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206 LA COSTA CT - Building Permits
O Sp M CITY OF COSTA MESA 4 44e.:\ BUILDING DIVISION Ia rDEVELOPMENT SERVICES DEPARTMENT PE M NUMBER 1 WW.7a r v PERMIT iltbePcnarco M04-00329 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 206 LA COSTA CT Status: ISSUED Suite No Applied: 06/17/2004 Issued: 06/18/2004 Vicinity: Parcel Number: 42620276 ISSUED BY: Applicant: MERCER, CHAD Address: 29736 AVE DE LAS BANDERAS Phone: 949-589-2021 RANCHO SANTA MARGARITA,CA Zip: 92688 Owner: FORSYTHE, MARC C Address: 206 LA COSTA CT Phone: COSTA MESA,CA Zip: 92627-2100 Contractor ALISO AIR INC Address: 29736 AVE DE LAS BANDERAS Phone: 949-589-2021 RANCHO SANTA MARGARITA,CA Zip: 92688 License:526420 SCOPE OF PERMIT ADDITION OF AN A/C FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall HV $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $14.80 1 Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct $0.00 0 Over 50 hp/Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $38.30 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or it work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6100) DECLAkATrJNS Q • WORKERS'COMPENSATION DECLARATItn.: I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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 wers',compen5`ation Inrance carrier and policy number are: n� Carrier: ii4:V1.10. JLLrB (CHl'l �^ Policy Number: Ica� /)C7�/�OG (This section n not be completed i the permit s valuefat one hundred dollars($100)or less.) fr ❑ 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 Celifo ' .and ee that if I should become subject to the workers'compensation provisions of Section 3700 of th .Labor Code,I shall forthwith comply with these provisio - / i O /� HApplicant Signature: Date: 4� /6( WARNING:FAILURE TO SECURE WORKERS' PENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS(5100,000).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 of Division 3 of the Business a • P ofessions Code,and my license is in full force andeffect.Lic.# —grip y to Class# C / Contractor's Signature: C� (t fn, t� �- Date: l� !� OC/ f/ CONSTRUCTION LENDING AGENCY: O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ❑ 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 end 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.). O I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license, ❑Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: O I hereby certify that no excavation five(5)or more feet in depth Into which a person Is required to descend,will be made in connection with work authorized by this permit,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: I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required.has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apgermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? U Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (If yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 It a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required tor 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 end Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. O� f Legal Owner(s) / `r---) �� o• t/ y) f And/Or Authorized Applicant � Febate CO2E1, INSPECTION rift WI INTITULS CODEC INSPECTIONTYPE 2611 AI INTIfIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 3 •VAVA�•"••'A\ 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 200 (6 60.54? AYE'R .% A iJ CITY OF COSTA MESA PLANNING DIVISION SUBJECT TO BLDG. DEPT. REG. NOTE:ADDITIONS, DELETI S, OR CORRECTIONS SHALLu� APPR VED BY THE PLANNI BY .`9 DA : .iiwrgtei -HG u6yam L Ant 44 AA ii eyhd ,9,1 . ibil Dint) a-copy3crir advi a Pemd /Et tAta-404. 6/0 /° 4 ( 381-Wave 6y 6ur;ri Win g1/44- t_ 1246a) 7 •3 Costa Mesa Parcel4--Microsoft Internet Explorer provided by CITY OP COSTA MESA : '- gout Cam" h . 11 / - 1 e _ .I; •v°'] . . .!'-v,.., p � 'J �i ..—.;.......;p\��'`s �_s'; '�� 4.� 11I '� .._._.t PG_ ' re ah http:ffinesagis2xfWWSITE(COSTAMrSAfPARCELfdetaultasp p•�' ! R'4„ Propany Informa2im Map Production Facilities O f}y. t p5 1 ' ,?' At1Iflt'� ; 7'� '` y1,° ' • aa.m..' w1h rtsk r•-, a' 'i *t' �� 7 � ,a • , fib`.✓." 4`a ^.' ".' "Art:2°1 . a�, 2. J.zt f ,.R+' ' [tom' 2 r' •` r fc;>e • Acct -''r-'4 -..S r . et , -.,p' 4. @ 16 �.d 1� ). • 1 ��. �t� "ti,l „ ...,\A-.. 't,„ 4f^ ]2 •-„; "Y_. , �42 a< 4 -,n ., V�' ty. ." _ r� 1 a { tJ F t S?Ys . "t% rot dk `r "'t ' .. ,PAx '`7 zFrtISIIkrstd . q . " .,31k . / t a • i I�` ..i w ,,. zoa t, �' ,. s't <1/41./t.7,1;-..-iv: It: t `?9a t"`T9 ,. +it r ,ti.: o°R04t is 3o sort a ' i.,-:..,,p, r.�•' ,,„ t `'..'z Imo' ® S :: f 7?F•- X4.../. �. , Powe`;by Geo tract. et.1 ... _. _ __ . . ... f . _ SS Cur,eatT!l1i2 .mleByrnnIe a .. ' - ; �:••i7ieS•4.y=Ziti24i43 C .L _.�_ _ -Stil.1 ,-. .rr, 1J ilrl - _ ]Cost•-� alesi P4rceI i- 44.,501114s 9 CITY OF COSTA MESA 6 BUILDING DIVISION H• .. •y', DEVELOPMENT SERVICES DEPARTMENT PER NUMBER + r PERMIT 04-00692 .ye (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 206 LA COSTA CT Status: ISSUED • Suite No Applied: 06/17/2004 Vicinity: Issued: 06/18/2004 Parcel Nunmber: 42620276 Applicant: MERCER, CHAD ISSUED BY: Address: 29736 AVE DE LAS BANDERAS Phone: 949-589-2021 RANCHO SANTA MARGARITA,CA Zip: 92688 Owner: FORSYTHE, MARC C Address 206 LA COSTA CT Phone: COSTA MESA,CA Zip: 92627-2100 Contractor: ALISO AIR INC Address: 29736 AVE DE LAS BANDERAS Phone: 949-589-2021 RANCHO SANTA MARGARITA,CA Zip: 92688 License: 526420 SCOPE OF PERMIT ADDITION OF AN A/C,RE:M04-00329,WORK INCIDENTAL TO MECH PERMIT: • • FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $0.00 0 . .. up to 50 kva/kw $0.00 0 Recept Outlets $0.00 0 up to 100 kva/kw $0.00 0 Switches $0.00 0 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment _ $0.00 0 Res Appl $4.75 1 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 the $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 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(6/00) DIECLARATIONS 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. O 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 caper and policy number are: //'' ( �J��/� Carrier: L \ 11^A&L- LL(C ly \ ffutej Policy Number: (C&J5o I C/3do (This section nate not be completed If th permit is vatted attltohundred dollars($1 )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 gree that if I should become subject to the wor rs'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provision //,,,, Q � "'Tit ' Applicant Signature: LL Date: ' /G / [ / WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed un�1r,provji��s of Chapter 9(commencing with Section 7000)of Division 3 of the Business and p�fsssions Code,and my license is in full 'it force and effect.Lie,A 0Class Contractors Signature: C. Date:Date: 6i/!