HomeMy WebLinkAbout1106 VICTORIA ST - Building Permits PROJECT ADDRESS: 1106 VICTORIA ST uxlr: A CITY OF COSTA MESA - BUILDING PERMIT PERM NO: B 059910
OWNER'S NAME: FRANCIS CHEATHAM
ADDRESS: 12211 HACKAMORE RD PERMIT NO: B 059910 PLAN CHECK NO: N GOVT: N SUPP: N
GARDEN GROVE
CA 92640 CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE: OTH
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : LEGALIZE STAIR REPLACEMENT SQ FT: 1 , 200
ADDRESS: UNIT:
CLAIM VALUE: 1 , 200. 00 CALC-VALUE: 1, 200 . 00 GROUP OCC; R-1 /
PERMITTEE: FRANCIS CHEATHAM ( 714 ) 530-7179
ADDRESS: 12211 HACKAMORE RD COMMENTS: REPLACEMENT OF STAIR TO UNIT 'A' ONLY,
�Eyt�t+tFP
GARDEN GROVE CA 92640 ********* ****)r*�r*Rr*RHRH*�P**�r+EBF+ter*�H**�P*******4****************RF**********RH***
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7p13)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS
CITY LIC.: STATE LIC.: CLASS:
Date: - Signature: MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers_ FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). 'LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ' PROV: PARCEL; 42204142 ZNE: REF NO:
sr 'Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division, PLANNING NOTES>
>
Date: Applicant: _ *******************************************************************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMENTS
I certify that in the performance of the work for which this permit is issue 'hall not employ any pe in ny mann o as to become
subject to the Workers'CompensationoLaws of California. ^ rL.'' q ZONING APPROVED BY DATE;
�x Date: /I ,/Z-9 2 Signature: /1 —nu� / 1 L4 -
NOTICE:H.after making this declaration,you should be e subject to the Workers' ompensation provisions of the Labor BUILDING APPROVED BY : r3)'' �/ / ar - DATE: // /2-
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. /0i -
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: f S.
which this permit is issued(Section 3097.Civ.C). ************************* r *******. . -*** ** 4 **** **************** / / **
LENDER: ******************************************* . .**********************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that l 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 29 . 00 . 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'Stale License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SM IP/NON-RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars(5500). ISSUE FEE
I. as owner of the property or my employees with wages as their sole compensation, will 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'Slate License Law TOTALS----> 29 . 50 0. 00 0 . 00 29. 50 29 . 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 orro herm own employees,provided that mpl improvements me are notthe intended or offeredoffor sale.It. notd building yr REVENUE DIVISION TOTALS——> COLLECTED• 29. 50 OVER/SHORT: . 00
improvement ovhof is sold withins,one year oft such imp the entsr will have the burden provinghe/she did not howeverbuildthor improver
for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SNIP/TOT GRADING PLAN-CHECK
I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 29. 00 . 50
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves(hereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware *******************************************************************************
that proof of their Worker's Compensation insurance mould be provided to me. INDIVIDUAL F E E BREAKDOWN
w I am exempt under Section:B P 7044 B.8 P.C.
tor this reason: CONTRACTING OWNER a /4 , TYPE QTY DESCRIPTIO N UNIT COST ' TOTAL COST
Date: 1(—J2 9? Owner: 11 ♦. .. A , /.21 lir
I do hereby certify that I am aware of and understand the requirements of Cali rrnia Health and Safety Code Sections 25505,25533,and SFR 1200 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 1 , 200 . 00
25534 ane that I or any future building occupant wiflwifl not(circle one)need to comply with said state codes and the requirements for a END OF FEES
permit lox construction oe modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions.
•
Date: Applicant:
I hereby certify that I have read this application and state that the abov lormation is correct.I agree I.comply with all city and county
ordinances and state laws relating to building construction and herebbr e representatives of Imo(enter opo the.trove-mentioned
property lar inspection purposes. _/ 1
Dale:_LJ�-I 9 Z Signature: 4 4I :- /
yr
Driver's License or Social Security»:
• 1641.46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
I t
•
•
CONSTRUCTION AND PLANNING POO ;PA -
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location •
•
24 Snil,YL -
d
ipe-Undr rn .. 53. Steel Reinforcement •
.aic
�, EleFttical Condur1115ity-Undrgrnd. 54. Forms ,
'1:41`Ef y1t ical ConduitrU5ndrgrnd. 55. Electrical Bonding
'� m .
