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HomeMy WebLinkAbout233 16TH PL - Building PermitsCITY OF COSTA MESA A(O�n MFq 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 ``"^°°°h°°5� PERMIT NUMBER: P11-00177 PERMIT TYPE PLUM APN: 93673038 JOB ADDRESS: 233 E 16TH PL CM Vicinity: STATUS: DATEISSUED: ISSUED BY: Suite/Unit: E ISSUED 09/19/2011 KJB SCOPE OF WORK: REPAIR WATERLINE TO UNITE. WATERLINE WAS LEAKING. NO OTHER WORK AUTHORIZED BY THIS PERMIT. OWNER: YESSAYAN, HARRY E Address: 233 16TH PL #E PHONE: City/State/Zip: COSTA MESA, CA APPLICANT: C AND R DRAINS INC Address: 1525 MAC ARTHUR BL. PHONE: 714.641-1545 City/State/zZip: COSTA MESA, CA CONTRACTOR: C AND R DRAINS INC License No. 531746 Address: 1525 MAC ARTHUR BL. PHONE: 714-641-1545 City/State: COSTA MESA, CA ZipCode: 92626 CELL: ARCHITECT: License No. PHONE: ENGINEER: License No. PHONE: PLUMBING PERMIT FEE SUMMARY PLAN CHECK FEE: $0.00 PERMIT FEE: $33.30 TOTAL FEES: $33.30 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. CODER. INSPECTION TYPE DATE INTITIALS CODE INSPECTION TYPE DATE INTMALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing X Q- ;L Iry 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 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. ❑ 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: Carrier: n�) b 5n_& (rhasedianneednot be wmdeettedd the rxmRa rvalued al one huu) mp ndr odi(S I W); -less 'Policy Nu her: vii �i /-� LV S� / 0 ❑ 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 La Code, I all forthwith co ly with these provisio s. �r Appure / Da re 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 (5100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby 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. 7 Lia 1 % Class # / /, Contr d 'nature ' /D le CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lender's Address: 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: 3057-A6 (3107) Owner ID verified by drivense. E] 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, 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. Applicant's 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 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 fling 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. 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. naw IOwnegs) Data And/or A ht5rizedA Imant Date 01, A (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 PLUMBING PERMIT .lob Address. 233 16TH PL Suite No E Vicinity: AMT Parcel Nunmber: 93673038 Applicant: SZABO, KEVIN Address: 17390 MT CLIFFWOOD $0.00 Phone: (714) 241-1414 0 -- FOUNTAIN VALLEY Zip: 92708 Owner: YESSAYAN, HARRY E Address 233 16TH PL #E Phone: COSTA MESA, CA Zip: 92627-3827 Contractor: COAST ROOTER PLUMBING HTG & A/C Address: 17390 MT CLIFFWOOD Arch / Eng : Address: ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifier System Connect (Ice,Soda,etc) Dental Units . Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve FOUNTAIN VALLEY CHANGE OUT WATER HEATER Phone: (714)241-1414 Zip: 92708 License: 529127 Phone: Zip: License: SCOPE OF PERMIT Status: ISSUED Applied: 11/04/2004 Issued: 1111 04 /20004 ISSUED BY: _QTY FEE SUMMARY AMT QTY Sump Pump AMT $23.50 0 :.. Laundry Tub / Washer, $0.00 $0.00 0 -- Landscape Irrigation $0.00 0 0 P -Trap $0.00 $0.00 '10 Pressure Regulator- $0.00 $0.00 0 Process Piping (per 10 ft) $0.00 $0.00 0 Receptors $0.00 $0.00 0 Septic Tank $0.00 $0.00 0 Sewer Cap for Demo $0.00 $0.00 0 - Sewer Connect $0.00 $0.00 0 Sewer Private Line $0.00 $0.00 - 0 - Shower $0.00 $0.00 0 Sink, bar - $0.00 $0.00 0 Sink, commercial $0.00 $0.00 0 Sink, Floor $0.00 Status: ISSUED Applied: 11/04/2004 Issued: 1111 04 /20004 ISSUED BY: _QTY AMT OTY .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 Mr 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 $12.30 1 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) 7545626 2446-46 (aroo) DECLARATIONS WORKERS' COMPEN5ATION 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 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. l My workers' compensation Insurance carder and policy number are: -1 Carder.,' ST/rrE f=U,-J 0 Policy Number. 9-003 _(Th/s section need not be completed if the permit is valued at one hundred dollars ($100) or less.) I certify that in the performance of the work fo 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 Calif la, and agree t at HP sho Id become subject to the workers' compensation provisions of Section 3 00 of the Labor Code, shaNEOr hwith comply with these provisio ,Applicant' Signature: _ Date: - 1WARNING: FAILURE TO SECURE WO RS' OOM ON COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMP LOYERTO CRIMIN PENALTIES AND CIVIL FINES UP TO OUNDRED THOUSAND DOLLARE ($100,000), IN ADDITION TO THE CAST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES, LICENSED CONTRACTORS DECLARATION: I.herebyaffirm 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,N = i Class N - -3 Goniraclors Signature: ,� Date: J11W59— 11D4, £ 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). 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 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 cr 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,'the6wner-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 Cade for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Ddvoes 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 B, 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. ............................................................................................................................................................................................................................................I... ......I...................................................................................... 4 If an RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully co.... with? ❑ Yes ❑ No ..................................................................................................................... ildi........................................................................................................................................................................................................................................... difi................ 5 Does or will the oast Air or present or future building occupant require for the work which is the subject of this a plication eppermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Bye LJ No (Section 65050.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). .............................. ..................-.................................................................................... ........................................................................................................................................................................................................... ........................................... fi 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 (it "yes". the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ............................................................................................................................................................................................................................................................................................................................................................................................ 7 II 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 .................................................................................................................................. I-- ..................................................................................................................................................................................................................................................... B (II 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. Signatu a Of'Le al Owners)/ /Date AinWOLAuthonzed Applicant (D to CODE I. INSPECTION TYPE gam, INTITE4fl CODE# INSPECTION TYPE PATE INTIM9LS 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/Occupency TY OF COSTA MES._ CALIFORNIA 92626 P.O. BOX 1200 FROM THE OFFICE OF THE DIRECTOR OF BUILDING SAFETY Project Address Project Name Owners Owners Address Owners Telephone ,538 - �-S-/ Permit $ 1.3/ j3 ,Qlypie kJ t • fJ . _(,.XXQ J �aoZTp/�/) City Use Only I as Owner, Contractor, Agent (strike out all except one) Vhereby attest that employment of any.person, or persons, is not anticipated at the time of seeking the above -referenced permit. In the event that any person, or persons, are employed under the provisions of this permit, I shall immediately cause a valid Certificate of Workmens Compensation to be filed with the Costa Mesa Building Division. I agree to defend at my own cost, and to indemnify and hold harmless, the City, its officers, agents and/or employees, frcm and against, any and all liability, damage, costs, losses, claims and expenses, howsoever caused, resulting directly or indirectly frau, or connected with the improvement under this permit. I further state sponsibilities Contractors Sta Division 3, Cha that I have read and fully understand the implications and re - of the above statements, and will ccnply to License Law found under the Business pter 9, of the State of California. o 1`14N J S7-52/ar4,�5 Print Name Signature CMF 0777-46 with all provisions of the and Professions Code, �- may-- C5,_1 Date i� COSTA MESA BUILDING -SAFETY DEPARTMENT P.O.B0X1200 COSTA MkSA, CALIFORNIA 92626 APPLICATION, FOR STRUCTURAL PERMIT G For Applicant to Fill in Completely — Use In�kt Only RECEIVED BV 6R ' S' , 2' BUILDING //.Q ADDRESS V/ / C�`t A.P. NO. -/SI —t' 5 OWNER OR fI /]/Jz//J i1 1. /�.l /1/Lr TENANT �t"(!L /,�/i LGY1 LLl ✓U /G li F— l BUILDING � /(L/ ADDRESS II.r� l�lC.l� UNIT N 2 C SPACE N MAILING27 ) n ADDRESS �.7jI / L/N 0 T O LOT BLK. CITY IJEZuPc>r %3fS cry NOLbq��� EW ADD ALTER IREPAIR I MOVI NGJ DEMOLISH CONSTRUCTION LENDER BRANCH /q y LU UGC OWNER sY ISAQA4..//AJAr ADDRESS VALUE USE $ / ARCHITECT Dq� C0„1C��� TEL_q(} ("�t 1 OR ENGINEERI/7" N� 2 _ ZONE J TYPE GROUP ,1.r/+'—I/V C�.+I �j h ADDRESS [QST IF, ��� �/ `OJ G'U.>�rNE<j CONTRACTOR APPROVED BY DATE Z AD DR ES CITY APPROVED SETBACKS STATE (� CITV LIC. NO. /ifLIC. NO SIZE21,7g -7V OF LOT / ,J / �(J n NOW ON LDOT� z (R M , T T)/ USE OF �/�j_ . EXISTING BLDG. /C, R_ SIDE Separate permits are required for electric, plumbing and heating work. r q L sl FT REAR FT USE OF BUILDING AND WORK TO BE PERFORMED PLANNI G ACTION Gov✓10l.�J 11 aavao APPR D RV I hereby acknowledge that I have read this application and state that the above information is co/rect and ares to comply with all laws regulating building const/.c' I shall not employ any person in violation of t 's compensation laws of the State of Californi 1 hereby certify that 1 e rIV licensed as actor under the State of California mass and Pr s Code, Division 3, Chapter 9, and that such licenses are I force and effect, or I am ezarn from the provis( ns oft tate of California B siness antl Professionsn t a, Div' I n 3, Chapter 9. Signature Permittee of , / /iii 4�0 IA J s ... dULD F04QAMC1U RE`tlWk1 *NEI THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION $%5 Z (1J PERMIT FEE S PLAN CHECK $ TAX or7- A Authorized Agent Date TOTAL PAID S G y I (714) 754-5273 • Fax (714) 754.4856 • www.ci.costa-mesa.c$UILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 233 16TH PL Suite: A Vicinity: NEWPORT HEIGHTS BLDG A Primary Occ: R-3 Dwellings/ Cong Res <10 Type of Construction: V -N Parcel Number: TPNO0593 Zoning: Applicant: RODGERS, MIKE Address: 2626 NEWPORT BL COSTA MESA, CA Owner: NEWPORT HEIGHTS HOA Address 233 16TH PL COSTA MESA, CA Contractor: PETRONELLA ROOFING Address: 2626 NEWPORT BL COSTA MESA, CA Zip: 92627 Arch : Address: Phone: Phone: (949) 548-1645 ISSUED BY: Zip: 92627 Phone: Zip: 92627 Phone: (949)548-1645 License: 460707 Eng: Address: Status: ISSUED Applied: 10/20/2005 Issued: 10/20/2005 Phone: Zip: License: License SCOPE OF PERMIT REROOF CONDO BLDG A: T/O EXISTING WOOD SHAKE, REPAIRIREPLACE SHTG AS NEEDED, 2 LAYERS 30# FELT, APPLY "CLASS B MEDIUM SHAKE" 18SQUARES Plan Check: $0.00 Permit: $139.25 SMIP Res: $0.64 SMTP Com: $0.00 Other:. $0.00 Inspection: $0.00 Total: $139.89 SETBACKS MAIN STRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existing: 0 FEE SUMMARY Calc Valuation: $6,400.00 Claim Valuation: $6,400.00 PLANNING & ZONING Rear 0-0 Left 0-0 - Right 0-0 Rear 0-0 Left 0-0 Right 0-0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void If work is not commenced within 180 days, or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2aab-+e(6=) DECLARATIOMS 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 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 whkh this permit is Issued. My workers' compensation Insurance car r and policy number are: CarriCarrier:- � -l" i� 77y� -Policy Number: /TO15­7 L �sectlm need not be completed if the permit is valued atone 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 if I should become sub' he workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these prowsi ns. / / cAp-PIicaOLSlgftature: CA.. 0�1 Date—"A Lal6zs WARNING: FAILURE TO SECURE WORKERS' COMPENSATIONC ERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL E TIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($100,000), IN ADDITION TO THE COSTO COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706OF THE LABOR CODE, INTEREST, ANDATTORNEYS 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 LTc. � O O classy L' v � .- l �Contra�to�sSfture:. — jDate:__5p 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). 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 cMI 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: Signature: Date: Owner ID verified by driver's license. ❑ 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, Tille 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 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 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 plication a ermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 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 WIII 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 II 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 byCalifornia 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. / Signature Of Legal Owner(s) Date 11_/J And/OT uthomzed Appllcar)t �z�Data_� CODE E. INSPECTION TYPE V PATE IrrtmALS CODE r INSPECTION TYPE gd¢, RTITIA 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 Y� 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 10/20/2003 15:18 9495482617 PETRONELLA PAGE 02 THE R EROO' ING SPECIA`iISTS, ;1 NC. 1 P ROOFIIt0 CG rporate Oliice: Desert Off m: 2 i26 Newport Blvd, 68.314 Kieley Road - Costo Mcc+qaa., CA 92627 Cathedrf City. CA 92234 9 {9.54 a.I6451 Pax 949.548-2617 Llc=x 0466707 760.324-54921 Pox 760.329,4612 I P ETRONELLA ROOF1NCha timaa cnllc4 "CMntraela� and/Rr "So14r' ngrae it, provide the f,Rmving Grtd fnLur meleriafa MIRI mN.rnuction: NAME/OWNER: Nelrpa'1 MCIEMa HO — If Ally ye"AyAn .IPHONENM: 714.327.716& F ZROOP PROJECT ADDRRSS: 2331604Place (ITY, STATE A ZIP CODE Cama MCss, Cf A 92627 TLLINC ADDRESS: CITY. STATE At ZIP CODE: I II JBI)IT ONAL PMONE NUMBER: I FAX NUMBER: 714.327,411115 I6lrmmlla RaWing agora t6 provide all labor. 1 Mh spodLwUom artachcd as R.xhWft "A". Mu 'B" PmWom Median Shaka. I O -You coamidm Warramy 10 You Lndtod Motorial Wamnly I;au for (4) Separate PcIIdlftXL ......„..-- ERMS .13 Upon Award /3 Upon torr *W)wd /3 Upon completion SPECIAL INSTRUCTIONS: r(ME rOR b7ART(NO ANpCOI.1PLERNG I'ROB:Cr': R �!TCempCd lje�et. M 1. Owkn evnvhmxmddwtoNntdmee,wnhwmewatw+ff. rcfdfNts” to admmiRycoM.d+liam L,w, NOTICE 71Y RUYER: (V Dl M Ap, thu ape M Regm*k lay ednmwlrdpe fhM he / dp Im rad cod rt `NMiee m Op .r a ae re,er,e rii& Isfm ny a(A win d Rdtpp*Me piny hw Ap i dining the ngdimfia lq YOU, THE THIRD BUSINEa.0 BAY AFTER TRE DATE OP 17119 RAW OWNER RBSPONSIBL18 PARTY fhptrr/Rnpn r3M . Nsp �` (borer / Reepdaddk Prlry: Ry,vro 7.�/os— ) MISC.: cqulpum and imumnce to rcplam the witting roof "em in oeeardonm i 1 CONTRACT TERMS: 113 DCM;L. Stop133.33 1/31 Proarr c SI0�33.33 113 Final: S10r133.33 ,vRdl ..mmf1a 01 .' mt cl P dem from I se m nr cat ants mmm., rear e pmtimttly tin (lel wr,Ring dry. wqh nnedimal lithe to M a dmilnl .. 11..g 9, M the inial E'eI,lAlKpannpd M;. 4mll hr dor m t U iv d.,l em M my me1M la mdbr. 4 be bort 1mvRt1 eartve...ithin nmtty (3a) dm+ form nx dere gwcifad aMtp u e vipLRlm M the w lave tad R. (2) Ym ma Mthled io ggwd "Ty of" aerr . Id1 Ovo. t Avdmrired I a IMIft 6+ of the Iha ngtenn n Apwd by Cm rR. ". help 8 all Tmnq Condhidp and Rd IMl he / Ar Imo and ndl rtcvived , leryhlr rVy M rtmy da„mnN that Owner I A thr,irt4 mNRR. MAY CANCF2. TRLC TRANRACnON At ANY TIME I'RIORTO MIDATGIrT Of NRdCTAN NY N E(AI INH TINE SEU.RR, IN CANLO, AT Tl IR ABOVE AMT -11a IN IIOIIT M1p 4lO RHCIFVFR A ATTEMPTS D OST M-THf3 CONTRA F.I A WITH THE R; G TfTo R 111 RRCOVER All. RACT9 AND HAVE A IMRx A3RBCE AN W(TR TNIx RIGHT TO REQUIRE TIII: CONTRACTOR TO HAVE A PfiRR1MANCF. AND PAYMRNT j NTRAC:TOR(SEVAR) CONTRACT PRICE Y) Y'\ 111Yky' r d\,Ynm-AY Amnpe AMlhmIN Repro rMnt N. t ,rosrab RmIMd A~7M R V. traarvre x mtwm.r lMeaf9ek —" O.eb17 "Ag AkILicgrySCO AND AiGul.t rer, IiTA try) hTAi II It R, XFI'n 7» lillr CF(IaRq. IFYI -.'irrrml 'rMViW+I�w�l�b rolronemxlmNw ui4f1� ICp. 1 � Nml wr ur nn mn"rl,.Pn nP yy ' • Aa--m ]}IAMI fNF I+C M 1• +4Pa IW ('NNni'nT I�,n ilifa 1114 (ryIMR'1 In Ilryy.�,.tW Y < I � tt. nrrrrh+5+45 M1 .bWlAxrlcrl t�-•.•••r� nRbn M •im +rrld rr v+.t�� Nn,'in�uf •� RPi h'P+rftl M Mtll nUil N IC f+nrol'Ip� isq � natio Mlm 411'll)11d)' ot1 a binJirtk anh ll;rnl the ntemneq inti ��.vey rhe _`•"9r'�fMtltAMFmymistl 6+1 krhu Mow. nlFI4 SIaR litre I�4AbN eannR r'PMfi1114Y.>elltt.Tttlr:n Ua Wlmr N: ,tPI Ytr ryllh`Mlit CIIMIMjq(, 1'C'rNn � a]lf.n11HM11QCf'Oh •. NPI mtiehPrFf Pi j !hc <manlrynl. I N NnmPl l IN:rIW nrtmrml mr ell Ma YIS nt4m IiYMMIMIrnMI. i b oPrcla ro in cn?raw.. v„mTh+rl +Inr ��"'".•''<xl APntt lr Fa; MmnmNirt .II. PLun. rrwd4g Plm+n4r•a w PE7RONELLa O,r►CF, r r Pact 63 7a1tiPn n�`fe,'� YEW. ����1(Md�miN.�r�In4 Uw I+wNirinn latlJ'.a6411 Ae mMlyd In rnwmabiP 1 Olkr --w—flP ro rhyNar W, xiAq mehc x+M. IM f'Mn u+tt n anllw�✓+rnq Ih: n;ql N tfn 41V i1).tl NnWN F x�.ruiryj ^••n rRnpla.S inl I+Im •+mb. AMy< hP 'tlRmmua w. "rrvnP bm b,M <+n'4o�aNIWn ro.rl.w Mti.r�W /M1�•iW.+r Nur. rn�N.'ri`WY n.I� January 1, 1983 To: CITY OF COSTA MESA CALIFORNIA 92626 P.O. BOX 1200 FROM THE OFFICE OF THE DEVELOPMENT SERVICES DEPARTMENT/ PLANNING DIVISION State Board of Equalization Finance (2) ./Building Safety Division Communications Mesa Consolidated Water District County Clerk Engineering Division Fire Prevention County Administration Office Newport -Mesa Unified School District Manager, MID File (3) County Tax Assessor Pacific Telephone Company (2) Police Department - Ping. & Research Public Services Department (3) County Registrar of Voters Southern California Edison Co. Southern California Gas Co. Street Division United States Rost Office, C.M. United States Post Office, Santa Ana Zip 4 - Santa Ana California Coastal Commission The City of Costa Mesa wishes to advise you that in revising street addresses, the following addresses have been changed: For your convenience we are listing the agencies above that we have notified of the change. In addition to those listed, you are advised to notify your correspondents of the charge in order to avoid any possible interruption of mail service. Your cooperatiord imatter is appreciated. &EPH E. WIGHT.MAN Planning Intern hwm (F-1-48) cc: Barbara V. Winagle 901 Dover Drive Newport Beach, California 92660 77 FAIR DRIVE (714) 754-5245 OLD ADDRESS NEW ADDRESS A.P. NO. 1. 233 - Al 16th Place 233 - A 16th Place 425-201-21 2. 233 - A2 16th Place 233 - B 16th Place 425-201-21 3. 233 - B 16th Place 233 - C 16th Place 425-201-21 4. 233 - C2 16th Place 233 - D 16th Place 425-201-21 5. 233 - Cl 16th Place 233 - E 16th Place 425-201-21 6. 233 - D 16th Place 233 - F 16th Place 425-201-21 For your convenience we are listing the agencies above that we have notified of the change. In addition to those listed, you are advised to notify your correspondents of the charge in order to avoid any possible interruption of mail service. Your cooperatiord imatter is appreciated. &EPH E. WIGHT.MAN Planning Intern hwm (F-1-48) cc: Barbara V. Winagle 901 Dover Drive Newport Beach, California 92660 77 FAIR DRIVE (714) 754-5245 m.. 474 East 17th Street • Suite 208 Costa Mese • California 82827 • 714/8468418 �W TUCKER STRUCTURAL ENGINEER cuT iN f�. ro(z v�►JT ,oIeOVID� I - �X8 .-t L v IIofe,. (1 + a t �. OG K tai.. Ta P FE 2x4@I�Iioo, ,— FIX Au fNv0f,7yrATON GG T'it= Cc+RNCN„ WINNOW Fr�NUN(i /tT DIVING ROOM 010 NOT RSVF+AL ANJy 5'1*'C-Ak LCA0 wfu,>.� el�l t7 -fN�v pGL tt 7o S'rzra aglow, 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 California`) and approved plans, insulation has been installed in the building located at: l.r t.'s-=• _i �? 1V1 {� �• {'d rX_�i 1 C i-'\ }�jr (,7 !'< City Counb 7 '(.