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Permit No. 1058800085 4.05 SAN BERNARDINO COUNTY-EPWA/LAND AGEMENT DEPT • OFFICE OF BUILDING AND SAFETY P E RMI T AgPLICATION PERMIT NBR 105 88 00085 210A 01 I PAGE 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 01/27/88 ISSUE DATE 01/27/88 PARCEL NUMBER 1017831450000 PROPOSED USE: COVERED PATIO CURRENT USE: RES AND GAR 1TRACT 181K I 391 I SE29 I pI RNG I PRCL MMAP I PRCL COMMUNITY PLAN ZONE/LAND2USE DISTRICT GENERAL PLAN K LOT SEC TWN 08W0SUBDIVISION NAME SUBDIVISION PARCEL NO LOT DIMENSION IRREGULAR (CONST TYPE ABLDGS ON LOT 1 GROUP APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 31-160 CUSTOM PATIO CONCEPTS STD PLAN/ICBO FHA N 1245 W 6TH ST CORONA CA 92320-0000 GRADING INITIAL ACTUAL (714) 737 - 2640 CU.YDS. EXC. CU.YDS. FILL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER MELVIN, STEVE TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN 3157 OAKCREEK RD CHINO HILLS CA 91709-0000 PORCH 224 .20 45.00 (714) 597 - 1075 CALC. VALU 1,890.00 I ADJUSTED AREA 45 JOB SITE ADDRESS 3157 OAKCREEK RD ITEM CNT DESCRIPTION DETAIL TOTALS CHINO HILLS CA 91709-0000 RESIDENTIAL CONSTRU 28.00 CROSS STREET OAKHILL DRIVE ISSUANCE FEE 13.40 INSPECTN ACCESS TOTAL AMOUNT 41.40 CONTRACTOR NAME LICENSE NUMBER HAILING ADDRESS, PHONE, NUMBER MINIMUM SETBACK. DISTANCES 20 FRNT SETBACK/PROP LINE 5 REAR SETBACK/PROP LINE 10 SIDE SETBACK/PROP LINE W 5 SIDE SETBACK/PROP LINE E ONTARIO MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS COMPLETED NO. STORIES I NBOJITDWELLING I NO. BEDROOMS I FLOOR CO DATE: 4 x`98 EXT. WALLS I INT. WALLS ( CEILING ROOF I HEATING FIREPLACES WO (METAL IMASRY WATER PUBLIC (PUBLIC SEWER i MI000EPTHI S'000100I0000EI NEW/REPAIR COMMENTS y AMT WAIVED .00 AMT PAID 41.40 PAYOR NAME: CUSTOM PATIO CONCEPTS PAID 01/27/88 RECEIPT 96 EMPL: STACCATO-NYRI, M `. ,\ *LICENSED CONTRACTORS DECLARATION • N. I HEREBY AFFIRM THAT I AM LICENSED UNDER THE PROVISIONS OF CHAPTER 9 (COMMENCING WITH SECTION 70001 OF DIVISION 3 OF THE BUSINESS AND- PROFESSIONS CODE,(AS' AND MY LICENSE IS IN FULL FORCE AND EFFECT'` LI NSE CLASS d I LICENSE NUMBER `17''7 7 CONTRACTOR(1‘.,("1-(11/11A4/) ()t kjF /- ) - kg a 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 70001 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 [$50011 ❑ 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 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 I POLICY NO /O/9..--7/ COMPANY . ar J>.J)P 4-- "A�./ti�J ❑ CERTIFIED COPY IS HEREBY FURNISHED 21.CERTIFIED CQPY IS FILED WITHTHE COUN Y BUILDING INSPECTION DEPARTMENT APPLICANT //1.22...,14-414-4, A Af/1C�\ DATE 1 - a 7 - P 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 ISA 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 pUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSE SIGNATURE OF APPLICANT OR AGENT 4/l4/IA /�� (_% DATE / -a Q' EXPIRATION NOTICE APPLICATIONS FOR WHICH NO PERMIT IS ISSUED WITHIN1 80 DAYS FOLLOWING THE DATE OF APPLICATION SHALL EXPIRE,EVERY PERMIT SHALL EXPIRE IF WORK DOES NOT COMMENCE WITHIN 180 DAYS OF ISSUAN SUCH PERMIT OR IF THE WORK IS SUSPENDED OR DONED FOR A PERIOD OF 180 DAYS, FEES PAID ARE NOT REFUNDABLE AFTER ONE YEAR FROM OF PAYMENT, ALL FEES PAID MAY NOT BE REFUN 12-17588-469 • • INSPECTION RECORD Permit Number /a.S 08$O)/0P10-1 DATE I INSPECTOR I DATE I INSPECTOR Setback 4 15 8 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 Leach Line or Seep Pit Underslab Conduit 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 4 AC) a Fireplace Bond Beam Final On Site Improvements Roof Sheathing Final Off Site Improvements Framing and.Aftritingtin 14 7 8 g Final Dedication Roof Covering Final Zoning Rough Heating Final Electrical Electrical Service and Ground Final Gas Rough Electrical Developer Fees Paid Certificate of Occupancy WORKERS' COMPENSATION INSURANCE (YIN) DIVISION OF INDUSTRIAL SAFETY PERMIT (YIN) -"J21Sa ig Y'T' og / a.ArD d,r PL.ails ow, de)a S-/"rig' £Zf 3- bv,ie arc? / / Z Z —Ri ,/%a-� � es r� CXi P �t�fr,.�.. 'G/mac—4,c i� 6s/L Pew,- 41 SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDE X LONG X DEPTH OF ROCK N 0414G R F P,1G • W I; 5 'x10 � Q pE _arrcE PaTf o ll _ /1 r Inspector's Sig, and Initials cfeC_.. 12.17689-489