HomeMy WebLinkAbout2755 LORENZO DR - Building Permits •
1
Y �
4CITY OF COSTA MESA
F I BUILDING DIVISION
• �y�, DEVELOPMENT SERVICES DEPARTMENT P98-00327
' • PERMIT PERMIT NUMBER
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(714)754-5273 • Fax(714)754-4856 PLUMBING PERMIT 77 FAIR DRIVE,COSTA MESA,CA 92626 •
Job Address: 2755 LORENZO AV ,Status: ISSUED
Suite No Applied: 04/29/1998
Issued: 05/05/1998
Vicinity:
Parcel Nunmber: 14168305
Applicant: STASIAK, FRANCES J
Address:
Phone:
Zip:
•
Owner: STASIAK, FRANCES J
Address 2755 LORENZO AVE - - •
Phone:
COSTA MESA,CA Zip: 92626
•
Contractor NOCK PLUMBING
Address: 11612 KNOTT ST
Phone: 714 8951246
GARDEN GROVE,CA Zip: 92841 •
• License:707775
Arch/Eng:
Address:
Phone:
Zip: •
License:
SCOPE OF PERMIT
INSTALL WATER HEATER'.
FEE SUMMARY
AMT QTY AMT QTY AMT QTY
ISSUE FEE $22.00 Laundry Tub/Washer $0.00 0 Sump Pump - $0.00 0
Backflow irrigation $0.00 0 Landscape Irrigation $0.00 0 Swimming Pool $0.00 0
Backflow Preventer $0.00 0 P-Trap . $0.00 0 Trap Primer $0.00 0
Bathtub $0.00 0 Pressure Regulator $0.00 0 Urinal $0.00 0
Clarifier System $0.00 0 Process Piping(per 10 ft) $0.00 0 Vacuum Brkr Bkflow(1-4) $0.00 0
Connect(Ice,Soda,etc) $0.00 .0 Receptors $0.00 0 Vacuum Brkr Bkflow(5+) $0.00 0
Dental Units $0.00 0 Septic Tank $0.00 0 Wash Basin $0.00 0
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 0 Wash Basin Set $0.00 0
Drain,Floor $0.00 0 Sewer Connect $0.00 0 Waste and Vent System $0.00 0
Drain,Rainwater $0.00 0 Sewer Private Line - $0.00 0 Water Closet(Toilet) $0.00 0
Drain,Roof $0.00 0 Shower $0.00 0 Water Heater/vent $11.00 1
Drinking Fountain $0.00 0 Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink,commercial $0.00 0 Water Re-pipe $0.00 0
Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 0 Water Service $0.00 0
Gas(1-4 outlets) $0.00 0 Sink,kitchen $0.00 0 Water Softener $0.00 0
Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00
Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00
Gas Service $0.00 0 Spa(public) $0.00 0 PLAN CHECK $0.00
Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0
Interceptors(Sand Auto) $0.00 0
TOTAL CALCULATED FEES: $33.00
COMMENTS/SPECIAL CONDITIONS
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•
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714)754-5626
DECLARATIONS ( ( ) '
WORKERS'COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:
❑ I have and will maintain a certificate of consent to sell-insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the
work for which this permit is Issued.
❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued.
My workers'compensation Insurance carrier and policy number are:
Cartier: Policy Number.
(This section need not be completed l/the permit is valued at one hundred dollars($100)or less.)
❑ I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers'
•compensation laws of California,and agree that If I should become subject to the workers'compensation provisions of Section 37 of 00//ee Labor Code,I shall forthwith
comply with these provisions. rA,
Applicant Signature: � Date: CCS'
WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE(5100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professionsbode, nd my license is In full
force and effect.Lic. _ Dias �
Contractors Signature: ) -6\� ) - Date::
CONSTRUCTION LENDING AGENCY:
❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code).
Lenders Name: Lender's Address:
Signature: Date:
OWNER-BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions
Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.My violation of Section 7031.5 by any applicant for a permit
subjects the applicant to a civil penalty of not more than five hundred dollars($500).):
❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not Intended or offered for sale(Sec.
7044,Business and Professions Code:The Contractors License Law does not apply to an owner of properly who builds or Improves thereon,and who does such work
himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or Improvement Is
sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.).
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions
Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s)
license pursuant to the Contractors License Laws.).
