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Permit No. (21) 4111 III 106. SAN BERNARDINO COUNTY—EPWA/LAND GEMENT L'cPT OrFICE OF BUILDING AND SAFETY P E RMI T APPLICATIgN PERMIT NBR 106 91 01311 255A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 10/08/91 I ISSUE DATE 10/08/91 I PG 1 OF 1 PARCEL NUMBER 1024-131-23-0000 PROPOSED USE: ELECT FOR YARD LIGHTING 0' — /3 — CURRENT USE: RESIDENCE 13TRACT 651-3I BLK 000 I 051 LOT I NSEC E18 102S RNG I PRCL MAP I PRCL ACTIVITY : L820 0 0 COMMUNITY PLAN ZONE/LAND USE DISTRICTI GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/PD/IL1/FR1 M TO H LOT DIMENSION IRREGULAR CONST TYPE APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *BLDGS ON LOT 1 GROUP REICHL LANDSCAPING 748 E BONITA AVE 210 *PLANS RECD 0 LAND USE PLOT 0 INDEX NBR 24-140 POMONA CA 91767-0000 STD PLAN/ICBO FHA (714) 629 — 7402 ITEM CNT DESCRIPTION DETAIL TOTALS OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER 2 FIXTURES 7.00 FOX, HOWARD ELEC SUB—TOTAL 7.00 2453 HAWKWOOD DR ISSUANCE FEE 62.00 CHINO HILLS CA 91709-0000 TOTAL AMOUNT 69.00 (714) 736 — 0711 JOB SITE ADDRESS 2453 HAWKWOOD DR CHINO HILLS CA 91709-0000 CROSS STREET VILLAGE CENTER DRIVE INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER REICHL LANDSCAPING CONT000441073 PO BOX 2581 CRESTLINE CA 92325-0000 (000) 000 — 0000 ACTIVE WORKERS COMP DIV. OF IND. SAFETY PERMIT: MINIMUM SETBACK DISTANCES 46 FRNT SETBACK/CENTRLINE HAWKWOOD DRIVE R/W 50 20 REAR SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES I NO. DWELLING I NO. BEDROOMS I FLOOR UNITEXT. WALLS I INT. WALLS I CEILING ROOF 1 HEATING FIREPLACES METAL IMASRY ONTARIO WATERSEWER N DEPTH' S.F./100 SIZE NEW/REPAIR PUBLIC I PUBLIC I MIN 000 0000 COMPLETE COMMENTS DATE AMT WAIVED .00 AMT PAID 69.00 PAYOR NAME: REICHL LANDSCAPING PAID 10/08/91 RECEIPT 4114 EMPL: HALL, S PAID BY : CHECK NBR : 5325 •ICENSED 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 ,oki Q PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFEFFECT. - CLASS �'_�� LICENSE NUMBER � !4t0 l 7 CONTRACTOR « wC�DATE 1G 8f 9 I 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].): ❑ 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. 38/ `T 00,gLA^B.CC.`�.) �1 POLICY NO. r -10 COMPANY STATE ND ,❑ CERTIFIED COPY IS HEREBY FURNISHED LIQ CERTIFIED COPY IS FILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT , I PPLICANT ' ONA--0 Rc -lc L. bA RE Q-%L IANOSRT -P(ti pl C DATF I /8 ) l ITIONAL REVISION TIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS (5100] 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 I. LENDER'S NAME LENDER'S ADDRESF 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 HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT ❑ IS ❑ IS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY. I CERTIFY THAT I HAVE READ THIS APPLICATI AND STATE THAT THE OVE INFORMATION IS CORRECT, I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING T ILDING CONSTRUCTIO , ND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECT ON PURPO ES 4'1 NAT OF APPLICANT OR AGENTI I DATE IC)) /9 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.4/90 Owner Name ) . % 44a: Perrrk Numb J/.2SS cD / INSPECTION RECORD ' DATE INSPECTOR 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 fa-1-9/ 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 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 (YIN) Certificate of Occupancy • SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDF X LONG X DEPTH OF ROCK N. UN I AHIU C(hPI FTFD _ i npTF ;/.%— 0 —7 / . W. E. S. Inspector's Signature and Initials �L���7C:,�� 12-17589-469 Rev.3/88