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HomeMy WebLinkAbout1639 MINORCA DR - Building Permits F CITY OF COSTA MESA r . BUILDING DIVISION >t:l,,,,r ,r DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 41 ��% . PERMIT %"° �'� V P01-00522 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1639 MINORCA DR Status: ISSUED Suite No Applied: 08/31/2001 Issued: 08/31/2001 Vicinity: FRONT YARD ISSUED BY: - Parcel Nunmber: 13928301 Applicant: BARSTAD, DIANA.'" , , Address: 1639 MINORCA"DR. - , _ - - Phone: (714)641-1155'7 COSTA MESA,CA - - Zip: 92626 - _ ��,�' Owner: '''BARSTAD, DAVID& DIANA . Address 1639 MINORCA DR Phone: (714)641-1155 COSTA MESA, CA Zip: ' 92626 r • Contractor: OWNER-BUILDER Address: ' " - - �, Phone: . . , A: . Zip: License: 0 A ' . N , . Arch / Eng : - - / �_ - r\�. Address: - - , Phone: • Zip:. - _ • -- -License: _ _ } . SCOPE OF PERMIT • REPLACE EXISTING SEWER LINE - • . HFEE.SUMMARY � , • , AMT QTY - AMT "QTY �. - - AMT QTY ISSUE FEE $23.50 ,-Laundry Tub/-Washer $0.00 -:0 ; -•r Sump Pump $0.00 0 Backflow irrigation $0.00 " 0 Landscape Irrigation $0.00 0 Swimming Pool ,$0.00 0 Backflow Prevrente , $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 Bkfow(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 $24.65 1 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 - 1, 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 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 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: $48.15 COMMENTS I SPECIAL CONDITIONS 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. I FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) L '• DECLARATIONS (, ) fl WORKERS'COMPENSATION DECLARATION: I hereby affirm under penally 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 carrier and policy numberr are: Carder: �.' Policy Number: (This section need not be completed lithe 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 California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FNLURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL PINES 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.Lic.a 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: Lenders 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 pem4' 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.). /❑'P,,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions L.—L./Dade: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 e��t under e Business and Professions Code for this reason: -Signature: � f' Dala: 4511°)--_>- -Owner ID verified by driver's license. 0 Yes 0 No privets License 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,faisework,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,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? ❑Yes 0 No (Section 25505 of the Califomia 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 Califomia 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 Doers-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 ❑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 LJ No (Section 65850.2 of the Califomia Govemment 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 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 co •. 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 •�scribe�A d property or ction purppses.I agree not to occupy or allow occupancy of any building authorizedy this' unit until final inspection. ill fivir Signature Of Legal Owner(s)f�-.......,... Date:- .. And/Or Authorized Applicant Date CODE I yISPECTION TYPE BRIE ItfatlA6$ CODEI INSPECRON TYPE gd¢. I$IIMLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical n_ 1266 Pool Spa Final 208 Final Plumbing I 0-I 'Of —SFr 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 • • ealt67/444ccr��u y Diuidian lb . ,` 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 fequiiethe 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. 1. I personally plan to provide the major labor and materials for construction of the proposed property improvement. El Yes ❑ No 2. 