❑ I am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by driver's license. ❑Yes 0 No Driver's License No. Expires:
Verification of Ownership by(type of document,i.e.•property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this
permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec.
341,Title 8,California Administrative Code).
❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? 0 Yes 0 No
(Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every
business which has et any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons,
or 200 cubic feet of compressed gas at standard temperature and pressure).
2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No
(Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Flre Department by each business which at any
one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of
compressed gas at standard temperature and pressure).
3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)?
❑Yes ❑No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
4 If an RMPP Is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes I-]No
(Section 85850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No
(If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health end Safety Code).
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes 0 No
8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances
regarding Hazardous Materials and Emissions.
Signature: Date:
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information given is
correct.I agree to comply_with all state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the
above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection.
And/Or-Authorized Applicant— Date
CODE INSPECTION TTPF -, PAIE IhMALS COOFt INNSPECTION 17PP DAM rr ,`,``l�1.2
1616
206 Final
1266 Pixed ool Spa System Fire Prevention l 208 Final Plumbing Mechanical
H-� Lv/N�J
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy
2446-46
- . . Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.
PERMIT NO. .TRACT NO. LOT NO. UNIT NO. •
•
CITV9F'CGa`TAMESA CONSTRUCTION PERMIT 3�s---Z� 6692 3/ 14/811 72n50 TI
Project Address .2.7.-43— 4'L0 ' ' 2 O ,
`� Applicant's Mailing Address 1.Z Y 3 Rep An,_, 9/9 o7A An/A TYPE OF CONSTRUCTION LJ NEW U ADD LSY• TERATI•N U R PAIR
Owner's Name SEA WN r mA4 T/7� S3'6-6600 ❑ CONVERSION ❑ DEMOLISH El OTHER 4 is !L A p # Zone
Phone DESCRIPTION OF WORK/USE OF BLDG. -e ^ ✓1e7
Q Addre- 27fs LCa tFAZ0 S Main Building: Accessory Building:
,Y
t Z
. Arch/Erg License No. TYPE OF PERMIT C7 GRADING LJ FOUNDATION 7RUCTU RAL T Front Z
Address • ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL BA Rear N
• Contractor's Name -5722L-C (.20 OF d6 Phone i-47-Sn2q ❑ OTHER /�
2 .P EQ f1/G/ $/c)MTA n"/A. PROJECT DESCRIPTION SQ. F xrArri__ d15 OCCUPAN V ,\ -� C Right N
• Address(mailing) IA y3 0o G
CONSTRUCTION TYPE V VALUATION$ yd17�� $ Left
R
City License No. la-53-73 ZONE GRADING CU.YDS. ACRESE
LICENSED CONTRACTOR DECLARATION ^ / J Ping. Ref.# Parking Req./Provided
hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: t/ F' 1C O O r` ^�r Aagile/ Planning Notes: 0M
with section 7000) of Division 3 of the Business and Professions Code,and ,\ \ T
my license is in full force and effect.
License Class C.- 3 L se No. 39.5-999 $
Date 3-/4�./g Signature 6 PLUMBING FEES
WORKERS'COMPENSATION DECLA TION Bar Sink Showers
ELECTRICAL FEES
Q' tereby affirm that I have a certificate of consent to self-Insure or a certificate
Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
x800, Lab. C.) Automatic Washer Transformer 0 1550 KW
Policy No. O6 O68C3 -87 Company 57-47E / /&.O Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+ KW
_ T Certified copy is hereby furnished.
\ - Cerlified copy i filed with the city ul din Div ton. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date -1 -I r/-Yxb __ Applicant 2AY -. /0"
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit Is for one hundred ($100)or
-
less). Dishwasher Solar Piping Dryers ❑Gas DElectric Sub Panel
I certify that In the performance of the work for which this permit is Issued I
shall not employ any person In any manner so as to become subject to the Drinking Fountains • Solar Tank Fan Motors 00-1 HP 01%-8
Workers' Compensation Laws of California. __
Date . Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+
NOTICE:If,after making this declaration,you should become subject to the — - .
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes .
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Range
Lender's Name _
•
Lender's Address Kitchen Sink ' Water Service Switches Sign-
OWNER BUILDER'DECLARATION
I hereby affirm that"I'am exempt from the Contractor's License Law for the Lavatories Auto-Wash
Garbage Disposal Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,Improve,demolish or repair P-Trap Laundry
any structure, prior to its issuance, also requires the applicant for such permit Trays Y Generator 00-5 KW❑5-15 KW Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of RoofDrains
the Contractor's License Law(Chapter 9(commencing with Section 7000)of
the
.3 of the Business and Professions Code) or that he/she is exempt
erefrom and the basis for the alleged exemption. Any violation of Section '
331.5 by any applicant for a permit subjects the applicant to a civil
enalty of not more than five hundred dollars($500).
LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
•
compensation, will do the work,and the structure is not intended or offered Reinspection Fee I $15 Issue Fee $.3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or Improves
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑
sale. If, however,the building or improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By Date
plebe n, the owner will have the burden of proving he/she did not build or Im- Duct Under Ground Building Approved By I- ` - ���w Date
prove for the purpose of sale). J
❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By n Dem.?",11
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SU MARY OF FEES
builds or improves thereon, and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System MultipleSystemRepair/AlterationBUILDING PERMIT $ �.�r a� SMIP $ s S--C?
of ❑ 0
Drool their Worker's Compensation Insurance should be provided tome. PLAN CHECK $ PERMIT
❑ 1 am exempt under Section B.& P.C.for this reason Firepl/Fact.BIL ICBG 4 Fire Dampers PLUMBING $ ISSUANCE $
Date Owner - Heating System& Ducting Registers
PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000 BTL— _ ELECTRICAL $ GRADING $
• Information is correct. I agree to comply with all city and county ordinances - -
and state laws relating to building construction,and hereby authorize repre-
sentatives of this city to enter upon the above-mentioned property for 7
Inspection puyP o3ses. -G/ f - MECHANICAL $ TOTAL FEE $ -..Z r�
DSirivers' tten/T�d
—
CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING POOL& SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
-
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Updrgrnd. 55. Electrical Bonding
5. Steel Reinforcement/ 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. ; 57. APPROVAL TO COVER-GUNITE
7. Footings � 58. Electrical Conduit-Undrgrnd.
8. Foundation I 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd:. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line.8/ 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. 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 0 Gas 00r !
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil-.•
25. Roof Sheathing 3 r��SI "it 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat f 75. Dry Chemical /
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
- 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED (33. Final Electric Notes:
34. Final Heating & Air Conditioning .
35. Final Gas Pipe-Test '
36. Hood or Canopy
37. Final Factory Fireplace .
38. Final Plumbing
39. Water Service-Final
, 40. Gas Service-Final
,41. Solar Domestic-Final •
•
42. Backflow Preventer
43. Backflow Irrigation - •
44. Landscape Irrigation System I
/45. Sound Attenuation
J
46. Handicap Regulations / /
47. FINAL STRUCTURE & BUILDING �/Zs//g8 ,
48. Special Requirements Completed ✓� ///� -
49. Electric Release to Edison • I'
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date _
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA SA CONSTRUCTION ERMIT - - PEWIT NO. TRACT NO. LOT NO. UNIT NO.
Project Address c, ''6S L--a{z�t'z0 � 'd�ga'a 1165 9/30/85 • s000 IL
TYPE OF CONSTRUCTION U NEW U ADD U ALTERATION U REPAIR
•
Applicant's Mailing Ad51fe5/5/� V V'/ 47 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# • Zone
Owner's Name (/�]/(]'^� �+ l n Phone •, if DESCRIPTION OF WORK/USE OF BLDG.
Address • S Main Building: Accessory Building:
E Z
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION U STRUCTURAL T Front - . • 0
Address /' �7/ El TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N
Contractor's Name ilk I ! /✓(� Phones ❑ OTHER - • A
C Right - N
R
�� PROJECT DESCRIPTION SQ. FT. OCCUPANCY
Address(mailing) R )1 • CONST RUCTION TYPE
VALUATION$ '$ Left • - O
City License No. /)�� ZONE GRADING CU.VDS. ACRES E
1 LICENSED CONTRACTOR DECLARATION Ping. RCf.# Parking Req./Provided
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: • -7 •_ • M
with section 7000) of Division 3 of the Business and Professions Code,and - T
\ 27my license is in f• • - •• and effect.
