HomeMy WebLinkAbout2316 ELDEN AVE - Building Permits�� ��� ,
C057A MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 3i] COSTA MESA. CALIFORNIA
S
FOR APPL/CANT TO f/LL /N COMPLfTELY
TYPE OR PRINT
BVILDING�3,� p ���„�, ,� e. m
ADDRE55
COSTA MESA, CALIFORNIA
i ' • / i
�rx�
� �� REC�i��� _
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APPLICA'TvIO�N FOORPPERMIT
���BUILDING �cJp
FOR OFF/CE USf ONLY
IRECEIPT NO. I �I`� p�jT (J I
PEC�IVEC BY I OAT€f,i=CE1Vj0 I OwTE ISSOED
fG/ b�x
BUILDING��/ 4 ///J � /�f•
ADDRESS � �I � (1�/li4y�( ` /
COSTA MESA, CALIFORNIA
ADORE55/�6 <' L�/�i2/Yy�,.,�/J/�yi(iGN"C � S��
LEGAL LOT �i�YP� ^� 20NE /'� /�INO.OF
nEscniv'noH NO. � BLOCK TRAGT O � � P�ANS
r
�i
�— � � � D APPROVED
A.P. NO. I �- BY �
SIZE � �„ � .` �I NO.OR BLUGB. YARDS
OF LOT {! �LD rvow oH �or REQUIRED
USE OF • �, I�ENTER LINE ST.1
EXISTING BLDG. ��T� FRONT /
SETBACK LINE FROM I �
CENTER OF STPEET REAR YARD R. $IDE �
/ �
SIDEYARD ILEFT � ' RIGHT L.SIDE �%�
DESCRIPTION OF WORK REAR % /�n
NE' I� ALTERATION I II ADDITION I �( -if
REPAIR `' I IIMOVING 'I IIDEMOLISH I «-
SZEDINGdOI� ROOMS /D STORIES
EXTERI R W i IROOF
COVERING COVERING
USEDF BUILBING AND WORK TO. BE9ERFORM /
I DATE � � Z� �"
JING
USE OF NEW
�'BUIL�INO
DATE �n/� ,\
`EVES � �
LOWED
�1!,i�.� irv.
Ff. IN.
FT IN.
� , IN.
�
�-�/�D /O - /�-
I HENEBY ACNNOWLEOGE THAT 1 HAVE RERD THIS APPLILAT�ON yHE AMOUNT SHOWN UNDER VALUATION IS FOR THE
ANO STATE THAT THE /�BOVE IS CORRECT ANO AGREE TO COM-
PLV WITH /�LL CITY ORDINANCES ANO STATE LRWS FEGUINTING PUPPOSE OF E9TA0LISHING R PENMIT FEE ONLY.
BUILOING CONSTRII TION. VALUATION
SIGNATURE OF � � ��� �1 / / C ,r� PERMIT FEE $ � O
PERMITTEE �� !OJ%��
$ � U O� PLAN CHECK $ � v�
.—� �AUTHORIZED AGENT �J / Q —
/ E� TOTAL FEE $
1
- �0582
COSTA MESA BUILDING•SAFETY DEPARTMENT
P.O. BOX 31] COSTA MESA. CALIFORNIA
��
FOR APPUCANT TO f/LL /N COMPLETE[Y
TYPE OR PRINT
BUILDING Q/ f%1 /J �/� ��
ADDRE55 J �CJ7 ��
COSTA MESA. CALIFORNiA
n � /1 .
� ARCuITEGT LIC.
ADDRE55 /aa�l� aL�i.�..»� �r. J� lV
oescniviioH I NO. `% i'/ I BLOCK / I��1C�T "
A.P. NO. I I� '� ��/ � O �/
51ZE ` NO.OF e�ocs,
OF LOT ' �, ��J NOW ON LOT �
USE OF �`N,�
EXISTING BLDG. �V _
SETBACK LINE FPOM 7QC' �l �
DESCRIPTION OF WORK
REPAIR I II MOVING I II �
BUILDIN Q O.OF �/
SIZF / n p' I�.4df a� ROOMS (/
I HEHEBY ACKNOWLE�GE THAT I HhVE REAO THIS APPLICpTION
AND STATE THAT THE ABOVE IS COFFECT RNO AGHEE TO COM-
PLY WITN AlL QTY ORDIN.�NCES ANO STATE LAW9 flEGUL�TING
BUILOING CON�STR/UCT ON.
