HomeMy WebLinkAbout171 TERRAZA CT - Building Permits t` 9 CITY OF COSTA MESA
Aplik
BUILDING DIVISION
. ••t•„t. .40
DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
1. 1 w.._+i. i
PERMIT
444bvirsoo 144. P05-00239_00239
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 171 TERRAZA CT Status: ISSUED
Suite No Applied: 04/07/2005
Issued: 04/07/2005
Vicinity: WATER HEATER
Parcel Nunmber: 43929507 ISSUED BY: -l( _cisi
l
Applicant: NOCK PLUMBING
Address: 11612 KNOTT ST
SUITE 217 Phone: (714)895-1246
GARDEN GROVE,CA Zip: 92841
Owner: SJAW, WILLILAM J TR ,
Address 171 TERRAZA CT
Phone:
COSTA MESA,CA Zip: 92627
Contractor: NOCK PLUMBING
Address: 11612 KNOTT ST
SUITE 217 Phone: (714)895-1246
GARDEN GROVE,CA Zip: 92841
License: 707775
SCOPE OF PERMIT
WATER HEATER CHANGEOUT.
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 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 $0.00 0 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 $0.00 0
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) $0.00 0
Drain, Roof $0.00 0 Shower $0.00 0 Water Heater/vent $12.30 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 $0.00 0
Gas Earthquake Valve S0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 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: $35.80
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord. No,92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(6/00)
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
O 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.
�T.-. I have and will maintain workers'compensation insurance,as required by section 3700 of the Leber Code,for the performance of the work for
which this permit is issued.
My w rjk/e�rs('ycol�mp/snsation Igst rrerce carter end policy number ere: ky�`"-"C'—'
. Cagieh: DILA Lc IVSJn IiM1n)'V 1 Policy:Nu^mbei:-T O'I
-(This section need not be completed if tte permit is valued et one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit Is Issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with(hese provisions. O� ♦ -I-D S p ' 6 S
(1{)pGwntatur : L�1 /(
-WARNING:FAILURE T ECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER To CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby tt.Ll I�!)..la�l'Oens�kr) g�v ons of Chapter 9(commencing with Section 7000)of Division 3 of the Busi(tess aRAp{o ons Code,and my license is in full
force and effect.LIC-H �J_.... --'794,-€.----a------- lLlass-x--��j `{//-RC1 1
Co or'a'Si nature: Dye:. ">�', 0' s_ ) C
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Dale'.
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I em 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 Cale: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.).
O I,as owner of the properly,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.).
❑ l 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(typo of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2.Sec.
341,Title 8,California Administrative Code).
O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes ❑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 0 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? 0 Yes ❑No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application aRPermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? ID Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residontial building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feel from the outer boundaries of a school? 0 Yes 0 No
(If yes',the facility must meet the requirement of Sections 25534 end 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this
application,have all of the disclosures 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 COMPLIANCE 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 with all state laws and city ordinances relating to building construction,end authorize representatives of the City of Costa Mesa to enter upon the
above-described properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
a Of Legal Owner(s) ,�x�
—1 And/Ok'Aatliorizetl Applicant LDete"-'— - -
CODE• ittancRONTYPS DATE INTRULS CODE! INSPECTIONTYPE PAIL INTITtALS 1
1616 Fixed System Final Fire Prevention 206 Final Mechanical _
1266 Pool Spa Final _ 208 Final Plumbing . narc.--. ' t'
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
•
LpStQ MFS9 CITY OF COSTA MESA
447
!moo'. CALIFORNIA 92626-1200 P.O. BOX 1200
T.
1 'e DEVELOPMENT SERVICES DEPARTMENT
iff•~`O4PORGiFD 9S
"c4f{li
January 24 , 1991
To:
Building Safety Division Newport-Mesa Un. School Dst. (2)
Code Enforcement Pacific Bell
Communications Police Dept. - Ping. & Research
Copley-Colony of Costa Mesa Santa Ana Heights Water Company
County Administration Office Sanitary District Engineer
County Clerk/Bd. of Supervisors Southern California Edison Co.
County Registrar of Voters Southern California Gas Co.
County Tax Assessor State Board of Equaliziation
Engineering Division (2) Street Division
Fire Administration U.S. Post Office - AIS
Fire Prevention U.S. Post Office, Adams Avenue
Manager, MIS File (2)
Mesa Consolidated Water Dist.
The City of Costa Mesa wishes to advise you that the following
addresses have been changed or added:
OLD ADDRESS NEW ADDRESS A. P. NO.
