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HomeMy WebLinkAbout1216 LAS ARENAS WAY - Building Permits CITY OF COSTA MESA BUILDING DIVISION • -' DEVELOPMENT SERVICES DEPARTMENT PE MIT NUMBER r •• PERMIT 0,e@' B03-02023 (714)754-5273 • Fax(714)754-4856 • www.cl.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 1216 LAS ARENAS WY Status: ISSUED Suite: Applied: 11/21/2003 Vicinity: BATHROOM Issued: 11/21/2003 Parcel Number: 93633017 Zoning: Applicant: POLING, RYAN ISSUED BY: Address: 10661 ELLIS AVE UNIT G Phone: (714)968-3555 FOUNTAIN VALLEY,CA Zip: 92708 Owner: SPEIRS, DAVID H Address 1216 LAS ARENAS WY Phone: COSTA MESA,CA Zip: 92627 Contractor: ANTOINES INTERNATIONAL TILE & MARBLE Address: 10661 ELLIS AVE UNIT G Phone: (714)968-3555 FOUNTAIN VALLEY,CA Zip: 92708 License: 667375 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REMODEL EXISTING BATHROOM.WORK TO INCLUDE:REMOVE SHOWER,ADD AND RELOCATE ELECTRICAL FIXTURES,REPLACE VENT FAN, REPLACE BATHTUB.INTERIOR WORK ONLY. FEE SUMMARY Plan Check: $0.00 Calc Valuation: $17,000.00 Permit: $279.25 Claim Valuation: $17,000.00 SMIP Res: $1.70 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $280.95 PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. • INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2448-48 WOO) DECLARATIONS WORKER$'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: 0 ❑ 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, .DJ 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. v My workers'compensation Insurance carrier-� and olicy,Inumber are: Carder • C),I A-P C Wl zSLAT) 0 V\ M f� �t 51Arrevr p 1' Policy Number: )1.75191-1-2.-D0 -3 (This section need not be completed if the perm plif 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 California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these prowSG'+' sss...Appl WARNING FAILURE T dtRE X v✓ AGE I U YER EN Z A D Q THOU AN:FAILURE E( 10 RE W ERS'COMPENSATION COST O PENS ONUNLAWFUL AND SHALL ID DIFOR I AN EMTOY37 TO THECRIMINAL PENALTIES AND CIVIL FINES TP N ONE'SHUNDRED THOUSAND DOLLARE($100,000),IN DDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060E THE LABOR INTEREST,CADE, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licen a under provisionsjof Chapter 9(commencing with Section 7000)of Division 3 of the Businewnd Profes Ions Code and my license Is In full force and effect.Lic.N 7 3 .. Class x . ' k-I Contractors Signature: -L b - �i,.���C/ Date: j ) -- p 3 CONSTRUCTION LENDING AG t/ ❑ 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 permit 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 havetheburden 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,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: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response t0 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). _—. _.._ nfofor acutely hazardous s __...._.._ _ _ __. 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑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 gppplication aPpermit 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 IJ 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 o1 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 ❑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. /f Signatu Legal wner(s) Date ////r"3,r"—� u "-- 71 — D /` A Or Authorized Appll nt Date CODE t INSPECTION TYPE PAIL MALE 900Et INSPECTION TYPE PAIL PO7➢EL$ 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 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site �j � ,�L 204 Final Demolition 250 Final Building/Occupancy e>-1 / -by CQu„ cord -co,...) • • 0 .(19. * 0 • (reser AzcicJ) Ji • ( kc-cicoi Layovt- -- Qec.L.o 39 " t 91 " l• \i. a7 , \ ` I rt—Th (fmAXI rjscif -ao Slaves a7 Oil &I9Oil( wi& ) i 1 c 1 i <> _yee---- _ I 161er 1--Q ! I car> eXiM��cJ i s Kns � � Ca�et\5 H ,5w11:.E- �� Clost "1 37 jc (ecth t \ (c ,F. _) I7g „ ��s J •� CITY OF COSTA MESA 4 '@ BUILDING DIVISION F • •,,' ,i a DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER yIPINO / PERMIT raoa�„y° • M03-00617 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, OSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 1216 LAS ARENAS WY Status: ISSUED Suite No Applied: 11/21/2003 Issued: 11/21/2003 Vicinity: Parcel Number: 93633017 ISSUED BY: Applicant: POLING, RYAN Address: 10661 ELLIS AVE - - UNIT G - Phone: (714)968-3555 FOUNTAIN VALLEY,CA Zip: 92708 Owner SPEIRS,,DAVID H Address: 1216 LAS ARENAS WY Phone: COSTA MESA,CA Zip: 92627 Contractor ANTOINES INTERNATIONAL TILE & MARBLE Address: 10661 ELLIS AVE UNIT G Phone: (714)968-3555 FOUNTAIN VALLEY,CA Zip: 92708 License:667375 SCOPE OF PERMIT REMODEL EXISTING BATHROOM.WORK TO INCLUDE:REMOVE SHOWER,ADD AND RELOCATE ELECTRICAL FIXTURES,REPLACE VENT FAN,REPLACE BATHTUB. INTERIOR WORK ONLY. REF.:B03-02023 - - MECHANICAL TO INCLUDE: 1 VENT FAN. