HomeMy WebLinkAbout3412 LAVENDER LN - Building Permits4�5�Q M�'r4
4
O,
i . ;p
' '� d
J
a o�.�o d'*
m
CITY OF COSTA MESA ,
BUILDING DIVISION
77 FAIR DRNE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • w�^N.costamesaca.qov
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT TYPE PLUM
APN: 41237310
PERMIT NUMBER: P12-00013
STATUS: ISSUED
DATE ISSUED: 01I3112012
ISSUED BY: KJB
:IOB ADDRESS: 3412 LAVENDER LN CM Suite/Unit:
vicinity: '
SCOPE OF WORK: CHANGE OUT WATER HEATER. SAME LOCATION. LIKE FOR LIKE.
'�..7
OWNER: BAUQUET, RAYMOND TR Address: 3412 LAVENDER LN
PHONE: City/State2ip: COSTA MESA, CA
APPLICANT: MAZARIEGOS, BYRON Address: .
PHONE: 1888 611-0328 City/State/zZip:
CONTRACTOR: AFFORDABLE WATER HEATERS AND PLUMBING
Address: 24663 RAILROAD STREET
PHONE: 661 •259-7131
City/State: N�WHALL, CA ZipCode: 91321-1742
ARCHITECT: License No.
ENGINEER: License No.
.7t
�c
nt•
Ph
.;P
�"�'
.':;
License No. 627368
CELL:
PLUMBING PERMIT FEE SUMMARY
PLAN CHECK FEE:
PERMIT FEE:
TOTAL FEES:
$0.00
$35.80
$35.80
PHONE:
PHONE:
.��
'NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
�INSPECTIONS: In ortler for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and Fnal approval must be obtained Failure lo obtain inspections and fnal approval will resull in the expiration of this permit.
cooet, iNsvecnoxrne
�1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 FinalRe-Roof
�201 Final BlocklRetaining Wall
[�
202 Final Factory Fire Place
r:e
203 Final Si9n
204 Final Demolition
D� INIITIRLS 40DEt IN$PECTIONTYPE
206 Final Mechaniwl
208 Final Plumbing
270 Final Electnwl
272 Final Fire Prevention
220 Final Planning Approval
222 Final Si�e
250 FinalBuilding/Occupancy
�
ppTE NI TITIRLS
i< �- �9 - I o`�- �'6t}'
WORKERS' COMPENSATION DECLARATION: '
I hereby affrm under penalty o( perjury one of the follovnng declarations:
❑ I have and will maintain a certifca[e of consent to sel4lnsure for vrorkers'
compensation, as provided for by section 3700 0( the La6or Cotle, for the
peAormance o( the vrork for which this permit is issued.
❑ I have antl will maintain wnrkers' compensation insurance, as required by
section 3700 of Ihe Labor Code, (a the performance o( the work for which this
permi� is issued. My workers' compensation Insurance carrier and policy
number are:
Carrier. ���5 �F %f� L���T
(IDis sedlDn need irof be wmpeled d lhe pennR is vaWetl a( me Ountlietl dollars (5100) orless.)
Policy Number: �S4 SbZo 3a3D0
❑ I certify tha[ in the performance of the work (or which this permit is
issued, I shall not employ any person in any manner so as to become subject
to Ihe workers' comp tion laws o( California, and agree that if I should
become subject to t u cers' compensation provisions o( Section 3700 0(
the Labor Code sha with c� ply wi[h [hese provisions.
/- 3/-�z
App! n Wr Date
WARNING: FAILUR TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
(5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affrm ihat I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and eftect.
Lic.# �1'�6� Class# C ��
i^ 'l/ /Z-
G ig ture Dale
CONSTRUCTION LENDI G AGENCY:
❑ I hereby affrtn �hat �here is a consiruction lending agency (or the
pertortnance of the v.ork (or v,hich this pertnit is issued. (Sec. 3097, Civil Cotle).
Lender's Name:
Lender's Address:
OWNER-BUILDER DECLARATIONS:
I hereby aKrm that under penalty of perjury Ihat I am EXEMPT FROM THE
CONTRACTORS IICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Cotle: Any ciry or county which requires a permit ro
wnstruct, alter, impmve, demolish, or repair any strucNre, prior to its
issuance, also requires the applicant for such permi[ [o fle a signed statemen[
[hat he or she is licensed pursuant to [he pmvisions of the Contrectors
License Law (Chapter 9(commencing with Section 7000) o( Division 3 of the
Business and Professions Code) or [hat he or she is exempt iherefrom and
�he basis for the allegetl exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicant to a civil penalty of not more than
fve hundred dollars ($500).):
❑ I, as ovmer of the property, or my employees with wages as their sole
compensalion, WILL DO THE WORK, and the slructure is not inlended or
oRered for sale (Sec. 7044, Business and Professions Code: The Coniractors
License Law does not apply to an ovmer of pmperty who builtls or improves
Ihereon, and who does such work himself or hersel( or through his or her ovm
employees, provided that such impmvements are not intended or oRered for
sale. If, however, the huilding or improvement is sold within one year o/
completion, the owner-builder will have the burden of proving that he or she
did not build or improve (or purpose of sale.).
❑ I, as owner of [he property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to cons[ruct lhe project (Sec. 7044, Business antl
Professbns Code: The contractas License Law does not apply to an ovmer of
propeny who builds or improves thereon, and who contracts for such project with
a contractor(s) license pureuant to the Contractors License Lavs.).
❑ I am exempt under sec.
Business and Pro(essions Code (or Ihis reason:
305]-A6(3I0])
Ovmer ID verified by driver's license. ❑ Yes ❑ No
Driver's License No. Expires:
Verification of Ownership by pype of document, i.e. - pioperty tax bill or deetl):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby certify ihat no excavation fve (5) or more feet in depth into which a
person is required to descend, will be made in connection with wurk authonzetl
by this pertnit, and Ihat no builtling structure, scaffdtling, (alsework, or demolition
or dismantling �hereof, will be more ihan thirty-s�c (36) feet high. (Chap. 32, Gry
2, Art 2, Sec. 341, Ttle 8, Califomia Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would
require a permit from ihe Division of Industrial Safety, as noted above, unless
such person has a permit to do such work (rom [he tlivision.
Apphcanfs SignaNre oa�e
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant neetl to file and
certify a Business Plan for emergency response [o release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 ot the Califomia Health and Safety Code requires, with some
exceptions, tha[ a Business Plan be fled with the Cos[a Mesa Fire
Department by every business which has at any one time during a reported
year a quan[iry of hazardous materials equal to or greater ihan a weiqht of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will the applicant or present or fu[ure building occupant need to fle
a registration fortn for acurely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Sa(ery Code, with some
exceptions, requires registration vnth Ihe Costa Mesa Fire Deparlment by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic (eet of compressed gas at standartl
temperature and pressure).
3. Does or will [he applicant or present or fuNre builtling occupant need to
prepare an RMPP (Risk Management and Prevenlion Program (or acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of [he California Health and Satety Code provitles that the
Costa Mesa Fire Depariment may require the preparation, certifca[ion antl
fling with the Fire Departmem o� an RMPP by businesses which are requiretl
[o regisler acutely hazardous ma[erials with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the California
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or fuWre builtling occupant require for
the work which is the subject of this application a permit for such construclion
or modification fmm the South Coast Air Qualiry Management Distnct or from
any other air pollution contml district or agency? ❑ Yes � No
(Sectbn 65850.2 of the Califomia Govemment Code requires that the requested
infortnalion be fumished on applications (p rwn-residen[ial building pertnits).
6. Will any part o( Ihe facility to be constructed under Ihis permi[ be within
1000 fee[ from the outer boundaries of a school? ❑ Ves ❑ No
(If'yes", the facility must meet the requirement of Sections 25534 and 42303
of the Califomia Health and Safety Code).
7. I( a permit from ihe Soulh Coast Air �ualiry Management District or other
air polWtion control distnct or agency is required for the work which is the
subject of this application, have all o� the disclosures prescnbed by Califomia
Health and Safery Code Section 42303 been made? ❑ Yes ❑ No
8. Qf'yes", attach certificate of compliance from the appropriate air pollution
control oRcer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of peryury the
information given above is correcL I agree to comply with all state laws antl
city ordinances regarding Hazartlous Materials and Emissions.
SignaWre Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury �hat I have read Ihis application antl state that
the information given is correcL I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not ro occupy or allow occupancy of any building
authorized by this per � until fnal inspection.
Siqna� otL al s) Date
C
/ �� / z .
AnC/ r olit�anl Dale
AGDlicant to fill in all soaces excev< those witnin heavy Goraer Iines'zne sign all avVrovriata tleclarations.
CITY OF COSTA ESA CpNS`TyR,U,�C� ION P�RqM�I�T�
Prolect Address � Z � �"�.� � ✓r"• "��
:�,�plicant's Mailing Address � �'1 e�' �_ ���I� e/�p�
Owner'sf�qme �_%%%ls��h PhoneL�L1lf.SJ�
Address 3�i/,�. L.Gi ✓e/! ev� � R/� G�
Arch/Eng. License No.
Address
Contractor's Nam Phone
Address Imailin9)
City License No.
LICENSED CONTRACTOR DECLARATION
I hereby aftirm [M1at I am licensetl untler provi5ion5 ot Cnarter 9(<omT¢ncing
with section �000) of Division 3 of the Business antl Professions Cotle, antl
my Ilcense is in tWl tortt antl e(fect.
LicenSe CIa55 Licenze No.
Date Si9nature
`�+ORKERS'COMPENSATION DECLARATION
�:reby aHirm that 1 �ave a certificate of consen[ to Self-in5ure or a certificate
Workers' CompensatiOn InSurance, Or a carllfled copy thereo( ($eclion
a000, Lab. C.) _
Policy No. Company
BCertifietl copy is nereby fumishetl. •
Certifietl capy is filetl with the ciry Bulltling Division.
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl not be completetl it the permlt Is for one huntlretl ($100) or
less).
