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Home My WebLink About2335 ELDEN AVE - Building Permits� �� \ Applicant to lill in all spaces exceo� enose w(thln heavy bortler lines ana �sign all aoD�opriate Oeclantions. CiTY OF COS7A MESA CQNSTRUCTION ERMIT Project Address �335 �►-r-� Owner's Nam�o�� n Address �.�t� �.+P'r4T�E� �"�AL��r � Arch/Enq.R �� Lice se No. Address 1 Contractor's Nam Phone Address (mailing) � ' City License No. LICENSED CONTRACTOR DECLARATION I he�eby affirm lhal I am Ilcensetl untle� provi5ion5 of Cha�ter 9(commencing with sectlon �000) of �ivision 3 of the Business an0 Professions Code, antl my license is in f W I torce antl efiect. �.IC2OSC CId35 LIC205¢ NO. Date Si9nature WORKERS' COMPENSATION DECLAPATION iereby attirm that I have a certificate of mnsent to self-Insure or a certltitate Workers' ComponSatiOn Insutance, or a certifietl copy tM1ereo( ($ection J800, l.ab. C.) , Policy No. Company. 8 Certifi¢tl Copy is he�eby (urnishetl. .- Certi(ietl copy is filetl wltb tM1e city Builtlin9'�ivislon. Date Apolicant ��' EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thisseclion neetl noi Ce comple[etl if the permit is /or one huntlretl (E300) o� Iess). " I certify that in the performance oi the work.for wnich this perm�l is izzuetl, 1 shall not employ any pe�5on in any manner so as to Decome subject to the Warkers' Compensation Laws of Calitornia. Date Si9nature 'NOTICE: I(, after making this tleclaratlon, you shoula become subject to the Workers' Compensation provisions of lhe Labor Cotle, you must forthwith �<omply wilh zuch provisions or this pe�mit shall be tleem¢tl revoketl. CONSTRUCTION LENDING AGENCV 1 bereby aftirm lhat [here is a conSVuc[ion IenOing agency tor the performance of Ihe work for which this permi[ is issuetl (Sec[ion 309] Civ. CJ lPntler'S Name Lentler'S Hdtlress OWNER BUIL�EH bECLARATION I hereby afflrm that I am exempt from the Coniractor's License Law for the � followin9 reason ($ectlon �031.5 Business an0 Professional Cotle: Any tlty or �� munty whiGh �equires a permit lo con5[ruct, alter, improve, tlemOlish o� repair iany sbucturq prior to its Issuance, also requires tne applicant for such permit to file a signetl statement Ihdt he/she Is licensetl pursuant to the provizwns oi the Gontractor's Llcense Law �Chapcer 9(commencing with SecHon ]000) ot livision 3 o/ the Business antl Professions Cotle) or fhat he/sne is exempt iereM1om and the basis for [he allegetl ezem0<ion. Any violation of Sectlon %031.5 by any ap0��can[ for a permit subjects the aDPlicant to a Civll �enalty o( nol mo�e lhan irve huntlred tlollars ($500j. I, as owncr ot the property or my employees with wa9es as thair sole compensation, will tlo the work, antl Ihe structure is not intentletl or otferetl ior sale (Section 7044, Busines5 antl Proteszional Cotle: The Contractor's License 12w tloes not apOty to an own¢r of a property who builtl5 or impwve5 thereon, antl who tloes sucn work himselt/nerself or tnrough his or her own employees, pwvitletl thal such improvements are no[ in[entletl or offer¢0 fo� sale. It, howevtr, the builtlin9 0� ImOrovement is Soltl within one year of com- pletiOn, the owner will have tne burtlen of provin9 ne/she tlitl no[ builtl or im- rOve for tM1e purposc ot sale). t I, as owner o1 the property, am exclusively contractin9 with IicenseE con- racrors t6 conztruct the pro�ecl (Section ]044, Buziness antl Pr01es51on5 CoOe: The Con[ractor's License Law does not apply [o an owner oi propmty. who builtls or Imo�oves thereon, antl who contracts for zucn projects wltn a<on- tractor(s) IlcenSe Oursuant to tne Contractor'S License Law). I am aware tbat proo( oi Nelr Worker's Compensation insurance shoultl be proviaetl to me. ❑ I am enempt unaer Secllon B. &�. C. for this reason Date i]�/ ��' Ownef._-/E I here cer fy tnat I have read 'fhis information Is correcL 1 a9ree lo mmp antl stale laws relaHng ro builtling wn Signature� Drivers' cense ar 5! CMF OB65�46, rev. 10 04 en TYPE OF CONSTRUCTION �JEW U ADD LJ ALTERATION LJ REPAI R ❑ CONVEft510N ❑ DEMOLISH ❑ OTHE .�y, y� DESCRIPTION OF WORK/USE OF BLDG.� ��c� ;_„ TVPEOFPERMI7 LJGRADiNG ❑ TENANT ❑ ELECTRICAL ❑ OTHER PR0.IECT DESCRIPTION 5 T. CONST UC NTVP ZONE � GRE / 0.emarks: A/` �'fj� Sink Preventer Irrigation Drinking Fountains Floor �rains Floor Sinks GasService Outlets Interceptors Kitchen Sink � Lavatoties P—Trap Roof Orains Reinspection Fee � $15 Duct - Under Ground Duct - Strucmrol Duct - Ventilating Exhaust Syscem ❑ Multiple ❑ Firepl/Fact. BIL ICBO # Heating System & Ducting ❑ 0.100,000 BTU O t 00,000 8Ti Peinspection Fee � $15 Whlte - Builtling; Canary - Applicant: Pink - AcmUntlng; Goltlen�od - AsseSso� FOVNDATION�1 STRUCTVRAL LVMBING ❑ MECHANICAL VALUATION NGCV.VDS. � FEES $f10W2f5 Service Sink Sewer Cap � � Seu4er Connection ' Solar Collectors ' ' - $olar Piping . Solar Tank .i • Swimming Pool w/Spa Urinel Water Closet Water Heater Water Service Auto-Wash laundry Trays laue Fee � $ 3 Hood or Typel O Canopy Type II ❑ Refrigeration SVstem ❑0-100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fea A.P.qW �39-2 i S Main Building: E T Front i %F}G ARear x � � C Right �2„(p ' SLeft 8 � Ping. Ref. # p� .8(0 , Planning Notes: /�Q _ — 2/ E� 5221 5/1�=l9x 