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 . Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 _ - - - Commercial Incinerator $0.00 0 Refit Sys<100 k BTU $0.00 0 - Domestic Incinerator - $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 - 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace' $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $7.25 1 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers ' $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent ' $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 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(600) DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: O 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 l"`/work for which this permit is issued. 777 14' 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 andel poll /number are: Carrier: 5 4-P C(�Vt) ( b vt sa T i 0 Ll I715✓11'QMcp 4P-idPolicy Number 107S)`7/-7, y 3 (This section need not be completed if the ermit 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 California,and agree that it I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pro ons. / Applicant Signature: / ( � / Date: 2-( — 0 3 WARNING:FAILURE TO SE RE. RKERS'COMPENSATION COVEfiAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL ENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE(6100,000), ADDITION TO THE COST OFCOMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am liter ed under provisio'ys of Chapter 9(commencing with Section 7000)of Division 3 of the Busines and P51/4-141 (' rofe SI s CoAe,and my license Is in full force and effect.Lie.# (0 417 3 u] n Class# F7 C J 4 1 ( Contractors Signature: b 7-f - Date: I) —' 1-- 0 3 CONSTRUCTION LENDING A NCY: CCC/// ❑ 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: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 permit 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,Op 2,Art 2,Sec. 341,Title 8,California Administrative Cafe). ❑ 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 ❑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 _._ �...__... ._ _._ _ _.ihes_._ _...._ _ ___... 5 Does or willo the applicant or present ar emen building occupant at any other for the work which isi the subject of this application apermil for such construction or modification Iron the South Coast Air Quality Management District or from other air pollution control district or agency? (J Yes ❑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 pert 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 Califomla Health and Safety Code). 7 If a permit from the South Coast All 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 Califomla Health end 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. SI. ,I e0f -•al Owner(s) /f ^24 Owner(s) Date of . A'd/Or Authorized •pplicant Date ODE I INSPECTION TYPE PAIR P(IIDALS coDEt INSPECTIONTYPE PAIL 1616 Fixed System Final Fire Prevention 206 Final Mechanical 330.0 1 dr 1266 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 ,41111 CITY OF COSTA MESA BUILDING DIVISION ). N.j ,I DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F I w._.±�. I MS PERMIT Ep3_p1 96 44r441.(714)754-05.273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 1216 LAS ARENAS WY Status: ISSUED Suite No Applied: 11/21/2003 Vicinity: Issued: 11/21/2003 Parcel Nunmber: 93633017 ` 0� '��(-�=2 / / Applicant: POLING, RYAN ISSUED BY: J, _ Address: 10661 ELLIS AVE UNIT G Phone: (714)968-3555 FOUNTAIN VALLEY,CA Zip: 92708 Owner: ' SPEIRS, DAVID H Address .1216 LAS ARENAS WY Phone: COSTA MESA,CA Zip: 92627 Contractor: ANTOINES INTERNATIONAL TILE & MARBLE Address: 10661 ELLIS AVE UNIT G - Phone: (714)968-3555 FOUNTAIN VALLEY,CA - Zip: 92708 License: 667375 SCOPE OF PERMIT REMODEL EXISTING BATHROOM.WORK TO INCLUDE:REMOVE SHOWER,ADD AND RELOCATE ELECTRICAL FIXTURES,REPLACE VENT FAN,REPLACE BATHTUB. INTERIOR WORK ONLY. ELECTRICAL TO INCLUDE:5 LIGHT FIXTURES,2 OUTLETS,4 SWITCHES,AND 1 MOTOR TO 1 HP. 