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Home My WebLink About442 BROADWAY - Building PermitsADDlicant to fill in a11 spaces ezeept those witnin heavy �ortler Itnes antl sign all aoProvriate tle<laratlons. MESA — )N PERMIT � ProjectAddress Y�� - ��«h'.�� "� Applicant's Mail�in�9�Address `� 4 Z C�/lON� WA /� G�, Owner's Na1mIe w E�UU G�CC. �~TI�il3ERK�%phone b L�(p—� JO� Address Yyz- Y3Roi00�.�7/0�/ - ,G.M � Arch/Eng. License No. Address Contrector's Nam Phone Address (mailing) City Licanse No. IICENSED CONTRACTOR D CLARATION 1 nereby affirm that I am licensetl untler provisions o! Charter 9(commencing with section ]060) of Division 3 of the Business antl Professions �otle, antl my license is in tUll force antl'effect. License Class _ � - Lfcense No. Oate Signature NORKERS'COMPENSATION DECLARATION 1 hereby atfi�m thdt I M1ave a certificate ot con5¢nt to self-insure o� a certiticate of"Workers' Cornpensation Insurance, or a certifietl copy thereof (Section 3800, Lab. CJ , , Policy No. � Company eCertifietl copy is M1ereby furnishe0. Certifietl copy is filetl with the city Builtling Division. Oate Applicant EXEMPTION FfyOM WORKERS' COMPENSATION DECLARATION (This section need not be completetl ii the permit is for one huntlretl {$100) or less). I certi(y that in the performance ot the work for which this perm�t is issuetl, I shall' not employ any person in any manner so as to become subject to the workers' Compensation Laws of Calitornia. Date Si9nature NOTICE: If, afte� making this tletla�atiOn, you ShoWtl become subject to tlte Workers' Comp6nsation provisions of the l.abor COGe, you must forthwith comply wi[h s��h O�ovi5iOn5 0� thi5 permit shall be tleemetl �evoketl. CONSTRUCTION LENDING AGENCV I hereby affi�m that there is a const�uction lentling agency (or the p¢�fo�manG¢ of the work far which this permit is issuetl (Section 3097 Civ. C.) lentler's Name l.entler's Atltlress OWNER9UILDER DECIARATION - I hereby aifirm that I am exempt Trom tpe Contractor'S License Law for the lollowing reason ($¢�tion ]031.5 Business antl Professional Cotle: Any city or county wnicn requires a permit to construct, alteq improve, tlemolish or repair any st�ucture, pYior to {ts Issuance, dl5o �equires the applicant (o� Such pe�mit o file a signetl g[acement that he/she is licensetl pursuani to the provisions ot �e Con(ractor4 License Law (CM1apter 9(commencin9 with Section ]000) of .Oivision 3 ot the Business antl Protessions Cotle) or that he/she is exempt theretrom antl ihe basis for the allegetl exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil eendlty ot not rqore than five huntlred tlollars ($500).. LJ I, as owner oT the property or my employees with wages as their sole compensafion, will tlo the work, antl the structure is not intentletl or offeretl tor sale (Section ]044, Business anC Professional Cotle: The Contractor's License Law tlo4s not appty to an owner ot a property who builtls or improves th¢�eon, anC who does such wo�k himselt/hers2lf or ihrouqh his or he� own employees, O�ov�tletl that such ImO�ovements are not intentletl or o((ered for sale. It, howev¢r� the builtlin9 or improvement is soltl wlthin one year of com- o�e<ion, the owner will have tne burtlen ot oroving he/she ditl not builtl or im- �iove tor the purpose ot sale). U I, a5 owner pf the p�operty, am extlu5ively mnt�acting with lic¢nsetl con- tractors to mnst�uct the project ($ection 7044, Busine55 antl Professions Cotle: The Cont�actor'S License Law tloez not apply to an owne� of property who builtls o� imp�o�¢s thereon, antl who cont�acts tor such p�oject5 wifh a con- tractor(s) licens@ pursuant to the CanGactor's License Law). ❑ 1 am exempt untler Section _ B. & P. G. for this reason Date � �� . �� Y_ Owner �_ ,I hereby certify that I have reatl thfs a E- I o53 I I I � I TVPE OFCONSTRUCTION NEW ADD ALTERATION REPqIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p, # DESCRIPTION OF WORK ' S Main Buildi E TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL . T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Reaf ❑ OTHER PROJECT DESCRIPTION � 54. FT. oCCUaANCV � C Right K Left CONSTRUCTION TVPE VALUATION $ $ ZONE GHADING CU. VOS. ACRES Ping. Ref. # Remarks: Parking Req./Pr� , . � Use of Building: r PLUMBING FEES �P�anningNotes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishvrasher Drinking Fountains Floor Dreins Floor Sinks ' GasService Ou[lets Interceptors Kitchen Sink � Lavatories P-Trap Roof Drains I Reinspee[ion Fee $25 Dutt - Under Ground Duct - S[ructural Duct - Ventilatin9 Exhaust System ❑ Multiple Pirepl/Fact. Blt. ICBO # Heating System & Ducting ❑o-ioo,000 sru �ioo,000 antl state law elating to builtlinq construction, and hereby authorize rPde- sentatives ot t city to e ter upon he above-mentionetl property ?or inspection p r 0 5. Si9nature Date �" � Z'�y �rivers' License or 55 � Rainspection Fee CMF 0865-66 rev, 7/g3 White - Builtling; Canary - Applicant; Pink - Accounting; GOltlenroC - Assessor $25 $hOW¢f5 Service Sink Sewer Cap Sewer Connection Solar Collecmrs Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service laue Fee Hood or Type 1 � Canopy Type 11 ❑ Refrigeration System ❑ai oo,oao aru ❑ � oo,000 eT System Repair/Alteration Issue Fee $ 3 $ 3 2292 I/12/84 8.00 ?L 2one ' Accessory Building:' � Z O ' N I N � G R ' E Park.Fees $ , � U . � , R E N E N T ELECTRICAL Automatic Washer Transformer ❑ 15-50 KW Construction PoleSub. � 50+KW Cooking Unit Meter�'up to 100amps Dishwasher Meter ❑over100amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors004 HP�1'/,-6 F,A,U. Inc.Solar �9-15 HP �16- Fixtures � Microwave Device Boxes Pole Light Outlets Range Switches Garbage Disposal Generator �0-5 KW �5-15 KW Standing Sections Trash Compactor 5+ F I Reinspection Fee I$25 � �ssue Fee I $ 3 I PUBLIC SERVICES REQUIREMENTS: 2oning Approved By nate Application Approved 8y Date Application Iwuad ey Date SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ P�AN CHECK $ ��,� ENERGV P.C. $ ELECTRICAL $ _(Zc��+_ GRADING $ PLAN CHECK $ MICFOFILM $ MECHANICAL $ TOTAL FEE $ g, � PLAN CHECK . $ . CONSTRUCTION AND PLANNING P� --& SPA � APPROVALS Permit# E�OS31 Date� Inspector AppROVALS Permit# Date Inspector I. Temporary Electrical Service or Pole 52. Pool & Equipment Location _ 2. Soil Pipe-Undrgrnd. . 53. Steel Reinforcement � �3. Electrical Conduit Utility-Undrgrnd. ' 54. Forms• - 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding . � 5. Steel Reinforcemerit - 56. Rough Plumbing & Pressure Tesi � 6. Electrical UFER Grnd. � 57. �APPROVAL TO COVER-GUNITE 7."Footings , 58. Electrical Conduit-Undrgrnd. 8. Foundation - 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. � _ 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property�Sewer Line & House Connection - 62. Backwash & Receptor-Final 72' Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final � 14. Rough Plumbing - - 65. Elecirical-Final � 15, Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT 20, Rough Factory Fireplace APPROVALS Permit # 27. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating � 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test � 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank �Gas ❑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 Nailing , 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 35. Final Gas Pipe-Test � 36. Hood or Canopy , 37. Final Factory Fireplace • . - 38. Final Plumbing , . 39. Water Service-Final 40. GarService-Final ' 41. Solar pomestic-Final . 42. Backflow Preventer 43. Backflow Irrigation ' � ' � 44. ,Landscape Irrigation System - 45. Sound 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 • 51. CERTIFICATE OF OCCUPANCY . . No. - � � � Date _ �