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HomeMy WebLinkAbout140 21ST ST - Building Permits • CITY OF COSTA MESA BUILDING DIVISION A • Fy ", II 77 FAIR DRIVE,COSTA MESA,CA 92626 • (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us e. re . FOR INSPECTIONS CALL:(714)754-5626 PERMIT NUMBER: P07-00544 PERMIT TYPE PLUM STATUS: ISSUED DATE ISSUED: 10/15/2007 ISSUED BY: SOK JOB ADDRESS: 140 21ST ST,CMSuite/Unit:. Vicinity: _ SCOPE OF WORK: REPLACE WATER HEATER" OWNER: AMMANN, KENNETH M' . . . Address: 140E 21ST ST.#E - PHONE: r . -- ' City/State/Zip: COSTA MESA,CA ; APPLICANT: HENRY QUAKE - - -. Address: ' 3959 GUASTI RD " :UNIT B PHONE: 909-605-2011- - t• - City/State/zZip: ONTARIO,CA .. . CONTRACTOR: PLUMB-IN-TIME PLUMBING SERVICES INC License No. 895793 - Address: 3959 GUASTI RD UNIT B • • PHONE: 909-605-2011 City/State: ONTARIO,CA ZipCode: 91761 - " CELL: . . PLUMBING PERMIT FEE SUMMARY _ PLAN CHECK FEE: $0.00 PERMIT FEE: $35.80 .. TOTAL FEES: $35.80 ` - • . . . 3 . . . . .. . . . , , . . . a . • • , . • • . • . . . NOTICE: The work authorized by this permit 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 with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. CODE S. INSPECnQN TYPE DATE INTIALS CODES INSPECTION TYPE DATE INTITIALS 1616- Fixed System Final Fire Prevention - - 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing /fib//Of( 200 Final Re-Roof 210 Final Electrical f 201 Final Block/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 220 Final Planning Approval 203 Final Sign 222 Final Site 204 Final Demolition • 250 Final Building/Occupancy WORKERS'COMPENSATION DECLARATION: Owner ID verified by driver's lig. .,e. ❑Yes ❑No I hereby affirm under penalty of perjury one of the following declarations: Driver's License No. Expires: • ❑ I have and will maintain a certificate of consent to self-Insure for workers' Verification of Ownership by(type of document,i.e.-property tax bill or deed): compensation, as provided for by section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code, for the performance of the work for which this DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: permit is issued. My workers' compensation Insurance carrier and policy ElI hereby certify that no excavation five(5)or more feet in depth into which a number are: person is required to descend,will be made in connection with work authorized ,� by this permit,and that no building structure,scaffolding,falsework,or demolition Carrier: �jwv-yin 4/C G (Rw c1 S�c��$f �-n S CO ' or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp (This sec(.on need not be completed d the perm(u valued at one hund tars($100)or less.) A 2 5 J 2,Art 2,Sec.341,Title 8,California Administrative Code). O'S Policy Number: l-,)(' { 1 80 ❑ As owner-builder, I will not employ anyone to do work which would ❑ I certify that in the performance of the work for which this permit is require a permit from the Division of Industrial Safety,as noted above,unless issued, I shall not employ any person in any manner so as to become subject such person has a permit to do such work from the division. to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of Applicants Signature Dale the Labor Code,I shall -•hwith comply with these provisions. (0/75-4) y Division of Industrial Safety Permit Number: �licanfs Signature Date / HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE 1. Will the applicant or present or future building occupant need to file and IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL certify a Business Plan for emergency response to release or threatened PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS release of a hazardous material? ❑Yes ❑No ($100,000), IN ADDITION TO THE COST OF COMPENSATION. DAMAGES AS (Section 25505 of the California Health and Safety Code requires,with some PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND exceptions, that a Business Plan be filed with the Costa Mesa Fire ATTORNEY'S FEES. Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas I hereby affirm that I am licensed under provisions of Chapter 9(commencing at standard temperature and pressure). with Section 7000) of Division 3 of the Business and Professions Code, and 2. Does or will the applicant or present or future building occupant need to file my license is in full force and effect. a registration form for acutely hazardous materials? 0 Yes ❑No u Lic.# 15-7 r Class# G3fo (Section 25533 of the California Health and Safety Code, with some 0I (S /O 7 exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely - or's Signature Date hazardous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard CONSTRUCTION LENDING AGENCY: temperature and pressure). ❑ I hereby affirm that there is a construction lending agency for the 3. Does or will the applicant or present or future building occupant need to performance of the work for which this permit is issued.(Sec.3097,Civil Code). prepare an RMPP (Risk Management and Prevention Program for acutely Lender's Name: hazardous materials)? ❑Yes ❑ No (Section 25534 of the California Health and Safety Code provides that the Lender's Address: Costa Mesa Fire Department may require the preparation, certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. Signature Dale 4. If an RMPP is presently required, has Section 25534 of the California OWNER-BUILDER DECLARATIONS: Health and Safety Code been fully complied with? ❑Yes ❑No I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE 5. Does or will the applicant or present or future building occupant require for CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, the work which is the subject of this application a permit for such construction Business and Professions Code:Any city or county which requires a permit to or modification from the South Coast Air Quality Management District or from construct, alter, improve, demolish, or repair any structure, prior to its any other air pollution control district or agency? ❑Yes ❑No issuance,also requires the applicant for such permit to file a signed statement (Section 65850.2 of the California Government Code requires that the requested that he or she is licensed pursuant to the provisions of the Contractors information be fumished on applications for non-residential building permits). License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and 6. Will any part of the facility to be constructed under this permit be within the basis for the alleged exemption. Any violation of Section 7031.5 by any 1000 feet from the outer boundaries of a school? ❑Yes ❑No applicant for a permit subjects the applicant to a civil penalty of not more than (If yes",the facility must meet the requirement of Sections 25534 and 42303 five hundred dollars($500).): of the California Health and Safety Code). ❑ I, as owner of the property,or my employees with wages as their sole 7. If a permit from the South Coast Air Quality Management District or other compensation, WILL DO THE WORK, and the structure is not intended or air pollution control district or agency is required for the work which is the offered for sale(Sec.7044,Business and Professions Code:The Contractors subject of this application,have all of the disclosures prescribed by California License Law does not apply to an owner of properly who builds or improves Health and Safety Code Section 42303 been made? ❑Yes ❑ No thereon,and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or offered for 8. (If yes",attach certificate of compliance from the appropriate air pollution sale. If, however, the building or improvement is sold within