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HomeMy WebLinkAbout2918 ELLESMERE AVE - Building PermitsProject Address CI1'Y OF COSTA MESA GL�FORNIA 92B28 P.O. BOX 1200 FROM THE OFFICE OF THE DIRECTOR OF BUILDINO SAFETV 2� l$ �-�-esNE� Project Name f�l"�• �i(i (T �ol� o�,mers r�ame �K�N �ScH I�I�UE �tLCuKrtf O�mers Address �j4rf�lB Oaners Telephone �'rjq- � (�'�?j �rmit # ,S�L � �j'Pe Y City Use Qily I ���Gh� as Qaner, Contractor, Agent (strike out all except one) do hereby attest that e�loyrtent of any person, or persons, is not anticipated at the time of seeking the abovrreferenced pennit. In the event that any person, or persons, are e�layed under the provisions of this pennit, I shall iranediately cause a valid Certificate of Worlanens Co�g�ensation to be filed with the Costa Mesa Building Division. I agree to defend at my aan �st, arc3 to indemnify and hold harmless, the City, its offioers, agents and/or e�layees, fran and against, arry and all liability, damage, costs, l�ses, claims and eupenses, howscever caused, resulting directly or indirectly fran, or oonnected with the improvement under this permit. Z further state that I have read and fully �mderstard the implications and rr sponsibilities of the above state�nents, and will ca�ly with all provisions of the Contractors State License Iaw found under the Business arrl Professions Code, Division 3, Chapter 9, of the State of California. K�I KRoEScN Print Name Signat CMF 0777-46 5 -13-F1 Llate .j'� r« �Y•_TOJ� .. f COS7A MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 31] COSTA MESA. CALIFORNIA fOR APPL/CANT TO f/LL /N COMPLETE[Y � TYPE OR PRINT BUILDING 2918 Ellesmere Avenue ADORE55 COSTA MESA. CALIFORNIA c.��.vci lacentia t Beach :EE �Fctiv�� �Lc) �7-.r- ��o FINAI�CE DEPT. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING FOR Off/CE USE ONLY NECEIPI NO. 6RM! NO. I L��i ��_ IVEO Y OATE ftECE1VEO DM1TE ISSUED �� � �—)—(v.0 I GFR � 7� A� �Ecr ��c. - � COSTA MESA, CALIFORNIA O, iINEER NO. ADDRE55 FIRE ZONE TYPE GROUP � i CONTRACTOR K� i�� KOIILIC. NO. 61195 BYPROVED DATE acen a nooRess ZONING LEGAI I LOT I I 7[�� ZONE ^ I NO. OF I U9E OF NE :J • OESCRIPTION NO. �t BLOCK T�f � � PLANe Neuuci A.P. NO. wvPROVED /� I( .� neTc �—�-- ui SIZE 65x100 �irreg INO.OFa�oas. O yqRDS OF LOT rvow oH �oi REQUIREO USE OF Q ICENTER LINE 6T.) EXISTING BLDG. FRONT SETBRCK LINE FROM L n i CENTER OF STREET 0 REAR YARD LO R. SI�E SIDE YARD I LEFT , J� f I RIGHT S� � L. SIDE DESCRIPTION OF WORK .. REAR n I X II e� rcwerinra I II ennirinu I � li1 REPAIR I IIMOVING 1 II�EMOLISH I SZIEDING 1H4O S1 ROOMS 7 STO1,,RIES 1 EXTERIOR WALL.tUCCOICOVERIWOOLL S11ST181B8 COVERING J USE OF BUILDING AND WORK TO BE PERFORMED Sin le- a and Attached Garage ��C 1 HEREBY ACKNOWLEDGE THAT 1 H�1VE NEAO THIS APPLICTTION THE AMOUNT SNOWN UNOER VqLUAT10N IS FOR THE AND STATE THA E RBOVE 5 CORRECT RNO AGREE TO COM- PLY WITH ALL IT .ORDINr�t AND STA E LAWS FEOULATING PURPOSE OF ESTABLISHING A PENMIT FEE ONLY. eoi�oWGCo T rioN. � VAWATION ��' SIGNATURE F ' PERMIT FEE � PERMITfEE �j s /��I/' PLANCHECK $ �y�� / /. �j AUTHORIZED AGENT TOTAL FEE $ �/ /'� Z . �- U Z Z Q O u~i am J 7 � . J m Q U� ZQ W � aw J � m z J � W W O = Z � w � N � � � � z Q U I d Q � � � z 0 � U � � F N Z , 32?