1 (have/have not) f'per/£ signed an application for a building permit for the proposed work. 3. I have contracted with the following person (firm) to provide the proposed construction: Name Address City Phone ( ) -__ Contractor's Lic. No. 4. I plan to provide portions of the work,but 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 ( 1042-46 (REV.9/98) I hereby affirm that I have received a copy of the information set forth in Section 19830 of the State of California Health and Safety Code and have completed the above information to the best of my personal knowledge, in compliance with this State law. Signed: D ath t Fel Date: ZS(31 U �� 1 Name: r t J\(\c A l n S.SC A (Printed or Typed) /� C.D.L.#OR S.S.# For more information call City of Costa Mesa Building Division at(714)754-5273. 1042-46 (REV.9/98) • CITY OF COSTA MESA - tart, BUILDING DIVISION > erz . DEVELOPMENT SERVICES DEPARTMENT PERMIT N BER 4. p-I� r PERMIT 0 1489 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa ILDING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 Job Address: 1639 MINORCA DR Status: ISSUED Suite: Applied: 09/22/2000 Vicinity: Issued: 09/22/2000 Parcel Number 1398301, Zoning: -•. ; , Applicant: LEWIS FERGUSSON A Address: ISSUED BY: Phone: 714-754-1000 Zip: Owner: REHA, DELORES Address 1639 MONORCA ' Phone: • , ' COSTA MESA,CA Zip: 92626 Contractor: A PLUS SERVICES INC./A PLUS ROOF ' Address: DBA: FOUNTAIN VALLEY ROOFING . FOUNTAIN VALLEY,CA Phone: (714)775-1947 11237 SLATER AV Zip: 92708• License:. 675241 , Arch : Eng: Address: Address: . Phone: Phone: Zip: License: License: SCOPE OF PERMIT T/OFF SHEATH AND REROOD 275OSF RESIDENCE W/COMP SHINGLES,SMOKE DETECTORS REQ PER 97UBC. FEE SUMMARY Plan Check: $0.00 Calc Valuation: . ' $5,795.00 Permit: $125.25 - . . - - - Claim Valuation: $5,795.00 SMIP.Res: $0.58 • SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 ' ' • Total: $125.83 PLANNING &ZONING ' SETBACKS - ' . MAIN STRUCTURE Front 0-'0 Rear 0-0 Left 0-0 Right -0-0 - / - : ', f 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 2446-46(6/00) j I 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 wo�rks� compensation Insurance carrier and policy number are: / V Carrier: VI �/a 0,4..90 {)�. - ! Policy Number: w2-y '7 d3/ I (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 Califo ' nd agree t if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these visio Applicant Signature: ..tie Date: 7 p/ . v'/ero WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COV 5 UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDRION 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 7 0)of Division 3 of the Business and Profession Code,and my license is in full force and effect.Lie.a Class it C.3907 Contractor's Signatur` .I' J__ _ Date: 7-./0"O d 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 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 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 feel 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,AR 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 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 akPermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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 pan 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 at of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑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. /OP ro at 'Of Legal Owner(s) Data And/Or Author; :d 'PPlicart Date CODE 1 INSPECTION TYPE DIE 1NI10ALI CODE INSPECTION TYPE DATE 1 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing • 200 Final Re-Roof I 3"po &wt- 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 .----aC ..- --___ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. . _. O 7/.....„6_ 5e_D0-_4 TL • CITY OF COSTA,MESA 1 CONSTRUCTION,PERMIT RMMIT NO.y ! ,TRACT NO. ' rLOT NO 'UN;T NO. 1 Project Address •/ /W aia�'G'A - � �''�� r• " r { TYPE OF CONSTRUCTION-- LI NEW .0 ADD-1._d'A LTERATION• H REPAIR - [' Appbcant's Mai-hang'Address �3 /j.• • ❑ CONVERSION '❑ DEMOLISH ❑'OTHER=' * i Owner's Name �ft!/rC'-I'c� r 45 ,t25.r (',hone /�"�/�J4 I - - = A.P.# I '• .• - 1kk: Zone - _ DESCRIPTION OF WORK/USE OF BLOG.' • Address .-0-4/9-7e...