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Permit No. 1059000143 ); 105 SAN BERNARDINO COUNTY-EPWA/LAND(GEMENT DEPT • OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 90 00143 240A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 01/25/90 I ISSUE DATE 01/25/90 I PG 1 OF 1 PARCEL NUMBER 1031-311-40-0000 PROPOSED USE: EROSION CONTROL PATIO COVER ID 3 /- 3 // - 4/0 CURRENT USE: RESIDENCE WITH GARAGE 12625T I BLK LOT 386 I SE29 SEC I 'S RNG PRCL MAP I PRCL ACTIVITY : L876 000COMMUNITY PLAN ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CH/PD,IL1,FR1 LOT DIMENSION IRREGULAR CONST TYPE APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER ;BLDGS ON LOT 1 (GROUP GARY'S LANDSCAPE 430 E FOOTHILL BLVD ;PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 31-153 SAN DIMAS CA 91773-0000 STD PLAN/ICBO FHA (714) 599 - 3552 ITEM CNT DESCRIPTION DETAIL TOTALS OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER EROSION CONTROL 52.41 AUSTIN, CRAIG LAND SUB-TOTAL 52.41 3117 OAKCREEK RD TOTAL AMOUNT 52.41 CHINO HILLS CA 91709-0000 1714) 597 - 2113 JOB SITE ADDRESS 3117 OAKCREEK RD CHINO HILLS CA 91709-0000 CROSS STREET OAKHILL DRIVE INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER GARY'S LANDSCAPE SERVI CONT000357261 PO BOX 3358 SAN DIMAS CA 91773-0000 (000) 000 - 0000 DIV. OF IHD. SAFETY PERMIT: MINIMUM SETBACK DISTANCES 45 FRNT SETBACK/CENTRLINE OAKCREEK R/W 50 20 REAR SETBACK/PROP LINE • 5 SIDE SETBACK/PROP LINE E 10 SIDE SETBACK/PROP LINE W MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS �'lrra�, .\ -r E: 0 VI NO. STORIES 1 NO. DWELLING 1 NO. BEDROOMS 1 FLOOR ' (I UNITS CONCRETE ( 1 fig :. ' i' D EXT. WALLS I INT. WALLS I CEILING Lago I L U /-1 EAsa O Y ROOF I HEATING FIREPLACES WOOD METAL IMASRY n PUWATER 1 BLIC SEWER MIN DEPTH 5.0000100 SIZE NEW/REPAIR0 /`-1JC/�/ 79 00 COMMENTS 01/25/90 MODERATE TO HIGH LANDSLIDE SUSCEPTIBILITY. CONT. LICENSE EXPIRES 09/30/91._D.FLETES. ANT WAIVED .00 AMT PAID 52.41 PAYOR NAME. GARY'S LANDSCAPE SERVICE PAID 01/25/90 RECEIPT 295 EMPL: FLETS, DEBORAH PAID BY : CHECK NBR : 4689 •ICENSED CONTRACTORS DECLARATION • c ED♦ L I N a -.-"oaf. THA �� _ -c 15:D '\'Dc ''E PROVISIONS OF C'-APTcP 9 ICOMMENCINC WITH ScCT,v\ 70D0 OF DI\'510\ J= THE 3.151NE55 AND PROFESSIONS CODE AND \'N .(CENSE :S I\ FULL FORCE AND EFFECT LICENSE C_ASS LICENSE NUMBER CONTRACTOR OATS 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 SUCr 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 155001 I LJ 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 DROVIDED 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 CONTRACTORISI 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 ISEC 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 IS 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 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 ISEC 3097,CIV C LENDER'S NAMF , LENDER'S ADDRF 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 ' LJ I CERTIFY THAT NO EXCAVATION 5 FEET OP MORE FEET IN DEPTH, INTO WHICH A PERSON IS REQUIRED TO DESCEND WILL BE MADE IN CONNECTION WITH WORK AUTHORIZED BY TH'S PERMIT AND THAT NO BUILDING STRUCTURE SCAFFOLDING, FALSEWORK OR DEMOLITION OR DISMANTLING THEREOF,WILL BE MORE THAN 36 FEET HIGH L AS OWNER BUILDER I W':LL 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 SAFE T PERMIT NUMBER I CERTIFY THAT I HAVE READ THIS ADPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE -AWS RELATING TO BUILDING CONSTRUCTION AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE MENTIONED PROPERTY FOR INSPECTION PURPOSES SIGNATURE OF APPLICANT CF AGENT , DATF EXPIRATION AND REFUND NOTICE APPLICATIONS FOR WHICH NC DERMIT IS ISSUED WITHIN 180 DAYS FROM THE DATE OF APPLICATION SHALL EXPIRE PERMITS SHALL EXPIRE IF WORK DOES NOT COMMENCE WITHIN 180 DAYS OF ISSJANCE OF SUCH PERMIT OR IF THE WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 180 DAYS FEES PAID ARE NOT REFUNDAB.E AFTER 180 DAYS:ROM DATE OF -AvMENT EXCEPT FOR ERRORS IN ACCEPTANCE WHICH MAY BE REFUNDABLE UP TO ONE YEAR FROM DATE OF PAYMENT ALL FEES PAID M4v NOT BE REFUNDABLE /Z,_/7S-P/-