HomeMy WebLinkAbout1115 SAN JOSE AVE - Building Permits ��'` MFa CITY OF COSTA MESA
:4* BUILDING DIVISION PERMIT NUMBER
DEVELOPMENT SERVICES DEPARTMENT
rat
JK///� PERMIT
/399-131601
(714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626
BUILDING PERMIT
Job Address: 1115 SAN JOSE AV Status: ISSUED
Suite: Applied: 10/5/1999
Vicinity: HOUSE&ATTACHED GARAGE Issued: 10/5/1999
Parcel Number: 41207409 Zoning: R1 R1
Applicant: SELL, RON ISSUED BY:
Address: 17072 ROSEBUD
CA Phone: (714)993-3328
YORBA LINDA Zip: 92686
Owner: HARBER, GARY C
Address 1115 SAN JOSE AVE
Phone:
COSTA MESA,CA Zip: 92626
Contractor: SELL ROOFING COMPANY
Address: 17072 ROSEBUD
Phone: 714-993-3328
YORBA LINDA CA
Zip: 92686 License: 323842
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
REROOF SINGLE FAMILY RESIDENCE&ATTACHED GARAGE(29 SQ).TEAR OFF EXISTING SHAKE ROOF AND RESHEATH
WITH 1/2"OSB. INSTALL 1-LAYER OF 30#FELT UNDERLAYMENT&REROOF WITH"EAGLELITE MALIBU"-ICBO
#4660-(5.5 LBS).
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $8,900.00
Permit: $167.25 Claim Valuation: $8,900.00
SMIP Res: $0.89
SMIP Corn: $0.00
Other: $0.00
Inspection: $0.00
Total: $168.14
PLANNING &ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0
ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0
PARKING Existing: 0 Required: 0 Proposed: 0
NOTES:
•
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: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work 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.
FOR INSPECTIONS CALL: (714)754-5626
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 sell-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 and will in in workers'compensation• urance,as required by section 3700 of the Labor Code,for the performance of the/G((l GSS
work for which this permit is issued.
My workers' a ati Ins nce carder policy number are: /
Carrier: Policy Number: !!
(This section no not it a permit I valued at one hundred dollars($100)or less.)
❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of Cahfo and agree t t if If the Labor Code,I shall forthwith
comply with those provisio
Id become subject to the workers'compensation provisions of Section 3700 o 071
/-0 0
Applicant Signature: -( Date: '�
WARNING:FAILURE TO SECURE ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of g tpr_,9(commencing with Section 7000)of Division 3 of the Business end Professions Code,and my license is in full
force and effect.Lic.k j. Class k 1—
c G 3 9
Contractor's Signature: XL./ Date: /G — �j(—D al
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction tending agency for the performance of the work for which this permit Is Issued.(Sec.3097,Civil Code).
Lender's 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.).
❑ 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. ❑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:
❑ 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 8,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 tile 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 California 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 greeter than 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 California 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 California 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 it an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑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 Alr Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No
(Section 65850.2 of the California Government 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).
Coast
Air
_---D_...._.—_._.er._..--_._._._—_ .___...._ or agency
.r -fomes .__-__ __.-__ _
7 a a patron from the South iscAir prescribedri by Californiaenr Heal hr nSafety fit p Odeon ctionol 423030bt been agency is requiredsfor the work which is the subject of this
application,have all of the disclosures by Cia Health and Code Section made? ❑Yes ❑No
8 (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 . ate laws an. city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property I. •ion pury•'/.I:.ygb not to occupy or allow occupancy of any building authorized by this permit until final inspection.
