HomeMy WebLinkAbout207 LA COSTA CT - Building Permits ` _✓
` r -__ 6•- Applicant to fill in all spaces except those within heavy border tines and sign all appropriate declarations.
CII Y OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT N LOT O. UNIT NO. •
• -
Pfbject Address-'-`t LA GcCT,6 Cot/CD B (T` 06 0 l
I - - ! 1198 l I/27/B7 5F7..91
Applicant's Mailing Address d c.0 )�W7ix7 c p,a,„,
TYPE OF CONSTRUCTION NEW U ADD U ALTERATION LI REPAIR - Ti
Owners Name thei-az nee Phon •❑ CONVERSION ❑ DEMOLISH ❑ OTCVR _ (0 9^ ,O
rf /!�' ���o� 1" W S�A.I p. A.P.'NatY AL/a- oU �o� Zone Rt _
y� �y DESCRIPTION OF Wit/ F BLDG.
• Address 67 ' �S/A��Q0 p2+• OO1/�t 44. D�/l- '.AM ,L"( -{" I •� N C �/ S Main Building: Accessory Building: ,
i Arch/Eng.' }••Co/6.• � License No itO +7S TYPE OF PERMIT ❑ GRADING �' FOUNDATION 141 STRUCTURAL T Front 1 • O
Address 17 t2,11.1ZeELana J VUJE ❑ TENANT ❑ ELECTRICAL N PLUMBING ❑ MECHANICAL B Rear 111�11 N
�/� ❑ OTHER- A
Contractor's Name /� Phone l-2n �f _ C Right 5 f - -<7N
•
PROJECT DESCRIPTION sq. FT OCcu Pg1NC �.�n
Address(mailing) CONSTRUCTION TYPE�� VALUATION $11. I e.4yr s Left 1I 1 •
R
City License No. ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION - q ��.�• p - Ping. Ref.# --1-- 12815 Parking-Req./Provided 2('(,LL E
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: ��• W4/19^}t s�.� 05� • Planning NptestlOLD FOR SPECIAL, 7t(ZU1ketMblV1 ./ys n qMs _ M
with section 7000) of Division 3 of the Business and Professions Code, and `f vv�� ,, f-� �-�; ,, {r ,s.�' .-' "f�u^"01`�
my license is in full force and effect. c - r1 Vi,CL cTtF t .-1 U �""'" - (/ S
License Class License No. r �i f� ' _ r�' , /,,q
Date Signature PLUMBING FEES L-,C,L,�LQ.� a.atilt
(,Cj/ °/�.n�
WORKERS' COMPENSATION DECLARATION J c
I hereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers - ELECTRICALS 'FEES
of Workers' Compensation Insurance, orlb certified copy thereof (Section • .
3800, Lab. C.) • Backflow Preventer • Service Sink Automatic Washer Transformer 0 15-50 KW
Policy No. Company Backflow Irrigation Sewer Cap0 50+ KW ' '
8 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
Date - Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers • Solar Collectors Dishwasher Meter Cover 100 a ••s - - r
(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 m. ner so ,s to become subject to the Drinking Fountains Solar Ta•' Fan .
Workers' o s ro aws of Califor=. - Motors •:-1 HP ❑1'A-R
Date S'•• Floor Drains Swi• ing Pool w/Spa F.A.U. -
NOTIC If,of et-caking thi • _ on, y•-• •• -ecome subject to the Inc. • ar ❑g-15 HP ❑16-15+
Workers' Compensation provisions of • .4,0r ou must forthwith Floor Sinks rinal Fixtures
comply with such provisions or this permi shall deemed revoked. _ icrowave
•
CONSTRUCTION'LENDING AGENCY Gas Service Outlets Water Closet '
I hereby affirm that there is a construction lending agency for the performance Device Boxes Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) •
Interceptors Water Heater Outlets •
i 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 ' Garbage Disposal '
following reason'(Section 7031.5 Business and Professional Code: Any city or 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 ❑5-15 KW Trash Compactor ,
to tile a signed statement that he/she Is licensed pursuant to the provisions of Roof • .ins - '
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). '
LI I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee. $ 3
compensation, will do the work, and the structure is not intended or offered - Reinspection Fee .! $15 Issue Fee $ 3
I 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 . • TypeDEVELOPMENT SERVICES REQUIREMENT •
Boiler Hood or a /i ter_
employees, provided that such improvements are not intended or offered for I 0 •
'lo=1J-/ /
• sale. If, however,-the building or improvement is sold within-one year of com- — Canopy Type II 0 Zoning Approved By Date/ 2
•
pletion, the owner will-have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By \� SZ Date
srr for the purpose of sale).
