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Permit No. 1058901414 (4) 105 SAN BERNARDINO COUNTY-EPWA/LAND AGEMENT DEPT 1110 OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 705 89 0)414 225A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 06/12/89 I ISSUE DATE 07/11/89 I PG 1 OF 1 PARCEL NUMBER 1017-841-28-0000 PROPOSED USE: INGROUND SPA CURRENT USE: RESIDENCE W/GARAGE TRAC BLK LOT SEC THN 12625T 1000 331 I SE29 I p108W I PRCL 00AP I OPRCL CCTOMfIAVAIJITY PLANL821 ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS PUD LOT DIMENSION 45 X 104 CONST TYPE APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *BLOCS ON LOT 1 (GROUP MICHAEL S. CONLEY 3056 OAK CREEK RD *PLANS RECD 0 LAND USE PLOT 0 INDEX NBR 30-159 CHINO HILLS CA 91709-0000 STD PLAN/ICBO SP1137 FHA (714) 597 - 5640 ITEM CNT DESCRIPTION DETAIL TOTALS OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER SPA/HOT TUB STD PLA 104.95 MICHAEL S. CONLEY MISC SUB-TOTAL 104.95 3056 OAK CREEK RD TOTAL AMOUNT 104.95 CHINO HILLS CA 91709-0000 (714) 597 - 5640 JOB SITE ADDRESS 3056 OAK CREEK RD CHINO HILLS CA 91709-0000 CROSS STREET OAK CANYON ROAD INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER -- - DIV _OF-TND. SAFETY PERMIT._ - - _ - ,- - - - - - - - - - - MINIMUM SETBACK DISTANCES 45 FRNT SETBACK/CENTRLINE OAK CREEK ROAD R/W 50 20 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.UNITDWELLING I NO. BEDROOMS I CONCRETEE EXT. WALLS I INT. WALLS I CEILING ROOF I HEATING FIREPLACES WOOD METAL IMASRY WATER PUBLIC (PUBLIC SEWER I MIN 000EPTHI S 000100I0000EI NEW/REPAIR • COMMENTS AMT WAIVED .00 AMT PAID 104.95 PAYOR NAME: TM DESIGN PAID 07/11/89 RECEIPT • 3997 EMPL: STACCATO-NYARI, M PAID BY . CHECK NBR : 2038 410..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 CENSE LAW FOR THE FOLLOWING REASON(SECTION 7031 5,BUSINESS AND PROFESSIONS CODE ANY CITY OR COUNTY WHICH REQUIRES A PERMIT TO CONST CT, ALTER, IMPROVE, DEMOLISH OR REPAIR ANY STRUCTURE, PRIOR TO ITS ISSUANCE, ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED TATEMENT 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 [$5001 1 74 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 FONTRACTO LICENSE AW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON, AND WHO CONTRACTS FOR H I OJECTS WI H A CONT ACTORIS) LICENSED PURSUANT TO THE CONTRACTORS LICENSE LAW) ❑ I EXE UN E SEC j /, -, B AND P C FOR THIS REASON a (/ )! �v"Y DATF 7 // -V ' - /I W RKERS' COMPENSATION DECLARATION I HEREBY AFFIRM THAT I HAVE A CERTIFICATE OF 0 ENT 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 1$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 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 n //I //A I CERTIFY THAT I HAVE READ THISAPPLICATION AND S'T 1E HAT THE ABOVE F9RMAy{ N ISICORRECT, I AGREE REPRESENTATIVES COMPLY COUNTY WITH ALL CITY AND R UPON THE ORDINANC AND STATE LAWS RE TING TO BUIL FNG O S1RUCTION, AN HrBYOF THIS ABOVE- NTIONED PROPERTY FOR IN O 'P P v// GNATURE OF APPLICANT OR AGENT J ' / C I DATE7— /1 61 l/ / V v - /1 EXPIRATION AND REF NOTICE APPLICATIONS FOR WHICH NO PERMIT IS ISSUED WITHIN 180 DAYS FROM THE DATE 4;p;PPLICATION SHALL EXPIRE PERMITS SHALL EXPIRE IF WORK DOES NOT COMMENCE WITHIN 180 DAYS OF ISSUANCE OF SUCH PERMIT OR IF THE WORK IS SU6PENDED OR ABANDONED FOR A PERIOD OF 180 DAYS FEES PAID ARE NOT REFUNDABLE AFTER 180 DAYS FROM DATE OF PAYMENT, EXCEPT FOR ERRORS IN ACCEPTANCE WHICH MAY BE REFUNDABLE UP TO ONE YEAR FROM DATE OF PAYMENT ALL FEES PAID MAY NOT BE REFUNDABLE 12-17588-469 Rev 10/88 ids _ o Ll Owner Name Co.c.)LE ' Perm t Num - INSPECTION RECORD DATE INSPECTOR DATE I INSPECTOR Setback Zit 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 1 Septic Tank Underslab Ducts r p Leach Line or Seep Pit Underslab Conduit - Water Service Fireplace Foundation Lath or Drywall Nailing Joists and Girders Gas Line Air Test Electrical Ground Bdm" 'g-9-59? ,e 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 V-47-1.1 �� Developer Fees Paid WC (Y/N► Ind Saf (Y/NI Certificate of Occupancy /-/12-9/ - c,r/a,-,� SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDF X LONG X DEPTH OF ROCK N W E O, /tn S Inspector's Signature and Initials ._ 'O4S'l'�-'� -9.14 1Abk h9TT— i• 12 17589-469 Rev 3/88