Loading...
HomeMy WebLinkAbout1934 Whittier Ave - Building Permits _ Si ltC_ CITY OF COSTA MESA Sr. BUILDING DIVISION .'I DEVELOPMENT SERVICES DEPARTMENT • J � PERMIT PERMIT NJMBER P99-00165 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 • PLUMBING PERMIT Job Address: 1934 WHITTIER AV Status: ISSUED Suite No Applied: 03/12/1999 Issued: 03/12/1999 Vicinity: Parcel Nunmber: 42253205 Applicant: BENSON, JACK Address: Phone: Zip: Owner SMITH, SELINABEL Address P 0 BOX 2020 Phone: LAGUNA HILLS,CA Zip: 92654 Contractor: CONSTRUCTION RESOURCES & CONSULTING Address: 3419 VIA LIDO#222 Phone: (800)246-4123 NEWPORT(WCH,CA Zip: 92663 License: 655750 Arch/Eng: Address: Phone: Zip: License: SCOPE OF PERMIT REPAIR SFr)-REPLACE 1 WATER CLOSET, 1 SHOWER/TUB, 113ATHRM SINK, 1 KITCHEN SINK/GARB DISP., RELOCATE WTR HTR,REPIPE HOUSE•& 1 WASHING MACHINE. (B99-00351). FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $22.00 Laundry Tub/Washer $8.75 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 $8.75 1 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 $8.75 1 Dishwasher $0.00 0 Sewer 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) $8.75 1 Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $11.00 1 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 $8.75 1 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $5.50 1 Sink,kitchen • $8.75 1 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease, Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $91.00 COMMENTS/SPECIAL CONDITIONS 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)754-5826 WORKERS'COMPENSATION DECLARATION: II hereby affirm under penalty of perjury one of the following declarations: v_(( 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. ❑ 1 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: Cartier: Policy Number. (This section need not be completed i/the permiIssued at one hundred dollars($100)or less.) CII certify that in the perform: ce of which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws or • should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with rhes: • _ /2 _ ' I Applicant Signatu :: Al / — Date: i WARNING:FAILURE Ty. RE •-r.-. •• •ENS- r• ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLAR' $100,000),I ADD •% TO THE••i- 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 1ic9nse• hapter 9(commencing with Section 7000)of Division 3 of the Business 6gd_PPrrofggsions Code,and my license is in full force and effect.Uc.N (O � Class N ,# Contractor's Signature: Date: ,1-- /.2 S - CONSTRUCTION LENDI J I:1I hereby affirm that there •nstmction 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 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 driver's license. ❑Yes 0 No Driver's 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). ❑ 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 a permit 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 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 prescribed 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.1 agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLI' MEMORIZATION HORIZATION 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 comply :II state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-describ:• • -..- spection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. i a/% Signature Of Legal Owner(s) ^�[,�/Oato •• d/Or Autho zed Applicant �r / _ Ciliate • •Mai • cTION TYPE DAM UMW f•ODEA IN4PEC11ON MT DATE ICAO 1616 Fixed System Final Fire Prevention 206 Final Mechanical • 1266 Pool Spa Final 208 Final Plumbing 3/7/DO 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 Anal Demolition 250 Final Building/Occupancy 2446-46 ��'t ��� � CITY OF COSTA MESA � � BUILDING DIVISION t. ' ""p ' DEVELOPMENT SERVICES DEPARTMENT PERMIT PERMITMBER 'beano" M99-00115 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1934 WHITTIERAV Status: ISSUED Suite No Applied: 03/12/1999 Issued: 03/12/1999 Vicinity: Parcel Number: 42253205 Applicant: BENSON, JACK Address: Phone: Zip: Owner: SMITH, SELINABEL Address: P 0 BOX 2020 Phone: ' LAGUNA HILLS,CA Zip: 92654 Contractor: CONSTRUCTION RESOURCES & CONSULTING Address: 3419 VIA LIDO#222 Phone: (800)246-4123 NEWPORT BEACH,CA Zip: 92663 License: 655750 Arch/Eng: Address: Phone: Zip: License: SCOPE OF PERMIT REPAIR 5FD-REPAIR EXISTING WALL HTR UNIT.(B99-00351). FEE_SUMMARY Quantity Quantity ISSUE FEE $22.00 Repair!Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $12.25 1 Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $34.25 COMMENTS/SPECIAL CONDITIONS • • 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 DECLARATIONS WORKERS'COMPENSATION DECLARATION: j4i !by 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 Coda,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 pe is valued at one hundred dollars($100)or less.) . ❑ I certify that in the p• o • - • o t ��!