HomeMy WebLinkAbout2090 HARBOR BLVD - Building Permits vnui CR RVDJIYO LCytO J1NU IAV• URIC aa-- ' I'•
JOB ADDRESS 2090 Harbor Blvd. • BUILDING PERMIT NO. 39393
s GENERAL CONTRACTOR nay Construction DESCRIPTION of WORK Blockwall
A ;.115-240-62 LOT TRACT FIRE ZONE VALUE $ 1650.00
a INSPECTIONS Signature Date TYPE III GROUP F-2 ZONE Cl-CP
soli SUBCONTRACTOR PERMITS ISSUED
GAS Date I Number I Signature
WATER _ Plumbing
2 ROUGH PLUMBING^
PROP, SWR. LINE IJ HOUSE CON. 5 -
ll SPRINKLING SYSTEM -
MISCELLANEOUS _
0 ROUGH HEATING AND AIR CONDITIONING _ •
TEMPORARY SERVICE OR POLE _
UNDERGROUND 5 POWER 5 _
ROUGH WIRING L Heating and Vent.
TRENCHES ❑ FORMS 5 STEEL REINF. LSI/" 9-1/a-//."J'
FLOOR SYSTEM _
BOND BEAM n STEEL REINFORCE n
SHEATHING _
FRAME AND FLASHING
LATHING - IN S OUT n _
PL 'ER, BROWN COAT _
Si +-URAL, FINAL Electric_
HEATING, VENT., REFRIG. AND A.C., FINAL _
PLUMBING, FINAL AND GAS TEST n
ELECTRIC, FINAL _/f /I
BUILDING, FINAL ,fr7 e `j 7‘' 7 t
• Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. _ _ _ _ _
CITY C.4 cosTA)M.ESA i CONSTRUCTION/ CPERMIT I PERT INO/p - `/'�� TRACT NO. LOT NO.- UNIT NO. - ,
.'Piolect Address 2e 9O /bp•L'r:-,/Nye//�, �oc'A (70cY 1 3� 1 �l _
Applicant's Mailing Address -2''4r'. f,gv,t>f^est', Lam'•% 47-Telt TYPE OF CONSTRUCTION Li NEW U ADD 'P' ALTERATION U REPAIR - •
^^^^ - f^^ '^• - - •" �;.,
r/ -/ryQ �G� ❑ CONVERSION ❑ DEMOLISH ,❑ OTHER. A.P.# - • - ' Zone
Owner's Name PC A s' k;IT -Phone 1 ' _ '"(i - - - -
/• //, // DESCRIPTION OF WORK/USE OF BLDG.If'cc,L pe',frt...r..
1 Address. 2n Yn /Az,. #/✓xc rocIJ/7e S Y • - - S Main Building: - - Accessory Building: - • - Z
UC1 Arch/Eng. License No. TYPE OF PERMIT LI GRADING LI FOUNDATION ❑ STRUCTURAL T -Front O
Address n H /,,� /- ` ` ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear • N
Contractor's Name /3 tiff- S/cc-cry'L Phonef,cite'939 r ❑ 'OTHER A . - I
Ln !i•� 2•y FS .Eh z[ -2OJECT DESCRIPTION SQ. FT. - 'OCCUPANCY C Right , - - _ N
Address(mailing/HI
mailing)lE' ! / Cr,C `'�y <Y� K - _ - G
Or/
'L C O N ST RUCTION TYPE VALUATION$ s Left
City License No. O_ Zz O�7 ZONE • GRADING CU.YDS. ACRES - R
Q LICENSED CONTRACTOR DECLARATION _ Ping. Ref.# Park ing'Req./Provided' E
•-----_ I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: Q
with section 7000) of Division 3 of the Business and Professions Code, and - M
my license is In full force and effect. - , - T
License Cl ss' "• O 'cense'
N. n 131 I f • - S
Date Signature r��-.t� se - PLUMBING FEES
WORKERS' COMPENSATION DECLARATION Bar Sink Showers
'hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES
if Workers' Compensation Insurance, or a certified coo thereof (Section Backflow Preventer -Service Sink - -- -' - -- -` - - '
_ Automatic Waher' Transformer•❑ 15-50 KW
3800, Lab. Cal (, {/ey�
Policy No. 1 I31CQQ( Company '-`-' 0.I . Backflow Irrigation Sewer Cap -• ❑ 50+ KW
Construction Pole Sub.
Certified copy Is hereby furnished.
Certified 9 this filed with the city Building D Is on. L Bathtubs , Sewer Connection Cooking Unit Meter Duo to 100 amps
Date 1 I��1 Applicant 01 l` C (e-�\ •
EKEMPTIO FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher s Meter ❑_ over 100 amps i _ _ _-
(This section need not be completed if the permit is for one hundred ($100)or - - -
less). l Dishwasher Solar Piping Dryers OGas ❑Electric Sub Panel
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 Drinking Fountains , Solar Tank Fan Motors 00-1 HP 01%-8 '
Workers',Compensation I Laws of California. - - ,
. Date Signature Floor Drains , I Swimming Pool w/Spa • F.A.U.
