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Home My WebLink About877 19TH ST - Building Permits. . . .- '-i- - - . '.� .. ' �- E- , r ;u: <' �,�, 'E,.ts''4-"s�`'n.^.s..`--' '�: �_. t�� . - ,'+�J; :.�';� . �" »�--,.. - _ .. _ _ '. _'_:�. . • �_J4.1�'.. . )��. . .. . . �::. �..d ��^ -'.. � . .. , . , - ''��i�i.• WEST 19Tti STAEET 8T7, A & 3 . - � . � . ' ,'�i:.,' . . . ;;:4 > ;.. 5 9, 500. 4 849� - 6-24-58 ortices ':•;<,"•!; �.^'� � Elockaall 250. ' -.•�n:.y,:?� : 9676 - 12-17-59 . - .`r,t�:i, ' 24695 - u-16-65 Conv.nidB.to Rest. 6,000. ' '' �`''., 24876 _ 11-16-65 :�a :v1::-+.^. bo:: 300. �...Ns:.J..:s`!-�„s,�.F%yf:.... �2529� - 3-10-66 ELec. IiC (ii.H. & cocor) _ . . ., . . .... - :�.'�..�'-.+��`,- 258iL - 6-29-66 Eet. Alteration� g00. .. .: • _ . , . � . .. . r-;;,:,c�i 26815 - 3-28-67 Pstio Cover . .. . , . •"F�,.y:.;)yn --�- ' " . ' ' ^ r �: ' BP17401 a� �� ' � ' �t'�7M}�+aal.' • i ��S . 1 . �' ' �c -:r` � � /�/ . . � "�' 6,000 � . -. . �hj�jt.;�.��i. i 81863� . ' . ' . � � '!:':'isS4-.iL45' '� � � ' EF�� . . ' :7 �.!" ;.�<'S` .��. �4:` �� _ � "��; i_ ia6aa omzr. sa,000 - �' � �#�' y��/� �E;:� %f,�`.� a.��, � _ - - . . , r �> -�.`a� ,� 'vi. i` Y t l r..� � a✓' F�Yi��,ME �� i . ' ;:1< 1l , g- �. Y .ti � rl ..r� ac , . . . . � i ?�y�F {� a� - �� _ . ��.F nFr��.� ; ' . '-7 i�"_y�',��s`}�9}t�'+�' . ..,;t,U��i.;4r, x;::'. - � ;i�: =1,�:• ,,. � - _ �.:r:��'iric5,�V9'^n7iync ' 4i� i - a � �htf�� . ' - _.." tT%.�i�'2'J_� . .):-�:.:e..u)� . . 'y�.`� � ulv-a.n t fi.�" . • : :�):.. _,�;F: � -'i:.i'6�':i,:.�" � ��7�' r�i t� •:- -A � _.�� _'.� : ynl.. ,.. ;�v:i . '.N:':.i.`fM1. . . , . 'Y: �:.}�; M��. . !i:•l♦ . `..i.'��. ' ' 2 i �'. � . . . . � F?;.; r. . v - ` Y � ' '� � FEE R�CFI�ED .�..= - g�� ) C;OSTA MESA BUILDING DEPARTMENT �Iti - 1�1��C� P° B�" "' FINAN E EP�'. COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN APPLICA�iB�rPF��A�t�MiT BUILDING ' � � • ,�,.� . �. BUILDING A�DRE55 COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY W O RECEIPT NO. PERMIT NO. � /" T L 8 • OWNER � MAIL J� / AECErvED BY D TE AECENEO O• _ IS � ADDRE55.7 O'�. ��as? Niw� �f � Z�-.i / 2 � GITYL�Idii.1 d.i� /'��/fh TNO.�� OSIO ADD EI55 �� /� /� \ / ��c. COSTA MESA. CALIFORNIA O NO. T / ^ C oy/ FIRE �T !6 ZONE / ITY IC. .A . ZONE 1 PLO.�NS TYPE GHOIIP CONTRACTOR � L NO. �' S (,�/ ADDRE553 6-�� L NO.O��'�V �" qPPROV6BA -,�,�1 ✓�•� A � �e�/L� V.� //�" IEG�I LOT OE6CRIPTION NO. O BLOCK TRACT A.P. NO. - D� ��' O pL. SIZE O NO.OF B�OGS. OF LOT O ��ow oH wi USE OF E%ISTING BLDG. ' SET9ACN LINE FPOM y� / /� CENiER o� 9TREEr �(,/ REAF YARD 'J / SIDE YARD RIGHT LEFT � / DESCRIPTION OF WORK NEW ALTERATION ADDITION REPAIR MOVING DEMOLISH BUILDING NO.OF SIZE ROOMS STORIES O ! E%TERIOR WALL ROOF Q COVERING COVERING � N USE OF NEW �Q n��Cl /n-a, a/ a�� /�l wiui niur. ST�TE TNAT TME CITV OXDINANCE 1iOn. L � AUTFIORIZED AGENT '. CORRECTIONS MESA DA The Amount shown under valuation is for the 1 NA RE/�D TNIS tPPLI .�TION � O 1 EC .