The URL can be used to link to this page

Home My WebLink About1928 HARBOR BLVD - Building Permits :s . _—_�� r' - "-'COPES MESA BUILDING DEPARTMENT i WI- 555 B f1�•�East12Oth Street _ . . ,. - C .-.1. Mesa, California Date l? - 9-• CITY OF COSTA MESA /64-7L. 973raut& z4crn��C �/ iittt N�. ..Plumbbin'g�Permit No/ . f'Building...� �i7 % J;. :C • .._�iF.CCGni Ite The a ding ataga2ig — ... �[yjJ��I. ._...L:l.�z:c. �....A.-..E} ..4�' ' Lot /w2 ' �-a2 6Tract Y^••• (See reverse side for ate and Bounds) has been inspected and found to comply with the provisions of all City of Costa M din applicable thereto for a Groupdor.4,7 '• Occupancy. 18 ED "� A. J. �/fJ City fiela, (Owner of Building) BY,�•• - �-••CC;I�-U.. CC: 0 Original—Owner ❑1st copy—Gas Co. ❑2nd copy—Edison Co. 3rd copy—F Ile Form 206 G-H IN 12-53 v iisX. Wuth;.ltiCIVILW ` .=•ir r • r I NAIOSTA ,� _ f7356 !my, FDEPL`'a *ua48.00 COSTA MESA, BUILDING DEPARTMENT on OF CCc*h ANSA P.O.BOX 317 COSTA MESA. CALIFORNIA I FOR APPLICANT TO FILL IN APPLICATION FOR PERMIT BUILDING ADDRESS f47R .-IQ2t7j 1930 04R6cla e1.lId BUILDING COSTA MESA, CALIFORNIA - ! FOR OFFICE USE ONLY IRECEIPT NO. PERMIT NO. OWNER LAR,Ad41 P. tA[4/ /aMS I7 S-6 77�J (MAIL /� {/. RECEIVED BT DATE RECEIVED O_gT y�ry ADDRESS Sia S ,,'}Al 'CQt.„, • //-47 -�� (ZZ�id TEL. BUILDING „T T (/ CITY f3Qt6OA- tc Aa i NO.ie JS1is ADDRESS /9 `1� /2 � /O //c4-! o .1 ARCHITECTE •-"IN1 ''i NO. COSTA MESA. CALIFORNIA OR CTER IC. FIRE ADDR-aS ZONE CITY LIC. ZONE NOOF PLANS TYPE GROUP CONTRACTOR O+,.N„c, NO. ADDRESS 16 R . . T NO. O2 33 1‘ 6VPROVE, r'. ; DATE Al LEGAL LOT V/)'� CORRECTIONS DESCRIPTION NO. / BLOCK TRACT ifi A.P.NO. // S—. lJia - D s SIZE NO.OF BLOCS. APP R OF LOT Sr) i /4/0 NOW ON LOT E D USE OF ' EXISTING BLDG. L11. Igde I CITY ' CO/S+TrA MESA SETBACK LINE FROM /.� PLA LUNG Dot CENTER OF STREET . t 0 3 /� REAR YARD t3 SUBJE BLDG. DEPT. R G. G SIDE YARD RIGHT C0 LEFT h I /JJl DESCRIPTION OF WORK ' 2/u 8PLAN TECH. • DAT // NEW I/ ALTERATION ADDITION u•+...�Y+....•rmo-.~ REPAIR MOVING DEMOLISH , SIZE DING S ,..`/ NO.OF ROOMS 3 STORIES 1 EXTERIOR WAIL?A Jen, , COVROVERING I' A, K. , EOVERING TA 1+ ' ,(d USE OF NEW I 2 ,a/ric .� ,/� BUILDING 3 S Qel --�-' `� / tj / 44 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTRUC- TION. VALUATION PERMIT FEE $ 3�, -- SIGNATURE OF /�/) /] �/�� PERMITTEE (N (ff . 0. (SCJ R-s✓�+ / _ 73 . 0 ?� PLAN CHECK $ //(� AUTHORIZED AGENT TOTAL FEE $ Kd2 — "BMF a 9204 Iickiv�u COSTA MESA BUILDING-SAFETY DEPARTMENT eir 5 I 959 P.0.BOX 317 COSTA MESA,CALIFORNIA FINANCE DEPT. FOR APPLICANT TO FILL IN COMPLETELY APPLICATION'-FORLPERMIT TYPE O///R PRINT BUILDING BUILDING l/ K r/ // ',q E )31 0a • ADDRESS 7 fl/C 1 �+//�J COSTA MESA, CALIFORNIA FOR OFF/CE USE ONLY I �nt / %AL/4-N s RECEIPT NO. I(�2�RHIT NO. OWNER Y {/'/✓/� II.`% fZ1 MAIL J S // RECEIVED BY DATE RECEIVED DATE ISSUED ADDRESS S3 P /54T K FI . �i'✓'�% S A —S % -5-7)---.57 TEL. CITY /A/ 612/^7e An" NO.404, 3Sfj—IDDILRDEIN ARCHITECT /yiyAwFy ^w t,u D. COSTA MESA, CALIFORNIA AR !NEER q ,f NO. ADDRt:S C/,Y/44C.' .CAYeaceleCanc FIRE ZONE /t�y///p111e /JIJ/ group t-2------- STATE dbtJ/YFA LIC.NO. BY ( /� { DATE t5 /j CONTRACTOR V L ADDRESS S/ti1E- ZONING • LEGAL I LOT ai 19Q 9 ZONE .� 1I�NO.OF ^ USE OF NEW DESCRIPTION NO. / BLOCK ACT J/I PLANS U BUILDING A.P.NO. 1 SIZE /�//A' • •• BYAPPROVEO''�JI ap , - O•TE 5" SIlir - OF LOT . EVES moi Q!^ f 7 Q' I NO.OF NOW ON LOT6 I REOUSRED1,f.