HomeMy WebLinkAbout1589 ORANGE AVE - Building Permits •
ADDRESS OF BUILDING: 1325/ UKANl.7h AV uNT: CITY OF COSTA MESA - BUILDING PERMIT Mq19OOJ),i
owxERsxwElp PAM:JACKLIN, JOAN F PERM NO: M 087639
IDDREss: 1589 ORANGE AVE
COSTA MESA,CA 92627 PERMIT NO: M 087639 PLAN CHECK NO: N GOVT: N SUPP: N
APPL.M/dUNGADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: MEC PURPOSE: OTH
ARCHITECT OR EdKbIB:R: UC.NO.: JOB DESCRIPTION C/O WALL FURNACE — SQ FT:
ARCH.OR ENfl:s ADDRESS: °M` CLAIM VALUE: CALC—VALUE: GROUP OCC : R-3 /
rnNrRAaars NA1E A—AMES PLUMBING & HEATING ( 714 ) 530-2440
cpR IRACTOs MAILING 9911 LARSON AV COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT
GARDEN GROVE CA 250307 *******************************************+t************ ************>E*********
ADDRESS:
DDR 92642 Lc"o LWB Z ONING REQUIREMENTS
UCEN • ONTRACTORS�ACDECLARATION:I hereby affirm penaky olcp�erjury thin I am r�cerued under provisions of Chapter 9 S E T B A C K JC
ung •Ubbb$aoducnCof the ASS: Cu-3b Professions
/ p�EXP and 06/98 MAIN BUILDING ACCESSORY BUILDING
UC.No UC.CLASS: UC.No/: FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
' sero: -S' ��/ c drador ! LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWN - :UILDER DECLARATION:I hereby Winn under needy of perjury that I am exempt from the Contractor,License law for the
t•!• •reason(Section 7O31.5 Business and Professions Cade:My cityormrwywhidi requites apennilmtrewd,eller.iprove, PARKING REQ: PROV: PARCEL : 42534122 ZNE: REF NO:
doh,or repair any structure.prior to its issuance.also requires the applicant for such pennlf to fila signed statement that he or she PLANNING NOTES>
is licensed pursuant to the protons al the Contractors License Law(Chaplet 9(commencing with Section 7000)of Division 3 of the >
Business and ProfessionsCode] theeheshe lsexem a dill ead the heslethan five hudremploa.Anyvu)atond5ectbn ***********************************************************1E*******************
Busi.ebyanyeoplicein«o e]oithee he othea'a toexmthcief m altd thins isfothr he Meed exemption.
Y vol.
❑ I.aowaer a theproperty«my emPloywwthwagea esmeisole compensation,windo Me work.and the structure is not intended DEVELOPMENT SEW-VICES REQUIREMENTS
or offered for sale(Section 7044.Business and Professions Coda:The Contractors License Law does not apply to an Owner of property
who Wilds or improves thereon,and who does such work himself or herself or through he or her own employees,provided that such
improvements are not intended or shred for sale.If.however,the building or Improvement is sold within one year of completion.the ZONING APPROVED BY DATE:
• owner-builder will have the burden of proving he or she did not build or improve for the purpose of sale). .
❑ I,avoweratheproperty.ameaduaivelyoonnadkpwithliensedcontractors oonmudtheproject(Section7014.Businessend BUILDING APPROVED BY : DATE:
Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon end whoJ
contracts for such projects with a contrador(s)licensed pursuant to the Contractors Limine Law).
