HomeMy WebLinkAbout2556 SANTA ANA AVE - Building Permits _�.F- Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA J-f 1/034 PERMIT NO. TRACT NO. LOT NO. BLDG.NO. - - --
CONSTRUCTIOrrNN PERMIT
��� ���/�1. /�9� •
5191 3/01 /84 Ifi.01 TL
Project Address .IWI1Y/nlslrrfinr /// //tTZL ' TYPE OF CONSTRUCTION II NEW trA71771== -
Applicanl'sMailin Address' / er/ � t 1/ /•' (/ ❑ CONVERSION ❑ DEMOLISH El OTHER A.P.'Yh Zona -
Owner's Name l�u.t--( '�hi6 n hlka ) Phone' • DESCRIPTION OF WORK
.y ,,cc,,,, pJ/ S Main Building: Accessory Building: Z
Address ty j/n la71>`Q '(//Y(. I.f ie • '45tct M P SGS E • — — 0
r:, /69
TYPE OF PERMIT LI GRADING ❑ FOUNDATIO LI STRUCTURAL T Front N
Arch/Eng. ecrji -rioter ' �1 License NO.1 OO L ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL '
Address t�nP ("d /tin +f+q�Pd,L /)eM ori Nodi ❑ 'OTHER - A Rear N
Contractors Name 9V Ila,9e a/P. Hie.. Phone/h .�?A"� PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right G
Address(mailing) 7 ?frraq F Mild MU- /IVP. ([na helm . CONSTRUCTION TYPE • VALUATION$ S Left R
�o?/PO(03 ZONE GRADING CU.YDS. ;ACRES Pin Ref.# Park.Fees $ 0
City License No. g
U
LICENSED CONTRACTOR DECLARATION Remarks: • Parking Req./Provided I
1 hereby affirm that I am licensed under provisions of Charter 9 (commencing R
with section 7000) of Division 3 of the Business and Professions Code,and A Use of Building: E
my license is in f/ya�l�I fp�rq�ce andeffect. /,
License lass - (�'2(D Licen a No.3 a . PLUMBING `r IkES Planning Notes: M
Date''/c7A `fy'W7� Signature �S//./v - /(:/ (� I E
OR ERS'COMPENSATION DECLARATION Bar Sink • Showers ` 1 N
iereby affirm that I have a certificate of consent to self-Insure ora certificate Backflow Preventer 6. n.� /T"J • T
Workers' Compensation -Insurance, or a certified copy thereof (Section - v G. S'n - S
3800, Lab. C.) /./ nq / ���'"7� / ! / "
Policy No. .576'/;/0 Company(72ark k2/5 Z'9s. Backflow Irrigation C `k 1t1 / ELECTRICAL • FEES
lr.'Certif ietl copy Is hereby furnithetl. Bathtubs /:J"�(�onnec[i C Automatic Washer Transformer 0 15-50 KW
Je Cer ( i Is filed with the city I tlin9 ivision. Q•v
t q pqup� q �/ !
Date--re Applicant Vali; /a'/Q• E' //[L/CI. 7:-.77e.. Clarifiers ♦ ' Solar Collectors � C ❑ 50+KW
(a 6 Q / Construction Pole Sub.
EXEMPTIO F OM WORKERS'COMPENSATION DECLARATION . . _ _ _ -
lThis section need not be completed if thepermit Is for one hundred ($100) or Dishwasher Solar Piping CookingUnit 'Meter
ess) . Duo to 100 amps
I certify that In the performance of the work for which this permit is,issued I . Drinking Fountains Solar Tank Dishwasher Meter Dover 100 amps
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California. Floor Drains Swimming Pool w/Spa- Dryers ❑Gass ❑Electric • Sub Panel
•
Date Signature
NOTICE: If,after making this declaration, you should become subject to the Floor Sinks Urinal Fan
Workers' Compensation provisions of the Labor Code, you must forthwith - Motors 00-1 HP ❑1'F,-6
comply 'with such provisions or this permit shall bedeemedrevoked: i Gas Service Outlets Water Closet - F.A.U.CONSTRUCTION LENDING AGENCY - .Inc.Solar ❑9-15 HP ❑16-15+
I hereby affirm that there Is:a construction lending agency for the performance Interceptors Water Heater Fixtures
of the work for which this permit is issued (Section 3097 Civ. C.) •Microwave
Lender's Name • Kitchen Sink Water Service Device Boxes Pole Light
Lender's Address -
OWNER BUILDER DECLARATION Lavatories _ Outlets Range
I hereby affirm that I am exempt from the.Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or P-Trap Switches
county which requires a permit to construct,alter,improve,demolish or repair Sign
any structure, prior to its Issuance, also requires the applicant for such permit • .Roof Drains Garbage Disposal StandingSections
to file a signed statement that he/she is licensed pursuant to the provisions of •
the Contractor's License Law(Chapter 9 (commencing with Section 7000)of _
