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Permit No. 1058802669 , R. C? 105 SAN BERNARDINO COUNTY-EPWA/LAND �i}it•AGEMENT DEPT ---- ---• - ---.- OFFICE OF BUILDING AND SAFETY PERMIT APPLTCATICN PERMIT NBR 105 88 02669 210A 01 PAGE 1 or 1 THIS IS NOT A PERMIT UNTIL ISSUED - -- -- APPL DATE 10/01/88 ISSUE DATE 10/07/88 PARCEL NUMBER 1017-841-33-0000 PROPOSED USE: GAS T ELEC FOR SPA AND PATIO CURRENT USE: RES W/ GARAGE 12625TRAC7 1000 1336 LOT I SE29 SEC , 025 108W I PRCL OAP 1 PRCL ACTIVITY : L820 - COMMUNITY P1 AN ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO PUD RES 4 LOT DIMENSION IRREGULAR CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER #RLDGS ON LO( 1 GROUP R3 JENSEN, STEVEN ------ -- 3084 OAKCREEK RD UPLANS RECO 0 LAND USE PLOT 0 INDEX NBR 30-159 CHINO HILLS CA 91709-0000 STD PIAN/ICBG FHA N (714) 597 - 6539 GRADING INITIAL ACTUAL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER CU.YDS. EXC. JENSEN, STEVEN CU.YDS. FTIL 3084 OAKCREEK RD CHINO HILLS CA 91709.0000 TYPE l -SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN (7141 597 - 6539 ------ 111 --- - PORCH 156 .20 32.00 JOB SITE ADDRESS 3084 OAKCREEK RD CALC. VALI1 1,344.00 I ADJUSTED AREA 32 CHINO HILLS CA 9170'+-0000 CROSS STREET BAYBERRY DRIVE ITEM CNT DESCRIPTION DETAIL TOTALS INSPECTN ACCESS RESIDENTIAL CONSTRU 35.45 ISSUANCE FEE 16.96 ----- - --- - 101-AL AMOUNT 52.41 CONTRACTOR NAME LICENSE NUMBER MAILING ADDRESS, PHONE DUMBER MINIMUM SEIBACK DISTANCES 45 FRNT SETBACK/CENTRLINE OAKCREEK RD R/W 50 - 20 REAR SETBACK/PROP LINE 10 SIDE SETBACK/PROP LINE N 5 SIDE SETBACK/PROP LINE S MECHANICAL EQt1IP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIESf NO. DWELLING ( NO. BEDROOMS FLOOR UNITEXT. WALLS INT. WALLS CEILING ONTARIO _^ ROOF ' HEATING FIREPLACES COMPLETED METAL IMASRY /7.62— /O / PUWATER BLIC I SEWER MIN DEPTH' S0 F./IOOI0000SIZE1 NCW/REPAIR0 000 COMMENTS DATE PRE-ALTER BY CHARLIE LOFTUS AMI WAIVED .00 ANT PAID 52.47 PAYOR NAME: DfAHN JENSEN PAID 10/07/88 RECEIPT • 3979 EMPL: STACCATO-NYARI, M •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 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 CON TRACTORS 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 ($5001 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 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 I 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 ($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 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 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 BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES SIGNATURE OF APPLICANT OR AGENT 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 /0S/8k --aa6a. 9 aior4 6/ Ownec Name 7Lahca+ Permit Number INSPECTION RECORD • DATE INSPECTOR I 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 Underslab EMI.,a,16 10•a 7-1i1 SP< Leach Line or Seep Pit Underslab Conduit Water Service Fireplace Foundation Lath or Drywall Nailing Joists and Girders Gas Line Air Test i p'‘,/71? dr-141Y Electrical Ground Final Energy Mid-Height Bond Beam Final Plumbing 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 Electrical Service and Ground _ Final Gas Rough Electrical l/.-y.'�i l � IPK Developer Fees Paid -WC (Y/N) , Ind Saf (Y/N) Certificate yf Occupancy __ /O —Z3 -90 /d Qlcu( rt' '. -b 3 -..b -?/ YTau 7 N- / d -S/ Y r sf 7 Fidoiti ( Nufc cc B __ _ _ --- /J f =,- -a2-9 I 1; �t,.4.c�e ��+-4- o �s t- ,-/-o-77-7— i1O1 Iii /Z- tb - 9/ A ri .,,,_, e- 74-J-i / r ato SEPTIC TANK GALS. V , / SEEP. PIT X .GTED , /l - .'',---------- LEACH LINF WIDE COWI. 1 V__:--1---7-1-- X LONG X DEPTH OF ROCK DP`t� ...--r- N N. W E. LL i � "7/ /11, 1 S Inspector's Signature and Initials -.774/7/!..01.4.-- 12-17589-469 Rev 3/88