HomeMy WebLinkAbout1580 ORANGE AVE - Building Permits SCITY OF COSTA MESA
4
BUILDING DIVISION
.•�'VI• DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
1 ' ' P05-00387
4tbeeenePERMIT n /
cdP
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
PLUMBING PERMIT
Job Address: 1580 ORANGE AV Status: ISSUED
Suite No Applied: 05/18/2005
Issued: 05/18/2005
Vicinity:
ilk
Parcel Nunmber: 42533401 •-* r..: .r "c-- ISSUED BY: I.
Applicant: SZABO, KEVIN L ;- - //
Address: ;/ / .r"„ t•
d-. '.: .nom' y ` � _ A
,
�\ t;,.A - zip _ _
l
Owner BOSTWICK BARRY WALTER ��� , ,
Address 1582-1/2 ORANGE AVE �� , ,
y� „ - /
LTJ' Phone: ',
COSTA MESA,CA Zip: 92627-3770 / , •-` •
ah
. t Contractor COAST ROOTER PLUMBING HTG&A/C
Address: 17390 MT CLIFFWOOD,
-
- „; Phone: (714)241-1414 \
'FOUNTAIN VALLEY Zip: 92708 - ,� '; ',
License: 529127
- ` ._r i
SCOPE OF PERMIT - -
-_C • -.WATER HEATER CHANGE OUT(SAME LOCATION). { ',
FEE'SUMMARY - ' t fa,
”' AMT QTY - - - �-' AMT ,QTY 1',%/ AMT , QTY
ISSUE FEE--- ,\,,-$23.50• Laundry Tub/Washer $0.00 „ 0 Sump Pump J[J $0 004.E1,,- 0
Backflow,irrigation \, 1,,,'$0.00 0 - Landscape Irrigation $000-_; 0 Swimming PooV/ L $0.001k,'`0
Backfow,'Preventerr `.,‘;•,$0.00 0 P-Trap $0:00 —0' Trap Primer /2„,/ $0.00;' ' 0
Bathtuti?'-;)'; k -% vx$0.00 - 0 , Pressure Regulator:ra�;z,-, $0.00 0 Urinal a! ,- C„ $0.00' 0
Clarifier'Sy`stemk;•t, ,*" $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 BrkrBkflow(5+) -- $0.00 0
Dental Units`. .,','? $000,,` -,0 .. SepticTank 'c;, $000, -0 Wash.Basin r . $0.00 0
Dishwasher'-='- $000`'k 0 d ,<;Sewer,Cap,for Demo ...°$0.x/0,./.,r0 - .''+Wash-Basin Set'-. /.$0.00 0
"
Drain, Floor :.-,: $0:00 Nb',' Sewer Connect = :$0.00 0 - Waste and Vent System.! ; $0.00 0
Drain,Rainwater "
($0.00. ,- 0 - teSewer Private Lne i '-r $0.00„ ,0 a, Water Closet(Toilet) ' ,,/ $0.00 0
Drain,Roof r $6.00 � � 0 �.t: Shower ,` $0.00 "00 :::,----.2": WatefHh
eate�- ent�% / $12.30 1
Drinking Fountain -\$0 00 - 0./, _ -Sink,bar, . 'W, -` •u'$0:00-J a....5.-:, Water,Piping or
(Inst Rep.) $0.00 0
Expansion.Tank <C -$0.00 0/ / Sink,commercial - - ^ $0:00:'-0 - .Water Re-pipe " - $000 0
Gas Earthquake Valve "x'$0:00, .�'o .Sink, Floor'- _ -- $0.00 0 , , ,Water �Service $0.00 0
Gas(1-4 outlets) $000; 0 �.. ,y,„ -Sink,kitchen, _ $0.00- -';0 •', _Water.Sofener $0.00 0
Gas(Over 4 outlets) $0-00,`-=0 ', 'Sink,service/mop , .''- 1`.$0-00, 0`.,, , OTHER -' $0.00
Gas Repipe $0.00 ••••••:::0—..:,i1.--,, Spa(private). \ , _ $0.00i -0 ' :VIOLATION $0.00
Gas Service $0.00 0 <'- Spa(public) • • _ • , $0.00' 0 -,•''' PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 _ - _ _ REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
TOTAL CALCULATED FEES: $35.80
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
fora 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.