-.t t ) a-3 a(: 1 L M7/ Street No. (If Available) Street Lo( Number Tract No. DESCRIPTION OF INSTALLATION ROOFS Type of Material Manufacturer Thickness—R Value**_ EXTERIOR WALLS. t Type of Material ( K' f- 1> (, jttg Manufacturer " � "^�(�"' Thickness / R Value**�_ (0r Trade Name) CEILINGS BATTS: Typeof Material ' ; fit: MDI,3qV Manufacturer L-'" zl a '-)""� Thickness �= R Value** i t (Or Trade Name) ' Sq. Ft. Covered BLOWN: Type of Material Manufacturer Thickness No. Bags— (Or Trade Name) Wt./Bag Sq. Ft. Covered R Value**— FLOORS Type of Material Manufacturer Value**_ ' (Or Trade Name) -Thickness—R - SLAB ON GRADE Type of Material Manufacturer ThicknessValue**— (Or Trade Name) —R Width of Insulation .Inches FOUNDATION WALLS (if required) Type of Material Manufacturer Thickness—R Value**_ (Or Trade Nome) .. REMARKS (if desired) General Contractor (Builder) License By Title Date Sub -Contractor (Insulation Applicator)) License Number 3 A,;I `I S (Imulation. Masonry, Etc.) (State "SAME" If same as General Contractar) By k iTitle E`Je.l I Date h V d (•California AdminORoti.e Code, Energy Insulation Standards, declares: EXCERPT from Sec19873 of the Health and Safety Code of the Stale "Cnmpllares. Upon completion of the inamllation of insulation, a mrd of California:' ossifying thus the Iesuloslon has bean installed in conformance with the requirements of theft regulations shall be completed and ...cured by the insulation applimtor and by the buildr. This insulation complianm mrd shall be posted of a canmicuous location within the dwelling.") (••R Value is the measure of the resistanm of a material or building component ta the ",.age of heat. The resistance value (R) of mass -type insulations shall not Include any value for reflective facing.) "No mrtifcate of'occ.pancv or similar carbocation that a newly can. strutted hotel, metal, apartment house, It... or other residential dwelling is habitable shall be issued by such a building department unless the stmdum at least satisfies the minimum energy insulation standards established our .... I to this chapter." Form 116—© BUILDING NEWS, INC., 3055 Overland Ave., Los Angeles, Calif. 90034--(213)870.9871 ` Form 1486-0 BUILDING INDUSTRY ASSOCIATION OF CALIFORNIA, INC., 1571 Beverly Blvd., Los'Angeles, Calif. 90026-213) 625.5771 BN FORM 116 BIA FORM 1486 INSULATION CERTIFICATION This is to certify that, in conformance with the current energy regulations (California Adminis- trative (ode, Title 25, State of (alifornia*) and approved plans, insulation has been installed in the building located at: City county Streat No. (If Available) Street Lot Number Trad No. DESCRIPTION OF INSTALLATION ROOFS, Type oAMaterial Manufacturer Thickness—R Value**— EXTERIORh WALLS — r��� ,; Type of Material I• • t , f r{6>'°4 T Manufacturer S r. 01 + '� �� Thicknesses y R Value**�— (Or Trade Name) /4A, CEILINGS BAT- ia Type of Material ' dY' ni) G { �` Manufacturer t' t a 'i} "` N Thickness I^ R Value**ISL (Or Trade Name) Sq. Ft. Covered BLOWN: Type of Material Manufacturer Thickness No. Bill (Or Trade Name) Wt./Bag Sq. Ft. Covered R Value**_ FLOORS Type of Material Manufacturer Thickness—R Value**— (Or Trade Name) SLAB ON GRADE Type of Material Manufacturer ( Thickness—R Value**— (0r Trade Name) Width of Insulation Inches FOUNDATION WALLS (if required) Type of Material— Manufacturer Thickness R Value**_ (Or Trade Name) REMARKS (if desired) General Contractor License By _ Title Date SutrContractor (Insulation Applicator) (`S'4 tt ���0 License Number` l�-r (Infyl�aNm, ,Memnry, Ek.) (State "SAME" if same as General contractor) By \int e_n )�l��r a(to Ze•.. Title ('California Adminlilro\e Cade, Energy Insulation standards, declares, "Compliance. Upon completion of the installation of insulation, a card certifying that the insulation has been installed in conformance with the requirements of these regulations shall be completed and executed by the insulation applicator and by the builder. This insulation compliance card shall be posted at a conspicuous location within the dwelling.") (•'R Value is the measure of the resistance of a material or building moonenl to the passaa. of heat. The resistance value (R) of mass -type insulations shall not Include any value for reflective facing.) Form 116 —o BUILDING NEWS, INC., 3055 Overland Ave., Los Form 1486—(D BUILDING INDUSTRY ASSOCIATION OF CALIFORNIA, Date EXCERPT from Sec. 19875 of the Health and Safety Cade of the State of California: "No certificate of occupancy or similar wrtifmtion that a nowly con. structed hotel, motel, apartment home, home or other residential dwelling is habitable shall be Issued by such a building department unless the structure at least satisfas the minimum energy insulation standards established pursuant in this chapter." Angeles, Calif. 90034213)8700.9871 INC., 1571 Beverly Blvd., Los Angeles, Calif. 90026-4213) 625-5771 BN FORM 116 BIA FORM 1486 INSULATION CERTIFICATION This is to certify that, in conformance with the current energy regulations (California Adminis- trative (ode, Title 25, State of (alifornia*) and approved plans, insulation has been installed in the building located at: =A -1a M tcE t 0 iz Flll)C, t= city County Street No. (If Available) Street Lot Number Tract No. DESCRIPTION OF INSTALLATION ROOFS Type of Manufacturer Thickness—R Value**. EXTERIOR WALLS ` 1 r� Type of Material j= •' Iii -1 0 eh< c Manufacturer (,rte QA ,y' ,• t l —�+� Thickness 3 R Value**4-V (0r Trade Name) CEILINGS BATES: (2 ( Type of Material r .Ii4 �I ( n. (Or 0, rTradede NmaName) Thickness R Value**4-q Sq. Ft. Covered BLOWN: Type of Manufacturer_ (Or Trade Name) Wt./Bag Sq. Ft. Covered R Value** FLOORS Thickness No. Bags_ Type of Material Manufacturer Thickness R Value**- - (Or Trade Name) SLAB ON GRADE Type of Material Manufacturer Thickness R Value**_ (Or Trade Name) Width of Insulation Inches FOUNDATION WALLS (if required) Type of Material Manufacturer Thickness—R Value** (Or Trade Name) REMARKS (if desired) General Contractor License Number Sub -Contractor (Insulation Applicator) License Number 3GQ (in tion, Masonry, Etc.) (State "SAME" If same as Ganem Contractor) By /. n r� 11� < t , t ._� Title C t t N l` s- t Date(q,/7 `r S'� ('California Administrative Code, Energy Insulation Standards, declares: EXCERPT from Sec. 19875 of the Health and Safely Code of the Stale "Compliance. Upon completion of the installation of Insulation, a card of Calif..;.: certifying that the insulation has been installed In conformance with the reaul,amenb of these regulations shall be completed and azaculed by "Ne certificate of occupancy or similar certinmtion that a newly can. ,he insulation applicator and by the builder. This N..:ulatlon compliance strud d hotel, moral, apartment house, It... car other residential card shall be pasted at a conspicuous location wNhln the dwelling.—I dwelling Is habitable shall be Issued by such a building department ("R Value Is the measure of the resistance of a malarial or building component to the passage of heat. The resistance value (R) of moss.hpe Insulations shall not include any value for reflective facing.) unless the structuro at least satisfies the minimum energy Insulation standards established pursuant to this chaplar." Form 116 —© BUILDING NEWS, INC., 3055 Overland Ave., Los Angeles, Calif. 90034-4213)870-9871 Form 1486—(D BUILDING INDUSTRY ASSOCIATION OF CALIFORNIA, INC., 1571 Beverly Blvd., Los Angeles, Calif. 90026-4213) 625.5771 J IM I. `W Q U J M Lo] r-ti_� fi IM1 at!mm 233 16th Place - Condos w/attached garage A-1 51222 A-2 51223 B 51224 C-1 51225 C-2 51226 D 51227 Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. -CITY OF COSTA MESA PERl�A17 No7 `� TRACT NO. LOT NO. BLDG. NO. C6U&J'" IJCTION PERMIT L' P TYPE OF CONSTRUCTION ❑ NEW ❑ ADD ❑ ALTERATION O REPAIR ❑ CONVERSION ❑DEMOLISH ❑OTHER 24_80 2/24/82 ' 8.00 " ZONING REGULATIONS 'Project Address �.� GE - Owner Phon - 39 Addres ' 'd(�E 910 O Arch7Er, License No �a �J DESCRIPTION OF WORK A.P. Address �+ E.' I - 'ZONE PLNG. REF. :P Contracto-C s O CD J eX /ON Phone p- TYPE OF PERMIT. ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL - ❑ TENANT ELECTRICAL ❑PLUMBING ❑MECHANICA BUILDINGTTop SETBACK 5 . - SIDE YARD SLEDGE V ggitl1l INC PROPE RTV LINE -- - - - - - - Address Q :-i _ LICENSED•CONTRACTOR.DECLAR ION I licensed Charter 9 1 hereby affirm that am under provisions of (Com- mencing with section 7000) of 'Division. 3 of the Business 'and OTHER - - RIGHT Professions Code, nd my license Is In fu fort a d f I. l ��' ..❑ PROJECT DESCRIPTION' REAR YARD (TO P/L)- ucenClas - se V. FT' PKG. SPACE RED. PROVIDED• DateQ= Signature - .SD. - OCCUPANCY_ CONST R UCTI ON TYPE STREET WIDTH PARK FEE E WORKERS' COMPENSATION DECL ATION _ 1 hereby affirm that I have a certifi ate of consent to self -Insure or a VALUATION—ZONE ZONING APPROVED BY - DATE certificate -of Workers' Compensation Insurance, or d Certified copy - -- -- -. thereof (Section 3800, Lab. C.). GRADING CU. YDS. ACRES SPECIAL CONDITIONS: 'icy'No. Company' - REMARKS:. •- Certified copy- is hereby -furnished. _ -- _ .� Certified copy is filed with the city Building Division. ' EXEMPTIOMFROM"WORKERS' COMPENSATIONDECLARATION .(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 - PLUMBING - - -PLAN CHECK" -` ELECTRICAL - PLAN CHECK ' subject t0 the Workers' Compensation Laws of California. BATHTUBS SHOWERS- qQ, - - ' _ Date 1 Signature NOTICE: If after making this declaration, you should become subject TOILETS URINALS GENERATOR 0-1 KW -1-10 KW to the Workers' Compensation provisions o the Labor Code, you must TRANSFORMER forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE'LAVS - ,APPLIANCE - 10-50 KW_50-+ KW _ revoked. KIT. SINKS— DISHWASHERS- MOTORS -'0-1 HP 1-10 HP - CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the per- SERVICE SINKS I •� -SUMPS - ,UNC. SOLAR) 10-50 HPL. -50 + He formante Of the work for which this permit is Itsuetl (Section 3097 FLOOR SINKS - FLOOR'ORAINS' FIXTURES OUTLETS "SWITCHES - ' Civ. C:):+ - - - -- --- - - - - - - Lender's Name Lender's Address " DRINKING FOUNTAINS • GAS TUBE SIGNS OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for "INTERCEPTORS CLARIFIERS POLE LIGHTS SWIMMING POOL PTRAP•- LONS I HUL11u.4- the following reason (Section 7031.5 Business and Professions Code: Any city or county which requires a permit to construct, alter, POLES METERED SUB WATER SERVICE ' ALTERATION PANELS MAINSUB ' Improve; demolish -or repair any -structure, prior to its Issuance; also re- quires the aptlicant for such permit to file a signed statement that he - GAS SERVICE - OUTLETS SERVICE AMP, - '• is licensed -pursuant to -the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the WATER HEATERS BTU OUTPUT' _ 9 usiness and Pro/essions Code) or that he is exempt therefrom and the -sls for the alleged exemption. Any violation of Section 7031.5 by - SEWER' CONNECTIONS -applicant for a permit subjects -the applicant to a civil penalty lot mote than five hundred dollars ($500). r SOLAR TANK' - COLLECTORS - u 1, 5s owner of the properly; -Ur 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 'Professions Code: The SOLAR PIPING SYS. - - - ISSUE FEE - Contractor's License Law does not apply to an owner of a property - ISSUE FEE — - APPLICATION APPROVED BY - - -- -DATE who builds or improves thereon, and who does such work himself or ithrough his own empployees, provided that such Improvements are not MECHANICAL PLAN CHECK SUMMARY OF FEES I.tended or offered for sale. If, however, the building or Improvement Is sold within one year of completion, the owner will have the burden of proving hedidnot build or improve for the purpose of sale). I -BUILDING---- I ❑ b,..as owner .of the property, am exclusively -Contracting .with HEATING SYSTEM 0-100,000 BTU PERMIT $ SMIP E licensed contractors to construct the project (Section 7044, Business _ AND DUCTING 100.000 • BTU 'PLAN CHECK E PERMIT Law does y to and,Professions Cotle: The-Contractor's.builds -ISSUANCE E an who orimproves owner of property who builds or Improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING S - tracts from such projects with a contractor(s) Iipesnetl Pursuant to the SYSTEM - - - GRADING $ the Contractor's License Law). C 100.000- BTU PLAN CHECK E El I am exempt'under Section - —" - B. 6 P. C: for this r BOILERS BTU ELECTRICAL E -- -- - - - E r eason - - - PLAN 'CHECK $ ' •-MICROFILM,$• ' Date Owner SYSTEM REPAI R, ALTERATION EXHAUST SYSTEM MULTIPLE MECHANICAL $ � - TOTAL FEE LESS AD - I hereby certify that I have read this application and state that the above information is correct. I -a ree to Comply with all Cit and count 9 PY Y Y U PLAN CHECK -E E P VANCE PC $_ ordinances and slate laws r sling t construction, and hereby authorize - represenlatives f'in15 y t n[er upon the above mentioned _ property _for C _ urp s. , O O _ Signature Date ISSUE -FEE -- - - - — - - _ . FINAL FEE E - Drivers' Llcens r'SS - -- CMF 0865-46 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor TL CONSTRUCTION AND PLANNING APPROVALS Permit # F a 7j'-3 Date Inspector POOL & SPA _ •'-+�"? APPROVALS Permit # - Date'- Inspector 1. _ Temporary Electrical Service or Pole 43. Pool & Equipment Location - 2. SoilPipe-Undrgrn 44. Steel Reinforcement - - - - 3. Electrical Conduit Utility,-Undrgrn 45. Forms 4. Electrical Conduit-Undrgrn - 46. Electrical Bonding -- _5. Steelem orce - - 47. Rough Plumbing & Pressure Test - 6. Electrical -LIFER Grn 48. APPROVALTO COVER-GUNITE- - - - - - - 7. Footings _ _ 49. Electrical Conduit-Undr rn B. Foundation 50. Gas Pipe, ❑ Undr in, Test 9.._ Water Pipe-Undrgrn. _ 51. Backwash Lines P -Trap.❑ Undr4rri 10. Structural Floor System 52. APPROVAL TO DECK 11. Property Sewer Line & House Connection 53. Backwash & Receptor -Final .1.2. Street Sewer Connection 54. Heater &Vent -Final 13. Rough Plumbing, - ' 14. Rough Electric -Conduit -- 56: Electrical -Final 15. Rough Electric -Wiring - -- 57. Solar System -Final 16. Rough Heating & Air Conditioning - - - - - - encing & Access Approval 17. - Ducts in Structure _ APPROVED FOR PLASTERING - 18.• 19. 20. Ducts, Ventilating Gas Pipe -Rough & Test Roof Framing 60. - - - POOL/SPA SYSTEMS FINAL 21. 22. Roof Sheathing'- - - Frame and Flashing -� NOTES: ' 23. Insulation - - - 24. Lathing & Siding 25_. Drywall Nailing - -- 26. Plaster -Brown Coat 1 ' 27. Electrical Power Meter -Final 28. Final Electric - - - 29. Final Heating & Air Conditioning 30. Final Gas Pipe -Test. - 31. - Final Plumbing 32: Water Service -Final - - 33. Gas Service -Final 34. Solar Domestic -Final 35. Landscape Sprinkling System 36. Sound Attenuation - 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING - 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No. Date - - CITY OF�COSTA MESA CONSTRUCTION PERMIT Address Arch/Eng, Address - - Contractor 'm that I am licensed on h. section 7000) .of .D Code, ang, _rrly license to fill in all spaces within heavy border lines and sign all appropriate PERMIT NO. - - I TRACT NO. I LOT NO. License C ss - f f Date 4(--2aZz, Signature - •WORKERS' COMPENSATION DECLRTAT I hereby affirm that I have a certificate of certificate of -Workers' Compensation -Insu thereof (Section 3800, Lab. C.). "-'Icy No. ' -'-Company= 'ertified copy Is hereby furnished. .:ertifi¢tl Copy is filed with the city Buil EXEMPTION FROM WORKERS' COMP N (This section need not be completedif h ,($1001 or less). cert fy-that n the performance of t e o� issued. I shall not employ any perso . Date TYPE OF CONSTRUCTION 'hone + ❑ NEW ❑ ADD ❑ ALTERATION ❑ REPAIR ❑ CONVERSION ❑DEMOLISH No. ❑ OTHER DESCRIPTION OF WORK i of Charier 9 (com- of the Business antl oil ull fo e a a f nse toIf-insure or a ce, or a certified copy Division. ON DECLARATION I'm t is for ponee/hynndrod �ar wgfcytyiylpyrm/t i5 QYPE OF PERMIT ❑ GRADING -❑ FOUNDATION - El STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑PLUMBING, ❑MECHAI ❑ OTHER PROJECT DESCRIPTION 'SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION - ZONE GRADINGCU.YOS. ACRES REMARKS:. --_11Q J- 07_p - PLUMBING PLAN CHECK -- BATHTUBS --- SHOWERS- -- NOTICE: If after making this declaYetion, you sho I become subject 1TOILETS, URINALS - to the Workers' Compensation provisions of theCode, you must forthwith comply with such provisions or this p m r shall be deemed LAVATORIES DOUBLE LAVS - - revoked. 'CONSTRUCTION LENDING AGENCY - '- -KIT. SINKS - - DISHWASHERS - - SERVICE SINKS SUMPS -- - -I hereby affirm that there is a construction lending agency for the per. formance of the work for which this permit Is issued (Section 3097 FLOOR SINKS ' '- FLOOR DRAINS -- Civ. C.). -- - - - - - - - - 'Lender's Name Lender's Address - - - DRINKING FOUNTAINS—- OWNERBUILDERDECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for INTERCEPTORS - CLARIFIERS SWIMMING POOL PTRAP - the following reason (Section 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 re- quires the apOicant for such permit to file a signed statement that he WATER SERVICE ALTERATION - GAS SERVICE - OUTLETS--- ' is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the WATER HEATERS BTU OUTPUT Business and Professions -Code) or -that he is exempt therefrom.and the basis for the alleged exemption. Any violation of Section 7031.5 by SEWER CONNECTIONS - - - applicant for a permit subjects the applicant to -a -civil penalty. )(.more than five hundred dollars ($500). SOLAR TANK' - COLLECTORS ., as owner of the property, or my employees with wages as their sol¢ compensation, will do the work, and the structure is not intended GAS TUBE SIGNS or offered for sale. (Section 7044, Business and Professions Code: The SOLAR'PIPING SYS. - Contractor's License Law does not apply to an owner of a property ISSUE FEE - - who builds or improves thereon, and who does such work himself or through his own employees, provided that such Improvements are not MECHANICAL PLAN CHECK - intended or offered'for sale. -If, however, the building or improvement is sold within one year of completion, the owner will have the burden HEATING SYSTEM 0-100,000 BTU ANDDUCTING - -- - 100,000+BTU of proving he did not build or improve for the -purpose of sale). ❑ 1, as owner of -the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business and Professions Code: The.Contractor's License Law does not apply to, .. REFRIGERATION 0-100,000 BTU an owner of properly who builds or improves thereon, and who con- tracts from such projects. with a contractor(s) Iicesned, pursuant -to the Contractor's License Law). SYSTEM 100.000.+ BTU ,❑ I amexemptunder Section - - - B. & P. C: for this - -- BOILERS BTU reason Date O er , , SYSTEM REPAIR. ALTERATION Signature CMF0 J state that the above EXHAUST SYSTEM MULTIPLE all city and county and hereby authorize Date J / ISSUE FEE ; Pink -Accounting; Goldenrod -Assessor 4348 4/08/82 23.50 TL: ZONING REGULATIONS A.P. # ZONE PLNG. REF. -)r REAR YARD (TO P/L) _ - PKG.SPACE REQ. - - PROVIDED STREET WIDTH ` PARK FEE $ ZONING APPROVED BY - DATE -- SPECIAL CONDITIONS: ' PERMIT ISSUANC E'.'E'' PLUMBING $ ELECTRICAL- - -PLAN CHECK , - - '. 1 T V GENERATOR , TRANSFORMER 0-1 KW_1-lOKW'-- APPLIANCE - --10-50 KW_50+KW ' 'MOTORS - - 0-1 HP (INC. SOLAR). 30-50 HP -1-10 HP- 50+HP FIXTURES - OUTLETS SWITCHES GAS TUBE SIGNS .-- - POLE LIGHTS- --- — I POLES METERED SUB PANELS- - MAINJ SUB SERVICE - - AMP ISSUE FEE - - _ - _ APPLICATION APPROVED BY .DATE _ SUMMARY OF FEES BUILDING 'PERMIT $ - .. SMIP „$ PLAN CHECK $ PERMIT ISSUANC E'.'E'' PLUMBING $ RAD1 GING $ PLAN CHECK .$ - - '. 1 ELECTRICAL -$ $ PLAN CHECK $-- ;MICROFILM $ MECHANICAL- $ - '.TOTAL FEE $ PLAN CHECK' $ LESS AD- VANCEPC $_ FINAL FEE $_>.Z� CONSTRUCTION AND PLANNING APPROVALS Permit # 3.21 Date - Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location" 2. Soil Pipe-Undrgrn 44. Steel Reinforcement - �--•- - - 3. Electrical Conduit Utility-Undrgrn 45. Forms 4. Electrical-Conduit-Undrgrn - 46. Electrical Bonding -."- - - - -- 5. Steel Heinforce 47. Rough Plumbin '& Pressure Test -- - - - - - - 6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE- - - - •' - - L 7. Footings 49. Electrical Conduit-Undr rn 8: - Foundation - 50. Gas Pipe, IDUndr rn; Test 9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra"'-O 0 dFr`n• 10. Structural Floor System 52. APPROVAL TO DECK ` 11. Property Sewer Line & House Connection 53. Backwash & Receptor -Final 12. Street Sewer Connection - - 54. Heater & Vent -Final 13. Rough Plumbing 14. Rough Electric -Conduit 56. - Electrical -Final -• < 15. Rough Electric -Wiring - 57. Solar System -Final - - 16. Rough Heating & Air Conditioning* - Fencing & Access Approval 17. Ducts, in Structure - - APPROVED FOR PLASTERING;r''' 18. 19. 20. Ducts, Ventilating Gas Pipe -Rough &Test - Roof Framing - 60. POOL/SPA SYSTEMS FINAL 21. 22. Roof Sheathing- Frame and Flashing- NOTES: 23. Insulation 24. Lathing & Siding - 25. Drywall Nailing 26. Plaster Brown Coat - 27. Electrical Power Meter -Final 28. Final Electric 29. Final Heating & Air Conditioning ' 30. Final Gas Pipe -Test 31. Final Plumbing 32. -Water Service -Final - 33. Gas Service -Final 34. Solar Domestic -Final 35. Landsca e Sprinkling System 36. Sound Attenuation- - - 37. Handicap Regulations 38. FINAL STRUCTURE&BUILDING ' 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. '142. •\ CERTIFICATE OF OCCUPANCY No' Date Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA PERMIT NO. TRACT NO. LOT NO. BLOB CONSTRUCTION PERMIT L- 3 WO. ff�l TYPE OF CONSTRUCTION - - 4495 4/1 2/82 . 13.00 Project Ad Owner - Phon A ❑ NEW ❑ ADD ❑ ALTERATION CONVERSION MOLISH ❑ REPAIR 11❑DE ❑ OTHER , ^ - ZONING REGULATIONS ' Addres - Arch/Eng. License No. DESCRIPTION OF WORK - A.P. 'ZONE Address - _ - _ PLNG. REF. W ContractorL(IW 7 Phone VPE OF PERMIT ❑ GRADING - ❑ FOUNDATION ❑ STRUCTURAL 'O -TENANT❑ ELECTRICAL ❑PLUMBING •SETBACK C ST. SID YARD - ��O PIIIx'"gurvE -,- - - - Address i1LEFT CEN5ED CNTRADI,011 D CLARAT ON I hereby affirRU m that I am licensed unde provisions of Charter 9(com- - -❑MECHANICA SIDP_ VA RIGHT - mencing with. section ]000) of Div on of the Business antl ❑ OTHER _ 'Prof¢ssiens Code.li<¢ns! 1 If force nd of t. REAR YARD (TO PIU .Ind -' `-_ PROJECT DESCRIPTION- _ _ License ass PKC. SPACE REO. PROVIDED ` Date Signature COMPENSATION DE ARATIO_ _ _SQ. - OCCUPANCV_CONSTRUCTION.TVPE - - STREET WIDTH - PARK FEE $ ,WORKERS, I hereby affirm that I have a certificate of co nt to self -Insure ora VALUATION ZONE ZONING APPROVED BV _ ' DATE certificate of Workers' Compensation Insura ce,.or a certified copy thereof (Section 3800, Lab. C.). GRADING CU.,VDS. ACRES SPECIAL CONDITIONS: @-4icy NO. - - Company :ert Hied copy is hereby furnished. REMARKS:- ..j,tertilled copy is filed with the city Building Division. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION - (This section need not be-complet¢d if t perm s for one hundred S$100) or less): Certify that in the performance of th wok or w lith t ,t Issued, I shall not employ any person n a y mann r eco a PLUMBING PLAN CHECK - ELECTRICAL PLAN CHECK subject t0 [ e Worker ' Co mpensatlpn II BATHTUBS SHOWERSIJWISO. NG _ FT qQ PT Date `� nature NOTICE: f after making this ticclara ti o n, you shout ome subject TOILETS, s, URINALS'- '- GENERATOR "-0-1 KW KW to the WOrker2' Compensation provisions Of the Lab C de you must ,TRANSFORMER forthwith comply with such provisions or this per shall be learned LAVATORIES DOUBLE LAYS - - APPLIANCE 10-50 KW -50 t KW _ - leveketl. 