a riyision 3 of the Business and Professions Code) or that he/she is exempt - Generator 00-5 KW 05-15 KW Trash Compactor
+a efrom and the basis for the alleged exemption: Any violation of Section
./ka51 5 by any applicant for a permit subjects the applicant to a civil Reinspection Fee
Enalty of not more than five hundred dollars($500). pe ( $25 Issue Fee $ 3
❑❑ I, as owner of the property or my employees with wages as their sole Reinspection Fee $25 Issue Fee $ 3
compensation, will do the work, and the structure is not intended or offered MECHANICAL FEES
for sale (Section 7044, Business and Professional Code: The Contractor's PUBLIC SERVICES REQUIREMENTS:
License Law does not apply to an owner of a property who builds or improves Boiler Hood or Type I 0
thereon, and who does such work himself/herself or through his or hor own
employees, provided that such improvements are not intended or offered for Canopy Type II ❑ Zoning Approved By • nate
sale. If, however, the building or improvement is.sold within one year of corn- , Duct-Under Ground Application Approved By Date
pietion, the owner will have the burden of proving he/she did not build or im- -
rove for the purpose of sale). Duct-Structural Refrigeration System .
Application Issued By CA) Date 55 (Y�_
LJ I,as owner of the property, am exclusively contracting with licensed con- ❑0.100,000 BTU ❑100,000 BTU
tractors to construct the project (Section 7044,Business and Professions Code: Duct-VentilatingSUMMARY OF FEES
The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a con- Exhaust System 0 Multiple 0 System Repair/Alteration - BUILDING PERMIT $ SMIP $
tractor(s) license pursuant to the Contractor's License Law). PLAN CHECK ' $ • PERMIT ,A . -
0 ram exempt under Section 0.& P.C.for this reason Firepl/Fact.BIt. ICBG# •
PLUMBING $ ISSUANCE $ '6 ' 1
Date Owner - Heating System&Ducting PLAN CHECK $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above 3 ❑o-100,000 BTU V100,000 BTU— �t/��P`Pr(. `„ 3 $
Information is correct. I agree to comply with all city and county ordinances /,m /// ,1 F-lee ELECTRICAL GRADING $
and state laws relating to building construction,and hereby authorize repro- PLAN CHECK MICROFILM $
sentatives of this city to enter upon the above-mentioned property for $
Inspection pur se;., //
/ l Reinspection Fee $25 Issue Fee $ 3 PLAN CHECK - $ .3.00
CMF-0865-46 rev. 7/83 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod -Assessor - --
CONSTRUCTION AND PLANNING POOI PA
APPROVALS Permit # Date Inspector APPROVALS Permit# Date Inspector
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 UF ER Grnd. 1 57. APPROVAL TO COVER-GUNITE
7. Footings . 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd.,Test
9. Water Pipe-Undrgrnd. i 60. Backwash Lines, P-Trap, ❑ 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 1 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test ,' • 72. Underground Flush
244 Roof Framing �' �' 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing *' 74. Overhead Hydro
26.,T-Bar Ceiling (Structural) & Monocoat n 1 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation . - 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final80. FOOD CERTIFICATE ISSUED
33. Final Electric A Notes1,--7 r-� _h �
- o Y/Tu IY ¢ p47,
34. Final Heating & Air Conditioning �/�r
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
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'
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA. - PE MIT NO. TRACT NO. LOT NO. ; BLDG. NO. - -
CONSTRUCTION PERMIT /� ' 03 %'J .8593 8/I U/85 , 2000,1 TL
Project Address Z5 -- •• ' - fhvA—G0 ti TYPE OF CONSTRUCTION U NEW H ADD U ALTERATION U REPAIR Applicant's Mailing Mailing Address .0 1 eN r , t/ ❑ CONVERSION 10 DEMOLISH ,❑ OTHER A.P.# Zone
_ ``,, //-- DESCRIPTION OF WORK
Owner's Name Y. ����K�/%SG Phone S Main Building: - . . Accessory Building: - Z