ignat
r0 Let/egal cJ Lq! /0-3—
L�
And/.r Authorized Applicant Date t
CODE I INSPECTION TYPE gAffi INITIAL$ cODF( INSPECDON TYPE PAL INTRIAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final /7 208 Final Plumbing
200 Final Re-Roof /0 — y 7a`''/ 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 BuildinglOccupancy
2446-46
ADDRESS OF BUILDING: 1115 SAN JOSE AV MIT: CITY OF COSTA MESA — BUILDING PERMIT
0NNERS NAMEIF 101OM1: HARBER, GARY C FLOOD: AHL38 PERM NO: P 078077
ADDRESS HARBER, GRACE M
1115 SAN JOSE AVE PERMIT NO: P 078077 PLAN CHECK NO: N GOVT: N SUPP: N
COSTA MESA, CA 92626
APPL.UAILwG ADDRESS: CONSTRUCTION TYPE; V—N PERMIT TYPE: PLU PURPOSE: OTH
ARCHITECT OR ENGINEER: uc NO.: JOB DESCRIPTION : C/O DISHWASHER SQ FT:
ARCH OR ENG'5 ADDRESS: UMT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
coNmActarsNAME: NOCK PLUMBING ( 714 ) 895-1246
CONTRACTORSMMLBC 11610 SEABOARD CIR COMMENTS : NO OTHER WORK AUTHORIZED BY THIS PERMIT
ADDRESS: STANTON CA ma 511971 +t-u-st** *x-sEiEiE******** -************* -x*** -***********iter-*SEx**s(-K-***fs****K-itiE**** -rt*+t*
90680 UMT: Z ON ING R EQU IR EMEN TS
LICENSED CONTRACTORS DECLARATION:I hereby affirm under penaly d perjury that I em licensed under provisions of Chapter 9 SETBACK S
(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my ken is in full force and effect.
CITYLIC.ND: 050386 uccuss: C-36 uc.NO.: 511977 E 0 /97 MAIN BUILDING --- ACCESSORY BUILDING
G FRNT: FT IN REAR: FT IN FRNT: FT IN REAR : FT IN
pts: 6 ' f�� ( �ri c«nraa«: �(� (° LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
NER BUILDER DECLARATION:I hereby affirm under penaly of perjury that I am exempt from t Contradore License La or the
following reason(Section 7031.5 Busirbes and Professions Code:Any city or minty which requires a permit to(=amid,alter,improve, PARKING REQ: P ROV; PARCEL: 41207409 Z N E: REF NO:
demolish,or repair any structure,prior to hs 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
PLANNING NOTES>
Business end Professions Code]or that he or she is exempt therefrom and the basis to,the alleged exemption.Any violation of Section >
7031.5 by any applicant for a permit subjects the applicant toe civil penally of not mon then fire hundred dollars[$5001). *******************************************************************************
❑ I.asoweralthepropertyormyemployeeswihwageaastheirsoecompensation,willdothework.andthesuuctunvnotintended DEVEL OP MEN T SERVICES REQUIREMENTS
or offered for sale(Section 7044,Business and Professions Code:The Contractors license Law does not apply to an owner of property
who bolds or improves thereon,and vita doessuch suwork himself or herself or through his or her own employees,provided that such
improvements are not intended or offered for sale.t,howwver,the building or improvement is sold within one year d completion.the ZONING APPROVED BY DATE:
owner-builder will have the burden of proving he or she did not build or improve for the purpose of sale).
❑ I.as owner of the properly.am exclusively contracting with licensed contractors to constmat the project(Section 7044,BusMess and BUILDING APPROVED BY : DATE:
Professions Code:The Contractors License Lew does nappy to en owner d property who builds or improves thereon and who .
contracts for Stith projects with a c«fracton(s)licensed pursuant to the Contractors License Law). MI
❑ I am exempt under Section: B.11PC..for this reason: APPLICATION ISSUED BY: DATE-
*********************4**************** *************************. . .**
Dale: sass LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT:N
I do hereby certify that I am aware of and understand the requirements of Celdomia Health and Set sty Code Sections 25505,25533,and
25534.sand l«any u or modification buildingoccupant vwill/wilnot(dmoone)rcMtonom*withsekuatrequirements BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
a Duality Management District Residential mmmdion eppiratons me exempt from Nese
provisions. 8 . 75
Date: bpcerg; 252 SMIP/NON—RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penally of perjury one d the followcg dederatons: ISSUE FEE 22 . 00
o I have and wil maintain a certificate of consent to sell-insure for ivorkeri compensatioci,as provided for by Sadie°3700 of the Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
Code,for the periomanedthe work for which this permit dissued. TOTALS----> 8 . 75 22 . 00 0 . 00 30 . 75 30 . 75 . 00
❑ I have and al maintain workers'compensation insurance,as required by Section 3700 d the Labor Code,for the performance of the
N
work for whichis permit is issued.My workers' t insurance carrier end police number are:
Cartier: as1EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : --30 . 75 OVER/SHORT: . 00
Policy Number. UUUUVVUVUVUUVVV 01 /01 /01 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
itsection need not be competed f the permit is ler one hundred dollars(SILO)or Ice.) 30 . 75
LJ I certify that in the performance of the work for which this permit is issued,I shell not ploy any Person b any manner so as to
become subject to the workers'compensation laws d California,and ase tat ' 1 shoo. bjed to . workers' *******************************************************************************
cam//gg__vv wofn provisionsglof Section 3700 of the Labor code.Iawl forynpy Na.. ` .�'� r INDIVIDUAL F E E BREAKDOWN
ate W n-if—76 6 Applcanh / / y
ming:Failure to saaure workers'compensation coverage isunlawfuL nd shall subject an .loyer to criminal— gas and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST
dye fines up fo one hundred thousand dollar.($106000),In addition to the cost of romp - don damages
as Provided ler In
Section 3706 of the Labor Code Intenseand attorney's lees PLU 1 DISHWASHER 8 . 75 8 .75
CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjury that then is a construction lending agency for the END OF FEES
performance of the work for‘Mich this permit is issued Section 3097.CN.C).
