HomeMy WebLinkAbout882 18TH ST - Building PermitsCity of Costa Mesa
Building Safety Deparime�}
P. O. Box 317
Costa Mem, Californio
CERTIFICATE OF OCCUPANCY N� 2OSS C
The Building located at �'�- �u- �{+- �H- �1- ►iOh_ Ri
has been inspected and found to comply with the provisions of all
for a Group _ � Occvpancy.
of Costa Mesa Ordinances applicable ihereto
Use of Building 'R�e �i.i-'� S�l�'!U6'�M�3�- :�'ll7diflu _
Legal Description A. P. �r3?_Fi�112..:t0
($ee rever�e tida for Metes ond Bo�nds)
Building Permit No.�(J� Elecirical Permit No. �3�y�],�} Plumbing Permit No. Zy35�'�._
Floor Load SignS have been installed as Room Capacity $igns have been instaled as
required under Sec. 2308 U. B. C. . required under Sec. 3301 (1) U. B. C.
77050. CERTIFICATE OP OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occupied
until the owner or operator has been issued a valid cerTificote of occupancy by the enforcement agency.
(b) A new certificate of occupancy shall be obtained whenever there is a change in:
1) Occupancy classification of a building or portion thereof
2) The number of apartments or g�est rooms
3) Ownership
If Group H Occupancy, number of apartments and/or guest rooms as required under Sec. 17050.1 (d), California
Adminisirative Code, Title 8, Chapter 9, Article S.
Number of apartments_ and/or guest
ISSUED TO: Building Official
TAKOSKSC t�. by�� /u ����z�
Date ^�g'�r�� �,(A� 2n�F
'ihis Certificate of Occupancy SHALL BE posted in a conspicuous place on fhe premises and SHALL NOT BE removed
except by The Building Official of fhe Cify of Costa Mesa under Sec. 306 (e) U.B.C. po� snaa--iM—�i-ea--s-s r
� "
� � �
� JAN 27-6�A1D�� 8?2 0*�* `�.,,o
� � cxsn
COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX 1200 COS7A MESA, CALIFORNIA 92626
APPLICATION FOR BUILDING PERMIT
Fo� Applicant to Fill in Completely
FEC IV D B DATE RECEIVED DATE ISSUED
ADIDRESS 'y�i � �'L���
�,�' O/ ' / — O PE ITNO
OWNER A.P. NO.
ADORESS �/S� �^.l . .�' . BUILDING
7� � A�DRESS �� �
d U CITV C.Op �5 NOL � TRACT • LOT BLOCK
ZZ
Q CON5TRUCiION W ADD A P
O N IEN�ER G� �'/ �
am �
J � BRANCH
J N OWNER
mJ ADDFiESS r
m VALUE O�
J Q AFCHITECT TEL. E � 3
� OR ENGINEER G� - Y� N.
U FIRE
Z a ZONE � TVPE GFOUP F�
w 2 ADDRESS
d w APPROVED �j /
JO CONTFACTOR � ��, � j� BY DATE �La_!O �
m z �J � ADDRESS
w w TEI. ZONE NO.OF USE OF NEW /��vJ
� = dTV NO. P�� BUILDIN �
2H
w0 STATE CITV ��+RDSAPPROVED VARDSAPPROVED /�
y� �IC. NO. �IC. NO. MAIN BUILDING ACCESSORY BUILDING 1,"
7� SI2E NO.OF BLDGS. (FROM C EET)
OF LOT NOW ON LOT FFONT FT. FT.
USE OF ,�
EXISTING BLDG. S F. FT.
I� SIZE OF NO. OF
Z NEWBLDG. ROOMS STORIES L.SIDE FT. FT.
U EXTERIOR WA�L ROOF ,
COVEFING COVERING REAR FT. FT.
