HomeMy WebLinkAbout3407 LAVENDER LN - Building Permits/ Applicant to fill in a11 soaees except those within neavY boraer Iines ana sign all apProDriate tleclarations.
� CIT�OF C05TA MESA' PLAN 4 E� eV. B ' PERMIT NO. TRACT NO. LOT NO. BLDG. N. �jI �JJ 3IO� IB�1 STc7oFj:7 Ti
COIQS'fRUCT,IONPERMIT LOT 28 S�iv ZO! Z� "
ProjCCtAddIe55 340� LdV2CCnriar � R11P� rOStB �'�iPSd n^ TI�PEOFCONSTRUCTION NEW .qDO ,�ALTERATION REPAIR
Applicant'SMailingAddress �JLS-W- MBCAPthl1P B�VCI. C.I'I. ❑CONVERSION ❑DEMOLISH ❑OTHER q,p,# �Z�. � 2one �
OWnef'sName CTANIIARfI—PACiFIC CORP Phone 546-1161 DESCRIPTIONOFWORK S MainBuilding: ' ACCessOry-BUilding: 2
naa�e:s' �5b5—W MacArthur Bl vd °
�[n TVPE OF PERMIT GRADING ' FOUNDATION STRUCTURAL T Ffont Z'Z,� N
Afch/Eng. License No. uyQ� ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL � B Rea� � , �
Address �..7�g.a �����P�ric Cirslg, Irvine ❑�OTHER' � A N
C Right . . . C+
Contractor's Name �ee n• �o� Phone PROJECT DESCRIPTION 50. FT. '�5�� oCCUaA Cqv K � ' , E
Addre55��mailing) � �CONSTRUCTIONTVPE VALUATION$ �L0,864 S Left
G C . ZONE GRADINGCV.VDS. ACRES PIng.Ref.# - �_ �j ��� Pafk,Fees$' � (� ' L n
City LicPnse Na �
LICENSED CONTRACTOR DECLARATION � ' ' U
qemarks: '� . Parking Req./Provided �•Z� � �
I-hereby atfirm that I am licensed untler provisionsof Charten9 (commencinq R
with section 7000) ot, Division 3 ot the Business antl arotessions code, a�d . � , ' . Useof euilding: HOL �FOR SLECIflL R�fZGl1ZEI�h�.NTS S(n
my Iicense.is in (ul fo ce antl etfect. ' � M
LicenseClass �' en{ 24HO4Z ' - PLUMBING � FEES P�anningNotes: NnlhCnnv:��l+-+- �- GS.
Oate 1�T.i�:ti�i9nature ' - . _ "' ' _. ... _..,�.+._._:ua.i1V1J N .
WORKERS' COMPENSATION DECLARATION • 88f Si�k ShOW¢�5 .
T
1 hereby affirm tnat 1 have a certificate of consent to self-insure or a certiticate Backflow Preventer Service Sink � ' �'- S
of Workers' Compensation Insurance, or a certifietl, copY thereof (Settion
3800, Lab. Y�:.q � Backflow Irrigation , SewerCap - - ELECTRICAL . FEES
Por,�Y No.W�-84-225-856 Coriipany Fremont Indemnitv , -
eCertified cooY is hereby fumishetl. ��'.�. ; Bathtubs Sewer Connection Automatic Washer � Trensformer '
Cartifiea co y is filetl with the city B �ii'ding�qIvisipn. ❑ 15-50'KW
Date ��-��-$3 APPlicant_�.I3ri11dr�Pacific Clarifiers SolarCollectors -� ConstructionPoleSub. ❑50+KW
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Di5hWa5hEf SOId� Pipi�g COOking Unit , .M¢L2f ❑up LO 1002mp5"
(This section neetl not be completetl it the.pecmit is far One huntlr¢tl (5100) or �
less). �'�". Drinkin Fountains ' •
I certify that.in tbe peffofmance of the wolkjtOr which [his p¢rm�t is issuetl, I 9 - � $013I TdOk , ' ^.'�/ Di5hW25hC� M¢L2� ❑Ov¢� 100 dR1p5
shall not employ any person in any rr�nner"so as to become subject to the � . - '
Workers' Compensation Laws ot CalifeFnia. „r— - Floor Drains Swimming Pool w/Spa Dryers ❑Gas ❑Electric Sub Panel �
Date � Signature ^'%� —
NOTICE: If, after makin9 this tleclaration, You shoultl become subject to the Floor Sinks Urinal Fan �
Workers' Compensation provisions of the Labor Cotle, you must torthwith- 'Motors DO-1 HP �1'/x-8
comply with zuch �provisions or this pe�mit shall be tleemetl revoketl. GasService Outl¢t5 WaterCloset . - •� F.A.U. InaSolar09�15HP�i6-1$+
CONSTRUCTION LENDING AGENCV'. .
1 h¢reby aftirm that there is a mnstruction lentling agenq tor the performance Intercepmrs , Water Heater ' Fixcuies � Microwave
Of the work tor which this permit i5 i55uetl (Section 3097 Civ. C.)
ixntler•s Nama - _ . Kitchen Sink � Water Service • Device Boxes Pole Light � � �
Lentler•s Atltlress Lavatories
OWNER BUILDER DECLARATION - - � � � - �uHEtS Range �
I hereby affirm [hat I am exempt from the Cont�acto�'S License Ldw fo� the p_Tra '
followin9 reason (Seciion 703L5 Business andProfessional Cotle: Any city or P � " - Switches . Sign . �
county which requires a pe�mit to const�uct, alter, improve, tlemoli5h or r¢pair _ - ..,,
any structure, prior to its issuance, also requires the applicant for such permit Roof Orains � _ Gar6age Disposal • . Standing Sections :
to file a signetl statement that he/sM1e is licensetl pursuant to the provisions o(
th¢ Contractor's License l.aw (Chapfer 9(rommenting with Section ]000) of ' ' ' Generator �a5 KW 05-15 KW
'DiviSion 3 0( the Business antl Prote55ion5 Cotle) or that h¢/she.is exempt � . TIdSh COmpdC[O!
therefrom antl the basis for'tne alleqetl exemption. Any violation of Section . .
7031.5 by any applicant for a permit wGjects the aoo�icant to a civil Rains ction Fee �
�enalty ot not more than five huntlretl tlollars ($500). - Pe $25 � ISSue Fee $ 3
I, as owner of the property br my employees with waqes as tneir sole • ReinSpection Fee $25 luue Fee $ 3
compensation, will tlo the work, antl ihe structure is not intentletl or ofteretl MECHANICAL FEES
for sale (Section 7044, Business ana Professionai Coae:: The Contractor's . - - PUBLICSERVICESREQUIREM NTS: � �
LicenS¢ Law tloe5 not appty to an owner of a property who builtls or improve5 80i1¢� HOOd O� Type I ❑ -
tM1ereon, antl who tloes sucn work himself/he�self o� inrough his or h¢r own ' Zpning App�OV¢d By �C Ddte�c?<���k4�=
employees, provitletl that such improvements are not intentletl or ofteretl for Cd00py Type II ❑
Duct - Under Ground
sale. It, howeveq the building or improvement is soltl within one year of com- � Application Appro,ved By Dat
pl¢tiOn, the owner will have the burtlen of p�oving he/she tlitl not builtl or im- �
�rove tor tne purpose of sale). Duct - Structurel Refrigeration System �� Appliption Issued By _Dat
I, as owner of the property, am exclusively mntracting with licensetl con- -
tractorsto <onsiruct the o�oject (Section �044, Business antl Professions Code: . Duct - Ventilating ❑0-700,000 BTU ❑100,000 BTU �� SUMMARV OF FEES -
Tne Contrac(or's License taw.tloes not apply to an owner of property who _�Srj,�.�ja SMIP $� � R QFi
builds or improves thereon, antl who wntracts tor such projects with a con- Exhaus[ System ❑ Multiple 0' System RepaidAlteration BUILDING PERMIT $
tractor(s) liwnse pursuant to the Gontractor's License Law). ' PLAN CHECK $ 7� � PERMIT � '
❑ I'am enempt untler Section , , e. & P. C. for this reason Firepl/Fact BIt. ICBO # PLUMB WG $ .ISSUANCE $
Date Owner Hea[ing System & Ducting ' ' PLAN CHECK $ � ENERGY P.C. $
i hereby certify that i have reatl mis appiication antl state that the above ❑4100,000 BTU 0100,OOOBT . ELECTRICAL $- ' GRADING $
information is correct. I agree to comply with a11 city antl county ortlinances ,
antl.state laws relating to builtling construction, antl hereby authorize reore- � ' PLAN CHECK $ MICROFILM $
sentative5 0! is c' - t en � upOn the above-mentionetl pra erty o� ' .