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 $5.50 5 up to 50 kva/kw $0.00 0 Recept Outlets $2.20 2 up to 100 kva/kw $0.00 0 Switches $4.40 4 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 I Ckt $0.00 0 Service to 200a $0.00 0 Misc.Conduit $0.00 0 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 $4.75 1 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 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 and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 o1 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 S hTl ompensation Insurance carrier and policy number are: 1 1 1 Carrier: 5i-Ud-O I OVvt op v\ l pts In wat Slir1 ft! Policy Number: /675I�` - 7i 003 (This section need not be complete i/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 California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pro ns.ApplicJ Z - D 1 WARNIntNG: SignaFMLU ET: / Date: WARNING:FAILURE TO S URE RKERS'COMPENSATION COVE GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND COAL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000), ADDITION TO THE COST OF COMP NSATION,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 licens and rovisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,end my license is in full force and effect.Lie.It (D 7� -7 Class xC Sia, C Contractors Signature: A 7...6•4---ell-----4--9Date: )i— 2 / — 0 .3 CONSTRUCTION LENDING AGENCY: 7 ❑ 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: _ 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 end 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 permit 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 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: 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 �❑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 a plication appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? DI Yes LJ 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 feel 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 II 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're.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 end 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. ���--�//�— / gnatur f Legal Owner(s) / / _ ODate UAnd/Or Auihortz�d Applicant /� Date CODE I INSPECTION TYPE PATE num CODE! INSPECTIONTYPE ME EMI1DEL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical vst 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 CITY OF COSTA MESA < BUILDING DIVISION FrJ , 8 DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER I w:".'�.:1r ilC O PERMIT "Nm a 3-00773 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 1216 LAS ARENAS WY Status: ISSUED Suite No Applied: 11/21/2003 Issued: 11/21/2003 Vicinity: Parcel Nunmber: 93633017 ISSUED BY: Applicant: POLING, RYAN,' Address: 10661 ELLIS AVE UNIT G - Phone: (714)968-3555 FOUNTAIN VALLEY,CA Zip: 92708 Owner:' SPEIRS, DAVID H Address 1216 LAS ARENAS WY Phone: COSTA MESA,CA Zip: 92627 Contractor: ANTOINES INTERNATIONAL TILE& MARBLE Address: 10661 ELLIS AVE UNIT G Phone: (714)968-3555 FOUNTAIN VALLEY,CA Zip: 92708 License: 667375 • Arch / Eng: __ _ _ _ _ . Address: Phone: Zip: -- License: • SCOPE OF PERMIT REMODEL EXISTING BATHROOM.WORK TO INCLUDE: REMOVE SHOWER,ADD AND RELOCATE ELECTRICAL FIXTURES, REPLACE VENT FAN, REPLACE BATHTUB. INTERIOR WORK ONLY.REF.: B03-02023 PLUMBING TO INCLUDE: 1 BATHTUB, 1 SHOWER, 1 WASH BASIN AND 1 WATER CLOSET. 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 '$9.80 1 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 $9.80 1 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) $9.80 1 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 periost 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 thispermit. FOR INSPECTIOi'1S CALL: (714)754-5626 2446-46(8/00) 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 anq policy number are: � G 1 Carrier: 54-A}P CoVn 1^5A I &V\ )vIss LAVA &ce F-v+ hG'7_J d Policy Number: L ) 14L - 2-003 (This section need not be completed if a 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 California,and agree that If I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pro ens. ) Applicant Signature: IGci b Date: 1/'Z/ - O-3 WARNING:FAILURE TO SECURE KERS'COMPENSATION COVE GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),I DDITION TO THE COST OF NSATION,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 rovision f Chapter 9(commencing with Section 7000)of Division 3 of the Busine an PGroferssfiionns1C�odeend my license is in full force andt 'sect.Lic.a Dates: N ;I `-•1 fT l Contractors Signature: /Gv�^ � Date: �) —2 t — d` 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: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 permit 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 00 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 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 em exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,Le.