HomeMy WebLinkAbout134 SANTA ISABEL AVE - Building Permits CITY OF COSTA MESA
4 040 BUILDING DIVISION
Fi =-A. 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
'.1. FOR INSPECTIONS CALL: (714)754-5626
a-col 47'
PERMIT NUMBER: B10-00089
PERMIT TYPE B_ROOF2 STATUS: ISSUED
APN: 43928143 DATE ISSUED: 04/06/2010
. ISSUED BY: RMD
JOB ADDRESS: 134 SANTA ISABEL AV CM Suite/Unit:, -
Vicinity: FRONT UNIT ONLY ROOF ' -
Squares: 900 Valuations $3,000.00
SCOPE OF WORK: REROOF FRONT UNIT.ONLY.TEAR OFF EXISTING ROOF MATERIALS, INSTALL 1 LAYER OF 15#FELT AND
REROOF WITH 30 YEAR COMP SHINGLES ON FRONT UNIT ONLY,APPROX 900 SF(NO GARAGE INCLUDED).
REPAIR AND REPLACE SHEATHING AS NEEDED. COMPLIANCE FORMS ATTACHED TO PERMIT.,
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OWNER: WANG CARIE H Address: 17561 EAST 17TH ST. Unit:
PHONE: 714-573-3000 " City/State/Zip: TUSTIN,CA
APPLICANT: WANG CARIE H . Address: 17561 EAST 17TH ST: H Unit: :
PHONE: 714-573-3000 Cit •
y/State/Zip: TUSTIN,CA - -
CONTRACTOR: OWNER-BUILDER , . • License No. • '000000
Address: Unit: PHONE:
City/State/Zip: CELL:
ARCHITECT: License No. • PHONE:
ENGINEER: License No. PHONE:
FEE SUMMARY
Reroof Plan Check: $0.00 : , . - -
Reroof Permit Fee: $83.25 - -
Reinspection Fee: $0.00
Bldg Std Admin Fund $1.00 .
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TOTAL FEES $84.25
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, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODES. INSPECTION TYPE DATE INTI11ALS CODE INSPECTION TYPE DATE INTITIALS
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final � 208 Final Plumbing
f200 Final Re-Roof a (.4; 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 driiv, .. -ncense. 0 Yes 0 No
I hereby affirm under penalty of perjury one of the following declarations: Drivers License No. , (Explicit /Z-
0
❑ I have and will maintain a certificate of consent to self-Insure for workers' Venficationtof Ownership by(type of document,i.e.-property/tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
❑ I have and will maintain workers'compensation insurance, as required by
section 3700 of the Labor Code,for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
by this permit,and that no building structure,scaffdding,falsework,a demolition
Carrier: or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Cry
(This section need no!be wmpleled AMe permit is valued al one hundred dollars($100)or less)
2,Art 2,Sec.341,Title 8,California Administrative Code).
Policy Number:
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 Date
the Labo ode,I shall forthwith comply with these provisions.
� fir £/- 4&/�77--o/ Division of Industrial Safety Permit Number:
�.t.-AOpliiznf Signature ( Dat HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? 0 Yes 0 No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons,or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes ❑No
Lic.# Class# (Section 25533 of the California Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
Contractor's Signature Date - hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work for which this permit is issued.(Sec.3097.Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Date
4. If an RMPP is presently required, has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes ❑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 0 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 Government 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? 0 Yes 0 No
applicant for a permit subjects the applicant to a civil penalty of not more than (If'yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
❑ I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? 0 Yes ❑No
thereon,and who does such work himself or herself or through his or her own 8. (If"yes",attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of control officer).
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and
I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions.
OLIC�ENSED CONTRACTORS to construct the project(Sec.7044,Business and
Professions Code: The contractors License Law does not apply to an owner of Signature Date
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
0 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
authortpd by this permit until final inspection.