S��G�NA�URc O� / ` � �� Lfi6A/�/
■ AUTHORIZED AGENT
�
FIRE
ZONE
I�IF'li ]�
: �� ��L�.B�l�l�
- e.�/ �o- I(�-S'q
FINANCE DEPT.
APPLICATIOfJFFOR� PERMIT
F. . ._...,
BUILDING
fo,e officF vsE oNcy
I HECEIPT NO. I PERMIT NO.
COSTA MESA. CALIFORNIA
TYPE O GROUP '�
DATE��Z3
i
ZOIVING
NO.OF U9E OF NEW �//�
IPLANB�'�I9UILOING A�/.ni./
i r ./: �r�ce
/ � /p �
A DATE /I�/ fI �
J ''
EVES
ALLOWED
�i.l /� //
�� / A._W .��• IN.
�. � F7. I N.
�
� � FT. IN.
THE AMOUNT 6HOWN UNDER VpLU�TION IS FOp THE
PURPO6E OF EST.�BLIBHING A PERMIT FEE ONLY.
VALUATION � ��
��J'7�'] FERMIT FEE $
J oC
.. % /)/% V� PLAN CHECK S � �r
���
�(Fj 33a _' TOTAL FEE 5 �J'�
� .. ' � 151.5'�
„�.OSTA MESA BUILDING-SAFETY DEPARTMENT
P, O. BOX 917 COBTA ME6A. CALIFORNIA
For Applieanf to Fill In Complefely
TYPE OR PRINT
ADDRES9 � e � �f/�/�/ y�• C. �/
COSTA MESA. GALIFORNIA
� MAIL
TEL. //�
TEL.
NO.
� � � � _ / I NO. OP BLpGB.
88TBACK VNE FROM
CeNTER Oa sTReEi REAR YARI
SIDE YARO I�EF7 IRIGHT
DESCRIPTION OF WORK
� BUILDING `.d A �
WORK TO BE
,ricd�,c.c� —
I HEREBY ACKNOWLPDGE THAT AVE PFJ�D TNIB • IC
ANO BTATE THAT THE ABOV¢ CORRECI' AND A TO
PLY WITH A�-L QTY O INANCEB AND ¢'JATE REGUL
9UILDINO CONB ji. // /
AGENT
0
�ECEIU��
AUG 1.7 t°Sl
FiNANCE DEPi.
CITY OF COSTA MESA
APPLICATION FOR PERMIT
BUILDING
For Office Use Only
RECEIPT NO, PCRMIT NO.
f �5 ii i %
�EIVEO BV ( IlATE FlE EIV O � ATE IBSII
i ra � 7—(� l
BUILDING ��/ � � �/ �� /,
ADDRE55 X
GnSS1�A�MESA. CALIFORNIA
FIRE
APPRO `jl � /��E fJ
BY bAT
� ��� ZO ING
ZON NO. OF I U6E OF NEW
� � PLl�NS 7� BUILDIpp ��.
/iL /Td
)
LEGAL % % Q
D66CRIPTION ^ J�� �
A. P. NO. I I LL. �—/ 1 S�/ � (
(CENTER L�NE 8T.1
REAR FT. /c�� IN, F
APPROVE - �! � .��J /'� �
BY [� �/1 DATE � C�
�
4]
_ �
1 �,LS�; � � {.'�i'�'''.��� �
? n � d
I� � . � �' I{�
a
3 S? `� � �C� � a
�O d� �o-,,,, �
TNE AMOUNT $HOWN U SR VqLUAT1pN 18 OR TNE iL
PURPOHE OF EBTpBLIBHING A PERMIT P ONLY. V!
VALUATION y� A..yi O
PERMIT FEE $ ��� N LL�'
n
��S�D � PLAN CHECK $ �L a
��� z �
TOTAL FEE 4 j
COUN'I'Y OF ORANGE
BUII.DING DEPT.
636 No. Broadway
Santa Ana� Califomia
Phone: KI 2fi211
- _ •
/�pplication For Building. Permit
AND FOR A
Certificate of Use and Occupancy
�
Permit No..J.Q.I'�.._a�lp.-
�//. .� i —
I'ROPOSED
2. JOB LOCA7
3.
4.
i.
G.
7.
3.
9.
10.
I I.
n
p
'l.
