HomeMy WebLinkAbout1017 18TH ST - Building PermitsIR
A Applicant to fill in all spaces within heavy border lines and sign all, allrnpriate declarations.
3617 1/26/3J �I,Lb
CIT? OF OSTA MESA
PE IT NO. - /
TRACT NO. L NO. " BLDG. NO.
'
CONSTRUCTION PER
!T/
TYPE OF CONSTRUCTION
-KNEW ❑ ADD ❑_ALTERATION
❑REPAIR ❑CONVERSION ❑DEMOLISH
-_
-
Project Addressca
- Owner Phone' _
rAddress
73axen,4
❑:OTHER
ZONING REGULATIONS
- r
Arch/Eng. License No.
DESCRIPTION OF WORK
kFC
A.P. $ 1
ZOWE PLNG. REF. 11 -, s
Address - -
- Contractor WAY `C Phone
TYPE OF PERMIT - -sBUILDING
SETBACK
❑ GRADING ❑ FOUNDA ION - ❑ STRUCTURAL ID -YARD -
O TENANT 13 ELECTRICAL PLUMBING ❑MECHANIC gIEOE T - - -
XR BUILDING '
OPERTV LINE
-
- -
Address - "'
.LICENSED CONTRACTOR DECLARATION
licensed 9
I hereby affirm that I am under provisions of Charter (com-
mencing with section 7000) of Division 3 of the Business and
• -
-❑ OTHER:
RIGH
-
Professions Code, :antl my license is In full force and effect.
_
-PROJECT DESCRIPTION
, REAR YARD (TO P/L)
License Class License No.
.-.'
54. FT: - .- -_
PKG. SPACE REO.
_
PROVIDED
- -
Date ` - ' • Signature" -
STREET WIDTH
PARK'FEE E h'
WORKERS' COMPENSATION DECLARATION
OCCUPANCY_ CONSTRUCTION -TYPE.
I hereby affirm that I have a -certificate of consent to self -Insure ora
•
VALUATION ZONE
ZONING APPROVED BV-
DATE -
certificate of Workers' Compensation Insurance, or a certified cop,
- - - - --
SPECIAL CONDITIONS:
thereof (Section 3800, Lab. C.).
GRADINGtCU. YDS. ACRES
-
Noe Company-
ertified copy ishereby furnished._ -_ ._- - _
REMARKS:_
-
1 erti fled copy is filed with the city Building Division.
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section need -not be completed. if the permit -Is for one hundred
_ •� -
• 'i
-•:-' `
($300) or less1.
_ _ _ _
- _
certify that n the performance of the Work f r which this permit is
Issued, I shall not employ any person in any nner so as to -become
_
PLUMBING ,• ,, `._PLAN CHECK
_
ELECTRICAL - PLAN
CHECK - r
Subject to. the WOrkerS: CompensaLlOO l.a O Ifornia. --
_- _. -___ _ _.
BATHTUBS SHOWERS
- _ ...
- _ __
d _ .•r
Signature
Date Signature
NOTICE: If after making this tleclaralioR you should become subject
TOILETS;'- ,Ir ., -URINALS' �` ` '-
- GENERATOR - '0-1 KW_
1 -10 -KW, -
to the Workers' Compensation provision of the Labor Code, you must
_ TRANSFORMER
•�
forthwith comply with such provisions or this permit shall be deemed
_ - _
LAVATORIES DOUBLE LAVS _
- APPLIANCE--10-50'KW_50+-KW-
T
revoked. .. _ _ - _-
_ _
KIT. SINKS - -DISHWASHERS '- -
_ - - _ _
MOTORS-'- ' 0-1 HP_1-10 HP
1
CONSTRUCTION LENDING AGENCY
r7
that there is a construction lendingIsIs agency for the per.
