The URL can be used to link to this page

Home My WebLink About219 LILLIAN PL - Building Permits • 44,4111k° CITY OF COSTA MESA eta BUILDING DIVISION I ""'e DEVELOPMENT SERVICES DEPARTMENT T.b•.q '� PERMIT PERMIT NUMBER "'4omarso 898-02113 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT " - 17n y Job Address: 219 LILLIAN PL _ Status: ISSUED C/�✓ Suite: - ` • Applied: 11/23/1998 Vicinity: - Issued: 11/23/1998 Parcel Nunmber: 43921111 Zoning: Applicant: SUAREZ, BEATRIZ Address: 219 LILLIAN PL Phone: COSTA MESA,CA Zip: 92627 Owner: SUAREZ, BEATRIZ Address 219 LILLIAN PL . Phone: COSTA MESA,CA m • Zip: 92627 Contractor: Address: Phone: • Zip: License: Arch/Eng: Address: Phone: Zip License: SCOPE OF PERMIT . • R/R EXISTING GARAGE SIDE DOOR.REPLACE WITH A NEW TEMPERED GLASS FRENCH DOOR. FEE SUMMARY • Plan Check: $19.01 • Calc Valuation: $800.00 • Permit: $29.25 Claim Valuation: • $800.00 • SMIP Res: $0.50 SMIP Corn: $0.00 - Other • $0.00 2 Inspection: $0.00 Total: $48.76 • PLANNING 8 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 Existinq: 0 Required: 0 Proposed: 0 NOTES: • • • 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 7 I • I WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty Of perjury one of the following declarations: ❑ I have and will maintain e certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number. (This section need not be completed it the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in per .ance 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 law . f :rand agree that if I should become subject to the workers'compensation provisions of ction 370 of the Labor Code,I shall forthwith comply withthesp-'o -. -----,. 1 % y1 'n[ Applicanta ure: aI Li `s ear - -- •cDer if e S ! !1 WARNING:FNLURE TO SECURE WORKERS'COMPENSATI• ERAGE is UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRI I PENAL S AND GVIL FINES UP TOONE HUNDRED THOUSAND DOLLARS(stoop00).IN ADDITION TO THE••- • COMPENSATION,DAMAGES AS P-ROi`D FOR IN SECTION 37050F TH LABOR CODE,INTEREST,AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: • I hereby affirm that I em licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3sion oiness and Professions Code,and my license is in full force and effect.Lic.A Class R ��, so- Contractor's Sjgnatu aD le: 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: 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 ubje the applicant to a civil penalty of not more than five hundred dollars($500).): I' 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 pu -nt to the Contractors License Laws.). ❑ I am a :0 ' n••r sec. a Business and Professions Code for this reason: Signature: .�_ ' . A. Date Y r Owner ID ye ified by driver's Ii , 'e. 0 Yes 0 No Driver's License No. xpires: Verification of Ownership by(• of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY"'''' PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,Califomia Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes ❑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,ora 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 Califomia 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 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 aaermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? j�Yes LU No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑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 Alr 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 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: CERTIFICA I • OMPLULNCE 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 :gree to ply 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-deilir pe i for ins.ection pu ••.:s.I agree not to occupy or allow occupancy of any building authorized by this LLmit unci final inspection. Signal re Of :gal Own= s) / air And/0 .1 orized Applicant Date rnnE L INSPECTION TYPE DATE MEWL CODE f tNSPECTIONTYPF DATE =PALS 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 - 204 Final Demolition 250 Final Building/Occupancy 5-/9-99 C t )t[ 244&46 ti (� Fr • CITY OF COSTA MESA F`wair �l BUILDING DIVISION J DEVELOPMENT SERVICES DEPARTMENT PERMIT PERMIT NUMBER 41. 0 0 ""`°w E98-01218 (714)754-5273 • Fax(714)754-4856 - 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT ' Job Address: 219 LILLIAN PL Status: ISSUEDR'1A-7 Suite No Applied: 11/23/1998 Vicinity: GARAGE Issued: 11/23/1998 Parcel Nunmber: 43921111 �� Applicant: SUAREZ, BEATRIZ Address: 219 LILLIAN PL Phone: • DAA COSTA MESA,CA Zip: 92627 Owner: SUAREZ, BEATRIZ Address 219 LILLIAN PL ' Phone: ' COSTA MESA,CA - Zip: 92627 Contractor: - , Address: Phone: Zip: License: • SCOPE OF PERMIT C.E.CASE-STOP WORK NOTICE(P.T.)-PLUMB-REPIPE EXISTING HOUSE&GARAGE, ELEC.9 OUTLETS& 1 SWITCH.GAR.CONVERSION-CAP TOILET&SINK LINE AND REMOVE CLOSET-NO DEMO PERMIT REQ.ALL OTHER WORK COVERED IN NEW PERMITS. FEE SUMMARY ' Quantity -- ' - - • Quantity ISSUE FEE $22.00 1 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(34-units) $0.00 0 Transformers up to 1 kva/kw $0.00 - 0 ' Pool/Spa $0.00 0 up to 10 kva/kw $0.00 . 0 ' Lighting Fixts $0.00 0 ' up to 50 kva/kw $0.00 0 Recept Outlets $9.00 9 up to 100 kva/kw $0.00 0 Switches $1.00 1 - over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl- $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a . $0.00 0 Misc. Conduit $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 $0.00 0 Circus(mech ride or lights) . $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00- 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $32.00 Intermed Pole $0.00 0 COMMENTS/SPECIAL CONDITIONS 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 WORKERS'COMPENSATION DECLARATION: • I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of 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: WARNING:FAILURE TO SECURE WORKERS COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.a Class a Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: r 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 end Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,poor 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 subjectsjethe applicant to a civil penalty of not more than five hundred dollars($500).): ,I2 I.as owner of the properly,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 pur uant to the Contractors License Laws.). ❑ lam, :, pt - sec. Illik. Business and Professions Code for this reason: •Sjg /q� natare 2' .hi A2 p' 1tel/' Data:=II/r Owner ID verified by drivel. ••nse, 0 Yes rilfilo 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 B,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: _ Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to tile a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the Califomle 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 end 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 a permit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? LI Yes D No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 8 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the Califomia 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 California Health and Safety Code Section 42303 been made?. ❑ es 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 COMPUANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is cones ae to ply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the a e- nbed top for' spa tion purposes.I agree • to occupy or allow occupancy of any building authorized by this pe it u�fin I pection. (//1 Signature Of L=•- • ner(s) at And/Or Author ed •pplicant Date CODE I. MSPECTION TYPE DATE MIALS CODE I INSPECTInN TYPF DATE Rn5 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 _ 204 Final Demolition 250 Final Building/Occupancy 2446-46 OS) CITY. COSTA MESA ' I Fv,, )I Y BUILDING DIVISION i DEVELOPMENT SERVICES DEPARTMENT v..� • PERMIT ,. -' r PERMIT NUMBER. • toma0 P98-00867 (714)754-5273 • Fax(714)754-4856 - 77 FAIR DRIVE,COSTA MESA,CA 92626 • PLUMBING PERMIT Job Address: 219 LILLIAN PL Status: ISSUED1D • Suite No Applied: 11/23/1998 • Issued: ,11/23/1998 Vicinity: Parcel Nunmber: 43921111 Applicant: SUAREZ, BEATRIZ Address: 219 LILLIAN PL Phone: Y i COSTA MESA,CA • Zip: 92627 jYt / / .G1)111kHD Owner: SUAREZ, BEATRIZ - TF'7 y Address' 219 LILLIAN PL ' Phone: ' " . COSTA MESA,CA . Zip: 92627 Contractor: Address: , Phone: Zip: ' License: ,. Archl Eng: . , Address: • Phone: • Zip: - License: , SCOPE OF PERMIT ' •- . C.E,CASE-STOP WORK NOTICE(P.T.)-PLUMB-REPIPE EXISTING HOUSE&GARAGE,ELEC. 9 - OUTLETS&1 SWITCH.GAR. CONVERSION-CAP TOILET&SINK LINE AND REMOVE CLOSET-NO DEMO PERMIT REQ.ALL OTHER WORK COVERED IN NEW PERMITS. FEE SUMMARY AMT QTY AMT QTY - AMT QTY ISSUE FEE $22.00 , Laundry Tub/Washer $0.00 0 Sump Pump $0.00' 0 Backflow irrigation $0.00. 0 Landscape Irrigation - $0.00 0 Swimming Pool - . $0.00 0 Backflow Preventer $0.00 . 0 P-Trap $0.00 0 Trap Primer • $0.00 0 Bathtub $0.00 0 Pressure Regulator $0.00 0Urinal $0.00 0 Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 - Vacuum Brkr Bkflow(1-4) $0.00 0 Connect(Ice,Soda,etc) $0.00 0 Receptors ' $0.00 0 . Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units $0.00 0 Septic Tank $0.00 '0 Wash Basin $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 ' 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 0 Water Closet(Toilet) $0.00 0 Drain, Roof $0.00 0 Shower - $0.00 0 . Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 Sink, bar $0.00 '0 Water Piping(Inst or Rep.) $17.50 2 Expansion Tank - $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $8.75 1 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 ' Interceptors(Sand Auto) . $0.00 0 TOTAL CALCULATED FEES: $48.25 COMMENTS I SPECIAL CONDITIONS • 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 WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: k, ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Cartier: • Policy Number: (This section need not be completed if the permit is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of 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: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($106.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.4 Class N Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: � Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code: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 fore permit subjects the applicant to a civ,I penalty of not more than five hundred dollars($500).): o I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,end the structure is not intended or offered for sale(Sec. Ca. 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 e.: .to der s: iBusiness and Professions Code for this reason: `Si7/+��.� gnature: ' t ler DateZ : / Ei'Z O Owner ID verified by drivers tic, --. El Yes ❑No Drivers License No. xpires: Verification of Ownership by(• .: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,end 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? ❑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 with 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? ❑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 appennit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? U Yes L.J No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 8 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 (It 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 California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: _ _ Date: CERTIFICATE OF MPLIANCE 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 a yyy comp with all to laws and city ordinances relating to building construction,and authorize representatives oomnnof��f the City of Costa Mesa to enter upon the above-de r or insp:�n•ury>oses.I agree not to�r allow occupancy of any building authorized by Ni�e until nspection. ¶l4re' al117, Owne D to And/Or Authorized pp" ant Date CODES INSPECTION TYPE DATE ItQIDALS S4gP! RLSPFCTION TYPE DATE lM AL5 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 204 Final Demolition 250 Final Building/Occupancy 2446-46 PROJECT ADDRESS: 219 LILLIAN PL UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 05581 ? OWNER'S NAME: BUSH DAWN L ADDRESS: 219 LILLIAN PL PERMIT NO: E 055813 PLAN CHECK NO: N GOVT: N SUPP: N COSTA MESA,CA 92627 CONSTRUCTION TYPE: 5—N PERMIT TYPE: ELE PURPOSE; NEW ( 714 ) 657-6770 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : LEGALIZE534SQ FT GARAGE CONSTRUCTION SQ FT: ADDRESS: UNIT: CLAIM VALUE: CALC—VALUE; GROUP OCC: M-1 / PERMITTEE: GERALD BUSH ( 714 ) 650-6770 ADDRESS: 219 LILLIAN PL COMMENTS; RE• B55812 C.M. CA 92627 E*kF*****4******x*************N***+E>E******** **>E***N*>FSB*******kE*>F************ ** 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. S E T B A C K S CITY LIC.: STATE LIC.: CLASS: ' Dale: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT; FT IN REAR; FT IN mpensation Insurance.or a certified copy thereof(Section 3800,Lab.C). LEFT: FT IN RGHT: FT .IN LEFT; FT IN RGHT: FT IN I111UCY NO.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL; 43921111 ZNE: REF NO: ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. PLANNING NOTES> I` Date: Applicant **********1E**If***************************************************************** D E V E EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred si®)or less). L O P M E N T S E_ -R V I' C E S REQUIREMENTS I certify that m the performance of the work for which this permit is issued,I shall not employ any person in any manner so as to become e _ subject to the Workers'Compensation Laws of California. ZONING APPROVED BY 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. _ /q 1 CONSTRUCTION LENDING AGENCY: I hereby aftirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY• S DATE• U c' #41 which this permit is issued(Section 3097,Civ.C). ********************** — --- ***********. .**, *..**.* LENDER: CARPORT CONVERSION TO BE *********************************�E********************************************* ADDRESS: LEGALIZED ON OTHER PERMIT LEGALIZATION:N F E,'E/) SUMMAR Y' STRUCTURAL SEGMENT:N OWNER BUILDER DECLARATION: I hereby al firm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SHIP/RES GRADING (Section 7031.5 Business and Professional'Code: Any city of county which requires a permit to construct.alter,improve,demolish,or PERMIT 2 , 25 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 50$ • SM I P/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)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 PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). ISSUE FEE 15 . 00 I, as owner of the properly or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 2 . 25 15 , 00 0 . 00 17, 25 17, 25 , 00 r 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• 17. 25 OVER/SHORT: . 00 improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve for the purpose of 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 17, 25 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware ******************************************************************************* that proof of their Worker's Compensation insurance should b rovided to me. INDIVIDUAL F E E BREAKDOWN o I am exempt under Section: B.8 P.� � / forthis reason: q 7 TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST Dale: 1 '(C `V` ow ELE 1 FIXTURES LIGHTING 1 ST 20 EA. . 75 . 75 I do hereby certify that I am aware of and understand the requirements of California Health and Safety Code Sections 25505,25533,and 5 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a ELE 1 RECEP T/O TL ET 1 ST 2 0 EA, . 7 5 , 7 permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from ELE 1 RECEPT/SWITCH 1 ST 20 EA, . 75 . 75 these provisions. END OF FEES . Date: A IiCanl'. I hereby certify that I have read this applicati and state that the above information is correct I-, :•to comply with all city tl county ordinances and slate laws relating to building onstruction and hereby authorize r sentatives• ityl ter upon the ahoy mentioned 01 00106432-00 LUe F properly for• rp inspection purposes. DATE: O1/lu/4� I.`.j Date: I � `.� ' / Signature: Driver's License or social Security a: 1641.46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor . CONSTRUCTION AND.PLANNll - • L& 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 v • 3. Electrical Conduit Utility-Undrgrnd. - ' '54. Forms - :n '/) 4. Electrical Conduit-Undrgrnd. • 55. Electrical Bonding 5.•Steel Reinforcement • 56. Rough Plumbing & Pressure Test . 6. Electrical UF ER Grnd. - .57. APPROVAL TO COVE R-GUNITE • 7, Footings ` 58. Electrical Conduit-Undrgrnd. . 8. Foundation - '59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. '60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System -61. APPROVAL TO DECK i 11. Property Sewer Line...& House Connection - '62. Backwash & Receptor-Final , 12. Sewer Cap63. Heater & Vent-Final 13. Roof Drains - 64. Plumbing System - Final . . - i 14. Rough Plumbing - 65. Electrical-Final - • - _ i 15. Rough Electrical-Conduit 66. Solar System-Final • ' 16. Rough Electric Wiring 67. Fencing & Access Approval 17, Rough Wiring Sign 68. APPROVED FOR PLASTERING • . 18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL - 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace - APPROVALS Permit # 21. Ducts, in Structure - 70. Underground Hydro 22. Ducts, Ventilating - • 71. Product'Piping 0 Gas °Oil 23. Gas Pipe-Rough & Test - 72. Underground Rust(' . 24. Roof Framing - 73: Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing - ' 74. Overhead Hydro- 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical • 27. Frame and Flashing . 76. Dry Standpipe ' , 28. Lathing & Siding 77, FIXED SYSTEM-FINAL • 29. Insulation 78. FIRE PREV. FINAL - - V 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat .79. FINAL INSPECTION 32. Electrical Power Meter-FinalFDDD CERTIFICATE ISSUED 33. Final Electric � Dies: 34.•Final Heating-,& Air Conditioning , . - . - • 35. Final Gas Pipe-Test - - . t . 36. Hood or Canopy , ' 37. Final Factory Fireplace " ' - '• 38. Final Plumbing - - . . 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer, . - 43. Backf low Irrigation -44. Landscape Irrigation System - - - 45. Sound Attenuation - _ 1 46. Handicap Regulations - • - I 47. FINAL STRUCTURE & BUILDING • fr . 