The URL can be used to link to this page

Home My WebLink About330 16TH PL - Building Permits- _ � ADO��ant to lill in all spaces excep[ tho>.. _A, .�eavy bortler lines an0 sign all apDroOriata tleclarations. CITV OF COSTA MESA C NSTRUCTION NtF�i,,�M{�I 1 ^,� Project Address � 3�� l �� P CqCE [�S�%1 1'�-T . M /�� Applicant's Mailin�,g/� Address S12. 1 U-OW�. 5�(. � �� -1'G Owner's Name '-'( `�K� �' �N Phone Address ��2' f��W�Q` 5�, Arch/Eng. Ziu'�� Q7U1 Lp ��L(j ('p/JC�Q( License No. Address �3 � t s.�� CA dy Contractor's Nam Phone Adtlreu (mailinq) City LicenSe No. LICENSED CONT0.ACTOR DECIARATION I hereby aHirm lhat I am Ilcensatl untler provislonz of Cnartor 9(commenUng witn seclion 7000) ot Dlvision 3 0l tha Businoss antl Prolessions Cotle, antl my Ilcensa is in lull /orco antl eltect. License Class Licenso No. Da[e Si9nature WORKERS' COMPENSATION DECLARATION I nereDy aHirm tnat 1 havo a certi/icate of mnsnnt to selNnsure or a wrtilicate ' Workers' Compensation Insurance, or a certlfietl copy [hnreof (Section 100, Lab. CJ Molicy No. Company eCertifietl covY �s nereby furnisnetl. Certitietl capy B/ilee with the city Builtling Division. Date AOP��canl EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (T�is seclion n!!tl not be comD�Gtetl H th0 permit IT br OnG huntlr0tl (5100) Or less). I certlly lhat in the pe�formdn<e Ot the wO�k fOr wniGb thi5 pGrm�t is isSUGtl 1 shall nol emo�oy any person In any manner zppp as to become subjact to t{�e Workers' [ompenution Laws of Californla.�� Da[e �%'3� 'Y� Slgnature �.ti NOTICE: II, al[tr making�lhis tlecla�atio0, you shoultl becoma Sub�etl t0 lhe Workars' Compensatlon provi5ion5 0l Ihe L.bor Cotlo, you must forthwith comO�Y '�'��h suth prOviSiOns Or thls pe�mlt shall be tleemeU �evoketl. CONSTRUCTION LENDING AGENCV I ncreby aillrm that tnere Is a construction lentling a9ancy for tna oertormance Ot tho work fOr whiCn t�ls permll is ISsuetl (SOCtiOn 3097 Civ. CJ l,entler's Name Lentlar's Atltlress OWNER BUIL�EH UECLARATION I herlby atfirm thal 1 am aaempt from tho ConVactor's Llcania Law tor tne �.,iinwino reason ISoc[lon 7031.5 Businoss antl Prolessional Cotle: AnY city or a 'hcrefrom antl Ihe ba515 for [110 allegeO exemptlOn. Hny viola[�on o� xcuon 31.5 by any ap0��ant for a Oermlt subjec[s tbe ap0��ant l0 a tivil nalty ot mt more [han five buntlretl tlollars (E500). J I, as owner ot [�e Omperty or my employees with wages as tbeir sol9 compensation, will do the work, antl the struc[ure is not intentletl or otfered tor sale (Secilon ]044, Business antl Protessional Cotle: Tho Contractor's License Law does not aoP�Y �o an owner of a proparty who bulltls or improves thereon, antl who aoes sucn work M1imself/herseli or through his or her own Cmployea5, prOvitletl thdl suctl ImprOvament5 ar8 not Intentlatl or oitereC fOf Sale. Ii, hOweveq lhe bulitling Or ImprOvomont Is soltl within one y¢ar of COm- pletlOn, t�e Owne� will have l�¢ burtlen af proving he/sne Eitl nOt builtl o� Im- �rOve ior Ih0 pu�pOSG ol sale). I, a5 owner ot [hv proOerlY. am OxGlusivoly con[racting wilh IicanS¢tl COn- eractOrs to con5lruct tba project (Secllon 7044, Business antl ProtCsSiOns Cotle: Tno Contractar's Licenso I�w daos nOl apply [o an owner of property who builtls or Improvas lnoroon, antl wM10 contracts lor such pro�etts with a con- IraCtar(51 ImOnsn Ounuant to lh¢ ContraGlor'S Litense Law�. I am awarn Ihat proot o! ttloir Worker's Componsalion Insuranco shoultl ba provltletl l0 ma. L7 I am oxempt untler Sectlon B. 6 P. C. for this reason Dalo Owner I hereby certlly tnat I havp rpatl thls applicat on antl state that the above In/ormabon is corrCGl. I agr¢e to compty wl(h all Uty antl counly ortlinances TYPE OF CONSTRUCTION ❑ CONVERSION ❑ 1 DESCRIP.TION OF WOF1 �0 �.�T � PoR zq��) ' ��r VEW LJ ADD ALTERATION IJ REPAIR �H ❑ OTHER F BI,pG.Twv Sro�-y�S; u., TVPEOFPERNtiT LIGRADING'LJFOUNdRST10N LKSTRVCTURAL ❑ TENANT ❑ ELECTRICA/L �❑� �P,(L UMBING ❑ MECHA�ry/ 'ICAL ❑ OTHER . I� �aCp T Q'0.! .3 '✓ O PHOJECT DESCRIPTION 5Q. F7. oCCUaarvcV CONSTRUCTIONTYPE�� VALUATION ZONE GRADING CU. VDS. AC ES_ Remarkt: TJ/ G�l ZZ � Q / A .Z S Sink Preventer 1 Irrigation ]rinking Fountains Floor Drains � Floor Sinks 3as Service �Outlets Interceptors / Kitchen Sink Lavatories P-Trap Roof Dr i s • Reinspeetion Fee $15 Boiler Duct- UnderGrOund Dutt - Structural Duc� - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting � ❑0-100,000 BTU 0109,0006T� Iantl state laws relaling to builtlln9 construction, antl hereby authorizu repre- sentatives ot tnis• cit ent Lpon mo abova-mantionetl property tor inspection pwposes. �O 23_�/ , �Iqnature Oate 3� s' L'c SS � — - Applicanq Pink - Accounting: Goltlenrotl - Assessor $15 Service Sink SewerCap Sewer Connection Solar Coliecmrs Solar Pipin9� Solar Tank Sw�rtSming Pool w/Spa /�lrinal Water Clozet Water Heater Wacer Service Auto-Wash Laundry Trays Isue Fae 5 3 iANICAL FEE Hood or Type I ❑ / Canopy Type 11 ❑ Refrigeration Sys[em ❑0-700,000 6T�100,000 BTU System R ir/Alteration Dampers Registers �— Issue Fee � $ 3 A.P. # �, S - S Main Building: E T Front A Rear � C Right 1 SLeft 5i Ping. Ref. # Planning Notes: � r�z - Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Elen Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Dispoul Generator �0� W C � �j0 � �-i. � nc 9490 12/30/86 � Actessory Building: `P� _ " � - _ ' - 485,44 TL 2one �'�., ELECTRICAL Transformer ❑ 15�50 KW ❑ 50+KW Meter �up ro 100amps Meter Oover 100 amps / Sub Panel � MotorsOGl yD'bi'F,-8 Inc. Solar�9�15 HP � 76�15+ Pole Light Range Standing Settions 5 KW Trash Compactor �� Reinspection Fee � 515 ' I laue Fee DEVELOPMENTSERVICESREQUIREMENTS: � 2oning Approved By BuildingApproved8� ��_!�_,� 2 O N I N G R E � M T S FEES $ 3 a �i5�� SUMMARV OF FEES � BUILDING PERMIT $ � /2•OO SMIP $ PLANCHECK $ �6•9� pERM1T PLUMBING $� ISSUANCE $ PLAN CHECK 25% $ ENERG� P.C. $ ELECTRICAL $ G(iADING $ - PLAN CHECK 50% $. MICROFILM $ MECHANICAL S TOTALFEE $ PLAN CHECK 25% $ ,j 4 i CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical UFER Grnd. � � O�' 57. APPROVAL TO COVER�GUNITE 7. Footings �"E�(� 58. Elecirical Conduit-Undrgrnd. 8. Foundation ' 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System ��- 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor�Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final i 6. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Si�n 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # � 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing ',� 8'� Q 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frameand Flashing 8Z ,�� 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation $7 � 78. FIRE PREV. FINAL 30. Drywall Nailing � pw. HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning � 35. Final Gas Pipe-Test - 0 � �. 36. Hood or Canopy B...0 $� � G� J 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape �rrigation System , 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 4$ 48. Special Requirements Completed �' M 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co . 51. CERTIFICATE OF OCCUPANCY ` Date _ _ �� on� rVn�w �ia�� 81A FORM 1486 � . IIr�ULATION CERTIFICA:T:ION This is to certify that, in conformance with tha current energy regulations.