Inspeciio��� 1 _ ' MECHANICAL $ TOTALFEE $ ��%-R.�i
Signature Date peinspection Fee $25 laue Fee $ 3 PLAN CHECK $ '
Drivers' License or 55 � � '
�rvir vam-vo rev. i/ei wmce - ew�oing; canary -Hppucanp wnu -iaccoununy; �oiuenrou -�va easor
� CONSTRUCTION AND PLANNING _ POOL & SPA .
-` � APPROVALS Permit #� � Date � Inspector qppROVALS Permit # -Date Inspector .
ti
�,1+. Temporary Electric8l 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, ti
8. Foundation , - � g 59. �Gas Pipe, O Undrgrnd., Test .
9. Water Pipe-Undrgrnd. . 60. Backwash Lines, P�Trap, � Undrgmd. �
10� Structural Floor System . ' - 61. APPROVALTO 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
- i6. �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 i APPROVALS Permit #
21. DuCts,in Structure � 70. Underground Hydro
22. Ducts, Ventilating 77. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test . • 72. Underground Flush
24. Roof Framing �� 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing . � �s18y B 74. Overhead Hydro `
26. T-Bar Ceiling (Structural� & Monocoat 75. Dry Chemical �
27. Frame and Flashing ,. 7�y�yr� -� 76. Dry Standpipe
28. Lathing & Siding ' 77. FIXED SYSTEM FINAL
29. Insulation �'�� ✓� 78. FIRE PREV. FINAL
30. Drywall Nailing L�Y � W� ' 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 �� o�
35. Final Gas Pipe-Test � �� ,�p ���
36. Hood or Canopy
37. Final Factory Fireplace � -
38. Final Plumbing - ,
39. Water Service-Final � , � �
40. Gas�Service-Final � ' .
�'
41. Solar pomestic-Final , ' ' , ' C �
42. Backflow Preventer � � � ' �
43. Backflow Irrigation ' .' •
44. �Landscape Irrigation System , " '
45. Sound Attenuation � . �
46. Handicap Regulations , - ; . .
47. FINALSTRUCTURE&.BUfL"DING , �c�' �y �„/ ; � � .
48. Special Requirements Completed . � . - .
49. Electric Release to Edison ' . - �
50. Gas Release to Southem�California Gas Co , � - '
51. CERTIFICATE OF OCCUPANCY ;,
No. � Date � -
Applicant to fill in all spacas eaeeot those wlthin heavy boraer Iines ana sign all aDGropriate aeclantions.
- CITY OF COSTA MESA L/ PERMIT NO. TRACT NO. LOT O BLDG. . � ���� ..
�ONSTiiUCTION PERMIT �I�I% • / ' � � 3 ' Z� �� ' . . 30`_'3 .- 6/27/p4 , '�E.c5
PrOjeCt Add�eS TYPE OF CONSTRUCTION NEW A�D ALTERATION REPAI R �
ApplicanYSMailingAddfEiS: � CONVERSION ❑ DEMOLISH ❑ OTHER- q,p,# � ' Zone �
n DESCRIPTION OF WORK
Owner i Name .�r ��� (, O PLhone �� S Main euilding: ' Accessory Building: Z
Address ��« GC.� ��.'�/1L/� . � E .. . � � _ -O
TVPEOFPERMIT GRADING FOUNDATION STRUCTVRAL T Front N
Arch/Eng��%�����License No. ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAI. 6 qeaf � �
A N
Address' � - 3 ❑�ortiEa C Right . � G
Contractor's N Q� ��!�� � Phone� � PROJECT DESCRIPTION 5c1. FT. - oCCUPANCV K R
,/� �'JJJ� U� ) CONSTRUCTION TVPE VALUATION $ S Left E
Address (mai n .
City Licen52 Na G ZONE GRADING CU. VDS. ACRES p�ng. Ref. # Park.Fees $ �
LiCENSED CONTRACTOR DECLARATION � U
Remarks: � Parking Req./Provided �
I nereby a(firm that I am licensed untler provisions of Charter 9(commencinq R
wiih section 7000) oi Dlvislon 3 oi the Business antl Pr fessions Cotla, antl - Use of Building: E
my Iicense Is in full for�q antl �f }ct. �� a�%/` M
ucens �Cia `-�v � ns � PLUMBING FEES PlanningNotes:
Date�- � 5'q t /% E
WORKENS' COMPENSATION DECLA0.ATION Baf Sink Showers N
T
1 hereby affirm that I have a certlficate of mnsent to selt-insure or a certl(Icate sackflow Preventer Service Sink � -S
of Workers' Compenwtion Insurance, or a certified copy thereoi (Sactlon
3800, tao. Backflowlrrigation SewerCap - ELECTRICAL FEES
Policy No. ���� Compa T '
ny CferHiletl coov Is hereby turnisnea. ' Bethtubs Sewer Connection � Automatic Washer � Trensformer ❑ 15-50 KW
l�YCertifletl y f�IqG with the ci[y Bu' ing I - ❑ 50 + KW /
Date �� ��T aoaiicant Clarifiers Solar Collectors Construction Pole Sub.
EXEMPTION FROM WORKERS' COMP NSATIO DECLARATION D'15hwashef SOIa� Piping � COoking Unit M2ter ❑Up to 100 amps �(
(Thi55¢ttlOn need not be completetl if the permit I5 for One huntlretl ($300) or �(�i
less) � D�inkin Fountains '
I cErtity that In the pe�fo�manta ot Ih0 w0/k fo� which thls perm�t Is ISSUetl, I 9 $018� Td�l( / Di5hWe5h¢� � Meter �6V¢� 1 �� drt1p5 ��
snall not em0loy any person In any manner so as to become subject to the
Workers' Compensation taws of California. Floor Drains Swimmin9 Pool w/Spa / Dryers ❑Gas ❑Electric Suh Panel �
Date Signature
NOTICE: If,iatter making thiz tleclaraHon, you shoultl become subject to the Floor Sinks Urinal Fan �
Workers' Compensatlon provlsions of the Labor Cotle, you�must fortnwith MotorsO0.1 HP �1%-8 Q
comply wieh sucn provisions or this permit shall be tleemed revoketl: GasService �Outleis WaterCloset '
CONSTRUCTION LENDING AGENCV F.A.U. Inc.Solar 09-15 HP 016-15+
I hereby affirm that there is a constructlon lentling agency for the pertormance IntercEpto�s . � Water Heater Fixtures � Microwave
ot tne work for wM1lch thls permit i5 i5suetl (Section 3097 Civ. C.)