J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE B T. BET. MAIN &
a MAIN BL ACCESS. BLDGS.
a
Q VaR.� DATE
O � � C.U.P.# APPROVED '
~ �� P/'��OI"� APPROVED
ln '
Z
O
UI heraby acknowlatlge Ihet I have reatl ffiis aDP�ication antl sta[e
� Ihat the above into�mation is co�rect antl agree to comply with
� all laws reBulating builtlin8 construction, antl I shell not amploy
F any pe�son in violation of the workman's compensatiOn laws of
y the State of Celifornie. �
Z1 hereby certify thot I am properly licensetl as a contrector untler SQ. FT. o
the Stace of Calitornia Business antl Professions Cotle, Divisicn 3, THE AMOUNTSHOWN UNDER VA�UATION IS FOR
�
Chapter 9, end thet such licenses are in tull force antl eftect, or I TME PURPOSE OF ESTABLISHING A PERMIT FEE ON�V: ¢
am exampt trom e provisions ot Me $[am of California Business VALVATION �
antl Professions C de, Division Chapter 9. m
i O PERMIT FEE $ O� �
D '
Sig^ature of _� �— m
Permittee $ n� PLAN CHECK $ E
` `o ;
Authorized A t TOTAL FEE 5 �.1/ 0� LL`� �
\i
. ! � 22092
r^
COSTA MESA BUILDINGSAFETY DEPARTMENT
P.O. BOX 720� COSTA ME9A� CALIFORNIA 9ZE20
For AppllcaM 'to Ffll /n ComplNdy
TYPE OR pRINT
ouaonuo �B2 gg,� B8L6 6�9 By/° B9d
ADOR6YG B (f O' B =J�1T � '�
COSTA ME6A, CALIFORNIA
oxman 'r4 �!Q S K �O .
w� R 3 D/ urf
cirv BK' P �c�Qc�� NOLTj���
.�.e �u1TEC1' �/ril A�Oiz T /� / P!7 �o TQL
STATH � /yD �
LIG.NO. /
size gsY bo
OF LOT oZ
USE OR
DESCRIPTION OP M�ORK
sieo�Ha �X�.-2^F�
EXTHRIOR WALL� _.
I X[R6oY ACkNOWLtDOt TXAT.1 NI1K MfAD TXI� A►�YGTON
AND BTAT6 TXAT TNt AGOV{,I9 CORR[R ANO A0116{ YO COY.
PLY WITX ALL CITY OqDIlUNCY/ A�IO 4TAi[ L�1M� 11[YYL�TINO
BUILDINO CONR}HYtTOM. _ Lr�
HIONATUREOF _/� �%'
P6RMiTTH� [.ccCrQ� ` oui.,.. n,.
AVTNORIZ[D AO[N'[
��
rtt rct�rivtu
MAY 6 1984
FINANCE DEPT.
CITY OF COSTA MESA
A►PLICATION FOR PERM1�
BUILDING
Fo� OHIc� U» Only
�
■
�
ZON[ NO.O► UOiOIN[W I
•LANI � �YILDINO llJ
DlDCRIRIOI✓�M �+ �� �� � �
A.P.NO. I�(o� ��.�--�OT� / ��.
NOT6: NOEAVCOVHpNAN08XALLEBLlBBTHAN �
80' M 61D8 S REAR P. L
EAVEB 1
ALLOWHD (U.B.C.R80UIRHMBNT) v
YARDOAPPROV[D YARDBAPPROVBD `
MAIN BUILDINO ACCHB80RY BUILDIN6
(RROM C/LiTR6[T)
IRt M i�0 P1%- �8 Ff. ��t I
11.�Y10 �� I pr.
�� rr. �t nrovicc �, f//C•
L.81D �
RBAR � � PT. ��W �H PT.
DIBTANC6 BCf. 2S � BET. MAIN R
MAIN BLD08. ACC889. BLDOH.
VAR.Ii DATB
C. . APPROVHD
/1rlROV[D ,�Q -�/6/6v
OATi
HOLD FOR SPECIA RE UI F w
Pe�li�i� Y-o be �ova 'p' sYr�Pe�/a.�rcan' �
� la r��ec. rr. �
txe wrouert exowN uryoen vw�uenoN is ron �me �
�YRMG[ 0I fRAGLIGXINO A P6RMIT P68 ONLY. �
VALUA710N �
PHRMITRHB i /�� �
s ��j �'?' � �C'`� w
TOTXL F56 O� � v ^
_ ' s ����� r� -
COSTA MESA BUILDING-SAFETY DEPARTMENT
P. O. BOX Sf7 C08TA MEBA. CALIFORNIA
For Applicanf fo Fill In Complefely
TYPE OR PR(I/N�T
BUILDING �QG /�I /�%ry �Y
COSTA MESA.
