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Permit No. (38) • C5r 10,5;SAN BERNARDINO COUNTY-EPWA/LAND NAGEMENT DEPT OFFICE OF BUILDING AND SAFETY PERMIT APPLICATION PERMIT NBR 105 88 01856 201A 01 I PAGE 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 05/18/88 ISSUE DATE 05/18/88 PARCEL NUMBER 1017-022-22-0000 PROPOSED USE: RESIDENCE CURRENT USE: VACANT 13295T I BLK000 I LOT 1 NE32 SEC I TNN 0NG I PRCL M8W MAP I PRCL COMMUNITY PLAN ZONE/LLAANND USE DISTRICT( GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO LOT DIMENSION IRREG CONST TYPE VN #BLDGS ON LOT (GROUP R3 APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER #PLANS RECD 0 LAND USE PLOT 0 INDEX NBR 40-161 ROBERTS GROUP V STD PLAN/ICBO FHA Y 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 1796 1.00 1796.00 (805) 522 - 3484 GAR 438 .50 219.00 JOB SITE ADDRESS CALC. VALU 84,630.00 I ADJUSTED AREA 2015 16135 FIRESTONE LN CHINO HILLS CA" 91710-0000 ITEM CNT DESCRIPTION DETAIL TOTALS CROSS STREET WINGED FOOT WY RESIDENTIAL CONSTRU 745.30 INSPECTN ACCESS ADJUSTMENT FEE -589.40 TOTAL AMOUNT 155.90 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 Dilfrd lets NO. STORIES NO. DWELLING NO. BEDROOMS FLOOR "u 2 UNITS 1 4 CO WO EXT. WALLS INT. WALLS CEILING ' •`: tr. 1-TED MA ST SH ISH ts4.4 ROOF HEATING FIREPLACES TI NA METAL. 01 IMASRY WATER PUBLIC (PUBLIC SEWER I MIN 000DEPTH1 S.O000100I0000W SIZEI NEW/REPAIRW COMMENTS WORKERS COMP ON FILE. CHINO VALLEY REGIONAL MGR LETTER ON FILE. OK TO ISSUE PERMITS WITH SETBACKS PER PLOT- PER FRANK MOLINA. C OF C ON FILE WITH COUNTY OF SAN BERNARDINO. PERMIT ORIGINALLY ISSUED FOR 1449 SQ FT STRUCTURE UNDER PERMIT #1058800149201A01. SQUARE FOOTAGE INCREASED BY DEVELOPER TO 2036. ADDITIONAL FEES REQUIRED. AMT WAIVED .00 AMT PAID 155.90 PAYOR NAME: THE ROBERTS GROUP PAID 05/18/88 RECEIPT 1395 EMPL: RICHARDS, GARY &LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM THAT I AM LICENSED UNDER T PROVISIONS OF CHAPTER 9 (COMMENCING WITH SE ION 7000) OF DIVISION 3 OF THE BUSINESS'AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. g ' �Q LICENSE CLASS LICENSE NUMBER 0014 44"10 I eI B CONTRACTOR DATE I " " 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,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 OPY IS HEREBY FURNISHED ❑ CE TIFIED PY IS FILED WI HECOUNTY/BUIILDINGG INSPECTION DEPARTMENT APPLI ANT 44./x- ' A -Q�kr,---t". DATE 1 CERTIFICATE OF E MPTION 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. ❑ 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 APPLI TION AND STATE THAT THE ABOVE INFORMATION IS CORRECT, I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATIN TO BUILDING CONSTRUCTION, A1tlD HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPE TION PURPOSES. h� _ SIGNATURE OF APPLICANT OR ENT �-O ?,..17�1rDATE EXPIRATION NOTICE APPLICATIONS FOR WHICH NO PERMIT IS ISI ED 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 Owner Name c(.2 ' S 1111744-10 - - Per,Number /or-88-d/t 1-Zh/4-e/ INSPECTION RECORD - DATE I INSPECTOR I DATE INSPECTOR Setback I(j )'�� (r I Q. 1 Rough Plumbing I / 3 ea/il c7.- Temporary Temporary Power - _ I Shower Pan Test I I Foundation Reinforcing Steel 7—al- e I I cam. Stucco Mesh or Exterior Siding I I Excavation and Forms I'7-r•--err Ie.... Insulation _ _ _ I/ •)/- , I >v F.H.A. Foundation Reg, - I Sewer .7-0 R ir—I ��i- r sr e___ Slab Grade f 7----k . 071 C.. Interceptor I Ground Plumbing 6-()"- f'/l . Septic Tank I Underslab Ducts I Leach Line or Seep Pit r i i Underslab C 4 -7 i fr-- Water Service I'`f(' c.... (,'"-r'r adl v___J Fireplace Foundation I Lath or Drywall Nailing /2 ''' Joists and GirdersI Gas Line Air Test /_(,�, --- C Electrical Ground (J Fac(L 7. - 'I t-- Final Energy Ir Mid-Height Bond Beam r ri _ I Final Plumbing 3—/7�l `9 8-Foot Bond Beam l.�� V-7, ..--01,C Final Heating/A.C. 'Z S 7 t Final Bond Beam Final Construction :f 7 > C Fireplace Bond Beam I ' J Final On Site Improvements r Roof Sheathing I , f / ^ j/ Final Off Site Improvements Framing and Ventilation I -ir/ (�/ Final Dedication Roof Covering 12 / Final Zoning _ Rough Heating I I/ / Final Electrical /' ' C- Electrical'Service and Ground I / / Final Gas Rough Electrical le I/ Developer Fees Paid J WC (Y/NI Ind Saf (YIN) Certificate of Occupancy ?.►-�, ti.. ( -- t ./0 3-- •00/V`1 -,r7-01A —cr 1 . ' (1,...e.., - / krie__ --7-0,/"C100-0.) V;0-71 - l -x- _ -Q� -'-..-' --c-c.e.) 2: --P. -r •...-t......L,# .4'£ ,..7 $-4M-C.. . rrY -7..r+S.C,e_ di SEPTIC TANK GALS. SEEP. PIT X LEACH LINF WIDE X LONG X DEPTH OF ROCK N. W. E. "4$1:, ,1(--..r4V-:------ -• , S. Inspector's Signature and Initials -//I / J-l-i ' . 12-17589-469 Rev. 1/88 v v