HomeMy WebLinkAbout2182 SANTA ANA AVE - Building Permits CITY OF COSTA MESA
.®®® BUILDING DIVISION
u (, 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
t). Oita FOR INSPECTIONS CALL:(714)754-5626
me1091)) PERMIT NUMBER: M07-00577
PERMIT TYPE MECH S STATUS: ISSUED
APN: 42616113 ON° DATE ISSUED: 12/1712007
ISSUED BY: SOK
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JOB ADDRESS: 2182 SANTA ANA"AV CM Suite/Unit:
Vicinity:
SQ. FT: 0
SCOPE OF WORK: INSTALL NEW A/C AND'REPLACE FAU.
•
OWNER: STONE, E TWEED Address: 2182 SANTA ANA ST Unit:
PHONE: City/State/Zip: COSTA MESA,CA
APPLICANT: CARLOS ZAMORA Address: 22911 SAUI RANCH PKWY Unit:
PHONE: 818-735-7876 City/State/zZip: YORBA LINDA,CA
CONTRACTOR: SERVICE CHAMPIONS License No. 799170
•
Address: 22911 SAVI RANCH PKWYUnit: PHONE: 714-777-7777
City/State: YORBA LINDA,CA ZipCode: 92887 CELL:
•
•
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: $38.30
PLAN CHECK FEE: $0.00
INVESTIGATION FEE: ' - $0.00
REINSPECTION FEE: y $0.00
TOTAL FEES: $38.30
•
•
•
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations.(Ord.No.92-28,§ 1,12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE/. INSPECTION TYPE DRT IN1n1AL$ CODE/ INSPECTION TYPE DATE IN1TTIAL$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
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. ❑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
P
pe- rmance 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: person is required to descend,will be made in connection with work authorized
by this permit,and that no building structure,scaffdding,falsework,or demolition
Cartier: - ' TM, or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This sedan need not be completer rereee perm4 is valued atLone hundred dolars(S100)or fess.) 2,M2,Sec.y11 Title 8,California Administrative Code).
[Policy Number: '(/ 1-CO (O O OO t I 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 subje o the workers' compensation provisions of Section 3700 of
Applicant's Signature Date
the Labor Co ,I shall forthwith comply with these provisions.
y.2 (-7 0-1 Division of Industrial Safety Permit Number:
A ' Signature C 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
(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 i 'n full force and effect, a registration form for acutely hazardous materials? ❑Yes ❑No
n
Lit.# y r Class# CVO (Section 25533 of the Califomia Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
-(7 - each business which at any one time has on hand a quantity of acutely
Contra tor's Signature r 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)? ❑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 Califomia
OWNER-BUILDER 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 District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes 0 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 pan 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 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ 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 ❑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 properly, 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
ID 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 Legal�wnertsi �- Date
Signature Date
3057.46(31071
LAnd/or Authorized Applicant r Date
CITY OF COSTA MESA
• BUILDING DIVISION
F4 ; 77 FAIR DRIVE,COSTA MESA,CA ',54)754-5273 • Fax(714)7544856 • www.ci.costa-mesa.ca.us
' , t`1�R� S VIONS CALL:(714)754-5626
+%lS PERMIT NUMBER: E07-00947
PERMIT TYPE ELEC 0 )0.' STATUS: ISSUED
APN: 42616113 DATE ISSUED: 12/17/2007
Ii) ISSUED BY:• • SOK v ED
JOB ADDRESS: 2182 SANTA ANA AV CM Suite/Unit: rjlig
Vicinity: COE 1 D
SCOPE OF WORK: INSTALL NEW NC AND REPLACE FAU.
OWNER: STONE, E TWEED - Address: 2182 SANTA ANA ST Unit:
PHONE: - City/State/Zip: COSTA MESA,CA
APPLICANT: CARLOS ZAMORA - Address: 22911 SAUI RANCH PKWY Unit:
PHONE: 818-735-7876 City/State/zZip: YORBA LINDA,CA
CONTRACTOR: SERVICE CHAMPIONS License No. 799170
Address: 22911 SAVI RANCH PKWYUnit: PHONE: 714-777.7777
City/State: YORBA LINDA,CA ZipCode: 92887 CELL:
•
ELECTRICAL PERMIT FEES
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: $78.00
Reinspection Fee $0.00
TOTAL FEES $78.00
•
•
•
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 S. INSPECTION TYPE, DATE INTTRALS CODES INSPECTION TYPE DATE IN7111ALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 , Pool Spa Final 208 Final Plumbing
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 lir.. 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.-properly tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
pe rmance of the work for which this permit is issued.
C_-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
C - I/M by this permit,and that no building structure,scaffolding,falsework,or demolition
Garner or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp
(This secret need not be competed dthe permit is valued at one hundred dllars($100)or less.)