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O 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 then thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California 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 flied 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 apartment of en 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? ❑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 apermit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? Yes tJ 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 pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ti Yes ❑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 ❑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. Signature eget O er(s) ) Date 0 An Authorized Applican Date 3 WOE I INSPECTIONTYPE • gag ?MALS g00E( INSPFCI10N TYPE PAIL IKOALs 1616 Fixed System Final Fire Prevention 206 Final Mechanical _ 1266 Pool Spa Final 208 Final Plumbing 3 S�9y 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 1 202 Final Factory Fire Place 220 Final Planning Approval _ 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy NAM N PROJECT ADDRESS: 1216 LAS ARENAS WY UNIT: CITY OF COSTA MESA - BUILDING PERMIT PERM NO; P 063064 -...- OWNER'S NAME:GEORGE MINOR ADDRESS: 1216 LAS ARENAS WY PERMIT NO: P 063064 PLAN CHECK NO: N GOVT: N SUPP: N COSTA MESA CA 92626 CONSTRUCTION TYPE: 5-N PERMIT TYPE: PLU PURPOSE: REP (714 ) 645-6202 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : REPAIR TO SEWER LINE SQ FT: ADDRESS: UNIT: CLAIM VALUE: CALL-VALUE: GROUP OCC: R-1 / PERMITTEE:C & R DRAINS ( 714 ) 641-1545 ADDRESS: 1525 W MACAURTHUR 11 COMMENTS; RETAINING WALL REPAIR ON PERMIT #E62979 / REPLACES EXPIRED P59204 COSTA MESA CA 92626 ********4**********************,E****************** * * **** **** t*****:E******** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS CITY tic.:0450 1 4 STATE LIC.5 31746 cLASs:C-36 6C ? z_-- MAIN BUILDING ACCESSORY BUILDING Date: "7— /4 q Signature: oeFRNT; FT IN REAR : FT IN FRNT; FT IN REAR: FT IN WORKERS'COMPENSATION DECLARATION: Ihere affirm that l have a certificate of consent to sell-insure or a certificate of Workers' LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN POLICY NO.:1 U Compensation Ing$ppranoe.pr iertifipq�Q,,ffiiopy there (Section 3800,Lab.C � `J3 EXP.DATE: 0 /01 /94 comrmNY:STATE FUND PARKING PAARKINGGREQ.EQIES> PROV: PARCEL ; 93633017 'CNE: REF NO; ❑ Cerlilied copy is hereby furnished. LJ Certified copy is filed with the city Building Division. > ii ___— Date' /LH/ —9's3 Applicant: -27-- 14*********************************1E1E4E*********16-11.***-X1******X4E4F)P441A44*********PE*FE** EXEMPTION FROM WORKERS'COMPENSATION DECLARA . (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SER V I C E S-'..-/ R E Q U I R EMENT $ I certify that in the pedormance of the work for whi is permit is issued,IShall'not employ any person in any manner so as to become ' subject to the Workers'Compensation Laws of California. •/ . ZONING APPROVED BY i- DATE: • Date: Signature: NOTICE:If,after making this declaration,you should become subject to the Workers'Compensation provisions of the Labor BUILDING APPROVED BY : DATE: Code.you must forthwith comply with such provisions or this permit shall'be deemed revoked. 1. ', / / CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work far APPLICATION ISSUED B Y: �CS - ,+IT; • 4� DATE: 7SE * which this permit is issued(Section 3097,Civ.C). AI ************************* **#* * *** *****9c•,* *** -*************** * *�**** LENDER: ************************************************ %****%*********************** ADDRESS: LEGALIZATION:N F E E S U N N A' R Y STRUCTURAL SEGMENT: N 1 OWNER BUILDER DECLARATION: I hereby affirm that I 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 15 • 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 2 5% ..- r./. -. 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 : .i. Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation 01 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 PIAN=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 4 ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 15 . 00 2.0 . 0 0 ti's 0 . 00 3 5, 0 0 35 . 00 0 0 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 • 35, 00 OVER/SHORT: 00 orimprovementose sold within one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHPANIC FIRE SMIP/TOT GRADING PLAN-CHECK de for roc puenis of sale).wi 35 , 00 • ' I.as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business f' 'a ❑ and Professions Code: The Contractors'Slate License Law does not apply to an owner of property who builds or improves thereon p1 and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).l am aware ********************'*'****'****'*****3****'****'*******'%'**************************se* that proof of their Worker's Compensation insurance should be provided to me. INDI V I D U A L• /4 E E BREAKDOWN ❑ I exempt under Section: B.8 P.C. / ` or this reason: TYPE QTY DESCRIPTIO:N ' UNIT COST TOTAL COST •,s Date: Owner: PLU 1 SEWER, CONNECTION TO BUILDING EACH 15 . 