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Home My WebLink About386 20TH ST - Building Permits(714) 754-5273 • Fex (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 386 E 20TH ST Suite No Vicinity: Parcel Nunmber: 42623114 Applicant: TIMOTHY NOCK Address: 11612 KNOTT ST GARDEN GROVE, CA Owner: WORD, JARROD ANDREW Address 621 lIDO PARK DR NO F2 NEWPORT BEACH, CA Contractor: NOCK PLUMBING Address: 11612 KNOTT ST Arch / Eng : Address: ISSUE FEE Backflow irrigation Backflow Preventer Bathtub Clarifer System Connect (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earthquake Valve GARDEN GROVE, CA PLUMBING PERMIT Phone: (714) 895-1246 Zip: 92841 Phone: Zip: 92663-4409 Phone: (714) 895-1246 Zip: 92841 License: 707775 Phone: Zip: License: SCOPE OF PERMIT CHANGE OUT WATER HEATER. - AMT $23.50 L0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 30.00 50.00 $0.00 $0.00 $0.00 FEE SUMMARY QTY AMT Laundry Tub / Washer $0.00 0 Landscape Irrigation $0.00 0 P-Trap $0.00 0 Pressure Regulator $0.00 0 Process Piping (per 10 ft) $0.00 0 Receptors $0.00 0 Septic Tank $0.00 0 Sewer Cap for Demo $0.00 0 Sewer Connect $0.00 0 Sewer Private Line $0.00 0 Shower � $0.00 0 Sink, bar $0.00 0 �Sink, commercial $0.00 0 Sink, Floor $0.00 QTY 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Status: ISSUED Applied: 17/20/2003 Issued: 11/20/2003 ISSUED BY: `� EXpI ED ��aa3 0� SumpPump Swimming Pool Trap Primer Unnal Vacuum Brkr Bkflow(t-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / vent Water Piping (Insi or RepJ Water Re-pipe Water Service AMT $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $12.30 $0.00 $0.00 $0.00 Qn 0 0 0 0 0 0 0 0 0 0 1 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requlrements under California statutes and related regulations. (Ord. No. 92-28, § 1, 72-21-92) EXPIRATION: This permit shall automatically expire and become void it work Is not commenced within 780 days, or it work Is suspended or abandoned for a period of 1 BO days. � INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all epplicable codes, and all requirad Inapectlona and Iinel approval must be obtained. Failure to obtain inspections and final approval will result in the expiration o( this permit. FOR INSPECTIONS CALL: (714) 7545626 244&48 (N00) WORKERS' COMPENSATION DECLARATON: I hereby ettirm under penalry of perjury one of iha tollowing tleclarations: ❑ I have end wlll maintein a certiticete ot consent to salt-Insure br workers' compensetion, es provitled lor by sectlon 3700 ot the Lebor Cotle, for Ihe pertortnance oi the wo for which Ihis permit is issued. ave end wlll��QQQaint yyry'n workers' comper�satlon insurerrca, fls required by sectlon 3700 of t�e Lebor CoOe, for lho perfortnance of Ihe work for whlch Nis pertnit Is isss555uuuetl. My workers' cbrtper�at n Insura^ce dJrrier and policy number ere: I j/,� ^� ��(/� — Cerrier: `/� (A af�_ PolicyNumber. �r� � �� (Thls sectlon need not be completetl i! (he pemuNs velued al one hundred dWlars ($100) or /essJ ❑ 1 certity Ihat in Iha peAortnance of the work �or w�ich Nis permil I5 Issuatl, I shall not amploy eny person In eny menner so as to become sub�ect to the workers' compensation lews ot Cali�omia, antl egree Uai II I shoultl become sub�ect to Ihe woMers' compensellon provl51on9 0� SeCilon 3 00 0l Iho 6or Code, I shell Iorihvrit� comply with these provisions. Applicant Signeture: Dete: W ARNIN(3: FAILURE TO SECURE WORKERS' COMPENSpTIpd ppyERACE IS UMAWFUL M1D SHALL SUBIECT !W EMPLOYER TO CRIMINAL PEI TIES AND NIL S UP TOONE HWJDRED TMOUSAND DOLIARE (5100,000), �N ADDfiIIXJ TO THE Cp$T pF CpNPEN$pTIpN, DMi4GE5 AS PROVIDED FOR IN SECTION �]OB OF THE UBOR CODE, IMEREST, AND ATTORNEV'$ FEES. LICENSED CONTRACTORS OECLAfiAT10N: I hereby aHirtn Iha� I em Ilcensetl u r�sla force entl ettect. Lic. a Contreciofs Signature: with Sedion 7000) of DiWsion 3 0l Ihe Buslness antl 4afesslo entl my license is in full _ Cless a Dele: ll ' 2V ' D'7 CONS7RUCTION LENDING AGENCY: �� ❑ I hereby eHirm that there is a conswction lending agenty for t�e pertortnance ol the work br which this pertnit is issued. (Sec. 3097, Civil Code). I Lendefs Nama: Lende(s Address: I Signawre: Dete: OWNER•BUILDER OECLARAT10N5: I herehy aHirtn Ihet under penfllry of perjury Ihat I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW for ihe tollowing reason (SecJ031.5, Business entl Professiwu Catle: My Gry or counry which requires e pertnit io canswct, elter, improve, tlemdish, or repelr eny structure, pdor to its issuance, also requires Ne epplicant tor such pertnit to tile e slgnetl stetement Ihat he or she is Iicensed pursuant to ihe proWsions oi the Contrectors Llcense Law (Chepier 8(cammenGng with Secdon 7000) ot Divislon 3 0l �he Business entl Pwfessions Code) or Nat he or shB is ezempt therefrom end the besis tor the ellege0 e:omptlon. Any violetion oi Sectlon 7037.5 by eny applicant tor e pertnit subjects the epplicant to a civil penalry ol not more then Pve hundred tlollars ($500).): ❑ I, es owner of ihe property, or my employeeS with wages as thelr sole compensation, WILL DO THE WORK, end the structure is not Intentletl or otfered tor sele (Sec. 7044, Business and Professions Code: The Contractors lJcensa faw does not apply to an owner ol property who bulltls or improves Ihereon, and who does such work himsell or herself or through �is or her own employees, pravided thet such Improvements ere not Intende0 or otteretl lor sale. If, �owever, Ihe builtling or improvement is sold within one yeflr of completion. Ne ownerbuilder will heve the burden ot Oroving iha� he or sha Gitl not builtl or improve lor purpose ol saleJ. - ❑ 1, as owner oi the propeRy, am EXCLUSIYELY CONTRACTING WITH LILENSED CON7RAC70RS to construct the project (Sea 7044, Business and Protessions Cotle: The contracrors License Law tloes noi apply ro an owner o1 property who builds or Improves tharaon, antl w�o contracts br such pwject wilh a contrector(s) license pureuani to ihe Contractors License �ws.). ❑ I am exempt untler sac. Business end Pmiessions Code tor lhis reason: Si9nature: Deto: Owner ID verifiad by dnvers licen58. ❑ Yes ❑ No �river's UCenSe No. Expires: Vertlication af Ownership by (type oi document, i.�, . property tex blll ar deed): DIVISION OF INDUSTRIAL SAFETY PEflMR C�RTFICATION: ❑ I hareby cenify that no excavation five (5) or more feet In tlepth Into which a person Is required to descend, wlll be mede In connection with wark authodzetl by this permit, end ihat na building sWdure, sceHplding, falsework, or demolitlon or disman�linp thereot, will be more then thiny-six (38) leet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Title 8, Celltomia Atlministretive Code). ❑ As owner-hulltler, I will not employ enyane to do work which would require e pertnit Irom Ihe Dlvislon of Industrial Selery, as noted obove, unless such person has e permit to do such work trom the dMslon. Signeture: Dato: Division ot Intlustrial Salety Permit Number: ICERTIFlCATE OF COMPUANCE AND AUiHOR4AT10N OF ENfAV: I certity untler penalty ot perjury t�et I heve reatl thia epplication and stete thet Ihe iniormation given is I correct I agree to comply with ell siaie laws flntl city ordinances relating to building consWciion, end euthodze represemutives o1 the CiN ot Casta Mesa to enter upon the ebove-0escribed propeny lor inspection puryoses, t egree not to occupy or ellow occupancy of eny builtling euthonzed by this Oermil until linel inspectian. COpE �. INSPECl10NTYYE Q�¢, 1618 Fixed System Final Fire Preventlon 1288 200 Pool Spe Final Final Re-Roof 201 Finel BIocWRetalning Well 202 Finel Fec(ary Fire Place 203 Final Sign 204 Final Demolltlon �y; CODEI ixsreenonrvve 208 Final MecheniCnl - 208 Flnal Plumbing 210 Finel Eloctricel 212 220 222 250 Finel Flre PrevenOon Final Plenning Approval Finel Slle Finel Building/Occupancy � It� -,. (714) 754-5273 • Fax (714) 754-4856 • www.d.costa-mesa.�u�MBING PERMIT %� FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 386 E 20TH ST Suite No Viciniry: Parcel Nunmber. Applicant: Address: Owner: 42623114 NOCK,CANDY 11672 KNOTT ST SUITE 217 GARDEN GROVE, CA WORD, JARROD ANDREW Address 621 LIDO PARK DR NO F2 NEWPORT BEACH, CA Contracror: NOCK PLUMBING Address: 11612 KNOTT ST SUITE 2� 7 GARDEN GROVE, CA Phone: 714-895-1246 Zip: 92B41 Phone: Zip: 92663-4409 Phone: 714-895-1246 Zip: 92841 License: 707775 SCOPE OF PERMIT WATER HEATER CHANGE OUT FOR A SFD. ISSUE FEE Backflow irrigation Backflow Preventer Bathtu6 Clarifier System Connect (Ice,Soda,etc) Dental Units Dishwasher Drain, Floor Drain, Rainwater Drain, Roof Drinking Fountain Expansion Tank Gas Earihquake Valve Gas (1-4 ouHets) Gas (Over 4 outlets) Gas Repipe Gas Service Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT 523.50 $0.00 $0.00 $0.00 $0.00 so.oa $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $0.00 $0.00 $0.00 50.00 50.00 $0.00 50.00 � FEESUMMARY AMT LaundryTub/Washer $0.00 Landscape Irrigation $0.00 P-Trap $0.00 Pressure Regulator $0.00 Process Piping (per 10 ft) $0.00 Receptore $0.00 Septic Tank $0.00 SewerCapforDemo $0.00 SewerConnect �$0.00 Sewer Private Line $0.00 Shower $0.00 Sink, bar $0.00 Sink, commercial $0.00 Sink, Floor $0.00 Sink, kiichen $0.00 Sink, service/mop $0.00 Spa (private) 50.00 Spa (public) , $0.00 gn 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COMMENTS / SPECIAL CONDITIONS Status: ISSUED Applied: 10/03/2006 Issuetl: 10/03/2006 ISSUED BY: :' �•. ` �' =`,, t�- ,;. SumpPump Swimming Pool Trap Primer Urinal Vacuum Brkr Bkflow(1-4) Vacuum Brkr Bkflow(5+) Wash Basin Wash Basin Set Waste and Vent System Waler Closet (Toilet) Waler Heater / vent Waler Piping (Inst or Rep.) Water Re-pipe Water Service Water Softener OTHER VIOLATION PLAN CHECK REINSPECTION TOTAL CACCULATED FEES: AMT 50.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 50.00 $0.00 $12.30 50.00 $0.00 $0.00 50.00 50.00 $0.00 $0.00 $0.00 535.80 � 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Celitomia statutes and related regulations. (Ord. No. 92-28, § t, 12-21-92) EXPIRATION: This permit shall automatically explre and become void if work Is not commenced wlthin 1 BO days, or if work Is suspended or abandoned tor a period of 180 days. INSPECTIONS: In order for the Work authorized under this permit to be considered legal, such work must comply with all applicable codes, and ali requlred Inepections and flnal epproval musl be obtained. Failure to obtain inspections and tinal approval will result in the ezpiration of this permit. FOR INSPECTIONS CALL: (714) 75q-5628 2aaars le�oo) WORKERS'COMPENSAnON DECLARAnON: I here0y aMlrtn untler penalry of per�ury ane of t�e following declarations: ❑ I heve end wlll meinteln e ceNficata of consent to sell-Insure tor workers' crompensation, es proWded lor by section 3700 0l the Lebor Catle, tor the peAarmance of the , work lor which thls pertnit is issuetl. requireA by secY 3700 oi the labor Codre,for.the pertormance f t rk for which this permit is iss tl. l_------' _"_ _ Policy Numbor: uiMred dd/ars (5100) or less.) ❑ I cerlity that in Ihe peAormance ol the work tor w�ich this pertnit is IssueQ I shall not employ any parson in any mennor so es to becoma suD�ecl to It�e workers' wmpensation lews ot Calllamle sn hettt131�WTd' e�ca le subject to lhe workers' wmpereatlon provlsions ol Sactlon �700 W th� bpr Cotle, I shall forthwitli ComOh/ wl�h �h89e r ' . /Y / Y �' i (/A / / ApPlicam Sign � �—�� pete�--" / � � WARNINO� _ �URE TO �ENSATION COVERAGE I$ UNLAW FUL AND SHALL SUBIEGT rW EMPLOVER TO CRIMINAL PENALTIES AND pNL FlNES UP TO ONE HUNDRED TtIOUSAN (5100,000), IN ADOfT10N TO THE C06T OF COMPENSATION, DAMAGES AS PROVIOED FOR IN SEGTON 3108OF THE UBOR COOE, INfEREST, AND ATTORNEVS FEES. LICENSED CONTRAC70RS DECLARATION: I heraby aN��et I em licenao6-n��wyr�'sipns�l C�epter 9(commencing with Sectlan 7000) ol DlWslon 3.otthe Busineu entl P le �C e. entl my license Is in tull 10lGB�9nC BflBCt.-LICtM �G899�_ c«u�eaorss(�aw�� —� qeie: -- � i ii � CONSTRUCTION LENDING AGENCY: ❑ I �oreby eHirm Ihet Ihere is e conslruc[ion lending egency br tha peAartnance of t�e work tor which Ihis pormil is issuotl. (Sec. 3097, Civil Code). Lenders Name: Lentlers AdEress: Signeturo: OWNER•BUILDER DECLARATONS: Date: I �ere6y ettirtn that under penalry at perjury that I em E%EMPT FROM 7HE CONTRACTORS LICENSE LAW lor the following reeson (Sec. 7031.5, Business entl Prolessions Cotle: Any clry or counry which requires a permit to construct, alter, impmve, tlemolish, or repair eny strucWre, prior to Its issuance. elso reduires t�e epplicant lor suc� pe�mit ro file e signetl statement that he or she Is IicenseA pureuant ro t�e provisions of Ihe Con[reclora License Law (Chepter B(commencing wit� Section 7000) 01 Divlsion 3 ot the Business entl Profasslans Cotle) or that �e or she is exempt therefrom and Ihe besis lor the ellepetl ezamption. Any violatlon ai Sectlon 7031.5 by eny epplicant for a permit sub�ects Ihe epplicenllo a civil penalry c� not more Ihan fva hundred tlollars ($500).): ❑ I, es owner ot the property, or my emplqrees with wages as their sWe wmpensatioq WILL DO TME WORK, and the strucWre Is not Imended or oMeretl for sale (Sec. 7044, Business en0 Professions Cotle: Tha Contractors License Law does not apply to an owner of property who builds or improves t�ereon, end who does such work himself or herself or Ihraugh his or �er own emplayees, provitletl ihat such imprwements are not intentletl or offered for sale. If, hawever, the building or improvement is sold within one yoer of completion, the ov+ner-builder will heve the burden of proving that he or she did not build or improve for purposa of sala.). ❑ I, es owner ot t�e property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the prolect (Soc. 7044, Business antl Prolessions Code: The contrec�Orb LlcenSe Law does noi epply to an owner of property who builds or Impmves IhBreOn, and who contrects lor such prqeci wlih e wntraclor(s) license pursuent to the Camractors Licensa Lews.). ❑ I am ezempt under sec. Business enA Professions Code lor this reeson: Signeture: � Date: Owner ID vBrlfietl 6y tlrlvefs licensa. ❑ Ves ❑ No Drivers License No. Verllicatlon of Ownership by (type of tlocument, i.e. - property taa bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: Expires: ❑ I hereby cetlNy ihat no excavatlon flve (5) or mora feet in dep�h Into which e person is required to tlescend, wlll be mede in connection wlth work authodzed by this permil, antl Ihat no builtling strudure, sceHoltling, talsework, or demolition or tlismantling thereot, will ba more than thirty-six (38) leet �igh. (Chap. 32, Gry 2, An 2, Sec. 341, Title 8, Celitomia AdminlsiretNe Code). � As owner-builder, I wlll not employ enyone to tlo work which would reduire a permi� Irom tha DiWsion at Intlustriel Selery, es noted ebove, unless such person hes e pertnit to do such work Irom the division. Signeture: Date: Division ol Industriel Selety Permit NumDor: CERTFlCATE OF COMPLIANCE AND AUfHOR6A710N OF ENfAV: I certify under Oenalry of perjury thet I heve read this epplication end state t�et the Inlormation given is correct. I egrea to wmply with ell slete laws en0 ciry ordlnences releting to builtling consWclion, end authodze representetives af Ihe Ciry of Coste Mese to enter upon the ebova-descnbotl property far inspec�ion purposes. I egree not to occupy ar allow accupency of any Guilding euthonzed by this permit until linel inspectian. -,... _ � __.__� COpE �. INSPECTIONTYPE Qdj( �$ 1818 Fixetl System Finel Flre Preventlon 1268 200 Pool Spe Finel Finel Re-Raol CODEt INSPEGTIONTYPE 206 Finel Mechanical 20B Final Plumbing 210 Final Electrical 201 Final Block/Reteining Well 272 Final Fire Preventlan 202 Final fedary Fire Place 220 Final Planning AOOrovel 203 Finel Sipn 222 Final Site 20C Finel D8mo11tlon 250 Final Bullding/Ottupanry � PAIE It�li G �' C � (714) 754-5273 • Fax (774) 754-4856 • www.ci.costa-mesaB��DING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626 Job Address: 386 E 20TH ST Suite: Vicinity: ROOF Primary Occ: R-3 Dwellings/ Cong Res <10 Type of Conslruction: V-N Parcel Number: 42623114 Zoning: Appliwnt: JEFF LEHMEN Address: 2415 MARGARET DR NEWPORT BEACH, CA Owner: WORD, JARROD ANDREW Address 621 LIDO PARK DR NO F2 NEWPORT BEACH, CA Contractor. J S L ROOFING INC Address: 2415 MARGARET DR Arch : Address: Zip: NEWPORT BEACH, CA 2ip: 92663 Phone: License: Phone: 949-6463571 ISSUED BY: Zip: 92663 Phone: Zip: 92663-4409 Phone: 949-646-3571 License: 747706 Eng: Address: Status: ISSUED Applied: 03/14I2006 Issued: 03I1a2006 Phone: License: SCOPE OF PERMIT TEAR OFF EXISTING ROOF. INSTALL 1 LAYER OF 3QJF FELT, 40 YEAR COMPOSITION SHINGLES AND REPAIR/F2EPLACE SHEETING AS NEEDED. 