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HomeMy WebLinkAbout3004 ROYAL PALM DR - Building Permits r--. 1 CITY OF COSTA MESA b'-'44:, BUILDING DIVISION F�`1 1�.$ 77 FAIR DRIVE, COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us • , �.rf FOR INSPECTIONS CALL:(714)754-5626 �,,� PERMIT NUMBER! B07-00906 PERMIT TYPE B_ROOF2 STATUS: ISSUED DATE ISSUED: 08/20/2007 : - ISSUED BY: RMD JOB ADDRESS: 3004 ROYAL PALM DR CM Shite/Unit Vicinity: GARAGE ONLY SQ. FT: 800 Valuation $0:00 SCOPE OF WORK: TEAR OFF(E)ROOF MATERIALS,AND REROOF WITH A BUR SYSTEM ON FLAT ROOF GARAGE ONLY,APPROX 8 SQUARES. REF#: CD-07-0974.,•'' OWNER: NETHERTON;,LAURENCEM AND CYNTHIA A„ . . Address.` 2913 PEPPER TREE LN'APT A Unit: PHONE: 949724-4551 City/State/Zip: • - _ COSTA MESA,CA . APPLICANT: VALVANO,DOMENICF 1 Address: UN/IRVINE AVE Uriit: - PHONE: 866-783-4.400 - • - City/State/zZip: TUSTIN, CA - -- - CONTRACTOR: SUPERIOR ROOFING - .. License No. 865713' -- Address: 1100 IRVINE AVEUnit: . PHONE: 866783-4400 _ - '•• City/State: TUSTIN, CA :-ZipCode: 92780 - CELL: ARCHITECT: .. License No. PHONE ENGINEER: - - License No. - - • PHONE • FEE SUMMARY Reroof Plan Check: Reroof Permit Fee: '$83.25... Reinspection Fee: TOTAL FEES $83.25 „. NOTICE: The work authorized by this permit 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 obtain inspections and final approval will result in the expiration of this permit. CODE E. INSPECTION TYPE DATE INTITIALS CODE O INSPECTION TYPE DATE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof __ mat 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place _ 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy WORKERS'COMPENSATION DECLARATION: :,Owner ID verified by drive .Ise. ❑Yes 0 No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: 0 I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the - , . • performance of the work for which this permit is issued.0 I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized t � �'A l2� ✓mac, by this permit,and that no building structure.scaffdding,falsework,or demolition Garner- /'T or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp (This section need not be mmleted A the permit Is valued al one hundred dollars($100)or less) 2,Art 2Sec.341,Title 8,California Administrative Code). Bolicy Numbe� / Y3 0 ing2— 2 ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any pe son in any manner so as to become subject such person has a permit to do such work from the division. to the workers' corn ensati•'r of California, and agree that if I should become subject to the �r •mpensation provisions of Section 3700 of �y�. Applicant's Signature Date the Labor Code,' hA{ r ply with these provisions. .Z.41°117.— _ .f A/' Z=•2 — Q9- Division of Industrial Safety Permit Number: 'Apt tent's Signature Date--fes HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and e(te . a registration form for acutely hazardous materials? 0 Yes ❑No / Lic'# ) -� Class#--C. (Section 25533 of the California Health and Safety Code, with some �f7 exceptions, requires registration with the Costa Mesa Fire Department by 6 2�—� each business which at any one time has on hand a quantity of acutely Cant,. •r _.gr �� Date--------t— hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGENCY: temperature and pressure). 