HomeMy WebLinkAbout1984 CHURCH ST - Building Permits Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.
• CITY OF COSTA MESA ‘ PERMIT NO. TRACT NO. LOT NO. BLDG.NO. 4892 2/2J/B4 • 72. 2 TL
CONS1UCTIIOyN PERMIT/ _ 6 -'//S ..O O • a
Project Address'-.2a--1---e ---1(C-6------
/ 1 ✓ � �i. TYPE OF CONSTRUCTIO NEW LJ DD ALTERATION L'I REPAIR
Applicant's Mail//110B))g Addr• . El CONVERSION DEMO OTHER 7� A.P.9P Zone
Owner's Name 41/2e-1 is0•e _ 7 v '•one/L/ 31 DESCRIPTION OF WORK L uSr.44:- 1�O L ��'L $ Main Building: • Accessory Building: Z
Address I'7,7e/ 79e 4/ 01 /4,4 I ."7 �J !en L/ C�11.tI'.1,9777 0.1. 'O
TYPE OF PERMIT LI GRADING Li FOUNDATION ❑ STRUCTURAL ,T Front N
Arch/Eng. " I - License No. , 0 TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ' ' I
Address ❑ OTHER
•• C Right - . G
Contractor's Name: J Phone PROJECT DESCRIPTION. SQ. FT. OCCUPANCY K R
1y'/ CON ST.RUCTION TYPE VALUATION S /ne2o V- $ Left • E
Address(mailing) ( - .
ZONE GRADING CU.YDS. • ACRESPing. Ref.# Park.Fees $ Q
City License No. U
LICENSED CONTRACTOR DECLARATIONRemarks: ^p — / Parking Req./Provided 1
I hereby affirm that I am licensed under provisions of Charter 9(commencing R
with section 7000) of Division 3 of the Business and Professions Code, and • Use of Building: E
my license is In full force and effect. Planning Notes: M
License Class License No. PLUMBING FEES E
'•,e Signature - N
RKERS'COMPENSATION DECLAR Bar Sink Shower , Z00
zreby affirm that I have a cerci(: at consent to self-Insure or a certificate - -- - , -• S
of Workers' Compensation Insur e, or a certified copy thereof (Section Backflow Preventer Service Sink _ . S
3800, Lab. C.) Backflow Irrigation / Sewer Cap -
S� ELECTRICAL FEES
Policy No. • Company - --Certified copy is hereby furnished. Bathtubs . Sewer Connection —
Automatic Washer Transformer ❑ 15.50 KW
Certified copy is filed with the city Building Division. - y ❑ 50+KW
Date Applicant Clarifiers • Solar Collectors • Construction Pole Sub.
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION - n - '
Dishwasher Solar Piping ..Cooking Unit / Meter ❑u to 100 apps
(This section need not be completed If the permit Is for one hundred ($100)or i' ' 9 P f? .e0
less). DrinkingFountains ' ' d
I certify that In the performance of the work for which this permit Is issued, I Solar Tank - Dishwasher -. Meter Cover 100 amps
shall not) ploy any person in any ma�n¢r/so as to becom subject to te _
Date Workers'•C (1Gn;B4fao Laws of Canfornla l.r- �l ��/j p.�)f Floor Drains Swimming Pool w/Spa Dryers ❑Gas ❑Electric Sub Panel
Data / fifJll�"(l KKYY-- Signature •4�-�"t #.P "—N-.f/ —
NOTICE:I oaf a making this declaration, you should become su act to the Floor Sinks Urinal - FanMotors 00.i HP 01%-8
Workers' Compensation provisions of the Labor Code, you must forthwith -
comply with such provisions or this permit shall be deemed revoked. l Gas Service Outlets Water Closet 2 00 F.A.U. Inc.Solar 09-15 HP 016-15+
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a construction lending agency for the performance Interceptors / Water Heater .. Co Fixtures •Microwave '
of the work for which this permit is Issued (Section 3097 Civ. C.) _
