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HomeMy WebLinkAbout216 16TH PL - Building PermitsADDRESS OF BUILDING: 2216 16TH PL UNE A OWNERS NAME IF IIOWN: COSTA A MESA LEADER ADDREsS ENTERPRISES INC (LIN, MIKE S O BOX 15841 NEWPORT BEACH,CA 9265 APDL. MNUNO ADDRESS: ARCHITECT OR ENGINEER: Glc. NO.: NICN.OR ERG'S ADDRESS: UNIT.. coNmACTwswEJOE CARLOS PLUMBING COMPA (714)548-5558 CONTRACTon AuNIBND 1675 SUPERIOR AV ADDRESS: COSTA MESA CA uc.No.: 385443 92627 UNT: LICENSED CONTRACTORS DECLARATION: I hereby affirm under penally of perjury that I am Ucenead under provisions of Chapter 9 (curdnendng with Section 7000) of Division 3 of the Busineu and Prduebne Cale, and my Iiceroe u in bill lou end effect. CU1'LIC. NO.: �J 7 ,J 11C USS:C 36 .NO.: 3 •44 EXP: 122/7/ mate 10 COn� o OWNER BUIL ER DECLARATION: I hereby afar under parody d rjury Ihm 1 am exornpt fmn 11 Condon license Lew la Me folbwiN reamn (Section 7031 3 Business and Profeesioro Cade: Any sy a county, which regdrea a permit to Iona rucl, star, impo ar. {molsh, or repair any structure, pror to Is ssumos, also requires applicant for such yermt to Rb a signed statement Mat M or she e aomaed Nonan to the prawns of the Contractors License Law [Chapter 9 (oaamannnq with S.ctin 7000) of Deision 3 of the ;-%.ineu and Praensme Cale] or IMI he a and as exempt IheraMm and IM Mas dor the alleged exemption. My violation of Section 7MI.5 by any applicant for a Permit subjects the applicant to a civil penalty of not .oro than five hundred dollars jSWD. ❑ I. as owner d the property or my employee win wages as their mart campensdon. will do the woi and the studun is net interknd or offered for sale (Section 7044. Business and Professions Code: The Contractors License Lew does not appy to an owner of prop" wM Mists or ingwes 1Mrem, and who does such work himself or herself or thiough his or her own employees. provided that such impronaemerte ore and intended or Wered for mob. t, however, the buikiM or snprowment is sold within one year of completion, the owner builder will have the burden of proving he or she did not build or impwa for the purprea d sae). ❑ I, m owner of IM property, am exdusivdy oontrectsg with licsmsed contradme to oonstrnwt the project (Sedi n 7014. Business ark Pro reacts" Coda: The Cadrao. license Lew does not appy to an comer d propery, who build. or impreeae thereon and who contracts dor sand protests with a contnasta(s) licemed pursuant 10 the Contractor boon" Lew). ❑ 1 am axemq under Section: B. A P.C., for the reeam: Data: Owear: I do hereby candy Med I an aware of and understand the requirements of Callfmnia Nmth and Safety Coda Sedione 25505, PS.ST3, end 25534, and that 1 or arty More Mildbg ooarpenl will / ail not *.l. aro) need Io.* with asld sled. codes and IM nequbamene b a perms lororenem uctionor odificelionhanlMAi e�8�iy enepemant Dimna.Rpidamielandnabn eppfutiomersexemglmm Mese proviaions. Date: Applicant: WORKER'S COMPENSATION OMLARATION: I hereby affirm under penalty of pe0ay ane of the following dedaeti ns: ❑ I have and wiY maintain a caMien d consent Io seffinsure la wAera' componaeti0n, u provided Nor by Sest'an 37(N d the labor cede, dor IM perf0mwae of de work dor which Only partes b ivued. rl I have and will mountain workee' campevedsn insurance, m required by Section 37M d IM Lebon Cale, dor IM perlormence of the X' wok la which Ms pennh is iaaund. My wakes' mmpanWt iv rar u end pdi y mrmber are: cake GOODMAN EXPIRES Policy Nominee: (Iy /u 14 v»c3 06/01/98 ,hs sMion need nor be oompteted / IM perms se M ane hurknd ddArn /61001 a Area.) ❑ I tansy Med in the performance of the work for which this parmil this issued. I atoll ret employ any person in any manner oro u to become subject to the when compensation Is. d Caldo ma, and gree Ihed I ahead become subpct to IM warden' connpensallon p 'fon 1 S io 70 1`1 labor Code, ys faMMiM oomP� IFme roviaione. =a 9: Apq Wam/ng: Fegun I secure woken' consosnudon smears" Is un 'N1, and shell subfect an emplo M crlMnal P.M. and cls/ Oros rpt b are hurdrM tMuserrd ddArn (FtgD,pool. M eddl n to Me oval of ormaye uafbn, u p,prMM for In Section 37M of Me Lebo, Cade, Interest, and anomay's leu. CONSTRUCTION LENDING AGENCY: I hereby affirm under penally of perjury their then is e cantlruaion bndinp aperwy for the padormance of the ark lar whits IM .it is saved (Section 3097, Ce. c). LENDER'S NAME: LENDER'S ADDRESS: I unity Ihet I neva rend this application end Bede thal One above iMOrmaim a connect. I agree to canpy with all city and Oourdy ordirmou and area leve real to Mildug construction and hereby auderse repreeenlelivae of This oly Io enter upon the above-mentioned property for inspection purposes. JIM HODGES Date: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 085471] PERMIT NO: P 085470 PLAN CHECK NO: N GOVT: N SUP"P: N CONSTRUCTION TYPE: V -N PERMiT TYPE:PLU PURPOSE: OTH JOB DESCRIPTION REPLACE MAIN WATER LINE rROM METER SQ FT: CLAIM VALUE: 300.00 CALC-VALUE: GROUP OCC: R-3 i COMMENTS: REPLACE MAIN WAIER LINE FROM METER TO RESIDENCE if ie ill iF ill ii iF iExii x>cxix iF iF iExx xis ill iRxxit it ie ii ii rix if xis iF iixix iF iF Rr ie ie ie ii ie ie iexxifX xxie se ie ifxie ifxxitx is si-ib ie ie dr ii ii ill iexxxx Z O N I N G R E Q U I R E M E N T S S E T B A C X S ------------ MAIN BUILDING L- V 1V YV ---------- --------- ACCESSORY BUILDING - - FRNT: FT IN REAR: FT IN FRNT FT IN REAR: FT IN LEFT: FT IN RIGHT: FT IN LEFT • FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 42520505 ZNE: REF NO: PLANNING NOTES> > x x x ie x ii ie rt ii ie if i£ ie ie it ii it if it iv ie ie if ie ie iF i' iF ie ii ie if it• iF ii• it ii ii ii ii iris if ii it ie iFif ii ill ii ie it iA it it is ie it if ii if if ill ill iv iF i' if ill ie it ill ill ii is ii iF ii D E V E L O P M E N T S E R V I C E 5.--R E Q 0 I R E M E N T S N -N- AP-- ----U - - -- ttVhliY BUILDING APPROVED BY ; APPLICATION ISSUED BY: xxii"R'Jt'lt ii lir'It ll"R'rl'�iexxit it iA iY'R'1Fxxx xxltx xxxx xxxxxx xxxxxxx LEGALIZATION:N F E E S U M M A 'R Y UALt: DATE: DATE:a 9-7 xxxxiFK yy ft xxxxx wrxxiex STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP%RES GRADING PERMIT 8.75 25% SMTP/NON—RES PLAN ISSUE FEE 22.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 8.75 22.00 0.00 30.75 30.75 .00 REVENUE DIVISION TOTALS--> COLLECTED: 30.75 OVER/SHORT: •00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMTP/TO! GRADING PLAN—CHECK 30.75 1t'1t iF it'It x'it 1t'/t ft'it x 1t It ft i! l! f! 11' 1! 1t it ft It t! 1t 1t• 1! tt 1t It 1llF'r! x x x x it lA nt it 11"It'It i!'rt if f! 1t'It'1R1' ftlt lF'rt 1t 1t x It 1i T' f!'%! 9Y Yt'It'rt'R x Y! 1t fir 1t it"It'lt x I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST CO AL COSI PLu 1 WATER SERVICE 8.75 8.75 END OF FEES 10-29-1997/08:39 AM/$30.75 RCPTM:01-0014612 PERMIT:085470 CONSTRUCTION AND PLANNING POO IPA APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector i 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement " .3. Electrical Conduit Utility-Undrgrnd. 54. Forms - 4.1•Electrical Conduit-Undrgrnd. 55, Electrical Bonding ' - 5. Steel Reinforcement_ 56. Rough Plumbing & Pressure Test -6. Electrical UFER'Tnd. 57. APPROVAL TO COVER-GUNITE 7. Footings - 58. Electrical Conduit-Undrgrnd. :8: Foundation 59. Gas Pipe, 0 Undrgrnd., Test .� 9. Water Pipe-Undrgrnd. T. --. 60. Backwash Lines, 0 -Trap, C-1 Undrgrnd. 10. Structural Floor:'System 61. APPROVAL TO DECK 11, Property Sewer .Line-& Housa. Connection 62. Backwash &Receptor -Final 12. Sewer Cap :. 63. Heater & Vent -Final 13. Roof Drains _ 64. Plumbing System - Final - 74. Rough Plumbing .' 65. Electrical -Final ' 15. Rough Electrical -Conduit - 66. Solar System -Final 16. Rough Electric Wiring r. 67.. Fencing & ACCe;S'Approval 17. Rough Wiring Sign - -' 68. APPROVED FOR'PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL T9. Rough Hearing & Air Conditioning - - FIRE DEPT. REQUIREMENT - APPROVALSPeimit F 20. Sough Faptory Fireplace S z'? - 21. Ducts, in -Structure,- •• •• a - -+' 70. -Underg'roudd Hydro ' 22. Ducts, Ventilating 71. Product-gi m, `CTGas b On p" 23. Gas gripe -Rough &Test .,; > C rl jr tt . 72. Underground Flush 24. RooTFraming' 73 Undergr�d, Storage Tank C Gas ❑Oil 25. Roof.Sheathing . e: _ "i . 74. Overhead Hydras r 26. T -Bar Ceiling (Structural) & MonQcoat { _ y 75. Dry Chemical 27. Frame and Flashiti e ; r. r + -' �. *. t 76. Dry Stanapipe - i 28. Lathing&Siding =.4 _" '� t %- " ", •',� 77, FIXED.SYSTENJ,F,IN41_ 29. Insulation d �� ' - i �� 78. FIRE PREY. FINAL - -. �' 30- Drywall Nailing 't v ! 1 iv'' ' -,,'HEALTH DEPT .-REQUIREMENT y 31, Plaster B ovm-Coa,c r r i` r 79.FINAL'I,vSPECTaON - + 32. Electrical PmWr MFetertFinai ' - 44 _�- 80; FOOD CERTIFICATE eSS,UED ,. 33.-FinaLEle�tnc� � _ t � it Notes: 34. Final -Heating & AU ConditioniRg> " a 'e e Li . 35. Final Gas_Pipe;Te 36. Hood or Canopy 37. Fina(, Factory Fire' p hate _ ; - - 38. Final Plumbing 39. Water Ser -vice -Final -. 40. Gas Service -Final �%,..t u; .••- r t �a F � r _ - 41. Solar Domestic -Final - - 1 - r t + C - 42. Backflow Preventer„ 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulatiorsa 47. FINAL STRUCTURE & BUIEDING 48. FINAL PLANNING". r s. 49. Electric Release to Edison ; 50. Gas Release to Southern California Gas Co 511. CERTIFICATE OF OCCUPANCY No. Date ADDRESS Oi BMLOp10: 216 16TH PL UNIT..y� OIINER9NAMEIFItNao N: ANDREWS.-KELLEY IV ADDRm 216—E laH PL COSTA MESA,CA 92627 WL. NAIUNO ADORESS: 1RCNRECT OR ENGINEER: LIC NO, ARCN. OR MS ADDRM: UNIT: CONIRACTORSNMR: JOE CARLOS PLUMBING COMPA (-714)548-5558 CONTRACTOR'S MMUNG 16"15 SUPERIOR AV ADDREm: COSTA MESA CA mwo, 385443 9 2 be 7 DMT; LICENSED COMPACTORS DECLARATION: I hweby �m Dolan pwrly d pwpry Nat I em Twemed mdw War d Cheww P (aanmwlmq wah Section 1000) of Division 3 d the Buemee end Pralasatorr Code, aM my f eros u m tu0 hxv end eBW. Cm UC. NO.: G2-773 uc. ctwss: C 36 uC NO.: ,38544 EXP: 12i97 Data: D cordmoa: OWNER BUILDER DECLARATION: I Mraby athm u . pemly d perjll that I e1n eyemq Imn 1M Cwr n Hume taro to Na Idlox�p rano ISedia, 70:115 Bmeew sod Pmleseian Code: AmW ooumy whim nmume a pamd to omaum, eb«, imwove. 'mdeh. a neons any amxlae. prior b ea ewnm, ale npdnm IM to wm pemN to Ma a sipod atetertsm tlIat M a sM pcemad pureuam to the wml+iam d the C moll— Limrre Lew Mww S (mmmeawp with Sedion ]000) of Division 3 of the ,amen end ,damns Codel or that M a she a axempl therohan and the bete lar the albped exemption. Arty vclelm of SWM 7031.5 by am appluwm fm a pamat eubpcts the applicant to a dwl penalty of not orae then five hundred dollen ISSDOD. ❑ I, mowmra the mmmy m my ampbeee with wepes as lMT vole mmperhmon, will do the mh. aM the stmdum is ltd inteded or opemd for see (Sedion 70th. Buwmm and Prdeaeons Code: The Cmtreean Lioenu Lew due m1 apply to an owmrd praparty who builds o Impravee Ih.. end who does euro amrk Nmaell or h..l or Nrouph he a her own empl,., provided tM each impm memo ere ort imaMed a dlened I« sate. X. Mwaver, the Wddilq m m,P,melnem is soil within one year of oonlptmion, the oama, u ldw will hey- IM burden d pmvinp M m she did not build o improv to the pupae d sale). ❑ I. n owmr d IM popery. em mdusively oommctep wth liuned wnUacloa to m the project (Section 7044, Blninws and Prdeasiom Code: TM Comrecten Lic.. I.A. does m1-poly to an a— of moony who Wilde o Imprmm tMlean end who conlncn la sum pmjeds with a comramm(s) licensed pumuaM to the Cadrecdars License Lew). ❑ 1 am exempt under Section: B. d P.C., ter this reason: Det.: Owner. I do Mleby cenily that I e o awwe of and uMentand Uro nauimmems of CeUomte Ibmh AM Sddy Cale Sections 25505.2553.1, aM 25534, end that I a am MUM Wildeg mfipanl will i all M (mcb ar) mad to mmpty wffi said mate codes And the repuinmanb for e pemllt I«rawwctiona modifimionhan IM Ai�iuTi yl%nepenwm Oimrid. Rssidem®I amm�rGion appimtiwoua eawnghan Urea aayisione. Data: Applicant: WORKER'S COMPENSATION DECLARATION: I Mreby W. uMw mmlty d pwjW oro d O.Idbwilp dedweliom: ❑ I Mw eM wtll meimae a cenRicme d mnwnl to sadimuro ter warkare' mnpematun, m prwldad /m by 3anSu 3700 d tM labor T� Cade. la IM pedormema d Ne soak la which tNa pemM o hued. It' Thaw and soil me'uaee wwdrre'minparreatm'umnrenm,mrepu"ved by d an awn Ser ral Lmorcode,bOr pwlmnwlo dNe IF sold Ins wNm dos permit i. wsud. My worker• Brppgrpyp7¢rpcwa. sanpoky nunber are: cerMr: 1pV VLl`7HlV EXPIRES Policy Number. 06/01/98 lbis aeaian need ort M omnpbted/1M paml n I«ons hold doff. ts1wl a bm.l ❑ I only pW n Na pMamrca a IM soak « hen Ino permita issued. I sham employ any pwwn b a y m�nne w n ro become subject to the wken' oanpamuaw leve d CeNante, end spree Net ' 1 should become wNpct to tM worlws' canoe/m'mion P 'suns d ed ion 3 d IM Labor Cob. I I luhwuh morph Now p 'sum. Data: `' AppBeM: Waminp: FW b acus wor*ws'rolrpwuadan ovrwataa b until I, end alWl enblM- r sono. ro o ,wdpwrldm wK civil dnss up Mane A«MrM tnouaaN ddb. (110({000A h eddl ro Ne amt of rorlMwlseNory dernWw u pmvbed by In Scd. 3105 0/ pr Labar Cods, 1W.4 arld etromsy's /wa CONSTRUCTION LENDING AGENCY: I hereby Brum UM Penury of perjury that throe e e 000af tl10o bMbM apemy ter Na perormaca d the oak la whish the perm a awed (Samun 3041. Cw. C). LENDER'S NAME LENDER'S ADDRESS: 1 candy that I here mad this apphoaodo aM mate Ihet IM ebara team km is owed. I Mme to core* wish a0 city and cmmy oidklarma am, mora teas m,,,M to W WN cnnmuaim aM hwaby au Lze roprofentatirwe of the dry to enter upon IM ebova mamsxied pm,erty Im impecion purpose.. JIM HODGES ,sem Pdn Nemo `� Date: ai 310 a.4a�dApenv gonV tma« White-Buildip A Safety; Gmen Fle; Cmdry Apploam: Rnk-Rm mm; Goldlwmd-Assnaa CITY OF COSTA MESA - BUILDING PERMIT PERM NO: Pv85471 PERMIT NO: P 085471 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V -N PERMIT TYPE: PLO PURPOSE: GIH JOB DESCRIPTION : REPLACE MAIN WATER LINE 1.O RESIDENCE SQ FT: CLAIM VALUE: 300.00 CALL -VALUE: GROUP OCC: R-3 i COMMENTS: REPLACE MAIN WATER LINE FROM METER TO RESIDENCE ie ie rit>rwif ie ie ie ii ie ii ii if iei?ii wiixil dixii#itw srwiix>r>rii*ii ii ie dt it yr fr it ii iF iF it it iE>r iFxie iexwir iefc wii ix iFxit iF ie ik yr to ie iyxu>r ix it ii if Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: ET IN FRNT: FT IN REAR: FT IN LEFT: FT IN RIGHT: FT IN LEFT: -r'T IN RIGHT: FT IN PARKING REQ: PROV: PARCEL: 42520508 ZNE: REF NO: PLANNING NOTES> I N D I V I D U A L F E E B R E A K 1) U W N TYPE QTY D E S C R I P T I O N > TOTAL COST PLU 1 WATER SERVICE 8.75 8.75 1t'It ll' lt'!t 1y It l! � f It ft 1!')! 1! Y! jt jl' 1! 1t f! 1t R' ft ft 1! T' 1l' ft T' f!"!t x It lF 1t tt')t ft 9Y 9t jt'/t 1t 1! T' �' 1f 1t'11' Yt ft It fY jl' 9F It 1t jt x l'rt It R 1t'lt'R 1t It n' ft l!'1! i! rt'11'!1"It R D E V E L O P M E N T S E R V I C E S, R E Q it I R E M E N i S ZONING APPROVED BY DALE: BUILDING APPROVED BY : / DATE; APPLICATION ISSUED BY: DATE: lt9!'Rt111"Itrtrtltrtrtrtrt�lF'hrtrtftrtrtJt It 9t T"R Yt ly9t'R 1e ll'lt l!'RXst'R fllF lF lF'R flftltXl!'R'Jt 9t 1l'lt'Jt�xX1t 1t 1t'Il"II'1l"R IeRlF ft 9th lt'T 9t'It It LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 8.75 254 SMIP/NON-RES PLAN ISSUE FEE 22.00 BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 8.75 22.00 0.00 30.75 30.75 .00 REVENUE DIVISION TOTALS--> COLLECTED: 30.75 OVER/SHORT: e00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING 'PLAN -CHECK 30.75 1t 9t 1t 9t'Ik 1t' 9t f' H 1! l! 9' l! 1k 1F 1t 1t 9! 9F 9t ft 1t Yt 9t'R 9t 9t 9t'F Stint rt'R 9t rt rt 9t 9t'R rt rt rt R 9t'IF 9t R 9t R ft 9t'T rt'R 9t'R 9t'R ft 1t 9t 9t'R 9t 9t 9t 9t ft 9t rt'R'R 9t rt rt'R 9t 9t 1t I N D I V I D U A L F E E B R E A K 1) U W N TYPE QTY D E S C R I P T I O N UNIT COSI TOTAL COST PLU 1 WATER SERVICE 8.75 8.75 END OF FEES J 10-29-1997/08:39 AMA30.75 RCPT0:01-0014613 PERMIT:e85471 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POO 3PA APPROVALS Permit * Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2• Soil Pipe-Undrgrnd.. 53. Steel Reinforcement "3. Electrical Condpit-Utility-Undrgrnd. 54. Forms T'4. Electrical ConduitNr)drgrnd, 55. Electrical Bonding 5, Steel Reinforcemenfi 56. Rough Plumbing &Pressure Test " 6! Electrical LIFER Grrid. a 57. APPROVAL TO COVER-GUNITE �7. Footings 58. Electrical Coriduit-Undrgrnd. ' _ 8. foundation ` `{ _ 59. Gas Pipe, 0 Untlrgrnd., 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 - I - 63. Heater &Vent -Final 13. Roof Drains _ - 64. Plumbing System - Final 14, Rough Plumbing T, - - 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 r APP OVALS _ Peimit 20. ;Rough Factory F�e�lace 21 -Ducts, in Structure + •• 5 .r 70._'Underyr6uFld Hydro 22, Duffs, Ventilating) e _ .�. C .T 71. ProduhfPipfngTmas 00i1 23. -.Gas Pipe -Rough & T•est , _ "�' •- 72. Undergrdund Flush +" 24. Root Framing' > '_ ;. 73. Undergrrid. Storage Tan(c 0 Gas 0 Oil 25. Roof, Sheathing•j > 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Moso'coat _ r - -� ;, 75. Dry Chemical 27• Frame and Flashigq+ e r 76. Dry Standpipe-; 28. LatKing & Sitfng 77t. FIXED SYSTEf KtINAL 29. Insulation - _- _ I I � 79. FIRE PREV. FINAL 30. Drywall Nailing ? �' - ';,HFALTq DEPT: REQUIREMENT 31. Plaster &owmCoat: r . 79. FINAL INSPECT401\1 t " 32.-•ElectricaLPovrer Meier`JFinal - I "j� 8U. FOOD CERTlr,1CATE ISSUED 33.Fin 1 Electric d - z ' Notes: a 34. Final Heating& AWConditioniffg:. + � �• 35. final Gas Pipe -Test; 36. Hood or Canopy r - 37. Final. Factory Fire"pe_ _ •' - , 38. Final Plumbing r ' 39. Water Service-Fina•Ii 40. Gas Service -Final - t -, t 41. Solar Domestic -Final •' , - s "_ _ . - 42. Backflow Preventers R + 43. Backflow Irrigation,, r. a 44. Landscape Irrigation System 45. Sound Attenuation* •• ` _ - _ - ` 46. Handicap Regulations = 47. FINAL STRUCTURE'&BUILDING 48. FINAL PLANNING. r 49. Electric Release to Edison ' 5d. Gas Release to Southern California Gas Co i 51. CERTIFICATE OEOCCUPANCY No Date MDRMMBMtD01G: 216 1611'1 PL UNIT: gWlER4xAMEIF p10WN: ANQR EWJA KELLEY ADDRESS: 216—E 1b 11'1 PL COSTA MESA,CA 72627 APPL."M AOOPESS: ARCNRECT OR EMMIEER: M. NO.: MR. OR Ellf..'9 ADDRESS: UNIT: CONTRACTowsmi . JOE CARLOS PLUMBING COMPA (714)548-5558 CONTRACTORSYMUM 1675 SUPERIOR AV ADDRIM: COSTA MESA CA LIC.NO.: 385443 72627 UNIT: LICENSED CONTRACTORS DECLARATION: 1 hereby axsm under peoaly of perryry 0a I we licensed under prwievis of Chapter 9 fcommerc ung vmh Section 1000) of Chimp 3 of the Blas ea end protests. Cede. will m license is in WR lrce and axed. clrvuc.xo.:62577� LIaCuss: C 36 uc.Na: 387 3 EXP: 12%77 Data: 6L/�'1 q!-� OWNER BUIL ER DECLA ATION: I hereby effimt under pamly of pe that I am eeaunp, fere IM Cel ore limes law for IM fdlwng teem (Section 7031.5 Bmswss and Prebmbns Code: Arry ch county ahicit requites a perms to construct, ager, improve. 4moleh, or repair any structure, prior to as bwence, she require The applicatl Its such owes to fib a sgnecl statement Net he or she liceneed pursuant to IM provisions of Ina Canlredws License law (Chapter 9 (commencing vath Section 1000) of Dveln 3 of the ,amen and Prdeaw r. Cotlej a this he or she is esempr therelrem end The breis for the alaped memplln. Airy s olo n of Section /031.5 by any ae licent fa a tweet subjects the applicant to a civil penally of rot mare Then Me hundred ddbn (5500)). ❑ I, as owner of the property or my emplyeea cosh wages as their We compensation, will to the work, and the structure a not intended or offered for We (Section 1004, Business and Professions Coda: The Contractors Ucenea law does ted apply, to an owner of property who builds or inpeves thereon, and who duos such work Nmseff or herself or through he or her own employee, provided thin such imptovemema we ret intended or offered for este. 1, however, the h 1dkW er inprovemenl is soM within one year of pompimm, the owm,.,mWw will have the burden of previus,, M or end did net build or improve for the purpose of seta). ❑ I. m owswr of the propertywe mdo®valy, cootrwlig x4N licaeeed ponlraclws 10 arutrW The project (Section Toast Rusl"s and Pefessnm Coda: The Cantrectas license Lew does nor apply to ea owner of property who builds or Dnprwm thereon well who moved. for mutt projects with a conlradw(e) li mrend wo uent to the Contractors U. leer). ❑ 1 am exempt under Section: B. 8 P.C.. fa Nis reams: Dole: Oener: I do hereby mnify that I are wave of end undetsbnd the requirements of Cetlfomia Neellh and Solely Code Sectimw 25505.25533. said 25534, art That I a wry, More building ompeat will 1 wD rwl (cimb one) need to cwnply with steel rote codes end the requirements for Does: ApptManl: WORKER'S COMPENSATION DECLARATION: I hereby affirm under penaby of perjury cow of IM Ulcers, decareti0m: ❑ I have end coil metntain a cedfflate d consent to sW-inmm far ovarian' compete , m provided fm by Section 3700 ofThe labor Code. for the pedotmeace of the wodt for which this perms is lamed. �I I have end coil maintain wwkws' mmpamatun somanim, as required by Section 3700 of the Leber Code, for the Pedorrtwnu of The X' w«k for whits Nis partes b'ssuad. Mr wwFan' ewnjwrimmpn imweme mniw and policy number we carrier: GOODMAN EXPIRES policy Number: V /Itil qvJnb 06/01/98 nis section need net he completed 2 the pamtR is Mone hundred dollars (J10pj or bre.) ❑ lo Ky Nal in the pedomama d the work M which this paeans is iemnd, I "1 ret amply any penin in arty manner w w to become wbjW to The wodrere' compensation lova of Cetfforai , atW agree that A I shouts become subject to IM wmuss' companswim ro elm dgSeth n 3100 d the labor CodI ehgDle, hwhh comply oma govisiwn. Owe: -I Apdimat: C Wambp: Fellun h secure wodrwa' mrMerleetlon coverege /e un/AwN, and aNll aub/ecf en employs w m intnel penalty" and civil grws w m ars Auldred fMuaerM ddbre (J19q 0001. In Mdildwel Ns metol rompewflry d asps " provMsd les In Secln 37011 of Ne Labor Code, lntivi end.1fomeys I"s. CONSTRUCTION LENDING AGENCY: I hereby affirm under penalty of Mile, that there is a mnstrutlln biding agency M the pedormeus of the work for which the perms is awed (Section 3097, Civ. C). LENDER'S NAME: LENOER'S ADDRESS: I certify Ihel I have teed this application and date that IM above wilmeation is portrait. I agree to comply with all city end county ordinsrces and state lam relating to buildiq construction aril hereby aWorbe repreaenletivee of this city to enter open the above meminnd property far inspection purposes. JIM ROUGES Data: CITY OF COSTA MESA — BUILDING PERMIT PERM 1V0; 1' 022554 / PERMIT NO: P 085472 PLAN CHECK. NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH JOB DESCRIPTION : REPLACE MAIN WATER LINE SQ FT: CLAIM VALUE: 300.00 CALL—VALUE: GROUP OCC: R-3 i COMMENTS: REPLACE MAIN WATER LINE FROM METER TO RESIDENCE ie se iF if xis if it it ie ie rexdE 3F#iexwif iixxxiexsx ii�xie xixx ve sir if#iixxiexxse iiir cit ii ii ie it ii -ii it it it ieiefiiexse i<iEx kxxfix iE Rif if xis ie iv it Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REIN:-- PROV: PARCEL: 425205iO ZNE: REF NO; PLANNING NOTES> .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/IO'I GRADING PLAN --CHECK 30./5 ')t 9t fh X1lft"R9l'fY'R'lF It 1F 1t 1F It It It 1lll'1tiF1l'1!1l1t'1F 11'1l1tN1l It It l'11'1tr'!!1!Y!'11"J{'Il91"R 1F 1l1t at It ft lF ft It �'K�11'Yt 1!'fi It It f!'1l1t'%!'/t'It fF 1F'1t it X'R fl1! ft D E V E L O P M E N I S E R V I C E$ R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY APPLICATION ISSUED BY: ivwit ie ie iE ie rr ie iexxdF iixxie df iF ie xis teXXXXXX rt`�X XXXXX XXse LEGALIZATION:N F E S U M M A R Y BLDG PMT PLUMBING ELECTRIC MECHANIC PERMIT 8.75 2253 _ DATE: DATE: v 97 Xx X')l'iF 1t 111�1t it ll"R it flh XRXX Xrt1t'lt STRUCTURAL SEGMENT:N FIRE SMTP/RES GRADING SMIP/NON—RES PLAN ISSUE FEE 22.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 8.75 22.00 0.00 30.75 30.75 .00 REVENUE DIVISION TOTALS--> COLLECTED: 30.75 OVER/SIiORI: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/IO'I GRADING PLAN --CHECK 30./5 fl' l! 1l"!t It lt'lE'!t l!'%t It 7t 1t 1t lt'Jt'J! 9t'R 1! i!'I! f!'lt t! 1t 1! lt' 1l' It R it X fa fl' It X'lt x It lt' 1t 1! R X It'It 1!'It 1t' T' ft'Jt 1tj! lF'lt It x x lt'Itl!'%t X'R'R Jt'Yl"k X X R'!t X'%t"JI' X R I N D I V I D U A L F E E B R E A K D O W N TYPE QTY PLU 1 D E S C R I P T I O N WATER SERVICE END OF FEES UNIT COST TOTAL COST 8.75 8.75 IB-29-1997RCPTN:01-0014614 PERMIT:085472 CONSTRUCTION AND PLANNING POOL 'PA APPROVALS Permit # Date 1 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-Undrgind. 54. Forms �4. Electrical Condwt�Undrgrnd. '-• 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test " 6. 'Electrical LIFER Grnd. 1.. 57, APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation - 59. Gas Pipe, O Undrgrnd., Test T 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer :Line & House Conitection 62. Backwash & Receptor -Final 12. Sewer Cap ' • 63. Heater & Vent -Final 13. Roof Drains - 64. Plumbing System • Final 14. Rough Plumbing, ,i 65. Electrical -Final 15. Rough Electrical -Conduit , 66. Solar System -Final 16. Rough Etectric,V tri }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 APPROVALS- Parmit # -'-- 20. 'Roujh Factory FiFeblace ,Z TI r .r _ 21. `Ducts, in_Str=' ure, . •• , _� " - o - 70. Underground Hydro 22.,Qucti, Ventilating -,r oil 71. Produc�i�ing'lbGas � 23.'Gas Pipe -Rough & Test 72. Underground FIu3h , -• 24. Roof Framing �; •, 73. Undergr�d. Stolag`e Tank G Gas ❑ Oil > _ 25. Rooj,Sheathing _ ,• r - ! i 741 Overhead Hydro �. 26. T -Bar Ceiling (Strott, ural) & Monocoat e n ': " 7$. Dry Chemical 1 t ,'1 R Y 27. Frame and Flashi r 76. Dry Stan_6pipe--. *. D 28. Lathing'& Siding = e = = "F 77: FIXED SYSTEjVfFi,N!{I 1 29. Insulation -: y F J .. ( 711 FIRE PREY. FIN) e -• r 30. Drywall Nailing r i t i I', � ' 'HEALTH DEPT: REQUIREMENT _ 31. Plaster Brbwp.Coat 79. FINAL I_N$PECTiON - 32. Electrical Power Meter;Pinal i_ r'T 801 FOOD CERTIFICATE ISSUED I I 33. Final ElCctrir- ,., r r. •, Notes: i r1 c :• • 34. Final. Heaiing$+ Air `Conditioning' y 35. final Gas NOF.Test -,';, K _ i` - «� -'• ;; 36. Hood o4anopY i 37. Finaj,Factory Flrep�ce = `A _ 38. Final Plumbing = « u--- 39. Water Service -Final • 40. Gas Service -Final - r 1 41. Solar Domestic -Fine) :1 Y 42. Backflow Preventers v I- r -43, Backflow Irrigation'- 4 r , s. 44. Landscape Irrigation System c = ' n Y u 45. Sound Attenuation' 46. Haridicap.Regvlatiotis - e 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 ADORED OF SMLOoa: 216 16TH PL UNIT: OWNERS NAME IF IDeltim ANDREWS, KELLEY ADDIIEss: 216—E 1bTH PL COSTA MESA,CA 52627 APPL. WILING AODRESR MICNITECT ON ENGINEER: IlG NO_ ARCH O9 ENO•s ADDRESS: UNIT: cONRIACTOR'S NAME: JOE CARLOS PLUMBING COMPA (714)548-5558 CONTRACTORS MMLING 1675 SUPERIOR AV ADOIIESA COSTA MESA CA Liam, 385443 52627 UNIT: LICENSED CONTRACTORS DECLARATION: I hereby affirm under penNy of perjury this I on licensed wrier provisions d Chegw 9 (Wmmewnp wish Section TOO()) of Division 3 of the Bum. wmi Proleseions Code, wd my licanos s in lull /acs and affect. clrY LIC. No.: -2577' uc.cuss: C 36 LIC.NO.: 385 3 EXP: 12157 Dale: Comrasm: OWNER BUILDER DECLARATION: I hereby affirm under dandy d par' I=I erre azemq Inn the Com as Liraosa Lew he Ne fdbeng noson (Section 7031 Busiaaa and Ihdevabne Code: Any cry amroy whist n uiros a penny to owarnart, after. improve. "o sh, orraper any etmdure, prior Ip to swrorwro, area necuints the saw for such perms to fib a epos sWenrom tlW he or shs ioeneed puna nt to the pnovia rs of Ne Corwedae Lwwoe Lew [Chaps 9 (commenvlp wilt Semon TOW) of Division 3 of the einem end Proleosurro Cade] or Mad he or she he exempt thwefmn wd Me lamas for the ataged asu mplicn. Any vnlation of Radian IM1.5 by eery applkenl for a perms soilless the appliuml to a civil penalty of ml more Nen five hundred dellen [55001). I, se owner of the property or my empbyeee w%h wages m their sole compeneetion, will do the wvA, and the elmdun a not intended or offered for aide (Section 7004, Business and Prolaseions Cade: The Contractee Umnee Lew does no apply to an ewnw d property who Wide or inproves thereon, and who does such work umosff or herself or Ihnugh his or her own employees, provided tied such impraywrwie we not intended or offered for Baer. ff, however, the buikirp or'unprevemeM is sok wthin ars yew of comPW., IM ova wrbuiker will have the Wden of Prwirw he or she dk net Wik or impnwa for IM wrpose of seer). 0 I, as Dern, d the propeoy, am ezdmiwfy gnlradkp wsh hear mad rontrwlors Io mrntrad Ne project (Section 70m. G wins will Prolsamions Code: The Cmtrainm Lcenos Lew does not apply 10 an owrwrof property eho buikfa or improves thereon and who romrecla for vuM projects afth a mnwesa(s) menses punuert to the Gonia are Licenme Lew). I em w napl under Secfwn: S. A P.C., Lor this reason: Data: Comer: I do herby cwdy no I wo'were of and understand the reautremems of Celdreaw VIWh wd Suety Code 9arfum t!5!50!5. ?3533. end 25530. wd Net Iver any haune Wid N ocmp rm will / wB rid (arcs ars) treed 10 comply wth mud onto codes ark the roquinmaw err apenms forconsnusionormodi(relianhwnlMAi�y wwpenrm Dierks. flstldemiel mmtnics. ppirmion era nvmq 1. those Paymorm. Dart: Apgioem: WORKER'S COMPENSATION DECLARATION: I hereby affirm under penally of perjury oat of the Iollowmg declarations 0 1 have an! ml munlan a mrtdisal. of 1t.mat-iosun for warken'conomatern, n provked I. by eedwn 37M of Me Lobar Code, tar the mdormwse of the eaM for w this "not is sewed. jp I neve and w mermen wM1we• cmw vmlwsn Imunwm roe. required by Sectio'70d 30 theb Leor Cade. for the padm a ormar the h' work fa Mfiiir this parent s sued. My.1ons' owner and poky number we: Carrier: a1mA EXPIRES Pdky Number: G9 76140556 06/01/98 is shim awed nor he oandelwl 9 the pwmb is lar we handled dallan ISI WI a lose.) wryperson In wry mer wr ec esto become subject 0 the workery 9oast newion erwa of Calibms, sed elan Nat M1 1bhmM became srNject to the MoMn' Dara./�n11f / I App ; v —T� Worokp: Figura to aeon wortwi romperwatlon cos'arage s u I L end aha/l 1wai*I m wnployw f Era l PwWtlos and ,Is// Ones W m . hundred thouund saws (5100OOWr at aWl m Me most of mwlsearoo ow dameRtaa ore Provided for In Smctlon 3706 of Ne Labor Cods, direst, and &Mowery fere. CONSTRUCTION LENDING AGENCY: I hereby affirm armies penally of perjury Ilial then is e congnudlon bndinp mgancy for this P.O. s of the work for which this Pwmi s saved (Section 3097, Civ. C). LENDER'S NAME: LENDER'S ADDRESS: 1 mwfy that 1 have reed this application end gets that Urs abide Information s cones. I agree to comply Mhh N coy well Wmay ordawnme end slide have nking to WiMill eac,strutlion and hereby eWvas reoreventativas d this dy to enter upon Me abp1e11reelnlled property for inmmdian Wrposee. JIM HODGES (515146.WP) 1 Whte-uildig A Suety; Gn o,RI.: Canary -Applicant: Pink-Revenw; (iokenrod-Mueea CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 085473 PERMIT NO: P 085473 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OrH JOB DESCRIPTION REPLACE MAIN WATER LINE SQ FT: CLAIM VALUE: 300,00 CALC—VALUE: GROUP OCC: N-3 i COMMENTS: REPLACE MAIN WATER SERVICE LINE FROM MEIER TO RESIDENCE RR RRRRRRRR RRRRiFRRRRRRR RRRRRRRRRRvF i1iRRRRRRiFRRRRR RRR�ir#sf iiR RRRRR RRiFRRRR RR#'iFR RRRir Rik iF Z O N I N G R E Q U I R E M E N I S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FI IN RIGHT: FT IN PARKING REQ: PROV: PARCEL: 42520507 ZNE: REF NO: PLANNING NOTES> > RRiF iFRiF iF RiF iF iFRRiFR RiF iFR RiFRRiF iF iF iF iF iF iFR iFRiFRRRRiFxRRiF iF iF R.iFRRRRiFRiF iF#R RRiFRiFR iFRRRRRR.RRRRiFRRRR D E V E L O P M E N T S E R V I C E S R E Q U 1 R E M E N T S ZONING APPROVED BY BUILDING APPROVED BY : APPLICAIION ISSUED BY: R RRRRRR RRRIFRRRiiRRRRRRRet rt'A 1t 1e 1m tR LEGALIZATION:N BLDG PMT PLUMBING PERMIT 8.75 25t DATE: r DATE: DATE: a q 'RNhk'R1 1trt '11'17 7r 7t' T'h'RYt 1F rt'rtrtrtrt rtrt RR Rrtrtrtrtrt rtrtrt'h n'1t 9Y 'Rrtrtyf F E E S U M M A R Y STRUCTURAL SEGMENT:N ELECTRIC MECHANIC FIRE SMTP/RES GRADING SMIP/NON—RES PLAN ISSUE FEE 22.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK 'TOTAL PAID DUE TOTALS ---- > 8.75 22.00 0.00 30.75 30.75 .00 REVENUE D'IVISION TOTALS--> COLLECTED: 30.75 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMTP/TOT GRADING PLAN—CHECK 30.75 RRRRRRifRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRRiFRRRRRRRRRRRRRitRRRRRRRRRR I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST PLU 1 WATER SERVICE 8,75 8,75 END OF FEES 10-29-1997/08:40 0q/930.75 RCPT0:01-0014615 PERMIT:085473 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOI 'PA 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 Condui(Nndrgrnd. 55. Electrical Bonding ' ,5. Steel Reinforcement 56. Rough Plumbing & Pressure Test - 6: Electrical UFER G_rnd. 57. APPROVAL TO COVER-GUNITE 'T,7_. Footings 58. Electrical Conduit-Undrgrnd. - 8. Foundation 59. Gas Pipe, 0 Urfdrgrnd., Test 9. Water Pipe-Undrgt'nd. 60. Backwash Lines'_-, ?-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 0 .- - 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Fina7 14. Rough Plumbing 1 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval - 17, Rough Wiring Sign _ - 68. APPROVED FOR'PLASTERING 18. Rough Electrical -T Bar Ceiling - 69. POOUSPA SYStEMS FINAL 19. Rough Heating & Air Conditioning _ _ FIRE DEPT. REQUIREMENT APPROVAL'S' PEimit # 20. 'Rough Factory Fireplace , 21. Duct's, in Structure^ • _ _� _ �' 70.-Unde6grouyd PFYdro a 22. Ducts, Ventilj-ting' e _; 77. Product=Eli in r0p Is tf7Oil P g 23. Las Pipe- . ough & Test t - _� ;. n - • ' - 72, Undergrciuhd Flu'ch f 24. -Roof.Framing _ 73. Undergr"d. Stor'ate Tao 0 Gas 0 ail 25. Roof Sheathing 74. Overhead Hydly t 26. -T-BSc Ceiling (Structural) & Mongcoat 75. Dry Chemical i J .• 27." rame and Flashi - F n9r - v + '' " 76. Dry Standpipe= >?_ + +. -1 28. Lathing Si ng 7 FIXEO.81 STEf.kf 7NAtL . 29. Insulation 78. FIRE•PREV. FIN14L e.> - 30. Drywall Nailing Vit. -� _'tiHEALTH DEPT. REQUIREMENT 37. Plaster Brown.Coat 1.1. I '+ 79r. FINAL fNSPECT;ION r 32.:Electricaj,Povi r Met 80; FOOD CERTIFICATE I;SSyED, 33 'SFinarlr Ete�tria ^ "1 1 ` ' - Notes: ,• s t 34. -Final' Heating$ Aj ir6nditioning` -, r r 35. "Final Gas, Pipe' Test 36. Hood or Canopy C 37. Fina)-, Factory Fireplace 38. Final Plumbing - - '.. 39. Water Service -Final' f i I 1 .! 40. Gas Service.Final-, , n q r -: c • t .. -• - - _ v 41. Solar Dornestic-Findi 42. Backflow Preventer i J + .+ 43. Backflow Irrigation : p '•' e t .44. Landscape Irrigation System- n'. 45. Sound Attenuation$ -4'•; • 1 46..Hand icap,Regulatioos 1 YI 47. FINAL STRUCTURE & BUILDING 48. -FINAL PLANNING, + .49. Electric Release to Edison , 50. Gas fleieese to Southern California Gas Co 51. CERTIFICATE OF -OCCUPANCY No. Date ADDRESS OF BWLDING: 216 1 6TH PL UNIT: is MEWS KNuIE IF RIOWN: MIKE LIN HVA "mEss: P. 0, BO:{ 15841 NEWPORT BEACH, CA APDL. MAILING ADDRESS =11MECT OR ENGINEER: 11G NO.: ARCN.OR ENO's ADDRESS: um. CONIRACTDRSNAME: JOE CARLOS PLUMBING COMPA (714)548-5558 CCMRACIOWSMMLING 1675 SUPERIOR AV AooREss: COSTA MESA CA uc.ND.: 385443 92627 u1fl: LICENSED CONTRACTORS DECLARATION: I ereby affirm uM peruby of Perjury rMt I are Bossed urdar prabbne of Chaq« 9 («anmrm d weh Section 7000) of D ion 3 of Ne 13uema erM Pmlasiom Coda, end to 9oerua u in IWI hoe and" nd aged. CRYuC.NO.: U' S7y3 uc.clwss: C 36 NO.: 385 3 EXP: Date: O OWNER BUILDAR DECLARA ON: I hotsbY affirm under perWy of oe' ry Uiet I am ayempt hoot tile Co don liana few to, du IaOowig rsmoe (Setlbn 70313 Bteiieas ere Prtlaeeern Coda: Arty «wunty whkh requia a game to rommuct, alter, enprors. + ofeh, or raper arty Meru' Frgr W 4leaunoe, oleo squires IM In Sud pemN to Sls a sipud afafmrera Out M or Mere 'tamed Wreuent to IM Wovknom of du Cwrm«s Lioenae few Philp. 9 (ra«nenoop yAh Section 1000) d Dhroion 3 of iM Arun and Ndeee. Code) or them M or aha u asampl there. enld the teems lar gra eked uamplion. Arty yidYion d Section ., OI.5 by er0' appli and 1« a perms eWryeda IM eppiwarn to a Mrd penalty of not mon than We hurdled dotes R500D. ❑ Les.dtM pro," or my amployeea wfh sepes as tMi sale cwnparalion. will do ft work. and 0n smctum is not url rc or offerM for sale (Section 7W. Buena and Pmlessiotn Cada: Toa Coruractod Liosma law does net apply to an owmr of property wM Mich or Ynproaes tMrean. and edlo does slam wok Mna9 «haves or IWou h hits or Mr pert emplo le, prpided that ad prman«es are M warded «doted ler sale. 9, Mwwa, IM WSON or inproam«q is aM eel in ern yeer of ranplerion, ere owmrbdlder wig here IM burden of prodrq M a aha ctrl net b or wprove I« the gvpoes of safe). ❑ I, as owmr of Ne property. em ad &* aaaapkc weft RnrR.e wuadas W ooW W tlw p ja (seder 7 Boeire «W Prolesaiau Code. TM Comrades Liwna Lee doe nI apply lo a own. d Ia.Perry •dro buids or improra lh«am end who ppovadi ler erne pmlects eiN a aaerer100) ficamed Wnuam to IM Ca«edon Limine few). ❑ 1 am .,I uMer Semon: B. A P.C., for Still raroe: Date: C... I do hereby ttply Ihet I ern ewer. of eM uMerM Me regWternerm of Celeorrie Haabft end Sdaly Coda Sediam 25505. 25533. AIN 25531, ere thin I or any Mure IwikiN oplrpnl will 1 ell r (circle on1 reed to comply with sed some coda ere rite ngdramann ler Dole: Appioaol: WORKER'S COMPENSATION DECLARATION: I Itwaby affirm under pw.My of perpay «n of ft bbw'vp dettermiam: ❑ I ooe are wa oelgeeet aoendcafe of comers to ssfirmue for wvtkan'oernpermmion, As Wmided for by Section 3740 of IM Lobar Cade, I. Ne pert. of Ne werk for wNd tree Fomd'R issued. I l I Mw aM ,if nuieein waken' wmpemolion imus«toe. sa required by sadim 3744 d 1M left« Code. b Ne per'lor. e d iM 7C w«k i« whirl Me pemru u iauad. My warken' mmpemolion imuratcs urri« and Wfcy number ma: cerci«: GOODMAN EXPIRES Polly Number: V 9 /b 14 UJ b 06/01/98 e eedion mart n« ie c«npkes f I ft perms is M. hurdred ddlan ISIO21 or Isea.) L7 1 coney Net in tM ptl oe ca d IM work lar eI.. of pernr9 b lesued, 1 shell M em oY arnl person in anY mann« a n to become abject to IM waken' comoenaf tM lees C le. I3W, erre opera Ord e e ouM betas eubjw to iM warlmn' comnpenamron ''mom d 3)(10 d IM labor Code. I hwilh comply w511 Ih I e pmri Aero. Dete: / e//�/�,��? Mdimm Wambr9: Fee. W eaten worker: carnperraetlonro�aecpn Bork. cnmoemauon awarepa re un�, arW erns «!/eat art errrproyr e�iW pwl9a erre crux na.. ern ro ere huWrW tlnuaard dalmn yf14G044L M edU9on tlIe roof oy rorrowadpn es aeries d ler In CONSTRUCTION LENDING AGENCY: I Irenby affirm under Wmhy d perjury thee tMta u e corWnrcdion I«Ninp aperrry for the ped«menca of tM work for "h the pa.A is owed (Section 3097. CW. C). LENDER'S NAME: LENDER'S ADDRESS: I terrify thin I My reed Nis appvrom and Mete that Ne above idanrufon is coned. I Mm to cornply ekh al city and opunty ordinmua ore efals laws rewip to W iMkp con lrudim vet hereby aulhorco representmiva of Iris dry W enter upon IM abwa moeiioned popery fer inspection Wrpoas. JIM HODGEs` CITY OF COSTA MESA - BUILDING PERMIT PERM NO: P 08t)474 PERMIT NO: P 085474 PLAN CHECK NO: N GOVT: N SGPP: N CONSTRUCTION 'TYPE: V -N PERMIT TYPE: PLU PURPOSE: OOH JOB DESCRIPTION REPLACE MAIN WATER LINE SQ FT: CLAIM VALUE: 300,00 CALC-VALUE: GROUP OCC: A-3 i COMMENTS: REPLACE MAIN WATER LINE FROM METER TO RESIDENCE ii ie it iFiixxxiR ie ii4iixi4xii dt ii ie*iE ie iF it it if ii ii iF if ii ii ii i4 it itxie ie ii iR sir xis de ilrxii iRw+i Kirxxwxix i4ii iexxwie ixxwnie ix ix ii iinii Rio Z O N I N G R E Q U I R E M E N T S S E T B A C K S FRN-: -----Fir MAINN ijrr''iitt���INl --ii ----- IN RW FT IN --------- FRNTt N AEAAt F1 IN LEFT: FT IN RIGHT: FT IN LEFT; FT IN RGHIt F1 IN PARKING PLANNING RE-: PROv; NOTES> PARCEL: 42520513 ZNE: REF NO: nix14x x7Fxxx xxlExdrxxxxl{xxxxllxxx xxxxxxx xxxxxxxxxjr x'R it dFxx xxxxx xxdtxxxx Rxxxjr x'R R Rxxx'R xxxx D E V E L O P M E N T 5 E R V I C E 5 R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY DATE: APPLICATION ISSUED BY: DATE: /7 if i4 Ali i4 sixif i+Asir ii irx ii i?www#ir it irk iixxxx xxxxx�ii —x yr rx xxxx xir irxxw xiexxxx—rix ie ie iF#iEwiF iF ie,�� Rxx xxxiiair LEGALIZATION:N F E E U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE sMIP/RES GRADING PERMIT 8.75 25t SMIP/NON-RES PLAN ISSUE FEE 22,00 BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 8.75 22.00 0,00 30.75 30.75 .00 REVENUE DIVISION TOTALS—> COLLECTED: 30.75 OVER/SIiORT: ,00 BLDG PM'I PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOI GRADING PLAN -CHECK 30.75 xxxww+ix i4 i4fixx4iN ie ii yi iF x>twiixix*xiNxxifxiFie iE iirixie ie wifxRiew iF ie iFxir ie iF iE it if iiwix iR if isixiF itxxir >r iR cit irkir wiiriit ie it I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST 'i0'IAL COST PLU 1 WAIER SERVICE 8.75 8.75 END OF FEES 18-29-1997/08:40 NNA30.75 RCPTN:01-0814616 PERMIT:085474 CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector POOL PA APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ' 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement - ,3.. Electrical Conduit Utility-Undrgrnd. 54. Forms '4:• Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5, Steel Reinforcement. . 56. Rough Plumbing & Pressure Test -6. Electrical UFER Gfnd. •r 57, APPROVALTO COVER-GUNITE - Footings 'I' 58. Electrical ConduitUndrgrnd. - `8. Foundations -5c t 59. Gas Pipe, 0 Uridrgrnd., Test 9. Water Pipe-Undr'd. ,,� 60. Backwash Lines; P. -Trap, 0 Undrgrnd. 10. Structural Floor -,System _ 61. APPROVAL TO DECK 11. Property Sewer dine & House Conpection 62. Backwash & Receptor -Final 12. Sewer Cap _ 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final -. _ 14. Rough Plumbiri ADDRESS OF BUILDING: 216 16TH PL UNT: G tl1'INEITS NIAE IF INOWN: COSTA MESA LE.IWER ADoREu ENTERPRISES INC iLIN, MIKE S U BOX 15841 NEWPORT BEACH,CA 92652 APP'. "ONO ADORESS ARCHITECT OR ENIiNEER: UC. NO: UICIL DB ENOLS ADDRESS: UNT: cONtrumTowsN - JOE CARLOS PLUMBING COMPA (714)548-5558 CONTRACTORSMNUNG 1675 SUPERIOR AV ADDRESS: COSTA MESA CA mw-. 385443 92627 UNIT: LICENSED COMPACTORS DECLARATION: I Mreby aff m uoder penely d perjury the I ern Ilpaneed under prmidme of Cheper P (coranendrp wish Sembn 3000) of Oimsw 3 d Bre Busmen end Pd.W. Code, and my licans b In IW brca ad ansa. CITY LIC. NO, uc.CLASS: C 3b u 385443 E}iP: 12%97 Dale: (793 Caerea«: OWNER 8UILDE OECLARA ON: I hereby etfam uMr perulY tl prjvy I d I am Bump hoar IM Codrecta 'Dense lens la Ne IdbwbO rmeon (Sedan y03t3 Bwbeae and Pdmiom Cods: Airy Cry n Gamy whici andres a permY to areaal. Mr, it r . demdeh, a repel eery er rovi par b ea beets. ebo anew IM spell n19 ( each erml a th a alined e ) d Net M a eM b Iicemed pupae a oe l or Ie d Na Conlredae Licenm Law jCMPI« B (rommes all whh Ssdion ]000) d Dbbbn ] e Ion Rumen end Pr~ f Code) « the ro am b swap Ihrehan ae of lam for Ne Wepad exemption. Airy vbWion d Section 7031.5 by mY epp4nsnt la a pxml evbpM IM eppirav Ip a awl penshy d ru mae tron Ms MverW cacao (S500p. ❑ I. ee Owwr d tM property or W empoyws mh erapu as th role mmlaraelion. w50 do Ne w . and Ne eWdlve b rol wrlw W «aRead br eels (Sec m Tau, Sumeenae Pdese«u Code: TM Contudon Lianas Law dose not eppyto An owner of property wM baits «mpovw Ihreon, ere w1a dose such work timeell or M w ftm Ih M or hr oen employees, prewded the suer eopowmru ere M inbreed or aflaed for eels. B, hmeeww. Ne duldvq or enp eoi b sold ebhb as year of uoreplelka. Ne ownr-0Inlder xd have the deem d procnp M or ere de not hdd a enp kr Ua xwpome of eels). ❑ I. as aaar of IM popsy, an exdudvery oordoetlbG wkh licensed mntractors to roreprud tM poled (Sedian you. Basin. ed Pde o ore Code: TM C«uadae Llcenm Law does sal appy to an owner of popery wM Mike or oop oars threon end ed o ppwacb M r A project, er h a mmadap) Ikeael pursuant to the Ilona a florae Lew). ❑ 1 are sump u ° B. 8 P.C.. for IN. reawn: Dole: Oaw I M hereby C.* dot 1 em ansae of ere uMrsaM Ua rpui—rde of CeUfo ew Heelh arl Sdey Cods Section 25505, 35530, end P551s, ad Net I a amy Muro dik'vrp ooppre wM / wR sal Imcb ons) need a rorn0y wih eek ares uodw end tM nPdrerrreru fa WORKER'S COMPENSATION DECLARATION: I M slay a fvm weer pwwty of perjuy one of Na kGow'bp Md ions: ❑ Iheve ere Nme"vrbn acandrwe of came to seliruvve for wohre'oanpeaear, as pry la by Sadioe 370Od IM Labor Code, b IM pMamava d Na wpk f« wlich Nb prow b bawd. n I have eM wi meman wkwa' umperuaar ioruraoe. as nquired by S . 3]00 of tM LeMr Code. for IM Dedormaru of tM }Y w«k for which Nb pamw b blued. my w«ken' oomye DA irr N' wdr and Poky number ae: C,de; GvODMAN EXPIRES poacy Nanba: Ul I 0 06/01/98 ;'Dob union need oat M Cumpkved d Ne perms or for w hurrdM cobra IS 1071 or hem') ❑ I soon, Gat je the pedmname d IM work M tam of permB b bewe, eheh nal aI y arty Prem b ery' to tm e, n to beaarrre subject to IM workers' mnOO of tion laws d C. 1d02e, ad rorty Nty ri I • ub baadw robled to IM waMe' ' lsra d/yvd/�m JT0�0 )d tM leba COM. I hvdlh mmpy weh pawl ns. Dae: / App Wemhp: Fell. ro lease workri penpeuetlon cove+pe Ie unbwhy ab "1 a ,Nr No erploye to .-pere vee eW chM orae rp b era hundred tlrouuM dobe IJ1fe,pWA h mStlon Na coat of eorepeaaNerl awwgw u peoeded for In Sectlm 3M of Ne Labor Cote, lahe mL erel aamry's ha. CONSTRUCTION LENDING AGENCY: I hereby eNrm Un r peoely of perjury the thre b e oprol akn lee'm0 ADI f« Ore pedormenpe of IM work for w IM Pant b bated (Swbn ,Civ. C). LENDER'S NAME LENDER'S ADDRESS: 1 cents IMt I hew nee Nb epplketim ae ace the Urs abpe'vd«melsn b coned.) spew to campy wile all dry eM caurey ad'marpee ere eWe few dmiq b bdldbG rordbudipn and Mraby auNorbs repreeenleiym d tks ary to ear upon IM eboamreiorad property la inspection 'roses. JIM HODGES Date: / / / (5151a8.WP) wms-twrmeq a aaay: u."": "rror anus: uoamroo-raeavor CITY OF COSTA MESA — BUILDING PERMIT COMMENTS: REPLACE MAIN WATER LINE FROM MEfEA fO RESIDENCE iewwsFw se ii+F ye ii sr it iiwii 4if it irwwii ii iiwwsi•wwiF ixi?w ii ie iixwve if xs Xie si siwxii iewie ii se siwii ii ii ii it iexie;r 3F iF it wwBe yewwii iF ix x;! Z O N I N G S E T B A C K S R E Q U I R E M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING---------- FRNT: FT IN REAR: F'I IN FRNT: FT IN REAR: FT IN LEFTt FT IN RGHT1 FT IN LEFT; FT IN R(7HT; FI IN PARKING REQ: PROV: PARCEL: 42520506 ZNE: REF NO: PLANNING NOTES> w x ii iris it w w w ii it it ii iris iF it R it sF w t>r:e it x w ii• w Bi;t it ii•#>r w ie it wsi sf iF ii 1r ie ii ii if if iisF ii it ii iF si• li iE it is ie ii ii if ie ii ii ii fi ii ii�x ii ie iE iE iE iE ii is D E V E L O P M E N T S E R V I C E 5,,,: R E Q O I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY ; v APPLICATION ISSUED BY: xxxie iE ix ie de xii ii if iF iF it ii ie it if if iF iixxxx xxx xxx xxe xx xxxzx�il ie LEGALIZATION:N F E E U M M A R Y BLDG PMT PLUMBING ELECTRIC MECHANIC PERMIT 8,75 25% _ DATE: /•/� —7 -DATE: As7 / zeTzdez zzziF iF iFfiirxxrrzx zzxYrx STRUCTURAL SEGMENT:N FIRE SMIPiRES GRADING SMIP%NON—RES PLAN ISSUE FEE 22.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK IOTAL PAID DUE TOTALS ---- > 8.75 22.00 0.00 30.75 30.75 e00 REVENUE DIVISION TOTALS--> COLLECTED: 30.75 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOI GRADING PLAN—CHECK 30.75 xii iPw xix ie iE ii iF ie ie iE ie irx si ie ii ii•w ii iii<ie vi ii xis iiw iefii:xxxie iE xis iE ii if iF if if wax iF+e xix lief if iEit iE se ie ii•it>t ix iF ix:x ih tie xix x:R R;R ix it iT I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST PLO 1 WATER SERVICE 8.75 8.75 END OF FEES 10-29-1997/98:4 PERMIT:085475 PERM NO: P 085471 PERMIT NO: P 085475 PLAN CHECK NO: N GOVT: N SOPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: PLO PURPOSE: OTH JOB DESCRIPTION REPLACE MAIN WATER LINE TO RESIDENCE SQ FT: CLAIM VALUE: 300.00 CALL—VALUE: GROUP OCC: R-3 i COMMENTS: REPLACE MAIN WATER LINE FROM MEfEA fO RESIDENCE iewwsFw se ii+F ye ii sr it iiwii 4if it irwwii ii iiwwsi•wwiF ixi?w ii ie iixwve if xs Xie si siwxii iewie ii se siwii ii ii ii it iexie;r 3F iF it wwBe yewwii iF ix x;! Z O N I N G S E T B A C K S R E Q U I R E M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING---------- FRNT: FT IN REAR: F'I IN FRNT: FT IN REAR: FT IN LEFTt FT IN RGHT1 FT IN LEFT; FT IN R(7HT; FI IN PARKING REQ: PROV: PARCEL: 42520506 ZNE: REF NO: PLANNING NOTES> w x ii iris it w w w ii it it ii iris iF it R it sF w t>r:e it x w ii• w Bi;t it ii•#>r w ie it wsi sf iF ii 1r ie ii ii if if iisF ii it ii iF si• li iE it is ie ii ii if ie ii ii ii fi ii ii�x ii ie iE iE iE iE ii is D E V E L O P M E N T S E R V I C E 5,,,: R E Q O I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY ; v APPLICATION ISSUED BY: xxxie iE ix ie de xii ii if iF iF it ii ie it if if iF iixxxx xxx xxx xxe xx xxxzx�il ie LEGALIZATION:N F E E U M M A R Y BLDG PMT PLUMBING ELECTRIC MECHANIC PERMIT 8,75 25% _ DATE: /•/� —7 -DATE: As7 / zeTzdez zzziF iF iFfiirxxrrzx zzxYrx STRUCTURAL SEGMENT:N FIRE SMIPiRES GRADING SMIP%NON—RES PLAN ISSUE FEE 22.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK IOTAL PAID DUE TOTALS ---- > 8.75 22.00 0.00 30.75 30.75 e00 REVENUE DIVISION TOTALS--> COLLECTED: 30.75 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOI GRADING PLAN—CHECK 30.75 xii iPw xix ie iE ii iF ie ie iE ie irx si ie ii ii•w ii iii<ie vi ii xis iiw iefii:xxxie iE xis iE ii if iF if if wax iF+e xix lief if iEit iE se ie ii•it>t ix iF ix:x ih tie xix x:R R;R ix it iT I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST PLO 1 WATER SERVICE 8.75 8.75 END OF FEES 10-29-1997/98:4 PERMIT:085475 CONSTRUCTION AND PLANNING - APPROVALS Permit # Date Inspector POOL .,PA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe•Undrgrnd, '• 53. Steel Reinforcement ' -. �. Electrical Conduit Utility-Undrgrnd. 54. Forms ;4: Electrical Conduit Undrgrnd. 55. Electrical Bonding �5. Steel Reinforcement, 56. Rough Plumbing & Pressure Test - •61 Electrical UFER G•nid. 1 ++ T 57. APPROVAL TO COVER•GUNITE •*: 17'. Footings , ; 58. Electrical Cond-uit.-Undrgrnd. 8. Foundation ; r 59. Gas Pipe, 0 Undrgrnd., Test 99. Water Pipe-Und gond.60. Backwash Lines? P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK tt. Property Sewes_Lin@_& House Cannectiod62. Backwash & Receptor•Final, 12. Sewer Cap .., 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing --M 65. Electrical -Final 15. Rough Electrical -Conduit - 66. Solar System -Foal 16. Rough Electric'tNiri fj9 67. Fencing & Access rApproval - 17. Rough Wiring Sign - 68. APPROVED FglR PLASTERING• ' 18. Rough Electrica&T Bar Ceiling - - 69. POOL/SPA SYSTEM$ FINAL 19. Rough Heating & Air Conditioning _ _ - - - Y - FIRE DEPT. REQUIREMENT -• ^ r-1 i 6 -• APPROVALS~ 7 Pdmit 20.;.Rough F,actoyy Fireplace '_ - - t :T « •r 21.`Ducu, in_Stracture+ -• _ _- _ •� r, = 70. -Under ro-rid Hydro r. 22..Ducts, Ventilating 71. Produoi�Pi'ping" - as Oil 23. -.Gas Pipe -Rough & T.est 1:: ; :1 1= G 72• Underg7uhd Fl -sh 24.Roof• Framing r } ' r y ? 73 Undergr'nd. Storage Tan& 0 Gas 0 Oil 25. RooLSh€athing ,j, 6 r . •, 74, Overhead Hydro Y 26. T -Bar Ceiling IStraciurall & Monocoat - ti - `; 75. Dry Chemical,_ - 27. ,Frame and Flashirsgr V z' o t 76. Dry Standpipe.- 28. Lathing& Sidings = = _ i "i 7Z. FIXED�SYSTE(`.��1',F1N/jLy ry 29. Insulation `. S 1, _ t fir- 78. FIRE -PREY. FINAL e ' 30. Drywall fyaili'g Y �, '�. Si ' ;' �'-_�H ALTH DE . REQUIRIEMENT 31. Plaster Binwn,Coat 7g. FINAL 13JSPECT•kON i ' 32.'Electrical Power (eter:Final 1 • T •t 80J FOOD CERTIFICATE • 33. ;Final. Electric, „ ;r, - 1 .T s 'Y 1� t , i+. :� Notes: -a _••Tj 34. "Final. Heating :`& Air'Conditioning'" rl 35.:inaf Gas•Pip�Teu .i r _ lL x 71 36. Hood or�anopY ' 37. finaj;Fac ory Firep�ace .. is 38. Final'PIUmbing-- - 39. Wate? Service-FiniJ + 40. Gas Service -Final ;. •r •* - ! I'. 1. _ -_ r. 41. Solar Doinestic•Frn?1 •t 42. Backflow Preventer. U •, t. I ;:+ - T. Y T - 43, Backflow Irrigation r +' K t '' ry '' .44, Landscape Irhgation System, 1, •'. r - i -I k '45. Sound Attenuation - "• +. r �. •: - .� 'p - - "46..Handicap.Regulatpos a 47.:FINALSTRUCTURE &BUILDING •- - - �, _ 48. FINAL PLANNING-- LANNING49. '49.-ElectIric Release to Edison , 5Q. rGas Release to Southern California Gas Co = 51'. CERTIFICATE OF OCCUPANCY No. Date ADDRESS a BUILMNG: 216 16TH PL UNIT: MEWS NAME IF IOIOYIN: COSTA MESA LE-1wE ( MORM ENTERPRISES INC *LIN, MIKE S O BOX 15841 NEWPORT BEACH,CA APPL. MAILING ADDRESS: ARCNWECT OR ENGINEER: UC, NO-- ARCH. D:ARCH. OR ENO: S ADDRESS: UNIT: F 9265' COMRACTows NAME JOE CARLOS PLUMBING COMPA (714)548-5558 CONTIIACTOWS MM19q 1675 SUPERIOR AV ADDRESS: COSTA MESA CA uaw.: 385443 92627 .uxr: LICENSED CONTRACTORS DECLARATION: I hereby affirm under pertly of perjury, the I em licensed under psrisiona of Chepts 9 (conurm Ysp with Section ]ODD) of Division 3 of tM Business ark Pmfms i n Code. end my limnro is in full fume and effect. CITYLIC.140, V% 7793 UC.CLASS: C 36 UC.NO.: 38544EXP: 11/97 Gaw .: O p C«war. OWNER BUILOA DECLARA ON: I hereby affirm urx s perely of perpoy het I sm exempt from the Comms^ Llo n I.A. 1« the ldowsq msron (Seelon 7031.5 Buei ess ad Pmleasbn COM: A" W county wfioN mWimsi a perm, to loss, a., Ynpms. Mmolsh, or repair s y structure. Prior W is seuese. esO reRmdras IM f« such permit to Me a signed statement that M or She is licensed Pursuant to tM gOvsors of the Cwmciors Liwse Law (Chapter 9 (oommencirmp wlh Session Toa) of Drvsion 3 of the eusinm srrd Prdesssns Codd «that M or sM is exempt thssh«n red IM basis for the mts9sl esemgon. A" Yomton of Seolion 7031.5 by army appliceM for a Permit subpo s IM appfraN to a civil pnahy of rM mm then fNe hundred dollen PSODD. ❑ I, As Owmr of tM prop"« my anpldwo rdh wapn n their sole umpsrm4on, eraM the Bork, end tate strumrm is ne Worsted «offered for sale (Sms on 7016. Busneas sod Pmfeesons CoM: TM Contractors Licemm Lew does mI applyto en owmrd pope" wM bolds or inIsomi; thereon, ssl w/ro clan uoh woM1 hum all «hent or Moudm M or her own employes^. prwidad thin such wnp hr of. fe se m inteMed or o ed f« ssshowever. . a. . the « i Wiwi, np.remra is sow withes d in ane YoorrI the .= will Mw IM buNn of Pro rope M or the drd not build or onpow 1« the p rPpee of sale). ❑ 1.. owner of the popsy. am excLmvdy oordreeim9 wlh Iicssed commotion M construe the pmsct (Swion 7044. Busine s end Pmfeasicn Code: TM Commdos lioenn law does rats apply o en oww d pmpeny xis builds « "vnprOvn Iherepn ad wlmo 000l for suer popes with a mmmepr(e) Wem.d pursues to the Cwrsecre Li.. Lew). ❑ 1 sat exempt under Section: B. A P.C., or INS renen: Our.: Owsw: I M Mmby earliN that l as, aware of msl undssbM Ne Pituita s of Cshloms Ileekh and Safety COM Sodom 25505. 25633, end 25531. ars that I or s" Mite WWW omsua will / wR rte (circle am) red to rampty wlh saw eras oodn enol tM requ'vemens or apemal«c«struction or modifimion hart lMAi'M1_y en.Q~ Dipole. ResideNsl omdruat. spoorai ns m Bums from Iowa pr.vsons. Dan: Appliurd WORKER'S COMPENSATION DECLARATION: I Mr.by dor user p.0 y d perjl pens d 0a know&, d.draiom: ❑ Iheva forth` mevusoeesf mea for vvtocp SWinsm orwassi. comprsmon,n povldad la try Setien 3]OOdtM Lebo Cade, lathe pdomsrce d IM w«k 1« wNch this DerrrtH s s`mad. I�1 I have and wird meimair worksn' mnpeosI inumoos, As required by Seamon 3700 of the labor CUM, or IM paMmenu of tM 7C work /p which Ihs psmH s ivued. MY wpkers' mnpsnwion'unur wrier and pob y manber are: Carrier: GOODMAN EXPIRES Pdry Number. v 9 1 b 14 V»b 06/01/98 ;mit a ou. need rat M c«npstecl I ths psmr or M des hunted Jonas j$100f «AeasJ ❑ udlY IMI ie the the sss rca d tM woM1 lar wl. the Puma b sued. I Shell rr« employ ay preen s e" mama so as to become suged o tM d yd, opnperms the sws d Gddorris, sol area tlma Y `hos" ' . s his& to IM worker`' mmpneetjon ism d 3] IM lab« C.ds,JeF I IpMwith mmp/y t user p 'liana. Dae: U Apdurl/ Wsm/n9: F.H. to sscuw wprken' mmperu.tlon c.Ysrsps /� sub MI, rontl SMII rD/scd en s7mp/oyror f edMml P.M. ars ,1,11 Ors W as oat hrndrN You.. "Is ($10RDP0f, It..old/ n o tln cot./ corrperMSlod bmMMas u p Ylbd to, In S.H. 37M 01 th. LADor Cob. /nferasl, Sort stmmsy's Iron. CONSTRUCTION LENDING AGENCY: I h.raby dfim ands peuly of perjury Lha that s e aensmdon Nndirp sltency for the pwommnce of IM work 1« whoA the Purl is slued (Sseon 3097. Civ, C). LENDER'S NAME LENDER'S ADDRESS: 1 ceniy Ihet I have mad this epplicaion end slate that the eburs information is coned. I si to comply rash all city srd county o inamcn sol some laws mlmrog to baldvp wrsvumon W herby aahorhe replen(aatIVB` of the oily to sat« upon tM `bow-memomd popery for inspection Purpsee. .7IM BODGES i �r CITY OF COSTA MESA — BUILDING PERMIT I PERM NO: P 08547q PERMIT NO: P 085476 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH JOB DESCRIPTION REPLACE MAIN WATER LINE SQ FI: CLAIM VALUE: 300,00 CALC—VALUE: GROUP OCC: R-3 i COMMENTS: REPLACE MAIN WATER LINE FROM METER TO RESIDENCE iewwwww*wwwwwwifwwiew#wwwwwwwwwwwwwwwwwwwwiewwwwiewwwwiewwwwwwwwwwwwwwwwiFwwiewwwiewwwww Z O N I N G R E Q U i A E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAP(: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RIGHT: FT IN PARKING REQ: PROV: PARCEL: 42520505 ZNE: REF NO: PLANNING NOTES> � F wwwwww;ewwwwwwwwwiiiawwwfirwwwiEwwwww#wwwwwwwwwwwireww,www#wwwwwwwwiewwwwwww.hwwwwwwwwwiFww D E V E L O P M E N T S E R V I C E S", R E Q U I R E M E N 1 S !v ZONING APPROVED BY DATE: BUILDING APPROVED BY DATE: �7 APPLICATION ISSUED BY: DATE: wwwwwwwwwwwwwwwwwwwwwwxxxxPiwxxx`iexx x x x xxxxxxx xxwwwwwwwwwirexx xxx xxxww LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 8.75 25# SMIP/NON—RES PLAN ISSUE FEE 22,00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAIL DUE TOTALS ---- > 8.75 22.00 0.00 30.75 30.75 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 30.75 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 30.75 wwwwwwwwwwwwwwwirewwwwwwwwwwiewwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwww I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TVIAL COST FLU 1 WATER SERVICE 8,75 8.75 END OF FEES 10-29-1997/88:41 AMA30.75 RCAT0:01-0014618 PERMIT:085476 CONSTRUCTION AND PLANNING - - a APPROVALS Permit # Date Inspector POOL , ,PA 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 ' r4:' Electrical Conduit-USdrgrnd. - 55. Electrical Bonding .A.:,Steel Reinforcement- 56. Rough Plumbing & Pressure Test j6J {lectrical UFER.Gind. 57. APPROVAL TO COVER-GUNITE T. _7.5 Footings 58. Electrical Conduit-Undrgrnd. - s'8,-. Foundation F' 59. Gas Pipe, O Undrgrnd., Test ;19. Wafer 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. Rdof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit .Y 66. Solar System -Final 1 16. Rough ElectriclNli64 y 67. Fencing & Access Approval - ' 17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING STI / 18. Rough ElectricaL-T Bar Ceiling" 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning .1 1 - FIRE DEPT. REQUIREMENT r 7'-'r- APPROVAL'SD,'D P-rmit # ' .,; , -ir-- 20.-Rou0 Factory Fi,ceplace f, .. 21. Ducts, in Strugturer i .... _ r _ + 70. Underground Hydro 22. Ducts, Ventil5lin9 j 71. Product Piping blas � Oil 23. Gas Qipe-Roug)r &• est •jy 72. Underground Flush 24.'Roo£F4ming• �:i -'-• ^�� •= - x = 7.1 Undergrnd.StTang0Gas 0Oil 25. RooCSheithing - i •' '= R 74. Overhead Hydra _ + 26. tr-Bar Ceiling f5tructural) & Monocoat _� ''"• ` 7$, Dry Che mi ical S 27. 1FraSe arLd Flashir�,, 76. Dry Standpipe -l7 D 28. Latt ing & Sidin9 =- i + ",k 7i1 FIXED $YSTEj!i,,FJNA+L y 29. Insulation -. =i •• Y ra 7fl. FIRE.PREV. F•INY>L "'� *' " 30. Drywall Nailing �'' „ _- y •' _ HEALTH DEPT: -REQUIREMENT 31. Plaster B[owrr,Coat; :_ .. c Ir i 79. FINAL�FNSPECT{ONIF 32. Electrical PoWBr Mbter.Final �� 801 FOOD CERTIFICATE ISSUED 33.:Fin4.El(;1;tricc, i 34. Finai:Heatingl A[r;Conclitioning: Y, l I I I I L 35.•Y-inal'Gas,jPip4;TesL 36. Hood or, Canopy J -' '� i 1 I+ %' T1 ' 37, EinaPFactory Fireprpce' _ T! I 38. Final'Plumbing •? r -] �_ ` 1 - .S _ + --- + 39. Water Service -Fina(" L . 40. Gas Service -Final, c rt : +c+•r - : ,r , it _ - _ _� - 41. Solar Domestic. Final t 1 , v 42. Backflow Preventer ,: r• )x x -_• 1. 1 -43. Backflow Irrigation'- iS-� r t _ 44. Landscape Irrigation System, Y 7.r 7 '•+ a r -45. Sound Attenuation' ' r r, Q 46. Handicap Regulations 471. FINAL STRUCTURE & BUILDING j 48. FINAL PLANNING' 49. Electric Release to Edison is 50. Gas Release to Southern California Gas Co - -• _ .� r 511. CERTIFICATE OF OCCUPANCY No. Date ADDRESSXBMLDWG: 216 16TH PL UNIT: ONNERS NAME IF IINDMIL COSTA MESA LEADER ADORE55 ENTERPRISES INC %LIN, MIKE S O BOX 15841 NEWPORT BEACH,CA APPL. WILING ADDRESS A KITECT OR EN (NEER: UC Ni 3 926 UICIL OR ENG'S JU DBE59: UNIT: cONrRACTORSNAIE: JOE CARLOS PLUMBING COMPA (714)548-5558 CONTRACTORS MAIWID 1675 SUPERIOR AV ADoREss: COSTA MESA CA uD.No, 385443 92627 UNIT: LICENSED CONTRACTORS DECLARATION: I homey affirm uncer penely of peRwy Md I am licensed unclesw i uncles peons d Chat 9 (commemrhq wth S 00 Section ]0) d Diveion 3 d dn 0, Bueaad aProlessimm Code, and my lin Ise ls n It"!furca aro effect. erry UC. NO.: -2-Ol 79.3 Lie cuss: C ,36 uC. NO.: .3854 EXP: 12/97 Data: Contnd OWNER BUILDER IIIECLARAOIL I hereby alfitm Oder penaly d pay Ihd am exenq fmn the Corr ton lioenee Lew dor Me (deers, rseaon (section ]031.5 Busihesa and Pmfem«rs Code: Arry it counry w:. requMs a pomp t ponsmwd. Mo, knprovd, demollsh, or repair any sMrct.m. Pb« W is h—, also mquirea the ap cant for such perm'to Rb a signed sntee,m dad he o dhe is licensed Wnuanl 10 the Provisions d the Conlrecdoer License Law LCh er 9 (commenvlg wth Section 7000) d Dwision 3 d the Busineas ad Prdeesiona Code) or test he or aha ls exempt meehom and the basis for the allege exemption. AM vio Bion of Seddon 7031.5 by any, applvsnt her a Permit subjects the applicant to a civil penaby of not more than five hundred dodos R500D. I. es owner d the propdy or my employees arm wages es their soe compensation, will do the work. and the structure is not intended wdlmrdf«cola(Section7014,Buai endPMemsions Code: The Conlresom Li ma Lawdoaeredapplytoen&woodgopety wM bolds or knprevem thereon, ed who does such wink himes9 or Meal or through his or her am employees, provided Ihet such imprar,mm, ere cat imeMd or offered for area. N, however, nM bWiing «inpmanewt is sold within one year of completion, the ownerrL ader will have the Ween of prm imp he or she did nal bulb or improve for IM purpose d sale). 1, es overer of the propeM, an exclusively, contester, wth licensed contractors d construct Hct Project (Section 7061, Strums send Pro ;sons Code: The Commodore Lironse Lew does not apply m an own« of Properly who Wic e « knive'ae thereon and who convene for such projects with a mnnrmons) licenmd pursuers to IM Contractors License Law). 13 1 am exempt oder Sanson. _ B. & P.C., for Nim reavon: l Dde: 'ovman I do hereby candy Md I am awns of and udannnd the requirements of California health and Salary Cade Sections 25505, 25533, end 25530, and the I or my fulum Wildirq occupant mil / will not (clmls one) need 10 campy with said erste code; ad the requirements for eeemhtf«opmlrudimn«mdir�ionman the Ai3uliy erepenwnl Dindd.f4eidou®Imhstreldion appiresvnme brander men Maine Dam: Applicant: WORKER'S COMPENSATION DECLARATION: I herby affirm Udo perwNy of Perjwy one of the following dedenelum: I heve end soil maroons of ed for yd to ed insure iswuerf. c«npamelnn,u prodded dor MSed'wn 3]00dthe labor Code, l« the pedormarwe A Lha work f« which this Danns is ivud. f'•l I have and, l mammon workers' mnl+nadioh imwance. m mqubed by Section 3]00 of Met Labor Code, for the parlememoe or tM }t' work I« which Ilei; Pamd is iaued. My w«kem' comyenireurence nailer mrd pdiq number are: Career : GOODMAN EXPIRES Pdicy Numhr. V b 06/01/98 ,,This eermn nednot ber cnmVhfd / the pars, ls for one bundled delve 1VOO) or later) I codty the in the ped«narwe d the work for which thls mmei ls laud, I aha11 employ cry Person in any mann« ear m to bacon, wbjen to the workers' cempenesioo ewe of California. and agree tipl j I shook become aubpd to the wcvluve' ode: / V /✓- 1 / Applcem: Lyyr Wamvp: Fail. ro sit" wohwa'rompwsaaf/on roveraila Ie un arW-hall arL/ad an anle/oyM to nhdnel Penalties and civil finds W M ove hfndred Moudertd dollen (4i70GDDD1 M ackilup b Me coal of ronryoanueWn damapa M pnovWed for In Secflon 37060/ Me Labor Coda, interest and trio,msy i lead. CONSTRUCTION LENDING AGENCY: 1 hereby affirm uder peray of peauy the there is a oormnwion Wh&hq agency for Me Psommance of the work 1« which this Peri ls',sued (Section 3 . C'w. C). LENDER'S NAME: LENDER'S ADDRESS: I candy that I have read the application ad ode that the above information is coned. I epee to campy with ad dry and courts ordinances and data laws relating to building construction ad hereby awhorbe m surantdivem ofthis ohy to enter upon the above -o mmioned IwoPety for Inspection pur,esma. JIM HODGES Dde: CITY OF COSTA MESA - BUILDING PERMIT PERM NO: P 08547 PERMIT NO: P 085477 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OIH SOB DESCRIPTION ; REPLACE MAIN WATER LINE SQ F'I: CLAIM VALUE: 300.00 CALC-VALUE: GROUP OCC: R-3 i COMMENTS: REPLACE MAIN WATER LINE FROM METER TO RESIDENCE iiw re ie it iy vi ie if itTMx*iFw*if kix if if ii xir it ii i4 ie wit iFwif iiit ii ver ie#iew3F iF ii kwii ii ie it iF rt vFit iF+f ie it ie ie iF if if ii it it+f rF w �w %i4 ie'rt;'iF it i4 if Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCES'SORY_BUILDIN63 --------- FRNT: FT IN REAR: FT IN FRNT: FL IN REAR: FT IN LEFT: FI' IN RIGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 42520504 ZNE: REF NO: PLANNING NOTES> > ie iEiF iF iF ie ie dr is dr iF di ii itx 4%xiixxxxif it i2 ii iFxii xir iF if iE if iFRit iE if it iF*if RF iF irk iE ii ii ie x�"ievF iE if ii iii:ii ii sexxit iF it ie 3E k ie iF ie ie'iE ie'/E if D E V E L O P M E N T S E R V I C E S ,- R E Q U I R E M E N T S ZONING APPROVED BY /� DATE: BUILDING APPROVED BY APPLICATION ISSUED BY: ' it itfixfiwie dr iF ie ie iE iE dfif di ii xii ib iF ie ie�ir mr"7r"�'a'ii%xmt ><xx Rase 7e exam xcatx LEGALIZATION:N F E E S U M M A R Y BLDG PMT PLUMBING ELECTRIC MECHANIC PERMIT 8.75 25% PLAN ISSUE FEE 22,00 _ DATE: DATE: 7 w+a aeir+e it if ie if iE ie if rt iE 3r yr lexxx Lexie xe STRUCTURAL SEGMENT:N FIRE SMIPiRES GRADING SMIP/NON-RES BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 8.75 22.00 0.00 30.75 30.75 .00 REVENUE DIVISION TOTALS--> COLLECTED: 30.75 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/LOT GRADING PLAN -CHECK 30.75 ie is it it iF ie it ii if ie iE it i4 ie iF ie iA ii ii ii ie iF it dr if ii iE iF iF if st x iF ix iF se iF # ie iF ie iFii x ie iE if %ie ie sure �: de x ie ie # ie ii x it x x it ie it irx ieiF ir.x ie ie iF vi iF is I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST PLU 1 WATER SERVICE 8.75 8.75 END OF FEES 10-29-1997/08:42 RMK30.75 RCPT0:01-0014619 PERMIT:085477 CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector POOL _ ,PA 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 , L5, •Steel Reinforcement: 56. Rough Plumbing & Pressure Test ' 6: Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. ,-8. Foundation '. i 59. Gas Pipe, ❑ Undrgrnd., Test' 9. Water Pipe-Undigrnd. `, 60. Backwash Lines, P; Trap, ❑ Undrgrnd. 