•
'NOTICE: if,after making this declaration,you should become subject to the Inc.Solar ❑9-15 HP ❑16-15+
Workers'! Compensation provisions of the Labor Code, you must forthwith Floor Sinks ' - - . - - • - 5.." . -- +-
comply with such provisions or this permit shall be deemed revoked. - Urinal Fixtures l / 2�
Microwave 1
CONSTRUCTION LENDING AGENCY • - Gas Service Outlets - Water Closet - Device Boxes
•
I hereby affirm that there is a.conslructlori lending agency for the performance - - POIe Light
•
of the work for which this permit _is issued (Section -3097 Civ. C.)
Interceptors _ Water Heater Outlets Ran / ,L(\
Lender's Name - - 9e �-`�
Lender's'Address. _.- , ' - ' Kitchen Sink Water Service 1 .. 'Switches 6 Sign; ( 'w`
OWNER BUILDER DECLARATION — -
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories - Auto-Wash t ,
following:reason (Section 7031.5 Business and Professional Code: Any city or - Garbage Disposal ;Standing Sections ,
county which requires a permit-to construct,alter,improve,demolish or repair - P-Trap • Laundry TraysGenerator 00-5 KW❑5-15 KW
any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of •
Roof Drains - ' - - -
the Contractor's License Law(Chapter 9 (commencing with Section 7000)of - - -
-ivision 3 of the,Business and Professions Code) or that he/she Is exempt .
ierefrom and the basis for the alleged exemption. Any violation of Section - • -
,331.5 by'any. applicant for a permit subjects the applicant to a civil • - - -
- eenatty of not more than five hundred dollars($500). . I -
LJ 1,-as owner of the property or my-employees with wages as their sole Reinspection Fee I $15.i Issue Fee $ 3
-compensation, will do the work,and the-structure is not intended or offered 1 _ - - Reinspection Fee I $15 Issue Fee' - $ 3
for sale (Section 7044, Business and Professional Code:. The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or Improves t.
thereon, and who does such work himself/herself or through his or her own I DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler • Hood or Type I 0 ,
sale. If, however, the building or Improvement is sold within one year of com- Canopy Type II• 0 Zoning Approved By nate _
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date 1
prove for the purpose of sale). : -
❑ I,as owner of the property, am exclusively contracting with licensed con- Duct-Structural i Refrigeration System r • Application Issued By Date /( 27
tractors to construct the project (Section 7044,Business and Professions Code: '
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU SUMMARY OF FEES
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 aware thatBUILDING PERMIT $ SMIP 1$
proof o their Worker's Compensation insurance should be provided to me. Exhaust System 0 Multiple ❑ System Repair/Alteration
PLAN CHECK $ PERMIT ,
❑ Lam exempt under Section B.& P.C.for this reason Firepl/Fact.BIL ICBO# - Fire Dampers PLUMBING $ - ISSUANCE $
Date owner• - - Heating System& Ducting Registers PLAN CHECK 25% $ ' ENERGY P.C. $$ '
I hereby certify_that I'have read this application and state that the above ' ❑o-100,000 BTU 0100,000 BTU - . . - - • -7 •40 GRADING 1
information is correct. I agree to comply with all city and county ordinances ELECTRICAL ,$ $ ,
and state laws relating to building construction, and hereby authorize repre-
sentatives
PLAN CHECK 50% $ Z. MICROFILM $
sentatives of this city to enter upon the above-mentioned pr perty for •
inspection p oss s. ���y//�/// {� /q - MECHANICAL $
Signature/+<<+� +�i/ Date l�/�7(�'� i TOTAL FEE $ �� 1 •
4 Drivers' LI nse or 55 � Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
1 CONSTRUCTION'AND PLANNING . = POI. . SPA
APPROVALS Permit# - - Date - Inspector APPROVALS Permit# - Date Inspocmrp
;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. . 7/73[� cc - 55. Electrical Bonding '
5. Steel Reinforcement - f 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. - • 57. APPROVAL TO COVER-GUNITE
- 7. 'Footings .,. i 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 .
1'1. 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 ElectricWiring ~ v
9 9�,JAv,�SH� 1,.., �s l c..e 67. Fencing & Access Approval
17. Rough•Wiring Sign- • - 68. APPROVED FOR PLASTERING
18.'Rough Electrical-T Bar Ceiling ,2/6/8-'c C (b 69. POOL/SPA SYSTEMS FINAL
- 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
L
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 �(^/, CIII-30(8,c
C Notes: Q . ✓RL vwr . ..re24e.,r--
34. Final Heating& Air Conditioning `� '
S YdLf_0 ,C .
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 • I - ' , - '
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 t _ - - .
Applicant to fill in all spaces except those within er lines and sign all appropriate declarations.
CITY OF COSTA MESA • CONS RUCTION PERMIT - - P• • ERMIT--'NOi""a- TRACT NO. LOT NO. _ UNIT NO. 352Q_ 12/05/84 QaQQ TL,
Project+Address i ..Z(�0 r1YTG it-e -.13 LAYS./ :\ 1�0 4 ' - s - + - - • ..
•. TYPE OF CONSTRUCTION' LI NEW H ADD LTERATION LI.REPAIR r
Applicant's Mallin• Address - -0 - t Si i /,y�c(,},,,`q - - - e
❑ CONVERSION ❑ DEMOLISH ❑ OTHER' `• - A,p,# - , Zone
Owner's Name '� "' �� i - '���� s1,t DESCRIPTION OF WORK/USE OF BLDG.
