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Permit No. 1058802131 11tior,"-o-/ . . ;2'./...3/! 101, SAN BERNARDINO COUNTY-EPWA/LAND ' AGFMEN1 DEPT -• ------- - OFFICE OF BUILDING AND SAFETY P E RMT T APPLICAIIOM r)iIT NRR 105 88 02431 210A 01 I PAGE 1 OF 1 1HIS IS NOT A PERMIT UNTIL ISSUED - --- ----- APPL DATE 07/2E/88 ISSUE DATE 07/26/88 PARCEL NUMBER 1017-891-35-0000 -- PROPOSED USE: LATTICE PATIO COVER CURRENT USE: RESIDENCE TRAC LOT SEC G ACTIVITY : 126257 1000 1218 ( NE29 I � 1081,E ( PRCL MAP I PRCL COMMUNITY PLANL820 ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIV]SION PARCEL NO CHINO HILLS CH/PUD RES-4 LOT DIMENSION IRREGULAR CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *BUGS ON LOT 1 (GROUP R3 PALENSKE, GARNER A. AND BECKY E. 15519 OAKFLATS RD IIPLANS RECD 0 LAND USE PLOT 0 INDEX NBR 30-155 CHINO BILLS CA 91709-0000 STD PLAN/ICBO FHA N ( ) - GRADING INITIAL ACTUAL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER CU.YDS EXC. PALENSKE, GARNER A. AND BECKY E. CU.YDS. FILL 15519 OAKFLATS RD CHINO HILLS CA 91709-0000 TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN ( I - PORCH 240 20 48.00 JOB SITE ADDRESS 15519 OAKFLAES RD CALC. VALU 2,016.00 I ADJUSTED AREA 48 CHINO HILLS CA 91709-0000 CROSS STREET OAKTRAIL RD ITEM CNT DESCRIPTION DETAIL TOTALS INSPECTN ACCESS RESIDENTIAL CONSTRU 28.00 ISSUANCE FEE 13.40 --- — - TOTAL AMOUNT 41.40 CONTRACTOR NAME LICENSE NUMBER MAILING ADDRESS, PHONE NUMBER MINIMUM SETBACK DISTANCES 43 FRNI SETBACKif.ENTRLINE OAKILATS RD R/W 50 20 REAR SETBACK.?ROP !INF 5 SIDE SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUTRED SIDE SETBACKS NO STORIES I NO. NITDDWELLING NO. BEDROOMS FLOOR CO EXT. WALLS TNT. WALLS CEILING ROOF HEATING FIREPLACES WO METAL IMASRY PUBLIC WATER I SEWER I MIN 0 EPTH1 S.000 0000F./1001 SIZE1 NEW/REPAIR COMMENTS 111 / C(V'' 3 DAT ° _ -7-//`9° ,n4 lAMT HAWED .00 AMT PAID 41.40 PAYOR NAM. PALENSKE, GARNER AND BECKY PAID 07/26/88 1 nECEIPT • 2592 EMPL: RICHARDS, GARY 4 t •ICENSED CONTRACTORS DECLARATION• ' - V 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 LICENSE CLASS 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 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) X\OWNER ❑ I AM EXJEMMPPTQUN ER SECr jnB AND P C FOR THIS REASON 7 , / i / �JC��h /'7�tI f1 t/li) DATE //�lil/!J 1/ ' „�1.///As/vim / / - V 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 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 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 ISA 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 \/ ORDINANCES AND STATE LAWS RELATING TO BUILDING CONSTRUCTION,rN,ANDBHEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE OVE-MENTIONED PROPERTY FOR INSPE� ION PURPOSE � r,�1�J �/���� SIGNATURE OF APPLICANT OR AGENT V/1 IX 71i/l //' (�FOAZC DATE / l v V EXPIRATION NOTICE APPLICATIONS FOR WHICH NO PERMIT IS ISSUED WITHIN 180 DAYS FOLLOWING THE DATE OF APPLICATION SHALL EXPIRE,EVERY PERMIT 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 ONE YEAR FROM DATE OF PAYMENT, ALL FEES PAID MAY NOT BE REFUNDABLE 12-17588-489 Owner Name 'A'�--eNs ' 'Permit Numb.0S g8 Z413/--z/04-D1/ INSPECTION RECORD DATE INSPECTOR I DATE I INSPECTOR Setback 7--a.le,fr Rough Plumbing Temporary Power Shower Pan Test Foundation RimatarrAu9..arAL gStucco Mesh or Exterior Siding Excavation and Forms -/4"4781-em 411 / 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 Electrical Ground Final Energy Mid-Height Bond Beam Final Plumbing 8-Foot Bond Beam Final Heating/A C Final Bond Beam Final Construction Fireplace Bond Beam Final On Site Improvements 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) Certificate of Occupancy j -/'/d- 9 z er`T DrrccrzE2)CJ 5774/ /cm/AL -Zei 115/- /7" ll--qty I"at(o /4 k) /rl/1 SEPTIC TANK GALS SEEP PIT X LEACH LINF WIDE X LONG X DEPTH OF ROCK N U17- cNi Pt/141, 1,p m,et`a om _ rLERtHP tea �-6l G :ti „yeptri S In pector's Signature a nitials AO _ 12 17589-469 Rev 3/88