LENDER'S NAME:
LENDER'S ADDRESS:
I certify that I have read this application and date that the above information ie cored.I spree to comply with al my and county ordinances EXPIRED
and state laws relating to building corm/nfudian and hereby authorize representatives of this dry to enter upon the above-mentioned property
for inspection Wrpoaea.
ONJOCK '1:9— / -
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PdmN �/ / sir/ /sI� �_
,s� ✓� Date:
spawn d: ,p .i . t actor /
(5151de.WP) White-Building&Safely;Green-Rl:Caney-Appfrant;Pink-Revenue;Goldenrod-Assessor —
lir
POOL & SPA .14
CONSTRUCTION AND PLANNING •
APPROVALS Permit Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or.Pgle 52. Pool & Equipment Location' . .-
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement -•
3. Electrical Conduit Utility•Undrgrnd. 54. Forms ,
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding _ .
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF EA Grnd. 57. APPROVAL TO COVER-GUNITE "
7. Footings • . 58. Electrical Conduit•Undrgrnd. -
8, Foundation • 59. Gas Pipe, 0 Undrgrnd.,Test ,r
9. Water Pipe-Undrgrnd, 60. Backwash Lines, P-Trap, ❑ Undrgrnd.
f
10. Structural Floor System _ 61. APPROVAL TO DECK ',
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final")
12. Sewer Cap 63. Heater & Vent-Final e.
13. Roof Drains - 64. Plumbing System - Final
14. Rough Plumbing. 1 65. Electrical-Final "J
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Apprgyal-
17. 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 Factory Fireplace _ APPROVALS Permit#
21. Ducts,in Structure - 70. Underground Hydro
22. Ducts, Ventilating , . 71. Product Piping OGas 0 Oil
23. Gas Pipe Rough & Test 72. Underground Flush �°/')
ite
24. Roof Framing • 73. Undergrnd.Storage Tank 0 Gas 0 Oil li
,
25. Roof Sheathing 74. Overhead Hydro J
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
l
27. Frame and Flashing • I 76. Dry Standpipe •
if
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. Final Heating & Air Conditioning -
35. Final Gas Pipe-Test .• -f -
36. Hood or Canopy
37, Final Factory Fireplace ,
38. Final Plumbing -
39. Water Service-Final --
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation .
44. Landscape Irrigation System - - _
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING ,,y
48. FINAL PLANNING
49. Electric Release to Edison -
50. Gas Release to Southern California Gas Co -
51. CERTIFICATE OF OCCUPANCY -
No Date
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COSTA MESA BUILDING-SAFETY DEPARTMENT APPLICATION FOR/S?RUIC/111c RaPERMIT306,5I T4
P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 - .-
RECEIVE BV PERMIT
For Applicant ,�3 8 to Fill in Completely y N° 4 7 7
p y - Use Ink Only �Aii
BU
ADILDING DRESS 1115 San Jose Ave. A.P.No. , -�/,�--Q'`�a'-��j�
BUILDING
OWNER OR Wimbledon Assoc . ADDRESS 1115 San Jose Ave.
TENANT
UNIT OR
MAILING 1470 Jamboree Rd SPACE NO. 28
ADDRESS
TR.NO. LOT BLK.
