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Permit No. 1058903058 105 SAN BERNARDINO COUNTY-EPWA/LANDSAGEMENT DEPT 1110 bFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 89 03058 201A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 09/12/89 I ISSUE DATE 09/12/89 I PG 1 OF 1 PARCEL NUMBER 1031-051-04-0000 PROPOSED USE: RESIDENCE 14/GARAGE /o 3 /, a J -D y CURRENT USE: VACANT TRACT 10379-1I BLK 000 1048 I SW30SEC 002�flS 1008W I PRCL 00AP I PORCL ACTIVITY PLANL831 ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/RS 10379-1, PLAN 5, 09/12/89 - - - LOT DIMENSION VARIES CONST TYPE APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *BLDGS ON LOT GROUP PACIFIC SCENE, INC. - C. FRASE 2401 E KATELLA AVE *185 *PLANS RECD 0 LAND USE PLOT 0 INDEX NBR 20-159 ANAHEIM CA 92806-0000 STD PLAN/ICBO FHA N (714) 939 - 1290 TYPE I SQ FT I FACTOR/P.S.F. I ADJSTED AREA/VALUATN OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER PACIFIC SCENE, INC. - C. FRASE 1 1812 1.00 1812.00 2401 E KATELLA AVE *185 2 1470 1.00 1470.00 ANAHEIM CA 92806-0000 GAR 649 .50 325.00 (714) 939 - 1290 CALC. VALU 162,315.00 I ADJUSTED AREA 3607 JOB SITE ADDRESS 2128 OAK CANYON LN ITEM CNT DESCRIPTION DETAIL TOTALS CHINO HILLS CA 91709-0000 RESIDENTIAL CONSTRU 1,341.96 CROSS STREET PROMONTORY ROAD TOTAL AMOUNT 1,341.96 INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER PACIFIC SCENE INC CONT000506888 3900 HARNEY STREET SAN DIEGO CA 92110-0000 1714) 595 - 2000 DIV. OF IND. SAFETY PERMIT: MINIMUM SETBACK DISTANCES *** PER PLOT *** MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES I NO. DWELLING I NO. BEDROOMS I 5 E SE2TBAC EXT. WALLS I INT. WALLS SHEETROCK ✓/ ROOF I HEATING ( FIREPLACES s O T� I O TILE NATURAL GAS METAL 03 WATER SEWER MIN DEPTH S.F./100 SIZE NEW/REPAIR COAPLETED PUBLIC (PUBLIC I 000 I 000 0000 I NEW COMMENTS DATE: _�a ALL DEVELOPMENT FEES PAID ANT WAIVED .00 AMT PAID 1,341.96 PAYOR NAME. PACIFIC HOME CANYON PAID 09/12/89 RECEIPT 00005227 EMPL: STACCATO-NYARI, M Illii \ PAID BY • CHECK NBR : 539421 • •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 /� Q LICENSE CLASS / LICENSE NUMBER h 88 8 CONTRACTOR I/ .,CJ. DATE 3 G�3 // 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 DATF • 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 C�) POLICY NO W .` • 606 00/70 COMPANYiie1)( 2 a.O ❑ CERTIFIED COPY IS HEREBY FURNISHED APPLICANT CERTIFIEDQ FILED THE TY_BUILDING INSPECTION DEPARTMENT r/� /j/ DATF �--' 0 — 90 CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1$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 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 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 ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPEC 0 PURPOSES., 9 �q9 SIGNATURE OF APPLICANT OR AGENT !�l/ iIl! IJP 0.l.fil/1 DATE ` _(z- `5 r II EXPIRATION AND REFUND NOTICE 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 gyp Aof S9 0 3os7 ao/A 0/ Owner Name ���14-e.�All16Perms um INSPECTION RECOR4 DATE INSPECTOR I DATE INSPECTOR Setback 0.,7/1 Rough Plumbing I ,.••13.1?Pde Temporary Power i c.. 2 Shower Pan Test I ir/— f Foundation Reinforcing Steel 17"� //� Stucco Mesh or Exterior Siding I% Excavation and Forms Z- Insulation f f Pr.3.9 AO F H A Foundation Req. r )t Sewer Slab Grade 4°'Z4`;9 "g Interceptor Ground Plumbing /'`e7 7. Septic Tank Underslab Ducts fr"Z4•°0 ff Leach Line or Seep Pit Underslab Conduit Water Service 9/ d'f . . Fireplace Foundation Lath or Drywall Nailing /—S—pO ief Joists and Girders Gas Line Air Test j Electrical Ground ,A/i..fj / , Final Energy / / Mid-Height Bond Beam Final Plumbing 8-Foot Bond Beam Final Heating/A.0 / / Final Bond Beam Final Construction /Fireplace Bond Beam Final On Site Improvements jfil/ Roof Sheathing /I A Final Off Site Improvements A t / 4hl Framing and Ventilation .,*Y ,/ Final Dedication Al/ Roof Covering yth;jerFinal Zoning / Rough Heating ..1'7 / Final Electrical / Electrical Service and Ground 1 e/ / Final Gas / Rough Electrical 7 V Developer Fees Paid / J - _ -- WC (Y/NI_ _ _ Ind_Saf_IY/NI Certificate_of Occupancy__ — —It _ = _ ti - _ SEPTIC TANK GALS SEEP PIT X ft :`%: 1> :.t. . -A LEACH LINE WIDF V 9 a -1:• t X LONG X DEPTH OF ROCK co ET ED N ... .. 04 thip B W E S Inspector's Signature and Initials TIT— it'll — . Z.- 1 2-1 7 589-469 12-17589-469 Rev 3/88