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r PROJeuTADDRESS: 2J91 WESTMINSTER AV UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: F 05142`_
OWNER'S NAME: CUTLER, RAYMOND
ADDRESS: 2591 WESTMINS.%ER AVE PERMIT NO: E 051425 PLAN CHECK NO: N GOVT: N SUPP: N
• COSTA MESA,CA 92627
CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: OTH
642-2072
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : SERVICE UPGRADE
ADDRESS: UNIT: SQ !`T
CLAIM VALUE: CALC—VALUE: GROUP OCC : R-3 /
PERMITTEE: CUTLER RAYMOND ( 714 ) 642-2072
ADDRESS: 2591 WESTMINSTER AVE COMMENTS : SERVICE UPGRADE SMOKE DETECTOR REQUIRED
COSTA MESA CA 92627 ******* ¢****************/OPM9FT*>H6le**********************************************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING R E Q U IR EMEN TS
7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect SETH ACK S
CITY LIC.: STATE LIC.: CLASS:
Date: signature: MAIN BUILDING ACCESSORY BUILDING ---
'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to seIt-insure ora certificate of Workers' FRNT: FT IN REAR: FT IN FRNT; FT IN REAR: FT IN
'WORKERS
ompensation Insurance,or a certified copy thereof(Section 3800.Lab.Cl. FT IN LEFT; FT IN RGHT; F T IN
NO.:
COMPANY: EXP.DATE:
PARKING REO: PROV: PARCEL: 43919121 ZNE: REF NO:
L7 Certified copy is hereby furnished. 1:ICerfilied copy is Med with the city Building Division. LEFT: FT
PLANNING N l ES> Z N RGHT;
>
Date: Applicant: ***lE*****M*******J(**Yi**'k***********************IF******************BE.MAP*TOP)6******
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for on hundred($100)or less). DEVELOPMENT S E -R VICES REQUIR EM ENT S
• I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any man r so as to become
subject to the Workers'Compensation Laws of California. ZONING APPROVED BY .
DATE;
•
Dale: Signature:
NOTICE:It.alter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY ; -. / DATE
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 APPLICATION ISSUED BY. - '• ' eagerZd
DATE• /
which this permit is issued(Section 3097,Civ.C). **********************•.--• -•-• • • • •-• • • • • • - • - ********4* ,r,*};
LENDER: **********M********.**************a(-********* • '*****************************k
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 18 50
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 5 0 t SM I P/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 15. 00
I. as owner of the property or my employees with wages as their sole compensation, wit do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
® structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 18 , 50 15 . 00 0 , 00 33 . 50 33 . 50 , 00 '
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 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 will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 33. 50 OVER/SHORT: . 00
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 33 . 50
❑ and Professions Code: The Contractors'State 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)license pursuant to theContractors'State License Law). l am aware ***************t(•*********N**************?c**d(.**.***Ic.x-**.***.******-.**.****,*je********}i
that proof of(heir Worker's Compensation insurance should be provided to me. IND• I VID U A L F E E BREAKDOWN
❑ I am exempt under Section: B. 8 P.C.
• this reason TYPE QTY DESCRIPTIO N `UNIT COST TOTAL COST
te. -_ tsthi. owner: Ie-49 IC/ l ELE 1 SERVICES BELOW 600 V Si BELOW 201 AMP 18 . 50 18 . 50
I do hereby certify that I am aware of and understand the require Is of California Health and Safery Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant wilt/will not(circle one)need to comply with said state codes and the requirements for a
permit I r nstruction or m dI'cation from the Air Duality Management District.R•sidentiat construction applications are exempt from
hies 'prnV15'As.
Dal
Dat¢'_ hunt:
I hereby certify that I have read this application and state that the above infor r.'•• •rect.I agree to comply with all city and county
ordinances and state laws relating to building construction a : •reby a •de representativ.e • .• ter upon the above mentioned
property for inspection par s 5 • __ r _
• 01 07?3114—COO 3995 `I
�76 — -1 _� DATE: r• '9 i P'E: "—
Dale' Signature: JJ. _1. T' 15,,i
Driver's License or Social Security N.
