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Home My WebLink About769 BAKER ST - Building Permits(714) 754-5273 • Fac (774) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 769 BAKER ST Suite: Vicinity: TUSTIN MOTORS Parcel Number: 41820214 Zoning: C2 C2 Applicant: HANSEN, DUKE Address: 260 E. ALTON AVE " ;�- -% - . � � - - �. ISSUED BY: Status: ISSUED Applied: 09/27/2001 Issued: 09/27/2001 ,- /�' " -- � Phone: (714) 557-7440 - - SANTAANA,CA/i'�� . , Zip:�, 92707 � ' � .%-. . . _ � . _�� '� i ., �.� Owner. RUSSELC; VIRGINIA ROSE . . � � ', Address ,6809 HAZELGREEN RD N E-i � � �'^ � '. � � � �.. - i ` . . ' � _ _ � . � � - . - - � .,/.��. � �� -.Phone; �� ` � � 'i��;� � ; SALEM, OR � . -, ` Zip: 97305 _ - � , � � ��• � i A�- . . . , ... - - , ` . . Contiactor. `ROSS & BARROWS INC. �� ,�. � ' � Address: 260 E. ALTON AVE � � .� . ' , i,'' �� Phone:<�(714)557-7440 � �,, � . � ' � SANTA ANA, CA ` �' . . ' � . . Zip: , 92707; . ' License: ° 327802 ' � ' ' � . . Address: - - � , , � ;�- � - . . � � . �: Phone: , . Zip: � ' � License: �� / REROOF: REMOVE OLD B.U.R. AND INSTALL A - FEE SUMMARY - � � .'�' ` , ' � Calc Valuation: --� � — � ` � j � ; "; Claim Valuation " En9: �. _ _. Address: = VI'. YCKIYII I__ 80`SQUARES ° � � --� ` Phone: � � '� • ' �License: Plan Check: Permit: SMIP Res: SMIP Com: Other: Inspection: � � Total: $O.Otl $so�.ze $1.8tl $O.Otl $O.Otl $0.00 � , $18,035.00 f, �- $18,035.00( $309:05 � . ��. ,.. - „ �,...��__ „ PLANNING & ZONING � SETBACKS' i, .. �� , . �MAINSTRUCTURE;Front, 0=0' �: , � Rear �-.0-0 �.Left �0.0 - - �Right�, �0-0- . _ � ACCESSORY � Pront'- ,0= 0�� ,,Rear_ 0-0 � Letl 0- 0 - Rigtit - 0- 0 "� � PARKING Existing: � 0 Required: � 0 , Proposed: o � �_ � NOTES: � - � - NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under Califomia statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) '��. EXPIRATION: This permit shall aUtomaticalry 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 Inspeetlo�s and final epp�oval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (7�4) 7545626 2a48-46 (fJW) WORKERS' COMPENSATION DECLARATION: ' I hereby afrirm un0er penalry of perjury one of the tollowing declarations: � ❑ I have antl wlll meintain a ceniticete of consent to self-Insure for workers' compensation, as provided for by section 3700 of Ihe Lebor Code, for the peAormence of the work For which this permit is issued. �I have antl will maintein workers' compensation insurence, as requiretl by sectlon 3700 oF Ihe Labor Cotle, For the peAortnance of ihe work for which this pertnit Is Issued. My workers' crompensation Insurence carrier antl policy numher are: Camer. i5 i�i �w_ �JN� Policy Number: C9 �`-9 / O� � 6� oL (This section nesd nat be comp/eted il the permit is veluetl et one huntlretl dollers ($100J or /essJ . ❑ I certify that in the peAormence of the work for which Ihis permit is issued, I shall not employ eny person in any manner so as ro become subjacl to ihe workers' compensetion lews of Celitornia, entl egree that If I should become sub�ect to the workers' compensetion provisions ot Sec�ion 3700 of ihe Labor CoCe, I s�all fonhwith compty with these p%� isians.n Applicent SigneWre: I/✓�Y i�2 �' Date: y?