HomeMy WebLinkAbout2424 SANTA ANA AVE - Building Permits (11) g
AD DRFSSOFBUILDINg: 2424 SANTA ANA AV uric A-204 CITY OF COSTA MESA — BUILDING PERMIT 6q - 00aso
OWNERS NAME IF KNOWN: BACK MESA HOA PERM NO: B 086950
�, .0mut 2424 SANTA ANA AV
C.M. CA 92626 PERMIT NO: B 086950 PLAN CHECK NO: N GOVT: N SUPP : N
APDL.MAIINGADDRES3: CONSTRUCTION TYPE: PERMIT TYPE : STR PURPOSE: OTH
ARCHITECT OR DIMMER: lie.NO.: JOB DESCRIPTION : REROOF W/1 LAYER COMP . OVER EXIST. SQ FT: 1 , 300
ARCH.OR DIG'S AODRE55: UHT: CLAIM VALUE: 1 , 300 . 00 CALC—VALUE: 1 , 300 . 00 GROUP OCC: R-1 /
cot:macraNAIe: RELIABLE ROOFING ( 714 ) 964-6441
CONIRACTORSMNUNO 20351 MEANDER LN COMMENTS : EXIST. 1 LAYER OF COMP .
ADORESS: H.B . CA Ue.NO.: 347940 ******aE->F-x******* -ore- **** -- *->E->E** ***************ac**->F*->E->E** -**->F->E>f -**->E*+t*** -***;E***-x
92646 um: Z ON ING R E Q U I R EMENTS
LICENSED CONTRACTORS DECLARATION:I hereby aim under penally of perjury that lam licensed under pr• ' • ,el Chapter 9 S- E T B A C K S
(commencing with Section 7000)of Division 3 of the Business and Professions Code.and my r..'se is in full force I effect.
CITY LIC.NO.:038567 uc.cuss: C 39 uc.NO.: 34794 $) EX.!" 19/98 MAIN BUILDING ACCESSORY BUILDING
I r , FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
m.: a/Iy1�1S� Con:.•,: a .� .� _—.0. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
OWNER UILDER DECLARATION:I hereby affirm under penally Of perjury that 1 em exempt from the Contractors license In for the
folios/in reason(Section 70315 Business and Professions Code:Any city or county which requires a peri to construct,aper,improve, PARKING REQ: P RO V: PARCEL : 93489004 Z NE: REF NO:
dem h.or repair any structure.prior to its issuance,also requires the applicant for such permit to Be a signed statement that he or she PLANNING NOTES>
sed pursuant to the provisions of the Contractors License Law[Chapter 9(commenting with Section 7000)of Division 3 of the .
' business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section > " ' .
/031.5 by any applicant for a permit subjects the applicant to a civil penally of rat more than lee hundred dollars($5001). ***)E************************31*****************************3*********dE3E*********
o Prepery my dm'eea a w DEVELOPMENT SERVICES R EQU IR E M E N T" S
I,as offered ohne or em wlh wages as thei ode compensation,will do the honk,end the loan b o ml intended
or for sale(Section 7044.Business and Professions Code:The Contractors License Law does not apply loan isomer of property
who Wilds or iaprovee thereon,and who does such work Nmeell or herself or through he or her own employees,provided that such d'''''improvements are not intended or dfememreatenmisone ofcm
,however,the buildingor improvement sold within year d opleice,the 'ZONING APPROVED BY DATE: ren
owner-builder will have the When of proving he or she did nest build or improve for the ramose of sale). .
