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Home My WebLink About3049 LOYSBURG BAY - Building PermitsBUILDING AND SAFETY DIVISION RE DAMAGE INSPECTION REF .T (Required Prior To Permit Issuance) All y Address: 2 n —'/ 7 7 ^ `/C i n y� �041�aCllU�iit: Owner: L Owner's Address (if different from above): Street ,! City State of Structural permit required. Repair or replace as necessary. Plans required. Comments: Electrical permit required. Repair or replace as necessary. Comments: C Plumbing permit required. El Repair or replace as necessary. Comments: CEJ Mechanical permit required. Repair or replace as necessary. Comments: Inspector �^ Date 16] .a6 4id,=.: Oryi.w Owner; Veuwr Co [.W: pjnk-E1W1d g Dmsion Phone Applicant to fill In all spaces except those within border lines and sign all appropriate declarations. ADD U ALTERATION I FOUNDATION PLUMBING ❑ �1 �j�— GRADING CU. YDS. License No. __ Mater_Uover IUU amps .. Remarks: , LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing Clarifiers with section 7000) of Division 3 of the Business and Professions Code, and ^w�jiZ131�L�•CSiyli�ll�iil!Qi/?/moi 1.J� TYPE OF CONSTRUCT Drinking Fol Ucanse Class I Ucense No. ■CONVERSION ■ ' Baf Sink ' • .. Iall"�7�161.'Ar AN ..800, Lab. C.) I Me 511 = WNW. A DESCRiPTION OF WORK comply with, such provisions- or this .permit shall be deemed revoked:' ' :TYPEOFPERMIT 1 ■ GRADINT $ .a Qi a•) WE iii r_ i ■TENANT ■ELECTRICAL KimhenSinL MIS ImM151 Iris! 0 OTHER Lavatories I following that 1 am exempt from the CoProfessional following reason (Section rofe sionaliCode Law tot the Business and Prafess Any city or P—Tia ' P Permit t rove, dem or repair county which. requires a permit to construct, alter improve, damn such any structure, prior tat to Its Issuance, also requires the purr applicant for such Dorm it to file a Signed statement that he/she I9 (scammed pursuant to the Provisions Roof Drains Showers '. border lines and sign all appropriate declarations. ADD U ALTERATION I FOUNDATION PLUMBING ❑ �1 �j�— GRADING CU. YDS. License No. __ Mater_Uover IUU amps .. Remarks: , LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing Clarifiers with section 7000) of Division 3 of the Business and Professions Code, and my license Is In full force and affect. less) 1 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 subjectto the Drinking Fol Ucanse Class I Ucense No. Date - Signature WORKERS' COMPENSATION DECLARATION ' Baf Sink ' Backflow Preventer— iereby afflrm.that I have a certificate of consent to self -Insure or a certificate Workers' Compensation Insurance,. or a certified copy thereof (Section ..800, Lab. C.) Backflow Irrigation y No. Company or Mater_Uover IUU amps .. Certified copy is hereby furnished. Bathtubs e Crtified copy Is filed with the city Building Division. Date APPgrant Clarifiers EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed It the permit Is for one hundred ($100) or Dishwasher less) 1 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 subjectto the Drinking Fol Floor Drains Workers' Compensation Laws of California. Date ISignature Pole Light NOTICE: If. after making this declaration, you should become subject to the- — -- Floor Sinks Workers', Compensation provisionsof the Labor Code, you must forthwith ❑&100,OOB BTU 0100,000BT comply with, such provisions- or this .permit shall be deemed revoked:' ' - Gas Service CONSTRUCTION LENDING AGENCY $ ' Interceptors I hereby affirm that there Is a construction lending agency for theperformance of the .work for which - thl permit Is Issued (Sec Ion 3097 Civ. C.). KimhenSinL Landers( Name Lender's Address OWNERBUILDER ECLARATIO Lavatories I following that 1 am exempt from the CoProfessional following reason (Section rofe sionaliCode Law tot the Business and Prafess Any city or P—Tia ' P Permit t rove, dem or repair county which. requires a permit to construct, alter improve, damn such any structure, prior tat to Its Issuance, also requires the purr applicant for such Dorm it to file a Signed statement that he/she I9 (scammed pursuant to the Provisions Roof Drains Showers '. fof the Contractor'sfthe Buss Law (Chapter 9 (commencing with Section Wexa o/ Vvision 3 0/ the Business and Professions,ptiCode) or that! he//she of exempt srefrom and for the alleged exemption. Any violation of, Section Service Sink X alt by anyrthe for n permit subjects the applicant to a dull applicant penalty of not more than live nundrod dollars ($500). •-. 