_ i— �/ WARNING: FAILURE TO SECURE WORKEFS' COMPENSAiION COVERAGE IS UNLAWFUL ANO SHALlSU&IECT AN EMPLOYER TO CRIMIWLL PENALTIES AND GVI� FlNES UP TOONE HUNDRED THOUSAND OOLLARE (5100,000), IN ADDfTIqJ TO THE COST OF COMPENSFTIIXJ, DAMAGES AS PFOVIOED FOR IN SECTIIXJ 3]OB OF THE LABOR CODE, INTEREST, AND ATTORNEI"S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aNirm ihat I am licensed under provisic force antl e%ect. Lic. A ,� �.% _� � Z Comradofs SignaNre: ot Chapter 9(commencing with Section 7000) of Division 3 oi ihe Business antl Professlons Code, and my license is In full ciess a G —7 Y %> �—_' Da�e: `/ l— % — O/ CONSTRUCTION LENDING AGENCV: ❑ 1 here6y attirm ihat there is a construction lending egency for the pertormance ot the work for which ihis permit is issued. (Sec. 3097, Civil Cotla). Lender'S Name: Lender's Atltlress: Signature: Date: OWNER-BUILDER DECLARA710NS: I hereby aflirm Ihat under penalry of per�ury that I am EXEMPT FROM THE CONTHACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Busineu end Protessions CoOe: Any ciry or counry which requires e permit to construct, altar, improve, demolish, or repair eny slructure, prior to its issuance, also requires the applicant for such pertnit to file e signed stetement that he or she is Ilcensed pursuent to the provisions ol ihe Coniractors Llcense Law (Chapter 9(commencing with Section 7000) of DlWsion 3 of the Business antl Prolessions Code) or that he or she is exempt therefrom an0 the besis for the elleged exemption. Any violetion of Section 7031.5 Dy any epplicent for e pem+' subjects ihe appllcam to a civil penalry of not more than tive hundred dollers ($500).): ❑ I, as owner of Ihe property, or my employees with weges es �heir sole compensation, WILL DO THE WORK, and Ihe strudure is no� In�entle0 or oflered for sale (Sec. 7044, Business and Pmfessions Code: The Contracbrs License Law tloes not apply to an owner of property who builds or improves thereon, and who does such work himself or herself or ihrough his or her own employees, provitletl that such improvemenis are not Intendad or oHered for sale. H, however, �he building or improvement is sold within one year of completion, ihe owner-builder will have the burden of proving that �e or she did not build or improve for purpose oi sale.). ❑ I, as awner of ihe property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consimct the project (SecJ044, Business end Professions Coda: TTe conirectors License Lew tloes not apply to an ownet of pmperty w�o builtls or Improves Ihereon, antl who coniracts tor such pro�ect with e contractor(s) license pursuant to the Conirectors License Laws.). ❑ I am exempt under sec. Business and Protessions Code for this reason: Signature: Date: Owner ID veritietl 6y tlriver's license. ❑ Yes ❑ No Driver's License No. Expires: Verificatian of Ownership by (type of document, i.e. - propeny tez bill or deed): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION: ❑ I hereby certify