�
/
(House No.) b� � (Namc of5creetj' ' � `� (Tuwn lu �S.chool District)L�ir� ' M• '
LEGAL DESCRIPTION: Loc-----.�.G ..................-------------Block :.N.��..�.�.:.rJ:L..I---- Trac:..........�..11..U------------
(Metcs and Bounds Descnptioo--Use reversc eide o( (orm) , , . ' - ' �J �/ O–QS !' / `
CORNER LOT ( ) INTERIOR LOT ( ) THROUGH LOT ( ) SLOPE OF LOT ( �j
SIZE OF BLDG.:. - ................ - AREA:.... - ... ---�� -SIZE OF LOT: - - - - ...AREA:..........._ -
HEIGHT OF BLDG .:.............._.'..:.. _.. :....._...CEILING HEIGHT:.................--..--..---------NO. OF STOR]ES-__-_..-----..-_------------
NO. FAMILIES ..........:.._.-----�ze of SmallestBedroom:.';._,-..-'---:-.,--.1..:_.. ... Sizc of Kiechen-.--_....._-_....._-__.._.----
EXTERIOR WALL CONSTRUCTIQ�T,.1 . ....................!.. �..:...!.. ,....INTERIOR WALL COVERING..:...................._....._._..........
(Frame. Smtm. Etc.)' \J �. ' ' ' ' � . : : , . (PlascervDrywall. E[c.)
SETBACKS: Fronc Yard From Cenrer Line�of S_ t�t.:...:..:._i...'.._�..5 ...:.........:...c.....................................--------------�----......_.........---
• CJ
Nearest Side Yard ...........:..._.......R . iY,ard.i...;._".-...:..i...:Distance iri Ecet 13etwcen 131Jgs. on Same Lot............_......_.................--._
i
A COMPLETE PLOT PLAN IS REQ RED, SHOWIN ; Al. �YRUCTURES AND USE OF EACH.
' ' �.,�.. i��'�, Q . . . . .
For (a) Footing:, Width ...:.......:......i...... .......:...Depth in G, un .. .................--�---...Width of Wall............--�----........---
Accessory . . . ' • .
Bldgs.and ..:..;Spacing....' ..........:..........:"CC a inl of Floor......................-=---........
Similar �b) Size of Study:......._ .............
Stnttures:
(c) Size of Floor Joists :.:............................:.......:...Spac ...._..-----_ �t,,,�......_:'CC_
.. ..
(d) Size of Rafters :.............:..........:......:._�......1.......Spacing.:........... ...._......i4�C
12. VALUA7'ION OF�PIj�OP� D WORK: Including all labor, plumbing, cicctrical �'ng, heating, firc =_prinklcr=, painting and
sewagc disposal $......�?..._!i..'.'..!...� ....:.......... , ,
I3. ] HEREBY CERTIFY 7'HA7 TO THE BEST OF MY� RNOWLEDGE AND BELIEF TH;
APPLICATION ]S CORRECT AND THAT THE CONSTRUCTION WORK WILL CC
THE COUNTY OF ORANGE AND THE STATE OP CALIFORNIA APPLICABLE TH
Plans Filed:..... ................................�...,
FEES:
Bldg. Permit •
Plan Check -
Tota] • •
Receipt No. ���'
Paid to - •
Signed
By
MATION ]N THIS
TO ALL LAWS OF
FOR DEPARTMENTAL USE ONLY
GROUP.......r(. �
T Y P E............ � .......:.....
ll1ST. p�
MAP-------...�.. .A.T....��...
SHEET NO ............ ....
�
.
DATE.:........ Y.. , , �
; ..... .... ... ....�.............. ......... .....
•v M-P.91 � . .
�C; BY
APPLICATIO . .... . EALTH ............................
ZONING-- ..............I..f.... FIRE ;
MA KSHAL ............:...........
PLANS AND. .
SPEC'S ...............:.. �' STATE................._..............
CORRECTIONS ENGINEER
`P—..�
�/ �
COUN'I'Y OF ORANGE
BUILDING DEPT.
636 No. Broadway
' Santa Ma, Cali(omia
� Phone: KI Z-6211
1. OWNER'S
MAILING
i/9 -� �s/ -- � :
f�pplication for Building Perm�.
AND FOR A
Certificate of Use and Occupancy
(o
Permit No..�.Z_�/_..�
D,ce_...._../..�'.. �`..-�---- //'�S'Z---......---�-
-- -....._. PHONE:----------�---------------�
CITY. ��f. -�-��_-��-----
, -,-.
