HomeMy WebLinkAbout3050 KITTENDALE BAY - Building PermitsAGI
\(� CITY OF COSTA MESA -
CONSTRUCTION PERMIT
Applicant's Mail' Addre a
a
Project Address b 5w1w P:_hFV_,
I /�
Owner's N Q h ne W
Address
Arch/Eng. J ' L. nsa No. Z
Address
Contractor's Nem Phone
Address (mailing)
Cicerisa No. _ ' � I
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter.9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is In full force and effect.
LJcense Class _ I License No. I
Date Signature
WORKERS' COMPENSATION DECLARATION j
.. I hereby affirm that I have a certificate of consent to.self-Insure or a certificate -I
of Workers' Compensation Insurance.'or a certified copy thereof (Section
3800, Lab. C.) 1 (Sect!
cy No. ' Company I
Certifled' copy Is hereby furnished. •
LJ Certified dopy Is filed with the city Building Division.
Date Applicant
EKEMPTION.FROM WORKERS' COMPENSATION DECLARATION
(Thissection need not be completed if the permit Is for,one hundred ($100) or i
less). ,
I cert lfy,that In the performance of the work for which this permit Is Issued I
shall not employ any person in any manner so las to become subject. to the
Workers', Compensation' Laws of Cali fornla.
Date Signature '
NOTICE: If, after making this declaration, you should become subject to the '
Workers' ' Compensation provisions of the Labor 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 constructlon,lending agency for the performance,
of the work for which 'this permit Is Issued (Section 3097, Civ. C:),
Lander's1 Name
Lender's Address MMI III L '
OWNER. BUILDER DECLARATION t
7031.5 by any applicant for" a' permit subjects -the applicant to a civil '
flnalty of not more than five hundred dollars ($500). 1 { 1
I, as owner of the !property or -my employees with wages'as their solo
compensation wIM do the work, and the structure is not Intended or offered
for sale (Sec/Ion 7044, Business' and I Professional Code:' The Contractor's
License Law does not apply to an owner of a property who builds or Improves
themon,lano who ooes'such work himself/herself or through his or her own ,
employYees, provided that such Improvements are not Intended or offered for
sale. I/, however, the building or Improvement is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or im-
r ve for the purpose of sale).
as owner of the property, am exclusively contracting with.licensed con -
rectors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who ,
builds or Improves thereon, and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law).
❑ 1 am exempt under Section B, & P. C. for this reason
Date Owner
Drivers' License or'S�' 'r 41 go,
MF 0865-46 rev. 12/8 White -Bulltling; Canary - Appllcan ,Pink -
Ilca.t to fill In all spaces except those within heavy border lines and sign all appropriate declarations
PERM TNO.
TRAC -r_O.
LOT NO.
BLDG,NO.
'REPAIR
-
.07..72 6/21/03 .; $r�, I{o Cjj Ti.
' L
TYPE OFCONSTRUCTION ANEW LJ ADD LJ ALTERATION
❑ CONVERSION ❑DEM LISH ❑ OTHER --
DESCRIPTION OF WORKS -U to
Vvv
R
1✓ /. rq
J 79
,
ZONINGREGULATIONS
TYPE OF PERMIT Ll'GRADING LJ FOUNDATION ASTRUCTU
All
A. P. 91#
ZONE QZ
❑ TENANT ❑ ELECTRICAL
❑ PLUMBING ❑ MECHANICAL
,PLNG. REF.9W_ —7C1!
•BUILDING-
' ❑OTHER
TO BUILDING -I
-
PROJECT DESCRIPTION SG.
OCCUPANCY.PE
V INE-
REAR YARD (TO P/L
LEFT SIDE YARD ��'
RIGHT SIDE YARD L4,
.r,
CONSTRUCTION TYPE - ' VAL ATION$ )
ZONJ: _? GRADING CU.VDS'. ACRES "�;��/
PKG.SPACE RED. 5 t PROVIDED
Remarks - '
' i
'iTREETw16TH *50r;
PARK FEE$
SPECIA L CONDITIONS:
'HOLD FOR SI'MAL XtQU=1y1L'1A0 -.
PLUMBING ,
Bar Sink
Sewer Cap
ELECTRICAL
I
- 1 Backflow Preventer - - - - Sewer Connection' --•'• --- _ -
_ Automatic Washer _ _ Meter ❑over 100 amps'
Backflow Irrigation Soler_ Collectors. _
Construction Pole [Sub Panel' I
I
Bathtubs Solar Piping
Cooking Unit ,Sub Pole
Clarifiers ! Solar Tank I
Dishwasher Motors 00-1 HP ❑1'h-8 "
Dishwasher Swimming Pool w/Spa'
Dryers ❑Gass ❑Electric 'Inc.Solar ❑9-15 HP ❑16,154- j
Drinking Fountains Urinal i
Fan ' Microwave
Floor Drains Water Closet '
F.A.U. Pole Light I
- Floor Sinks - -- .- - -Water Heater _
Fixtures _Range
• be; Stirvice'OutletsWater Service I
•-
Device Boxes f Sign
Interceptors I - I - - - I r ,r.
1 ;
Outlets iStanding Sections
Kitchen Sinkl ' - I - _ l
Switches Trash Compactor
i Lavatories ,' ' - j '
Garbage Disposal
-
P—Trap
Generator E10-5 KW 05-15 KW '
- - - _
• Roaf. Digins �— - " . - �
.
- Transformer 015-50 KW
I
050+KW_
'Reinspection Fee
i
1 $15
- i
Showers
Reinspection Fee
$15
Meter ❑up to 1oOamps
I Issue Fee
i $ 3.
, _ -
Service Sink i �-
I
' Issue Fee ' I
$ 3
1
Zoning Approved BY Data
'
Application Approved By 'Date
'
Application (sued By Data
• I MECHANICAL
•
Boiler Refrigeration System
'
Duct - Under Ground ❑0.100,000BTU ❑100,000 BTU'
i SUMMARY OF FEES
;BUILDING PERMIT $ SMIP
iPLAN CHECK- $ PERMIT
I 1 ISSUANCE ' 1
'PLUMBING $ I-
$
$
�
Duct -Structural System Repair/Alteration
Duct- Ventilating
Exhaus;System ❑ Multiple 0.
PLAN CHECK' $'
ELECTRICAL $
I GRADING
I
$
$
Fiiepl/Fact. Bit. ICBG •/%
Heating System & Ducting
❑0.100,000 BTU 1:1100,00OBTL.
• - -
PLAN CHECKI $
MICROFILM ,
$
'
MECHANICAL $
TOTAL FEE
$ -
or
Reinspection Fee
$15
PLAN CHECK $
LESS
CanopyHood Type II ❑
I
ADVANCED PC j
FINAL FEE
$
$
Registers Issue Fee
_
$ 3
Goldenrod - Assessor -
_t '.?CONSTRUCTION AND PLANNING'
= `q
- POOL& SPA
_
_APPROVALS Permit: #
� Date
c
,Inspector
-
-APPROVALS; Permit#
',. Date
Inspector
. .
7: Temporary Electrical Service or; Pole
52.- Pool & Location `
-
I
..I
_Equipment s_
2.r Pipe Undrgrndr r. 1 'r e T
E -
�, t
-
'53' Steel Reinforcement
_
3: Electrical Conduit Utilitv-Undrgrnd. ' -��
."
