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HomeMy WebLinkAbout2856 TABAGO PL - Building Permits CITY OF COSTA MESA ctr • BUILDING DIVISION > > DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER 4. ...Fri ti . PERMIT z *+b.' so V B04-01802 (714)754-5273 • Fax(714)754-4856 • www.ci.costa•mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2856 TABAGO PL Status: ISSUED Suite: Applied: 10/22/2004 Vicinity: Issued: 10/22/2004 Parcel Number: 13933204 Zoning: R1 R1 Applicant: WALLACE, TODD ISSUED BY: Address: 2479 SANTA ANA AV Phone: 949-642-7812 COSTA MESA,CA Zip: 92627 Owner: WILLIAMS, CAROLINE B TR Address 2856 TABAGO PL Phone: COSTA MESA,CA Zip: 92626 Contractor MILES ABOVE ROOFING & WEATHERPROOFING Address: 2479 SANTA ANA AV Phone: 949-642-7812 COSTA MESA,CA Zip: 92627 License: 763165 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT RFEROOF:T!O SHAKE ROOF, INSTALL 7/16'OSB, 1 LAYER OF 30#FELT&37 SOR'S OF 50 YR.CERTAINTEED PRESIDENTIAL COMP. SHINLGES FEE SUMMARY Plan Check: $0.00 Calc Valuation: $8,000.00 Permit: $153.25 -- - Claim Valuation: $8,000.00 SMIP Res: $0.80 SMIP Corn: $0.00 Other: $0.00 Inspection: . $0.00 • • Total: $154.05 • • PLANNING &ZONING • SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 " Left 0-0 Right .0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 • PARKING Existing: 0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1,12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 • . 2446-46(6100) WORKERS'COMPENSATION DECLARATION: "t + I hereby affirm under penalty of perjury one of the following declarations: - 0 I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. -0 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: Carrier: Policy Number: (This.action need not be completed if rhe permit is valued at one hundred dollars($100)or less.), , 1 ;.'k �i 7 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 it I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith Comply with ih a pro �iC p Icant+SignatU7e: , Date' /N/7-7-74.`" /.'S`NG: cgs `VJARt�ING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CAVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full If e1Ceral effect.Lic.1t 7(P 3/ 5 �cV.,,--' aa�esf l G— a9 'tractor's Signature: ��- t ,J 7jn/7-y/v'/' CONSTRUCTION LENDING AGENCY: t� ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,CMI Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penally of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply loan owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' ❑ I,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 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 at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the Califomla Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application apermit for such construction or modification from the South Coast Air Duality Management District or from any other air pollution control district or agency? LI Yes 0 No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Duality 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? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials 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 ro arty for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. /O/ -7/o'� Signature Of Legal Owner(s) ate "And/Or9AUthonzed_Apppicapt i _-""7'..t ata; r gm A INSPECRON TYPE DATE INTITIAL@ CODEC INSPECTION TYPE RAM !MA45 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof / Z�"�/ `-- bee 210 Final Electrical 201 Final Block/Retaining Wall 2)2 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 CITY OF COSTA MESA • • 15 " a cc? � a4, BUILDING DIVISION : . ..►� DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F 1 4 r PERMIT PORW.- • M04 00825 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 2856 TABAGO PL Status: ISSUED Suite No Applied: 10/06/2004 Issued: 10/06/2004 Vicinity: S/ ISSUED BY: ///. T- Parcel Number: 13933204 Applicant: WILLIAMS, CAROLINE B TR Address: 2856 TABAGO PL Phone: 714-540-8752 COSTA MESA,CA Zip: 92626 Owner: WILLIAMS, CAROLINE B TR Address: 2856 TABAGO PL Phone: 714-540-8752 COSTA MESA, CA Zip: 92626 Contractor: OWNER-BUILDER Address: Phone: Zip: License:000000 SCOPE OF PERMIT REF B04-01229:ALT 1 DUCT SYSTEM. ' FEE SUMMARY ' • • Quantity Quantity ISSUE FEE $23.50 Repair/Alt Absorbtion Unit $0.00 0 Inst FAU<100 k BTU $0.00 0 Repair/Alt Refrigeration Unit $0.00 0 Inst FAU >100 k BTU $0.00 0 _ • Ventillation System $0.00 0 Repair/Alt Cooling/Heat $13.70 1 - Evaporative Cooler $0.00 0 Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys<100 k BTU $0.00 0 • Domestic Incinerator $0.00 0 Refrig Sys>100 k BTU $0.00 0 Compressors/Absorption Systems Gas Piping $0.00 0 Up to 3 hp/100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp/500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 - 7 .15 To 30 hp/1,000 k BTU $0.00 0 VAV Box $0.00 0 . - - 30 To 50 hp/1,750 k BTU $0.00 0 Vent Fan/Single Duct - $0.00 0 . Over 50 hp)Over 1,750 BTU $0.00 0' Appliance $0.00 --0 Boilers - Fire Dampers •_ , ,$0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent ' ' $0.00. 0 15 to 30 hp $0.00 0 Air Handlers< 10000cfm .$0.00 0. - 30 to 50 hp - $0.00 0 Air Handlers> 10000cfm $0.00 0 Over 50 hp - $0.00 0 Floor Furnace • $0.00 0 Other Mechanical Fee Floor or Suspend Heater - $0.00 0 Investigation-Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $37.20 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California,statutes and related regulations. (Ord.No.92-28,§ 1, 12-21-92) / EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. is, INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2446-46(600) 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 self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if 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 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed 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 effect.Lic.# Class# Contractor's Signature: 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). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is Licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($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 property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). • 1 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 exe t under s c. Business and Professions Code for this reason: "� Signature: L!//I _ _Date_:_`1 )d)L¢ /4 y Owner ID verified by driver's license. (-f)'Yes 0 No Driv'e�')License No. " ----Expires: -42)69 _—+ 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 Califomia Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). • 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LI Yes DI No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials 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 -II state laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above- ribed pr party .pec,• purposes.I agree not to occupy or allow occupancy of any building authorized by this permit yntil fipal inspection. dr / - l6/ 20/Oil Signature Of Legal.Owner(s) -Date And/Or Authorized Applicant Date ;ODE# INSPECTION TYPE PATE INTRIAL4 CODE# INSPECTIONTYPL �� ` (0 I , 1616 Fixed System Final Fire Prevention 206 Final Mechanical C•i'l 1266 Pool Spa Final . . 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall . 212 Final Fire Prevention 202 Final Factory Fire Place - 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition "250 - Final Building/Occupancy 111 r' l,�i� r� CITY OF COSTA MESA • 44041111 BUILDING DIVISION >:� ; , DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER F• 1 !ti • PERMIT ttwooaarm e4. V B04-01229 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 2856 TABAGO PL Status: ISSUED Suite: Applied: 07/08/2004 Vicinity: Issued: 10/06/2004 Parcel Number: 13933204 Zoning: R1 R1 Applicant: WILLIAMS, CAROLINE B TR ISSUED BY: /) Address: 2856 TABAGO PL ri I // Phone: 714-540-8752 COSTA MESA,CA Zip: 92626 Owner: WILLIAMS, CAROLINE B TR Address 2856 TABAGO PL Phone: COSTA MESA,CA Zip: 92626 Contractor: Address: Phone: Zip: License: Arch : Eng: EDMUND FORESTEL Address: Address: 2377 S EL CAMINO REAL Phone: SAN CLEMENTE Phone: 818-964-0014 STE 200 Zip: License: 92672 License: 957 SCOPE OF PERMIT 216 SQ. FT.SINGLE STORY ADDITON OF A DINING,ROOM. • 51 SOFT.REAR YARD COVERAGE PROPOSED;372.5 SOFT.PERMITTED. FEE SUMMARY - Plan Check: $208.81 Calc Valuation: $19,958.40 Permit: $321.25 Claim Valuation: $0.00 SMIP Res: $2.00 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 Total: $532.06 - PLANNING &ZONING SETBACKS • MAIN STRUCTURE Front 0-0 Rear 18-0 Left 0-0 Right 13-6 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: - 4 Required: 4 Proposed: 4 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 2448-ee WOO) WORKERS'COMPENSATION DECLARATION: - I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is Issued. . ❑ 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: Carrier: Policy Number: (This section need not be completed i/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 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: 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 DOLIARE(S100,000),IN ADDITION TO THE COST OF COMPENSATION.DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.A Class N Contractors Signature: 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). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is Iold 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.). ' '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.). 1 ❑ I am°Lt under c. Business and Professions Code for this reason: eqz,,Signature: di/ Date: L D!z, JD 1-1 r Owner ID verified by driver's license. - '51Yes 0 No Driver's License No. _—rEx Ires: 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 at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application appermit 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 ❑No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes ❑No (If yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPUANCE 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 st:to laws and city ordinances relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-des ed props for inspe p/purposes.I agree not to occupy or allow occupancy of any building authorized by this permi until final inspection. Signature Of Legal Owrriei(s) Date And/Or Authorized Applicant Date • CODE f fNSPECTIONTYPE PATE irmaski CODE. WWSPECTION TYPE 'ma I(TTTAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1286 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place - 220 Final Planning Approval • 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy /G,ZZ-t INSULATION CER1 ICATE IC-1 Site Address • Permit Number Sc4-p 1 :22? Number and Street City t`aM County Subdivision Lot Number Description of Installation L ROOF Material �%�r'4i7-- r/ Brand Name Thickness (inches) 45ft ( Thermal Resistance(R-Value) t 2. CEILING �`� Batt or Blanket Type X Brand Name Thickness(inches) Thermal Resistance (R-Value) aQ Loose Fill Type Brand Contractor's min installed weight/ft' lb Minimum thickness inches Manufacturer's installed weight per square foot to achieve Thermal Resistance (R-Value) 3. EXTERIOR WALL Frame Type WOO. A. Cavity Insulation /�w Material , Brand Name YvL. Thickness(inches) Thermal Resistance(R-Value) 13 B B . Exterior Foam Sheathi� Material Brand Name _ Thickness (inches) Thermal ResiKtance (R-Value) 4. RAISED FLOOR Material Brand Name Thickness (inches) Thermal Resistance (R-Value) 5. SLAB FLOOR/PERIMETER Material CDNC12.61-t Brand Name Thickness (inches) 41' Thermal Resistance(R-Value) Perimeter Insulation Depth (inches) 6. FOUNDATION WALL Material CONLR€ .c Brand Name Thickness (inches) la" - /5 " Thermal Resistance(R-Value) • Declaration I hereby certify that the above insulation was installed in the building at the above location in conformance with the current Energy Efficiency Standards for residential buildings(Title 24, Part 6,California Code of Regulations)as indicated on the Certificate of Compliance,where applicable. Item#s Signature, Date Installing Subcontractor(Co. Name)OR General Contractor(Co.Name)OR Owner Item#s Signature, Date Installing Subcontractor(Co. Name)OR General Contractor(Co. Name)OR Owner Item#s Signature, Date Installing Subcontractor(Co.Name)OR General Contractor(Co. Name)OR Owner Compliance Forms August 2001 A-36 IOU No 23460cItYOFLOS ANGELES • DEPARTMENT Op BUILDING AND SAFETY CERTIFICATE OF REAPPROVAL ML. 11 • This certifies that reapproval for one year is issued by the General Manager under the provisions of the Los Angeles Municipal Code es a . EABRICATOR/MiS/REBAR//1290 Testing Agency 0 • • Type I Fabricator ti 4 )ecC.rtner.t a ?uric ns an!? 5etcty SI ' 1- iij ('7151 �R's' n �s'e`iimrii;020. A11-Fab Specialties, Inc. • 2921 E. Coronado Street FABRICATOR 7J19/p4 so0Si.DO Anaheim, CA 92806 Date _ Total Due: 600.00 36DO.e0 • Annuat:neck: S6;tf. R: L Renewal Fee$ _ tlisApprovel 9/1/05 440264.)4( . T Expires . LADeS R-B( 31) License#: P020632 ' Expires 11/06/2005 . • ROMAN F KARAS STRUCTURAL-MANUAL PROCESS 'Y STRUCTURAL-SEMI AUTOMATIC i Issued by City of Los Angeles, . ..- Department of Building and Safely 'fl • Aa • 53 �e. ' CITY OF COSTA MESA • 44s. ell BUILDING DIVISION Y:� ,:,,, : ,� a DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER t i PERMIT k '4s E04-01072 .atm (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 2856 TABAGO PL Status: ISSUED Suite No Applied: 10/06/2004 Vicinity: Issued: 10/06/2004 Parcel Nunmber: 13933204 f /17 Applicant: WILLIAMS, CAROLINE B TR ISSUED BY: / A\ V Address: 2856 TABAGO PL k----17 Phone: 714-540-8752 COSTA MESA,CA Zip: 92626 Owner WILLIAMS, CAROLINE B TR . Address 2856 TABAGO PL . Phone: 714-540-8752 COSTA MESA,CA Zip: 92626 Contractor OWNER-BUILDER Address: Phone: Zip: License: 000000 SCOPE OF PERMIT REF B04-01229.5 LIGHTS,4 OUTLETS AND 5 SWITCHES. - FEE SUMMARY Quantity _ Quantity ISSUE FEE $23.50 - Temp Dist System/Lighting $0.00 0 Temp service test $0.00 Busway/100 ft - $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment . $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 "0 Lighting Fixts $5.50 5 -- - up to 50 kva/kw $0.00 0 Recept Outlets. $4.40 4 - - - - -up to 100 kva/kw $0.00 0 Switches $5.50 5 ' over-100 kva/kw $0.00 - 0 Non Res Appl $0.00 0 . Low Voltage Equipment . - . $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $1100 0 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a, $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 - 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord.No.92-28,§1, 12-21-92) / EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or If work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 244848(8/00) DECLARATIONS �j •. 