(�17W 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 subjects the applicant to a civil 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,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.). O I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors license Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Ttle 8,California Administrative Code). ❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes lIn No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required.has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owner(s) • /(Dat9��ye And/Or Authorized Applicant 6� �(/ Dat CODE r INSPECTION TYPE DATE CODE/ INSPECTIONTYPE PdIE =Ma 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing �J 200 Final Re-Roof 210 Final Electrical (e-72,10 201 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 `tier 12&115 WAS - 2ota LA coST-A 1-s NoW — 20 7 LA coST4 LOT ik. co Tr-Mir # 1'285 CJAS- *267 L 4 COSTA Is mat)- 20co LA cos* '',6‘7 t c? City of Costa Mesa TEMPORARY Development Services Department CERTIFICATE OF OCCUPANCY No. Building Safety Division P.O. Box 1200 Costa Mesa,California The Building located at 9(1G rnncfa rnnr"h has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group R-3 Occupancy. Use of Building Sisals Family Residence Legal Description 426-202-08,09 • (See reverse side for Metes and Bounds) Building Permit No_a27f61,R26277 Electrical Permit No. E 27376 _Plumbing Permit No. P 27098 Mechanical Permit No. M 29874,11 28057 Number of apartments and/or guest rooms ISSUED TO: Building Official Bill Howard Newport Harbor Builders, Inc. 1' 891 Production Place by ',_,.r, . ��, - %% • • 891 Production Place Newport Beach. CA 92663 Newport Harbor Builders, Inc. Mr. Geo. Eudmonson City of Costa Mesa P.O. BOX 1200 Costa Mesa, CA. 92626 RE: LA COSTA COURT We respectfully request a temporary occupancy on the above address. We are unable to complete the requirement at this time for the glass fireplace doors. They are being custom made to fit ou arched openings and are due approximately six weeks from now. S_2p. g7 Thank you for your consideration. Sincerely, Wi lia • loughb' Newport Harbor Builders Building Permit #B27060 Factory Fireplace #M-29874 Bldg. Address 206 La Costa Court Construction Management • General Contracting • Development • License#412984 • (714) 645-4913 • THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH THE CURRENT ENERGY REGULATIONS , CALIFORNIA ADMINISTRATIVE CODE , TITLE 25 , STATE OF CALIFORNIA , IN THE BUILDING LOCATED AT : • TRACT/PHASE : LOT NUMBER : . Co 206, G.9 LC,cr,q SITE ADDRESS : stS&! &'ii ��� r (1 q 16E99' umser :et City EXTERIOR WALLS : Manufacturer Ut Al Thickness /Type : 34 R/Value : g"J) ' I CEILINGS : Blown 41111110 ( circle one ) tee 1l Manufacturer : J Al Thickness : le..--1 J R/value : 4-3/11 GENERAL CONTRACTOR : lfwro hrl?W? .&25LICENSE # : BY : J TITLE : DATE : • INSUL TION CONTRACTOR : WESTERN INSULATION LICENSE # : lin??? BY : 14M4rIk TITLE : Sft',e�7`� DATE : 7,409/572 iN • r-,29 / _ LA GQsr?. Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. GIT(OF COSTA MES A _C ONSTRU�CPERMIT PERMIT NO. 'TRACT LOT NO. UNIT NO. Project Address t- r !� C(9, s�TIION TA aale13 'az •o G3 )6? / 5 CY„ Applicant's Mai lin. •ddress t, / f 7-xet, a, /t,•3 TYPE OF CONSTRUCTION EW H ADD H ALTERATION LJ REPAIR ^^• dr /��idf j ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# 9a/ 00 VI Zone tyro91 I. Owner's Name -•�7./•� L:Z+z / i Phone !J Y� � / S` t0v /a' A'.,,, ,p DESCRIPTION 9F WOR USE OF BLDG. /"� (Al Sidi, le — Address / u6970,1 / L fes•„K /Y ep S f� Q K Q� /(J S Main Building: Accessory Building: rL7 E oC 7 Z Arch/Eng. - _ License No. TYPE OF PERMIT ❑ GRADING FOUNDATION STRUCTURAL T Front . • 0 Address �/�- ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear' /� 757 N Contractor's Name SW Phone f0Z i3 ❑ •OTHER .o O Right 5/ N C PROJECT DESCRIPTION 5...4t0. TION rvcY_[-_\' Addresslmailing) ��G/��� �� �✓'J !15 ��y�b K Left / G aosz•y CONSTRUCTION TYPE VALUATION $ i � �dR City License No. -- ZONE GRADING CU.YDS. _ ACRES E LICENSED CONTRACTOR DECLARATION _ Ping. Ref.#• _•i' --/a (��5 Parking Req./Provided aG�(� / / D I hereby affirm 7 that I am licensed under provisions Charter i (commencing Remarks: P� $(��- Sb4 AS2 Planning Notes: with section 7000) of Division 3 of the Business and Professions Code, and s ?e^-' ar,.1.., my license is in full force .•- effect. Ii40 I VLD FOR $: L• Is�.Qtl:e,i.ntLr.1 eeneto7 License Class• - S t Date ��y Signature =~�— • PLUMBING FEES , i / Q) tCr..4C'(..7 rni021.0/60.4e /"GCJ I"U WORKER 'CO PENSATION DEC1• Bar Sink Showers ELECTRICAL (//1 FEES I hereby affirm that I have a certificat- •nsent to self-insure or a certificate • \ of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer • Service Sink 3800, Lab.��C7ys��((7�/- qp••77 .. Automatic Washer . Transformer 0 15-50 KW PolicyNo.(ddL_Q(")f-3192334941 Company �� Backflow Irrigation - .• .� -• ❑ 50'+,KW" / y - 9 Sewer Cap /, Construction Pole Sub. ✓1 ❑ Codified c py is hereby furnishe - ' edified s ith the cit uiltl' io Bathtubs Sewer Connection- " - a Cooking Unit Meter 0 u to 100 amps Date Applicant EXEMPTI N FR M WORKERS'COM ENSA N DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps N (This section need not be completed if th it is for one hundred ($100) or less). Dishwasher Solar Piping: ' Dryers ❑Gas DElectric Sub Panel I certify that in the performance of the work for which this permit is issued, I • shall not employ any person in any manner so as to become subject to the • Drinking Fountains Solar Tank - Fan Motors 00-1 •.1% B - Workers' Compensation Laws of California. — Date Signature Floor Drains Swimmin of w/Spa • - F.A.U. - 29-15 HP 016-15+ 'NOTICE:If,after making this declaration,you should become subject to the _ Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Uri Fixtures comply with such provisions or this permit shall be deemed revoked. Mit • ave • CONSTRUCTION LENDING AGENCY • Gas Service Outlets ater Closet Device Boxes I hereby affirm that there is a construction lending agency for the performance 'ole Light of the work for which his pe it 1�Issug�� cti9/� Civ. C.) interceptors Water Heater Outlets Lender's Name �l O s'.f` �^�✓"� Range Lender's Address ��7 eV CP /1.//3 Kitchen Sink Water Service SwitchesSign, OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash following reason (Section 7031.5 Business and Professional Code: Any city or j Garbage Disposal !Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap LaundryTrays , any structure, prior to its issuance, also requires the applicant for such permit y Generator ❑0- 'W ❑515 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Dr 5 the Contractor's 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 any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars($500). L_I I, as owner of the property or my employees with wages as their sole Reinspection Fee ! $15 Issue Fee $ 3 _._• compensation, will do the work,and the structure is not intended or offered - Reinspection Fee $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES '. - License Law does not apply to an owner of a property who builds or Improves _ _ thereon, and who does such work himself/herself or through his or her own — — - - DEVELOPMENT SERVICES REQUIREMENTS' ,/�, .,1 7, / �� �� employees, provided that such Improvements aro not intended or offered for Boiler Hood or Type I 0 �J /U-13.1('Date sale- If, however, the building or Improvement Is sold within one year of com- — Canopy Type II ❑ Zoning Approved By pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Contra • Approved By Date 7'��7-g! prove for the purpose of sale). - 7 vI�/ 0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By .S.• / "'WI/ Date /-a-7-87 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 0100,000 BTU SUMMARY OF FE builds or improves thereon,and who contracts for such projects with a con- — tractor(s) license pursuant'to the Contractor's License Law). 1 am aware thatExhaust System 0 Multiple 0 Sy Repair/Alteration BUILDING PERMIT $ y73.00 SMIP $ 53;015" proof of their Worker's Compensation insurance should be provided to me. • PLAN CHECK $ 76'S6 PERMIT 0 1 am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# Fire DampersyPLUMBING $ ISSUANCE $ Date Owner Heating System& Ductin Registers -..f. PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above ❑6100,000 BTU 0,000 BTL - "^'ELECTRICAL $ GRADING $ Information is correct. I agree to comply with all city and county ordinances and state la. 'ng to building construction,and hereby authorize repre- `PLAN CHECK 50% $ MICROFILM $ • sentatives pon the above-mentioned property fjppr inspection p. vy��'r�� _ _____/ MECHANICAL $ J -� /'97 Signature ��L`��' _ Date TOTAL FEE $ Drivers' Lic ossa or S • - , einspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ 111=1_ CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod -Assessor '' CONSTRUCTION AND PLANNING PDC_h SPA . APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector ':1. Ternporary;Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement -3. Electrical Conduit Utility-Undrgrnd.. 54. Forms 4'; A Electrical Conduit-Undrgrnd. • 55. Electrical Bonding i-'r eSteel Reinforcement - i 56. Rough Plumbing & Pressure Test . ir -6• Electrical UFER Grnd. I ,I �� ' 57. APPROVAL TO COVER-GUNITE I • ,.� 7. Footings ' ' ..,, '�i ;fft% 58. Electrical Conduit-Undrgrnd. ,\ ,* 8., Foundation , " 59. Gas Pipe, 0 Undrgrnd.,Test 1 y'n 9.,r Water,Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. ' /1. { 10. Structural Floor System 1 �plYlviesj 61. APPROVAL TO DECK ‘ riii 11. Property Sewer Line& House Connection i • 62. Backwash & Receptor-Final ' 12. Sewer Cap - 1 63. Heater & Vent-Final • 13. Roof Drains 64. Plumbing System - Final \0 14. Rough Plumbing; ' -" 65. Electrical-Final 15. Rough Electrical-Conduit - 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17: 'Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# ' 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating t;;- 71. Product Piping 0 Gas 0 Oil • 23. Gas Pipe-Rough &,Test 72. Underground Flush 24: Roof Framing ..:7-' ,'I 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing ( i.gif i 04. 74. Overhead Hydro 26. T-Bar Ceiling (Strugtural) & Monocoat Y 75. Dry Chemical 27. Frame and FlashiAg skill G,1 76. Dry Standpipe 28. Lathing &,Siding ,ts/n &r 77. FIXED SYSTEM FINAL 29. Insulation s%/ at te 78. FIRE PREV. FINAL - 30. Drywall Nailing •- 44IS 6 N HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat .'1 drs/S a.� 79. FINAL INSPECTION 32. Electrical Power Metes-Final /// • 80. FOOD CERTIFICATE ISSUED 33. Final Electric 61 Notes: FIRQ lanae-. FoC ts-t 2/31/97 r✓ 34.-Final Heating & Air Conditioning MOLD FOR SPECIAL REQUIREMENT: J'�' 1 n 35. Final Gas Pipe-Test '1 I8-i SC- ` ,play' 36. Hood or Canopy C1� �"'vy 37. Final Factory Fireplace - 38. Final Plumbing . 39. Water Service-Final' 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation - . 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING E �G vdti 48. Special Requirements Completed I,� /�32 n n' 49. Electric Release to Edison (p/ J . 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY . No. Date , - -A-4nApplitanttO fill in all spaces except those within heavy border lines and sig all appropriate declarations. CITY OF COSTA MESA CO STRUC::: ERMIT PERMIT NO. T A LOT NO. UNIT NO. B a�a 77 233 7053 11 /12/86 — 64.03 It Project•Address ��v /`p Applica- 's Mailing Address f57I /7/2c.> /7y�ch TYPE OF CONSTRUCTION LS NEW ADD U ALTERATION U REPAIR z' ""' ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Owner';1141111, kg+/3R•F Healv,7 /3/925 Phone tiA-4trr / 1 t" T' A.P.# C+4 -. Z0 2 —Oa 6t - Zone i.�-1 , DESCRIPTION OF WORK/USE OF BLDG. //� .,ea-•reed 1-cc Y Address CMI noi7acrie_/ 17/A/O / pG(� (/ S Main Building: Accessory Building:// Arch/Engr'•�l'-,l Lo '( P.a(0..1.5 t tucense No. TYPE OF PERMIT • II• GRADING FOUNDATION C�STRUCTURAL T Front 11414/7 � .¢ ld.�mi (Lot 6) • 0 Address f.G I99 wr.TA riitSo c21.2L ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear t p� s�/`�� //` N H ❑ OTHER 'A NASI PSTrle. f`-a-CQ ft 1 Contractor's Name Nom+-/%�-s'r ''(^Rr3o F2 iii J/7s-PhoneC 4S•4q/, C Right �1�IP //' N Address(mailing/ fit I,rZ-.-Pc T' F.I.4c • PROJECT DESCRIPTION SQ. FT. OCCUPANCY a'�'I K 'r0/ 3 • G at-V.5—GL/ CONSTRUCTION TYPE 1-/pt) VALUATIONS A 2ao'0. $ Left . oT7J./ // City License No. ✓��J ` ZONE GRADING CU.YDS. _ ACRES, ping. Ref.# Parking Req./Provided E LICENSED CONTRACTOR DECLARATION \ O \ I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: •2E D Planning Notes: '�J� _' �L �/�i M N. with section 7000) of Division 3 of the Business and Professions Code, and (✓ ^'�/'}�,s --,` ry'� lir GOlz eh.e�'e, �.rs--/'-' my license is in full fo and effect. 1,/^ 9V/ PC �-f U /Ia� `^ �po� / ' S License Class LI nSe No. C� !- i•f X_ sit/ -�-{��- Datelf-12,-8G Signatur PLUMBING _Ellanill ,/ 'ORKERS'COMPENSATION DECLA ATION Bar Sink Showers A - iereby affirm that I have a certificate of consent to self-insure or a certificate !!! 111 ELECTRICAL • FEE .A Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink 3800, Lab. G - Automatic Washer Transformer -❑ 15-50 KW Policy No. W�g6 3R 23 D�Company�• ''1 }-s I-tn''hf O Backflow Irrigation Sewer Cap -0 50+KW • Construction Pole Sub. ^I ❑ Certified copy is hereby furnished. - - t 1 , [�'Certif ietl copy is filed with the city Buil " 9 Di ' i n! Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 a • Datei•f-l7'C- Applicant - " EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher - Meter (Thissection need not be completed if the permit is for one hundred ($100) or Dover 101 .mps . less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric ' Sub Panel I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Ta Fan Motor 40-1 HP 01%-8 Workers' Compensation Laws of California. - _ Date Signature - Floor Drains Swi ing Pool w/Spa F.A.U.NOTICE:If,after making this declaration, you should become subject to the - - - I .Solar 09-15 HP 11116.15+ , Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Anal ' comply with such provisions or this permit shall be deemed revoked. Fixtures MidrowavC CONSTRUCTION LENDING AGENCY _. Gas Service Outlets Water Closet Device Boxes I hereby affirm that there Is a construction lending agency for the performance Pole Light of the work for ,which this permit is issued (Section 3097 Civ. C.) • - Interceptors Water Heater Outlets Range Lender's Name - _ 9 ' - Lender's Address t Kitchen Sink . •Water Service - OWNER BUILDER DECLARATION . Switches Sign I hereby affirm that.' am exempt from the Contractor's License Law for the Lavatories Auto-Wash ' following reason (Section 7031.5 Business and Professional Code: Any city or _ Garbage Disposal Standing Sections • county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundr Trays any structure, prior'to'tts issuance, also requires the applicant for such permit yGenerator CO-: KW ❑5.15 KW Trash Compactor to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Dr s • 'he Contractor's License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he/she is exempt- r - - ,herefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil • 7enalty of not more than five hundred dollars($500). 3 • I, as owner of the property or my employees with wages as their sole Reinspection FeeI $15 Issue Fee • $ ,Reinspection compensation, will do the work,and the structure is not Intended or offered - / Reinspection Fee ' $15 Issue Fee ' for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL' FEES $ 3 License Law does not apply to an owner of a property who builds or improves / thereon, and who does such•work himself/herself or through his or her own DEVELOPMENT SERVICES RE IREMENTS: // ��Z rs� employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑ -yy sale. If, however, the building or Improvement is sold within one year of com- — Canopy Type II ❑ Zoning Approved By �y� / • Date 1 pletion, the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground Building Approved By �j`�••" Date prove for the purpose of sale). ``// 1' /�j O I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration S • Application Issued By tF'V -- Date if'large tractorsto construct the project (Section 7044,Business and Professions Code: - - The Contractor's License Law does not apply to an owner of property who ' Duct-Ventilating ❑0.100 is. BTU 0100,000 BTU SUMMARY OF FEES builds or Improves thereon,and who contracts for such projects with a con- - /yam tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple❑ •stem Repair/Alteration BUI[DING PERMIT $ -323\-5-10 SMTP • $ • g r-/ proof of their Worker's Compensation insurance should be provided to me. _ PLAN $ —2,..v._0-2 PERMIT O I am exempt under Section B.& P.C.for this reason _ Firepl/Fact.BIt. ICBG# Fire Dampers PLUMBINGN CHECK $ RMITISSUANCE $ - Date Owner Heating System& Du ' g Registers • PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above 00-100,000 BT a 100,000 BTL $ information is correct. I agree to comply with all city and county ordinances ELECTRICAL , $and state laws relating to building construction, and hereby authorize repre- • MICROFILM S ysentatives of this city to enter upon the above-mentioned property for PLAN CHECK 50% $ inspectiansfptpose61 Signet tem` - Date f1-17-SC MECHANICAL $ 7r a3 Reinspection Fee I $15 . Issue Fee - TOTAL FEE $- /� Drivers''License oS 3 ."/"4. /../ PLAN CHECK 25% $ r S CMF 0865-46,rev.10/84 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 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding • 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 4--/a- C Y;pG/L���e 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 APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas 0 Oil 23. Gas Pipe-Rough &Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank OGas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75..Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final - 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: �,'/�d/f!b enct 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 43. Backflow Irrigation 44. Landscape Irrigation System . 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING cgira 48. Special Requirements Completed 49. Electric Release to Edison 50- Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. • Date Applicant to fill In all spaces except those within heavy border tines and sign all appropriate declarations. ICITYOF COSTA MESA CONSTRUCTION PERMIT � Y PERMIT NO. TRACT NO. LOT NO. UNIT NO. 1348 I�29/�3 52e36 TTL, Project Address ..Thj"',...._ 1•4� Cod 14.1 �.- WTI— 2.3-0 tr / Applicant's Mailing Address /hi A. C.4-ty.// Pi TYPE OF CONSTRUCTION L7 NEW U ADD U ALTERATION LJ REPAIR /) / t g7 J ,_ A / . at /J- ❑ CONVERSION ❑ DEMOLISH ❑ OTHERA.P.q}, Zone Owner's Name �-lL —Gln�b6>r /SY ULL9[l_Phone.(a7 DESCRIPTION OF WORK/USE OF BLDG. )t� Address S Main Building: Accessory Building: Arch/Eng. - License No. TYPE OF PERMIT U GRADING�❑ FfdU NDATION 0 STRUCTURAL TE Z Front 0 Address �} //r� �[., 0 TENANT ❑ ELECTRICAL LUMBING 0 MECHANICAL B Rear N Contractor's Na 'f(�- s ' %^ hone-��_�,t ❑ OTHER ./ Q PROJECT DESCRIPTION 5Q. FT. OCCUPANCY C Right N Address(mailing) - ,'7-Vf72.�/ • / CON ST RUCTION TYPE VALUATION$ g Left • R City License No. ZONE GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing Remarks: / R Srlanning Notes: 0 IL with section 7000) of Division 3 of the Business and Professions Code,�yand 27 0Lx3 — rh ^a�bh ` LQ/0 r Ave- .... + M my license is in full f rte app effect. yO6OfZ / S I License ass T .