•54: Forms .- - , , -
-
4'' Electrical Conduit-Undrgrnd. a ! -
'
_'
5'5:. Electrical Bondirig
_5: Steel Reinforcement ; ".; J `.56.
c:'v
c _
Rough Plumbing •& Pressure.Test
6. Electrical LIFER Grad. I ` I r'
-
- c': "
<57. APPROVAL TO-COVER-GUNITE -
9.
7. ,Footings -' '-1 ' c, I a ,
P
Conduit-Undrarnd.
� ,,
y ,
8. 'Foundation _' 159.
"Gas'Pipe; O_Undrgrnd., Test-
9. Water Pipe-,Undrgrnd. 1
- .
,60. Backwash Lines, P -Trap, 0 Undrgrnd.
'
_
I
10. Structural Floor System
^ " '9
61. APPROVAL TO DECK "
r
11. Property Sewer Line &1 House Connection
,fit. Backwash &_Receptor -Final
rt
12. Sewer Cap'- { ' 9� ,
! �I,�
:-63. Heater&Vent;Final, !
Roof!Drains
I
64. PlummF13.
-inal•
I
o
,
14.'Rough Plumbing l 1 I I-:
65. Electrical=Final' - - '•• -'
15l,Rough Electrical=Conduiti ""'-� -('
T ''"
j'�I
66., Solar Systea-Final
- 16, Rough Electric Wiring,
.:7�
�;1
i "-"'167
Fencing &AccessAPProval�
1
17. Rough Wiririg'Signi' I .� I I� �rw !
'.. '`'
'
68; APPROVED FOR PLASTERING
•.
16. A'ugh Electrical -T Bar Ceiling ` �� �'
, , I i
•' ; !
!69.! POOL/SPA SYSTEMS FINAL
-
19.,Rough Heating & Air,Cooditioning it I
�' 1 I
i `- I
FIRE DEPT,,REQUIREMENT
APPROVALS ` Permit #
20. 'Rough Factory FireplaceI +
i
21.,Ducts, in Structure, 1 �; 'I
j
I
70.i Underground Hydro
-22. Ducts, Ventilating
171,' Product Piping OGas OOil !
'
', _23. Gas Pipe -Rough & Testi` ;h �;r ,
1
j72.' UnIrground Flush r
1,24. tRoof Framing, i i i, i
I
'73., Undergrnd. Storage Tank O Gas Oil
-0
25.'R60f Sig'
g
�•
' �_'
74: Overhead Hydro`
_
26. T_Bar Ceiling (Structural), & Monocoat '
I .- i . 1
75., Dry Chemical
_
1:27. -Frameand Flashing
•28.,
las-.-
176.- Dry Standpipe -
5 Lathing & Siding r I I II I
{ ! I
77.1 FIXED SYSTEM FINAL -
.29. '.Insulation _ I:
78. FIRE Pf2EV. FINAL
'
-30. Drywall Nailing + "i 1 jI I
;,�
Notes
, i it
J
'31.'P6ster'BrownCoat
4'!II
32..Electrical;PowerMeter-Final I
33.,Final Electric _i _� i� ii I
`
•h!Y;
I _ L
34. Final Heating &� Air Conditioning
I
I
I
I 1 -
I
35. Final Gas Pipe3Test i- !' ; I
1•
-^I - ;'•
(` ; � i
- - ! "`, -
-
36.HoodbrCanopy;,'1
i s
37. Final Factory Fireplace=.
38. Final PIUnbing•I - ! "i I
i • I !
; I I
I
'
39. Water.Service-Final
40. Gas Service -Final
!
!
41. Solar pomestic!Final 4.
_:
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System I a•`
y
_
, - `. I - .
45. Sound Attenuation I'"
46. Handicap Regulations
47. FINALSTRUCT.i BUILDING•�5
!
-
48. Specie) Requirements Completed ? iWAD
49. Electric ReleaseltojEdisonl I
!
'
I_ _
_ ___ I T •-
50. Gas Release to Southern California Gas Cn
I '
'
{ I I • ' '
51. CERTIFICATEIOFOCCUPANCY
No
Date
Applicant to fill In all spaces except those within heavy b_ order lines and sign all appropriate declarations._
CITY OF COSTA MESA I PE W IT NO. ' TRACT NO. LOT NO. BL .
CONSTRUCTION PERMIT
Applicant's Mailing Address TYPE OF CONSTRUCTION ADD LJ ALTERATION L1 REPAIR
Project Address ,50 1 - ❑ CONVERSION '❑ DEMOLISH ❑ OTHER..
Owner's Name hone �p' , DESCRIP,TION,OF WORK
Address AI
- 1 -, - •.. = i -.
TYPE OF PERMIT 1 iGRADING FOUNDATION EISTRUCTURAL A.P.# ,
v Arch/Eng. - LICCnse No ' ❑ TENANT ❑ELECTRICAL BING ❑ MECHANICAL PLNG. REF. s4'
Address' ' ' ❑'OTHER ' 1. rn mu, nine•
1
Contractor's Nar4ie�/i7 �/ -/ hone 41
- I
PROJECT DESCRIPTION
CONSTRUCTION TYPE
ZONE ` -
50. FT.' ' ' OCCUP.
VALUATION$
GRADING CU. VOS. IA(
Address (ma 1'nel 0. /�7
r - n-2/� I
License No. 0:e e
__
L'_tCENSED CONTRACTOR DECLARATION
Remarks:
I hereby affirm that I aDi licensed under provisions of Charter (commenting
®■
$
3 i
with Section 7000) of Division 3 of the Business and Professions Code, and
my license Is In full force and af�Pct.
ilcense C '-•�Ucans' Na
PLAN CHECK
M®E
M®.
PLUMBING ,
Date ' Signature
WOR KE S' C MPENSATION DEC RATION
Bar Sink I
Sewer Cap
- -
L Backflow Prebenter- -
- Sewer Connection% -
Lhereby affirm that I have a certificateof consent to.self-Insur or a certificate -'_
of Workers' Compensation Insurance, or a certified copy thereof (Section..'
Backflow Irrigation I
Solar Collectors
- �-
3800, Lab. y /3 A A " I��' '^ • _ �- ,
Policy No. Z (I Y?Company W��•�!+'�I
'14-rtified co y,is ereby furnished. ; r
Bathtubs
Solar Piping '
fie c y ed with the cit I Ins Divisio .r.
Date-___ i Applicant _ _ �.
Clarifiers
Solar Tank _
EXEMPTI F OM WORKERS' CO P NSATION DE LARA N
(This section need not be completed if the permit Is for one h, d ($100) or ".
