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Permit No. (94) • <530. 105 SAN BER.NARDINO COUNTY-EPWA/LAND MANAGEMENT DEPT III OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 90 03349 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 PROPOSED USE: ' �'-I 9-1-10 CURRENT USE: VACANTNCE WITH GARAGE In�j 13792T 1000 10LOT 83 I SEC SE20 I � 108W I PRCL MAP 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 #BLDGS ON LOT GROUP R3 COSTAIN HOMES, INC./ROBERT WELLS -620 NEWPORT CNTR *400 *PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 26-146 .NEWPORT BEACH CA 92660-0000 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, INC. 1 1005 1.00 1005.00 ' 620 NEWPORT CNTR )t400 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 - 2678 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 #206 CITY OF INDUSTRY CA 91748-0000 (818) 810 - 2008 OTP/, OF TR), SAFETY PERMIT. MINIMUM SETBACK DISTANCES *** PER PLOT *** MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES I NO.ITS I NO. BEDROOMS I FLR 1 3 CONCRETE ;: EXT. WALLS I INT. WALLS CEILING STUCCO SHEETROCK SHEETROCK ONTARIO ROOF I HEATING FIREPLACES „3i� P�1.ETED TILE NATURAL GAS METAL IMASRY I: 90/ WATER PUBLIC (PUBLIC SEWER I MIN 000EPTHI S 000100I0000EI NENEWEPAIR 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 DECLARATIONS I HEREBY AFFIRM THAT I AM LICENSED UNDER 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. ( . LICENSE CLASS LICENSE NUMBER CONTRACTORC� � TE I 2. 1 Z_ , (7 C u 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 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.(. POLICY NO. COMPANY ❑ CERTIFIED COPY IS HEREBY FURNISHED ❑ CERTIFIED P IS FILED WITH HE COUNTY BUILDING INSPECTION DEPARTMENT ( APPLICANT t A—Q.I � DATF 1 2 1 2-6 G ADDITIONAL REVISION 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 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 ISA CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 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. ❑ 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 TI N PURPOSE . p irJ ^7 f J SIGNATURE OF APPLICANT OR AGENT `[.0 DATE t ,G.I Z E7 I O 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 Cas-TG!h * r Permit Numb! /0-SCIL . o In l INSPECTION RECORD 13 DATE I INSPECTOR I D„Af , S,' I INTOR Setback I /)I /1 A Rough Plumbing }f°i � I '/' Temporary Power I 1171/ I AA / Shower Pan Test Foundation Reinforcing Steel I I sr/ I/\ '"l Stucco Mesh or Exterior Siding Z-----/7--W Excavation and Forms I I 7 Insulation 7-or F.H.A. Foundation Req. I/- Sewer —_2J-9/ r I4(-5 Slab Grade l/(0— . —C7 1"1-12 j2 Interceptor 1 Ground Plumbing t *- 1 r 4 I `1113 Septic Tank Underslab Ducts Leach Line or Seep Pit I Underslab Conduit Water Service Fireplace Foundation Lath or Drywall Nailing gam, f� I �i Joists and Girders Gas Line Air Test %�2—y'`,ie— Electrical Ground kr"'(\-9 I ( Y) Final Energy Mid-Height Bond Beam Final Plumbing / 8-Foot Bond Beam Final Heating/A.C. I / i Final Bond Beam Final Construction (`\ / .tiler Fireplace Bond B9em Final On Site Improvements (J/ Roof Sheathinj eh� i O`Q _Cfinal Off Site Improvements tAb 1y_ Framing and Ventilation ( I A r A Final Dedication ,ii(jY Roof Covering n 67i)" I r ,c/ Final Zoning X11 / „ Rough Heating 01'7 I7 Final Electrical II Electrical Service and Ground y I Com/ Final Gas j / Rough Electrical 17 .,I/ Developer Fees Paid / WC (Y/NI Ind Saf (Y/N) Certificate of Occupancy Y I! nNTARIn SEPTIC TANK GALS. 1�..�� � �'� � SEEP. PIT X lrvi E _.i Cil'c ., LEACH LINF WIDE DA' �v X LONG X DEPTH OF ROCK N. W. E. S. Inspector's Signature and Initials CA\ .4R/W/Zd/ 12-17589-469 Rev.3/88