•77{. _-_F License No rs� DateJ/7-9 t7 Signature I}Qy & -Its PLUMBING FEES 4' 'YORK RS'COMPENSATION DECLARATION _ Bar Sink I Showers 2 CC-. - Nhereby affirm that I have a certificate of consent to self-Insure or a certificate ELECTRICAL FEES 1 of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer - Service Sink 3800, Lab. C.b}s /� dd /�/ / // Automatic Washer Transformer 0 15-50 KW Policy No. re- 9i/3 6y Company 1 rvil4 .Y< el 17 Backflow Irrigation Sewer Cap' Construction Pole Sub. • _❑ 50+KW �] �jrtified copy is hereby furnished. // IWCertifle///lll cop isisfiled with the city Beg)/i3y�oa 3 Bathtubs ( Sewer Connection //- Cooking Unit - Meter Cup to 100 amps• Date / f19 /, ) Applicant �, EXEM ON ROM WORKERS'CO PENSATIO DECLARATION Clarifiers Solar Collectors Dishwasher - Meter Dover 100 amps (This section need not be completed if the permit Is for one hundred ($100)or • - less). j Dishwasher _ Solar Piping 1... D Dryers ❑Gas ❑Electric Sub Panel _ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors❑0.1 HP ❑1'4-8 Workers' Compensation Laws.of California. - - ' �_ Date Signature Floor Drains Swimming Pool w/Spa F.A.U. NOTICE:If,after making this declaration, you should become subject to the - Inc.Solar 09-15 HP 016-15+ Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal comply with such provisions or this permit shall be deemed revoked. ( Fixtures . Microwave CONSTRUCTION LENDING AGENCY Gas Service �utlets 3 Water Closet d a Device Boxes Pole Light I hereby affirm that there is a construction lending agency for the performance 9 of the work for which this permit Is issued (Section 3097 Civ- C.) interceptors ( Water Heater O� Lender's Name 2-� Outlets' Range , Lender's Address j Kitchen Sink Water Service Switches OWNER BUILDER DECLARATION Sign I hereby affirm that I am exempt from the Contractor's License Law for the 4 Lavatories ( Auto-Wash p o0 Garbage,Disposal Standing Sections 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. any structure, prior to its issuance, also requires the applicant for such permit Trap Laundry Trays Generator 00-5 KW ❑5.15 KW Trash Compactor 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 Division 3 of the Business and Professions Code) or that he/she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ' LJ I, as owner of the property or my employees with wages as their solo Reinspection Fee I $15 Issue Fee $ 3 compensation, will do the work, and the structure is not intended or offered I - Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License Law does not apply to an owner of a property who builds or improves _a thereon, and who does such work himself/herself or through his or 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 ewill have the burden of proving he/she did not build or im- Duct- Under Ground Building Approved By a!___J___ Date prove for the purpose the pf ope). "`•-� AI�Ji.<•:i ❑ s owner o the the project am exclusively sinesscontracting with of licensedionsode- Duct-Structural ^Refrigeration System Application Issued By Dat: z tractorsTheconstructonBs Contractor's sLicense Law does not apply to an owner je is hla who Duct-Ventilating ❑0.100,000 BTU 0100,000 BTU SUMMARY OF FEES builds or improves thereon, and who contracts for such projects with aeon- tractor(s) license pursuant 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 ' — ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers PLUMBING $ qZ s ISSUANCE S Date Owner Heating System& Ducting Registers / ENERGY P.C. $ PLAN CHECK 25% $ I hereby certify that I have read this application d state that the above ❑0.100,000 BTU 0100,000 BT GRADING S Information is • ect. I .gree to comply with a 4y and county ordinances ELECTRICAL $ and state law T�11 tiny ' building constr i / . d hereby authorize repre- PLAN CHECK 50% $ MICROFILM $ inspection pa s.ci��i ter upon/ e-mentioned property for inspection p !�Jy Signature Date 2f a / MECHANICAL $ TOTAL FEE $ ry' '3 Drivers' License or SS 7f / Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865-46,rev.10/84 Whiter- 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 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. `-3O-y•7 Lrz9 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. /-3&-y7 L,t,) 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection g/,o/Dz Jf'C 62. Backwash & Receptor-Final 12. Sewer Cap //�/ 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 471f/17 ,SPre65. 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 PLASTERuING 18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# _ 21. Ducts, in Structure 70. Underground Hydro - 22- Ducts, Ventilating 71. Product Piping 0 Gas ❑Oil 23. Gas Pipe-Rough & Test • 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank ❑Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing - t 76. Dry Standpipe 28. Lathing& Siding 77. FIXED SYSTEM FINAL t 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric - Notes: 9.4f/F7 j '""I -O4'9f(927` 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace .4 38. Final Plumbing 39. Water Service-Final ' 40. Gas Service-Final t 41. Solar Domestic-Final - 42. Backflow Preventer "" 43. Backflow Irrigation • 44. Landscape Irrigation System ' 45. Sound Attenuation - ' • 46. Handicap Regulations , 47. FINAL STRUCTURE & BUILDING I 48. Special Requirements Completed 49.-Electric Release to Edison ''- ' 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY No. Date . Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRU�(7-TION PERMIT - PERMIT NO. `! TRACT NO. LOT NO. UNIT NO. Project Address 2O�p nGA Cary'27 Cease r" M a� 814- 3925 Si I ?/'17 I.' or T! Applicant's Mailli�i=dress �7/(/-`��Q!/��-/-t/f�JIS•-j /c-� /l/, 8. TYPE OF CONSTRUCTION U NEW LI ADD Li ALTERATION H REPAIR Owner's Name .1/E7.lJ�J2T T/o.ei EXl!_.G] .hone i6.1/S,47/3 ❑ CONVERSION ❑ DEMOLISH El OTHER q P,# I Zone DESCRIPTION OF WORK/USE OF BLDG. Address 6"/ m000c co.✓ ,A:-Z./ Aire • E Main Building: Accessory Building: Z Arch/Eng. License No. TYPE OF PERMIT U GRADING U FOUNDATION ❑ STRUCTURAL T Front O Address - G-' ❑ TENANT E1 ELECTRICAL ID PLUMBING El MECHANICAL B Rear N Contractor's Namere'I aer�'llik*yt &&jPhone ❑ OTHER A_ - 1 PROJECT DESCRIPTION SQ. FT. OCCUPANCY K - Right N Address( glS�j 20SC07 /52,4001.4-720")J p/- K • G CONSTRUCTION TYPE VALUATION$ Left S R City License No. ZONE GRADING CU-YDS-- ACRES LICENSED CONTRACTOR DECLARATION �n/ - Ping. Ref.# • Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: tri /1�Al/.1 Planning Notes: - M with section 7000) of Division 3 of the Business and Professions Code, and l6J ale os my license is in full tpJce and effect. ••• T License .d 5 ,7 �' No. I $ Date Se :y» Signature dirPLUMBING FEES ORKE affi COMP NSATION DE • Bar Sink Showers iereby affirm that I have a certificate of consent to se copy re or a certificate ' ELECTRICAL FEES of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Pfevent¢r Service Sink Li 3800, Lab- 4.y 3823300' 8&jr- Automatic Washer Transformer 0 15-50 KW ..... Policy No. Zf Company / Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+ KW Certified copy is hereby furnished. • JICefjJ fiepp opyy..,,is ed with the city Buaro g to Bathtubs - Sewer Connection - Cooking Unit Meter ❑up to 100 amps C'8 Dater)-1`1'a'/ Applicant ; EXEMPTION FROM WORKERS'COMP - ION DECLARATION Clarifiers Solar Collectors • Dishwasher Meter ❑over 100 amps (This section need not be completed if the permit is for one hundred($100) or - • less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance of the work for which this permit is issued, I ' shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank FanMotors Do-i HP Disc-8 Workers' Compensation Laws of California. - — Date Signature Floor Drains Swimming Pool w/Spa F.A.U. - NOTICE:If,after making this declaration, you should become subject to the Inc.SOlar 09-15 HP 016-15+ Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures comply with such provisions or this permit shall be deemed revoked. • Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes ' Pole Light hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ- C.) Interceptors Water Heater ' Outlets Lender's Name Range Lender's Address- Kitchen Sink Water Service - OWNER BUILDER DECLARATION • Switches Sign I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Gt ❑0-5 KW ❑5-15 KW any structure, prior to its issuance, also requires the applicant for such permit eneraor Trash Compactor 1:(O file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains - - . ',_j%-te Contractor's License Law(Chapter 9(commencing with Section 7000) of ' -';�-,alvision 3'of the Business and Professions Code) or that he/she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ' u I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 compensation, will do the work,and the structure Is not intended or offered MECHANICAL Reinspection Fee $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's FEES License Law does not apply to an owner of a property who builds or improves _ thereon, and who does Such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑ - sale. If, however, the building or improvement is sold within one year of coin- Canopy Type 11 0 Zoning Approved By Date pletlon, the owner will have the burden Of proving he/she did not build or Im- Duct-Under Ground Building Approved By Date E prove for the purpose o1 sale). b J l p/i )— ❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Data / i/ tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct- Ventilating 00-100,000 BTU 17100,000 BTU SUMMARY OF FEES builds or improves thereon,and who contracts for such projects with a con- - _ tractor(s) license pursuant to the Contractor's License Law). I am aware that jF xhaust System 0 Multiple 0 System Repair/Alterationeo BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insurance should be provided to me. Q PLAN CHECK $ PERMIT 0 I am exempt under Section B.& P.C.for this reason e1 Firepl/Fact.BIt. ICBG jy� Fire Dampers 2f PLUMBING $ ISSUANCE $ Date Owner - Heating System& Ducting Registers '1j PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this ..plication and state that the above - 00-100,000 BTU ❑loo,000BT - GRADING $ information is co •ree . •. ..ly with all city and county ordinances ELECTRICAL $ and state lawwaa elat'•q to but •• • pnstructlon,and hereby authorize repre- sentatives oe-this • y t. a upon t•• bov�'-mentioned property for PLAN CHECK 50% $ r - MICROFILM $ inspection purpos:- /Jp^ Q �� MECHANICAL ${ �/ _ Signature oA �.OaseU .TOTAL FEE $ -?+� - Drivers' Lir se or 55 � Reinspection Fee I $15 Issue Fee $ 3 CHECK 25% $ + � 1 3�©O CMF 0865-46,rev. 10/84 WMte - 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 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. •57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace • APPROVALS Permit# - - 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush ('/ 24. Roof Framing 73. Undergrnd.Storage Tank O Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL . 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test . 36: Hood or Canopy • (P 37'. Final Factory Fireplace • 38' Final Plumbing .:( % •r 39Nater Service-Final , - 40. Gas Service-Final ' .. 41. Solar Domestic-Final ' 42. Backflow Preventer J - 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound AttenuationI? '. ., +i 46. Handicap Regulations • J 47. FINAL STRUCTURE & BUILDING r!' I; i 48. Special Requirements Completed 49. Electric Release to Edison 7. V ' 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date • (/��f% Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - PERMIT NO. TRACT NO. LOT NO. UNIT NO. 56133 4/08/8] CITY OF COSTA MESA CONST/R UCTTIIOy,PER IT 33900 TL Project Address - �d dCsx/z Le - M c 8'6(97 �y 7t p (((/// TYPE OF CONSTRUCTION ❑ NEW U ADD ❑ ALTERATION L I REPAIR Applicant's Mailing Address /S �'7 Ann,r�!( hH�/ ! = u�7// /3 CI CONVERSION CI DEMOLISH ❑ OTHER _ A.P.# Zone Owner's Nam 'aY a Phonetic- / DESCRIPTION OF WORK/USE OF BLDG. Address Q ( " ?�'�/iGr f' /- 926.63 S Main Building: ' Accessory Building: Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL T Front 0 Address - ' ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear NI ,,��77 Contractor's Name . e .F%L�/..SL�3.7.+i Phone .� ❑ OTHER A 1 C Address(mailing) 7 3l • ✓LN/rtfc (T/' -A_ 926.43PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Rego G 3 Zl"62Z CONSTRUCTION TYPE VALUATION $ S R r� City License No. 'ZONE GRADING CU.YDS. ACRES t-\s0` LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req,/Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: , Pla nnin Notes: O CO with section 7000) of Division 3 of the Business and Professions Code,and A46.2--7e SIC' 9 M my license is in full force and Wed o'-'" — Z( T License C CLi ense Date Signature PLUMBING I FEES 'ORKERS'COMPENSATION DECLARATION Bar Sink Showers ' • iereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES Workers' Comp nsation Insurance, or a certifies spy thsereot (S-ction Backflow Preventer Service Sink 3800, Lab. C.) Q"� Automatic Washer Transformer ❑ 15-50 KW Policy No. /_ 5- Compo• Ar�_.