�N ♦GREE TO COMP Y WITM SL purpose of es�ablishtng a permi ee on y. �' VLSTING BVILOI G CONST C� - VALUATION � PERMiT FEE S 9 � / ` G � " PL.4N CHEGN S /4Gi � g ] ✓ . TOTAL FEE 5 ,3[� - `�°�` �� - COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.80% 317 COSTA MESA, CALIFORNIA fOR APPL/CANT TO f/L[ /M COMP[ETELY TYPE OR PRINT• BUILDING / �,(� ! ADDRESS � / � 1}�. / COSTA M�SA, CALIFORNIA OWNERf �U• . QKC��/J �� '/. �//Y MAIL ��i (L/ ADDRESS J 7'-/ [� �n'_�/ CITYI_�/A U�il V- LIC. NO. d I r STATE CONTRACTO� � /( Q ,� �JL.IQ NO. ` AODRE55 $ u�Y�` �l, �u�f / C�' /I LEGRL ��oT yo , � OESCRIPTION NO. J IBLOCK ITRAC A.P. NO. /I CJ �• `v,� V � O � 512E ��{ � y �� I NO. OG 6LOG3. OEX STING BL G. I ll��Y//- � V�r �CY BETBACK LINE FROM . CENTER OF STREET �� REAR YARO o sc�-L-� SIDE YARD I LEFf �/ I RIGHT DESCRIPTION OF WORK NO.OF ROOMS WALL 11LDIN _U,C� 1 HEREBY I�QEtloW CvpE mAT � HAy REAO THI9 AND STATE TNA �1! ABOVE IS R CT AND AG PLY WITN AlL ITY ORUJ� NCES STATE L/�W9 BUILOING C TjtQ�T�. / /� � � AUTHORIZED AGENT � =�� Rrc��u �_.;y_5-� FINANCE DEPT. '' `` CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING FOR offic� usF oNcy I RECEIPT NO. I P N 7 lVED BT I DMTE.0.EC ED I DA IS E COSTA MESA. CALIFORNIA FIRE / ZONE � � /: U APPROVED �/�(� DATEv—W" BY ZONING ZONE �/ I p ANS � I BUEILD NG� ` ��r APPROVED �µ BY DATE YARDS EVES REQUIRED ALLOWED (CENTER LINE 9T.1 7S m� THE AMOUNT BHOWN VNDER VALUATION IS FOR THE PURPOSE OF ESTABLI6HING A PERM�T FEE ONLY. VALUATION �� ^' � PERMIT FEE S $ ZS U � PLAN CHECK $ TOTAL FEE S Z "�' . � lCiTY OF C�SiA MESA 'OOSTA•MESA BURDING-SAFETY DEPARTMENT I r rr ' P.O. BOX 7200 COSTA ME6A, CALIFORNIA YY620 � CFP � l �Q�11 . � ." 24876 . COSTA MESA BUIIDINCrSAFETY DEPARTMEM P. O. BO% 1200 � G08TA MESA, CALIFORNIA 9T020 for Appl7cant fo FIII In Complete/y TYPE OR PRINT ADDRE'39 877 W. 19th Street COSTA MESA, CALIFORNIA OWNER James D. Ray and Merritt Revan ".'�'� ___ .188 E. 17th Street ' ^NGI en F. Aodgdon ,T,a`T,i8 452z ,�oR�ss 1,40 E. Coast Hrry: Newport Bea GONTRACTOR J• � �NSPRIICTION OOMPANY ....,__„_ 168 E. 17th St.: uc Ho. 126 426 Ho�" 642 4210 eize ]3zt 7C 300� I �o.or■u OR LOT noW ON 4 u66 OP EXISTIN6BLD0. Re8ti811T8IIti BCRACK LIX[ IROM Cvtnw o� tTn[R R[AI1 YA 81D8 YARDI L[Fi RIOFTT DESCRIPTION OF WORK • -•--•-•--.�x ---�-�--- eu 1 H�tGBY ACRNOWL6W6 AHO BTI1Tl TNAT Tf�tie HOP J. ] .,eio � orb.c� MAVt IIGD 1M�0 APPL�CATIOM CORR[R�AHO TO COY. 11ND R Tf • [OUI.ATIHO � � � c�rv or ��sra mEss NUV 4 1965 �� ,.... APPLI�� R run� ?,' eu1LDIN0-Lw/� � • ..�..+.... 9 ��/�tia T/j /G -o3i - 3 9 re ovcnnwNo sHwu ee �.ess rHu� YARDD MPROV HD MAIN BUILDIN6 DIGTANC� MAIN BLD VAR. }R YARDS APPflOVHD ACCEf80flY BUILDINO �1 � _! 