HomeMy WebLinkAboutOC_378562 - PermitsREGIONAL OFFICE
26052 GEfTY DRIVE
LAGUNA NIGUEL, CA 926]]
714-831-2610
s. 0 W
1� 011
APPLICATION FOI AvilAERMIT ryry�oCENTRAL OFFICE Q
48
COUNT` :E Y .400 CIVIC CENTER DRIVE WEST
EMA ___.MON ;. �r SANTA. ANA, CA 92702
714-8342626
EU
ADDRESS �J1!
TRACT / Rte' LOT NO.
AREA �0)=i'.9404pe
CONTRACTOR "Q e s
NEAREST .
CROSS STREET ®N�%�f
1 r r
ADDRESSV17 �U.1
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OWNER - p!8"✓rfl/'GGs
EL
CITY NO. — 9991
PROPOSE PRESEN
USE 1�
CERTIFICA N FOR REGULATION: PERMIT
Contra ^1 -.
I certify that Ne following Card, La No. _ D® entl Classihcetion
Is In full force and effec . ker s Compen r
Certificateo file vena tlb 'kNefiabon Bete.'%
PERMIT FEES
RES: $J5 per$1,000of. valuation
or fraction thereof.
FEE
Other APP Imam. '
-1 hereby certify I am exemptfrom Sea ]031.5 of the Business entl Professional Code,
Div. 3, Chap.. 9, Contractors License Law and under the following section:
i D Owner (Sect 7044), or
ElEpr Work under $IBB (Sect 7046), or
❑Employeeworking for wages only (Sect ]053), or
m
I ❑Other:
VALUATION:'
$
NO. TYPE OF FIXTURE OR ITEM. - "FEE
WATER CLOSET (TOILET)
p C'.
Cerification of Exemption fmm Sect 3800 of the California Labor Code, Article 3.
r Construction Permit:
❑ The permit is for One Hundred Dollars ($100) or less.
certify that in the performance of the work for which the permit is issued l shall not
employ any person in any manner so as to become subject to the Workers
Compensation laws of California.
If, after making such certification the applicant for this permit should became subject to
Worker's Compensation provisions of the Labor Cade, the applicant shall forthwith
comply with the provisions of Sed 3700 or this permit shalt be. deemed revoked.
- I hereby acknowledge and state that the information l have provided is correct both on the
!; permit and this certificate and agree to comply with all CountyOrdinances and State laws
regulafng buil construction
u' -Date
( p nts signature)`
" BATH TUB - - -
' .SHOWERSTALLE]I
Q
IL LAVATORY BASIN) Qi%'
KITCHEN SINK ❑GARBAGE DISPOSAL E]!ihe
LAUNDRY TRAY OAUTO WASH. MACH, El
--
DISHWASHER
SERVICE SINKa
FLOOR SINK
INSPECTION RECORD _
FLOOR DRAIN
U� Am f" Cy
URINAL
p-9
'F, . 6E. _.1.. S�v, ,a d
DRINKING FOUNTAIN
D
APPROVALS DATE Inspeplors Signature _
-SAND TRAP El INTERCEPTOR
+.
GROUND,WORKSOIL ONL
. `ROOFS DRAIN
GROUND WORK WITH
WATERPIPE ❑. GASPIPE ❑
- WATER HEATER
p p:
ROUGH PLUMBING,. --
'.WATER SOFTENER -
GAS PIPING -TO
LAWN SPRINKLERS RES. El COMM. El
WATER HEATER
GAS SYSTEM LPG ❑
NO. OF OUTLETS - NAT.
G
SEPTIC TANK;rkt`'E
-AUTO. FIRE SPR,. SYSTEM'
SEEPAGE PIT;a.
HOUSE SEWER -(VALUATION)
Q ®G
SEWER
SEPTIC TANK
`
GAS TEST
SEEPAGE PIT(S) -
91PRINKLER SYSTEM a• 1
LEACHING FIELD8
- -
.FINAL
` PERMIT ISSUANCE `0 I W I
` 3UTILITY
CO NOTIFIE `-'
BUILDING P 5N BERG ;.
N DOSS
TOTAL E
,(�. � 0 0.
RECD BY PLANS -
f CHECKED BY:
VERIFIED BY: ION1
•TF
PERMIT NO. PERMIT FEE CODE PLAN CHECK TOTAL