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HomeMy WebLinkAbout1976 ANAHEIM AVE - Building Permits vn11LIN UiibPat, 'PH.UMllb J . WAIL 1-Se-pU JOB ADDRESS 1976 Anaheim St. BUILDING PERMIT NO. 28833 #'GENERAL CONTRACTOR O ner-Bldr. DESCRIPTION of WORKAdd r'em.Hm.nearm.&atn to Hes. _A'' .1.1.1 -321-82 LOT TRACT FIRE ZONE VALUE $ 7/400•00 IN :CTIONS Si nAq7t u��le Date GROUP I ee tT TYPE V ZONE Rd l iY g-i-L.r SUBCONTRACTOR PERMITS ISSUED GAS /� . 117_b0 Date I Number I Signature WATER u� /I}7 f/a-G Plumbin ROUGH PLUMBING LY ! �// ,.41/ 7/2'__�� t af it PROP. SWR. LINE n HOUSE CON. tJa F r �r�/le)-� 4,te 7_,%-at ,F07 ,....- SPRINKLING SYSTEM • ��••it -4 ,tet ROUGH HEATING AND AIR CONDITIONING / 4,/f//7 t TEMPORARY SERVICE OR POLE ` I{ UNDERGROUND ❑ POWER ❑ ,j ROUGH WIRING / /Mj N1Q^ /^/ d Heating and Vent. TRENCHES 13-FORMS 0 STEEL REINF. 0 /.`„) e /// 6 a..la/ . p_G C. SW FLOOR SYSTEM 4.�(t `/e/p9 / BOND BEAM n STEEL REINFORCE n n / SHEATHING '/%�J�' D /O ., FRAME AND FLASHING 1 (+ lrL � a LATHING — IN OUT �(49- ! PLASTER, BROWN COAT I.j�1'•/„CSI Q 6'/Pi; I 5' 'URAL, FINAL l E eCi HE. .4G,C1NTL,7 REFRIG. AND A.C.,mFINAL fid y c�2u ol. /2-I 28&o& PLUMBING, FINAL AND GAS TEST gc1� �� 11;/5j7/ `�' S � ELECTRIC, FINAL �p JYm' 7 "/5'.3 • / BUILDING, FINAL r.rc Y '%e. 1�lf•% %/ . ' -!.%,, CITY OF COSTA MESA 4 SBUILDING DIVISION >:I ,- ..� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t I !.-ot ritrip• PERMIT ° II . . M P06-00648 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.csUMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1976 ANAHEIM AV - ' - ' Status: ISSUED • Suite No Applied: 08/10/2006 Issued: 08/11/2006 Vicinity: / '/ . 4 if y r I Parcel Nunmber: 42214137 s, �gsa J • , Applicant: PAULEY, SHANNON ISSUED BY: Address: 17390 MT CLIFFWOOD is2/_P.hone 27144241=1414`" ; i ° 8 ç77c Owner: Vci � Address1976 ANAHEIM ST - ��./ C (\ \\\\ ��Phone:�949-981=0669_ ,,,,\.N) 0SSTA MESA CAS' ci Zip? 92627 ----�� INC-, /\\\ 7(J' rte/ © ` .\\,-/�/ o� �� � \ \\�` Contractor. COAST ROOTER PLUMBING HTG AND AC �, MT Address: 17390MT"CLIFFWOODI�\- i// /� Phone: 714-241-1414 \"\���� \\\ FOUNTAIN VALLEY Zip-92708 _ `S_" \, �I t•License� 529127•.(`vo 9 �� \ ,\�� ✓ ��v / U ' \. M 1 1.:11 \-.-�J ll��; ) f (-,r:-. --,Ni 2_ ---SCOPE-OF.PERMIT-.. ' 1/-- ,. \' \1t. \a_ • 1�\ r \" / a WATER HEATER:CHANGE OUT,NO CHANGE IN LOCATION. �'� t\''\\�' ),;.1 i/i\a �( \ _ Ay -(,. �X v i v� IH�l -v U� FEE SUMMARY \X) \' ;1P ' Pi A f (�J , an AMT QTY_ - -AM'fs-i-OTY-_ _ _- �I I; AMT QTY 1. r--AMT $23.50 " cl '7]Lraund Tub'/Washer ]L$0.00' 10 r\\ry Sum PumpI I -$0,00 0 Backflow irrigationii t' $0.00 0 \,Jit Landscape Irrigation �l.L$0.001I( 0. A.Y �lj Swimming Pool c�0.I ( t-$0.00 I t,0 Backflow Preventer $0.00 0 .P-Trap - $0:00=',0- - . .Trap Primer t 1 I _$0.00 )k0 Bathtub_-.---‘ •,\\I) $0.00 d\ Pressure Regulator $0.00 0�' ^it Urinal . 1h , L $0.00 30 �Clarifiier System ',\\t1/14 $0.00 0 i Process Piping(per 10 ft) $0.00 0ppp ''' , Vacuum Brkr Bktow(1-4) $0.00 '( 0 Connect(Ice,Soda,etc) i1 $0.00 0 c-. -Receptor='' (-7-A7-1---,---,-$0,416-1/20 --- Vacuum Brkr Bkflow(54) 1!"$0.00!1' 0 Dental Units \` O r $0.00 0 re_----,_Septic Tank - �- $0:00lid-. _i .Wash Basin .-/r111 L- -$0:00,' ,,f1 0• Dishwasher- ‘t i" $0.00 0 Sewer Cap for Demote --$0.00 , 0' t Wash Basin Sett.'1/ $0.001) (0 Drain;;Floor J \ l $0.00 0 Sewer Connect $0.00 0 Waste and VentSystem . -$9.02, /0 Drain,'Rainwater c $0.00 0i Sewer Private Line ,$0.00 0 Water Closet(Toilet) 4 =$0.000 Drain)Roof� '� 0$0.00 0 Shower .,;,$0.00%'0 • Water Heater/bent(-----.„,:-...,,,$12.30/.. 