❑ I.as owner of the property,am exclusively contracting with licensed crontractom to COnStrUct the proiect(Section 7044.Business and BUILDING APPROVED BY : DATE: 4%"
Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon and who
contracts for such projects with a contractor(s)licensed pursuant to the Contractors License Law). j
❑ Iamexempt under Section: B.AVC..tor this reason: APPLICATION ISSUED BY : DATE-
********************************************* . *****************Bi*
Date: O1Ter LEGALIZATION:N F E E SUMM R Y STRUCTURAL rSE MENT:Y
I do hereby certify that I em aware of and understand the requirements of Caliomia Health end Safety Code Sections 25505.25533,and
25534,and that Ioany future Wildingocapenl will/will not(circle one)need)°comply with said date codes and the requirements for BLDG PMT PLUMBING ELECTRIC MECHANICFIRE SNIP/RES GRADING
a permit for construction or modification from the Aeby anagenwm District.Residential construction applications we exempt from these
provisions. PERMIT 43 . 00 . 50
Date: Applicant SMI P/NON—RES
PLAN
WORKER'S COMPENSATION DECLARATION:I hereby affirm under penaltyd perjury one of the following declarations: ISSUE FEE
❑ Ihave and Wmsntaeacedtuatedcertsent10eel-insure for workers'dunpemn,espr
atiaevdedforbySecd
Section 3700 BUILD'NG—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL h PAID DUE
Code,for the performancemthe work for which this permit iaissued. TOTALS----> 43 . 50 0 . 00 0 . 00 43 . 50 , 43 . 50 . 00
)•
Q 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 permit is issued.My workers'compensation insurance carrier end policy number are: ✓Y
Carrier: STATE FUND EXPIRES REVENUE DIVISION TOTALS--> COLLECTED : 43 . 50 OVER/SHORT: . 00
Policy Number: LCD-7CUNkIi3 /7 01 /01 /99 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
is section need not be completed I the pent is for one hundred dollars($1001 or less) 43 . 00 . 50
..J I codify that in the performance d the work for which this permit is issued.I shell not employ any Person in enY m nor eo as to l'
become subject to the workers'compensation laws of California,and agree that i I Mor me subject the waken' **********************************************************y(********************
oompensat pram of Section 3700 of the Labor cede, nwdn pry INDIVIDUAL I V F E E BREAKDOWN
Dere: J.X. °94- Apd'can. e
�Wa ng:Fall re to sec re workers'compensation coverage Is unlawml darol act an oyer to criminal penalties and TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
di, tines rpt to one hundred thousand dollars($104000A In addition to the cost of conpensstlori damages as provided for In
tlon 3706 of the Labor Code,Interest,and suomW+fsu. SFR 1300 REROOF BY VALUE RESIDENTIAL NOZONE •�'1 . 00 _ 1 , 300 . 00
1 CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjury that there is a construction lending agency for the END OF FEES
performance of the work for which the permit is issued(Section 3097,Cir.C).
LENDER'S NAME: r
LENDER'S ADDRESS: �1
I certify that I have read this application and sate that the above information a correct.I agree to comply with all city and county ordinances .
and state laws relating to building construdior and hereby authorize representatives of the ply to enter upon the above'mentioned properly •
•
for inapudionpurposes •
.ERIC BOLOT IN 11. 92121998/94:32 D9/1i43.5$
491,--
or RCDiq:Bl 8819639
r a / tea Date: �� ) � PEkIa1ITe0869�y
or Big: n'r n.^ ly:.10,.. •-,t!Dr
•
(5151-46.WP) White-Building A Safety:Green-Green- �Appicant:Pink-Revenue:Caddenmd-Assessor
l'�ONSTRUCTION AND PLANNING POOL A •
: I
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector
1? Temporary Electrical Service or'Pala 52. Pool & Equipment Location: r
ti ,
2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrixi. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE t/
-^r
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 1 -1
9. Water Pipe•Undrgrnd. '!' 60. Backwash Lines,P-Trap,kb Unargrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Cetection 62. Backwash & Receptor-Final,?
12. Sewer Cap _ 63. Heater & Vent-Final ------I
13. Roof Drains r:,-• 64. Plumbing System - Final_J'(
14. Rough Plumbing --C 65. Electrical-Final ••
15. Rough Electrical-Conduit 1 66. Solar System-Final :7 . •
16. Rough Electric Wiring 67. Fencing& Access Apprbval 'J
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
•
18. Rough Electrical-I 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 OGas 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 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 Z .- l 3 _97-- pAt /4 /PPS,-
43.
P _43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations •
.,
47. FINAL STRUCTURE & BUILDING q„G4,64 •
'-
48. FINAL PLANNING -_-__.• :w
49. Electric Release to Edison c -"
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 CONSTRUCTION
/I/PERMIT y� T PERM O. TRACT NO. LOT NO. UNIT NO. '
Project Address ?I aJo /1/ W-a #'lam/ ��c7/s3 1264 7/17,/%7 c l I�
Applicant's Mailing •'dress Y 'i _ . . .1 , A TYPE OF CONSTRUCTION LJ NEW H ADD H ALTERATION TJ REPAIR r
Owner's Name .4 a Phon f4�'(//��/n
CI CONVERSION CI DEMOLISH El OTHER A.P.# I Zone ,
PIP[�1/�p DESCRIPTION OF WORK/USE OF BLDG.