Lender's rvame . ' Kitchen Sink . Water Service Device Boxes Pole Light
L.entler•s Atltlrezs '
OWNER BUILDER DECLARNTION ' Lav2tOrieS Out12t5 Range ��
I hereby aftirm that 1 am exempt from [he Contractor's License L.aw for the p-T�a /
following reason. (Section 7031.5 Business antl Protessional Cotle: Any dty or P ' ' Switches Sign t�
•county which requlres a permlt to <onstruct, alcer improve, tlemollsn.or repair -
any structure, prlor to its issuance,�also requires t�e'aoP�icant tor such parmit Roof Drains ' ��- ' '-' ' -- . ./ Garbage Disposal . Standing Sections �
to file a slgnetl statement that he/she is Iltensetl pursuant to the provislons of '
Me Contractor's Licanse Law (Chapter 9(commencing'with Sectton �000) oT �
Divlsion 3 of the Businezs antl Professions Cotle) w that ne/she is exempt � ` Generator 00�5 KW �5-15 KW Trash COmpacto� �
therefroin antl tne basis for tha allegetl exemptlon-. Any violation of Sectlon ,
�031.5 �y any applicant tor a permit subjects� the applicant to a civil Reinspection Fee ' $25 laue Fee ' $ 3
�nalty o( not more Ihan tive huntlretl tlollars (5500). � . - . � .
LJ I, as owner o( the property or my employees with wagez as their sole MECHANICAL Reinspection Fee $25 �uue Fee ,$ 3
comoensation, wiu Go the work, antl the structura 6 not intentletl or otteretl � ' FEES
. for sale (Section 7044, euslness antl Pwtessional Cotle: The Contractor4 - PUBLIC $ERVICES REQUIREMENTS:
LI<ense Law Aoes not apply to an bwner of a property who builtls or improves Boil2� Hood or Type I ❑ '
tnereon, antl who tloes such work himself/herself o� th�ough his o� he� own ZOning App�OVBd By DdtB
employeas, provltletl tnat such improvements are not Intentle0 or offeratl Tor - Canopy Type II ❑ � �
sa1e. It, howaver, the builtling or improvament is soltl wlthln one year ot com- Duct � Under Ground � .
pletion, the owna� wlll hav! tha burtlen ot p�oving he/sh¢ tlltl not builtl or im- Building Approvad By Date �/-
rove for the purpose of sale). Duct - Structural Refrigerotion System " Applintion laued By �� �ate�
� I, as owner of the property, am exclusively contracting with�licensatl con- ❑0�100,000 BTU ❑100,000 BTU
tractors to construct the project (Section 7044, Businezs antl.Pro(esslons Cotle: Duct - Ventilating . SUMMARV OF FEES � �
The Contractor's Llcanse Law tloes not apply to an owner ot property who • BUILDING PEfiM1T $ ' SMIP �
builtls or improves thereon, antl who contracts tor such pro�ects with a con- Exhaust $ystem ❑ Multiple ❑ System Repair/Alteration ' $
tractor(s) Iicense pursuant to t�e Contrattor's Licensa Law1. PLAN CHECK $ � PERMIT �
❑ I�.am axempt unaer Section B. & P. C. tor thls reason ' FirepUPatt. Blt. ICBO �k PLUMBING , $ ISSUANCE $
Date owner • Heating�System & Ducting , � ENERGV P.C. $
-❑0.700,000 BTU 0100,OOOBT PLAN CHECK 25% $
I hereby certify t�at- I have reatl thls application antl state thac tha above � GRADING $
Information is carrect. I agree compry with all ci antl county ortllnan<es ELECTRICAL $ .
antl� state laws relating t ui ng construction, an hereby authorize rapre- , , � � � MICROFILM $
sentatives of thls city o e e abov entior}etl proper y�for • PLAN CHECK 50% $�
Inspectlonpurposes. . (i--��-�%� MECHANICA� $ TOTALFEE $ ��"'S`J-
Slgnature � Date �
orivers' Llcense or 55 � heinspection Fee $25 laue Fee $ 3 P�AN CHECK 25% $ �_ -
CMFOB65-46 rav.12/B3 White-BUIItlIn9;Canary-APpllcant;Pink-Accounting;Goltlenrotl-Azsessor ' -
.,
�CONSTRUCTION AND PLANNING . . . >` - POOL_& SPA:: ;�ry-� � � ---, , y : . -
Date Inspector -� �, _: '> - ' �Date � Irispector, '_
'�APPROVALS Permit# � . APPROVALS• Permit# _ � �-
k Temporary,Electrical Service or Pole • 52.. Pool & Equipment Location , � �-
r '
i
� 2.. Soil Pipe'Undrgmd. s 53.. Steel Reinforcement ; " �. ' � �
r,�.
3. Electrical Conduit�Utility-Undrgrnd.•� " _ � 54: Forms � -- - ' ��
' 4. Electrical Conduit-Undrgrnd. � � 55� Electricel Bonding ' � �- - � ' � �,. �
. - •
5: Steel Reinforcement _ L�� , 56. Rough Plumbing & Pressure'Test � • � i" '
`
6. Electrical UFER Grnd. . 57. APPROVAL�TO COV.ER-GUNITE . ,'."
7. Footings � � � .58' Electrical"Conduit-`Undrgmd. : �
-8.- Foundation . - 59. Gas Pipe, O Undrgmd., Test ` � � �
9; Water Pipe-Undrgmd. � i� r� 60. Backwash-Lines,�P-Trap, � Undrgrnd. „` . ���
10. Structural�Floor System '" �� � 61. APPROVAL-TO DECK -. �
11. Property Sewer Line & House Connection -�. - 62. Backwash &-ReceptorFinaL _-� . _
12. Sewer Cap � � . 63. Heater & Vent-Final. � `�� - �
%" - -
13. Roof Drains ' � � �64. PlumbingSystem•:Final-�' =�. �> � •� ' � -
� ��: .� ' r' _� . "
14. Rough Plumbing � � 65. Electrical-Final - - �
15. Rough Electrical-Conduit' - - 66. Solar System-Final � '- - - � �
16. Rough Electric Wiring �C �. ��, � 67. Fencing & Acczss Approyal � �, � - � . `
17. Rough�Wiring Sign 68. APPROVED FOR PLASTERING � ' � �
_ 18. Rough Electrical-T Bar Ceiling 69. POOC/SPA SYSTEMS FINAL � � ' -
�,
19. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT' '
20. Rough Factory Fireplace , APPROVA'LS Permiti# � , �
21. Ducts, in Structure - 70. Underground Hydro ' ' ,
22. Ducts, Ventilating . � 71.' Product Piping O Gas ❑ Oil ' , � , ��;�
23. Gas Pipe-Rough & Test � 72. Underground Flush� ' .
24. Roof Framing � - 73. Undergrnd. Storage Tank� � Gas- O,OiI ' ' '
�
25. Roof Sheathing � � - 74. Overhead Hydro '• - �
26. T-Bar Ceiling (Structural) & Monocoat . � 75. Dry Chemical . � y � �- _ �. � �
� 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 '
i
31. Plaster Brown Coat 79. FINAL INSPECTION �
32. Electrical Power MeterFinal � 80.�FOOD CERTIFICATE ISSUED ' � �
33. Final Electric � Notes � � ' _ ' ' � '
34. Final.Heating & Air�Conditioning / � .- , - �,� ' -• � _ "
35. Final Gas Pipe-Test �. ' � � : „ .
,� . . ,
36. Hood or Canopy� . � '
37. Final Factory Fireplace ' . � • ' • - - �
38. Final Plumbing , � � � '� .
39. Water Service-Final - ' � -- �'.
40. Gas Service-Final � ' � � ''
�
41. Solar pomesticFinal � -- - -'- --- -�--% � - - � . �
42. Backflow Preventer , � � . � � � _ � _ _ �
43. Backflow Irrigation � � . � ' _ , � -
I
44. Landscape Irrigation System - � . . � . : � � �' , �
- . . . , . , , . ;. _
45. Sound Attenuation ' � ' , ' ' � ' ' " _ �
46. Handicap Regulations , ' � ' � ' , ! � `� _
�,
47. FINALSTRUCT�URE&BUILDING � � � ' ' i '' , u :•
48. Special Requirements Completed, , � j ! , , � ' ' � 'j�� � "
49. Electrie Release to Edison • - i - - -, '( -�--' ' � ;' ` . �
50. Gas Release to Southem California Gas Co � � . ' , � � . � � � � �
.
