HomeMy WebLinkAbout216 16TH ST - Building Permits CITY OF COSTA MESA •
�'i'`ray' BUILDING DIVISION
F,4I, 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us
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1 yogi FOR INSPECTIONS CALL:(714)754-5626
""��a.nm� PERMIT NUMBER: B09-00056
PERMIT TYPE B_ROOF2 STATUS: FINALED
APN: 42520511 DATE ISSUED: 04/20/2009
;' ` ISSUED BY: RMD
JOB ADDRESS: 216 16TH PL.'}I • fi t' • Suite/Unit:
•
Vicinity: UNITS B AND C .
Squares: 2600 ' -Valuation. $8,000.00
SCOPE OF WORK: T/OFF COMP SHINGLES.INSTALL 1 LAYER 30 LB FELT AND 30 YEAR COMP SHINGLES CLASS A, 26
SUQARES.
UNITS B AND C
OWNER: EAST HAMPTON COURT- ", Address: ' HOMEOWNERS ASSN• Unit COSTA
MESA,CA ' _ _ -
PHONE: 9498745002' City/State/Zip: 172 FLOWER ST 1 •
• APPLICANT: TOM KORSVALL Address: 1346 LOGAN AVE - Unit: :SUITE
A001 . .
PHONE: 714-620-5916 . - - City/State/Zip: COSTA MESA,CA ,
CONTRACTOR: MILESABOVE ROOFING INC License No. 880263
Address: 1346 LOGAN AVEUnit: •: . '. .SUITE A001 - . - - PHONE: 714620-5916 <
City/StatelZip: COSTA MESA, CA, " 92626' - CELL: . .•
ARCHITECT: License No. . PHONE:
,ENGINEER: License No. PHONE: •
FEE SUMMARY :
Reroof Plan Check: $0.00;.,- -
Reroof Permit Fee:
Reinspection Fee: $0.00 -
Bldg Std Admin Fund $1.00
TOTAL FEES $154.25 .
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California_statutes and related
regulations.(Ord.No.92-28, §1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required Inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
CODE t, INWEC110N__ TYPE pia IN11T1ALE CODE II INSPECTON TYPE DATE IN1111AII
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1286 Pool Spa Final 208 Final Plumbing ' •
200 Final Re-Roof C4-28-Di ~— 210 Final Electrical . _
201 Final Block/Retaining Wall 212 Final Fire Prevention _
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site
204 Final Demolition 250 Final Building/Occupancy -
WORKERS'COMPENSATION DECLARATION: . - - Owner ID verified by drive_...sense. ❑Yes ❑No
I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires:
❑ I have and will maintain a certificate of consent to self-Insure for workers' Vedfiration of Ownership by(type of document,i.e.-property tax bill or deed):
compensation, as provided for by section 3700 of the Labor Code, for the -
performance of the work for which this permit is issued. •-
❑ I have and will maintain workers'compensation insurance, as required by DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
section 3700 of the Labor Code,for the performance of the work for which this
permit is issued. My workers' compensation Insurance carrier and policy ❑ I hereby certify that no excavation five(5)or more feet in depth into which a
number are: person is required to descend,will be made in connection with work authorized
by this permit,and that no building structure,scaffolding,falsework,cc demolition
Carrier: or dismantling thereof,will be more than thirty-six(36)feet high. (Chap.3.2,Grp
(This sector need not be completed/the pens/is valued al one hundred dollars(S100)or less.)
2,Art 2,Sec.341,Title 8,California Administrative Code).
Policy Number:
• owner-builder, I will not employ anyone to do work which would
❑ I certify that in the performance of the work for which this permit is r-. 41 -ermit from the Division of Industrial Safety,as noted above,unless
issued, I shall not employ any person in any manner so as to become subje � s , aj p��x,+ permit to do such work from the division.
to the workers' compensation laws of California, and agree that if I shou: } j '
become subject to the workers' compensation provisions of Section 3700 of ,;,
the Labor Code,I shall forthwith comply with these provisions. .�,.+' ham's t. alum Date
Division of Indust 'k -'y Permit Number:
Applicant's Signature Date HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑ No
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND exceptions, that a Business Plan be filed with the Costa Mesa Fire
ATTORNEY'S FEES. Department by every business which has at any one time during a reported
year a quantity of hazardous materials equal to or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds,or a volume of 55 gallons.or 200 cubic feet of compressed gas
I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure).
with Section 7000)of Division 3 of the Business and Professions Code. and 2. Does or will the applicant or present or future building occupant need to file
my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes ❑No
Lic.# Class# _. (Section 25533 of the California Health and Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
contractor's Signature Date hazardous materials equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
CONSTRUCTION LENDING AGENCY: temperature and pressure).
❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to
performance of the work fcr which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely
Lender's Name: hazardous materials)? 0 Yes ❑No
-- - (Section 25534 of the California Health and Safety Code provides that the
Lender's Address: Costa Mesa Fire Department may require the preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire Department.
Signature Date
4. If an RMPP is presently required. has Section 25534 of the California
OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? 0 Yes 0 No
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction
Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from
construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? 0 Yes 0 No
issuance,also requires the applicant for such permit to file a signed statement (Section 658502 of the California Government Code requires that the requested
that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits).
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the
Business and Professions Code)or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within
the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No
applicant for a permit subjects the applicant to a civil penalty of not more than (If"yes", the facility must meet the requirement of Sections 25534 and 42303
five hundred dollars($500).): of the California Health and Safety Code).
0 I, as owner of the property, or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other
compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the
offered for sale(Sec. 7044, Business and Professions Code:The Contractors subject of this application, have all of the disclosures prescribed by California
License Law does not apply to an owner of property who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑No
thereon,and who does such work himself or herself or through his or her own 8. (If'yes", attach certificate of compliance from the appropriate air pollution
employees, provided that such improvements are not intended or offered for .,
sale. If, however, the building or improvement is sold within one year of control officer). - - •
completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE:.I dertify`that under penalty bf perjury the
did not build or improve for purpose of sale.). information given above is correct. I agree to comply,with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH - -
LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and
Professions Code:The contractors License Law does not apply to an owner of Signature Date'
property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that
❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
Business and Professions Code for this reason: • • the City of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this permit until final inspection. .
_ Signature of Legal Owner(s) Dale
'Signature Date
3057-46(3/07)
And/or Authorized Applicant Dale
_ Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA N PERMIT NO. TRACT NO. LOT NO. BLDG.NO. •
.• CONSTRUCTION PERMIT ^ ) 0 7 02� 3563 2/02/84 B.00 Tl
•
Project Address21L' C• t(Sah Srs TYPE OF CONSTRUCTION ❑ NEW Li ADD U ALTERATION U REPAIR
.„.a Applicant's Mailing Address . ` s Os QA 770' CI CONVERSION ❑ DEMOLISH�-cu(OTHER A.P.# Zone
Owner's Name ca"-‘ BEL.at QSLT Phone 7-52.-I8— DESCRIPTION OF WORK tt--'o ?OC.PF2 c=t-nI P
S Main Building: Accessory Building: Z
Address 9..0, eox �4'zoL teN z>JQ.1 G:AL.t . I I tt � E 0
TYPE OF PERMIT GRADING L I FOUNDATION LI STRUCTURAL T Front N
Arch/Eng. License No. [11 TENANT ELECTRICAL C PLUMBING ❑ MECHANICAL A Rear I
Address ::77� ❑ OTHER N
'FZV@f..6cCIV—.5S.C.0 t�Phone 3S H IC Right G
Contractor's NamnPROJECT DESCRIPTION SQ. FT. OCCUPANCY K
R
Y
Address(mailing) T(�.0`�A 7�1� Si �T�t-sr
City License No. .3 a fp O � C ON ST RUCTION TYPE — VALUATIONS S Left E
tsf'?� ZONE GRADING CU.YDS. ACRES Ping. Ref.# Park.Fees $ u
LICENSED CONTRACTOR DECLARATION Remarks: Parking Req./Provided I
I hereby affirm that I am licensed under provisions of Charter 9 (commencing R
.� with section 7000) of Division 3 of the Business and Professions Code,and Use of Building: E
my license is In ful rce and effect.
'.icense Class t U/•n-'N •/ • •, 7 '1 PLUMBING FEES Planning Notes: / M
1/4 ate "27`- Signature • '' -.. z •N.
Bar Sink Showers N
WORKERS'COMPENSATION DECLARATION T
I hereby affirm that I have a certificate of consent to self-insure or a certificate Backflow Preventer Service Sink S
l of Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. C.) Backflow Irrigation Sewer Cap ELECTRICAL FEES
IQoo icy No. _\d- U 4& 01 Company SinVI F, (tn
-�.. Certified copy is hereby furnished. Bathtubs Sewer Connection Automatic Washer ' Transformer 0 15-50 KW
LLLLLLJJJJJJ--- r /.