I cfrtlfy [hat in the pe�fo�mance of the wo�k tor whiCh this pCrm' a isSUetl I
Slldll f10[ ERIpIOY dOy pCf50O �fl dOy manner 50 d5 [O E SU�ject to tl�e
Workers' or�pensat`o� Lay'� of Ca1i(o . _ - '_ 6
Date �� L�yK ,�S'9na[ure -p���� ��`
NOTICE: If, after making this tleclara[lor�n,�you shoulr become sub�ect to the
Workers' Compensation provisions o/ the Labor Cdtle, you must fo�thwith
comO�Y �+'��� Such prOvi5ion5 or tbi5 petmit ihall be tleemetl revoketl.
CONSTRUCTION LENDING FGEtiCV
I nereby afllrm that tnere is a<onstruction lentlin9 a9ency for the performance
of [he work ior which [his petmit is issuetl (Seclion 3097 Civ. C.)
Lentler's Nama
Lentler'S Adtlr¢Ss
OWNER BUILDER DECLARATION
I hereby aliirm that I am exempt from the Conlractor's License Law for the
following reason (Section �031.5 Business antl Professional Cotle: Any ci[y or
county which �equires a permit to construGt, alte�, ImprOve, tlemolish or re0ai�
any zlrucWre, prbr [o its issuance, also requires the appllcant tor such permit
to llle a signetl statement that he/she is Iicensetl pursuant to the provisions of
'•e Contractor'S Ucense Law (Chapter 9(commonang with Section 7000) of
�ision 3 ot ihe Business antl Profesvons Cotla) or that he/she is exempt
,retrom antl the basis for the allegetl exemPtlon. Any viola[ion ot SecHon
d I.5 by any applicant for a permlt subject5 [he applicant to a civil
e alty ot not more than five huntlretl tlollars (y500).
I^as owner of the prop^rty o� my emo�oyees witn wage5 az thei� sole
� m nnmlinn will M fM1a w rk. antl the stluCtUf¢ IS fIOI if1l¢ntlEd OI�Of(¢ICtl
) an owner of a proPerty who builtlz or
work himself/hersolf or through his oi
i imorovements are not intentletl or o
[ion; the owner will have th¢ burtlen of proving ne/sne aia not owia or im-
�ye torthe purpose of sale�.
t, as owner ot the property, am exclusively contractin9 with Ilcensetl con-
ctors to cOns[ruct the projec[ (Section ]044, Business antl Pro�ession5 GoOe:
ontractor's License Law tloes no[ appty [o an owner of proper[y who
x improves thereon, anU who contracts to� such oroiects with a ron-
5j LcenSe pursuant to me Conlracto!'s �IcenSe Ldw). 1 am aware Ihai
�( thel� Worker'S Compansa[ion insuranCe Shoultl be provitletl to me.
I exempt untler Section Bf�.B� AAC. for this reason
_' _ i .
oac� .� —�
I hereDy cerH
information Is
antl state laws
sentatives oi
in5pection p}�/
$igpdture /l9
Drivers' Licens
�.� Owner �
that I have reatl Ihl
rect. I aaree to com
or 55 $
[he
rte that the above
wunty ortlinances
y authorize repre-
netl property for
. F�.��� s�l 8 t� � 1201 I �-- � 5 I.,._ ,..,.
TVPE OF CONSTRUCTION NEW ADD A�TERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLOG.
TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION S�.FT. OCCUPANCV��
CONSTRUCTIONTVPE VALUATION$ �/ 6 lJ
ZONE G0.ADING CU. VDS. ACRES
Rema�ks:
Sink
Preven[er
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlecs
Interceptors
Ki[chen Sink
lavatories
P—Trap
Roof Drains
Reinspec[ion Fee � $15
Duct-UnderGround
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Pirepl/Fact. BIL ICBO �k
Heating System & Ducting
❑U700,000 BTU 0100,000
aa������o� F� � s�s
0865-46, rev. 5/88 White - Builaing; Canary - Appllcanh Pink - Accounting; Goltlenrotl - Assessor
Showers
Service Sink
Sewer (:ap
Sewer Cannection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Issue Fee
Hood or Typel ❑
Canopy Typell ❑
Refrigeration System
❑aioo,000sru ❑ioo,000
System Repair/Alteration
Fire Dampers
Registers
Isue Fee
n.P. �M. � - _
S Main Building:
E
T Front
B Rear
A
C Right U
g . Left
Ping. Ref. #
Planning Notes:
FEES Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Oryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
OuUets
Switches
zone
Accessory Bu
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+ KW
Meter ❑up to 100 amps
Meter ❑over100amps
Generator'�0.5 KW 05-15 KW
Sub Panel
Momrs 00.1 HP �1Yh-8
Inc. Solar �9�75 HP 016-15+
Microwave •
Pole Light '
Range
Sign
Standing Sections
Trash Compactor
Heinspectian Fae �$15 � � luue Fee
FEES
$ 3
O
N
I
N
G
R
E
�
M
T
$.
$3 DEVELOPMENTSERVICESREQUREMENTS: �j
Zoning Approved By � Date � 1' 2�� L
FEES BuildinB APP�oved By Date __ _
$ 3
� � � SUMMARV OF FEES
BUILDING PERMIT $ � SMIP
PLAN.CHECK • $ ��gS PERMIT
PLUMBING • $ ISSUANCE
PLAN CHECK 25% $ ENERGV P.C.
ELECTRICAL� $ GRADING
PLAN CHECK 50% $ MICROFILM
MECHANICAL $ TOTAL FEE
PLAN CHECK 25% $
$ O�
41 4�70184?3-OOOlE430 TGT �;.'s5
GA7E: }iioziss TInE: o�:o�
CC►lVSTRUCTION AND PLANNING P� ` SPA '�' { '
Date Inspector •- ' `�i�"e Inspector
APPROVALS Permit # APPROVALS Permit #
1. Tem�fi�rary Electrical Service or Pole 52. Pool & Equipment Location �
i
�2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement '
.3. Electrical Conduit Utility�Undrgrnd. � � 54. Forms . i �
� 4. Electrical Conduit-Undrgrnd. �� 55. Electrical Bonding , � •
5. Steel ,Reinforcement � 56. Rough Plumbing & Pressure Test �
, 6. Electrical UFER Grnd. � 57. APPROVALTO COVER-GUNITE ' • .:
� �
7. Footi�gs • r 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 . 61. APPROVAL TO DECK �
it. 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
'1-7. Rough Wiring Sign 68. APPROVED FOR PLASTERING
.18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
'79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
i
22. Ducts, Ventilating 1 71. Product Piping � Gas ❑ Oil
23. Gas Pipe�Rough & Test � 72. Underground Flush
24. Roof Framing � � 73. Undergrnd.StoregeTank OGas ❑Oil
25. Roof Sheathing . 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monowat 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 ��
G O �'dr/ // �O
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace ; � � eG a� 7�•
38. Final Plumbing
39. Water Service-Final �
�40. GasService-Final
�41. Solar pomestic-Final�
�
42. Backflow Preventer .
43. Backflow Irrigation � � ' �
44. ,landscape Irrigation System . • � �
r
45. Sound Attenuation � -
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING �� � Z� . . , �
48. Special Requirements Completed
49. Electric Release to Edison ' ' '
50. Gas Release to SouEhem California Gas Co � �. - ' rJ
51. CERTIFICATE OF OCCUPANCY , ' , �,
No. Date �, ' . ��
�
1: •alr .L : e• ra.o:�
�is x�e�xiar. ��a e�r.��a .sr►e� chss 3 I aa,� of
O�.T ���(�. r 1988. bY erd beb+een � Q �,(Il,f �P _ i�. �. �-U.IJ
he:einafter referred Lo as •LAt� RR�tt'• and _�QV�il�l(ti �. 1 f I�YlaS�7.tr�
hereinafter referced Lo as •A�TACI�2dP PROPEA7Y fiEdF�t".
It is hereb� egreed that a party �+nll will be aorLstxt�cted on the
Prq�erh' line beh+een ��{- � � �� A N
r
� q�.Gz6
�1- 92�zG
in the City of Casta Pfesa, Canty of Orange, State of Calitrnnia, as per map
reoottled in Bodc , Page of Miscellanews Maps, in the a�fice a� the
Cas�ty Aecorder o� said Co�nty. �e party w*all shall be peaaitted tc encraad�
IN WI�SS �DOP, the parties have entered into this Agreeient the
day ard yesr ficst above written.
IJ4ND dd�:R
(Signatase)
(�Ct,l.(/l�, Ce. � � � � e�-o
Nmoe t or Pran )
3� i i c��M.i,cWvt Sf ��.4i�e.dQ
cna�es�
A���
�► �ra •-a•rv • � r•
3�k l�i o{�a�-�c�-Q�t.. °C�s��, `��
(Ad�ess )
�t ' '� �1 7/ ? � �' �
City of Costa Mesa 3uilding Dept.
BY �.—_ DATE.LI—Z i 9 C�
THESE PI.ANS MUS � 6e ON 108 Ai AlL TIMES MAI(E
NO CHA'�'GES W2ITHOUT PpR!OR G.FPROVAL OF DEPT.
� .J � � O�
TH���3�•� C E OF. GP.A�ING G� A iEFh;ii OR APPROVAI OF
PLANS �`�J' f•cUFICATIONS SFiatt nGf ?F CONSTftU[D f0 dE A
PFA4ltT :. :2 AN APFAOY0.L CF. AN� `ROLA!!ON OF ANY UF
TNF PFC. -- ; OF iHl] CvD'L Nj PERMI' PRcS�!MING 10 GNE
AUTnQeu: •J JIOlA1F OR Cnn'CEL "`�E ��OVi510N5 OF THIS
GODt SnH„ f� JALIO, EXCEP? IM SO rA` AS iHF WORK OR USE
wHICH R ni.'-JH¢ES IS :A`•4'fU:.
THE 155i"" �E Oi A?ERMiT C:SED UP�N PL4N5 ANU
SPFCIFICATfC�S SHALL Np� c-_VEtiT 'kE 6UILDING OFFICIAL
PkC:A Tr'cRE..F '_R REO:ii'n�F';i iY.E :.G:�=��tON Of ERROR$ IM.
