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Permit No. (63) 1 4111 , 106 SAN BERNARDINO COUNTY-EPWA/LAND AGEMENT DEPT v OFFICE OF BUILDING AND SAFETY PERMIT APPLICATION \ PERMIT NBR 106 91 01501 201A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 10/31/91 I ISSUE DATE 11/26/91 I PG 1 OF 1 PARCEL.NUMBER TOW-984•4•8-0000 . On�(n �� nJ PROPOSED USE: RESIDENCE W/GARAGE CURRENT USE: VACANT TRACT 1000 12LOT 48 I NSEC W20 I � 10� I PRCL MAP I A0NT ACTIVITY : L831 COMMUNITY PLAN ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/PD,IL1,FR1 GH/M-H 13792 PLAN 3 10/31/91 - - - LOT DIMENSION VARIES CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *BLDGS ON LOT GROUP R3 COSTAIN HOMES 620 NEWPORT CENTER DR *400 *PLANS RECD 2 LAND USE PLOT 0 (INDEX NBR 25-146 NEWPORT BEACH CA 91660-6434 STD PLAN/ICBO FHA N (714) 760 - 1455 TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER COSTAIN HOMES 1 1005 1.00 1005.00 620 NEWPORT CENTER DR *400 2 1311 1.00 1311.00 NEWPORT BEACH CA 91660-6434 GAR 424 .50 212.00 (714) 760 - 1455 PORCH 44 .20 9.00 JOB SITE ADDRESS CALC. VALU 122,816.17 I ADJUSTED AREA 2537 2715 LA SALLE POINTE . CHINO HILLS CA 91709-0000 ITEM CNT DESCRIPTION DETAIL TOTALS CROSS STREET POINTE COUPEE RESIDENTIAL CONSTRU 1,425.00 INSPECTN ACCESS TOTAL AMOUNT 1,425.00 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 PERMTT! MINIMUM SETBACK DISTANCES *** PER PLOT *** 40 FRNT SETBACK/CENTRLINE LA SALLE POINTE R/W 37 15 REAR SETBACK/PROP LINE 4 SIDE SETBACK/PROP LINE 7 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES I NO. DWELLING I NO. BEDROOMS I FLOOR 2 UNITS 1 4 CONCRETE ONTARIO EXT. WALLS 1 INT. WALLS CEILING STUCCO SHEETROCK SHEETROCK CO M PLE).ED Z DATE ROOF I HEATING FIREPLACES � TILE NATURAL GAS METAL 01 IMASRY (5/14 WATER PUBLIC (PUBLIC SEWER I MIN 000EPTHI S'000100I0000EI NENEWEPAIR NCOMMENTS AMT WAIVED .00 AMT PAID 1,425.00 PAYOR NAME: COSTAIN HOMES PAID 11/26/91 RECEIPT : 00004845 EMPL: HALL, S PAID BY : CHECK NBR : 52941 • LICENSED CONTRACTORS DECLARAS 1 I HEREBY AFFIRM THAT I AM LICENSED UNDER THE PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 70001 OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS COD AND MY LICENSE IS IN FULL FORCE ANDBEFFECT.FET. a•'' /' y LICENSE CLA` / LICENSE NUMBEI 5744aCONTRACTOR AW N DATE /1 `6/9/ 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 700010F DIVISION 3 OF THE BUSINESS AND PROFESSIONS COOE)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 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.1. POLICY NO COMPANY O CERTIFIED COPY IS HEREBY FURNISHED ' /c2/.CERTIF)ED C I FILED WITH E CO i Y EU DING INSPECTION DEPARTMENT • `� APPLICANT DATE f//(/Zv! !/ ADDITIONAL REVISION CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS ($10C1 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 OATF 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.I. LENDER'S NAMF LENDER'S ADOPF« 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. O AS OWNERIBUILDER 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 0 IS 0 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 BUIG CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION -P,,, ES. // SIGNATURE OF APPLICANT OR AGENT . Jr.' , 1` �- / DATE /4,4 LI'h. 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. 12.17588 409 R. 4 90 Owner Name ()5k1-4----- • Permit Num. ( OW / 0156/ . 0/ ACV INSPECTION RECORD , eQy4 DATE INSPECTOR I, DATE INSPECTOR Setback „, Rough Plumbing 4''‘'/'Temporary Power IV Shower Pan Test ,1,(0. ,2/f" 'Foundation Reinforcing Steel IVY- /_ Stucco Mesh or Exterior Siding f Excavation and Forms V V Insulation 3-Jo--l•2. /3-74 F.H.A. Foundation Req. Sewer I 3 c.,S S S -2 t-S - 7472 Slab Grade /P, '/f-'( .r f Interceptor Ground Plumbing (;Ir//'ab Septic Tank Underslab Ducts Leach Line or Seep Pit JJnderslab Conduit Water Service '34'O ~9L --_ Ficeplaee-Fsunu_n�alion )(WPM_, M_ ',id./ y J� j);(5.------ Lath or Drywall Nailing y—3 - %Z fir-A/- Joists 4-W'Joists and Girders _ Gas Line Air Test 44-'2 ti-5t 7 - Electrical Ground n-,-/1-‘qt 25 Final Energy 4,1/./.1Mid-Height Bond Beam Final Plumbing ` ]/Z 8-Foot Bond Beam Final Heating/A.C. 4t Final Bond Beam Final Construction , 7 Fireplace Bond Beam Final On Site Improvements Roof Sheathing Final Off Site Improvements Framing and Ventilation i /I Final Dedication Roof Covering Q 7 t / Final Zoning Rough Heating n koZ A V Final Electrical , ® ,p -/..'''.. Electrical Service and Ground 4,�'' 1Y Final Gas 4I ". L - Rough Electrical J' Developer Fees Paid WC (Y/Ni inti Saf'(YRJi Certificate of Occt pancy S-2 6- 7 Z ilrYhi 49" 3--(1-0Z---- 'k`T / 5 - .t NA-- ONTARIO rrr►AfQI CTCn SEPTIC TANK GALS. n A TIC <— .Z(0 —`2 L SEEP. PIT X v O N LEACH LINF WIDF X LONG X DEPTH OF ROCK N. • W. E. / // nN / A S. Inspector's Signature and Initials 6116— 4t l-_— �-d� 12-17589-469 Rev.3/88