3,000 S.F. INCLUDES ATTACHED GARAGE. FEE SUMMARY Plan Check: $0.00 Permit: $15325 SMIP Res: $0.76 SMIP Com: $0.00 Other: $0.00 Inspection: $0.00 Total: $154.01 PLANNING & ZONING SETBACKS MAIN STRUCTURE Front ACCESSORY Front PARKING Existina: 0- 0 0- 0 Calc Valuation: s�.eoo.00 Claim Valuation: S�,eoo.00 Rear 0-0 LeR 0-0 Right 0-0 Rear 0- 0 LeN 0- 0 Right 0- 0 0 Reauired; 0 Pr000sed: 0 NOTICE: The work authorized by ihis permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92•2B, § 7, 72-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or it work is suspendetl or abandoned for a period ot 180 days. INSPECTIONS: In order for lhe work authorized under Ihis permit to be considered legal, suCh work musl comply with all applicable codes, and all raqulred inepectlone and finel epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration ot this permit. FOR INSPECTIONS CALL: (714) 7545626 � WORKERS' COMPENSATION DECLARATION: " ' I hereby aMirm under penelty of per�ury one at tho lollowing tleclaratlons: � ❑ I heve antl will meintain e cenificate of wnsent ta selFlnsure tor workers' compensation, es pmWtled tor by section 3700 of the Labor Coda, tor Ihe pertortnance of the work for whlch thls permit is issued. ❑ I �ave entl will maintain workers' compensatlon insuranco, as repuired by section 3700 0l tha Lebor Cotle, for the peAormance of the woM for which this pertnit is issued. My workers' compensatlon Insurence cerrier antl policy number ere: Cerrior. i Policy Num�er. (This sectlon noed not be campleretl/il the permi( /is/y� ued e! one hundred dollers ($100) ar Iess.J ❑�1 Certity•that In ihe peAOrman B ol ihe wo I6r w�ich this permit is Issuetl, I shell not employ eny person in eny manner so es to become subject to the workers' �compensation laws of Calj{d �la, end e a that II 1 should becrome sub�ect ro t�e workers' compensatlon provisions ol Sectlon 3700 ot Ihe Labor COAe, I shall lorthwith ComO�Y �'Ith these pran. i6 ApplicaN�SignuWre: '�/''' Date: `�� 5 � � �� 'G � � �- �. WARNWG:�FAIWRE TO SEC �'J� RS'vynrENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT M1 EMPLOYER TO CRIMINAL PENALTIES AND GVLL FlNES UP TOONE HUNDRED T110USAN�DIX.LARE�5100,, �,IN IiIONTOTHEW$TOFCOMPEN54TION,OAMAGESASPROVIDEDFORINSECTION3�OBOFTHEIABORCODE,IMEREST,ANDATTORNEI^SFEES. LICENSED CONTRACTORS OECLARATION: I herehy aNirtn that t em Iicensetl unEer provisions Chapter 8(commencing wilh Section 7000) of Divislon 3 of the Business antl Professyi ns Cotle, end my license is in full I�rce.antl�eNedrLic: a-- rClass n 2 7 Camrector'S SigneWre: � �Oele: � �G � / — 0' 1 — i r � CONSTRUCTION LENDI � AGENEV: � I hereby eHirm ihai I�ere is a wnstruction lentling egency for tho DeAormante ol ihe work tor which �his permit Is lssued. (Sec. 3097, Civil Cotle). LontleYs Name: Lentler'S Atltlress: Signeture: OWNEF-BUILDER DECLARATIONS: Data: I hereby eNirtn that untler penelry at perjury thet I am EXEMPT FROM 7HE CON7RACTORS LICENSE LAW tor t�e following reeson (Sec. 7031.5, Business end Protessions Cotle: Any ciry or counry which requires e pertnit to conslmcl, atler, improve, demdish, ar repair any structure, prior to its Issuance, elso requires ihe applicant lor such pertnit to lila a signed statement Ihet he or she Is Ibensed Dursuanl to tha provisions of the Contrectors License Lew (Chapter 9(commendng wit� Sedion 7000) of Ohrision 3 ot Ihe Business end Professions Cotle) or that he or sha is exempt Nerefram antl tha Eesis tor lhe allegetl exemption. Any violetion of Section 7037.5 by flny applicant For a pertnii sublects the epplicant to a civil penalry al not more than five hundred dollars (SWO).): ❑ I, es owner oi tha property, or my employees vrith wages as t�eir sWe wmpensation, WILL DO TME WORK, and the slrucNre is not intendetl or otterad tor sale (Sec. 7044, Business and Professions Coda: The Contractors License Lew tloes not appy to an owner of pmpeny who builds or Improves thereon, end who does such work himself or hereelf or Ihrough his or her own employees, proNded thai such improvements ere not intendetl or oNered /or sale. If, however, lhe building or imprrnement is sold within one year ol completion, the ownao-builder will have iha burtlen of pmving t�at he or sha did not builtl or improve lor purpose of sale.). ❑ I, as owner ol �he propatly, am EXCWSIVELV CONTRACTING WITH LICENSED CONTRACTORS to rnns�ruct Ihe pmject (Sec. 7044, Busineu and Pmfessions Code: The contractors Licensa Lew tloes not appty to an owner of pmperty who builds or Improves ihereon, and who mmracts tor such project with a contractor(s) license pursuant to the Contractors Licensa Laws.). ❑ I am exempt under sec. Business and Professions Code lor this reeson: SigneWre: Date: Ownar ID verilied by drivers license. ❑ Yes ❑ No Oriver's License No. Veritication of Ownership by (rype oi documem, I.e. - D�oOerry taz 6111 or Oeed�: DIVISION OF INDUSTRIAL SAFETV 7ERMR CERTIFICATON: Expires: ❑ I hereby certiy lhet no e:cavation live (5) or more leet in depth imo which e person is required to descend, will be metle in connection with work authorized by this permit, antl t�ai no building structure, sceHolding, falsework, or tlemolition or dismentling thereof, wiil bo more ihan Ihiny�six (36) feet high. (Chep. 32, Grp 2, An 2, Sec. 3C1, T�le B, CelifOmia Atlministr8iive Cade). � ❑ As awner-builder, I will not employ enyone to do work which would reQWre a pertnit from t�e Division ol Indusirial Setety, es noted abova, unleu such person has e permit lo Co such work from the division. Signeture: Date: Divislon ol Intlustrial Sefery Permit Number. CERTIFICATE OF COMPLIANCE AND AUTHORIIA710N OF ENTRV: I cenity under penalty of perjury lhet I have reatl this application antl state ihat ihe Information given is correct. I egree m comply with ell stete laws antl city ordinances relating to bullding construction, end euthonze representatives of �he City of Costa Mesa to enter upon the ebove-described properry for inspection py(poses. I egree not to acupy or allow acupancy of any huilding aulhorizad by Ihis permit umil linel inspection. OI Legal COOE �. INSVECTIONTYPE 1616 Flaetl System Final Fire Preven�ion 12fi6 Pool Spe Final 200 Finel Re-Rool 201 FInaI BIacWRetalning Well 202 Finel Fectory Fire Place 203 Final Sign 204 Final Demolition rr.s+�r,mmi�� -�N COOE 1 INSPECTION TYPE 206 Final Mechanlcal 208 Flnel Plumbing 210 Finul Eleclrical 212 Finel Flre Preventlon 220 Final Plenning Appmval 222 Final Site 250 Finel Bullding/Occupenry ueie u�i wweiviu�a,vr+: 386 E 20TH ST �no�sm CRAIG ETCHEOYEN 386 E 20TH ST �pCNlfEti OP ENtIIlEFN: IJICN. OA FNO.'B /�OORE53: caxm�crars ru�: CONIN1CfpR9 WJNO �ss uxr: 515-7022 uc no_ uNr: uc No, uxr: 110EN5EU COMN�CTON4 DECIAR�TION: I hsreby M�m ivdw pruly d pejW tlu� I em finrnad ivMs po.fibns W CMqm 9 (commemiq wuh `weion ]0001 tl Oiwion a d tlw &�ae eM Pmin�ivu COEe. W my 6came u in hA bm md dlotl. CRY 11C. NO.: 11F ttASS: 11C. NO.: EXP: om.: cma.a>: OWNEX BUILOEN DECIAPAiION: I MMy dfirm un0or pwary d px'My tIW I vn vemp han �M Can�rfon licenes lew la IM IoOow^0 �easm (Senun ]IX11.5 Bivieta wd Adue'nv COM: Np' UY a owveY wledi rp�um e D�� b mmtrucl, atlx. inprow. Eeinof R a rapei mry a0uctua. y'v b b eweroe. elio r4ma� IM eppiwtl b orA pemb to fils a v,yad Memaa Net M tt eM : IoroeA WnueN b Ihe V� d IM Caaiartm liowa law IClupr 9(omuna�q wE� SWion 1000) d Pvebn 3 tl Ihe ( .uy�wa eM Pralevioro Co0e1 a iAat Ir n Ne u aaemq IMahan uk iM bea la Ne �OsYb azeiMion. MV vioWion d Sedion 1W 1.5 by ay eppGrsm la e pwmu wmjed� IAs eppfra�a �o e ad pauEy d nd mws tMnlwa huMieE AoOen �SSOOn. ❑ I.nowrrrdtMpapenyamyaniyqse�xihwepmothrdeoomprmmcn,�iAdotlrwk,eMNeeo-uCu�senal'vYakeU a MeraE br aeb /SecUm 10u. B�� eM Pmlmdm� CoCe: TheCav'aum Lisne LewGom na nVW toenoxiw d qopeny wln buias «inpwse ihereon. rd Wo Eom �uch wvk h"vnW a Mna� n tlraqh hu a Mr mm emDbMs. qa'� �hel wc� impvwmmb ra m�'vnrded a aflsaE la Ws. tl, Mw�ws. th ddd'vp n inpwenan u wld wnAn ane ymr W mmplMion, Ow ownerMitlx W Mro Ne Mtlm iI pw"uq M a da EiE nd bultl a MP� Iw IM p�vpo�e d de). �i 1. ea owiwr d �M pWaH. em �+W�drdY maman0 rM bruM m�mernn b mmuud Ns 0�9b (SWion Nu. Bw'v�ne rd Vmletidu COAe: TM Can2dw+ lia�» law� Aou nd eDO�Y b am m�et M V�W�Y Mq bu0d� w npw'x �haean W Mn convacro b vdi pqrfs wuA e mwma(q �icen+ed to tM Cwur on lican+s law�. � I em exemq ukr SM'vi: i� B. 8 P.C.. �I Dale:��`20 'tl� Ornw: i eo nenW unM uw i.m...,. a.�e �ne«.iw me �.w:.m«o a c.uom�. H..m, .�e s.i«r cod. seeo�. uws. nsaa. e�w 2553�. vd Nm I«enf' haun dutluq omaY+. wA / wil na (ucb ane) neaE w oonwM �•t� uid qma avEm eM ihs �ewoM+sm br a DaM In amsuvtlion a�mdire�ion han �Ir N�v�epsnsa Oiuntl. Rddwa� mmuw ion eGD�ioro en eumq Imn Uwa a��. Dma: �oolcen: WONKEN'9 CONPENS�TION OKlAN�110N: I IwWy Nhm ivdr psuly d prjry ar M IM blow'vp dsdortlhro: ❑ �ne...�dwm.:n.n.wnaw.aomwvio.w;imu.ro,nok..•omaa�mw�...n��aMswions�ooain.�.eor Cade. la tM pMmnuKs W Ne �.ak Iw xi'rJi Nu pamb u buad. ❑ i n.�e.�d .d m.on.n .oM1err mmv�o� vm,mnw. e�.a�Pw M sw�an Too a ms �en« coe.. �or me o+n«menc. a ine wak la whiN Nu M� u iwuaE. MY wrrten' aanG�ion "vwrence un'r end W�Y m�mba me: Gerr4r: Pdiry NumEs: Ra ascTiwr nesE nd M ewnplerod i tM prml 'o lor aro huMrd do�vs �Si001 w bu ) �� canN �ne� m �n. o«�wmencs a �na .�ork �n wncn �nu o«ma u bww. �.neu na anoM �r o«.m n eny m.M.. n ea �o becana wbleq io iha xvrken' canpenWion kx� d Cd eM epiee tIW X I Nwk Eecwm eub�w to t�s xorknn' rompmvbn qwivbm d Sodion T00 d iM lebor COJe. I Mh�'nh oom�G�I IMn pwinms. \. Dete: �' ZO � 41 i �Vdhau: il�� L"� Wem/np� F�Nun ro reun woikr�'rompmutlon eov�np� l� unl�wNl. �iW 4Wl �,6Jst �n mp/oyw ro cNMnl p�n�/tlu �rM e�M� nMa w ro on. nu�e..e �m�,.�e ewr... ff�u4aooA a.de�rwn ro m. ro.� o� m�ro«ueran e.m.w o pcv�e.e ror �n S�ctlon.t106 0l M� LtlorCeb, /Mwv4 ��m�y'� Iw. CONSIHUCTON LENDINO AOENCY: I MreEy elfum undsr peiWy d parWry Rut iMra u e wn4�uqbn Imd4q pmcy M Na perbrme�e d iM v.ark la v.1�iN Ine pemi u ewsd (Seaun ]08). Civ. CI. LENDEN'S N�IIE: LENDEN'9 ADDflESS: I cenM t!� 1 heve iaM ino appfce�im vd ame IIW Ns eEwa'vdnrtW ion o canM. l ep�ae to compy rN� N ary uq mumy ordinence� eM nmle kxe relm�q b dtikn0 covutCion W hsebY euUn¢e np�m�nYivu d�he �YYb �nta u0� IM Wwe�maNioned papmly Irc'unpeqon PaD�. r r •r r � �y a� w�. [ I—�� om,: S'- Zo �i —f s�,�. a o.,w,�v�wc«.�,« (S15te8.WP) Whns�&�Miq d Se1a�Y: (3rwer +M: Ceneiy-MG�e: Rnk-Rown»: (iotleva6-Aawv � CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: B 082982 PLAN CHECK NO: 02016-97 L GOVT: N SUPP: N CONSTRUCTION TYPE: I PEAMIT TYPE: STR PURPOSE: ADD JOB DESCRIPTION : 91 LIN FT BLOCK PILASTERS W/WOOD S(j FT; 1,000 CLAIM VALUE: 1,000.00 CALC—VALUE: 1,000,00 GROUP OCC: U-1 / COMMENTS; "OWNER BUILDER TO CITY STANDARD" +r**�it**�******+�it*****��*�r��*x�r*��**:�r�r�t�tititat*at*+e*�rx�*+r*if*ftft�**�e**��****��**rr Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR; FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN PARKING REQ: PROV: PARCEL: 42623114 ZNE: R1 REF NO:. PLANNING NOTES> 30 INCH HIGH BRZCK WALL EXTENDING 36 LINEAL FEET ALONG FRON > T P/L AND 29FT ALONG S P/L AND 25,6 LIN, ET. ON RIGHT -S P/L. IE if 1E iE Ik IE iE iF If if fF 3F iE k!E ff !F 3k fE 4!! fE iF iE 1E 1E 1! 1tlf if ik 1k iE iElE If iE iE if 1f 1F fE 1f If iF iE 1E �E iF k k 1E IF 7E 1F 1flf 1flf 1Elf !t 1F k!F iF 1f 1flk Ik IF iE k 1E ff ff 1E 1f jk D E�I E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY • �' ��Pg��- DATE: S'Z�3-9% HUILDING APPROVED BY ; � DATE: S�ZO-� APPLICATION ISSUED BY; �INdi J DATE: �-2��9/ Ik ik iE ik 1E 1E iE if iE IE iE 1ElE IE 1E iE �f 1f 3! 1E 1f ik3f3F3F3FiF�FiF�FiFiF3F��if��3fiF��FTF3F�i�{F7F��F1E 1F 1E ik if 1E iF 1F ik iF��i�f iE 1E LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC PERMIT 34,75 PLAN 22.59 ZSSUE FEE HUILDING-DIV-> PEAMIT ISSUE PLAN-CHECK TOTALS----> 35.25 0.00 22.59 REVENUE DZVISION TOTALS--> COLLECTED: BLDG PMT PLUMBING ELECTRIC MECAANIC 34.75 FIRE SMIP/RES GRADING 50 SMIP/NON-RES TOTAL PAID DUE 57.84 57.84 .00 57.84 OVER/SHORT; ,00 FIRE SMTP/TOT GRADING PLAN-CHECK .50 22.59 IEfEiEiflFifiEiklFifjfjflFiflElEkiElEfklE�ElEiElEiEiklfikifikikiElf�kkiElElfkKiEl6Mkifltik�kMlfiEif1f1E16kM�ifkkkiFiFlEiEiE1k1E1EfEiElElklfiEiEiE1E I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST 5FR 3000 AI�TER BY VALUE RESIDENTIAL NOZONE 1.00 1,000,00 END OF FEES I^"". w' C' N� ,a 1�-, `*._ i ��J � ".. � � .-....•� � � r�� + n, ^�! `�`, 01997 �(, n 1r��1. � ; �.. ;� �:?ESA � CONSTRUCTION ANDPLANNING APPROVALS Permit# I Date Inspector 7. Temporary Electricai Service or Poie 2. Soil Pipe•Undrgrnd. 3. Electrical Conduit Utility•Undrgmd. 4. Electrical Conduit•Undrgrnd. 5. Steel Reinforcement 6. Electrlcal UFER Grnd. 7. Footings 8. Foundation 9. Water Pipe-Undrgrnd. 10. Structural Floor System 11. Property Sewer Line & House Connection 12. Sewer Cap 13. floot Drains 14. Rough Plumbing 15. Rough Electrical�Conduit 16. Rough Electric Wiring 77. Rough Wiring Sign 18. Rough Eiectrical•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. Foof Sheathing 26. T-Bar Ceiling (Structural) & Monocoat 27. Frame and Flashing 28. Lathing & Siding 29. �nsulation 30. Drywail Nailing 31. Plaster Brown Coat 32. Electricai Power Meter�Final 33. Final Electric 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Firepiace 38. Final Plumbing 39. Water Service�Final 40. Gas Service-Final 41. Solar pomestic•Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation SYstem 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRUCTUtiE&BUILDING 48. FINAL PLANNING 49. Electric Release to Edison 50. Gas Release to Southern California Gas POOI 'A APPROVALS Permit # 62. Pool & Equinment Location 53. Steel Reinforcement 54. Forms 55. Electrical8onding 56. Rough Plumbing & Pressure Test 5J. APPROVAL TO COVER�GUNITE 58. Electrical Conduft-Undrgrnd. 59. Gas Pipe, O Undrgrnd., Tesc 60. Backwash Lines, P-Trep, O Undrgrnd. 61. APPROVAL TO DECK 62. Backwash & Receptor�Final 63. Heater & Vent•Final 64. Plumbing System - Final fi5. Electrical-Fi�al 66. Solar SYstem•Final 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOUSPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # 70. Underground Hydro 71. Product Piping OGas OOiI 72. Under9round Flush 73. Undergrnd. Storage Tank � Gas ❑ Oil 74. Overhead Hyd�o 75.� Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEAITH OEPT. REDUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: Date inspector No. Date I I I � _ _ �I� F COSTA� . Proiect Address J Owner'S �. �B��t S% � �O,Jy,$TR�JCTION PERMIT ADpllcant to /ill in all sPaces ezcept lhosa wlthin Address u/{'J �. 7� .(an"' � YULr 740.11'/�4-�lsl'�C Contractor's Nam 7hone Address Imailing) !'� Ciry License No. � LICENSED CONTRACTOR DECLARATI N �� 1 nereby atlirm that I am Ilcensetl untlar provisions o� Cna.ter 9(commencing �' wil� section 7000) of Oivislon 3 0l [he Bus�xs' a tl Prolessiont COUe, antl ! Ty IICCIISC IS lfl Ipll �OIC2 dlltl CflCCI. � �pq� � Licensc Class � � ai sqnq. I Date ' Signature � � IWORKERS'COMPENSATION DECLA0.ATION , I here�y aftirm that I have a certi(iWte ot wnsent to S¢I(-7nsure or a certiiicate � ot Workers' Compensation Insurance, or a certifietl copy the�eo( (Section 3800, Lab. C.) �olicy No. Company I B Certiiietl copy is hereby turnishetl. Certifietl copy iz /iletl with the <Ity Bui(tlin9 D7vision. I Date Applicant ! EXEMPTION FROM WORKERS' COMPENSATION DECLARATION I(This sectlon neetl not be campletetl H tne permit Is for one hunUretl (E300) or I less). I c¢rtify Itlat in the Oerto�mance of [ho work t0 whI h thi5 pe�m�t i,isuetl, I shall not employ any perzOn in any mann as �eco ¢ sub� t to tha Worker�Corr�pnsa��Laws of Califor Date J �> Si9na[ure 'NOTICE: H, atter makin9 this tleclarat o, you shoultl become subiect t tne Workers' ComOensation provisions of.[he Labor Cotle, you must fort�witn compty with su<h provisions or Ibis Oormit Shall be tle¢metl r¢voketl. CONSTRUCTION LENDING AGENCV ' 1 hereby a(firm l�at tnere is a constructlon IenAing agency iOr [he pertOrman<e af iho work lor wnlcn thls vermlt is issuetl (Sectlon 3097 Civ. C.) lAntler's Name Le�tler's HUtlress OWNER BUILOEN �ECLFRATION I bereby alfirm that 1 am nx6mpt irom tho Contractor's Licanse Law fo� Ua following reason (Soction 7031.5 Busineis ane Profosslonal Cotlo: Any city or Wunly w�lcn requires a permit to construct, alter, Imvrove, tlemolish or reoalr any structure, orlor to Its issuanca, also requiret tho appllcant tor sucn oormit to �Ile a Signetl StatCment that he/ShC is IICCnsetl pufsuant ta llte pfovi5ions o1 the Contractor's Licanse Law (Chapter 9(commencing with 5ectlon 7000) of Division 3 of l�e Busine55 antl PrOte55ions Cotle) or that he/Shc IS axompt [heretrom antl lne basil for lho allagetl exemption. Any vlolaHon o� $actlon '031.5 by any applicant for a permi� suOjoGtS tba aoo�icant lo a Clvll nalty o/ no[ more t�an tive huntlretl tlollars (y500). , I, as owner of tha property or my employee5 with wag0s as lhair sola compensatlon, will tlo the work, antl t�o strutturo I5 nol intentletl or ofleretl (or sale (Section 7044, Business antl Grotessional Cotle: Thp Con[ractor's License Law tloe5 not apply �o an owner oi a property who bulltls or imprOves lheteon; antl who Ooes such wo�k himSCll/harselt o� lnrough bi5 or hGr own employees, provltletl that such improvaments are not intentlotl or oftoretl br sale. If, bowevaq Ihc bulltling or Improvament Is soltl wltltin ono year of <Om- Oletion, t�a ownar will have lh0 burtlun o/ Oroving ne/Sha tlitl nOt builtl or Im- t��.�o�va fOr the putposo of sale). L7T, as ownCr O/ [M1e ptoperty, am excluSlvely tontraCtin9 with Ilcensatl con- fractoR to consMuct the Projeci ($¢ction 7099, Buziness anC Profe551on5 Cotle: The ConVador'S License Law tlOei not aPply [o an owncr ot proper[y wM10 builtls or Imp.ovos thereon, antl who contracts for sucn pro7ects witn a com tractor�s Ilcense Oursuant to ttte Conl�acto�'S License Law). 1 am awaro thal �ro�of o� their Worker'S CompenSaUon InSuranta shoultl be provitletl to me. IFSI am exempt untl¢r Sectlon �y�— B. & P. C. iq{ tM1lt reason Da[e .�1/1 I herGby certi Intormation Is dlltl SIdIO IOWS sentatives oi Inspectlan py�r Signatur¢ fJ > Drivers' L¢ens , X l Owner�,�(. lnat I have reatl lnis 'rect. I aaree to como or55� a - �- � TVPE OF CONSTRUCTION rvEW ❑ CONVERSION ❑ DEMOLISH C QFs�giaZio�v,pF w11ftK�USE9E eLl eoraer Iines ana tlgn all aoaroorbte tleelanUons. — i�o�i � J ALTERATION REPAIR TVPE OF PERMIT LJ Gaaoirv FOVrvDnr� Q(1 S7R ❑ TENANT �LECTRICAL PLUMBING �MECHAN ❑ OTHER PROJECT DESCRIPTION 5(y�. ocCVa CONST C ION TVPE ��' VA VATION $ ZONE �� GRADINGCV.VDS.� A( Sink Preventer Irrigation Drinking Fountains Floor Orains Floor Sinks Gas Service Interceptors Kitchen Sink LavatOries P—Trap Roof Droins Rainspection Fee Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Tank Swimming Pool w/Spa Urinal Outlets Water Closet Warer Heater Water Service Auto-Wash $15 Boilcr Duc� - Under Ground �UCt - $LluCtuf81 Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/FacL Blt. ICBO �p Heatin9 $ystem & Ductin9 ❑4100,000 BTU 0100,0008T Rainspection Fea � $15 CMF 0865-46, �ev. 30/B4 WhItC - Builtlin9: Canary - Appliwnt Plnk - Accounting; GoltlenrOtl - A55e55or Issue Fee Hood or Type I � Canopy Type II ❑ Refrigeration System ❑o.,00,000aTu o,00,000 Sysrem Repair�Alteration F ire Dampers Registers , Isue Fee A.P. � 42 G S Main Buildi E T Front B Rear ' A e C Right � K Lett � S _ Ping. Ref. �h Planning Note:: FEES 6�3a riir�i � =i�o:: , � I[� 2one '� jA� Accessory Building: Automatic Washer ' Construction Pole Sub. ' Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets �� $ 3 $ 3 i I ,Generator 065 KW Reinspec[ion Fee Zoning Approvad By— Building Approved By Parking Req.IProvided ELECTRICAL Transformer ❑ 75-50 KW ❑ 50+KW 15KW Meter Llup to 100 amps Meter ❑over 100 amps Sub Panel � Motors 00.1 HP O 1 X- 8 Inc.Solar �9-15 HP �16-75+ Microwave Pole Light r' ' Range / Sign ; Standing Sections Trash Compacror /, • FEES �$15 luue Fee $ 3 IEQ�IIR�MF^NTS: , a � � � � . � � ^ SUMMARV OF i � .BUILDING PERMIT $ 215_ 50 ��PLAN•CHECK ' $'. PLUMBING $ � PLAN'CHECK 25% $ ,- ELECTRICAL $ — PLAN•CHECK 50% $ MECHANICAL S'� PLAN�CHECK 25% $ � e Z � N I N G R E � M T S ES SMIP S 2. 4 s PERMIT • ISSUANCE $ ENERGV P.C: $ GRADING S MICflOFILM $ TOTALFEE $ 2 �' S � CO STRUCTION AND PLANNING . AF ROVALS Permit # '� 1. Temporery Electrical Service or Pole � 2. Soil Pipe-UndYgrnd. � '�3. Electrical Conduit Utility-Undrgrnd. 4.�Elecirical Conduit-Undrgmd. � 5. S[eel Reinforcement 6� Electrical UFER Grnd. 7. Footings � s�',r�L 8. Foundation �� s 9. Water Pipe-Undrgrnd. 