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Home My WebLink About462 16TH PL - Building PermitsPP0.IECT R�ONESS: 4 G i 1( Tfi PL OWNEN'SNAMF: DAVE DREWENY FDOHESS: SAME RflCN/ENGINEEfl: REG.NO.: uxir: AbDNESS: UN17: �nMmee: DAVE DREWENY ( 719 ) 650-1105 :/nooeess: 4 6 2 1 6 TH PL C,M. CA 92626 LICENSEU CONTMC70H OECtAMTION: I hereby atlirm Ihat I am IicenseA unCer pmNsions a( C�apter 9(commencinq wit� Sec[ion 7000) af Division 3 of the 9usiness and Profassions Coae, anU my license is in fulliorta an0 ettect. Cltt LIC.: STRTE LIC.: C1A33: Oate: Signature: WOBNENS' COMPENSPTION OEClAMT10N: I AereUy aliirm tAat I have a cartificate oi wnsent ro sel4insure or a cetlificate ot Workers' ComDensation Insurance, or a certitied copy thereot (Section 3800, Lab. C�. PoIICY NO.: E%P. OATE: "OMPRNY: � Certifietl capy is h¢2hy furnisheU. ❑ Certified coDY is tiletl with the ciry Builtling DiNsian. Oate: NpD�icant: E%EMPTION FBOM WOBNENS' fAMPEN&1TION OECLANATION: Qhis sec1ian nee0 not be comDleteA if ihe permit is for ane hunOreO (5100) or Irss). I cetlity that in t�e De�ormance of the work fo which ihis Dermit is iuued I shall not employ any persan in any manner so as to Oecome suble�� o tAe Workers' Campenution Law ai Califamia. � , Date: � Signatua: �'�'^-¢' �-�-w-^-� ( NOTI . f, atler makinA ihis tleclaraiion, you s�oultl becama sublect to tAe Workers' ComD ��n Orovisions of tha Lahor Coda, you must forl�with compy with such provisians or this permit shall Ue OeemeA revoked. fANSTpUCT10N LEXOING IIGENCY: I hereby aifirm tAat there is a wns[ruction lendinp apency tor t�e petlarmance of t�e wark for which IhiS permi� is issuetl (Secfion 3097, Civ. C). LENOEN: ADONESS: OWNEB BUILUEP UECIAMT10N: I hereby affirm that I am exemD� ��om tha Contractors' State License Law for the followinp reason (Section 7037.5 Business an0 Pmtessional CoOe: My ciry oi caunry which reQuires a Dermit ta wnstrvci, atter, imD�ove, Aemolis�, or repair any structure, D�or to its issuance, alm mquires I�e apD�icant tor such permit to lile a siAneO statement that �e/she is IicenseC pursuant lo the provisions of ihe Contracrors' State licensa Law (ChaOter 9(commencinp with Section 70W) oi Oivisian 3 of the Business and Pmfessions Cotle) ar ihat ha/she is exempt thereirom and the �asis tor the alleAed exemD��on. Any viola[ion ol Saction 7031.5 Ey any appliwnt tor a permit suble��s t�e apPlicant to a civil Denalry of not more ihan iNe AunAreO tlollars (5500). I, as owner at the propeM or my emplayees with wages az their sale com0ensatian, will tlo ihe work. and the ❑ simctura is not intenaea or offere0 far sale (Section 7044, Business and Professional COAe: T�e Cantractars' Sta[e License Law does not aDPy to an owner al a property w�o builAs or impmves iherean, and who tloes such work himseli/herself or Ihmugh his or her awn emplayees, provitleOlhat such impmvements are not intendetl or oflered for sale. Ii, however tAe builtlinA or " imD�a�ement is salU within one year of wmpletion, th¢ owner will Aave the burtlen af pmvinp �e/she EiE not Cui10 ar imD��'e for Ne Durpose oi sale). i� I, as owner of ihe DmOerry, am exclusiv¢ly contracting witA Iicense0 wntractors ro constmct tAe D�oject (Section 7094. Business an0 Pmieuions Catle: The Can[actors State License Law Aou nM apply Io an owner oi DroDerry who hml0s ar impmves I�ereon i and wlw conirac�s �ar such pmiecis cith