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Home My WebLink About265 ESTHER ST - Building Permits, Aoolleant to fill in all spaces except those within heavY borEer lines anC sign all approorlate tleclarations._ � CiTYOFCOSTaMESA CONSTRUCTION.PE✓RM�I,T��q�� P RM NO. O TRACrTNO. COTNaO. � UNITN�C. , ' I2BQ IO/O�IIBS S%e�w � TI . Project Address �� r��'1�%��R. � " , �` ., v '� � . � � ' .. . . , . � "AppliCa�lFdOing Addre55 � TVPE OF CONSTRUCTION., NEW �ADD LTERATION � REPAI R �� ' Owner'S Name Pho� ❑ GONVERSION. ❑ DEMOLISH ❑ OTHER , A P # p � Zone � � DESCRIPT,lON OF WORK/USE OF BLDG. a� ^ � � Address ��L � � ' - S Main Building: Accessory Building: � - ' ' _ -' , . '. E � / " . . Z Arch/Eng. License No. � � TVPE OF PERMIT� J GRADING ❑ FOUNDATION STRUCTURAL T Front ,� p Addte55 ' ❑ TENANT y�vcLECTRICAL ❑ PLVMBING ❑ MECHANICAL . B Reat � 5 " ' ' N Conlractor's Nam � Phone � �OTHER A , � , � PROJECT DESCRIVTION Sq. FT. S �oCCUaANCY C Right � � N Addre551mailing) ' � CONSTRUCTIONTVP � � VALUATION$� .� g Left 2��7 � �' G R City License No. � , zoNE - � caaowG CU. vDS. ACRE �Ping. Ref. # ' Parking Req./Provided - �E LICENSED CONTRA OR DECLARATION ` • ' � '' Q 1 hereby affi�m that I am licensetl untle� provislons o( Charte� 9(commencing Remarks: � � "�� .Plannin NOt¢5: . wi[h section 7000� of �ivision 3 of tM1e Business antl Professions Cotle, antl �'�� S�I�_ ' �� ° 9 ' M my licenze is in full force antl ettect. ; ' � � ' - . - T - License Class License No. � � S Date � Signature� ' PLUMBING � ' " � FEES ' WOFKERS' COMPENSATION DECLARATION ' � - � 1 hereby affirm that I liave a certificate of consent to self-insure or a certificate Bar Sink Showers ELECTRICAL � FEES of Workers' Compensation Insurance, pr a certifietl_copy thereof (Section' gackflow P�evente� Service Sink 3800, Lao, cJ . - �'' - � Automatic Washer. � � � Transformer ❑ 15-50 KW � Policy No. � ' Company r- Backflow Irrigation ' Sewer Ca `� �• // ''�� ❑ 50+:KW Certifietl mpy is hereby furnishetl. � . . P'�• '�°� �^ Const�uction PoleSub.� , i� e'Certifietl m I5 tiletl with the city Builtlin Division. �� B3thtUbS � � � G�� " pv 9 Sewer Connecnon „ ,� ,. Cooking Unit Meter ❑up m 100 amps Date � � Applicant . � � � �' • EXEMPTION FROM WORKERS' COMPENSATION DECLARATION � Cl2�ifi¢l5 5012� COII¢ctOfS` !" ' � �� Dishwasher �� - Meter ❑OVC� 100aril�p5 (TM1is section neetl not be mmpletetl if.the permit is fo� one huntlretl ($100) or � �' . � ' , �ess). � , . Dishwasher ' . SolanPiping,��' .,�; s j jS _., Dryers ❑Gas �Electric Sub Panel i1 I certify that in the performance of the work for which this permk is issuetl, I � shall not employ any person in any manner w s to b co subject to the � Drinking Fountains Solai�Tank ��'� l� E"c� � j� �. Fan ` Motors �0-1 HP �1;'/x - 8 Workers'��p9�� epsat' ws o( CalitorJ�J ' . ' ' ' Da£e �L�� Signature -/-// Floor Drains - Swimmin Pool'�w/S'a •''� �� " 'NOTICE:If, attcr a�his tleclaratiort, you shoultl become syl/�ct to the . ,- 9 �P "'�� F�A�U� � � • Inc.Solar �9-15 HP�016-15+ Workers' Compensation provisions o/ Ihe Labor Cotle, you mg9t torthwith FloorSinks • Urinal ' . Fixtures ' � � comply with Such provi5ion5 or tM1is permit shall be tlee(aTetl rewketl. ��/ MiCroWave � . CONSTRUCTION LENDING AGENCV GaSService _Outlets .WaterCloset - DeviCeBoxeS I hereby affirm that there is a construction lentling�a9ency tor the pertormance POIC Light of [he work for wM1ich this permit is issue0 (Section 3097 Civ. C.) . Int¢rCeptOrS Wdter H¢atef OUtI¢t5 Lentler's Name - - � Range !