HomeMy WebLinkAbout401 BAY ST - Building Permits_Er1S2' 3AY S�TFiEET, 401
7k62 - 1959 _es -.+re:ti .�ar $16,168
39737 - 11-5-63 =:.:,,. :;c �:t.::.
29950 - 7-24-69 �v �.:::, _: ; ooi - Canceiled 3, 000
� �
_P20978 _ Pltnnbing '
���/ 9�85. —
�: - �
�OWNER p
�JOB ADDRESS
GENERAL CON
AP No. 118-2
INSPECTIONS
o SOIL
� GAS
W ATER
ROUGH PLUMBING
PPOP. SWR. LINE
SPRINKLING SYST
MISCELLANEOUS
ROUGH HEATING ANO AIR CON�ITIONING
UNDERGROUND U POWEF U
ROUGH WIRING
TRENCHES � FORMS � STEELI
FLODR SYSTEM
90N0 BEAM � STEEL REINFORCE
SHEATHING
FRAME AND FLASHING
u
PLASTER,BROWN COA
DATE 4-8-69
BUILDING PERMIT N0.
SUBCONTRACTOR
:� �
_* * w/[a1
, • S ��
COSTA MESA BUILDING DEPARTMENT
P. O. BO% 31'!
COSTA MESA, CALIFORNIA
FOR APPLICANT TO FILL IN
OWNER C1Fy$'
MAIL
ADDRE55 �
CITV
ARCHITECT I
OR ENGINEER
L16JV 1X1J' UYS"Op4
COSTA MESA. CALIFORNIA
i.evelopmenti
E. 17th St.
CITY
- ., ( -
� 11�7 � I
�� Yrr-livu J ��..-
Q-a-S� �.
F;�:'.::CE l�E�'i.
�. ..irri r "
APPLICATION FOR PERMIT
BUILDING
FOR OFFICE USE ONLY
RECEIPT NO. P�J.�I�J�Qy�
d aJM
ECEIVl� BY DATE RECErvEO D/�TE ISSUED
�,_ �i G'f_ T-( � SFP 5 iQ�
fEL. n BUILDING �
�10. �� p�� ADDRE55
��C. COSTA MESA. CALIFORNIA
NO.
FIRE
ri
A�DRE55 �9 F'• 1
LEGRL LOT [
OESCRIPTION NO. �O
A.P. NO.
S��E 75 x
OF LOT
USE OF
E%ISTING fiLDG.
$ETBACK LINE FROM
CENTEF OF STREEt
SIDE VARD
BLOGK
NO.OF BLDGS.
y�.� REAR YARD19�6�
RIGHT lO� LEFT 6�
DESCRIPTION OF WORK
NEW G ALTERATION � AOOITION
REP.CIR MOVING DEMOLISH
SIZEOING 160�. S PE RO MF� STORIES
EXTERIOR WALL.� ROOF
COVERING Jtl]CCO COVERING C��,
USE OF NEW Single faarily residence
BUI�DING
rrith
APPROVEO
BY
CORRECTIONS
F1an %'750E•
I NEREBY RCKNOWLEOGE TNqT I HAVE PE1D TXIS RPPLICFTION 4NO
STRTE THRT THE r�BOVE IS CORflECT 1rv0 sGREE TO COMPIY WITH RLL
CITY OROIN.�NCES TND STLT •WS VLATING BUIL�ING CONSTFUC-
T�ON. VALUATION pERMIT FEE $ 3g�OO
SIGNATURE OF I
PERMITTEE 1(���
7�1v s 16,168�VV PLAN CHECK $
AUTHORIZED AGENY'iao � COle OVQ yy TOTAL FEE SS��yy
s��
�1 .. !