3 ��L � 7 DAT6 T16 IIYOUHT OXOWN UN06p V�LU�TON IG IOR TH[ �URP08{ 01 faTAOLIBMINO I� PCPMIT R88 ONLY. vu.uwrwn �j G PHRMIT FEH s 3 �cj ',`e ' 25�14 COSTA MESA BUIIDINCrSAFETY DEPARTMEM `P.O. BOX 1200 � COSTA MEBA. CALIFORNIA Y20Z0 For Appl(canP fo FIII ln Completoly TYPE OR PRINT ��No �7� Gv. l l� SI DRE89 COSTA ME3A, CA4IFORNIA � � ",9 L1 c�rr S /`}NT'V� �N ucno. 2�/GS 3 eize 3D D x/ 3 2 OF LOT useor ��ST�9v E%IbTINO BLDO. t6TEACK LIN� I110Y � 3`Jioo L DESCRIPTION OP WORK WALL � xeaeer �cRnowtenoe ANO 6TAT8 TNAT TX6 I1O PLY WITX ALL CITY ORD lUILOINO CONeTRY SIGNATV R8 OP PERMITT6 AUTHORIZQD AORNT AtID CffY OF C��t� MItSA JUN 17 1966 for OHIm Ute Only 11LC[Irt No. ust nlc��J !O �o. o� ZONINi3 or n�w, .v �un� 'y euuomo � �ap� L�r9aI 1�91� 111R�ON �o. Y/ G -�,?I- 3 � [: N08AV60V[RMANOSMALL88LE88THAN YARDHMPROVHD I YARDSAPPFOVHD MAIN BUILDINO ACC8980NY BUILDINO err. VM. �C I DATB MPROV[D (� / OT ` T6 D a % �0 � � 1 � eo. Rr. � 0 n�e �rourrt oHown uxoan vw�u�noe� �e ro n�s � �YHPOOB OP �DTABU6MIH0 A P6qMIT �88 1LY. VALUA OM - � PERMIT F88 � % ' � s � � `" . �/ TOTALFEfi S �7 �� ` 26815 - COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 7200 � COBTA MEBA� CALIFORNIA Y2020 HitNZ�'(77PAIDOO 7�� cJ.+lir�uuJ.Qd CMSA a Applicant t0 flll in all spacas except I�ase with(n �eavy Cortler Iines anE si9n all appro0riale Eeclarations. CITY OF COSTa ME A CONSTRUrCTION PERMIT �. �� . Proje�tAddress �� 1� �'� `--�-'-i�� -��-!-�- �Applicant's Mailing Address .c��b � � �E �� 't �� 7N' �a Owner's Name � � —�� hone ��T Address ,��[^ Arch/En9. ��'9a- ,.�,s�.q�c�'¢Licenu No. Address o�` Contranor's Name _ hone��=J�)� Addreu Imailingl City License No: � � LICENSED CONTRACTOR DECLARATION I hereDy a(Iirm Ihat I am Iicensetl untler provl510n5 oi Charte� 9(commencing with section 7000) 01 Dlvition 3 of the Business antl Profe55ion5 Cotle, antl my licenze iz in full torce and eltect. Lcense C ss � � License No. �Z �� i� Da[c ��7� V c�oae .o� �i+ WORKE 5' OMVENSATION OEC�� I hereby atllrm that I nave a certiiiWte conitnt to sel(tinsure or a certiflcate of Workars' Compe/��salion In/yq� ance, or ^d certltied cooY ��ereof (Section 800�(1 Lab.�.) / I /._ 1 . _ % 1� �� .._ n. �il- /i Is tile3with t�e 'ION FROM WORKERS' COMVENSATION DECLARATION �.ion neetl not be compintetl if t�e permit is for one huntlred (5100) or thaf In lne pertOrman<e of IM1e wyrk tor which [hI er k Is issuetl I ym010 any person �in any ma�y! r�y to be me ubject to [{�e ,[qRyi�zptien Laws ol Califorpl�// _ � CONSTRUCTION LENDING AGENCV - 1 nereby afBrm tnal them is a conSVuction Ientling agency for the per(ormance of the work lor w�icb lhi5 Oermit Is Issuatl (SecNon 3097 Civ. C.) Ltntler's Name Lentler's Atltlress OWNER BUILOEN UCCLARATIOfi I ner¢by aHl�m.[hat I am Bxempt irOm [no Contracto�'S License Law (or th� lollowing reason (Sectlon 7031.5 Buslnass anE Prolesslonal.COUe: Any tlry o. counry which requiros a oermit to contbuct, alter, Improve, tlemolish or repa ....... .�..�.�.e ..n�. �.. uc ica�unce.