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Permit No. 1059001736 1-6(jr 105 SAN BERNARDINO COUNTY-EPWA/LAND AGEMENT DEPT_ - " • - OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 90 01736 201A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED • APPL DATE 07/03/90 , ISSUE DATE 07/03/90 I PG 1 OF 1 PARCEL NUMBER 1031-051-01-0000 PROPOSED USE: RESIDENCE W/GARAGE /O / - e 5-/ _ O / CURRENT USE: VACANT TRACT LOT SEC IVITY : 10379-1� BLK 000 1045 I SW30 12S 08$ PRCL M0AP I PRCL COTMMUNITY PLANL831 ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/RS 10379-1 PLAN 1 07/03/90 - - - LOT DIMENSION VARIES CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER 1)BLDGS ON LOT GROUP R3 PACIFIC SCENE, INC._- CHARLES FRASE 622 BREA CANYON RD PLANS RECD 0 LAND USE PLOT 0 INDEX NBR 20-158 WALNUT CA 91789-0000 STD PLAN/ICBO FHA N (714) 595 - 2000 TYPE ( SQ. FT. I FACTOR/P S.F. I ADJSTED AREA/VALUATN OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER - PACIFIC SCENE, INC. 1 1540 1.00 1540.00 3900 HARNEY ST 2 985 1.00 985.00 SAN DIEGO CA 92110-0000 GAR 630 .50 315.00 (619) 299 - 5100 • CALC. VALU 127,800.00 I ADJUSTED AREA 2840 JOB SITE ADDRESS 2078 OAK CANYON RD ITEM CNT DESCRIPTION DETAIL TOTALS CHINO HILLS CA 91709-0000 RESIDENTIAL CONSTRU 1,165.34 CROSS STREET PROMONTORY RD TOTAL AMOUNT 1,165.34 INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER PACIFIC SCENE INC CONT000506888 3900 HARNEY STREET SAN DIEGO CA 92110-0000 (714) 595 - 2000 ACTIVE WORKERS COMP nTV, OF TNT SAFETY PFPtIT: _ _ _ _ _ MINIMUM SETBACK DISTANCES PER PLOT MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES I NNOITDWELLING I NO. BEDROOMS I CONCRETE1 4 FLOOR 2 EXT. WALLS I INT. WALLS CEILING STUCCO SHEETROCK SHEETROCK • I ROOF HEATING FIREPLACES '''''''S:' 4 ` '1t/ TILE I NATURAL GAS 1METAL 03 IMASRY � , WATERSEWER MIN DEPTH S.F./100 SIZE NEW/REPAIR !(ik. 4Alio', / 44) PUBLIC (PUBLIC I 000 I 000 10000 I NEW cPArN!g:1;"‘ V COMMENTS y 1 / 0 AMT WAIVED .00 AMT PAID 1,165.34 PAYOR NAME: PACIFIC SCENE INC. PAID 07/03/90 RECEIPT 2822 EMPL: HALL, S PAID BY : CHECK NBR : 563441 •ICENSED CONTRACTORS DECLARATION• I HEREBY AFFIRM THAT I AM LICENSED UNDER THE PROVISIONS OF CHAPTER (COMMENCING WITH SECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT 5 LICENSE CLASS LICENSE NUMBER 5b6 �'g g CONTRALTO/ R^ DATE 1/q kg 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 [9500]1 ❑ 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 I POLICY NO __LLC-81L60/175 COMPANY / / ,/'' li � S�' `ertex,,, ❑ CERTIFIED COPY IS HEREBY FURNISHED ❑ CERTIFIED COPY IS FILED WITH THE COUNTY UILDING INSPECTION DEPARTMENT /!/�/ APPLICANT /�'0 —� DATE ADDITIONAL REVISION CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS (91001 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 DATF 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 ISA CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV C 1 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 HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT ❑ IS ❑ IS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY 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 INSPECTION URPOSE SIGNATURE OF APPLICANT OR AGENT '— DATE 7/5/1 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 12-17588-489 Rev 4/90 ,_, a lcr i / O 0/731S.020/790/ Owner Name �C �-' Permit Num /�S� INSPECTION RECORD ' DATE INSPECTOR DATE I INSPECTOR Setback (-.3-49%) *IL Rough PlumbinggNi _/� Temporary Power Shower Pan Test �+'(s Foundation Reinforcing Steel TJ 3 / � Stucco Mesh or Exterior Siding 10-0-CL) Excavation and Forms 9)-.340 Insulation (0--Ietd 411- - F H A Foundation Req Sewer V-.-1(} Slab Grade (6!) Interceptor Ground Plumbing li-3-iv Septic Tank Underslab Ducts Cl.) lic-3-9.1) 42 Leach Line or Seep Pit Underslab Conduit /?� t_3 .4.4 /47-11g, Water Service (`, PVC.- g-3-1k Fireplace Foundation Lath or Drywall Nailing 0-0-co L Joists and Girders Gas Line Air Test (f)-/t)40 A Electrical Ground e.I �.-- ) 94/J(!' Final Energy Mid-Height Bond Beam Final Plumbing / 8-Foot Bond Beam Final Heating/A C / Fi Beam &YT 57rF:/iZ 7-y -W 4/7-- Final Construction \ Fireplace Bond Beam _ [Final On Site Improvements 0/ Roof Sheathing r4 )3' ) ---r 1.14(/�I Final Off Site Improvements / Viji// Framing and Ventilation 1 -- /k*'- I Final Dedication v/ �y Roof Covering I Final Zoning 1% Rough Heating _,A,1'. ,,,e Final Electrical \./ Electrical Service and Ground /14 / -- I Final Gas / Rough Electrical ke I Developer Fees Paid / WC (Y/N) Ind Saf tY/N) I Certificate of Occupancy / SEPTIC TANK GALS SEEP PIT X LEACH LINF WIDF �*%a X LONG X DEPTH OF ROCK aeir Miles- + N VON 1"_, ~,2-1.T.13 : Jr '°'?- ;: q{) riAltvo'40 " l! -- k V. - W E r .,,� f A_ Ii S Inspector's Signature and Initials - " K�<< ,,/rpir 12-17589-469 Rev 3/88