5 I, as owner of' the properly or my employees with wages as their sole compensation will do the work, and the structure Is not intended or offered for Sale (Sec/ion 7044, Business and Professional Coda: The Contractor's _ FINAL FEE • Boiler - License Law does not apply to an owner of a property who builds or Improves thereon 'and who 'does. such work himself/horself or through his or her own em to ear rOvitletl that such Improvements are not Intended o/fared for R—EEP1AAII R"s�' ,kL A. P. sW —/ 1 —/7 R PLNG. EF. -0 7�5—%7p- TION $/ fVLJ LEFT SIDE YARD ' ,G ACR "N PKG.SPACE'RED. F. STREET WIDTH r SPECIAL CONDITIONS: sewer Connection- - -- Solar Collectors_ Solar Piping Solar Tank ' Swimming Pool w/Sne Outlets e however, the but to onor Improvement Is mord within one year o/ cam- n, the ownerwllhave the burl on of proving h0/she did not build orim- orthe purpose ofsale) ?T. Mater_Uover IUU amps .. Duct •Under Ground Sub Panel Duct -Structural as ownerofthe oroparty,amtont radIngwithlitensadCon- rtconstruct the project ``Setion 7044, Business antl ProfessionsCodDuct Contractor's Ucen- Law does not apply to an owner Of property who b ullds or Improves. thereon, and who contracts for such projects wit' a con- Vaclor(So license pursuant tD the Contractor's Licari L.aw). � ❑ Tam exempt under Sect lo' B. 8, P. C. for this reason Dishwasher - Ventilatingh Dryers []Gas ❑Electric Exhaust System ❑ Multiple ❑ Fan, Firepl/Fact. Bit. ICBO+ Date I Owner • Pole Light Heating System & Ducting I hereby: certify th t I have read this application and state that the above Information is c rr t. 1 agree to comply with ail city and county ordinances and state laws r I ng to building construction, and hereby authorize repro- sentatives of !t "ity to enter upon the above-mentioned pipperly ]or - ❑&100,OOB BTU 0100,000BT GRADING Haod or Type I ❑ 1 Die V' Lic oSS I I Registers ' MF 086-4 56 rev,. 12/92 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - AS Water Closet. Water Heater Water. Service ' ' 1 Reinspection Fee 9 Issue Fee ❑aloo,000BTu 010o,000eru System Repair/Alteration Reinspection Fee' Issue Fee $ 3 $15 $ 3 070' 6/21/0`3i14.b1. YARD (TO P/L) L F SIDE YARD 5; PROVIDED a F PARK sFEE $ Automatic Washer Mater_Uover IUU amps .. Construction Pole Sub Panel Cooking Unit Sub Pole Dishwasher Motors 130-1 HP 011 Y-8 Dryers []Gas ❑Electric Inc. -Solar 09-15 HP El 16-16+ Fan, Microwave F.A.U. Pole Light Fixtures Range Device Boxes c;,.., )age Disposal orator 110.5 KW 135 isformer ❑ 15.50 KN ❑5U+ KW' at ❑up to 100 amps Zoning Approved By.J Application Approved By Application Issued By _ Standing Sections Trash Compactor Reinspection Fee I ; $15 7t - OF FEES BUILDING PERMIT$, 1 'SUMMARY -3�//9`—� SMIP - $ / PLAN CHECK $ PERMIT i !PLUMBING $ ISSUANCE $ PLAN CHECK' $ GRADING $ ELECTRICAL, $ $ PLAN CHECK' $ MICROFILM $ MECHANICAL' f $ TOTAL:FEE, $ PLAN CHECK 1 $ I LESS ADVANCED PC 1 $ FINAL FEE • $ 7t - - >•: •_ �,CONSTRUCTION AND PLANNING -" - - - , .. - - -,POOL PA t' _ 'DSte -�Inspectbr :APPRQVALS Permit'#�� `'- _ - }.APPROVALS Permit,# Date _ Inspector t . - 1. Temporary Electrical Service or -Pole ;r':52., Pool &_Equipment location t • 2: 'Soil Pipe-Undf'grnd ` ' � �, : ° t `. '_ t3:= Steel Reinforcement uit Utility-Undrgrnd. Electrical 'Cond- - y ': 54. 'Formsf '- 4. Electrical-Gond Lit-Undrgrnd: , >` • - "55i Electrical.Bonding.' - 5: Steel Reinforcerent, . ,r, •` ': 4 -- - 56. Rough Plumbing &Pressure Test •'` 6. ,ElectricaPUFER•Grnd.- ��- E c - .571.APPROVALT000VER-GUNITE ,_ ¢ - r 7. Footings ;_-.`58'. _Electrical"Conduit•Undrornd. - 8. Foundationt59. Gas Pipe,:(] Undrgrnd:, Test 9. Water - Pi a-Undr rnd. P g •60. Backwash Lines, P -Trap, O Undrgrnd. `t - 10. Structural Floor System ._� 61. APPROVAL_TO_DECK `. 11. Property Sewer Line & House Connection - 62. Backwash &'Receptor -Final t 12. Sewer'Cap''• 5' - -. �c 63. Heater„& Vent -Final 13. Roof Drains. ' ' '64. Plumbing -System -Final - r I 14. Rough Plumbing,-: _ - '`65. Electrical`` -Final' - - `15: `Rough Electrical=Conduit-- '* -TM--'- � 1 -- -- - I - * ' --'- ,66.E So'IaF Sgs`tem-Final -- '- -' I S I t "416. jough-Elecric Wining, .- Fencing &rA`ccess ADProval, - - -- - - 17. RoughWiririg'Signi_ 68 APPROVED FOR PLASTERING 18. Rough ElectricaIJ'R i Ceilingl i� �� , ! ` �" - �69.' POOL/SPA SYSTEMS FINAL - @ 19:`rRough_Heaimg & Air ,Conditioning? - i FIRE DEPT. REQUIREMENT' APPROVALS) Permit # _ - 1 20. IRough,Factory Fireplace ` ;t r ) ' , ,I 21, bucts,_in Stiucture' _"' I I I i 70.E Underground Hydro 22. Ducts; Ventilating i. I ' 71.i Product Piping O Gas ❑Oil -.23.iGas'Pipe-Rough & Test t I cl ? I 72.Underground Flush 24. 'Roof -Framing ! ' X73.; Undergrnd. Storage Tank 0 Gas ❑ Oil i 25. ,Roof Sheathing •--i ' % _ I ; _ • - 94.• Overhead Hydro ' 26. iT-Bai Ceiling (Structural) & Monocoat I- ; i I J5.. Dry Chemical I ' 27.-[Frameand Flashi' iI "28. �`i -� S• 76.; Dry Standpipe ' 'Lathing & Siding -i �. .i I 'i I I ' _ 77. FIXED SYSTEM FINAL 29. ,.Insulation", 3 ' .. I ;I I� ,R X78. FIRE PREV. FINAL 30. Drywall.Nailirig I Notes: ,• 31, Plaster Brown Coat-� I •- , - -'- - -t-' _32. 'Electrical Power Meter -Final I! !- 33. Final Electric_ ( v1, I - 34. Final Heating &'Air Conditioning I 35. Final Gas Pipe -Test. �' , ` I �' ?' , +• , 1,_ ,„, ,- _ 36. Hood or 'CanopY:• �. 37. Final Factory FireOace 38. Final Plumbing , 39. Water Se'r'vice' -Final • ! r I f I 40. Gas Service -Final I 41. Solar Domestic -Final 42. Backflow,Preventer 43. Backflow Irrigation i 44. Landscape Iriigation_System 45. Sound 'Attenuation • 46. Handicap Regulation's I { .� ' ' i ' I ' 47. FINAL STRUCTURE & BUILDING i •. i� r , 48. Special Requirements Completed J , 1 4 49. Electric Release to Edison' 50. Gas Release to Southern California Gas Co v 51. CERTIFICATE�OFtOCCUPANCY No a 1i ' ' Date CITY OFF STA MESA, CASTRUCTION PER Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. _ I .. PEPIT NO TRACT NO. LOT NO. BL - do IX 1 TYPE OF CONSTRUCTION- NEW LJ ADD ALTERATION,_ REPAIR . )\ 1 J ❑ CONVERSION ❑ DEMOLISH ❑ OTHER, J phone (� . DESCRIPTION OF WORK , i TYPE OF PERMIT GRADING'. FOUNDATION STRUCTURAL License No. ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL ❑,'OTHER ,,_� rl� L�/if T � PChon-a_LL-/=1JJ PROJECT DESCRIPTION' SG. FT.OCCUPANCY_ 4ftn fVA - CONSTRUCTIONTYPF VALUATION$ ( ZONE _ GRADINGCU.YDS. ACRES_ ATION Remarks: Jar provisions Of Charter 9 (commencing _ the Business and Professions Code, and Data Signature/ Jl /K/M sCr. WORKERS' COMPENSATION DECIARA ZION /' hereby.affirm that I have a certificate of consent to self -Insure or a certificate. f Workers' Compensation Insurance, or a certified copy thereof (Section, 3800, Lab. C Policy No. J,/y•c'Acompany 0)15SiJ%1 ❑ Certified copy Is hereby furnished. n ' • . L�7J Certifiatl co��yy....JJs file0 with the city Bul11Cin Division. Oate /r�l/S -X ;j Applicant /'. I(�,E' I'M i_JJn/ EXEMPTION FROM WORKERS' COMPENSATION OECl RATION , (This section neetl not be completed if the permit Is for one hundred ($loo) r less).*. I ' I .. - , 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 subjectto the WorkersCompensation 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 1 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.) Lender's Name Lender's Address - OWNER BUILDER ddress-OWNERBUILDER DECLARATION - I hereby affirm that I am exempt from the'Contractor's License Law for the 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 requires the applicant for such permit herefrom and the basis for the alleged exemption. Any violation of Section /031:5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). ' I,- as owner of the property or my employees with wages as their sole compensation will'do the work, and the structure is not Intended or offered for Sale.(Sec/lon 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work himself/herself Or through his or her own Bar Sink ' Backflow Preventer - Backflow Irrigation Bathtubs Clarifiers Dishwasher ' Drinking Fountains Floor Sinks -- - Gas Service' Outlets Interceptors - Kit chen.Sink ' r Lavatories- r. ' Roof Drains Showers Service Sink employees, provided that such Improvements are. not Intended or offered for sale. I/ however, the building or Improvement is sold within one year of com- Applicant's Mailing \ V!\� Project Address _ ELECTRICAL ' Owner's Name - - Address' The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License law). ❑ I am exempt under Section B. & P. C. for this reason Arch/Eng.- Exhaust System ❑ Multiple Address Firepl/Fact. Bit. ICBG+ Contractors Nam& ' Address (mailing) _ hereby certify that I have read this application and state that the above nformation Is correct. I agree to comply with all city and county ordinances in License No. '___ ❑4100,000 BTU 0100,000 LICENSED CONTF Solar Tank I hereby affirm the with Section 7000) ;Motors 00.1 HP 1111A$ my license is In full Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. _ I .. PEPIT NO TRACT NO. LOT NO. BL - do IX 1 TYPE OF CONSTRUCTION- NEW LJ ADD ALTERATION,_ REPAIR . )\ 1 J ❑ CONVERSION ❑ DEMOLISH ❑ OTHER, J phone (� . DESCRIPTION OF WORK , i TYPE OF PERMIT GRADING'. FOUNDATION STRUCTURAL License No. ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL ❑,'OTHER ,,_� rl� L�/if T � PChon-a_LL-/=1JJ PROJECT DESCRIPTION' SG. FT.OCCUPANCY_ 4ftn fVA - CONSTRUCTIONTYPF VALUATION$ ( ZONE _ GRADINGCU.YDS. ACRES_ ATION Remarks: Jar provisions Of Charter 9 (commencing _ the Business and Professions Code, and Data Signature/ Jl /K/M sCr. WORKERS' COMPENSATION DECIARA ZION /' hereby.affirm that I have a certificate of consent to self -Insure or a certificate. f Workers' Compensation Insurance, or a certified copy thereof (Section, 3800, Lab. C Policy No. J,/y•c'Acompany 0)15SiJ%1 ❑ Certified copy Is hereby furnished. n ' • . L�7J Certifiatl co��yy....JJs file0 with the city Bul11Cin Division. Oate /r�l/S -X ;j Applicant /'. I(�,E' I'M i_JJn/ EXEMPTION FROM WORKERS' COMPENSATION OECl RATION , (This section neetl not be completed if the permit Is for one hundred ($loo) r less).*. I ' I .. - , 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 subjectto the WorkersCompensation 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 1 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.) Lender's Name Lender's Address - OWNER BUILDER ddress-OWNERBUILDER DECLARATION - I hereby affirm that I am exempt from the'Contractor's License Law for the 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 requires the applicant for such permit herefrom and the basis for the alleged exemption. Any violation of Section /031:5 by any applicant for a permit subjects the applicant to a civil enalty 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/lon 7044, Business and Professional Code: The Contractor's 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 Bar Sink ' Backflow Preventer - Backflow Irrigation Bathtubs Clarifiers Dishwasher ' Drinking Fountains Floor Sinks -- - Gas Service' Outlets Interceptors - Kit chen.Sink ' r