1 ~
29956 APR -8-69PA10Q� 343�` �'�**
�„5� 34.50
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
for Applicant to Fill in Completely APPLICATION FOR BUILDING PERMIT
ADORESS %OI L. /,J RECEIV�O�V DAiERiCEIVED ppTi�iU��
BU�LDING �Zq Q p T
�/ �q� P qM1T NO. /
OWNER L E F A.P.NO.I���JC�I—c'�' S�/�
� MAIL / BUILDING
Z qDDRESS SAMe ADDRESS �O/ � ��/q /
a U CIY� p,g NOL TflACT '� 23 LOT �� BLOCK
. FZ �,
Z Q (`pNSfRUC71 W ADD A
O N LENDER
i
a m -
J � BRANCH ,[ , , • �
J tn OWNER /DE�Z /?.
m J qppRESS . VA4UE j '
m ARCHITECT ('_1 TEL $�7 �
J N OR ENGINEER 0�� ✓7�NG N.� 8'%2JZL•
V n �j / /� FIRE
yZj 2 ADPRESS �' (. f(J/CpAO L✓FJ -!' (,J ' ZONE TVPE ROUP
aw '/
CONTRACTOR y �/y / ByPROVED DA7E"]
J O iF //N 00 f �_�
�J � ADPRESS 9 A�lU�r�ve
WW TEL. �ONE[� NO.OF USEOFNE
Z= CITV !Q2 E�✓ OV '� ' NO 3 Q Q• /)'' PLAN$ � BUILDING
H
Q STPTE CITY VARDSAPPROVED YAR�SAGPROVED
� 2 uc. No. 25 037� LIC. NO. MAIN BUILDING ACCESSORV BUILDING
� O (FROM C/L STjiEET)
$12E NO.OF eLDCS.
OF LOT NOW LOT / RO�`rT �� FT. FT.
USB OF �^} '
EXISTING BLDG. �N� ���'1 �(/ T FT
Z NEZ�BLDG. ,� �L ' RpOMS STORIES L SIDE j� FT. FT.
U EXTERIOR WALL ROOF
COVEFING COVERING REAF FT. FT.
J VSE OF BUILDING AND WORK TO BE PERFORMEO DISTANCE BET. BET. MAIN &
a MAIN BLDGS. ACCF�, BLDGS.
a
a / , ' C URP � MPROVED
�
~ ' APPROVE �
y — i
Z '
O
1 U I hereby acknowletl0e thet I heve reatl this epplication and stete
� chat the ebove intormatlon is correct antl apree to comply wlih
,� all laws regulacing builtlinq consttuction, antl 1 shall not amploy
F„ enY Pe�son in violetion of tho wo�kmen's cOmpansatlOn lawa of
� y Ma Siata ot Califomia. �
ZI hefeby certify that I am properly licensetl as a convactor untlar SQ. FT. O
the State Of California Business entl Protessions Cotle, Dlvisicn 3, THE AMOUNT SHOWN UNDER VAIUATION IS FOR
Chapter 9, antl thet sueh licenses are in full force antl ettact, or I THE PURPpgE OF ESTABLISHING A PERMIT FEE ONLV: Q
am pzampt from the Orovisions of the S�ete ot California Busineza �p.LUATION
entl Professions Co muon 3, Chepaar 9. 1 Qa m
PERMIT FEE 5 lJ j
SiBnaiura of - i� . v � m
Permittee "7 S � PLAN CNECK $�/ E
A�,Mo,iied Aee�i G�L/� `L �-Fz ` lS� °
LL
/ TOTAL FEE $ �
�oonas or amiuia: y v a. c a n x. � a
wmeasruYeivawwkSTUADEVANT, CLAYTON
� �SA2037DSWANT�RJULIE S
COSTA MESA,CA
�vx. �unma.00�sx
�PCNRECT ON ENCd1EER:
MCH OP FNG'S /iWNE53:
���g„•.,�.PETRONELLA ROOFING
������ 2626 NEWPORT
�S�COSTA MESA
92627
IJCENSED COMN�CfOXS DECLAfi�TION: I hemW MFm wWs
leommwian0 xqh Seeiian ]aM d �ivuun 9 d Ihs Bw'vm eed PN
cmuc.No:03260� uc.cuva:C 39 uc.wo
51
92626
uHT: _ . _ _ CITY OF COSTA MESA =__HUILDING PERMIT _
PERMIT NO: B 087186 PLAN CHECR NO: N
CONSTRUCTION TYPE: V-N PERMIT TYPE: STR
uc. xo.:
uxr:
(714)598-1645
CA „��, 00460707
uMr:
W mm i.m i�a � aa� a cnaqa s
, end m Gw� w in hA tan md dlea.
