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Home My WebLink About3445 SAKIOKA DR - Building Permits� `�cr CITYOF�6S7AME A CONSTRUCTIONpj�F RMIT .J ProjectAddress —��'¢S SA�1 i�/i 1�.1� �G �� Applicant's Mailing ddress I s� p Owner's Name �t,� on Address 3�75 �'K/oCA �LJ1�E Arch/Eng.� License NO. Address Contractor'sNam E aK G Phone �23 Address(mailin9� ao$ �, �eMll+�'' �++`�� 43%Z`S Ciry License No. 3 S3 �/L Bu? /i �% LICENSED CONTRACTOR DECLARATION . � � hereby attirm that I am licensetl untler provisioni oi Cnarler 9(mmmen<in9 with sectlon ]000) af Division 3 of tho Business antl Professlonz Cotle, and my litense is in f I forc¢ antl etfect. License Clasi '� �s r,o 3g4 3oa Oate N' -Z%�'i� SignaWre _ WORKERS'COMPENSATION DEC RATION lereby aftirm [ha[ I �ave a cerU(i ce ol consent selNnsure or a certificate Workers' Compensation Inzurance, or a c¢r tietl copy thereoi (Section .00, �b.��SoG 9y4o ,�� /r�P�r.� Policy No. Company �Certifietl copy is h¢reby lumis�etl. / P�� Cerfifiea copy i}Jiletl with the city Bull l�ig vi n.f�E Date /n'LZ'6�� APPliwnt �� EXEMPTION FROM WORKERS' CO ENSATIO ECLARATION ,(ThiS settion ne¢tl nOt b¢ Complet¢tl the permit is Or One huntlreU �E100) or I¢55). 1 certity [itat in the plrformanca o( th¢ work !o� hic� t�is p¢�m�t Is ISSUGtl I shall not employ any pe�son In any manne� so a5 lo betome Subjett to t{te Workers' Compensation Lawi ot CalitorNa. Date Si9nature NOTICE: If, after making this tleclaratlon, you shoultl become sub�ect [o lha WorkGrz' CompensaHon provlsions ot thG lsDor Cotle, you must torthwith comply wi[h such p�ovision5 Or'lnis permlt inall be tle¢mOtl �evoketl. CONSTRUCTION LENUING'AGENCV I hereby attirm tnat there is a constructlon lentling agancy for Ihe perlormance of lna wotk tor whi<h Ihis permit i2 ISSUCtl (SettlOn 3097 Civ. C.) I,.entler's Name Lentler's.AaCress pWNER BUILDEN OECLARATION ' I hereby affirm that I am axampt irom the Contractor's Ucansn Law 1or thu loilowin9 reason (Section ]031.5 Businozs antl Profossional CotlanAny tlty or tounty which requires a Oermit to construct, alteq improve, tlemolisn or repair any sVucture, prior to Its issuance, also reqWrns tno apDllcant for such'pormlt to tiie a signetl sta[emenl that ne/she ii Iicensetl pursuant to [he D�ovisions at Ihe Gonvactor's Licensn Law (Chapter 9 �commencing wlth $ecUon 7000) 01 Divisiom 3 of tne Businass antl Pro�esslons Cotlo) or [nat he/SM1e� is exemo� herefrOm anE lh! DaSis (or lha allegetl exeTption. Any viOlatlon ol SoctiOn 1031.S�by any applicant lor a permit subjects lhB applican� t0 d clvil penalty ot nOt more lhan five huntlretl t1011ars (5500�. LJ I, as owner oi me property or my emo�oyeez with wages as inelr solo CAmoenzation, will Oo the work, antl the slructure Is nol intentlatl or oiferoC '� tor sale (Section 7044�, Builnesz antl Protessional COEe: The Contractor'i License Law Coes not apply to an owner of a propar[y who bulltls or ImproWs lne�eon, antl wh0 does�suGh work'blm5¢It/he�salf Or t�rougb b15 or hOr own employoes, provitletl that such Improvements aru not IntentlaC or oiferotl for sale. It, however, the Dulltlin9 or improvament Is soltl within ono year of com- pletloq the ownC/ wlll hdva tho bu�tlen Of O�ovin9 ha/s�o tlltl nOt bulltl o� Im- prave for (he purposa o/. salu). � ' ❑ I, as owner of tne pro0erty, am exclusivety contractin9 with IlcenSeG con- I tractors to comtruct lh¢ project (SecHon 1004, BuSin¢ss antl Profa55ion5 Cotlo: The Contractor'S License Law doei not apP�Y �o an own¢r Of proporty who builtls or improves lhereon, antl wno contratts for such D/ojects wlth a con- tractor�s) license pursuant to tho Contrattor's Llcenie Lnw). I am awara that p�oof of tM1ei� Worker's COmpnnsation Insurance ShOultl bo Piovitletl t0 me. ❑ I am ezempt uneer Section B. 6 P. C. tor this reason Date - Owner _ I hareby certity th5[ I have reatl Ihis information is correcL I aqree [o comp antl state laws relating t bulltli Co sentatives oi this cl o e r p inspection pu�pose Si9�ature � Orivers' Lic e or 55 � 1F 0865- , rev. 30/84 White - uiltlin Date % "e I D' � icant to fill in all (pace�e6ptthbSeb(t�in heavy EorEer Iines antl siqn all aporopriate Eeclaration� PERMIT NO. O TRACT NO. LOT NO. � UNIT NO � � � J�I� TVPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR ❑ �ONVERSION ❑ DEMOLISH O OTHE q,p,.�t DESCRIPTION OF WORK/USE OF BLDG. �p��AL- - • � S Main Buildi E TVPE OF PERMIT GRADING FOVNDATION STRUCTURAL T FrOnt ❑ TENANT ❑ ELECTRLICA�L ❑ 7L��U�M�BpING O ECHANICA 7j� Z B qear P�OTHER � X�/N,GGtf� �''f/=5L� %� ECT DESCRIPTION 5(�. FT. oCCVaarvCv �Q�7 K Right CONSTRVCTIONTYPE VALVATIONS��'i� g Le(t 20NE GRADING CU. VDS. ACRES Ping. Ref. � qemark�: /J/f - i.`� �/�i'�� r%2[(„ Qr� , PlanningNotes: �� Bar Sink Back(low Preventer • • Back(lowlrrigation Bathtubs • - ' Clarifiers , Dishv.asher � ' Drinking Fountains � Floor Drains Floor Sinks Gas Service Outlets Interceptors � Kitchen Sink - Lavatories P—Trap Roof Drains � � Reinspection Fee • S15 Boiier Ducl- Under GrOund Duct-Struc�ural � Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting' ❑0�100,000 BTU 0100,000 BT Reinspec[ion Fee � $15 ; Canary - Applltant; Plnk - ACCOUnting; Golden�otl - Ass¢Sso� Showers Servlce Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w, Urinal Weter Clozet Water Heater Water Service Auta-Weih Laundry Trays laue Fee iANICAL Hood ar Typel ❑ Canopy Type tl ❑ Refrigeration System ❑0-100,OOOBTU ❑100,OOOBTU System Repair/Alteration Fire Oampers . Registers -. � laue Fee FEES 5 3 ' . 2147 2/II/87 Zone Accessory Building: . Parking Req./ProvidM Automatic Washer . Construction Pole Sub. Cooking Unit ' Dishwasher Dryers �Gas ❑Electric� Fan F.A.U. Fixtures Device Boxes Outlets Switches - Gar6age Disposal Generetor �0.5 KW �5-15 Reinspection Fee FEES DEVELOPMENTSERVI( Zoning Approved By_ Building Approved By ' Aooliwtion laued Bv_ $ 3 $15 ELECTRICAL Transformer ❑ 15�50 KW ❑ 50+ KW Meter IJup to 100 amps � Meter �overi00amps� Sub Panel � ' Molors �0.1 HP �tY.-8 Inc.Solar �9-15 HP �16�15+ Microwave Pole Light Range Standing Sections Trash Compactoi Issue Foe ' RE�UIREMENTS: 1293,24 TL FEES $ 3 � 2 O N I N G H E � M T S � . SUMMARV OF FEES � BUILDING PERMIT $,C��.�O SMIP ,$ � Q•� � P�AN CHECK � $ . PERMIT � - PLUMBING " $ ISSUANCE $ �� PLAN CHECK . 25%� $, ENERGV P.C. S ELECTRICA� $ GRADING $ PLAN CHECK 50% $ " . MICROFILM S MECHANICAL � $ TOTALFEE $ �� PLAN CHECK ��25% $ ' - ' • CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit # Date Inspector qppROVALS 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. ' 8. Foundation 59. Gas Pipe, O Undrgrnd., Test � 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 71. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains � 64. Plumbing System - Final 74. 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 (� � 79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT p I� 20. Rough Factory Fireplace APPROVALS Permit # _ �� t 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.StorageTank 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 Qa� + 29. Insulation 78. FIRE PREV. FINAL �1¢ , 30. Drywall Nailing HEALTH DEPT. REQUIREMENT � 31. Plaster Brown Coat 79. FINAL INSPECTION ; �(- 32. Electrical Power MeterFinai 80. FOOD CERTIFICATE ISSUED '�I j�� ' 33. Final Electric Notes: " ' 34. Final Heating & Air Conditioning � '� � r;� 35. Final Gas Pipe-Test �•� � 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-FinaF 41. Solar pomes[ic-Final . 