2464 Elden Avenue A - 151 Terraza Court 439-291-07
2464 Elden Avenue B - 155 Terraza Court 439-291-08
2464 Elden Avenue C - 159 Terraza Court Lots Combined
2464 Elden Avenue D - 163 Terraza Court
2464 Elden Avenue E - 167 Terraza Court
2464 Elden Avenue F - 171 Terraza Court
2464 Elden Avenue G - 172 Terraza Court
2464 Elden Avenue H - 168 Terraza Court
2464 Elden Avenue I - 164 Terraza Court
2464 Elden Avenue K - 160 Terraza Court
2464 Elden Avenue L - 156 Terraza Court
2464 Elden Avenue M - 152 Terraza Court
77 FAIR DRIVE
t901ECTAD'MESS: , �uum: F CITY OF COSTA MESA - BUILDING PERMIT PERM NO: G 049369
OWNER'S NAME: BRIGGS DEVELOPEMENT CO. •
•• ADDRESS: 23046 CARLOTTA AV #315 PERMIT NO: G 049369 PLAN CHECK NO: 04400-90 L GOVT: N SUP: N
)
LAGUNA HILLS CA
CONSTRUCTION TYPE: V-N PERMIT TYPE: ELE MEC PLU STR PURPOSE: NEW
ARCH/ENGINEER: 380-0685 REG.NO.: JOB DESCRIPTION : NEW APARTMENT 1 OF 12UNITS SQ FT: '2, 173
ADDRESS: UNIT:
CLAIM VALUE: _ CALC-VALUE: 129, 257 . 00 GROUP OCC: Rte . / Ai -'t
PERMITTEE: BRIGGS DEVELOPMENT ( 714 ) 380-0686
ADDRESS: 23046 CARLOTTA AV 315 COMMENTS : APARTMENT 1 OF 12 UNITS
LAGUNA HILLS CA 92653 **************+raE+r********************************at*****ar*** *>F****>f*** ********
UCENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in lull force and effect. SETBACKS /
CITY UC.: STATE UC.: • CUSS: i '
Dae: Signature: P • MAIN BUILDING ACCESSOR)! BUILDING •
WORKERS'COMPENSATION DECLARATION: I hereby affirm that)have a certificate of consent to self-insure or a certificate of Workers' FRNT: 12 FT IN REAR: 20 FT IN FRNT: FT INN_ REAR• FT' - IN
LEFT: 25 FT IN RGHT: 10 FT IN LEFT: FT IN RGHT -'FT
impensation Insurance,or a certified copy thereof(Section 3800, Lab.C). • IN
JULY
Co : EXP.DATE: PARKING REQ: 24 PROV: 24 PARCEL: 43929107 ZNE: R2 REF NO: DR9015
E
Certified copy is hereby furnished.Certified
❑ Certified copy is filed with the dry Building Division. PLANNING NOTES> ONE, 2-STORY DETACHED APT. UNIT (ONE OF A 12-UNIT PROJECT)
Date: •'• Applicant: ********************************aF*****1e*******ef af*********************it*3r;*******
EXEMPTION FROM WORKERS'COMPENSATI011 DECIAMTION:-(Dks section need not be completed if the permit is for one hadred($100)or less). DEVELOPMENT S 'E R V,. I C E. R Q U T A E M E N T• S
' I certify that In the performance at the work for which this permit Is issued,I shall not employ any person in any manner so as to become _ �q
subject to the Workers'Compensation Laws-of California. ZONING APPROVED BY �_" . DATE: l0•• �'.-/ 0
Date: Signature: �� f
NOTICE:If,after maldng this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY j�/ .‘ DATE: (O. ' U
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. r •
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: � I DATE: (1�0: 0
which this permit is issued(Section 3097;CIv.C). - ************************ . ` * ** ** *.' a k� *' ********************+v.* 4****
LENDER: ************************************ *** **************************************
ADDRESS: LEGALIZATION:N F E E') SUMMARY STRUCTURAL SEGMENT:Y
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC • MECHANIC FIRE SMIP/RES ')GRADING
(Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 744 . 50 27 . 00 62 . 0 6 . 15, 50 9 . 05
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 25% S,C)% ' 2 5$ SMIP/NON-R E S
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN 483 . 93
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by ISSUE FEE 3,00 1 5 • 0 0 15 . 00
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).
BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
I, as owner of the property or my employees with wages as their sole compensation, will do the work, and theC'
structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 8 S 8 . 11 3 3 . 0 0 483 . 93 1375 • 04 1375 . 04 . 00
does not apply to an owner of a property who builds or Improves thereon,and who does such work himsetf/herseti or through II
his or her own employees,provided that such improvements are not Intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 891 . 11 OVER/SHORT: . 00
improvement is sold within one year of completion,the owner w0l have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC' FIRE SMIP/TOT GRADING PLAN-CHECK
for the purpose of sale). 744 . 50 30 . 00 77 . 06. `' 30 . 50 9 . 05
At; I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business
C7 and Professions Code: The Contractors'State License law does not appfy to an owner of property who builds or improves thereon r
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'Slate License Law).I am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to me. I N D I V I D U A q, F E E BREAKDOWN