(California Administrative Code, Titie 25, State of Catifornia`) and npproved plans, insulation has been installed in the building located at:' Costa Mesa Orange Ciry County 16th Place 330 1 Unit St�unt�No. (II qvaila�w) Stwoi Lut Num6ar Tnct No. Ogle St. 331 Units- A, II C,& D. DESCRIP710N OF INSTALLATIOiJ � ROOFS Type af Materiul hi811U�eGNfUf Thfckneic R Velua•' EXTERIOR WALCS � Type of Material ' FIbet47.a55 Manufacturer Manvi110 Thltkness 3" R Velue•'. R-11 (Or Tratlo Nema) CEiLINGS � ' BA77S: � �� Type ot Macerial FibPxglass Manutacturer Nl�inville Thickneu 9;" R Volua•• R-30_ (Or Trotla Nemo) Sq. Ft. Covered 4625 BLOWN: Type of Materiel Wt./Bag Fl00RS Type of Matarial SLAB ON GRApE Type of Meterial . Width ot Insufation Menufecturer Thlckneu :,,,! No. Bept (Or Treao N�ms) Sq. Ft. Covered H Value•• Manulacturer Thickneu (Or Toeo N�ma) Manutacturer IOr Tntle Na� IOCM101 Thickness fl Value•• R Value•• FOUNDATION WALLS (i( raquirod) � Type of Matcriel Manulecturer Thfckness H Velue•• � REMARKS (if de�ired) General Contractor (Builder) By IOr 7�ace name) install R-19 Unfaced Zb Sloped Cei19n9s and Garage Ceiling and Overl�anys. Installed Poly Cel. Titte License Numbsr oece Suh•Cantrecmr Unsuiation Applicetorl �Prcrv Cbntrol Tns��lati on � Tnc _ �«ense Num6ar 404A22 .. pn�ul�[Ion, Me�onry, E«.) '��e "SAME" II ums e� Genaral Contratol— BY P'lichael E >>>�L'ar T�<<e w'PciAant Oete, ,T�,1� 7�19R7 (•Calllornia AdminhvacWs CoCe, Em�py InaWsiion SienOerd�, doclarm: EXCERPT trom Sec. 18878 oi the Hea1l0 end Sefity Cotle ot th� Ste�s "Comollance. Voon comolo�Ion of ina Im[elletlon ol Inmletlon. e certl ot Calllomla: � . e��tllyinp thm t�a imula�lon ha� 6een Immlled In conlormance with �he roqulromenu ol tRem roBulaciom sholl be completed antl executed bY "No certiflceta of�occupaacy ar dmller CerttltceUon thet e new{y ton- ths Intulatlon applicator and by tha bulltler. Thit Inmlallon com�liance arocted hotel, motsl, apeftmenl Aouq, � hOme or OIhOr rolltlentlel [ard ihall ba Oo�tad nt e conspicuou� Iocatlon wl�hin the dwelinp;') dwallinp It habltable thell be I�sUed hy ach e bulldinp depertmanl unle�� the aructure et lea�t mtidlq the minimum enarpy Inculetion (••R Value L ihe meawre ol iho ro�istanca ol a mo�erlai or bulltlinB �tendord�e�[abli�hedpur�uentrothiichap[er," com�onan� to Ua pes�age ol heal. The resi�lnnce valuo (R) of ine�a-typo In�u ations shall not Includo any volue lor rellaciiva lecinp.l � . � FOqN I18 - pUBUSMED BY � BaAdhg Hswa; �,� JOSS OVERUND AVENUE, LOS ANGELES, CAUFOANIA 80031—(217) 87aQg7�'-0�pgp � Form 1486 -� BUIIDING tNDUSTPY ASSOCIATIDN OF SOUTHEflN CALIFOflNIA, INC., 1671 Bevarly Blvd., LoiAnpela, Ce11f.80028- (219I Bt6•6771 -Y�I . � ADO��ant to fiil in all spaces eMcept tnose wflhin heavY Dorticr Iines antl sign all apprapriate aeclarations. �'!�� MESa CONSTRUCTION PERMIT FrojectAddress 33D �'{� L C� Applitant's Mailing Address ,� 1'�t,owc-+� .s-f• �M qz 1� Owner's Name �E L� a Phone z2—o ;6 Address Arch/Eng. �icense No. Address ConVacror'sNam Phone '5103 Address (mailing) City License No. LICENSED CONTRACTOR DECLA0.ATION 1 hereby affl�m tM1at 1 am licensetl untle� provislons of Charte� 9(Comm¢nCing with 5ec[lon 7000) o/ Divislon 3 0l tho BuSinesS antl Professlons Cotle, antl my license is in /uIl force antl etfect. Liconse Class License No. Date Signatur¢ WORKERS' COMPENSATION DECLARATION I hereby atfirm that I have a certificate ot consenl to seli�insure or a certificate ot Workers' Compansation Inzuranca, or a certlfletl copy Nereof (Sectlon 3800, �ab. C.) , Policy No. Company Cer[ifietl mpy is nereby furnishetl. Cer[ifietl copy is filetl wlth tne dty Bulltling Divislon. , Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section naetl not bo completetl if the permlt i5 for one huntlretl (5300) or Icss). I certify tha[ In th¢ perl0rmanc0 of th¢ wOrk tOr whi<h th15 perm�t i5 i55uetl I shall n0[ ¢mploy any pe�son In any manne as t0 ec�me subject to t�e Worker CQmp r� atlon Laws�of Calitorni . Date �Z-"�-�b Signa[ure .�� hd_�v �.Al�i NOTICE: II, afie� making lhis tlecld�ation, you Shoultl OECome sub�ect to the Workers' Componsation provisians ot the Lnbor Cotle, you must forthwith comply wlth such p�ovisions o� tM1is pe�mi[ Shall be tlCemetl revoketl. CONSTRUGTION LENDING AGENCV 1 nereby alflrm lhat Ihere is a consbuction lentling agency tor the performanco of th¢ work for whlch Ihis permif is issued (Section 309] Civ. CJ l.enaer's Name Lonticr's Atltlress OWNER BUILDEH OECLARATION I hereby a(firm that 1 am exempt from the Contractor'S License Law for the following reason (Secfion ]031.5 Business antl Professional Cotle: Any ciry or county wnicn requirez a permit to construct, alter, improve, tlemolish or repalr any structure, prior to�its Issuance, also reqWres the applicant for such permit to file a sign¢tl statement that h¢/She is Iic¢n5etl pu�suant to [he provi51on5 of the Contracror's LicenSC law (Chapter 9(commencing with SeCtiOn 7000) ot Dlvislon 3 of tne Business antl Protesslons Cotle) or that he/she is exempt y,�'nera(rom, antl the basis for tne allegetl exemplion. Any violatlon of Sectlon +j�,�'.�,'J31 5 by any applicanl for a permit subjects tM10 applicant to a civll !�,1TBnalty of no[ more tnan five huntlretl tlollars (E500). "L� I, as owner of lhe properly or my employees with wa9es as thelr sole compensation, will tlo thC w0/k, antl [he 5[ructUv¢ IS not Intentletl o� offeretl ior sale (Sectlon 7044, Business antl Professional Cotlo: The Contractor's License Law tloes nol apply [o an owner of a property wno bulltl5 or �mprov¢5 theleon, antl who tloes Sucli work M1lmsalf/M1erself of tbroug h hii or h¢r own ¢mployeei, prOvitletl that such improvemenl5 are not Intentletl o� o/feretl for sale. If, howeve�, the builtlin9 0� ImprOVOment Is sOltl within one yea� of com- pleHon, the owner will have [he burtlen ot proving M1e/sbo tlitl not bulltl or im- ��ova tor tha purposo of sale). I, as owner Oi the 0/operty, am ezGlusively contractinq wlth Ilcensetl con- lractors td construcl lhe project (SeCtlon 7044, Business antl Pwtessions Cotle: The ContractoYs License Law does noi apply [o an owner of property who builtls or improves thereon, antl who contracts for sucn projects wlth a con- t�aclo�(S) bcense pursuan[ to lM1e ContraCtor's Llcense Law). I am aware that prooi of their Worker's Compen5ation Insu�ance shoultl be providetl to me. ❑ I am exempt untler Section B. 6 P. C. ror this reason — . �� P . Date 4'�,rF�bb Owner 1 hereDy certity that I have rea informatlon Is correct. I agree to antl s[af¢ laws rclating to buil ir sentatives of thls city to er inspettlan purposes. Signa[ure Orivers' Litense or SS � _�� above � S- 26 4�58 � � I_.... ...,. TYPE OF CONSTRUCT�(ZN NEW P.�D ALTERATION (3EPAIR ❑ CONVERSION fJ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TVPE OF PERMIT LJ GRADING LJ FOVNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION 5c1. FT. oCCUaAN v1� CON STRUCTION TVPE Vn� uqTION $� ZONE GRADINGCU.VOS. ACfiES— Remarks: � Sink 'cflow Preventer kflow Irrigation Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Warer Heater Water Service Auto-Wash FEES Reinspection Fee ` $15 I I Issue Fee I $ 3 I MECHANICAL FEES Boiler Duct-UnderGround Duct - Structural Duct - Ventilating � Exhaust System ❑ Multiple Firepl/Fact Blt. ICBO # Heating System & Ducting ❑ ai oo,00a eTu O i oo,000 Rainspection Fee � $75 CMF 0865-46, rev. 10/B4 Wnite - Builtlinq; Canary - qppllcant; Pink � Atcounting: Goltlenrod - Assessor Hood or Typel ❑ Canopy Typell ❑ Refrigeration System ❑0-100,000 BTU ❑100,000 BTU System Repair/Alteretion Fire Dampers Registers Issue Fea $ 3 A.P. # S Main Buildi E T Front B Rear A C Right K Left S Ping. Ref. # Planning Notes: Aummatic Washer � Construction Pole Si Cooking Unit � Dishwasher Dryers ❑Gas ❑EI Fan F.A.U. Fixtures Device Boxes . Outl¢t5 Switches Garbage Disposal Generator 00.5'•I(Vv 7963 12/01/86 �' Zone Parking Req./Provided ELECTRICAL Trensformer ❑ 15�50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over100amps Sub Panel MomrS �0.7 HP O 1�- 8 . Inc.Solar �9-15 HP �16- ❑5-15 KW Pole Light Range Sign Standing Sections TraSh CompaCtof I fieinspection Fee � I $15 I I Issue Fee DEVELOPMENT SERVICES REQUIREMEN7S: Zoning Approved By Building Approvad By Appliption Issued 6v FEES $ 3 SU MARY OF FEES BUILDING PERMIT $ �7 SD SMIP $ D• �o PLAN CHECK $ PERMIT � . PLUMBING $ � ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50°,6 $ MICROFILM $ - MECHANICAL S TOTALFEE $ 2�•� PLAN CHECK 25% $ Z O N 1 N G R E Q M T 5 TL �:, CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector'�„� 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms , 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. � 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK , 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap - � 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring , 67. Fencing & Access Approval � 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 78. Rough Electrical-T Bar Ceiling , 69. POOUSPA SYSTEMS FINAL � 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # _ 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating . 71. Product Piping � Gas ❑ Oil . 23. Gas Pipe-Rough & Test 72. Underground Flush ' 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing � 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � 27. Frame and Flashing � 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL - 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing . HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical,Power Meter-Final B0. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning , 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing . 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation - 44. Landscape Irrigation SYstem � 45. Sound Attenuation ' 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING / 3 8� � � 48. Special Requirements Completed 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date _ ADolieant to fili in all spaees exceo� tnose witnin heavy Eoraer lines ana sign all aoPropriate aeclarations. �� ', CITY OF COSTA MESA CONSTRUCTI N PERMIT PERMIT NO.�� I --TRACT NO. LOT NO. UNIT -. , � - � � Project Address 3�� 1 i0 T� �L.fICE.'r �' ' � � , D424 4%01 /85 � 600�] TL ApplicanYs Mailin dd�es R�� /.1l� TYPE OF CONSTRUCTION NEW DD ALTERATION � REPAI R ' - - ❑ CONVERSION ❑ DEMOLISH OTHER q,p, # _ � Zone Owner's Name ., - Phone . DESCRIPTION OF WORK/USE OF BLDG. Address � S Main Building: Accessory Buildin9: ' Arch/Eng. License No. TVPE OF PERMIT GRADING FOUNDATION ❑ STRUCTURAL T Front ' _ p Add�¢55 ❑ TENANT�ELECTRICAL ❑ ,P,LI ,U,�MBING ❑ MECHANICAL A Rear N COntractor'sNam � � ��T �hone %� �'OTHER � ��( Addresslm �I' g) �� /�P�a!UO-�!d ��n PqOJECT DESCRIPTION $Q. FT. OCCUPANCV K Right G � CONSTRUCTIONTVPE VALUATION$ S� Left - ,�R City LiCEn52 NO. ZONE GRADING CV. VDS. ACRES ' LICENSEp CONT(3ACTOR DECLARATION Ping. R¢f.'� Pd�king R¢q./P�Ovided E I hereb affirm that I am licensetl untle� rovi5ions of Charter 9 commencin n Y P ( 9 pemarks: Planning Notes: � M witM1 section ]000) of Division 3 of tM1e Business antl Professions Cotle, antl T , my license is in full ce anf ffect. Licens ass � l Lic se No • ��% S Date — Signature i�� • PLUMBING . FEES � WORKERS' COMPENSATION DECLA ATION U � Bar Sink Showers I hereby attirm that I have a certlficate of consent ro selt-insure or a certificate ELECTRICAL FEES of Wo�ke�s' Compensation Insurance, or a certifietl copy thereo( (Section gackflowPreventer ServiC¢Sink ' 3Bo0, Lab. c.). .. - Flutomatic Washer ,Transformer ❑ 15-50 KW . PolicyNo. ' Company Backflowlrri9ation SewerCa - . ❑50+KW P Construction Pole Sub. Certified coOY is M1ereby furnishetl. Certitietl mpy is filetl witn the city Builtling Division. Bathmbs � Sewer Connection Cooking Uni[ � Meter up to 100 amps i e� Date � Applican[ ' E%EMPTION FHOM WORKERS' COMPENSATION DECLARATION Clarifiers Sol2� COII¢ct0/5 Dishwash2� M2t¢t �over 100 dmp5 (This section neetl not be mmpletetl it tM1e pe�mit is to� one huntl�etl ($100) or , � less). Dishwasher ' Solar Pipin9 ' Dryers ❑Gas ❑Electric Sub Panel � I certify that in the perto�mance ot the wo�k fo� which this permR is issuetl I ' shall mt employ any person in any m ne as to ecome subject to the Drinking Fountains Solar Tank ' Fan Motors �0.1 HP � 1'/a - 6 � Worker ComOe tion Laws ot Cali . Date �� _`�c Signature Floor Drains Swimming Pool w/Spa - F.A.U. � � IneSolar 09-15 HP �16-15+ �NOTIC : If, after making this tle[laration, you shoultl b ome s b ect the ' Workerz' Compensation provision5 of Ihe Labo� Code, ou m (ort with FIOO�SinkS U�inal ' Fixtu�Cs � comply witn such O�ovisions o� this permil shall be tleemetl r¢ ketl. Mic�Owdv2 CONSTRUCTION lENO1NG AGENCV _ G35 SC�vic2 Outl2t5 Watef CIOS¢t � D¢VIC¢ BOx25 • 1 nereby affirm that there is a wnstruction lentlin9 agency for the pertormance ' ' Pole Light � of the wo�k for which this petmit is Issuetl ($ection 3097 Civ. C.) �nterceptors � Water Heater �Utl¢t5 � Lenaer's Name - Range � . Lentlei's Address ' - ' ' Kitchen Sink � Water Service ' . ' OWNER BVILpER �ECLARATION `� Switches 'Sign 1 hereby atfirm tha[ 1 am exempt trom the Contractor's l.icense Law for the Lav2tOli¢5 AutO-WdSh C�d�bag2 Di5pO5dl ;$ianding SECtiOns followin9 reason (Section 7031.5 Busine5s antl Professional Cotle: Any city ot county which requires a permit to construct, alter, improve, demalish or repair P-Trep Laundry Trays ' Generator �0-5 KW �5-15 KW any structure, prlor [o it5 i55uance, also �equires the applican[ fo� such permit T�BSh COrtipdCtO� to file a signetl statement that he/sne is IicenSetl putsuant to tne provisionsbf ROOi D�ainS � the Con[ractor'Sl.icense Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business antl Protessions Cotle) or that he/She is exempt . : - therefrom antl tM1e basis for the alleqetl ezemption. Any violation of Section . . .' , � . � . • ]031.5 by any applicant for a'permit subjects'the aOP��ant to a civil penalty of not more than five huntlretl tlollars ($500�. 3 . � 0 I, as owner of the �property or my employees .with waqes �as thei� sole ReinSpectiOn Fee $75 ISSua F¢e $ compensation, will �tlo tne work, antl the structure is not intentletl or ofteretl - Reinspection Fee $15 ISSue Fee � $ 3 ' for sale (Section �044, Business ane Protessional Cotle: The Contractor's . � MECHANICAI � �- FEES License Law tloes not aOPly [o an owner ot a property who builtls or imp�oves thereon, ana wno tloes such work nimseli/herseH or through his or M1er own ' . DEVE�OPMENT SERVICES REQUIREMENTS: employees, providetl that sucn improvements are not Intended or orrerea for Boiler Hood or Type I ❑ . � sale. If, however, the builtling or improvement is soltl within one year ot com- � Canopy Type 11 ❑ Z°^�^9 /aPProved By Date pletioq the owner w'�II have tlte burtlen ot proving he/she tlitl mt builtl or im- Duct - Und¢r Ground' BUilding App�oved By DdtO ��ove for the purpose of saie). � I, as owner of the property, am exclusively contracting with licensetl con- Duct -S[�uCtu�dl R¢fligefdtiOn Sy5[¢m ApplitdtiOO ISSUBd By ' D3t Vactorsto mnstruct the projecl (Section ]046, Business antl Protessions Cotle: ' The Contractor's License Law tloes not apo�Y to an owner oi property who Duct - Ventilating ❑0-700,000 BTU ❑100,000 BTU SUMMARY OF FEES �' builtls or imptoves [hereon, antl who wntracts Po� such projects with a com � tractor(s1 license pursuant-m the Contractor's Liwnse Law). I am aware that Exhaust5ystem ❑ MWtiple ❑ System Repair/Alteration - BUILDING PERMIT $ SMIP �$ proof of their Worker's Compensation insurance shoula be prov�tletl to me. PLAN CHECK $ PERMIT ❑ I am exempt untler Section e. & P. C. for this reason Firepl/Fact. Blt. ICBO #` Fire Dampers ' ISSUANCE $ � PLUMBING $ oate' ' owner ' Heating System & Oucting Registers - PLAN CHECK 25% $ ENERGV P.C. $ I hereby certity [hat I bave reatl this'application antl stale th5t the above ❑0.100,000 BTU Ot00,0006T ELECTRICAL .