HomeMy WebLinkAbout2120 SANTA ANA AVE - Building Permits - a
CITY OF COSTA MESA
STN Aft
���, BUILDING DIVISION
•
;a. BUILDING
FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • wNw.costamesaca.gov
a. f FOR INSPECTIONS CALL:(714)754-5626
'"t.r. nsem PERMIT NUMBER: B11-00416
PERMIT TYPE B_ROOF2 STATUS: ISSUED
APN: TPN01109 DATE ISSUED: 11/29/2011
ISSUED BY: RMD
JOB ADDRESS: 2120 SANTA ANA AV CM Suite/Unit:
Vicinity: 6 CODNOS A, B,C, D, E AND F
Squares: 0 'Valuation: $14,000.00
SCOPE OF WORK: REROOF 6 ATTACHED CONDO UNITS(A THRU F).TEAR OFF EXISTING ROOF MATERIALS, INSTALL 1 LAYER
OF 30#FELT AND REROOF WITH 30 YEAR COMP SHIGNLES ON 85 SQUARES OF A PITCHED ROOF;ALSO
INSTALL BASE/2 PLY AND CAP ON 15 SQUARES OF FLAT ROOF. REPAIR AND REPLACE SHEATHINGA AS
NEEDED. COMPLIANCE FORMS ATTACHED TO JOB CARD AND CITY PERMIT.
NOTE:RESIDENTIAL RE-ROOF: Final approval of permit shall not be granted until access to dwelling unit(s) is provided for
verification of the installation of smoke and carbon monoxide alarms by the City Inspector. See Attachment w/Inspection Card
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OWNER: GEORGE HALBURIAN Address: 2207 RIM RD Unit:
PHONE: 714.777-4040 City/State/Zip: DUARTE, CA
APPLICANT: FERGUSON, LEW Address: Unit: :
PHONE: 714-7774040 City/State/Zip:
CONTRACTOR: MC CORMACK ROOFING AND WINDOW CO License No. 643700
Address: 1260 N HANCOCKUnit: SUITE 108 PHONE: 714-7774040
City/State/Zip: ANAHEIM,CA 92807 CELL: 949-347-1400
ARCHITECT: License No. PHONE:
ENGINEER: License No. PHONE:
FEE SUMMARY
Reroof Plan Check: $0.00
Reroof Permit Fee: $237.25
Reinspection Fee: $0.00
Bldg Std Admin Fund $1.00
TOTAL FEES $238.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010-PER CMMC Sec. 13-279
Monday thru Friday-7:00 am thru 7:00 pm. Saturdays-9:00 am thru 6:00 pm. Prohibitied all hours-Sundays and the following Federal holidays
New Years Day,Memorial Day, Independence Day,Labor Day,Thanksgiving Day and Christmas Day
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No.92-28,§ 1, 72-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE$ INSPECTION TYPFp� INTRIALS CODE# INSPEC110NIN111UL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final _ hn P 208 Final Plumbing
200 Final Re-Root X 3 ��ta r'11 210 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 drivers license. ❑Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
O 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.
g'� 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 is- ed. 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 ar-I person is required to descend, will be made in connection with work authorized
Caiers - ��u by this permit,and that no building structure,scaffolding,falsework,or demolition
1---rt- :o - or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
trots sapan need not be competed n the cerme is valued at one hundred dollars(4100)or less 2,Art 2,Sec.341,Title 8,California Administrative Code).
�C OL,CO—t7 - S C7'c'7
Policy'Number: ( g �� •
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
Applicant's Signature Dale
th- •bor hall forth.•h comply with these provisions.
' 1� z• ,L Division of Industrial Safety Permit Number:
`Applicants Signet'e 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 0 No
(5100,000), 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 iinf full force and effect. 3 a registration form for acutely hazardous materials? 0 Yes 0 No
Li K; Y '3 UC:3G o C(.lasstt
� � / (Section 25533 of the California Health and Safety Code, with some
ea
exceptions, requires registration with the Costa Mesa Fire Department by
•.--� � �-g!L( each business which at any one time has on hand a quantity of acutely
• ca t�aGa's ignat 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).
O 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? 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 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? 0 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 officer).