0 I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ❑Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 0 No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes ❑No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications for non-residential building permits). License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes 0 No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec. 7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes 0 No thereon,and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for 8. (If"yes", attach certificate of compliance from the appropriate air pollution sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). . information given above is correct. I agree to comply with all state laws and ❑ I. as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044.Business and Professions Code: The contractors License Law does not apply to an owner of Signature Date • property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I a Contractor(s)license pursuant to the Contractors License Laws.). certify under,penalty of perjury that I have read this application.and state that ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: - the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree no • •ccupy or allow occupancy of any building authorized by this permit un' 1... inspection. '•n. .r . I (s) Date Signature Date 3057-46(3/07) '///'� O ( Ar,7lit- ,Date n CITY OF COSTA MESA t.� QQQ BUILDING DIVISION • >4: DECLARATIONS n WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑^I have an will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. JMy w/oak ts' npensatlo Insurance carrier and policy number are: /' J� ^6�/Q -Carrier:- J 27(1 ,94/� Policy Number: L(/ C U .� C -(This section need not be completed if the permit is valued et one hundred dollars($100)or less.) --- ❑ I certify that in the performance oft work for which thi armit is issued,I shall not employ any person in any manner so as to become subject to the workers' compensation laws of Celifom a a agreitha 'f I shduld de sdbject to the workers'compensation provisions of Section 3700 of he Labor I shall forthwith compty with these provision /j /U �7 J Apppicant Signature:_ = <�V (/ iG�.(�i�� Date: - II WARNING:FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTI S AND CIVIEFINES UP TO ONE HUNDRED THOUSAND DOLLARS(S100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm thatl•am licensed iA pr. 'cions of Chapter 9(commencing with Section 7000)of Division 3 of.the Business and Professions Code,and my license is in full force and effect.tics--d 1,77/ 06 r Classt Q�3 Contractors Signature: i�ar /Date: l CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she Is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors 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 that such improvements are not intended or offered for 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.). O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec, 341,Title B,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater then a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomia Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the Califomia Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? D Yes LJ No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No B (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described propertyprJfor inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. �-� �%/ /,6lgitat a Of-Le>� r Date 3/Z7 Q/ ruthonz dApplicant _Date ODE INSPECTION TYPE DATE' IMmAL$ CODE( INSPECTION TYPE DATE tNTmALs 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final � � 208 Final Plumbing 1'6- 200 Final Re-Roof -I�r I//"� /�+"�.( 210 Final Electrical 201 Final Block/Retaining Well • 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition ' - 250 Final Building/Occupancy 10630 COSTA MESA BUILDING-SAFETY DEPARTMENT L Ui_'Qt-y w.; ' P.O.BOX 317 COSTA MESA. CALIFORNIA r FOR APPLICANT TO FILL IN COMPLETELY( APPLICATION IFOR_PERMIT TYPE OR PRINT - ..