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HomeMy WebLinkAbout1968 ANAHEIM AVE - Building Permits Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - _ N TRACT NO. LOT NO. CITY OF COSTA ME g; �, yTRU ION ERMIT to: ?^ %,a 6 8 UNIT NO. A P # Zone ``f(p 117 Project Address w /� 4 CIt- rI1 , t- �-l� ' �// S Main Building: Accessory Building: :Aiaplicant's Mailing Address�1�t440 CI; A, , 'V..E P' TYPEOFOF CONSTRUCTION U NEW U ADD L'ALTERATION L7 REPAIR E - Z /°IQ 1 Phona�'e'0—• - '_:u-CONVERSION ❑ DEMOLISH ❑ OTHER _ T Front _ O Owner's Name D€ RIPTIO OF W -K/US OF : DG. me. ' •� - A - I A Rear N Address C. 4..'�.i cid 0./ _ „... .1. -.W q N Arck/Eng. - License No. ''.TYPEOF;'' IT NI GRADI G OUNDA • U STRUCTURAL ' C Right - G Address - - - -TENANT ❑ ELECTRICAL LUMBING ❑,MECHANICAL S • Left i /r I ' ❑ •OTHER • R Contractor's Name •!J Phone�dls �j Ping. Ref. # Parking Req./Provided E PROJECT-DESCRIPTION SQ. FT. OCCUPANCY R 3 ' P(Snnin Notes: Q' Address(mailing) .may 9 M �\ CON ST RUCTION TYPE—r M - VALUATION$ City License No. ZONE GRADING CU.YDS. - ACRES ' ' LICENSED CONTRACTOR DECLARATION �y .e �j _ S. I her•• ' m that I am licensed under provisions of Charter 9 (commencing Remarks: 1 IX/ /(v P_/1�'_ �`�.[� �� with section .. , e •n 3 of the Business and Professions Code, and N V ' my license is in full f• . • ••a ., l -VI J p� ,` l ELECTRICAL FEES License Class - Lc - L�`I- .i--e ✓crit fdOfrIC, f rt'Orl treettrJ — Date Signature LUMBI G FEE Automatic Washer Transformer 0 15.50 KW _WORKERS'COMPENSATION DECLARATIONConstruction Pole Sub. • ❑ 50+KW / 'tby affirm that,I have a certificate of Consent to self-insure or a certificate Bar Sink Showers 1)\/ •rkers' Compensation Insurance, or a certified copy thereof (Section Cooking Unit Meter ❑up to 100 amps Lao. C.) Backflow Preventer Service Sink No. Company Backflow Irrigation Sewer Cap Dishwasher Meter Dover 100 amps _e-edified copy is hereby furnished. __ ,---- - • -ti(Certitied copy is filed with the city Building Division. Bathtubs Sewer Connection Dryers ❑Gas ❑Electric Sub Panel �— Date Ix'IL • Mo s 00.1 HP❑1%-8 ' EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors (Thissection need not be completed if the permit is for one hundred ($100)or — - F.A.U. Solar ❑&15 HP❑16-15+ less). Dishwasher Solar Piping nc. I certify that in the performance of the work for which this permit is Issued I Fixtures shall not emplo any person in'any manner so as to become subject to the Drinking Fountains Solar Tank Microwave Worker mp on Laws of California, +...„. Q - Date. Signature t4%ttn Floor Drains Swimming Pool w/Spa Device Boxes Pole,Light , NOTIC If,a ter making this declaration, you sltuld become subject to the e Outlets Ran Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal g • comply with such provisions or this permit shall be deemed revoked. - CONSTRUCTION LENDING AGENCY - Switches Sign a�`� Gas Service Outlets Water Closet 9 II I hereby affirm that were is a permit rlendiue agency for the performance Of the work for s hick this perrglt is\tissued (Section 3097 Civ. C.) Interceptors Water Heater Garbage Disposal Standing Sections Lender's Name - Lender's Address 1 ` Kitchen Sink Water Service Generator 00-5 KW 05-15 KW Trash Compactor ' OWNER BUILDER DECLARATION ki-dp.figeSontractor's I hereby affirm that I am exempt from the Contractor s`License Law for the Lavatories Auto-Wash following reason (Section 