51. CERTIFICATE OF OCCUPANCY � �-- . , . -; -� - - � - , 1
No. Date ` � � � ' - . . �
. . . . . �. r - _ - - • � . .
M' f
W
� T�
V
�y/i�r� �l� �
J Applicant to fill in all s0aces cep t se ithm M1eavy Oor m s antl z�gn all approD/�ate Oeclarations.
CITY,OF COSTA ESA STRU TI PERMIT PEBM;T'NO.' �� I TRACT NO. _ LOT NO. UNIT NO.
rr�
FToject Address �„L7� �� d��v�
ApplicanYs MaJ' res� ��
Owner's Nad6-��/A� LJ /P�}� ie 2'/!
Atldress � ��%/�'� ¢ /�f � �"p � ���
A�ch/Eng. License No. �
Address '
Contractor's Nam � Phon
Address (mailing
Ciry License No.
LICENSED CONTRACTOR �ECLARATION �
1 hereby affirm that I am licensetl untler p�ovisions ot Charter 9(commencinq
with section ]000) oi Division 3 of the Business antl Professions Cotle, antl
my license is in full t fe an ii cL �
Lice� ass ' - icense N .
Date Si9nature
WO ER ' COI PENSATION DECLARATION �
I hereby atfirm Ihat I have a<ertificate of mnsent to self-insure or a certificate
of Workers' ���ppp mpensation Insurance, or a cerfifietl copy thereof (Section
3800, Lab, dy7/A /�+-� , , �/ � / _ _ , p .
PolicY No�/Plci(I� r_omPanY �ik�ei�c�—�
Certifietl copy is hereby furnishetl.- /
ertifi c s fi ith the c fi iry4 � i n ,{�
ate___1����APPlica�/ �� '��f/�
EXEMP ION FROM WORKERS' COMPENSATION DECLARAT N
(This section neetl not be completeC it the permit is for one huntlretl ($100) or
IC55�.
1 certi(y tM1at in the performance o/ [Ite wo�k fo� which this pe�mit is issuetl, I
shall not employ any person in any manner so'as to become subject to the
workers' Compensation Laws ot Calitornia.
Date Signature
NOTICE: If, alter making this declaration, you shoultl become subject to the
Workers' Compensation provizions ot the Labo� Cotle, you must forthwith
comply �with such provi5ions o� this permit Shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV ' '
1 he�eby atfirm that Ihere is a const�uction lentling agenty for the performance
of the work far which this permit is issuetl .(Section 3097 Civ. 'CJ
Lentler's Name
Lentler'S Atld�ess _
OWNERBUILDER DECLARATION � '
I hereby attirm that I am exempt from the Contractor's License �aw tor the
followin9 reason (Section 7031.5 Business antl ProfesSional Cotle: Any city or
[ounty w�icM1 �equires a pe�mit lo Construct, alter, improve, tlemolish o� repai�
any slructure, prior to �its issuance, also requires the applicant (or such permit
to file a si9netl stalement tha[ he/she is licensetl pu�suant to lhe provisions of
the Coniractor's Licenze Law (Chapter 9(commencing with Sectlon ]000) of
�ivision� 3 of the Business antl Pwfessions Gotle) or that he/she is exempt
tM1eref�om and the basis for the allegetl exemption. Any violation of Section
7031.5' by any applicant for a permit subjects the.applican[ to a civil
�enalty of not more than five hundretl tlollars ($500).
LJ I, as owner of the property or my employees with wages as tneir sole
compensation, will tlo the work, ana the structure is mt intentled or afferetl
for Sale ($ection ]044, Business antl Professional Cotle: The ConVacto�'S
License Law tloes not apply ro en owner of a property who builds or improves
thereon, antl wno tloes such work himseli/herself or tnwu9h his or her own
employees, provltletl roa[ sucM1 Improvemen[s are not in[entletl or otteretl for
sale. It, however, the builtling c� improvement i55oltl within one yea� of com-
pletion, the owner will have [he burtlen ot provin9 he/sne tlitl not builtl or im-
�rove fo� tM1e purpose of sale).
I, as owner of tM1e pro0erty, am exclusively cont�acting wi[h licensetl con-
lractors to construct the project ($ection 7044, Business antl Professions Cotle:
The Cont�actor's License Law tloes not apply to an owner of property who
builds or improves thereon, antl who conVacts for such projects with a mn-
tractor(sl license pursuant�to the�Contractor'i Licenze Law). 1 am aware that
proof of their Worker's Compensation insu�ance shoultl be provitletl to me,
❑ I am exempt untler Section B. & P. C. for this reason
Date Owner
I hereby certity that I have read this application antl state thaT the
infOimation is co�recL 1 agr¢e to comply with all city antl county ortli
antl state laws rel$iing to buil0in9 construction, antl hereby authorize
sentatives of t�iy city, to enter up0� /Ihe qbovp-mentionetl Oroper
Signature
Driver5' License or 55 � —
CMF 0665-46, rev.4/84 Whi[e-Builtling; Canary
TYPE OF CONSTRUCTION . NEW U ApD LJ ALTERATION LI REPAI R
❑ CONVERSION ❑ DEMO ISH ❑ OTHER q,p, #
DESCRIPTION OF WORK/USE OF BLDG.
S Main Building:
TVPE OF PERMIT GRADING FOUNDATION E
❑ STRUCTURAL T Front
❑ TENANT ❑ ELECTRICAI\%� PlUM81NG ❑ MECHANICAL B R¢dr
❑ �OTHER / %�
PROJEC7 DESCRIPTION 5a. F7. oGcuaaNCv C Right
K Left
CONSTRUCTIONTVPE ' VALUATION$ $
ZONE - � GRADING CU. VDS. ACRES p�ng. Ref. #
Remarks: , I � �(��� Planning Notes:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs ' y
Clarifiers
Drinking Fountains
Floor Drains �
Floor Sinks
GasService Outlets
Interceptors �
Kitchen Sink
P—Trap
Roof Drains �
Reinspection Fee $15
Duct=UnderGround
Duct - Struccural
Duct - Ventilating
Exhaust System ❑ MWtiple ❑
Firepl/Fact.6lt. ICBO #
Heating System & Ducting
❑0-100,000 BTU O100,000BTi
Reinspec[ion Fee
Pink - Acrounting; Galtlenrotl - Assessor
$15
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecmrs
Solar Piping
Solar Tank
Swimming Pool w/Spa.
Urinal
Water Closet
Water Heater
Water Service
Issue Fee
Hood or Type I ❑
Canopy Type I I ❑
Refrigeration System
❑0-100,OOOBTU ❑100,000
System Repair/Alteration
luue Fee
FEES
Zone
Accessory Bui
Parking
ELECTRICAL
Automatic Washer Transformer ❑ 15-50 KW
ConsVuctior Pole Sub.