1 Dishwasher I
Swimming Pool w/Spa
_-_
less)': ,
I certify that in.the performance of the work for which this permR isIssued I"
shall not employ any Person in any manner so as to become subject. to the
Drinking Fountains
Urinal '
Workers' Compensation Laws of California.. ' /'r, Floor Drains Ii Water Closet i
Date Signature , 1
NOTICE:.If, after. making this declaration, you -should' -become subject to the--, - - Floor Sinks.l - --- Water Heater- •- -- - -- -
Workers'. Compensation provl sions of the Labor Code, you .must forthwith
comply 'with, such provisions • or' -this -permit 'shall be deemed, revoked- Gas Service _,Outlets - Water Service
CONSTRUCTION. LENDING -'AGENCY' i I{
I hereby affirm that there is a construction lending agency for the performance Interceptors I
of the work for which_ this permit -Is Issued •.(Section .3097 Civ. C.), _
Lender's Name I -
Lender's Address I
OWNER,BUILDER DECL'ARATIOf
more
for the'
'city or
or repair
I permit .,
qny yw,acwn-m Decoon
he applicant to a. civil
with wageslas their Sole '
not intended or offered
Code:, The Contractor's
r.who builds or improves '
through his or her own
'.Intended or offered for i
sale. If, however, the building or Improvement is sold within one year of com-
pletion, the owner,will have the burden of proving he/she did not bund or Im-
rove for the purpose of sale)'.
teas
owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044„Business and Professions Cotle:. -
The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a con. 1 1
tractor(s) license pursuant to the Contractor's License Law).
❑ I•,am exempt under Section B. & P. C. for this reason
Date - ' Owner '
I hereby, certify that 1 have read this application and state that -the above- -
information is correct. I agree to comply with all city and county ordinances ,
and state laws relating to building construction, and hereby authorize repro- '
sentatives of ;th 'city to enter ,upbn the above-mentioned property 16r ,
'iso or SS VE i
rev. 12/82 White - Building; Canary - Applicant; Pink - Accountim,
Lavatories ' 1
P -Tragi
Roof.Drains t — T I '•
Showers
Service Sink I
r
Boiler- I
Duct- Under Ground
Duct - Structural
Duct: Ventilating
Exhaust System LJ Multipl
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
El06100,000'BTU ❑100;00
Hood or Type I ❑
Reinspection. Fee
Issue Fee _
00-100,000BTU 11100,00(
System Repair/Alteration
Reinspection Fee
Issue Fee
$ 3
$15
63
;LEFT SIDE YARD
PKG. SPACE REO.
STREET WIDTH
SPECIAL CONDITIONS:
ZONING REGULATIONS'
I' ZONE , r
.. BUILDING ”
REAR YARD (TO P/L) ,
RIGHT SIDE YARD t,
i -
PROVIDED I '
PARK FEE $ .
Cooking Unit i
Dishwasher
Dryers ❑Gas' ❑Electric'
Fan
F.A.U.
Fixtures _
Device Boxes
Outlets
Switches
Garbage Disposal I '
Generator 0015 KW ❑5-15 KW
Transformer• 015-50 KW
050 KW'
Meter ❑up to 100 amps
Zoning Approved By
Application Approved By
Application Issued By
Sub Panel
Motors 1_10-1 HP LJI%
I nc.Solar 09-15 Hf' ❑
:Pole Light '
1Range .. _
Fee
M�wi
mmm
MEMO
M�m
Elmo
®®.
®■
$
®o
mm
PLAN CHECK
M®E
M®.
MMEM
==11111111'
SUMMARY OF FEES
•
BUILDING PERMIT
$
SMIP
$ '
PLAN CHECK
$
- 1 PERMIT
PLUMBING
$
ISSUANCE ,
$
PLAN CHECK
$
GRADING
$
ELECTRICAL
$
$
PLAN CHECK'
$
MICROFILM
$ ,
MECHANICAL
$
j TOTAL,FEEi
$
PLAN CHECK' I
$ I
LESS '
ADVANCED PC I
$
j
I
`
r�'b—
FINAL FEE; I
$
z
el C6ONS,TRUCTION.ANDPLANNING
0J 'T.'A-17
-'`
-� ;POOL&SPA., -
-
c 3 -
PPROVALS r,� Permit #.'-
Date
Inspector
,.'.APPROVALS, Permit.#'
Date =
Insctor--
�lO'-7T7
�` TemoorarylElectrical Service ori ole', °
-� r � c
`� -:�52-
Pool &'Equipment Location
r9 _ •.
.
,.
I 1 ,. -. � �
x'M 'Soil Pipe-Undrgrnd'
'Ica
r
"53,Steel Reinforcement
G 3:- I
El tility-Unrgrnd,
lonuiUd
ectrinaCdt
`54 :' Forms F -
y
t
rr: Electrical'Conduit;Und rgrnd.. - ' :-
�'
?
552'Electrical Bonding
.
o T
5: Steel/Reinforcement - ? a
c" a'
Rough Plumbing&_ Pressure Test-
;56,;
_
6: �El, ectncsl`,UFER Grnd; '•J? `r;
;
o, •r' `,
57, APPROVALTO.COVER-GUNITE
7. Footings ,j
.58. Electrical; Conduit-Undrari,li.
B. Foundation'
59. Gas Pipe;-O Undrgrnd., Test `
'
9. Water Pinundrgrnd. j "� r
- _
+1 •
60. Backwash Liriesj,P-Trap,-O Undrgrnd.
10. Structural Floor System.
61. APPROVAL TO DECK
11. Property Sew it Line &IHouse Connection'
-r ! :'
QJ °
62. Backwash &'Receptor-Final -
12. SewerG`aP_`.63.
Heater & Vent-Final -
-
_
13. Roof'Drains I 1
I 1
`,
64. Plumbing2System = Final
-
, .�? -
I
-�•�
14. Rough.Plumbing',:- •tet
�,QZZoo1
65. Electrical-Final
1= 15:;,RoOgh-Electrical=Conduit--'r'-r •,- i
T--(,- -
- --�--i
'66J Solar,System-Final
x_76: iRough, Elecfric,Winng; �: r
�1-r
_`67.Fencing & AccesrApproval-
II
- iJ.`;Rough'WiringiSign;?X68.
APPROVED FOR PLASTERING
,..-18` l Rough`Electrical-T`-Bar Ceiling'
; I f
'
!69.I POOL/SPA SYSTEMS FINAL
I
19„Rough�Hdating & Air'Conditioning g 1
I, I
:`'
j FIRE DEPT. REQUIREMENT
_ i
,
APPROVALS' Permit
20.•Rough,Factory Fireplace r it j. I
_
I I
I
21''I66cts,-in Sifrueture j r SII
I I
I I
70•, Underground Hydro
j 22. Ducts, VentilatingI i f
4 I
71.• Product Piping 0 Gas 00il
t; 23. �Gas`Pipe-Rough & Test .0 - I ��� ;I I„
-t 1
t j!. �
172. Underground Flush ;
I
24. jRoof FFamingY. I I
73.i Undergrnd. Storage Tank 0 Gas 0 Oil
25. 'Roof SheatFiin_g
74. Overhead Hydro -
rT-Ba"r Ceiling (Structural-). & Mon ocoat
`; ` 3
�,,
Dry Chemical
,-26. j
I I
! -
;751 _.
27. !Frame and Flashing I
'
76.. Dry Standpipe -
�� ,'
28. °ahh�
;.
I
77 FIXED SYSTEM FINAL
99 '1
'78. FIRE PREY. FINAL
'30.ibrywal�l
Nailing+ , + ;,
� I I
Notes:' _
j _
'f'31. 'Plaster BrownCoat '
-
' 32.(Electrical Power Meter-Final
..