I hereby affirmfthe
forman<e of the work for which this permit Is Issued (Section '3097
•SERVICE SINKS • 1 f" SUMPS' - ",'
-,(INC. SOLAR)- 10-50 HP_50
+ HP - - - - -
Cl vrC.):
FLOORSINKSFLOOR DRAINS
FIXTURES-- --OUTLETS--
SWITCHES r•
Lender's Name
'
_ _ _
Lender's Address
_ _
ORINKINGFOUNTAINS , - -
-GAS TUBE SIGNS
_
CLARIFIERS
`POL'E•LIGHTS-
OWNER BUILDER DECLARATIONINTERCEPTORS
i hereby affirm that I am exempt from the Contractor's License Law forI
'SWIMMING POOL'--- 'PTRAP'- -
-
---
POLES METERED
- - - -
SUB.
the following reason (Section 7031.5 Business and Professions Codes
Any city or.,counly which requires a permit to construct, alter,
', WATER SERVICE- ALTERATION
'.PANELS - '—' MAIN- `.
, SUB - -
`
Improve, demolish or repair any structure prior to its issuance, also re-
quires the ap'Oicant for such permlt to file a signed statement that he
GAS SERVICE' OUTLETS -
_
`SERVICE-' _ -
-""'AMP - - -
Is licensed pursuant to the proAsions•of the Contractor's License Law-
(Chapter 9 (commencing with Section 7000).01• Division 3.Of Ih0
Professions Code)'or that he is the
- -
Business and exempt therefrom and
b,ls for the alleged exemption. Any violation of Section 7031.5 by.
WATER HEATERS BTU OUTPUT'
'SEWER -CONNECTIONS --L
-
T 1R
' tpplicant-for a permitsubjects the- applicantf�to a civil penalty
I, more than live hundgpd ollars (4500).
•k owner of the property(tl/ -' - ,
'SOLAR TANK- •' COLLECTORS
_'as
�N•III do the t90 , an he s[r uct ur¢ IS not Intended
-
SOLAR PIPING SYS.' a
ISSUE FEE
or offered for sale. (Section 7044,-Busi ness and Professlons Code: The
-Contractor's License Law does not apply to, an owner Of a. property
-
agpp LICATION'APPROV ED BY
- -
DATE
who builds or improves thereon, and who tloes such work himself or
ISSUE FEE
'1 1
through -his own employees, provided.lhat such Impr9vemenls are not _
,
MECHANICAL•` `'PLAN CHECK
I SUMMARY OF. FEES I
r
Intended.00bfferecl for sale. If, however, the'bullding�orimprovement
one have the Burdon
Is sold within year of completion.'the'owner will:
of proving he did not build Or Improve for the purpose of sale).
BTU 1
- - ,.
BUILDING- _
'PERMIT -
_ .
-
property. y c g -with
❑ I, -as owner--ol the report am exclusive: •-' ontraclin
NHEATING SYSTEM 0-100,000
AND DUCTING,' - - - -
$ "' �• SMTP. - E _
- -' - "-- - - - --
licensed contractors to construct the project'(Section 7044�Business
and -Professions Code: The Contractor's -License Law does not apply to
s.- 100,000,+ BTU I
PLAN CHECK $
- - r'• ."
PERMIT' A. ..r
ISSUANCE-$ -
an owner of property who builds or Improves thereon, and who con-
REFRIGERATION 0-100,000 BTU (
,PLUMBING $ J
•. H
tracts .from, such projects with a contractor(s)
-' -'-
100,0001+-Iicosnotlpursuant•lo- -SYSTEM - - - BTU
- -•- -
- '-LAN CHECK
P
_rI GRADING' $
the Contractor's License Law).
$ _
I - .
❑ I am"exempt`untler section- ' - ^B, 6 P. C. for this
BOILERS BTU
ELECTRICAL $
$-
r. -
reason-- - - -
SYSTEM REPAIR, ALTERATION
-'PLAN CHECK S - -
-'-MICROFILM $
h
$.-
l0ata. Owner
EXHAUST SYSTEM MULTIPLE
MECHANICAL, E -
v
NOTAL FEE '�'
LESS'AO-
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
,PLAN CHECK E
_
VANCE PC $ _
Ord Ina n ces antl state laws relating zyconst r uct ion, ano hereby aut her i z¢
' • .,
representatives Of 'this' tgr ept¢r Upon the above mentionetl
property for inspect) up e ! _
Sl gnat ure Dale -Z4
''
ISSUE FEE - - - - -
-_ -
- - - - -
FINAL FEE $
- - ------
'•�/ `/ / -
Arivers' license or55 $%�
CMF 0865-46 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor
II
CONSTRUCTION AND PLANNING
APPROVALS Permit #
Date Inspector
v POOL & SPA -
APPROVALS Permit # Date Inspector
1.