10. Structural Floor System 11. Property Sewer Line & Hause Connection 12. Sewer Cap 13. Roof Drains, 74. Rough Plumbing 15. Rough Electrical�Conduii 16. Raugh Electric Wiring 17. Rough Wiring Sign 18. Rough Electrical-T Bar Ceiling 19. Rough Heating & Air Conditioning 20. Rough Facto[y Fireplace 21. Ducts, in Structure 22..Ducts, Ventilating - 23. Gas Pipe-Rough & Test 24. Roof Framing 25. Roof Shea[hin9 � 26. T-Bar Ceiling (Structural) & Monocoat 27. Frame and Flashing 28. Lathing & Siding 29. Insulation 30. Drywall Nailing 31. Plaster Brown Coat � 32. Electrical Power Meter-Final 33. Final ElecVic 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Faaory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING �� 48. Specia� Requirements Completed 49. Electric Release to Edison '� 50. Gas Release to Southern Califomia Gas Co, Date POO L , /A Inspector pppROVALS Permit# � 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms 55. Electrical Bonding I56. Rough Plumbing & Pressure Test I 57. APPROVAL TO COVER�GUNITE � I 58. Electrical Conduit-Undrgmd. � I 59. Gas Pipe, � Undrgrnd., Test 60. Backwash Lines, P�Trap, O Undrgrnd. Fi1. APPROVAL TO DECK I62. Backwash & Receptor-Final I63. 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 -ai 8� 72. Underground Flush ��b5 73. Undergrnd.StorageTank OGas ❑Oil �j�� 74. Overhead Hydro 75. Dry Chemical o19g 76. DryStandpipe �� $�i 77. FIXEDSYSTEM FINAL aq � 78. FIRE PREV. FINAL 3 � HEALTH DEPT. REQUIREMENT � G 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED �Nofes: sr�aa%9.r %�.._ _ .. v-� iol��iss' �srit�,� �,��s �- d�K ' �� y%f �oPT�� ,� Date � Inspector �U 3 ,INo. Date I .I I ' /, f ^ :_ PHOJECTpOUflESS: 38(j E 20TH ST OWNEP'S NAME: RANDY HONES noonEss �r..r 631-4990 AflLN/ENGINEEN: ADOXESS: flEG.NO.: uxiT: UNIT: PEBMITTEE: G AND S CONSTRUCTTON ( 71 4) 642-9204 aoaeess: g g g OAK ST COSTA MESA CA 92627 I UCENSEO CONTflpCTOfl OECLANATION: I h¢re0y atlirm tlut I sea unde� o�ovisio Gwp�er 9(commenunp wit0 Sec�ian 7000� ol Oivision 3 0l ��e Business an0 PmfeSsions CoOe. a y licens is in �NI lorce ��eci. ciTruc.:028296 sTeTeuc.:3697;2 ss:H Date: � Signatu e: _ _ WOflKEBS OMPENSATIONOECUBATION: IhereDyafiirm Illw acertitiwroofwnsemrosell-insureorawnificateotWorkers' Compenution Insurance, or a cenilied wp t�ereof (Seci 3800 ab. C�. roucrNo.:2299200035�0 E%P. ii: OSIOLIq COMPANY: STATE � Certilie0 mpy is here0y IumisheG. ❑ Certilie0 cop is IileE � Ne ary Bu' sion. Daie: � �� App6carit E%EMPTION FflOM WOPKEPS' COMPENSITION DECIAfNT10N' Rhis s on nceE wi 6e mmpkleE il the pamrt ¢ �a ane hunOreO (5100) or kss�. I ceNty t�a� in the periormance ol ��e work lor which lhi ermit is' ueQ I sAall not employ any Derson in any manner so as �o become suClecl lo Ihe Workers Compen5alion Laws af Calito a. Uaie: SignaWre: NO710E: If. alter making tAis Aeclaratbn, yau 511ou1a bewme suEject to t�e WOAers' Compen5ation pmvisions ai the Labar CaOe. you must fan�vn�� cam0ly vnt� sucn pmvisions ot Iks permit shall 6e UeemeO revokeG. CONSTBUCTION LENUING RCFNLY: I here0y allirm t�at Ihere is a canslruciron IenOinq agency lar ��e petlo�mance o� Ihe xrork lor w�ic� ��is permil is iSsuM (Section 3097. Civ. C�. LENDEfl: AODXE$$: '� OWNFB BUILOEB OEClAM710N: I �ere�y alfirm t�at I am exempt imm t�e Coniractors' State License Law for Ihe lollowinp reason (Section 7031.5 Business anE Pmlessianal CoOe: Any tiry ul counry wNth rtquiRS a pefm� to WnstnKl, alter, improve, Oemolish, or �¢Dair any SVutWre. O�p� �o i6 issuante. also lepares 1�¢ appliWni lOf wth perrtn� la lile a 4qnBd Slalemeni ttlal hpJshe 61iCensed pursuanno the pmvisians ol ihe Cantractars' State Licenu Law �Ctwpter 9(wmme�inp vni� Sec�ion 7000) af Oivision 3 0l t�e Business antl Prolessions CoOe) or itut hUs�e is erempt Iheretwm anG t�e Davs lor t�e allege0 eKemption. Any riolation ol Seciion 7031.5 Uy any apviicant lor a Dermii suGjttts �Ice aOW��ant to a civil ce�atty al not moa Itwn INe nurMrM da0ars (5500�. I, as owner al the pmpeny or my e�ployees witll wdAes as t�eir wle WmOenution, will tlo Ihe work, anE ihe ❑ stmcmre is no1 inten0ed orofiereG lor sale (Section 70aa, Business anE Pmfessional CoOe: Tne Contracrori Stata �icense Law aoes noi aooN to an ovmer al a property x1n ouilds or improves Orereon, ana wM aces sucn work nimsell/nersell or thmupn �i5 Or �er mvn emO�oY�S. pwviU¢G Ilul Suc� im0�%'emenls ar¢ n0i inl¢nEM or ofhrt0 lor sale. If, howev¢r lAe GuilAinp of imo�ovement is so10 wit�in one year ol completion. Ihe owner will IWve t�e GurEen ol Omvinp Ae/she Ui0 nol GuiIC or imDrove for ine vurpase ol satel. I, as owner ol I�e propeny. am erclu5iveIy cWirattinq wit� IicensPA conVaclors lo ConSlmti Ille projeci (Seclion 7094, BUSiness ❑ and Prolessrons Cotle: Ttie Contractori SWte ticeme Law Oces not apqy to an wmer ol properry who Eutl05 or imDroves itierean anG wlb tonttat6lor wt� D�%ecls'Ait� a ConVatlOt�S) littnu W�� o IAe fAnlfat�ors' Sia�e Lk¢n58law�. I am awdre Ihal pr001 ot Iheir WOrker'S COmp¢nsation insurant¢ 5houl0 Oe pmvW¢E Io me. � 1 am e�empt untle� Stt�ion: B. 8 P. C. lor ��is reason: Daie: Oa+ier. 1 tlo �ereEy cenity IIW� I am aware o� antl undersiana I�e repuiRmenis ot Californu Health antl $ale�y COEe Secli0n5 255U5, 25537, an0 2553d and Ihat I or any �ulute Ouilding acupant wiNwiO noi (tifcle one) neeG to compty wilh SaiG 5tate co0e5 anOlhe reQuiremenis br a permii lor cwsimction or moCdkation imm ine a� OuaGty Maiugemrnt D'atricL BesiGemul constmction apDliations are exempl imm in¢5e ptmdvons. Dale: ApplitanL I hereUy t¢rtity I�al I �ave reaG Ihis aD7��on and SiatE o�tlinawes ana s�ate laws reWiing Io OuiWing conslrucliory pm0eny�ar insper,�o�puro - s. r ` t �] � Oa�e:J � �J ` $i9(uWre: �nver's License or Saial Secunry M: � 164t<6 W�i�e—Buibmg: Green—COEe Enbrce inl0rmaiion a corr aArre lo wmDN �� a0 cilY atb caun�y �rizereDres¢nU� tNSury�oen�eruponlAeabove-menlionetl Pink—Revenue; GabenroC—Assessor CIT'Y OF COSTA MESA — BliILt)ING FERMIT ?ERM NO: IB 057235 PERMIT NO: IB 05/238 PLAN CHECK NO: N GOVT; h SUPP; Y CONSTRUCTIOh TYPE: PERMIT TYPE: OTH STR PURPOSE: OTH JOB DESCRIFTION : FINALIZE EXPIRED PERMIT NB19889 FOR ADDI SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / COMMENTS: ROOM AUDITION �" dE �� iE df if� iE �% % M 4f X�IE �% #f if %� M ie �If i( IF�Y.�jf �f �K !f ie #df �lE iE IE iE if %# i[ �If # dE iE �7f �% # iE �X �N� �k' if dE iF �� 7( if % iE if� if dE%�� iE �lf �7E 7( % if %� �1F l( %�7P }f iE�� lF �N� �x lf Z O N I N GS ERTEHQAUCjKRSE M E N T S ------------ MAZN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT; FT IN REAR: FT IN FRNT; FT IN REAR: rT IN LEFT; FT IN RGHT; FT IN LEFT; FT IN RGHT: FT IN PARKING REp • PROV; FARCEL: 42623114 2NE: REF NO; PLANNING N67'ES> i � * 3F iF �% 1E fF 3E 3(- 3E 3E 1E i! iF 3E if iE 1F 3E if 1f iF if iF 3f ## iF # aF if iE iF #�1F �lE 3f if 1F?f if if aF 3E iE?F iF iF IF X� k i4 iE ih i(-�lF if * id iF if if +f K if ie if if if! i( if 3E �)h iF i(� # 3E 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 A 70NING APPROVED BY DATE; HUILDING APPROVED BY : APPLICATION ISSUED HY; 1E iE IP If iE iF iF if !E IE aE 1f iF if iE 3E IF iF 1f if iE if3F'"� 3E IE iF #f �If # iE if iF iF if-iE if iF iF 1F )f iE if 3E ii # iF 1E LE<'�ALIZATZON: N HI,DG PMT PLUMHING DATE; DATE: �x � ��ifi(�iFifiF3fii�£ifif�flEiflEicN•iFiFfFlf�ii�?Fii�3iri�£�i#7E w iF►ifififiFfElfi��FiFiFiE1EiE1EiEY.-iliFiFifiEiEif#ifiEiFif#iF1F1Fif?Fi'riFifif#iflFii�aE#iEiE F E E S J M M A R Y STRUCTURAL SEGMENT:Y ELECTR'_C MECHANIC FIRE SMIP/RES GRALIIT�G PERMIT 30.00 SMIP/NON—RES PLAN ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PIAN=CHECH TOTALS----> 30.00 O,UO 0.00 REVENUE DIVISION TOTALS--> COLLECTED; HLDG PMT PLUMBING ELECTRIC MECHANIC _io,00 TOTAL PAZD DUE 30.00 30.00 .UO 30,00 OVER/SHORT: ,00 FIRE SMIP/TOT GRADING PLAN—CHECK iE i4 3E if �Flf %� Ib i(� if if # 1! 1f� iE lf 3f� iE If 1F IE # If iE iE IElE 1F 1E if 1F iE iF ff if it if 1E iF iF iE iE �)f !f �IE if �F iE k 1i� if ie ik if iF i(� 1E If if iE iE M� �f iF iF if ?E 1E if iE iF 3i� It N� ie ai iF iF iF I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAi. COST I�S 1 HUILDING RE—INSPECTION FEE 30,00 30.00 END OF FEES CONSTRUCTION AND PLANNING � POC SPA APPROVALS Permit # Date Inspector qPpROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe•Und�grnd. 53. Steel Reinforcement 3. Electrical Conduit Utility�Undrgrnd. 54. Forms 4. Electrical Cond�it-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 Undr9rnd., Test 9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK i l. Property Sew¢r Line & House Connection 62. Backwash & Receptor-Finat 12. Sewer Cap 63. Heater & Vent•Final 53. Roof Dreins 64. Plumbing SYstem • Final 14. Rough Plumbing 65. Electrical�Final 15. Rough Electrical-Conduit 66. Solar Svstem-Final 76. Rough Elettric Wiring 67. Fencing & Access ApP�oval 17. Rough Wiring Sign 68. APPflOVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAI 19. Rou9h Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Duc[s, Ventilating 71. Product Piping OGas OOiI 23. Gas Pipe-Rough & Tesc 72, Underground Flush 24. Roof Framing 73. Undergmd. Storage Tank O Gas ❑ Oil 25. Root Sheathing 74. Overhead Hydro 26. T-Bar Ceiling IS[ruc[ural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 76. FIRE PREV. FINAL 30. Drywall Nailing ' HEALTH DEPT. REQUIflEMENT 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 47. Solar pomestic•Final � 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irripation System 45. Sound Atienuation 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING �L 48. FINALPLANNING 49. Elearic Release to Edison 50. Gas Release to Southern Catitornia Gas Co 51. CERTIFICA7EOFOCCUPANCY No. Da[e aecrnooeess: 386 E 20TH ST OWNEH'S NFME: S� Y BONES AOOflESS: 631-4990 pNCNIENGINEEN: P flEG.NO.: UNIT: ' RDOPESS: UNIT: PEHMITTEE: CAREY WARD ( 714 ) 6 31-2 2 4 2 aooness: 126 E 19TH ST C.M. CA 92627 LICENSED CONTNpC7aP oECLAflFTION: I nere�y allirm tnat I am licensed under o�ovisions ol Cnapter 9(commencing wit� Section 7000� ol Oivision 3 al �he Business antl Prole55ions Code, anC my license is in tull fo¢e ana ellect. CITY LIt.: STRTE LIC.: CU1S5: Da�e: SignaWre: WOPREBS' COMPENSp710N OECLABRTION: I �ereGy affirm �ha� I have a cenificate ol consem to selbinsure or a cenilicate of Workers' ComOensation Insurance, or a certilie0 copY ��e�eol (Section 3800, Lab. C�. POLICY NO.: E%P. OPTE: Certified copY is hereby tumis�ed. ❑ Certifietl copy is IileG vn�h Ihe ciry BuilOing Oivision. �a�e: Applicant E%EMP710NFROMWOFI(EPS'LOMPENSpTIONOECLl�HATION: (ThissectianneeDiwtUecompletetlilihepermitisfaone�unareagt00�arless�. I ceNiy Ihai in I�e peAorman[e al ihe work lo� whith this Oermit is is5ued. I SAall not ¢m0�0y any person in any mannef 50 as �o betom¢ sub�ect lo lhe Workers' Compensalion Laws ol Calibmia. �ate: SiAnaNre: NOTICE: II. afler making ihis tleclaralion, you sOoulJ became suUlect to the Worker5' Compensation provisions of the Lahor COAe. you musi fatlM1wil� Compty wi�h Such pmvi5ion5 ar Ihis permil S�all Ue aeeme0 revoketl. WNSTflUCTION LEN�ING AGENCY: I hereDy a��irm tha� �here is a constmc�ion lentling agenry �or Ihe Detlarman[e oi lhe work lor which Ihis Oermii is issu¢tl (Settion 3W7, Civ. C�. LENDEfl: aooxess: OWNEN BUILUEB OECIAflFTION: I �ertDy a�lirm Ihal I am ¢x¢mpi Imm I�e CAnirat�or5' State License Law lor the following reason �Seciion 7031.5 Busine55 anA Pr01e55ional Cotle: Any ciiy Of t0uniy whith rCpuire5 a Dermil �0 wns�md, alier, impmve, tl¢moli5h, or iepair any slrucWre. prior lo ils issuance, also repuires Ihe applicant for such Dermit to lile a signeG statement tAat tle/s�e is Iicense0 pursuant io ihe O�ovisions ol l�e Canlracmrs' Staie License Law (C�aO�er 9(commencing with Seclion 7000) ol Division 3 0l ihe Business antl Pmlessions Cotle) or ihat helshe is exempi therefmm ana ine 6asis lor Ihe altepeU exemption. Any violation ol Seclion 7031,5 �y avny applitanl Ioi a permi� SUDI?��S IAe a001itan( to 2 CiWI penaliy at n01 more �han �ive �unGred Oollars (5560�. ,c, I, as owner ot t�e pmpeny or rtry employees vnt� wages as iheii sole compensation, wiil do Ihe work, ane the LJ simcture is not intenGetl or ollereA lar sale (SecUon 70aa, Busin¢ss and Professional CoOe: The Contratlors' State License Law tloes nol aOV�Y lo an owner o� a propetly wM10 Ouiltls or im0�ov¢5 ��ereon, and who does such work himSelVAersell or thmuph ' hi5 Or her own employee5. pmviaed Ihal Su[h imO�Ov¢men15 are nol in�¢ntl¢G or OIIereO �of 5ale. II, �oweuer �he Ouilding or impmvement is Saltl within one year of ComO�e�iM. IAe awner will have Ihe euraen ol provinA hPJshe OiA not buil0 or impmve lor Ine purpose ol salei. I, aS own¢r 0� Ihe pr00erty. am ¢xtlusively conVac�inq vnt� licensed conlradors to cons�mt� Ihe D�olecl (Seclion 704E. 8usiness ❑ and Pmlessions Code: T�e Conlraciors' Siale License Law tloes no� aOPly lo an owner ol pmperty who buil�s or imD�oves I�ereon antl who tonlratls IOr Such pwj¢tl5 wii� a tOnlratior(5� litenu pursuanl 10 Ihe Conlrat�ors' $taie LiCens aw�. 1 am aware Ihal pmol of iheir Worker's Campensation insurance should Ge proviaea to me. � I am eeem 1 un0er Section: B. 8 P. C. ior i is r7o�: � � Oate'. S Wmer. I tlo hereby [etlily ��al I am aware ot an0 unders�antl Ihe repuiremeni5 ot Cali�ornia He ar Safety Code Sections 25505, 25539, antl 2553d ane I�al I or any Imwe �ml0ing occupant wilUwill not (circle one) n¢ea lo com0' vm ai0 state cotles antl �he reQuiremenis lor a permii lor consimc�ion or modilicalion Imm ihe Air �ualiiy Management Dislricl. Res al constmclion applicalions are exempl �mm Ihese provisians. oate: Fpplicant I here�y cerlitytha� I �ave reatlihis applicatio nd Slate t�ai the abOvein�ormaiionis correc�. ordinances antl s�alelans�elatinglo OuilOing nslmction antlllereUy . horixerepres nla� pm0etl% �loi i 5peclion pYipo5e5. Dale' J_��.]_!�— SionaNre' with all ciry an� county on �he a�ove�menlionetl Oriver s Gcense or Social Security x: -- �� i64t�a6 Whne—Bwldmg. Green—Cope Enlorcemene Canarv—APpficam: Pink—Pevenue: GolQenmO—Assessor CITY OF COSTA MESA — BOILDING PERMIT �6;—�E--@5-}-8� PERMIT NO: IE 051870 PLAN CHECK NO: N 69Ei-'f, fd SBPP, Y � CONSTRUCTION TYPE; PERMIT TYPE: ELE OTH PURPOSE: OTH JOB DESCRIPTION : FINALI2E EXPIRED PERMIT #E22337 FOR ADDI SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / COMMENTS; AOOM ADDITION �r�r�t**�t**�e*�r**�r�t*�t�r�t*�r�r**�r�r***�r*x****�+t*�t�r�r*�t*�t�r*�r+t*****�*�t*�t�t�t*+t�t�r�ex�***�r**�r��r Z O N I N G R E Q U I R E M E N T S sEraAcxs ------------ 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: 42623119 ZNE: REF NO: PLANNING N(51'ES> i *****r**�r*�*�*****�r��r*�r*��*�*�***��r********�r�r***�r�r*�r�r**�r�*��**�r****�***�e*****�� D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE; BUILDING APPROVED BY ; DATE; APPLICATION ISSUED BY: ' DATE: 3 0 i6ififiFiFifiF�FifiFlfifif7EkififkiFifkiE if3ElEiE�FiEikiEiFif ±Eif iE iF iE if k if 1f iF k k 1E 1E if IE �f ff �E 1E 1k iE �f iE if iE IE fE if k fE �f k iE 1F iFiE 1f 1f if 3f iF if 1klf �f If �k iF If !f iE if M if M if iE iE �E ft iE 1E �F iE if iE iF iE 1f if IE iF if IE 1F ik ik it iE if LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 30,00 SOY SMIP/NON—RES PLAN ISSUE FEE HUILDING—DIV—> TOTALS----> PERMIT ISSUE PLAN—CHECK TOTAL PAZD DUE 30.00 0,00 0.00 30.00 30.00 .00 REVENUE DIVISION TOTALS--> COLLECTED: 30.00 OVER/SHORT: 00 BLDG PMT PLUMHZNG ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 30.00 ikiF M 1F 1f k k k if iF If k!f �F it 1f iE it 3f iF af iF if it if 1f if if if M �f iE 3f iF M M ik if 1f iE �k iF k if if M if if k jF ikiF k 1F if if iE iF M if It k �F if if iF if if iF if iE fF �f �E iE If k iF iE I N D I V I D U A L F E E H R E A K D O W N ELEE �TY1 ELECTRICALIRE—INSPECTION FE FQ� INSPE�TI��S TOTAL30O00 END OF FE S I CALL 754-5626 754-5627 ��l�N6.%�_—uG02b:4e - r�-- - -- Gk?E: C`/ul/9� �:.,� _:-a� .� CTION AND PLANNING : � SPA APPROVALS Permit# Date Inspector p�ppROVALS Permit# Date Inspector .+,�, 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Und�grnd. 53. Steel Reinforcement r -r �3� Electrical Conifuit..Utility-Undrgmd. 54. Forms _ - :r4. Electrical CondUit�Undrgrnd. 55. Electrical Bonding �'_5. SteerReinforcement 56. Rough Plumbing & Pressure Test '� � �:;�'6. Electrical UFER.Grnd. 57. APPROVAL TO COVER�GUNITE = 7. Footings •• 56. Electrical Conduit�Undrgrnd. � �� 8. Foundation = 59. Gas Pipe, � Undrgrnd., Test : 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd. � 10. Structural Floor System 61. APPROVAL TO DECK ... 11. Property Sewer Liae & House Connection .. 62. Backwash & Receptor�Final " " � � 72. Sewer Cap 63. Heater & Vent-Final � �� 13. Roof Drains �c 64. Plumbing System � Final 14. RoughPlum4��9'-' 65. Electrical-Final � 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electrte Wiring 67. Fencing & Access ApProval 17. Rough Wiring,Sign 68. APPROVED FOR PLASTERING 18. Rough Electr �I-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 79. Rou9h Heating & Air Conditioning FIRE DEPT. REQUIREMENT " - - - tr� �o�- c: , - 20: Rough_FactoryFireplace =� "_ c � APP.ROVP:LS�- PCimit#'� - �1 �D C" c �'�� T� ' � _7. � y� r 21.: Ducts,:in Sfructilre ' . �.. �'- - � � " � � ~ ' ��" �, , c� � t- 70..-�Und�ergrouod Hydro ro 22. D'ucts?Vedtilating � � � � � �="- �F %� 77. Product�i'ping`O�Gas OOiI /� '� n � _ � t�+ f . > . r . 23'. Ga3 Pipe-Rough'Bt.Test . ,�� ; „ � � �^z, . �_ 72. Undergrgund Fl�h ; - 24: Roof Fram'rng ; � - - : ^ � ,� � .. 73. Undergrnd. Stor�ge Tank O Gas ❑-Oil � 25. Roof Sheathing ��; i �� ." � - i j: *'' 7�. Overhead Hydro' s �"26: T�Bar Ceiling (Stiuctural� $t Monocoat � � ��> ; 76. Dry Chemical y a� �- t� 27: Frame and Flasring S - � in�, ^ 76. Dry StandPipe' �; �' ' �' �; , ' 28. Lathing & SidirtgY -: :�:'i r;: •• ••x a 7.7. FIXED SYSTEM-FINA'LJ ''' t . '1 .1 1 ' 29. Insulation � -' < �� , � '`� � I : ,; 78. FIRE PREV. FINAL '��, . �z �> .� �.� � � 30. Drywall Nailing t '- • - �-HEALTtl DEP-T�. REQUIR�EMENT le 31. PlasterBrownCoa,ts � _ ( j �. , 79. FINALINSPECTION ;"" ° �. 32. Electriwl P`ower MeterFinal' � . I � �� ,. ,� 80. FOOD CERTIFICATE ISSUED ' � � 33. Finai Electr.;c • _ � � �,�I '(„_ , * Notes: � �;'� ' - ';,r -.. � _ • :•. £ .. _ _ � � 34, Final Heating & Air`Conditjoning " � �. x. (y;-.,� j ;-:y� :t ,y - _ i 357 Final Gas Pipe-Test �� ` ^ � I k �� ^ • �.'�' '- ';-- ' .: �.� > A f'Y Y N ' I 5� � Y� .> �� T ' A L 1 �w ♦ v J ' . `; l - 36: Hood or Canopy .�'' . �- �. ,�� T r;r � - 37:' Final �actory FirePlace � �'•- - � "� � � �, Y S � -� , , ..^`` .4 T V . 38. Final Plumbing �., T�ry � � . �u � � ;k * � �' H 7 :7 ' 39. WaterService-Final� � - � � � � - 'T! ' �� - - � I ,. � �; , 40. Gas Service-Final : _ .a :r - - r tr � � � • ��'^ ��^� + .,•� . ,� 41. Solar pomesticFinat: " •� • � � � � ��_� ' I a - c ' 42: Backflow Preventer - _ '- ' � �� ' �� ''� ; _ -' - 43. Backflow Irrigation � " _ �' {� � - � . m x t • . 44. Landsca e�firi ationS stem;.�. - . `.'- x� P 9 Y �t �� . .t; iU ..�- t . O ' 45: Sound�Attenuation - �T • >. - ��" ' � . � ' '" - �ti r - �V - t 46; Handicap Regulat�ons _ � r �� ,. � � - �, ,. 47: FiNAL STfiUCTURE & BUILDtNG � I ^+ u> � � � F ' 46: FINAL PLANNING r�: � IJ ' '' - � � . : 49: Elearic Release to Edison I �� z '� ' � ' .� � _ 50. Gas Release to Southem Ca.lifomia Gas Co , I � ° ' : - . �=� ; ;;. - - . � � . 