•-, tgf Reinforceme.E1- 56. Rough Plumbing & Pressure Tkst,L
s 0...
',,U7-Qctrical UFEFc6'raad. 57. APPROVAL TO COVER-GUMTE
•
' ootings f r•r' 58. Eiectrical Conduit-Undrgrnd. t'
•
S-f oundation 4,-L.
r 59. Gas Pipe, 0 Undrgrnd., Test 1.,
till" $•
49.',I,Vater Pipe-Undrg td. ° 60. Backwash Lines,P-Trap, 0 Undo rnd.
10. Structural Floor System - 61. APPROVAL TO DECK '
11. Property Sewer Lin & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap rL, - _ 63. Heater & Vent-Final •
13. Roof Drains 64. Plumbing System - Final
c
14. Rough Plumbirt
9 p -
65. Electrical-Final
a.
15. Rough Electrical-Conduit 66. Solar System-Final -
16. Rough Electrica/iring 67. Fencing & Access Approval - •
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING -
18. Rough Electric4-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
... •.� .•. .r . .r'- to �: x 7 C'r-4'1X- u. r lL
20."tough Fitor r F?tlace • Sr ` ` ;: C H 3 ' .kt,ppR '�,/A p:E--Perigit# ° >''
r S tTt t _ _, r
21.'-Duets, I trW t p t 1-4 t-• .4..7> Y ti >. > ?- •i - T
rt-S F unet 7 '- - 1-•+ .r ^70. Undergrot•'-itd Hydro
22.•9uots, VVnti tinct' S ttt: 4' :-71• Produccprpilttg CiWas :Oil
23. .6as Pipe lough &•t-est I ,ns • tr <C -it + -72. Underground Flush, n t: _
24.-Roof Framing •2. I i--t-• ^t� * `' > 7 to w .r S73 vUnder7. grna'.Stor q•�- ' k;O GasO 61.moi.
^ -•w w t ht to -0 tu.r. t 3 ' V
25. RoOi Sheathing 'c t cC ;•-,y; 1-.:, y> cu-' x 74,?Overhead Hydro{• -
261T-Bit Ceiling (Structural) &'Molidcoat t "] D t^a. + 75--Qty Chemical ' - `C
!" `27._framewaSf FJgshi ' :ctr , Y > z• a 76.` ry Standfl - w a tr.
••:!..>4.• _S _
- ,.- ..
128- Lattga inSiding .t --Zs?: h 7. ••t.a -.a_ 77:-"FIXED SY TEMP NA -
ur o ---x - kIx
x ' r•. n ..I. I LLs :-• �. t]'
n29. Insulation t., Cl S .. .7 tn II �•I- t+ I 78 FIRE PR EV. FINAL e > <C
"30. Drywall-Naifilg S-" ✓ 4 I _si.`ii,. t -I H£ALTEPDEPT. REQUIREMENT
.r+ N I r .1 * w. •; '30 r; t-
t t ,. I Il �; a n to r
-31. Plaster B?own,Corty l tt•LT' * l• , a r,79. FINAL IL+ &CTI(IN ,.
Lill 1. 4. .t : - .r. i •1 r .. tr;."'- -
-32..ElectricalPower MetS'DFinall • t i'1 ..C4.44 .rt s rS0t*F00D CERTIFIR'A'TE ISSUED•-
T t of a
3."Fin l E ctricl > I VI411 ' `LN res: tr 'A. y "t
;t{34;Fins] Heptin'ai& A nCondition®l> --- r S C'is , ,-^
r •r• .y .> rrz L. 'n Y •> I 9. •t 11 H• I i-4 V• s •r•
,35.tgFinal G3`4Pi[fa-Test'" '' •y i, r * tl '� '�.i 't r -`�
t t `l .. Y H nl,.�PE .r' .7 En 0 t_71 t .