Cer ifieRd copy is flied with the city iltling Div'
Date 2.'"1- Applicant ,( 2 Clarifiers Solar Collectors Construction Pole Sub. 0 50+ KW
EXEMPTION FROM WORKERS'COMPENSATION ECLARATION Dishwasher '
(This section need not be completed if the permit is or one hundred ($100)or Solar Piping _ Cooking Unit Meter up to 100 amps
less). DrinkingFountains '
certify that in the performance of the work for which this permit is issued, Solar Tank Dishwasher Meter Dover 100 amps
shall not employ any person In any marrrrrrt�W����er so as t eco a bject to te •
Worke Cpmpcn{ation Laws of Canto e /p//�/ Floor Drains Swimming Pool w/Spa Dryers ❑Gas ❑Electric Sub Panel
Date 4-1-T59 _Signature -eV/
(/lpl 1+([ 33JJIL.tt
NOTICE: If,latter making this declaration, you should ecome subject to the Floor Sinks Urinal Fan - - Motors 00.1 HP 01%-8
Workers' Compensation provisions of the Labor Code, you must forthwith • i
comply with such provisions or this permit shall be deemed revoked. Gas Service Outlets Water Closet F.A.U. inc.Solar 09-15 HP 016-15+
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a construction lending agency for the performance Interceptors Water Heater Fixtures Microwave
of the work for which this permit is issued (Section 3097 Civ. C.)
Lender's Name Kitchen Sink Water Service Device Boxes Pole4.ightre< 'y� �T"
•
D
Lender's Address Lavatories l/__'-
OWNER BUILDER
-DECLARATION Outlets Range
I hereby affirm that I am exempt from the Contractor's License Law for the P-Trap reason (Section 7031.5 Business and Professional Code: Any city or P Switches Sign
-county which requires a permit to construct,alter,Improve;demolish or repair '
ny structure, prior to its Issuance, also requires the applicant for such permit Roof Diains • Garbage Disposal Standing Sections
) file a signed statement that he/she is licensed pursuant to the provisions of •
• Me Contractor's License Law(Chapter 9(commencing with Section 7000) of • Generator 00-5 KW 0545 KW Trash Compactor
Division 3 of the Business and Professions Code) or that he/she Is exempt •
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil Reinspection Fee $25 Issue Fee $ 3
enalty of not more than five hundred dollars($500). •
U I, as owner of the property or my employees with wages as their sole - Reinspection Fee $25 Issue Fee $ 3
compensation, will do the work, and the structure is not Intended or offered - MECHANICAL • ! FEES .
for sale (Section 7044, Business and Professional Code: The Contractor's -- - - -- - - - -- -- — -- - - -- - - -- PUBLIC SERVICES REQUIREMENTS:
License Law does-not apply to an owner of a property who builds or improves Boiler Hood or Type I . 0
thereon, and who does such work himself/herself or through his or her own • Zoning Approved By Date
employees, provided that such improvements are not Intended or offered for Canopy Type II 0 t. q �/
sale. If, however, the building or Improvement is sold within one year of com- Duct-Under Ground Building Approved By (/ ^l i� Date a -,-6S/
pletioh, the owner will have the burden of proving he/she did not build or Im- Duct-Structural Refrigeration System Application Issued By1/2 '2P<e4 "j /f
0 rove for the purpose of sale). 9 Y Date- -(` Y
I, as owner of the property,am exclusively contracting with licensed con- ❑0.100,000 BTU ❑100,000 BTU
tractors to construct the project (Section 7044,Business and Professions Code: - Duct-Ventilating SUMMARY OF FEES '
The Contractor's License Law does not apply to an owner of property who
builds or Improves thereon,and who contracts for such projects with a con- Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $
tractor(s) license pursuant to.the Contractor's License Law). PLAN CHECK $ PERMIT
❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG#•
• PLUMBING $ ISSUANCE $
HeatingSystem& DuctingPLAN CHECK 25% $ ENERGY P.C. $
Date Owner Y _
I hereby certify that I have read this application and state that the above ❑0-100,000 BTU ❑100,000BT1: ELECTRICAL $ �• �� GRADING $
informat ion Is c rrect. I agree to comply with all city and county ordinances ,
•
and-state laws rating tobuilding construction,and hereby authorize repre- PLAN CHECK 50% $ MICROFILM .$
sentatives of is city t e ter • •.f the above-mentioned property for
Inspection p oses. i/ _ MECHANICAL $ R.
Signature Qv/ �• jet . Date v1-e�' TOTAL FEE $ n- �Q
Drivers' License or SS# Reinspection Fee I $25 Issue Fee • $ 3 PLAN CHECK 25% $ •
CMF 0865.46 rev.12/83 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod -Assessor
• `
•
CONSTRUCTION AND PLANNING F, - &SPA
APPROVALS Permit# tef{27 Date
Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole / p� 52. Pool & Equipment Location
7 i K�
2: Soil Pipe-Undrgrnd. I 53. Steel Reinforcement
3: Electrical Conduit Utilify-Undrgrnd.) 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing& Pressure Test
. 6. Electrical LIiFER Grnd. , 1 57. APPROVAL TO COVER-GUNITE
7. Footings
' 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd. - 60. Backwash Lines,P-Trap, ❑ Undrgrnd.
10. Structural Floor System - 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap • 63. Heater& Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final -
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
•,j, Applicant to fill in all spaces except those within neavy border linea, -__..aeration.. ---• _ ____. ^
I COSTA MESA - p RMIT NO. TRACT NO. LOT NO. '- BLD ol{.NO. ,
•RUCTIOI PFRMIT _, �' w+ • ' 4. . 2426 1/16/84 52. .23 TL
Project Address ' 5!.`M1 rAIIIIMILSts. • TYPE OF CONSTRUCTI IA EW 1. ADD N ALTERATION I. REPAIR
��,, ❑ CONVERSION DEM SH ❑ OTI-TE S—ao/ .� ( q
Applicant's Mailing A ,6u , - -1 Lt
A.P.# J ��' I Zone J
Owner's Na�^a •t • ewe cJAC Phoned 91'l31 DESCRIPTION OF WORK Ltlel l t �J
'[YAAP �J S Mai Building: Accessory Building: / ,�to mile— Z
Address / D iJ 'fie u 'VII j r y/'11 rTYPE OF PERMIT ( GRADING �� OUNDATIOIy TRUCTURAL E Front Jar ei'OvsL leth.Q'vrt_ r2c ,�.p1,•.,-: Ph- ` N
Arch/EOgyr • License No. % ❑ TENANT ELECTRICAL il'A PLUMBING_N.4 MECHANICAL B Rear 9 r 2 (r ,7 ! _ /... i ly� I
Address _ ❑ OTHER A /�/ N
'o"'"'nto _ •hp • V_i��!F!as PROJECT DESCRIPTION 5 / J OCCUPANC K Right ,,j y 5"7 G
Contractors m:r A'�aa{i--'+��+L'="5'�--, �? bR
Address(mailing) 'i '� -_ S 7 ATP CONSTRUCTION TYPE VALUATION$N I a��(ne) S Left S/ �7 E
ZONE GRADING CU.YDS. 0 ACRES Ping. Ref.# DE—g 3 _Jo Park.Fees $ ,2.45"g, 7(o
City License No. • ,����(��ssss j // U
S LICENSED CONTRACTOR DECLARATION Remarks: % �cP 3_ SI C�- 3 Parking Req./Provided 4 a etturca_gU cf l,_4 T Go.cp.c-.-f- .. E
I hereby affirm that I am licensed under provisions of Charter 9 (commencing / R
with section 7000) of Division 3 of the Business and Professions Code,and ' L Use of Building: /�p0n' ��fl'!'t„
my license is in full force and effect.
License Class License No. PLUMBING ' FEES Planning Notes: M
E
Signature SOLO FOR SPFFI I F .:.N
•;7)ORKERS'COMPENSATION DECLARATION __Bar Sink Showers (� B (IUfR Vsu'f'•a
''1 hereby affirm that I have a certificate of consent to self-Insure or a certificate < a.W •i • S
of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink -1 S
3800, Lab. C.) Backflow Irrigation Sewer Cap ELECTRICAL . FEES „'
/
Policy No.
_Company - '
A
Certified copy is hereby furnishes,x Bathtubs Sewer Connection Automatic Washer -
Transformer 0 15-50kW
Certified copy is filed with the city Building Division. - 0 50+.KW
Date Applicant Clarifiers Solar,Collectors l Construction Pole Sub.
