HomeMy WebLinkAbout2722 SAN CARLOS LN - Building Permits ,• ^4 T a
. . ` CITY OF COSTA MESA
4 ail BUILDING DIVISION -
>
4-a..r..� • DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
F 1 PERMIT
J' ria Stte•thig no e4i /01-01288 •
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2722 SAN CARLOS LN Status: ISSUED
Suite: Applied: 08/17/2001
Vicinity: Issued: 08/17/2001
Parcel Number: 14155616 Zoning: R1 R1
Applicant: VALVANO, DOMENIC &AUDREY ISSUED BY:
Address: 2722 SAN CARLOS LANE, _
„v -Phone: 714-668-1252
COSTA MESA,CA - Zip: 92626 ,
/ i _ _
Owner: VALVANO; DOMENIC 8 AUDREY - ,
Address 2722 SAN CARLOS LANE -- ,
Phone: 714-668-1252 ,
COSTA MESA;CA Zip: 92626 -
Contractor: '
Address: - . "
Phone: - ,
Zip: License:
t.
Arch : Eng: -
-
Address: - - . Address:' -
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT _
/ CONSTRUCT 285SF GAME ROOM ON THE LEFT SIDE OF THE HOUSE. ,
FEE SUMMARY
Plan Check: ' $254.31 Calc Valuation: $24,367.50
Permit: $391.25 - - - - Claim Valuation: $0.00
SMIP Res: $2.44
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00 .
Total: $648.00 ,
PLANNING &ZONING
SETBACKS v - /
MAIN STRUCTURE Front 0-0 Rear 32-0 Left 5-0 Right 0-0
ACCESSORY Front -,0-0 ' Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 ' Required: ' 0 Proposed: 0
NOTES:
•
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92) /
EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 160 days,or if work is suspended orabandoned
for a period of 180 days. .
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result In the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626 //
•
244848(5/00) •
DECLARATIONS ' • y'„”
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under gspalty of perjury one of the following declarations:
I
❑ I have and willh this ea Is issuete of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit Is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued.
My workers'compensation Insurance carrier and policy number ere:
Carrier: Policy Number:
(This section need not be completed if the permit Is valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is Issued,I shall not employ any person In any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED
THOUSAND DOLLARE(S100,000),IN ADDMON TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.# Class#
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to Its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors license Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a perm*.
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am �:r-VELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors Licen � •.'s not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant to the Co.r� cense Laws.).
i m exempt A!!saJ Business and Professions Code for this reason: /} q —7 O t
e: Ar ./ / LDbte: y /7—
er ID verified by drivers license.e. O es 0 No
alp nse No. -- - Ex res:dZ G(t• O's
r
Verification of Ownership by(type of document,i.e.-property tax bill or deed).
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure). _
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater then a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feat of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apermit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes 0 No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health end Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No
8 (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws end city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND ' •TION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct. I agree to comply wit II st. •�' . end city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property • sp I j.• agree not to occupy or allow occupancy of any building authorized by this permit until final inspec' "�
Sign: •reaewner(s) Date
And/Or Authorized Applicant Date
CODE 6 INSPECTION TYPE PATE Pal POE INSPECTION TYPE DEE jNTmALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Signm 222 Final Site —yam-
204 Final Demolition 250 Final Building/Occupancy '�'/A'6nf/r�1'—
at -
• CITY OF COSTA MESAe 4
►. BUILDING DIVISION ,r,
>i�_o„ .A1 DEVELOPMENT SERVICES DEPARTMENT PE/MIT NUMBER
114.1 fl PERMIT
J' ra B01-01546
(714)754-5273 • Fax(714)754-4856 • www.cl.costa•mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 2722 SAN CARLOS LN Status: ISSUED
Suite: Applied: 10/01/2001
Vicinity: HOUSE&ATTACHED GARAGE Issued: 10/01/2001
Parcel Number: 14155616 Zoning: R1 R1
Applicant: VALVANO, DOMENIC ISSUED BY:
Address: 2722 SAN CARLOS LN ,. '
„� Phone: (714)668-1252
COSTA MESA;CA `, - Zip: 92626 „"/
'
/„ii''i
Owner: VALVANO;DOMENIC &AUDREY..
