HomeMy WebLinkAbout228 FAIRWAY PL - Building Permitsr
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CITY OF COSTA MESA
BUILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • wwN.ci.costa-mesa.ca.us
PERMITTYPE: B COMBO
Sub Type: RES_ALT
FOR INSPECTIONS CALL: (714) 754-5626
JOB ADDRESS: 228>FAIRWAY RL CM y as
APN: 43921310 Zoning: , ,
Vicinity: 2 ND STORY
Const Type: V-B SQ. FT: 747
PERMIT NUMBER: BC10-00174
STATUS: ISSUED
DATE ISSUED: 06I07I2010
ISSUED BY: KJB
Suite/Unit:
Primary Occ:
Valuation: $56,266.60
SCOPE OF WORK: 545 2ND STORY ADDTION MASTER BEDROOM , BATHROOM AND OFFICE. EXTEND EXISTING GARAGE
BY 202 SF AND 242 SF DECK AT REAR OF RESIDENCE. 1 ALT DUCT SYSTEM. 9 LIGHTS, 15 OUTLETS, 7 SW ITCHES. 1 BATH
TUB 1 SHOWER 1 TOILET 1 WATER HEATER 2 WASH BASINS
OWNER: DE GARCREAU,ERIC AND JANETTE Address: 228 FAIRWAY PL
Phone: 949-642•6643 CitylSlate2ip: COSTA MESA, CA
APPLICANT: REED WALLRICH
Phone: 619d05-4663
CONTRnCiOR: WALLRICH CONSTRUCTION
Phone: 619�OSd663
Cell:
ARCHITECT:
ENGINEER: NADER HEDJRAN
COMBINATION PERMIT FEE SUMMARY
Building Plan Check:
Building Fees:
Electrical Fees:
Mechanical Fees:
Plumbing Fees:
SMIP Residential:
SMIP Commercial:
Bldg Std Admin Fund
TOTAL FEES:
Address:
CirylState/zZip:
License No. 935142
Address: 3212 BROWNING STUnif:
Ciry/State: SAN DIEGO
License No.
License No.68179
$450.29
$692.75
$57.60
$37.20
$82.30
$5.63
$0.00
$3.00
51,328.77
Unit:
Unil: :
ZipCode 92106
PHONE:
PHONE:619-284-1848
"Ro/or to foo raeoi ts /or all faoe aid for ro oct
HOURS FOR CONSTRUCTION ACTIVITY: EFFECTIVE 3118/2070 - PER CMMC Sec. 13-279
Monday thru Friday-7:00 am t�ru 7:00 pm. Saturdays-9:0o am thru e:oo pm. Prohibited all hours - Sunday5 and lhe followin0 Fedefal holidays:
NO710E: The work authonzed by this pertnil shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
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 obWin inspections and final approval will result in the expiration of lhis permit.
CO�E� INSPECTIONTYPE OA,T IN7171R1 LOOE/ INSPEL710NTYPE DA INTIi1115� )
1816 Pixed System Final Fire Prevention 206 Final Mechanical X 0� ��� �(! H/�`�_[Y
12fi6 Pool Spa Final 208 Final Plumbing � Q-� 1- 1 U firvl {yl.� �
v �
200 Final Re-Roof 270 Final Electncal /� �" ZI - � V Nm � o�Qi
201 Final BIxWRetaining Wall
202 Final Factory Fire Place
203 FinalSign
204 Final Demolition
212 Final Fire Prevention
220 Final Planning Approval
222
250
Final Sile
FlnaiBuiitling/Occupancy /� 9'2���d Hm, Q
�,,
e�`.
WORKERS' COMPENSATION DECLARATION:
I hereDy aNirm under penalty of perjury one of the (ollowing declarations:
❑ I have and will maintain a certificate of consent to self-Insure tor workers'
compensation, as provided for by section 3700 of the Labor Code, for the
itormance of the work (or which this permit is issuetl.
I have and will maintain v.orkers' compensation insurance, as requiretl by
e tbn 3700 of the Labor Cotle, for the pedortnance ot the wo�r which this
permit is issued. My wor s compe sati surance car er and policy
number are:
Carrier.
