HomeMy WebLinkAbout232 19TH ST - Building Permits PROJECT ADDRESS: 232 E 1.-9TH -'ST UNIT. CITY OF COSTA MESA - BUILDING PERMIT P 811 No; n UDbZb'1
DW"R:CNAME: BRION, MICHAEL E
/ADDREss: BRION, JUDY D PERMIT NO; B 056264 PLAN CHECK NO: 02432-91 L uovs : N 5ur1-1; N
232 E 19TH ST
COSTA MESA,CA 92627 CONSTRUCTION TYPE: S-N PERMIT TYPE; STR PURPOSE; ADD
"RCM.ENGINEER: RANDALL B . COOMBS REO.NO.: C19185 JOB DESCRIPTION : ADD 3 BD RMS & BATHS/REMOD 2 BD RMS/BATH SQ FT: 1 , 162
,' ADDRESS: 2033 W. FLOWER AVE. UNIT:
FULLERTON CA 92633 CLAIM VALUE; CALC-VALUE: 80, 178 . 00 GROUP OCC; R-3 /
• PERMITTEE: MICHAEL E. BRION ( 714) 548-4056
ADDRESS: 232 E 19TH ST COMMENTS- SMOKE DETECTOR(S ) REQUIRED IN HOME, SMOKE DETECTOR
COSTA MESA CA 92627 *****'***x*****#NSF******+E� ***** +ESE********** ****** E******x****+E******** **** **
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z O N I N GS ER T EBQAUC I KRSE M E N T S REQUIRED
7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.
CITY LIC.: STATE UC.: CUSS:
Date: signature: MAIN BUILDING ACCESSORY BUILDING
F'RNT; 20 FT IN REAR; 38 FT IN FRNT; FT IN REAR: FT IN
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers' LEFT: 5 FT IN RGHT; 31 FT IN LEFT; FT IN RGHT; FT IN
Compensation Insurance,or a certified copy thereof(Section 3500.Lab.C).
(COMPANY: EXP.DATE: PARKING REQ- 2 PROV; 2 PARCEL- 42627117 ZNE; R1 REF NO-
cOMPANr:
Cenilied copy is hereby furnished. 0 Cenilied copy is filed with the City Building Division. PLANNING NOTES> 1162 SQ. FT. 1ST STORY ADDITION TO AN EXISTING SINGLE
FAM ILY RESP REVIEW REQ
1 •/ **************S**1E*ie*******1E* *3e*******iF*********3i***ff***********3e**********?P**
Date: Applicant:.'
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (Dissection need not be completed it the permit is for one hundred(S10O)or less).
D E V -E L O- P M E N-.T SERVICES REQUIREMENTS
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 a qWorkers'Compensation Laws of Catilpmia.'�S ZONING APPROVED BY; ; S.G-I " // DATE: 5-1
Date:? 'inn_
9'1- Signature: 15 BUILDING APPROVED BY ; kiln. , 4--ss,nocl0.'T'e-s DATE; 4.49
NOT E:If.after making this declaration,you should become subject to the Workers pensation provisio of the Labor _ _, (rte,, h
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked, Z. Q .t^/�
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED 'BY: p DATE-
,.... Z L
which this permit is issued(Section 3097,Civ.C). ' • *'*'**********'**********'7/ **' >! w..�' A***********IE************X44****7-** W I **sr**
LENDER: '/ *************-*******************#**i *********3F*************************44.******
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
• OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractor's'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE .-
GRAD:NG
(Section 7031.5 Business and Professional Code: My city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 554 . 00 - -8 .02o ,
repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed SMI P/NON=RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN 360. 10 -- '
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption Any violation of Section 7031.5 by ISSUE FEE ' '_any applicant for a permit subjects the applicant to a GW penalty of not more than live hundred ddlars(t500). BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the TOTALS----> 562 . 02 0 , 0 0 - 360 . 10 922 . 12 922 . 121 ' . 00
❑ structure is not intended or offered for safe(Section 7044.Business and Professional Code: The Contractors'State License Law
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through ' ' -_
his or her own employees,provided that such Improvements are not intended or offered for sale. If.however the building or REVENUE DIVISION TOTALS--> COLLECTED: 562 .02 OVER/SHORT: . 00
improvement is sold within one year of completion,the owner wit have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
• for the purpose of sale).
' 554 . 00 8 . 02
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business ' . C.
and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon -A
and who contracts tor such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware * ********************-*'********** 3i
********** *****'************N(7)(2*****
*' *****};****
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUA L. F E E BREAKDOWN - �i
ij I am exempt under Section:BP7044 B.&P.C. ,
for this tea : OWNER BUILDER TYPE Y DESCRIPTIO N UNIT COST r , N
I OTAL COST
a
Date:_2 Hot- Owner: FPLt B", LI b�44, SFR ?162 DWE-TYPE V-WOOD FR ME -GOOD 69 . 00 80, 178 . 00
I do hereby cenity that I am aware of and understand the requirements of California Health and Safety Cod ections 25505.25533,and ND OF FEES
25534 and that I or any future building occupant wid/will not(circle one)need to comply with said state codes and the requirements for a EXPI R E D • -
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from
these provisions. ) i PI to Inspects _ `
Dale: Applicant: Date" AP .� '1�: -; 1.2. . /.) . .
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county .- WS�s8CZ:
ordinances and state laws relating to building construction and hereby&Minnie representatives of this city to enter upon the above-mentioned 4/
ptopeny for inspection purposes.