CITY Newport Beach Not640-680 10275 28
CONSTRUCTI NEW ADD ALTER REPAIR MOVING DEMOLISH
LENDER c3Yltperial Savings & Loan
BRANCH
Pasadena X
61 So. Lake Ave. OWNER Wimbledon Assoc. /07„?a7
ADDRESSVALUE
TEL USE PRD o. o-`v_
ARCHITECT
OR ENGINEER Corbin/Yamafuji NQ 549-712.
//��
r^
ADDRESS 17992 Mitchell So. t Irvine ZONE Poe- TYPE --N GROUP - 3
APPROVED
CONTRACTOR McLain Dev. Co. BY DATE I 2.7i8/
ADDRESS 1470 Jamboree Rd.
CITY Newport Beach NO. 640-6800
F APPROVED SETBACKS
LIC.NSTAO. 273875 CITY LIC.NO. 18873
Lq SIZE NO.OF BLDGS. (FROM '•.-
etc-ow-nem PL
L OF LOT NOW ON LOT 0 FRONT a0 FT.
Q USE OF �j
CA EXISTING BLDG. ,ff.saw `-' FT.
Ca
FSeparate permits are required for L,SIDE S FT.
Cl- electric,plumbing and heating work. REAR,!:2T.
F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION
Q
(Z •
DATE
= PRD — New Construction 2E— 78—,3y APPROVED -p7-78
Single-family dwelling APT= DATE I;�`�
tx
ttOLD FOR SPECIAL REQUIREMENT:
Iu
CI hereby acknowledge that I have read this application and state
pe that the above information is correct and agree to comply with
L all laws regulating building construction, and I shall not employ
/ i
Z any person in violation of the workman's compensation laws of f---e-m' (O 7 • CO ^ g
Sthe State of California,
I hereby certify that I am properly licensed as a contractor under SQ. FT. n+
the State of California Business and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR o "
Chapter 9, and that such licenses are In full force and effect,i e I THE PURP06E OF ESTABLISHING A PERMIT FEE ONLY: e
am exempt from the provisions of the State o California Business (�A
and Professions Code, Division 3,C pt 9. VALUATION PERMIT FEE $ a99 w
at � o
Signature of •
� PLAN CHECK $ m
''i 0 p �
Permittee 70 //=7 TAX $ 737u e
or /
Authorized Agent Date �� � TOTAL PAID
$3o 4 ,in e'
Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA PERMIT NO. TRACT NO, LOTO. •BLDG.NO.
' CONSTRUCTION PERMIT $(O / 1O2�j 40 3429 B/I'4/8I 34432 TL
Project Address t1 I C A/ w \J pQ J TYPE OF CONSTRUCTION
Owner 14 . E .
, AL1>;‘diCe Phhone V(Cr,'7 9(L (NEW 0 ADD 0 ALTERATION
Address Cj CI(.-'1�_ 0 REPAIR 0 CONVERSION ❑DEMOLISH ZONING REGULATIONS
, Arch/Eng. I License No. 0 OTHER _��q
{ L.0 $._1$c
�r,_ DESCRIPTION OF WORK A'3',r I -1 n Lit A.P.$ 14j? `.' /
Address j FT a C, {f1 `Z,,.CO ('J ZONE p(% l�,� � PLNG. REF.yr
Contractor 69/6 Phone TYPE OF PERMIT I BUI LOIN ' &)f 0 r TOBID LDI NGNE /0 1/SETBACK k \.V ll
Address 0 GRADING 0 FOUNDATION NSTRUCTURAL SIDE YARD /O /i�✓ •
LICENSED CONTRACTOR DECLARATION 0 TENANT 0 ELECTRICAL ['PLUMBING ❑MECHANICAL LFT dIEDE YARD /
I hereby affirm that I am licensed under provisions of Charter 9(corn- - RIGHT '� 0 a •
mencing with section 7000) of Division 3 of the Business and 0 OTHER
Professions Code, and my license is in full force and effect. pROJ ECT DESCRIPTION _ REAR YARD (TO P/L) CD' (7/
License Class License No. . . art PKG.SPACE REQ. PROVIDED ---'
•
Date Signature • SQ. FT. 11.41 _
WORKERS'COMPENSATION DECLARATION OCCUPANCY CONSTRUCTION TYPE TZe `r`7UU tU STREET WIDTH PARK FEE$
I hereby affirm that I have a certificate of consent to self-insure or a VALUATION I l!r7O — ZONE ZONING APPROVED BY ettc (r Na DATECJ F CJ 1Jq/8i
certificate of Workers' Compensation Insurance, or a certified copy U w s
thereof(Section 3800, Lab. C.). GRADING CU.YDS. ACRES
SPECIAL CONDITIONS: '
Policy No. Company
❑ Certified copy is hereby furnished. REMARKS: •
❑ Certified copy is filed with the city Building Division. - -- --— -
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section need not be completed if the permit is for one hundred - -
($100) or less).