46(�Z07 EXP: 07/98
�; � �� Gon4etlIX: — V '
OWN BNLDEN DECLAA�TION: I hwaby elfim� uMr W pe'Wy p 1 am uanq han tM Camaaa+ lioxma lew la tM
n0 reaaon (Swion ]W I.5 Bwirou enE Ralm�ima : MY ciy a�ry Wiidi n0u"vee e i�Y lo mmbucl. alls. impwe.
Eand'ah, u repei my elrv,i�ae, prior w Ee eae�we, deo eaa nm tM eppli � Im eueh psrm's �o fib e egred etmemam Mn he p eM
�. iK«,.se w�m io in, wo+mo�. a m. com�ao" � i.. Icn r 9(aw�unmdiq x'rh Saaun "ldW) d 0'veion J d �b
Buvroaf antl Prdw"wn COCsI a Ihtl Ir a ehe 6 e�emq 1 Nmm aM s bew la Ns eOeB� niamHun. MV vide�on al $edion
)m�s M em aop�� �« • w.mv wbjsm �M wq� �o e a na mae �nm rnro wmrod dnoan �ssmp.
� I, u owmr W �M popeny w my empb/ses wIh wepa m t wnpeneetion, wiA do tlre xak, eM Ne evunun u� ime�MeE
or oflerad M veM (�ian ]Ou. Bmmu erd Froineorn Code: The Comreeon liceme lewtloes rwl epply loan ownerd properry
.,no wu. « mc�we. m.,ao�. m,e.no aoe..�n,.on� �,..n a n.,w «m.won n: «n�. �.maom... n«dae mm.�
imqowmeNs ue m� imeiWsE a a1MSE la veb. tl, howaver, tM buitlinp a inprmanM u wN xnhin ar yev M mmpblun, Ihe
owrer�WdM MiA heve IM buNen d pw'up M a ehe d'k nal WdE a'unpow /a Ihe pu�pms W aeb).
❑ I, ae owiw d iM poperiy. em eaduaivaN �trm'rp xith IioeneeE conirecwn to canmud tlro pml� (Sedion 1016. Bueineev eM
Profeoiwn Cade: TM Conlretlav Liceroe Lew Eoee rwl epply lo en ovmer d propa�Y ��iNe a imqwm tln�ean anE who
emlrecU la arh VN�s xnh e mMradule) IcameC Wnuani �o �M Lonvaeon licaeua lewl.
� I em eaemq uMer Snion: B. 8 P.G.. la t�b ieuon:
Due: �+mer
� do Mrenr cenM �nm � em a.me a em �ndenuM ins i.a�ramew a cd�anie Heean ene sdeiv coee seaom zssos. zss3�..m
T5551, eM tM1et I a eny tUure Wikiiq oxupem will / wil rw� (rircb me) need io canply wih eeid alete ooda enE �M repuiremeMe br
aparmntacaneVuciionamodifirationhanlMRi u�0i�aily�—erepemen�Dialnd.RmidmtielcaMiueioneppYcetiwanezemqiramthew
provieions.
Oele: MW�:
WOPKEH'3 COMPEN3ITION DECL�N�TION: I MroW dfirm uMs paW1y d parjury an d IM fdbxi�q ddvetiom:
� I heve erd wil memtan e cmNuta d mrm�t lo �aHinwn br xorkas' oompenWion. m prwidsd la Ey Sopion a)00 d IM lebv
coe.. �« ine wrtanuntt a �n..ak b.N:cn mro wmil o u.�ea.