one year of control officer). completion, the owner-builder will have the burden of proving that he or she CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the did not build or improve for purpose of sale.). information given above is correct. I agree to comply with all state laws and ❑ I, as owner of the properly,am EXCLUSIVELY CONTRACTING WITH city ordinances regarding Hazardous Materials and Emissions. LICENSED CONTRACTORS to construct the project(Sec.7044,Business and Professions Code:The contractors License Law does not apply to an owner of Signature Date property who builds or improves thereon,and who contracts for such project with CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: a contractor(s)license pursuant to the Contractors License Laws.). certify under penalty of perjury that I have read this application and state that ❑ I am exempt under sec. the information given is correct. I agree to comply with all state laws and city ordinances relating to building construction, and authorize representatives of Business and Professions Code for this reason: the City of Costa Mesa to enter upon the above-described property for inspection purposes. I agree not to occupy or allow occupancy of any building authorized by this'permit until final inspection. Signature of L-.. er(s) Date Signature Date /01/4 c/07 3051-46(3/07) jg,QfAuthor;zed Applicant Date • - 1 • • , • + CITY OF COSTA MESA `y BUILDING DIVISION H r .�...,. PERMIT NUMBER DEVELOPMENT SERVICES DEPARTMENTNa„ rik4t � � �; PERMIT B99-00962 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 140 21ST ST Status: ISSUED Suite: Applied: 06/23/1999 Vicinity: MASTER BEDROOM/BATHROOM&KITCHEN Issued: 08/31/1999 Parcel Number: 42612107 Zoning: Applicant: BURDELL, JIM • $y .� Address: 1330 S.E. BRISTOL ST. ISSUED BY: V` SANTA ANA HEIGHTS,CA - Phone:' (714)557-5171 SUITE 59 Zip: 92707 - Owner: AMMANN, KENNETH & JUDY Address 1062 SAN PABLO CIR Phone: ,/,-,COSTA MESA Zip: 92626 • Contractor: j DECLARATIONS WORKERS'COMPENSATION DECLARATION: - I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. My workers'compensation Insurance carrier and policy number are: Carder: Policy Number: (This section need not be completed i/the permit is valued et one hundred dollars($100)or less.) ❑ 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($100. ).IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,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 and effect.Lic.# Class# Contractors Signature: Date: CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant fore permit subjr the applicant toe civil penalty of not more than five hundred dollars($500).): I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt unyerSSg Business and Professions Code for this reason: Signature: ��TT// 6cs - '/ Date: �l ?i/ �l7' {/ Owner ID verified by drivers license. 0 Yes 0 No Drivers License No. Expires: Verification of Ownership by(type of document,i.e.-properly tax bill or deed): 111 DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely 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 temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? 0 Yes 0 No 5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes LJ No (Section 65850.2 of the Califomia Govemment Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes ❑No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If'yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information 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 Costa Mesa to enter upon the above-desc' pro e or inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit un' fiinaall�' spection. da e /9t Signature Of Legal Owner(s) ate And/Or Authorized Applicant Date ODE E JNSPECTION TYPE BATE INTRIALE CODES If1$PFCTION TYPE PATE INTRIALS 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa 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 - , O0 V L 2446-46 A N_Tarchitectural planning and design tro design 1330 S.E BRISTOL- SUITE 59 SANTA AAA HEIGHTS, CA 92707 JULY 2, 1999 COSTA MESA BUILDING DEPARTMENT COSTA MESA, CA 92626 PLEASE ACCEPT THIS AUTHORIZATION FOR MY ARCHITECTURAL DESIGNER, JAMES R. BURDELL,TO SIGN FOR THE ISSUANCE OF MY BUILDING PERMIT AND ANY OTHER FORMS REQUIRED TO ISSUE THE PERMIT. THANK YOU, )64\ 0)dWNIY‘Aht/wr KEN AM MANN PROPERTY OWNER OF THE RESIDENCE LOCATED AT 140 21ST STREET, COSTA MESA, CA. jburd@aol.com FAX 714-557-5033 PHONE 714-557-5171 St MeCITYCITY OF COSTA MESA y°4y _ BUILDING DIVISION PER T NUMBER h' WM1 ' DEVELOPMENT SERVICES DEPARTMENT i• PERMIT °Imm 99-00924 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 ELECTRICAL PERMIT Job Address: 140 21ST ST Status: ISSUED Suite No Applied: 10/6/1999 Vicinity: ROOM ADDITION Issued: 10/6/1999 Parcel Nunmber: 42612107 '� ISSUED BY: \i Applicant: E M G ELECTRIC Address: 21121 GREENBORO LANE Phone: (714)536-7728 HUNINGTON BEACH, CA Zip: 92646 Owner PECA, RALPH R Address 1062 SAN PABLO CIR Phone: COSTA MESA,CA Zip: 92626 Contractor: E M G ELECTRIC Address: 21121 GREENBORO LANE Phone: (714)536-7728 HUNINGTON BEACH,CA Zip: 92646 License: 743243 SCOPE OF PERMIT 12 LIGHTS,20 OUTLETS,9 SWITCHES& 1 100 AMP ELECTRICAL SERVICE FOR ADDITION. FEE SUMMARY Quantity Quantity ISSUE FEE $23.50 Temp Dist System/Lighting $0.00 0 Temp service•test $0.00 Busway/100 ft $0.00 0 Res.a/c package $0.00 Standing Section $0.00 0 New Res(1-2 units) $0.00 0 Misc Electrical Equipment $0.00 0 New Res(3+units) $0.00 0 Transformers up to 1 kva/kw $0.00 0 Pool/Spa $0.00 0 up to 10 kva/kw $0.00 0 Lighting Fixts $13.20 12 up to 50 kva/kw $0.00 0 Recept Outlets $22.00 20 up to 100 kva/kw $0.00 0 Switches $9.90 9 over 100 kva/kw $0.00 0 Non Res Appl $0.00 0 Low Voltage Equipment $0.00 0 Res Appl $0.00 0 Low Volt Wiring System/Ckt $0.00 0 Service to 200a $30.50 1 Misc.Conduit $0.00 0 Service to 1000a $0.00 0 Misc.Conductor $0.00 0 Service over 1000a $0.00 0 Circus(gen or ride) $0.00 0 Motors to 1hp $0.00 0 Circus(mech ride or lights) $0.00 0 Motors to 10hp $0.00 0 Christmas Tree Stand $0.00 0 Motors to 50hp $0.00 0 Fireworks Stand $0.00 0 Motors to 100hp $0.00 0 Other Electrical Fee $0.00 Motors over 100hp $0.00 0 Communication drops $0.00 0 Investigation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspection Fee $0.00 Sign Circuits $0.00 0 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES $99.10 Intermed Pole $0.00 0 • COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 s" DECLARATIONS •• WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: • 0 I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: Policy Number: (This section need not be completed if the permit Is valued at one hundred dollars($100)or less.) ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and a ree,th t:lf I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pions. T �) /(/(SI / Applicant Signature:�¢ ��— � Date: q WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(5100,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed under p visions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.1t- 74-3 a q 3 Class Contractor's Signature: ,,_"2/ CCC__ `J,.��..✓` Date: /0-6 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lender's Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant toe civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation.WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code: The contractors License Law does not apply to an owner of property who builds or improves thereon,and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely 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 temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the Califomia Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant or present or future building occupant require for the work which is the subject of this application apermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? 