/ / 1.r� H w Y///—c (L2
( ✓ A"c" (J S gneture of Legal Owner(s) ate
Signature Date
3051-4613/07) And/or Authorized Applicant Date
G„wf�-
ir
SW - 013 y'.
Prescriptive Certificate of Compliance: Residential CF-IR-ALT
"-Residential'Alterations (Page 1 of 5)
ProjectName: Climate Zone k
- }, P of SSories
" �lN� .
General Information
Site Aklr es`sl. r^-r-'tF z - f I Enforcement Agency: C.
1� /� Date: a//./, - 1
Building Type D Single Family Multi Family Circle the Front Orientation: N,E,S,W,or degrees
u ? Project Type: 0 Alterations 0 Envelope D Fenestration,M Roof 0 HVAC
Conditioned Floor Area(CFA):
I 'I" S �` J.tp. Replacement or Change Out D Duct Replacement 0 Water Heater _
:NOTE:This farm is not to be used Jar New!,'Constructed Buildings or Additions -
- Insulation Values For Opaque Surfaces(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 Boor must install the
mandatory rninimnm insulation value per§150 for the altered assembly.Fill in Columns A-C and enter mandatory insulation value in Column H.
❑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-.1
Opaque Surface lletails For the furred portioned of Mass Walls see Furring Strips Construction Table below.
-A B I C .. • II D . F ' C Ii ..._.I .._..b.-- J.__.-.....
Proposed'`c Note Standard i . Values From JA4 Table _
Framing Thicleness, Framed Continuous JA4 Proposed
Tag/ Assembly Name Material Spacing, U- JA4 Table Cavity Insulation Assembly ' Assembly
ID] or Type] and Size' or Others I facto? Numbers R-value° R-Value' Cell Value° , U-factor°
• Note:For Ihrred assemblies,accounting for Continuous Insulation R-value,see Page JA4-3 and Equation 4-1. For calculating furred walls use the Mass and
I Furring Construction table 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"0C;or Other for all other assembly description
such as Concrete Sandwich Panel,Spandrel Panel,Logs,Stew Bale Panel and etc....
4.Based on the Climate Zone;enter the Standard U facto'from Table 15I-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 R-value that is being installed in the wall cavity or between the laming;otherwise, enter "0".
7. Enter the Continuous Insulation R-value for the proposed assembly;otherwise, enter "0".
8.Enter the row and column of the U-factor value based on Column F Table Number and enter the Assembly U-factor in Column J
9.The Proposed Assembly U-factor, Column.1, must be equal to or less than the Standard U-factor in Column E to comply.
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Furring Strips Construction Table for Mass Walls Only
A I 15 C I D I E F I c _ H I I I J IC L 1 M
Proposed Properties of Masonry and Concrete I Added Interior or Exterior Insulation
Walls From Reference i in Furring Space from Reference
Joint Appendix'I able 4.3.5,4.3.6.4.3.7 1 Joint Appendix'I able 4.3.13
Assembly c." I o .i; 2 F- l- t o, v <. m m I Final
Muss Name or JA4 Table , _ I '- r, = E E o 'C !t s _ g Assembly
Thickness' Type' Number' < :2 = m c 1 1 5 i C S m r= U-factor6" Comment
- - r - -
I I 9 I I
Registration Number: Registration Date/Time; HERS Provider:
2008 Residential Compliance Forms August 2009
it .
Prescriptive Certificate of Compliance: Residential CF-1R-ALT
Residential Alterations (Page 3 of 5)
Projeet:Name:v ' 1_climate z ice#"` #of Stories
w 8-151 -
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ROOFING PRODUCTS(COOL ROOFS)§151012 ,
When the area of exterior roof surface to be replaced exceeds more than 50%of the existing roof area,or more than 1,000 f?, whichever is
less, the new roofing area must meet the roofing product "Cool Roof'requirements of§152(Ii)1Hi, 152(6)IHii,or 152(b)1Hiii.
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 Emittance requirements for roofing products in
§118(i)are not applicable.Do not fill table below.
