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Permit No. (89) AIR di . 120 Sinl BERNARDINO COUNTY-EPWA/LGEMENT DEPT OFFICE OF BUILDING AND SAFETY PERMIT APPLICATION PERM NBR 120 92 00601 201!A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPLE ATE 04/20/92 I ISSUE I1ATE 04/20/92 I PG 1 OF 1 PARCEL MJPBER 1017'-73 38.O098- 10 ^` p I_ b PROP D USE: RESIDENCE W/AARAGE d I I CURRET USE: VACANT 13792TT IIBLK 1070 I W120 102S 025 I 08W0I PRCL MAP I PORCL CCTV TTM PLAN L830 ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIV ION NAME SUBDIVISION PARCEL NO CHI ',; HILLS CH/PD,ILI,FR1 I GH/M-H 13792 .AN 3 04/20/92 - - - a LOT D MENSION 37 X 90 CONST TYPE VN APPLICA NAME, MAILING ADDRESS, AND PHONE NUMBER BBLD ON LOT 'GROUP R3 COSTAIN HOMES 62y) NEWPORT CENTER DR 1400 *PL RECD 2 LAND USE Pin 0 'INDEX NBR 25-146 NEIIPORT BEACH CA 91660-6434 STD t ICBO FHA N 0i141 760 - 1455 TYPE °I SQ. FT. I FACTOR4.S.F. I ADJSTED AREA/VALUATN OWNER I11AME, MAILING ADDRESS, AND PHONE NUMBER CMSTAIN HOMES 1 1005 1.00 1005.00 60 NEWPORT CENTER DR *400 2 1311 1.00 1311.00 NtTWPORT BEACH CA 91660-6434 GAR 424 .50 212.00 (7141 760 - 1455 PORCH - 44 .20 9.00 : JOB SITE ADDRESS _ 'L CALC. 'aVALU 122,816.17 I ADJUSTED AREA 2537 $762 LA SALLE POINTE PTc72---7(' 4 CHINO HILLS CA 91709-0000 ITEM �' DESCRIPTIONDETAIL TOTALS CROSS STREET GRANDRUE PL RESIDENTIAL CONSTRI 1,425.00 INSPECTN ACCESS 'i' TOTAL AMOUNT 1,425.00 7I} CONTRAOR NAME, ADDRESS LICENSE NUMBER C TAIN HOMES INC CONT000516662 • 620 NEWPORT CENTER DRIVE SUITE 400 _ NEWPORT BEACH CA 92660-0000 r` (010) 000 - 0000 DIV. OF#IND. SAFETY PERMIT: , MINIMUMSETBACK DISTANCES PER PLOT 36 FRN SETBACK/CENTRLINE LA SALLE POINTE R/W 37 15 REAM SETBACK/PROP LINE - - IL - 4 SIDE SETBACK/PROP LINE 7 SIDE SETBACK/PROP LINE i" i # MECHANICAL EQUIP NOT, PERMITTED IN REQUIRED SIDE SETBACKS i S NO. STORIES I NO. WELLING I NO. BEDROOMS I CONCRETETS 1 4 OR EXT. MALLSINT. WALLS CEILING STUCCp I SHEETROCK I SHEETROCK ONT,-- .,, TILEF HEATING FIREPLACES COMPLETED I NATURAL GAS 1METAL 01 I MASRY DATE /2��g v HATER PUBLIC (PUBLiSEIC R I MIOOOEPTH' S.F./100I0000E' NEM/REPAIR , COMMENT ALL FEES.DUE J f ' AMT VED .00ANT PAID 1,425.00 PAY' a NAME: COSTAIN HOMES PAID 04/20/92 RECEI,T i 00001233 EMP : HALL, S PAID Y : CHECK NBF : 53330 t 4114,NSED CONTRACTORS DECLARATION I HEREBY AFFIRM THAT I AM LICENSED UNDER THE PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESIS AND-+ PROFESSIONS CODE, AND FF LICENSE IS IN FULL FORCE AND EFFECT.T. LICENSE CLASS ( / LICENSE NUMBER_'let 69491 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 DATF 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 APPLICANT45 7AJ Horn S54' DATE /,/2/e// 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 ISA 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 BY. WORK AUTHORIZED •TFIIS 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 THAI.THE ABOVE INFORMATION IS CORRECT, I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING CONS RUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSP N PURPOSES. I�/)l SIGNATURE OF APPLICANT OR AGENT 411 ) DATE ¢/ _v,/ EXPIRATIONAND 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.4/90 41/6 Owner Namd,d15Imo' 1 - Permit NuilideD/ q 7 (oO) /,1 vi/JU,/ INSPECTION RECORD , �� DATE INSPECTOR DATE INSPECTOR Setback L Z 3— SL- 1Rough Plumbing a L 1, Temporary Power Shower Pan Test , _1 ( 1/414� Foundation Reinforcing Steel I ,.,. ,Si i /IAD ��Stucco Mesh or Exterior Siding � �� Excavation and Forms Ly......,..„— ,. Insulation 6 - 25 -5'2, /1/ F.H.A. Foundation Req. Sewer / �j 3 y L - II'-5 z .— Slab Grade y-Z S- v 73-74 Interceptor Ground Plumbing %is 5 y-1 3 -fL /2vt.i' Septic Tank Underslab Ducts e- !.t q—21 -17- Leach Line or Seep Pit Underslab Conduit Water Service/1/ 'VC G -/7-c Z A-44- Fireplace -Fireplace Foundation Lath or Drywall Nailing '7 •J7--7-z -_, Joists and Girders Gas Line Air Test D -11-el 1 S Electrical Ground I4.ce,y- 4-21 -p2.— 4/4- Final Energy /' Mid-Height Bond Beam Final Plumbing 8-Foot Bond Beam Final Heating/A.C. Final Bond Beam )(— SA1ldet- 6— 1 -- g 7 / Final Construction 1 0tti/ Fireplace Bond Beam Final On Site Improvements I a 1 , i ,1/ , Roof Sheathing _ AI A Final Off Site Improvements (/y� v \ / I I Framing and Ventilation q NX / Final Dedication ' I /7-11Roof Covering _V/ A/1V/ Final Zoning / 1 ,V/l Rough Heating 4/y V' % Final Electrical / L/its Electrical Service and Ground V/ y Final Gas / ( /I Rough Electrical V / Developer Fees Paid 7 V WC (YIN) Ind Sat (YIN) Certificate of Occupancy / I SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDE X LONG X DEPTH OF ROCK N. W. E. • S. Inspector's Signature and Initials 4,......,,_ /.4„..dr. JA/-- t)d.DOK i�t"��i 12-17589-469 Rev.3/88