51. CERTIFICATE OF OCCUP.ANCY , ,� ,";._ i . ,: ` No. Date �f-COSTA MES ' NSTRIlCTION PERMIT cc Addresz 3 0�� s� itant's Mailing Pddress _, �LRcNEng. 4cenx No. Address Contractor's Nam Phone Address (mailing) Ciry License No. LICENSED CONTRACTOR DECLARATION I nereby attirm tnat I am licensetl untler provisions of Charter 9(commencing with seclion 1000) o/ Dlvlsion 3 of the Buslness antl Professions Cotla, an0 my license is in full force antl eitect. LJC¢�1¢ C�d55 License No. Date Signa[ure RKEi35' COMPENSATION DECLARATION ' reUy aflirm that I �ave a cerUflcate of mnslnl to SelHnsure ar d ttrtl/lcate orkus' Compensation InsuranGa, o� a ttrtlliatl cooY ��ereof (Sectlon 0. Lab. CJ Policy No. Company eCertilietl copy Is nereby turnishetl. Certifie0 copy Is tiled with [ha city Builtlin9 Olvision. Date APPlican[ EXEMPTION FROM WOHKERS' COMPENSATION OECLARATION (This section ne¢tl not be complat¢C it ih¢ pe�mlt is fo� Ona huntlre0 (§700) o� iess). 1 artAy �hat in th¢ Oerto�manca Of th0 work fOr w�lch thls Oerm�t I sSueU, 1 zhail not empioy any person in any manner as�9.� eco sub' to tha Workers' Coeppen " n Laws o! Califor i � '{�p . Date �� `t � Signaturo � +� � /� �NOT�CE: it, atter making this aeclaration, you shoulE become subject to tne Worker5' Compensation provizions of lhe LabOr Cotle, y0u must forthwitb COmply wilh sucb provisloni or this Oermlt snall bG deemetl revokeG. CONSTRVCTION LENDING AGENCV I hertby altirm ihat thera is a construction lentling agency lor the perlormance o/ Ihe work IOr whiGh this Oermit is I55ueA (Section 309] Civ. C.) Lenaer's Name Lender'S Adaress OWNERBUILDER OECLARATION I �ereby a�firm [hat I am exempt trom the ConVactor's UttnSe Law tOr t�e Ioiiowing reason (Section ]031.5 Business antl Proleszional Cotle: Any city or munry whicn reQuires a permit to constru<t, al[e�. Improva, demollsb o� repalr any structure, prior to its issuance, also rlaWres the applicant for such pe�mlt ta lile a si9netl itatement that he/She is Iicensetl pureuant` o Ihe prOvisions oi von 3 of tlle Business anU V�'otesLons Coae) or [na[ ne snC a exempa �eirom an0 tha basi5 for th! allegetl ¢xemption. Any viOla ion of SectlOn .5 Dy any apP��an[ for a Oermit suD�¢cts Iha applicant to d civil , ry o/ not more than five nuntlr¢tl E011ars (5500). I, as owner o/ the prooerty or my emvloyees witn wages as ineir sola mmp¢nsation, will do tne work, an0 Ne s[ructure is nol intenaea or onarea lor sale (Section ]0a4, Butiness antl Pro�essional COGa: The Contractor's License Ldw tlocs not apoly to an owner of a oroperty who DuilCs or ImDroves thereon, an0 wno aoes such work nimsetl/herseli or thmu9h nis or her own employees, provitled lhat such imOrovements ara nOt 7ntenGetl o� otteretl (or sale. II, however, the builtling or improvement is soltl wilhin ona year ot com- pleUon, t�e ownei will have the burCen o/ provin9 h!/sbe Citl nof builtl or im- p1 o_vefort�e purpose oliale). Ll�l, as owne� of t�e Oroperty, am ezclu5ively contractin9 with Iicensed con- Vactors [o consV uct me pro]ec[ 15ection 70a4, Business antl Professlons COEe: 7ne ConVactor4 license Law does not apply la an ownlr of property who builOs or Impraves Iher¢on, anG who cont�acts for such projects wltn a con- Vaclm�s) licenu pursuant�to-tne�Contractor's license L.aw). I am aware that �roof o( lM1eir Worker's Comp wtion iny�rance ihoulE �a provlAetl to ma. 1 am exempt untler Sectbn �A Z/^ h e. 6 a. C. tor tnis reason Date � � Owner 1 hertby ttrtily tnat I have reae tnis application ane state that tne above information is mnect. I agree to compty wi[h all citY ana county ordinances an0 stata laws relating to builtling mnstruc[i n, and her¢by au[horize repre- s¢ntativas of t Is c' y to enter upo tha a ove�mentioneU Oroperty for insoection 0 r ses Q '_ �3 yG Signature Oate 75 Driveri' L' S 55 � � — :an1 to flll In all fpaces aacept tho30 within �etvY ��rCer Iinef anE si9n all appropriab Cacbntlons. PERMIT NO. TRAC7 NO. LOT NO. . UNIT NO. ,. � - 223 .. . - TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR � ❑ CONVERSION ❑ DEMOLISH ❑ OTHER � p� p�. DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TVPEOFPERMIT�y GRAOING FOUNOATION STRUCTVRAL T FrOnt ❑ TENANT lJ ELECTRICAL ❑ PLVMB�NG ❑ MECHANICAL � B Reaf ❑ OTHER %� PROJECT OESCRIPTION 5. FT. oCC�aArvCv C Right CONSTRUCTIONTVP�_ VALUATION$ g �eft ZONE GRADING CU. VDS. ACf3E5 P�ng. R¢f. � Remarks: ��C�Q�� Gn�� ;)tia nnr< � 0�114� PlanningNotes: Bar Sink Backflow Preventer Backflow Irrigation Bathtu6s Clarifiers Drinking Fountains Floor Drains Floor Sinks Gas Service OuUets I�terceptors Kitchen Sink Roof Drains Reinspaction Fee Showers Service Sink Sewer Cap Sewer Connxtion $olar Cqllectors S (ar Tank wimming Pool w/Spa Uri�al ater Closet Wa r Heater Water rvice Auto-Wazh Laundry Trays $15 laue Fae Dutt - Under Ground� Duct � Structural �uct � Ventilating ExhaustSystem ❑ Multiple Firepl/Fact. elt. If,BO � Heating System & Oucting ❑P100,000 BTU �700,000 Reinspection Fae � S75 CMF Ofi65�46, rev. 10/B4 Whife - Builtling: Canary - Appliwnt: Pink - Amounting: GOIGenrotl - Asussor Hoodor Typel ❑ Canopy Type II ❑ 's(rig ation Syrtem �0. 00,0008TU ❑100,000 stem RepairlAlteration Fire DamOe�s Registas laua Fee FEES N ._ .._ �'" _ _...._ "__ _, ._" __,"'_ 7182. ,I%I_3/86,: . ,. � .. . . . � . r„ Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers as lectric Fan F.A.U. Fixtures Device Boxes Outlets - � Zone Acceuory Buildin9: ' Parking Req./Provided EIECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter Qup to 100amps � Meter �3Ger 100 amps Garbage Disposal Generator 00.5 KW �575 KW Sub Panel Moto�s I�O� 1 HP � 1 h- 8 Inc.Solar �9-15 HP �16-75+ Microwave Pole Light � Range Sign ;Standing Sections Trash Compactor S 3' �- Reinspection Fee $75 laue Fee FEES DEVELOPMENTSERVICESREQUIREMENTS: Zanin9 APProved By 8uildi�g Appraved By Aooliption Isued Bv �i% ___ S 3 -Ze��T\ Z O N 1 N G R E n M T $ FEES S 3 SUMMARV OF FEES BUILDING PERMIT E SMIP S PLAN CHECK $ PERMIT PLUMBING E ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTpICAL $ �%..31�I GRADING $ PLANCHECK 50% $ MICROFILM $ MECHANICAL $ TOTA� FEE $ �`1", 30 PLAN CHECK 25% $ � CONSTRUCTION AND PLANNING POOL & SPA �'��APPROVALS Permit# Date Inspector qppROVALS Permit�# Date Inspecto� ��1. Temporary Electrical Service or Pole ' 52. Pool & Equipment Location �'.2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement � �.3. ��Electiical Conduit Utiliry-Undrgmd. 54. Forms � 4. �Electiical Conduit-Undrgmd., 55. Electrical Bonding • 5. Stee! Reinforcement 56. Rough Plum6ing & Pressure Test � ' 6. E�ectrical UFER Grnd. 57. APPflOVAL TO COVER-GUNITE 7:; Footings� . 58. Electrical Conduit-Undrgmd. . � � 8: Foundation - � ' , 59. Gas Pipe, � Undrgmd., Test ' � �.- 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, Q Undrgrnd. . � 70. Str'u'ctura'I Floor SYstem �� 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection . 62. Backwash & Receptor�Final � ' 12. SewerCap � ' 63. Heater & Vent-Pinaf ' - 13. Raof�Orains � 64. Plum6ing SYstem - Final ' � E 14. Rouph 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 t 18.j Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL .; t 1�i Rough_Heating & Air Conditioning FIRE DEPT. REQUIREMENT �' '� 20...Rough Factory Fireplace . ' APPROVALS Permit# ' 2l. �DuCts, ia Structure . � . 70. Underground Hydro � '�22. Ducts,Ventilating `, � ' � 77, p�oductPipingOGas ❑Oil . 23. Gas Pipe-Rough & Te§t 72. Underground Flush � 24. Roof Framing '� 73. Undergrnd. Storage Tank O Gas O Oil 25. Roof Sheathing 74. Qverhead Hydro :�: 1 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � ."27. Frame and Flashing " 76. Dry Standpipe �= 28. ':Lathing & Siding �� 77. � FIXED SYSTEM FINAL : 29. �.I�sulation . 76. FIRE PREV. FINAL i 30. Diywall Nailing HEALTH DEPT. REQUIREMENT :.31. Plaster Brown Coat: 79. FINAL INSPECTION : 32. Electrical Power Meter-Final '. / 3..g'(� �� 80. FOOD CERTIFICATE ISSUED � � 33. ,Final Electric Notes: "34: Final;Heating & Air Conditioning � 35. Final Gas Pipe•Test ' ' � � . 36. Hopd or Canopy 37. Final Factor.y fireplace � 38. FiAal Plumbiog , � 39. Water Service-Final � � 40: Gas Service-Final � 41. Solar pomestic-Final 42. Backflow Preventer . 43. Backflow Irrigation �� - � � � 94. ,Landscape Irripation Syrtem - . � 45. Sound�; Attenuation � , 46. Handicap Regulations � � 47. FINALSTRUCTURE & BUILDING 48. Special Requirements Complated . 49. Electrie Release to Edison 50. Gas Release to Southern California Gas Co 51. CER7IFICATE OF OCCUPANCY � , No Date . . , ,� \ � UJECT AODflE55: UNIT: OWNEH'SNRME: 38() E 20TH ST CITY OF COSTA MESA — BUILDING PERMIT PERM NO: E 05765 nonxess: RANDY BONES SAME PERMIT NO: E 057651 PLAN CHECK NO: N GOVT: N SUPP: N ANCHIENCINEEH: 6 31 —4 9 j O aoosess: PEHMITTEE: aooeess: G 6 S CONSTRUCTIOT 999 OAKnSTREET ULENSEU CONTflpLT1��lOt�'��eq af�irm ttwi 1 am Izei 7000� ol Divison 9 of I�e Business anE Pmleuions COAe. an0 my iicey CITY IIL.: STR7E LIC.: � aie. 2 296 ��6a'��762 � WOBKEfl M i RTIONO CIABRTION: IhereEyatlirmihailhave; Compensaiion Insurance. or a certifietl copY ��e�eof (Section 3800. La POLILY NO.: E%P. OR . •omrnxv: G2Tz 9y''�`p92�0j07�0j3}5�60 ' � Cenilie0 cbpyi5 TCree9 IuM1iisTfN'�j Cenifietl capy /ilea witt cuss: NEG.NO.: CONSTRUCTION TYPE: PERMIT TYPE: ELE PURPOSE: OTH uNir: JOB DESCRIPTION ; FINALIZE EXPIRED PERMIT ttH19889 FOR ADDI SQ FT: CLAIM VALUE: CALC—VALUE; GROUP OCC: R-3 / (714)642-9204 COMMENTS: ADD BREAKERS TO EXISTING 3LGTS 80UTLETS �P�r9(commenCingwilASec�ion ifiFMkiFiFiEiFiEiFIEiFifiFiEiEiFiklFiEltitiflfif�ElEififffiffEikiklfikiFiFitlflfkifif�E�Eifif3EiEMkafitif�flfiFififiFiFiFiFlFkkiFififiR�f1E�FlfMifiF�F a. Z O N I N G R E Q U I R E M E N T S S E T B A C K S consem ro selbinsure or a certilicate oi Workers' (/03/93 ciry BuilainA �s Date: ' � ✓ AppliranC E1fEMPlION FX WOflNEflS' LOMPEN511TION OECLAMTION: RNs clion e0 not Ue mmpktetl ii tlie permi� k fa one hunAreA (5100) or less�, I ce�ily I�al in the pedormance oi the work lor w�ich this perm 5 issu . I s�all noi employ any person in any manne� so as lo become Subj¢C� io ihe WOrk¢R' COmp¢p5dli0n LdwS 01 CalifOfnid. oate�. Signamre: NOTICE: II. afier making Ihis Ueclaration, you shouid 6ecome su�le�� o ��e Workers' Compen5ation provisions ot Ihe Labor Code. yau musi forl�wit� comply vnth suc� pmvisions or IM5 De�mii shall be GeemeO revoke0. CONSTBUCTION LENDING RGENCY: I �ere0y aliirm t�at t�ere is a wnsiructbn IenOinp agenry �or the peAormance oi the work for wh¢h Ihis permit is issued �Sec�ion 3097. Gv. C�. LENOEN: AOONESS: ' OWNEB BWLDEB oECLAHRTION: I nereoy affirm inat I am exemp� imm tne Coniractors' State License Law for the followinA reason i ISeclion 7031.5 Business antl Pmfessional Code: My ciry oi caunry whicA repuims a permi� to consiruct, alter, imD�o�e, tlemolish, or ' repair any simcture. prior to i�s issuance. also r¢puires �he ap0��n� lor such Dermi� to lile a sipnetl s�atemen� ihat he/she is licensed Oursuanl Io Ihe O�ovisions ol I�e Contracmrs' S�ate License Law (C�apter 9(commencinq wi�h Seclion 700�) ol Division 3 ol ��e Business anE Pmlessions COAe� or iha� �e/s�a is exempt t�erelrom and t�e basis br t�e alleped ecemption. Any violation ol Section 7031.5 Ay any aoClicanl for a Detmil su01��s tne appliWnt la a ciWl ce�alty ol Mt mo2 thdn five hunOreO Ooltars (3500). I, as owner al ihe pmpeny or my emylUyees with wa�es as tAeir 5ole tamDenSation, will tlo iha work, an0 tAe ❑ simcmre is not intenOetl or oiferetl for sale (Section 70a4, Buvness an0 Protessional Catle: The Coniractors' Siate License Law Ooes nol aDUly lo an owner ol a propetlY w�o Ouilds ar improves ihereon, ana w�o does such work Aimsell/hersell or Ihmug� his or her own employees. D��4e0 thai suc� imprmemems are nol intentle� ar afierea tor sale. II, however ihe buitOinA or impmvement is SoIA wil�in one yeat of Completion. I�e owner vnli �ave Ih¢ �ur0en oI provinp hUs�e tlid nol builA or improve ' lor iM1e purpose ol sale�. I, as owner of the propeny. am erclusively conlractinp with licensed coniractors lo consimtt ihe proiect (Section 7044, Business ❑ an0 Pwlessions CoOe: The Contractors' State Lkense Law Ooes not appy to an wmer of D�operty �Mio UuilUs or improves t�ereon and wh0 Conlract5 lor wth pmlecis wit� a tOn(racior(5) liCenu pursUanl �0 Ihe Canlfatiars' Siale LiC¢nse Law�. I am awar¢ I�a� proo� ol I�eir Worker's Compensation insurance 5�ou10 Ue D��viOetl to me. � I am e�empl unAer Seclion: B. d P. C. lor Ihis reason: oate: Owner. I ao nere0y cenily inal I am aware ol and unaerstana ine reQui¢menls of Calilomia Health an0 Safery CoOe Sections 255Q5, 25533, and 2553n and Ihat I or any IUWie Duilding occupani wilVwill no� (circle one) nee0 to tompty wilh saia stale co0es anA Ihe requiremen�s �or a permi� lor conslmction or moailicaiion irom t�e Air Ouably ManaAemeni Dislrici. PesiGeniial cansimclion apDlicalions are eeempi Irom Inese piovisions. Daie'. AOOlicanL I hereby cetlify �hal I have reaa Ihis applica�ion antl 51ati oreinances and sla�elawsrela�ing�o buil0ing consimdmn SignaWre: � Oriv¢r'S L¢¢n5¢ Or $pcidl $¢wtily p: , 16<t�06 White—BuilOmg; Green—( lo comply with all ciiy and couniy lo en�erupon�heabove-men�ioneA Pink—Revenua; Gdtlenraa—Auessor ------------ MAIN BUILDING ---------- --------- ACCESSORY BOILDING --------- FRNT: FT IN REAR; FT IN FRNT; FT IN REAR; FT IN LEF?: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN PARKING RE • PROV; PARCEL; 426Z3119 ZNE: REF NO: PLANNING N TES> > • *�r*****�r**�r****�r�*�e�r**�r�r�r**��r�e�r**�ri��r*�r�r�r*******��r�e*�**�**�r�*�r�****�r*�****�r�*�r� D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S Zf�fi�b �f�fl�dVE�t1 gY t DATE: �i�J��G��R� �Y'Y'�� Y' = � . ,� — ---- DATE: � � A/f ��1 ��M iF A�'M it iFr�F� k Rk iE# IF IF k�..�.k.�.�.kif iF if it 1�A�F } k3&�d�k3� ****x�***�rx��tx****�r�r********�r�r� �ei �e�r+t��r�t �t�ri �t***�t*****+t�r�t�r�r*�r*�e�r***�r�t�r��r�r��t�r�t*�t�r* LEGALIZATION:N F E E S M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUltBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 16,50 SOt SMIP/NON—RES PLAN ISSUE FEE 15,00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 16.50 15,00 0,00 31.50 31.50 .00 REVENUE DIVISION TOTALS--> COLLECTED: 31.50 OVER/SHORT; ,00 HLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 31.50 iFk it if if if if if iF aF M if �f if �f k if If M if if 1F If iF if if if 3F M if M k iE iF k if 1F iFiFif iF k it if il iFiF M if �F it iF k 1E iF iE iF�f M iF iF if �E k iF k iF iF �F af if �f M if iF k k 1F if I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST ELE 3 FIXTURES LIGHTING 1 ST 20 EA, .75 ELE 8 RECEPT/OGTLET 1 ST 20 EA. .75 ELE 3 RECEPT/SWITCH 1 ST 20 EA, 75 ELE 1 NON—RES APPLIANCE NOT OVER 1,0 HP 3,00 ELE 1 MOTOR/POWR APPARATUS 0,0 — 1.0 HP 3.00 END OF FEES �i , — , - --,' _ .-, � � _ ,_ . TOTAL COST 2.25 6.00 2,25 3.00 3,00 � � \� � CONSTRUCTION AND PLANNING ' P�� ' SPA APPROVALS Permit# � Date Inspector qppROVALS Permit# Date Inspector 1. Temporary Electrical Serviceor Pole 52. Pool & Equipment Location 2. Soil Pipe•Undrgrnd. �• t 53. Steel Reinforcement 3�fettricaiCondui2-IfF�Jfry-Untirgmd.�; ` 54. Forms -4.iElecirical Conduit�tlndrgrnd. 55. Electrical Bonding 5�Steel R6nforcemenp ; '� 56. Rough Plumbing & Pressure Tat �6•'E4ectrical UFER Grns� � 57. APPROVAI TO COVER�GUNtTE 7. Footings ' T �' 58. Electrica� Conduit•Undrgrnd. _A. Foundation .,� �' S9. Gas Pipe, f7 Undrgmd., Test 9. Water Pipe•Undrgrnd. 60. Backwash Lines, P�Trap, �7 Undrgmd. 10. Structural Floor System � 61. APPROVAL TO DECK 7 7. Property Sewer Line & Ho4se Connea�on 62. Backwash & Receptor�Final 12. Sewer Cap i ' . 63. Heater & Venc•Final 13. floof Drains . 64. Plumbing System � Final 14. Rough Plumbin� - 65. Electrica��Final 15. Rough Electrical-.Conduit 66. Solar System-Fina4 16. Rough Electric Nnring 67. Fencinq & Access ApProval 17. Rou9h Wiring Sign 68. APPROVED FOR PLASTERING 78. RoughElectrical�BarCeiling 69. POOUSPASYSTEMSFINAL 19. Rough Heating & A(r Conditioning FIRE DEPT. REQUIREMENT ' ' _ C �' J . �� . - .r ti' r 20. Bough Factory.Fireplace '� ` " �- " • %� 'HPPRQVACS�� = Berm'�t # � - � sir � �; 1, s, � . , � . „ ; . 21 . Ducts: in Strugture'; �, i' :. � ' ; i 7b. Undergronttd�HYc�ro r � 22. Ducts, Vantilating .� �� ` � '� ' •7,1. Product Pj�nj O'GBs ❑011 23. GdsPipe�Rbugh&T.�`,st � :t ;� ,� , :�� :72, Undergroun�IFlush� � � 24. Roof Praming • � • . .- • > '+ 7�3. :�ndergmd.5corage Tank O Gas ❑ OiP • - 25. Roof.Sheathing �,,: � - '�, 74, pverhead I-i�ydro �- 26. i-BanCeiling (Struaturall & Monocoat � '7 � 75. ��.ry Chemical � • 5?� �- _ _ 27. Frame and Flashin x� � � s�� „._ - i:, �� .:��cc - 'z�i �. 76. �Dry StandAlbe. • . � r� � 28. Lathing & Siding �,;. .; ,�_�: •c � � " '� 77, 'FIXED SYSTEM Fip1AL ' ' ''� . �9. Insulation �' � �� . ; ` � � r+ 78, fIRE PREV. FWAL . - � �,r:�^: 80. Drywall Nailing �. c �� HEALTH DEPT. REQUIREMENT V, 9 ' 31. Plasrer Brown Coat, e S � ; �, 7,9. fINAL INS�EFT107�7�' � - L �;, 32. Electrical @owei Meter;Final � *.. ' � 6AOD CERTIFIC7aSE_ISSUED ''� ' 33. Final�lectric � _ • �: ' : ��Q% � _ � Note's. _ � -`' ` " t �� - y ., p � : ,' 34. Final,Heating & Ai� Condicioni�g .: - - � ` .. � . _ �:z f , � 35. Finai Gas-Pipe-Test ' " _ • _ � • ` '- :. �i.. . �, � 36. Hood�or CanoPv . . �r - : r � �i s : >,V ' � � t r � 37. FinaFFactory Fireplate _ ' �-� ' " � y '. ' * `"-' _ ` � .n • 38. Fina4Alumbing .� .; s +7� � --• � 39. WatenSe�ce-FinaP` t - - � ^ _ �r ' i � - 7- 1 Y i � ' 40. GasService-Final ` l - � � :)� - � . ' . • = . . d�r r . i� ^ � . 91. SolarpomestioFinab > " - � - . �C'� ' t_ � n' J 'Y d2. Backflow preventer . „j '.'�. " ' . j . , ,-, . 43. Backflow Irrigdtion ' �' � � Y� 1 ' ' _ _ �" c[' N , t • 44. Landscape,lrri4ation System �r�4�-, �; .. - � '_�� ;r �.� - . � . • � A5. Sound Attenuation = ` = - � •' - r ' % ' �'L ' , x Z� { , ' 46. Handicap Regy�ation's � .; : ' �� ;;, ' - 47. �1NAL STRUETURE & BUILDING �� i ' . � � „ i �' � 48. FiNAL PLANNING . � � � � - � . 1.