'WI 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 ieissued.
!! k My workers'compensation Insura�nccarrier and policy number are: p
Carrier— erne. � f
( N( I COV. PolicyNumber: /768 6 sv —7.ck.2 y
(Thtrsection need not be completed it the permit is valued at one hundred dollars($100)or less.) 1.---1.....-
❑ I certify that in the performance of the work for which this permit is issued,I shill not employ any'person in any manner so as to become subject to the workers'
i compensation laws f Ilfornia,'an r e that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these p o sionl..
APPlicant,Signature:- ele• SIM/U S
WARNING:FAILURE TO SE UR WUfU2EmsvJMPENSATION 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 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS 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.Linc.R_l S--.2-S--.2-0/ Z-7
' �/ (Clasj# L3 G'
Contractor's Signature: rDatg: 45/((0(0 C
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).
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 toe 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 em exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 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 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 then 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? IP 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? 0 Yes 0 No
(If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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.
/ Igna a Of Legal Owner(s) //8/JDat
_f/j'_
d/Or,,'A➢Ihodzed Applicant., .c ( rDate
COPES 'INSPECTIONTYPE Pili' • •INTIMAL@ '- CODES INSPECTION TYPE ' ' ' - DATE • .1111
1616 Fixed System Final Fire Prevention - 206 Final Mechanical
.
I
1266 Pool Spa Final 208 Final Plumbing - =/
200 Final Re-Roof 210 • Final Electrical `• • . . . ' r •
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 - '
tat
CITY OF COSTA MESA
,ri c BUILDING DIVISION
• •.,,,.,,;,n:Hs ; DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
1. t /ti . PERMIT
J B03-00366
%400 Rao le
(714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.c�y;ILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626
Job Address: 1580 ORANGE AV U Status: ISSUED
Suite: Applied: 03/06/2003
Vicinity: Issued: 03/06/2003
Parcel Number: 42533401 Zoning:
Applicant: MOORE, ROBERT B ISSUED BY:
Address:
Phone: 714-546-7323
Zip:
Owner: BOSTWICK, BARRY WALTER
Address 1582 1/2 ORANGE AVE
Phone:
COSTA MESA,CA Zip: 92627-3770
Contractor: ROBERT B MOORE CONSTRUCTION CO
Address: 3138 KERRY LN
Phone: 714-546-7323
COSTA MESA,CA
Zip: 92626 License: 360859
Arch : Eng:
Address: • Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REPAIR ROOF/DRYWALL ABOVE BATHROOM WHERE WATER DAMAGED AND RE-ROOF.COVER WITH 25 YEAR COMP SHINGLE.
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $3,000.00
Permit: $83.25 Claim Valuation: $3,000.00
SMIP Res: $0.50
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $83.75
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
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
2448-46(600)
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.
O 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'comp atpn Jpsurance car ie nd policy number are: x. } ` `p/'� p
F
Carrier: Policy Number: V v ak.A
his section need not be complete l/the rmt 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 Ilio la, d a ree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
comply with these p ' to -�
Applicant Signature: Date: Co-0
WARNING:FAILURE TO ECURE WORKERS'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 3706 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.a Class a
Contractors Signature: g� g zrnP Date: (p -
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 Cade for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
O I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(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 e
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).
___ .....e....-....._ _ _
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0Yes 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? ❑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? jJ Yes LJ 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),
.h.Coast Quality
.Management
g mn District
i t.or other
a..pollution
u n c..tr 7 application,If a permit haveathe South s presby gement Di Healthal and Sr et po Codeeion coonl districtbeen agency is required for the work which is the subject of this
all of the disclosures prescribed by California Safety Section 42303 made? ❑Ves 0 No
B (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.
Signet ej,,9 ner s) n Date
A Or Authonzed ppllcant Date
;ODE I INSPECTION TYPE RALE iffM1ALS CODE I INSPECTION TYPE 2AA )NTmAL$
• 1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final � r z� 208 Final Plumbing
'?