1 DrinkingFountain' \ x$0.00 Q Sink,bar $0:00 0 Water Piping'(Inst or Rep.)' $0.000 Expansion Tank'- J _$0.00 0, Sink,commercialy, $0.00 0 Water Re:pipe/ $6,60 0 Gas Eanhquake.Valve $0:00 Sink,Fl00%Y},I6 ,i $0.00 0 Water Service �,.,/ '$0.00 0 Gas(14 outlets) $0.00 0, Sink kitchen., P $011X).” .0 Water Softener ///.$0.00 0 Gas(Over 4"outlets) ' $6.00\'t 0., Sink3service/mop °c ,3 ,, $0.1/405:7;;;:;:i.0,..,;,...,v_ OTHER% .-l} /r I/$0.00 Gas Repipe VV``�� $000\0.1.x" s` Spa(private)"r"t °3 r, $000 /"-0,!:; . L4'VIOLATION L--, //,'/$0.00 GasService\\ /$000 �OJ V ^ 0 Spal(pubho�o ' /,'!0 ` $000 0 ;�PLANCHECK y,/ $0.00 Interceptors(Grease,Oil)j$OAO 6,,,...„,,,,..:o o_`,' 0 -� (12 ° ` ^ - �REINSFECTION �/ $0.00 0 Interceptors(Sand' uto) C$0.00� O��oo o 4- 2 ;i o " n ' • i %� {/�2? /,,,I/ �' I\� _ o p o' �o ��i-i TOTALCALCCUULATEDFEES: $35.80 �/CCOMMENTS7'SPECIAL CONDITIONS {� �,-- ��� %j. 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 woo) -_ ; , 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 work 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. rr My works pens on Insure 1�'a�mer and policy number are: a '7 �j L. Carne-r' r(. 7 � r'"a,,...4, r Policy Number:D/7e 0 000 / Q/' L(TIv's section of be completed(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 C: "a,and agree that I1 I should bec" ubject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provi t Applicant Signature: �W�– _ _ _rirallefi _ifr:Date:+--- r (( - 0,6, WARNING:FAILURE TO SEC Tr-KERS'COMPENSATION COV'' GE IS UNLA D SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(Si®,", ADDITION TOME COST OF COMPENS4TION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. r: s: - LICENSED CONTRACTORS DECLARATION: , -� .r.y 1 � Ft t V. I hereby affirm that I am licensed under provisions of CM.er 9(commencing with Section 7000)'W Division.3 of the Business an rofessioys Code,and my license is In full _force and'effect-G N' _ `e1.� ' �r�.- ''.,,'•,>b f Class a. 4 3 (o -tooritrradtods'si ttbrr`e: v \9-- - - 'u Date:. 1 $ — U - O r. der 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 i4 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 isjexempt 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 himseror herself er through his or her own epyloyees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement Is sold wit'n 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,asd : er ni de togs Lice se EXCLUSIVELYoesnt CONTRACTINGanownerWITH LICENSED CONTRACTORS r on, nthe project(Sec.such project and Professions Code:The contrectoTs License�aw�Coes not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant toithii Contactors Lidlnse-L'aws.). ex ife v ❑ I am exempt under sec. a I-,/ •-, Business and Professions Code for this reason: Signature: at .fv Date: Owner ID verified by driver's license. Er Yrs 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 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: 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? ❑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 appernit for such construction or modification from the South Coast Air(Duality Management District or from any other air pollution control district or agency? U Yes LJ 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 pert of the facility to be construeted under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (11 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 AUTFIORRATION 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. mature Of Legal 04 Date IaNx- _ rAu7zedY: 7 t—_Date_ 1 CODE I INSPECTION TYPE RASE RIIUIALE CODE* INSPECTIONTYPE RATE IBIIDeLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical p 1266 Pool Spa Final 208 Final Plumbing a `0 -C9 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 222 Final Site - 204 Final Demolition 250 Final Building/Occupancy lige ,. 