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Permit No. (75) 9L11 105 SAN BERNARDINO COUNTY-EPWA/LAND AGEMENT DEPT • OFFICE O("`BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 90 03355 201A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 12/19/90 I ISSUE DATE 12/26/90 I PG 1 OF 1 PARCEL NUMBER PROPOSEi r"( CURRENTD USE: VACANTE WITH GARAGE - 13712 TRACT I 000 I LOTT I SEC SECp I � RNG 08N PRCL MMAP I PRCL ACTIVITY : L831 COMMUNITY PLAN ZONE/LAND USE DISTRICT( GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/PD,IL1,FR1 • 13792 PLAN 3 12/19/90 - - - LOT DIMENSION CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER gBLDGS ON LOT GROUP R3 COSTAIN HOMES, INC./ROBERT WELLS .620 NEWPORT CNTR 11400 1FPLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 26-146 - .NEWPORT BEACH CA 92660-0000 STD PLAN/ICBG 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, INC. 1 1005 1.00 1005.00 620 NEWPORT CNTR *400 2 1311 1.00 1311.00 NEWPORT BEACH CA 92660-0000 GAR 424 .50 212.00 (714) 760 - 1455 PORCH 44 .20 9.00 JOB SITE ADDRESS CALC. VALU 120,913.42 I ADJUSTED AREA 2537 2604 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 - P D C HOUSING GROUP CONT000539870 17595 ALMHURST ROAD )F206 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. STORIES I NOITDWELLING I NO. BEDROOMS 1 3SIDFLR E SET EXT. WALLS I INT. WALLSI CEILING STUCCO SHEETROCK SHEETROCK ONTARIO • ROOF 1 HEATING FIREPLACES TILE NATURAL GAS 1METAL I MASRY CO�WATPLT r�j/ ER SEWER MIN DEPTH F./100 SIZE NEW/REPAIR PUBLIC ,PUBLIC I 000 I S.000 10000 I NEW ATE COMMENTS • • AMT WAIVED .00 AMT PAID 1,425.00 PAYOR NAME: COSTAIN HOMES INC PAID 12/26/90 RECEIPT : 00005158 EMPL: FLETS, DEBORAH PAID BY : CHECK NBR : 51947 OICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 !COMMENCING WITH SEC ION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT r LICENSE CLASS LICENSE NUMBER CONTRACTOR p 1wLr) -BATE /Z--J t-6 !it> • 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 HE'R 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 C Y IS FILED WITH THE UNTY BUILDING INSPECTION DEPARTMENT I APPLICANT �T 1,2_A-- 1/LpDATF ( 2 12-6 I C' 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 WORKERS'COMPENSATION LAWS OF CALIFORNIA. APPLICANT DATF 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.). 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 PROPERTY FOR INSP ION� PURPOSES. �i SIGNATURE OF APPLICANT OR AGENT c lJ�-c�0 1L _,t-)-(2-9--4_ DATE 2-I '2--G '9_'J 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. 12-17588-469 Rev.4/90 Owner Name Co " n 0 ?7 Permit Num illImo-' /CO , -0 ' INSPECTION RECORD DATE I INSPECTOR I Dfriq I INECTOR Setback .1 S—go—?/ I //7%e--- Rough Plumbing o_AX:4 I / Temporary Power I Shower Pan Test 0- i(_1/— Foundation Reinforcing Steel 6--40—9/ I,/M _ Stucco Mesh or Exterior Siding _ _ _ , I y AExcavation and Forms 5—go-9'( Insulation 41st/ft/ t F.H.A. Foundation Req. r Sewer -.7 4-49*/ Slab Grade I Interceptor Ground Plumbing 1.r- t,_9/ Imo, Septic Tank Underslab Ducts � Leach Line or Seep Pit Underslab Conduit Water Service .JoisFireplace Foundation Lath or Drywall Nailing Iff'-'/K—_ ?( <4,--- Joists ts and Girders Gas Line Air Test 9?-2:-T-9/ Electrical Ground Final Energy / Mid-Height Bond Beam Final Plumbing / - 8-Foot Bond Beam Final Heating/A.C. — 1 Final Bond Beam Final Construction (Al/ t Fireplace Bond Beim _ IFinal On Site Improvements ,^,/ / t Roof Sheathin� ' e-...r._97)e)(0'.... Final Off Site Improvements YJ I Framing and t/entilation 11' yI f V Final Dedication LIV Roof Covering I r Vl/ J 4,,,,,/ `/ Final Zoning 1` 1 II / Rough Heating ir/ %-,4-, V Final Electrical `~� _/ Electrical Service and Ground I v/ I ~V Final Gas 7 / Rough Electrical I/ V Developer Fees Paid / WC (YIN) Ind Saf (YIN) Certificate of Occupancy X i • . --- // 4,4f I. -/ w v. E1CU SEPTIC TANK GALS. n n ` r r �/� I SEEP .PIT X v• + " "r LEACH LINF WIDE X LONG X DEPTH OF ROCK N. � .� /� /.157 W. E. 1 S. Inspector's Signature and Initials f� ---s`-- /'L"_ -- /�.� r �/ 4.../ _ i Z / v '/12-17589-469 Rev.3/88