❑ i n... ene wu meim.n wa�w.� wmv�on i�nurerce.., na���a M s«rian a�oo a me �.nu. coea. r« me wN�+�+� a n.
wpk fa which thie pertnit e usued. MY warFen' canpemvbn inwrence mmer enE pdiry numEa ue:
c�..:
vd�rrv�me«:
(lI�N ualan nseC rat M conWweJ l tMV�t m br wro M1wMd doN I la.f
S4-. � oenN �nm m u. wnamence a me ..oh ro. �.ncn �m. p.mn u e. . � � �a «�Wq .�v caeo� �.�v ma,�e. eo es �o
I•L'f become abjetl to tM xvrken' canpena�ion kws d GNdanu.�p ap IW Y I Wcuk Eemme amptl lo IM wake�s'
�•�ion pw'vunyeLSeyion 3]00 d iM laEa Cods. l NeY lal ' ompy wuA tlirop.ppyuiue.
W ip: FeOun ro uwn roMen'ro�tlon m
vn nn., w ro o,. mne.w mou.w eww. R+w
Sxtlm 3)(M' ol tlr� LeDor Cob, Intr.aL ���m�
CONSTFUCTION LENOINO ��ENCY: 1 Iwsby etfi�m
perlamence d iM xM la xhid� the prmi e eaeU (:
LENDEN'S NNIE:
LENDEN'3 �DDflE4S:
1 caniy thm I heva reeE Nn eppl"rafvi and pde �hn tM
eM sleb laxs nWiq m ddd�q rmnnrlim mtl heroby
�«�"'°°°�""°�i`OID WATTS
r
JOH DESCRIPTION : T/O RESHEATH W/1/2 " CDX 6 REROOF W/COMP
CLAIM VALUE: 6,000.00 CALC—VALUE: 6,000.00 GR
aa
PERM NO: H 087186._
GOVT: N SUPP: N
PURPOSE: OTH
SQ FT: 6,000
OUP OCC: R-3 /
COMMENTS: X
***�r*****w*+t*********+t*+t*it*�ti�**�tit******�r�r*�t*+t�t*r�t*+t�t�t+t***�r�t�t**�r*���r+t*+t+t******�*
Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN HUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ: PROV: PARCEL: 42624115 2NE: REF NO:
PLANNING NOTES>„ �'
i �,
k 1f iF ik if ik if if iklF k iF ik if if M 1! ff if M M if M iflt if iFlF 1t iE 1E it ik iF it M M ik ik ik ik k ik iF iF ik 1f iE 1E 3E k if iF �E 1F iF if iE Ik M ik i(� iF M±k iE if fF 1f iF.iE ik k ik 1k if iF ik iE
D E V E'L O P M E N T S E R V I C E S R E Q U I R E M E N T�S
LL^
ZONING APPROVED-�BY . DATE: -� .
BUILDING APPROVED BY :
�/ iJ
APPLICATION ISSUED HY:
iE i41k if M M i!'M ikit 1f it 11' ik ik ik it M!f iF ik if
LEGALIZATION:N F E E 5 U M M A R Y
BLDG PMT PLUMHING ELECTRIC MECHANIC
PERMIT 112.25 _
DATE:
iFiEititiFikititiEiFiFiFikiHF jlifififilik
STRUCTURAL:S GMENT:Y
FIRE SMIP/R6S�� GRADING ��
SMIP/NON-RES
PLAN '
ISSUE FEE
HUILDING-DIV-> PERMIT ZSSUE PLAN-CHECK TOTAL PAID DUE
TOTALS----> 112.85 0.00 0.00 112.85 112.85 .00
REVENUE DIVISION TOTALS--> COLLECTED; 112.85 OVER/SHORT: .00
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
112.25 ,60
1fatlFMikififiFiFifMiliFifiklfflftititifitif±tifif3klfiFififlfiFkiFiFiEiFiEiE�kMMikikikifiFMikiFMiEMif%MiF1FifKkikiEkMNMMlFiEifiFMiFifMi(�1F
Z N D I V I D U A L F E E H R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
n povMM M In
SFR 6000
ihtl Ihen u a omflruGun WMinp epeM.y br tlro
Dme:� ��
WMs-BuiMM 8 SdMY: Oreeri-Fik: Cerwy-�ppfum: Rnk-Rewnw: (bldenmFMae+wr