10. Structural Floor System 61, APPROVAL TO DECK - 11. Property Sewer--LineL& House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains - 64. Plumbing System - Final 14. Rough Plumbing 65. Elebtrical-Final e 15. Rough Electrical -Conduit r 66. Solar System-F�nal 16. Rough Electric ENirirlg67. Fencing & Acetiss Approval 17. Rough Wiring Sign 68. APPROVED FOR'PLASTERING 18, Rpugh Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPBOVAI,S� - Pd mit # ,_ 7 20. .Rough Factory Fireplace r 21.: -Ducts, in-Structurei •• - 4 �' _ 70.-Undergroufid Flydro 22. purls, Ventilating.; - 1 71. ProduFYPipingtJiG s []Oil 23. Gas,P.ipe 21i;ough &' .est r S ;. r r a 72. Undergr8und Ffush + 24. fiooT: Framing' ,7 73. Undergrpd. Sttu�6e Tan ❑ Gas ❑ Oil 25. Roof,Sheathing , _ r ,; •, - 74, Overhead Hydras t 26. -T-69' Ceiling (Structural) & Monocoat ;t� .4 t5. Dry Cheptical 27. Frame and Flashin§:; •t, - 1 'C v+: 76. Dry Stant pipe= W 28. Lathing & Siding' ' -• �_ ? "n, 72; FIXEDS'Y,STEh1 1;1NA�L 29. Insulation i r ` 78, FIRE PREY. FINAL t = ' 30. Drywall,Naili;ig _, _ I j�: `_ -HEALT31DEa'f`REQ'UIE'EMENT 31. Plaster elown'Coat 79. -FINAL INSPECr;tON +, ' 32. Electrical Po fdleteflFittaf ' r = it SOl FOOD C£RTIFfCATE �SS,UED 33.,Findl,Electric f n I liR Notes: _ ;•i, - 34.-Final:Heatin;B AirConditioning._ r ) ;r F _ - = + .. 35. r'Pinal Gas'Pipg-Test; 36. Hood or Canopy a :.J' !+ a: i _+ r 37. •Fina),Factory Fire'p(ace 38. Final'Plumbing _ r - _ = ` 39. Water Service-Fin21 40. Gas Service -Final- - T 41. Solar Domestic-Fibv- P I T 1 42. Backflow Preventei, i P .5 7 � 43. Backflow Irrigation, 44. Landscape Irrigation System • *, ' r - - '45.'Sound Attenuation Ir 7' 46.'HandicalTRegulatio;s 47.'FINAL STRUCTURE & BUILDING 48. FINAL PLANNING.,- - - r 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ADDRESS OF B(A.Ell 216 1 6 1 1 PL UNT: owl NONE IF KNOWN: ANDREWS, KELLEY ADDRESS216—E 1bTH PL COSTA MESA,CA 92627 APPL."UNG ADDRESS: ARONGECT OR ENGINEER: UC NO.: MW OR ENG'S ADDRESS: UNT: COMRACTWSNALGI: JOE CARLOS PLUMBING COMPA (714)548-5558 CONTRACTORSMNU110 1675 SUPERIOR AV ADDRESS: COSTA MESA CA uc.ND.: 385443 92627 UW. LICENSED CONTRACTORS DECLARATION: 1 hereby affim under penally of perjury that I em licensed under previeipu d Cheam 9 (commend, vmh Section 7000) of Dilation 3 of IM Bawn. end Professions Code, end my licenee Is in NO farce and effect. ClT`fDate .No.:/f� 3////u/�c.cuss: C 36 u o.: 385 3 EXP: 12%97 Date: �/ tf/ " / � Commdm: OWNER BUILD DECLARA ION: I hereby affirm under Pandy d pwj,il Ihet sin exempt from IM Co I dare Licata Law for fire Idlswkg naeaon (Section 7031.5 Basiwea and Pnieeaiarts Code: Airy NY manly efiirA resume . prod o mrwWct, eller, Mprove. demolish, o repair any structure, prior 10 its MUM006, at requires IM card for each paned to file a signed statemenl thin he m end icenced pursuant to the provisions d the Contractors License Law ( eptw 9 (commending with Section 7000) of Mormon 3 of the nears end Professions Code) or that he or and is exempt thmehom and IM beau for the WIWW exemption. My violation of Section 31.5 by am applicant lar a perms subjects the applicant to a and penally of no, mare than Me hundred dollen (BSDDD. I, ea ovmer d the m,n, or my employees wlh wages as their ante compemeation, will do rite sella, end the machos, o not intended w offered fm sale (Section 70M, Busima end PMessions Code: TM Contnctan Linensa Law does mat eppyto sa ownwd properly wM Wilds or fnpnoves memon. and wM does such oak himMlf oroug self or neWh hat ar her own employees, Wavidad thin each mata nm mnded imp avemea eor offered for sats. it, however, the Wittitq or inpnwern,wa 4 said within one year d completion. the ovmra4W dsr will heve IM Wman of proving M or she did has Wild or improve for the Wrpose of eels). I. as owner at the propend, am "costively contracmg wbh licensed contractors to construct the project (Section 7011. Business and PMess ors Coda: The Contract. License Law does not apply to an owner of asopeny who Wilds or bnpmves therean and who contracts for sudM projects wfh a corms ) licensed aunttam to the Contractors Lkanee Law). I am exempt under Section: B. b PC., for this reason: Date: Owner. I do hereby caddy Rest I am aware of and understand the raqutremenNs of California Health and Safely Code Sedans 25505, 25533. and 25530, end that I many Mure WildiW ooupent will /oil rot (dict one) need to comply wlh said date codes and the requirements for apemdlloroonemrd'anarmodilratianhanlM Ai ue y anegemeni Didrid.fbsidenlW wmtmd'on epgcmiomen ezemq hoar Nese provisions. Dare: Applicant WORKER'S COMPENSATION DECLARATION: I hereby chum under perW1y of perjury one of the MOowing decimations: I have end oil maintain a cedlfkale of consent to self -insure for wakens' compensation, m wc+ for by Season 37M of the Labor Cate, for the oedonreme of the weak for wNch this permit is snared. C-1 l have and MO meimait woken' mmpemsmioi immense. as required by Bodian 3700 of the Lethal Code. for the performances d the 7C atonic Int xhich thu pwmtl b iaued. MY w'orkena' compenamion imunuoa unw vd priory number aro: Cauer: GOODMAN EXPIRES Policy Number: 01 4V:,Db 06/01/98 r section need horW completed f IN, permf is by one humdrsf dollars /SI00/ or bv.) L-) I teddy Mel in the nedornama d tM work fm w ooh this panmh is imued, I shell ml emplw any paean in arty manner ao m to become object IP he wakars',ymnpensatbn N. of Cddamie. And agree 1Mt)f I shouid beanie sudeact to the waM1me' Warrrbp: Efate for ss.n workws' cpmpmwaden coverage Is unl{wNJ, and slWl srC/ecr wt a ill he mim'iMl pwlpu may civil fines rig to one hundred thousand clothes ($10f{000L In add on to she cost of MIIIf1NWtb demrypa u proyWM for In Section 3706 of Me Labor Code, Internal and adpmsye fess. CONSTRUCTION LENDING AGENCY: I hereby affirm under pemhy of perjury that then u . oonatmtlion Iwd'hV agency for the pedorreamw of Ihe work for which this permit is wetted (Section 3097, CN. C). LENDER'S NAME: LENDER'S ADDRESS: I codify that I have read this application and date that the above information is correct. I agree to campy wfh all any and coenly ordinances and state lava relining to building construction and hereby authorize representatives ofthis sty to enter upon the above-mentimed property for inspection purposes. JIM HODGES (5151d6.WP) While-BuiMiq B Salary:Green-Fb: Canwy-dppicanl: Purl Rmenue; Oddenrod-Mora CITY OF COSTA MESA — BUILDING PERMIT I PERM NO: P 085471 PERMIT NO: P 085478 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU PURPOSE: OTH JOB DESCRIPTION : REPLACE MAIN WATER LINE SQ FT: CLAIM VALUE: 300.00 CALL—VALUE: GROUP OCC: R-3 i COMMENTS: REPLACE MAIN WATER LINE FROM METER TO RESIDENCE if iFxxiFiexxie iE iE it se ie iE 9e ie if ii s(•ie yf iFiF ii itzxxxii iEfE iE if dF iP*xix flf('fe iixif xiE*>t iixxkfi'R'It �ifxxiT ie ii six eros it eros ie ii iexie fE irx Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING---------- FRNT: F1' IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RIGHT: FT IN LEFT: F1 IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 42520503 ZNE: REF NO: PLANNING NOTES> > 1t•'lY'1(' R � It � ft'Il' f! 1l' ft' T' jl' fl' 1! fF tt'Jt l!T"JF'R It ]t x H'R 1f 1t' 1F ll' 1! � jt' 1l' ll'T' 1l"� lf'R 1t 1t')f 1t'k_ 1F 1t Y! 1t!' 11' � It It T 1C'lt'If k'R � 1t sF sir eF se l''lt"R iY'rt'R'R 1t'%!'R 1t' D E V E L O P M E N T S E R V I C E S, R E Q U I R E M E N T S ZONING APPROVED BY LATE: BUILDING APPROVED BY APPLICATION ISSUED B fi it it iy iF ff iF ii fF#ii ie ii fifixx>F -lr ii LEGALIZATION:N BLDG PMT PERMIT F E S U M M A'R Y DATE: x;:;:ftieff ri;r O i<-7 STRUCTURAL SEGMENI:N PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING 8.75 25t SMIP/NON-RES PLAN ISSUE FEE 222,00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 8.75 22.00 0.00 30.75 30.75 .00 REVENUE DIVISION TOTALS--> COLLECTED: 30.75 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP%TOT GRADING PLAN—CHECK 30.75 if�xii fFrifF ii fy>c iE iifffixkiF fe ie ii ff#iFx xx3r4x xfixie iF�iixdr ie�xxie iter xis ie fe if is sir fe ye iF ix it ff fir ie iFie iexffxxfir•kriixxii ;R ri is fE fe fe fx I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P I I 0 N UNIT COST TOTAL COST PLU 1 WATER SERVICE 8,75 8.75 END OF FEES 10-29-1997/88:43 ANA38.75 RCPT8:81-0014621 PERMIT:085478 CONSTRUCTION AND PLANNING POOL 'A APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 1 53. Steel Reinforcement 3., Electrical Conduit-Utility-Undrgrnd. 54. Forms J4, Electrical Conduit-Undrgrnd. - - 55. Electrical Bonding `5.,Steel Reinforcement 56. Rough Plumbing & Pressure Test - • 6- Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE *! �.7. Footings Jr 58. Electrical Conduit-Undrgrnd. 18. Foundation 59. Gas Pipe, O U idqrnd., Test C 9. Water Pipe-Und&(6d.'^ 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 lyirirjg 67. Fencing & Access Approval 117. Rough Wiring Sign• 68. APPROVED FOR PLASTERING n: 18. Rough ElectricalyT Bar Ceiling - 69. POOL/SPA SYSTSMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APP�OVAhS: Permit # 20. Rougsjt Factor F4lace �. -� i _ •: 21, ducts, in -Structure; r •• J - - .; t _ 1 70. -Underground Hydro r 22. Ducts, Ventilasting r 1 _ R y j �' 71. Product'P?i�ing'fIPas Q Oil 23. Gas PipeRough &-fest - �: -•' 1 r 72. Underground FIUYh 24. 'Roof -Framing 'I ' - 4 _ " 73. UndergrRd. Stoll Tan GGas ❑-Oil yr 25. Roof�Sheathing .%' '�I ,, i r - _C r 74. Overhead Hydrb r: 26. :T -Bay. Ceiling (Struttural) & ,Wonocoat r' % r 75. Dry Chemical i ti 27. Frame and Flashir i t• it '' `- ` -- - 76. Dry Startdpi pew r ^ 28. Lathing&Siding =. r 77, FIXED_$1STEbkF�NAL 29. Insulatio+l -• �S� - - _ ;• 76. FIRE PREV. FINAL r z[ �-- ' 30. Drywall Nailing •_ " ! If ' -HEALTH DEM. REQUIREMENT _ 31. Plaster Bipwn,Coa;; r e ;+ . 79. `F"INAC Ii,1 PECT,ION F ^ 32. Electrical Powbr Mhter-Final r - S0: FOOD CERTIF-ICATE ISSPED 33. Final Ele�tric' ., r. r , •t' Nqtes: - ; - 34.'Finat;Heating� Aji,Conditioning. 35. Pinal'GaiVipfTert i 7 •, I �,� r '• _ 36. Hood_ or.Z;anopy • e .a _• r - t 37. ,Final'Factory Fi;ephpce --. 38. Final -Plumbing r •� r ' 39. Water Service -Final '•° '- 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer` j r - t - > ; --43. Backflow Irrigation - r 94. Landscape Irrigation System -, r- '45. Sound Ajtenuation' 46. Hand icap.Regulations - a 47. FINAL STRUCTURE & BUILDING - 48. FINAL PLANNING 49. Electric Release to Edison ,- - 50r Gas Release to Southern CaliforniaGas Co r s 51. CERJIFICATE OF OCCUPANCY No. Date ADDRESS OF BUILDING: 216 16TH PL UNIT: ONNERS NAME IF 10IOM LEE SALLY mDRPs3: 8431 ASPENWOOD AVE WESTMINSTER,CA 92683 APpL. MAILDto "mm ARCNRECT OR ENOBIEER: UO NO: L RGL OR END'S ADDRESS: UNIT: CONTRmTOITS MW-' JOE CARLOS PLUMBING COMPA (714)548-5558 CONTRACTORS 11MUIS 1675 SUPERIOR AV mitivis COSTA MESA CA ucial 385443 92627 ut/T: LICENSED CONTRACTORS DECLARATION: I hereby affirm urder panely of perpeY dad I an Tanned under pvidons of Chaptx 9 (commancin9 with Section 7000) of Division 3 of the Business and Pmfesai ins Code, and my Iceroe " in hid lama and aNed. CITY LIC. NO, 0257y3 u cuC. .. 2 ss: C 36 u 85443 E)'F: 1/97 Dole: D Cadrectan OWNER BUILDER DE' IARATIONI: I hereby alhrm udx penally d perjury Ih I amp( I. list Coraectas eros Law for the foulards,raven (Seabn 7W LS Baskws enol Pmlesaau Cada: AM W a eltway MdrA reywse a permd Io wntrw. sea. imprwa. demdnh, a repel ary swaura: pilar b ire beuenos, eeo reRuires the eppli fa each permit to Rb a dBnd statement Net he w she is licensed gamest 1. IM aoviman of the Codoes. license law (Chaplr 9 (.isncin0 with Section 7000) of DNbian 3 of the Boa. and Professions Cordal or, that he or she a vempl Ihsehan and the basis for the aReped exemption. Arty violation of Section 7041.5 by any applicant fa a perms aubpde IM appl"ram to a wit purely of not mora than Dae hodred dollen jsso0l). ❑ I. v ower of the psopM, or any ernpbyees ash wage as their ads ganpensatbn. sill do thio wend, and this elmewa bhis "wended or offered for side (Section 7044, Business and Professions Code: The Contreaom License law doss not mplyto an bastard popery wM Wide or inproves Iheneon. and its, doss eodr wend himself or herself or O.,h he or her own emplvJM, rovde!the such im,soisd end. as not intended or offered for sob. B, howsdr, the Wilding or vnprwennan is sold within ors, year of mrplation, the ..,4 uildr will have the burden of proving M or aM db rhe Wild or improve la IM Wroosa of side). ❑ 1, v owrs,r of 1M prapny, an, exduetwy conlredi, with liceneed contractors to construct the project (Section 7044, Business ad Professions Coda: The Conlradon Liwnws law done not appy to an owner of aoPary wdb Wide or impro.•es thereon and wfio contacts for sum projects with a comratons) licensed pweuam to the Canhactore Lkerea law). ❑ 1 an exempl under Section: B. 8 PC.. for this reason: Dale: Owner. I do hereby candy then I am senora d and urdersud this rpuiremads of California lleatlh ad Salary Code Sed'aas 25.5.. RSB44. and 25531, and And I or any future bdbin9 ocagenl will / will red (dmb one) need to comply ash sed ads codes and IM requirements for epertnF lwmnshrctbna modifrabnhomlM Air6iai y%ianpemmt Diarid. Reudarntel mrmaction eppirmiovan exempt hour Nese am seas. Dela: Applicant: WORKER'S COMPENSATION DECLARATION: I hereby elhml order prs,by of perjury, wit of this hdowbg detlad'nv: ❑Iharo ad will memten.wntiratedwaroW lc Code, lthis prare for werere'mnpmvtion,vaovidad lorbySemon 37GOdtM labor en IM cadormancs d the work la which Nn perms is issued. !•-1 I hero and wD mires across, con, lion insurance. u rrydaed by Section 4700 of the Labor Code. As the prbrmao of Or lir work la whim Ne permit b bsued. MY waken' ewnyevdbn imuraa:e order and policy number are: Cider: GOODMAN EXPIRES policy Number U9 to b 06/01/98 (Me aatlRYn dead IK1 be MnPldd I Da par11Ais br she Aladled dOAVH /Sim] arises) ❑ I oenty Nd in the pdormenu d IM oak M wfikJn this perms b laud, I doth nae pby ay perean in Any maus,r so v 1. became subject to the asslass' cempeasmion I.. d C iy atl ayes the 1 shad boons, aajaa to the soyas• compensation pwigpns y Sgd'an_3700rd me aNVAh mmply d oee p 'signs. ode: U///1,9� Anwfium: WarnIM: Figure b secure -alters' caniLaxMedon —illia la union N( and shat e16/eCI en arplo o naNilritl pxMltles aM e/v/l 0. od b ons hurM7ad Meusxd aldlan (AIOR OOOA In sold n b are ret o/ rorrpwatbn d ops u prodOd Ad, In Sacdwr 3706 of Ne Lobar Code, InfenesL and edomsy's fess. CONSTRUCTION LENDING AGENCY: I hereby affirm under penia y of perjury that there is e cwnaruaion bating agency hien the pdormsrca of the word for which the Dani b evd (Section 3097. Civ. C), LENDER'S NAME: LENDER'S ADDRESS: I candy that I have red this epplicdbn and pale that Na above idonmation is caned. I ayes to canpy vmh all dry acl county ordinances, and ode brit raising to building conaructbn ad hereby, authorize reprevenlatives of test city to sax Upon the ebma.med'nnd prop" for inepa'ion"npaeee. JIM HODGES WhM-Buibkq A Safety: Green -Fre: Canary -Applicant: PinkJR h anus: (bbenhcd-Neem CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: P 085479 PLAN CHECK NO: N CONSTRUCTION TYPE: V—N PERMIT TYPE: PLU [PERM NO: P 08547 GOVT: N SUPP: N PURPOSE: OTH JOB DESCRIPTION REPLACE MAIN WATER LINE SQ FT: CLAIM VALUE: 300,00 CALC—VALUE: GROUP OCC: R-3 i COMMENTS: REPLACE MAIN WATER LINE FROM METER IO RESIDENCE xiFwir iF ii iF ie rf ii st ii iF##iF iFie se ii irk wwwiF �w ie ie ie>r it iF tin ie ie iiwwvi if sir ii ie ii ix;ewif ii irxir ie it ie ii ii ii ie iE>txit iiriixiew it it;e iF ie iixiixx>r Z O N I N G R E Q U I R E M E N T S S E T B A C H S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING-------- FRNT: FT IN REAR: FT IN FRNT: FIT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RIGHT: FT IN PARKING REQ: PROV: PARCEL: 42520502 ZNE: REF NO: PLANNING NOTES> > iF x ie iF ie * ih ii iE iF se sF if ie x it iF if ii ie ie ii iF ie ii ih x ie if ie if ie it ii sir ii ii ie ie>r ie iE ii tr ii x if >f if:x ie ii ie viae yF ri k ii x ii iiia isle x it ii iiie ie ie dr iF ie ii• ie ie ie D E V E L O P M E N T S E R V I C E S'' R E Q U I R E M E N T S ZONING APPROVED by , t BUILDING APPROVED BY APPLICATION ISSUED BY: it di iF ii iF iexii ie ie iFwiixie sF iF dF ie iF ie iF ore srxsexde yrxsr de aidxst sail It ore leaoe""�Ti'te yr LEGALIZATION:N F E E S U M M A ft Y BLDG PMT PLUMBING ELECTRIC MECHANIC PERMIT 8.75 253 PLAN ISSUE FEE 22.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTALS ---- > 8.75 22.00 0.00 REVENUE DIVISION TOTALS--> COLLECTED: BLDG PMT PLUMBING ELECTRIC MECHANIC 30.75 DATE: DATE: xxsiae aye yew se wiF ii ii ii ii iF iF iF iiie or iae ie ie STRUCTURAL SEGMENT:N FIRE SMIP/RES GRADING SMIP/NUN-RES TOTAL PAID DUE 30.75 30.75 .00 30.75 OVER/SHORT: .00 FIRE SMIP/TOT GRADING PLAN—CHECK if iF ie x ie w if iE iF ix * ie if x iF ie>r ix w w w ii di di>r>r iF # iI iF w iF iE w sF it tic 441E ii ii vi ii if x ii ii ii w di w ii>r>r ii ie ii irk ie x ii w it ii>r ii+t x ie:R ie w ie se ix ie ase ie I N D I V I D U A L F E E b R E A P. D O W N TYPE QTY D E S C R I P T I O N UNIT COST fU'IAL COST PLU 1 WATER SERVICE 8.75 8.75 END OF FEES 18-29-1997/88:42 AM/$30.75 RCPT8:01-0814620 PERMIT:085479 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL � SPA 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 - ' -16: Electrical UFER Grhd. 57. APPROVAL TO COVER-GUNITE ' 7. Footings 58. Electrical Condit-Undrgrnd. Foundation 59. Gas Pipe, 0 UAdrgrnd., Test 9: Water Pipe-Undrgi'nd, - 60, Backwash Linee, P -Trap, ❑ 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 Plumbin9 65. Electrical -Final 15. Rough Electrical -Conduit - 66. Solar System -Fatal ' 16. Rough Electric Wiring _ -67. Fencing & Acceii 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 APPgOVAV,S '� Permit # 20. Rough Factory FV.eplace ,.r i - v I '_ 21. Ducts, in Structure ' •• - [ �_ 70: Undergrdu-,qd Hydro r 22. Ducts, VentllVn 9 71. ProduQt'Piping'ffpas boil 23. 'Gas Pipe?Rough &•Test _ _j.T _ ' ' 72. Undergiound Flush r 24. Roof Framing' Undergrnd.Sto�aeTan�OGas Ooil 25. Roof Sheathing 74, Overhead Hydro [ 26.>S -Bar Ceiling (Str&etural) & MOnQCOat 75', Dry Chemical r 27, Frame and Flashinyk i. -• s 76. Dry Standpipe + 28. Lathing & Siding 7FIXED $YSTE'{t4�F'!N!{`La ' 29. Insulation -. -_ .. i I ' Ia 78. FIRE PREY. FINAL 30. Drywall Nailing T ' I j'. ��; ;� j,�HEALT.N DEPT. -REQUIREMENT . 31. Plaster BiowrtCoat� 75x. FINAL L SPECTrtON r • 32. T:IectricaFPower Meter -Final _ . `' I ; �� ' 80! FOOD CERTIFICATE ISSUED 33. Fincl Electric, ., 1 � I k It Nates: +: *• 34.-Finat'Heating'& AirtConditionitlg. - r r Y I• 35. Final'Gai^Pipg-Test; a ,' ;' ' t .34. - 4 36. Hood or tanopY r iTi ' 37. ;Fina}'Factory Fireplace t 38. Final Plumbing t " 39. Water Service -Final` /� �i Z t •' --- - [ 40. Gas Service -Final - ••, •• t .n 41. Solar Domestic-Fip l - K t ` t 42. Backflow Preventers 4 43. Backflow Irrigations 44. Landscape Irriqation Systema - ? T1 7 7 -'Ir '45. Sound A(tenuation; ' _ - _ ^ • ;, 46. }iandicap.Regulations c + 7 •. 47, FINAL STRUCTURE & BUILDING I ' 48. FINAL PLANNING 7 49. Electric Release to Edison ! - r r 50. Gas Release to Southern California Gas Co 51; CERTIFICATE OF OCCUPANCY No. Date MDRESS<M BUILDIRO:_ 21 6 16TH PL UNIT: M OWNERSRAYEIFILEE EE JULIE ADDRESS: 8431 ASPENWOOD AVE WESIMINSTER,CA 92683 APDL. WRUNG ADDRESS: ARCHITECT OR ENGINEER: TIC. NO, MR. OR ENG'S ADDRESS: UNIT: CONTRACTOR'S RARE JOE CARLOS PLUMBING COMPA (714)548-5558 CONTRACTORS MNUNO 1675 SUPERIOR AV MORESS: COSTA MESA CA mmo, 385443 92627 UNIT.. LICENSED CONTRACTORS DECLARATION: I hereby affirm under Penalty of perjury des 1 am Iceneed under praviaei of Chapter 9 (cammancnq with Section 7000) of Division 3 of Ne Bosiress and Pmlessime Code. end my ho es, is in full fere end effect. CM SSC. NO, V"5793 u(. CLASS: C 36 uc.N - 5443 cis"P: 12/97 Data: 6, Connector 0412 OWNER BUILDER DECLARAT ON: I hereby affirm under penally, d pinpoy thin she exempt hpn the Cmracto ansa Law for the following reams (Section 70315 Business end Prdessicom Code: Any coy or cou Y which oqu'ves a perm) tom ct, alar, improve, dampish, or repel any structum, per to 1e, issuance, aeo regdres the spirituous or such posted to We a vii statements Nat M or she ':tensed N.t to The Promems of the Contractor License Law (Chapter (mmmencrg with Section 70W) of Div®bn 3 of the inees and Prdeat Coda] or that he or and he exempt therNmm and the bass for the allotted esemgin. Any, violation of Section A,5 by and applicant Tor a come subjects The applicant to a coil penally of nos more then fine hundred doDara [$!illi I, as owner of the propend m my employees with wages as their etre compenoatlon, will do the work, and the stluclure to not intended or offered for rude (Section 7044. Business red Pofessi m,Code: TM Contractor License Lew dere ml appy to an bwre,d property who Mida or inprovm Thereon, and who doe such work Nmsell or hersN or IMoutth he or her own employees, provided that such 'mprwemedsa are nos intended or olfwad In see. 1, however, the Miein, or knprovemeds m send within one Year of mnailmon, the owner -builder will have IM burden of provin, M or she did m build or improve faint opera of sae). 0 I. as owner of the popery, am excuaively ccoatractkg with licensed conUedm he construct the project (Section 7044. Business end Protrusions Code: The Contrectm License Lew dose not apply to an owner of proms" whip, Mulcts or imgwev thereon and who contracts M such projects with a comrectar(a) Icensed Nomads to the Contractors License Law). I am .,t under Becton: B. A P.C., b this reams: 1 do hereby candy that I am aware, to and understand the requirements of California Naalh and Safety Cade Sections 25505, 25533, and 25531, and that I or any Mum buidirg 000panl will / will not (doe one) need to comply with said stale coders and the mquirements for apermnlormnabuctionormodifiWa nhwntMAi ua-Caty ltenepemenl District. Residential constructioneppfmbnaaro avamglmmthaee provisions. Dale: Applicant: WORKER'S COMPENSATION DECLARATION: 1 hereby affirm under penally of perjury one tr the lollowitg decerationa: ❑ I Mm and will moment a onHkate of consent to seffmneure for woMen'mnpenWion, u provided lor by Section 37M of the Labor Code. for the performance d the work for which this permit is issued. I haw and will maintain workmo' compensaton insurance as required by Section 37M of Ne Labar Cade, forme performm® of IM work for which this Pinar is rcaued. My workers'canyanotion insurance carter and pdiry number are: Carder: GOODMAN EXPIRES Policy Number. V b 06/01/98 se tion need nW bo compbod r the permit is for ons hundred ""tars (SIM/ or eaa.) L.J I only that in IM performance d the work la which this permit is shouted, I eleR mI mpby anY Niton a any manner m as to becwm subject to the,aodmm' compensation ram oy0�� and agree In K ehwld bacorrw mbjes to the werbo' compensation p/p� Se fan 7odt Debar\`oda, shell nh 'I onVl; w' Nowpovisor. Data: / o� Applicant Roaming: F.U. ro axon wpdters'tompensaffon ccammon 1 sunt A and shall .45hd1; smpleys o crlMeW semesters, and c/vll Rata rpt W ons humanist Iheusand ddlera (S104000A in add n ro she owf of compwmoR dallohNse, as pnivMad far In Secdon 3706 of tle Labor Cods, Interest and ends, "'a lase CONSTRUCTION LENDING AGENCY: I hourly, affirm under, paned d perPM that Theo o construction nstru tion ending a9emy fp 144 Performance d The work for which the pemri sh'sswd (Section 3097. Ce. C), LENDER'S NAME: LENDER'S ADDRESS: I tend the I Mw reed this application and mare that IM above information is coned. I saes to comply, with au ouy and county ordinances and we ews cams, Ir midig conouaicn and hereby authori a representatNes of this coy W eller upon the above-meeised popery for impaction urposae. J M HODGES Dee,: / White SuiMbg 8 Salary; Qmm,Re; Canary-APpFam: Pink-Nevenue: GOMenmd-Aaesamr CIIY OF COSTA MESA — BUILDING PERMIT PERM NO: r 08548 - PERMIT NO: P 085480 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: V -N PERMIT TYPE: PLU PURPOSE: CITH JOB DESCRIPTION : REPLACE MAIN WATER LINE SQ FT: CLAIM VALUE: 300.00 CALC-VALUE: GROUP OCC: R-3 i COMMENTS: REPLACE MAIN WATER LINE FROM METER TO RESIDENCE vi ri ie xif ie it iiwxriit ii it if iF ie#iF;r ie sifixwxix iExie iixxve iexxir irri ie it iy>t ie iE irxii i4 iF ii riii irrifiie d+i ie�it iexxxxir ie ie 3E k it if tiiwxii ii ii Z O N I N G R E Q U I R E M E N 1 S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --- -- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RIGHT: FT IN LEFT: FT IN RGHHT: FT IN PARKING REQ: PROV: PARCEL: 42520501 ZNE: REF NO: PLANNING NOTES> > Jt f! } T' %t lt'R It x 1t x } T l! � )t x ll' 1t l! 1!• 1!'%! X'lt lt')f x'It x x X X'F 1{"R'R X!l' R'Jt'It'lt 11' it d! 1!'R' It X It TETE )t 1!• lt'It'lt'1! 1t 1t X X'R It it X It It')!')t ft X 1t'R N'It 1t'R D E V E L O P M E N T S E R V I C E S, R E Q U I R E M E N I S ZONING APPROVED BY DATE: BUILDING APPROVED BY DATE: ISSUED S E -tfY- 9 APPLICATION I; DATE; /0 T'atel'al'kXat'1tXT'1t Xltk91"lt f''R ft Xff ltXXX XXTPXXXrt Xrt XXe� XXX3lXXX XXXXXXX XXXXrtjI'k Xlt lt'%t'X X'RKXX'R RXrt XXT'1P LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMTP/RES GRADING PERMIT 8.75 254 SMT P / NON -RES PLAN ISSUE FEE 22.00 BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK IOiAL PAID DUE TOTALS ---- > 8.75 22.00 0.00 30.75 30.75 .00 REVENUE DIVISION TOTALS--> COLLECTED: 30.75 OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRM. SMTP/TOT GRADING PLAN' -CHECK "30.75 x xis iE ie iF iF iE di iF ifxirxrdr itxia iFiix ix ii iixxxiexxir ii xii iixiFx iF;r ie iE ii iE ie.xxxxii�xiexxii iv ii ii iexie it ie iE ie it iE ii is ic iE ii iF if ii ii if ii I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P 1 2 0 N UNIT GOBI TOTAL LOST PLU 1 WATER SERVICE 8.75 8,75 END OF FEES 10-29-1997/08:38 ANA30.75 RCPT0:01-0814611 PERMIT:085480 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL 'A 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-Uridrgrnd. 55. Electrical Bonding 5. Steel Reinforcement. 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grid. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 81 Foundation 59. Gas Pipe, 0 Undfgrnd., Test 9: Water Pipe-Undrgrnd. ;, 60. Backwash Lines, ?-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line.& House'Connection 62, Backwash & Receptor -Final 72. Sewer Cap _ 63. Heater & Vent -Final 13. Roof Drains _ 64. Plumbing System - Final 14. Rough Plumbing - - 65: Electrical -Final 15. Rough Electricai-Conduit _ 66. Solar System -Final 16. Rough Electric.Wiring 67. Fencing & Access Approval - 17. Rough Wiring Sign "- 68. APPROVED FOR -PLASTERING 18. Rough ElectricalrT Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL 19, Rough Heating & Air Conditioning - ' FIRE DEPT. REQUIREMENT APPROVALS. -' Pefmit # 20. Rough FactoFy Ficepiace �.r - - -. 21. Ducts, in -Structure 70. Underground Hdro 22. Ducts, Ventilating;; �' _( _ <l t , . 71. Product -Piping OGas CI Oil 23. Gas P.ipetRough & Test ,- �r - ^ . - 72, Underground Flush - 24. Roof Framing' - k 73. Undergrnd.Storage Tanlig 0Gas 0Oil 25. Roof4Sheathing - ;� ,. r ,� •� r 74. Overhead Hydro , 26. T -Bar Ceiling (Structural) & Monocoat '"' 7�. Dry Chemical 27. ;Frame and Flashi g r i 76. Dry Standpipe 28. Lathing & Siding 77f. FIXED SYSTO:tFINArL_ - 29. Insulatiop -. - -•• .t ��- 78. FIRE PREV. FINAL 30. Drywall NailingHEALTH DEPT. REQUIREMENT . 37. Plaster Brown Coat: i v 79. -FINAL L_NSPECT.LON - 32. 'Electrical_Power Meter -Final '- .I ,r '" 80'. FOOD CERTIFICATE ISSUED, I 33. final,Ele>tric. - Notes: 34. -Final. Heating '_& Air Conditioning - i S r 35. Final'Gas•Pipe-Test _ ° •. ;- _ 1 I'i; •_ 36. Hood or Canopy-- . 37. Fina).Factory Fireplace - ; •' j � `' 38. Fipai'Plumbing----- ,ia 39. Water Service -Final . 40. Gas Service -Final r • a •- - 41. Solar Domestic -Final -• k - ,� - .. - 42. Backflow Preventer. •• •. -- - 43. Backflow Irrigation:- t i 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 511. CERTIFICATE OF OCCUPANCY No. Date _ City of Costa Mesa Development Services Department a f. Building Safety Division CERTIFICATE OF OCCUPANCY No. O? `S P. O. Box 1200 Costa Mesa, California The Building located at 216 East 16Th Place, Unit A has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group R1 Occupancy. Use of Building Condominium Legal Description 425-202-14 (See reverse side for Metes and Bounds) Building Permit No R A019R Electrical Permit N6331212,R31579 Plumbing Permit No.P 31159 Mechanical Permit No. M '411471 . M a36G0 Number of apartments and/or guest rooms ISSUED TO: Ccnata Mesa t.caarier Rnterorise. Inc. 172 Flower Street Onaf•a Mpla . CA 92627 Building Official William T. Howard by Date March 21. 19A9 'I%is Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CMF 1015-46 rev. 1/63 White -Owner; Canary - Numerical File; Pink - Bldg. Permit File Applicant to fill in ail spaces except those within heavy border lines and sign all appropriate declarations. CIT, r F r0STA ME A CONST�R�I�CTIq� PERMIT PERMIT NO. TRACT N0. .LOT NO. UNIT.NO, Projecss Zllo E. -l(` ace��r 8 3 o i 93 to(o3z r (br l�3 /Az TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR Applica 's Mailing Address _ L] CONVERSION ElDEMOLISH ❑ OTHER Ownvi'A tne-:A,a rA M`5a L"ef14o2< tf.,� 1'i�l $';,•j Phone 7Z2 x-711 - - - 1'Ti yLvM1cr, Si C -?TA IAS5A, rU n2{c'1i7 ;DESCRIPTION OF WORK/USE OF BLDG. mt-4iEr h?Eno. License No. Address / Contractor's Nameglslh 1f� gokap� 4 Address(mailing) 11014W,ag17l. City License No. 04 ILL •7+ LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. I License Cl s L!Me No. 3 I. Sib 10 Date Sri_ Signature "IA_ lL�-4�`_"-" WORKERS' COMPS SATION DECLA r TION I hereby affirm that I have a certificateo consent to self -insure or a certificate �f Workers' Compensation Insurance, or a certified copy thereof (Section 100, Lab. C.) aicy No. -4-0- Y0_ n ?� 11 6F,_1 I CompanyUIS. `-� V•WbqM Certified copy is hereby furnished. C 11 zCert ietl qop.q y is filed with the city Bwl inq ivi ion. ate I _ is "" led Applicant iI I �j �U EXEMPTION FROM ORKE RS' COM PE NSA ION DECLARATION (This section need not be completed if the permit is for one hundred ($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. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097 Civ. C.) Lender's Name' Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason' (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of the Contractor's'.License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove er the purpose of sale). ❑ 1, afas owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves, thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date I hereby certi information is and state laws sentatives of inspection purl Signature _ CMF 0665-46, rev. Owner have read this application and state that the above agree to comply with all city and county ordinances o building construction, and hereby authorize repre-- t�qr upon the above-mentioned- property for White .4eiC i TYPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION �S4 FT OCC PANC//vv, CON STRUCTION TYPE VALUATION$ G ZONE GRADINGCU.YDS. - ACRES Remarks: EES A.P. #!"fes[ S Main BL E T Front B Rear ' A C Rig t K S Left Ping. Ref. # 5100 -9/11/37 P- 207- —14 Zone lding: Accessory Building: / CA k71, L7A.—Parking Rep./Provided 39'•1 Z O N I N G R E D M T S Bar Sink Showers - BUILDING PERMIT ELECTRICAL FEES Backflow Preventer - - Service Sink _ $ Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW El 50+KIN Backflow Irrigation Sewer Cap $ BathtObs ISSUANCE Sewer Connection 11_� $ - Cooking Unit Meter Dup to 100 amps Clarifiers $ Solar Collectors GRADING Dishwasher Meter ❑over 100 amps - Dishwasher MICROFILM Solar Piping Dryers ❑Gas ❑Electric Sub Panel .Drinking Fountains Solark Fan Motors DO -1H Floor Drains S ming Pool vv/Spa F.A.U. - Inc. Sola,❑9-15 HP 1:116-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes -Pole Light Interceptors Water Heater Outlets Range Kitchen Sink _ Water Service Switches - Sign Lavatories Auto1Wash Garbage Disposal 'rte - 9 p % Standing Sections P—Trap_ - Laundry Trays Generator D0�5'KW E15 -15 -KW - Trash Compactor Roof DraX ' ' . -, 1' •1 1 1 1 Reinspection Fee I $15 I I - Issue Fee 1 I $ 3 1 I Boiler Hood'or Type I ❑ / Duct - Under Ground Canopy Type I I ❑ Duct - Structural Refrigeration System ve Duct - Ventilating ❑0-100,000BTU 00,000 BTU Exhaust System D Multiple D System a it/Alteration Firepl/Fact. Bit. ICBO # e Dampers Heating System & Ducting Registers 00-100,000 BTU❑100 BTL - Fee 1 $15 1 1' Issue Fee Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $ 3 I Reinspection Fee 006� DEVELOPMENT SER Zoning Approved By _ Building Approved By EE$$ $15 Issue Fee IV LG • PLAN CHECK 25% $ $ 3 $ 4--76 SUMMARY OF FEES BUILDING PERMIT $. -3 37`©0 SMTP PLAN.CHECK $ -�4-"7�. PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% $ ENERGY P.C. ELECTRICAL $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL -$ TOTAL FEE PLAN CHECK 25% $ $ 3 $ 4--76 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA 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 LIFER 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, D Undrgrnd. , 10. Structural Floor System � 044- 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 APPROVALS Permit # _ 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas []Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank D Gas D Oil 25. Roof Sheathing 88 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing LL Qe- 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,4k 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: !f Be mow_ ((o• 34. Final Heating & Air Conditioning K• 35. Final Gas Pipe-Test ` 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final F - 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 g� ene 49. Electric Release to Edison �•- r 50. Gas Release to Southern California Gas Co _ 51. CERTIFICATE OF OCCUPANCY No. Date _ BN FORM 116 B(A FORM 1486 INSULATION CERTIFICATION This is to certify that, in conformance with the current energy regulations (California Adminis- trative Code, Title 25, State of (alifornia') and approved plans, insulation has been installed in the building located at: COSTA MESA city 216 Stmt M.. (It MIhbh) ROOFS 16TH PLACE Str.N ORANGE C.a.ty li/)/f =101 1N ll.m6r Tnd me. DESCRIPTION OF INSTALLATION Type of Materia! Manufacturer Thickness --R Value••_ .t CON".. OWENS COMINGS FIBERGLAS EXTERIOR WALLS FIBERGLAS BATTS 3: 11— Type of Material Manufacturer Thickness R Va:ae•• (or Tnd. Irmo (••e Y.». 4 14......... N M ...I.».w M ...MIN r 4NId:y CEILINGS FIBERGLAS BATTS OWENS CORNINGS FIBERGLAS BATTS: �9e 9 30 Type of Material Manufacturer Thickness R Value** Fw 1486-0 BUILDING INDUSTRY ASSOCIATION OF MIFORNUI, (or Sq. FL Covered BLOWN: Type of Material Manufacturer Thickness. No. Bags— (0, Tad. n.«) WL/Bog SQ. FL Covered R Value**— FLOORS Type of Material Manufacturer Thickness—It Value••— (or Tnd. N.».) SLAB ON GRADE _ Type of Hateript Manufacturer---- Thickness "' R Value••_ (or Tnd. N.md Yfidth of- Insulation Inches FOUNDATION WALLS (if required) Type of Material Manufacturer Thickness R Value••_ (or Tnd. Kaw) REMARKS (If desired) General Contractor (Builder) WEI—CHUAN CONST. & DEV LcenseNurnber 31.5,4 By Title oat. Subcontractor (Insulation Applicator) Accent Insulation Company License Humber 274283 o..N.d.,. r.r.a:-fent " i at.» -Lute• It .n... G. 1,11ew.d e Date 2-24-89 (•C.Ii.r.ia Ad.l.i~;. Cw., &. , N.NN1.. S».#"., d.dr... a:aarr M1.. Lr. eras N dr )164114 ..d sef tr C.d..f w s»» *'r..li..r. U. rM1»IiM .t IIN ».»11411. .( ».OIIFM, . O .t CON".. en:1,1.. me 14. »M.K.+ M. MM ».»I»d 1..w.l.rw.wa..i.. A. 4r "n. a 19 .1 rr..ylr r N.a»r e.09s11M IMI ...alr M• "vllw .+d M 14. 4414.. TW Im.0 -M r.vr .. N M»l, 0". ..re..N Mar. Mr r .14r r.NwdN .M 41.11 M ..M.d .. 1 ..w.N...... Indy .11.4 A. d.N4y=') 4. 1.6 » MN1.44 "1 M kr 4r rd . MI»iM w».. h .a...1... M I lids— IM d.l«..•..r I..AdM (••e Y.». 4 14......... N M ...I.».w M ...MIN r 4NId:y .».drd. r.Ml h d e..r..l» dd. dyer.'• .M,....., » n. w«r. N MN. TM ...I.e..r ..1.. (a) N ....,r.. 9 ».Nri... "I .r »N.d..•r .N.. f. "fico" T.dy.l �9e I Ftxm 116 —a% BUILDING NEWS. INC. 3055 overland Ave. Les Angela. Calif. 9000-0131870-9871 MAR Fw 1486-0 BUILDING INDUSTRY ASSOCIATION OF MIFORNUI, INC, 1571 Beverly Blvd, Los Angelm Calif. 90026—(213) 6255771 CITY OF COSTA MESA PARK FEES 5.1.110. W.1.118.7 •.• 12665.34 TL _ Fee Payment Receipt 001100 Project Address 21 �0 �'. 1 � ' �l-QiGC� A.P. Number 14 - Building Permit Number $,3a193 Thrtu _B302 0+ Owner's Name A/1.1144E� LI Mailing Address 172 F::If9WP.tr SfYeP>( C�CJSd7n YlCfSGt. FEE: Single Family * Number of Units 2 -Bedrooms or Less @ $ 861.76 = 3 -Bedrooms @ 1,205.67 = 4 -Bedrooms @ 1,545.62 = 5 -Bedrooms+ @ 1,810.50 = Multiple Family ** -Bachelor or Studio @ 474.37 = 1 -Bedroom @ 573.18 = 2 -Bedroom @ 881.51 = 3 -Bedrooms+ @ 1,229.38 = Total Fee *** '-1, 6& 3�zg nn nn 12, (oGS. 3�} Planning Department Approv4Date 15:1Z9''By Applicant's Signature t+�.lu ' NEE * City Ordinance 72.44 ** City Ordinance 72-45 *** City Resolution 78-116 CMF 0174-30, rev, 7/65 White—Planning; Canary—i Ig; Pink—Finance; Goldenrod—Applicant Oregorp 3!. cook M..f. FINAL GRADE CERTIFICATION February 23, 1989 City Of Costa Mesa 77 Fair Dr. Costa Mesa, Ca. 92626 Proiect: East Hampton Court 216 16th Place Costa Mesa, Ca. This letter is to certify that final grading for the above proiect has been completed and is substantially in conformance with the approved grading plan. All drainage is positive and away from the building and drainage devices and swales conform to that shown on the approved plan. ML 3190 J 0 ;u Gre Cook RCE 31570 MpN Z »a9 U CHENG'S SERVICE STATE LIC. No. 425983 9008 E GARVEY'AVE, #O - ROSEMEAD, CA 91770 TEL: (818) 288-3844 Ila, C TO: MR. RANDY BUCK, ELECTRICAL INSPECTOR, COSTA MESA FROM: CHENG'S SERVICE INC. DATE: MAY 2, 1986 SUBJECT: LOAD CALCULATION FOR 216 16TH PLACE, COSTA MESA ----------------------------------------------------------- COMPUTED LOAD ZcofFel NOTE: THE ABOVE LOAD CALCULATION! IS FOR EACH UNIT. 2 UNITS 4 UNITS 6 UNITS TYPES AREA(IN SQUARE FEET) parvn f I -1,439 II ��^ 1,470 III 1„427 LIGHTING ( 3 WATTS X SF) 3r7W 4,41OW 4,261W SMALL APPLIANCE CIRCUITS 3,OOOW 3,000W 3,000W APPLICATION OF DEMAND FACTOR: 3,OOOW @ I00% 3,OOOW 3,000W 3,000W 3,001W AND ABOVE fit 35% 1,511W 1,543W 1,498W GARBAGE DISPOSAL a 1007. 70OW 70OW 700W DISH WASHER 900W 900W 900W LAUNDRY CIRCUIT 1,68OW 1,68OW 1,680W FAN, ?00W 200W 20OW A/C UNIT C OR SPACE HTG.-)-------4,20UW------4,20OW-------4,20OW F (0 G 4 --------------------- TOTAL COMPUTED LOAD 12,191W 12,223W 12,178W ----------------------------------------------------------------- 50 AMPS 50.9 AMPS 50.7 AMPS NOTE: THE ABOVE LOAD CALCULATION! IS FOR EACH UNIT. CERTIFICATE OF COMPLIANCE PAYMENT OF SCHOOL FACILITY FEES NEWPORT -MESA UNIFIED SCHOOL DISTRICT Developer/Applicant: Costa Mesa Leader Enterprises Address: 177 Flnwpr h'trppt, rnsta Mesa Telephone Number: (714) 777-n636 Tract/Parcel and Lot Number(s): Pnrtinn of Lot 27,Newport Hpigh c trap Location of Project: 716 16th Plai-a. Costa Mpca Number of Square Feet of Residential Space 17,320 Number of Square Feet of Commercial and Industrial Space _ x $1.50 Total x $0.25 Total X 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 Newport -Mesa Unified School District. Business 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 representations are not true then this certificate shall automatically terminate and the appropriate City/County shall be notified. Date: 3/16/87 eloper/Applicant Sheet iC JERRY TUCKER 8 ASSOCIATES, INC. Job No. 61 102 CONSULTING STRUCTURAL ENGINEERS 465 EAST 17TH STREET SURE 200, COSTA MESA, CA 92627-3265 714/645-2422 Engineer EDIT iWFTON e2q�T- Inc ��. Ga11oe!� Date 4,-2,7'65• .1� 4j5r,K aXrz N (Jp B�T'>4'E I - $m ��� � c>4�!�Y '�•� �� ����-�r� � ins ��.. foe lr�/b° o m5, w( P3*4 IN 1,5 -m !*. sm, Siwee (1'•: TPS V,<51'2. HOF - JUN. �-' 8 11988 SEWER PERMIT APPLICATION COSTA MESA SANITARY DISTRICT P. O. BOX 1200 COSTA MESA, CA 92626 0 PERMIT K +•f 8679 11/17/8" C1 / 91f rA Qty sbte zip BuildingAddres sir/hP G'1_. r ''I�� Owner err �" - Phone No��/ -� "'� tate License No. 7 City Business Li ense No, I hereby acknowledge that I have read this application and state that the above is correct and agree tc comply with all State laws, City ordinances and Sanitary District regulations pertaining to sanitary sewers. I certify that I possess the above valid State of California classification or am the legal owner of the property described above. Signature of Permittee OFFICE USE ONLY Street Connection Fee $ Date Issued -fin House Connection Fee $ — Received b Issuance Fee $ — TOTAL $ INSPECTION USE ONLY DATE OWD BY Street Sewer YLSta House Sewer M. H. Sta No. REMARKS: AN "S" MUST BE PLACED ON ALL SEWER CONNECTIONS MUST BE CURB BEFORE CALLING FOR INSPECT117. INSPECTION. NLL 754.5307 V \9 (\ CMF 0706-68, rev. 2/80 40 \,O PERMIT SEWER PERMIT APPLICATION \ k 9660 PERMIT 1 1.2.00 COSTA MESA SANITARY DISTRICT �* 9600 11/17/NO P. O. BOX 1200 COSTA MESA, CA 92626 g n p Contractor 11l -1f -n5/• Address / 1,11,n— / l Ity • / State / Zip Building Address /-Fir/r! 1J '`butrr Owner 7711 AAic.;r--- Phone No('� /' 'G' c-0" - State License No. i�J.C� City Business License No.' - I hereby acknowledge that I have read this application and state that the above is correct and agree tc comply with all State laws, City ordinances and Saaitary District regulations pertaining to sanitary say.Ers. I certify that I possess the above valid State of California classification or am the leg I owner of the property described above. �T Signature of Permittee OFFICE USE ONLY Street Connection Fee $ Date Issued -� - House Connection Fee $ Received by 1� Issuance Fee $ TOTAL $ INSPECTION USE ONLY DATE OWD By Street Sewer Y Sta House Sewer M. H. Sta REMARKS: Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. VF COSTA MESA CONSTRUCTION PERMIT rolect Address I (-dn iii-. -14A Applicant's Mailing Address �/., Owner's Name 4 7 'Phone / �2 _ %' M Address 1�7z,1uteY �,t- (�1'rta MliiA/ l'.R qz6 Arch/Eng. License o. Address 6Jd Contractor's Nam i'i6lAn�' HIAf:h • 5 n� n19 Pho e(•�'hil r' Address (mailing) 14147 • rl(sfj'��'d. RA, �cl, i O M, l.'�DTGrI City License No. 04 V, 4-7 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and ffect. ens Lice CI 9 1 c nse NQ, Date/hj Signature VORKERS' COMPENSATION DEC LAR'ATION 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 3800, Lab. C,.)__D,I'6_,,7, I),S /� 611AYan i IPolicy No. 9'{1 Company �j Certifi If], Certifl�ad copy py !s fiI dbwithrthehcitty Buildi, c v Sion. yn to II/I APPl icanl-_7V*+a'I��.. -L ...� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed If the permit is for one hundred ($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. DateSignature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License, Law for the following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole com pensalion, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement Is Sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove efor the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractor(s1 license pursuant to the Contractor's License Law). I am aware that proof o their Worker's Compensation insurance should be Provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Ownel I hereby certify that I have ree information is correct. I agree to inspection purposes. Signature I Drivers' License 3r5'. CMF 0865-46, rev. 10/84 I this application and state that the above comply with all city and county ordinances 9 construction, and hereby authorize repre- upon the above-mentioned property for st 4, rlA/oh 31)5 01 1 CQ ELECTRICAL FEES Backflow Preventer Service Sink TYPE OF CONSTRUCTION LJ NEW LJ ADO LJ ALTERATION REPAIR Transformer ❑ 15.50 KW ❑ 50+KW ❑ ❑ ❑ Bathtubs CONVERSION DEMOLISH OTHER 42 O A.P. 0 DESCRIPTION OF WORK/USE OF BLDG. Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps S Main Buildi 1 LKJ Dryers ❑Gas ❑Electric E Drinking Fountains TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front �� ED TENANT ❑ ELECTRICAL D -PLUMBING ❑ MECHANICAL B F.A.U. ❑ OTHER Floor Sinks A Rear Fixtures - Microwave C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY Pole Light Interceptors rK CONSTRUCTION TYPE VALUATIONS O J $ Left ZONE GRADINGCU.YDS. ACRES Ping. Ref.# Remarks: 13 :�66 I C1 3 Sign Planning Notes: NG I FEES 9712 11/17/87 Zone Accessory Building: Parking Req./Provided 47,88 TL Z O N I N G R E Q M T S Bar Sink Showers CQ ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW ❑ 50+KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection 42 O Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps Dishwasher Solar Piping 1 LKJ Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 00-1 HP Ell 'A - 8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09-15 HP 016-15+ Floor Sinks Urinal Fixtures - Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors It Water Heater O J Outlets Range Kitchen Sink Water Service ud Switches Sign Lavatories Auto -Wash p j Garbage Disposal Standing Sections P—Trap Laundry Trays Generator 00-5 KW ❑5.15 KW - Trash Compactor Roof Drains I i . r Reinspection Fee I $15 I I Issue Fee I$ 3 I I Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 1:10100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 White - Building; Canary - Applicant: Pink - Accounting: Goldenrod - Assessor Hood or Type ❑ Canopy Type It ❑ Refrigeration System 00-100,0006TU 0100,000BTU System Repair/Alteration Fire Dampers Registers Issue Fee Reinspection Fee I $15 1 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By $ 3 SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK WA $ MICROFILM $ MECHANICAL $ TOTALFEE $ PLAN CHECK 25% $ $ 3 $ 3 CONSTRUf,TION ANDIPLANNING '• APPROVALS Permit•# Date Inspector POOL & SPA APPROVALS Permit# Date Inspector ..14'jemporary 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-WdFgrnd. l A. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings nl 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. �s �� 4 60. Backwash Lines, P;Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK , 11. Property Sewer Line & House Connection �O 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing �2f y� �' 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 APPROVALS Permit # _ r 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil ., .. 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank ❑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 PREY. FINAL - 30. Drywall Nailing HEALTH DEPT. REQUIREMENT ^' 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED ' 33. Final Electric Notes: . 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy /_ 37. Final Factory Fireplace 38_ Final Plumbing % !, 39. Water Service -Final -40. Gas Service -Final A' ,.41. Solar Domestic -Final 42. Backflow Preventer i .- `- `•' 43: Backflow Irrigation ._. 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47., FINAL STRUCTURE & BUILDING r '48. Special Requirements Completed- •- 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co • - 51. CERTIFICATE OF OCCUPANCY No. Date ' - . ' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA M -ESA/ CONSTRUCTION PERMIT Project Address -772l/!O 11fZy' oel c0$7 -A NxfT4 Applicant's Mailingdress5-�U��"• / Owner's Name GL%/1 ,6 9'" f �d Phone 69- 6 Address Arch/Eng. %(cense No. Address PifNG�/r�/tK A// Contractor:s Name 61 I Phone 949-f2F6 Address (mailing) City License No.�7 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (Commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in fullr_m3d effect. License Class •1 V License No. Date TO Signature /ORKERS' COMPENSATION DECLAR ION hereby affirm that I have a certificate of content to self -Insure or a certificate of Workers' Compensation Insurance, or a certified Copy thereof (Section 3800, Lab. C. o. Company Certified copy is hereby furnished. Certified copy Is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS'COMPENSATION DECLARATION (Thissection need not be completed if the permit Is for one hundred ($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 man r so as to become subject to the Workers' Commpq+1sation Laws of Calll1fw Date-11-�X Signet urd. NOTICE: If, after making this tlecla�atio , u should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I. as on of the property or my employees with wages as their sole compensation, will do the Work, and the stfUcture is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvemenit are not intended or offered for Sale. If, however, thebuilding or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I. as owner of the i' property, am exclusively contracting with licensed con- tractors t6 construct the project (Section 7044, Business and Professions Code: The Contractor's License law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that proof 0 their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for inspection purp Signature _......,33 q-71 Showers $ ELECTRICAL FEES Backflow Preventer TYPE OF CONSTRUCTION W ADD LJ ALTERATION LJ REPAIR 25% $ ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P-# DESCRIPTION OF WORK/USE OF BLDG. 50% $ Main Bui ldi Sewer Connection E E Cooking Unit TYPE OF PERMIT GRADING LJ FOUNDATION LLWRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL B Rear ❑ OTHER A Dryers ❑Gas ❑Electric C Right PROJECT DESCRIPTION SO. FT. OCCUPANCY K Fan CONSTRUCTION TYPE VALUATIONS S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. Remarks: .0 F- ` A -Z J / q '? Planning Notes: 0408 5/12/C'I Zone Accessory Building: Parking Req./Provided 3%p' l Z O N I N G R E Q M T S Bar Sink Showers $ ELECTRICAL FEES Backflow Preventer Service Sink 25% $ Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+ KW Backflow Irrigation Sewer Cap 50% $ Bathtubs Sewer Connection PLAN CHECK Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 00-1 HP ❑1 X - 8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09-15 HP ❑16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet, Device Boxes Pole Light Interceptors Water Heater /� Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash w Garbage Disposal Standing Sections P -Trap Laundry Trays Generator 00_5 KW 05.15 KW Trash Compactor Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting ❑ o -t 00,000 BTU ❑ 100,000 BTS Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant: Pink - Accounting: Goldenrod - Assessor Issue Fee Hood or Type 1 ❑ Canopy Type 11 ❑ Refrigeration System ❑o-100,000BTU 0100,000 System Repair/Alteration Fire Dampers Registers a rdw CO tis%E�fEQf Issue Fee $ 3 Reinspection Fee $15 Issue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL S PLAN CHECK 50% $ MECHANICAL S PLAN CHECK 25% $ SUMMARY $ 3 SMIP $ PERMIT ISSUANCE $ ENERGY P.C. S GRADING $ MICROFILM $ TOTALFEE $ CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit #_ Date Inspector 1'.. temporary E lectri ca (,Service or Pole n 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. J 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcemenyrj 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grsii.!• i 57. APPROVAL TO COVER-GUNITE !7. ,Footings f 58. Electrical Conduit-Undrgrnd. 8.. Foundation 59. Gas Pipe, O Undrgrnd., Test `9 . -Water Pipe-Undrgrnd. t 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line �i- 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 ,1-7.: Rough Wiring Sign 68. APPROVED FOR PLASTERING .1181 Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. .Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 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 Etas 0Oil ' 25. Roof Sheathing 74. Overhead Hydro 26. ,T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27.jFrameand Flashing 76. Dry Standpipe r) 1 28. Lathing & Siding 77. FIXED SYSTEM FINAL'" f . 29. Insulation 78. FIRE PREV. FINAL 30; Drywall Nailing HEALTH DEPT. REQUIREMENT , 31. Plaster Brown Coat 79. FINAL INSPECTION i 32: Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: - 34. Final Heating & Air Conditioning 35JFinal Gas Pipe -Test 36. Hood or Canopy , 37. Final Factory Fireplace � z 38. Final Plumbing 39. Water Service -Final i 40. Gas Service -Final 1 41. Solar Domestic -Final 42. Backflow Preventer - L 43. Backflow Irrigation 44. Landscape Irrigation System - 45. Sound Attenuation 46. Handicap Regulations I- 47. FINAL STRUCTURE & BUILDING 48.. Special Requirements Completed 49. Electric Release to Edison I ' 1 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date 1 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MEWQQ[(, CON STFRICTION PE ?I (y1E$� Project Address I(L�" I t�• Applicant's Mailing Address Owner's Na aPhone Z. ` z -` Address Arch/Eng. License No. Address Contractor's Nam W W(Fl P ne d Address (mailing) ON {EFF City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of th tr9gssiness and Professions Code, antl my license is in iWlt Lsmrxmdptfectx I '\ _ A.1 CPA/_ Date �i-N-SI Signature WORKERS' COMPENSATION thatIhave ce DELLA Hereby RS'affirm that I nave a certificate o con nt to el 'nsure or a certificate I of Workers' Compensation I'/nssu��rrrrance, a ertiffe coy thereof (Section Iv 3800, Lab. C.) 4 ©lI� (Ell 1✓FfH Policy No. —1� J Compo �Certifi¢/rCertifieat'copy is feletlbwil hr[hehcltY Build 1 n. Date �J p�'� Applicant EXEMPTION FROM WORKERS' COMPEN§ TI NDE A TION (This section need not be completed if the per . Is for one huntlretl ($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 at to become subject to t{te Workers' Compensation Laws Of California. Date Signature NOTICE: Ii, after making this declaration, you Should become subject to the Workers' Compensation provisions Of the Labor Code, you must forthwith comply with such provisions Or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter. Improve, demolish or repair any Structure, prior t0 Its Issuance, also requires the applicant for such permit il to fe a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License taw (Chapter 9 (commenting with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil renally of not more than five hundred dollars ($500). LJ 1, as owner of the property or my amploye'as with wages as their so10 compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improver li are not intended or offered for sale. It, however, the building Or Improvement is Sold within one year of com- pletion, the owner will have the burden Of proving he/she did not build or Im- prove for the purpose Of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con. 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 builds or Improves thereon, and who contracts ter Such projects with a con- tractor( license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation Insurance should be provided t0 me. ❑ I am exempt under Sectlon B. & P. C. for this reason Date Owner I hereby certify thatsyve read this 8 pplicatl0h and stale that the above information Is correct. I agree to comply with all city and county Ordinances and state laws relatin to b(Iiiding construction, And hereby authorize repre- sentatives of this city to me p ve above-mentioned Oro erty for inspection purposes. Signature Date hi Drivers' License or SS C M 33 (o 7 D I (. I I ! 11 --TYPE Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. 050+KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection $15 Issue Fee ! Clarifiers Solar Collectors OF CONSTRUCTION NEW ADD ALTERATION REPAIR Dishwasher Meter Cover 100 amps Dishwasher Solar Piping ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P,+Zone ` DESCRIPTION OF WORK/USE OF BLDG. ' - - Fan Motors ❑0-1HP❑IA-8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09.15 HP 016-15+ Floor Sinks Urinal S Main Building: ccessory Building: SUMMARY OF FEES $ $ $ $ $ $MICROFILM $ $ wZ Device Boxes Pole Light E System Repair/Alteration Outlets Range Z TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front Registers O ❑ TENANT ❑ ELECTRICAL PPLUMBING MECHANICAL 8 Rear - N �LAC� ❑ OTHERI Issue Fee '�� S y C Right N PROJECT DESCRIPTION SO. FT. OCCUPANCY K O CONSTRUCTION TYPE VALUATION § $ Left R ZONE GRADING CU. YDS. ACRES Ping. Ref. # Parking Req./Provided E Remarks: 3020 Planning Notes: Q M T Bar Sink Showers S 3 ELECTRICAL I FEES Backflow Preventer Service Sink Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. 050+KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection $15 Issue Fee Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors S 3 Dishwasher Meter Cover 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Date Date Det Fan Motors ❑0-1HP❑IA-8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09.15 HP 016-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet SUMMARY OF FEES $ $ $ $ $ $MICROFILM $ $ wZ Device Boxes Pole Light Interceptors Water Heater System Repair/Alteration Outlets Range Kitchen Sink Water Service Fire Dampers Switches Sign Lavatories Auto -Wash Registers Garbage Disposal Standing Sections P -Trap Laundry Trays Generator 00.5 KW 05-15 KW Trash Compactor Roof Drains Reinspection Fee I $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBG =* "V Heating System & Ducting C10-1 00,000 BTU 1:1100,000 Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee S 3 Reinspection Fee $15 Issue Fee S 3 IANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued 8y Date Date Det Hood or Type ❑ Canopy Type II ❑ Refrigeration System 00-100,000 BTU 0100,000BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ $ $MICROFILM $ $ wZ SMIP $ PERMIT ISSUANCE S ENERGY P.C. S GRADING S $ TOTAL FEE S - System Repair/Alteration Fire Dampers Registers Issue Fee '�� S y CONSTRUCTION AND^PLANNING APPROVALS Permit# Date Inspector POOL & SPA APPROVALS Permit Date Inspector 1.Jemporary Electrical Se I rvice 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 LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 71 Footings 58. Electrical Conduit-Undrgrnd. 8.. Foundation - 59. Gas Pipe, 0 Undrgrnd., Test 9.'Water Pipe-Uncirgr4 60. Backwash Lines, P-Trap, F1 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 Wirip Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush ' 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing &-Siding 77. FIXED SYSTEM FINAL / 29. Insulation r 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT t. 1 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 r, 37. Final Factory Fireplace r 38.-Final Plumbing- i - 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final`t l42. BackflowPreventer "43. Backflow Irrigation 44. Landscape Irrigation System - - 45. Sound Attenuation , "{. P/ 46. Handicap Regulations 47. FINALSTRUCTURE& BUILDING 48. Special Requirements Completed 49. Electric Release to Edison "! 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date W`s E-31-2— L Z _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate CITV OF COSTA MESA CONSTRUCTIONVILe, PERMIT ,1` Project Address �E' �• ��-� r� _L a=4'�A ;V eiaS gift Applicant's Mailing Addre s J FF ,y�� � � � Owner's NameL^g6s tied- ✓•'1 Y C1xEFL'nlSY�phone'97z,-k;11 Address 1% Feel r Arch/Eng. License No. Address _ Contractor's Nam; Mill e PhonfflKZO Address(mailing) ��- City License No. 1143 Il - LICENSED CONTRACTOR DECLARATICIN 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and £ff3. +-15-q L2 License C ss L V teen T Dale ( L SlgWtura VORK RS' CCMhNSATION_9RrCLZR,4TION hereby affirm that have a cer locate o consent to self -ins or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C c n .Policy No. — r1� O Company �LinJQ� ❑ Certified copy is hereby furnished. �l9 Certifi co y' iletl with the city Build Date 1- Applicant EXEMP ON FROM WORKERS' CO A ION DECLARATION (This section need not be completer) if the perIKI is for one hundretl1 00) or less). certify that In the performance Of the work for which this permit is issued shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. 11 however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im. prove for the purpose of sale). ❑ I, as owner of the property, am exclusively Contracting with licensed con. tractors to construct the project(Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con. tractor( license pursuant to the Contractor's License Law). 1 am aware that proof oft their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner _ 1 hereby certify that I have read this information is correct. I agree to comp and state laws relating to bpilding cop the Signature Drivers' Lic se or state that the above id county ordinances CMF 0965-46, rev. 10/84 White - Building; Canary . Applicant; Pink - Accounting; Goldenrod - Assessor I 9891 11/19/87 0 LJ Ll 0REPAIR 35.4n TYPE OF CONSTRUCTION NEW ADD ALTERATION ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P-# Zone DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessory Building: E Z TYPE OF PERMIT GRADING LJ FOUNDATION El STRUCTURAL T Front Q ❑ TENANT IF ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B N ❑ OTHER A Rear I C Right N PROJECT DESCRIPTION SQ. FT. OCCUPANCY K G CONSTRUCTION TYPE VALUATION$ S Left R ZONE GRADING CU.YDS. ACRES Ping. Ref. # Parking Req./Provided E D Remarks: Planning Notes: M T S PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Transformer ❑ 15-50 KW Backf low Irrigation Sewer Cap ❑ 50+KW Bathtubs Sewer Connection Cooking Unit Meter Xup to 100 amps Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps 1 Dishwasher Solar Piping Dryers ❑Gas []Electric Sub Panel If Drinking Fountains Solar Tank Fan Motors ❑0-1HP❑1'A-8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09.15 HP El 16.15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range o! Kitchen Sink Water Service v Switches Sign 1 Lavatories Auto -Wash Garbage Disposal Standing Sections P—Tiap Laundry Trays Generator 00.5 KW 05.15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Hood Type ❑ DEVELOPMENT SERVICES REQUIREMENTS: Boiler or Canopy Type I I LI Zoning Approved By Date Duct -Under Ground Building Approved By Data Duct - Structural Refrigeration System Application Issued By M s A Dat Duct - Ventilating 00-100,000 BTU ❑100,000 BTU SUMMARY OF F Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT Firepl/Fact. Bit. ICBG # Fire Dampers PLUMBING $ ISSUANCE $ Heating System & Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ 00-100,000 BTU ❑100,000BT - ELECTRICAL $ GRADING $ PLAN CHECK 50% $ O MICROFILM $ MECHANICAL $ TOTALFEE $ 3s VD Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0965-46, rev. 10/84 White - Building; Canary . Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date- Inspector . ' POOL & SPA 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.J 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd.: 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water'Pipe-Undrgrnd:/ 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line `& House Connection 62. Backwash 9C 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 6-�'7� 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil 23. Gas Pipe -Rough•& Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas 00il 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: -'• O A. 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 i 41. Solar Domestic -Final - 42. Backflow Preventer ' 43. Backflow Irrigation ' 44. Landscape Irrigation System - 45. Sound Attenuation - - 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING - 48. Special Requirements Completed - 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date .. - Applicant to fill in all spa ees exeept those within heavy border Tines dna sign all appropriate declarations. CONSTRUCTION PERMIT PERMIT NO._ , _ _ A I TRACT NO. I LOT NO. I UNIT NO. CITY Of COSTA MESA Project Address Z14;) E• k6* -t% t71L l C Ill Applican"s Mailiag Address FJ Owner's Name C T4 - A Li m61Z iO yP�ho a �7�Q Address �ry'f- ��^I.1L Y 77i (� C'" `;'7' AZ7 Arch/Eng. License No. Address 11� Contractor's Name U-W-Q(ral4-in cav%. iw.z Phone,me2-01,-6.1e —�r Address (mailing) 141 MaN,YgrAV pA<y Rd 47.7.1* h1Dk CR City License No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Cla}s License No n O6 �1 late I /i.l i� - Signaturev `zMW WORKERS' COMPENSATION DELLA fATION 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 3800, Lab. C.) �s ,1 Policy No. ��— ra21-1 bZSil Companyd-6 T=de. �-gs�aara NsrM 8 Certified copy is hereby furnished. Certified copy is filed with the city B.�a�z1'n-In9 Division. 1 Date�Ll�p_J_ Applicant r•2YA� AA ^' 1.1 •V% EX MOP ION F__RpM WORKERS' COMPTION DECLARATION (This Section need not be completed if the permit is for one hundred ($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. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil e natty of not more than five hundred dollars ($500). 1, as owner of the properly or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees• Provided that Such improvements are not intended or offered for Sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con. 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 builds or improves thereon, and who contracts for such projects with a con- tractors license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owne I hereby certify that I have re: Information is correct. 1 agree to and state laws relating to buildi sentatives of this city to ante Inspection purposes. Signature Drivers' License or SS ng cons r upon a the above ordinances rrize repre- operty for 1 b:ll 121l'i/ l TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR ELECTRICAL FEES Backflow Preventer Service Sink ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ❑50+KW /S" A.P. Zone / DESCRIPTION OF WORK/USE OF BLDG. Hood or T Type I ❑ Canopy Type II ❑ Cooking Unit Meter ❑up to 100 amps Clarifiers _ Solar Collectors Refrigeration System 00.100,0008TU 0100,Oo0BTU Dishwasher Meter ❑aver 100 amps Dishwasher Solar Piping SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ -3Dr OD GRADING $ PLAN CHECK 50% $ MICROFILM $ ii11 MECHANICAL $ TOTAL FEE $©'©y PLAN CHECK 25% $ S Main Building: Accessory Building: Fan Motors 00-1 HP ❑1'f.- 8 Floor Drains Swimming Pool w/Spa E Floor Sinks Urinal Z TYPE OF PERMIT 0 GRADING FOUNDATION C STRUCTURAL T Front O ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Lavatories Auto -Wash N ❑ OTHER A Rear - I C Right N PROJECT DESCRIPTION SO. FT. OCCUPANCY K G CONSTRUCTION TYPE VALUATION $ S Left R ZONE GRADING CU.YDS. ACRE$ Ping. Ref. # Parking Req./Provided E Remarks: D Planning Notes: M T S Bar Sink Showers $ 3 ELECTRICAL FEES Backflow Preventer Service Sink Reinspection Fee $15 Issue Fee S 0z) 6a— Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ❑50+KW /S" Backf low Irrigation Sewer Cap Bathtubs Sewer Connection Hood or T Type I ❑ Canopy Type II ❑ Cooking Unit Meter ❑up to 100 amps Clarifiers _ Solar Collectors Refrigeration System 00.100,0008TU 0100,Oo0BTU Dishwasher Meter ❑aver 100 amps Dishwasher Solar Piping SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ -3Dr OD GRADING $ PLAN CHECK 50% $ MICROFILM $ ii11 MECHANICAL $ TOTAL FEE $©'©y PLAN CHECK 25% $ Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 00-1 HP ❑1'f.