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HomeMy WebLinkAbout2403 LA MESA CT - Building Permits • • CITY OF COSTA MESA A`41 l g% 2_ BUILDING DIVISION c4 le 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us i FOR INSPECTIONS CALL: (714)754-5626 4`°'•-1—• PERMIT NUMBER: P11-00102 PERMIT TYPE PLUM STATUS: ISSUED APN: 43933245 DATE ISSUED: 06/15/2011 ISSUED BY: KJB JOB ADDRESS: ('2403-L-A;MESA"CTGM Suite/Unit: • Vicinity: 4 "ss'` '..'��s..."� -_ SCOPE OF WORK: REPLACE 40 GALLON WATER HEATER. OWNER: DIGIAMBATTISTA, MARK PAUL Address: 2403 LA MESA CT PHONE: City/State/Zip: COSTA MESA,CA APPLICANT: ATANASOV,STOIL Address: PHONE: 866-692-5273 City/State/zZip: CONTRACTOR: CALIFORNIA DELTA MECHANICAL INC License No. 811114 Address: 1235 GRAND AVENUE PHONE: 800-898-0008 City/State: SPRING VALLEY,CA ZipCode: 91977 CELL: 866-692-5273 • ARCHITECT: License No. PHONE: ENGINEER: License No. PHONE: PLUMBING PERMIT FEE SUMMARY ;r PLAN CHECK FEE: $0.00 PERMIT FEE: $35.80 TOTAL FEES: $35.80 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28,§1. 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODEX. INSPECTION TYPE DATE !MALS CODEX INSPECTION TYPE DATE IN1111ALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical ��.�p �/�/ 1266 Pool Spa Final 208 Final Plumbing )< 7-1/- /1 en f 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 WORKERS'COMPENSATION DECLARATION: . Owner ID verified by drive._.idense. ❑Yes ❑ No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill•or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. 0 I have and will maintain workers'compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy 0 I hereby certify that no excavation five(5)or more feet in depth into which a number are: Carrier person is required to descend,will be made in connection with work authorized S+a�.e, F(^i d by this permit,and that no building structure,scaffolding.falsework,a demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Gm (This section need notbe cmpleted itt a permit is valued at one hundred dollars($700)or less.) 2,Art 2,Sec.341,Title 8,Califomia Administrative Code). Policy Number: 16,@ 71g23 0 As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above. unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of Applicants Signature Date the Labor Code, fort] comply with these provi ions. A�/r'// Division of Industrial Safety Permit Number: Applicant's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes 0 No (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires.with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE. INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of LICENSED CONTRACTORS DECLARATION: 500 pounds.or a volume of 55 gallons.or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000)of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in fulll force and 3 effect. / ^?/ a registration form for acutely hazardous materials? ❑Yes ❑No Lic.# 1� I t1 Class# Lam- b (Section 25533 of the California Health and Safety Code, with some (II nl D 6/ /5-0/ exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely c vactor's Signature Date hazardous materials equal to or greater than a weight of 500 pounds. or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? 0 Yes ElNo" (Section 25534 of the California Health and Safety Code provides that the Lender's Address: Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. Signature Date 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? El Yes ❑ No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes 0 No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the Califomia Govemment Code requires that the requested that he or she is licensed pursuant to the provisions.of the Contractors information be furnished on applications for non-residential buildingits . License Law(Chapter 9(commencing with Section 7000)of Division 3 of the perm ) Business and Professions Code) or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? El Yes ❑No applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars(5500).): of the California Health and Safety Code). ❑ I. as owner of the property, or my employees with wages as their sole 7. If-a permit from the South Coast Air Quality Management District dr other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application. have all of the disclosures prescribed by California License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes 0 No thereon,and who does such work himself or herself or through his or her own 8. (If"yes",attach certificate of compliance from the appropriate air pollution employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and El I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044, Business and • Professions Code: The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. S- n of Le al Ownertst Date Signature Date /]//s/ 3057-46(Jlp]) Ando leonzed Applicant f/' Dale t __ CITY OF COSTA MESA F y ,l BUILDING DIVISION /PERMIT NUMBER i DEVELOPMENT SERVICES DEPARTMENT 4. 4; PERMIT "'e+onm® P99-00301 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 • PLUMBING PERMIT Job Address: 2403 LA MESA CT Status: ISSUED Suite No Applied: 05/25/1999 Issued: 05/25/1999 Vicinity: Parcel Nunmber: 43933245 ISSUED BY: � ,- Applicant: GLOVER, LORIE Address: ` - / / .-,v- - Phone: , ','r, 1 . _ - v Zip: /i�/ '///� \ \\ - \ / \ \ N-: Owner: /i-DIGIAMBATTISTA,-MARK PAUL" " '` Address 2403 LA MESA CT _ VA /" '\ N /2//- Phone: a\� < `\ / / �\--<" ,\\ N COSTA-MESA;CA Zip: 92627 �� Address Contractor m COAST PLUMBING & HEATING ' ;'i,/ ' 2737 S.CRODDY • . " ' r / SUITED , : .‘,..,....Phone: 714 241-1414 , ,, t - ` ` \ ' '�. ,I SANTA ANA CA I \ ,• -''1 'Zip: 92704 ",:/--,\\ , ,� .�,; c � 11./i?' } l ,✓ _. License: 529127 � ' i k\\'‘, �r 'n/ �vVA ' '�I (Arch/Eng / '1,' _ - ��" . . s,,1 ' � /Address., N 'r � . , l - Phone: , . - . 5. +, / ,._ ._ .. ` t i `i • License: �', ' ' - � - ' , : c , 1 •I,,N' - o 'F.: ` " "c412 SCOPEOF_PERMIT^ f ; _ ' •',WATER HEATER CHANGE OUT. _ _- -- - i (' I ' FEE SUMMARY -_ ' -AMT QTY ' I ISSUE FEE `VA ' , $22.00 - . Laundry Tub/Washer • $0.00 0 Sump Pump 'MOO/ 0 Backflow-irri ationo \ , g / $0.00 0'` Landscape Irrigation, _ $0.00 0 Swlmming•Pool \� $0.00 0 Backflow Preventet $0.00 0 • P-Trap r;,tf? $0.00 0 Trap Primer/ x$0.00 0 Bathtub\A�\:\ ,A, $0 00/, 0 Pressure Regulator . $6.60-',.