00 15 . 00 I do hereby certify that I am aware of and understand the requirements o1 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 fora , permit for construction or modification from the Air Ouality Management District.Residential construction applications are exempt from •,'r. , these provisions. /I r ,fi Dale: Applicant: i i I hereby certify that I have read this application and slate that the above information is correct.I agree to comply with all city and county ordinances and state laws relating la building construction and hereby authorize representatives of this ciey eo enterupon the above-mentioned property for inspeclion per01 00142998-00142998 TO T 35.00 p nate:2'1 " /ppases.3 Signature'/ / ' • '" DATE: 07/16/93 7111E: 09:30 /1- Driver's License or Social Security.: - 1641.46 White—Budding:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor CONSTRUCTION AND PLANNING POOL _ SPA I I DateInspector k I Date Inspector I APPROVALS Permit I;- APPROVALS Permits• • 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location I 2. So. Pip@-Undrgrnd. 53. Steel Reinforcement - ! I 3 ,'Icctr cal Conduit Utility•Undrgrnd. 54. Forms ' I 4 Electrical Conduit-Undrgrnd. 55. Electrical Bonding -- - - r E. :re. RN:^,:orcrment 56. Rough Plumbing & Pressure Test u ....PER Grnd 57. AP"RUVAL TO COVER Get-.171: 1 7. F,:ptra: 58. Electrical Cocdah-Undrgrnd. 8. Fou, ina- 159. Gas P.p.:, C1 Undrgrnd.,Test i I 9 '::atcr Pipc•Undrgrnd. ; 60. Backwash i.•nos, P-Trap, 73 Undrgrnd. 1 I 10. S^:ct.:a' Floor System 17A/� '.!�%= 61. APPROVAL TO DECK ---- 11. L P-.p. ••.r S-:,e: Lire & House Connection I rt 62. Baekr:a rn & Receptor-Pmol '2. Seen CaprL c. I _'1 63. Hefter & \ nt- ma: 64. P!umaing Sysr'an . F•nal I Ci.1 . ?lumbing 65. Electrical-Final h5 Hr.!a, Electrical-Conduit 66. Solar System-Fn'ai 16, Rr..gh Electric Wiring 67. Fencing & Accres Approval I - - J • 17. Hru.ir tti ':rg Sign 68. APPROVED FOR PLASTERING I s Rr.,h E' c:rical-T Bar Ceii in 69. POOL/SPA SYSTEMS FINAL I ...f__ 19 tiro_! .c 7 P: Air Ct,rdl':onin3 FIRE DEPT. REOUIRE.ME,vt - - - - �- - --. 73 R,:..g.- F..Gnry Fircplac, I I APPROVALS Permit # 21 D acts, in Structure 70. Underground Hydra I 72. Users, Ventilating 71. Product Pining i i Gas C Oil I I I 23 Gs .;a- s ' . Roo h & Test __ -_- -- 972. Underground Flush 24. Rout Fr::rn n3 ' 73. Undergrnd.Storage Tank LP Gas 0 r25 Rout St.eath:ng - -- --�.� 74. Overhead Hvoro - -- -�'- -- - _. 73. Rar O'•.'ng IStructurai F. islo hocoat 75. Dry l:hem rat I 2:. Ham.:aaFlashing • 76. Dry Standpipe ----- - -- - - j • 23. L2th:ng by Siding I I 77. FIXED SYSTEMFINAL I j 23. Lisa:atnon • i - 78. FIRE PREV. FINAL- �- -' I '- Li. a I \'ailing REALTH DEPT. REQUIRLT.E•:T r 11 . F etas dro,vn Coat -- 79. FINAL INSPECTION - - _ -_, - - - I 32. 7.,:. Pcv.er 7.4eter r ;;a, 80. FOOD CERTIFICATE ISSUED r - ---- -- -- -- �-. __ --- ------ - --- -L_ --_1- __ - 1 I 33. Fra! Fi,rtric I Notes' k[igf /90_0Cileily //%Tr�i'tii 34 1-Mat Hr_tirg& Air Conditioning • i.POY Q>.�f._ __. ._ _.. ± 35. Fre. C=ps Pipe-Test • 23. I':+. 't a- 0.rapv I 37. Heal F-c cry Flrcr.acc ' ------ -- ' 33. Jh /GJ� B ' 33. `.:'iter Service-Final - r --__- - --. .J 40 Sas Seruice-Final r41. Soar Domestic-Final 42. 3.ck`I a.: Pre'rerter -^ :3 Bac.r'c.i Irr'gati0 ____ - - -- Lt I ard•ctoc Irrigation Sy;tcm 45 Sound Attenuation 46. Handicap Regulations . . r-47. FINAL STRUCTURE & BUILDING --{ 4B FINAL PLANNING 49. EI9rtric Release to Edisor ' 50. Gas Release to Southern California Gas Co I ' 51. CERTIFICATE OF OCCUPANCY No. Date J 1 - - PROJECT ADDRESS: 1216 LAS ARENAS WY ' - UNIT: CITY OP COSTA MESA — BUILDING PERMIT PERM NO: P 059204 OWNER'S NAME: GEORGE MINOR S , 1 ADDRESS: 1216 LAS ARENAS WY PERMIT NO; P 059204 PLAN CHECK NO: N GOVT; N SUPP; N COSTA MESA r �- A CA 92626 CONSTRUCTION TYPE: 5—N PERMIT TYPE: PLU PURPOSE: REP • (714 ) 645-6202 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : REPAIR TO SEWER LINE SQ FT: ADDRESS: •UNIT: CLAIM VALUE: CALC—VALUE: • GROUP OCC: R—i / PERMITTEE: C & R DRAINS ( 714 ) 641-1545 ADDRESS: 1525 W MACAURTHUR 11 COMMENTS; RET,WALL REPAIR REQUIRES SEPARATE PERMIT COSTA MESA CA 92626 ***'****x-****-**fl**x**** ***x xx*x****x********** ** * -************ x* **** ** LICENSED