0 I am exempt under Section: B.6 P.C.
for this reason: � � TYPE QTY D E S C R I .P T I :q N UNIT COST TOTAL COST
Date: /C O owner: jar /�/� SFR 1773 DWE-TYPE V-WOOD FRAME -GOOD 69 . 00 122, 337 . 00
Ido hereby certify that I am aware of and understand the requirements of Calitor Health and Safety Code S ions 25505,25533,and SFR 400 RES-GARAGES TYPE Vim+, 17 . 30 6, 920 . 00
25534 and that I or any future building occupant will/will not(circle one)need to corn' with said state codes and the requirements for a ELE 1773 NEW RES BLDG FOR DiOR 2 UNITS/ SQ FT . 03 62 . 06
permit for construction ication from the Air Quality Management District. : sidential construction air -. n e exempt from MEC 1 INST FORC-AIR/GRAO'^IPURN <=- 100 K BTU 9 . 00 9 . 00
these provisions. NEC 1 FACTORY FIREPLACE:+ i 6 . 50 6 . 50
Date: (O Applicant: .� .%� PLU 1 BATHTUB ! 2 . 00 2 . 00
I hereby certify that I have read this application and state that the o for'"ion is correct.I agree• th an dry and county PLU 1 DISHWASHER 2 . 00 2 .0 0
ordinances and state aws feting t budding construction and her amho', presentatives of this n n the..• • en0aned PLU 1 GAS SERVICE 2 .00 2 .00
DAproperty for inspection epos PLU 1 SINK, KITCHEN 01 M/02t 00 0G;t,ty� 4_._ 2 . 00
01
Date: ® �/� Signature: �:/i/ LU
PLU 1
1 SEWERSHOWER CONNECTION TO BUILDING EACH 2 . 00 T:.,,F: :1:07 2 .00 • 1_.
Driver's License or Social Security
1641.48 White-Building:Green-Code Enforcement:Canary-Applicant:Pink-Revenue:Goldenrod-Assessor
F CONSTRUCTION AND PLANNINu , UC SPA
APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector
' 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location •
2,;Soil Pipe-Undrgrnd.; / f` 53. Steel Reinforcement - ` ,•11
�n�%�/�D/ fes
3. Electrical Conduit Utility-Undrgrnd. 54. Forms - ;
_
• 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding '
. .5.r.Steel Reinforcement /,!/-�fo �caf 56. Rough Plumbing & Pressure Test
6_•Electrical UFER Grnd. (Q2 1O 6.4'41. 57. APPROVAL TO COVER-GUNITE
-7.-Footings cj
• •- J�` -go 6" 58. Electrical Conduit-Undrgrnd. 1
.S..Fo `undation -. ,�a 4:1-07-* 642# 59. Gas Pipe, 0 Undrgrnd.,Test • -
9.1 Water Pipe-Undrgrnd. r ,017,2)_..„4//,.c---60. Backwash Lines, P-Trap, 0 Undrgrnd.
f10:-,Structural Floor System 61. APPROVAL TO DECK 4
•
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 / /q(/ /"[ 'Q66. Solar System-Final 5
16. Rough ElectritWiring 67. Fencing & Access Approval tr • '
-1 17. Rough Wiring Sigh 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL -
19.-Rough Heating & Air Conditioning _ _ FIRE,DEPT.,REQUIREMENI' Jill ,
2OrlRou h•Factor Fireplace cr= _ * ~ '
g y �C �- , _ < -APPROVALS--;=:Permit #
21'.-Ducts,in Structure " " S r ,i ' 4- '70. Underground Hydro
22...DuctsV
, eni[lating - . - - e '7 .r •=* > ;C 71. ProductiPiping 0 Gas 0 Oil
23:-Gas-,Pi pre...-R°rug h &yTest r ;" `-", Q; ` 72. Underground Flush,.
s
24.'Roof Framing :: r `• '111 zr .73 Undergrnd.Storage.Tank 0 Gas 0 Oil
25. Roof Sheathing ." ' '' _' -" 74 -Overhead Hydro�� T
•-' y. .., 71. .•t r * *
11 X
26_'T-Bar Ceiling (Strupturall &.Monocoat•: , (.3 . `v: * 75z Dry Chemical •.;.J ;�-.'1r 1:.;.t.1;1;,,-,- -
27 Frame and Flashing - = - 4 ' to* * 76. Dry Stan-pipe CID.; ,. H .•l ' -: :CI 1'•
'28. Lathin c& Siding- 1 F. ,-- A. - •;r'..:_ �,SML . ,•>. "!-Jl.a
'
•
29. Insulation ' ' = •''•:' ° ', t " 7Br.FIRE FR EV. FINAL � _ •'
_I} L7- _ - ,, ;' ,\ .�, .i- '-1 cal
30. Drywall-Nailing ,, - \- ,, ..0: A •Dov -,,,IEALTH)DEPT. REQUIREMENT•-• �q�r,
31. Plaster Brown eat- - `.' r, ' r 9. FINAL INSPECTION ' - c.-,•,:-..-`i
-32.;Electrical Power.Meter-Final "`t /�'�! /AV 8 -FOOD CERTIFICATE ISSUED. --t��p� %�}}Q .