2,Art 2Sec.341,Title 8,California Administrative Code).
policy-Number: -- Ai Oce 0 ( k U LI
` ❑ As owner-builder, I will not employ anyone to do work which would
0 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 Laborp de,I shall forthwith comply with these provisions. Applicant's Signature Date
- l-L, -11 U-U Division of Industrial Safety Permit Number:
�ApptraoPS Signature 1i_ 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.
CCic.# 2 1' O Class# CZ 0 a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code, with some
t7 � (� oy exceptions, requires registration with the Costa Mesa Fire Department by
�..-,------------- l 76�� each business which at any one time has on hand a quantity of acutely
L 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)? ElYes 0 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
that he or she is licensed pursuant to the provisions of the Contractors (Section 65850.2 of the California Govemment Code requires that the requested
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the information be furnished on applications for 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 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).
0 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 properly 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 „g (If yesattach 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
❑ 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.
Sign rwe of Legal Owner(s) Date
Signature • Date / T 2-1-7 01
L dl u onx¢tl Applicant 1 Dale
4_00
o�pis
"',: . CITY OF COSTA MESA
41 p • + ...� �te, P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628-1200
if, n:.
�} I [dim •�'it .
':i -_� .1.1/t
DEVELOPMENT SERVICES DEPARTMENT
\Isi, '.ORFlEO\17
BUILDING DIVISION
COURTESY NOTICE OF PERMIT EXPIRATION
•
July 22, 2009 •
Hazel E. Stone
419 Main Street #33
Huntington Beach, CA 92648-5199
PERMIT NUMBERS: E07-00947, M07-00577
PROJECT • 2182 Santa Ana Ave., Costa Mesa, CA
FOR: Install new air conditioner and replace faucets
Our records indicate the above listed permit(s) were obtained for property improvements or
alterations at the above address. Per the 1997 Uniform Building Code, Section 106.4.4
Expiration, permits are valid for 180 days from the date of such permit, or the date of the last
inspection for the project.
Our records do not show an inspection for these permits within the last 180 days nor have
they had an approved final inspection. If you have a signed inspection card showing that an
inspection was made within 180 days, or that the final inspection was approved, please
contact this office so we may correct our records. If you do not have an approved final
inspection, your permits will expire on August 3, 2009. Additional fees will be required to
finalize expired permits.
Requesting an inspection - If you need to request an inspection, please call our Inspection
Request Line at 714-754-5626.
•
Requesting an extension -If you wish to request an extension, requests must be made in .
writing addressed to Ed Petros, Chief of Inspection, at the above address, detailing
circumstances and listing an estimated date of completion.
If you have any questions, please contact the Building Division at 714-754-4871, between
8:00 a.m. and 4:30 p.m., and a staff member will assist you. The accuracy of records
affecting your property is our goal and we appreciate your working with us to resolve this
matter.
Sincerely,
6 B„441 Barbara J. Z rart
Office Specialist II
Building Division(714)754-5273 • Code Enforcement(714)754-5623 • Planning Division(714)754-5245
NF1 • • Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
COSTA MESA CONSTRUCTION PERMIT ` PERMj,'�No�� ��� TRACT NO. LOT NO. UNIT NO.
Project Address 2182 Santa Ana Ave. , C.M. 92627
JJ��(�Jff 8053 12/02/86 28.50 TL
Applicant's Mailing Address 126 Commercial, C.M. 9262 / TYPE OF CONSTRUCTION ElNEW U ADD bd ALTERATION LI REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q-p.# Zone