Address Z 556 .5.4r'!F.l--411.a '''ve— TYPE'OF PERMIT U GRADING ❑ FOU NDATI IR E N
+SfT\ ❑ STRUCTURAL T Front N
Arch/Eng. License No. ' ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL B Rear - 1
Address / /f ! `Q ❑ OTHER A _ • N
Contractor's Name lYr/7 L7,1(/" ` 5, -.11PROJECT DESCRIPTION SQ. FT. -OCCUPANCY C Right G
�7� 0 Non' K
Address(Mailing) Z70/ 5A4-7/CA/ Sr tten C O N ST RUCTION TYPE VALUATION$ - S Left E
City License No. ' OZ6OG3 ZONE GRADING CU. . ACRES Ping. Ref.# Park.Fees $ - Q
U
LICENSED CONTRACTOR DECLARATION Remarks: Parking Req./Provided I
I.hereby affirm that I am licensed under provisions of Charter 9 (commencing R
with section 7000) of Division 3 of the Business and Professions Code, and Use of Building: E
my license is in ful or e and effect. 'Q •
Licens malas I e/,r,� Z89SB8 PLUMBING • FEES Planning Notes: • M
.•• `ate / -�" Signature a SA • N
ORKERS'COMPENSATION DE LARATION E
Bar Sink • Showers -F
i hereby affirm that I have a certificate of consent to self-Insure or a certificate • •
Backflow Preventer Service Sink , S
of Workers' Compensation Insurance, or a certified copy thereof (Section - ' ._
3800, Lab. C.) 24,p3s �'' • _ ' Backflow Irrigation Sewer Cap I , ELECTRICAL ' FEES
Policy No. Company— _
Cbng//A17 1 Bathtubs Automatic Washer Transformer 0 15.50 KW
ietl copy is hereby furnished. '- /� I Sewer Connection ,
CertifJgtl poy Iletl with the city ui j�jl 7� •
( Date jj J a--) I Applicant !/ /!/t_//•'(f'/ ' QS ajArj . Clarifiers Solar Collectors , , Construction Pole Sub. ❑ 50+ KW
�. EXEMPTION.FROM WORKERS'COMVENSATION DES- • RATION Dish Washer - - Solar Piping - Cooking Unit Meter ❑dp to 100 amps - I
1 (This section need not be completed if the permit is for one hundred ($100)or ,
less).
V I certify in the performance of the work forwhich' this permit is issued, I _ Drinking Fountains Solar Tank ' DISIIW¢Sher Meter Dover 100 amps ,
shall not employ any person in any manner soas to become subject to the - '
Workers' compensation.Laws of California. Floor Drains Swimming Pool w/Spa Dryers ❑Gas ❑Electric • Sub Panel
Date • Signature - -
NOTICE: lf,'after making this declaration, you should become subject to the Floor Sinks Urinal - , • Fan Motors❑0-1 HP 01 -13
Workers' Compensation provisions of the Labor Code, you must forthwith- - -
comply with such provisions or this, permit shall be,deemed revoked. Gas Service Outlets - Water ClosetF.A.U. I Inc.Solar 09-15 HP 016.15+
CONSTRUCTION' LENDING AGENCY - -
I hereby affirm that there is a construction lending agency for the performance Interceptors - ' Water.Heater Fixtures Microwave
of the work for .which this permit Is Issued (Section- 3097 Civ. C.)
Lender's Name r ,0�� Kitchen Sink - Water Service ,. _ Device Boxes 'Pole Light •
Lender'sR Address AR Lavatories
OWNER BUILDER DECLARATION - Outlets Range
I hereby affirm that I am exempt from the Contractor's License Law for the P—Tra
following reason (Section 7031.5 Business and Professional Code: Any city or p - - Switches Sign
county which requires a permit to construct,alter,improve,demolish or repair
any structure, prior to its issuance, also requires the applicant for such permit Roof Drains • , ' Garbage Disposal Standing Sections
•o file a signed statement that he/she is licensed pursuant to the provisions of . - ,
le Contractor's License Law(Chapter 9 (commencing with Section 7000) of - - • Generator ❑Q5 KW ❑5-15 KW Trash Com actor
(vision. 3 of the,Business and Professions Cotle) or that he/she is exempt - P
nerefrom and the basis for the alleged exemption. Any.violation-of Section
7031.5 by'any applicant for'a' permit subjects the applicant to a civil
enalty of not more than five hundred dollars($500). - Reinspection Fee $25 Issue Fee $ 3
LI I,'as owner of the property'or my employees with wages as their sole Reinspection Fee $25 Issue Fee $ 3
compensation, will do the work,and the structure is not intended or offered • MECHANICAL I FEES - .
