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HomeMy WebLinkAbout2709 SAN LUCAS LN - Building Permits CITY OF COSTA MESA , v.. BUILDING DIVISION A Fµ .dl 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 1 `111 * FOR INSPECTIONS CALL: (714)754-5626 PERMIT NUMBER: E08-00043 PERMIT TYPE ELEC STATUS: ISSUED APN: 14131208 DATE ISSUED: 0210512008 ISSUED BY: BJK JOB ADDRESS: 2709 SAN LUCAS LN-CM Suite/Unit: Vicinity: RIGHT SIDE SFD - .. SCOPE OF WORK: ELECTRICAL OUTLET FOR-TANKLESS WATER HEATER:REF: P08-00041" OWNER: ROSS, LYNDA Address: 2709 SAN LUCAS LN Unit: PHONE: -City/Slate/Zip: , COSTA MESA,CA APPLICANT: LARRY HORTON - - ,: " " —Address:.Address: 560 LIBRARY ST. Unit: PHONE: 800-806-7374 City/State)zZip: .,SAN.FERNANDO, CA _ CONTRACTOR: MASTERSERV-INC'. License No. 580017 . Address: 560.LIBRARY STUnit: PHONE: " 800,806-7374 . .. " City/State: SAN FERNANDO,CA ZipCode: 91340 - . H . CELL: 818408-4100 ELECTRICAL PERMIT FEES Electrical Plan Check Fee: —$0.00 Electrical Permit Fee: $28.25 Reinspection Fee $0.00 TOTAL FEES $28.25 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 O. INSPECTION TYPE DATE INTITIALS CODE0 INSPECTION TYPE DATE INTrnALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing �J 200 Final Re-Roof 210 Final Electrical "�4l 0-- — 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 driver's tic. ❑Yes El No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: ❑ 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. 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 ❑ I hereby certify that no excavation five(5)or more feet in depth into which a number are: � (C./'� / / ,� person is required to descend,will be made in connection with work authorized Carrier by this permit,and that no building structure,scaffolding,falsework,or demolition (This section need nor be completed athe Permit is valued at one hundred dollars(sf00)or fess) or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp ,rxt //e,o R2,Art 2,Sec.341,Title 8,California Administrative Code). Policy Number: d� K (/ 0 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 person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code, I shall forth th comply with these provisions. Applicant's Signature Dale ;velure 7 "Division of Industrial Safety Permit Number: v Appli es Date 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? ❑Yes ❑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 effect./ a registration form for acutely hazardous materials? ❑Yes 0 No Lic.#� ©! Class# v (rSceptio 25533 the CaliforniatinHealth and SafetysaCode. with somet b ---1�-- l-Yeachp usrequires registration with the Costa Mesa Fire Department ly j�iG� each business which at any one time has on hand a quantity of acutely o rac ors sgnawre Dae 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). ❑ 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)? 0 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? 0 Yes ❑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 Califomia Government 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? 0 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 ❑ No thereon,and who does such work himself or herself or through his or her own 8 (If"yes". attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for 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 ❑ am exempt under sec. the information given is correct. I agree to comply with all state laws and city I 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 not to occupy or allow occupancy of any building authorized by this permit until final inspection. Segs-ureo e;-I O s) Date Signature Dale • 3057.4613/07) • AndI'r A.thonzed Applicant Dale CITY OF COSTA MESA BUILDING DIVISION Arrw.,� 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • .ci.costa-mesa. .us ara FOR INSPECTIONS CALL: (714)754-5626 PERMIT NUMBER. P08-00040 PERMIT TYPE PLUM STATUS: ISSUED APN: 