Loading...
Permit No. 1069101279 1 _ 106 SAN BERNARDINO COUNTY-EPWA/LAND AGEMENT DEPT - OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 106 91 01279 201A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 10/03/91 I ISSUE DATE 10/03/91 I PG 1 OF 1 PARCEL _0 ( 1 6? -,aCil PROPOSED USE: RESIDENCE CURRENT USE: VACANT 14924TRACT 1000 10104 LI SEC SW20 I p'2 10� I PRCL MAP I PRCL ACTIVITY : L831 0 0 COMMUNITY PLAN ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/PD,IL1,FR1, M-H 14924 PLAN 2 10/03/91 1017-151-39.0000 LOT DIMENSION CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER $BLDGS ON LOT GROUP R3 BROCK HOME CAP CORAL RIDGE 3380 SHELBY ST *100 *PLANS RECD 0 LAND USE PLOT 0 INDEX NBR 25-149 ONTARIO CA 91764-0000 STD PLAN/ICBO FHA N (714) 583 - 1061 OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN BROCK HOME CAP CORAL RIDGE 1 895 1.00 895.00 3380 SHELBY ST $100 2 870 1.00 870.00 ONTARIO CA 91764-0000 GAR 494 .50 247.00 (714) 583 - 1061 PORCH 30 .20 6.00 JOB SITE ADDRESS CALC. VALU 97,691.38 I ADJUSTED AREA 2018 2597 PASEO TORTUGA . CHINO HILLS CA 91709-0000 ITEM CNT DESCRIPTION DETAIL TOTALS CROSS STREET CALLE MADRID RESIDENTIAL CONSTRU 1,240.00 INSPECTN ACCESS TOTAL AMOUNT 1,240.00 CONTRACTOR NAME, ADDRESS LICENSE NUMBER BROCK M J T SONS INC CONT000054648 6767 FOREST LAWN! DRIVE. LOS ANGELES . ' CA 90068-0000 (000) 000 - 0000 ' DIV. OF IND. SAFETY PERMIT: MINIMUM SETBACK DISTANCES 43 FRNT SETBACK/CENTRLINE PASEO TORTUGA 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 I NO. BEDROOMS I SID2E SET ONTARIO EXT. WALLS I INT. WALLS CEILING STUCCO SHEETROCK I SHEETROCK ATED T -E �Z 1 -9 2........".."."'".ROOF HEATING FIREPLACES - ` TILE NATURAL GAS 'METAL 01 IMASRY //WATER Y PUBLIC (PUBLIC SEWER I MIN 000EPTHI S 000100'0000 SIZE' NENEWEPAIR COMMENTS AMT WAIVED .00 AMT PAID 1,240.00 PAYOR NAME: BROCK HOMES PAID 10/03/91 RICEIPT : 00004048 EMPL: FLETS, DEBORAH PAID BY • CHECK NBR : 3496 I 0.ICENSED 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 LICENSELIIS IN FULL FORCE AND EFFECT/ �/J r /�,�/� �j l LICENSE CLASS -* LICENSE NUMBER]+v V CONTRACTOR ♦ •�/- 4'vO&6ATE /4i7fr 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]) ❑ 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 POLICY NO COMPANY ❑ CERTIFIED COPY IS HEREBY FURNISHED A CERTIFIED COPYFILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT APPLICANT �— DATE /% k / • ADDITIONAL RE ON CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS 1$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 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 INSPECTIO P SES SIGNATURE OF APPLICANT OR AGENT DATE 0/0/ 710/ EXWATION 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 4/90 Owner Name 4VA S Permit Num111 - 1 - ,9--,e7/11i44/ INSPECTION RECORD DATE I INSPECTOR I I DATE I INSPECTOR Setback /p - 11- q/ Rough Plumbing Temporary Power Shower Pan Test Foundation Reinforcing Steel ,,' % I \ Stucco Mesh or Exterior Siding r Excavation and Forms n•..2:->''' (12/11.) Insulation/r(-)ck) 11-30_ I- L - S a 14"/ F H A Foundation Req Sewer(,t✓WR'7 S 13 7 7 7 /— s 3 — 2. Slab Grade Interceptor I Ground Plumbing 74?-3 S t o-2/ - 9 / Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service J"f V L I— / 3 - ? -- Fireplace Foundation Lath or Drywall Nailing 1 - f-rj'a- �7 -3J Joists and Girders Gas Line Air Test I - 3'0-5/.. • i4 Electrical Ground IA.T— /O- 2/-1/ C--irt,1 Final Energy /://A I Mid-Height Bond Beam Final Plumbing /x i1 j,7 8-Foot Bond Beam Final Heating/ -7 /.11P 1 Final Bond Beam Final Construction V Fireplace Bond Beam Final On Site Improvements Roof Sheathing p,‘,. /I 4 Final Off Site Improvements Framing and Ventilation 411 / Final Dedication Roof Covering �� ` Final Zoning ' Rough Heating Final Electrical /p,ti� r Final Gas 2,.....,..% q- 4.**K--------- �'/ ii Electrical Service and Ground , l �— Rough Electrical / Developer Fees Paid WC (YIN) --- Ind Safr(Y/N) __ - --Certificate-of Occupancy -- 1j• 7 ='' -- --- i- - / 2 -/0 - / S _K_ -- 0 14 uomptFTED 5 I to SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDF X LONG X DEPTH OF ROCK N W E S Inspector's Signature and Initials 49,4 -l.00• Ali-.rx.o" /3-14- 12-17689-489 7112-17689-489 Rev 3/88