a wnirattor(s) licenu pursuant to the Contacmrs' $tate License Law). I am awara that prool ol their Worker's CamDens.tian insurance s�aWd 6e D�oviOeU to ma. - � I am exempt unCer Section: B. 8 P. C. for this reason: ^ oata: � 6 Owner. z� ��- /��-�--�� I tlo here6y certiry t' am aware of anE understanU the requirements oi California Health antl Safery COAe Sections 255 5533, antl 25534 anE t�at I or any Mure Uuilaing accupant wiNwiil not (circle one) need ro camply with said state cotles antl t�e reQui�emenis for a permit for conslmciion or moEification fmm fie Nr Oualiry Manapement Disinct. ResiOential construction apD�ications are exempt from these provisions. Date: ' Applicant: I hereCy cetliy t�at I have reatl t�is apPlication anA state ihat ihe above iniormation is corroct I apree to compy witA all ciry antl or0inances an0 state laws relatinp to buil0inp c nsirudion and hereUy authonza reDresentativas of Nis ciry ro enter uDon the aDove-mE pmperry tar inspac[ion puryous. Oate: � — SiBnature: `�-� �`�-A Dnver's license or Sociai Securiry e: 16a1�96 W�ito—BuilCing; Green—CaAe Enbrcemant; Cenery—Applicam; Pink—Ravenue: Goldenrod-0.qsessor .` CITY OF COSTA MESA — BUILDING PERMIT PEAM NO: B 048546 PERMIT NO: H 048546 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE; STR PURPOSE: OTH JOH DESCRIPTION : REROOF 2700SF RESID & ATT GAR W/WOOD SHA SQ FT: 5,000 CLAIM VALUE: 5,000.00 CALC—VALUE; 5,000.00 GROUP OCC: R-3 /M-1 COMMENTS: X �� ***�rx�*****�r*�***�e��r�*�r****��r**�r�r*�****+��********�+r�r**�r*�*�� +� Z O N Z N GS ERTEBQAUCIKRSE M E N T S R��1 l�� ------------ MAIN HUILDING ---------- --------- ACCESSORY HUILDING --------- FRNT: FT IN REAR; FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN PARKING REQ• PROV: PARCEL: 00000000 ZNE: REF NO: PLANNING Nf5'I'ES> > i! iE * ik i! i! ik iF if iF 3E iE iE ik if if if iE iE iF if iF 3f iF if iE iE iE iE iE iE iE ik k if iE iE ik it it jt 1f it it iE �E ik it iE IE if 1E if �F IE 1E 1E iE if iE iE iE iF it �E iE iE j! iE'iE iE iE it 1E iE �f * iE 1E D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N'T, S / _ - ZONING APFROVED HY . BUILDING APPROVED BY : LEGALIZATION:N BLDG PMT PERMIT 72.00 PLAN ISSUE FEE DATE: DATE: ��. �' iE �f i6 if D�lk iF �E 3E ik±F��iFir'�iE ih ik iF ib iE iF ik 3F �E iE iE ik �E iE 3f 3F iE it it it ik i1 it if *�E iF 3E IE iE 9k iE it iE iE iR jk iE ik it IE jE 1k 3E 1t IElE 9F iE iE iE 1E 3E iE i! it ik i! iE F E E S U M M A R Y STRUCTURAL SEGMENT;Y , r PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING - .50 SMT2✓NON—RES t BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 72,50 0,00 0,00 72,50 72:50 ,00 REVENUE DIVISION TOTALS--> COLLECTED; 72,50 OVER/SHORT: 00 BLDG PMT PLUMHING ELECTRIC MECFiANIC FIRE SMIP/TOT GRADING PLAN—CHECK �2,�� ' ,5� iF iE i! �! i! 7E 7� �f if iF if it iE iF iE iF iF iE iE dk ik iE it iF f!!k j! 3! M if it iF ik it it iP i! ik fE �F �E ik 3E If ik if i6 i! iE 3k �f if �E iE if iE if iE it �E iE jE �E iF iE iE'1F iE iF iF iE �E i! i! �)f if 9E *�1F I N D I V I D U A L F E E B R E A IC D 0 W N , �TYPE QTY D E S C R I P T I O N UNIT COST . TOTAL COST SFR 5000 REROOF F3Y VALUE RESIDENIAL NOZONE END OF FEES 1.00 5,000.00 , •, � � /i O1 CtDD5�43lI—G40b7431 Y!