I ❑Cool Roofs Not Required in Climate Zones 1-12, 14,and 16 with a Low Sloped. Less or 2:12 pitch.
tool Roofs Not Required in Climate Zones 1 through 9 and 16 with a Steep-Sloped Roofs(pitch greater than 2:12)and product unit weight less
/than 51b/ft2.
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=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 hrft2-°F/Bm or at least a 3/4 inch air-space is added to the roof deck
over an attic;or
❑ Existing ducts in the attic are insulated and sealed according to§151(010;or •
❑--in climate zones 10, 12 and 13,with I ft2 of free ventilation area of attic ventilation.for every 150 ft2 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
❑ Building has radiant barrier in the attic meeting the requirements of§151(f)2;or
❑ Building has no ducts in the attic;or
❑ hi climate zones 10, 11, 13 and 14,R-3 or greater roof deck insulation above vented attic.
Exception to§152(b)1Hiii,Low-slope roof(pitch 5.2:12)
❑ Building has no ducts in the attic.
Other Exceptions
❑ Roofing area covered by building integrated;photovoltaic panels and solar thermal panels are exempt from the below Cool Roof criteria.
r❑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 Reflectance3'4 Emittance SRI5
❑ ❑ ❑ 0 ❑4
❑ ❑ ❑ ❑ ❑4
❑ ❑ ❑ ❑ 04 .
O 0 0 0 ❑4
O 0 ❑ ❑ ❑4
I. The CRRC Product ID Number can be obtained.from the Cool Roof Rating Council's Rated Product Directory at rwvw.coolroofs.org/products/search.nhp
2.Indicate the type ofpraduet is being usedfin'the roof top,i.e.single-ply roof,asphalt roof,metal roof etc.
3. If the Aged Reflectance is not available lathe Cool Roof Rating Concil's Rated Product Directory then use the Initial Reflectance value from the sane
directory and use the equation(0.2+0.7(p,,,i,e,i-0.2)to obtain a calculated aged value. Where p is the Initial Solar Reflectance.
4. Check bar if the Aged Refectance is a calculated value using the equation above.
5.Calculate the SRI value Ire using the SRI- Worksheet at ltier://ww,v.energy.cakov/title24/and enter the resulting value in the SRI Column above and attach acopv of
the SRI- Worksheet to the CF-/II.
To apply Liquid Field Applied Coatings,the coating must be applied across the entire roof surface and meet the dry mil thickness or coverage
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recommended by the coatings manufacturer and meet minimum performance requirements listed in§1180)4. Select the applicable coating:
❑ Aluminum-Pigmented Asphalt Roof'Coating 0 Cement-Based Roof Coating 0 Other
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Registration Number: Registration Date/Time: TIERS Provider:
2008 Residential Compliance Forms ' August 2009
I ti
Prescriptive Certificate of Compliance: Residential Ch-1 R-ALT
Residential Alterations (Pace 5 of 5)
. - PriijeaCNarne' m te;Zun " N of s
• �(AikNi /
HERS VERIFICATION SUMMARY The enforcement agency should pap special anention to the HERS Measurer specified in this
checklist belory. 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 PIERS verification is reyaired,for this measure.
❑ YES D NO YES:In Climate Zones 2 and 9-I6,if more than 40 linear feet of new or replacement ducts are installed in unconditioned
space,the ducts are to be sealed per§I52(b)1Dii and the newly installed ducts ate to be insulated pet §151(1)10.
' 0 EXCEPTION: Existing dnet 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(1-IVAC equipment and ducting)is replaced, the
ducts are to be sealed per§152(b)lDi.
❑ YES 0 NO YES:In Climate Zones 2 and 9-I 6,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 he
sealed per§152(b)1E.
❑ EXCEPTION:Duct systems that are documented to have been previously sealed confirmed through HERS
t: : - -ft•- verification in accordance with.procedures in.the Reference Residential Appendix RA3.
