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Home My WebLink About2552 WESTMINSTER AVE - Building Permits E! 1) rCITY OF COSTA MESA • r i BUILDING DIVISION F ,, , i. a. DEVELOPMENT SERVICES DEPARTMENT I PERMIT NUMBER 60 PERMIT r E04-01026 Rene (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2552 WESTMINSTER AV Status: ISSUED Suite No Applied: 09/21/2004 Vicinity: Issued: 09/21/2004 Parcel Nunmber: 43919212 Applicant: MCKIBBEN, MICHAEL AND MARCELA ISSUED BY: Address: 2552 WESTMINSTER AVE Phone: 949-631-6154 COSTA MESA,CA Zip: 92627-1346 , Owner: MCKIBBEN, MICHAEL AND MARCELA Address 2552 WESTMINSTER AVE Phone: 949-631-6154 COSTA MESA,CA Zip: 92627-1346 Contractor: OWNER-BUILDER Address: Phone: - Zip: License: 000000 SCOPE OF PERMIT CONSTRUCT NEW 480 SF STORAGE SHED LOCATED ON REAR OF PROPERTY.GAS/WATER FOR WASHER/DRYER ONLY.REF B04-01542.4 LIGHTS,6 OUTLETS,4 SWITCHES, 1 MOTOR UP TO 1 HP.AND 1 SUBPANEL. • FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway'/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) . $0.00 o - Transformers up to 1 kva/kw $0.00 0 Pool/Spa • $0.00 0 • - ' -up to 10 kva/kw $0.00 0 Lighting Fixts $4.40 4 . up to 50 kva/kw $0.00 0 Recept Outlets $6.60 _ 6 up to 100 kva/kw $0.00 0 Switches $4.40 4 over 100 kva/kw $0.00 0 Non Res Appl ' $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $4.75 1 Low Volt Wiring System/Ckt $0.00 0 Service to 200a . $0.00 0 • Misc.Conduit $0.00 0 Service to 1000a =$0.00 0 - Misc.Conductor • $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp ' $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 - Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand , $0.00 0 Motors to 100hp $0.00 0 , Other Electrical Fee - $0.00 Motors over 100hp $0.00 ' 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $30.50 1 Plan Check Fee $0.00 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(WOO) DECLARATIONS I I c-r \ ' WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations; ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of t!e work for which this permit is issued, ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or loss.) . ❑ 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,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND COI I ARE($100,000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under 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.Lic.# Class Si Contractor's Signature: Date: 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,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.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).): ❑ 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(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,end 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 wilt have the burden of proving that he or she did not build or improve for 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 project with a contractor(s) license purs ..�� the Contractors License Laws.). Tarp xe 4 r sec. Business and Professions Code for this reason: ignature: - _ Date: 'Z-moi—� Ow verified by drivers license. es 0 No siiiiip o. � - s: "7"--7^O9 Verification of Ownership by(type of document,i.e.-property tax bill or dee. DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feel 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 thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341.Title 8,California Administrative Code). ❑ 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 to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this Replication apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No B (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COM- • CE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to Nth all state law :rd city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the Aiabove-described• ••- for inspectio• •urposes. :. :e not to occupy or allow occupancy of any building authorized by this permit 'I final inspection. S•nature•f Legal Owner Dat And a App Ice ate coot# INSPECTION TYPE RATE NTITJAL$ CODE If INSPECTION TYPt . QM IEAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final _ 208 Final Plumbing ( /,,,.........