�
'&TATE I �/ / ( � � TEL.
LIC. NO. r i-r NO.
SIZE � NO. OP BlDGB.
�� � �r 237 ��.�. r �.,,.W .... ....
� 86TB�CK LINB PROM
������Ci�[•]3•73�'I•7 ;L'3
EXTERIOR WALL ROOF
COVBRING COVERING
USE OP BUILDING AND WORK TO BE PERFORMED
1 HERBBY ALKNOWLEDOB TXAT 1 XAV6 RH�D THIB �PPLIGTION
AND BTATC THAT TX2 ABOK IS COPREGT AND AONEH TO GON-
PLY WITX ALL CITY ORDINAN�B AND BTATH LAWB RH6ULATINa
BUIlDINO CONBtRUC�ION.
SIGNATURE OF �� ��(( �
PERMITTHF
AUTHORIZED AGENT
� � C�E ��C�6����
,�� s -�-��
FINANCE DEP'o.
CITY Of COSTA MESt3
APPLICATION FOR PERMIT
eua�iN�
For Off7ce Use Only
R!ClIPT NO. PEFMIT NO.
Y DATE PEGEI CD DAT6 IB8U6D
„ .r_.� �� �
a��
LE6AL
�9� /,�� /��'� �j
COSTA MESA. CALIFORNIA
ZONING
NO. OF I U66 OP NEW
PLANB BUIIDIN6
A. P. NO. /.I �� L� Z'^ �7
YARDS EVE6
APPROVED ALLO
(ClNTER LINe 8T.1 �� ��
THE ANOUNT BHOWN UNDER VALl1ATiON IB FOP THH
PUPPO86 OP EBi�BLIBMING /� PERMIT� ONLV.
VAWATION l ti '�✓. i O
PERMIT FEE $ �
% � �
S �� � PLAN CHECK $
�'�. `tp
TOTAL FEE $
�'
. e, ,
.ti
t .:���
� ?�C _
.•� �
0
I
,
AOPlicant to till in all spaces exeeD< <hose withi� heavy borEer Ilnes ana sign all avoropriate tleclantionz.
CITY OF COSTAn MaEpSA� COlNS�R�U�. T/�ION PERMIT PERMIT NO. _ _ �f1G7,�1Q� LyQT_NQ. UNIT NO.
Pfoject Address D L�,�L1����'� 3�(!J
Applicant's Mailing�/g ddr ss � �� �-� -��.��,.�.o
Owner's Name ^�� ����L � Pho .+��-¢GO-�
q�ldress
Arch/Eng. License No.
Address
Contractor's Nam �Phone �
Address {maiiingl � - D L O i►
City License No. 3 �
LI�ENSED CONTRACTOR DECLARATION '
I pereby atfirm that I am 1(censetl untler provisions of Charter 9(commendng
with section 1000) of Dlvision 3 ot the BuSiness antl P�ofezsions Cotle, antl
my ���ense iz in full tarce ana eHect, . �/
Licen�se� �C.lca�ss�� � 9 Li sE q.�%T7�9
Date[C�— $Ignature ' ��
WORKERS'COMPENSATION DECLARATION
' hereDy afflrm that I have a certificate ot cons¢nt to selftinsure or a certiilcate
� Workers' Compens5tion Insurance, or a certiHetl copy thereot (Sectlon
,e��. `�°. c�, 9G9o5z � �fL� 2n� �G.
Policy No. Company O/� � /+/���
Certifietl copY i5 he�eby (uvnishetl. ,
e� iti� cp,py is flletl with the Uly Byjltliyg Dl�vis�io � /{�/J '
ate -e'y' APPlicant pillYL dLd[gC/ jl/��i--
EXEMPTION�FROM WORKERS' COMPENSATION DEELARAi�OrI/
(Tdis section neetl not be comple[etl i/ tne permit Is for one hunOrea (E100) or �
iessl.
