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HomeMy WebLinkAbout302 WALNUT PL - Building Permits • ' `` 6481 � - lis t..8 U L® !COSTA MESA BUILDING DEPARTMENT 3/S/s'Sr v w P.O. BOX 317 OFFII'FINANCE DEPT. COSTA MESA, CALIFORNIA au OF C:1(�S1y11+L�FfiQ FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT BUILDING BUILDING ADDRESS 02 Walnut - COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY n RECEIPT NO. PERMIT NO. OWNER C-Ray. Inc. l Y� MAIL RECEIVED BY DATE RECEIVED OA IB ADDRESS 419 E. 17th St., 3-/�5/-J7 3 3� CITY Costa Mesa TNo-LI 8-3159 ADDRESS BUILDING 3a� ' " �"eV U ARC TCT Carlson & LIC. COSTA MESA. CALIFORNIA OR NEER Midd)ehronk NO. FIRE 3 ADDRESS'- Garden Grove ZONE Dike & Colegrove,Inc•ITY LIC. 7333 ZONE 16.\--) \ , 1 NO.OF TYPE GROUP t CONTRACTOR NO. r i, . ///,'ycITEL la APPROVED /��ADDRESS 419 E• 17th St• ND: 8-1159BV ° DATE LEGAL LOTCORRECTIONS DESCRIPTION NO. 1 BLOCK TRACT 1631. ��.�//) 2J� �� di A.P.NO. y-� �f/I� 7't-v! / SIZEOF LOT 75 x 80 I NOBLDGs. /v / NOWW ON LOT no ��.L•!vi!/ USE OF EXISTING BLDG. A .,� --i./�■ "�"�L Lk J. / • SETBACK LINE FROM /~ / / CENTER OF STREET 6' REAR YARD 1 t _ ' SIDE YARD RIGHT " - LEFT D le •. / S /1 .t� air ^1I • DESCRIPTION OF WORK re (/'Y — I—. . . S / NE XI ALTERATION I ADDITION 4 p % 0 • , .fie t° 3" S- cf REPAIR MOVING I DEMOLISH BUILSIZE DING 1601 Sq.Ft. NO.ROOMS OF 6 1 STORIES EXTERIOR WALL ROOF COVERING Stucco COVERING Comp. USE OF NEW t BUILDING' single family residence and / gj, garage /6.3C'a ScpIPlan 750BR 44 oPS '� --- Cie-p- i HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND S LAWS REGULATING BUILDING CONSTRUC• TION. VALUATION SIGNATURE OF PERMIT FEE S 32.00 PERMITTEE SPLAN CHECK $ 16.00 $ 13,690.00 Q 00 AUTHORIZED AGENT Dike & Colegrove, Inc. TOTAL FEE $ 48.00 VBNF CITY OF COSTA MESA ' - • % ;•''. 0,501 5 BUILDING DIVISION F1,•o 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us ". FOR INSPECTIONS CALL: (714)754-5626 R PERMIT NUMBER: M09-00126 PERMIT TYPE MECH STATUS: ISSUED ON: 42629316 DATE ISSUED: 12/24/2009 ISSUED BY: KJB JOB ADDRESS: 302 WALNUT ST CM Suite/Unit: vicinity: - - - SQ. FT: 0 SCOPE OF WORK: FAU CHANGE OUT SAME LOCATION.80K BTU OWNER: HUSTON,WILL F TR Address: 302 WALNUT ST Unit: PHONE: City/State/Zip: COSTA MESA,CA APPLICANT: SMYTHE, BRUCE Address: 3801 LENAWEE AVE Unit: PHONE: 310-838-0408 X120 City/State/z2ip: CULVER CITY,CA CONTRACTOR: ORANGE CO SVS INC DBA GEORGE BRAZIL PLU License No. 679898 409-00126 Address: 3801 LENAWEE AVEUnit: PHONE: 310-838-0408 X120 City/State: CULVER CITY,CA ZipCode: 90232 CELL: A ' MECHANICAL PERMIT FEE SUMMARY MECH ITEM FEE: $38.30 PLAN CHECK FEE: $0.00 INVESTIGATION FEE: $0.00 REINSPECTION FEE: $0.00 TOTAL FEES: $38.30 • .-i;' NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. CODE*. INSPECTION TYPE DATE IN1UAL$ CODE* INSPECTION TYPE DATE I LS t f� 1616 Fixed System Final Fire Prevention 206 Final Mechanical f afire) • 1266 Pool Spa Final 208 Final Plumbing _ 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention _ 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site rl :•1-7 L•^. 204 Final Demolition ' 250 Final Building/Occupancy WORKERS'COMPENSATION DECLARATION: Owner ID verified by drivers license. ❑Yes 0 No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: 0 I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ ave and will maintain workers'compensation insurance,as required by !section 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized //JJ ^^ h'.. by this permit,and that no building structure,scaffolding,falsework,at'demolition [Carder:—- 6-e--a. �I or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This section need not be completed/the permit a vahred at one hundred Wears($100)or less) ��Intl I 16 2,Art 2,Sec.341,Title 8,Califomia Administrative Code). PPIicy,Number: 0 As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall .. : . . . .erson in any manner so as to become subject such person has a permit to do such work from the division. to the • ers' compensation .ws of California, and agree that if I should b- .me subject to the woe - ' compensation provisions of Section 3700 of Applicant's Signature Date e Labor Code,I .. •••rt. .: .comply with these provis' ns. 1\ 2,4 01 1 Division of industrial Safety Permit Number: r_Apprcant's 9gnarure (-Date: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions C e. and 2. Does or will the applicant or present or future building occupant need to file my license i in full fo e a d IT. a registration form for acutely hazardous materials? ❑Yes 0 No Lia.#— g o (—Class# _CiO (Section 25533 of the Califomia Health and Safety Code, with some 1��_ exceptions, requires registration with the Costa Mesa Fire Department by .(� l .� each business which at any one time has on hand a quantity of acutely ("Contraoors Si ure te. hazardous materials equal to or greater than a weight of 500 pounds. or a - volume of 55 gallons. or 200 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes IDNo (Section 25534 of the California Health and Safety Code provides that the Lender's Address: Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required - to register acutely hazardous materials with the Fire Department. Signature Date 4. If an RMPP is presently required, has Section 25534 of the Califomia OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5. the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors (Section be fu of the California Govemment Code requires dithnt the requested License Law(Chapter 9(commencing with Section 7000)of Division 3 of the information be furnished on applications for non-residential building permits). Business and Professions Code)or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? 0 Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes",the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I. as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation. WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes 0 No thereon,and who does such work himself or herself or through his or her own 8. (If"yes", attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.), information given above is correct. I agree to comply with all state laws and ❑ I, as owner of the properly, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors Ucense Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a contractor(s)license pursuant to the Contractors Ucense Laws.). certify under penalty of perjury that I have read this application and state that 0 I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authoried.by-this-rm . ' final inspection. Signature. .:-.wner(s) Date Signature Date - 1012Y/3/012 7/3/ JOS]a6(3/07) And/or Authorized Applicant Date PROJECT ADDRESS: 302 WALNUT ST ((NIT: OF COSTA MESA — BUILDING PERMIT PERM NO: B 05418`_ OWNERS NAME: HALL PHILIP S • �� • ADDRESS: 302 HALL, ST PERMIT NO: B 059185 PLAN CHECK NO: N GOVT: N SUPP; N COSTA MESA, CA 92627 CONSTRUCTION TYPE: V—N PERMIT TYPE; STR PURPOSE: OTH 548-5630 JOB DESCRIPTION : T/OFF REROOF W/CLASS "A" SHINGLES SQ FT: 3, 200 ARCH/ENGINEER: flEG.NO.: A, ADDRESS: UNIT: CLAIM VALUE: 3, 200 . 00 CALC—VALUE: 3, 200. 00 GROUP OCC: R-3 /M-1 PERMITTEE: CROWLEYS ROOFING ( 714 ) 836-1966 ADDRESS: 1016 E 1ST ST COMMENTS: SMOKE DETECTOR REQUIRED IN THE HOME �(A �� p, SANTA ANA CA 92701 *************************** ***�Ex*+t�F**+r*NTt*aE*�t�F**�E***PR"P�*E*DEFE T©fe� *�E LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed on rovisions of Chao 9(commencing with Section ZONING R E U I R E M E 7000)of Division 3 of the Business and Profession -Code.and my license is NI torte and ettec SETBACKS REQUIRED CITY sec.: 03^18 0 0 STATE LIC.: -+/'j 8 5 2 1 . c ss- 39 Date: �'v , /Signature: � _ ! / MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: (hereby afh ave acertilicate of consen f-insure oracenifiCate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3803.Lab.C. LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICrNo.: 285-90UNIT 186 E :DATE: 01 01 /9 ' COMPANY: STATE FUND ARKING REQ: PROV: PARCEL: 42629316 ZNE: REF NO: ' 7 Certified copy is hereby furnished. CZ c died copy is y 1 the Building Di'on. /PLANNING N(7TES> /� / > Date: t--&)�C/ Applicant / r / i - *******FF****************************ik****************************aF***If********* EXEMPTION FROM WORKERS'COMPENSATION DECLARA 10 : (T : '. need not be compfet1•pernit is forme hundred(5100)or less). DEVELOPMENT SERVICES R E Q U I R E M E N -T S I certify that in the performance of the work for which C. i Tit is issued.I shall not emplo person in any manner so as to become C't • DATE: subject to the Workers'Compensation Laws of California. ZONING APPROVED BY Date: Signature: NOTICE:If,after making this declaration.you should become subject to the Workers Compensation provisions of the Labor - BUILDING APPROVED BY : DATE: Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. A' I / CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y; - DATE: I which this permit is issued(Section 3097.Cie C). ********************************************************************* **** * * LENDER: ***************************************************************************** * ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that lam exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMI P/RES , GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish.or PERMIT 63 . 00 repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed ' S O' pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business • SM I P/NON.rR ES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031,5 by PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($500). ISSUE FEE I. as owner of the properly or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'Slate License Law TOTALS----> 63. 50 0. 00 0. 00 6 3 . 50 63 . 50 . ; . 00 does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however the building or improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS——> COLLECTED: 63 . 50 OVER/SHORT: 00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 63 . 00 . 50 ❑ and Professions Code: The Contractors'State License Law Des not apply to an owner of property who builds or improves thereon /C• and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware ******************************************************************************* that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN ❑ I am exempt under Section: B.8 P.C. ft."— for this reason: 'TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date • Owner: SFR 3200 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 i I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES 3, 200. 00 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a _ permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from - / these provisions. 1 Date: Applicant: I hereby certify that I have read this application and ale that the above infor -,on correct.I agr o comply with and County , ordinances and state laws relating to budding cons coon and hereby authorir epre'•natives of t 5'-to enter upon the ove.mentianed property lot inspection purposes. ,�/'�_(�/ rgnatun _ -��-�• • 09. CI QO477-0009476 ../TOT , 51 DATE: 0/30/91 ?FhNr•1:.14 Diver's License or Social Security Ft: " 1641-46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink :nue:Goldenrod—Assessor • COtORUCTION AND PLANNING POO 3PA APP:,JVALS 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: -Electridal Conduit Utility-Undrgrnd: 54. Forms - . •4. Electrical Conduit-Undrgrnd. • 55. Electrical Bonding -;5. Steel Reinforcement56. 