14131208 DATE ISSUED: 02/05/2008 ISSUED BY: BJK JOB ADDRESS: 2709 SAN LUCAS LN CM Suite/Unit: Vicinity: SCOPE OF WORK: COPPER REPIPE AND GAS OUTLET FOR WATER HEATER(WATER HEATER UNDER SEPARATE "GREEN" PERMIT: P08-00041). OWNER: ROSS, LYNDA Address: 2709 SAN LUCAS LN PHONE: City/State/Zip: COSTA MESA, CA APPLICANT: LARRY HORTON Address: 560 LIBRARY ST : PHONE: 800-806-7374 City/State/zZip: SAN FERNANDO, CA CONTRACTOR: MASTERSERV INC License No. 580017 Address: 560 LIBRARY ST PHONE: 800-806-7374 City/State: SAN FERNANDO, CA ZipCode: 91340 CELL: 818-4084100 ARCHITECT: License No. PHONE: ENGINEER: License No. PHONE: • PLUMBING PERMIT FEE SUMMARY PLAN CHECK FEE: $0.00 PERMIT FEE: $39.45 TOTAL FEES: $39.45 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 A. INSPECTION TYPE DATE I141111ALS CODES INSPECTION TYPE DATE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical {� d(J� 1266 Pool Spa Final 208 Final Plumbing Z.-.�("V r _ 200 Final Re-Roof _ 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 driver's lice. . 0 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. 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' compen ation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: /J person is required to descend,will be made in connection with work authorized Carrier /e7dS by this permit,and that no building structure,scaffdding,falsework,a demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This secnn need not be completed r the permit is valued at one hundred doears(5100)orless.) 2,N1 2.Sec.341,Title B,Califomia Administrative Code). Policy Number: / D� // t `f 77- - /// 0 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 person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, all(onhwitthh comply with these provisions. Applicant's Signature Dale = sr Division of Industrial Safety Permit Number: App front's Signature Date 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 respons . to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 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 occupantneed to file my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes No Lic.# 5tet90 7 Class# C 6 (Section 25533 of the Califomia Health and Safety Code, with some ��� yrs— `�.,� exceptions, requires registration with the Costa Mesa Fire Department by ' each business which at any one time has on hand a quantity of acutely c• trader's Signature Date 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). ❑ I hereby affirm that there is a constmction 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 Managemynt_and Prevention Program for acutely Lender's Name: hazardous materials)? 0 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? 0 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 requir 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 fro construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No N issuance,also requires the applicant for such permit to file a signed statement (Secthat he or she is licensed pursuant to the provisions of the Contractors inform nt 65850.2 of the California Government Code requires that the roque tetl License Law(Chapter 9(commencing with Section 7000)of Division 3 of the mfortnaion be furnished on applications fa non-residential building permits). 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 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 25554 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 I/ License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes ❑No 79 thereon,and who does such work himself or herself or through his or her own 8. (If'yes", attach certificate of compliance from the appropriate air pollutt // employees, provided that such improvements are not intended or offered for 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 0 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 contractus 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 not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signatur of;:. q r s'.,= Date 3057 A6(3107) signature Dale S —Z� AnNor Authonzed Applicant Date - CITY OF COSTA MESA w, BUILDING DIVISION • „^^ �l 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa. s z. ..