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Permit No. (10) F NL • 105 SAN BERNARDINO COUNTY-EPWA/LAND AGEMENT DEPT OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 89 03489 210A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED -- APPL DATE 10/13/89 I ISSUE DATE 10/13/89 I PG 1 OF 1 PARCEL NUMBER 1031-281-38-0000 PROPOSED USE: COVERED PATIO /D 3 /- A / - 3 CURRENT USE: RESIDENCE TRACT 1000 10LOT 96 I NSEC W29 I o2 0W 8W I PRCL MAP I PRCL ACTIVITY : 1820 COMMUNITY PLAN ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/PD,IL1,FR1 I LOT DIMENSION IRREGULAR CONST TYPE APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *SLOGS ON LOT 1 (GROUP WATSON, RON 2670 HACKBERRY CIR *PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 26-156 CHINO HILLS CA 91709-0000 STD PLAN/TCBO FHA N (714) 597 - 0256 TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER WATSON, RON PORCH 372 .20 75.00 2670 HACKBERRY CIR CHINO HILLS CA 91709-0000 CALC. VALU 3,375.00 I ADJUSTED AREA 75 (714) 597 - 0256 ITEM CNT DESCRIPTION DETAIL TOTALS JOB SITE ADDRESS RESIDENTIAL CONSTRU 53.93 2670 HACKBERRY CIR TOTAL AMOUNT 53.93 CHINO HILLS CA 91709-0000 CROSS STREET PISTACHIO STREET INSPECTN ACCESS NT kW° CONTRACTOR NAME, ADDRESS LICENSE NUMBER Ctp[ETED DATE: ,a--e-co. r,$. DIV. OF IND. SAFETY PERMIT' - MINIMUM SETBACK DISTANCES 43 FRNT SETBACK/CENTRLINE HACKBERRY CIR R/W 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. STORIES WELLING ( NO. BEDROOMS FLOOR 1 UNITS CONCRETE EXT. WALLS I INT. WALLS CEILING ROOF 1 HEATING FIREPLACES WOOD METAL IMASRY PWWATER ATIR I SEWER I MINODDEPTHI S.00O100IOOOOEI NEW/REPAIR COMMENTS *MODERATE TO HIGH LANDSLIDE SUSCEPTIBILITY EROSION CONTROL PERMIT A1058902820240A01 STILL ACTIVE -SEE POOL PERMIT 1058902820225A01 AMT WAIVED .00 AMT PAID 53.93 PAYOR NAME: RON WATSON PAID 10/13/89 RECEIPT 5879 EMPL: ROTRUCK, S PAID-BY : CHECK NBR : 1448 LICENSED CONTRACTORS DECLARATION I 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 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 ,..‘.,[i.ALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS ($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 CONTRACTORIS) LICENSED PURSUANT TO THE CONTRACTORS LICENSE LAW) ElIAM EXMPT UNDEDSE ��� Z B AND P C FOR THIS REASON /�/ Q� 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 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 PERF RMANCE OFT ••K FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TOT E_1�ORKERS' COM•ENSATION k• S •F CALIFORNIA i APPLICANT— , ."(N`—'" DATE i I `�/no) NOTICE TO APPLICAT• IF,AFMAKING THIS CERTIFICATE OF EXEMPTION, YOU SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF THE LABOR COD 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 •:0INFORMATION IS CORRECT, I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION a N• EREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPE•T• PURP0S / SIGNATURE OF APPLICANT OR AGENT T ti DATE -EIPIRATION AND REFUND NOTICE APPLICATIONS FOR WHICH NO PERMIT IS ISSUED`NITHIN 180 DAYS FROM THE DATE OF APPLICATION SHALL EXPIRE PERMITS SHALL EXPIRE IF WORK DOES NOT -e COMMENCE WITHIN 180 DAYS OF ISSUANCE OF S PERMIT OR IF THE WORK IS SUSPENDED OR ABANDON 0 FOR A PERIOD OF 180 DAYS.FEES PAID ARE NOT -.REFUNDABLE AFTER 180 DAYS FROM DATE OF P NT, EXCEPT FOR ERRORS IN ACCEPTANCE WHICH M REFUNDABLE UP TO ONE YEAR FROM DATE OF PAYMENT ALL FEES PAID MAY NOT BE REFUNDA 12-17588-469 Rev 10/88 Owner Name i_L)O. (` — • Permit Numb 5 ra 140 INSPECTION RECORD DATE I INSPECTOR I I DATE I INSPECTOR Setback lb./`713f 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 r•ar17nifvGS 1/404,..10Y 2* 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 Electrical Ground Final Energy Mid-Height Bond Beam Final Plumbing 8-Foot Bond Beam Final Heating/A.C. Final Bond Beam Final Construction 0- 0-9/ _— Fireplace Bond Beam Final On Site Improvements Roof Sheathing Final Off Site Improvements Framing and Ventilation a- 8-9/ Final Dedication Roof Covering 1 Final Zoning Rough Heating Final Electrical Electrical Service and Ground Final Gas Rough Electrical Developer Fees Paid WC (Y/N) Ind Saf (Y/NI Certificate of Occupancy /f,V 7. Sf ,CPO?;*' 1 /07 /s/ PdaG 94A4 a #' 444%4 ice— CA 1" )� � U ti r tne r mss•e;uv n u�ry� 9 90, row r-� .-. 1 rH-7 �I SEPTIC TANK GALS. SEEP. PIT X LEACH LINF WIDF X LONG X DEPTH OF ROCK N. W. E. S. Inspector's Signature and Initials 12-17589-469 Rev.3/88 ' '