�,f9Yl,�as owner of the property, am'exclusively contracting with licensed con- Duct-Structural Refrigeration Syste Application Issued By ..c,............._.47 ' /.a..• .c_ Date /-- 7_. J
ctors 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 00100,000 : a 0100,000 BTU • - 1 SUMMARY OF FEE. , .
builds or improves thereon, and who contracts for such projects with a con- . _
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 Syst- •epair/Alteration BUILDING PERMIT $ 4/73.cp�• SMIP $ Q.Q`-
roo f of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ 7�• Ob PERMIT
}d am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBO'�h Fire Dampers PLUMBING $ •
- ISSUANCE _ $
Date • A -'m` Heating System& Ducting Registers : ENERGY P.C. $
PLAN CHECK 25% $
I hereb certify that I ha>�'w1_•Ilcatlon . d state that the above Co-100,000 BTU ❑1 , 00 BTL - GRADING $ -
•
information is correct. I agree to compl • all cit .ntl county ordinances - • ELECTRICAL $ •
and state laws relatin• to building constructlo , . - --reby authorize repre- • $ IMICROFI LM $ - ' -
sentatives of his' cit to enter upon the above-mentioned property for PLAN CHECK 50% /--��7 b
.inspection purr.ses� VI'
MECHANICAL $ TOTAL FEE . $ 7 J /r 7/
inspection �� • • Date /T •
Driver •—�' • Reinspection Fee •I . $15 Issue Fee $ 3 PLAN CHECK 25% $ - • ,
a -
:\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 UF ER Grnd. �j_p„i g7 6,-.4 57. APPROVAL TO COVER-GUNITE
7. Footings r;1413./81 Li ,"I 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 INV (,/J 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 1
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 t0
25. Roof Sheathing i( /g7 74. Overhead Hydro _
11 '
26. T-Bar Ceiling (Structural) & Monocoat l 75. Dry Chemical j
27. Frame and flashing s�/87 G/r/ 76. Dry Standpipe e �r�
c-.
28. Lathing & Siding 5 i3'21 (r/" 77. FIXED SYSTEM FINAL ,t, .-
29. Insulation S //7 GA/ 78. FIRE PREV. FINAL •'
•
30. Drywall Nailing Sir 3/71 Cr' HEALTH DEPT. REQUIREMENT
•
31. Plaster Brown Coat 6/s/pr G./1. 79. FINAL INSPECTION .
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes5$ FOR SPECIAL REQUIREMENTS.'
34. Final Heating & Air Conditioning - ..:.
F' :,7�[we e. F!. 212714'7 G N
35. Final Gas Pipe-Test X h /7 �,(1 FR 7 e/e7 6C V .
36. Hood or Canopy ci J�-��J-� ( r I
: ..M ,I•
37-.. Final Factory Fireplace *
-Final Plumbing - (
3f .
39.;Water Service-Final - t' . ..
40. Gas Service-Final
41. Solar Domestic-Final
-42. Backflow Preventer - (; "',
•43. Backflow Irrigation , it
_. .i 4:1
-44. Landscape Irrigation System
45. Sound Attenuation l • ' -t. - . 11`
46. Handicap Regulations , •j;,
, 47. FINAL STRUCTURE & BUILDING r q /dfes
.
48; Special-'Requirements Completed /ei al4 ,~ L
0
49. Electric Release to Edison ✓�
50. Gas Release to Southern California Gas Co -
51. CERTIFICATE OF OCCUPANCY
i
No. ''Date ,
v-
City of Costa Mesa TEMPORARY Expires 10/5/37
Development Services Department n
Building Safety Division CERTIFICATE OF OCCUPANCY No. 0 t!_!„ l F'
2
P.O. Box 1200
Costa Mesa,California
•
\ . The Building located at 207 La Costa Court
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 Sin4lo Family Residence
Legal Description 62G-202-08,09
(See reverse side for Metes and Bounds)
Building Permit No B27097 Electrical Permit No. E27878 Plumbing Permit No. 727097
Mechanical Permit No. M28010, 1.930039 Number of apartments and/or guest rooms
ISSUED TO: Building Official William s. Howard
L . Lava
iU33 Laurie Lanc by •- -
Cotai 3. CA Date Septe-rb r 3, 1987
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C.
CMF 1015-46 rev.1/83 White-Owner;Cane---Numerical File;Pink -Bldg. Permit File
1 . r
•
1195 1/27/87 6182.48 it
CITY OF COSTA MESA •
PARK FEES
• a� Fee Payment Receipt
(y 001069
•
Project Address Q.O -O3 eQO5 a07 Jo_ (motet (-mkt
A.P. Number ' /toa
A7 a0a On (J/
Building Permit Number ,StP 7060^Aa 706 Co
Owner's Name ')/1//1 O-
Mailing Address
9. .