• � � 99. Hect?pc iielease to Edison � '. � • ' a I 50. Gas Release to Southem California Gas Co ' �•; ; � '• • •- 51. CERTlFfCATE OF OCCUPANCW . � ,- -., . , _ • No. Date � PNOJECT AO�HESS: OWNEN'S NAME: aooeess: � ANCMIENGINEEP: E 20TH BONES r 631-4990 flFG.NO.: uxir: ROOflESS: UNIT: 4 CAREY WARD (714)631-2242 PEXMITTEE: 1 Z G E 1 9 TH JCT AUOflESS: C,M. CA 92627 ❑LENSED LONTBRCTOP OECLAflAT10N: I nere0y aHirm Iha� 1 am ficen5e0 un0er pwvisions ol Chapler 9(commenunp wit� Settion 701101 01 Drvison 3 0l Ine Business ana Pmfe55iWs Ca�e, antl my license i5 in IUA lo¢e an0 effeCl. CITY UL.: ST�TE LIC.: LLA55: Oale: SiA�aWre: WOflBEPS' COMPENSRTION OECIAflRTION: I �ereGy allirm t�al l have a certifitate of tunsent to selbinsure or a cetlifiCale ol Worker5' Comoensa�ion Insurance, ar a cer�ilietl copy t�ertol �Seciion 3800, laD. C�. POLICY NO.: EI(P. OPTE: COMPIINY: ❑ Cenified coOY is �ere�y tumis�ed. ❑ Certilie0 copy is fileE wiID the ciry Building Division. Oate: ApDlicanl: E%EMPiIONFBOMWOflNEflS'COMPENSl�TIONUEClAMTION: (ThissenionneeO�wtUecompkte0ifthepe�mtislorone�unGrea�Et00�orless). I te�ify I�al in Ihe pedOrman[e ol I�e wOrk lot w�iC� thi5 Dermii i5 iS5ue0. I Stwll no� empl0y any p¢rsOn in any manner 50 as l0 6etome sub�ect to Ine WorMeri Com0en5alion Laws Ot CalifOrnia. Oale: SgnaWre: NOTICE: II, aiter making this tleclaralion, you SMultl �ecame subjett Io I�e Workers' Compensation pmvisions o� �Ae LaOor Code. y0u mu51 Iorlh+nlA cOmOy wil� Sut� D�oMsionS Or lHs Dermii 5�at1 6e Oe¢me0 revOkeG. CONSTflUCT10N LENOING AGENCY: 1 �er¢Ey aHirm I�ai I�ere is a constm[tion lending agency lor ihe pehormante ol thC vrork �o� whic� I�is Oermit is i<sueC (Settion 9W7. Gv. C�. LENDEfl: aooness: OWNEB BUILUEB OECUIIATION: I Aereby afiirm t�a� 1 am eeempt fmm ine Camracmrs' State License Law lor t�e tollawinA �eason �Secuon 70.31.5 Business anA Pmlessional COCe: Arry p�Y ol counry wL'rcli repuires + perrtnt �o cansiruct, alter, improve, Oemolis4 or reDair any 9Ncture, pti0r to i6 i55uantt. al5o repuire5 I�e ao�CEn� for suth penm� ta lile a SiqneG statem¢nt tlldt hPlshe is Iitenu0 putsuanl to tne orovisions aI 1he Conlractori Slate l4ense Law IChapter 91�mmencing wiN SecUon 7UW� ol 0ivision J oI the 8usine55 antl Pmlessions CoGe) or t�at Oe/s0e is eremD� t�erafrom an0 It1e Oasis lar t�e aAe0e0 eeemption. My vi0lation of Sttlion 7031.5 Oy any applitanl tor a D«mil su�jttis ine apD��ni to a Crvil oenalty ol tqt more Ittan live huMr¢E aOAars (35001. I. as owner ol IAe D�aoeny ar rtry empIoyees wiltl waqes as their wle Compen5ation, wiA Eo Itle woM1, antl ine sINCWR 6 nat intenEM or ollemO for Sale (Sttuon 7btd, Busineu anC Pmfessional Cotle: ihe fAnlractoR' Slate License Law Goes not aDuly to an owner of a pmDeny who EvilGs or imprmes tllereon, anA w0o Uoes such work himself/�erself or tllmu0h �is or �er Own emobyees. DrovideU t�al su[� imptOvemenis are not inlmEea or offere0 far Sale. II. Iwwever Ihe 6uil01np ot imprOv¢menl i5 SOIG vnt�in One yea� ol tqmpl¢�i0n, t�e owner rtil luv¢ I�¢ hurtlen al OmvinO hNshe tli0 noi Ouila Or imO�Ova tor Ihe purpo5e 01 Sal¢�, I, as owner ol tAe pmperty, am exUusivelp coniractinq wit111icertteA coniractors la constmct Ihe pmlect �Section 704d, Business ❑ anE Pmlessions CoOe: ihe Comractors' State License Law Goes not appty to an ownei ol propeM � �uilds or impmves Ihereon antl wh0 COntratt5 lor Suth D�oletis wil� a COn�raciar�s) li[¢n5¢ pur5udni IO Ihe COnVaCiOrs SlatE 4tenSe Law am aware Ihat prool ol iheir Worker's Compensalion insurance shoula ee pmviaeE to me. � I am exem0� under $ection: B. 8 P 10� IIIiS �EdS Oate:_ ✓D � U�vne�� I eo hereoy ceni ��a� I am waie ol anu unCerstan0 me repuiremenis ol Calilorrtia Mea n a. a Safeiy Coae Sec�ions 25505, 25533, antl 2553d an4l�ai I or any lutwe 6uiltlinp atu0am wilUwill noi �cirtte one) neeG m comO�Y �th aia stare catles anA Ihe repuiremems lor a permn lor conslmciion or modilica�ion imm t�e Air ualny Managemenl DisVitl. flesiGe� �� I consimction apDlications are eaempt imm these pmvisions. oaie'. Apo�icam: i hereby ceNly Ihal I �ave reaa ims applical�Gn antl sla�e Ihat �he above inlormation a rorrecL I agr¢e to comply wi�h all tiry ana cou y orUinanresantlstatelawsrela�ingioEmiEm�consimcuonananere onrerepr ma' olt�i^drytoenteruponihea0ove�mentioetl pmpetly br inspec�ion Durposes � , �aie: � Sipnamre: �I Oriver's laense or $ocul $ecurity .: ifiai�a6 Wnne—Bwia�ng: G�aen—COJe Emorcemenr, Canary—npWica^t: Pmk—Revenoe; GobenroE—Assessor CITY OF COSTA MESA — HUILDING PERMIT PERMIT NO; IP 051869 PLAN CHECK NO: N CONSTRUCTION TYPE: PERMIT TYPE: OTH PLU PURPOSE: OTH JOB DESCRZPTION ; FINALIZE EXPIRED PERMIT pP19984 FOR ADDI SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC; R-3 / COMMENTS; ROOM ADDITION iE 1f 1F 1E iF iF iE 1F iE iF IE iF 1E 1k if 1E �E iE iE iE iE iF k iF iF iF ik if iFif iFiF�E 1F iEif if M aE 3f if iE iF iE 1E if if iflE 7E if if if iE 1E iE if if dE iF iEiF If 1F iEiE if �f if if iEif iF if if 3E iE iFiE Z O N I N GS ERTEBgAUCIKRSE M E N T S ------------ MAIN HUILDING ---------- --------- ACCESSORY BOILDING --------- FRNT; FT IN AEAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN PARKING REQ• PROV: PARCEL: 42623114 ZNE: REF NO: PLANNING NO'PES> 1 iF �F iE if iE�F �E iF IE �1F iE �Fik 1E IE if if iE �f iF IE �f �f 1E IE 1f iE af 1f 1E �f iF 3F 1E iE �f if if �E jE 1E if iF jf 3F iF iF3f �f iE �f �E 3F iF iE if �f iE jf iE if iE iE if iE if 1E �1f 3f iE iF iE if IE iF±F iE �E if D E V E L O P M E N T S E R V I C E S•. R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY : DATE; APPLICATZON ISSUED BY: DATE: �� O iflfiFifiFiFiFifkiFiFifiFifMiFik3Eififif�f ifififiElFif3l3fifiE ifiE MikiEififififif�fifiFkkifiFiFifkMkaFikkkMkkkMlfltiflE�flflFiFif�fiEiEiEifififlF�Ekifif�fifiFiflfkMifififiEMififMit�fMitlEiflfififMiFiFif1F LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 30,00 25t SMIP/NON—RES PLAN ISSUE FEE BUILDING—DIV—> PERMZT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 30,00 0,00 0,00 30.00 30,00 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 30.00 OVER/SHORT; .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 30.00 iF iF if �E iE if iE if 1f if iF if 1F �E if M iF 1f±f 1E if iF M 1f M M 1E 1f 1f fF 1F iF if 1F iF if iE iF iF if if if if iF if �F 1f if if If M iE iF K K af �F K if iE K iF If if 1f fE if 1f iE if K iE IF iE �F �F if if if I N D I V I D U A L F E E H R E A K D O W N �TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST PLU 1 PLUMBING RE—INSPECTION FEE 30.00 30,00 END OF FEES J. L1IJ; J ! � -�.. � .. f:l.7r: �"- . ... . -,,,r_: . ._ /' CONSTRUCTION AND PLANNING �POI.. . SPA �APPR�VALS Permit # Date Inspector AppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soi� Pipe-Undrgrnd, 53. Steel Reinforcement r..; '3:' Electcical Conduit-Utility-Undrgmd. 54. Forms "�4. Electrical Conduli�Undrgrnd. 55. Elec[rical Bonding '�5. Steel=Reinforcement 56. Rough Plumbing & Pressure Test � :�=;6. Electrical UFER-Grnd. 57. APPROVAL TO COVER�GUNITE � 7. Footings •�• 56. Electrical Conduit-Undrgrnd. �r � 8. Foundation F� 59. Gas Pipe, O Undrgrnd., Test . 9. Water Pipe�Undrgrnd. 60. Backwash Lines, P�Trap, � Undrgrnd. 10. Structural Floor System 67. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor�Final ' 12. Sewer Cap . 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing SYstem • Final ' 14. Rough Plumbing ' 65. Electrical�Final 15. Rough Electriwl-Conduit 66. Solar System-Final 76. Rough Eiectric Wiring 67. Fencing & Access Approval 77. 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 - - - ' ' _ * - n. . - - 2a' Rough�Factory Fireplace ' ' �� •_ ' �T� • � APPROVACS„� PeFmit # �� > , r � r i �" ]• ,;: ,Z -- e 21.: Dutts, in Stiuc{uje .. . - = _ , "' J � . _ S :: .t� ' 70. ��Underground kqdro .. 22_ Duas,:Ventilating� •- _ � _ �' �• •; 77, produ�I Pipinq O_�ias OOiI 23', Gas Pipe-Rough'&,Test ' : ir� ' r,- *.� 72. Underground Ffu� � _. 24; Roof�Framing _.. � . - . .^ � R h . _, • �� : 73i Undergrr�d.StorOBeTankOGas ❑Oil 25. Ro f $heathin `''' '" ' • �� '.,� �v�� ' � ' � 0 9 . , � -� � �•,p ,: . 74: Overhea�Hydro' , 26! T-Bar Ceiling (StrucWrap &.Monocoat � '7 ^7+ � 7�, Dry Chemical ' - -� _ �� 1 ,� 271, Frame gnd Flashirig �z,.. � d�; 76 Dry Stanppipe :��; " - s �,28. Lathin &Sidin f ' - �. '� � •• ` � - � �- a A'� 7A FIXED,SY�STEM:F)NAL � ' 29. Insulation � � - �' -., .r -� ' 4� r 78,,,FIRE PREV. F�NAL �� : �:- � 30. Drywa�l'Nailing �� i � �r ; HEALTH DEPT. REQUIREMENT . e � �; 31. Plaster Brown Coat .- � � �; ', 79. CFINAL INSPECTbN �' - � 32: Electrical Power Meter-Final� f � � I .s .,� 80: FOOD CERTIF.'ICATE �SSUED . 33: Final EYectr.ic , � � '� � "' `� Notes: - -�';; �. - '_ , � i 34, Final Heating & Air Conditioning ^ � ,; . r, ;S ' a q, -� :r - ' 35' Final Gas Pipe-Te's4 - �' " � !^-� '' �. sa .-. � ,� �, , 36: Hood or Canopy � ' - ,. - ', , � g `, ;c-� � - ' r r , : 37? Final F�actory Firepiace 'D �'. � '' ` ` ` f , . t 1 i. r < 38. Final Plumbing � � . .. .. .- S � 4` (�.�Q3. � _. �� " 39. Waier Service�Final ' - � �+ �� • -"r ' a: • s i '. x� - a':. ,; 40. Gas Seyvlce-Ffnal � . - - .; iY j + _ - � '. 41. Solar pomesticFinal_ ' " ' - . � r * �S�' .r �, ` � 42i Backflow Preventer - �{ '� `: ' - - , �_ � ' - 43. Backflow Irrigation �.- ' • ' ��• ' - ;z � _ � 44. Landscape Irrigation System �.= - - � '` , ' a �" - a =� s r, c 7 ; 45-. Sound Attenuation " - r � � - .- -� -c ,..� :s . . _ 46, Handicap Regulations ' - " �� ; , - �=, �� ,+ 47. FINAL STRUCTURE & BUILDING . �.' • � . t � ' i - '� 48. PINALPLANNING ' i ' • � . 49: Electric Release to Edison s � �� - l: ' i, � 50., Gas Release to Southem California Gas Co , � I �� » ` � - . o: � ". 51. CERTIFICATE OF OCCUPANCY � , , . ,_,� - , , , No Date II o,� 386 E 20TH ST OWNEn rne: S�EY BONES .�• nooeess: 631-4990 RflLNIENGINEEB: flEG.NO.: uxir: �OUflE55: UNIi: PEflMITTEE: C�EY W�D l 714 ) 6 31-2 2 4 2 nooxess: 126 E 19TH ST C.M. CA 92627 IICENSED CONTBACTOB OECIANATION: 1 �erehy aHirm tMi I am Iicen5e0 unG¢r pmvisi0n5 0l Chapler 9(commencinp with $etlion 7000) ol O�msion 3 ol 0e Business ana Pmtessions COCe, ana my license is in IuA force an0 effeci. CITY UC.: STATE LIL.: CIASS: �a�e� Signature: _ WORNEPS' COMPENSATION OECIAPAt10N: I hereby altirm tllal I have a certiliW le of tonsenl �o sell�insure or a cetlificate of Workers' Compensalion Insurance. or a certihee coov �hereoi (Section 3800. La�. CI. POLICY NO.: E%P. ��TE: COMPANY; �� Cendietl coOY �s �ere�y lumis�ea. ❑ Certilietl coOY is fiietl wit� t�e city BuilEing Uvision. Daie: ApOlicanc E%EMPiION FflOM WOflItEflS' LOMPENSATION oECtAMTION: R� �n netd �rot Oe cortwkleC if Ne pumt is iw oire �iabrcd (E1Q0) or kss�. I certity thal in t�e Dedorman[e ol �he work tar w�ich this permit is 5sue0. I shall nol empby any per50n in airy manner so as to become sub�e[1 lo I�e VJorkers' Comp¢nsatian laws 0� California. Uaie: 5gnature: NOiICE: II. after maMing iNs aeUaralion, yau stwula eeCome wEl�� o Ue woders' fAmpensation pwvi9ons ot ine Laoor CAGe. you muil IOrt�wii� comply wil� Such pmvisions or IN5 plrmii ShaA be Oeem¢0 revokpG. CONSTBUCTIDN LENOING PCENLV: I �ere0y atllrm ��ail�ere is a con5iruction IenUinp a0ency lor I�e petlormanc¢ ot t�e work �or wn¢n inis Oermn is issuea �Section 3097. Civ. CI. LENOEN: nooeess: OWNEB BUILDEB DECLABATION: I AereOy atlirm t�at l am exempt imm ��e Contractors' State Lkense Law Iar tAe I011owinA reason (Seclion 703f.5 6usiness anE Protessional Coae: My uty of cowry wNch repuires a Dermii ta constmct. alter, impmve, GemolisR or repair any 9mctute. D�ior Io ils issuance, alw repuires ine aoo�icdnl lor sucn permii Io file a sipnea slatement that ne/she is licensetl pur5uani Io Ihe pmm5i0n5 01 I�E Conlratiofs' State License Law �C�apter 9(commencinA vrit� Section 7000) of Division 3 ot t�e Business anU Vmlessions Catle� ai I�al �e/s�e is e�empt tAerelrom and �ne bavs lor t�e allepeE exemption. My Ndatian ol Section 7031.5 by any apolicant lo� a permit su0j¢tts ine applipnt lo a civil oenalty ol not mora ihan live AunArtA aallars (3d`001. � I, as owner ol ine O�oDeny ar my employees witn vrdpes as Ineit SOIe tOmpenSdtion, vnil Jo ihe work, antl ine stmcWre is not intenEetl ar ollerea lor sale �Secuon 70a4. Busmess anC P�oleuional Cotle: The Conlractars' State License Law Ooes nol apply to an owner ol a prOperty w�o builas or imOmves lhereon, antl who tloes such vrork himset�/Aefselt m@rouAtl his or her own emplayees. orovieee Ihat sucA imo�ovements are not inlen0e0 ar alleretl lor Sale. II, however IAe �uilding o� impmv¢ment is solA wilnin one year ol completian. Ihe owner will naue �hc DurAen ol provinp helsne tlie not Ouiltl or improve lor Ibe purpoSe al Sale�. I. as owner ol t�e pmpeny, am explusivHy contrac6nq with Iicen5e0 conlractors to conslmct ihe prolect (Section 7044, Business ❑ anU Prolessions Cade: TAe Contractors' Siare Licenu Law tices nol apPly to an owner ol D�oDenp wtw bmltls or imprwes ihereon an0 w�o ronbacis toi suc� O�ole�ts vnt� a contracmqs) licenu Dursuant to t�e Controctors' State License Law�. I am aware Ihal Orool of I�eie Worker'S Comp¢nSaQon insurance 51wu14 Oe prwitleC �0 m2. � I am e�empt un0er Section: B. 8 P. C. / br ihis eason: j � � /a i Oale: `��U / � t Q+mer. _ I 0o ACreOy ceNly Ihal I am aware ot an0 unGEr51an0 Ihe repuiremenls al Cali�Omia He h nA Safety Code Seclions 25505, 25533, antl P553d anG I�al I or any luWre EulCing aaupan� vnNwiA noi (prcle me) neeG Io compl vnt ui0 state a0e5 an01�e requirements for a periml lOr ton5iruclion or moEdiwGw tmm Ihe Air OvaOty Management Dis�dtt. flesiau.. 1 conslmctian appliplions are eKempt trom t�ese D�o�nions. Oate'. pDOfitanL I�er¢�y cer�ilyt�all �avereae IAis aD0litatian 0 SIaiE oiainantes an0 slalelaw5rela�ingio 6uilding Vuciion O�oDerty lo� i pecimn C /u�poses. Oale: `��/�L � Signa;ure' Oriver's l¢ense oi Saul Security d: maiian is correCi. I agiee to compN �� all city and repr¢5¢ntalivesafiNS pf.�lo enteruponineabove�me — _. ... . . _ .__v . 164L46 W�ile—Butltling; Green—CoEe Enlo¢emenq Canary—AppLcam; Pmk—Fevenue; GolOenro4—Assessor CITY OF COSTA MESA - HUILDING PERMIT �� , - PERMIT NO; IM 051871 PLAN CHECK NO: N ' 6AV'f, !i SF3rF--r' — CONSTRUCTION TYPE: PERMIT TYPE: MEC OTH PURPOSE: OTH JOB DESCRIPTION : FZNALIZE EXPIRED PERMIT ItM22277 FOR ADDI SQ FT: CLAZM VALUE: CALC-VALUE: GROUP OCC: R-3 / COMMENTS: ROOM ADDITION *+r�r*�r�r�r«�r�r*��r�r�t�r�e***�r**x*****�e***�c�e*+t+t*�t��t***�rr�t**�t+a�r�e.�*******�x�**�*+tx�*�t�t**�t�t Z O N I N GS ERTEB�AUCIRRSE M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN PARKING REQ• PROV: PAACEL: 42623114 ZNE: REF NO: PLANNING Nc)TES> � 1f M if �F iF if if 1E �f if if iF �E iF if ff 1F if if iF if if iF �F k M 1f if 1E if 1E 1f �lE iE �F iF IF 1F 3F iF iE iF 1E if iF if M M�f iE �E If �f if �! iE �E �E 1E 1E iP IF if iE 1k iF iE iF iF if K iF ah IE it if aE 3E if D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: HUILDING APPROVED BY : DATE: APPLICATION ISSUED BY• - DATE: 3 O I �F�EMitiElEiFifiE1t1t1tkiEikitifiFiFlEik1F iEiFifilikiFfFlfiEif ilit iF if M 1F�E iF M iF if M K if iF 1F iF iF if if k iF k iE k if 1f M iE if M iF k M If if �f 1f if it if iE if if K if N 1t iE �F iF iF k if k IE �E �f �E±F if M if if if 1F if iE 4 if If M 1E �IF if iF if if iF aE�f LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT:N PERNIT BLDG PMT PLUMBING ELECTRIC MEC30 p0 FIRE SMZP/RES GRADING '15! SMIP/NON-RES PLAN ISSUE FEE BUILDING-DIV-> PERMZT ISSUE PLAN-CHECK TOTAL PAID DUE TOTALS----> 30,00 0,00 0.00 30.00 30.00 .00 REVENUE DIVISION TOTALS--> COLLECTED: 30.00 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK 30.00 iE 1Fif iF if if if k it 1k M if iF if M ik IF �E M if if M iflF 1k iF k k iF 1F ikif �f �E1E 1! �i �f 1t 1f * 1f If i! k iF k iF if if if �f M if k iF iF k k if k 1F fF k 1t �F M iF IF if M if iF k 1F �E iF �f if I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST MEC 1 MECHANICAL RE-INSPECTION FEE 30.00 30,00 END OF FEES ,,' 'u1LC53. �_C '✓- - - - _-.� .Pi=: �:riG'. � �. -.. _. :°. ` CONSTRUCTION AND PLANNING _PO� . SPA • Date Inspector Date Inspector r1PPROVALS Permit # APPROVALS Permit # Temporary Electrical $ervice or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement c n' - r ��3? Electrical Coniiuit-Utility-Undrgrnd. 54. Forms =>4.� Electtical Conduti-Undrgrnd. 55. Electrical Bonding �°5. Steel�Reinforcement 56. Rough Plumbing & Pressure Test ��.�6. Electrical UFERGmd. 57. APPROVAL TO COVER�GUNITE � 7. Footings �•� 58. Electrical Conduit�Undrgrnd. �= 8. Foundation ;_' 59. Gas Pipe, O Undrgrnd., Test �� 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Structura� 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 �L 64. Plumbing System - Final 14. Rough Plumbing '" 65. Electrical�Final 15. Rough Electriral-Condu�t 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 - -- - - ' - 'T . - � r_ - . - 2� Rough':Pactory�Eireplace • X r Q. - .7 - R i t� qppROVACS- Permit #'' .'� .L �l' i: • S� T•'� S r 4� S ,'�. - � 21�. Ducts, in S�uc[die � ��S S �� . � 70. Underground Hydro • �� 22, Du_Lts,:Venti�,lating� -Z �} 77, product�Piping-C7�Gas OOiI 23;,Ga's Pipe-Rough�&;Tesc - v� � .:� . 72. Undergroond Flusli �. ""' 24: Ro"of Eraming �� .- ��^ �? ;� •� ` 73? Undergmil. Stor�g'e Tank. O Gas ❑�Oil 25. RoOf Sheathing' y � ' ' v��. ? �r C �� . 74; Over�head Hydro � ` � � � � 26! T•Bar Ceiling (Structurall &�. MonocOat •�'n -: r�� 7, Dry Chemical �� -: - �. � .. 27- Frame and Flashing ?�y., _ � z„ � 76. Dry Stand�pipe :'v '� �' �� " � � 28. Lathing & Siding � -. � : y.� tz • : , •��' � 77' FIXED�S1t5TE(y_FINALv _ � ' 29. Insulatibn `'r �' "�� , �� I � F a 7g; FIRE PREV. FIP}AL �� ,; ' 30. Drywall'Nailing � � ` �r > -HEALT.H DEPT. RE�UIREMENT - -, ': 31. Plaster:Brown Coat :._ � � I �� . 79. FINAL INSPECTION � � ' ' � 32^ Electrical P¢wer Mecer�Final •�' I I �� a� BQ. FOOD CERTIF.ICATE ISSUED � . 33� Fi4ial Etectric �. r, � ;r � � �� , '' Notes: _ _�„� � _ - ;.,, 34 Pirral Heating & Air Conditionjn9 ^ •�� R� LLj). �, ��:qa_ � �' ,- _ - .rr, 35? Final Gas Pipe�Test ,ti� - ' �; * r ' -� ' .� �'' �r= - r-. �.y � . t� _ •�'�. , �• • 36: Hood or Canopy - - , � : �. . y_ - ., ,� r M �T.' " 37- Final Factory Pireplace . - - � t� � 1 � t� t ;�W �e •:t.- 38. Pinal Plumbing � }-p; � •.• �� ♦ :V �, � • ti J_ .- s n ' 39. Wa'ter Service-Final y, • -- ' i� � 1 (� � „ �'�' ' v •' 'r � 40. Gas Ser�vice�Final �: r � �; -. _ , ( �, �; , _ �_ .- _ � 41. Solar pomesticFinal_ � ^ - � I Y � 42'. Backfiow Preventer .". � 1 f r� '" 43. Backflow IrFigation � - � � '. � 44. landscape Irrigaiion SVsrem � = i _ - - � �. ;.: . ' , . - " 45: Sound Attenuation ' - T ' `-• •' ' ' ' " � ` ' .. t n ,nr ; � � � - ' 46;� Handita.p Regulations . - �� a , " � �p 47c. FINAL STRUCTURE & BUILDING '� " - - .� �- ` 48:. FINAL PLANNING , . � „ , i :. ., ' ; � :. 