� Lender'sAdtlress ' r KitchenSink - WaterService " Switches Sign � b OWNER BUILOEN �ECIARATION� • I hereby aftirm [ha[ I am exempt irom the Contlactor's LicenSe Law fol the LdvdtOliES ' AutO-WdSh ' following reason.($ection 7031.5 Business antl Professional Cotle: Any city or - GB�bag¢ DiSpOsal ;$tanding $2CtiOnS county whlch �equires a permit to construct, alteq improve, tlemolish or repalr P—Trap � Laundry Trays Generator 00.5 KW �5-15 KW any st�ucture, priOr to itz i55uance, also'requires the applicant fo� such permit Tl25h COrtlpdCtO� to file a sign¢tl ita[emen[ that he/she is licensetl pu�suant to Ne provisions of ROOf D�dinS � Ihe ContraclorR License� Law (Chapter 9(commencing with Section 7000) of ' ' DiviSion 3 of tne Business antl' Pro(essions,Cotle) or that he/She is exempt , . _ therefrom antl Ihe basis for the alleged exemption. Any violation of Section . , . , ' ]031.5 by any applicant for a permit subjects tM1e applicant to a civil ' � �endlty of not more than five huntlretl tlollars ($500j. -" 3 - I, as owner of the property.or my employees with wages as their sole Reinspec[ion Fae $15 � ISSue Fee $ compensation, will do the work, and the structure is not intentled or offeretl �� Reinspection Fee $15 Issue Fee $ 3 for sale (Section �044, Business antl -Professional Gotle: The Contractor's' ' MECHANICAL FEES License Law tloes not appty to an owner ot a property wito builtls o� imp�ove5 � thereon, antl who tloes such work himselt/herself or throu9h nis or her own - DEVELOPMENTSERVICESR UIHEMEN7 S' employee5, prOvitletl that such improvements are not intendetl or offeretl fo! BOil2f� HOOd OI Typ¢ I ❑ � ��j � sale. It, however, the builtlin9 or imp�ovement is soltl within one year of com- . � C3nOpy - TypE I I ❑ ZOning Approved By �K `^'! Dat �� pletlon, tne'owner wI11 nave ine burtlen of. pwving he/she did not builtl or im- Duct - Under Ground - prove for the purpose of sale). ' Building Appraved By Date% '� ❑ I, as owner of the property,�am exclusively-mntracting with licensetl con- Duct -Svuctural Refrigeretion System � Appliration Issued By • Dat tractors to mnstruct the projecf ISection ]044, Business antl Professions Cotle: Tne Contractor's License �aw does not apply to an owner of property who, Duct - Ventilating ❑0-100,000 BTU ❑100,000 BTU ' SUMM {� V pEES . builtls or improves thereon, antl who contracts for such projects with a con- ' � � ��) �/7 c ' bactor(sl license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repai�/Alteration � BUILDING PERMIT $ `�• � SMIP $' �✓� �2L , proof o{ their Worker's Compen ��s ance sl�oultl be provitletl to me. PLAN CHECK �� $ J� • � PERMIT �� I am exempt un0e ction ' &` 'for this reason Firepl/Fact. BIL ICBO # Fire Dampers ' ' ISSUANCE � $ 1�C �c• ' ' PLUMBING . $ � Date ' � owner � Heating System & Ducting � Registers PLAN CHECK � 25% $' '' ENERGV P.C. $ I her ' certi y� at.l have reatl thi •applica io 5 tl stat hat the above - ❑0-100,OOOBTU-�100,OOOBT ' . GRADING � $ � intormation:is correct. I a9ree to comply with an city antl unty ortlinances i � ELECTRICAL • . $�� antl state laws relatin9 to builtl� construction, and hereby authorize repre- -P�AN CHECK 50% $�3'�/ MICROF.1 LM $� sentatives of thi5 i�v o ent u the above-mentionetl p�operty f �� ' ' � . q inspectionpur �� • MECHANICAL $,' �!•� Si9nature �. Date , � � TOTAL FEE $ � Reinspection Fee �$15 Issue Fee ' .