`- '- -'-'— - -- -. - � ' . Name '
Name ----------_..-- ..................................................---....`_�..:_.._.. ......-------------� --� ..........-�----- .......-----�------��---..... -.....
(Arc6irect or Engineet) , (Contractor)
' Address ...................... -...._._.......---�-------................._........... Address ..............- -�--------�--'- ........-----.....-- • ----...........-------....-----
City......-- '-'----'--...._ ........ .....- --'-'----- ---.....- .............._ City ...----... ` ........... ----................ - ......-----...--- -------'--' ......
Statc Sta[e
Lic. No. � .........:........................ Phone--- �------�� ---� ---............ Lic. No...... ..................... - ------- Phone --'-� ---.....---... -- ---.......
PROPQSED USE:
2. JOB LQCATION._
3.
4.
5.
6.
(House No.) (Name o( Street) , Town o Schoo7l Distr' )
NAME OF AND DIRECTION�FROM NEt1REST CROSS STREET_...���� °� v7d ............. .�...................._......_...
. �p� /Y
-- - ..
LEGAL DESCRIPTION: Lot.- --- ---:^"".......- /...��... - ---�- �L-------- -� U � -- ---..... Tract �- -- -........_ ........... ....
(Metes and Bounds Descripcion—Usc reverse side of form)
CORNER LOT ( ) INTERIOR LOT ( ) THROUGH LOT ( ) SLOPE OF LOT ( )
SIZE UF BLDG.:----/f�.....'_1__2�..AREA:-.--- �.�-0----.....SIZE OF LOT:..:T-d...--. ��-0----AREA:....�.Z..7. _�v..
. �/ � /
HEIGI-TT OF BLDG.:..._.._.p ...............................CEILING HEIGHT:......_......�...._..........NO. OF STORIES___........�......_...___..__.
�—
7. NO. FAMILIES_...-------_•_-------------_-.-.-.--Size of
8. EXTERIOR WALL CONSTRUC'I'ION:....`�
(Frame, Smcco, EtcJ . �
ROOFING COVERING ....:...........��.._..._..
9. STAT$ HOW MANY BU IL,DINGS NOW ON LOT
.. - ����- - - �� ' -- ........- � - - ........t�
.`...--�---._...... Size of Kitchen......_.... - ---,-/....
IIOR WALL COVERING__�.�..._�%S...X:._..
��,.�, (PlastcrvDrywall. Ett.) :
I
GIVE U OF EACH ..............�...:..__...r �
- � - ..._.... �
o ,,
]0. S�TBACKS: Front Yard.From Center Line of Street .........................:Uv_.. !, ...... ,
-
Nearest Side Yard...� ../:.� Rear Yard...� �� .Distance in Feet Between Bldgs. on Same Lot ......D.'_�.
(Propercy Linc) (Provcrcy Linc) �
I1. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRCICTURES AND USE OF EACH.
12.
(a) Footing: Width........---�------ �....----- Depth in Ground...._.... --�- ��----._..Width of Wall ...........................�--..
. �j /,, �� .
(b) Size of Studs:--_2x--:[---.----Spacing_---...._�W..---.--_"CC Material of Floor._ ................................-.---------
(c) Size of Floor',
"CC
(d) Size of Rafters:.....Z..� � pacin �`
...-- � --------- ��--- ---5 5�--- -----g ---�--- ��---...: `CC
13. VALUATION OF PROPOSED WC�C: Including all labor, plumbing, electrical wiring, heating; fire sprinklers, painting and
sewage disposal $...----_�._z- i�.....-..-----..-.....
14. I HERfiBY CERTIFY THAT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS
APPLICATTON IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF
THE COUNTY OF ORANGE AND THE STATE OF CALIF9RNIA A,�'PLI�BLE NHERETO.
/ l/
� Signed:
Plans Filed:....+.�(�-/l � � �
, --'...-"'-'--'-------'--'--_-"'--'----"-By:.
(Owner)
. .---------'---
{Au[horized Agent)
FOR DEPARTMENTAL USE ONLY
FEES: � �E��L�' BY
Bldg. Permit • $--..---...�_C..�_. .,/�--
GROUP..._..✓.. !. APPLICATION. ... .!:.. 1 �'riEALTH ............._.............