• 0 - -'Urinal:%// t -4. / $0:00 0 Clarifier System `"-/ $0 00/ ,0 - 1 Process Piping(per 10 ft) $6.06--:,,:,0:- - Vacuum Brkr Bkflow(1-4)441$0.00 0 Connect(Ice,Soda etc) $0,00 /,/�0 j ;Receptors.; ` --$6.00• ' 0 /-e-1.4.',,,,,-;',''' Vacuum Brkr,Bkflow(5+)/i/i, $0.00 0 Dental Units "CS /$0.00 '13,---,:\,5-\\:' ,Septic Tank " �''-' $0.00 -,0 + /,Wash Basin ;v // $0.00 0 Dishwasher \",--;- '/$0.00- 0 - Sewer Cap-for Demo ' $0.00 . 0 - 'Wash Basin Set /41,/ $0.00 0 Drain,Floor A`,`A x$0.00' ;-0 'Sewer Conned;; N $0.00 y 0 - Waste and,Vent,System $0.00 0 Drain, Rainwater v`1.--,,,-,,,\,$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 $11.00 1 Drinking Fountain .$000 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'. i -Water Service $0.00 0 Gas(1-4 outlets) $0.00 '0 : - Sink,kitchen- , ,\\, , $0.00 0 - ✓.v 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: $33.00 • 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 DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: , '1, t ' ❑ 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. a 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. Myrrkkers'cram ens'atitioonn Insurance carrier and policy number are: o Carrier: ` Y \4._ yt�7 Lary Policy Number: ndl 0gA 9 (This section nee not be compie edit 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 provisions. Applicant Signature: Date: )f�^7f WARNING:FAILURE T SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 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 and effect.Lic.# 5a 4/a-7 Class u C" ' (j Contractors Signature: Date: f-'—Y S CONSTRUCTION LENDING AGENCY: . 0 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. ❑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 Cade). ❑ 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? ❑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 Califomia 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 aaernit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the Califomia Government Cale 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(Duality 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 Califomia Health and Safety Code Section 42303 been made? ❑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 inspecti inoses.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. -S a s-9 S Signature Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE 0 IN$PFC ION TYPE " `QAIE INfllAL$ CODE/ INSPECTION TYPEPAIL - INRTUl4 1616 Fixed System Final Fire Prevention " ` - 206 Final Mechanical • 1266 Pool Spa Final 208 Final Plumbing Irirt t c Py,--1 200 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 2446-46 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. TRACT NO, LOT NO. UNIT NO. 439 -35Z 05, OCR _ 'Df10 L D. CITY OF COSTA MESA CONS,CONS{T�RUCTIO/7N PERMIT .Ha-1� q'P•# J7L (p zone f +tet Project Address 2405 / A Mgstk Ceuta' B :)q-23'1 IsISCo //'• t - d ./ Alb: p S Main Building: 4i Accessory Building: Applicant's-Meilipg Address l 82e WEs -c Lipr Ng• TYPE OF CONSTRUCTION -KNEW-_U ADD Li ALTERATION U REPAIR .E j� - . - Z �/p � (( / • •❑ CONVERSION ❑ DEMOLISH ❑ OTHER " T Front go Ct, g� 0 Owner's NameNEkie A•74 ARd.7Lft IOQ.5P Phor Ctz45'41�3 S//yG LE �/Q •"/4-7- • � B Rear V. l Cie:1 - N 25 JFSTc'L/Pf L•n /09 N• .. DESCRIPTION OF WOR /USE OF BLDG. Address / a P '1 WEU Cr 4/ f'� i • CO: �t 6 C Right Z i C i e: 1- - N Arch/Eng. PALE Pc/zaes License No, C-3040/ TYPE OF PERMIT 0 GRADING M.FOUNDATION STRUCTURAL • K G 17332 I RVI NPSLVp4//5 �L./�-TV 0J ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL $ Left " v AiJdress `, / //� - - R Contractor's NameAJEWeen-rHAR80e Si.SORss Phone a f• ft;11 .❑ 'OTHER 430 &At. - ' IPing. Ref.# pq g {2'7rsty�t��-P-a�r¢king Re p/P(ropyrI1��t 2,S /5 E PROJECT DESCRIPTION SQ. F 2307 £Es. OCCUPANCY R" �0 r� JIGl.1lf1 2s. GQUII 121E1,1•S� ._�- en Address(mailing) 1BZ-S (416577-cL/n fir`0109 A- • tet., sem. PlanningNotes: City License No. 2 D.e Co 4 CONSTRUCTION TYPE �- N VALUATION$ /6A 2 .4‘.rtit jr��)) . tee Fie ZONE - GRADING CU.YDS. ACRES_ ' �^ {.wAs.V rEcen Sa�q 'ISa � - 's. LICENSED CONTRACTOR DECLARATION . . ad..., - - - I-hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: aAN 1 • �,�/ D�f with section 7000) of Division 3 of the Business and Professions Code, and r s C my license is in full f e nd effect. ELECTRICAL _ ! FEES ��nse 4124&4 135/ 365--ez8A . License las - NO • Date - Signature • PLUMBING 'FEES Automatic Washer Transformer -0 15-50 KW ' WORKERS'COMPENSATION DECLARATION / Constr •ction Pole Sub. 050+KW • , `ereby,affirm that have a certificate of consent to self-insure or a certificate Bar Sink Showers • - • Workers' Compensation Insurance, or a certified copy thereof (Section kflow Preventer Service Sink �• - • Cooking Un / Meter ffiup to 100 a . - ' .00, Lab. C. , .• r'r. i Policy NoWPG S39t 300zi.%Com an Fit& a, rr �NS- / Backfl• Irrigation i Dishwasher ' Meter Dover •. amps • �." P y g Sewer Cap •i Certified copy is hereby th the ed,: •. �' Dryers Gas DElect Sub Par' - Z Certs ed yjyjy ed with the city et n. a Bathtubs 1 Sewer Connecuon- _ • Date (> Applicant'' ' s•• - - - / Fan • .tors❑0-1HP ❑1'h-6 EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar ColIectdr$ =' • -(This section need not be completed iflthe permit is for-one hundred ($100)or / F.A.U. Inc.Solar 09-15 HP 016-15+ : - • less). ./-, ' Dishwasher Solar Piping i p , I certify that in the performance of the work for which this permit is issued, I - .. Fi%tUreS shall-not employ any person in any'manner so,as to become subject to the Drinking Fountains Solar-Tan. T -: : (,� . �j4 ' rowave Workers' Compensation Laws of California. li/• •Device Boxes f DateOSignature - Floor Drains wi' • mg Pool vv//Spa` r ,y • . . _ _ " . NOTICE: If,after making this declaration,fte you should become subject to the • 59 Outlets . 1 n' I Workers' Compensation provisions of the Labor Code, you must forthwith FIOOf.