1 WORKERS'COMPENSATION DECLARATION: • • I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ 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: Carrier: Policy Number: (This section need not be completed if 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 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUEUECT AN EMPLOYER TO CRIMINAL PENALTIES AND CNIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($104000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 37060E 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 Professions Code,and my license is in full force and effect.Lic.# Class# Contractor's Signature: 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). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($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 property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not Intended or offered for sale.If,however,the building or Improvement Is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ' i,as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec.7044.Business and Professions --Code:The contractors License Law does not apply to an owner of property who builds or Improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am ex pt and r sec. Business and Professions Code for this reason: -Signature:exempt Date: )b)4.-/ y -. Coiner ID verified by driver's license. —��Yes 0 No Driver's Lice�No. � --r Expires: S Ap )O 9 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(38)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,California Administrative Code). ❑ As owner-builder, 1 wilt 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 materiel? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes IJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 It 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? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials 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-desc,V property f r inspectio pu oses. agree not to occupy or allow occupancy of any building authorized by this perglit until final inspection. 0 � / � Del Signet Of Legal0owners)J Date J And/Or Authorized Applicant Date gODE 4. INSPECTION TYPE gAIE IRA MIS CODER INSPECTION TYPE QAIE INS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final - 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical lZ ) " 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 • • Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. . a,-7-, / V'OF.COSTA E CONST UCTION PEC ilIT PERMIT NQ. �� ACT NO. LOT�N UNIT NO. A.P.# 1 9 -� 3132 ^ O -1 Zone .2 V • • �r, co mo C/7l 37L��CSlJ _ Pfojec�+y+ddrEss LI ���yyy S Main Building: Accessory Building: _ -Y-.elic4,t's.alaili•! Address �r Int _ �r TYPE OF CONSTRUCTION NEWrs,IDWOD U ALTERATION U REPAIR E \ - Z ❑ DEMOLISH LJ Olt ' T Front \\ 0 w `` - ❑ CONVERSION ti� • B ` �',� '/ N Owner's Ns�am//e. -�' � �.w - a Phone • - C I TION OF WORK/USE OF BLDG. M s J Address '--•�+ " O �Q LL ^ ��^ A Rear I ^ C Right C /(�t N Arch/Eng. License N.. TYPE OF PERMIT ❑ GRADING'•{ L� FOUNDATION STRUCTURAL — Address (P ❑ TENANT ELECTRICAL 1�VY LUMBING ECHANICAL $ . Left G / ❑ OTHER R Contractor's Nam • , �s • ,..166'hone` �7 Ping. Ref.# Parking Req./Provided E n� CO �y� PROJECT DESCRIPTION OCCUPAN Y K �•� ��_��p � _I O Address(mailing) =t C. Q� 00 Planning Notes: QA& lata ero n '( -(�Q_t- M D D Q Off/ - CONSTRUCTION TVP ALUATION$ LZ/ - - - T City License No. O / T-fes • ZONE GRADING CU.YDS_ ACRES -if .46�1L --(as .0_A�L ^-1^_'_Le: ,, `� S. I LICENSED CONTRACTORttI DECLARATION ION (S'K lSf l o s. -Para. rem,a .•`cg_,_) I hereby affirm t0) I am licensed underfprovisionsBusnssf Charter 9(commencing'and' Remarks: J with sectioneis 7000) of a Division 3 of the Business and Professions Code,and. my license is in fu tome . d effect. _ /C7 ELECTRICAL FEES License Class �' Li•e je •�v v ` C. 3S- �, Automatic Washer Transformer 0 15-50 KW Date +� Signature �, #� = _ _- PLUMBING I FEES - 0 50+ KW 'FIXERS'COMPENSATION DE L• RATION Bar Sink 1 Showers 2 00 Construction Pole Sub. reby affirm that I have a certificate of consent to self-Insure or a certificate workers' Compensation Insurance or a certif'ed copy thereof (Section Cooking Unit Meter ❑up to 100 amps 3800, Lab. CJ.,.- g per, 'tom /' Backflow Preventer Service Sink Policy No. J �QV I�te/ Company tea' �. O 'vP [.b ® Dishwasher Meter Dover 100 amps ■ 7-,..Certified ietl cop is hereby furnished. - •• �� .-' Dryers ❑Gas`•❑Electric Sub Panel Cer ifi p]T' etl with the city I.I. '51. Date 1' ,'. .I_ Applicant • _ _ _� II EXEMPTION FROM WORKERS'CO P NSATION DECLARA -•N Clarifiers Solar Collectors l' Fan ill • • •-�1 HP ■ �� Q (This section need-not b¢completed if th permit Is for one hunt 10)or ,_ II 7- Q F.A.U. ,� Inc.$Olay 09-15 HP 016-15+ less). /i -, Dishwasher Solar Piping I certify that in the performance of the ork 1. his permit is Issued, I _' shall not employ'any person In any n - • so as to become subject to the • Drinking Fountains ' Solar Tank •• ■®�0 Fixtures r Microwave 7 0 Workers' Compensation Laws ornia. - Device Boxes -- Date � gnature ' Floor Drains Swimming Pool w/Spe Pole Light • NOTICE: If, . • . ing this declaration, you should become subject to the Ci Workers' C•mpensation provisions of the Labor Code, you must forthwith 1 Outlets Range ' 7s- comply with such provisions or this permit shall be deemed revoked. Floor Sinks Urinal l /.r CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet fJ p Sitches - �. Sign I hereby affirm that there is a construction lending agency for the performance - 4_. - - 2 of the work for which this permit is issued (Section 3097 Clv. C.) Garbage Disposal• -• • Standing Sections - Lender's Name Interceptors Water Heater - -- p Lender's Address Kitchen Sink Water Service • Generator ❑0.5 KW ❑5-15 KW Trash Compactor OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law •r the Lavatories Auto-Wash • • - ' v following reason (Section 7031.5 Business and Professional Code: •• city or - - county which requires a permit to construct,alter,Improve,demo' or repair P-Trap Laundry Trays - ' any structure, prior to its issuance, also requires the applicant f• such permit - in file a signed statement that he/she is licensed pursuant to e provisions of Roof• Drains / 00 Contractor's License Law(Chapter 9(commencing wi • =coon 7000)of ' sign 3 of the Business and Professions Code) or at he/she is exempt • Reinspection Fee' $15' • Issue Fee $ - refrom and the basis for the alleged exemption •ny violation of Section 0 7031.5 by any applicant for a permit subje the applicant to a civil - - enaltyas of owner not moreof thanthe five hundredormdollars 00). 1. DEVELOPMENT SERVICES" • IREMENTS: I, property y ployees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 /O - �/1"Z��'y Zoning Approved By Date compensation, will do the work,and - structure Is not Intended or offered _ for sale (Section 7044, Business d Professional Code: The Contractor's MECHANICAL -Building-3C By • • • -- Date 2 License Law does not apply to .