$ 3 PLAN CHECK 25% $. � ' Drivers' License ar 55 � � ' CMF 0865-46, �ev. 30/84 White - Builtling; Canary - Applicanq Pink - Accounting; Goltlenrotl - Assessor .� � � ... . .> .... . ♦ .. . . .. . „ . . . . -. .. ,. i �• {" CQ7VSTRUCTION AND PLANNING PGOL�& SPA� ' - - - „ Date ' Inspector ' � Date 1 Inspector , '. � AP,NROVALS Permit# APPROVALS Permit# : " � _. � . . �l 52. Pool & Equipment Location � 1. �7; porary Electrical Service or Pole '-. � _ , 2. , il Pipe-Undrgrnd. �: 53. Steel Reinforcement � � � 3. Electiical Conduit Utility-Undrgmd. � 54. Forms '. . , i.' � .. 4r;Electrical.Conduit-Undrgmd. � - 55. Electrical Bonding " . � ' 5�Steel'Reinforcement . 56. Rough Plumbing & Pressure Test ' `_6. Electrical UFER'Gmd. 57. APPROVAL TO COVER-GUNITE �j �. �'' � ' :• - � 7:��Footings � 58. Electrical ConduirUndrgmd. �v .• - ,8:� Foundation . �- 59. Gas Pipe, O Undrgmd., Test • Y�'. '' � . '9�.Water Pipe-Undrgmd. � ' 60. Backwash �Lines, P-Trap, � Undrgrnd. , �' - � �0 � + 10? Structural Floor System '- �61. APPROVAL TO DECK � , �11: �Property Sewer Line & House Connection F 62. Backwash & Receptor-Final "'�� . •, 12.`Sewer Cap � - � . 63. Heater & Vent-Final �� 13. Roof Drains ' 64. Plumbing System - Final - ' '� ' 14.,Rough�Plumbing 65. Electrical-Final � - . . ' Y � � +" 15. Rough Electrical-Conduit _ 66. Solar System-Final . . ',�. � _ - � 16'�Rou h Electric Wirin � 9 9 ' l�'ar,� (�,9 '..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, _ i 20:.Rough Factory Fireplace ��', APPROVALS Permit # - k 21. D'ucts, in Structure - .� � 70. Underground Hydro � 22�.�Ducts, Ventilating ' - �71. Product Piping O Gas � OOiI . , .23. Gas Pipe-Rough & Test . 72. Underground Flush+ - ' - -- , �- %�24. �Roof Framing, � � . � 73. Undergrnd.StorageTank OGas ❑Oil �,- 25. Roof Sheathing � �� , � 74. Overhead Hydro ' ' � 26. T-Bar Ceiling (Structural) & Monocoat . � 75. Dry Chemical ' 5�' 27. Frame and Flashing �� / � 76. Dry Standpipe ', 28. �pg & Siding � �� t �/ -.�d�� 77. FIXED SYSTEM FINAL 29. �Insulation � �/ �fj � 78. FIRE PREV. FINAL . � 30. Dcywall Nailing ,�' � �4 �d � HEALTH DEPT. REQUIREMENT ' 31..Plaster Brown Coat � � 79. FINAL INSPECTION - �32. �Electrical Power Meter-Final ' _ 80.• FOOD CERTIFICATE ISSUED , � �-33. Final Electric ' (pr2 �l�_ Notes: � " 34�. Final,Heating & Air Conditioning - ," �,, '� _ � - 35. Final Gas Pipe-Test - � � � 36. Hood or Canopy � , ' � 37. Final Factory Fireplace , 38. Final Plumbing ' •• /p/,y9/�f 39. Water Service-Final � - ` 40. Gas Service-Final � 41. Solar pomesticFinal , - , -� 42. Backflow Preventer .- � ' � � � �. 43. Backflow Irrigation. ' " ':� � , 44. Landscape Irrigation System - . ' , 45. Sound Attenuation , , . / - . -46. Handicap Regulations . 47. FINACSTRUCTURE&BUILDING �4� ' 48. Special Requirements Completed � � 49. Electric Release to Edison __ _� " J; ;� �" ` 50. Gas-Release to Southern California Gas Co , �° ' . � '51. CERTIFICATE OF OCCUPANCY �U " � " . � No. Date _ , � ' � � � . � • . .; '` AVplicant to fill in all spaces CITY oF COSTA MESA CON�TRUCTION PERMIT . •� ProjectAddrPss 9�6s 1-. S��« � ' Applicant�s Mailin Address �� S �-' �= S�(�i � � ��.'.l� t-gr'tK.0 �h1� � Phone ��Z `�' Owner�s Na^m�e Address O�' S G. ��% t K �� CS�'G� � rSK n.,,..N n 1. � . . r _, Address ,SL�/V•'K hfL0.GTlJILG� J�.