HomeMy WebLinkAbout350 20TH ST - Building Permits�
CITY OF COSTA MESA �
��MFsq BIIILDING DIV/SION
rt S� 77 FAIR DRIVE, COSTA MESA. CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.wsta-mesa.ca.us
� FOR INSPECTIONS CALL: (714) 754•5626
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PERMIT NUMBER: BC07-00265
PERMIT TYPE: B COMBO
Sub Type: RES_RRIP
�os nooRess: 350 A E 20TH ST CM
APN: 42623407 Zoning: , ,
Vicinity: UNIT A
Const Type:
SQ. FT: 0
STATUS: ISSUED ,
DATE ISSUED: 09124/2007
ISSUED BY: ??
Suite/Unit: A
' Primary Occ: R3
Valuation: $35,600.00
SCOPE OF WORK: REVISION TO PERMIT ON 06/03/09 TO INCLUDE A WATER HEATER.
REPLACE 6 WINDOWS AND 1 SLIDER TO MEET 1997 U.B.C. EGRESS REQUIREMENTS. HEADERS WILL REMAIN THE SAME.
REPLACE 1 KITCHEN SINK, 1 DISHWASHER, 3 LIGHT FIXTURES IN BATHROOM AND 1 VENT FAN.
OWNER: BQHLER, BEVERLY A
Phone:
APPLICANT: JUDY GRIFFITH
Phone: 714-960-7052
CONTRACTOR: J K CONSTRUCTION
Phone: 714-004-9646 CELL
Cell: 714-960-7052
ARCHITECT:
ENGINEER:
COMBINATION PERMIT FEE SUMMARY
Building Plan Check:
Building Fees:
Electrical Fees:
Mechanical Fees:
Plumbing Fees:
SMIP Residential:
SMIP Commercial:
Bldg Std Admin Fund
TOTAL FEES;
"Refer ro fee recelp�s (or all tees pa10 (or proJett
Address: 350 E 20 ST #A
City/State/Zip: COSTA MESA, CA
Address:
City/State/zZip:
�� License No. 450297
Address: 915 LAKE STUnit:
City/State: HUNTINGTON BEACH, CA
License No.
License No.
$0.00
$502.85
$26.80
$30.75
$52.90
$3.56
$0.00
??
$616.86
Unit:
Unit: :
ZipCode 92648
PHONE:
PHONE:
'�EVI �
�ArE:
NOTICE: The wbrk authoiized by this permit shall wmply with all applicable handicap access requirements under Calitomia staWtes and related
regulations. (Ord. No. 92-28, § 1. 12-21-92)
EXPIRATION: P�RMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work musl comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiretion of this permit.
LOOER. INSiEC110NTYpE D�TE IN RL COOE� INSPECTIONTYPE ORTE IN1111RL
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Fiqal 208 Final Plumbing
200 Final Re-Rop( 210 Final ElectriCyl
201 Final8lock/qeWining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign ' 222 Final Slte �
204 Final Demoli�ion 250 Final BuilOing/Occupancy �
WORKERS' COMPENSATION DECLARA710N:
I hereby aKrm under penalty of perjury one of the follovring declarations:
❑ I have and will maintain a certifcate of consent to sel(-Insure (or vrorkers'
compensation, as pmvided for by section 3700 0( Ihe Labor Code, (or the
pedormance of Ihe work for which this permit is issued.
❑ I have antl will maintain wnrkers' compensation insurance, as required by
section 3700 of the Labor Cotle, for the pedortnance of the work for which Ihis
pertnit is issuetl. M vror ers' compensa�ion Insurance carner and policy
number are:
—�
Cartie�
(ThBsecionneetlrof!p p� e dC(n�e /�uvalueda�menunmeEtlouars(S�oO)aleu)
Policy�.Number: `O��J w �
❑ I certify that in the pertormance o( the work !or which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of California, antl agree that if I should
become subj t to the ers' ompe sation provisions of Section 3700 of
Ihe Labor C e al fo 't ply 'th these provisio s.
b Wre � p,
WARNING: AILUR TO SECURE WORKERS' COMPENSATION COVER4GE
IS UNfAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLIARS
($10Q000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force �a/ntl eHect. �p
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CONSTRUCTION LE DING AGENCY:
❑ I here6y affrtn �hat there is a consWcCan lending agency (a the
peNormance of the work for which this permit is issued. (Sec. 3097. Civil Code).
Lender's Name:
Lender's Address:
OW NER-BUILDER DECLARATIONS:
I hereby a(frm lhat under penalry of perjury that I am EXEMP7 FROM THE
CONTRAC70RS LICENSE LAW for the tollowing reason (Sec. 7031.5,
Business and Professions Code: Any city or couny which requires a permit to
construct, alter, improve, tlemolish, or repair any stmclure, prior to i�s
issuance, also requires the applicant for such permit to fle a signe0 siatemenl
that he or she is licensed pursuaM ro the provisions of the Conlractors
LicenSe Law (C�apter 9(wmmencing with Seclion 7000) of Division 3 of the
Business and Professions Code) or that he or she is exempt therefrom and
the basis for the alleged exemption. Any violalion o! Section 7031.5 by any
applicant for a permit subjects the applicant Io a civil penally of noI more Ihan
fve hundred dollars ($500�.�:
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and Ihe structure is not intended or
oflered (or sale (Sec. 7044, Business and Professions Code: The Contracrors
License Law does not apply to an owner of property who builtls or improves
thereon, and who does such vrork himself or herself or through his or her own
employees, provided that such impmvements are not intended or oftered for
sale. If, however, the building or improvement is sold within one year o!
completion, the ovmer-builtler will have the burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner of the propeny, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Pmfessbns Code: The contractors License Law dces not apply lo an ovmer of
property who builds or improves thereon, and who contracls for such project with
a contracta(s) license pursuant to the Contractors License Laws.).
0 I am exempt under sec.
Business and Professions Code tor [his reason:
SignaWre Oate
3051-0fi (3I0])
Ovmer ID verilied by tlrive� s license. ❑ Ves ❑ No
Driver's License No. Expires:
Verifcation of Ownership by (type of document, i.e. - property tax bill or tleetl):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby cetli(y that no excavation frve (5) or more leet in tlepth into which a
person is required to descend, will be made in connection vrith work autMrized
by this pertnit, and that no building s[ructure, scaf(dding, (alsework, a demolition
or dismantling lhereof, will be more than thirty-sia (36) feet high. (Chap. 3.2, Grp
2, M 2, Sec. 341, TUe 8, Califomia AdminisiraMe Code�.
❑ As owner-builder, I will not employ anyone to tlo work which woultl
require a permit from the Division of Intlustrial Safery, as noted above, unless
such person has a permit to do such vrork fmm the division.
FpPh�anl's SiB�a W re Dale
Division of IndusVial Safety Permit Number.
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant neetl ro(le and
certily a Business Plan for emergency response to release or threatened
release of a hazardous matenal? ❑ Yes ❑ No
(Section 25505 of ihe Califomia Health antl Safery Cotle requires, with some
exceptions, Ihal a Business Plan be filed with the Costa Mesa Fire
Department by every business which has at any one time tlunng a reportetl
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas
at standard �emperature and pressure).
2. Does or will ihe applicant or present or future building occupant neetl to file
a regisiration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safety Code, wiM some
ezceptions, requires registration with the Costa Mesa Fire Department by
each business which aI any one time has on hand a quantity of acutely
hazardous materials equal to or greater than a weight of 500 pounds, or a
volume o( 55 gallons, or 200 cubic feet o( compressetl gas at standard
tempereture and pressure).
3. Does or wili the applicant or present or (uWre building occupant neetl to
prepare an RMPP (Risk Management and Prevention Program for acutely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of �he Califomia Health and Safety Code provitles that Ihe
Cosla Mesa Fire Department may require the preparation, certification and
filing with the Fire DepaAment of an RMPP by businesses which are required
to register acutely hazardous materials with Ihe Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Califomia
Health and Safety Code been fully complied wi�h7 ❑ Ves ❑ No
5. Does or will the applicant or present or fuWre building occupaN require for
lhe work which is the subject of this applicacion a Dermit for such mnstruction
or modification from the South Coast Air Quality Management District or from
any other air poilution contml distnct or agency? ❑ Yes ❑ No
(Secibn 658502 0( lhe Califomia Govemmen� Cotle requires that the requested
informa�ion be fumished on applications fa nomresidential building pertnits�.
6. Will any part of the faciliry to be constructed under Ihis permit be within
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If "yes", the facility must meel the requirement of Sections 25534 antl 42303
o! the Califomia Health antl Safety Cotle).
7. I( a permi� fmm the South Coast Air �uality Management District or ot�er
air pollution wntrol district or agency is required for the v+ork which is the
subject of this application, have all of the disclosures prescribed by Califomia
Health antl Safety Code Section 42303 been made? ❑ Yes ❑ No
8. Qf "yes", attach cetlifcate o( compliance fmm the appropriate air polWtion
control officer�.
CERTIFICATE OF COMPLIANCE: I certiy that under penalty of perjury the
inlormation given above is correct I agree ro comply with all state laws antl
ciry ordinances regarding Hazardous Materials and Emissions.
�ate
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify untler penalry of perjury that I have read this application and state that
the in(ormation given is correcL I agree to comply with all state lavrs and ciry
ordinances relating to building construction, antl authorize representatives of
the Ciry of Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any builtling
authorized by this permit until final inspection.
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CITY OF COSTA MESA "
B!/ILD/NG D/V/S/ON
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (N4) 754-5626 .
PERMIT TYPE:
Sub Type:
JOB ADDRESS:
APN: 42623401
Vicinity: UNIT A
Const Type:
B_COMBO �
RES_RRIP �
0
350 A E 20TH�M
Zoning:
SQ. FT: 0
PERMIT NUM�������
AI,LOWED
DATESSSUED: 09/24R2007 PER ��
ISSUED BY: ?� �XPIRES �-3-oy
Suite/Unit: A
Primary Occ; R3
Valuation: $35,600.00
SCOPE OF WORK: REPLACE 6 WINDOWS AND 1 SLIDER TO MEET 1997 U.B.C. EGRESS REQUIREMENTS. HEADERS WILL
REMAIN THE SAME. REPLACE 1 KITCHEN SINK, 1 DISHWASHER, 3 LIGHT FIXTURES IN BATHROOM AND 1 VENT FAN.
OWNER: BOHLER,BEVERLYA
Phone:
AppLICANT: JUDY GRIFFI7H
Phone: 714-960•7052 .
CONTRaCiOR: J K CONSTRUCTION
Phone: 7f4�04-g846 CELL
Cpll: 714-960-7052
ARCHITECT: �
ENGINEER:
COMBINATION PERMIT FEE SUMMARY
Building Plan Check:
Building Fees:
Electrical Fees:
Mechanical Fees:
Plumbing Fees:
SMIP Residential:
SMIP Commercial:
Bldg Std Admin Fund
TOTAL FEES:
"Refcr to fee reccipis lor all fees paitl (or projoct
Address: 350 E 20 ST #A
CitylState/Zip: COSTA MESA, CA
Address:
City/StatelzZip:
License No. 450297
Address: 975 LAKE STUnit:
CitylState: HUNTINGTON BEACH, CA
License No.
License No.
$0.00
$502.85
$26.80
$30.75
$43.10
$3.56
$0.00
??
$607.06
Unit:
Unit: :
ZipCode 92648
PHONE:
PHONE:
NOTiCE: The work authorized by this permit shall comply with all applicable handicap access requireme�ts under Califomia sfaNtes and related
regulatlons. (Ord. No. 92-28, § 1. 12-21-92)
EXPIRATION: PERMIT EXPIRES 190 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTtON.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply wiN all applicable coCes, and a�l
required inspeetions and final approval must be obtained. Failure to obtain inspectlons and final approval will result in the expiratlon of this permit.
�QpF,r, ixsrEcnaxrrre p� ixmu{d
1818 Fixey S}5lem Final Pire Preven�ion
1288 Pool Spa Final
200
�71
202
2f13
Zb4
Final Re-Root
Final Block/Retaining Wall
Final Factory Fire Place
Final Sign
Final Damolitian
�qg� ixsrec�rrve
208 Final Mechanical
208
270
212
220
222
250
Final Plumbing
F7nat Electr�al
Final Fire Prevenlion
Final Planning Approval
Final Site
Final Building/Occupanry
¢� fNTffIALS
WORKERS' COMPENSATION DECLARATION: �
I hereby aKrm under penalty of perjury one of Ihe following deGarations: ,
❑ I have and will maintain a certifirate of wnsent lo self-Insure for workers'
compensation, as pmvidetl for by. section 3700 0( the Labor Code, for the
peAormance of the vrork for vfiich this permit is issued.
� I have and will maintain workers' wmpensation insu2nce. as required by
sectbn 3700 of the Lahor Code, ta Ihe performance of the woAc fa which this
pertnit is issued. My workers' compensation Insurence cartier and policy
number are:
Carrier:
(Tlus sertwr neetl nd �e mmpMetl a f�e peirtrf B.�IUMat we nurqretl0aoarslElro) aless )
Policy Number:
❑ I certify thal in the pertormance of the work (or which this permit is
issueQ I shall no1 employ any per5on in any manner so as lo become subject
to Ihe workers' compensalion laws of Calilomia, and agree Ihat i! I shoultl
become subject to Ihe workers' compensation provisions of Section 3700 of
Ihe Labor Code, I shall (orthwith comply vnth these provisions.
/ OO�iwni's SiB^a�ure
WARNING: FAILURE TO SECURE WORKERS' CAMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLAFtS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF TNE LABOR CODE. IMEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensetl untler provisions of Chapter 9(commencing
with Section 7000) of Division 3 0l t�e Business antl Protessions Code, and
my license is in tull torce and eHect.
Lic. # Class #
Gomractor's SignaNre
CONSTRUCTION LENDING AGENCY:
❑ I hereby affum that there is a construction IerMing agency fa the
peAortnance of the work fa which lhis pertnit is issued. (Sec. 3097, Civil Cqde).
Lender s Name:
Lender's Address:
OWNER-BUILDER OECIARATIONS:
I hereby aRirtn that un0er penalty af perjury Ihat I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the lollowing reason (Sec. 703L5,
Business and Pmfessions Cotle: Any city or counry which requires a permit b
construct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires the applicaN for such permit to file a signed statement
Ihat he or she is licensed pursuant lo Ihe provisions of the Conlractors
License Law (ChaDler 9(commencing with Section 7000) o( Division 3 of the
Business and Professions Code) or that he or she is exampt therefrom antl
the basis tor the alleged exemption. Any violation o! Section 7031.5 by any
applicant (or a pertnit subjecls the applicant ro a civil penalty ol not more than
five huntlred tlollars ($500).):
❑ I, as ovmer of the property, or my employees vrith wages as their sole
compensation, WILL DO THE WORK, antl the struclure is not intended or
oHered for sale (Sec. 7044, Business and Prolessions Cotle: The Contracbrs
License Law does not appty to an owner of property who builds or improves
Ihereon, and who dces such work himsel( or herself or lhrough his or her ovm
employees, provideG that such impravements are not intentled or offered tor
sale. If, however, the building or improvemenl is sold within one year of
completion, ihe owner-builder witl have the burden of proving Ihat he or she
did not build or improve for purpose of sale.�.
❑ I, as owner of the property, am EXCWSIVELY CON7RACTING WITH
LICENSED CONTRACTORS to tonstrucl the pmject (Sec. 7044, Business and
Professions CoGe: 7he contractors License Law dces not appty ro an ovmer of
property who huilds or improves thereon, and who contracts fw such project with
a contracta�s) license pursuant to Ihe Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Cotle for this reason:
]OS]�a6 (3IOl)
Owner ID verifed by Ariver „.�.:ense. ❑ Yes ❑ No
Driver s License No. Expires:
Venfication o( Ownership by (rype of Oocument, i.e. - property tax Dill or tleed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no exwvation (rve (5) or more feet in depth into v.fiicA a
pers n is required to descend, will be made in connectbn with work authorized
by t ermit, and thal no builtling s[mcN2, scaf(dding, false�wrk, or Oemoli�bn
or di thereof, will be more than I�irty-six (36) feet high. (Chap. 3.2, Grp
2, M1le 8, CalilOmia Administrative Code).
LJ4YAs o i vnll not employ anyone to do work which would
require a per ' f th iy� n of Industnal Safety, as noted above, unless
such oerson s er oF�ch wnrk (rom the division.
Daie
Division of IndusUial Salety Pertnit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or presenl or future building occupant need to file and
certily a Business Plan (or emergency response lo release or threatenetl
release ol a hazardous material? ❑ Yes ❑ No
(Section 25505 0l lhe Calilomia Health and Sately Code requires, with some
exceptions, thal a Business Plan be filed v+ith the Costa Mesa Fire
Department by every business which has at any one time dunng a reported
year a quantity of hazar0ous materials equal to or greater t�an a weight o(
500 pounds, or a volume of 55 gallons, or 200 cubic teet o( compressed gas
aI slandard temperature antl pressure).
2. Does or will ihe applicant or presen[ or future building occupant need to file
a registralion form for acutely hazardous matenals� ❑ Yes ❑ No
(Seclion 25533 of the Calilornia Health antl Safety Code, with some
exceptions, requires registration with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazardous materials equal to or grea[er Ihan a weighl of 500 pounds, or a
volume o( 55 gallons, or 200 cubic feet of compresse0 gas at standard
temperature antl pressure).
3. Does or will the applicant or present or future building occupam need to
prepare an RMPP (Risk Management antl Prevention Prog2m for acutely
hazartlous materials�? ❑ Yes ❑ No
(Section 25534 0( the Cali(omia Health antl Safety Code provides that the
Costa Mesa Fire Depanment may require the preparalion, certification and
filing vriN Ne Fire Department of an RMPP by businesses v+hich are required
to regisler aculely hazartlous materials with lhe Fire Department.
4. If an RMPP is presently required, has Section 25534 of Ihe Califomia
Health and Salety Code heen fully complied vri�h? ❑ Yes ❑ No
5. Does or will Ihe applicaN or present or future building occupant require lor
the work which is tha subject of this application a permil for such conStruUion
or modifcation from Ihe Sou[h Coast Air �ualily Management Distdct or from
any other air pollution control disMct or agency? ❑ Yas ❑ No
(Seclan 658502 0l ihe Califomia Govemment Cotle requires that Ihe requested
infortnation be fumished on applications (or non-residential builtling pertnits�.
6. Will any part ol Ihe (acilily to be constmcted under this permit be within
1000 feet (rom the ouler boundaries of a schoolT ❑ Yes ❑ No
Qf'yes", Ihe facility musl meet lhe requirement of Sections 25534 anC 42303
of Ihe Califomia Health and Salety Code).
7. If a permil (rom the SoWh CoaSt Air QUality Managemenl DiStrit� or Other
air pollution control district or agency is requiretl for the vrork v+hich is the
subject ol this application, have all ol the disclosures prescribetl by Calilomia
Health antl Safely Cotle Section 42303 been matle? ❑ Yes � No
8. Qf 'yes", attach certificate ol compliance from lhe appropriate air polWtion
contml oKcer�. �� �
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
infortnation given above is cortecl. I agree to comply wiN all state lavrs and
ciry ordinances regarding Hazardous Materials and Emissions.
SignaWre � Date ' -
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalry.of perjury that I have read this application antl s�ate ��at
the information given is correcL I agree to comply with all state laws and city
ordinances relating�to building cons�ruction, and authOrize representatives of
the Ciry of Costa Mesa to enter upon the above-describetl property tor
inspection purposes. �I agree not to occupy or allow occupanGy of any building
authonzed by Ihis permit until final inspection. � . ,
SignaWre ol Legxl
AnObr AN�OnzeC AOpht�ant
�
City of Costa Mesa
77 Fair Drive, Costa Mesa, CA 92626
79 4/754-4871
714/754-4856 (fax)
TO: Sofia Predo, JK Construction
FAX # 714/536-3868
FROM: Barbara J. Zwart
Fax # 714/754-4856
Subject: Permit # BC07-00265
350 E. 20`" Street #A., Costa Mesa, CA
# Pages 2
(including cover)
Comments:
If you have any questions, feel free to call me at 714/754-4871.
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TRANSI.fISSION OK
TX/RX NO
OESTINATION TEL lJ
OESTINATION I�
ST. TIME
TIf.fE USE
PAGES SENT
RESULT
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FAX #
FROM:
Fax #
SubJect:
# Pages
(ineluding cover)
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2473
917145363868
06/03 09:02
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OK
City of Costa Mesa
77 Fair Drive, Costa Mesa, CA 92626
714/754-4877
714/754-4856 (fax)
Sofia Predo, JK Constructlon
714/536-3868
Barbara J. Zwart
714/754-4856
Permit # BC07-00265
350 E. 20"' Street #A., Costa Mesa, CA
2
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�1�� L�- r� � �� � ,�� �'�� �'s p����-
`�'t�e_ v�� /�Y�u�-- � .�`�1 �u �� �'
� �� �� �
��-� ,�rr�.a r�� c,� �
� ct,P�de-u�-�' �d� �rOlrr�- d'�s/�61�� .
5��2cer�� 1 y r .
,
�a�- ��'�°�° �C.� ���-u.�� �i
?r4�-�(�- �os� '��
���/--b��-3�1P� �G 1
� .. � � � ...
N OF �STA MESA, . .DING SAFEIY DI'. ,ION '�
-���, �,5� �CONSPICUOI.►s PLACE ON THE. JOB
NOTI�:E
Schedule inspection one workday in advance. To schedule inspectians, call (71a) 754-5626. Provide the tollowing,�i7niormation:
i) Permit number, 2) Job address, 3) Inspection item numbe� � � r�� T d � —a I�Sfll—i i i-
BuilEingAdEress: � U ��� ��� �—
Bullding Permit �: LJ..V �' UD betrleal Permil : CD - 2 � Conhaclor. � �/\
Meohanlcel Permil N - Vlum�ing Permh 1: - Job Description �,4� ,��(�,�+_
NEW ADD AL7ER REPAIR MOVING UEMOLISH 65UE Df�TE� � �� ^
� u
PERMITS EXPIRE 180 DAYS (6 MONTHS) FROM ISSUANCE OR LAST INSPECTION
. . •.
Iiam� STRUCTURAL Da�e Inapeemr Itema POOL85PA Date In�pscror
3 Job Site Consult 94 Pool 8 Equipment Location
4 Footings I Ufer Ground 96 Steel Reinforcement
6 Slab 100 Electrical Bonding
8 Struclural Floor 102 Rough Plumb 8 Pressure Test
11 Pre-Inspect Roof 104 Approval to Cover - Gunite
12 Root Sheathing 1 Building Height 106 Elec Conduit - Underground
14 T-Bar Ceiling-StrucWral 108 6as Pipe I Underground Test
16 Shear Panel 110 Backwash Lines, P-Trap,
18 Frame 8 Flashing (,U�,�,p� Underground
20 lathing 8 Siding 112 Approval lo Deck
22 Insulation 116 Pool Plumbing System - Final
24 Drywall Nailing 118 Pool Electrical - Final
26 Plaster Brown Coat 122 Fencing 1 Access ! Alarms Approval
30 Pre-Groui 124 Approvalfor Plastering
, 31 NPDESIBMP 126 Pool I Spa Systems - Final
33 Disabled Access
� r •
S�h� �
1610 Overhd Hydro I Overhd Rough
p ��.. r S� �� 1612 Dry Chemical
LECTRICAL 1614 Dry Standpipe
36 Uter Ground 1616 Final • Fixed System
38 Elec Conduit - Underground
44 Rough Elec - Wiring •
46 Rough Elec. Conduit • ' •
48 Elec T-Bar Ceiling Call (714) 754-56261or the followin9: De1e inapec�or
50 Eiec Power Final ! Meter Helease 200 Final Re-FooT
51 Temp Power Final 201 Final Block I Retaining Wall
203 Final Sign
204 Finai Demoliiion
206 Final Mechanical
PLUMBING 8 MECHANICAL 208 Final Plumbing
52 Sail Pipe - Underground 210 Final Electrical
53 Shower Pan Call (714) 327•7400 for the tollowing: oete inspactor
54 Waler Pipe - Underground 212 Final Fire Prevenlion
55 Underground Gas Call �714) 754•5671 Iwo �2) working days
62 Rough Plumbing prior to final. oa�e enpineer
63 Prewrap 216 Final Public Svs. Qept. Apprnval
64 Rough Mechanical ' Call (714) 754-52451or the tollowing: oa�e in�pec�or
66 Rough - Factory Fireplace 220 Final Planning Approval
' 68 Sewer System Call (714) 754-56261or the following: oeie �napector
72 Gas Pipe - Rough 222 Final Sile
90 Gas Pipe Tesf - Final 250 Final Building � Occupancy
92 Water Service • Final
NOTES: SEE REVERSE �
0559�ae (rev, ]�06�
September 19, 1985
Tb:
CITY OF COSTA MESA
CALIFORNIA 92626 P.O. BOX 1200
FROM THE OFFICE OF THE DEVELOPMENT SERVICES OEPARTMENT/
PLANNING DIVISION
9uilding Safety Division
Business License Division
Ca�rtmmications
Cnunty .�clministration Office
County Clerk/Board of Supervisors
County Registrar of Voters
Ceur:ty TaK ASS?SSOT_�
Engineerirg Division (2)
Finance, F�venue Division
Fire Prevention
Manager, MiD .
Mesa Consolidated Water District
Newport-Mesa Unified School District (2)
Pacific �lephone Canpany (2)
Police Departrnent - Ping. & Research
Santa Ana Heights FTater Ccn�any
Sanitary District Erx�ineer
Southern California Edison Co.
Southern California Gas Co.
Stete P�ard �f Fi3ualizati�n
Street Division
United States Pe�st Office, Pdams Avenue
United States Fbst Office, Santa Ana
Zip 4 - Santa Ana
File (2)
The City of Costa Mesa wishes to advise you that in revisinq street addresses,
the following addresses have been changed:
• � •��•
350 E. 20th St.
NEW ADDRESS
350 E. 20th St.
Units A, B, C, D
A.P. NO.
426-231-19
Fbr your convenience we are listing the agencies above that we have notified
of the charge. In addition to those listed, you are advised to notify }rour
correspondents of the charge in ozder to avoid any possible interruption of
mail service.
Your cooperation in this matter is appreciated.
Y�
. ONY PEREZ
Planning Intern
JAP:alm (F-1-7)
77 FAIR DRIVE (774) 754-5245
V
�
a
�
�
��
�
��
�s � ��-,� ��,�� ,g- v� ,���
l
t
,
ADo���ant to (i11 in all spaces except those within heavy DorEer lines ana sign all avProvriate tleelarations.
CONSTRU�C,�TIO�PERMIT N P RMITNO. TR C NO. LOTNO. UNIT O.
- . � - � _ / s�� �� / l�7/� ! ,�
Applioant's
•
Owner's Nnai
Addrexs 6
Address "
Contracror's Namn QQ ��-�yy��r�j,� �PAhone
Address ( mai ling) /��/�Cl—(�7�J
City License No. /5 ��7 �� �%
LICENSED CONTRACTOH DECLARATION
I hereby affirm tba[ I am licensed under provisions o/ Charter 9(commencing
with Section ]000� Of Division 3 of the Bu5ine55 antl Profe55ion5 COtle, antl
my license is in f force antl eitect. �f—
License Class - Li nse No.�
Date �'� � 5'9 t � ���7
WORK 5' CQ VENSATION �E RATION
I hereby aftirm that I have a certiticate of consent to self-insure or a certificate
ot Workers' Compensation Insurance, or a certifietl copY thereof (SeCtion
3800, lab. rq1 ' (�in
Policy No. / � -�� -��d Jl )' Company �%�`%f � �Q�%Q't�
ertifietl copy is hereby fumishe
Certifi ca is ' tl with t city Builtll Di '
Date Applic ' '
EX PT N FROM WORKERS' CO NSATION OECLARA ION
(T is se ion neetl not be wmpletetl i he pevmit is to� One huntlretl ($300) or
less).
1 certify that in the performanCe ot th¢ work for which [his permk iSlssuetl, I
shall not employ any person in any'manner so as to become subject to the
Workers' Compensation Laws of Calitornia. , '
Date Signature
NOiICE: If, atter making this tleclaration, you shoultl become subject to the
Workers' Compensation provisions of the Labot Cotle, you muzt forthwith
comply with such p�ovisions o� this pe�mit shall be tleemetl �evoketl.
CONSTRUCTION LENOING AGENCV
I hereby affirm that there is a construction lendin9 a9ency for tne pertormance
of the wovk for wM1ich tnis permit is issuetl (Section 309] Civ. C.)
L.entler's Name �
Lentler'S AdCre55
OWNER BUILDER DECLARATION '
I hereby affirm that I am exempt from th¢ Contractor's License Law for the
followin9 reason (Section 7031.5 Business antl Professional Code: Any city or
county which requi�es a permit to constvuct, alte�, improve, tlemoiisn o� �epair
any structure, orior to its iszuance, also requires the applicant for such permit
to tile a signetl statement that M1e/she is lic¢n5etl pursuant to the provi5ions of
the Contractor'S License Law (Chapter 9(commencing with $ection 7000) of
Division 3 of the Business antl Professions Cotle) or that he/she is exempt
��;.,;�Jierefrom antl the basis for the alle9etl exemption. Any violation of Sectlon
;�+D31 5 by any applicant �or a permit subjects the applicant to a civil
-� ;�'¢ndlty of not more than five huntlretl dollars (§500).
❑ I, as owner o� the property o� my employees with wages a5 their sole
compen5ation, will tlo the work, antl the st�ucture is not intentletl o� offe�etl
for sale (Section 7044, Business antl Professional Cotle: Tne Contractor'S
License Law tloes not apply to nn owner of a property who builtls or improves
thereon, antl who tloes such work himself/herself or through his or her own
Employees, provitletl that such imp�ovements ar2 not intentletl or offeretl for
sale. If, however, the builtlinq cr improvement is soltl within one year of com-
pletion,-tha owner wlll M1ave [he burtlen of proving he/she tlitl not builtl or im-
�ove for the purpose oi sale).
LJ I, as awner of the property, am exclusiveiy tontractin9 with licensetl con-
tractorsto construct the project ISection ]044, Business antl Professions Cotle:'
The Contractor'S l_icense Law does not apply to an owne� of p�operty who
builtls or improves the�eon, antl who,wntracts for Such projects with a con-,
tractor(sl license pursuant to [he Contractor's License Law). I am aware that
proof o1 their Worker's Compensation insurance shoultl be provitletl to me.
❑ I am exempt untler Section B. & P. C. for this reason
Oate Owner
I herebvi certifv that I have rea
Drivers' LiceryE�or 55 �
�CMF 0865�46, rev. 4/84
f state that tne above
antl countv ortlinances
TVPE OF CONSTRUCTION Y1 NEW LJ AOD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p,# �()—�;
DESCRIPTION OF WORK/USE OF BLDG.
� ��/ S Main Building:
TYPEOFPERMIT GRADING FOUNDATION STRUCTVRAL T Front ��..�
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL � B Rear
❑ OTHER A
PROJECT DESCRIPTION SQ. FT. �� oCCUvarvC — C Right �! �•
K = ��
CONSTRVCTIONTVPE � VALUATION$ Z. g Left
ZONE GRADING CV. VDS. ACRES Ping. Ref. #D�,.g�
Remarks: p(� ,� p p � ��Q, �.j.(� Planning Notes: -7
Sink
kflow Preventer
kflow Irrigation
Dishwasher
Drinking Fountains
Floor Drains
Floar Sinks
GasService �-Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fee � $15
Boiler '
Duct- UnderGround
Duct-Strucmrel �
Duct-Ventilating .
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt ICBO #
Heating System & Ducting
❑ 4100,000 BTU O 100,000 BT
Reinspection Fee � $15
Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor
Showers
Service Sink
SewerCap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater �
Water Service
Issue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeretion System
❑aioo,000sTu ❑ioa,000
System Repair/Alteration
Issue Fee
EES
�.�' h� ���� i-:�.��i ' �
�
� � �9 Zone ���
Accessory Building:
� "
�7j� ParkingReq./Provided /Q �//)
Automatic Washer
Construc[ion Pole Sub.
Cooking Unit .
Dishwasher
Dryers ❑Gas ❑Elec
Fan
f.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator O0.5 KW C
$ 3 I
� - Reinspection Fee
FEES "
DEVELOPMENTSERVI
Zonin9 APProved BY_
Building Approvad By
APulication Issuad Bv—
$ 3
ELECTRICAL
Transformer ❑ 15�50,KW
❑ 50+KW
Meter ❑up LO 100 amps -,
Meter ❑over100amps
Sub Panel "
Motors O0.7 HP O1 h- B
Inc.Solar 09-15 HP �16-15+
Microwave
Pole Light
Sign
'Standing Sections
15 KW Trash Compactor
$15 luue Fee
FEES
$ 3
Z
O
I
N
G
R
E
Q
M
T
S.
SUMMARV OF TFEES
BUILDING PERMIT $ 2-, � `� SMIP $ ��
PLAN CHECK $ PERMIT
PLUMBING � $ ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM $
MECHANICAL $ TOTAL FEE $ � •
PLAN CHECK 25% $ �
N$TRUCTION AND PLANNING
.
'ROVqLS ' Permit #
moorarv Electric8l Service or Poli
2.
_ Date Inspector
:.y ,
%.
3:'Ele�$rical Conduit Utilify-Undrgrnd. �
r
4.' Electrical Conduit-Undrg'rnd.
-�5.;.Steel Reinforcement
6. ,�lectrical UFER Grnd. ; �
7; Footings � • �
8. Foundat�ion . 3
9. Water Pipe-Undrgmd. .
10. Structural Floor System •
ii. Property�Sewer�,Line&HouseConnection '
r
12. Sewer CaP ' - � ,,
13. Roof Drains � !/ .
14. Rough Plumbing '
15. Rough �lectrical-Conduit
16. Rough �lectric Wiring
17. Rough Wiring Sign •
18. Rough �lectrical-T Bar Ceiling
19. Rough Neating & Air Conditioning ,
20. Rough Factory Fireplace
21. Ducts, in Structure
22. Ducts, Ventilating
23: Gas Pipe-Rough & Test .
.�
24.:Roof Framing �
25. Roof Sheathing u �
26. T-Bar Ceiling (StructuraQ & Monocoat
27. ,Frame and Flashing .11
28. Lathing & Siding . - /�
29. Insulation 9
30. Drywall Nailing L
31c� Plaster Qrown Coat .
32. Electricyl Power Meter-Final
33. Final Electric
34. Final Haaiing & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or �nopy .
37. Final Factory Fireplace
38. Final Plumbing�,' . �
39. Water Service-Final :
40. Gas Service-Final
41. Solar pomestic-Final �
42. Backflow Preventer
43. Backflow Irrigation .. .
44. Landscape Irrigation SYstem
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed �S
49. Electric Release to Edison•
50. Gas Felease to Southern California Gas Co
51. CERTIFIC,9�sg OCCUPAN Y �
No. � Date�
✓�
v�-
u�
POOL �A
APPROVALS Permit# Date Inspector
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical8onding
56. Rough Plumbing & Pressure Test
57. APPROVALTOCOVER-GUNITE
58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, � Undrgrnd.
61. APPROVAL TO DECK -
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final �
65. Electrical-Final ,
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
71. Product Piping O Gas ❑ Oil '
72. Underground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes: Sly(&r /.i�`!'� �/� �GCi
� '
` ;.
/ '
�A
Applicant to fill in all spaces
CITYabF COSTA MESA CONSTRUCTION PEjQ� /MIT � �
�Projict Address � �"�� � Qo-�/
�pplicant's Mailing Addres
' Owner's Name '� Phone
Address !��o�uJOrf+-� A�l
Arch/Eng. License No.
Address
Contractor's Nam �� f' �S� %�� phone �`!�/���``�''���
Addresslmailing) �4��� s�[Ltn�..` �""P � lSZLThtI'lia..
Ciry Cicense No. ����OC�'. i
LICENSED CONTRACTOR DECLARATION
I hereby affirm [hat I am licensetl untler provisions of Charter 9(commencing
with iettion 7000) Ot DivisiOn 3 Of the Bu51ne55 antl Prof¢SSlons CoOe, antl
my licenze Is in full torce antl ei/ect.
IJcense C s �- Ice e �� �
Date��_ Signature
WORKE S COMPENSATION OECLARATION '
1 hereby altirm [ha[ I have a certifica�e ot mnsen[ to selt-Insure o� a ce�tlflt'ate
,ot workers' Compensation Insurance, or a cortl/ietl copy thereof (Sectlon
3800, Lab. C.) . '
Policy No. � Company
Cer[ifleA copy is hereby turnl5he0. '
Certifietl copy is filetl with the city Bulltlin9 Dlvlslon.
Date Appliwnt '
EXEMPTION�FROM WORKERS' COMPENSATION DECLARATION
(This sectlon neetl not �¢ completetl if [he permit 7z fOr One huntlr¢tl (E100) Or
less).
I certi/y that In the perlo�mance OI flt0 work 1or which this perm�t is i55ue0, I
snalt'not. employ any person in any r so as to��qqe e subj t to the
Worke o p ation Lnws of C f i�� � $-�
Date Si9na[u 'L�--" ��
'NOTI E: 1, after makirig this tlectaia on, you shoultl becoma subject to Ihe
workers' Compensalion pmvisions oi the Labor Cotle, you muze forthwlth
comply with such provisiOns or tM1is Oermll shall be tleemetl �evoketl.
