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Permit No. 1209200565 g rJl ( A,T 5/IDS:'' ridL__ 601,444 rn lup'iZ. 1111 120 SAN BERNARDINO COUNTY-EPWA/LAND AGEMENT DEPT OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 120 92 00565 205A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 04/13/92 I ISSUE DATE 04/13/92 I PG 1 OF 1 PARCEL NUMBER 1031-321-34-0000 ' / PROPOSED USE: CONVERT PORT GAR TO PLAYROOM /d 3/ - 3 P. l - -4 </ CURRENT USE: RESIDENCE 12625TRACT 1000 1337 LOT I NE29 SEC I � 10RNG 8W I PRCL MAP I PORCL ACTIVITY : L825 COMMUNITY PLAN ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO`' CHINO HILLS CH/PD,IL1,FR1, M-H LOT DIMENSION IRREGULAR (CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER IBLDGS ON LOT 1 GROUP R3 CATES, EDWIN C SR 3964 KENNETH ST *PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 30-159 RIVERSIDE CA 92509-0000 STD PLAN/ICBO FHA N (714) 685 - 7512 TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER HOLTMEIER, CURTIS AND CARLA 1 1 130 .50 65.00 3088 OAKCREEK RD CHINO HILLS CA 91709-0000 CALC. VALU 3,146.65 I ADJUSTED AREA 65 (714) 597 - 8048 ITEM CNT DESCRIPTION DETAIL TOTALS JOB SITE ADDRESS RESIDENTIAL CONSTRU 71.00 3088 OAKCREEK RD TOTAL AMOUNT 71.00 CHINO HILLS CA 91709-0000 CROSS STREET OAK HILL DRIVE INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER CATES EDWIN SR C0NT000463662 3964 KENNETH ST RIVERSIDE CA 92509-0000 (714) 68! - 7512 MINIMUM SETBACK DISTANCES 45 FRNT SETBACK/CENTRLINE OAKCREEK RD R/W 50 20 REAR SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE S ONTARIO 10 SIDE SETBACK/PROP LINE N COMPLETED DATE (-7d-S9�/�722' MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS 1 NO. STORIES I NO.UNITS I NO. BEDROOMS I COFLOOREE EXT. WALLS I INT. WALLSI CEILING STUCCO SHEETROCK SHEETROCK ROOF I HEATING FIREPLACES 'METAL IMASRY PUWATER ATIR I SEWER I MIN NODEPTH' S.F./1000001OSIZEI NEW/REPAIR COMMENTS CONVERTING PORTION OF GARAGE TO PLAYROOM AMT WAIVED .00 AMT PAID 71.00 PAYOR NAME: CATES CABINETS PAID 04/13/92 RECEIPT 1164 EMPL: ROTRUCK, S PAID BY : CHECK NBR : 4152 eICENSED 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 / (CENSE CLASS - I LICENSE NUMBER (Eh 3(, 1- v- CONTRACTOR T�/ (00 S,.-DATE 47--/ 3_ 57 Z.-- 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]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 CONTRACTORS) 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 ADDITIONAL REVISION 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 THEOORRKERS' COMP NSATILAWS OF CALIFORNIA APPLICANT _ --40-4 C.- �� — DATE __7/--- 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 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 TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPEC PURPOSES SIGNATURE OF APPLICANT OR AGENT �--143,---L-1.--143,---L-1.--L---. l � � — DATF `- (/ 3 p Z� t _ N EXPIRATION AND REFUND NOTICE APPLICATIONS FOR WHICH NO PERMIT IS ISSUED WITHIN 180 DAYS FROM THE DATE OF APPLICATION SHALL EXPIRE PERMITS 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 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 Owner Name n I t►�e icv ,Permit NumbilkL yQZ 66565 0 O A C / INSPECTION RECORD DATE I INSPECTOR I I DATE I INSPECTOR Setback Rough Plumbing I Temporary Power Shower Pan Test _ A Foundation Reinforcing Steel Stucco Mesh or Exterior Siding Is. r2 - I ��� Excavation and Forms Insulation 44 Z/.9,Q. I 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 Electrical Ground Final Energy _4-----ad`q 2— I Mid-Height Bond Beam Final Plumbing 8-Foot Bond Beam Final Heating/A.C. s--a/- 2-- Final Bond Beam Final Construction c'--("6/ ['a-- Fireplace Bond Beam Final On Site Improvements Roof Sheathing _ Final Off Site Improvements I Framing and Ventilates ie -2/., gad. Afik 6eu Final Dedication Roof Covering Final Zoning I Rough Heating I �#L) Final Electrical 91-- ,kg- .. Electrical Service and Ground I Final Gas I Rough Electrical w'Z I- Developer Fees Paid WC WIN) Ind Saf (YIN) Certificate of 9,pcupancy J . '-c2. ail-- _ aZ 0. 2_L-2_5--- c40,--/C70 '� 6 44/43 7-4-az-1-01 2- ToL4 - f)D a c ClZ.s f,.Asp-- j= S-5? Y7 ,t L UNiikRtO COMPLFTED d/ .moi DATE — �70�''��---- SEPTIC TANK GALS SEEP. PIT X LEACH LINF WIDF X LONG X DEPTH OF ROCK N. W E 4 / /".• n S Inspector's Signature and Initials ( 7 alio, "VI h/" 12-17589-489 Rev 3/88