7031.5 Business and Professional Code: Any city orcounty which requires a permit to construct,alter,Improve,demolish or repair P-Trap Laundry Traits - any structure, prior to its Issuance, also requires the applicant for such permitto file a signed statement that he/she•Is licensed pursuant to the provisions of Roof Drains �'y License Law(Chapter 9(commencing with Section 7000)of / 1 `Cr r IpG, �"'�-�� z�"on 3 _of the Business and Professions Code) or that he/she is exempt C r_ ,Reinspection Fee $15 Issue Fee - $ 3 'om and the basis for the alleged exemption. Any violation of Section $F'D, Eby any applicant for a permit subjects the applicant to a civil • •of not more than five hundred dollars($500). I DEVELOPMENT SEA VICES REQUIREMENTS: ,s owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $.3 Zoning Approved By date .ansation, will do the work,and the structure is not intended or-offered - - . for Tale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES , ' Building Approved By ea/ / Date ' 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 7— • Application Issued By e�/1`�i/���/e:—a .. Date } 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 11 ❑ SUMMARY OF 'EE motion the owner will have the burden of proving he/she did not build or im- Duct-Under Ground • rpro r the purpose of sale). \ / ' BUILDING PERMIT $ SMIP $ I,as owner of the property, am exclusively contracting with licensed-con- Duct-Structural Refrigeration System / tractors to construct the project (Section 7044,Business and Professions Code: _ _ ' Q/•� PLAN CHECK $ PERMIT �/I The Contractor's License Law does not apply to an owner of property who Duct-Ventilating DO-100,000 BTU 0100,000 BTU 'Pk—PLUMBING $ 7r 00 ISSUANCE $ 1 builds or improves thereon,and who contracts for such oroiects with a con- 1 tractor s1 license pursuant to tne Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 ystem Repair/Alteration <PLAN CHECK 25% $ ENERGY P.C. $ _ proo / their Worker's Compensa o�I Insurance should be provided to me. P GRADING $ 1 am exempt under Section �a �3 0 B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers ELECTRICAL $ MICROFILM $ PLAN CHECK 50% $ .Date e Owner i /�_, -�_ _ Heating System& Ducting ill Registers MECHANICAL $ TOTAL FEE $ 7; OD I hereby certify that I have read his applicani• and state% hat the above 00-100,000 BTU 0100,000 BT - / Information is correct. I agree to comply with all city and county ordinances V PLAN CHECK 25% $ , and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned pro erty for - . InSspection re pnrpOii /7 _4" Date y • �I _ drivers' S*i.�y _ 01 00015123-00015123 TFJT 7.00 0865-46,rev. 5/88 white - Building; Canary - Applicant; Pink -Accounting: Goldenrod - Assessor DATE: 09/21/$ TIME: 15:36 'I'� CONSTRUCTION AND PLANNING I, 'PO( e 1 _sate Inspector ! Date Inspector APPRQVALS Permit# - ,y APPROVALS h, ...+ 1. Temporary Electrical Service or Pole '1 7 3, 52. Pool & Equipment Location .. I ' 2. Soil Pille-Undrgrnd. ; 'a 53. Steel Reinforcement i ¢ �,Elect•rical'Conduii Utility-Unrdrgrnd. I. 54. Forms ,c; . ,y4:.Elecirical Conduit-Undrgrnd.l 55. Electrical Bonding b '5!Steel Reinforcement ' 56. Rough Plumbing & Pressure Test t ,tn.; • '6:' Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE �• ' ' 7. Eooting4 l 58. Electrical Conduit-Undrgrnd. ,: : .:B:�F,oundgtion 1 59. Gas Pipe, 0 Undrgrnd.,Test _ 0 92:Water Pipe-Undrgrnd. I • 60. Backwash Lines, P-Trap, 0 Undrgrnd. '10'tStructural Floor System (' 61. APPROVAL TO DECK .', 1'I Property Sewer Line& House Con`ection 62. Backwash & Receptor-Final ib' 12.