_ _ 0 EXCEPTION:Duct systems with less than 40 linear feet in unconditioned space.- - - .-.. . ..
❑ EXCEPTION:Existing duct systems cdnstructed, insulated or sealed with asbestos.
Refrigerant Charge- Split System HERS verification is required far this measure.
❑ YES 0 NO YES:In Climate Zones 2 and 8-15,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 charge measurement shall be verified per§152(b11F.
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(6)1 Ci to meet the requirements of§15)(f17B.
Documentation Author's Declaration Statement • cr-,
;'v I certify that this Certificate of Compliance documentation is accurate and complete.
Name: () ) Signature:
Company: / Date:
Address: If Applicable❑ CEA m'0 CEPE
2 5 3 / /lc /4,,,, s -EA c_,0 (Certification 10:City/State/Zip: Cl{ Phone:
74 "-;A- r,0 S'� 7re �7/ S� X73 j/o_v
:Responsible Building Designer's Declaration Statement
• 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.
• I 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 are consistent with the inInnnatioil provided to document this
building design on the other applicable compliance form:,worksheets,calculations,plans and specifications submitted to the enforcement
agency fm approval with this building permit application.
Name: 1 Signature:
Company: Date:
Address: License:
Citv'State/Zip: Phone:
For assistance or que,stiolis regarding the Energy Standards, contact the Energy Hotline at: I-800-772-3300.
Registration Number: Registration Dote/Time: PIERS Provider:
2008 Residential Compliance Forms August 2009
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in
e/ROJECT ADDOEss: t1 1 UNIT - .— - CITY• ,OF OSTA MESA BUILDING I FktMIT PERM NO;
�• 1. 34 SANTA ISABEL A.V 1 / . EMP ' 0451?. 3
i OWNER'S NAME-MARY MCCALLUM • - ••
ADDRss: 134 1 /2 SANTA ISABEL : • PERMIT NO EMP 046123PLAN CHECK NO: N GOVT; N SLTPP :•
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COSTA MESA •
CA 92627 - CONSTRUCTION TYPE': 5-N PERMIT: 'IYPE: ELE MEG PLU . '' ' . -PURPOSE: REP -• ,
• `! 714 ) 876-904• "2 -
ARCH/ENGINEER: . . •REG.NO,: ,JOB 'DE SCRIPTION : REP, /REPLACE :PLMB :, EL -'SMECH APPARATUS •• SQ .F'T t r '
ADDRESS: , .. . . - UNR: - _ s- r -
PFgMITTEE: CLAIM VALUE•.: _ CALC;VALUE: GROUP IOCC: R-3', . /. ' •
h1ARY MCCALLUM ( 714F'836 9042 ; •
ADDRESS -94• AMAI,F[ ' ,COMMENT'S : NO r"B" PERMIT '1'O REFERENCE. - ' - '-
SANTA ANA CA 92703 . • ****x*->F >ENxN>Ex*x*H **k*****N*x--x*+e*x-x•**�E�s ->E- *rtx*x-**>'F-rE#*x-sr�a***->E *****4er*ie***i�*iE*- t :
LICENSED CONTRACTOR DECLARATION:' I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section - • 7 O N I• N G R E Q, U IREMENTS -
7000)of Division 3 of the Business•antl Professions Code,and my.license is in full force and effect. S E T B A C. K S i — '
CITY LIC.: STATE UC.: CLASS: . • . -
Date: •
Signature: i • -- •--- -- MAIN BUILDING -------,---- ---------- ACCESSORY BUILDING ---------- t
'RKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRN'C: FT ;IN REAR': FT IN FRNTs FT IN REAR: FT IN ,
'enation Insurance.or a certified copy thereof(Section 3800;Lab.CI. LEFT: FT ' IN RGHT:: FT IN ' -' LEFT: i FT IN RGHT: ' FT : IN. •
,c dY NO.: EXP.DATE: ' • ,
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COMPANY: PARKING REQ: PROV: PARCEL: 43928143 ZNE: REF NO:
❑ Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> • . , • • ,
• .. . •, :,
Date: Applicant: - *.**.*************************ie***sit,****i(******iE****3E*******jE*3(**************3r**** •
EKEMPOON FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred(M0)or less). , D ' F !V E L O• P M EN T '`S E':;R, V I C ES R EOUIR EMEN T SI
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 Workers'Compensation Laws of California. 13"' ,
p •
ZONING APPROVED BY •
^_____ �' _ DATE:
'Date: ' Signature: _ - - : . _ . ._ -- . . .