• 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 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 not to occupy or allow occupancy of any building
authorized by this permit until final inspection.
ature of egai egs) Date
Signature Date II 2-g///
3057-46(3/071 /
,AoplprAuttgonzed lip wn ,—Dete—
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Prescriptive Certificate of Compliance: Residential CF-I R-ALT
Residential Alterations (Page .1 of 5)
Project Name: I LC I(�('^, ow) g,..v--- I Climate Zone# I ^ I #of Stories
General information ��f �/ + !_
Site Address: "24.2_0 Cd(4.n, 6yr,.. (At�,�r1;nforcement Agency( ifjJ .AJ Date: 7 I l_.l_.7"/ I l (
Building Type O Single Family -17 MtRti Family Circle the Front Orientation:N,E,S,W,or degrees
Project Type: 0 Alterations 0 Envelope❑Fenestrationof ❑ HVAC
Conditioned Floor Area(CFA): Replacement or Change Out 0 Duct Replacement ❑Water Heater
NOTE: This form is not to he used for Newly Constructed Buildings or Additions
- Insulation Values For Opaque Sod aces(for Furring use the Mass and Furring Strips Construction table below)
Assembly Alteration
❑Opening of framed cavity alone—Alterations that involve the opening of the framed cavity of a wall, ceiling, or floor must install the
mandatmV minimum insulation value per§150 for the altered assembly. Fill in Columns A—C and enter mandatory insulation value in Column H.
ID Replacement of entire assembly—Replacement of an entire wall,ceiling, or floor assembly requires the installation of Component
Package-D insulation values in Table 151-C. Fill in Columns A—J.
Opaque Surface Details For the furred portioned of Mass Walls see Furring Strips Construction Table below.
A It C - U ' E ' F C I H 1 IINutt
,l
Proposed Sic Standard Values From JA4 Table
Framing Thickness, Framed Continuous JA4 Proposed
Tag/ Assembly Name Material Spacing, U- JA4 Table Cavity Insulation Assembly Assembly
ID� or Type' and Size or Other' factor° Numbers R-value6 R-Value' Cell Values U-factors
Note:For furred assemblies,accounting for Continuous Insulation R-value,see Page JA4-3 and Equation 4-1. For calculatingfurred walls use the Mass and
iFurring Construction sable below.
1.For Tag/ID indicate the identification name that matches the building plans.
2.Indicate the Assembly Name or type:Roof/Ceiling, Walls, Floors, Slabs, Crawl Space,Doors and etc...Indicate the Frame type and Size:For
Wood, Metal, Metal Buildings, Mass, enter 2x4, 2x6,or etc...see JA4 for other possible frame type assemblies.
3. Enter the thickness for mass in inches or Spacing between framing members enter;16"or 24"OC;or Other for all other assembly description
such as Concrete Sandwich Panel,Spandrel Panel,Logs,Straw Bale Panel and etc....
4.Based on the Climate Zone;enter the Standard U-facto',f2 om Tabic 15)-B, C or D for each different assembly Name or type.
5.Enter the Table number that closely resembles the proposed assembly. •
6. Enter the il-value that is being installed in the wall cavity or between the framing;otherwise, enter "0".
7. Enter the Continuous Insulation R-value for the proposed assembly;otherwise, enter "0".
S.Enter the row and column of the U-facto value based on Column F Table Number and enter the Assembly U-factor in Column,1
9.The Proposed Assembly U factor, Column.1, must be equal to or less than the Standard U-factor in Column E m coinplr.
Furring Strips Construction Table for Mass Walls Only
A I B C L D i E I F G I H I I J I 1t L I M
Proposed Properties of Masonry and Concrete Added Interior or Exterior Insulation
Walls From Reference in Furring Space from Reference
Joint Appendix Table 4.3.5.4.3.6.4.3.7 Joint Appendix Table 4,3.13
r V c ` . < U
v: tr. ° C ._ 4v L 3 v cc
Assembly 2 . ° F- c �` " >':, Final
.'
I . 4 a, u 5 =
Mass None or JA4 Table � '" _ E __ o �_ � 4 - & e Assembly
Thickness' Type' Number' = 3 r ui ^ 4 c C S F N U-factor°" Comment
Registration Number: Registration Date/Time: HERS'Provider:
2008 Residential Compliance Forms August 2009
Prescriptive Certificate of Compliance: Residential CR-IR-ALT
Residential Alterations (Page 3 of 5)
Project Name: I IM I r I Climate Zone# n #of Stories
ROOFING PRODUCTS(COOL ROOFS)§151(112
When the area of exterior roof,surface to be replaced exceeds more than 50%of the existing roof area,or more than 1,0001»', whichever is .
less,the new roofing area mast meet the roofing product"Cool Roof'requirements of§152(b)1 Hi, 152(b)11111,or 152(6)1 Hiii.
