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Permit No. 1209200403 1110 ~ 120 SAN BERNARDINO COUNTY-EPWA/LAND M AGEMENT DEPT OFFICE OF BUILDING AND SAFETY P E RMI T APPLICATION PERMIT NBR 120 92 00403 201A 01 I STATUS: ACTIV THIS IS NOT A PERMIT UNTIL ISSUED _ APPL DATE 03/18/92 I ISSUE DATE 03/20/92 I PG 1 OF 1 PARCEL NUMBER 1024-102-26-0000 • PROPOSED USE: RESIDENCE WITH GARAGE /P ooL t/- /e _ A 4 CURRENT USE: VACANT TRACT BLK LOT SEC TY : 13651-2( 000 1063 I NW18 I T0{2NS 108W I PRCL 00AP I PRCL CCTOMIMIRIJITY PLANL830 ZONE/LAND USE DISTRICT GENERAL PLAN SUBDIVISION NAME SUBDIVISION PARCEL NO CHINO HILLS CH/PD,IL1,FR1 M-H 13651-2 PLAN 1 03/18/92 - - - LOT DIMENSION 60 X 100 CONST TYPE VN APPLICANT NAME, MAILING ADDRESS, AND PHONE NUMBER *BLDGS ON LOT GROUP R3 FIELDSTONE/13651-2 105 PLAN 1 145 S STATE COLLEGE BLVD *PLANS RECD 3 LAND USE PLOT 0 INDEX NBR 19-137 BREA CA 92621-0000 STD PLAN/ICBO FHA N (714) 990 - 3006 TYPE I SQ. FT. I FACTOR/P.S.F. I ADJSTED AREA/VALUATN OWNER NAME, MAILING ADDRESS, AND PHONE NUMBER FIELDSTONE/13651-2 105 PLAN 1 1 1114 1.00 1114.00 145 S STATE COLLEGE BLVD 2 1058 1.00 1058.00 BREA CA 92621-0000 GAR 619 .50 310.00 (714) 990 - 3006 PORCH 58 .20 12.00 JOB SITE ADDRESS CALC. VALU 123,639.14 I ADJUSTED AREA 2554 13774 VISTA GRANDE DR CHINO HILLS CA 91709-0000 ITEM CNT DESCRIPTION DETAIL TOTALS CROSS STREET POINT VISTA LN RESIDENTIAL CONSTRU 1,425.00 INSPECTN ACCESS TOTAL AMOUNT - - - • 1,425.00 CONTRACTOR NAME, ADDRESS LICENSE NUMBER FIELDSTONE COMPANY THE CONT000402826 14 CORPORATE PLAZA NEWPORT BEACH CA 92660-0000 (000) 000 - 0000 - -- DIV. 3F PM. SAF ET(-VERIUT:- — -- - - - - — - - - -- - '- - - - - - -- - MINIMUM SETBACK DISTANCES 46 FRNT SETBACK/CENTRLINE VISTA GRANDE DR R/W 50 20 REAR SETBACK/PROP LINE ^ 4 61 5 SIDE SETBACK/PROP LINE / 5 SIDE SETBACK/PROP LINE �I/ l O MECHANICAL EQUIP NOT PERMITTED IN REQUIRED SIDE SETBACKS / () \1 P�, ./7./ NO. STORIES I 2 UNITSWELLING I NO. BEDROOMS I FLR 1 4CONCRETE COl00)a (� EXT. WALLS I INT. WALLS I CEILING ©f- STUCCO SHEETROCK II SHEETROCK ROOF I HEATINGI FIREPLACES TILE NATURAL GAS METAL IMASRY 01 WATER / PUBLIC (PUBLIC SEWER I MIN 000EPTHI S 000100I0000EI NEEWEPAIR COMMENTS ALL FEES PAID AMT WAIVED .00 AMT PAID 1,425.00 t PAYOR NAME: FIELDSTONE CO. PAID 03/19/92 RECEIPT • 00000848 EMPL: HALL, S PAID BY : CHECK NBR : 11464 } - 1 "'LICENSED CONTRACTORS DECLARATIO• Y,J` 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, AN MY LICENSE IS IN FULL FORCE AND EFFECT Q.