Address •. Z D 9 Q - - ' BDQ-'�_ Lk) b = 'j iM - - ; - _ S Main Building: Accessory Building: , •
, •
• TYPE OF PERMIT • L GRADING �I FOUNDATION ❑ STRUCTURAL E Front ' Z
Arch/Eng. - _ License No.l + - O
•
❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B N
Address - A Rear I
j
ED OTHER
coContract&'s Name 15 �'-�� � - Phone42412.4+5, - •
- - C Right _ - - • N
W Z�33 5• ki k) 5r PROJECT DESCRIPTION SQ. FT. OCCUPANCY K G
Address(mailing) Left
,� - - -�r�- [ CONSTRUCTION TYPE VALUATION $ $ - - `
ly/,•J City License No. �J `7� ZONE GRADING CU.YDS. . ACMES R
Ping. Ref.# Parking Req./Provided . E
NLICENSED CONTRACTOR DECLARATION Q
I hereby affirm that I'am licensed under provisions of Charter 9 (commencing qe marks: , , Planning Notes: M
l with section 7000) of Division 3 of the Business and Professions Code,and - - . .
_ : T
eo my,license is in full f0 4n a e tett. -
License Cla s s-- . �p�^�Li enseMNo. ' ___ ' S
•
Date ''Lj j 'i Signature F - ` _// 6 J' . PLUMBING 1 FEES—[ I I - r i
WORKERS C MF; NSATION DECLA A ION ' " 1
' I hereby affirm that I have a certificate of consent to self-incur r a certificate Bar Sink Showers , ELECTRICAL FEES
of Workers' Compensation Insurance, or a certified copy ereof (Section _ Backflow Preventer -. - Service Sink -- - - - - - --- -• - -- -
-- "Automatic Washer Transformer ❑ 15-50 KW
3800,-Lab. cJ ' - .. . . .. - 0 50+KW
Policy No. cdmpeny - Backflow Irrigation Sewer Cap LGo'ristruction Pole'Sub. •
Certified copy is hereby furnished. , 1
Certified Eopfiletl with the city u n Div o Bathtubs , Sewer Connection Cooking Unit '! Meter ❑up to 100;amps •
Dae (�, Applicant j gL� � , - - I
EXEMPTION FROM WORKERS'COMP NSATION DECLARATIO Clarifiers I Solar Collectors Dishwasher ,' am
Meter Dover 100 ps,
r:
(This section need not be completed if the permit is foone hundred-( 00) or - - - - . - -- .
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric -Sub Panel
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 Drinking Fountains Solar Tank t fan
Workers' Compensation•Laws of California.. - �- • — Motors❑0-1 HP ❑i'h-B
. Date Signature - Floor Drains Swimming Pool w/Spa FSA.U.
Inc.Solar ❑9.15 HP ❑1 6-15+
NOTICE: If, •
after making this declaration,you should become subject to the - -
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks _- _ Urinal --- -.. - - Fixtures Microwave` '-
comply ;with such provisions or this permit;shall be deemed revoked. - 1 I
CONSTRUCTION LENDING-AGENCY. Gas Service -Outiets+I - Water Closet ' _ - .2 Device Boxes Pole Light
I hereby affirm that there is.a construction lending agency for the'performance- -I9
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors , Water Heater . I
Lender's; Name ' . •- - - P Outlets R• ange I
Lender's Addresi - -- - Kitchen Sink - Water Service ' SwitchesSign I r ,
OWNER BUILDER DECLARATION • -_ _ ..
I hereby,athat I am exempt from the Contractor's License Law for the Lavatories Auto-Wash ,
• ffirm following reason (Section 7031.5 Business and Professional Code; Any city or - Garbage Disposal Standing Sections '
county which requires a permit to construct,alter,improve,demolish or repair P-Trap ' - LaundryTrays I I
any structure, prior to its issuance, also requires the applicant for such permit y . - . Generator ❑05 KW❑5-15 KW Trash Compactor ,
to file a signed statement that he/she is licensed pursuant to the provisions of ' Roof Drains - [ -`r(� Pi p I-r,J� Z �- '
the Contractor's License Law(Chapter 9(commencing with Section 7000)of - ,
Division 3 of the Business and Professions Code) or that he/she is exempt . . . - -
therefrom and the basis for the alleged exemption. Any violation.ofSection - - I
7031.5 by any applicant- for a permit subjects the applicant to a civil + - - • ' . - - ;
penaltyaof not more than five hundred dollars($500).' - '
I, as owner of the,property or,myemployees with wages as their sole •Reinspection Fee 'I $15 '- Issue Fee o ' $ 3
compensation, will do the work,and the structure'is not intended or offered , - .Reinspection Fee I $15 Issue Fee I $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
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 - - DEVELOPMENT SERVICES REQUIREMENTS:I •
employees, provided that such-improvements are not intended or offered for Boiler Hood or Type I ❑
' sale. If, however, the building or Improvement is sold within one year of com- Canopy Type I I' ❑ Zoning Approved By Date
1 pletion,the owner will have the burden of proving he/she did not build or im- jExhaust
Duct- Under Ground Building Appioved By • - Ddte
Prove4or the purpose of sale). - , r
0 I, as owner of the property, am exclusively contracting with licensed con- ,,,
Duct-Structural ' Refrigeration System Application Issued By Dat `1
tractorsto construct the project (Section 7044, Business and Professions Code:C •ont
The Contractor's License Law does not apply to an owner of property whoDuct-Ventilating ❑0100,000 BTU ❑100,000 BTU SUMMARY OF FEES
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 aware that System ❑ Multiple ❑ System Repair/Alteration - BUILDING PERMIT $ SMIP $ •
proof of their Worker's Compenation insurance should be provided to me. PLAN CHECK $ PERMIT ' '
I: 'Lam exempt under Section B. & P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers .
I - + PLUMBING $ 'l.00 ISSUANCE $
Date owner Heating System& Ducting Registers PLAN CHECK 25% $ 1.00 i ENERGY P.C. $ _ '
I hereby.certify. that I.have read this application and state that the above - • 00100,000 BTU 0100,0008T , , - , - - - ELECTRICAL $ GRADING $ -
information is correct. I agree to comply with all city.and county ordinances - .
and.state laws rel ng to building construction, and hereby authorize repre- + PLAN CHECK 50% $ MICROFILM ; $
sentatives o Chi sty o enter upon the above-mentioned property f r
Inspection-p 0 . . Z/) MECHANICAL $ ' TOTAL FEE $ •• C- 0� •
Signature' a Date • Reinspection Fee $15 Issue Fee $ 3 i PLAN CHECK 25% $ _ • - • '
Drivers' License o •55* _ •
-; l _ _ •_ .-. ._I •+ - ._._ r
CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
., _
-
_ • CONSTRUCTION AND PLANNING POOL &SPA . - 4
APPROVALS Permit# • _ _ Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole, - 1 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 1 - 56. Rough Plumbing & Pressure Test
- 6. ,Electrical UFER 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. Prop rty 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
1.19. 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 I 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-Final80. FOOD CERTIFICATE ISSUEDSS� '
33. Final Electric Notes: /fly//2./F0/ .v/pTyB/w �'
• 34. Final Heating & Air Conditioning / • / g4- iJ.//.(--
35. Final Gas Pipe-Test ' v41jyt t- -o / 7
36. Hood or Canopy '
37. Final Factory Fireplace . ,
38. Final Plumbing 7/Zirlsr LED
39. Water Service-Final '
40. Gas Service-Final ,
41. Solar Domestic-Final ' , • - . -
42. Backflow Preventers _
•
43. Backflow Irrigation : i - - '
44. .Landscape Irrigation System
•
45. Sound Attenuation .
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING - - '
48. Special Requirements Completed, -
49. Electric Release to Edison, . ' - - -f - - ' -
•
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY - ' ' -
No. Date _ - _ .1 ;- -
AirigOrApplicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
2B36 /26/H4 1 ., n o .
CITY OF iZSTA•
E CONST•• UCTI ON PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. - ' •
Project Addresso -�•-••=� �i�va . i b3�1-7 vwl>1se�r,31
•Applicant's Mailin• 'ddress 1,, . A is 1/_ /F TYPE OF CONSTRUCTION ❑ NEW ADD ALTERATION LJ REPAIR •
�l / / ❑ CONVERSION .O DEMOLISH 0TH R .� A-P-# 115 a-10 lo, ' Zone (` / -G
Owner's Na. e L 6 J - a' 1 Ph. e DESC:IPTION OF WOR /USE e F BLDG. iV/./a-- a `
�y� " w ' • ' 0fiff =/ :ilA A £ i . . i^ dM e S Main Building: Accessory Building:
(Eng. amm�Y�,1/A/II//i).�//�� �Li7ceennse No,
�/1��/�j�t �' TYPE F PERMIT G•ADING FOUNDATI ION �f STRUCTURAL E Front l� 0
Address t / FT /noire
A' eC17 /5/T/vu2 �• TENANT ELECTRICAL P4 PLUMBING y_V MECHANICAL BA Rear - ' . N
Contractor's Name Tv✓ /v` r l 7? CCO — OTHER g J
�'� fyL• fR/ Phone C Right N
Address(mailin ) Ai . - Cr ie: •• • PROJECT DESCRIPTION SD. FT. OCCUPANCY K G
g CONSTRUCTION TYPE VALUATION$ ereJOf UUO• S Left
City License No. 2-� ZONE GRADING CU.YDS. f . ACRES AOC '` - R
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: "Al / , / Plannin Notes: ,1 r�r� O✓•�/ ab_ q Q
with section 7000) of Division 3 of the Business and Professions Code, and 1� � 'f �� BTS _ 9 W,1�1s�+�I`� vK ^`�r � -P n"' M
f� U T
my license is int I force and effect. Z����� 4 9/.0� Q/hy� CA-'' .0.0 IC-7-ey dip ,i $
/7C\ License Class i se
Date YKat-ORKERS'
'CO r95 Signature �6� PLUMBING FEE
YORKERS'COMPENSATION DE ATION Bar Sink Showers \
hereby affirm that I have a certificate of consent to self-Insure or a certificate ELECTRICAL FEES
of Workers' Compensation Insurance, or a certified copy thereof (Section •Backflow Preventer Service Sink Automatic Washer Transformer 0 15.50 KW
3800, Lab. /6-'2/ 7771 � t/44j, 1
Policy No. T-'eompanv "ry1 / �y� Backflow Irrigation Sewer Ca -- - 0 50+KW
/ P Construction Pole Sub,
�C�rtifietl copy is hereby furnished. -
CJ Corti Tied opy�iss bled with the city wilding Di vJ's,,iof Bathtubs Sewer Connection • - - ..------ Cooking Unit Meter Duo to 100 amps
Date (/� s•y Applicant 4, (T�/%t]�r/� - -
EXEMPTION FROM WORKERS'COMPENSAT ON DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit Is for one hundred ($100) or a
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
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 Drinking Fountains •
Solar Tank. - Fan Motors 00-1 HP 01%-8 • +
Workers' Compensation Laws of California.