$ ��O (�iRADINCi �$ intormation is correcL I.a ree [o comO�Y '�`��h all city antl county ortlinanGes - � -antl state laws r Iatin uiltling mnstruction, antl hereby authorize repre- . � PLAN CHECK 50k $ � MICROFILM $ �sentatives of y t en upon the ¢ntionetl Propert`� to� � � � inspection p � � / / l;S �� ' MECHANICAL �$ ' TOTAL FEE �$ , �'� Siqnalure Date�-� i7 , � � Reinspection Fee $15 laue Fee $ 3 � PLAN CHECK 25% ,$ - orivers' bicense or 55 � � � CMF 0865-46, rev: ]0/84 White - Builtling; Canary - qpplicant; Pink - Accounting; Goltlenrotl - Assessor - ' � - - • � - - � - - - - � - -� -- t CONSTRUCTION AND PLANNING � POOL & SPA APPROVALS Permit# Date Inspector - APPROVALS Permit# Date Inspector 1�. Temporary Electrical Service or Pole 52. Pool & Equipment Location � 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement �3. Electrical Conduit Utility-Undrgrnd. 54. Forms ' 4. Electrical Conduit-Undrgrnd. • 55. Electrical Bonding 5. Steel Reinforcement ^56. Rough Plumbing & Pressure Test ', 6. Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE - 7. Footings - 58. Electrical Conduit-Undrgrnd. $. Foundation � , ,' 59. Gas Pipe, � Undrgrnd., Test � 9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, � Undrgrnd. - 10. Structural Floor System 67. APPROVAL TO DECK - 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap �� 63. Heater & Vent-Final , 13. Roof Drains • 64. Plumbing System - Final � � 14. Rough Plumbing� 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval � 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINA� 79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 27. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush ' 24. Roof Freming 73. Undergrnd.StorageTank �Gas ❑Oil 25. Roof Sheathing � 74. Overhead Hydro 26. T-Bar Ceiling �Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding ' 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE P�REV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final S0. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test � 36. Hood or Canopy � 37. Final Factory Fireplace � � . 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer . , 43. Backflow Irrigation 44. .Landscape Irrigation SYstem - 45. Sound Attenuation � 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING • 48. Special Requirements Completed � 49. Electric Release to Edison � ' 50. Gas Release to Southern California Gas Co ' � 51. CERTIFICATE OF OCCUPANCY , - - • ' . . . � No. Date - • AOO��ant to fill In all spaces exeepl t�ose within �eavY �orEer Ilnes antl sl9n aIl apv�opriate aeclarations. a .� CITV OF COSTA M�E]SA CONSTRUCT�I7ON PERMIT PERM�S�10. �� TRACT NO. LOT NO. UNIT NO. Project Adtlr�ss .J �� a T h 1" L, � Applicant'sMailingAddress b /�L/S.'4 E, j.l��nc (.t, TYPEOFCONSTRUCTION NEW ADD ALTERATION FEP'AIR Owner'S Name m I �tl�i L I� Phone � CONVERSION ❑ DEMOLISH ❑ OTHER A p � Adtlress —j7Z rlOwc` S-t-, L.M. DESCRIPTIONOFWORK/USEOFBLDG. S MainBuildi E Arch/Eng. LicenseNo. TVPEOFPERMIT GRnDwG FOUrvDATION STRUCTVRa� T Front � AddreSS G ❑ TENANT � ELECTRICAL ❑ PLVMBING ❑ MECHANICP.L B Rear ContraCtor'S Nem `� hone � �? i � OTNER ' � A �. ` PROJECT DESCFIPTION 5Q. FT. OCCUPANCY K Right Addresslmnilingl_� Al.�i# C, �r✓i�L �� O� CONSTRUCTION TVPE VAl,UATION S g Left City LiC2n5e No. ZONE GRADING CU. YDS. ACRES LICENSED CONTRACTOR DECLARATION Ping. R¢f. # I horoby a/(Inn that I am Iiconsetl untl0r prOvislons ot Charte� 9(mmmencing aemarks: Planning Notes: with sa<lion 7000) oi Divislon 3 of the BuSiness antl Protessions Cotle, antl my Ikonse is In Iull forca antl e/teci. „_ _,_: ,� Date' -� Si9nature �1�.1� "u� Yn/(�/"� KERS' COMPENSATION DECLARATION . I hereby afflrm thal I hava a certifl<ate ot consent lo selt-insure or a certiiicate � of Workars' Compansation Insurance, or a certifietl copy thereof (Section � IB00, Lab. CJ Policy No. Company 8 Certifietl coOY is hereby lumisbetl. Ce�tliletl copy is fil¢tl with the city Builtling Divislon. Date � APplitan[ E%EMPTION FROM WORKERS' COMPENSATION OECLARATION '(THis sectian neetl not be completetl if tne permit is for one hunUretl (5100) or less). I ceriity that in the pertOrmance Of tbo wo�k to� which this permit is issueQ I Shall nOt emplOy any pe�ion In any man so a5 lQ become subject [o lhe Workers�ompep5ation Laws ol CalifomiJ�` 7: T�7 �� Date � S � Sl9natur0 NOTICE: If, aftar makin9 tnis tleclaratlon, you shoultl be<om¢ subject to tho Workcrs' Compensation O�ovisions ot the labor Code, you must forthwith comply with such provisions or this permit shall be tleemetl ravoketl. CONSTRUCTION LENDING.AGENCV I horCby afllrT that thCro IS a ConitructlOn Ientlinq ag¢n<y for Ihe Oerformanc¢ oi lho work lor whicn Ihis pCrmR is issuotl (Section 3097 Civ. C.) Lentler't Name Lentler'S Adarass OWfJER BUILDEH OECLARATION I �ereby aiflrm that 1 am enempt trom lhe Con(ractor's License law for the loilowing reason (Settion 7031.5 Business antl Professional Cotle: Any city or county whith roquires a oermit to canstruct, alter, improve, tlemolish or reoair any S[ru[ture, pdo� to It5 i55uance, alm �eqWres tha applicant t0/ zucn pe�mlt lo file a slgnetl Sldtem¢nl that Ile/sfle IS IicenS¢tl pursudnt to the plovi5ion5 01 the Contractor'S License Law (Chapter 9(mmmentlng with Section ]000) 01 Division 3 0( [he Buziness antl Pro/essions Code) or that ne/she ii exempt •'�ero(ram anE t�e Dasis for [he aile9ea exemption. Any vlolation of Section i1.5 by any applicant fOr d Petmit 5ubject5 the applicant to a Civll alty oi noi mora ihan five nuntlretl tlallars (5500). .� 1, as owner of the properry or my employees with wages as their sole CompensaHon will tlo t�e work, anU the st�uctur¢ is not int¢nOeC or offer¢tl fo� Sale (Saclion ]044, BuSiness antl PrOte55iOna1 COtle: Th< Conttactol's . Littnse Law Uoes not apply t0 an Owner of a property who builtl5 or iTprOves . the�eon, antl who tloe5 SUGh wo�k nfm5elf/herselt o� through h15 Or he� own employ ecs, provlCeG that such improvements are not intentletl or offeretl tor sale. 11, nowever, tne bulltlin9 or imProvement iz sma witnin one year oi com- pletlon, tna own¢r wlll have the buraen o1 provin9 he/she tlla not builtl or im- P/Ove lor thc Dur005¢ Oi ulo). ❑ I, as own¢r Of thG prOPerty, am ¢%cluslvely tontracting with Ilcemetl con- VattOrS t0 const�Ucl lhe projoct (Sacfion 7044, Business antl Proi¢SSionS Cotle: Tne ConVaGtor'S LI<en58 Law does mt apply to an owner ot property wM10 builtlz or Imoroves tnereon, antl who conVacts far such projects with a<on- traclor(51 IKense pursuant to tlie Contractor's LicenSe Law). I am aware Ihat proot o/ lheir Workar'i COmPOnsatlon insurancu SM1oultl be O�ovitle0 to mn. ❑ I dm exempt untlCr SGctiOn B. & P. C. �o! IhIS rtdion Date Owner - I hereby certity that I have reatl tnis application antl state tnat tne above Iniormatlon is correcL 1 agree'to <omply with all tlty antl county oralnances antl stato laws relaUng to bullEing tonstructlon, antl n¢reby aulhorize repro- sentativas ol tn15 cilY (e�¢nterp upon the above-mentlonetl property for inspection purpqses, 1f , /�, �� Signatura ' �1—/�'� �T��7/'w Date3-S'-� Drivers' License or 55 � � � Bar Sink Backflow Preventer. Backflow Irrigation Balhtubs Clarifiers � Dishwasher Drinking Fountoins Floor Dreins Floor Sinks Gas Service Outlacs '—Trap Roof Drains Reinspaction Fee � 515 8oiler Duct- UnderGround Duc� - Structuml Duct - Ventilnting Exheust$yscem ❑ MWtiple Firepl/Fact. Blt. ICBO �W Heating System & Ducting ❑ 0.100,000 8TU O 100,000 Reinspection Fee � ' S75 CMF 0865-4fi, rev. 10/84- White - Builtling: Canary - Appliwnt; Pink � Accountlng; Goltlenrotl - Asseszor Showers Service Sink Sewer Cap Sewer Connection Solar Colleclors Solar Piping Solar Tank Swimming Pool w/Spa Urindl Water Closet Water Heater Water Service Auto�Wash Isue Fee Hood or Typel ❑ Canopy Typell ❑ Refrigeration System ❑o-ioo,000eru ❑ioo,000 Sysrem RepaidAlteration Fire Dampers Registers Issue Fee FEES Automatic Washer � Construction Pole Sub. Cookin9 Unit Dishwasher Dryers �Gas ❑Elecvic Fan F.A.U. Fixtures Device 8aaes � Outlets 338d 3/05/87 Zone . Req./Provided ELECTRICAL Transformer ❑ 15�50 KW ❑ 50+KW Garbage Disposal � Generator �0�5 KW �5�15 KW Meter Llup to 100 amps Meter �over700amps Sub Panel Morors 00.1 HP � 1 Y. - 8 Int.Solar �9�15 HP �16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor � g�Reinspectian Fae 515 Issue Fee FEES DEVELOPMENT SERVICES RE�UIREMENTS: Zoning APProved By Building Approvad By Appliwtion laued Bv $ 3 49.50 TL Z O N I N G R E � M T S FEES 3 3 SUMMARV OF FEES BUILDING PERMIT $ SMIP $ � PLAN CHECK $ PERMIT PLUNiBING ' � $ � ISSUANCE $ PLAN CHECK 25% S ��y7�� ENERGY P.C. $ ' ELECTRICAL $ � GRADING $ PLANCHECK 50% $ � �I MICROFILM $ MECHANICAL S TOTALFEE $ � PLAN CHECK 25% $ CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor Sysiem 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar SYstem-Final 16. Rough Electric Wiring ��; _� 67. Fencing & Access Approval 17. Rough Wiring Sign �" 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POO VSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test 72, Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Freme and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Fina� 80. FOOD CERTIFICATE ISSUED 33. Final Electric 6^� � J•C , Notes: 34. Final Heating & Air Conditioning � 35. Final Gas Pipe-Test 36. Hood or Canopy 37..Final Factory Fireplace 38. Final Plumbing ' 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer , t . 43. Backflow Irrigatio� � �I - 44. Landscape Irrigation System � 45. Sound Attenuation . ' 46. Handicap Regulations � ' " 47. FINAL STRUCTURE & BUILDING , ' 48. Special Requirements Completed 49. Electric Release to Edison � 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date _ _ \ O \ Applieant to fill in all spaces except ihase within �eavy Eartler lines an0 si9n all aDOroOriale Ceclarations. CITY OF COSTA�MESA�.C�ONSTF�tlCTI PERNJI� �� Projett Address . � Applicant's Mailing Address S• � r Owner s Name Phone �231-Sib Address Arch/Eng. License No. � AddfQ55 �� Contracmi's Nem 1 — /�� o@�"-•-/-'- Address (mailing) � � !�['2�'� �.1C� - Accounting; Goltlenrotl - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal V42IQf CIOSCL Water Heater Water Service Auto-Wash laue Fee Hood or Typel � Canopy Type I I � Refrigeration System ❑aioo,oaaaru ❑ioo.000 System Repair/Alteration Fire Dampers Re9is[ers laue ee ES S 3 $ 3 Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher �� . Dryers �Gas ❑Elec Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator �0.5 KW C Fee 3478 3/06/87 Zone Accessory Building: ELECTRICAL Transformer ❑ 15-50 KW � ❑50+KW Meter Llup ro 100amps Meter ❑over 100 amps Sub Panel Momrs OO-7 HP O1 Yh - 6 Inc.Solar 09-15 HP 016-15+ Microwave Pole Light Range Standing Sections 5 KW Trash Compactor $15 Iszue Fao DEVELOPMENTSERVICESREQUIREMENTS: � Zoning Approved By Building Approved By BUILDING PEFiM1T $ PLAN CHECK � $ PLUMBING $ PLAN CHECK 25°6 S ELECTRICAL S PLAN CHECK 50% $ MECHANICAL � S PIAN CHECK 25% $ B<00 TL Z O N I N G R E Q M T S FEES SUMMARV OF FEES SMIP $ PERMIT ISSUANCE - $ ENERGY P.C. $ GRAOING $ -MICROFILM $ ! � '� TOTAL FEE $ Y�� CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit # Date Inspector p�ppROVALS Permit # Date Inspector i. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement i 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 71. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electriral-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 76. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 79. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT � 20. Rough Factory Fireplace APPROVALS Permit # 27. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil � 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank �Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT • 31. Plaster Brown Coat 79, FINAL INSPECTION � 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric - Notes: 34. Final �Heating & Air Conditioning � . 35. Final Gas Pipe-Test 36. Hood or Canopy , 37. Final Factory Fireplace ' � 38. Final Plumbing ' 39. Water Service-Final � 40. Gas Service-Final 41. Solar pomestic-Final � 42. Backflow Preventer • 43. Backflow Irrigation 44. Landscape Irrigation System , 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 57. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except tnose witM1in heavY �ortler Ilnes anC si9n all appro0��ate tlecla�ations. CITY OF COSTA MESA CON Fj�IJ.�TION PERMIT PERMInT NnO. TRACT NO. LOT NO. UNIT NO. Prolect AddrQss y ��] ' =�` � � L I � � Applicdnt"s Mdiliny Actd� 55 _�� ei 1._ �� TYPE OP CONSTRUCTION NEW ADD AI.TERATION REPAIR Owner's Name i �1 Phone � CONVERSION ❑ DEMOLISH ❑ OTHER (.S �( �,'� DESCRIPTION OF WORK/USE OF BLDG. Address Arch/Eng. License No. Address / r �7 CoMreciar'c Namr �f � Q� . �<I�php no .i'7 /� Address (maTngl �b ��If/ � i �+� V 1 i� City License No. �(,r�+ Y 1 LICENSED CONTRACTOR DECLARATION I nereby aHirm that I am licensetl untler provislons ot Charte� 9(commencing with se[tion ]000) of Division 3 of the Business antl Protessions Cotle, antl my license i5 i�flill )orce antl effect. � LICCO C�dSS � � � � �nn5 NO , Date � a� ��5'9 t • T t. 1 T—� WORKERS' COMPENSATION DECLARATION I hereby af(irm that I have a certiticate oi consent to selbinsure or a certlficate of Worke�5' Compensation Insura e,. o�� certifietl copy thereoi ($ection 3800, Lab. � �X^� � � I (� b7 ,.( � Policy No. r�� ^�+ Company ��a' � O �U �A � eCertifletl copy is hereby fumishetl. Certifietl wpy is filetl with the city Builtling Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section neetl not be mmpletetl if the permit is for one huntlretl (5300) or less). 1 certify that in the perfo�mance of tM1e work !Or which [his perm�t is iSSuetl, I sM1all not employ any pe�son in any manne� so as to become 5ubjeCt to tM1e Workers' Compensation Laws of California. Date Signature NOTICE: If, aiter making this tleclaration, you shoultl become subject to tha Workers' Compensation provisions of the 12bo� Cotle, you must for[hwith comply with SucM1 p�ovisions or ihis pe�mit shall be tleemetl �evoke0. CONSTRUCTION LENDING AGENCV ' � 1 M1e�eby af}irm that there is a conztruction lentling a9ency to� tM1e pe�fo�mance ot the work for which [hiz permi[ is issuetl (Section 309] Civ. C.) Lentler's Name Lentler'S Htltlre55 � OWNER BUILDER DECLARATION I nereby ai(irm ihat I am exempt from the ConVactor's License Law for the following redson (Se<tion ]031.5 Business antl Professional Cotle: Any city or counry whlch requires a permit to construct, alter, improve, tlemolish or repair any structure, prior to its issuance, also requires cne applicant for sucn permit lo file a signetl statement that he/she is licensetl pursudnt to [he provisions of � the contractor's License Law (Chapter 9(commencing witn Section �000) ot Division 3 of tM1e Business antl Professions Cotle) or that M1e/she is exempt the�etrom antl the basis for tM1e allegetl exemption. Any violation of SettiOn 7031.5 by any applican[ for a permit subjects the applicant [o a civil � penalty of not more tban five huntlretl tlollars ($500). � �❑ I, as owner of the property or my employees witn wa9es as their sote '. wmpensation, will tlo the work, antl the structure is not intentletl