• .wner of a property who builds or improves FEES r = ,p thereon, and who does suc •ark himself/herself or through his or her own _ Application Issued By �� -Dat �'� employees, provided that •ch improvements are not intended or offered for Boiler Hood or Type I 0 .it sale. If, however, the b ding or improvement is sold within one year of com- Canopy Type II 0 ' ' , . • SUMMARY OF FEES pletion, the owner • have the burden of proving he/she did not build or Im- Duct- Under Ground , /• r•r/ I rove for the our.; e of sale). „ pp//BUILDING PERMIT $ 22/5" oo SMIP $ J T 0 I,as owne •f the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System ZS,/OPLAN CHECK $ '•: 36 •S6 PERMIT tractors to • struct the project (Section 7044,Business and Professions Code: The Con .ctor's License Law does not apply to an owner of property who Duct-Ventilating ❑0.100,000 BTU 0100,000 BTU PLUMBING a $ 20. 00. ISSUANCE $ builds • improves thereon. and who contracts for such orolects with a con- tract• (s) license pursuant to me Contractor's License Law). I am aware that ,Exhaust System 0 Multiple 0 System Repair/Alteration I Q +O PLAN CHECK 25% $ ,,CC ENERGY P.C. $ proof of their worker's Compensation insurance should be provided to me. / ELECTRICAL' $ TOrSO • GRADING $ ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG* Fire Dampers MICROFILM $ PLAN CHECK 50% $ Date Owner , • Registers MECHANICAL $ 2174 TOTAL FEE $ X347.60 I hereby certif that I have read this application and state that the above ■I I I Ifsing ■ I s•IIs BT information is ••rrect. I agree t comply with all city and county ordinances PLAN CHECK 25% $ and state la s -lating to Ili f] g construction, and hereby authorize repre- sentatives o tis •ty t•� �i Lupo the above-mentioned property for ■ Inspection ..S's. . ,-� III Signature 0 r� - Date `^� O Jf Reinspection • Drivers' License •r SS • � `�� $15 . Issue Fee $-3-Ill "' _{jit:eL2 -ub.12('L2$ r1_ : • . 0865.46,rev.5/:8 white - Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor '317E: 02/22/S‘ t S{1L- Z+-fib I PC Si SPA -,'-CtS�Sr:RUCTION AND PLANNING i j • APPROVALS Permit# /Date Inspector APPROVALS Permit# Date Inspector "j (1. Temporary Electrical Service or Pole 52. Pool & Equipment Location • r v. r 2. Soil Pipe-Undrgrnd. �1 3�is/�J,Q L� I 53. Steel Reinforcement / ------fG, � • •3.i Electrical Conduit'Utility-Undrfj Utility - % CC..• / 54. Forms i / `� - 4.'Electrical,Coriduit'U&Br.arnd. ., vt / 55. Electrical Bonding / -yr 5-.>Stee1,Reinforcem?ni4 C % / 56. Rough Plumbing & Pressure/Test • --=03 El3ctricalUFER-Gir1d', --- rZl-9- 57. APPROVALTOCOVER1GUNITE _,-.1/4.,d:; 7.CF.00tings, •'_ r •r,Zs I 3jp; / 58. Electrical Conduit-Undrgrnd. t"- 8'1Fouridation Cri n \' I" 31-2A si 59. Gas Pipe, D Undrgrnd.,Test -1, 1-i' 9'$Water1Pl pe-U nd rgrntl. C---) �il 1 60. Backwash Lines, P�Trap, El Undrgrnd. 10 Structural Floor<Sy tem 4 1 \ II 61. APPROVAL TO/DECK ✓) 1 '.Property Sewer Line & House Connection .lt� ,-� " - .t I 62. Backwash & Receptor-Final 12.•Se�✓er Capr,y - ? �= )< �4=• / 63. Heater & Vent-Final dr 13 •Ro'pf4:Drains t l J, i ? 1r 64. Plumbjrig System - Final 71 14. Rough Plumbing•f 9et., 1.40'.4.€ Li, I 65. Electrical-Final et. 15. Rough Electrical-Conduit 66. Solar,3ystem-Final 1.6-' Rough Electric Wiring ,04767,g: 67. Fencing`&Access Approval • 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18., Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL i i9. Rough Fleating& Air Conditiohidg FIRE DEPT. REQUIREMENT • 2M Rough Factory •Fireplace APPROVALS Permit# r- . 21. Ducts, in Structure , i'' 70. Underground Hydro Z. Ducts, Ventilating IC' r. 71: Product Piping 0 Gas D Oil 23. Gas Pie-Rou h & Test P 9 Z2„Underground Flush • 24„'Roof Framing ( Z 73. Undergrnd.StorageTank DGas DOil ' 25./RpotSheathing--,- 4.-3--- 74. Overhead Hydro . • 26. T-Bar•Ceiling (Stcuctural) & Monocoat 75. Dry Chemical • 27. Frame�and Fleshing o si 76. Dry Standpipe r 28i Lathing Aiding cc 77. FIXED SYSTEM FINAL 29. Insulation orzsS 78. FIRE PREV. FINAL 30. Dry4111 Nailing (1 53951 g /1--- HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat.` - 004.1, 79. FINAL INSPECTION . i 32. Electrical Power'Meter-Final (/1 7 80: FOOD.EERTIFICATE ISSUED 1,- 1 33. Final Electric n 'Fh/f'49 ,,;#4- Ivotes'3/prf fq n0 offellone. ccp n i 34. Final Heating & Air Conditioning p(,7-4 (gip 2. r . 35. Final Gas Pipe-Test .1 NO slcccss ¢ -3-s-4) - 36. Hood or Canopy Th--..--, OK 7D £^4Zir ? .37.•Final Factory Fireplace!: NO AOi&uQD DIA-M/ vi-/ S!7C Owld9 38. Final Plumbing -1 Qf w 97-&, (.."0 614ilx9 e ne ot>`su&tcr-io S a/7E- 39. WaterlService-Final ' rPan gr L&p 50. Gas Service-Final l" �•Zy-a-9 1‘,0 Ott€^•goirw . &- n r 41. Solar Domestic-Final 4' j. r 1 • i OC2IZIv'-1 NO 00a- -NOM Erfc:.= 42. Backflow Preventer/ %- i' Fip L�4"" `Y G�. 0IZGP\ i3G i '43. Backflow Irrigation.- _'' L r , % -4d /` 4/ ' _ . .-1`- 'i44. Lariiiscape Irrigation•System '^ 45. Sound;Attenuation- I 46. Handicap Regulations- .1 . , 47. FINAL STRUCTURE &BUILDING O9Z2.49 / t Srviot�6- oar o/G 48. Special Requirements Completed 49. Electric Release to Edis`orir_ •. 50. Gas Release to Southern California Gas Co I • 51. CERTIFICATE OF OCCUPANCY • No. Date •. ,_• - ( 1 •• 1 . •' f Y ' ni CERTIFICATE OF COMPLIANCE , • PAYMENT OF SCHOOL FACILITY FEES • '. �. NEWPORT-MESA UNIFIED SCHOOL DISTRICT Developer/Applicant : 0 Al j I`ltv \ l:4gat-j e t v1,.�, • Address : Qt7 € 9e c oo,e Ac1Q,� -L.,-�-.-.V, \Q _ Creap Telephone Number : (7 \ a- )97 n SPt Tract/Parcel and Lot Number(s) :� ` Location of Project : tier-J-0Tct\± �^ ¶ , C , ►�'1 Number of Square Feet of Residential Space 33t . x $1 . 50 Total 7 , Number of Square Feet of Commercial and Industrial Space x $0 . 25 Total Commercial/Industrial Project is : (Check One) Mini-storage Motel Preschool Movie Theater Bank Auto Repair Racquet/Health Neighborhood Shops Hospital Warehouses R & D _ Large Office Heavy Industrial Hotel Office Bldg. Regional Shops Medical Office Restaurant Light Industrial Office Park Fast Food The provisions of Government Code Section 53080 are not applicable . This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and 65995 . Checks are to be made payable to New . •rt-Mesa Unified School District . Bus ess Manager Newport-Mesa Unified School District The above representation as to square footage is true . Developer/ Applicant agrees that if it is later determined that such representa- tions are not true then this certificate shall automatically terminate and the appropriate City/County shall be notified . �/ • i Date : 2 - L1 - p4,0 er/Applicant~�\l Maria Cullry CI" Y OF COSTA MESA \ . CALIFORNIA 92628-1200 P.O.BOX 1200 • Insulation Certificate • U ioN// d Streetumber and �PJs%/r ?� City (2244/1-1 c 6;r- County Subdivision Lot Number Description of Installation ROOF ��/9N / Material j—� y/ff d�'/Brand Name i/iGG Thickness(inches) /Q 41 Thermal Resistance(R-Value) ,Q-3 EXTERIOR WAT r / Material1-51P1-7— Ji�/LjlllSf Brand Name 0AN/Z-(---er— Thickness(inches) 3Y a ✓ Thermal Resistance(R-Value) ,/1-// CEILING / Batt or Blanket Type 47725 %//c f Brand Name 7479,41 e'/Z �- e Thickness(inches) /(2 fi Thermal Resistance(R-Value) 12-30 Loose Fill Type Brand Name Contractor's minimum installed weight/hi lb Minimum thickness inches Manufacturer's installed weight per square foot to acheive Thermal Resistance(R-Value) RAISED FLOOR Material B .'I . e • Hess(inches) Thermal Resistance(R- . . SLAB FLOOR Material i----- :rand Name Thickness{inches) The I. .. 'esistance(R-Value) Width-Catchy) FOUNDATION WALL> / ------ Material � Material / // /Brand Name Thick...