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Permit No. (46) • • 4 105 SAN BERNARDINO COUNTY-EPWA/LAND AGEMENT DEPT OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 88 03542 210A 01 I PAGE 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 11/23/88 ISSUE DATE 11/28/88 PARCEL NUMBER 1057-291-48-0000 PROPOSED USE: LATTICE PATIO COVER CURRENT USE: RESIDENCE 13TRACT 393-21 BLK 000 1 LOT 043 I NSEC W07 1038 1 1 PRCL 07WAP 1 PRCL ACTIVITY : L820 0 0 COMMUNITY PLAN ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/PUD LOT DIMENSION IRREGULAR CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *SLOGS ON LOT 1 GROUP R3 BLOCH, DON H. 17969 LARIAT DR *PLANS RECD 0 LAND USE PLOT 0 INDEX NBR 67-179 CHINO HILLS CA 91709-0000 STD PLAN/ICBO FHA N (714) 393 - 9322 GRADING INITIAL ACTUAL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER CU.YDS. EXC. BLOCH, DON H. CU.YDS. FILL 17969 LARIAT DR CHINO HILLS CA 91709-0000 TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN (714) 393 - 9322 PORCH 260 .20 52.00 JOB SITE ADDRESS 17969 LARIAT DR CALC. VALU 2,340.00 I ADJUSTED AREA 52 CHINO HILLS CA 91709-0000 CROSS STREET MYSTIC CANYON DRIVE ITEM CNT DESCRIPTION DETAIL TOTALS INSPECTN ACCESS RESIDENTIAL CONSTRU 53.93 TOTAL AMOUNT 53.93 CONTRACTOR NAME LICENSE NUMBER MAILING ADDRESS, PHONE NUMBER MINIMUM SETBACK DISTANCES 47 FRNT SETBACK/CENTRLINE LARIAT DRIVE R/W 50 15 REAR SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES I NO. DWELLING NO. BEDROOMS FCUNITO R EXT. WALLS INT. WALLS I CEILING ONTARIO ROOF HEATING FIREPLACES � [11.E D WO 'METAL (MASRY pfp . WATER SEWER MIN DEPTH S.F./100 SIZE NEW/REPAIR F► ATE:/:226 PUBLIC I I 000 I 000 10000 • I COMMENTS PRE-ALTER BY DALE BROSE AMT WAIVED .00 AMT PAID 53.93 PAYOR NAME: DON H. BLOCH PAID 11/28/88 RECEIPT 4773 EMPL: STACCATO-NYARI, M LICENSED tONTR"ACTORS 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 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 (55001.1. K.-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 NER / // .�^T�✓�� DATE 1�� ��47 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 ISEC 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 [51001 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 • • °+' -' r. 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 PURPO ,/ AT URE OF APPLICANT OR AGENT � DATE i//Z7/h` / / .. - 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-BUILDER VERIFICATION Attention Property Owner: / I'1�\\ An "Owner-Builder" building permit has been applied for in your name and bearing your signature. Please complete and return this information to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. Yes ❑ No 2. I (have or have not) signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed work. Name Address Contractor's License No. City State Zip Phone 4. I plan to provide portions of the work, but I have hired the following person to coordinate, supervise, and provide the major work: Name Address Contractor's License No. City State Zip Phone 5. I will provide some of the work but I have contracted (hired)the following persons to provide the work indicated: Name Address Phone Type of Work Name Address Phone Type of Work Name Address Phone Type of Work Signed: Property Owner /7,-7/ Date Please complete this information and return to the San Bernardino County Office of Building and safety listed below that will be issuing your permit: • 301 E. Mt. View Avenue — Barstow, CA 92311 — (619) 256-0511 • 477 Summit Blvd. — Big Bear Lake, CA 92315 — (714) 866-4115 • 17780 Arrow Route, Room 207 — Fontana, CA 92335 — (714) 829-6292 • 6527 Whitefeather Road — Joshua Tree, CA 92252 — (619) 366-3751 • 320 E. "D" Street — Ontario, CA 91764 — (714) 391-7500 • 385 No. Arrowhead Avenue — San Bernardino, CA 92415-0181 — (714) 387-4244 • 26010 State Highway 189 — Twin Peaks, CA 92391 — (714) 337-2405 • 15505 Civic Drive — Victorville, CA 92392 — (619) 243-8127 • 34282 Yucaipa Blvd. — Yucaipa, CA 92339 — (714) 797-6013 12.17627-469 Page 2 of 2 f /4' k� 35.‘/A 02/0A 0/ Owner Name AL. O L �"'�' Permit umber INSPECTION RECORD DATE I INSPECTOR DATE INSPECTOR Setback t( '�jl("j 9$ Rough Plumbing Temporary Power I Shower Pan Test Foundation Reinforcing Steel I Stucco Mesh or Exterior Siding Excavation and Forms J I l 7 asii�s,)_z 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 Fireplace Bond Beam Final On Site Improvements Roof Sheathing Final Off Site Improvements Framing and Ventilation Ii 28se 07/.1 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 SEPTIC TANK GALS. SEEP. PIT X LEACH LINE WIDE X LONG X DEPTH OF ROCK N. W. E. ,� ( ) S. Inspector's Signature and Initials !4/./0 12-17589-469 Rev.3/88