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Permit No. 1058802038 III4111 105 SAN BERNARDINO COUNTY—EPWA/LAND MANAGEMENT DEPT OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 88 02038 210A 01 I PAGE 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 08/15/88 ISSUE DATE 08/16/88 PARCEL NUMBER 1017-861-15-0000 PROPOSED USE: BUILD PATIO CURRENT USE: RESIDENCE 12625TRACT 1000 BLK 1300 LOT I SE29 SEC I TWN p1008W I PRCL 00AP I oRCL ACTIVITY L820 • COMMUNITY PLAN ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/PUD RES-2 LOT 0 DIMENSION IRREGULAR (CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER SBLDGS ON LOT 1 GROUP R3 SILVA, SAMUEL 15926 OAK CANYON DR *PLANS RECD 0 LAND USE PLOT 0 INDEX NBR 30-159 CHINO HILLS CA 91709-0000 STD PLAN/ICBO FHA N (714) 597 — 0548 GRADING INITIAL ACTUAL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER CU.YDS. EXC. SILVA, SAMUEL CU.YDS. FILL 15926 OAK CANYON DR CHINO HILLS CA 91709-0000 TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN (714) 597 — 0548 PORCH 200 .20• 40.00 JOB SITE ADDRESS 15926 OAK CANYON DR CALC. VALU 1,680.00 I ADJUSTED AREA 40 CHINO HILLS CA 91709-0000 CROSS STREET OAKCREEK RD ITEM CNT DESCRIPTION DETAIL TOTALS INSPECTN ACCESS RESIDENTIAL CONSTRU 28.00 ISSUANCE FEE 13.40 TOTAL AMOUNT 41.40 CONTRACTOR NAME LICENSE NUMBER MAILING ADDRESS, PHONE NUMBER MINIMUM SETBACK DISTANCES 45 FRNT SETBACK/CENTRLINE OAK CANYON DRIVE R/W 50 20 REAR SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE or lo MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS ONTAO i NO. STORIES I .y PIE.NO. DWELLING NO. BEDROOMS FLOOR COhy1E1 11'44 ,1 UNITS O EXT. WALLSI INT. WALLS I CEILING D, .TE: ROOF I HEATINGI FIREPLACES WO METAL MASRY PWATIER R I SEWER I MINN ODEPTH' S.F./100I00I0E' NEW/REPAIR COMMENTS PRE—ALTER BY DON BAKER AMT WAIVED .00 AMT PAID 41.40 PAYOR NAME: SAM SILVA PAID 08/16/88 e RECEIPT 2907 EMPL: STACCATO—NYARI, M •CENSED CONTRACTOIXS 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 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 I XI,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 EXEMPT UNDER SEC / B AND P C FOR THIS REASON / / WNER C. �w� DATF WL (/ 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 DATF 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 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 AVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT, I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANC AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOV NTIONED PROPERTY FOR INSPECTIO PUR 'a%‘=:. / IGNATURE OF APPLICANT OR AGENTWiLDATF EXPIRATION NOTICE APPLICATIONS FOR WHICH NO PERMIT IS ISSUED WITHIN 180 DAYS FOLLOWING THE DATE OF APPLICATION SHAL PIRE,EVERY PERMIT SHALL EXPIRE IF WORK DOES NOT COMMENCE WITHIN 180 DAYS OF ISSUANS SUCH PERMIT OR IF THE WORK IS SUSPENDED OR DONED FOR A PERIOD OF 180 DAYS, FEES PAID ARE NOT REFUNDABLE AFTER ONE YEAR FROM OF PAYMENT, ALL FEES PAID MAY NOT BE REFUND 12-17588-489 A - O2 ? 0700 /oA of Owner Name �SL VA ' Permit Num INSPECTION RECORD DATE INSPECTOR DATE INSPECTOR Setback 1<—y 135),AA4t-/,At-4/7-6111 Rough Plumbing Temporary Power Shower Pan Test Foundation Reinforcing Steel Stucco Mesh or Exterior Siding Excavation and Forms I�"�"$p£)L3 ,QT" Insulation F.H A Foundation Req Sewer Slab Grade i-f-Krd,(1)e11f' f,3CT d,4?1" 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 a6 Kj.' Fireplace Bond Beam Final On Site Improvements Roof Sheathing Final Off Site Improvements Framing and Vlda„uiauu„ R-c24--- "1 Final Dedication Roof Covering ) Final Zoning Rough Heating - Final Electrical C 0 M DI 1 r T E D Electrical Service and Ground Final Gas k ,” / II L C ) [ :� Rough Electrical Developer Fees Paid DATE 15c62.6 WC (Y/N) Ind Sat (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 12 17589-469 Rev 3/88