28833 JUL l2-61 A001065* ****40.50 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1296 COSTA MESA, CALIFORNIA 92626 . For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING euILDING For Offke Use Only ADDRESS 1-176 AMA/F I STS -- RECEIPT NO. cv Pgy91,40.3 COSTA MESA. CALIFORNIA RECEj r �i� / ^17/� 7-/2-E 6 X// /2 DATE D-- ( OWNER TLi4MAS NT. GIVER A - ADDRESS lcl�6 ANAHEIR ST ADD claaa /971p I���rt .uyl;� . . ..... FIRE ./�/}- -y[/ CITY COSTA PIEsA Til-NO. 6Y6.1y15 ZONE Lg TYPE.-�� ONO7-12 UjP /// �// ARCHITECT TEL APPROVED ARCHITECT 7inf DATE / -/2-k•�' OR ENGINEER 91dN9R NO. ZONING ADDRESS E Ro.or US[OFNEW Fa....✓y CONTRACTOR OWNER I PLANS Z II,L.6u1LDIND _!-Gl``f{S. Aponte DESCRIPTION /"r '+o/ d� Ti� �I�'g0 A.P.NO. ids--3a/ —a a CITY NOTE: NO EAVE OVERHANG SHALL BE LESS THAN STATE TEL BO'TO SIDE a REAR p.L LIC.NO. NO. VES 812E [['� p ^ NO.Or BLOTS. ALLOWED (U.B.C.REQUIREMENT) OF LOT 7�.7D x Igo' NOW ON LOT I YARDS APPROVED YARDS APPROVED USE OF MAIN BUILDING ACCESSORY BUILDING EXISTING BLDG, RESIDENCE �J (FROM C/L R ET) SETBACKTER LIN[OP FERN lilt a° REAR YARD gilt FRONTk 17 Pt CENHTR[8Y ,.,p �J SIDE YARDI LEFT a'9-/ I RIGHT IL;* R.'SIDE 2? Fr. / FT. DESCRIPTION OF WORK L.SIDE _5--.FT, Z FT. NEWALTERATION ADDITION V REAR ! / PT. FT. v_ DISTANCE BET. BET.MAIN& REPAIR MOVING DEMOLISH MAIN BLDGS. ACCESS.BLDGS. BUILDING �/ NO OF 3 VAR.# DATE SIZE 21x31-6 ROOMS STORIES I C.D•P•# APPROVED / EXTERIOR WAW LCD I ROOF ConfosJTION APPROVE � 7-��-eB COVERING COVERING SY �.A0 DAT[ - USE OF BUILDING AND WORK TO BE PERFORMED JIB 9. REsiocwce (EANSSY,Ben AND Rant aeons) W To B' SVC 1 t...5-6 / SQ.PT. et 1 HEREBY ACKNOWLEDGE',HATA HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE C AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CAM. PURPOSE OF ESTABLISHING A PERMIT FEZ ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION BUILDING CONSTRUCTION. �J u/',� • G PERMIT FEE s 27,00 PI PERMITTER 2"{tenon. /W'+y Of SIGNATURE �/ X / D PLAN CHECK 5 /'3i 5-19 IL AUTHORIZED AGENT TOTAL PEE S //O(-Co r . r 33469PA �#**!* JUL -3-64- A00 327 u b.00 ' COSTA MESA BUILDING-SAFETY DEPARTMENT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 For Applicant to Fill in Completely APPLICATION FOR BUILDING PERMIT /` RECEI�(.PJ41 DA..ERECEIVE p1 DATE ISSUED BUILDING / 7 / „Aar), //ffsCCRf'w// t/!/�Y 7_3"G9 ADDRESS Cr � �/jJJ / 76 V_/ G c A.P.NO. //•'S -3,X / 4°,2 I P I�f�IO/ OWNER / 1 Z ADDRESS /9 �� AUIDDIEG /(�7 il-4- 14-4:tV MAIL ,y/+ ADDRESS //L�ipC�C/)f I&U CITY a--)Y Iada/ NO.Ui i4{.�5 TRACT �ilea LOT2 BLOCK Z CONSTRUCTION ^ / NEW/ ADD ALTER REPAIR MOVING OFMOLISN 1 ON LENDER /V U N/F y • CL m /\ • J O BRANC J fn OWNER y / / ' COcc w—I ADDRESS VALUE ! ./‘ ARCHITECT TEL. S $ t/ 'I Q OR ENGINEER NO. UQ FIRE W CC ADDRESS ZONE TYPE V GROUP 0_Iki W Z CONTRACTOR 0 WA/6 E� 4Z Pic APPROVED , -'_ DATE -6 / Ca- Z Jit ADDRESS �� �,� w w /��� TE .�(.(j ZO NO.OF USE OF NE VS ((hj Zi- CITY A NO.,,�3S PLANS BUILDIN /ref . W- O STATE CITY T YARDS APPROVED YARDS AA.PPOROCVrEED y IL LIC. NO.SIZE / '7 LIC.NO. MAIN BUILDING ACCESSORY BUILDING =0 OF LOT f-20 JX S N./ e , NOW ON LO I FRONT40 f OFT/XS FT. USE OF yI 7 EXISTING BLDG. gESIDPCb ER_SIDE ,t9 p FT L FT. I—Z NIZE OF EW BLDG.Iof�4. xis1 ROOMS I"' STORIES I L.SI 13E07Sy/cast FT. < EXTERIOR WALL �t' ROOF V COVERING N°AIN COVERING OWVOS WO"! REAR .I' T/Izi FT. J USE OF BUILDING AND WORK TO BE PERFORMED DISTANCE BET. / BET.MAIN& C. (te.5/0 fi/4L /,PA_T_IO, &OVEICTO BEQVILT- MAIN BLDGS. ACCESS. BLDGS. Q SLAB . F VAR..s DATE O GO.'c ReIB LOOK ilAs /3JbEN ce,yLelt'o C.U.P.