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Permit No. 1058802314 i r r 11, 105 SAN BERNARDINO COUNTY-EPWA/LAND MANAGEMENT DEPT OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 88 02314 255A 01 I PAGE 1 OF 1 THIS IS NOT A PERMIT UNTIL ISSUED APPL DATE 06/24/88 ISSUE DATE 06/24/88 PARCEL NUMBER 1017-162-13-0000 PROPOSED USE: ELEC METER PEDESTAL CURRENT USE: VACANT TRACT I BLKI LOT I SEC IpW ( I PRCL MAP I PRCL COMMUNITY LAN ZONE/LAND�E DISTRICT GENERAL 000 000 SEC0 08W 0 CHINO HILLS DRES-2 SUBDIVISION NAME SUBDIVISION PARCEL NO LOT DIMENSION IRREGULAR CONST TYPE VN #BLDGS ON LOT (GROUP R3 APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *PLANS RECO 0 LAND USE PLOT 0 (INDEX NBR 24-157 UNDERGROUND CABLE SERVICE STD PLAN/ICBO FHA 8801 HELMS AVE RANCHO CUCAMONGA CA 91730-0000 GRADING INITIAL ACTUAL (714) 980 - 0113 CU.YDS. EXC. CU.YDS. FILL OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER CALIFORNIA MELCOR, INC. ITEM CNT DESCRIPTION DETAIL TOTALS 200 BAKER ST 1 ELEC WORK NOT LISTE 24.40 COSTA MESA CA 92626-0000 ELEC SUB-TOTAL 24.40 (714) 980 - 0113 ISSUANCE FEE 17.00 TOTAL AMOUNT 41.40 JOB SITE ADDRESS 15448 VALLE VISTA DR CHINO HILLS CA 91709-0000 CROSS STREET BAYBERRY INSPECTN ACCESS CONTRACTOR NAME LICENSE NUMBER UNDERGROUND CABLE SERVICE INC CONT000453335 MAILING ADDRESS, PHONE NUMBER 12155 MAGNOLIA AVENUE #4E RIVERSIDE CA 92515-0000 (000) 000 - 0000 MINIMUM SETBACK DISTANCES MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO. STORIES 1NO.UNITSS WELLING NO. BEDROOMS FLOOR ^i 741 N til EXT. WALLS I INT. WALLS I CEILING COMP, ,��� ED ROOF I HEATING IMETALFIREIMASRY DATE: . WATER I SEWER I PUN OOOEPTHI S 000 100(SIZE( NEW/REPAIR 00 COMMENTS ' AMT WAIVED .00 AMT PAID 41.40 PAYOR NAME: UNDERGROUND CABLE SERVICE PAID 06/24/88 RECEIPT 2087 EMPL: RICHARDS, GARY S N +CENSED 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 EFFECT if\LICENSE CLASS 4 LICENSE NUMBER 5"....,<- 33....cCONTRACTOR U e . DATE C /A v gyp'.- 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 CON TRACTORS 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 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 I POLICY NO COMPANY - ----- \! -1-- I� S • ❑ CERTIFIED COPY IS HEREBY FURNISHED ❑ CERTIFIED COPY IS FILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT APPLICANT /I C .S DATF /S- 5z/.4"2--- / ` / CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATION INSURANCE(THIS SECTION NEED NOT BE COMPLETED IF THE PERMIT IS FOR ONE HUNDRED DOLLARS (S1001 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 NAMF LENDER'S ADDRESS DIVISION,OF INDUSTRIAL SAFETY PERMIT CERTIFICATION THE CALIFORNIA HEALTH AND SAFETY CODE REQUIRES A DIVISION‘&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 RELATI - • BUILDING CONSTRUCTION H/ `. THORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE -'/ABOVE-MENTIONED PROPERTY FOR IN •ECTIO 0.POSES ^ i SIGNATURE OF APPLICANT OR AGEN /9- .op Q / �I� DATE /0i- ci/!�� EXPIRATION NOTICE APPLICATIONS FOR WHICH NO PERMIT IS I UED 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 CACI F. M-Lco • •I • INSPECTION RECORD Permit Number hAr-+nr- da3/(11 ZS'S"f}-v/ DATE I INSPECTOR I DATE I INSPECTOR Setback Rough Plumbing Temporary Power Shower Pan Test Foundation Reinforcing Steel Stucco Mesh or Exterior Siding Excavation and Forms Insulation F H A Foundation Req Sewer Slab Grade Interceptor Ground Plumbing Septic Tank Underslap 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 C J _/; Final Bond Beam Final Construction K)fJ 7/K9101- Fireplace ijFireplace Bond Beam Final On Site Improvements Roof Sheathing Final Off Site Improvements Framing and Ventilation Final Dedication Roof Covering A Final Zoning Rough Heating ,.j / /1/ Final Electrical Electrical Service and Ground j I'ry Final Gas Rough Electrical eArf Developer Fees Paid • V Certificate of Occupancy WORKERS' COMPENSATION INSURANCE (YIN) DIVISION OF INDUSTRIAL SAFETY PERMIT (YIN) SEPTIC TANK GALS. SEEP PIT X LEACH LINF WIDE X LONG X DEPTH OF ROCK 'S i `� -r=� N Ts,IA rnl! vt) .Eliiq�yf�r�r /�['i�nf �',/CJ�i N lV A A ////2)//sem W E S Inspector's Signature and Initials 12-17589-469 1