48. FINAL PLANNING • , • 49. Electric Release to Edison - 50. Gas Release to Southern California Gas ,- - - ,Co . 51: CERTIFICATE OF OCCUPANCY No. Date PROJECT ADDRESS: 2] 9 LILLIAN PL UNIT: CITY OF COSTA MESA - BCJILDING PERMIT PERM NO; B 057231 OWNER'S NAME: BUSH DAWN L ADDRESS: 219 LILLIAN PL PERMIT NO: B 057231 PLAN CHECK NO; N GOVT: N SUPP: N COSTA MESA,CA 92627 I CONSTRUCTION TYPE: 5-N PERMIT TYPE: STR PURPOSE: CON ( 714 )650-6770 JOB DESCRIPTION : LEGALIZE 240SF CARPORT CONV. TO DEN/LAUND SQ FT: 240 ARCH/ENGINEER: REG.NO.: C • • ADDRESS: UNIT: CLAIM VALUE: CALC-VALUE: 16, 560 , 00 GROUP OCC: R-3 / PERMITTEE: GERALD BUSH ( 714 ) 650-6770 ADDRESS: 219 LILLIAN PL COMMENTS : REPLACES 51340 & ' B ' PORTION OF 8E7295 COSTA MESA CA 92627 ***x******y6*** *** SEviE** *E6: ********* **+FT6*****x?f********Tri*N****** x:6** ****x* LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ON I NG R EQU IR EMEN TS • 17000)0l Division 3 of the Business and Professions Code,and my license is in full force and effect. S ETB AC K SS • CITY LIC.: STATE LIC.: CUSS: ' ° Date: signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers' FRNT; 20 FT IN REAR: 20 FT IN FRNT; FT IN REAR; FT IN Compensation Insurance,or a certified copy thereof(Section 3800.Lab.C). LEFT: 12 FT IN RGHT; 5 FT IN LEFT: FT IN RGHT: FT IN :a.POLICY NO.: EXP.DATE: 'OMPANY: PARKING REG- PROV; PARCEL; 4392111] ZNE• R1 REF NO: Certified copy is hereby furnished. D Certified copy is filed with the city Beading Division. PLANNING NOTES> LEGALIZE CARPORT CONVERSION, TWO CAR GARAGE PROVIDED ON 'SITE > Date: Applicant: **********************************************************3K******************** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be complete ' permit is for one hundred(5100)or less). DEVELOPMENT SERVICES REQUIREMENTS I certify that in the ierfor•ance of the work for which this permit is issued,I shall em a per ' any manner so as to become ^ / subject to the W. ers' ompensation Laws of California. ZONING APPROVED BY •_ CC-- ///'{/��/Fy/e`�// DATE: _�_ 2 —� Dale'. yut / , I^�'F"k—=�—�� BUILDING APPROVED BY /� Code, : . making this dply with s,youhshould become t i s ermit the Workers' rempensation provisions of the Labor ;l� • f //' /� DATE: s Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. • , CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: _ W/' r e' - • DATE; 4�� which this permit is issued(Section 3097,Civ.C). ********************** • ux " +- - ,e ' -*******************'TF**iF"Tf*** 7-** LENDER: CARPORT CONVERSION TO A *****************************************17************************************ ADDRESS: DEN & LAUNDRY ROOM, • LEGALIZATION:Y F E E SUMMARY STRUCTURAL SEGMENT; Y OWNER BUILDER DECLARATION: I hereby affirm that l am exempt from the Contractors'Stale License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SNIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city o1 county which requires a permit to construct,alter,improve,demolish,or PERMIT 360• 00 1 , 66 repair any structure.prior to its issuance,also requires the applicant for such permit to file a signed statement that he/she is licensed 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 • - 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($500). ISSUE FEE I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDIING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID • DUE ❑ structure is not intended or offered for sate(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 361 . 66 0 • 00 <%i 0 . 00 361 . 6 6 361 . 66 . 00 • does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through . I 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• 361 , 66 OVER/SHORT• 00 improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve for the purpose of 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 7644,Business 360 . 00 •-•'r 1 . 66 ❑ 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 acantractor(s)license pursuant to the Contractors'State License Law).l am aware **********************************,*.*****************************************.*** r+ that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN DE I am exempt under Se ion.B p 70 4 4 B.8 P.C. for this roan O EMPLOYEES TYPE QTY D E S C R I P T I ,Q. N • UNIT COST TOTAL COST ., —' Date: Y `r ya finer SFR 240 DWE—TYPE V—WOOD FRAME —GOOD - 69 . 00 16, 560 ,00 I do hereby certify that am aware of and understand the requirements of California Health and Safety Code cbons 25505,25533,and END OF FEES ' 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a r permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from r -- these provisions. 'iQr I Date: Applicant: EXPIRED I hereby certify that I have read this application and state that the above information is cor Os.I agree to comply with all city and county I ordinances and state laws relating to building construction and hereby authorize represent eso 'f1B�ity to enter upon the above-mentioned - P ('@ Inspeclior5s / property for i`nspeecc on p poses. }'� \ - ' •^___ Date: y 7 Z Signature Y • '\. Oat /J Sig+.4m. �J 01 1.0114!23'3611:`jl. _ L Driver's License or Social Security or: r DATE: 0505/71 1641-46 White-Building;Green-Code Enforcement:Canary-Applicant:Pink-Revenue;Goldenrod-Assessor 4 It r t CONSTRUCTION AND PLANNING.. POS SPA .. - APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole - _ . 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement - 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding - 5. Steel Reinforcement56. Rough Plumbing 8/ Pressure Test 6. Electrical UF ER Grnd. • 57. APPROVAL TO COVER-GUNITE 7. Footings 58. `Electrical Conduit-Undrgrnd. 8. Foundation i 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 4c. 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# 21. Ducts,in Structure 70. Underground Hydro 'F;. 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil - 1 23. Gas Pipe-Rough & Test 72. Underground Flush '- ': 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil ..t t R 25. Roof Sheathing 74. Overhead Hydro - -.r • . , I 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical v 27. Frame and Flashing 76. bry Standpipes •/: _ 28. Lathing & Siding 77. FIXED SYSTEM FINAL a /II 29. Insulation . ` � ' t s; 78. FIRE PREV. FINAL i` 30. Drywall Nailing 1 :� ',� - HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat -, r' 79. FINAL INSPECTION � 32. Electrical Power Meter-Final ;it. 80. FOOD CERTIFICATE/ ,fISSUED // /n� 33. Final Electric 'sA f Notes: r/8 frL \ �� f I 34. Final Heating& Air Conditioning !! 35. Final Gas Pipe-Test is 36. Hood or Canopy /" - 37. Final Factory Fireplace 38. Final Plumbing .r I. 39. Water Service-Final . 40. Gas Service-Final 41. Solar Domestic-Final - ' i' 42. Backflow Preventer •, ,. 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING V ' 48. FINAL PLANNING �-1' 49. Electric Release to Edison . ' 50. Gas Release to Southern California Gas Co ; 1 51. CERTIFICATE OF OCCUPANCY No. Date -_-- - • Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations- 4CITY CITY-OF MESA P IT Nq, TRACT NO, LOT NO. BLDG.NO. 0179 6/I p/63 • 27. K; T • CONSTRUCTION PERMIT- ` ,f 2 C 11 lv 3�I • I I ' Applicant's Mailing Address _ ,` sd TVP CONSTRUCTION LI NEW ti ADD'U'ALTERATIDN ,u REPAIR -_ . •i Project Address i S� Q' Ln CONVERSION ❑ DEMO�I�SsH ❑ OTHER - _ • - L Owners Name 1 2� n• ' •Phone�7yi��29 SSICRIPTION OF WORK - NV - O / p" (�D__ II. -Lcp -/{�(/ ZONING REGULATIONS • Address 1--A el; LI'LzA ht p�• - ~' / • 'Ty PE OF PERMIT,„, UiGRADING S FOUNDATION IA STRUCTURAL A.P..546 -?jq-�I? - (7 ZONE Pi - Arch/Eng.- z OWYV(.�- License NO. v • ❑ TENANT LW ELECTRICAL ❑ PLUMBING ❑ MECHANICAL V vpLNG.RpF.,#- BUILDING, 7 • • RE,F.,9*- SFTRArx r/t CT • .0,�OTHERREAR YARD (TO P/L) 5e- /ilddre55 ��' - �) - TO BUILDING- I N / Y - O7 [PROJECT DESCRIPTION SQ. FT. Yr • ,•' I OCCUPANC �' PROPERTY LINE '33 T , Address(mailing) Name ' Phone LEFT SIDE YARD 2 ? RIGHT SIDE YARD j CONSTRUCTION TYPE 1 . VALUATION$ c ODo J (� n. ie 1 Address(mailing) J! _ ... l • f : ; . - - ZONE GRADING CU.YDS. ' ACRES / - -PKG.SPACE REO. -CWi C0A ryh�" PROVIDED a_ r.• - p�� aLICENSED CONTRACTOR DECLARATION Remarks: " • S/3�O /( STREET WIDTH 5o' • PARK FEES - Lbereby.affirm that lam licensed under provisions of Charter 9 (commencing _ . - with section 7000) of Division 3 of the Business and Professions Code,and ' r ! .. SPECIAL CONDITIONS: ' POrl) pm cprf9,�1 RP QUUIPEMPNTS_ ' ' my license is in full force and effect. 4'' License Class' r License No H I PLUMBING - • 1 'i l , I• ��. 1 e Signature gar Sink Sewer Cap -• - I ELECTRICAL • KERS'COMPENSATION DECLARATION - - r, _ ' I raby affirm that 'Rave a.Insurance of.consen{to self-Insure or a f (Se certificate BeckflOw Preventer I. - Sewer Connection' . Automatic Washer !Meter Dover 100 amps • . of Workers' Compensation Insurance,,or a certified;copy thereof (Section ' - - ^" - - ' 3800, Lab. C.) _ ' 1 ', - I l Backflow Irrigation Solar_Collectors , _ ( Construction Pole , Sub Panel, I I Policy No. • i Company • Cooking Unit Sub Pole I • 1 • 8Certified-copy is hereby furnished. . , ' Bathtubs • I Solar Piping . I Certified copy is filed with the city'Bullding Division. r 1 I v 1 Dishwasher •- Motors ❑0-1 HP ❑1X$ _Date Applicant ' '. Clarifiers Solar Tank - - • EXEsectionP NTR pot beOIKERS COME permit I6N Done ARAtIlhundred($100)or ' 1 Dishwasher r • Swimming Pool w/Spa', Dryers ❑Gas, ❑Electric Inc,Solar •� ❑9-15 HP ❑16-15+ less): 1 - _ Microwave I certify.that in the performance of the work forwhichthis permit Is issued I ! Drinking Fountains I ;Urinal 1 FL, f.d } nl Fan: , shall•not employ any person In any manner so; to become subject to the 1 - - F.A.U. ' I ;Pole Li ht I worker¢• straws of'Cantor la ' &' ' •' Floor Drains' Water Closet " - g • Date 1"ViT"� fj� D Signature -+.' - - NOTICE:-If,after making this declaration;you s ould become subject to the-- Floor Sinks - - i .Water Heater' - - '! Fixtures • _ 'Range Workers's Compensation, provisions of the Labor. Code,.you,must forthwith -, - Device Boxes comply with, such provisions;'or.this.permit shall be(deemed revoked- , ' Gas Service` Outlets..- Water Service - '• ; - I Sign• ! _ CONSTRUCTION;LENDING.AGENCY 1 - - Outlets ' I hereby affirm that[here Is a construction lending agency for the performance. ; Interceptors -#"I -r - - . • i m Standing Sections , ' , -D S of the ,work for which this permit is issued (Section 307 Civ. C.) - - ' - ' - C ' Swit• ches • ' Lender's, Names' ' - ^ji.O.A G ' '-- ` 'i, Kitchen,Sink. - -• - - ! , h7 - Trash Compactor 0 I 'Lender's Address ' ' l *J�FS I - `' Lavatories, ' - c ' - ' i I Garbage Disposal i' OWNER BUILDER DECLARATION I 1' ' . . : _ , ' . ' c , i - ' I hereby affirm that I am exerript'.from the!Contractor's License Law for the , - - r Generator 00-5 KW 05-15 KW i / following reason (Section'7031.5 Business and Professional Code: Any city or P Trap• i. l ) county which requires a permit-to construct,alter,improve,demolish or repair - nt Transformer ❑15-50 KW ' 1 ! 1 any structure, prior to its Issuance,-also requires the-applicant for such permit i Roof Drains'? -' '• - - 4' 1 s. • , ( 1iie/jW`�"`+ •e a signed statement'that he/she is licensed pursuant to the'provisions of - ❑5U+KW • �\ ' ontractor's-Ucense Law'(Chapter 9(commencing with Section 7000)of ' ' Reinspection Fee on'3'of-the Business and Professions Cotle)"or that.he/she Islexempt Showers . , ' Reinspection Fee ' , $15 from and the basis for the alleged exemption: Any violation'of:Section - Meter 0u to 100 amps •IAU9 Fee! } $ 3. ' 7031.5 by any applicant for•:a permit subjects the -applicant to a civil ' - _ _ - ' e alty of not more than five hundred dollars($500). , 1 Service Sink ; Issue Fee ( .r $ 3 'Zoning Approved By "71 r...-i-, 'pate / / /e'3 't gI, as-owner of:the property - -- --• - - - - Y •/ 7 , k Jan.••,,,.—t!en willdothe work,and theafessiore,is not intended or 's ' r; MECHANICAL - ;^/Z7/vt 1 Application Approved By -Date 5/ /or sale (Section 7044, Business,and Professional Code: The Contractor's License Law Law does not apply to an owner of a property who builds or improves - Refrigeration System Boiler thereon, and who tloes.such.work himself/herself or through his or her own I i Application Issued By 'Date employees, provided that such improvements are.not intended or offered for 1 ❑0100,000 BTU ❑100,000 BTU. - Mle. If, however,the li have or Improvement is sold within one year of cam- Duct-Under Ground ' • SUMMARY OF FEES ' • • gletion, the caner:will have the burden of proving he/she did not build or Im- - Q��/l[ • rove for the rpurpose of sale). I • Duct-Structural System Repair/Alteration ' C. 'BUILDING PERMITO _ •• SMTP i r $ S( • I,as owner of the property, am excl uslvely contracting with Professions licensed con- - - • tractors to construct the project.(Section 7044„Business and Professions Code: ; Duct-Ventilating - -- . -. ' _ '� PLAN CHECK' $ ' PERMIT ' The Contractor's License Law does not apply to an owner of property who ( ; . ISSUANCE ' ' $ • builds or Improves thereon,and who contracts for such projects with a con- Exhaust System 0 Multiple❑1 I , ' / 'PLUMBING $ e�>._ • f . tractor(s) license pursuant to the Contractor's License Law). PLAN CHECK' $ Q -. GRADING • $ ' 0 1-am exempt under Section 1 , B.& P.C.for this reason Firepl/Fact,Blt. ICBG# ' 1 ELECTRICAL $ k. [� -i $ ' ' Date I Owner. •I - ! • Heating'System&Ducting I f • • PLAN CHECK $O.7O o ' MICROFILM $ OI hereby certify that I have read-this'.application and state-that the above - 00-100,000 BTU ❑100,000BTL - , Information is correct. I agree to comply with all city and county ordinances i iTOTAL FEE $ i • and state laws relating to bull Ing construction,and hereby authorize repre- - - _ MECHANICAL $ C /' sentatives of this o en upon-the above-mentioned property for Hood or. Type i 0 Reinspection Fee $15. • LESS • n`Q ' inspection Duro - �e.,� Canopy "Type II ❑ PLAN CHECK. $ , r//' i Signature DateAM'/ ZC iFg% I • ADVANCED�PC 1 $ �./ ; Drivers' License or,SS# • :' : Registers `•'Issue Fee $ 3 • , FINAL FEE ; $'g�1 CMF 0865-46 rev-12/82 •White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor ' • 1?CONSTRUCTI9ITAN0:PLANNING,' r ' r,..,----';,t." 1 ri `-, : ;r PO SPA,1'.-i' - ` ''APPROVALS -' Permit# 'C' - . --' Date ; 7 Inspector a - - , Date Inspector - APPROVALS` rmit# r d•. Temporary,Electrical Service or Pole - - 52f,Pool & E-quipment Location - • , • 2' 'Soil Pipe-Undrgrnd: '- ; �'. . , k- ; _ !a`, : • :;53 Steel Reeinforcement , - .y 31 Electrical Conduit Utility-Undrgrnd ' m (5,4' Fors `. • :, $ 4. ElectricalConduit-Uhdrgrnd:-." ; _ , : ;,� I55- ElectricalBonding - _ - 4 ; . 5 Steel Reinforcement': I. ,; = - " ' I 156 Rour ugh Plumbing:&-PressefTest . . - - - 6. ;Electrical UFERGrod.: , F '= -, -!..-:" .'-` !,::57;:,,APPROVAL--.TO,COVER-GUNITE•- . - , 7. Footings ' • I ' - ' . ' > _ -',11--' :-58' Electrical;Cpriduit:•Undre'rnr1.- ". 8. Foundation' _ I - - _ , =59. Gas Pipe, DUndrgrnd ,Test_ . , ;' 9. Water. Pipe-Undrgrnd. I - _ _ _ es,- i 60. Backwash LinP-Trap,,D Undrgrnd.' 10. Structural Floor System r r- <'= l -61. APPROVAL'TO DECK -•' `. - 11. Property Sewer Lin?& 62. Backwash & Receptor-Fipal , • •HousefConnection . • ; u y` , 12. Sewer Cap , I • ! o- _ 63. Heater&Vent-Final . ' - - . I 1 13. RoofiDrains I Ea ' r' c ? ;64. Plumbing:System-.Finals '_ ' '- i 14. Rough Plumbing i ' , :- ,.- : ' - - , 65. Electrical-Final -r I- - - - ' L '15"Rbugh-Electrical:Conduit-i --:- r'-"7-- _-! T -66'-SolarSystem-Finalr 1 " - - ` . _ • t r, .' er i 11 1 , i . ,_, I I ' O6.IRough_Electric Wiring, 1 a • 1: c . ;; (f„ _1671Fencing&AEcess-Approval - - - _ I x i_ .- - - ,)7. Rough Wiring•Signj. , , I I - -' i 68. ; APPROVED FOR PLASTERING - - - 18"::Rough Electrical-T Bar Ceiling , . i . i , • t • 69. POOL/SPA SYSTEMS FINAL ' . - - t 19. IRough`Heating& Air Conditionin•g l', : ! r' ! . [ 'i ' ! ,FIRE DEPT. REQUIREMENT: _ _ - E. ' 2d: 'Rough FractorV Fireplace i '' ' I 1 ' ; I APPROVALS : Permit# ' - a.n, ., , _ '21. rip6cts;i ; Sli'ueture;; Ii I 1 ; j I I 1 ,70.! Underground Hydro . 22. Ducts,.Ventilating It I I I l ;71 .' ProductPipingDGas DOil f23. 'Gas."Pipe,Rough & Test Y� ! '1 c ' I I i^ ' ! 1 72.! Underground Flush, - _ - - -- ,`24. Roof{Framing, ;•:;,1 l - ' tip J I '.1. 1- -1: '73.' Undergrrid.StorageTank DGas_D Oil y 25. Roof Shcatiiing ".' 'is - I ' h., • - _ I !744 Overhead Hydro - , - , P26. T Bar Ceiling (Structural),& Monocoat' ; I . •I - i ' 75.' Dry Chemical •27. Frame:aird Flashing• z ' ' i' QQ 76. Dry Standpipe - ,; 28. Lathing&Siding < ; Iry Jett, ,. i17-g3i1')L/ 77.' FIXED SYSTEM-FINAL . IC ': 29.,. lnsulation .7. - 11 V ' r IS i p �78i FIRE PREY. FINAL • --30. Drywall,Nailing : . 3 ' _S _- 12/sDh,TNotes: 6-(r-183 /../0..„:/../0..„:/../0..„:„.„ Gaye, . 31. Plaster"Brywn Coat,. `- 1 I , , ' ' ' , , , 1 , I I i 32. 'Electrical.PowerMeterFinal 1 t - I I , - I ' - :, 33. ,Final Electric ' : '; ' 1 i 1 I I ' 1 34. Final Heating&,Air Conditioning ; -1 i ' LT-1;1. , , _ , 35. Final Gas Pipe-Test '' • , - i - ' - . _it 36. Hood or Canopy_C., J ' i . , I s _ -, I: • - I 4 , - `t • .. _ ! 37. Final Factory Fireplace,: :I ' it:. ; i -' ! , • -_ -. - 38. Final Plumbing . I j ' �= I ` 4. 1 � , 1 , . •• 39. Water Service-Final ,I ' 't I I I � I ' I l . i ! - _ • 40. Gas Service-Final . i i , i I ; 1{ .' ' ' _ ' 41. Solar Doinestic-Final I ` I ' i } ' - 42. Backflow Preventer - I I • ' 1 I ' ' i . _i ' _- - _ . I• ,•' • - l 43. Backflow,Irrigation i, -_ - ; , - ' " i 1 s...:,.:)....7,,,, , ' r l- i pti .�-t 44. Lands-cal; Irrigatio,n;System '- r- _ :I 1 r_c, 7.. - t F 45. Sound Attenuation '. ;,,_ '. b 1- - j i ', `J"'• ' u _ 46. Handicap Regultion`s j ' i r, ',4 `'! I t , I "I - r , 47. FINAL STRUCTURE& BUI LDING t ' } I I I I i ' _ 1` ' - L 1 4 I I 1 _ - , , _.I ; I ; 48. Special Requirements Completed' '', , t~i I ' I cl ,. • I ,. 49. Electric Release,to'Edison' 1 1 4 ' l- ., _1 -(. -'- . ..j._ 1.-.�__i_- - .' .. ,f ,.,- 50. Gas Release to Southern California Gas Co 1 l ' ! ' I ' i I „j t It , ;,t ' l' ' . 51. CERTI FICATE'OE OCCUPANCY * _ .4.___'. ._:_ ! -_, i'__. _..1_ Imo_•. I ` 'r i I • i i ' ' I i� "�,, ..”