��-""" 777 200 Final Re-Roof 210 Final Electrical q 1 G ly t ./„•••Ire 2D1 Final Block/Retaining Wall 212 Final Fire Prevention �( U 202 Final Factory Fire Place . 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy i C CITY OF COSTA MES • A � BUILDING DIVISION :it SA, DEVELOPMENT SERVICES DEPARTMENT PE IT NUMBER }tom j PERMIT B04-01542 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2552 WESTMINSTER AV Status: ISSUED Suite: Applied: 09/02/2004 Vicinity: REAR OF PROPERTY Issued: 09/17/2004 Parcel Number: 43919212 Zoning: ' 4► Applicant: MCKIBBEN, MICHAEL ISSUED BY: 40107 Phone: Address: 2552 WESTMINSTER AVE / Phone: 949-422-3831 CELL COSTA MESA,CA Zip: 92627-1346 Owner: MCKIBBEN, MICHAEL AND MARCELA Address 2552 WESTMINSTER AVE Phone: 949-631-6154 COSTA MESA,CA Zip: 92627-1346 Contractor: 0 5 Address: Phone: Zip: License: Arch : Eng: DANIEL W MCGINNIS Address: Address: 14377 WOODLAKE DR Phone: STE 314 Phone: • CHESTERFIELD,MI Zip: License: 63017 License: C65634 SCOPE OF PERMIT CONSTRUCT NEW 480 SF STORAGE SHED LOCATED ON REAR OF PROPERTY.GAS/WATER FOR WASHER/DRYER ONLY. FEE SUMMARY Plan Check: $108.71 • Calc Valuation: $9,000.00 Permit: $167.25 Claim Valuation: $9,000.00 SMIP Res: $0.90 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 • Total: $276.86• - • PLANNING &ZONING . SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 10-0 Left 40-0 Right 5-0 PARKING Existing:' 0 Required: 0 Proposed: 0 NOTES: KUBOT_BJ 09/17/2004 PROP OWNER STATED HE WILL GET ELEC & • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) . DECLARATIONJ$ I 'ti.\ • WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ' ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Cede,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) .l1 •I c ' certify that in the performance of the w 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,an gr that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. \ q, -7 Applicant Signature: > `-�— Date: ? / -/7-01 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($100,022),IN ADDfRON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 370€OF THE LABOR CODE,INTEREST.AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under 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.Llc.# Class# Contractor's Signature: Date: 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,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: 1 hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.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 fore permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ 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(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 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 purpose of sale.). ' X I;as owner of the properly,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 project with a contractor(s) license pursuer •the Contractors License Laws.). O I am encamp sec. Business and Professions Code for this reason: Signature: _ii - Expires: 7'7-Cr, Verification of Ownership by(type of d. me ,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O I hereby certify that no excavation five(5)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 thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ 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 to do such work from the division. Signature: _ Date: _ Division of Industrial Safety Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of en RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? L I Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 yes 0 No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Qualify Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF CO. • • E AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to•amply Ith all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-describe. • opert inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. AP a 9- i7-o1 Signature Of Legal Owner(s)7 Date And/Or Authorized Applicant Date OODE 1 INSPECTION TYPE PATE INITIALS CODE 0 INSPECTION TYPE PATE 1NTITIAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 . Final Fire Prevention • I 202 Final Factory Fire Place - 220 Final Planning Approval 203 Final Sign 222 Final Site • - 204 Final Demolition ' . n 250 Final Building/Occupancy q'-6_b t- - CITY OF COSTA MESA • 4BUILDING DIVISION ,j %-- : F • r.,, I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER sa rr!s PERMIT VPO4-00640 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 2552 WESTMINSTER AV Status: ISSUED Suite No Applied: 09/21/2004 Issued: 09/21/2004 Vicinity: ISSUED BY: Parcel Nunmber: 43919212 Applicant: MCKIBBEN, MICHAEL AND MARCELA Address: 2552 WESTMINSTER AVE Phone: 949-631-6154 COSTA MESA,CA Zip: 92627-1346 Owner: ,MCKIBBEN, MICHAEL AND MARCELA Address 2552 WESTMINSTER AVE Phone: 949-631-6154 COSTA MESA,CA Zip: 92627-1346 Contractor: OWNER-BUILDER Address: Phone: Zip: License: 000000 Arch / Eng: Address: - • Phone: Zip: - - - License: SCOPE OF PERMIT CONSTRUCT NEW 480 SF STORAGE SHED LOCATED ON REAR OF PROPERTY.GAS/WATER FOR WASHER/DRYER ONLY.REF 804-01542. 1 GAS SERVICE AND 1 LAUNDRY TUB/WASHER.' , FEE SUMMARY AMT QTY - AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $9.80 1 - Sump Pump $0.00 0 Backflow irrigation $0.00. 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 _ . P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator ' $0.00 0 Urinal $0.00 0 Clarifier System $0.00 " 0 Process Piping(per 10 ft) $0.00 . 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0- Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0- Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewet Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain,Floor $0.00- 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0- Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21.92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6N0) WORKERS'CQMPENSATION DECLARATION: .es- I helaby affirm under penalty of perjury one of the following declarations: - • ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at 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' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND OVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,0O0),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under 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.Llc.# Class# • Contractor's Signature: Date: 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,Civil Code). Lender's Name: _ _ __ Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.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).): ❑ 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(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 does such work mself 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 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 project with a contractor(s) license pursuant • P:Contractors License Laws.). • =xempt • der.ec. Business and Pr. = •:for this reason: Igneture: iT:��. L [1Erifermi..„ G�Se .- : I verified by driver's license. �. ..- 0 No Drivers License No. • _ ��lii[I_ — Verification of Ownership by(type of document,i.e.-property tax bill or.::d DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)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 thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ❑ 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 to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,ore volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 II an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes 8 No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the Calitomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLI• ' a AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to com• •with all .ate laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described pro•_• for i :section purposes.I agree not to occupy or allow occupancy of any building authorized by this permit ur1'I final inspection. Signet r:Of Legal 0 'er(s) Date And/Or Authorized Applicant Date ;ODE II INSPECTION Mt PATE INTRIALS CODEI INSPECTION TYPE PAIS BMW 1616 Fixed System Final Fire Prevention 206 Final Mechanical x� 1266 Pool Spa Final 208 Final Plumbing /C,-b'e.h. 200 Final Re-Roof 210 Final Electrical. 