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Permit No. 1058801913 /9/3 .%105 SAN BERNARDINO COUNTY-EPWA/LAND NAGEMENT DEPT a T • ,2�rD OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR ]05 88 01913 210A 01 I PAGE 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 05/31/88 ISSUE DATE 05/31/88 PARCEL NUMBER 1017-841-•34-0000 PROPOSED USE: LATTICE PATIO COVER CURRENT USE: RESIDENCE 12625TRACT I BLK I 337 LOT I SSEC E09 I T0N I RNG 08N I PRCL MMAP I PRCL 0COMMUNITY IIYLPLAN ZONE/LAD USE DISTRICT( GENERAL PLAN 0004 SUBDIVISION NAME SUBDIVISION PARCEL NO LOT DIMENSION IRREGULAR (CONST TYPE VN *SLOGS ON LOT 1 GROUP R3 APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 31-159 CUSTOM PATIO CONCEPTS STD PLAN/ICBO FHA N 1128 E 6TH ST 8 CORONA CA 91719-0000 GRADING INITIAL ACTUAL (714) 737 - 2640 CU.YDS. EXC. CU.YDS. FILL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER HOLTMEIER TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN 3088 OAKCREEK RD CHINO HILLS CA 91709-0000 PORCH 150 .20 30.00 (714) 597 - 8048 CALC. VALU 1,260.00 I ADJUSTED AREA 30 JOB SITE ADDRESS 3088 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 COMPLETED CONTRACTOR NAME LICENSE NUMBER TRACY RICHARD CONT000474278 DATE /D-6- 0 MAILING ADDRESS, PHONE NUMBER 1245 W. 6TH STREET CORONA CA 97721-0000 (000) 000 - 0000 MINIMUM SETBACK DISTANCES 45 FRNT SETBACK/CENTRLINE OAKCREEK RD R/W 50 20 REAR SETBACK/PROP LIME 5 SIDE SETBACK/PROP LINE S 10 SIDE SETBACK/PROP LINE N MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES I NO. DWELLING NO. BEDROOMS FLOOR UNIO EXT. WALLS I INT. WALLS CEILING ROOF 1 HEATING FIREPLACES WO METAL IMASRY WATER PUBLIC (PUBLIC SEWER I MIN 000EPTHI S.F./1001 0000000EI NEVI/REPAIR COMMENTS PREALTERATION AND PRE-CONSTRUCTION INSPECTION BY DALE BROSE. AMT WAIVED .00 AMT PAID 41.40 PAYOR NAME: CUSTOM PATIO COVERS PAID 05/31/88 RECEIPT 1597 EMPL: RICHARDS, GARY LICENSED CONTRACTORS`DECLARATIO I HEREBY AFFIRM THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH SE ION 7000) OF DIVISION 3 OF THE BUSINESS AND ., PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECT� rcis �P� J! C t j p LICENSE CLASS LICENSE NUMBER t`'t CONTRACTOR `CJr DATE` .�•�l—_ 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 [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 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 {{ ll. 11 �yy POLICY NO .11)77 ' COMPANY (O/L(.Ja1TC _ 4-- //'. D(Or- ❑ CERTIFIED COPY IS H REBY.FURNISHED ❑ CERTIFIED COPY IS ILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT APPLICANT A nD �.�- DATF Yom/V`-''`--1../\- .11.7 � 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 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 IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV C I LENDER'S NAMF 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 V I CERTIFY THAT I HAVE READ THIS APPLICATION A IP STATE THAT THE ABOVE INFORMATION IS CORRECT, I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUI MNG CONSTRUCTION, A HEREBY UTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION Pff'POSES - SIGNATURE OF APPLICANT OR AGENT — �SI)AA A. DATF 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 ..1 Owner Name ,_` (102-- Per•Number INSPECTION RECORD DATE INSPECTOR DATE INSPECTOR Setback Rough Plumbing Temporary Power Shower Pan Test Foundation Reinforcing Steel Stucco Mesh or Exterior Siding Excavation and Forms!eYR 5EP I0""6`( L!"J,0(/ Insulation F H A Foundation Req. Sewer Slab Grade Interceptor Ground Plumbing Septic Tank Underslab 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 /0-6.6% C/$ak" Fireplace Bond Beam Final On Site Improvements Roof SheathingFinal Off Site Improvements Framing and Ventilation I0-6_c 'f CAI Final Dedication Roof Covering Final Zoning Rough Heating I Final Electrical � 1 � � ` t � I E Q Electrical Service and Ground I Final Gas yU Rough Electrical I Developer Fees Paid i Jr. WC (Y/N) Ind Saf (YIN) Certificate of Occupancy U_ '(J�b ' /1 7/21:157 f 41l //•e2i/v,1 eitrsti<K•i"eS,141 SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDE X LONG X DEPTH OF ROCK N. W. E. S. Inspector's Signature and Initials - 12-17589-469 Rev 1/88