Check applicable alternative or exception below if the roof alteration is exempt from the roofing product "Cool Roof'requirements.Note:If any
one of the alternatives or exception below is checked, the Aged Solar Reflectance and Thermal Emivance requirements for roofing products in
§1)8(i)are not applicable.Do not fill table below.
_-12r62-91 Roofs Not Required in Climate Zones 1-12, 14,and 16 with a Low Sloped. Less or 2:12 pitch. '
ool Roofs Not Required in Climate Zones I through 9 and 16 with a Steep-Sloped Roofs(pitch greater than 2:12)and product unit weight less
than 516/ft2.
Alternatives to§152(b)1Hi and§152(b)Hii,Steep-slope roof(pitch>2:12)
❑ Insulation with a thermal resistance of at least 0.85 hr•R?°F/Btu or at.east a 3/4 inch air-space is added lo the roof deck
over an attic;or
❑ Existing ducts in the attic are insulated and sealed according to§151(010;or
- 0 In climate zones 10,12 and 13,with I ft2 of free ventilation area of attic ventilation for every 150&of attic floor area,and
where at least 30 percent of the free ventilation area is within 2 feet vertical distance of the roof ridge;or
❑ Building has at least R-30 ceiling insulation;or
O Building has radiant barrier in the attic meeting the requirements of§151(02;or
❑ Building has no ducts in the attic;or
O In climate zones 10,11,13 and 14,R-3 or greater roof deck insulation above vented attic.
Exception to§152(b)lHiii,Low-slope roof(pitch S.2:12)
❑ Building has no ducts in the attic. •
Other Exceptions
0 Roofing area covered by building integrated;photovoltaic panels and solar thermal panels are exempt from the below Cool Roof criteria.
i 0 Roof constructions that have thermal mass over the roof membrane with at least 25 lb/ft2 is exempt from the below Cool Roof criteria.
Note:If no CRRC-1 label is available,this compliance method cannot be used,use the Performance Approach to show compliance,otherwise,
Check the applicable box below if Exempt from the Roofing Products"Cool Roof'Requirement:
Roof Slope Product Weight Product Aged Solar Thermal
CRRC Product ID Number' < 2:12 >2:12 < 51b/ft2 > 51b/ft2 Type2 Reflectmue3'4 Emittance SRI5
❑ ❑ ❑ ❑ ❑4
❑ 0 0 0 04
❑ ❑ ❑ ❑ ❑4
❑ 0 ❑ 0 _ ❑4
O 0 0 0 ❑4
I. The CRRC Product ID Number can be obtainedfora the Cool Roof Rating Council's Rated Product Directory at www.coolroo/s.ore/products/search.P/rn
2.Indicate the type of product is being used for the roof top,i.e.single-ply roof asphalt roof metal roof etc.
3. If the Aged Reflectance is not available in the Cool Roof Rating Council's Rated Product Directory then use the Initial Reflectance valuefrom the sante
directory and use the equation(0.2+0.7(p1,,11101-0.2)to obtain a calculated aged value. Where p is the Initial Solar Reflectance.
4.Cheek box if the Aged Reflectance is a calculated value using the equation above.
5. Orientate the SRI value by using Nie SRI-Worksheet at late://www.enertm.ca.yov/ti!/e24/and enter the resulting value in the SRI Column above and attach acnpy of
the SRI- Worksheet to the CP-I R.
To apply Liquid Field Applied Coatings,the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage
recommended by the coatings manufacturer and meet minimum performance requirements listed in §118(1)4. Select the applicable coating:
0 Aluminum-Pigmented Asphalt Roof Coating 0 Cement-Based Roof Coating 0 Other
Registration Number: Registration Date/Time: PIERS Provider:
2008 Residential Compliance Forms • August 2009
Prescriptive Certificate of Compliance: Residential CF-I R-ALT
Residential Alterations (Fatye. 5 of 5)
Project Name: ^' / �t D� I Climate`Lone it I/u1'Stories
ri 1 tAii.ct//, I u
PERS VERIFICATION SUMMARY 7/re enforcement agency should par special attention to the HEMS Measurer specified in this
checklist helms. A completed and signed CF-4R Form for all the measures specified shall be submitted to the building inspector before final
inspection.
Duct Sealing & Testing HERS verification is required Jor this measure.