REAOOF BY VALUE RESIDENTIAL NOZONE
END OF FEES
1.00 �-� 6,000.00
I
83-83-1998/82:32 PH/f112.65
RCDTH:01-0820?82
F'EkMIT:087186
i I
CONSTRUCTION AND PLANNING � _ POOL & SPA �
�APPROVAIS Permit �h �� �� Date Inspector qPPROVALS Permit #� � Date Inspector
1. Temporary Electrical Servica-or Pole . 52. Pooi & Equipment Location . I ,
�:2;15oi1 Pipe-Undrgrnd., . T _ 53. Steel Reinforcement ' �, �
c j 3,vE�¢cViwl ConduiUHiility-Un�rgrrM. 54. Forms � � � �
��4. E{^ectrical Cond,�it=Ffndrgrnd. _ 55. Electrical Bonding I
��-c•
�^'.,+�,:�t�el Reinforcemeni; 56. Rough Plumbing & Pressure Test � ° �
i
-26. Efectrical UFEFi�rnd. 57. APPROVAL TO COVER�GUNITE � '� �
+.� 7,�`Footings �� 58. Electrical ConduirUndrgrnd. I �
� v.'8. Foundation �^- : i 59. Gas Pipe, O Undrgrnd., Test �"
�
.`�9. Water Pipe�Undtgrnd�� � 60. Backwash Lines, P•Trap, O Undrgrnd. � ��
�70. Structural Floor System � . 61. APPROVAL TO DECK �
+t t. P,�operty Sewer Li �& Hou�Connection 62. Backwash & ReceptorFinaf • �
t2• �Wef �P t� 63. Heater & Vent�Final �
13. Roof Drains ^ % 64. Plumbing System � Final � I .
14. Rough Plumbipg � ;.Yj ��' 65. Electrical-Final � I
75. Rough Electrital-Gmduit •• � 66. Solar System-Final I
16. Rough ElectriC;Wiri�g � .� 67. Fencing & Access ApProval � .
17. Rough Wiring Sign�� - -� 68. APPROVED FOR PLASTERING I �
18. flough Electrical-T Bar Ceiting 69. POOVSPA SYSTEMS FINAL I
197Ropgh Neat�ng 8�-¢:ir Conditjqoin9 tr'�' � y z�Cr � ^' FIR£�3EPT�REQUI�REMEN�IT iu �I
�. ,� r-� r�. r•... ..n.-� n-� r+�o M (i3�v C1 C '�f IT'
20=_'Ro`-h F�c2'o`'rry place � ��" �^`` r S"'` '�"� n AP�O�AL�+ E" mit#'- t" ` �
_. � - �� � �+F 7CS H ''7 -7x� �C, .-.'7�: � �G v, I
21 �_Duc�ts, irtyStr�cty`TCv S � �: C> +-� C� ��-+ 70!^Under to0nd kiydro ''
- �' r c -�n
22:�u' is, �^j�nt ti � . ., � ,: O <t :"J 't�� .y a � i .
�., 4* � ^�.r, ,�.,� g ..�r. �... 71. Prod�;E�Pip'mg-QtiCaqS �70i1 � ;p
23.�Gasj'ipe�Roagh 8r'�est ; �.- �j� �' � � <+, O 72. Underground �Iu�sMi � } o �
24. Rogf Fratning � �„ - � ` 7,�, Under esd. Sto �9C�ari�c O Gas ❑ Oil
� a 8 ti.Xt i^,-, r�' � r.. c -� 9 � I
25,;,Roaf Sh6athing F � ,� ° " - �
3.,� 74;.'Overhead Hyd[�s' ��
Y
261-T•Bar Ce}ling (Structur3f) & Meriecoat * � %' a�'� 7 : �Dr Ch i al�"'-� � "� '
r � �: 'J' M � � Y .�+i�-� q i �� ' [ , I
� � c _"' x:- �+ ...x - ..� r„ � • - I
r 27;.�ra7neand Ft$shingq :..�n � r. �M. 76. DrySt�]Ylpipey.-� +:7 ^J U
~ 28. Lathin�&Siding � � 'vy"��' O �� I I r 7`�. FIXEC�S�'ST`f'I�1 FIN9:L`i n �
29. Insulatio � t S S :% � � � 28. FIRE PREV. 61I3AL x� r �
30. DrywalF� ailing * "'' � � * `" � � � � F7EAL�H DEPT�iE�,gUI�FEM�ENT