Lavatories- r. ' Roof Drains Showers Service Sink employees, provided that such Improvements are. not Intended or offered for sale. I/ however, the building or Improvement is sold within one year of com- Duct -Under Ground pletion, the owner will have the burden of proving he/she did not build or Im- r3vefor the purpose of, sale). I 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project. (Section 7044. Business and Professlons Code : ELECTRICAL ' Duct -Structural - Duct - Ventilating •_ 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). ❑ I am exempt under Section B. & P. C. for this reason - Meter C1 over 100 amps - , - Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBG+ Date Owner ' Heating System & Ducting ; hereby certify that I have read this application and state that the above nformation Is correct. I agree to comply with all city and county ordinances in _ ❑4100,000 BTU 0100,000 and state laws rejating to building coppstruction, and hereby authorize repre- sentatives of 'this city. to enter • updn the above4nentioned property for Inspection Purp sP ' cur� / p Signature -4 Date )S. -E Drivers' Licanse or SS 3t Solar Tank Hood or Type I El CanopyT e I I ❑ Registers I CMF 0865-46 rev. 12/82 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor A. P. -0 PLNG. REF.' -Y' TO BUILDING PROPERTY LINE LEFT SIDE YARD P KG. SPACE REO, STREET WIDTH' SPECIAL CONDITIONS: 01Jt1 0/!'I /o., BUILDING n (J GT .REAR YARD (TO P/L) RIGHT SIDE YARD PARK FEE $ `1 n'; Ti. Sewer Cap ELECTRICAL ' Sevver' Connection -• ` ' ,- ' - - - Automatic Washer -' - - - Meter C1 over 100 amps - , - Solar Collectors Construction Pole { 1 .Sub Panel. Solar Piping _ Cooking Unit ' Sub Pole ' Solar Tank Dishwasher ;Motors 00.1 HP 1111A$ Swimming Pool w/Spa Dryers OGas' ❑Electric Ina Solar.119-15I P'0'16 -i5+' Urinal Fan Microwave Water closet; — F.A.U. Pole Light Water Heater - - -• - Fixtures '_ - ,Range. Water Service Device Boxes Sign i Outlets Standing Sections a _ Switches Trash Compactor Garbage Disposal Generator 00-5 KW 05-15 KW 02 Transformer 015.50KW ' 1150+KW' Reinipection Fee S75 Reinspection Fea $15 Meter Oup to 100 amps Issue Fee $ 3 Issue Fee. $ 3 Zoning Approved By Application Approved By Date Date 1ANICAL Refrigeration System Application Issued By Date ❑0-.100,000BTU 11100,0008TU 'BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ SUMMARY OF FEES SMIP $ PERMIT Z_ ISSUANCE ' $ i System Repair/Alteration PLAN CHECK $ d _ GRADING $ ELECTRICAL $ $ PLAN CHECK, $' MICROFILM $ ._ MECHANICAL $ TOTALFEE $ Reinspection Fee $15LESS PLAN CHECK $. 1 ADVANCED PC $ Issue Fee $ 3 - FINAL FEE. $ -33'— r• C_- ONSTRUCTION AND'PLANNING - - ' -1-='. - -` = t - "- a _ POOL _BPA- - �= - r ; Date ,' y.taAPP,ROVALS = Permit°#= ' - ^ ' -- c - • I nspector" - •. APPROVALS--Peimit # - Date Inspector •1, Te`mporary,Electrical Service or=_Pole ` ` - o`• - . 52 Pool &'Equipment Location • •' 2`• S&il Pipe-Undrgrrid` ` ` c 5 ` /� :3 -� - ! - 53, Steel Reinforcement . _ Electrical Conduit Utility-Undrgrnd.' r 54r Forms', - y Electrical Conduit-Undrgrnd t%. > - 55._ Electrical Bonding - - 5': Steel' Reinforcement ` z 56. Rough Plumbing & Pressure Test 6! Electrical UFER Grnd.; 57.' APPROVAL TO COVER-GUNITE 7. Footings I �� ` = 58:. Electrical_ Conduit-Undramd. - 1 8. Foundation, f 1 - - - `•- 59. Gas Pipe,.E-Undrgrnd.; Test' 9. Water Pipe-Undrgrnd. '; t - 1 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection - ` .62. Backwash &Receptor -Final . 12. Sewer Cap 'o 63. Heater & Vent -Final 13. Roof Drains _ 64. Plumbing,SVstem - Final - - ., 1 1 I 14. Rough Plumbing'' 65. Electrical -Final i,15. -Rough Electrical=Conduit'-,--T-`, I66.I SolaySY siemFinal= ,Rou , K-16. h-Eleeiric.Wirm - j n ! ii - 'i 9 9i � -; -'�.; �: ,:� c '--L ''r r C' � 67.! Fencing &-Access Approval -- ps - ; , _ � `17. Rough WirPng S1gn - { :•'_ I I " = ' ,- I -' •- l 68. APPROVED FOR PLASTERING - x . �18.ffoughbeet'riralTTBagCeiling, 4 i:'c '. 69.'POO 0SPASYSTEMS FINAL 'Rough'Heating �19. & A_ir _Conditioning FIRE DEPT- REQUIREMENT - APPROVALS' . Permit # • ' '� 20. tRough Factory Fireplace' i 1; I i I - I1 I ,1 21. 0-6cts,5,in Structure l r ( I ( j I I 70.- Underground Hydro - ;Dr-11ucts, Ventilating �. n i , ( 71. Product Piping OGas 0Oil i 1 1_23. Pipe -Rough & Test7I�' I_ �'c•'I - j -� i --' "'__T .. 1 �72.i Underground Flush IGas �qt24. rRoof Framing, I'-'• I o ry ! ` 7 I 73.E Undergrnd. Storage Tank 0 Gas 0 Oil • - 25. Roof Sheath'irig 74•, Overhead Hydro '-26 T-Ba'r Ceiling (Structurall. &•Monocoat' I J - 75. Dry Chemical -- Cp , _7. Frame and Flashin 'I ;, ��291 . - I, j � � I -' I O6. Dry Standpipe 28. Lathing & Siding! , p I I it ( I I I I ! 77• FIXED SYSTEM FINAL - `9;Insulation',; _ I ' I 78. FIRE PREY, FINAL 1 I :'30. `Drywall Nailing 1 ,Notesa ,Q31. Plaster Brown Coat 4r32. ElecfrGI Power Meter -Final II 33. Final. Electric c- f1 I I _ 1 _ 34. Final Heating &•As Conditioning (; 35. Final Gas P10e,-Test '- ; ^' T' 36. Hood or 16anopY . 37. Final Factory' Fiie_place'� 'I I 38. Final Plumbing 51 39. Water Service -Final! 