Date:al 19"- Signature: OA.. , Lea
. Yip AQP` 1 �)
Driver's License or Social Security 0: �' 1
• r t.
1641-46 White—Building:Gwen—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
. '1
Y_
CrSTRUCTION AND PLANNING PO( SPA
tPPROVALS 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 � � 58. Electrical Conduit-Undrgrnd.
8. Foundation /� - 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. •
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final '
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final '
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System•Final
16. Rough Electric Wiring - 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
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 0 /.7L �/����� 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat ' 75. Dry Chemical . ,
27. Frame and Flashing p21/752.-.„Or 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
•
29. Insulation 17./a -ZQ 78. FIRE PREY. FINAL
30. Drywall Nailing _ )F- yr HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes_G 9y G- '
34. Final Heating & Air Conditioning 4.0
�J�Mt/
35. Final Gas Pipe-Test �
36. Hood or Canopy -
37. Final Factory Fireplace -
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System 41
45. Sound Attenuation -Qty � 20 0g .cKS�
46. Handicap Regulations _s Pie£e-Tie rf Pe.
47. FINAL STRUCTURE & BUILDING Y (letter-if- FL/3AL- pqtd� t -_^'
48. FINAL PLANNING -
49. Electric Release to Edison -
•
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
9
PROJE%ADDRESS: 232 E 19TH $T UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 060059
OWNER'S NAME: BRION,. MICHAEL E •
ADDRESS: BRION, JUDY D PERMIT NO: E 060059 PLAN CHECK NO: N GOVT: N SUPP: N .
232 E 19TH ST •
COSTA MESA,CA 92627 CONSTRUCTION TYPE: 5—N PERMIT TYPE: ELE PURPOSE: OTH
ARCH/ENGINEER: RANDALL B . COOMBS REG.NO.: C19185 JOB DESCRIPTION : ADD 3 BD RMS 6 BATHS/REMOD 2 BD RMS/BATH SQ FT:
ADDRESS: 2033 W. FLOWER AVE. UNIT: •
FULLERTON CA 92633 • CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
PERMITTEE: MICHAEL E. BRION (714 ) 548-4056
ADDRESS: 232 E 19TH ST COMMENTS; RE: B56264 PRIMARY BLDG. PERMIT•
COSTA MESA CA 92627 *******************************************************************************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS •
CITY LIC.: STATE LIC.: CLASS:
Date: Signature: BUILDING ACCESSORY BUILDING
S'COMPENSATION DECLARATION: (hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT; FT IN
Compensation Insurance.or a certified copy thereof(Section 3800. Lab.CI.
POLICY NO,: EXP.DATE:
COMPANY: PARKING REQ: PROV: PARCEL: 42627117 ZNE: REF NO:
r] Certified copy is hereby furnished. CI Certified copy is filed with the city Building Division. PLANNING NOTES>
• >
date'. Applicant: DEVELOPMENT SERVICES REQUIREMENTS
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less).
I certify that k
inthe performanc of the work for which this permit is issued, Shall not employ an in anyr so as to become
subject to thee '.kers's'Co•Co•sensation Laws of California. ZONING APPROVED BY DATE:
...—_ Date: // Lf Z' Signature: '
NO E:II.al . making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : // DATE:
Csae.you i st forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: !�/� DATE• 2- Z
which this permit is issued(Section 3097,Civ.C). ************************** *** **ic7. * ***** *************** * * *R
LENDER: ******************************************** *********************************
ADDRESS: LEGALIZATION:N F E E SUMMARY ' STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMB ING ELECTRIC MECHANIC FIRE SHIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct.alter,improve,demolish,or PERMIT 52 40
repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 5O Z SM I P/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
and Professions Cade)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by
any applicant for a permit subjects,the applicant to a civil penalty of not more than five hundred dollars($500). _ ISSUE—FEE - - - - - - - 1500 00 - -
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 52. 40 15. 00 0. 00 67. 40 67. 40 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees. provider that such improvements are not intended or offered for sale. I1,however the building or REVENUED I VIS ION TOTALS--> COLLECTED• 67. 40 OVER/SHORT
PLAN—improvement is sold within one year of completionthe owner will have the burden of proving he/she did not build or improve
. 0 0
• for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 67. 40
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projectb with a contractors)license pursuant to the Contractors'State License Law).l am aware ******************************************************************************* ,
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
® I am exempt under Section:BP 70 4 4 B.8 P.C. ��� .
or this reds TYPE QTY DESCRIPTION S C R I P T I O N WNER BUILDER UNIT COST TOTAL COST
r Dam'. as/". ft— Owner.'%%%dam'✓! �:pe ELE 14 FIXTURES LIGHTING 1 ST 20 EA. . 75 10 . 50
I do hereb eddy I I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and ELE t a. 2 0 RECEPT/OUTLET }} 1 ST 20 EA. . 75 15 , OO
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a ELE u 7 • RECEPT/OUTLET.d ADDITIONAL EA. . 45 3 . 15
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from Eg
these provisions. ELE 17 RECgE�PT/SWITCH '' 1 ST 20 EA, . 75 12 . 75
ELE 1 E XY$-E D PANEL
g END OF FEES 11 . 00 11 . 00
Date: Applicant: tt
I hereby certify that I have read this application and slate that the above information ist correct. agree to comply with all city and county •HIM,t8 I�
ordinances and scalp;laws relating to building construction and hereby authorize representatives of city to enterthe above-mentioned
property for ins tier ppuujur'oses �/7 \\ ..Dale: I� r-GT ' Z—' signature: • / `—' . - Sig
e Driver dense Sociat Security b: t' 1 .