License ss ce.s• • A S.
Date r Lir. •ignature Ira A /... :.. t PLUMBING - FEES .
WORKERS'COMPENSATION DECLARATION Bar Sink • Showers
I hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES
of Workers' Compensation Insurance, or a certified copy thereof (Section •
Backflow Preventer Service Sink - -
�y // • • Automatic Washer Transformer ❑ 15-50 KW
3800, Lab.. ./5 t!I r-/G/1 Company 4it�'41zZ_-t . ❑ 50+ KW
Policy No. l/trot, O Ll pony �/- Backflow Irrigation Sewer Cap 1 Construction Pole Sub.
„�C'ertified copy is hereby furnished. O
DatCert'ter {��is Ith the city r��{,patli lily?'Jorv� �/ �y-�/ Bathtubs Sewer Connection Cooking Unit • ,Meter Cup to 100 amps '
Date ��`+ Applicant l�(/v U ' Li�[i��!""L�e'�
' EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher , Meter Clover 100 amps.
(This section need not be completed if the permit is for one hundred ($100)or - -
less). Dishwasher • Solar Piping Dryers ❑Gas DElectric Sub Panel
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors 00-1 HP 01%-B
Workers' Compensation Laws of California.
Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP 016-15+,
NOTICE:If,after making this declaration, you should become subject to the — - - -
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures -
comply with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY . Gas Service Outlets Water Closet Device Boxes
I hereby'affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is Issued (Section 3097 Civ. C.) Interceptors - / Water Heater ' a Or) Outlets Range
Lender's Name
Lender's Address Kitchen Sink 'Water Service Switches Sign
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License_Law for the Lavatories - Garbage Disposal Standing Sections : -
following reason (Section 7031.5 Business and Professional Code; Any city or
county which requires a permit to construct,alter,improve,demolish or repair P-Trap . Generator ❑0.5 KW 05-15 KW Trash Compactor
any structure, prior to its issuance, also requires the applicant for such permit -
-to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains -
the Contractor's License Law(Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects-the applicant to a civil
senalty of not more than five hundred dollars ($500). -
•
o I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 • Issue Fee $ 3
compensation, will do the work, and the structure is not Intended or offered Reinspection Fee I $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or improves _
thereon, and who does such work himself/herself or through his or.her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I 0
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By Date
pletlon, the owner will have the burden of proving-he/She did not build or im- Duct- Under Ground Building Approved By Date
shrove for the purpose of sale).
U I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ' 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES
builds or improves thereon, and who contracts for such projects with a con- '
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple ❑ System Repair/Alteration BUILDING PERMIT $ SMIP $
proof of
their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT
0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# PLUMBING $ • S-010 ISSUANCE $
Date Owner - Heating System& DuctingPLAN CHECK 25% $ ENERGY P.C.' $
'
l t certify that haverread this application and state that the above ❑0.100,000 BTU ❑100,000 BT - ELECTRICAL $ GRADING $
information is correct. I agree toi comply with all city and y utie-
and state laws relating to building construction,and hereby authorize yfrif PLAN CHECK 50% $ MICROFILM $ '
repre-
sentatives of Is city to enter upon the above-mentioned property f / !'
inspection p • e /)-//'L.,. MECHANICAL $ TOTAL FEE $ Lc-0Cl
Signature _Yet i; A -� • D. a vl ! 7
Drivers'.License o SS# _ _. Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46,rev.4/84 White-Building:Canary-Applicant;Pink-Accounting;Goldenrod -Assessor
CONSTRUCTION AND PLANNING - POOL & _.. A
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2: Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.- 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
• 7. Footings 58. Electrical Conduit-Undrgrnd.
B. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System - 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap •
63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. 'Rough Electrical-Conduit 66. Solar System-Final
16.-Rough Electric Wiring 67. Fencing &Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT.
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough&Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:'
- 34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing 8'-y04 c,L)
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation . .
44. .Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING •
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT UNIT NO.
47 74•174•1d 9-a,y
ss 2
Project Addre '7 SS /-oeeAa 2.0 AVa-
Applicant's Mailing Address TYPE OF CONSTRUCTION Li NEW U ADD Li ALTERATION U REPAIR ,�I
Owner's Name Phone El CONVERSION I:7 DEMOLISH El OTHER A.P.# /L.�/— Co E.3 — O s Zone R I
DESCRIPTION OF WORK/USE OF BLDG.
