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Permit No. 1058801736 105 SAN BERNARDINO COUNTY—EPWA/LAND'AGEMEN', L'ENF . OFFICE OF BUILDING AND SAFETY P E RMI T APPLICA"'1c)N PERMIT NBR 105 88 01736 210A 01 I PAGE 1 or FHIS IS NOT A PERMIT UNTIL ISSUED — APPL DATE 05/11/88 ISSUE DATE 05/11/88 PARCEL NUMBER 1017-841-13-0000 PROPOSED USE: LATTICE PATIO COVER CURRENT USE: RESIDENCE 12625-4TRACT I BLK LOT 000 313 I SEC SE29 102S RNG PRCL 00AP PRCL CCHHIINNOO HILLUNITY S ZOHE/CH/PUD D USE DISTRICT( GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO LOT DIMENSION 50X100 (CONST TYPE VN *BLDGS ON LOT 1 GROUP R3 APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 30-159 CUSTOM PATIO CONCEPTS STD PLAN/ICBO FHA N 128 E 6TH ST CORONA CA 91719-0000 GRADING INITIAL ACTUAL l 1 — CU.YDS. EXC. CU.YDS. FILL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER KALITERNA, MIKE AND CINDY TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN 15985 OAK CANYON DR CHINO HILLS CA 91709-0000 PORCH 273 .20 55.00 (714) 597 — 0129 CALC. VALU 2,310.00 I ADJUSTED AREA 55 JOB SITE ADDRESS • 15985 OAK CANYON DR ITEM CNT DESCRIPTION DETAIL TOTALS CHINO HILLS CA 91709-0000 RESIDENTIAL CONSTRU 42.60 CROSS STREET BAYBERRY DRIVE TOTAL AMOUNT 42.60 INSPECTN ACCESS CONTRACTOR NAME LICENSE NUMBER TRACY RICHARD CONT000474278 MAILING ADDPESS,, PHONE NUMBER 1245 W 6TH STREET • „ COPOMA , - C4 92721-000O ,'i 000) ,G:rd.. ,7 -0(100 'MINIMUM SET3ACl( D1STAivi•ES ?0_ FRNT'SES r ICK/PROP L MEE " -2.0 HEAR 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. DDWELLING I NO. BEDROOMS I FLOOR UNITO EXT. WALLS INT. WALLS ( CEILING ROOF HEATING FIREPLACES WO METAL IMASRY PWAATER TIR I SEWER I MIN NODEPTHI S.F./100IOSIZEI NEW/REPAIR 000COMMENTS ONTARIO Y PREALTERATION AND PRE—CONSTRUCTION INSPECTIONS BY DON BAKER. COIg LUTED DATE: AMT WAIVED .00 ANT PAID 42.60 PAYOR NAME: CUSTOM PATIO CONCEPTS PAID 05/11/88 tECEIPT 1309 EMPL: RICHARDS, GARY 0LICENSED CONTRr4TOR3 DECLARATION& 1.. I HEREBY AFFIRM THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SE ION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT / JCENSE CLASS 3 LICENSE NUMBER try-t 27r !ONTRACTOR ‘ - 11,4 PLATE I` — ` 1^ I n 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 // ``rr `� r POLICY NO (c) '. l�' 1 1 COMPANY CJI?�/4d f..... "4— (cl'l o r- 1 1 ❑ CERTIFIED COPY IS HEREBY FURNISHED ❑ CERTIFIED OPY IS FILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT d APPLICANT DATE s-- I T r t( 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 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 B LDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION RPOSES ��r/�� t, SIGNATURE OF APPLICANT OR AGENT ��"`�C�` DATE °_1 ' t 1'"d 1 / 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 ORIF THE WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS, FEES PAID ARE NOT REFUNDABLE AFTER ONE YEAR FROM DATE OF PAYr1 NT, ALL FEES PAID MAY NOT BE REFUNDABLE 12-17588-469 f Owner Name ILA'.. ire 0 ./J PeriNumber /0 0-O/736- 2/C.4 o/ INSPECTION RECORD DATE INSPECTOR I I DATE ] INSPECTOR Setback �- -`/D �. 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 7-S- —2 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 7 j- YD --7)2/94-i Fireplace Bond Beam Final On Site Improvements Roof Sheathing n Final Off Site Improvements Framing and=,'a,,;,;a:u _ - 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) C r dtcatP of Occupancy—k?rut SEPTIC TANK GALS SEEP PIT X LEACH LINF WIDE X LONG X DEPTH OF ROCK N �g Atari /pva fi[ 5j'' Li lids ° e— ,. ons, -`� S Inspector's Signature and Initials .e1'A-' -�l_) -9L1N- 1-1) T• 12 17589-469 Rev 1/88