0 Yes U No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). ---._---___-dist_-_-dist-__-_------ _ 6 -------- Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If"yes",the facility must meet the requirement of Sections 25534 and 42303 of the Califomia Health and Safety Code). ....7---..._If--a from Coastthe South __. D._r—r--_t-___ sitr__dist_ —_-__- e..____ which 7 application,If a permit than losAir Quality Management is Healthat or otherd Safetyt podon controln42303 district been agency is required for the work whis the subject of this have all of the disclosures prescribed by California and Code Section made? ❑Ves 0 No ......oc ....f.ro...- iaef..__..., _.... .... .... .. .. ... .......__. - .. -----...--- -.-----._. -....----..- e (It"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE: I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information 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 Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. Sjgn re Of Legal Owner(s) Date And/Or Authorized Applicant Date CODE I. INSPECTION TYPE DATE INTDTALS CODE II INSPECTION TYPE DATE INrrIALS 1616 Fixed System Final Fire Prevention _ 206 Final Mechanical • 1266 Pool Spa Final 206 Final Plumbing 200 Final Re-Roof 210 Final Electrical k � l� 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 2446-46 - ' N �` CITY OF COSTA MESA s;r , BUILDING DIVISION PERMIT NUMBER 1 I r. ! DEVELOPMENT SERVICES DEPARTMENT `J S PERMIT M99-00471 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 MECHANICAL PERMIT Job Address: 140 21ST ST Status: ISSUED Suite No Applied: 10/11/1999 Issued: 10/11/1999 Vicinity: Parcel Number 42612107 ISSUED BY: Qr- Applicant: BERT ESPOSITO Address:. ,i ' Phone, 714-972-9472 Zip: Owner ,PECA -RALPH R ,' i _ - Address: N1062 SAN PABLO CO /n / \ `"2", / -. . Phone: - ' \ . --. ' ,, / COSTA MESA CA Zip: 92626 , ' \-, ,/ Contractor: WEST/BEST PLUMBING Ky''��y` - \N, ., :Addr ssn 722 E PINE � ,.'N % /y.r / 7 //17 ;,/ Phone: 714-972-9472 -- SANTA ANA,CA . _ . Zip: - 92701. . , iA %- - License: 359677 _ Arch/Eng 'i- 1 - Address 'fl /t ; ' (4/1.::,, y- - _ _ / - Phone: - u ^ ' � Zip: ` r r � License: N SCOPE OF PERMIT RESIDNERIAL ADDITION,'RE:B9'9-00962, INSTALL 2BATHROOM FANS: .. ', •,FEE SUMMARY,:,/ , v;/ + -Quantity - r - Quantity ISSUE FEE. - $23.50 -' Repair/Alt Absorbtion Unit $0.00 0i Inst FAU<100 k BTU - $0.00 __0 Repair/Alt Refrigeration Unit . $0.00 0 Inst FAU>100 k BTU $0.00 0 Ventillation.System / . $0.00 '0 ` Repair/Alt Cooling/Heat, $0.00 0 Evaporative Cooler 7 $0.00_, ' 0 ' Inst/Rep. Recess Wall Htr $0.00 0 Commercial Incinerator I $0.00 0 Refrig Sys<100 k BTU $0.00: 0- . Domestic Incinerator - - $0.00 0, Refrig Sys>100 k BTU - ` $0.00- 0 Compressors/Absorption Systems:,, , r Gas Piping v,1v V\ ,' $0.00 0 : Up to 3 hp,/100 k BTU. .` /0;/ / $0.00' 0' Factory Fireplace ::`,50 00 " 0 1�. >�3 To 15 hp/500 k BTU - , "i-,j ;-' $0.00" ,0 Hood w/Mach Ezhaust� \�s0 00 ' 0 - _ �- , 15 To 30 hp/1,000 k'BTU - / moo 0 VAV Box V��� �2, `$0.00,,, 0-Jr % '�1'30,To 50 hp/1,750k BTU.. -;� , $0.00' 0 i Vent Fan/Single Duct / ,,$1450 -.!;-,2.... - Over 50 hp/Over 1,750'BTU ;'$0.00 0 Appliance ' � $0 00 0 -c , - -Boilers . Fire Dampers V. '/\$000. 0 "- `=" "' y�Upto.3 hp` - - - :�//$0.00 0 Smoke Dampers , v-,, v .$0.00 `0.. 3 To 15 hp- Inst or Relocate Appl Vent,'. • " $0.00' - 0, - 15 to 30 hp $0.00 0 Air Handlers< 10000cfm -- $0.00' '10:: - , 30 to 50 hp .' $0.00 0 Air Handlers> 10000cfm -- '0 - / Over 50 hp , $0.00 0 Floor Furnace $0.00' 0 �, \\ , Other Mechanical Fee .- Floor or Suspend Heater $0:00 0 Investigation Fee ' $0.00 - - Plan Check Fee - $0.00 ' <Reinspection Fee $0.00 TOTAL CALCULATED FEES $38.00 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord.No.92-28,§1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: • ' ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ' ❑ I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'com ensafion Insurancg carrier an policy number are: Carrier: /2(i✓L ` `— 1 Policy Number: (This section need not be completed if th permit is valued at one hundred dollars($100)or less.)' ❑ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these provisions. Applicant Signature: Date: /r2//7/71 WARNING:FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE(MOM,),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am licensed undergrovisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code,and my license is in full force and effect.Lic.# / - � �/ Class# C 3 G Contractors Signature: T, 7 b Date: / D/77/99 CONSTRUCTION LENDING AGENCY: ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued.(Sec.3097,Civil Code). Lenders Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages as their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044, Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: • Owner ID verified by drivers license. ❑Yes ❑No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title 8,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safety,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). ....2-.......... 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑Yes ❑No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely 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 temperature and pressure). .ill..th- or future occupant need to 3 Does or will the applicant present or future building occupantneed to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑Yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. ctio teHealth Safety with? .............. ....--.-.. ..-........-. ...-.._--- 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Ves ❑No th --_. 5 Does e will the applicantsAiror present or future buildingsoccupant at require for the work which is the subject age of this application appermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? Yes LJ No (Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑Yes 0 No (11'yes",the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If yes,attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct.I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. - Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information 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 Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final inspection. C`. „ow-.i.nal tit.• 'gal Owners) /� Date And/Or Authorized Applicant Date CODE t.- INSPECTION TYPE DATE • 'INTRIALS CODE• INSPECTION TYPE pATE N xIAL, 1616 Fixed System Final Fire Prevention • - 206 Final Mechanical (X` CIO1 y 1266 Pool Spa 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 2446-46 wq CITY OF COSTA MESA 1 is: ,,) BUILDING DIVISION \J F; "^' ' DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER • yob, PERMIT P99-00527 (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 • PLUMBING PERMIT Job Address: 140 21ST ST Status: ISSUED Suite No Applied: 09/07/1999 Issued: 09/07/1999 Vicinity: A- ISSUED BY: Parcel Nunmber: 42612107 - Applicant: BERT ESPOSITO.'-' _ . = Address: - !' ‘ Phone: 714-972-9472/ - / i Owner:/PECA RALPH R - \:\\ Address' 1062 SAN"PABLO CIR .! ' Phone: '' ''' COSTA MESA,CA Zip:., 92626 S/ 1.- 'N ; ' Contractor - : ' • Address: : - f ` - `- , - - Phone:_ , ./. _ - Zip: _..i `4h. License: a ' Arch/Eng:. - - _ _ Address:' _ :. % . - Phone: - - _ - Zip: }' - ' License: t_' ' SCOPE-OF PERMIT/ / ' ' `-RESIDENTIAL ADDITION, RE:99-00962, INSTALL BATHTUB,LAVATORY,SEWER CONN AND - • RELOCATE GAS LINE. _ _ , • --FEESUMMARY ' 'AMT QTYAMT QTY AMT QTY ISSUE FEE • $23.50. Laundry Tub/Washer. - $9.80. 