HomeMy WebLinkAbout2040 GARDEN LN - Building Permits y�►a.'. 9 CITY OF COSTA MESA
4 BUILDING DIVISION
Fi , DEVELOPMENT SERVICES DEPARTMENT PER IT NUMBER
+s° PERMIT
44. B05-00840
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2040 GARDEN LN Status: ISSUED
Suite: C Applied: 05/27/2005
Vicinity: UNIT C,2ND STORY Issued: 05/27/2005
Primary Occ: R Type of Construction: V-N
Parcel Number: 42623208 Zoning:
Applicant: DOUG WOODING ISSUED BY:
Address: 247 COLTON ST
Phone: 949-697-8330
NEWPORT BEACH,CA Zip: 92663
Owner: ANGELL, RICHARD B III
Address 2040 GARDEN LANE
UNIT B Phone:
COSTA MESA,CA Zip: 92627
Contractor: OWNER-BUILDER
Address:
Phone:
Zip: License: 000000
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
•
SCOPE OF PERMIT •
REPAIR/REPLACE 2ND STORY BALCONY GUARDRAIL.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $875.00
Permit: $35.70 Claim Valuation: $675.00
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $36.20
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existinq: 0 Required: 0 Proposed: 0
NOTES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§ 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-48(aWW)
•
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is Issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued.
My workers'compensation Insurance carder and policy number are:
Carrier: Policy Number:
(This section need not be completed if the 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 a 1 111 I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with?hes ovislons. 6.-1.------14
� � –^ c 17�1 r
Applicant Signature: (� - �v �Dritb:— /.0 T
WARNING:FAILURE.TO SECU ORKERS'COMPENSATION COVERAGE WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PE TIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100, ,IN ADDITION TO THE COST OF COMP.DDAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that 1 am licensed under provisions of Chapter 9(commenting with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Uc.» Class a
Contractor's Signature: Date:
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: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit
to file a signed statement that he or she Ls licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License Law does not apply to an owner of properly who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U No
(Section 65850.2 of the California Govemment Code requires that the requested Information be furnished on applications for non-residential building permits).
6 WIII any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
_ ._ ... .__..._ other ..._ ured or._.. workct of this
7 a a icpaetion from tae South Coos? s pr scn ed by Califo is Heal or and Safety
tion control district03been or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Code Section 42303 made? ❑Ves 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,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes,I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
_,��tic.!/� O !i Unature//)U��elOwner(s) Dal�� /�.Se
AAnd/OFAutirodzetl' plicanl r'Date `
•
goof L l$5PECTJON TYPE DAM IB110ALS DOQEE INSPECTION TYPE MTh EMU
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing _
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place220 Final Planning Approval
203 Final Sign 222 Final Site 7�
204 Final Demolition Sen-250 Final Building/Occupancy C-y�T}
DECLARATION OF AUTHORITY Bldg. Permit#
FOR AGENTS OF PROPERTY OWNER This Permit#
TO APPLY FOR PERMITS •
Street Address:�� //;2° ,YU - z
6"/Iia060 -ANC Cos 114 B
meso AP Number:
1. I (we), ,4 ChA'� // Uj4 , declare that I am the Owner of Title of the above
referenced real property,and that I (we)hereby authorize:
Name: (406 L2oo L//N C Telephone Number: 9jC9 �7 7- Po
Street Address: aft) 6 ..1 .i-
City:/Veif d C7 elegaeA State: CA Zip: gzall
to obtain permits in my behalf,as owner/builder,for
at the above referenced property.
2. Should any person become an employee engaged in the improvement of the property, I (we)shall immediately provide Worker's
Compensation Insurance coverage and cause a certificate of that coverage to be filed with the Building Division of the City of Costa
Mesa,as required by State of California laws.
3. As owner/builder in fad, I understand and accept that my responsibilities do not transfer to any other person, company or
corporation.
4. I agree to indemnify and hold the City of Costa Mesa and its employees or officers harmless from any claim resulting in damage or
personal injury to myself or any other parties as a result of work authorized by the permits from the City of Costa Mesa.
5. I declare under the penalty of perjury that the foregoing is true and correct. /�
Executed this day of /f-•�J 20 dr ,at Lo /.!- a— , California.
Print Name: Rjt.il ad 13. k\ e ell °�
Signature:
Date: 01 I I 107/
41
Note: This authorization does not grant authorization to perform the work as owner,
it solely provides for limited power of attorney to secure this permit in any behalf.
