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1930 KAUAI DR - Building Permits
5 1 CITY OF COSTA MESA Awa BUILDING DIVISION ?. t�,, ;,' •,r•$, DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t .i MI I lr PERMIT •B01-01296 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT • Job Address: 1930 KAUAI DR Status: ISSUED Suite: Applied: 08/20/2001 Vicinity: SIDE YARD Issued: 08/20/2001 Parcel Number: 13951108 Zoning: Applicant: ERICHSON, FRANK ISSUED BY: • Address: Phone: 949-683-5000 Zip: Owner: BECK, JAMES D Address 1930 KAUAI PL '. Phone: COSTA MESA,CA Zip: 92626 Contractor: THE WLB CORPORATION Address: 17780 FITCH AVENUE • Phone: 949-250-8959 IRVINE, CA Zip: 92614 License: 524543 Arch : Eng: Address: - Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT 16 Lk. F. OF BLOCK WAL PER CITY STANDARD. -• FEE SUMMARY Plan Check: $15.28 • Calc Valuation: $320.00 Permit: $23.50 Claim Valuation: $o.00 SMIP Res: $0.50 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $39.28 • PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left :0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: • 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: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. 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. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have dad will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the it.." My ierK(or which this permit is issued. I E q/1 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. CV My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) O 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 is "at if I should become subject to the workers'compensation provisions of Section 3700 WWWW the Labor Code,I shall forthwith comply with then ovi ' s - '�-/�I Applicant Signature: Date: UUUU !/U WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37C6 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force act effect.Lic.# .�� Class# _�( �- - `� Contractor's Signature: Date: T 2" CONSTRUCTION LENDING AGENCY: O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or 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 to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing 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 7031.5 by any applicant for a perm/' subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,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(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). O As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire 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 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (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 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 temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the 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. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes D No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of 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 authorized by this permit until final inspection. -72-1/7,)razure Of Legal Owner(s) 21:1 /D I Date And/Or Authorized Applicant Date CODE E INSPECTION TYPE PATE INTRIAL8 CODES INSPECTION TYPE Mg INTMALS 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 1266 Pool Spa Final _ 208 Final Plumbing 200 Final Re-Roof � 210 Final Electrical 201 Final Block/Retaining Wall lG. 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 J. . — 1 •THIS SKETCH IS FOR INFORMATIONAL PURPOSES •SOLID WALLS/FENCES BETWEEN 2'-6'&6'IN HECHT SHALL ONLY. APPLICANT IS RESPONSIBLE FOR PROVIDING BE SETBACK AT LEAST 10' FROM FRONT PROPERTY LINE. AN ACCURATE REPRESENTATION OF THEIR PROPERTY IN CASE THE SHAPE AND SIZE DO NOT CORRESPOND •SOLID WAILS/FENCES SHALL NOT EXCEED 2'6'IN HEIGHT WITH THE INFORMATION PROVIDED ON THIS SHEET. WITHIN 10'OF THE FRONT PROPERTY LINE(NOT CURB LINE). •VERIFY DISTANCE FROM CURB TO PROPERTY LINE AND SHOW ON PLAN. VERIFICATION FROM THE STNS ENGINEERING DIVISION I5 REQUIRED. CALL(714)754-,A43 52/ 0/214 7B6 FOR INFORMATION. App49't,.fill/ D u- �i . Y � CITY OF COSTA MESA (VLAIINII;;G DIV. •UBJECI Id'3LUU• un' - -• J 0120' As uY tys •ATE 1 , •r P. RESDENCE SDE mJ Al /; -- :. k , V 1 7 \<",\ 1 S le. it \ 111.05It la. J z g Iy(� ' g a RE9DEMQ RESIDENCE1_' swisz RESiDENQ pl i N , ICCLULI .- n W W c MtnO( K _____ DIVISTUNTWBUILDI AFETY { E STREET CITY OF COSTA MESA APPROVED Bi BLOC I( V6�ALW c UT FOR titalthING PERMIT nista ei ans spRdlcaroisMST bekept mt'si*dd /bxh PDDITIONS, DELETIONS, OR CORRECTIONS SHALL n'ei acro`° ' °A "SiAnimagnenPNe1p10Av n n d BE APPROVED BY THE PLANNING DIVISION andSiett Car d Coda Vssa. mes sPananes spectators flw ►arbemomop Soer _,,S at Nie'.t s of any devi;i6tE D.any Cr G Cods Melo Gddanoe"dor lbS bar, ltes"Avs4neDartel.i'r ..'' a .' 4"wAT a "44 s' .G DIVISION - . / I 1 r • ) • r y TYPICAL 611 CONCRETE BLOCK FENCE •• ,• • Cement Coping Optional• !f --- -- ®' GEN E RA'L= NOTE S Channel Block With 13/B� i�t ,-__ - _� ��, Horizontal Top of all II Fences S f MORTAR: One:Parl;Plastic Cement 'and I . � �� MI MORTAR: Thrte:Ports Sand t. For Fences 5'or Len • �aIII{I{ GROUT. One Por t"Cemenl Three and _ yen.Bars 3/6"yS at a' 0""O.C. ��fl oWit ,_ - `J One.-Part-Cems Stand E( la1 a x COPING: One.:H rICCement, Three. - ; _ • For Fences Higher Than 5' ' . Parti'Sand I' Vert. Ban 3/8"0 at 32" o.C. ( as ii CONCRETE: well:Mixed 1:2- I/2: 3-1/2 Fill Cells Solid With Grout �I'( > Mar:of 7- I/2',Gnl;cns of ' Where Steel Occurs t{ u -1_. " . - 1 Water Per Sack p1.Cement t1��■$�1 I 11{11 1 �. > Rrudnrmng Steel Shall 1■■1 } m GROUT MAY BE POURED FROM THE T,OP i Conform to Sec.A 15 39 M u, 0 _ OF 1HE FENCE IN CELLS WHERE STEEL - • A.S.T.M. 1111z ' OCCURS. ` .. CELLS AND AREAS OF HORIZONTAL REIN _ _ _ FORCEMENT SHALL BE CLEAR.CLEAN& All Steel to be Lapped s. ' '--- FREE OF ALL MORTAR DEBRIS,ETC. a ,: -" _24"or to Code IN! I- '.1 - . - ' y NATURAL wwcGRADE J "Sl avDAIS v �;� 1 ,I ,�. TWOO BARS . . . CONTINUOUS TOP & BOTTOM III `f WIDTH _ TO 16 0 C MAX SEE CHART . BELOW HOPLACE EEL MUST BE TIED IN I DC OTIC LF C ARTHTCOTH PLACE AT TIME OF TRENCH I' I/3 THE HEIGTN OF FENCE INSPECTION- _1 t 19ELOW BOTTOM OF FOOTING �_e;� 1_._14_11 2.'— .— SCALE: I/211 = II FOOTING REQUIREMENTS CHART 1 WALL HEIGHT 6 ' S 4' 3' 1 WIDTH • 14" . 14" 12". 12" THICKNESS10" . 10" 8 " 8 " DEPTH OF EARTHTOOTH 2411 20" . . 16" 12" SPACING OF EARTHTOOTH 12' 141 . 16' 16' 1-zi-1 BUILDING DIVISION I„-1 CITY OF COSTA MESA 4. BUILDING DIVISION }t r ,1 . DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 1...4* I *It _9•0.1/1•1 Vic% * PERMIT E01-00739 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1930 KAUAI DR Status: ISSUED Suite No Applied: 08/20/2001 Vicinity: BACK YARD Issued: 08/20/2001 Parcel Nunmber: 13951108 Applicant: ERICHSON, FRANK ISSUED BY: Address: , . Phone: 949-683-5000 Zip: Owner BECK, JAMES D Address 1930 KAUAI PL • Phone: COSTA MESA,CA Zip: 92626 Contractor: THE WLB CORPORATION Address: 17780 FITCH AVENUE Phone: 949-250-8959 IRVINE,CA Zip: 92614 License: 524543 SCOPE OF PERMIT ELECTRICAL OUTLET AND MISC.CONDUIT FOR BARBEQUE IN BACK YARD OF A SINGLE FAMILY RESIDENCE. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 - .Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 - - up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 • - up to 50 kva/kw $0.00 0 Recept Outlets $1.10 1 • up to 100 kva/kw. $0.00 - 0 Switches . \ $0.00 ' - 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 •Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $0.00 : 0 - Misc.Conduit $18.20 1 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1 hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 , Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $42.80 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS 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: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. . 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. FOR INSPECTIONS CALL: (714)754-5626 244646(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the wo which this permit is Issued. 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 and policy number are: Carder: Policy Number: (This section need not be completed if the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the w k 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 'for ree that If I should become subject to the workers'compensation provisions of Section 370 of the Labor Code,I shall forthwith comply with thea ov o � �/ Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALT ES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license Is in full force and effect.Lic.