_ i',
1641-46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor ;
• .
i i
CONSTRUCTION AND PLANNING POOL ciA z
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole • 52. Pool & Equipment Location /
l ,./.."
/
2.rt."; . XUnr.K. /
ti %/ 53. Steel Reinforcement >% / n
s
47,
8..-Elegirical-G-oriquiWtility-Undrgrnd. t- • 54. Forms .•7'` ,i
-
' 4_`ElecfricarGonndt(MMUfidrgrnd. 55. Electrical Bonding r •f
s-
"5., S{e€l Reihfoe{ en(; • 56. Rough Plumbing & Pressure Test
116-E1ec`trical•VFERcGrAd. 57. APPROVAL TO COVER-GUal ^
7..1;44‘€11ngg, 't 58. Eiectrical Conduit-Undrgrnd. C °'
f- Ef. Foundaiiiii O[- I .1. 59. Gas Pipe, 0 Undrgrnd., Test /X C
9. Water PIi 4Jndrgrnd. f Jn 60. Backwash Lines,P-Trap, 0 Undrgrnd. J}
r
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Se l r Lint& House Connection i' 62. Backwash & Receptor-Final /13 )
12. Sevvfr Cap a %; 63. Heater & Vent-Final `{
13. Roof Drainst N 4ft-,1r 64. Plumbing System - Final �' �/
14. Rough Plum$if`ig " J�
65. Electrical-Final /IV,/
- a /
15. Rough Electrical-Conduit 1 66. Solar System-Final '
i
16. Rough Flectri&iring 1 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,Roi+gh FJct66y rite lace 'x'1 ¢'" " C C Cr* ' r` ,PPR 'JVA1.$1.'�CPerAit# r " 7 1-1-g
z S c., Q aP S-r `.t.Q w 5 -+ LT* x c.•. '-1 .> * r n Ctrs.TJ
21,_Ducts, int Stenctur.P.t Hs S D .-4*. .,"K ^70.Undergrotmtt Hydro x
�) S" S-V y n n.v u a _y
22. Dus, bntlY ting �� x G `, a� �• y71. Product `lUing �'s 14011Vi
23':GatpipR;Roj gh&test _cm * t^ T 6 O K x -72. Underground Flush * , JE
- f :., z.. . r > _ � •> X T v -t, > c > -
24.rRob7 Flaming 'a ..fa x > � i _x a 373bUndergrn?.Storatr'�Tank'�[.7Gas ❑dt9-'V - �>
25. Ro SF athin .x,4:. ' `u` :` ^ •h ' tux x ; - v --+-. K t 1
4f 9 < v 's, X _ -> ;Ji 74, Overhead Hydro.; x
26-?T-Ber Ceiling (Statetural) 80Aonocoat * T LI* * 75�Dry Chemical 'K -' •' -_ c {� ' ''/I
'
-.p X ' r mr,;s .
27.`,Frame a,ed Flash3i to
J f.r K S y A* * 76. Dry Stan t a 19.1: x S '.?-"J".; r;,n f ti
-.28. Lathing.& Sidingr�x. 1. ?'2c-= ;^ - X •• - •* x 777_ FIXED SY!TE ElNAIk H t_ 'rte -r - 1
y -.I * r -, .. .. ' V/ it c r i 11/4-.;
:L'� _.0 r
29. Insulation g* S .. * .. 7e FIRE PR EV. FINAL :: > .c 2,3 � i J
T30. Orywall Nailing < K c HEA LTHrDEPT! R€QNIREMENx -1 t
* :_ 'T lav n•: x -.,- n, f
231. Plaster gown COaf S tr,r x !A1c x .x791`FINAL 19 R�CTI(QkC r J 1r-`-x •
.t, .y 2„ I t-- •1 ---Tom -r-- 7�
(-32.-Electrical Pocveraleteb-Finale X '3 K x '80.nFOOD CERTIFIt%CFE ISSUED
r .`tNiles.
r
< C`33QFiral EIectr •x i X * ' Ne
, 2 ? , -; jr - J q` . ,
r,
a;34;Final Heating& Aie Conditioning: n x * .r - • I CY: S 2 -
Z .- •' .. t X r is '----...XX ,'' I-440 C I 1--te X •- - �,-•
t 35 f irifil Gas Pipc•Tist` ..,tT ,,1. :. ` k * no a: s ,�S ic IT Z.•t O
36. Hood orgCanopy � 1 .ti : a x Th K x X no rr=
;0
:37;'F41 Factory Fire�lace< : .'_'r vi r '/^x x r oo=.- L
-38. Fina! Plumbing :0 •� i'+% S -• k ct'
.q ; .� tu ;. it •t. A.
'739. Water Sevice•Finar 1 ,: fi 'K '0.17 r. cc
* -. .a H - - .. . . SS-C-.