- BUILDING ti-_.n,. . BUILDINGS3004 Royal Pam Drive COSTA MESA. CALIFORNIA FOR OFFICE USE ONLY • RECEIPT NO. tT • OWNER Dike & Colegrove.yLInc. ti MAIL . 419 E. 17th St. - RECEIVEDyY I DATE Dr^/..;- E I O� E_INWED 59 ADDRESS /�M/I +i / J- J�,f' CITY Costa Mesa TNOL:LIS—ll59 BUD EIN SS ARCHITECT Carlson & LIG. OR ENGINEER NO. COSTA MESA, CALIFORNIA Middlebrouk _ ,/J / FIRE ADDRESS Garden Grove ZONE TYPE, GROUP ')4/-'`T��y/ COIGTKkCTbk Colegrove, Inc. LC.NTO. 167293 APPROVED 4 BY DATE ADDRESS 419 E. 17th St., .Costa Mesa ZONING LEGAL I LOT 35 I I 2022 ZON6Q1 NO.OF USE OF NEW 1 DESCRIPTION NO. BLOCK TRACT. r 1 IPLANS �I BUILDING ..0.44 ( -yam/ A.P.NO. 68 BBAPPROVED w(() DATE .�U yi S / SIZE x 109 I NO.OF SLOGS-.none YARDS ll• I&ES`l OF LOT NOW ON LOT REQUIRED ALLOWED USE OF (CENTER LINE ST.) EXISTING BLDG. MFRONT .J7 FT. IN. �1 SETBACK LINE FROM 57!' REAR YARD 20 T R.SIDE / J` 'FT. IN. CENTER OF STREET SIDE YARD I LEFT 10! I RIGHT 151 Lk SIDE 10 FT. IN. DESCRIPTION OF WORK . qq'' REAR 3O FT.V/� I •• IN. NEW Ix I ALTERATION II ADDITION I ) REPAIR I II MOVING I II DEMOLISH I SII ZIE DING 351 \ NO.OF.......\ ROOMS STORIES 2 EXTERIOR WALL stucco. COVERING 3tUCCO. COVERIN rock USE OF BUILDING AND WORK TO BE PER MED Multiple family dwelling wi attached garage. (Four living un' •f 9 a ^ 7.3 e. a 411 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- THE AMOUNT SHOWN,UNDER VALUATION IS FOR THE PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. BUILDING CONSTRUCTION. �/ VALUATION IMO' SIGNATURE OF d J .�•, PERMIT:FEE ' $ 50.00 PERMITTEE ��V//ff ++" �^�^--111 /.y� — • $30)971OD PLAN CHECK $ 25.00 AUTHORIZED AGENT jlifP R. rnl POrmrn Tnr TOTAL FEE $ 75.00 J - - _ .. - _. .- ., -• --.APPliea nt to fill in all spaces except those within heavy border lines-and sign all aPPro Driate-tleclarations. CIT V'O,F-COSTA•MESA CO NSTR UCTI•• APER MIT PERM( NO- - TRACT NO. LOT NO. UNIT NO.' - "I ,/�J� (�/ %1 7870 •'1 /22/86 ' '50'50 TL 'Project Address - •' •• !s. 6 f a _ `�1�a 711// 'Ll I ��y _ , . -- . ,F -/ % ' % �t 7 _ _4 TYPE OF CONSTRUCTION, ' :U NEW 'LJ ADD LI ALTERATION EEP• - ' ' - `- ApplicantsMailingAddress' G� _❑ CONVERSION:❑'DEMOLISH - Owner a Name Dp,—�A ge s ( _ Phone - ❑ O, �; A.P,#, -• .. - Zone • r� : °ESC•IPTIONOF,WSRK/USE;O BLDG., - 3 ��P.�,' Address 21�� �kti (/CC C I C•� - 1 _ k xe / - raw, S Main Budduig. - _Accessory Building' TYPE OF PERMIT ' E Z , Arch/Eng. License No. GRADING NI STRUCTUR T 'Front-- { - Address • - I - 1 - -❑ TENANT ❑ ELECTRICAL'❑ PLUMBING ❑ MECHANICAL' - - B Rear , - - - .1 N, Contractor's Name - /CL C4.01,1�� t. Phho+ne7 K'•Chi' ❑ BOTHER' ' C Bight • _ ' - - - ' - Address(mailing) �f�" c /' LS 'esf/ l © . PROJECT,DESCRIPTION 50. FT: lCx� ' OCCUPANCY • K _ - - G - IU ' - C ON ST RUCTION TYPE ' VALUATION$ /C...0"-CO s Left ' ' City License No: • '1 l'.,' ZONE' - GRADING CU.YDS. ACRES - - 1 R LICENSED CONTRACTOR DECLARATION - PI •ng. Ref. •# I Parking Req!/Provided :_ , r- E ('.hereby affirm that-I am licensed under provisions of Charter 9;(commencing Remarks: . - • _ Planning Notes: - M ' with section 7000) of.DivIsion 3 of the Business and Professions Code, and I - I - - -• my license is in f rce and effect. �/�6 - • S I License Cla s "cense No - L - f • Date /�? ,Signature �'�—.�-� ��_.✓ PLUMBING • :FEES , t I '•.: ap RKERS'COMPENSATION DECLARATION Bef Sink Showers ELECTRICAL FEES • -•=ereby affirm that I have a certificate of consent to self-insure or a certificate k - _ _ _' Workers'-Compensation Insurance,-or a-certified-copy thereof (Section'- Backflow Preventer 1 Service Sink' 0 15-50.KW 3800, Lab. C.) // }/" / , l Automatic Washer Transformerr , Policy No. C 9y•V7- - Company ,5 n'r-�4 f •Backflow Irrigation - Sewer.Cap . - Construction Pole Sub. : 0 50.