# /7." Class# Contractors Signature: /"/(r% _ - Date: 4, I 0 - CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031,5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a pert$' subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,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(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above, unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire 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 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Doos or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes 0 No (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 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 temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the 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, 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application aggermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LI No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No B (If'yes',attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of 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 authorized by this permit until final inspection. Owner(s) by!J tOM / 0 Date aOf Le aluthorized Applicant / Date CODE I INSPECTION TYPE QhI IMRIALS ;OOEI INSPECTION TYPF gdg )EL$ 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical 1266 Pool Spa Final _ 208 Final Plumbing /�• 200 Final Re-Roof _ 210 Final Electrical • WD L/J 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 • Mac CITY OF COSTA MESA BUILDING DIVISION r� � DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER "1• PERMIT 4tb' "" P01-00499 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1930 KAUAI DR Status: ISSUED Suite No Applied: 08/20/2001 Issued: 08/20/2001 Vicinity: BACK YARD r jr ISSUED BY: Q�I/l1/J//��/� Parcel Nunmber: 13951108 Applicant: ERICHSON, FRANK Address: Phone: 949-683-5000 Zip: Owner: BECK, JAMES D Address 1930 KAUAI PL Phone: COSTA MESA, CA Zip: 92626 Contractor: THE WLB CORPORATION Address: 17780 FITCH AVENUE Phone: 949-250-8959 IRVINE,CA Zip: 92614 License: 524543 • Arch / Eng: • Address: Phone: Zip: License: SCOPE OF PERMIT GAS LINE FOR BARBEQUE IN REAR YARD OF A SINGLE FAMILY DWELLING. FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 • • Laundry Tub/Washer $0.00 0. Sump Pump $0.00 0 Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0 Backflow Preventer $0.00 0 P-Trap $0.00 0 Trap Primer $0.00 0 Bathtub $0.00 0 . Pressure Regulator $0.00 0 Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0. Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink, bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $6.15 1 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $29.65 COMMENTS (SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with ail applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work Is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. 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. FOR INSPECTIONS CALL: (714)754-5626 244646(6/00) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers 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 permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: • Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ 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 Callfornl:,an•agree that If I should become subject to the workers'compensation provisions of Sectlgq 3700 of t e Labor Code,I shall forthwith comply with these r• • i i//^,r'(,Jp Applicant Signature: 'd✓ Date: !/ / WARNING:FAILURE TO SEC RE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUEJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDRION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.B - , Class x / / Contractors Signature: 7�f Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:My city or 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 to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing 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 7031.5 by any applicant for a pernt subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,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(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I,as owner of the properly,em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet In depth Into which a person is required to descend,will be made In connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire 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 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (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 ono time has on hand a quantity of acutely 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 temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the 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. 4 If an RMPP is presently required,has Secti0n 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a_aemit for such construction or modification from the South Coast Air(Duality Management District or from any other air pollution control district or agency? U Yes LI No (Section 65850.2 of the California Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescnbed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given Is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of 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 authorized by this permit until final inspection. 6t •e:gal Owner(s) s lav/ d late An• •r Authorized Applican Date CODE( INSPECTIONTYPE gelE INRTIALS CODE( INSPECTIONTYPE E IE ItIIIDSLS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1288 Pool Spa Final 208 Final Plumbing ® 200 Final Re-Roof 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 +6 C.GJ PROJECTADORESS: 1930 KAUAI DR UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 064861 OWNER'S NAME: BECK, JAMES D CRIL ADDRESS: BECK, KATHLEEN M 1930 KAUAI PL FERMIT NO: P 064861 PLAN CHECK NO; N GOVT: N SUPP : N 's• COSTA MESA, CA 92626 CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: ADD ARCH/ENGINEER: REG.NO.:. JOB DESCRIPTION : 91SF TRELLIS, 80SF TRELLIS, 81SF ENTRY SQ FT; ADDRESS: UNIT: )CLAIM VALUE: CALL—VALUE: GROUP OCC : R-3 / PERMITTEE: WLB CORP ( 714r/60-0504 " n ADDRESS: 2921 CARED CCOMMENTS: REF: B-64547 N.H . CA 92660 4F*xatx8t*°E**+°******da+ ****+t**+ +C*ar+a**** *Br* "**at-*******BL* ****+r***->F** **u"u-*>F**>Erit** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING R EQU IR EMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect SETBACK S CITY LIC.: 05r,874 STATE LIC.: 52454 ' B • Date: A /y Signaluth rr# ica e of_ __ MAIN BUILDING ACCESSORY BUILDING /' WORKERS'COMPENSATION DECLARATION: I hereb n. consent to self-insure or a certificate of workers' FRNT: FT . IN REAR: FT IN FRNT: FT IN REAR: FT IN RGHT: FT IN LEFT LEFT: FT I Compensation Insurance,or a certified copy thereof(Section 3800.Lab.Cl ,N : FT IN RGHT: FT IN POLICY COMPANY:NO.: EXP.DATE: PARKING REQ: PROV: PARCEL: 13951108 INE: REF NO: ❑ Certified copy is hereby furnished- ❑ Certified copy is filed with the city Building Division. PLANNING NOTES> > date: Applicant: ******************************************************************************* EXEMPTION FROM WO ERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). D EV LOP MEN T SERVICES REQUIREMENTS I certify that in the p formance of the work for which this permit is' u II not ploy any person in any manner so as to become subject to}he Wo ers'Compensation Laws of California, ZONING APPROVED BY DATE: Date: CC signature: BUILDING APPROVED BY — NOTICE: .after making this declaration,you should become subject rhr orkers'Compensation provisions of the Labor T - DA 1 Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. •� r(7� CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y; Ey� DATE. 1 ' C.'I \ which this permit is issued(Section 3097.Civ.C). *.*****.***.N.*'**'****"k"*"***'***'**.**N'***ii s('• **+v• ***************************10 -tR*i *** LENDER: ******************************************************************************* ADDRESS: LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: thereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve.demolish,or PERMIT 5 00 repair any structure.prior to its issuance.also requires the applicant for such permit to tile a signed statement that he/she is licensed 25% _ - SMIP/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN and Professions Code)or that he/she is exempt therefrom 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 penalty of not more than five hundred dollars($500). ISSUE FEE 20, 00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the _ r structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS—— —> , 0 0 2 0 , 0 0 0 , 0 0 2 5 . 0 0 5 0 . 0 0 ❑ -25 . 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through , his or her own employees.provided that such improvements are not intended or offered for sale. If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 25 . 