Date Signature Floor Drains Swimmin Pool w/S a
NOTICE: If,after making this declaration, you should become subject to the g p F.A.U. Inc.Solar ❑9.15 HP 016-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal
comply with such provisions or this permit shall be deemed revoked. FiXtUr¢S' Microwave
' CONSTRUCTION LENDING AGENCY Gas Service Outlets' , Water Closet Devices0ozes Pole Light
I hereby affirm that there is a construction-lending agency for the performance - 9
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors, + ✓,/
Lender's Name P • Water Heater Outlets , Range -
Lender's Address - - Kitchen Sink Water Service - • Switches J' - ' Sign
OWNER BUILDER DECLARATION -
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories •
following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal 'Standing Sections
county which requires a permit to constcntt7alter,improve,demolish or repair. P-Trap -
any structure, prior to its issuance, alsq'requires the applicant for such permit Generator ❑0-5 KW ❑5-15 KW Trash Compactor
.to file a signed statement tfff011tpet he/she Is licensed pursuant to the provisions of Roof Drains
the Contractor's License Lap(Chapter 9(commencing with Section 7000)of - • -- _
Division 3 of the Busines9 and Professions Code) or that he/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 '
enalty of not more than five hundred dollars($500).L I, as owner of the property or my employees with wages as their sole Reinspection Fee i $15 Issue Fee ' $ 3 -
compensation, will do the work, and the structure is not intended or offered1 Reinspectiun;Fee'- I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's ' MECHANICAL FEES '
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 DEVELOPMENT SERVICES REQUIREMENTS: 1
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 .. �s�, I _Ir_
iel
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By •lA IG It fie G Date ` SJ-�
pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground Approved Bye< d Date • Y
move for the purpose of sale).
LI I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dat 1 R.—
tractors to construct the project (Section 7044,Business and Professions Code:The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU ❑100,000 BTU - , - SUMMARY F FEES
builds or improves thereon,and who contracts for such projects with a con- , 1^
tractor s) license ursuaht.to the Contractor's License Law). I am aware thatBUILDING PERMIT $ I "fV SMIP 1.40
tractor(s) PExhaust System 0 Multiple 0 System Repair/Alteration $
proof o their Worker's Compensation insurance should be provided to me. PLAN CHECK=' $ PERMIT
0 am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. (CBO# PLUMBING $ ISSUANCE $
Date Owner Heating System& Ducting PLAN CHECK' 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above 00.100,000 BTU 0100.000 BTL GRADING $
Information is correct. I agree to comply with all city and county ordinances ELECTRICAL $
and state laws relating to buildin• cons uction,and hereby authorize repro- - MICROFILM $
sentatives of this city t• • up0 the above-mentioned property for _ PLAN CHECK 50% $
inspection pure• -s MECHANICAL $
•
Signature _- . e Date(/ -o / TOTAL FEE $ I�e1 •V' 0
•\ ' Drivers' L' e- • ,r SS# / Reinspection Fee $15 Issue Fee $ 3 PLAN^CHECK 25% $ /
/�(\ t
CMF 0865-46,rev.4/84 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor
► 9.1°.
CONSTRUCTION AND PLANNING POvL&SPA
f.-Temporary
Permit# Date Inspector APPROVALS Permit# Date Inspector
' 1 Temporary Electrical Service or Pole 52. Pool & Equipment Location
r
•
rr. 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 r
7! Footings• - // 7 c/C-' 58. Electrical Conduit-Undrgrnd.
8J Foundation . 59. GasPipe,'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 Pfumbing 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
e
22. Ducts, Ventilating �• 71. Product Piping 0 Gas ❑Oil
23. Gas Pipe-Rough & Test - - 72. Underground Flush
.24. Roof Framing 73. Undergrnd.StorageTank ❑Gas ❑Oil
25. Roof Sheathing rr 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monoco
' 75. Dry Chemical
I� 27. Frame and Flashing //�/ �� 76. Dry Standpipe
28. Lathing& Siding ib1a1IK( ✓c/ 77. FIXED SYSTEM FINAL
29. Insulation i-2.4.1 "( �C/ 78. FIRE PREV. FINAL '
30. Drywall Nailing f�/K" c/q/ HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coaf/ ' //3//t3- Ok__ 79. FINAL INSPECTION
ea
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:ie waf 14 int 4441 - CI,v to C ac7EGi,
34. Final Heating & Air Conditioning 14)04.,C5 OKA-1 - 'Q(Colt to 4 - Eau am Ow/
35. Final Gas Pipe-TestKR tfuVp� - _
36. Hoodor Canopy
37. Final Factory Fireplace "177erJ +414-Z 674/1- (Q-' o42 -',O' a/ -
38. Final Plumbing ' M/FC Neches LAWO _
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 iy/i3/gz & '-
' 48. Special Requirements Completed
-
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
\ 51. CERTIFICATE OF OCCUPANCY
•
I\1 No. Date
'�
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 66/3 8/21 /04 lad n,
e
CITY OF COST' = R N P RMIT - PERMIT NO. _ TRACTLOT NO. �� UNIT NO.Project Address E '9 ���lQ��d� .� �i�F� .
