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Home My WebLink About285 17TH ST - Building Permits ter__ City of Costa Mesa Building Safety Department CERTIFICATE OF OCCUPANCY P.O. Box 1200 Costa Mesa,California The Building located at 27 ?9/, 2Pi?u1, 0 prtnC AND7. iCn5JJ7771 ST,r>GGT has been inspected and found'to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group Fa Occupancy. Use of Building (1 prrr rrc fig/ Legal Description 4 - P•1117-192-G3 I' AND 2 4 (See reverse side for Mates end Bounds) Building Permit No 33O 'G Electrical Permit No 295,11 ,?2469Plumbing Permit No. 5578,E Number of apartments and/or guest rooms ISSUED TO: Building Official by Jiw rn TRcccr Date This Certificate of Occupancy SHALL BE posted In a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 308 lel U.B.C. Form BU 30 Rev. 11/70 CITY OF COSTA MESA BUILDING DIVISION F • .!.+6 �I? DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER ,v'i PERMIT VE05-00261%%Rar6a (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 285 E 17TH ST Status: ISSUED Suite No Applied: 03/30/2005 Vicinity: Issued: 03/30/2005 Parcel Nunmber: 42522304 Applicant: JOEY ALIANO -. - . - ISSUED BY: Address: 9025 BALBOA AV - - _ _ SUITE 150 , _ Phone: 858-569-1400 SAN DIEGOCA;- - ' Zip 92123 : / / r, ; _ / '-•,, /: "/,-':' A Owner �PERLMUTTER, DAN M = -- �',"/_ Address ,36 MISSION BAY.DR ` / V� � , ' Phone: CORONA'DEL MAR,CA Zip: 92625 �' \ \ r\ ; ' Contractor. ' ULTRA SIGNS Address: /9025 BALBOA AV - P - .. SUITE 150 - Phone: 858-569-1400._-' SAN DIEGO,CA- Zip: 92123 - License:799881 • - "� - . • , - SCOPE OF-PERMIT • - - ,;'- 20.75 -20.75 SQ FT ILLUMINATED,CHANNEL LETTER SIGN"DOG SPAW REF.:..SB05-00038 ELECTRICAL TO INCLUDE: 1 SIGN CIRCUIT. c: FEE SUMMARY • Quantity - ' - - , Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 ;" ' Temp service test $0.00 Busway/100 ft E Res.a/c package $0.00 Standing Section - $0.00 ,o'::// r ' New Res(1-2 units) $0.00 0 _Misc Electrical Equipment $0.00 , -0 i -P New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 ;0 - ' Pool/Spa , S0.00 0 - - 'up to 10 kva/kw $0.00,-,,x,0 Lighting Fixts ' '$0.00 0 - up to.50,kva/kw $0.00.,-, 0 , Recept Outlets -$0.00 • _. , 0. -_ upto 100 kva/kw;;.-...$0.00/ 0'; . / Switches - � $0.00, '' 0 - _ ' over 100 kva/kv -" $0:00 0 , Non Res Appl . ' "$0.00 - 0 Low Voltage Equipment --;>$0.00%, "0 / '. Res Appl $0.00 - ; 0" Low Volt Wiring System I Ckt $0.00' ', 0 - ' Service to 200a $0.00 _ 0' Misc.Conduit � Service to 10006 $0.00 0 Misc.Conductor - $0.00 0: , ' „ Service over 1000a - - $0.00 o _ Circus(gen or ride) ` N $0.00 -0 - Motors to 1hp - $0.00- 0 - Circus(mech ride or lights) A ,'$0.00.'••,"0 Motors to 10hp ' $0.00 0 - • • Christmas Tree Stand ' $0.00 / 0 Motors to 50hp $0.00 0 . - Fireworks Stand- /$0.00' 0 Motors to 100hp $0.00 -0 - \Other Electrical-Fee ' A$0 :00 Motors over 100hp $0.00 ' 0 ' - _ - , - i' Communication drops $0.00 �0 Investigation-Fee , - $0.00 Sub panel to 200a $0.00 0 Plan Check ee' $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 h nd will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the rk for which this permit is issued. I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance and r end policy number are: -+F�x ��_ �7 p Cartier: S10C 4K7c Policy Number: y/i 1 /'io)O (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance o the work for which this permit is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of nd ayy9��ee that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions.California/ / ) ^ �� Applicant Signature: / L/ Date: �}/ OAS WARNING:FAILURE TO SECURE WORK RS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLWRE(5100)300),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chap er 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# 71/88 Class# 4-9S Contractor's Signature- ../1-5-: Date: 346$ CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,CMI Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or County Which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)Or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an ownor of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not Intended or offered for sale.If,however,the building or improvement is sold within One year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,faisework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Tttle 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. . Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds.or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑aYes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutety hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this erm application aUit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? _P Yes No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). _ part facility _ _ 6 Will any paR of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes ❑No 8 (II yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct.I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes,I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. /. SI nature Of Legal Owners) ate �l 'Yld/ms An r Authorizetl Applicant Dale CODE I INSPECTION TYPE BATE IBIIIIA1E COQEt INSPECTION TYPE RALE MIMI I 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical CO-1135— ' 'A4 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval • 203 Final Sign 222 Final Site • 204 Final Demolition _ 250 Final Building/Occupancy CITY OF COSTA MESA • . il4 4 .� BUILDING DIVISION • •&•_. , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER4. 1. 1 PERMIT "Gawnww, `. SB05-00038 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 SIGN PERMIT Job Address: 285 E 17TH ST Status: ISSUED Suite: Applied: 03/30/2005 Vicinity: Issued: 03/30/2005 Parcel Nunmber: 42522304 Zoning: ISSUED BY: W7_ Applicant: -- Address: - - i - , Phone: -i ' i,. Owner. PERLMUTTER, DAN-M- . Address 36 MISSION BAY DR- , - - - N Phone: CORONA DEL MAR,CA Zip: 92625 Contractor / V Address: /i ://, Phone:' '` Zip: . ',,.License: Arch%Eng: Address: - - .-. , Phone: Zip: - � License: . -. . ' SCOPEOF PERMIT ._ 20.75 SO FT ILLUMINATED,CHANNEL LETTER SIGN"DOG SPA1M FEE SUMMARY,%, Plan Check: $63.21 -,' ; Calc Valuation: $3,400.00 ' $0.00 Permit: $97.25 Claimed Valuation: r ' $3,400.00 SMIP Com: ' • $0.71 Other: $0.00 • _ • $0.00 -,--•;: . . . Inspection: $0.00 / ' $0.00 o $0:00 , - , j Total: v $161.17 ; ' PLANNING &ZONING- � ',/ i moi:i NOTES: ,` . . o. a: NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: ." I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the ork for which this permit is issued. • I have and mil maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurai Ce carter and policy number are: / Carrier: S-\r.VP ,LZaFA Policy Number: 'tet//3a/QS (This section need not be completed i/the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit Is Issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, d agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. ��'j0/O� Applicant Signature: Date: WARNING:FAILURE TO SECURE WORK 5'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOI I ARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professzl'ons Code,and my license is in full force and effect.Lic.4 cm Class a `'` -5 Contractor's Signature: I1� __ Date: 'fi'7n�oS I CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a Construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish.or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)•or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I.as owner of the property.or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If.however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2.Sec. 341,Title 8,California Administrative Cale). ❑ As owner-builder;I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds.or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a.permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�Yes 0 No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency Is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for' spection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. SI..- . e Of Legarewnegs) — /Date And/Or •. prized Applicant 7 Date LODEI INSPECTION TYPE DME !Mal CODE I INSPECTION TYPE gam, I[{1111,12 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place �� 220 Final Planning Approval '203 Final Sign , 19�'Q� F!�^r�1 222 Final Site • 204 Final Demolition 250 Final Building/Occupancy PROJECT ADDRESS: 285 E 17TH ST ' UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NU: lE Ub9 / 4t OWNEfl'SNAME: DMP PROPERTIES ADDRESS: SAME PERMIT NO: IE 069798 PLAN CHECK NO: N LOVE N SUPW : x CONSTRUCTION TYPE: PERMIT TYPE: ELE OTH PURPOSE: OTH ARCNIENGINEER: REG.NO.: JOB DESCRIPTION : REINSPECTION PERMIT SQ FT: ADDRESS: UNIT: CLAIM VALUE: CALL—VALUE: GROUP OCC : B-2 / PERMITTEE: L.A. NEON & SIGN ( 213 ) 734-3361 ADDRESS: 2982 N PICO BL 1 COMMENTS : "SHOE REPAIR" LUMINATED WALL SIGN, RE: #SB69168 L .A. CA 90006 *+F*+Fr******+FTF+r+c******+F**************+F*,c******+E+F+r**********+F+r-**err**** * x******** LICENSED CONTRACTOR DECLARATION: I hereby atlirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 of the Business and Profe i C e Thy license is in fu lore d e S E T B A C K $ �b� C-45 EXP: CI Ic.: sTATELIc.: Coss MAIN BUILDING ACCESSORY BUILDING te: _ -p_V Signature: el0"/ FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN ERS'COMPEN TIOND RATION: I hereby affirm that I have ac""le 79.