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Permit No. 1058803513 • 105 SAN BERNARDINO COUNTY—EPWA/LAND AGEMENT DEPT — • OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PFRNIT s48R 105 88 03513 205A 01 I STATUS: ACTI1' THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 03/01,89 I ISSUE DATE 03/01/89 I PG 1 OF 1 PARCEL NUMBER 1017-531-44-0000 PROPOSED USE: EXPANDING 2—BEDROOMS CURRENT USE: RESIDENCE W/GARAGE 9230TRACT 1000 1065 LOT I SW28 SEC I 0WN S I OWI PRCL 00AP I PRCL ACTIVITY PLAN COMMUNITYIJL823 ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS RS RES 6 LOT DIMENSION IRREGULAR CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *BOGS ON LOT 1 (GROUP R3 BENTON CONSTRUCTION 16079 MADLAR LN *PLANS RECD 0 LAND USE PLOT 0 INDEX NBR 33-157 CHINO HILLS CA 91709-0000 STD PLAN/ICBO FHA N (714) 597 — 5959 TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER ALDER, MIKE 1 440 1 00 440.00 3321 PAISLEY ST CHINO HILLS CA 91709-0000 CALC. VALU 19,800.00 I ADJUSTED AREA 440 (714) 597 — 8595 ITEM CUT DESCRIPTION DETAIL TOTALS JOB SITE ADDRESS RESIDENTIAL CONSTRU 183.29 3321 PAISLEY ST TOTAL AMOUNT 183.29 CHINO HILLS CA 91709-0000 CROSS STREET PEYTON DRIVE INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER COMPLETED 1607960TON MARK G CONT000409488 DATE �. ?/ �'Q�C ' MEDLAR LANE DATE i-7 (�� _x1✓ CHIN HILLS CA 97709-0000 (000) 000 — 0000 - — DIV OF IND. SAFETY PERMIT: MIt1IMUM SETBACK DISTANCES 55 FRNT SETBACK/CENTRLINE PAISLEY SIRCET R/W 60 15 REAR SETBACK/PROP LINE v. _ _ r__ _ _ _ . 5 SIDE SETBACK/PROP LINE 10 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES NO.TS I NO. BEDROOMS I CONCRETi• UNIE EXT. WALLS INT. WALLSI CEILING STUCCO SHEETROCK II SHEETROCK ROOF HEATING FIREPLACES COMP SHINGLE NATURAL GAS (METAL IMASRY IPWAATER I SEWER I MIN NO0 DEPIHI S.F./100I000OSIZEI NEW/REPAIR ICCOMMENTS ***ISSUANCE PENDING PRE—CONSTRUCTION INSPECTION. NO LAND DISTURBING OR CONSTRUCTION ACTIVITY TO BEGIN UNTIL - APPROVED*** • 3c v ,/r'7 0 J ri/0 S—fY-c>6dd t{i-- k5%,-6/ , ...)��-4--Ai r77 / vwe c-7, C...?"-Pry 0w0 /T//{/p/7� p1 t'YOI,q P L /r-J7t�f al AMT WAIVED .00 AMT PAID 183.29 ,[ PAYOR NAME BENTON CONSTRUCTION PAID 03/01/89 ate Ze�G4 •••c3 /04 , 8/C% RECEIPT • 914 FMPL: RICHARDS, GARY 1 _ PAID BY • CHECK NBR : 5299 • SLICENSED CONTRACTORS DECLARATIO e I HEREBY AFFIRM THAT I AM LICENSED UNDER THE PROVISIONS OF CHAPTER 9 (COMMENCING WITH SE ION 7000) OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE, AND MY LICENSE IS IN FULL FORCE AND EFFECTFF LICENSE CLASS 1 ,- ` LICENSE NUMBER �-1J4'•`cCONTRACTOR /1//C ,�6aJ7rtJ DATF 3 / ' /5V 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, LAB C I r POLICY NO - - „ COMPANY ❑ CERTIFIED COPY IS HEREBY FURNISHED; 4 ❑ CERTIFIED COPY IS FILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT c[5 APPLICANT DATE 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' COMPE TION LAWS�pF CALIFORNIA - --` - - - - - ' --- - APPL Ce..IT�/7/J A -C-� _xi DATE /7 iS l� NOTICE TO APPLICANT IF,AFTER MAKING THIS CERTIFICATE OF EXEMPTION,YOU SHOULD BECOME SUBJECT TO THE WORKEF 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 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 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 CONSTRU TION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES c SIGNATURE OF APPLICANT OR AGENT / ��/ /�- <�i DATE I / •� /� J 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 Warne `ft'L.�i • Permit Number•/d,—)–ge e53373"ZaS Cf INSPECTION RECORD DATE INSPECTOR I DATE I INSPECTOR Setback 3.42Cal CI CCSI� Rough Plumbing I Temporary Power Shower Pan Test I _ Foundation Reinforcing Steel Zl2fg-8 ( aS0t9Stucco Mesh or Exterior Siding 5-Ar-s7 60 I Excavation and Forms 3.2S-Vi CBOT Insulation • F H A Foundation Req Sewer / Slab Grade 3-21-SY a3flInterceptor Ground Plumbing 1 Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service Fireplace Foundation Lath or Drywall Nailing c'''I / '. (a( Joists and Girders Gas Line Air Test Electrical Ground Final Energy Mid-Height Bond Beam Final Plumbing �� � 11—/8-Foot Bond Beam Final Heatin /A C Final Bond Beam Final Construction I 11 V A ii Fireplace Bond Beam Final On Site Improvements a I' "/ ,fl .. Roof Sheathing Final Off Site Improvements 117 / &, Framing and Ventilation ,5-5.-” G Final Dedication _Lify I,, Roof Covering S'3-¶( 7n sce Final Zoning Rough Heating I S- 5-S CP I c+ ?S, Final Electrical I Electrical Service and Ground I I Final Gas I Rough Electrical I.6'-5--SI I CSA" Developer Fees Paid I/ WC (YIN) Ind Saf (Y/N1 Certificate of Occupancy 1 A � / 3- Z- - , . Cr N o-A) -a J .,_k_ CA.tj--r -, e.o --C-4-4..-t var--cil et a v-�� c " 4 '' C. .ec.......c•4-e_Q, . ct...1._. fr -00-Q.- vf-c, ---- -•g..4.4 v .S.:�/--. - -- — — - -- - — -- _ S?• 1r? /3. t....). rtiar7 , E-4a'r d.Ceer c5----/e- 87� .510 Cc7 ,t1G%5, IVdP'P ') '4 4'' n n��� p . r -r r n t, tJWIrI. L 1 i. v DATE 3!-b7( � � r SEPTIC TANK GALS SEEP PIT X LEACH LINF WIDE X LONG X DEPTH OF ROCK N W E A/_. / /moi A S diVii Inspector's Signatve and Init/ =' C. 12-17589 469 Rev 3/88