'KIT. SINKS' _ - DISHWASHERS MOTORS _ 0-1 HP_110 HP CONSTRUCTION LENDING AGENCY - - 1 hereby affirm that there is a construction lending agency for the per- formance(INC. of the work for which this permit is issued (Section 3097 - ' FLOOR SINKS" FLOOR DRAINS -' }FIXTURES--' OUTLETS- SWITCHES -" Civ. C.). - - "'- Lender's Name :Lender's Address DRINKING FOUNTAINS ' - GAS TUBE SIGNS - - - - OWNERBUILDERDECLARATION INTERCEPTORS CLARIFIERS- LIGHTS- -- -' - I hereby affirm that I am exempt from the Contractor's License Law for .POLE the following reason (Section .7031.5 -Business and Professions Code: SWIMMING POOL -- "PTRAP -- - - -- - Any city or county which requires a permit to construct, alter, POLES METERED UB WATER SERVICE - ALTERATION - PANELS - MAIN - UB improve, demolish or -repair any structure, prior to Its issuance, also re- quires the ap.licant for such permit to file a signed statement that he _ 0 �a GAS SERVICE OUTLETS - SERVICE - -AMP -- is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Seetlon 7000) of Division 3 of the is WATER HEATERS BTU OUTPUT -• Business and Professions Code) or that he exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by SEWER CONNECTIONS- for a per it jestsdollatheto a civil penally El,atpmo more hundred ($SOOjicant SOLAR TANK COLLECTORS' F}"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 Professions Code: The _ SOLAR PIPING'SVS. ISSUE FEE --- Contractor's License Law does not apply to an owner of a property ISSUE FEE - -� APPLICATION APPROVED BY 'DATE " - who'builds or -improves thereon, and who does such work himself or through his own employees, provided that Such improvements are not MECHANICAL PLAN CHECK intended or offered for sale. -If, however, the building or improvement Is sold within one year of com pletid n, the owner will have the burden I SUMMARY OF FEES Of- proving he did not build Or -improve for the purpose of sale). HEATING SYSTEM 0-100,000 BTU j _ - BUILDING - _ E1.1, az owner.of.o contracting with. -AND DUCTING - - -" - g ----- - - --' i SMTP $• -- - - - - n 7044, Business licensed contractors to construct the project (Section construct the pr ject (Section 100,000 +BTU , PLAN CHECK $ PERMIT, ' O' es not antl Professions Code: -The Contractor's License.Law does not apply to - - - - - - ISSUANCE- $ - - an owner of properly who builds or Improves thereon, and who con. REFRIGERATION 0-100,000 BTU ,PLUMBING $ - • 1$ tracts. fro m. such projects with a.. Contractor (s),I icezned pursuant to SYSTEM - f - -- _ _ -GRADING the Contractor's License Law). 100,000 F BTU ,PLAN CHECK $ •' - , f.- ❑ 1 am exempt under Section B. & P. C. for this $ BOILERS BTU ELECTRICAL $ reason. SYSTEM REPAIR, ALTERATION EXHAUST SYSTEM EM MULTIPLE - ' _ _ PLAN CHECK $ - ,MECHANICAL .$ - : •. MICROFILM 5 `', TOTAL FEE $ ( ' l Date, Owner I hereby cert f at ave read t i al Plication and state that [he above information is orrec .' a r omply with all city antl county PLAN'CHECK $ - - 'VANCEPC $-- d orinances tl [ate la r o on sbutt i on, antl hereby authorize I ... repres.mall o e ter"u Pon' tile' ab0 ve mentlonetl' '• ' property fo __ Slgnat ure Date i -, FINAL FEE $�-:_— Drivers' License or SS qp ISSUE FEE -- GMF 0865-•i6 White- ilding; Canary -Applicant: Pink -Accounting; Goltlenrotl-Assessor �� T4' CONSTRUCTION AND PLANNING APPROVALS Permit # aZ Date Inspector POOL & SPA,- ^ Date - �lntpector - APPROVALS Permit # '_ _ 1. Temporary Electrical Service or Pole - .43. Pool & Equipment Location SoilPipe-Undrgrn 44. Steel Reinforcement - - `-- _3. . Electrical Conduit Utility.-Undrgrn 45. Forms 4.- Electrical Conduit-Undrgrn k C e-- 46. Electrical Bonding., - - - -- - 5. Steel Reintorce . _ - 47. Rough Plumbing & Pressure. -Test - - - - 6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE ---- •- - 7. Footings 49. Electrical Conduit-Undr rn 8. Foundation 50. Gas Pipe, ❑ Undr rn,•Test, - 9. Water Pipe-Undrgrn _ 51. Backwash Lines P -Trap',' E] hiif rn 10. Structural Floor System 52. APPROVAL TO DECK - "- " ---- " _11. 11. . Property Sewer Line & House -Connection 53. Backwash & Receptor -Final ' 12. Street Sewer Connection 54. Heater & Vent -Final 13. Rough Plumbing _ Final 14. Rough Electric -Conduit - - 56.. Electrical -Final ' 15. Rough Electric -Wiring_ IFencing (2 • 57.- Solar -System -Final 16. Rough, Heating & Air Conditioning - & Access Approval 17. Ducts,.in Structure APPROVED FOR PLASTERING':;., 18. 19. 20. Ducts, Ventilating Gas Pipe -Rough & Test Roof Framing. 60. POOL/SPA SYSTEMS FINAL 21. 22. Roof Sheathing-' Frame and Flashing _ _ NOTES: 23. Insulation - 24. Lathing & Siding - - - - ' 25. Drywall Nailing - 26. Plaster Brown Coat, - 27. Electrical Power Meier -Final - - 28. Final Electric 29. Final Heating & Air Conditioning 30. Final Gas Pipe -Test - 31. Final Plumbing _ - 32i -Water Service -Final . 33.- Gas Service -Final 34. Solar Domestic -Final 35. Landscape Sprinkling System - 36. Sound Attenuation , 37. Handicap Regulations ' 38. FINAL STRUCTURE & BUILDING -- 39. Special Requirements Completed' 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. ' CERTIFICATE OF OCCUPANCY ' No. Date - "`'- LOT Pati++Lor -TVE W. ADPCF-: � pE2MtT N�M�6rz �AwATrot4 �7S S. Tax P�Ck[�= , Pl_C.r.��slr i FEES F�� I j 2 / 219 �2 33 !� -►w pt . SZ (o / S 3 6 46 So ` /43 � oo ' 3 SZ G / sisa 193; 00 I � !cell sd, /9300 . 2 � S �• ;! S2 � I S 3 !F'e' 0 0 2 6 j i, �, S2/5"'i 3iGB j6Sol! o0 I !131s- 69a i22�S7 ioo`i / /SBoo i I � 'I li I i I I I _ ! II I ! � ' I + I I t ! I 1 Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESAIT S TRACT NO. LOT NO. 'BLDG. NO. CTI CONSTRUON PERMIT Project Address 3 BATHTUBS SHOWERS TYPE OF CONSTRUCTION ❑ NEW ElADD - ❑ ALTERATION C ❑ REPAIR ❑CONVERSION ❑DEMOLISH ❑ OTHER DESCRIPTION OF WORK -TYPE OF PERMIT. ❑ GRADING ❑ FOUNDATION- ❑ STRUCTURAL TENANT ❑ELECTRCAL-❑PLUMBING ❑MECHAN Owner Phone 5 _ Address Z7j �i7 (P k.µa:% - - - -Arch/Eng. _' License No. Address - - Contractor -Plone Address R.0 ?-,EzrQ 0 LICENSED CONTRACTOR DECLARATI ;I hereby affirm th4t I am licensed under provisions of Charter 9 (com- . - mencing with 'section 7000)' -of 'Division 3 Of the Business antl ❑OTHER Professions Code, and my license is In full forcta effect. OWNER BUILDER DECLARATION ---- - - I hereby affirm that I am exempt from the Contractor's License Law for , end -3(-g `4 c)4 PROJECT DESCRIPTION - License Class�_ Lie a No..1i I— WATER SERVICE ALTERATION - 'Date c-? H28 l I-8 t' Signature SQ. FT: ._ OCCUPANCV_CONSTRUCTION TYPE WORKERS' COMPENSATION DECLARATION DIAIA (.. I hereby affirm that I have a certificate of consent to sse_II -insure or a VALUATION ZONE ,certificate of Workers' Compensation Insurance, or a certified copy SOLAR TANK '- - COLLECTORS.., Tereof (Section 3800, Lab. C.). GRADING CU..YDS. ACRES y,qy No. ._ - Company P $_ -RE copy is hereby furnished. Certified copy is'filed with the city Building Division.EXEMPTION FINAL FEE $12711'J_ 06 M FROM WORKERS"COMPENSATION'DECLARATION (This section need not be completed if the permit is for one hundred($100)orlessj.Icertifythat In the performance of thework for which, this permit iiissuetl, I shall not employ any person in ypyjrnillrmJS SD a5 to become.PLAN CHsubiecLto the Workers' Compensation- aX. rGY IRd 1. Date �� (-$Z Signature' % 1 BATHTUBS SHOWERS _TOILETS URINALS " - ,NOTICE: If after making this tleclaratio n, you should ecome su /e`c[� t o the Workers' Compio ensatn provisions of the Labor Code, you must 'forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE lAVS-" - revoked. _ _ KIT. SINKS - - DISHWASHERS 'CONSTRUCTION LENDING AGENCY SERVICE SINKS SUMPS - 'I hereby affirm that there is a construction lending agency for the per- Jormance of the work for which this permit is issued (Section 3097 FLOOR SINKS FLOOR bRAINS ._ _ .. _. _ Lender's Lendeer's Name Lender's Address DRINKING FOUNTAINS OWNER BUILDER DECLARATION ---- - - I hereby affirm that I am exempt from the Contractor's License Law for INTERCEPTORS CLARIFIERS the followingreason (Section -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 're- quires the applicant for such permit to file a signed statement that he 'SWIMMING POOL - PTRAP -` WATER SERVICE ALTERATION - GAS SERVICE OUTLETS - is licensed pursuant to -the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the _ WATER HEATERS BTU OUTPUT' Business -and Professions Code) -or that -he is exempt' therefrom and the 's for the alleged exemption. Any violation of Section 7031.5 by SEWER CONNECTIONS - -- -applicant-for a permit subjects the applicant to a civil penalty lot more than five hundred dollars ($500). SOLAR TANK '- - COLLECTORS.., ILI I, as owner of the property, or my employees with wages as thele 6651 8/24/62 26900 TL ZONE BUILDING SEppTBACK C/L ST. IIEppFTYAR D - RIIGHTA REAR YARD (TO P/L) PKG. SPACE REQ. STREET WIDTH 'ZONING APPROVED BY SPECIAL CONDITIONS: ELECTRICAL -- REGULATIONS - PLNTG.. gREF. p�F PRO PEIRTV LINE PROVIDED, -- PARK FEE $ DATE -PLAN CHECK _ cn FT -- GENERATOR 0-1 KW— TRANSFORMER - - APPLIANCE" -.'"30 -SO KW_50+KW 1-10. KW - - " MOTORS 04- HP -1-10 -- - (INC. SOLAR)--10-50-HPy HP 50+HP '�- FIXTURES OUTLETS -'SWITCHES- " GAS TUBE SIGNS - REFRIGERATION 0-100,000 BTU ' ;POLE LIGHTS -- sole compensation,. will..do.the work, and the structure 1s not,intended-, or offered for sale. (Section 7044, Business and Professions Code: The - SOLAR PIPING SYS.1• Contractor's. License Law,does not apply to an owner -of a property - _ _ - _ ISSUE FEE ' ` 1 who builds or improves thereon, and who does such work himself or through hisown employees, provided that such improvements are not MECHANICAL PLAN CHECK intended or offered for sale. If, however, the building or Improvement is.sold. within -one year.of completion, the.owner will have the burden HEATING SYSTEM 0-100,000 BTU 'HND DUCTING 100,000+BTU " of proving he did not build or improve for the purpose of sale). El I, as -owner- of the property,- am -exclusively- contracting with licensed contractors to construct the project (Section 7044, Business and-Proffesfons- Code: The -Contractor's License -Law does not apply to REFRIGERATION 0-100,000 BTU an owner of property who builds or improves thereon, and who con- tracts from such -projects -with -a contractor IS)- I! cesned-pursuant-to the Contractor's License Law). SYSTEM-- -'- - -- 100,000 + BTU ❑ 1 em exempt untler Section - - B-& P.- C. for this BOILERS BTU reason' — - -- - - - -- - - GRADING '$ Date- - - Owner - SYSTEM REPAIR, ALTERATION EXHAUST SYSTEM MULTIPLE 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 construction, and hereby authorize representatives of this city to enter A�� VJ,,, above mentionetl property forj& ect n urposes. R� Of o`Z„-o �, Signature (C Date U l O DriverY License or SS gr _ ;-f IG.�I (V S P &C 2D(:,LSSI N3 3 - - - ISSUE FEE - - - -1 3 CMF 0865-46 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor PANELS MAIN " 'SERVICE -' 15SUE FEE APPLICATION' APPROVED BV - DATES vL SUMMARY OF FEES - 'BUILDING -` -• -- - -- - PERMIT $ _ �•, SMIP•'- PLAN CHECK $ 'PERMIT _ (PLUMBING ISSUANCE $- - $�...._{a GRADING '$ PLAN CHECK •$(^ •. I-. - ELECTRICAL $ PLAN -CHECK- $ ”"J MICROFILM$ - ' �- � TOTAL FEE $ MECHANICAL $ ' -- "PLAN 'PLAN LESS D - CHECK' $ P $_ - _ FINAL FEE $12711'J_ 06 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector .e •__•''•-^ POOL & SPA' - _ - APPROVALS Permit # �u �+ Date Inspector 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location - - 2. Soil - ipe•Undrgrn - 44. Steel Reinforcement - 3. Electrica Conduit Utility-Undrgrn _ 45. Forms - 4. Electrical Conduit-Undrgrn 46. Electrical Bonding. - - - - 5. Steel ein orce _ 47. Rough Plumbing & Pressure Test 6. Electrical LIFER Grn _ _ _ 48. APPROVAL TO COVER-GUNITE 7._ Footings _ _ - 49. Electrical Conduit-Undr rn _ 8. Foundation 50. Gas Pipe, ❑ Undr rn, Test 9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra • ❑ Undrqrn 10. Structural Floor System 52. APPROVAL TO DECK- ' 11. Property Sewer Line & House Connection _ 53. Backwash& Receptor -Final 12. Street Sewer Connection -- _ - 54. Heater & Vent -Final 13. Rough Plumbing_ _ _ _ _ - - 14. Rough Electric -Conduit 56. Electrical -Final 15. Rough Electric -Wring - - - - 57. Solar -System -Final - ' - 16. - Rough Heating & Air Conditioning b8. Fencing & Access Approval 17. Ducts in Structure 9. APPROVED FOR PLASTERING - 18. Ducts, Ventilating 60. POOL/SPA SYSTEMS FINAL 19. Gas Pipe -Rough & Test 20. Roof Framing 21. Roof Sheathing NOTES: 22. Frame and Flashing 23. Insulation 24. Lathing & Siding - - - 25. Drywall Nailing ' 26. Plaster Brown Coat 27. Electrical Power Meter -Final 28. Final Electric 29. Final Heating & Air Conditioning _ 30. Final Gas Pipe -Test - 31. Final Plumbing •.?'-� - •4"". - 32. Water Service -Final - -33. - Gas Service -Final - 34. Solar Domestic -Final 35. Landscape Sprinkling System - - 36. Sound Attenuation 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING 39. Special Requirements Completed - 40. Electric Release to Edison - - - 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No. Date APPLICATION FOR A BUILDING P' 'AIT -7j/%1 C wt, I/ 9viLip"go? Tract Block Lot BUILDING PERMIT NO. 57/ 2 2 — n 2� Electrical Permit No. a?33 Building / /� Adtlress /ry Plumbing Permit No. Cross Mechanical Area Street Permit NO. Owner �,/ /� •V `2 Type of Project: ❑ New Aller ❑ Addition Address ❑ Repair ❑ Convert ❑ mo ❑ Occupancy Pml. City Zip Phon A.P. Sup. Dist./ Into. Area Architect/ Decigoer License No. Zona Sol. Pmt. No. Setbacks St. Street Width Address City Zip Phone Yards g ear p '^ Engineer lJcanse No. ��� 7�{J dva ol. EnIC/L 19 �`_ FL Address ✓ N (_. ark ng pacai ov a overs City / 497% Zip hone Struct Height No. of Stories No. o/ Family LICENSED CONTRACTOR'S DECLARATION 1 hereby affirm that 1 am licensed under provisions of Chapter 9 Park Fees Yes Required No C.T. Fee Receipt Zoning Approved BY: Date (commencing with Section 7000 of Division 3 of the Business and Professions Codedne my license is ih full force and e7e�77/� License Cl. of License Number / Data .(.� Misc. /Contractor Adrtdress U Proposed Use of Structure City antl Zip Phone OYS CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the ork for which this permit is issued (Sac. 3097, Div. C.). Occ. Class TypeCode Const Year USE/;CCU ANCY SIZE SO. FT. Lender's Name F"'G Lender's Address.LIJXA'� OWNER -BUILDER DECLARATION DECLARATION I hereby affirm that I am exempt from the Contractor's License Law 1 for the following reason: ❑ I, as owner of the property, or my employees with wages as their 2. sole compensation, will do the work, and the structure is not intended or offered for sale. El I, as owner Of the property, am exclusively contracting with 3. a licensed contractors to construct the project, ❑ 1 am exempt tinder Sec. , B&PC for this reason Total Valuation Date Owner WORKERS' COMPENSATION DECLARATION Encroachment Permitqulrad ❑ Yes ❑ No 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„.,^ rs� .jy r� Policy No LLL/`��(n ny f -Al Grading Pmt. Required ❑ Ves ❑ No Grading Pmt. NO. a certified copy is hereby furnished. r r Certif' copy is filed with A. C Rough Grading Approved by: Date Date � 'ppli cant - CERTIFICATEO ) MPTION FROM WORKERS'COMP NSATIONI NCE (This section need not be completed if perm for $100 or I.W. I certify that in the performance of the work for which this permit is PERMIT FEE issued, I s all t employ any person in a annex so as to become subject to he kers' Compansa ' s alitr ia. Dat Applicant NOTI CPT�APPLI CANT: If, after NOTIC T APPLICANT: It, after makin s Certificate of Ex em lotion, you should become subject to thrkeri Compensation provisions of the Labor Code, you must fort with comply with such provisions or this permit shall be deemed revoked. Structural $ Plan C eck $ Electrical $ Special Invest. $ plumbing $ I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. I AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS Mechanical $ RELATING TO BUILDING CONSTRUCTION, AND HEREBY AUTH- ORIZE REPRE N IVES OF THIS COUNTY TO ENTER UPON THE ABOVE TIONED PROPERTY FOR INSPINSP T POSES Sign Applic Agent to Inspection $ In pectio Pre -Grade $ Rec. No. Permit $ Issue All spaces within this box toast be completed to process Plan Check By: Issuance Approvetl: CMF 0335-46 (BU -28) rev. 6/80 • 019C/ Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. CITY OFCO VA MESA FPEWIT UO. TRACT NO. LOT NO. B . N - GO&TRUCTION PERMIT 3 /� / TYPE OF CONSTRUCTION El NEW ID ADD ❑ALTERATION ❑,REPAIR ❑ CONVERSION ❑DEMOLISH 4319 4/07/82 44.00 • Project Address (,Lt`P OWner Phone Address. 3 �r ❑ OTHER ZONING REGULATIONS Arch/Eng. License No. DESCRIPTION OF WORK A P # Address 3 �- 7VPE OF PERMIT " - ❑GRADING ❑ FOUNDATION ❑STRUCTURAL - ❑ TENANT ❑ ELECTRICAL ❑PLUMBING ❑MECHANICA ZONE 'SETBACK LST. I YARD PLNG. REF. 7f . Tp BL1I l.DING PROPERTY LINE - Contractor Q- Phdn Address - Obn_ (� LICENSED CONTRACTO DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (com- f SIDE yq RIGHT mencing with section- 7000)- of Division 3 of the. Business and ❑'OTHER- Professlons Code t land y license is In full force a tl e fact. cn{j�� PROJECT DESCRIPTION' REAR YARD (TO P/L) - - - _ Licensf�la�j ` lice e f L�.rlaL - SQ. FT. - - PKG.SPACEREQ. - PROVIDED - Dale Signatur WORKERS' COMPENSATION DECLARATION OCCUPANCY_ CONSTRUCTION TYPE STREET WIDTH PARK FEE $ - I hereby affirm that I have a certificate of Consent to self -Insure orayq LUATION ZONE ZONING APPROVED BY DATE - certificate of Workers' Compensation Insurance, or a certified copy ' thereof (Section 3800, Lab. C.). GRADING CU. YDS. ACRES SPECIAL CONDITIONS: 'Cy NO. Company' _ertllled copy Is hereby furnished. _ REMARKS: - L -I Certified copy is filed with the city Building Division. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION / (This section need not be completed if the permit is for one hundred- `-- S$300I _ certify that In the perfor man Ce of the work for which this permit is PLUMBING _ ' - PLAN CHECK' - - - - — (ELECTRICAL - PLAN -CHECK - - issuetl, 1 shall not employ any person a manlier so as to became subject t_ B War ars'-Co mpensatlo f Calif r BATHTUBS SHOWERS a --UAHAUL - Date Signature �ln� NOTICE: If after making this tleclaralion, you shoultl b oma subject -TOILETS URINALS -- - - 'GENERATOR- 0-1 KW_ 1-10 KW to the Workers' CO mpansation provisions Of the Labor Cotle, you must TRANSFORMER .forthwith comply with such provisions or this permit shall be deemetl LAVATORIES DOUBLE LAVS - (� APPLIANCE 10-50 KW_50+KW revoked. KIT. SINKS - - -DISHWASHERS-- - Q MOTORS -0-1 HP_1-10 HP CONSTRUCTION LENDING AGENCY - I hereby affirm that there is a construction lending agency for the per. SERVICE SINKS SUMPS -- -• - -- - - ,(INC. SOLAR) 10-50 HP 50 + HP' formance of the work for which this permit is issued (Section 3097 - , - :Civ. C.). - - -- - - - Lender's Name - FLOOR SINKS - FLOOR DRAINS -- FIXTURES OUTLETS -SWITCHES-- --- Lender's Address - - DRINKING FOUNTAINS- - GAS TUBE SIGNS - - - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for INTERCEPTORS - CLARIFIERS -- POLE LIGHTS - the following reason (Section 7031.5 Business and Professions Code: -SWIMMINGPOOL - PTRAP - ' - ' Any city or county which requires a permit to construct, alter, POLES METERED SUB - Improve, demolish or repair any structure, prior to its issuance, also re- WATER SERVICE ' ALTERATION PANELS MAIN -SUB quires the apllicant for such permit to file a signed statement that he is licensedpursuant-tothe provisions of the Contractor's License Law -GAS SERVICE- - OUTLETS - ' SERV ICE - AMP ' (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and -Professions Code) or that he Is exempt therefrom antl-the WATER HEATERS- - BTU OUTPUT - - - - - - -`g7'es for the alleged exemption. Any violation of Section 7031.5 by SEWER CONNECTIONS - +- -- - -. applicant for a permit subjects the applicant to a civil penalty :hot more more than five hundred dollars (§500). ` SOLAR TANK COLLECTORS. - - -- - - - - - 0'1, 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 7 04 4, Business antl Prof ass i o n5 Code: The SOLAR PIPING SYS. ISSUE FEE - - - - Contractor's License Law does not apply to an owner of a property - ISSUE FEE _ - -- _ - - - APPLICATION -APPROVED BY- - DATE who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not - MECHANICAL PLAN CHECK - - SUMMARY OF FEES - Intended or offered for sale. If, however, the building or Improvement Is sold within one year of completion, the owner will have the burden of proving he did not build or Improve for the purpose of sale).' HEATING SYSTEM 0-100,000 BTU BUILDING PERMIT ❑ I, as.owner of the property, am exclusively contracting with AND DUCTING- _ - $ - ,SMIP $ licensed contractors to construct the project Section 7044, Business ( 100,000+BTV PLAN CHECK $ - _ PERMIT and Professions Code: The Contractor's License Law does notapply to ISSUANCE an owner of property who builds or Improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $ _$' , tracts fromsuch. projects with a contractor(s) Ilcesned pursuant to SYSTEM- - _- -100,000+BTU -_ GRADING $ the Contractor's License Law). -PLAN CHECK $,. ❑ I amexemptunder Section� B. & P. C. for this - r -• r § �ea ,on BOILERS BTU - - -- - SYSTEM REPAIR, t ELECTRICAL $ PLAN CHECK $ MICROFILM $ '$ Date Owner ALTERATION EXHAUST SYSTEM MULTIPLE MECHANICAL $' TOTAL FEE LESS AD - I hereby certify that I have read this application and slate that the above information is correct. 1 agree t0 comply with all city and county PLAN CHECK § VANCE PC $ - ortlinatnta and state laws relating to construction, and hereby authorize _ representatives thi y to enter upon the above mentioned l property f i eG or SeS. 4/4, Signature Date ISSUE FEE FINAL FEE § Diivers' License or SS gr \ CMF 0865-46 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor TU CONSTRUCTION AND tPLANNING �1 "o pZ %� APPROVALS Permit # •. Date Inspector POOL & SPA J ^i <--- Date - Inspector APPROVALS Permit # 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location - 2. SoilPipe-Undrgrn _ 44. Steel Reinforcement -- - - - - 3. Electrical Conduit Utility-Undrgrn 45. Forms 4. Electrical Conduit-Undrgrn 46. .Electrical Bonding.. - - - - - 5_._S_te_e1 Reintorce. 