I certify that in the performance ot the work for which this perm�t is issuetl I
shall not emploY any person in any manner so as to Decome subject to the
Wprkers' Compensation Laws ot CaIlfoTia.
Date Signature
NOT�CE:It,diter making [bis �etlaration, you ihoultl became subject to tha
WO�kers' CompensaUon provisions 01 the Labor Cotle, you must torinwilh
comP�Y wit� such provlsions or tbis permlt 5na11 be.aeemetl revoked.'
CdNSTRUCTION LENDING AGENC�' ' • �
I hereby atflrm that there is a'constructiomlentling a9ency (or the peiTormance' '
of ttie work tor wM1ich this permit is'issuetl (Section 3097 Civ. CJ
�¢ntler's Name _ _ ,
L¢ntler's AGtlress � _
OM�NER BUILDER DECLARATION�
� pereby af(irm that I am exempt from the Contractor's License �aw for [ne
fo�lowing reason (Settion 7031.5 Business antl Pwfessional CoOe: Any city or -
county which requires a permit to Construct, alter, improve, tlerttolish or repdir
anY Strutture, ptb� [o Its Issuance, a150 �equi�es the applicanl fOr such pCrT�t
(o tile a slgnetl statemen[ tha[ he/she is IicenS¢tl p4rsuanl lo tlte provisions Of r
Iroe Conlractor'S Licen1¢ La�+ (Chapt¢r 9(commencin9 with 5edion �OOO) 05
Di�ision 3 of the Business antl Prolessions COGe) or that he/she is exempt
� erefrom antl the Dasis (or tbe alloged exemptlon. Any violallon of SectiO�
031.5 by any applicant for a permit subjects the applicant. to a tiv0
endlty ot not more than tive huntlretl tlollars ($500). �
❑ I, as ownel of lhe p�OPe�ty or mY.employees with waqes as thelr sole
�pm0en5allon, will tlo tbe work, antl the'Structur¢ i5 not intentled or o�fer¢tl
�or wle (Section 7044, Businesz antl Protessionat COAe: The ConVactor'3
License Law does nol appty to an owne� o( a property who builtls or improves
(pereon, antl who tl0¢z Such work hiTself/herSeH o� through ni5 or he� Own
en�Ployees, provitle0 tnat such improvements are not intentlotl or offeretl for
gy�e. If, howeveq the bulltling cr improvement is so�tl within one year o( <om-
pl¢tlon, the owner wlll have the burtlen ot provinq he/she tlitl n0t builtl or IT-
��ove fo� the pu�posa of saleJ.
I, ai owne� oi l�e propertY, am exClusively cont�actlng wlth licen5etl COn-
bSctors to construc[ Ihe prOlect (5¢ctio� �044, BuSinesS antl Profe55ion5 Cotl¢:
Tpe Contracto�'s License Law does nOt apply ro dn owner ot property who
bJ��tlS or improves thereon, antl who contract5 tor such projeGts with a con-
tractor(s1 Ilcense pursuant�to the ConVactor's �icense Law). I am aware that
oroof of tneir Worker'S Compensatlon insurance ShoWtl �e provitletl to me.