.,Address �4 l l J S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT GRADING FOUNDATION E
Ell Front 0
❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL g N
Address , - _ A Rear I
�s.1 (2 o` /� ❑ OTHER
Contractor's Name -i ,A(,iptn �! f hone ea 1 U�.S C Right - N
Address(mailing) //1`J i.QPROJECT DESCRIPTION SQ. FT. OCCUPANCY K G
CON ST RUCTION TYPE VALUATION $ S Left
City License No. ‘30 ZONE GRADING CU.YDS. ACRES R
LICENSED CONTRACTOR DECLARATION Ping. Ref. # Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: 'fIR7 M
with section 7000) of Division 3 of the Business Professions Code, and • `'CD JUL 7
my license is in fu f• c--and effect, a C``E'Y T
Lice. ? C .s :I ♦ {SA, / c sell. • 7 'a[ GII S
Date.?'! �'�� Signature / / r r PLUMBING I FEES •
.� WORKERS'COMPENSATION DECLARATION Bar Sink Showers '� ELECTRICAL FEES
I hereby affirm that I have a certificate of consent to self-insure or a certificate
of Workers' Compensation Insurance, or a certified c py thereof (Section
Backflow Preventer Service Sink - Automatic Washer Transformer 0 15.50 KW
100, Lab.„0„)/q /� p
olicy No j Li-ny a 1 Company Backflow Irrigation - Sewer Cap0 50+ KW
Construction Pole Sub.
.,,,Certified copy is hereby furnished. - - --
Certif' pyQ /f/ with the city l Iv n Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date fs' � Aliplicant � '
EXEMPTION FROM WORKERS'COMPENSATI N DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100) or -
less). Dishwasher ' Solar Piping Dryers ❑Gas ❑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 manner so as to become subject to the Drinking Fountains Solar Tank • Fan Motors❑0-1 HP ❑1'/z-6
Workers' Compensation Laws of California.
Date Signature Floor Drains Swimming Pool w/Spa - F.A.U.
NOTICE: If,after making this declaration, you should become subject to the — Inc.Solar 09-15 HP 016-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave
comply with such provisions or this permit 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.) ei
Interceptors f
Water Heater
. Lender's Name P — Outlets Range Lender's Address Kitchen Sink Water ServiceSwitches Sign-
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal
following reason (Section 7031.5 Business and Professional Code: Any city or P Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays Generator DO-5 KW ❑5-15 KW
any structure, prior to its issuance, also requires the applicant for such permit 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 -
therefrom and the basis for the alleged exemption. Any violation of Section
'031.5 by any applicant for a permit subjects the applicant to a civil .
•natty of not more than five hundred dollars($500).
J 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 (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, thebuilding or improvement is sold within one year of com- • Canopy Type II .❑ 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 •
ssue
prove for the purpose of sale). �O�7
❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System ApplicationId By Date C
tractors t0 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 OD-100,000 BTU ❑100,000 BTU SUMMARY OF FEES
builds or improves thereon, and who contracts for such projects with a con-
tractors) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $
proof of their 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. ICBO# Fire Dampers PLUMBING $ $/ OD 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 ❑100,000 BT ' . GRADING $ •
information is correct. I agree to comply with all city and county ordinances ELECTRICAL_ $ •
and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives of this city to enter upon the above-mentionedproperty for �t
inspection r poC� Q7 MECHANICAL $ �(.:
Signature // A _. _. I Date ( '' - TOTAL FEE $ c
Drivers' License or SS* / Reinspection Fee $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 -11
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
r.
5.,Steel Reinforcement 56. Rough Plumbing & Pressurj;Test
6. Electrical UFER Grnd. . 57. APPROVAL TO COVER-GONITE
7. Footings 58. Electrical Conduit-Undrgrritl;
8. Foundation. 59. Gas Pipe, ❑ Undrgrnd.,
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. 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 ❑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 Notes: ' ,
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace - -
38. Final Plumbing �6cc
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 _
FIApplicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITYAF COSTA MESA CONSTRUCTION PERMIT - PERM NO. TRACT NO. LOT NO. UNIT NO.
ms t-/- Soln ,1-2._04 30Q99 5472 9/17/87 Soon TL
Project ntAs Mss a pq�/�r�� "^ C� aro tJ ` lam✓
Applicant's Mailing1A,d.,dress s/7 7 {' C ..� TYPE OF CONSTRUCTION U NEW ❑ ADD LI ALTERATION G REPAI R
Mac S Phoney'-'r,�4/ ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.#. Zone
Owner's Name ap DESCRIPTION OF WORK/USE OF BLDG.