47. Rough Plumbing & Pressure Test 6. Electrical UFER Grn- _ 48. APPROVAL TO COVER--GUNITE - -- - - - - - 7. Footings 49. Electrical Conduit-Undr rn 8. Foundation _ 50. Gas Pipe, ❑ Undr rn, Test 9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra -0' ndr rn' - 10. Structural Floor System 52. APPROVAL TO DECK - - 11. Property Sewer Line & House Connection - 53. Backwash & Receptor -Final 12. Street Sewer Connection - - 54. Heater & Vent -Final 13. Rough Plumbing -? yz 14. Rough Electric -Conduit 56. Electrical -Final 15. Rough Electric -Wiring --'- • - 57. -Solar System -Final 16. Rough Heating & Air Conditioning - • Fencing & Access Approval 17. Ducts, in Structure 59. APPROVED FOR PLASTERING 18. - 19. 20. Ducts, Ventilating- Gas Pipe -Rough &Test Roof Framing - 60. POOL/SPA SYSTEMS FINAL ` 21. 22. Roof Sheathing Frame and Flashing - . NOTES: - 23. Insulation 24. Lathing & Siding 25. Drywall Nailing - 26. Plaster Brown Coat 27. Electrical Power Meter -Final- - 28. Final.Electric - - - 29. Final Heating & Air Conditioning 30. Final Gas Pipe -Test a1 - 31. Final Plumbing ' 32. Water Service -Final - - 33. Gas Service -Final 34. Solar Domestic -Final 35. Landscape Sprinkling System 36. Sound Attenuation - 37. Handicap Regulations- - - 38. FINAL STRUCTURE & BUILDING _ 39. Special Requirements Completed _ 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. - 42. CERTIFICATE OF OCCUPANCY No Date - - o '�q7g -�9- 80 R & R Concepts 234 E. 17th Street, St. 205 Costa Mesa, Ca. (714) 548-1181 March 1, 1982 Mr. Vic Newton Director of Building Division 77 Fair Drive��,�'� Costa Mesa, Ca. 92626' R Dear Sir: This is to advise you that R & R Concepts is the legal owner of the plans and specifications for the condominium project at 229 and 233 16-th Place, Costa Mesa, and that we authorise Barbara Gothard and Dick Miles, the owners of said project, to use said plans for the purpose of construction. Respectfully submitted, Owner, R & J i - A"au„.a na-m'nll in all svaces within heavy border lines and sign all appropriate declarations. CITY Oii COSTA MESA PERMIT O. ' '1 . r TRAC ANO. LOT NO. BLDG. NO. CONSTRUCTION PERMIT 'APPLIANCE 7e (�-] I Project Address Se(�tif�j80QQ1�P`f...Co mpany [jdhNS• Co•GRADING licy No. WW LL /! ��/! �/certified r _ T�Y�p/PEF CONSTRUCTION - Owner s Phon , - NEW C1 ADD El ALTERATION Adss Q dre �.f/ Q C El REPAIR ❑ CONVERSION' ❑DEMOLISH rCh ng. - C J License No. - ❑OTHER A P i. I„ __ - — _ _ _ - . DESCRIPTION OF WORK wmracrorL-Oj D N OCT O rnon Y!" 7 - TYPE OF PERMIT 10 Address/4(Q -$ Q EI -GRADING ❑ FOUNDATION deTRUCTURAL LICENSED -CONTRACTOR DECLARATION - ❑ TENANT ❑ ELECTRICAL ❑PLUMBING ❑MECHANICA 1 hereby affirm that, I am licensed under provisions of Charter 9 (Com- ' \, men ting with section -7000) of Division- 3 of the Business and ❑ OTHER - - - Professions Code, d y license is in I ford - �( LicenW Class nse o. PROJECT DESCRIPTION - - - FT -GAY T13�•� '� y through -his own- employees,.provided thatsuch. improvementsare not intended or offered for sale. If, however, the building or improvement is sold within one_year.of completion, the owner will have.the burden of proving he did not build or improve for the purpose of sale). 1_11, -as owner of the property, am-' exclusively' contracting with licensed contractors 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 con- tracts from Such projects with 'a contractor(s) licesned pursuant to the Contractor's License Law). ❑ I am exempt—wing, Section - - B. & P. C. for this reason - - - Date-- Owner - - I hereby certify that., have read this application and state that the above information is correct. I a9r a to co ply with all City and county ordinances antl St a laws r ng to c yr], sit ruction, and hereby authorize 'pep Psentative5 /,1�^is pto a Er upon the above mentioned . erty for p o r se 3 q- 9"L Signature Date) L D MECHANICAL Date. �..Z SQ.W. -I?YPE '1 . r WORKERS' COMPENSATION DEC RATION - - -OCCUPANCY CO NSTR VCTION TYPE 'APPLIANCE 1 hereby affirm that 1 have a certificate of consent to self -insure or a certificate of Workers' Compensation Inss(urance, or a certified copy VALV ATION ZONE TU I 0-100,000 BTU— Se(�tif�j80QQ1�P`f...Co mpany [jdhNS• Co•GRADING licy No. WW LL /! ��/! �/certified CU. YDS. ACRES (INC.SOLAR) - -10-50 kthe,eof' copy is hereby furnished. - - Mertified copy is filed with the city Building Division. '- REMARKS: BTU SYSTEM REPAIR, ALTERATION . EMPTION FROM WORKERS' COMPENSATION DECLARATION - EXHAUST SYSTEM (This section need not be completed if the permit is for one hundred .POLE LIGHTS- --- -" 1$100) or less). I certify that in -the performance of the.work.for which this p.Cmit 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 -'-- -- SMIP $ _ - PLUMBING - PLAN CHECK -_ BATHTUBS SHOWERS TOILETS 'URINALS ' - - - NOTICE: If after making this declaration, you should become subject ISSUANCE $' - to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAYS revoked. - CONSTRUCTION LENDING AGENCY KIT. SINKS DISHWASHERS 1- - SERVICE SINKS - • SUMPS ` N I hereby affirm that there is a construction lending agency for the per. formance of the work for which -this permit is issued (Section 9097 FLOOR_ SINKS FLOOR ELECTRICAL Civ.-C.). - - Lender's Name $ �$ - Lender's,Addre,ss• f OWNER BUILDEWDECLARATION - - a• Ihereby affirm that l am exempt -,from the -Contractor's License -Law for the following reason (Section' 70311.5-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 re- quires the ap: licant for such permit to file a signed statement that he is licensed-pursuantto .the provisions of the Contractor's License Law (Chapter, -9. (commencing with --Section ,7000): oOiDivisjon.3 of the, Business and P,04essions Code) t or-thatie is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by -DRAINS _ DRINKING FOUNTAINS': -- - - '— - INTERCEPTORS ,CLARIFIERS SWIMMING POOL PTRAP"-- - WATER SERVICE - ALTERATION _Gq5 SERVICE ' .-OUTLETS WATER HEATERS BTU OUTPUT SEWER CONNECTIONS TOTAL FEE $ a-- applicant for a'permit-subjects the applicant'to a civil penalty it more than five hundred dollars ($500). _ _ SOLAR TANK COLLECTORS LESS AD- as owner of the property, or my employees with wages as their $ - - - ., eu•c-Com pensation, will.do the .work, and the structure is not intendetl or offered for sale. (Section 7044, Business and Professions Code; The SOLAR PIPING SVS. 7 .. Contractor's License Law does.not apply -to an owner- of a property- ISSUE FEE who builds or improves thereon, and who does such work himself or through -his own- employees,.provided thatsuch. improvementsare not intended or offered for sale. If, however, the building or improvement is sold within one_year.of completion, the owner will have.the burden of proving he did not build or improve for the purpose of sale). 1_11, -as owner of the property, am-' exclusively' contracting with licensed contractors 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 con- tracts from Such projects with 'a contractor(s) licesned pursuant to the Contractor's License Law). ❑ I am exempt—wing, Section - - B. & P. C. for this reason - - - Date-- Owner - - I hereby certify that., have read this application and state that the above information is correct. I a9r a to co ply with all City and county ordinances antl St a laws r ng to c yr], sit ruction, and hereby authorize 'pep Psentative5 /,1�^is pto a Er upon the above mentioned . erty for p o r se 3 q- 9"L Signature Date) L D MECHANICAL PLAN CHECK HEATING SYSTEM 0-100,000 BTU AND DUCTING - AMP" 'APPLIANCE 100,000+BTU t REFRIGERATION TU I 0-100,000 BTU— SYSTEM'- - SYSTEM 100,000;+ BTU (INC.SOLAR) - -10-50 I BOILERS BTU SYSTEM REPAIR, ALTERATION . SWITCHES- -- GAS TUBE SIGNS EXHAUST SYSTEM MULTIPLE Drivers' L' SS - ISSUE FEE -- - - CMF 0865-46 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor REAR YARD (TO PKG.SPACE REQ. STREET WIDTH 3386 3/17/82 SPECIAL CONDITIONS: ELECTRICAL REF. PROVIDED Z^;'^ v PARK•FEE$ TIN w,w1$ TE 3 rrt� REQMEMM PLAN CHECK � I � I � I i GENERATOR 0-1 KW_ 1-30'KW _ ,TRANSFORMER '- - AMP" 'APPLIANCE 3050 KW_50 + KW MOTORS 0-1 HP —'- HP - (INC.SOLAR) - -10-50 HP=' 50--HP—�-' -- --- FIXTURES`- OUTLETS- SWITCHES- -- GAS TUBE SIGNS - - -- - DATE'3' .POLE LIGHTS- --- -" -" -- - PANELS MAIN SUB 'SERVICE '- - AMP" ISSUE FEE- ' APPLICATION -APPROVED By&j - - -- - DATE'3' SUMMARY OF FEES ,BUILDING . PERMIT $ r. - -'-- -- SMIP $ 'PLAN CHECK S PERMIT' �t - - - - -- ISSUANCE $' - PLUMBING $ - GRADING . PLAN CHECK $' ELECTRICAL $ $ �$ - MICROFILM PLAN CHECK $ - MECHANICAL $ TOTAL FEE $ LESS AD- 'PL'AN CHECK $ - - - ., VANCEPC $_ r .. FINAL FEE $ / E CONSTRUCTION AND PLANNING APPROVALS Permit z# Date Inspector `- POOL & SPA - ��'- Date-.- Inspectors APPROVALS I Permit 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location - - - '- - - _ 2. Soil Pipe-Undrgrn 44. Steel Reinforcement -- - �'- - - - - -- - 3. Electrical Conduit Utility-Undrgrn 45. Forms - - - 4. Electrical Conduit-Undrgrn _ 46. Electrical Bonding - - 5. Steel ein orce 47. Rough Plumbing & Pressure Test - 6. Electrical LIFER Grn 48. APPROVAL TO COVER-GUNITE 7. Footings 49. Electrical Conduit-Undr rn • 8., _Foundation- _ _ _ _ j $ 50.. Gas Pipe, .❑ Undr rn,-Test 9.. -Water Pipe-Undrgrn 51. Backwash Lines P -Trap.'❑ n r rr' r - 10. Structural'Floor System 52. APPROVAL TO DECK 11.. Property Sewer I,ine,& House Connection _ 53. . -Backwash & Receptor -Final _ 12. Street Sewer Connection54. - - -- Heater & Vent -Final - - 13. Rough Plumbing - -- - - -'-'' ' -' -`-' - •' 14. 56- - Electrical -Final -- 15. Rough Electric -Wiring - -- - --- -• - • - -- 57,. - Solar System -Final 16.- --Rough Heating & Air Conditioning - -.. .. encing,& Access Approval 17. Ducts, in Structure 59. APPROVED FOR PLASTERING --18. Ducts, Ventilating. 60. - POOL/SPA SYSTEMS FINAL 19. Gas Pipe -Rough & Test _ 20. .Roof Framing 21. Roof Sheathing NOTES: S .22. Frame and Flashing . 23. Insulation-' - - 't`c+,.. - +. �!a-s3t• 24. Lathing & Siding - ,2H 25. Drywall Nailing 06 26. Plaster Brown Coat 27. Electrical Power Meter -Final ;- - 28. Final Electric S - 29. Final Heating & Air Conditioning . 30.. Final Gas Pipe -Test .31. Final Plumbing 32. Water Service -Final-._ 33. -'Gas Service -Final - 34. Solar Domestic -Final 35. Landscape Sprinkling System - 36. Sound Attenuation - 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING 39. Special.Requirements Completed ♦'j - - ` -- - 40. Electric Release to Edison - - - - 41. Gas Release to Southern California Gas Co. - 42. CERTIFICATE OF OCCUPANCY- • No. Date - _ �i COSTA MESA BUILDING -SAFETY DEPARTMENT APPLICATION FOR STRUCTURAL PERMIT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only R EIVE BV PERMIT J� ° 515 3 2 BUILDING "'f, / �II/'r- ADDRESS q!% [_/�f� A.P. NO. ZZ 7 - OWNER OR TENANT BUILDING ADDRESS UNIT N SPACE NO. MAILING //� /�//// /nG ADDRESS `7 (�//J li ��ff�� TR.NO. LOT BLK. TEL. CITY NO. NEW ADD ALTER REPAIR MOVING DEMOLISH CONSTRUCTION LENDER BRANCH OW R ADDRESS VALUE S ARCHITECT TEL. OR ENGINEER 0. ZONE TYPE GROUP ADDRESS CONTRACTOR —7� APPROVE ? BV DATE ADDRESS `SCJ TEL. CITY / NO. 77j l CITY STATE §777117 LIC. NO. / / LIC. NO. APPROVED SETBACKS SIZE OF LOT No. OF BLDGS. I NOW ON LOT (FROM C/L STREET) PONT FT. USE OF EXISTING BLDG. Separate permits are required for electric, plumbing and heating work. L. SIDE FT. REAR FT. USE OF ILDING AND WORK TO BE PERFORMED r PLANNING ACTION PATE APPROVED APPROVED r I hereby acknowledge that I have read this application and state that the above information is correct and agree to comply with all laws regulating building construction, and I shall not employ any person in violation of the workman's compensation laws of the State of California. I hereby certify that I am properly H sed as a contractor under the State of California Business Professions Code, Division 3, Chapter 9, and that such lice s are In full force and effect, or 1 am exempt from the provl ' s of the State of California Business and Professions Code, 3, Chapter 9. Signature o Perm itte I ' SO. FT. THE AMOUNT SHOWN UNDER VALUATION IS FOR THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION S PERMIT FEE $ O PLAN CHECK $ TAX S or Authorized gent Data TOTAL PAID E .00 TU C. COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 411- 2/81 196.68 TL'APPLICATION FR STORL PERMIT e / i A _/ _i RECEIVED PERMIT 5-12-2-2— 222— For Applicant to Fill in Completely - Use Ink Only BUILDING, BUILDING 3� //T•/t! Lip..0 ADDRESS J b /L^7 C!-• A.P. NO. R EOms�} BUILDING ADDRESS X233 /G�pa TENANT �ry'LQ//� G 22 , /G.LI MAILINADDRESS35( L�Qa UNIT SPACE NO 4 ,( T . LOT BLK. /�/J �J( CITY [(f�/L/ C NOL(f}'C'8[.J NEW ADD ALTER IREPAIR IMOVING DEMOLISH CONSTRUCnON LENDER BRANCH KA .jj ,t� OWNER �� ADDRESS VALUE USE $ ARCHITECT Pr /�Q C� TEL R. fl8l (' 1, OR EN INEER4 c � ' LOS ADDRESS L/J � )6, � �I C•%Y%- �. ZONE TYPE � GROUP APPROVED I 2 CONTRACTOR BY ADDRESS `` /DATE TEL g. B CITY • NO(p STATE ./ CITV LIC. NO. /'I LIC. NO.��I/7J 3 APPROVED SETBACKS •O/ d N SIZE% n OF LOT/ 37 S NOW ON LO L (FROM E3) / FRONT USE OF / cQ EXISTING SLOG:lgi�_`j'• �s Separate permits are required for L sl T. electric, plumbing and heating work. REAR T. USE OF BUILDING AND WORK TO BE PERFORMED PLANKING ACTION t/—'ON O O A/ DATE ROVE _,.?3 V .. ) APPROVDATE 1 hereby acknowledge that I have read this application and stet@ �l • /3520 that the above Information Is correct and agr to comply with all laws regulating building constr c shall not employ 430- any person in violation of the n's ompensation laws of the State of CeI:f.rn HOLD yQszl/ FO� DS REQUIREm` r-rr I hereby certify that I am r Iicanse tractor under . "C3" the Stateof California B ass and essio p sion 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that su licenses a e in f once and affect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of ata of California Business and Professions Code, D Ion 3, Chapter 9. VALUATION PERMIT FEE E Slgnaiure of `/sem/s / PLAN CHECK $ O Permittee S J G.. / {p TAX E 3 8 or �• O Authorized Agent Date TOTAL PAID E e / i A _/ _i I COSTA MESA toll-OALSAFETY DEPARTMENT 0.'0. BOX 1100 Costa Mesa, California 57G5 5111/82 13 19:011 'TL r r , I I I Contractor � c- TRACT N0. LOT NO. gEC'D BY PERMIT NO. Address f St BUILDING USE DATE ISSUED City Zip Code 92_K 0 6 State License No 3 y �L % Class. C 2_0 BU= iA ADDRESS z 3 City License No. Tel. No. �O 1913 NO. ITEM EACH FEES COSTA MESA, CALIFORNIA � �, •- FAU, Wall, or Gray. Furn. Incl. Ducts and Vents ''//� T 00 NEAREST A/ CROSS ST. �^.�` OWNER Q Mr �.�+ to 100,000 BTU over 100,000 BTU MAIL '-�.� J�s.O ADDRESS 3,% ,f !/ .�L.r UO - J 7T CITY /1/ `/ TEL. N0. 6 L / Jy� 'v 7J Vent (if not incl. above) r 1 hereby acknowledge that I have read this application end1stete: [hat the above is correct and agree to comply _4i'th all City Ordinances and State Laws regulating Heat - ling; Ventilating, Refrigeration and Air -Conditioning. I certify that I possess the above valid State of Calif - orria classification or I am the legal owner of the single family residential property described above. Signature of ertnit[ee Suspended Heater Alter or Replace Appliance ver 1 feet o gas piping it BOILERS OR COMPRESSORS 3 H.P. or less •� ;Y" Over 3 H.P. to 75 H.P. .S __j- I�OO Vent Fan—Sin Ie,Dact k4t REMARKS:Ventilatinq�Hood \� [ F/ �3ro7 APPROVALS INSPECTOR DATE Ducts Underground Ducts in Structure Ducts Ventilating Heating — Rough Hoods Refrigeration Lines Pressure Test Sub -Total DD Air-Cond. Final Reinspection Fee Ventilating Final —.2 1 Heating Final Processing Fee 3 % 3 p� Refrigeration Final Final Gas Test TOTAL FEES mD Utility Co. Notified Q 1 CMF 0449-46 r BLDG. PERMIT NO. _t� -45'oZ�%l 9 a 3 COSTA MESA BUILDING -SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 REC For Applicant to Fill in Completely — Use Ink Only PERMIT '2— .BUILDING ADDRESSGE J ///�/ 15 A.P. NO. //7—/,5/—/2J2 A L�JJ ///f[,1 / LI+ &A CE $�H , TENANTOWNER �J�(�/•.'-C '�^' ✓1/ "� G�� ADDRESS— G� J (rJ " \. MAILING // ADDRESS3� Q CIS© UNTTOR SPACE NO LOT BLK. NOG//` (JGJ� CITY /,,[,z� O2% ��zzt r-�7 L NEW ADD ALTER IREPAIR IMOVINGIDEMOLISH CONSTRUCTION LENDER BRANCH XLJU1V[f/ OWNER ADDRESSa VALUE ELS &-llg> ARCHITECT /f� 60 USE $ �( OR ENGINEER Y 1'I/ y) /� /)/) / 23 ���I' 2 5 je ADDRESS tom+/'/. ZONE TYPE GROUP jr r �� CONTRACTOR �J(fj/l/ L APPROVED BY DATE ADDRESS (456a TEL f CITYr 1 NO II STATE CITY LIC. NO. LIC. Nqj;"7 APPROVED SETBACKS / /J r NO. OF BLDG$ s7 (FRO T SesSIZE OFLOT NOWONLOT G RONiM USE OF C� EXISTING BLDG. /C f Separate permits are required for L. SIDE FT. electric, plumbing and heating work: l R E A FT. USE OF BUILDING AND BE PERFORMED PLANNING ACTION `WORK )TO co DATE w'00 — APPROVE RV I hereby acknowledge that I have read this application and state Z / G that the above information is correct and a o comply with ( ✓,52 //// all laws regulating building constructio tl I shall not employ any person In violation of the w mpensation laws of the State of California. "OLID FOR rqEa I hereby certify that I a Ilcensetl sac actor under SQ. the State of California Bus! ss and Professi ode, Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such censes are in f rce and effect, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from She pro Isionz of the St of California Business and Professions Code, Ion 3, Chapter VALUATION PERMIT FEE E p 17 Signature of_ PLAN CHECK $ Permittee $/1�/�.+ TAX E gj or Authorized Agent Date 7�i TOTAL PAID $ City of Costa Mesa Building Safety Department P.O. Box 1200 Costa Mesa, California CERTIFICATE OF OCCUPANCY ! 3566 The Building located at 2,41. — 1(f -h has been inspected and found to comply for a Group—L-1 M 11-1-1 Occupancy. i ith the provisions of all City of Costa Mesa Ordinances applicable thereto Use of Building 11rlrr1n [ritA ati'achr->{7 craraap Legal Description A_P.t:11.7-1.51-12 (See reverse side for Metes and Bounds) Building Permit No 51922--- Electrical Permit No. dA6;44 Plumbing Permit No. vooro Number of apartments —n— and/or guest rooms —n— ISSUED TO: Building Offici- al — �n .id313APA Y+ JME Victor C. Newton—Director Building Divisic 7 Date Oct6 er 20. 1981 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. 306 lel U.B.C. Form 6U 34 Rev. 11170 (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.cIBU►ILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 233 16TH PL Suite: B Vicinity: NEWPORT HEIGHTS BLDG B Primary Occ: R-3 Dwellings/ Cong Res X10 Type of Construction: V -N Parcel Number: TPNO0593 Zoning: Applicant: RODGERS, MIKE Address: 2626 NEWPORT BL SMIP Res: COSTA MESA, CA Owner: NEWPORT HEIGHTS HOA Address 233 16TH PL Inspection: COSTA MESA, CA Contractor: PETRONELLA ROOFING Address: 2626 NEWPORT BL COSTA MESA, CA Zip: 92627 Arch : Address: Phone: Phone: (949)548-1645 Zip: 92627 Phone: Zip: 92627 Phone: (949) 548-1645 License: 460707 Eng: Address: ISSUED BY: Status: ISSUED Applied: 10/20/2005 Issued: 10/20/2005 Phone: Zip: License: License: SCOPE OF PERMIT REROOF CONDO BLDG B: T/O EXISTING WOOD SHAKE, REPAIRIREPLACE SHTG AS NEEDED, 2 LAYERS 30# FELT, APPLY "CLASS B MEDIUM SHAKE." 9SQUARES FEE SUMMARY Plan Check: $0.00 Permit: $97.25 SMIP Res: $0.50 SMIP Com: $0.00 Other:, $0.00 Inspection: $0.00 Total: $97.75 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existing: 0 Calc Valuation: $3,200.00 Claim Valuation: $3,200.00 Rear 0-0 Left 0-0 Right 0-0 Rear 0-0 Left 0-0 Right 0-0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754.5626 eases l6100l DECLARATIONS 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 performance of the work for which this permit is Issued. SI 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. Camey workers'`omppnsatlon Insurer a carrier and policy number are: —S + � 'POIICy Number. �C) i S7R' — 6 G l(Thls section need not be completed lY the permit Is valued at one hundred dollars ($100) or less.) L-� ❑ 1 certify that in the performance of the work for which this pennit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these pro�vis7ions. ApplicanUSIgnatu�"6! k2Ld�T/ [Datat ll�l o/O to WARMING.`FAILURE TO SECURE WORKERS' COMPENSATI l OVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER'TO CRIMINAL PENALTI SAND CIVIL FlNES UP TO ONE HUNDRED LLARE(SIODOOOI, IN ADDITION TO THE COS OF THOUSAND DOCOMPENSATION, DAMAGES AS PROVIDED FOR IN SECTIONs706OF THE LABOR CODE. INTEREST, ANDATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Sectio 7000) of Division 3 of the Business and Professions Code, and my license is In full force anQ.effect_Liq O CI" (r �c% CcntracWa-SIgnat6re:_ Date: G 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 Cade). 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 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. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or Improve for purpose of sale.). ' ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by 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, Tulle 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 hes a permit to do such work from the division. 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 Cade 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 Doee or will the applicant or present or future building occupant require for the work which is the subfecI of Iris .application a ermit for such construction Or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes INC (Section 65850.2 of the Califomia Government Code requires that the requested Information be furnished on applications for non-residential building pernits). ...................................................................................................................................................................................................................................................................................................................-........................... .......................................... 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). W.W. 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 ............................... ......... ..................................... .............. .................................... ........... ............................. ....... .................. _......................................... ........................................................................................... _.