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Permit No. (7) 105 SAN BERNARDINO COUNTY-EPWA/LAND•AGEMENT DEPT • OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 89 02686 201A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 08/01/89 I ISSUE DATE 08/01/89 I PG 1 OF 1 PARCEL NUMBER I b2 y� / 33— o�7�,��t), 1 Gt PROPOSED USE: RESIDENCE W/ATTACHED GARAGE ( l l CURRENT USE: VACANT TRACT BLK LOT SEC TWN TY 13651-3! 000 ! 053 ! NE18 ! p ! 08W ! PRCL 00AP ! PORCL CCT ITM PLANL831 ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/PD 13651-3 PLAN *3 08/01/89 1017-121-17-0000 LOT DIMENSION IRREGULAR CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *BLDGS fiN LOT GROUP R3 BROCK, M.J. AND SONS INC. 250 E RINCON RD *PLANS RECD 0 LAND USE PLOT 0 INDEX NBR 24-140 CORONA CA 91719-0000 STD PLANfCBO FHA N (714) 736 - 0711 TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER BROCK, M.J. AND SONS INC. 1 1394 1.00 1394.00 250 E RINCON RD 2 1320 1.00 1320.00 CORONA CA 91719-0000 GAR 595 .50 298.00 (714) 736 - 0711 PORCH 116 .20 24.00 JOB SITE ADDRESS CALC. VALU 142,020.00 I ADJUSTED AREA 3156 2456 HAWKWOOD DR CHINO HILLS CA 91709-0000 ITEM CNT DESCRIPTION DETAIL TOTALS CROSS STREET VILLAGE CENTER DRIVE RESIDENTIAL CONSTRU 1,235.61 INSPECTN ACCESS TOTAL AMOUNT 1,235.61 • CONTRACTOR NAME, ADDRESS LICENSE NUMBER BROCK M J T SONS INC CONT000054648 6767 FOREST LAWN DRIVE LOS ANGELES CA 90068-0000 (000) 000 - 0000 DIV. OF IND. SAFETY PERMIT: MINIMUM SETBACK DISTANCES 48 FRNT SETBACK/CENTRLINE HAWKWOOD DRIVE R/W 50 20 REAR SETBACk/PROP LINE 40 SIDE SETBACK/CENTRLINE HAWKWOOD DRIVE R/W 50 5 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES ! NO. DWELLING I NO. BEDRO1OMS !2 UNICFLOOR ONCRETE EXT. WALLS INT. WALLS CEILING ONTA STUCCO SHEETROCK SHEETROCK ONTA RIO CON►pLETE ROOF HEATING FIREPLACES • DATE TILE NATURAL GAS !METAL IMASRY 02 C5 y�� '4... WATER SEWER MIN DEPTH S.F./100 SIZE NEW/REPAIR PUBLIC !PUBLIC ! 000 ! 000 !0000 ! NEW COMMENTS APPROVED CONSTRUCTION PLANS ON FILE. APPROVED PLOT PLAN ON FILE. C OF C ON FILE FROM CHINO UNIFIED SCHOOL DISTRICT. CHINO VALLEY MGR'S OFFICE RELEASE LETTER ON FILE. SEWAGE FACILITY DEVELOPMENT FEE RELEASE LETTER ON FILE. ZONING";INFO: IMPROVEMENT LEVEL 1 FIRE SAFETY OVERLAY - FR 1 LANDSLIDE SUSCEPTIBILITY - MODERATE TO HIGH AMT WAIVED .00 AMT PAID 1,235.61 PAYOR NAME: BROCK, M.J. AND SONS INC. PAID 08/01/89 RECEIPT : 00004436 EMPL: RICHARDS, GARY PAID BY : CHECK NBR : 349781 LICENSED CONTRACTORS DECLARATIONS ✓ ' 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 'I (SCI LICENSE CLASS u 7 ( LICENSE NUMBER,_5-44.0,P CONTRACTOR DATE (a!31 OWNER-BUILDER DECLARATION «l 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 ($5001)' ❑ 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.) /��/� Jf� POLICY NO. QAC 13 S 3‘75---L.�F'r COMPANY Itk -V\4 ❑ CERTIFIED COPY IS HEREBY FURNISHED ❑ CERTIFIE 0 Y IS Fl D WITH j'a,i TYTY � � SPECTION DEPARTMENT / APPLICANT ' U ` �� ��' °�• DATE (Z/ zAg 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 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 ISA 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 CONSTR I%J, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED TY R SIGNATURE OF APPLICANT ROR AOGENTSPF IOf1�UR�P SES. xQ DATE / 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 Owner Name M.r• S :?:V40C- Permit Numb4IOs— 21-c& C "2cif -c L INSPECTION RECORD `7 DATE INSPECTOR IAA1 f I INS CTOR Setback A'� _ Rough Plumbing #/4 I /' 1/ Temporary Power np'-� Shower Pan Test I _../ Foundation Reinforcing Steel 1 •P.r- Stucco Mesh or Exterior Siding Excavation and Forms 1.1V . Insulation '-7-2 41 /1( 1,7 F.H.A. Foundation Req. f Sewer 4"6 . 9 Slab Grade 2`7- ' Interceptor Ground Plumbing Septic Tank I I Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service -10' Fireplace Foundation Lath or Drywall Nailing /I 1.4.7 _.......-!---- Joists and Girders Gas Line Air Test pricAi )(/'" %i __ Electrical Ground G -20.--70) Pr Final Energy n v Mid-Height Bond Beam Final Plumbing 8-Foot Bond Beam Final Heating/A.C. / Final Bond Beam Final Construction Fireplace Bond Beam ( Final On Site Improvements at / Roof Sheathing •ff\ 4 /Final Off Site Improvements 1�7 Framing and Ventilation V A`l /,•/ di I Final Dedication Roof Covering dHq / 1/, /' I Final Zoning /I Rough Heating ► I Final Electrical Electrical Service and Ground I A I I Final Gas I Rough Electrical X( 1, I Developer Fees Paid WC (YIN) Ind Sat(YIN) I Certificate of Occupancy I/ X ONTAHIO COMPLETED DATE r SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDE ' r - X LONG X DEPTH OF ROCK N. W. E. I ,..404,6.0.............", /y r,".,. S. Inspector's Signature and Initials /4+'" ic--- /Y te— 1 12-17589-469 Rev 3/88