for sale (Section 7044, Business and Professional Code: The Contractor's PUBLIC SERVICES REQUIREMENTS:
License Law does not apply to an owner of a property who builds or improves Boller Hood or Type I 0
thereon, and who does such work himself/herself or through his or her own Zoning Approved By Date
employees, provided that such improvements are not intended or offered for - Canopy Type II ❑ - - '
sale. It, however, the building or Improvement Is sold within one year of com- Duct-Under Ground ., Application Approved By Date ///
pletlon,the owner will have the burden of proving he/she did not build or im- LL/rr
rve for the purpose of sale). • Duct-Structural Refrigeration System //
Application Issued By— �� Date / /
oI, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044,Business and Professions Code: Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES
The Contractor's License Law does not apply to an owner of property who BUILDING PERMIT $ SMIP $
builds or improves thereon, and who contracts for such projects with a con- Elihaust System 0 Multiple 0 System Repair/Alteration .
tractor(s) license pursuant to the Contractor's License Law). , • PLAN CHECK $ PERMIT
0 I am exempt under Section B. &P.C.for this reason Firepl/Pati.BIC ICBG* ii Ask LA—t-1-4-0 — PLUMBING $ ,ISSUANCE $
•
Date owner Heating System&Duucting 111N-). PLAN CHECK $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above I. 00100,000 BTU/3:1100,000BTL _ � ELECTRICAL $ GRADING $
information is correct. I agree to comply with all city and county ordinances
I and state laws relating to building construction,and hereby authorize repre- •
PLAN CHECK $ • MICROFILM $ _
sentatives of this'city to enter pon the abve-mentioned property ,for
/�
inspection purposes. '/ PJ"S - MECHANICAL $ /ay— TOTAL FEE $ 20r
Signature /.GC � Date
Drivers''License or SS# Reinspection Fee $25 Issue Fee $ 3 PLAN CHECK $
•
'CMF•0865-46'rev. 7/83 White-BuildIng; Canary'-Applicant;Pink-Accounting;Goldenrotl 'Assessor - - -- - - - . - .. . -
. V
CONSTRUCTION AND PLANNING - • PO_ 4 SPA
APPROVALS Permit Date Inspector APPROVALS Permit Date Inspector
1. Temporary Electrical Service or Pole - -52. Pool & Equipment Location
2. Soil Pipe.Undrgrnd. ;��. 53. Steel Reinforcement
•
3. Electrical Conduit Utility-Undrgrrid. i1 - 54. Forms
4.'Electrical Conduit--"Undrgrnd. ,55. Electrical Bonding
5.'dteel Reiriforcenierit - 56. Rough Plumbing & Pressure Test '
-
6.-•Electricaj-UFER Grni1.'"• . 1 57. APPROVAL TO COVER-GUNITE
7.;Footings. • i _ ;i -:58. Electrical Conduit-Undrgrnd.
.
8.,F6u'ndation '-,A: 59. Gas Pipe, 0 Undrgrnd.,Test ,
9. Water Pipe-Undrgkpd-. ..j 4.1.;:s.- • 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10..:SVuctuiai Floor System --' �' 61. APPROVAL TO DECK
-t.
11. Property Sewer Line & House Connection - " 62. Backwash & Receptor-Final
12.,Sewer Cap 63. Heater & Vent-Final
13.• Roof Drains r; „ _ . 64. Plumbing System - Final
14. Rough h Plumbing '
9 -? - ••.' 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 0 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 PREV. 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 Notep�f�26fr Catna4-4t Peg.7QS a eiMG 4,10
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 . -
,x
42. Backflow Preventer
43. Backflow Irrigation
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 . L',
51. CERTIFICATE OF OCCUPANCY - _ _
No. Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. . '
CITY OF COSTA MESA CONSTRUCTION PERMIT - PERMIT NO. TRACT NO. - LOT NO. UNIT NO.
�6 SC.V A ,CMM Alice SOO r' • 1394
Project Address 5/31/614 10 5.50 II'
Applicant's Mailing AddressL TYPE OF CONSTRUCTION X NEW Li ADD LI ALTERATION LJ REPAIR
1/ 1 ❑ CONVERSION El DEMOLISH ❑ OT�/F�� A.P.# Zone
Owner's Name/U/r/S/V�I�Y�TC��/ t/BU Phone �" f L� L' eits/' ' '
{'*3 �1 //�� DES/rL TION '2 WORK/ OF BLDG.