��� TYPE OF CONSTRUCTION NEW 0 ADD ALTERATION U REPAIR
Applitant'i Maili • •. rr55 {���L• ' 0 CONVERSION { `
•
1w� r/.�i� .- Phone • 0DEMOLISH 0OTHER A.P.# 'w +�� �� ZoneG'-CP •
Owner's Name �,. DESCRIPTION OF WORKSE 99F BLDG. `
Address �' i �Of`F B S Main Building: . Accessory Building: - .
ArchlEng.clt�++ �f/►„�,�'1�a�� �ILJ��� TYPE OF PERMIT ❑ GRADINGL L� F VIND TION ❑ STRUCTURAL T Front .IZ,9 l - G ,
Address /ihnitir�,eil/IR '�'� ��' vim: `�/ 0 TENANT ❑ ELECTRICAL ❑PLUMBING ❑ MECHANICAL R Rear Of // N
Contractor's Nam- 1 gine 'T T/!MP,M Phone ❑'OTHER - - C Right 107 - N
•e+snik� PROJECT DESCRIPTION SQ. FT. OCCUPANY K• ./ • G
Address(mailing) ��L '� _ S Left Df
CONSTRUCTION TYPE VALUATIONS S)I R
City License No. ZONE GRADING CU.YDS • ACRES �- __'
LICENSED CONTRACTOR DECLARATION Ping. •Ref.# Parking Req./Provided E
Ci
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: CC j G 5 $¢L • Planning Notes: ,x /` , i$ a /r - Der # U 'al a; a M
with section 7000) of Division 3 of the B ess and fesslons Code and - }}.�...��
( my license Is in• - Ortaan. �� / 1 b ,2 I, / Q• Aa Ili .l. I/I,' 'J /I I r , .• S.
—
C, Date " T
/ . Ji Signatu�■'11�fifh/�k--1' �,�I�T/l riirl, PLUMBING FEES orp na . Graff - ,, ' JBp ' _LI. ' 4 h i -, 4 i/ A /d
( WORK RS' OMP NSATION D N Bar Sink ShowersELECTRICAL I1 FEE" I
1 I hereby affirm that I have a certificate a c• sent to self-Insure or a certificate . -
�J if Workers' Compensation Insurance, o a certified copy thereof (Section Backflow Preventer. _ Service Sink '
Automatic Washer Transformer 0 15-50.KW.
•
J800, Lab. C.) �y.,.� - ,A1,j, 1n • _ -- -
icy Nord 52k - �S Compnyll�'1•' ✓ C'/�'J1J/+4 ( - Backflow Irrigation Sewer Ca ❑ 50+KW
P •
Construction Pole Sub.
Certified copy is hereby furnished. - -
CerUf' Q copy is filed with the city Buff ,ng,. wisio - Bathtubs Sewer Connection Cooking Unit Meter Cup to 100 amps
Date10 Applicant Applicant s'.+s�l(� fY�D-•r�� •
EXEMPTION FROM WORKERS'COMPENSATION dECLARATION Clarifiers , Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100) or . -
m
less). Dishwasher • • Solar Piping Dryers OG-as ❑Electric Sub Panel .
I certify that in the performance of the work for which this permit is issued, I -
shalt not employ any person In any manner so as to become subject to the . Drinking Fountains Solar Tank Fan
Workers' Compensation:Laws of California. - _- Motors 00.1 HP 01%-8
Date. - Signature Floor Drains) I Swimming Pool w/Spa F.A.U. '
NOTICE:It,after making this declaration, you should become subject to the _ 'Inc.Solar ❑9-15 HP ❑1615+
Workers' Compensation provisions of the Labor Code, you must forthwith - Floor Sinks _ Urinal Fixtures •' •
comply with such provisions or this permit,shall be deemed revoked. - - MICIOWave
CONSTRUCTION LENDING AGENCY I Gas Service .
Outlets " ' Water Closet Device Boxes , Pole Light
I hereby affirm that there is a construction lending agency for the performance 9
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors .Water Heater Outlets Range
Lender's' Name -
Lender's Address - ' ' Kitchen Sink . Water Service• - Switches Sign •
OWNER BUILDER OEC LARATION .
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories - Garbage Disposal , I
following reason (Section 7031.5 Business and Professional Code: Any city or - 9 P 'Standing Sections ,
county which requires a permit to construct,alter,improve,demolish or repair P-Trap . _ Generator ❑0.5 KVV ❑5-15 KW
any structure, prior to its issuance, also requires the applicant for such permit - - Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains - -
the Contractor's License Law (Chapter 9.(commencing with Section 7000)of -
Division" 3 of the Business and Professions Code) or that he/she Is exempt - •
Therefrom and the basis for the alleged exemption. Any violation of Section
)031.5 by any abplicant for a permit subjects the applicant to a civil
LImalty of not more than five hundred dollars($500).