2 Z zo�e Accessory 8uilding: / — � 2,j �� Parking Req./Provided ELECTRICAL Automa[ic Washer Transformer ❑ 15�50 KW ConstructionPoleSub. � 50,+KW Cooking Uni[ Dishwasher Dryers ❑Gas ❑Electtic Fan F.A.U. Fixtures Device Boxes O ut le(s Switches Garbage Disposal Generator �0-5 KW �5-15 K i �s Meter ❑up ro 100 amps - Meter ❑over100amps Sub Panel Motors �0�7 HP � 1 X- 8 Inc.Solar 09-15 HF 016-15+ Microwave Pole Light Range Sign ; Standing Sections �'�' Trash Compacror Reinspection Fee I $15 I FEES DEVELOPMENTSERVICESREQUI 2oning Approved By Building Approved By . Aoolication Issued Bv $ 3 laue Fee � NTS: SUM V OF FEES BUILDING PEfiM1T $ 3�� •� SMIP PLAN CHECK $ PERMIT PLUMBING $ ' ISSUANCE PLAN CHECK 25% $ ENERGV P.0 ELECTRICAL $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ Z O N 1 N G R E Q M T $ FEES $ 3 .. COi�ISTRUCTION AND PLANNING POl SPA AS�PROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location '^ 2. Soil Pipe=UndYgrnd. 53. Steel Reinforcement 3.`�Electrical'Conduit Utility-Undrgrnd. 54. Forms , 4f;ElectricalConduit-Undrgmd. 55. Electrical Bonding 5.^.Ste,el�'�ieFpforcgment 56. Rough Plumbing & Pressure Test s�•'�Elec[fical UF�R Grnd. 57. APPROVAL TO COVER-GUNITE . T�ifQOtipg3� � - 58. Electrical Conduit-Undrgrnd. , B,�Fpundation �`�• � 6 � 59. Gas Pipe, O Undrgrnd., Test F 9,%Water Pipe�UndYgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd. � 10 ;'St�};uct�r31 Flobr System 61. APPROVAL TO DECK . 11. Propert�Sewer� Line & House Connection 62. Backwash & Receptor-Final � "' 12. 5eyberjCap 63. Heater & Vent-Final 13. Rpof Di2ins 64. Plumbing System - Final � r 14. Rough�Plumbing 65. Electrical-Final 15. Roug}i Electrical-Conduit 66. Solar System-Final 76. �Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar��eiling 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. ProductPiping�Gas ❑Oil 23:.'Gas Pipe-Rough &=T�'s't '� 72, Underground Flush 24'�'Roof Framing '� �� 73. Undergrnd.StoregeTank OGas ❑Oil 25. Roof Sheathing '�-� ,� 74. Overhead Hydro 26. T-Bar�Geiling (Structural) &�Monocoat 75. Dry Chemical • 27. Frart3��and Flashing �� ,3p 6 j?�� 76. Dry Standpipe 28. Lathi g&,Sjding L 86 D/�' 77. FIXED SYSTEM FINAL 29.' Insulatiori � ' /O � 78. FIRE PREV. FINAL 30.`Dryw�ll.tNailing �{ ', . 0 � p( Q,�' HEALTH DEPT. REQUIREME�NT 31. PlasterrQeown Coat' �. - �� L(� Q{6 79. FINAL INSPECTION - 32. Electrical�Power Njef�r-Final 80. FOOD CERTIFICA7E ISSUED ,..,. 33. Final ElectYic . � Notes: s �� 34. Final Heating & Air��Conditioning �6 � B r � 35. Final Gas Pipe-Test Q� ,Q �- 36. Hood or Canopy 2-lu-1i� � ' Ol< 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final � 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer . 43. Backflow Irrigation ' • � • 44, tandscape Irripation System 45. Sound Attenuation � 46. Handicap Regulations � 47. FINALSTRUCTURE&BUILDING �. 48. Special Requirements Completed / � MM 49. Electric Release to Edison . 50. Gas Release to Southern California Gas Co . 51. CERTIFICATE OF OCCUPANCY No. � Date ' � � V` . ti Aov�icant to fill in all soaces except tnose witnin neavy boraer lines antl sign all aDo�opriate Oeclarations. ,CITY OF COSTA MESA CONSTRUCTION PERMIT • Project Address �-��p�� e � ApplicanYs Mail�' 9Ad resas '`!ur�%` .w,� CQ'�IU j� .c� . 9a6� Owner's Name �1� l� Phone Address � � � � ��P �^_'�.�� Arch/Eng. License No. Address Contractor's Nam ` � ,^,,',. � Phone�.�� Addresslmailingl�� I�I.._112�-L• • Ciry License No. �� LICENSED CONTRACTOR DECLARATION � I hereby affitm thdt 1 am licenzetl untler provisions of Cfiarte� 9(commencing witM1 section �]000) of DiviSion 3 of the Bu5ine55 antl Prolessions Cotle, antl my license�is in full fo ce antl effecl. ' License CI ss_ '� i ens N. � Date Si9natur -`�OfiKE 5' C MPENSATION DECLA ATION mreby affirm that I nave a certifica�e of consent to self-insure or a certificate Workers' Compensation Insurance, or a certlfietl copy thereof (Section 3800, Lab (�L Policy No�45��9Company r /(�.%�.A�� Certifietl copy is hereby furnlsM1eA. Cert'' i tl m9 y� Is filetl.with th¢ citY i i q dvi o��,� ate__s��(#5.�.—� APPIic'an�� , EXEMPT ON �ROM WORKERS' COMPE SATION OECLARATION � (Thissection neetl not be compleletl it tM1e Oetmlt is for one huntlretl ($S00) a� iess). I certify that in the pe�fo�mance of tfte wo�k for.whiCh this pe�mR is is5uetl, I� sball not employ any person in anY manner So as [O become subject to [he Workers' Compensation Laws of California. Date Si9nature � 'NOTICE: if, after makin9 thls tlecla/atlon, you shoultl become subject to the Workers' Compensatlon provisions of tne Labor Cotle, you must forthwith comply with such pwvizions ar this permit shall be tleemetl revoked. CONSTRUCTION LENDING AGENCV ' I hereby af}irm tM1a[ tM1ere is a conSlrV�tion lentlinq agency for the performance ot the work tor which ihis Oef it is issuetl ($ectian 3097 Civ. C.) Lentler's Name � � � � Lentler's Atldress� OWNER BUILOEH �ECLARATIO I hereby affirm that I am exemp[ from the Contrattor's License Law for the following reason (Section ]031.5 Business antl Professional Cotle: Any city or munry which requires a permit to co�5trutt, alt2r, improve, tlemolish or re0ai� any sVucture, prior to its issuance, also requires the applicant for such permit •to ti�e a signetl