1 ' Sump Pump $0.00 0 Backflow irrigation • $0.00 ' 0 .Landscape Irrigation $0.00 0 - Swimming Pool - $0.00 0 Backflow Preventer ' ' $0.00 0 . • ......P-Trap $0.00 . 0 '- ' : . Trap Primer $0.00 0 Bathtub ,$9.80 1 • " Pressure Regulator - $0.00 0 Urinal $0.00 0 Clarifier System $0.00- 0 Process Piping(per 10 ft)„ $0.00 0, ' - Vacuum Brkr Bkflow(1-4)" $0.00 0 Connect(Ice,Soda,etc) '$0.00 0 Receptors $0.00 0 - Vacuum Brkr Bkflow(5+) $0.00 0 Dental Units - $0.00' ' 0 Septic Tank - $0.00 ' 0 - Wash Basin ' $0.00 0 Dishwasher $0.00 0 Sewer Cap for Demb • $0.00 0 Wash Basin Set $0.00 0 Drain,Floor ' '$0.00 0 Sewer Connect $24.65 1 Waste and Vent System $0.00 0 Drain,Rainwater $0.00- 0 Sewer Private Line $0.00 • 0 Water Closet(Toilet) $0.00 0 Drain, Roof $0.00. ' 0 , • Shower $0.00 0 Water Heater/vent $0.00 0 Drinking Fountain $0.00 0 - Sink,bar $0.00 0 Water Piping(Inst or Rep.) $0.00 0 Expansion Tank $0.00 0 Sink, commercial ' ' $0.00 0 Water Re-pipe $0.00 0 Gas Earthquake Valve $0.00 0 Sink, Floor $0.00, 0 Water Service $0.00 0 Gas(1-4 outlets) $0.00 0 Sink, kitchen - ' ' -'$0.00 0 Water Softener $0.00 0 Gas(Over 4 outlets) $0.00 0 Sink,service/mop $0.00 0 OTHER $0.00 Gas Repipe $0.00 0 Spa(private) $0.00 0 VIOLATION $0.00 Gas Service $9.80 1 Spa(public) $0.00 0 PLAN CHECK $0.00 Interceptors(Grease,Oil) $0.00 0 REINSPECTION $0.00 0 Interceptors(Sand Auto) $0.00 0 TOTAL CALCULATED FEES: $77.55 COMMENTS/SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations.(Ord. No.92-28,§ 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days,or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required Inspections and final approval must be obtained.Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714)754-5626 DECLARATIONS WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury one of the following declarations: ❑ I have and will maintain a certificate of consent to self-Insure for workers'compensation,as provided for by section 3700 of the Labor Code,for the performance of the work for which this permit Is issued. •0 I have and will maintain workers'compensation insurance,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. My workers'compensation Insurance carrier and policy number are: Carrier: - Policy Number: (This section need not be completed/t the permit Is valued at one hundred dollars($100)or less.) iff I certify that in the performance of the work for which this permit Is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California,and agree that if I sho d become subject to the workers'compensation provisions of Section 3700 of the Labor Code, I shall forthwith/ comply with these pr ions.42.9 Applicant Signature: ,G6. Date: 9////LP1/p/q'/ • WARNING:FAILURE TO S CURE WORKERS'COMPE TION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARE($1000001,IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am license un er pr9yisions of Chapter 9(commencing with Section )of Division 3 of the Business an��yprofessions Code,and m license is in full force and effect.Lic.k y / / Class II 0i �n 7 C'r-S 4, ✓ 4 Contractor's Signature: At--41"n ,( Date: T c� CONSTRUCTION LENDING AGENCY: /- ❑ I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued.(Sec.3097,Civil Code). Lenders Name: Lender's Address: Signature: Date: OWNER-BUILDER DECLARATIONS: I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason(Sec.7031.5,Business and Professions Code:Any city or county which requires a permit to construct,alter,Improve,demolish,or repair any structure,prior to its issuance,also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars($500).): ❑ I,as owner of the property,or my employees with wages es their sole compensation,WILL DO THE WORK,and the structure is not intended or offered for sale(Sec. 7044,Business and Professions Code:The Contractors License Law does not apply to an owner of property who builds or improves thereon,and who does such work himself or herself or through his or her own employees,provided that such Improvements are not intended or offered for sale.If,however,the building or improvement is sold within one year of completion,the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property,am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the project(Sec. 7044, Business and Professions Code:The contractors License Law does not apply to an owner of properly who builds or improves thereon, and who contracts for such project with a contractor(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by driver's license. 0 Yes 0 No Driver's License No. Expires: Verification of Ownership by(type of document,i.e.-properly tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation five(5)or more feet in depth into which a person Is required to descend,will be made in connection with work authorized by this permit,and that no building structure,scaffolding,falsework,or demolition or dismantling thereof,will be more than thirty-six(36)feet high.(Chap.3.2,Grp 2,Art 2,Sec. 341,Title B,California Administrative Code). ❑ As owner-builder,I will not employ anyone to do work which would require a permit from the Division of Industrial Safely,as noted above,unless such person has a permit to do such work from the division. Signature: Date: Division of Industrial Safety Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? 0 Yes 0 No (Section 25505 of the California Health and Safety Code requires,with some exceptions,that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one time during a reported year a quantity of hazardous materials equal to or greater than a weight of 500 pounds,or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature and pressure). 2 Does or will the applicant or present or future building occupant need to file a registration form for acutely hazardous materials? 0 Yes 0 No (Section 25533 of the California Health and Safety Code,with some exceptions,requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely 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 temperature and pressure). 3 Does or will the applicant or present or future building occupant need to prepare an RMPP(Risk Management and Prevention Program for acutely hazardous materials)? ❑yes ❑No (Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation,certification and filing with the Fire Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department. 4 If an RMPP is presently required,has Section 25534 of the California Health and Safety Code been fully complied with? ❑Yes ❑No 5 Does or will the applicant Or present or future building occupant require for the work which is the subject of this application a ppermit for such construction or modification from the South Coast Air Quality Management District or from any other air pollution control district or agency? LJ Yes LJ No (Section 65850.2 of the California Government Code requires that the requested Information be furnished on applications for non-residential building permits). 6 Will any part of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? 0 Yes 0 No (If'yes',the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code). 7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? 