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Permit No. 1058900521 105 SAN BERNARDINO COUNTY—EPWA/LAND AGEMENT DEPT _—M—_ _ OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 89 00521 210A 0] I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED — APPL DATE 03/14/89 I ISSUE DATE 03/14/89 I PG 1 OF 1 PARCEL NUMBER 1017-841-04-0000 PROPOSED USE• 1—PATIO DECK/1—LATTICE PATIO CURRENT USE: RESIDENCE W/ GARAGE TRAC LOT SEC WN NG 12625T 1000 1301 I SE29 I 0 S 108W I PRCL 00AP I PRCLCOMMUNITY PLANL820 ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS PUD RES 2 LOT DIMENSION 50X110 CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *RLDGS ON LOT 1 (GROUP R3 RUTHERFORD, JESS 350 S. MAPLE ST #F *PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 30-159 CORONA CA 91720-0000 STD PLAN/ICBO FHA N (714) 736 — 2161 TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER ALTO, JOHN PORCH 336 .20 68.00 15934 OAK CANYON DR CHINO HILLS CA 91709-0000 CALC. VALU 3,060.00 I ADJUSTED AREA 68 (714) 597 — 6182 TTEM CNT DESCRIPTION DETAIL TOTALS JOB SITE ADDRESS i RESIDENTIAL CONSTRU 53.93 15934 OAK CANYON DR TOTAL AMOUNT 53.93 CHINO HILLS CA 91709-0000 CROSS STREET BAYBERRY DRIVE INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER , RUTHERFORD JESS C CONT000353716 2089 GLENHAVEN CORONA CA 9]720-0000 (000) 000 — 0000 AC)IVE WORKERS COMP 6I,. -CF INJ:--0AFF1Y ^!i2MIT: - - -=- — - - _ -- MINIMUM SETBACK DISTANCES 20 FRNT SETBACK/PROP LINE 15 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. DWELLING I NO BEDROOMS FLOOR UNITS CONCRETE EXT. WALLS INT. WALLS CEILING ROOF HEATING FIREPLACES WOOD METAL IMASRY PUHATER BLIC I SEWER I MIN0DEPTH' S•0000100I0000 NEW/REPAIR ONTARIO '/ v COMMENTS COMTE d A PREALTERATION AND PRE—CONSTRUCTION INSPECTIONS $oda BY C. LOFTUS. PATIO DECKS MAY NOT ENCROACH INTO THE REQUIRED DATE s i ��1 �v 15' REAR YARD SETBACK. ca AMT WAIVED .00 AMT PAID 53.93 ' PAYOR NAME. RUIHERFORO CONSTRUCTION PAID 03/]4/89 RECEIPT • 1187 EMPL: RICHARDS, GARY PAID BY • CHECK NBR : 2534 r LICENSED CONTRACTORS DECLARATIO• `/ • - 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 MYLICENSE IS IN FULL FORCE AND EFFECT / - r „.),\ LICENSE CLASS -'-(//., / LICENSE NUMBER gS" rf t 4o CONTRACTOR DATE p /eiM 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,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 3800, LAB C 1 POLICY NO COMPANY ❑ CERTIFIED COPY IS HEREBY FURNISHED EERTIFIED COP IS FILED WITH TaUNT BUILDI INS TION DEPARTMENT APPLICANT 04.42.42 vA` t/L DATE 7/4/%4 t I. 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 a �.L ❑ AS OWNER/BUILD,ER I WILL NOT EMPLOY•ANY,ONE 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 J. • I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THA ABOVE INFORM TION IS CORRECT, I AGREE TO COMPLY WITH ALL CITY AND COUNTY s l ORDINANCES AND STATE LAWS RELATING TO BUILDING CONST' ION, AN' HEREB AUTHORIZE REPRESENTATIVES OF THIS COU TY TO ENTER UPON THE BOVE-MENTIONED PROPERTY FOR INSPECTIO1 PURPOSES 9 SIGNATURE OF APPLICANT OR AGENT _ ( . i. DATE J / t EX'IRATIO116 AND REFUND NOTICE APPLICATIONS FOR WHICH NO PERMIT ISS 1/ED WITHIN 180 DAYS FROM THE DATE OF APPLICATION SHALL EXPIRE PERMITS SHALL EXPIRE IF WORK DOES NOT COMMENCE WITHIN 180 DAYS OF ISSUA E OF SUCH PERMIT OR IF THE WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS FEES PAID ARE NOT REFUNDABLE AFTER 180 DAYS FROM DA E OF PAYMENT, EXCEPT FOR ERRORS IN ACCEPTANCE WHICH MAY BE REFUNDABLE UP TO ONE YEAR FROM DATE OF PAYMENT ALL FEES PAID MAY NOT BE REFUNDABLE 12-17588-469 Rev 10/88 • ALTT3 Owner Name 411— Permit NumbOOs Z/'2/0/4-V/ INSPECTION RECORD DATE INSPECTOR DATE I INSPECTOR Setback A b. 11e-e' 4/43 Rough Plumbing Temporary Power Shower Pan Test 6Foundation Betafose...e :,,,.; -/,. s--i4.--0 Ar Stucco Mesh or Exterior Siding Excavation and Forms 1, 2 ,s/6, £€ 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 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 ✓ nal Construction /Z- 6-`f0 --Z07 - Fireplace Bond Beam `'`rFinal On Site Improvements Roof Sheathing I Final Off Site Improvements Jrammg /t a. S---/e,-89 10 I Final Dedication Roof Covering Final Zoning Rough Heating (✓ inal Electrical A lectncal Service and Ground "I Final Gas �� tough Electrical PZ-1,-,0I �j I Developer Fees Paid WC (YIN) Ind Saf (YIN) I Certificate of Occupancy - is-&S 4 -21/4..rriti&S A T7' d l ,T,g,,,,s o - _�-ate_ . • _ - . - x !Sea r -- *'^, • : • I( -99 grrt.'rft 'TG D112G,e. Ater fie.” - orecp AT -rW/C 7',fl A /!•.0? G$ oi) 2T2oe6w .L ?✓L' . 1414Td-t rC,rrJ6 SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDE X LONG X DEPTH OF ROCK N ONTAk kli WA r 1 tai W E QV 411111 Cs ,. /Z.-4 -co ., ., L 77 ��. , /17'/i► S Inspector's Signature and Initials �`- G,2 12-17589-489 Rev 3/88