.11,i , No 8 1 f Date f i = d.' PROSECT ADDRESS: 219 LILLIAN PL UNIT: r CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 057232 OWNER'S NAME: BUSH DAWN L ADDRESS: 219 LILLIAN PL PERMIT NO: E 057232 PLAN CHECK NO: N GOVT: N SUPP: N COSTA MESA,CA 92627 CONSTRUCTION TYPE: 5—N PERMIT TYPE: ELE PURPOSE: OTH ( 714 ) 650-6770 a ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : LEGALIZE 240SF CARPORT CONV.TO DEN/LAUND SQ FT; ADDRESS: UNIT: CLAIM VALUE; CALC—VALUE: GROUP OCC; R-3 / '. PERMITTEE: GERALD BUSH ( '714 ) 650' 6770 n E ADDRESS: 219 LILLIAN PL COMMENTS : RE•B57231/ALSO REPLACES E PART OF BE7295Q. SL{cp • COSTA MESA CA 92627 ************4*************************************�""..********* *s************(-***" � ,r LICENSED CONTRACTOR DECLARATION: I hereby affirm 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 eftect. SETBACKS CITY LIC.: STATE LIC.: CLASS: Date: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT; FT IN REAR : FT IN ' Compensation Insurance.or a certified copy thereof(Section 3800,Lab.C). , LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY ND.: EXP.DATE: COMPANY: PARKING REO• PROV: PARCEL:. 43921111 ZNE: REF NO: ] Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> > Date: Applicant: ************-**********************N,******************************************** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). D E V E L O P M E N T S E"!R V I C E S REQUIREMENTS I certify that in the p•rforma 'of the work for which this permit is issued, I- I npYjfnplo any person in any manner so as to become _ " subject to 1haWo e s' o• n anon Laws of California. // ZONING APPROVED BY •° : DATE: S i • re, Date: Signature: NOTICE:If.after making this reclaration,you should come subject to the orkers'Compensation provisions of the Labor BUILDING APPROVED BY :_ a • DATE: Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. •' �---/ CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y• .ft '. .' // DATE• J / y/yrZ which this permit is issued(Section 3097.Civ.C). **************K*******ir.= • *'xi ' 1 • ,s R.it**+Finkri 'R*3i.*****, **********iiio��"""CCC1F d A•�f*** ** ALEDER: CARPORT CONVERSION TO A **********************************yE******************************************* DEN 6 LAUNDRY ROOM, LEGALIZATION:Y F E,'E,.. S u M M A R Y STRUCTURAL SEGMENT;N i 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 SNIP/RES GRADING (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT ' 12 , 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 S O SM I P/NON—RES pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)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 PLAN any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE 15. 00 I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV— > PERMIT ISSUE, PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered for sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS————> 12 , 00 15, 00 0 . 00 27 , 00 27 . 00 , 00 does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through his her ownisemployees,within provided that mph improvements me ori not intended bd de offeredoffin sale.Ifnotthe building or REVENUE DIVISION TOTALS--> COLLECTED: 2'7. 00 OVER/SHORT• ,00 hisimprovementorher sold within one year of ct such limp the entsr will have the burden proving forhe/she did not howeverbuild the or improver ffrthepurposeofsale). BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the property,am exclusively contracting with licensed contractors Co construct the project(Section 7044.Business 27. 00 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of property who builds or improves thereon "A - and'.who contracts for such projects with acontractor(s)license pursuant to the Contractors'State License Law). l am aware *****************************************.******************X*************it:99**** that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN t ® I am exempt under Se ion: B P 7 0 4 4 B.8 P.C. 'for misrea n: O EMPLOYEES TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST '�� Date: ��y Owner: h ELE 1 FIXTURES LIGHTING 1 ST 20 EA, '75 , 75 I do herebycoral hat fuze aware of and understand the requirements of Cal' into Health and Sate Code Sections 25505,25533,and ELE 5 RECEP T/OUTLET 1 ST 20 EA, . 75 3 , 75 25534 and that I or any future building occupant will/will (circle one)need to comply with said state codes and the requirements for a ELE 2 RECEPT/SWITCH 1 ST 20 EA, , '75 1 , 50 permit for construction or madilicalion from the Air Quality Management District.Residential construction applications are exempt from these provisions. END OF FEES Dale: Applicant: • 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 stalelaws lotto to building construction and hereby authorize rep entativ this city to enter upon the above-mentioned ,`// property for inspec/torfp'Ju�rp s. Date: �/ / 1t Signature: • / 4'1 00114K2-1171 i -;..3.7"; " . Driver's License or Social Security a: DATE: 05;US/'12 " 1641-46 white—Building:Green—Code Enforcement:Canary—Apolicant:Pink—Revenue:Goldenrod—Assessor CONSTRUCTION AND PLANNING - PC SPA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector. 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location • - • 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. - 54. Forms ' 4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding 5. Steel Reinforcement 56. .Rough Plumbing & Pressure Test 6. Electrical UPER 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, O Undrgrnd. 10. Structural Floor System - 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62: Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final_ • 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS F{NAL 19. Rough Heating & Air Conditioning - - FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation - !-'• 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final ./:' 8n FOOD CERTIFICATE ISSUED 33. Final Electric ,/�//_,/.71 4dotes: 34. Final Heating & Air Conditioning �"`7T ff`"`''LL�Z✓✓ , 35. Final Gas Pipe-Test �- - • 36. Hood or Canopy 37. Final Factory Fireplace • 38. Final Plumbing 39. Water Service•Final 40. Gas Service-FinatC', 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING ' 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ; 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to till in all spaces within heavy border lines and sign all appropriate declarations. V•OF COSTA MESA 1 PERMIT'NO. TRACT-No: ' LOT NO. .,' •BLDG.NO. - - "' -` _ - - " NSTRUCTION PERMIT F • eject Address TYPE OF CONSTRUCTI • - _ FL 00 TL 'L\ci � �wlsr� Pc yy 4779 9/i�/tli Awber"" �G�RP•1A- Phoneelt-509 y.� NEW -0 ADD ALTERATION T LI1 " - - i •• ' _ I Address- Z -^ -- :-D REPAIR 0-CONVERSION ❑DEMOLISH a LQ Liu Ch J' � ZONING REGULATIONS,. Arch/Eng. ora/CA, License No. -- D OTHERA P - Address '- - - - DESCRIPTION OF WORK .. _ - '' ' _ / /1'/Vs . - •- - _ _ A ._ - ,. _ -- •._- ----- ZONE PLNG:REF,: $L ' .q l_ 4p-contractor � � r9i -, -- Phone- -- - • - TYPE OF PERMIT,: - • - -- • BUILDING-- - -- - TTQQ B�t11ILLDING SETBACK C/LST. PROPERTY LINE• ; Address G/P. - - " ' - 0 GRADING • 0 FOUNDATION ' 0 STRUCTURAL - SIDEARD . ._- - _ LICENSED CONTRACTOR DECL'A RATION - ❑ TENANT 'ELECTRICAL-❑PLUMBING" OMECHANICALt SIDE YARD - - - - - --- - - I hereby affirm that I am licensed under provisions of Charter 9(corn- - RIGHT mencing- with'section 7000) -of 'Division -3--of the- Business and• -0 OTHER -- - - - - Professions Code, 'and my license is In full force and effect. • 1 -• REAR YARD(TO P/L) , PROJECT^.DESCRIPTION __ _ _ _ License Class _ License No. 50. FT•- I d>� ' PKG.SPACE REQ. PROVIDED , - Date Signature - __ - • WORKERS'•COMPENSATION DECLARATION - - .�. OCCUPANCY_CONSTRUCTION T_V9E • 'STREET WIDTH PARK FEE $ • I hereby affirm that I have a certificate of consent to self-insure•or a VALUATION - ZONE - ZONING APPROVED BY ,, I DATE certificate of Workers' Compensation-'Insurance; or-a certified copy - - --- -- .-- - - - - ." . ' 'of(Section 3800, Lab.C.). SPECIAL CONDITIONS: 't GRADING CU,YDS. ACRES . ' No. Company :rtified•copy Is hereby furnished. "• . --. - - - -. . . REMARKS: ' ' - ! - - - -- - , Li Certified copy is filed with the city Building Division. - - - .. . , - .I • ' EXEMPTION FROM WORKERS'-COMPENSATION DECLARATION '" - - ' - - -- - - - s:P. SL3 hod `�l (This section need noLbe completed if the perms Lis"for one_hundred . - _ . _ _ _ - - - ($100) or less). ,e. r. , _ " •� .I�" I certify that In.the-performance of.the work for which this permitis ,_,- _- .__ __ _ _ _ _ _ _ Issued, I shall not employ any person in any manner so as to become PLUMBING. PLAN CHECK - ' ELECTRICAL .PLAN CHECK, - subject to the Workers'Compensation Laws of-California. - BATHTUBS SHOWERS Date Signature ' 50 FT SO FT NOTICE: If after making this tleclaratio n, you should becomesubject TOILETS ,URINALS GENERATOR - 0-1 KW 3.-16 KW r to the Workers' Compensation provisions of the Labor Code,you must - - TRANSFORM_ ER - I forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAYS- - ' -- "" .APPLIANCE '10-50'KW - 50+ KW - -C - - revoked.. - - _ CONSTRUCTION LENDING AGENCY KIT.SINKS DISHWASHERS`- '" - - - MOTORS' - -- '' 0=1 HP'_1=10 HP - -I I herebyaffirm that there is a construction lendingagency for the per- SERVICE SINKS ' _ '. SUMPS" • "--- ' 1 `--- ---- -(INC.SOLAR)-- - - e Y P - 30-50HP=50+ HP• Civ. C. formance - the work for which this permit is issued (Section 3097 ! - - - - Civ. CJ. - - - • - FLOOR SINKS •r,% ,1FLOOR DRAINS • • ;FIXTURES ( 'OUTLETS SWITCHES 2 ` -n - Lender's Name - _ _ __ ` - _ - - - • �" �d Lender's Address DRINKING FOUNTAINS _ GAS'TUBE SIGNS-"' - ' ' _ - - ' ' ' OWNER BUILDER DECLARATION'"-- - - INTERCEPTORS CLARIFIERS - POLE LIGHTS -- " ---"- I hereby affirm that 1 am exempt from.the Contractor's License Law for •• - • r the following reason (Section-7031':5-Business-and Professions Code: -SWIMMING-POOL ' - PTRAP - _ • : '- - - CONS I.KUL I IUry _ - _ - Any city or county which requires a permit t0 Construct, alter, -POLES METERED SUB • . n Improve,demolish or repair any structure, prior to its issuance,'also re- WATER SERVICE - ALTERATION - •- "PANELS-PANELS - -' MAIN - SUB .- . " .-- ' • quires the applicant for such permit to file a signed statement that he - - ' is licensed-pursuant to'the provisions of the-Contractor's License Caw GAS SERVICE • OUTLETS ',, •• - i` "SERVICE'-"" • "" '-"'- ' AMP - fr-•rater 9 (Commencing with Section 7000) of Division 3 of the +•• ^ ' ss and Professions Coder or-that'he is exempt thereftom'and the -WATER HEATERS' • BTU OUTPUT - -"' '"- • ""-' "' -' "' ir the alleged exemption. Any violation of Section 7031.5 by - - ' _ plicant for a permit subjects the applicant to"a civil penalty SEWER CONNECTIONS ._ ' - '_ - . more than five hundred dollars ($500). • - ` i1 I, as owner of the property,or my employees with wages as their • SOLAR TANK - COLLECTORS' ' "" -" -` -- " ' . " - " - - sole compensation, will do the work, and the.structure.is not intended - ' or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. ISSUE FEE-- " - Contractor's-License.Law does notapply to an owner of_a property. _ • - - 'APPLICATION APPROVED BY -r - DATE who builds or improves thereon, and who does such work himself or ISSUE FEE _ through-his-own employees, provided-that.such improvements are not __ _ intended or offered for sale. If, however, the building or improvement MECHANICAL PLAN CHECK • SUMMARY OF FEES; is sold within one"year of completion, the owner will have the burden _ _ proving he did not build or improve for the purpose of sale). I BUILDµV G, C-D - I, 'as 'owner of the property am-exclusively contracting with HEATING SYSTEM 0100,000 BTU _ _ PERMIL lv P I� I- SMIP S AND DUCTING Icensetl contractors to construct the project (Section 7044, Business 100,000+ BTU p�e WSpeCtIOf15 PERMIT and Professions-Code: The Contractor's License Law does'not'apply to - ISSUANCE-" $ _ an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING Ca It tracts from suchsprotects' with a contractor(s) Ilcesnetl pursuant to SYSTEM I - - --r - �% •t ll. A I („i CIt the Contractor's License Law). 100,000+gTU_ �a Pt, vI`ra•�.I — $ 0-1 am exempt under Section B.& P.C.for this BOILERS BTU L TRI •L $ ` 42 reason _ _ MICROFILM S SYSTEM REPAIR,ALTERATION "PLAN CHECK' $ - Dace - Owner TOTAL FEE$ • MECHANICAL-$ Lhereby certify correct. I read this application.andhstate that the above EXHAUST SYSTEM MULTIPLE LESS AD- "r` information is correct. I agree to comply with all city and county PLAN CHECK $'-- -'VANCE PC '$_ ordinances and state Jaw elating to construction,and hereby-authorize representatives of this ity to enter upon the above mentioned It '' propert• • rposes. � .- --i - -g764 1,M1 I I FINAL FEE $ I Signature se•res Dat �e�/ / - ' - ISSUE FEE Drivers'License or SS# E. - - �' - ' 0865-46 White-Building;Canary-Applicant; Pink-Accounting;Goldenrod-Assessor CONSTRUCTION AND PLANNING - • POOL& SPA APPROVALS Permit# Date Inspector •APPROVALS Permit# - Date. Inspector • 1. Temporary Electrical Service or Pole . , c 43. Pool Equipment Location --• . - II 2. Soil Pipe-Undrgrn • 44. Steel Reinforcement • 3. Electrical Conduit Utility-Undrgrn • - 45. Forms - - 4. Electrical Conduit-Undrgrn• 46. Electrical Bonding - - - - .. 5. Steel Reinforce47. Rough Plumbing & Pressure Test- 6. Electrical LIFER Grn 48. APPROVAL TO COVER-GUNITE - ., 7. Footings 49. Electrical Conduit-Undrgrn 8. Foundation. • 50. Gas Pipe, ❑Undrgrn,Test - • 9. Water Pipe-Undrgrn - 51. Backwash Lines. P-Trap.•❑ Undrqrn 10. Structural Floor System 52. 'APPROVAL TO DECK 11. Property Sewer Line & House Connection - . 53. Backwash & Receptor-Final .'012. Street Sewer Connection, - . _ . . 54. Heater & Vent-Final '13. Rough Plumbing _ • 55. Plumbing System -Final •- 14. Rough Electric-Conduit - • X56. Electrical-Final . 15. Rough Electric-Wiring . ate-nett .. • - - 57. • Solar System-Final 16. -Rough Heating & Air Conditioning - 58. Fencing&Access Approval 17. Ducts, in Structure •. - - ' 59. APPROVED FOR PLASTERING 18. Ducts; Ventilating 19. Gas Pipe-Rough &Test - . 60. POOL/SPA SYSTEMS FINAL • • 20. - Roof Framing . . . .. . 21: Roof Sheathing . . . . . . 22. Frame and Flashing NOTES: • 23: 'Insulation :. . . • P eet7/-s S7 24. Lathing & Siding - . - 25. Drywall Nailing 26. - Plaster Brown Coat .. . . 27. Electrical PowerMeter-Final . 28. Final Electric <A/92 29. Final Heating-& Air Conditioning 30. Final Gas Pipe-Test , _ 31. Final Plumbing ' 32. Water Service-Final , - • fi 33: Gas Service-Final - - - 34. Solar Domestic-Final ' 35. Landscape Sprinkling System' 1 •'i 0 " A 3 ..- • • • 36. Sound Attenuation -' - Ili ait;,u-no-v.! - 37. Handicap Regulations SLn t..J • 38. FI NAL STRUCTURE & BUILDING_.'_„_ ,r,;; • . 39. Special Requirements Completed - 40. Electric Release to Edison - - 41. Gas Release to Southern California Gas Co. - . - 42. CERTIFICATE OF OCCUPANCY No Date - . P Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA • ' P MIT NQ,,,, TRACT NO. LOT NO. BLDG.NO. - ' i':: -. - , '- T CONSTRUCTION PERMIT 5E- 72 9C I,l -, . ii J Applicant's Mailing Address - ie1 TYP ��ECONSTRUCTION NEW ADD1J LJ ALTERATION El REPAIR• �/ Project Address S'ysu,.. L9 CONVERSION 0 DEMOLISH 0 OTHER IX- I CRIPTION OF WORK "la 0 DEC Owner's Name r� "`x'�Ln Phone&WZ'Sr/ZQZONING REGULATIONS V Pc ,a.rCT(✓RTE �F/ Mi7' Address �v Ci (�I Lc 1& - r l PE OF PERMIT_,,, DING LJ FOUNDATION IICJ STRUCTURAL A.P.# -1-3y-,/a - // ZONE P 1 'v Arch/Eng. OL-r A g_y - License No. `--1" 0TENANT LbELECTRICAL 0PLUMBING 0MECHANICAL PLNG.R F.# — BUILDING jFTRG! k r•/1 ST Address ❑ OTHER TO BUILDING 2 N / i / r 2L� PROPE RTV LINE J31 REAR YARD (TO P/L) a-J j Contractor's Name t P S Phone PROJECT DESCRIPTION Sq. FT.�- oCCUPANC�y ��- l CONSTRUCTION TYPE VALUATION$ cf'QDO LEFT SIDE YARD 3 / RIGHT SIDE YARD es/ it ttw 11.....A-Ge Address(mailing) PKC.SPACE REQ. PROVIDED J ZONE GRADING cu.YDS. ACRES /-CQJ� CLt,'+�J[I✓� a-CIVy Cu(1.1� ({_p�-- License No. _ � _ D .. -I LICENSED CONTRACTOR DECLARATION Remarks: 0 STREET WIDTH Sol PARK FEE S I hereby affirm that I am licensed under provisions of Charter 9(commencing - • - with section 7000) of Division 3 of the Business and Professions Code,and SPECIAL CONDITIONS: (Mi 1` i 11 ti-Ly1 i:1-4) ,prk'T my license is in full farce and effect. • License Class License No. PLUMBING ' • late Signature Bar Sink $eer Cap • wELECTRICAL IORKERS'COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self-insure or a certificate ' Backflow Preventer Sewer Connection Automatic Washer Meter Clover 100 amps of Workers' Compensation Insurance, or a certified copy thereof (Section - • Construction Pole i Sub Panel 3800, Lab. C.) Backflow Irrigation SolarCollectors Policy No. Company ' _- Cooking Unit Sub Pole Certified copy is hereby furnished. Bathtubs • Solar Piping _ 'Certified copy Is filed with the city Building Division. - Dishwasher Motors 00-1 HP ❑1X$ Date Applicant • Clarifiers Solar Tank ' EXEMPTION FROM WORKERS'COMPENSATION DECLARATION - - Dryers ❑Gas ❑Electric Inc.Solar 09-15 HP 016-15+ (This section need not be completed if the permit Is for one hundred ($100)or Dishwasher Swimming Pool w/Sod less) - Fan Microwave I certify that in the performance of the work for which this permit is Issued 1 Drinking Fountains Urinal - . shall not employ any person In any manner so to become subject to the F.A.U. •Pole Light Workers' cgmp9gsat ws of Cantor la Floor Drains Water Closet • Date MP5Y '/ f//7 Q.Signature ^•'� - Fixtures •NOTICE:If,after making this declaration,you 5 Quid become subject to the Floor Sinks Water Heater / Range D 20 Workers' Compensation provisions of the Labor Code, you must forthwith I comply with such provisions or this permit shall be deemed revoked. �. IGas Service Outlets - --III Water Service Device Boxes Sign CONSTRUCTION LENDING AGENCY • Outlets I hereby affirm that there is a construction lending agency for the performance Interceptors Standing Sections 0 eft - of the work for which thik permit is issued (Section 3097 Civ. C.) • Lender's Name ^1'0"f' F Kitchen Sink ' •• Switches Trash Compactor 0 110 Lender's Address I`-) Nie.. - • Garbage Disposal OWNER BUILDER DECLARATION Lavatories 9 P I hereby affirm that I am exempt from the Contractor's License Law for the ' —P-Tra - • Generator 00-5 KW 05-15 KW following reason (Section 7031.5 Business and Professional Code: Any city or p . . county which requires a permit to construct,alter,Improve,demolish or repair Transformer 015-50 KW any structure, prior to its issuance,also requires the applicant for such permit Roof DrainsCOVil . file a signed statement that he/she is licensed pursuant to the provisions of ' e Contractor's License Law(Chapter 9(commencing with Section 7000)of • ❑5U+KW ‘ Reinspection Fee vision 3 of the Business and Professions Code) or that he/she is exempt Showers - ' Reinspection Fee $15 - . erefrom and the basis for the alleged exemption. Any violation of Section Meter ❑up to 100 amps Issue Fee $ 3 7031.5 by any applicant for a permit subjects the applicant to a civil —Date _ _ •e.alty of not more than five hundred dollars ($500). Service Sink Issue Fee ' $ 3 T Zoning Approved By Y ./ r� Date (7/ /0/8 3 a= I, as owner of the property ' / ' ' / -.Ith .. 