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION - Dishwasher Solar PipingCookingUnit • • Meter •
-
(This section need not be completed if,the permit Is for one hundred($100)or _ ❑up to 100 amps
less).
I certify that in the performance'bf the work for which this permit is Issued I Drinking Fountains Solar Tank Dishwasher Meter Dover 100 amps.
shall not employ any person In any manner so as to become subject to the - ., -
Workers' Compensation Laws of California. Floor Drains Swimming Pool w/Spa Dryers ❑Gas ❑Electric Sub Panel •
Date Signature
NOTICE: If,after making this declaration,you should become subject to the --Floor Sinks Urinal _ Fan Motors 00-1 HP 01Y2-8 _
•
Workers' Compensation provisions of the Labor Code, you must forthwith - --
comply with Such provisions or this_permit shall be deemed revoked. Gas Service . Outlets I Water Closet I F,A-U. . Inc.Solar.❑9-15 HP❑16-15+
CONSTRUCTION LENDING AGENCY - '
I hereby affirm that there Is a construction lending agency for the performance Interceptors Water Heater Fixture's 'Microwave
of the work for which this permit Is issued (Section 3097 Civ. C.)
Lender's Name - Kitchen Sink Water Service _ Device Boxes Pole Light
Lender's Address •OWNER BUILDER DECLARATION • Lavatories - Outlets"• Range
1 hereby affirm that I am exempt from the Contractor's License Law for the p-Tfe
following reason (Section 7031.5 Business and Professional Code: Any city or p Switches• Sign
county which requires a permit to construct,alter,Improve,demolish or repair
any structure, prior to Its issuance, also requires the applicant for such permit Roof Drains Garbage:Disposal Standing Sections
to file'a signed statement that he/she is licensed pursuant to the provisions of - _ '
the.Contractor's License Law(Chapter 9(commencing with Section 7000)of L Generator 00.5 KW 05-15 KW • Trash Compactor '
'Division 3 of the Business and Professions Code) or that he/she is exempt - ..
therefrom and the basis for the alleged exemption. Any violation of Section - .
7031.5 by any applicant for a permit subjects the applicant to a civil Reinspection Fee
-
enalty of not more than five hundred dollars($500). Pa I $25 Issue Fee $ 3
0 I, as owner of the property or my employees with wages as their Sole - -- Reinspection Fee . $25 Issue Fee $ 3
compensation will do the work,and the structure is not intended or offered MECHANICAL FEES 'n
for sale (Section 7044, Business and Professional Code: The Contractor's - _ PUBLIC SERVICES REOUIRSMENTS'
License Law does not apply t0 an owner of a property who builds or Improves Hood or Type I ❑ , \ (t / 1 / G.
thereon, and who does such work himself/herself or through his or her own Boiler yp Zoning Approved By fb ,1 nate // Ad/ Ai
employees, provided that such improvements are not Intended or offered for Canopy Type II ❑ FF�� // 111
sale. If, however,the building or improvement is sold within one year of com- Duct-Under Ground - Application Approved By Date
pletion, the owner will have the burden of proving he/she did not build or im-
r ve for the purpose of sale). Dsict-Structural Refrigeration System Application Issued By �/ 14 / Date
I,as owner of the property,am exclusively contracting with licensed con- ❑0.100,000 BTU ❑100,000 BTU
rectors to construct the project (Section 7044,Business and Professions Code: Duct-Ventilating SUMMA Y OF FEES q '�
The Contractor's License Law does not apply to an owner of property who BUILDING PERMIT $ e5'�. •,�� SMTP $ '/' ..3
builds or improves thereon,and who contracts for such projects with a con- Exhaust System 0 Multiple 0 System Repair/Alteration '
tractor(s) license pursuant tthe Contractor's Lice se Law). i PLAN CHECK $ PERMIT
0 i am exempt under -ction 4 B.& P.C. or chi reason Firepl/Fact.BIC.ICBG# ISSUANCE $
• ►/ 1 PLUMBING $
Date DYi'IIWIS. owner ►,a1Vallreifigri7�.M Heating System& Ducting ~ PLAN CHECK $ ENERGY P.C. $
I.here. car P t at have read s is application and state that th above D0-100,000 BTU 0100,000 BTL-- ELECTRICAL $ GRADING $
Information I corn-ct. I e to comply with all city and county ordinances 1'
and state la s rel. ing • ilding const ction, and-hereby authorize repre- • PLAN CHECK $ MICROFILM $
sentatives o' th city ••enter upon e above-mentioned property for - Sat)
Inspection pu •. s. • (I. MECHANICAL $
Signature -� •ate / / TOTAL FEE $ S�r,rf.43
Drivers' Licens •
CMF 0865-46 rev. 7/83 White.Bu Ong;Canary-Applicant,Pin- -Accounting;Goldenrod-Assessor S
I- . ..
,ONSTRUCTION AND PLANNING POuL & SPA
'fi;OVALS 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 2_9 ri. .3 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
. ..:
7. Footings - 58. Electrical Conduit-Undrgrnd.
8.'Foundation Z 9-tcf IP 59. .Gas Pipe, ❑ Undrgrnd., Test
9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, 0 Undrgrnd. '
10. Structural'Floor System 61. APPROVAL TO DECK - I '
11. Property Sewer Line & House Connection - 62. Backwash & Receptor-Final
12.Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 04. Plumbing System - Final •
14. Rough Plumbing - 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
, 21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23: Gas Pipe-Rough & Test 72. Underground Flush
244 Roof•Framing 3/` /$K i5' -7 73. Undergrnd.Storage Tank OGas ❑Oil
25. Roof-Sheathing L/ ,�u.,�y }7, 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical .
27. Frame and Flashing . 5S2/Ry A Iv/ 76. Dry Standpipe
1 ' Lathing & Siding ‘..t./...71 Clay./ 77. FIXED SYSTEM FINAL
' 29. Insulation tqso/x+ Aim 78. FIRE PR EV. FINAL
30. Drywall Nailing -Y--,gy beast, HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat ��/ �--G �- 79. FINALINSPECTION
32. Electrical Power Meter-Final "`�� 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: 1.16 -rt H A61TAN1•k SLAP ONLY 0443p
34. Final Heating & Air-Conditioning 1-7---/ b:/A.<2.ArrE=Z C-A,E,O 27-SLA6: G K £4
35. Final Gas Pipe-Test • S 9- ri F RAM//VG rcNSvc TH TMMA/- �P
36. Hood or'CanFactor opyI
_ D' _� T f...--;•rne 1 _
37. Final Factory Fireplace ���/ ✓�' '�[s Zf�
38. Final Plumbing
39. Water.Service-Final
40. Gas Service-Final
41. Solar Domestic-Final }
42. Backflow Preventer
43. Backflow Irrigation •
-•144. .Landscape Irrigation System
145. Sound Attenuation
46. Handicap Regulations
17. FINAL STRUCTURE & BUILDING ' 7-any etc
18. Special Requirements Completed /b,T'b1 'btp .
19. Electric Release to Edison
I ; Gas Release to Southern California Gas Co
\CERTIFICA2O F O Da eIC? . r�. ry �,. tr ked
11, ��
i
4
1 cD
City of Costa Mesa INSULATION CERTIFICATION - Building Safety Division
Number and Street City County
•
Subdivision Lot Number
pRA -;* B 1056
DESCRIPTION OF INSTALLATION
ROOF
Material Brand Name
Thickness (inches) Thermal Resistance (R Value)
EXTERIOR WALL
Material ff6r--,cy/A 5 , Brand Name /14411///La's
Thickness (inches) 3 Thermal Resistance (R Value) //
CEILING
17AA11//l(S
Batt or Blanket Type 7-7��Ek�'�ais Brand Name /
Thickness (inches) Thermal Resistance (R Value) /9
_
Loose Fill Type Brand Name
Minimum Thickness (inches) Number of bags Weight per bag lb.
Area Covered (ft2) Thermal Resistance (R Value)
FLOOR, ELEVATED
Material Brand Name
Thickness (inches) Thermal Resistance (R Value)
FLOOR,SLAB
Material Brand Name
Thickness (inches) Thermal Resistance (R Value)
Width (inches)
FOUNDATION WALL
Material Brand Name
Thickness (inches) Thermal Resistance (R Value)
DECLARATION
I hereby certify that the above insulation was installed in the building at the above location in conformance with
the current regulations setting Energy Conservation Standards for new residential buildings (located in Title 24
of the California Administr ve Code),
_el 17r— s, < nCiketSS' 14 7 3 3 7
d CA in TiCo ac f(B ilder)///_p • License Number pe
Signature ar(d Title Date
cst ..TAiszc(�cfio� co fArm• 4:1 423670 C,-
Sub Contractor (Insulation Applicator) License Number
41isa SE, /? /9 81
Si nature and Title Date
CMF 1106-30
- • Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. .