$inks in- - comply with such provisions or this permit shall be deemed revoked. .r' CONSTRUCTION LENDING AGENCY 1 GasService 5 - Outlets ] X Water Clo - - - 3.I Switches - Sign 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.) - :(f Garbage,Disposal Standing SectionsN - - V Lender's Name _ Interceptors Water Heater^1 Lender's Address - I Kitchen SinkWater Service rGnerator` 0 5 KW❑5-15KW Trash Compactor OWNER BUILDER DECLARATION I hereby affirm that am exempt from the Contractor's:License Law for the 5 Lavatories Auto-Wash following reason (Section 7031.5 Business and Professional Code: Any city or / - _ _ 'a county which requires a permit to construct,alter,improve,demolish or repair P-Trap - - .1 Laundry Trays •. .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 f,hROOF Dr s i, • - • e Contractor's License Law (Chapter 9 (commencing with Section 7000) of ' - ' - --;:—.:vision 3 of the Business and Professions Code) or that he/she is exempt -j R9inspection-Fee $15 Issue Fee $ 3 • `-',erefrom and the basis for the alleged.exemption. Any violation of Section • - -.07;131.5 by by any applicant for' a permit subjects the.applicant:to a civil chatty of not more than five hundred dollars($500). I . - - DEVELOPMENT'SERVICES REQUIREMENTS://�1�� y� /�� 'Coq I, as owner of the property'or my employees with wages as their sole Reinspection Fee $15 ' Issue Fee - , Sr 3 Zdning,Apprpved By NJL/t-t16J"'bate'C..� _��O compensation, will do the work,and the structure isnot intended or-offered - 1, for sale (Section 7044, Business and Professional Code: The Contractor's . - . .MECHANICAL - FEES 1 Building Approved By. Date ' License'Law does not apply to an owner of a property who builds or.improves - - .1 thereon; and who does such work-himself/herself or through his or her own - pp ;Alicatioglssued By �� I/ !x - \ Date_jQ��/I ' `�� - employees, provided that such•improvements are not intended or offered for Boil 1 ' Hood of Type I ❑ sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 - •�:' 1$47FEES - 22 sale.pletiIf,,-the owner will have the burden of proving he/she did not build or im- • Duct--Under nd - rove for the purpose of sale). ' BUILDING PERMIT $ SMIP $ ' 1' O I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN'CHECK,• $ / PERMIT 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 ❑0100.000 B 1000006TU PLUMBING $ ISSUANCE $ builds-or improves thereon:and(who contracts for such oroiects with a con- • -^ - - 1 - ' tractors license pursuant to tne-Contractor's License Law). I am aware that - Exhaust System 0 Multiple ❑ • - 'epair/Alteration ' PLAN CHECK 25% $ ENERGY P.C. $ proof of their Worker's Compensation Insurance should be provided to me., ELECTRICAL $ (GRADING $ 0 I am exempt under Section B.& P.C.for this reason . 2 Firepl/Fact.Blt. ICBG 44 7&C I ' Fire Da •ers ' , C PLAN-CHECK 50% $ MICROFILM $ Date Owner �Hleating System&Ducting Registers ' - - et ' 12- ,- I hereby certify that I have read this application and state that the above /- 40-100,000 BTU ❑100 %10 BT ,." ." .-. MECHANICAL $ TOTAL FEE ' $ - ��� �` information is correct. I agree to comply with all city and county ordinances • PL'AN'CHECK 25% $ • and state laws rely g.to b ilding construction, and hereby authorize repre- - •i , sentatives of'this ty, to ter; upon the above-mentioned property for • _ •1 • , u_ F . Inspection purpos 8 _ f'% Signature •5 i Date'b 7• :'y,. • , i ' Drivers' License or SS ' - Reinspection Fee •$15• • Issue Fee $ 3 r i 0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 01 00100?569-00007571' TOT' :l79?.72 t • ' 'CONSTRUCTION AND PLANNING • ' . - - POl SPA `APPROVALS Permit# Date Inspector • APPROVALS Permit# Date Inspector 1. Tempo ry El‘f,ctrical Service or Pale -� • 52. Pool & Equipment Location 2. So=Pipe-Undrgrnd_ " 53. Steel Reinforcement _ 07.Si.ElectriicalbConFluit1Utility-Undrgrnd. rn +l,I 54. Forms • 4.tElectrical Conddit'bndrgrnd. -- cy , ji , v 55. Electrical bonding ..---.1"...---.1". 5.4 Steel Reinforceme t'� 0/ ,,, 56. Rough Plumbing & Pressure Test • (r)A 6. .ElectricalUF.ER:G"rnd /7e ` � . 57. APPROVAL TO COVER-dUNITE rp v - 1.-Footirig'si� .� �� y7/��l l 58. Electrical Conduit-Undrgrnd. • " f: - 8' Foundation rp 4-1 'l" ., / 'V . 59. Gas Pipe, 0 Undrgrnd.,Test •V - . _ is 9., Water Pipe-Undrgrntl. 'i,�) 4 -- lin A 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10 t Structu`al Floor'�Sy:tem £ U 61. APPROVAL TO DECK - - v 11:-Property Sew gr LiRe & House Connection i62. Backwash & Receptor-Final -----A ' 12.-Sevoei• CapJ '' 0-- • 63. Heater & Vent-Final - - i 13. Roof Drains l /1-. 4 64. Plumbing System - Final tO ' 14. Rough PI robing-'� . - 65. Electrical-Final n. 15. Rough Electrical'Conduit 66. Solar System-Final . 6'. Rough electric Wiring 67: Fenci•ng& Access Approval 11 . I.7/.-1 :Rough Wiring Sign ' ,ls • 68. APPROVED F0/13PLASTERING "' • I 9 lig \ - 69. POOL/SPA SYSTEMS FINAL\ ., • • d$. Rough Electrical-T Bar Cellin ,+ • Id?Rough Heating & Air Conditioning \ IV FIRE DEPT, REQUIREMENTt / ` . 20.1`Rough,Factory Fireplace /- ''� APPROVALS' Permit# I • 21. Ducts, ,Structure 70. Underground Hydro \ /n - . . 22. Ducts, ventilating 7.-) \ 71. Product Piping 0 Gas 0 Oil \ n / 1 23.:Gas Pipe Rough &,Test ) \` 7,2: Underground Flush . , � ' . ,24. Roof Framing"J< - 2 - /r,\� '73. Undergrnd.StorageTank 0Gas 0 Oil \t/;/ •25. Roof.4heathing/u. I�y//C�b! i 1, `74. Overhead Hydro / l ` ' A. 26. T-Bar_Ceiling (Structural) & Monocoat !- ' % 75. Dry Chemical / .\ Frame�d Flashirig 4) ///alt .der76.�Dry Standpipe - \ ..27,; 28. Lathing;&'(Siding /277/''(.,/ '_ 77. FIXED SYSTEM FINAL -i' . • � 29. Insulation In. /t//�,8 ,j" 78. FIRE'PREV. FINAL / 'N 30. Drywall Nailing 49, /z�1-e A - 'HEALTH DEPT. REQUIREMENT \ CI / 79. FINAL INSPECTION 31. Plaster Brown Coat. �i - • 32.. Electrical Power(Mier-Final / 80. FOOD CERTIFICATE ISSUED - - 33. Final Electric St 7 - Notes: 34. Final Heating & Air Conditioning, ry IU ` SPECIAL y-5/ ' .1_ n_ •-HOLD.FOR ,V_' 35. Final Gas Pipe-Test - s [7� C. -iII 41a J 36, Hood or Canopy - -1 III/ 1-37. Firhal.Faetory F`ceplace� ±- T ,.?. Tjziiit! .38.1FinalPlumbing . / v • /39. War Service-Final.i 'l ` ` telc 40. Gas Service-Final 1:.': \ , �♦ i1 _ ' G41. Solar DomesticiFinal \ i • {ti rt `42 '. Backflow Preventers •\ --- :• 1.i`/.1 • . .43. Backflow Irrigation; .2'. \ - n . hi I 44. Landscape Irrigati•on System . / ` - 45. Sound Attenuation 'I' / �` - . 