Temporary Electrical Service or Pole
43.
Pool & Equipment Location
2.
Soil ipe-Undrgrn- _
44.
Steel Reinforcement - -
3.
Electrical Conduit Utility-Undrgrn-
45.
Forms - -
4. _
Electrical Conduit-Undrgrn_
46..
Electrical Bonding - - -
_5-.
Steel Reinforce I _
47.
Rough Plumbing & Pressure Test -
6.
Electrical LIFER Grn _
48.
APPROVAL TO COVER-GUNITE
7,
Footings
49.
Electrical Conduit-Undr rn
8..
Foundation-
50.
Gas Pipe, ❑ Undr rn, Test
9. _
Water Pipe-Undrgrn _ -
51.
Backwash Lines P -Trap,❑ Undrqrn -
10.
Structural Floor System _
52.
APPROVAL TO DECK
11.
Property Sewer Line & House Connection
-
.. 53.
Backwash & Receptor -Final
12.
Street Sewer Connection
- 54.
Heater &Vent -Final. -
13.
Rough Plumbing
55,
Plumb'no S%isterri7 Final- - -
14.
Rough Electric -Conduit
- - -- -
-56.
-Electrical-Final
15.
'Rough Electric -Wiring-
- •- - - - - -
- 57.
Solar System -Final '
-16.-
Rough Heating & Air Conditioning -
- -- -W
Fencing & Access Approval
17..
Ducts in Structure -
_
APPROVED FOR PLASTERING '
. 18.
Ducts, Ventilating
60.
POOL/SPA SYSTEMS FINAL "
19. Gas Pipe-Rough&Test• _ _
20. Roof,Framing
21.'
Roof'Sheathin
NOTES: - - �tf
l 22: Frame.antl Flashing _ _ _
' 23. -Insulation
_ -
-_ _ - --
_.24.
-Lathing & Siding
'
25-
Drywall -Nailing
' 26.
Plaster Brown.Coat
-
-
27.
Electrical Power Meter -Final'
28. - Final, Electric-
-
29. Final ;Heating & Air Conditioning-
• 30!__
Final Gas Pipe -Test
- -
-
_ - 7
31.. Final Plumbing _
32.
Water Service -Final.
33.
Gas Service -Final -
-
34.
Solar Domestic -Final
,
35.
Landsca e Sprinkling System
I 36.
Sound Attenuation
_
37.
Handicap Regulations
--�
38.
FINAL STRUCTURE & BUILDING
•.
39.
Special Requirements Completed
-
i 40.
Electric Release to Edison
,
i 41.
Gas Release to Southern California Gas Co.
42.
CERTIFICATE OF OCCUPANCY
No. Date
_
Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CONSTRU9>CTION P MIT i PENT NO.� TRACT NO. LOT NO. UNIT NO.
Project Address �G� % �� �Le• S 7
Applicant's Malls tldress
Owner's Name �/Q�«ems Phone=r
Address �Q�% �-✓ • % S
Arch/Eng. License No:
Address `l/
p
Contractor's Na mQ ,:+✓rN, .u�,e / phren= K_&�ai
V Address (mailing) �r�/-/• �% �' (ter.-! ��. (�L'/
City License No.
LICENSED CON -IR TOR DECLARATION
f hereby affirm that 1 am licensed under provisions o1 Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
' my license is in full fo, a a eyect.
License Cla s �i _LI en
•
DateCA Z,40 Signature
WORKERS' COMPENSATION D LA RAT, I '
I hereby affirm that I have a certificate of co sent to SaH-insure or a certificate
f Workers' Compensation Insurance, or a certified copy thereof (Section '
add, Lab. C/.(1, 1
Policy No. T WG��3Z" Z Company
BCertified copy is hereby furnished.
Certifie py is filed With the city Building D{-ylsio�sn
Date1�22— Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section need not be completed If the permit is for one hundred ($100) or
less). '
'
less).
that in the performance of the work for which this permit is issued, I
shall. not employ any person in any manner so as to become subject to the
'Workers' Compensation Laws'of California.
. Date iSignature
'NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions Of the Labor Code, you must 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 which this permit is issued (Section 3097 Civ. C.)