200 Final Re-Roof /9 a3 - - 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 • •
JECT ADDRESS: 1580 ORANGE AV UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 063885
OWNER'S NAME: BOSTWICK, ROBERT EDWARD
ADDRESS: TR PERMIT NO: E 063885 PLAN CHECK NO: • N GOVT: N SUPP: N
866 CENTRAL PARK DR •
PARADISE, CA 95969 CONSTRUCTION TYPE; PERMIT TYPE: ELE PURPOSE: OTH
ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : REWIRING ENTIRE HOUSE SQ FT:
ADDRESS: UNIT: ,
CLAIM VALUE: 3,000 . 00 CALC—VALUE: GROUP OCC; R-3 /M-1
PERMITTEE: BEACHWOOD CONSTRUCTION ( 714 ) 646-7569
ADDRESS: 259 LILAC LN COMMENTS: REWIRING ENTIRE HOUSE
CM CA 92627 ***********************************************y ****yEx*RL*EE ****>E**+E*EE*aE•*+c******
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
70110)of Division 3 of the Business and Professions Code.and my license is in lull force and effect. SETBACKS
CITYuc.:04�594 STATE LIC.:45674 ,2 s: B ) C / C
Date: signature _ _ MAIN BUILDING ACCESSORY BUILDING
�
WORKER ' OMPE ATI DECLARATION: Ihereby affirmthat lhav acenificate con 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.Cl. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ.; PROV; PARCEL: 42533401 ZNE: REF NO:
Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING N ES>
. >
Date: Applicant: *********************************•********le****1L•**1E*****************************
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section needn• urdeted if the permit is for one hundred($100)or less). DEVELOPMENT S�.E R V I C E S REQUIREMENTS
I certify that in the performance of the work for which this permit is its / II not employ any•,-m r •.niter so as to become
subject to thew kers'Compensation Laws of California. ZONING APPROVED BY DATE;
--� Date: / I Signature �i ,
NOT If.al .r m ung this declaration.you should become subject to r. War e�ompen on provisions of the Labor BUILDING APPROVED BY : DATE:
Co .you must forthwith comply with such provisions or this permit shall r • .r .d r r r.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance*the work for APPLICATION ISSUED B Y: t-l -� DATE; 1.3-
which this permit is issued(Section 3097.Civ.C). 4 ********************************************************************* **** ****
LENDER: *******************************************************************************
ADDRESS: LEGALIZATION;N F E E SUMMARY STRUCTURAL SEGMENT: N
OWNER BUILOER DECLARATION: I hereby affirm that l 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 4 6. 25
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()% SM I P/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 15,00
•
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 46. 25 15. 0 0 0 . 00 61 . 2 5 61 . 25 . 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 her ownisemployees.provided year that suchimprovements me are notthe intended or offered01for sale.If, nothowever build or ipREVENUE DIVISION TOTALS--> COLLECTED• 61 . 25 OVER/SHORT; 00
hisimprovementor sold within.one year completion.improve entsr willehave the edrornproving he/she did not r the improvebrgor
for the purpose of 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 61 . 25
❑ and Professions Code: The Contractors'State License Law goes not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors State License Law).I am aware *********************************************F,L/ * {,�`}Ar� *RI ************
that proof of their Worker's Compensation insurance should be provided to me. {.� ,■
INDIVIDUAL F E E tiff 22CC AAA_11CSS+ UU
❑ I am exempt under Section: B. &P.C.
