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Permit No. 1058900363230A01 1.95. SIN BERNARDINO COUNTY-EPWA/LAND NAGEMENT DEPT ---- • OFFICE 41F BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 89 00363 230A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED - APPL DATE 03/21/89 I ISSUE DATE 03/21/89 I PG 1 OF 1 PARCEL NUMBER 1000-181-10-0000 -------------------- PROPOSED ----,•____.____,._.-._._._PROPOSED USE: RETAINING WALL CURRENT USE: VACANT TRACT 1000 10LOT 07 I SEC NE36 1035 10911 RNG I PRCL MAP I PRCLACTIVITY : L820 COMMUNITY PLAN ZONE/LAND USE DISTRICTI GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/PUD RES-3 LOT DIMENSION IRREGULAR CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER #BLDGS ON LOT GROUP R3 DYKIER, PAUL 122 VIKING AVE #PLANS RECD 0 LAND,USE PLOT 0 INDEX NBR 12-162 BREA CA 92621-0000 STD PLAN/ICBG FHA N (714) 255 - 0429 GRADING INITIAL ACTUAL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER CIJ,YOS. EXC. 652 DYKIER, PAUL CU.VOS. FILL 490 122 VIKING AVE BREA CA 92621-0000 TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN (714) 255 - 0429 FENCE. 2480 .20 496.00 JOB SITE ADDRESS 16213 CANYON HILLS RD CALC, VALU 22,320.00 I ADJUSTED AREA 496 CHINO HILLS CA 91709-0000 --- CROSS STREET SPRING CREEK WAY TTFM CUT DESCRIPTION DETAIL TOTALS TNSPECTN ACCESS RESIDENTIAL CONSTRU 201.77 TOTAL AMOUNT 201.77 CONTRACTOR NAME, ADDRESS LICENSE NUMBED DIV. OF IND. SAFETY PERMIT: MINIMUM SETBACK DISTANCES 55 FRNT SETBACK/CENTRLINE CANYON HILLS RD R/W 6(. 20 REAR SETBACK/PROP LINE JO SIDE SETBACK/PROP LINE IO SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES NOITDCONCRETE NO. BEDROOMS FLOOR E EXT. WALLS 1 INT. WALLS CEILING STUCCO SHEETROCK SHEETROCK ft ' [ TA ROOF HEATING FIREPLACES TILE I NATURAL GAS METAL IMASRY COt, HCTE 11 / WATER PUBLIC IPRIVATEI MIN 030EPTHI S 060100I1000EI NENEWEPAIR TE.. O C % p COMMENTS O AMT WAIVED .00 AMT PAID 201.77 PAYOR NAME: PAUL DYKIER PAID 03/21/89 RECEIPT 1340 EMPL: STACCATO-NYARI, M PAID BY : CHECK NBR : 138 •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 PROFESSIONSCODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT LICENSE CLASS LICENSE NUMBER CONTRACTOR DATF 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 ($500] I' 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 E PT U ERRSE-P. n^ B AND P. C. FOR THIS REASON �' �j VNER � A %Y/72., DATE c"--Y—IC:). U / %/ 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 DATF 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 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 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 ADDRFSS 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 ORDINANCE AND STATE LAWS RELATING TO BUtDING CONST CTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE- TIONED PROPERTY FOR INSPECTIONPUf�P /� gY�� ^, �� �/� IGNATURE OF APPLICANT OR AGENT DATE / / - EX IF�ATION AND REFUND NOTICE APPLICATIONS FOR WHICH NO PERMIT IS ISSUED WITHIN 180 DAYS FROM THE DATE OF APPLICATION SHALL EXPIRE.PERMITS 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 180 DAYS FROM DATE OF PAYMENT, EXCEPT FOR ERRORS IN ACCEPTANCE WHICH MAY BE REFUNDABLE UP TO ONE YEAR FROM DATE OF PAYMENT. ALL FEES PAID MAY NOT BE REFUNDABLE. 12-17588-469 Rev. 10/88 ^—� X,C/79— ' 3 4.3 Z 5 OAb o/ Owner Name V ��E t•7 • Permit Numtogr INSPECTION RECORD h DAT I INSPECTOR I DATE INSPECTOR Setback 1°4 EPA. - Rough Plumbing Temporary Power _ w11 Shower Pan Test Foundation Reinforcing Steel r �' ' l Stucco Mesh or Exterior Siding Excavation and Forms • Insulation F.H.A. Foundation Req. Sewer Slab Grade I _ A Interceptor Ground Plumbing he 4 (,i ij-1'3 Septic Tank Underslab Ducts 1J 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 Final Plumbing 8-Foot Bond Beam Final Heating/A.C. Final Bond Beam 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) IndCSaff (Y/N) Cerrtti``f ,e of Occupancy LeAvAi Orc-C4r.p/v64.-4= ifesto zie 4-G - fcoTi+V 44,t waGG Opp r / 01®C , AIb 4 L V 4"u' fai _ .44,4.44L l o•vA 11E9Ai la ' 4,4,464, o,C All dp..t 4.4-4 M C► 4 '4• Mø• Zenw-kI b .470 '•tci4GG e-148"'"? ts.' \ s '," / SEPTIC TANK GALS � SEEP. PIT X LEACH LINF WIDE ( _u_o e X LONG X DEPTH OF ROCK '441:0 N. W. E. S. Inspector's Signature and Initials Xre7 /Q'&)l */) 12-17589-469 Rev.3/88