00 OVER/SHORT: 00 improvement se of salele) iesold )hm one year of completion,the owner will have the burden of proving he/she did not build or improve for the purpose BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I,as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 25 . 00 , ❑ and Professions Code: TheContractors'State LienseLaw does t appan owner of property who or,improves thereon and who contracts for such prolecls with a contraerLaidoese pursuant to the Contractors'StateLicense aw).I. aware ******************************************************************$*E********** that proof of their Worker's Compensation insurance should be provided to me. IND I VIDUAL F E E B. R E AK D OWN ❑ I am exempt under Section: B.8 P.C. - torthisreason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner: PLU 1 GAS PIPING SYS OF 1 TO A OUTLETS 5 . 00 - 5 . 00 1 do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES - 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I ha read this application and stale that the above information is correct.I agree to comply with all city and county ordinances and state la s relating to building construction and hereby authorize represe•atives of this city to enter upon the above-mentioned property for inspecti purposes. pDale: °7Signature: Di 00150494-00150494 TOT 25. OQ Driver's License or Social Security d: DATE: 11/12173 T 1 i1E: 02:12 I 164146 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue;Goldenrod—Assessor CONSTRUCTION AND PLANNING POOL 'A APPROVALS Permit# Date Inspector APPROVALS Permit=,'a` 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. 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 Connections 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Root 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 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 (Structurals & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. 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 l-12-‘g-41- COYL /an, 'vo. 36. Hood or Canopy /-3/-13-`7f=/t,m-zeifte_ g (;).r 37. Final Factory Fireplace e7-)7 ,7lf7 ,rte--_=3";L Pit770-.' 38. Final Plumbing J -/T5l-2_ / 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 +s 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date JApplicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. — PERM T O. TRACT NO. LOT NO. UNIT NO. 0165 I I �24�67 CITY OF COSTAfy/M�ESA CONSTRUCTION� PERMIT M 3/02 ga7.00 IL Project Address F"$30 TcG].t.l„0• l �l/S / t-, i{ p� TYPE OF CONSTRUCTION U NEW H ADD U ALTERATION ❑ REPAIR Applicant's Mailin Addr ss L=-]•�Z CX�`l�, C 4� t.--le:, ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone Owner's Nameti"l � P — DESCRIPTION OF WORK/USE OF BLDG. Z Address 1 AS six A . ! _!/I ! �A �i S Main Building: Accessory Building: wt� Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL E Front D \� Address —.1 El TENANT 111 ELECTRICAL 111 PLUMBING CI MECHANICAL A Rear N .. /rr l�N /` \ " x/71 _ i/_L.'7t. ❑ OTHER Contractor's NCa+e1 Ph9pe"a(p L1K1L� C Right • N Address(mailin• i f -AJ uc PROJECT DESCRIPTION SQ. FT. OCCUPANCY K r G ,rj�LJ7 l '^ Ae72R CON ST RUCTION TYPE VALUATION$ $ Left teCity License No. � J ZONE GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided •���j, E I hereby affirm that I'am licensed under provisions of Charter 9 (commencing Remarks: , • Planning Notes: RECEIVED NOV 1 3 iJt M with section 7000) of Division 3 of the Business and ...Professions Code, and R t T my license is in full force . d effect. a © L 1 Li tens5 Class � � �a. Li cg No �(p S IsNo Date�i—���Signature "_s PLUMBING FEES . WORKERS'COMPENSATION DE • RATION Bar Sink Showers ELECTRICAL FEES i *.\_, 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��/2,G � fAutomatic Washer Transformer ❑ 15-50 KW \ Policy N C a� (Company 1 r'1N`G\.tiL' ' Backflow Irrigation Sewer Cap Construction Pole Sub. • El50+ KW . S:artified copy is hereby furnished. . "Ce titled o`y d with the ci • Builds 9 Divisio Bathtubs Sewer Connection r Cooking Unit Meter ❑up to 100 amps Date Applican �? EXEMPTION FROM WORKERS'COMPENSATION 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 e'. 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 011/2-8 Workers' Compensation Laws of California. __ Date Signature - - Floor Drains Swimming Pool w/Spa F.A:U. Inc.Solar ❑9-15 HP 016-15+ NOTICE: It,after making this declaration, you should become subject to the — Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks : Urinal Fixtures comply with such provisions or this permit shall be deemed revoked. Microwave - - • CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet - I hereby affirm that there is a construction lending agency for the performance • Device Boxes Pole Light • of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors . Water Heater Outlets Lender's Name - . Range Lender's Address Kitchen Sink Water Service Switches OWNER BUILDER DECLARATION Sign I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash 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 Laundry Trays Generator ❑0-5 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 F the Contractor's License Law (Chapter 9(commencing with Section 7000) of Roof Drains Division 3 of the Business and Professions Code) or that he/she is exempt •erefrom and the basis for the alleged exemption. Any violation of Section ' 31.5 by any applicant for, a permit subjects the applicant to a civil ' natty of not more than five hundred dollars($500). ' Li 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 Boiler Hood or Type 0 DEVELOPMENT SERVICES REQUIREMENTS: , employees, provided that such improvements are not intended or offered for sale. If, however, the building 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 prove for the purpose of sale). / ❑ I,as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dat: ii a •I' 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 0100,000 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 Wain'❑ I am exempt under Section B. & P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ ISSUANCE ' $ (•� Dateowner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $• I hereby certify that I, have read this application and state that the above . ',2 '100,000 BTU ❑t00,000BTL1 /� ® ELECTR ICAL $ GRADING $ information is correct. I agree to comply with ail city and county ordinances - and state laws relating to building construction,and hereby authorize repre- sentatives • is city to e• er upo- the above-mentioned property for rr��..������,,�ta1,,yyrI��a inspect'• s. MECHANICAL $ gyp"""" TOTAL FEE $ 1 0C 11. 8•Sr7 DSirivers' i rrSS# '� - Date Reinspection Fee $15 Issue Fee • $ 3 --- PLAN CHECK 25% $ CMF 0865-46,rev.10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor h•. • CONSTRUCTION AND PLANNING POC 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-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 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 1.7. Rough Wiring Sign - 68. APPROVED FOR PLASTERING • 4E. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT • 720. Rough Factory Fireplace APPROVALS. Permit# 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑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 _/ Notes: 34. Final Heating & Air Conditioning ikeyer Lep 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 k 12/ 2, 43. Backflow Irrigation ( rr; 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 - -%r 51. CERTIFICATE OF OCCUPANCY No. Date • - _ Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. 'STY OE COSTA MESA P MIT I Q TRACT NO. LOT NO. BLDG.NO. Q NSTRUCTL .GON PERMIT OP — 7_, ....,4 (4,3 8¢ 1 263.65 TL Project Af&ess ' SO KV .0 AI St. \,_ TYPE OF CONSTRUCTION� J4� Ii2O/e2 Owner tYl lack1Y1RC gem Phone 54R 47r1 2 NEW u.QIOD 0 ALTERATION ' - Address S Wt ❑ REPAIR ❑ CONVERSION ❑DEMOLISH 3''i2YLt.1Ti..LC License No.-2I '-''1 ❑ OTHER ZONING REGULATIONS Arch/Eng. Address ^� 'CY_D ¢��� I DESCRIPTION OF WORK— f J'-i-io' s A.P. 1501 —511 — 08 ZONE p1,-.I PLNG.REF.Ss Contrac r`"i-•ov.12a> , Phone-771D—S TYPE OF PERMIT , BUILDING BUILDING , ������ SETBACK CIL PROPERTY LINE ot• Address ' 4J . ) �fc) . L.� �¢'tiA W Vel,. ❑ GRADING ❑ FOUNDATION STRUCTURAL SIDE YARD b i on . LICENSED CONTRACTOR DECLARATION 0 TENANT ❑ ELECTRICAL ❑PLUMBING ❑MECHANICAL siDE YARD I hereby affirm that I am licensed under provisions of Charter 9(coin- RIGHT 15r CY ± mencing with section 7000) of Division 3 of the Business and ❑ OTHER (S,Oy Professions Code, and my license Is in full force and ' feet . REAR YARD(TO P/L) ( PROJECT ESCR License Class cense No. - _� s„y sem. d eato PKG.SPACE REQ. ----7-' PROVIDED •� Date J IG Signet ure le---_1'L� ��� sQ.FT. `-' �_�I—�-�TI WORKERS'COMPENSATION DECLARATION OCCUPANCY NSTRUCTION TYPE V STREET WIDTH PARK FEE$ i , I hereby affirm that I have a certificate of consent to self-Insure or ZONING APPROVED By h( I DATE VALUATION �fl00NE Vel 1I1/�-L1�1 r certificate of Workers' Compensation Ins ante, or a certified cop f ( p thereof(Section 3800 Lab. C.). !7cs GRADING CU. YDS. C ACRES SPECIAL CONDITIONS: (7 ,P--"cy No. ''?L. -R"1 Company • .L-4.n. �1(1 M:�-�'1 her P!