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Permit No. (71) III ' 106 SAN BERNARDINO COUNTY-EPWA/LAND •GEMENT DEPT OFFICE OF BUILDING AND SAFETY PERMIT APPLICATION" PERMIT NBR 106 91 01510 201A 011 STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED ADPL DATE 10/31/91 I ISSUE DATE 11/26/91 I PG 1 OF 1 PARCEL NUMBER ' ���� r✓ PROPOSED USE: RESIDENCE W/GARAGE I t CURRENT USE: VACANT 1TRACT I BLK000 I 074LOT I SEC C0 I ' I RNG I PRCL MAP I PRCL ACTIVITY : L831 70 COMMUNITY PLAN ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/PD,ILI,FR1 GH/M-H 13792 PLAN 2 10/31/91 - - - LOT DIMENSION VARIES (CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *BLDGS ON LOT GROUP R3 COSTAIN HOMES/BOB WELLS 620 NEWPORT CENTER DR *400 *PLANS RECD 2 LAND USE PLOT 0 (INDEX NBR 25-146 NEWPORT BEACH CA 92660-6434 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 1 978 1.00 978.00 620 NEWPORT CENTER DR 1400 2 1034 1.00 1034.00 NEWPORT BEACH CA 92660-6434 GAR 425 .50 213.00 (714) 760 - 1455 PORCH 46 .20 10.00 JOB SITE ADDRESS CALC., VALU 108,196.35 I ADJUSTED AREA 2235 2738 LA SALLE POINTE . CHINO HILLS CA 91709-0000 ITEM CNT DESCRIPTION DETAIL TOTALS CROSS STREET POINTE COUPEE , RESIDENTIAL CONSTRU 1,314.00 INSPECTN ACCESS TOTAL AMOUNT 1,314.00 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 38 FRNT SETBACK/CENTRLINE LA SALLE POINTE R/W 37 10 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.2 DWELLING I NO. BEDROOMS I CONCRETE1 3 FO EXT. WALLS IINT. WALLS I CEILING ONTARIO STUCCO SHEETROCK SHEETROCK • COY:TLE/TED ROOFHEATING FIREPLACES � �E -L D- 2 '�� Z- TILE ' NATURAL GAS 'METAL 01 IMASRY ----++++ �� WATER SEWER MIN DEPTH S.F./100 SIZE NEW/REPAIR / T F✓ PUBLIC (PUBLIC I 000 ' 000 '0000 ' NEW COMMENTS ALL FEES DUE AMT WAIVED .00 AMT PAID 1,314.00 PAYOR NAME: COSTAIN HOMES PAID 11/26/91 RECEIPT : 00004844 EMPL: HALL, S PAID BY : CHECK NBR : 52941 • LICENSED CONTRACTORS DECLARA• _ I HEREBY AFFIRM THAT I AM LICENSED UNDER THE PROVISIONS OF CHAPTEfi*9 (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS COD ND MY LICENSE IS IN FULL FORCE AND EFFECT. / /�j /A LICENSE CLASS �/ LICENSE NUMBECOO a CONTRACTOR CQ,l � DATE,/I G�! L 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 CODEI 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). ❑ 1 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 O CERTIFIED COPY I HEREBY FURNISHED • CERTIFIED C S LED LTH T COU BUILDING INSPECTION DEPARTMENT • APPLICANT _ DATE .//46 /// ADDITIONAL REVISION CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS - (51001 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 ISEC.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. O 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 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 A. • STATE THAT THE ABOVE INFORMATION IS CORRECT, I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO 'INC CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COU TY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTI• ' -•RoSE / [ o SIGNATURE OF APPLICANT OR AGENT A __L1�4 �C.�, Ttte r - DATE /// 4G/ !/ 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. 7SHB-469 P•v 4 90 0. .- Owner Name 6C5tet.A. f.----S Permit Num.f(-- .0'9/6)/57 0=2Q I I INSPECTION RECORD DATE INSPECTOR I DATE INSPECTOR Setback / Plumbing .9"1------1'Temporary Power (7fr Shower Pan Test �,2im511/� AFoundation Reinforcing Steel 1 V �1� Stucco Mesh or Exterior Siding / Excavation and Forms Insulation cf.2 3-9Z- /›..x/F.H.A. Foundation Req. �/ /y- Sewer 13�y6Gj -)- --(a-92_ t 71 Slab Grade tZ Zv-�i �f�/ Interceptor 'Ground Plumbing /)--(3_O)/ �C Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service 4 - tb -Ci t-- - Fireplace Foundation 'Mr Drywall Nailing �'"-/.1gf Joists and Girders Gas Line Air Test �o - -91 . "4 Electrical Ground (Z-( (1f r15 Final Energy `4 f Mid-Height Bond Beam Final Plumbing I 71., L 8-Foot Bond Beam Final Heating/A.C. t /S fX Final Bond Beam ( , Final Construction Fireplace Bond Beam /I /./ Final On Site Improvements Roof Sheathing ,41V7I I l Final Off Site Improvements Framing and Ventilation / iiV Final Dedication Roof Covering I `1//,/ I i IV Final Zoning Rough Heating IA` A I V Final Electrical , ‹.fj� . .I Electrical Service and Ground V,` I Final Gas kr-......;„;...-- ��/ Rough Electrical t ' I/ Developer Fees Paid WC (Y/N) Ind Saf (Y/N) Certificate of Occupancy G -23-7z- .4 --(U-q> ail T.,vi---, 7714) a" 7ah t - nytO COMPLY y_v ... ? --3____2e-___-'-' SEPTIC TANK GALS. DATE __/‘ ,, , _ SEEP. PIT X /WW LEACH LINE WIDF X LONG X DEPTH OF ROCK N. W. E. /59.•r...e /cilt k./s-:�/rte /. ./j/ A S. Inspector's Signature and Initials Atit- 6(1411, 01-// 76(GrG," 12-17589-469 Rev.3/88 / j