CIF '
- PERMIT NO. aII T.RACy NO. LOT NO. BLDG.NO. I 3843 2/06/84 I j O.8J TI
`CON•STRUCTION PERMIT 1775 - /6 fFY !,
Project Address• •
1•14 '�y- TYPE OF CONSTRUCTION LJ NEW LI ADD H ALTERATION H REPAIR
Applicants Malli, ngQddress/ f. I 't 1I4�'P 2 El CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# IZone •
Owner's Na - .)_ 'AA -• AI - Phone�T-1/ O1 . DESCRIPTION OF WORK - �J
S Main Building: Accessory Building: Z
Address . ! r2a. � ''MI tlit c dr til E ... . O
TYPE OF PERMIT 71.-ELECTRICAL
�y( ❑ GRADINC,� FOUNDATIONU STRUCTURAL T Front . N
Arch/Eng. a %� License No. ❑ TENANT LLE LECTRICAL D'VPLVMBING MECHANICAL A Rear - •
-
N
Address ❑.BOTHER /
+��ta+w:... � C Right G
Contractor's -',�,QEPIaGtf[lh��l�s1'%IlY'Gs0 `o e' +%.•�L•0� PROJECT DESCRIPTION• 5 OCCUPANCY K R
"
Address(maili-! ' 174Z F - Leag( • C O N ST RUCTION TYPE VALUATION$ S Left E •—
City LiCenSe'N0. • ZONE • - GRADING CU.YDS. ACRES ' Ping. Ref.4 Park.Fees $ • Q
LICENSED CONTRACTOR DECLARATION a , U
Remarks: �O S� (/ Parking Req./Provided I
I hereby affirm that I am licensed under provisions of Charter 9 (commencing -• R
with section 7000) of Division 3 of the Business and Professions Code, and , - Use of Building: - E
my license Is in full force and effect. Planning Notes•
: M
7. License Class License No. PLUMBING FEES E
ate • Signature • . Bar Sink ' Showers - N
AORKERS'COMPENSATION DECLARATION T
I hereby affirm that I have a certificate of consent to self-insure or a certificate Backflow Preventer - Service Sink ' - • • - . "_ S
of Workers' Compensation Insurance, or a certified copy thereof (Section' -• '
3800, Lab. C4- - - 7, • Backflow Irrigation'/, - Sewer Cap -� ELECTRICAL FEES
Policy No. ' •-' - Company 4 - -
•
�, Certified copy is hereby furnished. -• — Bathtubs , Sewer Connection - /4 Au. Brit Washer- Transformer 0 15-50'KW '
— Certified copy Is filed with the city Building Division. ._
0 50+KW
Date Applicant Clarifiers Solar Collectors Constru 'on Pole Sub. _
EXEMPTION FROM WORKERS'COMPENSATIONf DECLA , Dishwasher - Solar Piping 4 ' Cookin Unl Met ❑u to 100 amps
(This section need not be completed If the permit is,for one hundred ($100) or ----'
9 P ,
less). "^ DrinkingFountains '
I certify that in•the performance of the work for-which this permit is issued, I + Solar Tank . Dishwasher ' afar Dover 100 amps
shall.not employ any person In any manner so as•to become subject to the - •
��
Workers' Compensation'Laws of California.. Floor Drains Swimming Pool w/Spa /"
Dryers ;&as DElec 'c Sub Panel /O
Date • Signature
NOTICE: 'Latter making this declaration,you should become subject to the Floor Sinks Urinal - Fan Motors 00-1.F1112142-B
Workers' Compensation provisions of,the Labor Code, you must forthwith
LI:
Comply with such provisions or this permit shall be-deemed revoked. Gas Service Outlets Water Closet --74- F.A.U. Inc.Solar • '-15 HP 016-15+CONSTRUCTION LENDING AGENCY SC,
I hereby affirm that there is a construction lending agency for the performance Interceptors - Water Heater . il -- Fixtures cr•- ave
of the work for which this, permit Is issued •(Section 3097 Civ. C.) • �_
' Lender's Name 1....... Kitchen Sink ± Water Service - Device Boxes PrOle t
•
Lender's Address - Lavatories [�
OWNER BUILDER bECLARATION . • - -' O • Outlets / f0
Range /� 1,-aI hereby affirm that I am exempt from the Contractor's License Law for the J
following reason (Section 7031.5 Business and Professional Code: Any city or p—Tra p - Switches Sign to
county which requires a permit to construct,alter,Improve,demolish or repair . 1
any structure, prior to Its Issuance, also requires te applicant for such permit Roof Drains Garbage Disposal •• ' Standing Sections
:o file a signed statement that he/she is licensed pursuant to the provisions of
the Contractor's License Law(Chapter 9(commencing with Section 7000)of
Division 3 of the Business and Professions Code) or that he/she is exempt - Generator ❑s.: KW 05-15 KW Trash Compactor
therefrom and the basis for the alleged exemption. Any violation of Section - - -
7031.5 by.any applicant for,.a permit subjects the applicant to a civil3
" -
walty of notmorethan five hundred dollars($500). Fee r, $
Reinspection 25Issueee -
F $
LJ I, as owner of the property or my employees with wages as their sole nspection Fee $25 Issue Fee $ 3
compensation will do the work, and the structure Is not Intended or offered MECHANICAL FEES
for sale (Section 7044, Business and Professional Code: The Contractor's - - - - 'IUBLIC SERVICES REQUIREMENTS:
License Law does not apply to an owner of a property who builds or improves - Boiler Hood or Type I ■
thereon, and who does such work himself/herself or through his or her own - • Zoning Approved By Date
employees, provided that such improvements are not intended or offered forCanopy Type II D
Duct'-Under Ground
sale. If, however, the building or improvement Is sold within one year of corn- Building Approved By Date
pletion, the owner will have the burden of proving he/she did not build or im-
•���--Q.ve for the purpose of sale). • Duct-Structural Refrigeration Application Issued By . / Dat
t 'I, as owner of the property,am exclusively contracting with licensed con-
rectors
on- s s s s s s : D100,000 .
tractors ter construct the project (Section 7044,Business and Professions code: Duct-VentilatingSUMMARY OF FEES
The Contractor's License Law does not apply to an owner of property who •
builds or improves thereon,and who contracts for such projects with a con- Exhaust System 0 Multiple 0 BUILDING PERMIT $ SMIP $
tractors) license pursuant to the Cont tor's LIcense Law). -
❑ I am exempt under Section B. a, P. for this reason Firepl/Fact.Bit. ICBG 4 PLAN CHECK $ -2 PERMIT
//ll i ..� PLUMBING $ �,C.3.OU ISSUANCE $
Date '�' �(J' t . Owner, = • • D _ , ' PLAN CHECK 25°/ $ /} , 0 O ENERGY P.C. $ '
I herebyormacertifysnave read t is application all and state that the above `•s sl sss [ 0100,0008T• ■ ' .A• F 0 GRADING $
Information c• rec agree to comply with all city and county ordinances ELECTRICAL /
and state laws r'latln• to b (ding constr tion,and hereby authorize repre- . • PLAN CHECK 50% .$ , G 0 MICROFILM -$
sentatives of•th- c y top ter upon t .bove-mentioned •ropprty or
Inspection pur•• -
Signature -, �� r•te '' Q- Sl• MECHANICAL $ _ TOTAL FEE $ eW
Drivers' License o �
-Accounting:Goldenrod-Assessor
•, n _ - - PC....._ . -
" CONSTRUCTION AND PLANNING - _ - , •
Date Inspector - - • 'Date Inspector
-,APP'ROVALS Permit# - APPROVALS Permit# -
i a .
1. Temporary Electrical Service or Pole _ . _ 52. Pool & Equipment Location ; --
r 2. Soil Pipe-Undrgrnd.' • .2f4' A 53. Steel Reinforcement
3: Electrical Conduit Utility-Undrgrnd. : 7/�yg 16 54.i Forms '- ..17.-: - - ' ' -
'"4:Electrical Conduit-Undrgrnd:' 55. Electrical Bonding ; ' - .