- r - • : ' { : - S;, Main Building: 1 ' Accessory Bwldmg ' C"‘ • 1 Arch/Eng. ' License No , TYPE OF PERMIT : ❑,GRADING----❑ FOUNDATION ❑ STRUCTURAL , ' T Front • a I ! _ :O Address '-y�� m �q�_ p��� ❑ TENANT;• ❑aELECTRICAL .LTJ PLUMBING DEMECHANICAL, B Rear , • N i p r Contractor's NamN_Ae..5/911i4 Pm-Pmhone 1_[rL.>ZLZ.o n• ❑ OTHER _ I { • - A" _ • - I ! V t ✓-- PROJECT DESCRIPTION SO. FT. ' OCCUPANCY t •C Right Address lmailingl/733 IA FA-7/Lie4 ,tJ aN4//e-//27 - K - _ G • p _ CONSTRUCTION TYPE I VALUATION$ • IS Left . - ' I r, ' City License No. c1'93a • ZONE ' GRADI NG CU.YDS: ACRES ' R ) 'Pl ng. Ref,# Parking Req,/Provided 'Ea' LICENSED-CONTRACTOR DECLARATION ' - _ - - ' Q r , I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: I { , ' - , 'Planning Notes: 1 - ry1 •with section 7000).of Division 3 of the Business and:Professions Cede, and - - - - ' r `I • L • 4QOs' my license is in full for- an• a fect. , 1 /�/ S ; ; . : • - .�F�GI V EU, �' IrJ - - ' I. •S Licens- Class ' -. - Lica se' Co / • _ f la - i _ 1 Date '-- r - -Signature A(L f a a sir • 1 • PLUMBING I FEES . - 1 I 60 'WORKERS'COMPENSATION DECLARATION - -' I a ' • f a I hereby affirm that I have a certificate of consent to self-insureI Bar Sink. • 1 Showers ELECTRICAL ' ;FEES r ora certificate ' 1 of Workers' Compensation Insurance, 'or a certified 'copy thereof (Section Backflow Preventer _ Service Sink _ - • 3800;-Lab: C.) //p,/ • - - '- - -- -. Automatic Washer - - { - - -- Transformer 0-15-50•KW �- - { 'olicy No. a`7`-0 1`° Company 1 Vel S• Backflow Irrigation ! Sewer Ca t , . ' ) 0 50+KW • , ' r G etl copy is hereby furnished. p Construction Pole Sub. a rfietl co y;spied with the city lldin Di alp ' Bathtubs i 1 Sewer Connection. }3 y J } cityw �} J' [� /,/�, CookingUnit 1 Meter ❑u to:100 amps,\ Date V•O?/-d-1. APplpcanj�l /tis-t�N �-i/ o R-e�� - • ' ' P P EXEMPTION FROM WORKERS'COMPENSATION DECLARATIONClarifiers Solar Collectors Dishwasher Meter Dover 100 anps I I ;.(This section need.not be completed if the-permit-is for one-hundred ($100) or a .. - . r-- I 'less). Dishwasher . Solar Piping Dryers ❑Gas ❑Electrica i I I I certifythat in the _ p 9 y Sub Panel performance of the work for which this permit is issued,t shall-not employ any person in any manner so as to,become subject to the Drinking Fountains Solar Tank : 1 Fan ' Workers' Compensation Laws' California, a ' Motors❑0.1 HP ❑1'/x-8 1 I I �— — . Date Signature Floor Drains I 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'Cole, you must forthwith ' Floor Sinks Ufinal Fixtures Microwave comply with such provisions or this permit shall be deemed- revoked: - ' • - - a - -} - - - •CONSTRUCTION LENDING AGENCY , c .' . . Gas Service. Outlets ' a Water Closet I hereby affirm that'there is a construction lending agency for the performance - - Device Boxes Pole Light r of the work for which this permit is issued (Section 3097 Civ. C.) Lender's 1 Name _ •• Interceptors Water Heater , 0/ q 6 a Outlets Range 1 Lender's Address- • _ - ' Kitchen Sink _ . Water Service - : • Switches Sign ' f OWNER BUILDER DECLARATION- - ia - ' 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'construcq alter,improve,demolish or repair B-Trap . • a Laundry Trays . ' I �' Generator ❑0.5 KW ❑5-15 KW Trash Com actor 1 I any structure, prior to its issuance, also requires the applicant for such permit - P I a 1 to file a 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 . a _. _ - on',3 of the Business'and Professions,Code) or that he/she is exempt ; . - t therefrom and the'basps for the alleged exemption- Any violation.of Section 4 . • 7031.5 by any -applicant for a permit subjects$ 500);-the 'applicant -to a civil - - ! ' ' 'chatty of not more than five hundred dollars($500): • - - • 3 - I, as owner of the property or my.employees with wages as their sole 1 Reinspection Fee - ! $15 - Issue Fee $ • ', - compensation; will do the work, and the structure is not intended or offered - Reinspection Fee ! $15 Issue Fee ' I '$ 3 I or sale (Section 7044, to ss'and Professional Code: The Contractor's 1 - . - MECHANICAL '- FEES. r ' thereon, Law does not apply to an owner of a property who builds or improves a thereon,'and who does.sucha k himself/herself' or through his or