Lender's ,Name
Lender's Address
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the CdntraCtor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, improve, demolish or repair
any structure, prior to its Issuance, also requires the applicant for Such permit
to file a signed statement that he/She Is licensed pursuant -to the provisions of
the Contractor'S'License Law (Chapter 9 (commencing with Section 7000) of
Division 3'of the Business and Professions Code) or that he/she Is exempt
•refrom and the'basis for the alleged exemption. Any viola icin of Section
11.5 by any applicant for a permit subjects the applicant l0 a civil
.salty of not more than five -hundred dollars ($500). - 1 ,
L] I, as owner of the property or my employees with=wages as their Solo
compensation, will do the work, and the structure is not intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law doesnot 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. I/, however, the building or improvement is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or im-
t�rove for the purpose of sale).
L� I, as owner of the properly, am exclusively contracting with licensed con- '
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of properly who
builds or Improves thereon, and who contracts for such projects with a con-
tractor(S license pursuant to the Contractor's License Law). I am aware that
proof V their Worker's Compensation insurance should be Provided to me.
❑ 1 am exempt under Sectio B. & P: C. for this reason
Date Owner I
TYPE OF CONSTRUCTION LJ NEW LJ ADD
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
-
LJ ALTERATION LJ REPAIR
A.P. 46
S
Main Building:
TYPE OF PERMIT' LJ GRADING 17 FOUNDATION 11 STRUCTURAL
1:1 TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER -
T
Front
B
A
Rear
PROJECT DESCRIPTION SQ. FT. OCCUPANCY
CON STRUCTION TYPE VALUATIONS
ZONE GRADING CU.YDS. ACRES
C_
Right
S
Left
Ping. Ref. #
Remarks:
r
I Planning Notes:
Sink
Irrigation
tubs
rinking Fountains
loor Drains
loor Sinks
as Service Outlets
Itchen Sink
P—Trap
Roof Drains r
Reinspection Fee
Boiler
Duct- Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ h
Firepl/Fact. Bit. ICBO
Heating System & Duc
00.100,000 BTU ❑ 1
...n...,...•..• , an., .. ,
sentative - t s city e r n the above-mentioned Property for
Inspects osez. '
i Signature Date orS'.S I
Drivers' 4c nse or 5 — Reinspection Fee
SF'0865-46, rev. 10/84 White = Building; Canary - Applicant: Pink - Accounting; Goldenrod'. Assessor
7831. 2/20/8.5- 7a0_, -TL
Zone
Accessory Building: !
Z
-O
N
I
N
G
r R
Parking Req./Provided E
M
T
Ed S
Showers
' ELECTRICAL' FEES
Service Sink
Automatic Washer - -
Construction Pole Sub.
- -
Transformer [1-15-50 KW- ,
❑ 50+ KW
1
Sewer Ca P
Sewer Connection
Cooking Unit
Meter ❑up to 100 amps 1
Solar Collectors
Dishwasher
Meter ❑fiver 100amps
Solar Piping
Dryers ClGas ❑Electric
Sub Panel'
Solar Tank
Fan
Motors 00.1 HP 111 A - 8
Swimming Pool w/Spa
F.A.U.
'
Inc.Solar 119-15 HP016-15+
Urinal
Fixtures -
Microwave — - - -- - -
Water
Water Closet-
.
Device Boxes I
Pole Light
WleseeHtWtar .LJpaL
(J,
Outlets
Range '
Water Service
Switches I
Sign
•
Auto -Wash -
Garbage Disposal
I
; Standing Sections
Laundry Trays
Geherator.1:10.5 KW 115-15 KW
Trash Compactor
$15
Issue Fee
$ 3
ReiAspection Fee
$15
Issue Fee 1$ 3
MECHANICAL
FEES'
DEVELOPMENT SERVICES REQUIREMENTS: '
Zoning Approved By Date
Building Approved By Date C�
- Application Issued By Oat
Hood or Type '❑
Canopy Type 11 ❑
Refrigeration System '
06-100,00OBTU 11100,00OBTU
BUILDING PERMIT
- PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
- MECHANICAL I
PLAN CHECK 25%
I SUMMARY
$
$
$ .nig
$
i$
$
$
�$
-�
OF FEES
SMIP $
PERMIT t
ISSUANCE •$
ENERGY P.C. $
GRADING; '$
MICROFILM $
TOTAL FEE 1$ �xf.dL
le ❑
System Repair/Alteration
Fire Dampers
to BT
Registers
.. - -
'
$15
I Issue Fee $ 3
- 'CONSTRUCTION AND PLANNING - "-
. APPROVALS Permit# Date
-
Inspector
- - r POO SPA
APPROVALS- Permit#
Date
Inspector
1. Temporary Electrical Service or Pole52.
Pool & Equipment Location
_
�.2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3.Electrical Conduit Utility-Undrgrnd. ,
54. Forms
'4.,Electrical Conduit-Undrgrnd.