� /I `8� •mitred copy is hereby furnished. REMARKS:��{ / s 7,, -/ .MPTIOed copy ed with the cityCBuilding TION n. r�( f Y a /6 9• J 2 1 Iv, t%� ye/ EXEMPTION FROM WORKERS' COMPENSATION DECLARATION C7 GL. I (This section need not be completed if the permit is for one hundred ($100) or less). • 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 PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK subject to the Workers'Compensation Laws of California. UWELLINia GM HAb e. Date Signature BATHTUBS SHOWERS SO FT SO FT NOTICE: If after making this declaration, you should become subject TOILETS URINALS GENERATOR 0-1 KW_1-10 KW - ' to the Workers' Compensation provisions of the Labor Code,you must TRANSFORMER forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS - APPLIANCE 10-50 KW50+KW ' revoked. - CONSTRUCTION LENDING AGENCY KIT.SINKS DISHWASHERS MOTORS 0-1 HP 1-10 HP ' - I hereby affirm that there is a construction lending agency for the per- SERVICE SINKS SUMPS - - (INC.SOLAR) 10-50"HP 50+HP _ formance of the work for'which this permit Is issued (Section 3097 it - Civ. C.). FLOOR FLOOR DRAINS FIXTURES OUTLETS SWITCHES Lender's Name - ' • Lender's Address • - _ DRINKING FOUNTAINS GAS TUBE SIGNS OWNER BUILDER DECLARATION • • INTERCEPTORS CLARIFIERS POLE LIGHTS I hereby affirm that I am exempt from the Contractor's License Law for - the following reason (Section 7031.5 Business and Professions Code: SWIMMING POOL P TRAP • - LUNS I HUL I IUN - Any city or county which requires a permit to construct, alter, POLES METERED SUB improve,demolish or repair any structure, prior to Its Issuance,also re- WATER SERVICE ALTERATION PANELS MAIN SUB quires the applicant for such permit to file a signed statement that he Is licensed pursuant to the provisions of the Contractor's License Law GAS SERVICE OUTLETS • SERVICE AMP (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the WATER HEATERS BTU OUTPUT bask for the alleged exemption. Any violation of Section 7031.5 by a- oplicant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS c more than five hundred dollars ($500). L , as owner of the property,or my employees with wages as their SOLAR TANK COLLECTORS ' sole compensation, will do the work, and the structure is not intended or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. ISSUE FEE � //// Contractor's License Law does not apply to ansuch cowner a prs tyor APPLICATION APPROVED BY DATE//�/�' . who builds or improves thereon, and who does mph work tare himself of ISSUE FEE inrough his own employees, provided that such improvements not intended or offered forsale. If, letion, the buildingl or improvement MECHANICAL PLAN CHECK $U[v1MARY OF FEES is sold within one year of completion,the ownerfor will have the burden �� of proving he did not build or improve for the purpose of sale). HEATING SYSTEM 0-100,000 BTU BUILDING - ❑ I, as owner of the property, am exclusively contracting with PERMIT $ •�� SMTP b `� AND DUCTING licensed contractors to construct the project (Section 7044, Business 100,000 +BTU and Professions Code: The Contractor's License Law does not apply to PLAN CHECK 5 PERMIT ISSUANCE $ an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $'• tracts from such projects with a contractor(s) licesned pursuant to SYSTEM GRADING $ the Contractor's License Law). 100,000+BTU PLAN CHECK $ ❑ I am exempt under Section B.& P.C.for this BTU ELECTRICAL $ $ reasonMICROFILM 5 PLAN CHECK $ Date Owner SYSTEM REPAIR,ALTERATION TOTAL FEE$ I hereby certify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE MECHANICAL $ LESS , Information is carred. I agree to comply with all city and countyPLAN CHECK $ VANCE PC E_ preand state r TOconstruct'representativesthisenterto ups the above mentioned 261.6) property `aor41 purposes L Signature `^-+ 1[r. _rte Da �`i�2 C . $S'zo3 FINAL FEE $ Drivers'License or SS $ UUU ISSUE FEE CMF 0865-46 White-Building; Canary-Applicant;Pink-Accounting;Goldenrod-Assessor • • j CONSTRUCTION AND PLANNING POOL&SPA /r • APPROVALS Permit # Date Inspector APPROVALS _ . Permit# Date -Inseectorl' 1. Temporary Electrical Service or Pole • 43. Pool & Equipment Location 2. Soil Pipe-Undrgrn 44. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrn 45. Forms 4. Electrical Conduit-Undrgrn 46. Electrical Bonding 5. Steel Reinforce alt.) , ' harrig.ivae, 47. Rough Plumbing & Pressure Test 6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE 7. Footings ft., - �1N� / esob1r)'S '9 49. Electrical Conduit-Undrgrn 8. Foundation S.a.,,jA Q,s . 'D-5 -1S, Y3. 50. Gas Pipe, ❑Undrgrn, Test 9. Water Pipe-Undrgrn ------ • '51.- Backwash Lines. P-Trap. ❑ Undrgrn 10. Structural Floor System 52. APPROVAL TO DECK .11. Property Sewer Line & House Connection •53. Backwash & Receptor-Final 12. Street Sewer Connection 54. Heater & Vent-Final 13. Rough Plumbing 55 Plumbina System - Final 14. Rough Electric-Conduit -56. Electrical-Final 15. Rough Electric-Wiring 57. -Solar System-Final 16. Rough Heating & Air Conditioning b8. Fencing &Access Approval 17. Ducts, in Structure 59. APPROVED FOR PLASTERING 18. Ducts, Ventilating 19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL 20. Roof Framing 21. Roof Sheathings .�C3)5 - a-4 $+- 22. Frame and Flashing � 7y2 NOTES: 8 o JAL Ce �,,sa4 Yytcte�. a. 23. Insulation " h ( -D 24. Lathing & Siding ➢ S .S' 4..94_ 1.1 4-4 C�fl-, .J -s OuJA)¢A /_e, oQc c`c- .L14!X.41 25. Drywall Nailing , IeFS La&ti At_ S /-14•$'LCT 26. Plaster Brown Coat Y U 27. Electrical Power Meter-Final t 5 rt. 28. Final Electric V' 29. Final Heating & Air Conditioning 30. Final Gas Pipe-Test 31. Final Plumbing 32. Water Service-Final 33. Gas Service-Final - 34. Solar Domestic-Final • 35. Landscape Sprinkling System- - 36. Sound Attenuation 37. Handicap Regulations • 38. FINAL STRUCTURE & BUILDING DS t/S/S-y 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY 'Nd Date `ayta'ksa CITY OF COSTA MESA Y• X \ CALIFORNIA 92628-1200 P.0.BOX 1200 �I s I;ai A. ir.' DEVELOPMENT SERVICES DEPARTMENT October 25, 1984 Mr. & Mrs. Beck 1930 Kauai Street Costa Mesa, California 92626 Re: Permit No. Ba3C,u Dear Mr. & Mrs. Beck: The Building Safety Division of the City of Costa Mesa has asked this office to prosecute legal action against you concerning the above- referenced permit. It is our understanding that the permit has expired without canpletion of the required inspections and that enforcement personnel have tried to obtain your cooperation, without success. Please be advised that your failure to comply with inspection require- ments subjects you to criminal prosecution and penalties, as %ell as encumbering your property with an illegal structure. Please contact the Building Safety Division at 754-5273 immediately to arrange for compliance with legal requirements. Your failure to do so within ten (10) days £ran the date of this letter will result in the filing of criminal charges. Very truly yours, ELEANOR M. WEAVER Assistant City Attorney EVI4:hvan (A-1-14) Code Enforcement/Business License (714) 754-5234 Building Division (714) 754-5626 Planning Division (714) 754-5245 77 FAIR DRIVE Applicant to fill In all spaces within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA PEggIl����IT NO. TRACT NO. - LOT NO. •BLDG.NO. . CONSTRUCTION PERMIT /� <V7®l0 • 1930 Kauai Place TYPE OF CONSTRUCTION 2133 2/ 6/92 5.00 - Project Address .. Owner Jim Beck Phone 549-479" 0 NEW ri ADD 0 ALTERATION Address 1930 Kauai Place 0 REPAIR ❑.CONVERSION ❑DEMOLISH ZONING REGULATIONS Arch/Eng. License No. 0 OTHER A P DESCRIPTION OF WORK Address • - • - ,.ZONE PLNG. REF. Contractor Leaverton—Beck Phdne 979-356( TYPE OF PERMIT - . BUILDING Tp gt�I�pING AddressSETBACK CJL ST. PROPERTY LINE 16721 Hale, Irvine. Ca. 92714 0 GRADING 0 FOUNDATIONyy ' 0 STRUCTURAL SIDE YARD LICENSED CONTRACTOR DECLARATION . 0 TENANT 0 ELECTRICAL L'JPLUMBING ❑MECHANICAL SIDE YARD I hereby affirm that I am licensed under provisions of Charter 9(com- RIGHT mencing with section 7000) of Division 3 of the Business and 0 OTHER Professions Code, and my license Is In full force and effect. REAR YARD(TO P/L) PROJECT DESCRIPTION LicenseClassCSiu Uceni%Np.]