❑ Ins exempt under sedon B.APC., «Mhreason: APPLICATION ISSUED BY: DATE:
**********************3t*************dict}********* **************** * **
Date: Owner: LEGALIZATION:N F E E SUMMARY STRUCTURAL SE MENT:N
I do hereby certify that I am aware of and understand the requirements al California Health end Safety Code Sections 25505,pccni,and
25534.and that)oreny future building occupant will/wit nor(circle one)need to comply with said state codes and the requirementsor BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a permit for conatmdionor modificatonfrom the Arouertylranagentent District.Residential construction applications are exempt from these PERMIT 13 . 25
provisions. 25% SMIP/NON—RES
Dale: Applicant
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one of the following declarations: ISSUE FEE 22 . 00
❑ Ihave and will malnlnacertificate dconsent lself-insure for worker'''compemeon.o«
tidridedfor bySection 37OOelthe Labor BUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
Code.for the ped« m
mweofdiewckforwhchthispermiisisued. TOTALS----> 13 . 25 22 . 00 0 . 00 35 . 25 35 . 25 . 00
AD I have and ail mainten weakens'compensation insurance.es required by Section 3700 of the Labor Code,for the performance of the
wont l«what,this permit lsissued.My w«Fere:copipemsatienunurgppe Reim and policy member are: EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 35 . 25 OVER/SHORT: . 00
- Oen"`' N01080317 03/01 /99 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
Policy Number:
(This section need not be completed I the permit is for one hundred dollars($too)or less.) 35 . 25
FMmintheperformanceofthewkl«whichthispe ®ued.IshellnalempkryanYPinsoninanYmannersoO10subject Ks the wckers'co mpensaton laws of Cerdamie, and agree Met dI shark become subject to the wahss'
..on provisions d Section 3100a the Labor Cde.l shad for INDIVIDUAL FEE BREAKDOWN
Applicant: �siure to secure waken'conloesation coverage Is unlwTul,and shall sb/ect an employer to cdMrul pensftles arWTYPE QTY DESCRIPTION UNIT COST TOTAL COST
to one hundLabor Code,Interest,dollars
In Wdllbnhllse cost of conMerlrwR damages as provided roan MEC 1 INST/RELOC RECESSED WALL HEATER 13 . 25 13 . 25
sectlon 3165 0l Ms Labor Cada,Infsnsh and sOomey'a fees
CONSTRUCTION LENDING AGENCY:I hereby affirm under penalty of perjury that there is a comsouction lending agency for the END OF FEES
performance of the work for which the permit is issued(Section 3097,Cb.C).
LENDER'S NAME
LENDER'S ADDRESS:
I certify that I have read this application and state that the above infonnmion 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 property
tori"apedia"Pur"se`CARLOS CASTANEDA
04-08-1998/02:28 PH/535.25
P est Ni,yRCP1H:014O22115
/, , AS Date: 4J — 8— 48 PERMIT:087639
rre of Owned .nUA..IWn4'C. actor
(5151de.WP) White-Building A Safety;Green-File;Canary-Applicant;Pink-Revenue:Goldenrod-Assessor
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit MN Data Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pore 52. Pool & Equipment Location
2. Soil Pipe•Undrgrnd. •
53. Steel Reinforcement
3. Electrical Conduit Utility•Undrgrnd. 54, Forms
4. Electrical Condult•Undrgrnd, 55, Electrical Bonding
5, Steel Reinforcement 56. Rough Plumbing& Pressure Test •
6. Electrical UFER Grnd. 67, APPROVAL TO COVER•GUNITE
7, Footings 68. Electrical Conduit•Undrgrnd.
8, Foundation 59, Gas Pipe, C7 Undrgrnd„ Test
9, Water Pipe-Undrgrnd. 60. Backwash Lines,P•Trap, CI Undrgrnd.
10. Structural Floor System 61, APPROVAL TO DECK '
11. Property Sewer Line & House Connection 62. Backwash & Rocoptor•Finol
12. Sewer Cap 83, Hooter & Vont.Final
13. Roof Drains _ 64, Plumbing System • Final
14. Rough Plumbing 65. Electricol•Flnal
16. Rough Eloctrical•Conduit 06, Solar Systom•Final
16. Rough Electric Wiring 67, Fencing & Moots Approval
17, Rough Wiring Sign 68, APPROVED FOR PLASTERING
18, Rough Elactrical•T Bar Calling 80, POOL/SPA SYSTEMS FINAL
10. Rough Heating & AIr Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit dh
21, Ducts, in Structure 70, Underground Hydro
22, Ducts, Ventilating 71. Product Piping 0 Gas 0 O11
23. Gas Pipe•Rough Si 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 76. Dry Chemical
27. Promo and Flashing 76, Dry Stnndpipo
28. Lathing& Siding . 77, FIXED SYSTEM FINAL
29. insulation •
78. FIRE PREY, FINAL
30. Drywall Nailing . HEALTH DEPT. REQUIREMENT
31, Piaster Brown Coot 70, FINAL INSPECTION
32. Electrical Power Meter•Final 80, FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
® dd .