_t� ^•?._� DATE� OElI�4190 7IMF.: 11:22 CONSTRUCTION AND PLANNING PO� _& SPA APPROVALS ,�rmit # Date I�spector 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 Reintorcement 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 �we� line & House Co�nection 62. Backwash & Receptor�Final 12. Sewer Cap 63. Heater & Vent-Final 13. Foof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 75. 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 79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permi[ # 21. Ducts,in Structure � -70. Underground Hydro 22. Ducts,Ventilating 71. Product�PipingOGas ❑Oil 23. Gas Pipe�Fough & Test • 72. Underground Flush 24. Roof Fram�ng � 73. Undergrnd.StorageTank OGas OOiI 25. Aoof Sheathing ' 7A. Overhead Hydro 26. T-Bar Ceiling (Structurall & 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. Electrital 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 Plun�bing � . � 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 'S•'"'( ^lt � Ctp 0�C 46. Handicap Regulations � � (,�/ 47. FINAL S7RUCTURE & BUILDING S�Y � 48. FINAIPLANNING 49. Electric Release to Edison 50. Gas Release to $outhern California Gas Co � 51. CERTIFICATE OF OCCUPANCY No. - Date AOP��ant to fill in all spaees axcept thase within heavy OorGer Iines anE sign all appropriate Oeclaratians. . �znt i/30/84 . 5.50 TL ' CITY OF COSTA MESA � PE T NO. � TRACT NO. • LOT NO. BLDG. . . . � ' , - CONSTRUCTION PERMIT �- /Q 7�� ' , • PfOj2tt Addlet5 TYPE OF CONSTRUCTION NEVJ ADD, � ALTERATION REPAI R" Applic2nY5 MailMing Addr¢ss' �++�+F - ❑ CONVERSION ❑ DEMOLISH ❑ OTHER - - A p �t - Zp�g � Ownef 5 Neme �•��]%�L�C 5��x '�� PhOne ��%-� DESCRIPTION OF WORI( S Main BUiiding: ` Accessory Building: � � 2 Address �1-�w� F E , . 0 TVPE OF PERMIT GRADINGp� FOUNDATION STRUCTURAL - T Front - � N Arch/Eng. LiCen52 No. ❑ TENANT ❑ ELECTRICAL �A{ VLUMBING' ❑ MECHANICAL . B Rear � ' � . � � Addf255 ❑ �OTHER ' A , N Contracror's Nam • � Phone PROJECT DESCRIPTION 5R. FT. ocCUPANCv C Right � - � � G K Left R CONSTRUCTIONTVPE VALVATION$ $ Address Imailing) , . � E� ' ZONE GRA�WG GU.YDS. ACRES PInJ. R¢f.'/k Park.Fees $ 4 City �License No. � IICENSED CONTRACTOR DECLARATION Remarks: � � Parking RCq./Provided � ' - u I hereby aiflrm thxt I am Ilcensetl untler provislons ot Charter 9(commencing R with 5ection 7000) ot Dlvision 3 of the Buslness antl Gwtessions Cotle, antl ' � Use Of Building: . ' � . E my Ilcense is in tull force antl effect. - Licensa Class l.icense No. PLUMBING . ' FEES Planning Notes: . . ' M E Date Sl9nature i' � WONKERS' COMPENSATION DECLARATION � Bar Sink Showers , N �•eby affirm that I have a certiticate of consent to sel(-insure or a certlficate —- ' - � -�� -- � � T �orkers' Compensation Insurance, or a certifletl copy [hereof (Sectlon Backflow Preventer Service Sink � S �, Lab. C.) � Backflowlrrigation SewerCap � � . ELECTRICAL ' FEES Policy No. Company ' . � � �' �Certlfletl copy Is hereby furnishetl. ' BathtUbs Sewer Connection AUtomatic WaSher Transformer ❑ 15-50 KW Certified copy Is filetl with the city Builtlin9 Divlslon. , ❑ 50+ KW Date Applicant ' Clarifier5 ' Solaf ColleCtOrs COnstruCtion Pole Sub. EXEMPTION FROM WOHKERS' COMPENSATION DECLARATION Dishwashef � Solar Piping � � (Tnissection neeC not be complatetl if the permit is tor one huntlretl (E100) or Cooking Unit Me[ar ❑up to 100 amps less) ' Drinkin Fountains ' I certiry that In the performanCe of th¢ work (or wnlch thls permR Is is{uetl I 9 ' $018r Tank DIShWaSher M¢ter �ov¢r 100 dTpS shall not amploy any person in any manner so as