_33-:Final Electric - •- (jv� •K �•� ` otes: ' '41O.1OR SFC 1Y ! -
(/ ��� i. c
34.;Final Hating & Air Conditioning • 2 . /�fc - : •-
rs
:--
35. Final Gas Pipe-Test ' 6ig/`Q r,_* z.1 tli-r
• 1 tar, /�
•;36.:Hood orCanopy . `.t x ;`. - _ i' Cd/Jj `' �/D
37:-Final Factory Fireplace : F: • CAlietL LE - " 'j !
-
7.381Fi14Plumbing ' 431/41 t t.1a C -41 'J J -16, is
'• 39.,Water Service-Final. ,: Z--- 41/&•''/4/ /%14 lb*. * - ) •1 r CC `F+
40: GasService•Final ' -"�' 1 "'Y
4.
41:' Solarpomestic-Final' - i -• • --
•
r 42. Backflow Preventer, c• ' c- _
43. Backflow Irrigation - - - _
X44.. Landscape lim'ripation Syste . \Z -• _
-45.-Sound Attenuation •
• • -t•• r •' '
.46: ancap•HdiRegulations _
' `-'
.47-.''FINAL STRUCTURE & BUILDING.- C p-q(
sfrELJ o70Z�f/- r
:49- Electric Release to,Edison - q _
- 50.:Gas;Release to Southern California Gas Co �-1'� - _ - ;-i - -
-51. CERTIFICATE OF OCCUPANCY • -
No. Date
EADJECT ADDRESS: UNIT:
OWNER'S NAME:
ADDRESS: PERMIT NO: G 049369 PLAN CHECK NO: 04400-90 L PAGE: 2
********************:t**************3:a***4*4E*3:E*3t*4*et:Eek**:t***3t:t:4******ft*:E***ft:H**
ARCH/ENGINEER: REo,xo.: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
ADDRESS: UNIT:
PLU 3 WATER CLOSET (TOILET) 2 . 00 6 . 00
PERMITTEE: PLU 1 LAUNDRY TUB OR WASHER 2 .00 2 . 00
ADDRESS; PLU 1 WATER HEATER AND/OR VENT 2 . 00 2 . 00
PLU 1 WATER SERVICE 2 .00 2 . 00
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section END OF FEES
7000)of Division 3 of the Business and Professions Code,and my license is in lull force and effect.
CITY UC.: STATE UC.: CUSS:
Date: Signature:
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers'
Compensation Insurance,or a certified copy thereof(Section 3800.Lab.C).
POLICY ND.: EXP.DATE:
r:OMPANY:
Certified copy is hereby furnished. El Certified copy is filed with the city Building Division.
Date: Applicant:
EXEMPTION FROM WORKERS'COMPENSA71ON DECLARATION: (This section need not be completed it the whit is for one hundred($100)or less).
I certify that in the performance of the work for which this perndt 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:
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 construction lending agency for the performance of the work for
which this permit is issued(Section 3097,Civ.C).
UNDER:
ADDRESS:
OWNER BUILDER DECLARATION; I hereby affirm that I am exempt from the Contractors'State License Law for the following reason
(Section 7031.5 Business and Professional Code: My city of 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/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
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penally 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(Section 7044,Business and Professional Code: The Contractors'State License Law
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own 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
for the purpose of sate).
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business
❑ 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 s41h a conoactorfs)license pursuant to the Contractors'State License Law).I am aware
that proof of their Worker's Compenstlion Insurance should be provided to me.
❑ I am exempt under Section: B.a P.C.
for this reason:
Date: Owner:
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and
25534 and that I or any future building occupant vMUwill not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions. E RECO:
Date: Applicant: 01 00071435—'1"17144 TOT /)
DATE: 10/08/40 T<"c' '•r7
I hereby certify that I have read to wildinon and state and
aboveh information nist correct.I is agree to comply with all city and county t t... 1.•_
ordinances and state taws relating to buiMvig construction aro hereby authorize representatives of N¢city to enter upon the above-mentioned
property for inspection purposes.