--- inches) / / Thermal Refit. I • (R-Value) Declaration I hereby certify that the above insulation was installed in the building at the above location in conformance with the current Building Energy Efficiency Standards for new residential buildings contained in Title 24 of the California Administrative Code. edC/�DrP,f1,4 .Pc>roZez/,vl� Q- 56 LF3K General Contractor(Builder License Number 7-7---v g s��e 7 // signature and Title Date Sub-Contractor(Insulation Installer) License Number \LN> Signature and Title Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. ,.OYTY'OF COSTA MESA CONSTRUCTION PERMIT PERMIT'NO. TRACT NO. LOT NO. • UNIT NO. - Projecf'Address 925° ` 74Q8zir' b' AG0 PL. ��w 80E2 5/I ':/"'7 orn • A9llicant's Mailinr7gg Address $0-"s C. TYPE OF CONSTRUCTION ❑ NEW U ADD U ALTERATION L'J REPAIR r ,/s e, �' ❑ CONVERSION CI DEMOLISH ❑ OTHER A.P.# Zone Owner's Name SI eLIA/F (.I�1LLL4Ni Phone DESCRIPTION OF WORK/USE OF BLDG. Address R a""-12-- S Main Building: Accessory Building: Arch/Eng. TO A/ License No. TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION U STRUCTURAL T Front Z0 Address S&"`^4-_ /nJ h �.•� ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear N 0/8 cgo-O /S'7/ ❑ OTHER g Contractor's Name Phone g 3 C Right N PROJECT DESCRIPTION SO.}F/T.�iZOU O.op OCCUPANCY K G Address(mailing) • C ON ST RUCTION TYPE V VALUATION$ ` S Left R City License No. ZONE GRADING CU.YDS. ACRES E LICENSED CONTRACTOR DECLARATION - p Ping. Ref.# Parking Req./Provided I hereby affirm that.I am licensed under provisions of Charter 9 (commencing Remarks: ^= (—oUr I i b Planning Notes: M with section 7000) of Division 3 of the Business and Professions Code,and gT license is in full force and effect. ^i T License Class ' License No. late' ' Signature _ - PLUMBING I FEES a - IORKERS'COMPENSATION DECLARATIONBar 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 Cup to 100 amp Date Applicant EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors_ - Dishwasher Meter Dover 100 ps (This section need not be completed if the permit is for one hundred ($100)or less). Dishwasher Solar Piping _ Dryers :has ❑Electric Sub Panel I certify that in the performance of the work for which th •ermit is issued, I - . shall not employ any person in any : ner s. as to e bject to the Drinking Fountains Solar Ta Fan Motor i 0-1 HP 011/2-B Workers' PrsRipap hon Laws of Cali .epi.. - Date �s//lvl[/ 7 Signatur - -�-�." Floor Drains Swi ing Pool w/Spa F.A.U. I .Solar ❑9-15 HP ❑16"15+ NOTICE: If,of er making this declaration, you should become subject to the — - Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks inal 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 Lender's Name Outlets Range •Lender's Address • Kitchen Sink Water Service - Switches Sign OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposa following reason (Section 7031.5 Business and Professional Code: Any city or Standing Sections county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays Generator V s 5 KW 05-15 KW Trash Compactor any structure, prior to its issuance, also requires the applicant for such permit o file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains he Contractor's License Law(Chapter 9(commencing with Section]000)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 - I 7031.5 by any applicant for a permit subjects the applicant to a civil pp��T,ralty of not more than five hundred dollars ($500). VJ 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 nr 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 ins- Duct- Under Ground Building Approved By -/g/' Date CA5A/� prove for the purpose of sale). //_5�1 ❑ I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Data 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 BTIJ 0,000 BTU SUMN�ARY OF FEES builds or improves thereon,and who contracts for such projects with a con- '`,O tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System R Ir/Alteration BUILDING PERMIT $ . 00 SMTP $ ' Co proof of their Worker's Compensation insurance should be provided to me. _ PLAN CHECK $ PERMIT ❑ I am exempt under Section •.C.for this reason Firepl/Fact.Blt. ICBO# F' ampere PLUMBING $ ISSUANCE $ Date ei Y7 Owner _Is © i Heating System& Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ I hereby.certify that I have read this application and state that the above ❑0.100,000 BTU 0100,000 ELECTRICAL $ GRADING $ information Is correct. I agree to comply with all city and county ordinances and state laws elating to buildin• o struction, and hereby authorize repre- sentatives of I is cit . to e r n above-mentioned pr per y for inspection p es. nry(�e /� 9 MECHANICAL $ TOTAL FEE $ 14.5V Signature - -4.-.J 'V - Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865.46,rev. 10/84 White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL&SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation • 59. Gas Pipe, O Undrgrnd.;Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final . 16. Rough Electric Wiring 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 ❑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: e- cif 24e41 1 9lv G'4t fK✓FY 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37: Final Factory Fireplace - • 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation • 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING . 48. Special Requirements Completed , 49. Electric Release to Edison • 50. Gas Release to Southern California Gas Co r 51. CERTIFICATE OF OCCUPANCY - ; ). No. Date Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA PERT NO , ) TRACT NO. LOT NO. BLDG.NO. _ . CONSTRUCTION PERMIT `�O/ Project Address LO)b Tabago Ji. - TYPE OF CONSTRUCTION , 311Z6 I /17/83 3.p-; ITL , Owner Mr. Williams Phone D4J-L832 ❑ NEW 0 ADD 0 ALTERATION Tl_n - _ Address 2856 Tabago P1. - ❑REPAIR 0 CONVERSION ❑DEMOLISH X70 - - ZONING REGULATIONS Arch/Eng. - License No. 0 OTHER • DESCRIPTION OF WORK Replacement ot. Water ,, A:P.* - Address _-' Heater - ZONE' PLNG. REF.#, Contractor A-ames Plumbing-Heatinghone53U-L441. TYPE OF PERMIT - BUILDING Tp gt�I LDI G • 10422 'Trask Ave. harden Grove SETBACK CP-5-I-• PRO PERT�LINE Address _ ❑ GRADING ❑ FOVNOAT,,II+�O,N ❑ STRUCTURAL - L pFE YARD - - - _ . • LICENSED CONTRACTOR DECLARATION 0 TENANT'0 ELECTRICAL LI PLUMBING ❑MECHANICAL SIEpET YARD , I hereby affirm that I am licensed und- •rovislons of C arter 9(corn- RIGHT - - . ' - mencIng with section 7000) of 3 of the ` -Iness and ' 0-OTHER" Professions Co d my 0 • full o J -.effect. REAR YARD(TO P/U) '" - - Cot, PROJECT DESCRIPTION License Class Lice • - - — PKG.SPACE REQ. PROVIDED - �I/��_ SQ.,FT. .. h Date - sign.' - -ice,' - - ], 11 FJ3 . STREET WIDTH - PARK FEE-ST (WORKERS'COMPENSATIONthatIhavenDECL•,'I•TION -OCCUPANCY CONSTRUCTION TYPE ' - • ZONING APPROVED BY - - DATE .. - 1 hereby affirm that I a certifica of consent to self-Insure or a VALUATION ' • ZONE • certifithereof (ce�.o fypgWorykpeprs'I,�Compensation bo mC.)nsation Insurance, or a certified copy GRADING CU.YDS. ACRES - - WYOG0/0417 FremontSPECIAL CONDITIONS: -' Policy No Company - - ' - - - - • - . -- . . . - ❑ Certified copy Is-hereby furnished. _ REMARKS:'•' ' ' - - • _ _ .. _ _ __ ❑Certified copy is filed with the city Building Division. • _ "- ' - EXEMPTION FROM WORKERS' COMPENSATION DECLARATION - - - • - (This section need hoLbe completed if the permit Is for one hundred - • ,n 1($100) or less). - _ •_ • - - - - _. _ - _ - .1J-certify that in the performance of the work for which this permit Is - issued, I shall not employ'anyperson