Address 2722 SANCARLOS LN
- - Phone: (714)668:1252 - ,
,COSTA MESA;CA - Zip: 92626 -
Contractor `OWNER-BUILDER
Address:
Phone:
Zip: License: 0 - •,
Arch : - Eng:
Address: r
, _ • Address
- , . - Phone: Phone: - '
Zip: - -License: License:
SCOPE OF PERMIT
REROOF EXISTING SINGLE-FAMILY RESIDENCE&ATTACHED GARAGE(23 SO).TEAR OFF EXISTING ROOFING, .
INSTALL 30#FELT UNDERLAYMENT,&REROOF WITH 25 YEAR COMPOSITION SHINGLES. '
FEE SUMMARY
Plan Check: $0.00 - — - - Calc Valuation: $2,000.00
Permit: $69.25 - Claim Valuation: $z,006.Oo
SMIP Res: $0.50
•
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: ;$69.75. - .
PLANNING &ZONING
SETBACKS ' , / ,
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 ' - Rear' 0-0 Left 0-0 Right 0-0
PARKING Existing: -0 Required: 0 Proposed: 0
NOTES: '
•
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
2446-46(600)
DECLARATIONS ,
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit Is issued.
❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is Issued.
My workers'compensation Insurance carrier and policy number are:
Conder: Policy Number.
(This section need not be completed It the permit Is valued at one hundred dollars(Sf 00)or less,)
❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES MD CML RNES UP TO ONE HUNDRED
THOUSAND DOLLARS(5100.000).IN ADDMON TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lic.4 Class 4
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,CMI Code).
Lenders Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit
to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of DMsion 3 of the
Bu ins and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
I1 `the applicant to a civil penalty of not more than five hundred dollars(5500).):
Os owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or Improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors Lice , Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
license pursuant tot '"ractors License Laws.).
❑ I am exam..., Business end Professions Code for this reason:
/Signature: / iL./.7 �[El. �_/). —�7
Owner ID Verified by drivers license. 0 Yes 0 No Drivers Llcen o./
Cafret2T -j- 6\-
Verification of Ownership by(type of document,i.e.-property tax bill or deed): 1 —
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more then thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the Calilomia Health and Safety Code requires.with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Flre
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Cade been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application ajaPermit for such construction or modification
from the South Coast Air Duality Management District or from any other air pollution control district or agency? Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
-7 If a permit from the South Coast Air Duality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8- (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHOR r�tl•• OF ENTRY:I certify under penally of perjury that I have read this application and state that the Information given is
correct.1 agree to comply with all stat: :ws J . .. ordinances relating to building construction,end authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspe
o• p Y' is .gree not to or allow occupancy of any building authorized by this permit until final inspection.
S e nl ture Ofure Of Legal (s) Date7_12 k
And/Or Authorized Applicant Da e
LODE I INSPECTION TYPE all 8I1AtS LODE( INSPECnoN TYPE MI a5
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1268 Pool Spa Final ,�J 208 Final Plumbing
200 Final Re-Roof WIZ RAI ?r,I 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
204 Final Demolition 250 Final Bullding/Occupancy
.40-3
' CITY OF COSTA MESA
'rte' BUILDING DIVISION
>:l DEVELOPMENT SERVICES DEPARTMENT PERM UMBER
F r PERMIT
J
4alitPonanos#
MM_OOd9f1
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
MECHANICAL PERMIT
Job Address: 2722 SAN CARLOS LN Status: ISSUED
Suite No Applied: 08/17/2001
Issued: 08/17/2001
Vicinity: /�/]_,
Parcel Number: 14155616 ISSUED BY: V •
Applicant: VALVANO, DOMENIC.&AUDREY
Address: 2722 SAN CARLOS LANE /
Phone: 714-668-1252 /
COSTA"MESA,CA . Zip: 92626 � �
/ / ,v
Owner 1 VALVANO, DOMENIC &AUDREY -
Address:, 2722 SAN CARLOS LANE
' Phone: 714-668-1252
COSTA MESA,CA Zip: 92626
Contractor: - , ,
Address: - - - ,
" , _Phone: '
Zip
- _ License: " / "
SCOPE OF PERMIT
REF B01-01288. .