for this reason: TYPE QTY DESCRIPTIO N CATET COST TOTAL COST
Date: Owner ELE 11 FIXTURES` LIGHTING 1 ST 2D EA754-5626 . 75 8 . 25
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533.and ELE 20 RECEP T/OUTLET 1 ST 23 , EA. . 75 15. 00
25534 and that I or any future building occupant wiMUwill not(circle one)need to comply with said state codes and the requirements fora ELE 1 O RECEPT/OUTLET ADD I T I O VAL
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from EA, or . 45 4 . 50
mese provisions. ELE 1 SERVICES BELOW 600 V & BELO4 20',1,. AMP 11. 50 18. 50
Dale: Applicant: END OF FEES 754-5627
I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county
ordinances and stale laws relating to building construction and hereby aril • CCpf natives of this cit to,er nr. the abs entioned
property for inspec t ppurpoles. /�
Date: ! J V/ Signature: ,/:%/ ��—r/t�,�'�— D01 AT00146601-0014460110/93 10:43 T 61.25
Driver's Lr nse or rat Security er:
' 1641.46 while—Building;Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
- CONSTRUCTION AND PLANNING POO SPA TI i
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Serv.cc or Pole p y 52. Pool & Equipment Location
s
2. Soil Pipe-Undrgrnd. , • 53. Steel Reinforce-Fent ,
3. Electrical Condu't Utility-Unth'grnd. •f 54. Forms
4. Electrical Condu.vUndrgri,d, 55. Electrical Bend'rg
5. Steel Reinforcement 56. Rough Plumb rp & Pressure Test i i
I I
6. Eiectncal UF ER Grnd 57. APPROVAL TO COVEP.GL4r.''.TE
7. Footings 58. Electrical Conduit Undrgrnd. I j
8. Foundation 59. Gas Pipe, U Unt rgrnd , Test • I- I
9. Water Pipe-Undrgrnd. 60. Backwash Linc•-, P-Trap, C. Ur..ul)mid
10. Structural Floor System •
_( 61. APPROVAL TO DECK I
11. Property Sewer Line & Hot.se ;nnnection jr- 62. Backwash & Rec.;t✓•?r.:
12. Sewer CapVent-Final - --I-_-i
63. Heater &
13. Roof Drains .4 64. Plumbing Sy,.tem • F-nal --j
14. Rough Plumbing ." I : 65. Electrical-Final I
h Electrcai•Condut
{
15. Rough L -I} n
- 66. Solar SysterFinui I
16. Rough Electric Wiring 1O -t5 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 1I
J-
18. Rough Electrical-T Bei Ce,... g 69. POOL'SPA SYS`. 1'.'S FINAL _ -
19. Rough Heating & Air Cordit or ingi I FIRE DEPT. REQUIREMENT
20.'Rough Factory Fireplace ! ' T.I • SPPRUVALS'I ' P.jhn 1
• t
21, Ducts, in Structure- •• •• I 11.+• '70. Uhdergrouh _
d Hyro •
22. Ducts, Ventilating . 71 Product iptn; lids 'JO,'
-
23.:Gas Pipe-Rough & Test _ r i72. Undergrc.MTu F'Jst I I --
24. Roof Earn ri - __J' ..73. U.ndergmq"Sn'',:f 1--.-.rk Gaw •- G - -•
25. Roof Sheathing I : • 74. Overhead Hymn _-- - - - J
26. T-Bar Ceiling (Structural) P• Monocoat - 75. Dry Chum �si • r
27. Frame and Flashing 73. Dry Stands-Tv: - - -
---•.i_ --_ t
1.28. Lathing. 5dny ' I •'I 77. FIXED SYj E-i f-T`\AL
29. Insulation - ( 78: FIRE PREY FINAL '---
- 30. Drywall NailingI 'HEALTH DEPT. R'EQUIREMENT '
31. Plaster Town Coot F 79. F!'.AL I'!j°CC' ON -
•
32.'E!ectnca' Power V-.Cer•F.ra. I I 80. FCOD CEEL .!'I 'r.TE 155._'LD ,
1- - 1-.-
33. FinalElect7ic I Notes: .•y
.34. Final Heating& kr Corditioning
35; Final Gas Pipe-Test •; I It ' . , ,
36. Hood or Canopy ' . _ 1 '_F-- -- - - - -- _ - --
•
37..Final Factory Fireplace •
38. Final Plumbing ' t - _ _ __
39. Water Service-Final
--- -i =-s ---- ---.
