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Permit No. 1059001067 1110 105 SAN gERNARDINO COUNTY-EPWA/LAND•GEMENT DEPT OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 90 01067 210A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 04/30/90 I ISSUE DATE 04/30/90 I PG 1 OF 1 PARCEL NUMBER 1025-411-11-0000 PROPOSED USE: PATIO COVER/REPLACE WIN. W/ DR CURRENT USE: RESIDENCE WITH GARAGE 0 7046TRACT 1000 1181 LOT I SE21 SEC 102S 08W RNG I PRCL 0 P PRCL ACTIVITY PLAN L820 ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CH/RS,IL1,FR1 • LOT DIMENSION IRREGULAR CONST TYPE APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER IBLDGS ON LOT 1 (GROUP KUSKOSKI, JAMES 12625 OAKS AVE 1/PLANS RECD 0 LAND USE PLOT 0 INDEX NBR 39-149 CHINO CA 91710-0000 STD PLAN/ICBO FHA N (714) 628 - 5163 TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER BOGLE, BOB PORCH 325 .20 65.00 14999 SANDALWOOD LN CHINO HILLS CA 91709-0000 CALC. VALU 2,925.00 I ADJUSTED AREA 65 (714) 597 - 2368 - ITEM CNT DESCRIPTION DETAIL TOTALS JOB SITE ADDRESS RESIDENTIAL CONSTRU 53.93 14999 SANDALWOOD LN TOTAL AMOUNT 53.93 CHINO HILLS CA 91709-0000 CROSS STREET ROSEWOOD WAY INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER KUSKOSKI JAMES CONT000223402 12625 OAKS ST CHINO CA 91710-0000 (000) 000 - 0000 DIV. OF IND. SAFETY PERMIT: - MINIMUM SETBACK DISTANCES 55 FRNT SETBACK/CENTRLINE SANDALWOOD LANE R/W 60 15 REAR SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE 10 SIDE SETBACK/PROP LINE MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES I NO. DWELLING I NO. BEDROOMS I FLOOR UNITEXT. WALLS I INT. WALLS CEILING ROOF 11 HEATING FIREPLACES METAL IMASRY PWAATER TIR I SEWER I MINN DDEPTH' S.F./100IOOOOEI NEW/REPAIR COMMENTS 04/30/90 LICENSE EXPIRES 10/31/90. D.FLETES. ONTARIO COMPLETED AMT WAIVED .00 AMT PAID 53.93 PAYOR NAME: JAMES KUSKOSKI PAID 04/30/90 RECEIPT 1787 EMPL: FLETS, DEBORAH PAID BY : CHECK NBR : 1110 LICENSED CONTRACTORS DECLARATION I HEREBY AFFIRM THAT I AM LICENSED UNDER T OVISIONS OF CHAPTER 9 (COMIIENCING WITH SE7000) OF DIVISION 3 OF THE BUSINESS AND R ESSIONS CODE, AND MY LICENSE IS IN FULL CE AND EFFECT :Pt-) t 5 LIC NSE CLASS -( LICENSE NUMBER 7 7 14 0 2- CONTRACTOR k() 5/695 Xi DATE 4- 3 0 - 9 D 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 135001 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 OWNERDATF 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 NCERTIFIED 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 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 T WORKERS' COMP NSATION LAWS OF CALIFORNIAC / PLICANT D ..--..--,.....--/`c7Z�v`-'v c,DATF LI - 3 - / 0 NOTICE TO A// 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 E 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 %ROVE-MENTIONED PROPERTY FOR INSPEE/TION PURPOSES Li,„-7,....,./..I., NATURE OF APPLICANT OR AGENT I/rriw- e- / DATE 4- 3 ? o 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 10188 Owner Name 67°(-el -Q-- permit Num l`C7 00/06"7 /0 1 INSPECTION RECORD DATE I INSPECTOR I I DATE I INSPECTOR Setback 15 9'-e: I&JV Rough Plumbing Temporary Power I Shower Pan Test Foundation Reinforcing Steel I Stucco Mesh or Exterior Siding Excavation and Forme/Z)s/ j2 s-9_9d �� Insulation F H A Foundation Req Sewer Slab Grade e)CK-S / Interceptor Ground Plumbing Septic Tank Underslab Ducts Leach Line or Seep Pit Underslab Conduit Water Service Fireplace Foundation Lath or Drywall Nailing Joists and Girders Gas Line Air Test Electrical Ground Final Energy Mid-Height Bond Beam Final Plumbing 8-Foot Bond Beam Final Heating/A.0 Final Bond Beam Final Construction /,--f 419 "jj _-- Fireplace Bond Beam Final On Site Improvements Roof Sheathing Final Off Site Improvements Framing and Ventilation Final Dedication Roof Covering Final Zoning Rough Heating Final Electrical Electrical Service and Ground Final Gas Rough Electrical Developer Fees Paid WC (YIN) Ind Saf (Y/N) Certificate of Occupancy _ SEPTIC TANK GALS SEEP PIT X LEACH LINF WIDF X LONG X DEPTH OF ROCK N ft ROTA ra `:*311 W EVtd,k40 d'eV 1 L L E IV // IUU (' —i � _ e,k / /1 /��� w s tl tl l.10 N 1. 4 J. ICIG �.///%'!?i�./Illi .////� w.4 /I w // >rrrInspectof'//s Signature anr -() 12-17599-469 Rev 3/88