statement tha[ he/5Pe is licensetl pur5uan[ to the provi5ion5 of the ContracloYs License taw (Chap�er 9(commencing with Section ]000) of livision 3 0( Me Business an� Pro�essions Cotle) or tnai he/she is exempt nerefrom antl the basis for tM1e alle9etl ezemption. Any violation of Section /031.5 by 5ny applicant for a permit subjects the applicant to�a civil �enalty of not more than five huntlretl dollars ($500j. ,' U I, as owner of the property or my empioyees with wages as thelr sole mm0ensation, will tlo the wo�k, antl the structure is not intendetl o� offeretl for sale (Section 7044, Business 5ntl Protessional Cotle: The Contractor's License Law tloes not appty to an o�'ner of a property who builtls ar improves thereon, antl who tloes sucn work himself/herself or through his or her own employees, provl�etl tM1at such imPfovements are no[ intentlea o� offeretl for sdle. If, however, the builtlinq or iri�Provemen[ is soltl within one y¢dr of com- pletion, the owner wlll have tM1e bu�tlen ot proving he/she tlitl not bulltl or im- ptove for the pu�pose of sale). ' ❑ I, as owner of [he property, am exUusively <onVacting with licensetl com tractorsto construct lhe project (SectiOn ]044, BuSiness antl Professions Code: The ConVactor's Lirense Law tloes not apply to an owner of property who- �uiltls or improves lhereon, antl who contracts for such projects with a con- tractor(s} license pursuant�to [he ConVactor's License Law). I am aware that proof ot tneir Worker's Compen5ation insurance shoultl be provitletl to me. ❑ I.am ezempt untler Section— B. & P. G(or this reason Oate - Owner � 1 hereby certify that I have reatl ��is a in(ormation is correct. I aqree to cnmply antl state laws relatinq to builtling const sen[atives of tyq city to,enter UPon Drivers' License the above �rtlinances rize repre- iperty for TYPE OF C�NSTRUCTION� 4CI NEW U ADD LJ ALTERATION IJ REPAI R — ❑ CONVERSION ❑ DEMOLISH ❑ OTHER qp.# DESCRIPTION OF WORK/USE OF BLDG. H�S 1 p A1 G+-¢' - S Main Building: TVPE OF PERMIT GRADING FOUN�ATION E .O STRVGTURAL T F�Ont ❑ TENANT � ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B R2df ❑ OTHEF A C Right PROJECT DESCRIPTION Sq. FT. � oCCUaANCV K CONSTRUCTIONTVPE VALUATIONS S Left ZONE GRADING CU. VDS. ACRES P�ng. Ref. # Remarks: R� n. p,p L l I L� aft iS �� / h n Planning IVotes: 8ar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Drinking Fountains 'Floor Drains ' Floor Sinks Gas Service Outleis Interceptors Kitchen Sink Lavatories ' P—Trap Roof Drains ReinspeMion Fea � j $15 Boiler Duct - Under Ground Duct - SVuc[ural . Duct - Ventilating � Exhaust System ❑ Multiple � Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑0-100,000 BTU 0100,000 BT� Reinspection Fee � $15 CMF 0865-46, rev. 10/B4 White - Builtling: Canary - qppli<ant; Pink: Acwunting; Goltlenrotl - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collecmrs Solar Piping Solar Tank Swimming Pool w, Urinal Water Closet ' Water Heater Water Service •Auto-Wash Isue Fee Hood or Typel ❑ Canopy Type I I ❑ i 3efrigeration System . �aioa,000eTu ❑iao,aoosTu System Repair/Alteration Fire Dampers Issue Fee $ 3 $ 3 Automatic Washer Construction PoleSub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A,U. Fiatures Device Boxes OuUets 3 Switches 23 Garbage Disposal Generamr �0.5 KW �5-� 6280 5%2B%86 2one Accessory Buiiding: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter up to 100 amps Meter pover 100amps . Sub Panel Motors�0-7HP�1'h-8 � Inc.Solar �9-15 HP �ifi-15+ Microwave � Pole Light Range ; Standing Sections KW Tresh Compacmr � Reinspection Fee f$15 � � Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Appliratian Issued By � ti3.20 TL FEES $ 3 Z O N I N G R E Q M T S � SUMMARY OF FEES . BUILDING;PERMIT $ SMIP $ PLAN CHECK $ PERMIT � PLUMBING � $ '�SSUANCE $ PLAN CHECK 25% $ �7,� �� ENERGV P.C. $' ELECTRICAL ' $ �:94� GRADING �, $ � PIANCHECK 50% $ I3.�ID MICROFILM $ � MECHANICAL $ TOTALFEE $ � � PLAN CHECK 25% g ., . CONSTRUCTION AND PLANNING ;�� POC . SPA APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector � 1. Temporary Electrical Service or Pole."' �- 52. Pool & Equipment Location 2. Soil�Plpe-Undrgrnd. _" �� 53. Steel Reinforcement � ' 3: Electrical Conduit U4i�ity-Undrgrnd. �" � 54. Forms � 4..Electrieal,Conduit-Undrgrnd. � � 55. Electrical Bonding ^ � 5. Steel �ReinforcementS ,%�, � ' :,-T - 56. Rough Plumbing & Pressure Test - � 6?'Electrical`UFER GFnd.�'I ,, �- 57. APPROVAL TO COVER-GUNITE 7..Footin'gs •�- �',� � �` '�� 58. EI c rical Conduit-Undrgmd. . ., 8. Foundation � _� 59. Gas Pipe, O Undrgrnd., Test .. 9. Water Pipe-Undrgrnd.� .• 60. Backwash Lines, P-7rap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK . i t. Property Sewer Line;& House Connection ' � 62. Backwash & Receptor-Final ,. � . 12. Sewer Cap �. � � , - . 63. Heater & Vent-Final - � 13. Roof Drains � � ?� "� 64. Plumbing System - Final _ 14. Rough Plumbing � '' � 65. Electrical-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 Ceilirig.' 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 �Gas ❑Oil 23. Gas Pipe-Rough & Test -" 72. Underground Flush 24. Roof Framing ' 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing �"1 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. Drywail�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 ^ -' ��1 v-§ _ .tl"�;� 35. Final Gas Pipe-Test , 36. Hood or Canopy - 37. Final Factory Fireplace ' . 