I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee • $ 3 •
compensation. will do the work,and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL - FEES
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 ownDEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 - �J�J�/'�
sale. If, however, the building or improvement is sold within one year of corn- Canopy Type II 0 Zoning Approved By / v )I De Date 8 -2-1—8y
pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground e o•2/^7eb
move for the purpose of sale). Building Approved By �{� Data
LJ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural RefrigerationSystem • ApplicationByC . W Date
Issued e-zr -s4
tractors to construct the project (Section 7044, Business and Professions Code: - ,
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU '0100,000 BTU SUMMARY OF FEES '
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 aware that . Exhaust System 0 Multiple 0 System Repair/Alteration ' ' BUILDING PERMIT $ 6o'SO SMIP $ - V
•
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ 2.52.. PERMIT J
❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# PLUMBING $ ISSUANCE $
HeatingDucting •PLAN CHECK 25% $ • ENERGY P.C. $
Date Owner System&
I hereby certify th. h• • read t p1 -.. ''n and state that the above 00-100,000 BTU 0100,000 BTL - ELECTRICAL $ GRADING $
Information is corr et. I a•re J o co • • th . I city and county ordinances
and - aws re :tin ! n• o cti•. , and hereby authorize epre- PLAN CHECK 50% $ 'MICROFILM $
sante `11;(a.„1 cit \ u• r=•• mentioned er •r
,j'I� / /p�/ - MECHANICAL $ TOTAL FEE $ I 53.46
(Signet• It e����s.� it , Date i�• I_Ji
Drivers' •nree OTT-- a Reinspection Fee $15 Issue Fee • $ 3 PLAN CHECK 25% $
rev.4/84Pink- - - - - - N.
CMF 0865-46, �White-Building;Canary-Applicant; Accounting;Goldenrod Assessor
•
•
i CONSTRUCTION AND PLANNING •.\ POOL _.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.'Electricel'Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. ' 55. Electrical Bonding'
S:;•Steel Reinforcement I 56. Rough Plumbing & Pressure Test
.
6` Electrical UFER'Grnd. ' . 57. APPROVAL-TO COVER-GUNITE
7. ,Footings - -_r lohidc/ r� . ' 58. Electrical Conduit-Undrgrnd. - . •
8. Foundation" 1 59. Gas Pipe, 0 Undrgrnd.,Test
9: Water Pipe-Undrgrnd. . it 60.• Backwash Lines, P-Trap, 0 Undrgrnd. a
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:- .,,' . 'c ' 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 0il
25. Roof Sheathing W0i14,/N_ aS 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: 1 ,•{'t'`-- ;„,::•=.,_:2 �,,t 1c iiit 'pe
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 - nj -• - ,
n
42. Backflow Preventer
43. Backflow Irrigation - .
44. ,Landscape Irrigation System -
45. Sound Attenuation '
46. Handicap Regulations •
47. FINAL STRUCTURE & BUILDING gilf-� .5 ,,s..
48. Special Requirements Completed T
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 within heavy border lines and sign all appropriate declarations. sj
•
5168 I /9B/BS 5.7�
CITY OF COSTA MESA_CONSTR UCTION PERMIT — PERMIT NO. _ TRACT NO. LOT NO. UNIT NO. _
\�o7o HaeAaR 9s.,i) • rn I (�i '3� ,
Project Address ,
Applicant's Mailing Address• J - J TYPE OF CONSTRUCTION U NEW 0 ADD U ALTERATION U REPAIR - '
`` fCMe • 0 CONVERSION1
Owner's Name I hQOsl-4- R a" ' phon0DEMOLISH 0OTHER A•p•q(6 - I2one
• DESCRIPTION OF WORK/USE OF BLDG.
Address S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING •❑ FOUNDATION ❑ STRUCTURAL E Front I ++ , - - r - ZO
Address "� I • ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING �MECHANICAL B Rear `� I� -
Contractor's Name 5 lS Hen 4:4;45 i 4/c Phone R3702DD0 ❑ 'OTHER. - - - C Right \ 0 - N
•Address(mailing) *.17 i,ZY CJtmr.an CA,J 5/-R R^/C I,rj`7 PROJECT DESCRIPTION SQ. FT. - OCCUPANCY K Left \ \ G
/ rCON ST RUCTION TYPE VALUATIONS $
- .
