HomeMy WebLinkAbout2543 BACK BAY LOOP - Building Permits PROJECT ADDRESS: 2543 BACK BAY LOOP • UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M 052926
,,OWNER'S gAME: CRAWFORD, ROBERT - '
ADDRESS: 2543 BACBAY LOOP PERMIT NO: M 052926 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA
•
CONSTRUCTION TYPE: PERMIT TYPE: MEC PURPOSE: OTH
548-5639
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : HEATING & REFRIGERATION SYSTEM SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-1 /
PERMITTEE: IRVINEWEST HTG & AIR ( 714 ) 979-1337
ADDRESS: 638 SOUTHERN AVENUE COMMENTS: MAIL—IN PERMIT
ORANGE CA 92665 *>FSE*******>E*DE*RE*********N********+E*+a>ESE+Ex*SF*k **-****+E**>F >F**xRFSE>E**kF**>E*********>f*
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
CITYuc.: 018139 STATE LIG.:46860 cuss: C-20)
Date: 7 —13 — 9 / signature:_ _ MAIN BUILDING ACCESSORY BUILDING
WORKERS'COMPENSATION DECLARATION: I hereby allirm that I have a cenificate of consent to sett-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
POLICYNO.: WCP12760-1 EXP.DATE: 07/01 /92
1 cOMPANY: CITATION IIS, PARKING REQ: PROV: PARCEL: 93765059 ZNE: REF NO:
' 1 Certified copy is hereby furnished. Certified copy is filed with the city Building Division. PLANNING NOTES>
Dale: 7 — 2-3 — ` / Applicant: IE✓ A:eD ne
* >
E *
F********************iE1 ***********i **** ei ************* t*********
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is fpr one hundred(5100)or less(. DEVEL OPM EN T S E R_.`>2V ICES REQUIREMENTS
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 o the Workers Compensation Laws of California. ZONING APPROVED BY _ DATE:
Date: N / Signature:
NOTICE:It.alter 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 BY: / .. ®: a DATE: q" 'C
--�
which this permit is issued(Section 3097.Civ.C). ********$**X***.******* *.***.***.***.* 7{.********{(.
LENDER: . ******************************************* **If******************************
a00REss: LEGALIZATION:N F E E S U M M ' R Y STRUCTURAL SEGMENT:N
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 9 . 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 S- 2 5% 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 live hundred dollars($500). ISSUE FEE 't" 15. 00
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DI V—> PERMIT ISSUE P,LAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 9 . 00 15 . 00 - 0 . 00 24 . 00 24 . 00 . 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 o1 proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 24 . 00 OVER/SHORT: . 0 0
fnrthe purposeof sale). BLDG 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 ,1 24 . 00
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon q
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware *******************************************************************************
that proof of their Worker's Compensation insurance should be provided to INDIVIDUA •
U A .L F E E BREAKDOWN
o I am exempt under Section: B.&P.C.
for this reason: , TYPE QTY DESCRIPTION UNIT COST TOTAL COST
Date: N 41owner MEC 1 INST FORC—AIR/GRAV•
TURN <= 100 K BTU 9 .00 9 . 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 a•)
(hese provisions.
Dale: '7 23 — �i ! Applicant: 7-Si- l ^A + n •
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 a '
ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned
property for inspection purposes. � 0 n ,
ZA
Date: 7— 23 —9./ Signature:tin.--4-e../La—
/,..�'U.,..+— 3 ." ,
Driver's License or Social Security.: (- t. r i ^0396,42-0`2`i6,62 F:'T _ .C.;)
OATS: 09/07/9 . TAI'S. ..=_f
1641-46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor
9 CONSTRUCTION AND PLANNING • POO SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. • 53. Steel-Reinforcement -
3: Electrical Conduit Utility-Undrgrnd:., 54. Forms
4. Electrical Conduit,Undrgrnd. 55. Electrical Bonding
" 5. Steel Reinforcemment 56. Rough Plumbing & Pressure Test
a 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
.7. Footings • t 58. Electrical Conduit-Undrgrnd.
6, Foundation .. ' -- 59..Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap - 63. Heater & Vent-Final '
13. Roof Drains t 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit - 66. Solar System-Final •
16. Rough Electric Wiring - 67. Fencing & Access Approval
17. Rough Wiring Sign • 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20.-.Rough Factory Fireplace - 'i. - ' APPROVALS: Permit #
21. Ducts,in Structure . ; _ . .70. Underground'Hydro
• r, .
