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Permit No. (15) 1111 . ,120 aN BERNARDINO COUNTY-EPWA/LAND MANAGEMENT DEPT t FFICE OF BUILDING AND SAFETY P E RMI T APPLICATION 'PERMI1 NBR 120 92 00884 201A 011 STATUS: ACTIV HIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 66/09/92 I ISSUE DATE 06/11/92 I PG 1 OF 1 PARCEL NUMBER �3�-1� 1f_I PROPOSED USE: RESIDENCE W/GARAGE CURRENT USE: VACANT (TRACT I BLK000 I 063LOT I SSEC EC0 I � I RNG I PRCL MAPMI PRCL ACTIVITY : L830 3792COMMUNITY PLAN ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS I CH/PD,ILI,FR1 I GH/M-H 13792 PLAN 1 06/09/92 I - - - i LOT DIMENS±ON 42 X 99 (CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *BLDGS ON LOT GROUP R3 2 COSTAIN HOMES 620 NEWPORT CENTER DR *400 *PLANS RECD 2 LAND USE PLOT 0 (INDEX NBR 27-146 NEWPORT BEACH CA 92660-6434 STD PLAN/ItBO FHA N (818) 810 - 2008 TYPE d Se. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN =OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER COSTAIN HOMES/13972 LOT 63 1 908 1.00 908.00 620 NEWPORT CENTER DR *400 2 1049 1.00 1049.00 NEWPORT BEACH CA 92660-6434 GAR I 429 .50 215.00 (818) 810 - 2008 PORCH I 90 .20 18.00 4 _../"' JOB SITE ADDRESS CALC. 'VALU 106,017.90 I ADJUSTED AREA 2190 2799 LA SALLE POINTE . CHINO HILLS CA 91709-0000 ITEM CIIT DESCRIPTION DETAIL TOTALS CROSS STREET GRANDRUE PLACE } RESIDENTIAL CONSTRU 1,277.00 INSPECTN ACCESS ' TOTAL AMOUNT 1,277.00 CONTRACTOR NAME, ADDRESS LICENSE NUMBER COSTAIN HOMES INC CONT000516662 620 NEWPORT CENTER DRIVE SUITE 400 NEWPORT BEACH CA 92660-0000 (000) 000 - 0000 DIV. OF IND. SAFETY PERMIT: (MINIMUM SETBACK DISTANCES 22 FRNT SETBACK/CENTRLINE LA SALLE PT. R/W 37 10 REAR SETBACK/PROP LINE 4 SIDE SETBACK/PROP LINE 7 SIDE SETBACK/PROP LINE �g_ ONT ,RIO 1MECHANICAL EQUIP NOT. PERMITTED IN REQUIRED SIDE SETBACKS f�M,P�ETED ,, 'vC NO. STORIES I NO. DWELLING I NO. BEDROOMS I FLRCONCRETE )/~ � C EXT. WALLS INT. WALLS CEILING STUCCO SHEETROCK SHEETROCK ROOF HEATING FIREPLACES TILE NATURAL GAS METAL 01 IMASRY WATER SEWER N DF./UBLIC (PUBLIC I MIOOOEPTHI S'OOOl0010000E1 NESIZW/WEPAIR NE 1 : COMMENTS kLL FEES DUE ?ER CONDITIONS THERE SHALL BE A TEN FOOT SEPERATION BETWEE 3UILDINGS THERE IS A MINOR VARIANCE APPROVED FOR ONE FOOT ENCROACHME IN FRONT SETBACK I AMT WAIVED; .00 AMT PAID 1,277.00 . PAYORINAMEi COSTAIN HOMES PAID 06/11/92 RECEIOTi 00001880 EMPL: HALL, S PAID BY : CHECK NBR : 53469 I •ICENSED CONTRACTORS DECLARATION • I HEREBY AFFIRM THAT I AM LICENSED UNDER THE PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESSIAND ,,, PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT. (64)4741\'^- �� ..Q LICENSE CLASSa"'-� S6 eOOI 6(02-LICENSE NUMBER CONTRACTOR C.� 1" '1_. � "^'� DATE 6111 icI� 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 [$500].