(rnisseaunneetlrrotor�nrri ere�da/mepnma(a�vary(q' e�menu^nOmdtlyoears(Et00)a�essJ
POlity Number. d�� � 0/ v v� O.�J O �
❑ I Certi(y Ihat in �he peAormanCe of Ihe wOrk !or whiCh lhis permil is
issued. I shall not employ any person in any manner so as to become subject
Io Ihe work�� ompensation lavrs o( Califomia, and agree ihat if I 5hould
become fibj f to rk rs' compensation provisions of Seclion 3700 of
the L r de, I f rt h wmply with the5e pmv'sions I\
V
� litam'sSlgnpWre • _a(�'� iL �\
L�:=.F
ARNI : AIIURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UN FUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
(3100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
AiTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Profess" ns Code, and
my �icensQys�gtorcg �nq.eHeetr�
�`ONSY�CTION LENDING AGENCY: '
❑ 1 ereby at(vm that lhere is a consWction lending agency !w the
peAormance of the work for which this pertnit is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Adtlress:
Date
OWNER-BUILDER DECLARATIONS:
I hereby affrm that untler penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for Ihe lollovnng reason (Sec. 7031.5.
Business and Professions Code: Any city or counry which requires a Dermit to
construct, alter, improve, demolish, or repair any structure, pnor ro its
issuancn, also requires the applicant fw sucn permit to file a signetl statemenl
Ihal he or she is licensed pursuant to tha provisions of the Contractors
License Law (Chapter 9(wmmencing wilh Section 7000) of Division 3 of the
Business and Professions Cotle) or Ihat he or she is ezempt therefrom and
lhe basis for the alleged exemption. Any violation of Section 7031.5 by any
applicanl for a permic subjects lhe applicant to a civil penally of nol more than
five hundred dollars ($500).):
❑ I, as ovmer ol the propeny, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the structure is not intentled or
offered for sale (Sec. 7044, Business and Professions Code: The Coniractors
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 Ihat such improvements are not imended or oflered tor
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 ol lhe property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRAC70RS lo constmct Ne projecl (Sec. 7044, Business antl
Protess'ans Code: Tne contractors License Law dces not appty to an ovmer ot
propetly who builds or improves Ihereon, and who cont2cts fa such project with
a cmtracta(s) license pursuant to the Contractors License laws.).
❑ I am ezempt under sec.
Business and Professions Code for this reason:
SignaWre Date
305]-i6 (]/0]
.`
ti
Ovmer ID verified by driver's license. � Yes ❑ No �
Driver's License No. Expires:
Verification of Ownership by pype o( document, i.e. - pmperty tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CER7IFICATION:
❑ I hereby certity that no excavation (rve (5) or more (eet in depth inro which a
person is requiretl to tlescend, will be made in connecibn with work authorized
by ihis pertni�, antl that no building sWcfure, scaffdding, falsework, or demolilion
or tlismantling thereol, vrill be more than thirty-siz (36) feel high. (Chap. 3.2, Grp
2, Art 2, Sec. 341, Tille 8, Califomia Administ2tive Code).
❑ As owner-builder, I will not employ anyone lo do work which woultl
require a permit Irom the Division of Industrial Salery, as noted above, unless
such person has a permit to do such work from the divisian.
AOWi�'nnfs SipiaWre Da�e
Division ol Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIfICATION:
1. Will the applicant or present or future builtling occupant need to fle antl
certify a Business Plan tor emergency response to release or mreatened
release of a hazartlous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safety Code requires, wilh some
exceptions, Ihat a Business Plan be fled with the Cosla Mesa Fire
Departmenl by every business which has at any one lime during a reported
year a quantity ol hazardous materials equal ro or greater than a weight o!
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard tempareWre and pressure).
2. Does or will Ihe applicant or present or (uNre 6uilding cecupant need to file
a regislration form (or acutely hazardous matenals? ❑ Yes ❑ No
(Section 25533 ot the Cali(ornia Healm antl Safety Code, with some
exceplions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hantl a quantiry ot acutely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic (eet of compressed gas at standard
temperature and pressure).
3. Does or will the applicant or present or future building occupant neetl to
prepare an RMPP (Risk Managemen[ and Prevention Program (or acutely
hazardous materials�? ❑ Yes ❑ No
(Section 25534 of the Cali(omia Health and Safery Code provides Ihat lhe
Costa Mesa Fire Depanment may require the preparation, certifiration antl
fling with the Fire Departmenl ot an RMPP by businesses which are required
to register acutely hazardous materials with t�e Pire Depatlmem.