22. Ducts, Ventilsating - - • - - ' -71- Product Piping 0 Gas 0 Oil
-
23. Gas PipetRough& Test . 72. Underground Flush
24.>RoofFraming '•73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Slt,e.athing 74,- Overhead Hydro-
26�T-Bar Ceiling (Struotural) & Monocoat • - .. t. 75. Dry Chemical • '
27:'Frame and Flashing' 76. Dry Standpipe
28. Lathing& Siding; : . - - - G • • 77.- FIXED SYSTEMINAL F '
29. Insulation ,• • -. - 78, FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat. ( i �, r79. FINAL INSPECTI9N
32. Electrical Power Meter-Final, _ • •�,. - 80.-FOOD CERTIFICATE ISSUED
. 33. Final Electric - I \ ' Notes:10(-9'I /To OhC acme-
-34, Final Heating & Air-Conditioning f /ef I /r.) . '. ,
o . G/ �KiY
35. Final Gas Pipe-Test' •
(l ;
•36- Hood or.Canopy . r ; - i -
37.-Final Factory Fireplace.. .."--4.C.:
-38. Final Plumbing - I _` ' t ,
• r
39. Water Service-Final . - ' - - -J - . ,
40. Gas Service-Final ,r , , • _ r
41. Solar Domestic-Final -- • •
•
42. Backflow Preventer, • i, • _ . -
43. Backflow Irrigation -
•
, `44. Landscape Irrigation System , } • 1 ,
=45. Sound Attenuation a - .
46. Handicap Regulations -
47. FINAL STRUCTURE & BULLDING
48: FINAL PLANNING •: - - - •
•
. 49. Electric Release to EdisonL - • > • r
I r .
50- Gas-Release to Southern California Gas Co I/ ,
.51. CERTIFICATE OF.OCCUPANCY
No. Date •
-
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
-- PERMIT NO. TRACT NO. LOT NO. UNIT NO. ••� 1 �, ` I Zona
Cyst OF COSTA MESA CONSTRUCTION PERMITA.P.# ] 1
P 2sy'J D a�t.6ay �,,. Cosmo w�e�sA• 316,5-_3 12-21`f
yeject Address //��P M" S Main Building: Accessory Building:
//,}�plicant's Mailing Address i.1rt,51I kf tw Flo U twoi't C RO'V TYPE OF CONSTRUCTION H NEW ADD U ALTERATION UCR/EPPAIR E Front �O +� Z
/O oar's Name mr�w'a`^�l a"A• Phone', ..,0 ., ,0 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ,/�XJ.ST / Cie, T f cc a �, O
7 U- DE'?IPTION OF WORK/ SE OF BLDG. add/ <«• $ ce I A Rear IA/ N
Address se�/s/F•2 Ydoe et•7'l-i D for / N
e TYPE OFPERMIT /�.J GRADING FOUNDATION (..� STRUCTURAL I C Right
Arch/Eng. License No. }"� K G
Address cc /� ❑ TENANT ❑ ELECTRICAL 0 PLUMBING 0 MECHANICAL S Left S/ R
e`Se'Osh PON - Phone 59- )Xl. U OTHER Ping. Ref.# Parking Req./Provided E
Contractor's Nam
Address lmailin 1 �+ AJ 41-Nos PROJECT DESCRIPTION SQ. FT. OCCUPANCY 7 O
g .�55_� (.lo 0a.#ales c .o..-L Planning Notes: I I ) d 4-� Cov M
4R33910 CONSTRUCTION TYPE
.r A./ VALUATION$ .0 CS • r Q T
City License No. ZONE GRADING CU.YDS. ACRES _ S.
LICENSED CONTRACTORlicensed DECLARATION ? �s A �/ �
I affirm that I am sion3 under provisions of Charter 9 (commencing Remarks: 3040 �( rPs C U/ IItAin,f,e
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full rce and effect. U '1 Q U �/I ELECTRICAL FEES
Licens Class License `5641&� ) /f fr5- Ca C- -/�/ �� /2/O
} t PLUMBING I FEES Automatic Washer Transformer 0 15-50 KW
Date Y'• 9 Signature -tet
WORK 5'COMPENSATION DEC • RATIONConstruction Pole Sub. • 0 50+KW
•eby affirm that I have a certificate of consent to salt-insure or a certificate Bar Sink Showers .