__.......................... _................ B (It "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 slate 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 Of Legal Owner(s) D to AndhO,,# ttwdzed-AppfCr :X Pat CODE 0. INSPECTIONTYPE p jF INTMAL$ CODE INSPECTION TYPE p gNTITIA 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing 200 Final Re-RoofS-/S - -e 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Building/Occupancy Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA PER T NO. TRACT NO. LOT NO. BLD . NO. CONSTRUCTION PERMIT OF CONSTRUCTION ❑ NEW ❑ ADD ❑ ALTERATION ❑ REPAIR ❑ CONVERSION ❑DEMOLISH ❑ OTHER ' 4349 4I08I82 23a50 ZONING REGULATIONS Project AddressTYPE Owner Phone Address Arch/Eng. License No. DESCRIPTION OF WORK YPE OF PERMIT ❑GRADING ❑ FOUNDATION ❑STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑PLUMBING ❑MECHANICA A.P. $ ZONE SBUILDING ETBACK C ST. SLID V K C PLNTG.. gRtE�F. p$ PRfJ PE1RTVNlGINE - Address Contractor Phone Addrizs LICENSED C TRACT DE LARAT I hereby affirm that I am licensed Under visions of Charter 9 (com- g IEpE YARD RIGHT mencing with section 7000) of Ol707. 3 of a Business and ❑ OTHER Professions Cote, an m iicen5etui f r REAR YARD ITO P/L) PROJECT DESCRIPTION License sce se , _ FT. ' PKG. SPACE REQ. PROVIDED - Date Signature SQ. STREET WIDTH PARK FEE E WORKE S' COMPENSATION DECLARATION OCCUPANCY_ CONSTRUCTION TYPE I hereby affirm that I have a certificate O/ consent II -Insure Ora ,VALUATION ZONE ZONING APPROVED BY DATE certificate of- Workers' Compensation Insure rico, a certified copy _ thereof (Section 3800, Lab. C.). GRADING CU. YDS. ACRES SPECIAL CONDITIONS: policy No. Company REMARKS: f - r' 'ertified copy is hereby furnished. ertified copy is filed with the CITY Building Division. _c MPTION FROM WORKERS' COMPENSATION DECLARATION _ (This section need not be completed If the per is for ne hundred ($100) or less). _ - - - I certify that In ilio performan<¢ Of the -0 /to /o w c�`yll�h 5 p Issued, I shall not employ any person innn s01 pSt PLUMBING PLAN CHECK ELECTRICAL - PLAN CHECK subject t�Compenzatlpn Laws f I n7a / / / BATHTUBS SHOWERS �' '0 Date gnature NOTICE: If after making this decleration, you should becci ub bt TOILETS URINALS - - - - GENERATOR - 0-1 KW_ 1.10 KW to the Workers' Compensation provltion5 of the Labor COtlO u must TRANSFORMER forthwith comply with Such provisions Or this permit Shall a oeemetl LAVATORIES DOUBLE LAVS APPLIANCE - 10-50 KW_50+KW revoked. KIT. SINKS- DISHWASHERS - -MOTORS - 0-1 HP -1-10 HP CONSTRUCTION LENDING AGENCY 'I hereby affirm that there IS a construction lending agency for the per. SERVICE SINKS SUMPS - (INC. SOLAR) 10-50 HP_ 50 + HP formance of the work for which this permit Is Issued (Section 3097 FLOOR SINKS - FLOOR DRAINS - FIXTURES OUTLETS SWITCHES Civ. C.). - - Lender's Name Lender's Address DRINKING FOUNTAINS - - GAS TUBE SIGNS - 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 Professions Code: INTERCEPTORS CLARIFIERS - POLE LIGHTS - SWIMMING POOL P TRAP -- POLES - METERED SUB Any city or county which requires a permit to construct, alter, WATER SERVICEALTERATION PANELS MAIN - SUB improve, demolish or repair any-str Ucture, prior to Its Issuance, also re. quires the ap4lirant for such permit to file a signed Statement that he GAS SERVICE OUTLETS ''SERVICE' AMP Is licensed pursuant to the provisions of the Contractor's License Law 2(Chapter 9 (commencing with Section 7000) of Division 3 of the WATER HEATERS BTU OUTPUT - - - usmess and Professions Code) or trial he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by SEWER CONNECTIONS - .I- - -_ av applicant for a permit Subjects the applicant to a civil penalty jet more than five hundred dollars ($500). SOLAR TANK -COLLECTORS - - -- - �i asownerof the property, or my employees with wages as their 5c"compensation, will do the work, and the structure is not intended I or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. I - ISSUE FEE - Contractor's License Law does not apply to an owner of a property ISSUE FEE - '- APPLICATION APPROVED BY _ _ _ DATE - -who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not MECHANICAL PLAN CHECK - - SUMMARY OF FEES ' intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the Owner will have the burden of proving he did not build or improve for the purpose of sale). HEATING SYSTEM 0-100,00D BTU BUILDING El 1, .az .owner ol_the property, am exclusively contracting with AND DUCTING - _ PERMIT E SMTP E licensed contractors to construct the project (Section 7044, Business 100,000 + BTU PLAN CHECK E PERMIT and Professions Code: The Contractor's License Law does not apply to - _ISSUANCE E an owner of property who builds Or improves thereon, and who con- REFRIGERATION 0-100,000 BTU ,PLUMBING E tracts. from such projects with a contractor(s) licesned pursuant to SYSTEM - E the Contractor's License Law). 100,000 + BTU PLAN CHECK $- _GRADING ❑ I am exempt under Section B. & P. C. for this $ BOILERS BTU ELECTRICAL $ 023- reason SYSTEM REPAIR, ALTERATION EXHAUST SYSTEM MULTIPLE PLAN CHECK $ MECHANICAL $TOTAL MICROFILM$ FEE $ LESS AD - Date Owner I hereby certify lha I h v this application d state that the above information Is c read agr em Ith all city and county PLAN CHECK S VANCE PC $- ordinances ant st le la relat n o c can, and hereby authoriz r repr¢5¢ntatives f city I up n the aPov ention property for i p - 'J' ' Signature �/ Date - ISSUE FEE �c FINAL FEE $ J o Drivers' Licen r 55 # CMF 0865-46 White-Build)/g; Canary' -Applicant; Pink -Accounting: Goldenrod -Assessor TL CONSTRUCTION AND PLANNING APPROVALS Permit # FSIP-1-8 Date Inspector POOL & SPA: APPROVALS Permit #- Date- Inspector 1. Temporary Electrical Service or Pole _ 43. Pool & Equipment Location' ' 2. SoilPipe-Undrgrn 44. Steel Reinforcement - 3. Electrical Conduit Utility-Undrgrn 45. Forms 4. Electrical Conduit-Undrgrn A4_ I "m _C. 46. Electrical Bonding- - - - - 5. Steel ein orce 47. Rough Plumbing & Pressure Test - - 6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE- - - 7. Footings 49. Electrical Conduit-Undr rn 8. Foundation 50. Gas Pipe, ❑ Undr rn; Test 9. Water Pipe-Undrgrn 51. Backwash Lines P.Trjp -Q Undeorn 10. Structural Floor System 52. APPROVAL TO DECK --•' -' ' 11. Property Sewer Line & House Connection 53. Backwash & Receptor -Final 12. Street Sewer Connection 54. Heater & Vent -Final 13. Rough Plumbing 55- Plumbin System - Final 14. Rough Electric -Conduit 56. Electrical -Final 15. Rough Electric -Wiring _ 57. Solar System -Final 16. Rough Heating & Air Conditioning bb. Fencing & Access Approval 17. Ducts, in Structure 59. APPROVED FOR PLASTERING 18. 19. 20. Ducts, Ventilating Gas Pipe -Rough & Test Roof Framing 60. POOL/SPA SYSTEMS FINAL 21. 22. Roof Sheathing Frame and Flashing NOTES: 23. Insulation 24. Lathing & Siding 25. Drywall Nailing 26. Plaster Brown Coat 27. Electrical Power Meter -Final 28. Final Electric 29. Final Heating & Air Conditioning 30. Final Gas Pipe -Test - 31. Final Plumbing 32. -Water Service -Final 33. Gas Service -Final 34. Solar Domestic -Final 35. Landsca e Sprinkling System 36. Sound Attenuation - 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No Date _ �- Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA PERMIT NO. TRACT NO. LOT NO. BL G. NO. " CONSTRUCTION PERMIT E -�3 /�^ L TYPE OF CONSTRUCTION ❑NEW 1:1 ADD ❑ALTERATION ❑ REPAIR [] CONVERSION ,[]DEMOLISH ❑OTHER � , - - _ 4/196_ 4/12/82 13;00 - " - ZONING REGULATIONS Project Address+ Owner z Phon Address 4X41 Arch/Eng. License No.. DESCRIPTION OF WORK TYPE,OF PERMIT" "' - [] GRADING O FOUNDATION -[] STRUCTURAL- [] TENANT [] ELECTRICAL (]PLUMBING "[]MECHANICA P � - A.P. ZONE PLNG. REF. T , ' Tp g1JILDING PROPERTY LINE SET YARD T I EVA Address - - -- - -Contractor. a Pho ' Address LICENSED CONTRACTOR EC RATION 1 hereby affirm that I am licensed antler Charter 9 provisions of (com- mencing with section- 7000) of Division 3 Of the Business -and ❑ OTHER.' RIGHT Professions Co�dg, aqo my license Is In full fort REAR YARD (TO P/L) _ ' ^1� PROJECT DESCRIPTION - _ _ License C15ss J License No. SQ. FT: _ - PKG. SPACE REQ. WIDTH PROVIDED - - PARK FEE S Dale -' Signature WORKE SSATION DECLARATION OCCUPANCY_ CONSTRUCTION TYPE .STREET I hereby affirm that I have a certificate of consent to self -Insure ora VALUATION ZONE ZONING APPROVED BY' DATE certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.). GRADING CU. UOS, ACRES SPECIAL CONDITIONS: Policy No. - 'Company - - - r ':ertified copy Is hereby furnished. REMARKS: ertified copy Is filed with the city Building Division. -- - .cMPTION FROM'WORKERS' COMP SATION DECLARATION - (This section need not be completed if permit is for one hundris ' A ($100)"or less). - - - ' certify that in the parlor me rice of t 0 w rk r ch is pe Is issued, I shall not employ any pers0 In ny an e s 8 - PLUMBING PLAN CHECK - ELECTRICAL' PLAN CHECK - - - subject t rompensati0 gf Cal" or 'BATHTUBS 'SHOWERS _ _e -1 Date gnature i NOTICE: If after making this decl ration, you should, me subject TOILETS ,URINALS '- - - - GENERATOR _0-1-KW_1-10 TRANSFORMER KW to the Workers' Compensation provisions of the Labor e, you must forthwith comply with such provisions or this per Shall be deemed LAVATORIES DOUBLE LAVS -- - - APPLIANCE - 10-50 KW_ 50+ KW revoked. I 'KIT:'SINKS - ' DISHWASHERS - - - MOTORS - - 0 -1 -HP 1-10 HP - CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the per- SERVICE SINKS SUMPS' - -(INC. SOLAR)-10-50-HP= 50 + Hp formance of the work for which this permit is Issued (Section 3097 -FLOOR SINKS- FLOOR DRAINS- FIXTURES OUTLETS SWITCHES Civ. -C.). - -- - -- - - - Lender's Name Lender's Address - - DRINKING FOUNTAINS - GASTUBESIGNS •- - - - OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for INTERCEPTORS CLARIFIERS POLE -LIGHTS - the following reason (Section 7031.5 Business and Professions Coae: SWIMMING POOL P TRAP - - Any city or county which requires a permit to construct, alter, POLES METERED SUB improve, demolish or repair any structure, prior to its issuance, also re- WATER SERVICE ALTERATION PANELS MAIN SUB r' quires the ap.licant for such permit to file a signed statement that he ' is licensed -pursuant to the provisions of the Contractor's License Law -GAS SERVICE "" OUTLETS SERVICE - -- AMP - -' - (Chapter 9 (commencing with Section 7000) of Division 3 Of the WATER HEATERS ---- BTV OUTPUT "- - - - - - Business and -Professions Code) or -that he Is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by SEWER CONNECTIONS "1 •--- - - - - - - - - - - - anv-applicant-for a permit "subjects the applicant to a civil penalty. il more than five hundred dollars ($500). SOLAR TANK COLLECTORS • - - - - -- - - - -- - as owner of the property, or my employees with wages as their S, . compensation, will do the work, and the structure is not intended or offered for sale. (Section 7044, Bdsiness and Professions Code: The "SOLAR PIPING SYS. - -.r -' - ISSUE FEE - - - - Contractor's License Law does not apply to an Owner of a property _ ISSUE FEE - - `!(- - ' -' (APPLICATION APPROV ED -BY -- - DATE "- Who builds or improves -thereon, and Who does such work himself or through his 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 will have the burden MECHANICAL PLAN CHECK - SUMMARY OF,FEES of proving he didnotbuild-or Improve for the purpose of 'sale). ❑ - HEATING SYSTEM 0-100,000 BTU - BUILDING - - E - - - - - SMTP $AND I, as owner of -the property, am .exclusively contracting _with DUCTING - - -- ,PERMIT - - - licensed contractors to construct the project (Section 7044, Business 100,000+BTU PLAN CHECK $ PERMIT 't and. Professions. Code:-The.Contractor's License. Law does not apply to - - - ISSUANCE S an owner of property who build$ or Improves thereon, and who con- REFRIGERATION 0-100,000 BTU I 'PLUMBING E tracts from such projects -with -a. contractor(s) licesned .pursuant -to SYSTEM - - +_- _ . - GRADING 'E the Contractor's License Law). 100,000 + BTU 'PLAN CHECK S ❑ I am' exempt -under Section - - -8. d P. C. for this' $ , BOILERS BTU ELECTRICAL S a ' ' !eason - SYSTEM REPAIR, ---" - - PLAN CHECK $ -- MICROFILM$ Date Owner ALTERATION EXHAUST SYSTEM MULTIPLE - .MECHANICAL $ _ TOTAL FEE $ - LESS AD- D- 1 hereby certi/y lh I ave this application antl state that [he above nformion Is -c rre gre to comply with all city -and county - PLAN CHECK.: $ LANCE $ ordinances ortl ina rices and ate I v r¢ ti g to co Sir , and hereby aulhod ze representativesof1 cit 0 n -above _mentioned' ty for Signatrure FINAL FEE S/_195P Drivers' License or SS �p ISSUE FEE CMF 0865-46 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor TL CONSTRUCTION AND PLANNING 1 .: Date APPROVALS Permit'#Z.1- �`�, POO C& SPA - - - Inspector APPROVALS Permit # Date. << Inspector • 1. Temporary Electrical Service or Pole _ 43. Pool & Equipment Location - - 2. Soil Pipe-Undrgrn 44. Steel Reinforcement-- _ 3. Electrical Conduit Utility-Undrgrn 45. Forms - - 4. Electrical-Conduit-Undrgrn Ii. vi -11- 46. Electrical Bonding 5. S ' teal Reinforce 47. Rough Plumbing & PressureTesf ', -• - 6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE - ••`• ` t- - - 7. Footings 49. Electrical Conduit-Undr rn 8. Foundation. 50. Gas Pipe, ❑ Undr rn;Test+�. 9. Water Pipe-Undrgrn 51. Backwash Lines P-Tra- ❑ Uad�cirn -- 10. Structural Floor. System 52. - APPROVAL TO DECK . 11. Property Sewer Line & House Connection 53. Backwash & Receptor -Final 12. Street Sewer Connection - - - 54. Heater & Vent -Final 13. Rough Plumbing _ ' 14. Rough Electric -Conduit '- - 56. Electrical -Final 15. Rough Electric -Wiring jr,. e - 57. Solar System -Final - 16. Rough Heating & Air Conditioning - Fencing & Access Approval 17. Ducts, in Structure APPROVED FOR RLASTERING'.,. 18. 19. 20. Ducts, Ventilating Gas Pi pe -Rough &Test - - Roof Framing - - - - 60. - - - : -, _ POO L/SPASYSTEMS FINAIL 21. 22. Roof Sheathing- - - Frame and Flashing - - - ' - _ NOTES: 23. Insulation - - - 24. Lathing & Siding - - - - 25. Drywall Nailing - 26. Plaster Brown Coat - 27. Electrical Power Meter -Final 1 28. Final Electric 29. Final Heating & Air Conditioning - - - - 30. Final Gas Pipe -Test - - 31: _ Final Plumbing 321 Water Service -Final 33. Gas Service -Final = I- _ 34. Solar DomestiL-Firial t - 35. Landscape Sprinkling System ' 36. Sound Attenuation ' 37. Handicap Regulations -- - 38. FINAL STRUCTURE & BUILDING 39. Special Requirements Completed- 40. Electric Release, to Edison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No. Date 19 M 6(�/ Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. C(Ty' COSTA MESA PE MIT NO. TRACT NO. LOT NO. B G. CONSa F =41ON PERMIT TYPE OF CONSTRUCTION ❑ NEW ❑ ADD ❑ ALTERATION ❑ REPAIR ❑ CONVERSION ODE MOLISH ❑OTHER 4320 4/07/82 44.00 - ZONING REGULATIONS 'Project Address Owner Phone Address 3 r ' Arch/Eng. License No. DESCRIPTION OF WORK A.P• * ZONE PLNG. REF. $ Address Q- Contractor �f /J Phone TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL ❑ TENANT-.❑ ELECTRICAL ❑PLUMBING ❑MECHANICA SETBACK C SID YARD - Tp YLDING PROPERTY LINE Address D LICENSED CONTRACTOR DECLARATION I hereby affirm thLt I am licensed under provisions Of Charter 9 (Com- SIEpE VA 'RIGHT meneing with section 7000) of Division 3- of the Business and ❑ OTHER Professions Code, A license IS In full force a eft ct. - REAR YARD (TO P/L) �y PROJECT DESCRIPTION License Class �G U� c s,(g./p�1o� PKG. SPACE REQ. - _ _ PROVIDED - yp.�(-� — Z SQ. FT.' Date Signature 'S)Ci1G r^��'�-`� - , STREET WIDTH PARK FEE $ ., WORKERS'.COMPENSATION DECLARATION OCCUPANCY_ CONSTRUCTION TYPE I hereby affirm that I have a certificate of consent to self -Insure ora VALUATION ZONE ZONING APPROVED BY - DATE ' certificate of Workers' Compensation Insurance, or a -certified copy thereof (Section 3800, Lab. C.). GRADING CU. YDS. ACRES SPECIAL CONDITIONS: Policy No. --Company - -- - �' ':ertified copy is hereby furnished. REMARKS: . 't\- ertlfied copy Is filed with the city building Division. .- . EMPTION 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 pers0 in a y n 50 a5'to-become PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK - subject t the W rs Compensatio of la " BATHTUBS SHOWERS- (� Date Signature NOTIC : If after making this declaration, you shout become subject TOILETS URINALS 40C GENERATOR 0.3 KW_1=10 KW to the Workers' Compensation provisions Of the Labor Code, you must TRANSFORMER -. forthwith comply with such provisions or this permit shall be deemed LAVATORIES 3 DOUBLE LAVS - APPLIANCE 10-50 KW -50 + KW revoked. CONSTRUCTION LENDI NG AGENCY KIT. SINKS - DISHWASHERS .06 MOTORS 0-1 HP_1=10 HP - I hereby affirm that there Is a construction lending agency for the per. SERVICE SINKS SUMPS - 'UNC. SOLAR). 10-50 HP 50 + HP - - formance of the work for which this permit is issued (Section 3097 FLOOR SINKS - FLOOR DRAINS- FIXTURES OUTLETS' SWITCHES Civ. Name C.). Lender's Len Lender's Address DRINKING FOUNTAINS - GAS TUBE SIGNS OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for INTERCEPTORS - CLARIFIERS J - POLE LIGHTS - - - - SWIMMING POOL ^•P TRAP the following reason (Section 7031.5 -Business and Professions Code: Any city or county which requires a permit to construct, alter, POLES METERED SUB WATER SERVICE ALTERATIONPANELS MAIN - SUB improve, demolish or repair any structure, prior to Its issuance, also re. quires the ap:liwnt for such permit to file a signed statement that he GAS SERVICE -OUTLETS - SERVICE - - - AMP •- is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with section 7000) of Division 3 of the 'WATER HEATERS - BTV OUTPUT - - - - Business and-PrOlessions-Code) or That he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by SEWER CONNECTIONS ate•• applicant for a permit -subjects the applicant to a civil penalty rt more than five hundred Collars ($500). \ SOLAR TANK COLLECTORS- a5 owner of the -property, or my employees with wages as their s­_ compensation, will do [he work, and the structure is not intended - or oHeretl for sale. (Section 7044, Business and Professions Code: The _ SOLAR PIPING SYS: - - _ ISSUE FEE - - - - Contractor's License Law does not apply to an owner of a property ISSUE -FEE - 'APPLICATION APPROVED BY - - -- DATE who builds or improves thereon, and who does -such work himself or through his Own employees, provided that such Improvements are not MECHANICAL PLAN CHECK SUMMARY OF FEES intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner will have the burden of proving -'he did not build or improve for the purpose of sale).- HEATING SYSTEM0-100,000 BTU BUILDING PERMIT - - - '❑ I, as owner of the. property, am exclusively contracting with AND DUCTING $ SMTP $ licensed contractors to construct the project (Section 7044, Business 100,000+ BTU PLAN CHECK $ PERMIT and. Professions Code: The Contractor -5 License Law does not apply to - ISSUANCE- $ an owner of properly who builtls or improves thereon, and who con. REFRIGERATION 0-100,000 BTU ' PLUMBING $ ¢� tracts from Such projects with a contractor(s) licesned pursuant to SYSTEM - GRADING $ - the Contractor's License Law). 100,000 +BTU PLAN CHECK $ 0 am exempt under Section' B. & P. C: for this BOILERS BTU ELECTRICAL S - $ reason - PLAN CHECK $_ MICROFILM $' Dale Owner -- - SYSTEM REPAIR, ALTERATION EXHAUST SYSTEM MULTIPLE MECHANICAL '$- TOTAL FEE '$ LESS AD - 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' - PLAN CHECK $ VANCEPC $_ " ordinances and state laws relating to construction, and hereby authorize representatives- of his ity t0 enter upon -the above mentioned property for Its tl OT Signature Date 41 ` _ FINAL FEE Sq e'L/ Drivers' License or SS ISSUE FEE . CMF 0865-46 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor TU CONSTRUCTION AND'PL-ANNING APPROVALS Permit +83 Z// Date Inspector ' POOL & SPA APPROVALS Permit '# Date Inspector 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location 2. SoilPipe-Undrgrn / 8Z 44. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrn 45. Forms - 4. Electrical Conduit-Undrgrn 46. Electrical Bonding -- - - 5. Steel ein orce 47. Rough Plumbing & Pressure -Test - - - - - 6. Electrical UFER Grn 48. APPROVAL TO COVER--GUNITE 7. Footings 49. Electrical Conduit-Undr rn 8. Foundation 50. Gas Pipe, ❑ Undr rn, Test ' 9. Water Pipe-Undrgrn 51. Backwash Lines P-Trap,❑ride in - 10. Structural Floor System 52. APPROVAL TO DECK _ - -- - 11. Property Sewer Line & House Connection 53. Backwash & Receptor -Final 12. Street Sewer Connection 54. Heater & Vent -Final 13. Rough Plumbing -,�-8¢ 55, Plumbino System - Final 14. Rough Electric -Conduit - 56. Electrical -Final 15. Rough Electric -Wiring - - 57. Solar System -Final 16. Rough Heating & Air Conditioning encing & Access Approval 17. Ducts, in Structure APPROVED FOR PLASTERING_ 18. 19. 20. Ducts, Ventilating Gas Pipe -Rough &Test Roof Framing _. 60. POOL/SPA SYSTEMS FINAL 21, 22. Roof Sheathing- Frame and Flashing - NOTES: 23. Insulation 24. Lathing & Siding 25. Drywall Nailing 26. Plaster Brown Coat 27. Electrical Power Meter -Final 28. Final Electric 29. Final Heating & Air Conditioning _ 30. Final Gas Pipe -Test 4F 31. Final Plumbing f Z 32. Water Service -Final - 33. Gas Service -Final 34. Solar Domestic -Final 35. Landscape Sprinkling System 36. Sound Attenuation 37. Handicap Regulations - - 38. FINAL STRUCTURE & BUILDING 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No Date Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA PENT NO. ILJ CTrO. LOT NO. BLDG. NO- 'll 1 3387 3/17/82 193.00 CONSTRUCTION PERMIT C`l7 IRI I TYP FCONSTRUCTION NEW ❑ ADD ❑ ALTERATION ❑REPAIR ❑CONVERSION ❑DEMOLISH ❑ OTHER ' i ZONING REGULATIONS Project Address �, -2 Owner O _ Phon ' — Address �(.(/ �• ' rc �R Eng. CO C, ...( License No. DESCRIPTION OF WORK t A P 5F _ I �Z - ZONE Rn PLNTG.. �-60-9 drC$s 2.. S'XSrA Contractor U1 elm ;T qlC oylihon TYPE OF PERMIT � � ❑GRADING❑ FO UN DATIO {d STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑PLU)ABING ❑MECHANICA nn SETBACK C S l-�'LJrW If 51 YA%RD LPT 55 pD log gRtE1F.. p� PRO PEIRTVNLINE %i �76 If Address NG C LICENSED CONTRACTOR DECLARATION 1 hereby affirm Ihat 1 am licensed under provisions of Charter 9 (tom- .