42. Backflow Preventer ' 43. Backflow Irrigation � 44. Landscape Irrigation System � 45. Sound Attenuation . 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING ' �. 48. Special Requirements Completed 49. Electrie Release to Edison . 50. Gas Release to Southern California Gas Co � 57. CERTIFICATE OF OCCUPANCY No. Date � � ADP��ant to fill in all spaces except enose witnin heavy boraer Iines ane sign all apv�oDrlate Ci7v oF COSTa, �E /p1 ON�ST^R.�UCTIO!1N PERMIT i�P Project AddreSs�'�G7'�� 7f-IRi�XiQ f.�2 � q�( Applicant's Mi��in .Address S � Owner's Na TH�l�e� ,ia�rr �� Address .� ��%S Q�� N�%�� 9�' Arch/Eng. License No. Address Contractor's Nam��r ��Q�h% �� _phone " U �Zj Address Imaili0g � A � City License No ('�3 f�3�1Z LICENSED CONTRACTOR OECLAftATION 1 hereby atTirrr� tnat 1 am li[¢nsetl untler p�oviSiOns of Charle� 9(commencing with section 1040) of Divisbn 3 ot lhe Business and Prof¢ssbns Cotle, antl my license is in � ��'/orce antl effect. l.icense Class� � se No � Dat� �2%'�� Signature WORKERS' COMPENSATION DEC RAT ON 'meDy aftirm that I have a certificate of consen Ii-insure or a tertificate Wotke�s' COmpensation Insu�anc¢, o� d cer!t� .ietl copy [hereof (Section ,.tl00, Lab�.G�2.%UGSIgSCompany J�, � n%. S. Polity No. BCer'CJ1(,ietl.�c'oPpYv I�51f�Ietlbwithrthehc t�y Bui aI Ivi /� Da[elJ�i� �`-T APPlicantl�( � ��1NK� .L�. � f P� EXEMPTION 6AOM WORKERS' COMPENSATION DECLARATION (ThisSection neetl nol be completetl if the permit is for one hu�tlretl ($300) or less). � I certify that iP Ihe perfo�mance of tbe work for which thls p¢rmk is i55uetl, I sM1all not emO�pY any person in any manner so az to become subjett to the Workers' Compensation l.aws o( Calirornla. �a[e Signa[ure NOTICE: If, atte� makin9 lhis tletlaraliOn, you shoWa� OeCOTe subject to the Worker5' Compensa�ion provisions ot [he Labo� Cotle, yoU must rortnwim comply with such provisions or tnis permit shall be tleemetl revoketl. CONSTRVCTIDN LEN�ING AGENCV � 1 nereby aiti�m that there ii a constructloa lentliv9 agency tpr the pertormance of the work for which this permit is issuetl (Section 3097 Civ. C.) l.enaer'S Name Lentler'sAtltlress�- - - -- OWNER BUILDER �ECIARATION I hereby affirrP Ihat I am ¢xempt frOm the Contractor'S LICe�Se Law for the followin9 reasOn (Section 7031.5 Business an0 Protessional Cooe: Any city or county which �equires a permit to co�StruGt, alter, improve, Cemolish o� �epal� any stlucture, ptlOr to it5 i55uance, al5o r¢quires the appli<dnt tor Su<h permit to (ile a signetl stalement that he/sM1e Is licensetl pu�suan[ to tM1e prOvlsions o1 [he Contractor'S Licenze Law (Chapte� 9,(<omm¢ncing wilh $ection 7000) o( 9ivision 3-of �na Business antl Pro(essions Cotle)�or lhat ne/she is exempt herefrom antl the ba5i5 for the all¢g¢tl ¢x¢mption. Any vlo�ation ot Section /031.5 by anY applicant for a�permit subjec[s the applicant to a civil �enalty of not more than five huntlred tlollars (E500). I, as owne� of Ihe property o� my employee5 with wa9es as their sole compensation, w�� tlo [h¢ work, antl th¢ slrUctu�e is not intentl¢tl Or offCr¢tl for 5ale (Section 7044, Business antl Profes5ional Cotle: Tha Contractor's License Law tloes not apply to an owner of a property who builtls or improvez ihereon, antl who aoes such work himseli/herseli or through nis or her own emoloyees, pro��tletl tnat such improvements are not Intentletl or ofieretl tor sale. I1, noweveq tne builtling or Improvement Is soltl wl[hln One year of com- oletioq the ow�er wlll have the burtlen ot proving he/she tlltl not bulltl or Im- ��Ove fo� the pu�pose of sale). I, as owner of the pro0erty, am exclusively contrac[Ing with licensetl con- tracrors to con4truct the projec[ (SecNon 7044, Business and Professions Cotle: The Contractor'S License l2w does �o[ apply to an owner of property who builtls or improves thereon, antl who wntracts for such proiectz wlth a con- [rac[or(s ucense pursuant to the Contra<tor'S License Law). I am aware that prool o� their Worker's CompensatiOn Insu�ance Shoultl be provltletl to me. ❑ I am exemp� unaer Section . B. & P. C. for tnis reasom Date Owner I hereby certib tbat I have reatl tbis application antl state Nat the above information is mrrecL I agree to compry with all city antl county ortlinances. antl state IawS rela[ing lo builtling con5tructlon, antl hereby au[hotlie rep�e- 5entatives of this qky) [�fnjgr uppn the above-mentioneA property. for Si9natme � Drivers' Licens or 55 � TYPE OF CONSTRUCTION .'. LI NEW LI'.ADD LI ALTERATION LI REPAIR ' O CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORKIUSE OF BLDG. TVPEOFPERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELEGTRICAL ❑ PWMBING ❑ MECHANICAL ❑ OTHER ' PROJECT DESCRIP710N Sq. FT. oCCUPayrv� ��y/� CONSTRUCTION TYPE VALUATION $7.LY_� ZONE GRADINGCU.YDS. ACRHS /{� / /1 Remarks: � ), / ni..11 � i�i r� /.—.� � _� I Bar Sink Preventer Clarifiers Dishwasher ' Dridking Fountains Floor Orains ' � Floor Sinks Gas Service Outlets Interceptors ' Kitchen Sink - Lavatories P—Trap Roof DrainS Reinspection Fae FEES Showers Service Sink Sewer Cap $¢W¢! Conn¢C[iOn Solar Collectors SOlar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heacer . WaterService ' Auto-Wash Laundry Trays $15 Issue Fee � $ 3 eoiier Duct - Under Ground Duct - SVuctural Duct - Ventilaiing Exhaust System � Mul[iple FirepVFact BIL ICBO # Heating System & Ducting ❑ o-i ao,aao sru O i oo,aoo Reinspection Fee I �15 r� CMF 0865-46, rev. 10/84 Wnite - Builtling; Canary - Applicant Vink - Accounting; Go�tlenrotl - Assessor Hood or Typel ❑ Canopy Type I I ❑ Re(rigeration System �0-100,U006TU ❑100,0�0 System Repair/Alteration Fire Dampers Registers . Issue Fee � $ 3 A.P. qW S Main Buildin9: E T Front' • A Rear C Right K g Left Ping. Ref. # Automatic Washer Construction Pole Si Cooking Unit Dishwasher Dryers ❑Gas ❑E Fan F,A.U. Fixtures DEVICE BO%ES Outlets $WitCh25 Garbage Dispoul Generator DO-5 KW lectric � 7146 10/09/87 2one Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ SO+KW Merer �up to 100 amps Meter �over100amps Sub Panel Motors�0-1 HP �1'F.-8 Inc.Solar �9-75 HP �16-75+ Microwave Pole Light Sign ' - Standing Sections Trash Compactor � Rainspeciion Fee �$15 � � Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: �Zoning Approved By Building APProved BY Appliwtian Issued By i 517,10 TL FEES $ 3 Z O N I N G R E Q M T S SUMMI�Y OF ES �� '7 BUI�DING PERMIT $ �SMIP $ _ y / U PLAN CHECK g PERMIT P�UMBING 5 �SSUANCE $ PLAN CHECK 25% �$ ENEqGV P.C. $ ELECTRICAL � 5 GRADING $ PLAN CHECK 50% $ MICPOFILM $ � MECHANICAL $_ , TOTALFEE $ � PLAN CHECK 25% $� CONSTRUCTION AND PLANNING � POOL & SPA. APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector 7. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. � � 53. Steel Reinforcement 3. Elecirical 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. APPROVALTO COVER-GUNITE 7. Footings - 58. Electrical Conduit-Undrgrnd. 