~Sewer Cap ? 63. Heater & Vent-Final ,4.; 43`- RooflDrains Th. 64. Plumbing System - Final K 14: Rough Plumbing, 65. Electrical-Final e 15. Rough Electrical-Conduit • 66. Solar System-Final 1-16. Rough•Electric Wiring 67. Fencing & Access Approval t'1.7. Rough,Wiring Sign '`1 68it. . APPROVED FOR PLASTERING !78. Rough Electrical-T Bar Ceiling %•••1 69. POOL/SPA SYSTEMS FINAL •19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace -1 APPROVALS Permit# 0. n 21. Ducts,in Structure :.i 4 70. Underground Hydro 22. Ducts,Ventilating Y! - • - 71. Product Piping 0 Gas 0 Oil r 23. Gas Pipe-Rough & Test '!''I'? 72. Underground-Flush 24. Roof I laming C; r 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing ..••-' �•" 74. Overhead Hydro 26• . T-Bar Ceifng (Structural) &.--se 75. Dry Chemical 27. Frame and Flashing J Cr76. Dry Standpip 28.E Lathing& Siding r'.n'q 77. FIXED SYSTtEM FINAL 29. Insulation � ' R. 78. FIRE PREV.FINAL 30. Drywall Nailing 2 e� HEA'LTH DEPT. REQUIREMENT 31./Plaster Brown Coat ? �• • 79. FINAL INSPECTION 32. Electrical Power Meter-Final ;,: , 80. FOOD CERTIFICATE ISSUED 33. Final,Electric ~^'r Notes: /O/// .%ir /aYJYJ'FAdr 34. Final Heating & Air Conditioning ))) J // .., 35. Final Gas Pipe-Test - !?e 36. Hood or Canopy ' 37. Final Factory Fireplace - 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final •.7 41. Solar Domestic-Final / t 42. Backflow Preventer / 1,--4' v. 43. Backflow Irrigation , Q 44. Landscape Irrigation System G 45. Sound Attenuation - �Ll 46. Handicap Regulations - A Y 47. FINAL STRUCTURE & BUILDING • 48. Special Requirements Completed • 49. Electric Release to Edison - w it 50. Gas Release to Southern California Gas Co / 51. CERTIFICATE OF OCCUPANCY 0 / No. Date I -...-.7- - , Col Mesa Building Department ill EAST 20th STREET // 7APPLICATION FOR PERMIT • COSTA MESA, CALIFORNIA Ott j 4 / O BUILDING `: FOR APPLICANT TO + IN FOE OFFICE USE ONLY _ Receipt No. _ ,PQQrmit (ry� Building / y • 2U� / J Address ; 3 5" Costa Mesa, California Received by Date Recd. I ate Issue t Nearest I i4C\,,, 7t` 8r/2-5 Cross St. �}/\) N Building ai Address ' MailOwn /1Costa Mesa, California Address� ai 9 3e l �J �/., Nearest Cross St. City t M , I - °►. No. `I t;y 10//� / Zone O i/ I No. I Type i . I Group r Architect or Lic. V Engineer No. Approved by Date • )dress CORRECTIONS �1)l City Lio. -ontractor 2.t t-11. QLIO4o. i,57 Address 2 ' 9 3 0-4, si .1 Q+.../-,,tQ�, pp/jail-4 _ ■^1,,,` DescLription l I No.Lot 2.S I Block racT -t-'.s' Do / jail-4 (Attach Metes and Bounds) I I J — 3'y/— 3 Tj•��i No.of Bldgs- 1(1�p Size of Lot .567 I We.. I Now on Lot t AUG 10 1954 O Existing Bldg. / , I Fare lies I I Roomsk A n O Setback Line from 4�l/ '' ,,.RearYard -6 0 Z Center of Street ,SideBide Yard 5 y DESCRIPTION:OF WORK - r New I Alteration I I Addition I Repair I I Moving I I Demolish I - a Building yJ �// No.of Size Q �Tb Rooms S Stories / trior Wa�l1l Roof N ,ering ,i.