�also reaWres Ihe anolicant tor sucb parmi ana thc basls ior tha nalty o1 not mo�e than 1lve hun0�etl t1011ars (5500). J �, as owner o� the oroverty or my-employeas with wagoz as their zoie compensalion, will Oo Iba work, anC tna structure Is not Intentletl or ofteretl ior 5al¢ (SectiOn 7044, BUsine55 antl Pr0leislonal Cotle: Th¢ Contractor'S License l.aw tloes not apPly to an owner ot a proparty who bulltli or improves thereon, ana who aoes such work himtetl/ners¢It or tnrougn his or her own emplOyees, provitlatl tba[ such ImprOvemen[s ar0 not int¢ntl80 or offeretl /Or Sale. Ii,'how¢ver, th0 bulltlin9 0� imp/ovnmant is soltl wit�in on¢ Yea� 01 com- Oletlon, tha owner will hdve [ne bu�tlen 01 provin9 h0/she tlitl not builtl o� Im- prov0 (Or Ihe pu�pa5o ot salo). ❑ 1, as own¢r ot lhe property, am excluSlvety cont�acting with lic¢ns¢tl con- traCto�sto conSVutttbe prOjecl ISec[ion ]044, Business antl PrOfessions Code: Tne Contractor's Litenx Law docs not apply to an owner ot property who builtls or improves Uer¢on, ana wno contracts for sucn projects wlth a con- bactor(SI license pursuanl l0 1he Contraclor's License Law). 1 am aware that proot o( their Wo�kar'S CompenSatiOn insurance ShOultl be provlUeG to me. ❑ I am ezemOt unaur Section B. & P. C. for this reason Date Owner — I hereDy certity that I have reatl tnis info�matlon IS w�recL I agree to com0 antl� state laws rel ting o builtli 9 n sen[aUves oi thi y, ¢nt o� inspeG[ion purpo Si9nature Drivers' License or 5 the Ihat the above TVPE OF CONSTRUCTION R�J NEW LJ ADD IJ ALTERATION LJ REPAI0. ❑ CONVERSION ❑ DEMOLISH ❑ OTHER p�p yy, � 1 DESCRIPTION OF WORK/USE OF BLDG. 9a..a (i- �• A+ On ,� ' • V � "" S Main Building: E TVPEOFPERMIT GRAOING OUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBINnG^ ❑ MECHANICAL 6 R¢ar ❑ �OTHER ��,., li✓yCY A PRQIECT DESCRIPTION Sq. F7. oCCVaa Y C Right 0f/� CONSTRUCTIONTVVE VALUATION5�/�� $ Left 20NE GRADING CU. VDS. ACRE P�ng. Ref. # 0.emarkr. ��'�) ��p�� PlanningNotes: fQ � Sink Preventer Irrigation Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink lavatories Roof Drains Rainspaction Fae $15 Boiler Duct - Under Ground Duct - Structural Duct � Ventilating Exhaust System ❑ Multiple Firepl/Fact. BI[. IC80.# Heating System & Ducting ❑ ai oo,000 sru O i oo,000 Reinspattion Fee I S75 CMF OB65-46, rev. 30/84 White - Builtling: Canary - Applicant: Pink - Accountlng; Goltlenrotl - Assessor Showers Service Sink Sewer Cap Sewer Connection Salar Callectors Solar Tank $wimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auta-Wash laue Fee g 3 1ANICAL FEE Hoodor Typel ❑ � Canopy Type II ❑ Refrigeratian System ❑aioo,000sTu ❑ioo,000aru System Repair/Atteration Fire Dampers Registers laue Fee � $ 3 Automatic Washer Construction Pole & Cooking Unit Dishwasher . Dryers �Gas ❑EI Fan F.A.U. FixWres Device Boxes � Outlets Switches Garbage Disposal Generator �0.5 KW Reinspection Fee — ' DEVELOPMEN7 SERVI Zoning Approved By_ � Building Approvod By � �A liration luuad B � PP V_ 1920 ".-- -" -'- -- I Zone Accessory Builtling: ' Parking Req.�Provided ..�� ELECTRICAL Transformer ❑ 75-50 KW ❑ 50+KW 15 KW Meter ❑up ro 100amps Meter pover100amps Sub Panel Motors O0.1 HP O1'r4 - 8 .� Int. Solar �9�15 HP �16-75+ Microwave Pole Light Range Sign �- ; Standing Sections � � Trash Compactor � / 113059 7L FEES $15 luue Fee � � . 5 3 ��IgEM NT�S: , ' � , ' Date � N Dale A . .