Mailing 91 Iwow taay, PP, Al 8
FEE: Single Family * Number of Units
2-Bedrooms or Less @ $ 861.76 =
3-Bedrooms @ 1,205.67 = ,!A
4-Bedrooms 7 @ 1,545.62 = /Rd.48
5-Bedrooms+ @ 1,810.50 =
Multiple Family
•Bachelor or Studio @ 474.37 =
1-Bedroom @ 573.18 =
2-Bedroom @ 881.51 = •
3-Bedrooms+ @ 1,229.38 = ,p -1 ,Q
9 14,.,, , I I .,, .- Total OFeoe n*=* C� /V a .'9
Planning Department App val D / -a-7"87 By �J-P� Lo /3` b.12/ -J
Applicant's Signatu
* City Ordinance 72-44 ** City nce 2-45 *** City Resolution 78-116 I�7 tI`gl�1�Iru�ll�
CMF 017430,rev.7/85 Wnite—Planning;Canary—Planning;Pink—Finance;Goldenrod—Applicant WUt�JJS,U-��
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE.
WITH THE CURRENT ENERGY REGULATIONS , CALIFORNIA ADMINISTRATIVE CODE ,
TITLE 25 , STATEOFCALIFORNIA , IN THE BUILDING LOCATED AT :
TRACT/PHASE : 12815 LOT NUMBER :
Zo7 LAGosrA .ir •
SITE ADDRESS : eO(p�p U � f Cam ME,,519
umber St et City
EXTERIOR WALLS :
`\ �n 11 1
Manufacturer U /v ' Thickness/Type : 3 7e R/Value : g'"J)
CEILINGS : Blown ( circle one ) e- 3J o - 1 � 9
�
e-aa 7yyli
1�
Manufacturer : 141 Thickness : g-19 R/Value : 67-7/1).
GENERAL CONTRACTOR : hf(ilno r /VW? a:LICENSE # :
BY : /I TITLE : DATE :
•
INSUL TION CONTRACTOR : WESTERN INSULATION LICENSE # : rni97 d
BY : TITLE : j-(71, f9 DATE : z0/77
•
ilk
r
x.20 7 c�G Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
` CITY OF COSTA _MESAA CONSTRUCTION PERM4T — PERMIT j O. q_ TRACT NO. LOT NO. UNIT NO.
Project Address ' r G I fit sC, a ST Pt l •c v c r L- G. (J
Applicant's Mailing Address [', h IY12—CS l L7 n TYPE OF CONSTRUCTION U NEW U ADD U ALTERATION U REPAIR t
❑ CONVERSION El DEMOLISH 0 OTHER A.P.,lls Zone
Owner's Name Phone DESCRIPTION OF WORK/USE OF BLDG.
Address • S Main Building: 1 Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT UGRA01NG LI FOUNDATION ❑ STRUCTURAL E Front r AN -1Ir' 0
Address , 0 TENANT ❑ ELECTRICAL ❑ PLUMBING El MECHANICAL BB Rear r• rr" N
Contractor's Name AA . t-1 I\V ' LC-ae Phone T3 r66 El OTHER C qi ht N
son 33 y PROJECT DESCRIPTION SQ. FT. OCCUPANCY g MAR 2 C 14r'
Address(mailing) Pa aoK G
CONSTRUCTION TYPE VALUATION$ Left R
City License No. 2' 6Z i S '�
ZONE GRADING CU.YDS. ACRES ping. Ref.# LI:'`....---------
LICENSED
�--� Flatting Req.IProvided E
LICENSED CONTRACTOR DECLARATION - s. '( Q
I hereby affirm that I am licensed under provision%of Charter 9 (commencing Remarks: t3 .2_7030 Planning Notes: CITY Ut COSTA M
with section 7000) of Division 3 of the Business and Professions Code, and T
my license is in full force and effect. _
Ucen a Class - Kan • $
Date 2-2 6-37 Signature sa C PLUMBING FEES /
WORKERS' COMPENSATION DECLARATION •ar Sink Showers '7'
I hereby affirm that I have a certificate of consent to salt-Insure or a certificate ELECTRICAL FEES
of Workers' Compensation Insurance, or a certified copy thereof (Section Back PreventefService Sink
3800, Lab. C.) - I Automatic Washer Transformer 0 15-50 KW
Policy No. Company Backflow Ir '•.tion Sewer Cap - Construction Pole Sub. 0 50+ KW ' I oCj
8 Certified copy is hereby furnished. . `
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter ❑Up to 100 amps ,------
Date
/Date Applicant ..