Address S Main Building: Accessory Building:
Arch/Eng. License No. TYPE OF PERMIT ❑ GRADING LI FOUNDATION Li STRUCTURAL T Front ATEA CYIED o
Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear `Lf N
(444!x4( ❑ OTHER
Contractor's Name 5 1.`7- Phone; C Right Z5/ N
L'30 S PROJECT DESCRIPTION SQ. FT. OCCUPANCY K �� G
Address(mailing) CONSTRUCTION TYPE VALUATIONS S Left
/ .
City License No. `,{,�_�s'sJ _T, CO-IC ZONE GRADING CU.YDS. - ACRESR
LICENSED CONTRACTOR DECLARATION _ Ping. Ref.# Parking Req./Provided E
CI
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: Is/• Q, i 5t-i n bo.� M
with section 7000) of Division 3 of the Business and Professions Code, and JJ T
my license is in full force and effect. "0yA,, (7�g� a Ia)a-f-f-i Q ori af MAX L`-
License Class - License No. C $
Date Signature PLUMBING FEES / (net t o , 4A.
ViCGQ = LEO 50 f '(-�
• /MAu RQ(/L = S•r. •
WORKERS' COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL FEES
I hereby affirm that I have a certificate of consent to self-Insure or a certificate
of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
3800, Lab. C.) Automatic Washer Transformer 0 15-50 KW
Policy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub.
0 50+ KW
,� Certified copy is hereby furnished.
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
Date Applicant
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred($100)or '
less). Dishwasher Solar Piping Dryers OGas ❑Electric Sub Panel
I certify that in the performance of the work for which this permit is issued I
shall not employ any person in any man Cr so as to become subject to the Drinking Fountains Solar Tank Fan Motors 00-1 HP ❑1''A-8
Workers' So p satipn Laws of Californi /�
Date �/ �ff Q'-1 Signature Y�X.V�IY( Floor Drains Swimming :.a �— F.A.U. Inc.Solar ❑9-15 HP 016.15+
NOTICE: If,after making this declared n,you sh d becomes lett to the
Workers' Compensation provisions of the Labor Code, you m forthwith Floor Sinks Fixtures
comply with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets i k oset Device Boxes
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is Issued (Section 3097 Clv. C.) Interceptors alar Heater Outlets Range
Lender's Name _
Lender's Address - - then Sin Water Service Switches Sign
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatb .e5 Auto-Wash Garbage Disposal Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,improve,demolish or repair ap Laundry Trays Generator ❑0-5 KW ❑5-15 KW
any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of R dins —
the Contractor's License Law (Chapter 9(commencing with Section 7000)of
Division 3 of the Business and Professions Code) or that he/she is exempt
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars($500). $ 3
0 I, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee
compensation, will do the work,and the structure is not intended or offered - Reinspection Fee 1 $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES _
REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑ -16 -F7
sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By r ' ' Date �I '�
pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground Building Approved By Date
prove for the purpose of sale). - -
❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By - Date
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00.100,000 BTU 0100,000 BTU SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that _ BUI LDING PERMIT $ SMIP $
(/ ) Exhaust System 0 Multiple 0 System Repair/Alteration
0I proof o their Worker's Compensation Insurance should. P.C.for dedthis to me. PLAN CHECK $ PERMIT
❑ I am exempt under Section - B.& . .for this reason Firepl/Fact.BIL. COO# Fire Dampers PLUMBING $ ISSUANCE $
Date owner Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above 0o-100,000 BTU 0100,000 BTL ELECTRICAL $ GRADING $
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize repre-
sentatives of this city to enter upon the above-mentioned property for
inspection purposes. - MECHANICAL $ TOTAL FEE $
Signature Date Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $
Drivers' License or SS,
CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING POOL& SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# _ Date Inspector
•
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4- Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. • 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & 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 I \FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace rAPPAPRO,VALS Permit# -
21. Ducts, in Structure ,70. Underground Hydro
22. Ducts, Ventilating '91' Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 1.1,;74. Underground Flush
24. Roof Framing { Y'3. Undergrnd.Storage Tank 0 Gas 0 Oil
25- Roof Sheathing 4: y 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ,
27. Frame and Flashing Nib 76. Dry Standpipe
28. Lathing
& Nom, f 77. FIXED SYSTEM FINAL
29. Insulation vA 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;
�i Notes;
34. Final Heating & Air Conditioning +v dif
35. Final Gas Pipe-Test .„
36. Hood or Canopy 7.
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation I
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING • r -
48. Special Requirements Completed
•
49. Electric Release to Edison t' r
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
2c.,
Applicant to fill in all spaces excei2rthose within heavy border lines and sign all appropriate declarations.