�r►r� 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 • . fom.antl•" ' at if I should become subject to the workers'compensation provisions of Section 3700 N he Labor Code,I shall forthwith comply with the - • ovisions., ( i Applicant Signature: ��4 '_ �/2 Date: "- /��i7 7 WARNING:FAILURE To 57 RE O-- 't .-ATION COVERAGE IS UNLAWFUL MD SHALL SUBJECT AN EMPLOYER TO CRIMINAL-ENALTIES MD CIVIL FINES UP TO ONE HUNDRED THOUSAND COLLAR- .1,000),IN AD/I . -E COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST.MD ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am liven .aur.�• y. of Chapter 9(commencing with Section 7000)of Division 3 of the Busines, and P Ions Code,and my license is in full force and effect.Lic.# _a.Wilti Class# /1 Contractor's Signal A �•Ar= _ Date: J,7 ^ �S CONSTRUCTIO DIN AGE Y: " ❑ I hereby affirm that the ••-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,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 driver's license. 0 Yes 0 No Driver's 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,faisework,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: I 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 compiled 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 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 ❑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 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 F COMPLIIW• ' D AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is correct.I a e to comply wi all -ate laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-d ri icor:Y -- ion purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. le .5)` /`i •r•Or Authorized Applicant Date di CODEL , 're.., •- Dell UOIDALS DDDEL I6gPFOTIONTYPF p��� / �g 1616 Fixed System Final Fire Prevention 206 Final Mechanical r7 _ !VI/ nL.N r, 1286 Pool Spa Final 208 Final Plumbing 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 2446-48 p CITY OF COSTA MESA ,°4 ,4. BUILDING DIVISION t. •" •�,'•, 3 DEVELOPMENT SERVICES DEPARTMENTizaboairo PERMIT PERMIT UMBER B99-00351 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 • BUILDING PERMIT Job Address: 1934 WHITTIER AV Status: ISSUED Suite: Applied: 03/12/1999 Vicinity: • Issued: 03/12/1999 Parcel Nunmber: 42253205 Zoning: Applicant: BENSON, JACK Address: Phone: Zip: Owner: SMITH, SELINABEL ^� D Address P 0 BOX 2020 Si `l't jl,J, Phone: S ''� LAGUNA HILLS,CA Zip: 92654 �1� I Contractor: CONSTRUCTION RESOURCES & CONSULTING 9p'I Address: 3419 VIA LIDO#222 Phone: (800)246-4123 NEWPORT BEACH,CA Zip: 92663 License: 655750 • Arch : Eng: Address: Address: Phone: Phone: Zip License: Zip: License: SCOPE OF PERMIT REPAIR SFD-REMOVE&REPLACE ALL WINDOWS IN HOUSE. R&R KITCHEN&BATH CABINETS.REPAIR PLASTER THRU OUT HOUSE. SAND BLAST&RE-COLOR COAT.REMOVE DRY ROT&REPLACE WITH NEW WOOD. REMOVE ALL ILLEGAL&NON-PERMITTED STRUCTURES. REMOVE&REPLACE FENCING ON SOUTH WEST CORNER&REAR PROPERTY LINES. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $20,000.00 Permit: $287.25 Claim Valuation: $20,000.00 SMIP Res: $2.00 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $289.25 • • 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 NOTES: EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or If work is suspended or abandoned fora 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 i DECLARATIONS i WORKERS'COMPENSATION DECLARATION: I here ffirm 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 Me permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the perfor man 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 • ••� 1• d a. - hat If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with t - �J Applicant Signature: _ alga. 3 r� Date: /o2 - ,c/ WARNING:FAILURE net - •••'•KE•S'•• •TION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CAVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE( 80,100,I -•DITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am license• neer pr. •ns 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.4 r a Class 4 /4- 'f [S er Contractors Signature. � - Date: 2 /2 —S 5 , o_✓ a17. CONSTRUCTION LENDIN a AGE•CY: ❑ 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: O W NER-BUILDER-DECLARATIONS: .C./ J/,` ffl I hereby a“_fitrn. 