Plan Check - $...��--... TYPE-.-.--_.9.[L�..---.._-------.. FIRE
_ ZONING--•-----••--........i�
Total , , , $....- -f �.---- DIST. �, _ Q p- MARSHAL--------- �-------...
}.� PLANS AND
Recei t No. - d' � MAP------------------ '-----...C.__... c/
P ��------ ��� �/� SPEC'5 ....... ..... ............ STATE------------��--�------...
- ----
Paid to � • ........,.. .�.��.�.�I. SHEET NO .......... ................ CORRECTIONS ENGINEER
YL'RM "1= 7
�� �/�J ��
DATE----.1... ...1 J' - - /------------ ---.......--�- -- -� 5
s000--v-sv
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, • i
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P
�
✓ OF
N G E
Mr. Peter H. Lainbeer
1609 Baker Street
Costa Mesa, California
Dear Mr. Lainbeer:
�grk��'M'�P��7ME���
JOHN R. PHILP, M.D.
HEALTM OFFICER
SRNTA ANA OFFICE
8TM 8 NORTH RO55 STREETS
SIINTA ANA, CALIFORNIA 92702
TELEPHONE: 83{-3t3f
Molllnq Addr.iit P. O. Bor 355
Sanee Ana. Call/ornla 9170I
pNAHEIM OFFICE
1011 SOUTN EAST STREET
ANAMEIM,CALIFORNIF
TELEPMONE: 7]6�5551
Molllnq Addni.: P. O. Box 355
Son�a Ana. Ca17h�nia 92701
An investigation was conducted of property owned or controlled
by you, located at 2316 Elden Avenue, Unit A, within the City of
Costa Mesa. This investigation revealed several violations of the
Uniform Housing Code which are listed below for your information
and action.
1. Section H-505(g) - Plumbing fixtures installation and
maintenance improper - toilet is inoperative.
2. Section H-601(b) - Shelter - rear porch area is not
weatherproof.
3. Section H-601 (c) - Exterior wall surfaces not pro-
tected against decay.
4. Section H-701 (b) - Electrical equipment - wiring in
some areas appeara hazardous.
5. Section H-1001 (b) 12 - Inadequate Sanitation - a
heavy cockroach infestation is evident.
6. Section H-1001 (b) 13 -
unita are showing aigns oP
maintenance.
�
7. Section H-1001 (b) 15 -
garbage and rubbieh storage
General dilapidation - all
dilapidation and lack of
There is a lack oP adequate
and remoyal.
8. Section��H-.1001 (h) - faulty weather protection -
exterior walls - ineffective weatherproofing.
.
�
Page 2
DATE: December 24, 1970
T0: Peter H. Lainbeer, 1609 Baker Street, Costa Mesa
RE: property located at 2316 E1den Avenue
9. Sectlon H-1001 (k) - Hazardoua or unsanitary premiaea.
There is a buildup of junk and debris on and about the
premises.
• In accordance with Section H-202, you are hereby notified that
this premise is declared to be subetandard and.is a public nuisance
which ahall be abated by repair, rehabilitation, demolition or re-
moval.
The unit has been posted as "Unsafe to�Occupy". The utility
companiea have been directed to discontinue aervice to this address
and service will not be reinstituted until corrections are made and
a reinapection has determined that the unit ia safe and sanitary to
occupy. �
If I may be of aseistance to you in the above matter, please do
not hesitate to call.
. Yours very truly,
GGS:dh
cc: Roy June, City Attorney
D. Dorris, Building Inspector
m
GEORGE (3. SKEITH, R.S.
Environmental Health Sanitarian
�
0
P�
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r oF
NGE
HEALTH DEPARTMENT
December 24, 1970
Southern Callfornia Edison Company
1505 Mesa Verde Drive - East
Costa Mesa, California
Gentlemen:
JOHN R. PHILP, M.D.
HENLTN OFFIGER
SANTA ANA OFFICE
8TN 6 NORTH RO55 STREETS
SANTA RNA, GALIFORNIl1 92]02
TELEPHONE: 83�-3131
Molllny Add...it P. 0. Box 355
Santa Ana. Caliiomla 9i707
ANAMEIM OFFICE
1011 SOUTM EAST STREET
AN�HEIM,CALIFORNIA
TELEPHONE: ]76-5551
Mallinp Addr•+r: P. O. Bo+ 355
San�o Ana. Calilo�nla 92702
We are requesting that the electrical meter and
service be discontinued at 2316 Elden Avenue, Unit A,
Coata Mesa. This department hereby declares that the
structure located at this address is unsafe to occupy.
