HomeMy WebLinkAbout1312 BELFAST AVE - Building Permits 11 1' � CITY OF COSTA MESA
4 BUILDING DIVISION
-
> j ,.___ DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER
PERMIT M06-00657
(714)754-5273 • Fax(714)754-4856 • www.ci,costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626
• MECHANICAL PERMIT
Job Address: 1312 BELFAST AV Status: ISSUED
Suite No Applied: 10/17/2006
Issued: 10/17/2006
Vicinity:
Parcel Number: 14103904
ISSUED BY:
Applicant: YENOLONIS, LAURA `�
Address: 422 JENKS CIRCLE
•
Phone: 714-998-4300
CORONA,CA OZ.
- Zip: 92880 -
Owner ESCH;KARLA V TR , - ,
Address:/ -106 VERDIN LN - ?:'
a
•
- - - Phone: e.
' ALISO VIEJO,CA Zip: 92656-1861 " •�
Contractor: ALLIED PLUMBING - HEATING -AIR CONDITIONI$t " "
Address: 422 JENKS CI• • "er.:.- '''._
Phone: 714-998-4300 t.
• CORONA,CA - Zip: 92880
• License:610780
SCOPE OF PERMIT
FURNACE CHANGE OUT FOR SFD(SAME LOCATION). ,
WORK TO INCLUDE: 1INST FAU<100K BTU.
FEE SUMMARY
Quantity . - Quantity
ISSUE FEE • $23.50 ' -- ' • -Repair/Alt Absorbtion Unit $0.00 0
Inst FAU<100 k BTU $14.80 1 Repair/Alt Refrigeration Unit $0.00 0
Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0
Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0
Inst/Rep. Recess Wall Htr $0.00 _ 0 __ ` . - Commercial Incinerator - $0.00 0
Refrig Sys<100 k BTU $0.00 0 - • Domestic Incinerator $0.00 0
Ref rig Sys>100 k BTU $0.00 - 0 Compressors/Absorption Systems
Gas Piping $0.00 0 Up to 3 hp/100 k BTU • - ' $0.00 0
Factory Fireplace, . $0.00 0 - 3 To 15 hp/500 k BTU
Hood w/Meth Exhaust . $0.00 0 15 To 30 hp/1,000 k BTU
VAV Box $0.00 0 30 To 50 hp/1,750 k BTU , , - $0.00 0
Vent Fan/Single Duct $0.00 0 •_Over 50 hp/Over 1,750 BTU - $0.00 0
Appliance - $0.00 0 Boilers '
Fire Dampers $0.00 0 • Up to 3 hp $0.00 0'
•
Smoke Dampers $0.00 0 - ' 3 To 15 hp . _ $0.00 0
Inst or Relocate Appl Vent $0.00 0 15 to 30 hp - $0.00 0
Air Handlers< 10000cfm "$0,00, 0 30 to 50 hp . - $0.00' 0
Air Handlers>`10000cfm . $0.00'.`;0 - - Over 50 hp �� / .$0.00 0
Floor Furnace - $0.00 '0'` . - - Other Mechanical Fee '
Floor or Suspend Heater /'$0.00 0 - ' ' . ' Investigation Fee " . ' . / , $0.00
Plan Check Fee $0.00
Reinspection Fee $0.00
•
TOTAL CALCULATED FEES $38.30
COMMENTS/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.
FOR INSPECTIONS CALL: (714)754-5626 •
2446-46(6/00)
DECLARATIONS • U
WORKERS'COMPENSATION DECLARATION: - i •
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.
a 1 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.
-„, efs"dom ensatlo Insurance carder and policy number are:
C `� `t ' /]?%&(') -Co
LCamer:ti \C \ C_o.ued olicy'Nu7nber: 1.JC-��"l J 1
(7h(s sec(ion need not be comp tetl 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 la s of California,and a e that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith
complywith.thes rov i ns.
r th- 1Tk-Otp
Applicant • M 4 \ pate:
WARNING:FAILURE TO SECURE ERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE($100,000),I D ITION 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,licp���n��_ssed under rovisions of Chapter 9(commencing with Section 7000)of Division 3-of theSusi d Professions Code,and my license is in full
force and effectnJ R \C1 � \_ L ?
Class' rt an
CONSTRUCTION LENDING AGENC ?
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: 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 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. 0 Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,I.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
•
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑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 Flre
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 ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this Application appermit for such construction or modification
from the South Coast Air/Duality 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 fumished 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 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.