2 33, Final Electric_ l� I
L
_' _ U 1
, 1
•c_ -
-
'34. Final Heating &*Air: Conditioning
i j l
I
35. Final Gas Pipe-Test
36. Hood or'CariopY ��, ^
37. Final Factory Fi`r'eplace`'
38. Final Plumbing I I I of -
l
,
I
•�/�7yy
, _. - �
39. Water Sewice-Final' i •' ,I
-
I
40. Gas Service-Final
I
, 1
41. Solar Do„ q
mestic-Final '
•'.1 I_
42. BackflowP.reventer
1
I
__i
-_ _- _ -
43. Backflow: Irrigationr'.•l _�
Ic
_ 1-f -1 -Iv I I
-
44. Landscape Irrlgation;SYstem I
! ° I
`j
_�
45. Soundr %Attenuation ,�, 14 !
' '
1 z
46. Handicap RegulBtlonf
d
47. FINAL STRUCTURE &B,UILDING
48. Special Requirements Completed A
49. Electric Release'to Edison
--' - -
T-4
50. Gas Release to Southern California Gas Co
I
I
51. CERTIFICATE ONOCCUPANCY
No II 1, Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations
CITY OF COSTA MESA E/W q (� f TRACT
CONSTRUCTION PERMIT
'-
Applicant's Mailing Address 0'-4PE OF CONSTRUCTION EW LJ ADD LJ ALTERATION LJ REPAIR
Project Address 906 O /16 ❑ CONVERSION ❑ DEMO ❑ OTHER .
Owner's Name GGhone F DESCRIPTION OF WORKZONI E
Address agjfl YGULr. rJlGli , -
y GU TIONS
TYPE OF PERMIT LJ GRADING LJ FOUNDATIot4 LJ STRUCTURAL A. P. 4A ZONE
Asch/Eng. License No. ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL PLNG. REF. * BUILDING
❑ OTHER REAR YARD (TO P/L)
Address TO BUILDING -
Contractol's Nam % honeqg PROJECT DESCRIPTION SO. FT. OCCUPANCY PR PE Tv INE
Address(mailing)TYPE—VALUATION
CONSTRUCTION $ •�� LEFT SIDE YARD RIGHT SIDE YARD
-Fcf�
License No.
ZONE _ GRADING CU.YDS. ACRES PKG.SPACE REO. PROVIDED
___
LICENSED CONTRACTOR DECLARATION Remarks: — STREET WIDTH PARK FEE $
1 hereby affirm that I am licensed under provisions of Charter 9 (commencing _
with section 7000) of Division 3 of the Business and Professions Code, and SPECIAL CONDITIONS:
my license Is in full fo a effect. �sl,�I,n/
Ucense Class cen PLUMBING
Data /b' Signature Bar Sink Sewer Cap ELECTRICAL
WORKERS' COMPENSATION DECLARATI
I hereby affirm that I have a Certificate of consent to self -Insure or a certificate Backflow Pr"enter Sewer Connection Automatic Washer Meter Dover 100 amps
of Workers' Compensation Insurance.: or a certified copy thereof (Section -
3800, Lab. - / - ' - - Construction Pole Sub Panel
K!-0i7i2 Backflow Irrigation Solar_ Collectors
Policy No. company - - `. Cooking Unit Sub Pone '
�Certified copy Is herr Bathtubs Solar Piping
1}❑�.Cer[Ifi tl filed with the city B Ing IIyvISlon. / q Dish Washer Motors 00-1 HP 01%-8
'oaTe� App. icant Cir711.711 yl'/,T t•! - Clarifiers .( Solar Tank _
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Dryers ❑Gas ❑Electric Ina Solar ❑g-15 HP ❑16-15+
(Thissection need not be completed if the permit Is for one hundred ($100) or Dishwasher Swimming Pool w/Spa
lecerlify that in the performance of the work for which this permit is Issued 1 Drinking Fountains Urinal ;'- Fan .Microwave 1
shall not employ any Person In any manner so as to become subject. to the - F.A.U. Pole Light
Workers' Compensation Laws of California. Floor Drains Water Closet, 9
Date Signature - - Fixtures
NOTICE: If, after making this declaration, you should become subject to the - Floor Sinks Water Heater - Range
Workers' Compensation provisions of the Labor Code, you must forthwith Device Boxes
comply with: such provisions or , this permit shall be deemed revoked. Gas Service Outlets Water Service Sign
CONSTRUCTION. LENDING AGENCY
I hereby affirm that there is coo ns,-preum[ion lensing agency for the Ci li.anca. Interceptors _ Outlets Standing Sections
o/ the work for. which r It is Issued (Section 307 7 Civ. C.) Switches
Lender's Name _ _ Kitchen Sink - - Trash Compactor
Lender's Address-
OWNER BUILDER DECLARATION Lavatories - Garbage Disposal
I hereby affirm that I am exempt from the Contractor's License Law for the _ p_Tra - Generator E10-5 KW ❑5-15 KW
following reason.(Section 7031-5 Business and Professional Code: Any city or P - -
county which requ'res a per to construct, atter Improve; demolish orrepair.- Transformer Ell 5-50 KW
an structure, prlor to Its Issuance, also requires cite applicant for such permit Roof Drains — - -
lo file a signed statement that he/she Is licensed pursuant to the provisions of ❑50+ KW I
the Contractor's,Lice.. Law (Chapter 9 (commencing with Section 7000) of - Reinspection Fee $1B
Division 3 of the Business antl Professions Code) or that he she_ Is exempt Showers Reinspection�Fee , $15 _
therefrom and the, basis for the alleged exemption. Any•violat ion of Section - Meter ❑up to 100 amps Issue Fee $ 3
7031.5 by any applicant for a permit subjects the applicant to a civil
enalty of not more than five hundred dollars ($500): Service Sink' - Issue Fee $ 3 Zoning Approved By Date
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 MECHANICAL Application Approved By Date
for sale (Section 7044, Business and Professional ,Cotle: • The. Contractor's
License Law does not apply town owner of a property who builds or Improves goiter - Refrigeration System A IiWtiOd Issued 8 �� 2
thereon, and who does such work hlm5<If/h¢rselt or through his Or her own - pP y Date
employees, provided that such Improvements arenot Intended or offered for Duct- Undec Grou nd ❑0-100,000BTU ❑lDD,000BTU
sale. 1 however, the building or Improvement Is sold within one year�of com- ,
pletion, the owner will have the burden of proving he/she did not build or Im- , SUMMARY OF FEES
rove for the purpose of sale). 1 Duct - Structural System Repair/Alteration BUILDING PERMIT $' l SMIP $
t, as owner of the property, am exclusively contractingwith licensed con-
tractors to construct the project (Section 7044, Business and Professions Code: Duct - Ventilating - 'PLAN CHECK' $ PERMIT
d
The Contractor's License Law oeh not apply if r s owner je property who I ISSUANCE $
builds or i cense Pursuant
to and who contracts for such projects with acon- Exhaust System ❑ Multiple ❑ ;PLUMBING l $
tractor(s) license pursuant to the Contractors License Law).. PLAN CHECK $ GRADING $ '
❑ I:am exempt under Section ' B. & P. C. for this reason Firepl/Fect. Bit. ICBG
Date I ' Owner' Heating System & Ducting 4 ELECTRICAL $ $
•I -hereby certify that -I have read�this-applicatlon and state that the above 100,000 BTU ❑1DQD00 BT -- -
.PLAN CHECK $ MICROFILM $ r
-information Is correct. I agree to comply with all city and county ordinances ' TOTAL FEE $
and state laws relating to building construction, and hereby authorize repre- MECHANICAL $'
sentatives of this city, to n er upon a above-mentloned property for Hood or Type I ❑' Reinspection Fee. $15 LESS '
Inspection purposes. CanopyT e It ❑ PLAN CHECK $ —�— ADVANCED PC $
Signature at Registers Issue Fee $ 3 I FINAL FEE $ �—
Drivers' License or SS
r
=>7CONSTRUCTION;AND= PL'ANNINGy
'�
- ,'
f _
:', - _..POOL&SPA-
••cgppROVALS Permit#�'- 4
-'•Date'I
nspector3-APPROVALS'-'`
-- - - -
Permit# •
Date
Inspector,
-
^' 1: Temporary Electrical SerGice or�Pole �j
� >
b7 ''i
'52� pool &Equipment Location
N. 2? Soil Pipe-Undrgrnd' -,� ; z
•
53, Steel Reinforcement- -
-
- '3! Electrical Conduit Utility-Undrgrnd.
