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Permit No. 1058803524 • 105 SAN BERNARDINO COUNTY-EPWA/LANDIAGEMENT DEPT — • /el."' Vr OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 88 03524 210A 01 I PAGE 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 11/21/88 ISSUE DATE 11/21/88 PARCEL NUMBER 1017-861-12-0000 PROPOSED USE: PATIO CURRENT USE: RESIDENCE W/GARAGE TRAC SEC 1 12625T 1000 1297 I SE29 I S 108W I PRCL 00AP I PRCL ACTIVITYCOMMUNITY PLANL82ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CN/PUD LOT DIMENSION IRREGULAR CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *BLDGS ON LOT 1 (GROUP R3 BERG, DAVID 15904 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 - 8494 GRADING INITIAL ACTUAL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER CU.YDS. EXC. BERG, DAVID CU.YDS. FILL 15904 OAK CANYON DR CHINO HILLS CA 91709-0000 TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN (714) 597 - 8494 PORCH 307 .20 62.00 JOB SITE ADDRESS 15904 OAK CANYON DR CALC. VALU 2,790.00 I ADJUSTED AREA 62 CHINO HILLS CA 91709-0000 CROSS STREET OAKCREST DR 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 45 FRNT SETBACK/CENTRLINE OAK CANYON DR R/W 50 20 RF?P SFTRACK/PROP ZINE 5 SIDE SETBACK/PROP LINE 10 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES I NO. DWELLING I NO. BEDROOMS I FLOOR UNITEXT. WALLS INT. WALLS I CEILING ROOF HEATING FIREPLACES METAL IMASRY PWAATER TIR I SEWER I MIN NODEPTH' S.000 0000F./1001 SIZEI NEW/REPAIR COMMENTS e F ..,t-- r ?' CORRECTION NOTICE BY MIKE PARADA i J PRE-CONSTRUCTION ON FILE COWLEiED I•AT E D Lai- gv '---)el; ;41 AMT WAIVED .00 AMT PAID 53.93 PAYOR NAME• DAVID BERG PAID 11/21/88 RECEIPT • 4711 EMPL: STACCATO-NYARI, M •ICENSED CONTRACTORS DECLARATIONS 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 ) 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 Fit g CH PROJECTS A CONTRACTORIS) LICENSED PURSUANT TO THE CONTRACTORS LICENSE LAW) J 7r)XE S , / B AND P C FOR THIS REASON // -1/ X/�DATE • / ( / ` /[J [J WOR RS' COMPENSATION DECLARATION l I HEREBY AFFIRM THAT I HAVE A CERTIFICATE OF CONSENT TO S F-INSURE OR A CERTIF ICATE OF WORKERS'COMPENSATION INSURANCE OR A CERTIFIED COPY THEREOF (SEC 3800, LAB C 1 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 N IN ANY MANNER SO AS TO BECOME SUBJECT TU YHE W1.,RKERS 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 A••D •TE THAT THE ABOVE INFORMATION IS CORRECT, I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING T B • SIN'. CONSTRUCTION, ND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COU Y TO E ER U ON THE ABOVE ME NED PROPERTY FOR INSPECT ('PURP. ES NATURE OF APPLICANT OR AGENT A� Y � DATE / � I C/ EXP( T N NOTICE APPLICATIONS FOR WHICH NO PERMIT IS ISSUED WITHIN 180 DAYS FOL ING 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 /6.57,7g - 03-S-a(7/ a_ioA a -Owner Name ��. �, Permit Number. INSPECTION RECORD DATE INSPECTOR DATE INSPECTOR Setback h--,Y7 /44-- 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 f Lath or Drywall Nailing Joists and Girders //— 3016 —v1/0 Gas Line Air Test Electrical Ground Final Energy Mid-Height Bond Beam Final Plumbing 8-Foot Bond Beam Final Heating/A C 4 Final Bond Beam Final Construction //`?AL9-Qp Fireplace Bond Beam Final On Site Improvements Roof Sheathing Final Off Site Improvements Framing and 11- 3 f Final Dedication Roof Covering Final Zoning Rough Heating Final Electrical Electrical Service and Ground Final Gas Rough Electrical Developer Fees Paid WC (Y/NII Ind Saf (Y/N) Certificate of Occupancy SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDE X LONG X DEPTH OF ROCK N tCrl, rt J - d V • 11. LIQ W ELee d elan� tl 0 i, y _-f; 9 �y/i/}��4 S Inspector's Signature and Initials 12-17589-469 Rev 3/88