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Permit No. (29) Ill III 1t5 SAN BERNARDINO COUNTY-EPWA/LAND MANAGEMENT DEPT OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 90 01457 255A 011 STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 06/07/90 I ISSUE DATE 06/07/90 I PG 1 OF 1 PARCEL NUMBER 1024-201-50-0000 0, 'j y J"-c0/*-- /*--50 PROPOSED USE: ELEC AND GAS FOR SPA CURRENT USE: RESIDENCE W/GARAGE TRACT BLK LOT SEC IVITY : 13651-9( 000 1049 I SE18 102S 108W I PRCL 00AP I PRCL COTMMUNITY PLANL820 ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/PD,IL1,* LOT DIMENSION IRREGULAR CONST TYPE APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER #BLDGS ON LOT 1 (GROUP JOE BARNARD 12130 MARGUIS LN #PLANS RECD 0 LAND USE PLOT 0 INDEX NBR 22-143 CORONA CA 91719-0000 STD PLAN/ICBO FHA (714) 278 - 1771 ITEM CNT DESCRIPTION DETAIL TOTALS OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER 1 PLUG MOLD 5.06 DRABECK, KRISTIN B ELEC SUB-TOTAL 5.06 2252 HEDGEROW LN I GAS PIPING OUTLETS 13.80 CHINO HILLS CA 91709-0000 PLUM SUB-TOTAL 13.80 (714) 627 - 2309 ISSUANCE FEE 33.55 TOTAL AMOUNT 52.41 JOB SITE ADDRESS 2252 HEDGEROW LN CHINO HILLS CA 91709-0000 CROSS STREET AUTUMN HILL LANE INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER BARNARD JOE CONT000239096 6384 N ROBIN LIVINGSTON CA 95334-0000 (000) 000 - 0000 DIV. OF IND. 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. STORIESI NO.DWELLING I NO. BEDROOMS FLOOR ITS r- ® TRIO EXT. WALLS INT. WALLS l CEILING �: I corY 5'rr ROOF HEATING FIREPLACES METAL I MASRY DAT. (-//-9 PUWATER BLIC (PUSEWER BLIC I MIN DEPTH( S.F./1001 00000 000SIZE] NEW/REPAIR 000MMENTS *MODERATE TO HIGH LANDSLIDE SUSCEPTIBILITY. AMT WAIVED .00 AMT PAID 52.41 PAYOR NAME: VICKI MINOR PAID 06/07/90 RECEIPT 2414 EMPL: ADAMS, C PAID BY : CHECK NBR : 1222 eICENSED CONTRACTORS DECLARATIONS I HEREBY AFFIRM THAT I AM LICENSED UNDER THE PROVISIONS OF CHAPTER 9 (COMMENCING WITH SE ION 7000) OF DIVISIO 3 OF THE BUSINESS ANi> PROFESSIONS CODE N MY LICENSE IS IN FULL FORCE AND EFFECT. / ��� b77/ LICENSE CLASF /'J� LICENSE NUMBER -',.J� V / b CONTRA DA E �U / l/ 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 70001 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 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.VI 38V,001 LAB.�C.).. POLICY NO. I/ 'i`I. V e V/ COMPANY ❑ CERTIFIED COPY IS HEREBY FURNISHED ❑ CERTIFIED COPY IS FILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT APPLICANT DATE ADDITIONAL REVISION CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ]$100] 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 NAMF 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 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 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 CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECT PU S� IGNATURE OF APPLICANT OR AGENT /`r��� ^\) / `/�/C� t'/ DATE i f EXPIRATION AND REFUND NOTICE I 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 i9// - S'/s //h/ Permit Numbee5 9 4 /y-5 7 .5 .VA/ INSPECTION RECORD DATE I 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`BneNs GAS, C - --rl� ,ecr Leach Line or Seep Pit Underslab Conduit Water Service Fireplace Foundation Lath or Drywall Nailing Joists and Girders Gas Line Air Test /J—9a i S Electrical Ground Final Energy Mid-Height Bond Beam Final Plumbing 8-Foot Bond Beam Final Heating/A.C. Final Bond Beam Final Construction ) —)kg I -400 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 Ga•l ,r4r 17" ' b v€ ' 4J 4/4/dr' "1',7 40a 7 INstli'c enc r7G9neSiyia1/ ,C.rli+'f. ,Or4ers '44 714-i90 ox rAir 1-1/' f/ cawGL/T tvyvL~ate 00v it/o w1t.C, - ormitto SEPTIC TANK GALS. • 211•. SEEP. PIT X LEACH LINE WIDE RTC. / -t/` (_ X LONG X DEPTH OF ROCK rtt N. W. E. S. Inspector's Signature and Initials _ 4.rJQ�- �ei - 12-17589-469 Rev 3/88