 DAYS FROM DATE OF PAYMENT,EXCEPT FOR ERRORS IN ACCEPTANCE WHICH MAY BE REFUNDABLE UP TO ONE YEAR FROM DATE OF VA WALL Owner Name A V A i Permit Numlii!OS 8I ©d.6 33 a 3a INSPECTION RECORD • - DATE INSPECTOR I DATE I INSPECTOR Setback Rough Plumbing Temporary Power I Shower Pan Test Foundation Reinforcing Steel I , g5�',�� 0 Stucco Mesh or Exterior Siding Excavation and Forms Insulation F.H.A. Foundation Req. I Sewer Slab Grade Interceptor Ground Plumbing Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service Fireplace Foundation Lath or Drywall Nailing Joists and Girders Gas Line Air Test Electrical Ground Final Energy Mid-Height Bond Beam 7—// -et CDrt Final Plumbing 8-Foot Bond BeamV,�� Final Heating/A.C. Final Bond Beam —7—14 — ri t '"';`J J Final Construction Fireplace Bond Beam Final On Site Improvements Roof Sheathing Final Off Site Improvements Framing and Ventilation Final Dedication Roof Covering Final Zoning Rough Heating Final Electrical Electrical Service and Ground Final Gas Rough Electrical Developer Fees Paid WC (YIN) Ind Saf (Y/N) Certificate of Occupancy 7'i/-st YTg 3a7 Ofigt SEPTIC TANK • GALS. -vitt-1 �'"•.- SEEP. PIT X QNi LEACH LINE WIDF . n i A X LONG X DEPTH OF ROCK N. f W. E. S. Inspector's Signature and Initials 12-17589-469 Rev.3/88