1 ALTER DUCT SYSTEM. .• - - , - -
FEE SUMMARY
• Quantity - Quantity
ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0'
Inst FAU<100 k BTU $0.00- -0- - • • Repair/Alt Refrigeration Unit $0.00 0
Inst FAU>100 k BTU $0.00 0 - Ventillation System $0.00 0
Repair/Alt Cooling/Heat $13.70 1 Evaporative Cooler $0.00 0
Inst/Rep.Recess Wall Htr $0.00 0 Commercial incinerator $0.00 0
Refrig Sys<100 k BTU $0.00 0 Domestic Incinerator $0.00 0
Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems ,
Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0
Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU - $0.00 0
Hood w/Mech Exhaust . $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0
VAV Box $0.00: , 0 - 30 To 50 hp t1,750 k BTU $0.00 0
Vent Fan/Single Duct' $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0
Appliance - - $0.00: 0 Boilers , '
Fire Dampers . $0.00 .0 - Up to 3 hp $0.00 0
Smoke Dampers $0.00 0 3 To 15 hp $0.00 0
Inst or Relocate Appl Vent '$0.00 0 15 to 30 hp $0.00 0
Air Handlers< 10000cfm- , $0.00 , 0 - 30 to 50 hp $0.00 0
Air Handlers> 10000cfm' $0.00 ,0 Over 50 hp $0.00 0
Floor Furnace N . ' $0.00 - ' 0 - Other Mechanical Fee 7
Floor or Suspend Heater $0.00 0 Investigation Fee - $0.00
. . Plan Check Fee $0.00
Reinspection Fee ' . $0.00
TOTAL CALCULATED FEES $37.20
COMMENTS /SPECIAL CONDITIONS
.
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes end related
regulations.(Ord.No.92-28,§ 1, 12-21-92) //
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspent��r abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit,
FOR INSPECTIONS CALL: (714)754-5626
244646(6100) d
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of tho following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the tabor Code,for the performance of the work for which this permit is Issued.
My workers'compensation Insurance carrier and policy number are:
Cartier. Policy Number.
(This section need not be completed if the permit Is valued et one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit Ls issued,I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARMNG:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND OWL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,000),IN ADOMON TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full
force and effect.Lie.I Class I
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors license Law does not apply to an owner of property who builds or Improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,em EX LUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License - :-not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s)
license pursuant to e Con . t• 'cense Laws.).
Ai :• •xempt l"se _ Business and Professions Code for this reason: a i
:gnatur: .. ����T�
_ • : 0 Oct- oft
Verification of Ownership by(type of•:ument,i.e.-propertytax bill or de:• •
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code). ,
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas et standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure). _
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑yes ❑No
(Section 25534 of the California Health end Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP is presently required has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application appermit for(such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes L.I No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date: ___
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION V ' Y:I certify under penalty of perjury that I have read this application and state that the Information given is
correct. I agree to comply with all state law a :s relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection 1 s -r.•- py or allow occupancy of any building authorized by this permit until fin c I n.