:40. Gas Service-Final n <tr .tr• S r: •r, t = * 7,- a.n) .. • • • •
X41. Solar Domestic-FirtaIS C; '- * O 41 K -I.`1• `
11 .. K .,gr = -. .w :C
42.'Backflc Preventey' ~ �',,• .tx ,r, >- '
43. Backflow Ir6gatiorl y S S x r `, X. v u
> '.C� T
--44. Landscape lirigation Systerip••7., r K ,q = - x r: `c a :A sn *
t. a- . z . -- -- -t - ' r r -
S45t:Sound Attepuatioif f
:.=46:,Handicap Regulations 5 x ' R K K r -3 S o
47SFINAL STRUCTURE & BUILDING '' II I i-r x ' -- .5
C -
t .K -.-
48j FINAL PLANNING I .- Hr r z 11 �� , . ,I a 2 X J
=49:rElectric Release to'Edison i .e / .-E. .z 1le
50.,Gas•Release to Southern California Gas Co x Li Ic x.- -4 ^. -
•• Y
_'51. CERTIFICATE OF„OCCUPANCV ':r x .5 z a OO c •"C
No. Date
PROJECT ADDRESS: 232 E '19TH •ST UNIT: - CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 060060
OWNER'S NAME: BRION, MICHAEL E
ADDRESS: BRION, JUDY D PERMIT NO: M 060060 PLAN CHECK NO: N GOVT: N SUPP: N
232 E 19TH ST
COSTA MESA,CA 92627 CONSTRUCTION TYPE: 5—N PERMIT TYPE: MEC PURPOSE: OTH
ARCH/ENGINEER: RANDALL B , COOMBS REG.NO.: Cl 5185 JOB DESCRIPTION : ADD 3 BD RMS & BATHS/REMOD 2 BD RMS/BATH SQ FT:
ADDRESS: 2033 W. FLOWER AVE, UNIT: _
FULLERTON CA 92633 CLAIM VALUE; CALL—VALUE: GROUP OCC; R-3 /
PERMITTEE; MICHAEL E. BRION ( 714 ) 548-4056
ADDRESS: 232 E 19TH ST COMMENTS; RE: B56264 PRIMARY BLDG. PERMIT. '
COSTA MESA CA 92627 +t*****+t**+ESL*HELP********TE********************LP****************Tr******************
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code,and my license is in lull force and effect. SETBACKS
CITY LIC.: STATE LIC.: CLASS: .
Date: signature: MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN RE : FT IN FRNT: FT IN WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT:: FT IN
Compensation Insurance.br a certified copy thereof(Section 3800.Lab.CI.
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ• PROV: PARCEL: 42627117 ZNE: REF NO:
Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> •
Date: Applicant: DEVELOPMENT SERVICES R E U I R E M E N T S
�.
EXEMPTION FROM NSAWORKERS' thepermithundred erformCOMPENSATION
the work for which this permit is issued, s q1 nyper
/ry�an manneras to become
subject to the Wor s'Com salion Laws of California. "ZONING APPROVED BY - .DATE:
— Date: / Tis Signature: •
BUILDING APPROVED BY
NOTICE' I.after along this declaration,you should become subject to the Workers'Compensation provisions of the Labor DATE:
Code. oo must forthwith comply with such provisions or this permit shall be deemed revoked. % G �` / /
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for —APPLICATION ISSUED B Y• - DATE• /(/ /f"
which this permit is issued(Section 3097,Civ.C). ************************* ***- ' * **** * * ***** ************* 4E* �iiiffE*****
LENDER: ********************************************** *******************************
ADDRESS: • LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 44 .50
repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 25% SMTP/NON—RES
pursuant o the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by .. - -
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE - 15:00
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'Slate License Law TOTALS----> 44 . 50 15 , 00 0 . 00 5 9, 50 59 . 50 0 0
does not apply to an owner of a property who builds or improves thereon.and who does such work himself/herself or through
his or her own employees, provided that such improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOTALS--> COLLECTED• 59 . 50 OVER/SHORT: 00
orimprovement is ofsolds le)hin one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SM IP/TOT GRADING PLAN—CHECK
for the purpose of sale).
I.as owner of the DmDerty,am exclusively contracting with licensed contractors to construct the protect(Section 7044,Business 59 . 50
❑ and Professions Code: The Contractors'St ate License Law does not applyto anhe Contractors'
property who builds or improves thereon *******************************************************************************
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware
P�, that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
Ki I am exempt under Section:8P7044 B.8 P.C.
for tWs reason 0 ER BUILDER •/ TYPE QTY DESCRIPTION UNIT COST TOTAL COST
.---
Date:_// r-7 *Z_ Owner; ...i"-e.---1417/4 _" MEC 1 t INST FORC—AIR/GRAV FURN <= 100 K BTU 9 . 00 9 . 00
I do hereby c�ily that aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and MEC 1S','('' REFRIGERATION SYSTEM lc 100 K BTU/H 9, 00 9 , 00
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a MEC 2111.' FACTORY FIREPLACE f. 6. 50 13, 00
permit for construction or modification from the Air Ouality Management District.Residential construction applications are exempt from
these provisions. MEC 3 VENTILATION FAN CONN TO SINGLE DUCT 4 . 50 13. 50
E X P i*E Q END OF FEES
Date: Applicant.
om,,faYa !r;:;;tr>.ctions-
I heretic ordinances and
that I laws
s tin this ingllon and state that the above information representatives
ist ties of 1 agree to comp) with all city and county • `' r�i
tpertyandstr4on relatingsuseto building construction and hereby authorize represenlalives of this city to portth bove mentioned •
property for inspe.ion cur see. 4_ 5
Date:4l Z3 L L Signature: v
Driver's License ocial Security 4: 4
• 1641-46 White—Budding:Green—Code Enforcement;Canary—Applicant:Pink—Revenue:Goldenrod—Assessor ,
rf
f I
CONSTRUCTION AND PLANNING • POO WA
APPROVALS Permit # Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole a% 52. Pool & Equipment Location '�'
i
2. Soil Pipe-Undrgrnd. moi . 53. Steel Reinforcement I
/
'3A .7EteGtricaI do u t.Cltilit Undr rod. 54. Forms 5././ �%
,..A flectricatCon clitrU idrgrnd. - 55. Electrical Bonding' t-
?