/orkers' Compensation Insurance, or a certified copy thereof (SectionBackflow Preventer Service Sink Cooking Unit Meter Duo to 100 amps
__ Lab. CJ Dishwasher Meter Dover 100 amps
Policy No. Company Backflow Irrigation Sewer Cap
9Certified copy is hereby furnished. Dryers ❑Gas ❑Electric Sub Panel TJ
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection
Date ApplicantFan Motors 00-1 HP OVA-8
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors . -
(This section need not be completed if the permit is for one hundred ($100) or). Dishwasher Solar Piping F.A.U. Inc.Solar❑9.15 HP ❑16.15+
I certify that In the performance of the work for which this permit is issued I Fixtures Microwave
shall not employ any person in any manner so as to becopf) subject to the Drinking Fountains Solar Tank
Workers CotenLon Laws of Californi`.0 V/ Device Boxes
Date Uwe- I "Y Signature J-e'0"-- 10`s'� Pole Light -
Floor Drains Swimming Pool w/Spa
NOTIC'dVllf,after making this declaration, you should become subject to the Outlets Range
Workers Compensation Provisions of the Labor Code, you must forthwith Floor Sinks Urinal
comply with such provisions or this permit shall be deemed revoked. Switches
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet - Sign
I hereby affirm that there is a construction lending agency for the performance Garbage Disposal
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater 9Standing Sections
Lender's Name Generator 00.5 KW 05-15 KW Trash Compactor
Lender's Address Kitchen Sink Water Service _
OWNER BUILDER DECLARATION
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 or
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays
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 Roof Drains -
toe Contractor's License Law(Chapter 9(commencing with Section 7000)of -
,. jsion 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee $15 Issue Fee $ 3
',..'f'''1-4.'--'efrom and the basis for the alleged exemption. Any Violation of Section •
"5i:Ji15 by any applicant for a permit subjects the applicant to a civil
&enalty of not more than five hundred dollars($500). 3 DEVELOPMENT SERVICES REQUIREMENT I-Ll I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ Zoning Approved By � 'Date
compensation, will do the work,and the structure is not Intended or offered
for sale (Section 7044. Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By a : -t. Date g
License Law does not apply to an owner of a property who builds or Improves - �'1•���/i
thereon, and who does such work himself/herself or through his or her own • Hood or TypeApplication Issued By .r►�-�. ��' vi._�- Dat
employees, provided that such improvements are not intended or offered for Boiler I 0
sale. If, however, the building or Improvement Is sold within one year of com- Canopy Type II 0 SUMMARY OF FE 1 •
pletion, the owner will hove the burden of proving he/she did not build or Im- Duct-Under Ground
prove for the purpose of sale). BUI LDING PERMIT $ 37.CO SMIP $•
• in)
0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK $ i4.O•- PERMIT
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00100,000 BTU 0100,000 BTU ' PLUMBING $ ISSUANCE $
builds or improves thereon.and who contracts for such oroiects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $
proof of their Worker's Compensation insurance should be provided to me. $ GRADING $
❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBO# Fire Dampers PLAN ELECTRICALCAK 50% $ MICROFILM $
•
Date Owner Heating System& Ducting Registers
MECHANICAL $ TOTAL FEE $ i 's3-
I hereby certify that I have read this application and state that the above 00100,000 BTU 0100,000 BTL PLAN CHECK 25% $
Inform [ion is correct. I agree to comply with all city and county ordinances
and ate laws relating to building construction,and hereby authorize repre-
se atives of this city to enter •on the above-mentioned property for
, spection purpo - ��n�n� ,,r��••7777/ ��������P{�9q�q
. Signature -ter �� Datd.Lt ' . (7 / Reinspection Fee $15 Issue Fee $ 3 01 00039792-00039794 TOT :1.55
Drivers' License or SS# v� DATE: 08/07/89 TIME: 13:34
1 0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
/ coxsTt eeTION AND PLANNING POO SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole'- , 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. t s 53. Steel Reinforcement
3. Electrical Conduiell ility-Undrgrnd. ,' 54. Forms y'
4, Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5.:Steel Reinforcement •`;. 56. Rough Plumbing & Pressure Test 4
6.`2F-IeciricalUFER'GrndO 57. APPROVAL TO COVER-GUNITE
l 4
7.:F6otings i 1N z.74/., 58. Electrical Conduit-Undrgrnd. , I
8. Foundation / 59. Gas Pipe, 0 Undrgrnd.,Test •
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap,0 Undrgrnd.
10.-Structural Floor System '" 61. APPROVAL TO DECK
11. ,Property Sewer Line,& House Connection 62. Backwash & Receptor-Final
71
12: Sewer.Cap �.: l; �, 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
1'61 Rough Electric Wiring 67. Fencing & Access Approval •
'17:; Rough Wiring Sign " 68. APPROVED FOR PLASTERING
1a: Rough Electrical-T Bar Ceiling n't69. POOL/SPA SYSTEMS FINAL .