_I t- ill at.* tl.
cs , t ' ,. Y IS1`1'i � r ?_ s:'1r36: Hood oCanopy- r :� :lati 0. ..C.
'.� tl.
, ,-r ea . t• . Ir it] 4,1 > V
>6 •r ,n ;'O .t .i. -,U,
"37:-Fin Factory Fif> ace,.,. I 't'• `'t x :h i '1 -11,_
711 '-1';
n t tit
INF O a tIr_.> t a. _ .i
t-38. Final Plumbing ^•.a tU i •-• t I 11 r t_ S t to �'3
- '-39. Water Service=Final I ''' 4 x tl •••L*1 a `T.
S ? o] 't '-r.',
t.t :o S. 1 :.' I I l 1.
-40. Gas Service-Final t,• ytr:r ri v. M I •• t. On• n . .r
>41. Solar Domeilic-FinelS Cl, •• .} r_':t f <t,.' t•4 . _
a > 4:1 .. I I ,0�r a Er ._i0 a- y. X -,
42' ackf low Preventers pi >, " I I l> a. r•; j� • r r• r.
43. Backflow Irrfationi `S + : Uc '- -•
x LK .3. t' U 1
V
444. Landscape 10igation Systemntnn o; a: Ln C .7 c'.4. -* cC Co Lr, *
`45,CSound Attenuation' 1-414.(- Ert: 3_• t- 'L-• t-t t. • , t-• trot LS.•.... r
1r -1 .i: . .. :r is rrt int, x -• Cr S •1: • 4''.. t
•
46E,Handica0.Regulatiops r t i. t , iX u: 00 .t t
LC
47.:FIN:AL STRUCTURE & BUILDING t t = .o a± v "
48 .$Ih}ALPL-ANNINC> i [�[- I.4.. ,' Ire'f/ri ' g ^n -
c>s9:Electric Release to Edison I t I''„ F it * s_ Litt
.i50..s.Gas-Release to Southern California Gas Co - • • t{t , , •- t-• . c to s
.- _ .., .
51. CERTIFICATE OF.4000UPANI;V > s . r IN Ella ?' t • _1
No. Date
ADDRESS OFBIALDWO: 1106 VICTORIA ST DAFT' CITY OF COSTA MESA - BUILDING PERMIT
OAWERSNAMEIFwa: CHEATHAM, EARL FRANCIS TR PERM NO: B 078428
A ADDRESS 12211 HACKAMORE RD
GARDEN GROVE, CA 92640 PERMIT NO: B 078428 PLAN CHECK NO: N GOVT: N SUPP : N
530-7179
' APPL.SWUNG ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: OTH
I
ARCHITECT OR ENGINEER: lie.NO.: JOB DESCRIPTION : T/OFF 6 REROOF W/FIBERGLASS SHINGLES SQ FT: 4 , 000
MK OR ENG.'S ADDRESS: WIT:
CLAIM VALUE: 4 , 000 . 00 CALC-VALUE: 4 , 000 . 00 GROUP OCC: R-3 /
CONTBACTORSNAME: DALE' S ROOFING ( 714 ) 534-6398
CONTRACTORSMMLRC 11550 ANABEL COMMENTS: REROOF 3700SF RESIDENCE W/FIBERGLASS SHINGLES
ADDRESS GARDEN GROVE CA =NG: 503508 ***************************+t+E+t+ERE+r*REREatRERExRE Rid*********+ESE*+E+E+E+E*:r**********RERk+t+t****
92643 WIT: Z ON ING R EQU IR EMENTS
LICENSED CONTRACTORS DECLARATION:I hereby elfin under penalty of perjwy that I em(cawed under provisions of Chapter S S ET B ACK S
(commencing with Section 7000)of Division 3 d the Business end Prorsesio s Code.and my license is n force and effect.