4. If an RMPP is presently required, has Section 25534 of the California
Health ana Safety Cotle been fully complied with? ❑ Yes ❑ No
5. Dces or wiu Ihe applicant or present or tuture building occupant require for
the work whiCh i5 Ihe subject of Ihis application a pertnit for such wnsWction
or motlificalion from the South Coast Air Qualiry Mana9ement District or from
any othar air pollution conlrol �istrict or agency? ❑ Yes ❑ No
(Secibn 65850.2 ot Ihe Calilomia Govemment Code require5 �hat lhe reque5ted
information be fumished on applications for non-residential Guiltling pertnits).
6. Will any part of ihe facility to be constructetl untler this permit be vrithin
1000 leet from the outer boundaries of a school? � Yes ❑ No
Qf'yes", the facility must meet the requirement o( Sections 25534 and 42303
of the Califomia Health antl Safety Cotle).
7. If a permit from the South Coast Air �ualiry Management DisMct or other
air pollution control district or agency is required for the work which is the
subjecl of this application, have all of the disclosures prescri�ed by California
Health an0 Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf yes', attach certifcate of compliance from the appmpnate air pollution
control otfcer).
CERTIFICATE OF COMPLIANCE: I certi(y Ihat under penalty of perjury the
information given above is correct I agree to comply with all state laws and
city ordinances regartling Hazartlous Matenals and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application and sWte that
the information given is correcL I agree lo comply with all state laws antl ciry
oMinances relating to building consWction, and authorize representatives of
the City of Costa Mesa lo enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this mit uniil final inspection.
� ' Wr al (s) � Dat �
�i'A � i .AW�OniCAI�ppIiCLlll` .
May 12, 2010
CITY OF COSTA MESA
P.O. BOX 7200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200
OFFICIAL PUBLIC
NOTICE OF ZONING APPROVAL
RE: ZONING APPROVAL FOR BUILDING PLAN CHECK
NO. BC10-00174
FAIRWAY PLACE, COSTA MESA
The Planning Division has completed its review of the above-referenced project. The addition
has been approved based on the following project description.
PROJEC7 DESCRIPTION:
The applicant proposes to construct a 544 square foot second story addition consisting of a
master bedroom, bathroom, and office. Second floor construction is subject to the -City's
Residential Design Guidelines. The proposed addition meets the purpose and intent of the
Residential Design Guidelines, which are intended to promote design excellence in new
residential construction, with consideration being given to compatibility with the surrounding
residential properties. The
Design Guidelines because
existing building.
proposed construction complies with the intent of the Residential
the addition will not significantly increase the overall mass of the
The zoning approval will become final at 5:00 p.m. on Mav 19, 2010, unless appealed by an
affected party (including filing of the necessary application and payment of the appropriate fee)
or is cailed up for review by a member of the Planning Commission or City Council.
If you have any questions regarding this notice, please feel free to contact the project planner,
Mel Lee, at 714-754-5611, or at mlee[c�ci.costa-mesa.ca.us.
Distribution:
Haden Living Trust
222 Fairway Place
Costa Mesa, CA 92627
Eric DeGarceau
228 Fairway Place
Costa Mesa, CA 92627
File
Thomas Welbourn
234 Fainvay Place
Costa Mesa, CA 92627
Trinon Cirello
2651 Club Mesa Place
Costa Mesa, CA 92627
�
CITY OF COSTA MESA
BI/ILDING o1V/SION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
(714) 754-5273 • Fax (714) 754-4856
JobAddress: 228 FAIRWAYPL
Suite:
Vicinity: GARAGE
Parcel Nunmber: 43921310
Applicant: FRITSCH, LAWRENCE J TR
Address: 228 FAIRWAY PL
COSTA MESA, CA
Owner: FRITSCH, LAWRENCE J TR
Address 228 FAIRWAY PL
� COSTA MESA, CA
Contractor. O�f N E n
Address: �`
Zip:
Arch :
Address:
Phone:
BUILDING PERMIT
Zoning:
Phone:
Zip: 92627
Phone: (949)5483821
Zip: 92627
Phone:
License:
Eng:
Address:
v
PERMIT NUMBER
''� 899-00662
77 FAIR DRIVE, COSTA MESA, CA 92626
ISSUED BY:
Status: ISSUED
Applied: 05/13/1999
Issued: 0 5/1 311 9 9 9
Phone:
2ip License: Zip: � License:
SCOPE OF PERMIT
DEMO PERMIT FOR REMOVAL OF BATHROOM FROM STRUCTURE AND RETURN STRUCTURE TO ORIGINAL USE.
