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Permit No. 1058800335 1110 11;5 SAN BERNARDINO COUNTY-EPWA/LAND *GEMENT DEPT OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 88 00335 201A 01 I PAGE 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 01/26/88 ISSUE DATE 01/27/88 PARCEL NUMBER 1023601170000 PROPOSED USE: RESIDENCE/MOD 3-PERMIT CURRENT USE: VACANT • TRACT BLK LOT I SEC 1pW1 UW1 PRCL MAP I PPRCLI COMMUNITY PLAN ZONE/LAND DISTRICT( GENERAL 1324 000 023 SE07 SCHINO HILLS CH/PUD S SUBDIVISION NAME SUBDIVISION PARCEL NO LOT DIMENSION IRREGULAR (CONST TYPE VN TR 13249 MOD 3 01/26/88 *BUGS ON LOT GROUP R3 - APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 131-22 RICHMOND AMERICAN STD PLAN/ICBO FHA N 1 PARK PL IRVINE CA 92714-0000 GRADING INITIAL ACTUAL (714) 474 - 1001 CU.YDS. EXC. CU.YDS. FILL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER RICHMOND AMERICAN TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN 1 PARK PL IRVINE CA 92714-0000 1 1378 1.00 1378.00 (714) 474 - 1001 2 1171 1.001171.00 GAR 619 .50 310.00 JOB SITE ADDRESS PORCH 52 .20 11.00 13091 SAN RAFAEL DR • CHINO CA 91710-0000 CALC. VALU 120,540.00 I ADJUSTED AREA 2870 CROSS STREET CHINO AVE INSPECTN ACCESS ITEM CNT DESCRIPTION DETAIL TOTALS RESIDENTIAL CONSTRU 920.50 TOTAL AMOUNT 920.50 CONTRACTOR NAME LICENSE NUMBER MAILING ADDRESS, PHONE NUMBER MINIMUM SETBACK DISTANCES 49 FRNT SETBACK/CENTRLINE SAN RAFAEL DRIVE 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 1 FLOOR 2 UNITS 1 4 CO EXT. WALLS I INT. WALLS CEILING ST SH SH ROOF 1 HEATING FIREPLACES TI NA METAL 01 IMASRY PUWATER BLIC (PUSEWER BLIC I MIN 000EPTHI S.F./100I0000SIZEI NEW/REPAIR COMMENTS CHINO VALLEY MGR OFFICE LETTER ON FILE. C OF C ON FILE WITH COUNTY OF SAN BERNARDINO. AMT WAIVED .00 AMT PAID 920.50 PAYOR NAME: RICHMOND AMERICAN PAID 01/27/88 RECEIPT : 04676 EMPL: RICHARDS, GARY 1111 • 4110-ICENSED CONTRACTORS DECLARATIONS , 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 o 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 [$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, TH WNER-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) ❑ IAM EX PUU DER SEC (i1 B AND P C FOR THIS REASON /,/� OWNER 4 ` DATE // 7/�"% // / ORKERS'// '/ /COMPENSATION DECLARATION I H EBY AFFIRM THAT I AVE 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 DATF 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 PERFORMANCE OF THE RK FOR WHICH THIS PERMIT IS ISSUED,I SHALL NOT EMPLOY ANY PERSON I ANY MA NER SO AS TO BECOME " SUBJECT TO THE •'K,RCOMEATIO WS OF CALIFORNIFy� J APPLICANT Y� DATF /l �` NOTICE T LICANT IF, AFTER M I THIS CERTIFICATE XEMPTION,YOU SHOULD BECOME SUBJECT TO THE WORKER COMPENSATION PROVISIONS OF THE OR CODE, YOU MUST HWITH COMPLY WIT UCH PROVISIONS OR THIS PERMIT SHALL BE DEEMED REVOKED CONSTRUCTION LENDING AGENCY I HEREBY AFFIRM THAT THERE Ivi ///���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 BEMORETHAN 36 FEET HIGH L 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 APPLICATIO - D STATE THAT THE ABOVE INFORMATION IS CORRECT, I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING T& BU DIN CONSTRUC ON, AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COU TY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPEC ON 'URP SES SIGNATURE OF APPLICANT OR AGENT c DATE / Z7/f // // // - / / , EXPIRATI OTICE r APPLICATIONS FOR WHICH NO PERMIT IS ISSUED WITHIN 180 DAYS FOLLOW G THE DATE OF APPLICATION SHALL EXPIRE,EVERY PERMIT SHALL EXPIRE IF WORK DOES NOT COMMENCE WITHIN 180 DAYS OF IS CE OF SUCH PERMIT OR IF THE WORK IS SUSPENDEEABANDONED FOR A PERIOD OF 180 DAYS, FEES PAID ARE NOT REFUNDABLE AFTER ONE YEAR F DATE OF PAYMENT, ALL FEES PAID MAY NOT BE R ABLE 12-17588-469 o23 • INSPECTION RECORD - = Permit Number/O =8g-O653S-2O/A-O/ DATE INSPECTOR I I DATE I INSPECTOR Setback flieg ' r , Rough Plumbing I ,�I ,�� Temporary Power . / / Shower Pan Test to,...T/'°- I j�Foundation Reinforcing Steel Stucco Mesh or Exterior Siding Excavation and Forms ,, Insulation Q-9 f 4s -- F H A Foundation Req. Y7 Sewer Slab Grade 7 / Interceptor Ground Plumbing SLA-6s; , Septic Tank Underslap Ducts 40 J ,5-•Ji-gar 1r— Leach Line or Seep Pit Underslab Conduit Water Service Fireplace Foundation Lath or Drywall Nailing IR-/9 ► r' L -5 !r*. Joists and Girders Gas Line Air Test ,9- - Electrical Ground t/1 /X., St M.-g fes r . Final Energy I / Mid-Height Bond Beam Final Plumbing I / 8-Foot Bond Beam Final Heating/A C I �, / Final Bond Beam Final Construction I jIPP Fireplace Bond Beam Final On Site Improvements I ,N �, Roof Sheathing 1 Final Off Site Improvements I el , / Framing and Ventilation / Final Dedication 11v Roof Covering 47" I y' Final Zoning II Rough Heating I 10,7°' Final Electrical I / Electrical Service and Ground /4 I C7 Final Gas y Rough Electrical I/- I/ Developer Fees Paid I I Certificate of Occupancy I I WORKERS' COMPENSATION INSURANCE (Y/N) DIVISION OF INDUSTRIAL SAFETY PERMIT (Y/N) • rt MIT UM" SEPTIC TANK GALS Vh'Ye BV SEEP PIT X CO .6' DLETEf ` LEACH LINE WIDE n i X LONG X - DEPTH OF ROCK ATE. �Jg...// j N �-' � W E !iief.44..0wei ii . S Inspector's Signature and Initials , U 12-17589-489