�5 �lAR -4-71cnsa�0 122 o***tr*5.00 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 APPLICATION FOR BUILDING PERMIT For Applicant to Fill in Completely RECEIVED BV DATE flECEIVED DATE ISSUED AD�ORESS Z91.H ELI,ESMERE ' �' � `3 ' � � -3^ - � PERMIT NO. OWNER A.P. NO. — MAIL BUILDING ADDRESS 2918 ELLESMERE ADDRESS TEL. TRACT LOT BLOCK CITV NO CONSTRUCTION W P LENDER � BRANCH OWNEF ADDRESS VALUE ARCHITECT TEL. � ��✓ � � SOC%/ OR ENGINEER FIRE ADDRESS ZONE TVPE �GROUP APPROVED � � I CONTRACTOR BV DATE� AODRESS ZONE NO.OF VSE OF EW � TEL. PLANS BUILDI CITY NO. STATE CITV �ARDSAPPROVED VAR�SAPPROVED LIC. NO. UC. NO. MAIN BUILDING ACCESSOflV BUILDING SIZE NO.OF BIDGS. (FROM C/LS OF LOT NOW ON LOT 1 ROM � FT. EXISTINGBLDG. HOUJE T. FT. $IZE OF NO. OF � NEW BLDG. ROOMS STORIES L. SIOE �S FT. FT. EMERIOR WALL ROOF �' COVERING COVERING AjtUM. PEAR FT. FT. USE OF BUILOING AND WORK TO BE PERFORMED DISTANCE BET. BET. MAIN & MAIN BLDGS. ACCESS. B�OGS. PATIO C VRP q� pYPROVE� _ rJ7�, ' APPFOVED _ / pivK. I hareby acknOwletlBe thut I heve reatl [his epplicetion entl itate that iho above information iz correct entl aprea ro comply wlth ell laws regulatlnB builtl(ng consVuetion, antl I shall not amploy ' eny person in violatian ot tha workman's compensation laws of the State af Califomla � � I hereby certify that I am proparly Iicensotl ea e contrector undcr SQ. FT. � the Starn of Celifornia B�sinass antl Profassions Cotla, Divisicn 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chaptar 9, nntl thnt such licans¢s ere In ivll force antl effect, or I THE PURPOSE OF E5TABLISHING A PERMR FEE ONLV: � am exempt bam Na Orovisions of che Smte of California Businass VALUATION A"' �� ontl Professlons Cotlo, Divi 'on haPter 9. J�' � / PERMIT FEE 5 . '. Slp^etura oi /`✓ �- ' Pormlttae $ ��a PLANCHECK�S Au[horized ABent c� ~ � TOTA� FEE $ `� (��'"!�!�j� ♦ • COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only � BUILDING �1A i b !^ / / F � W L Q H y '� F C W � a > r .� x w o. O � 0. z � 3 OWNER /���L MAIL /�pn / ADDFESS e �� CITV � p, CONSTPUCTION LENDER BRANCH ADDRESS ARCHITECT OR ENGINEEF ADDRESS CONTRACTOR � CITY STATE LIC. NO. SIZE OF LOT USE OF u NZ TEL. NO. CITV LIC. NO. NO. OF BLDGS NOW ON LOT I T1NG BLDG. r�,lt ' t / Separate permits are required for elec[ric, plumbing and heating work. OF BUILDING AND N/ORK TO BE PERFORMED r'-' � 1699 ii.oeJz9 . �=.is� iioei�9 �.