�_"_� Z O N I N G R E Q M T S� � . �7�t1 M�MARV, eO,F� Ff,E� :i ..' BUILDING PERMIT $ �Q,�/�{,�S°��7R-p� $ � " PLAN CHECK $ ��ry��EFiM1T PLUMBING $ ISSUANCE $ , PLAN CHECK 25% $� ENERGV P.C. $ � ELEC7RICAL $ GRADING $ � PLAN CHECK 50% $ MICFiOFILM $ 2 r MECHANICAL $ TOTALFEE $ ''J'`J . PLAN CHECK 25% $ CONSTRUCTION AND PLANNING A�PROVALS Permit# 1. Temporary Electrical Service or Pole ' 2. Soil Pipe-Undrgrnd. �3.� Electrical Conduit Utility-Undrgrnd. '.4. Electrical Conduit-Undrgrnd. � 5. Steel Reinforcement �• Electfical UFER Grnd. - 7. Footings . , • ' H. foundatiun 7 � 9. Wa[er f'ipe-Undrgmd. 10.. Structural Floor System 11. Prope�ty Sewer Line & House Connection 12. Sewei Cap � 13. Roof Drains 14. Rough Plumbing 15. Rough Electrical-Conduit 16. Rough Electric Wiring � 17. RougN Wiring Sign �18. �Rough Electricai-T Bar Ceiling � .. 19. Rough.Heating & Air Conditioning 20. Rough Factory Fireplace '� 21. Ducts, in Strucwre - • 22. Ducts, Ventilacing 23. Gas Pipe-Rougii & Test 24. Roof Framing 25. Roof 5heathiny � ; 26. T-Bar Ceiling (Structural) & Monocoat 27. Frame and FlaaRiny 28. �.2th1f19 & J'IJii'�y 29. Insulation 30. Drywall Nailing �, 31. Plaster Brown Coat � � 32. Electrical Power Meter-Final 33. Final Electric � 34. Final Heati�g & Air Go�ditioni�9 35. Final Gas Pipe-Test 36. Hood nr Canopy 37. Final Factory Fireplace 3R. Final Plumbing 39. Water 5ervice-Final 40. Gas�Seivice-Final 41. Solar pomes[ic-Final 42. Backflow Preventer � 43. Backflow Irrigation 44. -Landstape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE & BUILDING 48. Special Requirements Completed 49. EleMriC Release to Edison 50.•Gas Release to Southern California Gas Co 51'.'CEFiTIFICATE OF OCCUPANCY Date Date POOL 'A Inspector p�ppROVALS Permit # - 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms 55. Electrical Bonding ��/ 56. Rough Plumbing & Pressure Test 57. APPftOVAL TO COVER�GUNITE �/G/ , 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, O Undrgrnd., Test • 60. Backwash Lines, P•Trap, O 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 � Gas ❑ Oil 72. Underground Flush 73. Undergrnd. Storage Tank � Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL 76. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT � 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: 1 .F L� � / /Ail /��/ �- � �- 3 Ui%T Date � Inspr.ctor i l- � �� "..`t'.� � _ STREE� - -� � � 'N �a � � � r � r 4 . g � � w M w n w s � w s e w � _ _ STREET �_ M,wU,��,,," STRUCTIlAAL APPRDVAL t�NLY SEPARATE PER��?�TS A,ri� RFCiL�IREO FO(? ELEi;TRIGc,.. f'tU�"bIiJG, HcFi�i:�. �JF.;'�i?fldCii�=G AND RE`�IUL(i>°�',('�Y V!i:i3K �_�_t— �._ �.___._ _. ; ,y� �;1 .,.� �6��i �O6`i l� � ,� . !`:: {� B'c C ? 't. 't...=____._ ..___..__.V.r_,..._ .... _ ' (:: +�li�A(�JY i C � � ill.:. ... , . . , a�. �J ... __._.�__�. - - - - - _.�.�.. { �0(: 8:71,;, • . .. .. , yi�E jG Gc � i.l, '.''°:L , „ �� . i "iit JYA�{: i}f i;AiJStca" .. , ; .LU�7r;i:�i SCFE7Y 5L f.u�:5�iitD i01i AJC!TIONAL FEOUu;i�SfN7S. < ' +ri �S � o� 0 Z D Z ~ O j� e^ �5 o Z ° � p Z � � � � O �OD�� m ��m � � � I .. . � ADD�icant to till in all s0aces except tnose witM1in �eavy DorEer Ilnas anE sign all approv��ate tleclarotions. - - - PERMIT NO P' -- � �TRACT NO � � LOT NO " UNIT�N6 - CITY OF COSTA ESA CONSTRUCTIQJ,V�E �I.