8. Foundation � ' 59. Gas Pipe, O Undrgrnd., Test ' . 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK . i l. 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. Electricel-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 O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72, Underground Flush -' 24. Roof Framing 73. Undergrnd.StorageTank 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 �?j, 29. Insulation 78. FIRE PREV. FINAL � �i� 30. Drywall Nailing HEALTH DEPT. REQUIREMENT .. 31. Plaster Brown Coat 79. FINAL INSPECTION ' 32. Electrical Power Meter-Final 80. F000 CERTIFICATE ISSUED 33. Final Electric Notes: ^ 34. Final Heating & Air Conditioning . 35. Final Gas Pipe-Tes[ ' 36. Hood or Canopy � � 37: Final Faaory Fireplace " � , ' 38. Final Plumbing _ . _ - � „ 39. Water Service-Final � � 40. Gas Service-Final � � * � . , 41. Solar pomesticFinal . � -. � ' 42. Backflow Preventer ' � - ' " 43. Backflow Irrigation " � � � . �, � 44. Landscape Irrigation System _ • � , � 45. Sound Attenuation 46. Handicap Regulations � ` ' 47. FINALSTRUCTURE&BUILDING � � . 48. Special Requirements Completed . ' ' � 49. Electric Release to Edison y . 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY - No. Date n Applicant to /ill in all spaces except lhose within heavy Da�Oer lines anE sign all aOVroDriata tleclarations. ci7Y o�� COS7a MESA CONSTRUCTION PERMIT Proj2ct Aadress '��5 �� C, �1 C/j�H �2 d Applicant's Mailing Address ' p1c IL 37 � i� 2FING � Owner's Name � �ma � Phone Addreu Zo z � P�rs�,v ��s e re De ii 3 z2u�,�E Arch/Eng.- � � License No. � Address ' Contractor'sName— « Phone � 'IG�Q AdAress (r^ ' � „� ;% ��RN6 E Ciry License No. (p.� 3 � LICEfJSED CONTRACTOR DECLARATION � I TClC�Y�d�IIIT IIIdI'I dT�IICCOSCd IIOGBI provlsions of Charte� 9(commencing with u<lion 7000) of Division 3 of [he Buslne55 antl Profesibns Cotl¢, anA my Iicenie Is in full orce antl'eitect. O��OY b License qasi � ke se No.p� . Date.�n' ZZ' F< Signature � WORKERS' COMPENSATION DECLARATION ' I her¢Dy alfirm that I have a certificate ot consen[ to SelLinzure or a certifiwte of Worken' Compensztion Insurance, or a c¢rtHletl coDY thereof (Sectlon ��3800, lab. CC1n 'Fi�G�j/CN� Policy Na. �+r�ZZS��%S Company n� i,�`'rtifietl copy is �ereby fumishetl. D�CJ CertllO. Z py b�� fJ� wAPPI cantY Buil� Divl i, _; op.��µ' 1 Y r . /AiK9Cf EXEMPTION FROM WORKERS' COMPENSATION DECLARATION -(Thlssection neetl no[ be'com0�etetl�it the pe�mit is for one nuntlretl (E300) or less): . 1 certify lhat in the plrformance of the wo�k for�whiCh tbis pe�mit is issuetl, 1 shall' not employ any person in any manner so as to become subject to the Worker5' Compansa[ion'Laws of Calitornia. Data Si9nature � NOTICE: If, after making this tlecla�ation, y0u shoultl betome zubject to the �Wo�kers' Comp¢nsation pmvisions o( th¢ tdbot Cotle, you must torthwilh comply with. such provisions or this permit shall be,tleemetl revoketl. CONSTRUCTION LENDING-AGENCV ' 1 hereby attirm tba[ tnere is a construction lentlin9 agency for the performance of lhe work for which thiz permit is issuetl (Section 3097 Civ. CJ Lentler's Name. �entler'i ACdress _ ' OWNER BUILDER DECLARATION�� - ' I heraby affirm that I am exemp[ from the Contractor's License Law for the followin9 reason (Section 7031.5 Businezs antl Professlonal Cotle: Any city or county which requires a permit to construct, alter, Improve, tlemolish or,reoair any st�uCture, prlo� to it5 Issuance,lalso requires the applicant tor Such permit to t0e a signetl statement tnat he/she is licensetl pursuant to Ihe provisions of �the Contrac[or's License Law (CnaO<er 9(commencing wlth Section ]000) of Oiviziom 3_of tne Business antl Protessions Cotle) or that he/she is exempt Ih¢�e1rom dntl thG basis for the alleg¢tl exemption. Any vlolation.of Section .=]031.5 by any applicant tor a pe�mit suDjects Ihe applicant to a civil eendlty of not more than five huntlretl tlollars (E500). , L� I, az owner of the oroperty or my employees with wages as their sole compen5atlon, will do the work, antl the st�utture is not int¢ntletl ot offeretl � for ule (Sectlon ]044, Business ana Professional Cotle: The Contractor's Licenx Law tlo¢s not apply to an owner of a O�operty who builtls Or imp�oves thereon, antl who tloes such work himself/herseli or through his or her own employea5, Provltle0 tM1af Such improvemenlz are not int¢naetl or offeretl fo� sale. If, howeve�, lhe UUIlOing cr improvement is Soltl witnin OnG year of com- D�et�On, �he owner wlll have the burtlen ot provinq he/she tlitl not builtl or im- �ove tor tne purpose ot zale). LI I, as owner of the property, am exclusively contractln9 wRh licensetl corv Itactorsto conSVucl Ihe project ($ection 7044, Bu5ine55 antl Profe55ions Cotle: The Contractor's License Law tloes not apply to an owner of properiy wno Dulltls or Imoroves lhereon, ana who contracls ior such proiects with a con- tractor(5 Ilcense pursuant�to the Contractor's License �aw�. I am aware that prOot o� lheir WOrker'S Compensatlon insurance shoultl be provitletl ro me. ❑ I�am exempt untler Section 8. & P. C. for this r¢ason � Da[a Owner � I hereby certify that 1 have reatl this appliwtion antl state that the above Information is wrrecL I agtee to [omply with dll City antl cOunry ortlinanc¢S antl state lawz relating to Dvilamg constructlon, antl hereby authorize repre- senlativa5 of thi5' city to enter upon [he abova-mGnNoneE O�operty tOr inspection pu�p /p.l=_P!� Signature Da[e Drivers' Llcense or 55 aF E �a3�,i TVPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER - q_p. �E - DESCRIPTION OF WORK/USE OF BLOG. � L ivtT6 c o T /� ' S Main Building: TVPE OF PE MIT GRADING FOVNDATION ❑ STRVCTURAL " T Front . ❑ TENANT �ELECTRICAL ❑ PLUMBING ❑ MECHANICAC ' - , A Rear . � ❑ �OTHER ' . • � PROJECT DESCRIP710N S�.FT. OCCUPANCY C Pi9ht K Left CONSI'RUCTION�TVPE VALUATION$ � $ 20NE � GRADINGCV.VDS. ACRES PIng.Ref.# Remarks: Planning Notes: %' �- Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers �. Dishwasher � Drinking Fountains Floor Orains ' Floor Sinks Gas Service Interceptors Kimhen Sink Lavatories. � P—Trap Fioof Drains '. Reinspection Fee � Showers . Service Sink � Sewer Cap �, ' Sewer Connection ' � Solar Collectors � Solar Piping Solar Tank Swimming Pool w/Spa • Urinal Oudets' Water Clout Water Heater ' 'WarerService ' $15 Bailer Duct - Under Ground Du[t-Structurel � Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. BIL ICBO # Heating System & Ducting ❑aioo,000 aTu oiao,000 Reinspection Fee � $75 CMF 0865-46, rev. 4/84 White - Builtlin9; Canary - APPliwnt; Pink - Accounting; GoltlenroG - Assessor Issue Fee Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑0.100,OOOBTU ❑100,000 System Repair/Alteration � laue Fee !S a �� $ 3 I S 3 2666 10/22/85 � ` Zone ' . Accessory Buildin9: � Pa�king Req.�Provided . ' ELECTRICAL � �Transformer ❑ 15-50KW . e.. / ❑SO+KW Cooking Unit � Meter LJup to 100 amps Dishwasher er 100 amps Dryers �Gas OElectric � Sub Panel Fan ' Motors�0.1HP�1:4-8 � F.A.U. Inc.Solar 09-75 HP �16�15+ Fixtures . _Microwave Device Boxes . ' Pole Light Outlets � Range Switches � Si9n � Garbage Dispoul � � ' Standing'Sections Generator �0�5 KW �5�15 KW Tresh Compactor ' i .