40. Gas Service -Final I ; ! I• I I • I I = - i ' 41. Solar Domestic -Final j 1 'a �� I_ 42. Backflow Preventers a - 4 -t- - - 43. Backflow Irrigation) ti 44. Landscape Iriigatibn;System I j I'nI. 45. Sound Attenuatlon',.. I I �•j I ' -,, _ 46. HandicaPlRegulations 47. FINAL STRUCTURE & RUILD iNG 48. SpecialRequiretnents con'pleted P 1 ' f i • ! `' I I I , C r 1 , t I 49. Electric kelease,toEdisonl -.� _ �- +_I _. 50. Gas Release to Southern California Gas Co I 1 51. CERTIFICATE OFIOCCUPANCY 1- ' I. No q Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA j. Y CONSTRUCTION PERMIT PERMIT NO. A4 - A `]' TRACT NO. ' . LOT -NO. BL Applicant's Mailing Address - a'V1a Project Address 3049 'T nyGhlj. R3aT �' Owner's Name M n Tanen (s0 Phone' TYPE OF CONSTRUCTION ❑CONVERSION'❑ DEMOLISH DESCRIPTION OF WORK Metar NEW LJ ADD LJ ALTERATION LJ REPAIR F-1 OTHER -.e-plaee Address ' TYPE OF PERMIT- GRADING ElTENANT ElELECTRICAL FOUNDATION STRUCTURAL El PLUMBING yq MECHANICAL _ :- Arch/Eng- License No. - Address - ❑ ,OTHER - - PROJECT DESCRIPTION SQ.FT.'- 'OCCUPANCY - Contractor'sName C62ct Fi'rgp3_0A Phone -639-1 82C. 1080 N'. Rai"SiV jj,.'.1-'- (1ra�.. ngp.n.2Fi License No: l�L0 CONSTRUCTION '7 CONSTRUCTION TYPE - VALUATION$ ZONE GRAOINGCU.YDS. ACRES - PLUMBING $' LICENSED CONTRACTOR DECLARATION _ ' Remarks: _ 1 1 S d ' 1"hereby, affirm that 1 am licensed under provisions Of Charter 9 (commencing $ with section 7000) of DlviSl on 3 of the Business and Professions Code, and my Ilcense'is in full force and effect. ELECTRICAL $ - PLUMBING License 61as - L e No.,�3$L Date Signature-��'u�. 1 'ORKERS' COMPENSATION DEC 'R ION' Bar Sink Sewer Cap - - Backflow Preventer ', Sewer Connection ' areby affirm that 1 have a. cert i Ica a obconsent to saii-insure or.a certificate Workers' Cornn�atl$�q� Wsurr�nce or a certified copy thereof (Section _ Backflow irrigation ';f _ Solar Collectors - - 3800, Lab. CJ 51! JU4•iS 3"( M739JC ' i Policy No. ' Company_ Aetna Certified copy is hereby furnished. Bathtubs Soler Piping Cer i 'e �oppy' f letl withthecitBng DI s 1O. Applicant_ �ICLA�(4ATION ClarifiersSolar kDate TankEXEMP710N•FROM WORKERS'COM N ION (This section need not be completed if the permit is for one hundred ($100) or DiShvvasher , Swimming Pool w/$pe _ Drinking Fountains I , Urinal less): I 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 tjle Workers', Compensation Laws of California. Floor Drains - Water Closet - Date' - Signature ' NOTICE: If, after making this -declaration, you should become subject to the ' Workers' Compensation provisions of the Labor Cotle, you must ,forthwith comply ,with such provisionsorthlspermit l shall bedeemedrevoked, i -'- Floor Sinks ' - I-_ ^ - ' Water Heater - -- - Gas Service. -Outlets Water Service , CONSTRUCTIONLENDING AGENCY " ' Interceptors I hereby affirm that there is a.constructlon lending agency for the performance 1 of the work for which this permit is issued -(Section 3097 Civ. C; Lendw-s Name - - Kitchen Sin_ k Lender's Address- OWNER.BUILOER DECLARATION ) Lavatories„ - I hereby affirm that I am exempt from the Contractor's License Law for the following reason'(Sectlon 7031.5 Business and Professional Code: Any city or p -Trap p - county which' requires a perrnit_to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit . t0 file a signed statement'that he/she Is licensed pursuant to the provisions of 'he Contractor's License Lew (Chapter 9 (commencing.with;Seation 7000) of 'vis ion 13 -of the 'Business and Professions Code) or that he/she is exempt erefrom-antl the basis for the alleged exemption. Any violation roil Section 031.5 by any applicant for.,a permit- subjects the applicant to a civil_ Penalty of not more than five hundred dollars ($500): - - LJ 1.-as'owner of, the;Property or my employees with wages -as their sole ' compensation wiihdo the work, and. the structure is not intended or offered for sale (Sec{ion 7044, Business and, Professional Code: The Contractor's 1 License Law does not apply to an owner of a property who builds or Improves + thereon, and who tlo¢5l such work himself/herself or through his or her own employees, provided that such Improvements are not Intended or offered for Wis. 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- rove for the purpose of sale). -' , - Roof Drains L I J ' Showers -- ' Reinspectfon�Fee $15 Service Sink - 1 laus Fee - MECHANICAL -. Boiler. i - Refrigeration $ stem 9 Y ❑0-100,000BTU 0100,000BTU ' Duct -Structural System Repair/Alteration I, as owner of the property, am exclusively contracting with licensed con- tractors to construct.the project.