. , _
,:= ��
,54:( Forms
•" 4: Electrical Conduit-Undrgrnd'. ; :'
. °
• 55. ElectricalBondi
_
'ng-
5: §t eel `Reinforcement
-- -
56.. Rough Plumbing-& Pressure -Test
6' Electrical UFER Grnd.' rt
,!-''
r _'
• 57-:' APPROVAL TO COVER-GUNITE
7. Footings n F,
- _
r`
'58' Electrical Conduit-Undrarnd.
lPipe,Ir
8. Foundationi 1 1_
59. Gas ��:Undrgrnd:Test-
+I
9. Waters Pipe-Undrgrnd. i I ' '
_o =
!',60. Backwash Lines, 'P-Trap,OUridrgrnd.
'
10. Structural Floor System'.!
-` I
-.61. APRROVALTODECK
11. Property". Sewer 64& House Connection.
•,
:,62. Backwash &Receptor -Final;"
12. Sewer Cap 1
,63. Heater &Vent -Final
13. Roof lDrains I ' j 1 `:_
�'
��
'64. Plumbing.Systein'- Final
<
14. Rough Plumbing 1 •' j L�
l
-
'65. Electrical=Final' -
-
,:.15i'°Rough'Electrical=Conduit"- 1, "--'+-
1 r ,, I' I
- T'i�-
'"�' 1
i - - j
- 66y So& -System -Final
16: Rough,Elect`ric Wiring
' ,, T n• ' i I- I
i °, ; `, I ^
'-
i.-' - I-
�67., Fencing &Access Approval,
rs7.-Ro49h%Wiiirig`Signr `• �. I Ij ''',_. ;
_ i ' (^
j : ( ,
68.1 APPROVED FOR PLASTERING
_
II 161R9ugh-,Electric>31UT",Bar.Ceiling'
1.
l ": ` %'
69.POOL/SPA SYSTEMS FINAL _
I' 19.pRough`�Heating &'Air Conditioning ,
'
,
j FIRE DEPT. REQUIREMENT-
APPROVALS' Permit#
'
II 20.'I%ugh.Factory Fireplace, I I I
F.
; I
( j
l; 21. DucCs,in Stiucturer
Underground Hydro
422. Ducts, Ventila[in - I i I
9 tt jl
I - I
71. Product Piping 0 Gas 11 Oil
.-
23. Gas Pipe -Rough & Test I
�n , -�
j I
T
72., Underground Flush
_
II'24. Roof Framing/ �• i,� ,;
; I j ,• i ,4
, •.
73.E Undergrnd. Storage Tank 0 Gas Mil
74., Overhead Hydro -
,` 26. T -Bar Ceiling (Structural): & M,onocoat • I
j >'
',r ; ; I
;75.• Dry Chemical -
.27. Frame and Flashing , ' 11 II I
' 1 j
, !
96.! Dry Standpipe
IL- -
.
y 28. Lathing & Siding 1 y,
I
j S'i i
77.FIXED SYSTEM'FINAL
I,2!). �Insulati'onl � r � i "' � � 1 �'� �• 1
� �
I � 1 �
178.j FIRE PR,EV. FINAL
i-30. Drywall Nailing j:-' ', 1 j r;
I
j j I
'Notes:i '
31. Plaster Brown Coat
h`32. blectIrical Power MetertFinal i I
I
ti
1
I
uu 33. Final Electric
_1
_G
SFinal
� u
_ _
~I
34. Heating &'Airy Conditioning
N� j
I • " ,
35. Final Gasl:Pipe=Test`1 1 : `I
, ,
36. Hood or Ca noPY2' -' i ( `. 'i '
I i
e L .I nl ,1
37. Final Factory Fireplace': -" �I j
38. Final Plumbing i - • j
1 it
�' I j
i l
I j- - I _
39. Water Service -Final,
40. Gas Searvice-Final--
e
1 1
41. Solar Domestic -Final j
42. Backflow Preventerl z j
43. Backflow Irrigation,
44. Landscape Irngation',Systdm I 1
=
45. Sound AitenuaTlonl ', I ° �
I
;' I
T
i I
46. Handicap Regulations
-
47. FINAL STRUCTURE & BULLDING
48. SpeciaRequirementsCompletedi
h
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATEOFOCCUPANCY
I
No. 1 1
Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations
ap
I CITY O6 COSTA MESA- t - - - •
CONSTRUCTION PERMIT.
PERMIT NO. _
-
: TRACT NO.
LOT NO.
BL
" ' - —, - -'
Applicant's Mailing Address
Project Address
TYPE OF CONSTRUCTIONNEW LJ AGO LJ ALTERATION, DREPAIR
❑CONVERSION ,❑ DEMOLISH ❑ OTHER' :
- - -
Application Approved By -Date '
Application Issued By ,iL,• �� Date
Owner's Name M.D.'Janes. -CO, hone-
DESCRIPTION OF WO RK —f1X'eP1aAA.
ZONING REGULATIONS'
TYPE OF PER GRADING FOUNDATION STRUCTURAL
A. P. 4h ZONE
SUMMARY OF FEES
'
BUILDING PERMIT $ SMTP $
I
PLAN CHECK - $ PERMIT '
Address
Arch/Eng.' ---License No.
Address '
❑ TENANT ❑'ELECTRICAL ❑ PLVMBING ®MECHANICAL -
❑.OTHER I ' ' -
' PROJECT DESCRIPTION. SO. FT.- OCCUPANCY
PLNG. REF. 4% BUILDING
TO BUILDING ,
PROPERY INE REAR YARD (T0 PIC) -
Contractor's Name:_C L' • Phone 659-1 8 6
LEFT SIDE YARD RIGHTSIDEYARD '-'
, T�ise$1r�e�,.