�1. PKG.SPACE REQ. PROVIDED Date 2-16 82 signature ear SQ.FT. _ WORKERS'COMPENSATION DECLA ION _ OCCUPANCY_CONSTRUCTION TYPE STREET WIDTH PARK FEE$ I hereby affirm that I have a certificate of consent to self-insure or a VALUATION ZONE ZONING APPROVED BY DATE certificate of Workers' Compensation insurance, or-a-certified copy _ - SPECIAL CONDITIONS: thereof(Section 3800, Lab.C.). GRADING CU.YDS. ACRES Policy No. P22164 N Company Zenith"Inc. - . _ mo,.}}, rtified copy is filedby withrnishethe city Building Division. REMARKS: , _.. MPTION FROM WORKERS' COMPENSATION DECLARATION - - - (This section need not be completed if.the permit Is for one hundred - - ($100) or less). .. 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 PLUMBING - PLAN CHECK - ELECTRICAL " PLAN CHECK - subject to the WorkersCompensation Laws of California. •UW tLLIrv(a 1aAHA(aE • Date Signature BATHTUBS SHOWERS • 'SG FT CO FT - NOTICE: If after making this declaration, you should become subject TOILETS - - •• • URINALS - - , - • GENERATOR 0.1 KW_1-10 KW to the Workers' Compensation provisions of the Labor Code,you must TRANSFORMER forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAYS - APPLIANCE 10-50 KW_50+KW _ • revoked. - •_ _ . CONSTRUCTION LENDING AGENCY KIT.SINKS - DISHWASHERS MOTORS 0-1 HP 1-10 HP 1 hereby affirm that there Is a construction lending agency.for the per- SERVICE SINKS SUMPS - ' " (INC.SOLAR) 1030 HP 50+HP formance of the work for which this permit is issued (Section 3097 • Civ. - • - FLOOR SINKS FLOOR DRAINS- x FIXTURES OUTLETS SWITCHES Civ. C.).Lender's Name - ` r �_ " ' - • Lender's Address • DRINKING FOUNTAINS - ' GAS TUBE SIGNS - OWNER BUILDER DECLARATION - INTERCEPTORS CLARIFIERS POLE LIGHTS . I hereby affirm that I am exempt from the Contractor's License Law for - - the following reason (Section 7031.5 Business and Professions Code: SWIMMING POOL - P TRAP - - LUIS I Hut•I iuN Any city or county which requires a permit to construct, alter, POLES METERED SUB _ improve, demolish or repair any structure, prior to Its Issuance,also re- WATER SERVICE ALTERATION PANELS MAIN SUB quires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law GAS SERVICE / OUTLETS 3 _oz7 p-t+ SERVICE " AMP (Chapter 9 (commencing with Section 7000) of Division 3 Of the Business and Professions Code) or that he is exempt therefrom and the -WATER HEATERS BTU OUTPUT - - - . basis for the alleged exemption. Any violation of Section 7031.5 by a--- applicant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS - - . • t more than five hundred dollars (5500). - - as owner of the property, or my employees with wages as their SOLAR TANK COLLECTORS - soie compensation, will do the work,and the structure Is not intended . or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. ISSUE FEE Contractor's License Law does not apply to an owner of a property ''11 who builds or improves thereon, and who does such work himself or ISSUE FEE - 3 A.,c) APPLICATION APPROVED BY DATE through his own employees, provided that such Improvements are not - - intended or offered for sale. If, however, the building or improvement MECHANICAL PLAN CHECK SUMMARY OF FEES Is sold within one year of completion, the owner will have.the burden of proving he did not build or improve for the purpose of sale). BUILDING HEATING SYSTEM 0-100,000 BTU PERMIT III, as owner of the property, am exclusively contracting with AND DUCTING $ SMIP $ licensed contractors to construct the project (Section 7044, Business 100,000+ BTU PLAN CHECK $ PERMIT and Professions Code: The Contractor's License Law does not apply to t'a O ISSUANCE $ an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $ J tracts from such projects with a contractor(s) Iicesned pursuant to SYSTEM 100,000 +BTU PLAN CHECK $ GRADING $ the Contractor's License Law). ❑ I am exempt under Section B.8. P.C.for this - ELECTRICAL $ $ BOILERS BTU reasonMICROFILM $ PLAN CHECK $ Date Owner SYSTEM REPAIR,ALTERATION TOTAL FEE$ MECHANICAL $ I hereby certify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE PLAN CHECK $ LESS AD- information is correct. I agree to comply with all city and county VANCE PC $_ ordinances and state laws relating to construction,and hereby authorize representatives of Is ci y to enter upon the above mentioned property for ns n r se Signature ` ys i� Da - FINAL FEE E�� Drivers'License SS s ' ISSUE FEE • CMF 0865-46 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor CONSTRUCTION AND PLANNI G POOL&SPA - APPROVALS Permit# -; /'7 Date Inspector •APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location 2. Soil Pipe-Undrgrn 44. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrn 45. Forms • 4. Electrical Conduit-Undrgrn 46. Electrical Bonding 5. Steel Reinforce 47. Rough Plumbing & Pressure Test 6. Electrical UFER Gm 48. APPROVAL TO COVER-GUNITE 7. Footings 49. Electrical Conduit-Undrgrn 8. Foundation 50. Gas Pipe, ❑ Undrgrn,Test 9. Water Pipe-Undrgrn 51. Backwash Lines, P-Trap, ❑.Undrgrn 10. Structural Floor System 52. APPROVAL TO DECK 11. Property Sewer Line & House Connection - 53. Backwash & Receptor-Final • 12. Street Sewer Connection - 54. Heater & Vent-Final 13. Rough Plumbing . . , 55. Plumbing System -Final 14. Rough Electric-Conduit • •56. Electrical-Final 15. Rough Electric-Wiring 57. Solar System-Final 16. Rough Heating & Air Conditioning - - 58. Fencing &Access Approval 17. Ducts, in Structure 59. APPROVED FOR PLASTERING 18. Ducts, Ventilating 19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL • 20. Roof Framing t 21. Roof Sheathing • 22. Frame and Flashing NOTES: 23. Insulation •• e /7 ars✓Oy �' 'ai'J i-moi--r e'r 24. Lathing & Siding U l� 25. Drywall Nailing 26. Plaster Brown Coat • 27. Electrical Power Meter-Final _ 28. Final Electric - 1 29. Final Heating & Air Conditioning 30. Final Gas Pipe-Test gzff/,f:'g 31. Final Plumbing 32. Water Service-Final 33. Gas Service-Final 34. Solar Domestic-Final 35. Landscape Sprinkling System 36. Sound Attenuation 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No - Date Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. 1, CIT PIQF COSTA MESA PERMIT NO. . .. TRACT NO. - LOT NO. -BLDG.NO. . . . _ • - - _ __ . . . • CONSTRUCTION PERMIT EQ7�6. - - • - Project Address •N ',,o .pr UP.\ J .J Ir 0 '.:V",-- TYPE OF CONSTRUCTIONM2491 2/24/82 , - 8.72 TL Owner kVA�� a�(�.� • Phone549-!�fl 0 NEW 0 ADD y_7 ALTERATION L,�.r Q -- -. • Address•``-�",�K�e�_ 0 REPAIR 0 CONVfERSION 0 DEMOLISH ,/� ' -Arch/Eng. License No. 0 OTHER ZONING REGULATIONS - - - _ DESCRIPTION OF WORK + Address - ZONE -- - PLNG. REF.glf Contractor�71� �y PhoneN''r/1 . . BUILDING Tp U /.�/..{��/,Fi� �,GF,/JrI/ `!C, `}FfRJIISS TYPE OF PERMIT - SETBACKC/LST. PROPERTDYNLINE Address/73/L� SkN Lj-txl F.t/ - ❑ GRADING,s,� 0 FOUNDATION 0 STRUCTURAL - P SIDE YARD 'LICENSED CONTRACTOR DECLARATION LEFT ❑TENANT 1(1 ELECTRICAL ❑PLUMBING ❑MECHANICAL IDE YARD I hereby affirm thirt I am licensed under provisions of Charter 9 (corn- /� - •mencing with section 7000) of Division 3 of the Business and 0 OTHER Professions Co e, and my license -Is in full force-�andel effect. REAR YARD(TO'P/L) PROJECT DESCRIPTION License Class Its License N6PKG.SPACE REQ. PROVIDED Date Signature .7j&4- 7P9 SQ. FT. WORKERS'COMPENSATION DECLARATION OCCUPANCY_CONSTRUCTION TYPE STREET WIDTH PARK FEE $ I hereby affirm that I have a certificate of consent to self-insure or a VALUATION - ZONE ZONING APPROVED BY I DATE certificate of Workers' Compensation Insurance, Or a certified copy thereof (Section 3800, Lab.C.). GRADING CU.YDS. ACRES SPECIAL CONDITIONS: Policy No. Company - •- ',edified copy is hereby furnished. . REMARKS: t'1 �/�/ /� , :ertified copy is flied with the city Building Division. f� Of (O T EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred - ,_ _ ($100) or less). - • 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 PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK subject to the Workers'Compensati Laws of For 'BATHTUBS SHOWERS • LIWtLLINO UARAtat Date 2-'14-SI— Signature - SO FT SO FT NOTICE: If after making this declar tion, o should become subject TOILETS URINALS GENERATOR 0-1 KW_1-10 KW to the Workers' Compensation provisions of the Labor Code,you must TRANSFORMER forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAVS APPLIANCE 10-50 KW 50 + KW revoked. CONSTRUCTION LENDING AGENCY KIT.SINKS • DISHWASHERS MOTORS 0-1 HP_1-10 HP I hereby affirm that there is a construction lending agency for the per- SERVICE SINKS SUMPS (INC.SOLAR) 10-50 HP 50+HP . formance of the work for which this permit is issued (Section 3097 •Civ, C.). 