❑ I am exempt untler $ection B. & P. C. �or this reason
Date Owner
I �ereby certltY thal I hd+e reatl thi5 application antl sta[B [nat th¢ abOve
inPo/mation is CortecL I dg�ee to ComplY with dll dtY antl COu�ty ortlinanGes
antl state laws relating to builtling constructlon, antl hereby authorize repre-
sen�ativ¢s of this clty to ���iter upon the above-mentionetl praperty for
insPection as Y] � L�n� ,/
�� Datqpy__E�i'�
TYPE OF CONSTRUCTION LJ NEW LJ ADO Ll ALTERATION IJ REPAI R
❑ CONVERSION ❑ DEMOLISH ❑ OT.H��
DESCRIPTIONOFWORK/USEOFBLDG. /-J__,.�� o-�P
/
TVPE OF PERMITI� GRADING FOUNDATION STRVCTURP.L
❑ TENAN7 LJ E..�//p� TRICAL ❑ PLUMBING ❑ MECHANICAL
❑ �OTHER // P�
PROJECT DESCRIPTION 5 FLG'�P OCCUaANC
CONSTRVCTIONTVPE �VALUATION$ I O
ZONE GRADINGCV.YpS. ACRES -
Remarks:
Sink
Pre�enter
Irriga[ion
Drinking Fountains
Floor Drains�
FlOor Sinks
Gas Service � Outl8t5 -
Interceptors � '
Kitchen Sink
Lavamries -
P-Trap ' � � ' _
Roof Drains �
Reinspection Fee . I � $15
Boiler
Duct - Under Ground
Duct - Strucmral '
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact.8lt ICBO #
Heating System & Ducting
❑P700,000 BTU 0100,000
Signature _
DY��ers' License or 55 � .�, I I Reinspection Fee
CMF 0865-46, rev.4/84 White - Builtlinq; Canary -APPlicant; Pink - Accounting; Goltlenrotl -Assessor
$15
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
WaterCloset' •
Water Heater
Water Service
Issue Fee . ,
Hood or Typel ❑
Canopy Typell ❑
Fefrigeretion Syscem
❑aioo,000eru ❑ioo,000er
System Repair/Alteration
laue Fee
$ 3
S 3
A.P. # �% - �'
�
S Main Buildi
E
T Front
A Rear
C Right
K
c Left
Ping. Ref. #
Planning Notes:
Automatic Washer _. _
Construction Pole Sub.
Cooking Unit
Dishwasher
Dry¢rs ❑Gas ❑Electric
1669 6/05/B4
Zana
Actessory Building:
�
^ Parking Req./Provided .
Fan �
F.A,U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generetor DO-5 KW �5-15 KW
;ICAL
Transformer_.� }5-SOKW
❑ 50+KW
Meter ❑up to 100 amps
Meter ❑over700amps
Sub Panel � - �
Motors �0-1 HP �1 %- 8 '
Inc. Solar �9-15 HP 01615+
Microwave
Pole �ight � �' '
Range , .
Standing Section5
Trash Compactor •
159.05 TL
FEES
2
O
N
I
N
G
R
E
Q
M
T
S.
� Reinspection Fee �$15 � ' Issue Fee ' I $ 3 �
DEVELOPMENTSER I E REQU MEN7S: � • �[
Zoning Approved By � � ' ' Date ��_L
Building Approved By ' Date
AppliqtiOn luuBd BV Dat�
SU ARV OF FEES ' �
BUILDINGPERMIT $ I��•Q.� SMIP � �$ I DS
PLAN CHECK $ PERMIT -
PWMBING S �SSUANCE $
PIAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING $
PLANCHECK 50% $ � MICROFILM $ n
MECHANICAL $ TOTALFEE $ S-1 �O
PLAN CHECK Z5% $ '
r,
�,
CONSTRUCTION AND PLANNING � POO� & PA
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location -
2. Soil Pipe-Undrgrnd. � .� - ' i 53. Steel �Reinforcement .
3. ,Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd.. , ' 55. Electrical Bonding