( Section 7044, Business antl 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- Duct -Ventilating Exhaust System ❑ Multiple ❑ - ' tractor(s) license pursuant to the Contractor's License Law)., - 1' Firepl/Fact. alt. ICBO #3195(]� ❑ i am exempt under Section B. & P. C. for this reason Date owner -1-hereby' certify that I have 'read in Is -application and -state that the above :information is correct. I ares to comply with all city, and county ordinances and state laws relating to bulldin construction, and hereby authorize repre- sentatives of this sty t enter upon the above-mentioned property for inspection our s i. ll. 16 83. Signature L Date Drivers' Ci -S # ' Heating System & Ducting ❑0-100,000 BTU (3160,0009TIL i 1 HOOd or TYI ❑ Cano T ' e II ❑ ' Reinspection Fee 1 $15 Registers Issue Fee - $ 3 ,`CMF 0865-46 rev. 12/82 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod -Assessor A. P. # P LNG. REF. 51k TO BUILDING PROPERTY LINE LEFT SIDE YARD PKG.SPACE REG. STREET WIDTH SPECIAL CONDITION: Cooking Unit Dishwasher , Dryers ❑Gas ❑E Fan F.A.U. Fixtures Device Boxes ' ZONE . BUILDING 'mac-ronC,y rr cr :REAR YARD (TO P/U RIGHT SIDE YARD PROVIDED PARK FEE ELECTRICAL ' Meter Clover 100 am' Sub Panel Sub Pole Motors 00-1 HP El Inc. Solar,❑g-15 HP Microwave ,Pole Light Range--. Sign Standing Sections I Trash Compactor , Garbage Disposal Generator 110.5 KW 05-15 KW Transformer ❑ 15-50 KW ❑5Ut KW' Meter ❑up to 100amps Zoning Approved By Application Approved By Application Issued BY ' ' 191 l•>y SUMMARY OF FEES l BUILDING PERMIT $. SMIP i $ PLAN CHECK $ PERMIT PLUMBING $' ISSUANCE $ PLAN CHECK $ GRADING $ ELECTRICAL $ $ , PLAN CHECK $ MICROFILM $ MECHANICAL $% 00 TOTAL,FEE' $ 1 'PLAN CHECK $ 2.00 LESS ' ADVANCED PC $ ' FINAL FEE 1. $ • 00 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POO` SPA APPROVALS - Permit 46 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 UFER Grnd., 57. APPROVAL TO COVER-GUNITE�' 7. Footings . - 58. Electrical Conduit-Undramel- 8. Foundation ." _ 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd: 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System r; 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 APPROVALS Permit # 20. Rough Factory Fireplace 14//00jr "j5 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank OGas ❑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 Notes: 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 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co - 51. CERTIFICATE OF OCCUPANCY No Date Applicant to fill in all spaces except those CITY OF COSTA MESA CONSTRUCTION PERMIT Applicant's Mailing Address ProjecPAddress _:?041CG Owners Name.9 n.rill hone li=.337e Address r . �' 0-M. Arch/Eng._ License No. Address Contractor's Nam c. Lr' hone Address (meihng! License No LICENSED CONTRACTOR DECLARATION Thereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Coda, and My license Is In ful lora and effect. License Class -�-5 Lice No. Date � Sig t GYJ7 - KERS' COMPENSATION DECLARAT baby affirm.that I have a Certificate of consent to set nsure or a certificate Workers' Compensation Insurance, or a cartifiel copy they of (Section Polly Lao- CJ /� G �� P�.ol00, ab ��` lDO � Company. L,{L Certlff cflad opY Ipp Is flied withs hereby thecity. Bu ,_Int Divl�lslon. ^ i Date Applicant SHV EXEMPTION FROM WORKERS' COMPENSA�ARATION (Thlssectlon need not be completed If the permit Is for, one hundred ($100) or less). I 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. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Lepor Code, you.must forthwith comply with such provisions.Or this. permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that inergt Is a construction lending agency -for the performance of the work for wairJY,..tpIs permit is issuetl (Section 3097 Civ. CJ Lender's' Name Lender's Address OWNER:BUILDER DECLARATION'S I hereby affirm that I am exempt -from the Contractor's License Law for the 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 requires the applicant for such permit to file a stoned statement that he/she Is licensed Pursuant to the Provisions of refrom and the basis for the alleged exemption. Any violation of Section 11.5 by any applicant for apermit subjects the applicant to a civil ally of not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole 'lpensalion will do the work, and the structure is not Intended or offered sale (Section 7044, Business and Professional Code: The Contractor's ansa Law does not apply to an owner of a property who builds or Improves neon, ind who does such work hlmself/herself or through his or her own ploylia, provl dad that such Improvements ore,not Intended or ofiared for i. If, however, the boil ding or Improvement is so to within one year of com. tion, the own or will have the burden of proving he/she did not build or Im. ve for the purpose of sale)". I, as owner of the property, am exclusively contracting wlthalcensed con. :torsto construct the project (Section 7044, Business and Professions Code;-. I Contractor's License taw does not apply to an owner of property who Ids or Improves thereon, and who contracts for such projects with a con- ;tor(s) Ilcen.0 pursuant to the Contractor's License Law): 1 am exempt under Sectlon B. & P. C. for this reason , Date Owner ' hereby certify that I have read this application and state that in Information Is correct. 1 agree to comply with all city and county or( and'state laws relating to building construction, and hereby allthoriz sentatives of this city ant r upo he Above-mentioned prop( Inspection purposes. / (f�I Signature -L../1/ ' / Date �`�5 — / Drivers- License or 55 # CMF 0865-46 rev. 12/82 White - Building; Canary TYPE OF CONSTRUCTION ❑ CONVERSION ❑ DE DESCRIPTION OF WORK border lines and sign all appropriate declarations. ADD LJ ALTERATION U REPAIR 'HER 72140 "e. TL TYPE OF PERMIT U GRACING LI FOUNDATION LI STRUCTURAL A. P. sW ZONE ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING RT MECHANICAL Dishwasher BUILDING E3, -OTHER t Inc.Solar 09-15 HP ❑l PLNG.REF.