FEE SUMMARY
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$0.00
$21.00
$0.50
$0.00
$0.00
$0.00
521.50
SETBACKS
MAIN STRUCTURE Front 0- 0
ACCESSORY Front 0-0
PARKING Existinq: o
NOTES:
Rear 0-0
Rear 0-0
Re uired: 0
PLANNING & ZONING
Left 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0. 0
Right 0-0
aioo.00
$ioo.00
NOTICE: The work authorized by this permit shall compiy with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 9248, § 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 authonzed under this permit to be considered legal, such work must comply with all applicable codes, and all
requlrad Inepeetiona end finel epproval must be obtained. Failure to obtain inspections and final epproval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545628
'NORKERS' COMPENSATON DECLARATION: �
I hereby a1(irtn under penalry ot perJury one of Ihe �a�lawing declaratlons: �
❑ I heve anO will maintein e certiflcate ol con5ent to sell-Insure for workers' compensetion, es providetl tor by secllon 3700 ot the Labor Cotle, for Ihe peAortnance of the
work for w�ich thi5 pertnit i5 issued. .
❑ I have entl will meintain workers' compensaU� insurance, as required by sectlpn 3700 ot the Labor Code, iw the peAortnance of Ne work tor whiU ihis permit is issued.
h1y workars' cnmpensation Insurance cartie� entl policy number ere:
Carner: � Policy Number:
(This secNon need not be comp/eted I/ the permit Is velued et one hunQretl dollers ($100) oi less.)
❑ I cenity that in Ihe pertormence of Ihe wofk for which ihis permit Is Issuetl, I shell not employ eny person In eny manner so es to become sub�ect to the workers'
compensation laws ot Celitomia, end agrea that ii I should become suh�ect to the workers' compensetion provisions of Section 3700 0l the Lebor Code, I shall forihwith
comply wlth Ihese provisions.
Applicant Signature: Date:
WARNINO: FAILURE TO SECURE WORKERS' COMPENSAT�ON C�VEiiAG'c IS UNLAWFUL AND SHALL SUBJECr AN EMPLOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TO ONE HUNDRED
THOUSAND DOLLARE ($tOD,000), IN ADDfTION TO THE C�ST OF COAIPENSATION, DAhNGES AS PROVIDED FOR IN SECTIIXJ 3]W OF THE LABOR CODE. IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARA710N:
I hereby aHirtn Ihai I am licensed under provlslon5 ot Chapier 9(commenGng wlth Section 7000) of DiNsion 3 of t�e Business and Professions Code, and my license is in full
force Bntl effecL Lic. M Cless #
Coniractors Signature: Date:
CONSTRUCTION LENOMG AGENCY: �
❑ I hereby eNirtn ihat there is a constructlon lending egency for ihe pertormance ot Ihe work tor which Ihis permit is Issuad. (Sec. 3097, Civll Cotle).
Lentler's Name: Lendefs Adtlress:
Signeture: Date:
OWNER-BUILDER DECLARATIONS:
I hereby eHirtn that untler penalry of perjury thet I am EXEMVT FROM THE CON7RACTORS LICENSE LAW lor the lollowing reason (Sec. 7031.5, Busineu antl Professions
Code: Any ciry or counry which requires a pertnit to �nsiruct, alter, improve, tlemolish, or repair any siructure, prior to Its Issuance, also requires lhe epplicant for such pertnit
to file e signetl sletemen� Ihat he or she is licensetl pursuant to the provlsions of Ihe Coniractors License Lew (Chapter 9(commencing with Section 7000) of Division 3 of Ihe
Business and Professions Cotle) or that he or she �s exempt therefrom end the besis tor ihe alleged e:emptian, Any vlolation of Section 7031.5 by eny epplicant for a pertnit
suh�ects the epplicant to e civll penalty o1 not mor� then five hunCred Collers ($500).):
❑ I, ns awner af the property, or my employees with wages as Iheir sole compensation, WILL DO 7HE WORK, antl the stmcture Is not Intended or aReratl tor sale (Sec.