Date: ' Signature:
Driver's License or Social Security it •
1641>8 White—Building:Green—Code Enforcement;Canary—Applicant;Pink—Revenue;Goldenrod—Assessor
CONSTRUCTION AND PLANNING POI. . SPA (11
APPROVALS Permit # Date Inspector APPROVALS Permit #_ Date Inspector
• 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility•Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, Q 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=RoughlFactoiy Fireplace APPROVALS Permit #
21F Ducts, in Structure 70. Underground Hydro
22_;Ducts,Ventilating 71. Product Piping 0 Gas 0 Oil
23.-Gal Pipe'Rough & Test 72. Underground Flush
24.Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25._Robf Sheathing 74. Overhead Hydro
26`;T-Bar dilinZ(RAturall & Monocoat 75. Dry Chemical
27'.fFrameand Fias trig; 76. Dry Standpipe
28. Lathing;& Siding. 77. FIXED SYSTEM FINAL
29. Insulation n E4 78. FIRE PREV. FINAL
30. Drywall Na(i gtiHEALTH DEPT. REQUIREMENT
31. Plaster 4Brownttoat 79. FINAL INSPECTION
v . _
32rElectrical Pae rR1eter-Final 80. FOOD CERTIFICATE ISSUED
33?:Final ElectriCS: r1 Notes:
34..)Firal Heating&LAir Conditioning
35=Final Gas Pipe-Test tr'
36.-Hood or Canopy r''
.. m
37?Final Factory Fireplace
38.-,Final Plumbing
39..Witer Service-Final
40: Ga-s Service-Final
41;4Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape liridatioh System
45. Sound Attenuation
46. Handicap Regulations
47.:FINAL STRUCTURE & BUILDING
48::FINAL*PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
•
•
FINAL GRAQING CERTIFICATION
. Project Address: /7/ Terraza Court
Lot Number:
•
Permit Number:
By Civil Engineer:
I certify to the satisfactory completion of grading in accordance with the approved plans,
specifications, local and state codes. All drainage devices required by the grading permit,
grading plan and grading ordinance have been installed. Adequate provisions have been made
for drainage of surface water from each building site.
The minimums are:
2% Fall from structures within 5 feet from exterior walls.
1% Fall for asphalt surfaces and landscaped areas.
0.5% Fall for concrete surfaces to approved disposal areas.
The final monuments as shown on the recorded tract map were set. All final grading eleva-
tions are within ± 1/10 of the desig e elevations.
Supervising Civil Engineer Reg. No. PCF 117,n
(Signature)
Date 6/11/91
•
•
ti1 .
/92
• `rT CIV1t ��Q
9 •
FOF CMACv
S ;:-ip and SIN
•
MY 0F COSTA !UEFA
---A ..AtJPORNIA 92628-1200 P. 0.1)0X 4-00 yq
Insulation Certificate L '/� �0Il 00(R-
2468 ELDEN AVENUE"umher end Stre-et City
ORANGE --- ---...._ UNIT F _
County Subdon Nu nivisi - ---- lou bcr_
•
Description of installation
ROOF
Material It rand Name
'Thickness(inches) -_— --- Thermal Resistance(R-Value)
EXTERIOR WAI.1..
Material _—BATTS___---.__....,...._ . Brand Name _IIANNJLLE
Thickness(inches) ' Thermal Resistance(R-Value) R-11
C EII_iNC
Mau or Blanket Type BATT_ _._.._........................ Brand Name MANVILLE
Thickness(inches) _ 'thermal Resist nce(R-Value) R-1.9 and_R.c3.4 _________
Loose Fill Type Brand Name.
COntractor's minirnurn installed weigladr 2 lb Minimum thickness inches •
Manufacturer's installed weight persquart foot to wheivc The mal Resistance(R-Value)
RAISED F!.00R
Material Brand Name
Thickness(inches) Thermal Resistance(k-Value) --
—
•
SLAB FLOOR
Material Brand Name
Thickness(inches) ..._................_....... .........._. .._........__...._....__ Thermal Resistance(R-Value) ----„------
Width (inches)
FOUNDATION WA IA. •
Material )luno Name
T7uekness(incus) ... ....__._ 'likeermalResistance(R-Value)
Declaration
•
I hereby certify that the above insulation was installed in the building at the above location in confbnnance with
the current Building Energy Efficiency Standards for new residential buildings contained in Title 24 of the
California Administrative (:ode.
n)Canvacum (Iluild:') li.:emc lvumir_r
:ii t;ncrm!n,rl I ulc .� lane
t........WESTERN_INSULATION,....ING......_..._. ._.. ._.. 'F:':>....481278
��. - Nut,(', n::n: Int (In(,let ion I,c.tnllrt) _.._....._..___.._...
Authorized_Agent /'•, 6-4-91
..'.. le ... .
,. nit.I Tole _ etc
PROJECT ADDRESS: 21174 :ID E ) (yJy UNIT: F CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 05038
• 'OWNER'S NAME: BRIGGS DEVELOPEMENT CO.
ADDRESS: 23046 CARLOTTA AV #315 PERMIT NO: M 050389 PLAN CHECK NO: N GOVT: N SUPP: N
LAGUNA HILLS CA
CONSTRUCTION TYPE: V—N PERMIT TYPE: MEC PURPOSE: OTH
380-0685
ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : NEW APARTMENT 1 OF 12UNITS SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: CALL—VALUE: GROUP OCC: R-1 /
PERMITTEE: SANTIAGO AIR CONDITIONING ( 714 ) 998-1600
ADDRESS: 231 BLUERIDGE COMMENTS: RE: G49369 PRIMARY BLDG, PERMIT.