to beto a sub'e Ao t�e . workers' Com nsation l.aws ot Ca1i rnia. ' Floor.Drains Swimmin9 Pool w/Spa ' Dryers �Gas ❑Electric ' � Sub Panel. DatB �—�T'� Si9nature � ` ' NOTICE: If,�after makin9 this tleclaratlon, you sho Itl ecoma sub�ect to e' Floor Sinks � Urinal Fan - Motors 061 HP �7'h- 8- ��- Workers' Compensation provisions of the Labor otle, you must �orthwith . — comply with suc� provisions or mis permit snall be tleemetl revoketl. x Gas Service' Outlets Water Closet � p • F.A.U. : IncSolar �9-75 HP 016-15+ CONSTRUCTION LENDING AGENCV I hareby afflrm that there iz a construction lentling agency for the pertormance Intercepto�s Water Heater Fixfures - Microwave - of the work tor whlch- this permit iz Issuetl (Section 3097 Clv. CJ . Lentler's Nama Kitchen Sink - Water Service •Device Boxes Pole Light � Lender's Aatlress Lavatories. OWNER BUILDER DECLARATION - ' � OULIEtS' � Range I hereby atflrm that I am exempt trom the Gontractor's Llcense �aw for the p—T�a following reason (Sectlon 7031.5 Buslnass antl Profe551onal�Cotle: Any city or P � Switches Sign county which requiras a permit to construct, alter, improve, tlemollsh or repair - . ' ' any structure, prlor to its Issuance, also requires the applicant for such permit Roof Drains . ' �Garbage Disposal Standing Sections to file d slgnatl Statement thdt he/She is Iicensetl pur5uant t0 [he prOviSions Of . the Contractor's License Law (Chapter 9(commencing with.5actlon 7000) of . ' " � Generator �0-5 KW 05-15 KW Trash Com actor � Dlvision 3 of the Buslness antl Protessions Cotle) or that he/she is exempt � P (rom antl the basis for the alle9etl exemption. Any vlolatlon oLSectlon . 5 by any applicant tor a permit subjects the applicant to a civil Reins ec[ion Fee 3 ��ty of not more than five huntlretl tlollars ($500). P �5 Issue Fee $ - I, er f. the property or my amployees witn wa9es as thelr sole � Reinspection Fee � $25 Issue Fee ' $ 3 tom tlo rne work, antl the�structure Is not intentletl or ofteretl ' MECHANICAL . FEES for sale ctlon 7044, Business antl Professional CoAe:�The Contractor's PUgLICSERVICESREQUIREMENTS: License Law tloes not apply to an owner of a property wno bulltls or improves gpiler � Hood or Type I ❑ ' ' [h¢rGOn, anU wn0 tloes such wotk himself/herself ar throu9h hls or her own 2oning Approved By Date amploy ees, provitletl that zuch improvements are not Intentletl or oHaretl tor �nOpy Type II ❑ SaIG. If, hOweve�, the builtlin9 or improvement Is soltl within one year of com- Duct - Under Ground � jBuilding Approved By pletlon, tne owner will have the burtlen of proving he/she tlitl not builtl or Im- . —Dat� �rove for tha purpose oi sa�e). Duct - Structural Refrigeration System Applifation Issuad By— Dat 1, as owner of the property, am exclusively contracting wlth Ilcansetl con- • � ❑0-100,000 BTU ❑100,000 BTU tractorstd <onstruct the project f5ection 7044, Businesz antl Professions Cotle: Duct - Ventilating . _ $UMMARV OF FEES The Contrattor'S License Law does not apply to an owner of property who Eulltls or Improves thereon, ana wno contracts tor sucn proie<ts witn a con- Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ SMIP $ tractor(s) Iicense pursuant to the Contractor's Ucense Law). , PLAN CHECK $ PERMIT � ❑ I am ezempt untler Section e; & P. C. tor thls r¢ason Firepl/Fact. Bit. ICBO # PLUMBING $� ��UANCE $ Date� �'?