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Permit No. (51) y410105 SAN BERNARDINO COUNTY—EPWA/LAND MANAGEMENT DEPT 4n , OFFICE OF BUILDING AND SAFETY PERMIT APPLICATION PERMIT NBR 105 88 00205 201A 01 I PAGE 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 01/26/88 ISSUE DATE 01/26/88 PARCEL NUMBER 1017022200000 PROPOSED USE: RESIDENCE CURRENT USE: VACANT 13295TRAC7 1000 1020 LOT I SEC SE32 I T022SS 108W I PRCL MAP I PORCL COOI�NONHITY ILLSLAN ZONE/LPRRDD USE DISTRICT GENERRAL ESPLAN SUBDIVISION NAME SUBDIVISION PARCEL NO LOT DIMENSION IRREG CONST TYPE VN T13295 PLAN 2 1/26/88 *BUGS ON LOT (GROUP R3 — APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER ()PLANS RECD 0 LAND USE PLOT 0 INDEX NBR ROBERTS GROUP V STD PLAN/ICBO FHA N BOX 1749 SIMI VALLEY CA 93062-0000 GRADING INITIAL ACTUAL (805) 522 — 3484 CU.YDS. EXC. CU.YDS. FILL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER ROBERTS GROUP V TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN BOX 1749 SIMI VALLEY CA 93062-0000 1 1567 1.00 1567.00 (805) 522 — 3484 GAR 480 .50 240.00 JOB SITE ADDRESS CALC. VALU 75,894.00 I ADJUSTED AREA 1807 16127 FIRESTONE LN CHINO CA 91710-0000 ITEM CNT DESCRIPTION DETAIL TOTALS CROSS STREET WINGED FOOT WY RESIDENTIAL CONSTRU 696.60 INSPECTN ACCESS TOTAL AMOUNT 696.60 CONTRACTOR NAME LICENSE NUMBER ROBERTS GROUP INC THE CONT000470190 MAILING ADDRESS, PHONE NUMBER P 0 BOX 1749 SIMI VALLEY CA 93065-0000 (000) 000 — 0000 MINIMUM SETBACK DISTANCES *** PER PLOT *** MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES I NO. DWELLING NO. BEDROOMS FLOOR 3,;g.,=w-r' i 2 UNITS 1 I 3 I CO WO . , TAM EXT. WALLS INT. WALLS CEILING t. MA ST I SH ISH }:' .7-°", a „. '�4.3. ROOF I HEATING 'METAL FIREPLACES rTI NA 01 MASRY s`.; 4 L.r ' f� PUBLIC CI WATER (PUBLIC SEWER I MI000EPTHI S.Ofi 01000( 000E) NENEWEPAIR COMMENTS WORKERS COMP ON FILE. CHINO VALLEY REGIONAL MGR LETTER ON FILE. OK TO ISSUE PERMITS PER PLOT} PER FRANK MOLINA. C OF C ON FILE. AMT WAIVED .00 AMT PAID 696.60 PAYOR NAME: THE ROBERTS GROUP PAID 01/26/88 RECEIPT : 04628 EMPL: CASTRO, K •ICENSED CiiNTRAGTORS 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 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 [$5001.): ❑ 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 CONTRACTORIS) 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.0 I. POLICY NO. COMPANY ❑ CERTIFIED COPY IS HEREBY FURNISHED ❑ CERTIFIED COPY IS FILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT APPLICANT DATP 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 DATP 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 .2 Di , - • dos-2n Uv zv u1,4_0/ INSPECTION RECORD Permit Number DATE INSPECTOR I DATE_, I INSPECTOR Setback /se—/f cill e,-• Rough Plumbing 11,1V 1r e Temporary Power r _ _ Shower Pan Test I Foundation Reinforcing Steel "/ —'��r' I C„_.. Stucco Mesh or Exterior Siding L/) /ie----rr I CZ— Excavation and Forms 1—7-11/' 0.--, Insulation , y3 t y' r,k I<.— F.H.A. Foundation Req. I Sewer "/ - 77C,tr.77C, I kT iT r I ce__-- Slab Grade (Jr 7-7" VI ..e.-_' Interceptor ` v I Ground Plumbing 4,-/ )'- , 1'1 L, Septic Tank Underslap Ducts I Leach Line or Seep Pit_ I c� I Underslab CoJ 6• 'Conduit � a 3 ' Yi C. Water Service ( C' (/(J C. 16'—fiYI r o Q._J Fireplace Foundation , r..y I Lath or Drywall Nailing I/ 3 'j-)'. Joists and Girders lct fk� /�d( tri--<__ Gas Line Air Test 1% —4, --- ____f_es Electrical Ground () /€/L 7--7--N' I ar... _) Final Energy ' Mid-Height Bond Beam I Final Plumbing -3--/7 ‹ 8-Foot Bond Beam I Final Heating/A.C. Zj----/7".--)1/ ate_ Final Bond Beam I Final Construction 71,3 C Fireplace Bond Beam ,1% Final On Site Improvements Roof Sheathing ,4 V I ) Final Off Site Improvements Framing and Ventilation ,(1'7 I / Final Dedication Roof Covering 47 I 4// Final Zoning Rough Heating 1;/ I 1 Final Electrical 3'7 7 C__. Electrical Service and Ground (/ I / Final Gas Rough Electrical V I / Developer Fees Paid V Certificate of Occupancy 3 f 7 WORKERS' COMPENSATION INSURANCE (YIN) DIVISION OF INDUSTRIAL SAFETY PERMIT (Y/N) • • SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDE X LONG X DEPTH OF ROCK N. W. E. S. Inspector's Signature and Initials 12-17589-469