CONTRACTOR DECLARATION: I hereby attirm that I am licensed under provisions of Chapter 9(commencing with Section • Z ONING REQUIREMENTS 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect. SE TBACK S CITY LIM.: 0 45014 STATE LIC,:5 317 4 6 cuss: C-36 •— MAIN BUILDING ACCESSORY BUILDING Date: /i�! Signature: / FRNT: FT IN REAR: FT IN FRNT; FT IN REAR ; FT IN WORKERS COMon MpPyEENSATIOO(N g.unified py thI ere?"' hat Ihve a�certificate of consent to self-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN CompenPOLICY NO.: 1058 /71"92 EXP.DATE: e/z/O1 /93 COMPANY: STATEPARKING REO' PROV: PARCEL ; 93633017 ZNE: REF NO: • 0 Certified copy is hereby furnished. L•raa�J` Certified copy is filed with the city Building Division. PLANNING NOTES> , > • Date: y-- 2-5 54a_Applicant: e✓/.... .eaI _ Saw -� **************************************************************************3E**** -allrEXEMPTION FROM WORKERS'COMPENSATION DECLAR• ON: (This section need not be completed if the permit is for one hundred($100)or less). • DEVELOPMENT SERVICES REQ UIREMENT S , I certify that in the performance of the work for wh this permit is issued.I shall not employ any person in any manner so as to become - subject to the Workers'Compensation Laws of California. ZONING APPROVED BY DATE: Date: Signature' BUILDING APPROVED BY : DATE: Code.y:If.after making thiscdeclaration,wihu should become subject mit the Workers'mempensation provisions of the Labor ` / Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. //t 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 DOC:; 92 which this permit is issued(Section 3097,Civ.C). *************************/ x- - *lt It** '*• '* *********It*******!y` '*****tF*?t**ft**3E LENDER: ******************************************** ' ***BE***************TXr************** — ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby Arm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMB ING ELECTRIC MECHANIC FIRE F---T /RES r` GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or P ERM I T 15 . 00 _ repair any structure.prior to its issuance.also requires the applicant for such permit to rile a signed statement that he/she is licensed 25% - pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN S'.M 1 P vON—{?.ES and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by r• any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 20 . 00 - 1 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECKT 10 PAID DUE I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the To ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 15, 00 20 , 00 0 ,-00: 3 f ,J ,e�- 35 . 00 , 00 1 goes not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through 1 his or her own employees,provided that such improvements are not intended or offered for sale. If,however the buildingor r improvement is sold ithin one year of completion,the owner will have the burden of proving he/she did not build or impve REVENUE DIVISION TOTALS——> COLLECTED: 3., , ER/SHORT: .00 for the purpose of sale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE S ei /TOT GRADING PLAN—CHECK 35 . 00 - • I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business . ❑ 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).l am aware *******************************3(3(1(3(***'******1 ****. ***************************** that proof of their Worker's Compensation insurance should be provided to me. - INDIVIDUAL - F E £ ' BREAKDOWN ❑ I am exempt under Section: B.8 P.C. A for this TYPE QTY DESCRIPTIO N \ UNIT COST TOTAL COST Date: Owner: PLU 1 SEWER, BUILDING / TRAILER 't ' "• 15 . 00 15 , 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 wilUwill 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. I ' Date: Applicant: 2t /w 44 L ZZ /993 I hereby certify that I have read this application and state that the above information is correct.I agree to comply with all city and county , ordinances and state laws relating to building construction and hereby authorize representatives of this city to enter upon the above-mentioned property ton inspection purposes. Date: / 3 9 Signator'�' 11 ,�/7",--e--42----- 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 i 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 c% Water Pipe-Undrgrnd. I 60. Backwash Lines,P-Trap, 0 Undrgrnd. • 10. 