GGS:dh
Yours very truly,
GEORGE G. SKEITH� R. S.
Envlronmental Health Sanitarian
�
O
P
�
rv o F
AN G E
HEALTM DEPARTMENT
December 24, 1970
3outhern CaliPornie Gas Compar�y
P. o. Box 333u
Maheim, Cai�fornia - 92ao3
Gentlemen:
JOHN R. PHILP, M.D.
MERITH OFFICER
SANTF RNA OFFICE
BTM S NORTM RO55 STREETS
SANTF ANA,CALIFORNIA 92702
TEIEPHONE: 83�-3131
Molllny Addr•rit P. 0. Bei 355
San1a Ana. Coli/o�nla 9I703
RNAHEIM OFFICE
1011 SOUTH EAST STREET
AN�HEIM,CALIFORNIA
TEI.EPHONE: 776�5557
Malllny Addr.i�: P. O. Boi 355
San1a Ana. Cal!lornla 9270i
We request that the gas service be diacontinued at
2316 Elden Avenue, Unit A, Costa Mesa. This department
hereby declares that the atructure located at this
addresa is unsaPe to occupy.
08S:dh
Yours very truly,
GEORl3E f3. SKEITH� R. S.
Environmental Health Sanitarian
Appli<ant to fiil in all spaces except those within heavy Dortler Iines antl sign all aoaroo/�ate tleclarations.
CPi'YroF COSTA MESa CONSTRUCTION( PERM�T
� Project Address Z3 1 �+ E, c� e1J � I'\
Applicant'S M'a,i`lina AArlrecc 50�{- �r� An1.�%S iQ' '
Owner's NamN� � W��T a-�Q4DA� U�r /.�i�CPahon 'O�-G �
Address ���- QP.n--A��!{ �,Q .
Arch/Eng. License No.
r-
Address
Contractor's Name � d � � Phone
Address (mailingl �
City License No.
LICENSED CONTRACTOR DECLARATION �
1 hereby affirm that I am licensetl untle� p�ovislons of Char[er 9(commencing
wltM1 section ]000) of Oivision 3 oi the Business antl Pwfession5 Cotle, and
my license is In tull torte antl efiect.
License Clazs l.icense No. �
Da[e 519nature
WORKERS'COMPENSATION DECLARATION
' hereby aftirm that 1 have a certllicate ot consent to self-insure or a certlticate
Worker5' Compensation Insurance, or a cerUfietl copy thereof (Section
J00, Lab. C.) ' ,
Policy No. Company
eCertifietl copy Is hereby turnished.
Certifietl copy B fileC"with the city Builtlin9 Divislan.
pate � Applicant
E%EMPTION FROM WORKERS' COMPENSHTION DECLARATION
(TM1isseclion need m[ be wmplet¢tl if the pe�mit is fo� one huntlretl ($300) ar
Icss).
1 certify thal in ihe Oe�to�mance of the work fo� which this pe�mit is issuetl, I
Shall no[ employ any pe�son in any mann So a5 f0 betome subj¢Cf to ihe
Workers' ComDensa2ion Laws o( Califo '
Date �7- �`� ��f 7 Signatur¢ � �•
NOTICE:Jf,after makinq this tloclaration, you shoWG become subjecLto the .
Workers' Compensation provislons of the Labor Cotle, you must forthwith
comply with sucn provision5 Or,thls permit Shall be tleemetl revoketl.
CONSTRVCTION LENDING AGENCV
1 hereby affl�m lhal th¢re i5 a wnstruc[Ion lentling agency to� the De�fo�mance
al the work fOr which this Oermii is issued (Section 309] Civ. C.)
LRntler's Name �
Lentler's Atltlress -
� OWNER BUILDEN �ECLARATION
I hereby affirm that I am exempt irom the ConVactor's License Law for tne
following reason (Seetion ]031.5 Business antl Professional Cotle: Any city or
county which requires a permit to construct, alt¢q improve, tlemolish or repai�
any ztructure, prior to its issuanc¢, also requires the applicant tor such Oermit
to flle a signetl statement that he/she is Iicensetl pursuant to ihe provisions of
ierefrom antl the basis for the alle9etl exemption. Any violation ot Secllon
731.5 by any applicant for a Permit subject5 the applicant to a civil
nalty of not more than five hundretl tlollars ($500�.