(�� I Covering trek), APPROVALS Usof Buie ldinNow1Y/�� Foundation Location Inspector Date g I _ R� I Forms,Materials, Under-Pinning Frame: Fire Stops, Bracing,Bolts I hereby acknowledge that I have read this Application Lath. Int. and state that the above is correct and agree to comply Lath.Ext with all City Ordinances and State Laws regulating building construction. /'� Signature of r Plaster, Int- Permittee " / ///tel OL',". /t Plaster,Ext Authorized Agt. Masonry Reinforced Valuation d Permit Fee $ 2 2- Z_it O Plan Check $ '' , Bond Beam $ I01 C 1 Total L� e e Is Fee $'Z� FINAL �V3 FORM 204 O-H 2M 8-54 . . " o. . o EL' _ I. . _ ta-fr . . • • c; . •• . ..(, , • . • __ . -• •• • - • . • . • Street _ • • 4.? . 1 •%9 -• - • PLOT PLAN Show location and distances from • property line and between buildings. • „- . • • . . - - - - - - •- • -• - - • • ":-Pill • • • . . ,• . • .. • Lawe tatGP/Qu 72e56 T J • ' COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT r P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 R ECEIVEDIV 'PERMIT �t7 3 �-t •e For Applicant to Fill in Completely— Use Ink Only /At 8 ADDRESV BUILDINGn,3 /✓4JC/ �/ ' y/� A.P.NO. ro i �'1 to / BUILDING `�� OWNER OR DEQ I_ ADDRESS/ 40' TENANT {p/ {� !( 0 MAILING � // � rays UNIT OR ADDRESS 1965 C`p{.J-Q ,' J4 s,Lf?-J[l/ SPACE NO. ������IIII//// ����7777 Vr '"`� TR.NO. LOT BLK. CITY 64 Fe NOL CONSTRUCTION NEW IAD ALTER 'REPAIR 'MOVINGIDEMOLISH LENDER BRANCH '' n OWNER M• t fess�ytw/ ADDRESS ALOE Th. ARCHITECT TEL. USE/ca,ra. $ 8232- }. OR ENGINEER NO. r ADDRESS ZONE "� I r iv GROUP /� - �� % BPPROGED _ - y A „•/,Qa CONTRACTOR , x c / (�eJ/(p�/ .J/1 BV t/K/L DATE CJS NJ (/ ADDRESS IQ 6-Zi )1,JEcroo .�lJ/ jOi.y,^/ �, T E�d//293$ CITY TE F STATE ^�,(' L/,�'�` J/�J CITY APPROVED ACKS /� �/// LIC.NO. ` J '' ( f i LIC.NO. �. i X �./ ���/(,/� 6,1 SIZE NO.OF BLDGB.2 (FROM C / / fL OF LOT t�/, k /20 NOW ON LOT FRONT �r FT. Q USE OF ✓' // (/ �. EXISTING BLDG. R Sl 1 FT.G ' ca ( r 2 Separate permits are required for L,SIDE 3 FTO Cst - C electric,plumbing and heating work: REAR FT© if F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION a K R „�� �/�nQ S �— OVE[paa �fi EY X / A C ' tAPPRO A DATE �QZ�j !7 J IM - • i i -` _ • _ • _ • .. 's.T. a I hereby acknowledge that I hay ead this application and state n /:4 that the above Information is correct and agree to comply with L all laws regulating building construction, and I shall not employ i. Z any person in violation of the workman's compensation laws of Mthe State of California. /j•7 silo SQ. FT. S z J 2•— D 3 I hereby certify that I am properly licensed as a contractor under N the State CaliforniahaBusiness and Inf os Code, effect, 3, THE AMOUNT SHOWN UNDER VALUATION FEIS FOR m Chapter 9, and that such licens are In full force d effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: e am exempt from the •rovi es o e State of 'Ifornia Business a VALUATION PERMIT FEE $ LIQ. — a, and Professions ••e , An apter 9. /, v �� en a PLAN CHECK E `n A�l' L Signature � a Permftte- ///L, /, $ 8 232._ TAX $ •�. �Q U Authorized Agent Date • TOTAL PAID 5 72. n• �cR 18328 8i2222//B�aax59 TU "COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR SFRUC--TURAL PERMIT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 RE PERMIT N° . 50568 For Applicant to Fill in Completely —Use Ink Only BUILDING r A.P. NO. r ADDRESS ` /`kj./((/�/[Lj BUILDING �• 'Z OWNER OR 4/74, L ADDRESS /�� N ��A.I TENANT G.