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Permit No. (34) 1110 105 Cµ1 BERNARDINO COUNTY—EPWA/LAND 1 NAGEMENT DEPT OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 88 01303 230A 01 I PAGE 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 03/11/88 ISSUE DATE 03/11/88 • PARCEL NUMBER 1023-111-11-0000 PROPOSED USE: 2 PROTECTION WALLS 13 ..q CURRENT USE: RESIDENCE AND GARAGE TRACT I BLKI 000 LOT I SEC SE07 I 02S 10NG I PRCL M8W MAP I PRCL CHINO NIIYLPLAN ZONE/LLANND USE DISTRICTIGENERAL PLAN 000SUBDIVISION NAME SUBDIVISION PARCEL NO LOT DIMENSION VARIES (CONST TYPE *BLDGS ON LOT 1 II GROUP APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 22-134 BRAMALEA CALIFORNIA, INC. STD PLAN/ICBO FHA N 3151 AIRWAY AVE *N COSTA MESA CA 92626-0000 GRADING INITIAL ACTUAL (714) 850 — 1001 CU.YDS. EXC. CU.YDS. FILL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER BRAMALEA CALIFORNIA, INC. TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN 3151 AIRWAY AVE *N COSTA MESA CA 92626-0000 FENCE 128 .20 26.00 (714) 850 — 1001 • CALC. VALU 1,092.00 I ADJUSTED AREA 26 JOB SITE ADDRESS 1 LA SIERRA DR ITEM CNT DESCRIPTION DETAIL TOTALS CHINO HILLS CA 91709-0000 RESIDENTIAL CONSTRU 28.00 CROSS STREET OLYMPIC VIEW DRIVE ISSUANCE FEE 13.40 INSPECTN ACCESS TOTAL AMOUNT 41.40 CONTRACTOR NAME LICENSE NUMBER BRAMALEA CALIFORNIA IN CONT000409610 MAILING ADDRESS, PHONE NUMBER 3151 AIRWAY AVENUE SUITE N COSTA MESA CA 92626-0000 (010) 000 — 0000 MINIMUM SETBACK DISTANCES *** PER PLOT * * MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES I NO. DWELLING NO. BEDROOMS FLOOR 1 UNIT EXT. WALLS1 INT. WALLS I CEILING ONTARIO hLs :c ROOF HEATING FIREPLACES CO YY,ir` P L ET D I (METAL IMASRY I 'El PWATER UBLIC SEWER C I MIN DEPTH( S.0 0010010000 COMMENTS IIE1 NEW/REPAIR NEAR LOTS 40 AND 55 TR 13249-4 TO PROTECT SO. CALIF. EDISON EQUIPMENT AMT WAIVED .00 AMT PAID 41.40 PAYOR NAME: TRUDY WILSON PAID 03/11/88 RECEIPT 429 EMPL: STACCATO—NYARI, M !CENSER CONTRACTORS DECLARATION -• t 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 pLICENSE IS IN FULL FORCE AND EFFECT. LICENSE CLASS /6' LICENSE NUMBER 410 /6 CONTRACTOR �i�Am4GEA 6.9fole0ATE -3"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 [85001.1: ❑ 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 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.0 I. POLICY NO.6/WEMX7�q I6 COMPANY /T04)%e7-F0L7 SSS- Co ❑ CERTIFIED COPY IS HEREBY FURNISHED CERTIFIED COPY IS FILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT v p APPLICANT �'t44,rzy0.' �! �?!1YrJ DATE 3 -//- O o 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 IS A 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 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 INSPECTION PURPOSES. �/� SIGNATURE OF APPLICANT OR AGENT LACK DATE "1"/ V � EXPIRATION NOTICE APPLICATIONS FOR WHICH NO PERMIT IS ISSUED WITHIN 180 DAYS FOLLOWING THE DATE OF APPLICATION SHALL EXPIRE,EVERY PERMIT 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 ONE YEAR FROM DATE OF PAYMENT, ALL FEES PAID MAY NOT BE REFUNDABLE. 12-17588-469 /oc/ff- o/5o5 • ! INSPECTION RECORD Permit Number DATE INSPECTOR I DATE I INSPECTOR Setback Per2 pi_igrI ;3•ia� ,?i Rough Plumbing Temporary Power I A Shower Pan Test Foundation Reinforcing Steel i3- ?-1ê' I „j Stucco Mesh or Exterior Siding Excavation and Forms , ��y�g ' Insulation F.H.A. Foundation Req. Sewer Slab Grade Interceptor Ground Plumbing Septic Tank Underslap Ducts Leach Line or Seep Pit Underslab Conduit Water Service Fireplace Foundation Lath or Drywall Nailing Joists and Girders Gas Line Air Test Electrical Ground 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 Final Off Site Improvements Framing and Ventilation Final Dedication Roof Covering Final Zoning Rough Heating Final Electrical Electrical Service and Ground Final Gas j Rough Electrical Developer Fees Paid Certificate of Occupancy WORKERS' COMPENSATION INSURANCE (YIN) DIVISION OF INDUSTRIAL SAFETY PERMIT (YIN) - #e ciuA •ado 7-,v4- O/tr, SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDE X LONG X DEPTH OF ROCK N. W. E. S. Inspector's Signature and Initials 81/05 6 G�;:;.ifili v 12-17589-469