°".5,5e I Reinfbccenhrj 56. Rough Plumbing & Pressure Tesf ' d
oscBJEtectricatHF•ER.Grnd. 57. APPROVAL TO COVER-GUNITE �4.
, rr _
2:4,yFd6 ing` t= s- - 58. Electrical Conduit-Undrgrnd. a.
' 8 1. !T
E 8. Foundati4 pt_ 59. Gas Pipe, 0 Undrgrnd., Test
n
9. Water Pfpe.1.lndrgrnd. S 60. Backwash Lines, P-Trap, 0 Undrgrnd. '
10. Structural Floor System if _ 61. APPROVAL TO DECK
J 1
11. Property Sevier Line.& House Connection
Y r. r / 62. Backwash & Receptor-Final ;,/ n
12. SegVer Cap L, y :/t,,�' 63. Heater & Vent-Final
13. Roof Drains C rt ,� 64. Plumbing System - Final ! ` �'
14. Rough PlumbIrfg i 65. Electrical-Final ' ! f _ Ci'
- 15. Rough Electrical-Conduit 1. 66. Solar System-Final /,/ I i
16. Rough Etectric;Wiring 67. Fencing & Access Approval /71
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING ^`
18. Rough Electrical-T Bar Ceiling 69.-POO USPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning ut•/Alift £40 FIRE DEPT. REQUIREMENT
20=.Rogh F�ctaty Fireplace I :n1 s ftitiq *APPROVA'1:S%OPetthit# * > r n'am
'C •j x d >x s r s _[ '6 . 'L .g cJ Lg. 6:0-: > x e- C:.r:'i-.
r - - ,Z1 r - -7 xx -t > :S:✓7¢ m x A
21;,Dikcc1s, L Stytcttuex . •. ,.,� „ S _ .J-, < -,70. tindergrpwid Hjglro x
s S' _ _
22. Ducts, Vbntitatiriax ::S : S crx A a 71. Produof ing Was f3Oil
r r r 1 x v. - Q :-* x : r, Cl
Oil
Pipt Roti h &• est r,S *. , •• < ; # 72. Undergro nd Fruth � '_"
24ZRo& Fleming -n< , .- , ••.n -' > 0 * K S73PUndergrrx`1-Storat_7TankCGas 0011-L!'-
,-_
25. Rod Sf�eathin ` ''C r' '_n DJx x r H'r s -
g .o m d +% J3x •s74 Overhead Hydro-- ,
26:5T-$ r Ceiling (Shot/ & m .:
ctural) Monocoat x J 'qx w 75rDry Chemical 1 M b "'I X v>
27xFrame a d Flash" m t x '' 76'Dr 13''1 GS- - s .r ia!r.)S
_ :xx ,� .; >• rx x Y Stan,••pi,pe ;• c..x:.- s,: I
J V --i.1.1‘..; n r n x ' L v, lc .i , , ..
'�28. Lathing$ Sidings,- > y4 c ,C > ••• ..+c x 77,r FIXED SYSTEN75INAC r(: '
_. r+ 1 h• x -, - - -, r ^..,,. ar
H : T .. j a . . ..*A .,-_-,
:CS �- - 1
29. Insulati6n ., I 78 FIRE PREY. FINAL x ^ c, ,SiK; •
r30. DrywaltiVailing-z*: r' lj!:. WEALTH-CEP-P. REQUIREMENT
p31. PlasterIrovynCt�atf5 1 ,rr jx ",r79-FINALI ECTf�N „....x:3:.--c..
-32:TElectrical Po4evertfs4etel-Final rr v ',x x r8O iFOOD CERTIFADATE ISSUED . > C - -'
:3 M _ • -
{_33SFii5 l Electric M ,,, 1, x '' x x ' NQies: ' 'S K -: >`' s
r r` T
rc' S d - x 1 J. x ., I /+ r4 +. ... J 7L J * 0+'1 ti
,1346 Fioal Heating&Alf;Clonditiongtg i :, 2 _". s r - >
'35.1Firial Gas Pipe-Test! 7 _` - x * fl n'7ris- • x r 5, .t...0 C.;
x x ,:. ¢C C. x T
-c36.Hood or'LCanopv .< -S i T : - ' i /x :: > o . - M r •i-, •- r
437, Fin5l Factory Firepleeer ' S v .n - '/7/ w - t 1• r. oma• Zvi
`38. Fioal Plumbing x v fi ��� s ; , . v
_ r rr
,7:39. Wafer S&vice-Final, 5 I - /e(l ' roe ..• 'UM -c co.3
)( x :
;40. Gas Serxice-Final , c„ „4,7- , . to b x - Z1 _fe tc " -Dt -
. . c r
>41. Solar Domestic-Finals c_- :-, I t x
•• x .n ! t r ia: i x Z n
-42.aBackflorrw Prevente r' 9i3 : •3 Iix ` IS '-
43. Backflofv Irdigation• • 55 x * ! - s' •< A.-•,2•t
a ;c ,( sJ x
' ;.44. Landscape Irrigation System,mr, x , -r C. - -IX c ; .'.1 p) X^ 0000
<450Sound AtteBuation :'' • % ,. '1 -.i ..-i L'.. '<
'l y - .. .. - r n x . - _ C g
-I=46:• Handicap Regulations - ,'• i Co N.
