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Permit No. (19) ze 4ik , 0 - -- 105 SAN BERNARDINO COUNTY-EPWA/LAND MANAGEMENT DEPT OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 88 02.303 201A 01 I PAGE 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 06/23/88 ISSUE DATE 06/24/88 PARCEL NUMBER /0-5- 7- f71-at PROPOSED USE: RESIDENCE W/GARAGE CURRENT USE: VACANT 13TRACT 393-3I BLK 000 1028 LOT I NW07 SEC I TWN pI RNG I PRCL OAMAP I PRCL CO0CHIMNO HILLSITY LAN ZONE/LAND CH/PUD USE DISTRICT( GENERALPLAN SUBDIVISION NAME SUBDIVISION PARCEL NO LOT DIMENSION 40X100 (CONST TYPE VN TR 13393-3 MOD 4 06/23/88 1057-261-02-0000 *BLDGS ON LOT GROUP R3 APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 67-180 LARWIN COMPANY STD PLAN/ICBO FHA N 16255 VENTURA BLVD *900 ENCINO CA 91436-0000 GRADING INITIAL ACTUAL (714) 986 - 8890 CU.YDS. EXC. CU.YDS. FILL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER LARWIN COMPANY TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN 16255 VENTURA BLVD *900 ENCINO CA 91436-0000 1 973 1.00 973.00 (714) 986 - 8890 2 748 1.00 748.00 GAR 477 .50 239.00 JOB SITE ADDRESS 18053 LARIAT DR CALC. VALU 82,320.00 I ADJUSTED AREA 1960 CHINO HILLS CA 91709-0000 CROSS STREET WRANGLER ROAD ITEM CNT DESCRIPTION DETAIL TOTALS INSPECTN ACCESS RESIDENTIAL CONSTRU 723.40 TOTAL AMOUNT 723.40 CONTRACTOR NAME LICENSE NUMBER LARWIN COMPANY CONT000435206 MAILING ADDRESS, PHONE NUMBER 16255 VENTURA BLVD 900 ENCINO CA 91436-0000 (000) 000 - 0000 MINIMUM SETBACK DISTANCES 45 FRNT SETBACK/CENTRLINE LARIAT DRIVE R/W 50 15 RFAR SF1RAC(tFROP UNE 5 SIDE SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS ONTARIO N0. STORIES N0. DWELLING NO. BEDROOMS FLOOR COMPLETED 2 UNITS 1 4 CO ST EXT. WALLS ISH 1SH INT WALLS CEILING CTAT E: 2z.e 8 ROOF HEATING FIREPLACES TI INA (METAL 01 IMASRY WATER PUBLIC (PUBLIC SEWER I MIN 000EPTHI S.000F./ 0000 000SIZEI NEW/REPAIRE COMMENTS ALL SCHOOL AND DEVELOPMENT FEES PAID. SEWER LETTER ON FILE. AMT WAIVED .00 AMT PAID 723.40 PAYOR NAME: LARWIN COMPANY PAID 06/24/88 RECEIPT : 00002081 EMPL: RICHARDS, GARY LICENSED CONTRACTORS DECLARAT - 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 LICENSE 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 [$5001 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 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.I. 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 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 NAMF 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 DATF 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 z8 Owner Name L- .w i A) Co 0 Permit Number /0 -'D z 3 o3 --Zp/A--o/ INSPECTION RECORD DATE INSPECTOR I I DATE I INSP,CTOR Setback I'/1 / 7 Rough Plumbing I!// g* Temporary Power I Shower Pan Test r . _....--I-- • Foundation Reinforcing Steel 17/!� eej K.) Stucco Mesh or Exterior Siding I�/ I .. Excavation and Forms Insulation I7,// �{•• ii 1 F.H.A. Foundation Req. —I ^ Sewer ,Q J�f #� f Slab Grade 7�? ,, _ Interceptor 1 Ground PlumbingS ,/r//,.e' , Septic Tank I Underslab Ducts Leach Line or Seep Pit I J� Underslab Conduit I Water Service I,/ Fireplace Foundation I Lath or Drywall Nailing 1/Z ' s114-, �C_I Joists and Girders I Gas Line Air Test I/./yo be) ,� Electrical Ground /'�gR � Final Energy 1.zy 8A A C� Mid-Height Bond Beam Final Plumbing 1 8-Foot Bond Beam I Final Heating/A.C. I / Final Bond Beam I Final Construction I Fireplace B;..,,: V// /w6 Final On Site Improvements X Roof Sheathing f Final Off Site Improvements Framing and Ventilation X Final Dedication Roof Covering / I Final Zoning Rough Heating , I Final Electrical Electrical Service and Ground V- I Final Gas Rough Electrical /X I Developer Fees Paid WC (Y/NI Ind Saf (Y/N) Certificate of Occupancy SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDE X LONG X DEPTH OF ROCK N. W. E. A /1 � rh� d n S. . Inspector's Signature and Initials /✓ f` 12-17589-469 Rev.3188 1