�a /7 ALLOWED USE OF �/ �T (CENTER LINE ST.) / EXISTING BLDG. leL-/i4/L ST`.ie`L FRONT FT. IN. SETBACK LINE FROM ,,// �/ CENTER OF STREET �/l . REAR YARD �n ,. R.SIDE � FT. IN. SIDE YARD (LEFT f"' / I RIGHT �� L.SIDE __Li" FT. IN. DESCRIPTION OF WORK I REAR FT. N. N I I ALTERATION I VI/��I ADDITION I � v� I117z2!'�f.t/ REPAIR I II MOVING II DEMOLISH I • ' QC�C-C ' BUILDING '/ I NO.OF SIZE /7 Y Cy ROOMS / STORIES EXTERIOR WALL/ _ I ROOF �/jf76/2A A2.°c'\- COVERING S TcrQ COVERT G 1 USE OF BUILDING AND WORK TO BE PERFORMED CayF-c17,04/A.,r I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM• PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING BUILDING CONSTR TION. VALUATION SIGNATURE OF i �,6 PERMIT FEE $ rt, aCO 1 I PERMITTEE �, ,f/ $ /n!y// PLAN CHECK $ AUTHORIZED AGENT !/ �/ - TOTAL FEE $ e%17, 04-0f � /05" CITY OF COSTA MESA 4 411%) .. - BUILDING DIVISION >:r,.,,,lcDEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER l;r % PERMIT �M02-00001 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 • MECHANICAL PERMIT Job Address: 1928 HARBOR BL Status: ISSUED Suite No Applied: 01/02/2002 Issued: 01/11/2002 • Vicinity: KITCHEN - Parcel Number 41920517 ISSUED BY: Applicant: CIRKS, KEN ' ' Address: 1442E LINCOLN/#334 ' , , = . Phone: (714)632-6717 /, N ORANGE,CA Zip: - 92865 _ , Owner: RUFFELL, DAVID A TR- -�, Address: 307 E BAY FRONT Phone: ' BALBOA ISLAND,CA Zip: 92662 -- " ' ' Contractor CIRKS CONSTRUCTION INC. - Address: 1442 E LINCOLN#334 Phone: (714)632-6717 , ' • ORANGE,CA Zip: 92865 ` License:763589 '' - -" " SCOPE OF PERMIT \ INSTALL TYPE 1 HOOD.NO STRUCTURAL WORK TO BE DONE TO EXISITING SHAFT."GLOBE EUROPEAN DELICTESSENI'.REF:F01-00271: / - . v" ' PC FEE PAID UNDER B01-02000. ' FEE SUMMARY - , Quantity _ Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit '$0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 . „ • - -- Domestic Incinerator . , - $0.00 '0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping ' v $0.00 0 - Up to 3 hp'/100 k BTU, $0.00 0 Factory Fireplace `, $0.00 -0 3 To 15 hp/500 k BTU ' ' ' ' $0.00 "0 Hood w/Mech Exhaust ' $10.65 1 15 To 30 hp/1,000 k BTU ' . $0.00. 0 VAV Box "$0.00" 0 30 To 50 hp/1.750 k BTU - -$0.00 0 Vent Fan/Single Duct . $0.00 ,0 Over 50 hp/Over 1,750 BTU ' ' ,/ $0.00 0 Appliance $0.00 -0 - Boilers - ' / / •Fire Dampers $0.00 " 0 _ Up to 3 hp $0.00 0 Smoke Dampers ,. - $0.00 0 • 3 To 15 hp - $0.00 0 . Inst or Relocate Appl Vent $0.00, 1 0-_ __ 15 to 30 hp $0.00 0 Air Handlers< 10000cfm N. $0.00 . 0 / 7 ' - - 30 to 50 hp, $0.00 0 Air Handlers> 10000cfm -7 $0.00 0'- .- / - , - Over 50 hp • , - ' - ,, $0.00 0 Floor Furnace '$0.00 0 _ , . Other Mechanical Fee,�� Floor or Suspend Heater $0.00 ._0 InvestigationFee .; $0.00 - , . -Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $34.15 COMMENTS/SPECIAL CONDITIONS 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)754-5628 244646(6100) 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. -0-1 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'_ comp nation Insurance carrier and policy number aro:—.7. / (� /' 'Carrier: S-i-c fe. co sleets a.#-' 9 rt L"A,S rrPolicy Number. - I✓ -j OIY -� -(This section need not bjcompleted if the permit is valued at one hundred dollars($100)or less.) L--- — . - ❑ 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 Califo and ree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisi _ Applicant Signature: / l_Date: + Of—g —0 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARE($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 Iam.licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Businessgnd Professions Code,and my license Is in full