�.. FOR INSPECTIONS CALL:(714)754-5626 41%"°" °fi� PERMIT NUMBER. P08-00041 PERMIT TYPE PLUM STATUS: ISSUED APN: 14131208 DATE ISSUED: 02/05/2008 ISSUED BY: BJK JOB ADDRESS: 2709 SAN LUCAS LN CM Suite/Unit:- Vicinity: uite/Unit:Vicinity: RIGHT SIDE SFD - • SCOPE OF WORK: WATER HEATER CHANGE-OUT TO TANKLESS WATER HEATER. , OWNER: ROSS, LYNDA Address: 2709 SAN LUCAS LN PHONE: - City/State/Zip: COSTA MESA,CA APPLICANT: LARRY HORTON Address: 560 LIBRARY ST : PHONE: 800-806-7374 City/State/zZip: SAN FERNANDO, CA • CONTRACTOR: MASTERSERV INC License No. 580017 Address: 560 LIBRARY ST PHONE: 800-806-7374 City/State: SAN FERNANDO, CA ZipCode: 91340 • • - 'CELL: 818-408-4100 ARCHITECT: • -- License No. - PHONE: ENGINEER: - • License No. • PHONE: • PLUMBING PERMIT FEE SUMMARY • PLAN CHECK FEE: - • $0.00 PERMIT FEE:': $35.80- TOTAL FEES: • $35.80 • • ZRr 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. CODES. INSPECTION TYPE DATE INTTALS CODES INSPECTION TYPE DATE INnIIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical �p ,T 1266 Pool Spa Final 208 Final Plumbing 2- -"0 200 Final Re-Roof 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 (t I j� a WORKERS'COMPENSATION DECLARATION1 Owner ID verified by driv Ch. ❑yes No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: ❑ 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. 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 ❑ I hereby certify that no excavation five(5)or more feet in depth into which a number are: p r �f person is required to descend, will be made in connection with work authorized Carrier: � S//�7(/K.7 2^' - 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 (This seclon need not be compleleBii the permit is valued at one hundred dollars($100)or less) // 2,Art 2,Sec.341,Title 8,Califomia Administrative Code). Policy Number: CD( �k7Ck' /7Q�Q '$ j D 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 person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I sh-Il forthwith comply with these provisions. IC/ Applicant's Signature Date 24009 Division of Industrial Safety Permit Number pp mom's ignature Date 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? ❑Yes Rflo ($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 fullGforce and effect. 7 a registration form for acutely hazardous materials? ❑Yes No Lic.# �//(9D7'7 Class# e 7 6 (Section 25533 of the California Health and Safety Code, with some 6>.(7 0 V/.- _ . exceptions, requires registration with the Costa Mesa Fire Department by oc 7�`f' .Ti�l/`� /`� / / �� each business which at any one time has on hand a quantity of acutely Contractor's Signature Date 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). ❑ 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)? El Yes YR'X`'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 /y El DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes 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 pUstlict or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Govemment Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications fix 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 'gNo 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 ❑ No 44 thereon,and who does such work himself or herself or through his or her own 8. (If"yes", attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for 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 ordinanc s rega i/ t=g H.zard..s -tenets and Emissions. cy LICENSED CONTRACTORS to construct the project(Sec.7044,Business and r . inaz`GJ'-a�-O Professions Code: The contractors License Law does not apply to an owner of gnaiure 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 0 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 not to occupy or allow occupancy of any building authorized by this permit until final inspection. Si• azure e--al O. er(s) Date �'f Signature Date / `'�' 3057-46(3/07) ,t ' _t../....