+KW • ! edified copy Is hereby furnished. . Certifi Q o filed with�t/ha city Buil g DIv ton. Bathtubs I - Sewer Connection I Cooking Unit Meter Duo to 100 amps ate / ON FROM • AERS'ant 0 (/ [//RATION AT I��EXEMP ON WORKERS'COMP TION DELL RA ATION -- Clarifiers Solar Collectors - - -- • Dish ,washer - - - - •_- - 4--.-- -Meter ❑over{ — 100 amps'• ' - ' - - (This section need not be completed if the permit is for one hundred ($100) or - less). Dishwasher ' Solar'Piping Dryers OGas DElectric • Sub-Panel - i • I certify that in the performance of the work for which this permit iissued I 1 - shall not employ any person in any manner so as to become subject1 to the - Drinking Fountains Solar Tank , Fan Motors❑0-1 HP ❑1%4'8 ' Workers' Compensation Laws of.California. - Date Signature Floor Drains I , SwimmingPool w/S a' - - , P I F.X.U.F 'UInc.Solar D9-15 HP ❑16-15+ NOTICE:If,after making this declaration, you should become subject to the _ _ _ _ __ _ _ I Workers' Compensation provisions of the Labor Code, you must forthwith FIOof Sinks- - ' comply with such provisions, or;this permit shall be; deemed revoked. . Urinal - Fixtures Microwave CONSTRUCTION LENDING AGENCY - Gas S¢fv- - ...Outlets Water Closet Device Boxes ' POI¢ Light ' I hereby affirm that there is a construction lending agency for the performance - - j 9 - iir of the work for which' this permit is issued. (Section 3097 Civ. C.) - Interceptors - • - . ,Water Heater .. Outlets Rangef Lender'i Name: - , Lender's Address ' - - - - - - - i ; - Kitchen Sink . - ,Water Service'- • OWNER BUILDER DECLARATION - 1 . Switches , Sign , I hereby affirm that I am exempt from the Contractor's License-Law for the Lavatories' i1 ' - Auto-Wash , - _ Garbage Disposal I Standing Sections following reason (Section 7031:5 Business and Professional Code:.Any city or - ' - ' _ - - county which requires'a permit to construct,alter,improve,demolish or repair - • P-Tra '1 y y • , '* , . Generator ❑0-5 KW D5.15 KW 'Trash Compactor P - ,.Laundr Trays_ any structure, prior to its issuance, also requires the applicant for such permit _ - _ P, -to file a Signe `statemen Lthat.he/she is licensed pursuant to the provisions of Roof Drains 're Contractor's License Law(Chapter 9(commencing with Section 7000)-of _ _ , ' (vision 3 of the Business and Professions Code) or that he/she is exempt ' .031.5om and the basis for the alleged exemption. Any violation-of f Section r - I I 1 , '7031.5 'by any applicant for a permit subjects the applicant to a civil r •_ ' ggnalty of-not more than five hundred dollars($500). _ - -. , - - - -3 LJ I, as owner of the property or my employees with wages as their sole . ReinsPe Mion.Fee I $15 Issue Fee $ compensation, will do the work,and the structure isnot intended or offered - - ' - Reinspection Fee !I $15 • Issue Fee • $ 3 1 for sale (Section 7044, Business and Professional Code: The Contractor's + ' 'MECHANICAL FEES -. . _ License Law does not apply to an owner of a property who builds or improves _ - - - - •- thereon, and who does such work.hveme/herself or through his or her own - - • ; - DEVELOPMENT SERVICES REQUIREMENTS: ' employees, provided that such improvements are not intended or offered for Boiler : , , ! Hood or- Type I ❑ sale. If, however, the building or-improvement is sold within one year of com- . Canopy Type II ❑ -1 ) Zoning Approved By I Date pletlon, the owner will'have the burden of proving he/she did not build or im- I Duct- Under Ground , Building Approved By • Date prove for the purpose of sale). - •- 1 1 'iDa pf ❑ I, as'owner of.the