I certify that in the performance of the work for which this permit is
issued, I sh I not employ any person in any manner so as to become PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK
subject t e Wo er 'Compensation s li ornia. UWtLLINO GAHAfat
ni
BATHTUBS SHOWERS
'Date Signature SO FT SQ-FT
NOTICE: If of er making this declaration, you should become subject TOILETS URINALS GENERATOR 0-1 KW_1-10 KW
to the Workers' Compensation provisions of the Labor Code,you must TRANSFORMER -
forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAYS APPLIANCE 10-50 KW 50+ KW -
•
revoked. ' '
CONSTRUCTION LENDING AGENCY KIT.SINKS DISHWASHERS MOTORS 0-1 HP 1-10 HP .
I hereby affirm that there is a construction lending agency for the per- SERVICE SINKS SUMPS (INC.SOLAR) 10-50 HP 50+ HP
formance of the work for which this permit is issued (Section 3097
Civ. C.). FLOOR SINKS FLOOR DRAINS FIXTURES OUTLETS SWITCHES
Lender's Name
'Lender's Address - - DRINKING FOUNTAINS GAS TUBE SIGNS
OWNER BUILDER DECLARATION .
INTERCEPTORS CLARIFIERS POLE LIGHTS
I hereby affirm that I am exempt from the Contractor's License Law for -
the following reason (Section 7031.5 Business and Professions Code: SWIMMING POOL P TRAP LUNSi HUL I ION
Any city or county which requires a permit to construct, alter, POLES METERED SUB
improve, demolish or repair any structure, prior to its issuance,also re- WATER SERVICE ALTERATION PANELS MAINSUB
quires the applicant for such permit to file a signed statement that he '
is licensed pursuant to the provisions of the Contractor's License Law GAS SERVICE OUTLETS SERVICE AMP
(Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that he is exempt therefrom and the WATER HEATERS BTU OUTPUT
basis for the alleged exemption. Any.violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS
ooff, not more than five hundred dollars ($500).
OSL I, as owner of the property, or my employees with wages as their SOLAR TANK COLLECTORS
tole compensation, will do the work, and the structure is not intended
or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. , ISSUE FEE
Contractor's License Law does not apply to an owner of a property � ��
who builds or improves thereon, and who does such work himself or ISSUE FEE APPLICATION APPROVED BY DAT�//
through his own employees, provided that such improvements are not
intended or offered for sale- If, however, the building or improvement MECHANICAL PLAN CHECKSUMMARY OF FEES
is sold within one year of completion,the owner will have the burden - -
of proving he did not build or improve for the purpose of sale). - BUILDING �s
HEATING SYSTEM 0-100,000,BTU PERMIT $ a0.Sa SMIP $ v SD
❑ I, as owner of the property, am exclusively contracting with I AND'DUCT!NG
licensed contractors to construct the project (Section 7044, Business _ - I_ - 100,000 +BTU PLAN CHECK $s PERMIT
Is / and Professions Code: The Contractor's License Law does not apply to' ' ' "' - ISSUANCE $
UI an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 B PLUMBING $
tracts from such projects with a contractor(s) licesnetl;pursuant to SYSTEMGRADING $
1`4j
the Contractor's License Law). ^ a'. - 100,000+BT PLAN CHECK $
0 I am exempt under Section _ - B.& P.Cr forthis- BOf LE RS-, _ BTU EXPIRE ELV CTR ICAL $ S
reason - f) 'T In(..mi Tete Ijtsr��pp {{[[11f1J • - MICROFILM $
r("+Ch( t't' \ 'lk^ SYSTEM REPAIR,ALTERATION N r•pl_ NCHECK $
Date S' I Owner ��N TOTAL FEE$
r MECHANICAL $
1 hereby certify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE - LESS AO-