40. Gas Service-Final -
41. Solar Domestic-Final - -1 ^•`z/ t
•
11:
42. Backflow Preventer ! 1 I "'iii - - '� 4:1 -.7
1
43. Backflow Irrigation i
44. Landscape Irrigation System - . •
. i 2 -_---
45. Sound Attenuation . •
46. Handicap Regulations ... _. _ _ _
I I ---
-1
47. FINAL STRUCTURE & BUILDING I -
48. FINAL PLANNING ' - -
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co I
51. CERTIFICATE OF OCCUPANCY r
No. Date
— 1`\
PROJECT ADDRESS: 1580 ORANC UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 063887
OWNER'S NAME: BOSTWICK, R EDWARD
ADDRESS: TR PERMIT NO: P 063887 PLAN CHECK NO: N GOVT: N SUPP: N
866 CENTRAL PARK DR
PARADISE,CA 95969 CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OTH
ARCH/ENGINEER: REG.NO.: JOBDESCRIPTION : WATER REPIPE SQ FT:
ADDRESS: UNIT:
CLAIM VALUE: 1 , 500. 00 CALC—VALUE: GROUP OCC: R-3 /M-1
PERMITTEE:
BEACHWOOD CONSTRUCTION ( 714 ) 646-7569 R
ADDRESS: 259 LILAC LN COMMENTS: WATER REPIPEJ '&c : !E— EY e1eS
CM CA 92627 ********************** ** **************************-**x***********************
LICENSED CONTRACTOR DECLARATION: I hereby allirm 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 lull force and effect. SETBACKS
CITY LIC.: 045945 STACK cig,:456742 " 13 B 10 C3 (p
Date:_ signature:_ _ .n`j�� MAIN BUILDING ACCESSORY BUILDING
WORKERS' PEN ION0 RATION: I hereby affirm that I have a certificate of t, •• .: nsure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
Compensation Insur,ce.or a cenifieg copy thereof(Section 38W.Lab.CI. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
POLICY NO.: EXP.DATE:
COMPANY: PARKING REQ: PROV: PARCEL: 42533401 ZNE: REF NO;
Certified copy is hereby furnished. ❑ Certified copy is bled with the city Building Division. PLANNING NOTES>
>
Date: Applicant: *********************************************** .*******************************
•
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred(SAW)or less). DEVELOPMENT S E R V I C E S'/. REQUIREMENTS
I certify that in the performance of the work for which this p;:isim
all nploy any pe r a any manne .s to become
subject t� Wor .rs'Comrnsatipn Laws of California. ZONING APPROVED BY 12.i� DATE:
Data_ Signature: diet 40
��'��'[� of
:
NOT If.after akin his declaration,you should e subject to the Workers' ompensaii f the Labor BUILDING APPROVED BY w/ DATE;
Cod .you mu' forthwith comply with such provisions or this permit shall be deemed revoked ' • q
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction tending agency for enormance of the work for APPLICATION ISSUED BY; wO DATE; O— (�
which this permit is issued(Section 3097.Civ.Cl. **************************** ************* *********************rya—
***
LENDER: *******************************************************************************
ADDRESS: LEGALIZATION:N F E E SUMMARY 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 SMI P/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish.or PERMIT 7,00
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 2 5 ✓•� j , SM I P/NON—RES
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN •
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(SSW). ISSUE FEE 2000,
I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN=CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 7, 00 20 , 00 0 , 00 27, 00 27, 00 , 00
does not apply to an owner of a property who builds or improves thereon.and who does such wont himself/herself or through 7
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 of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED; 27. 00 OVER/SHORT: . 00
tar the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the properly,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 27, 00
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractors)license pursuant to the Contractors'State License Law).I am aware **********************************'{E**'**** * * T� *le*************
that proof of their Worker's Compensation insurance should be provided to me. 1
❑ I am exempt under Section: B.R P.C.
I N D I V I D U AIL "F E EB` R
for this reason: TYPE QTY DESCRIPTIO N CA6INIT COST TOTAL COST
Date: Owner: PLU 1 WATER RE—PIPE
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 EES 754-5626 7. 0 0 7, 00
25534 and that I or any future building occupant wilVwill not(circle one)need to comply with said state codes and the requirements for a ��
4
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from � or
these provisions. . i 754-5627
Date: Applicant:
I hereby certify that I have read this application and stale that the above information is correct.I agree to comply with all city and county
ordinances and slate laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned x'
property for i�nspec/lm9 Durpos s //Ai x
Dare: //_1 Signature: G
Driver's Lir nse or tial Security a; �'/ 01 00146602-00146602 TOT 27.00
164146 White—Building:Green—.Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor DATE; 05/30/93 TIME: 10R3
LIPPly ..
-
CONSTRUCTION AND PLANNING POO SPA
APPROVALS Permit- Date Inspector APPROVALS Permit ;k j Date Inspector
1, Temporary Electrical Servicepf,Pole 52. Pool & Equipment Location
F
rnd.