�� 'VINh 1 •\. Contractor's Name Phone Address (mailing) City License No. ' LICENSED CONTRACTOR �ECLARATION �- I hereby affivm that I am licensetl untlet provislons of Cha�ter 9(commencing with section �000) of Division 3 oi the Businezs antl Protessions Cotle, ana' my license is in full fOrce antl effeci. - s �JCEf152 CId55 LIC2fI5C iVO. Oate Signatu�e � - — RKERS' COMPENSATION DEGLARATION ereby affirm�[hat I have a certifi[ate of tonsent to self-insure o� a certiiicate f Workers' Compensation Insurance, or a certifietl copy thereof (Section 800, Lab. C.) ' Policy No. - Company � eCertified copy is hereby turnisnetl. .,._ � : � Certifietl copy is filetl with the ciry Builtlin9 Dlvision., �a[e Applicanf � EXEMPTION FROM WORKERS' COMPENSATION OECLARATION ' (This section neetl not be wmpletetl if the permit is tor one huntlretl ($300) or less). • I certify 3t in the Oe�formance ot the work tOr which this erm�t is i55uetl, I shall n em0loy any person in any ma ne� sa as to b e ubject to the Wo�k s' C p� Q(n en5ation Lawsbf Califo �. . . Dat � L�1��Si9nature -NO IC� If, afFermakin9�this tleclaration, you shoultl� bec me s ject to the Workers' Compensation provisions of the Labor Cotle, you must forthwith comply witM1 such provi5ion5 or this permit shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV I hereby atfirm inat there is a mnstruction lentlin9 a9ency for the performance of the work'for which this permit is issuetl (Section 3097 Civ. C.) Lentler'S Name Lentler's Atltlress - OWNER BUILOEN DEC�ARATION � I hereby affirm that'I�am exempt from the Contraclor's License Law tor fhe followin9 �eason (Seciion ]031.5 Business antl Professional Cotle: Any city o� county which requires;a pe�mit to construct, alte�, improve, tlemolish or repair any structure, p�io� to.its issuance, alm requires Ihe applitant for such permi[ o tile a si9netl slatement that ne/she is licensetl pursuant to the provisions ot e Contractor's License Law (Chapter 9(commencing with Settion 7000) ot vision 3 of the Business antl Professions Cotle) or tha[ he/she is ezempt erefrom antl the basis tor the allegetl exemption. Any violation of Section 3L5 by any applican[ for a pe�mit Subjec[s the applicant to a civil nalty of not more Ihan five huntlretl tlollars ($500). I, as owner ot Ihe property or my employees with wa9e5 as thei� sole � rompensation, will tlo the work, antl the structur¢ i5 not intentled o� offeretl for'sale (Section 7044, Business and Professional Cotle: The Contractor's License Law does not apply to an owner ot a property who builtls o� imp�ove5 lhereon, antl who tloes such work himself/herself o� th�ough M1is o� her own employees, provitletl lhat suclt improvements a�e not intentletl or offeretl fo� �sale. If, however, the builtlin9 or imp�ovemen[ is zoltl within one yea� of com- pletion, tM1e owner wlll have LM1e burtlen of proving he/she tlitl not bulltl or Im� �rOve for the purpose of sale). I, as owne� of the property, am exclusively Con[racting with licensea con- ttactorsto con5tructlhe D�olect (Section ]044, Buziness antl ProTessions Cotle: The Contractor's license Law tloes not apply to an owner ot property wno builtls,or improves [he�eon, antl who con[rac[5 for such projects witb a mn- Iractor(s) I¢enze pursuant to tne Contracto�'s License Law). I�am aware tha[ proof of their Worker's Compensation inzurance shoultl be provitletl to me. ❑-I am exempt untler Section - B. & P.