140.-4•4* MECHANICAL �$, / 4, s will do the work,and the o ession isnot intended offered Application Approved By /`J Date --\� for sale (Section 7044, Business and Professional Code: The Contractor's V /Y^"� License Law does not apply to an owner of a property who builds or Improves Boiler Refrigeration System thereon, and who does such work himself/herself or through his or her own • Application Issued By Date employees, provided that such improvements are not intended or offered for Duct-Under Ground ❑0-100,000 BTU ❑100,000 BTU - sale. If, however, the building or improvement is sold within one year of com- SUMMARY OF FEES pletion, the owner will have the burden of proving he/she did not build or im- LQISMIP $Duct-Structural, System Repair/Alteration BUILDING PERMIT nov,eafsorotwhneepruOrfpothsee opfrosapleer)t.y, am exclusively contracting with licensed con- tractors to construct the project (Section 7044,Business and Professions Code: Duct-Ventilating PLAN CHECK $ 4:2PERMIT The Contractor's License Law does not apply to an owner of property who ISSUANCE $ builds or improves thereon,and who contracts for such projects with a con- Exhaust System ❑ Multiple D • PLUMBING $ Awn- tractor(s) license pursuant to the Contractor's License Law). GRADING $ • ❑ 1 am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# PLAN CHECK $ i C`. ELECTRICAL • $9: 4'0 /4, $ �C Date Owner Heating System& Ducting MICROFILM $ O I hereby certify that I have read this application and state that the above ❑0-100,000 BTU ❑100,000BT1f— PLAN CHECK $0•70 information is correct. I agree to comply with all city and county ordinances • • MECHANICAL $ G TOTAL FEE $ and state laws relating to buil ing construction,and hereby authorize repre- Hood or Type I ❑ ' - /' 19 sentatives of this ./o en upon'the above-mentioned property for VP Reinspection Fee $15 LESS `ci inspection purr) Canopy Type II D I PLAN CHECK $ Signature Date/ANI u/Fg ADVANCED PC $ /��g/�� . Drivers' License or SS# Registers I Issue Fee $ 3 _ FINAL FEE $ ;1 CMF 0865-46 rev.12/82 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod -Assessor V CONSTRUCTION-AND PANNING t PO' 1PA•, .. APPROVALS Permit#• Date - Inspector APPROVALS . .,it# Date Inspector r a 1. Temporary Electrical Service or Pole 52. Pool & Equipment Locatign 2. Soil Pipe-Undrgrnd. • 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms . 4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. - 57. APPROVAL TO COVER-GUNITE 7. Footings 58: Electrical Conduit-Undrernri. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Uniirgrnd. - 60. Backwash Lines, P-Trap, 0 Undrgrnd. , 10. Structural Floor System - 61. APPROVAL TO DECK • ii. Pi opal ty Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final • 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing. 65. Electrical-Final • - 15t Rough Electrical-Conduit -I' 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 2d. Rough Factory Fireplace APPROVALS Permit# .. 21 . Ducts,.irifitructure 70. Underground Hydro .. 22. Ducts,.Ventilating ' 71. Product Piping 0 Gas 0 Oil ' .23. Gas Pipe Rough & Test ' ' 72. Underground Flush 24. Roof Framing. - ' 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Hoof Sh�;athing ,. 74. Overhead Hydro . ' 26. Y-Bar,Ceiling (Structural).& Monocoat ' - 75. Dry Chemical 27. Frame:aifd Flashing Fs h� i l/i Az 76. Dry Standpipe 28. Lathing &Siding - h 6-17-83 ill 1917 77. FIXED SYSTEM FINAL - - 29. Insulation D 5 /_99_L[.i1 78. FIRE PREV. FINAL 30. Drywall Nailing .. . S i..4 1s Notes: 6_(r-$..3 L/� o. nay/ ' 31. PlasterBrpwn Coat, •.` �! 32. Electrical-Power Meter-Final • ` /j . • 33. Final Electric 4� 1M. .Il - 34. Final Heating & Air Conditioning ll�t� t\\ i^,.,'1 • 35 • L Final Gas Pipe-Test ' - I 36. Hood or Canopy . ' 37. Final Factory Fireplace , : 38. Final Plumbing . - - - 39. Waterpefvice-Final ' 1 i I j , I . ; I 40. Gas Service-Final 41. Solar Domestic-Final ` ' .. ' - ` 42. Backflow Preventer I I 43. Backflow.Irrigation " - 44. Landscape Irrigation-System - _ 45. Sound Attenuation -. ,; I -+" ' 46. Handicap Regulations . • ' , • 47. FINAL STRUCTURE & BUILDING 't . ' - I l - 48. Special Regdiremegts Completed ' 49. Electric Release.th Edison! , •- I - . _ .. 60. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY ; . . . :I - No. Date PROJECT ADDRESS: �-..L4' . UNIT: OWNER'S NAME: DDR219 LILLIAN PL CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 062570 AESS:BUSH DAWN L 219 LILLIAN Pb `� PERMIT NO: E 062570 PLAN CHECK NO: N GOVT: N SUPP: Y COSTA MESA,CA • 92627 CONSTRUCTION TYPE: 5—N PERMIT TYPE: ELE PURPOSE: OTH ARCH/ENGINEER: ( 714 ) 650-6770 RE6.N0.: ADDRESS: UNIT: JOB DESCRIPTION : LEGALIZE 240SF CARPORT CONV.TO DEN/LAUND SQ FT: PERMITTEE: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / ADORESS:GERALD BUSH ( 714 ) 650-6770 219 LILLIAN PL COMMENTS: RE- E57232 COSTA MESA CA 927 *�E+ESE*�t*�E�E*�r�E4*****�E�E****�E�E*�E�E�E�E�E�E�E�E�E+E**�E�E**�E****�E�P**�E �E**�E�E*�E�E**�E�E�E�E*NSE*EE�E�E*�E�P�E LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions atChapter 9(commencing with Section ZONING REQUIREMENTS 7000)of Division 3 of Use Business and Professions Code.and my license is in full force and effect. CITY LIC.: STATE LIC.: CLASS: SETBACKS Date: Signature: MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to sell-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Compensation Insurance.or a certified copy thereof(Section 3800.Lab.Cl. LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN POLICY NO.: EXP.DATE: COMPANY: PARKING REQ: PROV: PARCEL: 43921111 ZNE: REF NO: 3 Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. PLANNING NOTES> > - 1 Date'. Applicant', **********************************-********************************************* EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed it the permit is for one hundred(5100)or less). DEVELOPMENT S'-'E`R V I C E S REQUIREMENTS lenity That in the performance of the work for which this permit is issued.I shall nno :dl�:ny person in any manner so as to become _ subject to{},ne Wirer''�zompensation Laws of California. ��/ ZONING APPROVED BY DATE: 'Date. V L / Signature: T ,S NOTICE:If.after making this declaration,you should become bject to the Worke 'Compensation provisions of the Labor BUILDING APPROVED BY : ' ' DATE: Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for ADPL I CAT ION ISSUED BY• '��— �7� DATE• p / O� which this permit is issued(Section 3097.Civ.Cl. ********************** **********P4*t*L4**** LENDER: *************************************** **************************�*t*****i*iii***** ADDRESS:CARPORT CONVERSION TO A DEN & LAUNDRY ROOM. LEGALIZATION:N .F' E,.E S MMARY STRUCTURAL SEGMENT: N OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTR 'C 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 18 •0 repair 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 the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business 50% SMIP/NON—RES 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(5500). ISSUE FEE 4 • 50 I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE ❑ structure is not intended or offered br sale(Section 7044,Business and Professional Code: The Contractors'State License Law TOTALS----> 18. 50 4 . 50 0 . 00 23 . 00 23. 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 ' improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve REVENUE DIVISION TOTALS--> COLLECTED: 23. 00 OVER/SHORT: ,00 for the purpose of 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 23 . 00 ❑ and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law). I am aware ******************************************************************************* that proof of their Worker's Compensation insurance should be provided to me am exempt under Sectiom B.s P.C. INDIVIDUAL F E E BREAKDOWN )p /b/pI/'Y.) NO EMPLOYEES TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST /oat, 0 /'Q.) Owner: I do hereby certify that lam aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and ELE 1 SERVICES BELOW 600 V & BELOW 201 AMP 18 . 50 1 8 . 50 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a END OF FEES permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I 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 re sent yeso is city to enter upon the above-mentioned /operty for ins ection purposes. ate -44e? Signature: 01 00140813-00140813 TOT 23.00 Driver's License or Social Security A DATE: 06/11/93 TIME: 09.15 1641.46 White—Building:Green—Code Enforcement:Canary—ApplicanC Pink—Revenue;Goldenrod—Assessor . CONSTRUCTION AND PLANNING POt. .v SPA APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. . _53. Steel Reinforcement - 3. .Electrical Conduit Uttlity-Undrgrnd. -54. Forms 4. Electrical Conduil,Undrgrnd. '55. Electrical Bonding 5-• Steel Reinforcement: 56. Rough Plumbing & Pressure Teat -; 6. ElectricalUFERGrnd 57. APPROVAL TO COVER-GUNITE 4. .. 1.•Footings 58. Electrical Conduit-Undrgrnd. - '• 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd, :60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK ii 11. Property Sewer Line& House Connection 62. Backwash & Receptor-Final , .1rewer Cap -. 63. Heater & Vent-Final sii, 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 & Ai Conditioning • r FIRE DEPT. REQUIREMENT 20.Rough 6_ctorry Fifeyplace ; ^ . c fli APPROVALS -Perit# 4 J 7 21. Ducts,inStrricture' x f0. Underground:Hyiho 22. Ducts, Ventilating ,. ` ' ' -7 d X71. Product Piping D Gas DOH 23. Gas Pipe-Rough & Test _ _ .- x - -72. Undergrotmd. 12= 's Flus - 24. .RodF Framing '„; - '' '..:• "73--Undergrnd'Storage;7ank CI Gas 0 Oil - 25. Roof Sheathing .athing . r; 74 `Overhead Hydro': x -. 26. j-B*r Ceiling (Structural) &'Nigrtocoat . 75';-0ry Chemical _ ;: • { 27. Frame and Flashing - v. 1- 76. Dry Standipip - 28. Latliing$i Siding -:_t " r _ ri z • 77:. FIXED SXSTEM-F.INAL4 _ ,- c- 1111111 78rFIRE PREY, FINAL -, ' -c 4 . " HEALTH,tEPT:REQUIREMENT • . : . r9. FINAL INSPECTION • ,t J .-. _32'-:Electrical Power Meer-F`nal, - _�0,_FOOD CERTIFICATE ISSUED - ,33.¢inal Electrid. f q I�� rYl l // I Notes: 34.Final Heating& Air-Conditioning. C r x _ -35.;FinalGas;Pipe-Test• .'. - •, _ - - . 36. Hood or Canopy ' lia ill ^ . - r 37. Final Factory Fireplace c -- • 'I 38, Final Plumbing -4. iiUII t ;,•40. Gas Service-Final - - 'a♦ _ •• . w 41. Solar Domestic-final - " a. r 42. Backflov'Preventer• 43. BackfloW Irrigation` r - . - c_ ', 44. Landscape Irrigation System=. '1 - •45. Sound Attenuation s ; 16. Handicap•Regulations - _ •- 47. FINAL STRUCTURE& BUDDING I I .-1--. 1 - -, -. 48-'FINAL PLANNING' - - _ 49.-Electric Release to Edison �� 50.:Gas Release to Southern California Gas Co t _ - • 51. CERTIFICATE OF OCCUPANCY I t - - ' No. Date 1 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY CA COSTA MESA CONSTRUCTION PERMIT P NO - TRACT NO. •• , LOT NO, UNIT NO. ' _ ' �j L re I,(0� I 1884 '4f 25/85 IP: cu ''r =� 'Project Address c-37/9- • "_r /�/A� IJ ADD U ALTERATION REPAIR ,6 TYPE OF CONSTRUCTION. ❑ NEW '- Applicant's Mailing Address /` .F S ° (A �ogzsnc ❑ CONVERSION ❑ DEMOLISH ❑ OTHER 7 A.P.qp # • • Zone Owner's Name Phon DESCRIPTION OF WORK/USE OF BLDG, RriS3Z)S Z"1 -S Address = SA-+"-�-• - DOM C.S-4-IG .SO(A/Li S Main Building:. Accessory Building: Arch/Eng. License No. TYPE OF PERMIT �'❑ GRADING ❑ FOUNDATION ❑.STRUCTURAL E Front' •- - - . . o Address _ _ �I - '' ❑ TENANT ELECTRICAL-PLUMBING CI MECHANICAL A Rear 7 ' I . • - N Contractor's Name Hon.-e. C.b .sA2Q '- Phone93117/3 ❑ 'OTHER C _ I ` i PROJECT DESCRIPTION SQ. FT.- OCCUPANCY C Right • - N �`l City jis(mailing) )57/ 5 - Sw,+-k75f K G ^ _ - 1 �1 Cis a l I • y • CONSTRUCTION TYPE VALUATION$ ; S Left _ R \_,w1 City LiC¢n5C NO. q'-7o'-' I ZONE GRADING CU.YDS. ACRES Ping. Ref.# Parking Req./Provided I ' E ' ( LICENSED CONTRACTOR DECLARATION • . . - , 1 ,• _ - Q ^^ Thereby'affirm that'i am licensed under provisions of Charter.9(commencing Remarks: 1 N Q {/ -�' vE - PlanningiNotes: _ M `I ) with section 7000) of Division 3,of the Business and Professions Code, and -' 1 f�-� rte- T my license is in full force and effect. €^ -7 'j L �•r� �� G(Oi7S/O LJ Z� !' S. License Class r-/'Y Zig License No - '- - - • _ ; • • 1.10 Date 4/--17 Signature �S_ A.4. PLUMBING . FEES WORKERS'COMPENSATION DECLARATION ' I , i - hereby affirm that I have a certificate of consent to self-insure of a certificate Bar Sink Showers • ELECTRICAL FEES I Workers' Compensation Insurance, or a certified,copy thereof (Section - Backflow Preventer _ Service Sink ' Automatic Washer - Transformer ❑.15-50 KW_ ,bo, Lab. C 'q - Policy Nob Ck'.YSfOS-7 Company VI e�A)A' Backflow Irrigation Sewer Capf' - ❑ 50+ KW Construction Pole Sub. •- q Certified copy is hereby furnished. i , — ' _�Cert i.figtl copy is filed with the city uild" g Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps ' • • • ate �'7 Applicant I A EC LARA -1• / - , EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers 'L Solar Collectors V 00 Dishwasher M¢t¢r •❑Over 100 amps', (This section need not be completed if the permit is for one hundred ($100) or <y.� less). Dishwasher - / Solar Piping 1 2 SO 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 .5 do Fan / Motors 0-1 HP 01%-8 ' I ' OC Workers' Compensation Laws of California„ ; - 1 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_provisionsof .the Labor Code, you must forthwith Floor Sinks Urinal •- _ Fixtures Microwave „� comply with such provisions or this permit shall be,deemed revoked. - -- - - CONSTRUCTION LENDING' AGENCY Gas Service ' Outlets Water Closet " ' I Device Boxes I hereby affirm that there is a construction lending agency for the performande Pole Light i a of the work for which this- permit is issued (Section 3097 Civ. C.) Interceptors' - , Water Heater / Outlets Range ' 1 Lender's' Name- _ g �� Lender's Address Kitchen Sink _ - Water Service Switches OWNER BUILDER DECLARATION Sign I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories following reason (Section.7031.5 Business and Professional Code:'Any city or Garbage Disposal — 'Standing Sections - county which requires a permit to construct,alter,improve,demolish or repair: ' P-Trap I ' Generator ❑0-5 KW ❑5.15 KW ' Trash Compactor any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of _Roof Drains ,the Contractor's License Law (Chapter 9 (commencing with Section 7000) of - "vision 3-of the Business and Professions Code) or that he/she is exempt _ ` i refrom and the basis for the alleged exemption. Any violation of Section ' _ - - - I ' 31.5 by any applicant for a permit subjects the applicant_to a civil - • ' natty of not more than five hundred dollars ($500). - - - ' 3 0 I, as owner of the property:or my employees with wages as their sole Reinspection Fee , I $15 Issue Fee •. $ . compensation, will do the work,and the structure is not intended or offered - Reinspection Fee I $15 Issue Fee' • , , $ 3 for sale (Secion.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 nr•her own - DEVELOPMENT SERVICES REQUIREMENTS: • 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 ❑ Zoning Approved By • Date pletion, the owner will.have the burden of proving.he/she did not build or im- ' Duct-Under Ground Building Approved By Date LJrave for the purpose of sale). 1 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System - Application Issued By , � - date '1,2-5— - tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU .SUMMARY OF FEES builds or Improves thereon,and who contracts for such projects with a con- ' tractors) license pursuarit to the'Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ • SMIP , $ — proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ `/ PERMIT l 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# : PLUMBING $ l I 'op ISSUANCE $ Date owner • - Heating System& Ducting . • , , , PLAN CHECK 25%l $ ,ENERGY P.C. $ ( I hereby-certify that I have read this application and state that the above ❑O-100,000 BTU ❑100,000BT - - ELECTRICAL $ �" 20 GRADING $ information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction;and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $ ' • sentatives f this city to enter, upon the above-mentioned property for inspection p o s. t/ • MECHANICAL $ TOTAL FEE $ (�'2-b Signature • _`M�c.r-A-Qw.•-e�—� L!_/'7 Date • Reins coon Fee I $15 Issue Fee $ 3 PLAN CHECK ,25% $ Drivers' License or 55 . - - CMF 0865-46,rev.4/84 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod -Assessor - -- -- - '- - -- - - - - ' CONSTRUCTION AND PLANNING _ - - - POO ;PA - , APPROVALS Permit#_ - - Date Inspector APPROVALS . Permit# Date Inspector -1. Temporary Electrical Service or Pole • . . 52: ,Pool & Equipment Location • 2. Soil Pipe-Undrgrnd. 53. SteeLReinforcement . 3. Electrical Conduit Utility-Undrgrnd. - ' 54..Forms 4. Electrical Conduit-Undrgrnd. • 55. Electrical Bonding - - 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test . 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings • 58.. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System - ' 61. APPROVAL TO DECK 11. Property'Sewer Line & House Connection ' , 62. Backwash & Receptor-Final - 12. Sewer Cap • 63. Heater & Vent-Final 13. Roof Drains 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 I 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING ' 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL _ •- 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT - 20. Rough Factory Fireplace APPROVALS Permit# ' 21. Ducts, in Structure • 70. Underground Hydro ' 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil ' 23. Gas Pipe-Rough& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing - 74. Overhead Hydro • 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing . • , 76. Dry Standpipe . 