STA MESA CON TRUCTION PERMIT - PERMIT NO. TRACT!-t
O LUNIT NO.ddress r1 ss _(�?jV�/`/LO Q.4,t.•C. 3/ ��l I289 2/ D/87p �cant•s Mailing Address TYPE OF CONSTRUCTION NEADD U ALTERATION U REPAIR ^ ,
—1 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.50 1 r— V Zone t+e
Owner's'Pame Pn(AK 4 4 Phone S frQCO yet I�\ Ic� � S 1`\
k-414/K1-C)
__ ,•. DESCRIPTION OF WORK/U EOFr LDGa �--Pe a,�i �LJ 12"t •
Address Z7 SS .C/114M�YJhp 'q 1C x'r.,�y' Of IE �,p (�f❑S ��rrt',XL-�J\� S Main Building: Accessory Building:
E 0 (7 Z
• Arch/Eng. License No. TYPE OFPERMIT .❑ GRADING FOUNDATION STRUCTURAL T Front ejp-JL
0
• ddress ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear 1111 NJ
J� � ,,..�s� ❑ OTHER L/ A Z' �_
nt act '-� ,n �rnundL11 PROJECT DESCRIPTION SQ. FT_ �T OCC UPANr.V 1\��/ C Right L�• N
dress(mails g)_ASO t— CONSTRUCTION TYPE V � �o$' �' K Left CI G
VALUATIONS: $ ligi5 R
CityC LiNcense No. ZONE GRADING CU.YDS. ACRES Ping. Ref. # alt,
-� kfarking Req./Provided E
LICENSED CONTRACTOR DECLARATION - tet,y',�F Q
I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Com- �6pa/deo/44,j Planning Notes: � M
with section 7000) of Division 3 of the Business and Professions Code, and - /5 � f���z `� /.S y'•�r(/ �_/1
my license Is In full force and effect. 1-E.C4- Z4Ti0N OI 7 r or coin v S
T
License Class • License No. 7 I PLUMBING FEES
. Date - Signature - - f
WORKERS'COMPENSATION DECLARATION p • 1 Bar Sink Showers '
I hereby affirm that I have a certificate of consent to self-insure or a certificate - - ELECTRICAL FEES
of Workers' Compensation Insurance, or a certified copy thereof (Section a Backflow Preventer Service Sink '
3800, Lab. C.) Automatic Washer Transformer ❑ 15-50 KW
Policy No. Company 7 Backfiow Irrigation - Sewer Cap Construction Pole
0 50+KW
fl Certified copy is hereby furnished. $Ub.
Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter Dup to 100 amps
e Applicant -
EY,EMPTION FROM WORKERS'COMPENSATION DECLARATION L.. Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps
This section n tl of completed if the er It is ne h ed 100) or
ess). /1/�.0� j�g� /Jy I pishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
a certify tflat sn tnt perlorman<e of(h? w� th15 I uetl, I
(J all not employ any person In any manne,so as to bacon bj t to the Drinking Fountains Solar Tank Fan . Motors❑0-1 HP ❑1'h-8
• orker Co pen ation Laws of California.
ly late —.�___ _- —. - Floor Drains Swimming w/Spa/S a
—
' NOTI : f of - making this declaration, you should become sub I to the P I F.A.U. Inc Solar ❑9-15 HP 016-15+
Workers' Compensation provisions of the Labor Code, you must f'rthwith Floor Sinks Urinal Fixtures '
comply with such provisions or this permit shall be deemed revoked. 1 - Microwave
CONSTRUCTION LENDING AGENCY 'Gas Service Outlets Water Closet •- Device Boxes
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is issuedion 3097 Civ. C.)