55. Electrical. Bonding
-
i
' 5. SteelReinforcement
56. Rough Plumbing & Pressure Test
6. ElectiicalUFER,Grnd.
57..APPROVAL TO+COVER,GUNITE
„
' 7:•F6otings
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
r
15. Rough Elecfrical-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. POO VSPA SYSTEMS FINAL
-
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace -
21. Ducts, in Structure
70. Underground Hydro
22J Ducts, Ventilating
71. Product Ning0Gas, 0Oil
23. Gas Pipe -Rough & Test
72." Underground Flush
'24. Roof Framing
73. Undergrnd. Storage Tank ❑Gas 00il
25- Roof Sheathing
74. Overhead Hydro '
26. T -Bar Ceiling (Structural) & Monocoat '
75. Dry Chemical
-
27. Frame and Flashing
76. ,Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
• 78. FIRE PREV. FINAL
30. Drywall Nailing
i
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final _
1
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes:�-
34. Final Heating & Air Conditioning _
��f�
J/��
/ �,= ' 7-' •��`
35. Final Gas Pipe -Test -
36. Hood or Canopy
C
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
45. Sound Attenuation
i
46. Handicap Regulations
t
i '
47. FINAL STRUCTURE&BUILDING
48. Special Requirements Completed
1
i
49. Electric Release to Edison
r
i
-
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations
1
CITY OF COSTA,MESA CONSTFWCTIOlV PERMIT
PERMIT NO.
TRACT NO.
LOT NO.
I UNIT NO.
- 7412 2/13/85- ' -;j,•] - TL
_
Project Address 1
- -
-
_
Applicant's Mai' Address L�_ 1 • .7
TYPE OF CONSTRUCTION
❑ ❑
NEW ADD ALTERATION
❑
REPAIR
I
-
�Ns>p`�rs
CONVERSION DEMOLISH
OTHER
A.P. �k _ '.
Zone
a
Owner's Name Sa(-`s"^ q Phon�
�'
OESCR I PTION_OF WORK/USE OF
BLDG. _
-
- Accessory Building:
Address �d17 i✓, /?? /• L•-^
- '
S
Main Building:
Arch/Eng. License No. -
TYPE OF PERMIT GRADING FOUNDATION S7RUC7U RAL
T
Front
' -
p
I
❑ TENANT ❑',ELECTRICAL
❑ PLVMBING. ❑MECHANICAL
N
Address - // w�,s//��JJ 2
❑OTHER
'B
A
Rear
- -
I
Contractor's Name r1NIC'D ✓1/ Phnnrfi 'ALe�
C
Right
- _
N
//// '' 7>•- �. �
^ (/s.4/ G G�
PROJECT DESCRIPTION SQ. FT.
OCCUPANCY
G
Address Ima"I' g) L(�r/% "�
CONSTRUCTION TYPE
VALUATION $
S
Left
City License No. �(_
_ T.•—
IR
20NE GRADING CU. VOS. ACRES
-
Ping. Ref. �
Parking Req./Provided
E
LICENSED CONTRACTOR DECLARATION
O
1 hereby affirm that I am licensed under provisions of Charter 9 (commencing
Remarks:
.Planning Notes:
- -
M
with section 7000) of Division 3 of the Business and Professions Code, and
my license Is in full rte effect.yf�-j• iy/
T
License Class Ice se N�/����JT
S
Date '� Signatu� -Ta"- _
-
_
PLUMBING
FEES
1
'
/
WORYCER-S_' CO`M'PENSATION LAIR ON l
Bar Sink I
Showers
I ELECTRICAL FEES
I hereby affirm that I have a cern licate o/con sant to self -insure or a certificate
I
If 'Workers' Compensation Insurance, or a certified Copy thereof (Section
Backflow Preventer
Service Sink -
- -
- Automatic Washer' -
- -Transformer-El 1550 KW' - - -r
ab.