`\ 164146 Wlnle—Building:Green—Code Enforcement:Canary—Applicane Pink—Revenue;Goldenrod—Assessor
/ \
{ 41,0 P & SPA ! i
1,• CONSTRUCTION AND PLANNING
ras 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 UF ER 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 ,II
14. Rough Plumbing 65. Electrical-Final -./ 'i%
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 O Gas OOil
23. Gas Pipe-Rough & Test72. 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 PREY. FINAL
30. Drywall Nailing - 1 HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat . 79. FINAL INSPECTION
•32. Electrical Power Meter-Final S�6 ,�� a0. FOOD CERTIFICATE ISSUED -
33. Final Electric �j,/ .ft / Notes: •
34. Final Heating & Air Conditioning • 1..:. •35. Final Gas Pipe-Test '
36. Hood or Canopy . r - - -
37. Final Factory Fireplace 1'
38. Final Plumbing -
39. Water Service-Final
40. Gas Service-Final -
41. Solar Dom(icFinal
42. Backflow Prevepter •
43. Backflow Irrigation
44. Landscape Irr'ygation System .
45. Sound AttenJation
46. Handicap Regulations
'47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING _
.
49. Electric Release to Edison •
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
. - -• ;Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. -
CITY OF COSTA MESA CONSTRUCTION PERMITy/ PERM}? NO. ��� TRACTNOO. L •OT N .I UNIT NO.
Project Address. Q///i.�57`'197/AJ stew /! //�S A Biz.,
•
' Applicant's Mailing Address c c'A 1-MC TYPE OF CONSTRUCTION LJ NEW .J ADD LLL"`333"""ALTERATION LI REPAIR
/�/� m/� ❑ CONVERSION ❑ DEMOLISH ❑ OT R _ �y 6224 I O/29/8LI Zone /�
' Owner's Name FSC/s/!' 7 U' 'et/ Phoneln�//� -s ✓1'�L A.P.# ('CJ f yen - �l 'I /C..� I7e0� TL
l q DESCRIPTION OF WORK/MO OF BLDG. QaV'u5� �
Address -fll�e�74/12//L Cies .4LJ-Q . &t(s a- A- ?D co U l/ja'retq p/^-Joe �y� S Main Building: Accessory Building: z
Arch/Eng.�.P License No. TYPE OF PERMIT iL-JI GRADING FOUND ION STRUCTU RAl�Q1„a�� T Front . p
0 TENANT 0 ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
N
Address B Rear I
❑ OTHER /
Contractor's Name - 0�� • Phone PROJECT DESCRIPTION 5r,7 �T OCCUPANCY __/ C Right G
Address(mailing) �/V- 7� K
CONSTRUCTION TYPE ( VALUATION$_4 re- •� - S t R
City License No. ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION • Ping. Ref.# Parking Req./Provided E
1 hereby affirm that l-am licensed under provisions of Charter 9(commencing Remarks: /�__�.�/ ,� //J !/� 1 (d• Planning Notes: 11/. . `, a „ C/ Arn/ M
with section 7000) of Division 3 Of the Business and Professions code,and GL.ir(f` N \„ 6 (torn/
my license is in full torn and effect. /n/ /^ - r T
License Class License No. •5 E. C v 1C. - 397 _ . l a iL e. GL//I A.• S
Date Signature PLUMBING FEES r . ,
"YORKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FE
hereby affirm that I have a certificate of consent to self-insure or a certificate
A Workers' Compensation Insurance, or a certified copy thereof (Section •
3800, Lab. C.) Backflow Preventer • Service Sink Automatic Washer Transformer 0 15-50 KW
7
Policy No. Company Backflow Irrigation Sewer Cap0 50+ KW _.
8 Certified copy is hereby furnished. Construction Pole Sub.
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection • Cooking Unit Meter Duo to 100 amps
Date - Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors _ Dishwasher Meter Dover 100 a 5 _ •
(This section need not be completed if the permit Is for one hundred ($100) or Dishwasher
less). - Solar•Piping Dryers DGas DElectric Sub Panel .
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 bee me subject to the Drinking Fountains Solar Tank Fan Motors❑ HP ❑1'h-8
Workers' Compensa ,Laws of Califorym
Date /(._aq�-- i_Signature C-41/4427,45.2t -Li Floor Drains Swimmin ool w/Spa • F.A.U. InaStar 09-15 HP 016-15+
NOTICE:If,after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Uri
comply with such provisions or this permit shall be deemed revoked. • Fixturesrowave
CONSTRUCTION LENDING AGENCYGas Service Outlets - ater Closet Device Boxes
I hereby affirm that therd Is a construction lending agency for the performance Pole Light •
of the work for which this permit is issued (Section 3097 Civ. C.)