��'2 ownet �. -. � n , ^ Heating System & Ducting � � ' � P�P.N CHECK 25% $ ENERGY P.C. $ I hereby certify that I nave reatl this appli< o antl state that tha ova ❑0.100,OOO.BTU �100,OOOBT - � GRADING $ INormation is correct. I agree to comply wlt all city antl county ortllnancas ' .J f ELECTRICAL dntl StdtO IdwS �elating to builtlin9 const�uc on, antl ha�eby dutbo�lie �ep�e- . , ' � MICROFILM ,$ sentaelves ot tnis city to enter� upon the above-mentlonetl property for � � , i .� PLAN CHECK 50% $ _ . � � inspattlon.purposas. `�j j'� i �) �' ��/{]]�—��jj//�/ ' MECHANICAL ,$ TOTALFEE �$ �-+•J� Slgnatufe NA/! S o .7'.!y� ,�c(itiK//�fD te� Drivers' LI e s o SS � � Reinspection fee $25 Issue Fee $ 3 PLAN CHECK 25% .$ CMFO865-46 rev.12/83 White-Builtlln9:Canary-Appllcant;Pink-Accounting;Goltlenrotl-Assessor � � � . �' CONSTRUCTION�AND PLANNING • POOL F�''P�r . � � APPROVALS Permit # ' Jate , Inspector qppROVALS Pern�.. #' Date Inspector � � 1, Temporary Electrical Service or Pole • ; 52. Pool & Equipment Location �� 2� Soil Pipe-Uhdrgrnd. ,. . � 53. Steel Reinforcement � I 3. Electrical Conduit Utility-Undrgrnd. 54. Forms i '- 4. Electrical Conduit-Undrgrnd. - ' ' 55. Electrical Bonding .� � 5. StBel Reinforcement � _ � . 56. Rough Plumbing & Pressure Test � � j� 6. Electrical UFER G�nd. . � 57. APP.ROVALTO COVER-GUNITE - � � 7. Footings . 58. Electrical Conduit-Undrgrnd. �� ' �� 8. Foundation 59. Gas Pipe, O Undrgrnd., Test - � ' �' 9. Water Pipe-Undrgmd. - ��80. Backwash� Lines, P-Trap, O Undrgmd. � i; 10. Structural Floor System � , � 61. APPROVAL TO DECK � , i t. Property Sewer Line & House Connection ' i 62. Backwash & Receptor-Final f� . 12. Sewer Cap � � 63. Heater & Vent-Final : i i 13. Roof Drains . • 64. Plumbing System - Final '� � i 14. Rough Plumbing - 65. Electrical-Final � 15. Rough Electrical-Conduit - 66. Solar System-Final � -- � 1.6:' 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 • - 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 O Gas ❑ Oil 23. Gas Pipe-Rou�h & Test 72. Underground Flush 24. Roof Framing ' 73. Undergrnd.StorageTank'OGas OOiI � 25. Roof Sheathing � 74. Overhead Hydro 26. 'f-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 MeLer;Final � � 80: FOOD CERTIFICATE ISSUED • 33. Final Electric Notes:�,G �� O 34. Final �Heating & Air Conditioning F r. 35. Final Gas Pipe-Test - � L�SI � . 36. Hood or Canopy� 37. Final Factory Fireplace �_ � 38. Final Plumbing ' 39. Water Service-Final � , � 40. Gas Service-Final � � ' 41. Solar pomestic-Final - , i , � 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 Southem California Gas Co ,, I ' . � ;' �� 51. CERTIFICATEOF�OCCUPANCY - � - i• � - � • 'i' � No. � Dirte, � ' ' _ ' � � � �� , �� _ Applicant to filt in all soacas axceol those within neavy eortler Iines ana si9n all approoriate tleclarations. ��✓ � b'rE2— CITV OF COSTA MESA �� '.,_ CONSTRUCTION PERMIT Project Address — � Applicant's Mailing Address : Owner's Name o ' hone S� Address � Z �� /�� Arch/Eng. Licenu No. Address y \Contractor's Nam �v�QT �� S ona��z�S'} � Addresslmeiling) �—�'-3� /��o�/�oJi� � /i�-�. �\_ City License No. �g n�� \LICENSE� CONTRACTOR DECLARATION • ' I hereEy affirm that I am Ilcensad untler provisions of Charter 9(commencing with 5ection 7000) of Dlvlslon 3 of the Business antl Profezslonz Cotle, antl \my Ilcense is in tull force an /fee�7� LJcense Class �� '/ I n5 No. � Z� (� Date � � Si9nature � WORKERS'COMPENSATION DECLARATION ,!,hereby affirm that I have a certHlcata ot consent to seH-Insure or a certlficate =°„Workers' Compensatlon Insurance, or a certlf tl coOY thareof (Sectlon .3`�I,BQ Lab. C.L "ifaiicy rvo. 7/—d (. /. /G % company Cartlfietl <opy I5 heraby turnishetl. Certlfl cop �5 tl Ith the City BuiE�� Date_ Applitant E%EMPTION FROM WORKERS' COMPENSATION DECLA0.ATION (Thls section neetl not be complatetl it tha parmit is for one huntlretl ($100) or less). 