�4ca�� APPLICAT[ONIF.O���RII�`I'i��1��1{M[T IQ �---- REC Y ER EIVED D TE SVE � � PERMITN . A.P. NO. I� � � 7Z �� ADIDRE 5 �9/� Ec.LFsmE?E �v TRACT 'J �L LOT BIOCK W A A T P � WNER /�/��{ 4 L O l[Il/LUE D O S FIRE ZONE TVP GROUP APPROVED BV DATE 20NE NO.OF USE OF N PLAN$ BUILDING VARDSAPPROVED VARDSAPPROVED MAIN BUILDI G ACC SOilY BUILDING (FROMGL$T T) DISTANCE I haraby acknowlatlBa that I have reatl this eppllcallon entl stnte that the above Informatlon Is correct enC epree to comply with ell lews reBuletinp builtlinB construction, antl I chall not employ any parwn in violatlon of Me workman'a compansetion lews of Me State of Celifornle. 1 heraby cartify that I am properly Iicansetl as a eontractor unAer Sn' � tha Stato oi Colifornla euziness nntl Profassions Cotla, Dlvlslon 3, THE AMOUNT Chapter 9, and t�at such licensas era in tull tarca enE effect, or I THE PURPO6E i em oxempt from Me provlsions ot the Smte of Cnlifornla Busineu VALUATION entl Professions Cotle, Dlvislon 3 Choptar 9. � slenatu.aot .L.L— y+ �l .�i� /±OD� Pa�mittae �T� /X/( $ �� Authorizad ABant BET. MAIN ACC65. BI DATE n m i 0 m N JN UNDER VALUATION IS FOR m 'ABLLSHING A PERMR FEE ONLV: u PERMIT FEE S � Qa N m PLAN CHECK y ./ "� 0 TAX S � Q � U TOTALPAID E � S'�J F��+ C 0. Q � � F G W F � J Q 7 i' .a a � a O a o. z W S 3 COSTA MESA BUILDING-SAFETV DEPARTMENT APPL[CATION F�R�STRUCTI7RALPERMIT.� 63� P.O. 80X 1200 COSTA MESA, CALIFORNIA 92626 (3EC PERMIT �, � � Z For Applican[ to Fill in Completely — Use Ink Only BUILDING �%�j j Q 1'1 1 Y/�.1�nG A.P. NO. — Z72 � ADDRESS �L I� 0 c���-c7� � H� �7 A j�� � � OWNER OR ,1 nI` Q I '1 ADDRE55 L 6 /�j[�f'�/ TENANT ��V KI�E�� lJ�I,,.{.{� UNIT OR MAILING SPACE NO. ADDRE55 ��.}+�.E TR.NO. �� LOT � BLK. CITV �jTiA !� No`� �i4(6i1 NEW ADD LTER REPAIR MOVING DEMOLISH CONSTFUCTION LENOER E BRANCH OWNER �u F.�OC��T (�I�C�� ADDRESS USE ��• �'Y�D� ALUEE 9� OS ARCHITECT r TEL � OR ENGINEER Lr N ►� �% ADDRESS 20NE TVPE � GROUP ^ � 'u-n� APPROVEO p CONTRACTOR Df(J�{ BV DATE ��3 Q I ADDRESS TEL. CITV NO. STATE CITV APPROVEDSETBACKS LIC. NO. LIC. NO. SI2E /J� r /6, NOAFBLDGS. (FflOMGLSTREET) OF LOT N�CAO {�T NOW ON LOT 1 pNT USE OF � , �.A u � E%ISTING BLDG. ft+'� � / Separate permits are required for L SIDE S FT. D/ r electric, plumbing and heating work. 8� �// REAR FT. USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION ^Al � DATE �i�r APPROVED n APPROVED � �/'L 8' c/ I hereby acknowledge thet 1 have �eatl this application and state thai the above information is correct and aBree to comply with ell laws regulating builtling construction, antl I shell not employ any person in violallon of the workmen's campensation lews of the Steta of California. �+ �� I hereby certify that I am properly licensetl as a contractor untler J SQ. FT. the State of California Business antl Protessions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOP Chapter 9, antl that such licenses ere in tull force antl effect, or I THE PURPpSE OF ESfABLISHING A PERMIT FEE ONIV: am exemOt from the Orovisions ot the State of California Business VALUATION PERMIT FEE S and Professions Code, Division 3, Chapt r 9. d .Od PLAN CHECK $ S �O Signature of Perm�`ttee ' � _ �' $Z 3/ O�(� TAX S / [ v Auihorizetl Agent Date TOTA� PAID S 61 TL �� Applicant lo Iill In all �/ CITY OF COSTA MESA � �aeRnniT c CONSTRUCTION PERMIT I /� Addres withln heavY boraer lines ana sign all aOProvriata eeclaratlon TRACT NO. LOT NO. BLDG. NO. � TYPE OF CONSTRUCTIO PhOn¢ � 2 D ❑ NEW ❑ ADD �TERATION - ❑ REPAIR ❑ CONVERSION ❑DEMOLISH LiCense No. ❑ OTHER DESCRIPTION OF WORK Address �}V [.