• R11GHT ll men ting with section 7000) of Division 3 Of the Business and Professions Cotle, an my license is In fu 1 fort d gfl ❑ OTHER REAR YARD (TO P/L) r[�v G-. PROJECT DESCRIPTION Llcen Class L 5e _ I SG' FT' 4 ����, PKG. SPACE REG. 2 ,5 PROVIDED _ 2 Date Signature / OCCUPANCY CONSTRUCTION TYPE - STREET WIDTH • r7 PARK FEE E fp WORKERS' COMPE NSATI ON DECL ATION I hereby affirm that I have a certili ate of consent to self -Insure or a (a"L �.j7s: VALUATION ONE ZONING APPROVED BY DATE cJ t certificate of Workers' Compensation Insurance, or a certified `copy thereof ( 1&38 o �bls/)' /nyY6 �.(/.%• lA." GRADING CV. YDS. ACRES SPECIAL CONDITIONS: Ilcy Ne Company 'ertified copy is hereby furnished. - - - REMA KS: ,ertllled Copy Is filed with the city Building Division. — R EXEMPTION FROM WORKERS' COMPENSATION DECLARATION r (This section need not be completed if the Permit Is for one hundred 1$100) Or less). 42 certify that in the performance ofthe work for.which this. permit Issued, I shall not employ any person in any manner so as to become PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK subject to the Workers' Compensation Laws Of California.- 'BATHTUBS SHOWERS FT, qO.FT- i Date I Signature NOTICE: If after making this declaration, you should become subject TOILETS - URINALS GENERATOR 0.1 KW_ 1-10 KW ' to the Workers' Compensation provisions of the Labor Cotle, you must _ TRANSFORMER forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE LAYS APPLIANCE 10-50 KW_50 + KW revoked. KIT. SINKS DISHWASHERS MOTORS 04 HP_1-30 HP CONSTRUCTION LENDING AGENCY I herebytffirm that there is a.constructlon lending agency for.tho per. SERVICE SINKS (INC. SOLAR) ]0-50 HP_ 50 i HP -- " formance:of. the work for which.this permil.is-Issued (Section 3097 - .SUMPS' FLOOR SINKS FLOOR DRAINSy FI%TURES OUTLETS SWITCHES Civ' C•I• s Lender's Name, s Lender's Address - DRINKING FOUNTAINS s GAS TUBE SIGNS - OWNER BUILDER DECLARATION INTERCEPTORS CLARIFIERS • - 'POLE LIGHTS I hereby affirm that I am ekempt from the C6,,tlatt Or.'s License Law for following SWIMMING POOL PTRAP POLES METERED SUB " Ihb reason (Section 7031.5 Business and Professions Code: Any. city or county which requires a permit to construct, alter, WATER SERVICE ALTERATION - PANELS MAIN SUB Improve, dome fish or repair any structure, prior to Its issuance; also re- quires the ap, licxnt forsuch permit to file a signed statement that he GAS SERVICE OUTLETS SERVICE AMP Is licensed pursuant t0 the provisions of the Contractor's License Law 1 Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or thathe is exempt therefrom and the _ - basis for the alleged exemption. Any violation of Section 7031.5 by WATER HEATERS BTU OUTPUT _ CONNECTIONS applicant' for a permit subjects the applicant to a civil penaltySEWER A more than live hundred dollars ($500). SOLAR TANK COLLECTORS as owner of the property, or my employees with wages as their sole COmponsation, will do the work, and the structure Is not intended or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SYS. ISSUE FEE Contractor's License law does not apply to an owner of a property ISSUE FEE 'APPLICATION APPROVED BY _ DATE3// who builds or Improves thereon, and who does such work himself or through his own employees, provided that such improvements aro not MECHANICAL PLAN CHEWCK SUMMARY OF FEES intended or offered for sale. If, however, the building Or improvement Is sold within one-year of completion, -the owner will have the burden -BUILDING- - _ of proving he did not build or improve for the purpose of sale). -as-owner HEATING SYSTEM 0-100,000 BTU PERMIT s _ f-3- - SMIP S I, of the property,- am ex Cluslvely contracting with AND DUCTING - - licensed contractors to construct the project (Section 7044, Business 100,000 . BTU,PLAN CHECK $ PERMIT and Professions Code: The Contractor's License Law does not apply t0- - ISSUANCE E an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTUPLUMBING $ tracts from such projects with a contractor($) llcesned pursuant to SYSTEM GRADING $the Contractor's License Law). 100,000 + BTUIPLAN CHECK $1 am exempt under Section B. 6 P. C. for this BOILERS BTUELECTRICAL $ $ reason - - CHECK $ MICROFILM $ Date -Owner SYSTEM REPAIR, ALTERATIONPLAN EXHAUST SYSTEM MULTIPLE MECHANICAL $ TOTAL FEE SI - LESS AD - I hereby certify that 1 have read this application and state that the above information is corre1. I a re_e to comply with all Illy and county PLAN CHECK S— VANCE PC S ordinances ontl state laws r Ung t onstr uctlon. antl hereby authorize _, ' representatives this y to Mir upon the above mentioned properly for i urp $. _ Sl9nature Dat ez ISSUE FEE '- FINAL FEE S - Drivers' Licen or SS CMF 0865.46 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod! -Assessor // • CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA gpPROVALS Permit # Date _ Inspector 1. Temporary Electrical Service or Pole 43. Pool'& Equipment Location - - - 2. SoilPipe-Undrgrn - 44. Steel Reinforcement - - 3." Electrical Conduit Utility-Undrgrn 45. Forms 4. Electrical Conduit-Undrgrn 46. Electrical Bonding- 5. Steel ein orce 47. Rough Plumbing & Pressure Test 6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE 7. Footings IS 4_4 49. Electrical Conduit-Undr rn 8. Foundation S ,tjt % 50. Gas Pipe, ❑ Undr rn,-Test 9. Water Pipe-Undrgrn_ _2`7 51. Backwash Lines P -Trap, C1ndr r6 '• 10. Structural Floor System - 52. APPROVAL TO DECK - 11. Property Sewer Line & House Connection 53. Backwash & Receptor -Final 12. Street Sewer Connection _ 54. Heater & Vent -Final 13. Rough Plumbing - -- - -- -- 14. _ Bought liict:ifc Co wt •'• ' '' "' -• 56. Electrical •Final 15. Rough'Electric-Wiring - - .57.: Solar. System -Final - 16. Rough Heating & Air Conditioning - - - - -.encing.& Access Approval 17. Ducts in Structure 59. APPROVED FOR PLASTERING 18. 19. 20. Ducts, Ventilating Gas Pipe -Rough & Test Roof Framing 60. POOL/SPA SYSTEMS FINAL 21. 22. Roof Sheathing Frame and Flashing- S- _ 'L S - NOTES: _ - 23. Insulation 24. Lathing & Siding ' 25. Drywall Nailing 26. Plaster Brown Coat 27. Electrical Power Meter -Final - 28. . Final Electric ' 29. Final Heating & Air Conditioning _ 30. Final Gas Pipe -Test - ' 31: Final Plumbing 32: Water Service -Final - •. 33.*. Gas Service -Final 34. Solar Domestic -Final 35. Landscape Sprinkling System 36. Sound Attenuation _ 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING 39. Special Requirements Completed 27 2!i$' 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No: Date a COSTA MESA BUILDING -SAFETY DEPARTMENT P.O.BOX1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Completely — Use Ink Only BUILDING r+l71� // �'eQerZ A BUILDING 1 LL ii ,:i /, OWNER OR TENANT MAILING ADDRESS CITY/ A BRANCH ADDRESS ARCHITECT ADDRESS L--> IL+ I / J/, LV- v./1/. CONTRACTOR^ ADDRESS 6QZ AQ(5 TEL. CITY a IN ,S STATE CITY LIC. No.If 7 �� LIC. IN SIZE �J Q NO. OF BLOCS OF LOT /'S / �58 NOW ON LOT USE OF fJ Separate permits are required for electric, plumbing and heating work. USE OF BUILDING AND WORK TO BE PERFORMED I hereby acknowledge that 1 have read this application and state that the above Information is correct and agree to comply with all laws regulating building constructlo shall not employ any person in violation of a wo s compensation laws of the State of California I hereby certify that I a r e cMns ra for and a the State of California Bus ass and Profe o e, Division 3, Chapter 9, antl that nuc censer era i orce and affect, or I em exempt from the p visions of the ate of California Business end Professions Coda inion 3, Chapter . Signature of ` Permittee or Authorized Agent 0 e ,i VCS I�!�itll 176 !,4' APPLICATION FOR STRUCTURAL PERMIT/ BUILDING ADDRESS UNITR ���)9 ` �� e� SPACENi �A��G� G J NEW I ADD (ALTER IREPAIR IMOVINGIDEMOLISH OWNER CAS IW.Pf (MGIC! USE VALUES SZi ,Sj ZONE /`- APPROVED X09 /lp xl APPROVED SETBACKS (FROMC T? ROM T. a s L. SIDEREA ,r LA A FT. PLANNING ACTION �— DATE \ APPROVE APPROVa .` L ivy c2 /3��5nn2 o a&A cue JVi m O HOLD FOI> §F4� CIAL REQUIREMLN-r� M THE AMOUNT SHOWN UNDER VALUATION IS FOR m THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: VALUATION PERMITFEE E n m /t PLAN CHECK E C $ S//��� �/v TAX E D M TOTAL PAID E I l COSTA MESA B111601NG=SAFETY BEPATMENT P.O. BOX 1200 Costa Mesa, California 5704 5kl"t /BE- 19.00 'TL I t UU011111113 Contractor , �/ (r/,f TRACT N0. REC 'D BV LOT NO. BUILDING USE PERMIT ,NO. DATE ISSUED Address `Y' T City ` Zip Codc State License No.33 A-72 I Class. C — Z.O BUILDING ) ) ADDRESS .2, City License No. 51!Tel. No.61 NO. ITEM EACH FEES \ l COSTA MESA, CALIFORNIA FAU, Wall, or Grav, Furn. Incl. Ducts and Vents 100 000 BTU D D NEAREST CROSS ST. , OWNER_ l0 over 100,000 BTU MAIL ADDRESS CITY ��� EL. N0. / 7S�_�.�.�.i Vent (If not incl. above) I her y acknowledge that I have read this application and,state,that the above is correct and agree to comply -wlth ail "City Ordinances and State Laws regulating Heat - -ing; Ventilating, Refrigeration and Air -Conditioning. y I certify that I possess the above valid State of Calif - ornia classification or I am the legal owner of the single family residential property described above Signature of Permittee Suspended Heater Alter or Replace Appliance - ver 1 U feet o gas piping gyp) BOILE RS OR COMPRESSORS 3 H.P, or less. Over 3 H. . to 1. `t' 5 H � �� t Vent Fan—Sin Ie.Duct OD REMARKS: (-\� y' Ventilating�Hood Q� M isc.- 1 �/' iLl0 J�6,90 0,35-0-7 APPROVALS INSPECTOR DATE Ducts Underground Ducts in Structure Ducts Ventilating Heating — Rough Hoods Refrigeration Lines Pressure Test Sub -Total 00 Air-Cond. Final Reinspection Fee Ventilating Final Heating Final Processing Fee 00 Refrigeration Final Final Gas Test TOTAL FEES QD Utility Co. Notified CMF 0449-46 BLDG. PERMIT NO.^, (714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 233 16TH PL Suite No D Vicinity: UNIT D Parcel Nunmber: 93673037 Applicant: KAMINSKY, PAUL Address: 11612 KNOTT ST GARDEN GROVE, CA Owner: RAFNEL, EVELYN Address 233 16TH PL UNIT D D COSTA MESA, CA Contractor: NOCK PLUMBING Address: 11612 KNOTT ST Arch / Eng Address: GARDEN GROVE, CA CHANGE OUT WATER HEATER. PLUMBING PERMIT Phone: (714) 895-1246 Zip: 92841 Phone: Zip: 92627 Phone: (714)895-1246 Zip: 92841 License: 707775 Phone: Zip: License: SCOPE OF PERMIT Status: ISSUED Applied: FEE SUMMARY 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: 09/19/2002 Issued: 10/02/2002 OTY 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 $12.30 1 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 2446-66(6/00) DECLARATIONS 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 performance of the work for which this permit Is issued. 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. thave y workers' compen��satiYYon Insur[,a�n`ce carder�a�ntlwpallcy number /� nT -�,•� o+ r6-h': I�c)� r"l F. W Z� V>' �� MVS--a( Policy Number: \ HyC (lav I (o 115(1:0--g— (This section need not be Completed /f the permif is valued at one hundred dollars ($100) or less.) ❑ 1 certify that in the erto once o1She work for which this permit is Issued, I shall not employ any person In any manner so as to become subject to the workers' compensafipniaws o li mia, end agree that If I should become subject to the workers' compensation provisions of Section 3 00 of the Labor Code, I shall forthwith comply with thes p Ito 0. t Applicant Signature: Date: WARNING: FAILURE TO SECURE WORKE COM NSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES ANDCIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE (5100,0(10), IN ADDITI TO COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37060F THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. TRACTORS DECLARATION: t I em liGa�sed undo( Rr vvlsions of Chapter 9 (commencing with Section 7000) of Division 3 of the BusiOBs� Prpfis;igns Code, and my license is in full Ebh icIO Class x10 Cature: Date: t0 • 2 • c)% CONSTRUCTION LENDING AGENCY: ❑ 1 hereby affirn that there is a constmc ding agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders 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 Lew (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 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, 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 contractors) license pursuant Id the Contractors License Laws.). ❑ 1 am exempt under sec. - Business and Professions Code for this reason: Signature: Date: Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires: Verification of Ownership by (type of document, Le. - 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, TIt1e B, 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 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 feat 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 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 Mction artment 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 2SS34 of the California Health and Safety Code been fully complied with7 ❑ Yes ❑ No ............................................................................................................................................................................................................................................................................................................................................................................................ 5 Does or will tha applicant or present or future building occupant require for the work which Is the subject of this a plication aermit for such construction or modification a 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). ........................................................................................................................................................................................................................................................................................ ........................................................................_................ 8 Will any part of the facility to be Constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Ves ❑ No (if "yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Cade). ............................................................................................................................................................................................................................................................................................................................................................................................ 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 01 the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No .............................................................................................................................,...................................................................................................................... ........................................................................................an.............................p. p.....D 6 (If'yes", attach cenificate 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 abovedescriroe for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. l/ nature Of Legal Owner(s) Date And/ Authorized Applicant Date CODE Jr. INSPECTION TYPE 2&M INTITIeL$ CODE I INSPECTIONTYPE 2M INTMELS 1616 Fixed System Final Fire Prevention 206 Final Mechanical (� ,, 1266 Pool Spa Final 208 Final Plumbing 1I ,�c _EbL 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 (714) 754-5273 • Fax (714) 754.4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT Job Address: 233 16TH PL Status: ISSUED Suite No D Applied: 04/25/2007 Issued: 0425/2007 Vicinity: Parcel Number: 93673037 ISSUED BY: Applicant: ARENAS, ERIK Address: 9911 LARSON AVE Phone: 800-842-2637 GARDEN GROVE, CA Zip: 92644 Owner: RAFNEL, EVELYN Address: 233 16TH PL UNIT D D Phone: COSTA MESA, CA Zip: 92627 Contractor: A AMES PLUMBING, HEAT, AC Address: 9911 LARSON AVE Phone: 800-842-2637 GARDEN GROVE, CA Zip: 92644 License: 250307 SCOPE OF PERMIT CHANGE OUT FURNACE. 60K BTU , FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Repair / Alt Absorbtion Unit $0.00 0 Inst FAU <100 k BTU $14.80 1 Repair / Alt Refrigeration Unit $0.00 0 Inst FAU >100 k BTU $0.00 0 Ventillalion System $0.00 0 Repair/Alt Cooling/Heat $0.00 0 Evaporative Cooler $0.00 0 Inst / Rep. Recess Wall Htr $0.00 0 Commercial Incinerator $0.00 0 Refrig Sys <100 k BTU $0.00 0 Domestic Incinerator $0.00 0 Refrig Sys >100 k BTU $0.00 0 Compressors / Absorption Systems Gas Piping $0.00 0 Up to 3 hp / 100 k BTU $0.00 0 Factory Fireplace $0.00 0 3 To 15 hp / 500 k BTU $0.00 0 Hood w/Mech Exhaust $0.00 0 15 To 30 hp / 1,000 k BTU $0.00 0 VAV Box $0.00 0 30 To 50 hp / 1,750 k BTU $0.00 0 Vent Fan / Single Duct $0.00 0 Over 50 hp / Over 1,750 BTU $0.00 0 Appliance $0.00 0 Boilers Fire Dampers $0.00 0 Up to 3 hp $0.00 0 Smoke Dampers $0.00 0 3 To 15 hp $0.00 0 Inst or Relocate Appl Vent $0.00 0 15 to 30 hp $0.00 0 Air Handlers < 10000cfm $0.00 0 30 to 50 hp $0.00 0 Air Handlers > 10000cfm $0.00 0 Over 50 hp $0.00 0 Floor Furnace $0.00 0 Other Mechanical Fee Floor or Suspend Heater $0.00- 0 Investigation Fee $0.00 Plan Check Fee $0.00 Reinspection Fee $0.00 TOTAL CALCULATED FEES $38.30 COMMENTS / SPECIAL CONDITIONS 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) 7545626 2446-06(6100) DECLARATIONS 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 performance of the work for which this permit Is Issued. ,r I have and w 11 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.workeIS ce�npensationinnsurance tamer and policy number are: Cemb� S TT��r _✓7.2 PoltNurYtber.—OvoO (This section need not be Completed if the pemlit rs lued at one hundred dollars ($100) or less.) ❑ I certify that in the performance of the wo r which this permit is issued, I shall not employ any person In any manner so es become subject to the workers' compensatlon lawa of Celli la, and a instill should become subject to the workers' compensation provislons of Secli 3700 of the Labor Cade, I shall fonhwith Comply wlth.these pro n_,r//0 A,I�Slgnature:—' Dale��r `.1 WAR 1 FAILURE TO 5 RE W PS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMI PENALTIES AND CML RNES UP TO ONE HUNDRED THOUSAND DOLLARE (S ,000). TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3ma OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I em licensed under provision I Chapter 9 (comencing with Section 7000) of Division 3 of the Business antl Professions Cade, and my license is In full force and effect. UC-4­10J C 6isss a- O C �o Contractors Sig'Lture:� Data:: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following 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) o1 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 penult subjects the applicant to a civil penalty o1 not more than Me 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 Professlons 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. It, 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 Ucense 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 em exempt under sec. Business and Professions Code for this reason: Signature: Date: 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: ❑ I hereby certify that no excavation two (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 permil 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 WIII 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 exceptlons, 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 then a weight of 500 pounds, or a volume of 55 gallons, or 2DO Cubic feet of compressed gas at standard temperature and pressure). ....�__...___....... nt rove—"'—............_............_.rove_ __........_.__ _—._ 3 Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management antl Prevention Program for acutely hazardous materials)? ❑ Yes ❑ tJ0 (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 o.. the California Health and Safety Code been fully complied wilh7 ❑ 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 appertnit for such Construction or modificationfrom the South Coes) Ali Quality Management District or from any other air pollution COnIr01 tllSlfiCi or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). ............................ _....................__._........................_..—_.._......................_....._._..__..._......................_............................... ...... ..................................................................................._..............._..............__...... 6 WIII any part OI the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a schod? ❑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 L isfict or other air pollution control district or agency is required for the work which is the subject of this application, have all of the dLsciosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ NO ................................................ I..................... I......................................... I.................................. _........................................................................................................ I............................. ................._............__....................__............... — B (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 penury 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 Clryof Costa Mesa t an upon the above-described property for Inspectionas. I agree not to occupy or allow occupancy of any building authorized by this permit until final iction. 7,7 tgnalure f g Owner(s) telG S f i Itloftred.Applicant- � CODE E. INSPECTONTYPE DAIS INTMALB CODE)! INSPEC71ON TYPE 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 206 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retalning Well 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 (714) 754.5273 • Fax (714) 754-4856 • www.cl.costa-mesa.dRUILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 233 16TH PL Suite: D Vicinity: NEWPORT HEIGHTS BLDG D Primary Occ: R-3 Dwellings/ Cong Res <10 Type of Construction: V -N Parcel Number: 93673037 Zoning: Applicant: RODGERS, MIKE Address: 2626 NEWPORT BL COSTA MESA, CA Owner: RAFNEL, EVELYN Address 233 16TH PL UNIT D D COSTA MESA, CA Contractor: PETRONELLA ROOFING Address: 2626 NEWPORT BL COSTA MESA, CA Zip: 92627 Arch : Address: Zip: Phone: License: Status: ISSUED Applied: 10/20/2005 Issued: 10/20/2005 Phone: (949) 548-1645 ISSUED BY: Zip: 92627 0117, Phone: Zip: 92627 Phone: (949)548-1645 License: 460707 Eng: Address: Phone: License: SCOPE OF PERMIT REROOF CONDO BLDG D: T/O EXISTING WOOD SHAKE, REPAIR/REPLACE SHTG AS NEEDED, 2 LAYERS 30# FELT, APPLY "CLASS B MEDIUM' SHAKE." 