38. Final Plumbin9 � � . 39. Water Service-Final � 40. Gas Service-Final • 41. Solar pomestic-Final . 42. Backflow Preventer '� • � . 43:�8ackftow Irrigation 44,.m� Landscape Irrigation System - 45.-aSound Attenuation 46�Handicap Regulations ' 47QFINALSTRUCTURE & BUILDING . 48. Special Requirements Completed 49. Electric Release to Edison � - 50�Gas Release to Southern California Gas Co 51;iCERTIFICATE OF OCCUPANCY . a No. Date 1 AOVlicant to fill in all spaces exce0t tnose wit�in heavy bortler lines antl sign all appropriate tleclarations. CITV OF COSTA MESA CONSTRUCTION PERMIT Project Address %��S FI.I1xN ST_ Applicant's Mailing Address 2121 S. (�,�� A�• .�1i l��A � Owner's Name Phone F+47—iR1 i 1// � Address Arch/Eng. Licenu No. Address Convacror's Nam ST�RA FNtrrRfY�hiF'�mel Phone QS��QQ� Address (mailingl �%171 C G[jpN�1 4\7R„ GAA71'Q [S]p City �icense No. �17491 i � ' LICENSED CONTRACTOR D�CLAR f10N I bereby affirm that 1 am IlcenEetl u tl � provi5ion5 ot Charter 9(commencin9 witn section �000) of Division 3 o he usi ss,�tl P�otessions Cotle, antl .my Ilcense is in full (orce antl effect. / t� �icense Class . CZ� i�e ePYF ��5194 �IDate //uoo Si9nature � r \ WORKERS' COMPENSATION DE ARATION � ' hereby aifi�m Ihat 1 have a cer�{fica e of onsent lo self-i ura or a certificate � it Workers' Gompensation InSurante, o d ce�tltietl co y tltereot (Set[ion 3800, Lab. C.) N0107123IX,IC F .�1 Policy No. C pa � 1` �Cettifietl copy is hereby fur�izhetl. \Cerlifiqcy,c�qY is tiietl with the cit B i i 5i Oate �� ApDlicant Q EXEMPTION FROM WORKERS' C MPENSATION DE LA A ION (This soction neetl not be comple[etl the pe�mlt is tor O'hun �etl ($100) or \Iess). I cerlify thal in the pe�fo�mance of th¢ work fo� whith thi5 p¢ m�t i5155Uetl, I shall not employ any person in any manner so as to become subjecl to the Workers' Compensation Laws of California. � Date Signature � 'NOTICE: 1f, aiter making this tleclaration, you shoultl become subject to tne Workers' CompensatiOn pvovisions of [he Labor Cotle, you must forthwith comply with sucb provi5ions or this permit sh311 be tleemetl revoketl. CONSTRUCTION LENDING AGENCV - - - I hereby a/firm tM1al lhere is a cOnsVuc[ion lentling agency for [ho pe�fo�Tante of tha work for whicn this permit is issuetl (Sectlon 309� Civ. CJ' _ Lentler's Name Lentler's AtltlreSs - OWNER BUIIDEH �ECLARl�TION 1 nereby afllrm lhal 1 am exernpt trOm the Contracto�'s License Law for the ' following reazon (Section 7031.5 Business antl Professlonal Cotle: AnY city or county whicn requires a permit [o construct, alter, improve, tlemolisn or repair any Structu�e, priot to Il5 issu8nce, also require5 the appliCant fo� such pe�mit _ to tile a signetl statement [hal he/she I5 licansetl pur5uanl to [h¢ provisions of the ConVa<tor:s License Law (�hapter 9(commencin9 witn Sectton 7000) of Division 3 of tbe Business antl Professions Cotla) or tnat he/sbe is exemp[ the�efrom an0 the basls tor [rye allegetl exemptiOn. Any violatlon of Section 7031.5 by any applican[ for a-permii subjects the applican[ to a civil �enalty oi no[ more [han five hundretl tlollars (y500). 1, as owner of the property or my employeas witn wa9os as their sole compensation, will tlo the work, antl the sVuciure is not Intentletl or otteretl fOl SdIC ($CCllOfl ]004, BUSiM1p55 dOd P!O}QSSIOOdI Cotle: The COO[ldCIO(�5 License l.aw tloes not apply to an owner ot a prop¢rty wno bWltls o� improve5 thereon, antl wno does such Work nimself/herseH or tnrough his or her own employees, prOvitletl that suCh improvements are not intentletl o� offe�etl tor Sale. If, howeveq the builtling or improvement Is soltl witnln one year oF com- pletion, the owner will have Ihe bu�tlen Of p�oving he/she tlid mt builtl or im- prove for tne purpose of sale). ❑ I, as owner of the property, am exclusivety contractinq with licensetl con- traCto�s t6 cons[tuct the PYOj2CI (SCCIIOfI iO4O� BUSIOE55 dOC PIO�C5510115 COtl2: The ContractoYs Li<ense LaW tloes noi apply to an owner of property who builtls or improves thereon, a�tl who con[racts for such pwjeCls with a con- lractor(sl license pursuant�to [he Contractor'i License Law). I am aware that proo/ o( theit Worker's Compensafion insutance Shoultl be provitled to me. ❑ I am exempt/yntler Seclion 8. 3 P. G. �or this reason Date ot Signature Oriver5' Liten CMF 0865-46, rev. — owner I h e reatl tn' application antl state tnat the above - 1 a e to co I wilh all city ana county orainances to 1 inq c ruc ion, antl hereby author'ze r pre- t r above-menlionetl Pro ert (pr Date Z TYPE OF CONSTRUCTION LJ NEW LJ ADD L1 ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q.p, # DESCRIPTIONOG.WORK/USEOF BLDG. S Main Bui TVPE OF PERMIT Gaaoirvc ❑ FOUNDA7ioN SraUCrV RaL T Front ❑ TENANT O ELECTRICAL ❑ PLUMBING � MECHANICAL A' Rear ❑ OTHER PROJECT DESCRIPTION 50. Fr. oCCUPANcv C Right K Left CONSTRUCTIONTVPE ' VALUATIONS $ ZONE GRADING CU. VDS. ACRES p�ng. Ref. # aemarks: g[jjj,p� pgg�'p #$237$Q Planning Not P Sink cflow Preventer . cflow Iriigatiori itubs - ifiers : ; ' Drinking Fountains " Floor Drains �� Floor Sinks U25SC(VIC2 ' OUIIELS . Interceptors ' ' �� Kitchen Sirik � Lavatories . P—Trap Roof Drains IReinspection Fee � $15 Boiler � Duct-UnderGround Duct - Sttuctural Duct - Ventilating u tip e Firepl/Fact. BIL ICBO # � 1 Heatinq System & Ducting �4100,000 BTU 0100,000 BT Rein cY F or 55 � I spe �on ee 0/04 White - guiltlin9: Canary - Applicant: Pink - ACCounting; Goltlenrotl - Asse55or $15 Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping � Solar Tank Swimming Pool w/Spa Urinal Water Closet - . Water Heater � Water Service AULO�W8511 Issue Fee Hood or Typel ❑ Canopy Typell ❑ Refrigeration System ❑0-t00,0008TU ❑100,000 Sys[em Repair/Alteration Fire Dampers Registers ' Issue Fee FEES 3 3 �,! $ 3 Automatic. Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers �Gas ❑Electric Fan F.A.U. ' Fixtures Device Boxes Outlets Switches Garbage Dispoul Generator �0.5 KW O5-� �. � ".. . n �i . — _ . .. ._ Zone • � Accessory Building: . Parking Req./Provided � ELECTRICAL - Transtormer ❑ 15-50 KW ❑ 50+KW Meter Dup ro 100 amps Meter �over 100 amps Sub Panel ' Motors �0-1 HP � 7'f, - 8 � InaSolar �9-75 HP �i6-15+ - Microwave Pole Light Range ; Standing Sections 5 KW Trash Compactor 'FEES Z O N I N G R E Q M T S Heinspection Fee $15 luue Fae $ 3 � DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved By � Date Building APProvad By Date �/✓�///�'//%�j��/�J� Application Issued By � DatELa�� Y—l--�— � • SUMMARV OF FEES BUILDING PERMIT $ SMIP $ — PLAN CHECK $ PERMIT PLUMBING § ISSUANCE $ PLAN CHECK 25% $ � ENERGY P.C. S ELECTRICAL $� GRADING 5 PLANCHECK 50% $ MICROFILM S — MECHANICAL $ ,�3- � TOTA� FEE $ � PLAN CHECK 25% $ o%-. SZ� � �;. �D i� • .CONSTRUCTIONANDPLANNING , � POC ,SPA � �APPROVALS Permit# Date Inspector AppROVALS 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 o;` - � 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test -_ , 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE -� 7. Footin s �� ' 9 .- M `'l � 58. ElectricalConduit-Undrgmd. _`.�?;�� 8. Foundation + / _�_ t+- 59. Gas Pipe, � Undrgrnd., Test , 9. Water Pipe-Undrgrnd. _-� 60. Backwash Lines, P-Trap, � Undrgrnd. 70. Structural Floor System '� 'y�. 61. APPROVALTO DECK 11. Property Sewer Line & House Connection - 62. Backwash & Receptor-Final 12. Sewer Cap ' �•� �� : 63. Heater & Vent-Final � • 13. Roof Dreins 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical�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 �,Z,�_�(� �� FIRE DEPT. REQUIREMENT � 20:'Rough�FactoryFireplace 4.24�` � APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating -Zq�-df6 G� 71. Product Piping � Gas ❑ Oil ` '" 23. Gas Pipe�Rough & Test 72. Underground Flush 24. RoofFraming 73. Undergrnd.StorageTankOGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 2J. 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 60. FOOD CERTIFICATE ISSUED � 33. Final Electric Notes: GJ'/ �` , 34. Final Heating & Air Conditioning �/�/� I9 /i 35. Final Gas Pipe-Test ' , 36. Hood or Canopy 37. Final Factory Fireplace / f%r(r/ �¢ 38. Final Plumbing 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. FINALSTRUCTURE&BUILDING f 48. Special Requirements Completed 49. Electric Release to Edison . 50. Gas�Release to Southern Cali4ornia Gas Co 51. CERTIFICATE OF OCCUPANCY � c; No. Date � Aoolicant to fill in all soacas except thase within heavy bortler lines ana si9n all oo0ropriata Oeclarations. CITY BF COSTA MESA CONSTRU(T�TIION PERMIT %�M�LNOip TRACT NO. LOT NO. UNIT . `Prolect Address � �� / c� Y� �/�—/ . qpplicant'sMailingAddress .2�J/11 �%tl -/f�Q �l t�fi[f„ Owner's Name ��y� �/✓o ..� I`� �7 Phone� Z Address '7��(� Il�✓1��Y %��'��- /'� Arch/Eng. License No. Address �p p Con[ractor's Nam �' r i_Phone �Jp�._7� Address Imailing) �� I 1, ,_ � rU c�r i� 9 SLf , f-� lr. CityLicenseNo. � � �yY� LICENSED CONTRACTOR DECLARATION I M1ereby a/flrm that I am licensetl untler provi5lon5 of Charter 9(commencinq with iection 7000) ot Divislon 3 of the BuslnesA antl Professlons Cotle, antl my Ilcense is in full iorce antl eftect. License Class License No. Date $igniWre "�ORKERS' COM�ENSATION DECLARATION ereoy affirm Ihat I have a cerfiircate ot consent co sei!-inzure or a certiticate Workers' Compensation Insurance, o�'a certifietl COpY tM1nreof (Sectlon, 3800, Lab. C.) � � • '' � !`� Policy No. ' Company - - . eCertifietl opy IS hereby fumishe0. � ` �, Certi ' IS 1 tl ith the city B� ':� Date • pplican[ � ' EXEMPTI N FR M WORKERS' COM NSATIOry DECLARATION (ThiS S¢cli n neetl not be tOmpletetl if the permit �k for On¢ huntlretl ( 00) Ory Icss). I cer[ify tha[ in lhe pertormance of lhe w k Or W I 1 �Ihis 2��t Is issuetl' �I Shall not em loy a y person in any e� so �� t ec me ubjeG[ to t�e Workers' ns Laws ot Calif . ' Date $I9natur¢ � 'NOTI . f a ng this tlecla� o u z o e o ne jeGt o h Workms' Comp nSdtlOn provi5ion5 o the Labor �otle, y0u mu5t f hwit comply with such provisions or tM1is Oermit shall be tleemetl evoketl. CONSTRUCTION LENDING AGENCV - 1 hereby aftlrm tha[ tM1e�e is a construction lentling a9enty to� the OerformanC¢ of tho work for whi<h this Dermit is issuetl (Sectlon 309] Civ. CJ Lentler's Name Lenticr's Adtlress OWNER BUILOEH �ECLARATION I hereby af/irm that I am exempt lrom the Coniractor's Llcense Law for the