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors ' Dishwasher i Meter Dover 100 amps It S 6. no
•
(This section need not be Completed if the permit is for one hundred ($100) or
less). Dishwasher Solar Piping i Dryers ❑Gas ❑Electric i Sub Panel ' 6 QL
I certify that in the performance of the work for which this permit is i ued, I
shall not employ any person in any rniFer y/as to bac subje to the Drinking Fountains Spier Tank •t Fan Motors❑0.1 HP 011.4-8 2(jC
Workers' Compensation Laws of Califor / lig �(�
Date j -1-6 Signature //^!/ �'r, Floor Drains Swimmin• "••1 w/Spa
NOTICE: If,after making this declaration,you should become subject to the I F.A.U. - `— Ino$Olar ❑9.15 HP 016-15+ / Gl L
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks • in. I�•, Fixtur¢s �O
comply with such provisions or this permit shall be deemed revoked. 'Y1 Microwave '3
CONSTRUCTION LENDING AGENCY Gas Service Outlets 'ate loset Device Boxes Pole Light
I hereby affirm that there is a construction lending agency for the performance _
of the work for which this permit is issue(' (Section 3097 Civ. C.) Interceptors Water Hea 'i Outlets Range t Jo 2.0
Lender's Name •
Lender's Address Kitchen Sink ' Water Service 3 -T Switches Sign ,7 -{
/r C-
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash ..11111111111111111 --a-
'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-Trap Laundry Trays Generator 00-5 KW 05-15 KW Trash Compactor
any structure, prior to Its issuance, also requires te applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drain
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 -3
7031.5 by any applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars($500).
I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 '
•
compensation, will do the work, and the structure is not intended or offered _ - ‘ Reinspection Fee $15 Issue Fee S 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL PEES
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 Hood or Type I ❑ 'DEVELOPMENT SERVICES REQUIREMENTS:
r
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 ono year of corn- Canopy Type II ❑
['lotion, the owner will have the burden of proving he/she did not build or Im- Duct-Un Ground _Building Approved By ri �sr s/ Date (•t/�O�
prove for the purpose of sale). '� r(f./ti•rK\ `2 O
0 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date
tractors to construct the project (Section 7044,Bysiness and Professions Code:
The Contractor's License Law does not apply tO an owner of property whoDuct-Ventilating 00-100,000 B 100,000 BTU • -- SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con-
tractors) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple Syste epair/Alteration -'" - BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation Insurance should be provided to me. PLAN CHECK $ PERMIT
0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.BIt. ICBO# • Dampers ISSUANCE S
• PLUMBING $ _
Date 9 Owner Heating System& Ducting Register 4 ENERGY P.C. $ _ -
'3 ' la • PLAN CHECK 25% $
I hereby certify that I have read this application and state th t the above 00-100,000 BTU ❑ ,BBD BT • f ,,rf
information is correct. I agree to comply with all city and county ordinances ..!' ELECTRICAL $ • 4� GRADING $
and state laws relating to building construction, and hereby authorize repro- '-- I. a , 2 O
Signature
of this c' en[erigpon th above-mentioned property for et
PLAN CHECK 50% $ [ MICROFILM $
inspection purposes ((�����••
Signature / Dasa3'Z-6—21'7 I I MECHANICAL $ TOTAL FEE $ 6 a s �Ct
1S111 �'
CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
I
CONSTRUCTION AND PLANNING PULL& 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
1 3. Electrical Conduit Utility-Undrgrnd. • l 54. Forms
•
4.4Electrical Conduit`-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical OF ER Grnd. 57. APPROVAL TO COVER-GUNITE - -
7. Footings 58. Electrical Conduit-Undrgrnd. es
i
8. undation 59. Gas Pipe, 0 Undrgrnd., Test
Fo
9. Water Pipe-Undrgrnd. • 60. Backwash Lines, P-Trap, 0 Undrgrnd. ' -1
• 10.•Structural Floor System 61. APPROVAL TO DECK . N
11. Property Sewer Line & House Corinection . ,,,/, 62. Backwash & Receptor-Final
/.
12. Sewer Cap -. j 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 #_�� cc 74 67. Fencing & Access Approval
-17. Rough Wiring Sign 7 �fD�� 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 - 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 74x$7 J G Notes: (��.
34. Final Heating & Air Conditioning .. - _ -, - ,;` lx.v1 �1� LY 1('dl
35. Final Gas Pipe-Test -
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing .
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final ,._-j.
42. Backflow.Preventer - . .
43. Backflow'Irrigation t
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed •
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY • . - -
No. Date
2 /a `�j ant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA'I 0 , T.L . - 11 riERMIT MIT O. - TRACT NO. LOT NO. UNIT NO. 3,p(1 :TL
. • 4I ' . - g�/0 5323 4/03%87
. . Project Address ' Iy-� ,
Applicant's Mailing Address 2121 S. GRAND AVE. TYPE OF CONSTRUCTION Xln NEW ❑ ADD U ALTERATION U REPAIR
I Owner's Name. TOM LOVE Phone 642-2901 . ❑ CONVERSION ❑ DEMOLISH ❑ OTHER - A_P.# Zone
DESCRIPTION OF,. IRK/USE OF BLDG.