- 8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar ❑9-15 HP El 16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal Standing Sections P—Trap Laundry Trays Generator ❑0.5 KW 115-15 KW Trash Compactor Roof Drains Reinspection Fee 1 $15 Boiler Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting ❑0-100,000 BTU ❑100,000BT Reinspection Fee 1 $15 • t 6 Wnite -Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 Reinspection Fee $15 Issue Fee S 0z) 6a— iANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: - Zoning Approved By Date Building Approved By Date Application Issued By - Dat Hood or T Type I ❑ Canopy Type II ❑ Refrigeration System 00.100,0008TU 0100,Oo0BTU SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ -3Dr OD GRADING $ PLAN CHECK 50% $ MICROFILM $ ii11 MECHANICAL $ TOTAL FEE $©'©y PLAN CHECK 25% $ System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector POOL & SPA , APPROVALS , Permit# Date Inspector 1: Temporary Electrical -Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. ' 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms ! 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation `, 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgmd. _ 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 APPROVALS Permit # 20. Rough Factory Fireplace 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 OOil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL , 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT ,. 31. Plaster Brown Coat 79.. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED - 33. Final Electric Notes: 34. Final Heating & Air Conditioning - !1 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 1 48. Special Requirements Completed '49. Electric Release to Edison 50. Gas Release to Southern California Gas On ' 51. CERTIFICATE OF OCCUPANCY t. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. -ITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO TRACT NO LOT NO N Project Address .21 � a. \6 til Q L, poSTA MLiJa . Applicant's Mailing Address Owner's Name Cr 2 MESA I:t;NVEV, &JWLV L7 46 Phone_722-'1311 Address 7"12 IWWeS 5T. CU'518 f.9ssA- CA gz62-1 Arch/Eng. License No. Address Contractor's Name- UAuG . Hur-1 6H hon Phon L Address (mailing) 1 �•/ Ina X142 5 12 01"1 ���'�7� City License No r "1 1 !_ LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force a effect. 3IL-2 , i Li cen a Clz s Uce � p,�j Date — Signature WORKERS' COMP NSATION DECLARA N hereby affirm that I have a certificate of c sent to self -insure or a certificate if Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) ^� LL r}-.� ry Policy Nq. 40- 31.1 b C�m Pany U17 • Yi ��s+` I KL� Certified copy is hereby furnished. CG C tiff tl cop Is filed with the city Bul[��Q lyi�i fin. 1 Dat�a1Y�J— Applicant �r • Lf4'/t-i ;H EU EXEMPTION FRO M�RKERS' COMPENSATION DECLARATION (Thissection need not be completed if the permit Is for one hundred ($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. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section '7031.5 by any applicant for a permit subjects the applicant to a Civil malty of not more than five hundred dollars ($500). LJ I, as owner of the property or my employees with wages as their sole cv m pensalion, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that Such improvements are not Intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code; The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law),I am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that 1 have read this aplication and state that the above information is Correct. I agree to comply with all City and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of th'c^cj�y to ente oo the above-mentioned propert j' for inspection pure se _q 1 _ Signature cv Date �7 Drivers' License or S CMF 0865-46, rev. 10/84 White - Building; „$S 30205 1 1 1 u IrND. TYPE OF CDNSTRUCTIorj LJ NEW LJ ADD LJ ALTERATION LJ REPAIR 5107 13/II/R7 r17 n ❑ CONVERSION DEMOLISH ❑ OTHER A.P. # Zone DESCRIPTION OF WORK/USE OF BLDG. -1) e -V O' Cub SQu1eY S Main Building: Accessory Building: TYPE OF PERMIT ❑ GRADING FOUNDATION 2 STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ® PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CO N STRUCTION TYPE VALUATION$ 11000,, S Left ZONE GRADING CU. YDS. ACRES Ping. Ref. # Parking Req./Provided Remarks:. t Planning Notes: Preventer Irrigation Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee 1 $15 Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting C3 0-100,000 BTU 0100,000 BT Reinspection Fee 1 $15 licant; Pink -Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Issue Fee Hood or Type 1 ❑ Canopy Type If ❑ Refrigeration System ❑0-100,00013TU 01100,0006T System Repair/Alteration Fire Dampers Registers Issue Fee FEES ELECTRICAL FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter ❑over 100 amps Dryers ❑Gas [!]Electric Sub Panel Fan Motors ❑0-1 HP ❑l %- 8 F.A.U. Inc. Solar 719.15 HP 016.15+ Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign " Garbage Disposal' Standing Sections Generator 00.5 KW 05.15 KW Trash Compactor Z O N I N G R E Q M T S $ 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By _.1Z Application Issued By Date Data Dat BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ 1FV-17. SMTP $ PERMIT $ _S• C) ISSUANCE $ ENERGY P.C. $ GRADING S MICROFILM $ TOTALFEE $ $ $ $ S $ $ (3 $ 3 TL CONSTRUCTION AND PLANNING APPROVALS Permit'.# Date Inspector POOL & SPA APPROVALS Permit# Date Inspector 1,. 'Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 1 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrprnd. - 55. Electrical Bonding 5. Steel Reinforcement i 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd.' 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap' 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 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 APPROVALS Permit # _ 20. Rough Factory Fireplace 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 O Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro I 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 I 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 r 35. Final Gas Pipe -Test 1 36. Hood or Canopy 37. Final Factory Fireplace , 38. Final Plumbing 39. Water Service -Final I I ., 40. Gas Service -Final 41 . Solar Domestic -Final , 42. Backflow Preventer 1 43. Backflow Irrigation ,:44. Landscape Irrigation System X45. Sound Attenuation 46. Handicap Regulations - 47. FINAL STRUCTURE & BUILDING •- 4P. Special Requirements Completed • • i 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date - t 0 l) 3& � C3°`� I �S� � V5 0 T GU rn1 l . ,w SO.1. C� 'VUT I fl G g�oJ I C-4�Ey"IN (i MA)(' Y� 4ea s clr o� 2-`l Tom I c Bt,c ears 1O N Ar — A TIWAJ L -,I City of Costa N-<, L.,:'-, (�ll it;E.E PLANS MUS. EE C.1 ;sd <S K,AKE NO Cv-ncsc H'ITYOL': C:R •:}>,:a.: OF DEPT. THE `( t r1 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. - CITY OF COSTAr'L�MESA CONSTRUCTION PERMIT�J` PrOI'Pfdd145$ L �� �'�_ -.�.b "'. I I... PEpMIjT NO. Iµ1 /Its w�uM B I O 1 1 LOT NO. .� UNIT NO. TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR El CONVERSION ❑DEMOLISH ❑OTHE�� DES IPTION OF WORK/USE OF BLDG. eva� �r �b 1 1vG+• Applicant's Mailing Address �= L L��p �-•� ��� Owner's Name —T�^� R_'^ � � � � Phone L]�.l S1s�� -7• _ Address r3a?( 426.2 L-e1T4�116 _ A.P.q,p,# y2 �O`— Zone ���, S Main Buil Ace or Buildin i Y 9: c L i -f rh-/ Arch/Eng. Licend No. Address TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL Cl PLUMBING ❑ MECHANICAL ❑OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION$ ��_ 20NE GRADING CU. VDS. ACRES�� T �D Front O A /s )) Rear .CITY 0 P O % / C N I Contractor's Name 1 V 1!5 rG_�Dv.G.e,, -_-_Phone 3S9'S OA� { Address (mailing) - �-K City License No. �0& O LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provislogs of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in to I force and elifectn License Cl SS a Lice se No C Right '--r N $ Left �. G - Ping. Ref. # Parking Req. /Pro ided �- E O Remarks: Planning Notes: `� C / M 7y /,.,0 V sv - h � T S. PLUMBING FEES G hate 7' Signat/- Bar Sink Showers ELECTRICAL FEES KE S' CO MPENSATIOIJ-D�c LA R ATI ON hereby affirm that I have a certificate of consent to self -insure or a certificate Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50� KW if Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab, C.)^ _ 0�.�-5I--rn �� Policy No. L/1K1./,{_O Company 'TE.I`T'� t Certified copy is hereby turn ishetl. Certltie co y s II with the city Divisiorsz Backflow Irrigation Cap Sewer Ca Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps .1ding ate �• APPlican[�q -�� lC..-, ' rte- �•ry EXEMPTION FROM WORKERS' COMPENSATION DECL'AR'/�T ION Clarifiers Solar Collectors Dishwasher - Meter ❑Over 100 amps , (This section need not be completed if the permit is for one hundred ($100)0, 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. - Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel 10rinking Fountains Solar Tank Fan Motors 00.1 HP Ell 16 - B Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 119-15 HP 016-15+ Date Signature NOTICE: If, after making this declaration. you Should become subject t0 th0 Floor Sinks Urinal Fixtures Microwave Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Gas Service Outlets Water Closet Device Boxes Pole Light CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance Interceptors Water Heater Outlets Range of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address - OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or Kitchen Sink Water Service Switches Sign Lavatories Garbage Disposal Standing Sections P -Trap Generator 00-5 KW ❑ 5-15 KW Trash Compactor 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section Roof Drains 7031.5 by any applicant for a permit subjects. the applicant t0 a civil ee natty of not more than five hundred dollars ($500). LJ 1, 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 (Section 7044, Business and Professional Code: The Contractor's 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 tier own employees, provided that such improvements are not intended Or offered for Sale. If, however, the building or improvement is Sold within one year o1 com- potion, the owner will have the burden of proving he/she did not build or im- Fve for the purpose Of sale). I, as owner of the property, am exclusively contracting with licensed con- Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQ%l1llI�Ry�EMENTS Zoning Approved By Building Approved By ' Application Issued By /ll�ll l�� �� Date ' Date 2�ipDate �v Boiler Hood Or Type I Eld� Canopy Type I ❑ Duct - Under Ground Duct - Structural Refrigeration System 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 builds or improves thereon, and who contracts for such Projects with a con- tractor(s1 license pursuant to the Contractor's License Law). I am aware that Proof off their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Sectlon B. & P. C. for this reason ❑0-100,000 BTU 0100,0130BTU Duct - Ventilating BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ SUMMARY OF FEES .3Q • s-2 SMTP $ 2S.c7. - PERMIT ISSUANCE $ ENERGY P.C. $ Exhaust System ❑ Multiple 13 System Repair/Alteration Firepl/Fact. Sit. ICOO # Date Owner Heating System St Ducting 1 hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county Ordinances and state laws relating t0 building construction, and hereby authorize repre- Sentatives of Ihii city to ter yp the above-mentioned pro rty for inspection wcp�es. I// %e / / Signature �C Vb�� Date--(_Z-� Drivers' LVense o� r 55 � P 100,000 BTU 0100,00087 ELECTRICAL $ PLAN CHECK 5096 $ MECHANICAL $ PLAN CHECK 25% $ GRADING $ MICROFILM $ TOTAL FEE $ U Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 4/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor OAND PLANNING PPROVALS Permit # te Daspector InNSTRUCTION POOL & SPA 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 Reiriforcement 'J 713/-1/ 56. Rough Plumbing & Pressure Test 6- Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7 -Footings g QZ 58. Electrical Conduit-Undrgrnd. 8. 'Foundation J, 59. Gas Pipe, ❑ Undrgrnd., Test 9"Water Pipe-Undrgrnd, 60. Backwash Lines, P -Trap, O Undrgrnd. 10`;/structural Floor System 61. APPROVAL TO DECK 11.. Property Sewer Line &LHouse 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 APPROVALS Permit# 2. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro ti 22. Ducts, Ventilating 71. Product Piping 0Gas ❑Oil 23. 'Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro - 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 029. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final r 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing, 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer , 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed r 49. Electric Release to Edison' 50. Gas Release to Southern California Gas Co _ 51. CERTIFICATE.OF OCCUPANCY No. Date PrA PROJECT ADDRESS: 1116 1 6TH PL OWNER'S NAME: LEADER INVESTMENT ADDRESS: SAME UNIT: H AflCHIENGINEER: 644-4757 REG.NO.: ADDRESS: UNIT: PERMITTEE: CASSEL ELECTRIC SERVICE (714)748-0987 ADDRESS: 3614 W PSRK BALBOA ORANGE CA 92668 LICENSED CONTRACTOR 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 tic se is in full force and effect. CITYDate .:054304 sraTe}Ic 1p8 CLASS Dale'. �RKERS' COMPENSATION DECLARATION: I hereb fhat I have a certificate of consent to self -insure or a cerificale of Workers' mpensation Insurance, or a cerlfied copy there action 3800, Lab. C). POLICY NO.: EXP. DATE: COMPANY: ❑ Certified copy is hereby furnished. ❑ periled copy is filed with the city Building Division. Date: Applicant. EXEMPTION FROM WORKERS' COMPENSATION DEC ATION: (This section need not be completed if the permit is for one hundred ($100) or less), I cenity that in the performance of the work for Ich this permit is issued I shall not employ any person in any manner so as to become subject to the Workers' Compensation Law f Callforma. Date'. 9 1. ZG this you shr� NOTICE: If. after making this declaration, you shoal oma subject to Compensation provisions of the Labor Code. you must forthwith comply with such prov' ns or this permit slffhhhhaall be deemed revoked. 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 (Section 3097. Civ. Q. LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the ContractorsState License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of 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/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (S500). I, as owner of the property or my on loyees with wages as their sole compensation, will do the work, and the ,J structure is not intended or offered for sale(Section 7044, Business and Professional Cade'. The Contractors' State 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 employees, provided that such improvements are not intended or offered for sale. It, however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). 1.a, owner of the properly. am exclusive)p contracting with licensed contractors to construct the project (Section 7044, Business Eland Professions Code' The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who contracts lot such projects with a contractors) license pursuant to the Contractors' State License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. B P. C. for this reason: Date: Owner: I do hereby terrify that I am aware of and understand the requirements of California Health and Safety Code Sections 2551),5, 25533, and 25534 and that I or any future building occupant well not (circle one) need to comply with said slate codes and the requirements for a permit for construction or modification from the Air Oualny Management District. Residential construction applications are exempt from these provisions. Dale: Applicant: I hereby certify that I have reaa mis applicatio and state that the above information is correct. l agree to comply with all city and mdnces and stale laws relating rebuilding careened and hereby authorize representatives of this city to enter upon the above -me property for inspection purposes. Date: / — 2 6 '� 9� Signature. Driver's License or Social Security n: 1641.46 White—Buddmg: Green—Godo Enrorcement Canary—Applicant: Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA - BUILDING PERMIT PERM NO: E 0541.2 PERMIT NO: E 054126 PLAN CHECK NO: N GOVT; N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE; OTH JOB DESCRIPTION INSTALL OUTLETS FOR TV CABLE SYSYTEM SQ FT: CLAIM VALUE: CALC-VALUE:; GROUP OCC: R-1 / COMMENTS: NO OTHER WORK PERMITTED Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING RE • PROV: PARCEL: 00000000 ZNE: REF NO: PLANNING N TES> #####�*###*############�ETt####->E###�r;�Ex###x#####�##�#�**kEFE###r##*#�L#•#x#**##v>Fa###I� D E V E L O P M E N T S.E,'R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY n DATE; APPLICATION ISSUED BY: %a #iF DATE: Zl LEGALIZATION:N F E;E' S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING $LECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 12.35 50% SMIP/NON-RES PLAN ISSUE FEE 15.00 BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS ---- > 12,35 15,00 0.00 27,35 27,35 ,00 REVENUE DIVISION TOTALS—> COLLECTED: 27,35 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN -CHECK 2'7. 35 ITr I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST ELE 3 RECEPT/OUTLET ADDITIONAL EA, ,45 1.35 ELE 1 MISC CONDUIT NOT LISTED REQ PERMIT 11.00 11.00 END OF FEES ITr CONSTRUCTION AND PLANN,.,, APPROVALS Permit # Date Inspector JOL & SPA 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 z. 6. Electrical UFER Grod. 57. APPROVAL TO COVER-GUNITE r 7. Footings - 58. Eiectrical 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 'APPROVALS. _Permit 4L- 20. Rough Factory Fireplace c - 21. Ducts, in Structure 21. _ 70. Underground Hydro 22. Ducts, Ventilating 71. Product'Piping OGas 00il 23. Gas Pipe -Rough & Test _ 72. Underground Flush 24. Roof Framing - - -•73.'Undergrnd.Storage -Tank OGas 00il 25. Roof Sheathing 74, Overhead Hydro 26.'T -Bar Ceiling (Structural) &-Monocoat r 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 8n FOOD CERTIFICATE ISSUED 33. Final Electric _., ! l lll"'zzzTTT I 'as: ' -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. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co _ 51. CERTIFICATE OF OCCUPANCY No. Date City of Costa Mesa Development Services Department ®(� 9 Building Safety Division CERTIFICATE OF OCCUPANCY No. V �L P. O. Box 1200 Costa Mesa, California The Building located at 216 Fast 16th Place, Unit H has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Grou ccupancy. Use of Building Conr3aniniUm Legal D (See reverse side for Metes and Bounds) Building Permit No B 30200 Electrical Permit No. E 31219 Plumbing Permit No.P 31166 Mechanical Permit No. M33697, M33478 Number of apartments and/or guest rooms ISSUED TO: Costa Mesa Leader Enterprise, Inc. 172 Flower Street Costa Mesa, CA 92627 Building Official William T. Howard by Date March 21, 1989 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CMF 1015-46 rev. 1/63 White -Owner; Canary - Numerical File; Pink - Bldg. Permit File Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTAr/Mj/E��SA�s CgNSTRU ION��71P,^EsR,^.M�, IT__ PERMIT NO. TRACT NO. LOT NO. UNIT NO. Project Address Gel W G' l Y aztt Q Z l i��032 IAF b� Applicant's Mailing Address TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR Owner's Namew5�1 tvgA LtA96Z ck1YEE`'xyiES Phone 1.2z-8-411 ❑ Address 1 � 3- S'i, C.ONA ME -A . OF, ` "sbz 7 Arch/Eng. License No. Address Contractor's Nam �,A% O!U Pho I o Address (mailing) �t do -wimp it S�s'i to uD�eil�llri City License No. 04 1L4 2— LICENSED LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. -Cense Class License No. late Signature WORKERS' COMPENSATION DECLARATION 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 3800, Lab. C.) / 2 Policy No. dD-D 31'l661 ICompanyl� S• 017W ,il$ Certified copy Is hereby furnished. Certified cop 1s filed with the city Builtl_ipg Div"cion, -H E-' 1 Date-- Applicant 'S � sr� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($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. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I'am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair ny 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 the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). L� I, as owner of the properly or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im. prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- traclor(sl license pursuant to the Contractor's License Law). I am aware that proof off their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have rea information Is correct. 1 agree to and slate laws relating to buildir sentatives of this ci to en q inspection purpose Signature Drivers' License or SS Y this application and state that the above comply with all city and county ordinances g construction, and hereby authorize repre- p Con the above-mentioned property for IJ _. 21 1 — � 1 5095 9/11/87 385.82 Ti. ❑ CONVERSION ❑ DEMOLISH OTHER A,P.4A Q- iZ1r5 — 1; Z, I_1+ I Zone '-,> DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessory Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ' -t'D ��. �j,C,c,• ❑ TENANT ❑ ELECTRICAL ❑PLUMBING ❑ MECHANICAL B Rear ❑ OTHERA PROJECT DESCRIPTION SG. FT. OCCU PANCv C Right CON5T RUCTION TYPE VALUATION$ b �`00� S Left ZONE GRADINGCU.YDS. ACRES Ping. Ref. yW Parking Req./Provided Remarks: Planning Notes: Sink Preventer Irrigation Drinking Fountains Floor Drains Floor Sinks Gas Service Oi Interceptors Kitchen Sink Lavatories P—Trap Roof Drains - - Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting 130.100,000 BTU 11100,000 Reinspection Fee 1 $15 CMF 0865-46, rev. 10/8 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water'Service -Auto-Wash Issue Fee Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System 00-100,00013% ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee I N G R E D M T S FEES ELECTRICAL FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+KIN Cooking Unit Meter ❑up to 100amps Dishwasher Meter ❑over 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors 00,1 HP Ell %-8 F.A.U. Inc. Solar ❑9-15 HP El 16-15+ Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal Standing Sections Generator ❑0-5 KW ❑5-15 KW Trash Compactor $ 3 Reinspection Fee S15 Issue Fee $ 3 FEES DEVELOPMENTSERVICES.RE�,6: Zoning Approved By V� ) Date "V Building Approved By Date Application Issued By Date BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ SUMMARY OF FEES 32 r, '0 d SMIP $ 5 Z' S'3 ' 3O PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ p TOTAL FEE $ $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement '"4 3. Electrical Conduit Utility-Undrgrnd. 54. Forms '• 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. /r j; p 57. APPROVAL TO COVER-GUNITE 7. Footings !I 6"LL- 58. Electrical Conduit-Undrgrnd. 8. Foundation '_. 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. r,• 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 APPROVALS Permit# 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas 0Oil 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 6 77. FIXED SYSTEM FINAL ' 29. Insulation ?�Ago 78. FIRE PREV. FINAL 30. Drywall Nailing 9 & HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat Z d0 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace ' 38. Final Plumbing 39. Water Service-Final , 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation , 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING�- 48. Special Requirements Completed 8 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ' BN FORM 116 BIA FORM 1486 INSULATION CERTIFICATION This is to certify that, in conformance with the current energy regulations (California Adminis- trative Code, Title 25, State of (alifomia') and approved plans, insulation has been installed in the building located at: COSTA MESA 216 StrN( No. (If Ann.N4 16TH PLACE str ORANGE eau.b A91 -1 - Lot We," DESCRIPTION OF INSTALLATION ROOFS Type of Material Manufacturer Thickness—It Value`•_ OWENS COMINGS FIBERGLAS EXTERIOR WALLS FIBERGLAS BATTS 31 I I Type of Material Manufacturer Thickness R Va:ae•• (Or Tndd 1404 CEILINGS FIBERGLAS BATTS OWENS COMINGS FIBERGLAS BATT$: 30 Type of Material Manufacturer R Value•' Thickness --R (or Tnd. Nawar Sq. Ft Covered BLOWN: Type of Material Manufacturer Thickness_ No. Bags_ (or T.Wd N.a) WL/Bag Sq. Ft Covered R Value•`_ FLOORS Type of Material Manufacturer TWcknesrR Value••_ (or TnN Ndwdl SLAB ON GRADE , Type of Mate bl Manufacturer_"-'–' Thickness "–R Value**_ Width of. Insulation (Or TnN Nw.4 Inches FOUNDATION WALLS (if required) Type of Material Manufacturer –Thickness—It Value••_ (or Tadd 114a4 REMARKS (If desired) General Contractor (Builders WEI–CHUAN CONST. & DEV 'License Number By Title Date Sub -Contract" Qnsulation Appricator) Accent Insulation Company License forth r 274283 0...h4«. Mow 0 (bJ I,, _ % (SYY "SAYE" N n N Gia I Adfiv ud 1-C,111". Ad.Y.~;.a c.d.. &. r N.A dw sm d d., dd., ••C.�..Ihw- . u.« a..:l,iM MN r4 YM.F« M. hw Y.NIW Y swhrw.....r:.h Ny .w.1M...rNdn "PH, MWNNiH.M h.h.nWW.. .. Tkk 1= .dssNWNt« ...aPM.Nrw. .d .l M .dNM.rlu.I.Md« .I.dr d-Nlw:h•jr (-•1 YNM h rM .w...n N A. nNN.w M. w I su r hNld'iw 111 N .•...•bM Y.NNh...h.11 M hd.d..p MIM k MNdWM YdM•) Date 2-24-89 O(alrr rn0 S.a. rrOS N Ih. H..lrh W SN.h Gd. N .M sl.h N •M. e.NNt... N ....e.dq M .Iwll.r ...Nria.N.. Ah • ...Ir d..• dYwrM h.hl. P.W. ....Iw.M hw... Mr N Nh.r ...td..Nd Y.Ildi.. d..wrwwN «h.. Ih. .F..hw N 1...1 wdl.rw. Ih. NNw.w «war YwdN'0. .h.d.eH MYNI.hM ew...w Y N.Id d1..M.." MAR 2. 1989 Fona 116 —C BUILDING NEWS. INC.. 3055 Gvedwd Ave, Los Angeles, Calif. 90031--(2131870-9871 Form 1186-0 BUILDING INDUSTRY ASSOCIATIGN OF CALIFORNIA. INC. 1571 Beverly Blvd, Los Angeles. Calif. 90026–,M3) 625.5771 .1w Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY of COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT O. 9898 11/19/87 35o40 TL Project Address 216 F_- 11-44, Cdei-A MEta �'1 'Lf 12, " L Applicant's Mailing Address1 YL I TYPE OF CONSTRUCTION NEW ADO ALTERATION REPAIR Owner's Name&it 4'�r'�'�.t_ t G.Me-r Cn.Pi' %-585 Phone 7224311 ❑ CONVERSION ❑ DEMOLISH DO THER A.P. # Zone P DESCRIPTION OF WORK/USE OF BLDG. Address La tdotarl- IT, C,4!jrP:j I S Main Building: Accessory Building: Z Arch/Eng.—License No. TYPE OF PERMIT GRADING FOUNDATION 0 STRUCTURAL T Front 0 Address I ,�, ,�..,,���� ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL BA Rear. N Contractor's Nam 1 L £� Phone LrT)' (_� ❑OTHER C Right N Address (mailing) 1 % T C- QA9/7adv PROJECT DESCRIPTION SO. FT. OCCUPANCY K G CONSTRUCTIONTYPE VALUATION$ S Left R City License No. ZONE - GRADING CU.YOS. ACRES E LICENSED CONTRACTOR DECLARAT ON Ping. Ref. # Parking Req./Provided Q I hereby affirm that 1 am licensed under Provisions of Charter 9 (commencing Remarks: - �s _ Planning Notes: M with Section 7000) of Division 3 Of the Business and Professions Code, and T my license is In full rce and of ct. Li cense Cls T/O C �ZD /tel trerS4¢ No ��S�� Date �1(/I'�f a- Signature (/�P PLUMBING FEES WORKERS' COMPENSATION D_FJa R 7 N hat I hereby affirm tI have a certiliGdte of tcAsent to self -Insure a certificate Bar Sink Showers ELECTRICAL FEES of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink 3800, Lab. C. I Automatic Washer Transformer ❑ 1550 KW Policy No.- D� Company ��• '�N� Backflow Irrigation Sewer Ca ❑ 50+KW 9 p Construction Pole Sub. Certified copy is hereby furnishetl. Certifl cc Is tiled with the city Bull tli ivi r Bathtubs Sewer Connection Cooking Unit Meter up to 100 amps Date Applicant _ E%EMP IONFRO WORKERS'COMPENS ONO CLARATIO Clarifiers Solar Collectors Dishwasher Meter El 100 amps (This section need not be completed if he per It Is for one hundred ( 100) or less). / Dishwasher - Solar Piping ` Dryers ❑Gas ❑Electric Sub Panel certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan MotorsE10-1 HP OVA - B Workers' Compensation Laws of California. Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09.15 HP 1:116-15+NOTICE: If, after making this declaration, you should become subject to the Vol Workers' Compensation provisions Of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes PalLight I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Range Lender's Name Lender's Address Kitchen Sink Water Service Switches Sign OWNER BUILDER DECLARATION {� 1 hereby affirm that I am exempt from the- Contractor's License Law for the LavatoriCs Auto -Wash 1 Garbage Disposal Standing Sections following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair P—Trap Laundry Trays Generator ❑05 KW ❑5-15 KW Trash Compactor any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of ROOf Drains the Contractor's License Law (Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Professions Cotle) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole ReinspeotiOn Fee $15 Issue Fee $ 3 compensation, will do the work, and the structure Is not intended or offered Reinspection Fee F s15 Issue Fee S 3 for sale (Section 7044, Business and Professional Code; The Contractor's MECHANICAL FEES License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not Intended Or offered for Boiler Hood or Type 1 ❑ sale. If, however, the building or improvement Is sold within one year o1 com- Canopy Type II C1Zoning Approved By Date pletion, the owner will have the burden of proving he/she did not build or im- Duct - Under Ground Building Approved By Date prove for the purpose of sale). /mss ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct -Structural Refrigeration System Application Issued By - - - 'r-= Date_ A�� tractors to construct the project (Section 7044, Business and Professions Code: !� ❑ The Contractor's License Law does not apply to an owner of property who Duct - Ventilating 0.100,000 BTU ❑100,000 BTU SUMMARY OF FEES Cl builds or Improves thereon, and who contracts for such projects with a con- tractor(s1 license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple 11 System Repair/Alteration BUILDING PERMIT $ SMIP $ proof off their Worker's Compensation Insurance should be provided to me. PLAN CHECK S PERMIT ❑ I am exempt under Section B. & P. C. for this reason Firepl/Fact. Bit. ICBO # Fire Dampers PLUMBING $ ISSUANCE S Date Owner Heating System & Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above ❑0100,000 BTU ❑100,000 BT ELECTRICAL $ GRADING $ information is correct. I agree to comply with all city and county ordinances and state laws relating t b Iding cc struction, and hereby authorize repre- MICROFILM $ SentativeS of this 'ty o mer n the above-mentioned proper y for PLAN CHECK 50% $ - inspection purposes (s MECHANICAL $ TOTAL FEE $ Signature Date Drivers' Lice a or S 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 APPROVALS Permit # r Date .� Inspector .+ v .. .. POOL&: - APPROVALS Permit # Date Inspector 1: Temporary Electrical Service or Pole i 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Uridrgrnd. 55. Electrical Bonding 5. Steel Reinforcement, 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd.�- 57. APPROVAL TO COVER-GUNITE 7. Footings, 58. Electrical Conduit-Undrgrnd. 8. Foundation ; : 59. Gas Pipe,.0 Undrgrnd., Test 9. Water Pipe-Undrgrnd1 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%3 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 APPROVALS Permit # "- 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil 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: ' 34. Final Heating & Air Conditioning r 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 51. CERTIFICATE OF OCCUPANCY No. Date Y' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. g�pg ]/gy 47038 TL - CITY OF COSTA MESA CONSTRUCTION PERMIT �y Project Address �k r7 I k%i'i.t 97l_ #1 1 PER IT NO. ' TRACT NO. LOT NO. UNIT N TYPE OF CONSTRUCTION NEW 11 ADD 11 ALTERATION LJ REPAIR E] CONVERSION 1:1 DEMOLISH F-1OTHERA.P. DESCRIPTION OF WORK/USE OF BLDG. -Applicant's Mailing Address /•C_. t� N nrf4Phone � r�(� )I Owner's Namel v17o-4 / 1 �/h Address�r�. L' 1p ��bo�+%'>`- q(y✓L.a I✓A' R� # - Zone S Main Building: Accessory Building: Arch/Eng.j/�sI �License No. 6+/� Address W�,�� !`A ta&,, TYPE OF PERMIT GRADING &IFOUNDATION ❑ STRUCTURAL ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADINGCU.VDS. ACRES T Front O B A Rear N I .Jf Contractor's Name Phone CityAddLicensess e in . o4�-;, aL. �'i. IG 1: ,l1 � City License No. (J`f-Z �/ ii I LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) Of Division 3 of the Business and Professions Code, and my license is in full force and effect. C Right G I K S Left R Ping. Ref. # Parking Req./Provided E Remarks: O-�� Planning Notes: M " T Licenseflass SignaturerLlcpp�nse No. J PLUMBING FEESDate PENSATION DECLARATIONWOR�'�7 I hereby affirm that I have a certificate of consent to self -insure ora certificate Bar Sink Showers 0'• ELECTRICAL FEES I of Workers' Compensation Insurance, Or a certified copy thereof (Section 3800, Lab. C.),,, ,q /., POh cy No. ate^'— ✓3� �%�� I Company L35 -i rq 8 Certified copy is hereby furnished. (� Cert if ie copy is filed with the city Building Division. _y/ Date I'I r` Applicant— EXE EXEM PT IM PT I ONRKERS' COMPENSATION DECLVARATION (This section need not be completed lithe permit is for One hundred ($100) or less). 1 certify that in the performance of the work for which this permit is issued Backflow Preventer Service Sink Automatic Washer Transformer ❑ 15-50 KW ❑ 50+ KW COn$trn CtlOn POIe Sub. Backflow Irrigation Sewer Ca p Z Bathtubs Sewer Connection - a, t Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter Dover 100amps Dishwasher Solar Piping l Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors LIG-1 HP ❑i'/=- 8 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09-15 HP 1116-15+ Date Signature NOTICE: If, after making this declaration, you should become subject to the Floor Sinks Urinal Fixtures ures Microwave Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY ''- hereby affirm that there is a construction lending agency for the performance Gas Service LL Outlets Water Closet ..J Device Boxes Pole Light of the work for which this permit is issued (Section 3093 Civ. C.) tinder's Name Interceptors Water Heater d+ -- Outlets flange Lender's Address OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code! Any city or Kitchen Sink Water Service -J Switches Sign 3 Lavatories ' Auto -Wash O J Garbage,Disposal Standing Sections P -Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Roof Drains ' Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil malty of not more than five hundred dollars ($500). LJ I, as owner of the property or my employees with wages as their sole Ccwill do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building Or improvement is sold within one year of com- pletion. the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or Improves thereon, and who contracts for such projects with a con- on- Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date ' I Building Approved By Date} C -Cs.' 1 1187 I O / Application Issued By Date Boiler Hood Or Type 1 ❑ Canopy Type 11 ❑ Duct - Under Ground Duct - Structural Refrigeration System ❑0.100,000 BTU ❑100,000 BTU Duct - Ventilating SUMMARY OF FEES Exhaust System ❑ Multiple ❑ _ System Repair/Alteration tractor( tractor(SI license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. s P. C. for this reason BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ Firepl/Fact. Bit. ICBO # Fire Dampers Date Owner 1 hereby certify that I have read this application and state that the above information Is correct. I agree to comply with all city and county Ordinances Heating System & Ducting [:10-100,000 BTU 0100,00067 Registers PLAN CHECK 25% $ 3 10 ENERGY P.C. $ ELECTRICAL $ GRADING $ and state laws relating to building construction, and hereby authorize re,- sentatives of this 'city to enter upon the above-mentioned property for inspection purposes. Signature - 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 APPROVALS Permit* Date Inspector POOL & J, APPROVALS Permit # Date Inspector ..1: Temporary Electrical Service or Pole r- 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. �+ 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Und`rgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings" 58. Electrical Conduit-Undrgrnd. B. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. �g// , ' 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 S.Z%/O$ 4Fi,9 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 APPROVALS Permit # _ 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank [:]Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 'j 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical " 27. Frame and Flashing .- -- - 11 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: i 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test l; 36. Hood or Canopy 37. Final Factory Fireplace 38�Final Plumbing r. 39: Water Service-Final ' 40. Gas Service-Final •� •; --' i=41. Solar Domestic-Final 42.'Backflow Preventer i 43. Backflow Irrigation 44., Landscape Irrigation System ' - 45: Sound Attenuation '. 46.-Handicap Regulations 4T..F I NAL STRUCTU RE & BUI LD ING 48. Special Requirements Completed • • - - 49. Electric Release to Edison L 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date " �1 - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. �1 •'d - �• - CITY OF COSTA MESA CONSTRUCTION PERMIT PE ITNjy� TRACT NO. LOT NO. UNIT 0. Proieci Address `ll b 1%'f'j1�L CVA MZSA Applicant's Mailing Address /'' Owners Name SCS M cGRDCC F,T ('Sa hone »-� 8 I I Address 17 �' �Q� �-:?• hu`e M�S.e G.4 Lf,�(o>11 S �� RIIAV ,� TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER eh nn DESCRIPTION OF WORK/USE OF BLDG. C A.P. *, / Zone S Main Building: _ Qccesso(Y Building: Arch/Eng. License No. Address TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL f❑ TENANT ❑ ELECTRICAL ElPLUMBING MECHANICAL V� OTHER �IRZ ��/lt�� PROJECT DESCRIPTION SO. FT. OCCUPANCY CONSTRUCTION TYPE VALUATIONS— ZONE GRADING CU.YOS. ACRES T L„1 Vf lrV. In 1„-- Front Z 0 B Rear N �1 ..11/n� YY -�/ HUM Contractor's Nam, nLl/'NQ UCI y �i3l sb9��! —rOI1 L� Phone / y —.y Address(mailing) Lr+ /�'t DA�'iLw'R��'pj�$S 1� ��+ Mp�,pC�I City License No. 04'��`f”-y I l7 LICENSED CONTRACTOR DECLA ION 1 hereby affirm that I am Ilcensetl der ovis10ns of Charter 9 (Commencing with Section 700 01of Division 3 ! the siness tl fessfons Code, and my license is in full force an effect A C Right IN $ Left G R Ping. Ref. # Parking Req./Provided E 0 Remarks: D 2 Q a"'' Planning Notes: M T Licens Class 3D Licen e o Date — — Signature PLUMBING FEES 1 WORKERS' COM NSATION DECL RAT ON 1 hereby affirm that I have a certificdt of c sent to elf -i sure or a Certificate Bar Sink Showers ELECTRICAL, FEES of Workers' Compensation Insurance or a certifie cc y thereof (Seth n 3800, Lab. C)) p Pollc Na. R-fi�G317CpO �I 5, f�—I l Y Comp ny Certified copy is hereby Backflow Preventer Service Sink Automatic Washer Transformer ❑ 15-50 KW ❑50+KW Construction Pole Sub. Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps with thehetl. C¢rt lfiltl� op tiletl with the city Builoi Is n Date Applicant EXEMPTION FROM WORKERS' COMPENS N D ARATION (This section need not be completed if the permit Is for n huntlratl (5100) or less). Clarifiers $tiler Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel 1 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. Drinking Fountains Solar Tank Fan Motors 00.1 HP 1:11 Yf - 8 Floor Drains Swimming Pool w/Spa F.A.U. InC.Solar, 09-15 HP 1:116-15+ Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Cotle, you must forthwith Comply with such provisions or this permit Shall be deemed revoked. Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name r Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign g Lender's Address OWNER BUILDER DECLARATION Lavatories Auto -Wash Garbage Disposal Standing Sections I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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 P—Trap Laundry Trays ',. Generator ❑0.5 KW ❑5.15 KW Trash Compactor Roof Drains t0 file a signed Statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty 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 (Section 7044, Business into Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- piaci. n, the owner will have the burden of proving he/she did not build or im- prove for the purpose of Sale). ❑ I, as owner of the property, am exclusively contracting with licensed con. Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Oate ) Building Approved By Date `_— Application Issued By Dat U Boiler Hood or Type I ❑ yp Canopy Type I1 ❑ Duct - Under Ground Duct - Structural Refrigeration System 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 builds or improves thereon, and who contracts for such projects with a Con- lractor(s1 license pursuant to the Contractor's License Law). I am aware that proof off their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section— B. & P. C. for this reason 00100,000 BTU ❑ 100,000 BTU Duct - Ventilating SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBG # 3,0 Fire Dampers Date Owner Heating System & Ducting Registers PLAN CHECK 25% S ENERGY P.C. $ 1 hereby certify t I have read this application and state that the above Information is c rrec I agree to comply with all city and county ortlinances and state laws r Iating o Dn Wing construction, antl hereby authorize repre- of t y to n the above-mentioned oro rty i r 1 Inspection Inspection our ses, dh Signature Date Drivers' License or S ❑0100,000 BTU ❑100,00087 ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ d aw PLAN CHECK 25% $ Reinspection Fee $15 Issue Fee 'S/ $� CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION ANb�PLANNING APPROVALS Perrdrt# , Date Inspector POOL & 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 LIFER Grnd. 57. APPROVAL TO COVER-GUNITE r7.. Footings �t 58. Electrical Conduit-Undrgrnd. ,8.; Foundation c 59. Gas Pipe, ❑ Undrgrnd., Test 9.NWater 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/SPASYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit 20. Rough Factory Fireplace i i21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0as 0Oil 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 .v 29. Insulation 78. FIRE PREV. FINAL t q 30. Drywall Nailing HEALTH DEPT. REQUIREMENT • "; 31. Plaster Brown Coat r 79. FINAL INSPECTION r 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUER 33. Final Electric Notes: r 34. Final Heating & Air Conditioning •� 35. Final Gas•Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 3 ( ifq Lip 38. Final Plumbing !l: r• 1 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final - 42. Backflow Preventer / ' 43. Backflow Irrigation L7 44, Landscape Irrigation System r .45. Sound Attenuation 46.'Handicap Regulations ' 47: FINAL STRUCTURE & BUILDING r 48. Special Requirements Completed 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co- 51. CERTIFICATE OF OCCUPANCY No Date M3347'3 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 0415 5/12/88 37.50 TL CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address 21G L �o/ Cyon TA atria.. PERMIT NO. 9' 7$ TRACT NO. I b�O3a LOT NO. D24PT 63 NIT NO. TYPE OF CONSTRUCTION NEW LJ ADD LJ ALTERATION U REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. Applicant's Mailing Address FOO k• Owner's Name W-ffkTatL F,1qjikA I O Phone 9&9-r9 & Address A.P. # Zone S Main Building: Accessory Building: Arch/Eng. (cense No. Address iJ= /k r /(_ TYPE OF PERMIT GRADING ❑ FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL ❑ OTHER PROJECT DESCRIPTION 5Q. FT. OCCUPANCY—K CONSTRUCTION TYPE VALUATION$ ZONE GRADING CU. YDS. ACRES E T Front Z O B Rear N I Contractor's Name .�nl i Phone ��� 1? Address (mailing) City License No. -] `/ LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing With section 7000) of Division 3 of the BVSineSs and Professions Code, and my license is in fUl force and effect, r License Class U_.2 d License No. A Right G S Left R Ping. Ref. # Parking Req./Provided E Remarks: 3O QO Planning Notes: M T PLUMBING FEES Date '/ ^ Signature - WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate Of consent to self-insure or a certificate Bar Sink Showers ELECTRICAL FEES of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Backflow Preventer Service Sink Automatic Washer Transformer ❑ 15-50 KW Backflow Irrigation Sewer Cap Construction Pole Sub. _ ❑ 50+KW Certified copy Is hereby furnished. Certified copy is filed with to niv ginn Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps (Thissection need not be completed if the permit is for one hundred ($100) or less). 1 certify that in the performance of the work for which this permit is issued, I Shall not employ any person in any m r so as to become subject to the Workers' m ns.lon Laws of Cal ifor Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors ❑0-1 HP ❑1'/ - 8 Floor Drains SwimmingPool w/S a _ p F.A.U. Inc. Solar ❑9-15 HP 1116-15+ Date Pf-� Signatur NOTICE: If, after making this declaration, you should become subject to the Floor Sinks Urinal Fixtures Microwave Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit Shall be deemed revoked. Gas Service Outlets Water Closet Device Boxes Pole Light 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 (Section 3097 Civ. C.) Lender's Name InterceptOrs Water Heater Outlets Range 9 Kitchen Sink Water Service Switches' Sign Lender's Address OWNER BUILDER DECLARATION Lavatories — Auto-Wash Garbage Disposal Standing Sections I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business And Professional Code: Any city or - P=Trap Laundry Trays Generator 00-5 KW 05-15 KW Trash Compactor -d 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 RPOf Drains to file a signed Statement that he/she Is licansed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) Of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars ($500). LJ 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 (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended Or Offered for Sale. If, however, the building or improvement is Sold within one year of com- pletion, the owner will have the burden of broving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con. 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 builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware thatBUILDING proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Approved By Date Building Approved By Date Application Issued By r Dat Z Boiler Hood Or Type] ❑ Canopy Type I I L1Zoning Duct - Under Ground Duct -Structural Refrigeration System 00-100,000BTU E1100,000BTU Duct - Ventilating PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% SUMMARY OFF FEEK $ SMIP $ $ PERMIT $ ISSUANCE $ $ ENERGY P.C. $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBG # Fire Dampers Date Owner Heating System & Ducting Registers I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating t wlding construction, and hereby authorize repre- Senlatives of this city o mer upon the above-mentioned property for inspection purposes. Signature I Date �tilfC Drivers' License or SS # 00-100,000 BTU 0100,000BT ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% $ GRADING $ $ q MICROFILM $ J s00 ?7rs� $ TOTAL FEE $ J $ ` y10o 1 aTo w Lill dfSCA- Reinspection Fee $15 Issue Fee '$ CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING r APPROVALS Permit # r Date Inspector POOL & . APPROVALS Permit # Date Inspector 1,./Temporary Electrical'Service or Pole 52. Pool & Equipment Location 2' Soil Pipe-Undrgrnd. rti 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 LIFER Grnd,/ 57. APPROVAL TO COVER-GUNITE 67.,,Footings 58. Electrical Conduit-Undrgrnd. .8., Foundation 59. Gas Pipe, 0 Undrgrnd., Test '9 Water Pipe-Undrgrnd.Z� i% 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.LRough Wiring Sign 68. APPROVED FOR PLASTERING ,181•Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19.,Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil 23. -Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0Gas 0Oil - 25. Roof Sheathing 74. Overhead Hydro 26.1T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical �I 27. -Frame and Flashing 76. Dry Standpipe (� t 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. jnsulation 78. FIRE PREV. FINAL l 30. Drywall Nailing HEALTH DEPT. REQUIREMENT .' 31: Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 7. 33. Final Electric Notes: s 34. rFinal Heating & Air Conditioning hJ1i I�Y{ ujp 35. -Final Gas Pipe -Test 36. Hood or Canopy i 37. Final Factory Fireplace 38. Final Plumbing 1 39. Water Service -Final x 40. Gas Service -Final .i 41. Solar Domestic -Final 42. Backflow Preventer 43. Backf low Irrigation .44. Landscape Irrigation System j `'' .. •` - I i 45. Sound Attenuation . 46. Handicap Regulations d7. FINAL STRUCTURE & BUILDING I 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co p 51. CERTIFICATE OF OCCUPANCY No. Date ` - - -' City of Costa Mesa ,/ Development Services Department CERTIFICATE OF OCCUPANCY No. 002420 Building Safety Division , P. O. Box 1200 Costa Mesa, California The Building located at n14 o_..♦ tc«ti otw..e., unit n has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group R1 Occupancy. Use of Building Condominium Legal Description 425-202-14 (See reverse side for Metes and Bounds) Building Permit No B 30197 Electrical Permit No. E 31215 Plumbing Permit No. P 31162 Mechanical Permit No. m 33474,. M33693 Number of apartments and/or guest rooms ISSUED TO: Building Official wittiam T. Hot -yard rrata f+tesa Leader Enterprise, Inc. 172 Flower `Street by �_ ,• - �� �_ 1- ('nata masa. CA 92627 Date march 21, 1989 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. 'CMF 1015-46 rev. 1183 white - owner; Canary - Numerical File; Pink - Bldg. Permit File ) Applicant to fill In all spaces except those within heavy border CITY OF COSTA MEE1S1AC✓✓ONSTRUCTION Plae� PERMIT D Project Address sF� Applicant's Mailing Address Owner's Narri Ot3A LEADER 'Etgle? IES phone Z2' 1 Address 1"7 Z. It20if S -T• C"AA DiSA - C1 ai2lzI Arch/Eng. License No. Address Contractor's Nam�.r��y Phon 0 4. Address (mailing) 14� �e� `-I�O L-1. City License No. 0 4 2 (4 1 F LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and .{fact. D I License Class Y7_;74—Lice".'1152(� Date Signature WORKERS' COMPE14SATION DECLARA ON I hereby affirm that I have a certificate of c nsent to self -insure ora certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. // Vy., 6 r( Policy No. � CompanyU.7 1-11J61�'fi �(r�'I �Certifietl copy is hereby furnish d. 1% Cer£ ietl copy is ed with the city Builtl�"ng �pWjSjorl.S"� Date Applicant �(7 YFfA"A"\ IT EXEMPTION FROM ORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). 1 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. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a Construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she Is licensed pursuant t0 the Prov SionS of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt - therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil nenalty Of not more than five hundred dollars ($500). I, as on 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 (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an Owner of a property who builds or Improves walk hi If h r If or through his or her own thereon, and who does such mSe / ¢ s¢ employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com. pletlon, the owner will have the burden of proving he/she did not build Or im- prove er the purpose of sale). I, asfoowner of the property, am exclusively contracting with licensed con. 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 builds or improves thereon, and who contracts for such projects with a con. tractor S' license pursuant to the Contractor's License Law). I am aware that proof o their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have rea information Is correct. I a¢ree to and state laws rete sentativesof t inspection purp s Signature Drivers' License or IF 0865-46, rev. 10/ Y this application and state that the above comply with all city and county ordinances g construction, and hereby authorize repre- upon the above-mentioned property for Date B 3o l 97 I 1oc,32 �� TYPE OF CONSTRUCTION NEw 7 -.DD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TYPE OF PERMIT LJ GRADING -f❑f-�� TENANT ❑ ELECTRICAL J OTHER PROJECT DESCRIPTION SO. FT._ CONSTRUCTION TYPE VALUATION $ GRADINGCU.YOS. At :s and sign all appropriate declarations. NO. UNIT NO. tot (03 ?7 ALTERATION LJ REPAIR )FOUNDATION LJ STRUCTURAL PLUMBING ❑ MECHANICAL Remarks: Y 51.0.4 9/11/87 400.05 TL A.P. # aZ5 _70Zone R3 S I Main Building: Accessory Building: E Z T Front O ARear ib 11 �` N C Right 1,ji N K Left off CSI tip O R Ping. Ref. # 4L0 Parking Req./Provided E Planning Notes: 2�'�I CCS.-�e27i"t 6.� 1 V(.^ M Boiler 10 ` Z5 THOW Y�S.> I DEVELOPMENT SERVIAF,$� ZoningApproved B—% Approved By Application Issued By G U1al a� FOR -T ' PLUMBINGFEES Duct -Under Ground Duct - Structural Bar Sink Showers Duct -Ventilating ELECTRICAL FEES Backflow Preventer Service Sink ,/ H�-t $ $ $ $ $ $ ¢OQ bj Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑50+KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping $15 Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors ❑0-lHP❑1 Y.-8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09-15 HP E116-15+ Floor Sinks Urinal Fixtures Microwave Gas,Service Outlets Water Closet Device Boxes Pole Light Interceptors Water.Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories I Auto -Wash Garbage Disposal Sianding,Sections P -Trap - Laundry Trays Generator 00.5 KW 05.15Kw u Trash Compactor Roof Drains - '> "• Reinspection Fee $15 --__„••„_•, Issue Fee $ 3 Reinspection Fee S75 Issue Fee $ 3 Boiler Hood or Type ❑ 'Canopy Type I I EllBuilding DEVELOPMENT SERVIAF,$� ZoningApproved B—% Approved By Application Issued By REI yJfiF}/ IT'Vy > ll t�"�� // Date Date Dat Duct -Under Ground Duct - Structural Refrigeration System ❑0.100,000BTU 0100,000BTU Duct -Ventilating BUILDING PERMIT PLAN CHECK. PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% $ $ $ $ $ $ $ $ SUMMARY OF FEES 3¢o Qa SMIP S'S • LS PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM TOTALFEE ,/ H�-t $ $ $ $ $ $ ¢OQ bj Exhaust System Multiple System Repair/Alteration Firepl/Fact. Bit. ICED # Fire Dampers Heating System & Ducting ❑ 0.100,000 BTU C1 100,000BT Registers Reinspection Fee $15 Issue Fee $ 3 Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # '!' Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. rz y 57. APPROVAL TO COVER-GUNITE 7. Footings A 9jj„CL yJ 87 pd 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 & Hodie 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 APPROVALS Permit # _ 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro i 22. Ducts, Ventilating 71. Product Piping 0 Gas 0Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas 0Oil 25. Roof Sheathing as D. 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 JAI78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 9,3 Q 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Not s: 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 Ib 48. Special Requirements Completed .160. 49. Electric Release to Edison , 50. Gas Release to Southern California Gas Co - 51. CERTIFICATE OF OCCUPANCY No. Date , Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address 1 E +t% 171— '17 jlpplicant's Mailing Address Owner's Name -L^ hone Address V% � G 1 Y 16-1. L,44 -A G66 , (A 1-76-e1 Arch/Eng. ' /License No. Address Contractor's Name _ – Phone 3 "0 Address (mailing 4' ��`� a�sltiYPuL f'Q�� 1 City License No. 01 4, LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is In full force and effect. UPS a Clas --35LI ense No. DaleSignature -1:(P. / WORKERS'COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self -insure or a certificate if Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) 1r Policy No. ILLOZ �n1sl'^7G1! Company V 1TT (G7 Qp ❑ Certified copy is hereby furnished. Derltif�T,c�oyp� is filed with the Building Division at A y � 1 EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($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 Ike Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Cotle, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 30971 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION ,'L I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code:.Any city or county which requires a permit to construct, alter, improve, demolish or repair any'slructure, 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 ,efrom and the basis for the alleged exemption. Any violation of Section 11.5 by any applicant for a permit subjects the applicant to a civil afty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole t pensation, will do the work, and the structure is not intended or offered sale (Section 7044, Business and Professional Code: The Contractor's arise Law does not apply to an owner of a property who builds or improves reon, and who does such work himself/herself or through his or her own ployeeS, provided that such improvements are not Intended or offered for i. If, however, the building or improvement is solo within one year of com- tion, the owner will have the burden of proving he/she did not build or Im- ve for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed can. :tors to construct the project (Section 7044, Business and Professions Code: 3 Contractor's License Law does not apply to an owner of property who Ids or Improves thereon, and who contracts for such projects with a CON :tor(S license pursuant to the Contractor's License Law). I am aware that sof of their Wor ker'S Compensation insurance should be Provided to me. 1 am exempt under Section B. & P. C. for this reason Date Owner Inspection purposes. Signature Drivers' License or ; I have read this application and state that the above I agree to comply with all City and county Ordinances to building construction, and hereby authorize repre- to enter upon the above-mentioned property for P_3ii6'L I I TYPE OF CONSTRUCTION LJ NEW LJ ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. — ALTERATION LJ REPAIR TYPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY_ CONSTRUCTION TYPE VALUATION $ ZONE GRADINGCU.YOS. ACRES_ Remarks: A.P. eW S Main Buildi E T Front B Rear A C Right K S Left Ping. Ref. # Planning Notes: 9709 11/17/87 Zone Accessory Building: Parking Req./Provided 4708 TL Z O N I N G R E Q M T S Bar Sink Showers Op ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Ij Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100amps Dishwasher Solar Piping u Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors ❑0-1 HP 0 %- 8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09-15 HP 016.15+ Floor Sinks Urinal Fixtures) Microwave _ Gas Service Outlets Interceptors Water Closet Water Heater U2 Device�Boxes Outlets Pole Light Range Kitchen Sink Water Service J Switches Sign Lavatories Auto -Wash (z) a is Garbage Disposal Standing Sections .j. P–Trap Laundry Trays Generator 110-5 KW ❑5-15 KW Trash Compactor Roof Drains .�. Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL _ FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved ByDate�jj�������' Application Issued By Data_ 'LILL Boiler Hood or Type ❑ Canopy Type 11 [I Duct -Under Ground Duct -Structural Refrigeration System 110.100,000 BTU 0100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ 3 ISSUANCE $ $ Q • 8 ENERGY P.C. $ $ GRADING $ $ MICROFILM $ w $ TOTAL FEE $ "r $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact Bit. ICBG# Fire Dampers Heating System & Ducting ❑O-100,000 BTU❑100,00067 Registers Reinspection Fee $15 Issue Fee $ 3 z CMF 0865-46, rev. 30/84 Whit¢ -Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA 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-Uni drgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER 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 r1l.11' 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign r r C 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling _t f "'' 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit -� 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping C Gas C Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas Coil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing "I 76. Dry Standpipe i 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT / 31. Plaster Brown Coat l l 79. FINAL INSPECTION I,I 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED - 33. Final Electric Notes: ". 34. Final Heating & Air Conditioning n 35. Final Gas Pipe-Test 36. Hood or Canopy 37., Final Factory Fireplace ` -! 38.• Final Plumbing ,y Y4 (,9P - r 9 h39. Water Service-Final - •J - '- ,' 1 ,40. Gas Service-Final 11.41. Solar Domestic-Final 1,42. Backflow Preventer - i '- I- r 43, Backflow Irrigation 44. Landscape Irrigation System I • '` 45i- Sound Attenuation _ `'_l . 46. Handicap Regulations '• _ •.- '" ~' 47; FINAL STRUCTURE & BUILDING ,: `!" �• - 48. Special Requirements Completed 49. Electric Release to Edison"- J I 50. Gas Release to Southern California Gas Co h 51. CERTIFICATE OF OCCUPANCY No. Date ' M-_3-_3'47+ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CO1ma I n CTION PERMIT -f PERMIT NO. =b,u TRACT NO. LOT NO. UNIT NO. 'Project Address 1_2/L �G ; O� COST MEfA Applicant's Mailing Aid/dress /MO 007- �/ b Owner's Name Mailing De O�IiF /�/� phone _ - Address Arch/Eng. matLicense No. Address Contractor's Name Phone L9-fD Address (mailing City License No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Fr—ofessions Code, and my license is in fur 13rj and effect. License Clazz O co�j License No. �bN LSN Signature— WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self -insure or a certificate .f Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Policy—No. py is herfurnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person Inany ma as to become subject to the Workers' Cory1 satlon Laws of Calif Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she Is licensed pursuant to the provisions of 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 herefrom 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 nneenelty of not more than five hundred dollars ($500). 1, 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 (Section 7044, Business and Professional Code: The Contractor's Li Cense 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 employees, Provided that such improvements are not Intended or offered for sale. If, however, the building Or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build Or im - prove efor the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con. 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 builds or improves thereon, and who contracts for such projects with a con- tractor(s1 license pursuant to the Contractor's License Law). I am aware that proof off their Worker's Compensation insurance should be provitled to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information Is correct. I agree to comply with all city and county ordinances and stale laws relating to building construction, and hereby authorize repre- sentatives of this cit err ter upon the above-mentioned property for inspection purpos / Signature Date Drivers' License or SS # 0 !o 0411 5/12/8B TYPE OF CONSTRUCTION fJ NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # Zone DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessary Building: E TYPE OF PERMIT El GRADING FOUNDATION LJSSRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING E:;- IiECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SO. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU. YDS. ACRES Ping. Ref. # Parking Req./Provided Remarks: R Z T/ 4 -7 - Planning Notes: Sink Preventer Irrigation Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Kitchen Sink Drains Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash FEES Reinspection Fee I $151 I ' Issue Fee I $ 3 I I Duct- Under Ground Duct - Structural Duct- Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBG # Heating System & Ducting 00-100,000 BTU ❑ 100,000 Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System ❑0.100,000BTU 1:1100,000 System Repair/Alteration Fire Dampers Registers Issue Fee Automatic Washer Construction Pole Su Cooking Unit Dishwasher Dryers ❑Gas ❑EIS Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW ELECTRICAL Transformer ❑ 15.50 KW ❑ 50+KW Meter El up to 100 amps Meter Dover 100 amps Sub Panel Motors 1:10-1 HP ❑1%-8 Inc. Solar 09-15 HP ❑16-15+ Microwave Pole Light Range Standing Sections 15 KW Trash Compactor 37,,50 TL FEES I Reinspection Fee I $15 I I Issue Fee I $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Data Application Issued BYea�jpce9'Lllss.... Data %// --� Z O N I N G R E Q M T S PLAN CHECK 25% $ Y SUMMARY OF FEEV BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% S ENERGY P.C. S ELECTRICAL $ GRADING $ PLAN CHECK 50% MECHANICAL $ $ MICROFILM 3� TOTAL FEE $ $ 3 J•.5'� PLAN CHECK 25% $ Y CONSTRUCTION AND PLANNING ,APPROVALS Permit # , Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1 , Temporary Electrica I:Ser vice or Pole 52. Pool & Equipment Location 2. 'Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Uridrgrnd. 55. Electrical Bonding 5. Steel Reinforcement,,' 56. Rough Plumbing & Pressure Test 6. Electrical UFER GrnLe 57. APPROVAL TO COVER-GUNITE 7,.r,Footings �, 7 58. Electrical Conduit-Undrgrnd. .„8 !111 Foundation . f... 59. Gas Pipe, 11 Undrgrnd., Test 9.1IWater Pipe-Undrgrnd , 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & -louse Connection Y 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 1.7. Rough Wiring Sign u 68. APPROVED FOR PLASTERING q8. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. -Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # j 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22.,Oucts, Ventilating 71. Product Piping ❑Gas OOil ' 23. "Gas Pipe-Rough & Test 72. Underground Flush 24.; Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27I., Frame and Flashing 76. Dry Standpipe 28. Lathing &Siding 1 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30; Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION M `1 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: ! s, 34. Final Heating & Air Conditioning ' L� 35.\Final Gas Pipe-Test -1 36. Hood or Canopy , 37. Final Factory Fireplace 38. Final Plumbing r 39. Water Service-Final 4. 40. Gas Service-Final 1 i'. 41. Solar Domestic-Final -i 42. Backflow Preventer I r _ 43. Backflow Irrigation 1 44. Landscape Irrigation System 45. Sound Attenuation V 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING ill 48. Special Requirements Completed ) - r r 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date 7r . Applicant to fill in all CITY. roject COSTA pq� �COi S i d PERMIT Moog Project Address G _ ,- Applicant's Mailing Address Owner's Name(, Dq(A) M 5�➢ Pho e r �(� Address a7n ON ST D tj- LlIES0� C2 Z� Arch/Eng. License No. Address Contractor's Nam W '• ✓ OAt 'afJ Ph e Address lmailing) J ON WsKsik 2�0 City License No. ---W 7- 4 7 - LICE NSED LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensetl provisions of Charter 9 (commencing with section 7000) of Division of Ih Business and Professions Code, and my license is in full force and effe t N License Class Date ( hereby affirm that I have a certifiditeo consent to self- sure or a certificate I Workers' Compensation InSuran r a cert d o y thereof (Section `. 3800, Lab. C.) %� }} '1 �/y� /• L T Policy No. -Curb J) l.{jb I I Come Y • Y ��p L) I entified copy is hereby furnished. Cert ifi 9 ` y s filed with the city Bui ldi n Date Applicant EXEMPTION FROM WORKERS' COMPENSTI D ARATION (This section need not be completed if the per s for n hundred ($100) or less). I certify that in the performance of the work for which his permit is issued I Shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions Of the Labor Code, you must forthwith comply with such provisions or this permit Shall be deemed revoked. 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 (Section 3097 Civ1/C.) Lender's Name Lender's Address r OWNER BUILDER DECLARATION - •t I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code; Any pity or county which requires a permit to construct, alter improve, demolish or -repair any structure, prior to Its Issuance, also requires tke applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the contractor's License I zw tChaoter 9 /commencing with Section 7000) of herefrom and the basis for the alleged exemption. Any violation of Section /031.5 by any applicant for a permit subjects Ahe applicant to a civil LJpenalty of not more than, five hundred dollars ($500), I, as owner of the roperty or my employees with wages as their sole compensation, will do the work, and the structure Is not intended Or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law doesnot 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 employees. Provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have theb union of proving he/she did not build or Im- prove for the purpose Of Sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con. 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 builds or improves thereon, and who contracts for Such projects with a con. tra Ctdr(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Ownei t hereby certify that 1 have rea Information is correct. ee to and state laws relating to ildh sentatives of this city�l0 rte, Inspection purposes. Signature Drivers' License or SS qP this cou those within heavy border lines and sign all appropriate declarations. TRACT NO. LOT NO. UNIT NCL TYPE OF CONSTRUCTION -'&NEW LJ ADD LJ ALTERATION L I REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER —A.p.# . DESCRIPTION OF WORK/USE OF BLDG. - In S Main Building: TYPE OF PERMIT GRADING FOUNDATION ❑ STRUCTURAL T Front ❑� TF TENANT ELECTRICAL ,/❑ PLUMBING CRMECH ANICAL B Rear U4,0THER r- nlncf- A PROJECT DESCRIPTION SQ. FT. C Right OCCUPANCY CONSTRUCTION TYPE VALUATION 5 S Left ZONE G ADING CU. YDS. ACRES Ping. Ret. # Remarks: 0 Planning Notes: 15 � Accessory Parking Zone Z O N I N G R E Q M T Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink - Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW I ❑50+KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps Dishwasher Solar Piping - Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 1:30-1 HP ❑l h- B Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09-15 HP 016.15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet "! Device Boxes Pole Light Interceptors Water Heater �', Outlets Range Kitchen Sink - Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal Standing Sections [P -Trap Laundry Trays Generator 130-5 KW 115-15 KW Trash Compactor Roof Drains Reinspection Fee- $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Dat Boiler Hood or Typel ❑ Canopy Type I I ❑ Duct - Under Ground Duct - Structural Refrigeration System 00-100,000 BTU 0100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY $ $ $ $ $ $ CO $ $ OF FEES SMIP $ PERMIT. ISSUANCE $ - ENERGY P.C. $ GRADING $ "- MICROFILM $ TOTAL FEE $ Exhaust System ❑ Multiple 0 System Repair/Alteration Firepl/Fact. Bit. ICBG# 6� Fire Dampers pr 1 Heating System & Ducting 00-100,000BTU❑100,00OBT Registers Reinspection Fee $15 Issue Fee $ b CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND /' APPROVALS Permit r# J Date Inspector POOL & SPA APPROVALS Permit# Date Inspector 1 •Temporary E lectr ica l,Se'r vice or Pole 'r• n l 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing '& Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 'r7Footings 58. Electrical Conduit-Undrgrnd. 8. -Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrn r. , 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 )y8. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL _ 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # et - , 20. Rough Factory Fireplace 2 / 0 ;3.r �_ ,21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas ED Oil 23. Gas Pipe -Rough & Test 72. Underground Flush r 24. Roof Framing, 73. Undergrnd. Storage Tank 0pas 0Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 'v 28. Lathing &Siding 77. FIXED SYSTEM FINAL 'C 29. Insulation 78. FIRE PREV. FINAL + ` 30. Drywall Nailing HEALTH DEPT. REQUIREMENT •�1 31. Plaster Brown Coat 79. FINAL INSPECTION . t �•'7 •; r 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning1,- 35. Final Gas -Pipe -Test 36." Hood or Canopy 37. Final Factory Fireplacely y4 CiEe -! _ 38 Final Plumbing t - 39. Water Service -Final ( -`� i!•� -- _ .:i•; r I 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer .i ✓ . x'43. Backflow Irrigation - Y`„ r �- ";,r t• 's.... 44: ;Landscape Irrigation System .45. Sound Attenuation 46.•H5ndicap Regulations - '• ,y _, 47. FINAL STRUCTURE & BUILDING - •-' .'i !•r -� -`" I -` r• 48. Special Requirements Completed .`, '(- - . 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date v --, Applicant to fill in all spaces except those within heavy CITY OF COSTA MESA CONSTRUCTION PERMIT Vroject Address Z1k &. Idih Pd— C:x!�An /01 *0 Applicant's Mailing AddrAe,tss Owner's Narr lG4�1'/l:'y' U.V&tCVDY1o5 Phone �"DStc rr Address �Al-r-3PY �C S�41 hbeedi CA Sze?7 Arch/Eng. License No. Address Contractor's Nam Address (ma"I" g)�7 �r �,� City License No. LICENSED CONTRACTOR DECLAR 10 I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in iforce and effe5I.�%�„ License ClaJs �/ G— &-'' 9 .f e No. �87TL Date �I t/�7ti /��7 Signature WORKERS'COM—PENDili LA ION hereby affirm that 1 have a certificate o consent to self -Ins re or a certificate if Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Q / �ley No. V O Company L�f Certifled copy is hereby furnished. Corti ca 'letl with the city Buil Date 2 Applicant EXEMP ION RO WORKERS' PE TIO DECLARATI (This section need not be completed if the reit is for one hundre($100) or less). 1 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. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of 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 herefrom 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). 1, 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 (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. If, however, the.building or improvement is sold within one year of com- pletlon, the owner will have the burden of proving he/she did not build or im. prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or Improves thereon, and who contracts for such projects with a con- tractors on- tractor (s1 license pursuant to the Contractor's License Law). 1 am aware that proof o their Worker's Compensation insurance should be provided to me. ❑,1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to uildi construction, and hereby authorize repre- sentatives of this yi / upon the above-mentioned property for inspection purpo �,� Signature Date 1) illi lines and sign all appropriate declarations. JT NO Bar Sink IShowers SUMMARY OF FEES Backflow Preventer Service Sink BUILDING PERMIT Backf low Irrigation - Sewer Cap TYPE OFF CONSTRUCTION NEW ADD ALTERATION REPAI R $ _ PERMIT E:1CONVERSION ❑ 0 PLUMBING Dishwasher Solar Piping DEMOLISH OTHER Drinking Fountains Solar Tank A.P.# DESCRIPTION OF WORK/USE OF BLDG. ELECTRICAL Floor Sinks Urinal $ Gas Servicer Outlets Water Closet $ l n . RD - MICROFILM S Main Building: TYPE OF PERMIT�- 11i 'GRADING F-1FOUNDATION❑STRUCTURAL T Front ❑ TENANT ITS ELECTRICAL ❑ PLUMBING ❑ MECHANICAL P—Trapr' Laundry Trays B ❑ OTHER A Rear C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: FS �J.n )(4,F7 Planning Notes: Bar Sink IShowers SUMMARY OF FEES Backflow Preventer Service Sink BUILDING PERMIT Backf low Irrigation - Sewer Cap $ Bathtubs Sewer Connection $ _ PERMIT Clarifiers Solar Collectors PLUMBING Dishwasher Solar Piping $ Drinking Fountains Solar Tank $ ENERGY P.C. Floor Drains Swimming Pool w/Spa ELECTRICAL Floor Sinks Urinal $ Gas Servicer Outlets Water Closet $ l n . RD - MICROFILM Interceptors Water Heater MECHANICAL Kitchen Sink Water Service $ 35.40 Lavaioiies Auto -Wash $ P—Trapr' Laundry Trays R Reinspection Fee $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting 011100,000 BTU ❑ 100,000 Reins action Fe Drivers' LI Pose or SS # I 1 P a CMF 0865-46, rev. 10f84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 Issue Fee $ 3 IANICAL FEE Hood or Type ❑ Canopy Type I I ❑ Refrigeration System 00-100,000BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers❑Gas ❑Elea Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW C 9894 11/19/87 35,40 TL .. Zone - - —rAccessory Building: O1 Parking ELECTRICAL - Transformer ❑ 15-50 KW ❑ 50+KW Meter Xupto 100 amps Meter ❑over 100 amps Sub Panel Motors ❑0-1 HP 01 'A - 8 Inc. Solar 09.15 HP 016-1 Microwave Pole Light TRange Sign Standing Sections KW Trash Compactor L Reinspection Fee - I $15 I Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By FEES $ 3 01 N G R E Q M T S SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ _ PERMIT PLUMBING $ ISSUANCE - $ PLAN CHECK '25% $ ENERGY P.C. $ ELECTRICAL $ 7 GRADING $ PLAN CHECK 50% $ l n . RD - MICROFILM $. MECHANICAL $ TOTALFEE $ 35.40 PLAN CHECK 25% $ CONSTRUCTION AN&PLANNING APPROVALS Permit,# Date .Inspector POOL & SPA 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-UVrgrnd. 55. Electrical Bonding 5. Steel Reinforcement•• 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnq , • 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation ;1 7 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 t -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 APPROVALS Permit 4#- 20. Rough Factory Fireplace 21. Ducts, in Structure 21. 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil, 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas 0Oil 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 1 - 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED - 33. Final Electric Notes: 34. Final Heating & Air Conditioning ' 35. Final Gas Pipe-Test g 36. Hood or Canopy _ 37. Final Factory Fireplace r• i 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 r 45. Sound Attenuation 46. Handicap Regulations 47. -FINAL STRUCTURE & BUILDING ', ^ 48. Special Requirements Completed r 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. TR erT hill I I nT ND CITYOFCOSTAME A ,CIIO_NSTRUCTIONPERMITI.6 qJ_ Prolec;'Address � 1 PL (%°SQA �Lfa4— Applicant'iMailing Address 112 'F(.OWL� S'(. CASLA (J�l: Sft Ovvnnr's NafneC�-%k-4EkWEN*K ms=s Phone a�z-A311 Address 17- 1fd-2W*K 5-T r.4fA 06A- CA 4"(20 Arch/Eng:• License No. Address Contraoto ' N �izh0 e 6 Address (mailing) City License No. l)4 ^ r r r LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is In f�u1tLf orce2and effect. License Class .� License No Date Signature WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self -Insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section J800, Lab. C.) Policy No. Company B Certified copy is hereby furnished. Certified copy Is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less) I certify that in the performance ofn the work for whir his permit is Issued 1 shall not employ any person f any manner So come subject to fife WOrke rs,' =1 IP& Laws of California. � Date ICE. 1J�—Signature - NOTICE. Compensation after making this ions f on, you shoultl become Subject to the Workers'ithSuhprprovisions of the Labor Code, you must forthwith comply with such LENDING or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there IS a construction lending agency for the performance which Of the work for which this permit Is Issued (Section 3097 Civ. CJ Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or rnunty which reauires a permit to construct, alter. Improve, demolish or repair rierefrom and the basis for the alleged exemption. Any violation of section ;031.5 by any applicant for a -permit subjects the applicant to a civil enalty of not more than five property or dollars (5500). Z 1, as owner of the property hundred d employees with wages as [heir sola compensation, will do the work, and the structure Is not intended or -offered for Shce (SeCIiOo 7044, Business and Professional Code: The Contractor's 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 employees, provided that Such Improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletlon, the owner will have the burden of proving he/she did not build or im- Xve for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con. tort to construct the project(Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such crolects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Sectlon--x—r � B. & P. C. for this reason Date Owner I hereby car I c to t at I have rthis application and State that the above Information IS correct. 1 agree to comply with all city an county rite r ores and state laws relating to bulltll g nstr uction, antl hereby authorize repre- sentatives of this city to on ythe above.mentioned pro arty fppr Inspection purposes. C QO Signature Date Drivers' License or SS'p .a S$13 Reinspection Fee Backflow Preventer Service Sink y-&5 Backflow Irrigation Sewer Cap TYPE OF CONSTRUCTION LbANEw LJ ADD LJ ALTERATION REPAIR ❑ CONVERSIONAERO LISH ❑OTHER _ DESCRIPTION OF WORK/E OF BLDG.(=AAA- rs lex2ap A114 TYPE OF U GRADING FOUNDATION`- L] STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER Gas Service Outlets Water Closet . r PROJECT DESCRIPTION SQ. FT. OCCUI CONSTRUCTION TYP—E—Jr S VALUATION! �_.rs.n •m0 ZONE GRADINGCU.YDS. ACRESs�•=— Remarks: r1 M I .4 1 11, 11 f'1 /7 9,Z`f_ 1 . • 4-1t% 1 FEES Bar Sink Showers Reinspection Fee Backflow Preventer Service Sink -DEVELOPMENT SERVICES REQUIREMENTJLl Zoning Approved By—?Ooing Approved By ;Building Apprpved By Applination Issued By Backflow Irrigation Sewer Cap FEES'' Bathtubs Sewer Connection $ Clarifiers Solar Collectors • Dishwasher Solar Piping Drinking Fountains Solar Tank $ Floor Drains Swimming Pool w/Spa MICROFILM Floor Sinks isnot Gas Service Outlets Water Closet . $ _8l, Interceptors Water Heater Kitchen Sink Water Service Lavatories - Auto -Wish P -Trap Laundry Trays Roof Drains Reinspection Fee $15 Boiler - Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System 0 Multiple 'Firepl/Fact. Bit. ICBO dk Heating System & Ducting 00100,000 BTU 0100,000 Reinspection Fee I $15 0865-46, rev. 5/88 White - Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor Issue Fee Hood or Type ❑ Canopy, Typell ❑ ri rgeration System 0100,000BTU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee A.P. SW o% 5- Oo1 - �L S Main Building: Accessory E / T Front B Rear / A C Right K Ping. Ref, dh I Parking Req./Provided Planning Notes: C2JL. r 30'�^-' ,^A/ C n H /��_ --L. I ELECTRICAL Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter Dover 100amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors 130-1 HP❑1''A-8 F.A.U. Inc. Solar 09-15 HP 016-15+ Fixtures Microwave Device Boxes Outlets Switches 10 Garbage Disposal Generator 00.5 KW 05-15 KW Zone Sign Standing Sections Trash Compactor $ 3 I N G R E Q M T S. FEES $ 3 SMIP Reinspection Fee $15 Issue Fae -DEVELOPMENT SERVICES REQUIREMENTJLl Zoning Approved By—?Ooing Approved By ;Building Apprpved By Applination Issued By $ 3 - FEES'' ISSUANCE $ • ]7 SUMMARY O FE + BUILDING PERMIT $ &7�% r9J PLAN CHECK $ 3.r 110 .�, PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ ' $ MICROFILM $ TOTALFEE $ _8l, ba $ 3 I N G R E Q M T S. FEES $ 3 SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTALFEE $ _8l, ba 01 00017476-00017478 TOT 89.60 DATE: 10/19/88 TIME: 14:12 CONSTRUCTION AND PLANNING APPRb.VALS Permita#: Date Inspector PO SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil•Pipe-Undngrnd. 53. Steel Reinforcement ' Electrical Conduit Utility-Undrgrnd. , 54. Forms 'V1Elecf6csl Conduit-Undrgrnd_ 1 - 55. Electrical Bonding ' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test - 6. ElectricalUFER�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 r 62. Backwash & Receptor -Final 12. Sewer Cap r 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 761 Rough Electric Wiring 67. Fencing & Access Approval X17: Rough N(iring Sign - 68. APPROVED FOR PLASTERING X18: Rough Electrical -T Bar Cei`irig 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Congitibning FIRE DEPT. REQUIREMENT APPROVALS Permit # X20. Rough Factory Fireplace - 21.6ui 's, in Structure, 70. Underground Hydro 22, Dugsti Ventilating t.,)71. Product Piping❑Gas El Oil 23..Gas PipeiRough & T14st --- 72 � Underground Flush 24. Roof Flaming r 73. Undergrnd. Storage Tank 0 Gas 0 0, 25. Roof S. %athing t,1 74. Overhead Hydro 26: T-Bar'Ceiling (Structural) CMonocoat 75. Dry Chemical 27. Fra mel -and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulati n 78. FIRE PREV. FINAL 30. Drywal Nailing r �� Z-�i•• HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coate 79. FINAL INSPECTION 32. Electrical PowerlMeter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric �) Notes: (p '_f �y 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 'R72) �- 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing , 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final L 42: Backflow Preventer 43. Backflow Irrigation. i 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations F•'� 7 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Cc ' V _ 51. CERTIFICATE OF OCCUPANCY No. Date •l 1 City of Costa Mesa Development Services Department Building Safety Division CERTIFICATE OF OCCUPANCY No. g 0/- b 2 7 P. O. Be. 1200 Costa Mesa, California The Building located at 216 East 16Th Place, Unit E has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group Rl Occupancy. Use of Building Condominium Legal Description 425-202-14 (See reverse side for Metes and Bounds) Building Permit No, R 30198 Electrical Permit No. E 31216 Plumbing Permit No. P 31163 Mechanical Permit No. M 334751 M 33694 Number of apartments ISSUED T0: Costa Mesa Leader Enterprise,. Inc. 172 Flower Street Costa Masa, CA 92627 Building Official and/or guest rooms William T. Howard by Date March 21,1989 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CMF 101546 rev. 1/83 White -Owner; Canary - Numerical File; Pink - Bldg. Permit File Applicant to till in all spaces except those within heavy border lines and sign all appropriate declarations. • CITY OF COSTA MESA CON CT PERMIT Project Address !n,-�(o �i�lX-f-P� PERMIT NO. "3O/ q TRACT NO. 10(032 LOT NO. �e} (D3 UNIT NO. 'E 5105 �j-l/-$rJ 400.05 TL C416 - �x, Applicant's Mailing Address TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR Owner's Nameiip-!TA A 56 LEAw<R F.+eRPRISGS Phone �z2-P'sIl ❑ CONVERSION 1:1DEMOLISH ❑ OTHER A P # (k- Z ;1 — !V (�. Zone 3 112 rL0)1rr"R 5T WSfA flYCfiA (i{1 11-1;S1 DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessory Building: Address Arch/Eng. License No. TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front p ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Address 1 Contractor's Name �iV al:,4i UU6L 51i�C 1" � Phone A!— L- - D 4-Z ❑ OTHER 09 A RearN I 1 PROJECT 1 C Right N //�s�. 1 �LL (mailing) �mSS I✓1vNjE�Y PASS Y�-N Z10 %'��k�I76t DESCRIPTION SG. FT. OCCUPANCY G T CONSTRUCTION TYPE VALUATIONS &j3 S(JO.! S Left G ' CityAddLicenei City License No. t.1k21, �F2 R LICENSED CONTRACTOR DECLARATION .ZONE GRADINGCU.YDS. ACRES Ping. Ref. # p — �U Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: 0(0 M with section 7000) of Division 3 of the Business and Professions Code, and my] I censii is in full force and effect P> Lic S 2 0 L- — C' 1 S License Class o.37 Date s - TI -S`( Signature PLUMBING.FEES J W WORKERS' COMPENSATION DEC LARA ION I hereby affirm that I have a certificate of nsent to self -insure or a certificate Bar Sink Showers _ ELECTRICAL FEES of Workers' Compensation Insurance, or a certified copy thereof (Section 3600, Lab. C.) C-) Backflow Preventer Service Sink Automatic Washer Transformer ❑ 15.50 KW / (t Policy No.*Company(a-SlVehTY 4L,1 lv Backflow Irrigation Sewer Ca p Construction Pole Sub. ❑50+KW Certified copy is hereby furnished. : C>. 'Certified copy is filed with -the city Bui �vis�an.^" Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date �(L\h_4'7 Applicant /}IV �fT EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers _ Solar Collectors Dishwasher Meter ❑Over 100 amps (This section need not be completed if the permit is for one hundred ($100) or less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel . I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors ❑01 HP ❑1 A- B Workers' Compensation Laws of California. Date Signature _ Floor Drains Swimming Pool w/Spa F.A.U. Inc.S013r 09-15 HP 016-15+ NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets. Water Closet Device Boxes Pole Light I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) ' Interceptors '' Water Heater Outlets Range Lender's Name �' - Lender's Address Kitchen Sink '-' WateG Service Switches 'Sign - OWNER BUILDER DECLARATION I hereby affirm that Iam exempt from the Contractor's License Law for the - Lavatories - Auto -Wash Garbage Disposal Standing Sections following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair P—Trap yra Trays Laurdr T y Generator ❑05 KW ❑5-15'K0 T.rash'COmpactor any structure, prior to its issuance, also requires the applicant for such permit to file a signedstatementthat he/she is licensed pursuant to the provisions ofRoof Drains-•' "-' l' the Contractor's.License Law (Chapter 9 (commencing with Section 70001 of .:� _. .• r 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 enalty of not more than five hundred dollars ($500). $ 3 I, as owner of the property or my employees with wages as their sole Reinspect tan Fee $15 Issue Fee compensation, will do the work, and the structure is not intended or offered Fee Reinspection p $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 employees, provided that such improvements are not intended or offered for Boiler Hood Or Type I ❑ .DEVELOPMENT SERVIC S R IRE E�'7l/�r� S �•s sale- If, however, the building Or improvement is sold within one year of com- Canopy Type II ❑ Zoning Approved By I l/ __� Date_\/ pletion, the owner will have the burden of proving he/she did not build or im- - Duct - Under Ground Building Approved By Date prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct - Structural Refrigeration System Application Issued By Dat 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 ❑4100,000 BTU ❑100,000 BT.0 SUMMARY OF FEES builds or improves thereon, and who contracts for such projects with a con. � � tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System El Multiple El System Repair/Alteration BUILDING PERMIT $nen $ �O proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK —SMIP $ '1 -r -2-- S PERMIT L1I am exempt under Section B. & P. C. for this reason Firepl/Fact. BIt. ICBO # Fire Dampers PLUMBING $ ISSUANCE $ Date Owner Heating System & Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ 1 hereby certify that I have read this application and state that the above ❑0100,000 BTU ❑100,00087 ELECTRICAL GRADING $ $ information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50°.6 MICROFILM $ $ sentatives of this cit to e on the above-mentioned property for inspection �I ,��•1 purpo 1 MECHANICAL $ TOTAL FEE $ �1-'�D' Signature Oatdiz--�t— Reinspection Fee $15 - Issue Fee $ 3 PLAN CHECK 25% $ Drivers' License or 5 CMF 0865-46, rev. 10/8 White - Building; Canary -Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit Date Inspector POOL & SPA APPROVALS Permit#, Date Inspector 1. Temporary Electrical Service=or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms - 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. - B. 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 & Hou`se 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 APPROVALS Permit # _ I, 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 171 Gas 0Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas []Oil 25. Roof Sheathing j 88 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 y 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing _ 39. Water Service -Final - 40. Gas Service -Final y ' 41. Solar Domestic -Final- ' ' 42. Backflow Preventer • 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations , 47. FINAL STRUCTURE&BUILDING '3 - 48. Special Requirements Completed leo 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co , 51. CERTIFICATE OF OCCUPANCY No. Date 33 `✓ Applicant to fill In all spaces except those within heavy border lines and -sign all appropriate declarations. CITY OF COSTA'MESA CONSTRUCTION PERMIT PERMIT NO. 3/J7 TRACT NO. I LOT NO. UNIT NO. If ?4 �10 a 12 LoT 63 E Project Address C //'J l' e0 �� R"F-94 Applicant's Mailing Address �.!-O ' • r- f6T &• /� fj TYPE OF CONSTRUCTION NEW ADD Owner's Name_9,51-%L/ ` dE /-2�0 Phone 9 S A ❑ CONVERSION ElDEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. — Address ALTERATION LJ REPAIR Arch/Eng. dg0,Lil¢ense No. TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL Address �N U '^'�- /r/! - �� �-, gyp/ ❑ TENANT ❑ ELECTRICAL ❑ PLUM13ING MECHANICAL Contractor's Name F� Phone 9re9-89P6 ❑ OTHER _ PROJECT DESCRIPTION SQ. FT. OCCUPANCY— Address (mailing) CON STRVCTION TYPE VALUATION $ City License No.'% _7 ZONE GRADING CU.YDS. ACRES— LICENSED CONTRACTOR DECLARATION $ I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing Remarks: with section 7000) of Division 3 of the Business and Professions Code, and $ my license is in full force and effect. License Class – License No.T.-, GRADING Date C–/f– signat. Bar Sink WORKERS' COMPENSATION DEC TION ' hereby affirm that I have a certificate of consent to self -insure or a certificate Backflow Preventer J Workers' Compensation insurance, Or a certified copy thereof (Section 3800, Lab. C.) Backflow Irrigation Polic CompanI i ied copy is hereby furnished. LJ Certified cotiY is filed with the tih ^'°'^^ Bathtubs (Thisseclion need not be completed if the permit Is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner ,$�' as to become subject to tike Worker§, 9rTPrrtion Laws of Cali f0 rrN3. 7C1s� Date ''SS �s SS Signature l� NOTICE: If, after -making this declaration, Should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prl or to Its issuance, also requires the applicant for such permit to file a signetl statement that he/she is licensed pursuant to the provisions of 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 herefrom and the basis for the alleged exemption. Any violation of Section 031.5 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 (Section 7044, Business and Professional Code: The Contractor's License Law does; not apply to an owner Of a property who builds or improves thereon, and who tloes Such work himself/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 com- pletion, the owner will have the burden of proving he/she did not build or im. rfr the purpose of sale). ,%owner of the property, am exclusively contracting with licensed can. 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 builtls or Improves thereon, and who contracts for such projects with a con. tractor(SI license pursuant to the Contractor's License Law). I am aware that proof off their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner 1 hereby certify that I have read this application and state that the above information Is correct. I agree to comply with all City and county ordinances and statelaws r ng to building construction, and hereby authorize repre. sentatives of th y to enter upon the above-mentioned property for inspection p If i Sigr urea Date – Drivers' License or SS j Drinking Fountains Floor Drains Floor Sinks glas Service Outlets Interceptors Kitchen Sink Lavatories P -Trap Roof Drains Reinspection Fee $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting 00100,000 BTU 0100,000 Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Issue Fee Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System 00.100,Ooo BTu ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 A.P. # S Main Buildi E T Front B Rear A C Right K S Left Ping. Ref. # Planning Notes: 0412 5/12/68 Zona Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ❑50+KW Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00-5 KW 05.15 KW Meter I-Jup to 100 amps Meter Dover 100 amps Sub Panel Motors ❑ 0.1 H P ❑ 1% - 8 Inc. Solar 09-15 HP 016-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor Reinspection Fee 1 $15 I I Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved y Application Issued By SUMMARY Or BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ 3 rOO PLAN CHECK 25% $ Z/ i57D 37.50 TL Z O N I N G R E 0 M T S FEES $ 3 SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTALFEE $ (CONSTRUCTION AND PLANNING OAPPROVALS Permii# Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1•��Temporary Electricaltervice or Pole 52. Pool & Equipment Location 2.+ Soil Pipe-Undrgrnd. r' 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcemen r 56. Rough Plumbing & Pressure Test 6. Electrical UFER GrAd'/ 57. APPROVAL TO COVER-GUNITE C7.6Footings ����� 58. Electrical Conduit-Undrgrnd. 8.�Foundation 1rA �� 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 v7. Rough Wiring Sign n 68. APPROVED FOR PLASTERING .\781 -Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19:,f3bugh Heating &Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # '' 20. Rough Factory Fireplace 21.4Ducts, in Structure 70. Underground Hydro 22.;Ducts, Ventilating 71. Product Piping 0 Gas El Oil _ 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ElGas 0Oil 25. -Roof Sheathing 74. Overhead Hydro 26. ,T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ' 27. Frame and Flashing 76. Dry Standpipe 28.r Lathing & Siding 77. FIXED SYSTEM FINAL! 29..Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT, REQUIREMENT i 31.,Plaster Brown Coat 79. FINAL INSPECTION 32.'Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED f 33. Final Electric Notes: I s, 34. Final Heating & Air Conditioning 3�y 6q 35. Final Gas Pipe -Test -j 36. Hood or Canopy 37. Final Factory Fireplace I ^ I 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 51. CERTIFICATE OF OCCUPANCY No. Date - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.'` CITY OF COSTA MESA CONST/R A1C ION PERMIT PERIyIITs N( 31 ��^ z / TRACT NO. LOT NO. Project lLddress 14 Post A MESR ��/� ✓< y y!24 1988 Applicant's Mailing Address TYPE OF CONSTRUCTION L6 NEW U ADD U ALTERATION REPAIR MAY 1:1CONVERSION ❑ DEMOLISH 1:1OTHER 7,9 D A.P. 0 �___� •.y Zone Owner's Name. - Phone Z311 DESCRIPTION OF WORK/USE OF BLDG. Address ON �,� F 62 S Main Building:CITy "'j&�Building: E Z Arch/Eng. License No. TYPE OF PERMIT U GRACING FOUNDATIOfZt STR VCTU RAL T Front O Address ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING /LI MECHANICAL A Rear N Contractor's Name N Gp� _Pilo e ' °q' 2 El OTHER C Right N Address (mailing) MO I% D Lj I PROJECT DESCRIPTION SO. FT. OCCUPANCY K G CONSTRUCTION TYPE VALUATION 5 $ Left City License No. y ZONE GRADINGCU.YDS. ACRES R LICENSED CONTRACTOR ECLARATION Ping. Ref. 'lk Parking Req./Provided E D I hereby affirm lhdt I am Iitens<tl under prgvl5lon5 of Charter 9 (commencing Remarks: %D ZD LlPlanning Notes: M With section 7000) of Division 3 e Business and Professions Code, and T my license is in I I force and effect '1 ��z p / $ License Class is a No. •/ b O Date Signature _ PLUMBING FEES WORKERS' COMP NSATION DE LA TION Bar Sink Showers ELECTRICAL FEES hereby affirm that I have a cert ii lC consent to If -in re or a Certiflute 4 Workers' Compensation Insurance, or a cern d copy thereof (Section Backflow Preventer Service Sink 3800, Lab. C.) !2L (,,�0 Automatic Washer Transformer ❑ 15-50 KW Policy No. 4n 031168'0 Company '7 r'- SIT Backflow Irrigation Sewer Cap Construction Pole Sub. ❑ 50+KW ❑ Certified copy i5 hereby furnished. ID Certif c i d with the City Building DI Ion. Bathtubs Sewer Connection Cooking Unit Meter ❑up t0 100 amps Date Applicant _ EXEMPTION FIROM WORKERS' COMPENSATI D R ION Clarifiers Solar Collectors Dishwasher Meter ❑Over 100amps (This section need not be completed if the permit Is ne dred ($100) or less). Dish Washer Solar Piping Dryers ❑Gas ❑Electric Sub Panel 1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person In any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors ❑0-1 HP ❑1'h - 8 Workers' Compensation Laws of California. _ Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP ❑16-15+ NOTICE: If, after making this declaration, you Should become subject to the _ Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures Microwave comply with such provisions or this permit shall be deemed revoked - CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Light I hereby affirm that there is a Construction lending agency for the performance of the work for which this permit IS issued (Section 3097 Civ.1•C.)' Lender's Name Interceptors Water Heater Outlets Range Lender's Address Kitchen Sink Water Service Switches Sign - OWNER BUILDER DECLARATION �- I hereby affirm that I am exempt from the Conlractor'S License Law for the Lavatories Auto -Wash Garbage Disposal Standing Sections following reason (Section 7031.5 Business and Professional Code: Any.city or county which requires a permit to construct, alter, Improve, demolish or repair IP—Trap Laundry Trays %•' Generator 00-5 KW 05-15 KW Trash Compactor any Structure, prior t0 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 „J the Contractor's License law (Chapter 9(commenting with Section 7000"0' 'Division 3 of the Business and Professions Code) Or that he/She is exempt herefrom and the basis for the alleged exemption. Any violation of Section 031.5 by any applicant for a permit Subjects the applicant l0 a civil penalty of not more than five hundred dollars ($500). $ 3 Lj 1, as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee compensation, for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL will do the work, and the Structure is not intended or offered Reinspection Fee $15 Issue Fee $ 3 FEES License Law does not apply to an owner of a property who builds or improves thereon• and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that Such Improvements are not Intended Or offered for Boiler Hood Or Type 1 ❑ sale. If, however• the building or Improvement Is Sold within one Year Of Com- Canopy Type 11 ❑ 'Zoning Approved By Date pletion, the owner will have file burden of proving he/she did not build or Im- Duct - Under Ground Building Approved By Date eve for the purpose Of Sale). s I, as owner of the property, am exclusively Contracting with licensed Con- Duct - Structural Refrigeration System Application Issued By ,I Dat tractors to construct the project (Section 7044, Business and Professions Coder The Contractor's License Law does not apply to an owner of properly who Duct - Ventilating ❑0-100,000 BTU ❑100,000 BTU SUMMARY OF FEES builds or Improves thereon, and who contracts for such projects with a con- tractor(s1 license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple C3 System Repair/Alteration BUILDING PERMIT $ SMIP $ proof off their Worker's Compensation Insurance should be provided to me. _ PLAN CHECK $ PERMIT ❑ I am exempt under Section B. & P. C. for this reason Firepl/Fact. Bit. ICBO 4h 2401 Fire Dampers PLUMBING $ ISSUANCE $ Date er Heating System & Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ information certify that I In ve re application and State that the above ❑4100,000 BTU ❑100,000BT ELECTRICAL $ GRADING S Information is correct. I a ree to c y with all city an county ordinances and state laws relating to ulldi g lr tion d hereby authorize repre- PLAN CHECK 50% $ MICROFILM $ sentatives Of this city t Ove -mentioned Or P rty f r i inspection purposes. g' MECHANICAL $ TOTALFEE $ Signature Date Drivers' License or SS , 0 Reinspection Fee $15 Issue Fee 15-- ME Si $ r(�r PLAN CHECK 25% $ CMF 0865-46, rev. 10/64 White - Building: Canary - Applicant: Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Perniii # Date Inspector POOL & SPA APPROVALS Permit # Date , Inspector 1.7Temporary 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 LIFER Grnd. 57. APPROVAL TO COVER-GUNITE r,i.'Footings 58. Electrical Conduit-Undrgrnd. 78.(Foundation 59. Gas Pipe, O Undrgrnd., Test 9� Water Pipe-Undrgrndh.- - . 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 131 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 48. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # t 2/4 20. Rough Factory Fireplace 121. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas OOiI 23. Gas Pipe -Rough & Test 72. Underground Flush - 24. Roof Framing 73. Undergrnd. Storage Tank OGas OOil / f 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 .L_ ��• ' 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT �•' 31. Plaster Brown Coat 79. FINAL INSPECTION r;�1 ^ 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas•Pipe-Test 36.• Hood or Canopy _ - - 37.,Final Factory Fireplace-- 38..Final Plumbing -� 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer - I '43. -Backflow Irrigation _ _:; =.`� -• j r 9 44. ,Landscape Irrigation System 45: -Sound Attenuation - • '- ; .. r. • • P • 7 L46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING • ``- ' 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ` 51. CERTIFICATE OF OCCUPANCY No. Date - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. d -Y'OF COSTA MESA CONSTRUCTION PERMIT Project Address 2fE E; IEfh pL.cot,4l e Applicant's Mailing Add/r ss Owner's Nameco ;i A �r ✓�SfflYbYYC Phone 7iz-,F311. Address L17-D(,;rr - (s¢e. %/IEr 7P r'A1 47�ar� -1 Arch/Eng. License No. Address Contractor's Nam • Phone w Address Imailing) -e• City License No. OA LICENSED CONTRACTOR DECLARATIO I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force a Q effect.) Ucensa C ass C l]_ L ense N Date ^- Signature WORK RS'COM ENSATION DB A ION ' hereby affirm that 11 have a cern/irate o1 onsenl to selftin re or a certificate If Workers' Compensation Insurance, r a certified copy thereof (Section J qLab. CJcy No. __�S O Company -/--t ' F✓�V Cer titled copy is her y furnished. Cert f e copy s filed with the city Bull in j !o Date Applicant EXEMP ON F OM ORKERS' C MP N ATION DEC LARATI (This sec ion neetl not be completed if the p It Ig {or.one huner ($100) or less). 1 certify that in the performance of the Ork 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. Data Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit Shall be deemed revoked. 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 (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit t0 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/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Olvision 3 of the Business and Professions Code) or that he/she is exempt herefrom and the basis for the alleged exemption. Any violation of Section /031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property Or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for .sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such Improvements are not intended or offered for Sale. 11, however, the building or improvement is told within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove efor the purpose of sale). I, as owner of the Property, am exclusively contracting with licensed con. tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor( license pursuant to the Contractor's License Law). 1 am aware that proof' O(( their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section — B. & P. C. for this reason Date I hereby cerci. information is and state laws sentatives of inspection purr Signature _ Drivers' Llceds CMF 0865-46, rev Owner _ that I have read thi sect. 1 aoree to com SS a the TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION DEMOLISH ❑ OTHER A.P. DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TYPE OF PERMIT GRADING El FOUNDATION STRUCTURAL T Front ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 'B Rear ❑ OTHER A PROJECT DESCRIPTION SO. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATION$ S Left ZONE - GRADINGCU.YDS. ACRES Ping. Ref.# Remarks: i6isl•116?% I Planning Notes: ar Sink ackflow Preventer ackflow Irrigation athtubs larifiers ishwasher rinking Fountains loor Drains loor Sinks as Service Outlets rterceptors Itchen Sink avatories -Trap' Ioof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑0.100,000 BTU 0100,000 BT Reinspection Fee I $15 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System O0-100,000 BTU Cl 100,000 System Repair/Alteration Fire Dampers Registers Issue Fee FEES . Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A. U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator C10-1; KIN E15-15 K 9895 11./'19/87 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15.50 KW ❑ 50+KW Meter up to 100 amps Meter Clover 100 amps Sub Panel Motors 00-1 HP Ell 'A - 8 Inc. Solar 09.15 HP Ell 6-15+ Microwave Pole Light Range Sign Standing Sections W Trash Compactor $ 3 $ PERMIT Reinspection Fee $15 Issue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By -e^/ Building Approved By RCen Application Issued By J/ ENERGY P.C. $ GRADING $ MICROFILM $ SUMMARY OF FE BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ �_._ ELECTRICAL $—_ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ $ 3 35.40 TL N G R E Q M T S FEES $ 3 SMTP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTALFEE $3r.k CONSTRUCTION AND PLANNING APPROVALS Permit #- Date I 'Inspector POOL &SPA 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. i 55. Electrical Bonding 5. Steel Reinforcement., 56. Rough Plumbing & Pressure Test 6. Electrical LIFER GrHZ ' 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation i r 59. Gas Pipe, 0 Undrgrnd., Test 9. Wates Pipe-Undrgrnd, 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line ,& House Connection62. 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 7 -17 -chi •( V _67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL l( 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil 23. Gas Pipe -Rough & Test 72. Underground Flush ' 24. Roof Framing 73. Undergrnd. Storage Tank 0Gas 0Oil 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 n . 30. Drywall Nailing HEALTH DEPT. REQUIREMENT lj,' 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 �! K 'e 38. Final Plumbing ,•` ; 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final a 42. Backflow Preventer • 43. Backflow Irrigation 44. • Landscape Irrigation System } - 45. Sound Attenuation r 46. Handicap Regulations 47'. FINAL STRUCTURE & BUILDING r 48. Special Requirements Completed r '. 49. Electric Release to Edison - 1 a 50. Gas Release to Southern California Gas Co •, 51. CERTIFICATE OF OCCUPANCY No. Date r , H Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMITLL ',Project Addressy b . F. I&A'N �. =ri e-{ `n.y ',U. Is 1163 —1..,, "" _" UNI' . G Meter ❑up to 100 amps TYPE OF CONSTRUCTION LJ NEW Ll ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER - DESCRIPTION OF WORK/USE OF BLDG. - Applicant's Mailing Address y, Owner's Name-�.C:iLS_OLiG�Yb� rPFone-L�-z1j_ Address �n"Y `%r+Is 11.i 4< L:9�i h'- P(�al QQ�/-,yam] Dryers []Gas ❑Electric A.P.yM, E T B A Main Bu Arch/Eng. leen se No. / Address 1�v� �/lr�&PA %Ah TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL � ❑TENANT ❑ELECTRICAL PLUMBING ❑MECHANICAL ❑ OTHER Front Rear Contractor s Name- Address am Phone Address(mailing)�' � 7%1, rtr'r✓.(pr Inc W, .tib i37/C. A2 PLe CA C17q, City License No. 0116 tl"Z LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and affect.�j Licensee�C,llass `� icense N �� 20 is Date ]�eI S9 SignatureZ +�%//--A 'VOR KERS'CO PENSATION DECLARATION hereby affirm that I have a certificate of consent to self -Insure or a certificate A Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) p IPolicy No. �—�%-I�hrl T%� CompanyV), 5, �77��� Gl'lAh� CY CertlfCertiigecity Is fieetlbwithrn d. Building DlvlSion. /}J Date �'x �' Applicant c ���N+ EXEMPTION FROM WORKERS' COMPENSATION D CLARATION (This section need not be completed if the permit is for One hundred ($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 t0 become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, You must forthwith comply with Such provisions or this permit shall be deemed revoked. 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 (Section 3097.•Civ. C.) Lender's Name Lender's Address _ OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License-L-aw for the following reason (Section 7031.5 Business and Professional 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 forsuch permit to file a signed statement that he/she is licensed pursuant to the provisions of 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 Iteration, and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant t0 a civil penally 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 (Section 7044, Business and Professional Code: The, Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden Of proving he/she did not build or im. prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tract Or(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. 8 P. C. for this reason Date Owner I hereby certify that I have rea information is correct. I agree to and state laws relating to builtlii sentatives of this cit [o enter inspection purposes. Signature Drivers' License or 5�* this PROJECT DESCRIPTION SG. FT. OCCUPANCY C Right KLeft ' CONSTRUCTION TYPE VALUATION $ $ ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: rj ZA I C% O Planning No 3ar Sink 3ackflow Preventer 3ackflow Irrigation 3athtubs Dlarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Sas Service S Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping - Solar Tank Swimming Pool w/Spa Urinal Outlets Water Closet Water Heater Water Service Auto -Wash $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑6100,000 BTU ❑100,000 upontheabove-mentionedPro ertY for 0 Date (1 � - 4 � h- Reinspection Fee -7 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 9708 11/17/87 Zone Accessory Building: Parking Req./Provided 47d3B TL Z O N 1 N G R E Q M T S osalStanding Sections 0-5 KW 05-15 KW Trash Compactor Issue Fee ELECTRICAL FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+ KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter Dover 100 amps Dryers []Gas ❑Electric Sub Panel Fan Motors 00-1 HP ❑1''A - 8 F.A.U. Inc. Solar 09.15 HP 016-15+ Fixtures; Microwave Device Boxes Pole Light Outlets Range Switches Sinn - osalStanding Sections 0-5 KW 05-15 KW Trash Compactor Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 4ANICAL . FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved ByDate Application Issued By ­-4-Data Date k Hood or Type I ❑ Canopy Type 11 ❑ Refrigeration System 00-100,000BTU 1_1100,000BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ $ $ $ $ _ SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ r'D System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 CONSTRUCTION AND:,OLANNING APPROVALS Permit# Date Inspector POOL & SPA APPROVALS Permit# Date Inspector 1 :'Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. :�/� // '� 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings/ 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR'PLASTERING 18. Rough Electrical -T Bar Ceiling ,..;. k- w 69. BOOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # _ 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas El Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing i� it 1 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT n. 31. Plaster Brown Coat r , 1 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 30-:' Final Plumbing - 3r/,v7;4 LO , 39. Water Service -Final 40. Gas Service -Final' - „41. Solar Domestic -Final 't •• �42. Backflow Preventer • 43. Backflow Irrigation 44' Landscape Irrigation System 1 �� n' �. - •; r ' 45. Sound Attenuation 46. Handicap Regulations ' 47.•FINAL STRUCTURE&BUILDING 48. Special Requirements Completedr- 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date City of Costa Mesa Development Services Department Building Safety Division CERTIFICATE OF OCCUPANCY No. 002443 P. O. Box 1200 Costa Mesa, California The Building located at 216 East 16Th Place, Unit J has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group Rl Occupancy. Use of Building Condominium Legal Description 425-202214 (See reverse side for Metes and Bounds) Building Permit No B 20201 Electrical Permit No. E 31220 Plumbing Permit No. P 3116+7 Mechanical Permit No. M 33479, M 33698 ISSUED TO: \ Costa Mesa Leqder Enterprise, Inc. /2 Flower Street \ Costa Mesar CA 92627 Number of apartments and/or guest rooms Building Official William T. Howard //1) // March 21, 1989 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CMF 1015-46 rev. 1/83 white -Owner; Canary - Numerical File; Pink - Bldg. Permit File Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY O.F COST=ACON ITRI)CTION PERMIT # 7 Project Address Applicant's Mailing Address Owner's Name Lt%�FT,"j LEAVEK Eiv(ERI'f:15L--5 Phone'722-2:10 Address 04 (LrVV1 5T. Co5tr1 VV-: GP R2bz7 Arch/Eng. License No. Address 11�.w'1L Contractor's Named Antes !-�I ,11 . 7 �Phon�l Ail- 2 Address(mailing) G� 1-teT/T�1a'' PI;S'�+-s 110 I ke hS( City License No. LICENSED CONTRACTOR DECLARATION - I hereby affirm that I am licensed under provisions of Charter 9 (commencing vith section 7000) of Division 3 of the Business and Professions Code, and ny license is in full for antl effect. License Class-ice\rta o33 q20 Date S -L- 1 — e7l Signature r 4 3- ---� WORKERS' COMPENSATION DEC LARAN I hereby affirm that I have a certificate of ddd nsent to self -Insure or a certificate if Workers' Compensation Insurance, or a certified copy thereof (Section 1800, Lab. C.) 1 / V �I �US �b5W V > 44kh � Policy No. �0—b$ 1I Compan C`I=f L9 t.YlTA^"1 ❑ Certified copy is hereby furnished. Cp Certifietl opy is filed with the City Buil n wi5ion. j )ateQ IApplicant �( s}i �`-' EXEMPTION FROM ORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the' performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to became subject to the Workers' Compensation Laws of California. Data Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name' Lender's Address OWNER BUILDER DECLARATION hereby affirm,that 1 yam exempt from the Contractor's License Law for the :ollowing reason` (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Oivisi.0,3 of the Business and Professions Cotle) or that, he/she is exempt 7031.5 by any applicant for a'permit subjects the applicant to a civil enafty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their Sole compensation, -will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law tloes not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for Sale. If however, the buildingor improvement is sold within one Year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove efor the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con. tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). 1 am aware that proof of their Worker's Compensation insurance should be provided to me. ❑'I am exempt under Section B. & P. C. for this reason Date I hereby certifl information -is c and state laws i sentatwes Of if inspection purl,{ Signature y` Drivers' License Owner that I have read this application and State that the above 'rect. I agree to comply with all city and county ordinances lating to building construction, and hereby authorize core. citty__rto_ upon the above-mentioned property for /kc - - Dace -� TYPE 1- OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. S Main Building: TYPE OF PERMIT L1 GRADING 0 FOUNDATION E STRUCTURAL T Front ❑ TENANT' ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A / PROJECT DESCRIPTION Sq. FT. OCCUPANCY kl C Right10, CONSTRUCTION TYPE VALUATION^$ S Left 6_{�4_ ZONE GRAOING CU.YDS. ACRES Ping. Ref. # T/'�. Remarks: Planning Notes: 1 PLUMBING I FEES 5096 9/11/87 Zone Accessory Building: b Parking Req./Provided 365,82 TL Z O N I N G R E O M T S Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Transformer ❑ 15.50 KW Construction Pole Sub. 1:150+KW Backf low Irrigation Sewer Cap Bathtubs _ Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors C30.1 HP❑1'/,-B Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09-15 HP ❑16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service - Outlets Water Closet Device Boxes Pole Light Interceptors • Water Heater Outlets Range _ Kitchen Sink Water Service. Switches Sign Lavatories Auto -Wash Garbage Disposal - Standing Sections ' P—Trap _ _ - - - Laundry Trays Generator ❑0-5 KW 05.15 KW Trash Compactor Roof Drains -- Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fast $ 3 MECHANICAL FEES Boiler Hood or Type I ❑ Canopy Type II El.- DEVELOPMENT S ICE I EM S: G, Zoning Approved By Date r O Building Approved By Nl'��� Date' � � p 7 Application Issued By Duct - Under Ground Duct -Structural Refrigeration System - ❑0100,000 BTU 0100,000BTU Duct - Ventilating SUMMARY, OFF EES [r''2 BUILDING PERMIT $ 3L6 "r�0 SMIP $ PLAN CHECK $-3 0 PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25%j $ ENERGY P.C. $ ELECTRICAL $ GRADING - S PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTALFEE $ 383- SZ PLAN CHECK 25% $ Exhaust System ❑ Multiple ❑ System Repair/Alteration - Firepl/Fact. Bit. ICBG# Fire Dampers Heating System & Ducting ❑0100,000 BTU❑ioo,000u Registers - Reinspection Fee $15 Issue Fee $ 3 IF 0865-46, rev. 143/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector POOL & SPA 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 LIFER Grnd. ij u ijyJ4 57. APPROVAL TO COVER-GUNITE 7. Footings N P 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'- 8 61. APPROVAL TO DECK" �' •• ' - 11. Property Sewer Line & HouConnection / 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 00il 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas 0Oil ' 25. Roof Sheathing '" 8 D� 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Mono oat 75. Dry Chemical 27. Frame and Flashing - 7 O 76. Dry Standpipe 28. Lathing & Siding a 77. FIXED SYSTEM FINAL - 29. Insulation 1 0-4"-"- 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat b' 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 31 Sl OF ir�22 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 •�6, 8 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co _ 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. GkTY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT Nil.. Project Address �'I b (^.-�fa �L• Applicant's Mailing,^ddr Ow er's NameCCYXLL=ii_-�11ALL c t^, �j6hone�LD-^VZ I% Address T��T�rxsl.P7v �il( �!1l+I'A II (e4is y /.A Z7,i Arch/Eng. License No. Address _14 ft Contractor's Nam r Oyu ��u n V hone,LZ tJ r'I" m / )24— Address (mailing) 3"Ci1! t, City License No. OU -J. Fy-7— LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions o1 Charter 9 (commencing vith section 7000) o1 Division 3 o1 the Business and Professions Code, and my license is In full force an affect. _ I_ License ClassLl ansa No. �(J� Date Signature •� WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self4mure or a certificate rf Workers' Compensation Insurance or a certified copy thereof (Section 3600, Lab. C.) D31�6 ml Policy No. ompany ¢�Ce'titre Copy Is filed with y is hereby rthe hcity Building Olvision. pate ( {^ Applicant— EXEMPTION EXEMPTION FROM WORKERS' COMPENSATION EELARAT ION (This section need not be completed if the permit Is for one hundred ($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. Date Signature NOTICE: If, after making this declaration, you Should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I/i I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is Issued (Section 3097} C1v. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License law for the following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cotle) or that he/She is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Subjects the applicant to a civil malty of not more than five hundred dollars ($500). LJ I, as owner of the property or my employees with wages as their sole compensation, will tl0 the work, and the Structure IS net intended Or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that Such improvements are not Intended or offered for sale. If, however, the building or Improvement is Sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Inn. rove for the purpose of sale). -I, as owner of the property, am exclusively Contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con. tractor(sl license pursuant to the Contractor's License Law). 1 am aware that proof of( their Worker's Compensation Insurance Should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentionedpro arty for inspection purposes. l� �/ Signature Date Drivers' License or SS 9704 11/17/87 47.38 TL 1'31/6 SUMMARY OF FEES BUILDING PERMIT $ SMIP S TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ ❑ ❑ $ ISSUANCE S CONVERSION DEMOLISH OTHER $ g • ENERGY P.C. A.P. ,#b Zone DESCRIPTION OF WORK/USE OF BLDG. $ GRADING S PLAN CHECK 50% $ MICROFILM $ S Main Building: Accessory Building: t_ f 2 p +- +-7.3o MECHANICAL E 5 .3 TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B ❑ OTHER A Rear C Right PROJECT DESCRIPTION SQ. FT.OCCUPANCv K CONSTRUCTION TYPE VALUATIONS S Left ZONE GRADING CU.YDS. ACRES Ping. Ref.+ Parking Req./Provided Remarks: R 2/7Z0I Planning Notes: Sink Preventer Irrigation Drinking Fountains Floor Drains - Floor Sinks Gas Service 3- 'Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct- Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO + Heating System & Ducting ❑ 0-100.000 BTU ❑ 100.000 BT Reinspection Fee I $15 `0665-46, rev. 10/84 White - Builtling; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Issue Fea Hood or Type I ❑ Canopy Typeil ❑ Refrigeration System ❑a100,000BTU 0100, System Repair/Alteration Fire Dampers Registers Issue Fee FEES Automatic Washer Construction Pole Su Cooking Unit Dishwasher Dryers ❑Gas ❑EIS Fan F.A.U. Fixtures Device -Boxes Outlets, Switches Garbage Disposal Generator 00-5 KW ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KIN Meter ❑up to 100 amps Meter Dover 100 amps Sub Panel Motors 00.1 HP El h - 8 Inc. Solar ❑9-15 HP ❑16-15+ Microwave Pole Light - Sign Standing Sections 15 KW Trash Compactor 53' Reinspection Fee 1 $15 Issue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By _. $ 3 FEES $ 3 Z O N I N G R E O M T S SUMMARY OF FEES BUILDING PERMIT $ SMIP S PLAN CHECK S PERMIT PLUMBING $ ISSUANCE S PLAN CHECK 25% $ g • ENERGY P.C. $ ELECTRICAL $ GRADING S PLAN CHECK 50% $ MICROFILM $ t_ f 2 p +- +-7.3o MECHANICAL $ TOTAL FEE 5 .3 PLAN CHECK 25% $ CONSTRUCTION AND"PLANNING APPROVALS Permit# Date Inspector POOL & SPA 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 LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings , 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. �7 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection*lyf NN 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing S1 /Sly LED 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign r n 68. APPROVED FOR -PLASTERING 18. Rough Electrical -T Bar Ceiling .+,..r 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # _ 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas OOil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Unci Storage Tank OGas OOil 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 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 191 36. Hood or Canopy 37: Final Factory Fireplace •.- .� •' 38, Final Plumbing 3h3 y4 cC/o 39. Water Service -Final 40. Gas Service -Final sy ' 41. Solar Domestic -Final - - C � ..r • -42.,Backflow Preventer • ' "43. Backflow Irrigation i 44. Landscape Irrigation System i7' f - t' 45. Sound Attenuation 46. Handicap Regulations , +i • r_ , -. . 47.: FINAL STRUCTURE & BUILDING }'• -V- r �- 48. Special Requirements Completed n 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ' „- 33 q' � APPlicant to fill in ail spacers except those within heavy border lines and sign all appropriate declarations. CITY OF.COSTANESA CO,NfSTRUCTI�O-/N •�PERMIT PERMIT NO. 3_7,4 ' TRACT NO. LOT NO. �1jV1T NO. Project Addresf o?l(7 1L` t'{:S/A /KF A Applicant's Mailing Address w• r -,7-A,'/0` 6 --yp Owner's Name _e7fd%R C10 1704 N%ld Phone _%o _r,% Address Arch/Eng.(cense No. Address Contractor's Na MELK Phone q��9-8996 Address (mailing) City License No. h �� LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing vith section 7000) of Division 3 of the Business and Professions Code, and ny license is in ful force nd effect. ab'I GS -1 License Class `a icense No. Date 6-11-8i Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure or a certificate rf Workers' Compensation Insurance, or a certified copy thereof (Section 1800, Lab. C.) - BCertified copy is hereby furnished. Certified copy is f' wslo Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issuetl, I shall not employ any person in any mann o eco me subject to the Workers' Comp anon Laws of Calif Orn Date' ,/� Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address – OWNER BUILDER DECLARATION hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance; also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business any Professions Code) or that he/she i$ exempt therefrom and the basis for the alleged exemption. Any violation of Section '031-5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). 1, 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 (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). I, as the of the property, am exclusively contracting with licensed con- Iractorsto construct the project(Section 7044, Business antl Professions Cod a: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that proof o their Worker's Compensation insurance should be providetl to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of thi enter upon the above-mentioned property for inspection purp Signature _ Date Drivers' License or SS x B ;3 C3 =J—bi— • ' I I Q oR I oT 7 BarSink Showers $ TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR Backflow Preventer Service Sink GRADING ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # DESCRIPTION OF WORK/USE OF BLDG. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps S Main Bui Dishwasher Meter Clover 100 amps ET TYPE OF PERMIT 1:1GRADING 0 FOUNDATION STRUCTURAL Drinking Fountains Solar Tank Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL B ❑ OTHER A Rear Fixtures Microwave Gas Service Outlets - Water Closet Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY—C KLeft CON STRUCTION TYPE VALUATION$ S ZONE GRADING CU.YDS- ACRES Ping. Ref. # Remarks: Q 7i C—yn ?, / Planning Not 0416 5/12/88 Zone Accessory Building: Parking Req./Provided 37o5G TL Z O N I N G R E Q M T S PLUMBING FEES - BarSink Showers $ - ELECTRICAL FEES Backflow Preventer Service Sink GRADING Automatic Washer Transformer ❑ 15.50 KW ❑ 50+KW Construction Pole Sub. Backflow Irrigation Sewer Cap $ ' Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps Dishwasher - Solar Piping - Dryers ❑Gas ❑Electric - Sub Panel Drinking Fountains Solar Tank Fan ,Motors ❑0-1-HP❑1X-8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 119-15 HP 016-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets - Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal Standing Sections R_ Trap Laundry Trays Generator 00-5 KW El 5-15 KW Trash Compactor Drains I Reinspection Fee 1 $151 1 Issue Fee 1 $ 3 1 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBG # Heating System & Ducting ❑ D7 00,000 BTU ❑ 100,000 Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White . Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type ❑ Canopy Typell ❑ Refrigeration System ❑0-ioo.00OBTU 0100,000137 System Repair/Alteration Fire Dampers Registers Issue Fee S I Reinspection Fee 1 $15 1 1 Issue Fee 1 $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ ' TOTAL FEE $ 37'3-0 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1,"Temporary Electrical; Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd.il' 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement el' 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd A - 57. APPROVAL TO COVER-GUNITE n7 ;Footings j 58. Electrical Conduit-Undrgrnd, 8.