5. S4eel Reinforcement � 56. Rough Plumbing & Pressure Test ' . .�
6� Electrical UFER,Grnd. , 57. APPROVAL TO COVER-GUNITE
7. Footings � , � 58. Electrical Conduit-Undrgrnd.
8. �Foundation � � ' � 59. Gas Pipe, O Undrgrnd., Test �
9. ,Water Pipe-Undrgrnd. �. 60. Backwash Lines, P-Trap, O Undrgrnd. �
10. Structural Floor System ' 61. APPROVAL TO DECK
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 - �
i 6.� Rough Electric Wir.ing 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. RoughFactory.Fireplace APPROVAIS Permit#
21. Ducts, in Structure ' 70. Underground Hydro �
.22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil
23. Gas Pipe-Rough & Test . 72. Underground Flush
24. Roof Framing � � 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing , �74, Overhead Hydro
26. T-Bar �Ceiling (Structural) & Monocoat 75. Dry Chemiral
27. Frame and Flashing ' � 76. Dry Standpipe
28. Lathirig & Siding ' 77. FIXED SYSTEM FINAL
29. Insulation ' 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. final Electric � Notes: - II
34. Final Heating & Air Conditioning . II
35. Final Gas Pipe-Test, i � I
36. Hood or Canopy � . I
37. Final Factory Fireplace , �
38. Final Plumbing. � ,
39. Water Service�Final � . �
40. Gas Service-Final � ,
41. Solar pomestic-Final � •
42. Backflow Preventer _ � ' ' �
43. Backflow Irrigation . . . �
44. .Landscape Irrigation System .
45. Sound Attenuation �
46. Handicap Regulations - , �j
47. FINAL S7i2UCTURE & BUILDING r- � '�a � y� JB � g�
48. Special.Requirements Completed
49. Electric Release to Edison � • '
50. Gas Release to Southern California Gas Co � �
51. CERTIFICATE OF OCCUPANCY . '
No. Date
. Aop�icant to 1111 In all spacas ezcept those witnin neavy boreer Ilnef ana sign all aoV�opriale tleclarations.
CITV OF COSTA MESA CONSTRUCT ON� ,/PERMIT �MIT NO. TRACT NO. LOT NO. � UNIT NO. �
i
ProjpctAddress �9y �• ��� '�^t'
Applicant's Mailing Addre�'ss�'�,`` �I�' �'�-
Owner's Name �{s�IL� Phone
Address `�
Arch/Eng. License No.
Address ���' '�'"�'
Contrector'sNam � �✓ Phonesc�_v_�
Address (m� I'nol �A3 � W�I i ��.�li Q � � ti'ln�
City License No. �'r� t%
LIC@NSED CONTRACTOR DECLARATION �
1 ner¢by aliirm that I am Ilcenzetl untler orovisions o( Charter 9(commencing
witn sectlon �000) ol DlviSion 3 ot the Buzine55 antl Proteisloni Cotle, antl
my IicenS< Is In full f �ce an!etl ¢ffect.
LicenseClais �-3r L en No.��',`[.49!9�
�at¢�%-7�L�h $i9nalure � �-.�5-�-
WORKERS' GOMPENSATION DE��RATION
I ttereby atfirm tpat 1 hdve a cei'titic�yd ot conzent to sel(-insura or a certifiwte
��, Worke�s' CompenSatiOn Insurance, o� d ce�tiflGtl copy tnar<of (Section
06, Lab. C.) �
ncv No�ui�ll /�/y �� comca�r �_.%�.�..i /
��`ertifietl copY is hereby furnishetl. �,U �
lS Certi(ietl mp�15 `i; fileG with the city Buil�di19 Di,v�ij �an.
Date / 1% 7f 8 APPlicant � v` v` ��^�
� EXEMPTION FROM WORKERS' COMPE SATION DEC RATIpN
(Thib seclion ne¢tl not be Compleletl I the ermit IS tOr one nuntlretl (5100) or
less�.
I te�Uty that In [he pert0/mdnce of tne WOrk fo� whlch th6 pe�m�t is issuatl � 1
shail no[ employ any porson In any manner so as to become subject [o [�e
Workers' Compensa[ion Laws of Calilornia. ,
Date 9gnature
NOTiCE: It, af[ar makin9 this tleclaratlon, y0u shoultl bemme Subject to the
WorkerY Compensation pwvisions of the Labor Code, you muit forthwi[h
comp�y with sUCh , p�ovl5ion5 0� thts Oe�mit shall b¢ E¢OmBtl revokeG.
COrySTRUCTION IENDING AGENCV ,.�
I hereby af/lrm that there i5 a construclion lentlin9 agen<y for tne pertormanco
of ihe work for which this permit is Izsuetl (Sectlon 3097.'Civ. C.)
