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Permit No. 1058802764 I • 105 SAN BERNARDINQ.COUNT -EPWA/LAND AGEMENT DEPT OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 88 02764 P10A 01 I PAGE 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 08/13/88 ISSUE DATE 00/00/00 PARCEL NUMBER 1023-371-21-0000 • PROPOSED USE: PRE-ALTER PATIO/GAS T ELEC SPA CURRENT USE: RESIDENCE 12581TRAC BLK LOT SEC TY : T 1000 1057 I SNOB I p2 RNG PRCL 00AP I PRCLOCCTOMIMWJITY PLANL873 ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVIISION PARCEL NO CHINO HILLS CH/PUD LOT DIMENSION IRREGULAR CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *BOGS ON LOT 1 (GROUP R3 SHORT, RICHARD A. 13426 HOWENDY CRESCENT . *PLANS RECD 0 LAND USE PLOT 0 INDEX NBR 31-134 CHINO HILLS CA 91709-0000 STD PLAN/ICBO FHA (714) 590 - 8559 GRADING INITIAL ACTUAL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER CU.YDS EXC. SHORT, RICHARD A. CU.YDS. FILL 13426 HOWENDY CRESCENT . CHINO HILLS CA 91709-0000 ITEM CNT DESCRIPTION DETAIL TOTALS (714) 590 - 8559 JOB SITE ADDRESS 13426 HOWENDY CRESCENT . CHINO HILLS CA 91709-0000 CROSS STREET MITCHELL DRIVE INSPECTN ACCESS CONTRACTOR NAME LICENSE NUMBER MAILING ADDRESS, PHONE NUMBER MINIMUM SETBACK DISTANCES 45 FRNT SETBACK/CENTRLINE HOWENCY CRESCENT R/W 50 15 REAR SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES I NO.UNITS WELLING I NO. BEDROOMS I FLOOR EXT. WALLS I INT. WALLS CEILING ROOF I HEATINGIMFIAL FIREPLACES WO MASRY PWAATER TIR I SEWER I MIN000 000 DEPTH DEPTH' S.F./1001 000OSIZEI NEW/REPAIR COMMENTS I3 AMT WAIVED .00 AMT PAID .00 PAYOR NAME. SHORT, RICHARD A. PAID 08/19/88 RECEIPT • 3015 EMPL: GUTIERREZ, BRUNO LICENSED 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 LICENSE CLASS LICENSE 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 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] 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 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) POLICY NO COMPANY ❑ CERTIFIED COPY IS HEREBY FURNISHED ❑ CERTIFIED COPY IS FILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT 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' 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) 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, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES SIGNATURE OF APPLICANT OR AGENT u DATE EXPIRATION NOTICE APPLICATIONS FOR WHICH NO PERMIT IS ISSUED IN 180 DAYS FOLLOWING THE DATE OF APPLICATION LL EXPIRE,EVERY PERMIT SHALL EXPIRE IF WORK DOES NOT COMMENCE WITHIN 180 DAYS OF IS E OF SUCH PERMIT OR IF THE WORK IS SUSPENDE BANDONED FOR A PERIOD OF 180 DAYS, FEES PAID ARE NOT REFUNDABLE AFTER ONE YEAR FR ATE OF PAYMENT, ALL FEES PAID MAY NOT BE RE ABLE 12-17588-469 Owner Name02-A Permit Numbs fl8g 7<oCf / INSPECTION RECORD DATE INSPECTOR DATE INSPECTOR Setback 9—f-4 Rough Plumbing Temporary Power Shower Pan Test Foundation Reinforcing Steel Stucco Mesh or Exterior Siding Excavation and Forms Insulation F H A Foundation �R7eq G Sewer Slab Grade ,FibZ (3 4•7•9d 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 V-6? Fireplace Bond Beam Final On Site Improvements Roof Sheathing Final Off Site Improvements Framing and Ventilation `'a-1f� Final Dedication Roof Covering Final Zoning Rough Heating Final Electrical Electrical Service and Ground Final Gas Rough Electrical Developer Fees Paid WC (YIN) Ind Saf (YIN) Certificate of Occupancy SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDE X LONG X DEPTH OF ROCK N A ts>,tvp, a, U 1 Pt Nn rift TE. k W E kta* ec "!J 1 S Inspector's Signature and Initials tom' 12 17589-469 Rev 3/88 _ • County of San Bernardino • Date Rec'd EPWA/Land Management Department By OFFICE OF BUILDING AND SAFETY PREALTERATION REPORT Applicant Complete This Section Owner's >t-I O2T. 't\ �G 14AA . Address Job Address 1?4zee, -440WENO Y 09--E J i Lot,Tract and APN Work to be done(Specify use)R tTI /6A-S--ELECT QIC FOQ SQA Index No Inspector Complete This Section LTJ' RESIDENTIAL ❑ NONRESIDENTIAL ❑ Citation/Stop Order Issued (Date ) ❑ Addition ❑ Alteration ❑ Plans Required ❑ Brown Line Plot Plan Area of Existing Building ❑ Bring Existing Structure to Code Existing Type of Construction ❑ Insulation Walls , Ceiling Floor Slab Wood Existing/Previous Use ❑ Glazing %/S F — Dual/Single ❑ Shading (West) (South) No of Stories With Addition/Alt Overhang (South) ❑ Required Foundation Continuous/Piers Plans Required ❑ Firewalls/Firedoors ❑ Brown Line Plot Plan ❑ Add Light and Ventilation Sq Ft ❑ Floor Plan of Existing Building/Area Location ❑ Architectural and Structural Plans ❑ No of Stories With Addition/Alt. ❑ Structural Calculations for the following ❑ Other ❑ Mechanical/Electrical/Plumbing SITE PLAN 1 ❑ Other CEC Title 24 _ ❑ Forms 1 , 2 & 3 on Modified Bldg Envelope ❑ Forms 4 & 6 on New Mechanical Equipment ❑ Form 5 on all Proposed Lighting ❑ Forms on all Changes of Use or Occupancies ❑ Other NOTE Existing mechanical, electrical and plumbing systems must be up to Code if they will be part of proposed addition, alteration and/or new use or occupancy Describe deficiencies or information necessary for compliance % 4Q1.011,0.e P70-iisIT 07.P<14 /16 4.411..0 z.—c %o e- /ie /iP `,vad-R $ y4/1•w / 1Ze'/kv/ et.C6Wied1k3 . L r I I L! A �(! n t �I P R1C C` .Sems.�p fl/ . r_AIL 2, L JDA . 715 [Qd S004444:141, Inspected By Date4%,0_2_/- gEstimated Valuation THIS REPORT MUST BE ATTACHED TO ANY REQUIRED PLAN FOR OFFICE USE YES NO Zoning , G P Minor Deviation/Site Approval Required ❑ ❑ Setbacks Front_ ) DISTRIBUTION White — Office On-Site Parking Spaces Required ❑ ❑ Sides __ Canary — Owner Curbs and Gutters Required LI CI Pink — Contractor . 15-6062-469 Rev 8/85