Address - 2033 LAURIE LANE, COSTA MESA '^ ( S Main Building: `- Accessory Building: _
E' Z
Arch/Eng. License No. TYPE OF PERMIT Address •
GRADING FOUrvD AT1 OZf.I%_ CI STRUCTURAL T Front - •- , - O
• El TENANT El ELECTRICAL ❑ PLUMBING ICSMECHANICAL B - - N
-
SIERRA ENVIRONMENTAL 9578991 CIOTHER-
A Rear
. Contractor's Name Phone - . _ - - C Right N
• PROJECT DESCRIPTION SQ. FT. OCCUPANCY "' • G
Address(mailing) 2121 9S.1 GRAND AVE. , SANTA ANA K Left ..
024912 ' CONSTRUCTION TYPE VALUATION$ $ I R
City License No. - ZONE - GRADING CU.YDS. ACRES I E
• LICENSED CONTRACTOR DECLARA ION - - Ping. Ref.# Pafking Req./Provided }
•
I hereby affirm that I am licensed unde provisions of Charter 9 (commencing Remarks: B2706O � Planning Notes: - M
`with section •
7000)"of Division.3 oft Business and Professions Code, and -
• my license is in full forgq�nd effect. 4 •
•
• S
License Class „prated
L \c,,,,,./a119 _ N
A Date '3/30/87 Signature Jry1� {Ip/yy�y�' PLUMBING FEES I% I C, - '
�, WORKERS' COMPENSATION DECL RATION `J • Bar Sink Showers i I ' ELECTRICAL I - FEES
I hereby affirm that I have a certificat of consent to sensure ora certificate I
` of Workers' Compensation_Insurance or a certified py thereof_(Sectlon - Backflow Preventer !- - Service Sink•• - .- - -
3800,Lab.IC.) I '� ' Automatic Washer Transformer 0 15-50;KW
N01071230WC _ I , FARMERS - I 50+ KW
Policy No. • C •pan Backflow Irrigation • Sewer Cap ! j Construction Pole.Sub.
Certified copy is herebyifurnished- •
r�
$ Cert ifie�l pq qy i$,Med with the city 'di ii y� Lir. f I Bathtubs $ewers Connection . ' Cooking Unit • Meter ❑up to 190 amp
` Date .S/JU/9 Applicant �AA..A a a i:.I •
EXEMPTION FROM WORKERS'CO PENSATION D s LA' -TION Clarifiers Solar Collectors "y^ Dishwasher Meter Clover 101 %mos i
• (This section need not be completed if the permit is for o.e hundred ($100)or - - -
less) ; • I Dishwasher I Solar Piping rte/) Dryers ❑Gas ❑Electric Sub Panel 1
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' .'7, Fan Mo : s❑0-1 HP ❑1 v-8 I •
Workers' Compensation Laws of California.
-
Date Signature •
Floor Drains ! Swimmin• 'ool in/Spa 'el F.A.U. . ' I ne.Solar 09-15 HP 016-15+ I
i 'NOTICE: If,after making this declaration, you-,should become subject to the - - ; —
Workers' Compensation provisions of the Labor.Code, you must'forthwith . Floor Sinks . i - '- . . Uri•. - I - --f Fixtures - -- r - - - - - - -
comply with such provisions .or this permit shall be deemed revoked.. I MICIOWdVe ,
CONSTRUCTION LENDING' AGENCY Gas Service - Outlets ater Closet, I
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 , , Outlets Range )
Lender's Name ' ' _
' 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 T Lavatories• _ 1 Auto-Wash • -
following reason (Section 7031.5.Business and.Professional Code: Any city:or s Garbage %lsposal !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 ❑0-5 KW❑5-15 KW Trash Compactor.
