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Permit No. 1069101377 106 SAN BERNARDINO COUNTY-EPWA/LANDtGEMENT DEPT OFFICE OF BUILDING AND SAFETY PERMIT APPLICATION PERMIT NBR 106 91 01377 230A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 11/06/91 I ISSUE DATE 11/06/91 I PG 1 OF 1 PARCEL NUMBER 1031-311-42-0000 PROPOSED USE: RETAINING WALL 4'8fX 75' l/ 3 /- // - y i� CURRENT USE: RESIDENCE 1TRACT I BLK000 I 388LOT I SE29SEC I f( RNG08W I PRCL O P I PRCL ACTIVITY : L820 6COMMUNITY PLAN ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/PD,IL1,FR1, L-M LOT DIMENSION CONST TYPE APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *BLDGS ON LOT 1 (GROUP VASQUEZ, THOMAS 3133 OAKCREEK RD *PLANS RECD 2 LAND USE PLOT 0 INDEX NBR 31-159 CHINO HILLS CA 91709-0000 STD PLAN/ICBO FHA N (714) 597 - 8535 TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER VASQUEZ, THOMAS FENCE 450 .20 90.00 3133 OAKCREEK RD CHINO HILLS CA 91709-0000 CALC. VALU 4,356.90 I ADJUSTED AREA 90 (714) 597 - 8535 ITEM CNT DESCRIPTION DETAIL TOTALS JOB SITE ADDRESS RESIDENTIAL CONSTRU 71.00 3133 OAKCREEK RD TOTAL AMOUNT 71.00 CHINO HILLS CA 91709-0000 CROSS STREET OAKHILL DRIVE INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER DIV. OF IND. SAFETY PERMIT: MINIMUM SETBACK DISTANCES 47 FRNT SETBACK/CENTRLINE OAKCREEK RD. 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 NO. STORIES I NO. DWELLING I NO. BEDROOMS I FLOOR UNITEXT. WALLS I INT. WALLS I CEILING ENDT ARIO ROOF IHEATING FIREPLACES IMETAL IMASRY CDOMPLETO ,Y7 PWAATER TIR I SEWER I MIN NODEPTH' S.F./1001 0I0E1 NEW/REPAIR V COMMENTS AMT WAIVED .00 AMT PAID 71.00 PAYOR NAME: THOMAS VASQUEZ PAID 11/06/91 RECEIPT 4599 EMPL: PRYOR, KEITH PAID BY : CHECK NBR : 1302 LICENSED CONTRACTORS DECLARATI I HEREBY AFFIRM THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER 9 (COMMENCING WITH ECTION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE. AND MY LICENSE IS IN FULL FORCE AND EFFECT. • LICENSE CLAS .LICENSE NUMBER CONTRACTOR DATF 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 APPUCANT 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 ($500).): O 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 704-4,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). O 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 EX�PT UNDER SEC. — B. AND P. C. FOR THIS REASON DATF //- / _ -i \4'NE' �`r� - / 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 :800, LAB C 1 - POLICY NO COMPANY • 0 CERTIFIED COPY IS HEFEBY FURNISHED O CERTIFIED COPY IS FILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT APPLICANT DATE ADDITIONAL FEVIS'ON CERTIFICATE 0'EXEMPTION FROM WORKERS'COMPENSATION INSURANCE(THIS SECTION NEED NOT EE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS (S 1001 CR 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 W =,KERS'COMPENSATION LAWS OF CALIFORNIA 111) LICANT //;1/f'ii J �/�� i,_• DATE // /� - NOTICE TO APPLICANT IF,AFTERMAKING THIS CE TIFICAT EXEMPTION, YOU SHOULD BECOME SUBJECT TO THE WORKERS'COMPENSATION PROVISIONS CF THE LABC9 CODE, YOU MUST FORTHWITH COMPLY WITH SUCH PROVISIONS OR THIS PERMIT SHALL EE DEEMED REVOKED CONSTRUCTION LENDING AGENCY I HEREBY AFF'S'.1 THAT THERE ISA CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV C 1 LENDER S NAM` LENDER'S ADDRESS DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRES A DIVISION OF INDUSTR'AL SAFETY PERMIT AS A PREREQUISITE TO PERMIT ISSUANCE UNLESS THE APPLICANT SIGNS ONE OF THE CERTIFICATES BELOW O I CERTIFY THAT NO EXCAVATION 5 FEET CR MORE FEET IN DEPTH, INTO WHICH A PERSON IS REQUIRED TO DESCEND,WILL EE 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 O AS OWNER'EUILDER I WILL NOT EMPLOY ANYONE TO DO WORK WHICH WOULD REQUIRE A PERMIT FROM THE DIVISION CF INDUSTRIAL SAFETY,AS NOTED ABOVE UNLESS SUCH PERS0N HAS A PERMIT FROM THAT DIVISION DIVISION CF INDUSTRIAL SAFETY PERMIT NUMBER I HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT 0 IS 0 IS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT, I ACREE 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 INSPE IJ PURPOSES ,/ AleTURE CF APPLICANT OR AGENT Gfi//�///�_c1b G -, DATE // 1 - fj �� --- I' d L EXPIRATION AND REFUND NOTICE APPLICATIONS FOR\',HICH NO PERMIT IS ISSUED WITHIN 1E0 DAYS FROM THE DATE OF APPLICATION SHALL EXPIRE FERN'ITS SHALL EXPIRE IF WORK DOES NOT COMMENCE 1':ITH,'J 1E0 DAN S OF ISSUANCE CF SUCH PERMIT OR IF THE WORK IS SUSPENDED CR ABANDONED FOR A PERIOD OF 1E0 DANS FEES PAID ARE NOT FEFUNDAELE ',FTER ISO DANS FROM DATE CF PANI,'ENT E\CERT FOR ERRORS IN ACCEPTANCE WHICH MAY EE REFUNDABLE UP TO ONE N EAR FROM DATE CF FAN VENT All. FEES PAID MAY ',OT BE REFUNDAEIE 1: 17:E6 c(s c,. ,co Owner Name (/ /7 S Qti e j,•/ retic c Permit Num./0 6 2/Oa 77 a 3D/90/ INSPECTION RECORD DATE INSPECTOR I DATE 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 Ducts Leach Line or Seep Pit Underslab Conduit Water Service Fireplace Foundation Lath or Drywall Nailing 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 Fireplace Bond Beam Final On Site Improvements I 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 Developer Fees Paid I WC (YIN) Ind Saf (YIN) Certificate of Occupancy 0 .rrfl n ,,GI SEPTIC TANK GALS SEEP PIT X LEACH LINF WIDF X LONG X DEPTH OF ROCK N W E S Inspector's Signature and Initials tig-14/it /3 : 12-17689-469 Rev 3/88