Address `/ S Main Building: Accessory Building:
Arch/Eng. _ License No. TYPE OF PERMIT 0 GRADING s-,�LIFOUNDATION 111 STRUCTURAL E Front Q
Address / ❑ TENANT CI ELECTRICAL LA'.-PLUMBING ❑ MECHANICAL B Rear N
Contractor's Nam- SII ILI I.•hone ? Q� ❑ OTHER - C Right N
�/ p iT ,/ PROJECT DESCRIPTION SQ. FT. OCCUPANCY K
Address(mailing) 1 ' a+ 1V CONSTRUCTION TYPE VALUATION$ S Left R
City License No. SO 73S ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION Ping. Ref.# r Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9 (Commencing Remarks: Planning Notes: I RECEIVED SEP 1 M
Q
with section 7000) of Division 3 of the Business and Professions Code, and 5 19$1
my license is in fu f. • and effect. T
License Clss ` Li ense • / • - S
bDate - 41 'r Signature A / ! -% _ . /nr PLUMBING FEES
WORK'RS' r'e MPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES
I hereby affirm that I have a certificate of consent to self-insure or a certificate
f Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
100, Lab. �3Automatic Washer Transformer 0 15-50 KW
I _olicy No. �y9,3y ( I Company0* Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+ KW
erotic copy is hereby furnished. n
Da
filed with the city di f)) il;ifryr //j�y7 z Bathtubs - Sewer Connection Cooking Unit Meter Our) to 100 amps
Date / Applicant NSATI N
EXEM TIO FROM WORKERS'CO PENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100) or
less). f Dishwasher
— Solar Piping C'.9`•GC Dryers ❑Gas ❑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 manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors 00-1 HP 01%-8
Workers' Compensation Laws of California.
Date Signature Floor Drains Swimming Pool w/SpaF.A.U. Inc.Solar ❑9-15 HP ❑16.15+
NOTICE: If,after making this declaration, you should become subject to the —
Workers' Compensation provisions of the Labor code, you must forthwithFloor Sinks Urinal Fixtures
comply with such provisions or this permit shall be deemed revoked. Microwave
• CONSTRUCTION LENDING AGENCY • Gas Service Outlets Water Closet Device Boxes 'Pole 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.) Interceptors Water Heater Outlets e Ran
Lender's Name g
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 Auto-Wash Disposal Standing Sections
Garbage
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 Laundry Trays Generator 00-5 KW 05-15 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
therefrom and the basis for the alleged exemption. Any violation of Section
+s931.5 by any applicant for a permit subjects the applicant to a civil
tnalty of not more than five hundred dollars($500).
+.1, 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 ` $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL I 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 Hood or Type I ❑ DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Zoning Approved By - Date
sale. If, however, the building,or improvement is sold within one year of cam- Canopy Type II ❑
pletion, the owner will have the burden of proving he/she did not build or Im- Duct- Under Ground Building Approved By Date
prove for the purpose Of sale). • p b
. ❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By • Date / /7-a 7
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 pal 00,000 BTU ❑100,000 BTU SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con-
tractors) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. - PLAN CHECK $ PERMIT
❑ 1 am exempt under Section B. & P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ 5 , D O ISSUANCE $
•Date Owner Heating System ' DuctingPLAN 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 B
information is correct.•I agree to comply with all city and county ordinances ELECTRICAL $ GRADING $
and state laws relating to building construction, and hereby authorize repre-
sentatives of this city to enter on the a.•ve-mentioned property for
inspection our/ es. " I / MECHANICAL $ TOTAL FEE $ �00
Signature —fr /��� ��. / nate _ .J a 7 Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
Drivers' Lir se or SS �� _ - •
CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink - Accounting; Goldenrod - Assessor
CONSTRUCTION ANdPLANNING POOL & SPA
Date Inspector Date Inspector
APPROVALS Permit# APPROVALS Permit#
1. Temporary ElectricalService or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
44,
3. Electrical Conduit Utility-Undrgrnd. 54. Forms s!i
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GVNITE
7. Footings 58. Electrical Conduit-Undrgrnip •
8. Foundation - 59. Gas Pipe, O Undrgrnd., Testc•
9. Water Pipe-Undrgrndr -. 60. Backwash Lines,P-Trap, ❑Y(gdrgrnd.
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 I. FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# _ ••
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O 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. HFIXED 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 • Notes: •
34. Final Heating & Air Conditioning ..-
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing 341.3V LCb • •
39. Water Service-Final '
i f
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 '