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Permit No. (29) , 105'SAN BO;RNARDINO COUNTY-EPWA/LAND AGEMENT DEPT 1110 OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 89 03267 201A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 09/21/89 I ISSUE DATE 09/21/89 I PG 1 OF 1 PARCEL NUMBER 304.7.=.0.93=2,4c0494).2, 103 I� �I PROPOSED USE: RESIDENCE W/GARAGE P/R I CURRENT USE: VACANT 13792T BLK LOT SEC T 1000 1104 I NW20 I � 108W I PRCL 00AP I PRCLOCCTOMIMU(IJITY PLANL866 ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/PD 13792, PLAN 2-2 09/21/89 1017-151-10-0000 LOT DIMENSION VARIES CONST TYPE APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *BLDGS ON LOT GROUP PDC HOUSING GROUP INC.- DEBRA SCHAR 17595 ALMAHURST RD *206 *PLANS RECD 2 LAND USE PLOT 0 INDEX NBR 25-146 CITY OF INDUSTRY CA 91748-0000 STD PLAN/ICBO FHA N (818) 810 - 2008 TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER PDC HOUSING GROUP INC. 1 910 1.00 910.00 17595 ALMAHURST RD *206 2 990 1.00 990.00 CITY OF INDUSTRY CA 91748-0000 GAR 423 .50 212.00 1818) 810 - 2008 CALC. VALU 95,040.00 I ADJUSTED AREA 2112 JOB SITE ADDRESS 2544 LA SALLE POINTE . ITEM CNT DESCRIPTION DETAIL TOTALS CHINO HILLS CA 91709-0000 RESIDENTIAL CONSTRU 971.23 CROSS STREET POINTE COUPEE TOTAL AMOUNT 971.23 INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER P D C HOUSING GROUP CONT000539870 17595 ALMHURST ROAD *206 CITY OF INDUSTRY CA 91748-0000 (818) 810 - 2008 DIV. OF IND. SAFETY PERMIT: MINIMUM SETBACK DISTANCES *** PER PLOT *** MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIESI UUNNITSWELLING I NO. BEDROOMS CONCRETE. ONTARIO 3 EXT. WALLS I INT. WALLS I CEILING C® ' {; TED1/ STUCCO SHEETROCK SHEETROCK ROOFHEATING FIREPLACES D'!ATEe //-4?-9.6TILE I NATURAL GAS (METAL IMASRY WATER PUBLIC (PUBLIC SEWER I MIN 000EPTHI S 000100I0000IIE� NENEWEPATR COMMENTS ALL DEVELOPMENT FEES PAID AMT WAIVED .00 AMT PAID 971.23 PAYOR NAME: NEW TRADITIONS - PAID 09/21/89 RECEIPT : 00005455 EMPL: STACCATO-NYARI, M PAID BY : CHECK NBR : 1623 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. {�j Q� LICENSE CLASS /9 LICENSE NUMBER % / 45;"--7/) CONTRACTOR PDC__ DATE U//�1 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 [$5001.1. ❑ 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 CONTRACTORIS) 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,A � LAB C.). Q� � �� POLICY NO IA// - ! -/[� �U�.5 3 COMPANY ❑ CERTIFIED COPY IS HEREBY FURNISHED O ' ❑ CIED COPY IS FILED r ITH HE COUNTY BUILD G IECTION DEPARTMENT APPLICANT DATE '7-25 7/2 U CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$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 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 1 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 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 BUILD! CONSTRUCTION, ANHEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNT TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PU ES/f�� ����,/� SIGNATURE OF APPLICANT OR AGENT /�t�l 0^, ,� / DATF (/ EXPIR1TION AND REFUdD 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. 10/88 .vc. o •- ' -- -• le3j/g9 0.. 1672,0/4 - ' Owner Name L! INSPECTION RECORD DATES I , INSPECTOR Y DATE I_ INSPECTOR T Setback I `^!�� Rough Plumbing 4 /,,,,,,,/// Temporary Power I / ,'/ l 7 Shower Pan Test 01/6-- - ,1 Foundation Reinforcing Steel I IfiV I 6z- Stucco Mesh or Exterior Siding Excavation and Forms V V Insulation ''/7",c.2 L.Or F.H.A. Foundation Req. 1 Sewer °7.2ifril, 101 Slab Grade Kr44—it, I Interceptor Ground Plumbing lie q4/!t 0 Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service Fireplace Foundation Lath or Drywall Nailing 77 Joists and Girders Gas Line Air Test Electrical Ground `-/Y 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 �j A A Final Off Site Improvements ) / 1 Framing and Ventilation A i-® , / Final Dedication , / / Roof Covering ,.!„I� / / Final Zoning Rough Heating IVI I" / Final Electrical �. / Electrical Service and Ground / / Final Gas Rough Electrical Y ! Developer Fees Paid r / WC (Y/N) Ind Saf (Y/N) Certificate of Occupancy A ►• at s SEPTIC TANK GALS. (' i P T t SEEP. PIT X Diii.T �j• .� - LEACH LINE WIDF /! i �$ a Rm■ X LONG X DEPTH OF ROCK N. W. E. A / �/1 4 / / S. Inspector's Signature and Initials / . r 12-17589-469 Rev 3/88