28. Lathing & Siding 77. FIXED SYSTEM FINAL ' 29. Insulation _ 78. FIRE PREV. FINAL , - 30. Drywall Nailing • HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION , 32. Electrical Power Meter-Final • . ,80. FOOD CERTIFICATE ISSUED • 33. Final Electric ,I"/k/O- G2' Notes: 34. Final Heating & Air Conditioning i 35. Final Gas Pipe-Test , ' - 36. Hood or'Canopy . - 37. Final Factory Fireplace - , - - - 38. Final Plumbing , , ' 39. Water Service-Final - - . 40. Gas Service-Final , - - , 41. Solar Domestic-Final S/i/dr C19 - • 42. Backflow Preventer 1) 43. Backflow Irrigation • 44. .Landscape Irrigation System 45. Sound Attenuation - - . ' 46. Handicap Regulations i - I - 47. FINAL STRUCTURE& BUILDING i - ' - 48. Special Requirements Completed , , 49. Electric Release to Edison - - • / - '50. Gas Release to Southern California Gas Co IgarkH i• \ ' , '51. CERTIFICATE OF OCCUPANCY 4 ' No. Dater I . _ _ vY.. cif , ..a RESIDENTIAL SOLAR SPEC SHEET qv Customer FFed1Idlf kilt h in Date/Time /3 rai I q ( 7/ ring h Time Arrived / C 4,s-42Ai .poi l' 7)fes) Time Departed. ' A ROOF INFORJIAATyIO� Condition_ �IY I Roof Waiver DYes o Roof Material n/ Y Roof Rafter r l L� " xT� _�-{� � � . Span_a___.' @ __________' ac. Attic Space from Joist to Ridge J Roof Pitch L�^, ° Ground to Roof Footage B COLLECTOR II)IF1O: � Size • -l(( x '� Orientation . / ° / I Quanity # Pitch �� 'V `— o- Flush Mount >1. 2.5 Levelleg Reverse Enclosure • • C PLUMBING INFORMATION: Plumbing Type (Existing) J3aiv ❑Copper ❑Other Water Heater Relocation Oyes ONo __,`) Approx Gas Line Needed one or(�,1t►� ' Size APPROVED Shed Needed [�yes ONo 32" x 32" x 88" (Prefab) A Y YYll�pOO • Slab Needed SXYes ONo City of Costs \Its* / Building Fitt i)t, _ Water Heater Platform Needed ❑Yes ['No tram BY ----- U:lta Garage Floor Size ' x That Plana mot be On l'ou et . an t limit Mike tth chMttt ViAtw•. D ELECTRICAL INFORMATION: / nu,A 11E04' lt\tw„w,M Nt%"4'• 110 Vac Outlet Within 5' of Proposed Stora °cation' ❑Yes 'CNo ' • If No, How Many Feet to Nearest Outlet / , E; GENERAL INFORMATION: • Foundation: OSleb } Raised Footing ['Space Safety Hazards Space Heating: ❑Central ['Chill Chaser Comments . rs, .\ Install Signature & Date ti H G C-32 HOMEGUARD CONTRACTORS, INC. ( • - 4. - Resi(d- ential Solar Plot`Plan - - - - - -- - - - - - _ Address Name 1 1 (D/`fQf 4 ,M /_0 /4 !P .1('!A nib M , YT// 1_ Phone Number f7/U)GL/ '�c)69 , 1� , d r `a ! 1el 1 /]hn noCity /? � /� o� _ • ! •11r 'i 1 = NIsea !:!:l::: :rQ==w=== •3 s • N_ • real= • =t:' x 1 1 =:J PP: === �: = ii = N 1 {NItIl .t. e! E *.i.. 1 1 f.tl RIfl = =-rets ---111,81.14061111411.4010i L. . .i I � f. :. II •. i • - ii • YII i Nil 1. ,u Ifillti 11 •• .. .. • .. li=1 N 1 Im 1 � II •:: :.wi nunimtt !:.-e .. - :;�:.:i: NEI :� t ' : _ 1 CN 11 1 ::llid, Hsu:. ......Ii1f.. . =Y:= 7==:r:iI :•illitiI�NarHu��iY 1� 11 . I��i I =llnnl=itl iiiltlltiiit! . i _ _1 _ _•• " • .. f n:7=pHil •=xx11i = _ •"••=N•== E= N ; • nu _-NN_ r 1 - Ia•IAA 111H 11 7itTii 5NN"".....Pl:a:lC::Z•._i....n ..Ae�1A.;•Ht.. 7 a � 4.1161+1' �. . +t I JI+t -+i + r _. .� • 11 ! • ! •• d 9Y: !:•O!••{ua•il-s...1Hl�3 ©is}+: _.r . .�.1 I+. 111 1. • 1 •"•11 ��IIN Illilill li . •::=:is • ••..YY '16••••••••N•' t7� H _ n1 n�xiiil��tjiit •1 ill ' e r•.ii•U . i:rii •c mita ..t- Uri {. ±iii -- -, Y•• In 111i ii11 11 1111X1 :.•••II••••'=ffiffi=16_911_nWilB=•• = lii°CH: I + ' „ it: : �jp Np g �� II .•�•• .. Ca !Y• c _!e s:"u L. . .i ._ AE• M�• L:. + 1 B t N11opiiilniill !1111 xii 11't�l�1 It'�..niiiiil e.E�iti l:�pean .SN6. .�. N' W --1-1-it _ t4, i , pull i=i1 IIX n::;aI :..I\:• •• a'x'is. *"9ra: i . , 1 'f=e:!iHnA: .ai�� .. ••_ rthir N in_ .L.- a.•.-AM.•-i: +ya 1 11 11 IlNnovuu n7: Y 3•L•• •: ii .3 ■■ �'. iy� fT'r�+-f -Yk-�t$T+. + r ilii YHH 1111 .!Mill!!, INNniili .I•�YNli61ilinuni;;.N..... r. . 19 ..+ r +++ :+ + _ u t� . �� P YY n '37CT6L3 9 CLCL' JLiY _ -s:li:i!_ � 4:4:i, _'� I-k .} i+ � {r +i '1 11 :::Ilii!!ii H•tifiH' ::::NH :... piNl;tee:::1.11:..'4°' tt�jj x ti-++4.-.,1`if„-7,11: T • r} ; + +I - • ••t••.p NNi.NI 1 uui ..nedliutii uNaxr•ni :u uunI T `T ' +n++,+' +,-i it-+ •. ••. e:: 1.11 1 �:u H 1 • - • :: •• •" 9.:niittit7leAL..... ••• _• 1.11 ••• •° ,.- ,. N -a :: ±x 3! 11 Y�YY.\YYtlo.Zr77:=•=•�+••: ::••• :!: 17:; H' • • T+._ _..+.{-'.t_ .}_..111 11 x =:sisniil33iO4m •reirY•.„.1•.:3-.... ....•••;�l.iiti:.1x- t N i� 1 -++,ti+ .4_,t1N H ;S . ..Yl NN..l3 3 :7Cn..Y.... Y .:''sr...YYY .. ... 3t. H 1 11 pN . li L7 11 L =..:=73355 ... 3� Si' n+ .+; r+ + Il \9!7crl :!.••.:a• .•_ •. Y • Y Y.nl:..: ;• ext n .+.1 . • .f_ -HHY I:I: Y �•: •N Y YNI"�i��Y�qq �Y" ,�,� • �* _ n x11 1 11 ,!7••iiiilli•H••=' px xll^: •• •• . .. N y :INI: 11 •NI •iii • +++ i n l 1 r1: - 11np R l::.•YY..S0:5555� _ _�ug.,lYl. .e ' raq+� lltt � '` 'I '"�+I+ ii��i1' 1 XN HII 11 . :!Nil �ix'•55 N ;;NGi°•' • •p' •jllN=''\. Fib• 474-.419„7.-1.14. . I ! a .+ r� t+ + - n pY YY Y it u-Cr. •ii m- �_.�;a;.....�p.$"e\ YYp i-+ --f-+i �j NI�I iiiiii E aAYA... .1.:4 :N!W. l• H d::uYNBIIJ:: N N • HIYI 1 1 .r 1 t 11 111 u ::.... ...• :.0 :::.Ysi Hu ii."r:1!!.. .;I..Y;n++„•.leN .. . . . .-. •: .firm .. .. .... .. - 1111 - II 1 n 1 Y Yx .•Y••••rn.. .•==1 ... ...H 7.•.= YY.. .. Mpg i 11++ I _ • ON! II 11, IIlt.lixixm !:•• N ••U13..l71.\H7... LE!ii :I\xtty 11 • p IIY + T- I1 111••!X. ::11 eCr:ii•.ti iin6ppin 1111 NNN: :iil�•X' E.n...Inn 11 xl tl II m••• •sYY mpp� • •.I\ •.•55::7 ::iinii +__ .'_ T-r-Y-T Np NpJxN N x11pp it ilt h= 1111 1 11 x 1 11 N ,�M .X N ��=11111 =_ .Yit=::=l� 1.11 tl n x + 4-±144-1-; NN III1!111!'1 ..i: r 3: iii'!. i1 •L II or ;Y.i''=Dx Nn+.• ti 1 1 N f :' + I�Ciupii pnu ;;n. • :1!1x7'•: 55©iY..Y..I.... iCi7Giii• .+i+ ! xpp�.. '!Ii 9H . • . Nx ` .r! O 1 1 N �11 1 1 X .. 6• npn.. x .......a •1.�.::....ii. f.7 pN 1 xINI+x { Flit-1-4' C: iTmaga;:ai vali =:=11••11 • ••xm•\S.i."... •7HN H: H 41 _+4.311 T ' I IHN :H !a. 3 : xl 7A : :: \::.•I\p•� •:Y:. 1•.!I ti :f 1 1 11 11 H [' 11T4,-.7„ : 1 IN 1 11 i pif11 N::: l :::L•p :!1.1x1 11•'• 1, 1pN IG�NY u Yp ..1� • .,,,,I : 11.1 HHNHIINti HHl nllii I�:IN I=ii1NHH ::r::u .a. l„ H 1 I I{€ 1 fl . . •:1111lll!lIIIII.NI x IIN••=•Y.=XN IIn ..x.. .11 N N N N ;NUJ 11 MAW" :m1 it••:J•uu =ii::::•X 11x1 m= •iumn. •WIUUlx x i1N + I I !I 11 1p1Nd lipPi:YN::YI' :.: • 1:111 a •.... •••9.. uua t • H 11, H\ llHHiiii X:=911 lil l;:HHHNi1 1 1111!a............................ :: Nn�N • N .......... 1 11 II + Y11N 4++ • • IInn •• :HHHI• uunrre:Y! !il ...... ." f''.i!,,�, • 1 IIIC Iix N I A Aih l II•IIi 1 r . ::YYxu:.::::: XNNNup.:•• ••xxlf•.=•••• N r • X• I�I Lr • N 1 Aral• Ili' ••••11111 IYNx NIINNIIti==N==1: 41...+ 11 ••• 1 IIm�A AA quluota .apIANAwtlt ningmIornI : IiMin ::u:: IIN X77: 11 �NHHI N 1=== rA••N• ••NII li�l.+ 1 1 111p p:1��ym�i' �� '� I N 4 1 91111 ;:: :. N n 4-4-14-1H-- +-1-{f i I 1 tl x un •::mun I•n ;; . Y=• • :. • s sB.1x1 pi xIll H IIN. Ym.I 1 IIB N11INNt' 551 1"EWERiliii l�piiNx"ttii' ppiiuleminuiiiilii::i lil �i.N, • Npmg �+ - ■ tt :l 11 :Ja55:,A 1•11 :YR:Y :._ t r=-4_,..t., -4. xHx1p11.. YY MC::...IC11....•11 •.' ' .N I ' 111 NI •B•1X1••••! !unman x 11.... . ._.::::1 • •==iil.iLii �ium I ll ' f � •• I 1•ll•p n11pNH111 33:•p:.::. . r { I I I + • li I p !Y • N 1•BBY LdxLTIY••Y••••9::::::....•.YY :w•. • Lill ; HL+I �lI 1 I 1444 I + I B SW Hx ::::lis • . • ::• Y•!• Y •...Y....I. ..{; • Y N N N :•m••, ••Y _ Y N {.Hm i YYYY Y . Y•Itl.' YY. • m.Il. Y!m p -x11 tlYY55x::alp:•YYYtl.I::••••'•ii::.•YY:= :7.6!16 I �X I Y • ri - x 111 • x11 ••••Y•• l' 1111 • Y •91x•• •' „ •••••;: _ X uultlx�upuuinnnlnelluxn,,.Y..Yiuhnpl�npuH..55. 6 m � , ,{. . I , q .....•..1...1.� ::1111iH=1111Ni`g1 Tilt=" L • Jia. . 6. , N n niu • r �Y• uY 9 _ IIA .Y• Anuria:: Hm�.x..3C#ll H . nm .._it IIBII ti : I117XX�1 !.1++, _ . .- � i un n�ixnAlmylaxm NN IX HH HYI • •91ixYaY • - ••••�I �, n L. I �..• .. _ Y. ...... ,IIN x • 11•• .. I, SI • •IYlYY ..•Y �t .Y.... • . 1111 • YYY. . _••_l.� purview, !! + pill : • •, ' I\I.'••1•.I.. • 1._11111 .• _ I_ II . • I .I`I'\1-;' I Y!_ .. a J !111.1 1 !! ... .. 4m:L.�•_ I •_� ,ti. •N II I MI 1 t� N,:• .. •i� .. .. _' N 1=11111 1-. .f1 - _{ ,.,.'i•I, • �i'�1N�I • • 1 1lY�.L.•. . { 1111 PJ1 N• A =,gl1i' �{ I Y•.•. .:III I ilil� ' 1.111 , _. Niii�� i NEM 55x1 a ii I ' Il - � N �1 ...0 i';.. I1 =annular" . .rsmmn . , • , , _. 1 til • •I .. C:•. . 11 !_m • .1 Y . pplmaailltS:.r'•I� as I sm;!.: ..Y�• 1 y� S 1 • IIIIUYI:al H 1 "\ it ••••YYYY-HI '_•' pp NIl::551:111111 •••••••••••tNW.Y �p11B T`'. x11. •`+ - ii.l.YYtl ^"* _•t!r - a Yr�N... ,..• IlHHm •:::::3 3!!.35555:553::1�:x::n.Y•7! 't".<,,,, --t: ::uit=::n xx::B55 x f IW xxN=fl'r•:::11 .:: :7l:l77n:p:7L:7T.Y• •Y• !.... a .,;;• r- arna7._:!N : rummaL.T-_IiT.auniama:assatiIL..Y... HGC-09 • • - - • -- --- - - HGC-25 SOLAR 7 'COLLECTORS HOME-GUARD CONTRACTORS INC. . : ^� AIR VENT GEN. PLUMBING DIA. . ` i„;� �� SOLAR SYS. P.W. I I-84 j i! I GALV, FLASHING 12 VDC /' NSOR %� • :;k SO K OHM ::-;' �� i 3/4 COPPER eM~ alwa „f..,� -- ss�.i= ;+r I 4 ''.- -: PIP E f; INSULATION OPEN LOOP; ACTIVE ( .� I SOLAR SYSTEM '-'' HOSE BIB `I I 0 VAC 111 GATE a - CONTROLLER COLD PUMRQJAMP MIXING VALVE - HECK VALVE♦ I aHILLER BYPASS ihi ISOLATION VALVE HOT c / "(PASS W/H DIELECTRIC 4— CHECK A VALVE s1). 4' 4” 7/i,IA' /4n42l/ // UNIONS /ii(ii///cu i//(c/i, l Ii kP&T PaT • I ANODE I ' ROD I I a I I I " * —DIP TUBES PETCOCK I I u ----DRAIN 1 u GAS Or 1 THERMOSTAT '4 • ts iii/l,,, i,„. ////i'/U// HEATER STORAGE TIE . _ rEssata.. akrik 11 DobIldrustrr- 4sg,e! s 1433 126 WEr 4:1( le m t 44 Les WET OVERALL 00.11a1SIoN9- AIX le z.4226,101,15" 4irgi :-.41,245;al as" ------„,.,. W"le c P4Mg inflow, (vow 11, STPLICTUFML -,----„, 31/444b ALLIMigum ExTRuStea 4 gese4'in '''- '4.), APPROVE ----„,., 0 tat. -1" .. . , ( itY "I CoFt 1 ki iu Ho mt Gutkii .41? no ,„,,, ,,,, . --, ..c,..,,,,_.....„..cp ..,, ---- .4,, gee. --ivr6fie:, 1)f., ,,,,... -.4.411 +4r4. :fannis,itunsf he on ;19' 401.510 '''-., dit ie. ;, ,,,, ;',1)0(hannit . 1;b:ir ''..---,..........1 ..:4,,, -"! nt. STrAgOixRD RogiF MOkilarr 44 tx-rti,o.... 104- Ptvi . -...,, ---- -- r- _ 1 4- SOLAR FlithT PLATS cou-scroRs i i -- - T 1 T I lii _..: \ I 1s. . 1 • , 1 I i . :-.-- ..k.-Z:.-..,.-7-7 .e Z.'-: :-. -it,- ...e, -- ---ii, “t1.41R‘115 Roar SEIMALIT- 12! AA' ix re: Abw cos; ft ...,, . - ps0430 SPACE i I # ' 'ILLO t 14 \ 1-- I.— 24 4.; 701 ST ---t \lie x a d Law, WA :4"a a- FR047-- ziarno‘..- 44"Pasati-thast Fie WE ., 1;7' '';7.::''''' Oid• � taSrô Water Heaters sotio, , .. r .L,_ __......„ ,,,Solar Saver Products - .„‘ - `str, " . � �a" California a 46?,,,, =litk ' 6 Solar/Electric Water Heater, Solar-Storage Tank Models 1 t 3ss . 29v-�r? ..-.-''.Features: • R £1.1 solossaver Foamlock®insulation—full 11/2" ultra dense polyurethane. 2"on 0 –mo i 120 gallon. It provides for an R factor of 12 on the 65 and 80 gallon �t " ,k models and an R factor of 16 on the 120 gallon model: • VAlt - Av.10 Vitraglas® lining for years of extra service. rirl Factory installed nipples—no dielectric fittings or unions needed. grair Side T&P valve opening. Thermal Feet: Unique design provides complete tank isolation. , Prevents thermal conduction through bottom of tank. Vii, ii Pre-wired sensor lead from storage sensor mounting stud to top of tank. Top tank access for all connections. Available as insulated storage tank or electric models ,0:"..!,,, I I equipped with a 4500 watt heating element and automatic l' lk thermostat where a back-up system is desired. d .s.enkki .` ;"'' Tank—heavy gauge steel automatically formed, rolled and •.,,,r. welded to assure a continuous seam for glass lining. Each tank ICy;5;41 • Nam is triple tested to insure quality. d �' "i QUALIFIES FOR CALIFORNIA TAX CREDIT , VS :z 5 year warranty Full 3 year, plus additional 2 year limited ;,' • a+v v. �M warranty on tank for additional protection. //ww__ ` � l 0i1• ■i 3.. -40 A. Wires from Sensor Solar Saver Mounting Stud Products M . Q B. Thermostat C. Heating Element e )/ D. Collector Return 6', , Tube .4M3 ' P: B E. Cold Inlet Tube 2� 0 , F. Ultra Dense Foam '- • #1-a'.'Pump Suction Insulation #2-+s-Cold Inlet \ • #3-,. Collector Return I G. Pump Suction #444"Hot Outlet Tube H. Hot Outlet/Anode F ^ A p7:1 14-: r A '1 f-c�DRod O I T O s ♦ i' H I. Sensor Mounting ,G E� .1 Stud 9 B B `? - C C J. Thermal Feet // K. Glass Lined Tank 0 0 0 - II l L. Drain Valve i ° o f ° t t M. T&P Valve Solar Electric • Solar-Storage Tank rb Water Heater ' Opening F -4K I I Solar Saver Models B c D ,y�. Ht. Ht. Ht. A Floor to Floor to Floor to Approx. ' L► Gal. Approx. Jacket Heater Water T&P Shpg. ,� -• 8 • Model Cap. R Factor Diam. Top Conn. Valve Wt.(lbs.) \�j S / • MS65RF3(S) 65 12 21" 583/4" 593/4" 521/2" 165(168) • MS80RF3(S) 80 12 23" 583/4" 593/4" 53" 210(213) • MS120RF3(S) 119 16 28" 621/2" 631/2" 561/4" 310(313) General NOTE:Suffix Letter S denotes models with 4500 Watt Electric Heating Element and eWC Surface Mounted Thermostat.All Models Certified at 300 P.S.I.Test Pressure and 150 (� P.S.I.Working Pressure.All Water Connections 3/4"N.P.T.Electrical Connections 3/e'.All _ Models are U.L.Listed.'Qualifies for California Tax Credit. Bradiord•�Vhite Dimensions and specifications subject to change without notice in accordance with Bradt— �l3/�■L .��i YAG our policy of continuous product improvement. Corporation California 5 Year Tank California Full 3 Year Warranty Corporate Offices Warranty on Component Parts 24th & Ellsworth Streets BRADFORD-WHITE CORPORATIONS BRADFORD-WHITE Philadelphia, Pa 19146 full 3 year/limited 2 year warranty: CORPORATION has a 3 year 215-546-3800 protects your investment in a quality warranty on replaceable parts— glass-lined water heater. If the tank thermostats, elements, magnesium leaks for reasons of faulty materials, anode rod,dip tube, drain valve. Service Centers workmanship, or corrosion within the These quality components are NORTHERN CALIFORNIA warranty period, the heater will be manufactured for us by industry Palo Alto replaced with a comparable heater of leaders and will be replaced in the 415-858-1600 our manufacture. See complete copy event of failure during the parts SOUTHERN CALIFORNIA of warrantyincluded with the heater. Anaheim warranty period. 714-630-5430 501-B-285-G 100 YEARS OF EXCELLENCE Printed in U.S.A. • 411 OPTIMA IIS al 48 410 LIQUID-COOLED FLAT PLATE SOLAR COLLECTORS. High Efficiency Attractive Design 10 Year Full Warranty The Novan Optima II collector series introduces a new standard of collector design. Its streamlined appearance and ' high performance make it the choice of discerning solar professionals. Each panel is anodized in a bronze color to provide an attractive,durable, scratch-resistant surface. -- ' ' " - '.•' -- •- The two piece extruded aluminum frame offers maximum strength, minimum weight, and excellent integrity against unwanted air or moisture intrusion.The glazing cap strip is - - - easily removed from the face of the collector,allowing access to the interior of the panel or the glazing without GENERAL DATA removing the collector from operation. Collector Dry Weight,(lbs):48:125 410:156 Structural mounting is made simple and secure by the Fluid Capacity.(gal): 48: 1.29 410: 1.50 integral mounting channel.A Novan innovation,the channel Maximum Working Pressure: 150 PSI accepts a;4" bolt or jam nut which can then be moved to OVERALL DIMENSIONS anypoint around theperimeter of the collector.This allows width x Length,(i410e4): 48: 47.25 x 97.25 410:47.25 x 127.25 extremely secure mounting connections without penetrating Depth of all collectors,(inches):4.00 the collector in any way. Novan's complete, pre-packaged Gross Area,(R'): 48:31.91 410:39.79 mounting systems combine with the mounting channel to Net Area,(Or): 48: 29.93 410:37.47 make even the most difficult mounting situations simple and Net to Gross Ratio: 48:94%410:94% secure.The attractive mounting hardware is made up of ABSORBER PLATE: bronze-anodized aluminum and black-oxidized stainless Construction:Parallel Risers,Internal Manifold Steel hardware. Material:All copper alloy Riser Tube Size:%inch The absorber plate in an Optima II collector is entirely Riser Tube Spacing:2 inches on center copper for excellent heat transfer,total fluid compatibility, and Manifold Size: 1 inch,Type M many years of reliable performance. Riser tubes are spaced Manifold Length,(inches): 48:50.5 410: 50.5 two inches apart to maximize efficiency and brazed into one Total Absorber Length,(inches): 48:96.5 410: 118.5 inch flow-through headers. This absorber configuration Coating:Black Chrome over Nickel Substrate results in a very low pressure drop, while minimizing field- Absorptivity:.97 Emmisivity:.10 to 12(SC Series) installed piping around the collectors. Rugged EPDM seals GLAZING isolate the copper absorber from the aluminum frame, absorb Material:One sheet low iron patterned tempered glass expansion, and prevent unwanted infiltration. Thickness,(inches): 48,410:.156 Optima II collectors are glazed with low-iron tempered Solar Transmittance: 48,410: 90.7% glass which is textured to reduce reflected glare.This glass Gasket:Seamless EPDM extrusion adds an extra measure of safety and performance.A one- MAIN FRAME piece EPDM gasket surrounds the glass, providing a Material:6005 T5 Structural Aluminum Extrusion complete, reliable seal. Finish:Bronze Anodized If desired, installed collectors can be surrounded with Sidewall Insulation:(Long sides)1 inch Polyisocyanurate Foam with Aluminum Foil Facing(R8),(Short sides) 11/2 inch unbonded Fiberglass(R5) Novan's collector trim kits.Anodized a bronze color to match Bottom Insulation. 