force and effect.Lic.s d 76,1.'a9 cCless a ' /J� C ZO— C76 Contractor's Signature: / Date: a iI—a Z CONSTRUCTION LENDING AGENCY: O 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: Lenders Address: Signature: Date: re OWNER-BUILDER DECLARATIONS ' c. •4-• /(,S I hereby affirm that under penalty of perjury that I am EREMPT 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 pulsuant 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 moreapn 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 owne6-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). O 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 properly who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). O 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: O 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(38)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? 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,ore 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 en RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. req- _..._..l_....__.. _. 4 If an RMPP is presently required,has Section 25534 of the California Health end 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 a plication a.aPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No (Section 65850.2 of the California Govemment Code requires that the requested intonation 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 ❑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 penally 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 properly for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sig re gal Owners) Dat of jmz And/Or Authorized Applicant ( Date g0DP 1, INSPECTIONTYPe RAI MALI RODE INSPECTION TYPE r� PAIL 1111• - : 1618 Fixed System Final Fire Prevention 206 Final Mechanical n'R 'Oa1 •• N 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 222 Final Site 204 Final Demolition - - - - 250 ,.Final Building/Occupancy PROJECT ADDRESS: 1930 HARBOR BL UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO; IB 071055 OWNER'S NAME: DAVID A, RUFFELL ADDRESS: 1922 HARBOR BL PERMIT NO: IB 071055 PLAN CHECK NO; N GOVT: N SUPP : Y COSTA MESA CA 92626 CONSTRUCTION TYPE ; PERMIT TYPE : OTH STR PURPOSE: OTH 548-0259 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION ; NEW TENANT FOR CERTIFICATE OF OCCUPANCY SQ FT; ADDRESS: UNIT: PERMITTEE: GLEN STEWARD ( 714 ) 631-2708 CLAIM VALUE: CALC-VALUE: GROUP OCC : B-2 / ADDRESS: 5101 SEASHOREDR A COMMENTS : NO CONSTRUCTION -. C OF 0 Auk FURNITURE" NEWPORT BEACH CA 92663 **a6+y***x-T6*******;e**+e*-x*************** ,******->F*vE***+r-u-**s*+i•***AF*-a *******+e*-u-***** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in lull force and effect. SET AC CITY LIC.: STATE LIC.; CLASS: EXP; . Date signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that l 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.C). LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ• PROV: PARCEL ; 41920517 ZNE: REF NO; '1 Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> Date: Applicant- ***iE**:E*********a*************************u****iE*********u********************* • EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the•• " hundred($100)or less). DEVELOPMENT SERVICES REQUIREMENT' S I certify that in the performance of the work for which this permit is is ed.I sh. • .