In any manner so as to become PLUMBING- - PLAN CHECK _ •' ELECTRICAL - - —PLAN CHECK - . - - subject to the Workers'.Compensatlon Laws of California. - - _ • UW tLLING _ GARAGt _ Date Signature ! BATHTUBS -- SHOWERS -SQ.FT. sin FT •- - NOTICE: If after making this declaration, you should become subject TOILETS URINALS - i . .. GENERATOR - 0-1 KW -• KW - - - - to the Workers' Compensation provisions of the Labor Code,'you must !TRANSFORMER , .forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE-L / - -APPLIANCE 10-50 KW 50+.KW -. .. revoked. - - - - ' KIT.SINKS DISHW SH6/R6✓ - 'MOTORS !CONSTRUCTION LENDING AGENCY ^^VV -0-1-HPy1-30 HP 11 hereby affirm that there is a construction lending agency for the per- SERVICE SINKS ;UM�S% - • - -. (I NC..SOLAR), 10-50_HP 50+HP_ formance of the work for which this permit is Issued (Section 3097 '{AI` \R. Civ. CJI '- — - - - FLOOR SINKS 00 DRAINS-- ' - FIXTURES--- OUTLETS • SWITCHES -- - • - -Lender's Name - ,Lender's Address DRINKING F UNT - • - - - 'GAS TUBE-SIGNS - ___ .. - _ - 'OWNERBUILDERDECLARATION - • INTERCEP ORSCLARIFIERS - ' -• POLE LIGHTS —----- ' • - !I hereby affirm that 1 am exempt from the Contractor's License Law for . the following reason (Section -7031.5 Business and Professions Code:- SWIMMIN POO • - PTRAP - LUND1 HUL I IDN - Any city or county which requires a permit to construct, alter, POLES 7 -METERED SUB - " - improve, demolish or repair any structure, prior'to its issuance,also re- ' WATER S E' ALTERATION - - - - PANELS - - - MAIN SUB--- - quires the aps licant for such permit to file a signed statement that he - - Is licensed pursuant to the provisions of the Contractor's License Law GAS SERVICE 'OUTLETS- '" - ' - SERV ICE - - AMP - 'Chapter 9 (commencing with Section 7000) of Division 3 of the $ZOO usiness and Professions Code) or that he is exempt therefrom and the WATER HEATERS - -BTU OUTPUT• - - . . --- -- . . .. - -- - - _ • _ _• •asis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty SEWER CONNECTIONS ' - — - •— •- •- •— -- _ . _ of not more than five hundred dollars ($500). '- 1 ' • • ❑'I, as'owrier of the property, or my employees with-wages as their SOLAR TANK' - - COLLECTORS - I -- . • - - - - . - _ 'sole compensation, will do the work,and the structure is not Intended ''or-offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. - -" - ' _ - - - ISSUE FEE - . . - - - ` - Contractor's License Law does not apply to an owner of a property -• $ 3.00 APPLICATION APPROVED BY _ _DATE who builds or improves thereon, and who does such work himself or ISSUE FEE - • 1 t through his own employees, provided that such improvements are not - - ----- - - Intended or offered for sale. If, however, the building or improvement MECHANICAL - PLAN CHECK - SUMMARY OFF EES -- lis sold within one year of completion,the owner will have the burden .. ' :of proving he did not build or improve for the purpose of sale). - - - - - t BUILDING. - . _ _. . ' `❑ I, as owner of the•property, am exclusively- contracting with HEATING SYSTEM 0-100,000 BTU PERMIT $ SMIP $ (Section 7044, Business AND DUCTING - - - -- licensed contractors to construct the project0 100,00 +gTU . PLAN CHECK $ PERMIT and Professions Cotle: obuilThe-Contractor's License Law does not apply to- - - .-2-1-0 :10 LL ISSUANCE -.$' 3.Off an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU rPLUMBING $ J•l. tracts•ROM-such projects-with a contractor(s) licesned pursuant to SYSTEM - - - $ ' GRADING• $ 'the Contractor's License Law). 100,000+BTU PLAN CHECK" _ '- •-❑ I am exempt under-Section' B.&-P.C.for this - - ELECTRICAL $. , BOILERS BTU 5 1 '' MICROFILM $ ' 'reason- - -- - - - - • - PLAN CHECK- $-- . (Date Owner SYSTEM REPAIR,ALTERATION - - - - '5.00,-- , MECHANICAL $ TOTAL FEE$ • I hereby cert ify t• •.ve read this app' -t'on and state that the above EXHAUST SYSTEM MULTIPLE LESS AD ' Information I-agree c• p,. with all city and county PLAN CHECK 5- - VANCE-PC -5_ ' ordinance •u• aws relatifs. ns•uct on,and he -by . o represen this-city Lair u�r • e ab• e - - ti n - ' proper fJmm '' I. urpo / _ +-Signal .. FINAL FEE $ Il�at%-aa. '� ` - ISSUE FEE Dr vers'License or - �� � - _ - CMF 0865-46 White-Building;Canary-Applicant; Pink-Accounting;Goldenrod-Assessor CONSTRUCTION AND PLANNING ! POOL&SPA - . • • `� APPROVALS Permit# Date Inspector APPROVALS Permit# .- t Date: Inspector 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location 2. Soil Pipe-Undrgrn 44. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrn - 45. Forms 4. Electrical Conduit-Undrgrn 46. Electrical'Bonding ' A"_. -• __ 5. Steel Reinforce 47. Rough Plumbing & Pressure Test,: . .- •^..- 6. Electrical UFER Grn - _ • - 48. APPROVAL TO COVER-GUNITE 7. Footings 49. Electrical Conduit-Undrgrn 8. Foundation • 50. Gas Pipe, ❑Undrgrn,Test " ' _ 9. Water Pipe-Undrgrn 51. Backwash Lines, P-Trap. ❑Undrgrn 10. Structural Floor System 52. APPROVAL TO DECK - - 11. Property Sewer Line & House Connection 53. Backwash & Receptor-Final 12. Street Sewer Connection 54. Heater& Vent-Final - -- i• r �^ 13. Rough Plumbing 55 Plumbing System - Final 14. Rough Electric-Conduit - 56. Electrical-Final • 15. Rough Electric-Wiring 57. Solar System-Final 16. Rough Heating & Air Conditioning 58. Fencing &Access Approval 17. Ducts, in Structure 59. APPROVED FOR PLASTERING 18. Ducts, Ventilating 19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL 20. Roof Framing - 21. Roof Sheathing • 22. Frame and Flashing NOTES: • 23. Insulation - - 24. Lathing & Siding • 25. Drywall Nailing - 26. Plaster Brown Coat - - 27. Electrical Power Meter-Final 28. Final Electric " 29. Final Heating & Air Conditioning 30. Final Gas Pipe-Test 31. Final Plumbing 32. Water Service-Final • _ 33. Gas Service-Final - 34. Solar Domestic-Final 35. Landscape Sprinkling System 36: - Sound Attenuation 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING 39.. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. . 42. 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 MIT NO. TRACT NO. LOT NO. UNIT NO. / ��t A.P.# Zone Project Address 243 6 1 n BA. Co O Pt-, - r -7� �1/ S Main Building: Accessory Building: Applicant's Mailing Address �� • TYPE OF CONSTRUCTION U NEW/J�dCLADD U ALTERATION U REPAIR E Z ❑ CONVERSION ❑ DEMOLISH OTHER T Front 0 Owner's Name ��1�i4 � Phonel�4 DESCRIPTION OF WORK/USE OF BLDG. IB Rear N Address ,...5'.,4721. --- r�t Arch/Eng. License No. TYPE OF PERMIT LJ GRADING LI ❑ STRVCTURAL FOUNDATION C Right N Address a Q ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL S ' Left R GAL1Fn2NIA �jC yy V�filoWe .-•S ❑ OTHER 2�3 I Ping. Ref.# Parking Req./Provided E Contractor's Name e • PROJECT DESCRIPTION SQ. FT. OCCUPANCY ' PlanningNotes: Address(mailing)a�29 S• SJff? — G7UtLG�'� M CONSTRUCTION TYPE iN VALUATION$ City License No. 3 fn P'& ZONE GRADING CU.YDS. ACRES T LICENSED CONTRACTOR DECLARATION ////���� S. I hereby affirm tht I am licensee under provisions of Charter 9 (commencing Remarks: /'P • SP •s/ O� ��Ae i with section 7000) of Division a oof the Business and Professions Code, and /Y1 / r ELECTRICAL my license is in full}pace and effer�y�,•G, w FEES License:7,s i LI - o Automatic Washer Transformer 0 15-50 KW Date '5 /7/7 Signature .0 /.4 //L _i PLUMBING FEES h,{ - 0 50+ KW WORK 5' PENSATION • C AR• ION Bar Sink Showers Construction Pole Sub. I hereby aff'rm that I have a certificate of consent to self-ins• e or a certificate of workers' Compensation Insurance, or a certified copy thereof (Section Cooking Unit Meter pup to 100 amps 3800, Lab. �• / / Backflow Preventer Service Sink A O(('J (( u[/3_ Dishwasher Meter Clover 100 amps `, N. Policy No. 1✓Cd tr he Co pang ! RK Backflow Irrigation Sewer Cap ertified copy is hereby furnished. II Dryers ❑Gas ❑Electric Sub Panel •Cer��if_j� o y 15 lied with the cit .Y Aj ng • v o1, , Bathtubs Sewer Connection A Da •s[.I1�8� Applicant - .