Lender's Name / Kitchen Sink . / Water Service 21/ aX) S Device Boxes Pole Light
Lender's Address
OWNER BUILDER DECLARATION Lavatories z co s Outlets Range
I hereby affirm that I am exempt from the Contractor's License Law for the p—Tra
following reason (Section 7031.5 Business and Professional Code: Any city or p 3 Switches Sign
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 Roof Drains • Garbage Disposal Standing Sections
i! file a signed statement that he/she Is licensed pursuant to the provisions of
.".,.:.,-. Contractor's License Law(Chapter 9(commencing with Section 7000)of
"-" tsion 3 of the Business and Professions Code) or that he/she is exempt Generator 0(1-5 KW 05-15 KW Trash Compactor
'& refrom 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 Reinspection
enalty of not more than five hundred dollars($500). $25 Issue Fee $ 3
enspon Fee I, as owner of the property or my employees with wages as their sole _ MECHANICAL - - — - - Reinspection Fee $25 Issue Fee $ 3
compensation will do the work,and the structure is not intended or offered FEES
for sale (Sec/ion 7044, Business and Professional Code: The Contractor's - - - - - -- -- --- -- - - PUBLIC SERVICES REQUIREMENTS:
License Law does not apply to an owner of a property who builds or improves Boiler Hood or Type I ❑
thereon, and who does such work himself/herself or through his or her own Zoning Approved By Date
employees, provided that such•improvements are not intended or offered for Canopy Type 11 0
sale. If, however,the building or Improvement Is sold within ono year of com- Duct-Under Ground Building Approved By
elation,the owner will have the burden of proving he/she did not build or Im- — DatO y�
eLove for the purpose of sale). _Duct-Structural • Refrigeration System Application Issued By AO//'/ ' DateO '47 8'
U I, as owner of the property,am exclusively contracting with licensed con• ❑0.100,000 BTU ❑100,000 BTU
tractors to construct the project (Section 7044,Business and Professions Code: Duct-Ventilating SUMMARY OF FEES y
The Contractor's License Law does not apply to an owner of property who BUILDING PERMIT $ /7 Sa $MIP $ .A O
builds or Improves thereon,and who contracts for such projects with a con- Exhaust System 0 Multiple 0 System Repair/Alteration
tractor(s) license pursuant to the Contractor's License Law). PLAN CHECK $ 7it 33 7 PERMIT
❑ I am exempt under Section - B.& P.C.for this reason Firepl/Pett.Bit. (CBO=♦h ( '�/�-(�L �,P I)0-C-2 V 90 PLUMBING 1/-:BSS$ ISSUANCE $
Date o1 e4L Owner //•-✓✓/) .�frV —" Heating System&Ducting . • - T --OS rlJ ENERGY P.C. $
PLAN CHECK 25% $
I hereby' certify hat I have read this application and state•that th above '00.100,000 BTU 0100,000 BT - ELECTRICAL $ ¢S r00 GRADING 'S '
Information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction,and hereby authorize repre- -
sentatives of this ity to enter upon th- above-mentioned •r•perty for PLAN CHECK 50% $ ]v S!) MICROFILM $
Inspection pg•`�v, • MECHANICAL - $ r 00 TOTAL FEE $ 77637
Signature I. • /
CMF 0865-46 rev.12/83 •` Ito- suilding: .nary-Applicant;Pink•Accounting:Goldenrod -Assessor •
i:CONSTRUCTION.AND PLANNING • PO •.SPA - _ - _ .
Date Inspector - Date Inspector .
APPROVALS Permit# APPROVALS Permit#
t1.