077946(rev.11100)
PROJECTADDRESS: ' 2040 GARDEN LN UNIT: B CITY OF COSTA MESA - BUILDING PERMIT PERM NO: P 049123
OWNER'S NAME: JEWELL •
ADDRESS: SAME AS ABOVE PERMIT NO: P 049128 PLAN CHECK NO: N GOVT : N SUPP: N
UNIT A
CONSTRUCTION TYPE: PERMIT TYPE; PLU PURPOSE: OTH
714 /548-7234 •
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION ; WATER HEATER REPLACEMENT SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: /
PERMITTEE: NOCK PLUMBING ( 714 ) 895-1246
ADDRESS: 11610 SEABOARD CIR COMMENTS : MAIL—IN PERMIT
STANTON CA 90680 ##;.x##;s#######################tt###############tF####################>F#sr###*#*##::
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 full farce and effect. SETBACKS
c'TYu 050386 STATEUC.:511971 cuss: r-36
Date: �— i 90 signature: --41rv1 /107---2--- MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: .FT IN REAR: FT IN
Compensation Insurance,or a certified copy thereof(Section 3800,Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICYNO.: 116799290 EXP.DATE: 03/01 /91
'QMPANY: STATE PARKING REQ: PROV: PARCEL: 41218228 ZNE: REF NO:
Certified copy isishereby furnished. 2O Certified copy is filed with the city Buitdin sig . PLANNING NOTES>
Date: at—2.-CD - l0 Applicant: ,�/�i ##############################################iF"%eE####?F##iE######################
EKEMPRON FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one h red(5100)or less). DEVELOPMENT SERVICES� R EQUIREMEN TS
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. ZONING APPROVED BY
DATE:.
Date: Signature:
NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : ••.- DATE: _ _
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. /D. 4 /1---a l J
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:' GD. !/ /
which this permit is issued(Section 3097,Civ.C). ##################################-.,.Rx################ie############1FT.##########
LENDER: ###############################################################################
ADDRESS: LEGALIZATION:N PEE ' 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 2,00
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she Is licensed
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 2 SMIP/NON—RE S
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN •
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(8500). ISSUE FEE 3 . 00
I as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ' ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS————> 2 . 00 3 . 00 0 . 00 5 .00 5 . 00 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or
improvement BLDG PMTPLUMBING ELECTRICMECHANICFIRESMIP
within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUVO __ ODS OVER/SHORT:
/TOT/S
forthe purpose sold GRADING PLAN—CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 5 . 00
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with acontractor(s)license pursuant to the Contractors'State License Law).l am aware #################'Y. i;#################iF############################?f#############
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
o I am exempt under Section: B.8 P.C.
for this reason: TYPE QTY DESCR IP T ION UNIT COST TOTAL COST
•
Date: owner PLU 1 WATER HEATER AND/OR VENT 2 . 00 2 . 00
I do hereby certify that I 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 not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from
these•provisions.
•
Date: Applicant:
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county •
ordinances and state laws relating to building construction and hereby authorize representatives of this ''ty to enter upon the above-mentioned
property for inspection purposes.
01 Do:7os5o-^oo;0339 o Ct!T : r'
Date' 99-z-8---170 Signature: /8.1
SATE: 10/61/901 TIME: 1. 5`
Driver's License or Social Security N: V
1G4t-46 White—Building;Green—Code Enforcement;Canary—Applicant:Pink—Revenue;Goldenrod—Assessor -
CONSTRUCTION AND PLANNING PO s SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location I
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
• 4. Electrical Conduit-Undrgrndi. 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, O Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd.