(Sect -
7InterceRange
ptors Water Heater Outlets
Lender's Name _ _ - - -
Lender's Address - - - Kitchen Sink - Water Service
OWNER BUILDER DECLARATION Switches Sign
I hereby affirm that 1-am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal
following reason (Section 7031.5 Business and Professional Code: Any city or 9 P Standing Sections
county which requires a permit to construct,alter,Improve,demolish or repair P—Trap Laundry Trays Generator ❑0-5 KW ❑515 KW
any structure, prior to its issuance, also requires the applicant for such permitTrash Compactor-
.
to file Nlsigned.statement that he/she Is licensed pursuant to the provisions of Roof Drains -
the Contractor's License Law(Chapter 9(commencing with Section 7000)of
Division-3 of the Business and Professions Code) or. that he/she is exempt -
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5' by any applicant for a permit subjects the applicant to a civil -
LIenalts(of not more than five hundred dollars($500).
I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
-'mpensation, will do the work, and the structure is not Intended or offered Fee $15 Issue Fee $ 3
Reinspection
sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES p
ense Law does not apply to an owner of a property who builds or improves
..ereon, and who does such work himself/herself•or through his or her own — DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I 0 I �'L( ^
-}'- r/
sale. If, however, the building or Improvement Is sold within one year of com- — Canopy Type II ❑ Zoning Approved By y�// Date
pletlon, the owner will have the burden Of proving he/she did not build or im- Duct-Under Ground Building Approved By !y � Date /Z— y-d�
prove for the purpose of sale). ..y_./] //
0 I. as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By ,c.•..`./ 4/. 71 DatnY-- 7 t7 /
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's- License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU ❑100,000 BTU SUMMARY OF F S
builds or improves thereon,and who contracts for such projects with a con- p�
tract (s license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple❑ System Repair/Alteration - poi-BUILDING PERMIT $ ./O8'C ' SMTP $ a
pr f of their Worker's Compens t' n nsurOe should be provided to me. PLAN CHECK $ ___..5"10 PERMIT
I am exempt under Section / r3 B.& P.C.for this reason Firepl/Fact.Bit. ICBG# Fire DampersISSUANCE $
/� PLUMBING $
Date owner .4471/4-R I'- -G a Heating System& Ducting Registers ENERGY P.C. $
2( ❑0-100,000 BTU 0100,00087 PLAN CHECK 25% $
I hereby <e tify that have read this application and state hat the above GRADING $
Information is correct. I agree to comply with all city and county ordinances ELECTRICAL $
and state laws relating to building construction, and hereby authorize repre- MICROFILM $ •
Inspection
fives of this ity to enter upon the above-mentioned property for PLAN CHECK 50% $
I ignat ton purpose /''� MECHANICAL $ /93 4/z
Signature ' (�S.G-e� Date l���I g� Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ TOTAL FEE $
Drivers' License or 55 7f
CMF 0865-46,rev.10/84 white - Building: Canary - Applicant: Pink -Accounting; Goldenrod -Assessor
-11111111111111
•
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 G ntl. . 57. APPROVAL TO COVER-GUNITE
7. Footings /)/.; 58. Electrical Conduit-Undrgrnd:
8. Foundation 59. Gas Pipe, O Undrgrnd.,Test
..
9. Water Pipe-Undtgrncl:' 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System: 61. APPROVAL TO DECK . '
•
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final ,
12. Sewer Cap - 63. Heater & Vent-Final '
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing • 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring - : 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL •
19. Rough Heating & Air Conditidning FIRE DEPT. REQUIREMENT .. .
20. Rough Factory Fireplace APPROVALS Permit# _
21. Ducts, in Structure 70. Underground Hydro •
22. Ducts, Ventilating 71. Product Piping O Gas O Oil , •
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank O Gas O 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 _ t
29. Insulation 78. FIRE PREV. FINAL -•
30. Drywall Nailing HEALTH DEPT. REQUIREMENT `l
31. Plaster Brown Coat 79. FINAL INSPECTION .'
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED '
33. Final Electric Notes:
Jo3 S%.% 'e_._ CcII•wtsutA� w4�
34. Final Heating & Air Conditioning
Gw,n rZ a"-c G»a'✓w¢ .