property, Se exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By I I 1 Data d1 4YJ tractors to construct the project (Section 7044,Business and Professions Code: = I . The Contractor's License Law.does not apply to an owner projects operty who - Duct--Ventilating - • - D0=100,000 BTU 1❑100,000 BTU - - $UM AR�V�pi FEES I 1 , �� builds or improves thereon, and who contracts for such prjests with a con- BUILDING,PER MIT ' $ •l../•" I SMTP ' $ tractor(s)license pursuant to the,Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration I t proof of their Worker's Compensation insurance should be provided to. me.; PLAN CHECK I • $ PERMIT • 0:I,am'exempt under Section B.& P.C.for this reason •- Firepl/Fact.Blt. ICBG# Fire Dampers , 4 • PLA PLUMBING • $ 'ISSUANCE , $ Date ' Owner = Ducting t Registers • 1 I. PLAN CHECK 25% $ ENERGY P.C. • $ I ' -hereby certify-that I'have read this application and state that the above ■r II 116 : ■ s I 111 - GRADING t $ ' information is correct. I agree to comply with all city and county ordinances ' ' ELECTRICAL $ ' - , , and state laws relating to building cos fiction, and-hereby authorize repre- , MICROFILM . $ sentatives of thi ity o enter the .•ove-mentioned pr pert ifor ! i I PLAN CHECK .50%, $ ' - inspection purp- , 1 I {O /' / ��-" MECHANICAL ; $ TOTAL FEE $ • �Sn:J (J Signature ,� �,�/ date , • Drivers' License or;SS 3 "' — _ Issue Fee PLAN CHECK 25%, $ • I , CMF 0865-46,rev. 10/84 White - Building; Canary - A••licant; Pink -Accounting; Goldenrod -Assessor CONSTRUCTION AND PLANNINGpit - PO <SPA - ' Date Inspector - - Date Inspector /APPROVALS Permit# - APPROVALS Permit # P d ,1. Temporary Electrical Service or Pole • 52. Pool & Equipment Location • 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. r' 54. Forms - 4.'Electrical Conduit:Undrgrnd. 55. Electrical Bonding - S.:Steel Reinforcement -7 56. Rough Plumbing & Pressure Test • 6. Electrical'rUFER Grnd.. 57. APPROVAL TO COVER-GUNITE 7. Footings - • • ' 58. Electrical Conduit-Undrgrnd. 8: Foundation :' I ; .•1 59. Gas Pipe, O.Uridrgrnd.,Test • 9:�Water Pipe-Undrgrnd. :h - . - 60. Backwash Lines, P-Trap, 0 Undrgrnd. 1.• 10- Stiuctural'Floor System • �• 61. APPROVAL TO DECK - y' 11. Property•Sewer Line & House Connection 62.,Backwash & Receptor-Final - 12. Sewer Cap +- Jr 63: Heater & Vent-Final • - 13. Roof Drains e 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 . - - - 1-7.•Rough Wiring Sign ' 68. APPROVED FOR PLASTERING" - 18. Rough Electrical-T Bar Ceiling . 69. POOL/SPA SYSTEMS FINAL _ ,19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT • . 20. Rough Faciory Fireplace - - , APPROVALS Permit# - .i 21. Ducts, in Structure 70. Underground Hydro, . • 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil , 23. Gas Pipe-Rough& Test ' 72. Underground Flush -- 24. Roof Framing , , -73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing ' .1 ahr6 _1/1/ '741' 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 PREY. FINAL , 30. Drywall'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. Finan Heating & Air Conditioning ' 35. Final Gas PipeiTest , , , 36. Hood or Canopy - - 37. Final Factory Fireplace 38. Final Plumbing ' • 39. Water Service-Final ' ' ' 40. Gas Service-Final 41. Solar Domestic-Final ,I -' 42. Backflow Preventer i ' , 43. Backflow Irrigation - . ' 44. 'Landscape Irrigation System ' - - 45. Sound Attenuation . . . .t • 46. Handicap Regulations ' - • 47. FI NAL STRUCTURE & 9UILDING ' /�J�/s •p ' , 48. Special Requirements Completed /•+ •u 49. Electric'Release to Edison . ' - - - - - - - - • 50. Gas Release to Southern-California Gas Cn - $ , ' 51. CERTIFICATE OF OCCUPANCY No. - Date