10. Structural Floor System • j 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final •
12. Sewer Cap 63. Heater & Vent-Final•
13. Roof Drains I 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
i
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric • Notes:
34. Final Heating & Air Conditioning '
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace •
38. Final Plumbing /2/24/W (gip
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING -
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
•
PROJECT ADDRESS: ' L040 GARDEN LN UNIT: C CITY OF COSTA MESA - BUILDING PERMIT PERM NO: P 049125
OWNER'S NAME: JE;;ELL
anus: SAME AS ABOVE PERMIT NO: P 047126 PLAN CHECK NO: N GOVT : N SUPP : N
CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OT::
714/543- 7234
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : L.AIER HEATER REPLACEMENT SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: CALC-VALUE: GROUP OCC: /
PERMITTEE' NOCK PLUMBING ( 714 ) 895-1246
ADDRESS: 11610 SEABOARD CIR COMMENTS : MAIL-IN PERMIT
STANTON CA 00680 #**;:*x;zs:stu*#;1.***ce;the*** ;r11#*#Rus***ff* *#x##**vert*******#*:r*.*** rt# *** *****X;rxotxx
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON ING REQUIREMENTS
7030)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SETBACKS
CITY tic.: 0 5 0 3 3 6 STATE tic.:51 1971n ,CLASS: C--3 5
oat.:q-2-(2 —To Signature: •-tiv4 1/10-12/...-- -- MAIN BUILDING ACCESSORY BUILDING - --- --- - -•
WORKERS'COMPENSATION DECLARATION: I hereby affirm that)have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR : FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance or a certified copy thereof(Section 3904 Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY ND.: 116199230 EXP.DATE: 03/01 /91
' •OMPANY: STATE • PARKING REQ: PROV: PARCEL : 41218228 ZNE: REF NO:
Certified copy is hereby furnished. ❑x Certified copy a Ned with the Buil ' cion. PLANNING NOTES>
Ci - 23 -90 > .
Date: Applicant: ****************************************##',E***iiiit**************************#****
•
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed tithe permits for one hundred(5100)or less). DEVELOPMINT S E R V I C E S' .• R E Q U I R E M E N T S
I certify that In the performance of the work for Mich this permit is issued.I shall not employ any person in any manner so as to become -
subjecttotheWorkers'Compensation Laws of California. ZONING APPROVED BY _ DATE:
Date: Signature:
NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : - DATE: _ _
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. 7T.//://
k
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 : ib U
which this permit is issued(Section 3097,Dv.C). ***************ee**********************. ****#*#******3FTFiF'##*********TE iF*IFIFIF-Anc3FiF**
LENDER: **********#****34****#***Y.**-U***********************ib*#-***********#**********-E-**
ADDRESS: LEGALIZATION ;N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECURATION: 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 2 . 00
repair any structure,prior to Its issuance,also requires the applicant for such permit to foe 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 2 5% SMIP/NON-RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penally of not more than five hundred dollars($500). ISSUE FEE 3 , 00
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(Sallee 7044,&elness and Professional Code: The Contractor'State License Law TOTALS---- > 2 . 00 3 . 00 0 . 00 5 . 00 5 . 00 . 00
does not apply to an owner of a properly who builds or Improves thereon,and who does such work himself/herself or through
or
prroovemenown sdd�thin one�yeaar Ged ecompetiion the owner are
havnot e thee buurden of provined forsale.
he/she did notr the build orimproveREVENUE DIVISION TOTALS- > COLLECTED : 5 . 00 OVER/SHORT: . 00
for the purpose ofsale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
I,as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 5 . 00
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who MdMs or Improves thereonand who contracts for such voiced with acontractor(s)license pursuant to the Contractors'State License Law).l am aware *************************#*ie***********************************************i>*#fE
that proof of their Workers Compensation insurance should be provided co me. INDIVIDUAL F E E BREAKDOWN
❑ I am exempt under Section: B.&P.C.
for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
Date Owner. PLU 1 WATER HEATER AND/OR VENT 2 . 00 2 . 00
I do hereby certify that I am aware of and understand the requirements of Catania Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant wilhdll 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.
Date: Apptcant:
I hereby certifythat I have read this application and state that the above information is correct.I a to complywith all city and county (,//
ordinances and state taws relating to building construction and hereby;Wno' ' oft ' ' to enter upon the above-mentioned
property forinspectionpurposes.osJ(/(�5�,
Date: h- (3S' L0 Signature: • 21 0DC7.1 s ,_Ii?r]E31 ;"C'- .. ..
DPTEe :0/0:1“ '_(:c: 1(..:;
1 Driver's License or Social Security is:
164146 White-Building;Green-Code Enforcement;Canary-Applicant:Pink-Revenue;Goldenrod-Assessor
N
CONSTRUCTION AND PLANNING _ PC & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. - 54. Forms
• 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation / 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection _ 62. Backwash & Receptor-Final
12, Sewer Cap 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 APPROVALS Permit #
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
•
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating& Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing *Cho C.612
39. Water Service-Final /"
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING ./ .
49. Electric Release to Edison ��-
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date