p �%a I 8 /'-v
Signe : • Legal Owner(s) Date
And/Or Auto nzed Applicant Date
;ODE I g18PEcliet'TYPE PATE ILLS ;ODE( INSPECTION TYPE
1616 Fixed System Final Fire Prevention 206 Final Mechanical Q
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Flre Prevention —
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
CITY OF COSTA MESA
BUILDING DIVISION
>%/" ,� DEVELOPMENT SERVICES DEPARTMENT PER NUMBER
� °� PERMIT 01-00733 •
Stit•oRmso
(714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
ELECTRICAL PERMIT
Job Address: 2722 SAN CARLOS LN Status: ISSUED
Suite No Applied: 08/17/2001
Vicinity: Issued: 08/17/2001
Parcel Nunmber: 14155616
Applicant: VALVANO, DOMENIC & AUDREY ISSUED BY:
Address: 2722 SAN CARLOS LANE ,i - " ' - -
�ii
Phone: 714-668-1252
COSTA A/IE --- : - - _ • Zip: 92626
/
. i
--
Owner:'<VALVANO, DOMENIC&AUDREY '
Address /2722 SAN CARLOS LANE ,
Phone: 714-668-1252
/
COSTA MESA,CA• Zip: 92626
Contractor: ,
Address: - -
;,Phone:
Zip:
License: -
SCOPE OF PERMIT
REF B01-01288.i ' - - "
3 LIGHTS,4 OUTLETS AND.2 SWITCHES.. " - . ,
' FEE-SUMMARY ' ' ,
Quantity - i/ Quantity '
ISSUE FEE ' $23.50 Temp Dist System/Lighting $0.00 0 ,
Temp service test $0.00 Busway/100 ft $0.00 0
Res. a/c package $0.00 Standing Section $0.00 0
New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0
New Res(3+units) $0.00 0Transformers up to 1 kva/kw $0.00 0
•
Pool/Spa $0.00 0 - up to 10 kva/kw $0.00 0
Lighting Fixts $3.30 3 • up to 50 kva/kw $0.00 . 0
Recept Outlets. $4.40 4 - up to 100 kva/kw $0.00 0
•
Switches . $2.20 . - ,2 over 100 kva/kw 50.00" 0
Non Res Appl, , $0.00, . 0 _ Low Voltage Equipment $0.00 0
Res Appl ' $0.00' - , 0 Low Volt Wiring System/Ckt , $0.00 ; .0
Service to 200a $0:00. 0' Misc.Conduit $0.00 ' 0 '
Service to 1000a , $0.00 , 0 . , Misc.Conductor - $0.00 0
Service over 1000a , . $0.00 0 Circus(gen or ride) $0.00 0
Motors to 1hp $0.00 ' 0 . Circus(mech ride or lights) ' $0.00 0
Motors to 10hp $0.00 ' 0 Christmas Tree Stand • $0.00 ,0
Motors to 50hp $0.00- . 0 Fireworks Stand $0.00 . . 0
Motors to 100hp $0.00 - 0 " Other Electrical Fee $0.00
Motors over 100hp $0.00 -- 0 , , -
Communication drops $0.00 0 Investigation Fee $0.00
Sub panel to 200a $0.00 0 Plan Check Fee _ $0.00
Pole Light Pkg $0.00 0 Reinspection Fee $0.00
Sign Circuits $0.00 0
Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $33.40
Intermed Pole $0.00 0
COMMENTS/SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes-and related
regulations.(Ord.No.92-28,§1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days. %/
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result In the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
244E-46 Woo) /
DECLARATIONS
WORKERS'COMPENSATION DECLARATION:
I hereby affirm,under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is issued.
❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Carier: Policy Number.
(This section need not be completed li the permit is valued at one hundred dollars($100)or less.)
❑ I certify that In the performance of the work for which this permit is issued,I shall not employ any person In any manner so as to become subject to the workers'
compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these provisions.
Applicant Signature: Date:
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED
THOUSAND DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full
force and effect.Lic.1i Class#
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lender's Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fora perN'
subjects the applicant to a dvil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or Improvement is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I,as owner of the property,am LUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions
Code:The contractors License does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s)
!cense pursuant to the Co• y%rs License Laws.).
.� m exempt u••.r s= Business and Professions Code for this reason:
• s verifl:d by drive ¶ose. 'es 0 No De,License No. Ex es:S t- -#—°r'
Verification of Ownership by(type of document,i.e.-property tax bill or deed): (�
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-slx(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
.pa.___
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
a If en RMPP is presently required,has Section 25534 of the California Health end Safety Code been fully compiled with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication e..ppermlt for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�Yes L-d No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No
(If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have et of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No
8 (If yes',attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the Information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND •• - ••IZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct.I agree to comply wit s- • •s and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property f• !• - // -5.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
/��' S'r C�) — D
Ig -turejj .- Owner(s) /bbate
And/Or Authorized Applicant Date
BODE r INSPECTION TYPE 12All ff lAL5 SODEt I6SPECTION TYPE PATE UIImeLS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Fool Spa Final 208 Final Plumbing
200 Final Re-Root 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
204 Final Demolition 250 Final Building/Occupancy
Lot 41 Tract 428
•
gs�� an `EIVED
COSTA MESA BUILDING-SAFETY DEPARTMENT 1 SEP 6 1961
P. O. BOX 9I7 COSTA MESA. CALIFORNIA FINANCE DEPT.
CITY OF COSTA MESA
For Applicant fo Fill In Completely APPLICATION FOR PERMIT .