# APPROV,E,,.D...,,,/// APPROVED /_ 3 /f alid Z AS PART OPitemApblT+am (Paha' /•'0• x$833) _gv / ,DATE / c �+ O i U I hereby acknowledge that I have read this application and state p that the above information is correct and agree to comply with CC all laws regulating building construction. end I shall not employ I— any person in violation of the workman's compensation laws of /A the State of California. co Z I hereby certify that I am properly licensed as a contractor under SQ. FT. O the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such licenses are in full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: R em exempt from the provisions of the State of California Business VALUATION Sl and Professions Code•Division 3 Chapter 9 O L/ co ea PERMIT FEE $ D Signature of / {(�/{ m Permittee IT /'/ $ l�7� PLAN CHECK $ '� E V o Authorized Agentu ,LTOTAL FEE $ O IPROJECT ADDRESS: 1976 ANAHEIM AV UNIT: • CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 053145 1 owxEli•sNAME'aME: GILMER, THOMAS J ADDRESS: 1976 1976 ANAHEIM ST PERMIT NO: B 053145 PLAN CHECK NO: - N GOVT: N SUPP: N COSTA MESA,CA 92627 . CONSTRUCTION TYPE: 5—N PERMIT TYPEf STR PURPOSE: ALT ARCH/ENGINEER: ( 714 ) 646-1425 REG.NO.: r ADDRESS: UNIT: JOB DESCRIPTION : T/0 EXIST ROOF/APPLY 'COLD APP—BUILT—UP SQ FT: 500 PERMITTEE: CLAIM VALUE: 500 . 00 CALC—VALUE: 500. 00 GROUP OCC: R-3 /M-1 ADDRESS:TEE; THOMAS J. GILMER ( 714 ) 646-1425 1976 ANAHEIM AV COMMENTS: PROTECT YOUR FAMILY WITH SMOKE DETECTORS COSTA MESA CA 92627 *************+ **********x****; * +6+6*z**** ***N * ***>F*****IF***************x***Fc•* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section , Z ONING REQUIREMENTS • 7000)of Division 3 of the Business and Professions Code, and my license is in full force and effect. SETBACKS CITY LIC.: STATE LIC.: CLASS: ' Date: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: , FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.Cl. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ• PROV: PARCEL: 42214136 ZNE: REF NO: ) ' Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING N TES> ' > . ,dte: Applicant: *******************************************************************B(•lE•Fe********* . EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if 0e permit is for one hundred($100)or less). DEVELOPMENT SERVICES R E Q U I R E M E N•,P S 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.' ZONING APPROVED BY DATE: 7._'. . Date: Signature: NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING AP PROVED BY : _ a DATE: Code.you must forthwith comply with such provisions or this permit shall be deemed revoked I CONSTRUCTION LENDING AGENCY: hereby affirm that there is a construction lending agency far the performance of the work for APPLICATION ISSUED BY• -x'• e / •( F-.-� DATE• 7 �3 / ' which this permit is issued(Section 3097.Civ.C). ****E****.{(.***********.**** * * .** . *ff ir* ****************** is SFR%** LENDER: *************************************** * *********************************** ADDRESS; LEGALIZATION:N F E E SU MARY STRUCTURAL SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE ' SMIP/RES ' GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 1 5. 0 0 ,50 repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed • pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/NON—RES • and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN . any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 'I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—,> . PERMIT . ISSUE PLAN—CHECK TOTAL PAID DUE • ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS——--> 15 . 50 0 . 00 0 . 00 15. 50 15 . 50. . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his or her own employees.