crryuc.No.: 03905 Lit.CLASS: C-39 uD. 35 P: 08/96 MAIN BUILDING ACCESSORY BUILDING
` ���P� FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
r/-7 Da.: c«waa«: LEFT: FT IN RCHT: FT IN LEFT: FT IN ROHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under penally a perjury that I am exempt from the Contractors License Law for the
follo7 y do,or rrpesanary°st =e«-toissuance.Busies,end thheappp«icanttforschpewhich mmtofleasig°neeconstruct eller.d thath�e«�shhe PARKING REQ: PROV: PARCEL: 42204141 ZNE: REF NO:
.s licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commending with Section 7000)of Division 3 of the PLANNING NOTES>
-Business and Professions Code]or that he or she is exempt therefrom and the basis for the Alleged exemption.Ary violation d Secton > •
7031.5 by anyepWNam for a permit suhieds the appfcaa to advtpenalty d not more thanfns hundred dollen(SSOOU. *******************************************************************************
❑ I.as owneralhepropenyormyemployeeswihwagesastheirsolecompensation.willdotework.adthestructureeratintended DEVELOPMENT V E L O P M E N T S E R V I C E S R E Q U I R E M E N -T S
or offered for Bele(Section 7044,Business end Professions Code:The Contractors License Law does nor ppy to an Owner of property Q
who bolds or improves thereon.end who does such work himself or herself or through his or her own employees,provided that such
improvements are nor intended or offered tor sale.If.however.the building or improvement is soldyear d within one completion,the ZONING APPROVED BY DATE: , .
owner-builder wit have the burden d proving he or she did not build or improve for the purpose of sale).
the
❑ I.
mdeecos owner Coodder The��ontreexclusively
�e Lawcontfloes with not ppgyy to ed rn awterdprp«rywto builds otractora to construct the project rmproves therm emend who BUILDING APPROVED BY : DATE: .
contracts for such projects*rah a contractor(s)licensed pursuanl to the Contractors License Law). ^ / r
❑ Iamexempt under Sealant B.AP.C.,I«thiereason: APPLICATION ISSUED BY: DATE: `` f ( 1C7
Dale: O^'^« LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT: Y
I do hereby caddy that I am aware of and understand the requirements of California Health and Safety Code Sedans 25505,P55'3,end
25534.end that I or any future building=upon'win l wit not(dree one)need to comply with said state codes and the requirements for
a permit for conswmknomodification from the Air .aagemenDistrct.Reekeraids«mnwapplications t
ionaionsareexemptfromeae BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 87 . 25 . 50
Date: A siicav: SMIP/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty a perjury one of the following declarations: PLAN
ISSUE FEE
❑ Ihave and will mammas a vindicate of oonsenl to self ansure for workers'compensation,as provided f« Section a t
by Sion 3700 he labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Code. performance of the for which the permaletsarea. TOTALS----> 87 . 75 0 . 00 0 .00 87 . 75 87 . 75 . 00
❑ I have and WI merman workers'compensation insurance.as required by Section 3700 d the Labor Code,for the performance of the
work for which this permit S issued.My workers'compensation Terrace carrier and policy number we:
Cana: STATE FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 87 . 75 OVER/SHORT: . 00
Perry Number: 07'i9979-4i 11 /01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
(This section need nor be completed i the permit is for one hundred dollars(5100)or lees./ 87. 25 . 50
❑ I certify that in the performance of the work for whish this penin is issued,I a -Ind employ any pe in any manner iso as to
I become subject to the workers'compensation laws d Calif. eg,Al • if t �qed to the worre19' *******************************************************************************
I compensation provieiom ion 3700 o the Labor Code.I ' . wit. ., ply
7—� 7 ' /` INDIVIDUAL F E E BREAKDOWN
Dae: Applicant:_ .,,
Warning:Failure to secure workers'compensation coverage Is unlawful,and shell subject en erployer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
WWI fines as, one a hundred thousand dollars(5ta 4000),in addition to the cost of compensation,damages es provided for In
Section DZUe of the Labor Cods,Interest,and efromsyi/Asa SFR 4000 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 4 , 000 . 00
• CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjury that there is a construction lending agency for the END OF 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 the application and sae that the above information is coned.I agree to comply with ell city end minty ordinances
end state Lawn reset;to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property
for inspection purposes. 1yp - - -
1�-yGtC� I,EER
�/ /J/
'� 1 f-1
-1 Signature of Oven err edUAppkmnUContnd« Date: /�/ro
/ (5151.46.WP) White-Buildkg A Safety:Green-File:Canary-Applicant:Pink-Revenue:Goldenrod-Assessor
}
CONSTRUCTION AND PLANNING POO. . SPA
APPROVALS Permit 4# Date Inspector APPROVALS Permit # Date Inspector
•
1. Temporary Electrical Service or P61e 52. Pool & Equipment Location
•
2. Soil Pipe•Undrgrnd. 53. Steel Reinforcement •
-8,• Electrical Conduit Utility-Undrgrnd. 54. Forms '
C4-•Electrical Conduit•Undrgrnd. - 55. Electrical Bonding
_i,5f•S'eel Reinforcemeryt• 56. Rough Plumbing & Pressure Test
6. Electrical OF ER.,Grnd. 57. APPROVAL TO COVER-GUNITE
` 7` Footings .J.;. 58. Electrical Conduii Undrgrnd.