34, Final Heating& Alr Conditioning
36, Final Gas Plpe•Test
36. Hood or Canopy.
37, Final Factory Fireplace
38, Final Plumbing
39. Water Service•Finol
40. Gas Sorvico-Finol
41, Solar Dometttc•Final
42. Backflow Proventor
43, Backflow Irrigation .
44, Landscape Irrigation System
46. Sound Attenuation
48. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co - •
61, CERTIFICATE OF OCCUPANCY
•
No Dote
•
r ADDRESS OF BUILDING: 1589 ORANGE AV OAT: CITY OF COSTA MESA — BUILDING PERMIT
OWPffWS NAME IF MOWN: JACKLIN, JOAN F I PERM NO: B 07485`_
ii ,ti ADDRESS: 1589 ORANGE AVE f
COSTA MESA,CA 92627 PERMIT NO: B 074855 PLAN CHECK NO: N GOVT: N SUPP : N
IS 646-4325
ADPL.MAILING ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH
ARCHITECT OR ENGINEER; UC.NO.: JOB DESCRIPTION : T/OFF INSTALL 20YR COMP SHINGLE SQ FT: 2, 387 •
ARCH.OR ENG.'S ADDRESS: UMT:
CLAIM VALUE: 2, 387 .00 CALC—VALUE: 2, 387 . 00 GROUP OCC: R-3 /M-1
CONTRACTOR'S NAME: CRANK BROTHERS ROOFING CO ( 714 ) 548-5569
CGNTRACTOFFSMIRNG 126 COMMERCIAL WY COMMENTS: SMOKE DETECTORS REQUIRED PER 1991 UBC
ADDRESS: COSTA MESA CA uc.NO.: 408677 ************x*+E***aERE**REREx*RE**R6***x**iERERE*RERE**iERFAFRFRPRERERERE**R6iERER6x RE**RERERE+E****RF****RE*+F
92627 UHT: Z ON ING REQUIR EMENTS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penalty of perjury Matt am licensed under provisions of Chapter 9 SETBACK S
(commenting with Section 7000)of Division 3 of the Business and Professions Code,and my license is full forte and effect.
CITY LIC.NO.: 005993 LIC.CLASS: C 39 #0.: 40867 EXP: 06/96 MAIN BUILDING ACCESSORY BUILDING
Dae: J c— cotmct« �� „.../.2.42..., FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
91LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER BUILDER DECLARATION:I hereby affirm under•. perjury that I am exempt from the Contractors License Law for the
following reason(Section 7031.5 Business and Profess, . Any city or county whim requires aperms to construct,alter,improve, PARKING REQ: PROV: PARCEL: 42534122 ZNE: REF NO:
demolish,or repel any structure,prior to as issuance,also .. free 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(commenting with Section 7000)of Division 3 of the PLANNING NOTE S.>
Business and Professions Code)or that he or she is exempt therefrom end the basis for the alleged exempton.Any violation of Section
70315 by any applicant for epermit subjects the applicant toeavil penally dnd more than lve hundred dollen(SSool). ******W W***********************************************************************
❑ I,as owner o the property or my employees with wages as their sole compensation,will do the work,and the structure is not intended D EV E. L OPMENT SERVICES R E Q/� U I R E M E N T S
or offered for sale(Section 7044.Business end Professions Code:The Contractors License Law does not apply loan owner of property M
who buide or improves thereon,end who does such work himself or terse'Or through he ix her own employees,provided that such
improvements are not intended Cf offered for sale.f.however,the building or improvement is sold within one year of completon,the ZONING APPROVED' BYowmer-builder will have the burden of proving he or she did not build or improve for the purpose of Sale). DATE:
has owner of the property,am exclusively contractg with licensed contractors to construct the project(Section 7044,Business and •
o
Professions Code:The Contractors License Law does not eptlyownerof
to an property who builds or improves thereon and who BUILDING APPROVED BY : DATE:
contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law). A
ElIamexemdunder Section: B.dP.cL P.C., APPLICATION ISSUED BY: I` DATE:
Date: Owner:
LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:Y
I do hereby worry that I am aware of and understand the requirements of Calaomia Health end Safety Code Sections 25505,25533.and
25534,end that I or any future building occupant will/wil not(circle one)need to comply with said state codes end the requirements for