StRF
ORANGE CA 92665 ****** *>EBF*T¢*SE*�E*S¢SFTF* ¢*T�*�6SE*SE*I¢x* ********SF*S¢S6*a6SF+¢*****S6*SE*aE*******+FSPR*SF**w**
LICENSED CONTRACTOR DECLARATION: I hereby affirm that am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in lull force and effect. SETBACKS
CITYLIC.: 015264 STATEuc.:269496 cuss: C-20
Date:/��d—i7signature:_ MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
WORKERS'COMPENSATION DECLARATION: I hereby allirm th'.i have a certificate of consent to sell-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
Compensation LtsuraPFe pc a,c;ttjuep copy thereof(Section WOO.Lab.C1.7/01 /91
POLICY NO.: WW UU J L V 71 EXP,DATE: U
' $CDMPANY: PACIFIC STATES,,S5,TPARKING REQ: PROV: PARCEL: 43929107 ZNE: REF NO:
J Cemfied copy is hereby furnished. 1-'T Certified copy is filed with the city Building Division. PLANNING NOTES>
• >
D31e-lit/J 9O Applicant*
_ ***************
****************************************************************
DEVELOPMENT SERVICES REQUIREMENTS
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: ion need not be=Meted if the perrot is tor one hundred(5700)or less).
I certify that in the performance al the work for which this permit is issued.I shall not employ arty person in any manner so as to become ZONING APPROVED B Y •
DATE
subject to the Workers'Compensation Laws of California.
Date: Signature: BUILDING APPROVED BY : DATE:
NOTICE:II.after making nes declaration,you should become subject to the Workers'Compensation provisions of the Labor
Code.you must
DINGvAG AGENCY:
Iwith suchprovisionsthat r Itits permit
eucin lending agency lo. APPLICATION ISSUED BY: N. �j DATE: ��.'EC�eiC%
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency IOr the performance of the work for
which this permit is issued(Section 3097.Civ.Cl. **'*****'**********.x'*'*'*'*'*'*'* *'*'*' *' Al *** **'***ih**'**N'**'***'***'*'** ** *****
LENDER: ************************************** * *************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve.demolish,or PERMIT 9AJ,,00
repair any structure.prior to its issuance,alio requires the applicant for such permit to file a Signed statement that he/she Is licensed L 5% SMIP/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
and Professions Code)or mat he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by ISSUE FEE 15 . 00
any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars(ASW).
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
I. as owner of the property or my employees With wages as their sole compensation, will do the work, and the TOTALS----> 9 .00 15 . 00 0 . 00 24 . 00 24 . 00 . 00
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law
IIIdoes not apply to an owner of a property who builds or improves thereon.and who does such work himsell/herself or through
his or her own employees.provided that such improvements are not intended or offered for sale.II,however the building or REVENUE DIVISION TOTALS--> COLLECTED• 24 . 00 OVER/SHORT• .00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SHIP/TOT GRADING PLAN—CHECK
for the purpose of sale).
I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 24 . 00
❑ and Prhcontractsdfo The Coojects withState LicensrLaw ensrsuly tponctorstate0icense improvesIather¢re **********.*************************************%*******************************-
and who contracts e: hprojects with a contractor(s)LiesLw tensenot pursuant to owner ofContractors'gState builds
am aware
that proof uI their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.&P.C.
forthis reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: MEC 1 REFRIGERATION SYSTEM <= 100 K BTU/H 9 . 00 9 . 00
I do hereby cendy that 1 am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and END OF FEES
25534 and that I or any future building occupant will/will net(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions.
Date: Applicant:
I hereby certify That I have read this application and state that the above information is correct.I agree to comply with all city and county I:L I.6. J a3r_�l 17t1/413: 't -�y�.--
ordinances and state laws relating to budding construction and hereby authorize representatives of this city to enter upon the above'mentioned
property for inspection D;,;E: .!20Ii G Tr:: ).::7
De%r—�/p0
AoolicanL Pink—Revenue:Goldenrod—Assessor
W IP
IPCONSTRUCTION AND PLANNING PO%PA
APPROVALS Permit# Date Inspector APPROVALS Permit # - Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. i.. -. 53. Steel Reinforcement
' 3.'Electrical Conduit Utility-Undrgrnd. - 54. Farms
> , 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
, 1 5. Steel Reinforcement _ 56. Rough Plumbing & Pressure Test
6.-Electrical UF Grnd. i 57. APPROVAL TO COVER-GUNITE
,f
I- 7. Footings 58. Electrical Conduit-Undrgrnd.
•� B. 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 r . - - _ • - APPROVA•L'S Permit# -
21' Ducts, in Structure: - _ : - _ ', - •70. Underground Hydro
22. Ducts, Ventilating - - i 71. ProductPiping 0 Gas 0 Oil
.
23.;Gas Pipe-Rough & Test C .72. Underground Flush .