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 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 driver's 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,faisework,or demolition or dismantling thereof,will be more than thirty-six(38)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 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 wit 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 Flre 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 compiled 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 appermit 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 ❑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 pad 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 prescribed 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 COMPUAN 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 comply II state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described p operty •• pection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. 11 as ` ' ignature Of Le!al Owner(s) 3-- /2 _ �f§te And/Or Authorized Applicant ate Olin ' er., •I' WE IIaMALS CQDH iNSPFcTION TYPE DATE IHMIIMS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1288 Pool Spa Final 208 Final Plumbing 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 • 2446.48 Thr CITY OF COSTA MESA +' '� BUILDING DIVISION : DEVELOPMENT SERVICES DEPARTMENT arNI '� PERMIT PE IT NU BER 99-00209 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 • ELECTRICAL PERMIT Job Address: 1934 WHITTIER AV Status: ISSUED Suite No Applied: 03/12/1999 Vicinity: Issued: 03/12/1999 Parcel Nunmber: 42253205 Applicant: BENSON, JACK Address: Phone: Zip: Owner: SMITH, SELINABEL Address P 0 BOX 2020 Phone: LAGUNA HILLS,CA Zip: 92654 Contractor: CONSTRUCTION RESOURCES & CONSULTING Address: 3419 VIA LIDO#222 Phone: (800)246-4123 NEWPORT BEACH, CA Zip: 92663 License: 655750 SCOPE OF PERMIT REPAIR SFD-REPLACE 2 LIGHTS,3 SWITCHES 8 6 OUTLETS 8 CONVERT GAS WATER HTR TO ELECTRIC. (B99-00351). FEE SUMMARY Quantity Quantity ISSUE FEE $22.00 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 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $2.00 2 up to 50 kva/kw $0.00 0 Recept Outlets $6.00 6 up to 100 kva/kw $0.00 0 Switches $3.00 3 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $4.25 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 lhp $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 $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $37.25 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS 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 DECLARATIONS WORKERS'COMPENSATION DECLARATION: by 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 Ih 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: Carder: Policy Number. (This section need not be completed if the porth ' :Sued at one hundred dollars($100)or less.) . ❑ I certify that In the .- ..•::nce oft r which this permit is issued, I shell not employ any person in any manner so as to become subject to the workers' compensation law •- alifomia,- If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with t•. :f•rovisio J. �, Applicant Signature: _4 , a. • Date: -3' /02 WARNING:FAILURE`I ECURE YAK---iiiirirrioN COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTI ES AND CAVIL FINES UP TO ONE HUNDRED THOUSAND DOILA:IJ 5100,000),I AD',MON 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 licens:d under•rovisi• §yf Chapter 9(commencing with Section 7000)of Division 3 of the Business nd P,e4 sslons Code,and my license is in full force and effect.Lic.• � , CJ Class a �t/-(,.) SI natu rte- t Contractor'srallor —57 g rte. nIt. Date: — �n7 ir CONSTRUCTION LE B ING • -CV: A� ❑ 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 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 driver's license. 0 Yes 0 No Driver's 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). ❑ 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 end 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 Califomia 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? 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 appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? iYes L.]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 Califomia Health and Safely Code). 7 If a permit from the South Coast Air Duality 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 .PUANCE D 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 with .I state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-describe. •r ,:ction purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. /' o`, ee:Of Legal• ner(s) v ) I bur �r Or Authorized Applicant ate AV OIL , ;PIT rr LATE MEALS =El INSPECTION TYPE QM IMAM 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing /J 200 Final Re-Roof 210 Final Electrical �-IO'OM /h 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final SignL 222 Final Site •, 204 Final Demolition 250 Final Building/Occupancy 2446-46 • PROJECT ADDRESS: UNIT: OWNER'S NAME: 1934 W A ER AV , — .:.., CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 060820 ADDRESS:SMITH SELINABEL 436 DE SOLA TER PERMIT NO: E 060820 PLAN CHECK NO: N GOVT: N