SAtD PLANS n^�D SP�Cl��Cl�f:G*+5 C:R F�"OM PREVEN7ING
B��i0��3 a'Eu.TIJ�CS nf..� �- C47RIfD O:t iMFREUNiJER WHEN
IN b'tfNAttON QF 7l+5 CUBE C4 Q` M'Y O"�'cR Q:2DINANCE Of
�.__' iG�/ / i
0
dW
�W
�¢
�
N
NEbIDEMCE
3ylZ
NOTE
ADDITIONS, DELETIONS, OR CORRECTIONS SHALL
BE APPROVED BY THE PLANNING DEPARTMENT
N[lIO�MCL
REBIDEMCE
�Q�IE er_ (.-sin� SrREer o- _
RFtIDEMC[
. ,a�����
j � ��OF COSTA MESA
� FLANNING DEpi,
; auaiEcr ro ewcs. c�. e�.
Ia�'—� � n� � • z - � 8
, BI o� nu�►�ua
Cement Coping Optional —�
CFiannel Block With 13/8�
Horizontal Top of all
Fences
For Fences 5' or Less
Vert. Bars 3/8" � at 4' -0" O.C.
For Fences Higher Than 5'
Vert. Ban 3/8"� at 32" O.C. �
fill Celis Solid With Grout
Where Steel Occurs
Reinforcing Steel Shall
Conform to Sec.A•15-39
A.S.T.M.
All Steel to be Lapped
24" or to Code
NATURALGRADE
TW0�3/8"$ BARS L
CONTINUOUS TOP
& BOTTOM - -
ii002.STEEI MUST BE TIED IN
P.LACE AT TIME OF TRENCH
INSPECTfON.
TYPICAL 6" CONCRETE BLOCK FENCE
s
0
a x
��
�
> w
� _
a
>Z
a
i �
W O
U 1-
i«�e 'p i�+
on
D '
I-�WIDTH
p" SEE CHG
o BELOW
D.I'n
FOOTING REQUIREMENTS CHART
GENERAL- NOTES
MORTAR: p�e Parf Plasfic Cement, and
Thret Parts Sand
GROUT: One Part Cement Three and
One Half Parts S�and
COPING: One Part Cement, Three
Parts Sand
CONCRETE: Wei l Mized 1:2- I/2: 3- I/2
Max. of 7- 4/2 Gallons o4
Wotar Per Sack of Cement
GROUT MAV BE POURED FROM THE TOP
OF THE FENCE IN CELLS WHERE STEEL
OCCURS.
CELLSAND AREASOF HONIZONTAL REIN�
FORCEMENT SHALL BE CLEAR, CLEAN &
FREE OF AlL MORTAH DEBRIS, ETC.
H OF EARTFfiTCOTH
I/3 THE HEIGTH OF fENCE
�OW �BOTTOM OF FOOTING.
SCA�E: i/2�� = I'
....__ .._._... _ _ . _
WIDTH . . . . . . . . . . . . . . .14" . . . . . . . . . . .14'� . . . . . . . . . . i._12":.__.. _ 12°.':
THICKNESS . . . . . . . . . . . .10'�. . . . . . . . . .. .10° . . . . . : . .'. . . e". . . . . . . . . . . 8�.
DEPTH OF EARTHTOOTH . . . 24" . . . . 20�� .
16" . . . . . . 12°
SPACING OF EARTHTOOTH. . 12' . . . . . . . . . . .14' . . . . 16'. . . . . . . . . . . 16'
.. City of Costa Mesa, California
• Building Department
i a ��.. ._.._�_ . jLEVISEP NOK62
OWYERS NAME: _ _ _ _ _ _ _ — — _ _
JOB ADDRESS: — _ _ _ _ — — _ _ _ _
FERMIT NUMBER:_ _ _ _ _ _ _ _ _ _ _ _ _ �
SIGNATURE: _ _ _ _ _ _ _ _ _ _ _ _ _ _
AOPlicant to till in all svaces ezceot ihose within neav� boraer 17nez ana si9n all a0o/ovriate tlec .
.-�tTy GF cosTn mesa PLAN 4 El v.. A
, CONS1�iUCTION PERR�IT LOT 15
ProjGct Address �� 1 �T_�_i_Q���o.+��^ I� n��_�wg}�_(��
Applicant'sMailingAddress }����f� M�n��_B�V��_�_6.j�Q.
Owner'sName �.�a.p���a-�_o ��j �:��r�Phone C���_��o�
Address � ���f ,����^ Q� �•� , -
Arch/Eng. ��S�S�reecer License No. �ge8�
Address �Tgg� s��,-���E���rvine
Contractor's Nam �ee�y��-Phone
Address (mailingl
City License No. �G�j�% G �
LICENSED CONTRACTOR DECLARATION
I'hereDy affi�m tha[ I am lic¢nsetl untler provision5 oT Charte� 9(mmm¢ncing �
with section ]000) of Division 3 ot the Business antl Professions Cotle, antl
my license is in (ull (orce antl eftect.
License Ciass - U�48042
Date � �__�__��_�� Siqnature
WORKERS'COMVENSATION DEGLARATION
I hereby affirm that 1 have a certifica[e of consent to self-insure or a certitica[e '
ot Workers' Compensation Insurance, or -a certifietl cooY thereot (Saction
3800, Lab. C. y " � ` �
Poii�v No. W�-R4-995-R56 com6a�'v-Framnnt TndPmnitv
eCeriifietl copy is hereDy fumishetlC� �� �
Certifietl cop y is filetl with the city Builtlin9 Division.
Date 1�6_RZ Apolicant Cfanrlav�ri Darifir
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION �
(Thls section neetl not be completetl i( the permit I5 tot one huntlretl (5300) or
less). �. � •
I certify that in the Oetfo�mance oT i6e wo[k for which thi5 Oe�m�t is i55uetl I
shall not employ any person in anL-�manner so,az to become zubject to t{�e
Workers' Compensa[ion Laws of California. , �
�ate Signature �
NOTICE: If, after making this tleclarztion, you shoultl become subject to the '
workers' Compensation provisions of the Ldbor Cotl¢, you must forthwith '
comply with such provisions or this Dermit snall ba tleemetl revoketl.
CONSTRUCTION LENOING AGENCV • ' � • �
I hereby affirm fhat [here is a construction lentling agency fo� the pe�tormance
ot the work for which this permit iz issuetl (SecHon �309] Civ. C.)
Lentler's Name
lxntler's Atltlress �
OWNER BUILDER DECLARATION
I hereby atfirm that I am exempt trom the Contractor'S License L.aw fbr the
following reason (Section 7031.5 Business antl ProfesslonaLCotle: Any ciry or
wunty w�icn requires a pe�mit to construct, alter, im0�ove, tlemolish o� repal�
any structure, prior to Its i55uanc¢, also r¢quires the appliCdnt for Such pe�mit
to tile a si9netl statement that he/she is Iicensetl pursuant to the provisions of
the Contracior's License Law (Chapter 9(commencing with Secilon 7000) ot
)ivi5ion 3 of lhe Business and Profe55ions Cotle) o� tha[ he/5M1e is exempt
herefrom antl the basis tor the allegetl exemption. Any violation o� Section
]031�.5 by any applitant fo� a petmit subjects tne appliCant to d civil
�enalty ot not more than five buntlretl tlollars (g500).
I, as' owne� of the pmperty or my employe¢s with wages as thel� sole '
comoensalion, will tlo the work, antl the structure is not intentletl or otteretl
for ule (Section 7044, Business antl Protessional Cotle: The� Contractor's
l.icense law tloes not apply [o an owner of a property who builtls or improves
thereon, and w�o does suth work hlmself/herself or fhrougM1 his or M1er own
employees, prOvitl¢tl that such ImOrovements are not Intentle0 O� ofteretl fo�
sale. It, however, the builaing or improvement is soltl within one year ot com-
pletion, the owner will have tne burtlen of proving he/she aia not Duiltl or im-
�rove to� the purpose of sale).
I, as owner ot [he property, am exclusively contracting with licensetl con-
tractars to construct the prqect (Section 7044, Business an0 Protesslons Cotle:
The Contractor's License Law does mt apply to an owner of Oroperty who
builtls or improves thereon, antl who contracts for such orojects wlth a con-
SIdC2al(5) �ICCI152 0�115UdOi SO ih2 COOSldCIOf'S LICEf152 LdW).
❑ I am exemo� untler Section B. & P. C. tor this r¢ason
�ate
Signature (�/�� ��
Drivers' �icense or 55 �
CMF 0865-46 rev. 7/83
Owner
have reatl this apo���ation antl state that the above
a9ree to comply with all city antl county ortlinances
o builain9 �onstruction, and �ereby authorize repre-
t eng� ter. upon Ihe above-mentionetl pro rty for
�' �' Date y !
_.. .. . _. . - -- — _
(�9 /zoil ��5 � �p�
TYPE OFCONSTRUCTION r�Ew noo ALTERATION LJ aeaaia
❑ GONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK
TVPE OF PERMIT LJ GRAOING LJ FOVNDATION LJ STRVGTURAL
❑ TENANT ❑ ELECTRICAI ❑ PLUMBING ❑ MECHANICAL
❑ OTHER ',n^
PROJECT DESCRIPTION SQ. FT.�y OCCVanNcv_
CONSTRUGTION TVPE VAWATION $ �_'Le._g
ZONE GRADINGCV.VOS. ACRES �
Remarks: 3 �Q_ � � �
Sink
Preventer
Irrigation
Clarifiers
Dishwasher -
Drinking Fouotains
Floor Drains
FloorSinks �
Gas Service '�OuUets.
Interceptors
Kitchen Sink - �
Roof Drains
ABING � FEES
Showers
Service Sink '
Sewei'Cap f. �
Sewer Connection - •
Solar Collectors � -
Solar Piping ' '
SolarTank ?�. -- ('�
Swiniming Pool�,w/Spa �
Urinal �
Water Closet .
Water Heater .
Warer Service , .
�Reinspection Fee � $p5, � � Issue Fee ' � $ 3
Boiler
Duct- UnderGround
Duct - Structural
Duct - Ventilating
ExhaustSystem ❑ Multiple
Firepl/PacL Blt. IC80 #
Heating System & Duciing
❑ ai oo,000 eTu o i oo,000
� �� � ' I I Reinspection Fea
W hite - Builtlin9; Canary - Applicant; Pink - Accountin9: Goltlenrotl - A5ses5or
$25
Hood or Type I ❑
Canopy Type 11 ❑
Refrigeration System
❑aioo,000aru ❑�oo,000
SVs[em Repair/Alteretion �
Issue Fee ' I $ 3
A.P. iW
S Main Bui
E
T Front
8 Rear •
A
C Right
K Left
S
Ping. Ret. �h
Use of Building:
Planning Notes:
Automatic Washer
ConsVuction Pole Sub.