apermit for construction or modification from the Ai usifyManagement Dierks.Resdconstruction onstrunapptcatiwre are exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
provision& PERMIT 54 . 00 . 50
Date: Applicant: SM I P/NON—RES
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penalty of perjury one of the following declarations: PLAN
❑ Ihave and wilmntanacertificateconsent toselfinsure for workers'compenstion.asprwkSection ISSUE FEE
ad
Code,for theped«manceoftheworkforwhichthispermiisIssued. BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
9 I have and will maintain workers'compensation insurance,as required by Seethe 3703 of the Labor Code.for the pedarmerte of the TOTALS — 5 4 . 5 0 0 . 0 0 0 .00 54 . 50 54 . 50 . 00
work for which this permit is issued.My workers'compensation insurance canner and policy number are:
Cartier STATE FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED: 54 . 50 OVER/SHORT: . 00
Pricy Number: 7AS/774-9S 01 /01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
(This section need not be completed i the penna is for one hundred dollars(SSW)or less.) 54 .00 . 50
❑ I codify Nat in the performance of the work for which this permit is issued,I shall not employ person in any manner so as to
become subjectcompensation
Ceiba'•I hagree het l become euyjedtothe workers'
crysel'ro potions of Section of Labor fonnh comply ions.
Date / — 26'—9.i/
Applicant: 101 [ �.' . ***********************************************W***************
****************
INDIVIDUAL F E E• BREAKDOWN
Warning:Fallunt to secure workers'compensation cove- •-I unlawful,and shall subject an employer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
civil fines up to one hundred thousand dollars(S100,,,v),I,addition to the coat of compensation,dine-pea as provided for In .,.
&teflon 3706 of the Labor Cods,Interest,and gnome sf & SFR 2387 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 2, 387 .00
• CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of perjury that there is a construction lending agency for the END OF FEES
performance of the work for which the permit is issued(Section 3097.Civ.C). r
LENDER'S NAME:
LENDER'S ADDRESS:
I 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
end stale laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned prapenty •
for inspection purposes. .1 •
/ ill JIM SANK
mi t /a < led Et:19?i_t.i -0,53104, TCT �`'=
e Date: r T i :"; )�
s lure of Owner/Ag: ppicant/Contractor
(5I51'46.WP) White-Building 6 Safety;GnwrFFle:Canary-Appicant:Pink-Revenue;Goldenrod-Assessor
,4,ONSTRUCTION AND PLANNING POOL &SPA 7
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or$ole 52. Pool & Equipment Location - •
2. Soil Pipe-Undrgrnd. 0 53. Steel Reinforcement
s-4r.Electrical Condti+t UOity-Undigrnd. 54. Forms
•
74t•Electrical Conduit4Jhdrgrnd.- 55. Electrical Bonding '
14Ca. - ,
D;"5?Ste- l Reinforcement- 56. Rough Plumbing & Pressure Test - ,
..-C` - - .i.
:E
- 6lectrical UFER=Gin-d. 57. APPROVAL TO COVER-GUNITE .
--Cr. Footings r-c 58. Electrical Cond iit•Undr rnd. `
•
c,`$t•Foundation L':- Cu c. 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrrnii. 't _ 1 60. Backwash Lines,•P-Trap, 0 Ubdrgrnd.
10. Structural FIooCSystern I 61. APPROVAL TQ.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 Plumbin Pm 65. Electrical-Final
Y
15. Rough Electrical•Coduit cr 66. Solar System-Final .
n
16. Rough Electric V(?irir?g
.0 67. Fencing & Access Approval
17. Rough Wiring Sign - •
68. APPROVED FOR PLASTERING ,
18. Rough ElectricaJT Bar Ceiling 69. POOL /SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE r DEPT. REQUIREMENT
^1 - - w ' x _ _
•
r- 1-'20. Rpugh FactoryFicap ; ,�,lace � j x " 0 Td.. ,APPFSOVALS` Permit r ...a` Peit # �
21. Ducts-in Structure, •• -,_- S C� - 'r •l 70. •t3ndergvourid Hydro
22. QuctS;Veiitilatingtk • `u _ < �•' ' 71. ProduR Piping•0-Gas G'Oil
; s 1:9;7lt. ... r
23. Gas �ipe-,Roug-h & 'lest ;-i -' It* 72. Underground Ftus-h _ u
24. goof-Framing" x .-c--, t' e H* 73, Undergrnd.StarareeTank;JJGas ❑Oil
r7.