, Temporary Electrical Service or Pole 52. Pool & Equipment Location _ '
•2: Soil Pipe-Undrgrnd. - • , 53. Steel Reinforcement'• -
. : Electrical Conduit Utility-Undrgrnd. ,r 54. Forms . - • - r
, 4. Electrical Conduit-Undrgrnd: 55. Electrical Bonding _
5: Steel Reinforcement 56. Rough Plumbing & Pressure Test
6: Electrical UFER Grnd 4 - 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 .
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final -
12. Sewer Cap 63. Heater & Vent-Final
_ a
13. Roof Drains 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 1,' - APPROVALS Permit# `
;21. Ducts, in Structure 70. Underground Hydro
F
.122. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23.4Gas 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 - l '
27. Frame and Flashing 76. Dry Standpipe ,
28. Lathing & Siding - 77. FIXED SYSTEM FINAL - '
29. Insulation _ 78. FIRE PREY. FINAL
30. Drywall Nailing . 4 HEALTH DEPT. REQUIREMENT •• .
31. Plaster Brown Coat 79. FINAL INSPECTION • '
32. Electrical Power Meter-Final , ; 80.'FOOD CERTIFICATE ISSUED
33. Final Electric �3)Tq Bnsj Notes:
34. Final Heating & Air Conditioning t•/3/$y 7
35. Final Gas Pipe-Test tea' ! A • - • .
.
36. Hood or Canopy t -
37. Final Factory Fireplace •
38. Final Plumbing - AliceR 241
39. Water Service-Final �V %
40. Gas Service-Final ' t•r-
41. Solar Domestic-Final - -
42. Backflow Preventer
43. Backflow Irrigation •
44. .Landscape Irrigation System .
45. Sound Attenuation •
46. Handicap Regulations : -
47. FINAL STRUCTURE & BUILDING .d(4/t /V 74 •
48. Special Requirements Completed -," % - •
49. Electric Release to Edison - , - . . - ' ' I ,
I I -
50. Gas Release to Southern California Gas Co I
51. CERTIFICATE OF OCCUPANCY - - t
No. - Date - - .- -
AWNESSWBummD: 1984 CHURCH ST UMi: CITY OF COSTA MESA - BUILDING PERMIT
ONNEWSNMIEIPKNOAN: PRIMMER ROBERT H PERM NO: B 079487
ADDRESS: 316 MARIGOLD AV
PERMIT NO: B 079487 PLAN CHECK NO: N GOVT: N SUPP : N
CORONA DEL MAR, CA 92625
APDL.MMUNG ADDRESS: CONSTRUCTION TYPE: V-N PERMIT TYPE: STR PURPOSE: REP
ARCHITECT ORDaIEER: UC NO: JOB DESCRIPTION : REPAIR GARAGE WALL EAST SIDE SQ FT: 300
ARCM OR EM'S ADDRESS: WIT:
CLAIM VALUE: 300 . 00 CALC-VALUE: 300 . 00 GROUP OCC : R-3 /U-1
CONTRACTORS NAME:
caNwACTDRSIMMO COMMENTS: REPAIRS TO GARAGE AND ELECTRIC SERVICE UPGRADE
ADDRESS Lit w: **********+EST-******Sex"** ** -**** xx************Mitt******MM SE****xxx*SES(*SE*****Sr****
WMT: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby a Era under penally of perjury that I em lisensed under provfsb s ol Chapter 9 SETBACKS
(commencing with Section 7000)of Division 3 d the Busier and Professions Code,and my Sense is in hu force and eller.