following reason (Sectian �031.5 Business antl Protessional Cotle: Any <ity or county wblch rCquires a permil to tonstrucl, dlter ImD�ov¢, tlemoli5h or repair any slructure, P�ior to ils issuance, also requi�es lhe applicant for Suc� permit to fil¢ a Sl9netl Statement that he/she i5 licensetl pursuant to th¢ Provi5ion5 of �he ContraclOr'S Llcense Law (Chap[er 9�commeqcing wllh Se[tion ]000) ot ivi5ion 3 of Ihe Business antl Profess�ons Catlp) o� tltat hC/she i5 exempt ,erfhom antl the basis fo� Ihe alle9etl exemptiOn. Any viOlatlon' of Sectlon .031.5 by any appliGant fOr a permit subjecl5 [be applicant to a civil �enalty ot not more than five huntlretl tlollars (5500). I, a5 Owner of tM1e prope�ly Or my employ@es with wages as lh2ir sole comDensatfon, will Ao the work, antl the structure is not Intendetl or oiteretl for wle (Section ]049, Business antl Grofessiop�l Cotlr. TM1e Contractor'z l.icense Law tloes mt apply to an owner of a pronerty wha builtls or improves tnereon, antl who tloes zuch work himself/nerself or [hrough hiz or her own employees, provitletl that such improvements are not Intentletl or of/erea lor sale. It, hOwever, the builtling or imp�ovemenl is SOItl wilhin one yea� of com- oletion, tne owner will have the burtlen of provin9 he/she tlitl not builtl or Im- prove �o� lhe purpOse of Salc). ❑ I, as owner of the o�operty, am ezclusively cbntracting with Ilcensetl con- traclorzto construcl lhe O�olect (Section 7044, BUsiness antl Protes5ions Cotle: The Conlractor'S �License Law tloes not apply tp dn owner ot property who builtls or Improve5 thareon, antl who conVac[s for such projecls wilM1 a con- lractor(sl 0«nse pursuant�to tM1e Contructor's License Law). I am aware Ihat proo� of Ineir WOrker's Compen5ation insuranCp Shou10 be provltlltl [o me. ❑ I am exemp[ untler Section , — B. & P. C. far this reason Date O'N�e� I herebvi certit]�hat I have reai antl state ia r at n sentatives of rs it Inspection p os . Si9nature _ Orivers' License or 55 TYPEOFCONSTRUCTION LIGNEW U ADo Ll ALTERATION LJ REPAIR ❑ CONVERSION ❑ OEMOLISH ❑ OTHER q p# DESCRIPTION OF WORK/USE OF BLDG. S Main Building: TVPE OF PERMIT GRA�ING FOUNDATION ❑ STRVCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Reaf ❑ OTHER A PRQIECT DESCRIPTION Sc]. FT. ' OCCVPANCY C Right CONSTRUCTIONTVPE ' VALUATIONS 5/ �eft ZONE GRAOING CU. VDS. ACRES p�ng. Ref. # Remarks: � � �,� � "A � . Planning Notes: Sink Prevenrer Irrigation Drinking Fountains Floor Orains Floor Sinks � Gas Service . ' : Outlets Interceptors ' Kitchen Sink Lavatories � P-Trap Roof Drains Reinspection' Fee � $15 Duct- UnderGround Duct � Svuctural Duct - Ventilating Exhaust System ❑ Multiple ❑ FirepUFacL Blc ICBO # Heating System & Ducting ❑6100,000 BTU � 100,000 BT Reinspection Fee � $15 CMF 0865-46, �ev. 30/84 White - Builtlin9: Canary . qpplicant; Glnk - Accounting; Goltlenrotl - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Close{ Water Heater - Water Service A uto-W ash Laundry Trays Isue Fee Hood or Typel ❑ � Canopy Typell ❑ Refrigeration System ❑a� oo,oao aTu ❑ i oo,000 System Repair/Alteration Fire Dampers Registers Isue Fee ES $ 3 FEES $ 3 Aummatic Washer Construction Pole Sub. Cookin9 Unit Dishwasher - n AtcessOry Building: Parking Req./Provided ELECTRICAL Transformer ❑ 75-50 KW ❑50*KW Meter ❑up [0 700 amps Meter ❑over100amps Dryers LJGas LJElecvic Fan F.A.U. � Fixtures Device Boxes ' Outlets Switches Garbage Disposal Generator �0.5 KW �5-15 KW Sub Panel Motors�0.1 HP 01X-8 Inc.Solar, �9-15 HP Ot6-15+ Microwave Pole Ligh[ Range Standing Sections � Trash Compacmr Fee �$15 � � luue Fee FEES 5 3 Z O N 1 N G R E Q M T S DEVELOPMENTSERVICESREQUIREMEN7S: Zaning Approved By Date Building Approved ey Date Application luued By Dat � � SUMMARV OF FEES � BUILDING PERMIT $ SMIP $ PLAN CHECK $ �� PERMIT PLUMBING $ ��,] � ISSUANCE $ � PLAN CHECK 25% $ �% •�a ENERGY P.C. $ ELECTRICAL $ GRADING S PLANCHECK 50% $ MICROFILM $ ' MECHANICAL $ TOTALFEE $ So�.3� PLAN CHECK 25% $ _ � CONSTRUCTION AND PLANNING POC SPA Date Inspector Date Inspector `�APPROVALS Permit # APPROVALS Permit # 1. Temporary Electricel Service or Pole r 52. Pool & Equipment Location i .� 2. � Soil Pipe-Undrgmd, s27-23 (,kp �, . 53. Steel Reinforcement � 3., Electrical Conduit Utility-Undrgrnd. ' i. �' 54. Forms � 4. Electrical Conduit-Undrgrnd. � 55. Etectrical Bond'ing 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical'UFER Grnd. . 57. APPROVAL TO COVER-GUNITE 7..Footings � � � 58. Electrical Conduit-Undrgrnd. 8. Foundation , 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. (i-'�1�8� LE� 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System , 61. APPROVAL TO DECK 11. Property Sewer Lind & House Connection b��d.b �O „ 62. Backwash & Receptor-Final , 72. SeweF'Cap 63. Heater & Vent-Final 13. Roof Drains ' 64. Plumbing System - Final 14. Rough.Plumbing � ��Y(p �,�§p 65. Electrical-Final 15. Rough Electrical�Conduit 66. Solar System-Final 16. Rough Electric Wirin9 67 Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T 6ar Ceiling 69. POOL/SPA SYSTEMS FINAL 79. Rough Heating & Air Conditioning .� FIRE DEPT. REQUIREMENT 20. Rough Factory FireP�ace � APPROVALS Permit # ' 2�. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. 'Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & 7est ,. 