18 SQUARES FEE SUMMARY Plan Check: $0.00 Calc Valuation: $6,400.00 Permit: $139.25 Claim Valuation: $6,400.00 SMTP Res: $0.64 SMIP Com: $0.00 Other:, $0.00 Inspection: $0.00 Total: $139.89 SETBACKS MAIN STRUCTURE Front 0-0 ACCESSORY Front 0-0 PARKING Existing: 0 PLANNING & ZONING Rear 0-0 - Left 0-0 Right 0.0 Rear 0-0 Left 0-0 Right 0-0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 2"6-46 (6/00) DECLARATIONS WORKERS' COMPENSATION DECLARATION: I hereby all 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. 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 permll Is issued. t— y workers' compensation Insurance yorder and policy number are: Cerner:'--,ar-S�--A- ....J TPolityNum C7 I a O(J-79 � 6 .(Ri/ssecbon need not be completed i/ the permit is valued atone 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 If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with these pro 'sions. ApPlica tS nature: , .✓' /2 /�i/7 ��p.�ate�:�-1 ��/2O �G 6 WARNING: FAILURE TO SECURE WORKERS' COMPENS N COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLPrEH TO CRIMINAL ENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000), IN ADDITION TO THE T OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 37060E 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 effecrl7o.�Y Err o 7 Class? G— -3 R' I Con1racWAsSlgnature;7=— Date:-0 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). 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 apply to an owner of properly 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 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: ❑ 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 B, 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 hes 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). ........................'..... .............- ................I......... 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 teat of compressed gas at standard temperature and pressure). ........................................................... ... ...... ............. .... ....... .......................................... ....................... ............................... ................................... ........................................................ ................................................. -................ .................................. 3 Does or will the appplicant 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 aEermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LI 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 pertnit 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. 1 agree not to occupy or allow Occupancy of any building authorized by this permit until final inspection. &,Signature �Of�Legal Owner Date rAncVOr_!AyjjjjoflzGd Applicant [Piate' CODE If INSPECTION TYPE SIF ISL§ CODE I INSPECTION TYPE 2LUtixrn"Ls 1616 Fixed System Final Fire Prevention—F��y//�. 206 Final Mechanical 1266 Pool Spa Final v 208 Final Plumbing 200 Final Re-Roof 210 Final Electrical 201 Final Block/Retaining Well 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 Building Safety Department. CERTIFICATE OF OCCUPANCY P.O. Box 1200 ' Costa Mesa, California The Building located at - has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a G ccupancy. Use of Building - - --, Legal Building Permit No ISSUED TO: i_t (See reverse side for Metes and Bounds) lectrical Permit No. i f,'" Plumbing Permit No. Number of apartments . — and/or guest rooms Building Official 27/ Date 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. 306 lel U.B.C. Form BU 34 Rev. 11/70 C� COSTA MESA BUILDING,SAFETY DEPARTMENT APPLICATION F&A�li CILOKALPERMI'I'Nyt!SldP:;:k P.O.BOX1200 COSTA MESA, CALIFORNIA 92626 `a RECEIVED Y PERMIT For Applicant to Fill in Completely — UseInk Only BUIL DING �� /Y/DD ESS L JS OWNER OR I&'Le BUILDIN ADDRESS 233 e �I11',V TENANT F LL! .'V�'{ -/J MAILING,[ / UNIT O , ADDRESS t(�� GOO SPACE . „J� TR LOT BLK. CITY F�Li�%voj NOLiij L'C7 I NEW ADD L--1 REPAIR MOVING DEMOLISH CONSTRUCTION LENDER BRANCH 4/rQ0A 1141A 6LG OWNER [!i ADDRESS VALUE ('' USE E�/P ARCHITECT[%JJ�� n �Y CrO��C1.¢�/�TEL/a�// / Vk-•!`%J OR ENGINEER i'% ///� ADDRESS [, uJ/t�S 20NE L� TYPE GROUP APPROVED CONTRACTOR BY A DATE ADDRESS TEL CITY I NO STATE CITV APPROVED SETBACKS LIC. NO. LIC. N� SIZE NO. OF OF LOT NOW ON LOT£ RONT USE OF n� EXISTING BLDG. /�. To Separate permits are required for L SIDE electric, plumbing and heating work. / REAR FT. �- USE OF BUILDING AND WORK TO BE PERFORMED PLANNING ACTION C 0 d /N/ APPROVE APPRO r I hereby acknowledge that I have read this application and state�/ that the above Information is correct and agree to comply wIM all laws regulating building construction, antl a I not employ any person In violation of the wo m mpensation laws of �L the State of car,prnia• HOLD FOR SPECIAL REQUI MEN; 1 hereby certify that I o ro s or under SQ. FT. the State of Cnli,ornla Busines ntl Professions ons Division 3, THE AMOUNT SHOWN UNDER VALUATION IS FOR Chapter 9, and that such li sos are In full and of act, or I THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the pr siona o1 the Stat Celiforn Business end Profasslons Cotle, I slop 3, Chapter 9. VALUATION PERMIT FEE $ Signature of • PLAN CHECK S 6�S Permittee 5 TAX E �s or Authorized Agent Date TOTAL PAID E `a (714) 754-5273 • Fax(7114)754-4856 • www.ci.costa-mesa.cBUILDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 233 16TH PL Suite: C Vicinity: NEWPORT HEIGHTS BLDG C Primary Occ: R-3 Dwellings/ Cong Res <10 Type of Construction: V -N Parcel Number: TPNO0593 Zoning: Applicant: RODGERS, MIKE Address: 2626 NEWPORT BL SMIP Res: COSTA MESA, CA Owner: NEWPORT HEIGHTS HOA Address 233 16TH PL Inspection: COSTA MESA, CA Contractor: PETRONELLA ROOFING Address: 2626 NEWPORT BL COSTA MESA, CA Zip: 92627 Arch : Address: Phone: Zip: License: Status: ISSUED Applied: 10/20/2005 Issued: 10/20/2005 Phone: (949) 548-1645 ISSUED BY: Zip: 92627 4107 Phone: Zip: 92627 Phone: (949)548-1645 License: 460707 Eng: Address: Phone: License: SCOPE OF PERMIT REROOF CONDO BLDG C: T/O EXISTING WOOD SHAKE, REPAIRIREPLACE SHTG AS NEEDED, 2 LAYERS 30# FELT, APPLY "CLASS 8 MEDIUM' SHAKE" 9SQUARES FEE SUMMARY Plan Check: $0.00 Permit: $97.25 SMIP Res: $0.50 SMIP Com: $0.00 Other:. $0.00 Inspection: $0.00 Total: $97.75 PLANNING R ZONING SETBACKS MAIN STRUCTURE Front 0-0 ACCESSORY Front 0- 0 PARKING Existing: 0 Calc Valuation: $3,200.00 Claim Valuation: $3,200.00 Rear 0-0 Left 0-0 Right 0-0 Rear 0-0 Left 0-0 Right 0-0 Required: 0 Proposed: 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12.21-92) EXPIRATION: This permit shall automatically expire and become void if work Is not commenced within 180 days, or If work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained. Failure to obtain Inspections and final approval will result In the expiration of this permit. FOR INSPECTIONS CALL: (714) 754.6626 2"6.46 (&W) DECLARATIONS 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 performance of the work for which this permit is Issued. � ,-have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Cade, for the performance of the work for which this permit is issued. My w�orkeerrs' compensation Insu nce ca and policy number are: �1 ,.0 Pofl�c9'Number. 6;'b 4, C1 � > (This section need not be Completed If the permit is valued at one hundred dollars ($100) or fess.) ❑ 1 certify that in the performance of the work for which this pernit is issued. I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that If I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply.with these prove i ns. Applicant Slgnature: . WARNING: FAILURE TO SECURE WORKERS' COMPENSAT} N 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 CGST 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 untler 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. Ub 7r7'7 L?asn�-ax C— 31l ConVedors Signature: Data. CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code). Lenders Name: 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 apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by 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: ❑ 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, talsework, 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 WIII 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). ..............._._.___............................_..._.r__ sent or......_................_ng occ..........._need t_..file.........__...._................__.................___.....................___.... ._......."'.......__.........._.__.......__......._. 2 Does or will the applicant or present or future building occupant need to file a registration form for acutety 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 appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)? ❑ Yes ❑ fJo (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 en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complietl wit h7 ❑ 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 eggermlt for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Ll Yes u No (Section 65850.2 of the California Government Cade requires that the requested information be furnished on applications for non-residential building permits). ............................................................................................................................................................................................................_..........................................................................................................._.............._..................I.................._......... 6 WIII any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Ves ❑ No (If 'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). ........................................................................................................................................................................................................................................................................................................................._................................................................. 7 It apermit 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. S nature Of Legal Owner(s) Date Antl/0 J zetlApplicant-"- (—Dates CODE t. INSPECTION TYPE QBj_ INTITIALS CODE INSPECTION TYPE gAM INTm1LS 1616 Fixed System Final Fire Prevention �((�206 Final Mechanical 1266 Pool Spa Final V 208 Final Plumbing 200 Final Re-Roof I I 210 Final Electrical 201 Final Block/Retaining Well 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition 250 Final Bullding/Occupancy Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. 1�nn r:,117fnn 193.00 TL ' CITYOF COSTA MESA PER M112 NNO. TRACT NO. LOT NO. BLDG. NO. - - •CONSTRUCYION PERMIT 1 117 F CONSTRUCTION - NEW 1:1 ADD ❑ALTERATION E] REPAIR EI -CONVERSION ❑DEMOLISH []OTHER _ _ ZONING REGULATIONS Project Address 93 167-11TVP OwnerC-,07-,11j _Jr- Phon Address3 V14 ('A Q "MOOA AAEAC11"MOO rch Eng. Ce CF S License NO. DESCRIPTION OF WORK' TYPE OF PERMIT � � A.P. 4z5 - ZCiNE -'5 .PLNG. REF. 4° ME) -,(50 HU11LUING � u TO�l11LDING �n 1 SETBACK C,/Lt L11r D "PADFETZT'F'CrIQE7 CJ • C.QS• Ff I Contractor �-�• phone' _ _ - AddreSi Q A%O � �/-r G El GRADING. 0 FOUNDATION' 94 TRUCTURAL ❑ TENANT EI ELECTRICAL ❑PLUMBING ❑MECHANICA LEFTYAROu (.�. •_ LICENSED CONTRACTOR DECLARATION - - - - 1 hereby affirm that 1 am licensed under provisions of Charter 9 (com-. FIIGHTAR r�n menting-with-section 7000) of Division 3 of -the-Business and ❑OTHER ' Professions Code, and my license is in f I fort a d eff t. _ REAR YARD (TO P/L) r - - - -1.� 3z PROJECT DESCRIPTION '- Licensa Class �s nse do. _ / />'_ FT. O'�� 'PKG.-SPACE REO. Q,,S PROVIDED-2:rj Date •• �Z L. Signature 'I--- SQ: {.;/.((fµf;-8�.(dr_t3�iZ �CT:� ffr-� _ STREET WIDTH f v PARK�FEE $ , WORKERS' COMPENSATION DEC RATION - -- - - I hereby affirm that 1 have a certif ate Of, <on sent to self -insure or,a . OCCUPANCYP_f NSTRUCTION TYPE `V ALV ATIONL��'ZONE r -ZONING APPROVED BV ATE 17 certificate of Workers' Compensation Insurance, or -'a certifietl"copy GRADING CU. YOSACRES SPECIAL CONDITIONS: - - thereof (Se - -ti -00d - Policy No. company N�h� / - F- +rtifled Copy is hereby furnished.- __. - ._ .- REMARKS:ca-) w FOR NWM trifled Copy is filed with the city Building Division. �E-e.MPTION ) , FROM WORKERS' COMPENSATION DECLARATION - (This section need not be completed if the.permit is for one hundred _ _ ' ($100) or less). • - r _ __ _. - _ _ _ _ _ .. .- 1 certify that un -the: performance of the work for which this permit- -' issuetl, I shall not employ any person in any manner so as to become .PLAN PLUMBING - i -PLAN CHECK -- ELECTRICAL" '-'PLAN CHECK ' subject to the Workers' Compensation Laws of.Callforn Is _ _ _ BATHTUBS _ _ _ _ _ _ -' SO,FT- SO.FT -- - Date Signature NOTICE: If after making this declaration, you Should become•subjecu TOILETS •, y, (, -URINALS - - -GENERATOR- 0-1 KW_1-10-KW. to the Workers' Compensation provisions of the Labor Code, you must - (TRANSFORMER - forthwith comply with such provisions or this permit shall be deemed LAVATORIES DOUBLE CAVS - APPLIANCE "'- 10-50'KW=50 +-KW - - ... revoked.- _ _ KIT. SINKS DISHWASHERS- ` '- "' -; "',MOTORS -- -0=1 HP._1-10'HP-'- '- - CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for, the per-, SEgV ICE S1:4*S ' ] SUMPS -"-" - - - (INC. SOLAR)--- -10-50 HP_- 50 +-HP - - formance_of:the:wbrk,foi_ which this permit -is issued:(Section•3097 - - FLOOR SINKS FLOOR DRAINS -' - iFIXTURES" "' OUTLETS "''SWITCHES" ' Civ. C:). , { ->;.' - -"-- "-'- 1,* Lender's Name y'-� _ _ _ _ _ _ _ _ _ Lender's Address- DRINKINCq FOUNTAINS, +-' - GASTUBESIGNS OWNER BUILDER DECLARATION-:' ti hereby affirm that I.am exempt from.the-Contractor's License.Law.for INTERCEPTORS 's` CLARIFIERS 'POL"E LIGHTS'-` '- --' - - the -following reason (Section 7031.5- Business 'and- Professions Code: SWIMMING POOL P'TRAP' - -'- - - � Any city. or county which requires a permit to construct, alter, POLES METERED SUB WATER SERVICE ALTERATION _ PANEL'S -' MAIN UB - - - - - - - SUB- improve, demolish or repair any structure, prior to its issuance,, also re- quires the ap'.licant for such permit to file a signed statement that he - - - GAS SERVICE OUTLETS SERVICE" ^' - ^-- -AMP- - -- is licensedpursuantto the provisions of the Contractor's License Law (Chapter (Chapter 9 (commencing with Section 7000) of Division 3 of the WATER HEATERS - BTUOUTPUT - - — - -- - -- - -- - - - - - Business and Professions Code) or that he is exempttherefrom and the basis.for the alleged exemption. Any violation of Section 7031.5 by --SEWER CONNECTIONS -" - '"-""'•-' -^' - - anv-oplicant-fora' permit subjects -the applicant 1:6 a'"civil-penalty' of more than five hundred dollars ($5p SOLARTANK- COLLECTORS' -lo L s owner of the property, Or my employees with wages as'theii sole-..ompensation,.wiII-do the work,and.the structure is not intentletl. or offered for sale. (Section 7044, Business and Professions Code: The SOLAR PIPING SVS. - kl - --" ISSUE FEE'-"-' Contractor's -License Law -does not apply to an owner. of .a -property_.. - ISSUE FEE :APPLICATION APPROVED BY-- - DATE who builds or improves thereon, and who does such work himself or through his.own.employees, provided -that suchimprovements are not MECHANICAL PLAN CHECK SUMMARY OF FEES intended or offered for sale, If, however, the building or improvement within one year. of completion, the owner will_have the burden of proving he did not build or improve for the purpose of sale). of El I,^'as"owner' of-theproperty,am exclusive) contractin with HEATING SYSTEM 0-100,000 BTU - - BUILDING -- - - - -- - - 'PERMIT $ �9Q'_"_ SMIP,; $� - r licensed contractors to construct the project Section 7044,.Business P 1 ( AND DUCTING r 100,000•+ BTU PLAN CHECK $ - - _ ,PERMIT y and Professions-Code:'The -Contractor's License Law does nobapply to - -- - - - -- -- ISSUANCE-$ - - an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $ 'fir tracts from -'such projects' with -a contractor(s)-Iicesned pursuant to SYSTEM - - ` "- - - - - _ GRADING _$ the Contractor's License Law). 100,000,+ BTU - [ ,PLAN CHECK $ - ❑ I am exempC under Section - B. & P. C. for this BOILERS BTV-$, 'ELECTRICAL $ t reason"fv11CROFl SYSTEM REPAIR, PLAN CHECK LM$- Date- - - - - - Owner - - - - ALTERATION EXHAUST SYSTEM MULTIPLE '•� ,MEC - 4PLAN — "" _ -r 'TOTAL FEE $ _- LESS AD- I hereby certify that I have read this application and state that the above_ information I is correct. agree to comply with all city and county CHECK $ _ VANCE PC" $_ ordinances and state laws ql sting t construction, and hereby authorize representativesq{s this/jyrt t enter upon the above mentioned p for_,mdpp ctydr ) •- property purg es. - Z 7- Signature //( J/� C..C.! ` D te� "ISSUE FEE - - "-- -- --- FINAL F L EE $ Drivers' Liccn�.r `_ 0865-46 White -Building; Canary -Applicant; Pink -Accounting: Goldenrod -Assessor d� I CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA=,•r �, APPROVALS - Permit # f f+ Date _- Inspector 1 . Temporary Electrical Service or Pole 43. Pool & Equipment Location - - - - - - - - 2. SoilPipe-Undrgrn 44. Steel Reinforcement - -- - - - - 3. Electrical Conduit Utility-Undrgrn__ 45. Forms - - .4. Electrical Conduit-Undrgrn _ _ _ _ 46. Electrical Bonding - _5. Steelem orce - - 47. RoughPlumbing & Piessure Test _ 6. Electrical UFER Grn _ 48. APPROVACTO COVER-GUNITE -- - - - 7. Footings <11i�. ,�,- '.z 49. Electrical Conduit-Undr rn .8.. Foundation .S. 5 .'n_ 50., Gas Pipe, ❑ Undr rn, Test - - .9.. Water Pipe-Undrgrn 51. Backwash Lines P -Tray. ❑ Undr rn' -• - - • -- -10.- _ -Structural Floor,System 52. APPROVAL TO DECK -11.. Property.Sewer.l,ine-&_House.Connection _ _ -53. _ Backwash & Receptor -Final ` -•• 12. Street Sewer Connection . _ " -- 54. Heater &Vent -Final - 13. _Rough IuLph ,. ,.,. an 773+. _ .. 55, Plumbina - - Final 14. Rough I`ectric -56. -Electrical+inaI _ 15. Rough Electric -Wring ----- -- --- --- - 57. --Solar System -Final 16. Rough Heating & Air Conditioning - ---- - - - - Fencmg & Access Approval 17. Ducts in Structure _ _ _ -59. APPROVED FOR PLASTERING ' 18. Ducts, Ventilating 60. _ POOL/SPA SYSTEMS FINAL - 19. Gas Pipe -Rough & Test - 20. Roof Framing 21. Roof Sheathing '�a' z NOTES: a-�v-s . 22: Frame and FlashingV. 23. Insulation _ -- ' _ _ 24. Lathing & Siding 7K - 25. Drywall Nailing �j-•'f. ,Z _ - 26. Plaster Brown Coat 27: • Electrical Power Meter -Final _ - 28. Final Electric - - 29. Final Heating & Air Conditioning - - 30. Final Gas Pipe -Test ' 31. Final Plumbing 32. - Water Service -Final - - -33. - Gas -Service -Final 34. Solar Domestic -Final 35. Landscape Sprinkling System . + 36. Sound Attenuation 37. Handicap Regulations - 38. FINAL STRUCTURE & BUILDING - g ga ,B.ry� 39. Special Requirements Completed 40. Electric. Release to Edison 41. Gas Release to Southern- California Gas Co. 42. CERTIFICATE OF OCCUPANCY ' No. Date ''- DApplicant to fill in all spaces within .. CITY OF CPSTA NAESA - PE,5JIT NO. rCOi INSTRUCTION PERMIT J border lines and sign all appropriate declarations. TRACT NO. I LOT NO. I BLOGM. n oleo nwress v TYPE OF CONSTRUCTION ❑ NEW ❑ ADD ❑ ALTERATION ❑ REPAIR ❑ CONVERSION ❑DEMOLISH \ - ElOTHER DESCRIPTION OF WORK Owner Phone Address- 1 Arch/Eng. License No. Address�� Lender's Address - DRINKING FOUNTAINS - Contractor Phone TYPE OF PERMIT - ❑GRADING El ❑ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑PLUMBING_❑MECHANIC AddressIi LICENSE CONTRACTOR DECLARATION 'I hereby affirm thLt I am licensed under provisions of Charter 9 (com- 3 , ❑ mencing-with section 7000) of Division of the Business and Professions Code, nd my license is in full for nd effect. OTHER G PROJECT DESCRIPTION iLicense Clas Lice - Date Signature _ SQ. FT. WORKERS' COMPENSATION DECLARATION OCCUPANCY= CONSTRUCTION TYPE I hereby affirm that 1 have a certificate of consent to self -Insure ora VALUATION ZONE - 'certificate of -Workers' -Compensation Insurance, or a.certified copy REFRIGERATION 0-100,000 BTU_ _SYSTEM 100,000+ BTU thereof (Section 3800, Lab. C.). - GRADING CU. YDS. ACRES Policy No. Company - -- REMARKS: ,Certified copy -is hereby furnished._ Certified copy is filed with the city Building Division. .-ay Z7 MECHANICAL- 4321 4/07/82 44.00 'TL� A.P. # ZONE " REAR YARD (TO P/L) PKG. SPACE REQ. 'STREET WIDTH- - SPECIAL CONDITIONS: REF. me BUILDING )PERTY LINE PROVIDED PARK FEE $ DATE .XEMPTION FROM WORKERS COMPENSATION DECLARATION s - ,(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 i ny"manna so as to,become PLUMBING j PLAN CHECK - ELECTRICAL - - PLAN CHECK subject IQ thp,W ars' Compensahop'� of pp llfgyjni a. - _-.