CITY UC.NO.: LIG.CLASS: UC.N0.: EXP : MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Dale: Contractor: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under pasty of perjury that I an exempt from the Cora:acor'license Law for the
Nowkyreason(Radian ro313BMira and Profession Cods:Any ehacounty which requires aprmsto=alma,asr,nwove, PARKING REQ: PROV: PARCEL : 42626409 ZNE: REF NO:
ndeh,orepereny'MS aim is lama esonqukes"app zdlw such PenptoNeaeiPadmelenwW ch
tl Dbe"the PLANNING NOTES> •
(tensed pursuant to the provisions d the Co tradprs License Law(Chapter 9(mm
amon with Section 7000)d Division 3 d the
Business ess rPrda'v
en Code)or lbs is he or sheexempt therein=end the basisfor Cr acrid exrnpAr
ion. y violation el Section > _
7031.5 by any epplum for a permit subjects On epprmant to a tete steady of not more Own Two hundred doges(SSOOD. ********************************************************************:***********
❑ I.es owner dthe'WetyanrymWvaasvAhwagmaaNeisolecompr«mon,Ndothewrk.andthe.aucluesnoierded D E V E L O",P M E N T SERVICES R E
or offered for tale(Section 7044,Business end Professions Code:The Contractors Licensees
Law does nappwn
y to an One d property Q U I R E M E N� T S
who builds or Inproves Ihreadoes n,end who such work tines/or hens/a through gh IS a her own errpkrves,provided that such t •+
improvements re nos intended od(ed for side.If.however.the beldiga inpownra is sold within one yew of completion.the ZONING APPROVED BY. -, : DATE:
y owner-builder wig Mw the burden of proving he or she ad ml did or improv i. ., puna of seal. .-. .
D bIowsr°IIMKW"'antutsymrvsadiowith •
y •u.praier(Sad"ma,Ew:. d r. BUILDING APPROVED ,BY : DATE:
VMrelorw Code:The Cmmam License Law does not ..• b 0 •- et who bids or inseam thereon and who
ctrn audi wM a mmtla(e)licensed. . . i.
❑ I B.aP.c.. • I
APPLICATION ISSUED 'BY:
( �j.yr *el _ ************************************************* i€*�E g******D*+Tr*iE**REit* i€*�E*#its*
Date: ` /(r /�((p Osmec LEGALIZATION:N — F E E SUMMARY STRUCTURAL SEGMENT:Y
I do hereby cosy that I ern aware d and understand the requirements d California Health ad Safety Code Sections 25505.25533.and '
25534,and that I oany future building oo.certwillnal/ova I(dale orem)need comply with sad rits codes and requirements emerts ( •"i
s perm to construction or modacation from the Alr Curacy
Mennonite D'srka.Residential combustion applcsa.s are exempt hornthese ra BLDG PMT PLUMBING ELECTRIC 'MECHANIC FIRE SMIP/RES GRADING
provisions. PERMIT 21 . 00 - y . 50
Dale: App rem k1 . SMIP/NON-RES
PLAN ...
WORKER'S COMPENSATION DECLARATION:Ihereby mfemudrpenalty ofperreyone odthe following dedarmom: ISSUE FEE c,
❑ they.end MI!natal erdrl«naconsent tosd. rsrorwrkendconperrmion.=prodedforbySed4n370odv»Lab« BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK r''' TOTAL PAID DUE
Code,fathe pedamn .d n.wnlaw«d wpenmg .�p.d. TOTALS----> 21 . 50 0 .00 -• I • 0 . 00 L' 21.. 50 21 . 50 . 00
❑ I have and wR=Mull workers' wmio
e 'ornprn insurance,surance, mailed by Sedumd 3700 the Labor Coda,for the performance the rr
work tor Mach this rtwo.My workers'compensation:mp.sK.mdrwpdn�arme«we: REVENUE DIVISION TOTALS--> COLLEC-TED: 21 . 50 OVER/SHORT: . 00
Canter:
Pwy Numbs: _ BLDG PMT PLUMBING ELECTRIC MECHANIC FIRF�;+"SMIP/TOT GRADING PLAN-CHECK
((The section not Mm
ipn ed rwlsnd/vin pas ntfor hundred ls
peer nu, .e ICO)or n) 21 . 00 : ' • 'j . 50
L I amity the n the.. - d the work tor which cts permits'" r .,I .. any pray n ammanner - to i -
become tied to t.. . . •comr
enlod n ten camorie .1'. 1 .. Scan subleet .to the -•• *************************************/****.e*************************************
/�Ir ' ' . ' .w07®dth Lobar Code.l sum.. prey cions I N D I V I D U A L% : F E E • B REA K D O W Nj : ;
DataApphoant:
.