0 Yes 0 No 8 (If"yes",attach certificate of compliance from the appropriate air pollution control officer). CERTIFICATE OF COMPLIANCE:I certify that under penalty of perjury the information given above is correct. I agree to comply with all state laws and city ordinances regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY:I certify under penalty of perjury that I have read this application and state that the information 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 Costa Mesa to enter upon the above-described property for inspection purposes.I agree not to occupy or allow occupancy of any building authorized by this permit until final Inspection. Si• nr Legal Owner(s) i 7 Date And/Or Authorized Applicant Date CODE# INSPECTION TYPE g9IE ItQII1919 CODE I INSPECTION TYPE PAlE INTIIAIS 1616 Fixed System Final Fire Prevention 206 Final Mechanical /� 1� r.�c� 1266 Pool Spa Final 208 Final Plumbing , %'X 1 'w F\N 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 2446-46 ADURESSOPBWL0ma 140 21ST ST WIT: A CITY OF COSTA MESA — BUILDING PERMIT cy!aacPNEIEIo'•x*, RON PICA • PERM NO: B 087648 fSS: 140 21ST ST C.M. CA 92626 PERMIT NO: B 087648 PLAN CHECK NO: N GOVT: N SUPP: N APDL.MAILING ADDRESS: CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH ARCHITECT OR ENCINER MC.N0. JOB DESCRIPTION : TEAR OFF COMP REPLACE WITH COMP ROOF SQ FT: 1 , 600 ARCH.OR ENG•S ADDRESS: tiliT: CLAIM VALUE: 1 , 600 . 00 CALL—VALUE: 1 , 600 . 00 GROUP OCC: R-3 /U-1 CONTRACTOTSKANE:WHITNEY ROOFING ( 714 ) 548-0769 CONTRACTOWS RAM 790 NEWTON WY COMMENTS: ROOFING PERMIT APPLIES ONLY TO BLDG. A AooeEs&COSTA MESA CA UC.IC.: 4060 - ***It**i'r***************SESE*AEStStMMSt*****+ESE+E********St*****iE+E*fE************+E*****+E*** 92627 uNT: 2 ONING REQUIREMENTS LICENSED CONTRACTORS h ) DECLARATION: penally perjury that em - p%. . of Chapter 9 SETBACKS (commencing with Section 7000)c 3d the Business and Professions CITY LIC.NO.:0280 •CLASS: C 39 LW.NO.: 40b02 3''• 07/98 MAIN BUILDING ACCESSORY BUILDING / FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN Date: Contractor LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN 0 R BUILDER 0 LAR ION:I hereby affirm under penally of perjury that I am e •apt from the Contractors License Law for theanni wing reason( :. . 703 .5 Business and Professions Code:Any city or county whi.• requires a pto construct,mer.improve, PARKING REQ- P ROV: PARCEL : 42612107 Z N E: REF NO: demolish. rept*or rep : structure,prior to itsissuance,ance,ebo requires the applicant for euch permit lo file a signed aletement that he a ahe licensed pursuant o the provisions of the Contractors License Law(Chapter 9(commencing with Section 7000)d Division 3 d the PLANNING NOT E S.> useless and Professions Code)or that he or she is exempt therefrom and the basis for the alleged exemption.AMY violation d Sedan > 7031.5 by any epptkantl«eparml subjects the applicant toe civil perahydar mos than lie hundred dollars[S5001). • *************Wit******************************************************'********** ❑ I,as owner of the property or my employees with wages as their sole compensation,will do the work,and the structure is not intended D E V E L OP MEN T SERVICES R E or offered for saemdoes(Seon 7044,Business and Professions Code:The Contractor,License Law donappty to an owner of properly1 Q U I R E M E N T S who builds or improves thereon.and and who does such work emailor herself or through he or her own employees,provided that such imprwementaare not hueadedordf«edforsae.B,I owever,the building ainaoiemer "Id within ooeYea"ccuupleron,he ZONING APPROVED BY - , owner-water will have the burden of proving he or she did not build or improve for the purpose of sae). DATE ❑ I.sa owner of the property.am exclusively contracting with licensed contractors to construe the project(Section 7044,Business and Prde® o ons Code:The Contractor.License Law does nappy to an owner d property who builds or improves thereon and who BUILDING APPROVED BY : DATE: ^ contracts for sixth projects with a contd reor(s)licensed pursuant to the Contractors license Law). 1, ❑ lam exempt under Section: B.&P.C,.for hereason: APPLICATION ISSUED BY: DATE: *********************************************** ** **************** F* Dale LEGALIZATION :N F E E SUMMARY STRUCTURAL SE MENT:Y I do hereby caddy that I am aware d and understand the requirements of Cations Heath and Safety Code Sections 25505,25533,and 25534,and that 1 a e ry future building occupant_will/coil not(circle one)need to comply with said state codes W the requirements for a permit construction or nadifmtion Iran the Ar ekiy anagem«nDistra.Residential construction appimianen exempt from these BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING provisions. PERMIT 51 . 25 . 50 Date: Apptcer: SMIP/NON—RES WORKER'S COMPENSATION DECLARATION:I hereby affirm wrier penalty of penury one of the Mowing dedar«aa: PLAN ISSUE FEE ❑ I have Codeandveipeaintainacetdcatedixenttomivunersued. compensation,esprovided for bySarmn3700ofteLabor BUILDING—DIV—> PERMIT ISSUE PLAN CHECK TOTAL PAID DUE cnd..f«rep«famarnc.dhe work f«which the perms is issued. TOTALS 51 . 75 0 . 00 0 . 00 51 . 75 51 . 75 . 00 ❑ !have and will maintain slickers' npens«od n insurance,as required by Section 3700 the Labor . t performance of the . work for which this pesN a®Ued,My workers'compensation insurance carder and policy number. . Cartier. / REVENUE DIVISION TOTALS--> COLLECTED : 51 . 75 OVER/SHORT: . 00 Policy Number: / BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK This—_.ion need not be completed d the pnni is for one hundred dollars(51001 or req.f 51 . 25 . 50 jY I certify that in he•. continua d to wok for which this permit a issued.I shatpe • any manner so as to r become .'n,o he compenaaton ewe d Caldome.and agree � ,. assnathewaken0 .. ..i1t+s . dt saw loan:Codeh.glanwvnI N D I V I D U A L F E E B R E A K D O W N rApplicant: Warning:FeNu to score workers*compensation tonna lsunlawNLend shall object anemployer to criminal penalties and TYPE QTY DESCRIPTIO N UNIT COST TOTAL COST civil fines up • -hundred thousand dd/an(Slogan In addition to the cost• compensation damages as provided for in Section 37W.I the Use Labor Code,Interest,end sftom.y's lees. SFR 1600 REROOF BY VALUE RESIDENTIAL NOZONE 1 . 00 1 , 600 . 00 • CONSTRUCT!.N LENDING AGENCY: I hereby affirm under penalty d perjury t 'e a construction lending agency for the END OF FEES performance of the work for whin the permit is issued(Section 3097.Ci+,C). LENDER'S NAME: LENDER'S ADDRESS: I certify that I have read this application and sale that the above inform, .,I ..to comply with all dry and county ordinances t and state lava relatingto buildingconstruction end hereby authorize ...of the to enter upon leebova menlennd property for inspection purposes.ROBERT WHITNE • Print Name //�� Iffy at ? APR081999 A G'iIIII Date: 1U� Signature of O«w/AgenvAppican r .Of ' lak Cilia OF C°511‘ os b WI (5151J6.WP) White-BuiMng A Safety:Oreen-R ppicant;Pink-Revenue:Golden•. - CONSTRUCTION AND PLANNING - - POOL .PA . Date Inspector Date Inspector ...APPROVALS Permit# - APPROVALS Penrii:# , 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location Soil Pipe-Undrgrnd. . , _ - 53. Steel Reinforcement , - 3. Electrical Conduit Utility-Uhdrgrnd. • 54. Forms 4. Electrical Conduit-Undrgrnd. - 55. Electrical"Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK • 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final • - 15. Rough Electrical-Conduit 66. Solar System-Final . 16. Rough Electric Wiring - - 67. Fencing& Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Alr Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 11-1_etg 644 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe - 28. Lathing& Siding • 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREY. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric . Notes: 34. Final Heating& Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final - - 41. Solar Domestic-Final '"s`: M1 42. Backflow Preventer ;� ,.0• 43. Backflow Irrigation (.