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition . - ' ' 250 Final Building/Occupancy ADDRESS 0P BUILMNS: 2552 WESTMINSTER AV DME CITY OF COSTA MESA — BUILDING PERMIT avN niam""mwN: SALAM0N, BRADFORD <,... "PERM NO: P 076571 ADDREss: SALAMON, CHRISTINA 2552 WESTMINSTER AVE PERMIT NO: P 076571 PLAN CHECK NO: N GOVT: N SUPP : N COSTA MESA,CA 92627 APPL.MNUNGAODRESS: CONSTRUCTION TYPE: V—N " PERMIT TYPE: PLU PURPOSE: OTH ARCHITECT OR ENGINEER: UC.NO.: JOB DESCRIPTION : C/O WATER HEATER SQ FT: ARCH.OR ENG.'S ADDRESS: ORT: CLAIM VALUE: CALL—VALUE: GROUP OCC: R-3 / CONTRACTORSNNIE: NOCK PLUMBING ( 714 ) 895-1246 CONTRACTORS MNLMG 11610 SEABOARD CIR COMMENTS : X ADDRESS: STANTON CA sac.NO.: 511971 1ER6dEREdEfL-REd6*fL-d6d6dE1L-16R6dE**46)EdflEdEd6169E*1EdE-ikdEx-i(-#iFiE1f-#ifi(-IEiEiElflEiEiE-3fiE1EN-ffiElEiE+Elfif***N-x-fE-ik***IEIEN-1Eif3fiflhlEx- 90680 tIMT: ZONING REQUIR EMENTS LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 SETBACKS ' , (commencing with Section 7000)of Division 3 of the Business and Professions Code,end my license is in full force end effect. CITY UC.NO.:0 038 Lie.CLASS: C-36 uc.NO.: 511971 EXP: 02 /97 MAIN BUILDING ACCESSORY BUILDING /yJ � y FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN ae: 2, y� conada:�fb P� � �/ //lJ�— LEFT: FT IN RGHT: FT IN LEFT: - FT IN RGHT: FT IN ER BUILDER DECLARATION: hereby affirm under penalty of perjury that I am exempt from the Contractors License Law for the olbwing reason(Section 70313 Business and Professions Code;Any city or county which requires a permit to construct,alter,improve. PARKING REQ: P ROV: PARCEL: 14167210 Z N E: REF NO: demolish,or repot any structure,prior to its issuance.aleo requires the applicant for such permit to Re a signed statement that he or she --licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 d the PLANNING NOTES> asiness and Professions Code)or that he or she is exempt therefrom end the basis for the alleged exemplion.Airy violation of Section > .i31.5 by any applicant for a permit subjects the applcant to a civil penalty of not more then five hundred dollars[550311. {(.{(.****************s**********.***.*3E*.*.**************************************f(**** ❑ I,as owner of the properly or my employees with wages as their sole compensation,will do the work,and the structure is not intended DEVELOPMENTSERVICES - R E U I R E M E N T S or offered for sale(Section 7044,Business and Professions Code:The Contractors License Law does not apply to an Owner of property Q who budde or improves thereon.end who does such work himself or herself or through he or her own employees,provided that such improvements are not intended or offered for sale.V.however,the building or improvement is sold within one year of completion.the ZONING APPROVED BY . DATE: owner-builderwill have the burden of proving he or she did not build or improve for the purpose of sale). • ❑ I.as owner of the property,am exdusivey contracting with licensed contractors to construct the project(Section 7044,Business and Professions Code:The Contractors License Law does not appy to an owner of property who builds or improves thereon and who BUILDING APPROVED BY : DATE: contracts for such projects with a contractor(e)licensed pursuant to the Contractors License Law). b L/ illi / ❑ lamexempt order Section: B.BP.C.,for this reason: APPLICATION ISSUED BY: DATE: Date: Owner: iElE1E1E1E1EiL-3L-IEiflElEiE************************1E �E aE*****lElEiElfiElfiEiE�E1EiF16#3EiL-fF***• • ** I do hereby certifyHealth that I am aware of and understand the requirements of Calfomie and Safety Code Sections 25505,25533,and LEGALIZATION: N F E E S U,, MMARY STRUCTURAL SEGMENT: N 25534,and That I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements ler --- apermit for construction ormodification from the AkDuTyEIrnagementDistrict.Residential eonslmd'an applications are exempt from these BLDG PMT PLUMBING ELECTRIC , MECHANIC FIRE SMIP/RES GRADING pfOv Ions. PERMIT 7 . 