�C. for this reason Date Ownerl��{�( � I her by certify that I have veatl this ap0lication antl te � information is correcL I agree to compty with all tlty antl mu antl state laws relating to builtlin9 con5truction, antl hereby a sentatives oi this city to en r u on the above-mentionetl inzpection gurp�. �� I , I . _ wifhin heavy bortler lines antl sign all aOG�aV/�ate tleclarations. IACT NO. � L T NO � � UNIT NO. � 3582g � TVPEOFCONSTRUCTION NEW ADD 'ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER p,p.# ,� DESCRIPTIONOF�WORK/USEOFBLDG. ADD �A��LA6lr p� d/t• : t � S Main Building: E TVPEOFPERMIT . GRADING FOUNDATION STRVCTURAL T Front� 4 '� ❑.TENANT ❑ ELECTRICAL ❑ PLUMBING O+ECnH.ANUAL A Rea��/ � � OTNER. ' S. Cu'� PROJECT DESCRIPTION 5a. FT. oCCUPANCV � � C Right � ,^� ��... � K Left � ' ' CON'STRVCTION TVPE v � VAWATION $ �'�vVC �ZONE GIiADING CU.YDS. ACRES p��y, Ref. # ' ,Remarks:� , ; � , Planning Notes: 3ar Sink ' 3eckflow Preventer � 3ackflow Irrigation � 3athtubs Clarifiers Dishwasher ' Drinking Fountains Floor Drains Floor Sinks . Gas Service Outlets Interceptors � .. � Kitchen Sink �'f Lavatories • P—TraP ' • o-�. . Roof Drains � ' r ' Reinspection Fee $75 Boiler Duct - Under Ground. Duct - Structural ' Duct - Ventilating ' Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Hea[ing System & Ducting ❑ O-7 00,000 BTU � 100,000 BT� Drivers' Licen— s�55 #� / ��- y_�_ I I Reinspec[ian Fee CMF OB65-46, rev. 30/B4 Wnite - Builtlinq; Canary - Applicant; Pink - Accountlng: Goltlenrotl - Assessor n Showers Service Sink Sewer Cap Sewer Connection � ' Solar Collecrors � Solar Piping - Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service . - Auto-Wash . Laundry Treys Issue Fee Hood or Typel ❑ Canopy Type I I ❑ Fefrigeration System ❑o-ioo,000eru ❑ioo,000 System Repair/Alteretion PireDampers � � Registers FEES , , ' Zone ' Accessory Building:� . Z : ' ' � O t•� � N � I � 211G� TD r ' N 1 � Y S'�"� ry Parkinq Req./ vided E Q ' .S V � � M . T S ' � ' � , ELECTRICAL . � � Automatic Washer Transformer ❑ 15-50 KW . ConstructionPoleSuh. ' . . '050+KW Cooking Unit � Meter ❑up ro 100 amps Dishwasher . Meter ❑over100amps . Dryers ❑Gas �Electric . Fan F.A.U. . . Fixtures . . Device Boxes a Outlets ' ' . � Switches Garbage Disposal , - Generotor �0-5 KW 05-15"KW Sub Panel � � � Motors DO-1 HP Oi %- 8 . Inc.Solar 09-75 HP �i6-15+ Microwave � Pole Light; o �,.e . � r� $�__ Reinspection Fee $15 Issue Fee FEES �DEVELOPMENTSERVICESREQUIREMENTS: �Zoning Approved By - �-' S � Date _ Building Approved By �� Datey„_ Aaolintion Issued Bv ` at� $15 I I - laue Fee �� I $ 3 _ __ .........�oi.� BUILDING PERMIT $ , — PLAN CHECK $� �� PLUMBING $ � � PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ � MECHANICAL S PLAN CHECK 25% $ SMIP ' PERMIT. ISSUANCE ENERGY P.C. GRADING MICROFILM TOTALFEE iTp�F: iji," $ 3 �CONSTRUCTION AND PLANNING POOL & SPA �APPROVALS � Permit #�� Date Inspector qppROVALS Permit # .Date Inspector --i, � - 1� yTemporary Electrical Service�or Pole 52. Pool & Equipment Location_j; ` . � .�^ i n 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,. , ,., C'%} � 27 D �! ' l. 7. Footings ; f �. S�,�� r .L� ��-- 58. Electrical Conduit-Undrgrnd:`, j � 8. Foundation �(`, � � 59. Gas Pipe, 0 Undrgmd., TestL' ' �•; ! 9. Water Pipe-Undrgrnd. . � 60. Backwash Lines, P-Trap, O'Clndrgrnd. � 10. Structural Floor System � ) $o � �'� 61. APPROVAL TO DECK - ) !