�jrr Cantractor �)���, Phone Address LICENSED CONTRHCTOR OECLARATION I hereGy atflrm that I am Ilcensetl untler provi5ion5 of Charter 9(com- men<Ing witn sec[lon 7000) of Divlsion 3- of the Buslnesi antl Professions Cotle, antl my Ilcense Is In �ull force antl ef/ect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 have a certifitate of consent to self-insure or a ttrtHlca[e of Workers' Compensation Inzurance, �or a tertltietl copy Inereof (Sectlon 3800, Lab. C.). - �icy No. Company :ertifletl copy is hereby furnlshetl. Certlfietl <opy Is flletl with tha <Ity Builtlin9 Dlvision. E%EMPTION FROM WORKERS' COMPENSATION DECLARATION (This sectlon neetl not �e completetl i(.tha permit Ii for one huntlretl (E1001 or less). 1 Certlfy that in the pertormante ot. the work for which lhis permit is 155uatl, I shall not emPioy any oerson in any manner so as to become SubjeGt to Ihe Work¢ri CompenzatlOn LawS ot Californid. Date Signature NOTICE: If after making this �eclaration, you shoultl become subject to the WOrkers' COmpenSation provl5iOn5 of Ih¢ Labor COCe, you mu5t forthwlth comply with suGh provisions or thi5 permlt Shall b¢ tleCmetl �avOk¢tl. CONSTRUCTION LENDING AGENCV I hereby afflrm that thGrB IS a ConSVUction Ientling agenty fOr thC Per- formance of Iha work for which this permit is issuetl (Section 3097 Civ. C.). Lentler'S Name Lentler's Atltlre55 OWNER BUILDER DECLARATION I hereby affirm [hat I am exempt from the Cont�acto�'s Llcense Law fOr th¢ following r¢asOn (Sectlon 7031.5 BUSIn¢55 dntl Professlons Cotle: Any city Or County which r¢qWr¢s a permit to conStruGt, alteq ImprOv¢, tlemoli5h or rlpait any structure, prior to its issuance, a150 r¢� quir05 thc appliWnt f0� such permit to file a si9netl statemen[ that hB is Iltensetl purSUant to the provi5ions Of the ContraCtor'S LiG¢nse taw (Chapter 9(commencing with Se<[ion 7000) of Dlvision 3 of [he Business antl Prde55ions Cotle) or tnat he is exempt theretrom antl the �•sis tor the alle9etl exemption. Any violatlon ot SecHon ]031.5 Dy appllcant lor a permit subjec[s t�e appliwnt to a civil penalty �ot more than five huntlretl tlollars (E500). � I, as owner ol the property, or my employees wlth wages as their Sole ConlpenSatiOn, wlll tlo the work, an� the SVucture is n0[ IntCntletl or oHeretl for sale. (Settion ]044, Business antl Rofessions Cotla: The COOtrd<LOt's LlcenSe Lnw tlo2s nol apply t0 an ownef of d prop¢rty wM10 bulltl5 or imprOVCs tbereon, antl who tloes sucM1 wOrk himselt or through his own employeas, provi0etl thai such improvemen(5 are no[ intentletl or offeretl for sale. 