TYPE OR PRINT BUILDING
BUILDING „
ADDRESS 2722 San Carlos Lane
COSTA MESA. CALIFORNIA For Office Use Only
OWNER Mesa Del Mar Development Ca. _ I RECEIPT NO. I _LaeGi) n
MAIL RECEI D BY I D��. E1+�CEIVED DATE ISSUED
ADDRESS 3800 E. Coast Highway I d"/ y 6I
TELAriole BUILDING
CITY Corona del Mar No. 1-4970 ADDRESS
ARCHITECT TEL.Oriole COSTA MESA. CALIFORNIA •
OR ENGINEER MaCCO Corp. NO. 1_/. 9h
ADDRESS 3800 E. Coast Highway FIRE /// ` o p��
ZONE TYPE - GROUP v
CONTRACTOR MaCCo Corp. • APPROVED
BY DATE .
ADDRESS 3800 E. Coast Highway ZONING
ZONE NO.OR USE OF N�C��,,TQ.�(( �
CITY Corona del Mar I PLANE I BUILDING( .//7A w1 '
STATE TEL 98808-SB-1 NEoOriole 3-4220 LEGAL .j-� 1/.2,�� ����""" JJJYYYr i
DESCRIPTION ). n
SIZE NO. OF BLOC'S.
OF LOT 6140 S F NOW ON LOTTLOTIP A.P.NO.
USE OF noneYARDS EVES
EXISTING BLDG. APPROVED ALLOWED
SETBACK LINE FROM , (CENTER LINE ST.)
CENTER OF STREET 2 I REAR YARD 20 1 FRONT ' Z FT. ,..----
IN.
SIDE YARD I LEFT 613" I RIGHT 5R R.SIDE `S_ FT. IN.
DESCRIPTION OF WORK L.SIDE FT. I3 N.
NEW I X II ALTERATION I II ADDITION I REAR a O
Ft —^ IN.
II IMOVING I DEMOLISH I BBP/PROVED (vII�d/f CD DATE //"/(I
REPAIR
NO. OF
SSIZIELOING 591911x501 ROOMS 6 STORIES 1
EXTERIOR WALL woodROOF Comp. and
COVERING 0 StuCCO ICOVERING Gravel
USE OF BUILDING AND WORK TO BE PERFORMED
Single family residence wlattached Living Area 1405 S F
Garage Garage Area 432 S F
Covered Porches
etc. .-Area 32 S F
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OR ESTABLISHING A PERMIT FEE ONLY.
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING
BUILDING CONSTRUCTION. VALUATION
SIGNATURE OF esa Del Development Co PERMIT FEE $ 3 5--
PERM
PERM ITTEPtisk ^7 B
B NA $ 15 ,326.00 PLAN CHECK $ / 7-so 4/'
AUTHORIZED A• �''�����'�'�'6"""��/ TOTAL FEE $ 52.50 p
LL
ADDRESS OFBwLDNd 2722 SAN CARLOS LN UMT: CITY OF COSTA MESA - BUILDING PERMIT
OWNERSNAY%RlUWN SARO, JOHN K PERM NO: B 084°3`.
ADDRESS: ASARO CAROL JANE
•
2722 SAN CARLOS LANE PERMIT NO: B 084635 PLAN CHECK NO: 03699-97 S GOVT: N SUPP: N
COSTA MESA,CA 92626
APDL.IWInM ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE : STR PURPOSE: CON
ARCNRECT OR ENGINEER UC.NC.: JOB DESCRIPTION : CONST. 245SF OPEN TRELLIS PATIO SQ FT: 245
ARCH.OR ENasADDRESS: WIT: CLAIM VALUE: 5, 000 . 00 CALL-VALUE: 3, 949 . 40 GROUP GCC: R-3 /
CONmiCTwspom MCCAUS9 LAND ( 714 ) 505-0234 COMMENTS : X
coNlRAefORS Arm TUSTIN CA UGIq_ 353203 ******************;Fri*********x****,:*******; ;r*ri;Ex; ;:****;F************************
92781 inn ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby Slim under penalty d perjuy thatm fre
I ernunder provisionsof Chapter 9 SETBACKS
(commencing with Section 7000)of Divisor 3 d the Bashes and Profession Code,end my Sorsa is in"A force end afar.