Cooking Unit
Dishwasher
Oryers ❑Ga�.
Fan
F.A.U.
Fixtures
Device Baxes
OuUets
Switches
5162 3/01/84
_ s Zona
Accessory Building:
/n.0 /i�..i� Park.Fees $ i�U -li-
ELECTRICAL "..
Transformer ❑ 15-50 KW
�50tKW
� Meter LJup to 100'amps
Meter ❑over 100 amps
lectric SubPanel '�
Motors � 47 HP � 1 X- 8
Inc.Solar �9-15 HP �16-
�� Microwave •
Pole Light
Range
Garbage Dispoul Standing Sections
Generator �45 KW �5-15 KW Trash Compactor
�
5T2.85 T�
FEES
O
N
I
N
G
R
E
�
U
1
R
E
M
E
N
T
� Reinspectian Fee � S25 � laue Fee �'$ 3 I
PUBLIC SERVICES REQUIREMENyS:
2oningApprovedBy l%K��+'�-��3 Date Z% �
Application ApProved By Data
Aooliwtion laued Bv � � Date ,��
BUIIDING �ERMIT
PLAN CHECK
PLUMBING
PLAN CHECK
ELECTRICAL
PLAN CHECK
MECHANICAL
PLAN CHECK
SUMMARV OF FEES
$ 4A5.50 SMIP $ 8.46
$ ]$.$9 PERMIT
$ ISSUANCE $
$ ENERGY P.C. $
$ GRADING $
$ MICROFILM $
$ TOTALFEE $ S�Z.HS
$
'�� CONSTRUCTION ANDPLANNING
- AFPROVALS Permit #
•�1. Temporary Electrical Service or Pole �
2. Soil Pipe-Undrgrnd. ��
3. Electrical Conduit Utility-Undrgrnd. -
, 4. Electrical Conduit-Undrgrnd.
5. Steel Reinforcement ,. '
6. Electrical UFER Gmd.. - .
7. Footings . �
8. Foundation ,
9. Water Pipe-Undrgrnd. '
10. Structural Floor System ' .
i i. Property Sewer Line & House Connection
12. Sewer Cap
13. Roof Drains
14. Rough Plumbing �
15. Rough Electrical-Conduit - �
i 16. Rough Electric Wiring �
77. Rough Wiring Sign �
18. Rough Electrical-T Bar Ceiling
19. �Rough Heating & Air Conditioning
20. Rough Factory Fireplace
21. Ducts, in Structure �, -
22. Ducts, Ventilating -
' 23. Gas Pipe-Rough & Test �
24. Roof Framing � _ .
�� 25. Roof Sheathing ` '
i
26. T-Bar Ceiling (Structural) & Monocoat
I27. Frameand Flashing ,� . .
28. Lathing & Siding
29. Insulation
30. Drywall Nailing
31. Plaster Brown Coat
� 32. Electrical Power Meter-Final
� 33. Final Electric • �
34. Final Heating & Air Conditioning
�� 35. Final Gas Pipe;Test
I � 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. Backf�ow 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 California Gas Co
51. CERTIFICATEOFOCCUPANCY
� No. Date '
Date
Inspector
���
PO(._. a SPA
APPROVALS Permit #
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55.� Electrical Bonding '
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER-GUNITE
58. Electrical'Conduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, � Undrgrnd.
61. APPROVAL TO DECK
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final
66: Solar System-Final �
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
71. Product Piping O Gas ❑ Oil
72. Underground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe �
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION �
60. FOOD CERTIFICATE ISSUED
Notes: .� .., /,_ / n /� � .. .
/D
Date � Inspector
e
Applicant to fill In all spaces exce0� those within neavY bortler lines antl sign all apPropriate tleclarations.
CITY QF COSTA MESA,
CONSTRUCTIONPERMIT � ��� /,a_
.ProjCiLAddf25 - TVPEOFCONSTRUCTION � NEW ADD ALTERATION -REPAIR
AppliCant'SMailin Addre55 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER
� OWner'S Nam2 / m�/ hone �ESCRIPTION OF WORK
Address ���/�� ` �n�u� � TVPEOFPERMIT GRAOING FOUrvoqTloN STRVCTURAI
�' Arch/Eng.���� ��/PS� Licen52 No. ❑� TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL
1 I�I
Address tJ�OTHER -'
1, Contractorj' a�J —�-� PROJECT DESCRIPTION 5�. F7. OCCUPANCv
/�d� �jy/��� �(J �e f= �U CONSTRVCTION TVPE � VALUATION $
ng
Address (m 1 ) ,
City License No. Os�iG �
LICENSED CONTRACTOR OECLARATION
1 hereby alfi�m Iha[ I am'licensetl untlet prOvlSionz of Charte� 9(commencing �
with section 7000) of DlviSion 3 of the Business an0 Professions Cotle, antl
my Iicense Is In tull rc�a��¢(fecL �� Q�!'�
Licens �Clds �� —)i5e9�a�
Date i9nature ��V�
/'�_
;��ORKERS'COMPE SATION DECL 0.ATION
��,� hereby aHirm that I have a certifitate ol consent to self-insura or a certificate
I:�f Workers' Compensa[lon Insurance, or a<erUtietl copy thareof (Section •
3800, Lab. �7 `y '
POIIGy No '.��1 �� Company C� • �
Certltietl copy is hereby fumisnea.
rti 'etl c is fi ith the city Bui ing vi �
Odte APplicant
EXEMPTION FROM WORKERS' COMP NS . ION DECLARATIO _
(This section neetl not be camplatatl it the permit is for one huntlretl (E100) or
1e55).
I c2rtity Ihat In Ih¢ perto�mance of the work for whlGh thi5 pBrmR is ISSUetl I
snall not employ any person in any manner so as to become subject to t�e
Workers' Compensation Laws of Californla,� '
Date Signa[ure �
NOTICE: It, aiter making tnis tleclaratlon, you zhoula become subject to tne
Wo�ke�s' Compensation provi5ion5 ot fhe Ldbo� CoEe, you must (orlhwith
comply wilh su<h proviSlons or thls Oermit shall be deemetl revoketl.
CONSTRVCTION' LENOING AGENCV � ' - '
I heraby aftlrm that tnere is a mnstructlon lentling a9ency tor the pertormance
of tM1e work lor which this pe�mit i5�issuetl_(SecHon 3097 Clv. CJ .
Lentler's Name '
�enaer's Atltlr¢ss � .
OWNER BVILDEii DECLARATION '
I hereby affirm that 1 am�exampt trom the�Contractor's�Ucense Law for,[�e i
tollowing rea5on (Section 7031.5 Buslnoss antl Professional Cotle: Any clty or �
rom antl the basis for�the allegetl exemptlou. Any violation ot 5<
5 by any applicant for. a permit, sub)ects the� aoolitant to a
�,y ot not more than five huntlretl dollars (§500).
as owner ot the property ror, my employees witn wa9es as thni�
aniation. will tlo the work. antl [he structure Is not IntOntleC or ol
License Law tloes not apply to an ownar of a property who bulitls or improves
th¢reon, antl who'tloe5 Such work blrt�self/he�self or through lils or her own
employeos, provitletl that such ImOrovaments are not Intentletl or offoretl for
sale. If, however, [he bulltlin9 or ITprOvement is soltl wi[hin one year ol com-
pletlon, the awner will have tne burtlen of proving he/she tlitl not bulltl or im-
�rove for the purpose of sale).
1, as owner of tM1e property, am exclusively contractin9 �+�th licensetl con-
[ractorsto constructthe project ISection 7044, Business antl Protes5ions Cotle:
Tha Contractor's �icense Law doez not apply_to an owner of property who .
Culltls Or improves theroon, and who contraC[s for Such proj¢Cts with a Con- '
tractor(s) Iicense pursuant to the ConVactor's Llcense l.aw).
❑ I•am oxempt untler Section � 8. 6 P. C. for this reason
�ate Owner' �
1 hereby certiry that I have reatl tnis applicatlon antl state lhat lhe abovo
information is wrre<t. agree to comply with all <ity antl county ortlinances
antl state laws re tin to builtlin onstr ction, antl hereby authorize re re-
sentaUves of t s c nt pon ie above-manHy netl pr op t for
inspectlon pur s . /� .. /U.� �
Si nature °�ate /
Remarks:
$ink
Preventer
Irrigation
D�inking Foun
F}oor Drains.
Floor Sinks
Gas $ervice �
Interceptors�
Kitchen Sink
Lavatories ��
Roof Orai�
GRADING CU.VDS. ACRES_
Outlets
Fee $25
Duct - Under Ground .
Duct-Structural '
Duct - Ventilating .
' Exhaust System ❑ Multiple 0'
Firepl/Fact. BIL ICBO#
Heating System & Ducting ,
❑ 0.100,000 BTU � 100,000 BTl
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Callecmre
Solar Piping �-
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater '
Water Service ��-
Issue Fae
EES
Hood or, Type 1 ❑ � � •
Canopy � Type I I ❑ �
Refrigeration System
❑o-ioo,000eTu ❑�oo,000sTu
System RepaidAlteration
9
D I e' Lic e 55 � {� ' I I fleinspection Fea � ,$25 I I � Issue Fea
CMF 0865-46 rev. 7/83 ' White - Builtling; Canary - Applican[; Pink - Accounting: Goltlenrotl ..Assessor �
$ 3
A.P. ;�
S Main Building:
E
T Front •
B Rear
A
C Right
K Left
S
Ping. Ref. #
Parking Req./Provi�
Use of Building:
Planning Notes:
Auromatic Washer
Construttion Pole Sub.
Cooking Unit � - -
Dishuvasher �
Dryers ❑Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes . .
Outlets
Switches
Garbage Disposal
Generator �0-5 KW C
'soue 6i��iea.
