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Permit No. 1209200534 ✓ L PY ` 120 SAN BERNARDINO COUNTY—EPWA/LANDWNAGEMENT DEPT • OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 120 92 00534 206A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPL'DATE 04/07/92 I ISSUE DATE 04/07/92 I PG 1 OF 1 PARCEL NUMBER 1031-321-43-0000 PROPOSED USE: CONVRT.PRT.GAR.TO LAUNDRY RM. /0 3 / — 3 J_ Ci 3 CURRENT USE: RESIDENCE TRACT 1000 1384 I SSEC E29 I 0( 1088WW I PRCL MAP I PRCL ACTIVITY : L825 0 0 COMMUNITY PLAN ZONE/LAND USE DISTRICT PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHPD/IL1/FR1 L TO M LOT DIMENSION 66 X 100 CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *8LDGS ON LOT 1 (GROUP R3 SUNCRAFT DEVELOPMENT CORP. 433 N FLEETWOOD PL *PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 31-159 GLENDORA CA 91740-0000 STD PLAN/ICBO FHA N (818) 914 — 2029 OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN SPEIGHT, BILL 1 130 .50 65.00 3101 OAK CREEK RD CHINO HILLS CA 91709-0000 CALC. VALU 3,146.65 I ADJUSTED AREA 65 (714) 597 — 5721 ITEM CNT DESCRIPTION DETAIL TOTALS JOB SITE ADDRESS RESIDENTIAL CONSTRU 71.00 3101 OAK CREEK RD TOTAL AMOUNT 71.00 CHINO HILLS CA 91709-0000 - CROSS STREET BAYBERRY DR INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER ONTARIO COLLETT JOHN A CONT000617890 433 W FLEETWOOD PL, GLENDORA CA 91740-0000 COniIPLETED6,_a_ (818) 914 -- 2029 DATE 7 ..,227 ., DIV. OF IND. SAFETY PF'HTTe — - — MINIMUM SMACK DISTANCES 45 FRNT SETBACK/CENTRLINE O1K CREEK R/W 5o 15 REAR SETBACK/PROP LINE 10 SIDE SETBACK/PROP LINE W 5 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES I NO. DWELLING 1 NO. BEDROOMS I 1 UNITS CONCRETE EXT. WALLS INT. (WALLS CEILING STUCCO SHEETROCK I SHEETROCK `� ROOF I HEATINGI FIREPLACES TILE NATURAL GAS METAL IMASRY PUWATER BLIC IPUBLICR I MIN DEPTH' S.F./100I0000000EI NEW/REPAIR COMMENTS — AMT WAIVED .00 AMT PAID 71.00 PAYOR NAME: JOHN A COLLETT PAID 04/07/92 RECEIPT 1086 EMPL: HALL, S PAID BY : CHECK NBR : 1306 r L .ICENSED CONTRACTORS DECLARATIONS 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 SE CLASS LICENSE NUMBER 6,L set O CONTRACTOR.5UK04.44 ✓��•• 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 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]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 DATE 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 CERTIFI PY I ILED WIT THE CO LDING INSPECTION DEPARTMENTMir 471-7 / -7 LICANT DATE T" /-413Z ADDITIONA VISION • CERTIFIC OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS [$100] O 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 DAT' 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) 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 I HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT ❑ IS ❑ 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 AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING T• ILDIN? ONSTRUCTI , AND HE" THORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECa �'P' 5 / 4/"-- ^7 111111,9F APPLICANT OR AGENT a / /�•/ DATF L ` G-- EXPIRATION AND REFUND NOTICE APPLICATIONS FOR WHICH NO PERM( I SUED WITHIN 180 DAYS FROM THE DATE OF APPLICATION SHALL EXPIRE PERMITS SHALL EXPIRE IF WORK DOES NOT COMMENCE WITHIN 180 DAYS OF IS NCE OF SUCH PERMIT OR IF THE WORK IS SUSPENDED 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 4/90 7 Owner Name S'peI' A c y Permit Numhe/020 f 023 r ,,,240 $ INSPECTION RECORD DATE INSPECTOR I I DATE INSPECTOR Setback Rough Plumbing Temporary Power Shower Pan Test Foundation Reinforcing Steel Stucco Mesh or Exterior Siding Excavation and Forms Insulation TV 0S-74- 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 f��t ^9 Z - Joists and Girders Gas Line Air Testy 34-1) Electrical Ground Final Energy ape 4S Mid-Height Bond Beam Final Plumbing 6-11- y8-Foot Bond Beam Final Heating/A C 6'13--q-,), J7Y Final Bond Beam Final Construction 6-18-q2- Fireplace -J$- _Fireplace Bond Beam Final On Site Improvements r� Roof Sheathing Final Off Site Improvements Framing and Ventilation s- (f- ft-- /S14- Final Dedication Roof Covering Final Zoning Rough Heating 5-1s-1j Final Electrical (f-qi - Electrical Service and Ground Final Gas Rough Electrical 5 - (s--f L *]+ Developer Fees Paid 1 , • WC (YIN) - Ind Saf (Y/N) Certificate of Occupancy 4-0— -!J.� 65-a -t sb a(G Per k3a_ta ONTARri -n5flinA r-re-, 9_)i1TC / Jam. r-4-- QQ L-4 /6 7 c", SEPTIC TANK GALS SEEP PIT X LEACH LINF WIDE X LONG X DEPTH OF ROCK N W E S Inspector's Signature and Initials '1n J - - 4 12-17589-469 Rev 3/88