1 certlfy that in the periormance ot the work for which Ihls perm�t i5155uatl I shall not emD�oy any person In any manner so as to become subject to the Workers' Compensation Laws of Calitornia. Date Signature NOTICE: If,�aftar makinq thiz Ceclaration, you 5hou10 become subject to tne Workers' Compensation provislons of tne Labor Cotla, you must forthwilh comply wit� such provislons or this parmlt 5hall ba tleametl revoketl. CONSTRUCTION LENDING AGENCY I hareby aifirm that there Is a<onstruction IenEing agency tor tne parformance Of the wOrk fOr wM1ich tnis permit is Issuatl (Se<tlon 3097 Civ. C.) l.entler's Name Lantler's Atltlress OWNER BUILDEfi DECLARATION I herlCy attlrrtl that I dRl B%eTpt flOT th8 COntfdttOl'S LIc0n50 Ldw (Or the following reason (Sectlon 7031.5 Buslness antl Professlonal Cotle: Any clty or county which requires a parmit to construct, alter improve, tlamollsM1 or repalr any 5tructure, prlor to Its Issuance, also requlres t�e applicant for such permlt to flle a signetl statement that he/she is Ilcensetl pursuant to the provisions of the Contra<tor'S Llcense Law (Chapter 9(commencing wltn Sactlon 7000) of Dlvislon 3 of the Butlness antl Professions Cotle) or that na/sne is enempt �' -sfrom anA t�e basis for the allegetl exemption, Any vlolation oT Section ' .5 by any applicant for a permit subje<ts the appllcant to a clvll rty of not moro than five huntlretl tlollars (y500). L 1. as owner of the orooertv or mv emolovees wlth waaei as Sheir sole an owner oi a properiy wno oui�as or �ork hlmself/herself or throuqh hls or ImDrOvBrtl¢nt5 dr8 n0t IntlntlBG Of O'� Il, llowOVCI, [t10 OUIIOIng of Implovament IS SoIO wlttlln ona yeaf oi com- �,lon, tha ownar wlll have the burCen of provin9 ne/sne EIU not DUIIC or Im- ve iorthe purpose ol5ale). I, as owner of [he proparty, am excluslvaly <ontracting wlth Ilcensetl con- :tors t8 construct the project (Sectlon 7044, Business antl Professlons Cotle: i Contractor's Llcensa ldw doa5 �Ot apply to dfl OwnBr Of OrOparty wh0 Itls or improves thereon, antl who conVatts for such pro�ects wlth a con- 3or(5) Iicense pursuant to the ContractoYs Licensa law). I am exempt untler Sectlon B. & P. C. tor thls reason TYPE OF CONSTRUCTION LJ NEW LJ ADD �1 ALTERATtON U REPAIR ❑ CONVERSION ❑ pEMOLISH ❑ OTHER DESCRIPTION OF WORK - TVPEOFPERMIT � GRADING FOVNDATI N STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING �MECHANICAL ❑ OTHER PR0.IECT DESCRIPTION Sq. F7. OCCVPANCv CONSTRUCTION TVPE VA�UATION $ ZONE GqA�ING CU. VDS. ACRES � Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtu6s Dishwasher Drinking Founteins Floor Drains Floor Sinks Gas Service Outlets Kitchen Sink Lavatories P—Trep Roof Drains ' Reinspeetion Fee $25 Boiler Dutt - Under GrOund Duct - Structurel Duct - Ventilating Exheust System ❑ Multiple ❑ Firepl/Fect. BIL ICBO # Oate Ownar H ating System & Ducting I hereby certlfy that I have reaa thli