Zone
Acceuary Building:
Park.Fees $ � �
ELECTRICAL �
• Transformer 0 15-50 KW
❑ 50+KW
�� -Meter ❑up-to100amps-
Meter �er 100 amps
ic .Sub Panel ,
� Motors DO-1 HP �}7% - 8
.IncSolar �9-15 HP �t�6-
� Microwave �
. �Pole Light
� Range ,
Si9n
5 KW �' � Trash Compactor
I Reinspection Fee � I$25 I �ssue Fee� ' '
PUBLIC SERVICES REQUIREMENTS:
Zoning Approved By , Date
Appliwtion Approved By _ Date
5+
�6a.i�J Y�.
. Z
O
N
�
N
G
R
E '
Q
U
�, .
R
E
M
E �
N
T
S
FEES
$ 3
SUMMARV OF FEES � .
BUILDING PERMIT $ SMIP $
PLAN CHECK . $ PERMIT �
� PLUMBING � § ISSUANCE . $
� PLAN CHECK $ �--�y) ENERGV P.C. $ •
ELECTRICAL ' $ -Je'���r �V GRADING $ ,
7 � MICROFILM $
PLAN CHECK $ � ��, ��
MECHANICAL . $ TOTAL FEE � $
PLAN CHECK $
CONSTRUCTION AND PLANNING PO� t 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
Y .
5. Steel Reinforcement 56. Rou9h Plumbing & Pressure Test
- 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd. �
8. Foundation _ • �� _ 59. Gas Pipe, O Undrgmd., Test �
. 9. Water Pipe-Undrgrnd. 60. 8ackwash Lines, P-Trap, O Undrgrnd.
10.•Structural Floor System . 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62._ Backwash & Receptor�Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains � 64. Plumbing System - Final
14. Rough Plumbing . 65. Electrical-Finai
15. Rough Electrical-Conduit ' 66. Solar System-Final -
i 6. Rough Electric Wiring C� 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 OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑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. BackflowPreventer , " � .-
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 California Gas Co
51. CERTIFICATE OF OCCUPANCY _
No, Date � � � �
P �pTN ���'tl tl��9rt
Applicant to till in all s acez e t ose ithin hea Y or e es anO si all appropriate tlecla�ations.
cit� oF COST,4 MEsq� S��ION ERMIT
Project Address ���
Applicant's Mai � �ress /
Owner"s Nam /y� Pho�{v //G/
Address��S i�g� �G �� �-�
Arch/Eng. License No.
Address
Contractor's Na � ' P/b9 e �
Address (ma'I'ng) � �j � Gl�ft�-. �_�
City licenxe No, _3_p2t
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensetl untle� p�ovi5ions of Charter 9(commencing
with section ]000) of DiviSion 3 of the Business antl orofe55ion5 Cotle, antl
my Iicense is in fulljqrce a ttect. e
Licen ss ` ' L' en e o.
Date Signature
WOR RS'CO ENSATION DECLARATION �
1 hereby atfirm that I have a certi(icate of consent to self-insure or a certificate
of WorkerY Compensztion Insurance, or a certifietl opy thereof (Section
3Bo0. Lab. (j�y .� /y�i' // .
Policy Noy f�=� ��T comoanv
Certitietl copy is hereby fumisM1etl.
ertif' c y is � e with the city d,i�]g i ion.
ale APPlican�1���+> � �� � 1
E%EMPTION_�_`�RKERS' CUMPENSATION �ECLA0.AT�ON
(Thissection neetl nat be com0leted it the permit is for one huntlretl ($300) or
less).
I certify that in Ihe Performance of tbe wo�k fo� which thi5 pe�m�t is i55uetl I
5M1a11 not employ any person in any manner So as to berome Subje<[ to t�e
Workers' Compensation Laws ot California.
Date � Signature
NOTICE: If, after making this tleclaration, you shoultl become subject to the
Workers' Compensation provi5ion5 of ihe la0or Cotle, you must torthwith
comply with� such 0/ovisions or this permit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I hereby afflrm that there Is a construction lentling a9ency for the performance
of the work for which ihis permi[ is iszuetl (Section 309Z qv. .C.) '
Lentler's Name �
Lentler'S HGtlress �
OWNER BUILDER OECLARATION-
I hereby affirm that I am exempt from the Contracror's License,Law (or the
following reason (Section 7031.5 Business antl Professional Cotle: Any city or
county which requires a permit to canstruct, alter, improve, tlemolish or repair
any sGucture, prlor to its issuance, also requires ihe applicant for such permit
to file a signetl statement that he/she is licensetl pursuant to the provisions of
. the Contractor's License Law (Chapter 9(commencin9 with Section ]000) of
Division 3 of the Business antl Professions Cotle) or chat be/she is exempt
tbe�efwm antl the basis for the alleqetl exemp[ion. Any violation of Section
7031.5 by any applicant tor a permit subjects the applicant to a civil
�enalty of not more than five nuntlretl tlollars ($500).
LJ I, as owner of the property or my employees with wa9es as their sole
compensation, will tlo the work, antl Ihe st�uctu�e is not intendetl or offe�etl
for sale (Section 7044, Business antl Profe55ional Cotle: The Contractor's
License Law does not appty to an owner of a property who builds or improves
[M1ereon, antl who tloes such work himseN/herself or tM1�ouqn his or her own
employees, provitletl that such improvements are not intentletl or offe�ea fo�
sale. It, M1owever, the builtling cr improvement iz soltl within one year of com-
pletion, Ihe owner will have the burtlen of p�oving he/sne tlid not builtl ot im-
�rove Pot the purpose of sale).
I, as owner of [he O�operty, am exclusivety mntracting with IicenSetl con-
tractorsto mnstruct the project (Section ]044, Businessantl Professions Cotle:
The ConVactor's License Law tloes not apply to an owner of property who
builtls or Improves thereon; antl who contracts for such projects with a con-
tractor(s1 license pursuant-to the�Contractor'i License Law). I am aware�that
proof o( Iheir Worker's Compensation insurance shoultl be provitletl to me.
❑ I am exemp[ un0e� $ection B. & P. C. to� this reason
Date Owner —
I hereby certi(y that I have reatl thi
info�mation is co�recL I agree to com
antl state laws rel ting to building m
Sentatives of Yhi city to enteq upt
Signature
Drivers' Lice se or 55 �
TVPE OF CONSTRUCTION NEW LJ ADD LJ ALTERATION LJ REPAIR
'❑ CONVERSION ❑ DEM LISH ❑ OTHER q,p, #
DESCRIPTION OF WORK/USE OF BL�G.
, S Main Building:
TVPE O PERMIT GRADIN ❑ FOVNDATION E
❑ STftUCTURAL T Front
❑ TE ANT ❑ ELECTRICAL�PLUMBING ❑ MECHANICAL B Rear
❑ �OTHER � � %�
C Right
PROJECT DESCRIPTION 5a. FT. � ocCUanrvGv K
CONSTRUCTION TVPE VALUATION $ S Left
ZONE � GRADING CU.YOS. 11CRE5 ping, Ref. #
Remarks: . . I I CI� PlanninqNotes:
3ar Sink
3ackflow Preventer '
3acktlow Irrigation
3athtubs
�larifiers
Jishwasher '
Jrinking Founiains
Floor Drains
Floor Sinks
GasService 'Outlets
I ntercepmrs
Kitchen Sink
Lavatories �
P—Trap
Roof Drains -
Reinspection Fee $15
Boiler
Duct-UnderGround
Duct � Sttuctural ,
Duct - Ventilating
Exhaust System ❑ Multiple ❑
FirepVFacL.Blt ICBO #
Heating System & Ducting
❑0.700,000 BTU �100,OOOBT
ReinspeMion Fee � $15
CMF 0865-46, rev. 4/84 Wnite - Builtling; Canary -Applicanh Pink -Accoun[inq; Golaenrotl -Assessor
Showers
Service Sink '
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet .
Water• Heater
Water Service -
Issue Fee
fEES
Automatic Washer
Cansnuctior Pole Sub.
Cooking Unit
Dishwasher -
� Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fix[ures
Device Boxes
Outlets
�� Switches
Garbage Oisposal
. Generamr 00.5 KW �5-15
$ 3
Zone
Accessory Bui
ELECTRICAL
Transformer ❑ 15-50 KW
❑ SO+KW
Meter LJup to 100 amps
Meter ❑over100amps
Suh Panel
Momrs �0-1 HP O1 %- 8
Inc.Solar �9-15 HP 076-15+
Microwave
Pole Light
Range
Sign
Standing Sections
Trash Compactor
� � Reinspectian Fee � $15 luue Fee
iANICAL FEES
Hoodor T DEVELOPMENTSERVICESREQUIREMENTS:
ypel ❑
Canopy Type I I ❑ Zaning Approved By
_ _ _ _ Building Approved By
Refrigeration System
❑0-100,OOOBTU ❑100,OOOBTU
System Repair/Alteretion
Issue Fee � � $ 3
e
FEES
$ 3
Z
O
N
I
N
G
R
E
Q
M
T
$.
� SIWNAAARV OF PEES
BUILDING PERMIT $ SMIP $
' PLAN CHEC � PERMIT
\PLUMBI�� � �/%t�' �A CE � $ \�
' PLAN CHECK 5 IErJE� G P.C.I s�j
ELECTRI L GRADI G $
PLAN CHECK 50% $ MICROFILM $
MECHANICAL $ TOTAL FEE $
PLAN CHECK 25% $
� CONSTRUCTION AND PLANNING . POOL & SPA
' APPROVALS . 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 "�
4. Electrical Conduit;Undrgrnd. . 55. Electrical Bonding '
5. Steel Reinforcement ' 56. Rough Plumbing & Pressure Test '"'
���6.ElectricalUFERGrnd._' - 57.APPROVALTOCOVER-GUNITE .
� 7. Footings ,. ��� � 58. Electrical Conduit-Undrgrnd.
