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Permit No. (24) . . V III 105iSAN BERNARDINO COUNTY—EPWA/LAND 1TANAGEMENT DEPT OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 89 00865 201A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED - APP(_ DATE 04/04/89 I ISSUE DATE 04/05/89 I PG 1 OF 1 PARCEL NUMBER 1001 O/ --C6) CURRENTD USEUSE: VACANT: RESIDENCE W/GARAGE BLK LOT SEC IVITY : 13651TRACT—9( 000 1049 I SE18 102S 108W I PRCL 00AP I PORCL CQTMMUNITY PLANL831 ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS PUD TR 13651-9, M*3 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 22-143 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 1167 1.00 1167.00 145 S STATE COLLEGE BLVD *660 2 879 1.00 879.00 BREA CA 92621-0000 GAR 591 .50 296.00 (714) 990 — 3006 PORCH 35 .20 7.00 JOB SITE ADDRESS CALC. VALU 105,705.00 I ADJUSTED AREA 2349 2252 HEDGEROW LN ' CHINO HILLS CA 91710-0000 ITEM CNT DESCRIPTION DETAIL TOTALS CROSS STREET AUTUMN HILL LANE RESIDENTIAL CONSTRU 1,026.69 INSPECTN ACCESS TOTAL AMOUNT 1,026.69 CONTRACTOR NAME, ADDRESS LICENSE NUMBER FIELDSTONE COMPANY THE CONT000402826 14 CORPORATE PLAZA NEWPORT BEACH CA 92660-0000 1000) 000 — 0000 ACTIVE WORKERS COMP 0!" 4F TWO. SAFETY PERMIT: MINIMUM SETBACK DISTANCES 43 FRNT SETBACK/CENTRLINE HEDGEROW LANE R/W 50 20 REAR SETBACK/PROP LINE 15 SIDE SETBACK/CENTRLINE P/L AUTUMN HILL LANE R/W 50 5 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES I NO. DWELLING I NO. BEDROOMS FLOOR 2 UNITS 1 4 11 CONCRETE EXT. WALLS INT. WALLS CEILING ,E�,,) t. i'k i ., STUCCO SHEETROCK I SHEETROCK 1- ��' !l ,,u i rye,�i' ,i,�:.ac,,, «y+—'� ROOF HEATING FIREPLACES `,L, '.', ,} *• ! pt. t! f ) TILE NATURAL GAS (METAL 01 IMASRY ry" ` ., WATER I I MI000000 SEWER DEPTH S.F./100I 0000EI NEW/REPAIREPA PUBLIC PUBLIC COMMENTS ALL DEVELOPMENT FEES PAID AMT WAIVED .00 AMT PAID 1,026.69 PAYOR NAME: THE FIELDSTONE COMPANY PAID 04/05/89 RECEIPT : 00001741 EMPL: STACCATO—NYARI, M PAID BY : CHECK NBR : 763 SLICENSED 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 AND PROFESSIONS CODE, A MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS LICENSE NUMBER 4(e1,--Y-26 CONTRACTOR DATF 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,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.)`�(� �j POLICY NO /1424 ✓ Y�( / /0o/ COMPANY v /r ❑ CERTIFIED COPY IS HEREBY FURNISHED (/J/ C"CERT1FF COPY IS FILEDD ITH THf1COUNTY BUILDING INSPECTION DEPARTMENT APPLICANT / /� /t�C !i( \7 'iL.•P/��/��` DATE //' // -, CERTIFICFJ,E 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 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 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 RELATIVIJO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECrION PURPOSES '- 1 /S49 SIGNATURE OF APPLICANT OR AGENT(AGENT(-- _ _ �'G ` 6 '`—� DATF 77 / I ' 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 Lot '77 3&05/PermitNum �D3 27 Qe�(D�d�LJ��'�/� Owner Name �II .,... INSPECTION ECORD I.."1 DATE I INSPECTOR I DATE I INSPECTOR Setback I1,�Yj eiru�.,.= Rough Plumbing ,IJ/ I Art Temporary Power I. / Shower Pan Test $117- Foundation Reinforcing Steel - Stucco Mesh or Exterior Siding .a Excavation and Forms I ,/� Insulation '7//'k iF.H.A. Foundation Req. I �,n Sewer //01 f'9/ ZJ Slab Grade0 � Interceptor - I Ground Plumbing (dn 4 2/ im Septic Tank I Underslab Ducts I _r Leach Line or Seep Pit Underslab Conduit I I Water Service 7111% _ I(1 Fireplace Foundation I I Lath or Drywall Nailing r Joists and Girders , I I /f, Gas Line Air Test 71 jam`- �jlvr Electrical Ground 7/7(0' `/ Final Energy 17 t Mid-Height Bond Bea Final Plumbing iii 44 I 8-Foot Bond Beam I I Final Heating/A.C. �/� Final Bond Beam I I Final Construction `• , _� Fireplace Bond Beam 1 I Final On Site Improvements 8.-I Roof Sheathing I I _n /9j' Final Off Site Improvements ,, I Framing and Ventilation 17/7/1 3 i[`� Final Dedication I Roof Covering I y /� j Final Zoning Rough Heating I r4 , Final Electrical �� Electrical Service and Ground 1 alt V- / v--- Final Gas ,r Rough Electrical Y Developer Fees Paid WC (YIN) Ind Saf (YIN) Certificate of Occupancy 41// //4Yr7 I (4-' rI r / IPri! t Cilli as-": nAt.o Ra"V SEPTIC TANK GALS. q.1`;:." �`•.. 1 ICis • SEEP. PIT X it FA W f." tt#`/A����J��.j(��( LEACH LINE WIDF ELN A ti L. 7---P 21—(s=7 I., , I X LONG X DEPTH OF ROCK N. W. E. S. Inspector's Signature and Initials 12-17589-469 Rev.3/88