CONSTRUCTION CENDING�AGENCV - -
I hereby alllrm tnat there Is a construction�lending agency for tne.perPormance
of the work (or which this permit is issuetl (Section 309] Civ. CJ
l.entler's Name
Lentler's Atltlress -
OWNERBUILDER DECLARATION � -�
I hereby atfirm thal I am exempt 1rOm N¢ Cont�ac[or's LlcenSe Lnw to� [ne
tollowing reason (Saction 7031.5,Business antl Professional Cotlu: Any cily or
county wM1ich requires a permit to construct, alter, imptove, Demolish or repair
any sVucture, prior to its Issuance, also requires the applicant tor su<h permlt
to file a�si9netl 5[atemenl that he/She Is Iicensetl pur5udnt to th¢ Provlsions oi
[ne Contrattor'S License Law (ChaO�er 9(wmmencin9 with Sectlon 7000) of
Division 3 0l the Bu5in855 antl Pfote55iOn5 Cotle) Or tha[ he/she is ex8mp[
theretrom antl [he ba51s tor the allegetl exemption. Any vlolation of SecHon
'03L5 by any appllcant tor a po�mit subjecls the appli<ant to a civil �
�enalty ol not more tnan tive huntlrotl tlollars (5500).
❑ I, as owner of tne property or my employces witn wages as their sole
comvenzation, wi11 tlo the work, antl the structure is not int¢ntletl or ofteretl
for sale (Section 7044, Business antl Profe55ional Cotle: The Confmctor's
LicenSe Law tloez not apply to an owner of a property who builtls or improves
thereon, antl who tloes sucn work himself/ner5eli"Or through his o� har own
employees, 0/ovitletl that Suth improvementz are not Intentle0 or offeretl for
sdle. I/, howev¢r, the bulltling or Improvemen[ I55oltl within On¢ yea� of com-
pletion, the owner wlll have the burtlen of provinq he/she 014 not builtl or im- �
p�ova tor the putpose oi sale�.
❑ I, as owner of tne property, am extlusively contracting wlth licensetl con-
. tractorsto constructthe oroject (Section 7044, Business antl Professions Cotle:
The Contracror's �icense Law tloes not apply to an owner of property who
builtls or improves [hereon, antl who conVactS fOr Such projeGts with a con-
Vactor(s1 license pursuant to the Contractor's License Law�. I am aware that
Oroof o( IM1ei� Worker'S Compensatlon Insu�ance shoultl bo provitletl to me.
❑ I am exempt untler Section �. B. & P. C. tor this reason
Date Owner ._
I hereby certify tha[ I have reatl this
information Is cor�ect. I agree lo cOmp
I$igna[ur¢� �• '
Drivers' Llcense or 55 �
those witM1in heavY bortler Iines antl si9n all appro0riale tleclarations.
TRACT NO. LOT NO. UN57 N!i -
TYPE OFCONSTRUCTION LJ NEW' U ADD LIALTERATION LJ REPAIR
❑ CONVERSION -❑ DEMOLISH ❑ OTHER � A p �6
DESCRIPTION OF WORK/USE OF BLDG.
' � S Main Buildi
E
TVPE OF PERMIT GRADING FOUNDATION STRUGTURAL T Front
❑ TENANT �ELECTRICAL ❑ P�UMBING ❑ MECHANICAL � B Reaf
❑ �OTHER � ' A .
PRQIECTDESCRIPTION Sa.FT. oCCVanrvCV C Right
K
CONSTRVCTIONTVPE VALUATION$ S Left
ZONE � ' GRADING CV. VDS. ACRES Ping. Ref. #
wemarks: - Planning Noces:
3ar Sinli
3ackflow Preventer
3ackflow Irrigation
3athtubs
�laritiers
7ishwasher
Jrinking Fountains
=1oor Drains
Floor Sinks �
3as Service �1IL12t5 �
Interceptors '
Kitchen Sink
Lavatories .
P—Trap '
Roof�Drains - '
Reinspection F.ee , $15
Duct - Under Ground
Duct-Strucwral �
Duct - Ventilating _
Exhaust System ❑ Multiple
Firepl/Fact.81LICB0# �
Heating System & Ducting
❑P700,000 BTU �100,000
Reinspection Fee �� $15
Pink - Accounfing; Goltlenrotl - Assessor
Showers
Service Sink ' '
Sewer Cap
Sewer Connection t
Solar Collectors
Solar Pipin9
$olar Tank
Swimming Pool w/Spa
Urinal - .
Water Closet
Water Heater
WaterService
Auto-Wash �
Issue Fee
�ANICAL
Hood or Type I ❑
Canopy Type I I ❑
Refrigeration Syrtem �
❑aioo,000sTu �ioo,000s=
System Repair/Alteration �
Fire Dampers �
Registers
ISSue F¢B
FEES
0658 4/p4/95
2one
Accessory Buildin9:
Parking Req./Provided
13e�]
Z
O
N
� - I
N
G
R
' E
Q
� M
T
S
ELECTFICAL � FEES
Automatic Washer � Transformer � 15-50 KW
. /
Construction Pole Sub. ❑ 50 + KW �`�
Cooking Unit � Meter ❑up to 100amps
Dishwasher � Meter ❑over100amps �
Dryers �Gas ❑Electtic Sub Panel
Fan • Motors �0-1 HP � 1%- 8
F.A.U. � Inc.Solar �9-75 HP �16-75+
Fixtures Miciowave � ' — —�
Device Boxes Poleli9ht � '
Outlets Range
Switches Sign
Garhage Disposal ;Standing Sections
Generator �0�5 KW �5�15 KW Trash Compactor
$'�
Reinspection Fee $15 luue Fee $ 3
FEES
DEVELOPMENTSEHVICESREDUIREMENTS:• �
Zoning Approved By Date �
Building Approvetl By � Date
Application Issuad By -Data_��
SUMMARV OF FEES
BUILDING PERMI7 $ � SMIP $
PLAN CHECK $ � PERMIT
PLUMBING � � $ ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $ �
, ELECTRICAL ' $ Q.CiO GRAOING $
PLAN CHECK 50% . $ MICROFILM $
MECHANICAL $ TOTAL FEE $ g' ���
$ 3 PLAN CHECK 25% $ '
•
,-,
� CC�NSTRUCTION AND PLANNING . POOL �,.PA -
� APPROVALS Permit# � Date Inspector qppROVALS Permit# Date Inspecror
J: Temporary Electrical Service or Pole <�q �� 52. Pool & Equipment Location
/
2. Soil Pipe-Undrgrnd. . 53. Steel Reinforcement
3. Electrical Condu�t Utility-Undrgrnd. 54. Forms .
4. Electrical Conduit-Undrgrnd. . 55. Electrical Bonding
5. Steel Reinforcement 56. Rbugh Plumbing & Pressure Test
- 6. Electrical UFER Grnd. 57. APPROVAI TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
� 8. Foundation 59. Gas Pipe, O Uniirgrnd., Test
. 9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, O Undrgrnd. �
10. Structurel Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection - 62. Backwash & Receptor-Final
12. Sewer Cap � 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final �
15. Rough Electrical-Conduit 66. Solar SVstem-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 Structu�e 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 f.7 Gas ❑ Oil
25. Roof Sheathing � 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27, Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric � Notes:
34. Final Heating & Air Conditioning '
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final _
42. Backflow Preventer '
43. Backflow Irrigation .
44. .Landscape Irrigation System
45. Sound Attenua[ion
46. Handirap Regulations ' -
47. fINAL STRUCTURE & BUILDING �
48. Special Requirements Completed
49. Electric Release t0 Edison � � � . ,
50. Gas Release to Southern California Gas Co ,
51. CERTIFICATE OF OCCUPANCY '. . - � . ,
i
j��o. ' Date
Applicant to fill in all ipaces except ihose within heavy bartler lines anE si9n all appropriate Geclaralions.
CITv oF COS7a ME CONSTRUCTION PERMIT
Project Address ��� Z O i%'� S�
�Applicant'sMailin9Address � zStlO C��-�Fb�lN�q �„�n�e,�
Owner's Name rS�M 9 p C^'�S i Phone _Gy�'G��
Addrew ��Z GrAP OL6ZA
Arch/Eng. License No.
Address
Contractor'sName �H'� ��bb Ca Pnone'43�5`�J`�'
Address Imailingl �300 CNLIF t, ivc hkn �N-
Ciry License No. ��/ .
LICENSE� CONTRACTOR DECLARATION . .
I hereby affirm that I' am'licensetl untler orovisions oi Charter 9(commencing
wit� section 7000) of oivision 3 of the Business antl Pro�essions Cotle, antl
my license is in full force antl eflect. /
License Class l.i ns lo. � S�9 Q
Da[¢����5'r Signa)ure �
WORKERS'COMPENSATION OECI RATION
1 hereGy affirm tM1at I M1ave a certifi<ate of consen[ to self-insure or a certi/Icate
�f Workers' Compensation Insurance,, or a certifietl copy thereof (Sectlon '
B00, Lab. C.)
Policy No. ���—�� Company STn'f'E FV��
Certifietl copY is hereby furnishetl.
CertifieC copy is filetl with the city Bu tling ivisi �
ate - Applicant �� � �
EXE TI N�RKERS' COM NSATION DECLARATION ,
(Tnis section neetl noi be completetl if the permit is tor one huntlretl ($100) or
less). � ' . .
I certify that in the performance of th¢ work for Which tM1is pe�mk is issuetl I
sM1all,not em0loy any pe�son in any manner so as to become Subj¢ct to t�e
workers"Comoensation Laws ot Calitornia. ,
Date Si9nat�re ,
`NOTICEi If, aiter making this declaration, you shoultl become subject to the
Workers' Compensation provisions ot the Labor Cotle, you must fortnwith .
comply with�such provisions or tM1is permit �shall be tleemetl revoketl.
CONSTRUCTION ,LENDING AGENCV '
1 hereby a/flrm that IM1ere is a const�uction Ientlin9 agency tor the perPormance
ot the work for which thi5 permit is issuetl (Section 3097 Civ. CJ.
Lentler's Name
Lentler's Atldress
OWNERBUILDER OECLARATION �
I hereby affirm that I am exempt trom the Contractor's License Law for the
following reason (Section ��031.5 Business antl Vrofessional Cotle: Any city or
county whicb requires a permit to cOnst�uct, al[eq improve, tlemoli5h or repai�
any ztruc[ure, prior to its issuance, also �equires the applicant fOr sucb pe�mit
to fiie a si9netl statement that he/she is licensetl pursuant to tne provisions of
ihe Contractor's License Law (Chapter 9(commencing witM1'Section ]000) of
Division 3 of the Busine55 antl Professions Cotle) o� that he/she is exempt
`herefrom antl the basis fo� lhe allegetl exemption. Any violation ot Section
13L5 by any ap0licant Po� a permit subjects tne applicant to a civil
.nalty of not more than five huntlretl tlollars (g500). '
� I, as owner ot the property o� my employees with wa9es a5 tnei� sole
Cortlpensation, will tlo the work, and the�structure is not intenGetl or of(eretl
for sale (Section 7044; eusiness antl Protessional Cotle: The Contractor's
License Law tloes not apply to an owner ot a prope�ty who builtls or improves
thereon, antl who tloes such wo�k himselt/Ite�selt or through his or her own
employees, provitletl that such improvements are not intentletl or offere� for
wle. If, however, the Ouiltling or improvement is �sol� within one year ot com-
plelion, ihe owner will have the bu�tlen of Proving he/she tlitl not builtl or im-
prove for the purpose o( sale�. �
❑ I, as owner of the property, ain exclusivety tont�acting with IicenSetl con-
Vac[ors to construcl tne project (Section ]044, Business antl Professions Code:
The Contractor's �icense Law tices not apply to an owner of oroperty who
builtls or improves� thereon, antl who contracts tor suc� projects with a con-
tractor�sl license pursuant to the ConVacror's License Law). 1 am aware tbat
proof of [heir Worker's Compensation insu�ance shoultl be ptovitletl ta me.
❑ I am exempt untler Section � B. & P. C. for this reason
Date � Owner
I her¢by certify thal I.have reaa this�application and state that the above
in/ormation Is mrrecL I agree to comply with all city antl county ortlinances
antl State laws relating to builtling construttion, an0 hereby autho�ize repre-
sentafives o( th's ty to ente upon ne above-mentionetl o�operty toL
inspection purp es /� '� , � (/
� Signature� �� � (� Date�
Drivers' Licens! or 55��,}_� �
U -I�/0 '
TYPE OFCONSTRUCTIO NEW ADD ALTERATION REPAIR_
❑ CONVERSION �OEMOLISN ❑ OTHER A p #
DESCRIPTION OF WORK/USE OF BLDG.
' S Main Buildi
E
TVPE OF PERMIT GRADING FOVNDATION STRVCTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear '
❑ �OTHER ' C Right �
PROJECT DESCRIPTION 5Q. F7. OCCUParvcv K
CONSTRUCTION TVPE VALUATION $_ I� g 1-eft
ZONE GftADING CU.YDS. ACftES Ping. R¢f. q�
Remarks: �� . Planniny Notes:
3ar Sink
3ackflow Preventer
3ackflow Irri9ation
3athtubs
Clari(iers
�ishwasher �
7rinking Fountains
Floor Drains '
Floor Sinks
�as Service
Interceptors
Kitchen Sink �
Lavatories
P—Trap
Roof Drains
Reinspection Fee
Duct - Under Ground �
Duct - Sttuctural
Duct - Ventilating .
Exhaust System ❑ Multiple �
Firepl/FactBIt.ICBO# �
Heating System & Ducting
❑aioa,000 eru �ioo,000er
Nainspection Fee � $15
` CMF 0865-46, rev. 30/84 wnite � Builtling; Ganary - qpplicanp Pink - Accounting; Goltlenrod - Assessor
i
Showers
Service Sink
Sewer Cap
Sewer Connection
Soiar Collecmrs , _
Solar Tank
Swimming Pool w/Spa �
Urinal
WaLe! CIOS¢S
Water Heater
Water Service
Auto;Wash
w
Issue Fee
Hood or, Typel ❑
Canopy Type 11 ❑
Refrigeration Sys[em
❑0-100,000 BTU ❑ 100,000 BTU
System Repair/Alteration
Fire Dampers �
Registers
Isue Fee
FEES
$ 3
$ 3
Automatic Washer
Construction PoleSub.
Cooking Unit �
Dishwasher ' �
Dryers �Gas ❑Elec'
Fan
F.A.U.
Fixtures
Device 8oxes �
Outlets
Switches
Garba9e Disposal
Generator �0-5 KW �
8465 3/01/85
Zone
. Accessory Buildin9:
Parking�Req./Provided
i
� ELECTRICAL .
'Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑'up to 100 amps �
Meter ❑over100amps� -
�� Sub Panel . '
. Motors 041 HP O1 h- 8
Inc.Solar�09-15 HP �16-15+
5-15 KW
Pole Light
Range
Sign
', Standing Sections
Trash Compactor
� Reinspection Fee I$15 � I luue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved By
Appliwtion Issued 6y �M
25a0G TL
$ 3
SU ARV OF FEES � � �
BUILDINGPEFMIT $ ' �� SMIP $ �
PLAN CHECK $ PERMIT ' �
PLUMBING $ S OO ISSUANCE $ -
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING ,$ �
PLAN CHECK 50% $ MICROFILM $
MECHANICAL $ TOTALFEE $ � '�Q
PLAN CHECK Z5% $ � ,
Z
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1
N
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Q
M
T
S
�
� CONSTRUCTION AND PLANNING ;; � POOL ,PA
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Insper.rnr �
i. Tempor,ary ElectricBl Service or Pok . ' 52. Pool & Equipment Location
H
r2. Soii PipE-Undrgrnd. � � 53. Steel Reinforcement �'
-3. Elecfric�l Conduit Utility-Undrgrnd. . � 54. Forms
-4�„Electrical Conduft-l�ndrgrnd. �� � 55. Electrical Bonding � � - ;��'y
� 5'" Steel R�nforcement 56. Rough Plumbing & Pressure Test .
6�'•Electrical UFER;;Grnd. 57. APPROVALTO COVER-GUNITE �
7�� Footings -- 58. Electrical Conduit-Undrgrnd. '"�' .
�
� 8. Founda[ion �. - �� ,�t 59. Gas Pipe, O Undrgrnd., Test
�! Water Pipe-Undrgrnd. ' - ' . 60. Backwash Lines, P-Trap, O Undrgrnd.
10. SLiuctural Floor Sys'tem �� � �. 61. APPROVAL TO DECK �
11. Prppe�tY Sewer Line & House Cqnnection - � � 62. Backwash & ReceptorFinal �
12. Sewer,Cap �' 3 � f j�,� � 63. Heater & VenrFinal .
13. Roof'Drains , . 64. Plumbing System - Final "
14. RougfiPlumbing�. 65. Electrical-Final �'�
15. RQugh Electrical-Conduit 66. Solar SYstem-Final ,
16. �Rou9h Electric Wiring ' � 67. Fencing & Access Approval �
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING �
18. Rough Electiical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure . 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil
23. Gas Pipe-Rvugh & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank �Gas �OOiI .
25. Roof Sheathing � 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat � 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & 5iding � 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
• 30. DrYWall Nailing • HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSRECTION
.�32. Electrical Power Meter-Final 80. FOOD CERTIPICATE 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 Irriqation System
45. Sound Attenuation "
46. Handicap Regulations � �
47. FINAL STRUCTURE & BUILDING �
,
48. Special ReqUirements Completed ,
49. Electric Relsase to Edison • '
50. Gas Release to Southem Calitornia Gas Cn � � ,
57. CERTIFICATE OF OCCUPANCY . . . .
� No. � Date .
' �� �' AOp��cant to fill in all spaces except �bose within beavY Oortle� Iines anC sign all appro0riate tleclaratlons.
LITv�oF cosrA MESA CONSTRUCTI�N PERMIT /�
Project Address ��Q C • u� /'/
P licant's Mailing Address I�/����{.�1�Y�r,,��cn��PovrR
�., O�art�e ' �� Sr f �^'"�""'7�+ Phone
Address 3S '�% %_�• ��
Arch/Eng. �A•"'"� LicenseNo. 3/����
Address p ��
Contracror'sName ✓�� '� '�"� Pho �'�
��Address�mailing) �534 �1�-D�iQC�J, /9'
City License No. �J� �
LICENSED CONTRACTOR DECLARATION
1 hereby af(i�m tha[ 1 am Ilclnsetl untler provi5ion5 ot Charte� 9(commencing
with sectlon 7000) of Division 3 of tne Business antl Professions Code, antl
my license is In tull foC[e xntl eifect. ... ..��rf�
�ate "1 �.1!/✓�i' Si9nature
I hereby aRirm that I have a certiticate ot consent to self-insure or a certificate
of Workers' Compensalion Insurance, or a certifietl mpy'thereot (Settlon
I800, l.ab. C.) � -- -
Policy No. - Company
Certitietl copy is hereby lumishea. �
Certi�t"e�,�coy� I�71etl with lhe dty il ' g ivision
Date_ 1i�7".`_ AOPlicant • �
EXEMbTl04 FROM WORKERS'C PENSATION DECLARATION
(ThiSsection neetl not be completetl i M1e pe�mit is fo� one ituntlretl (E300) or
less).
I[ertify thal in the pe�formance of th¢ wo�k tor which this perm�t is Issuetl I
shall no[ ¢mploy any person in any manner zo as to become subjec[ to t�e'
Workers' Compensation Laws oi Califomia. ,
Date 519nature
�NOTICE: If, after making (�is tleclaration, you shoultl become subjec[ to [he
Waiker5' COmp¢nsation provi5ion5 of the Labor Code, you must farthwith
comply with suc� p�ovislOnz Or thiz p¢rmit Shall be tleemed revoketl.
CONSTRUCTION LENDING�AGENCV - -
I hereby aifirm tnat tnere is a consiruction lentling agency for Ihe p¢r(ormante
oi the work tor whicn lnis permit is issuetl (Section 3097 Civ. C.)
Lentllr's Ndm¢
Lentl¢r'S Atltlre55
OWNEP BUILDEN DECLARATION
I hereby afflrm tnat I am exempt from the Contractor's Ucense Law for the
following reason (Section 7031.5 Business antl Professional Cotle: Any ci[y or
County which rEqui�es a pe�mlt to const�uct, alter, improve, tlemolizh or �epai�
any structure, prior to It5 issuance, al5o requires the appliwnt for such permit
to file a signetl stalem¢nt that he/She is licensetl putsuan[ to th¢ provi5ion5 of
the Conbactor's License Ww (CbaO�er,9 (commencing with Section ]000) of
, pivision 3 of the Bu5ine55 antl Professions Cotle) or that he/she is exemp[
,;�(,herCfrom antl the basis fo� t�e allegetl exemption. Any violation ot $ection
��,.,.'J31.5 by any aoo�icant tor a permit subjects tM1e applicant to a civil
�^'ndlty of not more than five huntlretl �011ars ($500).
��� I, as owner of the property o� my employees with waqes as thei� sole
com0en5ation, will tlo the wo�k, antl the 5[tucture is not intentled or ofter¢tl
for sale (Section 7044, Business antl Profesvonal Cotle: The Con[ractor's
License Law tloes not apply to an owner ot a prope�ty who bWltls or improves
thereon, ana who Aoes such work himselt/herselt or through his or her own
em0�oyee5, provitletl lhat sucM1 improvements are mt intentletl or offeretl for
sale. If, howav¢r, Ihe builtling o� imp�ovement is soltl wilhin one year of com-'
pletiOn, the owner will nave the burtlen of proving h¢/She tlitl mt builtl o� Im-
provG tor the purpo5e of sale). .
❑ I, as owner ot [hE property, dm exclusively contractin9 with li<lnsetl cOn-
tractors to construct the project (Section 7044, Business antl Professlons Cotle:
The ConVactor's License Law tloes not aoP�Y to an owner of property who
builtls or imD/oves thereon, and who contracts for suth p�oje[ts with a con-
trat[or(sl license pu�suant�to the Contractor's Litense Law). I am aware�that
prool o( lheir Worker'S Compen5ation insurance shoultl be Orovitletl to me.
❑� I am�exempt untler Section B. 6 P. C. tor Ihis reason
Date ' pwner
1 hereby cerlity ihat I have reatl [his application antl state that Ihe above
information is mrrect. I agree to comply with all city antl county ortlinances
antl state laws relatin9 �o builtling conSVuciion, and hereby authoriEe re0re-
sentatives of t�is city [cy,ent j upon the abgve-mentionetl property for
Signature _�/�L�M
Otivers' LifAe�se or 55
CMF OB65-46, rev. ]0/84
TVPE OF CONSTRUCTION �NEW LJ ADO LI ALTERATION IJ REPA1 R —
❑ CONVERSION ❑ OEMOLISH ❑ OTHER Ap #
DESCRIPTION OF WORK/USE OF BLDG.
S Main Building:
TVPE OF PERMIT GRADING FOUNDATION STRVCTURAL T FrOnt
❑ TENANT ❑ E�ECTRICAL J�.PLUMBING ❑ MECHANICAL B Rear
❑ OTHER � g q{ght
PR0.IECTDESCRIPTION Sp.FT. OCCVPANCV ' K
CONSTRUCTIONTVPE VALUATION$ S Left
ZONE GRADING [U.YDS. ACRES p�ng. Ref. #
Remarks: /�! 7� �.� �+ g Planning Notes:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers �
Dishwasher
Drinking Fountains
Floor Drains
Floor $inks
Gas Service Outlets
Intercepmrs �
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fee
Boiler
Duct- Under Ground
Duct � Strucmrel
$15
Exhaust System ❑ Multiple ❑
Firepl/Fact Blt. ICBO #
Heating System & Ducting
❑ ai oo,000 sru O i oo,000 sr
Reinspaction Fee � $15
Wni[e - Builtling; Canary - Applitant; Pink = Accounting; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet �
Water Heater
Water Service
Aum�Wash
Issue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑o-ioo,000eru ❑ioo,000
System Repair/Alteration
Fire Dampers -
Registers
Issue Fee
FEES
Auromatic Washer
` ,I �Construction Pale
H- Cooking Unit
Dishwasher
$ 3
$ 3
0109 3/26/85
0 2one
Acceuory Building:
Parking Req./Provided
ELECTRICAL
Trensformer ❑ 75�50 KW
❑ 50+KW
Fan '
F.A.U.
Fixtures
Device Boxes
Outlets '
Switches
Garbage Disposal
Generator �0�5 KW �5-15 KW
Meter Llup to 100 amps
Me[er ❑over100amps
Sub Panel
Motors �0.1 HP � 7 h- 8
Inc.Solar 09-15 HP �16�15+
Microwave �
Pole Light
Range
Sign
; Standing Sections
Tresh Compactor
I Rainspaction Fee �$15 I � Issue Fee
DEVELOPMENT SERVICES RE�UIREMENTS:
Zoning Approvad By
Building Approved By
Applintian luued By . ��� i
30o0i.
FEES
$ 3
Z
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1
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G
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Q
M
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$
' SUMMARV OF FEES
BUILDINGPERMIT y SMIP $
PLAN CHECK $ PERMIT
PLUMBING 3 �� ISSUANCE $
PLAN CHECK 25% $ �i6 O ENERGV P.C. S
ELECTRICAL $ . GRADING $
PLAN CHECK 50% g MICROFILM $ -� �' /��
MECHANICAL S 707AL FEE � $ -�
PLAN CHECK 25% $ �
�
CO STRUCTION AND PLANNING POOL ,PA
��AP VALS - Permit� Date � Inspector p�ppROVALS Permit# Date Inspector
�,
t. TemG rary Electrical Ser�ice or Pole -w 52. Pool & Equipment Location
•2. So�l Pipe-Undrgrnd. �� Z�(�� L� 53. Steel Reinforcement '
3. Electrical Conduit Utility-Undrgrnd�. '. 54. Forms .�
4.' Electrical Conduit'-Undrgrnd. '�' � 55. Electrical Bonding
r
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6� Electrical UFEFi Grnd. . 57. APPROVAL TO COVER-GUNITE �
7: Footings ��, _. - - 58. Electrical Conduit-Undrgmd. �
8., Foundation �� 59. Gas Pipe, � Undrgrnd., Test " _f',
9. Water Pipe-Undrgrnd. ?�j�/�r �,ti%� 60. Backwash Lines, P-Trap, � Undrgrnd. �'
10. Structural Floor System ' 61. APPROVAL TO DECK •
11. Property Sewer Li�e& HOuse Connection 3���� � 62. Backwash & Receptor-Final ���
12. Sewer Cap' � ' , •i _ �, 63. Heater & Vent-Final �
,�� .
7�3:' Roof Drains � •.. 64. Plumbing System - Final.
14. Rough Plumbing � � Ij ��' �'S� .�� 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 Electrica6T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace •, APPROVALS Permit #
21. Ducts;in Structure 70. Underground Hydro
22. Ducts, Ventllating 77. Product Piping O Gas ❑ Oil
23 `�Ges Pipe-Rough & Test L. f'/ � f' j�� 72. Underground Flush
24. Roof Framing � 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheaihing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
2S. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80�. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test � �
�
36. Hood or Canopy �
37. Final Factory Fireplace
38. Final Plumbing ,` �� �
39. Water Service-Final �� Y� � �
40. Gas Service-Final
41. Solar pomestic-Final .
42. Backflow�Preventer �
43. Backflow Irrigation � -
44. Landscape Irrigation SYstem �
45. Sound Attenuation
46. Handicap Regulations � ,
47. FINALSTRUCTURE&BUILDING �
48. Special Requirements Completed , � �
49. Electric Release to Edison -
50. Gas Release to Southern California Gas Co ''
51. CERTIFICATE OF OCCUPANCY .
No. ' Date � �
� wOP��eanq�o nu in an soaces exeept tnosa within neavy uoraer Iinas ane sign all ap0�opriate aeclarauons. L�E�LO 5/06/y5 � � I 9o^c5�
CITY OF COSTA MESA PER IT NO. TRACT NO. LOT NO. BLD . �� '
' CONSTRUCTION PERMIT � g � 5 �97�p
PfojeCt�Address TYPEOFCONSTRUCTION NEW� ADD ALTERATION REPAIR
Applicant'sMeilfncg�A�ddress. ❑ CONVERSION ❑ DEMOLISH ❑ OTHER Ap �6 Zone
Owner'S N3ma �..3Y '� £R PhOn�����w DESCRIPTION OF WORK
S Main Building: Accessory Building: Z
Addreu �'�Z ��ROo2a47F I�Li�.� T O
I – N TVPE OF PERMIT GRADING FOUNDATIOfy, STRUCTV RAL T Fron[ ry
��-. Afch/Eng. L'ICenie No. ❑ TENANT ❑ EIECTRICAL ❑ PLUMBING � MECNArviCAL B Rear �
�Address ❑ ,o7HER ' A' N
Contractor's Nam I1 hone�� PROJECT DESCRIPTION 5[�. F7. oCCUPnNCV � A�9ht _ G
��6 ^' ONA�AJ/�i NELCJ�IR% REIIGY CONSTftUCT10N TYPE VALUATION $ - g Le([ R
1 Addre55 (meiling) L/�", E
' ZONE GRADINGCU.�'OS. ACRES �
�Ciry Licenso No. ��9L7 �/ Ping. Ref. # Park. Fees $
LICENSED CONTRALTOR DECLARATION Remarks: � � Parking Req./Provided u
1 n¢reby alfirm [hat I aT IlcensGtl untlBr provislons of Charter 9(commencing p
wlth settion 7000) of Dlvislon 3 ot [ha Business antl Professlonz Cotle, antl � U5C o( Building: E
my Iicansa is In full forcej� af�f t.�.-� '/
LJcen Ci s--•— ✓�� ,¢�y�cense No. �"z�b�� PLUMBING FEES P�anning Notes: M
Date � qg�.r��.o %...[�/�l�f�J/I 7!_ E
WORKERS' COMPENSATION DECIARRTION Bar Sink Showers N
T
L�;j�ereby aftirm tnat I nave a tartltiwta of consent to salf-insure or a cerHflcate Beckflow Preventer Service Sink S
Workers' Compensa[lon Insurance, or a cer[ifletl copy t�ereot (Section •
o`,�'£�00, Lab.� /,��rQ/ p�O ���A'L Backflowlrrigation � SewerCap ' ELECTRICAI FEES
POIICY NO. �(OCJ J ComPanY Z �� . '
[] Cartlfietl copy Is hereby furnlshetl. Bathtubs $ewer Connection ��. qutomatic Washer Transformer ❑ 15-50 KW
J11 �rUti _ P Is i a witn tne city Builein i' ❑ 50 + KW
bate Appiicant Clarifiers Solar Collectors � Construction Pole Sub.
EXEMPTION F0.0M WORKERS' COMVEN A I DECLARATION Dishwdsher ' Solar Pi in
(This saction neetl not be completetl if tne permit is for ona huntlratl (E300) or P 9 /' CoOking Unit Mete� �up to 700 amps
less). Drinkin Fountains
1 certHy thal in t�e periormance ot [he work tor whlch this perm�t is Issuetl I 9 Solar Tank .Dishwasher Meter �over 100 amps
shall not amploy any person In any manner so as to become subject to t�e
Workers' Compensatlon Lawz of Calitornia. Floor Drains Swimmin9 Pool w/Spa Dryers �Gas ❑Electric Sub Panel
Date Si9nature
NOTICE: If,�atter making this tleclaration, you shoultl become subject to the FIDotSinks . Urinal Pan MOtorS �61 HP �1X-B
Workers' Compensation provislons of the Labor Cotle, you must tarthwith
comply wlth such provisions or tnis permlt snall ee tleemea revokea. GasService Outlets Water Closet F.A.U. Inc.Solar 09-15 HP �16-15+
CONSTRUCTION LENDING AGENCV
I hareby tfllrm thdt thBf815 a COnStfuction Ientling agency fol the peffofmant8 IfItEICEptOfS WdtCf HEdt2f FiXtuf¢5 MictOwdv¢
of tho work tor whlch tnis permit is issuetl (Secflon 3097 Civ. C.)
Lenaer's Nama Kitchen Sink Water Service Device Boxes Pole Light
Lantlar'S ACtlrezs Lavatories
OWNE0. BUILDER DECLARATION OUtletS Range
I hereby a(firm that I am exempt lrom the Contractor's License Law for the p—Tra
followin9 �eason (Sectlon 7031.5 Bu5lness antl Professional Cotla: Any city or P Switches Sign
county which rapuires a permit to construct, alter, imprave, tlemollsn or repair
any structure, prlor to Itt issuanca, also requlres the appllcant for such permit Roof D�ainS � ' Garbage Disposal Standing Sections
to file a signetl Statement that he/sne is Iicensetl pUrsudnt t0 th< provi5ion5 Of
the Contractor'S lJcanse Law (Chaptar 9(commencing with Sectlon 7000) of
,^'vislon 3 of the Buslness antl Pro/essions CoCe) or that ne/she is exempt ' Generator 00.5 KW �5�15 KW Trash Compactor
,'��,�1��efrom antl tne basis for the alle9atl exemption. Any vlolation of Section
,(��4�`�3.5 by any applicant tor a permlt suC�ects the applicant to a civil
`� Ei.�(alty of not more than five huntlretl tlollars ($500). � ReinSpection Fee $25 laue Fea $ 3
b I, as owner ot tha property or my omployees with wages as their sole Reinipaction Fee $25 �ssue Fee $ 3
tomDensation wlll tlo tne work, antl the structura is not Intentletl or offerea MECHANICAL FEES
for sale (Sec4lon 7044, Buslnass antl� Protezslonal Cotle: The Contractor'z - PUBLIC SERVICES REQUIREMENTS:
Llcense Law tloes not apply lo an owner of a properry wno bulltl5 or Improves goiler � Hood or Typ2 I
thefaon, dntl who tloe5 Such wOrk hIrt1581f/helself al IhroU9h his o! het own �� ZOning ApplOVBd By— AdtB
amploy aes, provi0etl tM1at SucM1 Improvemants are not inie�tletl o� ottGretl tor Cd�Opy Typ¢ II
sale. If, �owever, tho builtling or improvament is soltl within one year o1 <om- Duct - Under Ground � Building Approved By Date
Dletlon, the ownar will have the burtlen of proving he/she tlitl not builtl or Im- J
erove for ene purpose ot sale). Duct - Structural Refrigeration System Applieation laued By ,., Dat
LJ I, as owner of the property, am excluslvely contracting with Ilcensetl con- ❑0.100,000 BTU ❑100,000 BTU
tractors to construct the project (Sactlon 7044, Business antl Professlons Cotle: Duct - Ventilating � SUMMARV OF FEES '
The Contractor's License Law does not apply to an owner o( property who BUILDING GERMIT $ SMIP
bulltls or Impraves thereon, antl who <onfracts tor such projects with a con- Exhaust System ❑ Multipl¢ ❑ System Repair/Alteration $
tractor(s) Ilcense oursuant to tne Contra<tor's Llwnse Lzw). PLAN CHECK $ PERMIT
❑ I am axempt untlar Section B. & P. C. for this reason Firepl/Fact. Bit. ICBO # PLUMBING $ ISSUANCE $
Date owner � ting System & Ducting PLAN CHECK 25% $ ENERGV P.C. $
1 hereby cartlfy that i have raad this appliwtlon antl state that tha abova ` 4100,OOOBTU �100,0008 ELECTRICAL $ GRADING $
Informatlon is corract. I agree to comply wlth all <Ity and <ounty ortlinances ��
antl state laws ralating to bulltlin9 constructlon, antl hereby aulhoriza reDre- MICROFILM $
sentatives of t�is Uty ter upon t above-mentionatl property for 3 Tf� d£N TS � P�N CHECK 50% '$
Inspectlon purposes.
�� � MECHANICAL $ � � — TOTAL FEE $ �
Slgnature Date Reins e[ion Fea
Drlvers' Ucense ar 55 qF Pa -'$25 Issue Fee $ 3 PLAN CHECK 25% $ ��3 •��
CMF 0865-46 rev. 12/83 White - BUIItlin9; Canary - AGPliwnt; Pink - A<counting; Goltlenrotl - Assessor � � -
TL
`' = CONSTRUCTION AND'PLANNING 1 . POOL 'A � -
APPROVALS Permit # Date Inspector p�ppROVALS Permit # Date Inspector
� 1. Temporar'y Electricgl Service or Pole � 52. Pool & Equipment Location
� 2. Soil Pipe-Undrgrnd. - ! �, 53. Steel Reinforcement
3" Electrical Conduit Uti�ity-Undrgrnd. ' 54. Forms � -
4. Electrical Conduit-�Jnd�grnd. �� � 55. Electrical Bonding . '�,
5. Steel Reinforcemeni /� ', � 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. : 57. APPROVAL TO COVER-GUNITE �
•. i
7. Pootings - ' � � 58�. Electrical Conduit-Undrgmd. . �
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 s 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 Ba� Ceiling' '. � 69. POOUSPA SYSTEMS F,INAL �
19. Rough Heating & Air Conditioning ,�/�`�s L�� FIRE DEPT. REQUIREMENT :. , ��
20. Rough Factory Fireplace ' APPROVALS Permit # ,
21. Ducts, in Structure �,• 70.� Underground Hydro � �
22!Ducts, Ventilating _ . ��� dS C.tLO 71. Product Piping OGas! OOiI .-
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 Standpipe � ,.