46. Handicap Regulations ''1 .•,/ /// ,s ''� _ ., 47. FINAL STRUCTURE & BUILDING .�/Y/gip /�' 48. Soecial Requirements Completed ' t/y(/'c- 1/u K 049. Electric Releaseto Edison , . _-.I ' -. r' - <1 •• 50. das Release to Southern California Gas Co , , • - _ - L••••• 51. CERTIFICATE OF OCCUPANCY - .�-' i! '4 , . ' No. Date • ,.•i CITY OF COSTA MESA PARK FEES Fee Payment Receipt 001137 Project Address,Q1-4 I - o'ZyOtP (_a H�5c4.. Cr ttt 00007565-00007565 TOT 9273.72 A.P.Number �F 3q — 33a — 05• o� Building Permit Number Owner's Name N wiper+ 4,1,arbD r Skis Mailing Address I %02-5 (- cto Ni 15 FEE: Single Family * W Number of Units 2-Bedrooms or Less @ $ 861.76 =- 3-Bedrooms 3-Bedrooms @ 1,205.67 = 4-Bedrooms CO @ 1,545.62 = V737 7,- 5-Bedrooms+ @ 1,810.50 = Multiple Family ** •Bachelor or Studio @ 474.37 = 1-Bedroom @ 573.18 = 2-Bedroom @ 881.51 = • 3-Bedrooms+ @ 1,229.38 = 88 Total Fee *** /q , L73. 7�. Planning Department Approval Date&'C? I - By `ikee LLLttiw Applicant's Signature ' * City Ordinance 72-44 *" City Ordinance 72-45 ***City Resolution 78-116 CMF 0174-30,rev.7/85.White—Planning;Canary—Planning;Pink—Finance;Goldenrod—Applicant o I • FQ ilk: ih' 'M• A�' .f• iN M' .i,P�• \Y-tel` %M. /V\' erg •M" ne . r'I I i INSULATION CERTIFICATION ii: ;' k •.This is to certify that insulation has been installed in conformance with the 3. ; �W ? torrent energy regulation, California Administrative Code, Title 25, State of yCalifornia, in the building located at: N �� SITE ADDRESS 2403 La Mesa Ct . , Costa Mesa l' ' ;�•' CEILINGS 6 1/4 19 • or. Y. Batts: Type Fiberglass Manufacturer Owens/Corning Thickness 9 1/2 R-Value 30 �,...'.k > •, i:�,S f� Bloom: Type Manufacturer Thickness R-Value Cei <ici... EXTERIOR WALLS % �'•S ) Type Fiberglass Manufacturer Owens/corning Thickness 3 1/2 R-Value 11 FLOORS Type Manufacturer Thickness R-Value '' ;`•: "General Contractor License f t: BY Title Data. 3 ''S t `�.Schmid,Insulation Contractors, Inc. License f 221517 C-2 )` a.. . • �r<( • PC: ;BYalLas tes 1. Title Vice President Date April 13, 1989 •'1. ,.,;' "t.,� '� moi.; :. '� ` ��,` . + • v} �A" �U'" 'iA wr • ! ?A SA: /A FVC !M M �.A ./.4';‘, ��..' 1 re :. '"--- INSULATION CERTIFICATION:(. % T 6G This is to certify that insulation has been installed in conformance with the 01H •. : current energy regulation, California Administrative Code, Title 25, State of 4:. California, in the building located at: ` F• i . . SITE ADDRESS 2403 La Mesa Ct. , Costa Mesa 'Pt GW, 3. CEILINGS 6 1/4 19 ' _S Batts: Type Fiberglass Manufacturer Owens/Corning Thickness 9 1/2 R-Value 30 `4;_ :Blosa: Type Manufacturer Thickness R-Value L' ' + EXTERIOR WAILS W •• , Nc:: tic,/ Type Fiberglass Manufacturer Owens/Corning Thickness 3 1/2R-Value 11 - ?r FLOORS Type Manufacturer Thickness R-Value ��L. " C General Contractor License I V.14 C I $ By Title Date Schmid Insulation Contractors, Inc. License Y 221517 C-2 ��' 14 By ,_ , , � • Title Vice President Date April 13 , 1989 se 3� ` -/ per _J!(M• V5-- ,.e .w w� w"# e w:NV',,wit w, w. ` e!: iw. Cat, w. .w. C•: i t • ROBIN S. HAMERS ¢3e c s 2C13& ASSOCIATES, INC. COST.MESA.G aQpg7 CIVIL ENGINEERS • PLANNERS • SURVEYORS f►•t4164on,aG , ) 1 . IApril 28, 1989 Mr. Gary Conlon City of Costa Mesa Engineering Division t 77 Fair Drive • Costa Mesa, CA 92628 li RE: TRACT NO. 13456 276-280 SANTA ISABEL x Dear Gary: I, Enclosedplease find nine copies and a duplicate tar of the P.-„�' P P my lar tract map. The final monuments as called for on the map were set on April 26, 1989. The finished grading has been completed substantially in accordance _ with the approved Grading Plan as determined on April 28, 1989. If further information is required, please contact me at (114) 548-1192. , , 7c1r1:1Y' i , Rob n B. Hamers ` RBH/Jp • cc. John Peterka , , Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. , • CITY OF COSTA MESA CONSTRUCTION PERMIT PERMITN'Qq. TRACT NO. LOT NO. UNIT NO. �/ r 3y 3 15 iiys6 �,eF Project Address .294 3 <g lyis4 'e4�' [J - O/3ol' 717 x144.10 ,9a TYPE OF CONSTRUCTION ❑ NEW H ADD ALTERATION ❑ REPAIR - • Applicant's Mailing Address "� / ,ty ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # I Zone _ Owner's Name /vG�G��� //t/fr$1j' Phone��✓ �L�[3 . DESCRIPTION OF WORK/USE OF BLDG. Address /5'Zs•4 e -{«l/7 l0Q 4't ' S Main Building: Accessory Building: Z Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING M1r❑r FOUNDATION ❑ STRUCTURAL T Front 0 • Address• /� ma�y1.�,�. //�� ❑ TENANT ❑ ELECTRICAL LCJ PLUMBING ❑ MECHANICAL B Rear N Contractor's Name fF4t 2 ��'Llds P14 P hone Aro"7 3 ❑ OTHER • C Right - - - N Address(mailing) /,a aa¢ a:9 _�}ai oc, 70650 PROJECT DESCRIPTION SQ. FT. OCCUPANCY . K G ` � • CONST RUCTION TYPE VALUATION 5 s Left r.a „, R City License NO. �7jy ZONE GRADING CU.VDS. ACRES -- i i'vl°'Is, sls I. 1 ' 11°- LICENSED CONTRACTOR DECLARATION • Ping. Ref.# • ' Par king~F1eq./Provided la I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: 2 y l� � `� Q 2 L( •]�/� Planning Notes: Ml with section 7000) of Division 3 of the Business and Professions Code,and i.J f� 46 (l 7 L / T my license is in full force and effect. S License Cla s ' A: se No Date Signature .-1-.111 Se _r_ _ PLUMBING FEES - - ORKERS' COMPENSATION DEC LA RATIO Bar Sink / Showersry ELECTRICAL FEES lereby affirm that I have a certificate of consent to self-insure or a certificate • of Workers' Compensation Insurance, or a certified cop thereof (Section • Backflow Preventer • Service Sink 3800, Lab. C.) - Automatic Washer Transformer ❑ 15-50 KW Policy No{O,3Ci 71 Company -i n: ✓ Backflow Irrigation . Sewer Cap - - 0 50+ KW ' • - ConstructiomPole Sub. Certified copy is hereby furnished. - B • Certiff'e co is filed with the city Buil.pi 7visiori , N Bathtubs Sewer Connection la N Cooking Unit • Meter Dun to 100 amps Date I Applicant 'rap!.'_ L . -_.