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 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. 3800, LAB.C.). POLICY NO. COMPANY ❑ CERTIFIED COPY IS HEREBY FURNISHED ❑ CERTIFIED COPY IS FILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT APPLICANT DATF ADDITIONAL REVISION CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1$1001 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 WORKE� ' COMPEN/ SAJ,ION LAWS OF CALIFORNIA. APPLICA �...44 � %� DATF w�(/l�'Z- NOTIC T APLICe: IF,AFTER MAKING THIS CERTIFICATE OF EXEMPTION,YOU SHOULD BECOME SUBJECT TO THE WORKERS' COMPENSATION PROVISIONS OF TH ABOR CO E, 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 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 TY FOR SIGNATURE OF APPLICANT ROR AGENT .."'"/ .//PIJRP SE /� �, - DATE �//� // / /-'2' r 3 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. 12-17589.469 Rev.4/90 ttr I /� Owner Name 4E74 ! ' • Permit Numb��l9909O0 cc- �p 20/4CY 9 V INSPECTION RECORD 26 -7t, 6&-- . DATE INSPECTOR DATE INSPECTOR Setback I /.-2;-S — 314 Rough Plumbing 9 i ,-t__ Temporary Power I I Shower Pan Test 4j S' '5 Foundation Reinforcing Steel I 1.t ,.t,,1 Stucco Mesh or Exterior Siding Excavation and Forms ' Insulation C f re.,--r1 9'-U-7-z_ -c....- F.H.A. t_-F.H.A. Foundation Req. I I Sewer/St?y)' le-/V-92._ e.. Slab Grade 14 -;p-7 2 I /5 Interceptor Ground Plumbing 4 3 S Ip .21-s'Z I 1Septic Tank Underslab Ducts I Leach Line or Seep Pit Underslab Conduit I Water Service l/11 PVC- 4 . '-/7 - 'i 1 Fireplace Foundation I „ Lath or Drywall Nailing 9--A-7-e.. ei___ 5k/44 4 /1&t - s-ti-f#( Gas Line Air Test /V rZp q3 C Electrical Ground �.C.— (Ar -z t-Tz 1" 164 Final Energy Mid-Height Bond Beam Final Plumbing /(-y T-2_ I + 8-Foot Bond Beam Final Heating/A.C. / - y q - Final Bond Beam Final Construction I (( ^f,L 9 "— Fireplace Bond Beam Final On Site Improvements I I Roof Sheathing 4 9 7 1- -e_._ Final Off Site Improvements I I Framing and Ventilation 9 4 1p 7 ( C J Final Dedication Roof Covering 1 ('� "1 L f4 - Final Zoning I I Rough Heating q l '-L--1- c` Final Electrical lit egidjf Z I P Electrical Service and Ground Pill/1.-1' ‹...., Final Gas I// --C-r( at-L.C7 Rough Electrical /: e' 41.4 C. Developer Fees Paid I I WC IY/N) Ind Saf (Y/N) Certificate of Occupancy I/( (frZi >G 9 -50-J=5 -L. C P3 o d do,.-k)-01 C 4 p e 4---.._:....„1.7 �� re n . i" �4 , /O-�-?2 r - / v 0 0-.4--.)-- -- ..-- . 17 f 'i -,6,/f776-rt- .� i P-2-"-"A' 664 ii-�C C EAA K /Y►-r c-//�•-0 - �2 c 1. "'3 7/O SEPTIC TANK GALS. SEEP. PIT X LEACH LINE A WIDEtn. X LONG X DEPTH OF ROCK �.n11r`� _ 7 N. "_c, .4171,-- - . 0.3%.y�GV; r� _-.P.''.-4'-; _--t--- rt'- W O;,, _--t--- W. E. . /I 1 /..e/Aird Z7�� Orr /7/P`- ' / ,,�,(� `'1 \1 fl n S. Inspector's Signature and Initials _� i��.4-Att" 1),4• l`t ')ULL•A U U 12-17589-469 Rev.3/88