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Permit No. (3) 1111 • 105 SAN BtRNARDINO COUNTY—EPWA/LAND MANAGEMENT DEPT OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 89 00751 265A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 03/31/89 I ISSUE DATE 03/31/89 I PG 1 OF 1 PARCEL NUMBER PROPOSED USE: RELOCATE A/C UNIT (031-02_M-to CURRENT USE: RESIDENCE W/GARAGE TRACT 1000 10LOT 98 I NSEC W29 I 0' 108W I PRCL MAP I PRCL ACTIVITY : L820 COMMUNITY PLAN ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS PUD LOT DIMENSION IRREGULAR CONST TYPE APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *BOGS ON LOT 1 GROUP LONGOBARDO, JAMES H. . 2646 HACKBERRY CR *PLANS RECD 0 LAND USE PLOT 0 INDEX NBR 26-152 CHINO HILLS CA 91709-0000 STD PLAN/ICBO FHA (714) 393 — 0793 ITEM CNT DESCRIPTION DETAIL TOTALS OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER 1 FORCED AIR/GRAVITY 15.45 LONGOBARDO, JAMES H. . MECH SUB—TOTAL 15.45 2646 HACKBERRY CR ISSUANCE FEE 36.96 CHINO HILLS CA 91709-0000 TOTAL AMOUNT 52.41 (714) 393 — 0793 JOB SITE ADDRESS 2646 HACKBERRY CR CHINO HILLS CA 91709-0000 CROSS STREET BAYBERRY DR INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER DIE+. OF 1N0. SAFETY PERMIT: MINIMUM SETBACK DISTANCES 18 FRNT SETBACK/CENTRLINE FROM P/L R/W 50 15 REAR SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE 10 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS C 014 C ,RIO NO. STORIES NO. DWELLING NO. BEDROOMS FLOOR COM LET I UNITS P ' EXT. WALLS I INT. WALLS CEILING (f. / I LLL ROOF I HEATING 'METAL FIRELACES IMASRY WATER PUBLIC (PUBLIC SEWER I MIN 000EPTHI S 000100I0000EI NEW/REPAIR COMMENTS PRE ALTER DONE BY DON BAKER. a AMT WAIVED .00 AMT PAID 52.41 PAYOR NAME: LONGOBARDO, JAMES H. PAID 03/31/89 RECEIPT 1657 EMPL: GUFIERREZ, BRUNO PAID BY : CHECK NBR : 115 .ICENSED 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 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 [5500] I. IWNA,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 PROJ CTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRACTORS LICENSE LAW) ❑ I& PT UN sal SEC B. AND P. C FOR THIS REASON �y OWNE' �1„l/#* n,—"ft.- DATE ----- --3(-- �/ / Li'' l V1// " /f s WORKERS' COMPENSATION DECLARATION E6 RI HER _AFFIRM THAT 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 WI 00] 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 I. 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 \f\AN,, I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE TH' TH ABOVE INFORMATION IS CORRECT, I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATI TO BUILDING CONS R)CT 0N, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE BOVE-MENTIONED PROPERTY FOR INS' ON PURPOSE . SIGNATURE OF APPLICANT OR AGENT ��� (� "� DATE {�.e / t— / / EXPIRS4TION AND REFUND NOTICE APPLICATIONS FOR WHICH NO PERMIT IS IS ED )(THIN 180 DAYS FROM THE DATE OF APPLICATION SHALL EXPIRE.PERMITS SHALL EXPIRE IF WORK DOES NOT COMMENCE WITHIN 180 DAYS OF ISSUANCE 0 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 12-17588-469 Rev 10/88 Owner'Name Loh 0°4(gq.1Q _ Permit Numb` °6-("OO -S--/d on/ INSPECTION RECORD - . ' DATE I INSPECTOR I DATE INSPECTOR Setback Rough Plumbing Temporary Power Shower Pan Test Foundation Reinforcing Steel Stucco Mesh or Exterior Siding Excavation and Forms Insulation F.H.A. Foundation Req. Sewer Slab Grade Interceptor Ground Plumbing Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service I ' Fireplace Foundation Lath or Drywall Nailing I fP` Joists and Girders Gas Line Air Test `^}" 'Electrical Ground Final Energy 1 n I ICP Mid-Height Bond Beam Final Plumbing I ,y 8-Foot Bond Beam Final Heating/A.C. /• ,� Al V t 4 Final Bond Beam Final Construction / /' , I Fireplace Bond Beam Final On Site Improvements `I 11U t) 1 Roof Sheathing Final Off Site Improvements /I , Framing and Ventilation Final Dedication \ Il 1 A Roof Covering Final Zoning I Rough Heating Final Electrical Electrical Service and Ground Final Gas Rough Electrical Developer Fees Paid WC (Y/N) Ind Saf WIN) Certificate of Occupancy I • .. n ti r 46 .rf� /1 / ` 1 .� a_c_14--tZ,r.4) c17- dir-3.___U ,t,r Jr I .,s.F£ c) is V . •) t 442-44)4r 2-c 3 �_ W�t,t,0 y-/O-8 9 d N Tn t'r)ftl P&Te P,fo r<C,7 'N' OF F/ZEortJ 4.INES TN 7zeAI ci -_ i � (lam cf.- �. .� �-�� � c y- .d c7 69E4 Ti ,e tree"? ► _ I ►. 0r- ci/Q 7, 1 *// (/# r v e-�rv .r.r t J (i-37--r7 CO A) . .,e_.py.._i �,,iketeZ-0-r---Ia.) .;J'�-cX $1,.. ,.e.. 1 _.2"--,10...... N es -72-e ex.A.ti,.6. ...A, g I . G. Q..., 1 SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDE X LONG X DEPTH OF ROCK N. W. i E. /�j/7 /.1_//_ ,,j/i/�j..e iy/ _...--517_ ....01.•/ S. Inspector's ure and Initi4 ‘1 �L/ V 12-1759-469 Rev.3/88