: 8. Foundation '' 59. Gas Pipe, � Undrgrnd., Test '
9. WaterPipa,-Undrgrnd. , � � 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System � , 61. APPROVAL TO DECK
11. Property $ewer Line & House Connection 62. Backwash & Receptor-Final �'
12. Sewer Cap ' � '� ' 63. Heater & Vent-Final '
13. Roof Drains , . 64. Plumbing System - Final . �
14. Rough Plumbing � 65. Electrical-Final
15. Rough Electrical-Conduit � 66. Solar System-Final
16. Rough Electric Wiring - 67. Fencing & Access Approval
17. .Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19._Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
�20'�Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure -" 70. Underground Hydro
22. Ducts, Ventilating � 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rougti & Test � / � 72. �Underground Flush
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 antl 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 � "- �
47. Solar pomestic-Final '
42. Backflow preventer �
43. Backflow Irrigation . _
44. ,Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations ' �
47. FINALS7RUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co �
51. CERTIFICATEOFOCCUPANCY
No. Date
�`/� i' �i , �s Applicant to fill in all s0aces axeept t�osa witM
�� CITY OF CdSTA MESA • . PERMIT N0. TRACI
, CONSTRUCTION PERMIT � / ��
cProject Qddress T.YPE OF CONSTRUCTION
Applicant'SMaili gAddr ss., '❑ CONVERSION ❑ DEM LISH
—� �o DESCRIPTION OF WORK
Owner's i gm�� ��- ho
�
borEe� Iines anE sign all aOGropriate tlecla�alions.
J ADD� LJ ALTERATION LJ REPAIR
OTHER
Addf255 L � TVPE OF PERMIT GRADING LI FOUNDATION LI STRUCTURAL
Alth/Eng. LitenSe No. ❑ TENANT ❑ ELECTRICAL �IUMBING ❑ MECHANICAL
Address ❑ �OTHER '
Contractor's Nam Ph ne5 � S PR0.IECT DESCRIPTION � 5�. F7. oCCUPaNCv_
Addtess (mw �'��� � � � � • � •� � � �n � _ CONSTRVCTION TVPE VALUATION $
2��Gt� ZONE GRADING CU. VDS. ACRES—
Ciry �icense No.
LICENSED CONTRACTOR DECIARATION Remarks: //h L �
I hereby afflrm that I am Ilcensetl untler provisions of Ch rter 9(commencing
with sectlon 7000) of Divislon 3 of the Business antl ofessions Cotle, anE
my Iicanse Is In tu for an effe . � G
License Class � Llcense
'�ate Si9nature -
VORKERS'COMPENSATION DECLARATION
I hereUy�affirm that I hdve a certlticat¢ of consent to seH-Insure or a certlfiGate
Poll<yrNars' Com�en�i;`�^$UfdO�Compa�Yertltletl q py th eot (SeCtlon•
3800. Lab. F)". �9 �r7 J.PJ r
w ` -
�I�'-ly.�.ertifietl capy I5 hereby furnlshetl. �
�C.,Car fi' E m y. iletl with the tlty uiltli � I I lon. �
bate � Applicant `� �^^ //�'�
E%EMPTION F,RO WORKERS' COMPENSATION DECLAftATION �
(This seclion neetl nat be campletetl it the permit is tor ona huntlratl (E300) or,'
Iess).
I certi(y that in the performance oi Ihe work for whlch this'perm�t is Istuetl I
shall not employ any person in any manner so as to become subject to t�e
Warkers' Compensatlon Laws o( CaliforNa.
oate Si9nature
NOTICE: It,iafter making th(s tleclaratlon, you sboultl becoma sub7ect to tbe
Workers' Compensation provisions ot the l.abor Cotla, you must forthwlth
comply with'such provisions or this'permlt shall be Ceemetl revoketl.
CONSTRUCTION LENOING AGENCV
I hereEy a/firm cM1at t�ere is a construction lentling a9enty for tha performance
ot tbe work for which Ihis permit is 75zuetl (SecHon 3097 Civ. CJ
t2ntler'S Name
Lenaer•z Aaaress
OWNERBUILOER DECLARATION
I hereby affirm tha[ � am enemp[ from the Contractor's Ucense L.aw !or the
tollowing reason (Saction 7031.5 Buslna5s antl Prote55ional Cotle: Any clty or
counry wbich requires a permit to construc[, alter, Improve, Eemolisn or repalr
any structure, prlor to Its Issuanca, also requires the appllcant for suth parmil
o/ile a 519�atl Stdtam¢nt Ihdt he/She is Iicensetl pursuant t0 th0 provlsiOns O/
ae Contractor's License Law (Chapter 9(commencin9 wlth Sactlon ]000) ot
JIvlSion 3 of the Business antl Pro(e55ions Cotla) or that he/sha is exampt
theretrom antl Ihe basis for the alle9eC exemptlon. Any violallon of Sectlon •
7031.5 by any applicant for a permil sub7ect5 Iha apolicant to a civil �
�enalty o/ not mare than flve huntlretl tlollars (SSOOj.
I. as owner of the orooertv ar'mv emolovees with waaes as thelr sole
Ii� �owBvet, tM1e Dulldln9 or
�n, tha ownar wlll have the i
for the purpose of sale).
as owner of the property, z
RStG COOStluct the project (.
_ontractor's Llcense Law d
I am exempt unaer
re nai mcenaea or anarea �or
Is soltl witnln one year oi mm-
�Ing he/she tlltl not builtl or im-
contracting wlth Iicentetl <on-
Business antl Protasslons CoEe:
to an owner of property who
� tor such pro�acts wlth a con-
Icense Lawl.
— B. & P. C. �or tnis reaion
Date Owner
I hareby <artify that 1-have read this applicatlon antl state that ihe above
Informatian Is correct. I a9ree to comply with all city anU county ortllnances
antl state laws relating to CuiltllnB �onstructlon, antl hereby autnorize rapre-
se�tatives of� hls city o enter u on the above-mentionetl 0� er y for
Inspectlan pu ose �Z
�J
8ar Sink
Backflow Preventer
Backflow Irrigation
Dishwasher � '
Drinking Fountein5
Floor Drains
Floor Sinks
Gas Service Outlets
Kitchen Sink '
Levatories • , �
P—Trap
Roof Drains
Reinspection Fee $25
Boiler •
Duct - Under Graund '
Duct - Structurel
Duct - Ventilating �
Ezhaust System ❑ Multiple ❑
Firepl/Fect Bit. ICBO #
Heating System & Ducting
� ❑P100,O00 BTU �100.0008T
Signatura Data qeinspection Fea
Drlvers' License or 55 �
CMFO865-46 rev.12/B3 Whita-Builtling;Canary-Applitant;Pink-Accounting;Goltlenrotl-A55essor
$25
PLUMBING
Showers
Service Sink
Sewer Cap
Sewer Connettion
Solar Collectors •
Soler Piping �
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater•
� Water Service
Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0.700,000 BTU ❑100,000 BTU
System Repair/Alteretion
Issue Fee
F
$ 3
$ 3
A.P. �f`-
S Main Buildi
E
T Front
B Rear
A
C Righ[
K Left
$
Ping. Ref. #
Paiking Req./Pn
Use of Building:
Planning Notes:
Aucomatic Washer.
Construction Pole Sub.
Cooking Unit �r,
Dryers LJGas LJElectric
Fan
F.A.U.
5753 3/09/84
2ona
Accessory Building:
� Park.Fees $
ELECTRICAL
Transformer � 75-50 KW
❑ 50+KW
Meter ❑up to 700 amps
Meter �over100amps
Sub Panel • �
Motors OP7 HP �1'h - 8
Inc.Solar 09-15 HP �76-15+
� Microwave
Device Boxes Pole Light
Outlets
Switches
Garbage Dispoul �
Generator O0.5 KW 05-15 KW
Sign
Standing Sections
Trash Compactor
F
38.00 TL
Z
O
N
I
R
E
Q
U
I
R
E
I Rainspeetion Fee I$y5I �ssue Fee � I S 3 I
PUeLIC SERVICES REQUIREMENTS:
Zoninp ApO�aved By Oate
Building ADProved By Date
Application Issued By Date�
SUMMARV OF FEES
BUILDING PERMIT $ SMIP � $ '
PLAN CHECK $ PERMIT '
PLUMBING $ ,� %^— ISSUANCE $
PLAN CHECK 25% $ %� ENERGY P.C. �$
ELECTRICAL S GfiADING $
PLANCHECK 50%�$ ' MICROFI�M �$
MECHANICAL $ TOTAL FEE $ �
PLAN CHECK 25% $ �
•-� 'CO�ISTRUCTION AND PLANNING • ' - PO. & SPA - . :-i _ _ '
- Date Inspector � . � ,�Date ` Inspector�`
��APPROVALS _ Permit# APPROVALS Permit#
1. "�emporary Electrical Service or Pole _ • 52: Pool & Equipment Location �
', '''2.� Sail Pipe-Undrgrnd. . -�J/�j(y', ��� 53: Steel Reinforcement - � � _ � � �
�,
- 3.'Electrical Conduit Utilify-Undrgrnd. �� -, � 54:;Forms �, - . '. ' � ,
_ �
' 4: Electricl Conduit-Undrgrnd. . - � � 55. Electrical Bonding . ' .
. �
' 5. Steel Reinforcement, , � ' 56. Rough Plumbing �& Pressure Test � �• ' � �� �
,
6.' Electrical UFER Grndr � ' �• 57. APPROVAL TO COVER-GUNITE. = � . "� '
� n'. � .
� 7. Footings � � � � . , � - �_5S: Electricai Conduit-Undrgmd. .. _ � �.��'-•
� .
8. Foundation � . � � - ' 59. Gas Pipe, O Undrgmd., Tesf ' . _ • �
J 9. Water�Pipe-Undrgrnd. . '�j/p(��y :(�� 60. Backwash �ines, P-Tra�p, � Undrgmd. _; � - ,
10. Structural Floor System . '� ^� 61. APPROVAL TO DECK , , � , �� , ,
11. Property�Sewe� Line &,House Connection � 6���V �i� 62. Backwash�& Receptor-Final . �
1
' 12. Sewer.Cap � ' 63. Heater & Vent-Final � � ' �.
� . .