,
•
7 5'. Steel Reinforcement • 56. Rough Plumbing-& Pressure Test
. 6: Electrical UFER'Grnd. _ 57: APPROVAL TO COVER-GUNITE • I -
7. Footihgs - 58. Electrical Conduit-Undrgrnd: -
8. Foundation' - 59. Gas Pipe,-❑.Undrgrnd.,Test:
9. Water Pipe=Undrgfn 1. ' 1//6.1" C 60. Backwash Lines,P-Trap, O Undrgrnd. -.
10. Structural Floor System - • 61. APPROVAL TO DECK • - ,-, )
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final - i'
12. Sewer Cap : '63. Heater & Vent-Final - - "
a ,
13. Roof Drains " ' - 64. Plumbing System - Final r • -
14. Rough Plumbing •2 T C/W/f1r ......MC - 65. Electrical-Final - '15: Rough-Electrical-Conduit ' ' -• • - - . 66. Solar System-Final - -
'
16. Rough Electric Wiring .Si 'rt.._ -,!`'. 67. Fencing &Access Approval
17. Rough Wiring Sigh - . ' 68.'APPROVED FOR PLASTERING
• 18. Rough-Electrical-T Bar Ceiling' - 69.' POOL/SPA SYSTEMS FINAL '
19. Rough Heating & Air Conditioning . .//ll/q17L FIRE DEPT. REQUIREMENT:
20.IRough Factory Fireplace {/y/'/ $$-L?i ` j' APPROVALS Permit# .
V. Ducts, in Structure - 70.E Underground Hydro •
' '227saucts, Ventilating . • 1 I 71. Product Piping ❑Gas.: 0 Oil
S3. Gas Pipe-Rough &Test s/,j/rf•• C(9 12- Underground Flush '
244 Roof Framing - 73. Undergrnd.Storage Tank,❑Gas O Oil ,
25. Roof Sheathing . • . 74. Overhead Hydro r ,
26. T-Bar Ceiling,IStructural):& Monocoat 75. Dry Chemical '
27. Frame and Flashing r. . • • 76. Dry Standpipe •
28. 'Lathing & Siding ; 3 ' , . • . , 77. FIXED SYSTEM FINAL ' ,
29. Insulation 78. FIRE PREV. FINAL . '
' 30. Drywall Nailing . , " I , , ,HEALTH DEPT. REQUIREMENT ,
31. Plaster Brown Coat 79. FINAL INSPECTION
.32. Electrical Power Meter-Final - / 80.',FOOD CERTIFICATE ISSUED '
33. Final Electric 'tet l C'Y Notes:'3/�-//fV 7.7:cejY 4,./40 Ylr'N.044 - - -
34. Final Heating & Air Conditioning , , ?tail( Coot 6,12.,8/d"/-.PL S.TIC. c.75 C..11-it 11-1s714c4a It-Pr.4LE OF
35. Final Gas Pipe-Test . - I Q
� �/ co Fc�c.lr✓L cord- or (-CoLEp
36. Hood or Canopy ' .
37. Final Factory Fireplace • , qff7,/ Gin _ . •-
38. Final Plumbing i 9!a/ f t40 .
39. Water Service-Final ; : - - _
40. Gas Service-Final Siei/ • LEO - •'
41. Solar Domestic-Final � . ._. _ _ ,
•
42. Backflow Preyenter . _ - - • _ .•
"'j
43. Backflow Irrigation - '
•
44. Landscape Irrigation System i - -
45. Sound Attenuation - ;
r -
46. Handicap Regulations -
47. FINAL STRUCTURE & BUILDING, . 7:-.2903f. ' I - ' -
48:;Specialr Requirements Completed I
49. Electric Release to Edison I ' -I 1
50. Gas Release to Southern California Gas Co -
51. CERTIFICATE OF OCCUPANCY - --
No. --Date - - '
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. B156 9/14/84 18.0IL
•
CITY OF COSTA KigSA. CONSTRUCTION- PERMIT PE MIT NO. - TRACT NO. LOT NO. UNIT NO.
Project Addrels _ ^Ib E t(-7,' '.S. �T I 1 0
(( l
Applicant's Mailing Address f?O. YV en, 1'i 143 1 sk- Ia TYPE OF CONSTRUCTION I�7'NEW lJ ADD Li ALTERATION Li REPAIR
Owner's Name Tr71r �.0,,s, tort ICI Phone SSI^8137 ❑ CONVERSION ❑ DEM6LISH ❑ OTHER A.P.# I Zone
d Ag. • ` NG . DESCRIPTION OF WORK/USE OF BLDG.
Address �� -_ S Main Building: Accessory Building:
Arch/Eng. s W L . .� License1No. TYPE OF PERMIT U GRADING U FOUNDATION 0 STRUCTURAL T Front O
Address I. , r ;PQJ-, TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear - N
Contractor's Nam: N IIII,- t P Phone ..aL* OTHER (--t)WCr WI C2 El..- A 1
r PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right N
Address(mailing) S !.'- - � K Left G
CON ST RUCTION TYPE VALUATIONS S
City License No. S - AP ZONE GRADING CU.YDS. ACRES R
LICENSED CONTRACTOR DECLARATION Ping. R¢f.# Parking Req./Provided E
I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: Si sS Planning Notes: - M
✓�'-with section 7000) of Division 3 of the Business and Professions Code,and T
CIOmy license is in full torte �ef feet. '
tIO License lass / Lice se s(� S.
Date . ' I Signature a. -- L _ PLUMBING I FEES 1
WORKERS'COMPENSATION •'PLANATION • • '
1 I hereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers ELECTRICAL FEES
of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
3800, Lzb."C. - — •
Automatic Washer Transformer 0 15-50 KW
Policy No. nd- GO—020/company icere Ft-- Backflow Irrigation Sewer Cap Construction Pole Sub, ' 0 50+KW
Certified copy is hereby furnished. ,/
ertified copy i filed with the city g Divisi n. Bathtubs Sewer Connection Cooking Unit '2„,.._Meter I�lup to 100 amps /0 000
Date Q--11-114 Applican
EXEMPTION FROM WORKERS'C PENSATION DECLARATION Clarifiers Solar Collectors Dishwasher 1 Meter Dover 100 amps
(This section need not be completed if the permit is for one hundred ($100)or --
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors 00-1 HP Om.8
Workers' Compensation Laws of California. _ -
Date Signature ' Floor Drains Swimming Pool w/Spa F.A.U. ' Inc.Solar 09-15 HP 016-15+
NOTICE:If,after making this declaration,you should become subject to the
workers' Compensation provisions of the Labor Code, you must forthwith . Floor Sinks Urinal Fixtures Microwave
comply with Such provisions or this permit shalt be deemed revoked.
CONSTRUCTION LENDING AGENCY Gas Service ' Outlets Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the'performance Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) interceptors Water Heater Outlets Range
Lender's Name _ -
Lender's AddressKitchen Sink Water Service Switches
OWNER BUILDER DECLARATION Sign
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories -
following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair - P—Trap - Generator 065 KW ❑5.15 KW
any structure, prior to Its issuance,also requires the applicant for such permit Trash Compactor
to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains .
the Contractor's License Law(Chapter 9(commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt
therefrom and the basis for the alleged exemption. Any violation.of Section
7031.5 by any applicant for a permit subjects the applicant to a civil -
¢nalty of not metre than five hundred dollars($500). $ 3
I, as owner of the property or my employees with wages as their solo Reinspection Fee $15 Issue Foe
compensation, will do the work,and the structure Is not intended or offered - Reinspection Fee $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her ownDEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such Improvements are not intended or offered for Boiler HOOd or Type I 0
sale. If, however, the building or improvement is sold within one year of com- Canopy I Type II ❑ Zoning Approved By Date
oletion. the will nave lh¢burden of proving he/she did not build or im- Duct- Under Ground Building Approved By Date
�srove for owhener
r purpose of sale).
LJ I, as owner 01 thet pam exclusively sinesscontracting with of licensed con-. Duct-Structural Refrigeration System Application Issued By_�'U� Dat
hetors the project (Section 7044,Bto
and Prof t Code:
The Contractor'smproLicense Law peh not ora t to an owner je isproperty who Duct-Ventilating 00.100,000 BTU 0100,000 BTU SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUI LDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT
❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.BIt. ICBG# PLUMBING $ ISSUANCE $
Date Owner Heating System& Ducting PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read his application and state that the above ' 00.100,000 BTU ❑100,000BTL—
information is correct. I agree to c mply with all city and county ordinances
-
and state laws relating to b • ing construction,and hereby authorize repre- PLAN CHECK 50% $ aJ 'op ' MICROFILM S
sentatives of chi city to r eon the above-mentioned property / r
Inspectiongnatupu•p .s. I Q MECHANICAL $ TOTAL FEE $ /etc
Signature ly Date L.�I �B
Drivers' L nse or Si# Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46,rev,4/84 ' White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor -
CONSTRUCTION AND PLANNING ! POOL&SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
' n
r 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
18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL
•
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
• . 21. Ducts,in Structure 70. Underground Hydro
22.- Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing _ 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
• 29. Insulation 78. FIRE PREV. FINAL
• 30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final /' 80. FOOD CERTIFICATE ISSUED
p
!(�`'1 B4
33. Final Electric l Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final •
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System -
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
. No. Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
•
` PERMIT NO. TRACT NO. LOT NO. UNIT NO.