.. 28. .Lathing & Siding , , . 77.� FIXED SYSTEM FINAL �
29. Insulation � - 78. FIRE PREV. FINAL �
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat � 79. FINAL INSPECTION �
32. Electrical Power Meter-Final � 80. FOOD CERTIFICATE ISSUED • '
- 33. Final Electric Notes:
34. Final-Heating & Air Conditioning � �
35. Final Gas�Pipe-Test . , .
36. Hood or Canopy
37. Final Factory Fi'replace �
38. Final Plumbing ,
39. Water Service-Final �
40. Gas Service-Final ,
41. Solar pomestic-Final - � .
42. Backflow Preventer � �
43. Backflow Irrigation
44. Landscape Irrigation System � .
45. Sound Attenuation - �
46. Handicap Regulations � ' . ,
47. FINALSTRUCTURE&BUILDING � .
48. Special Requirements Completed�
49. Electric Release to Edison , i ' �
�
50. Gas Release to Southern California Gas Co � �
�. 51. CERTIFICATEOF�OGCUPANCY - � - �� ;
n ,.
� No. ' � ' Date , +
ADOlicant to fill In all spaces except those within neavy oorEer Iines an0 zign a1l approvriate aeclarationz.
CirV�OF COSTA MESA CONS RUCTION PERMIT
' PrajectAddress �.5� .�.� �i�e.�
Applicant's Mailing Address I^-� '
Owner's Name � �✓� � f � � ❑hone
Addiess,
Arch/Eng. _ License No.
Address
Contractor's Name��A�/`�'�/+ �- �" -S S E�e �phon
Address Imailingl.� V b S� E.' i�'(f2 . isg•�
City License No. � O a'�
LICENSED CONTRACTOfi DECLARATION
1 her¢by affi�m Ihat 1 am licensetl untler provisioni of Chart¢r 9(commencing
WI(h SBC��00 %QO�) 01 �IVISIOII J Of [hC BUSIpQ55 dOd Pro�¢551005 COtlG, d�tl
my Ilcense is in fu11 to�i ce antl ettect. c
Li<tnse las `� �� icen N �SU
Date - Si9nature
WOR ERS' COMPENSATION DECLARATION
I h¢reby aftirm thal I have a certificate of mnsent to selt-insure or a certificdte
of Workers' Compensation Insurance, or a certliietl' copY ��ereof (Sectlon
'�800, Lab. C.) . � � �
�olicy No. Company
8 Certifietl copy is hereby furnisnea. ' � '
Certifietl copy is filetl with the city Builtlln9 DlviSion.
oate Applicant �
EXEMPTION FROM WO(3KER5' COMPENSFTION DECLARATION
(Thi55eCtion neetl not be completetl if the permit I5 tar One huntlred ($100) or
less�. ,
I certity [hat in the per(ormance Of th¢ work fo� which this perm�t is i55uetl I �
shall not emplo an person in an n r so to ec sub� to t�e
Workers' C n ryLa ws oi Ca " o
Y Y Y
Data �%%���Signatur • / ��
'NOTIC��If, afl � making this tle[lara�on, you Shoultl become subject [o the �
Workers' Compen5ation provisionz of the t.abor Cotl¢, you must forthwilh
cOmply with SucM1 p�ovisions o� this pe�mit sitall be tl¢emetl rewketl.-
CONSTRUCTION �ENDING AGENCY •
1 nereby afflrm tnat there is a conslruction lentling agency tor the performance
of iM1e work for which this permit is issuetl (Section 309] Civ. C.)
L.entler's Name
Lentler's AtltlreSz
OWNER BUILOER DECIARATION . ' ' �
I �ereby affirm that I am ezempt from the Contracror's License L.aw for the
following reason (Section ]031.5 Business antl Protessional Cotle: Any city or
county which requi�es a Oermit to construct, alter, improve', Gemolish or repair
any structure, orior to Its issuance, also requires tne apo��cant (or such permit
to tile a signetl Statem¢nt thd[ he/she Is licensed pursuant to lh¢ provi5ions of
the Con[rac[or's Li<ense Law (Chapter 9(mmmencinq with Sectlon 7000) of
Divlsion 3 Of the Busin¢ss antl Protession5 Cotle) or (haf h¢/zhe is exempt
ther¢trOm antl the Da5i5 fo� the allegetl ezemptiOn. Any vlolation ot Seclion
931.5 by any a0���can( (or a, permit suDjects the aOP�icant to a clvil �
:nalty of not more than five hundretl dollars (g500). �
.� 1, as owner of fh2 prope�ty or my employees wi[h wages as lheir Sole '
compensa[iOn, will tlo the work, antl [he st�uctu�e Is not intentletl Or off¢rCtl
tor ule (Section ]044, Business antl Pro(essional Cotle: The Contractor'S
LicanS¢ Law tloes not apply lo an owner of a property who builtls or improv¢s
thereon, ana who tloes such work himself/herseli or through his o� her own
employees, p�ovitletl that zuch im0�ovemenls are not intenCetl or offeretl for
sale. If, howev¢r, [he builtling or improvement is soltl wkhin one year ot com-
pletion, the owner will have the burGen ot proving he/she aitl not builtl or Im-
ptOve to� the purpOSe of sale).
❑ I, as own¢r of [he pro0e�ty, am eztlusively cont�acting with lic¢n5etl Con-
tractors to construct the Oroject (Section ]044, Busine55 antl Proteszions Cotle:
The Convactor'z License Law does mt apply to an owner of property who
builtls or impwves fhereon, antl who contracts for such projecti with a mn-
tractor(s1 license pursuani�td tne Contractor's License Law). 1 am aware tnat
proof o/ their Worker's Compensa[ion insurance shoultl be provitletl t0 me.
❑ I am exempt untler Sectian . B. & P. C. for this reason
Date Owner
I hereby certify Ihat I have reatl IhiS application antl sta[e that tne above
informaHon is correct. 1 agree to comply with all city antl county ortlinances
antl state laws relating to buitding construction antl hereby authorize repre-
sentatives of is�[o ep9e�ivpon e above-mentionetl property for �
inspeclion r s �!i /�J/ � �
Si9nature /`� C.p' oate� r[+
Drivers' LicenSe or 55 �
TYPE OF CONSTRUCTION LI NEW U ADD LJ ALTERATIOfV LI REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPE OF PERMIT LJ GRADING LJ FOVNDATION LJ STRVCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION 50. FT. oCCUvnNCv_
CONSTRVCTION TVPE VALUATION 5
. ZONE GRADING CU. VDS. ACRE$_
Remarks: � �/..�21'1/..
Sink
Preventer
Irrigation
Drinking Fountains '
Floor Orains
Floor Sinks � '
Gas Service . Outlets
Interceptors
Kitchen $ink �
Lavarories
Roof Drains
Service Sink
$ewer Cap ''
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank ��
Swimming Pool w/Spa
Urinal
.Water Closet
Water Heater
Water Servici
Auto-Wash
Laundry Trays
Reinspeciion Fee � $15 � I Isue Fee ,- I $ 3
Boiler
Duct- UnderGround
Duct - Strucmral
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/FacL BIL ICBO #
Heatin9 System & Ducting
❑aioo,000 sTu oioo.000sr�
Reinspection Fee � $15
CMF OB65-46, rev. 30/84 White - Builtling; Canary - Appllcanh Pink - Accountlng; Goltlenrotl - Assessor ' '
\
Hood or Type I , ❑ ' '
CanoPY TYPeII ❑ ' .
Refrigeration System
❑aioo,000e-ru ❑ioo,000sru
System Repair/A�teration
Fire Dampers
Registers
laue Fee ; � $ 3
A.P. qlE
S Main Buildi
E
T Front
B Rear
A
C Right
K Left
S
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
lectric
Fan� �
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Dispoul
Generator �0.5 KW
2877 5/13/8Ei - --- �F�e�O . Tl.
Zorie
Accessory Building:
Parkin9 Req./Provided
ELECTRICAL
� Transformer ❑ 15=50 KW
❑ 50 + KW
Meter up to 100 amps '
�Meter ❑over100amps
Sub Panel
'MotorsO0�1NPO1X-8 �
Inc.Solar��9-15 HP �16-15+
Pole Light � '
Range
Sign
! Standing $ections �
5-15 KW Trash Compactor .
I kl-o�Y, YNf�' 1 5�ch
FEES
Z
O
N
I
N
G
A
E
Q
M
T
$
� Reinspaction Fee I$75' � laue Fee ' I $ 3'
DEVELOPMENTSERVICESREQUIREMENTS: ' • �
Zoning Approved By Date
Building Apv�oved By Date
Appliption Issuad By L� Dala S�
SUMMARV OF FEES . • -
BUI�DING PERMIT $ SMIP $ �
PLAN CHECK $ PERMIT
PLUMBING 5 ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ �.%D GRADING $ -
PLANCHECK 50% $ 'Z-r. FbO MICROFILM $ �
MECHANICAL ' $ TOTALFEE $ ��'��
PLAN CHECK ZS% $ '
�
CONSTRUCTION AND PLANNING � P��� '�A
P
APPROVAL5 -� Permit # Date Inspector AppROVALS Permit # Date Insper.*or
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
� �2. �So>I Pipe-Undrgrnd. . 53. Steel Reinforcement
3. Electrical Co�duit 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 Conduif-Undrgrnd.
8' foundation � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd� � 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor Systein 61. APPROVAL TO DECK
i t. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
-12. Sewer Cap 63. Heater & Vent-Final .
73. Roof Drains � 64. Plumbing System - Final
14. Rou9h Plumbing , 65. Electrical-Final �
15. Rough Electrical-Conduit 66. Solar SYstem-Final -. �
16. Rough Electric Wiring s C� 67. Fencing & Access Approval .
17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Celling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating &�Aii Conditioning FIRE DEPT. REQUIREMENT .
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure � 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rou9h & 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' Electriral Pqwer 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-Flnal
40. Gas Service-Final
41. Solar pomestic-Final .
42. Backflow Pre�enter �
43. Backflow Irrigation .
44. landscape Irrigation System
45. Sound Attenuation . -
46. Handicap Regulations - '
47. FINALSTRUCTURE&BUILDING �
48. Special Requ�rements Completed ' �
49. Electric Release to Edison � i
50. Gas Release to Southecn Califomia Gas Co .
51. CERTIF.ICA7E OF OCCUPANCY - . .
No. Date - ' '
, —AOP��eanrao�nvin-mrspaces'exUo<<hose within heavy Eortler lines ana si9n all aovropriate Eaclarations.
Ci7V oF cOSrA MESA • CONSTRUCTION PERMLIT
. Project AddreSs _ 3�� t, 10 �N+. ST. � mUn iL Q
ApplfcanYs MBiling Address � �oI',Mra-�[ 1'�G1A ��(�
Owner'sName Sin�l�a De�elvpMerrt PhoneiG'f'(I-6/AO
Addreu �� 2 L�orporafe P/oza, +�''190 - N�'13c� n
Arch/Eng. ���na�C/� t QSSOt� . LicenseNo. �5��
Address 2'4� � Npu1�0f� a�V[l ' NP�1�ic�l i�4
Contractor'sName�ac� Ma�MEf � Phone6�3-4/�/I
Address (mailingl 'S'��� HdYt U5 AYP. �- i1��'�.���
CiryLicenseNo, f?��q�'�'
LICENSED CONTRACTOR DECLARATION
I hereby af(irm that I am Iicensetl untler pr visions of Cnarter 9(commencin9
with Seciion )000) of Divlslon 3 OI e ziness antl PrOfessiOns Cotle, antl
my Iicense is in full farc an efie<t. �'
License �CI�¢ � � Littnse No. Z�Z91�
Date � I/ Signature _
WORKERS'COMPENSATION DECLARATION
I hereoy aftirm that I have a certificate ot consent to soli-insure or a certlticate
of Workers' Compen5ation Insurance, o� a certlfietl coOY thereof (SOGtfon
3aoo, �n. c�9U-S/5/66-3 i� r
Policy No. Company �a KtrM
Certifietl coPY i5 �ereby fumish¢tl.
Certi(ietl coPY is file0 wiM tM1e cIty Builtling DIVISion. ^n' �. ./
Date Applicant ��V�`�'�el
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thi55ection n8etl not Ge compl¢tetl i7 tne permit I5 for one huntlretl (5300) o� .
less).
1 c¢rtify that IP the perfo�mance o( the wo�k to� which th15 pe�T�t is issuetl, 1
SM1all not ¢mplay any pe�son in any mann¢r so as to becOme subject lo the
Workers' Compensation Laws of Califomla.
Oate Si9nature
`NOTICE: If, atter makin9 this tleclaration, you shoultl become subject to the
Workers' Compensation provisions of the Labor Cotle, you must torthwith
comply with su[h provisions o� [ni5 permit snall b¢ tleeTetl revoketl.
CONSTRUCTION LENDING AGENC�'
I he�eby affirm that there iz a con5[�ucliOn I¢ntling agency for the'Per(ormance
ot Ihe work �or� which � this permit is � issuetl (Section 309] Civ. C.) �
LenOer'S Name
Lentler's Adaress
OWNER 9UILDER �ECLARATION
I hereby a(lirrt� lhat I am ezemp[ from tha ConVactor's License L.aw fOr Ihe
following rea50n ($ection ]�31.5 Bu5ine55 antl Profe55ional Cotle: Any tl[y o� '
county which �equires a oermlt to construct, aiter, Improve, tlemolish or repair
any sVucture, prior to its'issuance, als0 requlres the applicani for sucn permit
to file a signed statement that he/zne IS IlcenSetl pursuant to th¢ Provisions of
the Contractor'S License Law (Chapter 9.(commencin9 with 5¢c[ion ]000) of
Division 3 ot [he Business antl Professions Cotle) or that he/She is ezempl
�heref�om antl [he basis for the alloged exemption. Any vlolatlon o1 Section
031-.5 by anY applicant for a permit subjects the aOP���ant to a clvil
enalty Ot not moYe [han tive huntlrCtl dollars (y500). '
L� I, as own¢r of the p�ope�ly o� my employee5 with wa9e5 as thelr 501¢
compensation, �+�II tlo Ihe work, antl [be structure Is not intendetl o� oHe�etl
tor sale (Sectlon 7044, Businesz antl Pmfessmnal Cotle: The Con[ractor'S
License law tlOez not dpply lo an owner ot d property who builds o� im0/oves '
Ihereon, antl who tlaes such work himzeit/hersell or through his or her own
employees, 0�0'/ided tM1at such Improvements are not Intentletl or offeretl for
sdle. It, however, the bulltling o� imorovement is soltl wlihin one Year oi com-
pletion, the owner will have.the burtlen of provin9 ne/sne tlitl not builtl or im-
prove tor the purpose oi sale).
❑ 1, a5 ownet ol lhe D�operty, am exClusively contracting wltM1 Iicensetl con-
tractors to conS�ruct tne project (Section ]044, Business antl Pro�essions Cotle:
The ContractoYs License Law tloes not apply to an owner of property who
builtls or improves thereon, antl who contracts for such projects witb a con-
Vactor(s) license pursuani�to'Ihe Contractor's Llcense Law). I am aware that
proot of their Worker'S Compen5atlon insurance Shoultl be provitletl [o me.
❑ I'am exempl un0et Sectlon B. & P. C. for this reason
A
Date
I hereby certitY tha�
intormation is corre
antl sla[e laws relati
Sentatives ot Chis I
inspection purposes
Signature �
Orivers' Litens2 or 55
(' Owner
have reatl tnis application antl state fhat Ihe above
agree to comply with a11 city antl county ortlinances
o builtlinq mnsbuction, antl hereby au[horize repre-
to enter upon the above-mentionetl pr p¢rt tor
�— Date..�jy�8�
._
lN1 1�SC) J 2 � � � �`1
TVPE OF CONSTRUCTION NEW ADO ALTERATION REVAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHE .
DESCRIPTION OF WORK/USE OF BLDG. �OYI U ML
TYPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION 5�. FT. �300 ocCUPnN_Clv �
� CONSTRVCTIONTVPE VALVATION$ YB�.,�
ZONE GRADINGCU.Y�S. ACRES_
Remarks: � l � �
Sink
Preventer
Irrigation
tuhs
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service ' Outlets
Interceptors
Kitchen S"ink
Lavatories
P-Trap
Roof Drains
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
WBiCf C�052[
Water Heater
Water Service
Auto-Wash
ES
Reinspection Fee I $15 I I laue Fee I $'3
Boiler
Duct - Under Ground �
Duct - Structural
Duct - Ventilating .
Exhaust System ❑ Multiple
FirepUFacL Blt. ICBO #NR
Heating System & Ducting
00-100,000 BTU 0100,000
Reinspection Fee � $15
CMF 0865-46, rev. 10/84 White - Builtlin9: Canary - Appllcant; Pink + Accountin9: Goldenrotl - Asse55or
A.P. ;f`-
S Main Build
E
T Front
B Rear
A
C Right
K Left
S
Ping. Ref. #
Automatic Washer -
Construction Pole Sub.
Cooking Unit,
Dishwasher
Dryers ❑Gas ❑Electric
Fan �
F.A.U. ^
Fixtures
Device Boxes
Ou[lets
$witCh¢5 '
Garbage Dispoul
Generator �0.5 KW
wi�'y-y --..
2911 ' s//�/�/ 6o0C TL
2ane
Accessory Buildin9:
Parking Req.lProvided
' ELECTRICAL
Transformer ❑ 75-50 KW "
❑ SO+KW
Meter ❑up m 100'amps �
Me[er ❑over100amps
' Sub Panel
Morors 00.1 HP � 1 Yh - 8
Inc. Solar �9-75 HP �16-15+
Microwave �
Pole Light
I I; Standing Sections
15 KW Trash Compactor
IANICAL Reinspection Fee $15 luue Fee
FEES
Hoodor T DEVELOPMENTSERVICESREQUIREMENTS:
ype I ❑
Canopy Type I I O ' Zoning APProved ey
_ _ Building Approved 6y
Refrigeration System
❑0-100,OOOBTU ❑100,OOOBTU
System Repair/Alteration
Fire Dampers
Registers
Issue
$ 3
BUILDING PERMIT $
PLAN CHECK $
PLUMBING $
PI.AN CHECK 25% $
ELECTRICAL �$
PLAN CHECK 50% $
MECHANICAL g
PLE1N CHECK 25% $
2�
O
N
I
N
G
R,
' EI
�I
M
T
S
; FEES �
�
$ 3
SUMMARV OF FEES _ �
SMIP $
PERMIT �
ISSUANCE $
� ENERGY P.C. $
GRADING $
MICROFILM $
��— TOTALFEE '$ g'��
�
, CONSTRUCTION AND PLANNING
� APPROVQLS � � Permit #
1. Temporary Electrical Service or�Pole
2. �Soil Pipe=Gndrgrnd.
. 3. Electrical Conduit Utility�Undrgrnd.
4. Electrical Conduit-Undrgrnd.
5: Steel Reinfor�cement � �
6. Electrieal,UFEFt Grnd. .
7; Footincls � ' �
8: Fouridation -
9. Water Pipe-Undrgmd.
10.� Structural Floor System
11. PropertY Sewer Line & House Connection
12. Sewe'r CaP ..
13. Roof Drairfs � �
14. Rough Plumbing � .
15. Rough Electrical-Conduit
16. Rough Electric Wiring
17. Rough Wiring Sign • �
18. Rough Electrical-T Bar Ceiling
19. Rough Heating & Air Conditioning
20. Rough Factory Fireplace 3
21. Ducts, in Structure
22. Ducts, Ventilating -
23. Gas Pipe-Rough & Test �
24. Roof Framing �
25. Roof Sheathing -
26. T-Bar Ceiling (Structural) & Monocoat .
27. Frame and Flashing �
28. Lathing & Siding . �
29. Insulation . �
30.. Drywall Nailing - '
.31. Plaster 6rown Coat . ` �
32' Electric8l Power Meter-Final
33. Final Electric
34. Fi�al Haating �& Air Conditioning
35. Final Gas Pipe-Test
36. Hood or CanopY �
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow.Preventer
43:' Backflow Irrigation ,
44. .LandscaPe Irrigation System
45. Sound Attenuation �
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
r49. Electric Release to Edison �
50. Gas Release to Southern California Gas Co
Date
Date
POOL 3PA
Inspector pppROVALS Permit#
52. Pool & Equipment Location
53. Steel Reinforcement
. 54. Forms
55. Electrical Bonding
� 56. Rough Pluinbing & Pressure Test
57. APPROVA�TOCOVER-GUNITE .
�58. Electrical Conduif-Undrgmd.
59. Gas Pipe, O� Undrgrnd., Test
60. Backwash Lines, P-Trap, � Undrgrnd.
61. APPROVAL TO DECK
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final �
65. Electrical-Final
66. Solar System-Final . ' .
" 67. Fencing & Access Approval . .
68. APPROVED FOR PLASTERING
- 69. POOL/SPA SYSTEMS FINAL
FIRE DEPT. REQUIREMENT
L� APPROVALS Permit #
Date � Insper.ror �
�
70. Underground Hydro
77. Product Piping OGas ❑Oil
72. Underground Flush �'
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe .
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT•. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes:
�ROBIN B. HAMERS
6 ASSOCIATES, INC.
CIVIL ENGINEERS • PLANNERS � SURVEYORS
September 12, 1985
City of Costa Mesa
Building and Safety Division
77 Fair Drive
Costa Mesa, CA
RE: ON-SITE FINISHED GRADING COMPLIANCE
350 E. 20TH STREET - TRACT N0. 11976
Gentlemen:
234 E. '17TH 3T.. SUTE 205
COSTA MESA, CA 82627
��a� saaite2
Subject property is graded substantially in conformance with the
the approved grading plan. There is positive drainage away from
the buildings and drainage towards the street.
Si cerely,
�6���>
Robin B. Hamers
R.C.E. 31720
RBH/kjc
cc. CCM Engineering
Mark Kehke
�
. f'
�
�VTY OF ORANG&
•CLJILDING DEPT.
636 No. Broadway
Santa Ana� California
Phone: KI 2-6211
Application for Building Permit
AND FOR A
Certif�cate of Use and Occupancy
Permit No.�--�%Q X--�O-- �
t
U V �g.�
--- -Date---'---- -�- -- �---`6-- -�-� r/- --
/ /
1. OWNER'S NAME_---------�.Q=-/6-�---�--'---�-a-n--�---�-�- -- PHONE��-b_��'�v✓
MAILING ADDRESS -------...._ �._So------�--� �---��----=rf-- ---- �
------ ---- — CITY ---g "f-To�-/��-'5-�-
�rame
Address .________ _____ .
City ---- ---------- -
State
Lic. No. ----------....
PROPOSED USE:
(Atchitec[ or Enginee:)
Phone
Name.._'.__.___ O Y-e
________"'_.. ____ ____(�lJ.___� __..Qr__________.___________
(Concracror)
Address.--------------------.-""------------- -- --------'----
City ---_-.
$eate
Lia No.
-� �-`---'�--- --1 -� �_.!�.�_�r._-� ----_--------�
—P � t r � n
r-� --
2. JOB LOCATION-----�-- --',-�-�---...-<'---�=-'--�-'�--J-�-------------------�-0--�-T-a=--�-�--�-�—`L--'-
(House No.) (Name oF Saree�) (Town or School Distric[)
N/w/ i � 6 �
3. LEGAL DESCRIPTION: Lot:__-'------_�1---ia----------_---Block ----=--.._---_�------'--_-_--'------_Trac[ N/JT �%TS._ =!1'.R-1 G
(Metes and Bounds Description—Uae reserse side oE Eorm) —� / S7
4. CORNER LOT ( ) INTERIOR LOT (� THROUGH LOT ( ) SLOPL- OF LOT ( )
5. SIZE OF BLDG.: :________________.._...__.AREA:__� `f �5,�{_�f_SIZE OF LOT:.�a 6�X 3 9_¢� AREA: ____ _.
U
6. HEIGHT OF BLDG.:._...___LS_�___.__„__.__CEILING HEIGHT:.._.__._.___.S�_____..._.__
NO. OF STORIES_____ _ ___._._._._
7. IVO. FAMILIES ._..___ _____.__.......______.......__..Size of Smallest Bedroom: .___._.____�__�.____.. Size of Kitchen: _____.--
8. EXTERIOR WALL CONSTRUCTION:.__�t`Q.�n_�.__..__._.INTERIOR WALL COVERI[VG�.a 5��_r____
(Frame, Smtco, Em.) (Plas�er-Drywall, Eoc.)
9. SETBhCKS: Fronc Yard from Center Li�e of Street_----_---_,_.8 Q'_-�_-"'__-----------------------------__-_"__-__-_----__---_-----_-_
/ / �
Nearest Side Yard.__� f..__...Reat Yard..�.�0._____._.D�stance in Feet Between Bldgs. on Same Lot ____.___.3_O.__ -__ ___
1G. A COMPLETE PLOT PLAN IS REQUIRED, SHOWI[VG ALL STRUCTURES AND USE OF EACH.
11. For (a) Foodag: Widch ------�-� �/ p "
..___.__..___.. De th in Ground._.____._._�_a.__._____Width of Wall ____.
Actessory ' / o// �
Bldgs. and (b) Size of Studs:___z�___��...______.S atin �.b�_____...________"CC Marerial of Floor.�i��'^'�
Similar p g.-__.__ _. __._'__-__._"._.
Strucmres:
(c) Size of Floor Joiscs: ......_�'.`.Ch:+ti-t......__.Spacing ----_ _-__--.--__ -----------_"CC
(d) Size oE Rafcers: --'-' - ----�--X ' �-"---------.Spacing --------3-Q--"-----'--- ��CC
12. VALUATION OF PROPOSED WDRK: Induding all laboq plumbing, electrical wiring, heating, fire sprinklers, paino
ing and sewage disposal $--1 _O-Q_D'-__-�_S.'_-"_-'--__"--'----- •
l3. I HEREBY CERTIFY TH,AT TO THE BEST OF MY KNOWLEDGE AND BELIEF THE INFORMATIOLV IN
THIS APPLICATIOIV IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL
LAWS OF THE COULVTY OF ORANGE AND THE STATE OF CALIFORIVIA APPLICABLE THERETO.
Signed:.'__�r -------- �- - ---- -- -- -
-- -------------
� � `' � C / '%L��Owner) ' � � ��
Plans Filed:_.___. _.-----�- ---------5'7 -----��-- �------------------
Bldg. Permit
Plan Check
Total - -
Receipt No. -
Paid ro -
9M.-].SO
FEES:
��-�-�--------------------
� -----'--------------------
(Auchorized Agenc)
FOR DEPARTMENTAL USE ONLY
GROUP---..Y--�--- ----
TYPE --.�_.------- --- ------
DIST. /�
MAP-----y�,,,�---- -= - �
SHEET NO.______.�._.____
DATE. .f�..--- -�j--�-�-`-�---f-------
CHECKING BY
APPLICATIOD�� HEALTH ------------.----.
ZONING._____..__,/___... FIRE
PLANS AND , MARSHAL
SPEC'S_---------F - - STATE.--------- - ---------
ISSUED
'.ANGE COliNT1' BLDG. DEPT.
,i No, �roadway
Santa Ana, California
.
N° 85� .
`
Date. "� �' �
COUNTY OF ORANGE
CERTIFICATE OF OCCUPANCY
Bldg. Permit No.�Y���._..Elect. Permit No..�.U%.�.__Plumb. Permit No._..._..........
Use of Buildin �d�ji' HLi2`ePP3*.-------�-------------------- ................�--------------
g......----�---'-----" ................
The building located at-_-------------------------------_-------_--..--
.. -- --_...._....... 35t7 .:. Ufhr.._Costa :'ee�
-�- � .............. . �-- --
Lot-�---------. Block----------�---------------`----- Tract ................................................
(See Reverse Side ior Metes and Bounds)
Has been inspected and found to comply with the provisions of all County of
Orange Ordinances applicable thereto for a Group...._D2 ............................................
Occupancy.
ISSUED TO:
Shr,1; ' " �,
- - -- '� -.-`...._... ....:.:-... - �-
35Q .:.. � UO� n ` of.B.i�ar'.a��8)
CC: [17' ngmal—Owner ❑ 1s[ Copy—Gas Co.
.,/
ST7-7-50
C. W. DONOHUE,
County Bldg. Inspector
By........... .......................--- -_..._..........-'---
4�2nd Copy—Edison Co. fj] 3rd C�py—Pile
Y� .
► �
' CITY OF ..JSTA MESA ' �
� PARK FEES 0054 3/26/B5 �jIJo62 T�-
. �� � Fee Payment Receipt Ns � 9 8 2
. "�;.
Project Address %� �• �[/TV1 �JTKc�I 7 U��TJ /"�� � '
A.P. Number �i-Z�O —%/'>� — � q Park Area —�'
Building Permit Numher
Owner's Name � � C
MailingAddress�2(F,CFT9/11�TE (�I.A ��d �'{-7L{7"!'LT �i�"' _
FEE: Single Family ` Num r of Units
2-Bedrooms or Less @ $ 861.76 -
3-Bedrooms @ 1,205.67 '
4-Bedrooms @ 1,545.62 =
5-Bedrooms+ @ 1,610.50 =
� Multiple Family "
Bachelor or Studio @ 474.37 = �
1-Bedroom @ 573.18 =
2-Bedroom @ 881.51 =
3-Bedrooms+ _� @ �,zZg,38 = •-�9-��ll]•SZ
�/�,, n`Total Fee'�' �y'
Plenning Depart roval D te _['`/�C/ � By N�
ApplicanYs Signa ��
• City OrOinance 72•44 • Glty Ortllnance 72-45 " City Resolutlon 78436 (j� mIe
CMF 017432 Rev. 6/79 White—Planning; Canary—Plannin9: P�nk—finance; (3o�tlenro0—ApDlicant I � U�
. f �.'�'_��:._'
I CJ/r_ U'�•xunin,alrr A rr. pG Cnrdrn l:rnrr. Cil 9pfi�l:f
7l4-530-9530
(��:�,���� a .is��92
3041
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
CURRENT ENERGY REGULATIONS, CALIFORNIA ADMINISTRATIVE CODE, TITLE 25, STATE
OF CALIFORNIA, IN THE BUILDING LOCATED AT:
/ t''�'TT Cn''jj1Q._ LOTp —_5—TRACT#
�,TREET�JQ_�r]. 7�� STI:F.RT C�'1 t'•, CITY C�STA I•t�'.SA �
EXTERIOR WALLS: �
' • _ � q
MANUF.AC7URER '�'��l�J[,,L� THICKNESS/TVPE �}- VALUE_�,1__
CEICINGS�.
BATTS� • - � �q_ -
MANUFACYUREF T�IA?.'VTLT.F. �THICKNESS/TYPE 9 VALUE��
BLOWN IN; MINIMUM R-
MANUFAC7UREfi � THICKNESS VALUE __
S�UARE FOOTAGE COVERED NUMBER CF BAGS USED
FLOORS;
MANUFACYURER THICKNESS/TYPE ^
SLAB ON GAADE:
MANUFACTURER_ TF:ICKNESS/TYPE
,`_ DTH OF INSULATION WCHES
FOUNDATION WALLS�
R-
VALUE
R-
VALUE
R-
MANUFACTURER_ _ THICKNESS/TVPE VALUE
GENERALCONTRACTOR
CALIFORNIA CONTRACTORS LICENSE N
SIGNATURE
INSULATION CONTRACTOR .
CALIFORNIA CONTRACTORS LICENSE #
.L�
/�
� � , SIGNAT�
DATE
r15-23-(35
— ��SfS�r-- -
TITL
nr `'M
Caller's Name
CITY OF COSTA MESA
SERVICE REQUEST & PUBLIC ASSISTANCE FO �^ �_ ��
Date
. ►-y
c�
Time
�-�
Phone
Nature of Request: (location, type, severity)
�0 �- "a '� I �-
. �- _ ��
�
Referred to
Call back
Person Receiving Call `�
CMF 0378-18
�
Service Only �
Information Only �
' � Aov���ant to fili in ali sDaces exceot those witnin neavy eoraer lines ana sign a11 appropriate tleclarations.
CITY QF COSTA MESA CONSTRUCTION PERMIT PERMIT NO_/ �� TFACT NO. LOT NO_ UNIT .�
' ��/ �T c�' Z
Project Address �5� f. ��TIL/• , V��
Applicant'S Mailing AddreSs < G 7L� �H z rr '�' Z e%' � TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
�, , I� C/ M ❑ CONVERSION ❑ DEMOLISH ❑ OTHER p� p. �
Owner'sName ✓tw�EA �� �t1FLnM1iIfTE�ryo�e �n� d/1C� L � � �
DESCRIPTION OF WORK/USE OF B�DG.-
Address �.c .�,%XOa.G+7r$'�f�4.9/F�2g P N
Arch/Eng. �.P�LE� �— T S�—/�License No. f% S7 �
�dress '-��� ��22tJpe,,.^^T-,Y�ui� ,/ii �
�
Contractor's Nam �� ' Phone 673 9'/9�
Addresslmailing) �3ob l�Is�ec�ug i1T
( City License No. O/ O �'7
�LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensetl untler provisions of Charte� 9(commencing
� with zection ]000) ot Division 3 of the BuSiness antl Professions Cotle, antl
�my license is in i II force antl eitect. ��
L1C¢lISC CId55 L.ICEOS NO.
Date -'���C � 59 t C T - 2 ^r-�
WORK RS' C MPENSATION D LARATION
, ' hereby affirm that I have a ceriificate ot consent to s If-insure or a certificate
Workers' Compensation Insurance, or a certifietl wpy the�eof (Se<tion
d00, Lab. C '
Poi;�y No. �i3 -S/S�LB-3 comPanv �prE - %P�+'�
Certifietl copy is hereby turnished.
Ce 'fi d copy's filetl with th y i DI //�
Dat APPIi� � S�^'
EXE PTIOe�RKERS' COf�{+ENSATION DECLA TION
(This section neetl not be completetl ii the Oermit is for one h� ntlreG (5100) or
less�l '
I certify [hat in the Oertormance ot the work fo� wnicM1 this pe�m�t is issuetl, I
shall not employ any Oerson in' any manner so as to become subject to the
workers' Compensation Laws o( Calitomia. . �
Date Si9nature
NOTICE: It, after making this tleUaration, you sM1oultl becOme subject to the
Workers', Compensation provisions of the Labor Cotle, you must forthwltM1
comoly with such provisions or this permit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I hereby aifirm that tnere is a mnstruction lentlin9 agency for the pertormance
ot Ihe work for which thi5 permit is issuetl (Section 3097 Civ. CJ
LPntler'S Name
Lender's Atltlress
OWNEF BUILDER DECCARATIOIV-- - '
I hereby aftirm that I am exempt /rom Ihe Con[�actor's License Law for the
followin9 reason (Section 7031.5 Business antl Protessional Cotle: Any city or
county which requires a permit to construct, aRer, improve, tlemolish or repair
any structure, prior to its issuance, also requires [he applicant for Such permit
fo tile a signetl statement that he/she is licensetl pursuant to the provisions of
the Contractor's License Law (Cnao�er 9(wmmencinq with Section 7000) of
�-;2ivision 3 oi tne Business antl Professions Cotle) or tha[ he/she is exempt
�Y;,�e�efrom anC the ba5is fo� the allegetl ex¢mption. Any violaUon of Section
ia,j31.5 by any applicant for a permit subjects tM1e applicani to a civil
_�enalty ot not more than five huntlretl tlollars ($500).
n I, as owner oi the property or my employees with wages as their sole
mmpen5ation, will tlo [he work, antl tlte structu�¢ is not intentletl or offeretl
for sale (Section ]044, Business and Professional Cotle: The Contractor's
License law tloes not apply to an owner ot a property wno builtls or improves
the�eon, antl who Ooes such work himself/herselt or through Itis or her own
employees, provitletl tM1at such improvements are not intentled or offeretl fo�
sale. If, howeve�, the builtlinq c� imp�ovement is soltl witbin one year ot com-
Oletion, the owner will Itave the burtlen o( p�oving he/she tlitl not builtl o� im-
�ove for the purpose ot sale). .
LI I, az owner of the property. am ex<lusively contracting with licensetl con-
tractors to const�uct the project (Section ]044, Business antl Protes5ions COtle:
The Contractor's License Law tloes not appiy to an owner oi property who
builtls or improves thereon, ana who contracts for such projects with a con-
tractor�s) license pursuan[ [o Ihe Contractor's License Law). I am awa�e tbat
. proof of [heir Worker's Compensation insurante shoultl be provitletl to me.
❑ I am exempt untler Section B. & P. C. tor this reason
oate Owner
I hereby certi(y that I have rea
intormation is correcL I aqree to
and state laws relafing to builtlir
sentatives ot thi�y to enter
inspe n e
Signat e
Drivers' nse or 55 �
CMF 0865-46, rev. 4/84 \ hi e-
—� 5 Main Bwlding:
TVPEOFPERMIT GRADING FOUNDATION STRUCTURAL T Front�.
❑ TENANT ❑ ELEGTRICAL ❑ PLUMBING ❑ MECHANICAL B
❑ �OTHER � A Rear /
PROJECT DESCRIPTION SQ. FT. �'�nn ocCUPn � C Right /�„ i.