7044,-Business end Professions Cotle: The Contrectors License Lew does not epply to an owner oi Dropeny who 6uilds or improves Ihereon, end who does such work
himself or hersell or ihrough his or her own amployees, provided that such Improvements are not Intendetl or oHarea tor sale. tl, however, ihe bulltling or Improvement is
sold within one year of completlon, tha owner�builder will have the burden of proving Ihat he or she did not bulld or improve tor purpose of sale.).
❑ I, us owner af the property. am E%CLUSIVELV CONTRACTING WI7H LICENSED CONTRACTORS to conswcl tha project (Sec. 7044, Business end Professians
Cotle: The contractors License Lew tloes not epply to an owner ol proparty who builtls or improves thereon, antl who conirects for such prolect with a contractor(s)
license pursuant to tha Contractors License �-ews.).
� I am exem t under sec.
Signatura: �
Owner ID verified by drivefs litense.
� ves ❑ No
8usine55 antl Professians Code tor ihis reason:
oe�a: — /3 -
Drivers License No. /�. Ezpires:
Verification of Ownership by (rype ot tlocument, i.B. - property tax blll or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATION:
❑ I horeby certiFy that no ezcavatlon five (5) 0� more feet in Gepth into which e Derson is required to descentl, wlll be mede in connectlon wlih work euthonzetl 6y this
permii, entl t�at no builtling strudure, scefloltling, falsework, or tlemolltlon or Olsmentling ihereof, will be more then ihirry-six (36) feet hlgh. (Chep. 32, Grp 2, Art 2, Sec.
347, Title 8, Celifornia AdmiNstretive Coda).
❑ As owner-builtler, I will not employ enyone 10 ao work which woultl require e permit Irom tha Division of Intlusirial Safery, as notetl ebove, unleu such person has a
permit ro do such work irom the division.
Signature: Date:
Division of Inaustrial Safery Permit Number:
CERTIFICATE OF COMPLIANCE AND AUTHORIYATON OF ENTRV: I certify untler penelty ot perjury Ihet I have read Ihis eppiication and sta�e ihe� ihe infortnation given is
correct. I agree to comply with all state laws end ciry ordinances relating to Gulltling wnstruction, antl euthodze representatives of the City of Casta Mesa to enter upon the
ebove-descdbed property for inspectlo purywes. I e ree not to wcupy or allow occupanq of any building euthanzetl Dy this pertnit until tinal Inspectlon.
�:�.���� �.�� � r- �3 - qy
SlgnaWre Oi Legal O�+�ner(s) Date
AndlOr Authonzed App�icant Date
CODE �. INSPECTIONTYPE
1616 Fixetl System Final Fire Prevention
1266 Pool Spa Finel
200 Finel Re-Roof �
207 Final Block/Relaining Wall
202 Final Fectory Fire Plece
203 Final Sign
204 Finel Demolition
2696�Y8
P9ff 1t�94S
�
COOE 1 INSPECTION TYVE
206 Final Mechanical
208 Final Plumhing
210 Finel Electncal
212 Final Fire Preventlon
220 Finel Planning Approval
222 Flnal Site
250 FlnelBulldino/Occuoanc
Q�jf, IIfiITI
AOP��cant to fill in all s0aees within neavy DorCer Ilnes anO sign all apOropriate tleclaretions.