19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
2r" i r0! Rough Factory Fireplace ; APPROVALS Permit#
21. Ducts, in:Structure r
70. Underground Hydro
22: Ducts, Ventilating FA 71. Product Piping 0 Gas 0 Oil
23.: Gas Pipe-Rough & Test .l- ' 72. Underground Flush
24L Roof Framing - 73. Undergrnd.Storage Tank 0 Gas 0 Oil
•
25. Roof Sheathing.; , •_ :. -- • - 74. Overhead Hydro
•
• 26. T-BarCeiling (Structural)& Monocoat - 75. Dry Chemical
27. Frame and Flashing i• - 76. Dry Standpipe
28. Lathing &'Siding 77. FIXED SYSTEM FINAL
29. Insulation ' �. ' 78. FIRE PREY. FINAL
30. Drywall Nailing m HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat.„ 79. FINAL INSPECTION
32. Electrical Power Meter-Finall' 80. FOOD CERTIFICATE ISSUED
33. Final'Electric Notes:OXOrci-in NOT !23-P)
34. Final Heating,& Air Conditioning
35. Final Gas Pipe-Test
73¢. Hood or Canopy
'37. Final Factory.,
38. Final Pluinbing ,'
39. Water Service-Final. -
n i�
'40. Gas Service-Final C t 1�
41. Solar Domestic-Final . f ,
i
42. Backflow Preventer - 7 . L:
43. Backflow Irrigation 2, ' / t
44. Landscape Irrigation System
'/t
45. Sound Attenuation: . ,4,se.,:./
46. Handicap Regulations /
47. FINAL STRUCTURE & BUILDING p4.1¢9 ��S,tol2-L Der cid jcir
48. Special Requirements Completed / i
.,49. Electric Release to Edison •y'• 1: �•I
50. Gas/Release to Southern California Gas Co • ' ✓�'
i „ •
151. CERTIFICATE OF OCCUPANCY a •t ! _ t`:
No. - Date ....../1" r)
t
'NIApplicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
•
CITY OF COSTA MESA,/ COrlet-F JCT1ON PERMIT PERMIT NO. I TRACT NO. LOT NO. UNIf.(uJO. - �Z� • 0880 '4/09/85 • ' 8p00 IL
- Project Address �,? 3 fK' � �j g.��y, ,Y/sl/�1 (T7) (J
'Applicant's Mailing�Ad^dr-ess `t s�0 I r U��, TYPE OF CONSTRUCTION ' M NEW U ADD Li ALTERATION ❑ REPAIR . -
!, l� g /� j 75'24
/ / CI CONVERSION fill DEMOLISH El OTHER
Ay.#' Zone
Owner's Name v s-sr' 0' •h• e 2 b/0
r7 �I •
DESCRIPTION OF WORK/USE OF BLDG.
'Address 1 ! 7- S r Cos...---f- L - , �} 2.0 2. • S Main Building: Accessory Building:
E Z
Arch/Eng. License No. TYPE OF PERMIT U GRADING U FOUNDATIOI`{x ❑ STRUCTURAL T Front - O '
Address ❑ TENANT ❑ ELECTRICAL L44-5
❑ PLUMBING '-bl MECHANICAL B Rear N
(,,7y Ill .CI y(, •�1s A I
Contractor's Name -` Phone Z- M C Right N
) PROJECT DESCRIPTION SQ. FT. OCCUPANCY
Address(mailing) .! t . 4 e-• f(yr. , 'LO-O. K- K G
CONSTRUCTION TYPE VALUATION$ S Left
City License No. Q /81 (9 ZONE GRADING CU.YDS. ACRES R
LICENSED CONTRACTOR DECLARATION - r Ping. Ref.# Parking Req./Provided E
I hereby.affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: • M
with section 7000) of Division 3 of the Business and Professions Code, and . T
•
my license is in full orc@@and effect, 2 `g-l(y/ _ S
License{�ass G� SLic n - '
Date .3 14 "- F signature � Q �`-- PLUMBING - FEES • ,
WORKERS' COMPENSATION DECLARATION Bar Sink ' Showers
'hereby affirm that I have a certificate of consent to self-Insure or a certificate ELECTRICAL FEES
I Workers' Compensation Insurance, or a certified copy thereof (Section Backflow-Preventer - Service Sink .