49. Electric Release to Edison E. ': S . '�� 50. Gas Release to Southem Califomia Gas Co ; � � I, ,. ' - , - ". `., 51. CERTIFICATE OF OCCUPANCY . ,� r ; .: No. Date ' PflOJECT ROUHE55: OWNEN'SNRME: 3BG E 20TH ST aooRess: RANDY BONES SAME AflCH/ENGINEEP: fjjl-499� noonEss: PEflMITTEE: aooxcss: G & S CONSTRUCTION �(�/��9T99n Oy�ApKqySTREET ULENSEO CONTBACTOREfEfAflFMOR•4tlefeoy allirm Iha� I a iten 7000� of Oivision 3 of t�e Busineu anC Pm�esSions COGe, anG m licen! CITY IIC.: z$ �,/STRTE LIC.: G I Oate: �/ " � /A �ip�naiure 6 z �GomDenSdiion Insurance. or a roucr xo.: 2 T2� 9pT_ 9p 2 ' 7 Cenyee CWPAnPreD9 ry ION: I �ereby aifirm Ihal l � copY �hereof (Sec�ion� 3560 EXP. R' � Cenilietl copy s IileA UNIT: NEG.NO.: uxiT: f714)642-9204 f�visiols�oM1CNeD�� 91c mencinp wi�� Seciion lorce and eneci. ' ConSentio 5el-insure ol a t¢tli�icafe o�Workers' 3/93 /1 —Wf¢� �7_� u "� ApplicanC � E%EMPfION FBOM WOPMEN$' COMPENSP➢ON OECUMTION: Qh' eCiion nee ol be wmvlete0 ii Ne pwmn is �or one AwOreO (51 WI oi kss�. I ceridy tha� in Ue pedormance ol Ihe work �or w�ich ihis Oe� is i55uetl, �all n0i employ any person in any mann¢r 50 a510 beWme su0�etl lo t�e Worker5' CAmDensation LaxS ol CaliPornia. Date: SipnaWre: NOtICE: II. at�er making �Ais Declara�ion, you shoulC Gecome mEle�� o ihe Workers Compen5aiion D�avi5ion5 ot I�e La�or Catle, you musl forlhwiih comDly with such pmvi5ions or ��is Dermi� shall be Oeemetl revoketl. CONSTPUCTION LENOING RGFNCY: I �ereby aflirm t�at there is a constmclwn lenaing aAency lor t�e ce�ormance ol t�e work for which Ihis permit is issuetl (Seciion 3097, Civ. C). LENOEN: RODFESS: OWNEfl BUILUEN OECIAPATION: I hereby af�irm tAal I am exempt Imm Ihe Conirac�ors' State I.icense �aw lor Ihe �ollowing reason ISeclion 7031.5 Business ana Professional Code: any city of wunry which reQuires a Oermi� to consimcl, alter, imo�ove, eemalisn, m repair any slmclure. D�ior to ils issuance, also repuires Ihe applicanl far such permit to lile a signea statement ihal he/sAe is licensetl pursuant lo Ihe pmvisions ol Ihe Contramors' Stale License Law (ChaO�er 9(cammencing wilh Section 7000) o1 �ivision 3 0l ihe Business and Pmfe55ion5 Cotle) ar Ihal he/she is exempl there�rOm and I�e 6asi5 br ihe alleged eMemptian. Any violation o� Section 70.31.5 by any aDDlicant for a oermit subjec�s the apPlicant to a civil penatly ol no� more than five hunared Oollars (5500�. I, as owner of ine pmpeny or my emplayees vnin wages as their So1e compensation, will Aa t11e woM, antl the ❑ slmcWre is no� inlenaee or ofiered for sale (Semion 70a4, Business antl Pwlessional Cotle: The Coniracmrs' Stale License Law Ooes no� apply lo an owner oi a property who builds or impmves t�ereon, an0 who aoes such work him5eli/herull or thmugh hi5 ot �¢r own employ¢e5, pwviEeG Ihal 5u[� impmvemenis are no� in�endeJ of Otl¢red tor sale. II, howevet Ne Euildinq or improvemenl is soltl within one year o� compleiion, the owner will have �he bur0en of pmving he/she tlitl not huilE or impmve � for ihe ourpOse ol sale�. I, as owner oi Ihe pmDerty. am excNsively comracling wilh licensetl coniracmrs m conslmcl ��e D�ole�� (Seclion 7044, 6usiness I, ❑ anG PmIe53iM5 COde: ihe CAnlratiors' State Licenu Law tices not appry to an owner of OmpeM � �uilOs or improves thereon ' antl who comracts br suc� pwjects wit� a contrazmqs�license Dursuam to t�e Contracrors' Stale License Law),I am aware �hal pmal o� Iheir Worker'S ComOe��ion insuranre should be pmvitle0 to me. � I am evempi untle� Seciion: B. 8 P. C. lar inis reason: oa�e: I 00 �ere�y terpty I�ai I am awar¢ ol and un4er51an0 i�¢ 2553d antl �Aal I or any N�ure buiiaing occupant will/will n permi� �o� constmclion or mo0tlicalion �mm Ihe Air Ouali mese o�ovisions. Date: Pppli[ani: _ I her¢by c¢tli�yihallhave reatll�is apPlicaiion antl S�a�el ordinantes antl 5lalelaw5�elaiing�o builEing cOns�mtlion]I proper�y lor inspeclion Our ses. / i � � Dale: Signalure: _ Oriver's license oi Sacial Securiiy x: _____� 1641�a6 wnite—Buildina�. owner repuiremenu of Calilomia Healih an0 Salery CaOe Sections 25505, 25533, ana oi(tirtle One� n¢etl�o tomply vnih Said Slaie co0e5 anJi�e r¢Quifemen�s�Ora ry Managemem OislricL Hesitlential canstruction appliwlions are exemD� ��om information is carr I agree to comply vniA all city an0 counly lnzereD�eSentaY �t�isciryto¢nterupanl�ea0ove-meniion¢G Pink—Revenue: Goltlenrotl—Assassor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P 05765 PERMIT NO: P 057652 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE: OTH JOB DESCRIPTION ; FINALIZE EXPIRED PERMIT #H19889 FOR ADDI SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / COMMENTS: CAP WASTE 6 SUPPLY LINES iEiFif if if if if iE if dE �lf ik if iF if iE iF jE �f iFif if iE 1F 1Eif iE if �f if 3f if iF fE if �E If M 1f �E if iE1f iF iEiEiF�E iE1f iE if 1EiF if iEiE k iEiF 1E if if ik�E 1F 1E if ik �f iE �E If �F iF1ElE af �E 2 O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING --------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN PARKING REQ• PROV; PARCEL; 42623119 2NE; REF NO: PLANNZNG NtSTES> > r iE 1F 1E iF iE ff 1f 1E Ik 1k1k 1E If If fE IE �f 1E 1F if ik Ik Ik k k iE �f iE M!E!f ik ff If iFlf k if if k k k ik k if ik.k Mit iF iF Mif M iE if �f iE 3E if �F if if if k if iF �f k!f if if iE 1f iFiF ki! k D E V E L O P M E N T S E R V I C E S. R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY ; G DATE; � APPLICATION ISSUED BY• � � � DATE• ��G.� iFMkififMifikk�Eif�E�E�flEkkiFlFlF�fk 'iF�"��F�Fft�f�tkiFiFffif ft�f M!E!flfiEiE�EiEiFiEIklEikffiFifklFifiFififffiE1f1E1t !F!FlF1kiF3tkltitif�k�fk�f�tifih�kiF if iffFiFifiEffifiFifflifif�f�k3ffFaFiFiFifiF�FiEifiFik3fif LEGALI2ATION;N F E E S U M M A R STRUCTURAL SEGMENT:N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADZNG PERMIT 4.00 25Y SMIP/NON—RES PLAN ISSUE FEE 3.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 9.00 3.00 0.00 7,00 7,00 ,00 REVENUE DIVISION TOTALS--> COLLECTED; 7,00 OVER/SHORT; 00 BLDG PMT PLUMBING ELECTRZC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK %,�� M!k!f 1F if if it �t �f ik ih �f if �Flf k if k if if 1f �f �! �f if k �flf It M ik M 1t M I! if if iF 3f iF k M k if 1F iF if iF M 1F 1f iF iE iF if If iflFiF if iF iF iF ik if 1f if M if if * k M M if 1f aE �t 1f I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST PLU 1 GAS PIPING SYS OF 1 TO 4 OUTLETS 2,00 2,00 PLU 1 SEWER CAP / DEMOLITION EACH 2,00 2,00 END OF FEES n'.�t i r._i,��l�_.J CONSTRUCTION ANDPLANNING ' POG SPA APPROVALS Permit #T_. Date Inspector qppROVALS Permit # Date inspector 1. Temporary EIeC.trical Seivic�e or Pole �ii 52. Pool & Equipment Location 2. Soil Pipe•Undrgrnd. . ' r 53. Steel Reinforcement . �. .� , 3� FJ�ectrical Condui4 Uf71iry-Undrgrnd ;' `� 54. Forms '[4?+Eleciricei ConduiY•Wndrgrnd. ' 55. Electrical Bonding `5�'�Steel R�inforceme�'t'; � 56. Rough Plumbing & Pressure Test - :6:��Electrical UFER~Gmd. _ �- 57. APPROVAI TO COVER-GUNITE � ��7. footings ' ��, �� 58. Electrical Conduit-Undrgrnd. `' ,�8. Foundation .� � 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Und�g�nd. 60. Backwash Lines, P�Trap, Q Undrgrnd. 2 10. Struttural Floor System � 61. APPROVAL TO DECK 71. Property Sewer Line�& House ConneCtion 62. Backwash & Receptor-Final 12. Sewer Cap , 63. Heater & Vent-Final 13. Roof Drains '� 64. Plumbing System � Final 14. flough Plumbin�' `" 65. Electrical�Final 15. Rough Elettrical-Gondu'rr 66. Solar System�Final 16. Rough Electric W��ng 67. Fencing & Access ApProval 77. Rou9h Wiring Sign 68. APPROVED FOR PLASTERING 78. Rough Electrica;,T Bar Ceiling 69. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT . , _, c^ � - 20. Roug6 Factory�Fireplace �� " * _, '� : /�ppROVAtS�'��%�er�R #�� L' n -i ' ; r a � ' T. i.L -J '? � ..i • 21. Ducts; in Scructure ' .. . . � - � '" "' � n,. . 7A. Undergrounti t�ydra ?� 22. Ductk; Ventila�n9 ' ' ' _ � `�� - 'x1. Product (�'ryng OG�S OQiI 23. Gas dipe•Rbugri & Test � - t -�. jz, Undergrour� Flusli,`^, . - 24. Roof�Framing•- - � � *-= ' •i yy„ 73. �F)ndergrnd�3torage,'�ank OGas ❑Oi�-� �" 25. Roof he��hin ' ,� ". ,,� „ _ �_; ,, _ � ,�_ ,$ yt 9 e t v�. r� �. .�74. ,Qverhead Hydro - . 26. T-Bar•Ceiling (5truc[ural) & Monocoat T _ �D •7 .�* . 75. �)ry Chemicrl �,� _ ' - ��{� 27. �Uame and Flashinq� _ - _ y T,°, . 76. Dry Standpip.�. - F' `�' " 28. Lathing&Siding t�i ��" •'i ^� • 77, �IXEDSYS EM'F�1p,L y. �`Z9. Insulation! �, ' ' �� ^ ,; � . � �: � 78. �IRE PREV. FINAI�I s � e C� �0. Drywall Nailing �� " � k +• HEALTH �EPT.'REQUIREMENT 37. Plaster Brown.Coat . � ,.,,. � .. _79. FINAL INSRE�TIO� ;: ` , j� �' �2. Electrical�PowerMeterFinal -. I �• 80. FOODCERTIFICATf ISSUED �� 3. �naFEleciric.� '` ` _ � : T i � , Noteil T =�r ` -•,. �4. Fi,naf,�ieat�ing & A�r 6onditioning , -� �� r, � _ ? S t. S GG + -- c 35. Final Gas�?ipe�Test ' _ • ' � � - ' *•� r �` `� F . Lr, r .r 36. HoodAr CanoPY � � - t • . '� E F �G • + � .� Y . z+ a 37. final'Fac(bry Pireplace , � � r'' ! ',� s' T' '' * � .... � 'T� ' . � - 38. Final.Plumbing - ,. .- G' ?�q y .: - _ ., i r_ , . 1 ) 39. Water Service-Final � � r � � � {', � • "' *'x " Z 40. Gas ServicR�Final '. , ' -. r � � `�� ,.,» a � ,,, 47. Solar pomestic�Final -. " • " = � �Lc� '- '� , • 7 0 •- • 42. Backflow Preventer � _ � � "'_ : � .' :, 43. Backflow�trrigLtion'� ��'•' ' - �� ; =� _ . �F J 44. Landscape� Irr,qation, SYstem � , G �l' - � A . (IJ �� ;a.: : � � � .' �. 45. Sound Attemiation � � � > ' " � � � '��' � ' � - .. .� � � . . 46. Handicap$egulation� _. '`- ' ` ' '� ]. ' � -" �� t � •` - 47. FINAL STRUCTURE & BUIL"DING � � ' �: � , < - ' A � f � 48. �INAL PLANNING.. � � - ;, � �F ' .:i d • E A9. Hectnic Release to Edison . n� � - � v , n J a 50. Gas Release to Southern Cafifomia Gas Co � ! (: � � . . ;-', ;; , - � - 51. CERXIFICAT60f OCCUPANCY ,, _,�� . � , - _ No. Date � I PflOJECi AODNE55: OWNEfl'S NAME: ' AOOflESS: � 631-4990 �H ST UNIT: AHCM/ENGINEER: HEG.NO.: ' AOOHE55: UNIT: PEPMITTEE: C�EY w%�D ( 714 ) 631-2242 nooeess: 126 E 19TH ST C.M, CA 92627 LICENSED CONTflACTOfl DECNPATION: I �ere�y allirm Iha1 I am Iicense0 unUer D�o�isions ol C�apter 9(commencing with Section 7000� o� OiNsion 3 0l t�e Business antl Pw�essians Code. ana my license is in lull force antl eltect. CITY LIC.: STATE LIC.: CUSS: Oate: Signawre: wOflRENS' COMPENSpTION OEClABA7lON: I herehy allirm inat I have a cenilicale ol consent lo selbinsure or a cenilicate of Workers' Compensalion Insurance. or a cenilie� coDY iM1ereof (Seciion 9800, Lab. C�. POLICY NO.: EXP. DATE: ' � COMPRNY: ] Cerli�ietl coDY is �ereby lumished. ❑ Cetlilied caDY is liled with I�e city Builtling Division. Date: Npplicant: E%EMPTION FROM WOBIIEHS' COMYENSATION OECLARATION: (ihis section neea no� be complelea il ihe permit is lor one hundretl (S1W� or less). I cenify ihat in ine oedormance of the work lor which ihis Dermit is issueA, I shall not employ any person in any manner so as to become SuDle�t lo Ihe Workers' COmp¢nsalion LawS ol California. � �ale: SignaWre: NOTICE: Ii, after making I�is declara�ion, you shoulU beWme sublett �o �h¢ Workers' Compensa�ion pmvisions o� the La�or CoOe. you musi ton�wn� compty wiih suc� D�odsions or t�is permii shall he UeemeO revokeU. LONSTflUtTION LEN�ING AGENCY: I hereby allirm Inal ihere is a tonslmc�ion lending aAenty lor �he pedormante o� �he work br whic� Ihis Oermit is issuetl (Sec�ion 3097. Civ. C�. LENOEfl: AODPESS: OWNER BUILOEB OECIABRTION: I hereGy allirm tAat I am exempt irom ��e Contractars' Siaie License Law lor Ne tollawing reamn �Setlion 703t5 BU5ine55 anG Pml¢SSional COOe: Any Ciiy 01 taUnty whit� r¢quir¢5 a Dermii Io tons�mCl, alteL improve, tlemoliSR or repair any slmciure. D�ior �o its issuance. also reQuireS Ihe applicani lar sucA permil lo lile a signed s�a�emem �hai helshe is licensed pursuant �o Ne provisions ot the Cantracmrs' State License Law (Chapter 9(commencinp vnih Sectian 70W) ol ONision 3 oi the Buvness an0 Pmfessions COUe) ori�al he/stre is exemp� ��er¢IrOm and I�e Da5i5 �or IAe alleq¢0 eKemption. Nny vi01a[ian ol Seciion 703/.5 Dy any appliCani for a permil SUbjet�5 Ihe appliCan� IO a Civil penally Of nol more Ihan �ive hunGr¢4 d011ar5 (5500�. � I, as awner al I�e pwp¢rty or rtry employees witfl wages as t�eir Sole mmpenutlon, will da tAe work, antl ihe 5lmtiurei5 noliniend¢0 orotler¢tl�or5al¢�Seciion 700E. Bu5Nes5 an0 PfaIE55ionalC00e: The Cqnlraclar5' Siale Li[en5e Law doe5 not apply IO an owner 0� a O�oOehy who builtl5 or impmve5 IOereOn, antl who Aoei SUCh waM1 himselt/herself or I�mugh nis or ner own employees. provitleA ihat such impwvemenis are nol intendeJ ar affere0 for Sale. II, how¢ver the builtling or imD�ovement is sola vnthin one yeae ol comD�elion, the owner will twve i�e huraen ot pmving Ae/she Oid nol 6ui10 or impmve mr me o�rpo:e o� uiel. I. as owner ol Ne O�opetly, am exclusivel9 coniracting with Iicense0 canlraclors lo consiruct ihe pmleci (Section 704a, Business ❑ an0 Prote55ion5 CoOe: The Conirat�ors' State Licens¢ Law aoes noi apDly to an awner ol DroOerry who OuilCs or improves tAereon an0 who tonlratts for Sut� D�ole��s wilA a tonVaclOr�s) IicenS¢ pur5uani 10 IAe Canlratiors' Sial¢ Lit � Law�. I am aware that D�ool ol i�eir Worker's Compensation insurance shoNC Oe proui4eE ia me. � I am exempl untler Seclion: B. 8 P. C /� / lor I�is reas ' / � / oa,e � 3b1� � � Qr+ne �L I aa nereby cendy ihal I am aware at an0 unAerstana Ine reQuirtmenis ol Califomia He .ih itl $afety COEe Sections 25505. 25533, antl 2553G ana ��al I or any lulure builaing occupanl willlwill noi (cirde one) neeG 10 compl vn� saia stale co0e5 antl Ihe requiremen�s �or a permil lar consimction or motlilicalion Iwm I�e Air Oualily Managemenl Oislrici. flesitlential constmction aD0lications are exem0� �mm 1�¢se pmvisions. �ale: I h¢re�y cer�ily t�a� I �ave rea4 ihi5 aOD�� ordinances anA slaie IawS relaling to �uildi properiy lor inspeclion purpases. Daie: Oriver's License m Social Securiiy p' Itu( I�e a nve in�ormalian is tOrretl I aA�e¢ l0 tomply witll all Ciry anE uniy ana ner ulhorke repres;n� ti� ol t�is ciry� enrer uDon the above-me tionetl /J I ii t6<bn6 Wmte—Buiitling: G�een—CoOe Enb¢emem: Canarv—ApohcanL Pink—Revenue: Go�amro0—Assessor CITY OF COSTA MESA — BUILDING PERMIT , PERMIT NO: IB 051868 PLAN CHECK NO; N �66 T. �i��g, Y CONSTRUCTION TYPE: PERMZT TYPE: OTH STR PURPOSE: OTH JOB DESCRIPTION ; FINALIZE EXPIRED PERMIT #B19889 FOR ADDI SQ FT: CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 / COMMENTS: ROOM ADDITION *��**x **x �*****x��t ***�e**��*�******+t+t*****�r**x�*�*�****�t*+t*****+t+t******+r**+�***+r*�* Z O N I N G R E Q U I R E M E N T S S E T H A C K S ------------ MAIN BUILDING ---------- FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN --------- ACCESSORY BUILDZNG --------- FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ• PROV: PARCEL: 42623114 ZNE: REF NO: PLANNING Ni31'ES> i +��**«*+�**�r+t�t�r�t*�t�t+r*�t***+t�t�t+t�r�t�r�***�t***+t*�t�t�t*�t**,r��r*��r�t�tx�*�t***�r**�t*�t�r*�r�r****�t*�r* D E V E L O P. M E N T S E R V 2 C E S. R E Q U I R E M E N T S ZONING APPROVED BY ' DATE; � BUILDING APPROVED BY ; APPLICATION ISSUED BY: fEiFifiFififiEiEikiFiFi!lFiE1EiFlFifiEifkif � * if 3E if iF iF IE iE if if iF ik if 1E if iF IF %if %%iE if iF if iE �E ik if if �Elf �F if iE if iE iF iF ik k ik �F if If k*!f if ik 3t if if iF �E iF fE �F ik LEGALIZATION:N F E E S U M M A R Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE PERMIT 30.00 DATE; DATE: �� iF.itiFlEiFfFiFif ikif ifiFifiE1E1F�E�Eff iFiEifiEifif�fiFlfif STRUCTURAL SEGMENT;Y SMIP/RES GRADING PLAN SMIP/NON—RES ISSUE FEE BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 30.00 0.00 0,00 30.00 30.00 .00 REVENUE DIVISION TOTALS--> COLLECTED; 30,00 OVER/SHORT: 00 BLDG PMT PLUMBZNG ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 30.00 iEifiFikiFiFifiFififMiflFiFlfifkMkMkifiF�fkiElklfk�fafffkMifkkiFkififiFifkM�filklfifk3FiEifkiFiFifiFlEiFiFififiEiF�kff MiFiFMiFiFiflfif!!iF I N D I V I D U A L F E E B R E A K D O W N TYPE (�TY D E S C R I P T I O N UNIT COST TOTAL COST INS 1 BUILDING RE—INSPECTION FEE 30,00 30,00 END OF FEES i�i �1�.Cu..�i'�' dEQ�• i .'., _ _ ' _ DATe= OS'i','4i �'�,;.:_.i_.u---" � �6� —� �� _ CC.VSTRUCTION AND PLANNING .�PO ,SPA APPROVALS Permit #� Date Inspector p�ppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement -3. Elec4rical ConduirUtility-Undrgmd. 54. Forms • �: r4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding .='5. Steel.Reinforc2ment 56. Rough Plumbing & Pre:sure Test .� r6. Electrical UFER Gmd. 57. APPROVAL TO COVER-GUNITE 7. Footings r 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 74. Rough Plumbing 65. Electrical-Final - 15. Rough Electrlcal-Conduit 66. Solar SYstem-Final . 16. Rough Elettrit Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electriwl-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT _ '. �. _ _ _ ' � _ .T l: �,.;�: CC .v. - -- 20: R6ugh:Factory Fireplace +� T _ t ^ � � � y' •4 �* APPROV'A�1.S�C Pe'rmit # i } :� S. lD � � ; a ^�^ S �',.' S 3' n- J; '�S. CJ,� :> .. -r� ;l, 21: Ducts,-in Structure '.. �-.S t �� 70.� ndeiground F:tydro * � 22; Ducts; Veritilating� � i_ �r `�' '' ��- 71, ProdJFt?Piping'�as �Oil 23: Gas Pipe-Rough'Bi�,Test �� , �. ,. `,;, ;;' 72. Undergrcu�d Flush,� : 24. Roof�Framing .: � � ;��'-- - > � � J�e � _ 73! UndergrnH.Sto��ank OGas ❑�Oil - 25. Roof Sheathing'�.` �: �,, ,;,'y �=� �;r ; 74, Overhead'Hydro. '� � �'r, 26: T-Bar Ceiling (STtuctural) & Monocoat � �� ? e r 7�_ Dry Chemical ;�'� C' - 27,� Frameand Flashi�g �,�� .� c�z . A 76.�Dry Sta{jdpipe'-��j ;�' ' � .. -4 . ' 28. Lathing&Sidiqg• rc ..r_�Y �� ••� �M � 7�7; FIXED�S�TEHj:�FINA� � - �_ �. . ' 29. Insulation '- .. � T� � � :'. r 7�. FIRE PREV. F�INAL �. A ^ � 30. Drywall Nailing v Y � �(71'L I - �- -HEALTH DEPT.-REQUIR�EMENT `.' 31. PlasterBrown Coat . ��ri,., � I I t� x t* 79� FINAL I'NSPECT�ON ;� �' S r 32: Electn"cal Power MeterFinal y� � �' � � �t. -K c• 8U� FOOD CERTIFtCATE ISSUED _ , 33: Final Electric • � J ; T- I �' ��' NStes: � �L � ,.., _ � r J ;; .. _� ^u� . . . � �. � 4 LV• ` ' , 34, Fi�al Heating & Air Conditiortirig I i .. ;�rG +. ,_, � �" 35�. Final Gas Rpe-Test _ = = � �� • • :=:�= ` �" � e � Lo ..r� . a��.�� , �q . ..� . ,. , _,�� 36: Hood or Canopy � - �^ � ( �r „ y r_ f o > !7 �� i �. �' 37-�. Final Factory Fireplace ` ;6� �, -' ; � �`: ;L . .. _ ' c 1 ; 38. Final Plumbing � - � � - � r a: �z .� 39. Water Service�Final � ^ �� ' i� r , =-�� 7 i. �: - . . ,,G • I ro . , 40. Gas Service-Final � � � � � `� ' .� �r;r :5 n � i� . C.� or� . " 47. Solar pomesticFinal: • � ' � ^ ' _ '� . , .f ... � �a a ;r .i;� r T 4Y Backffow Preventer•'" �� " ' � �:� : r e� �� 43. Backflow Irrigation -�s� � a '�:^ '� � a '�, r S � � t' i ^" i � ll ' 44. Landscape:lrrigation System�� - _ � ,• �» < �3 ,-,; .^,� , ._ 4fi' Sound Attenuation -•. T v f-' ' � '� � "�^K i r S V. r . ; 46. Handicap Regulatlons ` - ' �� ' , � �, "�� '=`� �� . J � 47.: F(NAL STRUCTURE & Bt11LDING L i , _ ; ; 48: FINAL PLANNING � :' '� : �� : . :, '-= �t ; � � 49- Electric Release to Edison � � I ' i. :� z �r � .