her own - , - DEVELOPMENT SERVICES REQUIREMENTS: i 1 employees, provided that such improvements are'not intendedior offered for , Boller_ a - I 'Hood or Type I ❑ • Ia sale. If, however, the building or improvement is sold within one year of co m- - - _ ;Canopy Type II ,❑ t ,. Zoning Approved By Date j pletio n, the owner will have the burden of proving he/she did not build or Im- ' Duct,- Under Ground , 1' Building'ApprOved By Date- ; ' I rove for the purpose of Sale): I 1 LJ I, as owner of the property, am exclusively contracting with licensed con- ! Duct-Structural a , Refrigeration System -r Application Issued By \1 /IV/) Date 30^n'(n 1 tractors to construct the'project (Section 7044,Business and Professions Code: _ 1 ' The Contractor's License Law does not apply to an owner of property who ' Duct-Ventilating 00-100,000 BTU 0100,000 BTU / 4! aSUMMARY OF FEES , I builds or improves thereon,and who contracts for such-projects with a,con.-� a - I 1 tractor(s) license pursuant to•ihe contractor's License Law). I am aware that "' BUILDING PERMIT a$ SMTP • •$ = ' // Exhaust System 0 Multiple 0 System Repair/Alteration , proof o their Worker's Compensation insurance should be provided to me. '• '� . - , PLAN CHECK $ PERMIT O ❑ I am exempt under Section ' B.8 P.C.for this reason Firepl/Fact.Bit. ICBO# , Fire Dampers " ' `t 1 PLUMBING +$ U ISSUANCE $ �"" { 1 Date ' ' Owner • ' Heating System&Ducting ' { Registers a _ PLAN CHECK 25% $ ENERGY P.C. I$ ' ' I hereby certify that I,have•read this application and state that the above 00-1 00,000 BTU 0100,000 BTL _ 1t� GRADING, i$ �• 'information is correct. ',agree tocomplywith all,city'and county-ordinances a ; -- ELECTRICAL -$ - • : ' a and state laws relating to building construction, and hereby authorize -circ- a _ PLAN CHECK 50%• ,$ MICROFILM I$ 1 sentatives of this city atO ent}r u n the- above-mentioned property for • r - 1 - . . a I r inspection Rpy6pse a� i •&_a 7 �6 a MECHANICAL '$ ; TOTAL FEE ;$ Signature ��.,r'j",r�� � Date Reinspection Fee $15 Issue Fee $ 3 I 'a PLAN CHECK 25% $ j I Drivers' License or 55 ��' �•.: - ' CMF 865146,rev.10/84 White - Building;'Canary - Applicant: Pink :Accounting; Goldehrdd - Assessor - - - -- -' - - CONSTRUCTION AND PLANNING - - POOL &..;A _ - - , APPROVALS Permit.# - Date Inspector APPROVALS ' Permit# Date - Inspector, • 1 Temporary Electrical Service or Pole - - ' 7 52. Pool & Equiprnent Location i i 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. RoughPlumbing & Pressure Test _ - '6..Electrical UFER Grnd. . 57. APPROVAL TO-COVER-GUNITE r--7. Footings58. Electrical Conduit-Undrgrnd. - • 1. '8. Foundation - 59. Gas Pipe, 0 Undrgrnd., Test ••. - 9. Water Pipe-Undrgrnd. - • - - 60. Backwash Lines, P-Trap, 0 Undrgrnd. . 10. Structural Floor System - - 61. APPROVAL TO DECK - - ;11. Property Sewer Line & House Connection • - 62. Backwash &.Receptor-Final - 12. Sewer Cap 63. Heater &,Vent-Final 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 - i.- ' 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 7d. 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 , I 76. Dry Standpipe - 1 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 I - �� ' 32:•Electrical Power Meter-Final '80. FOOD CERTIFICATE ISSUED 33. Final Electric - - Notes: V-S,yL LEFT CAao. LdEO__- _ _._ 34. Final Heating'&-Air Conditioning z-q-f -CAkG Z. - - . -- - -- R.5 PER. ' o,3 V.r'C L,E.O 35. Final Gas Pipe-Test ' _ = - 4 •36. Hood or Canopy - . - - - • - - 37. Final Factory Fireplace I 38. Final Plumbing 39. Water Service-Final •:f: - • 40. Gas Service-Final ;, • • , - ` 41. Solar Domestic-Final -- - - - - - - - -- !J 42- Backflow Preventer - ' 43. Backf low Irrigation ;,-t _ , , - - • 44. ,L'andscape lirigation System! / r _ , • - _ 1 r , i , 45. Sound rAttenuation - - 'r 46. Handicap Regulations -• , -. ID 47. FINAL STRUCTURE & BUILDING • I '• H ' I , ` I • , tI 48. Special Requirements Completed I , - • ' , A ' 49. Electric Release to Edison ' , , -1 - ---4-- - . • - -, `, ' I , - I ' ' t: 50- Gas Release to Southein California Gas Co "' r. h. 1 o _. - --3 51. CERTIFICATE OF OCCUPANCY : - - - +-- -+-- ' - - .. ,r- No. Date . . - I_.