' .to file a signed statement that he/she is licensed pursuant to the provisions of .- Roof Dr.'- - I
'the Contractor's License Law (Chapter 9(commencing with Section 7000)of - - - - i I '
- Division'3 of the Business and Professions Code) or-that he/she is-exempt . - , - , I . , _-
therefrom and the basis for the allegedexemption. Any violation or Section . . • _ I . • • '
'7031.5 by any applicant for 'a permit subjects the applicant to.a, civil - ' 1
penalty of not more than five hundred dollars($500). - • ' ' •- - , • I
❑ I, as'owner of the property or'my employees with wages as their sole Reinspection.Fee i $15 Issue Fee - $ 3
compensation, will do the work, and the structure is not intended or offered '" YYY Reinspection Fee' + I $15 Issue Fee • $�3
for sale (Section 7044, Business and Professional Code: The Contractor's ' MECHANICAL I • ' ' FEES I - -
, 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) 0
sale, If, however, the building or improvement is sold within one year of com- , Canopy Type II 0 I 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 licensee con- Duct-Structural ' •Refrigeration System ' • , Application Issued Byte Date 31$7
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 '2 Duct-Ventilating I ❑0-100,000 BTU ❑100,000 BTU i n/^ • SUMMARY OF FEE
builds or improves thereon, and who contracts for such,projects with a con- - l/U •
tractor(s) license pursuant to the Contractor's License Law). I am aware thatExhaust System 0 ,Multiple 0 System Repair/Alteration I BUILDING PERMIT $ SMIP $'
proof sof their Worker's Compensation insurance should be provided to me. P LAN CHECK $ • PERMIT,
, 0.1 am exempt under Section - B. &P. C.for this reason Firepl/Fact.Bit. ICBG# Fire Dampers , I PLUMBING $ ISSUANCE $'
Date owner ' 1 Heating System&Ducting Registers •• I PLAN CHECK 25% $ ENERGY P.C. $
• I hereby certify th. I have read this appli ation and state that the above ' 1A0-100,000 BTU 0100,000 BTL - - -- - GRADING $
information is corre t. I agree - co ply i • all city and county ordinances PO ELECTRICAL $ I
• and state laws r ia' ng t. bu' 'i d c'nstr il li,n and hereby authorize repre- I - ' PLAN CHECK• 50% $ MICROFILM! $'.
sentatives of th ity I. n e • in to- bo --mentioned��, ggqro artyV--///kttt or '
inspection purpos I A� -� \� MECHANICAL $ i��� TOTAL FEE $ /3 . 0b
Signature ♦a ' • 0771Le1 l ,Reinspection Fee $15 Issue Fee $ 3 , PLAN CHECK 25% 5' 2-d0
I Drivers' License o• 5'T� -
CMF 0865-46,rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor
h
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 0 Gas 0 Oil
25. Roof Sheathing - 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical - -
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat - 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
-71227-121--t
J/Zf' �7 t
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 r
51. CERTIFICATE OF OCCUPANCY
No. Date
...r. (JZOApplicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
I CIT.I/'OF.COSTA
rMESA
/ CONSTRU TIO/NPERMIT — PERMIT NO. TRACT NO. LOT NO. UNIT NO. �I�4•. I /CJ72i 5247 IL
Project Address-3 t— 44 coifs ce.„-e' /' 2.7.01'2--
��II�� .,�/ I
Applicant's Mailing Addre s _/ V / let rl,l P/ / Q,s TYPE OF CONSTRUCTION LYNEW ❑,ADD H ALTERATION H REPAIR , I347 1/29/87 52.36 TL
Owner's Namee�C•u(/ per err( ,1u Phone 7s�0 7r/1y El CONVERSION ❑ DEMOLISH ❑ OTFf,E p A.P.# . Zone
Address / �' 4 war DESCRIPTION OF WORK/USE OF BLDG. U' /\
Gofer ! S Main Building: Accessory Building:
E Z
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING FOUNDATION ❑ STRUCTURAL T Front O
Address - /� ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B Rear •
N
Contractor's Name P.1, d 4C/ry}j ePhone6_._'lJ.7 ❑ OTHER
` Address(mailing) JeV Anne/
C Ri hU - N
,/l PA PROJECT DESCRIPTION SQ. FT. OCCUPANCY K g G
1.\fl
�y�7Z CONSTRUCTION.TYPE VALUATION $ S Left R
City License No. ZONE GRADING CU.YDS. ACRES Ref.# Parking Req./Provided •— E
LICENSED CONTRACTOR DECLARATION ///ttt
IIJC hereby affirm that am licensed under provisions of Charter 9 (commencing Remarks: /,[ "1'�n�1's 1'�. A / _ �/ / 4•10�� N t Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code, and u eG IV C/ /�0T (/y 6 b < if r}�
my license is In f for nd effect. Op Ov Y S
�s License CI ss � - License N •
�I Date /1gJt� Signature .....- PLUMBING FEES
•
WORKERS'COMPENSATION DE LARAT N Bar Sink 1 Showers 2 '°L I
I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES
, of Workers' Compensation Insurance, or a certified copy thereof ection Backflow Preventer Service Sink
Automatic Washer Transformer 0 15-50 KW
3800, Lab. 7 / / ^
. A Policy No. ! 9?�✓ Q� Company t e •t r 1r Backflow Irrigation - S• ewer Cap Construction Pole Sub. 0• 50+ KW
�Y tifie copy is hereby furnished. /
ert'fie co y yfi d with the city B g IP Si n. 3 Bathtubs r Sewer Connection // a� Cooking Unit Meter ❑up to 100 amps
Date a Applicant /t I .� . iI _ - __
EXEMP ION F OM WORKERS'CO 'E`SATO DEC ARA �O Clarifiers Solar.Collectors • Dishwasher . Meter Dover 100 amps