5•iructural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final • 12. Stlwer Cap 63. Heater & Vent-Final • 13. Prof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final • 15. Roagh Electrical-Conduit 9 66. Solar System-Final 16, Rough Electric Wiring • 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrica6T 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. Root 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 i 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing - , HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat i 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED • • 33. Final Electric Notes:0-5-.4m Ho-r _col7PteTX-C.•C-O 34. Final Heating& Air Conditioning f -_-r�U_9 3 Dre,(2-ey1 t-r C,4 fl -4.4_i:L'l_9 35. Final Gas Pipe-Test • r' 1E4- 10. 3 UPC-- 4) 36. Hood or Canopy 3�3t )>4.5 Peeitw crc4tnc4 6 As E'rt/Z. 37. Final Factory Fireplac •e - - STc.C.• 20.3 crPc, r+ino i45 N,esQ'9.o (Tr[ 38. Final Plumbing - (FLPANT' o PS. m,r. c. €0 39. Water Service-Final 40. Gas Service-Final • _ X.:/ 41. Solar Domestic-Final -p• :.��t - -`L. 42. Backflow Preventer :PI-- 43. Backflow Irrigation ", i;>' .,. • n-• 44. Landscape Irrigation System 45. Sound Attenuation • 46. Handicap Regulations e% 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 4 PROJECT ADDRESS?. ` UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO; B 062979 DwNER'S NAME: 1216 LAS ARENAS WY aoDREss:225YMOORE WILLSON PERMIT NO: B 062979 PLAN CHECK NO: N GOVT: N SUPP: N C.M. CA CONSTRUCTION TYPE: V PERMIT TYPE: STR PURPOSE: REP ARCH/ENGINEER: J78-1885 REc.xo.: ADDRESS: UNIT: : SQ JOB DESCRIPTION REPAIR RETAINING WALL FT: 500 PERMITTEE: CLAIM VALUE: 500 . 00 CALC—VALUE: 500 , 00 GROUP OCC: R-3 / ADoRESs:J.DAVID FRIESEN ( 619 )727-0709 �/2835GySUNKIST DR. (`n q (bpd COMMENTS: REPAIR RET, WALL IN GARAGE 0ICTIA dEtyN s16 d1 Liter iEiP**iE3EiE1Eif1EIEiEiE3FiEif*i(1fitif**iE**3E4elEiE**3fiEiE- ieiE*iE*NiEiE3EiEit**3EiF9F****it*if**1(-dE%***yf-ifiFItiE****iF*X LICENSED CONTRACT R E lA TION: I hereby all that I am licensed un yr a ter 9(commencing with Section Z O N I N G R E Q U I R E M E N T S 70001 of Division 3 of the Business and Professions Code.and my license is in lull force..c1 elle t. CITY LIC.: STATE LIC.:463944 CUSS:B SETBACKS Date: /Z/93 Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'C PENSATION DECLARATION: I hereby affirm that I have a certificate • tai iinsureoracenificate 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: 93633017 ZNE: REF NO: ❑ Certified copy is hereby furnished. 0 Certified copy is tiled with the city Building Division. PLANNING NOTES> > Date: Applicant: *citff****************************************-************************if*if********* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (itis section need no be completed iI the permit is for one hundred(5100)or less). D E V E L O P M E N T SERVICES 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 issue I shat not employ any person in any manner so as to become i subject to the W ers'Com nnssatiioon Laws of California. 20NING APPROVED HY DATE; �' ' Date:_L 1Z/ /�y Signature: �""�^_. NOTICE: alter mating this declaration,you should become s IS tt°workers'Compensation provisions of the Labor BUILDING APPROVED BY : ( DATE: . Code.you must forthwith comply mlh such provisions or thus mils be deemed revoked. �'V/ CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y• DATE; �'�93 which this permit is issued(Section 3097.Civ.L). ******************************************* *********************** . ** LENDER: ADDRESS: **If lE************************************************If IE*************X****cif****** LEGALIZATION:N F E E S U M21 A, R Y STRUCTIJRALSEGMENT: Y OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC _ - FIRE SM IP/RE GRADING (Section 7631.5 Business and Professional Code: Any qty al 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/she is licensed PERMIT 15. 00 , - 5 0 pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 7 , e .• G SMIP/NOAI—R ES • • 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 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars MOO). ISSUE FEE 'i i I. as owner of the property or my employees with wages as their sole compensation, will iso the work, and the BUILDING—DIV—> PERMIT ISSUE PL}N—CHECK TOTAL PAID DUE ❑ structure is not intended oraDeredfor sale(Section 1044.Business and Professional Code: The Contractors'State License Law TOTALS----> 15, 50 0 , 00 ./4 0., 00 /' 15 . 50 15 , 50 . 00 does not apply to an owner of a progeny who builds or improves thereon,and who does such work himsefflhersell 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 wit have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED;: 15. 50 OVER/SHORT• 00 tor the purposeof sale). 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 15 . 00 • e • i . . 