Interceptors Water Heater Outlets
Lender's Name Range
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 .
any structure, prior to Its issuance, also requires the applicant for such permit p • Laundry Trays Generator 00-5 ❑5-15 KW Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Dra
The Contractor's License Law (Chapter Professions(commencing with Section is7000) of
ie Con 3 to s e Lic nse La and 9(co Code) or that he/she exempt of ////
lerefrom and the basis for the alleged exemption. Any violation of Section •
b31'.5 by any applicant for a permit subjects the applicant to a civil
nalty of not more than five hundred dollars($500). t
I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3
compensation, will do the work, and the structure is not intended or offered - 7 Reinspection Fee $15 Issue Fee $ 3
for sale (Section 7044. Business and Professional Code: The Contractor's MECHANICAL FEES
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: //////J//a n
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑ // /�1r ' /O • r1G•�//�,
sale. If, however, the building or improvement Is sold within one year of com- Canopy Type II ❑ / Zoning Approved By '/ .�i a Cane
the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground Building Approved By ori/�W.�.i Date �V'194�G
prove for the purpose of sale). __ 4.4
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration SySt••- Application Issued By f /!/_a-z Date to-2-7 tit
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 ❑0-100,10; :TU ❑100,000 BTU -
builds or improves thereon, and who contracts for such projects with a con- SUMIy1ARY OF FE S
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 '•stem Repair/Alteration BUILDING PERMIT $ /0' 00 SMIP $ ' 5 Y 0
• proof of their Worker's Compensation insurance should be provided to me. PLAN $ �'�1 PERMIT
' ❑ I am exempt under Section B.
&-P.C.for this reason Firepl/Fact.Blt. ICBG# ' Fire Dampers PLUMBINGN CHECK $ ISSUANCE $ -
Date /1_(.12-_ _L42-1-fOwner L7.e f 7 1LZ&Mf. Heating System& D • ng Registers • ENERGY P.C. $ •
I hereby certify that I have read this application and state that the above 00-100,000 : 5 ■100,000 BTL PLAN CHECK 25% $
Information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ GRADING . $
and state laws relating to building construction, and hereby authorize repre- MICROFILM $
sentatives of this city to enter .n the above-mentioned property for PLAN CHECK 50% $ -7
•
Inspection Pur ses. /a _�7_Cf�_ MECHANICAL $ TOTAL FEE , $ / /'a 00
Signature x i, t2iL-[.� Date d"t7 --
Drivers' License or SS#
"���� Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $
1 -
CMF 0865-46,rev. 10/84 white - Building; Canary - Applicant; Pink -Accounting; Goldenrod -Assessor
I
1 CONSTRUCTION AND PLANNING POOL & SPA
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 r
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:
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
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation - ..I'
44. Landscape Irrigation System
45. Sound Attenuation f�
46. Handicap Regulations „O, _ , // •
..
47. FINAL STRUCTURE & BUILDING A
303 /TVS 06C *4
48. Special Requirements Completed 7
49' Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
•
ADDRESS OF WILDING: 2591 WESTMINSTER AV SPIT: CITY OF COSTA MESA — BUILDING PERMIT
acNEWSNAIIEIvalavx: WORLD SAVINGS 6 LOANS — PERM NO: E 072685
ADDREss: 150 PAULORINO * 127
745 966-38387 J PERMIT NO: E 072685 PLAN CHECK NO: N GOVT: N SUPP: N
APPL.MMLDMADONES5: 710 MAIN ST CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: OTH
H.B . , CA. 92648
ARCHITECT OR ENGINEER: NC NO.: JOB DESCRIPTION : ELECTRIC METER SQ FT:
ARCH.OR ENG.'S ADDRESS: Sar: CLAIM VALUE: CALC—VALUE: GROUP OCC : R-3 /
CONTRACTORS NAME
CONTRACTORS MMUNG COMMENTS : X
*******************************************************************************
lit 113uxr. ZONING REQUIREMENTS
SETBACKS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under positions of Chapter 9
(commencing with Section 7000)a Division 3 a the Business and Pramaions Code.and my license is in lull force end effect.
CrTYUC.NO.: UC.CLASS: UC.NO.: EXP: MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Date: Contractor: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby drum under penely of perjury that I em exempt from the Contractors License Law for the
followirg reason(Section 7031.5 Reisss end Professions Code:Any Cay or county which requires a permit to oomuma.eller,improve, PARKING REQ: P ROV: PARCEL : 43919121 Z N E: REF NO:
demolish,or repair any structure,pion to its esunce.also requires the applicant for such permit to file signed statement that he or she PLANNING NOTES>
is licensed pursuant to the provisans of the Contractors License Law[Chapter 9(commencing with Section 7000)of Dimon 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 permt aublaae the applicant to a dvi penalty a not more than fire hundred doOen ISSOOD. *******************************************************************************
1'as efof the° cMY 744Business do� ` pae the oe sof
ptore is wintended
n er DEVELOPMENT S ER VICES REQUIREMENTS erdorsale(Section 0nPrlsionssCodemeContraaoreLicesLa does not aplynOwne vwho
but,or improves thereon.and who does such work himself or Ismael«trough his or her own employees.provided that such ,,
intendedoffered improvements are nor « d for sale.V.however,the building or inproemam is sold within on.year a canplagn.the ZONING APPROVED BY DATE:
owner-builder will have the burden a proving he or she did not bald or improve for the purpose of safe).