applitatlon antl state that the�above 0.100,000 BTU �100,0008T Informatlon I5 correct. I agree to comply wlth all city antl county ortlinan<es antl state laws ralating lo bui n9 construcllon, a tl hereby authorize repre- . sentatives of t�is Uty to e on he a e-manUonatl property for Inspattlon purposes. �� d c� S+ C�� Siqnature �� peinspaction Fee $25 Drlvers' License or SS CMF 0865-46 rev. 12/83 Whita - Builtling; �anary - ApPlifant; Pink - Accounting; Goltlenrotl - Assessor PLUM8ING Showers - Service Sink Sewer Cap Sewer Connection Soler Collecrors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Weter Closet Water Heater Warer Service laue Fee Hoodor TYPeI ❑ Canopy Type I I ❑ Refrigeretion Sys[em ❑0.100,OOOBTU ❑100,000 System Repair/Alteration Isiue Fee FEES A.P. �k S Main Building: E T Front A Rear C Aight g Left Ping. Ref. # Parking Req./Provided Use of Building: Planning Notes: 4070 2/OB/84 Zone Park.Fees ELECTRICAL Automatic Washer Transformer ❑ 15�50 KW Construction Pole Sub. � 50 + KW Cooking Unit ' Meter ❑up to 100 amps Dishwasher � Meter ❑over100amps Dryers �Gaz ❑Elec[ric Sub Panel Fan Motors �0-1 HP 01 X- 6 F.A.U. Inc.Solar 09-15 HP �16 Fixtures Microwave Device Boxes Pole Light Outlets Range Swi[ches Sign Garbage Dispoul Standing Sections Generator �0.5 KW 05-15 KW Trash Compactor $ 3 Reinspection Fee $25 laue Fee FEES PUBLIC SERVICES REQUIREMEN7S: Zoning ApO�a`/ed By Building Approved By Applintion luued By � r � $ 3 5+ 7.(]': TL S 3 Z O N I N G R E Q U I H E N T SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLANCHECK 50% $ MICROFILM $ MECHANICAL S 7� � TOTALFEE $� PLAN CHECK 25% $ . y�_ _� — `: �'CONSTRUCTION AND PLANNING � APPROVALS Permit # ' �� "- 1. Temporary Electrical Service or Pole � 2. Soil Pipe-Undrgrnd.�. ' . . - , 3i Electrical Conduit Utility-Uridrgrnd. ' � :4'. Electrical.Conduit-Undrgrnd, . " . � 5. Steel Reinforcement , � - - _ 6. Electrical UFER Grnd.: ' 7. Footings � � ^ 8. Foundation ' . �. 9. Water Pipe-Undrgrnd. ' • � 10. Structural Floor System - � � 11. Property:Sewer Line & House Conne �ion 12. Sewer Cap ' r 13. Roof Drains � • . � 14. Rough Plumbing ..� , 15. Rough Electrical-Conduii' 16. �Rough Electric Wiring � 17. Rough Wiring Sign ' � 18. Fiough Electrical-T Bar Ceiling, 19. Rough Heating & Air Conditioning - 20. Rough Factory Fireplace � 21. Ducts, in Structure ' � ' 22. �Ducts, Ventilating � ' 23. Gas Pipe-Rough & Test , 24. Roof Framing ' . 25. Roof Sheathing . . 26. T.-Bar Ceiling (Structural) & Monocoat 27. Frame and F2shing . , i� . 28. Lathing & Siding � ' 29. Insulation ' � , 30. Drywall Nailing � 31. Plaster Brown Coat . . 32. Electrical Power Meter-Final 33. Final Electric 34. Final-Heating & Ai��Conditioning 35. Final Gas Pipe-Test . � 36. Hood or Canopy " 37. Final Factory Fireplace , . 38. Final Plumbing , � 39. WaterService;Final ' � 40. Gai Service-Final � � 41. Solar pomestic-Fina�l � ' � 42. Backflow Preventer - 43. Backflow Irrigation � - i ' 44. Landscape Irrigation System 45. Sound• Attenuation , � 46. Handicap',Regulations , 47. FINAL` STRUCTiUFtE & BUILDING i r � 48. Special Requirenients Completed . 49. Electric Release to Edison � , 50. Gas Release to Southem Califomia Gas Co 51. CERTIFICATEOF�OCCUPANCY ' No. � - � - Date: - Oate � I Inspector p afq-9y POOL & �4 �� . - APPROVALS Perm�.# _ �Date' Inspector , �52. Pool & Equipment Location ' ' - •� 53. Steel Reinforcement . 