that no excavation tive (5) or more teet in depth into which e person is requlred to tlescentl, will be matle in connection with work authorized by this permit, antl thet no building siructure, scaHolding, talsework, or tlemoliUon or dismemling ihereoi, will be more than thirty-siz (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, 7tle B, Calitornia Administretive Cotle). ❑ As owner-bullder, I will not amploy anyone to tlo work which would require e permit from the Division of Indusirlel Sefery, es notetl e6ove, unless such pereon has e permit to do such work irom the division. SiqnaWre: Date: Division of Indusinal Sefety Permit Number: CER7IFICATE OP COMPLIANCE ANO AUTHORIZATON OF EN7RV: I certify under Denalry of perjury that I have reatl i�is application antl state ihat the information given is correct. I agree to comply wtth ell state lews and ciry ortlinances relating to bulltling construction, entl authorize representatives of ihe Clry ot Casta Mesa to enter upon the above-tlescribed propeM �or inspection puryoses. I egree not to occupy or allow xcupancy of eny building authorized 6y this pertnit until finel inspedion. � Signature Of Legal Owner(s) Date �C -��— Z � — U/ AnNOr Authonzatl Applicant Date COOE t. INSPECTIONTYPE 1616 Fiaed System Final Fire Prevention 1266 200 201 202 203 204 Pool Spe Final , Finel Re-Rooi Final BIocWRetaining Well Final Factory Fire Placa Final Sign Final Demolitian �i[ IMRIRLS /�'i ,`l�� CODE� INSPECTIONTYVE 206 Final Mechanical 20B 210 212 220 222 250 Final Plumhing Final Electricel Finel Fire Prevention Final Planning Approval Final Site Finel Building/Occupancy o�rE 1[�L3 � --� 7 Pfl0.1EtTA00XE55: 769 BAKER ST OWNEH'S NAME: RAY RUSSELL nooness: zy�2 CENTURY PL COSTA MESA CA 92626 ABCHIENGINEEfl: aooaess: flEG.NO.: UNIT: uxir: PEflMITTEE: THE HAKER COMPANY ( 714 ) 835-8572 ADOflE55: 1ZO2 HUNTER SANTA ANA CA 92705 LICENSEO CONTXPCTOP OECIAflRTION: I tlereUy afiirm ��a� 1 am licensea untler pmvisions of ChaD�e� 91�ommencing with Section 7000� ol Urvision 3 0l Ue 9usiness ana Pmlessions CoOe. and my li nse is in lull �orce an eHeci. ciTruc.:q47439 STRTElIC.55496? cuss:C-1� Oate: �(2��7� SignaWre:_ � 'OflNE S'COMPENSATIONOECIAflRTION: IhereGyaf' ihatlhaveacenilicaleafconsenitoself-in5ureoracenifiWteolwarker5' mpen5ation Insurance. ot a cenilietl cooy ther¢ai � tion 3800. La�. CI. AIILYNO.:wC 71?5194324 EXP.ORTE:O%�OS�93 con+rnxr:CNA INS CO ❑ Ce�ihetl copy i5 �ere0y Iumishe0. � Cetlilie0 cop�y is Ie/�J+nih Ihe ciry Buil g Division. Ua�e: � � G FppliCa t�— // � /1/� EXEMPTION FBOM WOPKEBS' COMPENSRTION OELUPATI :(This section nee0 no� be completM it the permit is lor one hunAreO (5f00) or less�. I cerlily Ihal in t�e petlormance o� Ine work for whic� I is p¢rmil is issued, I s�all nol employ any Deaon in any manner w as �o b¢come 5u0�ec1 to t�e Workers' ComDensa�ion Laws o� Calibrnia. Date: SignaWre: NOTILE: II. al�er making ihis Jeclaration, yau shoultl Cecome suhleci lo I�e Workers' Compensation pmvisions ol t�e Labor COEe. you mu5i tarthwilh comply vnt� such pmvisions ar Iltis Dermit shall Oe aeemetl