Sign'aiuur�ree WOOfft1Legal Owne s) t l`Date
f nd/Or7luthprized. pti4nta DateO(
CODE L INSPECTION TYPE - PAIL 1tiEDALS CODE it INSPECTION TYPE V6 URITtALE
I�
1616 Fixed System Final Fire Prevention 206 Final Mechanical "J -is-Q7 by/I 3t_
1266 Pool Spa Final 208 Final Plumbing
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
war.) CITY OF COSTA MESA
L 'r q .41� BUILDING DIVISION PERMIT NUMBER
DEVELOPMENT SERVICES DEPARTMENT
e PERMIT
B99-00417 1
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1312 BELFAST AV Status: ISSUED
Suite: Applied: 03/25/1999
Vicinity: Issued: 03/25/1999
Parcel Nunmber: 14103904 Zoning: R1 R1
ISSUED BY:
Applicant: KIRBY, KEVIN
Address:
Phone:
Zip:
Owner: ESCH, KARLA V TR
Address 1312 BELFAST AVE
Phone:
COSTA MESA,CA Zip: 92626
Contractor FOUNTAIN VALLEY ROOFING
Address: 11237 SLATER AV
Phone:
FOUNTAIN VALLEY CA
Zip: 92708 License: 675241
Arch : Eng:
Address: Address:
Phone: Phone:
Zip License: Zip: License:
SCOPE OF PERMIT
REROOF-T/O,ADD 1 LAYER 30#FELT AND 2400 SF OF ELK PRESTIOUE 25 YR.COMPOSITION SHINGLE ROOF.
FEE SUMMARY
Plan Check: $0.00 Cab Valuation: $4,825.00
Permit: $99.75 Claim Valuation: $4,825.00
SMIP Res: $0.50 ._
SMIP Cam: $0.00
Other $0.00
Inspection: $0.00
Total: $100.25
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia 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
1 •
•
DECLARATIONS
WORKERS'COMPENSATION DECLARATION: • •
I hereb under penalty of perjury one of the following declarations:
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 Insurvce carrier and policy number are:
Carder: 572/t" , it/ °.✓�Y/�YQyne • Policy Number: Tif 5 -r/7
(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 California andee the If I should e subject to the workers'compensation provisions of Section 3700 of the Labor Cale,I shall forthwith
comply with these provisions 6
Applicant Signature: ' /'I � Date: _///2i/ t < ,
WARNING:FAILURE TO SECURE WO ERS'COMPENSATION VERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is In full
force and effect.Lic.# ' Class it
Contractors 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 Coda).
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 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 en 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 ❑No Drivers License No. Expires: _
Verification of Ownership by(type of document,i.e.-property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made In connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
I 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 ❑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? ❑Yes ❑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 ❑No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apernit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes L-I No
(Section 65850.2 of the California Government Code requires that the requested information be fumished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑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? ❑Yes ❑No
ch ceonce frompropaa___-ll_tion___..__._officer).
8 (If yes",attach certificate of compliance from the appropriate air pollution control
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.
I atur L ner(s) �/ Date
4 ' /err-- Z/ t 'Z
And/Or tho ed Applicant Bate
CODE# INSPECTION TYPE PAM JNTITIAL$ CODE# INSPECTION TYPE PAI® INTITIALE
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final � 208 Final Plumbing
`f •
_
200 Final Re-Roof "g,99210 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
2446-46
2 Z 1-)
PROJECT ADDRESS: 1312 BELFAST AV UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; P 068509
OWNER'S NAME: ESCH, ALYCE E TR
ADDRESS:: 1312 BELFAST AVE PERMIT NO: P 068509 • PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA,CA 92626
CONSTRUCTION TYPE; V—N PERMIT TYPE: PLU PURPOSE: OTH
546-4798
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION ; DISHWASHER C/O SQFT:
ADDRESS: UNIT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
PERMITTEE: NOCK PLUMBING ( 714 ) 895-1246
ADDRESS: 11610 SEABOARD CIR COMMENTS; NO OTHER WORK AUTHORIZED BY THIS PERMIT
STANTON CA 90680 +trt*at+E** *+Eek**a6+ESE**+t*:+E*sr*aE*xsr**************************+tat***+P+E******x*******St*+E
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON I NG R EQU IR EMENT $
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. S E T B ACK S
CITYLIG.: 050386 STATELIC.: 511971 cum: C 6 EXP: 02/
aw
l..B" —1 —$`I Signature: �" ��J MAIN BUILDING ACCESSORY BUILDING •
KERS'COMPENSATION DECIMATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
ompensation Insurance or a certified copy thereof(Section 3800.Lab.C.J. LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
POLICY NO.: 1167992-94 EXP.DATE: 3/0 1 /9 5
COMPANY: STATE PARKING REQ• PROV; PARCEL: 93405031 ZNE: REF NO:
❑ Certified copy is hereby furnished. LX Certified copy is h-. the city Bui.' • rivision. P .ANN I NG NOTES>
'S' c/tF > 1
D E V E L O P M E N T SERV R V I C E S''1 R E U I R E M E N T S
EiEMATION FROM WORKERS'COMPENSATION DECLARATION:this
is issued.
ail notcomplete,inthe permit n for onehundredso(as to loQ
I certify that in the performance of the work for which this permit is I shall not employ any person in any manner so as to become (�
subject to the Workers Compensation Laws of California. ZONING APPROVED BY .