--9 L� Y Gg-—� U And/or Authorized Applicant Date "PA I ai Q && Ae 'itional Description c Work (.- L�it6ELLCG�4 Lie.#580017 .Q f , 'MAYER (800) 806-7374 Fax (888) 280-4106 ' . PRESSURE - "r" Corporate Office Northern California Office Mastir. 560 Library Street 5205 Prospect Road,Unit 135 r� San Fernando,CA 91340 San Jose,CA 95129 California's Leading Copper Repine Specialist Repining Since 197S Visit Ourr/'Date: !1 Owner's Name::/ (la Xa55 Job #: "6-97/Jr: Work to be performed at: j ( GUG G/1/• This is an additional description of the work to be performed at the above described address: 11 ! I ! 1 F - _ -- 1 f ! 1 __ ' ( 1 - 1 I IL ' ' ---1- ' _ ' 1, ; 1 ' - ! 1 --- '_ L 1! i 11 1 _ x- 1 Mat 1 __ LT 1 r �11 -., 1 , . - 1__- 1 L . __ ! I ! i I _- 1 L - _.-I ! L .._ I ! 1 j I � .__ — 1 I -- r I 11 I 1 , / .a � i 1 I 111 1 I 1 • .- , I � ' — , : : . ............. ....... . . 1 -II a f ` 1 I 1 ' ' 1 1 / , 1 S 1 , , , 1 ; 1 : , , li peg,. -,—,' 1 I 1 . 1 1 , Owner: Lynda Pn.% Owner: X . cw 1 29/np / (Print Name o Owner) (Owner Sign 44441��leeeere) / (Date) Original-Contractor's Copy-Owner's 0an.wars...Inc r R to a....d rr CITY OF COSTA MESA • "i BUILDING DIVISION h f,ilillitkreggia ) 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa. s • v. FOR INSPECTIONS CALL: (714)754-5626 PERMIT NUMBER. B07-00900 PERMIT TYPE B_ROOF2 STATUS: ISSUED DATE ISSUED: 08/15/2007 'ISSUED BY: JOB ADDRESS: 2709 SAN LUCAS LN CM Suite/Unit -. , Vicinity: SQ. FT: 0 Valuation: $0.00 SCOPE OF WORK: T/OFF SHEATH'AND REROOF 1250SF RESIDENCE W/COMP SHINGLES OWNER: ROSS, LYNDA Address: - 2709 SAN LUCAS LN Unit: PHONE: City/State/Zipi- COSTA MESA,CA APPLICANT: LYNDA ROSS Address: ' - Unit ., - - : PHONE: 714-546-6249City/State/zZip: . .. CONTRACTOR: - - - License No. „ • ' , _ Address: Unit: PHONE:- ,. City/State: ZipCode: - CELL: ARCHITECT: -• - - License No.- - - - . 'PHONE: - ENGINEER: • . - License No. - PHONE:' ' FEE SUMMARY Reroof Plan Check: Reroof Permit Fee: Reinspection Fee: ' $0.00 :_ - TOTAL FEES • 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 p. INSPECTION TYPE DATE INI111ALS CODEA INSPECTION TYPE DATE INIIIIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final // / �/ 208 Final Plumbing 200 Final Re-Roof /••�O-•O7 �- 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 :nse. El Yes 01No �y I hereby affirm under penalty of perjury one of the following declarations: / Driver's License No. /pires: 7 —3--D� ❑ I have and will maintain a certificate of consent to self-Insure for vaorkers' 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. - _ El 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 by this permit,and that no building structure,scaffolding,falsework,ar demolition Carrier: or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp (This sedan need not be compered if the permit is valued at one hundred dollars(sf00)or less) 2,Art 2,Sec.341,Title 8,California Administrative Code). Policy Number: ❑ 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 person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of Applicant's Signature Date the Labor Code, I shall forthwith comply with these provisions. Division of Industrial Safety Permit Number: Applicant's Signature Date 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 effect. a registration form for acutely hazardous materials? 0 Yes ❑No Lic.# Class# (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 Contractor's Signature Date 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). ❑ 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)? 0 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? 