-.., - EXEMPTION FROM WORKERS'COMPE ATION 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). f Dishwasher. Solar Piping - 2 1'V Dryers ❑Gas DElectric 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❑O-1 HP Di%-B Workers' Compensation Laws of California. _ Qo Date Signature Floor Drains • Swimming Pool w/Spa F.A.U. • Inc.Solar ❑9-15 HP ❑16-15+ 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 Fixtures Microwave comply with such provisions or this permit shall be deemed /revoked. C . ' _ CONSTRUCTION LENDING AGENCY V%- I Gas Service Outlets , 11 moi% hereby affirm.that there is a construction lending agency for the performance 's Water Closet a Device Boxes 7' Pole Light of the work for which this permit, is issued (Section 3097 Civ. C.) r • i n Interceptors Water Heater 2 N Outlets. 'j f Range `V Lender's Name ..,:4, :/ Lender's Address - • / Kitchen Sink '/ Water Service 4 p/ Switches. • •- Sign - ' OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law,for the ?? Lavatories / Auto-Wash . ,Z w GarbagaiDisposal Standing Sections r"' S following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair ,n P-Trap Laundry Trays ry Generator ❑0-5 KW 05-15 KW : Trash Compactor .n . ' any structure, prior to its issuance; also requires the applicant for such permit j ' to file a signed statement that he/she is licensed pursuant to the provisions of RoofDrains the Contractor's License Law(Chapter 9(commencing with Section57000)of -- �� Division 3 of the Business 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). • ❑ I, as owner of the property or my employees with wages as their sole Reinspection Fee $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 I 0 DEVELOPMENT SERVICES REQUIREMENTS: - employees, provided that such improvements are not intended or offered for yp Zoning Approved By Date sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 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). 9 p 0 I, as owner of the.property, am exclusively contracting with licensed'con- Duct-Structural - Refrigeration System Application Issued By ' Dat •--/19-111C,L.8 C 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 ❑0-100,000 BTU 0100,000 BTU SUMMARY OF FEES builds or improves thereon,and who contracts for such projects with a con- tractor(s) 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 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers PLUMBING $ SSUANCE $ - , • Date• Owner - Heating System'& Ducting - ' Registers ENERGY.P.C. $ ❑0-100,000 BTU ❑100,000 BTU, PLAN CHECK 25% $ L • I herebyat certifyc recti have read this application and state that the aboves ELECTRICAL $ GRADING $ information is correct. agreeui toicomply with all dy and county ordinances - sanden state laws helots to bending co ruction, andhereby authorizepr /epee- - PLAN CHECK 50% $ MICROFILM $ inspection of this to enter u tile above-mentioned property for 13 inspection purpose '/ Signature Date 4✓ • MECHANICAL $ TOTAL FEE $ �— Drivers' License SS 9f • Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ • rev.10/84 White - Building: CanaryAccounting; - - --- was- ..vVJV L1•/ a t= if 7.00 CMF 0865-46, g: -Applicant; Pink - Goldenrod - Assessor CONSTRUCTION AND: Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CON$TRUCTI ON PF. IMIT PER IT NOM . TRACT NO. LOT NO. ' UNIT NO. IAP # Zone . • rr'' LV �(N�'� �S�/7 S Main Building: Accessory Building: Project Address Z7�3 7 A U ALTERATION ❑ REPAIR Applicant's MailiirsAddress l/�s34 /r"'1/1�VM+Tr (.4 A 3 al, yam/ '73 TYPE OF CONSTRUCTION NEW ❑ ADD E - - Z Owner's Name 'I`+• elikar 'r 0�An. Phone e K- 111 CONVERSION CI DEMOLISH ❑ OTHER, T Front / _ O DESCRIPTION OF WORK/USE OF BLDG. I-%ZY 37.. I B Rear r N Address - i A - I C Right N Arch/Eng. • License No. TYPE OF PERMIT ❑GRADING ❑ FOUNDATION ❑ STRUCTURAL K • G Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL $ •- Left - R �Ies ALS /�� /_T]_-1./t/ ❑ OTHER . " Ping. Ref.# Parking Req./Provided - E Contractor's Name_4110t54‘• E l Phone�e_v—Ey�f Q PROJECT DESCRIPTION SQ. FT. OCCUPANCY Planning Notes: M AddressLicense (mailing) � 7--- -CONSTRUCTION TYPE VALUATION$ T City License No. fe ZONE GRADING CU.YDS. ACRES - S. LICENSED CONTRACTOR DECLARATION ((JJ,� I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: T/ 3 Y 3-7—-4-- �� . with section 7000) of Division 3 of the Business and Professions Code, and T my license is in full force a effect. // J-y ELECTRICAL FEES License Class y`- License 7 7 Date -__/4 Signature . PLUMBING FEES Automatic Washer f Transformer 0 15-50 KW ' WORKERS'COMPENSATION DECLARATIONSinkShowers Construction Pole Sub. • 0 50+ KW NVBar ereby affirm that have a certificate of consent to self-insure ora certificate Workers' Compen Wuu 1 r n e, f a certified copy thereof (Section Cooking Unit Meter ❑up to 100 amps 77-ryq' 2_ Backflow Preventer_ Service Sink - Policy No. Company ]C�fTTT(RC ��I Backflow Irrigation Sewer Cap e, Dishwasher Meter Dover 100 amps Certified copy is hereby furnished. '• Dryers ❑Gas ❑Electric Sub Panel certified copy,Ls fygy�with the city Buil DivySion /1� Bathtubs -•f Sewer Connection it /(j' -fbi-i�J" Applicant L-�.l,9 f'�L�. ". Fan EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers & Solar Collectors - Motors 00.1 HP 01%-8 (This section need not be completed if the permit is for one hundred ($100)or - - / F.A.U. Inc.Solar 09-15 HP 016-15+ less). Dishwasher Solar Piping 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 Fixtures Microwave Workers' Compensation Laws of California. Device Boxes Date Signature Floor Drains Swimming Pool w/Spa l •, • Pole Light 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• Outlets comply with such provisions or this permit shall be deemed revoked. Range Switches CONSTRUCTION LENDING AGENCY Gas Service Outlets Sign I hereby affirm that there is a construction lending agency for the performance Water Closet of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater _ Garbage Disposal Standing Sections Lender's Name - Lender's Address Kitchen Sink Water Service Generator 00.5 KW 05-15 KW Trash Compactor OWNER BUILDER DECLARATION - 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 county which requires a permit to construct,alter,Improve,demolish or repair P-Trap • Laundry Trays • 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(commenting with Section 7000) of - • • tivision 3 of the