� II Fan Motors Do-1 HP D 1'h-8 EXEMPTION FROM WORKERS'C• PENSA I•N D- ATION Clarifiers Solar Collectors • (This section need not be completed if the per it is for one endred ($100)or F.A.U. Dishwasher Solar Piping less). Inc.Solar 09-15 HP 016-15+ I IeI certify that in the performance of the work or which this permit is issued, I Fixtures • shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Microwave Workers' Compensation Laws of California. Device Boxes Date Signature Floor Drains Swimming Pool w/Spa Pole Light NOTICE:If,after making this declaration,you should become subject to the Outlets Range Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal • _ comely affirmfisuch provisions or this permit agencyseil fe r the ptl ro m ed.nce ■' CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Switches Sign I herebywok that there is a is permit se ssue c for the performance C.) of the work for which this permit is issued (Section 3097 Civ. C.) Disposal Lender's Name Interceptors Water Heater Lender's Add. ... .... . .. ...(C SiWater Service Generat ■a ■5-15 KWTrash Compactor OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractors License Law or the LavatoriesAuto-Wash following reason (Section 7031.$ Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair P—Trap - Laundry Tray 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 Reinspection Fee Joe Issue Fee $ 3 therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil - enalty of not more than five hundred dollars($500). I U I, as owner of the property or my employees with wages as their sole Reinspection Fee DEVELOPMENT SERVICES REQUIREMENTS: ! $15 Issue Fee $ 3 compensation, will do the work,and the structure is not intended or offered Zoning Approved By - Date for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By Date License Law does not apply to an owner of a property who builds or improves Application thereon, and who does such work himself/herself or through his or her own A PP Issued By Date f r9 employees, provided that such improvements are not intended or offered forI .b' . '_ ';I .; ; sale. If, however, the building or improvement is sold within one year of com- SUMMARY OF FEE pletion, the owner will have the burden of proving he/she did not build or im- Rtep! oft bprove for the purpose of sale). IrLDIN(i PERRMMIT $ 3o• 00 SMIP $D I, as owner of the property, am exclusively contracting with licensed con-tractors to construct the project (Section 7044,Business and Professions Code: PLAN CHECK $ PERMIT The Contractor's License law does not apply to an owner of property who BTU 0100,000 s PLUMBING $ ISSUANCE $ builds or improves thereon.and who contracts for such oroiects with a con- ENERGY P.C. $ tractors) license pursuant to the Contractor's License Law). I am aware that .Exhaust ystem ■ Multiple ■ Repair/Alteration PLAN CHECK 25% $ proof of their Worker's Compensation insurance should be provided to me. ELECTRICAL $ GRADING $ D I am exempt under Section B.& P.C.for this reason ■ :• 44 ■ Fire Dampers PLAN CHECK 50% $ MICROFILM $ ,ra�� Date - Owner Heating System& Ducting Registers MECHANICAL $ 30• c/L/ I hereby certify tha I have read this application and state that the above ❑0.100,000 BTU 0100,000 BTL TOTAL FEE $ _ Information is come i I agree to comply with all city and county ordinances PLAN CHECK 25% $ and state laws rola /g to building cons uction, and -ereby authoriz- repre- sentatives of Ord to .. • up• the above entioned Pr•r•rty or inspection pw•• Signature -#�A /�/i�// Date A/%, p: L'n93,3'-�?7-7Cn.77J - d D Reinspection Fee $15 Issue Fee $ 3 ��r-. '�_', /+ .`;r = T . . Drivers' License or 5 t� �� �' P '0 . 0865-46,rev. 5/13B White - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING R,JL & 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-Und6rnd. `l 55. Electrical Bonding 5. Steel Reinforcement •,7 : 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd 1 57. APPROVAL TO COVER-GUNITE 7.: Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. c 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 f"' 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 I11{6: Rough Electric Wiring 67. Fencing & Access Approval .1,7. Rough Wiring Sign 68. APPROVED FOR PLASTERING 1'8. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 49, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT "20. Rough Factory Fireplace - ; APPROVALS Permit# • 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating t,, 71. Product Piping ❑Gas 0 Oil 23. Gas Pipe-Rough & Test ye- 72. Underground Flush 24.. Roof Framing ,; 73. Undergrnd.Storage Tank Q Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro - 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing r"! - 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 i - • . 40. Gas Service-Final 41. Solar Domestic-Final J - 42. Backflow Preventer ' 43. Backflow Irrigation - 44. Landscape Irrigation System - 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 23 48. Special Requirements Completed 49. Electric Release to Edison _ 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY • No. Date °NMI:E eMI-DM 2856 TABAGO PL // LINT: CITY OF COSTA MESA — BUILDING PERMIT OWNERStMYEIEIOCYN: WILLIAMS, CAROLINE B TR 1bu PERM NO: P 071971 ADML 2856 TABAGO PL COSTA MESA,CA 92626 PERMIT NO: P 071971 PLAN CHECK NO; N GOVT: N SUPP : N 540-8752 AWL.MAIUNGADDRESS: CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OTH ARCHITECT OR ENGINEER: LIC No: JOB DESCRIPTION ; WATER HEATER CHANGE—OUT SQ FT; ARCH.OR ENDS ADDRESS: UHT: CLAIM VALUE: CALC—VALUE: GROUP OCC : R-3 / coNmACTar9NME NOCK PLUMBING ( 714 ) 895-1246 caimAclogsuauNG 11612 KNOTT ST COMMENTS : NO OTHER WORK AUTHORIZED BY THIS PERMIT AooRES& GARDEN GROVE CA uc.ra.: 511971 *err**+Er*********ac*** ESE**+c+r**tF******r****+cr.caF*irr**r*x-,.