'FLOOR SINKS FLOOR DRAINS - FIXTURES 5 - OUTLETS/(Q SWITCHES S• q!2 Lender's Name Lender's Address DRINKING FOUNTAINS GAS TUBE SIGNS OWNER BUILDER DECLARATION INTERCEPTORS CLARIFIERS' POLE LIGHTS - I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professions Code: SWIMMING POOL P TRAPLUNSI NULI IUN Any city or county which requires a permit to construct, alter, ' POLES" METERED SUB improve,demolish or repair any structure, prior to its issuance,also re- WATER SERVICE ALTERATION - - PANELS- MAIN • SUB quires the aro,licant for such permit to file a signed statement that he - is licensed pursuant to the provisions of the Contractor's License Law GASSERV ICE OUTLETS SERVICE. - AMP (Chapter 9 (commencing with Section 7000) of Division 3 of the - • . Business and Professions Code) or that he is exempt therefrom and the WATER HEATERS-- BTU OUTPUT - - - - .. basis for the alleged exemption. Any violation of Section 7031.5 by - - -5 i.applicant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS • • - - — . ymcit more than five hundred dollars ($500). aa��„„,� as owner-of the property; ormy employees with wages as their ' SOLAR TANK COLLECTORS •- sofe'compensation, will do the work, and the structure is not Intended or offered for sale. (Section 7044, Business and'Professions-Code: The SOLAR PIPING SYS. - ISSUE FEE - -- - - _� Contractor's License Law does not apply to an owner of a property '--4. who builds or improves thereon, and who does such work himself or ISSUE FEE APPLICATION APPROVED BY. _ • DATE ' through his own employees, provided that such improvements are not • intended or offered for sale. If, however, the building or improvement MECHANICAL PLAN CHECK ' is sold within one year of completion, the owner will have the burden SUMMARY OF FEES v of proving he did not build or improve for the purpose of sale). HEATING SYSTEM 0-100,000 BTU BUILDING - .. 0 I, as owner of the property, am exclusively contracting with PERMIT $ SMIP $ v licensed contractors to construct the project (Section 7044, Business AND DUCTING 100,000+ BTU • PLAN CHECK $ PERMIT �- and Prwn r of property.t: The C wilds or is prse hew tl , a not apply to - _ ISSUANCE S to ownrr of ch who with a improves thereon, and who con- REFRIGERATION 0-100,000 BTU - PLUMBING $ , tractshe tom such projects ), a contractor(s).licesned pursuant to SYSTEM GRADING $ • 1 the Contractor's License Law). 100;000+BTU PLAN CHECK $ {J - - 1 ❑ I am exempt under Section_ - -B.&-P.C.for this BOILERS BTU- - - ELECTRICAL $ Q �pl $ - season - - - _- • . . PLAN CHECK $ - " MICROFILM $ SYSTEM REPAIR,ALTERATION Date Owner_ _ TOTAL FEE$ Z I hereby certify that I have read this application and state that the above EXHAUST SYSTEM MULTIPLE MECHANICAL $ I- Information-is-correct. I agree to-comply with all city and county PLAN CHECK $ VANCE PC t ordinances and state laws relating to construction,and hereby authorize I _ $- ' 'd representatives of this cit to enter upon the above- mentioned'�/ e �/ ^ L property f pection p r Ose ZY—€` /L Signature ADate - - FINAL FEE $ Drivers' License 5S# . . . ISSUE FEE - - __ CMF 0865-46 White-Building; Canary-Applicant; Pink-Accounting;Goldenrod-Assessor CONSTRUCTION AND PLANNING POOL POOL&SPA • APPROVALS Permit # 4c2 Date inspector APPROVALS' , y Permit# _:. r -•• Date ' Inspector ' 1.. . Temporary_Electrical Service or Pole . ' 43. Pool & Equipment Location _"-' • - -. ' 2.. _ Soil Pipe-Undrgrn ' - '_ . _ . - _ _ - - _ - 44.. _Steel Reinforcement -" �'- - - -. .-_. - . ' - 3.-Electrical Conduit Utilit Undr rn _- -. __- _ 45. Forms - - - -' - - - - ---• - -,-- _1 4: --Electrical Conduif-Undr rn- - - - - - - - - - -- - • - - -- - - - 9 - - - -- --. r. - - --- - -- 46. Electrical Bonding _ 5._ . Steel.Reinforce, • -_ __ ... . _ . . . _ , 4Z. Rough Plumbing & Pressure Test-- -- -- - - - • Z. _Electrical.UFER.Grn__ _ ._ _ .- . , . 48.. APPROVAL TO COVER-GUNITE _ -. .;.- - ; '_-_7..-Footings- _ _ _ . . - _- . _ - • 49. Electrical Conduit-Undrgrn ' - .. _ . .. - 1; - 8-- Foundation- -. ------- --- --- -- :-. -- . 50.• -Gas Pipe, ❑Undrgrn,Test • '" . I. -9. - Water Pipe-Undrgrn - _ _- 51. Backwash Lines;P-Trap, ❑Undrgrri - '-- - - - - . --10. -Structural Flobr.System - _ _ - .. 1 .52. APPROVAL TO DECK ' - - .-. - - - . • 11. --Property Sewer.Line &-House Connection .. - - - - 53. Backwash & Receptor-Final - '._ 12: -Street-Sewer-Connection- -� - -. '- . . . - - -- - - 54. Heater &Vent-Final ' - 13. Rough.Plumbing. _. ____ ___ - ..-.. _ 55. Plumbing System - Final -- - ... --- . . _ ., 14. Rough Electric-Conduit _ - - •- '56:-` Electrical-Final ' - - "tl'." 15. Rough Electric-Wiring 2/2 Fut' - �U- - - 57.- Solar System-Final --- - - - .- - - .- ' 16. Rough-Heating & Air Conditioning _ - - - - - .-58. Fencing & Access Approval. , • ' 17 Ducts, in-Structure.; ` . - - __. t __ ,. - 59. APPROVED.FOR PLASTERING',.,. r.,. 18. Ducts, Ventilating- - ._ __ - - _ t - . . -- ._ _ _ -- _ - 19, Gas Pjpe=Rough &Test - 60. POOL/SPA SYSTEMS FINAL - , , 20. Roof•Framing - - _- -- -- - - - ,_ -- - - -, - ! 21: Roof'Sheathing. - . _ - . ' 'NOTES: - �' - ,, 1-- me and-Flashing '• - - - - - ' ' -23: Insulation -- -- -- - = . .' - - - - -. -- - - - - . . , 24. Lnthirg & Siding - -- - - - - -- - - - - - - - - . - 25. Drywall Nailing - c , - - - - ' - - _ _ 1 26. Plaster Brown Coat - • -- • - -- -- - - - - - I • • 27: Electrical Power Meter-Final • - - - - - -- - --- - - - - - - • ' 28. Final Electric - - -- -- ._ - 3/i/5L -/fG -- - - _ - - . , 29. Final Heating & Air Conditioning- - - - - - - - - • - 30. Final Gas Pipe-Test - - - - - _ _ - - -- . - ' - 31. ••Final,Plumbing - - - - - - - - - - • - ' 32. '-Water Service-Final , , - • .• . - ,- • - 33?- Gas Service:Final - - • - -- • - - - . - ., , • ' - . , 34. Solar Domestic=Final ' ' ' - _ _ " - . - 35. Landscape Sprinkling System - - . -. : - 36. Sound Attenuation - - _ 37. Handicap Regulations - - • -- - - - " . - ' 38. FINAL STRUCTURE & BUILDING _, ._ _ _ -. • • 4'• 39. Special Requirements Completed _ 40. Electric Release to Edison ••- __ i 41. Gas Release to Southern California Gas Co. , - •. - . 42. CERTIFICATE OF OCCUPANCY - - . --- - - ' - No._ Date 2_Z r Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - -- • • 7120 3/21 /80 • 275p G ,:;ITV OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. QT/ROACT LOT y0. UNIT NO. ProjectAddress kCJ O K AAAI 32�CJ C' l `' j - • • ' A4cani s'Mailing Addresss�-�C- "neTYPE OF CONSTRUCTION LI NEW El ADD U ALTERATION U REPAIR Owner's Name .,I^'v �`-` Phone^�'ZS ❑ CONVERSION El DEMOLISH ❑ OTHER A.P. A39 -,5 _0$ • I Zone RI DESCRIPTION OF WORK/USE OF BLDG. / Address �g Kra.\J) S Main Building: ' Accessory Building: , E 2 • Arch/Eng.^ °.r- License No. TYPE OF PERMIT U GRADING ❑ FOUNDATION ❑ STRUCTURAL T Front O Address \�' • -❑ TENANT ❑ ELECTRICAL. ❑ PLUMBING ❑ MECHANICAL .B Rear N • Contractor's Name \AI It.--LtGlv't Ar•!e,-1 l 4QO phone---110 IotZ ❑ OTHER ' `� �^, N PROJECT DESCRIPTION SQ. FT. �C°OOCCUPANCY 3 C Right G • Address)mailing) -#ZI }rIi61�LFZS 1rV11�`5Kao. U)1;joK Left ` s •� CONSTRUCTION TYPE v� VALUATION $ k000O $ B City License No. /, 2 e�G{j ZONE GRADING CU.YDS. ACRESE LICENSED CONTRACTOR DECLARATION '.' Ping. Ref.# Parking Req./Provided (Lte�nn �� I hereby affirm that I am licensed under provisions o Charter 9 (commencing Remarks:�7� fir s� s-I_�. �s per-., , ~ Planning Notes: ��y_}�s �')'L.C3 yy+ R/rtiM� M with section 7000) of Division 3 of the Business r Professions Code,and Velk/i Otri- t-,A- FT2R+0-frt 4• IC-sm°N - Y/1 n.f'tR' my license is In /�tJlJ force and effect. T �t� res 1 r� d $ License Class 15 -1 L.9--)v Li a 0.4c/sr'q' NMI GAv/-) siti •• Date 3--1 6 Signature - PLUMBING FEES • WORKERS'COMPENSATION DECLARATION Bar Sink I Showers Z(Tp ELECTRICAL FEES ' hereby affirm that I have a certificate of consent to self-insure or a certificate — Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink • Automatic Washer Transformer 0 15.50 KW ,800, Lab. C�.) •� on _ Policy No. O+S?j$-I t{"p i Company��� I-41�t0 Backflow Irrigation 0 50+ KW 8 Certified copyIs hereby _ g - Sewer Cap Construction Pole Sub. thehetl. Cert 1 co, Is,1f with the city leyiltling visio ' Bathtubs Sewer Connection . 0./ Cooking Unit Meter ❑up to 100 amps Date - Men Applicant 1 ),.Js` EXEMPTION FROM WORKERS'COMPENSATION ARATION • Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps (This section need not be completed if the permit is for on 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 An shall not employ any person in any manner so as to become subject to the Drinking Fountains • Solar Tank ` ' Fan Motors 00-1 HP 01'4-8 3 Ou I "\ Workers' Compensation Laws of California. — Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+ 6) NOTICE: if,after making this declaration,you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal I I Fixtures Microwave comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets I Water Closet Z 0') Devicejsoxes Pole Light ', I 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 Outlet Range t I r Lender's Name g M �]Q Lender's Address " - Kitchen Sink Water Service ea Switches Sign L} `V OWNER BUILDER DECLARATION .. • \� I hereby affirm that I am exempt from the Contractor's License Law for the •., Lavatories "� Auto-Wash y+/ Garbage Disposal Standing Sections ••••-a.. 