13. Roof Drains , �� 64. Plumbing SYstem .<Final �
14. Rough Plumbing . � '7�({.,�� � -65. Electrical-Final' - - `
15. RoughElectrical-Conduit i V , 66. SolarSystem-Final �� - � � -�- ,-- � -
�•16. Rough Electric Wiring �- , � 67. Fencing & Access Appioyal =- � ' -' � '
�-
���77. Rough Wiring Sign ' � 68. APPROVED FOR PLASTERING � "- � �
' 18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL � I� � �"
' 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ' �� �' i �
� 20. Rough Factory Fireplace � APPROVALS Permit # _ . � i
21. Ducts, in Structure � 70. Underground Hydro ;�- � �� '
c
.22� Ducts, Ventilating � � 71. Product Piping 0 Gas, ❑ Oil �: i, �
23. Gas Pipe-Rough & Test . -- 72; Underground Flush ' ' ' �
n24. Roof Framing � ' 73. Undergrnd.StorageTank OGas ��Oil�� '� �
�
25. Roof Sheathing . � 74. Overhead Hydro � ` �
26. T-Bar Ceiling (Structural) & Monocoat ' � 75. Dry Chemical � ��' ' � � � �
i �
i �
27. Frame and Flashing � _ 76. Dry Standpipe . � - � ' � . .
28. Lathing & Siding , 77. FIXED SYSTEM FINAL � , �
i i
29. Insulation � 78. FIRE PREV. FINAL � � �
30. Drywall Nailing - ' HEALTH DEPT. REQUIREMENT � � ��
37. Plaster Brown Coat 79. FINAL INSPECTION � ' � '
I
32. Electriral Power Meter-Final ) `'� ' 80.' FOOD CERTIFICATE ISSUED -
!33. Final Electric '.' � Notes:""�' ` � i � '
34. Final.Heating & Air Conditioning � . . � °
35. Final Gas Pipe-Test qr� L� . ,� , ,_
36. Hood or�Canopy' ' � ' - ' � - . -� � �
37. Final FactoryiFireplace . ' � � i ' _ � . , � ' - -
38. Final Plumbing � /g% � LE.p � � '
i
39. Wa'ter Service-Final � � � '
t
40. Gas Service-Final . . ' � . , ' -
� �
41. Solar pomestio-Final - '- - - -
42. Backflow Preventer _ ' - �, '_" � �
43. Backflow Irrigation' � , � ' � � - , '
44. .Landscape Irr,igation System . • ' � ; � -
45. Sound Attenuation� � � . � � _ . , ,�
46. Handicap Regulations , ' � • � ' � ' ' , � '
47. ,FINALSTRUCTURE & BUILDING , ' � , � �"
� . ,
48. Special'RequirementsCompleted , ', � � ' " -
c
49. Electrie Release to Edison . � - ' � � , �" �"' � � � ' � ; � - : - �
50. Gas Release to Southem California Gas Co � � � , t. .,,
51. CERTIFICATE OF OCCUPANCY - - : � , � '
No. . . � Date' - - - - � -- ... .. - .
>
ADo���ant to fill in all spaces except tnose within heavY bor7er lines ana sign all apD�ovriate tleclarations.
CiTY oF coS7a MES CO $y.�R CTIO PERMIT
Project Address 9
Applicant's Mailing ddres �
Owner's Nam,� 5 Phone
Address � �
Arch/Eng. License No.
Addrew — �
Contractor's Nam �_Phone
Address (mailing)
City License No.
LICENSED CONTRACTOR DECLARATION '
I hereby affirm that I am licensetl untle� provi5ion5 0/ Char[e� 9(commendng
with section ]000) of Division 3 of t e Business antl Pro�essions C tle.antl
my licen is i �u rce antl eftect. ��
Licen ��ens � o. �
oate Signature
WORKERS'CO PENSATION DECLARATION
' hereby aifirm tnat 1 have a certificate of mnsent to selt-insure or a<ertificate
ii Worker5' Compensation InSurance, or a cerP{i tl copy�reof (Sectlon
3800, lab.�/p�1i�/�
Policy No. F Yi Company ' '
Certiti tl opy'S her¢by turnishetl. —^ (`(
Ce I y"s tiletl with the city �y(� i� p I ..��.�f1
DaYe ApP���ant (���I , ` 1„dr'J`
EXEMP O FR M WORKERS' COMPENSATION�DECLARATION
(Tnis section need not De completetl it the permit IS tor one huntlretl ($100) or
less)
I ce�tify that in the performance of the work fo� Whlch thi5 pe�m�t is issuetl I
sM1all not empioy any person in any manner so ds to become subject to the
Workers' Compensation Laws ot California.
Date $ignature
NOTICE: If, aite� making [his tlecla�ation, you shoultl become subject to the
Worken' Comp¢nsation provisions of the Labot �otle, you must forthwith
comply wilh such O�ovlsions or this pe�mit shall be tle¢metl �evoketl.
CONSTRUCTION lEN ING AGENCV
I hereby affirm that th � Is a construction lentling a9enry for the pe�formance
of the work for �VtMs Permit is issue� (Section 3097 Civ. C.)
Lentler's Name � ��
Lentler's Atltlress '
OWNER BUILOER DECLARATION-- ' -
I hereby atfi�m that I am ezempt trom the ContYacto�'s LicenSe Law for the
following reason (Section 7031.5 Business antl Protessional Cotle: Any city or
wunty which requires a Oermii to construct, alter� improve, tlemolish or repai�
any structure, prior to its issuance, also requires the applicant for such permit
to file a signetl stat¢ment that he/She is licensetl pursuant to the provisions of
.ine fnntractor's I icense Law IChaote� 9([ommepcino wi[h Section 7000) of
'�`M1erefrom antl the basis for the allegetl ez¢mptl4n. Any violation of Section
�7031.5 by any applicant for a permit subjects the�applicant to a civil
�enalty of not more than five huntlretl tlollars ($500�.
I, a5 owne� of Ihe prope�ty or my employFes with wa9e5 as their sole
compensation, will tlo the work, antl the structur¢ is not intenaetl or offeretl
for sale (Section ]044, BuSiness antl Profe55ionab Cotle: The Contractor's
LicenSC law tloes not apply to an owner of a prop¢rty who builEs or improves
tne�eon, antl who tloes Suth work hirnself/hersel( or IM1rough his or har own
¢mployees, p�ovitletl that such imP�ovements are not.intentletl or offe�etl fo�
sale. If, however, the bullding cr improvement is soltl within one yea� of com-
pletion, the owne� will have the burtlen of proving he/she tlitl not builtl or'im-
�rove for the purpo5e of sale). -
I, as owner ot the proDerty, am exclusively epnt�acting wlth licensetl Con-
tractorsto wnstruct the project (Sec[ion 7044, BUsiness antl Professions Cotle:
The ConVactoYs License Law tloes not apply tp an owner ot property who
builtls or Improves thereon, ana who wntracts for such projects with a com
tractor(st license pursuant�to the�Con[ractor's Li�¢nse Law). I am aware tnat
proof o( Iheir Worker's Compensation insurancy shoultl be p�ovitletl to me.
❑ I am exempt untler Section B. & P. C. far this reason
TYPE OF CONSTRUCTION �J NEW LJ ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER A,p, #
DESCRIPTION OF WORK/USE OF BLDG.
S Main Buildi
E
TYPE OF PERMIT ❑ GRADING ❑ FOUNDATIO� STRUCTURAL T Flont
'❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL B R¢d� '
❑ OTHER p`
PROJECT DESCRIPTION SGi. F7. oCCUPArvCv C Ri9ht
K Left
CONSTRUCTIONTVPE VALUATION$ $
ZONE GRADING CU. VDS. ACRES p�ng. Ref. #
Remarks: ��ii � -�1 - Pianninq Notes:
Date Owner � I
I hereby certify that 1 have reaa thls application antl state that the above
information is rrecL I agree to co 4�ly with all clty antl munty ortlinances
antl state laws elating to builtlin co�}struction, antl hereby authoriie epre-
sentatives o his city [o ente upop the bo�e-mentionetl pr er for
inspection pu . / G5
Signatu�e U �ate ;�
Drivers' License or 55 � Reinspection Fee
CMF 0865�46, rev. 4/B4 White - Builtling; Canary . ApP���anq Pink - Accounting; Goltlenrotl - Assessor
Sink
Preventer
Irrigati0n
Dishwasher .
Drinking Fountains
Floor Orains
Floor Sinks
Gas Service �ULI2L5
Interceptors
Kitchen Sink
Lavatories
Roof Drains
Reinspection Fee � $15
Boiler
Duct- UnderGround
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
�He ng SVstem & Ducting
L1P700,000 BTU �100,000
$15
FEES
ShoWers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa �
Urinal
Water Closet
Water Heacer
Water.Service '
Issue Fee � 3
3611 7/06/84
2one
Parking Feq./Provided
ELECTRICAL
Automatic Washer Transformer ❑ 15-50 KW
Construction Pole Sub. ❑ 50 + KW
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elec[ric
Fan
F.A.U.
Fiztures
Device Boxes
Outlets
Switches
Garbage Dispoul
Generator �0-5 KW �5-15 KW
Meter ❑up to 100amps
Meter ❑over100amps
Sub Panel
Motors�0�1HP�1'/:-8 �
Inc,Solar �9-75 HP �i6-15+
Microwave
Pole Light
Rang¢
Si9n
Standing Sections
Trash Compacmr
Reinspection Fee I$15 Issue Fee
IANICAL FEES
Hoodor Typel ❑ DEVELOPMENTSERVICESREQUIREMENTS:
Canopy Type I I ❑ 2oning Approved By
Building Approved By ,�
Refrigeretion Sys[em
�0-100,000 BTU ❑100,000 BTU
System Repair/Alteretion
Isue Fee
$ 3
BUILDING PERMIT $
PLAN CHECK $
PLUMBING S
PLAN CHECK 25% $
ELECTRICAL $
PLAN CHECK 50k} �$
MECHANICAL �%��+
PLAN CHECK 25% $
BeO�' TI
Z
O
N
I
N
G
R
E
Q
M
T
S.