1 inch unbonded fiberglass and 1 inch Polyisocyanurate Foam the collector frames,these are used to conceal mounting with Aluminum Foil Facing(1112) hardware and piping.The trim kits give the appearance of Hardware:Black Oxide Plated Stainless Steel collectors flashed into a roof, without the difficulty and potential liability of such an approach. All Optima collectors are covered by a full ten-year Tempered Low Iron Glass with EPDM Gasket ��t�—• warranty, including parts, labor and shipping,against defects ,r in material and workmanship. A standard three year warranty All Copper Absorber Plate -P414 covers corrosion of the absorber plate, unless the collector is Unbonded Fiberglass Insulation la a ,` installed with a Novan Optimizer module and charged with 1" Fiberglass Reinforced Polyisocyanurate Insulation 1 Or Novaflow or Brayco 888 heat transfer fluids. In this case, the Extruded Structural Aluminum collector is covered by a full ten-year warranty against I-Beam Profile Main Frame corrosion. Please refer to the actual warranty, available upon with Integral Mounting ChannelPAAT. Y11; `5 .t,r,}1?. U--' request. .014" Coated Aluminum Backplate 1/40111 ice,g+ :le61'r' �f THE LEADER IN PRE-PACKAGED SOLAR SYSTEM TEC'NOLOGY • OPTIMA H Solar Collector WATER FLOW RATES VS PRESSURE DROPS PERFORMANCE PLOT TS - TECHNICAL SUPPORT (IN.WATER) Data in this section was taken from Model 1.0 GPM 2.0 GPM 3.0 GPM 4.0 GPM FR re=.774 FRUL=.798(48SC) performance tests 4835-0725-S1 or#83S-0726- FR ra=.789 FRUL=.762(410SC) 51 conducted at Desert Sunshine Exposure so Testing in Phoenix,Arizona. Tests were 48 .25 1.0 1.8 2.5 10 00 conducted inaccordance with Sd CC Standard 410 .31 1.3 2.3 32 so �\ 100-81,using ASHRAE Standard 93-77. so The graphs shown indicate performance for RECOMMENDED NOMINAL FLOW RATES(GPM) = 40 gross area of the collector. Flow rate for the test u 30 was .88 GPM(48SC),or Model Water 50/50 Glycol Brayco 888 w 20 1.11 GPM(410SC) of water.Performance values l0 calculated for net aperture area are: 48 .9 1.0 2.1 0 FRra=.623 FRU_=.849(48SC) 005010015020025030035040045050055 FR ro=.839 FRUL=.811 (410SC 1 410 1.1 1.2 2.6 Performance plot based on gross coi octor area The incidence angle modifier,K or.describes - _ Tin-Ta F (°F ft4hr/B7U) the decrease in efficiency of a collector at non- I zero incidence angles.K ar varies with incidence SECOND ORDER EFFICIENCY EQUATION angle according to the equation: Tin -To efficiency=.766-.632 1 4381/Tin -Ta 2 Kar= 1-b0( 1 - 1) DURABILITY TEST RESULTS (48SC) ( I / \ I Gose (SOLAR COLLECTOR THERMAL SHOCK/WATER efficient = Tin- Ta Tin -Ta ' )y .778-.531 l -.551 1 SPRAY TEST:Test conducted in accordance with 410SC / where b0=incidence angle modifier constant and SRCC 100-81. Results:"No evidence of damage 0=incidence angle. or leakage." NO-FLOW 30 DAY EXPOSURE TEST:Test The incident angle modifier constant be,for this SOLAR COLLECTOR THERMAL SHOCK/COLD conducted in accordance with SRCC 100-81. collector is.234(48SC).or.141 (410SC).The time FILL TEST:Test conducted in accordance with During this test the collector was exposed to a constant is a measure of the time required for the SRCC 100-81.Results:"No sign of leakage or cumulative total of 30 days having a solar collector to respond to changes on solar radiation damage noted." radiation total in the collector plane of 1500 STATIC OVERPRESSURE AND LEAKAGE TEST: BTU/ftr or greater.There was no visible change level or inlet temperature.The measured time Test conducted in accordance with SRCC 100- in the condition of the collector.All data on this constant for the Optima II collectors is.87 minutes 81.Leak test pressure: 160 PSI.Results:"No page is the result of post-exposure testing. (485C)or 1.24 minutes(4105C). leakage noted." SUGGESTED SPECIFICATIONS of not less than.907.Insulation shall be a hardware may be attached without drilling or combination of low binder,unlaced fiberglass and penetrating the collector in any way.The collector Solar collectors shall be Optima II series high rigid board type fiberglass-reinforced shall be furnished with 1 inch nominal copper performance liquid-cooled flat plate type as polyisocyanurate foam providing a minumum of internal manifold,yielding four 1 inch type"M" manufactured by Novan Energy,Incorporated. R12 behind the absorber.R8 at the long collector copper connections.The performance Collectors shall have a solid copper absorber sides.and R5 at the shod collector sides.The characteristics of the collector as tested in with a maximum working pressure of up to 150 components of the collector shall be unitized by a accordance with ASHRAE Standard 93-77 shall psi.The absorber shall be coated with a selective weather-tight extruded structural aluminum frame. not be less than FR to= ,and not greater black chrome over a nickel substrate.The coating The frame shall have an anodized bronze finish. than FRUL= ,and shall not degrade shall yield an absorptance of.97 and an The frame shall be constructed in two parts, significantly after 30 days of stagnation with a emittance no greater than.12.The collector's providing access to the glazing without minimum solar flux of 1500 BTU/h2-day.All front cover shall be textured,low iron,tempered interruption of service.The frame shall have an hardware used in the collector shall be black glass,and shall have a solar energy transmittance integral mounting channel so that mounting oxide coated stainless steel. • Al - ASSEMBLY, INSTALLATION The integral mounting channel-a Novan TYPICAL FLUSH MOUNTING APPLICATION • innovation-is the key toithe simplec and eure 4. installationhanel, of Novan Ocma II collectors.of The channel,designed to accept the head of a36 inch Angles diameter boltor jam nut,eliminates the need to (Adjustable for two heights) i penetrate thee collector.Mounting hardware may be attached at any point around the entire perimeter of the collector.Shown here are Q / t illustrations of standard mounting kits and application.The mounting channel,combined ae.m M Wa.Me with Novan's mounting kits,offers unlimited n-nN flexibility in all installation situations.The optional acx - a, -4.4- trim kits,used to conceal piping and mounting I• r I hardware.are also installed on the mounting channel. .k mil _______cy0 Collector tube connections are 1" nominal type TYPICAL STANDOFF MOUNTING "M"copper.These flow-through copper headers APPLICATION II � z are isolated from the structural aluminum sidewalls by rugged EPDM grommets designed to Integral Mounting Chiang Intal allow ainannion and contraction,werThe grommets .)---„,..‹,,,IT, Angles alsovemaintain air and weather-tight Aima seal in Vertical Support Leg even the most extreme climates. maximum of 6 collectors may be piped directly together in Angle parallel without provisions for flow balancing. (Adjustable for two heights) .1 All mounting angles and vertical uprights are ) made of bronze-anodized structural aluminum alloy.All bolts,nuts,and washers are black-oxide - -�` coated stainless steel. L NOVAN Energy, Inc. 1630 N. 63rd Street • Boulder, CO 80301 • (303) 447-9193 A PUBLICLY OWNED COMPAP - NOVN(NASDAQ) / Brochure 4 PB 12064 All Spechwcations subject to change without notice. • / Applicant to fill in all spaces within heavy border lines and.sign all appropriate declarations. CITY OF COSTA MESA PERMIT NO. TRACT NO. LOT NO. ••BLDG.NO. C6NSTRUCTION PERMIT_I p� 79S Project Address 1.4/61, LI A) 6R_,•. TYPE OF CONSTRUC�TyIrfNsl " . p .0 1 't • So.. 7I- •Address 62_\G}' LLI,VI )60J _• "' .. '(] REPAIR'0 CONVERSION'0DEMOLISH • ZONING REGULATIONS 'Arch/Eng. •Carpejae.44,- - •• License No. - - 1=1 OTHER . .-- ' - - - ' -- - -- - - - - - DESCRIPTION OF WORK 05 -LOCAA.P.le •, Address ' ll , „Cj 'ZONE PLNG. REF.4- • •" • ' • • Contractor 2l j.. L 1.9-42( Phone `�^_ TYPE OF PERMIT -SETBACK NG TTpp 30LaI -p I G -_ SETBACK C/L ST. PROPE RT�LINE . Address �- • ❑ GRADING (] FOUNDATIO ❑ STRUCTURAL LIDET YARD • . LICENSED CONTRACTOR DECLARATION ----. - •" - - 0 TENANT 0 ELECTRICAL PLUMBING ❑MECHANICAL SIDE YARD I hereby affirm that I am licensed under provisions of Charter 9(con- - RIGHT - - - mencing with section 7000) of .Division '3 of the Business and ❑ OTHER - '- Professions Code, and my license is in full force and effect. REAR YARD(TO P/L) • - PROJECT DESCRIPTION • - ' License Class _ • License No.- - • I PKG.SPACE REQ. PROVIDED Date Signature SQ. FT. - ' - - ISTREET WIDTH PARK FEE$ WORKERS'COMPENSATION DECLARATION - "-- " • OCCUPANCY_CONSTRUCTION TYPE •--- - ' ' ' I_hereby affirm that 1 have a Certificate of consent to self-insure or a •VALUATION - • ZONE .ZONING APPROVED BY DATE , certificate of Workers' Compensation Insurance, or a certified copy - - - , thea+-ef(Section 3800, Lab.C.). , f _ .. - 'GRADING CU.YDS. ACRES •SPECIAL CONDITIONS: - ' PC '.pilo. Company - - • ' /� -/ G rt... copy Is hereby furnished. -"- " - REMARKS: t�/I^/3'`4[ / 4( -I - - ❑ Certified copy is filed with the city Building Division. / _ _ _ _ EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Re5.'.4-i q.pgrlq./ •e rA►rir _ (This section need not be-completed if the permit Is for one'hundred - / - --. - - -- . ($100) or less). • .3..r /L of a .S'72 sr .. I'certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to-become PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK • subject to the Workers'Compensation'Laws of California. - _ DWELLING GA HA(at . • Date Signature • BATHTUBS SHOWERS 40,FT Sn_FT ' - NOTICE: If after making this declaration, you should become-subject , TOILETS' -.i •- URINALS GENERATOR 0-1 KW .1-10 KW ' - -- to the Workers' Compensation provisions of the Labor Code,you must --TRANSFORM ER - - - - - forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAYS APPLIANCE 10-50 KW 50 + KW • - •• revoked. '- -- - - - _ - - • CONSTRUCTION LENDING AGENCY KIT.SINKS DISHWASHERS MOTORS 0-1 HP 1-10 HP I hereby affirm that there is a construction lending agency for the per- SERVICE SINKS SUMPS - -(INC.SOLAR) 10-50 HP50 + HP formanceof the work for which this permit is issued (Section 3097 Civ. C.). FLOOR SINKS FLOOR DRAINS FIXTURES OUTLETS SWITCHES Lender's Name ` ' Lender's Address DRINKING FOUNTAINS GAS TUBE SIGNS , . OWNER BUILDER DECLARATION INTERCEPTORS CLARIFIERS POLE LIGHTS - ' I hereby-affirm that I am exempt from.the Contractor's License Law for ' the.following reason (Section 7031.5 Business and Professions Code: SWIMMING POOL P TRAP LOINS I HUt.IION ' . Any. city or county which requires a permit to-construct, alter, - - POLES METERED SUB' improve, demolish or repair any structure, prior to Its issuance,also re- WATER SERVICE ALTERATION / ,a 90 'PANELS MAIN SUB . 1- - ' quires the applicant for such-permit.tO-file a signed statement that-he is licensed pursuant to the provisions of the Contractor's License Law GAS SERVICE OUTLETS SERVICE - AMP (Chapter-.9- (commencing with Section 7000)-of Division 3 of the -• Mr' --and Professions Code) or that he is exempt therefrom and the WATER HEATERS BTU OUTPUT ba the alleged exemption. Any violation of Section 7031.5 by - - ar icant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS ' . ' of nore-than five hundred dollars ($500).. - - ' I, as owner of the property, or my employees with wages as their SOLAR TANK COLLECTORS \ - ole compensation, will do the work, and the structure is not Intended . or offered for sale. (Section 7044, Business and Professions Code:The . SOLAR PIPING SYS. ISSUE FEE Contractor's-License Law'does not apply to an-owner of-a property -- APPLICATION APPROVED BY DATE who builds or improves thereon, and who does such work himself or : ISSUE FEE „.3e30i through his own employees.-provided that such improvements are not - - - intended or offered for sale. If, however, the building or improvement MECHANICAL PLAN CHECK _ SUMMARY OF FEES • is sold within one year of completion,the owner will have the burden I - --• - , • of proving he did not build or improve for the purpose of sale). BUILDING - i HEATING SYSTEM 0-100,000 BTU - • PERMIT $ - SMIP $ ❑ 1, as owner of the property, am exclusively contracting with AND DUCTING licensedcontractorsto construct.the project (Section 7044, Business .. - .100,000 +BTU PLAN CHECK $ PERMIT and Professions Code: The Contractor's License Law does not apply to `Q� ISSUANCE $ an owner of property who builds or improves thereon, and who con: • REFRIGERATION 0-100,000 BTU PLUMBING $ V ' tracts from such projects with a contractor(s) licesned pursuant to SYSTEM - • .. GRADING $ the Contractor's License Law). .. . . ,_ __ 100,000+BTU .PLAN CHECK $ ' - _ . • ❑ 1 am exempt under Section B.& P.C.for this • - $ • .BOILERS BTU. _ ELECTRICAL $ ' - ' MICROFILM $ reason _ PLAN CHECK $ ' ' SYSTEM REPAIR,ALTERATION • Date Owner I ' - TOTAL•FEE_$ i EXHAUST SYSTEM • MULTIPLEMECHANICAL:E I hereby certify that I have read this application andallate that the above - - - - - - LESS AD-- -. information is correct. I agree to comply with city and county - PLAN CHECK $ VANCE PC $ ordinances and state law relating to construction;and hereby authorize • representatives Of this ity to enter upon the above mentioned - property f ctl urposes: / - - • - 6,00 Signature - &`/ ISSUE FEE • • CMF 0865-46 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor I0 aµ •{ Q-" CONSTRUCTION AND PLANNING POOL&SPA - -. APPROVALS Permit # Date Inspector APPROVALS • Permit# - Date Inspector 1. Temporary Electrical Service or Pole 43. Pdol & Equipment Location 2. Soil Pipe-Undrgrn - - ' 44. 'Steel Reinforcement _ • -- 3. Electrical Conduit Utility-Undrgrn - 45. Forms •• • 4. Electrical Conduit-Undrgrn 46. Electrical Bonding -- 5. Steel Reinforce - 47. Rough Plumbing &Pressure Test ' •• 6. Electrical UFER Grn • . - 48. APPROVAL TO COVER-GUNITE - - 7. Footings 49. Electrical Conduit-Undrgrn - 8. Foundation - - - - 50. Gas Pipe, ❑Undrgrn,Test • 9. Water Pipe-Undrgrn 51. Backwash Lines. P-Trap, ❑Undrorn• - . 10. Structural Floor System 52. ' `APPROVAL TO DECK 11. Property Sewer Line& House Connection 53.- - - - 53. Backwash & Receptor-Final • 12. Street Sewer Connection 54. Heater &Vent-Final _ 13. Rough Plumbing - 55. Plumbing System -Final - _ 14. Rough Electric-Conduit . , • • .56. Electrical-Final 15. Rough Electric-Wiring - - - • • 57.'- Solar System-Final • • 16. Rough Heating &Air Conditioning - b8.•, Fencing,&Access Approval - 17. Ducts, in Structure - 59. APPROVED FOR PLASTERING 18: Ducts, Ventilating 19. Gas Pipe-Rough &Test • . • 60. POOL/SPA SYSTEMS FINAL - 20. Roof Framing • 21. Roof Sheathing , 22. Frame and Flashing - - NOTES: • 23. Insulation _ 24. Lathing & Siding • - • 25. Drywall Nailing 26. Plaster'Brown Coat 27. Electrical Power Meter-Final - 28. Final Electric - - . '- 29. Final Heating & Air Conditioning _ _ _ 30. Final Gas Pipe-Test ' 31. Final Plumbing [ L.c 1(04-3-5( _ ' _ • 32. Water Service-Final - - - - 33. Gas Service-Final - 34. Solar Domestic-Final , • ' 35. Landscape Sprinkling System - • • 36. Sound Attenuation • - - ' 37. Handicap Regulations - -. - - I - " ' 38. FI NAL STRUCTURE & BUILDING . • • 39. Special Requirements Completed I - - - . - - . ' - -- - - 40. Electric Release to Edison . . - - -- ••--- _ - - - - - - 41. Gas Release to Southern California Gas Co. - - - - 42. CERTIFICATE OF OCCUPANCY I.1/4 - _ - - • - - - No - Date - - - oy FS C. Y OF COSTA MESS O V %, CALIFORNIA 92626 P.O. BOX 1200 HI a J. in o FROM THE OFFICE OF THE DIRECTOR OF BUILDING SAFETY • . °A Project Address 2 1 Li(-uAti i S��!o C--. L. �-C. Permit # s l 3 y ! AL re.I- :P Ce-vz.l=ae- ..--- Project Name 61../-4e-i6,cJ Type Owners Name Fr..---f0 c7c^2cA Owners Address 2Act (.4 .Li.{;1-J Pc, . c-. AA , City Use Only Owners Telephone 1.2Y.2.-5 .2_6/ It�.IQ COOewe it as Owner, Cotaeter, Agowt (strike out all except one) do hereby attest that employment of any person, or persons, is not anticipated at the time of seeking the above-referenced permit. In the event that any person, or persons, are employed under the provisions of this permit, I shall immediately cause a valid Certificate of workmen Compensation to be filed with the Costa Mesa Building Division. I agree to defend at my own cost, and to indemnify and hold harmless, the City, • its officers, agents and/or employees, from and against, any and all liability, damage, costs, losses, claims and expenses, howsoever caused, resulting directly or indirectly from, or connected with the improvement under this permit. I further state that I have read and fully understand the implication and re- sponsibilities of the above statements, and will comply with all provisions of the Contractors State License Law found under the Business and Professions Code, Division 3, Chapter 9, of the State of California. Print Name / Signatu - Date CMF 0777-46 ki- Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA 9ON �R UCTIQPER MIT PE. Iv)IT NO..7p T'AAT U. L T I�1O. UNIT NO. A P # L{�rj�..�. `l �/ - Zone 2J t '«Project Address (k Q<<e: -+-� 3/ O s�`� 1 1 6 -I K Qh - r rr '' u f S Main Building: Accessory Building: Abplicant'srMa i ling Address ` . 'Ca0.NVlz-G TYPE OF CONSTRUCTION NEW u ADD ALTERATION U REPAIR E Z Owner's Name .rT Lh Ws Tryst ,`t00 KPhone bjI]J,{ ❑ CONVERSION ❑ DEMOLISH ❑ OT _; _ T Front O _ D RIPTI OF WORK/U OF BLDG. _ �� e�'tL ' B Rear N Atldress 21 .L'11-1- o&, Ic'G ter r' fl e- t A . Arch/Eng. License No. TYPE OF PERMIT LJ GRADING ❑ FOUNDATION �TRUCTURAL`i C Right G AdPress ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL $ • Left , Contractor's Name /v'\CJ- /*q�,3 Phone ❑ OTHER �j t I Ping. Re . - Parking Req./Provided Q !!! �` PROJECT DESCRIPTION SQ FFyT�s ' OCCUPANCY /` J PlanningNotes: 1 �/�-�^ L (� Address(mailing) r> - CONSTRUCTION TYPE y /v VALUATION$_ ��0 �� p1/ y11S I�I lei OF /J/'fi1/\/eJ/,/I,III '��f M City License No. T ZONE GRADING CU.YDS. ACRES 'l f2S'�g1'•1'1-`Ps-"- eri GFrfrC G( �Jrs S. LICENSED CONTRACTOR DECLARATION ./ I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: •• with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. • ELECTRICAL FEES License Class _License No. Date Signature - PLUMBING FEES Automatic Washer Transformer 0 15-50 KW WORKERS' COMPENSATION DECLARATION Sink Showers Construction Pole Sub. ❑ 50+ KW 'eby affirm that I have a certificate of consent to self-insure or a certificate /orkers' Compensation Insurance, or a certified copy thereof'(SectionCooking Unit Meter ❑up to 100 amps .0, Lab. C.) Backflow Preventer Service Sink Policy No. Company Backflow Irrigation Sewer Cap Dishwasher Meter Dover 100 amps — 8 Certified copy is hereby furnished. Dryers ❑Gas ❑Electric Sub Panel Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Date Applicant Fan Motors❑0-1HP ❑1%-8 EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors — (This section need not be completed if the permit is for one hundred ($100) or F.A,U. Inc.Sol 9-15 HP ❑16-15+ less). Dishwasher Solar Piping I certify that in the performance of the work for which this permit is issued, I Fixtures shall not employ any perso in any manner so as to become u lett to he Drinking Fountains Solar Tank ' owave Workers' om sattyyppgggggg sof California.