-44 ' A / Backflow Irrigation Sewer Cap0 50+ KW / Construction Pole Sub. _Certified copy is hereby furnished. "� rertifietl gbpytc�jlgd�yith the city B eivi Bathtubs $ewer Connection Cooking Unit Meter Clop to 100 amps Date 7�0 /f7 Applicant _ //L , ` EXEMPTION FROM WORKERS'COMPENSATION 0 CLARATION Clarifiers -. Solar Collectors _ Dishwasher Meter Dover 100 amps (This section need not be completed if the permit is for one hundred ($100) or ' less). Dishwasher . , Solar Piping - Dryers ❑Gas DElectric Sub Panel I certify that in the performance of the work for which this permit is issued, I - shall not employ any person'in any manner so as to become subject to the Drinking Fountains Solar TankFan Motors 00-1 HP ❑1'/z-a Workers' Compensation Laws of California. Date Signature Floor Drains Swimming Pool w/Spa F.A.U. NOTICE:If,after making this declaration,you should become subject to the _ _ Ino.Solar 09-15 HP 016-15+ Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures comply with such provisions or this permit shall be deemed revoked. Microwave CONSTRUCTION LENDING AGENCY . Gas Service Outlets Water Closet I hereby affirm that there is a construction lending agency for the performanceDevice Boxes • Pole Light of the work for which this permit is issued (Section 3097 Civ. C.) I • nterceptofs Water Heater -• Outlets Lender's Name Range Lender's Address - - - - Kitchen-Sink Water Service - Switches Sign ' OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal Standing$eCLIOPs county which requires a permit to construct,alter,improve,demolish or repair P-Trap LaundryTrays any structure, prior to its issuance, also requires the applicant for such permit Generator 00-5 KW 05-15 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains , • 'he Contractor's License Law (Chapter 9 (commencing with Section 7000) of - -, 'vision 3 of the Business and Professions Code) or that he/she is exempt - -- - - ierefrom and the basis for the alleged exemption'. Any violation of Section ' 1031.5 by any applicant for a permit subjects the applicant to a civil ., penalty of not more than five hundred dollars($500). • ❑ I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee S. 3 . compensation, will do the work, and the structure is not intended or offered • - - Reinspection Fee I $15 Issue Fee $ 3 FEES for sale (Section 7044, Business and professional Code: The Contractor's MECHANICAL License Law does not apply to an owner of a property who builds or improves .thereon, and who does cork himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: • employees, provided thatt such improvements are riot 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 prove for the purpose of sale). • 0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dat 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 r-.{ Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU ' builds or improves thereon, and who contracts for such projects with aeon- ( — � / ' SUMMARY OF FEES tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP - $ proof of'their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT -❑ I am exempt under Section - B. & P.C.for this reason Firepl/Fact.BIt. ICBG# Fire Dampers PLUMBING $ ISSUANCE $ Date Owner ( Heating System& Ducting •egisters VP- PLAN CHECK 25% $ ENERGY P.C. $ - I hereby certify that I have read'this application and state that the above •K0-100,000 BTU 0100,000 BT �[ information is correct. I agree to comply with all City and county ordinances • 7 ELECTRICAL $ GRADING $ and state laws relating to building con Action, and hereby authorize repre- sentatives of this c y to rater 'p the above-mentioned property for • PLAN CHECK 50% $ inspection pure l.( /� /gip) /!I,/ MECHANICAL $ �./Y��i , TOTAL FEE $ '00 Signature t bb s-j` ./1.-0•1-..C.". Date 7 9 `�s Drivers' License or SS# _ • Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ Srfr • CMF 0865-46,rev. 10/84 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 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding • • 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8, Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line Sc 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 *///a.J / FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS 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 Notes: ,c.///y/p .�/ _/ ��.� 7 �7fYLr L -SrJ 34. Final Heating & Air Conditioning 7 4/A1 1r/7�£" // 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace x' • 38. Final Plumbing • .39. Water Service-Final ' 40. Gas Service-Final -41. Solar Domestic-Final ' .42. Backflow Preventer 4 43. Backflow Irrigation• . • ' 44. Landscape Irrigation System ' 45. Sound Attenuation • 46. Handicap Regulations • 47-. FINAL STRUCTURE & BUILDING • ri 48.-Special Requirements Completed 49. Electric Release to Edison • 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY • No. Date /J / / / ,0V `4- �tis� evU .2,7- Applicant to fill in all spaces excep se within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESACONSTRUCTION PERMIT - P MIT NO. ' F♦ M9 LOT NO. UNIT O. / 1 1 t• 2452 2/18/87 58p69 TL Project Address re (__s �= a 73`7( :� �� > ' Applicant's Mailing Address _ e. TYPE OF CONSTRUCTION NEW LIADD H ALTERATION H REPAIR L]❑ CONVERSION ❑ DEMOLISH ElOTHER A.P.# I Zone Owners Namy---gteaf u4l0/.r i • d DESCRIPTION OF WORK/USE OF BLDG. Address //0/. /1- tls-f M... a.yJ�/ • • LI � S Main Building: Accessory Building: s Arch/Eng. License No. TYPE OF PERMIT L I GRADING U FOUNDATION 0 STRUCTURAL T Front O Address • / //JJ�� ❑ TENANT 0 ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N Contractor's Name ^ , '.O , Phone i ❑ OTHER Address(mailing) 77c1/ /k(U• tC. 't& 4,040 PROJECT DESCRIPTION SQ. FT. OCCUPANCY K Right G i b7 ��� l CONSTRUCTION TYPE VALUATION$ ftS City License No. - . ZONE GRADI NG CU.YDS. ACRES R LICENSED CONTRACTOR DECLA ATION �APing. Ref.# Parking Req./Provided E I hereby affirm that I am licensed under pr•. ision of Charter 9 (commencing Remarks: t F x7063 Planning Notes: M with section 7000) of Division 3 of the : in- s nd P fesslons Code, and my license is in full f• e ag• effect. T License ass J.•'` I/� la. 41,• • , S ^ V nature O PLUMBING FEES ' jai,' YORK RS'COMPENSATION DELL-RATIO• Bar Sink ., Showers hereby affirm that I have a certificate of con--nt to self-Insure or a certificateELECTRICAL FEES of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink 3800, Lab. C.) /• Automatic Washer Transformer 0 15.50 KW Policy No. Company Backflow Irrigation Sewer Cap - 0 50+ KW I, OD Construction Pole Sub. Certified copy is hereby furnished.Certified copy Is filed with the city Building Division. Bathtubs Sewer Connection / Cooking Unit / Meter up to 100 amps /Os 'Ml Date Applicant .. - J�� EXEMPTION FROM WORKERS'COMPENSAT •N D ARAT • Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps (This section need not be completed if the perm is for •n¢hun• :100)or l less). Dishwasher Solar Piping / Dryers OGas lectric i Sub Panel 1o, [ D I certify that In the performance of the work or ch th'.•- • It I- issued,I shall not employ an person in any menne• s• .- torn sub Oct to the Drinking Fountains Solar Tank Fan Motors 00-1 HP ❑1'/S-8 Workers' �rpyangt Laws of California.,� _ — Date °l 00''EE(( Signature Floor Drains Swimming Pool w/Spa / F.A.U. NOTI If,a ler m king this declaration l'ou shou • b: 4-he subject to the ( Inc.Solar 09-15 HP 016-15+ .J1 Workers' Compensation provisions of the Labor •ode, you must forthwith Floor Sinks Urinal Fixtures - , /y/ comply with such provisions or this permit _hall •e deemed revoked. / Microwave lfr CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet -/I hereby affirm that there is a construction lending agency for the performance •- �- Device Boxes Pole Light I. of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Lender's Name us Outlets Range (� Lender's Address Kitchen Sink Water Service ��.