�. _ ti'i_ IQo01 TL FEES Z O N 1 N G H E Q M T S. I Reinspeaion Fee I$15 I� I laue Fee I $ 3' DEVELOPMENTSERVICESRE�UIREMENTS: � Zoning Approved By Date Building Appraved 6y Date Application laued By Date ��a �5 � SUMMARV OF FEES BUILDING PERMIT $ SMIP $ . PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ � GRADING $ PLAN CHECK 50% $ ' MICROFILM $ MECHANICAL $ �TOTAL FEE $ %Q � PLAN CHECK z5% $ - i� � CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit# Date Inspector p�ppROVALS Permit# Date Inspector Temporary Electrical Service or Pole `j 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - , � 53. Steel Reinforcement • 3. Electrical Conduit. U[ility=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. , 8.'Foundation � . � ' • 59. Gas Pipe, O Undrgrnd., Test , 9�. Water Pipe-Undrgmd. � 60. Backwash Lines, P-Trap, O Undrgmd. ':` 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 Piumbing; 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 Heati�g & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure , 70. Underground Hydro 22. Ducts; Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush � 24. Roof Framing , 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing ' 74. Overhead Hydro 26. T-Bar Ceiling (Structurall & 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 60. FOOD CERTIFICATE ISSUED 33. Final Electric � f� Notes: � 34. Final Heating & Air Conditioning �, . 35. Final Gas Pipe-Test 'i 36. Hood.or Canopy 37. Final Factory Fireplace � . � 38. Final Plumbing� � 39. Water Service-Final , , ' 40. Gas Service-Final ' 41, Solar pomestic-Final� . ; 42. Backflow Preventer � 43. Backflow Irrigation . . . � � ' 44. .Landscape Irrigation System � � �� 45. Sound Attenuation . � ; � ' 46. Handicap Fegulations � ' - 47. FINAL STRUCTURE & BUILDING . 48. Special Requirements Completed , 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co � 57. CERTIFICATE OF OCCUPANCY ., /' No Date � � nppucam m rm m au sOaces excep� tmie wRmm �eavY ooroer nnes ana sign a�i appropnaw aeuanuons. CITY OF COSTA MES CO TR UCTION PERMIT PE IT NO. TRACT Nq. LOT NO. UNIT NO. � 00(} 'j� • �1s� � 5 K,oKA Dz ��i� 1�34 I 2664 ioi22ie5 Project Address , Appli�ynt'S Mailing A./�1��lrwcc �[ ,�� TVPE OF CONSTRUCTIOiV NEW AOD ALTERATIpN RE7AIR OEAJC�//(AeC. C�OATIIRULBhSi � CONVERSION ❑ DEMOLISH ❑ OTHER q,p,# ' � Zone - Owner'sName ^e DESCRI TIONOFW RK/USEOFBLDG. . �QZI �LLS(A1fS5 CEUTE.¢ Dz 1 l/3 .� � S Main Building: Acceuory Building: nda�ess isfa owEG L�oNs reuc TiowJ AfChlEng. � LiCense No. � TYPE OF PERMI , GRADING .FOUNDATION STRUCTV RAl T Front . � . p Addf@SS . ❑ TENANT, �I ELECTRICAL ❑ PLUMBING ❑ MECHANI�AL A Rear � • -� . � N CAnveCtOr'SNam hone� q'L �.� �'OTHER _ C Riht � - '" N 3 OlZAN6 E PROJECT DESCRIPTION 5�. FT. oCCUPANCv 9 _ (� K G Addr955�mailin9) J./�Lu- % . . CONSTRUCTIONTVPE � VA�UATION$ ' g Left , , R CityLiCenieNo. IO�i3I ' ' 20NE � GRADINGCV.VDS: ACRES � ' UCENSED CONTRqCTOR DECLARATION Ping. RNf.'� Pefking Req./Provided' ' - E I'hereby�affirm [hat 1 am litensetl untle� provislons ot Cbarter 9(commenUng qemarkz: ' Planning NOIes: � with �clion 7000) Ot Dlvislon 3 01 Ihe Buslne55 antl Pr01e5sion5 COtle, antl M my Ilcense is in f WI torte antl eifect, ' ' �t ' . � � T Uceny¢ Class _ - � � LiF e,�nje No. � V�0 �� ' ... S� Oate ' � 9gnature �i_:1dZ1d1L�µ'• _ ' ' . PWMBING FEES W00.KER5' COMPENSATION DECLARATION Bef Sink � ShOw¢f5 � � ' � � ' I hereby atflrm that I have a certificate of consent to self-insure or a certiticate , ELECTRICAL FEES ' of Warkers' Compens5tion Insurance, or a cerGtietl copy tnareof (SecUon Backflovw Pieventer . Service.Sink � �� - •- • �- � -- - - Transformer 015-50KW _ 3800, Lab.,�+ )p� � l Policy No.3C..btiZ2-�IgS . Gompany FQEIHONT Backflowlrrigation SewerCap ' ❑ SO+KW C n ,. 1 nstruction Pole Sub `) y� @rUfietl copy is �ereby furnishetl. X� C@rti(i<G co y Iy 1�e tl with tne city Bu 4tl-ing� D��iv}�io Bathtubs � Sewer Connection � ing Unit Meter ❑up f0 1�� BTpS Date JO� Z�'YS qpplicant {%_�7O(��'�' � ' E%EMPTION FROM WORKERS' COMPENSATION DECLARATION Cldflfi¢�S $012� COIIECt0�5 Dishwasher � � ver 100 amps � � (Tnis sect(on neetl not be completetl if the permit is (or one huntlrotl (E100) or � - less). Dishwesher - ' � Solar Pi in - , I certily.tnat in Ibe p¢rfo�mance of Ibe work fo� whiCh this petm� _ P 9 Dfy¢f5 ❑i�id5 ❑EIECL�iC Pep¢I ( IS �SSl1Ctl� 1 snall' nat employ an person in any manner so as to become subject to the Drinking Fountains Solar Tank � Fan Motors 061 HP �7'h - 8 Workers' Comoe�� on Laws of Californla. , Date 519nature Floor Orains � Swimming Pool w/Spa F.A,U. � NOTICE: If, after making this Ueclaratlon, you shoultl become zub�ett to the � Ina Solar 09-15 HP Q�6-75+ Workeri' Compensation provlsions of t�e Lnbor Cotle, you must forthwitn Floot $inks � ' Urinal Fixtures � comply wlth such p�ovisions or this permit 5hali be tloemetl ravoketl. Microwave CON$TRUCTION LENDING AGENCV ' Gas$ervice OuUetS. Wa�erCloSet ' DeViCeBOxes I norqby aftirm tnat Naro is a constructlon lentling a9ency tor the pertormance Pole Light ot lho work fOr whith lnis p¢rmit Is issuotl (5¢ction 3097 Civ. C.) - Interceprors � Water Heater LenEar's Name - Outl¢t5 Range . Lenaer's AEaress � Kitchen Sink � Water Service � - OWNER BUILDER DECLARATION� � � ' SwiLCh¢5 . Sign I heroby at(irm that 1 am exempt from ihe Contractor's UcenSU Law tor the ' LavatOrieS � ' Garba e Di o5dl ' follo�ving reason (Sectlon 7031.5 BuSiness antl Proleszional Cotla: Any citY or 9 SP Standing Secti0n5 couqty whic� requims a p¢/mit lo COnst�uCt, alter, Improve, tlemoli5h o� �epair P-T�dp ' ' • - ' any structure, prior to its issuance, also requtres the aoP��ant br zucn permit Generator �0.5 KW �5-15 KW Trash C.ompacror to flle a signetl slat¢mCnt lhat he/she is Iicent¢tl pu�suant to the provi5ions o( ROOf D�diOS - " ' • .the Con[ractor's License Law (Cnapter 9(commencinq with Sectlon 7000) of Dlvi3ion- 3 Of t�e Bu51ne55 antl Prote55ion5 Cotle) ot Ihat he/iha is ezempt � , , . ' the�@1rOm anG lne basi5 b� lhe allegetl ez¢mption. Any violaliOn o1 SeCtiOn '. ' _ ' . 7031.5 by any applicant for a permi[ subjects the applicant [o a civil eenalty o� not more Nan five huntlretl tlollars (5500). � - � ' LJ I as owner oi th¢ property or my amployees with wages as tneir sole ' Reinspec[ion Fee � .$15 Issue Fee $ 3 COmp¢nsatlon, will tl0 Ne work, antl the St/ucW/e Is not Intentletl or offeretl R8in5p8CtiOn Fee §15 ISSUB F88 $ 3 for Sa1e (Section 7044, Business antl Professional Cotle: Tne Contractor's . MECHANICAL . FEE$ Liceni¢ Law tloes not apPIY l0 nn own¢/ of a p/operty who bulltl5 O� improves tnereon, antl wno tloes such work himselt/herselt or through his or her own � . DEVELOPMENTSERVICES REdUIREMENTS: . emp�oy ees, provitletl that such improvements are not in[entlatl or oHeretl tor Boiler . HoOd or Type I ❑ sale. II, however, the bullain9 cr improvement is soltl witnln one year ot com- . Canopy Type I I ❑ ZoninB APProvad By Date O�etlpn, Ihe owner will have the burtlen of proving h¢/ine tlIA n0t builtl Or im- Duct - Under Ground � • �rovp tor the purpose of sale). � Building Approved By Data LJ I, as owne� of the properry, am excluslvely COnt�actin9 with Ilcen5C4 con- DuCt - SlfuCtUf31 Refrigeration System AppllCetian ISsuBd By Det lractors to con5[ruct th0 proja[t $ectlon 7044, Bu5ine55 antl ProfeSSions Cotl¢: ' Tho ConVactor's �icensa L.aw �oes nol aoPly to an owmr of proporty who Duct - Ventilating ❑0.100,000 BTU ❑100,000 BTU builtls or Imowves thereon, antl wno contracts tor such pro)ects with a con- SUMMARV OF FEES vactor(s ticense pursuant to the Contractor's Lltensa Law). 