Business and Professions Code) or that he/she is exempt • Fee Reinspection ierefrom and the basis for the alleged exemption. Any violation of Section P $15 Issue Fee • $ 3 /031.5 by any applicant for a permit subjectf the applicant to a civil enalty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS: LiI, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 Zoning Approved By Date compensation, will do the work,and the structure Is not intended or-offered for sale (Section 7044, Business and Professional Code: The Contractor's - MECHANICALFEES Building Approved By Date / License Law does not apply to an owner of a property who builds or Improves . - A) 2y thereon, and who does such work himself/herself or through his or her own Application Issued By 0 nate 6a employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0 sale. If, however, the building or improvement Is sold within one year of com- Canopy Type II 0 SUMMARY OF FEES pletion, the owner will have the burden of proving he/She did not build or im- Duct-Under Ground prove for the purpose of sale). - - BUILDING PERMIT $ SMIP $ ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural _ Refrigeration System tractors to construct the project (Section 7044,Business and Professions Code: PLAN CHECK $ PERMIT The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU PLUMBING ISSUANCE $ - builds or improves thereon. and who contracts for such oroiects with a con- $ ENERGY P.C. $ tractor(s) license pursuant to the Contractor's License Law). I,am aware that Exhaust System 0 Multiple❑ System Repair/Alteration I PLAN CHECK 25% $ proof of their Worker's Compensation insurance should be provided to me. ELECTRICAL $ GRADING $ • ❑ I am exempt under Section B. & P.C.for this reason Firepl/Fact.Bit ICBG dk Fire Dampers• MICROFILM $ ,S PLAN CHECK 50% $ Date Owner Heating System& Ducting Registers 7 II,, [80-100,000 BTU ❑100,000BTL MECHANICAL $ �� TOTAL FEE $ a7` I hereby certify that have read this application all and state that the above — In stat is correct. agreeui toicomply cost with all dy and county irepre- sentatives PLAN CHECK 25% $ and state laws relating to building construction,and herebyion authorize yfor netios pu this ci to e of u� the above-mentioned proP/rptyir inspection purpose! ��/I t / /— Signature Date Drivers' License or SS 9f ' Reinspection Fee $15 Issue Fee `5 $it 0865-46,rev. 5/88 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor 01 00017492-00017492 TOT 24,00 GATE: 10/19/88 TIiIE: 15:21 CONSTRUCTION AND PLANNINGPO, A 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. Electfical Conduit Utility-Undrgrnd, 54. Forms 4. Electrical Conddit-Undrgrnd. 1. 14 55. Electrical Bonding 5. Steel_Reinforcement - •' 56. Rough Plumbing & Pressure Test r• 6. Electrical UFER 57. APPROVAL TO COVER-GUNITE 7''Footings . t i -� - 58. Electrical Conduit-Undrgrnd. r 1. 8.:Foundation 59. Gas Pipe, 0 Undrgrnd., Test • 9.'Water Pipe-Undrgrnd. �; ' I 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System - ,v 61. APPROVAL TO DECK 11'. Property Sewer Line & House Connection ,�-. , 1 62. Backwash & Receptor-Final .1• 12. Sewer Cap 63. Heater & Vent-Final • • 13. Roof Drains I 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 Lgg FIRE DEPT. REQUIREMENT •20. Rough Factory Fireplace APPROVALS Permit# r , 2T. Ducts, in Structure I70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas ❑Oil 23. Gas Pipe-Rough & Test 11 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. Insulaution 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 1v 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 r/re 35. Final Gas Pipe-Test i �Y / 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 43. Backflow Irrigation 1 r 44. Landscape Irrigation System 45. Sound Attenuation r7l 46. Handicap Regulations - 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison • is 50. Gas Release to Southern California Gas Co -s• 51. CERTIFICATE OF OCCUPANCY L• No. Date )4 . S' "10 it,ar—t Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION R IT 05.Larriss4 PER ITN TRACT NO. LOT NO. UNIT NO. A P # I Zane �� Project Address 'ams I d� cr. S Main Building: Accessory Building: Applicant's Mailing Addre>Xx^Sy�1�'��1 FF d _ TYPE TYPE OF CONSTRUCTION tall NEW LJ ADD ❑ ALTERATION LJ REPAIR E Z Owner's Namtotc 1j'r a :a.'3b ❑ CONVERSION- ❑ DEM�OLI�H ❑ OTH/E�R B Front I N 'VefLT'1-1418").4W Phon ^Vj DESCRIPTIO OF WORK/U E OF BLDG. -(i T'i� ErF Rear • Address' SkJ)gyy7. ..t Ftr �,. 1O7 AJ•./3. �j ' 4&O 'a i.. e . r �- I�A • I Arch/Eng. 'i 1 C Right G �Y4Gtixd..[LIAA icense No. TYPE OF PERMIT GRADING ❑ FOUNDATIttttttsONIIIIII STRUCTURAL 2 ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING/q.MECHANICAL $. Left Address / R Contractor's Name 5roaifien #7° — Phon`��r-'— ✓✓�j ' ' �Q�{)t ❑ OTHER Ping:Ref.# Parking Req./Provided E PROJECT DESCRIPTION SQ. FT. ?Open OCCUPANCY_ Q Address(mailing) - Planning Notes: M O.7_� 4 CONSTRUCTION TYPE VALUATION T City License No. ZONE GRADING CU.YDS. ACRES - LICENSED CONTRACTOR DECLARATION - S. I hereby ionaffirm7 that I am licensedion under provisions Charter 9 (commencing Remarks: ris 1 Al'., Y _ 1 y�.3/.1�J� /ter with hereby ion of ic3 of the rovi loss and harters9• Code, n• v` r�u 111�����«�������' �f E/ —S J my license is in full free and effect. a ELECTRICAL ;FEES • Licen lass S License No. .. l E./the: _973:0S- Signature _�J _ WOW. PLUMBING FEES Automatic Washer . Transformer 0 15-50 KW - • -OR ERS' OMPENSATION have ON DECLARAT ON Construction Pole Sub. 0 50+KW Bar Sink Showers :reby affirm that I have a certificate of cense to self-insure • a certificate - - __ . Workers' Compensation Insurance, or a c-rtified copy thereof (Section Cooking Unit Meter Dup to 100 amps l - Backflow Preventer Service Sink tom. o00, Lab. C.) - — (]V( Policy No. St"S 7.1 Company �N��✓✓1Q13 1 Backflow Irrigation Sewer Cap Dishwashea Meter Dover 100 amps Certified copy is hereby furnished. - Dryers Gas DElectric Sub Panel git o s,ted with the cit Reiltlin •vi ion. Bathtubs Sewer Connection I ate ` Applicant Fan /,-P • Motors 00-1 HP 01%-8 • EXEMPTION/Flit; WORKERS'COMPENSATIO ECLAR ON Clarifiers • Solar Collectors • (This section need not be completed if the permit' or one hu red ($100) or ...