// •-/ R MAI DDRES (t1g7 -uNn s. SPAUNIC N G ADDRESS S"/ SPACE NO. TR.NO. LOT BLK. / CITY n/,' , TEL. NO. -- - CONSTRUCT/10"N ' r NEW I ADD ALTER REPAIR MOVING DEMOLISH LENDER BRANCH • Al S /D� OWNER ADDRESSOF E$ 400 w�Or ((p�� ` ARCHITECT TEL. i_ OR ENGINEER NO. T ADDRESS ZONE TYPE ROUP-__r•-' (SI A2/..m./.7-- ..t./s••1, CO YPROV ED / C-0-2�j\/1 O CONTRACTOR ,., /�nf nnn��_ s,/ /' BY DATE �-��/ ///LLl'''{{{fff ADDRESS /�5' �/ ///�W/U✓llJ� /ynJ`,yy CITY S/`T, /NO. 7s/V t)? E-1APPROVED�7 CITY APPROVED SETBACKS S LIC.NO. 3 / 6I. r� LIC. NO. �J (FROM C/L STREET) BA SIZE NO.OF BL .Six OF LOT NOW ON LOT FRONT FT. USE OF 'cn EXISTING BLDG. R.SIDE FT. La I-. Separate permits are required for . L.SIDE FT. ci electric,plumbing and heating work: REAR FT. (�. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION Q APPROVED • APPROVED 3.. tale/ J Oir —HY DATE EX VA Q I hereby acknowledge that I have read this application and state N N. a that the above information is correct and agree to comply with g• all laws regulating building construction, and I shall not employ > Z any person in violation of the workman's compensation laws of S the State of California. -= m 3 I hereby certify that I am properly licensed as a contractor under --- SQ. FT. N 3 the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR al Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT rFEE ONLY: to am exempt from the provisionsate of Califis Business 7 VALUATION PERMIT FEE $ Sao and Professions Code, C r 9. �---•----22 PLAN CHECK S . Signature of �� u. Permittee 4� L•I/✓ $ �� //J TAX $ SP f or / / �lV Authorized Agent Date - ` TOTAL PAID $ cc re) • 18` ' COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FFR�STIkUCTURaALPERMIT--26:00 TL: • P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 _ RECEI D 'PERMIT N2 5 0 8 2 3 For Applicant to Fill in Completely —Use Ink Only BUILDING / /b, //�� /r�h� A.P.NOL��_ lat,'—� ADDRESS o /l�L /7 OWNER OR d BUILDING (o� �"^ `` TENANT //2- /DUGh ADDRESS VGr 11� IVx UNIT OR ADILIEGya !�^ SPACE NO. Yap . ADDRESS (('`/{j/gyp,, / O. LOTS, 1 �C BLK. 1/. TELJ70-)37i� r'f�t'lTe_ TrtOf'CZe'n L--� CITY �ye 2� NO. V NEW iADD ALTER REPAIR [MOVING DEMOLISH CONSTRUCTION t,// LENDER BRANCH OWNER �4� -74-774. ADDRESS VALUE N ARCHITECT TEL. USE GnC>lt. (i ) $ OR ENGINEER NO Q C.../)/ ADDRESS ZONE ` `� /JSVPE GROUP V �j CONTRACTORrktte_aA, •L/ /` / DATE �D ���d( ADDRESS ///��/D///52i NRd?o/Crz,�l�(JQ.O�IpETE �(��71�.// CITY St Go NOrrni 7J0 .Fn STATE CITY ^ APPROVED SETBACKS LIC.NO. S'57 798 LIC.NO `aC7 SIZE [� ( a NO.OF BLDGS. �) (FROM C/L REET) 0. OF LOT .. O , /2 NOW ON LOT Ly- FRONT FT. _ Q CA EXISTING BLDG. {��E/lir/L' J-' GARflG USE OF L0 ii R.SIDE FT. La li H Separate permits are required for L.SIDE 50 FT. G electric,plumbing and heating work: REAR 0 FT. F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION Q • •.-1-49# a. /Q t , �/—/� /ice/ DATE (//•/}yy� F} [� APPROVED //�/�� ny 1A\� C. DATE /.t-» xxl Cg W gix G I hereby acknowledge that I have read this application and state n g4 that the above Information is correct and agree to comply with L all laws regulating building construction, and I shall not employ Z any person in violation of the workman's compensation laws of 2 2 the State of California. - coSQ. FT. I hereby certify that I am properly licensed as a contractor under D the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR ta Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:^ e am exempt from the provisions of th State of California Business VALUATION PERMIT FEE $ / 7 O v m and Professions Code .' 'sio prat 9. n ,../ 2,./..PLAN CHECK $ "I Signature of •// $ X T8.