CITY OF COSTA MESA CONSTRUCTION PERMIT ���307� 0075 5/09/84 18.09 TL
Project Address. 21 E'•• 1‘24••1‘24••‘:"� • Si- }� KNEW•
Applicant's Mailing Address s� P.LO ;Box 1143 RT"r<S -• TYPE OF CONSTRUCTION KNEW U ADD U ALTERATION Li REPAIR
�'D t--L l7�N�OT'CT ❑ CONVERSION El DEMOLISH ❑ OTHER A.P.# Zone
Owner's Name Phone 8�l'013'] DESCRIPTION OF WORK/USE OF BLDG.
Address tP.CD.1;k:.A52.oZ- U S Main Building: Accessory Building:
Arch/En . CALVtJJ COATS L'ZOCVI4 TYPE OF PERMIT ❑ GRADING ❑ FOUNDATION STRUCTURAL E Front Z
Arch/Eng, ( � License No. T O
Address TJfa.W1��NL' - g9UGr-I a❑[1 TENANT El ELECTRICAL El PLUMBING El MECHANICAL B Rear N
Contractor's Nam¢ FiV1?eStat 9E9T-GbA hone "'S� ( L� OTHER �2.CL p(.,A�` C Right N
Address(mailing) . ,--0.. $0% at� PROJECT DESCRIPTION SQ. FT. OCCUPANCY K G
EC 2/ F�Vp�¢gylpF gZsl� CON ST RUCTION TYPE VALUATION$ S Left
E
City License No. ZONE GRADING CU.YDS. ACRES
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E
Q
I hereby affirm that) I am licensedion of er provisions f Charter i ns Code, nq Remarks: Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code,and ' '0,5(0b T
my license is In ful orce and effect.
License Class - .� nse �.a 4 3 S.
Dale Signature - ..aa..• : I LVAL•a.,. PLUMBING FEES
WORKERS' COMPENSATION DECLARATION iBar Sink Showers ELECTRICAL FEES
I hereby affirm that I have a certificate of consent to sell-Insure or a certificate
of Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink
3800, Lab. Cr) Automatic Washer • Transformer 0 15-50 KW
PolicyNo. '10-(�-✓ Z Comp. y STILTS �et'Y• Backflow Irrigation Sewer Cap ❑ 50+ KW
9 Construction Pole Sub.
Certified copy is hereby futhe cit
Certified4opyXj filed with the city =u1.ing Divisi 9./ r Bathtubs Sewer Connection Cooking Unit Meter Dula to 100 amps
Dat 1y'5.- t39 Applicant .A4 c.."1..." _ I/.h11L
EXEMPTION FROM WORKERS'C. PENSATION /lCLARATION Clarifiers Solar Collectors Dishwasher Meter !Dover 100 amps
(This section need not be completed If the permit is fo one hundred ($100)or
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
I certify that In the performance Of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors 00-1 HP 01,A-8
Workers' Compensation Laws of California.
Date Signature Floor Drains Swimming Pool w/Spa F.A.U. _
09.15 HP 016-15+ •
NOTICE:If,after making this declaration, you should become subject to the
Workers' Compensation provisions Of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures
comply with such provisions or this permit shall be deemed revoked. Microwave
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Range • '
Lender's Name
Lender's Address Kitchen Sink Water Service '
OWNER BUILDER DECLARATION' Switches Sign
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Garbage Disposal Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Generator 00.5 KW 05-15 KW
any structure, prior to its issuance, also requires the applicant for such permit Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of q Roof Drains • 4106
the Contractor's License Law(Chapter 9(commencing with Section 7000) of e{
Division 3 of the Business and Professions Code) or that he/she is exempt
therefrom and the basis for the alleged exemption. Any violation of Section '
7031.5 by any applicant for a permit subjects the applicant to a civil
LJenalty of not more than five hundred dollars($500). '
I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 -
compensation, will do the work, and the structure is not intended or offered Reinspection Fee $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to en owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑
sale. If, however, the building or improvement is sold within one year of com- Canopy Type 11 ❑ Zoning Approved By Date
Mellon, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date
rove for the purpose of sale). 7-7V/
I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 0o-100,000 BTU 0100,000 BTU SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that BUILDING PERMIT $ SMIP $
(fExhaust System ❑ Multiple ❑ System Repair/Alteration PLAN CHECK $ PERMIT
proof o their worker's Compensation Insurance should be provided to me.
0 I am exempt under Section — B.& P.C.for this reason ,� Firepl/Fact.Blt. ICBG#1S$1 07® PLUMBING $ OO ISSUANCE $
Date - Owner Heating System& Ducting PLAN CHECK 25% $ ENERGY P.C. $
I hereby certify that I have read this application and state that the above 1:10.100,000 BTU 0100.000 BT ELECTRICAL $ GRADING $
information is correct. I agree to comply with all city and county ordinances
and state laws lacing to uilding construction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives of is city t ter n the above-mentioned property for
inspection roses. gVp ny,u}�yo MECHANICAL $ /�®'0
Signature j •v�A/l/S.P/Vi Date S-9-94
TOTAL FEE $
Drivers' License or SS v7 Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ IrQQ
a
CMF 0865-46,rev.4/84
White-Building;Canary-Applicant;Pink-Accounting;Goldenrod -Assessor
CONSTRUCTION AND PLANNING - POOL &SPA -
APPROVALS Permit# _ Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. 'Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3.,Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ,
5: Steel Reinforcement 56. Rough Plumbing & Pressure Test
• 6. Electrical UFER Grnd. , 57. APPROVAL TO COVER-GUNITE
7. Footings - , ' 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test I
9. Water Pipe-Undrgrnd. .- ' _ 60. Backwash Lines, P-Trap, 0 Undrgrnd. •
10. Structural Floor System 61. APPROVAL TO DECK •
•
11. Property Sewer Line& House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains //I v1111`1 L69 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.rRough 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 cifrif! Di/Vf APPROVALS Permit#
21. Ducts, in Structure /fes( 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping ❑Gas 0 Oil '
23. Gas Pipe-Rough& Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 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 y
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace q/ft,(l . L4'O ,
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final .
41. Solar Domestic-Final
42. Backflow Preventer ''
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MEA/. CONSTRUC 11ON:.ERMIT PERMj7�S/ 1-5--
// TRACT NO. LOT NO. UNI NO. ,,t 9778 10/09/84
Project Address ra,.b E 1 ('1y[ , /// `v 7-J l� ae�(+ T
Applicant's Mailin dress \ 0. Cy/ --]—Ltt 3 k',s/, TYPE OF CONSTRUCTION U NEW U ADD U ALTERATION REPAIR 1
3 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone
Owner's Name -a Phone f3S1 1 _OI 7
1 DESCRIPTION OF WORK/USE OF BLDG.
Address �. �/ Oz1/� trill In Ar- S Main Building: Accessory Building:
Arch/Eng. A4\ v,...„ OcttTC WnflEicense No. • TYPE OF PERMIT U GRADING ❑ FOUNDATION ❑ STRUCTURAL E Front O
Address 1\1 c.-.1 f.rst---t CGI J-, �❑7I TENANT ❑ EE.LECTRICAL ❑ PLUMBIN MECHANICAL A Rear N
• i (�-S n Phone35`�-$ /I y+ OTHER ( rtnS WIPTN`$ E7. C Right N
Contractor's Nemp• _ - '�'? (�
Address(mailing)``�t Y tV, �U 9JS„(3 PRECT DESCRIPTION SQ. FT. OCCUPANCY K Left G
_il 7t CON ST RUCTION TYPE OCCUPANCY
VALUATION $ R
City License No. HCl C[J`�- ZONE GRADING CU.YDS. ACRESE
LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided
I hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code,and
my license is in full force and eff• / 4 • T
License IS s Lic•nsejw. ,.
S.
Date ftp Signet 1� . PLUMBING I FEES• I •
WORKE-S'COMPENSATIO . CLARATION ,
I hereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers ELECTRICAL FEES
\ of Workers' compensation Insurance, or a certified copy thereof (Section ' Backflow Preventer Service Sink -
3800, Lab. C.)' Automatic Washer Transformer ❑ 15-50 KW
Policy No. ' Company Backflow Irrigation Sewer Cap. Construction Pole Sub. 0 50+ KW
-.