00 Date: Applicant: 25% ,; 1. SMIP/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the ldlovring declarations: PLAN . ❑ I have enndwii maintain acendcate of consent toself-insure for workers'compensation,as provided for by Sedbn 3700 of the Labor ISSUE FEE 20 . 00 (J/ Code,for thepedamanceoftheworkforwhichthispermitisissued. BUILDING—DIV—> PERMIT ISSUE Pli_AN—CHECK TOTAL PAID DUE Cl Ihave end sitmaintanworkers'compensation insuranoe,as required by Section 3700 of the Labor Code,for the performance of the TOTALS----> 7 . 00 20 . 00 , 0'. 00 27 . 00 27 . 00 . 00 X— work for which this permit is issued.My workers'compensation insurance cattier end policy number are: Carrier STATE' EXPIRES REVENUE DIVISION TOTALS--> COLLLCTED : 27 .00 OVER/SHORT: . 00 Policy Number: NWC'{911x1 (1!1 09/30/96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK section need not be completed if the permit is for one hundred dollars($1001 or less) 27 . 00 it L, 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 . ,.1 become subject to the wakrs'compensation law of Caldani .res that it should become subject to the"dun' .*d(.*.**.*{b.K.dl.,lFlFlEfhil.N-N.1h1flE.K.1f.M.1E1f.fE.lhlhlflFd(.fhf(-fE1E,lE,lFdhi(.dElE'lE,N,#,IE,IF7E,N.1EM..lE.N.,lEfE1E1EdE,)Eiblf,Ikif.N,ifdEfEiEfElEihlflf,N-ihaE,N,dflh M,iF mPensation Provisxca of Section 3700 of the labor Code,I s t i comply I N D I V I D U A L- F 'E E B R E A K D O W N te: '�7�7/9G. Avd'cent: L ming:Failure to secure workers'compensation coverage la unlawful,end shall subject en employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Nil lines up to one hundred thousand dollars($104000),In addition to the cost of compensation,damages as provided for In don 3706 of m.Labor cod.,Interest,and attorney's fees. PLU 1 WATER HEATER AND/OR'.VENTrI 7 . 00 7 .00 CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there lee construction lending agency for the END OFt,-FEES performance of the work for which this permit is issued(Section 3097,Civ.C). LENDER'S NAME: LENDER'S ADDRESS: ' /) I certify that I have read this application and state that the above information is correct.I agree to comply with all dry and county ordinances - ) and state laws relating to building construction and hereby au0hor'cs representatives of this city to enter upon the above-mentioned property for inspection purposes. , RON NOCK ,; Mint Name Lsr i T ��1 — Date: 2-7/j' j/1 Signature of Owner/ � X ••'• t1/")l/�I (5151-46.WP) White-Building 8 5: :ty;Green-Fle;Canary-Appicsnt;Pink-Revenue;Goldenrod-Assessor CONSTRUCTION AND PLANNING , - POOL A APPROVALS Permit - Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location I: 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement - 3.. Electrical Conduit'Utility-Undrgrnd. 54.• Forms 4,, Electrical Conduit-Undrgrnd. 55. Electrical Bonding , `5.-Sfee-I Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE .7.- Footings - - 58. Electrical ConduitlUndrgrnd. 8._Foundation 59. Gas Pipe, 0 UnSlrgrnd.,Test '9.. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap,O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK t_ 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final f 13. Roof Drains 64. Plumbing System - Final ; I 14. Rough Plumbing - _ 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING • 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA.SYSTEMS FINAL 19. Rough Heating & Air Conditioning . - FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace - - . APPROVALS- Permit# -• 21. Ducts, in Structure -. 70. Underground Hydro t 22. Ducts, Ventilating - 71- Product Piping OGas 0Oil 23. Gas Pipe-Rough & Test . - _ ,r , `72. Underground Flush _ 24. Roof Framing - _ • •73,. Undergrnd.Storage Tank Gas 0 Oil 25. Roof Sheathing - 74. Overhead Hydro c . 26- T-Bar Ceiling (Structural) & Monocoat _ 75. Dry Chemical - ' 27. Frame and Flashing - 76. Dry Standpipe I. - - 28. Lathing & Siding s 77:, FIXED SYSTEM FINAL ' 29. Insulation 78i FIRE PREV. FINAL 30. Drywall Nailing - - r .. HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat -- - 79. FINAL INSPECTION ' 32. Electrical Power Meter-Final 80... FOOD CERTIFICATE ISSUED • 33. Final Electric - Notes: tt,,�_/ �p •y _ - - I7fll f 6 rvB ON's It�y0I . .t.,,.. ,..../...2....7.... .OaA 34. Final Heating& Air Conditioning - t t p`MOGrCrCr d ,4_ •, -F.A 35. Final Gas Pipe-Test - A �t - 36. Hood or Canopy - _ . . 