�� o Permittee p p /V\U TAX $ • GJrD LL Authorized Agent Date /0/�1/(,/ e / TOTAL PAID $a ! _CC u Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. CI-P4 OF COSTA MESA . PERr6{T NO TRACT NO. LOT NO. •BLDG.NO. ' CO.NSTRUCTION PERMIT P 1 ,Project Address 9 k 1 4 - e ' - ` TYPE OF CONSTRUCTION Owner 7770.441 '-r: Phone CI NEW C) ADD 0 ALTERATION 43•• 9��I /CI5.00 TI. Address ( Q A - ❑ REPAIR 0 CONVERSION ❑DEMOLISH Arch/Eng. License No. ❑ OTHER ZONING REGULATIONS DESCRIPTION OF WORK A.P.t Address _ ZONE PLNG. REF.rt • • • �"i Contractor 9ZO Phone TYPE OF PERMIT BUILDING a�1�l�i G � - SETBACK C/L ST. INE Address I ❑GRADING 0 FOUNDATION ❑ STRUCTURAL SIDE YARD ' LICENSED CONTRACTOR DECLARATION ----- ❑ TENANT ❑ ELECTRICAL ❑PLUMBING ❑MECHANICAV SioE YARD I hereby affirm that I am licensed under provisions of Charter 9(corn- RIGHT mencing with section 7000) of Division 3 of the Business and 0 OTHER _ '" Professions Code, and my license Is in full force and effect. • REAR YARD(TO P/L) - PROJECT DESCRIPTION - Llcense Class License No. PKG.SPACE REQ. PROVIDED Date Signature SQ.FT. WORKERS'COMPENSATION DECLARATION ' ' OCCUPANCY_CONSTRUCTION TYPE' STREET WIDTH PARK FEE S I hereby affirm that I have a certificate of consent to self-Insure or a VALUATION ZONE ZONING APPROVED BY I DATE - certificate of Workers' Compensation Insurance, or a certified copy thereof(Section 3800,Lab.C.). GRADING CU.YDS. ACRES SPECIAL CONDITIONS: 'Icy No. Company , • Certified copy Is hereby furnished. - -- REMARKS: - - _ Certified 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 - - - - ($100) or less). .. • .• certify that n the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become PLUMBING- .. PLAN- CHECK ELECTRICAL PLAN CHECK . subject to the Workers Compensation Laws Of California.- BATHTUBS SHOWERS DWELLING UAKA(at I Date Signature - SO FT GO FT ' NOTICE: If after making this declaration, you should become subject TOILETSURINALS GENERATOR 0-1 KW 1-10 KW ' to the Workers' Compensation provisions 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 - - revoked. - -- -- CONSTRUCTION LENDING AGENCY KIT.SINKS DISHWASHERS MOTORS 04 HP 1-10 HP I hereby affirm that there is a construction, lending agency for the per- SERVICE SINKS SUMPS (INC.SOLAR) 10-50 HP 50+HP formance of the work for which this permit is issued (Section 3097 - • Civ. C.). • • . FLOOR SINKS FLOOR DRAINS FIXTURES OUTLETS SWITCHES Lender's Name' ' - - ' - Lender's Address DRINKING FOUNTAINS GAS TUBE SIGNS OWNER BUILDER DECLARATION INTERCEPTORS CLARIFIERS POLE LIGHTS I hereby affirm that I am exempt from.the Contractor's License Law for - the following reason (Section 7031.5 Business and Professions Code: SWIMMING POOL P TRAP CUNSI NUL I iuN Any city or county which requires a permit to construct, alter, POLES METERED SUB Improve,demolish or repair any structure, Prior to its issuance,also re- WATER SERVICE ALTERATION PANELS MAIN, SUB quires the applicant for such permit to file a signed statement that he y�yss�� � v�� Is licensed pursuant to the provisions of the Contractor's License Law GAS SERVICE LeLE+VUTLETS a — SERVICE AMP (Chapter 9 (commencing with Section 7000) of Division 3 of the • Business and Professions Code) or that he Is exempt therefrom and the WATER HEATERS BTU OUTPUT .. for the alleged exemption. Any violation of Section 7031.5 by - ' applicant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS • it more than five hundred dollars ($500). • L) I, as owner of the property,or my employees with wages as their SOLAR TANK COLLECTORS sole compensation, will do the work, and the structure is not Intended - - - or offered for sale. (Section 7044, Business and Professions Code:The SOLAR PIPING SYS. s ISSUE FEE Contractor's License Law does nett apply to an owner of a property '- who builds or Improves thereon, and who does such work himself or -ISSUE-FEE\ 1.