SUPP: N CORONA DEL MAR,CA 92625 CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: 0TH ARCM/ENGINEER: REG.NO.: ADDRESS: UNIT: JOB DESCRIPTION : ELECTRICAL SERVICE CHANGE OUT SQ FT: PERMITTEE: CLAIM VALUE: CALL—VALUE: GROUP OCC: R-3 / ADDRESS:AMBURGEY ' S ELECTRIC ( 714 ) 979-2311 945 COLORADO ST COMMENTS: 100 AMP SERVICE (('` gg pp GG -****************************************************************************** LICENSED CONTRACTSRCIFLSAATIO81'.Elhterreeby affirm that I am licensed undererprovisions of unapter 9(commencing with Section Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. S E T BA C K S CITY LIC.: STATE LIC.: C S: 02386 395tuu C 10 Date:.a—(� 3- Signature: _ MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: thereby affirm that I have a certificate of consent to self->I'ure o certificate of 'rkers' 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: PROW: PARCEL: 42253205 ZNE: REF NO: 0 Certified copy is hereby furnished. D Certified copy is filed with the city Building Division. PLANNING NOTES> > Sate: Applicant: ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($1W)or less). DEVELOPMENT S f ERVICES REQUIREMENTS I certify that in the performance of the work for which this permitt' ''sued.I shall not employ any person in any manner so as to become ' r 5ubletl tp the Work'ers�Drgpypsatian Laws of California. �� /` . I o/�` �j"� C I//�] /�—/�csGete¢LL� ZONING APPROVED BY DATE: Date. • Signature: [ /a NOTICE:II,after making this declaration,you should become subject to the Workers'Compe'.tion Ir ons 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 B Y• DATE which this permit is issued(Section 3097,Civ.C). **,** * ***************** �' ** LENDER: ******************************t'************* *** ***************************** 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 1 8 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 50% SMIP/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 subiects 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, 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'State License Law TOTALS----> 18 . 50 15• 00 0. 00 3 3. 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 sate). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the properly,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 the Contractors'State License Law). I am aware *,*,*,*,*,**x,** ***************,******,********************************************** that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B.8 P.C. INDIVIDUAL F E E BREAKDOWN tor reason: TYPE ' ,QTY DESCRIPTION UNIT COST TOTAL COST Dale: Owner: I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and ELE 1 SERVICES BELOW 600 V 6 BELOW 201 AMP 18 . 50 18 . 50 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END OF FEES permit for construction or modification from the Air Quality 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 above information is correct.I agree to comply with all city and county ordinances and stale laws relating to budding construction and hIhor ntativeso city to enter upon the above-mentioned property lot inspection pur wen �� �] / 7 — Date: � — -7 � Signature: � ' 111 ' ' 't "' - - Driver's License or Social Security a: I r' t64t'46 White—Building.Green—Code Enforcement;Canary—Applicant: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 • 2. Soil Pipe-Undrgrnd., ,. 53. Steel Reinforcement 3. Electrical Conduit Utility-Uric+rgrnd. . . 54. Forms 4..Electrical Conduit-Undrgrnd.pi 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 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 , ' - . I. . . APPROVALS-, ' Permit# - • ' ' 21. Ducts,in Structure - - - . ` 70. Underground-Hydro 22. Ducts, Ventilating - • - - 71. Product Piping 0 Gas ❑bil 23. Gas Pipe-Rough & Test - - ' 72. Underground Flush - {4. Roof Framing' X73. Undergrnd.Storage;Tank O 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 - I • _ 782•FIRE PREV. FINAL 30. Drywall Nailing I 1 I • - HEALTH DEPT, REQUIREMENT '.'31. Plaster Brown Coat- - I .79. FINAL INSPECTION • ' 32.TElectricail.PoWer Meter-Final ! r r S0. FOOD CERTIFICATE ISSUED _ , .33. Final Electric - /�/��J - •i.� Notes: m .- --34: Finat Heating& Air Conditioning - ' - 35.- Final Gas Pipe-Test. I - - i 36. Hood or Canopy . -:1- -37. --37. Final Factory Fireplace 38. Fin& Plumbing 1 39. Water Service-Final - • -I 40. Gas Service-Final I r 41. Solar Domestic-Final ' �t 42. Backflow Preventer r. . 43. Backflow Irrigation ll - - __1 44. Landscape Irrigation System - ' '45. Sound Attenuation . 46. Handicap Regulations . • I I 47. FINAL STRUCTURE & BUILDING { I '1 - 48. FINAL PLANNING j i 4 c 49. Electric Release to Edison I 50.-Gas Release to Southern California Gas Co { 1 51. CERTIFICATE OF OCCUPANCY No. Date