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Permit No. 1058801915 /F< { III to 105 SAN BERNARDINO COUNTY-EPWA/LAND NAGEMENT DEPT — -- — OFFICE OF BUIIDING AND SAFETY PERMIT APPLICATION PERMIT NBR 105 88 01915 2]OA 01 IPAGE 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED — - --- -- - - - - ——-- — - APPL DATE 05/24/88 ISSUE DATE 05/24/88 PARCEL NUMBER 1017--84]-15--0000 — PROPOSED USE: LATTICE PATIO/GAS-ELEC FOR SPA f CURRENT USE: RESIDENCE 1TRACT I BLK000 I LOT I SEC SEC9 1 1 10NG I PRCL M8W MAP ' PRCL COMMUNITY IIYLPLAN ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO LOT DIMENSION IRREGULAR 'CONST TYPE VN *BLDG'S ON LOT 1 GROUP R3 APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 30-159 GOHRES CONSTRUCTION COMPANY STD PLAN/ICBO FHA N 2323 WANDERING RIDGE DR CHINO HILLS CA 91709-0000 GRADING INITIAL ACTUAL (7141 590 - 2977 CU.YDS. EXC. CU YDS. FILL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER - KUBAS, CHARLES TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN 15973 OAK CANYON DR CHINO HILLS CA 91709-0000 PORCH 240 .20 48.00 (7141 597 - 8802 CALC. VALU 2,016.00 "ADJUSTED AREA 48 JOB SITE ADDRESS — ----- •1 — 15973 OAK CANYON DR ITEM CNT DESCRIPTION DETAIL TOTALS CHINO HILLS CA 91709-0000 RESIDENTIAL CONSTRU 28.00 CROSS STREET OAKCREEK RD ISSUANCE FEE 13.40 INSPECTN ACCESS IOTA! AMOUNT 41.40 CONTRACTOR NAME LICENSE NUMBER- COMPLETED GOHRES CONSTRUCTION CO CONT009242022 MAILING ADDRESS, PHONE HUMBER J ATE ,C--/C-0'. C4g! 4720 DL+RINDA RD - YORBA LINDA CA 92686-0000 (0110) MTD - 0000 MINIMUM SEfBACY, n1srANCu. 45 FONT SE1BACK,/CENTRLINE OAK CANYON DR R/W 50 20 REAR SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SLOE SETBACKS —__NO. STORIES NO. DWELLING N0. BEDROOMS FLOOR 11NZTS CO EXT. WALLS INT. WAILS CEILING ROOF HEATING_ FIREPLACES NO METAL MASRY ` WATER SEWER PUBLIC PUBLIC I MIN 000DEPTH T S 000100T0000E NEW/REPAIR COMMENTS JJII II PRE ALTERATION AND PRE-CONSTRUCTION INSPECTION BY DALE BROSE. PERMIT 10 INCLUDE GAS AND ELECT HOOKUP FOR SPA *PIT WAIVED .00 AMT PAID 41.40 PA10G NAME. GOHRES CONSTRUCTIOPI CO PAID 05/24/88 RECEIPT 1498 EMPL: RICHARDS, GARY ICENSED CONTRACIORSPFCLARATION I HEREBY AFFIRM THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SE ION 7000) OF DIVISION 3 OF THE BUSINE AND PROFESSIONS COD /AND MY LICENSE IS IN FULL FORCE AN EF CT /� �j n-f,L �/' LICENSE CLASS L�/ / LICENSE NUMBEf �V� CONTRACTOR 56/'.N�6/ DATE 6 L� O ee / / 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 [S5001 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 DATE WORKERS' COMPENSATION DECLARATION I HEREBY AFFIRM TH•T I HAVE A CERTIFICATE OF CONSENT TO SELF-INSURE OR A CERTIFICATE OF WORKERS'COMPENSATION INSURANCE OR A CERTIFIED COPY THEREOF (SEC 3:s•, LAB C I POLICY NO 1 1. COMPANY ❑ CERTIFIED C•PY IS HEREBY FURNISHED ,c ❑ 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 1$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 I LENDER'S NAMF LENDER'S ADDRESF 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 APA ICA riO )ND STATE THAT THE ABOVE INFORMATION IS CORRECT, I AGREE TO COMPLY WITH •LL CITY AND COUNTY ORDINANCES AND STATE LAWS REL N /• : LDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS•COUN' TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR I ": 0 ' RPOSES SIGNATURE OF APPLICANT OR AGE , ►/Ii- -,�._• • DATE i 0 W.J 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 Name �'�.16-1 = Pere Number/65-0--0/Pr- VOA'O/ INSPECTION RECORD DATE I INSPECTOR I DATE INSPECTOR Setback $.F•&1?-l t I dS,7/4. ofewyRough Plumbing Temporary Power Shower Pan Test Foundation Reinforcing Steel __ Stucco Mesh or Exterior Siding Excavation and Forms/.ir/Zy/B-x-1=24...oy 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 be4Fror Drywall Nailing TA-2.s-- Joists rj_-Joists and Girders Gas Line Air Test / '' j/�•j.. ( C�i!►Jh Electrical Ground Final Energy Mid-Height Bond Beam Final Plumbing 8-Foot Bond Beam Final Heating/A C Final Bond Beam Final Construction —/ MC (/ Fireplace Bond Beam Final On Site Improvements Roof Sheathing n v Final Off Site Improvements Framing ybQ,,.'_" _ �11!, to-Po-fit .r3 Final Dedication Roof Covering Final Zoning Rough Heating Final Electrical U � 1- Electrical Service and Ground Final Gas n Rough Electrical Developer Fees Paid WC (Y/N) Ind Saf (YIN) Certificate of Occupancy Gao- goise Cli -Perur�o r r?To s, Atm 4c1 k(�A pp ✓T r >� '7- t2-n- Gw -g oc 7—�3-9k Vu � SEPTIC TANK GALS SEEP PIT X LEACH LINF WIDF X LONG X DEPTH OF ROCK N l W E 1 A n U (// ,/4-467,6w7,-/s S Inspec or's Signature and Initials 1 U'S 12 17589 469 Rev 1/88