Address? 5.411'l)4 ANA /mfr,`^ /V 1Q�m U a LI S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING��qj' FOUNDATION ❑ STRUCTURAL E Front Cl
Addr¢55 T' s�. ❑ TENANT ❑ ELECTRICAL ,1'R PLUMBING ❑ MECHANICAL A Rear N
T�.T Ft—v 37 N�1 Phon_e � /75Ti ❑ OTHER C Right Contractor's Namr N
Address(mailing/Z-1-7/4.‘ � �� bLT Rb PROJECT DESCRIPTION SQ. FT. OCCUPANCY K
g7V/ CON ST RUCTION TYPE VALUATION$ S Left G
City License No. 3 ZONE GRADING CU.YDS. ACRE$ R
LICENSED CONTRACTOR DECLARATION _ -f(/ / Ping. Ref.# Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: j/�/' Planning'Notes: M
with section 7000) of Division 3 of the Business and Professions Code, and JJJ"'
my license is in full force an effect. p T
License Class �� / - License No. 4] S.
Dater"3i -29 Signature ‘ • - - PLUMBING sH�. 1}"est f
- YORKERS' COMPENSATION DECLARATION Bar Sink Sho Hr.". ,V
�alq / ^ ELECTRICAL FEES
hereby affirm that I have a certificate of consent to self-insure or a certificate s 4 ✓ f
_ of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Ser ' `
3800, Lab. C.) -c' t ,e-' to - Automatic Washer Transformer ❑ 15-50 KW
Policy No. Company Backflow Irrigation Sewe ./ 0 50+ KW
9 elf•• Ai i YY Construction Pole Sub.
Certified copy is hereby furnished. / V f
Certified copy is filed with the city Building Division. /Bathtubs , Sewer Conn tiq 1 1 2 (,, Cooking Unit Meter ❑up to 100 amps
Date Applicant dsj
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Col Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred($100) or
less). S Dishwasher Solar Pipin in 00 Dryers OGas ❑Electric Sub Panel
I certify that in the performance of the work for which this permit is Issued I -
shall not employ any person in any m_a}7ner so as to be 09 object to the Drinking Fountains Solar Tank ( Fan Motors❑0.1 HP ❑1'h-6
Workers' epsati y}-aws of Calif "_/L//'/i -ts� ,
Date / —/ Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP 016-15+
NOTICE:If,after ring this declaration, you should beco eject to the
Workers' Compensation provisions of the Labor Code, you ust forthwith Floor Sinks Urinal - Fixtures
comply with such provisions or this permit shall be deemed revoked. '` Microwave
CONSTRUCTION LENDING•AGENCV 5—Gas Service / Outlets Water Closet • Z OC Device Boxes
I hereby affirm that there is a construction lending agency for the performance • 0 4 Pole Light
the work fo-.0'lch1 .this 59/4n3 is sy�q ,( Cti� .087 iCiv.fye7 Interceptors �" Water Heater (0 CU Outlets Range
Lender's Name r] �f't[J h/'tN C.-7kK fY�1
Lender's Address _r. r L -� :-ii: . -__ • 5 Kitchen Sink / Water Service tape Switches Si n
OWNER BUILDER DECLARATION , g
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories (4 ^���
following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair 'P—Trap •
any structure, prior to its issuance, also requires the applicant for such permit Generator 1:10.5 KW 05-15 KW Trash Compactor
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
.herefrom-and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
watt).of not more than five hundred dollars($500).
U 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 I - Reinspection Fee J $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 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
0 rove for the purpose of sale). L
I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date
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 ❑100,000 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 $ SMIP $
proof oftheir Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT
❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# PLUMBING $ (}+ •C10 ISSUANCE $
Date Owner Heating System 81 Ducting PLAN CHECK 25% $ 10. ' b ENERGY P.C. $
I hereby certify that I have read this application and state that the above '❑o-100,000 BTU 0100,000 BTL ELECTRICAL $ GRADING $
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize repre-
sentatives of s city to enter upo the above-mentioned property for
inspection pu yes. /in
Date S - MECHANICAL $ TOTAL FEE $ SO
Signatur Is YY/ lel�-•
Drivers' License or SS#
—
CMF 0865-46,rev.4/84 white-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor
CONSTRUCTION AND PLANNING POt._a SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole; 52. Pool & Equipment Location
2, Soil Pipe-,Undrgrnd. ) : -• 53. Steel Reinforcement r�
3. 'Electrical ConduitLUtility-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 A',
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation •
59. Gas Pipe, 0 Undrgrnd.,Test
.9. Water Pipe-Undrgrnd. ' 60. Backwash Lines, P-Trap, ❑ 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.rDucts, Ventilating 71. Product Piping 0 Gas ❑Oil
2'3. Gas Pipe-Rough & Test 72.- Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing r 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat\' .•'r 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
30. Drywall Nailing ,
31. Plaster Brown Coat i 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
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