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Permit No. 1058802153 • 4244—)::3 105 SAN BERNARDINO COUNTY—EPWA/LAND r AGEMENT DEP1 OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 88 02153 210A 01 I PAGE 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 06/17/88 ISSUE DATE 06/17/88 PARCEL NUMBER 1017-861-11-0000 PROPOSED USE: LATTICE PATIO COVER CURRENT USE: RESIDENCE 12625T I BLK I LOTT I SE29SEC I TWN 108W NG I PRCL MMAP NO I PRCL 0COOIMMUNIITY IYLPPLAN ZONE/LANDD UD E DISTRICTIGENERAAL LS PLAN 000SUBDIVISION NAME SUBDIVISION PARCEL NO LOT DIMENSION IRREGULAR (CONST TYPE VN (FBLDGS ON LOT 1 GROUP R3 APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER (t PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 30-159 CUSTOM PATIO CONCEPTS STD PLAN/ICBO FHA N 1128 E 6TH ST 8 CORONA CA 91719-0000 GRADING INITIAL ACTUAL (714) 737 — 7640 CU.YDS. EXC. CU.YDS. FILL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER CARTER, WILLIAM TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN „ 15900 OAK CANYON DR CHINO HILLS CA 91709-0000 PORCH 320 .20 64.00 (714) 597 — 0574 CALC. VALU 2,688.00 I ADJUSTED AREA 64 JOB SITE ADDRESS 15900 OAK CANYON DR ITEM CNT DESCRIPTION DETAIL TOTALS CHINO HILLS CA 91709-0000 RESIDENTIAL CONSTRU 42.60 ws CROSS STREET OAK HILL DRIVE TOTAL AMOUNT42.60 INSPECTN ACCESS C 0 M P 1 E I E h CONTRACTOR NAME LICENSE NUMBER DATE'71:/fit TRACY RICHARDCONTOOO474278 MAILING ADDRESS, PHONE NUMBER 1245 W. 6TH STREET CORONA CA 92721.0000 100) 000 — Outr0 - _ MINIMUM SETBACK DISTANCES 20 FRNT SETBACK/PROP LINE 20 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.UNITS WELLING I NO. BEDROOMS I FLOOR CO EXT WALLS INT. WALLS I CEILING ROOF HEATING FIREPLACES WO METAL IMASRY PUWATER BLIC (PSEWER UBLIC I MIN DEPTH( S'000100I0000 EI NEW/REPAIR ' 00 COMMENTS I PREALTERATION AND PRE—CONSTRUCTION INSPECTIONS BY DON BAKER. ANT WAIVED .00 ANT PAID 42.60 PAYOR NAME: CUSTOM PATIO CONCEPTS PAID 06/17/88 4 RrCEIPT 1977 EMPL: RICHARDS, GARY LICENSED CONTRACT`ORS•DECLARATION I HEREBY AFFIRM THAT I AM LICENSED UNDER T 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 1 I / LICENSE CLASS }' LICENSE NUMBER `l1'-f 7.'1. `ate CONTRACTOR64��`LAW' �yGATE CO "L 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] I ❑ 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 THAT I HAVE A CERTIFICATE OF CONSENT TO SELF-INSURE OR A CERTIFICATE OF WORKERS'COMPENSATION INSURANCE OR A CERTIFIED COPY THEREOF (SEC'I38100, LAB C I '. / POLICY NO Lv 2:7 ICOMPANY 66 %A.r 'cr— T \./Ill//ElCERTIFIED COPY IS EREBY'FURNISHED /� ❑ CERTIFIED COPY I FILED WITH THE COU 1�BUILDING I/SPECTION DEPARTMENT / _ A MJ APPLICANT `."�vt/�.� DATE CERTIFICLAI 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 I 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 PIERSON 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 ILDING CONSTRUCTION, ND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE OVE-MENTIONED PROPERTY FOR INSPECTIO PURPOSES J syAB SIGNATURE OF APPLICANT OR AGEN 'b vA__,t / �l/ �i"' DATE_ ( VV� ---- - �� EXPIRATION NOT ICE X 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 06.4-7-4E0--- Permit Numb*�4 -- O2t'r3 . 210,4-0/ INSPECTION RECORD DATE INSPECTOR DATE INSPECTOR Setback ig.Q en /,. 74 Rough Plumbing Temporary Power Shower Pan Test Foundation Stucco Mesh or Exterior Siding Excavation and Forms / A''. fe Insulation F H A Foundation Req. Sewer Slab Grade 1�i 4. 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 -df S 7' ekK Fireplace Bond Beam Final On Site Improvements Roof Sheathing Final Off Site Improvements Framing and Ventilation C1.--/.51`5?"61.12)PCIr, Final Dedication Roof Covering Final Zoning Rough Heating I Final Electrical Electrical Service and Ground Final Gas Rough Electrical I Developer Fees Paid WC IY/NI Ind Saf (Y/N) Certificate of Occupancy r fl PsR D I k r G [ .. .r .•. • v L e L LI r /'1 RATE SEPTIC TANK TANK GALS SEEP PIT X LEACH LINE WIDE X LONG X DEPTH OF ROCK N W E �i LC".{Qe5r,5 //w4 / M A �c.� �GJ Inspector's Signature and Initials AK #4(2,"&"<-- 12-17589-469 Rev 3/88