Certified copy is hereby furnished. - - •
- Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps
DateX - - • ApplicantRS'COMPENSATIONClarifiers Solar Collectors Dishwasher • Meter
EXEMPTION FROM WORKERS' DECLARATION _ Clover 100 amps
(This section need not be complet¢tl if the permit is for one hundred($100)or
less).erDishwasher Solar Piping Dryers ❑Gas' DElectric Sub Panel
I ltno thatm in the performancepersonin the work for which this permit issued,t tI shall -
' employ anyiperson of any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors❑0-1 HP ❑1''A-8
Workers' Compensation Laws of California.
Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+
NOTICE:If,after making this declaration,you should become subject to the •
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures -
comply with such provisions or this permit shall be deemed revoked. J Microwave' -
' CONSTRUCTION LENDING AGENCY • ,2Gas Service Outlets Water Closet 1/80 Device Boxes
I hereby affirm that there is a construction lending agency for the performance Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Range
Lender's Name
Lender's Address Kitchen Sink Water Service Switches Sign
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories
following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P-Trap r
any structure, prior to Its issuance, also requires the applicant for such permit . - Generator 00-5 KW 05-15 KW Trash Compactor
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains
the Contractor's License Law (Chapter 9(commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she Is exempt
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars($500). '
Li I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3
compensation, will do the work, and the structure Is not intended or offered - Reinspection Fee $15 Issue Fee $ 3
for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS:
employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑
sale. If, however, the building or improvement is sold within one year of corn- Canopy Type II ❑ Zoning Approved By Date
diction, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date
strove for the purpose of sale). Q
u I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Dater r-9
tractors to construct the project (Section 7044,Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU ❑100,000 BTU SUMMARY OF FEES
builds or improves thereon,and who contracts for such projects with a con-
tractor(s) license pursuant'to the Contractor's License Law). I am aware that Exhaust System El Multiple❑ System Repair/Alteration BUILDING PERMIT $ SMIP $
proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT
❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# PLUMBING $ 7„Q O ISSUANCE $
Date Owner Heating System& Ducting
PLAN CHECK 25% $ / 0 U ENERGY P.C. $
I hereby certify that I have read is apps' ation and state that the above 00-100,000 BTU 0100,000 BTL ELECTRICAL $ GRADING $
Information is correct. I agre to o iy w h all city and county ordinances
and state laws relati to b Illi nstr tion,and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $
sentatives of his y to me on e above-mentioned pro ertyy for
ei
inspection p o s. dB/I MECHANICAL $ TOTAL FEE $ r //
e"...-
Drivers'
�- Dat L.
Drivers' ' ase or 55# Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46,rev.4/84 White-Building:Canary-Applicant;Pink-Accounting;Goldenrod-Assessor
CONSTRUCTION AND PLANNING - POOL Si 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, 0 Undrgrnd.,Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. •
10. Structural Floor System 61. APPROVAL TO DECK
17. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
•
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit •
66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval •
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning - FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure O. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
•
23. Gas Pipe-Rough &Test - 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro •
- 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
•
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 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 WWII t9
36. Hood or Canopy •
37. Final Factory Fireplace
38. Final Plumbing -
39. Water Service-Final
40. Gas Service-Final loftely'K
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation -
44. Landscape Irrigation System
45' Sound Attenuation
46. Handicap Regulations •
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas CO
51. CERTIFICATE OF OCCUPANCY
No. - Date
Applicant to fill in all spaces except thos arder lines and sign all appropriate declarations.
CITY OF COSTA MESA PERMIT NO. : • • "• TT . T _ LOT NO. BLDG.NO.
CONSTRUCT!, i PERMIT S23 = /O '55t�- I 2427 1/16/84 34.37 TL
' } • - -
Project Address _ / ��A a TYPE OF CONSTRUCTIO U NEW U ADD Li ALTERATION U REPAIR
Applicant's Mailin. Address Ii / _ .747n.r �G E CONVERSION EMOLI I❑ OTHER 4-a c- --0/.-• / (/ ��
� / yyy//////����__ A.P.#' Zone
DESCRIPTION OF ORK - j�-- S Main Building:•
Accessory Building: �/ Z
Owner's Na #1,.... IG I P one _� /J� cX� I��l
yA/ ���Ad/d�ress I a - ♦t "Cr) $ J��' - t7L YPE OF PERMIT- ❑ GRADING U FOUNDATION 0 STRUCTURAL T Front //. N
Veld/aft-Mt -i ic: se No. ✓-A 'fir I
YYAne+fETlg' f f �, El TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear /
Address /-r.-�wr�Il��ii ,_ • { ❑ OTHER p' ./ N
•ntractor's Nam: sa +>i 1"�`,.. M Phoc I Z (PROJECT DESCRIPTION SQ. FT. OCCUPAN Y T C Right R
L r/�■TiI,LivvL CON ST RUCTION TYPE VALUATION$ OO. V Si(
Left E
ss(mailing
// sty License No. ZONE GRADING CU.YDS. AC ES Ping. Ref.# Park.Fees $ Q
LICENSED CONTRACTOR DECLARATION Remarks: Parking Req./Provided U
I hereby affirm that I am licensed under provisions of Charter 9 (commencing R
with section 7000) of Division 3 of the Business and Professions Code, and Use of Building: . E
my license is in full force and effect. Planning Notes: �l F�v�p nsn,•_„ . 19. M
License Class _License No. PLUMBING FEES /` _ _ "_——
late Signature E
T
AORKERS'COMPENSATION DECLARATION Bar Sink Showers
I hereby affirm that I have a certificate of content to self-insure or a certificate Backflow PreventerService Sink S
of Workers' Compensation Insurance, or a certified copy thereof (Section --
3800, Lab. C.) Backflow Irrigation Sewer Cap r ELECTRICAL FEES
Policy No. -- Company
8 Certified copy is hereby furnished. Bathtubs • Sewer Connection Automatic Washer _ ■ • 1
Certified copy is filed with the city Building Division. ■ 50
Date Applicant Clarifiers Solar Collectors Construction Pole Sub. .
EXEMPTION FROM WORKERS'COMPENSATIONDECLARATION .
Dishwasher Solar Piping Cooking Unit ■ • amps(This section need not be completed if the permit Is for one hundred($100) orIecs). Fountains I . . 'LLOLlI
I certify that in the performance of the work for which this permit is issued, I Drinking Solar Tank Dishwasher
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California. ' Floor Drains Swimming Pool w/Spa. Dryers ❑Gas DElectric Sub Panel
Date Signature
NOTICE:If,'after making this declaration,you should become subject to the Floor Sinks • Urinal - ■a ■
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such.provisions or this permit shall be deemed revoked. Gas Service Outlets Water Closet ' - ■• • E16-15+
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance Interceptors Water Heater '
of the work for which this permit is issued (Section 3097 Civ. C.)
•
Lender's Name Kitchen Sink - ,Water Service , Device Boxes
Lender's Address - • I Pole- Light
OWNER BUILDER DECLARATION Lavatories Outlets Range '
I hereby affirm that I am exempt from the C;ontractor's License Law for the -
following reason (Section 7031.5 Business and Professional Code:Any city or P—Tra p • ._ Switches' Sign
county which requires a permit.to construct,alter,improve,demolish or repair _ . '
any structure, prior to its issuance, also requires the applicant for such permit Roof Drains Garbage Disposal Standing Sections
o file a,signed statement that he/she Is licensed pursuant to the provisions of -. -
he Contractor's License Law (Chapter 9 (commencing with-Section 7000)of •
Division 3 of the Business and Professions Code) or that he/she is exempt I Generator ❑0.5 KW ❑5-15 KW Trash Compactor
therefrom and the basis for the alleged exemption. Any violation of Section - .
7031.5 by any applicant for a permit subjects the applicant to a civil •
. nalty of not more than five hund •red - .
red dollars($500). Reinspection Fee $25i Issue Fee $ 3
pe
LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee $25 Issue Fee $ 3
compensation, will do the work,and the structure is not intended or offered - - MECHANICAL FEES'
for sale (Section 7044, Business and Professional Code: The Contractor's PUBLIC SERVICES REQUIREMENTS:
License Law does not apply to an owner of a property who builds or Improves Boiler Hood or Type I 0
thereon, and.who does such work'himselt/herself or through his or her ownRefrigeration System Zoning Approved By Date
' —
employees, provided that such improvements are not intended or offered for Canopy Type II ❑
sale. If, however,the building or improvement Is sold within one year.of com- Duct-Under Ground Application Approved By Date Data
pletion,the owner will have the burden of proving he/she did not build or im- -
�ryve'for the purpose of sale). I Duct-Structural - ��
¢y I,as owner of the property, am exclusively contracting with licensed con- ❑p-100,000 BTU ❑700,000 BTU
Application Issued By
Tractors to construct the project (Section 7044,Business and Professions Code: Duct-Ventilating 'SUMMARY OF/� FEES .
uil Contractor's License Law does notapply to an owner je property who - BUILDING PERMIT $ SMTP $ sa
builds or improvesse thereon, ande who contractso 'sLicense for suchLaprojects with a con- Exhaust System 0 Multiple 0 System Repair/Alteration
tractor(s) license pursuant to the Contractor's Law). PLAN CHECK $ /,' PERMIT
•
❑ Tam exempt under ••ction B.& P.C. or thl3s reason Firepl/Fact.BIL ICBG* ISSUANCE ' $
A i _ t y - PLUMBING $ 5-• 0 1 .
Date ri3i%�1 Owner MT-.: n--B.
(j� ' Heating System&Ducting PLAN CHECK ' ' $ ENERGY P.C. • $
1 heresy cert hat I have read is application and state that the above ❑D700,000 BTU 0100,00.0 BTL ELECTRICAL • $ • GRADING $
information i •ect. I a• -e to comply with all city and county ordinances - -
and state law -ting t•el ilding const ction,and hereby authorize repre- PLAN CHECK $ MICROFILM $
sentatives of city • enter upon - above-mentioned prop•rty •
MECHANICAL $
inspection pu
Signature t • a.te - TOTAL FEE - $
Drivers' Licen e or,5S �� �_
Accounting;Goldenrod -Assessor - - - -- - - - - -
• CONSTRUCTION AND PLANNING �.�L & SPA
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole , 52. Pool & Equipment Location
2. Soil Pipe1Undrgrnd. 53. Steel Reinforcement •
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical-Cbriduit-Undrgrnd. 55. Electrical Bonding
5. ,Steel Reinforcement.' 56.,Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings _. 58. Electrical Conduit-Undrgrnd. ,
8. Foundation - 59. Gas Pipe, 0 Undrgrnd.,Test ,.
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 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
'18.. Rough Electrical-T.Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil
23. Gas Pipe-Rough & Test • 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling-(Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation ' 78. FIRE PREY. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final • 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test • -
36. Hood or Canopy
37. Final Factory Fireplace •
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation -
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations -
47. FINAL STRUCTURE & BUILDING Ceoa •
48. Special Requirements Completed •
49. Electric Release to Edison - -
•
•
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
COUNTY OF ORANGE
BUILDING DEPT. Permit No a 5/c/9...Z,
•
' 636No.Broadway .
Santa Ana, California Application for Building Permit
Phone:KI 2-6211 AND FOR A
Certificate of Use and Occupancy
Date jai/ 7s. :
.1 1 •ri
1. OWNER'S NAME ri----ne -• 2 714--0-19) PHONE-
MAILING ADDRESS '9( / 2 - e / ? ' _if./ CITY. era.. ingrat...-
Name Name . atet4-inec•"-- 4-1•44:e.06"...
(Architzeteer) (Contractor)
Address Address
City City
State State
Lic. No. Phone Lic. No Phone
,
PROPOSED USE:
2. JOB LOCATION 0:26 e. /4. -zi , 4-2-t.
(House No.) "78 , (Name of Street) (Town or School Distnct)
:CD LEGAL DESCRIPTION: Lgt ...C3 Block Tract .
(Metes and Bounds Description-Qlse reverse side
4. CORNER LOT ( ) INTERIOR LOT ( )C) THROUGH LOT ( ) SLOPE OF LOT ( )
„ e
5. SIZE OF BLDG.1:4,21 $ "rig AREA- /1212, 0 SIZE OF LOT•St° 24/3 7 AREA-
1J. / .i
6. HEIGHT OF BLDG ' / y. CEILING HEIGHT- AY NO. OF STORIES -/
7. NO. FAMILIES../.& lAtinj Size of Smallest Bedroom- q K.? Size of Kitchen .2 Y I
8. EXTERIOR WALL CONSTRUCTION- .2444.4...o INTERIOR WALL COVERING -P-telext=
(Frame, Stucco, Etc.) - (Plaster-Drywall, Etc.)
J-0 r
9. SETBACKS: Front Yard From Center Line of Street r.413..,..
, /
Nearest Side Yard S. Rear Yard ...4-," Distance in Feet Between Bldgs. on Same Lot /--------
10. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH.
, .-
11. For (a) Footing: Width ... /k" Depth in Ground A 102- -/ Width of Wall Is—a
Accessory
Bldgs. and
Similar 7e
(b) Size of Studs:...22(X ti Spacing / "CC Material of Floor.Ca4t.44.t../142.aes-
Structures:
(c) Size of Floor Joists; Spacing "CC 0. /
4 CY,C ,
pi." 1"......e.......
(d) Size of Rafters' .2:- X. ‘:. Spacing ,,/.‘ "CC
12. VALUATION OF PROPOSEp WORK: Including all labor, plumbing, electrical wiring, heating, fire sprinklers, painting and
sewage disposal-
0 C' efSeIA)
-----•
13. I HEREBY CERT/WTO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATION IN THIS
APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF
THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO.
Signed• ne-aftefte- --S 721-06.1.4.4
Plans Filed- - ,..5-- (Owner)
By.
(Authorized Agent)
FOR DEPARTMENTAL USE ONLY
FEES: j A.C.H5?(DIG BY
Bldg. Permit • S./Carl...0 GROUP 4 .. APPLICATIONHEALTH
Plan Check • $:..I.7....7..01° TYPE ZONING SA FIRE
Total • • • $./..94,..0 DIST. e1/4:, MARSHAL
PLANS AND
Receipt No. • ... 0..3.K. MAP C-...: /7
SPEC'S // STATE
Paid to - • SHEET NO CORRECTIONS ENGINEER
Date 6 —2.t... VERIFIED CAL
PEItaTIRSLIE7-013INUE rat-SINNTIPiarggillilini
DATE (11k-4.57
I DEPUTY
5M-2-51
t 4
METES AND BOUNDS DFSCh. iON:
" e.Q 141
i -711 ' :1 a9n
0
10 20 30 90 SIO 610
:1011111111 1 Effillal 11111101111-:
litlirElliiiilikilinktily
-5-1 I oppi 1 .. appelummo-
1 ... %mom whismiling 1 ll
= w
CITY OF COSTA MESA. - , ., 2425 I /16/54
- 2458.75 TL.,
PARK FEES
Fee Payment Receipt N° - 925
Project Address /to E. f& . S A.P. Number -$ 3 — _20/ — I F5 Park Area
Building Permit Number
•
Owner's Name IOhn l trt e d i Lf
Mailing Address ?t ,vufltC rvt, I.(ruyo,l I r trkr . . C-4 . R 7/ti
FEE: Single Family * Number of Units
2-Bedrooms or Less @ $ 861.76 =
3-Bedrooms @ 1,205.67 =
4-Bedrooms @ 1,545.62 =
5-Bedrooms+ @ 1,810.50 =
Multiple Family **
Bachelor or Studio _ @ 474.37 =
1-Bedroom @ 573.18 = •
2-Bedroom @ 881.51 =
3-Bedrooms+ @ 1,229.38 =
Total Fee `•' alga. 7 to
Planning Department Approval Date By
Applicant's Signature
• City Ordinance 72-44 •• City Ordinance 72-45 ••• City Resolution 78-116 (1 I,IFI ryr$II((I��(�t,)�.II
CMF 0174-32 Rev.6/79 white—Planning;Canary—Planning;Pink—Finance;Goldenrod—Applicant IJOiUUI!nwil
City df Costa Mesa
Development Services Department (`.f b O
Building Safely Division CERTIFICATE OF OCCUPANCY No. 00C
P.0.Box 1200
Costa Mesa,California
The Building located at 21R PASO` 1ti'PH .'a'Nk 7P1
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group a_1 Occupancy.
Use of Building 9 tarrm i,oaRrivinwf1
Legal Description 47,;_9(11-1A
(See reverse side for Metes and Bounds)
Building Permit No B-10560 Electrical Permit NoPME10997,E1521^Plumbing Permit NoPIE10997,P41307E
Mechanical Permit No. 137-10997.14413078 Number of apartments �� /and/or guest rooms
ISSUED TO: Building Official 49 Z an• giebil
tom Benedict • by
P.O. BOX 4202, IRVINE, CA. 92716
Date ,c3
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 307 lel U.B.C.
CMF 101546 rev. 1/83 White-Owner;Canary-Numerical File;Pink-Bldg.Permit File