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank � 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.. laster Brown Coat 79. ,FINAL INSPECTION �. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test � ��y 36. Hood or Canopy 37. Final FactorY Fireplace 38. Final Plumbing � �7 39. Water Service-Final 40. Gas Service-Final 47. Solar pomestic-Final 42. Backflow f?reventer 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 5L CERTIFICATE OF OCCUPANCY - No. Date CityofCostaMesa IN5ULATION CERTIFICATIUN� suildingSafetyDivision �J�..7 '�r �L/./tt�`� /�'�F CYf/i(% /"•C7J� Q/� Number and Street Ciry Counry / 2-.1" 7 � .� ,i Subdivision Lot Numher DESCRIPTION OF INSTALLATION ROOF Material Thickness (inches) EXTERIOR WALL 1 Material %2'"/ � Thickness (inches) � ��z- � � CEILING Batt or Blanket Type � — �C� Thickness (inchesl �0 ��Z � � Loose Fill Type Minimum Thickness (inches) Area Covered (ftZ) FLOOR,ELEVATED Material Thickness (inchesl FLOOR,SLAB Material Thickness (inches) Width (inches) FOUNDATION WqLL Material Thickness (inches) Brand Name Thermal Resistance (R Value) Brand Name _L��ii�L-� Thermal Resistance (R Brand Name /�/f%Jl/(%/�-�--L Thermal Resistance (R Value) Brand Name _ Number of bags Weight per bag Thermal Resistance (R Value) Brand Name Thermal Resistance (R Value Brand Name Thermal Resistance (R Value) Brand Name Thermal Resistance (R Value) DECLARATION I hereby certify that the above insulation was installed in the building at the above location in conformance with the current regulations setting Energy Conservation Standards for new residential buildings (located in Title 24 of the California Atlministrative Code�. � �� General Contractor (Builder) �NESTERN IN� LATI(��'ature and Title / 3621 W. MOORE AVC. SANTA ANA, Cq gp7p4 Sub Contrattor �InSulatiOn Applicator� CMF 1306-46 ,� ��s� � � License Number 2 n Dete yk� z��' License Number ��—/7, � , Z /U -�7 Signature and Title � Date 1:7 Aoplicant to fill in al1 spaces exceot those within heavy boraer lines ana sign.all approoriate tleclarations : CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT 6. .. . �Project Address '0:3-� .-r�pq �E�� C��n.f-�J1I ��7 -E 3 �I - , ' 6279 5%2B%86 43�20 T Applic2nt�s Mailiny Ad �E55 J�SeJ_ �pL�_�ll l� A�� (��r��,�� TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR u (�_�� n,,� ' J � CONVERSION ❑ DEMOLISH O OTHE`R Owner's Name �alJCY-.1[�2�. �z0-�� -I —Phone DESCRIPTION OF WORK/USE OF BLDG. r'�S l P N Q.P _ ' A.P' # , Zone Address �� 7�� P�a�C�P - ' ' S Main Building: � Accessory Buildingr Arch/Eng. - License No. ' TVPE OF PERMIT ❑ GRADING FOUrvoA710N ❑ STRUCTURAL T Froni � p ❑ TENANT � ELECTRICAL ❑ PWMBING ❑ MECHANICAL, Atldress p�y ❑ .OTHER A Rear � N Contracmr'sName ' Phone�3=�(1_) � � � `� . PRO�ECT DESCRIPTION 54. FT. � pcCUPANCV� K Right G Address (mailing) C � — CONSTRVCTIONTVPE VALUATION$ S L¢ft City Licen N " ��T �� • ZONE GRADING CU. VOS. ACRES R LICENSED CONTRACTOR DECLARAYION Ping. R¢f. # Pd�king R2q./Provid¢d 'E 1 hereby affirm that I am licensetl untler Provisions ot Charte� 9(commencing Remarks: `r Planning Notes: ' - M wi[h seciion J000) of pivision 3 of thd 8usiness antl ProfesSions Cotle, antl my license is in full tor antl eftect. � � T Liceni 1 55 � IC OS NO. `S Date Z Si9nature - PLUMBING FEES � WORKEftS' COMPENSATION DECL RATION � Bd�Si�k ShOW¢�5 lereby a(firm that 1 have a certificate o1 consent to seif-insure or a certificate ELECTRICAL FEES Worken' Compensation Insurance, 0� a certitietl copy tM1ereof (Section � Backflow Preventer Service Sink � %... Automatic Washer Trensformer ❑ 15-50 KW � J800, Lab t . �, aoiicy No.�S e�.��"��iqCompany �._�µnAl?"T� P_M � gackflowirrigation ' SewerCa ❑ 50+KW • P Construction PoleSub. �Certi(ietl Copy'is hereby furnishetl. Certit' o filed with"the city �I i g�Dl4i;lp�_ _D, �� BathWbs ' Sewer Connection Cooking Unit - Meter �up to 100 amps Dale .��., AOPlicant (� - EXEMPTION F OM WORKERS' COMP SATION OECLARATION Clarifiers � � SOlaf ColleCtors DiShwashef _ Meter ❑oVer 100 amp5 � (Thissection neetl not be completetl if the Permit is for one hundretl (5100) or less). � . Dishwasher ' Solar Piping .;r� Dryers ❑Gas ❑Electtic Sub Panel I tertity thal in the pertoimance o( the++o�k fo� wM1lch this pe�mi[ is issuetl, I - _ shail not employ any penon in any manner so as to become subject to the Orinking Fountains Solar Tank � Fan � ' I � workers' Compensation Laws oi Californ�a. �� Momrs �0-1 HP �1 %- 6 Date Si9nature Floor Drains Swimming Pool w/Spa' �=� F.A.U. 'NOTICE: If, af[er makinq this tleUaration, you shoultl become subject to the Inc Solar �9-15 HP 076-75+ Workers' Compensation provisions ot tPe Labor Cotle, you must forthwlttt FIOO�SinkS U�indl ) Fix[u!