Address(maiiing) nR(1 •TT. Asstairi a !lN t\r•�.-�..-e O'J �. �. •l.
CONSTRUCTION TYPE : � VALUATION
PKG.SPACE:REQ. PROVIDED -
,
Exhaust System ❑ Multiple ❑
l��^�
License No. 11.L1
ZON$ GRADINGCU.YDS. ACRES
__
LICENSED CONTRACTOR DECLARATION
Remarks:-
STREET WIDTH ' 1 PARK FEE $ -
1 6areby;affirm that I am licensed under provisions of Charter 9 (commencing
.PLAN CHECK' $ GRADING $
$ s
ELECTRICAL $
PLAN CHECK $; MICROFILM $
TOTAL FEE $
'MECHANICAL $ ,
LESS
PLAN CHECK' $ • n0 ADVANCED PC , $
1
- _ FINAL FEE $ O - nn
SPECIAL CONDITIONS: -
Firepl/Fact. BIL ICBG #31951
with section 7000) of Division 3 of the Business and Professions Code, and
QQ
my license ISI fullf9rte and, effect.
PLUMBING
- -
1
license Cla s' — µlc -rye o 11 1 7
Date Signature A .Jn._
WORKERS' COMPENSATION DEC RA-ONI+
I hereby affirm that I have a cartfficate of consent to sol -insure or a certificate
of Workers- Comoens5tlon Insurance„ or certified copy thereof (Section-
3800, Lab. C.)
51730483OCCA/,59JC Aetna
Policy No. - CompanY-
ertifiatl copy Is hereby furnished. '
1 Bar Sulk Sewer Cap
_ _
ELECTRICAL
BackflOw.Preventer _ _ _ $ewer Connection' .. -_
Automatic Washer Meter over 100 amps
Backflowlrrigation Solar Collectors
- - _
COnstructiOn,POle Sub Panel
an
' Bathtubs i '''t Solar Piping -, (
Cooking Unit $ubPole
- 1
Certifla ropy Is fllatl with the cit .B I D o
Date_�'� % AVPllcant
Clarifiers Solar Tank
Dish'washer'. Motors 00.1 HP ❑1K$
EXEMPT 10WF O WORKERS' COMP TION'DECL ATION- "'-
(This section need not be completed if the permit Is for one hundred ($100) or
Iecertify that In the performance of the work for which this permit is issued I
shall not employ any Person in any manner so as to become subject, to the
Workers'. Compensation Laws of California.
Date Signature ,
Dishwasher Swimming Pool w/Spa -
Dryers -❑Gas -❑Electric - -- -
'•'Ina Solar ❑9-15 HP' ❑16'15+'
i Drinking Fountains' Urinal :
Fan :Microwave
- ,
Floor Drains Water Closet
F.A.U. Pole Light
g
!Range
NOTICE: If, after making this declaration,. you should become subject to the '_
.- Floor Sinks _' - _ . Water Heater- _,- ,' -- •.
-
Fixtures 1
Workers', Compensation provisionsofthe labor, Code, you must forthwith
comply with such provisions or'this permit shall be deemed revoked.
CONSTRUCTION LENDING 'AGENCY' 1-
I hereby affirm that there Is a construction lending agency for the performance,
of the work for which this permit is Issued (Section 3087 Civ. C.).
Lender's' Name
Gas Service ;Outlets Water Service _
-
Device Boxes 'Sign: I
-
Interceptors V -
-
i
Outlets Standing Sections '• j
Kitchen Sink'• ; _ - -
Switches 'Trash Compactor
Lender's Address -
OWNER BUILDER DECLARATION . - -
_ ..
Lavatories - -
-
Garbage Disposal
I hereby affirm that I am exempt from the Contractor's License Law for the'
-
I P—Tr
Generator 00-5 KW 05-15 KW I '
ap
following reason (Section .7031.5 Business and Professional !Code: Any city or
county which requires a permit to construct, alter Improve, demolish or repair
any structure, prior to Its Issuance, also req litres site applicant such permit
to file a signed statement that he/she Is licensed pursuant to the provisl ons of
the Contractor's License Law;(Chapter 9 (commencing with Section 7000) of
Division 3 of the ,Business and Professions Code) or that he she Is, exempt
therefrom and thebasis for the alleged exemption: Any vlolatlod of Section '
7031.5 by any applicant for a permit subjects the applicant to a civil
enols of not more than five hundred dollars
y (5500). I
n
Roof Drains .. : - - ,
• • • -
Transformer
r i 015.50 KW t i
050+ KW ,
( Reinspection Fee $15•
- - $15
! Showers �,� Reinspection�Fee
'
Meter ❑up to 100'amps 'Issue Fee' I I $ 3.
- 1 - :• 1
Service Sihk s Issue Fee I $ 3
i ' i
"—
Zoning Approved BY 'Date
s MECHANICAL
- �. -
L -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 I
for sale,(SeeIon 7044, BuslnesC antl: Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or Improves
thereon,•antl 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 com- {
pletion, the owner will have the burtlen of proving he/she tlltl not build or lm.
move for the purpose of sale). '. I
LJ I, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044, Business and Professions Code:
Application Approved By -Date '
Application Issued By ,iL,• �� Date
Boiler Refrigeration System
Duct-- Under Ground ' ❑0.100,000BTU ❑100,000BTU
SUMMARY OF FEES
'
BUILDING PERMIT $ SMTP $
I
PLAN CHECK - $ PERMIT '
- -
Duct - Structural System Repair/Alterationt
Duct - Ventilating
The Contractor's License Caw does not apply to an owner of property who '-
builds or improves thereon, and who contracts for such
p projects with a con-
PLUMBING $; r ' I ISSUANCE $
i
,
Exhaust System ❑ Multiple ❑
tractor(s) license pursuant to the Contractor's License Law).. -
❑ I am exempt under Section B. 6 P. C. for this reason
.PLAN CHECK' $ GRADING $
$ s
ELECTRICAL $
PLAN CHECK $; MICROFILM $
TOTAL FEE $
'MECHANICAL $ ,
LESS
PLAN CHECK' $ • n0 ADVANCED PC , $
1
- _ FINAL FEE $ O - nn
1
Firepl/Fact. BIL ICBG #31951
I1
.4
QQ
Date - Owner
I_hereby certify. that t have read this application and state that the above
Information is correct. I agree to comply with ail city and county ordinances
and state laws relating to iltling onstruction,'and hereby authorize repre-
sentatives of t .cl enter Pon the above-mentioned property for
.inspection Purp s p �p '
Signature r Date �$13
,Drivers' Licen or 5 $ -
Heating System & Ducting
❑0-100,000 BTU ❑10,0006 _ - -.
Hood or Type II ❑. Reinspection Fees
$15
Registers Issue Fee
$ 3
CMF 0865=46 rev: 12/82 White - Buildlnq; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING
- Q%.
POOL & SPA
1 -'APPROVALS 'Permit+�'
; ,-Pite
Inspector'
-APPROVALS Permit+
Date
Inspector
-,i. Temporary Electricial Service or Pole
'52. Pool & Equipment Location
2.'Soil Pipe-Undrgrnd'.
51 Steel Reinforcement
I
i3- Electrical Conduit Utility-Undrgrnd.
