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Permit No. 1058904055 105 SAN BERNARDINO COUNTY-EPWA/LAND•AGEMENT DEPT 4110 , OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 89 04055 206A 01 I STATUS: ACTIV '` THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 12/18/89 I ISSUE DATE 12/18/89 I PG 1 OF 1 PARCEL NUMBER 1031-321-21-0000 • PROPOSED USE: GARAGE CONV.TO PLAYRM. //J 3 / - 3 /-.a 1 CURRENT USE: RESIDENCE WITH GARAGE TRATI BLK I LOT I SEC II UNGI PRCL O P I PRCL ACTIVITY : L820 15 000 321 SE29 02S COMMUNITY PLAN ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CH/PD LOT DIMENSION IRREGULAR CONST TYPE APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER #BLDGS ON LOT 1 (GROUP CLOTT, MELVIN H. 15937 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 - 2114 TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER CLOTT, MELVIN H. 3 85 1.00 85.00 15937 OAK CANYON DR CHID HILLS CA 91709-0000 CALC. VALU 3,825.00 I ADJUSTED AREA 85 (714) 597 - 2114 ITEM CNT DESCRIPTION DETAIL TOTALS JOB SITE ADDRESS RESIDENTIAL CONSTRU 53.93 15937 OAK CANYON DR TOTAL AMOUNT 53.93 CHINO HILLS CA 91709-0000 CROSS STREET OAKCREEK ROAD INSPECTN ACCESS CONTRACTOR NAME, ADDRESS ,LICENSE NUMBER - ' _ -DIV. OF IND. SAFETY_PERMIT• _ MINIMUM SETBACK DISTANCES 45 FRNT SETBACK/CENTRLINE OAK CANYON DRIVE R/W 50 10 REAR SETBACK/PROP LINE 40 SIDE SETBACK/CENTRLINE OAKCREEK ROAD R/W 50 5 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES I NO. DWELLING I NO. BEDROOMS I FLOOR / UNITS rt g iY1 EXT. WALLS INT. HALLS CEILING1 1' t`$?$ I SHEETROCK I SHEETROCK V y^� CT 3/ V e'' ROOF HEATING FIREPLACES 1 � ,0IMETAL IMASRY e � �1 'r yr WATER ISEWER I MIN DEPTH' S.F /1001EI Nh/REPAIR ,if'I PUATIR 000 000 0000 COMMENTS PERMIT LICENCE #577979 SENT TO SB OFFICE. AMT WAIVED .00 AMT PAID 53.93 • PAYOR NAt4E• TIM WATTS P2I4 12/18/89 RECEIPT • 6957 EMPL:-fLCT&r BEO0R'AH PAID BY • CASH NBR : ::' ,1142/9)9715 SENSED 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 PROFESSIONS CODE AND MY LICENSE IS IN FULL FORCE AND EFFECT �A '`' y� Q/� Q, LICENSE CLASS B LICENSE NUMBER 677,79 CONTRACTOR rri l WA7Z DATE 9,*2/�1 6, 41 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 700010F 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 [5500)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 CONTRACTORIS) 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 I /NZ),A/g� POLICY NO `✓1/ 9t T/ COMPANY ,c "7 7,r� + ❑ CERTIFIED COPY IS HEREBY FURNISHED ❑ CERTIFIED COPY IS FILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT � APPLICANT 77'M DATE 9 (1 )AV 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 p `�j APPLICANT 77+1 W1777 DATE /4(7,/ a7 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 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 .......V.SIGNATURE MENTIONED PROPERTY FOR INSPECTION PURPOSES S (`/4 IGNATURE OF APPLICANT OR AGENT DATE /2 -116 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 Owner Name C LOT 82 67 hM Permit Numl./e90 V 5S Oc M( INSPECTION RECORD DATE INSPECTOR DATE INSPECTOR Setback Rough Plumbing Temporary Power Shower Pan Test I Foundation Reinforcing Steel Stucco Mesh or Exterior Siding Excavation and Forms Insulation I4 '- 9 4.e3 F.H A Foundation Req. Sewer Slab Grade Interceptor Ground Plumbing Septic Tank I Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service del .01 Fireplace Foundation Lath or Drywall Nailing gq A Ir Joists and Girders Gas Line Air Test Electrical Ground Final Energy I Mid-Height Bond Beam Final Plumbing I 8-Foot Bond Beam Final Heating/A C kr 3 --9:c./ e.- Final Bond Beam Final Construction Iii- 3 -- -c) c_ Fireplace Bond Beam Final On Site Improvements I ' Roof Sheathing _ Final Off Site Improvements I Framing and Ventilation 1� , Final Dedication I Roof Covering - Final Zoning I Rough Heating • .9 &. ' /J 7 Final Electrical I SI• 3 -- Q las Electrical Service and Ground 1 _ Final Gas I1�)0 N 4 -�' Rough Electrical ,11/ .•'4V'V'•k9 Iflt 5 Developer Fees Paid [ I WC (YIN) Ind Saf (Y/Nl' - Certificate of Occupancy IV— 3 --/C G' Ie_'- /- .S- ye - r -2z-F6 )T 3 t: I V-3 70 ` o--/ ,f 07 r e_c.1-z , a Xfoft. C e_ Q._, V� r Y n 13;6',.." RU %r .; SEPTIC TANK GALS orC., a.> SEEP PIT X r� - � LEACH.LINF WIDE X LONG X DEPTH OF ROCK N W E Z. 7 -./.../'H 77., .[r�i A•••1 ,1 /-1 1 , ./_i_4_, S Inspector's Signature and Initials 12-17589-469 Rev 3/88