1 am aware thal Exhnust System ❑ MWtiple ❑ System Repair/Alteration BUILDING PERMIT $ SMIP $ proof o� their Work¢r's Compensation insurance shoultl be provieetl to me. PLAN CHECK $ PERMIT ❑ I am exempt unCer SecUon B. 6 P. C. tor thiz reason Firepl/FacL BIt. ICBO � PLUMBING $ , ISSUANCE $ Dato Owner . Heating System & Ducting ' PLAN CHECK 25% $ ENERGV P.C. $' 1 herany certitv that i have reatl this appilcatlon antl stata that tne above ❑0.100,000 BTU 0100,0008T ELECTRICAL $� GRADING $ inb�matlon iz correct. I a9ree to comply with all city antl county ortllnances antl slato Iaws relaUn9 �o bulltlin9 construction, antl hereby authorize repre- ' . PLAN CHECK 50°6 $' MICROFILM $ senletives of t�is Uty to enter upon tho above-mentlonetl properly for � Inspactlon Pu I,' , / � Si9nature �C1�/ � 3la� Reinspection Fee S75 �aue Fae S 3 PLAN CHECK ZS% $ � ' CMF p865-46, rev. 4/84 White - Builtlin9; Canary - ApPliwn[: Pink - Accounting; Goltlenrotl - qsse55or 1� CONSTRUCTION AND PLANNING - � POOL & SPA APPROVAL$ Permit �Ih " Date Inspector AppROVALS Permit # Date Inspector •1. Temporary Electrical Service or Pole �� 52. Pool & Equipment Location � 2. Soil Pipe-Undrgrnd. � � � 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgr.nd. . 54. Forms 4? Electrical Conduit-Undcgrnd. ` 55. Elec[rical Bonding 5.'Steel Reinforcement - 56. Rough Plumbing & Pressure Test � 6i Elect"ricel UFER Grnd. 57. APPROVAL TO COVER-GUNITE � 7. Footings - ' .._ 58. Electrical Conduit-Undrgmd. 8: Foundation � "' - 59. Gas Pipe, � Undrgrnd., Test ' 9. Water Pipe-Undrgrnd. ,' � , 60. Backwash Lines, P-Trap, � Undrgrnd. - 10. Struaural 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-Fina� 16. Rough Elec[ric 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 Fleating & Air Conditioning FIRE DEPT. REQUIFiEMENT 20. Rough Factory Fireplace ' APPROVALS Permit # 21. Ducts,in Structure �70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23.'Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing , 73. Undergrnd. Storage Tank O Gas ❑ Oil ' 25. Roof Sheathing � 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame a�d 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 Condi[ioning S� 35. Final Gas Pipe-Test � 36. Hood or Canop'y � 37. Final Factory Fireplace 38. Final Plumbing , 39. Water Service-Final 40. Gas Service-Final i 41. Solar pomestio-Final - 42. BackflowPreventer , -^ 43. Backflow Irrigation . . 'Ir �• • 44. .Landscape Irrigation System �� . 45. Sound Attenuation � '�; � - 46. Handicap Regulations - � , 47. FINALSTRUCTURE�.&BUILDING . � 48. Special Requirements Completed � 49. Electric Release to Edison � ,! � 50. Gas Release to Southern California Gas Co � �� .• 51. CERTIFICATE OF OCCUPANCY �'� r No. Date „' �,- ADO��eant to lill in ail ipaces axcept those wit�in �eavy DorEer Iines antl si9n all appropriate tleclarations. , CiTY O�COSTA MESA.1 C�ON�STR CT1'ION PER}M�IT PERMIT TRACT, 1NO. LOT NO. UNIT NO. 2665 10/22/65 9aO� TL � Proje[ttlddr¢55 ��yS � I 1�QKI�Kf� L�= � � � �Z ~ l . . Applicant'SMailingAtld�es5 ��V Jy ��%6E TVPEOFCONSTRUCTION NEW /�.DD ALTERATION REPAIR ' ' . � ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p, �L . Zp�q Owner'sName �,1��/1�t1AQIL' Phone DESCRIPTIONOF ORK/USEO�BLDG. � Address �� /JMS� AJLSS CENTC.� .1i2 � �/•o� p/�L CONST.�w �T/ o " S Main Building: Accessory Building: Arch/Eng. LicenseNo. ' TYPEOFPER IT GRADING LJFOVNDAT�oN STRVCruRAL T Front � � . � - p Address � ❑ TENANT � ELECTRIGAL ❑ PLUMBING ❑ MEGHANICAL A Reer ' . ' N Contractor's Nam � L W ha�e Q •Z �Q ��OTHER . � C Right � • N /� �Si � OK.lFNG.L - �I1�iGG� �PAOJECTDESCRIPTION Sa.PT. oCCUPANCv K. , . _ G AAdreSslmailingl-�3C_� . . , CONSTRUCTIONTVPE VALUATIONS g Left ' � � � R Ciry License No. - 6 a�� , ZpNE GRADING CU.vDS. ACRES ping. Ref. �h � Parking Req./Provid2d' F LICENSE� CONTRACTOR DECLARATION � � 1 hereDy,attirm that 1 am Iicensetl untler provisions of Charter 9(commencing Remarks: " Planning NOtes: � . � � M wit� zection 7000j ot Dlvision 3 of t�e Business antl Pmtessions Cotle, ana T . my Iicense is in i I /orce antl etfect. � ^� �O� � ' ' ' ' � ' � S ❑C8fI5C CId55 � pSC NO. �� - � Date ��"ZZ'�S Si9�ature � - � PLUMBING - FEES ' WORKERS' COMPENSATION DECLARATION � Ba� Si�k � ShOW¢�5 ELECTRICAL , ' FEES : I hereby atfirm t�at I have a certitica[e of tonunt to self-Insura or a cerUfiwte ' of workers' Compensytlon Insurance,•or a certltietl copy thareof (Section_ gackflowPreventec . � _ Service.Sink, � � 3800; Lab..C.) ' : ' -' � - - -- AutomaticWasher Transformer ❑ 15-SOKW ._ _ Policy No. SFYSZZ.S I�r ' COmpany FiQ.L/1%/NT Backflowlrri ation $ewerCa ❑ 50+KW � f„i , 9 P onstruction ole Sub. ' � [� erti(ied copy i5 hBrGby futnishetl. 1 .G Cer�tietl copy i�qed witn tne ciry Bu11pJn D v'si Bathtubs Sewer Connection � ('qoking Unit � Meter ❑up to 100 amps Date 0•LL-Y qpp��ant {�L EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Cld�i(i¢�5 $018! CAII¢Ct0�5 Di5hwd5hCf � ! 0 amps, , (Thls SecliOn neatl not be completEtl it the permit is fo� one hunCretl (5100) or , . . ._ _ _ _ iess). -� � Dishwasher Solar Piping Dryers �Gas ❑Electric u anel I cerNry that in lhe performance of tne work for w�ich this perm�t is issuetl, I . shall not employ any person in any manner so as to become subject m the . Drinking Founta�ns Solar Tank Fan , Workers'� Compensati0d Lnws of Califomla. . Motors �61 HP Oi'h - 8 Date' Signaturo Floor Drains Swimming Pool wlSpa F.A.U. - Inc. Solar �9�15 HP �16-15+ NOTICE: It, atter making this tleclaration, You 5houlU become subject to lha Workers'� COmpensa[IOn pwvi5ion5 ot [he Labo� Cotle, you must forthwith FI00� SinkS ' � Uli081 ' Fi%tU�¢5 . comply with such orovisions or this pormit s�all be Ueemetl revoketl. � -- -� -. Miaowdve _ CONSTRUCTION�L�NDING AGENGY CoatSeryi<e OUtl¢ts -WatClCbsei _ DeviteBoxeS I horeby afflrm that tqere ii a construcUon'lentling agency tor'tbe perrormance� , Pole Light Of lhe wo�k fo� Whith Ihis permit Is I55ultl (Sectlon 3097 Civ. C.) Int¢�C¢pt0�5 - Wdt¢� H¢d[E� Outlets ' Range � Lentler's Name Lantler's ACtlress ' � Kitchen Sink � Weter Service Switches Sign OWNER BUILDER DECLAR%1TION� � ' ' I M1e�aby af�irm [hat I am exampt from [ha COnlrac[orY I:ICCnSe Law loi th¢ Lavatories � following'reason (SOCtion 7031.5 Business antl Protez5ional Cotlo: Any city or , Garbage Disposal Standing Sections counly which r¢qW/B5 a p0�mit t0 cOnstru<l, alter, improve, tlemolish or �epalr � P-hdp any st�uGture, p�lo� tp its'I55udnce, al5o reqWres the aOP�«ant for Such�perm{t Generemr O0.5 KW �545 KW T�dSh COTpdCtO/ to fi�e a slgnetl statement Ihat ne/she is Ilcnnsetl oursuant to the orovisionz of pOof Drains the ConVactor's License Law (Chap[er 9(commencing wlth Sactlon 7000) oP � DlviSion 3 0/ tba BUsineii antl Professlons Cotle) or tnat no/sna is exempt . -themtrom and lhe basis for t�e allegotl oxomptlon. Any vlolatfon o/ Sec[ion • ' - � 7031.5 by. any applitant for a Pe/mil subj¢Cts [ha applitant lo a civil �enalty ot not more �han five huntlretl tlollars (5500). 