1f, however, the builtling or improvement Is sola wltnin ono year ot completion, the owner will have tne burtlen of p�oving he ditl not builtl or improvc for the purpose ol sale). ❑ I, as owner of the property, am ezclusively contracting with Iicensetl contractors to construct the project (Secllon 7044, Buslness and Professions Cotle: The ConVactor's License Law tloes not apply to an owner ol property wM10 builtls or improves thereon, antl who con- bacls from such pro�ects with a contractor(s) IicesneC pursuant to the Contractor's License Law). ❑ I am exempi untler Sectlon B. & P. C. for this reason Date Owner� � �r I hereby cerU�y that I have reatl this a p i atio a state [ha[ [he above Information Is correct. I d9ree t0 0 ply Ith all city antl county OftlinanGes antl St t¢ Idws fGlating to con5tfucti 0, antl h¢rGby dulhOriz¢ fepre5enldtive5 ( thi5 t t0 entef upon the aDove mentloned property for ins tion os s Q �� Signature -���� Date s-.4i orivers• L� ax TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION STRVCTURAI ❑ TENANT ❑ ELECTRICAL OPLUMBING ❑MECHAI ❑ OTHER PROJECT DESCRIPTION SQ. FT. ^ OCCUPANCV CONSTRVCTION TVPE � VALUATION' 2-S�'�ZONE GRA�ING CU. VOS. ACRES PIUMBING TOILETS LAVATORIES KIT. $INKS SERVICE SINKS FLOOR SINKS DRINKING FOUNTAINS INTERCEPTORS SWIMMING PDOL- WATER $ERVICE GAS SERVICE WATER HEATERS SEWER CONNECTIONS SOLARTANK SOLAR PIPING SVS. ISSUE FEE PLAN CHECK SHOWERS URINALS DOUBLE LAVS DISHWASHERS SUMPS FLOOR ORAINS CLARIFIERS , PTRAP ALTERATION OUTLETS BTU OUTPUT COLLECTORS MECHANICAL aLnN cHECK HEATING SVSTEM 0-30�,000 BTU ANDDUCTING 100,000+g7U REFRIGERATION 0-300,000 BTU SVSTEM 100,000+BTU BOILERS BTV SVSTEM REPAIR,ALTEkATION EXHAUST SVSTEM MULTIPLE ISSUE FEE CMF 0865-46 VJhite-Builtling; Unary-APPliwnt; Pink-Accounting; Goltlenrotl-Assessor A.P. � ZONE REAH YARD (TO PKG. SPACE RE(�. STREET WIDTH 4984 9/14/BI NING REGULATIONS �.� a— � PLNTGp. gREFL. � PROPE�RT�VNLINE SKT�I� T .) � -PROVIDED PARK FEE $ SPECIAL CONDITIONS: ELECTRICAL PLAN CHECK TRANSFORMER 0-1 KW_1-10 KW _ APPLIANCE 30-50 KW_50 + KW _ MOTORS 0-1 HP._3-30 HP _ (INC.SOLAR) 30-50HP SO+HP _ FI%TURES OUTLETS SWITCHES GASTUBESIGNS - ' POLE LIGHTS - POLES METERED SUB PANELS MAIN SUB SERVICE AMP ISSUE FEE ' n qPPLICATION APPROVED BV /�� i ��cr: n SUMMARV OF FEES BUILDING PERMIT $� SMIP $_��(7 PLANCHECK $� PERMIT ISSUANCE $ PLUMBING $ GRADING $ PLAN CHECK $ ELECTRICAL $ $ PLAN CHECK $ MICROFILM E TOTAL FEE $ � MECHANICAL" S PLANCHECK E VANCEPC E_ FINAL FEE S—�..��� CONSTRUCTION AND PLANNING POOL & SPA �� ,, APPROVALS Permit # Date Inspector qpPROVALS Permit # Date Inspector' � 1. Temporary Electrical Service or Pole 43. Pool & Equipment Locaiion ' � � • �� Soil ipe-Undrgm 44. Steel Reinfdreement - 3. Electrical Conduit Utility-Undrgrn 45. Forms 4. Electrical ConduirUndrgrn 46. Electrical Bonding � . tee ein orce 47. Rough Plumbin & Pressure Test 6. Electrical UFER Grn 48. APPROVALTO COVER-GUNITE 7. Footings 49. Electrical