' 31. Plaster �Fav`qr},'Coat� j �.., ,,: ' �x � 79. fINALt PEC�ION � p p. p, I
� .. _ T , . : -�=;=
32.' �lectric`ai Pa'wer M2ter�fvnal� �, t rt, � I � 80. FOOD �RTI�l(;qTE �SSLE'PJ �'
t 33:''FirsaiEl�ect�i� k...'" � � y,� ! I �T IVotes: <t cnCi * J H^> �I
34�:Fioa! Heating�& Air.Canditioningy c*f � r I + �r. cu �-. i E-F�y 'i� M
.-, . �� n n m s * r� � o
35!tFinal Gas� P�Pe�Test'� '� " ""' � Fx � "'„ '� N,
-,.� t: a. [t� „-• • C�7 ti
36 _Hood oc�noPY �= • _ •a = rc � I �r. � xo •: ta tiY �,
i * . r I
37.'Finzl Fa��'[ory Pirep�ace" '„�; ;�; z W j � � R• � �i
�J
38. Final Plutnbing � n' � � --� �x � � ' �'' � � `i�� X �
r I I .,Y .t. S I
` 39. Water Servic�Final»• ` ' n x S � ��'' �` �� �r = �
C �.l ` ��. I. :' +r, T
;�' 40. Gas Service-F4nai �, " nr.:_ j �; �; I IU';{,: H• r�� a: -r, I
� H �
-� 41. Solar po�nesNcFinal` 'T� x ' K .* `sr� ^ �, z p
co +: D � � � � �, i' S I
42f BackfloW Preventer� ry �j�,,.� *,� ' ' « r. �rr-p w: � -,
" x c. n � •� �.
43. Backflow Irr,i�ation� - ^ �K '^ �' � k - ' I
��. M K R . (�i � � J
44.;;Landscepa liigatio6 Systerrnd.: :T: t� ,^ - .�""' S � O�L T� :� ��
� c r . C.•
45.; Sound ' "tte?uatiori . •• ~ n: ''� �W m K ' ''p "� I
Y S �+: :� �.�: . .-� � ...i �
'46. �Nandicap Reg�lations S .. :� � � n.� 7 y � Cj .k '
- f � • e I
r47.y� INYAL S7RUCTUR�E & BUILDING �'O� � : ^ N � ..�*� ? .
48.;;FINALP4RNNING: , ' ,� � �r'�r n cu _. Y v -
t �. � r
�-49.�Electric�Release to Edison ' '� � 4' •n ^ _ `�
c i �_"a = '� C7; r,< G �
riN w I
�50.'Gas�ielease to Sout�ern faliia_p�a Gas Cn � s : : o :, «
r . .� -, -,
bi. CEFI7IFICATE OP OCCUPANCY
No. Date
I
I
AColicant to fill in a1l spaces exeeo< <�ose within heavy Gortler Iines ana sign all avProoriate eeclarations.
CITY oF cOS7A�MLESA CONSTRUCTION PERMIT
Project Address r� � � ��� /
ApplicanYsMailingAddress ��-jj ���LI�iAI.I%tl�e� Ariah,
Owner's Name � Phone
Address .?D37 Si�,� / �nr �i"a ,[�%✓�, a C/,•LL.2C
Arch/En9. License No.
Address
Coniractor's Nam Phone?1��
Address 1m�'i'��I /Z 3 3 /,� � , i.i/ !r/I, /�e /�:do
City License No. � -%�C%J�d
LiCENSE� CONTRACTOR DECLARATION
I hereby attirm that I am licensetl untler provislon5 oi Charter 9(comm¢ncing
witn se<tion 7000) at Division 3 of t�e Business antl Professions Cotle, and
my license is in full force anq,effect. f n� r�
License Class �" •Z�� C se rv /
Date ���-3 Y(' Si9nature, ^ � ��h !'X�'�
WORKERS' COMPENSATION OECLARATION � � �
I hereby affirm that 1 have a certificate ot consent to selbinsure or a certiticate
of Worke�s' Compensation Insurant¢, Or a certitietl-cOpy thereof ($ectlon
3800. Lab. C ( 3�p� �P� L� S.
Policy No. �"X�� Company
ertifietl mpy is hereby furnishetl.