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 .-r • Oivision 3 of the Business and Professions Code) or that he/she is exempt • ' terefrom and the basis for the alleged exemption, Any violation of Section )31.5 by any applicant for a permit subjects the applicant to a Civil - J • efnalty of not more than five hundred dollars($500). 'c I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee ' �' IU compensation, will do the work, and the structure is not intended or offered — - Reinspection Fee I $15 Issue Fee 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: / .�fir, s1 /� pA, employees, provided that such improvements are not Intended or offered for Boiler Hood or Type 0 ZoningApproved 8 r/ 'lJ"� Date J • • OLJ • sale. If, however, the building or Improvement is sold within one year of corn- Canopy Type II ❑ pp y • _ 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). 16 0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dat 7� �1 rC tractors to construct the project (Section 7044,Business and Professions Code: - '•• I 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 70 builds or improves thereon,and who contracts for such projects with a con- D__ tractor(s) license pursuant to the Contractor's License Law). I am aware thatyl SC BUILDING PERMIT $ 1/7 a SMTP $ ►' Exhaust System 0 Multiple 0 System Repair/Alteration Y proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ 74°r PERMIT 0 1 am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBO# Fire Dampers PLUMBING $ /3= ISSUANCE $ • Date Owner Heating System& Ducting Registers PLAN CHECK 25% $ Z CC' ENERGY P.C. $ i hereby certify that I have read this application and state that the above ❑0-100,000BTO 0100,000 BTL ELECTRICAL $ 3c!1 GRADING S information is correct, I agree to comply wi all city and county ordinances and state I ws relating to building co ru • , and hereby authorize repro- PLAN CHECK 50% $ it 3 MICROFILM $ sentatives •l t•'s city t. enter u•• t •ova-mentioned property for inspection • rp' e . Ilk ,.� Y c MECHANICAL $ IR SO TOTAL FEE $ 2—')S zG - Signature a. „re i" Date .1 $ ` 13 Drivers' License or SS# "_� Reinspection Fee $15 Issue Fee _$.B� PLAN CHECK 25% CMF 0865-46,rev. 10/84 White - Building; C. ark, - Applicant; Pink -Accounting; Goldenrod - Assessor . ` `. CONSTRUCTION ANI'PLANNING . - • • • POOL &SPA APPROVALS Permit# Date - Inspector APPROVALS Permit# Date Inspect\\ 11 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 UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7, Footings - 58. Electrical Conduit-Undrgrnd. •&: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 . 12. Sewer Cap 63. Heater & Vent-Final 13. Roof brains 64. Plumbing System - Final ' 14. Rough Plumbing Ylfr/ta [CD 65. Electrical-Final 15. Rough Electrical-Conduit �� / 66. Solar System-Final 16. Rough Electric Wiring y1ahe • rt/!.! _h 67. Fencing & Access Approval 17. Rough Wiring Sign V�'�'� 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 0 Oil 25. Roof Sheathing 74. Overhead Hydro 1 26. T-Bar Ceiling (Structural) & Monocoat r , 75. Dry Chemical _ 5 27. Frame and Flashing �p R- - -O... p . 76. Dry Standpipe - 28. Lathing & Siding ,!/A//u 77. FIXED SYSTEM FINAL 29. Insulationbelf 78. FIRE PREY. FINAL _- : 30. Drywall Nailing i )€ e 00 HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION - 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric -pp64,44_ Notes: 34. Final Heating & Air Conditioning 7. qW t D � L4 a o9AV75r 35. Final Gas Pipe-Test •�, 36. Hood or Canopy ' 37. Final Factory Fireplace - , 38. Final Plumbing 7-/-ft t-E ) - - 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 _ ' io46. Handicap Regulations � C47. FINAL STRUCTURE & BUILDING C /-:;*-- 48. Special Requirements Completed P q� ' ' ,, 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY - - . Date _ . ; `- PROJECTADDRESS: 1930 KAUAI DR UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 06486C ) OWNER'S NAME: BECK, JAMES D ADDRESS: BECK, KATHLEEN M PERMIT NO: E 064860 PLAN CHECK NO: N GOVT: N SUPP: N T 1930 KAUAI PL F COSTA MESA,CA 92626 CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: ADD ARCHIENGINEER: REG.NO.: JOB DESCRIPTION : 91SF TRELLIS, 80SF TRELLIS, 81SF ENTRY SQ FT: ADDRESS: UNIT: CLAIM VALUE: CALL—VALUE: GROUP OCC: R-3 / PERMITTEE: WLB CORP ( 714 )760-0504 ADDRESS: 2921 CAREE COMMENTS: REF: B-64547 N.B . CA 92660 ##################################################################>t#########.>t## LICENSED CONTRACTOR DECLARATION: I hereby atfirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 I the Business and Professions Code.and my license is in ful force and effect. SETBACKS CITY uc.: j33874 y� STATE LIC.: 5 2 4 /' _—• Date:I'/_ _AL/ Signa �a MAIN BUILDING ACCESSORY BUILDING WORN RS'C MPENSATIDN DECLARATION: Ihereb ave. le of consent to setbinsure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT : FT IN REAR: FT IN Compensation Insurance,or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ• PROV: PARCEL : 13951108 ZNE: REF NO: 0 Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING N TES> > r Date: Applicant: ###############################fM#iF############################################# EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This ,lion need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT S E" R V I C E S R E Q U I R E M E N T S I cenily Thal in the p ormance of the work for which This i shall no mploy any p;son in any manner so as to become • subject to the Wor rs'Compensation Laws of Califon ZONING APPROVED BY DATE -2-----Date: -2----- Signet ' V)a BUILDING APPROVED BY �— : DATE: NO CE:If.alter making this declaration.you should•ecome subjec to the Workers'Compensation prowsio • •• .bon Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. q CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y: e, DATE : I i Fill(l ) which this permit is issued)Section 3097.Civ.C). ################################## " ' • #############i iFTFii:••.7F TF## LENDER: ############################################################################### ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct.alter,improve,demolish,or PERMIT 3 . 00 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 5,0% SMIP/NON—RES pursuant to the provisions of the Contractors'Slate License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN and Professions Code)or that he/she is exempt therefrom 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 penalty of not mare than five hundred dollars(S50W. ISSUE FEE 15,00 I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE pVTOTALS----> 3 , 00 15 . 00 0 , 00 18 . 00 18 , 00 . 00 ❑ structureisnot intendedorofferedforsale(Section7044,iBprovessheron,fandi who Code: The Contractors' License 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 employees,provided that such improvements are not intended or offered for sale.If,however the building or REVENUE DIVISION TOTALS--> COLLECTED: 18 . 00 OVER/SHORT: . 00 improvemento is of sle). one year of completion.the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK for the entis of sale). I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 18 . 00 ❑ and Professions Code: The Contractors'State 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)license pursuant to the Contractors'State License Law).I am aware #############################Oe#################Oc############################### that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BR E AK DOWN ❑ I am exempt under Section: B.&P.C. forma reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: Owner ELE 4 FIXTURES, LIGHTING 1 ST 20 EA, , 753 , 00 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that 1 h e read this application and state that the above information is correct.I agree to comply with all city and county ordinances and state la.s relating to building construction and hereby authorize representatives of this city to enter upon the above.menlioned property for inspecti purposes. 01. 