CONSTRVCTIONTVPE VALUATIONS ��� S Left !� ��
ZONE GRA�ING CU.YDS. ACRES p�n9. Ref. #�u' �g(
Remarks: - ��� � ��j � (�Q . � Planning Notes: '7-
Sink
low Irrigation
Drinkin9 Fountains
Floor Dreins
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories '
P—Trap
Roof Drains
Reinspection Fee � $15
Boiler
Duc['�UnderGround
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact.Blt.ICBO �k
Heating System & Ducting
❑0.100,000 BTU � 100,000 BT
Reinspection Fee
Builtlin9; Canary -Applicant; Pink -Accounling; Goltlenrotl -Assessor
$15
� l� Sz1--Fd4 �-
PLUMBING
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping '
Solar. Tan k
Swimming Pool w/Spa
Urinal
�Water Closet �
Water Heater .
Water Service
Issue Fee
Nood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0-100,OOOBTU ❑100,000
System Repair/AI[eration
laua Fee
FEES
$ 3
$ 3
Automatic Washer
Construction Pole Su6.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elec
Fan
F.A.U.
Fixtures
Switches
Garbage Dispoul
Generator �0-5 KW
= Reinspection Fee
DEVELOPMENTSER
Zaning Approved By_
Building Approved By
Application luued By_
t
O[t61 3/26/q5
Parking Req./Provided
Zone
ELECTRICAL
Transformer ❑ 15-50 KW
❑50+KW "
Meter ❑up to 100 amps
Meter ❑over]OOamps �
Sub Panel
Mators �0-7 HP O1 X- 8 -
Inc.Solar 09-15 HP 016�15+
Microwave
Pole Light
Range
Standing Sections
5 KW Trash Compacmr
$75 Issue Fee
354,Gt3
�
2
O
N
I
N
G
R
/ E
Q
M
T
s.
FEES
$ 3
S M V F FEES
BUILDING PERMIT $� SMIP $ 3^ 3q
PLAN CHECK $ PERMIT
PLUM8ING $ �SSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING $
PLANCHECK 50% $ MICROFILM $
MECHANICAL $ TOTAL FEE $ � � 3
PLAN CHECK 25% $
CONSTRUCTION AND PLANNING d`� POOL ,PA , .
,�4PPROVALS Permit # � Date % Inspector qppROVALS , Permit # Date Inspector
c.
7. Tehipora�y Electrical Service or Pole� �d � 52.. Pool & Equipment Location .
�
2.•Soil Pipe'-Undrgmd. _ �� �� / 53. Stee6Reinforcement - �
3. Electrical•Conduit'Uiiliiy-Undrgrnd.�J ; � � 54. Forms � � �
4. Electrical:Conduit-Undrgrnd. i 55. Electrical Bonding ��
f J
5. Steel.6einfo ement .' `�v 56. Rough Plumbing & Pressure Test `' :,
� . i
6: Electrical'UFER Grnd.� ' , 57. APPROVAL TO COVER-GUNITE �'�
� 9 � ✓� ` ,. ,
7. FoUtirigs� 1�� � ��� y9 � 58. Electrical Conduit-Undrgmd. ,' � ir
8. Foundation � ��
'� x- ,� � (�. 59. Gas Pipe, O Undrgrnd., Test ,:
9. �Wa`ter`Pipe-Undrgrnd. � ��� 60. Backwash Lines, P-Trap, � Undrgrnd. 7
1�0. Struc[ural Floor System �' q 61. APPROVAL TO DECK -
11 . Property 6ewej Line & House Connection ��/r 62. Backwash & ReceptorFinal �
v . � �
12. Sewer�Cap %� ' � �'{�� � ; � 63. Heater & Vent-Final � ��
13. Roof Drains' " � � _ � -
,� . _� y � 64. Plumbing System - Final �"
14. Ro^gh Plumbing � � ' � 65. Electrical-Final � ���
15. Rough Electrical-Conduit 66. Solar SYstem-Final
16. Rough Electric 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
20. Rough Factory Fireplace APPROVALS Permit #
21. Du�ts, in Structure 70. Underground Hydro
22:,Ducts, Ventilating ' J1. Product Piping OGas ❑Oil
23�-• Gas Pipe-Rough & Test , 72. Underground Flush
24.;Roof Framing � . 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing {(� (�(/ 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat � 75. Dry Chemical
27. Frame and Flashing � � � 76. DrY Standpipe
28. Lathing & Siding (� g� �� 77. FIXED SYSTEM FINAL
29. Insulation � 78. FIRE PREV. FINAL
30. Drywall Nailing �� HEAITH DEPT. REQUIREMENT
� 31. Plaster Brown Coat 79. FINAL INSPECTION
32.. Electriral Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33: Final Electric Notes: y �' �r /� ��j �h12'� ��/ (/�
34. Final Heating & Air Conditioning �/1 /j��-
•Yv
35. Final Gas Pipe-Test '
36. Hood or Canopy . �
' Y
37. Final FactorY Fir'eplace '% _
38. Final Plumbing ' • � '
39. WatervService-Final - ,
40. Gas Service-Final ' �
41. Solar"Domestio-Final , „ . ' �
42. Backflow Pceventer � � . . �
43. Backflow Irrigation .. . _ � � �
44. Landscape Irrigation SYstem � "'
45. Sound Attenuation
46. Handicap Regulations .
47. FINALSTRUCTURE&BUILDING � d �
48. Special Requirements Completed /3 gs K�/"
i ��--
49. Electric Release to Edison. . �
50. Gas Release to Southem.California Gas Co , , -
51. CERTIFICATEOFOCCUPAN Y � � �
No._ �s Date �_�� � �'/ C ,
\r
�
.l
ij
AVP���ant to fill in all spaces ezcept those wil�in �eavy OorOe� Ilnes antl sign all aoPropriate aeclarations.
CiTY OF COS7a MESa . CONSTR UCTION PERMIT PER IT NO. 7RACT NO. LOT NO. UN1T NO.
.- � � ai�o a
Project Address � � I
•AppliCant'SMailingAddr255 ���rm � loz, �Z90 TYPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR
S//`7�.�4 �F.bE <oPMFN7TiG ,`� C>/ZO � CONVERSION ❑ DEMOLISH ❑ OTHER
Owner's Name hone� DESCRIPTION OF WORK/USE OF BLDG.
Address Z�, a.� �/ez.. s� 290 �i. /�
Arch/Eng. S�AN K' A�'� SSO � License No. yS% �
Address z7 `'/O �E'vl'r2/� ��r//J N� /3.
Contractor's Name �4'��—G•+�t .-y<..� Phone'�73' /9/
Addreu�mailing) �3� �A��uS iflia
City License No. �! O �77
LICENSED CONTRACTOR DECLARATION
1 hereby aHirm lhat I am licensetl untler p OviSi ns ot C�arter 9(commencin9
wit� sectlon ]000) of Division 3 0l t e u5i ess an0 Profe551ons Cotle, antl
my Iicense is in iu rce antl etfect.
Licens,eI 'Class — � _License No.�'�24/ Z
Date�t�v�sf Si9nature
WORKERS'COMPENSATION DECLARATION
� hereby affirm tha[ I have a cerNlicate ot consen[ ro self-insure or a cer[ificate
1 WoBe�s' CompeniatiOn InsurdnGe, Or a ce�tlfled copy thereof ($ection
�800, lab. Gr) C
PolicY No. /O's/ S�/G �3 Co nY J��n.-...
❑ CufiTietl mpY is hereby furnishetl.
�'Eertiti tl co IS 'letl wrth [he city ing �IVISion.
Date '� � Applicant
EXEMPTION FROM W00.KER5' C PENSATION DECLARATION
(Thizsection neetl not be com0�etetl if Ne permit iz fOr One huntlretl (E300) or
less).
I certify that in the Oertormante of th¢ work fOr which [his perrO�t I5 Issuetl, I
snall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of Calllornia.
Date Signature
'NOTICE: Ii, atter making this tleclaration, you shoultl become subject to the
Workers' Compensailon provi5ion5 Of Ihe Labor Cotle, you must torthwith
[omply with such provisions or this pe�ml[ shall be tleemetl �evoketl.
CONSTRUCTION LENDING AGENCV
I hereby affirm that lhere is a construction Ientling agency for the performance
Of the work for which tnis Oermit is issuetl (Sec[iOn 3097 Civ. C.)
LPnEer's Name
Lentler'S Aatlr¢55
OWNERBUILOEH bECLARATION
I he�eby af(irm [hat I am exempt trom [he Coniractor'S License Law for the
following reason �Section �031.5 Business antl Professional Cotle: Any ci[y or
coun[y which �equire5 a permil to con5t�uci, altEr, Imptove, tlemolizh or �e0ai�
any struclure, prior to its Issuance, also requires the applicant for sucn permit
lo (ile a Si9netl statement Ihat he/she I5 Iicensed purSudn[ to tha provision5 of
the Contractor's License Law (Chapter 9(commencin9 with Sectlon ]000) of
Division 3 of (he Business antl Professions Cotle) or tM1at he/she is exempt
`herefrom antl the basis for the allegetl exemptlon. Any violatlon ot Section
'031.5 by any applicant for a permit subiects [he applicant to a tivil
�nalty of not more than five hundretl tlollars ($500). \
LJ I, as owner oi the property or my employees with wages as thnir sole
compensation, will tlo the work, antl the structure is not intentled or oHeretl
tor sale (Section 7044, Business antl Prot¢55ional Cotle: Tha Con[rac[or's
License 12w tloes not apply to an owner of a property wno builtls or improves
thereon, antl who tloes such work hlmself/herSCl/ or thrOugh hi5 or h¢r own
employees, provitletl tnat such improvements are not Intentletl or oHeretl for
sale. If. M1owev¢q the builtling or Imptovement i5 soltl wlthin one year of com-
ple[ion, Lte owner wlll have lhn Uurtlen of proving he/sM1c tlitl mt bulltl or im-
prove tor the purpose of sale).
❑ I, as owner of tM1e p�operty. am exclusively cont�actin9 witM1 Ilconsetl Con-
tractors to construcl the projecl ISeclion 7044, BuSiness antl Professions Cotle:
The Cmtractor's License l2w does not apply lo an owner of pro0erty who
builtls or improves thereon, ana who conVacts tor such projects with a con-
tractor(si license pursuant�to�the�Contrac[or's Licanze Law). I am aware that
proof o( thei� Worker's Compensation Insurance ShoWa be provltletl to me.
❑ 1 am exempt untl � Sectlon 8. 8 P. C. tor this reason
Date Owner•
I hereby certify t at I hava raaa this apo�icatlon antl state that tne above
Information corr ct. I agree to cOmpty wi[h all clty antl county ortlinances
antl State la re ting to builtling Constructlon, antl hereby auth0/Ire rep�e-
sentatives h' city to enter upon the above-mentionea vroverty for
inspection sEs. ��/�y/�j�
Siqnature Da[e /
Driver5' License or 55 $ �
TVPEOFPERMIT GRAOING U FOUNDATION LJSTRVCTURAL
❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCHIPTION 5c?. FT,
CONSTRUCTION TYPE
Sink
Preventer
Irrigation
Drinking Foun[ains
Floor Orains
Floor Sinks
Gas Service Outlecs
Intercepmrs
Kitchen Sink
Lavatories
P—Trap
Roof Drains
VALUATION $
RADING CU. VDS. AC
Reinspection Fee � $75
�uct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑ o-i oo,000 eru O i oo,oao
Rainspection Fee I S15
CMF 0865-46, �ev. ]0/84 White - Builtlin9: Canary - Applicant; Pink - Ac<ounting: Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Issue Fee
Hood or Type I ❑
Canopy Type I I ❑
Refrigeration Sys[em
❑0-100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registen
Isue Fee
FEES
A.P. #
S Main Buildi
E
T Front
B Rear
A
C Ri9ht
K Left
S
Ping. Ref. •A`-
Planning No[es:
Automatic Washer
Construction Pole Si
Cooking Unit
Dishwasher
�ryers ❑Gas ❑E
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �0-5 KN
lectric
r
1
405fi II/14/65
�
Accessory Building:
—v
c:,0 TL
2one
Parking Req./Provided
ELECTRICAL
Transformer ❑'15-50KW
❑ 50+KW
� Meter up to 100 amps
Meter ❑over700amps �
$ub Panel
Momrs OO-1 HP O 1%- 6
Inc.Solar 09-15 HP �16-15+
Microwave
Pole Li9ht
Range
_� ', Standing Sections
5-15 K � Trash Compactor
$ 3 I
�. Reinspaction Fee $15 Issua Fee
FEES
�DEVELOPMENTSERVICESREQUIREMENTS:
Zaning Appioved By
8uilding Approved By
Appliration Issued By
$ 3
Z
O
N
I
N
G
R
E
Q
M
T
S
FEES
$ 3
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING g ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL $ � GRADING $
PLANCHECK 50% $ MICROFILM $
MECHANICAL S TOTALFEE $ �
PLAN CHECK 25% $
� CONSTRUCTION AND PLANNING
, APPROVALS Permit#
�
-7. Temporary Electrical Service or Pole
2. Soil Pipe:Undrgrnd.
3. Electrical Conduit Utility�Undrgrnd.
4. Electrical Conduit-Undrgrnd.
5. Steel Reinforcement
6. Electrical UFER Grnd.
7. Footings
8. Foundation
9. Water Pipe-Undrgrnd.
10. Structural Floor System
11. Property Sewer Line & House Connection
12. Sewer Cap
13. Roof Drains
14. Rough Plumbing
15. Rough Elect�ical�Conduit
16. Rough Electric Wiring
17. Rough Wiring Sign ,
18. Rough Electrical-T Bar Ceiling
19. Rough Heating & Air Condltioning
20. Rough Factory Fireplace
21. Ducts, in Structure
22. Ducts, Ventilating �
23. Gas Pipe-Rough & Test
24. Roof Framing
25. Roof Sheathing '
26. T-Bar Ceiling (Structural) & Monocoat
27. Frameand Flashing
28. Lathing & Siding
29. Insulation
30. Drywall Nailing
31. Plaster Brown Coat �
�. 32. Electrical Power Meter-Final
33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
� 37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
-- 43. Backflow Irrigation
44. .Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STfiUCTURE & BUILDING
48. Special Requirements Completed
49. Elec[ric Release to Edison •
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
Date
Date
/��
POO, � SPA
Inspector AppROVALS Permit#
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER-GUNITE
58. Electrical Conduit-Undrgrnd.
� 59. Gas Pipe, � Undrgrnd., Test
60. Backwash Lines, P-Trap, � Undrgrnd.
61. APPROVAL TO DECK
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
71. Product Piping O Gas � Oil
72. Underground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro
. 75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
/'-�
Notes:
Date �Inspector
AOP�lcant !a 1111 in all spacas exceo< tnosa witnin �eavY borGer Ilnes antl sign all avProvriate Oeclaratians.
CITV OF COSTA MESA
CONSTRUCTIONPERMIT
Project Address �,j.]1_�y 2r� � S % •
Applicant'S Mailing Address ;
Owner's Nam ��.5�7,p �� �"'� /.I�fi2S /p�1 ln/Z/
Addreu � ��=ZNQ�{ ris�r/ � ��/�7 � ��
Arch/Eng. Licenu No.
Addrass /��� /��
Contrector'sNam����%�r�/ /T7�f�Ts���hone s
Address lmailingl 1J�9 /%�ldN11�Jx.ilfA 'it/E �a' ti
CirylicenseNo. F%�90�i�
LICENSED CONTHACTOR DECLARATION
I nereby affirm thac I am Iicensed unaer provlslons of Charter 9(mmmencing
wlth sec[lon 7000) oi Divislon 3 of tha Buslness antl Pro(esslons Cotle, antl
my Ilcense is In fu11 force etf ^�
Llcen j� �� �n L ce se No. � ��
Date �if S( qg�a���.._ _�
�'7RKER5' COMPENSATION DECLARAT ON �
ireby a(firm that 1 have a certificate of consent to self-insure or a certifiwte
Workers' Companzation Insuranca, or a cer[IfieO copy thereof (Sectlon
3800, LaO. C.) � ����rj�� >
Polity No. �U J� Company �� u/:��
Certlfletl topy Is hereby furnlshotl.
erUfl — y i wlth tha tity BuIItlI�i �
Date Applicant—�jy
EXEMPTION FROM WORKERS' COMPENSFTIO DECIARATION
(Tnis sectlon neetl not Oe complatetl If the permit is for one huntlretl (y300) or
IB55).
I certify that In tne performance of the work for whith this perm�t is issuetl I
sM1all not employ any person In any manner so as to become subjett to t�e
Workers' Compensaclon Laws of Callfornla.
Date Signature
NOTICE: It,iaftar makin9 this declaration, you 5houltl b¢come subJect to the
Workers' Compensatlon provislons af tba Labor Cotle, you must forthwlth -
comply'wlth suc� provisions or thls permit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
1 hereby afflrm that there is a con5truttlon Ientlin9 agency tor the pertormance
Of tlte wOrk for which thi5 pBrTlt Is ISSUetl (Sectlon 3097 Civ. C.)
Lentlar's Name
Lantler's Atltlress.
OWNER BUILDER DECIARATION
I hereCy a(firm.that I am exampt lrom the Contractar'S License Law for tha
following reason (Sec[lan 7031.5 Business antl Professlonal Cotle: Any city or
county which reqWr85 d p¢rmlt ta coMt�uct, alte� improve, Cemolisn�or rapalr
any ttructure, prlor to Its Issuance, also requires l�e aDP��cant for such permit
to flle a si9netl sta[ement that he/sha is Ilcensetl pursuant to the provlslons of
'�e Contractor's Llcense Law (Cnapter 9(commencing with Section 7000) of
�islon 3 0/ t�e Business antl Professions Cotla) or that he/she Is exampt .
refrom and lhe basis for the allegetl exemption.�Any violation at Sectlon
. e31.5 by any applicant for a permit sub�ects the applicant to a civll
lLenalty of not more than flve nuntlretl tlollars (E500).
LJ I, as owner of the property or my employees with wa9es as their sole
com0ensation, w111 do the work, antl the siructure is not IntenEetl or ot(eretl
ucense �aw aoes not appry co an owner o* a property wno omias or improves
thereon,� antl wno Ooes such work himself/herself or throu9h his or her own �
employ ees, piovltlatl that such Improvemants are not Intentled or olfaratl for
sale. 1(, however, the Eulltling or improvament is soltl wlthin one year of com-
D�atlon, the owner will have the burtlon of proving ho/sho tlitl nof bulltl or Im-
�rove for the purpose of sale). i
I, as owner of Ihe Oroperty, am excluslvely contractlng wich Iicensed con-
tractors tb construct the pro�ect (Sactlon 7044, Bu5lness antl Profettlont Cotle: .'
The Contra<tor's License Law does not apply to an owner of property who
bulltls or Improves thereon, antl who contracts for such projects wlth a con-
tractor(s) Iit<nse pUrsuant to the COntractar'S Llcense Law1.
❑ 1 am exempt untler Section B. 8 P. C, for this reason
oate Owner
rvnyvll i Ivµ � 1� � nn�. �
rr� < <;
TYPE OFCONSTRUCTION NE
❑ CONVERSION ❑ DEMOLISH
OESCRIPTION OF WORK
J ADO LJ ALTERATION LJ REPAIR
OTHER
TVPE OF PERMIT LJ GRADING LJ FOUNDATI LJ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING �MECHANICAL
, ❑ OTHER
PROJECT DESCRIPTION SQ. FT. oCCUPANCY_
CONSTRUCTION TVGE VALVATION $
ZONE GRADINGCU.YDS. ACRES_
Remark�: �_ � X� %�
Bar Sink
Beckflow Preventer
Becktlow Irrigation
Bathtubs '
Clarifiers
Dishwasher �
Drinking Fountains
Floor Dreins
Floor Sinks
GesService Outlets
Citchen Sink
Lavetories
°—TreP .
Foof Drains
Reinipeetion Fee � $25
Boiler :
Duct- UnderGround
Duct - Structural
Duct- Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
�[6700,000 BTU 0100,000
inspection purposas. /'J�[///�/�y����J �(/ rj T � v•
Slgnatura S////r ����r- Date� '
Orivers' Llcense or 55 � RBinipection Fee
CMF 0865-46 rev. 12/83 White - Builtlln9� Canary - Appllcant; Pink - Accounting; Goltlanrotl - Assessor
$25
ShOwers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecror5
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water.Heater
Water Service
Issue Fee
iANICAL
Hoodor Typel.
Canopy Type I I ❑
Refrigeration System ,
❑6100,0008TU ❑100,000
System Repair/Alteration
, Issue Fee
FEES
A.P. �1`-
S Main Building:
E
T Front
A Rear
C Right
g left
Ping. Ref. #
Parking ReqJProvided
Use of Building:
Planning Notes:
2621 5/09/a5
I2one
Accessory Building:
Park.Fees $
ELECTRICAL .
Automatic Washer Transformer ❑ 15-50 KW
Construction Pole Sub. � 50+ KW
Cooking Unit Meter �up to t00amps
Dishwasher Meter ❑over100amps ,
Dryers �Gas ❑Electric Sub Panel
Fan Motors �0-1 HP � 1 X� 8
F.A.U. Inc.Solar 09-75 HP �16�15+
Fixtures � Microwave -
Device eoxes Pole Light
Outlets Range
Switches � �g�y�
Garbage Dispoul Standing Sections
Generator 00.5 KW �5-15 KW Trash Compactor
$ 3 I
� Reinspection Fea $25 luue Fee
FEES
3 O PUBLICSEHVICESREQUIREMENTS:
ZOning Approved 6y
Building Approved By '
( n
$ 3
17o2n TL`
FEES
$ 3'
2
O
N
I
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G
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N
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SUMMARV OF FEES �
BUILDING PEFiM1T $ SMIP , $
PLAN CHECK $ PERMIT ' �
PLUMBING $ ' ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL $ GRADING $ , ` }S
PLANCHECK 50% $ • MICROFILM $
MECHANICAL $ �� •�— TOTAL FEE $ �
P�AN CHECK 25% g ��r.-3--r 2-a,� _.,
' CONSTRUCTION AND PLANNING • - P���' 'PA � . - '
Date ' Inspector � ' �Date Inspector
AP@ROVALS Permit# APPROVALS. Permit-# _ �
?: Temporary Electrical Service or Pole � 52. Pool & Equipment Location . � -.� ;
� 2. Soil Pipe-Undrgmd. ' � � t . 53. Steel Reinforcement • _ - .
3. Electrical Conduit Utitity-Undrgrnd. � , 54. Forms • � - �. " �
4. Electrical Conduit-Undrgrnd. • , - 55. Electrical Bonding : ' � � � ' "
5. Steel Reinforcement' � 56. Rough Plumbing & Pressure Test � ���
� , i
� 6. Electrical UFER Grnd. . � 57. APPROVAL TO COVER-GUNITE ''.
7. Footings � : - � 58. Electrica6Conduit-Undrgrnd. '.� " . .
8. Foundation �. ,� 59. Gas Pipe, � Undrgrnd., Test � �/
9. Water Pipe-Undrgrnd. � • �Y ' 60. Backwash Lines, P-Trap, � Undrgmd. . " •
70. Structural Floor System �� � : 61. APPROVAL TO DECK _
17. Property Sewer Line & House Connection �� - 62. Backwash & ReceptorFinal - � " . ,
12. Sewer Cap � 63. Heater & Vent-Final � � �
13. Roof Drains , � f � 64. Plumbing System - Final�-� _ � '
14. Rough:P,lumbing � 65. ElectricaPFinab � - � - � � `; "
75. Rough Electrical-Conduit , 66. Solar System-Final -'� � ��- �
� � •;i.
16. Rough Electric Wiring - 67. Fencing & Access Approval �- ,' -�." - -
r,
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING , ��
' .,
18. Rough Electriral-T Bar Ceiling 69. POOL/SPA SYSTEMS F.INAL
19. Rough Heating & Air Conditioning �r��j� (� FIRE DEPT. REQUIREMENT . .
i.
20. Rough Factory Fireplace . APPROVALS Permit # �- � '�
i
21. Ducts, in Structure � � 70. Underground Hydro �' ��
22. Ducts, Ventilating � l 6� L.IFi/J 71. Product Piping O Gas OOiI - •
23. Gas Pipe-Rough & Test , 72. Underground Flush ' � � �
24.•Roof Framing � 73. Undergrnd.StoregeTank'OGas OOiI � ' '
25. Roof Sheathing 74. Overhead Hydro � � ' �
.i
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ' . i� '
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 S0. FOOD CERTIFICATE ISSUED '
33. Final Electric Notes: .
34. Final Heating & Air Conditioning � r '.
35. Final Gas Pipe-Test . � � - -
i�
36. Hood or Canopy , . • � , _ _ , � -
37. Final Factory Fireplace � � . � � - ` ,
38. Final Plumbing � � � ' �
39. Water Service-Final ' � '
40. Gas Service-Final
41. Solar pomesticFinal - , , - .
42. Backflow Preventer , � . ._ ._ _ � - i ,
43. Backflow Irrigation � � ' � ' �
44. Landscape Irrigation System ' •' � -� �
45. Sound Attenuation , � . . , w - . �
46. Handicap Regulations � � , � � ' �
47. FINALSTRUCTURE&BUILDING � . � ' �
48. Special Requirements Completed � , '
49. Electrie Release to Edison � � - � . . , � �� � �
50. Gas Release to Southern California Gas Co . �� � ,
y
�51. CERTIFICATE OF OCCUPANCY ' . - - � 1" �
' � /
No. Date' .. . � . . . _ . - - � � -_.. _ _
Aop�icant to fill in all zoaces except tnose within neavY �oraer lines antl sign all approo��ate tleelaralions.
� CITY OF COST,4 MESA CONST UCTION PERMIT
. �Project Address ��� a� �L � ��
Applicant� l�4ailingAddress �/���� � ' �
Owner'sName 51�� [3SA1 � Phone
�
Address
Arch/Eng. ` License No.
Address •
Contractor's Name�`�'� v�'� ^�" � � ho/�je �
Address (mailing) ODG3� .il clldu fl..�� �, (�: LM J�
Ciry Cicenu No.
LICENSED CONTRACTOR DECLARATION ' '
I nereby affirm that 1 am licensetl untler provlsions of Charter 9(<ommencing
wi[h section 7000) ot DlviSion 3 0( lne Bu51ne55 antl Prote55ion5 Cotle, antl
my license Is in tull force ana effect. � os
License Class � Licen No �
Date Signature
WON ERS COMPENSATION DECLARATION �
� hereby aifirm that I have a certificate of consent to selt-Insure or a certlflcate
f Workers' Compensation Insurance, or a certl(latl copy thmeof ($ectlon
,800, Lab. CJ � . . .
PoII<y No. Company
eCertitied coOY i5 hereby tumishetl.
Cer i i U py is ,tl with the cit ui in �Ivli n.
Date Applican
EXEM ION F OM WORKERS' COMP NSATION C A ATION
(Thizsection neetl not be completetl If [ne permit is for One huntlretl (5300) or
I¢SS).
I certify that in [he performance of tM1e wo�k fo� which Ihis pe�m�t is 6suetl, I
snall' not empioy any person In any manner so as lo become sub�ect ro the
Workers' Compensation Laws of California.
. �ate Signature
�NOTICE: If, after making this tleUaration, y0u Shoultl b¢rome svb�ect to [he
Workers' Compensalion pmvi5ion5 ot Ihe Labor Code, you must (orthwitb
comply wltn such pfOVI510I15 or thii pe�mil shall be tleemetl revoketl.
CONSTFUCTION LENDING AGENCV
I hereby af/irm tha[ [hem is a mnstruction lentling agency for the performan<e-
of lhe work for. which lhis permit is issuetl (Sectlon 3097 Civ. 0.)
LenEer's Name
Lenaer'z Atlaress
OWfYEH BUIIDER �ECLARATION �
I hereby afflrm that I am.exempt from the Coneractor's License �aw for the
tollowing reason (Section 7�31.S�Busines5 antl Protessional Cotle: Any Uty or
county whi<h requires a permit lo tonstruct, alter, improve, tlemolish or repalr
any 5[ructure, p�ior to it5 ISSuance, also reqW�es the applitdnt fOr such pe�mil
lo �ile a signetl stat¢ment that he/slte IS Iic¢ni¢tl pursuant to [ne provi5ion5 of
the Contractor's License Law (Chapter 9(commencing wi[h Sectlon ]000) of
DiviSion 3 of the Business antl Professions Cotle) or tha[ he/she iz exemp[
'hcretrom and the basis tor Ihe alleqetl exemption. Any violation of Sectlon
�031.5 by any applicant tor a permit 5ubject5 the applicanc to a civil
�'�enalty of not more tnan five �untlretl tlollars (E500).
1, a5 owner of the O�oOertY �or my employees with wages as titel� sole
tompensation, will tlo the work, antl the structure is not intentletl or otieretl
'for sale (Section 7044, Business antl Proteszlonal Cotle: Tha Contractor's
LicenSe Law tloes not apply to an'owner o( a property wno buHtls or improves
thereon, antl who does such work nimseli/herself or throu9n his or her own
employees, prOvitletl that such im0�o�ements a�e not intendetl Or offeretl lo�
salo. If, howevar, tne Euilding �r improvement Is soltl witnin ono year ot com-
plelion, the owne� will Oav! the bu�tlen Of proving he/she tlitl nol builtl Or Im-
prove for t�e purpose of sale).
❑ 1, as ownei of the property, am exclusively ContraCting wilh IlcenSetl con-
Vactorsto wnstruct the owject (Section �044, Business ana Professions Cod¢:
TM1e ConVactor•s License Ldw does not apply to an owner oi pro0erty who
builtls or impwves thereon, antl wno conVacts for such projects with a<on-
tractor(sl license pUrsuant�to the Conlractor'S License Law�. I am awaro tha[
proof af tbeir Worker'S Compen5ation insurance zhoultl be provltleC to me.
❑ 1'am exempl under Section B. & P. C. for thls reason
Date Owner '
I hereby certify tha[ I have �eatl this application antl s[ate that the above
iniormation is mrrecL I agree to comply wlth a1l dty antl county ortllnances
antl state laws relaling to builtling constructlon, an0 hereby autborize repre-
senfa[ives o( Ity to en r u$9 n the above-m¢nliOnetl ProPe�ty tor
inipec[io p /�j r
Signatu • !/'�i.GL/ Date /� J
Drivers' � ��_^�_ � /— �^—'� �� '
Or55�
E I 8 z,Z 1�
TVPE OFCONSTRUCTION NEW ADO ALTERATION REPAIR
❑ CONVERSION �O DEMOLISH ❑ OTHER p�p #
DESCRIPTION OF WORK/USE OF BLDG.
S Main Building:
TVPEOFPERMIT GRADING FOUNDATION ❑STRUCTURAL T Front
❑ TENANT ❑ ELECTRICAI ❑ PLUMBING ❑ MECHANICAL � B Reef
. ❑ �OTHER . A
PROJECT DESCRIPTION SQ. FT. - OCCUPANCV C Right
K Left
CONSTRUCTION TVPE VALUATION $ $
ZONE GRADING CU. V�S. ACRES Ping. Ref. #
Remarks: ' ��.. �') � � Planning Notes:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Jrinking Fountains
=1oor Drains '
=1oor Sinks
3as Service Outlets
Interceptors �
Kitchen Sink
Lavarories .
P—Trap
Roof Drains
Reinspection Fee $75
Duct- Under Ground
Duct - Strucmral
Duct - Ventilating '
Exhaust System ❑ Multiple ❑
Firepl/FacL BIL ICBO #
Heating System & Ducting
❑0.100,000 BTU 0100,000BT
Rainspection Fee . � $15
CMF 0865-46, rev. 10/B4 Wbite - Bulltling; Canary - Appllcant Pink - Accounting: Goltlenrotl - Assesior
Showers
Service Sink -
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool wlSpa
Urinal
Water Closet -
Water Heater
Water Service
AutaWash
�Laundry Trays
Issue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System '
❑0.100,000 BTU ❑100,000 BTU
System Repair/Alteration
Fire Dampers
Registers
luue Fae '
Automatic Washer
Cons[ruction PoleSub.
" 'Cooking Unit
/ Dishwasher
§ 3
$ 3
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
SwiLcheS
Gar6age Disposal
Generetor 00�5 KW
Reinspection Fee
2878 5/13/8�
�
Zone
Accessory Building:
Parking Req./Provided '
ELECTRICAL
�Transformer-0 15=50 KW
O 50+KW
Meter ❑up to 100 amps
Meter ❑over100amps
Sub Panel
MotorsOaiHP�1'h-8 �
Inc. Solar �9-15 HP 016-15+
Microwave
Pole Light
Range
; Standing Sections
5 KW Trash Compactor
$15 Issue Fae
DEVELOPMENT SERVICES RE�UIREMENTS:
Zoning Approved By
Building Approved 9y
_ M ,
O�o�O T�'
FEES
1
$ 3
, SUMMARV OF FEES �
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL $ �•(00 GFADING $
PLANCHECK 50% $ ICo�'J('7 MICROFILM 'S
MECHANICAL $ TOTAL FEE $ S(,Q�i�
PLAN CHECK Z5% $ ,
Z
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-1-' CONSTRUCTION AND PLANNING� . POC._ a SPA
Date Inspector Date Inspr.ctor
AP.PROVALS . � Permit # APPROVALS Permit # -
, 1. Tgmporary Electrical Service or Pole �52.. Pool & Equipment Location
," 2. .Soii Pipe-Undrgrnd. - � � 53. Steel Reinforcement
3. Electrical Condui[ 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 Cqnduif-Undrgrnd.
8: Foundation _� 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgmd. 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
73. Roof Drains � � - 64. Plumbing System - Final
14. Rough Plumbing , 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final . � �
i6. Rough Electrie 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 & Ai� Conditioning FIRE DEPT. REQUIREMENT .
2�. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure . 70. Underground Hydro
22. Ducts,Ventilating 71. ProductPipingOGas ❑Oil
23. Gas Pipe-Rough & Test �� � � . 72. Underground Flush
24. Roof framing 73. Undergrnd.StorageTank �Gas OOiI
25. Roof Sheathing ' ' - 74. Overhead Hydro �
26. T-Bar Ceiling (Structural} & Monocoat . 75. Dry Chemical �
27. Frame and F.laShing � - 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 Powsr Meter-Final 80. FOOD CERT�FICATE ISSUED
33. Final Electric � Notes:
34. Final Hea[ing f� 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 Irrination System �
45. Sound 'Attenu8tion
46. Handicap Regulations �
47. FINALSTRUCTURE&"BUILDING
48. Special flequirements Completed
49. Eiectric Retease to Edison - �- �
�50. Gas Release to Southern California Gas Co
'51. CERTIFICATEOFOCCUPANCY
Nn. � � Date. _
vl
�
m
AOp���ant to fill in all spaces except those wilhin neavY Oortler lines anG sign all appropriate Oeclaralions.
CITY 0� �QSTA MESA CONSTRUCTION' P1ERLM^7IT PERMIT NO. TRACT NO. LOT NO. UNITAIh
ProjectAddress ��D E' ,'ff}(� s7' - uNli O
Appiicant's Mailing A�d�d�r�es�s 1� O�'A�fYC�E �IG'ZAi ��2q0
Owner's Name S'•w,+ UGYQ �o YNEV1 . •P(�hone ��("6^���
Address 1 (�o✓vora�l-e. �D(aZa � ��q� IU'�'f, �A1y ( A.
Arch/Eng. ��N�A �d��Y_ L�_A�eO_C�Lic.ernse No. ���(�/�1_r���
Address �%"+v rvc��1�f'r ��VC.� • N�' i�i� .�c��
Contracror's Name Phone G�3-H!4/
Addresslmailing) 3�i(o MAr[�ts • rP_ N�-f-._$r_�C�n.
CityLicenseNa. �lb�%��`
LICENSED CONTRACTOR �ECLARATION • � '
1 ne�eby affirm that I am licensetl untler provisions of Charter 9(commencing
with section 7000) of Division 3 of t usiness and Professions CoOe, antl
my license is in tW I torce antl eftect. � l'��/�
License ss License No. a
�ate Si9nature
WORKERS' COMPENSATION DE LARATION '
I hereby affirm tha[ I have a Certititate ot mnsent to selt-insure or a certlficate
of Worke�s' Compensation Insurance,' or a rertitietl copy thereof (Section
3800, Lab. C.) �
'Policy No. 4o•5I5/6$-3 �ompany 5+.�-fe. Farin.
�Certifietl copy is hereby fumishetl.
Certifietl copy i5 filetl with the city Builtling Qivisio ./
�at¢ Applicant � 1�'�
EXEMPTION FROM W00.KER5' COMPENSATION DECLARATION
(TM1is section neetl not be completetl it the permit is tor one hund�etl ($300) or �_
1255).
I certify that in the pertormance of th¢ work fo� whicM1 this perm�t is issuetl, I
shall not employ any person in any manner so as to become subject to the
Wo�ke�s' Compensation Laws ot Califomia.-
Date Si9nature �
�NOTICE: If, afte� making tM1is tlecla�ation, you Shoultl bewme subject tn the �
Workers' Compensation provisions ot Ihe Labor Cotle, you must for[hwi[n
Wmply with such provi5ion5 or this permit shall De,tleemetl �evoketl.
CONSTRUCTION LENDING AGENCV '
1 hereby affirm that there is a consiruction lentling agency fo� the pertormance
ot the work for which this permi[ is issuetl (Section 3097 Civ. C.) ,
Lentler's Name
Lentler's Atltlress �
OWNER BUILDEN DECLARATION "
I hereby affirm that I am exempt from tbe ConVactor'S Licenze Law fo� the
fallowing reason (Section ]031.5 Business antl Professional Cotle: Any city or
wunty which requires a oermit to consGuct, alter, improve, tlemolish or repalr
any structure, prior to Its issuance, also requires the applicant for such permit
to file a si9netl statement that he/she is IicenSetl pursuant to the provisions of
the Contractor's License Law (Chapter 9(commencing with Section ]000) of
Division 3 ot the Business antl Profeszions Cotle) or [hat he/she is exempt
theretrom anG the basis to� the allegetl exemption. Any violdtion ot $ection
�]031.5 by any applicant tar a pe�mit subjects the appllcant to a civil
�enalty of not more than five huntlred Oollars ($500).
