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HomeMy WebLinkAbout1040 WESTWARD WAY - Building Permits •51111 CITY OF COSTA MESA - 4. 9 BUILDING DIVISION F , 41 DEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER 110.411 PERMIT B03-01721 ;tbeftamco (714)754-5273 • Fax(714)754-4856 • www.ci.costa-meSa.cBUILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1040 WESTWARD WY Status: ISSUED Suite: Applied: 10/06/2003 Vicinity: FLAT PORTION ONLY Issued: 10/06/2003 Parcel Number: TPN99015 Zoning: Applicant: PEARSON, VESS ISSUED BY: Address: P 0 BOX 3908 Phone: 562-429-7663 SEAL BEACH, CA Zip: 90740 Owner: WESTBLUFF VILLAGE HOA Address MIKE BERRY COSTA MESA,CA Phone: 1024 SEA BLUFF DR Zip: 92626 Contractor: G M ROOFING Address: P 0 BOX 3908 Phone: 562-429-7663 SEAL BEACH,CA Zip: 90740 License: 472566 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF ON FLAT PORTION OF ROOFS ONLY. INSTALL 4-PLY HOT MOPPED GRAVEL ROOF SYSTEM. INCLUDES 1040- 1048 WESTWARD WAY. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $6,125.00 Permit: $139.25 Claim Valuation: $6,125.00 SMIP Res: $0.61 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $139.86 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 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 2446-48(6/00) DECLARATIONS ('`) 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 Code,for the performance of the work for which this permit Is Issued. My workers'compensation I surance carrier and policy number are: ,h Cartier: �K) Policy Number: l')o( I i 02. - 20 Cr; (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 shell not employ any per%pn in any manner so as to become subject to the workers' compensation laws of Iltornia,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 ro ions. 10-- /tO—� Applicant Signature: �^ - c' M . . ' i°'- Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($103.000),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 licensesd2r DryylSjpnsp(9hagter 9(commencing with Section 7000)of Division 3 of the Business artProfeSsigps Code,and my license Is in full force and effect.Lic.# '1._r)L_ 7(P Co Class# -S l Contractors Signature: A.� {I ..in-x M.--�/ Date: "s'' (c,^43 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).): O 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.). • ❑ 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 to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): 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,California Administrative Code). O 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,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 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 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? 0 Yes LU 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 end 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 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 COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and stale that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. SiLure Of Legal Owner(s) Date '�1,&-'- ti ,,,,,,,- (p-io-v 3 And/Or Authorized Applicant Date S-'0DE 7 INSPECTION TYPE PATE g1RIlALS COOEI INSPECTION TYPE PAIS !MAO 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 1041-03—03 210 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 IF f t An"- ._ cFP 70-76 Fatu00 9ocr, -t**259.^1 COSTA MESA BUILDING-SAFETY DEPARTMENT p,0.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Complg(ely — Use Ink Only v,, - 1 _/7 RECEIVED BY DATE RECEIVED DATE ISSUED BUILDING Tyj ADORES / •y �/ /��/ //�� PEgM No.7 OWNER f . I it A.P.NO. l,. e< C: i MAIL BUILDING ////�Ir/�t JJ .J • Q ✓.�IL�7y(/�}/(/� ADDR S OO id_ lir ADDRTSR$/r.•j'�"at• /-4�Q ACT T IIIBK /I� TE [/•. -- CITY /JT1/ ( NO0- CONSTRUCTIOfJY • NEW DD ALTER REPAIR MOVING DEMO)ISH LENDER /� ,�/t / )/t/� BRANCH OWNER A£T�oFGrC/ l/y�[,o_ ADDRESS /j }' /7,, J� VALUE ARCHITECT EP4 4141 ��__ 7/ _TEL. USE�"r+NQ° V NI� E OR ENGINEER //.1/I+`' t�Jj/yi/i� s`J NO. FIRE ADDRESS ZONE TYPE GROUP ( S APPROVED CONTRACTORArke-1-- BY DATE ADDRESS TEL. ZONE INO.OF USE OF NEW CITY NO. PLANS BUILDING F STATE n 7 -77 'j CITY YARDS APPROVED YARDS APPROVED LIC. NO. /�� LIC.NO. MAIN BUILDING ACCESSORY BUILDING SIZE �� pp NO.OF BLOCS. (FROM C/L STRE ET) 0. OF LOT axe— NOW ON LOT FRONT FT. FT. Q USE OF en EXISTING BLDG. R.SIDE FT. FT. rn FSeparate permits are required for L,SIDE FT. FT. electric,plumbing and heating work. WREAR FT. _ FT. [.. USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& CMAIN SLOGS. ACCESS.SLOGS. : ( /Jitgrc 19677QAO5 V UVAR.