- LL•--C/�Sll_ _. /Y'D`-!a /l ai/ BATHTUBS -- -/ -" -SHOWERS "i �.. �r - ,NOTICE: If after making this declaration, you should7become subject TOILETS , 3 . URINALS -- - - Jo the Workers' Compensation provisions of the Labor Code, you must - forthw'th I ith h or this permit shall be deemed LAVATORIES DOUSLE LAVS - 1 comp y with suc prow tions P em .revoked. :CONSTRUCTION LENDING AGENCY Se if C f thi - 1-10 KW , KIT. SINKS DISHWASHERS SERVICE SINKS - SUMPS - ;I hereby affirm that there is a constru0on lending agency for the per. Iformance of the work for which this permit is issued (Section 3097 Civ. CJ: — - - -- - - - - -- - - (Lender's Name - FLOOR SINKS - - FLOOR DRAINS Lender's Address - DRINKING FOUNTAINS - OWNER BUILDER DECLARATION - I hereby affirm that I am exempt from the Contractor's License Law for INTERCEPTORS _ - CLARIFIERS SWIMMING POOL -PTRAP- the -following reason -(Section 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 re- quires the api.licant for such permit to file a signed statement that he WATER SERVICE - ALTERATION GAS SERVICE' OUTLETS is licensed pursuant to the provisions of the -Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the WATER HEATERS - BTU OUTPUT Business and -Professions Code) -or -that he is exempt therefrom and the basis for the allegedexemption. Any violation of Section 7031.5 by SEWER CONNECTIONS ae -applicant for a.permit subjects the applicant to -a -civil penalty more than five hundred dollars ($500). .S owner of -the -property, -or -my employees with -wages as their - SOLAR TANK - - COLLECTORS; �s6 compensation, will do the work, and the structure is not intended or 6ffered for sale:(Section 7044, -Business and Professions 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 or SOLAR PIPING SYS-. -" - -' -- ISSUE FEE" ,through his own employees, provided that such improvements are not 'intentletl -or -offered for sale: If, however, the building or improvement is sold within one year of completion, the owner will have the burden of proving -he did not build or"improve for the purpose of sale). '❑ I, -as owner of. the property, _am exclusively .contracting with licensed contractors to to nstruct the project (Section 7044, Business and. Professions Code: The Contractor's License Law does not apply -to MECHANICAL - - PLAN CHECK - HEATING SYSTEM 0-100,000 BTU_ AND DUCTING - 100,000,+BTU_ REFRIGERATION 0-100,000 BTU_ _SYSTEM 100,000+ BTU an owner of property who builds or ilnproves thereon, and who con- tracts from such projects with a contractor(s) licesned-Pursuant_to- the Contractor's License Law). ❑ 1'am exam t'und _ B'& P - P er c on or s BOILERS - BTU reason Date. Owner- SYSTEM REPAI R, ALTERATION I hereby certify that 1 have read this application and state that the above EXHAUST SYSTEM MULTIPLE information is correct, I agree to -comply -with all city and county ordinances and state laws relating to construction, and hereby authorize representatlyee�� qf7 [hi -ci y -{o enter upon -the above mentioned -- - - pro aet.y �dJ n urp set. Siqnat ure Z� Date - " Drivers' License or SS :P / /%�, ISSUE FEE . CMF 0865-46 White -Building; Canary -Applicant; Pink -Accounting: Goldenrod -Assessor GENERATOR - 0-1 KW__ TRANSFORMER APPLIANCE 10-50 KW-50+KW_ 1-10 KW , MOTORS - - 0-1 HP_1-30 �(INC.SOLAR) 10-50 HP -50 HP - - +.HP _ •FIXTURES OUTLETS SWITCHES - :GASTUBESIGNS - - POLE LIGHTS - - - -- - PANELS- MAIN - SUB SERVICE - AM 'APPLICATION APPROVED BY - -- DATE SUMMARYOF'F EES BUILDING ), _- P.ERMIT $ SMIP, $ PLAN CHECK $ PERMIT. 'PW ISSUANCE $ N181NG $ ,Q� GRADING $ PLAN CHECK $ - - ,ELECTRICAL Is ' - - - $ MICROFILM $ ,PLAN CHECK $- - MECHANICAL- $ _ TOTAL FEE $' 'LESS AD- - PLAN CHECK $ VANCEPC $_ FINAL FEE CONSTRUCTION AND PLANNING APPROVALS Permit # � 3�/ D Date Inspector POOL & SPA Date Inspector APPROVALS Permit # _ 1. Temporary Electrical Service or Pole 43. Pool & Equipment Location - - - 2. SoilPipe-Undrgrn 44. Steel Reinforcement -- - 3. Electrical Conduit Utility-Undrgrn 45. Forms T. Electrical Conduit-Undrgrn 46. Electrical Bonding , - - -- 5. Steel ein orce 47. Rough Plumbing & Pressure Test - - 6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE - -- - 7. Footings 49. Electrical Conduit-Undr rn B. Foundation 50. Gas Pipe, ❑ Undr rn, Test - 9. Water Pipe-Undrgrn 51. Backwash Lines P -Trap,❑ ndr r'n - 10. Structural Floor System 52. APPROVAL TO DECK - - 11. Property Sewer Line & House Connection 53. Backwash & Receptor -Final 12. Street Sewer Connection 54. Heater & Vent -Final 13. Rough Plumbing - Z55. Plumbing System _ Final 14. Rough Electric -Conduit 56.' Electrical -Final 15. Rough Electric -Wiring '- 57. --Solar System -Final 16. Rough Heating & Air Conditioning bs. Fencing & Access Approval 17. Ducts, in Structure APPROVED FOR PLASTERING 18. Ducts, Ventilating 60. POOL/SPA SYSTEMS FINAL ' 19. Gas Pipe -Rough &Test - 20. Roof Framing 21. Roof Sheathing- NOTES: 22. Frame and Flashing 23. Insulation 24. Lathing & Siding 25. Drywall Nailing 26. Plaster Brown Coat 27. Electrical Power Meter -Final - 28. Final Electric I - - 29. Final Heating & Air Conditioning - 30. Final Gas Pipe -Test 31. Final Plumbing - - -d 32. Water Service -Final 33. Gas Service -Final to 34. Solar Domestic -Final - 35. Landscape Sprinkling System 36. Sound Attenuation 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No Date Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. 4350 4/00/02 23.50 CITY OF -COSTA MESA P RMIT NO 3oZ TRACT NO. LOT NO. BLDG NO. OONSTRUCTION PERMIT TYPE OF CONSTRUCTION ❑NEW ❑ADD ❑ALTERATION ❑ REPAIR ❑ CONVERSION C1 DEMOLISH ❑ OTHER - ZONING REGULATIONS Project Address Owner r Phina Address ArchlEng. License No. DESCRIPTION OF WORK ` _ TYPE OF PERMIT. - - -' ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL .❑ TENANT ❑ ELECTRICAL ❑PLUMBING ❑MECHANICA A P ZONE Bt1 SETBACK[ ST. SIDE YARD SIl D YAR PLNG. REF. # Tpgt1ILDING PRO PE RTV LINE - Address Contractor 1011,r - Phone Address - LICENSED C TR C OR DEC LARA ON I hereby affirm that I am licensed oncerovisi sof Ch art 9 (eom- 7000) los.-3 ❑ RIGHT men ting with section of Div' o the Business and Professions Code, antlm license is ull for n;e •at. OTHER REAR YARD (TO P/L) /in PROJECT DESCRIPTION Llcense ass L ¢n o - SO. FT. 't "- PKG. SPACE REO. STREET WIDTH PROVIDED - - PARK FEE $ " �` Date Signature ,[A.v[.,L_ WORKE S' COMPENSATION DECLARATION b'v"/ 'OCCUPANCY _CONSTRUCTION TYPE •1 hereby affirm that I have a certificate of cons t to self -insure or VALUATION ZONE - ZONING -APPROVED ED BV DATE certificate of Workers' Compensation Insuran , or a certified copy thereof (Section 3800, Lab. C.). GRADING CU. YDS. ACRES SPECIAL CONDITIONS: - -' policy No. Company - - - `�.Certified copy Is hereby furnished. _ REMARKS: Certifled copy Is flied with the city Building Division. EMPTION FROM WORKERS' COMP ATION DECLARATION (This section need not be completed if a ar is for one hundred , (• ($100) or less). sr�� Is _ - PLUMBING PLAN CHECK ELECTRICAL - - PLAN CHECK 1 certify that In the performance oft w r ftlr hi is issued, I shall not employ any perso in n man s e subject t he Wo e ' Compensatio lif, r15fp BATHTUBS - SHOWERSAA SO -FT FT Date Signature If NOTICE: If after making this declaration, you should ¢tome subject TOILETS �_ URINALS .G EN ERATO 0-1 KW_ 1-30 W - to the Compensation provisions of the Lab Code, you must _ TRANSFORMER forthwith comply with such provisions or this perm' shall be deemed LAVATORIES DOUBLE LAVS - APPLIANCE 10-50 KW_50+KW revoked. KIT. SINKS - DISHWASHERS- MOTORS 0-1 HP -1-10 HP _ _ CONSTRUCTION LENDING AGENCY - 1 hereby affirm that there Is a construction lending agency for the per. SERVICE SINKS SUMPS _ (INC. SOLAR). - 10-50 HP 50 + HP. formance of the work for which this permit is Issued (Section 3097 FLOOR SINKS - FLOOR DRAINS FIXTURES - OUTLETS SWITCHES - - - Civ.Cr- - - Len's Lender's Name Lender's Address - DRINKING FOUNTAINS ,GAS TUBE SIGNS - - OWNER BUILDER DECLARATIONINTERCEPTORS I hereby affirm that I am exempt from the Contractor's License Law for CLARIFIERS - POLE LIGHTS -' - - POOL - P TRAP KUU - the following reason (Section 7031.5 Business and Professions Code:SWIMMING Any city or county which requires a permit to construct, alter, POLES METERED -SUB' - WATER SERVICE - ALTERATION '- PANELS MAIN SUB - improve, demolish or repair any structure, prior to its issuance, also re- quires the ap4licant for such permit to file a signed statement that he GAS'SERVICE - - OUTLETS SERVICE - - 'AMP is,licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the WATER HEATERS - BTU OUTPUT - - - -- Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by SEWER CONNECTfONS- - - _ - - a--- applicant for a permit subjects the applicant to a civil penalty st more than five hundred dollars ($500). SOLAR TANK COLLECTORS - - - - - - - - as owner of the property, or my employees with wages as their sme compensation, will do the work, and the structure is not Intended _ or offered for sale. (Section 7044, Business and Professions -Code: The SOLAR PIPING SVS. - ISSUE FEE - - - Contractor's License Law does not apply to an owner of a property ISSUE FEE - APPLICATION APPROVED BY - DATE who builds or improves thereon, and who does such work himself or through his own employees, provided that such improvements are not MECHANICAL PLAN CHECK -SUMMARY OF FEES intended or offered for sale. If, however, the building or Improvement is sold within one year of completion, the owner will have the burden of proving he did not build or improve for the purpose of sale). HANDEA SYSTEM 0-100,000 BTU PBUILDING 'PERMIT $ SHIP $ I, as owner of the. property, am -exclusively contracting with El I, DUCTING • licensed contractors to construct the project (Section 7044, Business 100,o00 + BTU PLAN CHECK $ PERMIT and Professlons-Code: The Contractor's License Law does not apply to - ISSUANCE $ an owner of property who builds or improves thereon, and who con- REFRIGERATION 0-100,000 BTU PLUMBING $ tracts from such.projecls with a contractor(s)-licesned pursuant to SYSTEM- GRADING $ the Contractor's License Law). ❑ -under - - - 100,000 + BTU PLAN CHECK $ -- _ $ I am exempt Section B. & P. C. for this BOILERS BTU - ELECTRICAL- $ $s11—�� reason PLAN CHECK $ MICROFILM $ _ Date Own _ SYSTEM REPAIR, ALTERATION EXHAUST SYSTEM MULTIPLE 'MECHANICAL $ TOTAL FEE $ ESS AD. 1 hereby cerlifyth t I hav ad th s p ica i antl state that the above information is c ire I.I 'gree to m y tth all city and county '.PLAN CHECK $ VANCE PC - $- ordinances and st la elelingt n r c ton, and hereby authorize o representatives t t to a to - p the -above nentiort properly for In e s s. /-79Z ¢p � Signature Dated= FINAL FEE $.48 . Drivers' License or Si eF ISSUE FEE - - CMF 0865-46 White-Bullding;Lanary-Applicant; Pink -Accounting; Goldenrod -Assessor T `I CONSTRUCTION AND PLANNING APPROVALS Permit # 30�-� Date Inspector POOL & SPA •'. APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole _ 43. Pool & Equipment Location" - - - 2. Soil ipe-Undrgrn 44. Steel Reinforcement • • T. Electrical Conduit Utility-Undrgrn 45. Forms 4. Electrical Conduit-Undrgrn 11-%'L 46. Electrical Bonding - - 5. Steel ein orce 47. Rough Plumbing & Pressure Test - 6. .Electrical LIFER Grn 48. APPROVAL TO COVER-GUNITE -- -- -- - -- 7. Footings 49. Electrical Conduit-Undr rn 8. Foundation - 50. Gas Pipe, ❑ Undr rn, Test ••. 9. Water Pipe-Undrgrn . 51. Backwash Lines P -Trap" -El Uridrcirn 10. Structural Floor System 52. APPROVAL TO DECK 11. Property Sewer Line & House Connection 53. Backwash & Receptor -Final 12. Street Sewer Connection 54. Heater & Vent -Final 13. Rough Plumbing - -5 1 5.' Plumbina System - Final Rough Electric -Conduit - - -56. =Electrical -Final 15. Rough Electric -Wiring -$Q 57. Solar System -Final 16. Rough Heating & Air Conditioning bb. Fencing & Access Approval 17. Ducts, in Structure 59. APPROVED FOR PLASTERING ; •, 18. 19. 20. Ducts, Ventilating Gas Pipe -Rough &Test - - Roof Framing 60. POOL/SPA SYSTEMS FINAL - • 21. 22. Roof Sheathing Frame and Flashing NOTES: 23. Insulation ' 24. Lathing & Siding - 25. Drywall Nailing 26. Plaster Brown Coat 27. Electrical Power Meter -Final 28. Final Electric 2 29. Final Heating & Air Conditioning 30. Final Gas Pipe -Test 31. Final Plumbing - 32. Water Service -Final 33. Gas Service -Final 34. Solar Domestic -Final 35. Landscape Sprinkling System 36. Sound Attenuation 37. Handicap Regulations - 38. FINAL STRUCTURE & BUILDING 39. Special Requirements Completed 40. Electric Release to Edison 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY No Date Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA PERMIT NO. TRACT NO, LOT NO: BLOC/�V O. ' CONSTRUCTION PERMIT / TYPE OF CONSTRUCTION ❑NEW ❑ADD, ❑ALTERATION ❑ REPAIR El CONVERSION ❑DEMOLISH ❑ OTHER 4497 4/12/62 _ 8000Owner - - _ ZONING REGULATIONS - Project Addre Phone Address" - - - - Arch/En License No. - g-__ DESC RIPTION OF WORK A.P. ' ZONE- PLNG. REF. Address _ _ Contractor - -- Phoncs-AM - TYPE OF�P.ERMI T- ❑ GRADING ❑ FOUNDATION - ❑ STRUCTURAL ❑ TENANT ELECTRICAL ❑PLUMBING ❑MECHANICA SETBACK ST. IRF YARD Tp B�1ILpING - PROPERTY LINE - Addre55 - LICENSE CONTRACTOR DECLARA 10 - - 1 hereby affirm that I am licensed untler ov' s of Charter 9 (com- RIGHT mencing with section 7000) of'Div o o the B Iness and OTHER- Professions Code, and y license s full force REAR YARD (TO P/L) PROJECT DESCRIPTION -- License Class "ren PKG. SPACE REQ. PROVIDED: Date - ignature -SQ. ET. OCCUPANCY_ CONSTR UCTION TYPE STREET WIDTH -PARK'FEEE- WORKERS' COM NSATIONDECLARATION I hereby affirm that 1 have a certificate of cons t o self -Insure or VALUATION ZONE ZONING APPROVED BY DATE certificate of Workers" Compensation Insuranc , or a certified copy thereof (Section 3800, Lab. C.). GRADING CV..VDS. ACRES SPECIAL CONDITIONS: _ _ MIicy No. Company - - - - =ertified copy Is hereby furnished. - REMARKS: Certified copy Is filed with the city Building Division. EXEMPTION FROM WORKERS' -COMPE ATION DECLARATION - - ' `.v (This section need not be completetl if t rmit is for one huntlretl ($100) or less). -- " I certify that in the performance of th wor or whl h his p Issued, I shall not employ any person a ma er o e PLUMBING - PLAN CHECK ELECTRICAL - - PLAN CHECK' - - subject t '� h� W,�ork�¢"r�'- Q r _ - - _ _ BATHTUBS SHOWERS SO, FT_ qn- '-UA"AutFT co�mpensation Date 45rgnature NOTICE: If after making this decla ron, you Shout fe o e subject TOILETS f, URINALS - - "- GENERATOR 0-1 KW_ l'-10 KIN to the Workers' Compensation provisions of the Labor o you must - TRANSFORMER - forthwith comply with such provisions or this permi shall be deemed LAVATORIES DOUBLE LAVS - "•"APPLIANCE 10-50 KW -50 + KW - revoked. - KIT. SINKS - DISHWASHERS "' MOTORS- -'-- 0-1 HP -1-10 HP CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the per- SERVICE SINKS - SVMPS" - t(INC• SOLAR) -.10-50 HP_50+HP formance of the work for which this permit is Issued (Section 3097 FLOOR SINKS -FLOOR DRAINS 'IFIXTURES -OUTLETS SWITCHES Civ. C.).. - - "'- - --- -- - "' Lender's Name _ _ _ _ _ _ Lender's Address DRINKING FOUNTAINS - -GAS TUBE SIGNS- - - - - - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for INTERCEPTORS CLARIFIERS- •POLE'UGHTS - - -- -' - POOL PTRAP - - - - - the following reason -(Section -7031.5 Business and Professions Cotle:SWIMMING Any city or county which requires a permit to construct, alter, POLES METERED SUB WATER SERVICE - ALTERATION - - PANELS' -MAIN SUB '- Improve, demolish or repair any -structure, prior to Its Issuance, also re- quires the ap�licant for such permit to file a signed statement that he 'GAS SERVICE - OUTLETS --- SERVICE - -' AMP - - Is licensedpursuantto the provisions'of -the -Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the WATER HEATERS - --BTU OUTPUT - - _ - 9usiness and Professions Code) or that he is exempt therefrom and the batis for the alleged exemption. Any violation of Section 7031.5 by ' SEWER CONNECTIONS -- - ..�.pplicant-for a -permit subjects'the applicant -to acivil' penalty' :,"M more than_five hundred dollars ($500). SOLAR TANK - 'COLLECTORS' "" - - - - --- - -"'r as owner of the property, or my employees with viages as their sole -compensation, will do-the.work,.and the structure is not intended or offered for sale. (Section 7044, Business and Professions Code: The _ SOLAR PIPING SYS. - ISSUE FEE -- - - Contractor's License. Law_doesnotapply to an owner of a property ISSUE FEE APPLICATION APPROVED - DATE -- - builds or improves thereon, and who does such work himself or through his own employees,. provided that suchimprovements.are not I MECHANICAL PLAN CHECK SUMMA RV OF FEES intended or offered for sale. If, however, the building or improvement is sold.within. one year of completion,.the owner will have the burden of proving he did not build or improve for the purpose of sale). 'BUIL-DING - - - i.f, - - - ❑'I,'as owner of the -property; am exclusively contracting with HEATING SYSTEM 0-100,000 BTU _ _ AND DUCTING 'PERMIT $ $MIP - $- licensed contractors to construct the project (Section 7044, Business 100,000+BTU PLAN CHECK E •PERMIT Code: Tho to License Law doesnotwho antlowner f - - -ISSUANCE $ or is owner of property who builtls or improves thereon, and who con- p builds c REFRIGERATION 0-100,000 BTU I PLUMBING $ tracts' such contractor(s) Ilcesnetl -pursuant to tre SYSTEM - - - -- - - GRADING. _'S the Contractor's License Law). Contractor's cenects- ). 100,000,+ BTU ' PLP.IV CHECK E - ❑ 1 am exempt under Section - - -- - B. & P. C. for this ee o D - -S BOILERS BTU ELECTRICAL $ reason - -- - SYSTEM REPAIR, ALTERATION EXHAUST SYSTEM MULTIPLE PLAN CHECK -$ -MECHANICAL. E- s MICROFILM_$ TOTAL FEE $ -- - LESS 'AD- i Date - -Owner �I hereby certifyth I e ead lois appli lion antl state that the above information is c rr 1 gree to with all City and County 'PLAN CHECK $ VANCE PC' $_ ortl finances andat ws r la o ction, and hereby authorize - representatives o 's c nt on the above mentioned properly for _ _ Signature Date 'ISSUE FEE - - _ FINAL FEE $I�10 - _ Drivers' License or SS - - - CMF 0865-46 White -Building; Pink -Accounting: Goldenrod -Assessor CONSTRUCTION AND PLANNING `..., • n APPROVALS Permit* _� iA, POOL & SPA Date Inspector - APPROVALS Permit # •Date. _Inspector •� 1. Temporary Electrical Service or Pole _ 43. Pool & Equipment location' - - - •'' -= ===' 2. Soil Pipe-Undrgrn 44. Steel Reinforcement - - . 3. Electrical Conduit Utility-Undrgrn 45. Forms - 4. Electrical Conduit-Undrgrn �( _� �' 46. Electrical Bonding_; 5. Steel ein orce 47. Rough Plumbing & rressure.Test 6. Electrical UFER Grn 48. APPROVAL TO COVER-GUNITE. - •- Z�' 7. Footings _ _ 49. Electrical Conduit-Undr rn 8. Foundation - 50. Gas Pipe, ❑ Undr rn,- Test 9. Water Pipe-Undrgrn _ 51. Backwash Lines P-Tra • ❑ ' ndr rn •. - '` 10. Structural Floor System 52.. APPROVALTO DECK '- -'• -" "' -"`"' - s 11.. Property Sewer Line & House Connection 53.. Backwash & Receptor-Final ' 12. Street Sewer Connection_ _ _ - 54. Heater & Vent-Final 13. Rough Plumbing _ _55. Plumbino System - Final 14. Rough Electric-Conduit - - :56. -Electrical-Final 15. Rough Electric-Wiring _ 2 - - - - 57. Solar System-Final - 16. Rough Heating & Air Conditioning- -Fencing & Access Approval 17. Ducts, in Structure . _ APPROVED FOR PLASTERING •, i 18.- 19. 20. Ducts, Ventilating Gas Pipe-Rough & Test Roof Framing 60. POOL/SPA SYSTEMS FINAL 21. 22. Roof Sheathing"-" Frame and Flashing NOTES: 23. Insulation 24. Lathing & Siding - - - 25. Drywall Nailing - 26.. Plaster Brown Coat 27. -Electrical Power Meter-Final -� 28. Final Electric - - `2,0 �- 29. Final Heating & Air Conditioning 30. Final Gas Pipe-Test - 31. . FinalPlumbing- -321- -Water Service-Final - - - - 33. - Gas Service-Final _ 34. Solar Domestic-Final 35. Landscape Sprinkling System 36. Sound Attenuation 37. Handicap Regulations 38. FINAL STRUCTURE & BUILDING _ 39. Special Requirements Completed 40. Electric Release to Edison - 41. Gas Release to Southern California Gas Co. 42. CERTIFICATE OF OCCUPANCY •No Date a i� C. -r7 COSTA MESA BUILDING -SAFETY DEPARTMENT APP LICATION •FgkLATRyfTJRO�LPERMIi 66 P.O.BOX11200 COSTA MESA, CALIFORNIA 92626 Rel' . RECEIVEDB PERMIT ' s% 2 2 For Applicant to Fill in Completely — Use Ink Only BUILDING }fhl'� //�2 �� CC `f�'�q L J A.P. NO. 7 / ADDRESS OWNER OR e. /�//,/�/ TENANT Lit /rf' V` BUILDING r�j��R� MAILING ADDRESS 33 L� 0 UNITSPACE IN . �/ /fin Q TR. LOT- BLK. CITY/ Y &V� G'aL/ NOL.(/ L'(J NEW ADD ALT R REPAIR MOVING DEMOLISH CONSiRUC710N LENDER BRANCH /111V/j /1ZZ OWNER ,C L7l✓C/D L4J V/y CJ ADDRESS /] USE VALUE �rry� $J �/ ARCHITECT�jp� / / OR ENGINEE/R/2KG` CZ:, �. r '7 /JN/E� /f�/t ADDRESS ZS, Fes. // ZYS/ 'tOS C, 127. ZONE 3 TYPE GROUP APPROVED E X Pd Z CONTRACTOR 1;;,,. e e �nsp ADDRESS TEL. Da ^'='ill .. n$rt CITY NE STATE CITY LIC. NO. LIC. NC APPROVED SETBAC - Sia _ L� Q OF !37 IF OTS ( M S FY. ONO. G LOT / J� „] (% NOW ON L RO USE OF l (/ EXISTING BLDG. Separate permits are required for L. SID FT. electric, plumbing and heating work. / (� REAR FT. USE OF BUILDING AND WORK TO BE PERFORMED PLANNI G ACTION DATE (f0NQ0( 0�7APPROVE APPRO D I hereby acknowledge that I have read this application and state f /352 that the above Information is correct and agree to comply with all laws regulating building construction, d�shall not employ any person in violation of the s compensation laws of the State of Celiforni I hereby certify that I am p rd, a tractor untler HQ t rthe Stata of California B ass antl Pr ivision 3,THE AMOUNT SHOWN UNDER VALUATIONIS FOR Chapter 9, antl that suc licenses er n rce and effect, or 1 THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY: am exempt from the provisions of i tate of California Business VALUATION PERMIT FEE $ and Professions Coda, ion 3, Chapter 9. i Signa / PLAN CHECK $ Permittee $ �(�� J TAX $ or Authorized Agent Date TOTAL PAID $ Rel' . 0 LU F Q J Q } J IY lL CL 0 cc CL Z W 2 _H 2 W CL 0 } V_1 N 2 f— COSTA-MESA BUILDING -SAFETY DERARTMeNT P. -O. BOX 1200 Costa Mesa, California 5706 5/11/B2 19.00 TLI I 10 I r r I Contractor Q ey/J L TRACT NO. LOT No. PERMIT NO. RECD BV_� YQ J Address T BUILDING USE DATE ISSUED City zip Code State License No.33 g 3--2 Class. – 2-0 BUILDING - f� ,t •, ADDRESS City License Na. ' Tel. No. � �J NO. ITEM EACH FEES COSTA MESA, CALIFORNIA �•,,t " FAU. Wall, or Gray. Furn. Ind. Ducts and Vents to 100 000 BTU over 100,000 BTU C NEAREST CROSS ST. OWNER MAIL ADDRESS CITY 0 TEL. NO. / A, 1!/ J Vent (if not incl, above) I hereby acknowledge that 1 have read this application and state that the above is correct and agree to comply with ell'City Ordinances and Slate Laws regulating Heat - •Ing;sVcntil sting, Refrigeration and Air -Conditioning. 1 certify that I possess the above valid Stale of Calif - ornia classification or 1 am the legal owner of the single family residential property described above Signature of Permittee I tz"l Suspended Heater Alter Replace Appliance Over eat o gas piping BOILERS OR COMPRESSORS \' 3 H.P. or less �y Over 3 H.P. to 15 H. P. `s' '.' Z_ Vent Fan—Sin Ie.Dluct, REMARKS: _ /"' I' - Ventilating•,Hood Q r _ r. M isb.l O SDS3 T APPROVALS INSPECTOR DATE Ducts Underground Ducts in Structure Ducts Ventilating Zr Heating — Rough Hoods Refrigeration Lines Pressure Test Sub -Total 0 Air-Cond. Final Ventilating Final S— Reinspection Fee Heating Final 7-1 Processing Fee Refrigeration Final Final Gas Test TOTAL FEES ®� Utility Co. Notified ' CMF 0449-46 BLDG. PERMIT NO. "- 1