� , . ♦ n .f �. : 50. Gas Release to Southem California Gas Co '. t ` J ""' - `'; � I f,:. - o• ci� _ j � , 51. CERTIFICATE OF OCCURANCY ' - _ �- ;��, , . � � .j � No. Date Aoplicant to fill in all spaees exeeot ihose within neavy Dortler Iines and si9n all avProoriate Ceclaratlons. C��osTn MES C�NSTRLICTION PERMIT . Project Address �� 7 9 sT ^ Applicant's Mailing ddress �� d ��i (' {vl Owner's Name �U� �' �� +�R Phone �'�4 Addreu �_ 1 � Arch/En9. License No. Address Contractor's Nam Phone Addreu (mailing) Ciry License No. LICENSED CONTRACTOR DECLARATION I herlby aiflrm that I am Ilcensetl untler prOvi5iOn5 of Charte� 9(commencinq wlth 5ection ]000) of Divi5lon 3 oi Ihe Business antl ProfeS51on5 Cotle, antl my Iicense is in full forG¢ antl effect. License Clazs Lirense No. Oate Si9nature WORKERS'COMPENSATION DECLARATION lereby ai/irm [hal I have a ceriitica[e of mnsen[ to self-insure or a certificate .' Wolker5' CompanSaliOn Insurdnte, Or a Certlfletl cOpy [hereot (SecOon lB00, LaD. CJ ' Pollcy No. Company 8 Certifiea copY is M1ereby turnishetl. Certifietl copy is filetl with the city Builtlin9 Dlvision. Date APPlicant EXEMPTION FROM WOqKERS' COMPENSATION DECLARHTION (Thiz sec[ion neetl nol be campletetl i/ th¢ permit is for one huntlretl ($300) or less). I certify that in tM1e perlo�manca of the work for wltich fhis perm�t i SSuetl, 1 sM1all not employ any person in any manner as �eco s� ub. Gt to the Workers'�Co e= n Law9of Calitorpf. oare �_ Si nature �t� � 'NOTICE: I(, after makln9 this tleclaralion, you shoultl become zubject to the Worken' Compensation provi5ion5 Ot [he LabOr Cotle, y0u mus[ forthwi[h comply with such provisions or lhis perml[ shall be �eemetl �evoketl. CONSTftUCTION LENDING AGENCV I hereby allirm that there I5 a const�uction lentling agency fo� tM1e pe�to�mance of th¢ wa�k fo� wn�cn lM1is permit is issuetl (SeCtion 309] Civ. C.� l.entler's Name Lentle�'S AGtlress OWNER BUILDEH �CCLARATION I h¢reby atflrm thal I am exemD� irom the Contractor's License Law for the following reason (Sectlon ]031.5 Businezs antl Pro(essional Cotle: Any city or counry which requires a permit to const�uct, alter, imp/ove, tlemolish or repair any structure, prior to Its issuance, also requires tne applicanl tor such permit lo fi�e a signetl statemenl Ihat he/She Is Ilcensetl pursuant to the provisions of •he Con[racror's License Law (Cnao�er 9(commencin9 with Section ]000) ot '�vision 3 of the Bu5in255 antl P�olessions Cotle) or that he/she is ezempt ere(tom antl th¢ basis for [he allegetl exemptiOn. Any violalion of Section .031.5 by any applicant tor a permit subjecls tbe applicant [o a civil en ty of not more tban five huntlretl tlollars ($500). I, a5 Owne� of the property o� my employees with waqas as th¢ir sole comp¢n5ation, will tlo Ihe wo�k, antl the Struc[ure is not intentletl or offeretl tor wle (Section 7044, BuSiness antl Protessional Cade: TM1e Contractor's License Law tloes not app�Y to an owner of a property who builtls or improves tnereon, antl who tloes zuch work hlmself/nersel( or through his or her own emplOyees, 0/ovitletl tnat suc� imOrov¢mentz are no[ Intentletl or otferetl fo� sale. 11, however, the bulltling or improvement Is soltl within one year ot com- pl¢ti0n, the owne� wlll have tM1e bu�den ot provinq he/5M1e tlIE not builtl or im- p ove fnr the puroose �i srle). �I, as owne� of the property, am ezclusively cont�acting with licensetl con- l�actoR [O Conztruct the D/ojec[ ($ection 7044, Business antl Professions Cotle: The ConVactor's License Law tloes not appty to an owner of property who builtls or ImOroves thereon, ana who conVacts tor such projects with a con- Iracto��s Ilcense pu�suant�to�the Conttacfor'S Litense Law). I am aware that �roof o� their Worker's Comp sation iniy�ance shoultl be p�ovitletl to me. I am exempt untle��$ecUon �A ��'�'� B. & P. C. for thi5 reason Date � ^ (—�' �f Owner � I hereby certi(y that I have reatl this a Inform5tion i5 w�rect. I agree to compry $i9nahre Drivers' Lic nse or 55 CMF OB65-46, rev. 10/84 tate that the above tl county ortlinances :by dutno�ize �ep�e- ionetl property �or oate —�� TYPE OF CONSTRUCTION LJ NEW L17 ADD IJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ' A p�, DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TVPEOFPERMIT�}�. GRA�ING FOUNDATION STRVCTURAL T Ffont ❑ TENANT L7 ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER %� PR0.IECT DESCRIPTION 5. FT. OCCUanrvCY C Right K Left CONSTRUCTIONTVPE M . VALVATION$ g ZONE GRADINGCV.YDS. ACRES PIng.Ref.# Rema�ks:J�'CJ��y' G�2��7 �Fp/J�(1.rS �221C%/ PlenningNotes: Bar Sink Backflow Preventer Backflow Irrigati0n Bathtubs Clarifiers Dishwasher Orinking Fountains Floor Drains Floor Sinks Gas Service Outlets IntefCeptofs Kitchen Sink Lavatories P-Trap Roof Dreins Reinspection Fee Showers Service Sink Sewer Cap Sewer Connection Solar Collectors S (ar Tank wimming Pool w/Spa Urinal ater Closet Wa r Heater Water ervice Auto-Wash ,�undry Trays $15 Issue Fee Boiler Duct� UnderGraund Duct - Structural Duct - Ventilating ExhaustSystem ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑4100,000 BTU O 100,000 Reinspection Fea � $15 White - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor Hoodor Typel ❑ Canopy Type II ❑ lefrig� ation Sys[em 70. OO,OOOB7U ❑100,000 stem Repair/Alteretion Fire Dampers Registers Isue Fee FEES Automatic Washer Construction Pole Cooking Unit Dishwasher Dryers as Fan F,A.U. Fix[ures Device Boxes Outlets SwiLcheS Garbage Disposal 7182 I/13/B6 2one Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Metef ❑up to 100 amp5 � Meter Q]'BLer 100 amps Generetor O0.5 KW 05�15 KW Suh Panel Motors I�D� 1 HP � 1`/, - 8 D Inc.Solar �9-15 HP 016-15+ Microwave Pole Light � Range Si9n ; Standing Sections Trash Compacmr S�Reinspection Fee $15 luue Fee FEES DEVELOPMENTSERVICESREQUIREMENTS: � 2oning Approved By_ Building Approwd By AppliptiOn IaUBd BV $ 3 so:'u T�l� Z O N I N G R E Q M T 5 FEES �� E3 SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ��UANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ � GRADING $ P�ANCHECK 50% $ MICROFILM $ /� MECHANICAL $ TOTAL FEE $� L`1', 30 PLAN CHECK 25% $ CONSTRUCTION AND PLANNING P�� SPA APPROVALS Permit# � Date Inspector AppROVALS Permit�# � Date Inspector '�t. Temporary Electrical Service or Pole - 52. Pool & Equipment Location 2. Sail 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. Ejectrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE . 7.; Footings� ' 58. Electrical Conduit-Undrgrnd. � . 8. Foundation , � . 59. Gas Pipe, � Undrgrnd., Test .�� . � 9. Water PiPe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd. , 10. Structural Floor System � 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection . 62. Backwash & Receptor-Final ' 12. Sewer Cap � - 63. Heater & Vent-Final ' 13. Roof Drains �� 64. Plumbing System - Final ' - � 74. RougFi Plumbing 65. Electrical-Final ' 15. Rough Electrical-Conduit. 66. Solar System-Final _ 1.6.'Rough Electric Wiring �l 67. Fencing & Access Approval . 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL ' 19��Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace ., APPROVALS Permit # 21. �Ducts, in Structure . 70. Underground Hydro 22. Ducts, Ventilating ` �' 77. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Teit • 72. Underground Flush . 24. Roof Framing '' 73. Undergrnd. Storage Tank � Gas ❑ Oil 25. Roof Sheaihing � 74. Overhead Hydro 26. T-Bar Ceiling (5tructural) & 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 '. / 3-�` CG 80. FOOD CERTIFICATE ISSUED 33. Final Electric � Notes: 34. Final:Heating & Air Conditioning . .„� . � � 35. Final Gas Pipe-Test ' � 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing , � � 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final " . 42. Backflow Preventer , ; • 43. Backflow Irrigation � � � � � 44. �Landscape Irtigation System 45. Sound Attenuation � 46. Handicap Regulations . 47. FINAL• STRUCTURE & BUILDING � 48. Special Requirements Completed . 49. Electric Release to Edison � 50. Gas Release to Southern California Gas Co - 51. CERTIFICATE OF OCCUPANCY � - , � No. Date - - �� - • � � ' .-i ApD��ant to fill in atl s0aees exeept thosa within heavy Eortler lines antl sign all apP�oO��ate tleclarations. CtT.Y OF COSTA ?MESA C NSTF311p�TION PERMIT J7roject Address �J..� �'L . �pplicanYs Maili 9 d ress _1� �ner's Na e one Address S P.I�/Eng. License No. Address Contractor's Nam Phone Addreu (mailing) City License No. LICENSED CONTRACTOR DEC4ARATION I hereby affirm that I am licensetl untler provi5ions of Charter 9(commencing witb section ]000) of Divislon 3 of the Business antl Professions Cotle, antl my license is in full torce antl e(fect. License'Class License No. pate Slgnature _ WORKERS'COMPENSATION DECLARATION I hereby affirm that I nave a certiticate oi consent to selt-insure or a certificate Y Workero' Compensation Insurance, or a certifletl cooY thereoi (Section 300, Lab. C.) � Policy No. Company eCertified copy is hereby fumishetl. � Certifietl copy is filetl with the city Builtling Divislon. Date Applicant EXEMPTtON FROM WORKERS' COMPENSATION DECLARATION (Thissection neetl not be completetl if the permit is for one hundretl ($300) or less). I certify [hat in the pertormance Of the wo�k t r wh'ch this pe�mit is i suetl, I shall not employ any person in any ma e o as ecoi subje to the Work`y�Co/pp nsat��,�aw9ot Callf ia. ' Date (1�'K ^ � Si nature• �NOTICE: 1!, alter making this tleclaration, you shoWC become subject to e Worke�s' Compensation provision5 of the Labor Cotle, you must forthwith comply with such provisions or ehis permit snall be tleemetl revoketl. CONST0.UCTION LENDING AQENCV 1 hereCy afFlrm that there is a construction lentling agency for the performance of [he work for which this permit is issued (Section 309� CivJ C.) Lentler's Name Leritler's Adtlress OWNER BUILDER �ECLARATI(jN i hereby affirm that I am exempt trom the Contracror's License Law for the foilowing reason (Sectlon ]03L5 Business antl Protessional Cotle: Any city or county which requires a permit to construct, alteq improve, tlemolish or repair any structure, prior to Its Issuanc@, also requires the applicant tor such permit to file a signetl statement Ihat he/she i5licensetl pursuant to the provisions ot the Contracror's License Law (Chapter 9(commencing with SecNon 70Do) of m.pivision 3 of the Busine55 antl Profes5ion5 CotlB) o� that he/she is exemp� +-.[+`�;erefrom antl the basiz.for the dlle9ed exemption.'Any violation of Section �� " 31.5 by any applicant tor a p¢�mit subjects the applicant [o a civil ��.'+n ot not more Ihan five huny�etl tlolla�s (5500). as owner of tne property (�� will tlo the wark, 8n e 5 ruc u�e is nof in en o� otter¢tl for s' ale (SeLtion ]044, Business antl Professional Cotle: The Contractor's License Law tloes not applY to an owner of a properfy wno builas or improves thereon, antl wM10 tloes such wo�k himself/her5elf o� through hIs o� her, own emO�oYees, provitletl that su[h improvements are not intentletl or offe�etl tor sale. If, M1owever, ihe builtling or �mprovement ii soltl wlthin One year of com- pletion, the owne� will have the puitlen of proving he/she tlitl not builtl or Im- prove for the purpose of sale). ' ! � ❑ 1, as owne� of Ihe property, am exclusively contractinq with licensetl COn- tractors to conztruct lhe pro�ect (Section 7044, Business antl Protessions Cotle: The Contractor's License Law dpes not apply to an owner of property who builas or improves Mereon, antl �yno contracts for such projects wifh-a con- iVactor(51 license pursuznt ro the Contractor's License Law). I am aware that prqpf of thei� Worker's ComQenyy�O^ i�su�ance Shoultl be provltletl to me. I�I am exempt untler Sectlon J(? � ti r B. & P. C. for this reason ..�- ��.�cv�:��am.ia� certity�that I have read this application antl state t >n is co�rect. I agre¢ to comply with all city antl com laws relati�9, to bWIding cOnstruction,�qntl hereby ai of thic cµy to,yntey,uoon the aVo�e-mentionetl Signature �„ Drivers' License or 55 ��'b TYPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR � ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.p.# DESCRIPTION OF WORK/USE OF BLDG. S Main Building: TVPEOFPERMIT GRADING ❑ FOUNOATION STRUCTURAL T Front - ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL A Reer ❑ OTHER PROJECT DESCRIPTION 5c�. FT. oCGUPANCv C Right CONSTRUCTION TVPE VALUATION $ S Left ZONE GRADING CU. VOS. ACRES Ping. Ref. # Remarks: Planning Notes: 3ar Sink 3ackflow Preventer 3ackflow Irrigation Bathtubs Claritiers � Dishwasher, . Drinking Fountains Floor Drains Floor Sinks Gas Service In[erceptors Kitchen Sink Lavatories P—Trap . Roof Drains Reinspec[ion Fae i Boiler Showers Servite Sink ' Sewer Cap Sewer Connection . Solar Collectors Solar Piping Solar Tank Swimmin9 Pool w/Spa Urinal . Outlets Water Closet Water Heater , Warer Service Auto-Wash . � Laundry Trays $15 Duct- Under Ground Duct - Structural Duct � Ventilating Exhaust System ❑ Multi�e Firepl/Fact. Blt. ICBO # � # � Heating System & Ducting ❑0.100,000 BTU 0100,000 Rainspection Fee � S15 � CMF 0865-46, rev. ]0/84 White - Building; Canary - Applicant; Pink - Accounting; Goltlenrotl - AssesSor Issue Fee Hood or Type I ❑ Canopy Type I I ❑. iefrigeration System �0-700,0008TU ❑100,000 System Repair/Alteration Fire Dampers Registers laue Fee FEES Auromatic Washer - Construction PoleSub. Cooking Unit ' Dishwasher � Dryers ❑Gas ❑Electri� Fan F.A.U. Fixtures Device Boxes � Outlets Switches Garbage Disposal Generator �0-5 KW �5- zone Accessory Building: Parking Req./Provided ELECTRICAL - Transformer� � 75-50 KW ❑ SO+KW Meter ❑up to t00amps � Meter ❑over100amps Sub Panel Motors�0-iHP01y,-S ' Inc.Solar �9-15 HP �16-15+ Microwave - Pole Light _ $ign � � Standing Sections ; Trash Compactor FEES JTL Z O N I N G R E � M T S $ 3 Reinspection Fee $15 luue Fee ' $ 3 FEES DEVELOPMENTSERVICESREQUIREMENTS: -` ' � Zoning Approved By Date Building Approved 6y � Date Application laued By � Date / g-S SUMMARV OF FEES . � BUILDING PERMIT $ SMIP : $ PLAN CHECK $ PERMIT � PLUMBING ' $ ' ISSUANCE $, PLAN CHECK 25% $ � ENERGV P.C. $ ELECTRICAL $ GRADING $� PLANCHECK 50°� $ ---�-�y� MICROFILM $ MECHANICAL $ J!ILS� TOTALFEE � $ �� $ 3 PLAN CHECK 25% $ � , _ _. �CO� RUCTION AND PLANNING POOI '�PA ' APPR � VALS� Permit # Date Inspector AppROVALS Permit #, Date Inspector �1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement � � 3. Electrical Conduit Utility-Undrgrnd. 54. Forms � 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test �� '6. Electrical UFER Grnd. . 57. APPROVAL TO COVER-GUNITE � 7. Footings � 58. Electrical Conduit-Undrgrnd. � 8. Foundation � 59. Gas Pipe, O Undrgrnd,, Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 67. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer'Cap 63. Heater & Vent�Final 13. Roof Drains 64. Plumbing System - Final _ 14. Rough Plumbing ' 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar SYstem-Final 76. 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 � y�� J FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure � 70. Underground Hydro � 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil �'23. Gas Pipe-Rough & Test 72. Underground Flush i 24. Roof Framing � 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing . 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. �Frame and�Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation ' �78. FIRE PREV. FINAL 30. Drywall Nailing - HEALTH DEPT. REQUIREMENT � 31. Plaster Brown Coat 79. FINAL INSPECTION • 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED � 33. Final Electric � Notes: 34. Final Heating & Air Conditioning � 35. Final Gas Pipe-TesY , � � _ - 36. Hood or Canopy � - 37. Final Factory Fireplace . 38. Final Plumbing � , � 39. Water Service-Final ' 40. Gas Service-Final 41. Solar pomestic-Final � 42. Backflow Preventer 43. Backflow Irrigation � � 44. Landscape Irrigation Systern 45. Sound Attenuation ' � ' 46. Handicap Regulations �� 4 47. FINAL STRUCTURE & BUILDING �i'�� J .¢,, C P� 48. Special Requirements Completed . 49. ElectrieReleaseto,Edison, � � 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY . No. Date e /� / ADolieant to fill in all sDaces exceo� inose within heavY Dortler Ilnas ana sign all aoCrooriate tleclarations. CIT`.iOF COSTA MES�Ay C. 5A1 F{ U(7:- -I �I VN �Yt-F+SIVII I PERM17, NO. TRACT NO. LOT NO. UNIT NU. . Pro;ect AdB�ess �n�i��'J�� { 6 / ''� S� � AppTi�a{t'sAkaili g dd[ress /` n Owner'sPlamn �J��/CQ�� Ptinnn ��_7`]� Addreu � � �/ �_S�� Arch/Eng. License No. �— Address Contracror's Nam � Phone Address (mailing) City License No. LICENSED CONTRACTOR DECIARATION 1 hereby affirm Ihat I am IicenSetl untler provislons ot Chart<r 9(commencing witM1 section �000) of Dlvision 3 of tne Business antl Professions Cotla, antl my license is in full torce and effec[. LIC¢OS¢ CId55 LICCO52 �`10. Oale $ignalure '�JRKERS'COMPENSATION DECLARATION iereby atfirm that I have a certificate of consent to sel/-insure or a ttrtHlcate e( Worker5' Compensation Insurance, o� a certliietl copy the�eol (SeCtion 380q Lab. C.) ' Policy No. Comoany 8 Certifietl copy is nereby fumishetl. Certifietl copy is iiletl with the ciry Builtlinq Divisian. Date AppliCant EXEMPTION FROM WORKEf35' COMPENSATION pECLARATION (This section neetl nat bC complete0 if the permit i5 tor on¢ huntlretl ($300) or less). I certify that in the Oerformance of tne work tq� whlC({ thi5 pErm�t iszuetl I snall not employ any pe�son in any ma9ner�p as y_berop� sub e,Ct to t�e Workers' COmpe➢fdtion LawS o1 Calilprp�p, // CY�'P /Q/�(7. ! �NOTICE: If, afl£r making this tleUalaCon, you shoultl become Subject to th¢ Worke�s' Comp¢nsation provisions of the Labor Cotle, you must forthwi[h tomply with such O�ovisions or Ihiz perml[ shall b¢ tleemetl �evoketl. CONSTRUCTION LENDING HGENCV 1 hereby ai(irm thai tnere is a mnstruction lentling a9ency for tne performance of [he work Por wblo� lhis„�permit is issuetl (Section 309� Civ. C.) Lender's Name rV flf+ LenGer's ACtlress — �/Y� (��j= OWNER BUILDEH'OECLHRATION I he�eby atfirm that I am Cxempt f�om the Contracto�'S LlcenSe Law for tne followin9 r¢ason (Section 7031.5 Busin¢55 antl P�ofessional COtle: Any city or counly which requires a pe�mit lo cons[ruct, alter, improve, tlemolish Or repal� any struclure, prior to ils issuance, also requires the aoP�icant for such permit �O tile a Signetl statem¢nt [hat he/she i5 litensetl pu�suant to Ih¢ provi5ion5 of ie Contractor's License Law (Chapter 9(commencin9 with Section 7000) ot �ivision 3 of the Business antl Professlons Cotle) or that ne/sbe is exempt ,herefrom antl the basis (or the aile9etl exemption. Any vlolation ot Section ]031.5 by any applicant tor a, pa�mi[ subjects tne applicant to a civil �enalty ot not more than five nuntlretl tlollars ($500). , as owne� of the property o � � �,pinpertf!lblry will tlo tne work, antl the structure is not inten ed or oHeretl � for sale (Section 7044, Business antl Professional Cotle: The Contractor's License Law tloes not apO�Y t0 an own¢r of a p�operty who builtls o� improves thereon, antl who tloes such work himself/herselt ar througn his or her own employces, provitletl that such improvements are nol intentled or ofteretl for sale. If, however, the builtling or imp�ovemen[ is soltl within ono yaar of <om- pletioq tM1e owner will bav¢ tM1e burtlen of p�oving he/she tlitl no[ builtl or Im- �rove for the putpose ot sala). I, as owner ot Ihe property, am exUusivery contractin9 with licensetl con- tractors to construct tna project (Sectlon 7044, Business antl Pwfessions Cotle: The Contractor's License Law tloes not aoP�Y �o an owner of property who builtls or improves inereon, antl who contracts br such projecls with a con- tractor(z) fcense pursuant'to tne Contracto}'s License Law). I am aware that Oroof ot Ineir Worker'S Comp��(.