#W DATE APPROVED r APPROVED .rlel _ BY DATE Q, `A'vwrlc 7: loots, is tid eiP ex, 1.11 NV pI hereby acknowledge that I have read this application and state 3 nal"Hi n 1-13 /at 7 13o 841130!W cam/ ce that the above Information is correct and agree to comply with m Cl. all laws regulating building construction, and I shall not employ V. _ �R E. `V Z any person in violation of the workman's compensation laws of � v W the State of California. �Jr /}�[t� I hereby certify that I am •roperiy licensed as- ontractor under 61$11�� SO. FT. �`154 RdSrjo ry the State of Californi= B ness and Profe .lo ode, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9 • hat lc. Menses are n ?II • ce an• effect,or THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: a L� am exe •t fro th/p/visl• s of t a •.t • Califo nia : sin y "` and Pro onions o• r vis n 3,C ap L I VALUATION PERMIT FEE ELh Signature of r _IAt . '� S `�� �oo TAX CHECK 3 ��L 2� U Authorized Agent TOTAL PAID $ t X Patn 4 Gq'� rllr3l77P,.,,trri,�,3zz ;t`,t*38Z.5G COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely —Use Ink Only l, ryyWooly/go RECEIVED BY DATE RECEIVED DATE ISSUED BUILDIN 1/{+./ /J ��n/ ADDR ES �'�- H'� I hp,T- FpW PERMIT NO. OWNER A.P.NO. MAIL BUILDI#*.2 9_4_JWc5YWAfSO M$y, ADDRESS ADDREF/7�_�y�f PVr+7 DY/�/7 TEL. TRACT I CITY NO. LOT BLOCK CONSTRUCTION NEW I ADD ALTER REPAIR MOVING DEMOLISH LENDER //\J�/ BRANCH yt � ��) OWNER �_`llll• /.f.r/.1/V ADDRESS /�� VALUE ..._.2C;;,ARCHITECT TEL. USES /C $ OR ENGINEER NO. FIRE ADDRESS ZONE TYPE GROUP APPROVED CONTRACTOR BY DATE ADDRESS ZONE INO.OF USE OF NEW TEL, PLANS BUILDING CITY NO. F STATE CITY YARDS APPROVED YARDS APPROVED gLIC.NO. LIC.NO. MAIN BUILDING ACCESSORY BUILDING w SIZE NO.OF BLDGS. (FROM C/L STREET) G. OF LOT NOW ON LOT FRONT FT. FT. Q USE OF CA EXISTING BLDG. _R,SIDE FT. FT. c. F Separate permits are required for L.SIDE FT. FT. Ci electric,plumbing and heating work. _REAR FT. FT. W USE OF BUILDING AND WORK TO BE PERFORMED F DISTANCEBET. BET.MAIN& Q 2 MAIN AINBLD BLDGS. ACCESS. BLDGS. Q VAR.# DATE • C.U.P.# APPROVED > APPROVED > BY DATE 12 W 0 I hereby acknowledge that I have read this application and state � 2 that the above information Is correct and agree to comply with m 4 all laws regulating building construction, and I shall not employ i Z any person in violation of the workman's compensation laws of 2 the State of California. ci I hereby certify that I am properly licensed as a contractor under SQ. FT. N the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR sa Chapter 9, and that such licenses are in full force end effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: vs am exempt from the provisions of the State of California Business VALUATION PERMIT FEE (��t v and Professions Code, Division 3,Chapter 9. $, d l / �, [!/1 M PLAN CHECK $ m Signature of O Permittee $ TAX $ U. U Authorized Agent TOTAL PAID $ g.--2.I. 52 .. . COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in C mple •ly —U • Ink Only //yy RECEIVED BY DATE RECEIVED DATE ISSUED BUILDINGDDRE ADDRESS %(0) /, J,4 -' , {s' �s OWNER �_J a � 'A'P!N O. �`6:6C)3° PERMIT NO. BUILDING MAIL ADDRESS alr 0 -, I 1- IADDRESS 4 d /,W, _ �•J - CITY �_A_ Nr, .0 ,! / TRACT/A'� �•�LO ID- I- 3 OCK ^ T. 4 2 i es CONSTRUCTION � NEW ADD ALTFR REPAIR MOV G • MOI ISH LENDER „21101..� T BRANCH 54 ADDRESS /'iv( - - _ OWNERS S& Alit . ■EY .! Ataf J VALUE ARCHITECT / TE Sr •ris /i.1 ir /4 $ OR ENGINES' ,,,S 41..-..� s Si ' ,71%(f-,3 4 , FIRE if ADDRESS GROU E ZONTYPE APPROVED CONTRACTOR etia/ BY DATE 1 ADDRESS .yam ��NO.OF �7 USE OF [�_ / TEL. t,/�/ /Y�PLAIsa BUILDING CITY NO. r�0" C/rrl (/l F STATE CITY YARDS APPROVED YARDS APPent gLIC. NO. . y 2.2_3 LIC.NO. MAIN BUILDING CCESSORY���dddUILDIN SIZE �^- NO.OF BLDGS. (FROM CASA.;T/46� L OF LOT SAS • NOW ON LOT FRONT FT. Q USE OFCG EXISTING BLDG. R.SIDE-4.1 /FT. FT. CII F Separate permits are required for L.SIDE /O FT, FT. electric,plumbing and heating work. REAR 3 .T FT. I--, USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN& - Q MAIN BLDGS. ACCESS.BLDGS. GI VAR,# DATE // (j C.U.P. APPROVE /5-7/_ Q 3 ////�/ Kn VVVVVV���OQQ >-' RV ED -/,4J/\ ,DATE'/- ,-1 HOLD FOR SPECIAL REQUIREMENTS 0ihereby acknowledge that I have read this application and state n cd that the above information is correct and agree to comply with co O. all laws regulating building construction, and I shall not employ Z any person In violation of the workmen's compensation laws of ,s e the State of California. //}' To �J`2e w /y� m I hereby certify that I am properly licensed as a contractor under ✓ JJ SO. FT.J (�.