revokeG. CONSTBULTION LENOING AGENCY: I hereby a�lirm ��at ��ere is a conslmciion IenOing agency br the peAormance o� t�e work tor wnicn �nis permil is i5suetl (Section 3097. Civ. C�. IENOEfl: AOOPESS: OWNEH 601LOEB OECLABATION: I �ereGy allirm ��al I am exemp� �mm �Ae Coniractors' Slaie License Law lo� ��e following reason �Section 7Q31.5 Business antl Pmlessional Cotle: Any ciry oi counly which repuires a permil �o constmc�, alter, impmve, tlemolish, or repair any simclure, priar to iis issuance, also reQuires ine applicant tor such De�mit to file a signe0 statement ihat he/she is licensetl pursuanl io Ihe provisions o� ��e CanVanors' S�a�e License Law (ChaD�er 9(commencing vnth Sectian 7000) o� Division 3 0� the Business ana Pmlessions Coae) or ihal he/she is eaemD� ��erefmm ana ihe Easis for ine allege0 exemption. Any nolatian ol Setlion 703L5 by any applicani for a Dermil subjec�s ��e applican� to a cidl penalry oi not more �han five hunOretl Oollars (E500). I, as awner of Ihe pmpetly nt my employees witA wages as lheir 5ale comp¢nu[ion, will do IAe work, antl [he ...� simcWre is noi inrenCeG ar ollereC lor sale (Sec�ion 706C, Bu5ine55 an0 Pmiessional Cotle: The Contractors' S�aie License Law aoes not appty �o an owner ol a pmperty who Cuiltls or impmveSlAereon. an0 who Ooes such wo�n himsell/h¢rsell or t�mug� his or �er own emDloy¢es, pwvitletl �hat such impmvemen�s are noi intenaetl ar ol7erea for sale. Ii, however Ihe builaing or impmvemenl is soltl wilhin one year oi completion, Ihe owner will have t�e burtlen oi pmving �e/s�e 4i0 not Ouild or imDrove lor ine ourpose of sale�. I. as owner of the D�operty, am exclusivelp contrac�ing wi�h licensed conlractors to tonsimct the pmleci (Section 7044, Business ❑ antl Pmfessi0ns COde: T�e Conlraciors' Slaie LiCense Law Ooes no� apply �o an owner o� pmperly wA0 OuiIJS ar improve5 �Aereon and who conVac�s for such pmlec�s wilh a contracior�s) license pursuan� lo Ihe Contraclors' Slate License Law�. I am aware Iha� pmof ol �Aeir Worker'S Compensalion insurance ShoWA De D�ovitletl �o me. � I am e�emp� under Seclion: B. 8 P. C. lor Ihis �eason: Daie: Ownec I tlo here�y cenity �hat I am aware ol and untler5lan01he requirements of Calibmia Healt� antl Sa�ery Code Sec�ions 255Q5. 25533. antl 2559A and l�al I or anV �Wure �uiltling occupant will/will not (circle one� neetl to com0ly wi�h saitl state codes and Ihe requirements tor a permit for consimction or matlilica�ion Imm I�e Air Oualiry Management �isirict. FesiOential consimclion applica�ions are exemp� imm ihesc pmvisions. �ale: AOPlicani: I here�y certilythal I have r¢aa�his aDPlicalian antl staie orainances an0 slale laws relaling lo builtlmg conSiNc�ion � pmpetly lar i Aspe��ion p rposes. �ale: � v� � SignaWre- Oriver's L¢ense or Social Securi�y N.' inlormalian is� orrect I agree Io comply wiih a�l ciry and counry oriz¢ repre5enpiive5 ollhis ciry�o en�eruponihe above-mentioned t64bA6 White—Bmltling�, Green—Cotle Enlorcemem; Canary—Applicanl; Pmk—Revenue: Goltlenrotl—Assassor CITY OF COSTA MESA — BUILDING PERN.IT PERM NO: F 061990 PERMIT NO: F 061940 PLAN CHECK NO: 01903-93 i GOVT: N SUPP: N CONSTRUCTION TYPE; PERMIT TYPE: FIR PURPOSE: OTH JOB DESCRIPTION : BACKFLOW RETROFIT SQ FT: ,CLAIM VALUE: 3,900.00 CALC—VALUE; GROUP OCC; H-2 / COMMENTS: THE "RUSSELL BUILDINGS" if if iE 1E # iF # if -1(� �1C�iE iE i! if� if-iE iE il� i4 �lf �lh �lf ##### iE ff #�lE �)k # 1F 3E i(� � iE �E iE iE# i!