�x-4/ LICENSE CLASS LICENSE NUMBER 2_ 0 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 ($500] 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 S B AND P C FOR THIS REASON q�1 OWNER I k DATE 4.'2)1"Lb j I L- 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, LABC c POLICY NO 612— C31./ COMPANY ❑ CERTIFIED COPY IS HEREBY FURNISHED ❑ CERTIFIED COPY IS FILED WITH THE COUNTY BUILDING INSPECTION DEPARTMENT APPLICANT DATF • ADDITIONAL REVISION 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 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'C NSATION LAWS OF CALIFORNIA �w j ^ �I APPLICANT DATF `i ( • ' r 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) LENDER'S NAMF LENDER'S ADDRECC 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 ❑ 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 HAVE READ THE HAZARDOUS MATERIALS QUESTIONNAIRE AND THE WORK APPLIED FOR ON THIS PERMIT ❑ IS ❑ IS NOT SUBJECT TO THE APPLICABLE REQUIREMENTS OF THE HEALTH AND SAFETY CODE AND THE LOCAL AIR QUALITY AGENCY 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 PURP 1 fC SIGNATURE OF APPLICANT OR AGENT DATE 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 12-17688-469 Rev 4/90 . r= 1 -^Owner Name , l-�c.5%_ W .3 Permit Numb W/aorvr `/d3 7//1 INSPECTION RECORD . ' DATE I INSPECTOR I I DATE INSPECTOR Setback 4)- T-Cj� rtL-- Rough Plumbing 19'0-'91.- p Temporary PowerShower Pan Test 19-f0 -4/2_ Foundation Reinforcing Steel --,54-6,14------ , f Stucco Mesh or Exterior Siding If •% _J ea ' cp Excavation and Forms ......----=-; Insulation I$-/i(� . C-- Q• C/-) a?4*--- 92 -4�--7 Sewer /tic,2 47 ler - 3. 4E 7 Slab Grade 5- Slab Interceptor Ground Plumbing ()WV -1 - Septic Tank I Underslab Comte (AA c.(p -4(, hi? Leach Line or Seep Pit I f Underslab Conduit Water Service I 6 -/r q7,_ /A/, A / Fireplace Foundation 5-'2/, q/ j Lath or Drywall Nailing I Cj _ I <6 '9Z pre517,CAnik411 Joists and Girders Gas Line Air Test I/44 -1 ef'_- Electrical Ground ( kilt- 5---_ c L I1/ Final Energy r Mid-Height Bond Beam _ Final Plumbing I//r9 9 L 8.1.9.1- :.aam f --,)/1., 4 -2-/"2- 'e Final Heating/A C i t q -1 Z,____ ___ Final Bond Beam Final Construction I i/ -4 __ __ Fireplace Bond Beam Final On Site Improvements I Roof Sheathing 9it,-9'Z e Final Off Site Improvements I Framing and Ventilation 9 l'v 9 Z e. Final Dedication I I Roof Covering Final Zoning I I Rough Heating 9'_p -91,1e. Final Electrical I`t 9 * Z.- lc-- Electrical Service and Ground q'7�J -9 z_ p Final Gas Iji q 42...-I Rough Electrical 9-0 Z Ie. Developer Fees Paid I. vVC it/NI Ind Sat(Y/N) - 1 Certificate of Occupancy IA i 4P'L4-G -.mac('y -- l /i/l 19 G g 7 AP,71e0,1 , h-)-07,:f‘'5 0- 9-9--7Z. Co) o .J � .. 44 . e (� "4 4zsnc .°.4,t Z E. Le' ' 122 c,q(y(7 PITh , '. `-/" SEPTIC TANK GALS ^k0 - SEEP PIT X LEACH LINF WIDE ^ X LONG X DEPTH OF ROCK v �,�'" �l� N ��� t/ • ..,`-',.-t\-- W E A . ./ V n _ _/.1/2 /f1 _/ln S Inspector's Signature and Initials G - 41" _ 12-17589-489 Rev 3/88