35. Final Gas Pipe-Test
\Z- l6-gam . -
36. Hood or Canopy
37. Final Factory Fireplace -
38. Final Plumbing ' -
1
39. Water Service-Final I
40. Gas Service-Final .
41. Solar Domestic-Final
%.- 1 •
42. Backflow Preventer -!
4L-----
43.
43. Backflow Irrigation
•
44. Landscape Irrigation System .
•45. Sound Attenuation I
1 '
•
46. Handicap Regulations / - - • _f'
47. FINAL STRUCTURE & BUILDING L�lri/.,,re� t,
48. Special Requirements Completed /'f,+//l of - -
49. Electric Release to Edison
50. Gas Release to Southern California Gas Cc-c?
51. CERTIFICATE OF OCCUPANrY
. .
No. Date
...Ail
.. 19536
AAY22W63
COSTA MESA BUILDING-SAFETY DEPARTMENT I II
P.O.BOX 317 COSTA MESA,CALIFORNIA HI!: I .0 IJ_'
•
C;IV OF LCSL, ,.I_S.'
For Applicant to Fill In Completely APPLICATION FOR PERMIT
TYPE OR PRINT BUILDING
For Office Use Only
BUILDING 2755 Lorenzo Ave, r{ %�'
ADDRE59 RECEIPT NO. pERy{` NO,
COSTA MESA, CALIFORNIA (J]y[J� ��J+
RECEI O 8Y DATE RECEIVED DATE ISSUED
OWNER Macco Realty Co. _25--(--)-/—‘3 MAY 2 8 1963
BUILDING
ADDRESS 3800 E. Coast Highway ADDRESS
FIRE 7
C'^'GOLOna del Mar, Calif. ;ROE 34220 ZONE TYPE OROUPj
APPROVED
Or,cNIGENEER Macco Realty Co NOI"OR 34220 BY DATE
ZONING
ADDRESS Same as above `1 11r
zomp_l I NO.OF USE O�yF�7N�E 1/..,
Macco RealtyCo. 11 PUNS BUILD j( (f� I
CONTRACTOR L(j .J
LEGAL
ADDRESS Same as above DESCRIPTION Lot 68 Tract 4784
A.P.NO.
CITY
NOTE: NO EAVE OVERHANG SHALL BE LESS THAN
?Inc,. 207343-A-SB 1 o' OR 34220 SO'TO SIDE Q REAR P.L.
EAVES
SIZE No.OF BLDG ALLOWED (U.B.C.REQUIREMENT)
OF LOT 65 x 94 I now ON LOT none
YARDS APPROVED YARDS APPROVED
USE OF
none MAIN BUILDING ACCESSORY BUILDING
EXISTING BLDG.
(FROM C/L/ STREET/
SETBACK LINE FROM I 1 FRONT '`�_O FT. FT.
CENTER OF STREET 5O REAR YARD 33 _ 1/
SIDE YARD I LEFT 51-6" I RIGHT 5 I -611 R.SIDE .S FT. ` FT.
0 DESCRIPTION OF WORK L.SIDE ,c FT. (' Fr.
NEW X ALTERATION _ ADDITION REAR 33 FT. FT.
DISTANCE BET. BET.MAIN&
REPAIR MOVING DEMOLISH MAIN SLOGS. ACCESS.BLOCS.
BUILDING I I II NO.OF VAR.# 1 DATE
SIZE 54 x41 -6 ROOMS 7 STO IES 2 C.U.P. APPROVED
WALL ROOF 12 APPROV
COVERING
EXTERIOR stucco 1 COVERING e6tapO shingle BY A �WIM'1 DATE S-d/VrrJJ
�
USE OF BUILDING AND WORK TO BE PERFORMED
Single Lam, res, w/att. gar.
Plan No, 500-AR
226 S.F. Gar. 460 S.F. N
Dwe ing SQ.FT. G
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE Y
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM. PURPOSE OF ESTABLISHING A PERMIT PEE ONLY. G
PLY WITH ALL CITY ORDINANCES AND STATE LAWS REGULATING VALUATION -
BUILDING CONST ION. �J B
SIGNATURE 0i' �� ,, // PERMIT FEE $ �� B
PERMITTED !f ��-�n' aN� �+ LH m
$ 23,925.00 LA HEC 5o &
1.
AUTHORIZED AGENT �� fin_ TOTAL FEE $ /72'SO