LJ I, as owner of the p�operty or my emPloyees with wages as thei� sole
compensatian, will tlo the work, antl thestructure is nob intentletl or offered
for sale (Section ]044, Business antl Protessional Cotle: The Contractor's
License Law tloes not apply to an owner of a p}operty who builCs or improves
thereon, antl wM10 tloes such work himself/herself o� th�ough his o� her own
employees, Provitletl that such improv¢ments Sre not �Infentletl ot offe�etl for
sale. If, howeve�, tne builtlin9 or improvement is soltl within one year of com-
pletion, the owner will have.the burtlen ot proving he/she tlitl not builtl or Im-
prove for fhe purpose o/ sale), �
❑ 1, as owner of the property, am exclusively contrac[ing with IicenSed con-
tractorsto wnstruct the oroject (Section ]044, Business antl Professions cotle: .
The ConVacror4 License Law tloes not appty to an bwner of property who
builtls or improves the�eon, antl who contracts to� such project5 with a con-
tractor(5) litense puhuant�to the Contractor's License Law). 1 am aware tltat
proof of theit Worker's Compensation insurance shauttl be provitletl to me.
❑ I am exempt untler Section B. 8 P. C. for tnis reason
Date Owner
I hereby cerlify that I haye p�ad tM1is application antl sta[e that the aDove
informatlon is correct. I ag/ee/Ro comply with all city antl munty ortlinances
ng construction .antl hereby authorize repre-
r upon the above-mentionetl Oro erty /�f�or
Date�7Z5_
�� �_
sentauves or mis nc
inspectlon purposes.
� Signature �
Drivers' License or 55
CMF OB65-46, r¢v. 10/84
TVPE OF CONSTRUCTION . LI NEW U ADD IJ ALTERATION_ LJ REPAIR —
❑ CONVERSION ❑ DEMOLISH ❑ OTHER /�p #
DESCRIPTION OF�WORK/USE OF BLDG. ndA Ni
• . . � S Main Building:
TVPE OF PERMIT GRA�ING ❑ FOUNDATION ❑ STRUGTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PIUMBING ❑ MECHANICAL 8 R¢af
❑ OTHER %�
PR0.IECT DESCRIPTION sa. FT. J30U oCCUanNcv I,R-I C Right
CONSTRVCTION TVPE VALUATION $�S'TtYIOZ• SO g Left
ZONE GRA�ING CU. VDS. ACRES p�ng. Ref. #
Rema�ks: �%"� � Q� ��� Planning Notes:
Sink
Preventer
Irrigation
Drinking Fountaios
Floor Droins'
Floor Sinks
Gas Service
Interceptors
Kitchen Sink
Lavatories
P-Trap `
Roof Drains,
Outlets
Reinspectian Fee . $15
Boiler .
Duct - UndeqGround
ExhaustSystem ❑ Multiple
FirepVFact. Blt. ICBO # N�
Heatin9 Sys[em & Ducting
❑ai oo,000 aTu O i oo,oao
Refnspection Fee � $�5
. .__ ______.. _. _.- _..____ __ _. . . __ .
Wbite - Building: Canary - Applicant; Pink - Acwunting; Goltlenrotl - Assessor
Showers.
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool wlSpa
Urinal
Water Cbset -
Water Heater
Water Service
Auto�Wash
Issue Fee
Hood or Type I ❑
Canopy Type 11 ❑
Refrigeration System �
❑aioo,000aTu ❑iao,000a
System Repair/Alteretion � �
Fire Dampers
Registers
Issue Fee
2912 5/i4/85
�
. Zone
Accessory Building: �
P�rking fleq./ProviJed
ELECTHICAL
Automatic Washer Transformer ❑ 75-50 KW -
Construction Pole Sub. � 50 + KW
Cooking Unit Meter ❑up to 100 amps �
Dishwasher Meter ❑over100amps
Dryers ❑Gas ❑Electric Sub Panel
Fan' " Motors�0-7HP�1'f.-8 '
F.A.U. ' . Inc Solar 09-15 HP 016-75+
Fixtures
Device Boxes
Outlets
Switches . -
Garba9e Disposal
Generator 065 KW 05�15 KW
Pole Light
; Standing Sections
Trash Compactor
$ 3 I —,
�— Reinspection Fee $15 luue Fee
FEES .
DEVELOPMENTSERVICESREQUIREMENTS:
Zoning Approved By
Buildin9 Approved By
Application Issued By
$ 3
�.0�
. Z
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FEES ,
$ 3
� , SUMMARV OF FEES � •
BUILDINGPERMIT $ SMIP � $ '
PLAN CHECK $ pERM1T �
PLUMBING $ ISSUANCE $
PLAN CHECK 25% �$ ENERGV P.C. $
ELECTRICAL $ GFiADING $
PLANCHECK 50% $ MICROFILM $ f� '
MECHANICAL $ �I •OO TOTAL FEE � $ U' �
PIAN CHECK ZS% $ 1 ,�O • '
CONSTRUCTION AND PLANNING � ' POOL & SPA
APPROVALS �� Permit # Date Inspector ' AppROVALS Permit # �- Date Insper,ror
, 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. .Soil Pipe=,Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgmd.- 54. Forms
4. Electrical Coriduit-Undrgmd. : � 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing &�Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE .
7. Footings � � 58. Electrical Conduit-Undrgrnd.
8' Foundation 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap,-O Undrgrnd.
10. Strucwral Floor System _ 61. APPROVAL TO DECK
.11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap ', ' 63. Heater & Vent-Final �
73. Roof Drains • � 64. Plumbing SYstem - Final
14. Rough Plumbing •. 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final . � �
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Fiough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT .
20. Rough Factory Fireplace �(/� dr �� 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 F.lashing �� - 76. Dry Standpipe .
28. Lathing & Siding . . . 77. FIXED SYSTEM FINAL
29. Insulation . � �� . . 78. FIRE PREV. FINAL .
30. Drywall Nailing -� ' _ HEALTH DEPT-. REQUIREMENT
31. Plaster Brown Coat . " � 79. FINAL INSPECTION
32" Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating �& Air Conditioning �
35. Final Gas Pipe-Test � � �
36. Hood or Canopy �
37. Final Factory Fireplace / �/� �
38. Final Plumbing
39. Water Service-Final �
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. .Landscape Irrigation SYstem
45. Sound Attenuation .
46. Handicap Regulations
47. F�NAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison � -
50. Gas Release to Southern California Gas Co � �
51. CERT.IFICATEOE.00CUPANCY
No. - � Date �
'
Appllcant to fill in all spaces exeept ihose within heavY �ortler Iinei anE si9n all ap0�op�iale tleclarations.
CITV OF C06TAMQ E�SAf� CONSTRUCT�IfOe�N YtH�� � PE IT N. TRACT NO. LOT NO. UNIT NO.
Projecr�P,ddress =Jv `-' � • �/ �'
Applicant's Mailing 'Ad^dres�_ �0� D(,�(H
Owner's Name ,� Phone
Address
Arch/Eng. License No.
Address _1.7J.`—� '3L c
Contractor's Nam ��'� e _Ph n J
Address (mailing) %�9 .C�
City Licanse Nn J �
LICENSED CONTRACTOR DECLARATION
I hereby alfl�m tM1at I am Ilcensetl untle� provi5ion5 of Chdrt¢r 9(commencing
with settion 7000) 01 Oivision 3 ot tha BUSiness antl Protessions Cotle, an0
my license iz in lull torte n efiect.
License GI ss �� '< se No.
Oate Si9nalure
WORK RS' OMPENSATION DE ARATION
' hereby alfirm that I nave a certificate o! consent to selhinsur¢ or a certlticat
f Workerz' Compensstion Insurance, or a certifietl copy thereof (Section
4800, Lab. C.)
Pnolicy No. Company '
y Ceriifie� copy is �ereby turnishetl. ' "
� Certifle cop i tl with the city Itl g C�o�ur'=�
Date ' Apo���ant ��
EXEM 10 FROM WORKERS' C ENSATION DECLARATION
(This section neetl no[ �e cOmpletetl [hn permit is for one huntlretl (E100) or
lez5).
I certi�y tM1at in th¢ perlormance Of [he work fOr whith thi5 pe�m�l is i55uetl I
shall mt employ any pe�son In any manne� so as [o become subject to t�e
Workers' Comoensatlon Laws o( California.
Date Si9nature
'NOTICE: II, atte� making this tlecla�atiOn, you Shoultl become subject to the
WOlkeri' COmO���tion provi5ion5 Of Ihe LdbOr COtla, you must (orthwlth
tomply with suc� 0/ovisiOns or Inis pe�mlt shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I hereby a�firm lhat there is a con5lruclion 1¢ntling agency lo� t�e performance
of t�e work for wnicn thts permlt is issuetl (Section 309] Civ. CJ
Lentler's Name
Londer's AOdress
OWNER BUILDEN DECLARATION
I hereby ailirm Inat I am exempi trom tho Contractor's License Law for tho
followin9 raason (Se<tlon ]031.5 Businass antl Prolesslonal Cotic: Any city or
counly whiGh rCqubes a permit to conslrutt, alter, improve, tlemolish or rOpalr
any 5[ruchro, pNo� to It5 issuance, al5o reqWres �ho applicant tor SUCh permlt
to filo a signod stalem¢nt lhdt h¢/She is licansatl pu�5uant f0 th¢ PrOvislons ol
tne Contraclor'S License Law (Cnapter 9,(commoncing wlth Section 7000) of
Division 3 of the Bu5ine55 antl Prolessions Cotle) or that he/she is exempt
'heretrom antl the basls IOr t�e allegetl exOmpliOn. Any violation of SeCtion
/031.5 by any ap0���ant for a permil subjects tne apo���ant to a clvil
�enalty ot not more tnan 11ve huntlrcU Dollars (E500).
I, a5 ownm of the prop¢rty or my employ¢OS with wages as thelr Sole
COmpCnShcion, will tlo th¢ wofk, antl lh8 Structute Is no� Intentletl Or OtfGrCtl
for sale (SUClion 7044, Business antl Prole55ional Cotlo: The Contractor's
LI<ense l.aw tloes noi avP�Y �o an owner of a property who bulltls or improves
thereon, antl who tloes such work hlmsetl/nerselt or thwugh hiz or hur own
employces, provitletl that such imD���emenlz are not Int¢ntlutl o� olteretl fOr
sale. I/, howover, tne bulltling or improvomant Is soltl wlthln one year of com-
pl¢liOn, Ihe own¢r will have the burtlen of proving ho/the tlitl nol builtl or Im-
�rOve fortha pur0ose olsale).
I, as ownCr ot the properiy, am ex<IuSively mn[tacting wi[h licensotl con-
tractors to consVucl lhe project ($ection 7044, Buslness an0 Prote55ion5 Cotle:
The ConVaclor's License Law tlOes not appty lo an owner of properly who
builds or improves thereon, antl who contracts /or such projecis with a con-
tractor(sl license oursuant�to me�Contractoi'z License Law). I am aware lhat
proot o( thoir Worker'S Compenvtlon insurance shoultl be provitletl [o me.
❑ I am exempt untler Seciion 8. b P. C. for this reazon
Date
I nereby certity tnat
in/ormallOn Is torrect
antl state laws relatin
sentatives oi tnls cit
inspection pur es.
Signaturc
Drivers' Lic 5e or 55
CMF 0065-4fi, rev. 10/84
_ Owner
I have rea0 tbis application antl s[ate that Ihe above
I agree to comply with all dry and countY ortlinances
to Ouiltling COnitruCHOn, antl her¢by au[horl¢e repre-
' to ente� upon ttro above-mentionetl Or perty tor
G_ F� ,�- ,,..e 3%�. /�s
�"%�/��
TVPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLOG.
TVPE OF PERMIT LJ GRADING U FOUNDATION LJ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION Sq.FT. oCCVVArvCv—
CONSTRVCTION TVPE VALUATION $
ZONE GRA�ING CU. VDS. ACRES—
Remarks:
Bar Sink
Backflow Prevenrer
Backflow Irrigation
Bathtubs
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors
Kimhen Sink
Wvamries .
Roof Drains
Reinspection Fea � §75
Boiler
Dutt-UnderGround
Duct - Structural
Duct � Ventilating
Exhaust System � Mul[iple ❑
Firepl/FacL Blt. IC80 #
Heating System & Ducting
❑ 67 00,000 BTU O 100,000 BTi
Reinspec[ion Fee
White - Builtling; Canary - AOPlicant; Pink - AGcounting; Goltlenrotl - ASSessov
$15
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collec[ors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
laue Fee
FEES
5 3
A.P. �
S Main Bu
E
T Front
B Rear
A
C Right
K Left
S
Ping. Re(, #
Washer
Cooking Unit
Dishwasher
Fan '
F:A.U. �
Fixtures
Device Boxes
Outlets
Switch¢S
Garbnge Disposal
Generator �0�5 KW
0110 3/26/85
Zone
Atceuory Building:
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter ❑over100amps
Sub Panel
Motors �0-1 HP � 1 X- B
Int.Solar �9-15 HP �16�15+
Microwave
Pole Light
Range
; S�anding Sections
5�15 KW Trash Compactor
Reinspection Fee $15 Issue Fee
IANICAL FEES
Hoodor T DEVELOPMENTSERVICESREQUIREMENTS:
ypel ❑ Zoning Approved By
Canopy Typell ❑
BuildinB APProved By (1 ,�,r
Refrigeration System
❑0.100,000 BTU ❑100,000 BTU
System fiepair/Alteration
Fire Dampers
Registers
Issua Fee I S 3
3Bo0�7 iL
Z
O
N
I
N
G
R
E
�
M
T
$
FEES
S3
SUMMARY OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ 7 PERMIT
PLUMBING $ --�2� ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL § GRADING S
PLAN CHECK 50% § MICROFI�M $
MECHANICAL S TOTALFEE $ :.!'.2GCLL!
PLAN CHECK 25% $
�
�• CONSTRUCTION AND PLANNING POC, ... SPA
i'
�APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
i. T�mporary Electrical Service or Pole 52. Pool & Equipment Location
' 2.. Soil Pipe�Undrgrnd. , Z,r� �0 53. Steel Reinforcemen[ +"
.3. Electrical Condu�t Utiliry-Undrgmd. 54. Forms •
4: EleFtrical 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. Founda[ion � � 59. Gas Pipe, � Undrgrnd., Test �i'
9�'Water Pipe�Undrgrnd:., � J� �%jjfl�5' LEp 60. Backwash Lines, P-Trap, � Undrgrnd. '
10. Structural Floor System " 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 3rL(ild�,$� (�n 62. Backwash & Receptor-Final
12. Sewer Cap .,� �; 63. Heater & Vent-Final ..�
1�: Roof Drains � � � 64. Plumbing SYstem - Final :•,
14. Rough Plumbing' % .,�/���f�� 1.��' 65. Electrical-Final
� '.
15. Rough Electrical-Conduit 66. Solar SYstem-Final
16. Rough Electric Wiring �� 67. Fencing & Access Approval
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating &%a�r Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory �ireplace ._ APPROVALS Permit #
21. Ducts, in StructUre 70. Underground HYdro
22. Ducts, Ventilating � 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test � k, � _ ��/ � 72. Underground Flush
r
24. Roof Framing ^ 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structurap & Monocoat 75. Dry Chemical
27. Frame and Flashing �� 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test L
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 �rrigation System ,
45. Sound At[enua[ion
46. Handicap Regulations '
47. FINALSTRUCTURE&BUILDING '
48. Special Requirements Completed
49. Electric Release to Edison .
50. Gas Release to Southern California Gas Co
51. CERTIFICATEOFOCCUPANCY .
No. Date
Eity of Costa Mesa
Development ServicBs Depar[ment
Building Safety Division "
� P.O.Box 1200
Costa Mesa, Ce�ifornia
CERTIFICATE OF OCCUPANCY No.00l36�
The Building �ocated at 350 EAST 2075i STRL�T UNIT #B
has been inspec2ed and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group �1 Occupancy.
Use of Building �ti�`1IUt1
Legal Description
(See reverse side for Metes and Bounds)
Building Permit No B18189 Etectrical Permit No.�'8322 Plumbing Permit No. P18189
Mechanical Permit No. �8933�M18846 Number of apartments � and/or guest rooms �
iSSUED T0: Building Official/�� �' �� tr���
Srnmn n�nvr.�vr bY �'�i l;. ��,9J.�i!/�i^
�k� (Y]RP(1RATF ➢TA7.A ��qn r�sapnam nFnru � ' 7 � ����� �.���
Date � ' 4
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Cos[a Mesa under Sec. 307 (e) U.B.C.
CMF 1015-46 .ev. �/83 White -Owner; Canary - Numerical File; Pink - Bldg. Permi[ File
(714) 754-5273 • Fax (714) 754-4856 � www.ci.costa-me5a.c�1���ryG�PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job nddress: 350 E 20TH ST
Suite: C
Vicinity: RESIDENCE AND ATTACHED GARAGE
Parcel Number: 42623403
App�icant: GOMEZ, PAUL
Address: 2626 NEWPORT BL
COSTA MESq, CA
Owner: CAIVERT, JAY WYNN
Address 10481RVINE qVE tl427
NEWPORT BEACH, CA
Contractor: PETRONELLA ROOFING
Address: 2626 NEWPORT BL
COSTA MESq, CA
Zip: 92627
Arch :
Address:
Zoning:
Phone: (949) 54&1645
Zip: 92627
Phone:
Zip: 92660-0602
Phone: (949) 54&1645
License: 460707
Eng:
Address:
ISSUED BY:
Stalus: ISSUED
Applietl: 10/02/2003
Issued: 10/02/2003
Phone: Phone:
Zip: License: License:
SCOPE OF PERMIT
COVER ONE EXISITNG LAYER WITH CLASS A 30 YEAR COMP. INCLUDES RESIDENCE AND ATTACHED GARAGE.
Plan Check: $0.00
Permit: $15325
SMIP Res: $0.72
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total: $153.97
SETBACKS
MAIN STRUCTURE Fronl 0- 0
ACCESSORY Front 0-0
PARKING Existinq: o
NOTES:
Rear 0- 0
Rear 0- 0
Re uired: 0
FEE SUMMARY
PLANNING & ZONING
LeR 0- 0
Left 0- 0
Proposed: 0
Calc Valuation:
Claim Valuation:
Right 0- 0
Right 0• 0
$7,200.00
$7,200.00
NOTICE: The work authorized by this permit shall compty with all applicable handicap access requirements under California staWtes and related
regulations. (Ord. No. 92-28, § i, 12-21•92)
EXPIRATION: This permit shall automg�ically expire and become void it work is not commenced within 1 BO days, or iF work is suspended or abandoned
for a period o� 180 days.
INSPEC710NS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred inapections and tinal approval must be obtained. Failure lo oblain inspections and final approval will result in the expiration ot thls permit.
FOR INSPECTIONS CALL: (714) 754-5626
26a6-46�N00)
WORKERS'COMPENSAnON DECLARAPON:
I hereby attirm under penalry ol perjury one of ihe tollowing declarations:
❑ I have and will maintain a certificete ot consent to selt-Insure lor workers' compensation, as provitletl tor by section 3700 of the Lahor Code, lor Iha peAortnance oi the
work for which t�is permit is issuetl.
e and will maintain workers' compensation insurence, as require� by section 3700 of the Labor Code, for the pertortnance of the work for whlch this pertnit is issued.
My workers' compens on Insurence wrrier anC policy number are: 1 'J p
Carner. S�TPT�. unP �r'S • Policy Number. _lS `'1 `T L1-U ' Fi �
(This section need not be complefed i( (he permil is valued af one hundred tlollers ($ I00J ar less.)
❑ 1 certily �hat in t�e p6A ce of l�e wOrk for which ihis pertnit i5 issuod, I Shall no� employ eny person in any manner so es o becoma subject �o Iha workers'
compensetion laws�of Califo ia, a d egree thet II I should 6ecome subJect to tlia worker4;compensation provisions oi Sectio 3700 Ihe Labor Cotle, I shell forthwith
comply with these � mvision ,`
ApplicantSignaWre: "`� -� Date: O V
WARNINO: FAILURE TO SE UR WORKERS' COMPENSNTION COVEMGE IS UNLAWFUL M'D SHALL SUBJECT AN EMPLOVEP TO CRIMINAL PENALTIE AND CIVIL FlNES UP TOONE MUNORED
T/KK15AN� DOLI.ARE (5100,000�, IN ADDIiION TO THE WST OF COlAPENSATION, DAMAGES AS PROVIDED FOR IN SECiION 3108 OF THE LABOR CODE, IMEFEST, AND ATTORNEI"S FEES.
LICENSED CONTRACTORS DECLARATION:
I �ereby ettirtn that I am
brce antl eNec1. Lic. s_
Contrattofs Si9naNre:
ol Chapter 9(commencing with Section 7000) ot Division 3 of the Business and Protessp ns C e, end my license is in full
classa 1 ,.�1 _ �i.i7
CONS7RUCT10N LENDING AGENCY:
❑ I hereby aHirtn thal there is a consiruction lending egency for ihe peAormence of the work tor which this pertnit is issuetl. (Sec. 3097, Civil Cotlo).
Lentlers Name:
Signalure: _
OWNER-BUILDER DECLARATIONS:
Lentlers Adtlress:
Date:
I hereby eMirm ihet under penelty of perlury Ihat I em E%EMPT FROM 7HE CONTRACTORS LICENSE LAW for the follawing reason (Sec. 7031.5, Business end Professions
Code: Any ciry or counry w�ich requires a permit to constmct, eltar, improve, tlemolish, or repair any stmcture, prior to its issuence, elso requires the epplicant lor such pertnit
to file e signed stetemem Ihet he or she Is Iicensad pursuent to ihe provlsions of ihe Contrectors License Law (Chapter 9(commencing with Section 7000) of Dlvision 3 of the
Business end Prolessions Code) or thet he ar she is exempl iherelrom end the besis for tha alleged axemption. Any violetion ol Section 7031.5 by any appllcant tor e pertnit
subjects lhe applicent to e civil penalty of noI more than tive �untlretl tlollers ($500).):
❑ 1, es owner of the property, or my employees with weges es thelr sole compensation, WILL DO THE WORK, end ihe structure is not Inientled or oHered for sale (Sec.
7044, Business and Prolessions Code: The Contractors License Law tloos not apply to an owner of proDerty who builtls or improves thereon, end who does such work
himselt ar herself or Ihrough his or her own employees, provitled that such improvements ere not intentled or oNeretl for sale. If, however, the building or improvement is
soltl within one year ot wmpletion, the owner-builder will havethe burden ol proving that he or she did nol build or improve tor purpose ol saie.). �
❑ I, as owner at ihe property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to consiruct the proiect (Sec. 7044, Business antl Profe551on5
Code: The contrectors License Lew tloes not appty to en owner of property who builtls or impmves thereon, antl who contracts for such pro�ect wiih e contrector(s)
license pursuent to the Contrectore License Lews.�.
❑ I em exempt under sec.
Siqnature:
Owner ID verltietl by tlrivefs license. ❑ Ves ❑ No
Business and Professions CoOe for ihis reeson:
Venficatian of Ownership by (type of document, i.e. - properry taz 6ill or Aeed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
Drivefs Licen58 No.
Date:
Expires:
❑ I hereby certify thel no excavetion five (5) or more leef in tlepth into which a person is required to descen4 will be matle in connection with work euthonzed by this
pertnit, antl lhal no building SWcture, scaHolding, falsework, or tlemolition or dismantling thereot, will be more than thirty-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec.
341, Title 8, Celifomia AdmInlSlrBllve Cotle).
❑ As owner-builder, I will not employ enyone to tlo work which woultl require e pertnit tmm the Division ot Intlustrial Safery. es noted above, unless such person has e
pertnit to do suc� wark Irom the division.
Signature: Date:
Division af Industnal Salery Permit Number:
CEfiT1FlCATE OF COMPLIANCE AND AUfMORVJITION OF ENTAV: I certity under penalty of perjury that I �ave read this applicalion and slate thal �he infortnation given is
correct. I egree to compy wilh all state lews end ciry ortlinances relating to building consWction, and auihorize representa�ives of t�e Ciry ot Costa Mesa to emer upon the
abova-described property tor inspection purposes. I agree not to occupy or allow occupancy ol any building authorized by this permit until final inspection.
CODE 1. INSPECTIONTYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Rooi
201 Final8lock/Retaining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Domolition
uW
i � � �
i �
SOUE 1 INSPECTION TYPE
206 Final Mechanical
20B Final Plumbing
210 Final Eledncal
212 Finel Fire Preventlon
220 Final Planning Approval
222 Finel Site
250 Finel Builtling/Occupancy
� �
?uonessw�auun: 350 E 20TH ST
°w"Eas""yEi°uaw":DAVID bULL
"°o"Eu 350 E 20TH ST
C.M. CA 92626
�vv�. �uuxa �ooxEss
/iHCNRECTONfIMiNFFA:
ACH OH FiNi'8 ADDIiE55:
�?
IlG NO.:
ux.: C CITY OF COSTA MESA - HUILDING PERMIT
F'ERMIT NO: P 087552 PLAN CHECK NO: N
CONSTRUCTION TYPE: V-N PERMIT TYPE: PLU
urn:
�a+TM"aa+g"n"E NOCK PLUMBZNG ( 714 ) 695-1246
CONTM"0T0R8°�UNO 1 1 6 1 2 KNOTT S T
"""^�� GARDEN GROVE CA ��� 707775
92891 uxr: 17
LICENSEU COMNRCTOXS OECL�P�TION: I heraby ellim uMx peealy d parjury thet I em liromed udx paiebm al CMqm 9
�mmm«,am wiin sec�c� �aool a dvi,o� a a me aue,eo m,e v�do,ima w mr �ne o N mo ruw ene enee.
cmuc.No.:05�8� uc.cuss:C-36 uc.No.: � 75 EXP: 02/99
WNEX BUILbEI{�DECIANATION: I haeby elfirm uMer penely d perjrty �het I em aramq ham �M CoMreqm Licenee Law la Ihs
wiq renvon (Seaion'lm1.5 Buaims end PNeaebna Cods: A^y W a wuNY xfiidi �ea�drw e Wme m awuun. Ma.'vnYove.
mdeh, w repei any NrucWra: p'v to Ya ewar�oe, e6o repuvee IM eppliteN ta ath pe�mM to fib e cgneE s�alemenl Nel M or eM
�icanaed pum,e�n m ine wowsiona d me comreaon Liomse le. Icheq> a(mmm.�ne wnn seaia, �aao) a owcim 9 a �ro
mrren ene Prolessian cadel «�het na u ahe o uemN iherMvn end the bese In ihe albped memqion. rlm/ vidmion d Seeun
1.5 by anY �GW� lar e pe�me wbptla iM epplicem to a oW penatly d nd mon then live hwdred ddlen �SSOOU.
� I.�oMtwrdlMpWa�Yn�N�wihw�mnlhsdemmGM+eCan.wdldoNewark.ardlhealructuieundinlendeE
a are�e r«.eie �s«mn>a.. ew�+.m arama�are cae: rnecaurmon umme �e. aoe. na eooN�oa� m.,�a,d werom
who buiM a inprwea Iheiem. anA x1q doea su h Mpk IimseC a henM a thaqh he a hx own mmpbyros. pwMed �MI euc�
„�nw,�+a+, �e �a �nawee «ar,..e e«..b. n. no.a«. ub adean «mw���v:.ae wnn� oo. r.e• a oo�da�. me
owmr-0uilder will hew �M duden at pwi�q ha w eM did m� dik «impo.e la �M WNas d We).
❑ I. u oxw d tM G�W�Y. am udisivelY mr4retl^0 wiN licemed cont�ectm b mmtrutl Ne p9b (Sacvn )OM. Buirve eM
Prdeaioeu Coda: The C«urowe licen» law droa m� epph W en oxner d propeny wM buildc a impwp ths�eon eM vAw
conVecd br wM WM�+ wiN e mmaeMe) IcameA O��aru �o �M Capreeas limn�e lar.1.
� I em eaemq uMer Seciion: B. 8 P.C., la Ne �aeaon:
� ao MmM �enM uw � em erue a.�e n,de.�end me �.w:anen a cwomie Heem� ene SeMr coes swlam zsws. zss3J..nd
?SS1a, vM ihtl I v eny Mun WYEip omWem will / wll nd (mcb one) naad m canply wYh uk mia oode� erd IM'puiromsnb br
e PemN IaoontVuclion v modifration homlMA��6ue iTylrar�epenra Oiarid. ReWenliel conqrutlion eCV�'vuere uemq Irom thees
pranaiom.
Dele: MN�
W ORKER'4 COMVENS�TION OKL�NAPON: I Mab� elhm uder ps�etly d pee�ny wr d tM blow'vp Mtleretoro:
❑ 1 heva xW �wl meime�. canfw. M oamnt Io votl;�wve br xaFen• can0��ion. n pw+dsd Iv M Seaion 3]ao d �M lebor
Cade, la IM psAanw�ce tl Ne Mak la iMich Nu prme u fnued.
� � n... ena w� me'vn.� .�on�«Y mno«mtion v�*„erc...s iwwb M seeion aroo a me �.n« coa.. �« ine w�«menw a m.
work lor whiN Nb pamil u inueE. MY �ken' mmGe�� ���a �w � DdkY number us:
c°^"�: GOLLIEAI EAGLE EXPIRES
varyN�mna: �tyc °-,�r3¢q^� 09/O1/98
�: �aro� �a �or a. �W�ad r me o�r r, ro. w�e n,,,d�ea edw. Riool o. iw.)
�..
I m�ly �IW in tM pe�l d Ihe wak la xfich �hu pmma b iea�ed. I qutl m� empby erry p«von in vry mennu w u �o
becwm euEj o IM rs' canpenea�ion leMe al Cefilmiu. eM pree Net k Dacoms aEjae m tM waekere'
cam0e�+t rov'u' bn �)00 d iM lebar Code. 1 Me0 I py ' p�w'nuru. —�
oa�e: •ow� �:
W�minp: F� un b ucun woilr�ri mmpr�utlon corw�p Is un , M�htll �u4/�ct �n w�rp/qw ro MMrW p�ultlu �M
Nvll flnu ,y ro ons hu+tlrM fhouuM eclMn (Sf00,OWA N�tlAltlon b!M cwf ol mmplru�tloM1 Aertups� �� prav/EW br In
Sxtlon 9]O6 0l Ms Lelor COW. /ntwt �� ���Y�� ��.
CONSTHUCTON LENDINO AOENCY: I hmaby elfirtn iuWs pautly d perj.vy ihel iM1se u e cmnrwion bM'uq e�jency br Ne
peAwmerKa M I�e xoA br whidi ihi prmi b eeued (`�� �). CM. CI.
LENDEP'S NAME:
LENOEP'4 �ODNES4:
� cenuy inm i nave iead w. mW�on w mm. mm m. enw. wwmmc� o co„ea. � epne io oomdr wn.0 ar•�d wwv o.dnwioe.
end ele�e leMs nleln0lo Wikvp conatlutlbn eetl MrWy ai4ha¢e iepemnte�im d th6 aryto entar upm Ihe ebove�men�oneE qopeM
1« impeeion w�0���
o cx
Pn Nama
� . om.:
Sqralure /RgeM/Apph�anUCm�reda
JOH DESCRIPTION : ZNSTALL DZSHWASHER
8-ooay3
PERM NO: P 087552
GOVT: N SUPP: N
SQ FT:
L•l�l:l�i3-9��yll:l
CLAIM VALUE: CALC—VALUE: GROUP OCC: R-3 /
COMMENTS: NO OTHER WORK ASSOCIATED WITH THIS PERMIT
iE iE it �E iE iF iE iE it �)E iE 3E �E iE �E 3F 3E iE iE iE �f aE 3E * aE 1k iE �E 1E iE af �lt iE 3E �E �E iE iE �E �1t �E �E 3t �)E 3E iE iE af iE iE �F if iE aE it 3F if 3t �E 3t iF iF aF 3E if iE iE iE �E iF iE if it it iF aE iE iE i!
Z O N I N GS ERTEH�AUCIKRSE M E N T 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: 42623903 ZNE: REF NO:
PLANNING NOTES>
i
,�+��+�***�****�*��***�**���x�*****�***�r�***�******��**��***�x*�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 HY: � DATE:
�3E 1E �E iF iE jE iE iE f(� iF 3f af iE iE fE i! ik iF ik iF iF it iE if 1E iE iE 1E �E i�E ik iEi�7FiFiE aE
LEGALIZATION:N F E E S U M M A R'Y STRUCTURAL SEGMENT:N
.�
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 8.75
25� SMIP/NON-RES
PLAN
ISSUE FEE 22.00
HUILDING-DIV-> PERMIT ISSUE PLAN-CHECK TOTAL PAID DUE
TOTALS----> 8.75 22.00 0.00 30.75 30.75 .00
REVENUE DZVISION TOTALS--> COLLECTED; 30.75 OVER/SHORT: 00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK
30.75
TYPE QTY
PLU 1
�E if �F jF iF fE �f iE iE af if 1P iE if iE iE iE iF iF iF iF if 1F iE if iE �Nr ff fF iF ik iE it iE iF if ik if iE iF 1F iE iF iF ff iE �4 �f �F 1E iE iE jE 3F �i 3E jk �E if iE �E 1E 1E
I N D I V I D U A L F E E B R E A K D O W N
D E S C R I P T I O N UNIT COST TOTAL COST
DISHWASHER 8,75 8.75
END OF FE S
��� �j�
�►'iF+ I I 04-02-1998/11:59 PH/938.75
kCFT�:ul ��21811
F'EFLt3IT: �87SSc!
f
� (5151d6.W P) WhGe-BuddM 8 SefmY.Oreen-Ra: Ce��'-APO�M: Rnk-Rerenua: GddervoFMaem �
�' CONSTRUCTION AND PIANNIN� rw� PA ^�
� APPROVALS Permit # Date Inspector qppROVAIS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52, Pool & Equipment Location
2. Soil Pipe�Undrgrnd. 53. S[eel Reinforcement
' 3. E�ectrical 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. Eloctrical Conduit�Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe�Undrgrnd. , 60. Backwash Lines, P-Trap, O Undrgrnd.
70. Structurol Floor Svstem 61. APPROVAL TO DECK �
i t. Property Sewer Line & House Connection 62. Backwash & ReceptorFinai '
12. Sewer Cap 63. Heater & Vent-Final
73. floof Drains 64. Plumbing SYstem - Final
74. Rough Plumbing � 65. Electrical-Final
75. Rough Electrical-COnduit 66. Solar System-Final '
16. Rough Electric Wiri�g 67. Fenciny & Access ApProval ' �
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-7 Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79. Rough Heating & Air Co�ditioning • FIRE'DEPT. REQUIREMENT
20. flough Factory FireP�ace APPROVALS � Permit #
21. Ducts, in Struaure 70. Underground Hydro �
22. Ducts, Ventilating � 77. Product Piping O Gas ❑ Oil
23. Gas Pipe•Rough & Test 72. U�derground Flush
24. Roof Framing ' ' 73: Underymd.StorayeTank OGas ❑Oil
25. Roof Sheathing .� 74. Overhead Hydro•
26. T•Bar Ceiling (Structurall & Monocoat � 75. Dry Chemical '
27. Frame and Flashing � 76. Dry Standpipe '
28. Lathing & Siding � 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL �
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
37. Plasier Brown Coat 79, fINAL INSPECTION
32. Electriwl Power Meter�Final 60. FOOD CERTIFICATE ISSUEO
33. Final Electric � ' Notes; �
34. Final Heatin9 & Air Conditioning
35. Final Gas Pipe-Test . ' � e�
36. Hood or Canopy - - � ,
37. Pinai Factory Fireplace, 1`�
.�
38. FinalPlumbing - t,'_n���� (�l .
39. Vdater Service-Final J . �
' ' �
40. Gas Service-Pinal � - . - �� �
� 41. Solar pomestic-Finat � �
42. Backflow Preventer �
43. Backflow Irrigation ' . . '
44. Landscape Irriqation System � . �
45. Sound Attenuation , � r
46. Handicap Regulatio�s
47. FINAL STRUCTURE & BUILDING �
48. FINAL PLANNING
49. Electric Release to Edison � - �
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
� �� . _ �I
•� ' Aov���ant to /ill in all svaces excev< <�ose within heavy Cortler lines antl si9n all a0orovriate tleclarations.
CIY OF�COSTA MESA � ONSTRU�O�V PE�IT G PE �N O TRACT NO. LOT NO. UNIT NU.
. Project Address � �n / ��
A}plicant's Mailing Address r 0� �
Owner's Name ��� hone
Address
Arch/Eng. License No.
Address
Contracror'c Nam�—� Phone � ' �',,..y �
Address Im�'i'��� — � 9���� aA✓i 1
Ciry License No � �
LICENSED CONTRACTOR DECIARATION
1 hlreby affi�m Ihat I am licensetl untler provi5ion5 of Cha�ter 9(commencin9
with section 7000) of Division 3 of the Business antl Professions Cotle, antl
my license is in tull fq�ce a ef ecL -
License CI ss �- ` icr e o. �
Date Signature ' �
WORK RS' COMPENSATION O CLARATION .