37. Final Factory Fireplace - . r 38. Final Plumbing wit.roit.c it-TZ 5Fj Jctz �-N'_.:. 39. Water Service-Final 1� - • 40. Gas Service-Final 41. Solar Domestic-Final ., • ' - 42. Backflow Preventer 43. Backflow Irrigation - r . Y - 44., Landscape Irrigation System - •- - • ' - 45. Sound Attenuation r 46. Handicap Regulations - 47. FINAL STRUCTURE & BUILDING - - - c - 48. FINAL PLANNING . ' - . 49. Electric Release to Edison . 50. Gas Release to Southern California Gas Co - _ _ 51. CERTIFICATE OF OCCUPANCY - - No. Date I Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. __ CITY OF COST CONSTRUCTION PERMIT PERMIT NO. TRACT NO. . LOT NO. UNIT NO. 4479 12/C1/84 2Se%5 11.- AL� L Westminster "6/67/ D Prefect Address _ i _ - 0 ' TYPE OF CONSTRUCTION L NEW LI ADD LI ALTERATION LI REPAIR - APPlicant•s Mailing Address ❑ CONVERSION ❑ DEMOLISH ❑ OTNE - ownersName George Reedy' Phone 544-0120 solar Domestic Heater A.P.# ( zone DESCRIPTION OF WORK/USE OF BLDG. Address - With Racks S Main Building: accessory Building: Z Arch/Eng. License No. - TYPE OF PERMIT L GRADING ❑ FOUNDATION ❑ STRUCTURAL T Front - - • O Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL - B Rear N Contractor's Name Home Guard Phone 937- 1104 ❑OTHER • A - I 1571 S . Sunkist , Anaheim PROJECT DESCRIPTION SQ. FT. OCCUPANCY ' C Right G - CityAddLicensess e(mailing) 5 7 CONSTRUCTION TYPE - VALUATION$ S Left , City License No. '927(g`v� ZONE GRADING CU.YDS. ACRES E LICENSED CONTRACTOR DECLARATION ��,. - Ping. Ref. # . Parking'Req./Provided E I hereby affirm that I am licensed tinder provisions of Charter 9 (commencing Remarks: s,.�I �11.� _gl�, Planning Notes: " M with section 7000) of Division 3 Of the B 51 ess and Professions Code, and s T my license is in I I ce and effect. je11 . . license Cass _ 1 L e Np. 407510 �f�ef�s S • Date 1 L 1 / 84 Signature _ I•}}}---1\ V f/i•L'—•,' • PLUMBING I FEES • WORKERS'y fCOMPENSATION DECte RATION/ s Bar Sink Showers t j I • hereby affirm that have a certificate of copse to s ff-Insure or a certificate ELECTRICAL FEES of Workers' Compensation Insurance, or a ce titled opy thereof (Section Backflow Preventer Service Sink 1800, Lab. C.) - Automatic Wisher - Transformer 0 15-50 KW Policy o. 59CK957400 Company etoa Backflow Irrigation Sewer Ca ❑ 50+KW p P. _ _ Construction Pole Sub. rtif led opy Is herd w th the het. 1/1 i Corti led o is filed with the cib Builtli g l// si ..I Bathtubs Sewer Connection Cooking Unit Meter Duca to 100 amps f' Date - Applicant C • ��I �� Il EXEMPTIO FROM WORKERS'COMPENSATION D LARATION Clarifiers .• • Solar Collectors Soo Dishwasher Meter Clover 100 amps • (This section need not be completed if the permit is for o hundred ($100)or • l� less). / Dishwasher /at Piping c G Dryers ❑Gas DElectric Sub Panel J I certifythat in the performance of the work for which th 5 permit Solar Pi in • p tis Issued, I shall not employ any person in any manner so askq�bfcome subject to the Drinking Fountains / Solar Tank 3 do Fan / Motors/a0-1 HP ❑1'h-B /(J t) Workers' Compensation Laws of California. . Date Signature Floor Drains Swimming Pool w/Spa F.A.U. IncSolar❑9-15 HP ❑16-15+ NOTICE:If,after making this declaration,you should become subject to the — Inc. Solar Compensation provisions of the Labor Code, you must forthwith - Floor Sinks i Urinal - - - Fixtures -' " comply with' such provisions or this permit 'shall be deemed revoked. -Microwave , CONSTRUCTION LENDING AGENCYt - Gas Service Outlets Water Closet Device Boxes I hereby affirm that there is a construction lending agency for the.performance Pole,Light of the work for which this permit is issued (Section 3097 Civ. CJInterceptors Water Heater Outlets 'Ran e Lender's Name - 9 Lender's Address • Kitchen Sink Water Service - ' OWNER BUILDER DECLARATION Switches Sign I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash - • following reason (Section 7031.5 Business and Professional Code: Any city