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Permit No. 1058903691 „( 5-S�N BERNARDINO COUNTY-EPWA/LAND AGEMENT DEPT - • 10 OFFICE OF BUILDING AND SAFETY PERMIT APPLICATION PERMIT NBR 105 89 03691 201A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 10/31/89 I ISSUE DATE 11/02/89 I PG 1 OF 1 PARCEL NUMBER /. 7'©/ -6 3 PROPOSED USE: RESIDENCE W/GARAGE / -2. CURRENT USE: VACANT 1TRACT2I BIK000 I LOTT I SEC SEC5 I ' I oN I PRCL MMAP I PRCL ACTIVITY : L831 COMMUNITY PLAN ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/SD/DVU 13507-2, PLAN 4 10/31/89 1017-231-32-0000 LOT DIMENSION VARIES CONST TYPE APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *BUGS ON LOT GROUP AHMANSON DEVELOPMENTS INC - K. MOTES 1123 S PARKVIEW DR 360 $PLANS RECO 0 LAND USE PLOT 0 INDEX NBR 50-164 COVINA CA 91724-0000 STD PLAN/ICBO FHA N (818) 915 - 8371 TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER AHMANSON DEVELOPMENTS INC - K. MOTES 1 1282 1.00 1282.00 1123 S PARKVIEW DR 360 2 1178 1.00 1178.00 COVINA CA 91724-0000 GAR 425 .50 213.00 (818) 915 - 8371 PORCH 120 .20 24.00 JOB SITE ADDRESS CALC. VALU 121,365.00 I ADJUSTED AREA 2697 16479 PATINA CT CHINO CA 91710-0000 ITEM CNT DESCRIPTION DETAIL TOTALS CROSS STREET AGATE ROAD RESIDENTIAL CONSTRU 1,109.88 INSPECTN ACCESS TOTAL AMOUNT 1,109.88 CONTRACTOR NAME, ADDRESS LICENSE NUMBER AHMANSON DEVELOPMENTS INC CONT000465688 1123 SOUTH PARKVIEW DR STE 360 COVINA CA 91724-0000 (000) 000 - 0000 ACTIVE WORKERS COMP - DIV. OF IND. SAFETY PERMIT! _ _ _ _ _ _ _ __ --- MINIMUM SETBACK DISTANCES *** PER PLOT *** MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES I NO.UNIT2DWELLING I NO. BEDROOMS I CONCRETE4 E EXT. WALLS I INT. WALLSI CEILING STUCCO WOOD SHEETROCK ROOFHEATING FIREPLACES TILE I NATURAL GAS METAL 02 IMASRY WATER PUBLIC (PUBLIC SEWER I MIN 000EPTHI S'000100I0000EI NENEWEPAIR COMMENTS AMT WAIVED _ .00 AMT PAID 1,109.88 PAYOR NAME: AHMANSON DEVELOPMENTS, INC. PAID 11/02/89 RECEIPT : 00006272 EMPL: STACCATO-NYARI, M PAID BY : CHECK MBR : 786 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 EF CT Qp LICENSE CLASCC LICENSE NUMBER "' CONTRACT75df/h4"' /DATE d/5U/C 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 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 1 POLICY NO COMPANY ❑ CERTIFIED COPY IS HEREBY FURNISHED ❑ CERTIFIED CO IS WITH TH C TY BUILDING INSPECTION DEPARTMENT APPLICANT DATE /77 goer v - ti 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 DATF 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 I 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 BUILDI . CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COU TY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTIO ' SES / �f Q SIGNATURE OF APPLICANT OR AGENT :/ \ DATE CC Lam' cY 1 v i v / / 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 Name - ' Permit Numki09~0969/...%10//4-0/ PIVSPECTION RECORD /.5-- DATE INSPECTOR I DATE I INSPECTOR_ Setback I/p. Rough Plumbing r Temporary Power 'I Shower Pan Test . '711.0, 111/-*- Foundation Reinforcing Steel i-V-a7 ,* ,;- Stucco Mesh or Exterior Siding Excavation_and Forms .- 7-.:111171- Insulation a I . / .��r'i;i i!/' ' I( - ' / Sewer /3 /412- _el' '" lab Grade I/- --�v 1e cc, ,„/...n Interceptor Ground Plumbing, - A' IF Septic Tank Underslab Ducts - .07. r//i Leach Line or Seep Pit Underslab Conduit r/�-/' .3 - Water Service Eastgacp Fnlindatap ("a / _ --- a Lath or Drywall Nailing a'2s".* 14ia" Joists and Girders I Gas Line Air Test ' ZS�-' �' 1, Electrical Ground (y./ev rf.n 40N Final Energy Mid-Height Bond Beam Final Plumbing if J 8-Foot Bond Beam I Final Heating/A C ..0 Final Bond Beam I Final Construction VV Fireplace Bond Beam I Final On Site Improvements (_' Roof Sheathing I Final Off Site Improvements — .41/---- Framing and Ventilation ♦- A 4 / ) Final Dedication (Al Roof Covering ^Ill I / *Fr Final Zoning Rough Heating , / V I e.,--1 Final Electrical / Electrical Service and Ground (4 I Final Gas Rough Electrical I f Developer Fees Paid / / WC (Y/N) - Ind Saf (Y/N) Certificate of Occupancy —9 - c Ay o v Si .0ti - a , e C-- c--4 P-e. • LT -40 OGv Il/Lei 4..ig‘-5 SEPTIC TANK GALS SEEP PIT X LEACH LINE WIDE X LONG X DEPTH OF ROCK N W E Air 7t' ,A$ . - ilf '- v. ,, . n ,. S Inspector's Signature and Initials 'V`'3 12-17589-469 Rev 3/88