❑ 50+ KW
Cooking Unit Meter ❑up to 100 amps
Dishwasher ' Meter ❑over100amps
Dryers ❑Gas ❑Electric Sub Panel
Fan � Motors�0.1HP01X-8
F.A.U. Inc.Solac �9-75 HP 016-15+
Fixtures . Microwave
Device Boxes Pole Ligtit
Outlets Range
Switches Sign
Garbage Disposal Standing Sections
Generator DO-5 KW �5-15 KW Trash Compacmr
$ 3 --. _'
Reinspection Fee $15 Issue Fee
FEES
DEVELOPMENTSERVICESREQUIREMENTS: �
Zonin9 APProved By
Building APProved By
Aonliwtion Issued Bv
$ 3
Z
O
N
I
N
G
R
E
�
M
T
S.
FEES
$ 3
SUMMARV OF FEES �
BUILDING PERMIT $ SMIP $
PLAN CHECK $ � PERMIT '
PLU N ��5�1�6 1 `b' —i--
P E K 25° E P. $
E ECT C� $ �'
PLAN CHECK 50% $ MICROFILM $
MECHANICAL $ TOTAL FEE $
PLAN CHECK 25% $
. .
•60NSTRUCTION AND PLANNING ' . POOL & SPA
n4PPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector
1. Temporar,y Electrical Service or Pole • 52. Pool & Equipment Location
2. Soil Pipe;Undrgrnd. , 53. Steel Reinforcement -' '
3. Electrical'Conduit'Utility•Undrgrnd. 54. Forms �
4i.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, � Undrgrnd., Test . �'
9. Water Pipe-Undrgrnd. ', -� 60. Backwash Lines, P-Trap, � Undrgrnd. • �`
� .
70. 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 Bai Ceiling 69. POOUSPA 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 ❑ 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 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 '
37. Final Factory Fireplace � �
38. Final Plumbing ' ����/�� (��) '
39. Water Service-Final �
40. Gas Service-Final
41 . Solar pomestic-Final
42. Backflow Preventer -
43. Backflow Irrigation . , . ��
44. .Landscape Irrigation System -
45. Sound Attenuation �
46. Handicap Regulations ' , �
47. FINALSTRUCTURE&BUILDING . - .
48. Special Requirements Completed
49. Electrie Release'to Edison � � �
50. Gas Release to Southern Califomia Gas Co �� �
57. CERTIFICATE OF OCCUPANCY
No. Date
�( • � a Applleant to BII In all ipacez ezce0t those within heavY
�`� CITY OF COSTA MEtq �� . : �
C�AiSTRUCTION PERMIT
Project Address
Applicant's Ma' ' Add�ss .
Owner's Nam���— h � � hCnC..� �
Address ��S ��- l ^�
Arch/Eng. License N0.
Address
Contractor's Nam hona �
Address (mA I'ngl� � ,�-� •q�'+ �l .t...._
City License No. ���
LICENSED CONTiiACTOR OECLARATION
1 herlby af7irT tnat I am Iicensetl untler provlslOnS Of Charter 9(COmTencing
with sattion 7000) of Divlslan 3 of tM1e Buslness antl Pr ezslons Cotle, antl
my Iicense is In ful torc n effe t. �Q �
Licenie Class � Icense a
Date Signahre
W00.KER5' COMPENSATION DECLAHATION -
I h¢leby afflfm that I have a cGItlflcdtB ot cOnSGOt t0 Sel/-InSurl,Or a CBvtIflCdtO
ot Workers' Compensation Insurance, or a cartlfletl copy Iheieof (Section"
3800, Lab. CJ. -
Policy No. �� S I O�y�D Company �
�Certltietl copy is hereby furnishetl. ' -
coru�yeq��oarr�iS4eA'witn rne acv epiyeios owM�ah. . .0 �_. _
EXEMPTION FkOM WORKERS' COMPENSATION DECLARATION
(Thls sectian neetl not be completetl it the permlt I5 for one huntlretl (E100) ar
less) '. •
I certify that in .the Performance of the work tor whlth this perml( is Itsuetl 1
shall not employ any person In any manner so as to become subjecf to t�e
Workers• Compansation Laws o1 California. ,
Date Si9natUre
NOTICE: If,iafter making this tlaclaraUon, you shoultl become sub7ect to tha
Workers' Compensation provlsions of tne Labor Cotle, you must forthwlth
comply with such provisfons or Ihis Oermit ihall De tleemetl revoketl.
CONSTRUCTION'LENDIN6 AGENCV
I hereby affirm that there is a constructlon lentling agency for tha parformance
at thB wo�k fa� wmm� thls pe�mil IS ISSuatl (SeCtlOn 3097 Clv. C.)
l.entler'S Name ,
Leneer•z Atltlrass �
OWNERBUILDER DECLARATION
I harebv affirm that I am exemot from the Contractor's Licensa Law !or tha
olvislon 3 ot tne Fluslness ana rroiessons coa9) or [nai na sne is axamp[
therefrom antl the basis for [ha allegatl exemption. Any vlola ion of Sectlon
7031.5 by any appllcant for a permit sub�acts the appllcant to a civll
�enalty ot not more than flve huntlretl tlollars (5500).
I, as ownar Ot tha p�ope�ty O/ Ty emplOyaes with wdges as thei� Sole
compensation will tlo [he wark, antl the structure is not Intantletl or offeretl
tor wle (SecFlon 7044, Businass anA Profe55ional Cotle: Tha Contractor's
License Law tloez not apply to an owner of a proparty who builtls or Improves
tM1e�eon, antl who tloas such work hlmsalf/harsolf or through his or her own
BTO�OyeeS, pfOvltl¢tl thdt sUth Impfov8m8nt5 dl0 nOt Int0fltlatl Or OffBfBtl fOr
sale. If, however, tha bulltling or Improvement Is soltl withln one year of com-
pletlon, tha owner wlll have tna burtlan of praving he/She tlltl nOt Dulltl or Im-
�ova for t�e purpose of sale). :
LI I, as ownar of the property, am excluslvely tontratting'with Iicensetl con-
tractorst8 conztructt�e oroject (Sectlon 7044, Business antl Professlons Cotle:
T�e Contractor'S Licenze Law does not apply to an ownar of Oroper[y who
bulitls or Imprava5 theraon, antl who contracts for such pro�ects with a can•
tractor(s) Ilcense pursuant to the Contractor's Llcense Law).
❑ I am exempt untler Sactlon , B. & P. C. for tnls reason
TYPE OF CONSTRUCTION .
❑ CONVERSION ❑ DI
. DESCRIPTION OF VJORK
TVPE OF PEHMIT LJ GRADI
❑ TENANT ❑ ELECTRICF
❑ OTHER
PROJECT DESCRIPTION S�. FT� OCCUPANcv
CON STRUCTION TVPE VALUATION $ _
GRADINGCU.VDS. ACRES_
lines anE sign all aDO�opriate tleclarations.
., �
J ADD LI ALTERATION LI REPAIR
OTHER"
FOUNDATION LJSTRUCTURAL
LUMBING ❑ MECHANICAL
Remark�:
Bar Sink
Backflow Preventer
Back(low I rrigation
Bethtubs
rinking Founteins
loor Drains
loor Sinks
as Service Outlets
lavatories
P—Trep
Roof Dreins-
Heinspection Fee � $25
Boiler
Duct - Under Ground
Duct - Struccurel .
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fect. BIt. ICBO 51E
5
�ate Owner� Heeting System & Ducting
1 hereby certly that I �ave reaG this� appllcatlon antl state cnat the abova : ❑0700,000 BTU �100,OOOBT'
Information Is corract. I agree to comply wlth all city antl county ortlinances
antl 5tate laws relaling to bulltling tonstructlon, antl hereby authorlie repre- ,
santatives of lhis clty a ter upon the above-mantlonetl pro ert f r
inspection OutO�
Signature Date_�3(/P�.
