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Permit No. 1058900784 (2) -et ,ate �Jos►o( 105 SAN BERNARDINO COUNTY-EPWA/LANDAGEMENT DEPT -- OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 89 00784 255A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED • - APPL DATE 04/13/89 I ISSUE DATE 04/13/89 I PG 1 OF 1 PARCEL NUMBER 1017-841-20-0000 PROPOSED USE: 1-ELECTRICAL OUTLET FOR A/C CURRENT USE. RESIDENCE TRAC LOT SEC A IVITY : 126257 1000 1320 I SE29 I � 1088N I PRCL 00AP I PORCH- CCTOMMUNITY PLANL820 ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/PUD -- LOT DIMENSION VARIABLE CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER 71BLDGS ON LOT 1 (GROUP R3 J.A.MARTIN HEATING AND A/C, INC. 442 W BONITA AVE ((PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 30-159 SAN DIMAS CA 91773-0000 STD PLAN/ICBO FHA (714) 599 - 9641 ITEM CNT DESCRIPTION DETAIL TOTALS OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER ] FIXTURES 5.06 SCALFANI, CHARLES ELEC SUB-TOTAL 5.06 15943 OAK CANYON DR ISSUANCE FEE 47.35 CHINO HILLS CA 91709-0000 TOTAL AMOUNT 52.41 (714) 597 - 7086 JOB SITE ADDRESS 15943 OAK CANYON DR CHINO HILLS CA 91709-0000 CROSS STREET OAKCREEK ROAD INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER MARTIN JOHN CONT000315103 442 W BONITA AVENUE SAN DIMAS CA 91773-0000 (000) 000 - 0000 DIV. OF IND. SAFETY PERMIT: MINIMUM SETBACK DISTALES 47 FRNT SETBACK/CENTRLINE OAK CANYON DRIVE R/W 50 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 NO. DWELLING NO. BEDROOMS FLOOR ONTARIO I UNITS I I CONCRETE EXT. WALLS I INT. WALLS CEILING C+ IT ED I ., ROOF HEATING FIREPLACES r WOOD I (METAL IMASRY PUBLIC WATER I SEWER 1 'MI000 EPTHI S•0001111100IOOOOEI NEW/REPAIR COMMENTS AMT WAIVED .00 AMT PAID 52.41 PAYOR NAME J.A MARTIN HEATING-A/C, INC. PAID 04/13/89 RECEIPT • 1937 EMPL: RICHARDS, GARY PAID BY : CHECK NBR : 16078 AP LICENSED CONTRACTORS 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 P,(OFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT 1/// /- �� J � S <5 ' LICENSE CLASS LICENSE NUMBER CONTRACTOR DATF 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 ❑ 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 CI POLICY NO �c-5-'54--"14 COMPANY% # -. - � �� ❑ CERTIFIED COPY IS HEREBY FURNISHED O t..."APPLICANT CERTIFIED CQPY IS FILED� WITH THECOUNTY BUILDING INSPECTION DEPARTMENT (/—/ ) y//� G/ DATF v 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 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 I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT, I AGREE TO COMPLY WITH ALL CITY AND COUNTY 0 INANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUT IZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE t. BOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES SIGNATURE OF APPLICANT OR AGEN r... 4 .•r� DATF // - ' . /7.rf7l ii....fn+ /? EXPIRATION AND kEFUND NOTE ... APPLICATIONS FOR WHICH NO PERMIT IS ISSUED WITHIN 180 DAYS FROM THE DATE OF APPLICATION SHALL EXPIRE PERMITS 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 180 DAYS FROM DATE 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 D Owner Name 6c04-C--4-4-APermit Numb /O5--U "00 7rv'2rA"0/ INSPECTION RECORD DATE INSPECTOR DATE J INSPECTOR Setback Y-2:494173 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 9'726, 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 Fireplace Bond Beam Final On Site Improvements Roof Sheathing Final Off Site Improvements Framing and Ventilation Final Dedication Roof Covering Final Zoning Rough Heating Final Electrical Yeo Electrical Service and Ground Final Gas Rough Electrical it.voolF7 Developer Fees Paid WC (YIN) Ind Saf (Y/NS Certificate of Occupancy i CT 111 • D? m - SEPTIC TANK GALS A4 ,52 SEEP PIT X LEACH LINF WIDF X LONG X DEPTH OF ROCK N -04 W E S Inspector's Signature and Initials `.�Ceg 12-17589-469 Rev 3/88