• 8i Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
_,9. Water Pipe-Undrgrnd. : 60. Backwash Lines,.P-Trap,O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO-DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-F.inal
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 le
17. Rough Wiring Sign 68. APPROVED FOR-PLASTERING
18. Rough ElectricakT Bar Ceiling- 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE QEPT..AEQUIREMENT
20. FFbugh Factory.Fireplace _ , , IAPPROVA'LS-. . Permit# -
21. giucts;in'Structurr- - _,- - ' 70. Underground Hydro
22. Ducts, Vutritileiin - _ 0
9 -j - 71. Product P}ping �, O Oil
23. Gas Pipe-Rough & Test - ' - 7. - 72. Underground Fldeh r= , -
-
24. Roof raining • . i - - t. I 73' Undergrrfd.StorageTank OGas OOil
25. RoofSheathing ^' /�!/6 74+ Overhead Hydrq
26. T-Bai Ceiling (Structural) & M000coat • 75r Dry Chemical _
27. Frame and Flashing 76. Dry Standpipe .. _
28. Lath ng Siding = _ 77.• FIXED SYSTEM?FINAL
29. Insulation - _. r • 78: FIRE PREY. FINAL .
30. Drywall Nailing , _ _ -HEALTH DEPT.. REQUIREMENT
,
31. Plaster Brown ' - •C ,, - F - 79. FINAL INSPECTION -
32. ElectricalPower MeterFinal r 480.. FOOD CERTIFICATE ISSUED
33. Final EleFjric • Notes: :r- _
-
T s
34. FinaL-leating & Air Conditionings
35. Final Gas-Pipe-Test:, _ ? 7 - -
36. Hood-or Canopy - _ -'r _ ,_„'
J37. F'inar:Eac ory Fireplace - s
- 38. Final-Plumbing _
c
-'39. Water Service-Final. r : - '
I..
.140. Gas Service-Final r 'n _ � C -
-41. Solar DomesticFinal - • ,
-
42. Backflow Preventer i, • V -
•
43. Backflow Irrigation , . K . •
44. Landscape Irrigation System -
45. Sound Attenuation , - -: , -
46. Handicap Regulations' ,...------t
47. FINAL STRUCTURE& BUILDING 7�jn6 i. nib: u•
I/ ! e
48. EINALPLANNING ` - • - -
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co .-- •
. •
51. CERTIFICATE OF OCCUPANCY '
No. Date
/ -trli _dt. Applicant to fill in all spaces exp)those within heavy border lines and sign all appropriate declarations. 5127 12/03/Sb CUo Et, TL''
CITY OF/COSTA MESA/ CONSTRUCTION PERM PERMIT NOS TRACT NO. LOT NO. UNIT NO.
\ , Address.t/io.h V/ G/ Of.;A �/'19 13 2i IS
.
