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Permit 1069101376205A01106 SAN BERNARDINO COUNTY-EPWA/LAND MANAGEMENT DEPT OFFICE OF BUILDING AND SAFETY P E R M I T APPLICATION P` RMIT NBR 106 91 01376 205A 01 9TATUS: AC%fIV THIS IS NOT A PERMIT UNTIL ISSUED A PL DATE 10/18/91 1 ISSUE DATE 10/1 /91 1 PW;" 1 OF 1 PARCEL NUMBER 1031-081-20-0000 PROPOSED USE: FAM.RM./BATH ADD. � r CURf2EN* USE; RESIDENCE .} TRACT I BLK I LOT SECTWN RNG PRCL MAP PRCL ACTIVITY : L823 10379-1 000 049 SE30 1. 02S 08W 0 0 COMMUNITY PLAN ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME I SUBDIVISION PARCEL NO I CHPD/IL1/FRI M TO'H APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER HILL, MILFORD 2142 OAK CANYON LN CHINO HILLS CA 91709--0000 (714) 393 - 0645 OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER HILL, WILFORD 2142 OAK CANYON LN CHINO HILLS CA 91709-0000 (714) 393 - 0645 JOB SITE ADDRESS 2142 OAK CANYON LN CHINO HILLS CA 91709-0000 CROSS STREET PROMONTORY RD INSPECTN ACCESS CONTRACTOR NAME, ADDRESS CIV, Of'-ItIll.-- SAFETY PERMIT' MINIMUM SETBACK DISTANCES 70 FRNT SETBACK/CENTRLINE OAK CANYON 15 REAR SETBACK/PROP LINE 15 SIDE SETBACK/PROP LINE 15 SIDE SETBACK/PROP LINE LICENSE NUMBER R/W 60 MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES NO. DWELLING NO. BEDROOMS FLOOR 1 UNITS CONCRETE EXT. WALLS INT. WALLS CEILING STUCCO SHEETROCK SHEETROCK ROOF HEATING FIREPLACES TILE' NATURAL GAS METAL MASRY WATER SEWER MIN DEPTH S.F./100 SIZE NEW/REPAIR PUBLIC PUBLIC 1 000 1 000 10000 . COMMENTS LOT DIMENSION CONST TYPE VN #BLDGS ON LOT I GROUP R3 *PLANS RECD 0 LAND USE PLOT 0 INDEX NBR 21--159 STD PLAN/ICBO FHA N TYPE I SQ. FT. I FACTOR/P.S.F. TADJSTED AREA/VALUATN 1 500 1.00 500.00 CALC. VALU 24,205.00 ADJUSTED AREA 500 ITEM CNT DESCRIPTION DETAIL TOTALS RESIDENTIAL CONSTRU 263.00 TOTAL AMOUNT 263.00 AMT WAIVED .00 AMT PAID 263.00 PAYOR NAME: MILFORD HILL PAID 10/18/91 REC41PT 4253 EMPL: PRYOR, KEITH PAID BY CHECK NBR :-4276 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 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 UCENSE 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 APPUCANT 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 HERSELFOR 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 CONTRACTS FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRACTORS LICENSE LAW). ❑ 1 AM EXEMPT UNDER ,.OWNER B. AND P. C. FOR THIS REASON DATE r� 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.1. POLICY NO. COMPANY ❑ CERTIFIED COPY IS HEREBY FURNISHED ❑ CERTIFIED COPY IS FILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT APPLICANT ADDITIONAL REVISION DATE 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 VMICH THIS PERMIT IS ISSUED, I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE WORKERSAOMPEIVSATION LAVVS'OF,OALIFORNIA. APPLICANT NOTICE TO DATE S CERTIFICATE OF EXEMPTION, YOU SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS COMPLY WITH SUCH PROVISIONS OR THIS PERMIT SHALL BE DEEMED REVOKED. CONSTRUCTION LENDING AGENCY I HEREBYAFFIRM 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/BUILOER 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 INSPECTION PURPOSES. ,, _ . I SIGNATURE OF APPLICANT OR AGENT DATE d ' EXPIRATION AND REFUND NOTICE APPLICATIONS FOR WHICH NO PERMIT IS ISSUED 1YITHIN 150 DAYS FROM THE DATE OF APPLICATION SHALL EXPIRE. PERMITS SHALL EXPIRE IF WORK DOES NOT COMMENCE 1NITHIN ISO DAYS OF ISSUANCE OF SUCH PERMIT OR IF THE WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF ISO 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 A 1 INSPECTION RECORD Permit Number O � / A y 7A M �/Ael SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDE_ X LONG X N. W. E. S. 12-17689.469 Rev. 3/88 DEPTH OF ROCK Inspector's Signature and Initials DATE INSPECTOR DATE INSPECTOR Setback Rough Plumbing Temporary Power Shower Pan Test AM - Foundation Foundation Reinforcing Steel Stucco Mesh or Exterior Siding Excavation and Forms Insulation F.H.A. Foundation Req. Sewer Slab Grade j', q/ Interceptor Ground Plumbing DUJ 10 1 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/NI Certificate of Occupancy (d ,2 -(? XX - t( -22-q( ' ,�- — & -. a / 11,i i m l zl it lzo *, I G-1 ,Ar !L . // SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDE_ X LONG X N. W. E. S. 12-17689.469 Rev. 3/88 DEPTH OF ROCK Inspector's Signature and Initials