- .c r . 44, Landscape Irrigation System .,. 45. Sound Attenuation 46. Handicap Regulations •.4 _ - S 47. FINAL STRUCTURE & BUILDING 14_4 If W 48. FINAL PLANNING - 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co \i 61. CERTIFICATE OF OCCUPANCY - -- -- No Date ' APPlicans —_......ea'except those within heavy border lines and sign all appropriate declarations. PERMIT NO TRACT NO. LOT NO. UNIT NO. CITY OF COSTA ME CONSTRUCSTrON PERMIT PEP1 RMIT 6 col A.P.# zone Project Address �' 5 ,c (CPU �m w LL Applicant's Maifijg Address /O� J�cS(CPU Pr 7C.1p C.m- TYPE OF CONSTRUCTION U NEW U ADD U ALTERATION U REPAIR E Main Building: Accessory Building: Z Owner's Name /)O'J /D/AJi4 PrreLY Phone `G'//-/700 ❑ CONVERSION 0 DEMOLISH 0 OTHER • T Front O i DESCRIPTION OF WORK/ E OF BLDG. I B Rear N Address C] Mf=+ ;,� �rIan_ . _C� - A_ I Arch/Eng. License No. TYPE OF PERMIT ■ GRADING III FOUNDATION . STRUCTURAL K Right G Address 0 TENANT 0 ELECTRICAL ❑ PLUMBING C MECHANICAL $ Left R .�. �....,, 0 OTHER Ref.# Re Contractor's Name LJU✓l= 46_Phone _ Ping. Parking q./Provided E PROJECT DESCRIPTION SO. FT. .. 1 OCCUPANCY PlanningNotes: Address(mailing) CON ST RUCTION TYPE Y-K/ VALUATION$ T • City License No. ZONE GRADING CU.YDS. ACRES -LICENSED CONTRACTOR DECLARATION I /� S. '1 hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: sv 3 I. 7 ' � tor ? with section 7000) of Division 3 of the Business and Professions Code, and J my license Is in full force and effect. ELECTRICAL FEES License Class License No. Date Signature PLUMBING FEES Automatic Washer Transformer 0 15.50 KW WORKERS' COMPENSATION DECLARATION 0 50+KW •'hereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers Construction Pole Sub. l,'orkers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink Cooking Unit Meter [pup to 100 amps 00, Lab. C.) - Policy No. Company Backf low Irrigation Sewer Cap Dishwasher Meter Dover 100 amps Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Dryers ❑Gas ❑Electric -- Sub Panel Date -. Applicant Fan EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Motors 00-1 HP ❑1'h-8 (This section need not be completed if the permit is for one hundred ($100) or Dishwasher F.A.U. Inc.Solar 09-15 HP ❑1615+ less). Solar Piping s shall no thatm in the performanceinanyf the work for aswhich gthis pe 1t is t to the , shall not employ anyperson in mann so as to beco ub'e<t to DrinkingFountains Fixtures • M' wave p y j Solar Tank Joro Dorker Co pen tipn Laws a California. Date d : if - d _Signature vMG Floor Drains Swimming Pool w/Spa Device Bozes Pole Light NOTI E: If,after making thisdeclaration,the you should become subject to the Outlets Workers' Compensation provisions of the Labor Code, you must forthwith- Floor Sinks Urinal Range comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AG ENCVSwitches Si n Gas Service Outlets Water Closet 9 I hereby affirm that there is a construction lending agency for the performance Garbo a Disposal of the work for whicn this permit is issued (Section 3097 Civ. C.) Interceptors er Heater gStanding Sections Lender's Name Lender's Address Kitchen Sink ! / Water Service Generator 00-5 KW 05-15 KW Trash Compactor OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash following reason (Section 7031.5 Business and Professional Code: Any city or — county which requires a permit to construct,alter,improve,demolish or repair P_Trap Laundry Trays any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law (Chapter 9(commenting with Section 7000)of "vision 3 of the Business and Professions Code) or that he/she Is exempt s •efrom and the basis for the alleged exemption. Any violation of Section Reinspection Fee $15 Issue Feb $ 3 ;1.5 by any applicant for a permit subjects the applicant to a civil ‘. ' salty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS: I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 mpensation, will do the work,and the structure is not intended or offered Zoning Approved By Date for sale (Section 7044, Business and Professional Cotle: The Contractor's MECHANICAL FEES Building Approved B —= J License Law does not apply to an owner of a property who builds or Improves _ _ _ __ _. _ Date thereon, and who does such work himself/herself or through his or her own Application Issued By er. .i.. ,,- aDate [r —3' ' employees, provided that such Improvements are not intended or offered for Boiler Hood or Type I ❑ A�� v_ sale. If, however, the buildingor improvement is sold within one year of com- pletion, the owner will have he burden of proving he/she did not build or im- Duct-Under Ground Canopy Type I I 0 SU 14• OF FE' prove for the purpose of sale). BUILDING PERMIT—$ SMIP $ ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System PLAN CHECK tractors to construct the project (Section 7044,Business and Professions Code: $ PERMIT The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑0-100,000 BTU 0100,000 BTU PLUMBING ISSUANCE $ builds or improves thereon.and who contracts for such oroiects with a con- $ tractor(s) license pursuant to the Contractor's License Law). I am aware that , ' PLAN CHECK 25% $ ENERGY P.C. $ proof oftheir Worker's Compensation insurance should be provided to me. Exhaust System 0 Multiple 0 System Repair/Alteration ry ELECTRICAL $ GRADING $ ❑ am exempt under Section B.$.SP.C.for this reason I Firepl/Fact.BIL ICBG dk', 0� Fire Dampers / 90 MICROFILM $ r / l p PLAN CHECK 50% $ Date Owner Heating System&Ducting Registers MECHANICAL •s� f I hereby certify that I nave read this application and state that the above 00-100,000 BTU 0100,000 BTL $ TOTAL FEE $ / 7 1--4—C) Information is correct. i agree to comply with all city and county ordinances PLAN CHECK 25% $ and state laws relating to building onstruction, and hereby authorize repre- sentatives of this city to enter Aon the above-mentioned property for Inspection pu • / yF• Signature •E .1...e•a. I Date i - VJ , �j, Drivers' License or SS# Reinspection Fee $15 Issue Fee • $ 01 0001E547-00018547 TT 13.57 -C 0865-46,rev. 5/88 white - Building; Canary - Applicant; Pink -Accounting; Goldenrod - Assessor DATE: 11/03/88 TIME: 09:31 • CONSTRUCTION AND PLANNING POO WA APPROVALS Permit# • Date Inspector APPROVALS Permit# Date Inspector • 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location • 2! Soil Pipe;Undrgrnd. 53. Steel Reinforcement 3.,Electrical Conduit(Utility-Undrgrnd. 54. Forms 55. Electrical Bonding r +electrical Conduit-Undrgrnd. 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings ! 58. Electrical Conduit-Undrgrnd. , • 8. Foundation ' 59. Gas Pipe, 0 Undrgrnd.,Test ' I ) 9. Water'Pipe-Undg#d. 60. Backwash Lines,P-Trap, 0 Undrgrnd. ' .1 , 10. Structural Floor System 61. APPROVAL TO DECK • 11•. Property Sewer Line & House Connection i 62. Backwash & Receptor-Final 12. Sewer'Cap 63. Heater & Vent-Final • 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final ' 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18'. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 2f1. Ducts, in Structure I.C. 70. Underground Hydro 22. Ducts, Ventilating _ I 71. Product Piping 0 Gas 0 Oil `ti 23. Gas Pipe-Rough & Test ^"''' 72. Underground Flush 24. Roof Framing 7 73. Uridergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing I'I 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & tvlonocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing'& Siding se`, 77. FIXED SYSTEM FINAL 29. Insulation if' 78. FIRE PREV. FINAL 30. Drywall Nailing ;L HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 7 . 