1, as owner oi ihe property or my employees witn wa9os as their sola Heinspection Foe $15 Isue Fea ' $ 3 compensation, will tlo tne work, antl tha slructure is not intantletl or offerna ,. Reinspectian Fee $15 luue Fee $ 3 tor sale (Section 7p44, Buslness ana Professionai Cotle: Tna ConVactor's �MECHANICAL FEES License l. w tloes no( appry to en owner ot a property wno bullUs or improves - thereon; antl wno tlbez such work himseH/herseH or thmugh hls or ner own Hood or Type I ❑ DEVELOPMENT SERVICES RE�UIREMENTS: employees, provitletl tnal such improvements are not IntentleC or ottere� for - Boilet sale. 11, howevor, tha builtlln9 cr improvoment is zoltl within one year of com- . Canopy Type II ❑ Za^��9 APProred By Date pletion, the Owner w�� have tha burtl¢n ot prOving �e/She GIE nOt bulltl or im- DuC[ � U�dC� G�OUnd rove tor che purposo ol sale). Buildin8 APPraved 6y Date � I, az owner af th¢ proverty, am exclusively contractlng with Ilcansea con- Duct - Structurel Rafrigeration System Application Issued 6y Date �� tractorsto construcl thn project (Sectlon 7044, Business antl Profesilons Cotle: Tne Contractor'S Litens¢ law doaz not avP�Y to an owner o� property wno Duct- Ventilating � ❑0-100,000 BTU ❑100,000 BTU SUMMARV OF FEES builds or Improves thereon, anE who tontracts ior such prolects with a con- . ' tractor(t ❑censo pursuant'to the Contracror's License Lnw). � am aware that Exhaust Syscem ❑ Multiple ❑ System Repair/Alteretion BUILD WG PERMIT $ SMIP $� ' proof o� thelr Worker't Compensation insurance shoultl be provltletl m me. PLAN CHECK � $ PERMIT ' ❑ I am exempt untl@r Section B. & P. C. for this reason Firepl/Fact. BIL ICBO # � PLUMBING $ ISSUANCE § Date Owner Hea[ing System & Ducting , � ENERGY P.C.- $ PLAN CHECK 25% $ I hereby certiry that.l have reatl mis aDP��ation anE scate that tha above ❑P100,OOOBTU_�100,0008 - ELECTRICAL $ � GFADING ' S Intormation is mrrecL I agree to complY with all tlty antl county ortllnances antl state laws relatin9 to builtling constructlon, antl nereey autnorize repre- PLAN CHECK •50% $ MICROFILM $ sen[atives ot thi5 qTy f0 entel upOn [hG dbOve-mGntionGG property for insoection ourimag; MECHANICAI. $ _ Si9nature d/ //,(Jnut�JYfR�/ Date �D�ZT-f� . TOTA� FEE $ Drivers' u�� 55 � �— Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865-46, rev. 4/94 White - Builtling: Canary - Applicant: 7�nk - Accounting; Goltlenrotl - Assessor ' _ . ... " CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit# Date Inspector ,qppROVALS Permit# Date � Inspector 1. Temporary Electrical Service or Pole //�� v 52. Pool & Equipment Location . 2. Soil Pipe-Undrgrnd. , � 53. Steel Reinforcement ' 3. Electric'al 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. 8.'Poundation, , - 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor SYstem 61. APPROVAL TO DECK 11. Proper[y.Sewer Line & House Connec[ion 62. Backwash & Recep[or-Final 12. Sewer Cap ; ; 63. Heater & Vent-Final 13. Roof Diains � . . 64. Plumbing System • Final 14. Rough Plumbing 65. Electrical-Final ' 15. Rough Electricat-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 Cei�ing 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. DuCts, in Struc[ure � 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 � Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling �Structural) & Monocoat 75. Dry Chemical � 27. Frame and Flashing � 76. Dry Standpipe 28. Lathing?& Siding 77. FIXED SYSTEM FINAL � 29. Insulation � 78. FIRE 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 , �G Notes: 34. Final Heating & Air Conditioning � ' , . 7'' 35. Final Gas Pipe-Test � � 36. Hood br Canopy 37. Final Factory F,ireplace ' 38. Final Plumbing � 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final � � 42. Backflow Preventer � �� :� 43. Backflow Irrigation . . . . i -' 44. .Landscape Irrigation System J �� ';'� � i 45. Sound Attenuation '��- . 46. Handicap Regulations � � ' 47. FINALSTRUCTURE'&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 exceo� enosa within neavy boraer lines ane sign all aopropriate tlecbrations. CITv oF COS7A MESA CONSTRUCTIO PERMIT �'"" /_� "��"' "`"' ""' "'"' "'"" '�" Project Address 3 y4s `�A 10/ f�_� 1�I�' �� ' ' �Applic3nY5 MJilipg Add�C55 LB03 So. C�lAa�� /�y6� q3%%� TYPE OF CONSTR CTION '� NEW ADD ALTERATION REPAIR p ❑ CONVERSION ❑ OEMOLISH ❑ OTHER A p *, Owner's Name LCCj/S /�.s1�< Phone DESCRIPTION OF WORK/USE OF BLDG. Address � � - S Main Building: Arch/Eng. � 6L a icense No. � � � E � �" TVPE OF PERMIT GRADING FOUNDATION � STRUCTURAL T FIOnt ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ ECHANICAL B Address S � I�A �OTHER F%/7� �j/��G,�N�� y$'"/�s�/ A Rear ' Convactor's Nama «��P��✓�L�� Phone �4j.�S - - PR ECT DESCRIPTION SO. FT. 2� � oCCUVArvCv C Right Addreulmailing1�03 S 0��7�'f�--'-+^Jp 9;.� - —� —� •K �� I'L _ CONSTRUCTION TVPE VALUATION $�� O � g Left City License No. � 7 ZONE GRAOIN CU. VDS. i ACRES � - � LICENSED CONTRACTOR�DECLARATION Ping. Ret # � 1 he�eby afiirm tnat I am Iicensetl untler provisions of Charter 9(commencing Remarks: Q� Planning Noles: ' ' with sec[ion ]000) ot Divlslon 3 ot the Buslness antl Protessions Coae, ana my license is i W torce antl eftect. ' License Class� ce No-3��8 Date � �.D'� 'Signature ' PLUMBING FEES � WORKERS' COMPENSATION DEC RATION Bdt Slnk ShOwerS . hereby aitirm tbat I have a certifi e of consent o self-insure or a cerHficate ' ' ' workerz' Compensation'Insu nce, or a ce itietl copy thereof (Sectlon' gackflowPreventEr ServiceSink. � ..800, Lab. / q AUtomatic Washer Pollcy No. ��w �Zo�� Company 'dt • �. Backflow Irrigati0n Sewer Ca � ' ---.-- P � Construction PoleSub. �Certifietl Copy is her¢by /urnizhetl. - � Certi�tls^ogjs_��iatl wilh the city Bulltli iv Bathtubs Sewer Connection i Cooking Unit Date �� Q�P APPlicant � � EXEMPTION.FROM WORKERS' COMP SATION DE AFATION Clarifie�s - . Solar Collecmrs - -- � - - - � - Dishwasher- ' � - (This section naetl nat tie <ompletetl if [ permlt is tor e huntlretl (.5100j or � less). , ' Dishwasher . Solar Piping Dryers ❑Gas ❑Electric I c¢rtify lhal� in lhe pertormance Of th0 work tor whi [his p¢rm�t ii ISSu¢tl, I � shall not employ any person in any manner so•as to become subject to�the Drinking Fountains ' Solar Tank � ' Fan � Workers' Compensation Laws ot California: , oate Si9nature ' Floor Drains Swimming Pool w/Spa� • F.A.U. 'NOTICE: 1/, after making this tleclaration, you shoultl become 5ublect to Ihe ' - Workers' Compensation Orovi5ion5 ot thG Labor COtlB, you muzt tOr[hwith ' ' FI00! $inks � Ulindl � ' FixtulCS, '� comO�Y "�'��h such �proviSiOns or tltis, permit' shall be tleemed �evoketl. • CONSTRUCTION IENDING AGENCV. +• " Gas$erviCE 'Outlet5 � Watef loset � � I her¢by afflrm that there is a const�uctlon lentling agency fo� the performance �+ Device Boxes ot Ihe work tor which this permll i5 isSuetl. (SeGtlOn. 