47:;FINcAL STRUCTURE & BUILDING ; • ( l* ' : S a -
r
48'.2.FINALPLANNING i ;-- f:� r t • `,
t49 Electric Release to.Edison . - I 1 „/"L.:: -. _
�50.;Gas Release to Southern California Gas Co I. I , . ._ ''_ n _ . . ••
•:51. CERTIFICATE OF,OCCUPANCY \:,.. e � Mr, r- x - c'J - '
No. Date -_
PROJECT ADDRESS: 232 E •19TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT YnttM NO: Y v� alo�
OWNER'S NAME: BRION, MICHAEL E
ADDRESS: BRION, JUDY D PERMIT NO: P 057165 PLAN CHECK NO: N l>UV t ; N bUF P: N
232 E 19TH ST
COSTA MESA,CA 92627 CONSTRUCTION TYPE: 5—N PERMIT TYPE: PLU PURPOSE: ADD
1 .
a9cx/ENGINEER: RANDALL B , COOMBS REG.NO.: C19185 JOB DESCRIPTION ADD 3 BD RMS & BATHS/REMOD 2 BD RMS/BATH SQ FT:
ADDRESS: 2033 W. FLOWER AVE, UNIT:
FULLERTON CA 92633 CLAIM VALUE; CALC—VALUE: GROUP OCC: R-3 /
PERMITTEE: MICHAEL E. BRION ( 714 ) 548-4056
ADDRESS: 232. E 19TH ST COMMENTS; REF 856264
COSTA MESA CA 92627 ****>E*t6*t6x ***R-**********)<T6*iF****+F****>F** *t6tc• ****aF*** FBF***+F************Tc*pct(**s
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I all,licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS
CITY LIC.: STATE LIC.: CUSS:
Date. signature: MAIN BUILDING ACCESSORY BUILDING
Date: S'COMPENSATIONDECURATION: Iignat allirmthatlhaveacenificateolconsenttoselbinsureoracenilicateofWorkers' FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insurance.or a certified copy thereof(Section 3800,Lab.C). LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN
POLICY NO.: EXP.DATE: PARKING REQ PROV: PARCEL: 42627117 ZNE; REF NO:
DMPANY:
PLANNING NOTES>
>:
Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division.Applicant /. ******************************************************************w.************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (iris section need not be completed if the pent is for one hundred($100)or less). DEVELOPMENT SERVICES REQUIREMENTS
I certify that in the pert• ance of he work for which this permit is issued.I shall not employ any son in any manner so as to become
subject to the W.r .,sr Compe• .tion Laws of California. .-� i ZONING APPROVED BY DATE:
Date: zi Signature. BUILDING APPROVED BY : DATE:
NOTI .II,alter .. mg this declaration,you should become subject to the Workers'�nsat�ions of the Labor
Cod'.you must I. hwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency or the performance of the work for APPLICATION ISSUED B Y: C . _ :T DATE: 27
which this permit is'issued(Section 3097.Civ.C). ,�/ ***X.*****************4 ' .1 ***************3e re *-
LENDER: /. r *******************************************************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT;N
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city 01 county which requires a permit to construct,alter,improve,demolish,or PERMIT • 25,50
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 25%
pursuant l0 the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 70011)of Division 3 of the Business PLAN SMIP/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by �'
any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($500). ISSUE FEE 3,00 /
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the
BUILDING—DIV—> PERMIT ISSUE PIAN:CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS————> 25 . 50 3, 00 0 , 0 0 2 8 , 5 0 2 8 , 5 0 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
ahis or her own employees,provided that such improvements are not intended or otlared for sale.IL however the building or REVENUE DIVISION TOTALS--> COLL`EGTED• 28 , 50 OVER/SHORT• 00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve MH I NG ELECTRIC E VHAN I C FIRE 5M I P/TOT GRADING PLAN—CHECK
for the purpose of sale). BLDG PMT PLU,
I,as owner of Inc property,am exclusively contracting with licensed contractors to construct Inc Protect(Section 7044,Business 28. 50 r
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to theContractors'Slate License Law).l am aware ***********************************:********************************************
that proof of Their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
2 I am exempt under Section: BP704 4 B.8 P.C. V
for this reason: OWER BUILDER { TYPE QTY D E S C R I P T I•,O N UNIT COST TOTAL COST
Date: Z_ Owner: ` / �� IA
"� PL[i. 2 BATHTUB r 2 . 00 4 . 00
I do hereby c y that I am are of and understand the requirements of California Health and Safely ode Sections 25505,25533,and PL U t. 1 LAUNDRY TUB CFR WASHER 2 . 00 2 . 00
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a PLTJ
I SHOWER r, 2 . 00 2 , 00
permit or construction or modification tom the Air Quality Management District.Residential construction applications are exempt from
these provisions. PLU WASH BASIN 2 . 00 $ , 00
4
PLU ) 2E'YP PIM CLOSET •(TOILET) 2 . 00 4 . 00
Date. Applicant: PLU IT let ER HEATER AND/OR VENT 2 , 00 2 . 00
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county PL U ,1,y_ �fj ? e SING SY5 OFt�' 1 TO 4 OUTLETS 2 . 00 2 . 00
ordinances and state laws relating o building construction and hereby authorize representatives of this 'ly to enterbpon the above-mentioned PLU Vat GAS I TNG SYS 5YA. OUTL—PER OUTLET . 50 1 . 50
property for insp^ on purpo /` END OF FEES
Date' t� Signature: Il
Drive'. License ' Social Security a: B• C ( ..i i _ r _:1 , -
164646 white—Building:Green—Code Enforcement:Canary—Aoolicanl:Pink—Revenue:Goldenrod—Assessor , -^
CONSTRUCTION AND PLANNING * _ . ROCS,
APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector.