�,Te�L� _; _ � ��rr Project Addresi ./ Applicant'sMailingAddress '�'� Ir '.�J�3 ' Owner's Name M�A . Phone � �. ' Address - . � Arch/Eng. License No. . . � Address ' p�.��/�r� � Contractor'sName • `J�d��Pn/�one �t]�a` �Addresslm��'�nl �•� ,��-��/3l3b %�•O' City Cicense No. d'�-�p,z_�C.1p LICENSED CONTRACYOR DECLARHTION ' ' I M1e�eby atfirm [hat I am licensetl untle� p�ovi5ion5 of a te� 9(commencing j with section 7000) ot P��sion 3 0/ the Business an Pr fe55ion5 Code, antl my license is in fu forc 3�tl e(fe t. �� '` License C d55 L Lic¢n o� � Date S�9nature � WORKE 5' COMPENSATION �ECLARATION , I hereby af(irm that I ha�e a certiticate of consent to self-insure or a certificate ' Workers' Compensation Insurance,-or a. certifietl copY reof (Sectlon 00, Lab. CJ �7/�� /p/./{�t � ,�,y�{ rolicY No. �� CamPanY �+"` V -��'v l ' � Q Certitietl mpy Is hereby fumishetlY� � ' jLyCertifietl o s' d �+ith Ihe cit B Oivis" n. iDate' � t qpplicant EXEMPTION ROM WpRKERS' COMPENSATION DECLARATION, (Thissectlon neetl not bC �ompletetl if tM1e permit is tor one huntlretl (5100) or less). � I certify that in lhe pe�fo�mance of the wo�k to� wltich [M1is perm�t is issuetl, I � snall not employ any person' in any manner So as to become subject to Ihe workers' Compensalion �ws of Calitomia. � .,Date Signature - ' ' 'NOTICE:.It, atte� makih9 tM1is tleclaratlon. You shOultl become subject to the _ 'Workers' Compensation�Provisions of the Labor Cotle, you must forthwith . �comoly. with such prtivisions or this_permit shall,be_tleemetl-revoketl. . CONSTRUGTION LENDING AGENCV ' I hereby a(tirm that there is a mns(ruction lentlin9 agency ior the pertormance ' of the work for which this permit, is issuea (Section 309� Civ. CJ� ' Lentler's Name , � LenOer's Atltlreis � � � ' ' - . OWNER.BUILDEN OELLARATION. ' � ; I hereby affirm that I am exempt from the Contractor's License Law for the . following reason (SectiOn 7031.5 Business:antl ProSessfonal CoOe: Any city or' ' county which.requires 3 PermiCto construct, alter, improve. aemolish or repalr ' any structure, ptlor to �ts.issuance, also requires the applicant for such permit to file a signetl stateme�t that he/sh¢ is licensetl pu�suant lo the p�ovisions of - the Contractor's Licens6 ��+ (Chapter 9(commencing with Section ]000) of � : Division .3-of,the Business antl:Professions Code) orthat he/she is exempt `=reVom antl the ba5is tor the allegeA exemption. Any viOlatlon of Section 31.5 by any applicant for a permit subjects .the aPPlicant to a civil ialty ot not more tnan five�huntlretl tlollars ($500). , . LJ I,.as owner ot;the Property or my emplOyees'with�wages as fhei� sole ' compensation, will tlo the work, antl the structure is not intentletl orAfteretl fOr sale (Section 7044; Bu5ine55�antl'Professional Cotle: The Contractor'S License Law tloes not aPP�Y to an