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Permit No. 1058800027 105 SAN BERNARDINO COUNTY-EPWA/LAND GEMENT DEP1' , OFFICE OF BUILDING AND SAFETY PER I T APPLICATION PERMIT NBR 105 88 027 210A 01 I PAGE 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 02/12/88 ISSUE DATE 02/12/88 PARCEL NUMBER 1017-831-43-0000 PROPOSED USE: PATIO/GAS-ELEC FOR SPA CURRENT USE: RESIDENCE AND GARAGE 12625T 1 BLK 000 1 LOT 389 I SEC SE29 I TWN I RNG I PRCLMAP I PRCLLCCOMMUNITY HINO HILLSLAN ZONE/LAND USE DISTRICT( GENERAL PUD RESPLAN SUBDIVISION NAME SUBDIVISION PARCEL NO LOT DIMENSION 59 X 100 (CONST TYPE #BLDGS ON LOT 1 GROUP APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 31-159 MARTIN, EDWARD J. STD PLAN/ICBO FHA N 3141 OAKCREEK ROAD CHINO HILLS CA 91709-0000 GRADING INITIAL ACTUAL 1714) 597 - 0247 CU.YDS. EXC. CU.YDS. FILL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER MARTIN, EDWARD J. TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN 3141 OAKCREEK ROAD CHINO HILLS CA 91709-0000 PORCH 240 .20 48.00 (714) 597 - 0247 CALC. VALU 2,016.00 I ADJUSTED AREA 48 JOB SITE ADDRESS • 3141 OAKCREEK ROAD ITEM CNT DESCRIPTION DETAIL TOTALS CHINO HILLS CA 91709-0000 RESIDENTIAL CONSTRU 28.00 CROSS STREET OAK HILL DRIVE ISSUANCE FEE 13.40 INSPECTN ACCESS TOTAL AMOUNT ONTARIO 41.40 CONTRACTOR NAME LICENSE NUMBER COM Pt E T E D MAILING ADDRESS, PHONE NUMBER DATE: z¢- MINIMUM SETBACK DIS1ANCES - __ _ - 20 FRNT SETBACK/CENTRLINE P/L OAKCREEK ROAD R/W 50 5 REAR'SETBACK/PPOPJ LINE 10 SIDE SETBACK/PROP LINE W 5 STDE''SETBACK/PROP LINE E MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES I NO. NITDDWELLING I NO. BEDROOMS I FLOOR CO EXT. WALLS I INT. WALLS I CEILING ROOFHEATING FIREPLACES WO I METAL IMASRY WATER PUBLIC (PUBLIC SEWER I MIN 000EPTHI S'000100I0000EI NEW/REPAIR COMMENTS PRE-ALTER BY DALE BROSE 5' REAR P/L SETBACK FOR PATIO ONLY AMT WAIVED .00 AMT PAID 41.40 PAYOR NAME: EDWARD J. MARTIN PAID 02/12/88 RECEIPT 285 EMPL: STACCATO-NYARI, M A • • •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 LICENSE CLASS LICENSE NUMBER CONTRACTOR DATE 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 [$500]1 KI,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) L SENSED PURSUANT TO THE CONTRACTORS LICENSE LAW) III O NER E U R SECS , :;�,, A, /^ B AND P C FOR THIS REASON DATF o� /C71'-'CW V 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) POLICY NO COMPANY ❑ CERTIFIED COPY IS HEREBY FURNISHED ❑ CERTIFIED COPY IS FILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT APPLICANT DATE CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [5100] OR LESS) -- I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THI PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TOT ;R .' COMPENS•L( • o•LIFORNI APPLICANT /1 A 1G( , ^ DATF (GI IK V v v V �, NOT• TO APPLICANT IF,AFTER MAKING THIS CERTIFICATE OF EXEMPTION,YOU SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS • 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 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 H READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION 11 ORRECT, I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES STATE LAWS RELATING TO BUILD • •. CONSTRUCTIOi HERE: • TH•i'IZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE = ABOVE-M ONED PROPERTY FOR INSPEC P /J••SES SI ATURE OF APPLICANT OR AGENT .�1J V �f • Ihe / / V DATF . ---6i) EXPIRATION NOTICE APPLICATIONS FOR WHICH NO PERMIT IS ISSUED WITHIN 180 DAYS FOLLOWING THE DATE OF APPLICATION SHALL EXPIRE,EVERY PERMIT SHALL EXPIRE IF WORK DOES NOT COMMENCE WITHIN 180 DAYS OF ISSUA�OF SUCH PERMIT OR IF THE WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS, FEES PAID ARE NOT REFUNDABLE AFTER ONE YEAR FRO E OF PAYMENT, ALL FEES PAID MAY NOT BE REFUNE 12-17588-469 ,' /oc/ g aioA• o f INSPECTION RECORD Permit Number DATE INSPECTOR DATE INSPECTOR Setback 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 Underslap Ducts [��lj �/��� f)7-6 Leach Line or Seep Pit Underslab Conduit 2/763 e) 4 ) - Water Service Fireplace Foundation Lath or Drywall Nailing Joists and Girders Gas Line Air Test 2/7E30 AU7± Electrical Ground Final Energy Mid-Height Bond Beam Final Plumbing 3 24 8'5+073 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 J,04 613 1,(" ) Electrical Service and Ground Final Gas Rough Electrical '' / 7 $ €3.1_„11) Developer Fees Paid Certificate of Occupancy WORKERS' COMPENSATION INSURANCE (YIN) DIVISION OF INDUSTRIAL SAFETY PERMIT (YIN) yT 72) i� SEPTIC TANK GALS SEEP PIT X LEACH LINF WIDE X LONG X DEPTH OF ROCK N. W E A n S Inspector's Sign re and Initials A.,J7-4) Y 7! 12-17589-469 410)