Owner's Name Mr F Stone P 548-2495 remove flat roof, apply
2182 Santa Ana; C.M. 926'2°P DESCRIPTIONOF WORK/USE OF BLDG..
'Address appy 3-py fiberglass Isys em w/hot f asphalt & rock. S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING L FOUNDATION LJ STRUCTURAL E Front • O
•
Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N
Contractor's Name Crank Bros Roofing COPhone 548-5569 ❑ OTHER C Ri ht N
PROJECT DESCRIPTION SQ. FT. 2.800 OCCUPANCY family g
Address(mailing) 126 Commer['7 al • C.M. 92527 CONSTRUCTION TYPE residential 'VALUATION 553,473.00 K Left • G
City License No. 005993 R
ZONE GRADING CU.YDS. ACRES Ping. Ref.# Parking Req./Provided E
LICENSED CONTRACTOR ECLARATION I - Q
I herebof m that,I a ..41 y' ed under provisions of Charter 9 (commencing Remarks: Planning Notes: • NI
with se t .,' 0�0 -rJ(g�yf5reh 3 of the Business and Professions Code, and
y my lice e in full force and effect. -
/� T
Az License C ass - •• S 1: o. r �� . - S
1 ' n�_7- ! i,' PLUMBING FEES
Date Signatur. -. //. L
WORKERS'COMPENSATION •-CLARATION Bar Sink Showers • - ELECTRICAL FEES
)' hereby affirm that I have a ce icate of consent to self-Insure or a certificate L_
Workers' C atigy- ;ranee, or a,ceftifr�ed yo thereof-(Se on Backflow Preventer Service Sink ❑ 15.50KW •
.1800, Lab. C. Ycf (�,p .�T-ttJ�G C ,' .L�S•f Automatic Washer Transformer
•
Policy No. Comp++y ...zis-„•e--'!l'lerllU!R Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+ KW
❑ Certified copy is hereby furnished- ■ -
b(I>tertii ,with the city Bll ' •"•:). t, Bathtubs Sewer Connection Cooking Unit Meter Dup to 100 amps
Date ' Applicant_L-- ,,t'7e LJ-a•L• • O•J'�4 saga,/ _
EXEMPTI¢ P RKERS'COMP • ATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section nee not be completed if t• •ermit is for one hundred ($100)or Dishwasher less). Solar Piping Dryers ❑Gas ❑Electric Sub Panel
I certify that in the performance of , work for which this permit is issued-I -
shall not employ any person in an manner so as to become subject to the Drinking Fountains 'Solar Tank ' • Fan Motors❑0.1 HP ❑1'h'-8
Workers' Compensation Laws of California.
Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 0-16-15+NOTICE: If,after making this declaration, you should become subject to the --
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures 'Microwave '
comply with such previsions or this permit shall be deemed revoked. •
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device BoxesPole Light
1 hereby affirm that there is a construction lending agency for the performance ,
of the work for which this permit is issued (Section 3097 Civ. C.)
Lender's Name Interceptors Water Heater Outlets Range
Lender's Address - - Kitchen Sink Water Service -
OWNER BUILDER DECLARATION Switches Sigh,
I hereby affirm that-I armexempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or
county which reburies a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator ❑0.5 KW 05-15 KW Trash Compactor
any structure, prior to-Its Issuance, also requires the applicant for such permitp
' to file a signed stat€mens that he/she is licensed pursuant to the provisions of Roof Drains -
the Contractor's License Law (Chapter 9(commencing with Section 7000) of
.t3v -
ision 3 of the Business and Professions Code) or that he/she is exempt --
•„Division
and the basis for the alleged exemption. Any violation of Section l '
.�i31,5 by any applicant for a permit subjects the applicant to a civil • -
nalty 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 offered _ - Reinspection Fee I $15 Issue Fee $ 3
for sale (Secion 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 0 _
sale. If, however, the building or Improvement Is sold within one year of com- 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 By Date
drove for the purpose of sale). 2
LI I, as owner of the property,am exclusively contracting with licensed con- Duct-SVUCLUral Refrigeration System Application Issued By •_ Date.
tractors to construct the project (Section 7044,Business and Professions Code: ❑0.100,000 BTU ❑100,000 BTU
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating SUI,�(M(1RY�OF FEES
builds or Improves thereon,and who contracts for such projects.with a con- Qn['
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.Bit. ICBG# Fire Dampers - PLUMBING $ • ISSUANCE • $
Date Owner - Heating System& Ducting Registers - - PLAN CHECK 25% $ ENERGY P.C.. $ . '•
I hereby certify that I have read this application and state that the above 00.100,000 BTU 0100,000 BT ELECTRICAL $ GRADING $
information is correct. I agree to comply with' all city and county ordinances - - -
•
and state laws relating to • •ing constru on;and hereby authorize repro- PLAN CHECK 50% $ MICROFILM $
sentatt • • this city to - e Upon e above-mentioned property for ' .�,p, ,\
inspection pu -ose J MECHANICAL •
$ TOTAL FEE $ at-s-U
Drivers'SiorS
-nse SS rive r. {/, S$a : — • Date/g- `
' ` Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $
-
CMF 0865.46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING POOL &SPA. \\
APPROVALS Permit Date Inspector APPROVALS Permit# Date Inspector
i
1. Temporary Electrical Service or Pole 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 UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings - 58. Electrical Conduit-Undrgrnd. •
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 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: Backflow Irrigation
44. Landscape Irrigation System -
45. Sound Attenuation
Handicap Regulations •
INAL STRUCTURE & BUILDING /�/�r$ i. r
Special Requirements Completed , I
49. Electric Release to Edison .
50. Gas Release to Southern California Gas Co r
51. CERTIFICATE OF OCCUPANCY
No. Date i