NOTICE If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor • BUILD I NG APPROVED B Y. : • • - ' " DAT F:'t
Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. • t '. ^y '-- --`'--'" '
•
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for j APPLICATION ISSUED B1 : _ DATE: 2. el' '
which this permit is issued(Section,3097,Civ.C). **4E43E843f**.x?(**(40***iF** R--.rt ' *TE�e*- *IN *37- - it 4'4 *�-E:)F,,(.*4**********it * nW it*-O*-
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LENDEfl: •
*'*****,*********4**it*********3E****it.*it******** t********************************K- '
• ADDRESS --, , - • LEGALIZATION: N - ' ' ' - F,
, ' E,.E ' S U 'H M A' R Y -STRUCTURAL SEGMENT' : N ,
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OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason .BLDG PM_ T ;PLUMBING ELECTRIC 'MECHANIC . . FIRE SMIP/RE:S-- • • GRADING '
(Section 7031.5 Business and Professional Code: Any city of county which requires-a permit to construct latter,improve,demolish,or PERMIT . , - .A 4 00“. 40 . 25 9 00 '
repair any structure,prioyto its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed . - ,
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business ' 2 5$ 'S O$ 2 S$ SMIP/NON-RES
and Professions Code)or that he/she,is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by PLAN h . . • ' .
applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($5001- ' .I S S U E ,FEE ' '.3 - 0 0 1 5 . 0 0 1 5 . 0 0 ' '
I. as owner of,the property or my employees with wages gas their sole compensation, will do the work, and the BUILDING-DIV-> • PERMIT ISSUE PLAN--CHECK TOTAL • PAID' DUE
structure is not intended or offered for sate(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS-fl--> 53 . 25 . 33 . 00 0 :00 86 . 25 86 . 25 - 010
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 awn employees,provided that such improvements are not intended or offered for sale. If,however the building or : y t c r•_ :'1'
-improvement is sold within one.year of completion,the owner will have the burden of proving he/she did not build or improve .REC ENU E• D IV IS ION TOTALa -> - C.OLL EC. : • 8 6 . 2 5 .OVER/SHORT: 0 0
, 'for the purpose of sale): C' BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE :SMIP/TOT GRADING/PLAN—CHECK •
• J.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 7 :00 . 55 . 5 . 241. 00 - ,
❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon -
andwhocontractsforsuchDrojectswlthacontractor(s)license pursuant to•the Con . tors'.State License Law):l am aware : ***********iE********************#**if*****************************it****.**_ *******
that proof of their Worker's Compensation insurance should be Provided to me. 'I N D I ' T V 'D U -A L . FEE B R E A IC D O W N •
Q I am exempt under Section:B P 7 0 4 4 B:8 P.C. (, _
for this reason: . SON DOING ALLTo . , WORK ` , • TYPE TY U E S C R 1: P T I O Tl UNIT COSTu J . I.01'AT, COST
Date: .'Z —/7 Owner % %
F� F.L,F,. 6 ' 'FIXTURES, LIGHTING 1 ST 20 F.A. - 75 ; 4 , 50 '
I do hereby that
or hat I fahtuture
aware of and understand the requirements of Coliform. eatth and Safety Code Sections 25505.25533,and r-