DATE:
Date: Signature:
NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY ,,
i-> DATE:
Code. you must forthwith comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY; 1/_'(n/''( I y .J,/ DATE:
which this permit is issued(Section 3097,Civ.C). **********.**.*******.*.*{E***********.lE***fVt'i (-*****.*********if,********,**,************
LENDER: *******************************************************************************
ADDRESS: LEGALIZATION; N FEE -SUMMARY STRUCTURAL SEGMENT :N
A!
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC, MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 7 , 0 0 'f
repair any structure.prior to its issuance.also requires the applicant for such permit to fife a signed statement that he/she is licensed 2 5 Y SMIP/NON—RES
pursuant to the provisions of the Contractors State 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 7031.5 by PLAN _
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 20 . 00
I. as owner of the property or my employees with wages as their sole compensation. will do the work, and the BUILDING—D 1V > PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 7 . 00 20 , 000., 00 27 , 00/ 27 . 00 . 00
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through '�
hisoris employees. oidedyear thatsuch improvements are not intended bddeoof pfor sale. If. inotbuild buildingvREVENUE DIVISION TOTALS--> COLLECTED. 27 .00 OVER/SHORT; , 00
his or her of asoldmwithins.one year ofth completion,limp the entsr will have the burden ooffered
provingdforhe/she deo not however the or improver )'
forme purposeol sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 27 . 00 y,.
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware ********************.X.****************.fj.************.******.*.**.*.*****.**.****.****,.N.***
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
o I am exempt under Section: B. Si P.C.
for this reason: TYPE QTY DESCRIPTIO N, UNIT COST TOTAL COST
Date: Owner: 4_,I,
I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and PLU 1 D I$HWA$HER t , 7 , 00 7 , 00
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END,)QFFEES t
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from 1
these provisions.
Date: Applicant
I hereby certify that I have read this application and state that the •ove information is correct.I agree to comply with all city and county /
ordinances and state laws relating to building construction and h. '.y uthorize repress' . ' 's of this city to enter upon the above-mentioned .V//
property for inspection purposes.
a( /
^1 01 00166124-00166124 TOT 27.00
ate: 1 `` Signature: DATE: 08/17/94. TIME: 10:23
Wer s License or Social Security a:
1641.46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor •
CONSTRUCTION AND PLANNING POOL & SPA '
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector .
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. r`.L- .y 53. Steel Reinforcement
-'-3..Electrical Conduit1USitity-8ndrgrnds4.' ♦ 54. Forms
;"4♦"Fiectrieal ConduijUndrgrnd.• � �t Bonding 1
55. Electrical 1
5:1Steel ReinforcEm"eritt 56. Rough Plumbing & Pressure Test -
r,r r ,•
,;7:Electrical UFEli trnd. 57. APPROVAL TO COVER-GUNITE -'
u 7.'-Footings -' - 58. Electrical Conduit-Undrgrnd. -'
8.3oundation r 59. Gas Pipe, 0 Undrgrnd., Test -
• 9, Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, 0 Undrgrnd. ,
r
10. Structural Floor System '' 61. APPROVAL TO DECK