Cer ' ietl Cgpy J�s filetl with the city Iltl�ingf� ivf iop�'
Date � �1—A'� APPlicanS��[.(`T �n//
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl not be completed if tne permlt is for one hunaretl ($100) or
I¢55).
I certify tha[ in tne pertormance oT the woB for whlch tbis perm�t is Issuetl 1
shall, not employ any person in any manne� so as to become subjeCt to t�te
Wo�kers' Compensation Laws ot Califomia. '
Date Si9nature
'NOTICE: If, afte� making this tleClara[iOn, you shOultl beCome subject to the
Workers' Comoensation pmvisionz of the labor Coae, you must forthwltn
comply with such p�ovislons or this Oe�mit �snall be tleemetl revok¢tl.
CONSTRUCTION LENDING AGENCV
1 hereby afflrm that there is a construction lentling agency tor the per(ormance
of [he work for which thls permi[ is issuetl (SectlOn 309� Civ. CJ
Lender'S Name
Lender'S Atltlress �
OWNER BUILDER OECLARATIOfJ �
I hereby affirm.tha[ I am-exemp[ from the ConVactor's License Law foqthe
tollowinq reason (Sectlon 7031.5 Business antl Professlonal CoCe: Any <ity or
counly which requires a permlt to construct, alter, Improve, tlemolish or repatr
any structure, prbr to Its issuance, also repuires the appllcant tor such permit
to file a SlgneO statement thdt he/she i5 IicenS¢tl putsuant [o the provi5iOn5 of
the Contractor's License Law (ChaO�er 9,(mmmencing with 5¢ction 7000) ot
Division 3 of the Business antl Professions Co�e) or tnat he/she is exempt
tnerefrom antl the basis for the alle9etl exemption. Any.violation of Sectlon
]031.5 by any applicant for a permi[ subjects the applicant to a civil
penalty ot not more [han iive nuntlretl tlollars (5500). '
❑ I, as owner ot [he property ot my employees with wagez as Ihel� Sole
compensation, will Co the work, antl the�stru2ture is not IntenOeE or ofteretl
for sale (Section 7044, Business antl Profezsional Code: The Contractor's
LiGenie l.aw tloes no[ apply to an owner ot a property wbo bui105 or improves
tporcon, antl who tloes such work himself/herselt or througb his orTer own
employee5, provitletl lha[ such imprOvements are not intontlotl or offeretl for
sale. If, however, tbe builtlin9 or Imp�ovement is soltl wlthin one yea� ot cOm-
pletlon, tne owner will have tne burtlen ot proving he/she Eltl not builtl or Im-
prOv! tor tha purpose of Sale). ' � � •
❑ I, as ownet ot the proper[y, am exClusively cont�acting witn IlcenSetl cOn-
tractors to construct the O+oiect (Section 7044, Business antl Professions Coae:
The Contractor4 License law tloes no[ apply ro an owner ot O�operty who
bui�tls or improves the�eon, antl who conVacts for Such project5 with a con-
tractor(sl iicense pursuant fo the Contractor's License Law�. I am aware that
proot o( cheir Worker's Compensatlon insurance shoulC be proviaea to me.
❑ I am exempt untler Section 8. & P. C. tor this reazon
Dafe owner
Slgnature -C_ '
Orivers' License ar 55 �
TVPE OFCONSTRUCTION LINEW IJ ADD LIALTERATION IJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q.p.;�
DESCRIPTION OF WORK/USE OF BLDG.