2. Sod Pipe-Undrgrnd. l�- -- -I /� • ~,
P 9 53. Steel Reinforcement
3. E'ectrical Cordu•t Utility-Urfo•grr.d. f^__ / 54. Forms
. _
•4. Electrical Condu.t-Undrgrnd ' 1 55. Electrical Bond ng
5. Steel Reinforcement 56. Rough Plumh.ng & Pressure Test
6. Electrical UFER Grnd 57. APPROVAL TO COVER•GUNITF
lt
cooungs 58. Electrical Conduit•Urd-grno. i
--i- --4
Foundation59. Gas Pipe, 7 Urumn d -ist I
a. Vater Pipe-Undrgrrd. ,, fi0. Backs-cashL.ne,,P Tr.;n, -? Urd., i
10. Structural Floor System Jr_ 61. APPROVAL TO DECK I I i
11-. Property Sewer Line & Housp,Cnrrlection 'hB2. Baaxc.ash & Reecht a: t ina! I t
' I' h - --I- -I
ti 12. Sewer Cap > 63. Heater & Vent-F1n - - --
: 13. Root Drai�
Drains - . 'I• 64. Plumbing System - Final
14, Rough Plumbing Q/28h3 LSD 65. Electrical-Final I -i--
15. Rough Electrical-Conduit , l _ 66. Solar System•F.n,.) - -
16. Rough Elcctr.c`Lring 67. Fencing & Ace,. A.ap•o.a'
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
F
18. Rough Electrical-1" Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 1
i 19. Rough Heating 8i Air Conditioning FIRE DEPT. REQUIREMENT
• 23, Rough Factory Fireplace ' • • . • • APPROVALS' i P°r(i t ,i
21. Ducts, in Structure 70, Jnderg;cun� Hy-: u
i i 1 .
1 22. OuCs, Vantilitm9 i
71. Product,P.omg "1Gar -La'
• 23..Gas Pipe-Rough &Test (NI, • .72. Underground Flush
24. Roof F/amicg i 73. Undergrnd.Startic Lank C Gas O
25. Roof Sheathing 74. Overhead Hydra
26. T•Bar Ceiling (Structural' & i10-ocoat 75. Cry Chen^ca ;
27. Frame and Flashing 76. Dry S•an Jr ipe
28. Latn.nc& S.d:ngr ' , -- 77. ;FIXED SY;,',' F_61AL .
29. Insulation •. -' I - 78. FIRE PREV. F!?:AL
30. Drywall Nailing I I 1 )-;FALTH•DEPT. REQUIREMENT
- I - - -- - - - -- -- -- --- - -
31. Plaster Brown Coat i .79.;FINAL INSPECT TQN I I
>
rN, -- -
- -- -- CI', --
32. Electrical PoweeterF�rali -''` 30!i'FCUD CEHiIF; -E ;SSU�D I
33, Final E'ectrc
votost0-F Cori-tic-Pp777-t'o^ rp
�f0-it_9 i_ /-ctuT_�a-FA. rte _ _ A(
35: Final Gds Pi 4•Teat I "a'• -�- • /'
36. Hood or Canopy
1--- -- -- - ----------- - --- - --
37..F.'-gI Factory Fireplace
38. Final Plumbing /10/1/f F"�f��l�
39. Water Service-Final 7 / I
40. Gas Service-Final - - -- - - j
41. Solar Domestic-Final I - {',
42. Backflow Preventer 1 I
43. Backtlow Irrigation - 1
44. Landscape litigation System •. . , .
1
45. Sound Attenuation - , , ---_ t-- --_--- - - -
46. Handicap Regulations -- 1 -~ _ - -
47. FINAL STRUCTURE & BUILDING -
'
48: FINAL PLANNING
•
49. Electric Release to Edison i
50. Gas Release to Southern Cal.fornia Gas CA „ •
51. CERTIFICATE OF OCCUPANCY
No. Date I
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
•
CITY OF COSTA MESA CONSTR UCTI S N PERMIT PERMI _ TRACT NO. LOT NO. UNIT NO. • -
cis 76- 5156 10/14/86 5.00 ,TL
Project Address ' r-r��
• I /ir �1 TYPE OF CONSTRUCTION ❑ NEW U ADD ❑ ALTERATION L:REPAIR l
Applicant's Mailing{A�d�Idr`es ll L.. f 1
Owner's Name j NA, It Phone AIM• ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone
DESCRIPTION OF WORK/USE OF BLDG.