C O. 0.: 022734 UC.CLASS: UC.NO.: 353203 EXP: 00/00 MAIN BUILDING ACCESSORY BUILDING
o: —P° — 97 Calmar 0.
4-1;-.4"-
,/ FRNT: FT IN REAR: 15 FT IN FRNT: FT
IN REAR; FT IN
--�/ (M`� �` LEFT: FT IN RGHT: 5 FT IN LEFT: FT IN RGHT : FT IN
NE UILDER DECLARATION:I hereby affirm under penalty of perjury that I Ln exempt tram the Contraction License Law for til
reason(Sedion7031.5 Bushes*and Professions Code:Any city atoady wtirh requires a Peri to censwo6 akar.imamve, PARKING REQ: PROV: PARCEL: 14155616 ZNE: R1 REF NO:..- -
o: raha repairany structure.prior to is issuance.also requite theapplim.fa such permitto fibs signed statement rat he or she PLANNING NOTES> ADD A LATTICE PATIO COVER TO THE REAR OF AN EXISTING' SFD .
T pursuant to the provisions d the Contredas ice se Law(Chapter 9(commencing with Sedan 7000)of Divblon 3 of the
Business and Profession Code)o thathe a she isesanpt therefrom and the bob for the alleged exemption.Any viWion of Seaton > 355 SF REAR YARD COVER PERMITTED; 245 SF PROPOSED,
7031.5 by any app& m s
anl for a permit theappatili to anivi peaky d not more than five hundred dollars(55001). **iE*****ii**i ****iE******* ********itde*****ilk***iE*ie*xiE*****if*iEitic*****i*iail*51***itis***-n-*
❑ I.as manta dere aopenya MY arnmbyees WO tapes as Ilse sole compensation,tell do the work and the structure b nes amended DEVELOPMENT SERVICES R E Q U I R E M E N T S
or offered for sale(Section 7044.Business and Professions Code:The Contractor"License Law does not apply loan Saner of property
who Wilds or improves thereon.and who does such reek tined or herself or through his a NW Own employees,provided that web .
improvements ere rid intended or offered for sale.I,hrweter.the beading or impermanentd completion,b soil within one yeacompletion,the ZONING APPROVED BY DATE: . .
owner.builder as have the bunko d roving he a she it'd not bold a improve for the purpose of sale).
❑ I.as owner d the property.em esaivey contraaiywin licensed contractors to usmactthe project(Sedon 7044.Business and BUILDING APPROVED BY : DATE: I'ProfessionscaConcur" �/
Code:The Co .License Law Ices notapply to an owner of properly
who bolds or improves Demon and who
contracts for such projects wish a wracton(s)"ceased punned to the Contractors License Law).
❑ Immexemprunder Swan: B,iP.c..fothis reason: APPLICATION ISSUED BY: DATE: --.