0 YES 0 NO YES:In Climate Zones 2 and 9-16,if more than 40 linear feel of new or replacement ducts are installed in unconditioned
space,the ducts are to be sealed per§152(b)IDii and the newly installed ducts me to he insulated pet §1151(1)10.
0 EXCEPTION: Existing duct systems that are extended,which are constructed,insulated or sealed with asbestos.
❑ YES 0 NO YES:In Climate Zones 2 and 9-16, if the existing space-conditioning system(HVAC equipment and ducting)is replaced,the
ducts are to be sealed per§152())1Di.
❑ YES 0 NO YES:in Climate Zones 2 and 9-16, if the existing HVAC equipment is replaced (including the replacement of the air handler,
outdoor condensing unit of a split system,cooling or heating coil,or the furnace heat exchanger)the ducts are to be
sealed per§152(b)IE.
❑ EXCEPTION:Duct systems that are documented to have been previously sealed confirmed through HERS
verification in accordance with procedures in the Reference Residential Appendix ltA3.
❑ EXCEPTION:Duct systems with less than 40 linear feet in unconditioned space.
— 0 EXCEPTION: Existing duct systems constructed, insulated or sealed with asbestos.
Refrigerant Charge - Split System HERS verification is required for this measure.
0 YES 0 NO YES: In Climate Zones 2 and 8-I5,when the existing HVAC equipment is replaced(including the replacement of the air
handler,outdoor condensing unit of a split system A/C or heat pump,cooling or heating coil,or the furnace heat
_ exchanger)a refrigerant charee measurement shall be verified per§1521b11F.
Central Fan Integrated (CFI)Ventilation System and Fan Watt Draw
_The ventilation requirements of§150(o)do not apply to existing residential homes.
Ducted Split Systems-Air Conditioners and Heat Pumps: Airflow HERS verification is required for this measure.
- 0 YES 0 NO YES:In Climate Zones 10 through 15,when the existing space-conditioning system(HVAC equipment and ducting)is
replaced.the airflow and fan watt draw shall be verified per§152(611 Ci to meet the reouirements of§151(fl7B.
I Documentation Author's Declaration Statement
• I certify
gthat this Certificate of Compliance, �� documentation is accurate and complete. �/J
Name: 1 " C (11e(mac V ck-St 93 r C ,�.�—�
Company: ( Date: ) I(-_# ((t
Address: f ' t7 L .�t 1 If Applicable rJ CEA or 0 CEPE
( (Certification 0w):
City/State/Zip: i vvAh� ^n c� g g `� 6,m_40 /' J� phone: ^/Cf m7 q0`k/1
Responsible Building Designer's Declaration Statement U V�(� l I / CJ
• I am eligible under Division 3 of the California Business and Professions Code to accept responsibility for the building design identified on
this Certificate of Compliance.
• 1 certify that the energy features and performance specifications for the building design identified on this Certificate of Compliance conform
to the requirements of Title 24,Parts I and 6 of the California Code of Regulations.
• The building design features identified on this Certificate of Compliance arc consistent with the information provided to document this
building design on the other applicable compliance forms,worksheets,calculations,plans and specifications submitted to the enforcement
agency fbr approval with this building permit application.
Name: Signature:
Company: Date:
Address: • I License:
City/State/Zip: I'hnne:
For asteistanec or questions regrinding the Energy Standards, contact the Energy hotline at:1-8(10-772-330(1.
Registrant»,Number: Registration Dale/Time: HERS Provider:
2008 Residential Conyrliance Forms August 2009
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
'OST.A E q Cg�ISTR4,� I,QN P RMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. B.QO TLL. .
�/I C) �SHAm 't�Yt It e �- -�3 70 / 3!79 6/29/84
Project Address pal
Applicant's Ma'.yCf Address� A TYPE OF CONSTRUCTION U NEW U ADD U ALTERATION U REPAIR
Thr. VL '.L Pho e, •�1 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone
Owner's a�m/rer•^� �kI I,� DESCRIPTION OF WORK/USE OF BLDG.