00150493-00150493 TT 1 T 188,00 �,. Date: Signature DATE: 11/12/93 TILE: 08: 11 Driver's License or Social Security a: 1641-46 white—Building;Green—Code Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor CONSTRUCTION AND PLANNING POOL .,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 UFER 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 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 1 16. Rough Electric Wiring )f jf 3, 121A 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-7 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final / q 80. FOOD CERTIFICATE ISSUED 33. Final Electric i1 qNotes: 34. Final Heating & Air Conditioning f 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 1 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 1930 KAUAI DR UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: B 064547 OWNER'S NAME: BECK, JAMES D ADDRESS: BECK, KATHLEEN M PERMIT NO: B 064547 PLAN CHECK NO: 04096-93 L GOVT: N SUPP: N 1930 KAUAI PL COSTA MESA, CA 92626 CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ADD ARCH/ENGINEER: REG.NO.: ADDRESS: 22445 CONOVER C1� 07 JOB DESCRIPTION : 91SF TRELLIS, 80SF TRELLIS, 81SF ENTRY SQ FT: 2, 252 22445 LA PALMA AV E YORBA LINDA CA 92687 CLAIM VALUE: 8 , 000 . 00 CALC—VALUE: 5, 729 . 60 GROUP OCC: R-3 / PERMITTEE: ADDRESS: WLBCORP ( 714 ) 760-0504 2971 CAREB COMMENTS : CALIFORNIA FRAME PART OF ROOF, MISC FACADE IMPROV, N.H . CA 92660 ********************+r****************yr*eta-**********eP*****+C********************* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am Iden d under provisions of Chapter 9(commencing with Section Z ONING R EQU IR EMEN TS 7000)of Division 3 of the Business and Professions Code,and my licens is in lull farce and effect. SETBACKS CITY uc.: 05$ 7�4 /�psra,�TEuc.:524543 S Date:_AA signature:— — � MAIN BUILDING ACCESSORY BUILDING WORKERS'Copppl����PENSATI�N DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: 20 FT IN REAR: 15 FT IN FRNT: FT IN REAR : FT IN Compensation Insurance,or a certified copy thereof(Section 3800.Lab.C). LEFT: 5 FT IN RGHT: 5 FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL: 13951108 ZNE: R1 REF NO: ❑ Certified copyishereby urnished. .Q Certifieacloyisfiled wit the city Building Division PLANNING NOTES.>• ADD'%•2_TRELLISSES TO REAR OF HOUSE; ADD CANOPY TO SIDE- OF -> HOUSE; ADD SRCHITECTURAL POP—OUTS TO FRONT. NO BAY WINDOW. Date: 4A/Zo�47 :. APPlicantyY /ACA **************.*****if*********.fE)f*******************************************i!**** 1. EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for ane hundred($100)or less). D E V Et L O P MEN T' S E R V I C E S' R E Q U I R E M E N'"•T S 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 t1_ �. �.' /.-'�? 4— p subject to the Workers-Compensation Lass of California.- ZONING APPROVED BY ' ,�. 1' 1 DATE: :�0 � 1 3 :' /.• Date: i Signature: ✓L / ' NOTICE:If.alter making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BAY 5�M / ej°il DATE: ' 0 eo 77 Code,you must forthwith comply wim'such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that,there is a construction lending agency for the performance of the work for APPLICATION ISSUED ,B Y:a i'•' /`/� i o fl 5'' which this permit is issued(Section 3097'Civ.C). i' kqr DATE:**************ak****lE**.******'***** *********iF******************* . :. . .. • ** LENDER: *************1E'******9E******W*************************************************** ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT :Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES. (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish.or PERMIT 8 1 , 0 0 GRADING repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 5 7 pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business SMIP/NON-R E S 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 52 , 65 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE rh I. as owner of the property or my employees with wages as 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 sale(Section 7044.Business and Professional Code: The Contractors'Slate License Law TOTALS----> 81 . 57 0 . 00 52 . 65 134 . 22 134 . 22 . 00 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 employees,provided that such improvements are not intended or offered for sale. If,however the building or `/; improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED• 134 . 22 OVER/SHORT• /_. ,00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING AN—CHECK I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 81 . 00 , 57 '' 52 . 65 ❑ and Professions Code: The Contractors'State License Law does not apply ban owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law),l am aware ,***,N,**********,*,*****,************************************************* ******** that proof of their Worker's Compensation insurance should be provided to me ❑ I am exempt under Section: B.&P.C. IND I V IDUAL F E E BREAKDOWN for this reason: TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Date: I Owner: SFR 171 RES—PATIO COVER—POST I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505.25533.and S PATIO 0 ER—POST & TRELLIS 14 , 80 , 530 , 80 25534 and that I or any future building occupant will/will not(circle one)need to comply with said slate codes and the requirements for a SFR 81 RES—PATIO COVER—POST & SOLID ROOF 14 . 80 1 , 98 . 80 permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from SFR 2000 ALTER BY VALUE RESIDENTIAL NOZONE 1 , 00 2, 0 , Q0 these provisions. END OF FEES i , Date: Applicant' I hereby certify that I have read this application and stale that the ab ye information is correct.I agree to comply with all city and county ' ordinances and stale ws relating o building construction and hereby ihorize representatives of lhi cit to enter upon theabove-mentioned property fannspen purpo Date: 4/2, 470 4705 Signatur . 01 00149210-00149212 1-1-07r 134.22 Driver's License or Social Security n: ) DATE: 10/20/93 TIME: 09:59 1641-46 While—Building:Green—Code Enforcement:Canary—Applicant;Pink—Revenue:Goldenrod—Assessor • CONSTRUCTION AND PLANNING POO, 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 U{ility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement /TZ713 Geyp 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. / 57. APPROVAL TO COVER-GUNITE 7. Footings 27-23 �` W� 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# j • 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 /r/B...g7 (,t/4- 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27.'Frame and Flashing 16-16,1-3 4j C976: Dry Standpipe 28. Lathing & Siding 11-22-11 �'W/ 77, FIXED SYSTEM FINAL 29. Insulation - V 78. FIRE PREY, FINAL 30. Drywall Nailing / / HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat /O/f5 79. FINAL INSPECTION 32. Electrical Power Meter-Final 7" .80. FOOD CERTIFICATE ISSUED 33. Final Electric t_LK_cut, 6It. �p--hl'rcs4 34. Final Heating&Air Conditioning 40_440 35. Final Gas Pipe•Test Q 36. Hood or Canopy dlr." 1 37. Final Factory Fireplace r . 38. Final Plumbing /i 13.-Crei /1 - Ay 4.4144- • 39. Water Service-Final /T 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer • 43. Backflow Irrigation I 44. Landscape Irrigation System . 45. Sound Attenuation - • 46. Handicap Regulations n 47. FINAL STRUCTURE & BUILDING /-z7..Ggq (c.4...64- S-_ ,1 g,„, a-b _ �.. // 48. FINAL PLANNING (1` 15- �9� 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Lot 7 - Tract 6384 Plan3-AR ' PAID .2.7:40(93 PAY 25-67E RAQ01399* *** 147.E 0 COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 917 COSTA MESA, CALIFORNIA For Applicant to Fill In Completely APPLICATION FOR PERMIT TYPE OR PRINT BUILDING BUILDING ADDRESS 1930 Kauai Place COSTA MESA. CALIFORNIA For Office Use Only oWNEclub House Road Joint Venture I RECEIPT NO. 11k1 MAIL RECB '�• RECEIVED E SUED ADDRESS 2850 Mesa Verde Drive (%r_ ... 137-,-2.2-671 . 'R4.a.-S CITY Costa Mesa NE0149-039° BUILDING ADDRESS OR ENGIINEER E.G. Kaltenbach NEo`54 7-804E COSTA MESA. CALIFORNIAI ADDRESS1823 E. 17th St, Santa Ana ZONE TYPE �/ GROUP c If CONTRACTOR Republic Homes Corp. APBYPROVED DATE ADDRESS 2850 Mesa Verde Drive ZONING fy, ZONENO.OF ^ USE OF NEW blab' CITY Costa Mesa 2 )H PLANS 2---BUILDING GV n LIC LEGAL NO. 197838 TEL. 549-0395 _ DESCRIPTION ./' 7, 7`P, ( ,gcf SIZE NO. OF OF LOT 60.44 x 100 I I NOW ON LOTS A.P.NO. USE OF YARDS EVES EXISTING BLDG. APPROVED ALLOWED SETBACK LINE FROMI 1 (CENTER LINE ST.) CENTER OF STREET 43 REAR YARD 32 FRONTFT. IN. SIDE YARD I LEFT 5 1 I RIGHT 5 1 R.SIDE S----FT. IN. DESCRIPTION OF WORK r__ L.SIDE �]J FT. IN. • ep NEW I X II ALTERATION I II ADDITION I REAR 3F 7-/T. �j IN. REPAIR II MOVING I II DEMOLISH I BYPROVED([l d I �' 5---- 0 DATE J - i-l'G17 $ZELDING2478sq• f t ROOMS 9 STORIES 2 ` 6C-7 i EXTERIOR WALL.�W00d&I ROOF COVERING JtuCCO COVERING Wood USE OF BUILDING AND WORK TO BE PERFORMED 1---, /frAl --. I HEREBY ACKNOWLEDGE THAT I HAVE R' • THIS APPLICATION THE AMOUNT SHOW NDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF, ESTABUSHING A PERMIT FEE ONLY. PLY WITH ALL C ORDINANCES AND STA LAWS REGULATING BUILDING cONrno / VALUATION q SIGNATOR _ Healt. PERMIT FEE $ /I-- N PERM ITTEFT ) n 1��✓p $ 3�l `� L PLAN CHECK $ 4/F� AUTHORIZED A����F�y���!C /-� H TOTAL FEE $ // _n