or otferetl ' tor sale �Section 7044, Business antl Professional Cotle: Tne Contraccor's LiCense Law tloe5 not appty to an owner ot a prope�ty who builtls o� Imp�oves thereon, antl who does such work himseli/herseH or through his or ner own employees, provitletl tM1at such improvements are not intendetl or otferetl fov sale. It, howeveq the builtling or improvement is soltl within one year of com- pletion, [be owner will bave [be bu�tlen ot proving he/56e tlitl not builtl or im- prove for the purpose of SaleJ. ❑ I, as owner of the D�operty, am exclusivery contracting with licensetl com tra<torsto construct the project (Seciion ]044, Business antl Professions Cotle: The Contractor'S License Law tloez not apply to an owner of property who builtls or improves thereon, antl who contrac[5 for such Drojects with a con- tractor(s1 iicense Dursuant to tne Contractor's License Law). I am aware that proot of their Worker'S Compensation insurance shoultl be provided to me. ❑ I am exempt untler Section B. & P. C. ior this reason Date owner _ 1 nereby certify that 1 have reatl this a iniormation is correct. I agree to comply antl state laws r latin9 to builtling <onst 520IdtIV25� S IS CIIy [O ¢Ili I Il 011� inspectio oses.�- Signa[ure Drivers' L cen5e or 55 � — that the above TVPE OF PERMIT LJ GRADING L1 FOUNOATION LI STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAI ❑ OTHER PROJECT DESCRIPTION Sp. PT. OCCUPANCV CON STRUCTION TVPE VALUATION $ _ ZONE GRA�INGCU.YDS. ' ACRES_ pemarks;_ � $ 'Z � % ^L 7 3ackflow Preventer �� 3ackflow Irrigation 3athtubs �larifiers 7ishwasher� 7rinking Pountains =1oor Dreins �loor Sinks . .'�35 $2lVIC¢ �UtIESS Intercepmrs Kitchen Sink Lavatories - P—Trap Roof Dra" s ReinspeMion Fee - $15 Boiler Duct- UnderGround Duct - Structural Duct � Veniilating Exhaust System ❑ Multiple ❑ Firepl/Fact.Blt.IC80 73G Heating System & Ducting ❑0.100,000 BTU 0100,OOOBT fieinSpBMion Fee � $15 CMF 0865-46, rev. 10/B4 � Accoun[ing; Goltlenrotl - As5e55or Showers 'ServiceSink ' Sewer Cap Sewer Connection Solar Collectors � Solar Piping Solar Ta Pool w/Spa Urinal Water Closet Water Heater Water Service � Auto-Wash Laundry Trays Issue Fea Hoodor Typel Canopy Type I I Refrigeration System ❑aioo,aooeru ❑ioo,00a System Repair/Alteration Fire Dampers Registers Issue Fee $ 3 $ 3 A.P. # S Main Buildi E T Front B Rear A C Right K Left S Ping. fief. # Planning Notes: Auromatic Washer ConsVuction Pole Sub. Cooking Unit� Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets $witche5 Garhage Dispoul ' Generator �0- ❑5-� 4507 3/24/87 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 700 amps Meter ❑over100am Sub Panel Motors O0. P O1 h- 8 - Inc.So 9-75 HP �i6-15+ M owave Pole Light Range I I Standing Sections 5 KW I I Trash Compactor I Rainspection Fee �$15 I I Issue Fee DEVELOPMENTSERVICESREQUIREMENTS: , Zoning Approved By euildin9 Approved By ,�9_/' [ a�- 14025 TL FEES $ 3 Z O N I N G R E � M T S SUMMARV OF FEES � BUILDING PERMIT $ � SMIP $ PLAN CHECK $ PERMIT PLUMBING $ � ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ � ELECTRICAL $ GRADING S P�ANCHECK 50% $ MICROFILM $ _� MECHANICAL $ . �� vJ TOTAL FEE S � • ZS PLAN CHECK 25% $ � `L.'�+0 ' � CONSTRUCTION AND PLANNING POO� .,. SPA APPROVALS Permit# Date Inspector p�ppROVAIS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment �ocation 2.�Soil Pipe-Undrgrnd. 53. Steel Reinforcement ' � 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical'Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel'Reinforcement , 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7.'Footings 58. Electrical Conduit-Undrgrnd. '8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Root Draint � 64. Plumbing SYs[em - Finai '_ 14. Rough Plumbing ' 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring ' 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18: Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace � APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro ,• 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage 7ank O Gas ❑ Oil 25. Roof Sheathing 74, Overhead Hydro 26. T-Bar Ceilin9 (Structural) & Monocoat � 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78, FIRE PREV. FINAL 30. Drywall Nailing , � HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat , 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICA7E ISSUED 33. Final Electric � Notes: � 34. Final Heating & Air Conditioning �� 35. Final Gas Pipe-Test 36. Hood or Canopy � 37. Final Factory Fireplace 38. Final Plumbing � 39. Water Service-Final 40. Gas Service-Final 47. Solar pomestic-Final 42. Backflow Preventer ' 43. Backflow Irrigation � 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations - 4�. FINALSTRUCTURE&BUILDING � 48. Special Requirements Cbmpleted � 49. Electric Release to Edison _ , 50. Gas Release to Southern California Gas Co ' � 51. CERTIFICATE OF OCCUPANCY . � No. Date ADPlicant to fill in all ipaces ezcept those within heavY OorCer lines an0 sign all apProp�iate Ceclarations. PERM17lW0. _. TRACT NO. LOT NO. UNiT Nh. cirY oF COSTa mESA (7;ONSTRUCTION PERMIT Project Addre3s �� C7 / G �x— o AppliCanYs Maili �I � ss � C � S• Owner"s Name � p Phone Address � � y �L � I-- � Arch%Eng. License No. Address � /�-� �g Conuacwr's Nam � � (� - �� o Phon,e, _9k�—��2nL� Addresslmailin9l�l✓ CJ, � a�L� City Licen<r Nn 0 Z �� :� � � LICENSED CONTRACTOR OECLARATION I hereby affirm tnat i am licensetl untler provisions of Charter 9(commencinq with section 7000� of Division 3 of the Business antl Professions Cotle, antl my license is I u 1/orce antl effecL � [ Licens Clas nse I Q� O Oate' j�� "� 5'g t WORKERS' COMPENSATION D CIARATION 'I hereby aiti�m that I have a certificate ot consent to selt-insure or a certiticate �f Workers' ComOensation Insur nce, r a certlfietl copY thereof (Section 3800, lab. �y � Lc J PolicY No. � � 9 � 11 �.�}PanY �� u � " Da�C ifietl mpy iz hereby futmshe ifi op � filea `�'Appl tant 9'� � EXEMPTION FROM WORKERS' C MPENSATION ECLA ATION (This zection neetl no[ be completetl if the permit is for one h ntlred (5300) or less). ' I certify t�at in the'perfarman<e of the worKfor which this permit is iSsued, I shall no[ employ any person in any manner, so as to become SubjeGt to [he Wo�ke�s' Compensation Laws �of California. ' Date $i9nature NOTICE: If, a(ter making this tleclaration, you shoultl become Subject to tne . Workers' Compensation provisions of the Labor Cotle, you must forthwith comply with such provisions or thi5 permit Shall be tleemetl�revoketl. CONSTRVCTION LENDING AGENCV 1 hereby affi�m tha[ IM1ere is a construction lentling d9ency for the perfo�mance of the work for which this permit is issuetl (Section 3097. dv. CJ Lentler's Name �entler's Atltlress OWNE0.BUILDEH DECLARATION � ' � I he�eby affirm Ihat 1 am exempt from'the ConVdttor'S License Law tor the following.reason (Section ]031.5 Busine55 antl Professional COGet Any city or county whicb reQuires a permit to con5truct, al[eq improve, tlemolish ot �epair any structure, priorto its issuance, also requires the applicant for such permit to file a signetl statement thdt he/she i5licen5etl pursuant to the p�ovi5ionsbf the Contractor's License Law (Chapter 9(commencing with Section 7000) of Divizion 3 of the Business antl Professions-Cotle) or that he/she is exempt [herefrom and ihe basis for the allegetl exemption. Any violation of Secfion ]031.5 -by any applicant for a permit subject5 [he applicant to a civil , eenalty ot not more Nan five nuntlreC tlollars ($500). . LJ I, as owner of Ihe'� property or my employees witn wages as tneir sole ' compensation, will tlo the work, antl ihe structure is not intentletl or olferetl �, tor sale (Section 7044, Business antl Professional Cotle: The Contractor's i License Law tloes not apply to an owner of a property who builtls or improves thereon, and who aoes such work himselt/herselt or through his or her own employees, provitletl Ihat sucb improvements are not intentletl or offeretl for sale. If, howeveq [he builtling or improvement is soltl within one year of com- pletion, the owner will have Ihe burtlen Of proving he/she tlitl not builtl or im- �rove for the purpose of sale). I, as owner of the Oroperty, am exclusively contractin9 �+�th licensetl ron- trattors to cbnst�uct the project (SectiOn �044, Business antl Professions Code: The Contractor's License Law does not appty to an owne� of property who bulltls o� imp�oves [hereon, antl wno conVacts for such projects witM1 a con- tractor(s ❑cense oursuant to the Contractor's license Law). I am aware that prooi o� their Worker's Compensalion inswance shoultl be provitletl to me. ❑ I am exempt untler Section B. & P. C. tor this reason Date ' - Owner — I he�eby ter[ify [hat 1 have reatl tM1 infotmatian is correct. I agr¢e [o con antl state laws rylating�to builtling p� Sentalive;i0g�ys'. ciTy t��,[er qp Signature Drivers' icense or 55 CMF 0865-46, rev. 10/B4 that the above TVPE OF CONSTRUCTION . Q`J NEW LJ.ADD LJ ALTERATION LJ REPAI R ❑ CONVERSION ❑ DEMOLISH ❑ OTHER p, p# DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TVPEOFPERMIT ❑GRAOING FOVNDATION STRVCTVRAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL B Rear ❑ OTHER. . %� C Right PROJECT DESCRIPTION Sq. FT. oCCUcnrvCv K CONSTRUCTIONTVPE VALUATION$ � S Left ZONE GRADING CU. VDS. ACRES p��y, qe{,.ps Remarks: - � Planning Notes: P BarSink� � � Backflow Preventer Backflow Irrigation Bathtubs ' � . Clarifiers ' _ Drinking Fountains Floor Drains Floor Sinks Gas Service Interceptors Kitchen Sink ' Lavatories P-Trap . Roof Drains ' Reinspection Fee Showers Service Sink Sewer Cap _ _� �Sewer Connection Solar Collectors Solar Piping - Solar Tank Swimming Pool w/$pa Urinal Outlets Water Closet Water Heater • � . Water Service . ' . AutO-WBSh . $15 Boiler Duct- UnderGrOund Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. BIL ICBO # Heating System & Ducting ❑0-700,000 BTU 0100,000 peinspection Fee . � I $15 White - Building; Canary - qpppcanh Pink - Accounting; Goltlenrotl - Assessor : ' Isue Fee Hood or Type 1 ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers Isue Fee 0 FEES Automatic Washer Construction, Pole Sub. Caaking Unit � Dishwasher Dryers OGas ❑Elec Fan � F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator �0-5 KW C �i� ii�wvi � 34 6 {`' Zone Accessory Building: Parking Req./Provitled ELEC7RICAL - Transformer-0 75-50KW ❑ 50+KW � Meter ❑up to 100 amps Meter ❑over-700amps Sub Panel • � MotarsOO-1 HPO1'/:-8 � Inc.Solar �9-15 HP �16-15+ Microwave Pole Light . Range Sign �' . 5 KW Trash Compactor $� Reinspection Fee $15 Issue Fee FEES DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved By Building Approved By , Appliption Issuad BY $ 3 ' SUMMARV OF.FEES � BUILDING PERMIT $ ' �/�S MIP $ PLAN CHECK $ �DIHERMiT � PLUMBING _ $ �ISSUANCE $ PLAN CHECK 25% $ .a�� '��ENERGV P.C. $ ELECTRICAL $ GRADING $ PLANCHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ P�AN CHECK 25% $ a tloUU iL ; 1 1. FEES $ Z O N I N G R E Q M T S, CONSTRUCTION AND PLANNING POOL & SPA . APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6� Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE � 7. Footings . 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, � Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final � i 6. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FIIVAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat - 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: � 34. Final Heating & Air Conditioning � 35. Final Gas Pipe-Test � 36.,Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing ` $ � 39. Water Service-Final . - 40. Gas Service-Final 41. Solar pomestic-Final � 42. Backflow Preventer 43. Backflow Irrigation � � 44. Landscape Irrigation System 45. Sound Attenuation . � • 46. Handicap Regulations . 47. FINALSTRUCTURE & BUILD�NG . 48. Special Requirements Completed 49. Electric Release to Edison • � 50. Gas Release to Southern California Gas Cn ; 51. CERTIFICATE OF OCCUPANCY No. Date AOP��ant to flll in all spaces eviceot t�asa withln neavy Goroer lines antl sign all apvropriata aeclaratians. CITY l,�F COSTA MESA CONSTR UCTI ON PERMIT '� PERMIT � � TRACT NO. �OT NO. � UNIT N0. yrojectAddress ,��30 ��G 3�/� j7117GG Applicant's Mailing Address a•�%� N� �'I�sstLG drriN�� Owner's Name AJ/�� L j�✓ Phone Address �%•� /r/C4�CJ� .3J� L�cs7�le_!_+1G.iE - Arch/Eng. License No. Addrea Convactor'sNama �l G f�Gbirll�/NG . Phone�%yS'✓�ZZ Addresslmailingl��%aND GLas'se! '-�i4 CiAi✓GG City Licenu No. FrS� � LICENSED CONTRACT00. DECLARATION � horeby aflinn tnat � am Ilcensetl untlar provi5ion5 a� C�ar[er 9(commencin9 j with 5eclion ]000) ot Division 3 af tne Business i�tl Proteisions Cotle, antl lti• my Iicense is in full force antl eliact. \Ucense Class C�� . Litt ze No.�/�/��%� oate �'�L' 8 �i 5lqnature � WORKERS'COMPENSATION DECLARATION � I hereby af/lrm that I have a certilicate of consent to ��+nsure or a certiflcate \/� ot Wo�kers' Compansation InSurance, or a cerllfietl wpy tha�eot (Sectbn 3800, Lab. C.) / / ` P IicY No. ��yC�"iSG% ComPanY J�%i� �(/rti� � ��CertHlea coOY is �ereby fumishetl. LJ Ce.t lied copy �is rilea witn the city Bui tl`, g �Ivisl n. Oate ��/L ' 31 �j APPlicant ��'^�-� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thiszectlon noetl not bn completetl It the permit ts �or o�e huntlrea (5100) or less). I cerUfy that in tM1e perbrmanc¢ ot the wOrk.tOr wp�th this pCrmi� iz ISsuetl I shall not employ any parson In any manner so as �o become subject to t�e Workers' CompensaUon Laws ot Calitornia. . � Date Si9nature NOTICE: 11, afler making lhis tlatlaration, you ihoqltl become sup7ect [o t�o WOrkerS' CompCnSatlon provlsions o1 th¢ Ldbot Cotle, y0u must lorthwitit comply with such p�avislons o� �his De�mlt Snall be tltemetl rOVOketl. CONSTRUCTION �ENDING AGENCV �- ' I nureby aHl�m lhal there i5 a mnSVuction Ientling agency lo� Inc parimmancu of the work for whith 1h15 pGrmit IS ISSuetl (Se�t�on 3097 Civ. C.) Lpntler's Namc - Lentler'S ACErc55 � OWNER BUILDEN UECLARATION ' I heroby afflrrn lhat I dm oxompt irOm Iho Cont�ac[o�'S Llcense I..aw lor th0 lollowing reazon (Soctlon 7031.5 Buslness antl Pro/esslonal Cotla: Any cilY or <ounty whicn requires a permit to construtt, allor, �mprava, tlemolizh or repalr am structure. orbr to Its Issuanco, also raqWres the appllcant for sucn Oormit Dlvislon 3 01 t�a Buslness antl Prolessions Cotle) or mac ne/sne is axomp� )hemlrom and lne basls for !he allogetl exemplion. AnY �lolatlon oi Sectlon '�jhh!�031 5 by any applicanl tor a purmlt subjects ��e applicant to a civil �<neunalty o/ not more tnan flve nuntlretl tlollars (E500I. • �'��"."� I, as ownor ol tne o�oparty or my omployeas wlth wagos as tnolr sole compensatlon, will tlo t�e work, antl Ihe itructure �i not Intantletl or olterotl for sala (Saction 7044, Business antl Profossiona� CoCa: Tho Contractor's License l.aw tloes nat apply IO an ownOr 01 a properry who builtl5 or ImprOves tnaraon, antl who tlocs sucn work hlmself/narsalf or througn his or hor own employces, Provltletl Inat suc� Improvamants aro not intontlod or oflared for sale. If, howevaq Ihe bulltling or ImOrovement Is soltl wit�ln ona voar of com- plsllan, lhn'ownar wlll M1avc the burCen ol O�oving ne/s�a tlltl not bulltl ar IT- �rove fOr [hn purposo ol sale�. I, as owner ol tne.Droperty, am exclusivnry coq�ractin9 wlth Ilcensetl con- Haclors lo con5[�uct lhe prOject (SeCtiOn 7044, Bus��ess antl PrOf¢SSionS Cotla: The COn(raCtor's Ucense Law does not dpply to On owner of pro0erty who builtls or imowvos thernon, antl who conVacts (of sucn projects with a con- tractor(S license pufsuant to lhe ContrdCtOr'S llGon58 Law). 