owner of a property who builtls or impmves thereon, antl who does such work himselt/herselt or Mrough�his or her own mninvnnc n nvinee mat such imorovements are not intentletl or otteretl for sale. N, poweve�, the bU��tling or impra pletion, the owner will have the bu�der prove tor the purpose of sale). � � I, as owner of the O�operty, am exa tractorsto construct th8 ProJect (Sectio The ContractorY License Law tloes n� builtlz or improves thereon, antl wno a fldCtO!(5) IICQOSC OUfSOdnt SO I�1C COfILI proof of their Worker's Compen5ation ❑ I am exempt untler 5ection � � ' � Date � � Owner _ '1 hereby�cert�f that I have reatl this infOrmation is c ect. ba9ree o�comp antl state�laws I ing to b ing�Con sent2[ives of t id �tY to er/f�por ing he/she tlid not builtl o� im- contracting with licensea con- Businezs antl Professlons Cotle: to an owner ot property who ��for such Projects with a con- License Ldw). I am aware that ce shoultl be provitletl to me. — B. & P. C. for this reason tion antl state that the above d�� Cliy dOd COOfI[Y Oftl1I1dI10E5 i. anC herebv authorize reore- ��p _.�o- � • TVPEOFCONSTRUCT ' NEW � ADD � ALTERATION- ❑�CONVERSION DEMOLISH ❑ OTHER � � " ' � DESCRIPTION OF WORK/USE OF BLDG. t 0�M � TVPE OF PERMIT. GRADING FOUNDATION $TRUCTURAL ❑�7ENANT ❑ ELECTRICAL PLVMBING ❑ MECHANICAC - � .�+OTHER - - ' � PRQIECT DESCRIPTION SQ..FT. OCCl1PANC'Y^_qn CON STRUCTION TVPE VALUATION $ �� ZONE GRADING CU. VDS.- ACRES_ Remarkz: ' � ' � . , 3ar $ink � 3ackflow Preven[er 3ackflow Irrigation 3athtubs Clarifiers ' � Dishwdsher � Drinking Fountains Floor Drains . � Floor Sinks ' Gas Service Outlets - _ Interceptors Kitchen Sink ' Lavatories " , . ' ' - P-Trap Roof Drains . . ' Reinspection Fee �„ $15 BOiICf: Ducf- Under Ground Duct - Structural Duct - Ventilating 1 Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO 4k Heating System & Ducting ❑ ai oo,000 eTu O i oo,000 ar� ' Showers - � Servire Sink Sewer Cap Sewer Connection � , Solar Collectors Solar Pipin9 "" Solar Tank � Swimming Pool w/Spa Urinal Water Closet � Water Heater Water Service, � Auto-WasM � � , _ REPAIR r� FEES � . � laue FBe '� $ Hood or Typel ❑ Canopy Type I I ❑ � Refrigeration System - ' � ❑o-iao,000aTu ❑ioo;000eTu System Repair/Alteretion Fire Dampers • Registers' �' , IJ.'•.�•� "�. '� � -�� :I , I Reinspection Fee I $15 I I Drivers' License or SS �` CMF OB65-46, rev. 10/84 Wh�te - Bullding; Canary � Applicant;�Pink --Accounting; GoltlenroE - Asse55or - ' - -�- luue Fee A.P. #. S' Main Buildin9: E` T Front ' B Rear ' A C Righf S, Left Ping. Ref. # Planning Notes: ' ' 689! - 2/0I /85 ^,,;r,v=T�- .,. _ ; , Zone � � Parking Req./Provided ELECTRICAL ' Automatic Washer _ Transformer ❑ 15-50 KW ConstructionPoleSub. ^ , �SO+KW CookingUnit Meter ❑upto.100amps• Dishwasher � Meter ❑over100amps ' Diyers'�Gas-�Electric ' SutiPanel�� . �� Fan Motors 00.1 HP Ot Yz - 8 F.A.U. � ' ' Inc,Solar09-75HP�016-75+ Fixtures � Microwave � i Device eoxes Pole Light . . � Outlets Range , ' Switches. . � t Garbage Dispoul Generaror,[]0.5 KW �5-15 KW Standing Sectionz Trash Compactor � Z , O N .I N - G - E Q � M T S FEES ' _ 0 i Reinspection Fee $15 luue Fee , $ 3� DEVELOPMENTSERVICESREQUIREMENTS: .