I hereby affirm that I have a cert � icate ol consen[ to salHnsure or a certlficate
nf Wotke�s' Compensatlon Inw�ance, o� a certifletl copy [he�eo( ($ection
100, Lab. CJ
�licy No. � Company
Certifietl copy is hereby fumishetl.
Certifietl copy is filetl with tM1e city Builtling Division. _
Dat¢ Applicant
EXEMGTION FROM WOftKERS' COMPENSATION DECLARATION '
(Thissection neetl not bc mm0�etetl if the pe�mit Is for one hunaretl (§100) or .
Icss). '
I certity tM1at in [he performance of the work for which thls peim�t is Issuetl, I
shall not employ any perzon in any manner so as to betome subjeci to Ihe
Workers' Compensation Laws of Galifornia. . .
Date � Si9nature
'NOTICE: If, afte� maklnq this tlecla�ation, you shoultl become subject to the
Workers' ComOensatlon Orovisions of lhe Labor Cotle, you must fortnwith
comply with Such prOvisions or this permit Shall be tleemetl revoketl.
CONSTRUCTION LENDING NGENCV
1 hereby affirm tha[ [here is a construction lentlin9 agency for the pertormance
ot tho work for whicn this Oermit is issue0 (SectiOn 3097 Civ. G.) ,
Lentler's Name
Lender'S AtlOress '
OWNER BUILDER DECIARATION
I hereby atfirm that I am exempt from the ConVactor's License Law tor the
followin9 reason (Section 7031.5 Business antl Prolezsional Cotle: Any ci[y or
counly w�ich requires a permlt to const�ucl, alte�, Improve, tlemolisn o� �epair
any Stru<ture, prior ta its issuance,�also requirez [he applicant for such permit
lo file a siqnetl slatement that he/she is licensetl pu�suant to the prOvisions ot
[ne Contractor's License Law (GnaOter 9(commenUng with Sec[ion 7000) of
Division 3 of the Business antl Professions Cotle) or that he/she is exempt
the�efrom antl the ba5is (or the allegetl exemptiOn. Any viOlatlon ot Section
'931.5 by any applican[ for a permit subjec[s tne ap011cant to a civil
nalty of not more than five huntlretl tlollars (y500).
J I, as ownev of the property, o� my employees with wages as thei� sole
comoensation. will tlo the work. antl the structure is not intentletl Or o(teretl
Llcense Law tloes not apply to an owner ot a properry wno bwias or improves
lM1ereon, and who tloes such work himself/he�self or through his or her own
¢mployecs, pwvidetl that such improvements are no[ Intentletl o� offeretl for
sale. If, howev¢r, the builtlinq o� improvement Is soltl wit�in one year o( com-
plellon, the Ownel will have the bU/tl8n Ot plOvlOg h¢/Sh¢ tlltl n0[ bWltl Of irtl-
p�ove tor the purpose ot sale).
❑ 1, as owner ot the Droperty, am exUusively cont�actlng with licensetl con-'
tractors to wnztruct the project (Section 7044, Business antl Pro(essions Code:
The Contracror's License Law tloes no[ apply to an owner of Property who
builtls o� improves thereon, antl who contracts (or such projects witn a com
tractor(sl Ocense pursuanl to tM1e ConVacmr'S License Law). I am aware [hat
proof o( tM1elr Worker's ComPensation insmance iM1oultl be provitletl to me.
❑ I am exempt un0er Section B. 8 P. C. for this reason
Date Owner _
t hereby certify tnai 1 have reatl thls
Intormation is correct. I agree to comp
CMF OB65-46, rev. 10/84
a
upon
t¢ that the above
COUOiy OfdIOdOCfS
y authorize repre-
netl oraoertv, tor
TVPE OF CONSTRUCTION LI NEW I—� ADD LI ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOlISN ❑ OTHER p,p, #
DESCRIPTION OF WORK/USE OF BLDG.
S Main Building:
TYPE OF PERMIT GRA�ING ❑ FOUNDATION STftVCTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PWMBING ❑ MECHANICAL B Rear
❑ OTHER A
PROJECT DESCRIPTION 5q. FT. oCCUPANCv C Right
K
CONSTRUCTION TVPE VALUATION $ S �¢ft
ZONE GRADING CU. VDS. ACRES Ping. Ref. �`-
aemarks: - i� �OI iL '—]Ji' 9 Planninallotes:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
GasService Outlets
Kitchen Sink
Lavacories
P-Trap
Foof �rains .
Reinspaction Fee $15
Duct- UnderGround
Duct - Sbucwral
Duct - Ventilating
Exhaust $ystem ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑6100,000 BTU �100,000
Reinspection Fee � $15
White - Builtlinq; Canary - Appliwnt; Pink - Accoun[ing; GOltlenrotl - ASsessor
PLUMBING
Showers
Service Sink
Sewer Cap
Sewr,r Connection
Solar Collecmrs
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auro-Wash
Laundry Trays
laue Fee
Hoodor Typel ❑
Canopy Type 11 ❑
Refrigeration System
❑aioo,000sru ❑ioo,000
Sys[em Repair/Alteration
Fire Dampers
Registers
Issue Fee
FEES
u
g 3 � f
0111 3/26/05
2one
Accessory Building:
� • Parking Req./Provided
m
ELECTRICAL
Aurometic Washer, Transformer ❑ 75�50 KW
ConstructionPoleSub� . �50+KW
Cooking Unit • -
Dishwasher �..
Dryers ❑Gas ❑Electric ,
Fan �
f '
F:A.U.
Fixtures
Device Boxes
Ouclets
Switches
Garbage Dispoul
Generator DU5 KW �5-15 KW
Meter ❑up to 100 amps -
Meter ❑over100amps
Sub�Panel � �
Motors OO-1 HP � t Y� - 8
Inc.Solar 09-15 HP �16-15+
Microwave
Pole Light
Range
Sign
; Standing Sections
Trash Compactor
Reinspection Fee ' $15 Issue Fee
FEES �
� DEVELOPMENTSERVICESREQUIREMENTS:
r
Zoning APProvad By
'.� Buildin8 APProved By
Aaolication Issued BV � � ��
$ 3
�Eo�'
FEES
$-3 _
SUMMARV OF FEES �
BUILDING PERMIT $ SMIP $
PLAN CHECK $ � PERMIT
PLUMBING $ _11V_SG� ISSUANCE $
PLAN CHECK 25% $��� ENERGV P.C. $
ELECTRICAL g GRADING $
PLANCHECK 50% $ MICROFILM $ r� �"j
MECHANICAL $ TOTAL FEE $ .�(J.FV//
PLAN CHECK 25% $
Z
O
N
I
N
G
R
E
O
M
T
S
CpNSTRUCTION ANDPLANNING POOL 'A
�yAPPROVALS Permit# Date � Inspector qppROVALS Permit# Date Inspector
i1. .Temporary Electrical Service or Pole 52. Pool & Equipment Location
�
2. Soil Pipe-Undrgrnd. y�fj$'� (,�O 53. Steel Reinforcemeni
3. Electrical Condujt 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 . y � 59. Gas Pipe, O Undrgrnd., Test �
9. Water Pipe-Undrgrnd. � '� /S� U6� 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System � 61. APPROVAL TO DECK
1�1. Property Sewer Line,& House Connection ��l �� 62. Backwash & Receptor-Final '
12. Sewer Cap ., �' '% . 63. Heater & Vent-Final �
' � , '..�
13. Roof Drains ' : �� �- 64. Plumbing SYstem - Final �
14. Rough Plumbing • - � tflyf i 65. Elec[rical-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 Pe�mit #
21. DuCts, in Structure -, 70. Underground Hydro �
22. Ducts, Ventilating 71. Product Piping 0 Gas ❑ Oil
23. Gas Pipe-Rough & Test ��� . ��� L ,72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing , 74. Overhead Hydro
26. T�Bar Ceiling (Strucmrap & 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. Electriral Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: � ��
34. Final Heating & Air Conditioning .
35. Final Gas Pipe-Test �� � , �� -^��24/p £'
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing � �
39. Water Service-Final / � � �
40. GasService-Final Q� � ��' f��a?(� £
41. Solar pomestic-Final �
42. Backflow Preventer -
43. Backflow Irrigation �
44. Landscape Irrigation System � � �
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison . . .
50. Gas Release to Southern California Gas Co � •
51. CERTIFICATEOFOCCUPANCY
No. Date �
)
m�
W
`
�
'� AVPlicant to fill in all spaces exeept thosa wiinin heavy bortler Iines anE sign all appropriata tleelarations.
CITY OF COSTA MESA PERM�T NO. � TRACT N. LOT NO. � BLD . 262�. S�QB/i7B I 9oc0
CONSTR�JCTION PERMIT N�
P�Oj¢Ct Add!¢55 TYPE OF CONSTRUCTION NEW ` ADD ALTERATION REPAIR �
Applicant'S Mailing Address . '/ ❑ CONVERSION ❑ DEMOL SH ❑ OTHER q,p, # � 2one � .
Owner'S Neme ��� !� Z�� �y�sn� hon Q� DESCRI7TION OF WORK
S Main Building: Accessory Building: Z
Address � � [bi»PF13PA-7F PLI¢'�....�i �L� � E 0
TVPE OF PERMIT GRA�ING FOVNDATION STRVCTURAL T Front N
ArCh/Eng. � LiCense No. ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING,i�MECHANICAL B �
Address / Rear N
��7 ❑ OTHER A
Contractor's Nam �� honef��' PROJECT DESCRIPTION SQ. FT. oCcuPANCv C Right G
/�+-�.,�[/ K
/ J J�j ��6NA�JZJ�A m{p .(�' CONSTRUGTION TVPE VALUATION $ g Left � E
Address (mailing) �/y, �p ZoryE GRAOING CU. VDS. ACRES U
City License No. (;L<- ( � Ping. Ref. # Park. Fees $
LICENSED CONTRACTOR DECLARATION Remarks: Parking Req.IPfOvided ' u
I hereby affirm that I am Iicensetl untler provislons oi Charter 9(commencing R
wlth sectlon �000) of DlviSion 3 ot the Business and Professlons Cotle, antl Use of Building: E
my Ilcanse is In full torce antl ftect. n
Llcense ss — �c nsa No. �' � PLUM8ING FEES Planning Notes: E
Date �� 519nature _ Ba� Sink ShOw¢rs N
WORKERS' COMPENSATION DECLARA ON T
,,��ereDy at8rm chat I have a certificate of consent to self-Insure or a certiilcate Backflow Preventer Service Sink' �� S
,,.;Workers' Compensation Insurance, or a ttrtifietl <opy thereof (Section
�+: io. Lab. C.)/ /�rO' ``�D ����� Backflow Irrigation � Sewer Cap -y ELECTRICAL FEES
�'PolicY No. /� —(GQ J ComPanY 7
❑_Certitietl copy is hereby turnishea. Bathtubs '� � Sewer Connection Automatic Washer Transformer ❑ 75-50 KW
�[Cartlf cyy y s tl with the Uty BWltling Divi " ❑ 50+ KW
Date -��X �� Appllcant Clarifiers Solar Collectors ' Construction Pole $ub.
EXEMPTION FROM WORKERS' COMPENSATI ARATION Dishwashe� Solar Pi in
(This sectlon neetl not be completetl if the permit is tor one �untlretl (y100J or "i P 9 ,� Cooking Unit . Meter ❑up to 100 amps,
less). . - Orinkin Fountains �
I certity that in the performance ot the work tor whlch this permit is issuetl I 9 Solar Tank � Dishwashe� . Mete� ❑over 100 arilps
5hall not employ any person in any manner so az to become subject to the -
workers' Compensatlon Laws of Californla. , Floor Drains Swimming Pool w/Spa Dryers ❑Gas ❑Electric Sub Panel
�ate ' Signature ' �
NOTICE: If,iafter makin9 this tleclaratlon, you shoultl-become subject to the ' Floor Sinks � Urina) ' '' Fan '' Motors �0.1 HP �1'/z - 6
Workers' Compensation provisions of the Labor Cotle, you must forthwith ,
comply with such'provisions or this parmlt shall be deemetl revoked. Ga552rvic2 Outlets Water Closet . F.A.U. Inc.Solar 09-15 HP O1fi-15+ �
CONSTRUCTION IEN�ING AGENCV
I hereby atffrm that there is a<onstructlon IenCing agencyfor the performance Interceptors Wate� HeSt2r " Fixtures � Microwave
of the work for whlch t�is permlt Is-Issuetl (Section 3097 Civ. C.)
Lender�s Name Kitchen Sink Water Service Device Boxes Pole Light �
L.entler'S Aatlrezs �
OWNER BUILDER DECI.ARATION lavatOri25 Outlets � .Range .
I hereby atfirm that I am ezempf trom tha Contractor'S License Law for the p—T�a
following reason (Section'7031.5 Business antl Professional Cotle: Any ciiy or P Switches Sign
county whith requires a permlt to construct, alter, improve, demolish or repair
any structure, prior to its issuance, also requlres Ihe applicant for suth permit Roof Drains - Garbage DispoShc Standing Sections
to flle a signetl statement'tnat ne/she Is Ilcensetl pursuant to che provisions of
the Contra<tor'S LicenSe Law (Chapter 9(commencing with.,5ection ]000) o� � . ��
4lyision 3 oi the Business antl Pro}e55IOr15 Cotla) or tnat he/she is exempt ' . � Generator �0.5 KW �5-15 KW Trash Compactor
n. ;�*'xirom anA the basis for the allegetl exemption. Any violation of SecHon .
'*'n",';.i's':,";t-.5 by any applicant tor a permit sub�ects'Ihe'apPlicant to a civil .
•:+�°alty of not more than tive huntlretl tlollars (5500). � � Reinspection Fee $25 Isue Fee $ 3 _ _
� �7 I, as owner ot the property �or my employees with wa9es as their sole � MECHANICAL Reinspection Fee $p5 �ssue Fee $ 3
compen5ation, will Ao the work, antl the structure I5 not intentletl or otferetl FEES
for sale (Section 7044, Business antl Professlonal Cotle: The Contractor•s PUBLIC SEflVICES REQUIREMENTS: '
Llcensa l.aw tloes not apply to an owner o( a property wno builtls or improves Boile� HOOd o� TYPe I -
thereon, antl who tloes such work nimself/nerself or tnrou9h nis or ner own ' � Zoning Approved By Date
employ ees, provitletl chat such Improvements ara not intantletl or otteretl for Canopy Type II ❑ .
sale. If, however, the builtling or improvement is soltl within one ear,of com- Duct - Under Ground _
Y Building Approved By Date
pletlon, the owner will have the burCen of proving he/zhe tlitl not builtl or im- . . � � �
�rove�for the purpose ot sale). Duct - Structural Refrigeration Syrtem � ' Appliwtion laued By Date�.%L_
1, as owner of tha Droperty, am exclusively contractin9'with Iicensed con- � ❑0.700,000 BTU ❑100,000 BTU
tractoiztd construct the project (Section 7044, Buslness antl Protessions Cotle: Duct - Ventilating _ ' SUMMARY OF FEES ' - '
The Contractor's Litense Law does not apPIY to an owner ot property who . • • �
Eulltls or improves thereon, antl who contracts Tor zuth projects with a con- Exhaust System ❑ Multiple ❑ System Repair/Alteretion BUILDING PERMIT �$ SMIP , $
tractor(s) Iicense pursuant to tne Contrattor's Llcense Lawl. PLAN CHECK $ � PERMIT �
❑ I am exempt untler Sectlon e. & a. C. tor this reason Firepl/Fact. BIt. IC80 # PLUMBING' $ ��UANCE .$
Date � Owner� ' - Heating System & Ducting ' ' Q PLAN CHECK 25% $ ENERGV P.C. $ ' '
I hereby certify that�l have reaE thls apD�i<ation antl�state that the above �0-100,OOOBTU �100,0008T �� � ,� i� GRADING $ �
Informatlon is correct. I agree to comply with all city antl county ortlinances ELECTRICAL � $
antl-stata laws relating to builtl' g conitructlon ntl heJeby authorize repra- �� $ ' : MICROFILM $ �
sentatives of'this�<ity tne• - entionetl propert for . � � ' • . , PLANCHECK 50% �
Inspectlon purposes. ('j�• � �
Signature Dat "'D MECHANiCAL $ —��•�� TOTALFEE .$
Drivers' Licanse or 55 � -' ' Reinspec[ion Fee $25' laue Fee $ 3 PLAN CHECK 25% $ `'�S�'� �i •a'S� .
CMF0865-46 rdv.12/83 White-BuIltling;Canary-ApPliwnt;Pink-Accouniing;Goltlenrotl-Assessor � �-
�= ' CONSTRUCTION AND PLANNING Y � ' C � . - .FOOL-! 4 � . �z• : , � ..
. APPROVALS Permit�# � Oate�� Inspector AppROVALS Permit#f •��� �� .Date- Inspectoi1?
' ' i _ ..3
� 1.,Temporary!Electrical Service or Pole �� . - 52. Pool & Equipment Location = , � � -
-
: 2. Soil Pipe-Undrgrnd. � � ,' 53. Steel Reinforcement - " . .
� 3. Electriral Conduit Utility-Undrgrnd. • ' � 54. Forms � _ � . � ' " � ' - , � � • i �
� 4. Electrical Conduit-Undrgrnd. 55.� Electrical Bonding. � - , . � _ �� �
5. Steel Reinforcement � "� 56. Rough Plumbing & Pressure TesU - " -- '-
�
6. Electrical UFER Grnd.` . - � . 57. APPROVAL TO-COVER-GUNITE' :^,:'�� ,�'
7. Footings " - 58. Electrical Conduit-Undrgrnd.
8. Foundation' � / . 59. Gas Pipe,.O Undrgrnd., Test � " � �� ,
i
9. Water Pipe,-Undrgrnd. ,� .�� � 60. Backwash'Lines, P-Trap, O Undrgrnd...� - � ,
10. Structural Floor System � �t � 61. APPROVALTO DECK � � � - �� � �
11. Property Sewer Line & House Connection �� � 62. Backwash & Recepfor-Final �- ; .. ��j
12. Sewer Cap � � 63. Heatec & Vent-Final � � �
13. Roof Drains � � � ; � 64. Plumbing System - Final '. - - � '
14. Rough Plumbing � - • 65. Electrical-Final- �� - ' � �,
15. Rough Electriral-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 F.INAL -, - �
19. Rough Heating & Air Conditioning ���� j Lnl� ' FIRE DEPT.,REQUIREMEN'f� �� - ,"
20. Rough Factory Fireplace � APPROVALS� , Permit # � ` , � �
� ,
21. Ducts, in Structure � � 70. Underground Hydro � � � ' n i
22. Oucts, Ventilating l0 1js C,FiO 71. Product Piping O Gas� ❑ Oil -� i � . ^
23. Gas Pipe-Rough & Test 72. Underground Flush� • � � , '
24r Roof Framing � 73. Undergrnd. Storage Tank O Gas ❑ Oil - ,
� 25. Roof Sheathing . � 74. Overhead Hydro � � .
26. T-Bar Ceiling (Structural) & Monocoat ' 75. Dry Chemical ' : , �-
., i �. x,
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 i
32. Electrical Power Meter-Final � 80. FOOD CERTIFICATE ISSUED
33. Final Electric ' Notes' � � � �
I �
34. Final Heating & Air Conditioning � g �P , �
35. Final Gas Pipe-Test , - � : . . .. _
36. Hood or Canopy � � � '_ - � ,.
37. Final Factory Fireplace - , � � - - . � _ �
38. Final Plumbing • � ��
i
39. Water Service-Final i - � � ' �
,�
40. Gas Service-Final � . ' � z . �+� ' ' - � "�
41. Solar pomesticFinal - . - , - . � - - �
�_- .'
42. Backflow Preventer � � � ' �
43. Backflow Irrigation , . � � , �
44. Landscape Irrigation System � � ' �. � J
45. Sound Attenuation � . ' ' _ - �� �. . - � � � �-��
46. Handicap Regulations ' . � • � � ' � � . •-
47. FINALSTRUCTURE&BUILDWG , ; , � ; ' . :� , ' �
48. Special Requirements Completed • ' � . . , � � • ' ` ' � - '
49. Electric Release to Edison � . ' ' " "` � " " � � � j
50. Gas Release to Southern California Gas Co � ' �; �
.y i
51. CERTIFICATEOFOCCUPANCY - �-� - - , , • ,� , � �" 1'
No. ' Date .- _ ` . -- - - ' . - � .. . _ � '- ..
�
�
�
M{
f' J
r
CiTY oF eosTA MEsn CONSTRUCTION pERMIT
��
Apv��cant to till In all soaces except tnosa within neavy eorEer Ilnes anG sign a11 apvropriate tleelaratfons.
Projec[ Add�ess 3� E. o10�Hi. ST. - nif L �
Applicant'sMailingAddress .2 Ceyrd�ra�Fe �laza; �9V
Owner'sName �� 1%e�e����'�� Phon 6�^�/�
Address r ra G
Arch/Eng. � i License �s�'�
Address ✓
Contractor's Name a Phone ,�y�
Addresslmailing) r �•
City �ir.ense No. .�%1� 9 �'�
LICENSED CONTRACTOR DECLARA N '
I hereby affi�m lhat I am licensetl untle ovisions of Charter 9(commencing
with section ]000) of Division 3 ot t usiness antl Grofesslons Cotle, antl
my license is in fun f rce antl etiecL z gz91 Z
License ss � License No.
Date Signature
WORKERS' COMPENSATION LARATION
I hereby affirm tnat I �ave a certlficate ot consent to selt-insure or a certiticate
of Workers' Compensation Insurance, or a certified copY thereof (Sectlon
3800, Lab. CJ ef - � L �
olicy No. ���5���`0�� Company �T�- �r�
�Certified copy is her¢by fumishetl.
CerHfietl copy is filetl witn the city Builtling pi "'��pn. (� �
Date Applicanl �����TY\
EXEMPTION F0.0M WORKERS' COMPENSATION DECLARATION
(This section neetl not be Comple[etl if the permit i5 for One huntlreC (5300) or
less).
I certify lnat in the per(ormdn<e Ot the wo�k to� which this perm�t is is5uetl, I
shall not employ any person In any manner so a5 to become subjeGt to the
Workers' Compensatiom laws o( California. .
. Date Si9nature
'NOTICE: If, atter making this tleclaration, you shoulC become subject to the
Worke�s' Compensation provisions of the Labo� Cotle, you mu5t forthwith
compty with such provisions or this permit�shall be tleemetl revoketl.
CONST0.UCTION LENDING AGENCV -
I hereby attirm that tnere is a construction lentlin9 a9ency for the performance
ot Ihe work for whiCh Ihis permit is I55ueU (Sectlan 3097 Civ. C.)
Lentler'i Name •
LenOer's AOtlreSs �
OWNER BUIL�ER DECLARATION �
I hereby aftirm that I am axempt trom tne Contractor's License Law for the
following rea5on (Section ]031.5 Buslness antl Prote55ional Cotle: An'y city or
county which requires a permit to construct, alter,'improvu, Oemolish or repair
any structure, prior to Its issuance, also requires the applicant for such permlt
to file a signetl statement that he/sM1e is licensetl pursuant to Ihe provisions of
the ContraCtor's License Law (Chapter 9(commencin9 with Sectlon 7000) of .
Division 3 of the Business dntl Profe55iOn5 Gotle) o� that h¢/she Is exempt
tnerefrom antl the basis for the alle9etl exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
=nalty of not more tnan tive huntlreU tlollars ($500). � -
� I, as owner o( the property o� my ¢mployees with wa9C5 as their 3ole
_ompensation, will tlo the wo�k, antl the SVucture is not Intentletl or offeretl
for sale (Section 7044, Business anA Professional Cotle: Tho Contractor'S
License I�w Ooes not apply to an owner ot a properry who bullds or improves
thereon, antl who tloes such work nimselt/herself or through his or her own
employees, provitletl [ha[ such improvom¢nts are not intentlotl or offeretl for
sale. If, howevet, [he bulltlinq o� Improvement i5 Soltl wI[nIn one y¢ar of com-
pletlon, ttle owner will have [ne buraen Of proving he/she tlitl no[ build or,im-
prova tor Ne purpose ot Sale). �
❑ I, as owner of the property, am ¢zclusively wntractln9 with licensetl con-
� Vattors lo construct the project (Section ]044, Business anC Pwfession5 Cotle:
Tne Con[ractor's License Law does not apply to an owner of prope�ry who
builtls or improves [hereon, antl wbo contracts for such p�ojects with a con-
tractor(sl license pursuanl'to the Contracto}'s License Law). I am aware tnat
proof of their Worker's Compensatlon insurance shoultl be provltletl to me.
❑ I am exempt untler Seciion 8. & P. C. for this reason
Datc
I her¢by certify that I
information is correct I
and state laws rela n
sentatives of thi5 i
inspection purpose
Siqnature
Drivers' License or 55
upon
above
�ances
rep�e-
v for
rn ��� �� �
TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHE} p�.p .�S
DESCRIPTION OF�WOFiK/USE OF BLDG. `��
5 Main Buildi
TVPE OF PERMIT GRADING FOUNDATION STRUCTV RAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL A Rear
❑ -OTHER C Right
PROJEC7 DESCRIPTION 5�. FT. oCCUanrvcv '
CONSTRUCTIONTVPE VALUATIONS��1•SD S Left
ZONE GRADING CU. VDS. ACRF_5 ping. Ref. #
Remarks: , j� �, Q� Planning Notes:
Sink
Preventer
Irrigation
Dishvrasher
Drinking Fountains
Floor Drains'
Floor Sinks
Gas Service
Interceptors
Kitchen Sink
Lavatories
P—Trap �
Roof Drains
9
Reinspection Fee � $75
Boiler
Dutt - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust Sysrem ❑ Multiple
Firepl/Fact. Blt. ICBO # u(t
Heating System & Ducting
O ai oo,000 eru O i oa,000
Reinspection Fee � $15
`CMF OB65�46, rev. 10/84 Wblte - Bulltling; Canary - Appllcant; Pink - Accountln9: Goltlenrotl - Assassor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank �
Swimming Pool w/Spa
Water Closet
Water Heater
Water Service
Auto-Wash
�Laundry Trays
Isue Fee
Hoodor Typel ❑
Canopy � Type II �
Refrigeration System
❑0-100,OOOBTU ❑100,000
System Repair/Alteration �
Fire Dampers
Registers
Issue Fee
FEES
Automatic
Construction Pole Sub.
Cooking Unit
D is6washeri'
Dryers ❑Gas� �ElecVic
fan �"
F.A.U.
Fixtures
Device eoxes
Outlets •
Switches
Gar6age Dispoul
Generetor 00�5 KW
2913 �a/14/B5
Zone
Accessary Building:
Parking Req./Provided
ELECTRICAL
Transtormer ❑ 15�50 KW ��
❑ 50+KW
Meter ❑up to 100 amps
Meter ❑over 100amps
' Sub Panel '
Momrs OO-1 HP � 1%- 8
Inc.Solar �9-15 HP �16-15+
Microwave �
Pole Light �
Range
; Standing Sections
15 KW �Trash Compactor
8e0� TL
�FEES
Z
O
N
I
N
G
R
E
Q
M
T
S
$ 3 I
� Reinspection Fea � $15 luue Fae $ 3
FEES
DEVELOPMENT SERVICES REQUIREMENTS: �
Zoning Approved 8y Date
Building Approved By Date
Appliption luued By Dat � �
SUMMARV OF FEES � � '
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
• OO pLUMeING $ �SSUANCE $ '
PLAN CHECK 25% $ ' ENERGY P.C. $
ELECTRICAL $ � GRADING $
PLANCHECK 50% $ MICROFILM $ 'l
MECHANICAL $ �'�� TOTALFEE $ ���v
$ 3 PLAN CHECK 25% $ I. �� �
�
• CONSTRVCTION AND PLANNING h� � � POOL � A .
APPROVALS-�Permit# Date Inspector p�ppROVALS Permit# - Date Insper,mr
� 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 Conduif-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�& HouseConnection ' . � 62. Backwash & ReceptorFinal
12. SeweF Cap ,' ' 63.- Heater & Vent-Final
13. Roof,Drains . �• � 64.� Plumbing System - Final -
14. Rough Plumbing. .. 65. Electrical-Final
15. Rough Electrica6Conduit � � - 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 & Ai� Conditioning FIRE DEPT. REQUIREMENT .
20. Rough Factory Fireplace �/�S/�S L� 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 �raming . � 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 Standpipe .
28. Lathing & Siding . . 77. FIXED SYSTEM FINAL
29. lnsulation� . � � . . 78. FIRE PREV. FINAL
30.. Drywall Nailing �- ' _ HEALTH DEPT-. REQUIREMENT
31. Plaster Brown Coa[ �- " � 79. FINAL INSPECTION
32: Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating�& Air Cbnditioning �
35. Final Gas Pipe�Test� � � �
36. Hood or Canopy '
37. Final Factory Fireplace !� �1' �
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final �
41. Solar pomestic-Final
�\ 42. Backflow Preventer
43. Backflow Irrigation
� 44. Landscape Irrigation System .
45. Sound Attenuation • �
46. Handicap Regulations '
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed '
49. Electric Release'to Edison� � �
� '50. Gas Release to Southem California Gas Co - �
51.CERTIFICATEOFOCCUPANCY � . _
� j�ln. Date .
�• -
\
Aop���ant to fill in all spaces ezcev� tnose within heavY eortler Iines antl sign all aoP�oprlate tleclarations.
CITY OF cosTA MESA CON^ST'R' �CjTION PERMI�
' . Project.4d�Oress ��� �`�/ NL �Q
'Ap�pliconf s Mailin9 Addrgss (��� �
Ownei'sName, ���i�'�- �!'�-�� � Phone
Address
Arch/Eng. �icense No.
Address
Contractor's Nam � Pho e �
Address Imailingl�E%���� ��o H'¢�' � �' �- f"�V'e
Ci2y License No.
LICENSED CONTRACTOR OECLARATION
1 hereby affirm that I am Iicensetl untler provislons o( Char[er 9(commencing
with zection 7000) of Oivision 3 of the Busin¢ss ane Protesslons Cotle, antl
my licenze is in fu fOrG¢ antl eHecL '
L�CEOSE` �I'd5'5 " �"�_ � �CB �V . �
Date IC 519nature
WOR ERS'COMPENSATION DECLARATION
1 hereby affirm that I have a certificate ot con5¢nt to 5¢If-insura or a certi(I<at¢
of Workers' Compensation Insurance, or a certifietl copy thereot (Secllon
�800, Lab. C.) _ . _ .
olicy No. Company
BCertifietlCoOY!sfiletlbwith,thehC�t I DI I on.,C/� ///�
� Oate / r APPlican��� � /� ! ( �
EXEM TIO FROM WORKERS' COMPENSATION DECLARATION
(This section neetl not be completetl if the permit is for one huntlre0 (5100) or
less).
�I certify thai in tne pertotmance of [ne wo�k tor whlch th15 pe�m�t i5 issuetl I
shall not employ any person in any mann¢r so as to becOme Subj¢Ct t0 l�¢
Workers' Compensation Lawz of Califomia.
. Date Signature
"NOTICE: If, aiter makin9 this tleclaratlon, you shoultl become suoject to tne
Workers' ComOensation provisions of the Labor Cotle, you must for[bwitb
comply wi[h such prOvisions or [hiz perml[ shall be tl¢em¢tl revoketl.
CONST0.UCTION LENDING AGENCV
I hereby aftlrm that [nere is a cons[ruction lentling agency for the performanca
of the work tor which this permit is issuatl (Section 3097 qv. C.)
Lentler's Name
Lentler's Adtlress
OWNER BUILDER �ECLARATION
I he�eby a�9�m that I am exempt �rom the Contracto�'S Ucense Law for the
following reason (Section 7031.5 Businesz ana Professlonal Cotle: Any ci[y or
county which repuires a pe�mil [o con5[�uct, alter, improve, tlGmOlish o� �e0alr
any structure, Orior to its issuance, also requires the applican[ for such permi[
to tile a signetl statement thal he/she i5 licensetl pursuant to the p�ovi5ion5 01
the Contractor'S License Law (Chapt¢r 9(commencin9 with Se<tlOn ]000) of
Division 3 of tne Business antl Protessions Cotle) or that he/she is exempt
[heretrom antl the basis for tne allegetl exemption. Any violation of 5ectlon
'031.5 by any applicant for a Oermit subjects tne aOP���ant to a civll
�nalty ot not more than five huntlretl tlollars (E500�. -
� I,:as� owne� o( the D�operty or my employees with wdgas as thelr sole
mmpensalion, will tlo the work, antl [he SL�uCturB is not Intantletl o� oft¢r¢tl
tor sale (Settion 7044, Business antl PrOfessional Cotle: The Coniractor's
License l.aw tloes not apply to an owne� ot a property who builtls or improves
t�ereon; antl who tloes zuch work himself/herselt or through nis or her own
em0�oyee5, provitletl tM1at such improvements aro not intentlotl or offeretl tor
sa1e. If, however, tne buil0ing or improvement is sola witnin one year ot com-
pletion, the owner will have the burtlen of proving he/she tlitl not builtl or im- �
prove fo� the purpose of sale).
❑ I, as owne� of [he property, am ezclusively contractinq wi[h IicenS¢tl Con-
� cractors to construci ine orojecf (Section ]044, Business antl Pro�essions Coae:
The ConVactor's Licens¢ 11w does not appty f0 an owner of property wh0
builtls or improves thereon, antl who contracts ior such orojects with a con-
tractor(s1 license pursuant�[o the�Contracto�'s Licanse L.aw). I am aware that
proof o( lheir Wo�ker'S Compensalion insurance shoultl be pwvitletl [o me.
❑ I am exempt untler Section , B. & P. C. (or thls reason '
Date Owner
I herebvi certifv tha[ I have rea
TVPE OFCONSTRUCTION LJ NEW IJ ADD LJ ALTERATION LIREPAIR
❑ CONVERSION �O DEMOLISH ❑ OTHER A p #
DESCRIPTION OF WORK/USE OF BLOG.
S Main Buildin9:
E
TVPE OF PERMIT GRA�ING .FOUNDATION STqVCTURAL T Front '
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear
❑ OTHER A
PROJECT DESCRIPTION 5�. FT. oCCunANCv C Right
K Left
CONSTRUCTIONTVGE VALUATION$ $
, ZOrvE GRADING CU.vpS. ACRES p�ng. Ref. #
Remarks: � Planning Notes:
Sink
Preventer
Irrigation
Drinkin9 Fountains
Floor Drains
Floor Sinks
GasService Outlets
Intercepmrs
Ki[chen Sink
Lavarories
P—Trap
Roof Drains
Reinspection Fae � � $75
Boiler
Duct - Under Ground
Duct - SlrucWral
Duct - Ventilating
ExhaustSystem ❑ Multiple❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑6100,000 BTU � 100,000 BT
Iinspection yo s. `� ��
Signatur �dte /!
Orivers' License or 55 � — — Reinipeetion Fee
, CMF 0865-46, rev. 10/B4 White - Builtling; Canary - Applicant; Pink - Accounting: Goltlenrotl - Assessor
a, 5
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecrors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Clout-
Water Heater
Water Service
Auto-Wash
laue Fea
Hood or Type I ❑
Canopy Type I I ❑
Refrigeration System
❑6100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers '
laue Fee
$ 3
$ 3
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers Ges ❑Electric
Fan
F.A.U.
F i xtures
Device Boxes
Outlets
Switches
Garbage Dispoul
GeneratOr �0.5 KW 05-1
2�79 5/13/B5
Zone
Accessory Building:
� Parkin9 Req./Provided
ELECTRICAL •
- Tran'sformer ❑ 15-50 KW
❑ 50+ KW
Meter �up ro 100amps
Meter ❑over100amps
Sub Panel
Motors �61 HP �1'/:-8
Inc. Solar �9-15 HP �16-75+
Pole Li9ht
Range
; $tanding Sections
5 KW �Tresh Compacror
51•50 TL
FEES
r
I Rainspectian Fee I$15 ' � luue Fee I $ 3'
DEVELOPMEN7SERVICESREQUIREMENTS:
Zoning ApProved 8y Date
Building Approved By ^^ Date
Appliption luued By ` S� Dat � ��
SUMMARY OF FEES �
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT �
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL . $ �jS � �pd GRADING $ �,
P�AN CHECK 50% �$ 1�o • 3O M�CROFILM $�
MECHANICAL ' $ TOTAL FEE $ S� -� �
PI.AN CHECK 25% $ �
Z
O
N
I
N
G
R
E
�
M
T
�
w v
•�CbNSTRUCTION AND PLANNING POOL 2A
ApppOVALS -� Permit # Date Inspector qppROVALS Permit # Date Insper,tnr
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 Conduif-Undrgrnd.
8: Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
17. Property Sewer Line & HouSe Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final �
13. Roof Drains � � 64. Plumbing System - Final
14. Rough Plumbing � 65. Electrical-Final
15. Rough Electriral-Conduit ' 66. Solar System-Final . -
i 6. Rough Electric Wiring �(.� � C1 CL 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 & Aii Conditioning FIRE DEPT. REQUIREMENT .