* Foundation r - 59. Gas Pipe, 0 Undrgrnd., Test 9..NVater Pipe-Undrgrnd:�f 60. Backwash Lines, P -Trap, 0 Undrgrnd. i 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 f1,7., Rough Wiring Sign 68. APPROVED FOR PLASTERING i18., Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19 -Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # _ 20. Rough Factory Fireplace 21.,Ducts, in Structure 70. Underground Hydro ' 22. Ducts, Ventilating 1 71. Product Piping 0Gas 0Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas 0Oil ' 25., Roof Sheathing 74. Overhead Hydro 26 -T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. yFrame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL , •. 29. -Insulation 78. FIRE PREV. FINAL G 30:' Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION C" 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning I 35.•Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace " 38. Final Plumbing 39. Water Service -Final ' � n 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer , �- 43. Backflow Irrigation 44. Landscape Irrigation System r J 45. Sound Attenuation 46. Handicap Regulations ( ✓ - 47. FINAL STRUCTURE & BUILDING ` 18 -Special Requirements Completed 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Q) 51. CERTIFICATE OF OCCUPANCY No. Date �( ( ' Applicant to fill In all spaces except those CITY OF.COSTA MF,Sp / CONSTRUCTION PERMIT Project Addren Ll C _(/, �'`r/, e!�iz-74 MESS Applicant's Mailing Address Owner's Na e-7 9� �yTf —MF k O E12 1, Address — �A 14 Arch/Eng. License No. Address Contractor's Nam �I 'N� ne Address (mailing) /rS3 RP City License No. tL 2642 LICENSED CONTRACTORDECL ATION I hereby affirm that 1 am license un provisions of Charter 9 (commencing ,ith section 7000) of Division 4 of th Busl is and Professions Code, and 4y license is in !At force and effe 52 0 License SIS - ice se No.� 7 Date S Signature WORKERS COMPE SATION DE LARA I N I hereby affirm that I have a cerlifi to of o sent t self-inswe or a certificate I Workers' Compensation In sura ta, as certlf ed copy thereof (Section thereof (Section 800, Lab. C.) 2 IIn Policy No. �1�.1�0311'L�1 Compan I1l Certified copy Is hereby furnished. atC!r ffPd/co y�YOlrj with t Canty Building Divi EXEMPT16N FROM WORKERS' COMPENSATION DRCLA ION (This section need not be completed if the permit is for one hundred ($100) or less). I c%tity 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. Date _ Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION hereby affirm that I am exempt from the Contractor's License Law for the rollowing reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of 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 'herefrom and the basis for the alleged exemption. Any violation of Section 031.5 by any applicant for a permit subjects the applicant to a civil aenally of not more than five hundred dollars ($500). ❑ 1, 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 (Section 7044, Business and Professional Code: The Contractor's 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 emp)pypes, Provided that sucn Improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, ds owner of the property, am exclusively contracting with licensed Con- 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 build% or Improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). 1 am aware that Proof o1 their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date I hereby certify that I Information is correct and state laws reMlin Sentatives of this cit inspeetlon purposes Signature Drivers' License or SS W CMF 0865-46, rev. 10/84 Owner a heavy border lines and sign all appropriate declarations. NO. I LOT NO. I UNIT Nf) TYPE OF CONSTRUCTION_ LPNEW LI ADD LJ ALTERATION r!1 REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER _ DESCRIPTION OF WORK/USE OF BLDG. eCN IN MIWAM TYPE OF PERMIT LJ GRADING L FOUNDATION ��11 LJ STRUCTURAL TENANT ElELECTR/IIC L QPLUMBING XMECHANICAL 95LOTHER If 15- WIK5 PROJECT DESCRIPTION SO. FT. OCCUPANCY, CONSTRUCTION TYPE VALUATION $ ZONE GRADINGCU.YOS. ACRES_ Remarks: U -ii �!, J 0 Sink Preventer Irrigation Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P -Trap Roof Drains Reinspection Fee $15 Boiler Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBG # U Heating System & Ducting ❑6100,000 BTU 0100,000 Reinspection Fee 1 $15 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash ✓ FEES Issue Fee $ 3 AANICAL FEE Hood or Type ❑ Canopy Typell ❑ Refrigeration System E10-100,000BTU 0100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee Ie Sea hARV 2d 10APt - A.P. # .._.11, Zone S Main Building:r nl1C rAccgs rA Building: E V. I I v1 ^' T Front B Rear A C Right K Left Ping. Ref. # Parking Req./Provided Planning Notes: - ELECTRICAL Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter ❑over 100 amps Dryers ❑Gas ❑Electric Sub Panel ' Fan Motors ❑0-1 HP ❑1'/:-B F.A.U. Inc. Solar 09-15 HP 016-15+ Fixtures Microwave Device Boxes Pole Light ' Outlets Range Switches - - Sign - Garbage Disposal Standing Sections Generator 00-5 KW ❑5-15 KW Trash Compactor Reinspection Fee $15 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By f! !Is FEES 3 Z O N 1 N G R E 0 M T S PLAN CHECK 25% $ SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ (�� �J` TOTALFEE $ PLAN CHECK 25% $ CONSTRUCTION AND'PLANNING. APPROVALS Permit# Date Inspector POOL & SPA APPROVALS Permit# Date Inspector l .-jemporary Electricar Service or Pole - 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE ,A,Footings 58. Electrical Conduit-Undrgrnd. �8.,,F.oundation 59. Gas Pipe, O Undrgrnd., Test 9.j Water Pipe-Undrgrnp! ; 60. Backwash Lines, P -Trap, D 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 r 68. APPROVED FOR PLASTERING .48. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # { 20. Rough Factory Fireplace n / .121. Ducts, in Structure i 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping DGas ❑Oil - 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank D Gas D 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 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: .7%? 34. Final Heating & Air Conditioning 35. Final Gas'Pipe-Test c 36: Hood or Canopy 37. -Final Factory Fireplace 38- Final Plumbing 39 'Water Service -Final 40. Gas Service -Final - K 41. Solar Domestic -Final 42. Backflow Preventer :-43! Backflow Irrigation • 44t Landscape Irrigation System - ( '� -�, -•- t+ . -'1 45.iS6und Attenuation- -7 L.- y - ,• ri �4VHandicap Regulations 47.IFINAL STRUCTURE & BUILDING -�, �. _ •( '- .. "�-K� + t 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 'r: r• _ 51. CERTIFICATE OF OCCUPANCY No. Date' ' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate -declarations. CITY, Ort COSTA MESA CONSTRUCTION P RMIT ,,1� Project Address 2(E F' IC �. G;G Stt� I�r ESa 'tC T Applicant's Mailing Address Owner's Name f S'E'A Mc's'a I 'n+iP✓ �SY,nY��GfAhone 7z c — Q-_ert Address I_QZ,_OatL:ce Si Ce -m, N v & GA 97E 7 Arch/Eng. License No. Address Contractor's Name qi!� £ " �Phone 7A Address Im 'f 1 � 4 City License No. LICENSED CONTRACTOR DECLAR TION I hereby affirm that I am licensed under provisions of Charter 9 (commencing Iith section 7000) of Division 3 of the Business and Professions Code, and ny license is full for and a fZ� O License CI s o Date ( N Signature WORKE S' COMP NSATION D [ARA tON 1 hereby affirm that I have a certificate of onsent to self -insure o a certificate s f Workers' Compensation Insurance, or a certified copy thereof (Section 80ji' Lab. C ) CC P��oy�7/cryy No. C Company ✓Cert ifi ed copy is her by furnished. LLLa�2---Cert if ie cop 'letl with the city Build Date T' Applicant EXEMPT ON FRO WORKERS' CO A N DEC LA RATIO (This section need not be completed the pergrit is for one hundred 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. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensationprovisions of the Labor Code, you must forthwith comply with such provisions or this permit Shall be deemed revoked. 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 (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (cornmencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 1031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole compensation, will, do the work, and the structure is not intended or offered for sale (Section 7044, Business and professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/nerself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the'building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im. prove for the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor($) license pursuant -to the Contractor's License Law). 1 am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read information is correct. I agree to r inspection purposes. Signature Drivers' Lice or 55 CMF 0865.46, rev. 10/84 to that the above county ordinances V authorize repre- ned pr ert for %li%P� F 3 t2_Z(D TYPE OF CONSTRUCTION IJ NEW LJ ADD LJ ALTERATION IJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TYPE OFPERMIT,j GRADING FOUNDATION STRUCTURAL LJ TENANT If-1T<Y ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SO. FT. OCCUPANCY CON STRUCTION TYPE VALUATION$ ZONE GRADINGCU.YDS. ACRES Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains _Floor Drains Floor'Sinks Gas Service -. Outlets Interceptors Kitchen Sink lavatories' P—Trap?= ` Roof.Dreins Reinspection Fee $15 Boiler Duct- Under Ground Duct -Structural . Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting ❑ 0-100,000 BTU 13100,000 BTI Reinspection Fee I $15 Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w Urinal Water Closet. Water Heater Water Service Auto -Wash Laundry Trays Issue Fee Hood or Type I ' ❑ Canopy Type If ❑ Refrigeration System ❑0100,000BTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee FEES ELECTRICAL 9899 11/19/87 A.P. # Zone S Main Building: Accessory Building: E T Front Fan ARear F.A.U. Inc.Solar ❑9-15 HP 016-1 C Right Device Boxes - K S Left Range Ping. Ref. # Parking Req./Provided Planning Notes: Standing Sections ELECTRICAL Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW -050+KW Cooking Unit Meter up to 100 amps Dishwasher _ Meter ❑over 100 amps Dryers ❑Gas ❑Electric Sub Panel - Fan Motors.00-1 He ❑ 1 Y - 8 F.A.U. Inc.Solar ❑9-15 HP 016-1 Fixtures - Microwave Device Boxes - Pole Light Outlets Range Switches Sign Garbage Disposal Standing Sections I Generator 00-5 KW 05-15 KW Trash Compactor $ 3 Reinspection Fee $15 Issue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By 35c40 .'TL Z O N I N G R E Q M T S FEES oo $'3 SMIP $ -- SUMMARY OFr' BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ ISSUANCE $ ENERGY P.C. $ GRADING - $ MICROFILM , $ $ 3 35c40 .'TL Z O N I N G R E Q M T S FEES oo $'3 SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING - $ MICROFILM , $ TOTAL FEE $ 35. yo CONSTRUCTION AND PLANNING APPROVALS Permit # Date _ Inspector POOL &SPA APPROVALS Permit # Date ' Inspector , 1. Temporary Electrical Service or Pole 52. Pool 81 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 LIFER Grriil. 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, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Linei&'.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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro '! 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil' 23. Gas Pipe -Rough & Test 72. Underground Flush Ij 24. Roof Framing 73. Undergrnd. Storage Tank []Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT , 31. Plaster Brown Coat 79. FINAL INSPECTION ! ` 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED -- 33. Final Electric Notes:+ 34. Final Heating & Air Conditioning ,i. 35. Final Gas Pipe -Test �o 36. Hood or Canopy ... '� 37. Final Factory Fireplace ` l+ 38. Final Plumbing 39. Water Service -Final ' 40. Gas Service -Final r' 41. Solar Domestic -Final I?+ • 42. Backflow Preventer r ' 43. Backflow Irrigation ,:44. Landscape Irrigation System 1' .• ' 45. Sound Attenuation -; 46. Handicap Regulations '• 47. FINAL STRUCTURE & BUILDING - 48. Special Requirements Completed 'r ' 49. Electric Release to Edison _ 50. Gas Release to Southern California Gas Co n- , 51. CERTIFICATE OF OCCUPANCY No Date ' City of Costa Mesa Development Services Department Building Safety Division CERTIFICATE OF OCCUPANCY No. 00 2 4415 P. O. Box 1200 Costa Mesa, California The Building located at 216 Raat 1611`h Plpt a, nnif•y hastbeen inspected and .found,to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group R1 Occupancy. Use of Bu Legal Description (See reverse side for Metes and Bounds) Building Permit No B 30202 Electrical Permit No. E 31221 Plumbing Permit No. P 31168 Mechanical Permit No. 1334801 M33699 ISSUED TO: Costa Mesa Lil Rntprnri AA. Tnr` 172 Plower Street Wsta Mesa, CA 92627 Number of apartments and/or guest rooms Building Official Williiaarn TTJ. Howard by Date March 21, 1989 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 lel U.B.C. CMF 1015-46 rev. 1/83 White - Owner; Canary - Numerical File; Pink - Bldg. Permit File q-. Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MEESA CONSTRUCTION PERMIT Project Address `I� ` • �(O. -� •' r� Applicant's Mailing Address Owner's Name CCSU NR>A L'eAyt: P'[rJ 1fRQA)1[ - Phone 722'' S 11 Address 172 TLOWER 57. C"5TA ItAl_nA. Lh R2627 Arch/Eng. License No. Address //� qq 4.4 Contractor's Name N�ANLt 4iU"el �A!glW Phone213--Zb V Address (mailing) \/•1'55 MbFiiCKEti (/ASSS' O. -f=21 b City License No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. License Class Liconsa`.f�pld/s 3%SZO� Date x'31 N,y Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of c sent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) y LIS Y`(Lti��Ni(YC:O Policy No. 440•-D317 L`371 Company U.S. RCertified copy Is hereby furnished. Certifled opy is filed with the city Building Division. Date A'-IIc-g'I Applicant _;tjYA t-� �HEU EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). 1 certify that in the performance ofthe wore 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. Date Signature NOTICE: If, after making th fissions of the you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 herebyrthat there is a construction lending agency for the performance work of the workk for which this permit is issued (Section 3097 Civ. CJ Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm -that I am exempt from the Contractor's License Law. for the following reason (Section 7031.5 Business and Professional Code- Any city or county which requires 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/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of ')ivision 3 of the Business and Professions Code) or that he/she is exempt herefrom 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 [e natty of not more than five hundred dollars ($500). LJ 1, 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 (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of com. pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of. the property, am exclusively contracting with licensed con. tractors to construct the project (Section 70A4, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(s1 license pursuant to the Contractor's License Law). I am aware that proof V their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner that I have read this application and state that the above 'rect. I agree to comply with all city and county ordinances satin to building construction, and hereby authorize repre- to en"on the above-mentioned property for Signature 't QJ d _ X -7 Drivers' License or CMF 0865-46, rev. 10/ TYPE OF CONSTRUCTION LJ NEW LJ ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. — lob (0'3 K ALTERATION 7REPAIR TYPE OF PERMIT LJ GRADING LJ FOUNDATION U STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY����_,�....rr CONSTRUCTION TYPE VALUATION $ 4& ZONE GRADING CU.YDS. ACRES_ Remarks: FEES Bar.Sink Showers ' Boiler Hood or Type I U Duct - Under Ground Canopy Type I I ❑ Backflow Preventer Service Sink Backflow Irrigation Sewer Cap BUILDING PERMIT_ Bathtubs Sewer Connection -428.00 Clarifiers Solar Collectors $ Dishwasher Solar Piping Exhaust System ❑ Multiple ❑ System Repair/Alteration Drinking Fountains Solar Tank 5 3. 3n Floor Drains Swimming Pool w/Spa F irepl/Fact. Bit. ICBG# Fire Dampers ' Floor Sinks Urinal PLUMBING • Gas Service Outlets Water Closet Heating System & Ducting Registers ❑0-100,000 BTU ❑ 100,000 BT Interceptors i Wate-rHeater $ Kitchen Sink Water -Service . PLAN CHECK 25% Lavatories S Auto -Wash P -Trap _ _ Laundry Trays $ Roof Drains r 1. •:' '7_ •� ELECTRICAL , Reinspection Fee 1 $15 I 1 Issue Fee 1 $ 3 Reinspection Fee 1 $15 1 1 Issue Fee - Applicant; Pink - Accounting; Goldenrod - Assessor $ 3 A.P. # Z -1i S Main Building: TFront Zo ARear 5 C Right Q K Left Ping. Ref. # PA Planning Notes: Automatic Washer Construction Pole Cooking Unit Dishwasher Dryers ❑Gas ❑ Fan F.A.U. Fixtures Device Boxes 5097 9/11/87 Zone Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW - 1:1 50+KW Meter ❑up to 100 amps Meter Dover 100 amps Sub Panel Motors 06.1 HIP Ell h-8 Inc.Solar ❑9-15 HP ❑16-15+ Microwave Pole Light Outlets Switches Garbage Disposal Generator❑0-5 KW 05-15:KW 1 Reinspection Fee ii DEVELOPMENT SER Zoning Approved By� Building Approved By Application Issued By_ $15 385082 TL FEES Standing Sections Trash Compactor Issue Fee - $ 3 Z O N I N G R E D M T S PLAN CHECK 25% $ . SUMMARY OF FEES BUILDING PERMIT_ $ -428.00 SMIP $ 4' S 2 - PLAN PLAN CHECK $ 5 3. 3n PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL , $ GRADING $ PLAN CHECK 50% $. MICROFILM $ MECHANICAL $ TOTAL FEE $��� 2p{ PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS .Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service'or Pole 52. Pool & Equipment Location 2. Soil pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55, Electrical Bonding - 5. Steel Reinforcement 56. Rough Plumbing & Pressure. Test 6. Electrical UFER Grnd. y3 p 04- 57. APPROVAL TO COVER-GUNITE 7. Footings S Q c;.� 4� I�� d 58. Electrical Conduit-Undrgrnd. 8. Foundations 59. Gas Pipe, 0 Undrgrnd.,-Test _ 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrrid' - 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line &Flo u;e 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 APPROVALS Permit # _ 20. Rough Factory Fireplace 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 ❑ Gas 0 Oil 25. Roof Sheathing 3 D�-- 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical , 27. Frame and Flashing ' 76. Dry Standpipe 28. Lathing & Siding 83 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning dq 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 r yo d �- 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY No. Date .. Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT 11// PERMIT NO j TRACT NO. LOT NO. UNIT . Project,Address �� L'- i4'� ?I,. _#r 3, 6 �/ y' Applicant's Mai 'ng Addre s TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A P # Owner's Name K hone l) DESCRIPTION OF WORK/USE OF BLDG. Address l+I2. ptra$,. r (i.0 7 LA "f�? Arch/Eng. License No. Address ccc& g1� '''' _""�t_� Contractor's Nam pf, Phone pr Address (mailing)14 (ll�Trpy l/z City License No. X64=Z' LICENSED CONTRACTOR DECLARATION 1 hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force a effect. License lass —Lice se �No.Q_ Date S,1l$9 Signature ✓ WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certifled copy thereof (Section 3800, Lab. C Policy No. �_ nom, I�I/:,P211 Company L'� r P�CT7 �Corlified copy is hereby furnished. . Cerus ie co Vied with the city Building Division.-/ / q��/ s DateIlI_ Applicant //�/�a+��+�n- EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This eeClion need not be completed if the permit is for one hundred ($100) or less). 1 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. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued (Section 3097 Civ. C.) Lender's Name - Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Caw for the following reason (Section 7031.5 Business and Professional 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 forSuch permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Eof not more than five hundred dollars ($500). ❑ I, as owner of the property or my employees with wages as their sole com pensa[ion. will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of $ale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Cotle: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a Con- tractor(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section IB. & P. C. for this reason Date Owner I hereby certify that I have rea information is Correct. I agree to and state laws relating to buildu sentatives of this city to a ler inspection purposes. / Signature Drivers' License or SS this upon a TYPE OF PERMIT LJ GRADING LiJ FOUNDATION LJ STRUCTURAL ❑ TENANT El ELECTRICAL ELECTRICAL PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SO. FT. OCCUPANCY— CONSTRUCTION TYPE VALUATION $ ZONE GRADINGCU.YDS. ACRES_ Remarks: Sink Preventer Irrigation Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service S Outlets Interceptors Kitchen Sink ' Lavatories P—Trap Roof Drains Reinspection Fee 1 $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBG # Heating System & Ducting ❑0100,000 BTU 0100,000 Reinspection Fee 1 $15 CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 0 Showers - Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Issue Fee Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System 00100,000 BTU 0100,0008T System Repair/Alteration Fire Dampers Registers Issue Fee ES S Main bullar E T Front B Rear A C Right K S Left Ping. Ref. # Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Generator LJO-5 KW105.15 9703 11/17/87 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer D 15-50 KW ❑ 50+ KW Meter ❑up to 100 amps Meter Dover 100 amps Sub Panel Motors 00.1 HP ❑1Ya - B Inc. Solar 09-15 HP 016-15+ Microwave Pole Light Range Standing Sections Trash Compactor 47.38 TL FEES .1 Z O N I N G R E Q M T S $ 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved ByDate Application Issued By Date Dat BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $PERMIT $ $ $ $ $ $ . SMIP ISSUANCE ENERGY P.C. GRADING MICROFILM TOTAL FEE $ $ $ $ $ $ $ 3 /i CONSTRUCTION AND PLANNING APPROVALS Perm iti# Date Inspector POOL & SPA APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. wn 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 LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings rl 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe Undrgrnd. /h%//Q7 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection "_AlFe AA11W 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 517 71gg ZjrD 65. Electrical - Final 15. Rough Electrical -Conduit 66. Solar System -Final 16, Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign ^ r 68. APPROVED FOR,PLASTERING 18. Rough Electrical -T Bar Ceilingr�',".1 )�,'t 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # _ i 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas OOil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing - 73. Undergrnd. Storage Tank OGas OOil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical" 27. Frame and Flashing _ - _ , i 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 t'I 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 _C 36. Hood or Canopy 37. Final Factory Fireplace 38r Final Plumbing 3h3 e? (.,,w n/ 39. Water Service -Final r 40. Gas Service-Final�� 41. Solar Domestic -Final , '42 -Backflow Preventer ` 43. Backflow Irrigation • y ; ! - I 44.Landscape Irrigation System � i✓C-, 45. Sound Attenuation 46. Handicap Regulations '47.1FINALSTRUCTURE&BUILDING _ ,j� ��,;xI'�1 48. Special Requirements Completed 49. Electric Release to Edison �- - - 50. Gas Release to Southern California Gas Go 51. CERTIFICATE OF OCCUPANCY No. Date ,, t i 33 TV Applicant to fill in all spaces except those within heavy.border lines and sign all appropriate declarations. CITY OF COSTA'MESA - CONSTRUCTION PERMIT PERMIT 9;1 � 2 1 $rj TRACT,N20. LOT NO. / '7 UNI�NO. Project Address a—�Q / 00 5Tp MFr4 n T" • Applicant's Mailing Address -- A147 -A,'11 311 Owner's Name NEL7'02 C?�XZ a[/y Phone Address Arch/Eng. License No. Address J Contractor's Name_ . Phone %9_0 Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. �5,✓ License Class C� d 6 — �' License No. aG —/ Date t—rh c'onar r�—� WORKERS' COMPENSATION DEC RLA ATION 1 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 3800, Lab. C.) POIICcompany ertified copy is hereby furnished. LJ Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). 1 certify that in the performance of the work for which this permit is issued I shall not employ any person in any marine so as to become subject to the Workers' Com tion Laws of Canto Date .S—//—- Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil 1, a,ity of not more than five hundred dollars ($500). 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 (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, thebuilding or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove efor the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that proof o their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above Information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentativesof in i y to enter upon the above-mentionetl property f inspection our os Signature Date Drivers' License or SS TYPE OF CONSTRUCTION yQ NEW LJ ADD LJ ALTERATION u REPAIR PERMIT ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ISSUANCE A.P. DESCRIPTION OF WORK/USE OF BLDG. $ GRADING $ • $ S Main Building: TYPE OF PERMIT GRADING FOUNDATION O-�t�RUCTURAL T Front El TENANT TENANT ❑ ELECTRICAL ❑ PIUMBING Lc?/MECHANICAL EJ OTHER A Rear C Right PROJECT DESCRIPTION SO. FT. OCCUPANCY K CONSTRUCTION TYPE VALUATION $ $ Left ZONE GRADINGCU.YDS. ACRES Ping. Ref.# Remarks: Z n n "'Z- Planning Notes: Sink <flow Preventer kf low Irrigation Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Kitchen Sink .Lavatories P=Trap Rpof Drains Reinspection Fee $15 Boiler Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 130.100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash .. Laundry Trays Issue Fee Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System 00-100,000eTU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee FEES Automatic Washer Construction Pole Cooking Unit Dishwasher Dryers ❑Gas ❑ Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 K 0417 5/12/88 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW 6 ❑ 50+ KW Meter ❑up to 100 amps Meter ❑over 100amps lectric Sub Panel Motors 00-1 HP Ell %. B Inc.Solar ❑9-15 HP 016-15+ Microwave Pole Light Range I , I Standing Sections 15 KW I Trash Compactor $ 3 I � FEES Reinspection Fee $15 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By I .. .tion Issued By G BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $. ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ SUMMARY OF FE 37o50 TL Z O N I N G R E Q M T S FEES $ 3 SMIP $ PERMIT - - ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ 37 (5w CONSTRUCTION AND PLANNING "• APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1,eTemporary Electrical. Service or Pole 52. Pool & Equipment Location 2C Soil Pipe-Undrgrnd.' L 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms - 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement '4 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grtid ;l 57. APPROVAL TO COVER-GUNITE t7.CFootings 58. Electrical Conduit-Undrgrnd. 8.' Foundation ( 59. Gas Pipe, O Undrgrnd., Test 9,'Water Pipe-Undrgrnd% it - 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor Systrem 61. APPROVAL TO DECK 11. Property Sewer Line & 1-louse 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. tRough Wiring Sign 68. APPROVED FOR PLASTERING y8. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. -Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro ' 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil 23. -Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas 0Oil 25. Roof Sheathing 74. Overhead Hydro 26..T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical f l 27iyFrame and Flashing 76. Dry Standpipe C/ 28., Lathing & Siding 77. FIXED SYSTEM FINAL }y , 29:' Insulation 78. FIRE PREV. FINAL 0 30.,Drywall Nailing HEALTH DEPT. REQUIREMENT 31' Plaster Brown Coat 79. FINAL INSPECTION 1 Vit' 32:. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED it ;'f 33. Final Electric Notes: j. 34:_Final Heating & Air Conditioning 35:' Final Gas Pipe-Test 1 36. Hood or Canopy t 37. Final Factory Fireplace 38. Final Plumbing I �' v 39. Water Service-Final 40. Gas Service-Final " I 41. Solar Domestic-Final u 42. Backflow Preventer 43. Backflow Irrigation` )l y 'i 44. Landscape Irrigation System 'j - - 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48' Special Requirements Completed q 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 1 51. CERTIFICATE OF OCCUPANCY No. Date J , - ' " Applicant to fill in all spaces CITYOFCOSTAn�jESA CO�N�[[I 'RUCTIONPE�^rR�MMrIT Project Address -4 t62 �' �V lit PLA Applicant's Mailing Addr ss Owner's Name� A 6SH ADeA, fN h net 22-8a Address I L-� s'•I't� t 11'iC gZi3 Arch/Eng. License No. Address Contractor's Name kA •Phone Address (mailing) r(.{��1_jV1d E Is pleDD City License No UT` tl u 2 I K L� f']M LICENSED CONTRACTOR DECLARATION t�- I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business an Professions Cotle, an my license is in ful ce and effect. 37i�20 License FI s /� rl a'�o o rv� (� Date ---'S- --rr Signature WORKER ' CO PENSATIONDECL TIO 1 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 3800, Lab. C.)r V Policy No. �_�3I omPanY u s r 1•r L1 U Certifiedc y i hereby fUrnishetl. � Ca i with the city Buildin S­ /DaN Applicant EXEMPTIO14FRC310 WORKERS' COMPENSATICUSIi ECLIO AT ION (Thissection need not be completed if the permit is for one nundred ($100) or less). 1 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. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097 CIv.J C.) Lender's Name Under's Address OWNER BUILDER DECLARATION "! I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division -3 of the Business and Professions Code) or that he/she is exempt' therefrom and the basis for the alleged exemption. Any violation of section 7031.5 by any applicant for a Permit subjects the applicant to a civil rpenalty, of not more than five hundred dollars ($500). Lj I, as on of the Property or my employees with wages as their sole coca pensat ,on, will do the Work, and the structure is not intended or offered for sale (Section 7044, 84slnes5 and Professional Code: The Contractor's License Law does not apply to an owner Of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that 54th Improvements are not intended or offered for Sale. If, however, thebuilding or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- 9v¢ for the purpose of sale), 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who build$ or Improves thereon, and who contracts for such projects with a con- traclor(s) license pursuant to the Contractor's License Law). I am aware that proof O!! their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information Is correct. I agree to comply with all City and county ordinances and state laws relating to b�ntuhcs hereby authorize repre- sentatives of this city to entioned ro erty for inspection purposes. SignatureDate Drivers' License or SS those within heavy border lines and sign all appropriate declarations. TRACT NO. I LOT NO. I UNIT (X TYPE OF CONSTRUCTION L4o!rNEW LJ ADD LJ ALTERATION LJ REPAIR PERMIT FEES ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ISSUANCE $ q.p.# Zane I/ ELECTRICAL $ ; DESCRIPTION OF WORK/USE OF BLDG. Service Sink S Main Building: —'-Ac_ess j,.y lding: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front vl' UJlfi It•s-`l ❑ TENANT ❑ ELECTRIRICAL ❑^PJ�UM IN I ,MECHANICAL Rear s- ❑ OTHER Y 1z II11 Solar Collectors A Dishwasher Meter ❑over 100anips Dishwasher C Right - PROJECT DESCRIPTION 5 .FT.,'— OCCUPANCY KLeft Solar Tank CONSTRUCTION TYPE VALUATION$ $ Motors 00-1 HP 01m, - R ZONE GRADING CU. YDS. ACRES Ping. Ref. # Parking Req./Provided Remarks: - fV, ) Planning Notes: Z O N I N G R E D M T S Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBG +2 Z1 Heating System & Ducting ❑0-1 oo,000 BTU ❑ 100,000 Reinspection Fee 1 $15 CMF 0665-46, rev. 10/64 Whit ding; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee Hoodor Type ❑ Canopy Type 11 ❑ Refrigeration System ❑o-100,000BTU ❑loo,o0o System Repair/Alteration Fire Dampers Registers $ 3 �_ Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: - Zoning Approved By Date Building Approved ByDate Application Issued By. Dat , 3 1v� SUMMARY OF FEES BUILDING PERMIT $ SMIP $ Issue Fee 5-1 $1 PLAN CHECK PLUMBING PERMIT FEES $ ISSUANCE $ PLAN CHECK Bar Sink Showers ELECTRICAL $ - ELECTRICAL FEES Backflow Preventer Service Sink MICROFILM $ Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW - ❑ 50+KW Backflow Irrigation Sewer Cap $ • Bathtubs Sewer Connection 25% $ o1a�s Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100anips Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 00-1 HP 01m, - R Floor Drains - Swimming Pool w/Spa F.A.U. Inc. Solar 09-15 HP 016.15+ Floor Sinks Urinal ' Q Fixtures Microwave - Gas Service - Outlets Water Closet - Device Boxes Pole Light i Interceptors Water Heater j,' Outlets Range " Kitchen Sink Water Service - Switches Sign Lavatories - Auto -Wash ./t 1 Garbage Disposal Standing Sections P-TrapLaundry Trays Generator l]0.5 KW ❑5-15 KW Trash Compactor Roof Drains i ' Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBG +2 Z1 Heating System & Ducting ❑0-1 oo,000 BTU ❑ 100,000 Reinspection Fee 1 $15 CMF 0665-46, rev. 10/64 Whit ding; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee Hoodor Type ❑ Canopy Type 11 ❑ Refrigeration System ❑o-100,000BTU ❑loo,o0o System Repair/Alteration Fire Dampers Registers $ 3 �_ Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: - Zoning Approved By Date Building Approved ByDate Application Issued By. Dat , 3 1v� SUMMARY OF FEES BUILDING PERMIT $ SMIP $ Issue Fee 5-1 $1 PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50%- $ MICROFILM $ MECHANICAL $ • TOTAL FEE $ PLAN CHECK 25% $ o1a�s CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector POOL &SPA 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 LIFER Grnd. 57. APPROVAL TO COVER-GUNITE r7j.'Footings I:; 58. Electrical Conduit-Undrgrnd. 8..'LFoundation �� 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 Wirirfg Sign 68. APPROVED FOR PLASTERING •18. Rough Electrical -T Bar Ceiling 69. POO USPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit# 20. Rough Factory Fireplace I !21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 0OiIl\=. 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0Gas 00il 25. Roof Sheathing 74. Overhead Hydro 1 -'- 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 PREY. FINAL ` 30. Drywall Nailing HEALTH DEPT. REQUIREMENT -'•� ' 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED - r 33. Final Electric Notes: 34. Final Heating & Air Conditioning •,.`;. 35. Final Gas Pipe -Test r 36. Hood or Canopy D t -r I 37. Final Factory Fireplace r 3/l3 tlY �a LL' r.� r•' '� •.-••y r _38. Final Plumbing --_� ti 4 _ ✓_ 39' Water Service -Final 40. Gas Service -Final J 1 41. Solar Domestic -Final 'i r.� - - I r 42:1 Backflow Preventer \�I `- �;•✓- `"'� -- 43� Backflow Irrigation 44. Landscape Irrigation System r.. '45. Sound Attenuation -46. Handicap Regulations -� j-•'-' 47. FINAL STRUCTURE & BUILDING a; �' •}. ,� _ 48. Special Requirements Completed ��.� �•�-�' l - t• 49. Electric Release to Edison --' 50. Gas Release to Southern California Gas Co e 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT 'c1' Project Address ZIE' E_ IE'iY\ a.. C.L4t0. MiafC. 4k PER NO. TRACT NO. LOT NO. UNIT NO. : 9900 I 1 / 19/87 35e/I�p': I �, TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑DEMOLISH ❑OTHER DESCRIPTION OF WORK/USE OF BLDG. Applicant's Mailing Address Owner's Name P hone Qp / Address 17a Olwlzr ST. Lt /i ei .. CA J� A.P.�6 Zone E Main Building: Accessory Building: Arch/Eng. License No. Address TYPE OF PERMIT JU GRADING 0 FOUNDATION LJ STRUCTURAL ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER - PROJECT DESCRIPTION SD. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YOS. ACRES T Front �• Z O BA Rear N Contractor's Nam _ Phone .4 Zt) Address (mailing) 1 I • .A-� ��- ce y.�av City License No. LICENSED CONTRACTOR DECLARA1 N C Right N KLeft $ G R Ping. Ref. + Parking Req./Provided E Remarks: Planning Notes: Q M 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full fort, and e((,fect, y�(�) r ii0 T Uceme Cl; ss ` Date ��I/(b Signature PLUMBING FEES Bar Sink Showers ELECTRICAL FEES WORKERS' COM EN SAT ION DF01_A R�. ION I hereby affirm that I have a certificate of consent to self -insurer a certificate Backflow Preventer Service Sink Automatic Washer Transformer ❑ 1550 KW ❑ 50+KW Construction Pole Sub. .Q of Workers' Compensation Insurance, or a certified copy thereof (Section 380 Lab. C. _ -I �g D . Fur`ll� Pot' y No. Company Backflow Irrigation Sewer Cap \ Certif ietl copy is Here y furnished. CertifIa cop ' ed with the city Builtli vi n. Bathtubs Sewer Connection , Cooking Unit Meter up to 100 amps s PO �./ ate Applicant EXEMP ON ROM ORKE RS' CO NSA ON DEC LA RATIO (This section need not be completed if the per t is for one huntlretl 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 Clarifiers Solar Collectors - Dishwasher Meter Dover 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 00-1 HP ❑1X-8 Workers' Compensation Laws of California. Floor Drains Swimming Pool w/Spa - ' F.A.U. Inc. Solar ❑9-15 HP ❑16-15+ Date Signature • i NOTICE: If, alter making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Floor Sinks- Urinal t- Fixtures MIClOW¢VQ Gas ServiceOutlets' Water Closet Device Boxes _ _ Pole Light CONSTRUCTION.LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance Interceptors Water Heater. Outlets Range of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Kitchen Sink Water Service "L? Switches -Sign ' Lenders Address OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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 t0 file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and' Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). LJ I, as owner of the property or my employees With wages as [heir sale compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law doesnot apply l0 an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not Intended or offeretl for Sale. If, however, the building Or improvement is sold within one year of com- pletlon, the owner will have the burden of proving he/she did not build or Inn- rove for the purpose of sale). I, as owner Of the property, am exclusively contracting with licensed con. tractors ld construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who builds or Improve$ thereon, and who contracts for such projects with a con- tractor( license pursuant to the Contractor's License Law). I am aware that proof o!! their Worker's Compensation insurance shoultl be provided to me. ❑ 1 am exempt under Section _ B. 8 P. C. to, this reason Lavatories Auto -Wash - ' Garbage Disposal Standing Sections P—Trap •1 Laundry Trays YGenerator 00-5 KW 05.15 KW Trash Compactor ROOF. Drains is Reinspection Fee $15 Issue Fe¢ $ 3 Reinspection Fee $15 Issue Fee "$ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By De Application Issued By $ Datat Boiler Hood or Type I ❑ Canopy Type I I El Duct - Under Ground Duct - Structural Refrigeration System ❑0.100,000 BTU ❑100,000 BTU Duct - Ventilating r SUMMARY OF FEES' _ BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ Exhaust System 11 Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO+ Fire Dampers Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree o comply with all city and county ordinances and state laws relating f0 u Ing cc ruction, and hereby authorize repro -I sentatives of this ci the above-mentioned property for Heating System & Ducting ❑0.100,000 BTU ❑100,00087 Registers PLAN CHECK 25% $ ENERGY P.C. $ s Q GRADING $ ELECTRICAL $ PLAN CHECK 50% $ Cy- MICROFILM $ i _ - inspection purposeMECHANICAL Signature Date ( -_ Drivers' LicerfCe or SS $ TOTAL FEE $ PLAN CHECK 25% $ Reinspection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor - CONSTRUCTION AND PLANNING APPROVALS Permit # Date - '� Inspector ;; POOL & SPA ,- APPROVALS Permit #1 Date Inspector It. Temporary ElectricalServiceor Pole 52. Pool & Equipment Location , 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Unargrnd. 55. Electrical Bonding 5. Steel Reinforcements .. 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd:t 57. APPROVALTOCOVER-GUNITE 7. Footings - 58. Electrical Conduit-Undrgrnd. 8. Foundation 1, I 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd., 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer. Line&�I-louse 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 �3 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 APPROVALS Permit # 20. Rough Factory Fireplace 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 u 24. Roof Framing 73. Undergrnd. Storage Tank OGas 00il 25. Roof Sheathing 74. Overhead Hydro •14 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 k' i .32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED , 33. Final Electric Notes: 34. Final Heating & Air Conditioning J 35. Final Gas Pipe -Test 36. Hood or Canopy " 37. Final Factory Fireplace *- q 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final - 41. Solar Domestic -Final ,i . 42. Backflow Preventer .' 43. Backflow Irrigation . 44. Landscape Irrigation System 45. Sound Attenuation - - r 46. Handicap Regulations - 47. FINAL STRUCTURE & BUILDING ' 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date _ _ t City of Costa Mesa Development Services Department Building Safety Division CERTIFICATE OF OCCUPANCY No. 002414 P. O. Box 1200 Costa Mesa. California The Building located at 716 East 16th Place, [flit L has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group R1 Occupancy. Use of Buildi Legal Description 425-207-14 (See reverse side for Metes and Bounds) Building Permit No n ar»m Electrical Permit No. F. 31227. Plumbing Permit No. P 31169 Mechanical Permit No. M33481, M33700 Number of apartments and/or guest rooms ISSUED TO: Costa Mess Leader Enterprise, Inc. 172 Flower Street Costa Mesa, CA 92627 Date March 21, 1989 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 lel U.B.C. UAF 1015-46 rev. 1/83 White - Owner; Canary - Numerical File; Pink - Bldg. Permit File Building Official William T. Howard by Com.. sP i� ray, Applicant to till in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF -COSTA M SA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT` �03 UNIT NO. EE7)(yII.t3 3 0 2 0 3 0(032 ./ I, Project Address Applicant's Mailing Address Owner's NameCDXA Nil LiFAW El.l(E(fR1555 Phone -122' 31 Address 1"12 'i-Lcltsk S"(, Co5,A A. cA cizkayl Arch/Eng. License No. Address Contractor's Name iMN ,Nuel SITYn Q Phon�64514' Address (mailing) City License No.=cty_4zc�Z LICENSED CONTRACTOR DECLARATION , 1 hereby affirm that I am licensed under provisions of Charter 9 (Commencing, with section 70001 of Division 3 of the Business and Professions Code, and my license is in full force 40 effect. License Cla S Lic rhe -.3152 D Dale Signature - WORKERS' COM ENSATION DECILARA$ION I hereby affirm that 1 have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section Policy LabNo. 40= 7J11�5B�1 U,5 QUAkAf, 380 No. Company 1I�yI� Certified copy is hereby furnished. CL W Cert ,. ed1tppy iF f jftl with the city Building D y s. qn 5`' �� Dale L1 I 'tl AIJ H EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($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. ' Date Signature NOTICE: If, atter making this declaration, you should become subject to the Workers' Compensation Provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I'am exempt from the Contractor's License Law for the following reason" (Section 7031.5 Business and Professional 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 o file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Subjects the applicant to a civil enalty of not more than five hundred dollars ($500). 1, as owner of the property Or my employees with wages as their sole Compensation, will do the Work, and the Structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that Such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of Com- pletion, the owner wilt have the burden of proving he/she did not build or mi n-ve for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property Who builds of improves thereon, and Who contracts for such projects with a con- tractors l license pursuant to the Contractor's License Law). I am aware that, proof off their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date inspection purpl Signature,_ Drivers' License CMF 0865-46, rev. - Owner have read this application and state that the above agree to comply with all city and county ordinances o building construction, and hereby authorize repre- to enter upon the above-mentioned property for Dale 'YPE OF CONSTRUCTION rvew ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER y -DESCRIPTION OF WORK/USE OF BLDG. — ALTERATION LJ REPAIR TYPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SO. FT. OCCUPANCY ;CONSTRUCTION TYPE VALUATION$ 1- 4 ASVD.— ,ZONE GRADINGCU.YDS. ACRES Re marksn fXi ,I-+= PLUMBING FEES Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors - Kitchen Sink Lavatories r P -Trap Roof Drains,• Reinspection Fee l $15 Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑ 0-100,000 BTU ❑ 100,000 BTS Reinspection Fee White - Building; Canary - APPlicant; Pink - Accounting; Goldenrod - Assessor $15 Showers Service Sink Sewer Cap Sewer Connection - Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water.Heater Water Service Trays A.P. # LbrL S Main Buildi E T Front I B Rear G A C Right K 5 Left Ping. Ref. # Planninq Notes: Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Drvers []Gas ❑Fle-tric Fan F.A.U. ' Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00.5 KW ❑ 5098 9/11/87 Zone Accessory Building: IFT Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100amps Sub Panel Motors ❑0-1 HP ❑ 1 X - 8 Inc. Solar ❑9-15 HP El 16-15+ Microwave Pole Light Range' Sign Standing Sections 5-15 KW Trash Issue Fee $ 3 Reinspection Fee $15 Issue Fee IANICAL FEES Hood or T DEVELOPMENT SERVbVCJ Z N/EupITS` Type I ❑ ��RJJ GGCC--/JJ i Canopy Type It ❑I I ] Zoning Approved By Date Building Approved By 7ZnA & Date Refrigeration System ❑0-100,000BTU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee -1 $ 3 1, 385.82 TL Z O N I N G R E O M T S FEES - $ 3 PLAN CHECK 25% $ SUMMARY OF FEES BUILDING PERMIT $ -3 2 -Q� SMIP $ 4_• 52 PLAN CHECK $'� �• 3D PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C: $ ELECTRICAL $ GRADING $ _ PLAN CHECK 50% $ MICROFILM $ 3 g85' Z MECHANICAL $ TOTAL FEE $ O PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS Permit #-T_ Date Inspector POOL & SPA 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 LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings E Cq-tIL p 58. Electrical Conduit-Undrgrnd. B. Foundation + 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. r 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System .. &og18 O 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 APPROVALS Permit # _ 20. Rough Factory Fireplace 21. Ducts, in, Structure 70. Underground Hydro 22. Ducts; Ventilating t 71. Product Piping OGas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas ❑Oil 25. Roof Sheathing 3 D�- 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding tr O 77. FIXED SYSTEM FINAL 29. Insulation q 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat or 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes:lb 6 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test IV IF 6 36. Hood or Canopy 3 1 37. Final Factory Fireplace - 38. Final Plumbing 39. Water Service -Final - 40. Gas Service -Final l 41. Solar Domestic -Final - - - 42. Backflow Preventer s 43. Backflow Irrigation - 44. Landscape Irrigation System - 45. Sound Attenuation 46. Handicap Regulations ' 47. FINAL STRUCTURE & BUILDING yp 'P , 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. OSTA MES -/A CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. -UNIT Nr>. pplica1111111111W,—nt's Maili Adores. Owner's Name � - '�y Phone ,IRM Address f/2co /fn -p1 4>f2� Arch/Eng. v License No. Address « UI d3Contractor's Nam Address (mailing) (2?d A, L25. hmy City License No. 6 d LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full forts and effect. %� ��� ,,,sss ��_ ��, License lass `5 License No.� \ Dated Signature RAYIO h% \n�1v WORKERS' COMPENSATION DECLARATION I hereby affirm that I atio a Insurance of consent to self -insure er a f (Section 1_ of Workers' Compensation Insurance, or a certified copy thereof (Section ro 3800, Lab. C��^^ / IPoIicY NO. `Ts/n� ComPanY l Certified copy is hereby furnished. G �Certi fietlLcOyyy is flied with the city Building Division. .fin �J Oa[e/y —Applicant '���E—/n-t- / \ EXEMPTION FROM WORKERS' COMPENSATIOfd�UECLARAT ION (This section need not be completed if the permit is for one hundred ($100) or less). I cc r iffy that in the performance of the work for which this Permit is Issued. I I shall not employ any person in any manner so as to become subject to the l Workers' Compensation Law$ of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation Provisions of the Labor Code, You must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Ise construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code:;Any city or county which requires a permit to construct, alter, improve, demoli,sh or repair 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 5rovisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employee$ with wage$ as their sole compensation, will do the work, and the structure Is not intended of otferetl for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for Sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im. E 10r the purpose Of Sale). ❑ I, as owner of the -property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractors license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date hereby certify tha' Information is comet and slate laws relatir sentatNes of this ci inspection purposes.' Signature / I Drivers' License or S° CMF 0865-46, rev. 10/84 . Owner have read upon above 3/l6 FLUMBINU z - TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A.P. 46 S Main Build TYPE OF PERMIT GRADING OUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL PLUMBING El MECHANICAL ❑ OTHER T B A Front Rear WJECT DESCRIPTION SQ. FT. OCCUPANCY ONSTRUCTION TYPE VALUATIONS ZONE GRADING CU.YDS. ACRES C K S Right Left Ping. Ref. # Remarks: r2,:�.0y02. Planning Notes 9702 11/17/87 Zone Accessory Building: Parking Req./Provided 47,38 TL Z O N I N G R E Q M T S White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor FLUMBINU FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+ KW TIT Backflow Irrigation Sewer Cap Z Bathtubs Sewer Connection VO Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher - Meter Clover 100 amps Dishwasher Solar Piping 7- UD Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors E10-1 HP❑ih-8 Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP ❑16-15+ Floor Sinks Urinal Fixtures, � Microwave Gas Service Outlets Water Closet fL Device Boxes A' Pole Light _ Interceptors Water Heater Outlets Range Kitchen Sink Water Service U) Switches Sign 3 Lavatories Auto -Wash OJ Garbage Disposal Standing Sections - P -Trap I Laundry Trays Generator 110.5 KW❑5.15 KW Trash Compactor Roof Drains �. Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee §75 Issue Fee $ 3 MECHANICAL FEES Boiler Hood or Type I ❑ Canopy Type I I C] DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date pat i Duct -Under Ground Duct - Structural Refrigeration System ❑0.100,00013TU 0100,000BTU Duct -Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ ISSUANCE $ $ 2117 ENERGY P.C. $ $ GRADING $ $ MICROFILM $ $ TOTALFEE $ $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICED =0 Fire Dampers HeatingSystem & Ducting 110-100,000 BTU 0100,000 BT Registers Reinspection Fee $15 Issue Fee $ 3 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNINGPOOL APPROVALS Perriiit# Date Inspector & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2.. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings , 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. ��/�/�' - 60. Backwash Lines, P -Trap, 0 Undrgrnd. ' 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line &House Connection 11D 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing �1,r ffD 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final - 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign r. 68. APPROVED FOR,PLASTERING 18. Rough Electrical -T Bar Ceiling ,l -j !- 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # _ r 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro ' 22. Ducts, Ventilating 71. Product Piping 0Gas 0011 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing _ _ ! �. 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 1' 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 7. '- i';, (- 31 Final Factory Fireplace 38. Final Plumbing 3113107 t CO r 39. Water Service -Final ,, ' /• 40. Gas Service -Final ` 1. 41. Solar Domestic -Final :•42. Backflow Preventer ( - - ,',43. Backflow Irrigation •(,f +' _ _ .- ' 44. Landscape Irrigation System 'r• ( 1^. , u �' -• - ' 45: Sound Attenuation 46. Handicap Regulations z 47.r FINAL STRUCTURE & BUILDING �,, •- _r , 48. Special Requirements Completed ) IT r. 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co i !� 51. CERTIFICATE OF OCCUPANCY No. Date M 3-4•gt Applicant to fill in all spaces except those within ICITYOFCOSTAMESA CONSTRUCTION PERMIT IPERMITNO.M.A3lt� 79c�1 Project Address c2g, (�O -A el COsTo M Applicant's Mailing Address M '. Aoe7jl Owner's Name f6EG7&1R QWgAc4-11, Phone 9 Address Arch/Eng. License No. Address Q , tiw M< L r 94,9 f 9 9L Contractor's Na ntr Phone Address lmailingl 450 w• /F00% A /l 61.4zwsA CA' City License No. �l✓7 g;� 9/701 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed untler provisions Of Charter 9 (Commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class —eR0 License No. 19 TAI Dale 8i Signature WORKERS' COMPENSATION DECLARATION 1 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 3800, Lab. C.) Polic No. le copy is hereby Iurnlshetl. Certllied copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($700) 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 mialenel so as to become subject to the Workers' Sp,V lrat ion Laws Of Calif Date 'rte/f K'J Signatur NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions Of the Labor Code, you must forthwith Comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a Construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following. reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair anystructure, prior to its issuance, also requires the applicant for such permit to the a signed statement that he/sbe Is licensed pursuant t0 the provisions of ,the Contractor's License Law (Chapter 9 (Commenting with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty 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 (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. If, huwever, the building or improvement Is sold within One year Of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- traCtors to construct the project (Section 7044, Business and Professions Code: The Contractor's License law doe; not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(sl license pursuant to the Contractor's License Law). I am aware that proof Of( their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner Ihereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of t Lti, o enter upon the above-mentioned property for inspection p SignatureDate Drivers' Lirense or 55 9F y border lines and sign all appropriate declarations. LOT NO. I UNIT NO, loss 12 10T (, ? L TYPE OF CONSTRUCTION Leff NEW LJ ADD LJ ALTERATION LJ REPAI R Showers ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. 46 DESCRIPTION OF WORK/USE OF BLDG. Backflow Preventer Service Sink S Main Build i Il����yyyyyy TYPE OF PERMIT 17 GRADING El FOUNDATIOSTRVCTU RAL T Front ElTENANT ❑ ELECTRICAL 1:1 PLUMBING MECHANICAL B ElOTHER A Rear Clarifiers C Right PROJECT DESCRIPTION SO. FT. OCCUPANCY KLeft Meter ❑over 100 amps C ON ST RUCTION TYPE VALUATION$ $ ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: r ^J n Z Planning Notes: 0418 5/12/88 Zone Accessory Building: Parking Req./Provided 37,50 TL Z O N I N G R E Q M T S Bar Sink - Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑50+KIN Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors0&1I HP ❑ 1'f. - 8 - Floor Drains Swimming Pool w/Spa F.A.U. Inc -Solar 09-15 HP 016-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal Standing Sections —Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES R EQU189MENTS: Zoning Approved By Date Building Approved By�,�r�r,� Data Application Issued By — �,qr� Date / Boiler Hood or Type ❑ Canopy Type 11 ❑ Duct - Under Ground Duct - Structural Refrigeration System 1-10-100,000 BTU E1100,000BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK -50% MECHANICAL PLAN CHECK 25% SUMMARY $ $ $ $ $ $ $—✓.-t $ OF FEEV SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ ' GRADING $ MICROFILM S 7 Cy� TOTALFEE $ 3r3 Y_0 Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO 916 Fire Dampers Heating System & Ducting ❑0.100,000BTU❑100,00067 Registers - HOX06TU U �daa ` T(AwC4Es+5EQ5 c/ Reinspection Fee $15 Issue Fee / a 47 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor (CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1./Temporary ElectricaPService or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. (0 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Uridrgrnd. -55. Electrical Bonding 5. Steel Reinforcementur 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd.�� i 57. APPROVAL TO COVER-GUNITE y 7! Footings " `�/ 58. Electrical Conduit-Undrgrnd. �8. Foundation �., 59. Gas Pipe, 0 Undrgrnd., Test 9rWater Pipe-UndrgrndV,' 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 . r, 68. APPROVED FOR PLASTERING 118. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19 Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit - 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro b 22. •Ducts, Ventilating 71. Product Piping 0 Gas [-]Oil 23. Gas Pipe -Rough & Test 72. Underground Flush ! n 24. Roof Framing 73. Undergrnd. Storage Tank OGas 0Oil 25. ,Roof Sheathing 74. Overhead Hydro ' - 26. -,T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical -j 27.)Frame and Flashing 76. Dry Standpipe U r 2B.' Lathing &Siding 77. FIXED SYSTEM FINAL 29.)nsulation 78. FIRE PREV. FINAL M 30..Drywall Nailing HEALTH DEPT. REQUIREMENT -T 31 !'Plaster Brown Coat 79. FINAL INSPECTION art 32. -Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED li7 33. Final Electric Notes: 34. Final Heating & Air Conditioning 3 iYhM Cen 35.;9inal Gas Pipe -Test "y 36. Hood or Canopy ,- 37'. Final Factory Fireplace r 38. Final Plumbing. 39. Water Service -Final II t. 40. Gas Service -Final k� ' 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation ,�� •-i ,� (�_. J 44. Landscape Irrigation System 45. Sound Attenuation I v v f 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING - 48. Special Requirements Completed I 49. Electric Release to Edison 50. Gas Release to Southern California Gas Cc - (• i 51. CERTIFICATE OF OCCUPANCY No. Date { I• CITY OG.COSTA M&C NST�I Project Address 6 Applicant's Mailing dress Owner's Name J.4 Address ('l 2 F�/4dL-� .±—f�f�4 CTION PERMIT L GO%IA- M1554 Q f [12 Arch/Eng. .,7 License No. Address d, Contractor's Name N ho Z Address (mailing) ( -S VIA IMPA City License No. 2 F.A.U. LICENSED CONTRACTOR DE LARATION Fixtures I hereby affirm that 1 am Ilce nsetl un provisions of Charter 9 (commencing with section 7000) of Di vi Sion 3 o th usl ss and Professions Code, and my license is In lull force antl act. 2 License Class Dale 4- Off Signature L' a No WORKERS' COM NSATION DE LARA 101 I hereby affirm that I have a terlif is to of n! n to elf -insure or a certificate of Workers' Compensation In uran e, a ilii tlq copys thereof (Section 3800, Lab. C.) 40-6317 f '^[ l/ -I r`LI UpD Policy No. Company •" Certified cop is h eby furnished. Certlfigp (ppIri Lji(Iyayit h the city Building on EXEMPTION FROM'WORKERS'COMPENSATION-OECLAAATION (This section need not be completed if the permit is for one hundred ($100) or less). certify that in the performance of the work for which this permit is issuetl. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become Subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY z. I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ: C.) Lender's Name -� Lender's Address OWNER BUILDER DECLARATION I hereby affirm that 1 am ekempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any, city or county which requires a permit to construct, alter, Improve, demolish or.repai anystructure, prior to its issuance, also requires the applicant for such permit in It In a sinned statement that he/she is licensed pursuant to the provisions of 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 �e nalty of not more than five hundred dollars ($500). L 1, 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 (Sectlon 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the buildih9 or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove efar the purpose of sale). as owner of the property, am exclusively contracting with licensed can. 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 builds or improves thereon, and who contracts for such Projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date I hereby certify Ina Information is come and state laws rete l sentatives of this i inspection purposes Signature Drivers' License or S! W 0865-46, rev. 10/84 Owner this to fill in all spaces except those within heavy border lines and sign all appropriate declarations. UNLIT NQ. _ _ _ TRACT NO. I LOT NO. I UNitr NO. TYPE OF CONSTRUCTION I^ NEW LJ ADD L7 ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHR DESCRIPTION OF� 9C1.1K �JEk1 LOG. Ef R � p n cc TYPE OF PERMIT LI GRADING LJ FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING t6 MECHANICAL �TE t_ OTHER R PROJECT DESCRIPTION SO. FT. OCCUPANCY— CONSTRUCTION TYPE VALUATIONS ZONE GRADING CU. YDS. ACRES— Remarks: Preventer Irrigation eking Fountains )r Drains )r Sinks Service Outlets Kitchen Sink Lavatories P -Trap Roof Drains Reinspection Fee Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Water Closet Water Heater Automatic Washer Construction Pole Sub. Water Service ' Cooking Unit Auto -Wash d, Laundry Trays n^„ Sub Panel Fan Motors 00-1 HP ❑ IX, - 8 F.A.U. $15 Issue Fee Fixtures Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # 250 Heating System & Ducting ❑o-100,000 BTU 11100,000 BTI Reinspection Fee I $15 White - Building; Canary - Applicant; Pink - Accounting: Goldenrod - Assessor Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System ❑o-100,000BTU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee FEES a MAY 24 1088 A.P. # _ —�""�� -,.R IZone S Main Building: '-`AcCeJiory Building: E T Front B Rear A C Right S Left Ping. Ref. # Parking Req./Provided Planning Notes: ELECTRICAL Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter ❑over 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors 00-1 HP ❑ IX, - 8 F.A.U. Inc.Solar 1:19-15 HP ❑16-15+ Fixtures Microwave. Device Boxes Outlets Pole Light Range Switches Sign Garbage Disposal Standing Sections Generator ❑0.5 KW 05.15 KW Trash Compactor $ 3 Z O N 1 N G R E Q M T S Reinspection Fee $15 1 1 Issue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Date Date Date BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% . SUMMARY OF FEES $ $ $ $ $ $ $0 $ zz- SMIP PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM TOTAL FEE $ $ $ $ $ $ ' $ % $ 3 Z O N 1 N G R E Q M T S CONSTRUCTION AND'PLANNING APPROVALS Permit# Date Inspector POOL &SPA APPROVALS Permit Date Inspector 1.gTemporary Electrical.Seivice or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd.. r. 57. APPROVAL TO COVER-GUNITE 71. Footings % 58. Electrical Conduit-Undrgrnd. "8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test �9.TWater Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 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 JAB. Rough Electrical -T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ' APPROVALS Permit # 20. Rough Factory Fireplace =21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas El Oil 23. Gas Pipe -Rough & Test 72. Underground Flush -� 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro i 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 f ' 31. Plaster Brown Coat 79. FINAL INSPECTION !' 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 1 f a^ 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 f ' 40. Gas Service -Final ` ,.�•�-. 