1. Temporary Electrical Service or Pole • 52. Pool & Equipment Location -
2. Soil Pipe-Undrgrnd. / 53. Steel Reinforcement
3. 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 58. Electrical Conduit•Undrgrnd.
8. Foundation 59. Gas Pipe, 0 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
067, 1. •62. Backwash & Receptor-Final
12. Sewer Cap ��
63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System -Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
•
16. Rough Electric Wiring 67, Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-I 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
I
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing 1-' HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:/r, -"
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 l
40. Gas Service-Final
•
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48, FINAL PLANNING r
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co ..
51. CERTIFICATE OF OCCUPANCY
No. Date
M1
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations-
• v eFCOST Mes1A CONSTRUCT ON PERMIT P IT NO TRACT NO. LOT NO. UNIT NO.
Prot•ect Address oc3a £` 19 -r-" Stec£ . ' 1 3S4S8 ._ ,
Applicant's Mailing Address SA 'C• TYPE OF CONSTRUCTION." 7J'NEW ADD iidALTERATION ❑ REPAIR -
1�KE x�2 R\C� 8.5 3151• 0 CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# • Zone
Owner's Nappm�gye rr� •l ) Phone8-54-3151 J f DESCRIPTION OF WORK/ SE OF BLDG. '-
Address .r4 P . R'Th S#RE'E-1- L{ -G ' ' /C (4.61-CX" -S Main Building: Accessory Building: ,
E Z
Arch/Eng. - . License-No. TYPE OF PERMIT U GRADING .11 FOUNDATION El STRUCTURAL . T Front .D
Address ❑ TENANT Olt: ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear - - N
TC E1 EG}'Rlr J--1IC• Phoner7a--)5 / ❑ 'OTHER
Contractor's Name-re' C Right N
G 1 PROJECT DESCRIPTION SQ. FT. ' - OCCUPANCY
ddrescense(mailing) '932 Er E`DIry C7EQ AVE.
4 , �O 1 CONSTRUCTION TYPE VALUATION$ S Left
G
CityLicense No. eq a. _ R
_. -, ZONE GRADING CU.YDS. ACRES Ping. Ref.# Parking Req./Provided E
LICENSED CONTRACTOR DECLARATION .U��Qp - O
1 hereby affirm that I am licensed under provisions of Charte 9 (Comma "ng Remarks: Planning Notes: '
with section 7000) of Division 3 of the Business and Profess) s Code, d M
my license is In full force/and fact. I T
L1can ClaIs In full
C. 1`� ens o. _ •
'S
Date`?-� / Wr Signature G m -_ • PLUMBING FEES. v
WORKERS'COMPENSATION DE RAT ON Bar Sink Showers ' '
hereby affirm that I have a certlf/(cattAe of consent to self-Ins or a certificate ELECTRICAL FEES
.f Workers' Compensation Insur or a certified.copy thereof (Section • Backflow- Preventer Service Sink - -
3800, Lab. C.) c q�-�'' r Automatic Washer Transformer 0 15-50 KW
;Policy No.
104/19)543-10CompapY v�' Cu(to Backflow Irrigation Sewer Cap- Construction Pole Sub. ❑ 50+KW
Certified copy is hereby furnished./BVI\J)EI/
1}I"'p"'1('�C n p i ed with the city u Jssg,1)tv o •» Bathtubs , Sewer Connection - Cooking Unit Meter Dup to 100 amps
'Date- /� Applicant LL" `�
EXEMPTION FROM WORKERS'COMPENSATIOP DECLARATION Clarifiers Solar Collectors .( Dishwasher - Meter Dover 100 amps - _ . _ -
(This section neednotbe completed if the p mit is••ffookk one hundred ($100)or -
less). • Dishwasher • Solar Piping s" Dryers ❑Gas ❑Electric Sub Panel
certify that in the performance the w for which this per R iz issuetl I
-
shall'not-employ any p on in any man r so as to b act to the Drinking Fountains Solar Tank ^r'; ✓ I Fan Motors❑0.1 HP ❑1'h-B l
Worke C nz�lQ�pLaaws of Califo ^�' - v .
. Date-% �`'�0 Signature �. N ,1 Floor Drains ' Swimming Pool w/Spa i' F.A.U. Inc.Solar (]9-15 HP D16-15+
'NOTI If,after making this declar tion, you sho become subject to the -
. .Workers' Compensation provisions of the Labor de,.you.must forthwith • - Floor Sinks - - - ' Urinal - - -� - - Fixtures - -_ Microwave' - '
-.comply with -such provisions or this permit shall' be deemed revoked., -
"-•' 'CONSTRVCTION LENDING AGENCY Gas Service Outlets ' • Water Closet Device Boxes Pole Light•
I hereby affirm that there is a construction lending agency for the performance - • _ ' - 9
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors - Water Heater - Outlets I
Lender's Name' - - Range
Lender's Address _ Kitchen Sink _ , , Water Service - Switches Sign •
OWNER BUILDER DECLARATION I '
' I hereby affirm that I am exempt from the Contractor's License Law for the' . • Lavatories Auto-Wash - Garbage Disposal '
following reason (Section 7031.5 Business and Professional Code: Any city or • ;Standing Sections
•
county which requires a permit to construct;alter improve,demolish or repair P—Trap - r Laundry Trays - - r. Generator O-5 KW ❑5.15 KW '
any structure, prior to its issuance, also requires the applicant for such permit - _ , Trash Compactor , 1
1 to file a signed statement that he/she is licensed pursuant to theprovisions of ROOF Drains - '-
the Contractor's License Law (Chapter 9_(commencing with Section 7000) of • • '
7ivislon 3 of the Business and Professions Code) or that he/she'is exempt s '
herefrom and the basis for the alleged exemption. Any violation of Section r- . _ - '
/031.5 by any applicant for a permit subjects the applicant to, a civil • ' .
