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Permit No. 1209200121 I. ill 4111 120 SAN BERNARDINO COUNTY—EPWA/LAND MANAGEMENT DEPT it OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PFRMI7 NBR 1211 92 00121 205A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPL,DATE 01/31/92 I ISSUE DATE 01/31/92 I PG 1 OF 11 PARCEL NUMBER 1017-531-38-0000 .,:o PROPOSED USE• ROOM ADDITIONS CURRENT USE• RESIDENCE 9TRACT I BLK I 071LOT I SECS I pM 10NG I PRCL M8WMAP I PORCL ACTIVITY : L823 000COMMUNITY PLAN ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/RS,IL1,FR1, 1—M LOT DIMENSION IRREGULAR CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER ;BLDGS ON LOT 1 GROUP R3 CIRA, ROBERT 3352 PAISLEY DR ;PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 33-157 CHINO HILLS CA 91709-0000 STD PLAN/ICBO FHA N (714) 597 — 5351 TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER CIRA, ROBERT 1 472 1.00 472.00 3352 PAISLEY DR CHINO HILLS CA 91709-0000 CALC. VALU 22,849.52 I ADJUSTED AREA 472 (714) 597 — 5351 ITEM CNT DESCRIPTION DETAIL TOTALS JOB SITE ADDRESS RESIDENTIAL CONSTRU 263.00 3352 PAISLEY DR TOTAL AMOUNT263.00 CSIRO TILLS CA 91709-0000 �� CROSS STREET PEYTON INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER ONTARIO COMPLETED r DATE tO "E '-.9 2- DIV. OF IND. SAFETY P RMI(: '" �. __ . _ �MINIMUM SETBACK DISTANCES . ,f { i/ )_ ( 27.FRNT'SETBACK'PROP LINE 15 REAR,SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE 10 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES ( NO.1 UNITS I NO. BEDROOMS I 1 1 CONCRETE EXT. WALLS INT. WALLSI CEILING STUCCO SHEETROCK SHEETROCK ROOF HEATING FIREPLACES COMP SHINGLE NATURAL GAS METAL IMASRY WATER PUBLIC (PUBLIC SEWER I MI00000EPTHI S 000100I0000EI NEW/REPAIR i COMMENTS 01/31/92 EXTENDING FAMILY ROOM,ENLARGING MASTER BEDROOM, ADDING BEDROOM. PRE ALTER DONE BY BRUCE HEWARD. D.FLETES. AMTJWAIVED .00 AMT PAID 263.00 PAYOR NAME• ROBERT CIRA PAID 01/31/92 PECEIPT 281 EMPL: FLETS, DEBORAH PAYD1B" : CHECK NBR : 471 •ICENSED CONTRACTORS DECLARATION 0 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 CLAQLICENSE NUMBER CONTRACTOR 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 T E BASIS FOR THE ALLEGED EXEMPTION ANY VIOLATION OF SECTION 7031 5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO A CIVIL PE TY OF NOT MORE THAN FIVE HUNDRED DOLLARS [$5001 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 C�B AND P C FOR THIS REASON \i/WNER e-4)71.-An DATE / I / U (/ 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) POLICY NO COMPANY ❑ CERTIFIED COPY IS HEREBY FURNISHED ❑ CERTIFIED COPY IS FILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT APPLICANT DATE ADDITIONAL REVISION c, 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 ISA CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV C 1 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 TO BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPEC ION PURPOSES k.,....(.!GNATURE OF APPLICANT OR AGENT /32.! oC�Q/ ti /l.(� DATE / 3/'- / 3 U U 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 12-17588-489 Rev 4/90 s , ; Owner Name c_( g_A- • Permit Numb. /a07aool&/ c)n-s-7 INSPECTION RECORD DATE I INSPECTOR I I DATE INSPECTOR Setback p 2g#52 (J & �}� Rough Plumbing /6-k ., ,4 q-,27--f - 0�f/ Temporary Power I Shower Pan Test Foundation Reinforcing Steel >2'24 Stucco Mesh or Exterior Siding {-aQ-g aL Excavation and Forms -24 57 Insulation F.H A Foundation Req. n Sewer Slab Grade 2,.-U -92 �� Interceptor Ground Plumbing Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service Fireplace Foundation Lath or Drywall Nailing //-q7" 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. , IV Final Bond Beam Final Construction \. W 7 Fireplace Bond Beam Final On Site Improvements .AiL 7 ti V Roof Sheathing Final Off Site Improvements 0, `1( Framing and Ventilation ,�R-/ r1/v R A i7 Final Dedication AV c_49-71,-,f7 Roof Covering y-�- � Final Zoning , Rough Heating /vZ Final Electrical / Electrical Service and Ground Final Gas Rough Electrical V- is 7 - Developer Fees Paid WC (YIN) Ind Saf (YIN) Certificate of Occupancy / - 5- 9'2- ( .i( ,, .7.,_t:," a C-,-, c_A ,. ��ty9o- CN-vv-. (<4-6 --nS U ( )7 . n 4 /I ova - -i ,,4-'l d v ODIC UVIVo -Li. ' . rJ ARIL 11/^_(e' ^/e7 L. °7(/-/ SEPTIC TANK GALS. U SEEP. PIT X LEACH LINF WIDF X LONG X DEPTH OF ROCK N. , W E /1 II n I I 1\ 11 \\ ill (l. 1 /IA l / S Inspector's Signature and Initials 1(.4 .iii: //T'J2l • a 12-17589-469 Rev 3/88 County of an Bernardino Date v 1 / .v.