� , //p Date ��5 Yt Signature 1 �Ce✓ Device Boxes Pole Light § Floor Drains Swimming Pool w/Spa 9 NOTICE: If,after mak n this declaration, ou should become subject to the Outlets Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Range comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY' Gas Service Outlets / ater Closet Switches Sign I hereby affirm that there is a construction lending agency for the performance W of the work for which this permit is issued (Section 3097 Civ. C.) Garbage Disposal Standing Sections • Lender's Name _ Interceptors Water Heater _ 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 r 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(commencing with Section 7000) of 1 •ision 3 of the Business and Professions Code) or that he/she is exempt •.- Reinspection Fee J $15 Issue Fee $ 3 efrom and the basis for the alleged exemption. Any violation of Section - - 31.5 by any applicant for a permit subjects the applicant to a civil DEVELOPMENT SERVICE • O IREMENTS: pe na y of not more than five hundred dollars ($500). 3 as owner of the propertyor my employees with wages as their sole Reinspection Fee $15 Issue Fee • Y 9 Zoning Approved By Date w compensation, will do the work, and the structure is not intended or offered - ` for sale (Section 7044, to s's and Professional Code: The Contractor's' MECHANICAL FEES - Building Approved By ,(Alga•!w Date min License Law,woes not apply to an owner of/a property who builds or improves - -- PPBy � '-r��x _ - Dab /�7�'. thereon, and'who does such work himself herself or through his or her own A lication Issued �� employees, provided that such improvements are not intended or offered for' Boiler Hood or Type I 0 111 sale, if, however, the building burden vement is sold within one year of com- Canopy Type II 0 SUMMARY OF FEES - prove , 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 $ fs.t,�7 SMIP $ 3?� 0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrige on 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 -100,000 BTU,0100,000 BTU PLUMBING $ ISSUANCE $ builds or Improves thereon. and who contracts for such oroiects with a con- - , tray r(s) license pursuant to the contractor's License Law). I am aware that Exhaust System 0 Multiple System Repair/Alteration;on I PLAN CHECK - 25% $ • ENERGY P.C. $ pr f of their Worker's Compensation Vance nce should be provided to me, ,/ ELECTRICAL $ GRADING $ Pi I am exempt under Section '7- 7 B.& P.qC.for this reason/ Firepl/Fact.Blt, ICBG# Fire Dampers • PLAN CHECK 50% $ MICROFILM $ - Date ��/S- /Owner •�_�� ,(' ,Y (/ Heating System& Ducting Registers • MECHANICAL $ TOTAL FEE $ ��`S� I hereby certify that I have'read tris application and state that the above - 010-100,000 BTU 0100,000 BTU information is correct. I agree to comply with all city and county ordinances , PLAN CHECK 25% $ and state laws relating to building construction, and hereby authorize repre- sentatives of this' city to 'enter upon the 4bRvectloned property' for Inspection Purposes.\ �' C -Q - - ' Signature �CR\(SJw "— Date J"1✓ CJ9 _ _ _ <,..:� DATE: 03/15/8? TIDE: 16;47 -. 0865-46,rev. 5/88 White - Building; Canary -Applicant; Pink - Accounting; Goldenrod - Assessor -APOC SPA CONST-RUCTION AND PLANNING - ,, APPROVALS Permit# Date Inspector APPROVALS Permit # .Date Inspector fa I 1. Temporary Electrical Service or Pole r 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. - / 53. Steel Reinforcement r• i 3(iElect)ical-Conduit Utility-Undrgrnd. J1- 54. Forms - '- 4?-Electial Conduit-Undrgrnd. 55. Electrical Bonding 1 C ,5':SteehReinforcement• 56. Rough Plumbing& Pressure Test - 6.;:Eiect?icaI UFERlGrnd.'• 57. APPROVAL TO COVER-GUNITE f ,f 7::^iFpotings �,.•,: _ 3-z(,i� 58. ElectricalConduit-Undrgrnd. j y 8'Foundation .-- 59. Gas Pipe, 0 Undrgrnd.,Test - 2'- I 9._Wate`p�Pipe-Undrgrnd. t 60. Backwash Lines, P-Trap, 0 Undrgrnd. 102Strtictural Floor System .61. APPROVAL TO DECK { 11'2Property •Sewer Line & House Connection ) 62. Backwash & Receptor-Final - • 12. Sewed Cap 63. Heater & Vent-Final 'r 13. Roof.Drains 64. Plumbing System - Final / r 14. Rough Plumbing 65. Electrical-Final , 15. Rough Electrical-Conduit . 66. Solar System-Final . J6: Rough Electric Wiring 67. Fencing & Access Approval )17. Rough1Wiring Sign 68. APPROVED FOR PLASTERING i8( Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19? Rough„Heating & Air Conditioning FIRE DEPT. REQUIREMENT n 20. Rough Factory Fireplace APPROVALS Permit# ' :21. Ducts, in Structure 70. Underground Hydro ' 22- Ducts,,Ventilating !j 71./Product Piping 0 Gas 0 Oil % - 237Gas Pipe-Rough & Test - 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas ❑Oil / 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar,Ceiling (Structural) & Monocoat • 75. Dry Chemical 27., Frarrj acid Flashing 76. Dry Standpipe 28. Lathing&SSiding 77. FIXED SYSTEM FINAL 29. Insulation - 78. FIRE PREV. FINAL 30. Dryw ltNailing 1.1 HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat % - 79. FINAL INSPECTION 32. Electrical'Power Meier-Final - 80. FOOD CERTIFICATE ISSUED iv . l 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy -._ i -37. Final Factory Fireplace- .38. Final Plumbing i - 39. Water Service-FinaL- i '40. Gas Service-Final - / _ v 41. Solar Domestic-Final / ' �-.k t • 42. Backflow Preventer .r ` / e-`.f 43. Backflow Irrigation' r >I 44. Landscape Irrigation-System '1.,9 45. Sound Attenuation , i1. 46. Handicap Regulations •'c_ _ 47. FINAL STRUCTURE & BUILDING t . 48. Special Requirements Completed . . ? 49. Electric Release to Edison :: 5.-.-. 50. Gas Release to Southern California Gas Co 1` f%., 51. CERTIFICATE OF OCCUPANCY %,� r-', -4 9 No Date CCOMPANt APPROVED Pernik # 37S City of Costa Mesa Building Dept. THIS NUMBER MUST A BY A DATE 3��5 19 ALL INSPECTION REQUESTS THESE PLANS MUST BE ON JOB AT ALL TIMES MAKE NO CHANGES WITHOUT PRIOR APPROVAL OF DEPT. PR - THEI ISSUANCE OR GRANTING OF A PERMIT OR APPROVAL OF 6VE APPL ED TO BE A PERMIT FOR, ORPLANS AND GAN APPROVAL OF, ANY VIOLATION IFICATIONS SHAH.NOT BE UOF ANY OF CITY �F COSTA MESA THE PROVISIONS OF THIS CODE.NO PERMIT PRESUMING TO GIVE 'NNING bEpy CODE SHALLAUTHORITY ER VALID, EE XCEPT IN SO FAR CANCEL THEAS OTHESIONS OF THIS WORK OR USE tUtJ� i0 aDG• DEPT. REG. WHICH IT AUTHORIZES 15 LAWFUL. /Y Dq THE ISSUANCE OF A PERMIT BASED UPON PLANS AND DR ON OP PLANNING SPECIFICATIONS SHALL NOT PREVENT THE BUILDING OFFICIAL _ FROJA THEREAFTER REQUIRING THE CORRECTION OF ERRORS IN - SAID PLANS AND SPECIFICATIONS OR FROM PREVENTING . BUILDING OPERATIONS BEING CARRIED ON THEREUNDER WHEN ;S,'�'"'`� IN VIOLATION OF THIS CODE OR OF ANY OTHER ORDINANCE O - IN OLACITYADO! � I d ;,` • 8E s l.. ' ;£;FT i0; , 0;t `--n'-1-- BY '�.ir ;CUU0NS SIV ;C putt ,,,. �`�� S.;AZL ��la,rr's L•[•Pr1i,°IENr . . i • L.l d �e RQIOt$CI ly Rt$IOtaCt Li; OttlOtRtt lel I A t h^(c�/ I w firer 2 i `I \ 6 W N 4------- — ------------- - L.i11r„ "'-- .-.---..STREE �., • TYPICAL 611 CONCRETE BLOCK FENCE ® GENERAL- NOTES Cement Coping Optional ::-Ii i on Channel Block With 1.3/8c 19t Ii ' _- ' Fences Dotal Top o1 all ee �, MORTAR: One Part Plastic Cement, and ep7� Three Parts Sand 1 GROUT: One Part Cement Three and For Fences 5'or Less Q One Half Ports Stand Vert.Bars 3/8"95 at 4' -0"O.C. d� F �' _' �—- - COPING: One Part Cement Three ax For Fences Higher Than 5' ,q a v FL Parfs Sand Vert.Ban 3/8"0 at 32"O.C. > W CONCRETE: Well Mixed 1:2-1/2: 3-1/2 cc xMax: of 7- 1/2 Gallons of 411/ Fill Celh Solid With Grout �` `> z „ ,� I Water Per Sack of Cement Where Steel Occurs )- 111 it Steel Shall 1 f tolel IIIIII GROUT MAY BE POURED FROM THE TOP Conform to Sec.A-15-39 w O OF THE FENCE IN CELLS WHERE STEEL OCCURS. A.S,T.M. CELLS AND AREAS OF HORIZONTAL REIN- ��I w r1 I- '.1I ___-_ - _ FORCEMENT SHALL BE CLEAR,CLEAN& All Steel to be Lapped I pe u. FREE OF ALL MORTAR DEBRIS,ETC. 24"or to Code I� NATURAL GRADE i II III v00 ...<O\'r gr. -p civ p'` ;„a- . TW03/8"q BARS !LS I De CONTINUOUS TOP I I &BOTTOM " •-o.-1 i•-' -WIDTH TO IS. 0.C. MAX, p SEE CHART AOMILSTEEL MUST BE TIED IN BELOW • DEPTH OF EARTHTCOTH PLACE AT TIME OF TRENCH ' I I ' 1/3 THE HEIGTH OF FENCE INSPECTION. e.IL i I. L. •-I120W BOTTOM OF FOOTING. • H 10 l..�� SCALE: 1/2" . I' • ' r FOCJjING REQUIREMENTS CHART• • ( WALL HEIGHT 5' ! 4' . • 3'1• WIDTH . 14" I _ 12 . ,: . . . . 12" 1 THICKNESS .. 10" 10" • 8" 8 " • DEPTH OF EARTHTOOTH V.. 24° 20" . .• . . . . . . . . . 16" . . . 12" i SPACING OF EARTHTOOT . 12' 14' 16' ' . . 16' ... OWNERS NAME: ' • ,City of Costa Mesa,California PERMTDORESS.NUMBER' d " i ' • ' Building • Dep•artment.: SIGNATURE! --- _ _ • • C-7�K Cie- -• 1 >} yl° P • • • J • .r. . OUSE FIA: ein-. SOgmPyi+ Z 3 MrIg a g mae. nm n 1 DOC a'^,7ino0C DT _ .. 1 --L_ I �y�Os TNjJs� 5..°1.O OO'^Z Z ,-° `7 nn I r L LL �x a s ., mo m Z �I _ A m^ N 2--. vi CO c 1n. 5. n" c3 n /� ,1/. /,.Jf �/ A�� 1V' 0,sr, T— A Y:�. l-r 4 <. t LI I i{1 N/ I act/��I It�I../ijM1�G O02.0OT DT-O„on<N, O Qt. ®� 1 1 ltiNsTE 7 1''' O-�AZm"13 Er. az° - 1m /� . ' I/ r}(yt ZONC�a'D. �O^O `-TO AO N Za 0I r? 1. brick u�� NC�Z �Z f �iV'1 ›r -,m n-+z ZCZ7a x6 i 0Z o �m � m A� _ F i.A- s Lo 1 nm ;. <mA D 1 '�' ..�[.Jn0. WI \� .mood I^ --Do m Ong �� ➢ C tin 7 �� J Oc3 oZ m<H ZO 0 ,._ m L2. u51 (V�`,f Z. I( Z anC 5 s e+aq I X / I co( II rOOTG� 'ok.n;.,m O p p 0_t L r D i --1 (.0 trcA p �y,�� N U Om2”' a O2Oy _. I Lon QQ\\ ZOZDO m=z�mr m , 1 70- • m _ 1 i‘) 11 f L" K l [O Farr • TY T tat 21.C..1A 11!AN n _ ? Me .1 C ii q2( S- � T C�14)tv4S1rib PROJECT ADDRESS: 219 LILLIAN PL UNIT' CITY OF 'COSTA MESA — BUILDING PERMIT PERM NO: B 05581 ; OWNER'S NAME: BUSH DAWN L ADDRESS: 219 LILLIAN PL PERMIT NO: B 055812 PLAN CHECK NO: 05319-91 S GOVT: N SUPP: N • COSTA MESA,CA 92627 • • CONSTRUCTION TYPE: 5—N PERMIT TYPE: STR PURPOSE: NEW ( 714 ) 657-6770 ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : LEGALIZE534SQ FT GARAGE CONSTRUCTION SQ FT; 534 • ADDRESS: UNIT: CLAIM VALUE: • CALC—VALUE: 9, 238. 20 GROUP OCC: M-1 / PERMITTEE: GERALD BUSH ( 714 ) 650-6770 ADDRESS: 219 LILLIAN PL COMMENTS: RE; EXPIRED PERMITS 51341 Si BE7297. C.M. CA 92627 ************�E>E***** **** *�LTt*******�E**�E�L****�E�r** ***************** -*********** LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING R EQU IR EMENIS 7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACK S • CITY-LIC.: STATE LIC.: CLASS: • bate: Signature; MAIN BUILDING ACCESSORY BUILDING WORKERS'COMPENSATION DECLARATION: Ihereby affirm that l have a certificate of consent to self-insure or a certificate of Workers' FRNT: FT IN REAR: FT IN FRNT: 25 FT IN REAR; 8 FT IN pensation insurance.or a certified copy thereof(Section MOO,Lab.C)- LEFT: FT - IN RGHT: FT IN LEFT; 5 FT IN RGHT: 35 FT IN ICY NO.: EXP.DATE: F MPANY: PARKING REQ• . PROV; PARCEL: 43921111 ZNE• R1 REF NO: Certified copy is hereby furnished, 0 Certified copy isfiled with the city Building Division. PLANNING NOTES> LEGALIZE AN EXISTING 2 CAR GARAGE BEHIND AN EXISTING SINGLE > FAMILY RESIDENCE• Date: Applicant: ********************************** *********************************:*********** EXEMPTION FROM WORKERS'COMPENSATION DECLARATION: (This section need not be completed if the permit is for one hundred($100)or less). DEVELOPMENT SER VICES R E Q U I R E M E.—NC1' S I certify that in the performance of the work for which this permit is issued.I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws of California. ZONING APPROVED BY SCC_ DATE: -Tv( (c-I 9 L- Date: Signature: - ret 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. t J Liy , CONSTRUCTION LENDING AGENCY: Ihereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED B Y; LC, DATE•• Xt• 2_ which this permit is issued(Section 3097.Civ.C). ********************************;3-*****��E**'**** ..*.*.*.x.**..**.x-*..x..****.*.*.*.*.*.{p *.*..*.k. .*.x. i LENDER: CARPORT CONVERSION TO BE ******************************************************************************* ADDRESS: LEGALIZED ON OTHER PERMIT LEGALIZATION:Y F E E SUMMARY STRUCTURAL SEGMENT: 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 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 234 . 00 . 92 repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 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 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 152 . 10 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ISSUE FEE I. as owner of the property or my employees with wages as their sale compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law TOTALS---—> 234 . 92 0. 00 76 . 05 310. 97 311 . 01 — . 04 does not apply to an owner of a property who builds or improves thereon.and who does such work himself/herself or through his roher mnt is employees.win provided tof t completion, improvements are not intended offeredhedeof rfor sale, If,eihowever ird or iimprve REVENUE DIVISION TOTALS--> COLLECTED : 234 . 92 OVER/SHORT: . 00 improvement purpoof sale). one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK I.as owner of the property.am exclusively contracting with licensed contractors to construct the project(Section 7044,Business 234 . 00 9 2 ❑ 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'Slate License Law).I am awar// *****************************************************************************.*.* • that proof of their Worker's Compensation insurance should be provided to me. (// INDIVIDUAL F E E BREAKDOWN ❑ I exempt under Section: for thisis reason: TYPE QTY DESCRIPTION UNIT COST TOTAL COST Date. / /1/4s--' 9 , er: SFR 534 RES—GARAGES TYPE V 17. 30 9, 238 , 20 I do hereby certify that I am aware of and understand the requirements 01 California,Health and Safety Code Sections 25505,25533.and END OF FEES 25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from these provisions. Date: Applicants • I hereby certify that I have read this applicator nd state that the above information is corr CL I agree to comply with all city and county ordinances and state laws relating to building nstruction and hereby authari reser ' of this city to enter upon the above-mentioned 01 00106433-01i10443. TO Q * J / / DATE: 0i. 6.'��. TtriE• 2..:7 a- property for inspection purposes.Date: / (s - Pe Signature: 1- • Driver's License or Social Security or: . 1641-46 While-806ino:Green—Code Enforcement:Canary—Aoolicant:Pink—Revenue:Goldenrod—Assessor R )L & SPA - CONCTRUCTION AND PLANNIf, ' s - APPROVAL'S Permit# Date Inspector Date Inspector. APPROVALS Permit # -1. Temporary Electrical Service or yole ' 52.'Pool & Equipment Location ' .• ' 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ., ' 3. Electrical ConduitUtility-Undrgrnd. 154. Forms _ , 4. Electrical Conduit-Undrgrnd. ' - 55. Electrical Bonding 5. Steel Reinforcement • '56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. .. 57. APPROVAL TO COVER-GUNITE ' 71 Footings _ '58. Electrical Conduit-Undrgrnd. 8. Foundation _ - 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. ' - 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System - 61. APPROVAL TO DECK - • 11. Property Sewer Line & House Connection - , 62. Backwash & Receptor-Final - 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains ' 64. Plumbing System - Final - 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit . - - • 66. Solar System-Final • 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 - _ T - APPROVALS • Permit # • 21. Duets, in Structure . • 70. Underground Hydro 22. Ducts, Ventilating • _ 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test � ' 72. Underground Flush . 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil I 25. Roof Sheathing 74:Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat . •• 75. Dry Chemical 27. Frame and Flashing •• • : 76. Dry Standpipe 28. Lathing & Siding . 77. FIXED SYSTEM FINAL 29. Insulation 78.-FIRE PREV. FINAL - 130. Drywall Nailing • HEALTH•DEPT. REQUIREMENT .-31. Plaster Brown Coat , 79.' FINAL INSPECTION . . 32. Electrical Power Meter-Final . ' *80::FOOD CERTIFICATE ISSUED 33.'Final Electric , - Notes: - . . 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test • - - - .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' '- 1` . 43. Backflow Irrigation- - - - -,44. Landscape Irrigation System- ,, - - .45. Sound Attenuation . 46. Handicap Regulations //'I 1r - 47. FINAL STRUCTURE & BUILDING vN?i< 48.'.FINAL PLANNING :, -fg tl/ ; -' , 49. Electric Release to Edison . • - 50. Gas Release to Southern California Gas Co .I 1 i -_, 51'. CERTIFICATE OF OCCUPANCY No. Date . . Applicant to fill In 411,,spaces except zhose within heavy border lines antl sign all ap Proprlate tleclaratlans CITY'Of.COSTAMESAL_ r I - - - - - • 1' _' "QIuu - 6/IQ/83 ..254.90.` CL _ I [ , l _ P MIT„NO. I - 1•-. TRACT NO. I - ' LOT NO./ BLDG NO. ! I CONSTRUCTION PERMIT ; .• i o- i '.. i 4 I ' 'I ` • ? u ' + �' E- 72 97 l.� 3 I i ' I -1. 1 Applicants Mailing Address : 7-7--t-4,V-.4 LJ Ali PG '''- ' 1 -TYPE OF CONSTRUCTION, I2 NEW ,•U ADD .L'J ALTERATIONS'U REPAIR ? r I • r rr t. • c ;� t • • • j Project Address- - • - SFS'-w�a I - i r _ ;❑ CONVERSION -❑ DEMOLI ❑ OTHER .~ I Owners Namea .(/LE.Y6 . .5,2-Ctd- ” r "Phon�Yt 71-e?2, pE CRIPT ION.OF WORK S. - ..: •1 _ _ L i �, ,. a fs!/e • i s : Z� 1 .ZONING•REGULATIONS� r F ' Address - 2-'- ' PC.i LC-BA-rni PGi t r t C I a r -.TYPE OF PERMIT m GRADING. III FOUNDATION• C STRUCTURAL C A.P,916 439. .....„2:1,p:„ . �'I i ; ZONE • Arch/Eng ` P+c-a-fi -/�/1-- - License NO.: ' • - ❑ TENANT ELECTRICAL 0PLUMBING' 'MECHANICAL i I .' 'BUILDING' ' ' • ' .'P LNG. REF.4k' ; _ - 1 I :Ta I . ewrwnrir r- el' • • ` - I !OTHER •- ' - ' i f i- • -REAR YARD (TO . ',Sir Address - • '+ i • TO BUILDING.PE RTY . Contractor:s Name �l ' Phone' I 'PRO.IECT DESCRIPTION SQ. FT- -�1 Z�' OccuPAN y_ ••� ,_• _ Address(mailing. - I • I - ) ) CONSTRUCTION TYPE ✓- • VALUATION • 33 - ) LEFT SIDE YARD 7 RIGHT SIDE YARD ��./: '$` :9/ ' ' 7 ZONE - PKG.SPACE REQ. PROVIDED License No: 'I i '- I •: r I - , . CuWIDTHFEE�I/`3 //� S�-7's, l I tth sectIonrm2 00) o a'm licensed 3'under prosiness f Charterro9i (cns Code,and - , T' ' !H/OLD'FOR SPECIAL REQUIREMENTS , w th dense is 7000) of Division 3 of the Business and Professions Code and ;., , 1. I ` t SPECIAL CONDITIONS: riy license-Is in full force and etfeat. i • 1 LJcense Class' ' 4' ` ' License No. - PLUMBING I I , ; ! ! , nate • i S19hdture 1 ! ' I . Bar Sink Sewer Cap , - + ; ELECTRICAL i RKERS•COMPENSATION DECLARATION. 