� '�� , ., 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final �'� ( --Y�' �� 4 ' 12. Sewer Cap 63. Heater & Vent-Final r �� ;. ' � 13. Roof Drains 64. Plumbing System - Final , y �- `r 14. Rough Plumbing 65. Electrical-Final �;~ e% . - ': N 15. Rough Electrical-Conduit 66. Solar System-Final �v 16. Rough Electric Wiring . 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING i/ 18. Rough Electrical-T 8ar, Ceiling� 69. POOL/SPA SYSTEMS FINAL Q. �" 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ,% t� 20. Rough Factory Fireplace APPROVALS Permit # r �� ' t, „' 21. Ducts, in Structure 70. Underground Hydro �j 22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil � 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank-O Gas ❑ Oil. ,� _� l�i 25. Roof Sheathing � ( g� ,�� 74. Overhead Hydro t�i �; 26. T-Bar Ceiling (Structural) & Monocoat . 75. Dry Chemical � .�� ,� � � 27. Frame and Flashing - _ 76. Diy Standpipe � :j„ � � , ' . � 28. Lathing & Siding 77. FIXED SYSTEM FINAL`� �` 29. Insulation 3'g� �- � 78. FIRE PREV. FINAL L 30. Drywall Nailing 5� uV� 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 � � � � � _ � ��./� � T 35. Final Gas Pipe-Test ��- � --. Z �'i '� � 36. Hood or Canopy ' � p t�l��l.- d L GCi� � 37,�Final Factory Fireplace Sv �`�' �, 38. Final Plumbing . t � 39. Water Service-Final I II-� I UG - p� �� cn, i I 40. Gas Se�'vice-Final O 41. Solar pomestic-Final � . . .42. Backflow Preventer . ' . � �.�Y i � ' 43. Backflow Irrigation , j � � 44. .Landscape Irrigation System � '`� w,. . ' 45. Sound Attenuation '- � " ' - - <' � � . 46. Handicap Regulations � � � � � , ' 47: FINALSTRUCTURE&BUILDING �l Z� �q � •� ' " 48. Special Requirements Completed ' � ,� - - 49. Electrie Release to Edison ' ' ��: 50. Gas Release to Southern California Gas Co � ;' � s L 51. CERTIFICATE OF OCCUPANCY,, - � No. "' Date ' � • < r r tiITY bF COST,4 ME A/ ON�STR ION PERMIT Project Address v, � G � ApplicanJ's Mailin9 A ss �- r ` Owner's Name � • l��`-'' Phone �! Address �� Arch/Eng. � - ' Licenu No. Address ' � Conttactor's Name � Phone � Address (mailing) 1 .i � City License No. LICENSED CONTRACTOR DEGLARATION I hereby affirm that I am licensetl untl¢r provi5iOn5 0( Chart¢t 9(comm¢nGing with section 7000) of DlviSion 3 of Ihe BuSin¢ss antl P�ofesslOns Cotle, antl . Ty IIC¢f15¢ IS lp (UII fOICE dOd CifCC�. License Class License No: Date � Siqnafure WORKE0.5'COMPENSATION DECLARATION � i hereby attirm tnat I have a certiticate ot consent to selt-insure or a certlficate ' Workers' Compensation Inzurance, or a certitiea mpy thereof (Sectlon 00. Lnb. GJ ;.� ' ✓ ..olicy No. Company 8 Certifietl copy'is hereby fuTishetl. ,%: Certified copy is filetl with the city Builtling Division. Date -' - Applicant "�' E%EMPTION FROM WORKERS' COMPENSATION DECLARATION (Tnis section neetl not be mmpletetl it [he permit is for one huntlretl (5100) or . less). � • � �� I Certify that in"the performan<e ot Ih¢ work for which thi5 pe�mi{ is issUetl I,i shall not employ. ny perzon in any manne� so as to come ubject to t�e Workers' mpe�tlon Laws of Calif � � Date V Si9na[ure �^",. NOTIC : It, after makin9 this tleclarabon, you shoula bec me su ct to the Workers' Compensatioo O�ovisions o( the Labor Cotle, you mu torthwith tompty wi[h such provi5ions or thi5 pe�mit sball be tleemetl �evoketl. ' CONSTRUCTION LENDING AGENGV � I hereby aifirm lhat there is a construction lentling agency for tne performance Of the work tOr which this p¢rmit i5 i55u¢tl (Section 3097 Civ. C.) Lenaer's Name ' Lentler's Atlaress OWNER BUILDER