- ant to self.' or ikota of Workers' LEFT; FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN Compensation Insurance.or a Milled copy thereof(Section 3800,Lab.Cl. POUCY NO.: EXP.DATE: PARKING REO• PROV; PARCEL: 42522304 ZNE: REF NO: COMPANY: PLANNING NOTES> rD Cerhlkd copy is hereby furnished. ❑ Certified copy is filed with the city:r Ming Division. > ******************************************************************************* Date: Applicant: DEVELOPMENT '-SERVICESS REQUIREMENTS EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (Ns section need not be completed If the permit is for on;hundred($I00)or less). ' - I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any•anner so as to become ZONING APPROVED BY • DATE: subject to the Workers'Compensation La .I California. ere _ ♦ — ✓( • .ignamre: !%�L7,r ,`, BUILDING APPROVED BY DATE: OTICE:It.after ing this d el. ation,you should become subject to the "ars' '. .enation ..+VISI. of I ' Labor 8Code.you must .nnwnn comply with such provisions or this permit shall be deem . re .ked. APPLICATION ISSUED BY: " DATE- CONSTRUCTION LE 'INC AGENCY: I hereby affirm that there is a construction lending at' cy for the performance .)the work for ************, **,**,*,k*****,**,*****,***,4,*,* *, ************************4*** *. ,* which this permit is issued(Section 3097.Civ.C). LENDER: ****************************** ********************************************* ADDRESS: LEGALIZATION; N E E SUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that lam exempt from the Contractors'State License Law for the following reason BLDG PMT P ING 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 30 . repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 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 P LAN 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 civil penalty of not more than five hundred dollars(55001 BUILDING—DIV—> PERMIT IS 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----> 30 . 00 . 00 0 , 00 30 , 00 30 . 00 , 00 ❑ structure is not intended or offered for sale(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 ; 30 . 00 OVER/SHORT: 00 improvement is sold within one year of completion,the owner win have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELE RIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK ' • for the purpose of sate). 3 . 00 I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044.Business ❑ and Professions Code: The Contractors'State License Law does not apply to an(tomer of property whobmlds or improves thereon ***-****************************.************************************************ and who contracts for such projects with a contractor(s)license pursuant to the ContractorsState License Law).I am aware I N D I V I D U A L F E E B R E A K D O W N that proof of their Worker's Compensation insurance should be provided to me. ❑ I am under Section: B.B P,C. for thisis reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner ELE 1 ELECTRICAL RE—INSPECTION FEE 30 . 00 30 . 00 I do hereby certify that 1 am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533.and END OF FEES 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 permit for construction or modification from the Wr MIF,Management District.Residential construction applications are exempt from these provisions. Date: Applicant: 1 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 ordinances and state laws relating to building cons . lion and hereby authorize repres• tatives of this city to enter upon the above.mentioned /`V/ property for inspection purposes, / 4 It 01 00171300-00171300 TOT 30.00 S gnature: / DATE: 11/07/94 TIME: 14:19 river's License Of So I Security : f • 1641-46 White—Budding:Green—Code Enlorcomont:Canary—Applicant:Pink—Rev uo:Goldenrod—Assessor . r CONSTRUCTION AND PLANNING POOL ;PA ' APPROVALS Permit# • Date Inspector Date Inspector APPROVALS Permit # 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 O Oil 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding 77 'CED SYSTEM FINAL 29. Insulation 7s. FIRE V. FINAL 30. Drywall Nailing H' ' H DEPT. REQUIREMENT • 31. Plaster Brown Coat .V79. FINAL Iy.PECTII.. 32. Electrical Power Meter-Final pp j 80. FOOD,' ERTIFICATE ISSUED • 33. Final Electric - ' I '4' 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 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING - 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date