C�TY OF COSTA MESA PERMIT NO. TRACT NO. LOT NO. �BLDG. NO. '
CONSTRUCTION PERMIT �- J0.3 �
ProjettAddress � TVPE OF CONSTRUCTION 38%Q @/cL;/Q� 5o�d
OWneY Ph0 ❑ NEW ❑ ADD ❑ ALTERATION
AddfCss � [ �REPAIR ❑ CONVERSION ❑DEMOLISH J
oTHER ZONING flEGULA710NS
Arch/Eng. License No. A P�
Addre55 DESCRIPTION OF WORK
20NE PLNG. 0.EF. �
Contrector� ( Phon � TVPEOF PERMIT - � ��oPU ��p ING
SETBACK C L T. ERTV LINE
Addres5/`j' a ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL 51 E VARD
LICENSEO CONTRACTOR �ECLARATION �❑ TENANT ❑ ELECTRICAL IDPLUMBING ❑MECHANICA SI�E V R '
I hereby afflrm that I am Ilcensetl untler provislons of Charter 9(com- �� RIGHT
mencing wlth section 7000) of Dlvition 3 0( the Business antl �❑ OTHER
Professlons Cotle, a tl my uttnse is In full tortt antl et ct. pROJECT DESCRIPTION REAR YnRD (TO P/L)
LlcenSe Class �� License No. ;^7T 7�2 PKG. SPACE REQ. PROVIDED
Date���d �� Signature � S�.FT. . _
WORKERS' COMPENSATION D CLARATION OCCUPANCY_CONSTRUCTION TVPE STREET WIDTH PARK FEE $
I hereby affirm [hat I have a certiBcate of consent to selbinsure or a VALUATION ZONE ZONING APPROVED BV DATE
certificzte of Workers' Compen5ation Insurance, or a certifietl copy - SPECIALCONDIT 5
thereof (Section 3800, Lab. C.). �s— Gf2ADING CU. VDS. ACRES T. �O -
PoIicY No. (�.I'GrlF ComPanY -�fr Il� '�l/�� �
❑ Certifietl copY IS her¢by turnishetl. REMARKS: ._. '
Certifletl cOpy IS tiletl with the city Builtlin9 Divisian. � • .
EXEMPTION FROM WORKERS' COMPENSATION DEGLARATION
(This se<tion neetl nat be Comple[etl if tlte pe�mi[ is to� one huntlretl _
($100) or less). . �
1 cerUfy that In the pe�to�mance of. the work fo� wbich thls pe�mit Is
issuetl, I shall not employ any person in any manner 5o as to become PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK -
subje<t [o the Workers' Compenzatlon Laws of Callfornia.
Date Si9nature BATHTUBS SHOWERS
NOTICE: It after making Ihis tleclaration, you shoultl become subject TOILETS VRINALS GENERATOR 0-1 KW_1-10 KW
to the Workers' Compenza[lon provisions of the labor Code, you must TRANSFORMER
torthwith mmply with such provlslons or thiz permit shall be tleemetl LAVATORIES DOUBIE LAVS "- APPI.IANCE 30-50 KW_50 � KW '
revoketl.
CONSTRUCTION LENDING AGENCY KIT. SINKS DISHWASHERS MOTORS 0-1 HP_1-10 HP ' '-
I hereby aftirm that there is a construction lentling agenty for [he per- SERV ICE SINKS SUMPS (�NC. SOLAR) 10-50 HP 50 + HP -
formance of the work tor whlch Ihis permlt is Issuetl (Section 3097
Civ. C.). FLOOR SINKS � FLOOR DRAINS � � FIXTURES OUTLETS SWITCHES
�entler's Name
Lentler•s Atltlress DRINKING FOUNTAINS GAS TUBE SIGNS -
OWNER BUILDER �ECLARATION INTERCEPTORS CLARIFIERS POLE LIGHTS
I hereby atflrm lhat I am exempt fmm tM1e Contracror's Llcense Law tor
the following reason (Secilon 7031.5 BuSiness antl Professions Coae: SWIMMING POOL PTRAP
Any tlty or <ounty which reqWres a permlt to consVuct, alter, POLES METERED SUB
improve, tlemollsh or repair any 5trutture, prior to It5 issuance, also re- yyqTER SERVICE AITERA ON PANELS MAIN SUB
qWres the appliwnt tor such permit to file a signetl statament that he
is Iicensetl pursuant [o the provisions of the Con[ractor'S License Lav+ GAS SERVICE OUTLETS SERVICE - AMP '
(Chapter 9(tommencing with Sectlon 7000) oi Dlvision 3 of tha
Bu51ne55 antl PrWessions Cotle) or thal he is exompt Iheretrom antl [no yyqTER HEATERS BTU OUTPUT - .
basis for the allegetl exampHon. Any vlolation ot Sectlon 7031.5 by
any appllcant for a permit sub7ects the apP���drtt to a tivil penalty SEWER CONNECTIONS
of not more than five huntlretl tlollars (E500).