Warning: alunrosecure workrv
workers* adoncoverage launlawhgand shallsubpatsnenWoyrtoamdwpenalties end TYPE QTY DESCRIPTIO N '� UNIT COST TOTAL COST
civil Rens up to one hundred thousand dollars(S104000A in addlrlon to the cost of conw.nrfbra damagm ea prodded for In '
S«0x3706 of Me Labor Codalmrr4 andmmmeye yea. SFR 300 ALTER BY VALUE RESIDENTIAL NOZONE '• 1 . 00 300 . 00
CONSTRUCTION LENDING AGENCY:I hereby alfa,under penalty d perjury that there is e construction lending agency for the END OF FEES ,
performance of the work for which this sends issued(Section 3097.Civ.C). ,
LENDER'S NAME:
LENDER'S ADDRESS: •
I cosily that I have reed Ibis estimation rd sate that the shove information is coned.I agree to comply with all city and corny ordinances ••
end elate lam Sang km casrudion end Mreby stivse representatives d this Gyro err upon the above-manicned rolvdy .} , �•
foinspedionp" OB ERT PRIMMER 0100215001-00215002 TOT 21.50
/214 i' DATE: 09/ib/9`t TIRE: 13:44
•
odd Nan. • y
Dea: G 9
Signature d OwnerlAgenv rador
•
(515146.WP) Whho-Euilding&Safety;Green-Fs:Carry-Appkrem;Pink-Revenue:Goldenrod-Assessor
R
CONSTRUCTION AND PLANNING
t POS ''k.. SPA
I► APPROVALS Permit# Date "Inspector APPROVALS rermit# Date Inspector
1. 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 Reinforcement . 56. Rough Plumbing & Pressure Test
6. Electrical UF ER 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- "
11. Property Sewer Line & House Connection I 62. Backwash & Receptor-Final ,
12. 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
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 .. , _ , • . APPROVALS Permit#
21. Ducts,in Structure - . . 70.`Underground Hydro
22. Ducts, Ventilating , r - 71. ProducfPiping ❑Gas ❑Oil
23. Gas Pipe-Rough& Test - - 72. Underground Flush '
24. Roof Framing . 73. Undergrnd.Storage Tank 0 Gas ❑Oil
25. Roof Sheathing - ,. - 74. ,Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat i 75. Dry Chemical . •
27. Frame and Flashing 1. 2-3.17 6-44-76.: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-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: 7 20 79 -' 4.:_ite g d re
34. Final Heating& Air Conditioning_
35. Final Gas Pipe-Test - -
36:Hood or Canopy - 7 _L 7-R7- '- � r------
37.F /Led el/,-
38. Final Plumbing ' -
39. Water Service-Final • =/1 - `l7 - r/fi g E _o //^ca -'
40. Gas Service-Final - ( Cry"CC"//' . - . -- --
41. •
Solar Domestic-Final L `G y
_ t
42. Backflow Preventer - r •
43. Backflow Irrigation - - - • - T - 1
- I
44. Landscape Irrigation System r, 1
•
45. Sound Attenuation - - . I
46. Handicap Regulations _ 1
47. FINAL STRUCTURE & BUILDING (y-et 47 60,41.-. , - -
48. FINAL PLANNING
49.-Electric Release to Edison - '
50. Gas Release to Southern California Gas Co _
51. CERTIFICATE OF OCCUPANCY