• a •erson in any ma er so as to become subject to the Worlye rs'C pensation Laws of California. ZONING APPROVED BY • DATE: zg 1 5" Signature: NOTICE:If.after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY ; DATE; 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 APPLICATION ISSUED B Y; - �� DATE; 62•7 6 -YS_ which this permit is issued(Section 3097.Civ.C). *************************. ******* ***. i. *. ********y*********************.**.*** LENDER: ****************************************** *********************************** ADDRESS: LEGALIZATION;N F E E SUMMARY 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 SM I P/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 , 00 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 P LAN SM I P/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 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 properly or my employees with wages as their sole compensation, will do the work, and the BUILD I NC-D IV-> 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----> 30 , 00 0 , 00 0 , 00 30 , 00 30 , 00 0 0 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 x improvement of sae)hin one year of completion,the owner will have the burden of proving he/she did not build or improve forthepBLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 30 . 00 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who Molds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).1 am aware ******************************************************************************* that proof of their Worker's Compensation insurance should be provided to me. IND I V I D U A _L F E E BR EAK D OW N I am exempt under Section:B P 7 0 4 4 B.8 P. C. for this reason: LL WORK BY OWNER - CT YPE QTY DESCRIPTIO N UNIT COST TOTAL COST -.9.0: .2-791 5-- Owner: ' INS 1 BUILDING RE-INSPECTION FEE 30 . 00 30 . 00 I do hereby certify that I 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 Air Duality Management District.Residential construction applications are exempt from these provisions. Date: Z/ Applicant 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 hereb . rrize representa' •.. ' ity to este .. .••• •entioned property for ins�n purpo s. _ _ In =r0it:`.._52'u0176352 TOT 30.00 0'/33 1 16( 6 � i DATE: ! 1'd TIME: 2 Dam' �� signature: � �� Driver's License or So al Security x: 1641-46 White—Building;Green—Code Enforcement:Canary—Applicant;Pink—Revenue;Goldenrod—Assessor • CONSTRUCTION AND PLANNING i POOL .PA • APPROVALS Permit# Date ' Inspector APPROVALS Permit # Date Inspettor t. Temporary Electrical Service or Poler 52. Pool & Equipment Location • 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement • d 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. - r 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test r 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 r 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval r 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 0 Oil 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-bat Ceiling (Structured & 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 '! HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat • • 79. FINAL INSPECTION 32. Electrical Power Meter-Final80. FOD CERTIFICATE ISSUED 33. Final Electric •-/ Not s: 34. Final Heating Si Conditioning �c a�/1 CSM/ 35. Final Gas Pipe-Te. 36. Hood or Canopy 'I A 37. Final Factory Pi .place I `� 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final . 41. Solar Domestic-Final i 42. Backf low Preventer 43. Backflow Irrigation • { 44. Landscape Irritation System - 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 3/1.03.-‘7722 . • DIY 48. FINAL PLANNING (/�[ " 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date