-1 *********************le*re-lcv*drse***yr-it ye*******ie*******yf*******************7e****ycye***
D ere: Goner: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
I do hereby certify that I ern aware of end undersand the tanmvamerms of Caliente Health and Safety Code Sections 25505.25533.and
25534,andlhat Ire any Apure Wilding omgenlmn/wnw(cads one)need mcanplywih said Male codesand fMaqutremenbI'm BLDG PMT PLUMBING ELECTRIC MECHANIC FIREief- SMIP/RES GRADING
e perm"for oonlaction or modncaidn from the Al Gooey Mangrrrrm Dona.Residential mntrtdon appimian are exempt hem these
provisions. PERMIT 87 . 25 _ . 50
Date: A°° PLAN 56 . 71 )
SMIP/NON-RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm oder perally d perjury one el the ltowhq dedmetSms: ISSUE FEE
❑ Have and dim.atomaeenimedcanwtosw-insurelaworbra'oampensrw.eprovtdedfabysedion37wdthe Labr BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL �A PAID DUE
Code.fothepedmd
rancethawaxfoeachtrame
prISued. TOTALS----> • 87. 75 0 . 00 56 . 71 144 . 46 144 . 46 . 00
i1 I have end w emeiman wanm
workers' npernce,enal itfurmas regalw
ed by San 370001 the Labor Code.ler the performance of the I '1
work lot which this pemd b issued.My waken' bourn wrier and policy number me:
Canter: E° `CVM EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 144 . 46 OVER/SHORT: 00
. Policy Number G76HbObis.) 01 /01 /98 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT' 'GRADING PLAN-CHECK
(tubae nneednabecmpletedltAeprrntbtaorshundreddoiars(5100)orLmJ 87. 25 . 50".'y�' r 56 . 71
❑ t candy that in the performance of the waiffor which This permit is Issued.I ghat mol empty any person n o anY manner I 10 ;/ j
subject to the workers'_..,_atm laws d C.Nmda,and spree that i I should booms subject to the workers' ***************x*******************ye***********************ie'ie *y**iE******it ii****
9 -'0an provisions a Section 3700 d the Labor cad., shall forth complytlro�a ,',` I N D I V I L U A L F E E B R E A K D 0 W N
- /7 Awns: Qom(/ (�L"
:Faun.m..ctw worr+•wn,swadm TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
r:orenp la u kneu4 and I stalsot In sandmen to as La provided
and
c nee W to ars hundred thousand,ldollars 0104000A In ad1/gon to Me cost oI c+onponsstlon damson es provided for In
0-. r.
Bocfm5706oimeLaborCoa.Intrust.andatmntoesh« SFR 245 RES-PATIO COVER-POST & TRELLIS 16 .7121 3, 949 . 40
CONSTRUCTION LENDING AGENCY:I hereby an under repay of perjury that Una is a cormnriun tenths'moray for the END OF FEES
/
performance d the work for*4,15,this perm S issued(Section 3097.Ca.C). ." '
LENDER'S NAME: v r r
LENDER'S ADDRESS:
I certify that I have read this applWian and state that the above information is canes.I pow to amply with at city and coumy ordinances
and state laws raining to building construction end hereby authorize representatives of this dry Ins enter upon the above-mentioned properly
for inspection pcpoers ALAN MACCAUSLAND 09-18-1997/08:48 kri'/$144.46
RC
Ck�C/ Date: 9 —/0-9 7 PERMI T e 084635
s re rlApp actor
(5151-46.WP) Whit rpt&Safely:Green-file:Cmtwy-Appiwi:pink-ansae:Goldenrod-Assessor
.CONSTRUCTION AND PLANNING - PG & SPA
APPRQVALS Permit # Date Inspector APPROVALS Permit# Date Inspector
!�1'. Temporary Electrical Service or Pole 52. Pool & Equipment Location
•
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. . 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER•GUNITE
7. Footings et-K-1-764.0- 58. Electrical Conduit-Undrgrnd. •
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. _ 60. Backwash Lines,P-Trap, ❑ Undrgrnd.
10. Structural Floor System • 61. APPROVAL TO DECK ,
11. Property Sewer Line & House Connection - 62. Backwash & Receptor-Final
12. Sewer Cap i; 63. Heater & Vent-Final
•
13. Roof Drains . _ 64. Plumbing System S Final -
14. Rough Plumbing 65. Electrical-Final •
1 /
15. Rough Electrical-Conduit 66. Solar System-Final -
16. Rough Electric Wiring - 67. Fencing & Access Approval ,
17. Rough Wiring Sign ' 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34, Final Heating& Air Conditioning
35. Final Gas Pipe-Test •
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing '1
39. Water Service-Final --
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backf low Irrigation /9-i,,r2fi
44. Landscape Irrigation System �
45. Sound Attenuation
46. Handicap Regulations I/
47. FINAL STRUCTURE& BUILDING (2- /J4 /
48. FINAL PLANNING
49. Electric Release to Edison
50'. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date