HomeMy WebLinkAboutOC_54234 - PermitsJ APPLICATION FOR A BUILDING PERMIT AND A CERTIFICATE OF USE & OCCUPANCY ((,
1. BUILDING INSPECTOR
REGIONALOFFICE COUNTY OF ORANGE
CENTRAL OFFICE
2HILTON wav ENVIRONMENTALREGULATION
MANAGEMENT AGENCY 12 NTA CENTER PLAZA
.. LAGUNAUNA HILLS, CA. 92653 REGULATION SANTA ANA, CA 92702.
714 472-7979 P.O. BOX 4048, SANTA ANA, CA 92702-4048 7148342626
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THE FOLLOWING WORK IS AUTHORIZED IN THIS PERMIT:.
- BUILDING- r -
ADDRESS �Q
TOTRUCT. 11 PLUMB. p MECH. p ELECT. SPECIFY OTHER
BELOW
ARCtif/�
ROSS
7REET rfi
OWNER O Q
TYPE OF PROJECT: AAIN❑ ALTER p ADDIT.
[I REPAIR C1 CONVERT El DEMO p OCCUPANCY PMT.
- ADDRESS - �f
/j
/�. 1 72A e2,
CI7Y ZIP PH,
-
A. P.
SUP. DIST./
CLIMATE
INSP. AREA
ZONE
ARCHITECT/ LIC. NO. - -
ZONE. FLOOD
SP' - M'T NO.
DESIGNER
PLAIN x
ADDRESS _ -
P/Lf
7REET
SET BACKS:
FYin
ST.
WIDTH
CITY - - - ZIP PH,
EFT YARDS:
RIGH
REAR
ENGINEER - LIC. NO.
- - LEFT
RIGHT
PROJECTIONS: EAVE
EAVE
FIR
- ADDRESS
PARK'G. SPACES: REO'D
PROVID
COVER'D
- CITY - - ZIP PH.
STR CT
-NO.OF - NO.OF -
I
HEIGHT
STORIES- MILES
LICENSED CONTRACTORS DECLARATION
PARK FEES ❑ VES
&EE
hereb aPormthatl am licensed under provisions of Chapter (commencing
Y p p I g with Section ]000
REQUIRED p NO
RECEIPT NO.
ZONING APPROVED B DATE
of Division of the Business and Professions Code, and my license is in full force and effect
LicenserClass Llcan3e, Number
REMARKS ..,.
'. t _
(OJContractor
Date Contractor, �}
PROPOSED USE .
ADDREBB�:'
OF STRUCTURE:
CITYANDZIP
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i^�C Ls
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CONSTRUCTION LENDIN
-�tNtCY'JiY
I herebyaffirm that there is a construction lending agencyfq E pedormanceofthe work for
which this Permit is issued (Sec. 3097, Civ. C) LENDERS 4At.'
LENDERS ADDRESS
eU Ir
UZ
- OWNER -BUILDER DECLARATION
-- - -
I reby affirm that I am exempt from the Contractor's License Law for the following reason
OCC. TYPE
CODE. OCC.
as owner of the property, or my employees with wages as their sole compensation, will do
the work. and the structure is not Intended or offered for sale.
CLASS CONST—ViL:
YEAR CODE #
❑. L as owner of the property, am exclusively contracting with licensed contractors to construct
- -
the project
USE/OCCUPANCY SIZE SO. FT
1 am exempt under Sec. . B&PC for this reason
L
2
3
WORKERS' COMPE ATION DECLARATION
f hereby affirm that Ihave a certificate of consent to self -insure, or a certificate of Workers -
- -
Compensation Insurance, or a certified copy thereof. POLICY NO
- COMPANY -
3
DATE EXPIRES
TOTAL VALUATION:
VERIFIED:
GRADING PMT JF ❑ VES GRA
`
Date APPLICANT:
CERTIFICATE OF EXEMPTION FROM WORKERSCOMPENSATION INSURANCE
REQUIRED f, !] NO PM
ROUGH GR G E
(This section need not be completed it Permit is for $100 or less)
I cantly that in the performance of the work for which this perrmit is issued. I shall not employ any
APPROVE V'
person in any manner so as to become subject to the Workers Compensation Laws of California.
REMARK
NN.•
INSTNS/ "-`Y
Date: - APPLICANT:
NOTICE TO APPLICANT: If, atter making this Certificate of Exemption, you should become
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subject to the Workers Compensation provisions -of the Labor Code; you must forthwithcomply_
with such provisions or this permit shall be deemed revoked.
y.�
PE Q �1 1 FEES
THAT WAVE READ THIS APPLICATION AND STATE THAT THE ABOVE
�R
+T
ELECT. SESWOV All
:INFORMATION
INFORMATION IS CORRECT I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
- STATE LAWS RELATING TO. BUILDING CONSTRUCTION, AND HEREBY AUTHORIZE
METER 'p,
REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE MENTIONED
PROPERTY FOR INSPECTION PURPOSES
ELECTRI- L
ISSUANCE FEE
—Y
PLUMB[ N': . '
-
3UBT0
igna Agent Date
MECHA AL:
.
{oof/Applicanto
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,
IiLIG1 -L L' ill
Print Applicarre Agents Name
GAS
PLAN CHECK
TV.
METE-
INSTNS./REMARKS:_ -
PRE ADE -
TOTAL PERMIT
INSPN.
FEE:
PLAN %ISSUANCE
7 CYoI /88' 4 4 G7`°t^6/.0 0
CASHIER DATE PERMIT NO, PERMIT FEE
GHECK By
_ � PfZRQ,
c
Z�ION
RA240 $$$ $$$0.00 TOTAIzmn
CODE PLAN CHECK TO AL = Oz
-- TYPE INSPECTION _ INSPECTION RECORDS
PLUMBING DATE APPSGNA REPRS.
IU
REMARKS
GROUND SOIL
GROUND WATER
TOP OUT
SEWER
GAS TEST
SANT: DIST. CERT. REO'D.
-
- FINAL PLUMBING
-
-
MECHANICAL „
" DATE
APPROVEDIINSPR'S.
SIGNATURE
REMARKS
UNDERGROUNDS
ROUGH
COMB. VENT.
AIR COND.
FINAL MECHANICAL
ELECTRICAL
DATE
APPR VED/INSPR'S.
SIGNATURE
REMARKS
TEMP. CONSTN. POWER
- -
UNDERGROUND:
PVC-METAL-D.B.C.
-
ROUGH WIRING
RECEPT, SPACING -
PACING-SERVICE-CIRCUIT
SERVICE - CIRCUIT
FIXTURES - TRIM
SONDINGS -
POOL LIGHT
REQ -D, FENCEM/ALL
FINAL
STRUCTURAL
DATE+°
--PPS D/ illREPR'S
- REMARKS
FOUNDATIOf�(: LOCATION
REINFORCE
{A xsr
+
SLAB: REINF...❑
MEMBRANE
UNDERPINNING
MASONRY BOND BEAM'u,
U
FIREPLACE,
ROOF FRAMING
ROOF SHEATHING
FRAMING
' n
INSULATION
SOUND/ENERGY-' t
3s
LATH EXTERIOF0
7}
LATH INTERIOR
DRYWALL
PLASTER, BROWN COAT
APPRO IIN PR'S.
BUILDING FINAL
ZONING FINAL
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