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HomeMy WebLinkAbout1536 ORANGE AVE - Building Permits 9 CITY OF COSTA MESA • 4 BUILDING DIVISION N DEVELOPMENT SERVICES DEPARTMENT PERMI UMBER PERMIT M04 A^6^1 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1536 ORANGE AV Status: ISSUED Suite No Applied: 12/01/2004 Issued: 12/01/2004 Vicinity: Parcel Number: 42533202 ISSUED BY: Applicant: STEVEN SCHNIERER Address: 2057 MANDARIN DR Phone: 714-719-1689 COSTA MESA,CA Zip: 92626 Owner: WILLIAMS, RICHARD Address: 1536 ORANGE AVE Phone: 562-592-1164 COSTA MESA,CA Zip: 92627 Contractor: ADD AIR INC Address: 1080 N BATAVIA ST UNIT N Phone: 714-997-2969 ORANGE,CA Zip: 92867 License:747643 SCOPE OF PERMIT 40KBTU NEW FURNACE IN ATTIC FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $14.80 1 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 $6.15 1 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 $0.00 0 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 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 • TOTAL CALCULATED FEES $44.45 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 24464e(WOO) • . WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: • O 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. ,p ` I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for wNch this permit Is issued. My workers'compensInsurance carrier and policy number are: Carrier: ¶ 4 c t ihA ,-- Policy Number: rr-' I UGI 7-2.4:37*-1- (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ', ❑ I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of alifornia,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Coda,I shall forthwith comply with thes-... .lo - ' / Applicant Signature: ii ✓ Date: 12) I I .....--- WARNING:FAILURE T•SECURE W- • '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 ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commenting with SectlorL7000)of Division 3 of the Business and Professions Code,and my license is In full force and effect.tic.4 '7 }7(0143 / Class 4 C.zo —7 Contractors Signature: f Date: L'1 r I[Yl C CONSTRUCTION LENDING AGENCY: t -- r ❑ 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). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she 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).): ❑ 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 owner-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 property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth Into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I 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,or a volume of 55 gallons. or 200 cubic feet of compressed gas at standard temperature and pressure). _ 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). __....._....__.__.--- _ ___ ___ . _.___...y _..— 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes 0 No 5 Does or will the applicant Or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? L_I Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 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 prescnbed by Califomla 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 penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. n Date Owner(s) 1zil/olt / And/Or Authorized Applicant Date CODE t INSPECTIONTYPE 12/,IE MAO CODF( INSPECTION TYPE PATE / am. .• 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1.2/7/114 4r et A.> 1266 Pool Spa Final 208 Final Plumbing Pr 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 • CITY OF COSTA MESA 4 9 BUILDING DIVISION > ,.,,,. , DEVELOPMENT SERVICES DEPARTMENT PERM NUMBER F I J •IrellkPERMIT ep P03-00583 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1536 ORANGE AV Status: ISSUED Suite No Applied: 09/09/2003 Issued: 09/09/2003 Vicinity: C� Parcel Nunmber: 42533202 ISSUED BY: _ Applicant: WILLIAMS, RICHARD Address: 1536 ORANGE-AVE - " Phone: 562-592-1164 . COSTA MESA,CA Zip: 92627 " ,. i - ' Owner. ' WILLIAMS," RICHARD Address '1536 ORANGE AVE Phone: 562-592-1164 COSTA'MESA,CA Zip: 92627 , Contractor: OWNER-BUILDER • Address: , . - Phone: Zip: License: 000000 Arch / Eng: Address: Phone: Zip: . License: - SCOPE OF PERMIT PLUMBING TO INCLUDE:GAS REPIPE. . " _ FEE SUMMARY . AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 - Sump Pump $0.00 0 Backflow inigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool , " $0.00 0 Backflow Preventer $0.00 0' P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) ' $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin - $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0:00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain,Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain.Roof $0.00 "0.. Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 • Expansion Tank $0.00 0 - Sink, commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 • NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 24443.46( ) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation Insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carder and policy number are: Cartier: Policy Number: (This section need not be completed If the permit is valued at one hundred dollars($100)or less.) stI certify mpe thasari in the performance C o , tare fort I tis permitecis issued, shall not employ any person in any manner as to•:comes bject to the,I shall forthwith laws of C.f o and. ., a res that I ould become subject to the workers'compensation provisions of Section . ' oft Labor= Code,I shall forthwith comply with these p c on Applicant Signature: Date: WARNING:FAILURE TO SECURE W• ERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI • PENAL S AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OFT ' LABOR vs•E,INTEREST,AND ATTORNEY'S FEES. • LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Uc.x Class N Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,CMI Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its Issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she 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 then 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 owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • ❑ 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 La! s not apply to an owner of property who builds or Improves thereon,end who contracts for such project with a contractor(s) license pursuant to the C itracto'- ''nse Laws.). �/p{�l I am exe u r sec. Business and Professions Code for this reason: r Signature; . �� �,/ D• are' Owner ID van i d overs litems:. 0 Yes 0 No Drivers License No: - . Expires: Verification of Ownership by(type of document,i.e.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). • ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: • HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 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,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑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 en RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health end Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes ❑No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 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 Tirriared 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 COMPLUW'E AND • �j ORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the Information given Is correct.I afire= to M•e ply wit all state Iyy' s : dtcity ordinances relating to building construction,and authorize representatives • the of Costa Mesa to enter upon the above-des 7 di♦ erty for i spectio ' ••••s.I agree not o occupy or allow occupancy of any building authorized by thi per It n' final inspection. b• 5 ign=ure Of Legal Owner(s) ' •ate And/Or Authorized Applicant Date C00E E I S ECNSP OTt NTYPE QATE INTRIALS i;OpE1 INSPECTION TYPE PA¢• 1t15 1616 Fixed System Final Fire Prevention 208 Final Mechanical 1266 Pool Spa Final • 208 Final Plumbing q1/7/06 200 Final Re-Roof 210 Final Electrical R 201 Final BlocIdRetaining 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 Ontatitil CITY OF COSTA MESA •BUILDING DIVISIONDEVELOPMENT SERVICES DEPARTMENT P MIT NUMBER PERMIT E04-01255 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1536 ORANGE AV Status: ISSUED Suite No Applied: 12/01/2004 Vicinity: Issued: 12/01/2004 Parcel Nunmber: 42533202 S.. tee_. Applicant: STEVEN SCHNIERER ISSUED BY: Address: Phone: 714-719-1689 Zip: Owner WILLIAMS, RICHARD Address 1536 ORANGE AVE Phone: 562-592-1164 , COSTA MESA,CA Zip: 92627 Contractor: ADD AIR INC Address: 1080 N BATAVIA ST UNIT N Phone: 714-997-2969 ORANGE,CA Zip: 92867 License: 747643 • SCOPE OF PERMIT INSTALL 1FIXTURE, 1 OUTLET AND AND 1 SWITCH FOR,NEW FAU IN ATTIC,RE:M04-00641. . ELECT WORK INCIDENTAL TO MECH PERMIT. • FEE SUMMARY Quantity - Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 • Pool/Spa $0.00 0 - up to 10 kva/kw $0.00 0 Lighting Fixts $1.10 1 "up to 50 kva/kw $0.00 0 Recept Outlets $1.10 1 up to 100 kva/kw $0.00 0 Switches $1.10 1 - over 100 kva/kw. $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 . Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp . $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work Is suspended or abandoned for a period of 180 days, INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) . WORKERS'COMPENSATION DECLARATION: - . I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. My workers'compensation((v� Insurance carrier and policy number are: I' Carrier: Stq �- {C Tnd / Policy Number: J 73-tl C(07-ZC04 (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) O 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 es to become subject to the workers' compensation laws• alifomia,and:gree th. if I should become subject to the wo rs'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these •ro i or Applicant Signature: ' ''' Date: 12I I IoC • WARNING:FAILURE •SECURE W. ERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100.000).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37(6 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lia# 7 ea 3 Class ii -Z.0 Contractor's Signature: , - Date: l Z'1 )04.1 / 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: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she 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).): ❑ 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 owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ 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 property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air(Duality Management District or from any other air pollution control district or agency? j�Yes L-I No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 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 ❑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 penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. / / ' : •f Leal Owner(s) Date 7" - :•y t , lob nd/Or Authorized Applicant Date CODE# INSPECTION TYPE Prim INTRIALS CODEI INSPECTION TYPE PETE IRIS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing• 1�c— 200 Final Re-Roof 210 Final Electrical 7�� QS t 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 • 'k CITY OF COSTA MESA a BUILDING DIVISION ` ' . DEVELOPMENT SERVICES DEPARTMENT P RMIT NUMBER F t � " PERMIT /E03-00803 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.aueCTRICAL PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1536 ORANGE AV t ' . Status: ISSUED Suite No Applied: 09/05/2003 Vicinity: Issued: 09/05/2003 Parcel Nunmber: 42533202 Applicant: WILLIAMS, RICHARD ISSUED BY: �/ Address: 1536 ORANGE AVE - - - Phone: 562-592-1164 COSTA MESA,CA Zip: 92627 . �', . Owner: " WILLIAMS, RICHARD ' - Address, 1536"ORANGE-AVE " - Phone: 562-592-1164 ��� 'COSTA MESA,CA Zip: 92627 Contractor: - - • - Address:' _ , Phorie: ' - - _ Zip: . ' License: , • ' SCOPE OF PERMIT ' SERVICE UPGRADE TO 100 AMP. 7 ' -- - • FEE SUMMARY Quantity _ - Quantity ISSUE FEE $23.50 Temp Dist System/.Lighting $0.00 0 ' Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 , - . New Res(1-2 units) $0.00 , " 0 Misc Electrical Equipment $0.00 0 .` - • New Res(3+units) ' $0.00 0 Transformers up to 1 kva/kw $0.00 .0 - , Pool/Spa • $0.00 0 _ - up to 10 kva/kw $0.00 '--0 • . Lighting Fixts -\ , $0.00 0 ' - - up to 50 kva/kw $0.00 -0 Recept Outlets '- $0.00 0 'up to 100 kva/kw $0.00" ; 0 Switches' . $0.00 0 _ over 100 kva/kw $0.00 0 - Non Res Appl $0.00 - 0 Low Voltage Equipment -- - $0.00 0 e ' Res Appl - , $0.00 . 0 Low Volt Wiring System/Ckt $0.00 - 0 , Service to 200a $30.50 1 . Misc:Conduit $0.00 0 Service to 1000a $0.00 0 Mi• sc.Conductor $0.00 0 /, Service over 1000a, \ ' $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp - $0.00 , 0 Circus(Tech ride or lights) -- • $0.00" ,0 Motors to 10hp `- V $0:00 ', -0 _Christmas Tree Stand $0.00 01� Motors to 50hp �N ,$0.00' 'i 0 - _ Fireworks Stand " - , $0.00 0 Motors to 100hp -- $0.00 0 " _ Other Electrical Fee $0.00,„ ' Motors over 100hp $0.00 0- - Communication drops $0.00 0 Investigation Fee - $0.00 Sub panel to 200a $0.00 .0- Plan Check Fee -. - $0.00 Pole Light Pkg $0.00 0 - _,Reinspection Fee $0.00 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain Inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(WOO) WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one d the ia'lowing declarations: . ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensatlor insur nce,as required by section 3700 of the Labor Code,for the performance of the wort for which this permit is Issued. My workers'compensat' n In u ance carrier alley number are: J P Carder: Policy Number 11/43 )) (This s n need not be completed if the pem(t is valued et one hundred dollars($100)or less.) I certify that in the performance of the w•rk for vet ch thl . it is Issued,I shall not employ any person In any manner so as to become subject to the workers' compensation laws of omi: : d =. e that If I sh•u[I corn ubJect to the workers'compensation provisions of Section 37p0 of thpp Labor Code,I shall forthwith comply with these provisions. _ / ^ I //o� Applicant Signature: A t• A- / L, Date: (/`� d// • WARNING:FAILURE TO SECURE WO-' RS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AN CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3105 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is In full force and effect.Lic.it Class N Contractor's Signature: - Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Susi ess 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 sub' cts the applicant to a civil penalty of not more than five hundred dollars($500).): I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure Is not Intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work 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 owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the prope ,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors L ense ,. does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pur an o the I ontratll -License Laws.). ❑ I am axe//O'r sec. Business and Professions Code for this reason: ^ ���T r Signature: h, AN _ - �R/lr>Ln� Date: Vlf (/lJ Owner ID v fie. driver's licen a tr. es 0 No Driver's License No. Expires: Verification of Ownership by(type of document,I.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,Califomia 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,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2............... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? aAI pplication ❑No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 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'yest 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 • D A - ORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given Is correct. I agree to cog•ly with all state 5yy i city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described pry• I or inspect•to :-'agree not to occupy or allow occupancy of any building authorized b ipermityln,jQ final inspection. ion: •.•• er(s)/7t//CAI no D • And/Or Authorized Applicant Date CODE I INSPECTION TYPE PATE INTITIAL5 CODE! IIfSPECTION TYPE DAIS IIS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 PoolSpa Final - 208 Final Plumbing e� 200 Final Re-Roofof - 210 Final Electrical 201 Final BlocWRetaining Wall • _ 212 Final Fire Prevention _ 202 Final rectory Fire Place 220 Final Planning Approval 203 Final Sign __ 222 Final Site • 204 Final Demolition 250 Final Building/Occupancy City of esaa 1/044 -esdc uy Dieda t ' 1111 OWNER-BUILDER VERIFICATION A city or county, which is required to give notice pursuant to Section 19830, shall attach to such notice, and, as a condition precedent to issuing a building permit, require the completion and require the return of, an owner-builder verification. Attention Property Owner: An `owner-builder' building permit has been applied for in your name and bearing your signature. Please complete and return this information in the envelope provided at your earliest opportunity to avoid unnecessary delay in processing and issuing your building permit. No building permit will be issued until this verification is received. I. I personally plan to pro ide major labor and materials for construction of the proposed property improvement Yes ❑ No 2. I (have/have not) signed an application for a building permit for the proposed work. 3. I havecontracted with the following person (firm)to provide the proposed construction: Name Address City Phone ( ) Contractor's Lic. No. 4. 1 plan to provide portions of the work, hut I have hired the following person to coordinate, supervise and provide the major work: Name Address City Phone ( ) Contractor's Lic. No. 5. I will provide some of the work but I have contracted (hired) the following persons to provide the work indicated: Name Address Phone Type of Work _ I 1042-46 (REV.9(9 0) Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. Y.0 F COSTA MEM CONSTRUCTIONI� � � PMIIT - PE1�IRRMIT NO. TRACT NO. LOT NO. UNITT7�� ,,,,.� 9024 3/11 /85 15.50 IL Project Address I 'b 3(? �0?--04-1b� �/L', /7 ` �, �et O� �/f ' 1 Applicants MailinggAddress %5 k C, TYPE OF CONSTRUCTION Li NEW U ADD II ALTERATION 'LI REPAIR y Owner's Name 1 1, ` �c._- • 1-- '"� ne z- "4' ❑ CONVERSION ❑ DEMOLISH ❑ O-F{1EER. T' Cr A.P.# I Zone '�I • 1A 7 0 SCR IPTION OF WsR USE,OF LAG. Y. F Address i S34 �K-�1�•f�F C. �/7� / •ez• QS' . / se M.•C>—�,MIL • I-51- • S Main Building: Accessory Building: / E Z Arch/Eng. License No. TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front O `� Address wry' c,.. l /� /� ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL BA Rear N Contractor's Namn l/'--- -/V I' �' '-C/'711,k ,y/pne 7 El'OTHER C Right N t Address(mailing) .69C/ AUJz'� �I V Z.r PROJECT DESCRIPTION SQ. FT. L1€00 OCCUPANCY -� 7' K G n CON ST RUCTION TYPE VALUATION$ OSZ-6•70 s Left N City License No: 3;Q R ZONE GRADING CU.YDS. ACRES Ping. Ref.