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. Property Sewer Line & H6use Connection 62. Backwash & Receptor-Final _ 12. Sewer Cap -, - 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing - . 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling, 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating& Air Conditioning • FIRE DEPT. REQUIREMENT ' ' 20. Rough Factory Fireplace t' - :APPROVALS Permit # 21.;Ducts,in Structure - 70. Underground,'Hydro 22. Ducts, Ventilating - ; r71. Product Piping 0 Gas ❑Oil 23.-Gas Pipe'-Rough & Test t - . , . .- , 72. Underground Flush 24. Roof Framing - -t 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing , 74. Overhead Hydro 26. T-Bar Ceiling (Structural) &Monocoat 11 - . - 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 Heatirig & Air Conditioning. I _ I- ' J 35.'Final Gas Pipe-Test' I : ' - • 36. Hood oi,Canopy• - . - s is 37. Final Factory Firedlace r • : . ' 38. Final Plumbing '-, ' Lr • • :39. Water Service-Final• � r 40. Gas Service-Final ,. ., 41. Solar Domestic-Firnal-, _ 1 42.'BackflowPrevente • t• , z - 43. Backflow Irrigation,- rr - - . • I •' J r,44. Landscape Irrigat�ajrSYs... r . i 45, Sound Attenuatidtt': . ' - '' r :46.,Handicap Regulation's 47. FINAL STRUCTURE &�I UILDING //�/17-1-.91 a.4.4 r "`�� ��r o tb- 4a-4' * i ' ' ' 48.1FINAL PLANNINGI -49. Eleciric Release to'Edison . • 50. Gas-Release to Southern California Gas Co , '51. CERTIFICATE OF OCCUPANCY No. Date /o rt PROJECT ADDRESS: 302 WALNUT- ST UNIT: . CITY OF COSTA MESA — BUILDING PERMIT PERM NO; M 07013( OWNER'S NAME: HALL, CEC IL IA E TR ADDRESS: 302 WALNUT ST PERMIT NO: M 070130 PLAN CHECK NO; N GOVT: N SUPP : N COSTA MESA,CA 92627 CONSTRUCTION TYPE: gNPERMIT TYPE: NEC PURPOSE: OTH 548-5630 ba ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : REPLACE A '.• 4 FURNACE CFA10 SQ FT; ADDRESS: UNIT: CLAIM VALUE : CALC—VALUE; GROUP OCC: R-3 / PERMITTEE: A.B .C . HEATING 6 A/C ( 714 ) 540-0972 ADDRESS: 2951 GRACE LANE COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT COSTA MESA CA 92626 **;Facy¢aE*+r****+ry.**********+c*****+r+e* *******r+a*******y.+r1t -+r+c******-Nx**********..?E***-* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(corn encing with Section Z ON INC REQUIR EMENTS 7000)of Division 3 of the Business and Professions Code.an my license is in lull force and effect. SETBACK S CITY uc:'00/6041cSArEuc.: 1332Q' c C-20 EXP , /95 i Data.. — / — / signal . _ / !/ MAIN BUILDING ACCESSORY BUILDING FRNT; £T IN REAR; FT IN FRNT; FT IN REAR ; FT IN WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate c sent to self-insure or a certificate of workers' LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN Compensation IpLraDyg(os rcened copy thereof(Section 3800,Lab.8.1 /0 1 /95 95 POLICY NO.: EXP,DATE: COMPANY: ,�y( PARKING REQ: PROV: PARCEL : 42629316 ZNE; REF NO: ❑ Certified copy is hereby furnished. lJ Cenilietl s d to In Building Division. PLANNING NOTES> 7 ° �^�//7/ Ap m '` E` - D E V E L O P M E N T S E R. V I C E S REQUIREMENTS EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be c pl d if the permit is for one hundred WOO)or less). certifyI that the performance of the work for which this permit is issued.)shall not oy any person in any manner so as to become ZONING APPROVED H Y f DATE: subject to the Workers'Compensation Laws of California. Date: Signature: BUILDING APPROVED BY ; _ DATE; NOTICE:It,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor Code.you must DINGwAGcomply I heth such provisions this pa construction tending deemed revoked. APPLICATION ISSUED BY : DATE; It.