800, "No'.-
-
Policy No.
Backflow Irrigation
Sewer Ca P
Construction Pole Sub.
❑ 50+KW
Certifiedfurnished.
❑ Certs/ietl copy is hereby
i 1
with thecit
e ifietl opi� ijlatl with the city BuilQf Dlvl iG .
Bathtubs
Sewer Connection
Cooking Unit
Meter ❑up to 100 amps
Applicant—
PPlitant EXEMPTION FROM WORKERS, COMPENSATION DECLARATION.
EXEMPTION
Clarifiers
Solar Collectors
-
'
Dishwasher
Meter Dover 100 amps I
(This section need not be completed if the permit is for one hundred ($100) -or
Dishwasher '
Soler Piping I
Dryers ❑Gas ❑Electric
less).
I certify that in the performance of the work for which this permit is issued I
'shall in to become to the
Drinking Fountains
Sub Panel
not employ any person any manner so as subject
Solar Tank
Fan I
' Motors ❑0-1 HP 011/, - 8
WorkersCompensation Laws of California. I
-
. Date' Slgnature
Floor Drains
SwimmingPool w/S a
p I
F:A. U. '
' '- i I
Inc. Solar El 9-15 HP El 16-15+
'NOTICE: after making this you should become subject the
1
h
of the Labor Code, you must forthwith
Workers' Compensation ions f the -
'this
Floor Sinks
•_ Urinal
-
.Fixtures - _
�
_ - - _
Microwave- --
suchprprovisions
comply with such provisions or permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY I I I
Gas Service Outlets {
Water Closet '
Q"
Device Boxes
1 Pole Light! 1
I hereby affirm that there is a Construction lending agency for the performance
,
of the work for which this permit is Issued (Section 3097 Civ. C.)
Interceptors
'
Water Heater' -
Outlets i
Range '
Lender's Name �
Lender's Address = - - -
Kitchen Sink _ -
Water Service - -
I
Switches
'
Sign
OWNER BUILDER DECLARATION - --
-
1
-
!
I hereby affirm 'that I am exempt from the Contractor's'License Law for the
'
Lavatories _.
Auto -Wash
Garbe a Disposal
9
Sections
following reason (Section 7031.5 Business and Professional Code: Any City or
-Standing
county which requires a permil.lo construct, alter. Improve, demolish or repair
P -Trap
Laundry Trays
Generator ❑0-5 KW ❑5-15 KW '
Trash Compactor
any structure, prior to Its Issuance, also requires the applicant for such permit
to file a signed statement that he/she Is licensed pursuant to the provisions of
ROOF Drains
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she ,is exempt-
_ -
,refrom and the basis for the alleged exemption. Any violation of Section
-
I
..
-
11.5 by any applicant for a permit subjects the applicant to a civil
'
ialty of not more than five hundred dollars ($500)• 1
- -
$ 3
I
-
'
LJ I, as owner of the property or my employees. with wages as their sole
.Reinspection Fee
$15
Issue Fee
compensation, will do the work, and the structure is not intended or offered
Reinspection Fee
$15 Issue Fee 1 $ 3
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 tloes, such work himself/herself or through his or her own-
Boiler' -
Hood or Type I ❑
DEVELOPMENT SERVICES REQUIREMENTS:' '
employees, provided that such Improvements are not intended or offered for
Improvement Is within one o1 com-
Canopy Type ❑
Zoning Approved By
i
Date
. sale. If, however, the building or sold year
pletion, the owner will have the burden of proving he/she did not build or im-
Duct - Under Ground
I I
Building ApprOVed By
Date
rove for the purpose of sale).
��
I, as owner of the property, am exclusively contracting with licensed con-
Duct -Structural
Refrigeration System
Application Issued By
Dat
tractors to construct the project (Section 7044, Business and Professions Code:
does to of who
❑0-100,000 BTU ❑100,000 BTU
-�
• The Contractor's License Law not apply an owner property
Duct - Ventilating
i SUMMARY OF FEES '
builds or improves thereon, and who contracts for such projects with a con-
,
tractors) 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.
