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Permit No. (13) I ` 1111 105 S N BERNARDINO COUNTY-EPWA/LAND AGEMENT DEPT ------ OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 89 00807 201A 01 I STATUS: ACTIV THIS IS NOT A•PERMIT UNTIL ISSUED APPL DATE 04/04/89 I ISSUE DATE 04/05/89 I PG 1 OF 1 PARCEL./Oc24 �0 / CURRENT USE: VACANT _ _ //[ d- PROPOSED USE: RESIDENCE W/GAR TRACT 13651-91 000 1 LOT 041 1 SEC BLK SE18 1025 1 RNG 0SW 1 PRCL MAP 1 PRCL ACTIVITY : L831 0 0 COMMUNITY PLAN ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS PUD TRACT 13651-9 #1 04/04/89 1017-121-17-0000 LOT DIMENSION IRREG CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER #BLDGS ON LOT GROUP R3 FIELDSTONE COMPANY, THE (JULIE T. ) 145 S STATE COLLEGE BLVD #660 #PLANS RECD 0 LAND USE PLOT 0 INDEX NBR 21-143 BREA CA 92621-0000 STD PLAN/ICBO FHA N (714) 990 - 3006 TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER FIELDSTONE COMPANY, THE (JULIE T. ) 1 940 1.00 940.00 145 S STATE COLLEGE BLVD #660 2 860 1.00 860.00 BREA CA 92621-0000 GAR 561 .50 281.00 (714) 990 - 3006 PORCH 39 .20 8.00 JOB SITE ADDRESS CALC. VALU 94,005.00 I ADJUSTED AREA 2089 2211 HEDGEROW LN CHINO HILLS CA 91710-0000 ITEM CNT DESCRIPTION DETAIL TOTALS CROSS STREET COTTAGE CIRCLE RESIDENTIAL CONSTRU 943.50 INSPECTN ACCESS TOTAL AMOUNT 943.50 CONTRACTOR NAME, ADDRESS LICENSE NUMBER FIELDSTONE COMPANY THE CONT000402826 14 CORPORATE PLAZA NEWPORT BEACH CA 92660-0000 (000) 000 - 0000 ACTIVE WORKERS COMP DIV. OF IND. SAFETY PERMIT: MINIMUM SETBACK DISTANCES 43 FRNT SETBACK/CENTRLINE HEDGEROW LANE 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 ( FLOOR fq�'r f-`i' t; 2 UNITS 1 3 CONCRETE V f.ni`.I , •.,`., t:4 t�if'`�(10 ,- U , EXT. WALLS I INT. WALLS CEILING '4,, E_;l'A ,:_!;i = �f,� �-:- '- i 1 1 -) STUCCO SHEETROCK SHEETROCK �� -N � . �� .. � ;., i'� •, , / I {:) ROOF HEATING FIREPLACES WC I : ��TILE I NATURAL GAS METAL 01 IMASRY #y - 7-- WATER PUBLIC 1PUBLIC ER 1 MIN 000EPTHI S 000100I0000EI NEW/REPAIR COMMENTS ALL DEVELOPMENT FEES PAID AMT WAIVED .00. AMT PAID 943.50 PAYOR NAME: THE FIELDSTONE COMPANY PAID 04/05/89 RECEIPT : 00001738 EMPL: STACCATO-NYARI, M PAID BY : CHECK NBR : 763 ()LICENSED 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 ANB PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT.FFFE LICENSE CLASS LICENSE NUMBER / �� CONTRACTOR / e DATE /d/trY r � 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 ($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 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 I POLICY NO. /./)Pf / 9' / COMPANY //`BGG GL{a �❑ CERTIFIED COPY IS HEREBY FURNISHED pCERTIFI ��YIS FI y73.WIT THEECOU TY TY BUILDING INSPECTION DEPARTMENT APPLICANT� // // Y r �'�G�l�L C�r� DATEL /�// 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 IS A 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 RELATIN BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSP CTIO //PUR/p OSES. Q / /u SIGNATURE OF APPLICANT OR AGENT LLL / /1 � � DATE s / /7- 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 of HI I36 /emit Num �'9 oaga' aoi°INSPECTION41)_14.5itint_.4 CORD ( _ ATE INSPECTOR I DA ,f INSPECTOR SetbackRough Plumbing I .4 4 . Temporary Power Shower Pan Test 47 i'("" 4....-Foundation Reinforcing Steel 6--/s-7e56--/s-7e5 ,� Stucco Mesh or Exterior Siding AI be Excavation and Forms . 7 �/1 Insulation I7/L 1r/ /' F.H.A. Foundation Req. I Sewer //M 5 I '�Q/ .Y6 h J '.-' Slab Grade f/7 Interceptor ` . I I Ground Plumbing Icif..5 f ,,. , �,/ Septic Tank I I Underslab Ducts ✓r Leach Line or Seep Pit II /1 r Underslab Conduit I Water Service Fireplace Foundation I Lath or Drywall Nailing rnS Joists and Girders /s Gas Line Air Test • I ` Electrical Ground /104, N ,1/ Final Energy I ni Mid-Height Bond Bea Final Plumbing I _ ,4I // l 8-Foot Bond Beam I _ / Final Heating/A.C. I/.. i/f_ I .iYk%'. Final Bond Beam I = Final Construction 13,r- Fireplace Bond Beam / Final On Site Improvements f I Roof Sheathing / A y Final Off Site Improvements Framing and Ventilation t - wi `, Final Dedication n Roof Covering 1 A I 'A11,1111 V . Final Zoning A fit f Rough Heating p ��r Final Electrical n /i ,Ff - pi,/V/ Electrical Service and Ground Final Gas `7,17v Rough Electrical I I Developer Fees Paid A AlWC (Y/N) Ind Saf IY/N) Certificate of Occupancy (1//%I V14(...... .n. M*tics PS En.1 tl_ 11101 �. .�,w 0fivIsA ;°"`fir '' r8t14{"LE. 1 LTJ . . tr., , cr'-- /' SEPTIC TANK GALS. .L A 1 L. SEEP. PIT X LEACH LINF WIDE X LONG X DEPTH OF ROCK N. W. E. S. Inspector's Signature and Initials 12-17589-469 Rev 3/88