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Permit No. 1058900883 105 SAN BERNARDINO COUNTY-EPWA/LAND'AGEM:NT OVA",_ '~ - • OFFICE OF MELDING AND SAFETY P E RMI T APCLICs 'ON 1 PERMIT NRR 105 89 00883 230A 011 STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED AFTL DATE 04/06/89 I ISSUE DATE 04/06/89 I PG 1 OF 1 PARCEL NUMBER 1000-191-08-0000 PROPOSED USE: RETAINING WALL CURRENT USE: RESIDENCE 9781TRA BLK LOT SEC T P ACTIVITY : CT 1000 1039 I NE36 02S 09H PRCL 00AP ORr� COMMUNITY PLANL820 ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CH/PUD RES 2 LOT DIMENSION IRREGULAR CONST TYPE APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER RBLDGS ON LOT 1 (GROUP DISPOSAL CONTROL SERVICE • 1369 W 9TH ST SPLANS RECO 0 LAND USE PLOT 0 (INDEX NBR 13-161 UPLAND CA 91786-0000 STO PLAN/ICBG FHA N (714) 983 - 0342 — TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER FINK, LARRY FENCE 427 .20 86.00 1359 OAK TREE CR CHINO HILLS CA 91709-0000 CALC VALU 3,870.00 I ADJUSTED AREA 86 (714) 996 - 6162 TTFM CNT DESCRIPTION DETAIL TOTALS JOB SITE ADDRESS RESIDENTIAL CONSTRU 53.93 1359 OAK TREE CR TOTAL AMOUNT 53.93 CHINO HILLS CA 91709-0000 CROSS STREET OAK TREE CROSSING INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER NEW DCS I CONT000S16240 1369 WEST 9TH STREET UPLAND CA 91786-0000 (000) 000 - 0000 DIV. OF IND. SAFETY PERMIT: MINIMUM SETBACK DISTANCES _ __ - - - - - -2c" iRNi SETBACK/PROP LINE --`" 20 REAR SETBACK/PROP LINE 20 SIDE SETBACK/PROP LINE 20 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES I NO. DWELLING ( NO. BEDROOMS I FLOOR UNITEXT. WALLS INT. WALLS I CEILING ROOFI HEATING METAL FIREiMASRY ONTARIO PWATER UBLIC IPSEWER UBLIC I MIN DEPTH' 5.000100IOOOOEI NEW/REPAIR COMPLETED 0ENTS PR0 CE ALTER DONE BY JOHN DUKE. 1 AMT WAIVED .00 AMT PAID 53.93 PAYOR NAME. DISPOSAL CONTROL SERVICES PAID 04/06/89 RECEIPT 1795 EMPL: FLETS, DEBORAH PATO BY : CHECK NBR : 21389 •ICENSED CONT,RACTQRS DECLARATION ..., .... REBY AFFIRM THAT I AM LICENSED UNDER THE PROVISIONS OF CHAPTER 9 (COMAiliktIi WIfiH SECT) N 7000) OF DIVISION 3 OF THE BUSINESS AND P FESSIONS CODE,E,AND MY LICENSE IS IN FULL FORCE AND EFFECT r / �� .. j�/ �/ / Q(� LICENSE CLASS /' / LICENSE NUMBER 5-76 2 CIO CONTRACTOR „'e,'✓ C.S/ DATE / (.J-U f 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 ($5001 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 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 3800,0LAB C I ^� Q `� y� n OLICY NO V /��L S '—R 1 COMPANY �'47/1 -e _ F ! IfLl ❑ CERTIFIED COPY IS HEREBY FURNISHED CERTIFIED C ^IS FILED WIT E COUNT BUILDING INSPECTION DEPARTMENT 6-(:?9 APPLICANT i�.. Y/) Q_ ....,.-41 -AV DATF - " CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS — [$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 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 CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT, I AGREE TO COMPLY WITH ALL CITY AND COUNTY KORDINANCES AND STATE LAWS RELATING TO BUILDING CONST CTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECT PURPOSES /� SIGNATURE OF APPLICANT OR AGENT Ji ,l f//7,4 DATE — 6 ----O /p(� 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 10/88 Owner er Name I(\1(-'-' , - ,. Permit Numb./05-1.??w�'83 OA-0 -0 I INSPECTION RECORD DATE INSPECTOR DATE INSPECTOR Setback Rough Plumbing Temporary Power � /�� Shower Pan Test Foundation Reinforcing Steel 'V�....e.- 6-414- CStucco Mesh or Exterior Siding Excavation and Forms �/� YInsulation F H A Foundation Req r 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 Mid Height Bond Beam 4-111-15 f k r� mal Plumbing i 8-Foot Bond Beam rFinal Heating/A C n/ / Final Bond Beam Final Construction 4f,///� //w Fireplace Bond Beam Final On Site Improvements r , I r X , 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 WC (Y/N) Ind Saf (Y/N) A, Certificate of Occupancy 1 lor (/- f L-ff tr C_v -.e.. C9Ypc c71. fit„., '' Sr1'r -''�7.7t6 2!l!/1 SEPTIC TANK GALS ,-U.fl / ti I M SEEP PIT X Al r ,_ I'LL—v � �f LEACH LINE WIDF w t r X LONG X DEPTH OF ROCK N W E S Inspector's Signature and Initials 12 17589-469 Rev 3/88