`
information is correct. I agree to comply with all city and county Date �--- `1aIS'-C- ECK"-$ VANCE PC $
ordinances and state laws relating to construction,and hereby authorize
representatives of t city, to enter upon the above mentioned 3 Yat
property f r I s,�(-ect oo p rposes. -
Signature o",_ _L) u 4461 Date SJI-I• S/ FINAL FEE $
Drivers'License or SS* ' ISSUE FEE
CMF 0865.46 White-Building;Canary-Applicant; Pink-Accounting;Goldenrod-Assessor
CONSTRUCTION AND PLANNING POOL&SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
-
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location
2. Soil Pipe-Undrgrn 44. Steel Reinforcement -
3. Electrical Conduit Utility-Undrgrn - 45. Forms
4. Electrical Conduit-Undrgrn • 46. Electrical Bonding
5. Steel Reinforce 47. Rough Plumbing & Pressure Test
6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE
7. Footings 49. Electrical Conduit-Undrgrn
8. Foundation - 50. Gas Pipe, ❑Undrgrn,Test •
9. Water Pipe-Undrgrn 51: Backwash Lines, P-Trap. ❑ Undrgrn •
-
\ 10. Structural Floor System 52. APPROVAL TO DECK •
11. Property Sewer Line& House Connection 53. Backwash& Receptor-Final
12. Street Sewer Connection 54. Heater & Vent-Final
13. Rough Plumbing - • , 55 Plumbing System - Final -
14. Rough Electric-Conduit _ •56. Electrical-Final .
15. Rough Electric-Wiring • - . . - 57. Solar System-Final - '
16. Rough Heating & Air Conditioning - - . _ 58. Fencing &Access Approval
17. Ducts, in Structure - 59. APPROVED FOR PLASTERING
18. Ducts, Ventilating . - � _ -
19. Gas Pipe-Rough &Test. . 60. POOL/SPA SYSTEMS FINAL � - • '
20. Roof Framing
21. Roof Sheathing • ' • .
22. Frame and Flashing NOTES:
23. Insulation ' •
24. Lathing& Siding '
25. Drywall Nailing
26. Plaster Brown Coat
27. Electrical Power Meter-Final - .
28. Final Electric
29. Final Heating &Air Conditioning
30. Final Gas Pipe-Test
31. Final Plumbing .
32. Water Service-Final
• 33. - Gas Service-Final f
34. Solar Domestic-Final I
35. Landscape Sprinkling System EXPIRED
36. Sound Attenuation -
37. Handicap Regulations - 170� P�jlel InaNeuliuna
38. FINAL STRUCTURE & BUILDING • Date 7 / ` 1" �de
39. Special Requirements Completed - -- 13�� - --
40. Electric Release to Edison - , .
41. Gas Release to Southern California Gas Co. t
42. CERTIFICATE OF OCCUPANCY
No. Date
o-
OWENS-CORNING
Fiberglas
Blanket Insulation
The contractor named below certifies that the Owens-Corning Fiberglas
Blanket Insulation used carries the NAHB Research Foundation, Inc. label
for assured thermal performance and that the Blanket Insulation is in-
stalled in conformance with current energy conservation regulations,
California Administrative Code,Title 25, State of California, in the building
locatdat:
/115-5a„ t105e Ay.. /D:2J5-
Street Lot Number Tract Number
Exterior Walls 3
Owens-Corning Fiberglas Blanket Insulation /l
Thickness R-Value
Ceilings �-
Owens-Corning Fiberglas Blanket Insulation //
Thickness R-Value
Floors
Owens-Corning. Fiberglas Blanket Insulation •
Thickness R-Value
Foundation Walls
Manufacturer Type Thickness R-Value
General Contractor_ License No.
By Title Date
(signature)/r ,,/�
Insular ontr ctor _ /'-��/.9��A• A��� •O_AC‘,-License No.51: 267.57”.
7'
By }
Title VP r Date {//.17/
( ,gnaturel
OWENS/CORNING
FIBERGLAS
Homeowner Copy (White) ,••,!•-r•
State Copy (Yellow)
Builder Copy (Pink) OWENS-CORNING FIBERGLAS CORP.
Insulation Operating Division
Pub.No.16-9L-6995-A Limo in U.S.A..July 1977 Fiberglas Tower,Toledo,Ohio 43659