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Permit No. (19) Y .. 4110 105 SAN BERNARDINO COUNTY-EPWA/LAND GEMENT DEPT OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 88 00521 201A 01 I PAGE 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 01/28/88 ISSUE DATE 01/29/88 PARCEL NUMBER 1017162130000 1017162550000 /6/7 _ C 9 - PROPOSED USE: RESIDENCE PLAN 3 CURRENT USE: VACANT 13313T I BLK 000 1 LOT 096 I SEC NW29 I 0 S 108W I PRCL MAP I OPRCL COMMUNITY ZONE/LAND USE DISTRICT( GENERALPUD PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO LOT DIMENSION IRREGULAR CONST TYPE VN TR 13313 PLAN 3 1/27/88 1017151040000 *BLDGS ON LOT GROUP R3 APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 23-152 STANDARD PACIFIC, L.P. STD PLAN/ICBO FHA N 1565 W MACARTHUR BLVD COSTA MESA CA 92626-0000 GRADING INITIAL ACTUAL (714) 546 - 1161 312 CU.YDS. EXC. CU.YDS. FILL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER STANDARD PACIFIC, L.P. TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN 1565 W MACARTHUR BLVD COSTA MESA CA 92626-0000 1 1448 1.00 1448.00 (714) 546 - 1161 312 2 1080 1.00 1080.00 GAR 600 .50 300.00 JOB SITE ADDRESS 2670 HACKBERRY CR CALC. VALU 118,776.00 I ADJUSTED AREA 2828 CHINO HILLS CA 91710-0000 CROSS STREET BAYBERRY DR ITEM CNT DESCRIPTION DETAIL TOTALS INSPECTN ACCESS RESIDENTIAL CONSTRU 920.50 TOTAL AMOUNT 920.50 CONTRACTOR NAME LICENSE NUMBER STANDARD-PACIFIC CORP CONT000248042 MAILING ADDRESS, PHONE NUMBER 1565 W MAC ARTHUR BLVD COSTA MESA CA 92626-0000 (000) 000 - 0000 MINIMUM SETBACK DISTANCES 18 FRNT SETBACK/CENTRLINE FROM P/L R/W 50 15 REAR 5ETDACKZPRC P LItIE 40 SIDE SETBACK/CENTRLINE PISTACHIO ST R/W 50 5 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES NO. DWELLING NO. BEDROOMS FLOOR 2 UNITS 1 II 4 CO WO EXT. WALLS I INT. WALLS CEILING ST SI SH SH ,%t!� .�_ l J}J Ii 1.' r n ROOF HEATING FIREPLACES '-�:% } w�tJ TI INA !METAL 01 IMASRY 'r ,.,', ,?} i� l� 1 WATERSEWER MIN DEPTH S.F./100 SIZE NEW/REPAIR �' i_�lli_ PUBLIC (PUBLIC I 000 I 000 10000 I NEW COMMENTS SCHOOL FEES PAID SEWAGE FACILITIES DEVELOPMENT FEE LETTER SUBMITTED RELEASE LETTER FROM CHIINO VALLEY REGIONAL MANAGER'S OFFICE. SUBMITTED AMT WAIVED .00 AMT PAID 920.50 PAYOR NAME: STANDARD PACIFIC OF ORANGE CO PAID 01/29/88 RECEIPT : 04863 EMPL: LUCAS, C 4110LICENSED 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 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 [S 5001.1: ❑ 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 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 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 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 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 i •• • INSPECTION RECORD Permit Number/CC/16 °, := -i 1aj,4 6 / DATE I INSPECTOR DATE QV INSPECTOR Setback e..e(- h1C"0/e-4 I Rough Plumbing 'U.-- ,/' Temporary Power - I 4i Shower Pan Test 4 d� /1' r'," Foundation Reinforcing Steel • t .-i/ I //LL,. Stucco Mesh or Exterior Siding y - _ !®� Excavation and Forms 1.4419 _ Insulation �y /6 s�1"'J�j; F.H.A. Foundation Req. I' f� Sewer Q "( / VW 7 • •Slab Grade IV^ G '/ - I G/ Interceptor ` IF Ground Plumbing 465 CM If-/7.1 ' Wilt.,—._ Septic Tank I Underslap Ducts ' ir Leach Line or Seep Pit Underslab Conduit I Water Service I /) Fireplace Foundation I Lath or Drywall Nailing I (( Yr I i� k,1 Joists and Girders I Gas Line Air Test du ,/ / G Electrical Ground WV-, I Final Energy t t( ` r '` I T Mid-Height Bond Beam U I / Final Plumbing iii I 8-Foot Bond Beam ill 1 Final Heating/A.C. _`55V / Final Bond Beam I / IV Final Construction ; /I Fireplace Bond Beam ft "7 Final On Site Improvements 1 w / I Roof Sheathing / y I / Final Off Site Improvements ,'"/ ,,Ir Framing and Ventilation h O / IA 91/ Final Dedicationl / Ir �\ Roof Covering 1 / (r\ i/ Final Zoning c 6/ \I \-se-/ Rough Heating / I \ / Final Electrical / VI, IV Electrical Service and Ground / I 1' Final Gas / \NI Rough Electrical / V Developer Fees Paid / lif I Certificate of Occupancy f-' /I, • WORKERS' COMPENSATION INSURANCE (YIN) DIVISION OF INDUSTRIAL SAFETY PERMIT (YIN) SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDE X LONG X DEPTH OF ROCK N. in AII .. - ' ‘°'ll ' if 5e- CAM ns,", , d it, . S. Inspector's Signature and Initials 12-17589-469