(This se lion need not be completed if the permit is for one hundred($100) or -
less). a Dis6w'asher • Solar PipingZ 4.-Y--+ Dryers ❑Gas ❑Electric Sub Panel
I certify that in the performance of the work for which this permit is issued, I - -
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank - �_ Fan Motors ❑0-1 HP ❑1'/z-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 9-15 HP ❑1Fi-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 dr—Outlets a Water Closet cr SU Device Boxes ' Pole Li ht '�'1
I hereby affirm that there is a construction lending agency for the performance f • g i
of the work for •which this permit is issued (Section 3097 Civ. C.) Interceptors / • Water Heater 'Z Outlets - '
Lender's Name Range
Lender's Address , Kitchen Sink _ - / Water Service 42(. (...4 —
OWNER BUILDER DECLARATION Switches Sign •
—
I hereby affirm that I am exempt from the Contractor's License Law for the U Lavatories r Auto-Wash /O DC) Garbage Disposal g
following'reason (Section 7031.5 Business and Professional Code: Any city or r g p Standin Sections
county which requires a permit to construct,alter,improve,demolish or repair P—Trap i Laundry Trays 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 ,
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). • 3
El I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $
•
compensation, will do the work,and the structure is not Intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL •FEES Reinspection Fee $15 Issue Fee $ 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 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 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). - - --- _ �(�ry/�
❑'I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dar /SS
tractors to construct the project (Section 7044,Business and Professions Code: --
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating . ❑0-100,000 BTU ❑100,000 BTUSUMMAR OF FEES
builds or improves thereon,and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. -. PLAN CHECK $ PERMIT
PLUMBING
❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampers $ APERMIT
ISSUANCE $
LL
Date Owner Heating System& Ducting Registers - `y ENERGY P.C. $ •
PLAN CHECK 25% $I hereby certify that I have read this applic- i. and state that the above 00-100,000 BTU 0100,000 BTL GRADING $
information is . nt. .ee to comply .lat.: city and county ordinances ELECTRICAL $•
and state law tela-i int. it.
co 11•, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
inspe •
ction
lves of is ,tl•/ - ter up- r�'f�.bove-mentioned pr•pert for
inspection p •.se�// / 441 Z,r P MECHANICAL $ TOTAL FEE $ 5 Z r 3
Signature !� i / Date
•
Drivers' License or SS# : ,•�
Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
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. 7-401 ...Ore 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 0 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
1 9. Water Pipe-Undrgrnd. .A1 ' jc/fil. 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
i 11. Property Sewer Line & House Connection i/'v/ !/'��si %. 1J? 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 Approvals
17. Rough Wiring Sign - "� 68. APPROVED FOR PL`ASTEI�TNG
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 ,r. '
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil. '
23. Gas Pipe-Rough &Test 72. Underground Flush r
24. Roof Framing 73. Undergrnd.StorageTank ❑Gas ❑Oil
25. Roof Sheathing 74. Overhead Hydro .•
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry/Chemical "
27. Frame and Flashing. .,t 76. Dry Standpipe ' ....• f
28. Lathing & Siding - 77. FIXED SYSTEM FINAL /
a
29. Insulation78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 1. 79. FINAL:INSPECTION
32. Electrical Power Meter-Final - 80. FOOD CERTIFICATE ISSUED •
33. Final Electric Notes:. /;Orr zfriz TvLded 44, eihrC'
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test ' 't c+'
36. Hood or Canopy
37.�knal Factory Fireplace - ;.. - •.... ,
V. •
38. Final Plumbing 7/92_0//��/ U� " - ' ,
39. Water Service-Final Q47 _ •
t
40. Gas Service-Final ., }•` •` - . t•/% '. ; .
_ '�
41. Solar Domestic-Final - :.
1.42t. . Backflow Preventer .,
•
;-43. Backflow Irrigation -- 1-, •
..44./Landscape Irrigation System 4. . •'
i
`.45. Sound Attenuation f .f 1'
c
.746,4-Handicap Regulations '
47. FINAL STRUCTURE & BUILDING _ (•'
48. Special Requirements Completed ' I • i
49r'Electric Release to Edison , ,, w: . " - _,
i
50. Gas Release to Southern California Gas Co " .
51. CERTIFICATE OF OCCUPANCY - ./
2.
No. Date 1�
_ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations-
CITY OF COSTAESA CONSTRUCTION_rPERMIT p P/�R'/(.p��IT NO. TRACT NO. LOT NO. UNIT NO. �:E/_ c/ '/ .
Project Address �1.c�-� / A co.•se•�err' - '3003� �S
Applicant's Mailing Address _rat.)i -amu a TYPE OF CONSTRUCTION EW U ADD U ALTERATION H REPAIR
Owner's Name ;� /��/�-v-5 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P..# I Zone.
�0€ ( `� 7z )12 °Jf Kj ,/ DESCRIPTION OF WORK/USE OF BLDG.
