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Permit No. (30) 105 S'AN BERNARDINO COUNTY-EPWA/LAND AGEMENT DEPT • OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION 'ERAIT NBR 105 90 01759 210A 01 I STATUS: ACTIV ' THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 07/03/90 I ISSUE DATE 07/03/90 I PG 1 OF 1 PARCEL NUMBER 1057-291-28-0000 PROPOSED USE: LATTICE PATIO COVER CURRENT USE: RESIDENCE WITH GARAGE 13TRACT 393-11 BLK 000 1 LOT 033 I NSEC E07 1 TWN I RNG I PRCL MAP I 30-1 ACTIVITY : L820 COMMUNITY PLAN ZONE/LAND USE DISTRICT ' GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/PD,IL1,M-H LOT DIMENSION IRREGULAR CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER #BLDGS ON LOT 1 GROUP R3 \ BASS, RUBEN AND. TAMMIE 17939 LARIAT DR #PLANS RECD 0 LAND USE PLOT 0 INDEX NBR 67-179 CHINO HILLS CA 91709-0000 STD PLAN/ICBO FHA N (714) 597 - 3999 TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER BASS, RUBEN AND TAMMIE PORCH 312 .20 63.00 17939 LARIAT DR CHINO HILLS CA 91709-0000 CALC. VALU 2,835.00 I ADJUSTED AREA 63 (714) 597 - 3999 • ITEM CNT DESCRIPTION DETAIL TOTALS JOB ,SI;T,E--ADDRESS1=-, RESIDENTIAL CONSTRU 53.93 7939' LARIATDR TOTAL AMOUNT 53.93 CHINO HILLS CA 91709-0000 CROSS STREET RANCHWOOD AVENUE INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER • ui'i. OF IND. SAP EP`! PE:.'i:T: MINIMUM SETBACK DISTANCES 45 FRNT SETBACK/CENTRLINE LARIAT DR. R/W 50 10 REAR SETBACK/PROP LINE 10 SIDE SETBACK/PROP LINE ONTARIO 10 SIDE SETBACK/PROP LINE COMPLETED MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS D AT E s _ " f NO. STORIES I NO.UNITDWELLING NO. BEDROOMS CONCRETEO -— EXT. WALLS INT. WALLS I CEILING ROOF HEATING FIREPLACES WOOD METAL JMASRY PWWATER ATIR 1 SEWER 1 MIN NODEPTH' S.F./100IOSIZEI NEW/REPAIR 000COMMENTS AMT WAIVED .00 AMT PAID 53.93 PAYOR NAME: TAMMIE BASS PAID 07/03/90 RECEIPT 2834 EMPL: FLETS, DEBORAH PAID BY : CHECK NBR : 1324 •ICENSED 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. t , 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 [$500].): 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 CONTRACJ FOR SUCH PROJECTS WITH A CONTRACTOR(S) LICENSED PURSUANT TO THE CONTRACTORS LICENSE LAW). ❑ • • PT UNDER S C. n B. AND P./C. FOR THIS REASON NER JAI1I/ . AI • , / /✓� 7J -9 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.). POLICY NO COMPANY ❑ CERTIFIED COPY IS HEREBY FURNISHED ❑ CERTIFIED COPY IS FILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT APPLICANT DATF ADDITIONAL REVISION CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100]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 HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT ❑ IS ❑ IS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY. 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 .ILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INS' 0 or URPOSES. IGNATURE OF APPLICANT OR AG. T / /._' /I 'l2d DATE 1D EXPIRATION AND REFUND NOTICE APPLICATIONS FOR WHICH NO PERMIT IS 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.4/90 07/03/90 ** PARCEL REPORT " PAGE: 1 14:50:20 PARCEL NUMBER : 1057-291-28-0000 FROM: 1057261090000 TO: UNFORMATTED LEGAL : TRACT 13393-1 LOT 33 TRACT : 13393-1 BLOCK: 000 LOT: 00033 SITUS ADDRESS : 17939 LARIAT DR. CHI , CA 91710 OWNER : BASS, RUBEN B ET AL OWNER ADDRESS : 17939 LARIAT DR. CHINO HILLS, CA 91709 • PERMIT HISTORY : PERMIT STATUS PERMIT STATUS PERMIT STATUS 1059001759210A01 ACTIV , • Owner Name Permit Numb r` C)C / 751���C7J INSPECTION RECORD DATE INSPECTOR�2DATE INSPECTOR Setback /y_1/ /���/1'-" Rough Plumbing Temporary Power Shower Pan Test Foundation Reinforcing Steel Stucco Mesh or Exterior Siding Excavation and Forms Insulation F.H.A. Foundation Req. Sewer Slab Grade Interceptor Ground Plumbing Septic Tank Underslab 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 l_a_9/ l� Fireplace Bond Beam Final On Site Improvements Roof Sheathing Final Off Site Improvements Framing and Ventilation i- ,/ffeee- Final Dedication Roof Covering Final Zoning Rough Heating Final Electrical Electrical Service and Ground Final Gas Rough Electrical Developer Fees Paid WC (YIN) Ind Saf (YIN) Certificate of Occupancy oz,st,ririrkt)nit % etat tet, SEPTIC TANK GALS. o9 K nE tU SEEP. PIT X kf® LEACH LINE WIDE w A T E• 0_9/ 9/ --r X LONG X DEPTH OF ROCK • U H 4' N. W. E. 1 S. Inspector's Signature and Initials 1� )- ' /fr . 12-17589-469 Rev.3/88 �' v