* Microwave F.A.U. I -Pole'Light TO BUILDING PROPERTY LINE REAR YARD (TO P/L) - PROJECT DESCRIPTION SG. FT. GCCUPAt%�� Outlets Standing Sections CONSTRUCTION TYPE VALUATION $([= LEFT SIDE YARD RIGHT SIDE YARD ZON9 GRADINGCU.YOS. ACRFg PKG. SPACE RED. PROVIDED Remarks: _ / Q STREET WIDTH PARK FEES - BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ SUMMARY OF FEES SMIP PERMIT ISSUANCE SPECIAL CONDITIONS: ' Pink - Accounting; Backflow Clarifiers Dishwasher Drinking Fountains Floor Drains ' Floor Sinks -- Gas Service= Outlets Interceptors Kitchen Sink. Lavatories P—Trap Roof Drains vice Sihk ler :t - Under Ground ;t - Structural Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ,-//w- g100,000 BTU 0100,000 BT Hood or Type 1 ❑ Registers enrod - Assessor Solar Piping Solar Tank Urinal Water Closet Water Heater Water Service Reinspection Fee Issue Fee iANICAL Refrigeration System ❑O.100,000BTU 0100,000 System Repair/Alteration Reinspection Fee i Issue Fee Automatic Washer Meter Uover 100 amps Construction Pole Sub Panel' Cooking Unit Sub Pole Dishwasher Motors 00-1 HP E111/.4 Dryers ❑Gas ❑Electric Inc.Solar 09-15 HP ❑l Fan • Microwave F.A.U. I -Pole'Light Fixtures I _ Range _ Device Boxes Sign Outlets Standing Sections Switches Trash Compactor Garbage Disposal Generator 130-5 KW ❑5-15 KW Application Issued By $15 ❑ ' 50+KW Reinspection Fee $15] Meter ❑up to 100amps Issue Fee I $ 3 $ 9 Zoning Approved By Date Application Approved By nate 13 -F-.? Lw� Application Issued By Date BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ SUMMARY OF FEES SMIP PERMIT ISSUANCE $ $ ' ' ' PLAN CHECK' $ GRADING $ ELECTRICAL $ $ PLAN CHECK, $ MECHANICAL $ MICROFILM TOTAL FEE $ $ ' $15 PLAN CHECK $ ADVANCED, PC FINAL FEE. $ $ Q' .�— $ 3 CONSTRUCTION ANDIPCANNING a _ Date; ~ APP.ROVALS =, Permit; #= '' Inspector - - - _ 'APP.ROVALS - :Permit-,+ :Date , Inspector, d. Temporary Electrical Service orPole ": ` L' "_ =� '52J. Pool &-Equipment Location F. 2? �Soil'Pipe-Undrgrnd:: - L �' n' ,3: - X53. Steel Reinforcement - - �� Electrical Conduit Utilitv-Undrgrnd. =� - ; u ,':• 54: Fojm4 ti 4. Electrical Conduit-Undrgrnd . _ : `' - " ' s' - -5e..' Electrical Bonding ^ x 5: Steel.Reinforcement T y = - - - 156. Rough,Plurnbing & Pressure Test , .6: :Electrical OFER,Grnd. r - r - - 57.' APPROVAL TO COVER-GUNITE - 4 7. 'Footings i` - 4 .�' - ^ 58. Electrical: Conduit-Undramd. , + ' 8. Foundation i I , � •59. Gas Pipe, -0 Undrgrnd., Test - 9. Water Pipe-Undrgrnd. '' Vc - r60. Backwash Lines, P•Tra'p, 0 Undrgrnd. ' i 10..Structural Floor System .61. APPROVAL TO DECK - 11. 'Property Sewer Line &'House� Cdnnection' - - 62. BackwasB & Receptor -Final 12. Sewer Cap, , I _ ? , •63. Heater &.Vent -Final _ 13. 'Roof'Drain's - - X64. Plumbing System -Final ' 14. (Rough Plumbing = - - '65. Electrical -Final - ", .15i Pough Electrical=Conduit jn - ' - - 1 -'- - - - --"� 66.� Solar System -Final X6.16. •R'ou h -Electric Wioin r .: I I• Y, 9 l 9 -- Fenci rig & Access. Approval - ml : .67- i - 17. Rough WiFmg Signer 68.' APPROVED FOR PLASTERING - Rough ElectricalT'BarCeiling i+• - -' '.-! 69; POOL/SPASYSTEMS� FINAL ,v18. 'y 19.'RoLWHoating &;AirConditioning I. -��,�/pf �. I i FIRE DEPT. REQUIREMENT_ APPROVALS' Pelrmit # - 20. jRough. Fabtory Fireplace 21. �'[Jbcts'in Structure 170., Underground Hydro - •`22: (Ducts, Veni lating ` I I l ' f '71! Product Piping 0 Gas 00il 1,23''6as:Pipe-Rough & Test, 11 I J2. Underground Flush - 24. •Roof Framing`- I ' I ` ,a� ! u `, q -! - •� �: 73: Undergrnd. Storage Tank 0 Gas ❑Oil - •:I. 25. Roof Sheathing I -- 74.' Overhead Hydro I 26. -Bar Ceiling& (Structural) Monocoat" l T J5. Dry Chemical - ''727. 'Frame and *lashing I i I 76. Dry Standpipe 28.. Lathing &Siding 1 i I I 177. FIXED SYSTEM -FINAL ' 29.Ilnsulattion s I r _i i (� I 1 ! 78: FIRE PFEV. FINAL I s30. Drywall Nailing i r '' I I I Notes: 'r31.4I' sterBrown Coat •I I I 1 -- -1 -' -i I I I r- ' ' -- ' -- - - - ''f32. Electrical Power Meter -Final 133. rFinal Electric 34. Final Heating ?t Air Conditioning 35. Final as Pipe -Teri 36. Hood or Cavo- - • L' , : : , r1 , PY- - - _ ' I'. - . I _ 37. Final Factory'Firep[ace; 38. Final.Flu'rnbing 39. Water:Se'i,vice-Fine l 1 I 40. Gas Service -Final 41. Solar Domestic -Final I i t_ -rj 42. Backflow,,Preventer 43. Backflow Grigation 44. Landscape Irrigation System 45. SoundiiAttenuation L. < j a+' i I,• I ' - " I 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Releaselto Edison; 50. Gas Release to Southern California Gas Co 51. CERTIFICA�TEOF,OCCUPANCIY - I_ No. ll I Date I I I l I Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Addiess -'—XLH L—U424A�! Applcant's Mail' Address _ / n'A Owner's Name �� JR Phone - Address Arch/Eng. ' License No. Address Contractor's Name Ph Address (mailing) City License No. 