or — Garbage Disposal Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P—Trap Tra 5 any structure, prior to Its issuance, also requires the applicant for such permit • Laundry y _ Generator ❑0.5 KW❑5-15 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division,3 of the Business and Professions Code) or that he/she is exempt - therefrom and the basis for the alleged exemption. Any violation of Section r - - '31-.5 by any applicant for a permit subjects the applicant to a civil laity of not more than five hundred dollars($500). • I,'as,owner of the,property for my employees with wages as their sole -Reinspection Fee I ,$15 Issue Fee $ 3 - compensation, will do the work, and the structure Is not Intended or offeredection Fee $15 Issue Fee $ 3 - Reins for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL I FEES p License Law does not apply to an owner of a property who builds or improves - - thereon, and who does such work himself/herself or through his or her own - DEVELOPMENT SERVICES REQUIREMENTS: ' employees,-provided that such improvements are not intended or offered for Boiler Hood or Type I 0 • sale. If, however, the building or improvement Is sold within one year of com- - - Canopy Type II ❑ Zoning Approved By Date pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground - Building Appro • ved By Date prove for the purpose of sale). ch__ I L,Z I 0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By U.� Datn tractors to construct the project (Section 7044,Business and Professions Code: ' The Contractor's License Law does not apply to an owner of property who - Duct-Ventilating ❑0.100,000 BTU ❑100,000 BTU - SUMMARY OF FEES builds or improves thereon, and who contracts for such projects with a con- - - - - • f6--0 tractor(s) license pursuant to the.Cont rector's License Law). i am aware thatBUILDING PERMIT - $ Sou SMIP $ of • Exhaust System 0 Multiple 0 System Repair/Alteration proof their Worker's Compensation insurance should be provided to me. _ PLAN CHECK $ ) '' // PERMIT 0 I am exempt under Section , B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBINGN CHECK $ / 9/ 0 U ISSUANCE ' $ Date Owner _ Heating System& Ducting • Registers ENERGY P.C. $ PLAN CHECK 25% $ I hereby certify that I ha read this application and state that the above ❑0.100,000 BTU 0160,000 BT V 0 GRADING $ information is correct. ireetto comply with all city and county ordinances ELECTRICAL $ and state laws relatim • •uilding construction,and hereby authorize repro- PLAN CHECK 50% $ • U MICROFILM $ sentatives of this in vy upon the above-mentioned property for inspection purposes. �� —QAC ^i ,[ $ TOTAL FEE '$ •a 4./75-- Signature S. •Date h''$ - • MECHANICAL Drivers' License or SS# * ^ - Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod -Assessor ,I+CONS jRUCTION AND PLANNING POOL 'A `APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1.- Temporary Electrical Service or Pole- 52, Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ' 3. Electrical Conduit Utility-Undrgrnd. - - . 54. Forms -.4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding _5. Steel Reinforcement - - 56. Rough Plumbing & Pressure Test ' '6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE . -7. Footings 58. ,Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash.& Receptor-Final ' 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit . - - 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval ' - 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70.. Underground Hydro 22. Ducts:Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush . 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 5'/16/dr (-EFT Cone . (-,a) 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final t 41(Solar Domestic-Final t 1///// `S'� 2ec�� t ib .0.�Z.sc 42. Baclflow Preventer' ' L 43. Backflow Irrigation 6 G5� O orb `i `X`- --..... 44. .Landscape Irrigation System /gl�/ jP•L • 45. Sound Attenuation ' 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed , 49. Electric Release to Edison -- • - - . 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY I ' - ' _ - - No. Date I