HomeMy WebLinkAbout324 COLLEEN PL - Building PermitsPROJECT ADDRESS:324 COLLEEN PL UNIT:
OWNER'S NAME: MR & MRS PERAULT'.
ADDRESS: SAME .•� ., .
•ARCHIENGINEER: 3 ' REG.NO. '
ADDRESS: UNIT:
PERRIREE: .BOB ELECTRIC - (714)'656-3.331
ADDRESS: 1539 MONROVIA 7
N. B.;- CA'92663
LICENSED CONTRACTOR 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 aoe ect.
Cl UC-: 0 3 4 4 2 STATE LIC.: LASS:
Datea, — � Signature: /��%��
WORK' 5' COMPENSATION DECLARATION: I hereby affirm that have a certificate of 4irsent to self -insure or a certificate of Workers'
Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C).
POLICY No.: WC 8 13 19 81 EXP. DATE: 0 5 / 31 / 9 0: ,
C0*ANY: STATE
Certified copy is hereby furnished.' Certified copy is file }}}} the city Buildln Di
nate: Applicant: ��:"�ti�
ter— r�—O
EXEMPTION FROM WORKERS' COMPENSIITNIN DECLARATION: (chis section lNetl nqi be mi
mDleled if the permit is tar one hundred ($100) or Rss .
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 a to become
subject to the Workers' Compensation Laws of California.
Date:Signature:
NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor
Code, you must forthwith comply with such provisions or this permit shall be deemed revoked.
- CONSTRUCTION LENDING AGENCY: Ihereby affirm that there is a construction lending agency for the performance of the work for
which this permit is issued (Section 3097, Civ. C).
LENDER:
.- ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt front the Contractors' State License Law for the following reason
(Section 7031.5 Business and Professional Code: Any city of 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/she is licensed
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) 0, that he/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). ..
t I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the
El, structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State License Law
`does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through
his or her own employees, provided that such improvements are not intended or offered for sale. It, however the building or
provement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve.
,for the pumose of sale). -
I, as owner of the propeM, am exclusively contracting with licensed contractors to construct the project (Sectian 7044, Business
El 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 contraclons) license pursuant to the Contractors' State License Law),I am aware
that proof of their Worker's Compensation insurance should be provided to me,
F-1 I am exempt under Section: B. 8 P. C
for this reason:
Date: Owner.
I do hereby certify that I am aware at Still understand the requirements of California Realth and Safety Code Sections 25505, 25533, and .
25534 and that I or any future building occupant will/will not (circle one) need to comply with mid state codes and the requirements for a
permit for construction or modification from the Air Quality Management District. Residential construction applications are exempt from
these provisions.
Date:Applicant:
I hereby certify that I have read this application and state that the above information is t. I agree to mply with all city and county
ordinances and state laws relating to building construction and hereby authorize represe hues f this city nter upon the above-mentioned
property for inspection purposes.
Date: " y Signature:
Driver's License or Social Security
1641.46 White—Building; Green—Code Enforcement: Canary—Applicant: Pink—Revenue: Goldenroal—Assessor -
..CITY OF COSTA MESA - BUILDING,PERMIT. PERM NO:, E 04490`5
PERMIT NO: E .044905 'PLAN,CHECK NO: N GOVT: •N SUPP:'N .
CONSTRUCTION -TYPE:' PERMIT TYPE: ELE`- PURPOSE:,ALT
i
JOB DESCRIPTION PANEL`'CHANGE OUT SQ FT:'_
..CLAIM VALUE: - CALC-VALUE: GROUP OCC: /
COMMENTS:
Z O N I N'G R E Q U I.R E.M E N T S.
S E T. B A C K S
------------- MAIN BUILDING ----- - ='------- - ACCESSORYIBUILDING - ---=
FRNT: FT IN REAR: FT IN 'FRNT: FT IN REAR:.,.'FT IN
LEFT: FT IN'RGHT: FT IN LEFT: FT. IN RGHT: FT IN. i
PARKING REQ: PROV: PARCEL: '00000000 ZNE: REF NO:
PLANNING NOTES>
>
D E V E L. O P M E N T. S E R V I C E S R E Q U I R 'E M E N, T :S
ZONING APPROVED BY DATE:
BUILDING APPROVED BY DATE:
APPLICATION' ISSUED BY: DATE: ��11
###3e##################7FTF3FTF3<TF�F iF�FiF'kF�F7F�F'TF'TF7F F73Tf'iF iFi�iFiF�iEiF�iF#1F######## 7F�##
LEGALIZATION:N ; F E E S U M M A R Y' STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE 'SMIP/RES GRADING
PERMIT 18.50 '
508 SMIP/NON-RES
.PLAN'
ISSUE FEE
1.5.00
BUILDING -DIV->
PERMIT'
ISSUE PLAN -CHECK TOTAL PAID
DUE
TOTALS--.->
.1.8,5,0
1.5,00 0.00 33.50 33.50
.00
REVENUE'DIVISION TOTALS-->,.
COLLECTED: 33.,50 OVER/SHORT:
00
BLDG PMT
PLUMBING ELECTRIC
MECHANIC. FIRE SMIP/TOT GRADING
PLAN -CHECK
'33:50
I N D I' V
I, D U A L' F E E' B R E A K D 0 W N'
TYPE QTY
D E S.0 R.I.P
T I'0 N UNIT COST
TOTAL COST
ELE 1
SERVICES BELOW
'600 V, & BELOW 200'AMP 18.50
18,50
:END OF FEES
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`'`���� 31 00047?16-1 04706'
TO 33. Su,
Le DATE: 11/13/0 TI11E;
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