79. FINAL INSPECTION 32. Electrical Power Meter Final' 80. FOOD CERTIFICATE ISSUED t '1'...1- - • 33. Final Electric '•` Notes: -1 , ' 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy �r''�/ 37. Final Factory Fireplace . j/yf e(fir 38. Final Plumbing f�/ t 1, 39. Water Service-Final ' 40. Gas Service-Final • , 41. Solar Domestic-Final t I 'I • 42. Backflow Preventer Li 43. Backflow Irrigation . `! r 44. .Landscape Irrigation System • 11 t' 45. Sound Attenuation .i 46. Handicap Regulations tI 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co - `.j - -, 51. CERTIFICATE OF OCCUPANCY i • No, Date _ . Applicant to fill in all spaces except those within heavy border,lines and sign all appropriate declarations. - , ! PERMIT NO�.--1 TRACT NO. LOT NO. UNIT NO. .CL .A MESA CONSTRUCTION PERMIT 13 34--� �/ Pr�;ect Addr s 1` 0 gat Cososs -� n - I,,. l 50 Appllcalit'Nailing Address I��L t� `1 Wka �01F 1Y 1 TYPE OF CONSTRUCTION U NEW U ADD LI ALTERATION U REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER '� t r� Owner's Name 'f`f t`s �1 A Phone,-1/6° A.P.AP ' YZ6 — (21 —0-7 I Zone I , �O[a2 ZR PPed n I-- ,•s- A DESCRIPTION OF WORK/USE OF BLDG. Address p�n��M�� �,,s,. (=�pn� , LD �-,/ S Main Building: Accessory Building: Arch/Eng.IO/-� 4WD s�� � �1�s115.�7,�/��^�'License., No. 10153 TYPE OF PERMIT ❑ GRADING LJ FOUNDATION LKSTRUCTURAL E Front /� /f p Address 11V2-2•' f gifR Tl y `^a' ❑ TENANT ❑ ELECTRICAL 111 PL MBINGp ❑ MECHANICAL B Rear 1S N Contractor's Name Phone El OTHER D31 '410 A • - I PROJECT DESCRIPTION SQ. FT. OCCUPANCY ��"3�J,,Xl CK Right [j N Address(mailing) CONST RUCTION TYPE �� VALUATION$ l-1 ....•a3 S Left 5/Z // G City License No. ZONE GRADING CU.YDS. ACRES (�s �) R LICENSED CONTRACTOR DECLARATION - (QJ D -��- -�`�— Ping. Ref.# I"���� �g� Parking Req./Provided E hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: s� /"'s � 33316 t � M Planning Notes: ' -"� � sJfw _ pvf.-s M with section 7000) of Division 3 of the Business and Professions Code, and ( ` I ' my license is In full force and effect. / 1 / e p 7 l� .0 F31/ UNIA- _ -Q- `alt L: 5 L. tt a ,.�..� y'�t t...._�,, • License Class License No. ` II ll. O� '( d /5 Z-1 ; ( A) I i.\ '1 ' 1 !'1 ' Date Signature PLUMBING FEES - - WORKERS'COMPENSATION DECLARATION i� Bar Sink Showers I hereby affirm that I have a certificate of consent to self-Insure or a certificate ELECTRICAL FEES of Workers' Compensation,insurance, or a certified copy thereof (Section Backflow Preventer a Service Sink • 00, Lab. C.) •- Automatic Washer Transformer 0 15-50 KW .icy No. Company Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+KW HCertified copy is hereby furnished. — \\ Certified copy is filed with the city Building Division. . Bathtubs Sewer Connection Cooking Unit Meter Dup to 100 amps Date Applicant r--- EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps (This section need not be completed if the permit is for one hundred ($100)or ... - less). ' Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel I certify that in the performance of the work for which this permit is Issued,I shall not employ any person In any manner so as to become subject to the Drinking Fountains Solar Tank Fan Motors❑0-1 HP 011/4-8 Workers' Compensation Laws of California. Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc.Solar ❑9-15 HP 016-15+ NOTICE:If,after making this declaration, you should become subject to the — Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks . Urinal Fixtures comply.with such provisions or this permit shall be deemed revoked. Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes I hereby affirm that there is a construction lending agency for the performance - Pole Light of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors . Water Heater , Outlets • Range Lender's Name Lender's Address Kitchen Sink Water Service Switches Sign OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories • ',. Auto:Wash Garbage Disposal Standing Sections following reason (Section 7031.5 Business and Professional Code: Any city or - —_, county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator 00-5 KW 05-15 KW Trash Compactor any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law(Chapter 9(commencing with Section 7000)of - ' .7l 3 Division 3 of the Business and Professions Code) or that he/she is exempt • therefrom and the basis for the alleged exemption. Any violation of Section 1 31.5 by any applicant for a permit subjects the applicant to a civil slty of not more than five hundred dollars($500). $ 3 i• ' I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee - compensation, will do the work,and the structure is not Intended or offered Reinspection Fee $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES - - License Law does not apply to an owner of a property who builds or improves . thereon, and who does such work himself/herself or through his or her own Hood or TypeDEVELOPMENT SERVICES REQUIREMENTS: p� employees, provided that such improvements are not intended or offered for Boiler I oCr -3 .SU sale. If, however, the building or improvement is sold within one year of com- Canopy Type II 0 Zoning Approved By Date diction, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By Date !ice for the purpose of sale). 119.1,also s owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date(6)--2,..- 63 tractors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 BTU 0100,000 BTU SUMMARY OF FEES builds or Improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ G26.00 SMIP $ 6.7G e proof of their Worker's Compensation insurance should be provided to me. _ PLAN CHECK $ f Z PERMIT ❑ I am exe pt nder Section AID �; P.C.for this reason Firepl/Fact.Blt. ICBO# Fire Dampers PLUMBING $ ISSUANCE $ ;Date laf ' Owner AlWar. ••-- -- / Heating System&Ducting Registers PLAN CHECK 25% $ ENERGY P.C. $ II hereby ce ify that I have read th .pplication and state that the above 00.100,000 BTU 0100,000 BTL ELECTRICAL $ GRADING $ information is correct. I agree to comply with all city and county ordinances and state laws relati • ' building nstruction,and hereby authorize epre- PLAN CHECK 50% $ MICROFILM $ sentatives of this • y o ente�r /.n the above-mentioned p❑rro/ops7er Otor `7 inspection purpos -. �x rpt �� • to £`� • ,. - MECHANICAL $ TOTAL FEE $ !� Signature/r.'N,. Drivers' License or 5$ •�� - Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ I`0865-46,rev. 10/84 White - Building; Canary =Applicant; Pink -Accounting; Goldenrod - Assessor 01 00011214-00011216 TOT 705.83 DATR: 0a,/n;/5i0 TIME, 1L2Ln • POOL &SPA CONSTRUCTION AND PLANNING Date Inspector Date Inspector .APPROVALS Permit# \\ APPROVALS Permit# 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd ' 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test • 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings ., 58. Electrical Conduit-Undrgrnd. -• " 8. Foundation.'• 59. Gas Pipe, ❑ Undrgrnd yTest 9. Water Pipe-Undrgrnd. / 60. Backwash Lines,P-Trap,❑ Undrgrnd. rY 10. Structural Floor System � 4 1,fie✓ 61. APPROVAL TO DECI<i 11. Property Sewer Line & House Connection 62. Backwash & Receptor;Final - 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final . • 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING.' :--.1 18, Rough Electrical-T Bar Ceiling69. POOL/SPA SYSTEMS FINAL + �, 19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ' i'4 20, Rough Factory Fireplace APPROVALS Permit# - 21, Ducts, in Structure 70. Underground Hydro f 22. Ducts, Ventilating 71. Product Piping 0 Gas 0-Oil . 