25. Roof$heathing • `/`q-l=,/ 4(.i J 74:.'Overhead Hydro
Cr
26. i-Bat Ceiling (Struttural) & Mo'rigcoat r ,� x - Jy 751,Dry Chemical _ tz c -
27. Frame and. Fla;;hir ; ^xx x - --.x 76. Dry Standpipe rr - _
.t. - ._ .;
28. Lath'S5g 8"i.`Siding Wit "-: `" -',, 712. FIXED SYJTEM FINAt _. 7'
-29. Insulation - 4
. c ) '- •- - i t z, • r
S • t: x 78. FIRE PREV. FIN2AL
30. Drywall lgiliog Mk " ^ ! '' S `HFALTR DEPT.TIEQUIR'''EEMENT
- 31. Plaster Bror;
wrtCoae; _ I ,r: 4 ( t 1 79.• FINAL ISISPECTtON - J _;
32. Electrical-Povver MFrer:Final - N ti80;, FOOD CERTIFICATE I S,&ED . µ
-r
i t : n C Cr,
z 33. E.inal,Eleciric-. . r, x I Notes: - " -a C- .^.,.:
-;34. Fina L'tieating'✓§ Air!ionditionirlg:. :' x ---• < r; 19/ f% fi.vt'4o G; G1 -cis " I ,
" ,a ,t, '
35. FinafGas'Pipitest - "cl •• ; v/._ � Y/9 Q L. IA
-36. Hood or canopy t+ +. =_ : _ ` r tt`1
e . rr .n
.,37. Finar•.Factory Fireplace 7. _„ � * m ;n: " _ a
�
3$. Final'Plurnbing f 4 u .. A { -
- . - x c. x:
39. Water Sery ce-F nal " ' r.
Y
-40. Gas Service-Final ,. T• <r n '1-I
1:41. Solar Dourest Fc Frna4 - r 4 ,, ,r. ;. :., 1-1
42. Backflow Preventer - x c; - . . G
. . ... v m r ' ,.) -
43. Backflow Irrigation .;ation .r >i c==
'^
44. Landscape.Irrigation•System -n^, c TI n r�' n- : ,r r� 0
45. Sound Attenuation 's '-irr- - `" F- i- ` - ,--.. I- C - U. i
46. Handicapttegulationb _ 1' : r --
_ .. a ' .p ,t,.-,,. ,t
47. F"INA4- STRUDTURf & BUILDING 1O-j _,? w , . - ,
48. FINAL PLANNING rF- x -
4 - c r -
49. Electric Releate to Edison * *
to. Gas Release to Southern California Gas Co '
51. CERTIFICATE OF OCCUPANCY - - - - - •
No. Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
city OF COSTA MESA CONSTRUCTION PER IT PERMIT NO. TRACT IItO � LOT NO. UNIT NO.
3 ProjZt Addressc. — �y M (.li'� • To, �L - �/ I
,-Applicant's Mailing A(ldress ��L� TYPE OF CONSTRUCTION NEW U ADD U ALTERATION U REPAIR:
• �� In( .` ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone
Owner's Name -�• ilk Ai .�_��! _ Pho` b DESCRIPTION OF WORK/USE OF BLDG. •
Address1/4.r. V S Main Building: Accessory Building:
Z
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING 0 FOUNDATION CI STRUCTURAL T Front O
Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N
��y� CI OTHER A` I
Contractor's Name Vl�l / Phone C Right N
Address(mailing) ^ Yom/ PROJECT DESCRIPTION SQ. FT. oCCUPANCV K Left
G
A \ CONSTRUCTION TYPE VALUATION$ $ R
LISNo. v ZONE G CU.vDS. ACRES E
LICENSED
CONTRACTOR DECLARATION Ping. Ref. # Parking Req./Provided
I herebyaffirm that I am licenseq underprovisions of Charter 9 (commencing Q
( 9 Remarks: Planning Notes: M
with section 7000) of Division effect.3 of the Business and Professions Code,and T
my license is in full force and S
• License Class License No.
