Loading...
Permit No. (42) • 105 SAN BERNARDINO COUNTY-EPWA/LAND MATJAGEMENT DEPT OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NSR 105 88 01462 TO1A 01 I PAGE 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 04/07/88 ISSUE DATE 04/07/88 PARCEL NUMBER 1023-661-59-0000 PROPOSED USE: PRE-CONSTRUCTION INSPECTION CURRENT USE: VACANT TRACT 13249-6I BLK 000 1029 LOT I SE07 SEC 102S 108W I PRCL 00AP 100RCL CHINO HILLSCOMMUNITY LAN ZONE/CH/PUDLAND SE DISTRICT( GENERAL SUBDIVISION NAME SUBDIVISION PARCEL NO LOT DIMENSION 110X180 (CONST TYPE VN *BLDGS ON LOT GROUP R3 APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 21-135 PETE VOLBEDD/RON STD PLAN/ICBO {I FHA N 199 S MONTE VISTA AVE *4 SAN DIMAS CA 91773-0000 GRADING INITIAL ACTUAL (714) 599 - 8000 CU.YDS. EXC. CU.YDS. FILL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER :.. DESAI, RASHMIKANT ITEM CNT DESCRIPTION DETAIL TOTALS 26 COMANCHE CIR PRE-CONSTRUCTION IN 16.00 POMONA CA 91766-0000 TOTAL AMOUNT 16.00 (714) 623 - 5519 JOB SITE ADDRESS 13536 LA SIERRA DR CHINO HILLS CA 91709-0000 CROSS STREET MIRAMONTE INSPECTN ACCESS CONTRACTOR NAME LICENSE NUMBER MAILING ADDRESS, PHONE NUMBER MINIMUM SETBACK DISTANCES F7. FRNT SETBACK/CENTRLINE LA !',,TERRA DRIVE P,/W 60 15 REAR SETBACK/PROP LINE 40 SIDF SETBACK/CENTRLINE MIRAMONTE CT R/W 50 5 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIESI NO. DWELLING NO. BEDROOMS FLOORO UNITEXT. WALLS INT. WALLS CEILING ST SH SH ROOF HEATING FIREPLACES TI NA METAL IMASRY WATER PUBLIC (PUBLIC SEWER I MIN 000EPTHI S 000 0000./1001 SIZ000EI NEW/REPAIRP COMMENTS AMT WAIVED .00 AMT PAID 16.00 PAYOR NAME: DESAI, RASHMI PAID 04/07/88 RECEIPT 723 EMPL: RICHARDS, GARY LICENSED CONTRACTORS DECLARATION ' I HEREBY AFFIRM THAT I AM LICENSED UNDER E PROVISIONS OF CHAPTER 9 (COMMENCING WITH SE TION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT LICENSE CLASS LICENSE NUMBER CONTRACTOR DATF 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 [55001.): ❑ 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 E 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). POLICY NO. COMPANY ❑ CERTIFIED COPY IS HEREBY FURNISHED ❑ CERTIFIED COPY IS FILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT APPLICANT DATF 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 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 ISA CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.3097,CIV.C I 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 DATE 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 County of anRernardino A/LAND MAIVAdEME'liIt DEPARTMENO OFFICE OF BUILDING AND SAFETY PRE-CON RUCTION INSPECTION REPORT Ownerls) 1-2:?__,_ U". .�� f7�s-,.lL..f_f Permit No. /:Application Date - /C- Job Address / ?S ? / / Z c#' gam /2- A.P.N. Net Lot Area Person to Notify Phone No. 1 1 Mailing Address INTER-OFFICE ROUTING/FOR OFFICE USE TECHNICIAN COMPLETE THIS SECTION To Regional Office From Regional Office When complete send to Regional Office Erosion control plans submitted concurrently? n Yes n No Building or grading plans submitted concurrently? U Yes n No This is in conjunction with what type of application or use? PLANT PROTECTION AND MANAGEMENT INSPECTION INSPECTOR COMPLETE THIS SECTION Total number of native trees or plants on property Number of native trees or plants approved for removal Number of native trees or plants approved for transplanting Nu ber of trees or plants approved for stockpiling No native trees or plants on the property subject to the provisions of this ordinance. (Check only if applicable) Conditions and/or comments The findings for removal for the protected trees and plants that may be removed on the above-described property, subject to the conditions and/or comments as shown, have been made in accordance with the San Bernardino County Code, Title 8,,_Division 11. • K....,,DATE APPROVED BY -. _ ofliP - _ .- ,, / Approval does not constitute a permit to remove trees orpi unless in conjunction approved land use application or development permit. FLOOD HAZARD INSPECTION Yes pf. INSPECTOR COMPLETE THIS SECTION YesnThere is evidence of a discernible watercourse which could affect or could be affected by the proposed improvements or land-disturbing activity. A Flood Hazard Development Review and approved plans are required in accordance with County Code Section 84.0330 prior to the approval of a development permit. Yes No ALTERNATE METHOD OF APPROVAL I 1 I 1 In lieu of the Flood Hazard Development Review required above, a discernible watercourse exists onsite which may be mitigated by one or more of the following measures(s): I I Elevate the building pad inches above the existing natural ground level. Move the proposed land-disturbing or construction activity to avoid obstructing the watercourse. n Protect the slope(s) adjacent to the watercourse from erosion. Other Conditions and/or comments l /-7 DATE / `CIU APPROVED BY `--<----f /' '/i/' f 1 04-17807-469 THIS REPORT MUST BEA HED TO ANY REQUIRED PLAN