Conduit-Undr rn 8. Foundation 50. Gas Pipe, ❑ Undr rn, Test 9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra ❑ ndr rn 10. Structural Floor System 52. APPROVAL TO DECK 11. Property Sewer Line & House Connection 53. � Backwash & Rece tor-Final 12. Street Sewer Connection 54. Heater & Vent-Final 13. Rough Plumbing 14. Rough Electric-Conduit �56. Electrical-Final 15. Rough Electric-Wiring - 57. Solar System-Final 16. Rough Heating & Air Conditioning � Fencing & Access Approval 17. Ducts in Structure APPROVED FOR PLASTERING � . 18. Ducts, Venti�ating 19. GasPipe-Rough&Test 60. POOL/SPASYSTEMSFINAL 20. Roof Framing 21. Roof Sheathin " . 22. Frame and Flashin �/_/ _/ NOTES: 23. Insulation ' /.� - 24. Lathing & Siding � 25. Drywall Nailing 26. Plaster Brown Coat � 27. Electrical Power Meter-Final 28. Final Electric 29. Final Heating & Air Conditioning 30. Final Gas Pipe-Test � . 31. Final Plumbing 32. Water Service-Final - � 33. Gas Service-Final 34. Solar pomestic-Final 35. Landsca e S rinklin S stem 36. Sound Attenuation 37. Handicap Regulations � 38. FINALSTRUCTURE&QUI�DING /-/ - 39. Special Requirements Completed 40. Electric Release to Edison 41 . Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No Date AOD���ant to /ill in all spaces except thofe wl��In heavy bortle� Iines anC sign ail aporopriata Oeclarations. CITK oF COS7A MESn CONSTRUCTION PERMIT ProjectAddress �„�Q/S�/�F��o"1�� G �'Yf � Applicant's Mailing Addrea / Owner'sName p� G Phone7SyG�'73 Address ���0 �-���M��L � � �% ' Arch/Eng. Licenu No. Address /� Contracror'sNamPG��o,�` � �pryonn�//SN$ Address�mailing) /�yry� �r�*E��% �-��/ CiryLicenseNo. �1�� y�Q�L% LICENSED CONTRACTOR �ECLARATION 1 hereby aHi�m lhat I am licensetl untler provi5ioni of Charte� 9(commenCing with section 7000) ot �ivision 3 of tne Businezs antl Protessions COEe, anC my Ilcense is In full (or<e an i e<t. License Clazs '� Licente No. �� ` Dalc �_'3.'�—�� Si9�ature WORKERS'COMPENSATIO CLARATION "'^re�y atlirm Ihal I Ilave a rtificata Ot COnSenl to 5eH-Insure oI a Certi(itdte Vo�kers' Comp¢nSdtiOn Inmrance, or a Ce`rt�ifl,e�tl copy thereof (Section D, Lab. �CJ t� ^T�/�� „79��1r.+..[��" FTi /% Policy No�[.�7—� � �� Company .✓f�� �Certifietl copY �s hereby furnis�ed. J TA��„�� Cerjif1etl cop is f' iih the city Bwl i�4 �isi n ����"`��� Date {'L' �?��APPlican[ �J',� �./� EXEMPTION FROM WORKERS' COMPENSqTION OECLARATION (Thissection neotl not be completetl if the Oerr�it Is tor one �untlretl ($300) or less). I certity that in the performance of the work tor whl<h thiz permrt is issuetl, I shail not emoloy any person in any manner so as to become subject to the Workers' Compansation Laws of Cali(omia. Date Si9nature NOTICE: II, after making this Oeclaration, yoU snoultl become sub�ec[ [o the WOrkers' Comp¢nsatiOn Orovi5ion5 O( thG la�or Cotle, you must forthwlth compry with SUGh provlsion5 Or [hls pa�Rdl Shall b¢ tleemetl �evok¢tl. CONSTRUCTION LENDING AGENCV 1 hereby aitirm that