54. Forms . �� 55.� Electrical Bonding � 56. Rough Plumbing�& Pressure Test _ 57. APPROVAL TO COVER-GUNITE � 58. Electrical Conduit-Undrgmd. . 59. Gas Pipe, � Undrgrnd., Test � . 60. Backwash'Lines, P-Trap, O Undrgrnd. 61. APPROVAL TO DECK � 62. Backwash & Receptor-Final ' 63. Heater & Vent-Final 64. Plumbing System = Final 65. Electrical-Final 66. Solar System-Final � - 67. Fencing & Access Approval - � ," 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT � APPROVALS Permit# , 70. Underground Hydro 71. Product Piping O Gas ❑ Oil � 72. Underground Flush 73. Undergrnd. Storage Tank O Gas ❑ Oil � 74. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe ' 77. FIXED SYSTEM FINAL � 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: a u c yOWNER �.1.$� r.. w. DATE 8-8-56 JOBHt)DRESS 462 16th Place BUILDINGPERMITNO. #3435 GENERALCONTRACTO AP117-361-15 �oT 22 BLOCK TRACT l�l.lj Res. x/att. gar. as per U. B. C GH..JP I& J TVPE V ZONE Rjl FIRE DISTRICT 3459 INSPECTIONS Footing Trench � Foundation Formsan Graa Rough Framing Plumbing, Rough to Slab ;, Plumbing, Rough Complete Temporary Pole Wiring, Rough Heating, Rough Heating, Final 6ewer, House Sew Septic Tank or Cesspool Lathing,InXJQ �•,�Ou Plz �ng Plu.. .�ng, Final, Fixtures G Plumbing, Final Gas Test Wiring, Final OccupanCy FOFM 210 9M 10�95 SUBCONTRACTOR PERMITSISSUED DATE I NUMBER I �7Ai7i�flL. 3439 .Costa Mesa Bnilding Department APPLICATION FOR PERMIT ' • ,� P.O.Box3�� 3�.59 BUILDlNG � COSTA MESA, CALIFORNIA FOR OFFICE USE ONLY FOR APPLICANT TO FILL IN Receipt No. Permlt No. Building �, � - 3 Address Costa Mesa, �'ia.11fOPII1S aec i ed by (/�Q ate rtedd oate �pesued Nearest •/ O � �� "O '""S CrossSt �` 'y / -' 9uilding � �� `�s Address Owner Costa Mesa, California Mail Address � �m Nearest Tel. Cross St. City _ No. Zone No. oT Type ,/ Group-�y- Arohitector �r Lic, � I Plans I V J-� Engineer N LJ� No. App ove v � �. b _ __ Date Address °V' � ,(/ C. . City Lic. � tractor No. nddress '✓c7 e'� �,- CI'(Y Of G�7��A MESA Le I Lot i'L'•^+ti1NG DEPT. Descrlption I No. �Y� I Block j Tract/ auo �� .. . «. �. (Attach Metesand Bounds) �/ % -' � �' `y� / � - � No. of Bldgs z � Sizeof Lot Nowon Lot B LY — �� . O 4seof No.of No.o� J _ - z Existing Bldg. I Familles I Rooms �� . -- - � Setback Line fram .i � Rear Vard �� Z Center of Street JD Side Yard . y DESCRIPTION OF WORH • � .� � ' , New I I Alteration I I Addition I - Repafr I Movfng I I Demolish I Bullding /� No.of � r:ri f1r " ' �.� Size �9 Rooms � Stories � � f V7 .J�. ..: � _.-..-HC f��-ingW�.�„a� I Coverin9��%(, C (iPPRQV.�isS' l d New `-'a'— Building � `� r �, Foundation Location Inspector � Date Forms, Materials, / Under-Pinning Frame: Fire Stops, Bracing, Bolts I hereby acknowledge that I have read this Application and state that the above is correct and agree to comply Lath. Int with all C7ty Ordinances and State Laws regulating building cronstruction. /—� Lath. Ext. SfgnatureofJ /� f�/`�/// _ (%D^ Permittee /� �� <T�1.�-�'� �y Plaster, InL AuthoHzed Agt Plaster, Ext Valuatlon Permlt Fee $ � �-� Masonry Reinforoed $ /� �j �� TotaCheck $ � � gond Beam Fee �� FINAL iORM 204 10��5 D. V. 8 5. i LV 1 i LLSl� &how loeatlon and distancea from propeHy Iine and between buildinga �r—.,-s!jJ cosrr.,c� .. ..r;5. /� n� I�liE5y1� Y ��;1 �' ' - , � � — . , .,�.' ��• . . . . � ' , �� . _. , • . � �, � , • 1. ' � : ` , _ �. ,f\)�. ' ,