41._ Solar Domestic -Final /•`,1 ` �__C "' - :,42. Backflow Preventer 1 L '43. Backflow Irrigation '-••�-'-�� 44. Landscape Irrigation System .45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed r 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co rR 51. CERTIFICATE OF OCCUPANCY No. Date• . ' - j ' ` - - Applicant to fill in all spaces except those within heavy border lines and sign all a CITYaf COSTA MESA CONSTRUCTION PERMIT ,Project Address =16 F /EA OZ.ag1t` e, Applicant's Mailing Address Owner's Name<<�'r �✓i11 6 r r l K Phone A- IN Address 172- Ceyll Mt?!l CA 9xil Arch/Eng. License No. Address Contractor's Name —Phone7 w AZ T -C' M ftAddress (mailing) City License No. ! !, ` Ya -h LICENSED CONTRACTOR DECLARA-FlOill 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full fors antl fe t. Z Licens1e1C ss is se N Date WORK RS'C MgENSATION LARAT N I hereby affirm that I have a certificate of c nsent to salt -Insure aka certificate lsq3 Of ��lvv1yyy���or kers' Compensation Insurance, Or a certified Copy thereof (Section Lao 3�, Lab. C.y,Q� sh �? - r� Po cy No. 8 e�_ir— Company LV Certified copy is hereby furnished. Certifletl co y i ed with the city Buil Date — Applicant C�% EXEMPTION FRO ?,led C PENSAT ON DECLARATION (This section need not be completed if the per}ffit Is for one huntlretl ( 00) or less). I carall no that in the performance n the work for which this permit is Issued, I shall not employ any person in any orhia. so as to become subject to the Workers' Compensation Laws a Calif orh ia. Dale Signature _ NOTICE: If, after making this ions f the you r Cod becomesubjectmust to the Workers' Compensation prprovisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I Hereby affirm that there is a Construction lendingagency for the performance issue of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ 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 (Section 7044, Business and Professional Code: The Contractor's 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 employees, pr avid etl that Such improvements are not Intended or offered for Sale. If, however, the building or Improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im. rove for the purpose of sale). I, 'owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a Con- tractors) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have real and state laws sentatives of Inspection purr Signature _ Drivers' Lice 0065-46, rev or '.ation and State that the above i all city and county ordinances on, and hereby authorize repre. above-mentioned property for iDate ll y 3 r "2, z,rL f TYPE OF CONSTRUCTION LJ NEW LJ ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. — ALTERATION declarations. REPAIR TYPE OF PERMIT GRADING LJ FOUNDATION U STRUCTURAL ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SO. FT. OCCUPANCY— CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YDS. ACRES Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets '.itchen Sink .avatones - -Trap'. toof Drains Reinspection Fee $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑0100,000 BTU Ell w000 Showers Service Sink Sewer Cap Sewer Connection, Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Issue Fee Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System 00-100,00013TU ❑100,000 System Repair/Alteration Fire Dampers Registers FEES $ 3 Reinspection 1 $15 1 1 Issue Fee - $ 3 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 9901 11/19/87 A.P. # I Zone S Main Building: Accessory Building: E T Front B Rear A 'C Right SLeft Ping. Ref. # Parking Req./Provided Planning Notes: 35.40 ELECTRICAL FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW ❑ 50 + KW ISSUANCE Cooking Unit Meter MUD to 100 amps 00 Dishwasher Meter ❑over 100 amps b0 Dryers ❑Gas ❑Electric Sub Panel 1-00 Fan Motors ❑O-1 HP Ell X-8 , F.A.U. Ina Solar 09-15 HP 016-15+/•OO ,. Fixtures Microwave Device Boxes Pole Light Outlets Range t OD Switches Sign Garbage Disposal Standing Sections I.A0 Generator ❑05 KW ❑5.15 KW Trash Compactor Reinspection Fee I $15 I I Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By etl Application Issued By SUMMARYOF BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL S PLAN CHECK 25% $ Z O N I N G R E Q M T S SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ - TOTALFEE $ CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector POOL &SPA 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-U_n6rgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd.' 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation /•� 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrndl, 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 APPROVALS Permit # �•' 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas OOil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0Gas 00il 25. Roof Sheathing 74. Overhead Hydro .. 26. T-Bar"Ceiling (Structural) & Monocoat 75. Dry Chemical 11j 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL I 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION , 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test -6 36. Hood or Canopy 37. Final Factory Fireplace °• Ir 38. Final Plumbing 39. Water Service -Final •�r 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer - ,`, :•; , i ,1. 43. Backflow Irrigation - / 44. Landscape Irrigation System ' 45. Sound Attenuation c 46. Handicap Regulations - 47. FINAL STRUCTURE & BUILDING �f s 48. Special Requirements Completed ' 49. Electric Release to Edison - -- 50. Gas Release to Southern California Gas Co -' 51. CERTIFICATE OF OCCUPANCY No. Date r. ' \ ' CITY OF COSTA MESA iN Mp BUILDING DIVISION a 4 F77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 - Fax (714) 754-4856 • www.ci.costa-mesa.ca.us �. FOR INSPECTIONS CALL: (714) 754-5626 '''^^�^'� PERMIT NUMBER: B10-00334 PERMIT TYPE B_ROOF2 STATUS: T. APN: 42520511 CITY OF COSTA MESA iN Mp BUILDING DIVISION a 4 F77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 - Fax (714) 754-4856 • www.ci.costa-mesa.ca.us �. FOR INSPECTIONS CALL: (714) 754-5626 '''^^�^'� PERMIT NUMBER: B10-00334 PERMIT TYPE B_ROOF2 STATUS: ISSUED 1 APN: 42520511 DATE ISSUED: 11/08/2010 Bldg Std Admin Fund ISSUED BY: RMD JOB ADDRESS:—r2�16TH-PL—CM Suite/Unit: Vicinity: UNITS D -AND E Squares: 2600 Valuation: $8,000.00 SCOPE OF WORK: T/OFF COMP SHINGLES INSTALL 1 LAYER 30 LB FELT AND 30 YEAR COMP SHINGLES CLASS A, 26 SUQARES. COMPLIANCE FORMS ATTACHED TO JOB CARD AND CITY PERMIT. UNITS D AND E OWNER: EAST HAMPTON COURT Address: HOMEOWNERS ASSN Unit: COSTA MESA, CA PHONE: 9498745002 City/State/Zip: 172 FLOWER ST APPLICANT: TOM KORSVALL A001 PHONE: 714-620-5916 CONTRACTOR: MILES ABOVE ROOFING INC Address: 1346 LOGAN AVEUnit: City/State/Zip: COSTA MESA, CA 92626 ARCHITECT ENGINEER: FEE SUMMARY Reroof Plan Check: $0.00 Reroof Permit Fee: $153.25 Reinspection Fee: $0.00 Bldg Std Admin Fund $1.00 Address: 1346 LOGAN AVE Unit: :SUITE City/State/Zip: COSTA MESA, CA License No. 880263 SUITE A001 PHONE: 714-620-5916 CELL: License No. PHONE: License No. PHONE: 'OTAL FEES $154.25 HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010 -PER CMMC Sec. 13-279 Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal holidays New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In 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. CODE 1, INSPECTION TYPE DATE INTmALS CODED INSPECTION ME DATE INTMAL 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final,,// 208 Final Plumbing A 200 Final Re -Roof 1 Z 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 WORKERS' COMPENSATION DECLARAI.vN: 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,9� d,6w /` (This Wont, thepis atmenundmddam(510)wies.) Poll Number: ❑ 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 sub'eetto the workers' compensation provisions of Section 3700 of the Lai ode I shall forthwith comply with these provisions. �A_ �O Apd nt§ 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 DOLLARS ($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. n '7 � Cm ctDrs Sigtuture FDale ONSTRUCTION LENDING AGENCY: ❑ 1 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 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, 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.). ❑ lam exempt under sec. Business and Professions Code for this reason: Signature Date 305746 (3m7) Ovmer ID verified by over', license. ❑ ves ❑ 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 struclure. scaffolding, falsework, a demolition or -thereof, will be more than thirty-six (36) feet high. (Chap. 3.2. Grp 2, Art Sec. 3 2, 41, 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. Applicant's Signature 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? ❑ Yes ❑ 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 feel 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? ❑ Yes ❑ 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 Safely 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? ❑ Yes ❑ 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 ❑ 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? []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? ❑ Yes ❑ 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. 1 agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized chis permit until final inspection. motor gal O.xmerls) Date ( An AutbDdzed Appumni - - `--Date -J CITY OF COSTA MESA • BUILDING DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 • Www ci costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT TYPE B_ROOF2 APOI: 42520511 JOB ADDRESS: Vicinity: Squares: 0 SCOPE OF WORK: UNITS A OWNER: MESA, CA PHONE: PERMIT NUMBER: B08-00290 STATUS: ISSUED DATE ISSUED: 10/14/2008 ISSUED BY: CAC 216 16TH PL CM Suite/Unit:' IEOjSH T/OFF COMP SHINGLES INSTALL 1 LAYER 30 LB FELT ACLASS A. EAST HAMPTON COURT Address: HOMEOWNERS ASSN COSTA 9498745002 APPLICANT: TOM KORSVALL - A001 PHONE: 714-620-5916 - CONTRACTOR: MILES ABOVE ROOFING INC Address: 1346 LOGAN AVEUnit: City/Slate/Zip: COSTA MESA, CA 92626 ARCHITECT: - ENGINEER: FEE SUMMARY Reroof Plan Check: Reroof Permit Fee: Reinspection Fee: TOTALFEES $0.00 $97.25- $0.00 $97.25 City/State/Zip: 172 FLOWER ST. Address: 1346 LOGAN AVE City/State/Zip: COSTA MESA, CA License No. 880263 SUITE A001 PHONE: 714-620-5916 - - - - CELL: License No. - PHONE: License No. PHONE: Unit: -:SUITE ^U uzJJ - f,"!. .1A Fitr';1F NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92.28, § 1, 12-21-92) ' EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In 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. CODE r. INSPECTION n DATE IMnn4Ls CODED INSPECTION gig I rx m Ls 1818 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof 210 Final Electrical 201 Final 81ockJRelaining 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 WOPKERS' C9MPENSATION DECLARATION: 1 hereby affiml under penalty of perjury one of the following declarations:. ❑ 1 have and will maintain a certificate of consent to self -Insure for workers' co enation, as provided for by section 3700 of the Labor Code, for the ormance 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 n er: (Th�isss /ronin�neednof be mmpereeerne perm4¢ vaArcN at we nwiarM cb6ars($100)wfeu) Poli�WNudlber 1 ❑ 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 C ! I shallf hwith comply with these provisions. A n1's Sen e WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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 m nse is in full force and effect. 1 — r� ntraaa nature Dal CONSTRUCTION LENDING AGENCY: ❑ I hereby affmn 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: Lenders 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 appy to an owner of property who builds or improves thereon, and who contracts for such project with a cantr cta(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: 305718 (3107) Owner ID verified by drivu ..cense. ❑ Yes ❑ No Driver's License No. Expires: r 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 feel 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, a 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. Appliwnl's Signature bale 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? ❑ Yes ❑ 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? ❑ Yes ❑ 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? ❑ Yes ❑ 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 ❑ 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? ❑ Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safely Code). 7. If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (If yes", attach certificate of compliance from the appropriate air pollution control officer). - CERTIFICATE OF COMPLIANCE: I certify that under penalty'of perjury the information given above is correct. I agree to comply with all state laws.and city ordinances regarding Hazardous Materials and Emissions. . Signature Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF *ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. nature of Le al 0.") Date 1,4 And Applicant le CITY OF COSTA MESA BUILDING DIVISION f77 FAIR DRIVE, COSTA MESA, CA 92626 - (714) 754-5273 - Fax (714) 754-4856 www.cl.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: B08-00291 PERMIT TYPE B_ROOF2 STATUS: ISSUED APN: 42520511 DATE ISSUED: 10/14/2008 ISSUED BY: CAC JOB ADDRESS: 216 16TH PL CM.. Suite/Unit- Vicinity: - - Squares: 0 .Valuation $7,000.00 SCOPE OF WORK: T/OFF COMP SHINGLES INSTALL 1 LAYER 30 LB FELT AND 30 YEAR COMP SHINGLES CLASS A UNITS J AND K- - ;r OWNER: EAST HAMPTON COURT;-' _ ; Address: HOMEOWNERS - ASSN.'' ME OMEOWNERSASSNiME SA. CA PHONE: 9498745002 k- City/State/Zip: 172 FLOWER ST APPLICANT: TOM KORSVALL .T Address: 1346 LOGAN AVE A001 PHONE: 714.620.5916 m- _ - City/State/Zip: C S CONTRACTOR: MILES ABOVE ROOFING INC -e N1 Address: 1346 LOGAN AVEUnit: - _ „ SUITE A001 _ O 14- -5916 City/State/Zip: COSTA MESA, CA 92626- - "- CELL: MCHITECT: License No. _ (/ PHONE:.' ENGINEER: License No. PHONE: FEE SUMMARY Reroof Plan Check: $0.00 Reroof Permit Fee: $139.25;= Reinspection Fee: $0.00 TOTAL FEES $139.25 Unit: COSTA Unit: ,:SUITE D f NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12.21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In 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 vrill result in the expiration of this permit. ODU INSPECTION TYPE lE INTMALS CODE INSPECTION TYPE 2M INTMAL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final �_.�� 208 Final Plumbing 200 Final Re -Roof l �l Ql 210 Final Electrical 201 Final Block/Retaining Wall J 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign -222 Final Site 244 Final Demolition 250 Final Building/Dccupancy 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 p ormance of the work for which this permit is Issued. I have and will maintain workers' compensation insurance, as required by ect n 3700 of the Labor Code. for the performance of the work for which this =it is issued. My workers' compensation Insurance carrier and policy nuare: arri 571 ") �Gl/V`L (T need tGe comrlpleted Alhe perOm4a valuM Sl ane hundred collars (sr0o)Driest.) Pot mber ❑ 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 C e shall fort Rf`comply with these provisions. ature ate 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 DOLLARS ($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. L'. t' f_t, _ #� u -/� Con lure L --Date CONSTRUCTION LENDI AGENCY: ❑ 1 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: 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 exempt under sec. Business and Professions Code for this reason: S,gnature Date 305746 (W07) Owner ID verified by dri tense. ❑ Yes ❑ 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. Applicant's Signature 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? ❑ Yes ❑ 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? ❑ Yes ❑ 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? ❑ Yes ❑ 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 ❑ 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? ❑ Yes ❑ No (If yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safely Code). 7. If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No 8. (If yes", attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: tl 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 - bate CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that 1 have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree hot to occupy or allow occupancy of any building authorized by this permit until final inspection. gnat of egal ens) Date 6 -1 , Ana/ ♦ mo� a Appew G� e IL ' CITY OF COSTA MESA BUILDING DIVISION F77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax(714)754-4856 • w%w.ci.00sta-mesa.ca.us �. FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: B08-00292 PERMIT TYPE B_ROOF2 STATUS: ISSUED APN: 42520511 DATE ISSUED: 10/14/2008 ISSUED BY: CAC JOB ADDRESS: 216 16TH PL CM Suite/Unit:;,; Vicinity: Squares: 0 ,Valuation: $7,000.00 SCOPE OF WORK: T/OFF COMP SHINGLES INSTALL 1 LAYER 30 LIMN R P S.CLASS UNITS L AND M OWNER: EAST HAMPTON COURT ''. Address: HOMEOWNERS ASSN, - 4nit COSTA MESA, CA - PHONE: 9498745002' - - - - City/State/Zip: 172 FLOWER ST-- - APPLICANT: TOM KORSVALL - . Address: 1346 LOGAN AVE Unit: SUITE PHONE: 714-620-5916 - _ - - City/State/Zip: COSTA MESA, CA CONTRACTOR: MILES AI3OVE ROOFING INC- - License No. 880263 Address: 1346 LOGAN AVEUnit: _ _ SUITE A001 PHONE: 714-620.5916 City/State/Zip: COSTA MESA, CA 92626 ` - - - CEI -L:- ARCHITECT: License No. ,' PHONE ' ENGINEER: License No. PHONE: FEE SUMMARY Reroof Plan Check: x$0:00 Reroof Permit Fee: $139.25"'_ _ Reinspection Fee: $0.00 Ck�1 TOTAL FEES $139.25 11r.rt. •�5:+1 � . NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In 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. CODE S. INSPECTIONTYPE If AN INITIALCODE t INSPECTION TYPINmMtS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof I I-3" o� by, 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/Cc panty WORKERS' COMPENSATION DECLARATIOP I hereby of lm under penalty of perjury one of the following declarations:, ❑ 1 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 �rformance of the work for which this permit Is Issued. „61_ I have and will maintain workers' compensation Insurance, as required by sectio 1 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation Insurance carrier and policy nu are: r r ST) TE J'et V 1) (ih 4lneedrpfaeccmp'efeairarepe ce of aro lruMrM daWrs(f IO6Jwkss.) P cy N bar: /9y!j� 18 '^en� 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 Co a -f shall forthvri mply with these provisions. �IWnI�ture WARNING: URE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWF AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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. i G las /p Jt7V / C V is gnatun, �� to 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: Lenders 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 appy 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: 305746 (3/67) Owner ID verified by drl -icense. ❑ Yes []No OF ' 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, a demolition or dismantling (hereof, 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. Appiiuras Signature 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? ❑ Yes ❑ 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? ❑ Yes ❑ 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 Safely Code been fully complied with? ❑ Yes ❑ 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 ❑ No (Section 65850.2 of the Califomia Government Code requires that the requested information be furnished on applications for non-residential building permits). 6. Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ 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? ❑ Yes ❑ 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 informationgiven 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 penally of perjury that I have read this application and slate that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by IN emit until final inspection. tun of gal (s) Date �p _1' L •[nd And/ d tarn Dat k Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITYOFCOSTAMESA GUNSI UGIIUN PtH M11"y,,1 Project Address Z� �O �• 'pLQ.C�R/ M Applicant's Mailing Address Owner's Name i%f%5'Tq Ti1n5A !SAO' Gl}!'ep 4�cKone7='-'V,311 Address 1^ 1%LOWor i"T. COSTA NALSA aLb74 Arch/Eng. License No. Address Contractor's Nam lI rTlsl(G�,yl,�` G HUH SH' _00�T Phonlop Address (mailing) 1 C+�p M) o1J j2Er ,qSS 42t> #410 City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force a g effect. / License Class __Lice. a lJ Date — Signature WORKERS' COMPENSATION DECLARlV ,ION I hereby affirm that I have a certificate of to nsent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof, (Section 3800, Lab..) —O 1_7 b9 / IAU Policy No. Company U - S. 4::1li f (-�I� � L7DgIv`^'T Certified copy Is hereby fUrm hed. GD - Certified co y is filed with the city BuggH.g Iv Sion, I-1 ��. Date Applicant S `Y� EXE M PTIORKERS' COMPENSATION DECLARATION (This sec less). tion need not be completed if the permit is for one hundred ($100) or , 1 certify that in the performance of the work for which this perm itis issued, I shall notWorkers' employ any person in any manner so as to become subject -to the Workers' Compensation La California. Si Date - Signature ` NOTICE: If, after making this ions f the you Should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit Shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm- for there is a construction issue agency for the performance L the work •tor which this permit is issued (Section 3097 Civ. C.) Lender's Name ` Lender's Address OWNER BUILDER DECLARATION 1 hereby affirm'that'1-am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to' its is$uance, also requires the applicant for such permit to file a signed Statement that he/she is licensed pursuant to the provisions of the Contractor's License LaW (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cotle) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil malty of not more than five hundred dollars ($500). 1, az 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 (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does Sucn work himself/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 com- pletion, the owner will have the burden of proving he/She did not build or im- ffve for the purpose. of sale)- Ll I, as owner of the property, am exclusively contracting with licensed con- tractorsto construct the project(Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant t0 the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section _ H. & P. C. for this reason Date Owne1 I hereby certify that I have red information is correct. I agree to and state laws relating to bUildii sent ativas of this cit to enter inspection purpos Signature tom\ r'L(_-If— Drivers' License or $Sg —C" this Data q ( 13.3 O'L b+ 1 Ib(o32 TYPE OF CONSTRUCTION 'NEW LADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER 'DESCRIPTION OF WORK/USE OF BLDG. ALTERATION LJ REPAIR TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION LJ STRUCTURAL '❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 1❑ OTHER PROJECT DESCRIPTION Sq. FT. OCCUPANCY CON ST RUCTION TYPE VALUATION $ -.'ZONE GRADINGCU.YDS. ACRES Remarks: -76- 5099 9/11/87 t 305pn2 It ` 11 A.P. # + r[, •� Zone C,/> FEES S Main Building:I Accessory Building: --.___� _•_„_���""s..asaD TFront <ri V O / ARear %' N — C Right Q N — S Left CJ sCJ R —1 Ping. Ref. #,�A — D Parking Req./Provided E Sewer Connection Planning Notes: O Cooking Unit � Meter ❑up to 100 amps Clarifiers Solar Collector3 ` 11 PLUMBING 1" FEES --.___� _•_„_���""s..asaD Bar,Sink -- Showers / ELECTRICAL - FEES _ Backflow Preventer Service Sink - Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+ KW / - Backflow•Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collector3 Dishwasher Meter Dover 100 amps _ Dishwasher Solar Pipi9e Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar ankFan Motors ❑0- HP ❑1'/:- B Floor Drains Swimming Pool w/Spa F.A.U. Ina So ❑9-15 HP ❑16-15+ Floor Sinks Urinal i Fixtures M" rowave Gas Service r Outlets Water Closet Device Boxes Pole Light Interceptors _+ WatertiHeater Outlets :/� Range Kitchen Sink " '' Wate%Service Switches - Sign - - Lavatories - _ - = AutojWash Garbage Disposal Standing Sections P—Trap - - ;., -"•a Laundry Trays Generator El W 0515.KW TFash Compactor Roof rains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Boiler Hood or Type I ❑ Canopy Type I DEVELOPMENT SERVI Zoning Approved By Building Approved By Application Issued By EO EM T L —Date Date. t Dat Duct -Under Ground Duct - Structural Refriger ' n System ❑ 00,000 BTU ❑100,000 BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING _ PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% $ $ $ $ $ $ $ $ SUMMARY OF FEES ��, q 3z. oz) SMIP $ _- � 2_ -5.3 •-3 PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ 395 TOTAL FEE $ •$ 2 Exhaust System ❑ Multiple ❑ System Repair/Alteration FirepllFact. Bit. ICBG# Fire Dampers Heating System & Du 'ng 110- 100,000 BTU 100,000 BTL Registers - Reinspection Fee $15 Issue Fee $ 3 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS 'Permit# Date Inspector POOL &SPA 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 CoPduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd./ 2p 57. APPROVAL TO COVER'-GUNITE 7. Footings 7 Ob 58. Electrical Conduit-Undrgrnd. 8. Foundation , / 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap,-O'Undrgrnd: r 10. Structural Floor System '. 8 7 Qrp 61. APPROVAL TO DECK 11. Property Sewer Line & HouselConnection 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 APPROVALS Permit # _ _ .. 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro, 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing - 73. Undergrn& Storage Tank 0 Gas El Oil 25. Roof Sheathing ;3 ' �8 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical , 27. Frame and Flashing 76. Dry Standpipe. 28. Lathing & Siding 8 77. FIXED SYSTEM FINAL 29. Insulation �j 6 QJd 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: /.� �j 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 1I r31es sh 'f(- ti: V K 36. Hood or Canopy 3 j-De-jr-1 4JfL 'K 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 145. Sound Attenuation 46. Handicap Regulations - - 47. FINAL STRUCTURE & BUILDING g 48. Special Requirements Completed • 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ' 1 M cr Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address .Zlh '�• IhYln (7L. it/1/) Applicanti's Ma//i lI�ing Address Owner's Namel,�'4+A &4& 1, LAdir/ 1JnlCV24hnng--'r2 Address II v %I n..1 v, I L,'r �ex,�-ti_AA-4,e,, Arch/Eng. License No. , Address 1201— C 161/1 Cd fyaa fL^�7a1� Contractor's Namea"�I ({hq 1'iP.. _ `-,'nNnMo Phone yt i 2 0 Address (mailing) I U' �i'In..-.% r"frt,!_ (Q144 PH -i-?AZ1b City License No. Gia 14s0. a CRs GI) LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Licen-s�e (;lass License No. Dale 25 9%11-6 Signature e WORKERS' COMPENSATION DECLARATION 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 3800, Lab. C.),,�% //JJ Policy No. r0�Q��'7b�,'� Company/Jt �l�P-�an�(T' I. Certified copy is hereby furnished. _� 1 Ce�tifiQ,d4co�is filed with the City Building Division, Date 1 / Applltdnt EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred (S100) 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. Date Signature 'NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency'for the peGformance of the work for which this permit is issued (Section 3097- Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Lzw for the following reason (Section 7031.5 Business and Professional Code: -Any city or county which requires a permit to construct, alter, improve, demolish or repair anv anent ure- .riot to its issuance. also requires the appllcant for:5uch permit therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the appllcant to a civil zenalty 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 (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for Sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im. prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law ddoes not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con. tractors license pursuant to the Contractor's License Law). 1 am aware that proof o their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this information is correct. I agree to comp) and state laws relating to building cons sentatives of this city to enter upon inspection purposes,n ,1_ Signature `�-//r , Drivers' License or SS r -P &0-7z) $ 3 -m-, TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR Showers ❑ ❑ ❑ ELECTRICAL FEES AANICAL CONVERSION DEMOLISH OTHER Service Sink A.P. # . DESCRIPTION OF WORK/USE OF BLDG. Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap z Bathtubs S Main Building: :71 Meter ❑up to 100 amps E Clarifiers TYPE OF PERMIT GRADING 1 TION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL B (J4 OTHER Sub Panel A Rear �❑ C Right PROJECT DESCRIPTION SD. FT. OCCUPANCY K CONSTRUCTION TYPE VALUATION$ S Left ZONE GRADING CU. YDS. ACRES ping. Ref. # Remarks: M �-, ^ .n y/ Microwave I Planning Notes: 9701 11/171$7 Zone Accessory Building: Parking Req./Provided 47,38 TL Z O N I N G R E Q M T S Reinspection Fee 1 $15 Ouct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ ,Firepl/Fact. Bit. ICBO # Heating System & Ducting 00100,000 BTU ❑ 100,000 BT Reinspection Fee '1 $15 1F 0865-46, rev. 10/84 While - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 Bar Sink Showers o a7 ELECTRICAL FEES AANICAL Backflow Preventer Service Sink DEVELOPMENT SERVICES REQUIREMENTS: Approved By Building Approved By Application Issued By Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Backflow Irrigation Sewer Cap z Bathtubs Sewer Connection UD Cooking Unit Meter ❑up to 100 amps SMIP $ PERMIT - ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ Clarifiers Solar Collectors Dishwasher Meter El over 100 amps Dishwasher - Solar Piping (J4 Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 110-1 HP Ell '/h- 8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09-15 HP ❑ 16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service 5 butlets Water Closet 8 Device Boxes Pole Light Interceptors Water Heater UJ Outlets "J Range - Kitchen Sink Water Service O) Switches Sign ' 3 Lavatories Auto -Wash J Garbage Disposal -„ Standing Sections P -Trap Laundry Trays Generator OO -5 KW 05-15 KW Trash Compactor Roof Drains . -,., .- - Reinspection Fee 1 $15 Ouct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ ,Firepl/Fact. Bit. ICBO # Heating System & Ducting 00100,000 BTU ❑ 100,000 BT Reinspection Fee '1 $15 1F 0865-46, rev. 10/84 While - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 AANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Approved By Building Approved By Application Issued By Date Date Z. Dat Hood or T Type ❑ Canopy Type 11 ElZoning Refrigeration System ❑0-100,000 BTU 0100,000BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ `R $ $ $ $ SMIP $ PERMIT - ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ System Repair/Alteration Fire Dampers - Registers Issue Fee $ 3 .CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector POOL & SPA 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-Unitrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings •' 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. �' 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection1G 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing65. .241ff 4V 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. POO USPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS ' Permit# - r 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro' 22. Ducts, Ventilating 71. Product Piping O Gas OOil - 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ' 27. Frame and Flashing _ �t s 76. Dry Standpipe ,i "r��• 28. Lathing & Siding 77. FIXED SYSTEM FINAL ' 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing - HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat I,I 79. FINAL INSPECTION r, 32. Electrical Power Meter-Final - 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: A, 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 0 36. Hood or Canopy -• i r 37: Final Factory Fireplace 38: Final Plumbing 3 l3 y/!( capt'- •' ' ' '.i 39. Water Service-Final 40. Gas Service-Final �/ ! v ,41. Solar Domestic-Final rt i- .� 42./Backflow Preventer _ rl = •43. Backflow Irrigation � '° ,• , `i ,44: Landscape Irrigation System 45. Sound Attenuation t' �- 46. Handicap Regulations ' • C • is r ,- 47!FINAL STRUCTURE &BUILDING - 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co y 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill In all spaces except those within CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address a/L /G 11 g 005%A A zs4 Applicant's Mailing Address 80W-Ip0711 fkcnaw- O/tdA r��d a %9-�'96L Owner's Name � Phone Address Arch/Eng. 6z �_„�.{elcense No. Address �(s ���- Contractor'sName 2- Phone-499j� Address (mailingl�O 1+.. F�o��•-�/�1 4zo5. C'tJ City License No. ���%! 17V LICENSED CONTRALTO DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 Of the Business and Professions Code, and my license is in full for 4a and effect. License Class C-dD License No. (X014 (/5 Date S'-//- lr Signature WORKERS' COMPENSATION DECLARATION 1 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 3800, Lab. C.) Company Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed If the permit is for One hundred ($100) or less). I certify that In the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compeppcation Laws of Callforni Date S-G-F'i 9gnature NOTICE: If, after making this declaration, 7trU should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter Improve, demolish or repair any structure, prior to its issuance, also req Ulres the applicant for such permit l0 file a signed statement that he/she Is licepsad pursuant t0 the provisions of the Contractor+s License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Cotle) Or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit SUbjects the applicant to a Civil enalty of not more than five hundred dollar$ ($500). I, as owner of the properly or my em Ployees with wages as their solo compensation, will do the work, and the structure is not in tentled or ofl¢retl for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself)therself 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 com- pletion, the owner will have the burden of proving he/she did not build or im- rprove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed eon- traclorstd construct the project'Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such projects with a con- tractor(, license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above Information is correct. I agree to comply with all city and county ordinances and state laws relating to building Construction, and hereby authorize repre- sentatives of this C. to enter upon the above-mentioned property for inspect) on our s Signature Date 6-1I— Drivers' License or SS :P / i- / border lines and sign all appropriate declarations. LOT NO. UNIT NO. 0419 5/12/8il Zone Accessory Building: Parking Req./Provided 37,50 TL Z O N 1 N G R E D M T S Bar Sink / G 66 3 aOA / oT (.7 TYPE OF CONSTRUCTION Ill NEW LJ ADD LJ ALTERATION LJ REPAIR Backflow Preventer ❑ ❑ ❑ CONVERSION DEMOLISH OTHER A.P. ,fs DESCRIPTION OF WORK/USE OF BLDG. Backflow Irrigation Sewer Cap S Main Building: Sewer Connection E Cooking Unit TYPE OF PERMIT LJ GRADING FOUNDATIO STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL B Dishwasher ❑ OTHER A Rear Solar Piping C Right PROJECT DESCRIPTION SO. Fr. occuPANCY Drinking Fountains CONSTRUCTION TYPE VALUATIONS S Left ZONE GRAADING CU. YDS. ACRES Ping. Ref. # Remarks: 12, -7.t-) ` r-) LL Planning Notes: 0419 5/12/8il Zone Accessory Building: Parking Req./Provided 37,50 TL Z O N 1 N G R E D M T S Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+ KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter Clap to 100 amps Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank I Fan Motors 00-1 HP❑1%-B Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP 016-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal Standing Sections P�Trap Laundry Trays Generator 00-5 KW 05-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee S 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Boiler Hood or Type ❑ Canopy Type It ❑ DEVELOPMENT SERVICES Zoning Approved By Building Approved By Application Issued By REQUIREMENTS: Date Date r �f—�Date-S Duct - Under Ground Duct - Structural Refrigeration System 00-10D,000BTU 01100,000BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF EES $ SMIP $ $ PERMIT $ ISSUANCE $ $ ENERGY P.C. $ $ GRADING $ $ MICROFILM $ $ TOTALFEE $ 3 $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICED # Fire Dampers Heating System & Ducting 00.100,000 BTU❑100,0008 Registers xrori 0-0N.clEw5t25ELECTRICAL L40,000. giU O F Fla r+ rulg -. Q19 Reinspection Fee $15 Issue Fee 01 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor ,CONSTRUCTION AND PLANNING APPROVALS Permit + Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1./Temporary Electrical'. Service or Pole 52. Pool & Equipment Location 2 •Soil Pipe-Undrgrnd. 1 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcemeni?� 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grntd!�7, 57. APPROVAL TO COVER-GUNITE `77 Footings �•r v 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 117.,Rough Wiring Sign 68. APPROVED FOR PLASTERING Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL T9. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit# 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping []Gas []Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas 00d 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical �v r 27. Frame and Flashing 76. Dry Standpipe V1 28. a Lathing & Siding 77. FIXED SYSTEM FINAL - 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION^.� 32..Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning iy 8 9 35.NFihal Gas Pipe -Test F" 36. Hood or Canopy rf 37. Final Factory Fireplace ' 38. Final Plumbing 39. Water Service -Final " J 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation1 ` f 44. Landscape Irrigation System I ,45. Sound Attenuation 46. Handicap Regulations •, . 47. FINAL STRUCTURE & BUILDING �.:. 48. Special Requirements Completed ' 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co + 51. CERTIFICATE OF OCCUPANCY No. Date` ' Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. " CITY OF COSTA MESAS TONS//TRU TION PERMIT n Project AVdress ,4I10�1'i' I PAC r aslFr mgm Applicant's Mailing Address 6q Owner's Na a CWTIrl" Address 112 (iL0_ Arch/Eng. License No. Address Contractor's Name CHU N Phone -0 G Address (mailing) City License No. 2 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed un rovisions of Charter 9 (commencing with section 7000) of Dlvision 3 of the usiness and Professions Cotle antl my license is In full f ce antl effect. License Class c e No. Date_>g I -IQ Signature p WORKERS' COMPENSATION DEC LA A ION I hereby affirm that I have a certificate f c risen to If -insure or a certificate Df Workers' Compensation Insurance, a cert d copy thereof (Section Polliccy No. D'40-63l16��1 cpmpan g' IoE�I Certif ietl copy is hereby furnishetl. rt if'ed c py I5 fled with the city Builtling Date Applicant EXEMPTIONRKERS'COMPE NSA ON EC A ION (This section need not be completed if the permit' r one dred ($100) or less). 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. Date Signature NOTICE: If, after making thisdeclaration, you Should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or, this permit shall be deemed revoked. 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 (Section 3097 Civ.C.) Lender's Name Lender's Address _ OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or•repalt 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 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 'herefrom and the basis for the alleged exemption. Any violation of Section 031.5 by any applicant for a permit subjects the applicant to a civil Znalty of not more than five hundred dollars ($500). LJ 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 0flared for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I; as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Cotle: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con. tractor(sI license pursuant to the Contractor's License Law). 1 am aware that proof O their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date I hereby certify that 1 Information Is correct. 1 and state laws relating t sentatives of this city Inspection purposes. Signature Drivers' License or SS # to that the above county ordinances TYPE OF CONSTRUCTION /CJ NEW U ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION 1:1 1) ❑ OTHER A.P.# MAY Zs 'IM j Zone DESCRIPTION OF WORK/USE OF BLDG. N S Main Building: _ Accessory Building: TYPE OF PERMIT El GRADINGFOUNDATION,/ STRUCTURAL T Front LJ TENANT El ELECTRICAL pPLUMBING I/J MECHANICAL 8 Rear ElOTHER T 1 Kf '!/-ji A PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right K CONSTRUCTION TYPE VALUATIONS S Left ZONE—A GRADING CU. YDS. ACRES Ping. Ref. # Parking Req./Provided Remarks: i () 2 0 4 r P') Planning Notes: Z O N I N G R E Q M T S CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic' Washer' Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+ KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers -Solar Collectors Dishwasher Meter El over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel - DrinkingFountains Solar Tank Fan Motors 1:10-1 HP❑1%-8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09-15 HP 016-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet r Device Boxes Pole Light Interceptors Water Heater - i Outlets Range Kitchen Sink Water Service Switches Sign ' Lavatories Auto -Wash Garbage Disposal Standing Sections ,P—'Trap Laundry Trays �'', Generator 00-5 KW ❑5.15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By ata Application Issued By Dat Boiler Hood or Type ❑ Canopy Type I1 ❑ Duct - Under Ground Duct - Structural Refrigeration System 0-100,000TU ❑100,000BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK .25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT E $ $ $ ENERGY P.C. S $ - GRADING $ $ MICROFILM S $ _�f�t-±" _ TOTALFEE $ $ a'S1bl`— Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBG # rjo Fire Dampers Heating System & Ducting ❑0100,000 BTU Elioo.00OBTL Registers Reinspection Fee $15 Issue Fee `S� $ $, CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL &SPA11 APPROVALS Permit # Date 1 Inspector 1 Temporary Electrical'Se'rvice or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE ^T.rFootings IC 58. Electrical Conduit-Undrgrnd. foundation `' 59. Gas Pipe, ❑ Undrgrnd., Test 9.' Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 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 iJB;11. Rough Elgct(ical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # ) 20. Rough Factory Fireplace f21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe "l _ 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL t 30. Drywall Nailing HEALTH DEPT. REQUIREMENT - - 31. Plaster Brown Coat 79. FINAL INSPECTION ,~ e. . 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED Y) 33. Final Electric Notes: ' 34. Final Heating & Air Conditioning 35. Final Gas'Pipe-Test 36,.Hood or Canopy C. 37� Final Factory Fireplace 3'jy �q (� - • _ �B. Final Plumbing 39. Water Service -Final 40. Gas Service -Final ", 41. Solar Domestic -Final 42. Backflow Preventer .43. Backflow IrrigationF-- ('44..Landscape Irrigation System r 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING • `•" 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date CITY OF COSTA MESS{q, CWN (7, ACTION PENIT Project.Kddress ';f�1..-1" �^' PL/i(F . (�vf t 5r� Applicant's Mailing Address r�1 Owner's Name�f hoe ZZ� 11 Address IZ �'/.1WEIZ >1ZQ 1"IEi'� Arch/Eng. License No. Address Contractor's Name ^n'' HU-(ttq-"Ip`f one Address (mailing)-, 'ydN �.1` f f p a City License No. � 262}2 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under w of Charter 9 (Commencing with section 7000) of Divi Sion 3 of the Business n rofessiobS Code, and my license is in full farce nd effect. %S2� License Class e s o / (- Date Signature WORKERS'COMPENSATION DECLAR TION I hereby affirm that I have a certificate of ns to elf -i ure or a certificate of Workers' Compensation Insurance, or a cartifie co heerreof (Section 3800, Lab. C.) rift D3I�f�8'1I Company �V`��r Policy No. �V I 'I Certified copy is hereby furnishetl. Certifi d cap 1 filetl with the city Building Dale— /may—'(—�f/ Applicant EXE MPTION FROM WORKERS'COMPENSATI DEC RATION (This section need not be completed if the permit Is for one hundred ($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. Date Signature NOTICE: If, after making this declaration, you should become Subject to the Workers' Compensation provisions of -the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performgnce of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address _ OWNER BUILDER DECLARATION i I hereby affirm that 1 am exempt from the Contractor's License Law for'the following reason (Section 7031.5 Business and Professional 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/She is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt 'therefrom and the basis for the alleged exemption. Any violation of Section '031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). LJ 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 (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove efor the purpose Of sale). I, as owner of the property, am exclusively contracting with licensed Con. 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 builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner 1 hereby certify that 1 h red Information is correct. gree fo and state laws relating t buil it sentatives of this city en*, Inspection purposes. Signature Drivers' License or SS !cation and state that the above in all city and county ordinances :Ion, and hereby author a repre- above-mentionetl pro erty for Date /( to fill in all spaces except those within heavy border lines and sign all appropriate declarations. WIT NQS _ ^ TRACT NO. I LOT NO. I UWIA NO. TYPE OF CONSTRUCTION KJ NEW LJ ADD LSI ALTERATION LJ REPAIR Backflow Preventer ❑ CONVERSION ❑ DEMOLISH ❑ OTHER(./ A.P. # DESCRIPTION OF WORK/USE OF BLDG. Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping $ Main Build! Floor Drains Swimming Pool w/Spa E Urinal TYPE OF PERMIT GRADING FOUNDATIO STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL L(�y�yM BIN MECHANICAL B Rear ❑ OTHER p 1'Y 6"T lf'� GRADING p' PLAN CHECK 50% $ MICROFILM C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY FK CONSTRUCTION TYPE VALUATIONS $ Left ZONE GRADINGCU.VDS. ACRES Ping. Ref.# Remarks:Q: $ I Planning Notes: Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Water Heater Kitchen Sink Water Service Lavatories Auto -Wash Roof Drains Reinspection Fee I $151 1 Issue Fee 1 $ 3 MAY 24 1988 � .i LJ )AGc655flC1 Zone ELECTRICAL FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+ KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter El over 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors ❑0-1HP❑1K-8 F.A.U. Inc. Solar ❑9-15 HP El 16-15+ Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal Standing Sections Generator ❑0-5 KW ❑5-15 KW Trash Compactor Z O N I N G R E 0 M T S I I Reinspection Fee .1 $15 1 1 Issue Fee 1 $ 3 1 1 Reinspection Fee I $15 I I Issue Fee IS' I $ 4 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By 1' Boiler Hood or Type I ❑ Canopy Type 11 ❑ SUMMARY OF FEES BUILDING PERMIT Duct - Under Ground $ Duct - Structural Refrigeration System 00-100,000 BTU 0100,000 BTU PLAN CHECK $ Duct - Ventilating Exhaust System ❑ Multiple ❑ System Repair/Alteration $ ISSUANCE S Firepl/Fact. Bit. ICBO # Fire Dampers $ ENERGY P.C. S Heating System & Ducting Do 100,000 BTU ❑ 100,000 BT Registers $ GRADING $ PLAN CHECK 50% Reinspection Fee I $15 I I Issue Fee IS' I $ 4 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By 1' SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE S PLAN CHECK 25% $ ENERGY P.C. S ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ CONSTRUCTION ANQ PLANNING APPROVALS Per mii # Date Inspector POOL &SPA APPROVALS Permit # Date F 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 LIFER Grnd. 57. APPROVAL TO COVER-GUNITE •7�.. Footings 58. Electrical Conduit-Undrgrnd. B. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9! Water Pipe-Undrgrnd- ,- r 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 7,8. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # • .i 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0Gas 0Oil 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 i 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: ' rr 34. Final Heating & Air Conditioning �- 35. Final Gas'Pipe-Test _ �• 36. Hood or Canopy 37. Final Factory Fireplace g �3 �jq LCO _ - •' . 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final - 42. Backflow Preventer v /� `� - ..• /� • 43. Backflow Irrigation _ • ` : >; 1- 44. Landscape Irrigation System :.. •.' 45. Sound Attenuation i• t 46. Handicap Regulations - "•f. _ 47. FINAL STRUCTURE&BUILDING 48. Special Requirements Completed 1 49. Electric Release to Edison .. 50. Gas Release to Southern California Gas Co ` • - 51. CERTIFICATE OF OCCUPANCY No Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. L.`-.-oF COSTA MESA CONSTRUCTION PERMIT Project Address »f< —5 /ETH III CC5M MM_" j Applicant's Mailing Address Owner's Name GLSffI .Elm L.Lf� h ne Addressi7L F&WC/Sir(ft{�l dlr�4 Ccs 9=Ef2 Arch/Eng. License No. AddressFrE �7 C"tfact0 's Name E Ph.. Address (mailing)- rigk7 MART AVC— 7>:MIK-- C17Y[Mg12 City License No. 4—z 1224 LICENSED CONTRACTOR DECLARATIO I hereby affirm that I am licensed under provisions of Charter 9 (Commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License lass C (n 20 Date ��l� Signature WORKERS' COMPENSATION D AR T N 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 338 0, Lab. C') n c uM D ICY No- Th� �� Company JT - `F Certified copy is hereby furnished. Certifie cop filed with the city Build' Ivl o Date 1 Applicant EXEMPTION FRO WORKERS' CO NSA ION DECLARATION (This section need not be completed if the permit is for One hundred or less). 1 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. Date Signature NOTICE: If, after making this declaration, you Should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there 1S a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a Civil 1n�1enalty of not more than five hundred dollars ($500). LJ I, as owner of the property or my employees with wages as their Solo compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License law does not apply to an owner of a property who builds or Improves thereon, and who does such work himself/hersei/ or through his Or her own employees, provided that such improvements are not intended Or offered for Sale. If, however, the building or Improvement is sold within one Year of com- pletion, the owner will have the burden of proving he/she did not build or im- Dve for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed COO. tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). Iam aware that proof of their Worker's Compensation Insurance Should be provitletl to me. ❑ 1 am exempt under Section B. d P. C. for this reason Date I hereby certify th information is corre and state laws relat sentatives of this I inspection purposes. Signature Drivers' Lice. , — Owner I have read this application and state that I agree to comply with all city and county to building construction, and hereby authr to Anter upon the above-mentioned or above lances repre. Y for ._ 31 2 -3 Showers SUMMARY OF FEES -_..._.VM FEES TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION U REPAIR Service Sink ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A P 46 DESCRIPTION OF WORK/USE OF BLDG. PLAN CHECK Backflow Irrigation Sewer Cap PERMIT S Main Building: TYPE OF PERMIT)/I GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT (sr.l ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A Meter El over 100 amps C Right PROJECT DESCRIPTION SO. FT. OCCUPANCY KLeft Sub Panel CONSTRUCTION TYPE VALUATION$ $ Solar Tank ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Z,6 'aim/ / Planning Notes: 9902 11/19/87 Zone Accessory Building: Parking Req./Provided 35.40 'til Z O N I N G R E Q M T S Bar Sink Showers SUMMARY OF FEES ELECTRICAL FEES Backflow Preventer ) Service Sink SMIP Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW ❑ 50+KW PLAN CHECK Backflow Irrigation Sewer Cap PERMIT Bathtubs Sewer Connection PLUMBING Cooking Unit ( Meter ©up to 100 amps 5-00 Clarifiers - Solar Collectors S Dishwasher Meter El over 100 amps Dishwasher Solar Piping GRADING 1 Dryers ❑Gas ❑Electric Sub Panel PLAN CHECK 50% MECHANICAL Drinking Fountains Solar Tank $ $_ Fan Motors 0&1 HP❑1%-8 $ Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09-15 HP 01615+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater 40 Outlets Range ef Kitchen Sink Water Service Switches Sign 0 Lavatories Auto -Wash Garbage Disposal 'Standing Sections P—Trap. Laundry Trays Generator 00.5 KW 05-15 KW Trash Compactor Roof Reinspection Fee 1 $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple F irepl/Fact. Bit. ICBG # Heating System & Ducting 0,0.100,000 BTU ❑100,000 Reinspection Fee ( $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 Reinspection Fee $15 Issue Fee IANICAL FEES Hood or Type 1 ❑ DEVELOPMENT SERVICES REQUIREMENTS: Canopy Type I1 ❑ Zoning Approved By Building Approved By n yea Refrigeration System - W100,000BTU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee 1 $ 3 $ 3 l SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% S ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% MECHANICAL $ $ __ MICROFILM TOTALFEE $ $_ PLAN CHECK 25% $ l CONSTRUCTION AND PLANNING APPROVALS Permit .Date '. ., Inspectors POOL & SPA APPROVALS Permit Date V Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ' 5. Steel Reinforcement ��� 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grrid. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation ! 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd.1' 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer LineA: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 t! 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil; 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas 0Oil 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 • ., 1 30. Drywall Nailing HEALTH DEPT. REQUIREMENT ) 31. Plaster Brown Coat 79. FINAL INSPECTION t I 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED F. -) 33. Final Electric Notes: 3 'BI 8 ifq)45job "- an % ' 34. Final'Heating & Air ConditioningUx I 35. Final•Gas Pipe -Test "0 36. Hood or Canopy i 37. Final Factory Fireplace - 38. Final Plumbing 39. Water Service -Final • w 40. Gas Service -Final • ' '1. ' r 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 ' M r1 51. CERTIFICATE OF OCCUPANCY No. Date 4 _ _ ■ iXFY OF COSTA MEQ/$ CONSTp%(�"�CTION PERMIT Project �iddress L��6 ^'�, Applicant's Mailing Ad s %bSh. Owner's Name �hlnnn `n $jr-RZI� Address Arch/Eng. License No. Address %F 2 1,/11�/�.1�y� Contractor's Namr Address lme'1'nol / City License No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Co e, and my license is In full force �1�p�dj effect. License CJ _nLice se Date y Signature1.11J —/r✓1� WORKERS' COMPE SATION DECLWATION 1 hereby affirm that I have a certificate of consent to self -Insure or a certificate of Wor ker S' Cor�r}}pe nsation Insurance, or a ser IIIiAd copy thereof (Section 3800, Lab, C.) y{, y-D� / (i� I L' Polity Nie `y is h �u d Co pony L('_____-}l� Certified copy is hereby Iumished. Certil TpV 'led with the City it n9 i i Date 1I Applicant EXEMPTION FRO WORKERS' COMPErIMATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued 1 Shall not employ any person in any manner So as to become subject to the Workers' Compensation laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions Of the Labor Code, you must forthwith comply with such provisions or this permit Shall be (learned revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 1031.5 by any applicant for a permit subjects the applicant to a civil Znalty of not more than five hundred dollars ($500). LJ I, as owner of the properly or my employees with wages as their SOle compensation, will do the work, and the structure Is not Intended Or offered (Secti for sale on 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended Or offered for Sale. If, however, the building or Improvement Is sold within One year of com- plation, the owner will have the burden of proving he/she did not build or im- prove efor the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- 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 builds or Improves thereon, and Who contracts for such projects with a con- traFtor(57 license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance Should be provided to m0. ❑ 1 am exempt under Section B. & P. C. for this reason Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMJJ NO. TRACT NO. LOT NO. UNIT NO. I hereby certify in information is corre and state laws relat sentatives of this i inspection purposes. Signature Drivers' License or this a f F TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION 0 REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P-.16 DESCRIPTION OF WORK/USE OF BLDG. $ Main Building: TYPE OF PERMIT DGRAOING EJ FOUNDATION U STRUCTURAL E El I TENANT El ELECTRICAL 1:1 PLUMBING 1:1 MECHANICAL 1—u OTHER PROJECT DESCRIPTION SO. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION S ZONEc1 In GRADINGCU.YDS. ACRES Remarks: T Front B Rear A C Right 3 Left Ping. Ref. # MPlanning Notes: FEES Bu Parking Req./Provided Zone Z O N I N G R E 0 M T S Bar Sink Showers - ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Transformer ❑ 15-50 KW ❑ 50+KW Construction Pole Sub. Backflow1lrrigation Sewer Cap -�C Bethtsibs Sewer Connection $ Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping PLUMBING Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank ISSUANCE Fan Motors 00.1 HP ❑l A - 8 Floor Drains Swimming Pool w/Spa $ F.A.U. Inc. Solar ❑9.15 HP ❑16.15+ Floor Sinks Urinal $ Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater PLAN CHECK 50% Outlets Range Kitchen Sink Water Service MICROFILM Switches - Sign Lavatories Auto -Wash $ Garbage Disposal Standing Sections P—Trap Laundry Trays $�%_ Generator ❑0.5 KW 05.15 KW Trash Compactor Roof Drains Reinspection Fee I $151 I Issue Fee I S 3 MECHANICAL I FEES Boiler Hood or Type 1 ❑ Duct - Under Ground Canopy Type I I ❑ Duct - Structural Refrigeration System Duct - Ventilating 00.100,000 BTU 0100,000BTU Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO # Fire Dampers Heating System & Ducting Registers ❑ 0. 100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 1 1 Issue Fee GMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $ 3 Reinspection Fee I $15 1 I Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Data 0100007707-00007107 T13T 30.00 SUMMARY OF FEES �p I�1 �� /gyp . `1 Inc `@UPLO�7PvffA1T $ -�C SMTP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $�%_ PLAN CHECK 25% $ 0100007707-00007107 T13T 30.00 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL &SPA APPROVALS Permit # Date Inspector 1`.,Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. '- 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings _ ,• 58. Electrical Conduit-Undrgrnd. B. Foundation ' r 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap c. 63. Heater & Vent -Final 13. Roof Drains - 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough Electricbl-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 APPROVALS ,Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑oil 23. Gas Pipe -Rough & Test 72. Underground Flush V 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL/-;�- 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT n. 31. Plaster Brown Coat 79. FINAL INSPECTION .•'- +•% 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED •-- 33. Final Electric H Notes:)ec,/� C, 34. Final Heating & Air Conditioning / ZZ -ad 35. Final Gas Pipe -Test {•'.__ 36..Hood or Canopy 37 Final Factory Fireplace ,y, L; ' �.• •- 38."Final Plumbing 39. Water Service-Final1. .T i 40. Gas Service -Final -4, x•41. Solar Domestic -Final �� - ( 11f `- n '42. Backflow Preventer 43. Backflow Irrigation •%' -. ) </ _ ~`^ 44., -.Landscape Irrigation System 45. Sound Attenuation ti 7. J ` •1.'.' ' 46..Handicap-Regulations i. 47:"FINAL STRUCTURE & BUILDING', 48. Special Requirements Completed 49. Electric Release to Edison .r 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date •- r r y ,*� (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 216 16TH PL Suite No B Vicinity: Parcel Nunmber: 42520508 Applicant: MOORE, MIKE Address: 1526 NEWPORT BL COSTA MESA, CA Owner: CARNEY, WILLIAM D Address . 216 B 16TH PL COSTA MESA, CA Contractor: EARL'S PLUMBING INC Address: 1526 NEWPORT BL Arch / Eng : Address: COSTA MESA, CA PLUMBING PERMIT Phone: (949)642-1756, Zip: 92627 Phone: Zip: 92627 Phone: (949) 642-1756 Zip: 92627 License: 217657 Phone: Zip: License: 1 SCOPE OF PERMIT REPLACE GAS SERVICE FROM METER TO HOUSE. Status: ISSUED Applied: 11/14/2002 Issued: 11/14/2002 ISSUED BY: QTY AMT FEE SUMMARY 0 AMT QTY 0 AMT ISSUE FEE $23.50 0 Laundry Tub / Washer $0.00 Backflow irrigation $0.00 0 - Landscape Irrigation $0.00 Backflow Preventer $0.00 0 P -Trap $0.00 Bathtub $0.00 0 Pressure Regulator $0.00 Clarifier System $0.00 0 Process Piping (per 10 ft) $0.00 Connect (Ice,Soda,etc) , $0.00 0 Receptors $0.00 Dental Units $0.00 0 Septic Tank $0.00 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 Drain, Floor $0.00 0 Sewer Connect $0.00 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 Drain, Roof $0.00 0 Shower $0.00 Drinking Fountain $0.00 0 Sink, bar $0.00 Expansion Tank $0.00 0 Sink, commercial $0.00 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 Status: ISSUED Applied: 11/14/2002 Issued: 11/14/2002 ISSUED BY: QTY AMT QTY 0 Sump Pump $0.00 0 0 Swimming Pool $0.00 0 0 Trap Primer "$0.00 0 0 Urinal $0.00 0 0 Vacuum Brkr Bkflow(1-4) $0.00 0 0 Vacuum Brkr Bkflow(5+) $0.00 0 0 Wash Basin 50.00 0 0 Wash Basin Set $0.00 0 0 Waste and Vent System $0.00 0 0 Water Closet (Toilet) $0.00 0 0 Water Heater / vent $0.00 0 0 Water Piping (Inst or Rep.) $0.00 0 0 Water Re -pipe $0.00 0 0 Water Service $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 244646(6/00) WORKERS' COMPENSATION DECLARATION: I hereb ofirtn under penalty of perjury one of the following declarations: ❑ have end will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 0l 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 career and policy number are: Carrier: Policy Number: (This section need not be completed it 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, 1 shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that it 1 should become subject to the workers' compensation provislons of Section0 of the Labor Code, I shall forthwith comply with these provil $. Applicant Signature: X11 37 - r -6� Date: 1 I ' T D--�_ 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 DOI-LARE (S1o0,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION Was 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. W Class R Contractors Signature:Date: l i CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: Signature: Data: OWNER -BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the fallowing reason (Sec. 7031.5, Business and Professions Cade: 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 Cade: 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. It, however, the building or Improvement is sold within one year of completion, the owner -builder will have the burden of Droving 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.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Data: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, I.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 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 e 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 t0 release or threatened release of a hazardous material? ❑ Yes ❑ 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 standartl temperature and pressure). ............_.................._._..................-............................ ... _............................_....................... "'.............................. _.... _.......................................................... ............_.... ......__........... ........ _............ _............ __....... 2 Does or will the applicant or present or future building occupant need to file a registration forth for acutely hazardous materials? ❑ Yes ❑ 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). .............6........... . ........................................................................................................................................................................................................................................................ -..................................................................................................... 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 matenals)7 ❑ Yes ❑ No (Section 25534 of the California Health and Safety Cade 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 materfals with the Fire Department. ..........._........................................ ......._...................................... ............ ................................... ................................. __..................................... __................................................................... ............... ........ _...................................... _........... .._... 4 If en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No .............._.................._.........................._...............-............................................... ____........................._..._..............................__._............................_..............................................._..._.....___................._.............._............. __. 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a �e plicailon amut for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? a Yes L -I No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building Permits). ..._..............._.._.................__.._................................ __..................................... ................................. __................................ _..___............................................................................................. .......... _._............... ..__............. _.......... 8 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (if "yes", the facility must meet the requirement of Sections 25534 and 42303 of the Callfomia Health and Safety Code). ..............................................................._,....................._..................._................................................._................................................onit............................................the........._...................-is-.1--h-e. _..