FEES
$ 3
SUMMARV OF FEES
SMIP $
PERMIT
ISSUANCE $
ENERGY P.C. $
GRADING , $
�MICROFILM $ -���;y/�
TOTALFEE $ _l�
CONSTRUCTION AND PLANNING POI. .Si 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 Conduii Uiiliiy-Undrgrnd. 54.�Forms
4. �Electrical ConduiY-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. � . 6D. Backwash Lines, P-Trap, D Undrgrnd. ,
10. Structural Floor System � � 61. APPROVALTO DECK
17. 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 Plumbinq 65. Electrical-Final '
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Eleciric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL -
79. Rough Heating & Air Conditioning 7/���� f LEp FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace � APPROVALS Permit #
27. 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.StorageTank OGas ❑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 CERTIF�CATE ISSUED
33. Final Electric Notes: -
34. Final Heating & Air Conditioning ��/�y L�
35. Final Gas Pipe-7est
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. BackflowJrrigation . . � _ �
44. Landscape Irrigation Sysiem
45. Sound Attenuation .
46. Handicap Regulations ' .
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison � . � .
50. Gas Release to Southem Califomia Gas Co . _
51. CERTIFICATE OF OCCUPANCY
No. Date '
AoO�icant to fill in all spaces except those within heavY bortler lines antl sign all apo�oo��ate tleclarations.
CiTVOFCOSTAMESA CONSTRUCTIONPERMIT
ProjectAddress 3412 Lavender Lane
Applitant's Mailing Address
owne�•sName Standard PdCif.7C COI'P. phone 546-1161
Address 1565 W.� MacArthur Costa Mesa 92626
' Arch/Eng. License No.
Address
Contractor'sNamP NPw Plum6ing Phone 5ZH—���IO
Addresslmailing) 7102 N_ Fee Ana Anaheim
City License No. .�28�� ,
LICENSED CONTRACTOR DECLARATION
I liereby affirm lhat I am licensetl unaer pruvii) ns o charter 9(commencin9
witn section 7000) of DiviSion 3 of the BU5'fiess an Profe55ion5 Cotle, antl
my Ilcense is in tull tprce�tl ettect. 426� �9
License Clzss ' �' �� i nse No.
oate 1 0� � D�RQ si9nature �_
WORKERS' COMPENSATION DECLARA N
i M1eteby affirm Ihat I have a certiticate ot mnsent to self-insure o� a CertifiCate
ot Workers' Compensition Insurance, or a certifietl, copy thereot (Sectlon
3800, Lab. GJ � ' - - ' ,
vou�v No.PWC-1777141 � comoa�v ' HOf112
�Certifietl mpy is hereby tu�nishetl. �
�¢r{jfi¢tl Copyjs tiletl with the citY 94ewn4•9'umBi ng �
Date � lJ� I�)/254 qpplicant �� Y
EXEMPTION FROM W00.KER5' COMPENSATION DECLARATION
(This section neetl not be completetl it the p@rmit is for one huntlretl ($300) or
less).
I certily [hat in the performance of the wo�k tor which this pe�m�t is Issuetl, I
shall not employ any pe�son in any mannpr so as to become subjeGt to the
Wo�ke�s' Compensation. LawS of Califomia.
Date Si9nature
NOTICE: 1(, after making this tleclaration, you shoultl become subject to the
Workers' Compensation provisions of the �ybor Gotle, you must forthwith •
comply with, suth p�ovisions or [his pQ�mit shall be tleemetl revoketl.
CONSTRUCTION LENDING•AGENCV -
I hereby affirm that there is a construction IQntling agency for the periormance
Of the work for which thi5 permit is' issued (Section 3097 Civ. C.)
Lentler•s Name
Lender's Atltlress . -
OWNER BUILDER DECLARATION�� '
I hereby atfirm that I am exempf trom tha ConVactor's License Law (or the
following reasOn (Section ]03L5 Busine55 dntl P�otes5ional Cotle: Any city o�
county which �equires a permit to con5t�uc[, alter, improve, tlemoli5h o� �epair
any Struc[u�e, p�ior to its issuance, also require5 the applicant for such pe�mit
to tile a signed Statement that he/sM1e I5 litpnsetl pu�suant to [he provi5ion5 of
`�'�the Cont�actor'S License Law (ChaOte� 9(cGmmencin9 with Section ]000) of
�'-.'r�IVISl00 3 O( fhC BUSI0055 dfld Pro(¢SSiOnS COtlE) 0! ihdf hE/ShC IS ezempt
i-�Th¢refrom antl the basis for the allegetl ¢x¢mption. Any violation ot Sectlon
7031.5 by any applicant for a permit Subjects the applicant to a civil
�enalty of not more than five huntlretl tlollars (5500).
LJ I, as owner o( the property or my employees with wages as their sole
compensatlon, will tlo the work, antl the structure is not intentletl or otferetl
fo/ sale (Section 7044, Business antl Pro(¢SSional Cotle: The Contractor'S
LiGense Law tloes not apply to an owne� o! a p�operty who builGs or imp�oves
tM1ereOn, antl who tloes such work hlmself�perself or tM1rougM1 his or M1er own
¢mployee5, provitletl that such improvemeqts are nof intentleG or offavetl for
sale. If, howeveq the builtling cr improvem¢nt i5 soltl within one year ot com-
pletion, the owner will have the burtlen oi proving he/she tlitl not builtl or Im-
�rove forthe purpose of sale).
I, as owner ot the property, am exUusiyely cont�acting with IicenSetl COn-
Vactorsto canst�uct the project (Section ]044, Business antl Prote55ions Cotle:
The Contractor's License Law tloes not apply to an owner ot property who
bulltls or Improves tnereon, antl �who contracts for such projects with a wn-
Vactor(sl license pursuant-to the Contractpr'S License Law). I am aware that
proof o� their Wo�ker'S Compensation inSurance shoultl be provlGetl to me.
❑ I am exempt untler Section B. & P. C. for this reason
Date
I hereby certity
information IS C(
this application antl state that the above
omply With all city antl munty orGinances
construction, antl hereby authorize repre-
upon the above-mentionea property for
TYPE OF CONSTRUCTION X� NEW LJ ADD LI ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WOfiK/USE OF BLDG.
TYPEOFPERMIT GRADING FOVNDATION ❑ STRUCTURAL -
❑ TENANT ❑ ELECTRICAL � PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION 50. FT. OCCUPANCV
CONSTRUCTIONTVPE � VALUATION$
ZONE GRADINGCU.VOS. ACRES
Remarki:
Bar Sink
Backflow Preventer
Backflow Irrigation
Drinking Fountains
Floor Drains �
Floor $inks
Gas Service � Outlets
Interceptors�
Kitchen Sink
P—Trap '
Roof Drains
ShOWers
Service Sink.
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Waten Service
FEES
%j
Reinspec[ian Fee I $15 I I laue Fee I $ 3
Boiler
Duct - Under Ground �
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
FirepUFacL Blt. ICBO #
Heating System & Ducting
❑6100,000 BTU Ot00,0006T
Inspectlon ¢
Signature Date ��—� y
D 5 L 55 � � Reinspection Fae
CMF 0865-46, rev.4/B4 White - Bulltling; Canary -Applicant; Pink -Accounting; Goltlenrotl -Assessor
$15
Hoodor TYPeI ❑
Canopy Type I I ❑
Refrigeration System
❑0-100,000 BTU ❑100,000 BTU
System Repair/Alteration
Issue Fee � $ 3
A.P. #
S Main Buildi
E
T Front
B Rear
A
C Ri9ht
K Left
S
Ping. Ref. #
Plannin9 Notes:
Automa[ic Washer
0182 10/12/84
5,3� TL
Zone
Accessory Building: �
Z
O
N
I
N
c
R
Parking Req./Provided � E
�
M
_ 5 .
ELECTRICAL
_Transformer
Construction Pole Sub.
Coaking Unit '
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �65 KW �5-15 KW
❑ 15-50 Kl
❑ 50+KW
Meter LJup to 100 amps
Meter ❑over 100 amps
Sub Panel
Motors � 0.1 HP � 1 Yh - 8
Inc.Solar 09�75 HP 076-15+
Microwave '
Pole Light �
Range
Sign
�Standing Sections
Trash Compacror
Fee �$15 � � luue Fee
FEES
$ 3
DEVELOPMENT SERVICES REQUINEMENTS:
Zoning Approved By Date
Buildin9 Approved By Date
Appliwtion Issued By— Date__..� Z'
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ �SnirD ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM $
MECHANICAL $ TOTALFEE $ �'SD
PLAN CHECK 25% $
CONSTRUCTION AND PLANNING P(�..-& SPA
APPROVALS Permit# � Date - Inspector AppROVALS Permit# Date Inspector
1..Temporary Electrical Service or Pole � 52. Pool & Equipment Location i
i
2. So�il Pipe-Undrgrnd. - � 53. Steel Reinforcement
3. Electrical Conduit Utility=Undrgmd. � � 54. Forms � i� •
4. Electrical Conduit-Undrgrnd. . , 55. Electrical Bonding . �
_ 5. Steel Reinforcement . ' � 56. �Rough Plumbing & Pressure Test �
' 6. Electrical UFER Grnd. � , , � 57. APPROVALTO COVER-GUNITE r
� 7. Footings , � � , , 58. Electrical Conduit-Undrgrnd. •
8. Foundation ' F� , ' 59. Gas Pipe, O Undrgrnd., Test �
9. Water Pipe-Undrgmd. . �✓ �� 60. Backwash Lines, P-Trap, � Undrgmd. �'
70. Structural Floor Sys[em � � 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final _ '��
12. Sewer Cap 63. Heater & Verit-Final `
13. Roof Drains . 64. Plumbing System - Final � r
14. Rough Plumbing � 65. Electrical-Final ^
.
15.�Rough Electrical-Conduit �� 66. Solar System-Final -
16. Rough Electric Wiring - _ � 67. Pencing & Access Approval
17. Rough Wiring Sign .� - 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # �
21. Ducts,in Structure. ' � 70. Underground Hydro
22. Ducts, Ventilating , 71. Product Piping O Gas ❑ Oil �
23. Gas Pipe-Rough & Test . 72. Underground Flush �
24. Roof Framing ' 73. Undergrnd. Storage Tank � 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 rO�i�S��[ �(ilE�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. Handicap Regulations � , �
47. FINAL STRUCTURE & BUILDING � �
48. Special Requirements Completed �
49. Electric Release to Edison � - .
50. Gas Release�to Southern Califomia Gas Co
57. CERTIFICATE OF OCCUPANCY
No. Date