+cr+c+era***a.iar**,F**are-Y-ac******* 92641 we 17 Z ONING REQUIREMENTS UCENSED CONTRACTORS DECLARATION:I hereby Stint under penalty of perjury that I am*tensed under provisions d Chapter 9 SETBACKS (commencing with Seoicn 7003)of Division 3 d the Business and Predation Code,and my kers,is it hat force and Wed. CITY Lt.NO.':`0 0386 UC.CLASS: C-36 UC.NO.: 511 71n EXP : 02/96 MAIN BUILDING ACCESSORY BUILDING Y�2 /p/ �� Gdmwr. MO PL-4—M/49 FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Data: LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN OWNER BUILDER DECLARATION:I hereby affirm(oder penalty d perky that I am exempt hem the C«LLradon License Lew for the following reason(Section 7031.5 Basins,and Paeseins Code:Any oily r county witch requires a wood to construct ager.improve. PARKING REQ: P R O V: PARCEL : 13933204 Z N E: REF NO: demolish,or repair any structure.prior fon issuance.ebo requires the applicant Id permit ord to file a signed statement that he or she is licensed panuanl to the prodelem of the Centrwos License Law(Chapter 9(commencing with Section 7000)of Division 3 of the PLANNING NOTES> Business and Prdessicns Code(or that he or she is exempt threaten and the basis for the aDeged exemption.My violation of Region > 7031.5 by any applicant for a penitis subjects the applicant to a chi penalty d w more than fire hundred dolars(SSOOD. *******************************************,)y,*********************************** ❑ I,as owner olthe properlyormyemployees wlhwages estheir Kee mrnprm'yr,wmdo the work and the swmoeismimended DEVELOPMENT V E L O P M E N T S E R V I C E S A E U I R E M E N T S or offered for sae(Section 7044,Business and Profession Code:T eCwracors License Law does not appy loanOwner d propend propeQ who burn or improves thereon,and who does such work himself or hecsel or(Hough his«her own employees.prodded Mssuch improvements are rot intended or offered for sale.IL however.the Loading or inprovemed is sold within one year or completion,the ZONING APPROVED BY owner-ladder wiS have the burden d prwmca g he or she didt bold or improve for 0e purpose d We). DATE : ❑ I,as owner of the property,am exclusively oomrading wth ocereed contractors to cd.mw the pr9ed(Swan 7044,Business and Professions Coda:The Commdon License Lew dnor close nato enw ower of progeny r n who bolds Maroc thereon end who BUILDING APPROVED B Y : DATE: contracts for such protects with a mend'(.)licensed Pursuant to the Crmadan License Law). ❑ lam exempt under Sad : B.AP.C..for this reason: APPLICATION ISSUED BY: DATE: ******************************************************************************* Dal°' Owner: LEGALIZATION: N F E E SUMMARY STRUCTURAL SEGMENT:N I do hereby caddy that I am aware of and understand the requirements of Calrna Health end Safety Code Sections 25.05.25533.and 25534,and need1hatlrawhaueerdMenfomthentoteiyrer(ddb°w) ,Re dentelmtn grewdasrd he exempt from BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING 2 permitand t ettI or ionan Inure builbnhdntMAi3isTly of(cele ate) 10 iom ply motivation adiaale cod a ns and requirements lmm these «mations. PERMIT 7 . 00 Date: Apgiaam: PLAN 25% SMIP/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby ellrn,under penally d prier one of the ldbwhq dada:tone one ISSUE FEE 20 . 00 ❑ I have and wil maintain a certilkate ol consent lo sethireure for weaken's:moans:doe as provided fa by Section 3700 of the Labor BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE Cob,Ir the pedrmwce d the work for With the prate is issued. o Ihave and MImental,workempesatinsurance,nrequired d Sectionor theLaborCode, theperfrmacedthe TOTALS --> 7 . 00 20 . 00 0 . 00 27 .00 27 . 00 . 00 n'w work for this,the permit is ford.My wades'mnprndion insurance wrier and poky number ars: Carrier: STATE EXPIRES REVENUE DIVISION TOTALS--> COLLECTED; 27 .00 OVER/SHORT; . 00 pdcy Number. 116 /992-45 03/01 /96 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK (This redo,need not be competed)the permit is for ono hundred Baan(s1O0)or Ism) 27 . 00 ❑ I may that in the perfdmrce of the ark for which this permit is Sued,I shell w employ any person III any manner ea m to become subyed to the workers'compensation laws of Carlota. agree mat if l should become subject to the waters' *****************************************el************************************es compensationons d 3700 d the Labor Cob.I on h comply w' provisions. INDIVIDUAL F E E BREAKDOWN / Date: 2` Apo.: ` \���� Warning:FEIunto secure workrs'COWowwgon covragels unlawful,and dull sublooan employer to criminal psaltim and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST ddf nos up to one hundred thousand dollars(5104000A hi as idon to the cul of compensation dsmegse as Provided for in hoodoo 3706 of the Labor Coda,Interest,and attorneys foes. PLU 1 WATER HEATER AND/OR VENT 7 . 00 7 . 00 CONSTRUCTION LENDING AGENCY:I hereby affirm under pansy of perjury that'hem is e conprwion lending agency for the END OF FEES performance of the work for which this puma is issued(Sorin 3097,Civ.C). LENDER'S NAME LENDER'S ADDRESS: I certify that I have read this app&ution end eats that the above information is coned.I agree to comply with all dry and dray ordinances and stale laws relating to buidip�and lWaM authorize representatives d this city to enter upon the ebwa mentioned propend Ir impedigremapawn�Lj -rut Nen.. d� Date: Z7//7p }/�' 01 00150715-00180715 TOT Z7.9Lf Signature . gemAppk sod DATE: 04/27/95 TIF E: 10:18 (5151-49.WP) White-Buddsq A Solely:Green-Re:Canary-Appk'am:Pink-Revenue:Goldenrod-Assessor CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location • • 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement • • 3. Electrical Conduit Utility-Undrgrnd. 54. Forms • 4. Electrical Conduit-Undrgrnd. • . 55. Electrical Bonding • 5. Steel Reinforcement 56, Rough Plumbing & Pressure Test 6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P•Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62, Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final • 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing& Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0Oil 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 T Notes: C- i 34. Final Heating& Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 1;# 39. Water Service-Final 40. Gas Service-Final • 41. Solar Domestic-Final 42. Backflow Preventer 43. Backf low Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date • Lot 43 :1 oa3i . ! L ,( /< _ - . , �/� -'COSTA MESA BUILDING-SAFETY DEPARTMENT MAR 6 19$1 P. O. BOX 917 COSTA MESA. CALIFORNIA FINANCE DEPT. ApplicantCITto Fill In Completely FORY OF COSTA MESA For P Y APPLICATION PERMIT ��`/yyy' TYPE OR PRINT BUILDING BUILDING a., .- ADDRESS COSTA MESA. CALIFORNIA For Office Use Only RECEIPT NO. PERMIT NO. OWNER Investors Marine Inc.} ... o cr. MAIL. 'I, 1••0 W. Coast Highway RECEIVED BY I DATE RECEIVED I DATE Ib • - ADDRESS kr_..-- otrin/2771 CITY We •ort BeachCalif. TEL • BUILDING ��[_, f NO. • ADDRESS p7jrl/(p - / / // ARCHITECT Same TEL. �j� COSTA MESA. CALI 'RNIB OR ENGINEER NO. vo" ADDRESS FIRE /J 9- -- ZONE TYPE GROUFpj� 0l- CONTRACTOR Mesa Verde Builders, Inc. APPROVED 1653 Minorca Drive BY DATE ADDRESS ZONING [[[(("""''''^^^'' CITY Costa Mesa,Calif. =ON iip I NO.OF _I USE OP NEWC•� PLAN9 BUILDING/,+y' STATE 1. •• TEL. •i •—E • LEGAL —Cr '�j -,_1// LIC.NO. ry� NO. DESCRIPTION- ` - �r�V 4J i- C41 '/ SIZE 74.50' x 1001 I NO. OP BIDGB.0 OF LOT NOW ON LOT A.P.NO. USE OF YARDS EVES EXISTING BLDG. APPROVED ALLOWED SETBACK LINE FROM A.3 I 29,_6,, (CENTER LINE ST.) A CENTER OF STREET REAR YARD FRONT 3 FT. (/—�+�' ` IN. I61 SIDE YARD LEFT 6 RIGHT R.SIDE 4 FT. IN. DESCRIPTION OF WORK L.SIDE 6 FT. IN. NEW I x II ALTERATION I II ADDITION I REAR 9 FT. 4, IN. REPAIR I I MOVING I D DEMOLISH I APBYPROVE. t,„ DATE 3 -R---47/ SB ZI3 DING 1500 Sq.Ft ROOMS 6 STORIES 1EXTERIOR ' i •' I ROOF -1 .1E j AJ• / aba COVERING U4 OCUSE OF BUILDING ANABICIRKrT0sBiE,PERFORMEDII. Vire, Model' 550-A 'I Attache. garage • q. . I HEREBY ACKNOWLEb0E T AT I HAVE READ T S A LIGATION THE AMOUNT SHOWN UNDER VALUATION Is FOR THE AND STATE THAT THE ABO E IS CO ECT'AND GR TO COM- PURPOSE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY DRDI NOES AN STATE GULATI O BUILDING CONSTRUCTIO/jp1.- /I / VALUATION 6 SIGNATURE OF! I/� / /V iI / I (I L/ (J G d0 PERMIT FEE $ 3 -- 1 N PERMITTEE //{ \ $ /((//lJ 7/ X PLAN CHECK $ / U - AUTHORIZED AGENN 5y— o TOTAL FEE . y