PLAN CHECK
I
$ PERMIT
t'
❑ 1 am exempt under Section B: 6 P. C. for this reason
Firepl/Fact. BIL ICBO �k
Fire Dampers
'
PLUMBING
'$ ,O'O ISSUANCE . $
Date Owner
System & Ducting
Registers
PLAN CHECK 25%
I ENERGY P.C.1
$
hereby certify that I have read this application antl stale that the above100,000
BTU ❑100,000BT
'
_
_
ELECT,RICALGRADING
$
information is correct. I.agree to comply with all city antl county oIdina nces
i
and state laws relating to builtlinq construction, antl hereby authorize repre-
T�He�ting
PLAN CHECK 50%
$MICROFILM $
sentatives e'f� this city••iP t upon the, above-mentionetl roperty f�
di pyrposes. // yg_ ^ C�
-
-
MECHANICAL'$
I O[�ti
Date 'tea•--�
ns Ilion Fee
$15
Issue Fee
$ 3
PLAN CHECK 25%
$ ' TOTAL FEE $
!
Drivers w
-
CMF 0865-46, rev. 10/84 White - Building: Canary - Applicant; Pink - Accountings; Goldenrod - Assessor -
-- -
'CONSTRUCTION AND PLANNING
-/7$0/� Date
Inspector
_ - POO ;PA '
_
Date
Inspector
_t APPROVALS Permit # ./�
APPROVALS Permit.#
.i: Tempo ary Electrical Service'or Pole
52.- Pool & Equipment Location
i •
i
2/Soil Pipe-Undrgrnd,,
53. SteePReinforcement
•.j,
3:1Elect'rical Condu(t,Utility-Undrgrnd.
-
-
54., Forms-
4'. Electrical Conduit-Undrgrnd. •.
-
55. Electrical Bonding
`1
' 5"Steel'R'mforcement '
56.' Rough Plumbing &Pressure Test
Electrical UF UFERGrnd.
-
57. APPROVALTO COVER-GUNITE
_
17I Footings ••
58. Electrical Conduit-Undrgrnd.' -
•8.• Foundation �•
' 59. Gas Pipe, 0 Undrgrnd., Test
9Water Fipe,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. RooflDrains �• +
-.
-64. Plumbing System - Final
14. Rough Plumbin6t
-
65. Electrical -Final'
15. Rough Electrical -Conduit I
- -
66' Solar System -Final
• 16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
-
-
t
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. RougKHeating & Air Conditioning
!�� 'FIRE DEPT: REQUIREMENT
t
-
_
20. Rough Factory Fireplace
APPROVALS Permit#
_ 21. Ducts, in,Structure
70. Underground Hydro
_
22. Ducts Ventilating
71. Product Piping OGas 00i1
23. Gas Pipe -Rough & Test -
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank 0 Gas 0Oil
I
25. Roof Sheathing -
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. 'Dry Chemical
,
_27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation. - _
78. FIRE PREY. FINAL
. 30. Drywall Nailing -
• HEALTH,DEPT. REQUIREMENT
31. Plaster Brown Coat
I
79. FINAL IDISPECT115
32. Electrical Power Meter -Final !'.�'
'80: F OD CERTIFICATE ISSUED
_
_
_
_ _~\•
33. Final Electric l l'
-Heafirig
Nptes: , 'dam?- �� - 1?gT /r!-/.e.�� �•iGf . _
34. Final &Air Conditioning
�-
� •'"o �j ''rte
j�� : � _ C
35. Final Gas Pipe-Test
..
�•�
14r
36. Hood or CariOpY.,
. t ' ° I ,
-O.
i f /
i v.
37. Final Factory Fireplace
38. Final Plumbing
i
39. Water Service -Final
J
i
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
43. Backflow Irrigation
44. ,Landscape Irrigation System
� �
45. Sound Attenuation 1
46. Handicap Regulations! j�
i
„ !
47. FINAL STRUCTURE & BUILDING
-)
,
48. Special Requirements Completed
-
r
,
49. Electric Releaselto Edison
50. Gas Release to Southern California Gas
,
51. CERTIFICATEOF•OCCUPANCY
- -
-•a-'-
- , ---- - ,
No. - Date l
---
-- -
"-� '---�-'---- - .. s. - -