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 ano Professions Code, an my license is in full fgrce and eJfgc(. —.0A-5 / Date I I_� Signature— WORKERS' COMPENSATION DEC RATION hereby affirm that I have a certificate of consent to self -insure ora ificate Workers' Compensat' n In Ilr ce, or acerb 'etl copy i reof ( e ion 4800, Lab. C ) Policy No. Company < _S2rtJed copyIs herby fuTi _ er(i/ieorcg py with the cit ' di ivi to —ll Date / sal Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for One huntlr¢d Il ) or less). , Icertify that in the performance of the work for which this permit is Issued, 1 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 permitshall 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.) Lender's Nam. Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's license law for the ■asRpr refrom and the basis for the alleged exemption. Any violation of Section 11.5 by any applicant for a- permit subjects the applicant to a civil ally of not more than five hundred dollars ($500). ' 1, as owner of the property or my employees with wages as their sole ' apensation, will do the work, and the structure Is not intended or offered Sale (Section 7044, Business and Professional Code: The Contractor's ense Law does not apply to an owner of a property who builds or Improves reon, and who does such work himself/herself or through his or her own ployees, provided that Such Improvements are not Intended or offered for i. If, however, the building or Improvement is sold within one year of core - tion, the owner will have the burden of proving he/she did not build or im- ve for the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con - :tors to construct the project(Section 7044, Business and Professions Code: • Contractor's License Law does not apply to an owner of property who. Ids or Improves thereon, and who contracts for such projects with a con- :tor(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 I have read information Is correct. I agree to r and state laws relating to buildin5 sentatives et—H+is city to enter Signature Drivers' License or SS CMF 0865-46 rev. 7/83 above cou Sink <flow Preventer <flow Irrigation stubs ifiers (washer - "- Ikinb Fountains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee I S25 Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑0-100,000 BTU ❑100,000 Reinspection Fee I 'S25 Applicant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/SF Urinal Water Closet Water Heater Water Service - Issue Foe Hood or Type ❑ Canopy Type II ❑ Refrigeration System ❑0-100,Oo0BTU 0100,000 System Repair/Alteration Issue Fee Z O N I N G R E Q U R E E N T ELECTRICAL FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW / ❑50+KW 6794, I'/ TYPE OF CONSTRUCTION NEW LJADo LJ ALTERATION D REPAIR_ ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. q(6 Zone - DESCRIPTION OF WORK S Main Building: - - Accessory Building: E Motors 00.1 HP ❑l'/:: - 8 TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front El TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL BB - ❑OTHER Device Boxes Rear C Right PROJECT DESCRIPTION SO. FT. OCCUPANCY K Sign CONSTRUCTION TYPE VALUATION$ S Left - ZONE GRADING CU.YOS. ACRES Ping. Ref. # Park. Fees $ - Remarks: Parking Req./Provided Use of Building: Rainspection Fee - PLUMBING FEES Planning Notes: PUBLIC SERVICES REQUIREMENTS: Zoning Approved By Date Application Approved By Date Application Issued ey Sink <flow Preventer <flow Irrigation stubs ifiers (washer - "- Ikinb Fountains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee I S25 Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑0-100,000 BTU ❑100,000 Reinspection Fee I 'S25 Applicant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/SF Urinal Water Closet Water Heater Water Service - Issue Foe Hood or Type ❑ Canopy Type II ❑ Refrigeration System ❑0-100,Oo0BTU 0100,000 System Repair/Alteration Issue Fee Z O N I N G R E Q U R E E N T ELECTRICAL FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW / ❑50+KW Cooking Unit Meter up to 100amps Dishwasher Meter El over 100 amps Dryers ❑Gas 2flectric ;Sub Panel /p _ Fan Motors 00.1 HP ❑l'/:: - 8 F.A.U. Inc. Solar 09-15 HP 016-15+ ' DFixtures Microwave Device Boxes Pole Light Outlets Range 8 j Switches Sign Garbage Disposal Standing Sections Generator ❑00.5 KW 115-15 KW Trash Compactor $ 3 Rainspection Fee $25 Issue Fee $ 3 FEES PUBLIC SERVICES REQUIREMENTS: Zoning Approved By Date Application Approved By Date Application Issued ey ' BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK MECHANICAL PLAN CHECK SUMMARY OF FEES $ SMIP $ $ PERMIT $ ISSUANCE $ $ ENERGY P.C. $ $3LY 0 GRADING $ $ /7,40 MICROFILM $ $ TOTAL FEE $ $ $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector . POO. SPA 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 UFER Grnd. 57. APPROVAL TO COVER-GUNITE 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 11 16 63 e 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating - 71. Product Piping 0 Gas L1 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0Gas 00il 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 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. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas CD 51. CERTIFICATE OF OCCUPANCY No. Date -