\? , a _. `4 - APPLICATION APPROVED BY DATE through his own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement MECHANICAL PLAN CHECK is sold within ono year of completion,the owner will have the burden SUMMARY OF FEES of proving he did not build or improve for the purpose of sale). HEATING SYSTEM 0-100.000 BTU BUILDING PERMIT $ SMTP $ ❑ I, as owner of the property, am e%clusively contracting with AND DUCTING licensed contractors to construct the project (Section 7044, Business 100.000+BTU _. PLAN CHECK $ PERMIT and Professions Code: The Contractor's License Law does not apply to CC ISSUANCE S an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $ "J. ' tracts from such projects with a contractor(s) licesned pursuant to SYSTEM GRADING $ the Contractor's license Law). 100,000+BTU PLAN CHECK S ' ❑ 1 am exempt under Section B.& P.C.for this $ BOILERS BTU ELECTRICAL S reason ' PLAN CHECK E MICROFILM E -- Dale Owner SYSTEM. REPAIR,ALTERATION • - • TOTAL FEE$ MECHANICAL $ I hereby certify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE -LESS AD- Information is correct. I agree to comply with all city and county PLAN CHECK $ VANCE PC $ ' Ordinances and state laws relating to construction,and hereby authorize . representatives of this city to enter upon the above mentioned property for n enrt'on purpose �' .,- FINAL FEE $ Signature , 4�'-� -ISSUE FEE - ' CMF 0865-46 White-Building;Canary-Applicant; Pink-Accounting:Goldenrod-Assessor CONSTRUCTION AND PLANNING POOL&SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location 2. Soil Pipe-Undrgrn - 44. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrn - 45. Forms 4. Electrical Conduit-Undrgrn 46. Electrical Bonding 5. -Steel Reinforce 47, Rough Plumbing & Pressure Test • • 6. Electrical UFER Grn 48, APPROVAL TO COVER-GUNITE _ 7. Footings - 49. Electrical Conduit-Undrgrn 8. - Foundation 50. Gas Pipe, ❑Undrgrn,Test 9. Water Pipe-Undrgrn 51. Backwash Lines.P-Trap. 0 Undrgrn 10. Structural Floor System 52, APPROVAL TO DECK - - - - 11. Property Sewer Line & House Connection 53. Backwash & Receptor-Final ., i 12. Street Sewer Connection - 54. Heater & Vent-Final • 13. Rough Plumbing - • 55 - Plumbing System -Final - - - 14. Rough Electric-Conduit - _ .56, Electrical-Final I 15, Rough Electric-Wiring- - _ 57, . Solar System-Final • 16, Rough Heating & Air Conditioning b8. Fencing & Access Approval 17, Ducts, in Structure 59. APPROVED FOR PLASTERING 18, Ducts, Ventilating 19, Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL- - - 20, Roof Framing - 21, Roof Sheathing NOTES: _J �`��� 22. Frame and Flashing ��er ± 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 • . ' 31. Final Plumbing 33. Water Service-Final 33. Gas Servic -Finl 7/21.f[ 7t-7J✓ -K/� {q'k . 34. Solar Domestic-Final 35. Landscape Sprinkling System 36. Sound Attenuation • 37, Handicap Regulations • - - 38. FINAL STRUCTURE& BUILDING 39. Special Requirements Completed 40. Electric Release to Edison • 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No Date r .