(/ ry the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, end that such licenses are in full force and effect,or I THE PURPCGE OF ESTABLISHING A PERMIT FEE ONLY: - am exempt from the provisions of the State of California Business o VALUATION PERMIT FEE E and Professions Code,Division 3 Chapter 9. us ////��� , / PLAN CHECK $ `^ Signature of -FSI- „ 'e u Permittee Pr, - --. $ TAX $ u. U Authorized Agent TOTAL PAID $ ffG9c COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 APPLICATION FOR STRUCTURAL PERMIT For Applicant to Fill in Completely — se Ink Only 77 RECEIVED BY DATE RECEIVED DATE ISSUED BUILDING 1 (}6 /,' /i , ADDRESS D / til/ (�( /I /�tt�� /M� �s�/�JJ-/ I A. NO" -° /O'165/ PERMIT NO. OWNER Ai��� /�/1ie/1lJ-_� MAIL j BUILDING ADDRESS a 1 Jj�._.. aADDRESS ,� • TEL. I. tie" r j .4 CITY `do4 NO, / _ / TRACT / ee).. y • K CONSTRUCTIO �) / I`tEt'�' ADD ALTER REPAIR MO IQ. Ifl MOI ISH LENDER "cyan° fO BRANCH I/ A /' J///- il ADDRESS /7 �. O0 /Li �4/ V LUE ARCHITECT / TEL. SE �/ OR ENGINEER /' FIRE •,� ADDRESS 20 4-3 PAW //.-f) . ZONE TVP / GROUP ft APPROVED CONTRACTOR dienha•^ BY • DATE — ADDRESS �2p�Ipr r.OF 1. USE OF NE� TEL. (/_/„/I/JPLgNS �/ BUILDING CITY NO. ,`r7` (A� F STATE CITY YARDS APPROVED VARUS gir LIC. NO.26$823 LIC.NO. IFRO MAIN BUILDINGLL"� ACCES V BUIL G t. L OF LOT 5-4,-SIZE I NOW ON LNO.OF OS FRONT<l J FT FT. Q USE OF ! // /l col EXISTING BLDG. R.SIDE /0'1A FT. VI E.• Separate permits are required for L.SIDE a FT. electric,plumbing and heating work. 7 WREAR / F'/I FT. E.-, USE OF BU LDING AND WORK TO BE PERFORMED DISTANCE BET. BET.MAIN& -1S � MAIN BLDGS. ACCESS. BLOCS. �j [Ay VAR.* �j/Q7 DATE 11-77�}^ - `�V ry�/I if/i�/L I�f APPRO Ele rR 1-�D_ATE V/— ' / I J (i(� w , HOLD FOR SPEC Al. REQUIREMENTS o I hereby acknowledge that I have read this application and state N. n IX that the above information is correct and agree to comply with m Q+ all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of �[j///� 4/� o Sthe State of California. `! D SO. FT.�'/ �/D r (E/ tmv I hereby certify that I am properly licensed as a contractor under the State of California Business and Professions Code, Division 3, TH AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e am exempt from the provisions of the State of California Business VALUATION PERMIT FEE vr and Professions Code,Division 3,Chapter 9. $ th PLAN CHECK $ en Signature o - o Permittee $ TAX $ V2 . U - U Authorized Agent TOTAL PAID $ _. rt r I pflOJECT ADDRESS: 1040 WESTWARD WY UNIT: CITY OF CESTA MESA — BUILDING PERMIT PERM NO; B 05689_ GOVT: N SUPP: N OWNER'S NAME: AL MARTIN R ADDRESS: SAME PERMIT NO: B 056843 PLAN CHECK NO: N a CONSTRUCTION TYPE: PERMIT TYPE; STR PURPOSE; OTH ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : TEAR—OFF S REROOF 1000SF FLAT ROOF SQ FT: 2, 115 ADDRESS: UNIT: CLAIM VALUE: 2, 115 .00 CALC—VALUE: 2, 115 , 00 GROUP OCC; R-1 / PERMITTEE: EVERGREEN ROOFING ( 714 ) 529-7427 ADDRESS: 1175 ORANGEWOOD DR COMMENTS: X BREA CA 92621 ***+r***+t******************+t+e******+ESE*+r+ *** •***********+ * *DE Ton LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 ommencing with Section Z ONING R EQUIREMENT 70001 of Division 3 of the Business and Professions Code.and my license is in full force and effect, SETBACKS NGEDCITY LIC.: 0553490STATE UC.: //6155311 ss: C37 / MAIN BUILDING ACCESSORY BUILDI Date: / GGZ ( signawr LEFT; FT IN REAR; FT IN LEFT: FT IN REAR: FT IN WORKERS'COMPENSATION DECLARATION: I hereby affirm Mat I have a certificate of consent to self-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT; FT IN RGH T: FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). POLICY NO.: EXP.DATE: COMPANY: PARKING REQ: PROW: PARCEL: 93523040 ZNE; REF NO: • 0 Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> .1• e: Applicant: ********)h*******************************j('**********************ik******.********* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the perm'is for one hundred(5100)or less). DEVELOPMEN T SER VICES R E Q U I R E M E N;1T S I certify that in the performance of the work for ich this permit is issued,I s not employ any p rson in any manner s 5 to become subject to the Workers'CompensationCLaws California. ZONING APPROVED BY DATE: Date: 7—�—/ 2- Signature: i employ r " NOTICE:II.alter making this declaration.you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE t Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. t CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction tending agency for the performance of the work for APPLICATION ISSUED BY: DATE• /, G ( el which this permit is issued(Section 3097,Civ.Cl. ******************************************* *********************** ** ******* LENDER: ******************************************************************************* ADDRESS: LEGALIZATION;N F E E S U M M A R YSTRUCTURA`L;.SEGMENT;Y OWNER BUILDER DECLARATION: thereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC' MECHANIC FIRE SHIP/RES, GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish.or PERMIT 54 . 00 1 ' 5 0 repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed SNIP/1'40N—RE$ pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of Inc Business PLAN fir and Professions Code)or that he/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 15500). ISSUE FEE I. as owner of the property or my employees with wages as their sole compensation, will ao the work. and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered Iorsale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 54 . 50 0 , 00 0 , 00 54 50 54 , 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. II, however the building or REVENUE DIVISION TOTALS--> COLLECTED; 54 . 50 OVER/SHORT: , 00 improvement is sold vnthin one year of completion,the owner will have the burden of proving he/she did not build or improve 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 54 00 50 O and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon • and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware *************************************•****************************************** that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL EXE E BREAKDOWN ❑ I am exempt under Section: B.8 P.C. for this reason: TYPE QTY DESCRIPTIO Ni. UNIT COST TOTAL COST nate. Owner: SFR 2115REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2, 115 . 00 Ido hereby certify that I am aware of and understand the requirements of Cahtomia Health and Safety 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 for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. Date: Applicant: ' I hereoy certify that I have read this application. i state that the shave information is carrect.I a'ree to comply with at city a a c my ordinances and state laws relating to building cm traction and hereby audod i representatives oft ' city ,enter upon the.••,e-pie oned - property tor inspection purposes. / '� /�,�slq—y Date: �— Signature: 'eek 1!/ tej(-/ - r Driver's License or Social Security N: llllll 164646 White—Bmtdinq:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor • CON&SUCTION AND PLANNING POOL & 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 1 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing I 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. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning T FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure ' r 70. Underground Hydro 22. Ducts, Ventilating 1 - 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough &Test 111 72. Underground Flush Q4.-Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing pi - 74.. Overhead Hydro 2677-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 HEALTH.DEPT. REQUIREMENT 31. Plaste'r Brown Coat 79. FINAL INSPECTION n . 32. Electrical Power Meter-Finab80. FOOD CERTIFICATE ISSUED • 33. Final Electric Notes:No c_ wuc. 2-_`1,t, [���y./.1' 34. Final Heating& Air Conditioning 35. Final Gas Pipe-Test e 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. Backf low Irrigation 44. Landscape Irrigation System , 45. Sound Attenuation • Handic 47. FINALaS 47. STRUCTURE & BUILDING ���s � 48. FINAL PLANNING YYY��� . 49. Electric Release to'Edisdn • 50. Gas Release to Southern California Gas Co • , 51. CERTIFICATE OF OCCUPANCY No. Date V - - -- -