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Permit No. 1058801973 105 SAN BERNARDINO COUNTY-EPWA/LAND AGEMENT DEP1 1110 , OFFICE OF BUILDING AND SAFETY PERMIT APPLICATION I PERMIT NBR 105 88 01973 230A 01 I PAGE 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED • I APPL DATE 06/02/88 ISSUE DATE 06/02/88 PARCEL NUMBER 1017-831-59-0000 PROPOSED USE: RETAINING WALL f CURRENT USE: RESIDENCE 12526T 1 BIK000 1LOT 4OT I SEC SEC9 I �' 108G I PRCL MMAP I PPRCLI CHINO IIYLPLAN ZONE/LANDUD D USE DISTRICT( GENERALPLAN SUBDIVISION NAME SUBDIVISION PARCEL NO LOTDDIDIMENSION LOT IRREGULAR ICONSTT TTYPE R APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 32-159 SIMON, RICHARD H. STD PLAN/ICBO II FHA N 3263 OAKCREEK RD CHINO HILLS CA 91709-0000 GRADING INITIAL ACTUAL (7141 597 - 8591 CU.YDS EXC. CU.YDS. FILL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER SIMON, RICHARD H. TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN 3263 OAKCREEK RD CHINO HILLS CA 91709-0000 FENCE 180 .20 36.00 (714) 597 - 8591 CALC. VALU 1,512.00 I ADJUSTED AREA 36 JOB SITE ADDRESS 3263 OAKCREEK RD ITEM CNT DESCRIPTION DETAIL TOTALS CHINO HILLS CA 91709-0000 RESIDENTIAL CONSTRU 28.00 CROSS STREET BAYBERRY DRIVE ISSUANCE FEE 13.40 INSPECTN ACCESS TOTAL AMOUNT 41.40 COMPLETED CONTRACTOR NAME LICENSE NUMBER DATE 0 _ -8415 MAILING ADDRESS, PHONE NUMBER ' MINIMUM SETBACK DISTANCES 45 FRNT SETBACK/CENTRLINE OAKCREEK RD R/W SO 20 REAR SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE 10 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES I NO. DWELLING I NO. BEDROOMS I FLOOR UNITEXT. WALLS I INT. HALLS I CEILING ROOF I HEATING 'METAL FIREPLACES MASRY PWWATER ATIR I SEWER I MINODII DEPTH S 000 100i SIZE( NEW/REPAIR 0000 COMMENTS 111 ' AMT WAIVED .00 AMT PAID 41.40 PAYOR NAME: SIMON, RICHARD H. PAID 06/02/88 RECEIPT • 1669 EMPL: FLETS, DEBORAH ....?...\\ , I LICENSED CONTRACTORS DECLARATIO I HEREBY AFFIRM THAT I AM LICENSED UNDER WPROVISIONS OF CHAPTER 9 (COMMENCING WITH SE 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 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 [5500]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 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 1 POLICY NO COMPANY ❑ CERTIFIED COPY IS HEREBY FURNISHED ❑ CERTIFIED COPY IS FILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT APPLICANT DATF CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [51001 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 IS A 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 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 PURPOSES SIGNATURE OF APPLICANT OR AGENT DATE 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 Qwner Name S I net On - ' - ` PereNumber /b5 73 a3o, , 1 INSPECTION RECORD , DATE INSPECTOR I I DATE I INSPECTOR Setback RE*i r 1 14-4-re` 4'/2, Rough Plumbing Temporary Power I Shower Pan Test Foundation Reinforcing Steel -. '"'1<9 Stucco Mesh or Exterior Siding I Excavation and Forms � Insulation FHA Foundation Req Sewer - Slab Grade Interceptor Ground Plumbing Septic Tank Underslab Ducts Leach Line or Seep Pit I Underslab Conduit Water Service Fireplace Foundation Lath or Drywall Nailing I Joists and Girders Gas Line Air Test I Electrical Ground Final Energy Mid-Height Bond Beam Final Plumbing I 8-Foot Bond Beam Final Heating/A C I Final Bond Beam Final Construction /1l Z3'gIS-els4 Fireplace Bond Beam Final On Site Improvements Roof Sheathing Final Off Site Improvements Framing and Ventilation Final Dedication Roof Covering Final Zoning I Rough Heating Final Electrical r 0 M P L O T E Lii Electrical Service and Ground ^ Final Gas 1 1V .//- 24.3PS1C44Developer Fees PaidOATE I I-*3-•g - WC (Y/NI) Ind Saf (Y/N)/ Certificate of Occupancy ,. SEPTIC TANK GALS SEEP PIT X LEACH LINF WIDE X LONG X DEPTH OF ROCK N W E S Inspector's Signature and Initials Lc le57 421 r2/ 12-17589 469 Rev 1/88