1 am aware that proot o� tnelr Workor's Compensatlon insuranca snoultl Do provitletl ta me. ❑ 1 am Oxempt untler SCctiOn B. & P. C. br thi5 r0a5on Date Owner I hereby certity �that I have reatl this applicatlon antl state that tho abovo informatlon�is rorre<L I agree to comply witn all C��Y ana county ortllnancas antl s[ate laws rolating to bulltling consVuction, antl hereby authorize repre� sanlativus ot tnis tlty to enter upon the abovo-mentlonetl property for inSpeCtlon purp SeS. Si9nature Date �"�6�� % Drivers' License or 55 yp - TYPE OF CDNSTRUCTION LN NEW U ADD LJ ALTERATION IJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER p.p.# � DESCRIPTION OF WORK/USE OF BLDG. • S Main Buildi TYPE OF PERMIT GRAOING FOVNDATION STRUCTURAL T FrOnt ❑ TENANT ❑ ELECTRICHL �PLUMBING ❑ MECHANICAL B R¢d� ' ❑ OTHER A C Right " PROJECT DESCRIPTION Sa. FT. oCCUaANCV K CONSTRUCTION TVPE VALUATION 5 S Left � ZONE�_ GRAOING CU.YDS. ACRES, Ping. ReL # Remarks: Q� �R� �� Planning Notes: 3ar Sink 3ackflow Preventer 3ackflow Irrigatibn ' 3athmbs . . Clarifiers . � Jishwasher Drinking Fountains Floor Orains - Floor Sinks Gas Service Outletss Interceptors Kitchen Sink Lavatorics P—Trap Roof Drains ' Rainspection Fea $15 Boiler Duct - Under Ground Duct � Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ FirepUFacL Blt. ICBO # Heating System & Ducting ❑0-100,000 BTU 0100 BT Fae � S15 Showers Service Sink Sewer Cap SPwef Connection Solar Collectof5_ � Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Warer Closet Water Heater Water Service Auto�Wash Issue Fee iANICAL Hood or Type I I Canopy Type 11 � Refrigeration Sys[em ❑0-100,0008TU ❑ $YSL2I11 f�E � I(EfF F' ampers Registers Issue Fea $ 3 $ 3 Automatic Washer Construct ion� Po le Cooking Unit . Dishwasher � Oryers ❑Gas ❑ Fan F.A,U. Fixtures Device Boxes Outlets Switches Gar6age Disposal Generator � K Zone Accessory B Park�ng Req./Provided ELECTRICAL Transformer ❑ 75-50 KW ❑ SO + KW �� Meter �up to 100 amps Meter ❑over t00amp Su6 Panel � . Motors �0. P �1'r4 - 6 Inc.S ❑9�75 HP �1&15+ rowave Pole L�ght / Sign � Standing Sections 5-15 KW . Trash Compactor . 1 Reinspeaion Fee �$75 � � Issue Fee DEVELOPMENT SERVICES RE�UIREMENTS: Zoning Approved By Building Approved By Applitation luuad By FEES $ 3 Z O N I N G R E � M T 5 • SUMMARV OF FEES V - BUILDING PEFMIT $ SMIP q PLAN CHECK �$ Z� PERMIT PLUMBING $ NJ.Sb ISSUANCE $. PLAN CHECK 25% $ '�-�' S� n��NERGY P.C. $ ELECTRICAL $ GRADING' . $ - PLANCHECK 50% $ MICROFILM $ � MECHANICAL � $ TOTALFEE $� PLANCHECK 25% $ {�(q. (,3 CMF 0865-46, rev. 30/84 Whi[e - Builtling; Canary - APplicanp Pink - Accounting; Goltlenrotl � Assessor ' '_� I\ �� / CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. � �/�) � � 53. Steel Reinforcement 3. Electrical Conduit Utility�Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE - • 7. Footings 58. Electrical Conduit-Undrgrnd. - 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection �� 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 16. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # _ 21. DuCts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 77. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72, Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank �Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy • 37. Final Factory Fireplace � 38�. Final Plumbing 4 . 39. Water Service-Final 40. Gas Service-Final 47. Solar pomestic-Final 42. Backflow Preventer � 43. Backflow Irrigation � � 44. Landscape Irrigation System 45. Sound At[enuation 46. Handicap Regulations � 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed � 49. Electric Release to Edison � . 50. Gas Release to Southern California Gas Co i 51. CERTIFICATE OF OCCUPANCY • No. Date _ � 8�74 12/I'%:= IcO.; : iL COSTA MESA SAPlITi4RY DISTRICT 0 0 3 5 51 MONEY RECEIPTS ADVIC@ Date ��-��- `,� Amount $ � ) • �% N�P l_;% ��,1;,�— L n�� , s_{ Payer � , " � . aa_...,. �i -� r' l L, �I-. I I C: �C,� For l� ,L — �" (-: - 3 S s�� '�=��L/.�.cl��-t��_,�� J � CMF q944-68 Wnite-CuStOmer, Canary-Department: Pink-Flmnce: Goltlenrotl-File ._ % COSTA MESA SANITARY DISTItICT iZ_[ r- .rS(:. nmount ��; f�7Z . �-� Payer For � MONEY RKEIPTS ADVICE 8573 12/II/8t 60��.00 003553 � ". 1 I .� t' � �r �P.a r(�,c'��f � .(� � -�i /.•r. l.!�., T V // — t�/ /�/`/'lCC Slgneri �/lC.G��-Cc-,.•-.�-! � U CMF 0944-68 WM[e-Customcr, Canary-Department: Plnk-Flnanca; Goltlenroa-Fila COSTA MESA SdNITAitY DISTRIGT Date � Z � � � - � � Amount $ � �, � • � MONEY RKEIPTS ADVICE � �' !� i� 'v F� l Payer -- `� ', l. ��=. '{'l` j� � l�--Gi=. Addres� For a�;� i��J�35�52 _� .�. ;� � � — Q��.- � � s�� (GC-C�I�� / ✓ CMF 0944-68 Wnite-Customar; Canary-Department; Pink-Finance; Goltlenrotl-Flle i54 S�'� � CITY OF�SSTA �4ES. BUILDING SAFETY OIVISiuN POST IN CONSPICUOUS PLACE ON THE JOB NOTICE . You must furnish PERMIT NUMBER and the JOB ADDRESS FOR EACH RESPECTIVE INSPFCTION. CALL 754�5627. qPPROVED PLANS SHALL BE ON JOB A7 ALL 71MES. A. P. NO. DATE ISSUED y�-s-.��-�o �a-3o- E�. TyPE GROUP PERM17 NO. �3 �/ ��7�� BUILDING ADDRE55 � 33d /6� �'/��e �a� �� NEW ADO ALTER REPAIR OWNER M��r� L; ti �,,,�, �z -�� ; � �, �os .�� s r•��y � c.a � Wl a�ln.�d aav-q P oV� --�- TBACKS Front Yd. Side Yd. L - Side Yd. L _ CONSTRUCTION AND PIANNING APPROVALS Permit # R Aear R Rear t. Temporary Electriwl Service or Pole 2. Soil Pipe-Undrgrnd. 3. Electrical Conduit Utility�Undrgmd. 4. Electrical ConduiPUndrgrnd. 5. Steel Reinforcement 6. Electrical UFER Grnd. 7. Fooiings �' ST�� 8. Foundation 9. Water Pipe-Undrgrnd. 70. Structural Floor SYstem 11 . Property Sewer Line & House Connection ] 2. Sewer CaP 73. Roof prains 14. Rough Plumbing 15. Rough Electrical�Conduit 16. ROugh ElectritWiring 17. Rough Wiiing Sign 78. Rough Electrical-T Ba� Ceiling 19. Rough Heating & Ai� Conditioning 20. Rough Factory Fireplace 21. Ducts, in Structure 22. Ducts, Ventilaiing 23. Gas Pipe�Rough & Test 24. Roof Framing 25. Roof Shea�hing 26. T�Bar Ceiling (Svuccuraq & Monocoat 27. Frame and Flashing 28. Lathing & Siding 29. Insulation 30. Orywall Nailing 31. Plaster Brown Coat CMF 0559•46, iev. 12/82 Date �Inspector /I- -LJ 32. Electrical Power P �� Final L__ 33. Flnal Electric 34. Final Heating & Air Condi[ioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbiny 39. Water $ervice-Final 40. Gas Servicc�Final 41. Solar pomestic-Final 42. Backflow Preventer 43. Backtlow Irrigation 44. Landscape Irrigation SYstem 45. Sound Attenuation 46. Handicap Fegulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed POOL & SPA APPROVALS Permit# 49. Pool & Equipment Location 50. Steel Reinforcement 51. Forms 52. Electrical Bonding 53. Rough Plumbing & Pressure Test 54. APPROVAL TO COVER-GUNITE 55. Electrical Conduit-Undrgrnd. 56. Gas Pipe, ❑ Undrgrnd., Tesi 57. Backwash Lines, P•Trap, O Undrgrnd. 58. APPROVAL TO DECK 59. Backwash & Receptor�Final 60. Heater & Vent-Final 61. Plumbing SYstem • Final 62. Electrical-Final 63. Solar System-Final 64. Fencing & Access Approval 65. APPROVED FOR PLASTERING 66. POOL/SPA SYSTEMS FINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # 67. Underground Hydro 68. Product Giping D Gas O Oil fi9. Underground Plush 70. Undergrnd. Storage 7ank O Gas O Oil 77. Overhead Hydro 72. Dry Chemical 73. Dry Standpipe 74. FIXED SYSTEM FINAL 75. FIRE PREV, FINAL Notes: 3� 14 7 O IC QD ��C, (see reverse for additional notes) �� l C. -� ,�?�.' � r� f'_„:'' ,•.: ;:..