�o� I�ran�—e ShOultl be provitletl [o me L�.1 amexempt unGer Sectlon� '3 � 8. & P. C. fqYlpis reason Date / � /' � � Owner � I hereby certify [hat I have reatl [hiz intormation is correcL I agree to comp Drivers' License or SS � TYPE OF CONSTRUCTION LJ NEW U ADD LJ ALTERATION LJ REPAI R ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q p# DESCRIPTION OF WORK/USE OF BIDG. S Main Buildi E 7VPE OF PERMIT GRAo1NG FouNOATIOrv STRUC7uRAL T Front ❑ TENANT ❑ E�ECTRICAL ❑ PLVMBING ❑ MECHANICAL B Reat ❑ OTHER %� PROJECT DESCRIPTION 5�. FT. oCCUaarvcv C Right K Left CONSTRUCTION TVPE VALUATION 5 S ZONE GRADING CU.YDS. ACRES p�n9. R2f. �k Remarks: Planning Notes: Sink Prevenrer Irrigation tubs king Fountains �r Drains ir SinkS Service Outlets Kitchen Sink Lavamries P—Trap Roof Drains Reinspactian Fae $15 Boiler Duct� UntlerGround Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # �eating System & Ducting 100.000 BTU � 100.000 BT Reinspection Fea � $15 ��"''^°F5-46, rev. 10/84 Whlie - Bulltling; Canary - Applicant: Plnk - Accounting; Goltlenrotl - Assessor $hOwC�S Service Sink ' Sewer Cap , Sewer Connection Solar Collecmrs Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Hearer Water Service Auto-Wash laue Fee Hood or Type I � Canopy Typell ❑ Refrigeration Sys[em ❑o-�oo,000eru ❑ioo,000eTu SVstem Repair/Alteration - F ire Dampers Registers laue Fee S 3 $ 3 Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers �Gas ❑Elec' Fan F.A.U. F i xtures Device Boxes Outlets Switches Gar6age Disposal Generator O0.5 KW C Fee 689�+ 1 /07/d6 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transtormer ❑ 15-50 KW ❑ SO+KW Meter LJup to 100 amps Meter ❑over 100 amps Sub Panel Motors �0-7 HP O 1 Y: - 8 InaSolar 09-15 HP �i6-15+ Microwave Pole Light Range ; Standing Sections 5 KW Trash Compactor $15 Issue Fee Ic•.l IL. FEES $ 3 Z O N I N G R E Q M T S DEVELOPMENTSERVICESREUUIREMENTS: � 2oning Approved By Date Buildinp Approved By DaTe��7�j� Application laued By Data i /=Q/LL ' SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ • PLANCHECK 50°6 $ MICFiOFILM $ MECHANICAL $ � TOTAL FEE $ �. n<� PLANCHECK, 25% $ � � CONSTRUCTION AND PLANNING P� & SP'4 � `AP�PRQVALS Permit# Date Inspector p�ppROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2, Sdil 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. Footirigs 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final . 12. Sewer Cap � 63. Heater & Vent-Final 13. Roof �Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Elecvical-Conduit 66. Solar System-Final . 76. Rough Electric Wiring 67. Fencing & Access Approval 17. �Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electriral-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning �/q�/�` � .FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # . 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing ' 73. Undergrnd.StorageTank OGas �Oil 25. Roof Sheathing � 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning � r� J/�y � 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backftow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed 49. Electric Release to Edison . 50. Gas Release to $outhern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date i ApPlican� to fill in all spaces eKeeO� those wilhln heavy Cortler lines antl fl9n all approDria�e Eeclarations. dTv oF C�STA nnESa CONSIRUCTION PERMIT P�L+✓t Address 3 R6 �• o�oT� 6� . Applicant'sMailingAdAress P.J• tiTV�W��ST. C�i�i/•'. Owner',Name �a-�4R-� Phone�B2 Address �� r` • �� 3 r • Arch/Eng. License No. 3 a�� Address B � Phone ��'�!� 1' Contractor's Nam Address (mailing) •D• g0 �(i . L�: M � Ciry license No. �� LICENSE� CONTRACTOR OECLARATION I M1ereby affi�m t�at 1 am licensetl untle� provision5 of Char[ur 9(commen<in9 with section 7000) of DiviSion 3 ot the Business antl Prof¢SSionS Cotle, antl my Iicense is in full force a/na� efwfeAc(. License Class �' � `-`tT— � Lic 5e No. �4��0 oate/i-3N- siynature �(�^- 'ORKERS'COMGENSATION DECLARATION �ereby aifirm tM1ac I have a certificate of consent to self-insure or a ceriificate .r Workers' Compensation Insurance, or a certitietl coOY thereot (Section 3800, Lab. CJ Policy No. Company BCertifietl copy is hereby fu�nished. Certi(ietl copy is tiletl with the city Builtling DiviSlon. Oa[e Applican[ EXEMPTION FROM WORKERS' COMPENSATION OECLARATION (This sec[ion neetl not be completetl if the Oermit is for one hundretl (g100) or iless). i certify that in the performance of the wo�k for which this Oe�m�t i5 i55uetl, 1 � sM1all not employ any person in any manner So d5 to be[ome sub�ect to the Workers' Co pensation Laws ot CalitoRtla�� C � 1 Date .1.s3 •�`�-`6� Si9nature r �-� �[JOTICE: If, after making tbis tleclaration, yov shoultl become subject lo Ihe Workers' Compensation provi5ion5 ot lhe Labo� Co�e, you must forthwith comply wi[h such prOvisions or lM1is pe�mit shall b¢ tle¢metl �evoketl. CONSTHUCTION IENDING AGENCY 1 hereCy a(firm roat there Is a construction lentlin9 a9ency ror the performance of Uie work for wM1ich tniz permit is issuetl (SecNon 309] Civ. C.) ttntler's Name Lentler's Atltlress OWNER BUILDER �ECLARATION I hereby atiirm that I am exempt irom tne ConVactor's License Law for the following reason (Section �031.5 BusMess antl Protesslonal Cotle: Any tlry or county which requires a permi[ to construct, alteq imOrove, tlemolisb or repalr any struclure, prior to I[5 Issuance, also reqWres the appliCant tor such permit to tiie a signetl statement that he/she is Iicensetl pursuant to the O�ovisions of '�e Coniractor's License Law (ChaO�er B(<ommencin9 wltn Settion 7000) of Ivision 3 of the Bu5ine55 antl P�ofe55ion5 Cotle) o� that ne/zhe is exempt mretrom antl tM1e basi5 lor the allegetl exemption. Any viOlalion of SectiOn 7031.5 by any applicant tor a p¢rmil subj<cl5 lhe ap0licant f0 a civil �enalty of not more tnan five huntlretl tlollars (E500). I, as owner ot tne oroperry or my employees with wa9os as lheir zole compensation, will do lhe work, ana the siruclure Is not inientletl or ofteretl for sale (Section 7044, Business antl Professlonal Cotle: The ContractoYs Licensa law aoes not apply to an owner of a property wno bulltls or improves thereon, and who tloes sucM1 work liimsell/M1crsall or [hrough his or he� own employee5, Provitletl tM1at such improvements are not intenaeE or oiierea ror sale. It, howeveq the builtling or Improvement IS Soltl wi[hin one year of <om- pletlOn, the owner wlll have [he burden Of Proving be/she ditl not builtl o� im- ., prova for the pu�0ose of sale). ' �❑ I, as owner of tbe property, am exUusively cont�acting wilh IicenS¢tl con- �, t�acton to consbuct lhe project ($ection ]044, Business antl Pwta55ions Code: Tne Contractor's Llcenze law tloes not apply to an owner oi property wbo builtls or improves tnerean, antl who COnVat[z for Sucn projecf5 with a con- tractor(sl license pursuant�ro tne Contracroi's License L.aw). I am aware that proof of tneir Worker's Compensatlon insurance shoultl be provitletl to me. ❑ I am ezempt untler Section B. & P. C. for lhis reason Date Owner 1 hereby certify that I have reatl tnis application ana state that the above info�mation is mrrecL I a9ree to mmpty with all city antl County Ortlinances antl state laws relatin9 to builtling construction, antl hereby authorize repre- Seniatives ot thi city to ente� upon the above-mentione0 properiy tor' inspection Ourpo e � Si9nature r� Date /,Z •R�'QJ Drivers' License ar 55 � ' TYPE OF CONSTRUCTION lJ NEW ljY ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q p �S DESCRIPTION OF WORK/USE OF BLDG. S Main Buildi E TYPEOFPERMIT GRAOING FOUrvDA710N S7RUC7URAL T Front ❑ TENANT �QELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear � ❑ OTHER PROJECT DESCRIPTION 5�. FT. oCCuaANCv C Right K Left CONSTRUCTIONTVPE ��+��-L VALVATION$ $ ZONE GRADING CU. VDS. ACRES P�ng. Ref. �k Remarks: . Planninq No[es: Bar Sink Backflow Preventer Backflow Irrigation Ba[htubs Clarifiers Dishovasher Drinking Fountains Floor Drains Floor Sinks Gas Service Kitchen $ink � , Y Lavatories ` P—Trap Roof Dreins Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple F irepl/Fact. BI L I CBO # Heating System & Ducting ❑U700,000 BTU 0100,000 Reinspec[ion Fee � $15 CMF 0865-46, rev. 10/84 White - Builtling; Canary - Applicant; Pink - Accouniing; Goltlenrotl - Assessor $f10WCf5 Service Sink Sewer Cap SewerConm Solar Collec u laue Fee Hood or Type I ❑ Canopy Typell ❑ Refrigeration System ❑aioo,000eTu ❑ioo,000 System Repair/Alteration Fire Dampers Registers laue Fee FEES Automatic Washer Canstruction Pole Sub. Cooking Unit Dishwasher Dryers �Gas �Elec Fan F.A.U. Fixtures Device Boxes OuFI¢LS Switches Garbage Disposal Generetor �0�5 KW C 6359 12/44/�5 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ SO+KW Meter ❑up to 100 amps Meter � over 100 amps / Sub Panel Momrsg90.1 H2 L� 1 h- 8 Inc. Solar �9�15 HP �16�75+ Microwave Pole Light Range ; $tanding Sections KW Trash Compactor :�o� T� FEES Z O N I N G R E � M T $ S 3 Reinspection Fee $15 - Issue Fee $ 3 FEES DEVELOPMENT SERVICES RE�UIREMENTS: Zoning Approved By Date Building Approved 6y Date Appliption Issued 8y � � ¢- Date /2 - /?5 SUMMARV OF FEES BUILDINGPERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING ' $ ��UANCE $ � PLAN CHECK � 25% $ . ENERGV P.C. $ ELECTRICAL $ . O GRADING $ PLAN CHECK' 50% $ MICROFILM $ MECHANICAL $ � TOTAL FEE $ � $ 3 PIAN CHECK 25% $ 9„� CyUNSTRUCTION AND PLANNING �' PC L SPA -!�'PROVALS Permit # Date Inspector p,ppROVALS Permit # - Date Inspector 1� Temporary Electrical Service or Pole 52. Pool & Equipment Location 2� Soil Pipe-Undrgrnd. -� - 53. Sieel Reinforcement '.3. Electrical Conduit l�tility-Undrgmd. 54. Forms � 4,� Electrical Condui�Undrgrnd. 55. Electrical Bonding � 5. Sieel Reinforcem�ni- ',} 56. Rough Plumbing & Pressure Test � 6• ElEctrical UFER�Grnd. "�� 57. APPROVAL TO COVER-GUNITE - 7. Fwtings' � � . .. 58. Electrical Conduit-Undrgrnd. 8- Fo�undation � 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10.�SI�uctural Floor System ' .�� 61. APPROVAL TO DECK i t. Property Sewer Line�& House Connection 62., Backwash & Receptor-Final 12. Se'wer Cap;� 63. Heater & Vent-Final 13. Rooi-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 77.� Product Piping � Gas ❑ Oil . 23. Gas Pipe-Rough & Test 72: Underg[ound Flush - �'24. Roof Framing . �� . �-c73. Undergrnd:StorageTank�OGas ❑Oil 25.�Fibof Sheathing ' 74. Overhead.Hydro 26. T-8ar Ceiling (Structural) & Monocoat _ � �75. Dry Chemical 27. Frame and Flashing �_ `�-Z6? Dry Standpipe 28. Lathing & Siding " ' - � .77: \FIXED SYSTEM FINAL 29..,Insulation . � � '7S. FIRE PREV. FINAL 30. Drywall Nailing :� � � _� , . �� -' HEALTH DEPT. REQUIREMENT , 31. Plaster Brown Coat �-' - ' `�J9: FINAL INSPECTION 32. Electrical Power Meter-Final �� ' �1� 80. �FOOD CERTIFICA7E ISSUED � 33. Final Electric �Notes: 34. Final Heating & Air Conditioning � � '� � 35. Final Gas Pipe-Test � 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing , � ' 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final � ' �_i. 42. Backflow Preventer � ' y 43. Backflow Irrigation � . I 44. Landscape Irrigation System � ' 45. Sound 'Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING � 48. Special Requirements Completed � � 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date C 1 ADV��ant to flll In all ipaees except lhose within heavy DorGer Ilnes anC sign all apD�opriate tleela�ations. CITY OF COSTA MESA CONSTR UC�TIOyN PERMIT 7 PERJy11T NO. '. � TRACT NO. LOT NO. UNIT NO. � Project Address •� $�j %r�t�i�" � 7 � ��/ Applicant�^.Mailing�dress� -� Owner's NameC AY Pl�nnn Address � ✓�� ArchlEng. , ' License No. Address � Contractor's Name hone Addresslmailingl/_/J� � � �%� City Licence No D.� �ICENSED CONTRACTOR DECLA0.ATION 1 hereby affi�m that I am licensetl untler provi5ion5 ot Cnarter 9(commencing with sec[ion ]000) of Dlvlsion 3 ot the Business antl Professions Cotle, and my Iicense is in tuu torc an etfect q.y �� License Class License o✓ J Date Signature � "ORKERS'COMPENSATION DECLARA ON iereby affirm that I have a certifica[e ot ConSent [o zelf-insure or a Certifitat¢ r" Worke�s' Compensation Inw�ance, o� a ce�ti(ietl copy the�eot (Sectlon 3800, Lab. C.) Policy No. Company ❑ Certifietl mpy is hereby fumishetl. ❑ Ce�tifietl copy is filetl with the city Builtling Division. Daie APplicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissectian neetl not be completetl if the permit is for one huntlretl ($300) or less). I certity that in the pertormance ot the wor or which thi ermi{ is i55uetl, I shall not employ any Oerson in any ma 50 a5 to om¢ Subjett to th¢ Worker�Cort]pePsati�l�pw�of Cal' Date ./ ��' Signatur¢ 'NOTICE: If, after makin9 this tleclaration, y snoultl b ome �ect to the Workers' Compenzation provisions of the Labo� Cotle, you must �orthwith comply with such p�ovi5ion5 or this pErmit Shall be ,tleemetl revoked. CONSTRVCTION LENDING AGENCV ' ' I nereby atfirm that Ihere is a mnstruction lentlin9 agency for the perrormance oi tne work for which this Oermi[ is issuetl (SecOon 3097 Civ. CJ Lentler's Name � Lentler's Atltlress OWNER BUILDEH UECLARATION I hereby atllrm that I am exempt from the Contractor's License Law tor (h¢ following reazon (Section 7031.5 Businezs antl Professlonal Cotle: Any city or counly whlch requires a Oerml[ t0 cOns[�uct, alte�, improve, tlemolisb or repair any SVuctu�e, prior [o it5 i55uance, also requires the applicanl tor such permit ,to fiie a signed statement [hai he/she is Iitensetl pursuant to the provisions ot ',�'�.�e Conlraclor's LI<ense Law (Chapter 9(commencing with Section 7000) of �vision 3 of tha Businnss antl Protessions Cotle) or that he/she is ezempt `��4ere/rom antl the basis tor the alleqetl ezemptlon. Any viOldtlon of $ection "�]031.5 by any applicanl fOr a permlt subject5 th¢ applicant to a<Ivil �endlty of not mo�e than tive huntl�etl tlollar5 (E500). 1, as owner of the property or my employae5 wi[h wages as thei� sole Compensation, will Eo the work, antl [M1e sl�uClurC i5 nOt inlentletl or o/feretl tor sale (Section ]044, Business antl Prof¢ssional Cotle: ThC Contrac[o�'s License Law tloes not apply to an Owne� ot a prOperry who DUlltls or imprOves thereon, and wno does su<M1 woru nimselt/herself or Mrough his or her own employees, provitletl that suth Improvementz ate not Inientled or offeretl for sale. If, howeve�, tM1e bulltling or imOrOvement I5 Soltl within ona yea� ot com- . pletion, tlte owner will have the burden of prOvin9 M1e/ine tlltl not builtl or im- prOve for the purpose Of sale). ' ❑ I, as owner of the properiy, am exUusively ConlraC[ing wi[h Ilcense0 Con- Vactors to mnstruct ihe project (Section 7044, Business and Professions Cotle: Tne Contractor's License Law does no[ apply lo an owner of property who builtls or improves Mereon, ana who contracts for such projects with a con- tractor(Sl license pursuant�to the Cont�actoi's LicenSe Law). I am aware Ihat , proof o( thei� WOrker'S Compensation insurance ihOultl be prOvitleO to me. ❑ I am exempt untler Section B. & P. C. for this reason Date� Owner _ I hereby certi(y that I have reatl this inPormation is wrrecL I a9ree to comp and ztate laws relating to builtling on sentatives ot this cit enter poi inspection purposef Siqnature above nances TYPE OF CONSTRUCTION LJ NEW�ADD LJ ALTERATION LJ REPAI R ❑ CONVERSION ❑ DEMOLISH OTHER DESCRIPTION OF WORK/USE OF BLDG. F S TVPE OFPERMIT LJ GRAOING� pLJ FOUNDHTION LJ STRVCTURAL ❑ TENANT ❑ ELECTRICAL ICl PLUMBING ❑ MECHANICAL O OTHER PROJECT DESCRIPTION 5�. F7. oCCUanrvcv— CONSTRUCTION TVPE VALUATION 5 20NE GRADINGCU.YOS. ACRES_ Remarks: Bar Sink Backflow Preventer Backflow Ir�igation Bathtubs 7rinking Fountains =1oor Orains Floor Sinks 3asService Ouilets Interceptors Kitchen Sink Lavatories �—Trap Roof Drains � Reinspection Fee $75 Boiler Dutt - Under Ground Duct-Structural � Duct - Ventilating Exhausc $ystem ❑ MWtiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑ a� oo,000 sTu � i oo,000 sT I"_,orivers' License ar 5$ � �� I I Reinspeetion Fee CMF 0865-46, rev. 10/84 White - Builtling; Canary - Applicanp Pink - Accountin9; Goltlenrotl - Assessor $15 Showers ' Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal � Water Closet Water Heater Water Service AUtO-W85I1 laue Fae Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑o-ioo,000eTu ❑ioo,000er System Repair/Alteration Fire Dampers Registers � Iswe Fee 5 3 $ 3 A.P. # S Main Buildi E T Front B Rear A C Right K Left S Ping. Ret. # Planning Notes: Auromatic Washer Construction Pole Sub. Cooking Uni[ • Dishwasher ' Dryers ❑Gas OElectric Fan F.A.U. Fixtures Device Boxes . Outlets 7646 7/29/B5 I zone Accessory Building: � Parking Req./Provided ELECTRICAL Transformer �� 15-50 KW ❑ 50+KW Garbage Disposal Generafor 00�5 KW �5�15 KW Meter LJup to 100 amps Meter ❑over100amps Sub Panel Motors �0.1 HP �1 K- 8 Inc. Solar �9-75 HP �76-15+ Microwave Pole Light � Range Standing Sections - Trash Compactor , 4Go67 TL FEES Z O N I N G R E � M T S I Rainspection Fee �$15 I I Issue Fee I $ 3 I DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Data Building Approvetl By Date Appliption Issued By Date% a - • SUMMARV OF FEES ' BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ � • SO �SSUANCE $ PLAN CHECK 25% $ S�3 � ENERGY P.C. $ � ELECTRICAL $ GRADWG $ PLAN CHECK 50% $ MICROFILM $ �� -�� i�� MECHANICAL $ TOTALFEE S S�U__L PLAN CHECK 25% $ CONSTRUCTION AND PLANNING POOL & SPA Date Inspector Date Inspector � APPROVALS Permit # APPROVALS Permit # I I 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. � j� � � 53. Steel Reinforcement 3. Electrical Conduit UtilitY-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reintorcement 58. 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 i ' 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing ,� ��Q �j� L j�,�� 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar SYstem-Final � 16. Rough Electric Wiring 67. Fencin9 & 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-Rough & Test 72. Underground Flush � 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil � 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical .• 27. Frame and Flashing � ,.� 76. Dry Sta�dpipe .. 28. Lathing & Sidi�g 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 Noces.,� �ZJro/di $ilO�t,�k.�E'YN,t � TUR3'i�Si 0,�. LED, 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test � � •" ,,. 36: �Flood 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 Compteted , r, ' •' ' 49. Electric Release to Edison � � ' 50. Gas Release to Southern California Gas Co � 51. CERTIFICATE OF OCCUPANCY , . No. Date � � - - : �' � � A I I) a0��s�? GDIu�Ns l J�o�� H,� !� Ivir�x�� 9 �� i�x �X i a columu. f3�o�K with usE� �3R��K - �� , � . - (� - - � � - � --f--;--. . , � �.�..� i � e -�s — — ��o� r