Address Ti[Y I. S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT IE GRADING U FOUNDATION STRUCTURAL T Front G
Address Q I.
OTHERT 111 LEG:1211c ❑�( � MEC NICAL BA Rear N
Contractor's Name eV/3 Phone C Right . N
-ROJECT DESCRIPTION S F OCCUPANCY K G
Address l mailing) CONST CTIO TYPE VALUATION$ s Left
CityLicense No. I R
ZONE' _ GRADING CU.YDS. ACRES E
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks:,.Remarks:,S a-7// O Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code, and L 3 i ( �1
my license is in full force and effect- i • T
License Class License No. S
Me Signature PLUMBING 'FEES
ORKERS' COMPENSATION DECLARATION Bar Sink Showers - '
I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL • 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 i Backflow Irrigation Sewer Cap - Construction Pole Sub. 0 50+ KW •
Certified copy is hereby furnished. •
•
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps .
Date Applicant , .
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors • Dishwasher - :Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100) or -
less). Dishwasher _ Solar Piping 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 ma n- so as to become subject to the Drinking Fountains Solar Tank Fan Motors 00-1 • 01%-8
Work o n La• • _
Date�51. - r-_�� Floor Drains - Swim • g Pool w/Spa F.A.U. Inc.Sol. ■9-15 HP 016-15+- -
NOTIC . 1 ,after making this de Ou become subject to the — •
Workers' Compensation provisions of t " ••e, you must forthwith Floor Sinks U • al Fixtures Mi .wave
comply with such provisions or this permi .II be deemed revoked. i
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Light
I hereby affirm that there is a construction lending agency for the performance9
of the work for which this permit is issued (Section 3097 Civ. C,) Interceptors Water Heater '
Lender's Name p Outlets Range
Lender's Address . --, -. Kitchen Sink Water ServiceSwitches - •', Sign •
OWNER BUILDER DECLARATION ,
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories i Auto-Wash • 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-TrapLaundry Trays Generator OM K ' •5-15 KW Trash Compactor
'ny structure, prior to its issuance, also requires the applicant for such permit P
file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains '
e 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). .
I, as owner of the property or my employees with wages as their sole Reinspection Fee ! $15, $ 3 Issue Fee'
•
compensation, will do the work, and the structure is not intended or offered - Fee Reinspection
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES p I $15 Issue Fee $ 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 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 0 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
rlfor the purpose of sale). /
as owner of.the property, am exclusively contracting with licensed con- Duct-Structu fol Refrigeration System Application Issued By _Dotal9 �_�
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU 0100,000 BTU S MARY 0 EES
builds or improves thereon, and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration BUI LDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. 13
PLAN CHECK $ PERMIT
•
❑ 1 am exempt under Section B.& P.C.for this reason �'1 Firepl/Fact.BIL ICBG /� Fire Dampers D. PLUMBING • $ ISSUANCE $ '
Date O nf. Heating System& Ducting ! Registers ENERGY P.C. $
PLAN CHECK 25% $
I hereby certify that I have read 'cation an state that the above 00-100,000 BTU 0100,00013W ELECTRICAL $ GRADING $
information is correct. I agree to com yy�� th all city a d county ordinances
and state laws relatin• to building constru u, , u,4 reby authorize repre-
sentatives of is ci • enter upon the above-mentioned pr p pgrty-for M
,Inspection par};,es. /.tJ-s MECHANICAL $ • 13-w
Signature Dale /2J/ TOTAL FEE $
Driver i ense or Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ •
,
_ W ,.
CMF 0865-46,rev. 1� - 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 Grad. • 57. APPROVAL TO COVE R-GUNITE
7. Footin s -- 1
g 58. Electrical Conduit-Undrgrnd.
a:. Foundation ' I - 59. Gas Pipe, 0 Undrgrnd.,Test
,t9. Water Pipe-Undrgrnd. I 60. Backwash Lines, P-Trap, 0 Undrgrnd. 1
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 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 I 1 ' ..
28. Lathing 4r-Siding - - 77. FIXED SYSTEM FINAL i- i. . - - ••
29. Insulation 78. FIRE PREV. FINAL - .
is .
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION 4
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED -
33. Final Electric Notes: 11'41'4 V P n rr- et:APTew 4S PEA -
34. Final Heating & Air Conditioning 30g 0. ll.M•C, c.,rko " .
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 - I
�43. BackflovL Irrigation ^ •
4.44. Landscape-Irrigation System - `1 ' i
45. Sound,Attenuation - - -
46. Handicap Regulations - _ 1).' . �
47. F•(NAL STRUCTURE & BUILDING
48. Special fequirements Completed : I ?, • - • I .
.49:'Electric Release to Edison .
1).50. Gas Release to Southern California.Gas Co - •
51. CERTIFICATE OF OCCUPANCY -
No. I- Date - • -
I - .