309] Civ. C.) - - . l.enaer's Name Interceprors Water Heater � Outlets; }� •- Lenaer's Aaaress '' � Kitchen Sink Water Service Switches �•.. '. � Y OWNER BUILDER �ECLARATION � ' I her¢by affi�m that 1 am azempt from the Contracto�'s License Law for the LBvdtO�i¢5 � � AuLO�W25h � followinq rea5on (Sectlon 7031.5 Businezs antl Protessional Cotle: Any city or Garbage Disposal _ tounry ,which requires a vermit lo construct, alter, improve, aemolizh or repair p—Trap . � Laundry Trays � � Generator O0.5 KW 05-1 any sVucture, prior to its itsuance, also requires the applicant for such permit � to tile a signetl ilatemen[ that M1e/she is Iicensetl pursuan[ to the provisions ot Roof Orains ' � • the Contracror•s License l.aw (Chap[er 9(commenting wi[n Section 7000) of " � ' 7ivision 3 ot lne Buslness ano ✓roressions coae) or inac ne�sne is examp� �erefrom antl the basis tor the allegetl exemptiOn. Any vlolation ot SecUon 031.5 •by any applicant for a permit subjects the applicant to a clvil . �eenalty of not more than tive huntlretl Uollars (y500). _ - LJ I, as owner oi the property or my emo�ovees with wages as iheir sole mmoensauon, wiu do me work, antl the structure is�not infenaetl or o((eretl for sale (Settion'7044, Buziness antl Protessional Code: The Con[ractor's Licenze I.nw tloes no[ apply.t0 an owne� of a prop¢rty who builtls o� Imp�oves � thereon, antl who tloes such work nlmselt/herselt or throu9h his or her own em0loyees, Owvitled tha[ such improvements are not Intentled or offeretl for sdle. If, M1ow¢v¢r, the bull01n9 or improvement is soltl wlthln one yea� o( com- pieHon, the owner will have [he bu�tlen Of provinq h¢/She tlitl not bulltl or im- prove tar the purpose ot sale). • � ❑ I, as owner of the property, am exclusively contracting with licensetl con- tractOrs to construct the projCct (SectiOn 7044, Bu5ine55 antl Profe551on5 Cotle: The Conbacror's License Law. tloes not apply to an owner of'properry who ' builas or Improves thereon, antl who contracts tor such proje<ts witn a con- traclor(sl license pursuant to the Contractor'S License Law). I am aware (hat' proof of thelr Worker's Compensation Insurance snoultl be providotl to me.' ❑ I am exempt uritler Sectlon B. & P. C. for this reason Oate Owner I hereby certify that I have reatl Ihis application antl stale that thc above ' Information Is wrrecL I agree to comply with al1 city antl county ortlinan<es antl 5[a[e laws relating to �uiltliny const�uclion, antl hereby authorize rep�e- � sentatives ol [M1i5 city ent ( upJ he above-mentionetl �O�operly foff inspection ouroases. � � �� _ (p Signature � Reinspection Fea 515 Boiler - Duct - Under Ground . Duct-Strucmral '� Duct - Ventilating - Exhaust System � Multiple ❑ Firepl/Fact Blt. ICBO # �� Heating System & Ducting , ❑4100,000 BTU 0100,000 BT t Drivers• Ucense 55 � I I Nei�spection Fee , I $15 CMF 0865-46, re . 10/fl4 White - Iltling; Canary - Appllcant; Pink - Atcoun[ing: Goltlenrotl - Assessor laue Fee- Hood or Typel� ❑ � Canopy TypelY ❑ � � Refrigeration System � � ❑aioo,00aeTu Oioo,000ai System Repair/Alteration • FireDampers � Registers ' . 1 " � $ 3 l Rainspec`tian Fee � • � , , ' Issue Fee $ 3 BuildinB APProved By, � 9803 7/2'I%86 Zone -ActessoryBuilding: � � Parking Req./Provided '. ELECTRICAL • Transformer ❑ 15-50 KW ❑ SO+KW Meter ❑up to 100 amps Meter ❑over 100 amps � Sub Panel Momrs061 HP�1h-8 Inc.Solar �9-15 HP �i6-15+ � r Microwave ' . . Pole Light � . Sign • � ;5tanding Sections � ' Trash Compactor ' . � " I $15 I � I� Issue Fee CESRE�UIREMENTS: -�• 1:918.99 • Tl � Z' O N 1 N G R E � Q M . T S FEES �$3 � � 5 M A F�FEES ' // BU�LDING PERMIT $ � � �,�SMIP . $ L7.d" % � PLANCHECK $�. PERMIT PLUMBING $, � ' :�ISSUANCE S i " - PLAN CHECK � 25%� $ - ' ' �ENERGV P.C. $ � ' ELECTRICAL $ � GRADING $ - PLAN CHECK 50% $ ' � �� MICROFILM $ � MECHANICAL $ � TOTAL FEE $ PLAN CHECK 25% $ [.Q/� CONSTRUCTION ANDPLANNING APPROVALS Permit# 1. Temporary Electrical Service or Pole 2. Soil Pipe-Undrgrnd, 3.� Electrical Conduit Utility-Undrgrnd. 4. Electrrcal Conduit-Undrgrnd. 5. Steel Reinforcement 6. Electcical UFER Grnd. . . � 7. Footings • � � 8. Foundation 9. Water Pipe-Undrgrnd. 10. Structurel Floor System 11. Property Sewer Line & House Connection 12.,Sewer Cap . � 13. Roof Drains � � 14. Rough Plumbing � 15. Rough Electrical-CqnduiL 16., Rough Electric Wiring , 77. Rough Wiring Sign � 18. Rough Electrical-T Bar Ceiling 19. Rough Heating & Air Conditioning 20. Rough Factory Fireplace ' 21. DuCts, in Structure 22. Ducts, Ventilating 23. Gas Pipe-Rough & 7est . 24. Roof Framing � 25. Foof Sheathing - 26. T-Bar Ceiling (Structural) & Monocoat 27. Frame and Flashing ' 28. Lathing & Siding 29. Insulation - 30. Drywall Nailing - 31. Plaster Brown Coat 32. Electrical Power Meter-Final 33. Final Electric 34. Final Heating &� Air Conditioning 35. Final Gas Pipe-Test � ' 36. Hood o� Canopy 37. Final Factory Fireplace � 38. Final Plumbing � ' 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer �� 43. Backflow Irrigation :. _44. Landscape�lrrigationSYstem 45. Sound Attenuation �46. Handicap Regu�ations ;47. FINAL STRUCTURE & BUILDING � 48. Special Requirements Completed _4.9. Electric Release to Edison - - � '50. Gas Release to Southern California Gas Co i51. CERTIFICATE OF OCCUPANCY Date Date e P00. SPA Inspector p�ppROVALS Permit# 52. Pool & Equipment Location 53. Steel Reinforcement � 54. Forms 55. Electricat Bonding � 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVER:GUNITE 58. Electrical Conduit-Undrgrnd. - 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines, P-Trap, � Undrgrnd. � 61. APPROVAL TO DECK 62. Backwash & Receptor-Final , � 63.- Heater & Vent-Final � 64. Plumbing System - Final 65. Electrical-Final - � . -66. Solar SYstem-Final 67. Fencing & Access Approval �• 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # 70. Underground Hydro 71. Product Piping O Gas ❑ Oil 72. Underground Flush � 73. Undergrnd. Storage Tank � Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical � 76. Dry Standpipe 77. FIXED SYSTEM FINAL � 78. FIRE PREV. FINAL � � HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION • 80. FOOD CERTIFICATE ISSUED Notes: [', r�-j � s.a....N ._ M.L...ew i � -L._Li... n1G w S.eerauate � W 3"��1lwr'�kS - 1°'��w.r !f9 �� ' �•r�et� ��hd� �1'�1'�� t Date � Inspector N�� e Aov��ant to fill in all svaces except those wltnin neavy eoraer Ilnes ana si9n all avvropriate tleclarations. CITY OF COSTA ME�SfA'1 ACONSTRUCTION PERMIT Project Address 5�7� �A��A [/i� 9�%�� Applicant's Mailing Adtlress � i�.3 S, 02AA1G� R UE �f(Xi Owner's Name ��kQ -�0/� V�ti��hone 1�'� Address .�� C�+`;� fl� � N�°W�bRT �79� CA 97//�' Arch/Eng. License No. Address � �Z� Contrector's Name �NK�� Phone Addresslmailingl��3 S. CXM,JL�iF RI.