DECLARATION I hereby atfirm lhat I am exempt (rom the Contractor's License Law for the following reason (Section 7031.5 BuSiness antl Professional Cotle: Any city or county wM1icb requires a permit to construct, alte�, improve, tlemolish or repai� any sV ucture, prior to its issuance, also requires the applicant tor such permlt to file a siqnetl statement that he/Sh¢ i5 licensetl pu�suant to the p�ovi5ion5 of the Contractor's License Law (Chapter 9(commencing with Section 7000) oi r+ivision 3 of the Business antl Profezsions Cotle) or that he/she is exempt �efwm antl the basis tor the alle9etl ezemption. Any violation oi Section 15 by any applicant for a permit subjects the applicant to'a civil F +�*y of not more than live nuntlretl tlollars (y500). .�I, as owner ot the property or my employees with wages as their sole ;y�compensation, wi11 tlo the work, antl the structure is not intentletl or.of(eretl '�for sale (Section 7044, Business antl Protessional Cotle: The ContractorR License 11w tloes not appty to an owner of a property who builtls or imOroves thereon, antl who tloes such work himself/herself or tnrough his or her own employees, pioviGed tnat such improvements are not intentletl or offeretl tor sale. If, nowever, the builtling or improvement is soltl'within one year of com- pletion, the owner will have the burtlan of proving he/she tlitl not builtl or Im- prOve for Ute purpose of sale). ❑ I, as owne� ot ihe property, am exclusively cont�acting with IicenSetl con- tractors to construct the project (Section 7044, Business antl Professions Cotle: Tne Contractor's �License Law tloes not apply to an owner of property wno builtls or improves thereon. antl who'contract5 for such oroiects with a mn- tractor(sI l�cense pursuant to tne Contractor•s License Law). I am aware thax proo! of [tlei� Worker's Compensa[ion insurance Shoultl be provitleC to me. ❑ I am exempt untler 5ection _ �& P. C. for this reason Date / � b owner I hereby certify that I have rea� Information is torrecL I agree to antl state laws relating to builtlin SEOidIIV25 Of (�1j5' LI(y (O 2fL� OB65-46,rev. 5/88 till in all spaces exeept lhose within heavy Gortler iines antl sign all apD/o0riale Oeclarations. _ - - .,,., ,..,. �f l� ,�/ , . A.P.# C% TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAI S Main Building: E � ❑ CONVERSION ❑ DEMOLISH ❑ OTHER G 7 F�Ont DESCPIPTION OF WORK/USE OF BLDG. � A Rear TYPE OF PERMIT GaaoING FOurvDATION STaUCTURa� I, C Right ❑ TENANT 0 ELECTRICAL ❑ PLUMBING ❑ MECHANICAL §� Left ❑ �OTHER � C//_ Ping. Ref. # PROJECT DESCRIPTION Sc�. FT. �"'� oCCUanrvCv� planning Notes: CONSTRUCTIONTVPE � VALUATION$ ZONE GRADINGCU.VDS. ACRES Remarks: Sink Preventer Irrigation Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trep Roof Drains Reinspection Fee , � $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting I �0.100,OOOBTUO100,0006T Reinspec[ion Fee � $15 White - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collecmrs Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet ' Water Heater Water Service Auto-Wash Issue Fee Hood or Typel ❑ CanOpy Typell ❑ Refrigeration System ❑0.700,OOOBTU ❑100,000 System Repair/Alteretion Fire Dampers Registers Issue Fee �� 3— Zo�a . Accessory Building: Z O N 1 N G R Parking Req./Provided E Q M T $. ELECTRICAL � FEES Automatic Washer Transformer ❑ 15-50 KW ConstructionPoleSub. � 50+KW lN Cooking Unit - Meter ❑up to 100 amps Dishwasher Meter ❑over100amps ,.,.