Date Signature PLUMBING FEES•
WORKERS' COMPENSATION DECLARATION Bar Sink Showers
1 hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES
of 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. _ Company Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+ KW '
8 Certified copy is hereby furnished. /V s
Certified copy Is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps -
(This section need not be completed if the permit is for one hundred ($100) or - -
less). Dishwasher Solar Piping Dryers OGas ❑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 ma as to beco subject to the Drinking Fountains Solar Tank Fan Motors 00-1 HP ❑1%-8 _ •
Workers' rpyep Sa ws of Cdlifor a. •t '
Date S l�aFf Signature ga ` Floor Drains Swimming Pool w/Spa FAU. Inc.Solar 09.15 HP 016-15+
NOTIC 1f,a ler making this declaration, you Should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave
comply with such provisions er this permit shall be deemed revoked.
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
Lender's Name P Outlets 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 00-5 KW 05-15 KW Trash Compactor
any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
\Division
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
fes / 7031ty of any applicant for n permit subjects the applicant to a civil
—
/J�lyl\p 0 I of not more than five hundred dollars ($500). $ 3
ai I, as owner of the property Reinspection Fee $15 Issue Fee
will do the work,and the ofe structure is not Intended or offered Reinspection Fee I $15 Issue Fee $�
for sae ction 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 com- 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
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 Date
Ltractors to construct the protect (Section 7044,Business and Professions Code:
The Contractor's License I, a Coes not apply tors owner je property who Duct-Ventilating ❑0100,000 BTU ❑100,000 BTU SUMMARY OF FEES
builds or improves thereon, and who contracts for such projects with a Con-
-
ractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. _ PLAN CHECK $ PERMIT
❑ Iam exempt under Section B.& P.C.for this reason Firepl/Fact.BIt. ICBG# Fire Dampers ISSUANCE $
PLUMBING $Date 'IT owner Heating System& Ducting Registers PLAN CHECK 25% $ 2T ENERGY P,C. $hereby Certify th I have read this application and state that the above ❑0100,000 BTU ❑100,000 BTLELECTRICAL $ )3.,SV GRADING $
nformation is correct. I agree to comply with all city and county ordinancesnd state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
entatives of thi o enteY up• the above-mentioned prop fornspection purp••es. MECHANICAL $ Q'� �•'
gnat ure �L 4.—._ •
Date TOTAL FEE $ l7 r'� O
-Accounting; Goldenrod - Assessor 41 UUUUBS9D-000U:W90 JJ.CIU
CONSTRUCTION AND,eLANNING I!' POOL & SPA
Date Inspector APPROVALS Permit# Date Inspector
APPROVALS Permity#
i'•.'Temporary Electrical Service or Pole 52. Pool & Equipment Location•
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement \q
3. Electrical Conduit Utility-Undrgrnd. 54. Forms IA
4. Electrical Conduit-Undrgrnd. RR r 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. WatFr.'Pipe-Undrgrnd'__.• 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 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 4
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 i.'
24. Roof Framing 73. Undergrnd.Storage Tank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro -i L.
--
i ,
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical r •
27. Frame and Flashing 76. Dry Standpipe ( r
P
28. Lathing & Siding 77. FIXED SYSTEM FINAL f
29. Insulation 78. FIRE PREY. FINAL C
30. Drywall Nailing HEALTH DEPT. REQUIREMENT •�.
31. Plaster Brown Coat 79. FINAL INSPECTION i.:`
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric ///,& 4' Notes:
34. Final Heating & Air Conditioning / Li
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace s
-138t Final Plumbing
,•39. Water Service-Final
1
40. Gas Service-Final
'41. Solar Domestic-Final •
I 12. Backflow Preventer 1
I
43: Backflow Irrigation 1 - .
.14. Landscape Irrigation System i
45. Sound Attenuation \-' .•
,
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48.-Special Requirements Completed q
49. Electric Release to Edison 4
t.50. Gas Release to Southern California Gas Co `
4 •
iihL51. CERTIFICATE OF OCCUPANCY„ r,
No. Date r