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Permit No. 1058902312 MIL • 105 SAN BERNARDINO COUNTY-EPWA/LAND•AGEMENT DEPT • OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 105 89 02312 211A 011 STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED - - APPL DATE 06/29/89 I ISSUE DATE 06/29/89 I PG 1 OF 1 PARCEL NUMBER 1017-561-20-0000 PROPOSED USE: ALUM PATIO ROOF CURRENT USE: RESIDENCE AND GARAGE 9231TRA BLK LOT SEC TY : CT 1000 1050 I NW28 102S 08W PRCL 00AP ( PRCLOCCTOMIMUNITY PLANL820 ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/RS LOT DIMENSION 76X143 CONST TYPE APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *BLOCS ON LOT 2 (GROUP PATIOS PLUS CONSTRUCTION `12040 LA CROSSE AVE *PLANS RECD 0 LAND USE PLOT 0 (INDEX NBR 35-156 GRAND TERRACE CA 92324-0000 STD PLAN/ICBO 2621P FHA (714) 783 - 1080 ITEM CNT DESCRIPTION DETAIL TOTALS OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER 1 ALUM PATIO COV STD 55.58 SOTELO, ROBERT J. T CHERYL L. MISC SUB-TOTAL 55.58 3542 VALLE VISTA DR TOTAL AMOUNT 55.58 CHINO HILLS CA 91709-0000 (714) 597 - 2583 JOB SITE ADDRESS COMPLETED 3542 VALLE VISTA DR CHINO HILLS CA 91709-0000 CROSS STREET CLIPPER DRIVE DATE ~� INSPECTN ACCESS CONTRACTOR NAME, ADDRESS LICENSE NUMBER BROWNSTONE DONALD L CONT000296757 12040 LA CROSSE AVE GRAND TERRACE CA 92324-0000 (000) 000 - 0000 ACTIVE WORKERS COMP DIV. OF IND. SAFETY PERMIT: MINIMUM SETBACK DISTANCES 63 FRNT SETBACK/CENTRLINE VALLE VISTA R/W 66 15 REAR SETBACK/PROP LINE 5 SIDE SETBACK/PROP LINE 10 SIDE SETBACK/PROP LINE MECHAW3pd EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS NO./STORIES I NO.UNITDWELLING I NO. BEDROOMS I CONCRETE EXT.EXT. WALLS INT. WALLS I CEILING ROOF HEATING FIREPLACES METAL METAL IMASRY ' WATER PUBLIC (PUBLIC SEWER I MIN 000EPTHI S 000100I0000EI NEW/REPAIR COMMENTS AMT WAIVED .00 AMT PAID 55.58 PAYOR NAME: PATIOS PLUS CONSTRUCTION PAID 06/29/89 RECEIPT 3768 EMPL: RICHARDS, GARY PAID BY : CHECK NBR : 2768 ini . • . ..... .ICENSED CONTRACTORS DECLARATION 0 I HEREBY AFFIRM THAT I AM LICENSED UNDER THE PROVISIONS OF CHAPTER 8 (COMMENCING WITH SECTION 70 0 OF DI ISION 3 OF THE B SINESS AND PROFESSIONS CODE, AND MYLICENSEIS (N FULL FORCE AND /� 1 I S 1 ) ) CL'' / ( 7 �J( l o +J S (_r, 9! Se LICENSE CLASS LICENSE NUMBER CONTRACTOR E 1 1 1 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 70001 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 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 \�3—` CJ 4-2,____,) ❑ CERTIFIED COPY IS HEREBY FURNISHED CERTIFIED COY IS FILED H THE COUNTY UILDING INSPECTION DEPARTMENT 11 C c� P\APPLICANT I1 l..-� �. DATE � l 2- l ti-" v- 'V 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 ISA 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 ADDRESE 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 401- ❑ 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 NFORMATION IS CORRECT, I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATINBUILDING N TRUCTION, AND REBY AUTHORIZE REPRESENTATIVES OF THIS OUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSP(PQ IO(NPU_RPOS S z(�, ��J } ��J - SIGNATURE OF APPLICANT OR AGENT lKs.Y�'l LULL 'O I DATE WI l l/ 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 �. -J o7'�Lv il/&f—S5— Z3/Z-- 2//!,-v/ • 'Owner Name � Permit Num INSPECTION RECORD • DATE INSPECTOR DATE 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 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.C. Final Bond Beam Final Construction 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 U U MPu L T E 0 Electrical Service and Ground Final Gas T y Rough Electrical Developer Fees Paid DATE ( _r7 . WC (Y/N) Ind Saf (Y/N) Certificate of Occupancy 3-y-7/7. 'PHTIZ) Con(srE re..Z) X177/407-M%•5 ef7 ods Lbti 7'a 8/ferF Y PATso Ee.S_ &A/I./ea/2o AIS . it/0 !//SINZE/21,91A4,0-5.. SEPTIC TANK GALS. SEEP PIT X LEACH LINE WIDE X LONG X DEPTH OF ROCK N. W E. S Inspector's Signature andACH LINE dr 12-17589-469 Rev 3/88