City License No. ZONE GRADING CU.YDS. ACRES �) - R
LICENSED CONTRACTOR DECLARATION Ping. Ref.` \ Parking Req./Provided -
I hereby affirm that-I am licensed under provisions of Charter,9(commencing Remarks: ' ' Planning Notes: _ ' - 0
with lection 7000) of Division 3 of the Business and Professions Code, and , ' T
my license is In full force and effect. •
q ( •
License Class LlCeesB �/ �9�K $
Date •1 - 5-3y Signature . Lien
C....�.�., • PLUMBING •FEES
A
--WORKERS' COMPENSATION DECLARATION
• hereby affirm at I have a certif irate of consent to self-Insure or a certificate ,• Bar Sink Showers ELECTRICAL•
FEES
of W i ricers' pensatio nsurance, • . certified copy there. (Section Backflow Preventer - Service Sink,. - Automatic Washer - Transformer 0 15-50 KW '
800 Lab. C '� - r . Backflow
i �, 0 50+KW
don,. No. ••mpa y Backflow Irrigation Sewer Cap ,i:(Construction Pole Sub. 1
re tifieby f niche• Illr
er • ed with he y Buie-4,74;4WBathtubs Sewer Connection Cooking Unit Meter Dup to 100 amps
Date_a C. APP ant Ar:`er�^s..-- -�
EXEMPTION FROM WORKERS'.COMPENSATION DE LARATION Clarifiers •
Solar Collectors Dishwasher • Meter Dover 100 amps •
(This section need not'be completed if the permit Is for one hundred(5100) or . - •
- - _
less). Dishwasher Solar Piping Dryers ❑Gas' ❑Electric Sub Panel
I certify that in the performance of the work for which this permit Is Issued I
•
shall not employ any person in any ma nGr so as to come subject to the Drinking Fountains Solar Tank Fan
Workers' Comp nsation Laws of Celiforr�pa./_ _ come _ •f_' Motors❑61 HP ❑1Y:-8
Date 1- $'V7 Signature /1 YJ��-^�'� Floor Drains ' Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP ❑16-15+
'NOTICE: If,after making this declarat(o you should c---one subject to the
•
Workers' Compensation provisions of the Labor Code, you must forthwith Eloor Sinks - .Urinal . - . Fixtures - -
comply with such provisions or' this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCYGas Service' • Outlets - Water Closet • - Device Boxes Pole Light
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.) interceptors •
Water Heater - Outlets
Lender's Name - - - - • Range • ,
Lender's Address Kitchen Sink ' Water Service Switches Sign •
• OWNER BUILDER DEC L-ARATION
I hereby affirm that I am exempt from the Contractor's.License Law for the • Lavatories Auto-Wash Garbage Disposal
following reason (Section 7031.5 Business and Professional Code: Any city or P ;Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P-Trap - Laundry Trays Generator ❑45 KW ❑5-15 KW
,any Structure, prior to its Issuance,also requires the applicant for such permit • - Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains •
the Contractor's License Law (Chapter 9(commencing with Section 7000)of '
- • •.
Division 3' of the Business and Professions Code) or that he/she is exempt • . s •- •
,
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 $ 3 • , '
LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee E $15 Issue Fee
compensation, will do the work,and the structure is not Intended or offered - Reinspection Fee • I $15Issue Fee $ 3
for sale (Section:7044, Business and Professional Code: The Contractor's :MECHANICAL FEES
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 - DEVELOPMENT SERVICES REQUIREMENTS: t
Hood or Type provided that such improvements are not intended or offered for Boiler I 0 ,
sale, If, however, the building or improvement is sold within one year of com- . - Canopy Type II 0 ' Zoning Approved By Date
•pletion, the owner will,have'the burden of proving he/She did not build or im- Duct-Under GroundoBuilding Approved By - Date
Cmove for the purpose of sale). -
I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By -rP Dat: I vas—
tractors to construct the project (Section 7044,Business and Professions Code: ,
The Contractor's License Law does not apply to an owner of property who . Duct-Ventilating 00.100,000 BTU 0100,000 BTU SUMMARY OF FEES
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 aware thatBUILDING PERMIT • $ SMIP $ '
proof of their Worker's Compensation insurance should bprovided to me. Exhaust System 0 Multiple❑ System Repair/Alteration
PLAN CHECK $
PERMIT
0 I am exempt under Section , B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers •
PLUMBING $ _ ISSUANCE $ '
Date owner; Heating System& Ducting Registers 3 �p PLAN CHECK 25% $ l
i 1 ENERGY P.C. $
I hereby certify that I have read this application and state that the above ., ❑0-100,000 BTU 0100,000 BT - -
and state laws relating•to building construction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $ t
senlatives of this city' to enter• upon the abve-mentioned .property 1 • 1
Inspection put o MECHANICAL $ �a •�(�
Signature .-. t Date •j--6Y TOTAL FEE $ CD 7
Drivers' License on 55 - _ • Reinspection Fee ) $15 r Issue Fee $ 3 PLAN CHECK 25% $ '7 S • •
CMF 0865-46,rev'.10/84 mule - Guiding; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor -
C-
CONSTRUCTION AND PLANNING."' POOL &SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
, 1. Temporary Electrical Service or Pole. . i 52. Pool &Equipment Location •
%. 2. Soil Pipe-Undrgrnd. ' 53. Steel Reinforcement y
S3-flectrical Conduit Utility-Undrgrnd. 54. Forms -
-
14./Electrical Conduit-Undrgrnd. 55. Electrical Bonding • _
5. Steel Reinforcement56. Rough Plumbing & Pressure Test '
. ;6....c.Electrical UFER'Grnd. 57. APPROVAL TO COVER-GUNITE )
Tat ootings " - - ` 58. Electrical Conduit-Undrgrnd.
-BXFoundation '-,; 59. Gas Pipe, 0 Undrgrnd.,Test ,
9. Water Pipe-Undrgrnd. '
__ 60. Backwash Lines, P-Trap, 0Undrgrnd.
10 Structural Floor Sysiem by >' 61. APPROVAL TO DECK i.�
.1Property Sewer Line & House Connection 1 ' { 62. Backwash & Receptor-Final
.
12. Sewer Cap t • - - 63. Heater & Vent-Final
13. Roof Drains r -
64. Plumbing System - Final -
14. Rough Plumbing_ 65. Electrical-Final
15.-Rough Electrical-Conduit 66. Solar System-Final
• 16..Rough Electric Wiring 4 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 ��6/;s" -'7t 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 7M/4d („ED
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. k Date •