❑ I, a5 Own¢r of the property, or my omployees wlth wage5 a5 thelr SOLAR TANK COLLECTOR$ '
sole compensatlon, will tlo the work, antl the sVu<ture is no[ in[entletl
or oflere0 for sale. (Section 7044, Business antl Aofesslons Cotle: The SOLAR PIPING SVS. ISSUE FEE
Contractor's License Law tloes nof appry to an owner of a property � APP�ICATION APPROV ED BY DATE
who bulltls or Improves [nereon, and who tloe5 Such work himself or ISSUE FEE
througb his own employee5, provltletl tnaf such improvemen[s aro no[
Intentletl or offeretl for sale. I(, however, the builtlin9 or improvement MECHANICAL PLAN CHECK SUMMARY OF FEES �
Is soltl withln one year of completlon, ihe owner will have the burtlen
o/ proving he tlitl not bWltl or Improve for the purpose of sale). HEATING SVSTEM Od00,000 BTU PERMIT G E SMIP .$
❑ I, as owner ot Ihe property, am exclusively contractinq with qND DUCTING '
licensetl con[ractors to consVutt the project (Sectlon �044, Business 100,000+BTU PLAN CHECK E PERMIT �
antl Protessions Cotle: Tbe Contractor's License Law tloes not appty [o ISSUANCE S
an Ownet oi prop¢rty wh0 Duiltls o� imprOves Iher¢On. antl who con- REFRIGERATION 0-300,000 BTU PLUMBING S
tratts from sucb pro�ects with a contractor(s) Ilcesnetl pursuant to SVSTEM GRADING 8
the Con[ractor's License Law). 300,000 + BTU PLAN CHECK E .
❑ 1 am exempt untler Sectlon 8. 3 P. C. for this BOILERS BTV ELECTRICAL S s ,
reason MICROFILM E
Date pwn¢r SVSTEM REPAIR, ALTERATION PLAN CHECK S TOTAL FEE S
I h¢r¢by certify [nat I have reatl [his applicatlon and state tbdt th¢ above EXHAUST SYSTEM MULTIPLE MECHANICAL $
information is wrreci. I a9ree to comply with all ciry anU county PLAN CHECK 5 LE55 AD-
ortlipanGes antl 5[at¢ IdwS reldting to ConstructiOn, and hereby autltoriz¢ VANCE PC $
representatives of this ci[y f0 entet upOn [h¢ above m¢ntioned
p�opC�ty fo� InSpection pu�po5e5. +1� _L'
Signature Date ai FINAL FEE E
�rivars' License or 55 � � �SSUE FEE ' - � - - �� -
enir oam-�o vvmie-ouuamg; wnary-nuu���a���; ����rc-n�wwnmg; t�oweurw-r�»mao�
�
CONSTRUCTION AND PLANNING POOL & SPA �
Date Inspector Date Inspector
APPROVALS Permit# APPROVALS Permit# .
i. Temporary Electrical Service or Pole 43. Pool & Equipment Locatlon '' '" ��
. Soil ipe-Undrgrn 44. Steel Reinforcement - ' � � ' �
3. Electrical Conduit Utility-Undrgrn 45. Forms
4. Electrical Conduit-Undrgrn 46. Electrical Bonding
. tee em orce 47. Rough Piumbin & Pressure Test ' •
6. Electrical UFER Grn 48. APPROVALTO COVER-GUNITE ' - � �
7. ootings '' 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 $ewer Connection 54. Heater & Vent-Final
13. Rough Plumbing ' ' � �
14. Rough ElectrioConduit -- �56. Electrical-Final �;
15. Rou h Electric-Wiring '����� 57. Solar System-Final
16. Rough Heating & Air Conditioning • encing & Access Approval
17. Ducts in Structure APPROVED FOR PLASTERING
18. Ducts, Ventilating
19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL �
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 pomestiaFinal
35. Landsca e S rinklin S stem
36. Sound Attenuation
37. Handicap Regulations
38. FINALSTRUCTURE&BUILDING
39. Special Requirements Completed
40. Electric Release to Edison
41. Gas Release to Southern California Gas Co.
42. CERTIFICATEOFOCCUPANCY
No Date