` / 9 • EPWA/Land Management Department S OFFICE OF BUILDING AND SAFETY C PREALTERATION REPORT Owner/sr-f- ,...,_row...„rTI— Permit No ' 'I Job Address 355 --L5 Ii ._ _/ Lr-- , Area 0---k- 11/ 1-4t Work to be done (Specify use) 21) t)'I I) / - INSPECTOR COMPLETE THIS SECTION - ØSID L ElNONRESIDENTIAL ENERGY REQUIREMENTS. ►\ Addition ❑ Alteration RESIDENTIAL Area of E 'sting Building Y,.es No V N xi Existing Type of Construction ❑ Special Package "A" Existing/Previous Ug to $ ❑ ❑ Other Copl'ance Method Proposed UsP �. Insulaes• Walls i- I I Celina re— 3 d No of Stories I With Addition/Alt Floor_"),/A Shading Coefficient ❑ Bring Existing Structure to Code &! Ingle Glaz'ng_LD / Ail L l I 41 ,rkp,,C %/S F A At igbNONRESIDENTIAL PERMITS, PLANS OR REPORTS REQUIRED Yes No Construction of Original Building X ❑ CONSTRUCTION PERMIT ❑ Before January 1, 1987 ❑ After January 1, 1987 ❑ ❑ COMPLETE CONSTRUCTION PLANS Yes No ❑ ❑ ABBREVIATED PLANS (ENERGY O LY) / ❑ ❑ New/Altered Mechanical Es • ent .NiJ ❑ TRUSS ENGINEERING/LAYOUT 1k 1.45e4- ❑ ❑ New/Increased Coni- ed Lighting ❑ ❑ REPRODUCIBLE PLOT PLAN ❑ ❑ New/Increas•: azing X ❑ EROSION CONTROL PLAN AND APPLICATION ❑ ❑ New/• -red Conditioned Building Envelope ❑ ❑ GRADING PERMIT AND PLAN ❑ ❑ • •propr'ate Energy Analysis Forms and Proof of ❑ IllPRECONSTRUCTION INSPECTION PERMIT/REPORT Compliance Will Be Required CI PRECONSTRUCTION PLOT PLAN ❑ ❑ Other ❑ ❑ STRUCTURAL CALCULATIONS FOR THE FOLLOWING ZONING/LAND USE. Yes No ❑ ❑ MECHANICAL/ELECTRICAL/PLUMBING PLANS ❑ ❑ Minor Variance Required ❑ ❑ OTHER ❑ ❑ Other Land Use Actio ❑ ❑ Planning Area u'rements See A e'l jN — I 111 1=1 and Overlay Requirements • ---,-_, -:7....' .-,.�X i See Attached PSetbacks and Land Use issues shall be as determined in the San 3 A.,--PJ i«.:1_ Bernardino County Code Refer to permit application for further • 4411.01. 4/ information (t- 12-, OTHER INFORMATION• i re`,-��'� • Yes No (;$ 10 ❑ Nt. School Fees or C 0 C Required 1L. r I, �❑ " Dept of Environmental Health Services Approval Required t ❑ �1 Additional Parking Spaces Re red xr ❑ Add Light arul Ventilatio V Sq Ft I Location -��- 4 :1-2......... 1.C/13:1;" ❑ Foundation. �nt'nuou�Plers NOTE:All work must conform to current codes Existing mechanical, /� ;:-V) electrical and plumbing systems must be up to Code if they will be a / part of proposed addition, alteration and/or new use or occupancy. Describe def'c nc'es or I/ ormat'on ne essary for ompll ce0 / n INSPECTED BY Q 4.4.4.tt #1,44/401---1/ DATE ! / 36/ / ' ESTIMATED VALUATION/FACTOR DISTRIBUTION White - Office 1e-6062-489 Rev 9/89 — THIS REPORT MUST BE ATTACHED TO ANY REQUIRED PLAN - Canary - Owner/Contractor • • OWNER-BUILDER VERIFICATION SAN BERNARDINO Attention Property Owner An "Owner-Builder" building permit has been applied for in your name and bearing your signature Please complete and return this information to avoid unnecessary delay in processing and issuing your building permit No building permit will be issued until this verification is received. 1 I personally plan,�to/provide the major labor and materials for construction of the proposed property improvement IQ Yes ❑ No 2 I (have or have not) x signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed work. Name Address Contractor's License No City State Zip Phone 4 I plan to provide portions of the work, but I have hired the following person to coordinate, supervise, and provide the major work. Name Address Contractor's License No. City State Zip Phone _ _ 5 I will provide some of the work but I have contracted (hired)the following persons to provide the work indicated: Name Address Phone Type of Work Name Address Phone Type of Work Name Address Phone Type of Work Signed. Property Owner . . �� V._O l_ ( 1/L,a Date /—• 3 /-9 2._ Please complete this information and return to the San Bernardino County Building and Safety Department listed below that will be issuing your permit: • 301 E. Mt. View Avenue — Barstow, CA 92311 — (619) 256-4750 • 477 Summit Blvd. — P O. Box 2835 — Big Bear Lake, CA 92315 — (714) 866-4115 • 57404 Twentynine Palms Outer Highway South — Yucca Valley, CA 92284 — (619) 228-5430 • 320 E. "D" Street — Ontario, CA 91764 — (714) 391-7500 • 385 No. Arrowhead Avenue — San Bernardino, CA 92415-0181 — (714) 387-4244 • 26010 State Highway 189 — P.O. Box 185 — Twin Peaks, CA 92391 — (714) 336-0640 • 15505 Civic Drive — Victorville, CA 92392 — (619) 241-7691 • 34282 Yucaipa Blvd. — Yucaipa, CA 92339 — (714) 790-3158 12 17627-487 Rev 9/91 Page 2 of 2