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Permit No. (4) 74::3 105 SAN BERNARDINO COUNTY-EPWA/LAND IDAGEMENT DEPT 1111 OFf.ICE OF BUILDING AND SAFETY P E RMI T APPLZ;CATIOK+ PERMIT NBR 105 88 00738 201A 01 I PAGE 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 01/29/88 ISSUE DATE 01/29/88 PARCEL NUMBER ) .-ra&c ` :6 PROPOSED USE: RESIDENCE/GARAGE PLAN 2 CURRENT USE: VACANT 13401T I BIK I LOT I SSEC E07 I O N 107RNG W I PRCL101MAP 122RCL COOMMMO IIYLPLAN ZONE/LLANND USE DISTRICTTGENERALS PLAN 008SUBDIVISION NAME SUBDIVISION PARCEL NO LOT DIMENSION IRREGULAR (CONST TYPE VN TR 13401 MOD 2 01.29.88 1033091060000 RBLDGS ON LOT GROUP R3 APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 65-177 CROSS, ERNIE STD PLAN/ICBO FHA N 24005 VENTURA BLVD CALABASAS CA 91302-0000 GRADING INITIAL ACTUAL (714) 371 - 7139 CU.YDS. EXC. CU.YDS. FILL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER GRIFFIN HOMES TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN 24005 VENTURA BLVD CALABASAS CA 91302-0000 1 1410 1.00 1410.00 (818) 992 - 6900 2 846 1.00 846.00 GAR 635 .50 318.00 JOB SITE ADDRESS PORCH 100 .20 20.00 6135 FLEETWOOD LN CHINO CA 91710-0000 CALC. VALU 108,948.00 I ADJUSTED AREA 2594 CROSS STREET WOODBRIDGE ST INSPECTN ACCESS ITEM CNT DESCRIPTION DETAIL TOTALS RESIDENTIAL CONSTRU 854.80 TOTAL AMOUNT 854.80 CONTRACTOR NAME LICENSE NUMBER GRIFFIN HOMES CONT000239926 MAILING ADDRESS, PHONE NUMBER 24005 VENTURA BOULEVARD CALABASAS CA 91302-0000 (000) 000 - 0000 MINIMUM SETBACK DISTANCES 19 FRNT SETBACK/CENTRLINE P/L R/W 50 15 REAR SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES NO. DWELLING NO. BEDROOMS FLOOR 2 UNITS 1 4 CO ST EXT. WALLS ISH INT. WALLS ISH CEILING ONTARIO ROOFHEATING FIREPLACES -� TI INA (METAL O1 IMASRY LETED WATERSEWER MIN DEPTH S.F./100 SIZE NEW/REPAIR DATE: iQG?z ze PUBLIC (PUBLIC I 000 I 000 10000 I T E NEW LLLL.... GJ COMMENTS CHINO COC ON FILE CHINO VALLEY MGR LETTER ON FILE AMT WAIVED .00 AMT PAID 854.80 PAYOR NAME: GRIFFIN HOMES PAID 01/29/88 RECEIPT : 04905 EMPL: BECK, JAN •ICENSED CONTRACTORS DECLARATION• I HEREBY AFFIRM THAT I AM LICENSED UNDER THE PROVISIONS OF CHAPTER 9 (OOMMENC;NG 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 [$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 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 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 [$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 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 /3 • 0 . INSPECTION RECORD Permit Number/OST O0`73g?--6/43/ DATE INSPECTOR I I DATE _ I INSPECTOR Setback 6 I ,�U�.1>' Rough Plumbing 92�1�J'_ Temporary Power — Shower Pan Test Foundation Reinforcing Steel 6�' c3F-3 I IJ/'S Stucco Mesh or Exterior Siding r,,,�...• I r Excavation and Forms / I — Insulation 0 z s,A F.H.A. Foundation Req. _ Sewer .► zrzlr.M Slab Grade b y /' Interceptor P - Ground Plumbing - ai /17 Septic Tank / - Underslap Ducts Leach Line or Seep Pit /'� Underslab Conduit I Water Service y/ _ _ _ Fireplace Foundation I Lath or Drywall Nailing �� ��� Joists and Girders I Gas Line Air Test f/ Electrical Ground b,o2 r//_ Final Energy 22 t 3 .. )/' Mid-Height Bond Beam Final Plumbing 7 8-Foot Bond Beam I Final Heating/A.C. Final Bond Beam _ _ Final Construction Fireplace Bent-8 � Zfj Final On Site Improvements ,1/ Roof Sheathing Final Off Site Improvements Framing and Ventilation I ll Final Dedication Roof Covering I I Final Zoning Rough Heating I I Final Electrical Electrical Service and Ground I I Final Gas Rough Electrical I Developer Fees Paid I I Certificate of Occupancy l' WORKERS' COMPENSATION INSURANCE (YIN) DIVISION OF INDUSTRIAL SAFETY PERMIT (YIN) SEPTIC TANK GALS , 2'>. 'k' Y' ' SEEP. PIT X LEACH LINE WIDE ' - ^'4F '' X LONG X ., •DEPTH•OF ROCK N. A, 't ., - 1 W. E. rTh n / i //I S. Inspector's Signature and Initials _A ' '5 AV—/Y•/ _si . --. 12-17589-469