-.U. i less). Dishwasher Solar Piping _ . Inc.Solar 09:15 HP 016-15+ • I certify that in the performance of the work f r which this ermit is issued, I //• • shall not employ any person in any manner so as to become subject to the Drinking Fountains - Solar Tank • Fixtures i Microwave Workers' compensation Laws of California. Date Signature Floor Drains Swimming Pool w/Spa Device Boxes Pole Light NOTICE:If,after making this declaration,you should become subject to the - Outlets • Range Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks • Urinal 9 comply with such provisions or this permit shall be deemed revoked. Switches CONSTRUCTION LENDING AGENCY Gas Service Outlets -Water Closet Sign • I hereby affirm that there is a construction lending agency for the performance ' of the work fwich. i per s ss e` c '- Interceptors Water Heater • Civ. 'C.) Garbage Disposal Standing Sections Lender's Name [ ' Lender's Addiess �� Generator 00-5 KW 05-15 KW Trash Compactor .� - /s'1R'Q - Kitchen Sink Water Service OWNER BUILDER DECLARATION • - 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 - ' county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays 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 he Contractor's License Law(Chapter'9 (commencing with Section 7000)of . •j,•-''ttivision 3.of the Business and Professions Code) or that he/she is exempt - Reinspection Fee $15 Issue Fee $ 3 ' %iierefrom and the basis for the alleged exemption. Any violation of Section 031.5 by any applicant for a permit subjects the applicant to a civil - enREQUIREMENTS: alty of not more than five hundred dollars($500). DEVELOPMENT SERVICES LI I, as owner of the property or my employees with wages as their sole Reinspection Fee ! $15 Issue Fee . $ 3 Compensation, will do the work, and the structure is not intended or-offered Zoning Approved By Date for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By Date 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 I ❑ • Application Issued By _ Dat: employees, provided that such improvements are not intended or offered foryp sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 SUMMARY OF FEES pletion, the owner will have the burden of provinghe/she did not build or im- Duct-Under Ground prove for the purpose of sale). BUILDING PERMIT $ _ SMIP $ ❑ 1,-as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK $ PERMIT 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 PLUMBING $ ISSUANCE $ builds or improves thereon.and who contracts for such oroiects with a con- - tractor(s) license pursuant to tne Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ ' System Repair/Alteration I PLAN CHECK 25% $ ENERGY P.C. $ i proof of their Worker's Compensation insurance should be provided to me. - ELECTRICAL $ GRADING $ 0 am exempt under Section B.& P.C.for this reason Fire I/Fact.Blt. ICBO##.1.: Fire Dampers p p (3 DO PLAN CHECK 50% $ �(''�� MICROFILM . $ Date • Owner Heating System&Ducting Registers MECHANICAL $ o`$ ' I hereby'certify that 1 have read this application and'-state that the above 00-100,000 BTU 0100,000 BT TOTAL FEE $ d'r Information is c•rrect. I agree to com•Iy with all city and county ordinances PLAN CHECK 25% $ and state .- -Iating to building ctlon, and hereby autho ize repre- - sentatives of tr it, to enter. above-mentioned •r--per y for • ' - Inspectl•n .ur••se rAr___' ' slgnat0 �f L1 7. Dat- �/ Jli ' - , 01 OQC31.27.,-0©031275 TOT 7• DriJers'License or.Ss — !' Reinspection Fee - ,$15, Issue Fee t S $ DATE: 0412c E• 15:26 5 CJO 4184 TIME: 0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING PO"""'.Y SPA Date Inspector Date Inspector APPROVALS Permit# APPROVALS Permit# - 1. TemporaryfElectrical Service or Pole n !.. 52. Pool & Equipment Location (. 'i -. �1 2,-FSoicAOe-Undrgrnd. f,� 53. Steel Reinforcement . . 31,Elecirical Conduit'Utility-Undrgrdd2 t' 1..• 54. Fo ms � ) 4. Electrical Conduit-Undrgrnd. I' 55. Electrical Bonding 1.:-.' •,: ..+ • �. ; _ 4. ti . 1.• 5%Steel-Reinforcement "7 56. Rough Plumbing & Pressure Test .3.4f - ,Ji 61 Electiical LIFER>Grnd"l r \ • 57. APPROVAL TO COVER-GUNITE - ] Ti'F•dotings. ' A- `t i -"I 58. (Electrical Conduit-Undrgrnd. I, y/ 1) -r ,i 81:•Fdurida-Ir'lion '----..1A I.;;� / 59. Gas Pipe, 0 Undrgrnd., Test I • 9l.".1Wate'r.Pipe-Undrgrnd. -1% n J 60. Backwash Lines, P-Trap, 0 Undrgrnd. i �j . 10:IStructucal Floor System ti 3: 61. APPROVAL TO DECK I,1? P(iierty,Sewer Line & HouseCCorinpction c -,i / 62. Backwash & Receptor-Final r^ 12. Sewer�Cap X `., ':� t'. '1.1 - 63. (Heater & Vent-Final -- '`l L I , 0 f.,- 1.3i1Ro'of�Drains -f' ..'1 t h' 1 64. Plumbing System - Final' „ 14F:Rough Plumbing., 'a 65. EI ctrical-Final ‘2,...., 15. Rough ElectricalConduit 66. Solar System-Final 'bra , 16. Rough Electric Wiring 67. Fencing & Access Approval /I 17? Rough Wiring Sign _ 68. APPROVED FOR PLASTERING 18'. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL � u, (19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# C1 1. Ducts, inlStructure - 70. Underground Hydro �c, 22. Ducts,•Ventilating ' i 71. Product Piping 0 Gas 0 Oil 23./Gas-Pipe-Rough &Jest '.) 72. Underground Flush 24! Roof Framing ,✓ 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing .1,. ' . - 74. Overhead Hydro 26. T-Bar Ceiling (Structural) &'Monocoat 75. Dry Chemical 27. Frarrieand Flashing 1` 76. Dry Standpipe 28. Lathing & Siding (;,: 77. FIXED SYSTEM FINAL 29. Inanition rf 78. FIRE PREY. FINALfr 30. Drywall Nailing lam, HEALTH DEPT. REQUIREMENT ;ti - I- 79. FINAL INSPECTION- 31. Plaster Brown Coat ' . 32. Electrical Power Meter-Final.) 80. FOOD CERTIFICATE ISSUED -- �.. Ay 33. Final Electric Notes: V 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace I441 • 38. Final Plumbing 39. Water Service-Final - • 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer cL 43. Backflow Irrigation 4" 44. Landscape Irrigation System I 45. Sound Attenuation . 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING • 48. Special Requirements Completed 49. Electric Release to Edison r 0 50. Gas Release to Southern California Gas Co - %' !