$witches OWNER BUILDER DECLARATION Sign g, DO I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash / following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal • Standing Sections I. 00 county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays f Generator ❑0-5 KW❑5-15 KW I any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor '• DD 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 3lvision 3 of the Business and Professions Code) or that he/she Is exempt - therefrom and the basis for the alleged exemption. Any violation of Section • 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500). ' LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3 compensation, will do the work, and the structure Is not intended or offered Reinspection Fee I $15 Issue Fee • $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License Law does not apply to an owner of a property who builds or improves ,_ _._ • thereon, and who does such work himself/herself or through his or her own Boiler Hood or Type I ❑ - DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not Intended or offered foryp Zoning Approved By Date sale. If, however, the building or Improvement Is sold within one year of com- Canopy Type II ❑ plebe n, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground Building Approved By ,G1 Date prove for the purpose of sale). • ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By ((�n�'( Dat 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 ❑O-100,000 BTU 0100,000 BTU SUMMARY OF FEES builds or improves thereon,and who contracts for Such projects with a con- , tractor(s) lie se pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUI LDING PERMIT S SMIP $ proof of th- Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT 0 I am exp Worker's Compensation /nr B. & P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers OIL PLUMBING $ ISSUANCE $ Date Ow r/ Heating System& Ducting Registers ENERGY P.C. $. ❑0.100,000 BTU 0100,000BTU PLAN CHECK 25% $ I hereby cer ify t I a e ad this a••licat ton and state that the aboveGRADING $ Information cor t. .• eee o .s•- • with all city and y authorize repre- sentatives ELECTRICAL $ and state law- rel g t• blf onstructi on,and hereby repre- PLAN CHECK 50% $ MICROFILM $ Inspection fives of IS 4� �0 upon the above-mentipne�prp`�qr Inspection Earp p •/ t I y - MECHANICAL $ S8• V f� Signature CODate A` TOTAL FEE $ Drivers' License or SS 9 Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865-46,rev. 10/84 Why e - Building; Canary - Appllliicant; Pink - Accounting; Goldenrod - Assessor • CONSTRUCTION AND PLANNING POOL &SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings • 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O 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 l 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 Flush 24. Roof Framing 73. Undergrnd.Storage Tank O Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe - 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ,/ ^ 79. FINAL INSPECTION 32. Electrical Power Meter-Final f((DD�' 77\ / 80. FOOD CERTIFICATE ISSUEb 33. Final Electric rNotes: i 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 , 43. Backflow Irrigation . -44. Landscape Irrigation System . 45. Sound Attenuation . • 46. Handicap Regulations • 47. FINAL STRUCTURE & BUILDING � • 48.-Special Requirements Completed 49. Electric Release to Edison - ' 50. Gas Release to Southern California Gas Co . - ' 51. CERTIFICATE OF OCCUPANCY • No. Date J(1)-1n° oq CITY OF COSTA MESA 32. Electrical Power Meter-Final j ' ` BUILDING SAFETY DIV'-'7N ectric 7:-23-i7 JC POST IN CONSPICUOtio PLACE :- .., - yogi 4 IrciliI �nditio ing 19/ 721 • ON THE JOB 35. Final !!sa-Test t7 ith 7 bNOTICE 36. HooPA no•y / You must furnish PERMIT NUMBER and the JOB ADDRE S ., - • •' ..' FOR EACH RESPECTIVE INSPECTION. CALL 754.562'. i Fa. .. -p e APPROVED PLANS SHALL BE.ON JOB AT ALL TIME . kJ / 3:: • u ��711/c A. P. NO. DATE ISSUED 39. Wate - . '• Q26 - aoa - o r 09 1 - 27- r or TYPE �� GROUP PERMIT NO. / 40. Gas Service-Final -UA/ "UP`3 Bc17069 41. Solar Domestic-Final BUILOI G ADDRESS ` , C. ,4-�C{ CO-St (7,urrt- 42. Backflow Preventer . TRACT tt LOT BLOCK / a g/ 5 43. Backflow Irrigation NEW // ADD ALTER REPAIR MOVING DEMOLISH 44. Landscape Irrigation System .V/J 45. Sound Attenuation OWNER r LI"Cr r '� 46. FINALap•Regulations • USE ��7///I!/y'e�w�c /,� Qr ar ls' • 47. STRUCTURE & BUILDING .�/ /VQw J tc \ - 48. Special Requirements Completed /Zo/$L MM POOL&SPA /Z1 SL APPROVALS Permit# Front Yd. Side Yd. L R Rear 49. Pool & Equipment Location Side Yd. L R Rear 50. Steel Reinforcement CONSTRUCTION AND PLANNING 51.- Forms Date Inspector APPROVALS Permit# 52. Electrical Bonding 1. Temporary Electrical Service or Pole 53. Rough-Plumbing& Pressure Test 2. Soil Pipe-Undrgrnd. \lir .�r 54. APPROVAL TO COVER-GUNITE 3. Electrical Conduit Utility-Undrgrnd. 55. Electrical Conduit-Undrgrnd. 4. Electrical Conduit-Undrgrnd. 56. Gas Pipe, 0 Undrgrnd.,Test 5. Steel Reinforcement 57. Backwash Lines, P-Trap, 0 Undrgrnd. 6. Electrical UFER Grnd. 2/3!?? i, i12 58. APPROVAL TO DECK 7. Footings C .e• 3 /.,j) 59. Backwash & Receptor-Final 8. Foundation 60. Heater& Vent-Final • 9. Water Pipe-Undrgrnd. ./ cee) /-[L' 61. Plumbing System • Final 10. Structural Floor System 3adrift 62. Electrical-Final 11. Property Sewer Line&House Connection 94,yr; ,947( 63. Solar System-Final 12. Sewer Cap 11 64. Fencing&Access Approval - 13. Roof Drains 65. APPROVED FOR PLASTERING 14. Rough Plumbing 66. POOL/SPA SYSTEMS FINAL 15. Rough Electrical-Conduit FIRE DEPT. REQUIREMENT 16. Rough Electric Wiring 4.0 c/1 (II APPROVALS Permit# 17. Rough Wiring Sign ua'D67. Underground Hydro 18. Rough Electrical-T Bar Ceiling 68. Product Piping OGas OOil 19. Rough Heating& Air Conditioning 69. Underground Flush 20. Rough Factory Fireplace 70. Undergrnd. Storage Tank OGas OOil 21. Ducts, in Structure 71. Overhead Hydro • 22. Ducts, Ventilating 72. Dry Chemical 23. Gas Pipe-Rough &Test 73. Dry Standpipe 24. Roof Framing 74. FIXED SYSTEM FINAL 25. Roof Sheathing 14k Ir * 75. FIRE PREV. FINAL , 26. T-Bar Ceiling (Structural)& Monocoat Notes:7117IF7 FI Rt.pLat',G f&G/ 27. Frame and Flashing Shin Gitj 28. Lathing& Siding 0113 - CeV 29. Insulation • I7 ; 6,// 30. Drywall Nailing 5113197 Cr-' 31. Plaster Brown Coat .413197 G.) (see reverse for additional notes) CMF 0559-46,rev.12/82 /