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Permit No. (16) 105 SAN BERNARDINO COUNTY-EPWA/LAND •GiEr CEPT -- --- -- - OFFICE OF BUILDING AND SAFETY P E RMI T APPLTCA1 f%N PERMIT NBR 105 89 02517 225A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 07/19/89 I ISSUE DATE 08/24/89 I PG 1 OF 1 PARCEL NUMBER 1023-681-06-0000 PROPOSED USE: POOL AND SPA CURRENT USE: RESIDENCE BLK SEC TWN ACTIVITY : 13249-6I 000 1018 I SW07 102S 108W I PRCL 00AP I �RC�- COMMUNITY PLANLB 1 ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/PD LOT DIMENSION IRREGULAR CONST TYPE APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER #BLDGS ON LOT 1 (GROUP BUCK, JOHN 13590 LA SIERRA DR *PLANS RECD 2 LAND USE PLOT 0 INDEX NBR 20-135 CHINO HILLS CA 91709-0000 STD PLAN/ICBG FHA (714) 627 - 1372 - ITEM CNT DESCRIPTION DETAIL TOTALS OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER POOL PRIVATE 251.68 BUCK, JOHN MISC SUB-TOTAL 251.68 13590 LA SIERRA DR TOTAL AMOUNT 251.68 CHINO HILLS CA 91709-0000 (714) 627 - 1372 JOB SITE ADDRESS 13590 LA SIERRA DR CHINO HILLS CA 91709-0000 CROSS STREET MONTEVERDE DRIVE INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER DIV. OF IND. SAFETY PERMIT: MINIMUM SETBACK DISTANCES 20 FRNT SETBACK/PROP LINE 15 REAR SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE W ONTARIO 10 SIDE SETBACK/PROP LINE E COMPLETED DATE AC -.07,.3-9/ $ 1 MECHANICAL. EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES NO. DWELLING NO. BEDROOMS FLOOR it, -, / 57-7 UNITS 31t/a EXT. WALLS INT. WALLS CEILING 1331.31d0100 OIHd1NO ROOF 1 HEATING FIREPLACES METAL IMASRY PUBIIC (PUBLIC SEWER I Mi000EP1'HI S 000100( SIZ000EI NEW/REPAIR COMMENTS FR1 AREA MODERATE OT HIGH SUSCEPTIBILITY TO LANDSLIDE STOCK PLAN # 86-30088225A00 AMT WAIVED .00 AMT PAID 251.68 PAYOR NAME: APEX ASPHALT MAINT PAID 07/19/89 RECEIPT 4165 EMPL: ROTRUCK, S PAID BY : CHECK NBR : 6792 ',LICENSED CONTRACTORS DECLARATION. 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 IS IN FULL FORCE AND EFFECT. LICENSE CLASS .ICENSE NUMBER CONTRACTOR DATE 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 [S500] 1• X 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). e I,AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC 7044,BUSINESS AND '7' 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 EXE PT UNDER SEC. B AND P C FOR THIS REASON OWNER I\.u. DATE F a Y- S 5 U 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 DATF CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [S 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 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 INSPECTI PURPOSES Q SIGNATURE OF APPLICANT OR AGENT / J/4 /1Y-/ DATE U 9l-Si %/ EXPIRATION AND REFUND NOTICE APPLICATIONS FOR WHICH NO PERMIT 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 10/88 • Owner Name $4.4 J6- IV_ Permit Numb. tO: Oa.s") 7claS Ao i INSPECTION RECORD DATE 16' -TOR DATE INSPECTOR Setback 09/26/g1 ]/ Rough Plumbing Temporary Power � _ Shower Pan Test Foundation Reinforcing Steel en/Zr/g, k/14-Th_ Stucco Mesh or Exterior Siding Excavation and Forms 09/26'/Ijo "r ,,41-‘. Insulation F.H.A. Foundation Req. / �J Sewer Slab Grade n Interceptor Ground Plumbing 08/t'/8f )rplia, Septic Tank Underslab Ducts --I Leach Line or Seep Pit Underslab Conduit C' IV 1211° Lj Water Service Fireplace Foundation / Lath or Drywall Nailing Joists and Girders /"""t_ Gas Line Air Test Electrical Ground Iao/t • 'Oe PAM? (,/4 •. 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 Rough Electrical Developer Fees Paid WC (Y/N) Ind Saf (YIN) _ Certificate of Occupancy nit /D-/-9/ 5rt 7/1 � /O- 5)---Pt% 1-7--,z#� `7 ,j, , /D .'_A g-5/ cram.-eA s y �:it?t - �!�� ter- Re--e) t- e r % I ✓ / /C/O ! /ged_. ,i,e,_/S,9fr''�-/ te).c•-, 1✓J _ /r4',S A"`- ..e=:, 7.-E".--- - /�,1 6fir 17 o\.` 00 t tr,-1:--6 / / 40 09/90"spe.cyt Arra -78A.A./ire/ _,- ,r te' (Ave,1,6 ,-,==.) SEPTIC TANK GALS. SEEP. PIT X LEACH LINF WIDF .�. n" vI v X LONG X DEPTH OF ROCK N. COMPLETED h „ , DAZE /`d ofive,-7 W. E. /2 , i//.�; /`..� n / \ . S. Insp ce tor's Signature and InitiE _ i i �< r.,_. . / ....v44-= 12-17589-469 Rev 3/88