�l i{ CONSTRUCTION LENDING AGENCY: hereby affirm That there is a construction lending agency for the performance of the work for ��Ct which this permit is issued(Section 3097.Civ.C). ****************************************** * ************************** * *** LENDER: ************************************4*********+F******+E**********x************** • ADDRESS: LEGALIZATION : N FEE --SUMMARY STRUCTURAL SEGMENT: N I OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct.alter,improve,demolish,or PERMIT —, 9 , 00 repair any structure.prior to its issuance.also requires the applicant for such permit to lite a signed statement that he/she is licensed 2 5!t SMIP/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN •. and Professions Code)or 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 penalty of not more than five hundred dollars(5500). ISSUE FEE — 15 . 00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the TOTALS----> 9 . 00 15 . 00 0 . 00 24 , 00 24 . 00 , 00 ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through his or tier own employees.provided that such improvements are not intended or offered for sale.lf, however the building or REVENUE DIVISION TOTALS--> COLLECTED; 24 . 00 OVER/SHORT: 00 improvement is sold within one year of completion.the owner will have the burden of proving he/she aid not build or Improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK for the purpose of sale). ds owner 01 the property,am exclusivelyy contracting with licensed contractors to construct the project(,Section 7044,Business 2 4 ._0 0 0 and Proi¢5ontra Codfo The projects with late License Law tlens not apply to an owner of ctoD¢M who s or Improves thereon ******* *********************************************************************** • and who contracts for such projects with a e Lice contractor(s)license pursuant to the Contractors'State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUKL ; F E E BREAKDOWN : ❑ I am exempt under Section: B.8 P.C. forthis reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Ovmec MEC 1 INST/RELOC YA11 9 . 00 9 . 00 I do hereby cenity that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES $NAS 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from t 14 t(9M these provisions. I Date:rApplicant' ' V hereby certify fat I have read this application and state at the above information isl correct. agree to comply with city and county /.' ordinances and state laws relating to pudding construction dhereby author¢ •ematives of this city to enter upon ve•mentioned "/, properly for inspection purposes. 01 00173649-001726149 —E 24 00 `l / g/, / DATE; 12/02/94 TIt7E: 07-9/Fit p / oc7 n re: Driver's License or Social Security a: (( 1641.46 White—Building;Green—Code Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit#_ ,6ate Inspector APPROVALS Permit # Date Inspector 1. TemporaryElectrical Service or Pole 'r / 52. Pool & Equipment Location % 2. Soil Pipe-Undrgrnd. , 53. Steel Reinforcement , , 3. Electrical Conduit Utility-Undegrnd. t•;� 54. Forms . 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical OF ER Grnd. 57. APPROVAL TO COVER-GUNITE / I 7. Footings �/- . 58. Electrical Conduit-Unclrgrnd. 1 8. Foundation - 59. Gas Pipe,0 Undrgrnd.,Test I'' 9. Water Pipe-Undrgrnd. ., . 60. Backwash Lines, P-Trap, 0 Undrgrnd. ac 10. Structural Floor System •/ - 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final ., . it 12. Sewer Cap 1.l/ •l /' 63. Heater & Vent-Final 13. Roof Drains /. 64. Plumbing System - Final ; 14. Rough Plumbing r 65. Electrical-Final 15. Rough Electrical-Conduit l� �r 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing& Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 1 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 1 I 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace • APPROVALS Permit # • 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM ANAL 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 {f 33. Final ElectricNotes: - 34. Final Heating & Air Conditioning / ,,--,,,A/ A• 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 1 43. Backflow Irrigation i' 44. Landscape Irrigation System j 45. Sound Attenuation 1 I 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date -