4800, Lab. C.) - - - , - . Automatic Washer Transformer 0 15-50 KW
-
Policy No. Company Backflow Irrigation Sewer Ca 0 50+ KW
8 Certified copy is hereby furnished. p 2. Construction Pole Sub.
Certified copy is flied with the city Building Division. Bathtubs Sewer Connection - Cooking Unit Meter ❑up to 100 amps
Date Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher- _ Meter Dover 100 amps - -
section need not be completed if the permit is for one hundred ($100),or • -
less). Dishwasher . Solar Piping '? Dryers ❑Gas ❑Electric Sub Panel
I Certify that in the performance of the work for which thispermit is Issued I '
shall not employ any person in any manner so as to become subject to the Drinking Fountains 1 ' Solar TankFan Motors 00-1 HP 01%-8
Workers' Compensation Laws of California- -
Date • Signature - Floor Drains, Swimming Pool w/Spa F.A.U.
'NOTICE: If,after making this declaration, you should become subject to the _ Inc.Solar ❑9-15 HP ❑16-15+ •
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks -Urinal - - - Fi%Lures -.
comply with such provisions or this permit shall; be deemed revoked. Microwave
CONSTRUCTION LENDING AG4NCY, Gas Service 'Outlets Water Closet
I hereby affirm that there is a construction lending agency for the performance ' Device Boxes Pole Light ,
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors ' Water Heater e Outlets Ran
Lender's Name - 9 •
Lender's Address - - Kitchen Sink' - . Water Service
OWNER BUILDER DECLARATION Switches Sign
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Disposal Garbage
following reason (Section 7031.5 Business and Professional Code: Any city or - 9 ;Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator ❑0.5 KW❑5-15 KW Trash Compactor
any structure, prior to its issuance, also requires the applicant for such permit _ Pa
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9(commencing with Section 7000) of - -
Division 3 of the Business and Professions Code) or that he/she is exempt - -
herefrom and the basis for the alleged exemption. Any violation of Section -
031.5 by any.applicant for a permit subjects the applicant to a civil - '
ee natty of not more than five hundred dollars($500), - •
U I, as owner of the property or my.employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3
compensation, will do the work, and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional.Code: The Contractor's MECHANICAL „ I FEES
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 - - DEVELOPMENT SERVICES REQUIREMENTS:
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 II 0 Zoning Approved By - Date
pletlon, the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground . - '
prove for the purpose of sale). Building Approved By Date
0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System • Application Issued ByDate y'
tractors to construct lhe'proiect (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU
builds or improves thereon,and who contracts for such projects with a con- - - SU ARV OF FEES
tractor(s) license pursuarit'to'the contractors License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. - PLAN CHECK .$ PERMIT
0 I am exempt under Section B.& P.C.tar this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ PERMIT
ISSUANCE $ •
Date Owner _ - Heating System& Ducting Registers - PLAN CHECK 25% $ ENERGY P.C. '$
I hereby certify that I have read this application-and state that the above I` QQ-100,000 BTU ❑100,000BTL ' - - - - O ELECTRICAL '$ GRADING' $
. -
information is correct. I agree to comply with all city and county ordinances d
and state laws relating to building construction, and hereby authorize repre-
sentatives of this city to enter n the above-mentioned property for p, !,
inspection purpos 3S1-‘-ear - MECHANICAL $ -0o TOTAL FEE $ C/-ov
Signature ) QA^. • Date < N
Drivers' License or SS# Reinspection Fee $15 Issue Fee $ 3 ' PLAN CHECK 25% $ .co
•
CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING POG- a SPA
- • APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
-2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3./Elecffical Conduit,Utility-Undrgrnd. 54. Forms
4`'Electrical Conduit-Undrgrnd. -' _ 55. Electrical Bonding
5.-.Steel Reinforcement"r, 56• . Rough Plumbing & Pressure Test
6.:Electfi6l UFER-;Grnd. 57. APPROVAL TO COVER-GUNITE -
7. Footing? 58. Electrical Conduit-Undrgrnd.
8. Foundation ' 59. Gas Pipe, 0 Undrgrnd.,Test
9%Water'Pipe-Undrgrnd 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line.& House Connection 62. Backwash & Receptor-Final
12r Sewei'Cap „i 63. Heater & Vent-Final
13. RooeDrains - 64. Plumbing System - Final
14. Rough Plumbing '_ 65. Electrical-Final i
15. Rough Electrical-Conduit 66. Solar System-Final -- _
16. Rough Electric Wiring 67. Fencing& Access Approval
• 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T yar 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-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78, FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION y^
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
J
34. Final Heating & Air Conditioning
35:'Final Gas Pipe-Test
Mar
36:,Hood or Canopy
37TFinal Factory Fireplace •
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final .
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
•50. Gas Release to Southern California Gas Co 1
• 51. CERTIFICATE OF OCCUPANCY
Nr, Date •