# Parking Req./Provided E LICENSED CONTRACTOR DECLARATION .,I I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: M Imo, with section 7000) of Division 3 of the Business and Professions Code, and LS T my license is in f I f• •and effect. License Clajj;; s• - ,/ c S UV No.2/ PLUMBING I FEES Date 2)-T ••• CT Signature v /lP WORKERS' COMPENSATION DECLARATION Bar Sink Showers , I hereby affirm that I have a certificate of consent to self-Insure or a certificate ELECTRICAL FEES •f Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink 3800, Lab. C. Automatic Washer Transformer 0 15.50 KW Policy No. _7T�r 7 Company grlrr Backflow irrigation Sewer Cap Construction Pole Sub. 0 50 rKW I1�yI titled copy is hereby furnished. ieefo 1tled with the city A:igz�IIvisiQ�}�j yl�, /� Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date -`"C �--• Applicant[i4��1� F r /�'� Lel- ' EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps (This 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 this permit is issued,I - shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors❑0-1 HP ❑1'h-8 Workers' Compensation Laws of California. Date Signature - Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar ❑9.15 HP 016-15+ 'NOTICE: If,after making this declaration, you should become subject to the - Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures comply with such provisions or this permit shall be deemed revoked. Microwave CONSTRUCTION LENDING AGENCY , Gas Service Outlets Water Closet Device Boxes I hereby affirm that there is a construction lending agency for the performance Pole Light of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Lender's Name Range Lender's Address Kitchen Sink Water Service Switches Sign OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal ;Standing Sections 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 Generator ❑0-5 KW❑5-15 KW any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor 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 - ' therefrom and the basis for the alleged exemption. Any violation of Section i 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). 3 U I, asownerof the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ compensation, will do the work, and the structure Is not intended or offered I - Reinspection Fee $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL 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 0 sale. If, however, the building or Improvement Is sold within one year of tom- Canopy Type II El Zoning Approved By Date pletlon, the owner will have the burden of proving he/she did not build or im- Duct--Under Ground Building Approved By Date prove for the purpose of sale). ❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System - Application Issued By Dat 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 ' 0o-100,000 BTU 0100,000 BTU SUMMARY OF FEES builds or improves thereon, and who contracts for such projects with a con- - tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple 0 System Repair/Alteration BUILDING PERMIT $ IS-OO SMTP ' $ •SO proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT ❑ lam exempt under Section B.S. P.C.for 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 00-100,000 BTU 0100,000 BT ELECTRICAL $ GRADING $ information is correct. I agree to comply with all city and county ordinances ' and state laws relating to buil•ing construction, and hereby authorize repre- fPLAN CHECK 50% $ MICROFILM $ sentatives o this'cit , t. e� th er upo e above-mentioned roperty Jar - inspection s. -LL.%S - TOTAL FEE $ (S•an SiDriverss'' License or SS ZZriver ��_ MECHANICAL_ _ Date ( � Reinspection Fee _I $15 Issue Fee $ 3 PLAN CHECK 25% $ D CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL Ci SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2: Soil Pipe-Undrgrnci. 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, ❑ 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 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 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank ❑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 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 Nntes:Sg K9' pVT Cit..J- z oiL Stl J-S-9 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 Domestic-Final • - 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation - 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING, O 48. Special Requirements Completed _ r i 49. Electric Release to Edison - - - - • 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date •