I, as owner of the prope�ty or my employees with wages as tneiv sole
� ompensation, will tlo the work, antl tne structure is not intentletl or offeretl
for �sale (Section 7044, Business antl Professional Code: The Contractor'S
Lirense l2w tloes not apply to an owner of a properiy who builAs or improves
[he�eon, antl who aoes such wo�k himself/he�self or through hi5 or he� own
employees, provltletl that such improvements are not intentletl or otferetl for
sale. If, howeveq the buildin9 or improvement is soltl within one year of com-
pletioq fhe owner wi11 have the burtlen of proving he/she tlitl not bWltl or im-
prove fot the Purpose ot Sale).
❑ I, as owne� of Ihe property, am exclusivery cont�acting with lic¢nsed con-
tracrorsto construct tne pro�ect (Sectlon 7044, Business antl Professlons Code:
The Contractor's License Law tloez mt apply to an owner ot property who
builtls or improves [hereon, antl who contracts for sUch projects with a con-
tracior(s) imense pursuant to tne Contractor's License Law). I am aware that
proot of th¢ir Worker's Compensation insurance ShOultl�be provitletl to me.
❑ I am exempt untler Section _ B. & P. C. for Nis reason
Da[e
Oriver5'
certiiy that I have reatl this application antl state Nat the above
m is correcL I a9ree to compry with all city antl county ortlinances
laws relating to builtlin9 construction, antl hereby authorize repre-
of thi ity/ to en ¢r upon the above-mentionetl /property /or
Pu'r ^�/ �� e/�-9—�7
_ i ��/�i.
Pink - Accounting: Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet '
Water Heater
Water Service
Auto-Wash �
Laundrv Travs
Issue Fee
Hood or Typel ❑
Canopy Typell ❑
Refrigeration Sys[em
❑0-t00,000BTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
luua Fee
Automatic Washer
Construction Pole Sub.
Cooking Unit
D ishwasher
Dryers ❑Gas ❑Electri�
Fan
F.A. U.
Fixtures
Device Boxes
Outlets .
Switches
Garbage Disposal
Generator 00�5'KW 05�
�
2one
ng:
ELECTRICAL
Transformer ❑ 15�50 KW
❑ 50+KW
' Meter ❑up to 700 amps
Meter ❑over100amps
Sub Panel
Motors00.1 HP�1Yh-8
Inc.Solar �9-15 HP �16-1
Microwave �
-- Pole Light ' �
Range
Standing Sections
� KW Trash Compacmr
$� Reinspectian Fee $15 Issue Fee
FEES
�DEVELOPMENT SERVICES RE�UIREMENTS:
Zoning Approved By
Building Approved By
Application Issued By '
FEES
S
- . SUMMARV OF FEES
BUILDING PERMIT �$ �� D D gN�Ip g • S� -
PLAN CHECK $ PERMIT
PLUMBING § ISSUANCE S
PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL $ GRADING � $
PLANCHECK 50% $ MICROFILM $ - gp�
MECHANICAL $ -VD TOTALFEE $ .7 !'S�
PLAN CHECK 25% $
Z
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1
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T
S
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit UtilitY-Undrgr�d. - 54. Forms � '
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding '
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe�Undrgrnd. • 60. Backwash Lines, P-Trap, O Undrgrnd.
70. Structural Floor System �v�u �,� �(r�� ��' � 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 Electrica�-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# _
27. Ducts, in Structure 70. Underground HYdro
22. Ducts, VentilaTing 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. RoofFraming - 73. Undergmd.StorageTankOGas ❑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 Nailinc3 � HEALTH DEPT. REQUIREMENT
37. Plaster Brown Goat 79. FINAL INSPECTION �
32. Electriral Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning �: l
f
35. Final.Gas Pipe-Test �
36. Hood or CanopY
37. Final Factory Fireplace . .
38. Final Plumbing
39. Water Service-Final •
40. Gas Service-Final
47. Solar pomestic-Final .
.
42. Backflow Preventer
43. Backflow Irrigation �
44'. Landscape Irriqation System ' ,
45. Sound Attenuation
46. Handicap Regulations � � Ov � �
6
47. FINALSTRUCTURE&BUILDWG l r�9s� V�� �
48: Special Requirements Completed
49. Electric Release to Edison � .
50. Gas Release to Southern California Gas Co
51. -CERTIFICATE OF OCCUPANCY
. �'
No. Date
: '