\_x in. VP- •F CONSTRUCTION U NEW ❑ ADD U ALTERATION $"REPAIR
. .pp pant's Ma i l ing Address - ' o'0 L: t li Ir Ld•�-.1 -
L _ Tin Lai Ph•ne O i CONVERSION ❑ DEMOLISH ❑ OTHER, /1 q p # Zone
Owner's Name •
DESCRIPTION OF WORK/USE OF BLDG. X'Z'- 200
� r Address ' - - .4 oft ��' a �0 .0 .„ _ _ . S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT GRADING MI FOUNDATION In STRUCTURAL E Front O
Address y ,// . ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N
A �Assor/rr1 t�h I7 777 Y6 ❑OTHER A I
Contractor's Name- P ne yr0 - C Right N
PROJECT DESCRIPTION SQ. FT. 3 p '
Address(mailing) i_b00 A/l/E V I /T l+J A•^'A OCCUPAN za K Left R
`7 36 CONSTRUCTION TYPE �VALUATION $ -_ S
City License No. 3`s ZONE GRADING CU.YDS. ACRES Ping. Ref. # Parking Req./Provided E
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: • Planning Notes: •• M
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full farce aqp act. T
•
License Class C •$ Lice se No 7 e , S
D 2— 3 N Signature "T^� if S �`� PLUMBING FEES
WORKERS'COMPENSATION DECLARAIION Bar Sink Showers ELECTRICAL
'hereby affirm that I have a certificate of consent to self-insure or a certificate •
I Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Prevented Service Sink
.,800, Lab. C.) Automatic Washer Transformer' 0 15-50 KW
Policy No. Company Backflow lrriga(Ioq Sewer Cap MI Construction Pole Sub. • 050+KW
Ekir
C �lifietl copy is hereby turn)she --_
aer�f =Qpy Is If
ith the ty Building.Division./� a Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
S �f> A ant
EXEMPTION FROM WORKERS'COMPE •TION DECLARATION Clarifiers ■ Solar Collectors ■■ Dishwasher . Meter Dover 100 amps
III
(This
(This section need not be completed if th- •ermit is for one hundred ($100) or
less). 'Dunking Solar Piping I, Dryers ❑Gas ❑Electric . Sub Motors el .
I certify that in the performance of the work for which this permit is Issued, I
ort ' employompeanyiperson inof any manner so as to become subject to the Drinking Fountains Solar Tank Fan
Workers' Compensation Laws of California.
Motors ❑0.1 HP ❑1'h-8
Date Signature Floor Drains Swimming Pool w/Spa • F.A.U. Inc.Solar ❑g-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 Urinal
comply with such provisions or this permit shall be deemed revoked. Fixtures Microwave
CONSTRUCTION LENDING AGENCY 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 Clv. C.) Interceptors Water Heater Outlets Range
Name an 9e
Lender's Address Kitchen Sink Water Service
I
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 Laundry Trays Generator ❑0.5 KW 05-15 KW Trash Compactor
any structure, prior to its issuance, also requires the applicant for such permit Pa
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
'herefrom and the basis for the alleged exemption. Any violation of Section
/031.5 by any applicant for a permit subjects the applicant to a civil
LIalty of not more than five hundred dollars($500).
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 Reinspection Fee I $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 whn 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 ❑
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
• prove for the purpose of sale). Building Approved By Date
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date
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 SUM ARV OF FEES
builds or improves thereon,and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware thatBUILDING PERMIT $ •OO SMIP $ 4
5-0
proof of their Worker's Compensation insurance should be provided to me. ,Exhaust System ❑ Multiple ❑ System Repair/Alteration •
PLAN CHECK $ PERMIT
❑ I am exempt under section B.& P.C.for this reason Firepl/Fact.Blt. !CBO# Fire Dampers PLUMBING $ ISSUANCE $
Date • Owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above' 00100,000 BTU 0100,000 BT • - ELECTRICAL $ GRADING $
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives of t I city to enter upon the abs menti property for �/ �y7
inspection pur e . i....Z— � pS� �a`.f-b;`•� MECHANICAL $ TOTAL FEE $ 3�1 'V
Signature / e •
Drivers' License or SS# _ - - . Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $
/\ CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor 1
•
1
4,Ftet
O
POO SPA
STRUCTION AND PLANNING "-
ROYALS Permit# , Date-./ Inspector APPROVALS Permit# Date Inspector
2. 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 •
i, 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& Siding77. FIXED SYSTEM FINAL
29. Insulation78. 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
44. Landscape Irrigation System ,
45. Sound Attenuation
46. Handicap Regulations //// �////
47. FINAL STRUCTURE & BUILDING 1p7jtf/�j, do
48. Special Requirements Completed ,-
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date