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure � 70. Underground Hydro
22. Ducts; Ventilating . 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test - � � . 72. Underground Flush
24. Roof Framing ,� � 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing ' ' - 74. Overhead Hydro �
26. T-Bar Ceiling (Strucwral) & Monocoat . 75. Dry Chemical '
27. Frame and F.lashing - 76. Dry Standpipe .
28. Lathing & Siding . � . . 77. FIXED SYSTEM FINAL
29. lnsulation _ � . . 78. FIRE PREV. FINAL
30. Drywall Nailing - ' . HEALTH DEPT•. REQUIREMENT � �
3L Plaster Brown Coa[ _ '� 79. FINAL INSPECTION
32" Electrical Ppwer Meter-Final � 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning - �- �
35. Final Gas Pipe.Test� � � �
36. Hood or Canopy " � -
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final �
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer �
43. Backflow Irrigation �
44. L.andscape Irrigation System �
45. Sound Attenuation �
� 46. Handicap Regulations �
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed , �
49. Electric Release to Edison � '
50. Gas Release to Southem California Gas Cn � -
�
i'.51. CERTIFICATEOFOCCUPANCY .
No. - Date '
�- �
City of Costa Mesa
Developmen[ Services Depar[men[
Building Safe�y O���sion
� P. O. Box 1200
Costa Mesa, Califomia
CERTIFICATE OF OCCUPANCY No. GG13�bEf
The Building loceted at 350 FAST 20RH STtZi.E' T iJi�]IT $C
has been inspectsd and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group R�-1 Occupancy.
Use of Building C(x'�IIL�4
Legal Description b2C—?.31-19
ISee reverse side for Metes and Bounds)
Building Permit No. A1R77R Electrical Permit No. E18923 Plumbing Permit NoP18190
Mechanical Permit No. ^� Ran�,�"�� Q��n Number of apartments and/or guest rooms
�/ // �
ISSUED TO: BuildingOfficial Y�%� K� ���
crn�aa n��rnDr.'�x,vr b �/ �' 1�LU-!�^v`
Y
$� ('f1RP(1RA'1'R PTA7F9714F�q(1_ NHZJPnRT RRA['t� , -
c�'' o�e ,x�1 _���.,� /9 �S
This Cenificate of Occupancy SHALL BE ported in a conspicuous place on the premises a� SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C.
CMF 3015-46 rev. 1/93 White � Owner; Canary - Numerical File; Pink - Bldg. Permit File
I
4
�
m
CITYDF COST�A �MyES�A�
Prdject Address J_�1f.LC
Appliwnt's Maili�ng �A�dd�ress�
Owner's N�ame �/yLY�+
Addreu �/ai
ION PER
Applicant to flll in all spaces exeeD� those within heavy Dortle� lines anE sign all aoorovriate aeclarations.
PE MIT NO./ ¢ TRACT NO. LOT,q10. UNIT NO �
— / 0��� l� l0
TYPE OFCONSTRUCTION rvEw ADD
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF B�DG. T
Arch/Eng � Li ense No. —Y __�p
Address � Nn � �b��T �b �� � l
Contractor's NamP ����� n�7lJ' �Phone 67� /
Address (mailingl ��AL ✓Y%}i.QQt/ S �v �
City License No. 0� d 9 7?
LICENSED CONTRACTOR DECLARATION
1 he�eby atfirm tM1at I am licens¢tl untler provi5ion5 of Charter 9(commenCing
with zection 7000) ot Dlvislon 3 of the Business antl Profeszions Cotle, antl
my licenze is in full /orce antl elfect.
License Class � � � License No��%2 �%z
Date Si9nature
WORKERS' COMPENSATION DECLARATION
. I hereby affirm that I have a certiilcate of consent lo selt-insure or a certificate
�-pf Workers' Compen5ztion Insuranco, or a certifietl mpy thereot (Section
3800, Lab. G.) '
aoncy rvo. `j'O S/ T�6 ,F3�omPany �ri77� %—AA �
�Certifietl copy is hereby furnishetl.
Certifi¢tl opy i iletl with the y Buil � si �
Date Applic
EXEM 10 ROM WORKERS' COM NSATION DECLAR ON
(This section neetl not be compl¢letl il the p¢rmit iz tor one hu retl ($100) or
1¢55)
I cettify that in [he pe�(o�mance ot the work (or whith thi5 e�m�t i5 issu¢tl, I
shall not employ any per5on in dny mann¢r so as to becom¢ subject to the
WorkeR' CompensatiOn Laws ot CalifOmia. �
Date 99��lure
NOTICE: If, a(ter making this tleclaration, you shoultl become subject ro the
Workers' Compensatlon provlsions of tne Labor Cotle, you mu5t torthwith
comply with suc� p�ovi5ion5 or thi5-permit Shall be tleemetl �evoketl.
CONSTRVCTION LENDING AGENCV
I hereby a(firm that Nere is a construction lentlin9 agency for the performance
of the work tor wbich thls permit is Issuetl (Section 3097 Civ. C.)
Lentler's Name
Lentler's AEtlreSs
OWNER 9UIlDER DECLAR/1TION -
I bereby affirm that I am exempf from [he Contractor's License Law for the
following reason (Seclion 7031.5 Business antl Professlonal Cotle: Any city or
county which r¢quires a permit [o conStruCt, alt¢r, improve, tlemolish or repai�
any structure, prlor to Its issuance, also requires the applicant tor such permit
to file a si9netl statement that he/she is Ilcensetl pursuant to the provislons oi ,
the Conlraclor's LicenS¢ Law (Chapter 9(comm¢ncing with Section 7000) of
-�ivision 3 ot the Business antl Prolessions Cotle) or Ihat he/she is ezemp[
'here(rom antl Ih¢ ba5i5 for t�e allegetl exemption. Any violation of Sectlon
031.5 by any applicant for a p¢rmi� subjec[s lhe applicanl [o a civll
`enalty of no[ more than five huntlretl tlollan (E500).
LJ I, as owner o( the property or my employees witn wa9es as their solo
compensalion, will ao the work, antl ihe structure is not intentletl or ofteretl
for Sale (Section 7044, Busineis antl Professional Cotle: The Contractor'S
License Law tloes not apply [o un owner of a property who builtls or improves
thereon, antl who tloes such work nlmself/ne�selt or through his or na� own
tmployee5, provitletl [hat suth improvements are not intentletl Or offe�etl for
sale. If, however, l�e builtling w improvement i5 Saltl within one yea� o( Com-
vletion, the owner will have th¢ burtlen oi provin9 ne/she tlia not builtl or im-
�rove tor the purpose oi sale).
1, as owne� of Ihe prop¢rty, am ¢xtluslvely con[racting with IlcenS¢tl con-
tractors to wnstruct the project (Section 7044, Business antl Proiessions Cotle:
The Contractor's License Law tloes not appry to an owner ot properry who
builtls or imOwv¢5 thereon, antl who conVacts tor such prOjects with a con-
Iractor(51 license pursuanl to the Contractor'S License Law). I am awate that
proof ol their WOrker's CompensaHon insu�ance shoultl be prOvitletl [o me.
❑ I am exempt untler Section B. & P. C. tor this �ea5on
Date Owner
I hereby certity that I have reatl this application antl state that the above
Information Is correcL I agree to compty with all city antl county ortlinances
antl stale laws �elaling ��iltling con5truction, antl hereby authoriz¢ �epre-
sentativ 1 1"- -" �i.anter uoon the above-mentionea orooertv.tor
Orivers' La.a'inse ar 55 � _
TVPE OF PERMIT LJ GRADINI
❑ TENANT ❑ ELECTRICAL
❑ OTHER
PROJECT DESCRIPTION SQ.FT._
LJ ALTERATION LJ REPAIR
T FOUNDATIDN L'J STRVCTURAL
PLUMBING ❑ MECHANICAL
CONSTRUCTION TVPE VA�UATION S
ZONE GftADINGCU.VDS. A(
Remarks:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Claritiers
Dishwasher
Drinking Foun�ains
Floor Drains
Floor Sinks
GasService Outlets
Interceptors
Kitchen Sink
Lavatories
F—Trap
Roof Drains �
Reinspectian Fee � $15
doiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑6100,000 BTU 0100,OOOBTi
Reinspection Fee � $15
CMF 0865-46, rev. 4/84 Wpi[e -�uf�in9: Canary - Applicant; Pink - Accountlng; Goltlenrotl - Assessor
$hoWers
Service Sink
Sewer Cap ' .
Sewer Connection
Solar Collectors �
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Wacer Closet
Water Heater
Water Service
laue Fee
Hood or Typel ❑
Canopy Typell ❑
A.P. �W
S Main Buildi
TFront '�'
B Rear �'
A
C Right
K
g Left G
Pin9. Ref. #`
Planning Notes:
— �� / —/`7
3
' Vo v.vl7 � 7�'
.4CJ�tPDJo `D'
;a�,�..
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishuvasher
Dryers �Gas ❑Electtic
" Fan
F.A.U.
Fixtures
Device Boxes
Outleu
Switches
Garhage Dispoul
- Genereror O0.5 KW C
ftefrigeration System
Oaiao,000sru ❑�oo,000eru
System Repair/Alteration
Issue Fee
$ 3
FEES
$ 3
an4n 3/26/85
Zone
Accessory Buildin9:
ELECTRICAL
Transformer ❑ 15-50 KW
❑ SO+KW
Meter ❑up to 100 amps
Meter ❑over 100amps
Sub Panel
Motors O0.1 HP O 1 h- 8"
Inc.Solar �9-15 HP �16-15+
Microwave -
Pole Light
5�15 KW
Sign
Standing Sections
Trash Compactor
�n4o:.;, T�
FEES
Z
O
N
I
N
G
R
E
Q
M
T
S.
Reinspection Fee $15 luue Fee $ 3
DEVELOPMENTSERVI�$,4t1 �R EIVTS:
2oning Approved By >>r c Date
Building Approved By . A� Date
Application laued By Date
SUMM V FEES �yC�
�` BUILDINGPERMIT $ � SMIP $ ��J 1
_.,GPLAN CHECK $ PERMIT
U�� PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING S
PLAN CHECK 50% $ MICROFILM $ [f
MECHANICAL $ TOTALFEE $ � 5 1� —
PLAN CHECK 25% $ J ��
i
I�
��
/ CONSTRUCTION AND PLANNING Y POOL rA .
�/,APPROVALS Permit# Date ;^ Inspector qppROVALS Permit# Date Inspector
1. Temporary El�trical Service or Pole �� 52. Pool & Equipment Location
2. Soil Pip�Unilrgmd. � !� � 53. Steel Reinforcement • �
3. Electrical ConduiLUtility-Undrgmd. ,' 54. Forms , :�
4. Electrical.Conduit-Undrg�nd. �� 55. Electrical Bonding '- �n
5. Steel_Reinforcement � � �L 56. Rough Plumbing & Pressure Test '
�.. ,
6. Electrical'UFER'Gcnd.� �v 57. APPROVAL TO COVER-GUNITE +'�
` /
7. Footingsf ' vf , 58. Electrical Conduit-U�drgmd. "��' .
8. Foundation �� �. ' �� vL 59. Gas Pipe, O Undrgrnd., Test �, �
i
9. Water Pipe-Undrgr"nd;� � � 60. Backwash Lines, P-Trap, O Undrgrnd. ': �
10. Structural�FloorSystem , 61. APPROVALTODECK
11. Property Sewer Line_& House Connection � : 62. Backwash & Receptor-Final
12.. Sewer.Cap �j "' . � 63. Heater & Vent-Final �I �
, f
13. Root Dreins ���' ' i � 64. Plumbing SYstem - Final � �
.f .' r.
14. Rough�Plumbing:,,. � -�� 65. Electrical-Final � '�+
15. Rough Etectrical-Conduit 66. Solar SYstem-Final
16. Rough Electric Wiring 67. Fencing & Accets Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18.�Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Cqnditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace ' APPROVAI.S Permit # �
21. Ducts, in Structure . . 70. Underground Hydro
22.-Ducts, Ventilaiing - 71. Product Piping �Gas ❑Oil
23. �Gas Pipe-Rough & Test . 72. Underground Flush
24:.Roof Framing ": � . 73. Undergrnd.Stora9eTank OGas ❑Oil
25. Roof Sheathing � � � �- 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing � 6 v 76. Dry Standpipe i�
28. Lathing & Siding t �. 77. FIXED SYSTEM FINAL
29. Insulation � �� 78. FIRE PREV. FINAL �
30. Drywall Nailing �� �(/G.i HEALTH DEPT. REQUIREMENT I
�
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final � 80. FOOD CERTIFICATE ISSUED I
33. Final Electric Notes: L� ! ,�%F�/(� �/f�,�1y( mK (/(i
34. Final Heating & Air Conditioning � 7jJ/�,s � I
35. Final Gas Pipe-Test II
36. Hood or Canopy ,
i_ �
37. Final Factory Fireplace • ,
38. Final Plumbing
39. Water Service-Final • � �
40. Gas Service-Final •
_+
41. Solar pomesticFinal � •
42. Backflow Preventer ' '
43. Backflow Irrigation • . • �
44. Landscape Irrigation System �
45. Sound Attenuation �
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING y ���
48. Special Requirements Completed _�3-gr %���
49. Elect�ic Release to Edison'
50. Gas Release to Southern California Gas Co
51. CERTIFIC TE F OCCUPAN �/
No. ' 3 Date r
. . �
CITY OF COSTA MESA
BYILDING DIYISION
F` � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-0856 • www.ci.costa-mesa.w.us
�•���D� FOR INSPECTIONS CALL: (714) 754-5626
� � � PERMIT NUMBER: BC07-00265
PERMIT TYPE: B COMBO STATUS: ISSUED
Sub Type: RES_ALT DATE ISSUED: 09/24I2007 �
ISSUED BY: ?? � �
doe nooRess: 350 E 20TH ST CM' Suite/Unit: � tl,O
APN: 42623404 - � � � Zoning:_ � , - � ' � p 0
Vicinity: - � � _ � � - ` � Primary Occ: - DA�
Const Type: � - ' � , SQ.;FT: � 0 � . - Valuation: $35,600.00
SCOPE OF WORK: REPLACE 6 WINDOWS AND 1 SLIDER TO MEET 1997 U.B.C. EGRESS REQUIREMENTS. HEADERS WILL
REMAIN THE SAME. REPLACE 1 KITCHEN SINK, 1 DISHWASHER, 3 LIGHT FIXTURES IN BATHROOM�AND 1 VENT FAN.
OWNER: BORKMAN, CHARLES 6; � � : Address: - 243 HILL PL - � � Unit:
Phone: , - � .. City/State/Zip: ��COSTA MESA, CA � �
APPLICANT: JUDY GRIFFITH . � . � , " Address: ' ' � Unit: :
Phone: 714-960-7052 City/State/zZip: . �
CONTRACTOR: J K CONSTRUCTION � . � �� � License No. 450297 �
Phone: 714-404-9846 CELL � Atldress: 915 LAKE STUnit: � .
Cell: 714-960-7052 , � .. City/State: HUNTINGTON BEACH, CA ZipCode 92648
ARCHITECT: � � . - License No. � � , PHONE:
ENGINEER: � � � LicenseNo. � � �PHONE:
COMBINTATION PERMIT FEESUMMARY -
Building Plan Check: - , $0.00 . ' . �.. �
Buitding Fees: $502.85- � -
Electrical Fees: .. � � - $26.80 - � - . - . �
Mechanical Fees: .. . - - � . $3075: � � -- - . � �
Plumbing Fees: . . -$43.10 - - -� -- - . . �
SMIP ResidentiaC � � $3.56 � - � . - � �� �
SMIP Commercial: - $0.00 -
TOTAL FEES: $607.06 .
"Refer to fee receip[s for all fees paid For project - --�-- �
NOTICE: The work authorized by this pertnit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92•28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply vnth all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and fnal approval will result in the expiration of this permit.
OE R INSPECTION TYGE DAIE INTI71pL5 CO�EN INSPECTION ME OR�F IN7771RL5
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 PoolSpa Final 208 Final Plumbing
200 Final Re-Roof 210 Final Electrical
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Site �
204 Final Demolition 250 Final Building/Occupancy
WORKERS' COMPENSATION DECLARATION� •� � '
� hereby affirm under penalty of perjury one o( the following declarations: ��
❑ I have antl will maintain a cerlifcate of consent to self-Insure tor workers'
compensation, as provided (or by section 3700 of the Labor Code, for the
peAormance of the work for which this permit is issued.
I�have and will maintain vrorkers' compensation insurance, as �required by
80Cfion�3700 of the Labor Code, (or the peAormance of the work for which this
permit is issued. My workers' compensation Insurance carrier and policy
numberaie� �f� �
.Car ier.—� .� y�� I 'G'. �� �,L'
policyNumbe�nee–`notbecomplele�;m� rtisvalu�aton�hund�aol�s(g100�oness
i��7 /� 1 l/' P/'7 /J i1 f
l/ l.Jv ._E, � (/ %' 1 L�
I:
I certify [hat in the peAormance of the vrork for which this permit is
issued, I shall not�employ any person in any manner so as to become subjec[
�o the workeis' compensation laws.of nia-and,agree that i( I shoultl
Ovmer ID verifietl by drivel�nse. ❑ Ves ❑ No ,.
Driver'S License No. Expires:
Verifcation ot Ownership by (rype of document, i.e. - property tax bill or deed):
1.
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:` .
❑ I hereby certify ihat no excavation Me (5) or more (eet in depth inro which a
person is required to descentl, wilt be made in connection with work authorized
by this permit, and that no building s[ructure, scaffolding, falsewnrk, or demolilion
or disman�ling thereof, will be more than thirty-six (36) fee� high. (Chap. 32, Grp
2. Arl 2, Sec. 341, Ttle 8, California Administ2tive Code).
❑ As owner-builder, I will no[ employ anyone to tlo work which would
require a pertnit from Ihe Division of Industrial Safety, as noted above, unless
such person has a permit to tlo such work fmm the division.
subject b lh�ker�pe tion pr�ions of Section 3700 of pppi;�nrs siynawre
r Code, I sh forthwith co p ih the ro ons. /�
�� A �/ � f� ,�C/ Division of Industrial Safety Permi[ Number:
�W�NIN(�fAILURE TO SE�R@ WORKERS' COMPENSATION COVER4GE
IS UNLAWFUL AND SHA SU&IECT AN EMPLOYER TO CRIMINAL
P NALTIES AND CIVI� FINES UP TO ONE HUNDRED THOUSAND DOLLARS
(5700,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SEC710N 3706 OF THE LABOR CODE, INTEftEST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby a�rm tF�at I am licensed under provisions o/ Chapter 9(commencing
with Section 7000) o( Division 3 of the Business and Professions Cotle, and
CONSTRUCTION LENDING AGENCY:
❑ I hereby affrtn that there is a construction lending agency for the
perfortnance of tha work for wfiich this pertni[ is issued. (Sec. 3097, Civil Code).
Lender's Name:
Lender's Atldress:
Signature Da�e
OWNER-BUILDER DECLARATIONS:
I hereby affrm that under penalty o( perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the follovnng reason (Sec. 7031.5,
Business and Professions Code: Any city or county which requires a permit to
constmct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires Ihe applicant tor such permit to fle a signetl statement
that he or she is licensed pursuaN to the provisions of the Contrectors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Pro(essions Code) or Ihat he or she is esempt Iherefrom and
ihe basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects ihe applicant to a civil penalty of not more than
five hundretl dollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensalion, WILL DO THE WORK, antl Ihe structure is not intended or
oflered tor sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an owner of property who builds or impmves
thereon, and who does such vrork himself or herself or through his or her own
employees, provided ihat such improvemeNs are not intended or offered for
sale. If, however, the building or improvement is sold vrithin one year of
completion, ihe ovmer-builder vnll have the burden�of proving that he or she
did not build or improve for pwpose o( sale.). .
❑ I, as ovmer of lhe property, am EXCl:U51VELY CONTRACTING WITH
LICENSED CONTRACTORS ro construd the project (Sec. 7044, Business and
Pmfessbns Code: The cont2ctors License Law dces not apply to an owner ot
property who builds or improves tbereon, and who conlracts !w such project with
a conlractor(s) license pursuant to the Contractors License Laws.).
❑ I am exemp[ untler sec. �
8usiness and Pro�essions Code for Ihis reason:
SignaWre Dale
305]-a6�310])
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Wili the applicant or present or future building ocwpant need to fi(e and
certify a Business Plan for emergency response [o release or threatened �
release of a hazardous matenal? ❑ Yes � No
(Section 25505 of the Cali(omia Health and Safety Cotle requires, with Some
exceptions, tha[ a Business Plan be filed with the Costa Mesa Fire
Department 6y every business which has at any one time during a reported
year a quantity of hazardous materials equal lo or greater Ihan a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressetl gas
at s[andard temperature and pressure).
2. Does or will the appliwnt or present or future building occupant neetl to file
a registration form for aculely hazardous materials? ❑ Yes ❑ No
,(Section 25533 of the Califomia Health and Sa(ety Code, with Some
exceptions, requires registration vnth the Costa Mesa Fire Oepartment by
each business which at any one time has on hantl a quantity of aculely
hazardous materials equal to or greater than a weight ot 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed qas at standard
tempera[ure and pressure).
3. Does or will the applicant or present or tuture building occupant neetl to
prepare an RMPP (Risk Management and Preven[ion Program for acutely
hazardous matenals)? ❑ Yes ❑ No
(Section 25534 of [he California Health and Safery Code provitles that the
Cosla Mesa Fire Deparlmen[ may require the preparation, certification and
fling with the Fire Department of an RMPP by 6usinesses which are requiretl
to regis[er acutety hazardous materials with the Fire Department.
4. If an RMPP is presently required, has Seclion 25534 0( the California
Health and Safety Cotle been fully complied with? ❑ Ves ❑ No
5. Does or will the applicant or present or fu[ure building occupanl require (or
the work which is the subject of lhis application a permit for sUch consUuction
or motlifcation from lhe South Coast Air Quality Management District or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Sec[ron 658502 of the Califomia Govemment Code requires that the requested
information be fumished on applications for non-resitlential building permits).
6. Will any part of the faciliry to be constructed under this permit be within
1000 feet from lhe ou[er boundaries of a school? ❑ Yes ❑ No
Qf'ye5", Ihe facifty must meel the requirement o( Seclions 25534 and 42303
of the California Health and Safely Code).
7. I( a permit fmm the Sou(h Coast Air Qualify Management Distncl or other
air pollu[ion contml tlistrict or agency is required for Ihe vrork which is [he
subject ot this application, have all of the disclosures prescribetl by California
Health antl Safery Code Section 42303 been made? ❑ Yes ❑ No
& pf j�es", attach certifcate of compliance from the appmpnate air polWtion
control offcer). _
CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the
information. given above is correct. I agree ro comply with all state laws and
city ordinances regarding Hazardous Materials antl Emissions. .
CERTIFICATE OF COMPIIANCE AND AUTHORIZATION OF ENTRY: I
certiry under penalty of perjury that I have read this application and 3tate that
the infortnation given is correct. I agree to comply with all state laws and city
ordinances relating to building construction, and authorize representatives of
the City of Cos[a Mesa to enter upo� Ihe above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any 6uilding
au[horized by this permit until fnal inspection.
�Signal r (Legal ner(s) Date /� /�/)
/` / Io�rAuy onza �Ilc - '-� _-��__V /
\'..�� <L/ `-_.-�,� �._ �.. �`�
OF CQSTA MESA
PE
ApO��cant to till in all spaees ezcev� those within heavY Oortler lines antl sign all apvro0�late tleclarations.
Ot159 3/26/85
P MIT N. TRACT NO. LOT O. UNIT NO. JOL u L? T;
Applicanl's Mailing Address Z��:{�o-�.97t � N 2/F �244 /�.�
Owner's ,N�ame Sl� A� r � e_� �hone �%I'o p�/7>
Address '� �.��a '-Zy� N -r,
Arch/Eng. �License No. �n
Address 2 x ��� • .�.=t10 /�
Contracwr'sName���G� � !�q�>��hone ��.��g{'��..c;y–•�
Addresslmailing) 3��� �r%��S �V� 1;�%/!S
City License No. Q � �% Q 7 7
LICENSED CONTRACTOR DECLARHTION
1 bereOy affkm that I am licensetl Untle� O�oviSiOns ot Charter 9(commenGing
with uction ]000) of �ivision 3 01 the Business antl Pmfessions Cotle, antl
my Iicense is in tull, rce antl eftect,
�JC8f15! �Id55 � �C¢OS NO. � �:_�
oate 3�26' f �"e � � /
'vOR RS' MPENSATION DECL ATION
�ereby aitirm that I nave a certi(icate of consent to self-inzur or a certiiicate
i Worke�s' Compensalion Insura�ca, o� a ce�ti(ietl coOY inaraof ($ec[Ion
3800, Lab. GJ l `��-ff `I—
PolicY No. �� s�'!�f �'=?ComPanY ���E/ ��m
�Certifietl copy is hereby furnished,
CertHletl copy is tiletl witb [he Uty Builtlinq Division.
Date AOPlicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl not be completetl il the permit is for one huntlretl (5100) or
Iess).
1 c¢r[ify [hat in the pertormance of tbe wo�k tor whlch this petm�i is i55uetl, I
zhall not employ any person In any manner zo as to become subjec[ to the
Workers' Compensa[ion Lawz ot Cdlitomia.
Date Si9na[ure
NOTICE: If, after making tnis tleclaration, you snoultl become zubject ro the
Wo�k¢r5' COmpensation p�ovi5ion5 pt [he Labo� �Cotle, you must tortttwith
mmpty wiU sucn provisions or tnls oermit zhall be tleemetl revokea.
CONSTRUCTION LENOING AGENCV �
I hereby aftirm that there is a construction Ientling agency for the performance
of the work for which tnis pBrmit is issued (Section 3097 Civ. CJ
Lentler'S Name
Lentler'S AdOress
OWNER BUILDER DECLARATION�
I hereby afflrm that I am ezempt (rom the Contractor's License Law for the
tollowing reason (Se�fion 7031.5 qusiness antl Professional Cotle: Any city or
counry whicb requires a pe�mit to [onst�uCt, alter, improve, tlemollsh or rCpai�
any sVutture, prior to its issuance� also requirez [he applicani tor suth permit
to (ile a siqnetl statement [hat he/ghe is Ilcensetl pursuant to the provlsion5 0(
•he Contractor•5 License Law �Chapter 9(commencing with Section �000) ot
livislon 3 of lhe BuSiness antl Professions Cotle) o� lhat he/She is exemp[
�e�etrom antl [he basis tor the allegetl ez¢mption. Any viOldHon o( Sectlon
7031.5 by any applican[ for a permit subjects the applicant to a civil
�enalty ot not more lhan five nuntlretl tlollars (5500).
LJ I, as owner of the property or my employeez with wages as molr sole
Cor�pensation, will tla [he work, ahtl the structu/e is not int¢ntle0 0� otfer¢tl
i0( Sd�f ($LCLI00 id44� BUSI0055 dOd PlOfe55100dI Cotle: The C011lldClO(�5
LiCenS¢ Law tloe5 not apply to an Owner ot a property who builtls o� improves
iher¢On, an0 who tloes suc� work himself/herseH ot through his ot her Own
employee5, prOvitletl that such imp�ovements a�e not intentletl or offe�etl for
� sale. If, howeveq lhe builtling u� ih�provement i5 soltl wi[hin one yoar of com-
. plction, the owner will have [he bUrtlen o/ provinq he/she Citl n0[ build or im-
I�rove tor the purpose of sale).
I, as owner of the prope�ry, aT ezcluzlvery contracting wit� lic¢nzetl con-
tractors to construct the project (SNctlon 7044, Business antl Professions Cotle:
The Contractor's License Law doQs nol apply to an owner af property who
Duiltls or Improves thereon, antl Who contracts for such proiects with a con-
tractor(sl license pursuan[ to the Conlraclor'S License Law�. I am aware that
p�ooi oi thei� Worker's Compensg[ion insurance shoultl be provlCetl [o me.
❑ 1 am ezempt untler 5¢ction B. & P. C. lof lhi5 r¢d50n
Date Owner
I nereby certify that I have rea
intormatlon iz WrrecL I agree to
antl state laws relatioa to builtlir
Orivers' �ense Or 55 �
CMF 0865-46, rev. 4/84
that the above
�- �8�/ � � !/ �
TYPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR
❑ GONVERSION ❑ DEMOLISH ❑ OTHER q,p.# [J
DESCRIPTION OF WORK/USE OF BLD� 0 I �
TVPE OF PERMIT LJ GanDwG h
❑ TENANT ❑ ELECTRICAL C
❑ OTHER
PROJECT DESCRIPTION SQ. F�r/.��
CON STRUCTION TVPE�/J—
ZONE GRADI
Remarks: PC '
�
PL
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Drinking Fountains
Floor Drains
Floor Sinks -
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trep
Roof Drains '
Reinspection Fae � $15
Boiler
Duct - Under Ground
Duct - Structurel �
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact.8lt. ICBO #
Heating System & Ducting
❑ ai oo,000 sTu O i oo,oao sn
Rainspaction Fee � $�5
ite - builtling: Canary -Appliwnq Pink -Accounting; GoltlenrOtl -Aisesso�
T � 5 Main Bwldi
FOUNDATION STRUCTVRAL T Front �
P�UMBING ❑ MECHANICAL B Rear
A
.9� C Ri9ht
OCCUPA CV
�VALUATION $ � 2 S Left ' �
I CV. VDS. ACRES P��g. Ref. #
� 0. � I(�i ��i Planning Notes:
Service Sink
Sewer Cap
Sewer Connection ,
Solar Collectors
Solar Piping
Solar Tank �
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Issue Fee
Hood or Typel ❑
Canopy Type I I ❑
Retrigeration System
❑0.100,000 BTU 0100,000 BTU
Sysrem Repair/Alteration
Issue Fee
$ 3
$ 3
Accessory Building:
Parking Req./Provided
ELECTRICAI
Automatic Washer Transformer ❑ 15-50 K�N
Construction Pole Sub. � 50 + KW
Cooking Unit Meter ❑up ro 100 amps
Dishwasher Meter �over700amps
Dryers ❑Gas ❑Electric Sub Panel - .
Fan Motors0al HP �1:4-8
F.A.U. Inc.Solar �9-75 HP �76-75+
Fixtures Microwave
Device Boxes Pole Light
Outlets Range
Switches Sign
Garhage Disposal • Standing Sections
Generator 00.5 KW �5-15 KW Trosh Compactor �
2one
Fea
DEVELOPMENTSER
Zonin9 APProved BY_
Building App�ovad By
$15
Issue Fee
FEES
$ 3
Z
O
N
I
N
G
F
E
�
M
T
$.
S V�FEES
BUILDING PERMIT 5 SMIP $ 3, 3`i
PLAN CHECK $ PERMIT
PLUMBING S ��UANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% § MICROFILM $
MECHANICAL $ TOTAL FEE $ _�
PLAN CHECK 25% $
� CONSTRUCTION AND PLANNING
APPROV�ALS Permit #
� !
• 7. Temporary Electrical Service or Pole�
2.JSoil Pipe-Undrgrnd. �r,
� 3� Electrical Conduit'Utility-Undrgrnd.'
�
,, 4. Electrical Conduit-Unilrgrnd. �
, 5. Steel Reinforcement �
� 6� Electr cal UFER Grnd. : .
.4 .
� M � � ' J i/
7. Fooiings - '
� �� a �,
� �
8. Foundation . � r.
.�
9. Wefer Pip`e-Und�grnd. ��
�
10. Stiuctural Floor System �
71. Property Sewe� Line & House Connection
12. �Sew /�Cap r ',� / �
' / . o
13. Roof�Dralns �
�
� i � A ..
14. Rough`Plumbing e ' %��'
15. Rough Electrical-Conduit
16. Rough Electric Wiring
17. Rough Wiring Sign
18. Rough Electrical-T Bar Ceiling
19. Rough Heating & Air Conditioning
20. Rough Factory Fireplace
21. Ducts, in Structure
22. Ducts, Ventilating .
23.�Gas Pipe-Rough &�Test
i-
24: Roof Framing � `
25. Roof Sheathing
26. T-Bar Ceiling (Structural) & Monocoat
27. Frame and Flashing
ZS• Lathing & Siding �
29. Insulation �
30. Drywall Nailing
31-: Plaster Brown Coat
3T. Electrical Power Meter-Final
33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood�or Canopy
37. Finaf�Fattory Fireplace-, �
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final , • '
41. Solar pomestic-Final . `
42. Backflow Preventer � ��
43, Backflow Irrigation , .
44, Landscape Irrlgation System
45, Sound Attenuation
46, Handicap Regulations
47, FINALSTRUCTUiiE&BUILDING
48, Special Requirements Completed
49, Electrie Release to Edison-
50, Gas Release to Southern California Gas Co
; 51. CERTIFICq TE OF OCCUPAN Y
uo. ( 3 � 3 Date �_��
�
y POl t SPA
Date Inspector qppROVALS Permit#
�
52. Pool & Equipment Location
� 53. Steel Reinforcement
�j 54. Forms
'y 55. Electrical Bonding
��' y� ��j 56. Rough Plumbing & Pressure Test
/' �' �/�, 57. APPROVAL TO COVER-GUNI7E
� �_ 58. Electrical Conduit-Undrgrnd.
� 3 � �'L. 59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
61. APPROVALTODECK
� �62. Backwash & ReceptorFinal
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrica6Final
66. Solar System-Final �
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPA SYSTEMS FINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
71. Product Piping O Gas ❑ Oil
72. Underground Flush
73. Undergrnd, Storage Tank O Gas ❑ Oil
I � " � "
b�� w 74. Overhead Hydro
� 75. Dry Chemical
a� � (`� 76. Dry Standpipe
� G d (�, 77. FIXED SYSTEM FINAL
� � 78. FIRE PREV. FINAL
F �� HEALTH DEPT. REQUIFEMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
C
Date �Inspector
Notes: y%��• �'S7F��/1 G3�6�D� 0YG
.
AOG���ant to fill in all 50ate5 exeept t�ose within heavy Gortler Iines an0 si9n all aDOroD/�ata Oeclarations.
CiTY OF coSTn MESA CONSTRUCTION PERMIT
,project Address 3S0 '� �Q/I�{f�. ST '7 yUH t� �
Applicant'sNailing Address T.Z lAf�,lpf0.�e YIAZfI_ �'*�R�
Owner's Name q�m�1 y�G �OilN�EH'{"� . phone5� Q'`� �
Address _� �C+f�YJ1Yl'T2 %��RZA � �'ii0 �� 6 ��
Areh/Eng. � ler � S ' icenseNo.
Address 7 �'�% L � 1r� ����• . ' .
Contracior'sName � '�' A�_T�PY ' Phone � 3-v//9-�
Addresslmailingl--3�/ !'WrCIIS f. � �; �.�i
CitV ��cense No. �( � q�'�
LICENSED CONTRACTOR pECLARATION
I hereby affirm thx[ I am liconsetl untle� rovislons ot Charte� 9(commencing
wlth section 7000) of Oivision 3 ot t usiness ana Professions Cotle, antl
my Ilcense is in full orce ana etiect. ' �A'�-R/ Z�
License C,J� 'l � License No.
oate - ) ��-I s'gn � . —
WORKERS'COMPENSATION DECLARATION '
I nereby aifirm tnat I have a certiticale ot consent to selbinsure or a cerUticate
f Warkers' Compensation Inwrance, ot a certlfletl copy the�eo( (Sectlon
.800, Lab. CJ . n�� ���
Gnolicy No. 90-s/SIGB-3 Company s��f
y Certifiea mpy is hereby fumishetl. ' '
�9 Certifietl moY �s filetl with the city Builtling �„ isioq� ��/�
Date Applicant ' ' �„Q�Tn� '
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This sec[ion neetl no[ be completetl if the permit I5 fo� one huntlretl ($100) or
Iess).
I certily that in the Oerformance of the work for which this pe�mk is i55uetl, I,
shall no[ employ any person in any manner so a5 to be[om¢ Subjett [o the
Workers' Compensation Laws ot Calitomia. .
Date Si9nature
�NOTICE: 11, atte� makinq this tleclatatlon, you snoultl become suDject to the
Workers' Compensation provisions of the Labor Cotle, you must forthwlth
comply wilh such prOvi5ion5 or this permit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
1 hereby afflrm thal [here is a cons[ructlon lentling agency for Ihe perfo�mance
of [ha work for wtlicM1 this permit is Issued (SecHon 309] Civ. C.)
Lentler's Name
Lentler'S AOtlreSs
OWNER BUILOER DECLA0.ATION
I hereby affirm that I am exemOt from the COntractor's Licensa Law for Ihe
followinq reason (SecHon 7031.5 Businezs ana Pwfessional Cotle: Any city or
county w�ich r¢quires a permit fo const�uct, alte�, Improva, tl¢molisn o� �epair
any structure, prior to Itz issuance, also requires the applicant for such permit
to fiie a signetl statement tnat he/sM1e is Ilcensea pursuant to the provisions of
the Contractor'S License Law (Chapter 9(mmmencing wifh Settion 7000) ot
Division 3 of the Business antl Professions Cotle) or Ihat he/she is exempt
therefrom antl [he baSis fOr the allegetl exemption. Any violation of Sectlon
�031.5 by any applicant tor a p¢rmit subjects tne applicant to a civll
�enalty of not more [han five huntlretl tlollars ($500).
