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Permit No. 1058802764 (4) 105 SAN BERNARDINO COUNTY-EPWA/LAND AGEMENT DEPT • OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 88 02764 T10A 01 I PAGE 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED ADPL DATE 08/33/88 ISSUE DATE 08/31/88 PARCEL NUMBER 1023-371-21-0000 PROPOSED USE: PRE-CONST INSP - PATIO CURRENT USE: RESIDENCE TRAC LOT SEC NG TY : 125817 1000 1057 I SW08 I � 0088W PRCL 00AP I PRCL CCTOMIMIVAIJITY PLANL874 ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/PUD LOT DIMENSION IRREGULAR CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *SLOGS 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 N (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 TYPE I SQ. FT. I FACTOR/P.S.F. ADJSTED AREA/VALUATN (714) 590 - 8559 PORCH 750 .20 150.00 JOB SITE ADDRESS 13426 HOWENDY CRESCENT . CALC. VALU 6,300.00 I ADJUSTED AREA 150 CHINO HILLS CA 91709-0000 CROSS STREET MITCHELL DRIVE ITEM CNT DESCRIPTION DETAIL TOTALS INSPECTN ACCESS PRE-CONSTRUCTION IN 16.00 TOTAL AMOUNT 16.00 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. DWELLING I NO. BEDROOMS I FLOORO UNITEXT. WALLS I INT. WALLS I CEILING ROOFHEATING FIREPLACES WO I METAL IMASRY PUBLIC WATER I SEWER I MIN NODEPTHI S.000 100I0000EI NEW/REPAIR COMMENTS AMT WAIVED .00 AMT PAID 16.00 PAYOR NAME: RICHARD A. SHORT PAID 08/31/88 RECEIPT 3209 EMPL: STACCATO-NYARI, M eICENSED 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 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,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 I 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 [$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 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) 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 DATE 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 12-17588-469 F ` County of San Bernardino 'm/4`/LAN0MANAGEMENT 0EPARTK8E. OFFICE OF BUILDING AND SAFETY PRE-CONS PRE-CONSTRUCTION INSPECTION REPORT Owner(s) ~�ff0��T �~� (��H Are6 . Permit No Application Date I �_^��� �_[_ �� r�\ / / Job Address -�—r^-w� ' ,, uu��J�1�� ��/�������E�/u7— L—�� /m�c� ��/c_L-4z; A.P.N. ID 2:3 -- 3-7/ — 2. I Net Lot Area Person to Notify Phone No ( • Mailing Address INTER-OFFICE ROUTING/FOR OFFICE USE TECHNICIAN COMPLETE THIS SECTION To Regional Office From Regional Office When complete send to ���� *o-TA 0-, Regional Office ~�� concurrently?Erosion control plans submitted [� . Yes �z /vu Building or grading plans submitted concurrently? Yoo This is in conjunction with what type of application or use? �-/f7C {] PLANT PROTECTION AND MANAGEMENT INSPECTION INSPECTOR COMPLETE THIS SECTION Total number of native trees or plants on property . . . . . . . . Number of native trees or plants approved for removal . . . . . . . . . . . . Number of native trees or plants approved for transplanting . . . . . . . . . „ . . . Number of trees or plants approved for stockpiling . . . . . . . . . . . . . �� �i" No native trees or plants on the property subject to the provisions of this ordinance. (Check only if applicable) Conditions and/or comments The findings for removal for the protected trees and plants that may be removed on the above-describedproperty, subject to the conditions and/or comments as ehovvn, have been made in accordance with the San BernardinoCounty.Codo' T�|n8' Division 11. " DATE g ~;"2~ g APPROVED BY der2•17 Approval does not constitute mpermit toremove trees mrplants unless inconjun��imnwith onapproved land use application or development permit. FLOOD HAZARD INSPECTION INSPECTOR COMPLETE THIS SECTION Yeo There is evidence of a discernible watercourse which could affect or could be affected by the proposed improvements or land-disturbing activity. A Flood Hazard Development Review and approved plans are required in accordance with County Code Section 84.0330 prior to the approval of a development permit. Yes No ALTERNATE METHOD OF APPROVAL | | . , /n lieu of the Flood Hazard Development Review required above, a discernible watercourse exists onsite which may be mitigated by one or more of the following measures(s): | - I ' Elevate �ho building pad inches above the existing natural ground level. Move the proposed land-disturbing or construction activity to avoid obstructing the watercourse. 0 Protect the slope(a) adjacent to the watercourse from erosion. - [ / Other Conditions and/or comments v . DATE ���~�«��~�� �� APPROVED BY 8 �� 0'