Address �UVk ,kQ • ,/w" c• •t Z S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING U FOUNDATION ❑ STRUCTURAL E Front - - ZO
❑ TENAN •
TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL N Address `itI • El OTHER A
Contractor's Nam•
Pb.. • • C RightN
Address(mailing/.• A 'Mr. '' _ i PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Left G
�s�, 1 CONSTRUCTION TYPE VALUATION $ 5
•
-
City License No. sR ZONE GRADING CU.YDS. ACRESR
LICENSED CONTRACTOR DECLARATION Pl ng. Ref.# Parking Req./Provided E
Q
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: - M
with section 7000) of Division 3 of th- B siness and Professions Code,and .
my license is in + Pore and effe - t 1 I ��/ T
License Cipili , ense No.�`F b L $'
Date lo--•X Signature P - PLUMBING FEES
WORKERS'COMPENSATION DECLA' A ION Bar Sink Showers ELECTRICAL FEES
' hereby affirm that I have a certificate o co sent to self-insure or a certificate
f Workers' Compensation Insurance, o a ertified copy thereof (Section -Backflow Preventer Service Sink
3800, Lab:,CJ' ' • Automatic Washer Transformer 0 15-50 KW
Policy No':t' Company Backflow Irrigation Sewer Cap / Construction Pole Sub. 0 50+ KW '
Certified copy is hereby furnished.
Certifietl'copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date '! Applicant '
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permi is for one hundred ($100) or '
less). - Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
I certify that in the performance o th. •r or hlch this permit is Issued, I '
shall not employ any person in an ',.n'€r •. ,. to become subject to the Drinking Fountains Solar Tank - Fan Motors 00-1 HP 01%-8
Workerk' C<otp nsation Laws of Ca o
Date y0 /!� _Signatur- - . >• Floor Drains Swimming Pool w/Spa F.A.U. .
09-15 HP 016.15+
NOTICE:If,after making this declar.tion y• should become subject to the '
Workers' Compensation provisions of the La tor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave -
comply with such provisions or this p- m shall be deemed revoked.
CONSTRUCTION LENDING AGENCY Gas Service Outlets - Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the •work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater _ Outlets Range
•
Lender's Name
Lender's Address Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Garbage Disposal '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—Trap _ Generator 00-5 KW❑5-15 KW Trash Compactor
-any structure, prior to its issuance,'also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law(Chapter 9(commencing with Section 7000) of
'Division 3 of the Business and Professions Code) or that he/She is exempt
aerefrom and the basis for the alleged exemption. Any violation of Section
031.5 by anyapplicant 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 Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work,and the structure is not intended or offeretl - Reinspection Fee $15 . Issue Fee $ 3
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 himself/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 corn- Canopy. Type II 0 , • Zoning Approved By Date
pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved ByDate
LIoprove for the purpose of sale).
I,as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By / / Date �n �
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00.100,000 BTU 0100,000 BTU SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con- —
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration , BUILDING PERMIT $ • SMTP $
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT
0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt: ICBG# PLUMBING • $ ISSUANCE $ '
Date Owner Heating System& Ducting PLAN CHECK 25% $ _ ENERGY P.C. $
I hereb e if tat I have read this-application and state that the above 00-100,000 BTU ❑100,000BTL— ELECTRICAL $ ' 6d GRADING $
informat • I, rr t. I agree to comply with all city and county ordinances
and state I. \ r at g to building construction, and hereby authorize repre- • PLAN CHECK 50% $ MICROFILM $
sentatives o h c y to enter upon the above-mentioned property for
Inspection • `+ s - MECHANICAL $ Ei
(50
Signature- L Al Date TOTAL FEE $
Drivers' Licens • SS# ��
{� Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46,rev.4/84 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod -Assessor
CONSTRUCTION AND PLANNING - POO. SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
pr
. Temporary Electrical Service or Pole; r7�j �t_ 52. Pool & Equipment Location
. Soil.P,ipe-Undrgrnd. -ti • 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 UFER Grnd. - 57. APPROVAL TO COVER-GUNITE
7: Footings , _ 58. Electrical Conduit-Undrgrnd. i
8 Foundation . ' .59. Gas Pipe, 0 Undrgrnd.,Test .
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
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
• 13. Roof Drains i - : 64. Plumbing System- Final . •
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit - 66. Solar System-Final • - - - •
16. Rough Electric Wiring 67: Fencing &Access Approval
17. Rough Wiring Sign - -. - 68. APPROVED FOR PLASTERING --
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace ._ . . . .. .. - APPROVALS Permit# - -
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating - 71. Product Piping 0 Gas ❑Oil
23. Gas Pipe-Rough& Test 72. Underground Flush - .
24. Roof Framing - 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe -
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE 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
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. BackflowIrrigation .
44. .Landscape Irrigation System
45. Sound Attenuation -
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison .
50. Gas Release to Southern California Gas Co '
51. CERTIFICATE OF OCCUPANCY
No. • Date