i
No Date '
,
* 'ADDROFBWLD01G: 1984 CHURCH ST MIT: 4 CITY OF COSTA MESA — BUILDING PERMIT
QRS NAME IF KNOWN PRIMMER, ROBERT H 't . 4- PERM NO: E 079486
. ADDRESS: 316 MARIGOLD AV
PERMIT NO: E 079486 PLAN CHECK NO: N GOVT: N SUPP : N
CORONA DEL MAR, CA 92625
APDL.MMUNG ADORES& CONSTRUCTION TYPE: V—N PERMIT TYPE: ELE PURPOSE: OTH
,a ARCHITECT onENGINEER: lit NCI: JOB DESCRIPTION : 100 AMP SERVICE UPGRADE/ GARAGE WIRING SQ FT:
ARCH.OR ENG.'S ADDRESS: LINT:
.tit CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /U-1
I CONTRACTORS MME
Ca:TRACTORSMnIwn COMMENTS : REPAIRS TO GARAGE AND ELECTRIC SERVICE UPGRADE
ADDRESS: M.1,10.: ***9F*1E*9L*ii di*iiia*#*9E****9Eii9Ekir***ii*9i*9i*****di**iE*0 iE9Efi dirt*9h**iE*ii*ih*ii* ****ibis***9-*ih*9E
UM: ZONING REQUIREMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury that I am licensed under provisions at Chapter 9 SETBACKS
(commencing with Section 7000)at Division 3 d the Business end Professions Code,and my license is in hall lace and effect.
CITY LIC.NO.: LIC.CLASS: UC.NO.: EXP: MAIN BUILDING ACCESSORY BUILDING
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Date: Contractor: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby aft=under penally of perjury that I am exempt from the Contractors License Law for the
fdlowiio reason(Section 7031.5 Business and Professions Code:Any dy«county wNeh requires a permit to menat.mer.improve. PARKING REQ: PROV; PARCEL: 42626409 ZNE: REF NO:
'emolsh,«repel any stnature.prior to es issuance'also requires the applicant for each Pane to Be a signed statement tied he«she PLANNING NOTES>
,licensed pursuant to the provisions d (commencing Contractors License Law(Chapter (commencing with Section 7030)el Division 3 d tit
Business end Professions Code)or that he of she is exempt therefrom and the bass 1«the alleged asmptun.My violation at Section > - -
7031.5 by any applicant for permit subleds the applicant to a dvd penalty of not mace than free hundred dotlen poop. kkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkkk k kk k kkkk k kkkkk k kk k k kk kkk k k kk kk
❑ I.as°yaw of the PloPeeTer rItY employees wih wages as their sole compensation.will do the work end the Immure is not intended DEVELOPMENT .' S•.E R V I C E S REQUIREMENTS
or offered for sale(Secion7044,Business end Professions Code:The Contractors License Law does nal apply to en owner at popery .
who ids improves thereon.and who does such work «
himself or herself through his«
ough her own ernployeesprovided,
that such -
bolds improveenerds are rid lilended ordf.eod for sale,It however,the building or Inteosemerd is soil wishinorueyeerat onmplatinn,the ZONING APPROVED BY 4 DATE:
owner-buider will have the burden of proving he or she did not build or improve for the purpose of SM).