11. Pioperty Sewer Line;& Hquse Connection 62. Backwash & Receptor-Final
12. Sewer Cap V • 63. Heater & Vent-Final
13. Roof Drains _ 64. Plumbing System - Final
14- Rough Plumbing - 65. Electrical-Final
r
15. Rough Electrical-Conduit,- 66. Solar System-Final
16. Rough Electric-Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning • ' FIRE DEPT, REQUIREMENT
20,SRough Factory Fjtepiace 3 r -- p T-r_ t -APPROVALS' i:Permit
21. Dud:;, in_Strtotute,, I;; t. O, e - j70. Onderground1Hysfro
22. Ducts, Ventilating, .. ,.i i„ -' .r., S ^vs :r71- Product Piping LTG-As ;Oil
23.'Gas'eipe_�iough 8i"T(est r:-..17 , _ -4., "t 2. Underground Flush:; .)/
24.Roof Framing. ••--• i : s73. 11ndergrnd;Storacue;Tank 0 Gas ❑Ott
'. T. 1 1 Y r
25. Roof Shathin9 't 1 ' -, - _ ' 4: O- verhead•r ydro--
_
26-•T-Bay Ceiling (Struc.fural) & Monocoat t_ :n ,7 -I a s 75:Dry Chemical 7 t ; 4 ; `-r
27. Frame and Flashing' t 'J ;' - r `-'-- -- '1 -
c ;Xs I: ••n . - 76: Dry Standpipe - _
�}[,8.`Lathing& Siding 1 , ❑ M •• -4l 77rFIXEDSYSFEM'FIN_AL' =r
29. Insulation ' --i - r n I 4..• 783FIRE PREV, FINAL , ; ^ rt-1 {I
L-30. Drywall Nailing - It : r-, • E •HEALTH;OEPT. REQUIREMENT
ig ,r
t31, Plaster Brown Coat'. _ 1 )1' > „79.'F NAL INSPECTION .. -
t ` r c. a --80.rF00D CERTIFICATE ISSUED
32.Electrical-Power h... .. Finai . 1 i _
`33.;�inal'Electric. - 1 - I ' I. " Notesii . ?.7 y -t =
J
-.34- Final-Heating& Air.Conditioging"- •= 1 1 • s 1
35. Final•Gas Pipe,Test' , I t -��
436. Hood or Canopy ..v n r. -- i 1* - :
37. FinahFactory Fireplace' T r h i Y ,` '1
38. Final.Plumbing z.t ,4 .. ..
1043.1, i � 'r . -+ ---....1
39, Water Service-Final - -• ` (' ^l - - ' 't
AO. Gas Service-Final
:41, Solar Domestic-Final . i" -- I I i" . - - -
42. Backflow Preventer- :� � i I: "
443. Backflow Irrigation r " - r r ft.. r•
-
44. Landscape Irrigation System i,x .l ;q . :r • S,
45. _,Sound Attenuation'.- -+ts:• _ ,. ,
46. Handicap;Regulatiorjs r; -' - r' tr.
47. FINAL STRUCTURE & BUILDING I I, . _ ,
48. FINAL PLANNING.. x . ii. -
49. Electric Release to Edison i • 1 I it . _ -
•
.50. Gas Release to Southern California.Gas Co l I r.
51; CERTIFICATE OF OCCUPANCY :. . ,
No, Date
OWNER COLLEGE MESA COMPANY DATE 11-20-58
JOB ADDRESS 1312 Belfast-Avenue BUILDING PERMIT NO. 8030
' GENERAL CONTRACTOR The Hale Cmmna y VALUE $ 12,890.00
AP. No. LOT 1j5 TRACT 2671 FIRE ZONE DESCRIPTION OF WORK Res. w/att. gar.
GROUP I & J TYPE V ZONE R1 PLAN NO.
INSPECTIONS DATE PERMITS ISSUED
SUBCONTRACTOR DATE NUMBER '
Trenches Forms Steel i Jr- al.5 'd-C1
Floor System 2..-• .A.- 12 -3-3-e•
Steel Reinforce Chimney Re-Rod r ^`n
Bond Beam fl---* ) — k--s .1/ L. .
Frame and Flashing Er/ / -- V .-n'Y
Lathing, In• Out ar/pr/& 7—i9
Plaster, brown coat g -(y., / -29—.3)"
Underground soil%/-fc W/G Pipe TestLW /Q-3-Si
Top Out le,--46 SY
Furnace r./.-I,/ /-/5-1t, y, ri,„.n vwACW,At /- / 3-59 (69 6
Gas Vents �y / C s, / 7
Rough Plumbing A.M 1-2-559 //i'o� :e"e_ ItQV 2 0 10bb?.yS9 T Ftc)9 5—/./J�36 ?'
Cesspool Septic Tank e a g 4„,e,,... KJ\\
Prop. Swr. Line /House Con./ St. SwE. l' 4, e .-..,e /.��2tj -3}}' /CCcI'`�-� `I
Sprinkling System
Heating Final /,. 4/ p./0.4 Thai
Plumbing Fixtures, Final d/., leJ,• -ly9
Final Gas Test //;l A.he'.aA AQ x• a "n,
Construction Pole - - 'V
Underground Power g p
Rough Wiring 7J 7. 1..)74- s�.c. C l/Le P -c i d-3o--s4 7 r 76 ' S)
Fixtures, Final v— 3-3 tO - 111 I
OCCUPANCY _ L W,?./D.-ke9
Form 210-5M-1-57