24.. Roof Framing 73. Undergrrid.Storage Tank 0 Gas 0 Oil -
25. Roof Sheathing - : 74: Overhead Hydro_
26. T-Bar Ceiling (Structural) &•Monocoat - , • 75. Dry Chemical
27. Frame and Flashing , : : 76. Dry Standpipe
28. Lathing& Siding ' ' - r 77. FIXED SYSTEM FINAL •
r29. Insulation . . 1 I. 78: FIRE PflEV. FINAL
• 30. Drywall Nailing •. • - I HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat' I I .-.1' � 79. FINAL INSPECTION
32. Electrical Power Meter-Final I,,•' I, ' 1. 80..FOOD CERTIFICATE ISSUED ••
•- 33:• Final Electric I • _ Notes: : _ ,
34. Final Heating& Air donditioninq•� i/ '/// tp3 .2.... . - • - ' '
35. Final Gas Pipe-Test' . . - .✓ ! /�`f,. ,�
36 Hood or.Canopy
37. Final Factory Fireplace. - .. •
•L.i. .
38. Final Plumbing ,
39. Water Service-Final - - - -•
40. Gas Service-Final ' ` I . , - •
•
=,41. Solar Domestic-Final
42. Backflow Preventer . ' '
43. Backflow Irrigation
44. Landscape Irrigation System °• , . ,
-. 45.'Sound Attenuation •
346: Handicap Regulations '
47. FINAL STRUCTURE & BUILDING -
48. FINAL PLANNING
49. Electric Release to Edison - •
50. Gas Release to Southern California Gas Co , , . - ` _ '
51. CERTIFICATE OF OCCUPANCY "- ,
No Date
\"l\ j --
,PROJECT ADDRESS: '2464 Eh$EN AV UNIT: F CITY OF COSTA MESA — BUILDING PERMIT PERM NO: F 05020i
OWNER'S NAME: BRIGGS DEVELOPEMENT CO.
nuns: 23046 CARLOTTA AV *315 PERMIT NO: F 050207 PLAN CHECK NO: 06804-90 S GOVT: N SUPP: N
LAGUNA HILLS CA
CONSTRUCTION TYPE: V—N PERMIT TYPE: FIR PURPOSE: NEW
380-0685
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : NEW APARTMENT 1 OF 12UNITS SQ FT:
ADDRESS: UNIT:
PERMITTEE: CALTA PLUMBING INC ( 714 ) 540-2914 CLAIM VALUE: 2, 400 . 00 CALC—VALUE: GROUP OCC: R-1 /
ADDRESS: 31030 W CENTRAL COMMENTS: APARTMENT 1 OF 12 UNITS
S.A. CA 9 E4 ***+ESE*+E*+EEr****SEES+Est***+ESE**+t***+t************aE*****************+t*SE********+e*+E*****
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am li under provisi. s of a apter 9(commencing with Section / Z ONING REQUIREMENTS
7000)of Division 3 I the Business and Professions Code.and my' is in full to' • and . .ct, SETBACKS
CITY uc.: 9sTATEuc. 3260 ` ss: C 6� MAIN BUILDING ACCESSORY BUILDING
Date: � Signature:_ - -eked' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
WORKERS' MPE ATIONDECLARATION: Ihereby affir 1that Ihave aunit .re of consent elf-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
Compensat n As• p^�^ ^• r m'ed ^ T(T thereof(Section 3800.Lab.C
POLICY NO.: • J92��� �" EXP.DAT
•v4/01 /`
COMPANY REPUBLIC KING REQ: PROV: PARCEL: 43929107 ZNE: REF NO:
7 Cerndieed cop is h ;by furnished. Lx nified copy is .' nth the city : •ivision. :IRKING
NOTES>
Date:/ 70 opticant: /( it • ."// • ****************************************************************if*************
DEVELOPMENT SERVICES R E U I R E M E N,T S
E%EMPTIOI RD ORKERS'COMPENSATION DECLARATION: (This sector .-.not be completed it the pemtil is to one hundred(5100)or less). Q
I certify t t in ie 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. ZONING APPROVED BY DATE:
Date: Signature: BUILDING APPROVED BY : DATE:
NOTICE:If.alter 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 construction lending agency for the performance of the work for APPLICATION ISSUED B Y: DATE- 0—' 1W a
which this permit is issued(Section 3097.Civ.C). ********************************************3f*********************if . . . . . .... . . . **
LENDER: *******************************************************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 54 ,00
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 65% SMIP/NON—RES
pursuant to the provisions of the Contractors'Slate License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption,Any violation of Section 7031.5 by 3 5 . 10
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE
L 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----> 54 . 00 0 , 00 35. 10 89 , 10 89 . 10 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himselllherself or through
his or her own employees, provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 54 .00 OVER/SHORT• 00
• improvementoes of sale).is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve 'BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
for
thepupurpose
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044.Business 54
O O
❑ and who ProfessionsCode: ThecContractors' IalcontenseLawiens pursuatoorthe owner who cense Lmp.aI a thereon
re ************.*******************************************************************
and Prof contracts for hh protract rs'h a contractor(s)LicenLwlicense notapply
to the neral prope'StwLicense Law).improves
am aware
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: 8.A P.C.