54. Forms
k4.:Electrical Conduit-Undrgrnd.:
'55. Electrical Bonding
r i I . I
Ste5. el Reinforcement
56. -Rough-Plumbing & Pressure Test
-6.1
Electrical LIFLRiGrnd,
57. APP06VAL TO COVER-GUNITE
7. 1 Footing
58. Electrical Conduit-Undrarnrl.
8.1 Foundition
,59. Gas Pipe, 0 Undrgrnd., Test
9JWater Pipe-Undrgrnd.
-Backwash,L nes' P
60. i -Tra'p, 0 Undrgrnd.
:
10.!Siructural FloorJSVstein
61. APPROVAL TO DECK
11., Property Sewer Lirie & House'Connection
62. Backwash & Receptor -Final
12.'S6wer Cap'
63. Heater & Vent -Final
13. Roof Drains
Plumbing System -'Final
14. Rough Plumbing
= 165.
Electrical -Final
15i?Rough Electrical -Conduit; i--
_66. SoliF_System-Final
16., Rough, Electric- Wiring
7
67.- Fencing & Access Approval
--
-17." Rough Wirikg Sjgri].1
68. APPROVED FOR PLASTERING
.,
: C
18.1 60u'gh El,ectrical-T Bar Ceiling .1
69. POOL/SPA SYSTEMS FINAL
19.' Rough, Heating & Air.Conditioning
I I
i
i FIRE DEPT. REQUIREMENT
'APPROVALS Permit +_
20.t Rough Factory Firieplace
21. Ducts;in.Str6icture, I
I
70. Underground Hydro
-22.Ducts, Ventilatin g,
-71� Prod uct:Piping'D Gas DOil
23. 'Gas Pipe -Rough & Test i
72� Underground Flush
24. Roof Framing
737 Undergrnd.,Storage Tank El Gas 0 oil
25. Robf Sheathing 1
74. Overhead Hydro
26.uT-Bir Ceiling (Structural)i;& Monbc6at
7,5. Dry Chemical
27. Frame and Flashing 1
1
76. Dry Standpipe
28.-" Lathing &,Siding
177. FIXED.SYSTEM FINAL,
29. Insulation
78. FIRE PREY. FINAL
30.1fprywall Nailing If
Notes:
31 Plaster Brown Coat 1 I
32., Electrical Power Meter -Final
33�.,.f inal Electric
34. Final Heating & Air -Condition i rig
35. Final Gas Oipe-Test
36. Hood*:Canopy
37. Final.Factory Fitreplace", ,
I
38. Fina0lumbing
39. Water. Service -Final
40. Gas Service -Final i I
41. Solar O.ornestic-Final 1
42. Backflow Prevente'r
43. Backflow Irrigation?'
44. Landscape Irrigation System
7
45. Sound 'Attenuation' I
, I it
-
46. Handicap Reguiations! i
47. FINA I ILSTRUCTURE . & BUI - LDlNdt
48. Special Recl'uiremelintsiCom'pleted
L
49. Electric'Release toEdsoA
50. Gas Release to Southern California d'asiCD
51. CERTIFICATEOF OCCUPANCY
No I !Date
Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations
CMF 0865-46 rev, 12182 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
Tf
CITY OF COSTA MESA
PER IT TRACT NO. LOT NO. BLD
.
CONSTRUCTION PERMIT/
t;�p��,,•,
06257
e�;
Applicant's Mailing drew LuzS
TYPE OF CONSTRUCTION
NEW ADD ' ALTERATION
REPAIR
�l
0 - 'a
❑CONVERSION DEMOLISH DOTHER
Project Address V
((y�t
r,��
Owner's Name ' ` \� -, �N phone
DESCRIPTION OF WORK
.
ZONING REGULATIONS'
Address
TYPE OF PERMIT \ GRADING 0 FOUNDATION STRUCTURAL
❑
Ivy'(\
A. P. #
ZONE
Arch/Eng. License No.
❑ TENANT ELECTRICAL
❑ PLUMBING MECHANICAL
PLNG. REF. Yk
' BUILDING
Address
❑,OTHER
TO BUILDING
Contractor's NaNm � �- h ne
D/,ri
\
PROJECT DESCRIPTION SO. FT.
OCCUPANCY
PROPERTY INE
REAR YARD (TO P/L)
-
Address (Meiling) ( S r
CONSTRUCTION TYPE
VALUATION $
LEFT SIDE YARD
RIGHT SIDE YARD
ZONA GRADING
CU.VDS. ACRES
PKG. SPACE REO.
PROVIDED
'
License No.
_
LICENSED CONTRACTOR DELLA ATION
Remarks:
S
STREET WIDTH
-PARK FEE $
I -hereby affirm that P am licensed under provisions Of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code nd
SPECIAL CONDITIONS:
'
my'license Is in full for a.yno If ct
ucenass — License N�
se.
PLUMBING
Datea Signature' -
+ Bar Sink
Sewer Cap
'
ELECTRICAL
'
WORKE COM SATION DECLARATION
I hereby affirm that 1 have a certificate of consent to self -Insure or a certificate
Backflow' Preventer -
Sewer Connection' ' -
Automatic Washer
IMeter El over 100 amps
of Workers' Compensation Insurance, or i certifl tl copY thereof ( ction
3800, Lab. C.)/ j f . ,Vv
Backflow Irrigation
- _
Solar Collectors
Construction Pole
Sub Panel
S ,
%�/ Vb-%(iYID
-
Policy No. Company
Certified copy is hereby furnished.
Bathtubs
Solar Piping
Cooking Unit
Sub Pole I
rtitie co Is Iletl with the clty.Buil g ivislon.
Clarifiers
Solar Tank
Dishwasher
,Motors ❑0-1 HP ❑1'/.-8
Dae Applicant
EXEMPT O_-�RKERS' COMPENSATION DECLARA,
Dish Washer
Swimming Pool W/SPa +
Dryers []Gas Electric
.I nc.Solar (]9-15 HP (]16-15+ _
(Thissectlon need not be completed If the permit Is for one hun ($100) or
_
less).
1 certify That In the performance of the wor (which this per is i o I
- -
+ Drinking Fountains
Urinal I
Fan +
Microwave
Z
shall not,,,���ggqqqqmploy any person in any mann r o'as to beco le e
-
F.A.U.
Pole Light
'
Workeylsa a Laws of Calif or ,
Floor Drains'
Water Closet'
Date //ter' Signature
NOTICE: If, after making this declaration, you should become s t to -the
Floor Sinks-
Water Heater
I D Fixtures
- Range _
1
Workers' Compensation provisions of the Labor Code, you 5 forthwith
Device Boxes
comply with such provisions or thispermitshall be deemed revoked.,
Gas Service• Outlets
Water Service -
Sign
-
CONSTRVCTIONILENDING AGENCY
Outlets
I hereby affirm that there Is a,construction lending agency for the'performance
Interceptors
Standing Sections
'
Of the work for which this- permit is Issued .(Section 3097 Civ. C.)
_
-
Switches
Lender's Name-
_ Kitchen;Sink.