0 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? 0 Yes ❑No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be furnished on applications fa 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). o I, as owner of the properly, 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 8. (If"yes", attach certificate of compliance from.the appropriate air'pollution employees, provided that such improvements are not intended or offered for control sale. If, however, the building or improvement is sold within one,year of 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 city ordinances regarding Hazardous Materials and Emissions. , 01 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 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 0 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.1 agree not to occupy or allow occupancy of any building authorized ithis permit until�y'nspection. • A .0-pk-7 ,•/ 5-40 .i�.at re of Legal Owner(s) Date - Signature Dale 307 I /<6(• r I And/or Authorized Applicant Date \� r 12244 • FEE RECEIVED COSTA MESA BUILDING-SAFETY DEPARTMENT � ` P. O. BOX 917 COSTA MESA. CALIFORNIA _QA- to - 1 l to For Applicant to Fill In Completely APPLICAT FINANCE DEPT. TYPE �'� � IOESA OR PRINT �J c� Lot 1 13 BUILDING ADDRESS BUILDING a / 0/San Lucas Lane Plan # RIB COSTA ME A. CALIFORNIA For Office Use Only I RECEIPT NO. I PERMIT NO. OWNER Mesa Dal Mar. Development C /..2 .2 SL0 MAIL RECEIVED ..DPY.� / DATE RECEIVED DATE ISSUED ADDRESS Suite 1, 3800 E. Coast Highway ,fit, Ems/?-40 6-/�-6ci CITY Corona del Mar TEL or 34221 BUILDING ADDRESS Stan T.urnR Tann ARCHITECT TEL. COSTA MESA, CALIFORNIA OR ENGINEEF�aymOnd Levanas NO. Or 37011 ADDRESS 3432 Via Oporto, Newport Beach FIRE , - / ZONE TYPE I/ GROUP�/V CONTRACTOR Macco Corporation APPROVED BY DATE ADDRESS 3800 E. Coast Highway ZONING ZCITY Corona del Mar DNR-1 I PLANS I E NO.OF USE OF EWSa1 BUILDING Model STATEC. o. 98808 TEL. 34220 DESCR Tract 3749 r !?r-/%3 DESCRIPTION SIZE OF LOT 71 x 116 I NO. OF BLOCS. 0 NOW ON LOT A.P.NO. none USE OF YARDS EVES EXISTING BLDG APPROVED ALLOWED SETBACK UNE FROM (CENTER LINE ST.) CENTER OF STREET REAR/ YARD1 FRONT ` 50 FT. IN. SIDE YARD I LEFT 5 I RIGHT 5 R.SIDE 7 FT. 7 IN. DESCRIPTIONOF WORK L.SIDE 7 FT. 97 IN. REAR 30 FT. IN. REPAIR I II MOVING I II DEMOLISH I APPROVED 6-13-60 BY W. L. D. 1 ATE EXTERIOR WALI, tUCC ROOF USE OF BUILDING AND WORK TO BE PERFORMED shingle ' l0'—r 'Y / Construct Single Famil• Residence ,/ V(11 0 / I HIDEREBY ACKNOWL D oTH ATI I HAVE READAND THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE ANSTATE THAT TH VE IB CORRECT AO BTO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY 1 CEO AND STATE LAW REGULATING- BUILDING CONST LI i VALUATION ) ) SIGNATURE OF PERMIT FEE $ 70A ' ^ PERMITTEE L CCN Si ./PLAN CHECK $ /6 •' Project Manage AUTHORIZED AGEN /..3� . Io TOTAL FEE $ T(T ,J PNOff&jADDRESS: 2709 SAN LUCAS LN UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 054259 ''' 'OWNER'S NAME: ROSS, HAL Z ADDRESS: ROSS, LYNDA PERMIT NO: B 054259 PLAN CHECK NO: N GOVT: N SUPP: N 2329 E 1ST ST LONG BEACH CA 90803 CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: ALT 4 213 439-6618 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : REROOF COMP 0/ WOOD SHINGLES SQ FT: 2, 662 ADDRESS: UNIT: CLAIM VALUE: 2,661 . 85 CALC—VALUE: 2, 662. 