Drivers' Licansa or 55 � Reinspection Fea $25
CMFO865-46 rev.12/83 Whlte-BuIItlIn9;Canary-Appllunc;Plnk-A<countln9;Goltlenrotl-Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collxtors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet �
Water Heater
Water Service
laue Fee
Hood or Type I �
Canopy Type I I ❑
Refrigeration Syrtem
❑0.100,OOOBTU ❑100,000
System Repair/Alteration
Issue Fee
�
FEES
$ 3
A.P. #
S Main Building:
E
T Front
ARear
C Right
g Left
Ping. Fef. dh
Parking Req./Provided
Use of Building:
Planning Notes:
575� 3/09/84
Zone
Park.Fees $
ELECTRICAL
Automatic Washer Transformer ❑ 15-50 KW
Construction Pole Sub. � 50 + KW
Cooking Unit Meter �up to 100 amps �
Dishwasher Meter �over 700 amps
Dryers ❑Gas ❑Electric Sub Panel �
Fan ' Moiors�0.1'HP07X-8
F.A.U. Inc.Solar �9-15 HP �16-15+
Pixtures ' Microwave ' �
Device Boxes Pole Light
Outlets � Range
Switches Sign
Garbaga Disposal •Standing Sections
Generator 00.5 KW �5-15 KW Trash Compactar
� Reinspactian Fee I$25 � �ssue Fee
PUBLIC SERVICES REQUIREMENTS:
2o�ing APOroved By
Buildin8 ApProvad By �� J
Aoolintion laued Bv
3B.O�i Ti
FEES
$ 3
Z
O
N
I
N
G
R
E
U
U
R
E
SUMMARY OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT �
PCUMBING $ � I'— ISSUANCE $
PLAN CHECK 25% 5 %' ENERGV P.C. $
ELECTRICAL $ GRADING $
PLANCHECK 50% $ � MICROFILM $
MECHANICAL $ , TOTALFEE •$ �
PLAN CHECK 25% $
'• : CONSTRUCTION AND. PLANNING � � ' . . ,POOL�& SPA : � � • : _
;APPROVALS Permit# - Date Inspector AppROVALS Permit# "-Date Inspector �"
1,� Temporary Electric8l Service or Pole • `� 52. Pool & Equipment Location . � -� �
.�. 2. Soil Pipe-Undrgrnd. � 3`!Tj � 53. Steel Reinforcement � � , -
$. Electrical Conduit Utility-Undrgrnd. 54- Forms � � ' '
' "`4. Electrical Conduit-Undrgrnd. �_' � � . 55. Electrical Bonding - � _ - �
� 5. Steel Reinforcement '' 56. Raugh Plumbing & Pressure Test . - �
' � - 57. APPROVALTOCOVER-GUNITE
6: Electrical UFER Grnd.- - �. � -
7. Footings � - � 58. Electrical ConduirUndrgrnd. � '
i
8. Foundation : . , � = 59. Gas �Pipe, O Undrgrnd., Test � . •
9. Water Pipe-Undrgrnd. ' 3p �,� �'� 60. Backwash Lines, P�Trap, � Undrgrnd.: � �
70. Structural Floor System ��- 1 - 61. APPROVAL TO DECK � � ' ��
11. PropertY Sewer Line &�House Connection ���(�t{� � 62. Backwash &� Receptor-Final ' . ',
12. Sewer Cap ' �� ' 63. Heater & Vent-Final ��
i
13. Roof Drains � • 64. Plumbing System - Final � - �
14. Rough Plumbing - � � ]�7.f`7 L�P � 65. Electrical-Final ' � ' � � .
15. Rough Electrical-Conduit-- - 66. Solar System�Final '� �' " - -
�
16. Rough Electric Wiring �67. Fencing & Access Appioval � .. `- -
17. f?ough�Wiring Sign 68. APPROVED FOR PLASTERI(JG ,
18. Rough Elecfrical-T Bar Ceiling � � .� 69. POOUSPA SYSTEMS FINAL '
19. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT � •
20. Rough Factory Fireplace APPROVALS Permit # �:� �
21. Ducts, in Structure ' 70. Underground Hydro '
22. Ducts, Ventilating - 71. Product Piping O Gas ❑ Oil � ^
�
23. Gas Pipe-Rough & Test � �- 72.� Underground Flush ' ' �
24. Roof Framing ' 73. Undergrnd. Storage Tank O Gas ❑ Oil ' �
2$. 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 i
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 � 9 ( (�Q _ ' � : ,
� . -
36. Hood or Canopy , . . .
37. Final Factory Fireplace ' , � - , '
38. Final Plumbing /D,j/�( f,�Q
39. Water Service-Final � - � � �
40. Gas Service-Final � � '
41. Solar pomestic-Final ' � -- -
42. Backflow Preventer � �
43. Backflow Irrigation . , .. . . � �
44. �Landscape Irrigation System � � . � � � .,
45. Sound Attenuation � � - � � � � �, ' �
46. Handicap Regulations • � �
47. FINALSTRUCTURE&BUILDING , �
48. Special Requirements Completed � � ' � �
49. Electric Release to Edison , � � • � '
50. Gas Release to Southern Califomia Gas Co �
51. CERTIFICATE OF OCCUPANCY -
No. Date _ . . _ _ _ . . . ,
AVClicant to /ill in a1l spaces except those'within heavy Gortler Iines ana si9n all aoarooriate aeclarations.
CITY OF COSTA M S �C TRU �ON ERMIT PERMIT NO. T A T N0. LOT NO UN1T NO. 3EI,E %/O6/B4 BoO' TI
Projecc Address � I � �� ��// y / � �
Applicant's Mailing dress -- TVPE OF CONSTRUCTION EW A�D ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p, # ZanB
Owner'sNam h e DESCRIPTIONOFWORK/USEOFBLDG.
Address � S Main Building: Accessory Building:
E Z
Arch/Eng. LiCenSeNo. TVPEOFPERMIT GRADING FOUNDATIO^NJ STftVCTURAL T FrOnt p
Addr¢ss � ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING L7MECHANICAL A Rear N
, Contracmr'sName Phone �'�THER C Right N
� .� PROJECT DESCRIPTION SR.FT. oCCUaANCv K- G
Address (ma'I' I
1 9 �[��' CONSTRUCTIONTVPE VALUATION$ g LZft
City Licenar Nn T ZONE GRl1DING CU. VDS. ACRES ' R
LICENSED CONTRACTOR DECLARATION Ping. Ref. # Parking Req./Provided E
1 hereby attirm lhat 1 am liceosetl U�tle� proviilons of Charte� 9(commenGng Remarks: Planning Notes'. M
witn section 7000) of Divislon 3 of the Business antl Profeszions Cotl , antl
' my Iice�� is in 1 y fqrjqantl effect.1 /� �\;� T
Licen G[/ / � ��a�.a. S.
Date � Signature —/T� N�� �- � PIUMBING FEES
W00.KE 5' COMPENSATION DEG A0.ATION BarSink Showers �
I hereby aftirm tnat I have a certifica�e of consent to It-insure or a certificate ' ELECTRICAL FEES
ot workers' Compensation Insuran�e, or a certifie copy ther¢ot (Section Backflow Prevenler Service Sink
3800, �ab.�a,p�D`/�� / FluromaticWasher Transformer ❑ 15-SOKW
Policy No. 'Pu n Company ` Backflowlrrigation SewerCa ❑ 50+KW '
P Construction Pole Sub.