there Is a construction lentlin9 agancy for tha performante OI tha work tOr which thi5 pGrmit is �SSuetl (Se[tlon 3097 Civ. C.) l.endcr's Namo Lonticr's AOtlrezs OWNER BUILOER DECLARATION I hereby atlirm lhat I am exemo� irom tho Contractor's Ucense Law for tho /ollowing rcason (Settlon 7031.5 Business and Profe551onal Cotle: Any cltY or counly which �aquires a pe�mit l0 cOnst�uGt, alte�, improve, tlemolish or rnpal� any sVucturq prbr to Its issuance, also roqulres lho applicant tor such pormlt to lila a signotl slatement lhat he/she I5 IlcanSotl pursuant to [ne provision5 ot Ihe Contractor'S License Law (ChaD�er 9_(cOTmencing with SecllOn 7000) Of ^�vision 3 of �he Buslne55 antl Prof¢z5ion5 CoaO) or that he/sh0 is exempt �Mrom anC tha basii tor the alle9etl exeTptlon. Any vlolaUon of Sectlon 11.5 by any applicant for a p¢rmll sub�acts the apP���ant to a civll nalty of not more tnan live nuntlrca tlotlars (E500). � I, as ownm ot lne property O� my ampl0y005 with wagos d5 tnei� sol0 <Ompensa�iOn, will tlo thC wofk, antl th¢ stf4Gtute IS 00l Intentl¢tl Of ot(er80 lor sale (Saction 7046, Business an0 Vrolessional Cotle: Tho Contra<tor's License t2w tloes not apOry to an owner ot a properry who bulltls or Improves lhercOn, antl who tloe5 Sucn work himself/harsoll or thro�gh his or �er own Cmpl0yce5, prOvitletl tbat such Improv8montl dr0 nOt Int¢ntletl or oflefetl for salc. If, however, tha building or improvement is soltl within one year of com- pletion, tha owner will have the burtlen ol provin9 ha/sne tlIO not builtl or im- prove tor the OurpOso o/ 5alo). ❑ 1, as owner of the Proper[y, am extluzive�y contracting with Iicensetl ton- tractors lo conslrucl tne prqect (Section 704d, Business antl Protezsions Cotla: The Contrattor's License Law does not dpply lo an owner o1 property who builtls or ImOroves tllermn. antl wllo COntla�(5 1or such oroi¢[ts with a r.on- trattor�il license pursuam ro me Comractors Ucense Law). I am aware tha[ proot o( lh¢ir Worke�'S Compensalion Inwranw Shoultl be provltletl to me. ❑ I am oxertlpt untle� SectiOn B. L P. C. to� this rea5on Date Owner I nereby certlly tnat I have reatl thiz application ana state that the above InformaHon is <orreci. I agree ro complY �+'��h all tlty antl counry ortlinances antl state laws relating to buil0in9 conscrucqpn, antl hereby aulhorize repre- 5¢ntdtives of NIs city to enter upOn lhe abov¢-mentiOnetl property toesro Inspection p rpo 5. �2 y.?"�° Signature �'' � Date Orive ' icen5e or 55 � � TVPE OF CONSTRUCTION U NEW LJ ADD U ALTERATION LJ REPAIR ❑ CONVERS�ON ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TVPEOFPERMIT GRA�ING POUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL �LVMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION 5�. FT. OCCVVANCv CONSTRUCTION TVPE VALUATION $ ZONE GRADINGCU.YDS. ACRES Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Jrinking FOuntains Floor Droins Floor Sinks Ges Service � Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee u S15 Boiler Dutt - Under Ground Duct - S[ruttural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. iCBO dk Heating System & Ducting ❑ ai oo,000 aru O i oo,000 sT Reinspection Fee � $15 0865-46, rev. 5/88 Wnite - Builtling; Canary - Appliwnt; Plnk - Accounting; Goltlenrotl - Assessor ShowCfS Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool wl5pa Urinal wacer Claset Water Heater Water Service Auto-Wash Leundry Trays laue Fee Hood or Typel ❑ Canopy Type II ❑ Refrigera[ion System OP100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers laue Fee A.P. qW S Main Buildi E T FrOnt B Rear A C Right K Left S Ping. Re(. # Planning NOtes: ES P.uromatic Washer Construttion Pole Sub. Cooking Unit 'Dishwasher Dryers OGas��DElec Fan F.A.U. FixtU�¢5 �Device Boxes '. Outlets � Switche5 Garbage Disposal Generator �0.5 KW [ 5 3 FEES 53 Zone Accessory ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100amps Sub Panel Motors �a1 HP �1'r5 - 6 Int.Solar 09�15 HP �16-15+ Microwave Pole Light Range � I Standing Sections 15 KW � Trash Compactor � Rainspection Fae '$15 ' � luue Fee DEVELOPMENT SERVICES REQUIREMENTS: ZoninB APP�oved By Building APProved By Applimtion Issued By � FEES $ 3 N I N G F E U M T S. SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ ��() PERMIT PLUMBING $ �' � " ��UANCE $ PIAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING $ PLANCHECK 50% $ MICROFILM $ —��y��y�� MECHANICAL $ TOTAL FEE $ `" " — PLAN CHECK Z5% $ #�ta�•�acar� R��Ea��-# oi caoz�a�s-o�ozai�s rrs� ;,Up DATE: 12/27/gg TIftE: iD:19 t ,.T . • . CONSTRUCTION AND PLANNING " POO SPA ` APPROVALS Permit # _ Date Inspector pppROVALS Permit # Date Inspector 1. 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 ConduioUndrgrnd. � � 55. Electrical Bonding � 5. ,Steel �?einforcement �- � 56. Rough Plumbing & Pressure Test 6. �Electrical UFER Grnd.. ' 57. APPROVAL TO COVER�GUNITE 7: �Footings . 58. Electrical Conduit-Undrgrnd. 8. �Fo�ndation 59. Gas Pipe, O Undrgrnd., Test � 9� Water Pipe-Undrgrnd. . 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection . 62. Backwash & Receptor-Final � 12. Sewer Cap ; � 63. Heater & Vent-Final 13. Roof Drains �.� � • F4. Plumbing System - Final 14. Rough Plumbing ' 65. Electrical-Final 15. Rough Electrical-Conduit 66i� Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval ' r 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 1�8. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19: Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. 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 OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structuraq & 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. Plasier 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 r f� � 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing � 'f�j'( �� 39. Water Service-Final 40. Gas Service-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 ' J � '