-r 51. CERTIFICATE OF OCCUPANCY No. Date ',�%' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA ry/�jF,S/A �,({`ON�T�/R(U�(,/TION�/PERMJT PERMIT NO. 7 TRACT NO. ^LOT NO. UNIT NO.• A P # - • Zone ' Pr3ject Address '044,12 7 /�/Y' ///iT • EZ-Ce " S - - - - - •1 s p// r I S Main Building: Accessory Building: Applicant's Mailing A.•fess • - • TYPE OF CONSTRUCTION In NEN/- 0_ADD U ALTERATION H REPAIR • �,/�� / l 0 CONVERSION ❑ DEMOLISH 0 OTHER • - • - T Front . , - 0 Owner's Name A OWar'-..-A.' Phone ' �/ DESCRIPTION OF WORK/USE OF BLDG. -- - .A Rear. - , - . • .. N Address . _ - C Right , ' _ �- N Arch/Eng. -- License No• . TYPE OF PERMIT GRADING ❑ FOUNDATION ❑ STRUCTURAL .K' Address' - • ❑ TENANT ELECTRICAL .❑ PLUMBING ❑ MECHANICAL_ •, $ Left ' Contractor's Name Ph ne WO 7 ❑ '0TH ER - O - / L*-- E �i eFeE iez,�. 3 y"- Ping. Ref.# Parking Req./Provided D PROJECT DESCRIPTION SQ. FT. OCCUPANCY Address(mailing) /97c; �ee - Planning Notes: - - - - M y,/�.Z ( - CONSTRUCTION TYPE - VALUATION$ - - City License No. 77 • ZONE GRADING CU.YDS. ACRES - ' - LICENSED CONTRACTOR'DECLARATION .. $' • Thereby affirm that:) am licensed under provisions of Charter 9 (commencing Remarks: .,�3Z "7'3 .. - with section 7000) of Division 3 of the Business and Professions Code, and / - - my license is In full( rice a Cfect. Cr - ELECTRICAL . - -FEES - • License lass' - ✓ icen • ,,fir/ D - Date " �` moi. a' - •� i _i��T/�� PLUMBING FEES Automatic Washer • Transformer 0 15-50 KW : ORKERS' COMPENSATION DECL• RATION Construction Pole Sub• . • 050+ KW - Bar Sink Showers • �" +"'..hereby,affirm that I have a certificate of consent to self-insure or a certificate _ e;if Workers' Compensation Insurance, or a certified copy-there (Section _ _ - Cooking Unit ( _ Meter ❑up to 100 amps _ , '�0 3800, Cab. t;J.'� G/�i 997/4.- (//� ' - - /L - Backflow Preventer Service Sink - (IJ o D ted s Policy No. Company Backflow Irrigation Sewer Cap Dishwasher Meter Dover 100 amps ' ed copy is hereby furnished. - - Dryers ❑Gas ❑Electric Sub Panel ' 1 Certif i¢gcop +r.fihed with the city --ui :" g Di / Bathtubs Sewer Connection k�h�) D t'v-�Lam' Applicant r/ . /•7 Fan • Motors ❑0-1 HP ❑1'/:--8 EXEMPTION FROM WORKERS'COMP NSATION DEC ARATION Clarifiers Solar Collectors - • (This section need not be completed if the'permit is for one hundred (5100) orF.A.U. less). - DishwasherInc.Soler 09-75 HP 016115+ s • Solar Piping - I certify'that'in the performance of the work for which this permit is Issued, - Fixtures ' shall not employ any person In any manner so as to become subject to the ' Drinking Fountains Solar Tank Microwave Workers' Compensation Laws of California. - • - Date Signature , Device Boxes Pole Light ' Floor DrainsSwimming Pool w/Spa 9 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 ' - 3, Outlets _, _ Rao9e comply with such provisions or this permit' shall be deemed revoked. ' CONSTRUCTION• LENDING AGENCY- - • - • - - Gas Service ••Outlets Water Closet - T Switches Sign - / 50 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- Garbage Disposal - Standing Sections ' Lender's Name'- ' . . - Lentler's Address - Kitchen Sink Water Service -' Generator ❑0.5 KW 05-15 KW Trash Compactor OWNER BUILDER DECLARATION �e 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 _ y/,J/, v _ 7c county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry-Train .✓—yl A % /. ,any structure, prior to its issuance, also requires the applicant for such permit - UUU 1/ -to file a signed statement that he/she is licensed pursuant-to the provisions of Roof Drains the Contractor's License Law(Chapter9 (commencing with Section 7000)of . -" _ - Division' 3 of the Business and Professions Cotle) or that he/she is exempt —' - - - - - Reinspection Fee I $15 Issue Fee • /5-9-4-)- ..� 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). DEVELOPMENT SERVICES REQUIREMENTS: I . 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 - - Zoning Approved,By Data_ for sale (Section-7044, Business and Professional Code: The Contractor's• - - --- MECHANICAL - I FEES Building Approved By Date (/_ ) License-Law does not apply to an owner of a property who builds or improves U,/`/ thereon; and who does such-work himself/herself or,through his or her own Boiler Hood or Type I ❑ Application Issued By �_ nate employees, provided that such.improvements are noIntended or offered for - yP - sale. If, however, the building or-improvement is sold within one year of com- Canopy Type II O' • SUMMARY OF FEES ' pletion,'the owner will have the burden of proving he/she did not build or im- Duct-Under Ground - - - • ,• prove for the-purpose of sale). - BUILDING PERMIT $ SMIP $' ❑ I, asfowner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System • PLAN CHECK $ PERMIT 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'❑100,000.BTU _ ISSUANCE - $• 'builds-or Improves thereon:and who contracts for such oroiects with a con-- - - - - PLUMBING $ - tractor(s) license pursuant to rile Contractor's License-Law). I am aware that: Exhaust System ❑ Multiple D ; System Repair/Alteration PLAN CHECK 25% $ ' ENERGY P.C. $ proof of their Worker's Compensation insurance should be provided to me. - • • ELECTRICAL �r/ s : GRADING $ ❑ i am'exempt under Section , B.B.& P.C.for this reason ' Firepl/Fact,Blt. ICBG# Fire Dampers ' •PLAN CHECK 50% $ MICROFILM $ Date I owner Heating System& Ducting ' - Registers MECHANICAL I hereby certify that I have-read this application-and - $state that the above : -- bo-100,000 BTU•❑100,000 BTL' - - - - - - -- - TOTAL FEE $ T information is correct. I agree to comply with all city and county ordinances - - - • PLAN CHECK 25% $ - and-5tate laws relating to building construction,and,hereby authorize repre- - - X sentatives of, this city to enter. upon the above-mentioned'property'f or - - ingature purposes. 01 00016824-0001632. TOT ' 99.50 Signature Date Reinspection Fee '$15 Issue Fee $ 3 23 6 Drivers"License or$59 F - DATE: 10/11� TRW:- 0865-46,rev. 5/88 white - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor .,. F CONSTRUCTION AND PLANNING '• POOL&,SPA ;APPROVALS Permit# Date; Inspector _ APPROVALS Permit# Date Inspector ., ! j1. Temporary Electrical Service or Pole !