�' �{�C.a 937ZS City License No. �3 g3 YZ LICENSED CONTRACTOR DECLARATION 1 M1ereby atfirm that I am Ilcensetl untle� p�ovi5ion5 oi Charter 9(commenCing with section 7000) a1 �ivision 3 of the Buiiness and Grofessions Cotle, antl my ncense is �n tuu �orce and enect. -�g930� License Class — " cpnse o. Date L+�Z�'P+� Si9nature WORKERS' COMGENSATION DEC ARATION � ' here�y affirm tbaLl have a certificate ol consent t If-insure or a certiTicate workers' Gompensation Insurance, or a certifletl cooY thereoi (Settion ,00. Lab. � , �. �+ Policy No. �`—Z7U65/9�S Company N J. .` B Certifietl copy is hereby lurnishetl. �� Certlfietl copy is tiletl wlth the tlty Buil g Ivi3.'yp�n. � oaie �-2/-83 aoaiicani �.]/' � /'� � EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Tnissection neetl not be completetl If the permit Is for one huntlretl ($100) �or less). I certi(y Ihat in the Oe�fo�manCe of Ihe work for which this pe�mit is ISSuetl, I shall not employ any p¢r5on in any manne� so as to b¢com¢ SubjeC[ to the Workers' CompenSdtiOn I.. ws ot Calitomia. ' Date Signature NOTICE: If, after making [his tleclaration, you shoultl become subject to the Workers' Comp¢n5ation p�ovisions ot thC Labar Cotla, you must for[hwith comply wilh sucn provi5ion5 or tnls Oe�mit shall be tleemetl tevoketl. CONST0.UCTION LENDING AGENCV ' I nereby affirm that there is a construction lendin9 a9ency for che pertormance ot the work tOr which tM115 permit is ISsuetl ($ection 309] Civ. C.) L.entler's Name �entler's AEtlress OWNER BUILDER �ECLARATION I nereby a/8rm thal I am exem0� f�om the Contractor's Ucense Law tor the followin9 reason (Se<tion 7031.5 Buziness antl Professional Cotle: Any city or county whlCh r¢quires a permlt to cOnst�uGt, alt¢r, improve, tlemolisM1 or rCpair any structure, prlor to its issuance, also requires [he applicant tor such permit to file a Signed slatement that he/she is licens¢tl pursuant lo th¢ Provision5 of the Contraclor's License Law (CM1apter 9(commenung with Sectlon ]000) of Oivision 3 of the Business antl Pro�estions Cotle) or that he/sne is exempt " erefrom antl Ihe ba5i5 lor the allegetl exemption. AnY violation ot Section 131.5 by any appllcant tor a Pe�mlt Subjects th¢ applicanl to a civil enalty of �OL TO�¢ [M1d� IIvC hUntlf¢tl t1011d�S (§500�. � I, as owner of the prop¢rty or my employeCs with wage5 as tnei� sole comoensation, will tlo the work, antl the structure is not intenaetl or oi(¢retl for sale (Sectlon ]044, Busine55 antl Professional Cotl¢: The Con[ractor's License Law tloes not apply [o an owner o( a prope�ry who builtls o� impiove5 thereon, antl who tloes such work nimself/nerself or throu9h his or her own employ¢e5, provltletl tnat zuch ImOrOvement5 ar¢ not intentletl or olfereU tor Sale. If, however, th¢ builtling or ITP�ovement is Soltl within on¢ Yeat of com- pletion, ine owner will have the burtlen of Provin9 he/she tlltl not builtl or im- �rove tor the purposa o/ sale). I, ds own¢r OI tlte prOperty, am ezclu5ively mnlraCting with licensetl con- tractors to consV uct the project (Section 7044, Business antl Pro(essions Cotle: The ContractoYz License Law does nol apply to an owner of property who builtls or improves lhereon, antl who conVacts tor such projects wifh a mn- tractor(5) IicenSe pu/SUant to lhe Cont�attor'S Llcense Law�. I am aware that proof of their Worker's Compensatlon Insurance shoula be provitletl to me. ❑ 1 am exempi untler Section B. & P. C, tor this reason Date Owner _ I nereby certify tha[ I have reaG lhl5 information.is correc(. I agree to compl antl slate laws relatl�Q [O}� uiltling con5 s¢ntatives ot thi5/City �/e�l.an upOn Siqnature � � D�ivers' Licen or 55 � — n an0 stdt2 tnat th¢ above city antl county ortlinances dntl he�eby autho�iEe repre- ve-mentionetl Oroperty for - l.J l/ TYPE OF CONSTRUCTION � NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TVPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTV RAL ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL ❑ OTHER - PROJECT DESCRIPTION SQ. FT. OCCUPA/N�C/V��_ CONSTRVCTION TYPE VALUATION § i,X. CC�Yi ZONE GRADINGCU.VDS. ACRES Remarks: . iui n:.1n � T .. A.. O //i Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers . Drinking Fountains Floor Drains Floor Sinks Gas Service � Outlets Kitchen Sink Lavamries � Roof Drains Showers � Service Sink Sewer Cap Sewer Connection � Solar CollectOrs Solar Piping ' Solar Tank � Swimming Pool w/Spa � Urinal Water Closet Water Heater Water Service' Auto-Wesh FEES Reinspection Fee � $15 � � Isue Fae � S 3 Boiler Duct � Under Ground Duc[ - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact Blt. ICBO # Heating System & Ducting ❑ ai oa,000 eru O � oo,000 eT Reinspection Fee � $15 CMF 0865-46, rev. 30/84 White - Bu��tling; Canary - Applicant; Pink - Accounting: Golaenrotl - Assessor Hood or Typel � Canopy Type I I � Fefrigeration System ❑o-ioo,000sru ❑�oo,000 System Repair/Alteration F ire Dampers Registers Issue Fea $ 3 A.P. � ' ' S Main Building: E T Fronc A Rear C Right SLeft Ping. Ref. # Planninq Notes: Aummatic Washer Consvuction Pole Cooking Uni[ ' Dishwasher Dryers ❑Gas ❑ Fan ; . Fixtures Device Boxes Outlets Swimhe5 Garbage Disposal Generetor �0.5 KW Fee 7148 10/09/87 2one Accessory Building: Parking Req./Provided 517010 TL ELECTRICAL . FEES Transformer ❑ 15-50 KW ❑ 50+ KW Meter ❑up to 100 amps � Meter ❑over100amps � Sub Panel � . � � Motors �0-1 HP �1 h� 8 Inc.Solar �9-75 HP �i6-75+ Microwave Pole Light fiange Standing Sections 5 KW Trash Compactor $15 luue Fee DEVELOPMEN7 SERVICES REQUIREMENTS: Zoning Approved By��i Building Approved B� / //-� �- $ 3 Z O N I N G R E 0 M T S � SUMM Y OF FEES �` � BUIIDING PERMIT $ �� SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ' ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $- � ELECTRICAL $ GRADING $ � PLANCHECK 50% $ MICROFILM $ ��/7�� MECHANICAL $ � TOTAL FEE $O!/__�E� PLAN CHECK 25% $ _ � CONSTRUCTION AND PLANNING � . POOL & SPA � APPROVALS Permit # Date Inspector qppROVALS 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 Condui[-Undrgrnd. 8. Foundation 59. Gas Pipe, � Undrgrnd., Test � 9. Water Pipe�Undrgrnd. 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 63. Heater & Vent-Final 13. Roof Drain; 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. POOUSPA SYSTEMS FINAL ' 19. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT � i 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro ' ` 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush � 24. Roof Framing 73. Undergrnd.StorageTank.O,Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro v 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe � ' 28. Lathing & Siding 77. FIXED SYSTEM FINAL �' g�' 29. Insulation 78. FIRE PREV.'FINAL � � 30. Drywall Nailing' HEALTH DEPT.. REQUIREME T 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 . -"" t 37: Final Factory Fireplace . . � � 38. Pinal Plumbing „ � , . r. :39 � Water Service-Final „� , . . �. 40. Gas Service-Final L � �47. Solar pomesticFinal . _ 42. Backflow Preventer - � ! ,. �43. Backflow Irrigation ,� ' " 44. Landscape Irrigation System . . • : � 45.�Sound Attenuation . ' - • � � , 46. Handicap Regulations � , , ' . 47. FINALSTRUCTURE&BUILDING .- . 48: Special Requirements Completed , � -� 49. Electric Release to Edison . 50. Gas Release to Southem Califomia Gas Co , ' - 51. CERTIFICATE OF OCCUPANCY �_ No. Date