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 will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 15. 50 OVER/SHORT; 00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK J15 . 00I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business . 50 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the ContractorsState License Law).l am aware *.*.*.******.*****.***********{E*.*.* (.*****.-***.***.*if.**{<-*{(.***.{(.*.**.***********.*****.**j(.****.* that proof of their Worker's Compensation insurance should be provided to we. INDIVIDUAL F E E BREAKDOWN N lam exempt under Section: BP704 4 B.&P.C. S9 for this reason; ALL WORK BY OWNER �f`__ TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date:_? .3/-p, owner: �`^�"`9 SFR 500 REROOF BY VALUE RESIDENIIAL NOZONE 1 . 00 500. 00 I do hereby certify that I am aware o1 and understand the requirements of California Health and Safe( ode Sections 25505,25533,andEND OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said slate codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential conskuc n applications are exempt from these provisions. Q 7,((//�.�,�, Dale: 7—Z/•"' [ � Applicant: 0741- •'• .0)1.----......- 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 ordinances and state laws relating to building construction and hereby authorize representatives of this 'ty to nter upon the above-mentioned / property for inspection purposes.seesor \(�',In/ • Date. 7 3LlSignature' alt ' �I1\6111/ `I V 01 00093521-000933522 '•CtT i55.Si1 Driver's License or Social Securityvl ll DATE: 07/31/91 TIUE: i0;48 : • 1641-46 While—Building,Green—Code Enforcement:Canary—Applicant: Pink—Revenue:Goldenrod—Assessor 4 • CONSTRUCTION AND PLANNING POO PA Date Inspector Date Inspector, ,; APPROVALS Permit# I APPROVALS Permit # _ 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location +' r. 2. Soil Pipe-Undrgrnd, . 53. Steel Reinforcement - "' 3.. Electrical Conduit Utility-Undrgrnd. . • 54. Forms ,/ y' / • 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding • 5. Steel Reinforcement - • 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test . 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK i` 1• 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 11.- 7( ' 12. Sewer Cap 63. Heater & Vent-Final `"- 13. Roof Drains 64. Plumbing System - Final , `--' - ;may 14. Rough Plumbing 65."Electrical-Final - - y ' 15. Rough Electrical-Conduit 66. Solar System-Final i ' 16. Rough Electric Wiring- 67. Fencing & Access Approval -. 1 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 OOiI 23. Gas Pipe-Rough& Test 72. Underground Flush ' 24. Roof Framing -73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing - •• •• 74. Overhead- Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding. : • 77. FIXED SYSTEM FINAL 29. Insulation • i ' 78. FIRE PREV. FINAL 30. Drywall Nailing ,ii< i HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coatt `11 79. FINAL INSPECTION -J ' 32. Electrical Power Meter-Final - � 0--41, .80. FOOD CERTIFICATE ISSUED - 33. Final Electric j /1 - 'Notes: -34. Final Heating'& Air Conditioning '-!-`---1 I ' 35. Final Gas Pipe-Test l %" _ •- • .36. Hood or Canopy - '�� - ' 37. Final Factory Fireplace - ' v.. 38. Final Plumbing t 39. Water Service•Final - `- 40. Gas Service-Final • Al. Solar Domestic-Final . 42. Backflow Preventer - 43. Backflow Irrigation- - .44. Landscape Irrigation System ' 45. Sound Attenuation 46. Handicap Regulations . 47. FINAL STRUCTURE & BUILDING • ?rail 48. FINAL PLANNING - - , 49. Electric Release to Edison ..":-/' t , 50. Gas Release to Southern California Gas Co I ' 51. CERTIFICATE OF OCCUPANCY No. Date -