7 : I : t • , - eby affirm.that I-have a certificate.of consent self-insure or a certificate- : ' �- - ! ._ __._ ._- .. - Automatic Washer. 1_" _... . I I,Meter Dover 100 amps _• -._ _- # Backflow Presenter Sewer Connection Workers' Compensation Insurance,lor a certified copy thereof (Section - _ - ' , 3800, Lab. CJ ' !' •, 1 - -- Construction Pole Sub Panel j Backflow Irrigation' Solar Collectors I I • 1 I Policy No. '+ Company -- - - o` , Cooking Unit , ;Sub Pole 9 Certified copy Is hereby famished. , i• } i Bathtubs j i Solar Piping , . . I . i Certified copy is filed with the'city Building Division. - Dishwasher , i ;Motors 00-1 HP 01%-8 i Date •' , t Applicant : . I _1 ' - , '' 1 Clarifiers ....k - ! i I :Solar Tank - EXEMPTIONFROM WO RKE RS'COM PENSATION DECLARATION {_ - - "'-' - ---__ _ _ _ . _. _�_ _ _ -__ -. , • (This section need not be completed if the permit Is forgone hundred($100)or ' Dishwasher ' i I Swimming Pool w/Spa i i Dryers ❑Gas ❑Electric I Ina Solar 09-15 HP 016-15+ less): i I t ) '! I - _i I i Fan` • ,Microwave r ' ` I certify;that in the performance of the work forwhich this permit Is issued r Drinking Fountains I I I Urinal _i f f ' ' • . NOTICE: If after Makin this tleclaratlon, ou-shou�omesub act to the Floor Si - shall;not employ any person In any manner so las to become subject to the • Work r •.Co p n I mLaws of Ca , ' r Floor Drams' i Water Closet•, F' 'U I ,Pole Light , mm S5aatt yy �f�($I�� t A Date 2�/7`( 5 Signature '`\�r'�� _ - i • - e 9 g -Y I nks•1- - ! -• 7 .Water Heater - - _ _ Fixtures,. , - I _• Range _ ' .._.�.... Workers'. Compensation provisions of the Labor Code, you revoked." th. - - v comply Rwithi,such ,provisionsYor:this-;permit.shall be deemed revoked." •,J - Gas Servicee I `Outlets. - iWater,Service f '" • Device Boxes 'Sign . j ..CONSTRUCTION LENDING 'AGENCY - I '• • ; 1 - 1 - C - • ' ' I hereby affirm that there Is alconstructlonlending agency:for thelperformancel :i Interceptors n. . i,. ,- 1 ^ / Outlets • t 4 Standing Sections 1 i ZD' ' of the work for which-this p r t is issued (Sect.on 3097- Civ. C ',Trash Compactor 0 i Lender's Name' ; {.e ' - ' i' ,> - / Switches I I ' Knchen'Smk I '=_ I : P I IJ'ntler s Address -n N17E - •- i i Lavatories- ' - ? r : Gartiage Disposal ) • • OW NE RBUILOER DECLARATION' - Y ' < " I 1 -a -� ; - I i - ' • I hereby;affirm.that I am exempb from the Contractor s,License Law for the .- Generator 00-5 KW 05-15 KW I •" .S'ti I I I I ' following reason:(Section'•7031.5 Business and Professional Code:Any city or _ : P-Trap' ' r I = + , .2.- I , ; ,, ! I county which requires a'permlllto construct,alter Improve,demolish or repair - - - _ - I ,'any structure; prior to its,Issuance,ialso requires the'applicant for such permit •• , Roof•Drains 1 • , rr I j - Transformer ❑15-50 KW t ''I+' � I I to file a signed statement that he/she Is licensed pursuant to the;provisions of l r o + - I I !!T ! Contractor's License Lawi(Chapter 9(commencing1with.Section:7000) of I ' ' - I y ' : ! 05U+KW• 1 i ` .;Re Speetion Fee ' ' $15' 7 Ision,3"of the Business and,Professions Code),or.that.he/shefis.exempt - I Showers i t' ' i; ' . . i Reinspection'Fee . $15 •' • - i 'efrom and- the;basis for the alleged exemption:Any violation-of'Section ' _ Meter ❑up to 100:amps .Issue Fee I $ 3 1:5 by'lany applicant fora permit'subjects:the applicant to a' civil , ' " i \ _ ', 7$�1,-as --a of not more than five hundred dollars($500j: • r, I Service Sink I I ' Issue Fee 1 $ 3 Zoning Approved B• Y �) r i/ - .L. 'Date - J!i I, as;owner of the property •^y • -eole - • compeocassen; will'do the work, and'the.structure is not intended or offered , -n ' , . MECHANICAL' I j Application Approved By 1 'Date C`�� • ! for sale.(Section 7044, Business and'Professional-Code:.The'Contractor's - i -7 • License Law does not apply to an owner of a property.who builds or Improves . Refrigeration System ! 1 ! ' i + ' • thereon,rand who. does'such work himself/herself or through his or her own i Boiler I c I 9 iY Application Issued By I ' + +Date • -- employees, provided that such9mprovements arainot Intended or offered for - 00-100,000 BTU 0100,000 BTU' ' sale. If, however, the building or Improvement is sold within ones year of tom- Duct-Under,Ground• r , ; ` /! SUMMARY OF FEES ' , prove f, the purpose have the burden of proving.he/she did not build or im- t . . $ • Dove for the purpose of coley. I ; I 1 Duct-Structural System Repair/Alteration ' I i' 'BUILDING PERMIT $ -�•�3'O• i SMTP ' i $ +—'1"'e LJ I, as owner of the property,arim exclusively contracting iwithe ed con- I :tractors to construct he's oject,(Sectlon 7044,.Bus lness-ane professions Coders - Duct--Ventilating.•._ . ' .,.- _ 1. 't ;PLAN CHECK, I $ I"r �' LZ , PE•RMIT + i The Contractor's License Law ddoes not apply to an owner of property who I ` 1 l ISSUANCE 1 • $ ' ' builds or. Improves.thereon,and who contracts for such projects with a con- I Exhaust System 0 Multiple❑ -I • , PLUMBING ! $ tractor(s) license pursuant to the Contractor's License Law). t 'PLAN CHECK' $ ( GRADING I $ r� 1 0 ram exempt under Section ' I B.& P,C.for this reason : Firepl/Fact.Blt. ICBG# ; 1 'y •l f ; I I I. ! j \l/ i f 1 'ELECTRICAL• $- 13• l0 ' $ I Date owner ' i I 1 . Heeting,System&Ducting I i , - I I I j MICROFILM : $ . O -I-hereby-certify^that -Ii have•read this application and-state thatthe-above —:. 06100,0001BTU-0100,000BT, - t-_--- - - • 'PLAN CHECK' • $ '073 f ! , Information is correct. I agree to comply with all city:and county ordinances • . I I r 1 I i i TO,TA LIFEEI $ l I`"/lJ and-state laws'relating to • Ildin9 constructlon,:antl hereby authorize lepra- ,MECHANICAL i $; I I sentatives of(this ;city to nter,upon the above-mentioned property for Hood or Type I ❑i y j I Reinspection Fee, $15 I i I LESS r I Signator _ _` ! i • ' } Canopy TYPe II 01 I ! ! (PLAN CHECK: I $ I I ADVANCED PC $ i �'+ ' fSignature • o• - 1 DatelWr / : ( . i } f Drivers' License or 5S -/ I r + Registers I Issue Fee j { I I • f : I • i i i ! $ 3 i I i r i i FINAL FEE! . ! $ i�Cf/ •� 7 CMF 086546 rev.12/82 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod -Assessor _ . , a _ _ 1,. ' , ., vr. -♦9:r.: 1--2 -_ ''POO?:;'. -.•:3PA _ 12. - . '. . p . ( •CONSTRUCTION ANDIPLANNING L f -,�O�' ? , ` C. ' - n , _ -:Date ' Inspector q - i -:•Date ' •Inspector -APPROVALS ' Permit# - , ,.•, • APPROVALS . -P• .ermit# - r j_ Temporary Electrical Serviceor.Pole 1.. V `'2 o? .ico 52-, Podl &'.EquipmentLocation'" ;� : s, - I -` v 2? (Soil Pipe-UndrgrAd _ I.5 `' - ; i'`.4-; ° I :I.> i a r>1 i 753`° Steel Reinforcement _ _ --:11;.f. ..41:,- : , .;:;:-:: . 1' _ 3: Electrical Conduit Utility-Undrgrndr ,�; • , ;• 1.2",t,'.,, .54 Forms?- `•'• '-Ck- , _ i : . . ,? 4: Electrical Conduit-UndrgrncP;:1"...X;• F7..1.31 < i 7 r.4 ;cg ,• epi ; 5;65 Electrical Bon`dmg;� o r• - - .:5-. ' j' 5t Steel Reinforcement - i , r 4a: y Nr. ;'56; Rough Plumbing& Ptessure Test I j , •6: Electrical UFER Grnd.1 1 'a ?T 1 " 57rn APPROVAL TO'COVERrGUNITEa .,o , • < 1 '' . - • • ,.. L. 7. Footings , 1 I { e 'm I . w• - c _ i -5;8" ElectrIcaa, nduit-Undrap,r _ , -j i 8. Foundation ' ' ' ' 1 - ' • r a + 1 :159 Gas Pipe;O;Undrgrnd.,Test,- ••c- '., 9.'Water Pipe-Undrgrnd. ; 1 tip A i '- '1.:;• 1 I'60. Backwash'Lines;P-Trap,'0 Undigrnd.-•; ..1.t.:- ' 1 10. Structural Floor System - T= s-- • ' , n. D l '-61 A1. PPL. ROVATO:DECK ; - 11. 'PropertySewer Line & House Connection! c -"- . - '• i1 • - _ n ' 62. Backwash &`Recepfor-Final: _ - 12. Sewer Cap - 1 ; .y , ' ? 6:- =`63. Heater& Vent Final : - • ' - .. . . 13. Roof Drains - ` 1 1 1' - _ .. - - - ' ' - I I ;� ( ;'64. Plumbing.Systerti'- Final `- 4 14. Rough Plumbing I i .j; 1 - ` -<: �'65. Electrical)=Final'-' - - I. - v + - .. -__ - _. _ .-- - 1. 15:=Rou h'Electrical-Conduit';"-•-__r._ "- �-- r---i--r- ' g .. i i. I I 66:1So'Ia�ISYs,, Final_!__. 1 1 • ' c16 R ough Electric Wiring; r; 11! 1 'Fm A-31 7-1--,) ihot2'_)-;. 67. Fencing&AccessiApproval 1 , "-Y - ,17. ,Rough'Wir:ng Sign•_ r `i ! ..- 1 i 1,22. 1 "1= 1 - r` ) 16g APPROVED FyOR.PLASTERING 11- 't I= , , • 1 6 _'+ 18.'Rough`Electri&l=T;Bagceilingi .! ! ' : 1 T I I- ? ', I :69 i POOL/SPA SYSTEMS•FINAL - - +'`' 19. Rough Heating & Air!Conditioning 1 ( _ I ' 1 I FIRE DEPT, REQUIREMENT' p - • _ j ko.:Rough~Fiactory Fireplace I 1 it I i i 1 i I 1 i APPROVAILS+ :Permit* • •• - .; ' ,r I , i 1 f . , 21. Ducts,'vi Structucep , • ;, 1 j 1 I I. 1 I ' i70.) Underground Hydro I. ' ' `• . I • `22. Ducts, Ventilating - i, a ,• rj j; 1 , 1 I. j 1 1 1714 Product I?ipiing O Gas D Oil i ; I, -, 423. IGas Pipe Rough&Test c I-- !;r,; I - i '. I 1 1 72.1 Underground Flush j ' 1 'i 1 24. .Roof Framing` f'' . r ,.1 11 ;" ; 1 1 1 r;(N N 1 a 1 : 1 : 73.i Uride'grrid.Storage Tank.D Op Gas OiI . , 25.''Roof Sheathing i,• l 1 ..r : I 17 41_ ! g 1 . I . 1. ' 74.,Oyerhead Hydro ' E. 1 ' ' , • x-26. IT Bar,Ceiling (Structural)i& Monocoat' 1 - , i 1 t 1 10 1 I b1 :.75. Dry Chemical 1 : 1• ` '• i 1 27 'Frame and Flashing I 1 t • r : 1 I s 1 i' 176.1 Dr,y Standpipe ',' '• ., ; , 28. '_Lathingr& Siding l q o 1 4 11 ,! 1 1 4 ' 1 �f r , 177,1 FIXED SYSTEM:FINAL. , - 1 1 1 G . 7-29. .Insulation -_' l', 6'-.• `; n j 1 11 ° j 4 I. I i I I. ; 178,1 FIRE PREY. FINAL ., e • . - I ' ; '11 ' 1 i j i 1 INo•tes•! I i p , , • .- 30. Diywall Nailing • 0 1-'. ( ! I i I 1 i i '1 1 i ' � '31. Plaster• Brown Coat ' . 1 1 111 I 1- -r- 1 , ; -� - ---��- -� '--._ ' _' ___. .I . i . _ 32. 'Electrical•Power Meter-Final ( 11 ,,• ! I I I j I ! • ! ' , + I I I . c. 33. Final Electric 1 ! ) Ii f ! 1 { 1 _ 34. Final Heating &.Air1 Conditioning ' ,. I 1 1 1 I - . -j-- .I '.1: ,' Y 1: , - 35. Final Gas Pipe Test. •- I` I ` 16' ' •` 1`. i'e 1>.. I - T Hi • - ' '1:i = _� 9; , '.4 • p U _ � N f. 1 f, Z • 4 i Y i �+ 1 L i1 1 36. Hood or Canopy:1-n 1 721 n' I 1 _ P I J 1 z t ;'... ;-" i ?I ' •_;. • - ~ -: <. 37. Final Factory Fireplace^I ' n, 11 • •_ ' - I ' l 1 I i . , i +I • 1 • • • +- ,. *' -, 1. 1- ,6 I -...n , , r 38. Final Plumbing ; .1 1 ! r-'11, . : .i '( 1 -. i , , i 1 1 f, I I 1 . 7 1'rt I -.r •' e r -- 39. Water Service-Fi1nali , 1 -I 1 w f 1 11 f�,- 1 1 1 I l ; } ',.Ir_ i - 40. Gas Service-f=inal I _' {'� ' ' t • ' 'I , ' - '_ , i; - G i! ' 1 1 1 I; I t 1 , 1 l ' ll 1 I i.� I { 1 $ 1 41. Solar Domestic-Final I ' • 1 i L 1 "I 1 ! j I 1 1 '7' • - 1 t i ' 42. Backflow-' • lPreventer' l :j 1 :1 k I ; i i i 1 ( `1 ' ' , '` .i' - !' I • , - -,i- -..--f--1--1 _- _ l 4-- ', 4---4-',-,--',--i-._.1- 'i 1 r . 43. Backflow Irrigation. t I 1 ''. i_1� _ ;n ( ' 1 I -'„ I., 'o I ,• t .;.3.;'•-.;i '1 r; ti 44. Landscape Irrigation-System - + !',-, ; - :'i - I-.`- I 1 ,I -11 rl. i';"'a. - _ _ } '- 45. Sound•Attenuation - IFLI eI I 1 14 -i • , I I.tier• `, .- - - - 46. Handicap'Regulations'I _ - 1•'1 c - I -I ITIxi I i 1 1 '1 .1' 1 I i i • . 47.'FINAL STRUCTURE & BUILDING ) 1 ' += ' " 1 1 1 I ! ' ' 1 48. Special Requirements'Completed; ' ; 1 1� I 1 I i I I I 1 1 1 - , +: .1 . t 1 II 1 .- 49. Electric Releaseto Edison) I , i. - -Ir -I ;4I_.. - '_� 1 _ __1 1 50. Gas Release to Southern.California Gas Co I ' I 1 1 1 1 1 j I 1 , ,,,' 51. CERTIFICATE OF'OCCUPANCY 41 i__. _ .1_ ' ' ' • ';" ' •-' No ' Date I I I : ! I ' 1 n — 63, lJ,- ' ^�-ca� 4aL 9 Gni r3S1 1--) ) It�JA.� 1� ly cI r : ;d Perm I if q� �. THIS NUMBER. MUST ACCOMPANY / - 0 1 06 11 Lt. - gpGF j •Fry �y�, . . -- ALLINSFECTION "REQUESTS Mite : Err I DEr f-1'.'', \______________ '� C° CARR anomti ie—. _Tann 1�` ADG151vi, . u s �Pa:�dG � v: . c3 `` BE ,,,‘?.2i-.L.L- l Nv 1 He ' P VISigle) 2,,/ , -to `c. 1114111a TO NIL at 7 •la/ l IL - si ss \\ 0 CITY OF COSTA MESA — — — - p CPS :1-iNE - - - PLANNING DEPT. f S i6JECT TO UDG. DEPT. - , ..--....tIVA- . IrC1011 OF MANNINO • - - - SCALE APPROVED BY: DRAWN BLS_r-_"�' � �:� le .2`C- C.-� w �1 REVISED +: � � DATE:' . �G.19 U L.L\baL `a Sik MESA _ UWN1ZK FRED SOFIA ' DATE' 2/6/81 JOB ADDRESS 219 Lillian Places r ZING PERMIT NO. 51341 GENERAL CONTRACTOR Owner lder DESCRIPTION of WORK ,atached Garage AP No. 439-211-11 LOT 11 TRACT 1163 FIRE ZONE VALUE $ 5,544.00 INSPECTIONS Signature Date ,TYPE V GROUP -1 ZONE 1R1 SOIL - PERMITS ISS4IED GAS SUBCONTRACTOR Date Number ber I Signature WATER Plumbing • ROUGH PLUMBING i tt4a#4:/T n,,,J 9-/[_ -x/ 9%. /O-/3&) PROP. SWR. LINE HOUSE CON. ❑ ` SPRINKLING SYSTEM MISCELLANEOUS . ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND ❑ POWER ❑ ' ROUGH WIRING Heating and Vent.TRENCHES FORMS 51 STEEL REINF. 0 f�C, 9 X2.3) FLOOR SYSTEM �Y� ;al BONO BEAM n STEEL REINFORCE fl E X P I R t D SHEATHING .1-. .5- (043-f) Incomplete Inspections FRAME AND FLASHING LATHING - IN n our n • acel to PLASTER, BROWN COAT Date .,•b 1 [l I/"' r'Q" A- ( STRUCTURAL, FINAL - -- _ ElertriC aHEATING, VENT., REFRIG. AND A.C., FINAL /� R PLUMBING. FINAL AND GAS TEST n y / ,.- yJLr ^) //`S•Q• 1i` ELECTRIC, FINAL 1 \�rlY6 We a V'rRK`C. Bs�' �f I� eat'+ Cay BUILDING, FINAL ` l! , '��"77i -/` SPEaIAL REOIIIRFMENTS • ''II,,�;; y 733 2/06/81 `$u*utz—_,. _ • COSTA MESA BUILD! tfl"SAFETY DEPARTMENT APPLICA'. 1 FOR STRUCTURALPERMIT P.O.BOX 1200 COSTA MESA,CALIFORNIA 92626 asaRECV 'PERMIT N° 5 1 3 4 1 ' For Applicant to Fill in Completely — Use Ink Only \\\\\\VVVVVV////// /+� ADBUILDINGDRESS 4---t CA ILL L-t,.t ; 1- C— A.P. NO. y3 ti/ �//// OWNER OR �./_� r) `�� A ADDRESS BUILDING '�r�/ / , ..�� 1 TENANT I r^sG'• `�-� R l ✓l,I/`^' IpC—. UNIT OR . MAILING SPACE NO. ADDRESS "Lt l• Ltt�((1C PL-, p TEL, ! TR.716 3 LOT // BLK, CITY f- AN , NO.6Y-LT NEW ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION ��' '�� LENDER �— {L� BRANCH OWNER 'tile-00 !-(2}Ce-{4' ADDRESS A� VALUE /�'� / OARCHITECT R ENGINEER tJ�F1s�� TEL. USE G7^"V � $SJ //j ADDRESS 1st- ZONE/L TYPE ie..-- GROUP /�1 ` rrAPPROVE/ 216 'Pt CONTRACTOR �vLLry,�� BY DATE (( ADDRESS TEL. / CITY NO. l /l0 F STATE CITY APPROVED S BACKS LIC. NO. • LIC. NO. C�-n SIZE NO.OF BLDG (FROM C/L/TRT) S. D• OF LOT �b' en NOW ON LOT FRONT /X FT. Q • USE OF V 'CX) EXISTING BLDG. _R.SIDE 56 FT. COL/ Separate permits are required for L.SIDE 3/ FT(� • C electric,plumbing and heating work: REAR C /FT.Q i _ F USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION Q .1 ' / IV� Vv� C�7C�� DATE APPROVED APPRO VED a / 6C /041:EAPPRO ATE2 Yy/>•1 _BY Lg a. Mi I hereby acknowledge that I have read this application and state mN CC that the above information is correct and agree to comply with n a. all laws regulating building construction, and I shall not employ dOZ D FOR SPECIAL REQUIREMENT: y' Z any person in violation of the workman's compensation laws of ^ � the State of California. r�V m eby certify that I am proper) s a contractor under �/ SO. FT. N the Sta e ' ornia • and Professions Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR m Chapter 9, and - •. lcenses are in full force and effect,or I THE PURPCBE OF ESTABLISHING A PERMIT FEE ONLY: ut am ex-• • nom the provislo - •, ate of California Business T VALUATION PERMIT FEE $ Z4 • an. -rofessions Code, Division Chapter •, •oo ' m • Signature of PLAN CHECK $ ft DO o Permittee $ J v\ � TAX $ D�so LL V • 1 {{{ u. Authorized Agent Date LCtil / S TOTAL PAID $ y t UWNtR FRED 5ORn DATE 2/6/81 JOB ADDRESS 219 Lillian Place BUILDING PERMIT NO. 51340 GENERAL CONTRACTOR Owner-builder DESCRIPTION of WORK Convert carport to den AP No. 439-211-11 LOT 11 TRACT _ 63 FIRE ZONE VALUES 7,860.00 IT CTIONS Signature Date TYPE V GROUP R-3 ZONE R1 S. SUBCONTRACTOR PERMITS ISSUED GAS Date Number ' Signature WATER '1.firC /Plumbing ROUGH PLUMBING p C\-(L-h I 7 9 1-.74-13-211 /'g1 PROP. SWR. LINE $ HOUSE CON. 0 SPRINKLING SYSTEM ,{Y+ MISCELLANEOUS I, S IL( _ pS I xl ROUGH HEATING AND AIR CONDITIONING TEMPORARY SERVICE OR POLE UNDERGROUND n POWER 0 ROUGH WIRING Heating and Vent. • TRENCHES FORMS STEEL REINF. —14,<„,V, e ; r-1 FLOOR SYSTEM 43 EXPIRED ro BOND BEAM n STEEL REINFORCE n Irtromclete Inspections • SHEATHING xxnn wan__ cancel toFRAME AND FLASHING Ivl I";/f2 S`ig ryg LATHING — IN n OUT n Date /r(y,1}J.� cin PLASTER, BROWN COAT STR"CTURAL, FINAL Elertric P-/d--iii _ a H ;, VENT., REFRIG. AND A.C., FINAL r� 'eh !'/C"IY/ �' �F'ViL. PL ,ING, FINAL AND GAS TEST n ID.,v ELECTRIC, FINAL br t , 3 BUILDING, FINAL 'J �\ ` tt �� corm�aI ocnnior..rurc ' i /332 2/Ub/bI 6b.DD IL: COSTA MESA BUILDIAFETY DEPARTMENT APPL[CAFOR STRUCTURAL PERMIT • - P.O.BOX 1200 COST SA,CALIFORNIA 92626 • RE PERMIT For Applicant to Fill in Completely —Use Ink Only N° 51340 I ADDRESS �l1 �l l-L-i Al~ ct• BUILDING A.P.NO. yqq�q I/�JJ OWNER OR ,_tel. � ,.� ADDRESS •`I ` L_'(�GIpaJ I9L-.. TENANT T / l� UNIT OR MAILING SPACE NO. ADDRESS Z I� L'iLUI /J ;�[,_. . T�R.NQ. 65 LOT / �BLK. TEL. titi TO. /A-�1f ( • NEW ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION LENDER • BRANCH —. _` OWNERir: Qf•—r ADDRESS �j VALUE OR EN INEEFl c5z//` NO`GYZ'Szl'ZoI USE c /Gl�/.ZE $ �/ • ADDRESS ZONE TYPE�— GROUP r�.-3 {� r� ,�/ APPROVED \F/f�/�.�}�r^� //� // CONTRACTOR IJ�N� BY Y V DATE 2/b/(Q1 ADDRESS TEL. CITY NO. 1-• STATE CITY APPROVED SETBACKS LIC. NO. 1LIC. NO. SIZE NO.OF BLDGS. (FROM C/L L `/OF LOT NOW ON LOT __FRONT Q USE OF '4 EXISTING BLDG. R.SIDE ( - f - cn P . FSeparate permits are required for L,SIDE FT. _ L1 electric,plumbing and heating work; • REAR FT. H USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION Q 0 a ///V�••�� //-��,�/J/�e exAr -• DATE RRR(((��VV� APPROVED rest DATa acra OLD FOR SPECIAL REQUIREjAEI I' ny O I hereby acknowledge that I have read this application and state �f �Q'- -px�ryy��q /J ,H� Q p,! that the above information is correct and agree to comply with (.2-rat �� 7 S all laws regulating building construction, and I shall not employ 4 Z any person In violation of the workman's compensation laws of a L the State of California. L`/Jr /� -� 1`� SO. FT. _ :r m :b certify that I am properly licensed asa •. . . • • CI the State o . . . . :usiness an. - ons Code, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR e] Chapter 9, and that - : - • ' full force and effect,or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: m am exemp t e provisio s of the Sta - • . . - :usiness VALUATION /1 't a • • • essions Code, Divisiorlt , Chapter 9. PERMIT FEE $ l /•eq 'n m Signature of e. - .r/r D� PLAN CHECK $ 2/2� ,00 0 Permittee •or •• 4.-...---•---"" $ / 4I TAX $ 0-ss' U Authorized Agent Date • G•‘98 ' V TOTAL PAID 6 6 •S S'