� if if iE # 3f �lf if iE iE if �If i( if iF iF # iF iF 9f �1E# ### dk iE 3E iF-lf ###�%iF iE �IF Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT ZN REAR; FT IN FRNT: FT IN REAR: FT ZN LEFT: rT IN RGHT; FT IN LEFT; FT IN RGHT; FT IN PARKING REQ• PROV: PARCEL: 00000000 2NE: REF NO; PLANNING NUTES> i ****x*****�**�e**�#�r*****#**�r�r*****�r*�r��r�rrt��r�r#�r*��r�x#+�*�*��#�*�r,�*��r*��r*#*#�##�r** D E V E L O P M E N T S E R V I C E S R E Q U Z R E M E N T S ZONING APPROVED BY DAT£: BUiLDING APPROVED HY ; DATE: APPLICATION ISSiJ�D HY; L DATE; �r� � iFiE'lE1fiE1Eii1E'1F1EiFiEiEiFiEiF161E1FiFif!ERil�i�FiFiFi'Fi�'liF1'F R%Y Sii—Ffi' SRiliF�mir��ltRfii%#iEi!#iFiEiflf##fR' fF�tR ttiFir iE 1f if if 1E if ?f �lf iE iE iElF iF iE !F iF if iE # iE If !E iE iE #!f if ii� if iFlE �f iE if 1E 1E fE �lE if �JF # ik-1E if iE if iE iF 1F iF if ik if iE# # if iE if 1ElE #!E ##!F iE iF # iE iE ##�)f iE if 3f # iF LEGALIZATION;N F E E S U M M A A Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT • 63.00 65$ SMIP/NON—RES PLAN . 90.95 ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTAiS----> 63.00 0.00 40.95 103.95 103,95 .00 i REVENUE DIVISION TOTALS--> COLLECTED:� 103,95 OVER/SHORT; .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADiNG PLAN—CHECK 63,00 40.95 iF if !E iE # 1( 1ElF 1f iF iE iE IE iE 1E �1F 1E IE # 1E iE iE iE 1E iP iF 1f-1E il� ### i4 # iE iE iE ## # iE 1F iE 3f 1k jf i(�!E 1Eif iEif i( dF �1E if # 3E �t �1EiF lE 1F -If # d4 iE iE iF iklE iE i(� if iF iF if 1f 1E I N D I V I D U A L F E E B R E A K D O W N TYPE QTY FIR 63 i'. _ �� D E S C R I P T I O N UNIT COST FIRE £QUIP FEE (F'ROM BLDG VAL TAHLE) 1.00 END OF FEE5 TOTAL COST 63.00 � �� D g93 � �, APR281 CITY OF. COSTA MESP► CONSTRUCTION AND PLANN.. .� APPROVALS Permit,� Date 1. Temporary Electrical ServicF qr Pole 2. Soi1 Pipe-Undrgrnd. j' : �+---- 3. ElecVical Conduit UttlrtY•UP,ifrgrnd. 4. Electrical Cond�it-Undre�.nd. 5. Stee� Reinforcement 6. Ei2ctrical UFER Gmd ` 7. Fooungs . � 8. FoundaLon ,!� 9. Water Pipe-Undrgrnd. c• '•� 70. Structurai Pioor System � � 11. Property Sewer Line & House Conr,ect on � �/- - 12. Sewer Cap � � .�-'_ r� _ 13. Roof Drains ,,��, -` ` 74. Rough Piumb�ng 15 Rough Eiectrlcal•Condurt 16. Rough ElettriclViring 77. Rough Wiring Sign 18. Rough Eiectricai-T Bar Ceihng -_ 79. Rough Heating & Air Co^diLoning 20. flough Fattory F;rep'.ace 21. Outts, in Str�cture � 22. Ducts, Ventilating � 23. Gat Pipe-Roogh & Test • - -- 24. Roof Praning ----- ---�----- 25. Pocf Sheathi�3 I 2"0. ?�Bir Ce�I�ng (Str.�c;..ra�i Ci,� ,4�o,ocoat I 27. Frane ard Flashing 78. Lathing & S�ding 29. Insulatwn � � -- - _.l. 3�_D /�.�all �dailino _! 31 P,,,str 8rorm Coat � 32. E',ectncal Pov.er 0.:uter�F�nal 33. Fin.l Electric 34. �in?I H23Lng $t A'r Coi�.:i[�iO.