' 25534 and thatIorany futurebuilding occupant will/willnot(circle one)need to co •, •'thsaid state codes and the requirementsfara ELE 1'4 .REC.EPT/OUTL;:ET • 1. ST 20 EA. 7J IO . S'0
permit for construction or-modification from the Air Duality Management District 'esid' tial construction.•.' . ons are exempt from ELE 9 : • R EC EP I'/S W I TCFI '1 ST 20 ' EA. . 75 +• '.. , 6 . 75
• these provisions. ELE '1 ' SERVICES BELOW 600 V &' BELOW 200 AMP . :18 . 50 ,r y •• 18 . 50
Date: .Z�/ y —7 (�Applicanf. MEC ' • 1 INST/RELOC RECESSED WALL ;'HEATER 9 . 00 • 9 . 00
L. PLU r 1 ST.NK, KITCHEN 2 . 00 2 . 00
I hereby certify that I have read this application and state that the above i prmation is correct.I agree to comply with all city and county PLU ''L WATER HEATER AND/OR VENT ; 2 . 00 2 . 00
ordinances and state laws relating to building construction and hereby authorize repre tives of this city to enter pon the above-mentioned - , - - ' .END OF FEES '
property for.inspection purposes. , - :
���a� Of 00054133-000541;5 [' 1 25
Date: Z / —P�. • Signature: • 1 • _ \''
_Driver's License or Social security N: \\\\ DATE: 02/14/90 TIME: 15:33 .
White-Buildino;Green=Code Enforcement:Canary-Aeolicent Pink-Revenue;Goldenrod-Assessor
- -. .. !I
r 'CONSTRUCTION AND PLANN _ •OL & SPA
b •
Date Inspector Date Inspector -
APPROVALS Permit #. APPROVALS Permit.#. I J ts,
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 ' , e
4. Electrical Conduit=Undrgrnd. %
55. Electrical Bonding `, 7' i - •
je
5. Steel Reinforcement 56: Rough Plumbing & Pressure Test •} -
• ' 6. Electrical UF ER 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 - ,` . • L`/177
12. Sewer Cap 63. Heater & Vent-Final s° i`1
• 13. Roof Drains 64. Plumbing System - Final �'� �, / .
14. Rough Plumbing 65. Electrical-Final i
15. Rough Electrical-Conduit 66."Solar System-Final •
,
16. Rough Electric Wiring 67. Fencing & Access Approval
ci 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
1
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating& Air Conditioning '• . - • `FIREDEPT. REQUIREMENT _
I 20. Rough Factory Fireplace APPROVALS" Permit#
21. Ducts,in Structure - 70. Underground Hydro ;
22. Ducts, Ventilating - - - 71. Product Piping OGas 0Oil
23. Gas:Pipe-Rough & Test - 72. Underground Flush '
I 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 t - - 78: FIRE PREV. FINAL •
30. Drywall Nailing /-�7. - ; HEALTH DEPT. REQUIREMENT -- -
31. Plaster Brown Coat /
_ / FINAL INSPECTION
32. Electrical Pow /j�'er Meter-Final. lgo. � Lr 000 CERTIFICATE ISSUED
33. Final Electric - 7Fj„/aiti ,• 127-" No ' ' - . :-
34. Final Heating & Air Conditioning _ ` _
35. Final Gas Pipe-Test - i - r i,,. - " . , -
! , .� .
36. Hood or Canopy • -.1.4 - • . .
.
I . 37.
.4.-
37. Final Factory Fireplace '
38. Final Plumbing l - -
•39. Water Service-Final , - 71 - • 1
40. Gas Service-Finalt
41. Solar Domestic-Final - .
42. Backflow Preventer -
43. Backflow Irrigation - • . in.-
44. Landscape Irrigation System -_ - _ -
• 45. Sound Attenuation - - - _ - ,
46. Handicap Regulations . - -
47:FI NAL STRUCTURE & BUILDING // •
48. FINAL PLANNING - JO 5 CC ale G ij -
•
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co -- '/, - - -
r 51. CERTIFICATE OF-OCCUPANCY
No. Date
1 - - .