Prasdn uofCthe FweartY*odde:ThC«trac= eLiaaddoesnt ppi, •"..,, d,'.•i. �Prnied 5115or thereon ines.wo BUILDING APPROVED BY DATE:
contracts . such with a contradots)famed Wo ,( the �' -.Law). - --,
❑ I B.aner •. .. . APPLICATION ISSUED BY: DATE: ��� i
' G r , *** ,E,�iE, **,E*, *, *, ** iE*** �E ,Ei� ,Ef�,�iEiE *,E,E * iE ,tiE * **** *** * ,�,�
S Oats:
Owner �� LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
I do certty I ern aware of and undessnd the regdremeats of Calf omia health and Soley Code Sections 25505.25533,and
25534.and that I«any pure building occupant will/wit not(alms one)need to comply with said state codes and the rgdmnens for
a perm,for constmai«,«modifirmionfrom roeA;Geary Management Distrm.RWdentil,«mmcto„Ppinaaiaateexemfafranthes, BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
pradsaw. PERMIT 34 . 25
Date Awa: 50% SMIP/NON—RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby affirm under pawky of perjury we of Me kalovdng derLratins: ISSUE FEE •
22 . 00
❑ Have and oil malmealarenirwed consent to sell-insure l«waiters'campan
wbprovided ovided fSectionnySection00 d
Section 37ue LaborBUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
code.f«the wd«m edthe work ler which Otis permit.issued. TOTALS----> 34 . 25 22 . 00 0 .00 56 . 25 56 . 25 . 00
❑ I have and MI maintain wakes'compensation insurance,as required by Smith 3700 of the labor Code,for the performance of the
work for which this permit is issued.My worker,compensation insurance carder end polio/number are:
Caner REVENUE DIVISION TOTALS--> COLLECTED : 56 . 25 OVER/SHORT: . 00
Policy Number: - . BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This anion need not be completed i the pane S for one hundred oblsrs($7001 or hes.) 56 . 25
aI certify in the onuance d the work for which this permit .. '..I .. any person b any manner so as to
aped t he workers'compensation laws d should Mows subject to the iEiklEfFiEifiElEiElffLik1F1f1Eik141E1kikiFiElfiElEiEifffiFffititiE1E1E1EfE1E1EiEiEiEiEfE1LlEiElEIEfFlE1E#IE1E#iElE1EiF1fiE1E1E1EiElElEfElElEffll3EiE#***
y� /�eop37godthe w«Coda.i n / sorsa provisions. IND I V I D U A .L FEE BR EAKDO 14 N
Dela: Y . LV Applicant:
Wand :Failure tosecure workers'compensation coverage Is unlawful,and shall subject anemployer tocrMMMpwlteand TYPE QTY DESCRIPTION UNIT COST TOTAL COST
clM fines up to one hundred thousand dollars(5104000A M addldon to aro cost of compensation damps as provided for In _
Section 3706 of Ms Labor Code,Interest,and atbmeylltoes. ELE 2 FIXTURE' LIGHTING • 1 ST 20 EA. 1 . 00 2 . 00
CONSTRUCTION LENDING AGENCY: I hereby affirm under penally d perj y that there s m
a conudion lading agency f«the ELE 3 ' EC EP T •FIXTURE- ,
ET • 1 ST 20 EA. 1 . 00 3 . 00
performance of the work for which thepenne is issued(Section 3097.LW.C). ELE 2E .r ICH 1 ST 20 EA. 1 . 00 2 . 00
LENDERS NAME: ELE 1 /,•. a LOW 600 V 6 BELOW 201 AMP 27. 25 27. 25
LENDER'S ADDRESS: S END OF FEES
I certify thal I have read this application and state that the above information is correct.I agree to comply with all city and county ordinances • , `/�
and stale laws relating to building construction and hereby authorize representatives of this dtyro enter upon the above.meminod popery DATE , en.0 { ✓L•k• e 1
,�
o w 01`00215003-00215003 TOT 56.25
r ROBERT PRIMMER // /k r a 7_p DATE: 09/16/95 TIME: -13:44
/, Print Name A
6/�/ U/L�/r .�' L���
\/ Date: /C//
Signature dOwnerlAgenVAppi 1/Contrm«
(5151-49.WP) White-Building A Safety:Green-Fle;Canary-Appicant:Pink-Revenue:Goldenrod-Assessorralli
•
• s•-•..4 • .:,..,‘_ POC SPA
CONSTRUCTION AND PLANNING . -
Z Date inspector Date Inspector
APPROVALS Permit #- APPROVALS Permit # •
1. Temporary Electrical Service or Pole • 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd, r • 53. Steel Reinforcement - ,
-3: Electrical Conduit Utility-Undrgrnd, . • 54. Forms r - '
4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding -
3;5, Steel Reinforcement 56. Rough Plumbing & Pressure Test
` r6" Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
X1'77 Footings 58. Electrical Conduit-Undrgrnd. -•-
.,
8. Foundation . 59. Gas Pipe, 0 Undrgrnd.,Test
`^9. Water Pipe-Undrgrnd. .> r 60. Backwash Lines, P-Trap,0 Undrgrnd,
10. St uctural Floor System / E'61. APPROVAL TO DEC�
11. Property Sewer Line & House Connection --- 62. Backwash & Receptor:Final ,
12. Sewer Cap C- 63. Heater & Vent-Final
ru
13. Roof Drains - i 64. Plumbing System - Final '
14. Rough Plumbing to I 65. Electrical-Final -
15. Rough Electrical-Conduit o., ij 66. Solar System-Final ,
.