' malty of not more than flve;huntlre0 dollars($500). - • • ` , �S O J
LJ I,_as 'owner of.the, property or hay employees,with-wages-as their-sole Reinspection Fee ,-. I' $15 Issue Fee - $ $:
compensation, will do the work, and.the structure is not intended or offered - Reinspection Fee I $15 Issue Fee t-r I
for sale (Section 7044', Business and' Professional Code: The Contractor's ' ' ' _ MECHANICAL, FEES -
License Law does not apply to an owner of a property who builds or improves _ _ __ '__ - _ -
'thereon, and who does'such.work himself/herself or through his or her own - _ __ 1 DEVELOPMENT SERVICES REQUIREMENTS: 1
employees, provided that such improvements are not Intended or offered for Boiler.- - Hood or Type I '❑ •
sale. If, however, the building or improvement Is sold within one year of com- ,Canopy . Type II ,❑ Zoning Approved By Date '
pletion, the owner will have the burden of proving he/she did not build or im- • Duct-Under Ground. 1 • - _ Building Approved By Date
rove fOCthe purpose of sale). •
18
. I, as owner of the property,am exclusively contracting.with licensed con- Duct-Structural Refrigeration System _ Application Issued By -� Date I� /u
� tractors to construct the,project (Section 7044,Business and Professions Code: ` ,
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating, -. 00-100 000 BTU 0100,000 BTU SUMMARY OF FEES t I
t builds or improves Hereon,-antl who Contracts for Such projects with a con- - - ,
'tractor(s) license pursuant'to the Contractor's License Law). I am aware that ' Exhaust System ❑ Multiple❑ System Repair/Alteration BUILDING PERMIT '$ SMIP •• $ • I
proof o their Worker's Compensation insurance should be provided to me. ,
- I PLAN CHECK .$ PERMIT
❑ I'am exempt under Section B. & P.C.for this reason Firepl/Fact.Bit. ICBG# , Fire'Da mpers I PLUMBING ,g ISSUANCE $ '
• 'Date Owner ' • l Heating System& Ducting ( • Registers •
PLAN CHECK 25% $ ENERGY P.C. ,$
I hereby'certify that I have,read this'application and state that the above 00-100,000 BTU 0100,000BTU -' - - ' '
information is c• ect. I•agree to comply with all city and county ordinances 1 ELECTRICAL $ 5 3,Sa 1 GRADING *$
and state laws r�:ting to buildin construction,and hereby authorize repre- • - 1 PLAN CHECK 50% '$ MICROFILM $
,sentatives of th city .to enter up the
the above-mentioned�•pr�o ppertyy for I ,
•
.insPecure 'q r.� • e 1 ,• r 7-2/'a
Signature Date • MECHANICAL $ TOTAL FEE $ 33,v1�
Drivers' License or SS .e � Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% '$ ) • i
r__CMFF 0865-46,rev. 10/84 white - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor V a UUU t.fQ 1 I.-LUULJ.14 , Ul 1 3.3,SQ
DATE: 09/27/RR Ithre nerd
1,1-- , .
CONSTRUCTION AND PLANNING - POOH a SPA
- °- Date ' Inspector - Date Inspector
APPROVALS Permit# - APPROVALS Permit#
1. TemporL Electrical Service or Pole
tY ';f 52. Pool & Equipment Location
'2. Soil. oAUndrgrnd. _ 53. Steel Reinforcement '
3. Elect, I Conduit-Utility-Undrgrnd. 54. Forms
,-4. Electrical Conduit-Undrgind. ' . 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, 0 Undrgrnd.,Test
9.-Water Pipe-Undrgrnd. .--- 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System • 61. APPROVAL TO DECK -
11: Property Sewer Line & House Connection -62. Backwash & Receptor-Final
12. Sewer Cap ., , - 63. Heater & Vent-Final
13. Roof Drains ., • - 64. Plumbing System - Final - '
14. Rough Plumbing . 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
tel Rough Electric Wiring - 67. Fencing & Access Approval
17' Rough Wiring Sign 68. APPROVED FOR PLASTERING
i8. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
1,9: Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT
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20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in=Structure 70. Underground Hydro
22. 'Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
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23. Gas Pipe:Rough& Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25..Roof Sheathing U 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 /Q _e3.s 80. FOOD CERTIFICATE ISSUED
33. Final Electric 70-3-8g e 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. Solar Domestic-Final • - t-„
42. Backflow Preventer - - _
43. Backflow Irrigation ,
44. Landscape Irrigation System .
45. Sound Attenuation
46. Handicap Regulations - (�
47. FINAL STRUCTURE & BUILDING
•
48. Special Requirements Completed -
49. Electric Release to Edison . ..
50. Gas Release to Southern California Gas Co
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51. CERTIFICATE OF OCCUPANCY - - _
No. Date - .•1
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