Lentler's Name
Lentler's Aaaress
OWNER BUILDER bECLARATION
1 hB�eby aHlrm that I am Oxempt trom th0 Contractor'S Ucense L.aw for tbe
followiny rcason (Sac[lon 7031.5 Businoss antl ProteSsional COGo: Any city or
�<ounty whicn rGquireS a permit to <onSlruCt, alter ImO�ove, aemOlish.or rOPair
iany structura, prior to its Issuance, also requires t{�e applicanl 1or suth permit
[o file a Signatl StatemBnl lM1at ha/sh8 I5 IIC¢n5etl pursUant IO the DfOvl5ion5 0/
the �onlractor•= U<ense lzw (Chapler 9(commencing with SecUod7000) ot
Division 3 ot the Businass antl Pro/essions Cotlu) or that �e/she li exempt
�M14�elrom antl tne Dasis for the allogetl oxempt(on. Any v(olatfon of Sectfon
` 5 by any applitant tor a Oarmit sub�ects the aOP���ant to a civll
Ity of pOt ntora than (Iv¢ huntlrOG t1011drs (§500�.
as ownor of tho propmty or my employoas with wagos as lheir sole
tort�pensatlon, will Go the work, antl tha sVucture Is not IntenOotl or otferotl
•/or 5al¢ (Section 7044, Business antl Professional Cotle: Tha Contra<tor'S
� LicpnSe law tloes.not appty to an owner of a proparry wbo bullAs or impwvoz
ther¢on, antl wno tlaes such wo�k Nmself/hetielf o� t�rouglf bii Or ner Own
empioypes, Orovitletl that such improvemenis ara not intentlatl or o(ferea for
SaIB. If, �owOve�, the bulltllpg Or Improvem¢nl IS TOItl within one yla� of <Om-
O�atiOn, lha owner wlll nav0 tne bur�en of OrOving M1¢/She Citl nOt buil� or Im-
�o�e fo� the purposo oi salo).
LI I, as owner of the pwperty, am axclusively con[racting witn Iicensetl con-
[�att0/s lo <onst�ucl th¢ projec[ ($eClion 7044, Buslne5s antl Prof85sion5 Cotle:
Tn8 Contractor's Li<ensc law doe5 not dpPIY EO an owne� 07 P�ope�iy wh0
builas or ImD�oves tnernon, antl who contracts tor suct� projetts with a con-
t�a�tOr(5) ❑cen5e Oursuant to Ino Conlrat[o�'s LlcanSO l.aw�. I dm dwa�e lhat
prOof o/ lheir Worker's Compensalion 7n5urdnGa snoultl bo provlEetl t0 ma.
❑ I dm axuTpt untler SecNon B. & P. C. tor tbis rea5on
3i4 •
TVPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPZION OF N{ORKIUSE OF BLD,G. �- 4=���� V
TYPE OF PERMIT �LJ GaADirvG� LJ FOU14D.aY
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING
❑ OTHER
PROJECT DESCRIPTION 5�. F7.
CONSTRVC710NTYPE �
ZONE GRADING CU. VPS.
Remarks:
ear Sink
Back(low Preventer
Clari(iers
Drinkin9 Fountains .
Floor Orains
Floor SinkS -
GasService 'Outlets
Interceptors
Kimhen Sink -
P-Trup
Roof Drains
Reinspec[ion Fee
LJ STRVCTURAL
MECHANICAL
Shawers
Service Sink
Sewer Cap ,
Sewer Connection
$olar Collecrors
Solar Pip�rtg'
Solar Tank
Swimming Pool wi
Urinal
wa[er Close[
Wacer Hearer
Water Service
Auto-Wash
Laundry Trays
OCCVPANCV
TI ON S _
— ACRflS_
$15 � � Issue Fee
Boiler
Duct- Under Ground
Duct - Scructural
Duct - Veniilating
Ezhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Date Owne� Heating System & Ducting -
I hereby certlfy (hat I have read Ihis application antl stata that the above ❑6100,000 BTU �100,000
InfOrma[lon is correct. 1 agree to comO�Y w�th all city antl county ortllnantez
and Slate IawS �elating l0 builtling Consiru<tiOn, antl hereby authoriz¢ �ep�0-
sen�atives of this city to enter ujJPn the above-mentionetl properly for
Msqection purpozes. <-. /'_ _ Oaie � �-!-9D
Si9nature i �7y'� -�
Dri�¢rs' LI 55 $ � �-' Reinspec[Fon Fea
CMF 0865-46, rev.^30/84 White J Builtlin9; Unary - Applicant; Plnk - Accounting; GolOenrotl - AsSezsor
$75
EES
$ 3
A.P. dh
S Main Building:
TFront �
ARear
C Right
S Left
Ping. Ref. #
Planning Notes:
� ! .