S Main Building:
E
TVPEOFPERMIT GRADING FOUNDATION STRUCTURAL T Front
❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL 8 R¢a�
❑ OTHER A
PROJECT DESCRIPTION Sq. F7. oCcuaANCY C Right
K Left
CONSTRVCTIONTYPE VALUATION$ $
ZONE � GRADINGCU.Y�S. ACRES PIng.Ref.#
Remarks: Planninq Notes:
Sink
<flow Preventer
cfiow Irrigation
rtubs
:no.� f
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service
Interceptors
Kilchen Sink
Lavarories
P—Trap
Roof Drains
Showers
Service.Sink
Sewer Cap
Sewer Connec[ion
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Outlets Warer Closet
Water Heater
' Water Service
Auto-Wash
Reinspeetion .Fee : � $15 � � Issue Fea
Bailer �
Duct-UnderGround ,
Duct - Strucwral ' ' -
Duct � Ventilating
Exhaust System ❑ Multiple ❑
FirepVFact Blt. IC80 #
Heating System & Ducting
❑0.700,000 BTU �100,OOOBT
oate.G �s3'rF.4`"
� Reinsvection Fee $15
FEES
Automatic Washer
Construc[ion Pole Sub.
' Cooking Unit
� Dishwasher �
Dryers ❑Gas �Elec
Fan
F,A.U.
Fixtures -�
Device Boxes
) � Outlets
Switches •
Garbage Disposal
. . Generator �0-5 KW �
$ 3
1681 ID/OB/85
Zone
Accessory Building:
Parking Req./Provided
ELECTFICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter pover700amps
Sub Panef
Motors�al HP�1'h-8
InaSolar��9-15 HP 016�15f
Microwave
Pole Light
Range
; Standing Sec[ions
5 KW Trash Compactor
Reinspection Fee I$15 I � Issue Fee �
IANICAL FEES
Hood or Type I ❑ DEVELOPMENT SERVICES REQUIREMENTS:
Canopy Type I I ❑ Zoning Approvad By
. Building Approved By {�a
Refrigeration System � . .
❑aioo,000sru ❑ioo,000s�
System Repair/Alteration
Fire Dampers
Registers
Issue Fee � � $ 3
5o0Q T�
Z
O
N
1
N
G
F
E
�
M
T
S
TFEES
, _ _-I -
$ 3
SUMMARV OF FEES ' '
BUILDING PERMIT $ - SMIP $ -
PLAN CHECK $ PERMI7 '
PLUMBING $ � ��UANCE $ �
PLAN CHECK 25� $ ENERGV P.C. �$
ELECTRICAL $ GRADING '$
PLANCHECK 50% $ MICROFILM �$
MECHANICAL $ TOTALFEE $ � � �
PLAN CHECK 25% $ ' ,
-- _ __. __ . _ — .
CMF 0865-46, rev. 30/84' White - Builtling; Canary - Applicant; Pink - Acrountln9: Goltlenrotl - Assessor - � � �
i
CONSTRUCTION AND PLANNING � POOL t� SPA '
APPROVALS - Permit # Date Inspector qppROVALS � Permit # Date Inspecror
7; TemPorary Electrical Service or Pole 52. Pool & Equipment Location �
2. �Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. ElecCrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
i
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6� Electrical UFER Grnd. 57. APPROVAL TO COVER-GUN17E �
7. Footings , 58. Electrical Conduif�Undrgrnd.
8' Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Wa[er Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Struttural �Floor System 61. APPROVAL TO DECK I
71. 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 ,
1S. 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 O 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. Insultrtion � . 78. FIRE PREV. FINAL
30. Drywall Nailing � � . HEALTH DEPT. REQUIREMENT .
31. Plaster Brown Coa[ � . 79. FINAL INSPEC710N
32. Electrical Power Meter-Final � 80. FOOD CERTIFICATE ISSUED
33. Final Electric � Notes:
34. Final Heating & Air Conditio�ing
35. Final Gas Pipe-Test
36. Hood or Canopy - '
37. Final Factory Fireplace
38. Final Plumbing ��/,y fr �Q
39. Water Service-Final
40. Gas Service-Final '
41. Solar pomesticFinal �
l,)
42. Backflow Preventer • . ' �
43. Backflow Irrigation � � �
� 44. Landscape Irrigation SYstem
45. Sound Attenuation ,
46. Handicap Regulations � �
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed �
49. Electric Release to Edison - - �'
50. Gas Release to Southern California Gas Co �
51. CERTIFICATE OF OCCUPANCY � .
No. Date