o I.as owner of the property.am exdusivehr contracting with licensed contractors to construct the project(Section 7044,Business and BUILDING APPROVED BY : DATE:
Professions Code:The Coot radon License Law does not apply to an owner a property who builds or improves thereon end who -7-1:7
1 '
contracts la such projects with a ootraaorist fcensed pursuant to the Contractors License Law). S
exam. r .- Section: B.a P.c.. « na, _. . / APPLICATION ISSUED BY: � DATE:
ncr_ ` / / **************************************** * * ******************** ****
°WeC LEGALIZATION:N F E E SUMMARY STRUCTURAL EGMENT: N
.. certify that I ant aware of and understand the requirements a CaBamie Heath and Safely Code •.Ens 25505.25533.and
--'- end that Wddirq occupant will/wit POI(aero aro)naed to comply with said mu... and the upuuem«te br BLDG PMT PLUMBING ELECTRIC , , MECHANIC FIRE SMIP/RES GRADING
a permit for construction or modification from the Aitaranagerrient District Residential construction eppfutiom are exempt from these
'so id«,s- PERMIT 18 . 5 0 .
Date: Aoomnt:_ 50% • SMI P/NON—RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby alfinm under penalty a perjury one ol the following declarations: ISSUE FEE 1.5 , 0 0 •
o Ihave and wilmaihtailarendcaleamsantose9impe
ureforworkers'comnsat ,mparaded for bySection 3700of the Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK • TOTAL PAID DUE
Code,for the performanceathe work for w: this pemd .Sued. TOTALS----> 18 . 50 15 . 00 0 . 00 33 . 50 33 . 50 . 00
o I have and 0341 mental workers'compensation insurance.es requited by Section 3700 a the Labor Code,for the performance of the
work for*44th Na permit is issued.My workerscompensation insurance peers and policy number are:
cad. REVENUE DIVISION TOTALS--> COLLECTED: 33. 50 OVER/SHORT: . 00
• Poky Number BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This section need not be completed I the pennf is for one hundred dinars 192001 or less) 33 . 50
•
❑ I pertly that in the perl«mance of the work for which this parrot is issued,I shall not employ any person in any manner o as to
become object to the workers'compensation lane of California,end agree Nat if l should became subbed to the workers' *******************************************************************************
compensation provisions of swan 3700 a the Labor Code,I.hall forthwith comply why Nose provisions. INDIVIDUAL F E E BREAKDOWN
Deb: Appfcent: '
Wanting:Failure to secure workers'onwse
endon coverage Is unlawful,and shall.W/act an employer to criminal penalties and TYPE QTY DESCRIPTIONUNIT COST TOTAL COST
civil Nus W to one hundred thousand dollars(sfx000).N addition to the oast of compensation damages es provided for In
Seddon 3706otthe Labor Cods,Infant end etromey'e lees. ELE 1 SERVICES BELOW 600 V 6• BELOW 201 AMP 18 . 50 18 . 50
CONSTRUCTION LENDING AGENCY:I hereby affirm under penally a perjury that there is a construction lending agency for the END' OF FEES
performance a the work for which this perms is issued(Section 3097,Civ.C).
•
LENDER'S NAME - , •
LENDER'S ADDRESS:
I candy that I have read this application and state that the above information is coned.I agree to comply with all city end county ordaenpee ••
and state laws reeding to building costuaion and hereby auN«¢e representative a this city to enter upon the above-mamioned property •
for inspection phspeaea.SCOTT GAMBELL • '
•
01 00153`33 CG183`03 TOT 33.50
��ctra Date: G/5/9 r DATE: 06/05/55 TIES: 13:44
.....-
Signature of r pfirantiContredor
(5151<A W P) Whae-Guidig A Safely:Green-Re:Cray-Appirant:Pink-Revenue:Goldenrod-Assessor
CONSTRUCTION AND PLANNING 1- i POuL & SPA
APPROVALS Permit # Date Inspector APPROVALS Permit Date Inspector
1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location
`r
2. Soil Pipe•Undrgrnd. . 53. Steel Reinforcement
C.:^3. Electrical Conduit Utility-Undrgrnd. 54. Forms `�
6t4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
7t5..Steel-Reinforcement 56. Rough Plumbing & Pressure Test .