BCerHf etl copy I5 bereby furnisM1etl. /
C is flletl witn the city iltlir/qp {yi ion /, Bathtubs Sewe� Connection Cooking Unit - Meter ❑up to 100 amps
Date��� APPlicant o 'ii�GL7'� {" �.Q'%��
EXEM I N F�20M WORKERS' COMPENSATI N DECLARATION CId�iFi¢rs '' 5012� COII¢CLO�S Di5hW35hE� Merer ❑Ov¢/ 1002Tp5
(ThI55eClion neetl n0[ be cOmpletetl i7 the permit i5 for one huntlretl (E100) or
less�. � Dishwasher Solar Piping �ryers ❑Gas ❑Electric Sub Panel
I certify tM1at in e perfOrmance ot he w k for which thi5 p Issuetl, I � _
shall not ny Qrson in Y er so as t ¢co �e t to the Drinking Fountains Solar Tank Pan
�4. Workers' C �� I�Opws o Ca��for� ��� ����F?�- i y Motors �0-1 HP �1 �� 8
Date Floor Dreins Swimming Pool w/Spa F.A.U. ' �
NOTICE: If, aft � king this tleclarati , y ultl become b�ect ro the . Ina Solar �9-15 HP 016-15+
Workers' Compensa ion provisions ot the Labor Cotle, you must forthwith FIOo�Sinks Urinal
comply wi[h suGh OrOvisiOns or tM1is permi[ shall be tleemetl revoketl. Fixtuf¢5 MiC�OWavC
CONSTFUCTION LENDING AGBNCV GasServiCe Outlet5 WaLCrCloset DeviCeBoXeS
I hereby affirm Ihat [he e s a construction lentlinq agency for the per/ormantt � P�IC Light
o( the work tor w permit is issuetl (Section 3097 Civ. C.) In�2rc2ptOf5 Water Heate� Outlets flange
Lentler's Name
Lentler's AGOress _ Kirehen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION�-
I hlraby atfirm that I am exempt Irom the ConVactor's License �aw tor tne LavatOli¢S -
following reason (Section 7031.5 Business antl Protessional Cotle: Any city ar Garbage Disposal Standing $¢ctions
counly which r¢quirez a pe�m{t to Go�Struct, alt¢r, imOtove, Oemoli5h or repair P—Tfdp
any structure, prior to its issuance, also req Wres ine applicant tor such permit Generator �0.5 KW �5-15 KW Tresh Compactor
t0 file a Slgnetl statement lhat he/sne I5 licensetl OurSuant to [he plovisions of ROOf D�dins
tne Contrattor's Licenze Law (Chapter 9(wmmencinq wltn Section ]000) of �
�Ivision 3 of [he BuSiness antl Profes5ion5 Cotle) or that he/she is exempt
there�rom antl [he basls �or the all¢9etl exemption. Any violation ot SectiOn
7031.5 by any applican[ for a permit subjects the applicant to a civil
�enalty of not more than five huntlree tlollars (E500). '
I, as owner ot lhe property or my employees with wa9es as their sole Reinspection Fee $15 Isue Fee $ 3
compensation, will Eo the work, ahtl the structure is not intentletl or offeretl Reinspection Fee $15 �Siue Fae $ 3
for sale (Settion 7044, Business ana Protessional Cotle: The Contractor's MECHANICAL FEES
LiC¢nie Ldw does not apply to en o�+'�er of a p�operty wbo builtls or imprOves
thereon, ana who does sucn work himzelf/herself or through his or her own DEVELOPMENT SERVICE$ REQUIREMENTS:
employees, O�ovitled that such Imp�ovemenls are not mtentletl or offeretl for BOiIE� HOOd O� Typ¢ I ❑
sale. If, however, lhe builtling cr in�arovement is soltl within one year ot com- Canopy Type I I ❑ 2oning Approved By Date
pletlon, the owner wlll have Ihe burtlen of proving he/she tlitl not builtl or im- Duct - Under Ground Building Approved By Date
�tOve totthe purpose of zale).
I, as owner oi lhe property, am ezclusively contracting with licensetl con- Duct - Structural , Refrigeration System AppliWtion IRued By Dat
t�aclor5to ConslruCt the D�ojecl (SE�LI00 %044� B115111255 dlltl Protessions Cotle:
Tne Convaclor's License Law does mt apply to an owner of property who Duc[ - Ventilating �0-100,0006TU ❑100,000 BTU
builtls or improves thereon, and who contracts for such projects with a mn- SUMMARV OF FEES
tractor(s) ❑cense pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Altera[ion BUILDING PERMIT $ SMIP $
prooi o( their Worker's Compensa��on insurance shoula be proviaetl to me. PLAN CHECK $ PERMIT
❑ I am exempt untler Section B. 3 P. C. tor this reason Firepl/FacL BIL IC80 # PLUMBING $ ISSUANCE $
Data Owner Heating System & Ducting ENERGV P.C. $
I hereby certity that I have reatl thls application antl state [hat the above I L�700,000 BTU 0100,OOOBT P�N CHECK 25% $ GRA�IN(�i $
informatlon is correct. 1 a9ree to c ply with all city antl county ortlinances ' ELECTRICAL $
and state la lating to builtli c pppstructlon, antl hereby authori reore- PLAN CHECK 50% $ MICROFILM $
sen[aNves ot is city to eit U�q� the above-mentionetl pro rt fo �
Inspectlon pu 5 s. / �� MECHANICAL %•EXG7 - DO TOTAL FEE $
Signature Date Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
Drivers' License or 55 �
CMF 0865-46, r¢v. 4/84 Whi[e - Builtling; Canary - ApPlicant; Pink - Accounting; Goltlenro0 - AssesSor �
�CONSTRUCTION AND PLANNING - POOL & SPA
� APpROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. _� - 53. Steel Reinforcement `
3� �lectrical Conduit Utility-Undrgrnd. . - 54. Forms � .
4� �lectrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement " 56. Rough Plumbing & Pressure Test
6� ,Electrical UFER Grnd. .- 57. APPROVA� 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, � Undrgrnd.
10. Structural Floor System . 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection '� 62. Backwash & Receptor-Final
�72. Sewer Cap � - - � 63. Heater & Vent-Final
13. Roof Drains � 64. Plumbing System - Firtal
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 '/q(�,1 L� FIRE DEPT. REQUIREMENT
20. qough Factory Fireplace APPROVALS Permit # �
27. pucts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24: fioof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. pverhead Hydro
26. 7-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing ' 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FlRE PREV. FINAL
30. prywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electriral Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: ,
34. Final Heating & Air Conditioning IO,�`�.' �
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 pomesticFinal -
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
' �.4o0��cant to fill in all soaces except tnose within neavy eortler Iines ana sign all aDPropriate tleclarations. OI JS � 0/ � 2/84
3.c� T�
CITY OF COSTA MESA CONSTRUCTION PERMIT PE�O.�^ � TRACT NO. LOT NO. UNIT NO. '
�J
Projec�Address 3407 Lavender Lane
Applicant'S Mailing AddreSi � TVPE OF CONSTRUCTION X NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p, # Zone
Owner'sName Strindarti �j'lflf Cnr(1, Phone_546-116� pESCRIPTIONOFWORK/USEOFBLOG.