��, Dryers ❑Gas—�Electric SubPanel ' Fan �• Motors �0-1 HP � 1 h- 8 • . F.A.U. Inc.Solar �9-i5 HP �16-15+ �� Fixtures Microwave .�.~-. • Device Boxes ," Pole Light . Outlets Range � �. Switches � � � ' Si9n Garbage Disposal-. Standing Sections ' �- Generator 00.5.KW 05�15 KW Trash Compactor FEES Rainspection Fee $15 luue Fee $.$-- DEV ELOPMENT SERVICES REQUIREMENTS: $ 3/� 2onin9 APProved BY Date FEES /, Building Approved By Date Applintion laued By � Date � 2— ' � SUMMARV OF FEES � BUILDING PERMIT $ SMIP $ ' PLAN CHECK $ PERMIT PLUMBING $ 13~ ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ � �GRADING $• PLAN CHECK 50% $ _� . MICROFILM $ �,� MECHANICAL $ �� TOTAL FEE $ R 7— PLAN CHECK 25% $ ��. �aq2i��:`�oo.�.:=a: �f S_ r G?.�t.v rez�: gt,�u:,�ss rrnE; e�:s� �4• B . ' . . '✓' .♦ ` Ga .1..J+Y';... -, a, � . .:� . y �:,.., .. v- _ � -y_.-h:_.�.�;�:y.ii;i ...::t,yw_ . .r _ . 5 _ . . . ' . . ` v�, r �Z��.'..� � . � CONSTRUCTION AND PIANNING � 'POOL.�''� �=-�'�ct' ' ' APPROVALS Permit# Date Inspector qppROVALS. Permif# Date Inspector 1. Tefiporary Electrical Service or Pole C f 52. Pool & Equipment Location �� ,�.�� , ; 2. Soil Pipe-�Undrgmd. �� 53. Steel Reinforcement • ,.,- � ��• 3. Elegtrical�Conduit Utility-Undrgrnd. 54. Forms ��i 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding r � 5. $teel Reir4fo�cemerit,:� 56. Rough Plumbing & Pressure Test � ,. i 6: Electiical UFER Grnd. 57. APPROVAL TO COVER-GUNITE I � � , : �. 7. Footings ' '� � 58. Electrical Conduit-Undrgrnd. �� : ; ,�, , 8. Foundation � '�. 59. Gas Pipe, O Undrgrnd., Test .�;i� . . 9.� Wate�.Pi e-Und�rgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. � P' � ' 10. Structur�l Floor System :�� 61. APPROVAL TO DECK � 17-. Property Sewe� Line & House Connection �� 62. Backwash & Receptor: final '-'-�� . � � ' ( 72.� S`e�Jer Cap . r . �, .'.: 63. Heater & Vent-Final �'� �;,�, � 7 3. Roof Drains ,� . . ;� 64. Plumbing System - Final S � 14. Rough�Plumbing ��q 65. Elettrical-Final t 15. Rough.Electncal-Conduit - �� - 66. Solar�System-Final , � �. �' % f_8�� Rough Electric Wiring �- ��lJ• ry� � ��,. _ 67 � Fencing & Access Approval 17%. Rough Wiring Sign � 68. APPROVED FOR PLASTERING 18'. IRough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19� Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT il 20. Rough Factory Fireplace ,'� APPROVALS Permit # 21. DuCts, in Structure ,.� � 70. Underground Hydro ' 22. Ducts, Ventilating ��' 71. Product Piping OGas ❑Oil 23 �Gas Pipe-Rough & TesL. 72._ Underground Flush 24.� Roof Framing �� , 'j lv 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing T:! �� 74. Overhead Hydro � � � � v 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frameand Flashing'� ��✓ V� 76. Dry Standpipe 28. Latli'ing & 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. iF00D(CERTIFICATE ISSUED ,, ..w �• � 33. Final Electric �'� � �7 � Notes: _ ��_ � :' 34. Final Heating & Ai� Conditioning '] 7 � � d i ' 35. Final Gas Pipe-Test � ' 36.-Hood or Canopy �•-• 37. Final Factory Fireplace � 38. Final Plumbing � -� � � � � 39. Water Service-Final �, � 40. Gas Service-Final ; . 41! Solar pomestic-Final `j'42- BackflowPreventer . ,�., i�. .� 43. Backflow Irrigation r��, � -� � ; � 44. .Landscape Irrigation SYstem ". 45. SouncJ 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 , r�: ' 51. CERTIFICATE OF OCCUPANCY .. �, -• ... . `� No. Date ,� � �) � �j� ' r'� �`� .i