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Permit No. (8) AUL r 1111 105 SAN BERNARDINO COUNTY—EPWA/LAND AGEMENT DEPT OFFICE OF BUILDING AND SAFETY PERMIT APPLICATION PERMIT NBR 105 89 03099 265A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 09/15/89 I ISSUE DATE 09/15/89 I PG 1 OF 1 PARCEL NUMBER --� d — 2 / — �'' J Pal PROPOSED USE: RE—LOCATE A/C UNIT r CURRENT USE: RESIDENCE TRAC LOT SEC 13313T 1000 1096 I NW29 102S 108W I PRCL 00AP P0 RCL CCTOMFI1tV1NITY PIANl820 ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/PD LOT DIMENSION IRREGULAR CONST TYPE APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER IIBLDGS ON LOT 1 GROUP CONTROL AIR BY METZ 13555 RAMONA AVE *31 *PLANS RECD 0 LAND USE PLOT 0 INDEX NBR 26-156 CHINO CA 91710-0000 STD PLAN/ICBO FHA (714) 628 — 9525 ITEM CNT DESCRIPTION DETAIL TOTALS OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER I FORCED AIR/GRAVITY 15.45 WATSON, RON MECH SUB—TOTAL 15.45 2670 HACKBERRY CIR ISSUANCE FEE 36.96 CHINO HILLS CA 91709-0000 TOTAL AMOUNT 52.41 (714) 597 — 0256 JOB SITE ADDRESS V:. , • •4 ��r 2670 HACKBERRY CIR CHINO HILLS CA 91709-0000 %, K^.C: i --... ,r„-n CROSS STREET PISTACHIO STREET ., �' °7't., • , :t.s, I�� {dC�dt� PJ:/k iv leo t�; ; INSPECTN ACCESS „ a_ 3 �i -,,'t CONTRACTOR NAME, ADDRESS LICENSE NUMBER MALINS POOL CONST CONT000438874 12345 MILLS 431VE UNIT AC CHINO CA 91710-0000 (000) 000 — 0000 r_. TNO. SAFETY PrPliTT: - MINIMUM SETBACK DISTANCES 43 FRNT SETBACK/CENTRLINE HACKBERRY CIR R/M 50 15 REAR SETBACK/PROP LINE 40 SIDE SETBACK/CENTRLINE PISTACHIO STREET R/W 50 5 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIESI NOIT DWELLING NO. BEDROOMS FLOOR EXT. WALLS I INT. WALLS I CEILING ROOF I HEATING FIREPLACES METAL MASRY PUBLIC WATER I SEWER I MIN NODEPTHI S.000 100I0000EI NEW/REPAIR COMMENTS REC'D COPY OF LICENSE EXP 6/30/90 OK TO ISSUE PERMIT BY BRUNO GUTIERREZ AMT WAIVED .00 AMT PAID 52.41 PAYOR NAME: CONTROL AIR BY METZ PAID 09/15/89 RECEIPT 5316 EMPL: STACCATO—NYARI, M PAID BY : CHECK NBR : 2056 •LICENSED CONTRACTORS DECLARATION. ., I HEREBY AFFIRM THAT I AM LICENSED UNDER THE PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISIO 3 OF HE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT ,(. Q �j CENSE CLASS - z- 0 LICENSE NUMBER CONTRACTOR --S7-3/ S 9 y DA /S-� 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].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 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 COPY IS HEREBY FURNISHED ❑ CERTIFIED COPY IS FILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT APPLICANT DATF 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 T0,..RKERS' CO6ENSATI LAWS OF/ A APPLICANT o k ` DATF ///:"K=' ../.. .NOTIC TO APPLICANT IF,AFTER MAKING THIS CERTIFICATE F EXEMPTION,YOU SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS HE 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 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 ABOV -MENTIONED PROPERTY FOR INSPECTION PURPOSE // � 9 SIGNATURE OF APPLICANT OR AGENT A-c . l//.4 DATE / ./i/`%.,r 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. 12-17588-469 Rev. 10/88 • s-/?5 - 0,5 sat,g-A -AOOwner Name JAY O A\ Permit Numb. INSPECTION RECORD DATE INSPECTOR I DATE I 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 Fireplace Foundation Lath or Drywall Nailing Joists and Girders Gas Line Air Test L Mr1 Electrical Ground Final Energy (CP, `-�"1 4 I 4:9,-13 r kk Mid-Height Bond Beam Final Plumbing 7 ..h 1 8-Foot Bond Beam Final Heating/A.C. Np" ^f,(0- , Final Bond Beam Final Construction '9i I Fireplace Bond Beam Final On Site Improvements Roof Sheathing Final Off Site Improvements Framing and Ventilation Final Dedication Roof Covering Final Zoning Rough Heating Final Electrical Electrical Service and Ground Final Gas Rough Electrical Developer Fees Paid WC (YIN) - Ind Saf (Y/N) Certificate of Occupancy ^ / 1r/ YT•? 6.7 C.tug<-0- m, c4.44) r� ailhJC,Q) c /2-4(177 �fl q-/J -O ` /V (�.oivir02 �/�1 //l�c-orid , zirT my . S--9.0 Q t 3 90 1 1'3a ,o. Li-6 1" A1.et'c,>°c` !-Z5-1'/ Yr4F 7 7trid- 9- 7 - 9 t Y- . - c-0< e i c.Otir,P " - r Gd--e S'cicc..t./ _ n T { .. -a N-.- ... D 1 .ilk ;,Pin SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDE X LONG X DEPTH OF ROCK N. W. E. S. Inspector's Signature and Initials Z211 :40-e--44444722?-- 12-17589-469 0-e-4444 7 7 2-7 7 589-469 Rev.3/88