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Permit No. 1058800337 4111 1105 SAN BERNARDINO COUNTY-EPWA/LAND GEMENT DEPT OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION I PERMIT NBR 105 88 00337 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 1023601220000 PROPOSED USE: RESIDENCE/MOD 3-PERMIT CURRENT USE: VACANT TRACT BLK LOT SEC I ' I RNG I PRCL MAP I PRCL COMMUNITY PLAN ZONE/LAND USE DISTRICT GENE PLAN 1324 000 08SE07 CHINO HILLS DRES-2 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/ICBG 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 1.00 1171.00 GAR 619 .50 310.00 JOB SITE ADDRESS PORCH 52 .20 11.00 13092 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 43 FRNT SETBACK/CENTRLINE SAN RAFAEL DRIVE R/W 50 15 REAR SETS".L'::/PRO° !IMF 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 FLOOR 2 UNITS 1 4 CO EXT. WALLSINT. WALLS CEILING ST ISH 1SH TI ROOF INA HEATING FIREPLACES IMASRY ONTARIO NTARIO \ a 1METAL PUWATER BLIC (PUBLIC I MI000EPTHI S'000100I SIZ000EI NEW/REPAIR C O P L t i t U CNTS HINOS VALLEY MGR OFFICE LETTER ON FILE. DATE://-; ,.��L .� 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 • •ICENSED CONTRACTORS DECLARATION S �_ 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 [5500)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 CONTRACTORS) 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 ❑ 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 ($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 ISA CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC 3097,CIV C LENDER'S NAMF 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- 11 p ' , ❑ I CERTIFY THAT NO EXCAVATION 5 FEET OR MOR_E,FEET IN DEPTH, INTO WHICH A PERSON IS REQUIRED TO DESCEND,WILL BE MADE IN CONNECTION WITH WORK AUTHORIZED BY THIS PERM)T,AFID TI-AT NO`-BUILDING,STRUCTURE,SCAFFOLDING,FALSEWORK,OR DEMOLITION OR DISMANTLING THEREOF,WILL BE MORE THAN 36 FEET HIGH ❑ AS OWNER/BUILDER TWILL 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 • 41,R. ? ._, Z INSPECTION RECORD Permit Number 10r—gi-6033 7-20/4 no/ DATE INSPECTOR I DATE J. INSPECTOR Setback I �„ eV � ?i� Rough Plumbing . � " I I Temporary Power a V V Shower Pan Test 6, I , Foundation Reinforcing Steel u/.1., ._ /1. , Stucco Mesh or Exterior Siding IV_ Excavation and Forms I - V Insulation 4)-41-3R L- F H A. Foundation Req. ld?/ � Sewer I Slab Grade F/ V Interceptor I Ground Plumbing S'a3-1; .1� Septic Tank Underslap Ducts AV (1-'0-4;S 1. - Leach Line or Seep Pit Underslab Conduit Water Service I Fireplace Foundation Lath or Drywall Nailing -4 `14 ,r-'411 .-' Joists and GirdersGas Line Air Test Electrical Ground V '/L- 5. .7'$116 .1= r--- Final Energy / Mid-Height Bond Beam Final Plumbing 1/ 8-Foot Bond Beam Final Heating/A C. V)I Final Bond Beam Final Construction 11'1 Fireplace Bond Beam Final On Site Improvements ,, / AX/ Roof Sheathing d jl`I 11 Final Off Site Improvements id / b Framing and Ventilation V V Final Dedication II / Roof Covering ^t0 / Final Zoning / Rough Heating 1 Final Electrical Electrical Service and Ground fe/ V Final Gas If V Rough Electrical V ,I/ Developer Fees Paid I Certificate of Occupancy WORKERS' COMPENSATION INSURANCE (Y/N) DIVISION OF INDUSTRIAL SAFETY PERMIT (Y/N) 4 SEPTIC TANK GALS SEEP PIT X _ LEACH LINE WIDE X LONG X DEPTH OF ROCK N W E • S Inspector's Signature and Initials 12-17589-469