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Permit No. (8) 106 SAN BERNARDINO COUNTY-EPWA/LAND AGEMENT DEPT OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 106 91 00402 201A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 06/19/91 I ISSUE DATE 06/20/91 I PG 1 OF 1 PARCEL NUMBER PROPOSED USE: RESIDENCE WITH GARAGE I11)32-04- - S CURRENT USE: VACANT TRACT I BLK 1 LOT I SEC I � 10I PRCL MAP I PRCL ACTIVITY L866 13915-2000 060 NE19 8W00 COMMUNITY PLANZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/PD,IL1,FR1, M-H 13915-2 PLAN 3 06/19/91 - - - LOT DIMENSION CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *BLDGS ON LOT GROUP R3 LYON CO./COPLEY ASSOC./TOM PARADISE 4490 VON KARMAN AVE *PLANS RECD 2 LAND USE PLOT 0 (INDEX NBR 21-145 NEWPORT BEACH CA 92660-0000 STD PLAN/ICBG FHA N (714) 833 - 3600 TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER WILLIAM LYON COMPANY/COPLEY ASSOC. 1 884 1.00 884.00 4490 VON KARMAN AVE 2 749 1.00 749.00 NEWPORT BEACH CA 92660-0000 GAR 455 .50 228.00 (714) 833 - 3600 PORCH 39 .20 8.00 JOB SITE ADDRESS CALC. VALU 89,076.54 I ADJUSTED AREA 1869 14581 FLAGSTONE CT CHINO HILLS CA 91709-0000 ITEM CNT DESCRIPTION DETAIL TOTALS CROSS STREET LOS RANCHITOS RD RESIDENTIAL CONSTRU 1,158.00 INSPECTN ACCESS TOTAL AMOUNT 1,158.00 CONTRACTOR NAME, ADDRESS LICENSE NUMBER RANDALL DICK J CONT000545733 P.O. BOX 7090 NEWPORT BEACH CA 92660-0000 (000) 000 - 0000 DIV. OF IND. SAFETY PERMIT: MINIMUM SETBACK DISTANCES 45 FRNT SETBACK/CENTRLINE FLAGSTONE CT RAI 50 20 REAR SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS ONTAR': NO. STORIES NO. DWELLING I NO. BEDROOMS I FLOOR COMPLETED ,-_ 2 UNITS 1 4 CONCRETE DATE /D -.2--S �7 EXT. WALLS I INT. WALLS CEILING STUCCO SHEETROCK SHEETROCK ROOFHEATING FIREPLACES TILE I NATURAL GAS METAL 01 IMASRY WATER PUBLIC (PUBLIC SEWER I MIN 000EPTHI S'000100I SIZ000EI NEW/REPAIR COMMENTS ALL FEES PAID SEWER/WATER LETTER RECEIVED AMT WAIVED .00 AMT PAID 1,158.00 PAYOR NAME: WILLIAM LYON COMPANY/COPLEY AS PAID 06/20/91 RECEIPT : 00002393 EMPL: HALL, S . PAID BY : CHECK NBR : 10390 •ICENSED CONTRACTOFiS DECLARATION • s,--- I rI HEREBY AFFIRM THAT I AM LICENSED UNDER THE PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 70001 OF DIVISION 3 OF THE BUSINESS AND:, PROFESSIONS CODE, AND MY LICENSE IS ININFULL FORCE AND EFFECT. LICENSE CLASS -----C06 LICENSE NUMBER ' /c/7 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 [$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 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 ❑ CE `(/ v FIED COPY IS HEREBY FURNISHED CERTIFIED COIEED WITH THE COU BUILDING INSP ON DE ARTMENT - L/ / 7./ ` 1 � APPLICANT /c9- _- - 1 --eDATF ADDITIONAL REVISION 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 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 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 HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT ❑ IS ❑ IS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY. I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE A O E.I FORMATION IS CORREC .,'I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCT aj AND HE EBY AUTH REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURP SES. �^, SIGNATURE OF APPLICANT OR AGENT i -- DATE _ CW L EXPIRATION 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. 1/.17RRA.4R9 Ray_6/90 Owner,Namey O1" • • Permit Nume/D6 ! 00,1 C22 f/7'v/ 6 • INSPECTION RECORD 0 DATE I INSPECTOR I DATE I INSPECTOR • Setback Ite i " Rough Plumbing 4. r _fir Temporary Power I '- IX Shower Pan Test 400' I 0 Foundation Reinforcing Steel I el -`ir, TY Stucco Mesh or Exterior Siding I� Excavation and Forms I - Insulation g-%40-7( I.f F.H.A. Foundation Req. I Sewer '7 -v."--7/43 Slab Grade 1--5 -71 Interceptor I Ground Plumbing 7�J Septic Tank I Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service I Fireplace Foundation Lath or Drywall Nailing Gj.0 4? Joists and Girders Gas Line Air Test el..�/�4( i'jElectrical Ground " -it Final Energy . ).7.7I Mid-Height Bond Beam Final Plumbing / 8-Foot Bond Beam Final Heating/A.C. _ / Final Bond Beam Final Construction `I/ / Fireplace Bond Beam Final On Site Improvements _7`� Roof Sheathing 11 / Final Off Site Improvements goy / Framing and Ventilation ' i / / Final Dedication ,23/ Roof Covering -ly / Final Zoning t� Rough Heating Final Electrical / / Electrical Service and Ground 1wy /1 Final Gas / Rough Electrical I/ 1/ Developer Fees Paid / WC (Y/N) Ind Sat(YIN) Certificate of Occupancy /i 4' VI' I AIIIU COMPLETED ., i SEPTIC TANK GALS. DATE p- L. -- z( SEEP. PIT X LEACH LINE WIDE X LONG X DEPTH OF ROCK N. W. E. I 4. ,...( /' S. Inspector's Signature and Initials ,I Il..... 12-17589-469 Rev.3/88