00 GROUP OCC: R-3 / PERMITTEE: RAINPROOF ROOFING ( 714 ) 536-8702 ADDRESS: 369 P.O. BOX COMMENTS: SMOKE DETECTOR(S) REQUIRED IN HOME. HUNTINGTON BEACH CA 92648 ****************************** *********************+t******sr********TtRE*TtTt****** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIREMENTS 70o0)of Division 3 of the Business and Professions Code.and my liven e is in full force and effect. SETBACKS CITY LIC.: 049442 STATE LIC.:557494 • CLASS: 3• __ ���' 3 `) I Signature._ ►'_C _� MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby af firm that I haw Aetlificate of consent tosell-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800, Lab. C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: 1182447-90 EXP.DATE: 04/01 /92 ' COMPANY: STATE FUND PARKING REQ• PROV: PARCEL: 14131208 ZNE: REF NO: ❑ Certified copy is hereby furnished. a Certified copy is red - the city Building Division. PLANNING NOTES> /o-3-97 Applicant ******************************************************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section• be completed if the permit is for one hundred(5100)or less). DEVELOPMENT S E R. V I C E S R E Q U I R E M E N' :T S I certify that in the performance of the work for which this permit is issue..I shall not employ any person in any manner so as to become sublecl to the Workers'Compensation Laws of California. ZONING APPROVED BY . DATE: A Dale: Signature: NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: ' Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. , CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY• DATE. iibf which this permit is issued(Section 3097,Civ.C). **********************-****************.** ***.****{F******.****.**.**.*.* *.**.7¢****,*'** LENDER: *****************************************• ***********************if*9E,********** ADDRESS: LEGALIZATION:N F E E S U M MAR Y STRUCTURAL. SEGMENT:Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMB ING ELECTRIC MECHANIC FIRE (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 54 . 0 0 SM I P/ .50 .. 50. GRADING'/ repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 5 ' pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SM I P/NON=RES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN , , any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE • ' ' %• I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID , , DUE ❑ structure is not intended or offered for sale fectson 7044.Business and Professional Code: The Contractors'State License Law TOTALS----> 54 , 50 0. 00 0 . 00 54 . 50 54 . 50 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through • his or her own employees.provided that such improvements are not intended or offered for sale.If,however the building or / �. �,V improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED; 54 . 50 OVER/SHORT; 00 for the purposeol sate). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT ' GRADING PLAN—CHECK I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 54 .00 . 50 ' ✓ .6-❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractors)license pursuant to the Contractors'State License Law).I am aware *****************************************************{F•********************7***{P{F that proof of their Worker's Compensation insurance should be provided to me. Y;. INDIVIDUAL F E E B R E A K .D O W N • o I am exempt under Section: B.&P.C. ♦ ' tor this reason: TYPE QTY DESCRIPTIO N •UNIT COST TOTAL COST �' Date: Owner: SFR 2662 REROOF BY VALUE RESIDENTIAL NOZONE1 , 00 �, .•001 ! Ido hereby certify that am aware of and understand the requirements al California Health and Safety Code Sections 25505,25533,and , 662 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END OF FEES permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from )' _ r• these provisions. ,. .• ' Date: Applicant: ' ' • I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county • • ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned ' ' property for inspection purposes. / ---;"r—./o" )`dl) Signature: /L�•:✓i�� a_ / '.. i _ - __ D"ver'sLicense orSocial Secudtya: ..(i'i+ ?'