� � 2oning Approved By ^ate Building Approved By ' Date � APPliotion Iwued BY �-�- ' . . � Data /- 3! .FS� � ' SUMMARV OF�PEES � BUILDING PERMIT �$ �7 .�% SMIP $ .�D PLAN CHECK $ PERMIT � � � ' PLUMBING � $ SOv ' ISSUANCE $ ENERGV P.C. I$ � � PLAN CHECK 25% $ , � ELECTRICAL �$ GRADING $ PLANCHECK 50°� $ � ' MICROFILM �$ MECHANICAL $ ' TOTAL FEE $ oL3-OU PLAN CHECK 25% �$ , � I� CONSTRUCTION AND PLANNING �-� ; , POC SPA ' � APPROVALS Permit# � Date �Inspector : qppROVAI:S Permit# �Date Inspector -� _ . 1. Temporary Electrical Service or Pole _ '52. Pool & Equipment Location t 2. Soil.Pipe-Undrgmd. � ,.�? � '� �� = 53. SteelReinforcement - � �� "-^' , '�3! Electrical Condu`it.Utility-Undrgmd. . ' � y 54. Forms. - ' ' ' 4. Electrical Conduit-Undr rnd. ' . 9 � 55. Electrical Bonding � �, �� Steel Reinforcement h .� ! 56. Rough Plumbing &-Pressure Test i ' ; !6� ElectricalUFER•Grnd: . � . 57. APPROVALTOCOVER-GUNITE �/� .i . ' 7:, Pootings . �� J � . � q � . 58. Electrical Conduit-Undrgrnd. _ � � ' 8. Fouridation �� /� � � 59. Gas Pipe, O Undrgrnd., Test � 4, ; 9. Water Pipe-Undrgrnd. �� -+ - 'l 60. Backwash Lines, P-Trap, O Undrgrnd. ,° 7�0.'Structural Floor System ' � J •� 61. APPROVAL TO DECK � i ly Property Sewer Line & House Connectiori 62. Backwash & Receptor-Final - � � 12. Sewer CaP ' ;- � yf- � � 63. Heater & Vent-Final 1�3. Roof Drains , . �• 64. Plumbing SYstem - Final �! 14. Rough Plumbing � 65. Electrical-Final -- 15. Rough Electrical-Conduit . 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval � 17, Rough Wirin9 Sign 68. APPROVED FOR PLASTERING 18. Rough Ele"ctrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL � J 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ' 20. Rough Factory Fireplacei � APPROVALS Permit # 21�. Ducts, in Structure . 70. Underground Hydro 22. Ducts, Ventilating 71. Broduct Piping �Gas ❑Oil ' 23. Gas Pipe-Rough & Test � - 72, Underground Flush . 24. Roof Framing � 73. Undergmd. Storage Tank O Gas ❑ Oil � . 25. Roof SheaYhing � ' 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 Na��ng � HEALTH DEPT: REQUIREMENT 31. Plaster BroWn Coat ' 79. FINAL INSPECTION 32. Electrical Power Meter-Final , 80. FOOD CERTIFICATE ISSUED 33. Final Electric � Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test . � 36. Hood or Canopy � - � 37. Final Factory Fireplace , � � 38. Final Plumbing ' � 39. Water Service-Final 40. Gas Service-Final 41. Solarpomsstic-Final � -- � � � 42. Backflow Preventer � i _ _ _ 43. Backflow I�rigation � � � - 44. .Landscape Irrigation System � 45. Sound Attenuation � ' . � �� ' � . . 46. Handicap Regulations' � ' . - , � 47. FINALSTflUCTURE&BUILDING . . � • � 48. Special Requirements Completed ' , ; � � � i � 49. Electrie Release to Edison , , 50. Gas Release to Southern California Gas Cn , � 51. CERTIFICATE OF OCCUPANCY ' - No. Date � _ _ _ - - • .