Loading...
Permit 1209200927205A01120 SAN BERNARDINO COUNTY-EPNA/LANO MANAGEMENTyDEPT` f OFFICE OF BUILDING AND SAFETY P E R M I T APPLICATION PERMIT NBR 120 92 00927 205A 01 STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 06/17/92 ISSUE DATE 06/17/92 1 PG 1 OF 1 PARCEL NUMBER 1028-174-18-0000 PROPOSED USE: CARPORT/ADDITION/CONV.-RENEWAL CURRENT USE: RESIDENCE TRACT BLK I LOT I SEC TMN I RNG I PRCL MAP PRCL ACTIVITY L823 L825 2576 000 001 NE27 02S OSN 0 0 COMMUNITY PLAN ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/RS,ILI,L-M LOT DIMENSION IRREGULAR CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER HAM, FRANC *BLOGS ON LOT 1 GROUP R3 *PLANS RECD 0 LAND USE PLOT 0 STD PLAN/ICBO INDEX NBR FHA N 49-155 4961 FAIRMAY BLVD CHINO HILLS CA 91709-0000 ( 714) 597 - 2089 TYPE SQ. FT. FACTOR/P.S.F. ADJSTED AREA/VALUATN ONNER NAME* MAILING ADDRESS, AND PHONE NUMBER 1 240 .50 2 136 .50 CARP 400 .20 120.00 68.00 80.00 HAM, FRANC 4961 FAIRMAY BLVD CHINO HILLS CA 91709-0000 (714) 597 - 2089 CALC. VALU 12,973.88 ADJUSTED AREA 268 JOB SITE ADDRESS ITEM CNT DESCRIPTION RESIDENTIAL CONSTRU RENENAL HALF FEE TOTAL AMOUNT DETAIL TOTALS 167.00 -83.50 83.50 4961 FAIRWAY BLVD CHINO HILLS CA 91709-0000 CROSS STREET AVERY STREET INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER DIV. OF -INO. SAFEW PERMIT: MINIMUM SETBACK DISTANCES 50 FRNT SETBACK/CENTRLINE FAIRNAY BLVD R/W 50 IS REAR SETBACK/PROP LINE 50 SIDE SETBACK/CENTRLINE QUAIL R/W 50 5 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS M. STORIES I NO. DWELLING I NO. BEDROOMS I FLOOR 1 UNITS WOOD EXT. WALLS INT. MALLS CEILING STUCCO SHEETROCK SHEETROCK ROOF HEATING FIREPLACES COMP SHINGLE NATURAL GAS METAL MASRY WATER SEMER I MIN DEPTH S.F./100 SIZE NEM/REPAIR PUBLIC 1 000 000 10000 COMMENTS RENEW PERMIT 1069101179205A01, AMT WAIVED .00 AMT PAID 83.50 PAYOR NAME: FRANK HAM PAID 06/17/92 RECEIPT 1970 EMPL: ADAMS, C PAID BY CHECK NBR : 2109 LICENSED CQNTRACj-ORS 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, AND MY LICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS LICENSE NUMBER CONTRACTOR DATE 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 [55001.): ❑ 1, 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). ❑ 1, 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 CONTRACT '..FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRACTORS LICENSE LAW). ❑ I AM EXwIPM UNAR SEC. OWNER_ AND P. C. FOR THIS REASON DATE— WORKERS' ATE 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,)• POLICY NO. 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 [5 100) 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 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 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 APPLICATIO STAT HAT THE ABOVE INFORMATION IS CORRECT, I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TB ING STRUCREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECT N P RPOS —` 7 5J ATURE OF APPLICANT OR AGENT `i DATE r / ( r' EXPIRATIO 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. , 12-17588.489 Rev, 4/90 Owner Name P ermlt Number INSPECTION RECOR -L4. SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDE X LONG X DEPTH OF ROCK N. W. E• 7�. S Inspector's Signature and Initials 12-17589.469 Rev. 3/88 i DATE INSPECTOR DATE INSPECTOR Setback -2$ Z Rough Plumbing Temporary Power Shower Pan Test Foundation Reinforcing Steel Stucco Mesh or Exterior Siding Excavation and Forms JLjj)(/Z, -Z F7, Insulation F.H.A. Foundation Req. Sewer Slab Grade 75 , interceptor Ground Plumbing Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit 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 (Y/N) Ind Saf (Y/N) Certificate of Occupancy Z to d Y -171t -L4. SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDE X LONG X DEPTH OF ROCK N. W. E• 7�. S Inspector's Signature and Initials 12-17589.469 Rev. 3/88 i