.-'•;6,`ElectrieaI UF ER Grnd. 57. APPROVAL TO COVER•GUNITE •• .
.L?r-Eootings 58. Electrical Conduit-Undrgrnd.
,„,,,,...Foundation 59: Gas Pipe, 0 Undrgrnd.,Test
-l9, Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd.
�.t„l0. Structural Floor System 1 : 61. APPROVAL TO DECK
'`11. Property Sewer Line & House Connection , 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
1?Roof Drains 64. Plumbing System - Final
14. Rough Plumbing to 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 Heatingr.
& Air Conditioning FJR� ar•EPT••REOUIjiEMENT _
T '-‘?,..1 7 x U o 31* �tp O _
120. 304h E•ctl y F;fiilace IS * S 1ti irs fJ APF OVSW„ Permit # -•
21 I-0utts, iiVStrSctdFAt I •• 1••r5 >x 5 d �.� y 70~tJnde�j�'-'d Hydro a-
r-, ¢• to 7*
C H 4 Cl H !"t % �: F+ f-.t'8
22..Duets, nt~'ti S-.Yc b * S �':# i [T' 1 . -
�) l fJ Y< C '?, fJ Eig Q 71. ProdgnAiPind Gas LI Oil
23. 'Gae.-Pipe-Ro h &Test I �� M K M Cr tt O* n 72. Underg tJnd Elesh '
24.`TRoof Fl.�in? ea I FF ••F >a > C r+k"< S
ry g O� � .. ft Undergrd.Stgrage Tank O Gas ❑Oil
r' .44 (J 4. t 1 M ci O J. I: a
25. Roof Sheathing t V. v'r* -y 7 > ^'t 74. Overhead Hydror
Y
t., C D'I i
26. .j-Bar Ceiling (Structural) &'fvt��r{"'rpcoat : rt �, G,. 7.5. Dry Chemical"..= t• r rt rci
T lv 4 -' tires r
27_:Frame aoF1 Flashing': pix * U' 31 s,A 76. Dry Sta`cdpipe-T 1-' 28.28. Lathin}:& Siding :; " ttir"e p 5 ..( ..' ..i *. FIXE4S/ST.EjaFINAL.. ,-, [,
r V_ .. .r ' 1 78. FIRE PREV. FI AL �,
29. Insulatibn *' 5 W
s
`•'- 30. Drywall'Nailing '� I-, 1 r, I I t:`; ti!f! ALTH DEPT'. REQUIREMENT
31. Plaster 8iown•Coat* 5 I R't*r * I 4, - 79. FINAL TD4SPECTION *
32.FtlectricalPower Me erPF,inall r3 8}�_ FOOD CERTIFICATE 1SSUr r
S T a1 - ii� _.1.
33.�Fina{ Electric 1 _ ✓VV���/ Notes• � • L0 `^r••� .ter //��
34..Final Heating-I& Ai iCoriditioning� ! �-'' _ n _�• t: .., in?C _&erll_YC-.
a.cfQp. f�
35.-Finan Gas Pipe-Test, r, _ /1- 14.) ;-,r
36. Hood or Canopy =* _ z T: *• ' 1 * _ . _ - r
- 37. .Final.Factory Fireplace• ._:�-. - - 4.7T�dr&awL ; 9L.e•t_•, 037
_ 38. Final,Plumbing ,4t- R C- - .� - a �, + a
r
39. Water Service-Final` . , , T ` -c
- 40. Gas Service-Final ! rT <rmt^ • r-• •
oc..
r - r• I .....i• ' - • • .
• 41. Solar Domestic-Final • H. - V.` « > r -t
42. Backflow Preventer, I - c • x '.0
A r-i L y
43. Backflow Irrigation; y - r .
.
J
-44. Landscape Irrigation System, ' 'Tl + r'
-45.1_Sound Attenuation F,,-
-46. Handicap•Regulations r I t -': _ ':c n. i
I-1
47.-FINAL STRUCTUf#E & BUILDING .., r,
48.FINAL PLANNING'. r t
- i. - •
Z49.tEledtric Release to Edison , •
, •, + _
:50.SJas Release to Southern California Gas Co .I - -- r_.$ - -
,- - .. 71.L ._
-51. CERTIFICATE OF'OCCUPANCY
No Date