¢5 ' compty wilM1 such p�ovi5ions or this Permit shall be tleematl revoketl. ! Microwave CONSTRUCTION IENDING AGENCV GasService OutlCts Wdt¢fC105¢t D¢V�C¢BOx¢5 I he�eby affirm that there i5 a mnstruction lentling agency for the pertormdnce POI¢ Light ' of [M1e work for which [his permlt is Issuetl ($ection 309� Civ. CJ Interceptors � Water Heater ' � OUkIBLS ' ' �enaer's Name Range ' Lender's Atlaress � . Kitchen Sink : � Wate� Service � OWNER BUILDER DECLARA ION ' SwitChCS . Sign � I M1ereby affirm that 1 am exempl from the ConVactor's Liwnse Law for ihe Lavatories Auto-Wash � following reAson (Section ]031.5 Business antl Professional Caae: Any city or ' Garbage Disposal ; Standin9 Sections � county which �equires a permit to construct, al[¢r, imp�ove, tlemolish or repair P-T�ap � LaUnd� T�3 5 ' ' any scructure, prior to its issuance, also requires the applicant for such permit � Y Generator �0-5 KW �5-15 KW Trash Compactor to file a si9netl stalement [hat he/she is IicenSetl pur5uan[ to the OroviSions a( j{OOf D�dinS � - „�.the Contractor's License �aw (Chapter 9.(�ommencin9 `�+�th Section ]000) of . � - Six`iyision 3 ot the Business antl ProfesS�ons Cotle) or that he/she is exempt _ . x� eretrom antl the basis for the alle9etl exemption. Any vlolation of Section ' �li�31.5 by any applicant tor a perm�� subjects Ihe applicant to a civil - �� nalty of,not more tban five huntlretl tlo�lars ($500). � , � � LJ I, as owner of the property or. my employees with wages as their sole Reinspection Fee ' �$15 Issue Fee $ 3 compensation, will tlo the wo�k, antl IhC siructu�e is not intentletl o� offe�etl � Professional Cotle: The Cootractor's Reinspection Fee $75 luue Fee $ 3 for sale (Se<tion 7044, Businezs antl MECHANICAL FEES ' License Law tloes not appryrto an owner of a property who builtls or improves - , thcreon, ana who �loes such work him5elt/nersel( or throu9h hls or her own - DEVELOPMENT SERVICES REQUIREMENTS: ¢mployees, provitletl that such improveinents are no[ in[entletl or offeretl tor BOiler HOOd or Type I ❑ . sale. If, however, tne builtling or improvement is soltl within one year of mm- - Canopy Type II ❑� Za^��9 %�PProved 8y Date pietion, the owner will have the burtlen ot proving he/she tlitl not builtl o� im- �uCt - UndC� G�Ound - prove for the purpose of sale). Building Approved By , Date��}�7' ❑ I, as owner ot tne pro0erty, am exdusively contracting with licensetl con- Duct - Structural Refrigeration $ystem AppliWtion Issuad 6y tractors to mnstruct the project (Section 7044, Business antl Professions Cotle: - �� Date O�d-7�(D The Contractor's Li<ense Law tloes not apWv to an owner of property who � Duct - Ven[ilating ❑0�100,000 BTU ❑100,000 BTU �- ' � builtls or improves thereon, and who co�Vacts tor such projects with a con- - SUMMARV OP FEES tractor(s) license pursuanf to the Cantractor's License �aw). I am aware that ExhaustSystem ❑ MWtiple ❑ System Repair/Alteretion � 6UILDWG PERMIT $ ' SMIP, $ proot ot their Worker's Compensation insurance sM1oultl be provitletl to me. _ pLAN CHECK �$ PEIiMIT ❑ I am exempt untler Section e. & P. C. for this reason ' Firepl/Fact. Bit. IC80�# Fire Dampers ISSUANCE $ PLUMBING $ Date owner � - Heating System & Ducting Regiscers pLAN CHECK 25% $ �� ENERGV P.C. $ I hereby certify that I have reatl this zpplication antl state that the�above ' � OP100,000 BTU O100,000BT � GRADING $ � information is mrrecL I agree to complY `�+�th all city antl county ortlinances ELECTRICAL $ , and state laws relating to builtlin9 construction, antl hereby authorize reore- ' MICROFILM $� sentatives of t s ciry to enter upon tne abov -mentionetl pr per y for � � PLAN CHECK 50% $ ' inspection pur s. 5 MECHANICAL $ TOTAL FEE $� 5�qnature peins ection Fea $15 Issue Fee $ Drivers',License r SS � - P $ 3 PLAN CHECK 25% CMF 0865-66, rev. 10/84 White - Builtling: Canary - APPlicanh aink - Accounting; Goldenroa - assessor ^CONSTRUCTION ANDPLANNING POC SPA � APPROVALS Permit# Date' Inspector AppROVALS Permit# Date Inspector 7. Temporary Electrical Service or Pole' �- 52. Pool & Equipment Location , r. .�. 2. Soil Pipe.:Undrgrnd. �- -��,; - 53. Steel Reinforcement � ,r � � 3r Electrical'Conduit Utility-Undrgrnd. � �� 54. Forms v 4.,Electrica{,Conduit,Undgrnd. S 55. ElectricalBonding � �.• 5. Steel �Reinforcement �_,�. � � 56. Rough Plumbing & Pressure Test . 6. Electrical UFER Gmd ;� • .- 57. APPROVAL TO COVER-GUNITE . 7. Footings � � :'� �. . � , 58. Electrical Conduit-Undrgrnd. , 8. Foundation �� _ � 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. �� , � ' �. 60. Backwash Lines, P-Trap, � Undrgrnd. '� e 10. Structural Floor System ; . � 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection . 62. Backwash & Receptor-Final 12. Sewer Cap r - � , 63. Heater & Vent-Final - 13. Roof Drains � 64. Plumbing System - Final � �. � 14.� Rough Plumbing ' � , _. 65. Electrical-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 y. • 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 # . � 21. Ducts, in Structure -� 70. Underground Hydro 22. Ducts, Ventilating � 77. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing � 73. Undergrnd. Storage Tank O 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. Electriral Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric � � Notes: ' 34. Final Heating & Air Conditioning , y:-� � � 35. Final Gas Pipe-Test � 36. Hood or Canopy 37. Final Factory Fireplace 3S. Final Plumbing 39. Water Service-Final � 40. Gas Service-Final 41. Solar pomestic-Final � . 42. Backflow Preventer - �- � , ' ' 43aBackflow Irrigation , � 44,�.�,�Landscape Irrigation System � � 45sSound 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 51cnCERTIFICATE OF OCCUPANCY 0 No. Date