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Permit No. (44) 410r 4 • 105 SAN BERNARDINO COUNTY-EPWA/LAND MANAGEMENT DEPT ••---•-••--- OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 88 01181 201A 01 I PAGE 1 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 05/12/88ISSUE DATE,05/12/88 PARCEL NUMBER 1023-681-06-0000 �' PROPOSED USE: RESIDENCE W/GARAGE CURRENT USE: TRACT BLK 1 LOT I SEC 110811 I PRCL MAP I PRCL COMMUNITY PLAN ZONE/LLANND USE DISTRICTI GENERAL PLAN 13249-6 000 018 SW07 02S HILLSRES 2 SUBDIVISION NAME SUBDIVISION PARCEL NO LOT DIMENSION IRREGULAR CONST TYPE VN tBLDGS ON LOT GROUP R3 APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *PLANS RECD 0 LAND USE PLOT 0 INDEX NBR 20-135 DUPIGNAC, BOB STD PLAN/ICBO FHA N 2146 BLUE JAY CA 92317-0000 GRADING INITIAL ACTUAL (714) 337 -- 1851 CU.YDS. EXC. CU.YDS. FILL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER BUCK, JOHN TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN 6605 KING ST CHINO CA 91710-0000 1 2439 1.00 2439.00 (714) 627 - 1372 2 1620 1.00 1620.00 GAR 1003 .50 502.00 JOB SITE ADDRESS PORCH 186 .20 38.00 13590 LA SIERRA DR CHINO HILLS CA 91709-0000 CALC. VALU 195,678.00 I ADJUSTED AREA 4659 CROSS STREET MONTEVERDE DRIVE INSPECTN ACCESS ITEM CNT DESCRIPTION DETAIL TOTALS RESIDENTIAL CONSTRU 1,186.70 TOTAL AMOUNT 1,186.70 CONTRACTOR NAME LICENSE NUMBER MAIITNG ADDRESS, PHONE NUMBER MINIMUM SETBACK DISTANCES 20 FRNT SETBACK/PROP LINE 15 REAR SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE W .. 10 SIDE SETBACK/PROP LINE E MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. .STORIFS I NO. DWFII.IWG NO. BEDROOMS FLOOR • 2 I .,UNITS 4 CO EXT. WALLS INT. WALLS CEILING ST SH SH ONTARIO ROOF HEATING FIREPLACES TI NA METAL 02 IFIASRY O1DA1 COMPLET E D PIUBLIC ATEPUBLIC MI000EPTH �' 0001000000E NENEWEPAIR � . ��`�, COMMENTS AMT WAIVED .00 AMT PAID 1,186.70 ' PAYOR NAME: BUCK, JOHN PAID 05/12/88 RECEIPT 1332 EMPL: RICHARDS, GARY LICENSED CONTRACTORS DEC.LARATIO•, I HEREBY AFFIRM THAT I AM LICENSED UNDER E 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 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 1$500) I: ❑ 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 1�7 OWNER ...:4/.-1- 6J DATF S-i�- 1� 1 ' 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 COPY IS FILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT APPLICANT ' DATE 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 ✓ HE SUBJECT TO TORKERS' COMPENSA ION LAWS OF CALIFORNIA. /�\1 ? APPLICANT i (C/fin`-1,-ro (... DATE .c--- )0 - gl NOTICE TO A PP (CANT: IF, AFTER MAKING THIS CERTIFICATE OF EXEMPTION,YOU SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS OF THE LAB 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 ' l ❑ 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 INSPECT PURPOSES. SIGNATURE OF APPLICANT OR AGENT .[^ 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 owner Name 71 u c t� Rerl Number /0.17- -'0/lel '20/19-0/ INSPECTION RECORD DATE INSPECTOR DATE I INSPECTOR Setback I c:/.7.88 I C�, Rough Plumbing A/ e4 Temporary Power I0/c: 1 Shower Pan Test Foundation Reinforcing Steel I✓A.- Stucco Mesh or Exterior Siding Excavation and Forms I`'-,C....) /1./ Insulation , F.H.A. Foundation Req. I I Sewer -3/.2G .5-..° Slab Grade I57($•0e I Interceptor Ground Plumbing -5-'17-8ad. Septic Tank Underslab Ducts v Leach Line or Seep Pit Underslab Conduit ,S/t•eie Water Service Fireplace Foundation A Lath or Drywall Nailing ��/��� � Joists and GirdersGas Line Air Test _ `d•¢J�' ..aL� Electrical Ground (),me- 5,Z, .$j. ..<-„A' Final Energy i Mid-Height Bond Beam Final Plumbing / 8-Foot Bond Beam Final Heating/A.C. / / Final Bond Beam L Final Construction n'1/ / Fireplace C. .: :.. t_- A' `Final On Site Improvements `.0/ �7 Roof Sheathing +� n /��#7/ I Final Off Site Improvements /fir 7 fiJ Framing and Ventilation A / / I Final Dedication / I r, Roof Covering . ill/ LJ 7 ' I Final Zoning 7 7 ' Rough Heating i.1 l I Final Electrical Electrical Service and Ground I�/� ' I / I Final Gas V 1/ Rough Electrical 1 / I Developer Fees Paid WCJY/NJ, / Ind Saf (Y/N) I Certificate of Occupancy r 1,3- $A" A/,)7, j �✓/�Ol , - V(40#r C! 5.30-OE 11=164.04,,/ G/C.t.04®,4 I fraii, ....I ..),✓), 4.....r / MG" I ,Std -4;�.. Q y4c_ / ,e,..7..y ...11-4-€.0.— ..„."_,... /,c_ .., ---2045_ '��RE 4C-%10.1e "'" .4= s .• {�4••••• 0. . AA4fi AA ,C,eca.iii- Io 541-gra7 5".eC /I �. •� .4:L _ L► /�G 4/ Ii J /�.. i ICS i SEPTIC TANK GALS. .— �e/• ��' 9� ._ e-5or�..44 SEEP. PIT X /G 2�T"S _ j�/G�! TA i , , •c.c.f .�c7lr 4 LEACH LINF WIDE e/rvgete-4 •+. S_ � N. / QF ROCK e v X LONG X DEP ► �I( 4, 00,2�ac, - / f . ..c/i ,--/ c::Ai /....___ - � i /0 .....2.,-/-e7-8P 7 :1��... al! i /1n.�.. ,�a 1 7 •�or�— , �.), lfr**47.e. , ,�I,,14 f-,- G��f��g • "'Lc...-�4.".c .��� .Y�i.. �,s /pig /GO�• S..` W. E. ?/1 /� C 6 �� 4 �..o • /g' 1/ r _ '80.• ."211111111.117ArilMt _ 7IK _1 S. Inspector's Signature and (nits;_/1 /_ 12-17589-469 Rev. 1/88