forthis reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date: Owner: FIR 54 FIRE EQUIP FEE ( FROM BLDG VAL TABLE) 1 . 00 54 . 00
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Cade Sections 25505,25533.and END OF FEES
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
permit for construction or modification from the Air Duaaty Management District.Residential construction applications are exempt from
these provisions. . '
Date: plicani:
J
I hereby certify that I have read this appncati n and state that metinformation is•• rect.I a.'•a to comply with all city an.county .
ordinances and state -w5 relating tobuiling(
Oh 00C,75736-007573:- T3T 4.151
1641,46 White—Building;Green—Code Enforcement:Canary—Aoolicant:Pink—Revenue:Goldenrod—Assessor DATE: 12/C6190 T4C. •.:15
. CONSTRUCTION AND PLANNING POO. ' SPA
APPROVALS Permit Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or.Pole - 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. . ca't- 53. Steel Reinforcement '
rc. c
,1., 3.;=Electrical Condu`n.Utility-Undrgrnd. : - 54. Forms
4. Electrital Conduit=Undrgrnd. t, 55. Electrical Bonding
.,i .r •
'i_5.;Steel Reinforcement c 56. Rough Plumbing & Pressure Test
6. Electrical UFEtFiGrnd. - 57. APPROVAL TO COVER-GUNITE
.,7-. Footings 58. Electrical Conduit-Undrgrnd. i'
'`'8.'[Foundation ' -` 59. Gas Pipe, 0 Undrgrnd., Test .
9.-Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. •
' 1&t.Structural Floor System 61. APPROVAL TO DECK
1.1:.-Property Sewer Line& House Connection 62. Backwash & Receptor-Final ,
12. Sewer Cap ;, .0 - '� 63. Heater & Vent-Final
t 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
. - - n. - - •.
20.TRotigh Factory Fireplace a .11 4 - I C 2 --3- r 'APPROVALS' =PerjStit# ` •
21 Ducts, in-StrpaurE. -70. UndergroundHydro -
a _ (i d DI Lt0)
22. Ducts, Ventilating: " r r '•7
' - ), Product'f iping O'Gas OOi1
23'-Qas PipeRough 8/Test • •r - • ;I. '72. Underground FlusIT, - ' 1010.41 an.
24:•Roof Framing . - • '.' .Y ' C ; ,* a 573`cUndergrnd'.StorageFTank O Gas 0 Oil
25. Roof, Shpathin
9 r' •- ;tet , 574.=Overhead Hydro^ - 4.5l toe)
•
26..T-Bar Ceiling (Stra
uctural) & Monocoat _ ^ _ 71. . 75tTDry Chemical - 7:
27.LFrameand Flvashing" - -- - 76: Dryp" '
;o, x« . Standpipe ' .
• 28:Lathing& Siding,+ _Si r. ›: " ••, r•i .✓'. 77.- FIXED SYSTEM;FINAL.* , - h 6, .$)
a � � w.
29. Insulation `; rx = ;` •- " .. . '`I [;., 78 ,FIRE PREV. FINAL ,t ,. t -- /94 tract Loa
Iii30. Drywall.Nailing r. s . (r. HEALTH DEPT: REQUIREMENT
...31. Plaster Brown Coe ' ,79:'FINAL INSPECTION '
^32:JElectrical Power Mater-Final , • ., i- r80.50FOOD CERTIFICATE ISSUED
X33 Final Electric ' ' ^ "Notes: r- r
1,34,^Final Hs'ting'& Air.Conditioning.. -1 , `' .R its ,y `r'.t v 7.....-
35:: Final Gas Pipe-Test• - I �' '• _ •-' r:.S -
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.,36.'Hood or�-CanopY . - ` .1. , • r T
37.CFina1 Facstory Fireplace,, ' ct' o- .t. T r ' " '•
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-38_Final Plumbing p. - x .
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�39.-Water Service-Final^ ., ,, s 1m,�.t, , I I ,• - ^• -
i�40`�GasService-Final �[,.R. C- o ' =
741.:Solar Domestic-Finals - =t •S- - _
- 42: Backflow Preventers " si - I � r" , -
43. Backflow Irrigation• ":S`. • .K!- '
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6- 1 - • T -Landscape44. Landspe litigation System., r - - `,: 1
45.'_Sound Attenuation - . i' - `•, •--. - �: : r• -
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;_46.,Handicap•Regulations - •'
47 TFIN'AL STRUCTURE & BUI1DING T •K ... .1.:
48. FINAL PLANNING 1 r.l` -, ' " '-
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49.;Eleci:ric Release to Edison , I ` - r1.1, ., .
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' 50.tiGas Release to Southern California Gas Co 1, _
51. CERTIFICATE OF OCCUPANCY - r: : -;
No. Date