1, as owner of Ihe prOperty or my employees with wages as thei� sole
wmpensation, wili tlo ihe work, antl the�structure is not intenGetl or otferetl
for sale (Section ]044, Business antl Professional Cotle: The Caniractor'S
License Law tloes no[ appty ro an owner ot a properry who builtls or improves
thereon, antl who tloes sucn wo�k nimself/herself or through his or her own
employee5, proviCetl lhat suCh improvements are not intentlea o� offeretl fOr
sal¢. If, hOwever, the bUiltllnq or Improvement Is sold wlt�in one Year of com-
Oletlon, the ownet will bave tne burtlen of proving he/sne tlitl not bwltl o� Im-
plOve for the Ourpose of sale�. '
❑ 1, ds owne� ol the prope�ty, am exclusively tontratting witn Ilcensed con-
tractors to consvuct tne project (Sec[ion �044, Business ane Pro/esslons Cotle:
The Contractor's Llcense Law tloez not apply to an owner of property who
builtls or impwv¢5 tbereOn, an0 who contracts ior suc� projects wltb a cop-
Vactor(SI ilcense pursuant to Ihe'Contractor'S Liconse Law�. I am aware that
proof o( their Worker'S Compensalion insurance zhoultl be P�ovltle0 lo me.
❑ I am exempt untler Sectlon B. E P. C. for this reason
oate
I hereby certity th '
, informatlon is mrre '
antl state Iaws re r
SClIIdIIVCS O: 'Ib� I
inspet[iOn purp .
Signature
Drivers' License r 5'
CMF 0865-46, rev. 30/B4
� reatl this application antl state tnat the above
:e to comply with all ci[y antl county o�tlinances
�iltlin9 consVuction, antl hereby autborize repre-
enter upon the above-mentlonetl pr Oerty lor
_ Date / � �
TVPE OF CONSTRUCTION 'LI NEW U ADD LJ ALTERATION ' LJ REPAI R
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WOPK/USE OF BLDG. �H�% ���
TVPE OF PERMIT LJ GRAOING LJ FOUNDATION LJ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL .
❑ OTHER
� �
PROJECT DESCRIPTION SQ.FT. �_ DO oCCVa
CONSTRUCTION TYPE VALUATION $
20NE GRADINGCV.VDS. ' A(
Remarks: /• �� y� ( I
Bar Sink '
Backflow Preventer
Backflow Irrigation
7rinking Foun�ains '
°loor Dreins
'rloor Sinks
3as Service Outlets
IOLClCE��OlS
Kitchen Sink
Lavatories
P—Trap
Roof Drains.
Reinspection Fee �$15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact Bh. ICBO # NR
Heating System & Ducting '
❑ ai oo,000 eTu O i oo.000
Reins ac[ian Fe
� � I I . a e
White - Bulltling; Canary - Applican4 Pink - Accountin9; Goltl¢nrotl - AssesSor
$15
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping -
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heacer
Water Service
Auto-Wash
Issue Fee
Hoodor Typel ❑
Canopy Type I I ❑
Re(rigeration Sys[em
�0.700,OOOBTU ❑100,000
Sys[em Repair/Alteration
Fire Dampers
Registers
Issue Fee
FEES
A.P. #
S Main Building:
E
T Frant
ARear
C Right
S Left
Ping. Ref. #
Planning Notes:
2914 S/14/85
, Zan
Acceuory Building:
Parking Req./Provided
ELECTRICAL �
Automacic Washer - Transtormer ❑ 15-50 KW
ConstructionPoleSub. � �50+KW
Cooking Unit�
DIShWdSflCf��� �
Dryers OGas ❑Electric
Fan y
F.A.U.
Fixtures
Device Boxes '
Outlets
Switches
Garbage Disposal
Generator DO-5 KW �5-15 KW
Meter ❑up Lo 100 amps
Meter ❑over700a,mps
Sub Panel
Morors�0.1 HP 01Y.-8
Inc.Solar �9-15 HP �16-15+
Microwave .
Pole Li9ht �
Range '
$ign
; Starttling Sections
Trash Compacior
$ 3 I
� Rainspection Fee $15 laue Fee 1
FEES
DEVELOPMENT SERVICES RE�UIREMENTS:
Zoning Appraved By
Building Approved By _�
Application Issued Bv
$ 3
9oG: il
FEES
$ 3
SUMMARV OF FEES � � .
BUILDING PERMIT $ � SMIP $
PLAN CHECK $ PERMIT
PLUMBING g ISSUANCE $ � �
PLAN CHECK 25% 5 ENERGV P.C. $
ELECTRICAL $ GRADING $
PLANCHECK 50% g � � � MICROFILM $
MECHANICAL , $ � -�� TOTAL FEE $ �- �U
PLAN CHECK 25% $ ( - �O ' i
Z
O
N
1
N
G
R
E
�
M
T
5
'CONSTRUCTION AND PLANNING � � POO�-a SPA �
APPROVALS � Permii # Date Inspector �qppROVALS Permit # Date Inspa.cror
'I. Temporary ElectriCal Service or Pole . 52. Pool & Equipment Location
' 2. -Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical �Conduit Utility-Undrgrnd. � �' 54. Forms
4. Elec[rical Conduit-UndFgrnd. � 55. Electrical Bonding ,
5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test
6_ Electrical UFER Grnii� . 57. APPROVAL TO COVER-GUNITE
>.
7: Footings . _ � . . ' . 58. Electrical Conduif-Undrgmd. .
•8: Foundation " 59. Gas Pipe, O Undrgrnd., Test
9. Wafer Pipe-Undrgrnd. " 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System i 61. APPROVAL TO DECK
17. Properry 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 86. Solar SY'stem-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 Fircplace y�5-/� �p 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. U�dergrnd. Sto�age Tank � Gas ❑ Oil
25. Roof Sheathing - ' - 74. Overhead Hydro '
26. T-Bar Ceiling (Structural) & Monocoat _ 75. Dry Chemical � �
27. Frame and F.lashing • 76. Dry Standpipe .
28. Lathing & Siding' . � . 77. FIXED SYSTEM FINAL
29. Insulation . � , . 78. FIRE PREV. FINAL
30� Drywall Nailing �� ' . HEALTH DEPT-. REQUIREMENT
31. Plaster Brown Coat �� '� � 79. FINAL INSPECTION
32" Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric ' Notes:
34. Final Heating�& Air Conditioning �
35. Final Gas Pipe-Test � �
36. Hood or Canopy � -
37. Final Factory Fireplace 5^,
L
38. Final Plumbing .
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Fin81 �
42. Backflow Preventer
� 43. Backflow Irrigation .
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations ' '
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed , ' ' ' '
49. Electric Release to Edison . � .
50. Gas Release to Southem California Gas Co . �
51. CERTIFICAT.E OF OCCUPANCY . . .
No, Date ,
Ciiy of Costa Mesa
Development Services Department
Building Safety Division
P. O. Box 7200
Costa Mesa, California
CERTIFICATE OF OCCUPANCY No. ��+���
The Building located at 350 F•AST 20T[i STF2ECf L1NIT i�D
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable chereto
for a Group R-7 OccuPancy.
Use of Building �•7DLl'LQ�IIIII�i
Legal Description 426-231—.�9
(See reverse side for Metes and Bounds)
Building Permit No Fil 9 Electrical Permit No.F.18924 Plumbing Permit No.P18191
Mechanical Permit No. T�� RQ�Q ^+�� �°�^ Number of apartments and/or guest rooms
r,-
ISSUEDTO: BuildingOfficial :"�� �� !•d�,1
ar;.ma ��rvr.�rnn.r�rr � '/ l
by Y, L 1'i de��-�-
{'7 (Y1RPf1RATF. PTA7,A ::Jfl(1. AI�$7P'(1RT RFA(9{. �, �^
�e �. ✓� /� s �
This Certificate of Occupaney SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C.
CnnF 1015-ab rev. i/83 White - Owner; Canary � Numerical File; Pink - Bldg. Permit File
ADplicant to fill in all s0aees ezcept lhose wit�in heavy Eo�Oe� li�es anE sign all appropriale tleelarations.
GTY ' CONST UCT�ON PERMI
Project Ad . _ _ �•�%:. � ' � �
ilpplicant's Mailing Addr�s; � 39 n �
' �i
Owner's Name �J hone
Address
Arch/Eng. License No.
Address
Contracto ' Name l �� AXS • ` Ph n l�
Address (m � � ��� �s�li� P��
City License No, 3�� 7
LICENSED CONTRACTOF DEGLARATION .
I hereDy af(i�m that I am licensetl untler provisions ot Charte� 9(commancing
with section ]000) of Division 3 of the Business antl Professlons Cotle, antl
my Iicense is in full tq�ce y�tl efiect. �,�„, ,
Date Signature ' • i'
WORKE S' C ENSATION D LA0.ATION �
1 hereby atfirm that I nave a certificate of consent ta self-insure or a cartiticate
of Workers' Compensation Inmrante, or a certifietl Copy tbe�eot (Section
1800. Lab. CJ . ' .
Pnolicy No. - Company
y.� Certi(ietl copy is hereby turnishetl.
�Q Cer i'etl o ' fllea with the city B� iv���
Date Applicant_ /- s
EXE 1 FROM WOHKERS' C NSATION DECLARATION
(This ction neetl not be com0letetl the permit i5 for ona huntl�e� (5100) or
less).
I certity tnat in tne per/ormance of tM1e work tor which this oermR Is Bsuetl, I
shall not employ any person in any manne� so as to betome subject to th¢
Workers' Comoensation Laws ot Califomia.
Date � Si9nature
'NOTICE: If, afier making this tleclaration, you shoultl become subject ro tne
Worker5' Comp¢nsa[ion provi5ion5 of Ne LabOr Cotle, you must forthwith
comply with such p�ovisions o� �ttis pe�mlt shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV �
1 nereby atfirm that there is a constructlon lentling agency for the performance
of the work for which [nis permit is issuetl (Section 3097 dv. C.)
lRntler's Name
Lentler's Atltlress
OWNER BUILDER DECLARATION
I her¢by aftirm tbat I am exempf frOm Ine Gont�acto�'S Llcense L.aw lor the
followin9 reason (Sec[ion ]031.5 Buzlness antl Professional Cotle: Any city or
county w�ich requires a Oermit to consVuct, alt¢r, improve, tlemolish o� �epdir
any SVuc[ure, prior to its issuance, also requires tne applicant for Such p¢rmit
to file a signetl statemen[ tha[ he/she is licensetl pu�suant to the prOvisions o1
the Contractor's License Law (Chapter 9(commencinq with Section 7000) of
Division 3 of the Business antl P�ofessions Cotle) or [ha[ he/she is exemo�
tM1erefrom antl the basis to� the all¢getl exemplion. Any vlolation ot SectiOn
'031.5 by any applicant for a pe�mlt subjects th¢ applicant lo a civll
endlty of not more than five huntlretl dollar5 (E500).
❑ I, as owner oi the property or my employees witn wa9es as lheir sole
com0ensation, will tlo the wo�k, antl [he sVuclure is no� Inlentletl or otfe�etl
for sal¢ (Section 7044, Business antl Profeszional Cotle: The Contractor'S'
License Law aoes not apo�Y to an owner oi a property who builtls or Improves
thereon, antl who tloes such work himself/herselt or through his or ner own
employees, oroviCetl that such imp�ovements are not intenaetl or oiteretl for
sale. If, howeveq Ihe builtlinq o� impwvement Is soltl wilhin one year of com-
pletion, the owner will nave ttte burtlen of proving he/she tlitl not builtl o� im-
prove tor the pu�0ose ot Sale).
❑ 1, as owne� ot the property, am ¢xUusively contractlng with Iit¢nsetl con-
tractors to construct the oroject (Settion �044, Business antl Professions COCe:
The Contractor'S License Law tloes mt apply to an owne� of proper[y who
builtls or improves thereon, antl who contracts for such projects wlth a con-
tractor(s) license pursuant�ro the Con[ractor'i License Ww). I am aware that
p�oof ol their Worker'z Compensation insurante Shoultl be provitle� to me.
❑ 1 am exempt untler Seclion B. 3 P. C. for this reason
Date Owner —
1 hereby certify Ihaf I have reatl this
information is co�rect. 1 agree to com0�
antl state laws relating to builtling cons
sentatives o�his city j0 enter upon
signature S
OIIVEtS� C SQ O( $$
CMF 0865-46, rev. 10/84
the above
l(d�OdOCES
�i2¢ �Gp�¢-
�DBftY f01
TVPE OF CONSTRUCTION LI NEW U ADD L.J ALTERATION LI REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p #
DESCRIPTION OF WORK/USE OF BLDG.
S Main Buildi
E
TVPE OF PERMIT GRADING FOurvDATION STRUCTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL g pyaf
❑ OTHER � A
PROJECT DESCRIPTION Sa. FT. oCCUVANCv C Right
K Left
CONSTRUCTIONTVPE VALUATION$ $
ZONE GRADING CU. VDS. ACRES p�ng. Ref. #
Remarks: R. j�/�/ ��— r( — y Planning Notes:
Sink
Preventer
Irrigation
Bathtubs
rinking Fountains
loor Drains
loor Sinks
as Service OuNets
Sink
Roof
Reinspection Fee
$15
Duct - Under Ground
Duct - Structural
Duct - Ventilating �
Exhaust System ❑ Multiple
Firepl/FacL Blt. ICBO #
Heating System & Ducting
❑ai oo,000 aTu � i oo,000
Reinspaction Fee I 815
White - Builtling; Canary - Applicant; Pink - Accountln9: GOItl¢nrotl - Assesso�
PLUMBING
Showers
Service Sink
Sewer Cap
fSewer Connection
Solar Collectors
Solar Piping
� Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Laundry Trays
Issue Fee
Hood or Type I ❑
Canopy Type I I ❑
Refrigeration System
❑0-t00,0008TU ❑100,000
System Repair/Alteratlon
Fire Dampers
Registers
Isua Fee
ES
i
Aummatic Washer
Construction Pola:
� Caoking Unit : �
Dishwasher
Dryers ❑Gas OE
Fan �'
F,A.U.
S3
FEES
$ 3
Device Boxes
Outlets
$WitCh25
Garhage Dispoul
Generemr �0.5 KW
Fee
0112 3/26/85
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15�50 KW
❑ 50+KW
Meter Llup to 100 amps
Meter ❑over 100amps
Sub Panel
Motors OO-1 HP O1 K- 8
Inc.Solar 09�15 HP �16�15+
Microwave
Pole Light
Range
; $tanding Sections
5 KW Trash Compactor
$15 Issue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
2aning APProved By
Building Approved By �
Aooliption Issued Bv
FEES
$ 3
SUMMARV OF FEES ' ,
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ � ISSUANCE $
PLAN CHECK 25% $ �6 ENERGV P.C. $
ELECTRICAL $ GRADING S
PLAN CHECK 50% $ MICROFILM $ o
MECHANICAL $ TOTALFEE $ 03 '�'
PLAN CHECK 25% $ �
2
O
N
I
N
G
R
E
�
M
T
$
' C.7NSTRUCTION AND PLANNING �` POOI �PA
APPROVALS Permit#' Date Inspector AppROVALS Permit# Date Inspector
1, Tempbrary Electrical Service or Pole 52. Pool & Equipment Location ,
Soil Pipe-Undrgmd. ' ?�(le+r �,Fj� 53. Steel Reinforcement '
Electrical Cond�it UtilitY•Undrgrnd: 54. Forms .
�
. 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-Undrgrrid. '� �yl �f (�PP 60. Backwash Lines, P-Trap, � Undrgrnd. �a
_
10. Structural Floor System 67. APPROVAL TO DECK � ,
11. Property Sewer Line & HOuse Connection 3 yy� r5' GRp 62. Backwash & Receptor-Final .
12! Sewer Cap ' 63. Heater & Vent-Final ��
r:
13. Roof Drains �� 64. Plumbing System - Final �
14. Rough Plumbin§•� '-' �f�I�$� G� � 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. Ducis, Ventilating ' 71. Product Piping O Gas ❑ Oil
' 23. Gas Pipe-Rough & Test \ •� � 72. Under9round Flush
24. Roof Framing -�' 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structurap & 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. FfNAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test (� t
36. Hood or Canopy
37. Final Factory Fireplace -
38. Final Plumbing � 9�6 �j
39. Water Service-Final � �r � �
40. Gas Service-Final
41 . Solar pomestic-Final �
42. Backflow Preventer
43. Backflow Irrigation-
44. Landscape Irrigation System �
45. Sound Attenuation
46. Ha'ndicap Regulations •
47. FINALSTRUCTURE&BUILDING .
48. Special Requirements Completed . �=,••' - .
, •A
49. Electric Release to Edison - . � . � � � ,
- 50. Gas Release to Southern Califomia Gas Co ' �
51. CERTIFICATEOFOCCUPANCY � �
No. Date
� �
� -
,�� ^ Appllcant to ftll In all spaces excapt t�ose within heavy OorEer Ilnes anG sign all approDriata Eeelarations.
CITY OF COSTA MESA
CONST'RUCTION PERMIT
Pro'ect Address � �
Applicant'sMai�lJing �Ad-dress C� ^7
Owner's Name Lel U G• Z �/��QT � ho e �,��� �-/
Address # �— �i',R�r>2hY� ��ii"'z'�A ,.��3'
Arch/Eng. Licenu No.
Address � ����-�
Contractor's Nam onel2lL-�?' �
A'ddresslmeilingl�-S�� �f����� ��� #�l1�
City License No. 8�90��
LICENSED CONT0.ACTOR DECLARATION
I hereby affirm that I am Iicensetl untler provlslons of �Charter 9(wmmencln9
wltM1 sectlon 7000) of Divlslon 3 ot [ha Buslness antl Professions Cotle, antl
my Ilcense Is in full force a �f=ect.� _, L.O �-7
Llcense Cla LC� ic n No. �
Date Sl9nature
WORKERS' COMPENSATION DECLARA �
ereby aftirm that 1 have a certiticate of consent to self-Insure or a cer[iflcate
Workers' Compensation Insurance, or a certlfietl <opY thereot (SecHon
.,800, l.a�. /� /�
Po11cY No. �� ��O/ ComPanY-����„/�/�"' �
�Certifletl copy Is �ereby furnishetl.
`CerUfietl C py�IS le tth the City Builtll ��I 1 /J
Date � x���Applicant ����� �'�/�%�
EXEMPTION FROM WOi3KER5' COMPE DECLARATION
(This saction neetl not be campletetl if the permlt is Tor one huntlretl ($100) or
less).
I certify that in the performance of Ihe work tor which thls permk is issuetl I
shall not employ any person in any manner so as to become subject to t�le
Workers' Compansatlon Laws oi CaliTornia. .
Date Sl9nature
NOTICE: If,iafter making this tleclaratlon, you shoultl become subject to the
Workers' Compensatlon provislons ot [he Labor Cotle, you must tortnwi[h
comply with zuch Orovlsions or this �permit shall be tleemetl ravoketl.
CONSTRUCTION LENDING AGENCV
I hereby affirm that Ihere is a construction Ientling agency tor the performan<e
of the work for whlch this permit is Issuetl (Sectlon 3097 Civ. C.)
LenCer's Name
Lender•s Atltlress
OWNER BUILDER DECLARATION
I hereby afflrm that I am exempt frorti the Contractor'S License Law for the
following reason (Sectlon 7031.5 �Buslness antl Professlonal Cotle: Any city or
countv whlch reaulres a oermlt to construct. alter. imorove. tlemolish or reoalr
�i.o oy any appucant tor a: permn sub�ects tne appucant to a civll
��nalty o( not more than five huntlretl tlollars (y500). -
I, as owner of Iha.property or my amployaes with wa9es as their sole ,
compen5atlon, wlll tlo the work, antl [ne structure is not intentletl or otferatl
for sale (Section 7044, Business antl' Profe55ional Cotle: The Contractor's
License Law tloes not apply to an owner of a property who builtls or Improves
thereon, antl who tloes such work himself/herselt or through his or �er own
employ eas, provltletl that such improvamant5 are not Intentletl or o(faretl for
sale. If, however, the Eulltlln9 or Improvement Ii soltl wlthin one year of com-
pletion, the owner wlll have the burtlan of proving he/she tlitl not builtl or Im-
erove for the purpose o7 sale).
LJ I, as owner of the property, am exclusively toniracting with�licensetl con•
tractorstd construct tha project (Section 7044, Bu5ine55 antl Prota55ions Cotle:
The Contractot's License Law does not apply to an owner of property who
builtls or Improves theraon, antl who contracts for such pro�ects with a con-
tractor(5)Ilcense pursuant to the Contrac[or's License Law): .
❑ I am ezempt untler Se<tlon B. & P. C. for Ihls reason
Data Ownar '
1 hereby carU}y Ihat I have rea0-this appliwtion antl'siate Ihat�tha abova
intormatlon Is corract. I agree to <om01y wlth all clty antl county ordlnan<es
antl state laws ralating to bulltling con5trucUon_ and herebv authorize reora-
Inspettlon purposes.
Slgnature
Drlvers' Lican�
CMF 0865-46 rev. 12/B3 W�ite - Bui
TVPE OF CONSTRUCTION �NEW U ADD LJ ALTERATION LI REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p#
DESCRIPTION OF WORK
S Main Building:
TVPEOFPERMIT GRADING FOUNDATI� STRUCTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL B Rear
❑ �OTHER %� ,
PROJECT DESCRIPTION 5�. FT. oCCVParvCv C Right
K Left
CONSTRUCTIONTYPE VALUATION$ $
ZONE GRADING CU. VDS. ACRES p�ng. ReF. #
Remarks: . Parking Fieq.IProvii
' Use of Building:
PLUMBING FEES Planning Notes:
Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Claritiers �
Dishwasher �r
Drinking Fountains
Floor Drains•
Floor Sinks
Gas Service Ouilets
<itchen Sink
Lavatories �
'—Trap. .
Roof Drains � �
Reinspection Fae '$25
)uct = Under Ground
Juct- Structural ,
)uct - Ventilating, �
=xhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO �k �
i� gating System & Ducting •
xIa100.000 BTU O 100.000 BT
>� �/ .. I I Rainspection Fee I $25
; Canary - Applicant; Pink - A<counting; GOICenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa ;
Urinal
WBICf C�052I _.
Water Heater
Water Service �
Issue Fee
iANICAL
Hood or Typel y{
Canopy Type II � ❑ �
Refrigeration System �
❑o-ioo,000eTu ❑ioo,oaoe
System Repair/Alteration �
luue Fee
�
Automatic Washer �
Construction Pole Sub.
Cooking Uni[
D ishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
$WIiCF125
Garbage Disposal
�Generator �0.5 KW 05-15
2623 5/�8/E5
I Zone
Accessory Building:
Park.Fees
ELECTRICAL
Transformer ❑ 15-50 KW
❑ SO+KW
Meter ❑up to 100amps
. Mete'r ❑over700amps
SubPanel� �
Motors �0-1 HP �1'/:-8
Inc.Solar 09-75 HP 076-75+
Microwave
Pole Light
Range
Sign
'Standing Sections
� Trash Compactor �
F
15085 TL
O
N
I
N
G
R
E
Q
U
I
R
E
E
0
$� ,
Reinspection Fee $y5 Issue Fae $ 3 �
FEES
PUBLIC SERVICES RE�UIREMENTS: .
3 Zoning APProved BY ^ate
Building Approved By Date
' Appliotion Issuad By � � Date � �
SUMMARV OF FEES ,
BUILDING PERMIT $ ' SMIP '$
PLAN CHECK $ PERMIT � '
PLUMBING $ ISSUANCE $
� PLAN CHECK 25% �$ ENERGV P.C. $
ELECTRICAI $ GRADING $ �,
PLAN CHECK 50% ,$ MICROFILM ,$ _1��
� MECHANICAL $ � � � •�� TOTALFEE $
$ 3 PLAN CHECK Z5% $ � "a"�� 3.dj� � . �
CONSTRUCTION'AND PIANNING � � . - � , . -POOL 'A � - . . -. ,�
APPROVALS ' Permit# Date Inspector • AppROVALS:��- Peimit# - 'Date Inspectoi .
�1, Temp,orary Electricgl 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. � � � � � �- � , � ,r' , � -
5. Steel Reinforcemenp . � . ' � � 56. Rough Plumbing & Pressure Test - � . ; ,.��'
6. Electrical UFER Grnd� �� �� � . 57. APPROVAL TO COVER-GUNITE; . � � . � .'
7. Fobtings � f • � ' _ � 58° Electrical Conduit-Undrgrnd. . � - . . - �J, � �
�
8. � oundatio� � �' � �� � 59. Gas Pipe, O-Undrgrnd., Test . . � ; � '
9. Water Pipe-Undrgrnd. ' � �: % . ,�: : • 60. Backwash Lines,�P-Trap, O�Undrgmd.'� � � .
10. Structural� Floor System '. / � . 61. APPROVAL TO-DECK • � - '� _ >
11 . Property Sewer Line & House Connection , 62. Backwash & Receptor-Final:. � . ' �`
12. Sewer Cap ' - �" �'63. Heater &�Vent-F�inal , " . . � � �
13. Roof Drains � 64. Plumbing System - Final � .� � -„ `
�;
14. Rough Plumbing � � � 65. Elecirical-Final � - ' - " "' "
15. Rough Electrical-Conduit - 66.� Solar System-Final � " � �- ' ' - � -� - �
16. Rough Electric Wiring 67� Fencing & Access�Appioval '- � ' ." ,= `
17. Rough Wiring Sign " 68. APPFiOVED FOR PLASTERING� ` . .� �
18. Rough-Electrical-T Bar Ceiling ' � 69. POOL/SPA SY,STEMS FINAL � � - � � . `-� �
19. Rough Heating & Air Conditioning S/�ql�� �,FyO FIRE DEPT. REQUIREMENT- - ' ^_' �'
, , i
20. Rough Factory Fireplace ' , APPROVALS Permit# ��
21. Ducts, in Structure :'� j 70. Underground Hydro � ' . , � . v' �
1
22r Ducts, Ventilating � ' S� �S Gg0 71. Product Piping OGas�,�0i1 ' � � � � I
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 (Structurap & Monocoat 75. Dry Chemical _ � - " '. � . .
.
27. Frame and Flashing �76. Dry Standpipe � ` - '� - � _
28. Lathing & Siding . 77. FIXED SYSTEM FINAL `. � '' �
� i
29. Insulation � ' J8., PIRE PREV. FINAL .
30. Drywall Nailing " 'HEALTH DEPT. REQUIREMENT , ' !
� i
31. Plaster Brown Coat 79. FINAL INSPECTION �
32. Electrical Power MeterFinal 80. FOOD CERTIFICATE ISSUED ' � � �
33. Final Electric ' Notes:
34. Final Heating & Air Conditioning !�� ar � � ,,, ,, . -
35. Final Gas Pipe-Test . � . . � -
36. Hood or Canopy , ' - ` - � -
37. Final Factory Fireplace � . - �. _ - � . - � ' "
38. Final Plumbing , � , � .
39. Water Service-Final ' , � �
40. Gas Service-Final ' � I � � � �
41. Solar pomestio-Final : - - � - - - - - �� � ' ,
42. BackflowPreventer � . . _ „ . _'_ � � -. � '
43. Backflowlrrigation + , � � � ' . ���
,,
44. .Landscape Irrigation System ' 1 , . ;i .' •`'
45. Sound Attenuation ' � � . ' , � � �'' �
46. Handicap Regulations � , ' ' � . - � � '. . ` -
47. FINALSTRUCTURE&BUILDING � � � ' �
,
_ �,
48. Special Requirements Completed , - . • : ' i � ' ' � - � ��
I
49. Electric Release to Edison � ' -'� � � � � " � - � �
� ' �
50. Gas Release to Southem Califomia Gas Co � � � � '� � � , ���
�'51. CERTIFICATE OF OCCUPANCY - -, - ; -- � - - � , � :-• �
No. ' Date .. � - - - ' - - ' - - . . - - - - ! . -
Applicanl to fill in all spaces except lnose wit�in neavy OorCer Iines anC si9n all appropriate Geclarations.
�ITY OF COSTA MESA CONSTR UCTION P RMIT y/ . PEtiM1T NO. TRACT NO. LOT NO. UNIT NO.
. Project hHdress 3 S� �-G� �� C E_P'
fjppticant;� Mai�g CAddress
Owner's Name —�-7�m�. p'� • Phone
Address
Arch/Eng. License No.
Address n
Convactor'sName�l��/l��v�" �_�ddS �eruhone �
Addrett 1 mailinglL' S23� ��Ol1 u P_.� �✓'e �
City License No. �7 (('�
LICENSED CONTRACTOR DECLARATION
I hareby aHitm lbat I am IlcenSetl untlet provi5iOn5 ot Chart¢r 9(COmmincin9
wlth s�ction 7000� ol OivlsiOn 3 Ot tlle Bu5ine55 antl PrOf¢SSIonS COCe, dntl
my Iicense Is in full force antl eftect. . / �
License C ass � ic N
Date 1�� Si9natur
WOR ERS' OMPENSATION DECLARATION
I nereby atfirm tnat I have a certiflcate of consent to self-insure or a certificate
it Worker5' Compensa[ion Insurdn<e, Or a rerti(i¢tl Wpy the�¢o( (SeCtion .
;800,'1.5b. CJ . , �
Policy No. Company
B`Qertitietl coPY is h'e�eb�APPI cani( 9 Dlv i� (j�:? 11//
��
E%EM TION-L�RKERS'COMPENSATIONDECLARATION
-(This sectlon nee0 not Ee completotl il [he parmit is for On¢ huntlretl (E100).or
less).
I cer[Hy tha[ In the pe�formance Of Ihe work tOr which thi5 p¢rm�t is ISsuetl, I
sM1all not employ any pe�son In any mannOr so as to becOme subject [o the
Workers' Compen5ation Lawi of Callfo�nia.
Oate Signa[ure
'NOTICE: It, alter making thl5 tl¢ClaratiOn, y0u Shoultl beComa Subject to the
Workers' CompenSation proWsions o1 the tabo5 COUa, you must fOrthwith
comD�Y �+'��M1 such O�ovislons o� thii po�mil snall be denmed �evoketl.
CONSTRUCTION LENDING AGENCV '
I hereby al/lrm that tnere is a tonstruction lentling a9ency /or the per(ormance'
of tho work for which Ihis permlt Is ISsuetl (SactiOn 3097 Civ. C.)
Lentler•s Nama
l.enEer's Aatlross
OWNER BUILDER �ECLARATIOfJ
I hereby alflrm thal I am axampt lrom tM1n Contractor's License Law for [he
following reason (Sectlon 7031.5 Business antl ProfeStional Cotle: Any city or
county which requiros a permlt to consiruct, alter, improvn, tlemollsh or repair
any structure, prlor to Ils I55uanca, dls0 reqWros tne ap011cant tor Such permit
to �ila a slgnod stalem¢nt thdt h0/St1C I5 IlcenSBtl pur5uant to the provisiOns of
the ConVattor'S License Law (ChaD�er 9(Commen<ing wilh Settlon 7000) o(
Divlsion 3 0l tho Bu5in055 antl Ploles5ion2 Cotle) Ar thdt h0/She is exempt
thCreM1Om dnE fI1C ba5is tOf [ha allogetl axOmptiOn. Any v101alion ot 5¢CtiOn
'031:5 Dy any ap0�icant for a pOrmit SUbjects the applicanl [O a civ0
,enalty ol not more than tive hunErCtl t1011arz (5500�.
❑ I, as ownar ol th0 prOpOrty o� my ¢mployea5 wlth wages as their Sole
<ompenSaHon, will Oo t�e wark, antl tho structura is not Intentletl or otteretl
tor zale (Section 7044, Businass antl Prolessional Cotle: The Contractor's
Lic¢nSe l,aw tloGs n0l apply to an owner oi a properry who builtl5 or improves
thoreon, antl wno aoes sacn work himsaN/nerseH or through his or her own
¢mployees, provl0etl Ihal such ImprovBmenls are not intentled Or 011eretl tor
wie. If, howevar, tha Duiltling or improvemant I5 soltl wit�in one year of com-
plelion, the ownor wlll have tho burCen ot provin9 he/she altl nol builtl or im-
prOv! tOt thc purpose of sale�.
❑ I, a5 Owne� of the p�operty, aT exclu5lvaly ContraGtlng wi[h Ilcensetl con-
IraGtors lo conSVuct the projtGt'$ection ]044, Buslness an0 AOte55ion5 Cotle:
The Con[ractor's License Ww doez nol appty to an owner ol property who
builtls o! improvas lnereon, antl who Wntracts tor sucn projects with a con-
traCtor(sl license pwsuant lo lbe Conlractor's Licanse l.aw). I am awa�e that
proof o( Ihelr WorkCr'S CompanSaUOn insUrance zhoultl be prOviOetl to m¢.
❑ I am ¢xempl untler Seclion B. d� P. C. fOr th15 reason
Date Own¢r �
I hereby certity that I have reaa thiz application antl state tnat the above
intormation is correct. I agree to comply with all city ana county ortlinances
antl sWte laws relatin9 to builtling consVuction antl nereby authorize repre-
sentaUves oJifhji �ity �[o ep}er �ypon jhj� above-mentlOnetl Property fo�
Drivers' License or 55 �
c�a Z D
TVPE OF CONSTRUCTION rvEw ADD ALrEanTION REaAiR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER Ap �6
DESCRIPTION OF WORK/USE OF BLDG.
S Main Buildi
E
TVPE OF PERMIT GRADING FOurIDAT�Orv STaVCTURAL T Front
❑ TENANT � ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 8 Rear
❑ OTHER - A
PRQIECT DESCRIPTION Sa. FT. oCCUParvCv C Right
K Left
CONSTRVCTION TVPE VALUATION S $
ZONE GRADiNG CU. VDS. ACRES p�ng. ReL #
Remarks: 3 ����' Planning Notes:
I rrigation
Clarifiers .
Dishwasher
Drinking Fountains
Floor Drains '
Floor Sinks '
Gas Service Outlets
Intercepmrs
Kitchen $ink
Lavamries
P—Trap
RooT Drains
Reinspection Fae � $15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. BIL ICBO �Ik
Heating System & Ducting
❑ o-i oo,000 eru O i oo,000 sT
Reinspection Fee � 515
CMF 0865�46, rev. 30/84 White - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assezsor
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
$olar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Wnter Heater
Wa[er Servico
Auto�Wash
Isue Fae I 5 3
Automatic Washer
Construction Pole Sub.
Cooking Unit
D ishwasher
Fan
F.A.U.
Fixtures . .
Device Boxes
Outlets
Switches
Garbage Dispoul
Generator �0.5 KW
2880 5/13/B5
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
� Transformer ❑ 15�50 KW
❑ 50+KW
� Meter ❑up to 100 amps
'Mecer ❑over700amps
Sub Panel
Morors 00.7 HP 01'h - 8
InaSolar �9-15 HP 016�15+
Microwave '
Pole Light
Fange
Standing Sections
5 KW Tresh Compactor
Reinspection Fee $15 luua Fee
IANICAL . FEES
Hoodor Typel O DEVELOPMENTSERVICESREQUIREMENTS:
CanoPV TYPe I I ❑ 2oning APProvad By
, Building Approved By
Refrigeration System
❑o-ioo,000aru ❑ioo,000
System RepaidAlteration
Fire Dampers
Registers
laue Fea � $ 3
5i.�o r�\
FEES
I
$ 3'
, SUMMARY OF FEES '
BUILDING PERMIT $ SMIP, $
PLAN CHECK § PERMIT
PLUMBING $ ISSUANCE � $
PLAN CHECK 25% S ENERGV P.C. $
ELECTRICAL �§ 'J5 �l0(7 GRADING $
PLAN CHECK 50% $ �SE - 3n MICROFILM $
MECHANICAL $ TOTALFEE $ ��-p�
PLAN CHECK 25% y
Z
O
N
I
N
G
R
E
Q
M
T
S
CGNSTRUCTION AND PLANNWG � POO. . SPA
..APPROVALS��Permit# Date Inspector qppROVALS Permit# Date Inspecror
1'. TemporarY Electrical Service or Pole 52. Pool & Equipment Location
� �. -�il Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. S[eel Reinforcement 56. Rough Plumbing & Pressure Tes[
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE .
7. footings 58. Electrical Conduif-Undrgrnd.
8: Foundation � 59. Gas Pipe, O Undrgrnd., Test -
9. Water Pip¢-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property 5ewer Line & House Connection 62. Backwash & Receptor-Final
� 12. Sewer Cap 63. Hea[er & Vent-Final
13. Roof Drains � 64. Plumbing SYstem - Final
14. Rough Plumbing . 65. Electrical�Final
15. Rough Electrical-Conduit 66. Solar SYstem-Final . �
i6. Rough Electric Wiring y�� � 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 Condiiioning FIRE DEPT. REQUIREMENT .
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in 5tructure � 70. Underground Hydro
�
22. Ducts, Ventilating �� 71. Product Piping O Gas ❑ Oil
� 23. Gas Pipe-Fough & Test � � � 72. Underground Flush
24. Roof framing . 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing ' ' � 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat . 75. Dry Chemical �
27. Frame and F.lashing � - � 76. Dry Standpipe .
28. Lathing & Siding . . 77. FIXED SYSTEM FINAL
' 29. Insulation . . 78. FIRE PREV. FINAL
30. Drywall Neiling � ' _ 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 Cbnditioning - , �
35. Final Gas Pipe-Test� � � . "
36. Hood or Csnopy ' ' �
37. Final Factory Fireplace �
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer �
, 43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations ,
47. FINALSTRUCTURE�&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison . � '
50. Gas Releasa to Southern California Gas Co
��� 51. CERTIFICATE OF OCCUPANCY ,
No. Date �
1