..... . .. ....��........
Automatic Washer
Construction Pole $ub,
Cooking Unit
Dishwasher
Dryers ❑Gas �Efectric
Fan
F.A.U.
Fixtures �
Device Boxes
Outlets
Switches
Garbage Disposal
Gonerator �0�5 KW �5-15
Zone
ELECTRICAL,
Transformer ❑ 15-50 KW
Q 50+KW
Meter ❑up to 100 amps
Meter ❑over100amps
fvlomrs �61 HP �1'h- 8�-
Inc. Solar �9-15 HP �16-15+
Microwave
Pole Light
Sign
Standing Sections
TraSh Compactor ,
Rainspection Fae $15 luue Fee
IANICAL FEES
Hoodor Typel ❑ DEVELOPMEN7SERVtCESREQUIREMENTS:
Canopy Type II ❑ 2oning ApprOved By
Buildin8 APProved By � ' �._�./i
9�eration System
5aioo,000eru ❑ioo,000
System Repair/Alteration
Fire Dempers
Registerz
Issue Fee
S 3
SUMMARVOF
BUILDING PERMIT $
PLAN CHECK $
PLUMBING $ r�OO
PLAN CHECK 25% S
ELECTRICAL 5
PLAN CHECK 50% $ �
MECHANICAL $
PLAN CHECK 25% $ '
;,
2
O
N
I
N
G
R
E
Q
M
T
S•
FEES
$ 3
SMIP g
PERMIT ,
ISSUANCE $
ENERGY P.C. $
GRADING S
MICROFILM S � /�n
TOTALFEE . $ �
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical 5ervice or Pole 52. Pool & Equipment Location �
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement .
3. Elec[rical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding
5. Steel Reinforcement • 56. Rough Plumbing & Pressure Te:t
6. Electrical UFER Gind. 57. APPROVAL TO COVER�GUNITE
7. Foo[ings �� 58. Electrical Conduit•Undrgrnd. � '
8. Foundation � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd.r /60. Backwash Lines, P-Trap, O Undr9rnd. �
70. Structurel Floar 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 PLASTER�NG
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. Duc[s, in Structure 70. Underground Hydro , �
22. Duc[s, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing . 73. Undergrnd.StorageTank �Gas OOiI ,-
25. Roof Sheathing 74. Overhead Hydro '
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Sidirig 77. FIXED SYSTEM FINAL ,_�
29. Insulation 7S. FIRE PREV. FINAL -
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT �
31. Plaster Brown Coat ' , 79. FINAL INSPECTION ' .
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED �
33. Final Electric ' Notes: � • ' .
34. Final Heating & Air Conditioning - � '
35. Final Gas Pipe-Test � t�.j'� [,(,fl � : .�
36. Hood or Canopy -
37. Final Factory Fireplace
38. Final Plumbing �y(o.j�� (�� ;. �
39. Water Service-Final '
40. Gas Service-Final '
41. Solar pomestic-Final .
42. Backflow Preventer -'
43. Backflow Irrigation •
44. Landscape Irrigation System • • �
45. Sound Attenuation .
46. Handicap Regulations •
. �
47. FINAL STRUCTURE & BUILDING
46. Special Requirements Completed , -? .
49. Electric Release to Edison - - , -.
50. Gas Release to Southern California Gas Co � . �
51. CERTIFICATE OF OCCUPANCY
No. � " Date � � � �