50 ❑ owner and Professions Code: The Contractors'State License Law does not apply to an that proof of their Worker's Compensation insurance should be provided to me. of property who builds or improves thereon /1.• e. ,,ii. and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Lawl,lant aware ******************************************************************************* I N D I V I D U A L. F E..E Bt"R E A K D O W N am exempt under Section: B.d P.C. i , for this reason: TYPE QTY D E S C R I P T I O. N.- . . 4` UNIT COST TOTAL COST Date: Owner: .. - Idohereby certify that l am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and SFR 500 ALTER BY VALUE RES ID ENTI At ' NOZONE 1 , 00 500 . 00 25534 and that for any future building occupant wierwill not(circle one)need to comply with said state codes and the requirements for a END OF,FEES 2 permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from • - these provisions. ` • t Date: Applicant: x / , I hereby certify that I have read this application and state that the above informal'i is c.rect.I agree to comply with all city and county 4 ordinances and state laws relating to building construction and hereby a (orae re•es nta 's of this city to enter upon the above-mentioned ', properly for ins coon pur oses. I /i, • Date:� /2�93 Signature: 01 00142606-00142607 TOT 15.50 Driver's License or Social Security B: DATE: 07/12/93 TIME: 09:21 1641.46 White—Building:Green—Code Enforcement:Canary—•.plicanL Pink—Revenue:Goldenrod—Assessor CONSTRUCTION AND PLANNING POOL _ SPA APPROVALS Permit 4 Date Inspector APPROVALS Permit Date Inspector 1. Temporary Electrical Service or_Pole - 52. Pool & Equipment Location t' 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ir553. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. . 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, :1. Undrgrnd. 10. Structural Floor System __ 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection62. Backwash & Receptor-Final I 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 4 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil . 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling tStructural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding I 77. FIXED SYSTEM FINAL 29. Insulation i-- 78. FIRE PREV. FINAL. 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat i 79. FINAL INSPECTION • 32. Electrical Power Meter-Final , 80. FOOD CERTIFICATE ISSUED 33. Final Electric ` Notes:dor(.40 a. .4,4,„ dee pair 3 4., pr-- ... 34. Final Heating& Air Conditioning , • �d/te�_de_40yr0_ yovay S. �a4t. 35. Final Gas Pipe-Test I /f� �‘ r Q 36. Hood or Canopy its /��teca 3._•, /� 37. Final Factory Fireplace I t . r n 38. Final Plumbing c> / 64 0/1040 r '39. Water Service-Final i r�r U Tho) 40. Gas Service-Final 41. Solar Domestic-Final r 42. Backflow Preventer . 43. Backflow Irrigation 44. Landscape Irrigation System • 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING $�t��J/iO� c171 /,�e 48. FINAL PLANNING • ' 49. Electric Release to Edison i 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date 1.a;te; 6alcerST:Cmnoioyies iiia i Master Builders, Inc. c370o Charm Bou:evarC Qeverend 0:.a 44122-5 5 5 4 ','� , TelPhex 980-3-5500 �r May 1, 1991 • Certificate of Interchangeability and Performance Embeco 885 Grout and Embeco 636 Grout Master Builders Construction Products TO WHOM IT MAY CONCERN: State of Ohio ) County of Cuyahoga) 66 I , Roderick X. Wells, Manager,• Product Development for Master Builders, Inc. , Cleveland, Ohio, duly depose and say: That Embeco 885 Grout: - is a specially prepared, ready-to-use, noncatalyzed, metallic- aggregate Containing nonshrink grout; and - although having a different formulation, can be used in place of, or substituted for Embeco 636 Grout; - has extended workability and greater compressive strengths than Embeco 636 Grout, i. e. , working time: 45-60 minutes for Embeco 885 Grout vs. 10-20 minutes for Embeco 636 Grout; typical compressive strengths at 3, 7 and 28 days: 4 ,000; 6, 000; and 6 , 000 psi for Eabeco 885 Grout vs. 3, 000; 5, 000; and 7, 000 psi for Embeco 636 Grout) - has improved placing characteristics which allow placement at 40°F to 100°F, whereas the recommended placing temperature range for Embeco 636 Grout is 45°F to 70°F; - meets, as does Embeco 636 Grout, the requirements of the Corps of Engineers ' Specification for Nonshrink Grout, CRD-C 621-80, -81, -82 , -B2A, -828, -83, -88 , and -89 . Roder4 Wellb Hager Product Development Subscribed and sworn to before me • this 1st day of May, 1991 Chrittine Sebras)cy, Notary iic State of Ohio My Commission Expires January 10, 1996 (Recorded in Lake County) Doc. 25