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Permit No. 1058801247 - 1111 135 SAN BERNARDINO COUNTY-EPWA/LAND PDINAGEMENT DEPT OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 88 01247 210A 01 I PAGE 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED • APPL DATE 03/10/88 ISSUE DATE 03/10/88 PARCEL NUMBER 1017-841-31-0000 PROPOSED USE: PATIO CURRENT USE: RESIDENCE AND GARAGE TRACT 1000 13LOT 34 I SSEC E29 I TOV2dS 108W I PRCL MAP I PORCL CHINO HILLSCOMMUNITY LAN ZONE/LAND USE DISTRICT( GENERPUDRESP4AN 0SUBDIVISION NAME SUBDIVISION PARCEL NO LOT DIMENSION 45 X 104 CONST TYPE *BLDGS ON LOT 1 GROUP APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 30-159 PATIO KING STD PLAN/ICBO FHA N 3900 VALLEY BLVD flH WALNUT CA 91789-0000 GRADING INITIAL ACTUAL (714) 595 - 7747 CU.YDS. EXC. CU.YDS. FILL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER LETTERMAN, DON TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN 3074 OAKCREEK ROAD CHINO HILLS CA 91709-0000 PORCH 90 .20 18.00 (714) 597 - 0298 CALC. VALU 756.00 I ADJUSTED AREA 18 JOB SITE ADDRESS 3074 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 41.40 CONTRACTOR NAME LICENSE NUMBER PATIO KING CONT000477864 MAT(TNG ADDRESS, PHONE NUMBER 3900 VALLEY RI SUITE H WALNUT CA 91784--0000 ' - - - -.i t."141 i iVV - Vl7VV— ------- __ - _ __ , _— -_ - - �- -- - - MINIMUti SETBACK DISTANCES- 20 FRNI''SETBACK/CENFRLINE P/L OAKCREEK ROAD P/N 50 5 REAR SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE , MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES I NO. DWELLING NO. BEDROOMS FLOOR UNITO EXT. WALLS INT. WALLS I CEILING ROOF HEATING 1 FIREPLACES C OMP1ET E D WO METAL IMASRY PWATER UBLIC (PUSEWER BLIC I MI0001111 EPTHI S.F./1001 0000000SIZE! NEW/REPAIR ®j�T ga !0 COMMENTS 7W PRE-ALTER BY DON BAKER RECD AUTHORIZATION LETTER FOR NICOLE DIGNAM AMT WAIVED .00 AMT PAID 41.40 PAYOR NAME: PATIO KING PAID 03/10/88 RECEIPT 425 EMPL: STACCATO-NYARI, M l •ICENSED 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 PROFESSION ODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT l / �`� `1 L SE CLASS I-t 1_ LICENSE NUMBER 7 D(U4 CONTRACTOR Allo P(C DATE 3/I o 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 [8500]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 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( POLICY NO SECEMLQ C-e)000 Q5R A COMPANY K (NIp(--- ❑ CERTIFIED COPY IS HEREBY FURNISHED ❑ CERTIFI OPY�ILEDW ITH,,HE COUNTY BUILDING INSPECTION DEPARTMENT1 �r AP CANT 71 -1 n Y\ 1 1�� DATP /J d I g CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$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 DATP 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 AN STATE LAWS RELATING TO BUI-DING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-ME ED PROPERTY FOR INSPECTION (RPO NATURE OF APPLICANT OR AGENT!/ / Gv `` /DATE ) o c / 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 ISSUANCE 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 FROM DATE OF PAYMENT, ALL FEES PAID MAY NOT BE REFUNDABLE 12-17588-469 last?? - a Ia,Y 7 6,710-A4 ._� • INSPECTION RECORD Permit Number DATE INSPECTOR DATE I 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 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 ,J Final Bond Beam Final Construction y � ! Fireplace Bond Beam Final On Site Improvements I `� Roof Sheathing , Final Off Site Improvements Framing and Ventilation y-2 ?..$9' ,;(4r- Final Dedication Roof Covering 1 Final Zoning Rough Heating Final Electrical Electrical Service and Ground Final Gas Rough Electrical Developer Fees Paid Certificate of Occupancy WORKERS' COMPENSATION INSURANCE (Y/N) DIVISION OF INDUSTRIAL SAFETY PERMIT (YIN) - wG E 1. . : SEPTIC TANK GALS. SEEP PIT X LEACH LINE WIDE X LONG X DEPTH OF ROCK N COMPLETFD (]A I t `,--z7-E74/0 W E V1/7Z/ i// S Inspector's Signature and Initials .. — or/, � 12-17589-469