-h-e.................................... 7 If a permit from the South Coast Air Quality Management District or other air pollution coon 4 district3be n agency is required for the work which is the subject of this application, have all of the disclosures proscribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature O a Owner(s) l� ' ``t' 1 Date A-n—d/ r ul o zed Applicant 1 UDate �- CODE If INSPECTION TYPE QM 11ML5 CODE. INSPECTION TYPE 2&19 INTTTIAl3 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing /�"/✓ry%a 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 2D4 Final Demolition 250 Final Building/Occupancy CI Applicant to fill in all spaces except those within heavy border lines and sign ar. _preprlate declarations. PE IT TRACT NO. LOT NO. UNIT NO, t CITY OF COST MESA CONSTRUCT( N PERMIT C A r Project Address C' !6 1T/rMFO Appliccit#s %ilin/gAddress lyl�( I) O��w---5er's Name-c+?t-o_s4JA L�'��'n hone .,vddress 17nU,)'Qil-7j,}., _ �.O CA t" 15411', CA Arch/Eng. / License No. Address Contractor's Nam e�` Phone 9z Address (mailing) IJ6?�r--�hT" ��h City License No. _�� DECLA%' LICENSED CONTRACTOR RATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing With section 7000) of Division 3 of the Business and Professions Code, and My license is in full torczf d effect. n O^ License s l.. JO - License No. Date Signature .WORKERS PENSATION DECLARATION hereby affirm that I have a certificate of consent to selNnsure or a certificate if Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab, C.) ��ss 7�t yy r NsV Policy No. '_— Company F Certif ipd copy is filed tmnls hetl. Certithl cop field with Inn city BuHdi D' son ate Yl Applicant — BXEMPTI FRO WO RIKERS'COMPEN O ECLARATI (This section need not be completed if the Permit is for one honored ($100) or (CSS). 1 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. Dale Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit snail be deemed revoked. 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 (Section 3097 Cly. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or County which requires a permit to construct, alter, improve, demolish or repair any structure, PIIOT to its issuance, also requires the applicant for such permit io file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five honored dollars ($500). 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law doesnot apply to an owner of a property who build$ or Improves thereon, and who does such work nlmself/herself or through his or her own employee$, Provided that such improvements are not intended or offered for Sale. If, however, thebuilding or improvement is sold within one year of Com- pletio n, ,the owner will have the burden of proving he/she did not build or im- rove for lne purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors 16 Construct the Project (Section 7044, Business and Professions Code: rhe Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con. tractorlicense pursuant to the Contractor's License Law). I am aware that proof o// s) their Worker's Compensation Insurance Should be provided to me. 0 1 am exempt under Section a. & P. C. for this reason Date I hereby certify that I information is correct. I and state laws relating' sentatives of this city Inspection purposes. Signature Drivers' License or SS V IF 0865-46, rev. 10/84 Owner above nances =__5 t2 I I PERMIT Reinspection Fee 1 $15 Issue Fee tANICAL FEES 9890 11/19/87 TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION 0 REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIUJONOF WOFK/USE BLDG. A.P. # Zone S Main Building: Accessory Building: TYPE OF PERMIT riGRADING LJ FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER T Front B A Rear PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION$ ZONE GRADING CU.YOS. ACRES C Right S Left Ping. Ref. # Parking Rey./Provided Remarks: Issue Fee Planning Notes: PLUMBING FEES Bar Sink Showers ELECTRICAL Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+ KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors ❑0-1HP❑1'/x-8 Floor Drains Swimming,Pool w/Spa F.A.U. Inc. Solar 119-15 HP 016-15+ Floor Sinks Uri Fixtures Microwave Gas Service Outlets ater Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal Standing Sections P—Trap Laundry Trays Generator 00-5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee 1 $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Du ng ❑ 6100,000 BTU 0 100,000 Reinspection Fee 1 $15 White - - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 PERMIT Reinspection Fee 1 $15 Issue Fee tANICAL FEES GRADING Hood or Type 1 ❑ Canopy Type II ElZoning MICROFILM $ DEVELOPMENT SERVICES REQUIREMENTS: Approved By Building Approved By Application Issued By ReNon System X,000 BTU ❑100,000 BTU SUMMARY OF FEI BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK '25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ System Repair/Alteration Fire Dampers Registers #$3 Issue Fee 8900 TL Z O N I N G R E G M T S FEES $ 3 SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTALFEE $ _ ) CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector POOL & SPA APPROVALS Permit# Date Inspertol \` i. Temporary Electrical Service or Pole . ool & Equipment Location - 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding S. Steel Reinforcement . 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation r 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrn(T./ 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Lines&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 APPROVALS Permit # - 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas 0Oi) 23. Gas Pipe -Rough & Test 72. Underground Flush �• 24. Roof Framing 73. Undergrnd. Storage Tank OGas 0Oil 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT; - - 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 8 OOD CERTIFICATE ISSUED - 33. Final Electric 57 Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test .36. Hood or Canopy " .37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final - - 41. Solar Domestic -Final .. 42. Backflow Preventer 2 -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 •-- A 7' r; 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date City of Costa Mesa Development Services Department Building Safety Division Vvt CERTIFICATE OF OCCUPANCY No. ( � i I-!.-� r� , ,( 4 P.O. Box 1200 Costa Mesa. California The Building located at 216 East 16" Plar_a, Unit- R has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group Rl Occupancy. Use of Building ronriomi n tlm Legal Description 425 -2n9 -1d (See reverse side for Metes and Bounds) Building Permit No, n Vn1Qr Electrical Permit Nn?A'121z, 1711911 Plumbing Permit No. A 31160 Mechanical Permit No. i'i 33472 Number of apartments and/or guest rooms ISSUED TO: Costa Mesa Leadar EnFPrnri CP' Tnr. 172 Flower Street Costa Glesa. CA 92697 Building Official William m_ Rnwa,vl by Date March 21, 1989 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 lel U.B.C. CMF 1015-46 rev. 1/83 White - Owner; Canary - Numerical File: Pink - Bldg. Permit File CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address z7 I En:Z�W owig-ee t o> Applicant's Mailing Address Owner's Namel[!0')'(A to A 1_isA9;1 1=1.1% QQ15cS Phone_r7Z1>II Address 5-T- &D STA MSSA . cA gzta? Arch/Eng. License No. Address Contractor's NamePuAjlir,U P n b4 Address (mailing) S(4t�� b )D City License No. 1114 1 �4 Z LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effec License Class Licen o. 2 0 Date Signature ny(y WORKERS' COMPENSATION DECLARAy N I hereby affirm that I have a certificate of c sent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section Policy Lab. C.) �s I �I ' 1 [ F1�TT Policy No. -4-Q-- 1) �i ( lC� 1 I ComPanY Vf.7 LL41wUT Certified copy is hereby furnishelC. CerYfietlopy is f ed with the city Buld nsQ qIvlsionS1 , ate ION FROMWApplicant SHAti I-t�L� EXEMP ORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($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. Date Signature NOTICE: If, after making this declaration, you should become Subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097 Civ. C.) Lender's Name - Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of the Contractor'sLicense Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil ,anally of not more than five hundred dollars ($500). owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, Provided that such Improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im - prove efor the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Cade: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declaration$. PERMIT NO. TRACT NO. I LOT NO. UNIT No. Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this y to a �{lpan the above-mentioned property for inspection purp /I _1 _ (� Signature 11/x`.— Date Drivers' License or Sy� �\ CMF 0865-46, rev. 10/84 White - Building; Canary 30195 1106,32 TYPE OF CONSTRUCTION LJ NEW I I ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. — 1VF ro 3 ALTERATION REPAIR TYPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SO. FT. OCCUPANCY CONSTRUCTION' TYPE VALUATION$ 6 ZONE GRADING CU.YDS. ACRES Remarks: FEES Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors '' Water; Heater Kitchen Sink Water Service Lavatories - Auto -Wash A.P. # A -7,`l S Main Building: E T Front B Rear 1�j A C Right L S Left to Ping. Ref. # PA - Planning Notes: 5102 9/11/87 2-14 Zone Accessory Building: �1 b Parking Req./Provided 40045 Z O N 1 N G R E O M T S ELECTRICAL FEES Automatic Washer Construction Pole Sub. Transformer 0 15-50 KW 0 50+KW Cooking Unit Meter ❑up to 100amps Dishwasher Meter ❑over 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors 00-1 HP ❑l %- 8 F.A.U. Inc. Solar 1:19.15 HP 016-154- 16.15+Fixtures Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal Standing Sections Generator 00-5 KW 05-15 KW Trash Compactor 1 IRoof Drains 1 1 I 1 I Reinspection Fee 1 $151 I Issue Fee 1 $ 3 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting 00-100,000 BTU 0100,000 BT Reinspection Fee 1 $15 ; Pink - Accounting; Goldenrod - Assessor Hood or Type 0 Canopy Type I I ❑ Refrigeration System 00-100,000 BTU 1_1100,000BTU System Repair/Alteration Fire Dampers Registers Issue Fee 1 FEES Reinspection Fee I $15 1 1 Issue Fee DEVELOPMENT SERV Zoning Approved By Building Approved By Application Issued By F,$R`E �Sjj DIME :G �6,--TT / l2//( /LZ =L" IT -101 Data Date DatA BUILDING PERMIT $ PLAN CHECK. $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL - $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ SUMMARY���.O F.EEES 4' _Q -DO SMIP $ 8 ..S ..S Z 5 PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTALFEE $4-0,9,,05 $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector POOL & SPA APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings S(js-L- 58. Electrical Conduit-Undrgrnd. B. Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water Pipe-Undrgrnd, 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System. - ,3 �� Y Y 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 APPROVALS Permit# _- 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas ❑ Oil - 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas []Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing S L i 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation e D 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT - 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace , 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final ' 41. Solar Domestic-Final - 42. Backflow Preventer ' ,43. Backflow Irrigation 44. Landscape Irrigation System - 45. Sound Attenuation 46. Handicap Regulations ' 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date BN FORM 116 SIA FORM 1486 INSULATION CERTIFICATION This is to certify that, in conformance with the current energy regulations (California Adminis- trative Code, Title 25, State of (alifornia`) and approved plans, insulation has been installed in the building located at: COSTA MESA ORANGE lib c...Lf 216 16TH PLACE d# 6 Sb..l R.. (If A.U.W.) st . W if b.r Tnd M.. DESCRIPTION OF INSTALLATION ROOFS Type of Material Manufacturer—Thickness--R Value'*— EXTERIOR WALLS FIBERGLAS BATTS OWENS COMINGS FIBERGLAS Type of Materia) Manufacturer Thickness 3} R Vatae•• 11 (or Tnd. n.1.4 CEILINGS FIBERGLAS BATTS OWENS COMINGS FIBERGLAS BATTS: Type of Material Manufacturer Thickness --R 30 R Value" (or Tnd. lu.Q SQ. FL Covered BLOWN: Type of Materia) Manufacturer Thickness No. Bags_ - (or T-6 M.a.) WL/Bag SQ. FL Covered R Vatue'e_ FLOORS Type of Material Manufacturer -Thickness--R Value`•_ (or Tad. N...) SLAB ON GRADE Type at Haterial Manufacturer_-•-' Thickness--- - R Vafue'•_ (ar Tnd. N..y Width of Insulation Inches FOUNDATION WALLS (if required) Type of Material Manufacturer Thickness R Vatue••_ (or TM& 11.1..) REMARKS (if desired) General Contractor (Builders WEI-CHUAN CONST Sub -Contractor (Insulation AppNcator) n(,(:e11L 11151.11 (low.b., H. R4r. -SME- 4 w By 2 �C rrUe� 1•CNilw. Ad.l.:~;N Gay [w.br 4.N.1W fb�N.d., d.Ar.o "f%...1:..... U. <e..41:M N M M.I.IINIw N MMN:w, ...rd ."F,i.. rbN 16.._' '_liw M. Mew b..l.1W M wMrw wA IM M ....le..d ..d � b. 16e M..Mi.w NN1.N.r w M M www . TW ,••E V.4. 1. 16........ N 9y w.IN N ...wnN .r b.twy w.1. ... (e) N r qv" wMC1.0 b.dw•1 & DEV license Number Dat. License Number 274283 oat, 2-24-89 EZCEN'T b.. ll . 1117S N A. II.N6 ..d S.M, Gd. N M Sbd. N 'TM .wrlllwr. N .r.w..q w .I.II. ...99..11.. lb.r ..wlr aw. ..y.r.d b. -I. —%I. w.N.eN b.e... bw w Nor w.NeN:N d.NM. 1. 4W1.161..ben M I..wd M ..6 . wwN" Me..1.w1 .1..d.1+. «aW04-d eww..1 r ral\ dwM.^ LM,, .' form 116 -c BUILDING NEWS. INC. 3055 0vMand Ave_ to Angeles. Calif. 90034-$13)870.9871 form 1486--e BUILDING INDUSTRY ASSOCIATION Of CALIFORNIA, INC` 1571 Bevedy Blvd. Los Angeles. Calif. 90026--(213) 625.5771 60 It J Applicant to fill in ail spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA M//ESA /CONSTRUCTION PERMIT Project AddressC- epplicant's Mailing Address y'., _p' �� Owner's Name A, r Phone �t�.l.l_ Address 177- v r,toey� ,,,% PSCv I(A eis6-/17 *ch/Eng. License No. s Address nm 4+✓, Contractor's Name. - K Phon 113 Address (ma rnn)149q r,fPtrg R4'4 OJ J11/e d10k CA9PJr �� City License No. 04Z64-2 LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with Section 7000) Of Division 3 of the Business and Professions Code, and my license is in full force and effect. Lice%ass , LiceJts No. 2F -10t Date1 Sq;naturer i- �n�+ WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. 4-0 - A; v6 S� I ` � / Policy No. I Company�s. �! r feYanYi ❑ Certified copy is hereby furnished. Certifi tl t py is filed with the city B din Division.. Date /(�6,9*7- Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for One hundred ($100) or less). 1 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 lite Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you Should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097'Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License'L-aw for the following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) Of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit Subjects the applicant to a civil Enalty of not more than five hundred dollars ($500). LJ I, as owner of the property or my employees with wages as their solo compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of Proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner Of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con. tractor( license pursuant to the Contractor's License Law). I am aware that proof off their Worker's Compensation insurance should be Provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this a information is correct. I agree to comply and state laws relating to building const sentatives of this city to enter upon inspection purposes. Signature Drivers' License or SS # - repre. Y for RN 9711 11/17/87 47,38 TL TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. A.P. 9W Zone S Main Building: Accessory Building: $15 i Issue Fee TYPE OF PERMIT GRADING -1 FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL LUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SO. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YDS. ACRES t $ 3 E T Front DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Z O B A Rear N I C Right N K S Left SMIP PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM TOTAL FEE Q R Ping. Ref. # Parking Req./Provided E Remarks: O Planning Notes: Q M $ 3 T S PLUMBING FEES Bar Sink Showers !!O ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer - Construction Pole Sub. Transformer ❑ 15-50 KW ❑50+KW Backflow Irrigation Sewer Ca 9 P Bathtubs Sewer Connection li,2 Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping CA Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 001 HP ❑1X - B Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar ❑g-15 HP ❑16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Oo Outlets Range Kitchen Sink Water Service 14W Switches Sign 4 Lavatories Auto -Wash T Garbage Disposal Standing Sections P -Trap Laundry Trays Generator 00-5 KW 5-15 KW Tras ompactor Roof Drains , Reinspection Fee 1 $15 Boiler Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting 00100,000 BTU 0 100,000 Reinspection Fee I $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee Hood or Type ❑ Canopy Type I I ❑ Refrigeration System 00.100,000BTU ❑loo,000 System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 Reinspection Fee $15 i Issue Fee t $ 3 FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Date Date Date__" S BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ �tpcT� $ $ $ $ $ $ SMIP PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM TOTAL FEE $ $ $ $ $ $ 41-`S8 $ 3 CONSTRUCTION AND•PLANNING APPROVALS Permit# Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1 -.'Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. / �y� f�i' 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 LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. B. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection �G f' 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing LV 65. Electrical -Final _ 15. Rough Electriral-Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign - r 68. APPROVED FOR -PLASTERING 18. Rough Electrical -T Bar Ceiling �_ '; -, 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # ' r' 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical I- 27. Frame and Flashing ii. 76. Dry Standpipe _ 28. Lathing & Siding 77. FIXED SYSTEM FINAL , 1, 29. Insulation 78. FIRE PREV. FINAL - 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat � i 79. FINAL INSPECTION C-' 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED t 33. Final Electric Notes: 34. Final Heating & Air Conditioning ._ n 35. Final Gas Pipe -Test - 36. Hood or Canopy r � _ 37.- Final Factory Fireplace •- '- - 38:' Final Plumbing 39. Water Service -Final 40. Gas Service -Final i ;'- r ;,41. Solar Domestic -Final-- • 42: Backflow Preventer',-- 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation „ - 46. Handicap Regulations - " ' - I r- 47: FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 'r - •. ,c 49. Electric Release to Edison t' 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date - - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MEESA CONSTRUCTION PERMIT Project Address �c �% 7 6 *� /J (1p�04 /v75 SIi Fypplicant's Mailing Address �&- Fi��i /1 61.. pp Owner's Name ���OR��1p d/00/1A 4/00 Phone _7r<u If 9A Address Arch/Eng. License No. Address �-Clr- �"-^ Q �' 4r/( Contractor's Nam Phoneyi 9. 89 Address (mailing) ICIE32 w' ( 1 City License No. LICENSED CONTRA TOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (Commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full once and effect. License Class 070 License No?ilN Dale Signature WORKERS' COMPENSATION DECLARATION 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 3800, Lab. C.) . Poll o CO mpany ertified copy Is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed If the permit is for one hundred ($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 Ao as to become subject to the Workers' Dattion Laws of Calif orn' . e � omp apsar Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit Shall be deemed revoked. 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 (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/She Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant t0 a civil Mof 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 (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for Sale. If, however, the building or Improvement is sold within one year of Com- pletion, the owner will have the burden of proving he/she did not build or im- rva r the purpose of sale). I, asfoowner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city e�[er upon the above-mentioned properly for inspection purposes. SignatureDate 511-1 Drivers' License or SS %1 PERMITNO. 4- � � TRACT NO. LOT NO. UNIT�O. 0409 5/ 1 2/0', TYPE OF CONSTRUCTION Lel ADD 11 ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A, P, # DESCRIPTION OF WORK/USE OF BLDG. $ Main Building: Accessory Building: E TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL BRear A ❑ OTHER C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ACRES Ping. Ref.+ Parking Req./Provided Remarks: O 9= ' L --% . /Q i Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets 'Citchen Sink Lavatories P—Trap Root Drains Reinspection Fee $15 Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG * Heating System & Ducting ❑ 0-100,000 BTU ❑ 100,000 BTi Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee Hood or Type 1 ❑ Canopy Type I I ❑ Refrigeration System 00-100,000BTU 0100,000BTU System Repair/Alteration Fire Dampers Registers FEES ELECTRICAL Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter Clover 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors Ell HP ❑ V/, - 8 F.A.U. Inc. Solar 09-15 HP Ell 6-15+ Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage Disposal Standing Sections Generator 00-5 KW 05-15 KW Trash Compactor Zone $ 3 Reinspection Fee $15 Issue Fee FEES DEVELOPMENT SERVICES REOUIREMENTS: Zoning Approved By _ Building Approved By Aunticat'no Issued By fe�— d +;)_Hudt7of5Til Fin+• ie- dEtisCeJ Reinspection Fee 1 $15 1 1 Issue Fee I 4 CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLAN CHECK 25% $ y'.S—CJ :17o"C TI Z O N I N G R E 0 M T S FEES $ 3 SMTP SUMMARY OF BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ V PLAN CHECK 25% $ y'.S—CJ :17o"C TI Z O N I N G R E 0 M T S FEES $ 3 SMTP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ 37'5-0 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1:Temporary Electrical.Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd.r'' 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Uridrgrnd. 55. Electrical Bonding 5. Steel Reinforcement; 56. Rough Plumbing & Pressure Test ' 6. Electrical UF ER Grnd.�� 57. APPROVAL TO COVER-GUNITE (7.,,.Footings �:' 58. Electrical Conduit-Undrgrnd. B.•Foundation 59. Gas Pipe, 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 '-,1,8,/,Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19: Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # r'+ 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping EI Gas 0Oil , 23. Gas Pipe -Rough & Test 72. Underground Flush 24! Roof Framing 73. Undergrnd. Storage Tank OGas 00il 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical •'i/ 27. tFrame and Flashing i 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL ! ! 29. 'Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED , 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. t�Pinal Gas Pipe -Test I. 36. Hood or Canopy i 37. Final Factory Fireplace ; 38. Final Plumbing 39. Water Service -Final -' 40. Gas Service -Final Imo•• I 41. Solar Domestic -Final '1 ' 42. Backflow Preventer 43. Backflow Irrigation ' 44. Landscape Irrigation System 145. Sound Attenuation •- , 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING r 48. Special Requirements Completed - 49. Electric Release to Edison - ) 50. Gas Release to Southern California Gas Cc 51. CERTIFICATE OF OCCUPANCY No. Date - I / 1 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. 111 I I CITY OF COSTA MESA CONSTRUCTION PtRMI 1 �p Project Address ZIE �• l E't:L I yL3• Ce5ba. kl el k `*L7 • 1 3 Applicant's Mailing Ad rKOwner's NameeCiliEr . LL "n1!tESPhone 7274311 Address Irl? ��nt_'21'S{'�(r.41-n 1/l��r�j (•/1_ 2E�� Arch/Eng. License No. Address �t Contractor's Name �� ACT ,� f•- C Phone �l�r � Address (mailing)— — L - C6:917 City License No. 4:3.194 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in flit) fore and ffect. LICCnse CIzSs+ Li cense o. ,.to �I)/—� Y-7�— Signal r 3 �P WORKERS' COMPENSATION DCe&RA ION I hereby affirm that I have a cerci li tate of Lonsent to self-insufte or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section P Iiccy NLab. o. C�^-Y_-J 6� 1T ri/�IJ Company Certified copy is hereby furnished. / Cerci fi tl co tiled with the ci Buil ib Le ateVL Applicant EXEMP 10� N R WORKERS'C PN ES N IODECLARATI N (Th iSsection need not be completed if the pe it is for one hundre ,00) 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. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 bany applicant for a permit subjects the applicant to a civil nnalty of not more thanfive hundred dollars ($500). 1, as owner of the properly or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for Sale. If, however, the building or improvement i5 Sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- traclor(51 license pursuant to the Contractor's License Law). I am aware that proof off their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Ihereby certify tha information is tourer and state laws retain sentatives of thi c' Inspection pare Signature Drivers' Li dose or Owner have rea this application and state that the above ,mply with all city and county ordinances cftruction, and hereby authorize repre- ,ppn the above-mentioned property for Date Ilffy IF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 9892 11/19/87 TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION U []CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. REPAIR A.P. I Zone $ Main Building: Accessory Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ElOTHER E T Front Z O B A Rear N C Right - N PROJECT DESCRIPTION SO. FT. OCCUPANCY ­­1RION TYPE VALUATION $ ZONE GRADINGCU.YDS. ACRES Left 6 G R Ping. Ref. # Parking Req./Provided E Remarks: 1�2 Planning Notes: D Nt Ll T S PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW 050+KW Backf low Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter Aup to 100 amps a Clarifiers Solar Collectors Dishwasher Meter El over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel fA Drinking Fountains Solar Tank Fan Motors ❑0.1 His ❑1 %- 6 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 119-15 HP ❑16-15+ I Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater U�O Outlets Range Kitchen Sink Water Service 1;77 Switches Sign Lavatories Auto -Wash Garbage Disposal Standing Sections P—Trap Laundry Trays Generator 00.5 KW ❑5.15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved ByDate Application Issued By Data)/ Boiler Hood or Type I ElDEVELOPMENT Canopy Type II El Duct -Under Ground Duct - Structural Refrigeration System 130-100,000BTU ❑100,000BTU Duct -Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ ISSUANCE $ ENERGY P.C. $ $ GRADING $ $ $ /O •$ MICROFILM S $ TOTALFEE $ _Ti $ Alf Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBG# Fire Dampers Heating System & Ducting 00.100,000 BTU❑100,000u Registers Reinspection Fee $15 Issue Fee $ 3 IF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor ,CONSTRUCTION AND PLANNING APPROVALS Permit # ' ' • Date I ' ,Inspector POOL &SPA _ APPROVALS Permit # Date Inspector 1 i . 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 LIFER Grn`d., 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation r 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's&'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 -,)7-%l 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 APPROVALS Permit # -I 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ElGas El Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0,Gas 0Oil 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT •• 31. Plaster Brown Coat 79. FINAL INSPECTION -, 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED - 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final ' 41. Solar Domestic -Final - 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System - 45. Sound Attenuation r 46. Handicap Regulations - 47. FINAL STRUCTURE & BUILDING r 0 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co . c 51. CERTIFICATE OF OCCUPANCY No. Date \ 1 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, GA 926.26 PLUMBING PERMIT Job Address: 216 16TH PL Suite No C Vicinity: Parcel Nunmber: 42520510 Applicant: SHANNON CLEVEDENCE Address: 01911 S MANCHESTER Phone: 714-953-6300 ANAHEIM CA Zip: 92802 Owner: SZABO, ALAN Address 216 16TH PL UNIT C Phone: 949-650-6068 COSTA MESA, CA Zip: 92627 Contractor: CULLIGAN WATER Address: 01911 S MANCHESTER Arch / Eng : Address: Phone: 714-953-6300 ANAHEIM CA Zip: 92802 License: 663091 Phone: Zip: License: SCOPE OF PERMIT INSTALL WATER SOFTENER Status: ISSUED Applied: FEESUMMARY Issued: AMT QTY 0 AMT ISSUE FEE $23.50 0 Laundry Tub / Washer $0.00 Backflow, irrigation $0.00 0 Landscape Irrigation $0.00 Backflow Preventer $0.00 0 P -Trap $0.00 Bathtub $0.00 0 Pressure Regulator $0.00 Clarifier System $0.00 0 Process Piping (per 10 ft) $0.00 Connect (Ice,Soda,etc) $0.00 0 Receptors $0.00 Dental Units $0.00 0 Septic Tank $0.00 Dishwasher $0.00 0 Sewer Cap for Demo $0.00 Drain, Floor $0.00 0 Sewer Connect $0.00 Drain, Rainwater $0.00 0 Sewer Private Line $0.00 Drain, Roof $0.00 0 Shower $0.00 Drinking Fountain $0.00 0 Sink, bar $0.00 Expansion Tank $0.00 0 Sink, commercial $0.00 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00 Status: ISSUED Applied: 10/10/2003 Issued: 10/10/2003 MA - QTY AMT QTY 0 Sump Pump $0.00 0 0 Swimming Pool $0.00 0 0 Trap Primer $0.00 0 0 Urinal $0.00 0 0 Vacuum Brkr Bkflow(1-4) $0.00 0 0 Vacuum Brkr Bkflow(5+) $0.00 0 0 Wash Basin $0.00 0 0 Wash Basin Set $0.00 0 0 Waste and Vent System $0.00 0 0 Water Closet (Toilet) $0.00 0 0 Water Heater / vent $0.00 0 0 Water Piping (Inst or Rep.) $0.00 0 0 Water Re -pipe $0.00 0 0 Water Service $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 2446-46(6/00) 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. lG'— 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' compensatI Insurance carrier antl poi numbanrr are: Cartier: �V N 1 C h AD Il Q AN. yz 4 D 3 L Policy Number., G (This section need not be completed it the permit is valued at one hundred dollars ($100) or less.) �-- ❑ 1 certify that in the performance of the work for which this permit is Issued. 1 shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree th t it I should ecome subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with thes ovisions. Applicant Signature:- - Data: % WARNING: FAILUB .TD90KTRE—VWMKERS'CCIaPENSATIONCOVERAGE IS UNUWFULANDSHALLSU9IECTAN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TOONE HUNDRED THOUSAND DOLLARE( ,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3106 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 end-erceoL uc. s �� class a y C r -Con tractors Slgdature: ' J Li Date:, CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affiml that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affimt 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 fora permit subjects the applicant to a civil penalty of not more then 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 appy 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, proAded 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.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, Is. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 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? ❑ Yes ❑ 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? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Code, with some exce tions, 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 aqua 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 Celifomia Health and Safety Code been fully complied with? ❑ Yes ❑ No 5 Does or will the oast Air or present or future building occupant require for the work which is the subject c this ,application a8p No for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? � Yes LJ No (Section 65850.2 of the California Government Cade requires that the requested information be furnished on applications for non-residential building permits). ._....................._.........................._.__..................._............................................................. ............................. ............................... __............................................................. ..........................................._................_................._.... 6 Will any pan of the facility to be constructed untler this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No (If 'yes W. 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? []Yes ❑ No .................................................. ........................... ................................ ....................................... _................................. _.............................. _...... .................................................................... ....................... .............. ............................................... . 8 (If yes , attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I cenity that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Si tura Of Legal O (s) Date i� t� a An Or Au orfze Applicant-- . (' ate CODE 0 114416014 TYP INTIT19LS CODE INSPECTION TYPE Qd[F It4tQAL$ 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing-O S- 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 City of Costa Mesa Development Services Department Building Safety Division CERTIFICATE OF OCCUPANCY No. 00'N21 P. O. Box 1200 Costa Mesa. California The Building located at 216 16th Place, Unit C has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group Rl Occupancy. Use of Building Condominium Legal Description 425--202-14 (See reverse side for Metes and Bounds) Building Permit No R 'M11QA Electrical Permit No. R 31214 Plumbing Permit No. P 31161 Mechanical Permit No. M 33473, M 33692 Number of apartments and/or guest rooms ISSUED TO: Building Official William T. Howard Coota F:3a3 Leader Enterprise, Inc. 172 Plowar Strcat by 71 Co3ta i-1Bz3, CA 92627 - Date match 21, 1989 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 lel U.B.C. CMF 1015-46 rev. 1/83 White -Owner; Canary - Numerical File; Pink - Bldg. Permit File Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMI PERMIT NO. TRACT NO. LOT NO. UNIT NO. Project AUdress 1.142 E. I �{'�` ���� B 3 O G 4 1 b(o �j2 of !oh 63 Applicant's Mailing Address TYPE OF CONSTRUCTION LJ NEW LJ ADD ALTERATION U REPAIR Owner's Name A ��\iv4 c. 'S.27EL`�S phone%%'a^1� ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. # Z _ DESCRIPTION OF WORK/USE OF BLDG. Address ti �WVTV- 5-'. L05TA Ml6<A ,.'.A 17�L Di S Main Building: E Arch/Eng. License No. TYPE OF PERMIT LJ GRADING 11 FOUNDATION STRUCTURAL T Front Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear Contractor's Nam t Pho IJ OTHER A Address (mail' 11r, D 10 �w PROJECT DESCRIPTION SQ. FT. OCCUPA/NCY K Right 7 CONSTRUCTION TYPE VALUATION $!^'�^r SLC .— S Left 1C LICENSED CONTRACTOR DECLARATION City License No. i%4A ZONE GRADINGCU.YDS. ACRES Ping. Ref.# FA I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: with section 7000) of Division 3 of the Business and Professions Code, and 1 my license is In full fortnd effect. / /_ License_ Cla`sj Liter rp :)152 O s� I& O -1 Date , -::P Signature , 1,- Sym PLUMBING I FEES WORKERS' COMPE SATION DECLARA ION I hereby affirm that I have a certificate of n5ent to self -Insure or a certificate of Workers' Compensation Insurance, or a certified copy. thereof (Section Policy Lab. n n I [) 5 . Policy No. Company I Certified copy is hereby furnished. G Cert' ie Copy's ' od with the city Build viziv n. L) Date —LJ Applica. g, L_ SN, EXEMPTION FROM ORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less). 1 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. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work 'for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/She is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty 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 (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within One year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con. 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 builds or improves thereon, and who contracts for such projects with a can. tractor(s) license pursuant to the Contractor's License Law). I am aware that proof off their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Signature Drivers' License CMF 0865-46, rev. 1 Owner this application and Stale that the above amply with all city and county ordinances construction, and hereby authorize repre. upon the above-mentioned Property for # White - Building; Canary DatA_1.1 —x Bar Sink Showers S $ Backflow Preventer Service Sink S Backflow Irrigation Sewer Cap Bathtubs Sewer Connection $ Clarifiers Solar Collectors $ Dishwasher Solar Piping PLAN CHECK 25% Drinking Fountains Solar Tank ENERGY P.C. Floor Drains Swimming Pool w/Spa Floor Sinks Urinal $. Gas Service Outlets Water Closet $ Interceptors v - Water Heater PLAN CHECK 50% MECHANICAL Kitchen Sink Water Service MICROF,I LM TOTALFEE Lavatories Auto -Wash ¢00'0S P—Trap Laundry Trays Roof Drains - Reinspection Fee 1 $15 Boiler Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICED # Heating System & Ducting ❑ 0-100,000 BTU ❑ 100,000 BT Reinspection Fee 1 $15 (cant: Pink - Accounting; Goldenrod - Assessor Issue Fee 1 $ 3 Hood or Type 1 ❑ Canopy Type 11 ❑ Refrigeration System 00.100.000BTU 13100,000 System Repair/Alteration Fire Dampers Registers Issue Fee 1 $ 3 Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW 05-15'1 Reinspection Fee 1 $15 DEVELOPMENTSERVI i�E 1 Zoning Approved By ��-- Building Approved By Application Issued By 5103 9/11/87 400oO5 TL Zone fX, j Accessory Building: Z O N I N G R Parking Req./Provided E fh) 3f-41 1 V M M T S ELECTRICAL FEES Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors 00-1 HP ❑ 1'/, - 8 I nc. Solar 09.15 HP 016.15+ Microwave Pole Light Range Standing Sections Trash Compactor Issue Fee 1 $ 3 BUILDING PERMIT PLAN CHECK S $ SUMMARY OF FEES -34-01013 SMIP -S PERMIT S 4' 00 PLUMBING $ ISSUANCE $ PLAN CHECK 25% S ENERGY P.C. $ ELECTRICAL $. GRADING $ PLAN CHECK 50% MECHANICAL $ $ MICROF,I LM TOTALFEE $ $ ¢00'0S PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS Permit#(71 Date Inspector POOL & SPA APPROVALS Permit# Date Inspector 1. Temporary Electrical Service*or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. % ifl (�- 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 v` 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas 0 Oil 25. Roof Sheathing r qp, 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing �-., 91f 76. Dry Standpipe 28. Lathing & Siding ® 77. FIXED SYSTEM FINAL 29. Insulation off 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat C 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing ' 39. Water Service-Final 40. Gas Service-Final , 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System g y 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date BN FORM 116 BIA FORM 1486 INSULATION CERTIFICATION This is to certify that, in conformance with the current energy regulations (California Adminis- trative Code, Title 25, State of (alifornia') and approved plans, insulation has been installed in the building located at. COSTA MESA rry 216 Str fl.. (Ir Ann.M.) ROOFS ORANGE 16TH PLACE sb c ..y DESCRIPTION OF INSTALLATION T..d w. Type of Material Manufacturer Thickness—11 Value**— EXTERIOR WALLS FIBERGLAS BATES OWENS COMINGS FIBERGLAS Type of Material Manufacturer Thickness 3} R Vxue•• 11 (or Tod. N.mo CEILINGS FIBERGLAS BATTS OWENS CORNINGS FIBERGLAS BATTS: Type of Material Manufacturer Thicknett 9 30 R Value" nh Todo Mw.) Sq. Ft Covered BLOWN: Type of Material Manufacturer- anufacturer Thickness_ No. Bags_ (or Tod. ft..) wL/Bag Sq. FL hovered R Value••_ FLOORS Type of Material Manufacturer Thickness R Value" for Tod. N.o.) SLAB ON GRADE . Type o7 Material Manufacturer '- - Thickness "' R Value" • (or Tode flood Width of. Insulation Inches FOUNDATION WALLS (if required) Type of Material Manufacturer Thickness R Value"_ for Tndo Noce) REMARKS (if desired) General Contractor (Builder) WEI-CHUAN CONST. & DEV license Number Sub -Contractor flmaloti.n. Y.m. Title Date C$44 -SAME- It o.00 a 1•Gl:l.r•i. Add.:.Uw:w Cod., E. I.wAm.. foN.N., 4-d.. •'rM.G..e.. V.«. <«..W:« N " 1A.I.11.11...4 M..1.6M. • a.N 4M..:.. a.. M.. I..I.IW M re.lwr.o b, Ili M..M.:r .r.ela.N. w M M. a.11/.r. 7►4 ES.f. a�rrwo and doll M .mood M . om..kww 1.(.CM .Ilal. W d.MGy `) f••a Y.4. 4 la..... M *. anl. .r ....4" r &Al " <warwl Y 04 .+.a.o. d a..l. U. aMd.w ww (al .1 m... hY. M..l.l:.w "I M IwdA...r t.1.. M oMdlw 6.1.6.1 License Number 274283 Date 2-24-89 alaa" s.m s.<_ I/uS .I w. N..Iw w S." CW..f la. son. N 4111wwiu ... . •14 aenflsl. a .u...wY w .Imll� s,flasa..a..- .lr.ae.d a...., a..» r d..l5y 4 a Wq b6 .loll M 4...d ti o.A • b. w" d.e.n�wl ..1... " .I.wl... M 1 e w A. 0..J.1..m .•mar M.A.U. p..d.ed. ed Wk%.d a.r....l r .Y. A..or.^ %.09 IM Form 116 —C BUILDING NEWS, INC. 3055 overland Ave. Los Angeles. Calif. 90034-2133870.9871 Form 1486-m BUILDING INDUSTRY ASSOCIATION OF CILLIFORNLk INCr 1571 Beverly 81vd, Los Angeles. Cafil 9 0 02 6 -01131 62 55 7 71 w Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Pcoject Address Applicant's Mailing Address �j mil Owner's Name Phone Address Arch/Eng. icense No. Address q Contractor's Nam > 'D 1 Phone Address (mailing) G 112 City License No. (YUfli�,IL7. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class --iV� is nse No Date.i-1 Signature WORKERS' COMPENSATION DECLA ATION 1 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 3800, Lab. C.) policy q��y11 Corn, IicY No. U.�L �l �V!/ r 1 Pant �Ce r of fed Copy is hereby furnished. Cer t if'ed op is filetl with the city Building Division. 7. Date ''S �Qy Applicant EXEMPTION FROM WORKERS' COMPENSATIO ECLARATION (This section need not be completed if the permit Is for one hundred ($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. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097.'Cly. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the Provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ 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 (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im. prove for the purpose of sale). ' ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a can- tractor(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance Should be provided to me. ❑ 1 am exempt under Section S. & P. C. for this reason Date Owner I hereby certify that I have read this application and stale that the above information is correct. I agree to comply with all City and county Ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon he above-mentioned property for inspection purposes. �1 Signature — Date Drivers' License or 5 # " - 311 r7 I $15 1 1 Issue Fee 1 $ 3 DEVELOPMENT SERVICES REQUIREMENTS: TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Date A.P. # DESCRIPTION OF WORK/USE OF BLDG. Date Application Issued By— y S Main Buildi SUMMARY OF FEES SUMMARY BUILDING PERMIT TYPE OF PERMIT GRADING STRUCTURAL T Front p �FOUNDATION LJ TENANT ❑ ELECTRICAL LT'LUMBING ❑ MECHANICAL B PLUMBING ❑ OTHER ISSUANCE A Rear $ ENERGY P.C. C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K PLAN CHECK 50% CONSTRUCTION TYPE VALUATION $— $ Left ZONE GRADING CU. YDS. ACRES Ping. Ref. # Remarks: CZ -Zn/4,6 $ Planning Notes: Sink Preventer Irrigation Drinking Fountains Floor Drains Floor Sinks Gas Service% Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays FEES Reinspection F I $,51 I Issue Fee I $ 3 MECHANICAL FEES 1 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG # Heating System & Ducting 00-100,000 BTU C31 00,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type ❑ Canopy Type II ❑ Refrigeration System ❑0.100,000STU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee 1 $ 3 9710 11/17/87 Zone Parking Req./Provided ELECTRICAL Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ❑ 50 + KW Cooking Unit Meter Cup to 100 amps Dishwasher Meter El over 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors❑0-1 HP❑1h-8 F.A.U. Inc. Solar ❑9-15 HP 016-15+ Fixtures Microwave r Device Boxes - Pole Light Outlets- - Range Switches Sign - Garbage Disposal Standing Sections Generator ❑0-5 KW 05-15 KW I I Trash Compactor 47.38 TL FEES Z O N I N G R E Q M T S Reinspection Fee I $15 1 1 Issue Fee 1 $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By— y SUMMARY OF FEES SUMMARY BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTALFEE $ PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector POOL & SPA APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. /j. 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 LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footirigs 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 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 7.7.1x8 L-A 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 -, 1 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # - 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑ Gas ❑ Oil 23. Gas Pipe- ough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing - .. r 1 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 'r 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED - 33. Final Electric Notes: 34. Final Heating & Air Conditioning •. ,J 35. Final Gas Pipe -Test 36. Hood or Canopy 37,. Final Factory Fireplace 38' Final Plumbing 39. Water Service -Final r,40. Gas Service -Final r ,' r 41. Solar Domestic -Final n ' '42. Backflow Preventer i- 43. Backflow Irrigation - 44. Landscape Irrigation System n ' � � - 45. Sound Attenuation 46. Handicap Regulations ''' ' • t J FINALSTRUCTURE &BUILDING 48. Special Requirements Completed r - 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co - 51. CERTIFICATE OF OCCUPANCY No. Date } Applicant to fill in all spaces except those wit CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRA( Project Address g/(, /Gt4 0/ C/OSTd /14ES Applicant's Mailing Address r< S() tom. FOA7 %L IZ b/y/� � Owner's Name k4er/ L dE lfAdi/10 Phonel�l�=a_�L6v Address Arch/Eng. License No. Address M -�— Contractor's Nam Phone _&-R9T. Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is m ful force and effect. a Ly L W License Class License No. Date _5-0- ` S9 t t `) WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 have a certificate of consent to self -Insure or a certificate of Workers' Compensation Insurance, Or a certified copy thereof (Section 3800, Lab. C.) Policy No, r-nmXF TT Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be Completed if the permit is for one hundred ($100) or less). I certify that in the performance of the < for which this permit Is issued, I snail not employ any person In any s a-erto become subject to the Workers' o eQjQtion Laws of Calif r Date-oO $i gnatur NOTICE: If, after making this declaratl , you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit Shall be deemed revoked. 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 (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/She is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enally 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 (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work hlmSelf/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 com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con. 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 builds or improves thereon, and who contracts for Such projects wlth a con. tractor(s) license pursuant to the Contractor's License Law). I am aware that proof O// their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorizerepre. sentatives of this cily, to enter upon the above-mentioned property for inspection our 5 SignatureDate � ��� J e Drivers' License or SS border lines and sign all appropriate declarations. TYPE OF CONSTRUCTION Io�'NEw LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH, ❑ OTHER A.P. # DESCRIPTION OF WORK/USE OF BLDG. S Main Build E TYPE OF PERMIT GRADING FOUNDATION RUCTU RAL T Front ❑ TENANT El ELECTRICAL 1:1 PLUMBING MECHANICAL BRear A ❑ OTHER C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks:I?F-30 l9 Planning Notes 0410 5/12/0, J/dr': I' Zone Accessory Building: Z O N I N G R Parking Req./Provided E D M S PLUMBING FEES PERMIT Bar Sink Showers $ ELECTRICAL FEES Backflow Preventer Service Sink GRADING Automatic Washer Transformer 0 15-50 KW ❑ 50+KW Construction Pole Sub. Backflow Irrigation Sewer Cap $ Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors ❑0-1HIP ❑1 y.-8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 139.15 HP ❑16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal Standing Sections P -Trap Laundry Trays Generator ❑0.5 KW 05.15 KW Trash Compactor Roof Drains Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting 130.100,000 BTU 1:1100,000 Issue Fee Hood or Type ❑ Canopy Typell ❑ Refrigeration System ❑0-100000BTU 0100,000 System Repair/Alteration Fire Dampers Registers $ 3 I Reinspectiqn Fee $15 Issue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Reinspection Fee $15 Issue Fee Fee Issue Fee 1011 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor SUMMARY OF BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $, $ 3 SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTALFEE $ CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1.1 emporary 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`(; r 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grr�id'`/ 57. APPROVAL TO COVER-GUNITE /7..Footings 58. Electrical Conduit-Undrgrnd. ' 8.- Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9'[IWater Pipe-Undrgrndi/ 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer LineHouse Connection 4 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 -U7. ,Rough Wiring Sign 68. APPROVED FOR PLASTERING .� 8l Rough Electrical -T Bar Ceiling tir 69. POOL/SPA SYSTEMS FINAL 19'. -Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # J J v 20. Rough Factory Fireplace 21. Ducts, in Structure I 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil 23. Gas Pipe -Rough & Test 72.. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank El Gas 0Oil 25. Roof Sheathing 74, Overhead Hydro 5� 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical .i 27.1 Frame and Flashing 76. Dry Standpipe 28.. Lathing & Siding 77. FIXED SYSTEM FINAL ( •' 29..insulation 78.' FIRE PREV. FINAL �y 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79, FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: .i 34.. Final Heating & Air Conditioning 35:1 Final Gas Pipe -Test 36. Hood or Canopy 1 37. Final Factory Fireplace - I .+ 38. Final Plumbing ' 39. Water Service -Final 40. Gas Service -Final - 41. Solar Domestic -Final i' 42. Backflow Preventer �- 43. Backflow Irrigation I�- 44. Landscape Irrigation System 145. Sound Attenuation •' '! ' ' 46. Handicap Regulations 47. FINAL STRUCTURE&BUILDING , i 48. Special Requirements Completed ' 49. Electric Release to Edison I 50. Gas Release to Southern California Gas Cc ' 51. CERTIFICATE OF OCCUPANCY No. Date - �' Showers Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NQTRACT NO. LOT NO. UNI�TDNO. II yI l� CITY OF COSTA M�7ESA CO($TTRUIPTTIION PERMIT Project Address ``1 �i'We 1H-M�S� iJ1 fr- Applicant's Mailing Address Date Bathtubs TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR 1:1 CONVERSION ❑ DEMOLISH ❑ OTHER A.P. Owner's Name S �g �— () Phone nn?Jn Solar Collectors Address 112 7y412 �1 �gz1q- MEPA 9z�21 DESCRIPTION OF WORK/USE OF BLDG. TYPE OF PERMIT GRADINFOU NDATION� STRUCTURAL G S Main Building: T Front Arch/Eng. License No. Address rn ❑ TENANT ❑ ELECTRICAL ❑PLUMBING MECHANICAL B Rear y H 4 0 1� Contractor's Nam U none b Address (mailing) M Q r�' �Q-SS RD 2lo q11 City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed' Or ovi SlonS of Charter 9 (commencing wlth section 7000) of Div I51on 3 f th Business and Protessi ons Code and My license is in full force and fect n j2 J License Cla�s�s Lice t o. '7 Dale -9— Signature WORKERS' COMPENSATION DEC AR TION I hereby affirm that I have a certifica a of consent t self nsure or a certificate of Workers' Comp@n� � n Insuranc r a certifi d Opy thereof (Section 3800, Lab. C.) INS p/� I Q% Policy No. O r Comp ny Q�Certified copy is hereby furnished. 1,d CertifK cm` ui is with the city Build 9 07 si Date �' 1-� ^T Applicant EXEMPTION FROM WORKERS' COMPE SAT E L RATION (This section need not be completed if the ¢antl i for o e undred ($100) or less). certify that in the performance of the wo f 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. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of^the work for which this permit I5 issued (Section 3097 Civ. 1C.) /Lender's Name , Lender's Address OWNER BUILDER DECLARATION 'I I hereby affirm that I am exempt from the Contractor's License Law farina tollowing.reason (Section 7031.5 Business and Professional Code: Any Sity or county which -requires a permit to construct, alter, improve, demolish orirepalr 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 the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for apermlt subjects the applicant to a Civil malty of not more than fivehundreddollars ($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 (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not Intended or offered for Sale. If, however, the building or Improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Inn- Eve m Ee fo- vr the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for Such projects with a con- tractor(s) license pursuant to the Contractor's License Law),I am aware that proof o// their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date �� Owner In Spection purposes. Signature Drivers' License or S? CMF 0865-46, rev. 10/84 J state that the above and county ordinances iereby authorize core- :ntionetl property for 5-lMDate OTHER -r-1Rr, PROJECT DESCRIPTION SO. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ _ ZONE GRADINGCU.YDS.ACRES_ Remarks: — -2-. 1 A Zt ( r_) ES A C Right SLeft Ping. Ref. # Planning Notes: Zone • Accessory Building: Z O N I N G R Parking Req./Provided E Q M T S Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+ KW Backflow Irrigation Sewer Cap Date Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dat Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank BUILDING PERMIT Fan Motors 00-1 HP 0 Y - 8 Floor Drains Swimming Pool w/Spa PLAN CHECK $ F.A.U. Inc.Solar 09.15 HP ❑16-15+ Floor Sinks Urinal $ ISSUANCE Fixtures Microwave Gas Service Outlets Water Closet j� - Device Boxes Pole Light Interceptors Water Heater PLAN CHECK 50% Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash $ "c r"'- TOTAL FEE Garbage Disposal Standing Sections P -Trap Laundry Trays Generator 00-5 KW 115-15 KW Trash Compactor Roof Drains :r Reinspection Fee $15 Issue Fee $ 3 Boiler Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBG #Q 1,./ Heating System & Ducting 1:10700,000 BTU ❑100,000 Reinspection Fee I $15 —r White - Building; Canary -Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System 00-100,000BTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee Reinspection Fee $15 Issue Fee =13 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Data `S 1 Application Issued By Dat SUMMARY OF FEES - BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ "c r"'- TOTAL FEE $ PLAN CHECK 25% $ CONSTRUCTION AND -PLANNING APPROVALS Permit # Date Inspector POOL &SPA APPROVALS Permit # Date Inspector 1.t Temporary Electrical'SeYvice 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 LIFER Grnd. 57. APPROVALTO COVER-GUNITE r7. F•ootings 58. Electrical Conduit-Undrgrnd. 118..Foundation- 59. Gas Pipe, 0 Undrgrnd., Test VWater 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 I - 68. APPROVED FOR PLASTERING 1i8. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning _ FIRE DEPT. REQUIREMENT APPROVALS Permit# 20. Rough Factory Fireplace 6�� 21. Ducts, in Structure 70. Underground Hydro r+ 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil ' 23. Gas Pipe -Rough & Test 72. Underground Flush I' 24. Roof Framing 73. Undergrnd. Storage Tank DGas 0Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical jj 27. Frame and Flashing 76. Dry Standpipe _t 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 i n, 33. Final Electric Notes: _ 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 1� ; 37. Final Factory Fireplace 3%Y -d-re / 38:; Final Plumbing - I 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final • 42. Backflow Preventer _ r _ ' 43. Backflow Irrigation 44. Landscape Irrigation System s _ _ •-.� - '' 45. Sqund Attenuation � •! : (•.- . "; r I' . - 46. Handicap Regulations - i • - • 47. FINAL'STRUCTURE & BUILDING +- •� - - 48. Special Requirements Completed ,' - • I' 7 '- 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date i , _., Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY 0S�COSTA MESA CONSTRUCTION PERMIT ,�^ PERMIT NO. _ - TRACT NO. LOT NO. UNIT NO. Poeci`[ddressZIP . lid 1x. Ct-4-bA Masa. *C/ Applicant's Mailing Address ,y,,' � Owner's NameC. hone a?-P5d Address 0L PY ST. eA Flet Arch/Eng. License No. Address i Contractor's Nam e' Phone Address (mailing) City License No. �� LICENSED CONTRACTOR DECLARAT ON I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force an effect. !.2 License Class Date f (//T i SignatureJJ \ WORK RS' OM ENSATION DECLAR ION r I hereby affirm that I have a certificate of consent to self-insulee or a certificate of Workers' Compensation Insurance, or a Certified Copy thereof (Section 38 0, Lab. C.), P icy No. --BT- Company N!� �. Certified copy is hereby furnished. Cer)'fi it c py is 'led with the City Bull g ry Dafe (� ` Applicant ` EXEM ION FRO WORKERS' C PENS fON DECLARATIO (This section need not be completed If the pe It is for one hundretl 5100) or less) 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. Date Signature NOTICE: If, after making this declaration. you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Comply with such Provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Landers Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil f5nalty of not more than five hundred dollars ($500). LJ 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 (Section 7044, Business and Professional Code: The Contractor's 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 employees, Provided that such improvements are not intended or offered for sale. If, however, the building or Improvement Is sold within one year of Com- pletion, the owner will have the burden of proving he/She did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractor(sl license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be Provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date impaction L pl inis inspection of in Signature Drivers' License or CMF 0965-46, rev. 30/ Owner have rea J this application and state that the above comply with all city and county ordinances g construction, and hereby authorlxe vp,ti- -Uy,on the above-mentioned pr per y for (/ Date �' a 9893 11/19/87 TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. Zone DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessory Building: E TYPE OF PERMIT 0 GRADING El FOUNDATION C1 STRUCTURAL : T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL BRear ❑ OTHER A PROJECT DESCRIPTION SQ. FT. OCCUPANCY—C Right KLeft CONSTRUCTION TYPE VALUATION $ $ ZONE GRADING CU.YDS. ACRES Ping. Ret. Parking Req./Provided Remarks: t7i emn Id2L Planning Notes: 35.40 TL Z O N 1 N G R E O M T S Bar Sink - Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑50+KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit ' Meter 9�up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps co Dishwasher Solar Piping ( Dryers ❑Gas ❑Electric Sub Panel (� Drinking Fountains Solar Tank Fan Motors ❑0-1HP❑1%-8 Floor Drains Swimming Pool w/Spa ' F.A.U. Inc. Solar 09.15 HP Ell 6-15+ Floor Sinks Urinal J Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater 4,0 Outlets Range Kitchen Sink Water Service 1,g, Switches Sign Lavatories Auto -Wash Garbage Disposal Standing Sections .P—Trap Laundry Trays - Generator ❑0-5 KW 05-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved ByDate Application Issued By Date_�� Boiler Hood or Type ❑ Canopy Type 11 El Duct - Under Ground Duct -Structural Refrigeration System ❑D100,000 BTU 0100,000BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK -PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEE $ SMIP $ $ PERMIT $ ISSUANCE $ P.C. $ $ $ GRADING $ $ MICROFILM $ $ TOTAL FEE $ $ Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. BIL ICED # Fire Dampers - Heating System & Ducting 0D-100,000 BTU ❑100,000 13TL I RegistersENERGY - Reinspection Fee s15 Issue Fee $ 3 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor . CONSTRUCTION AND PLANNING APPROVALS Permit# Date .-' Inspector POOL & SPA APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location t 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grrid �, 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. B. Foundation 59. Gas Pipe_ 0 Undrgrnd., Test 9. WaterlPipe-Undrgrnd% 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Linel&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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro - 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas 00il 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 �t 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED f ' 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 3 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 r r 46. Handicap Regulations -- 47. FINAL STRUCTURE & BUILDING ' 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co, 51. CERTIFICATE OF OCCUPANCY No. Date �-- * CITY OF COSTA MESA BUILDING DIVISION F77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 • Fax (714) 754-4856 www.ci.costa-mesa.ca.us `! FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER. B08-00201 PERMIT TYPE B_ROOF2 APN: 42520506 JOB ADDRESS: 216 G 16TH PL CM Vicinity: Squares: 0 STATUS: ISSUED DATE ISSUED: 07/08/2008 ISSUED BY: CAC Suite/Unit: G Valuation: $6,275.00 SCOPE OF WORK: TAER OFF COMP. SHINGLES - REPALCE WOOD AS NEEDED 1-30 LB FELT AND 30 YR COMP. UNITS G -H r i OWNER: EAST HAMPTON COURT HOA PHONE: 949-874-5002 APPLICANT: TOM KORSVALL A001 $139.25 PHONE: 714-620-5916 CONTRACTOR: MILES ABOVE ROOFING INC Address: 1346 LOGAN AVEUnit: City/State/Zip: COSTA MESA, CA 92626 ARCHITECT ENGINEER: FEE SUMMARY Reroof Plan Check: $0.00 Reroof Permit Fee: $139.25 Reinspection Fee: $0.00 TOTAL FEES $139.25 Address: 216 E 16TH PL City/Stale/Zip: CM Address: 1,346 LOGAN AVE City/State/Zip: COSTA MESA, CA - License No. 880263 SUITE A001 PHONE: 714.620.5916 CELL: License No. PHONE: License No. PHONE: Unit: Unit: :SUITE NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92.28, § 1, 12.21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In 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. QDEt INSPE"ON TYPE L0 INIMA OW INSPECTION TYPE DAT INTMA 1016 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final �J�p� 208 Final Plumbing 200 Final Fe-Roofr ^!�(L� !�.`!' 210 Final Electrical 201 Final BlocN/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 BuildingICccupancy WORKERS' COMPENSATION DECLARATION: ' I hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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 peante of the work for which this permit Is issued. l have and will maintain workers' compensation insurance, as required by se 3700 of the Labor Code, for the performance of the work for which this Cnu nmt issued. My workers' compensation Insurance carrier and policy r are: Cartier:/.t f1) (Tins sewn rql ha mnp'efed 4 me pmuuvo ✓eletane huMmd dodors(Sim) or law) Policy Number:aS-fas ❑ 1 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 subjecjtta4he workers' compensation provisions of Section 3700 of the Labor C d . I shall fo wit mply with these provisions. ppli n i re Dale 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 DOLLARS ($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 ecti 0) of Division 3 of the Business and Professions Code, and y It se i full force and effect. 7 is Signa CONSTRUCTIO LENDING AGENCY: ❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this peril is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: Dale 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 pmject (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 fa such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ 1 am exempt under sec. Business and Professions Code for this reason: Sigaalure Dale 3057,6 (3/07) Owner ID verified by driv. .,tense. ❑ Yes ❑ No t Drivers License No. Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 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, a demolition or dismantling thereof, will be more than thirty -sic (36) feet high. (Chap. 3.2, Grp 2, All 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 peril to do such work from the division. Applicants Signawre Dale 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? ❑ Yes ❑ 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? ❑ Yes ❑ 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? ❑ Yes ❑ 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 peril for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? ❑ 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 feel from the outer boundaries of a school? ❑ 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? ❑ Yes ❑ 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 CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalty of perjury that I have read this application and state that the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. gnalure of Legal OT^ I Dale 7 Aadlet TorLEe�!Ynt / Dale CITY OF COSTA MESA ' BUILDING DIVISION PERM NUMBER DEVELOPMENT SERVICES DEPARTMENT PERMIT (714) 754-5273 Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT Job Address: 216 16TH PL Status: ISSUED Suite: G Applied: 07/19/1999 Vicinity: UNIT G 2ND STORY Issued: 07/19/1999 Parcel Nunmber: 42520506 Zoning: ISSUED BY: Applicant: LIN, MIKE Address: 216 16TH PL #G Phone: 949-644-4757 %LIN, MIKE S Zip: 92659 Owner: LIN, MIKE Address , '216 16TH PL #G Phone: 949-644-4757 %LIN, MIKE S Zip: 92659 Contractor: " . Address: Phone: Zip: License: Arch Eng: ' Address: Address: Phone: Phone: Zip License: Zip: License: SCOPE OF PERMIT LEGALIZE ENCLOSURE OF AN EXIST. LOFT TO A 3RD BEDROOM. AND OPEN A DOOR TO THE EXIT CLOSET. FEE SUMMARY Plan Check: $26.16 Calc Valuation: $1,200.00 Permit: $40.25 Claim Valuation: $1,200.00 SMIP Res: $0.50 SMTP Com: $0.00 Other: $40.25 Inspection: $0.00 Total: $107.16 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 NOTES: 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 WORKERS' COMPENSATION DECLARATION: 1 hereby affirm under penalty of perjury one of the following declarations: ❑ 1 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. ❑ 1 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: Carder: Policy Number: (This section need not be completed if the permit is valued at one hundred dollars ($100) or less.) ❑ 1 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 these provisions. Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKERS' OOMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (SIOO,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706OF 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. Uc. 0 Class x Contractor's Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirm that there Is a construction lending agency for the pertormance 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 contra tars License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractors) license pursu t t the Contractors License Laws.). exempt u r c. \ Business and Professions Code for this reason: / lure: ate: ) R verified b driver's license. P—'q Yes ❑ No Driv se No. " Expires: Verification of Ownership by (type of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ 1 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? ❑ Yes ❑ 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? ❑ Yes ❑ No (Section 25533 of the California Health and Safety Cade, 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? ❑ Yes ❑ No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication a ermit for such constructlon or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes U 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? ❑ Yes ❑ No (11 '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? ❑ Yes ❑ 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 canity 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-descebed property for Inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Signature Of Legal Owners) Date An Ized AppI ant Date CODE t. INSPECTIONTYPE PATE INTDIALS CODES INSPECTION TYPE 2ATE INTITIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 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 _ zm- 2"646 —I VOID 2 3 r Is DIVISION OFI3UILDIN � AFETY 2 CITY OF COSTA ME A� APPROVE By na !A to + This set of piens and specifications tAUST bakepTrilm, sinni he D,Pja of Bu rQ 4 I make any changes or eleraCbn on lama wi!hcul w and Safety, Cly of Costa Mesa. :di r!CTbe eldtopa. : R rto napdrom! fsei'+sr. S Stai lav The stamping of lois pm ;miS u^� I V ul v?SG•, sc. l riS,n FnC of the e!c!atiar; ct aay pravia.un; ci ;ny T1TeP. G{LnB :c!d pont sl -all 6X �;I3 �� 1'dl;....... bi ...:.�..,,_. 80WN' , ll$� r:�!.aa�x^att�^er. C5J�3 � o\lz EXISTING WINDOW & WALL �OSTA MESA LEADER ENTERPRISES, INC 216-6 16th PLACE COSTA MESA, CA 92627 w 0 OPEN LIVING BELOW q9_ C-)JIz r OF —+L ?LANiy0 G DIV ESA TO BLDG. DEPT. REG. _,AI NOTE , BE AP2l;_;;: �'`�' Uh CDRRECTfONS SHALL r jl'E F..i;INING DIVISION USE COMPLIES A ITH ZON PLANNER INIT. DATE scale 1W = 1'•O' THIRD BEDROOM ENCLOSURE Page 1 NEW DOOR — 2'-6' 1 x � I 2x4 STUDS E 16' ➢.G / I 8 -� VISION O UII,DING SAFE 'Y CIA P' OED OSTA MESA jV 5'-4- y \ Date— This t f p;a an spec 5ca ' rs MUST . kepl this job at au t mes d t is unl wful to make n%� o alferaf on same wd u wr t ADDED WALL \ and 'oh�,Cd} fC staMrsa. Pe➢n5s�nirom DvsionOf j1diV Tho S.. 11++,y,y,➢f�G'1.v !?r gpti gp�?.�Tiint:un^ '1 Vi.i (}T be held to petmit to be ana (oVe! !the ie'I:!icn r - - _ a. ' mus „nr o. ns ',. 0rd;nance and(or Sta e law. ,rniv it,i 4 bib: n9 or 1 17180 vs of ksuanoE_ COSTA MESA LEADER ENTERPRISES, INC 21&G 16th PLACE COSTA MESA, CA 92627 4 EAST ELEVATIQN scale 1/2" =- TV THIRD BEDROOM ENCLOSURE Page N xnber 2 • ,f-- t1�-s' ,� 4' —� s -to• EXIST10. BEAMNG it12.4 6SRCS Ike2. WALL I NEQJWJNIg GF,,2.3''t':DINGSAFETY CITYnlq MESA APPROVED This sat of Plans and makeanjm, ,.,,,.-- way, I,ay of costa Masa. " "°'rfieunssion from the Division Cmitotm , Building lianrg lion cf p!�� s�ofthe vie:'angoth a; } SPALL (dOTeefield tope f my By of C ,1;. P.iasa O:dirortobeanaAProvlance and/or u ate lav,. ra:L::,:c:x•,rr:;,�:^c;:i,�M�U: i;,il. ... comenwandv; trd-hehuildin EST E COSTA MESA LEADER ENTERPRISES, INC 216.0 16th PLACE COSTA MESA, CA 92627 4'x12' LEVATI N Scale 1/2' IF 1'-0' THIRD BEDRO ENCLOS Page E 3 3'-1Q' COSTA MESA LEADER 21&G 16th PLACE COSTA MESA, CA 92627 DIVISION OF BUILDING Si CITY OF COSTA MESA EXISTING WINDOW — ;" 1193 pt O p E D x 5'-10' BY Dale This set of plans and specifications MUST be kept on this Ob at all times d it is unlawful mme make any dianges or alteration on Sam without vafllen permission from the ivision of Buildi and Safety, City of Costa Mesa. Tho s!amp no cf fna p an a xi scr fc2 e.r °1{At i_ IJOt . no!n rn na i! be an approval or me vwlai?e c!any provi>ions ;+! arr; C !v of Cesf i ldasa Ordinance nd/or State law. ana permit sh21' axpi;a by !Lrniai ^n a d teceme null and vo d if the building o; idl wi!hir tBO d2Va of ISeaamCe. EXISTING WINDOW AND WALL ENTERPRISES, INC SOUTH ELEVATION scale tPt =1'V THIRD BEDR OM ENCLOSURE Page E; �JIL EAST HAMPTON COURT HOMEOWNERS ASSOCIATION 216 16th Place Costa Mesa, CA 92627 TEL. (949)644-0292 FAX (949)720-3960 DATE: July 16, 1999 TO: Building Department City of Costa Mesa FROM: The Board of Directors East Hampton Court Homeowners Association RE: Third bedroom enclosure 216 16th Place # G, Costa Mesa After reviewing the third bedroom enclosure at unit # G, the Board of Directors of East Hampton Court Homerowners Association approves the attached plans. Mike Lin, President William Carney, Vice President City of Costa Mesa Development Services Department Building Safety Division CERTIFICATE OF OCCUPANCY No. 902t 423 P. O. Box 1200 Costa Mesa, California The Building located at 2% 16Th Place, Unit G has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group R1 Occupancy. Use of Building Condominium Legal Description 425-290214 (See reverse side for Metes and Bounds) Building Permit No B 30199 Electrical Permit No. F. 3121A Plumbing Permit No. D Z11GA5 Mechanical Permit No. M 33477, M 33696 Number of apartments and/or guest rooms ISSUED TO: Costa i°lesa Larder Enterorise, Inc. 172 Flour Streot Costa Mesa, CA 92627 Building Official William T. Fictaarei by Date starch 21, 1989 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 lel U.B.C. CMF 1015-46 rev. 1/93 White - Owner; Canary - Numerical File; Pink - Bldg. Permit File Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA M�jE)$A it TRU/CTIrIN PERMIT IT PERMIT NO. TRACT NO. LOT NO. UNIT NO. Project FtJdress �� r/• �!!/"( 1��1� �. 8 3 0 1 9 -1 10&32. 1por Applyant's Mailing Address TYPE OF CONSTRUCTION LJ NEW LJ ADD U ALTERATION LI REPAIR zElCONVERSION ❑ DEMOLISH ❑ OTHER A.P. .0 Owner's Name L OKtA Vf b Lleh9K r„tkk4R)SeS Phone_Tz_-f;_--LL DESCRIPTION OF WORK/USE OF BLDG. Address )Is VL`WU 5.. (",esiA Ar�!)A CA 612-1.0 S Main Buildings Arch/Eng. License No. TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front S� AddressIDTENANT C1ELECTRICAL ❑ PLUMBING ElMECHANICAL B Rear 5.1 � AKI( b Phon oT Z ❑ OTHER A Contractor's Name171.1Lu-i C Right PROJECT DESCRIPTION SO. FT. OCCUPANCY Address (mailing) �4-�TY b+/io �b��q�T J�4 K 0�1/ 2 CONSTRVCTION TYPE VALUATIONS E'G-SCO.— S Lafl G'('�' City License No. [} ZONE GRAOINGCU.YDS. ACRES Ping.Ref.#(iA— LICENSED CONTRACTOR DECLARATION `1 I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: V with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force andffect. License Class LTCB eyp D,3%�Zp DateSignature WORKERS' COMPE SATION DECLARA ON I hereby affirm that I have a certificate of nSent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.)l (( 1' /� Policy No. 4 b — t 1. I �. Yr�71 Ompany 11, J E O'e'L�TY Certified copy is hereby furnished. Certilietl opy is f” d with the city Buil LdJ C nl sg7 p sions.., 1 Date Applicant Lp.{,%M LI EXEMPTION FROM 0AKERS' COMPENSATION DECLARATION (Thisseclion need not be completed if the permit i$ for one hundred (S100) or less). certify that in the performance of the work for which this permit Is issued, I shall not employ any person In any manner so a6 to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration. you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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 10 file a signed statement that he/she is licensed pursuant to the provisions of the Contra Ctor's;License Law (Chapter 9(commencing with Section 7000) of Division .3 of the Business and Professions Code) or that he/she is exempt '.herefrom 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 ($500). I, as owner of the property or my employees with wages as their sole cc m pensation, will do the work, and the structure is not intended or offered for Sala (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does Such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for Sale. If, however, the building or improvement is Sold within one year of com- pletion, the owner will have the burden of proving he/She did not build Or Im- prove for the purpose Of Sale). ❑ I, as owner of the property, am exclusively cootracting with licensed Con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who builds or improves thereon, and who contracts for Such project$ with a Con- tractor(sl license pursuant to the Contractor's License Law),I am aware that proof off their Worker's Compensation insurance should be provided to me. Cl I am exempt under Section B. & P. C. for this reason Date Signature x\ i Drivers' License or SS — Owner I have read this Iagree to comp) to building cons to enter upon -P Mate that the above d county ordinances eby authorize repre- ioned ppropert y�'7for Date 47-11 —9 5106 9/II/B7 I Zone Accessory Building: i 5 Parking Req./Provided 385o82' TI. Z O N 1 N G R E O M T S Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Transformer ❑ 15-50 KW Backflow Irrigation Sewer Cap Construction Pole Sub. ❑ 50 + KW Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors ❑Dl HP 01'/a-8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar 09.15 HP 016.15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto. -Wash Garbage Disposal Standing Sections P—Trap - Laundry Trays Generator 00.5 KW 05.15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee S 3 MECHANICALReinspection Fee $15 Issue Fee $ 3 FEES Boiler Hood or Type ❑ DEVELOPMENT SERVICESR Canopy Type 11 ❑ Zoning Approved By Date ` ` Duct -Under Ground Building Approved By �Dete-`�7 //�� H._ (3 7 Duct -Structural Refrigeration System Application Issued By ' Date Duct - Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $—32ff'00. SMIP $ S3 • 3� Firepl/Fact. Bit. ICBO# Fire Dampers PLAN CHECK $ PERMITPLUMBING $ ISSUANCE S Heating System & Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ 00.100,000 13TU0100,00067 GRADING $ ELECTRICAL $ PLAN CHECK 50% $ MICROFILM 5 MECHANICAL $ TOTALFEE $ 395 'p2 Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ sCMF 0865-46, rev. 10/84 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA 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 LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings ` fl 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. + 60. Backwash Lines, P -Trap, ❑ Undrgrnd. 10. Structural Floor System ' Q 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 APPROVALS Permit # _ - 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 7yf B8 t+ 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing ? 76. Dry Standpipe 28. Lathing & Siding Qp 77. FIXED SYSTEM FINAL 29. Insulation j$ Q' 78. FIRE PREV. FINAL 30. Drywall Nailing e HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat t g 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy , 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final . 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY No. Date LJ UCJ CONSULTING STRUCTURAL ENGINEERS Sheet JERRY TUCKER 8 ASSOCIATES, INC. Job NO. �'e51 j Idy Date �•2°I'�° 485 EAST 17TH STREET SUITE 200, COSTA MESA CA 925273265 714/645-2422 Engineer Pi ZI G, I G7T , GasIA M � Gt6�- FP�3 b 17, n6roo IFre? (IN LIEu of (-,7LTI,s Hvz) VA�� abs, q-. i.�s•19-(y�3) (ia�(8�=1�48z!�.� P�Y1aa.�. MAX, ZSs"Z' +18 M07CH (4)I�+)`16ML45 Ni I(a Mt) AUG. 0 1 1988 BN FORM 116 B1A FORM IA86 INSULATION CERTIFICATION This is to certify that, in conformance with the current energy regulations (California Adminis- trative Code, Title 25, State of (alifornia`) and approved plans, insulation has been installed in the building located at: COSTA MESA ORANGE city u•.e 216 16TH PLACE Strut N.. (if Aan.N.) st.4 4 Num" Tract N.. DESCRIPTION OF INSTALLATION ROOFS Type of Material Manufacturer—Thickness—It Value••— EXTERIOR WALLS FIBERGLAS BATTS OWENS COMINGS FIBERGLAS Type of Material Manufacturer Thickness 3: R Va:ae•• I1 m. Tmd. N.m.l CEILINGS FIBERGLAS BATTS OWENS COMINGS FIBERGLAS BATTS: Type of Material Manufacturer Thickness—It 30 Value•` M, Tmd• N.m) Sq. FL Covered BLOWN: Type of Material Manufacturer Thickness No. Bags_ (or Two H.m) WL/Bae Sq. FL Covered R Value**. FLOORS . Type of SLAB ON GRADE . Type a: Materia!_ Width of. Insulation FOUNDATION WALLS (if required) Type of Material REMARKS (if desired) Manufacturer Thickness --it Value`•_ (or Tmd. N.m) _ Manufacturer —' Thickness "—R Value••_ N1 TmN N..y Inches Manufacturer —Thickness—It Value.._ (or Tod* Nrm) General Contractor (Builder) WEI—CHUAN CONST. & DEV L"cense Number By Title Date Subcontractor (insulation AppGcatort Accent Insulation Company license Number 274283 a...l.b«.. N.p.. / ar.r. -WIE- BY C ' / Title Date 2-24-89 I -C.10 .•ie Ad.W,",W.• C.d.. r•Mt1 I.f AMi" sm.awd.. ie.". enQlR h... aw. Nqs •/ M N.NI. w.1 S." 44 N M sial• "6.•1:«,., Yew ....IN:« .1 M M...IIN7« N ♦•.NNi«. • awd N wn:hle. KN M I..N•.:« ....... I.,MII.1 M r.1...w,..il. M •...hr.F N Mw MNNiww ANI M w.O."d «I w.wN1 Yr . "N. •..116,.I. N .M.«q w N.nr rrafiwtka I.N • r...11 a.► M h.N w111,.Iw W M M .Nur. This C+N.N« w..r.... A..I.1 ..NI. .. W. .' 1 ....•. .... w •..1 ANI M .wMd N ....W...+. 1•,.e« •AKY M I..IIiY:'1 d.Nu.. N ►.W6.64 ANI M 4,••d M ..A • wtd:.. M.•.I.wA (••! rN« h M ...... N M fta N • mMW r bww". ..M•. M .I.w1•w a Id "d.rm M WAI .. ....tY WWIOi .I..d..1. ft AWI .M M..W M NA. A..Nr: .•....•.1 1. M ...«. N ..N. TM m.1.1•.o M« (!) N ...if" W1 h.N.1:«• .N kala). •.r M nIMW« l.d".1 A Fonn 116 —Q BUILDING NEWS, INC, 3055 Overland Ave. Los Angeles. Calif. 90031-021318708871 Form 148" BUILDING INDUSTRY ASSOCIATION OF CALIFORNIA, INC„ 1571 Beverly Blvd, Los Angeles. Calif. 90026—M3) 6255771 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. f PERM PER IT NO. TRACT NO. LOT NO. UNIT NO. CITY OF COSTA MESA CONSTRUCTION IT . Project Address 244! 1, A� Applicant's Mailing Address Owner's Name " I Phone 977-10,70 Address 177.7.?/-700,j3.e- L7t .lflll�PU. i r %i' Arch/Eng. License No. Address Contractor's Nam I nl �' �1(%i nvhnvlq. Phone 13 ° Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. Licens -Class _License No. Date 'Q}' Signature AV-14a2 WORKERS' E ENSATION DECLARATION ' 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 3800, Lab. C.) ' ` IPPoolicy No. I10O i 0 171 1 11 91 l JCompanya/. L1YL1N IL1s Certifi�e�d Certified copy is py is hereby furnished. Building Division" Date 11/�(:�_�_ Applicant—Y j^ EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed if the permit Is for one hundred ($100) or lass). 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. Date Signature NOTICE: It, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1. I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is Issued (Section 3097' Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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 I le a signed statement that he/she is licensed pursuant to the provisionsof 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 .herefrom 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 ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, proAded that such Improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one Year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor( s) license pursuant to the Contractor's License Law). I am aware that Proof off their Worker's Compensation Insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date I hereby certify in. information is corre and slate laws relat sentatives of this i inspection purposes. Signature Drivers' License or 5 — Owner I have read this a I agree to comply to builtling Const toG/n ler yupon .2n -511(a 5 TYPE OF CONSTRUCTION U NEW LJ ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. — ALTERATION LJ REPAIR TYPE OF PERMIT LJ G RADINGFOUNDATION LJ STRUCTU RAL ElTENANT ElELECTRICAL 4 PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SO. FT. OCCUPANCY_ CONSTRUCTION TYPE VALUATIONS— ZONE— ALUATION$ZONE GRAOINGCU.YDS. ACRES Remarks: Sink Preventer Irrigation Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service 5 Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee I $15 Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting 110, 100,000 BTU 0 100,000 Reinspection Fee I $15 CMF 0865-46, rev. 10/84 While - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Issue Fee 1 $ 3 Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System 110-100,000BTU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee 1 $ 3 A.P. # S Main Buildi E T Front B Rear A C Right K S Left Ping. Ref. # Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas []Electric Fan F.A.U. Fixtures Device Boxes Garbage Disposal Generator 00.5 KW 9706 11/17/87 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15.50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors 00-1 HP 01 %- 8 Inc. Solar ❑9-15 HP 1316.15+ Microwave r Pole Light Range Standing Sections KW I Trash Compactor 1 Reinspection Fee I $15 1 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By PLAN CHECK 25% $ 47.38 TL FEES $ 3 Z O N 1 N G R E Q M T S SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING S33 ISSUANCE $ .PLAN CHECK 25%$q •Q ENERGY P.C. S ELECTRICAL S GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ 47.38 TL FEES $ 3 Z O N 1 N G R E Q M T S CONSTRUCTION AND -PLANNING APPROVALS Permit # Date Inspector POOL & SPA 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 LIFER 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 s�y� 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 r 18. Rough Electrical -T Bar Ceiling ,t .� - 69. POOL/SPA SYSTEMS FINAL ' 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # _ 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank GGas 0Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing -, !)t 76. Dry Standpipe ^- _•� i 28. Lathing &Siding i 77. FIXED SYSTEM FINAL _ 29. Insulation 78. FIRE PREY. FINALi' 30. Drywall Nailing HEALTH DEPT. REQUIREMENT i 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED _ 33. Final Electric Notes: M�ZFp/ 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 'r 37: Final Factory Fireplace 38. Final Plumbing 3/13/0 Lf10 39: Water Service -Final - 40. Gas Service -Final, r � '- 41. Solar Domestic -Final ' x'42: Backflow Preventer 43. Backflow Irrigation �'� ,, r •� "' ' 44 � Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations . �,, ' • •- i. _, ! 47.,'U FINAL STRUCTRE BULPING Fi•• 48. Special Requirements Completed 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date. N Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO 0441V#77 TRACT NO. LOT NO. UNIT NO. .Project Address o?//i /G f4 P/• CoS%a �.aald 10& a 6 0A b7? "�-6 Applicant's Mailing Address gr0 I.�, FoPT� 6/ TYPE OF CONSTRUCTION 1Z NEW❑LJ ADD ALTERATION LJ REPAI R Owner's Name /-/EG7d2 ds 9A / V/d Phone 2¢4 Address Arch/Eng. License No. Address Gl.�-tom Contractor's Nam Phone 9(.9-0 Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force an ffect. License Class C --16 - License No. �GH-L iN Dale =w4s Signature WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self -insure or a certificate ,f Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Pol' ompany Certif ietl copy is hereby furnishetl. Certifietl�t�K` -" 'Ion. LT.TI Annlicanv— EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner�cQ as to become subject to the Workers' Cow9vation Laws of Californ t;Si Date SS 771 Signature�Jc��" NOTICE: If, after making this declaration, you shoultl become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of 7ivision 3 of the Business and Professions Code) or that he/she is exempt herefrom and the basis for the alleged exemption. Any violation of Section /031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or Offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractors t0 construct the project Section 7044, Business and PIOfC5510n5 Code: The Contractor's License Law 11 oes nOt apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that 1 have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for inspection Per pg!01 If ( Signature � ��f ❑ CONVERSION ❑ DEMOLISH OTHER DESCRIPTION OF WORK/USE OF BLDG. TYPE OF PERMIT LJ GRADING LJ FOUNDATION STRUCTURAL 1:1 TENANT ❑ ELECTRICAL El PLUMBING MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY— CONSTRUCTION TYPE VALUATIONS— ZONE— ALUATION$ZONE GRADINGCU.YDS. ACRES Remarks: FEES S Main Buildi E T Front B Rear A C Right K S Left Ping. Ref. # Planning Notes: �Y 0414 5/12/88 Zone Accessory Building: Parking Req./Provided 371,50 Z O N I N G R E Q M T S Bar Sink Showers $ ELECTRICAL FEES Backflow Preventer Service Sink PERMIT Automatic Washer Transformer ❑ 15-50 KW ❑ 50+KW Construction Pole Sub. Backflow Irrigation Sewer Cap $ Bathtubs Sewer Connection $ Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors MICROFILM Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping 50% Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 110-1 HP ❑1%-8 Floor Drains Swimming Pool w/Spa 25% F.A.U. Inc. Solar 1-19-15 HP 016.15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets I Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal Standing Sections P� Trap _ Laundry Trays Generator ❑0-5 KW 05 15 KW Trash Compactor Drains Reinspection Fee $15 Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICED # Heating System & Ducting ❑ 0-100,000 BTU ❑ 100,000 BTI No, ow gro upNP� w Reinspection Fee I $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee I $ 3 Reinspection Fee $15 Issue Fee IANICAL FEES DEV E LOPMENT SERVICES REQUIREMENTS: Hood or Type ❑ Zoning Approved By Canopy Type I ❑ Building Approved By Refrigeration System ❑0-100,BBOBTU 0100,000 System Repair/Alteration Fire Dampers Registers lo..- Ci0Nf7%-11r0_ I IT' Issue Fee I N. SUMMARY $ 3 FEW $ SMIP $ PERMIT PLUMBING ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ Z/SV TOTAL FEE $• CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1! Temporary Electrical,Service or Pole ,r 52. Pool & Equipment Location 2. Soil Pipe-Uncirgrnd.il) 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-U&rgrnd. 55. Electrical Bonding 5. Steel Reinforcement.(/ is 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd.�' 57. APPROVAL TO COVER-GUNITE C7:iFootings 58. Electrical Conduit-Undrgrnd. -8.' Foundation 59. Gas Pipe, ❑ Undrgrnd., Test 9: (Water Pipe-Undrgrnd'. • 60. Backwash Lines, P -Trap, d Undrgrnd. 10. Structural Floor Systrem 61. APPROVAL TO DECK 11. Property Sewer Line(&tHouse 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 iit7.Fough Wiring Sign 68. APPROVED FOR PLASTERING ,Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19 -Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # ( x 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping []Gas ❑Oil - 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank []Gas ❑Oil . 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry ChemicalY 27. Frame and Flashing 76. Dry Standpipe 1. 28. Lathing & Siding 77. FIXED SYSTEM FINAL ,1 29A Insulation - 78. FIRE PREV. FINAL f`•� ;t+ 30.. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. ,Plaster Brown Coat 79. FINAL INSPECTION �7 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: ., 34.,Final Heating & Air Conditioning 1 35: Final Gas Pipe -Test {' 36. Hood or Canopy i 37. Final Factory Fireplace 38. Final Plumbing ,. 39. Water Service -Final 40. Gas Service -Final !� 41. Solar Domestic -Final it 42. Backflow Preventer 43. Backflow Irrigation ;r� i 1 ..!- , 44. Landscape Irrigation System � - •45. Sound Attenuation -i 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed ^? 49. Electric Release to Edison i 50. Gas Release to Southern California Gas Co I - t 51. CERTIFICATE OF OCCUPANCY No. Date - Applicant to sill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA M//E1 CON SiT UCTION PERMIT ,Project Address 41 V 'OL AGr COSjF}- Applicant's Mailing Address _ Owner's Name a A Me -'A LEAs phone-VhI ) Address r Arch/Eng. License No. Address Contractor's Name YVE) CH NAN S7. Pho e eN'[PA'15 PO f, Address (mailin9)O/I Z � `\ City License No. Y � 12 LICENSED CONTRACTOR DECL RATION I hereby affirm that I am licensed untl rovisions of Charter 9 (commencing with section 7000) Of Dl vision 3 of he siness and Professions Code, and my license is in full for nit effect. L Q License Class _ Lic n � �rJ (P Date /� ' Signature WORKERS' COMPENSATION DECA/TO ON hereby affirm that I have a certificate o nsent t se f -in re or a certificate A Workers' Compensation Insurance, or a certlf copy thereof (Section 3800, Lab. r -t, Policy No. SOS 1 Compan ' ❑ Certifis, pcopy is hereby furnished. Certi d I yy J ijled with the city Building tuts n. Date I6 Applicant EXEMPTION FROM WORKERS' COMPENSA 10 DEC ATION (This section need not be completed if the perm or One undred ($100) or less). I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you Should become Subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law fobthe following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish orrepair any structure, prior to its issuance, also requires the applicant for such ppermit to file a signed statement that he/she is licensed pursuant to the Prov loons of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Oivision 3 of the Business and Professions Code) or that he/she IS exempt herefrom and the basis for the alleged exemption. Any violation of Section /031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). 1, as owner of the properly or my employees with wages as their Sole compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of Proving he/she did not build or im- reve for the purpose of sale). I, as the of the property, am exclusively contracting with licensed cOn- tractorSto construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have ren information is correct. a to and State laws relating to I Sentatives of this city inspection purposes. I Signature Drivers' License or SS 11 CMF 0865-46, rev. 10/84 White above lances repro. v for 1 TYPE OF CONSTRUCTION NEW LJ ADD LJ ALTERATION LJ REPAIR SMIP r ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Bar Sink Showers A.P. # DESCRIPTION OF WORK/USE OF BLDG. NDf), ENERGY P.C. Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ❑50+KIN Backflow Irrigation Sewer Cap $ S Main Building: Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps TYPE OF PERMIT GRADING FOUNDATIrO�N(, STRUCTURAL T Front 1:1 TENANT El ELECTRICAL 13 PLUMBING YJ MECHANICAL B Floor Drains Swimming Pool w/Spa ❑ OTHER F.A.U. Inc. Solar ❑9-15 HP ❑16-15+ A Rear Fixtures Microwave Gas Service Outlets Water Closet C Right PROJECT DESCRIPTION SG. FT. OCCUPANCY K Kitchen Sink Water Service CONSTRUCTION TYPE VALUATIONS— S Left ZONE GRADING CU, Y ACRES Ping. Ref. 2* Remarks: Generator ❑0.5 KW 05.15 KW Trash Compactor Planning Notes: )Q 1 JZone Accessory Building: Z O N I N G R Parking Req./Provided E O M T S PLUMBING FEES SMIP $ Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink ENERGY P.C. Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ❑50+KIN Backflow Irrigation Sewer Cap $ Bathtubs Sewer Connection $ Cooking Unit Meter ❑up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 00-1 HP❑1%-8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar ❑9-15 HP ❑16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal Standing Sections P—Trap Laundry Trays i Generator ❑0.5 KW 05.15 KW Trash Compactor Roof Drains Reinspection Fee $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO +12_3_o Heating System & Ducting 00.100,000 BTU ❑ 100,000 BT Reinspection Fee I $15 Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System 00-100,0008TU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 Reinspection Fee $15 Issue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Apoliratian Issued By ^ BUILDING PERMIT S PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ $ 3 SUMMARY OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. S GRADING $ MICROFILM $ TOTAL FEE $ (dt�r CONSTRUCTION AND PLANNING (APPROVALS Permit# 1.- Date Inspector POOL & SPA APPROVALS Permit# Date Inspector 11, Temporary Electrical.Service or Pole 52. Pool & Equipment Location 2' -Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. ,Foundation t 59. Gas Pipe, ❑ Undrgrnd., Test 1 9"Water Pipe-Undrgrna',. ' 60. Backwash Lines, P -Trap, ❑ 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 j8. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL .'I 9:Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # •L 20. Rough Factory Fireplace- 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑ Gas ,D 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 ' i 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED .� 33. Final Electric Notes: 1 34. Final Heating & Air Conditioning i 35. Final Gas'Pipe-Test I 36. Hood or Canopy 37 f.Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final ! T, 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 - - - - - r. 48. Special Requirements Completed. •" , 49. Electric Release to Edison%•� ` 50. Gas Release to Southern California Gas Co } 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY CSF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO Pfoject Address V& 55.lbir6s PL. Ccight /TIPS Applicant's Mailing Addres//IIs Owner's Name il'.- h'I ESQ-PAdFY_J�.,st[�Yi hone -Z' Address /i.z `Gb✓.?1^ ST . Octel J!/veal [A 92.4 Arch/Eng. License No. Address Contractor's Name (. Phone Address(mailing).�T£)71 ^1/f- 7ti�U` City License No. LICENSED CONTRACTOR DECLARPTI N I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in f(—� V uh juce and effect._ License CI ss �l � GLV cen P b. Date 1 1. Signature WORK RS' OM ENSATION A TION r I hereby affirm that I have a certificate con14 sent to self-insu a Or a certificate L of Workers' Compensation Insurance, or a certified copy thereof (Section 380 Lab. �T lV C I /P \ Po cy No. t+ 0 Company l'f! Certified copy is her b furnished. Cer Ifi tlL co i filetl with the city Buildri �[ Date 1 Applicant ` EXEMP ION(FRO WORKERS' CO EN ON DEC LARATIO (This section need not be completed the per It is for One huntlre $100) Or less). 1 certify that in the performance of the wor 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. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair anystructure, 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 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 :herefrom 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 (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not Intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractorsto construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a Con- tractors) license pursuant to the Contractor's License Law). I am aware that Proof of their Worker's Compensation insurance shoultl be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner Ihereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and stale laws relating to Duiloung construction, and hereby authorize repre- sentatives Of this city ter upo the above-mentioned proper y for inspection purposes. (( (2 Signature Z Date Drivers' Licensstl�or'SS q1flat({, TY` PE OF CONSTRUCTION I NEW AID ALTERATION � IR ❑ CONVERSION ❑ DEMOLISH E.OTHER DESCRIPTION OF WORK/USE OF BLDG. TYPE OF PERMIT/LJ GRADING IJ FOUNDATION LJ STRUCTURAL ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SO. FT. OCCUPANCY— CONSTRUCTION TYPE VALUATIONS ZONE GRADINGCU.YDS. ACRES_ Remarks: A.P. # S Main Building: E T Front A Rear C Right K Left Ping. Ref. # Planning Notes: 9897 11/19/87 Req./Provided Zone 35,40 TL Z O N I N G R E O M T S Bar Sink Showers � ELECTRICAL FEES Backflow Preventer Service Sink $ Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+ KW MICROFILM Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter Aup to 100 amps /.co Clarifiers Solar Collectors Dishwasher Meter ❑fiver 100 amps oo Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors ❑0-1HP❑1'A-8 Floor Drains Swimming Pool w/Spa ' F.A.U. Inc. Solar 09.15 HP ❑ 16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range rQo Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash '1 Garbage Disposal Standing Sections ,0 P—Trap' Laundry Trays Generator 1:10.5 KW 05-15 KW Trash Compactor Reinspection Fee 1 $15 Boiler Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 00-100,000 BTU 13100.000BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System 1:10-100,000BTU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 $ � Reinspection Fee $15 Issue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By fid. $ GRADING $ MICROFILM $ �� SUMMARY OF FEI BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ $ 3 $ 3 SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ L2. /& CONSTRUCTION AND PLANNING APPROVALS Perris it # Date Inspector POOL &SPA 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 LIFER Grr d." 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 It. Property Sewer Liner& 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 7_ '� � 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 APPROVALS Permit# " 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 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 Notes: I 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test d 36. Hood or Canopy 37. Final Factory Fireplace It 38. Final Plumbing 39.. Water Service -Final ' 40. Gas Service -Final-• 41. Solar Domestic -Final ' 42. Backflow Preventer '•'� t 43. Backflow Irrigation ' 44. Landscape Irrigation System - 45. Sound Attenuation •• 46. Handicap Regulations .' 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed ' 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co �• ., 51. CERTIFICATE OF OCCUPANCY No. Date i � It CITY OF COSTA MESA J BUILDING DIVISION F77 FAIR DRIVE, COSTA MESA, CA 92626 • (714) 754-5273 - Fax (714) 754-4856 • www i.costa-mesa.ca.us �.� FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER.B08-00202 PERMIT TYPE B_ROOF2 STATUS: ISSUED APN: 42520506 DATE ISSUED: 07/08/2008 ISSUED BY: CAC JOB ADDRESS: 216 F 16TH PL CM Vicinity: Squares: 0 Suite/Unit: F Valuation: $4,500.00 SCOPE OF WORK: TAER OFF COMP. SHINGLES - REPALCE WOOD AS NEEDED 1-30 LB FELT AND 30 YR COMP. UNIT F OWNER: EAST HAMPTON COURT HOA Address: 216 E 16TH PL Unit: PHONE: 949-874-5002 City/Stale/Zip: CM APPLICANT: TOM KORSVALL A001 PHONE: 714-620.5916 CONTRACTOR: MILES ABOVE ROOFING INC Address: 1346 LOGAN AVEUnit: City/State/Zip: COSTA MESA, CA 92626 ARCHITECT ENGINEER: FEE SUMMARY Reroof Plan Check: $0.00 Reroof Permit Fee: $111.25 Reinspection Fee: $0.00 TOTAL FEES $111.25 Address: 1346 LOGAN AVE City/State/Zip: COSTA MESA, CA License No. 880263 SUITE A001 PHONE: 714.620-5916 CELL: License No. PHONE: License No. PHONE: Unit: :SUITE NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In 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. 1:QDg/, INSPECTION TYPE DATE INTMA CODE/ INSPECTION TYPE pig INTMAL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re -Roof � Z-;� 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 Iw IL WORKERS' COMPENSATION DECLARATION- I hereby affirm under penalty of perjury ooe of the following declarations: ❑ 1 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 s n 3700 of the Labor Code, for the performance of the work for which this permi issued. My workers' compensation Insurance carrier and policy kss.) ❑`Leertfy 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 Califomia, and agree that if I should become subjectjjj000 ttth.p workers' compensation provisions of Section 3700 of the Labor CotlLr l-sl� lh ly with these provision �tanf ure�/ pnt' ure 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 DOLLARS ($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 " ns in I tome and effect. �z(; cr 's cure � CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that them is a construction lending agency for the performance of the work fa which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lenders 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, 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: 005716 (3/07) Owner ID verified by dm, -ense. ❑ Yesy❑ Not Drivers 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 candy 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, a demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Califomia Administrative Code). ❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safely, as noted above, unless such person has a permit to do such work from the division. Apdkant's Signature Dale 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? ❑ Yes ❑ No (Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be fled Win 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? ❑ Yes ❑ No (Section 25533 of the Califomia 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? ❑ Yes ❑ 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 ❑ No (Section 65850.2 of the California Government Code requires that the requested information be fumished on applications fa non-residential building permits). 6. Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ 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? ❑ Yes ❑ 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 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 wth all state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this garmil until final inspection. ur p( 9K er(s) Date G An onz a A plit'ant Dale City of Costa Mesa Development Services Department Building Safety Division CERTIFICATE OF OCCUPANCY No. 00216 P. 0. Box 1200 Costa Mesa, California The Building located at '>16 F.gf• 16Th Plarrs?, Unit F has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group nl Occupancy. Use of Building nnn,i,.m; n; nm Legal Description A9r.-9r19_1A (See reverse side for Metes and Bounds) Building Permit No A 30194 Electrical Permit No. E 31217 Plumbing Permit No. P 311G4 Mechanical Permit No. m 33476, M 33695 Number of apartments and/or guest rooms ISSUED TO: (n.%t.a Ms»a Leedft Entrorise, Inc. 172 Flowsr Street rnata M?aa, CA 92627 Building Official William T. Howard 1 i by Date March 21, 1989 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CMF 1015-46 rev. 1/83 White -Owner; Canary - Numerical File; Pink - Bldg. Permit File Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations CITY OF COSTA MESA CONSTRUCTION PERMIT �Zl PERMIT NO. 3 a 1 `1 `{ TRACT NO. 10&3-2 LOT N0. lot 63 UNIT NO. 5I �I 9111187 396,52 TL Project Address (a Icor*^ �1 �e e� # TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. - Applicant's Mailing Addressff''.. Owner's Name 141"t 1-G1th%F. =v1feC OP.I S=.i Phone 722-n_II Address `,_11' ✓ C�,51'_Z �- G09(A PBA L1a 4_67-7 A.P.# Zone S Main Building: Accessory Building: Arch/Eng. License No. Address TYPE OF PERMIT ❑ GRADING FOUNDATION El STRUCTURAL ❑ TENANT ❑ELECTRICAL ❑PLUMBING ❑ MECHANICAL ❑OTHER PROJECT DESCRIPTION SO. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ L,O; ooc%— ZONE GRADING CU.YDS. ACRES E T i Front Z p B Rear ZU N I {. Contractor's Nam l� Ueli 5p D PhoneZ 32"07 �I'Z Address (mailing) 14-55 p10)�(F(i 1 }Ai5 �'9.`21b �4 DK (i1 G�7Cj j O 1 1 11 t City License No. Y tJ LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. 52 Ob License Class License Date 5 -3(' Signature s2g, A A K Right G S Left lO � R ^ Ping. Ref. # P!'* ���1 �Qx Parking Req./Provided E Remarks: ,�^1 Planning Notes: 3 �I- 1 �'��� 00 M 11 8R- A- li' T $ PLUMBING .FEES Bar Sink Showers ELECTRICAL FEES WORKERS' COMPENSATION DECLARATI 1 hereby affirm that I have a certificate of co nt to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, LabC.) 1 Policy No.. -"0300 -71 Compa,05 y\DiU(i:��-/1ih1iC�'Co ert if ietl copy is hereby furnished. DateCer 'fietl opy j' d with the city Bu qy,?_ �ls'jon. H —I.�_� v Applicant �l ` s'-"' SFl �CL� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thisseclion need not be completed if the permit is for one hundred ($100) or less). less). 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. Backflow Preventer Service Sink - Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. 050+K Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 a ps Clarifiers Solar Collectors / Dishwasher Meter ❑over 100emps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors 00,1 HIP ❑1 % - B Floor Drains Swimming POOI w/Spa F.A.U. - Inc. Solar'❑9.15 HP ❑1615+ Date'_ Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. Floor Sinks Urinal Fixtures Mic wave Gas Service Outlets .Water Closet Device Boxes O¢ Light 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 (Section 3097 Civ. C.) Lender's Name Interceptors - Water Heater Outlets Ran e 9 Kitchen Sink - r Water Service Switches Sign - Lender's Address OWNER BUILDER DECLARATION I hereby affirm thaCl,'am exempt from the Contractor's License Law for the following rea Son.(Section 7031.5 Business and Professional 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/She is licensed pursuant to the provisions of the Contractor's' License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 11I, 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 (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is Sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). - ./ Lavatories f Auto -Wash Garbage Disposal Standing Sections P -Trap Laundry Trays Generator 110-5 ❑5-15 KIN Trash Compactor ROOF Drains - ' - - , R¢i n5pection Fee $15 ISsu¢ Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES R EM T S _ (gS -" b Zoning Approved By Dale Building Approved By Data Boiler Hood or Type I El Canopy Type II ❑ / Duct - Under Ground Duct -Structural Refrigeration System ❑0-100,000 BTU 00,000 BTU ❑'I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for Such projects with a con- tractors) license pursuant to the Contractor's License Law). I -am aware that proof o their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section e. 8 P. C. for this reason Application Issued By Dat Duct - Ventilating SUMM&RY OF FEES BUILDING PERMIT $ 93 Y. 00 SMTP $ —4,76 PLAN CHECK $ �/� -f 7�i PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE s596,12 PLAN CHECK 25% $ Exhaust System ❑ Multiple ❑ System air/Alteration Firepl/Fact. Bit. ICBG # 'Fire Dampers Date owner 1 hereby certify that I have read this ,application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this y to enter n the above-mentioned property for inspection purp �! b Signature W Dal P Drivers' License or 5 Heating System & Ducting / ❑0.100,000 BTU ❑100,00067 Registers ReinSERection Fee $15 Issue Fee $ 3 CMF 0865-46, rev. 10/84 White - Building: Canary - Applicant: Pink - Accounting; Goldenrod - Assessor `�. CONSTRUCTION AND PLANNING APPROVALS Permit # Data Inspector POC . SPA APPROVALS Permit # Date In 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 LIFER Grnd. 57. APPROVALTO 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 - (O (yid- 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 00il 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas []Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing (3 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning / 35. Final Gas Pipe -Test 36. Hood or Canopy 37., Final Factory Fireplace 38.' Final Plumbing 39. Water Service -Final 40. Gas Service -Final '41. Solar Domestic -Final r 42. Backflow Preventer 43. Backflow Irrigation _ "44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 3,(iB, 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date BN FORM 116 ` BIA FORM 1486 n INSULATION CERTIFICATION ' iLA This is to certify that, in conformance with the current energy regulations (California Adminis- trative Code, Title 25, State of (alifornia') and approved plans, insulation has been installed in the building located at:'� COSTA MESA cab 216 Slr..t No. (It A.N.W.) ROOFS 16TH PLACE ORANGE Cw.tr 0/?/" --/vF I.t 11mb" Tod N.. DESCRIPTION OF INSTALLATION Type of Materia! Manufacturer Thickness R Value.._ EXTERIOR WALLS FIBERGLAS BATTS OWENS COMINGS FIBERGLAS Type of Material Manufacturer Thickness 3} R Vare•' 11 Of Twd. N.ea CEILINGS FIBERGLAS BATTS OWENS COMINGS FIBERGLAS BATTS: Type of Material Manufacturer Thickness --it 30 R Value• (Or T.a. Nae.) Sq. FL Covered BLOWN: Type of Material Manufacturer Thickness_ No. Bags_ me Trdo N.a) wullag Sq. FL Covered R Value••_ FLOORS Type of Material Manufacturer Thickness R Value••_ (Or TnN Raw) SLAB ON GRADE Type of 14aterW Manufacturer--mw-z ihitkness — R Value'•_ (Or TM. N...e) Width of. Insulation Inches FOUNDATION WALLS (if required) Type of Material Manufacturer Thickness R Vatue••_ (or TI.M Nave) REMARKS (if desired) General Contractor (Builder) WEI—CHUAN CONST. & DEV licenseNumber Title Sub'Contractor pnsulation Applicator) Accent Insulation Company License Number 274283 W.W.1i... M..w (:tate "SAYE" It .wr .. Cw IAL&mcwi By � /G Title pate 2-24-89 (•C.Ii1..J. AI.Ni.Iw1:N Cd.. r.MY I...t.11r SM."&. I.tW.o ••G•..Iwww. U.w t...IN:r .1 Rw N.NII.IN..1 a..ilri.. Th.a IU Nrawwr a.. \... M.Nlwa 1. rr.awr.w .1 I.... M.NFw .MII M awNW ..a .'W •Y ."nwa wa ti O. MOM. TLk t=ul.N....�.Gw.. owes ..MI M .....a w . w..t..... I.a.Nr .AOI. M. I.NGw:') (••R Y.N. w O......w a 0. w 1. .1 . e..wWI r M1wf e....w..a w O. rwr../ ►.... Ta...w.aww la) a ..wbn wMMtll" OW" -1 o(aarr A.. S.e- IYa7S .t M IwNO wa wer r.1..# e.. sNN .f C011".. —H. wMOew # .eaq..tY w WIM e.fixa a"A.- .ft-w! Mwl. .w..I. ww1.M a..... ►... w .Oar w.N..N.1 ..I. i.. pr.n... 16.0 .r..a 0. W.I...Mluiw ..w.Y N..IM:.. aN.A.rA. ..a.WlrMa M....a w W. MaR . Form 116 —e/ BUILDING RM INC.. 305S DeedaW Ave, Los Angeles. Calif. 90014-4213) 870-9871 Form 148" BUILDING INDUSTRY ASSOCIATION OF CALIFORNIA, INC` 1571 Beverly Blvd, Los AngeIM Ca6L 90026--!21316255771 i Applicant to flit in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA/ESA CO(NRUCTION PERMIT PE T NII. _ TRACT NO. LOT NO. UNIT Nti/ Project Address e{J'1 Applicant's Mailin/97Address Owner's Name CPP 7A IVIG5A LY%Q"r!. � r PI ne 9' 11 Address J12 Y'yW_ s� �OS1A (✓ICCtr Arch/Eng. License No. Address 1 Contractor's Nam w') i prYhoi M'J Address (mailing) 1^+ Y '0210 City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of Prk3usmeSS and Professions Code, nd my license is in full force and of ct. License Class Li @ No. r7 Date ��0(_ Signature - WORKERS' COMPENJATION DECLA A I N I hereby affirm that 111I111II ave a certificate f onsent If -in re or a certificate �f Workers' Co40-0311011 pensation Insurance, r a certitietl copy the reofsSection 3800, Lab. C.) 0-031 68 ZI.S �)D�LI-I Policy No. Company Certified copy is hereby furnished. Cert ifXd �y � filed with the city Building 'vis a e" IItt1—_i14—I Applicant EXEMPTION FROM WORKERS' COMPENSA ION ECLA TION (This section need not be completed if the permi is to one hundred ($100) or less). I certify that in the performance of the work for ch 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. DateSignature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097 Civ..'C.) Lender's Name Lender's Address v OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code; Any city or county which requires a permit to construct, alter, improve, demolish os -repair 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 the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil Hnalty of not more than five hundred dollars ($500). 1, 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 (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for Sale. If, however, the building or improvement is Sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove er the purpose of sale). I, afos owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts fpr such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that proof o their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date I hereby certify that I ha information Is correct. I ag and state laws relating to sentatives of this city to inspection purposes. Signature Drivers' License or SS # Owner CMF 0865-46, rev. 10/84 White - Building; in and state that the above city and county ordinances And hereby authorize repre- we-mentioned 'priapeyr for Date 0 TYPE OF CONSTRUCTION L)Q NEW J ADD U ALTERATION I REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER • fl %� DESCRIPTION OF WORK/USE OF BLDG. PE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTURAL ❑ TENANT ❑AF LEC?RICAL ❑ PLUMBING N MECHANICAL 7OTHER JECT DESCRIPTION SQ. CONST RUCTION TYPE— Remarks: TIL OCCUPANCY VALUATIONS _ GRAOINGCU.YDS. ACRES_ F A.P. # S Main Building E T Front ARear C Right K S Left Ping. Ref. Planning Notes: Accessory Parking Req./Provided Zone Z O N 1 N G R E Q M T S Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink PERMIT Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ❑ 50+ KW Backflow Irrigation Sewer Cap $ Bathtubs Sewer Connection $ Cooking Unit Meter El up to 100 amps - Clarifiers Solar Collectors MICROFILM =�' = TOTAL FEE Dishwasher Meter Clover 100 amps Dishwasher Solar Piping - Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors ❑0-1 HP ❑l% - 8 Floor Drains Swimming Pool w/Spa F.A.U.Inc. Solar 09-15 HP ❑16-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater •% Outlets Range Kitchen Sink Water Service Switches Sign'. Lavatories Auto -Wash Garbage Disposal Standing Sections P—Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee I $15 I I Issue Fee $ B Reinspection Fee I $15 Issue Fee IANICAL FEES Hood or T DEVELOPMENT SERVICES REQUIREMENTS; Type ❑ Zoning Approved By Canopy Type 11 ❑ Building Approved By Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO/Fact. Bit. ICBG # 23 Heating System & Ducting ❑01100,000 BTU ❑100,000 Reinspection Fee 1 $15 Applicant; Pink - Accounting; Goldenrod - Assessor Refrigeration System ❑01100,000 BTU 1_1 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee )5,— S— I $4 BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% IS ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ SUMMARY OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM =�' = TOTAL FEE $ $ `�•�"� CONSTRUCTION AND,PLANNING I APPROVALS Permit # Date Inspector POOL R. SPA APPROVALS Permit +_ Date Inspector 1. -.Temporary Electrical Service or Pole / 52. Pool & Equipment Location r 2. Soil Pipe-Undrgrnd. v 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE �J. Footings 58. Electrical Conduit-Undrgrnd. 8.. Foundation 59. Gas Pipe, 0 Undrgrnd., Test Y9.'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 Wiriyg Sign 68. APPROVED FOR PLASTERING ,,18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace r 21. Ducts, in Structure n' 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas ED Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas 00il ' 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: �l 34. Final Heating & Air Conditioning 35. Final Gas'Pipe-Test 36. Hood or Canopy 37.:Final Factory Fireplace �cr 1670- 38. - Final Plumbing 39: Water Service -Final ' 40. Gas Service -Final - 1 - ,. . I •.t i 41. Solar Domestic -Final 't 42! Backflow Preventer 43. Backflow Irrigation`�- i •' 44. Landscape Irrigation System 45. Sound Attenuation -.- - - 46. Handicap Regulations , •. ' s 47. FINAL STRUCTURE & BUILDING >> , 48. Special Requirements Completed 49. Electric Release to Edison i 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date NSTRUCTION PERMIT Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PE IT TRACT NO. LOT NO. UNIT NO - Project Address GItG C• sr[i slit fPL- lZ'S�M fyr CbdS zc \ i Applicant's Mailing Address Owner's Name�t5$1 .4��['. [![%l kr r.(fT Yd�NfEf Phone �pL.L�?el/ Address 177, =&,J r_,CT �.. 5 MC'SA1 CA / ZF_Y7 I Arch/Eng. License No. Address _ Contractor's Nam / ( Phone u��? Address lma'I' gl� / NV L -t-Cf City License No. ��4•�� LICENSED CONTRACTOR DECL- Ia ATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full-4orc and effect. q �7 License f (ass -� f,fjlp / C Date `7/'f�1, Signal WORK RSE 'COMPENSATI OL�rjATI ON I hereby affirm that I have a c fill qq consent to self -insure or a certificate of Workers' Compensation Insurance/ or a certified copy thereof (Section 380 Lab. Cg EJ �s �) /� ro , / 2 Poli y No. L i Company �l h !✓l.' Certified copy is hereby furnished. -Cern d c y is filed with the city Builrfin w'�ie • Date Applicant E%EM PT IOI FR M WORKERS' P S ION DEC LARATIO (This section need not be completed if the pe it is for one hundredf$100) or less). certify that in the performance of thew k 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. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty 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 (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- 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 builds or improves thereon, and who contracts for such projects with a con- tractor(51 license pursuant to the Contractor's. License Law). I am aware that proof off their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner . I hereby certify that I have read information is correct. 1 agree to c and state laws relating t bw ing sentatives of this City nter inspection purpose Signature Drivers' Lice4se or 5�4 .it state that the above v and county ordinances �.��2. r TYPE OF CONSTRUCTION LJrvEW qDD ❑ CONVERSION ❑ DEMOLISH [!].OTHER DESCRIPTION OF WORK/USE OF BLDG. — ALTERATION Ll REPAIR TYPE OF PERMIT LJ GRADING U FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY_ CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YDS. ACRES Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Seivice Outlets Interceptors Kitchen Sink Lavatories' P—Trap' Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting 00-100,000 BTU 1:1100,000 BT Reinspection Fee 1 $15 CMF 0965-46, rev. 10/84 White - Building; Canary - APP11Cdnt; Pink -Accounting; GoltlenrOtl -Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Issue Fee Hood or Type ❑ Canopy Type I I ❑ Refrigeration System ❑0100,000BTU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee FEES A.P. # S Main Buildi E T Front B Rear A C Right K S Left Ping. Ref. # Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 005 KW ❑5-15 9896 11/19/87 Zone_ Accessory ELECTRICAL Transformer ❑ 15.50 KW ❑ 50+KW Meter I/Nup to 100 amps Meter ❑over 100 amps Sub Panel Motors ❑ 0.1 HP E111% - 8 Inc. Solar 09-15 HP ❑16-15+ Microwave Pole Light Range Standing Sections Trash Compactor $ 3 Reinspection Fee $15 Issue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By /piQ1 SUMMARY OF FEI BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK25% $ ELECTRICAL- $ PLAN CHECK 50% $ d 17 MECHANICAL $ PLAN CHECK 25% $ $ 3 SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ 35*40 TL FEES $ 3 TOTAL FEE $ 3s Z O N 1 N G R E Q M T S CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector .• POOL & SPA 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 j 56. Rough Plumbing &Pressure Test 6. Electrical UFER Grnd." 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Uncirgrml -�;1 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 _!3 _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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ElGas 0Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank El, das Coil 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 PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION i 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED % 33. Final Electric i Notes: 34. Final Heating & Air Conditioning it ' 35. Final Gas Pipe -Test ll 36. Hood or Canopy l 37. Final Factory Fireplace -� 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final - - 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation I r (1 44. 'Landscape Irrigation System 45. Sound Attenuation ' 46. Handicap Regulations ' . 47. FINAL STRUCTURE & BUILDINGS-^~� ' 48. Special Requirements Completed 49. Electric Release to Edison 50. GasReleaseto Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. > PERMIT NO. .TRACT NO. LOT NO. UNIT CITY OF COSTA MESA ClONSTRUCTION PERMIT Project Adjress ?-It. F 1 G-I'LI pL- 4� Applicant's Mailing Address Owner's Name 4 Phone ZL I Address \11,nsJPY i'( �nGiA APF cA 9-;,6�7 Arch/Eng. License No. Address ���1� C 1 �c• Contractor's Namlli1,L911� HUEL—Ci lq V( --(T9, Phone(?I3ll u O Address (mai I ing) Y c4 Q. IllII% City License No. pa, / LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force andy�effect. 2 I License lass 9 ! LicenseN"Jnr' kb Date /s FiF _ Signature WORKERS' COMPENSATION DECLARATION 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 3800, Lab. C/r1 ,� tt(y� 1+r 11II Policy No. C�.n, n'I rl gn, Companyt� JOIL 11 ❑ Certified copy is hereby furnished. VV ++rr I� Cert'f1 d So py is filed with the city Building ny SX* ns Date 141 1 5 Applicant �7,� • %/Zn�+ i-. EXEMPTION FROM WORKERS' COMPE ATION DECLARATION (Thissection need not be completed if the permit is for one hundred ($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. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. 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 (Section 3097 Civ. C.) Lender's Name _ Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License,Lew for the following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section'7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty 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 (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as the of the property, am exclusively contracting with licensed con- tractorsto construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city t ent r upon a above-mentioned property for inspection purposes. / Signature r �' 7� Date') - - - Drivers' License or S # Sri TYPE OF CONSTRUCTION LJ NEW LJ ADD ALTERATION LJ REPAIR $15 1 Issue Fee ❑ ❑ ❑ $ 3 CONVERSION DEMOLISH OTHER A.P. # DESCRIPTION OF WORK/USE OF BLDG. REQUIREMENTS: !Dat Date 7 S Main Building: BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% E SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ TYPE OF PERMIT D GRADING VFOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL 0 PLUMBING ❑ MECHANICAL B ❑ OTHER A Rear C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY K CONSTRUCTION TYPE VALUATION $ S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service 5 Interceptors Kitchen Sink Lavatories Roof Drains Reinspection Fee 1 $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting 00-100,000 BTU 11100,000 Reinspection Fee I $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Issue Fee Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,00013TU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 1:10-5 KW E15-- 970.7 11/17/87 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors 1-10-1 HP 01% - 8 Inc. Solar ❑9-15 HP 016-15+ Microwave' Pole Light Range Standing Sections 5 KWTrash Compactor 47.38 TL FEES Z O N I N G R E Q M T S $ 3 Reinspection Fee $15 1 Issue Fee $ 3 FEES DEVELOPMENT SERVICES Zoning Approved By Building Approved ByDate Application Issued By REQUIREMENTS: !Dat Date 7 BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ $ $ $ $ $ $ $ SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ pp '41S, 0" $ 3 CONSTRUCTION AND'PLANNING APPROVALS Permit# Date Inspector POOL & SPA 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 LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. .a " 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 t 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # i. 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas ❑Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas 0Oil 25. Roof Sheathing 74. Overhead Hydro _ 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing i - - 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: U4 •L; 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 G I,••' - , I 41. Solar Domestic -Final , 42. Backflow Preventer l43. Backflow Irrigation - 44. Landscape Irrigation System - f45} Sound Attenuation 1 ;, 46. Handicap Regulations J " - 47 . FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date sn 41., in a u.... o. ,rn,..-il.i.. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address ��� /L f4 /Mr rd Applicant's Mailing Address i t. h//y ,s Owner's Name ° A0 Phone a; Address Arch/Eng. License No. Address Contractor's Nam /LI ��' • Phone Address (mailing a�+� City License No. q -G r7 LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class- License No.-26y(eJ2 Date V- 11- N Signature WORKERS' COMPENSATION DECLARATION i hereby affirm that I have a certificate of consent to self -insure or a certificate if Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) . _ . •' ertified copy is hereby furnished. Cert ifietl c y is flied with the city [vision. Date EXEMPTION FROM WORKERS' COMP SATION DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less). I certify that in the performance of the work for w ch This permit Is issued, I shall not employ any person in any man s to become subject to the Workers- p oa%ation Laws of Califor Date .7-1, 40 Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional 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/she is licensed pursuant to the provisions of the Contractor's License law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil ee natty of not more than five hundred dollars ($500). LJ 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 (Section 7044, Business and Professional Code: The Contractor's 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 employees, provided that such Improvements are not intended or offered for sale. It, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- prove efor the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con. 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 builds or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to but ltling construction, and hereby authorize repre. sentatives of this c to enter upon the above-mentioned property for inspection purposes S-_(/i�i Signature Date Drivers' License o�79L Ef border lines and sign all appropriate declarations. LOT NO. UNIT NO. COP- IAT (P3 -4 F TYPE OF CONSTRUCTION TJ NEW LJ ADD LJ ALTERATION LJ REPAIR $ ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A,P,+ DESCRIPTION OF WORK/USE OF BLDG. S Main Building: TYPE OF PERMIT ❑GRADING FOVNDATION STRUCTURAL E T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL BA Rear ❑ OTHER $ PLAN CHECK C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY KLeft CONSTRUCTION TYPE VALUATIONS $ PLAN CHECK ZONE-�f GRADINGCU.YDS. ACRES Ping. Ref.+ Remarks: I7 �/1 �A(� Pla n.mg Notes: Preventer Irrigation rinking Fountains lour Drains loor Sinks as Service Outlets Sink Trap )of Drains Reinspection Fee 1 $15 Boiler Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑6100,000 BTU 0100,000 BT Reinspection Fee 1 $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor ABING 1 FEES Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto -Wash Laundry Trays Issue Fee I $ 3 Hood or Type 1 ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,000BTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑0-5 KW E15 15 0413 5/12/8; Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter LJup to 100 amps Meter ❑over 100 amps Sub Panel Motors 120-1 HP ❑ 1'f. - 8 Inc.Solar 09-15 HP ❑16-15+ Microwave Pole Light Range Standing Sections Trash Compactor Reinspection Fee I $15 ' I Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By 37o7-0 TL Z O N I N G R E Q M T S FEES $ 3 SMIP $ PERMIT SUMMARY OF F BUILDING PERMIT S S $ PLAN CHECK $ $ $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ 33v Gy PLAN CHECK 25% $ L/ c 4'0 37o7-0 TL Z O N I N G R E Q M T S FEES $ 3 SMIP $ PERMIT ISSUANCE S ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE S __3r CONSTRUCTION AND PLANNING APPROVALS Permit# Date Inspector POOL & SPA APPROVALS Permit# Date Inspector 1. Temporary Electrical -Service or Pole 52. Pool & Equipment Location 2, Soil Pipe-Undrgrnd. 1 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement r? 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE C7.'.Footings 58. Electrical Conduit-Undrgrnd. •8., Foundation J, ' 59. Gas Pipe, O Undrgrnd., Test 49..'Water Pipe-Undrgrnd; ` 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap •• 63. Heater & Vent -Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final 15. Rough ElectricakConduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. -Rough Wiring Sign 68. APPROVED FOR PLASTERING - 8. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19'.,Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit I#- 20. Rough Factory Fireplace 21. Ducts, in Structure 21. 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping El Gas El Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd. Storage Tank E Gas El Oil - 25. Roof Sheathing 74. Overhead Hydro 26. •T -Bar Ceiling (Structural) & Monoccat 75. Dry Chemical P 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL i 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. 14EQU1REMENT A 31. Plaster Brown Coat 79. FINAL INSPECTION '• 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED S 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 I 39. Water Service -Final - 40. Gas Service -Final I 41. Solar Domestic -Final . 1 42. Backflow Preventer r 43. Backflow Irrigation i ' 44. Landscape Irrigation System 45. Sound Attenuation L'l 46. Handicap Regulations y i i 147. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison . 50. Gas Release to Southern California Gas Co , 51. CERTIFICATE OF OCCUPANCY No. Date