Address �.r1b�+-w MdCArthur QlStd M25a 9���� S MainBuilding: Accessory8uilding:
Arch/Eng. License No. TVPE OF PERMIT GRADING FOUnIDATION STRUCTURAL T Front � p
AddreSi � ❑ TENANT �❑ ELECTRICAL �PWMBING ❑ MECHANIGAL B R2af N
Phone�7R_11Q(� ❑�OTHER A I
Contracmr'sNam New Plumbing - c Pight " N
71f19 N Fce Ana Anahaim PROJECTDESCRIPTION $Q.FT. � OCCUPANCV G
Address�mailing) CONSTRUCTIONTYPE VALUATION$ g Left
City License No. '3'JA7l ZONE GRADING CU. VDS. ACRES R
� LICENSED CONTRACTOR DECLARATION ' Plny. R¢f. # Parking Req./Provided E
Q
1 hereby aftl�m tnat I am licensetl untler pr islons f Charter 9(Commencing Remarks: I S � � Planning Notes: � ry�
wllh section 7000) of Division 3 Ot the 8 Sin¢55 ntl Vrofes5ion5 Cotle, antl
my Iicense is in fu11 foJ�ce�j etfect. , � ' T
License Class y'�+� ense No. 4ZE)� O9 S'
Date�_Q.�j.Q�sl�— Signature � PLUMBING FEES
WORKE0.5' COMPENSATION DECLAf2AT10N � Bar Sink Showel5 ELECTflICAL FEES
1 hereby aitirm that I M1ave a certiticate ot mns¢nt to salt-insure or a certifica[e
ot Workars' CompenSLtiOn Insurance, 01 a c¢rtifietl COpy lheleot (Sectlon BdCkflOwP!¢V¢OtE! $¢fviCCSink '
3800, �ab. Aummatic Washer Tronsformer ❑ 15-50 KW
Polic No.P[�C-1777141 Company Home Backflowlrriation SewerCa ❑50+KW
y 9 P Construction Pole Su6.
Certified Copy is hereby tumishetl.
E Iifeq cy�7y B filetl with fhe city Bui�ping q�`y sion Balhtubs Sewet Connection Cpoking Unit Meter ❑up to 100 amps �
Date��l�ll1/2f4 APPlicant r1PW F�IIIffIb1f10
EXEMPTION FROM WORKERS' COMPENSATION DEGLARATION Cle�ifi¢�5 ' $Oldf C0112Ct0�5 DiShwdih¢/ M2t¢� ❑OVC� 100 amps
(Thi55¢ctiOn neetl not be completetl it the permit is far One huntlretl ($300) or - -
less). Dishwdsher Solar Piping Dryers �GaS ❑Electric Sub Panel
I certify tha[ ln the performance of the wo�k for which this permi{ is issuetl, I . �
shall not omploy any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors �0-1 HP �1 Yx - 8
Worke�s' Compensation LawS ot Califomia. -
Date Si9nature Floor Drains Swimming Pool w/Spa F.A,U. Ina Solar �9-15 HP �16-15+
NOTiCE: If, af[er makin9 this tleclaration, you Shoultl become sublect to the
Wofkers' Compen5dtion provisions of the LdbOr Cotle, you must torthwith FIOOf SinkS UliOdl FixLUI¢5
Comply wiln such pwviiions or Ihis permit shall be tleemetl revoketl. MiCroWavE
CONSTRUCTION LENDING AGENCV: � GasSeNiCe OutletS WaLerCloSE[ DeviCeBoXes '
I hereby affl�m that thete is a constru[tion'lentling agency for the perfo�mance POI¢ Liyht
of tha work for wbich this permit is Issuetl (Section 3097 Civ. C.) Interce tors Water Heater '
Lentler's Name P Outlets Range
Lenaer's Aatlress _ Kitchen Sink Water Service Swi[ches Sign
OWNER BUILDER DECLARATION
I hereby a1/7�m that I am exempt from the Cont�acto�'S License Law tor the Lavatories G2�b3gC Di5pO5dl StdOding $¢CtiOns
(ollowing reason (Section 7031.5 Business antl Professional Cotle: Any citY or
counW which requires a permit to construct, alter, improve, tlemolish or repair P-Trap • . _ ''
any SVUGtule, pflor to Its issuanc¢, also feqWr¢5 [he applicanl fOr such permit �i¢fl¢fdtOf Qa5 KW 05-15 KW TIdSh COmpdCtOf
to (ile a signetl Sta[ement that he/She is IicenSetl pu�suant to [he p�ovi5ions ot ROOf Df3if15
Ne Contractor'z License Law (ChaO�er 9(mmmencing wlth Seclion ]000) o(
DiviSiOn 3 01 the Buslne55 antl ProfeSsionS Cotle) ol thal hC/she i5 ¢xempt _
[h¢retrom antl the basis (or the allegetl ¢x¢mption. Any violalion of Section
7031.5 by any ap0licant for a permit subject5 [he applicant to a civil
�enalty ol not more lhan five �untlretl tlollars (E500). $ 3
LJ I, as owner of Ihe 0/operty or my emploYees with wages as their sole FieinSpeetiOn Fea $15 Issue F80
compensatlon, will tlo the work, antl the structure is no[ intentletl or offeretl Reinspection Fae $15 Issue Fee $ 3
for sale (Section -7044, Business ana Professlonal Cotle: The ConVactor's MECHANICAL FEES
License Law tloes not apply to an owne� of a proper[y who builtl5 or improves
thereon, antl who tloes such work nimseli/herseH or mrougn his or ner own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provitletl Ihal Such Imp�ovemen[5 are not intentletl or offeretl for BOiI¢� HOOd O� Typ¢ I ❑ Zp�ing App�OVBd By Dat2
sale. If, howeve�, the bullding cr improvement i5 Soltl wlthin one year of com- CenOpy Typ2II ❑
pletion, the owner will have the bu�tlen ot proving he/she tlitl nOt builtl or im- DUct - UndC� Ciround Buildi08 %�PP�oved By Ddt¢
�rova for lhe purpose of zale). . � �—� � Z
LI I, as owner of tne oroperty, am exclusively contractin9 witn licenzetl con- Duct - Structural Retrigeration System Applintian Issued 6y Dat��..d..�_�_
tractors to <onstruct the o�oject (Section 7044, Business and Proteszions Cotle:
The Contractor's License l.aw tloes not apply to an owner oi property who Duct - Ventilating ❑0-700 000 BTU ❑100,000 BTU �—
buims or improves thereon, ana who mntracts for such projects wim a con- SUMMARV OF FEES
tractor(s1 license pursuant m the ConVacior's Litense Law). I am aware thac Exhaust System ❑ Multiple ❑ System Repair/Alterotion BUILDING PERMIT $ SMIP $
proot Of their Worker's Compensation insurance shoum be proviaetl m me. PLAN CHECK $ PERMIT
❑ I am exempt under Seciion e. & P. C. tor this reason Firepl/Face. BIL ICBO # PLUMBWG $ J�rJr� �SSUANCE $
Heatin S stem & Ductin PLAN CHECK 25% $ ENERGY P.C. $
Da[e Owner 9 Y 9
1 hereby cartity [hat I have r tl t" appliwtion antl state that the above ❑P100,OOOBTU �100,0006T GRADING $
information is correcL I a9re to com ly with all tlry antl county ortlinances ELECTRICAL §
antl state laws relating to bi Itling c ntruction, antl hereby authorize repre- P�AN CHECK 50% $ MICROFILM $
sentdtives of i t0 e tet u on th¢ abOve-m¢ntlon¢tl p/operty r
inspection ourooses. MECHANICAL $ TOTAL FEE $
Signature � �i+'�- _ Date d � gy qeinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ ��O
Drivers' LI<ense or 55 � -
CMF 0865-46, rev. 4/89 White - Builtling; Canary - AppliCdnl; Pink - Accounting; Goltlenrotl - 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, O Undrgrnd.
10. Structural Floor System �j . 61. APPROVAL TO DECK t�
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 'r
12. Sewer Cap 63. Heater & Vent-Final i"'
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 Eleariral-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace ' APPROVALS Permit #
2-1.' Ducts, in Structure 70. Underground Hydro �
22. Ducts, Ventilating 71. Product Piping � 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 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 � (�N (��j
36. Hood or Canopy
37. Final Factory Fireplace '
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation � _
44. Landscape Irrigation System
45. Sound Attenuation '
46. Handirap Regulations � .
47. FINALSTRUCTURE�&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co �
51. CERTIFICATE OF OCCUPANCY
No. Date