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Permit No. (19) 4111 1155 SAN BERNARDINO COUNTY—EPWA/LAND AGEMENT DEPT . OFFItE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 89 00850 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 NUMBER /0 ✓ /` / �� PROPOSED USE: RESIDENCE W/GARAGE U CURRENT USE: VACANT TRACT BLK LOT SEC L P AC IVITY : 13651-9I 000 1045 I SE18 I p 5 1 I PRC08W0 AP I pRC� COTMMUNITY PLANL831 ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS PUD TR 13651-9 MR2 04/04/89 1017-121-17-0000 LOT DIMENSION IRREG CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER I(BLDGS ON LOT GROUP R3 FIELDSTONE COMPANY, THE_(JULIE T. 145 S STATE COLLEGE BLVD It660 *PLANS RECD 0 LAND USE PLOT 0 INDEX NBR 21-143 BREA CA 92621-0000 STD PLAN/ICBG FHA Y (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 1017 1.00 1017.00 145 S STATE COLLEGE BLVD *660 2 958 1.00 958.00 BREA CA 92621-0000 GAR 524 .50 262.00 1714) 990 — 3006 PORCH 21 .20 5.00 JOB SITE ADDRESS CALC. VALU 100,890.00 I ADJUSTED AREA 2242 2235 HEDGEROW LN CHINO HILLS CA 91710-0000 ITEM CNT DESCRIPTION DETAIL TOTALS CROSS STREET AUTUMN VIEW LANE RESIDENTIAL CONSTRU 998.96 INSPECTN ACCESS TOTAL AMOUNT 998.96 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 I2 FLOOR CONCRETE EXT. WALLS INT. WALLS CEILING STUCCO SHEETROCK 1 SHEETROCK `, 1 >y • • 1 Ci' : �' ,a I'\.; ' ROOF HEATING FIREPLACES TILE NATURAL GAS METAL 01 IMASRY (• ' K by.i _ 'if :"7:1-11-4, .j !� ,)' WATERSEWER MIN DEPTH S.F./100 SIZE NEW/REPAIR rt — • PUBLIC I PUBLIC I 000 I 000 10000 I NEW • ,, L_ _ .` : /y(44„..,• _.YY '` '' COMMENTS ALL DEVELOPMENT FEES PAID AMT WAIVED .00 ANT PAID 998.96 PAYOR NAME: THE FIELDSTONE COMPANY PAID 04/05/89 RECEIPT : 00001739 EMPL: STACCATO—NYARI, M PAID BY : CHECK NBR : 763 •LICENSED CONTRACTORS DECLARATION. 1/4. 1 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 Y LICENSE IS IN FULL FORCE AND EFFECT. ` ..,-----t l LICENSE CLASS LICENSE NUMBER % ° g' CONTRACTOR 7- CT � �10 DATE CI/3c)/ ' / / - 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 I: ❑ 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.). '`Q�� // POLICY NO CN �� ,O � 77' / / COMPANY ✓2-4-1 ❑ CERTIFIED COPY IS HEREBY FURNISHED N(CERTIFIE C Y IS FILED WI -THE CC NTY BUILDING INSPECTION` ECDEPARTMENT 1 APPLICANT _t/_�/ . 6-G-Le-4---A - DATF/ ti� -e CERTIFICATEL F 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 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) 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 RELATfNG T BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR I SPECTIO PURPOSES X / \ �r\'--/� �/���� SIGNATURE OF APPLICANT OR AGENT c.,...,'' DATF EXPIRATION AND REFUND NOTICE APPLICATIONS FOR WHICH NO PERMIT I 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 -6ds /34051-9 )06890�a0/A-e) Permit Numb INSPECTION RECORD •. A DATE INSPECTOR I DATE .,A I INSP ftTOR Setback I -rig i—b,.1., {� Rough Plumbing r�/ } Temporary Power I - "`�'`I Shower Pan Test �,1I'. ! / lli" Foundation Reinforcing Steel I/1i, / ,/',j I An/ Stucco Mesh or Exterior Siding I y Excavation and Forms I`' 41 d 1 I ilio.-- Insulation Virrtil F.H.A. Foundation Req. I , , ,A OI Sewer / / `f Slab Grade ., , ,y I,) Interceptor Ground Plumbing I° `2'! " rdei Septic Tank Underslab Ducts Leach Line or Seep Pit • Underslab Conduit Water Service 7(/ 'f/fIf' Fireplace Foundation Lath or Drywall Nailing 7/ Jfel 1p Joists and Girders A Gas Line Air Test )/G fJ Electrical Ground Final EnergyA� I' ' \y Mid-Height Bond Beam Final Plumbing // t= 4��� I gi 8-Foot Bond Beam Final Heating/A.C. IrAI/ „/� Final Bond Beam Final Construction Pr" _Y Fireplace Bond Beam Final On Site Improvements I IV Roof Sheathing A Final Off Site Improvements I I Framing and Ventilation 7//jJ L/ Final Dedication I I /l Roof Covering j1 A Final Zoning I i.,i4 I Rough Heating ,,,, Final Electrical I _I './-..,..-;''Electrical Service and Ground y Final Gas cI A Rough Electrical I /7 Developer Fees Paidr.I / I I WC (YIN) Ind Saf (YIN) Certificate of Occupancy I f It r/ ' ' t� SEPTIC TANK GALS. Pi;. - %u�t 4 SEEP'. PIT • X /G'.', w Ec 4''?:4 r LEACH LINE -WIDF fil x:4`1.,i4 t"i Lrw 1 �/ X LONG X DEPTH OF ROCK fru, r4 'c.©D'''', g/A�/,4',r`' ' N. 1g� g L0 : �-tf"'T • W. E. S. Inspector's Signature and Initials 12-17589-469 Rev 3/88