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Permit 1209200193265A01120 SAN BERNARDINO COUNTY-EPMA/LAND MANAGEMENT DEPT OFFICE OF BUILDING AND SAFETY P E R M I T APPLICATION PERMIT NBR 120 92 00193 265A 017 STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 02/11/92 ISSUE DATE 02/11/92 PG I OF 1 PARCEL NUMBER 1017-692-45-0000 PROPOSED USE: 4 -TON AC UNIT CURRENT USE: RESIDENCE TRACT I BLK I LOT I SEC TM) RNG I PRCL MAP PRCL ACTIVITY : L820 14924 000 010 SM20 02S 08M 0 0 COMMUNITY PLAN ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/PD,ILI,FRI, M -H LOT DIMENSION CONST TYPE APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER #BLDGS ON LOT 1 GROUP PRO -HEATING AND AIR 4572 E EISENHOHER CR ;PLANS RECD 0 LAND USE PLOT 0 INDEX NBR 25-149 ANAHEIM CA 92807-0000 STD PLAN/ICBO FHA (714) 779 - 6868 ITEM CNT DESCRIPTION DETAIL TOTALS OMNER NAME, MAILING ADDRESS, AND PHONE NUMBER 1 FORCED AIR/GRAVITY 20.00 BROCK HOME CAP CORAL RIDGE MECH SUB -TOTAL 20.00 3380 SHELBY ST #100 ISSUANCE FEE 49.00 ONTARIO CA 91764-0000 TOTAL AMOUNT 69.00 (714) 583 - 1061 JOB SITE ADDRESS 2572 PASEO TORTUGA . CHINO HILLS CA 91709-0000 CROSS STREET CALLE MADRID INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER PRO-FORMANCE INC COW000483411 5413 EAST LA PALMA ANAHEIM CA 92807-0000 (000) 000 - 0000 DIV. OF IND. SAFETY PERMIT: MINIMUM SETBACK DISTANCES 55 FRNT SETBACK/CENTRLINE PASEO TORTUGA R/M 50 15 REAR SETBACK/PROP LIMB: 5 SIDE SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES NO. DMELLING NO. BEDROOMS FLOOR UNITS EXT. MALLS I INT. MALLS I CEILING ROOF HEATING FIREPLACES METAL MASRY MATER SEMER MIN DEPTH S.F./100 SIZE NEN/REPAIR PUBLIC PUBLIC 1 000 1 000 10000 COMMENTS ANT MAIVED .00 ANT PAID 69.06 PAYOR NAME: LINDA STRATI PAID 02/11/92 RECEIPT 400 EMPL: HALL, S PAID BY : CHECK NBR : 2401 LICENSED CONTRACTORS DECLARATION .. j 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 AND1 () EFFECT. LICENSE CLASS LICENSE NUMBER 3 Cl( ` I CONTRACTOR �1nS-0 1E�c t2 t� DATE C /�- 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 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). ❑ 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,)• POLICY NO. ,t f A) C, n COMPANY Fo rJ ❑ CERTIFIED COPY IS HEREBY FURNISHED L;-tERTIFIED COPY IS FILED W TH THE COUNTY BUILDING INSPECTION DEPARTMENT i Cp APPLICANT 0 ` 1 � �- ""� DATE 2� ^ ( r l 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 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 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. SIGNATURE OF APPLICANT OR AGENT - \ (a- (2-1� DATE 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. 12.17688469 Rev, 4/90 Owner Name ZRE)ck tUc7 �`S INSPECTION RECORD Permit Number ��Q % ��lc a DATE I INSPECTOR I I DATE I 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 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 SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDE_ X— LONG X N. W S 12-17589-489 Rev. 3/88 E. DEPTH OF ROCK Inspector's Signature and Initials