16. Rough Electric Wiring t 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 • Ct,i a;7 7 -; U t=_ APPROVA'LSjO Permit #
21.Duds, i tStri.icture' I r"F x` ~r- y F« ¶ 70.yndelgro nd Hydro
22. Ducts, Ve'ntitatingj~ < CiS S a!:t a 71. Product:Piping 0 Gas 0 Oil
23.'Gas'Pipe'Roi h &'Test _.-, r" �' f- 72. Unde grA�und Flush • -
.. ,- ,, ',1^ , ice: a a, r-
24.,Roof?Framing. rrs E.l-. - t C `. TS'. Undergrnd.StorageTank OGas ❑Oil
r5. Roof'Sheathing r- rt' t` tritri O t"'t c Ta Overhead H dro ' . r=
c• l:- •- N : '-] - l9 i..‘k. - '
4.5-134r Ceiling IStr,`upkural) &dylonocaat _ tt+ t7 t*14 75'. Dry Chemical - (r; •
27.game and Flashirng �a� tr, r �- 76'. Dry Standpipe . _ - f
• 28. Lathing;& Sidingr„, c; -1ja•��;i ,rte-• ; g .• •• '.µ 7:7'. FIXED SYSTEM FINAL - -"-i
29. Insulation ext'- Q - " r ``t 1 I 1^yt 78. FIRE PREV. FINAL +'. = '
r^ '-w: S CJ M is U -' ' '
t•
30. Drywall (v�ailing py.: u I I! r-i i-•,t3EALTH DEPT. REQUIREMENT
c' 31. Plaster Brown Coal I
ter, if,79'. FINAL �`SPECTION - - ,
E' 32.LElectrical.,Power Rle ertFinal i HF ••' r. I I I 801 FOOD CERTIFICATE ISSUED - i
r 33. -Final,'Electric' `7* ,_ i lir `3'' `� : (Votes: �y',`20'�6' 4e/,' Ap .o k�•
t 1 34..FinahHeating-& Agt,Conditioni@gs t� ,- •,� gyp (//�
C>WKc4o. 'cc Gl-lit
' 35.Sinai-GasPipeiTest� "W 'y i -.nru' on
,.. ,, .- 4 * c ht . r : .. - - ,
36.'Hood or:Canopy -, , -r4--1 • . n !i: r _ no
• 37. -Final•Factory Fireplace i Sts' a t,1 I I C" :' (' - • - :
C S 38. Final PI tubii
ng1.-4t< r ..` - 4: ..t - - -------
39. Water Service-Final• - - -
40. Gas Service-Final , - -
41. Solar Domestic-Final - -
42. Backflow Preventer« -.
43. Backflow Irrigation- .
44. Landscape Irrigation System - T. - .
-45. Sound Attenuation - - -
. -
46. Handicap Regulations .. r - i 4
47, FINAL STRUCTURE & BUILDING - - . , '-
48. FINAL PLANNING - .
49,-Electric Release to Edison - . -
50. Gas Release to Southern California Gas CO - ,
51. CERTIFICATE OF OCCUPANCY , - -
No. Date -
I