..':"i T' !: ` 1641.46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor 'I s . CONSTRUCTION AND PLANNING POC_ S SPA Date Inspector Date Inspector -11 APPROVALS Permit# APPROVALS Permit# 1. Temporary Electrical Servi'ete or Pole rc 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 4. �c 53. Steel Reinforcement :3y?Electrifal Condutj j+lily-Undrgrnd. ''' 54. Forms 04 Electrical Conduttilndrgrnd. i' 55. Electrical Bonding nn;, r,- 'r ^;S rt C to (:Reinforcemer)i_ ;` 56. Rough Plumbing & Pressure Test rt.i L 6.C6eWrlcal UFER &cd. �� 57. APPROVAL TO COVER-GUNITE a '?7. Fdotin"gs r?..a..c• y - 58. Electrical Conduit-Undrgrnd. a n•8. Foundation _rt,� ;; ^' 59. Gas Pipe, 0 Undrgrnd., Test W -.9. Water Pipe-Und7grnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. a o 10. Structural Floor System 4.. 61. APPROVAL TO DECK .s 11. Property Sewer Lines& HaOse Connection 62. Backwash & Receptor-Final •12. Sealer Cap a. ti a, 63. Heater & Vent-Final 13. Roof Drains r 64. Plumbing System - Final 14. Rough Plumbirj§, ct 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16.. Rough ElectriTiring 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 _ FIRE DEPT. REQUIREMENT _ _ _ _ - _c: _ _ J 'tW' rg co 20. •Rou h Facto F?eplace t Sn ti=Z,. A : J CI: * APPROVALS=-, Perttiit# * >• -1- 4.0 S 'o s4C ?T > -t t•�. s co. z - - s- o; 7 r. > x . t-E- :CS Y .R Y 1 J V q > tri - 21,.Ducts,in-Stryctur,B.F .5 . S 1-+v: * -J0. Undergwtzxid;Hygro :r 22. Du&3, Ventilating•' I CJS * .S C.* x '- 1. Producf'Pl ing Qts D it ic r-^ I at x: '- -Irw *. F '*t E O J 0, c+ 23.;GaS�ip�Ro x�h &T,est , s Yr -•t < * -72. Underground Flush.;, ra 24.aRoat Framing, Z_ I r - 1 a > O J tea_ . ,�3.W_JndergrnCFI!Storarie7 rapk O Gas 740 Oi1 25. Root SFi tithing �r� S 'ti 1: 47 •'' ? - < '-,Fo .. .� t'1: q v r .7 ;� X74.;Overhead �Iydro0 5 26:,T-Bar Ceiling (Structural) &:Monocoat tU : « 75.�rry Chemical y « i--1 rJ _t D * .u2 IAx :F 76.�YY Stante C,T �S b1 '�:27 .-;Fra5ie aid Fcshrq9 �tCLC. :s a [ �. � .r vnd a. 74.74 .. E • v,.-+ .F .J ,-28. Lathing:& Siding., c, '=a•Q.0 uz x. S •-* 77.O'FIXED Sh`STEM•INNAL* ti'' r_. r nY r.rs, t I I. r -.1 nin n X29. Insulati n " �'" r' - - > :I. iA ' Y[ v a E -~ 1 * J to ,_,y S -. I I }k 'F 78.SFIRE PR EV. FINArL ..s. ,:-.s ix ->, . a.s .> t✓ F .� - r n w .e .F ' 30. Drywall,Naiitng -* lc ( I IF x . HEALTH:oEPTY.REQUIREMENT • -, I * r.. 1 1 r Y Air. '4 ..r {,,31. Plaster Bcown,Co4t S I ,74,14 * I f * 79:'FINAL lN?$CT10N d ` I .L til, F L^^ .. F .,. L:L:- '- - , 32.=Electrica(Power f ,tet3Final E * u I - Ix x t[80.jFOOD CERTIFICATE ISSUED .• _ . -1, ,9, , -. -. .33.`Ts.Finil Ele ,rid u;* t L7', * (r, I . :10 Notes: 2 'Z- ,r-lin t i. t� 1(n �, '. tti 1 I�h. .. } k I r. .r [-a 4•,, tts. ' x. -• 11,1134,-Fin_ii Heating& kfr, Onditionl(( tli I. • ,t a: S n.. S '7a I nt ic 35.mFinal Gas Pipe-T(sst* ox - * I It * - ' tics * :1' SO f rt * C.-.. :CC, C. -• # 74,74 ,c36.Hood or-TanoPYri+X o< i * r I : g T; no .+ x ,, , y1r. 37.-Fine'I Factory Fir's' lace ; S`-'' `" * .r, t, ' S (-) rss n pi -38. Final Plumbing * Cu I [.r '! I ` EF ;14 S 1-4 x to 7'39. Water Service-'Finalt -~ I w * I 1 [+ 'x Cl n11'1 TM' ': C re 'I' >'. I a I3 I • ` >r a. v S 0. Gas Service-Final i, I I 1 r'` s " • ** , . 01 trp 't Li .4.•-tris, `S * to � i y 04. n...;to * ..r >'41. Solar Domestic-Final S H. •• x Co {ft x ^i ^ e- T.: , `, w 741 'r I I it a CI ,. f�?•SIT v 'D -42.'Backf low Preventer • ' "' I I �t"� r` '�� -'• -I: AMA 43. Backflow Irrlation" 'XZ S -x - w t: :rt-,o + O t . >+ Ix :i[ :. N K Yaarjti ' -r44. Landscape "rdipation System.+nu' i -- rr * t ti � j --QQ .K - Jtd W -'` t . , C .' .t u: :c '-. ' ••a6 . a.5- E �:'��T�+1 >"45,=Sound Atter uatiorc I-stct-• 'Y' p s " E" ['4=1: :4- C' •-4 '-4 U'-'• IX' ^. n• - -r - •• •• 1. r in p1 i�•- " C 'd • 4-40 .k ; 6�Handica p,Regylatid is H ? _I to •• V�" r, -,rte' pa S �47._FIfilAL STRUCTURE & BUILDING 10 r ,LO '. 1'171 4'1. J J , , e- 1 : \e-e_ Cori/ 48.LFINAL PLANNING: I tL-C-- r nl I .I w to d 7i , • 1 - (. .. �,.1p -W-0.i c.49.3EleotricrRelease to Edison i , I I hK .4.. `= 1 * t 171. + •r. , S •J •_". .1: ,50.�GasyRelease to Southern California Gas Co ': I �r x F '• nn p�/� (' 0i51. CERTIFICATE OF;OCCUPANCY b * * •:,-5),/,? / '' !/T// No. Date /a-��, �