�lnt� J5. Finsl Gas Pipe�Tes; 3G. Hnd or Canopy 37. F.��tl Factory Firepletc 39. F�nal Plumbing 39. tVater Service-Final 40. Gas Serv�ce-Final 41. So�a� Domesc:cF�rai 42. 8ackflov, Preventer 43. Backflow �rrigation 44. Lsndscape Irriqation Systern 45. Sound Attenuation 46. Nandicap Regu�ations A7. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas 51. CERTIPICATE OF OCCUPAf�CY Date JOL & SPA Inspecior qPFROVALS Permi�;$ 52. Pool& Equipment Locauon 53. Steel Reinforcement 54. Forms 55. FleCtrical Bunding 56. Ruugh Ptumbinn & P��ssure Test 57. APPROVAL TO CO\'[ F,�GuNiTF 58. Electncal Condwt Undigrntl. 59. Gas Pipe, Cl Undiqrnd , Test 60. Backwash Lina�, P�Trap, C7 U� d�g� 67. APPROVAL TO L`ECK 62. Backwash&Recep'or�P�n:i 63. Heater & VenbPical � 64. Plumbing System � Finii � �� 65. Electrical�F�nal 66. Snlur System�final � 67. Fer,cing & Aceeas App� uv.ii �. 68. APPROVED FOR PLAS7ERING Date Inspector i'� � r `. �'_. � L i -- ;� -� - ---� j= - �I - �- - - . 69. POOUSPA SYSTEMS FINAL __� _ I '� FIRE DEPT. REQUiREh9F��T ; � � ,APPROVA't5 ?e�nnt ; I , � -'- -_.F-_-_, 70. Und�rgro��c. Hti.::o 71. Pruduc`Plpi�i9:lG,s :-'Oii �• 72. Unde�grOwitl F!,n�i_- - ��,(t .�- - -- ---- � � � 73. UndcrgmJ. Sm•� � � T ,� I: �� G�s - r� �- T - --- --� � ^�� •.,..a� n,c--- -- - -.--- ---� - -- -- - -------�---- -- 75 Dry Cham�cC � � 76. Ury Stonun pe t 77. FIkEDSYS'EP:: FINAL _ _ _ 7B. FIRE PREV. Fi`dAl _ j�-i�� i(�l F:- � NEALTH OEPT. REQL'IFiE� :F11T � 7�. FI'QAl li`:5"EC-i i^•� -- ---�- -- - I - - - -�- - - ----- -- - --- - � �- -- 30. FOOU CFRTi�IC.�TE !SSUED I t � i - - --- - --- ------ ---- Not:s: I-__� __�_�____ .__-_ . _ __ - _ _ -� -- ----- --- � -- -- -- - -- - ---- - - � ✓ ;� . � ! CITY OF COSTA MES STRU I ER� Project Address Applicant's Mailing AQd s Owner'sName � hone_ — Address Arch/Eng. _License No. Address Contractor i Nam � hone Addreu Imailing) City License No. LICENSED CONTRACTOR �ECLARATION 1 hereby atilrm [hal9 aT II<en5etl untle� proNslons Ot Charter 9(comm¢ndn5 with zettion 7000� of Dlvlsion 3 OI the BUSina55 antl Prof¢TSions Cotle, anc my Iicense is in full farce antl eflect. ' ' ;Llcense CIaSs License No. Applicant to fill in all spaca: except those witnin neavy DorCer Iines anC si9n all a00/opriate tleclarations. :-�Jate Si9ndture � WORKERS' COMPENSATION DECLARATION � I h¢reby atfirm Ihat I have a cerHtiwle oi consen[ [o self-inzur! Or a CertHiwt¢ of Workers' Compensatlon Insurance, or a rertifietl copY thereot (Section 3800, Lab. CJ � ' ' - ' ' ' ' ' Policy No. Company � BCertitietl copy i5 hereby (umi5hetl. Certitietl copy is (iletl with tne city Builtling Dlvision. Date Applicant EXEMPTION�FROMWORKERS'COMPENSATI DECIARATIO (Tnis section neetl not ba compbtetl if tho per " (or one huntlre (§3 � or IMS). 