_
Trash Compactor
Lender's Address
Lavatories
Garbage Disposal
OWNER BUILDER DECLARATION
1 hereby affirm that I am exempt from the. Contractor's License Law for the
Professional,
P—Trap
Generator El0-5KW Els-15 KW
following reason ,(Section 7031.5 Business and Code: Any city or
'county which requires a permit to construct, alter improve; demolish-ocrepair '
any structure, prior to Its Issuance, also requires the applicant dor such Pa rmit
P _
Roof Drains -
- - --
Transformer X15-50 KW
t0 file a signed statement'that he/she Is Iicensetl pursuant to the�provisl ons Of
- -
-
050 + KW
Reinspection Fee
spe $15
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 the Business Professions Cotle)'or that he/she. is, exempt
Showers -
-
Reinspection Fee
$15
of antl
therefrom and the basis for the alleged exemption. -Any violation of Section
Meter ❑up to 100amps
Issue Fee
$ 3
7031.5 by- any applicant for a permit' supjects the applicant to a civil
Service Sink
-
Issue Fee 7
$ 3
_ _- -
_ _ __
eenalty of not more than five hundred dollars ($500). ', :. [ _
.- I
Zoning Approved By
Data
LJ I, as owner of the property or my employees with wages as their sole
MECHANICAL•
fom Sensation will do the Work, and the structure IS not :,The eC n offered
for Contractor's
7044', Business and Professional Cwho
_ -
Application Approved By
trate
buil
nse LS doe owner a property who builds or Improves +
. License Law awes not apply
_
Boiler "' �
Refrigeration System
Application Issued B
PP V
^' Date 9
if
thereon, and who does � such work himself/herself or through his or her own
work
employees, provided that such improvements are not Intended or offered for -
00-100,000BTU ❑loomo BTLi
+
sale. If, however, the building or Improvement is sold within one year,of com-
Duct - Under Ground
;
SUMMARY OF FEES
'
pletion, the owner will have the burden of proving he/she did not build or im-
for the
-
Duct - Structural I
-
System Repair/Alteration
purpose of sale). 1
F
F
BUILDING PERMIT $
SMIP
$
1, as owner of the property, am exclusively contrading'withulceriseo con-
Duct - Ventilating_
PLAN $
+
tractorsto construct the,project (Section 7044. Business and Professions Code:--•
The Contractor's License Law does to an owner of property who
_ _
- -
_ _ _ _
CHECK
PERMIT
'
net apply ,
builds or Improves thereon, and who contracts for such projects with a con-
Exhaust System ❑ Multiple ❑;
PLUMBING $
_ ISSUANCE
$
' tractor(s) license pursuant to the Contractor's License Law).
GRADING
$
El am exempt under Section B. &.P. C. for this reason •
Firepl/Fact. Bit. ICBG #
'
PLAN CHECK; $
,ELECTRICAL
i
-
$
35 _
$ -
Date i Owner
Heating System &Ducting
"PLAN
MICROFILM
t
$
I hereby, certify that.; -have read this application -and state that the above
I ❑0.100,000 BTU 0100,000BT
-
CHECK, $
TOTAL
In format Ion is correct. 1 agree to comply with au city and county ordinances
MECHANICAL $
FEE
$
and state laws r ing to builtlin nstru ti ,•antl here b norize repro-
Hood or T ype I ❑
sentatives of t s city I to enter on a bove- netl ro`Ylfor
-
Canopy T e II ❑'
Reinspection Fee
$15
PLAN CHECK. $,
; LESS
1 t
Inspection our s
l/9 v •S
3�
3
ADVANCED PC
$ I
Signature Date ,
Drivers' License or SS
Registers
Issue Fee
$ 3
I FINAL FEE
$ S�
CMF 0865-46 rev, 12182 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
Tf
} C CONSTRUCTION AND PLgNNIN(
= `
t - -
- " - _ POOL,& SPA ,
/
APPROVALS = Permit # F-B�g !�
c Date
rl nspector
-APPROVALS - Permit
Date
Idspector
-
v••
-
- - - .
,(. Temporary.Electrical Service or Pole
_
_1 -
. 52. Pool &Equipment Location-
s 2: (Soil Pipe-Undrgrnd.i,`
53.- Steel Reinforcement
3: Electrical Conduit Utility-Undrgrnd.
`'
54r Forms - • - _
-
'q 4: Electrical Conduit-Undigrrid.
55. Electrical Bonding " -
-
r.i
5- Steel Reinforcement f
_ ' `
r'
' `56.Rough Plumbing &Pressure"Test
-
c
6. 'Electrical LIFER Grnd.
°
57. APPROVAL-TO COVER-GUNITE
7. �Footing4--58.
Electrical Conduit-Undrarorl.
•
_
B. Foundation _ -- a
-
�:
59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Uridrgrnd.
- -
60. Backwash Lines, P-Trap, O Undrgrnd. =
10. Structural Floor System " r- -
61. APPROVAL TO DECK
-
11. Property Sewer Line & House Connection
-
.r - -
62. Backwash & Receptor-Final - -
12. Sewer Cap
I
'
63. Heater & Vent-Final
13. Roof Drains -
"64. Plumbing System - Final
-
- -
14. Rough Plumbing - '
65. Electrical-Final-
-
1 15.'Rou h-Electrical-Cor.nduit' -
u . W 9 - -, n
1-' I- ,
,66.i Solar System-Final
- -
,
- - -
):-16.'Rough-Electric Wiring ' , ' :'
67 Fencing & Access Approval.-
17. cRough'Wiring,Sign} ;, I .� I-.
.- . '
t
68. APPROVED FOR PLASTERING_
_
18. RoughElectrical-T'Bar Ceiling l,
69, POOL/SPASYSTEMS FINAL
"19.:fiough Heating &IAir Conditioning I
FIRE DEPT. REQUIREMENT
,'
�I
APPROVALS- Permit #
' 20. `hough Factory Fireplace I �'
I
9 21. Ductsn Structure•
1
•70. Underground Hydro
-
22..Ducts, Ventilating ' ,j .�
I
,
JiJ Product Piping OGas OOil
1
,,'.23. iGas:Pipe-Rough & Test .j I i_ ii r
I�
:72. Underground Flush
t
24. ,Roof Framing- 'Ici
r� '
; I
73. Undergrnd. Storage Tank O G_as, 0 Oil
25. 'Roof SheathingI,;', • I
. i
74. Overhead Hydro
T-Bar Ceiling (Structural) & Monocoat
=
X75. Dry Chemical - -
,26.
r
p _27. Frame and Flashing 1
,
-
76. Dry Standpipe
_
1 . 28. ;Lathing &'Sidingo ., 1,
177. FIXED SYSTEM FINAL
.78.
-
29. `Insulation � 'i � j
I �
FIRE PREV. FINAL
-30. Drywall Nailing ;.� ',
( I
Nates: ,
- 31. 'Plaster Brown Coat
�32.,Electrical,Power Meter=Final
33.;Final Electric
34. Final Heating &'Air Conditioning
- - -
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
'
43. Backflow Irrigation I i
_ •'
-
44. Landscape Irrigation System
45. Sound Attenuation % I I
-t
- -
46. Handicap fleguletions
47. FINAL STRUCTURE & BUILDING' (`s
48. Special Requirements Completed,
I
1
�
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
t
51. CERTIFICATE;OFOCCUPANCY
No Date