Address _ J I I S Main Building: 1 Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT U GRADING U F9UNDATION U STRUCTURAL E Front o
•Address ❑ TENANT' ❑ ELECTRICAL fW.. UMBING 0 MECHANICAL B Rear N
Contractor's Nam �L-++ 4 It ./ 4•• Ph•ne_ 99D1c ❑ OTHER -- --- I
a' PROJECT DESCRIPTION SQ. FT. OCCUPANCY K" Right • G
Address(mailing) I IMMIIIIIMI Left
0 CONSTRUCTION TYPE VALUATIONS $
City License No. l r 5 ZONE GRADING CU.YDS. ACRES R
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E
0
I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: Planning Notes: S�Sa•s�� M
with section 7000) of Division 3 of the Business and Pra(e551ons Code,and II 'V�V n ^rT — 3 iaag T
my license is in full o e and effect. ,' —8' �C
Licen Cl. s ^ _ • in o. O -_ S
Date . '• •• e - Signature SAW _ i/ r- PLUMBING FEES
1 WORKERS' COMPENSATION DECLARATION Bar Sink, Showers ELECTRICAL FEES
\ hereby affirm that I have a certificate of consent to self-insure or a certificate
Workers' Compensation Insurance, Or a certified copy thereof.(Section Backflow Preventer Service Sink
_ Automatic Washer Transformer 0 15-50 KW
1Q Lab. }1np )AJC �� n� � r .(
Policy No. )( ;L 4l /2J Company /�(�!�l�t -WLI Backflow Irrigation Sewer Cap0 50+ KW
certified copy is hereby furnished.
' / Construction.Pole Sub.
e Cer i ppop,Kis filed with the city B d"pgl ftlyyic ii /� 4 //.r ' Bathtubs - Sewer Connection . • Cooking Unit Meter ❑up to 100 amps
Eate EXEMPTION11 V•FROM ApplicantR 'COMPENSATION��'V {y�AT�{� Clarifiers Solar Collectors • Dishwasher Meter Dover 100 amps '
WORKERS' DECLARATION
(This section need not be completed if the permit is for one hundred($100) or
less).• er • Dishwasher Solar Piping - Dryers ❑Gas ❑Electric Sub Panel
I shall o that the person performance of the work for as to this permit as issued,I
not employompeanyiperson in any manner so as to become subject to Life Drinking Fountains' Solar Tank Fan Motors❑0.1 HP D1'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 - �1 l Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) ' Interceptors ' Water Heater t7,OU
Outlets Range
Lender's Name _
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
following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal Standing Sections
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap Laundry Trays Generator 00-5 KW 05-15 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 .
'erefrom and the basis for the alleged exemption. Any violation of Section
31.5 by any applicant for a permit subjects the applicant to a civil - — - .
:malty of not more than five hundred dollars($500). •
O 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'sMECHANICAL 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 aro not intended or offered for Boiler Hood or Type I ❑
sale. If, however, the building or Improvement is sold within one year of cam- Canopy Type II 0 Zoning Approved By Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground Building Approved By Date
lova 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 00.100000 BTU 0100,000 BTUSUMMARY 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 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ - SMIP 5
•
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT
O lam exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBO# Fire Dampers • . •
PLUMBING $ SOO • 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 D100,000BTL ELECTRICAL $ GRADING $
information Is correct. I agree to comply with all city and county ordinances •
and-state laws relating to building construction,and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives of this city to e ter upon the above-mentioned property for - M '
inspection p s•1 r / o. a/ MECHANICAL $ TOTAL FEE $ 50
r Signature' _/.�•/I� �� .L./1 Date 9-a/�-Q lam. Reinspettion•Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
Drivers' License or SS#
I ��CMF 0865-46,rev.10/84 White - Building: Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
•
CONSTRUCTION AND PLANNING POOL& SPA
APPROVALS Permit# Date Inspector APPROVALS Permit -- Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. 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.,Testa
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0_Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK C)
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Finatt
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 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 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:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test •
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing 3/3/n G4Q
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
51. CERTIFICATE OF OCCUPANCY
No. Date