1 cer[ify lha[ in the perfor ance oi the wor r whlch IM1is pe rt i ssuetl I shall not e loy any on in any man r 25 t be ome ect [o t�e Workers' p tl ws of Calitorni Date �� 99�aluro NOTICE: It, after making this tloclaratlon, you shoultl become subjett to the Workers' Compensatlon provisions of Ihe Labor COUe, you must forthwith complY �+ilh suth prOviSioni or thii parmit shall De tleemetl revoked. CONSTRUCTION LENDING AGENCV � ' I hereby aftlrm that there is a<onstruclion lentling agency tor the performance Oi th¢ work fOr wMch th.s p<rmit Is ISSuetl (Set[ion 309] Civ. C.) Lentler's Name L � , LRntlC!'S Atltlf¢55 OWNER BUILDER DECLARATIOfi � � ' I hereby af8rm that I am exempt trom [ne Contractor's �icense Law for tha following reason (Settion ]031.5 Businosz and Grotesslonal Cotle: Any city or . sounry wnich reqWres a permit to construcq alter, imvrove, tlemollsh or repair ""�ny st�ucture, p/Ior to Its Issuance, a�so requir¢5 the applitdnt fOr sucb permit �4"io hle a zignetl statement that ne/she Is IICen50tl Oursuant to the provislons of the Contractor's License Law (Chapter 9(commencing wlt� Sectlon 7000) of Division 3' ot the 8uslness antl Professlons Cotle) or that he/she I5 axemp[ therefrom,antl the basls for tho allo9etl exemption. Any violation of Sectlon 7031.5 by any ap0��can[ tor a Dormlt sub�ects thn applicant to a civil alty of no[ moro than fiva nuntlrotl tlollars (5500). - I, as owner of tM1e p�o0e�ty or my ¢mployees wllh wage5 ds lhflr Sole ompensatlon, will Oo tne work, antl th0 zl�ucture IS not intentletl o� oHGr<tl for salc (Saction 7044, Businoss antl Professional Cotle: Tho Contractor's Llcense Law tloes not applY to an owner o( a property who builtls or Improves thereon, antl whn aoes sucn work himsolf/ncrsall o. through nis or nor own emplOy¢e5, prOvitletl tllat such ImprOveT¢nts a!e no[ intentl¢tl oI offefetl tor sale. If, �owever, tha bulltlin9 cr improvement is soltl within one year of com- pletion, tna own¢r will have the burtlen Ot prOving he/she Oitl not builtl or im- �rove for Ihqpurpose ol sale�. I, a5 own¢r Of lhe p�o0e�ty, am nxtluSively contracting with licensetl Co�- trattors to consV uct tha o�oject (Section 7044, eusiness ana Rofessiont Cotle: The Contrattor's Llcense Law doe5 nOl dpply lo an owner of pr0 Y who builas or improves tnereon, ana wno conVac tor suc� proj¢ct It a can- tracto��sl Ilcense purouant to the Contrac License Law). i m a ar¢ that proof o( their Worker's CompanSatlOn s anca ShOultl � roN tl t0 Te. ❑ I am e/cemptxntlqr Secji6� B. L P C. ( this reason Date above Drivers' LiCense or 55 $ TYPE OF CONSTRUCTION LI NEW IrJ ADD I.J ALTERATION LJ REPAI R ❑ CONVE(3510N ❑ DEMOLISH ❑ OTHER q,p,.�6 Q�$�,FjIp110NQF WORK/�SE pF BL➢G/ � � ir�EE �</ LL. .5 S Main Buildin9: TVPE OF PERMIT GRADtNG FOUNDATION STRVCTURAL T FrOnt ❑ TENANT ❑ ELECTRICAI ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER ' A PRWECTDESCRIPTION 5[Z.Fr. oCCUaAwCv C Right K Left CONSTRUCTIONTYPE VALUATION$_� $ ZONE GRADING CU. VDS. ACRES p�ng. Ref. qW qemark:: L�CQ[ /� F' � Planning Notes: tr�igation iking Fountains �r Orains >r Sinks $CfVIC2 �LILICLS Kitchen Sink Lavatories P—Trap RODf Orains Rainspection Fee � � $15 Boiler Ducl � Under Ground Duct - Structural Duct - Ventilating � Exhaust System ❑ Multiple Firepl/Fact Blt. ICBO # Heating System & Ducting ❑0.100,000 BTU 0100,000 Reinspection Fee � $15 CMF 0865-46, rev. 4/84 White - Builtling; Canary - APDliwnt; Pink - Accountin9: GolOenrotl - Assessor Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal , Water poset Wacer Heater Water Service Issue Fee Hood or Typel ❑ Canopy Type I I � Refrigeration System 00.100,OOOBTU ❑100,000 System Repair/Alteration Iswe Fee - Auromatic Washer - Construction Pole Sub. Cooking Unit ' �ISfIWd5f12f Dryers ❑Gas ❑Elec Fan F,A.U. Fixtures , � Device Boxes Outlets Switches � Garba9e Dispoul Generator �0�5 KW [ $ 3 ES $ 3 m 1723 6/06/84 2one Accessory Building: Parking Req.�Provided . ELECTRICAL Transformer ❑ 15�50 KW. _ . O SO+KW Meter ❑up to 100 amps Meter ❑over100amps Sub Panel � Motors �P7 HP O1 K- 8 Inc. Solar �9�15 HP 016-15+ Microwave Pole Li9ht • Range � I � Standing Sections 15 KW Trash Compactor � Reinspection Fee I DEVELOPMENT SERVICES R Zoning Approved By Buildinq Approved By _ Aaoliwtion luuad Bv $15 � � �szue Fea 39.a2 Tl FEES $ 3 Z O N I N G R E � M T S. Z �U M RY OF FEES BUILDING PERMIT �$ � SMIP $ �"� PLANCHECK 5 �.��L PERMIT PLUMBING 5 ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING 5 PLAN CHECK 50% S MICROFILM $� MECHANICAL S TOTALFEE $ �— PLANCHECK 25% $ ' - ,y�, 7L � ( CONSTRUCTION AND PLANNING . JOL & SPA - APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe�Undrgrnd. 53. Steel Reinforcement 3. Electrica( Conduit Utility-Undrgrnd. � � 54. forms . � ' 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. ftough Plumbing & Pressure Test � 6� �lectrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings � . 58. 2lectrical Conduit-Undrgrnd. '8. Foundation� �� - ' 59. Gas Pipe, O Undrgmd., Test ' .9� Water Pipe-Undrgrnd. - 60�. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK i i. Property Sewer Line & House Connection 62. Backwash & Receptor-Final ' 1'2. 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 i'16. Rough Electric Wiring ' 67. Fencing & Access Approval � 17. Rough�Wiring Sign: 68. APPROVED FOR PLASTERING 18. Rough Elearical�T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL 19. Rough I{eating & Air Conditioning FIRE DEPT. REQUIREMENT 20, Rough Factory Fireplace � � APPROVALS Permit # 21. Ducts,jn StruMure . �70. Underground Hydro ' 22. Ducts, Ventilating � 77. Product Piping O Gas ❑ Oil �23. Gas Pipe-Rough & Test � 72. Underground Flush 24. Roof Framing � 73. Undergr�d. Storage Tank O Gas O Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � ' 27. Frameand Flashing 76. DryStandpipe. � Z8. Lathing & Siding � 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. prywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat� 79. FINAL INSPECTION � 32. �lectrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric 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 pomestic-Final � 42. Backflow Preventer � � � 43. Backflow Irrigation � � 44. •Landscape Irrigation System � 45. Sound Attenuation . • 46. Handicap Regulations � ' � 47. FINAL STRUCTURE:& BUILDING � �' S^ ��✓ , 48. Special Requirements�Completed � 49. Electric Release to Edison - . . . 50. Gas Release to Southern California Gas Co ' . 51. CERTIFICATE.OF. OCCUPANCY " . - � No. Date y '