23, Gas Pipe-Rough & Test 72. Underground Flush 24, Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil ' 25, Roof Sheathing nit lb)fit, t!g•Iv ' 74. Overhead Hydroi• rr • 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical • i 27. Frame and Flashing /rf 3/ i y a:/i,j 76. Dry Standpipe ' 28. Lathing & Siding /./ At 6• 77. FIXED SYSTEM FINAL . 29. Insulation111 &•iJ. 78. FIRE PREV. FINAL t• U�1d OM 30. Drywall Nailing ///ic/RCfy N• HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION \ .. I 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: /at �S 34. Final Heating & Air Conditioning 2 35. Final Gas Pipe-Test �/' GAJ ///�/ 36-. Hood or Canopy didaid tlik-3/iG / l�•/1 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final :40: Gas Service-Final X41. Solar Domestic-Final • 42. Backflow Preventer - 43. Backflow Irrigation _ • 44:':Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 147/8 /� • // ft- 47. FINAL STRUCTURE & BUILDING y17,49 t'7- Sil/4'�� �J•f �� 48. Special.Requirements Completed 4/•,/tip // 49. Electric Release to Edison / f • ' 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANC` ,ic, i No. •- 6 Date City of Costa Mesa INSI ATION C ERTI FICATIOI _/ Building Safety Division .I 140 21 St. Street "B" Costa Mesa Orange Number and Street City County Subdivision Lot Number DESCRIPTION OF INSTALLATION ROOF Material Brand Name Thickness (inches) Thermal Resistance (R Value) EXTERIOR WALL Material Batts Brand Name Corning Thickness (inches) 31" Thermal Resistance (R Value) R—ll CEILING Batt or Blanket Type Batt Brand Name Corning Thickness (inches) Thermal Resistance (R Value) R-19 Loose Fill Type Brand Name Minimum Thickness (inches) Number of bags Weight per bag lb. Area Covered (ft2) Thermal Resistance (R Value) FLOOR, ELEVATED Material Brand Name Thickness (inches) Thermal Resistance (R Value) FLOOR,SLAB Material Brand Name Thickness (inches) Thermal Resistance (R Value) Width (incheslt FOUNDATION WALL Material Brand Name Thickness (inches) Thermal Resistance (R Value)• _ • DECLARATION • I hereby certify that the above insulation was installed in the building at the above location in conformance with the current regulations setting Energy Conservation Standards for new residential buildings (located in Title 24 of the California Administrative Code). BLUE RIBBON BUILDERS, INC . 232598 General W ntractor(Builder) License Number Ai -. MNRG. 1/9/89 Signature and Title a Date HATCH INSULATION CO.' �r-})0 C c/c a -2._ Sub Contractor(Insulation Applicator) License Number Signature and Title Date CMF 1106-46 $y Sgt.- 7864/ 7 CERTIFICATE OF COMPLIANCE PAYMENT OF SCHOOL FACILITY FEES NEWPORT-MESA UNIFIED SCHOOL DISTRICT �9�X57 2n Co St th-(56/a , Gra"-- Developer/Applicant : c ,K\ elk/AL Verm_./� Address : IC24,22 _s1,1 4sEuito CAP . Cetert . Telephone Number : L74 ( '-' ‘-7 � ISD Tract/Parcel and Lot Number( s) : �i , y� \ Location of Project : \40 2-� L a 71-15Ct { Number of Square Feet of to D -7; SO Residential Space knn1 1a x $1 . 50 Total / Number of Square Feet of Commercial and Industrial Space x $0 . 25 Total The provisions of Government Code Section 53080 are not applicable . This certifies that the above-named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and 65995 . Checks are to be made payable to Newport-Mesa Unified School District . • `;;ffjjc /�. L5 .i->uaw a Businds Manager Newport-Mesa Unified School District The above representation as to square footage is true . Developer/Applicant agrees that if it is later determined that such representations are not true then this certificate shall automatically terminate and the appropriate City/County shall be notified . Date : I l leve r A licant 0(Aiy&r,} Fc/1- C� I p . Wpm e� Dl x1aA (JEC Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT II PERMIT NO. TRACT NO. LOT NO. UNIT NO. A P 0Zone �(O L . a16r Sr. Cc6TAm 1 146 3474[!y — Project Address l ` �/� e �1 1 r S Main Building: Accessory Building: 'Applicant's Mail* Address 1O� SAO Prce .o I'1 II TYPE OF CONSTRUCTION L.1 NEW 1L LLADD U ALTERATION U REPAIR E - Z OlfWA Ran"7 Phone tOLI I-170 El CONVERSION ❑ DEMOLISH LQ OTHER T Front O Qvvner'Address Name (JtJ i DESCRIPTION OF WORK/USE OF BLDG. A Rear N Address F �� C. I ADRm �/ g Arch/Eng. License No.IS`�1 p•}J TYPE OF PERMIT Ell GRADING U FOUNDATION U STRUCTURAL C Right G Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL $. Left R _ ❑ -OTHER Ping. Ref.# Parking Req.IProvided E Contractor's Nemo L4' Phone Q PROJECT DESCRIPTION SQ. FT. OCCUPANCY PlanningNotes: Address(mailing) CONSTRUCTION TYPE VALUATION$ M City License No. T ZONE GRADING CU.YDS. ACRES S. LICENSED CONTRACTOR DECLARATION AlI hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Rey NS(p C�(2C � with section 7000) of Division 3 of the Business and Professions Code, and • my license is in full force and effect. ELECTRICAL FEES License Class License No. – • Date Signature PLUMBING FEES Automatic Washer Transformer 0 15-50 KW , WORKERS'COMPENSATION DECLARATION Bar Sink Showers Construction Pole Sub. ❑ 50+ KW `hereby affirm that I have a certificate of consent to self-insure or a certificate . Workers' Compensation Insurance, or a certified copy thereof (SectionBackflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps MO, Lab. C.) Policy No. Company Backflow Irrigation Sewer Cap Dishwasher Meter Dover 100amps- B Certified copy Is hereby furnished. Dryers ❑Gas ❑Electric — Sub Panel Certified copy Is flied with the city Building Division. Bathtubs Sewer Connection • Date Applicant Fan Motors Doi HP ❑1'/a-8 EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors (This section need not be completed if the permit is for one hundred ($100) or . less). Dishwasher Solar Piping F.A.U. Inc.Solar 09-15 HP ❑16-15+ I certify that In the performance of the work for which this ermit is issued I Fixtures shall not employ any person in any man so as to be o e subject to the Drinking Fountains Solar Tank Microwave , Worker ' COOtpi 'a tion yaws of Califor –•�'ej� , Date YS SignatureFloor Drains Swimming Pool w/Spa Device Boxes Pole Light NOTICE:If,after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Outlets Range , comply with such provisions or this permit shall be deemed revoked. • CONSTRUCTION LENDING AGENCYSwitches Si n Gas Service Outlets Water Closet g I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is Issued (Section 3097 Civ. C.) Garbage Disposal Standing Sections Interceptors Water Heater Lender's Name Water Service Generator ❑O-5 KW 05.15 KW Trash Compactor Lender's Address Kitchen Sink � OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the Lavatories Auto-Wash following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair P–Trap Laundry Trays any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains the Contractor's License Law(Chapter 9(commencing with Section 7000) of +vision 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee J $15 Issue Fee $ 3 -refrain and the basis for the alleged exemption. Any violation of Section 31.5 by any applicant for a permit subjects the applicant to a civil - eenalty of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS: • LJ I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 compensation, will do the work, and the structure is not intended or-offered Zoning Approved By Date for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES Building Approved By Date License Law does not apply to an owner of a property who builds or improves /2Date �/p`j thereon, and who does such work himself/herself or through his or her own Application Issued By ", ���"`---"'lll Date O J employees, provided that such Improvements are not Intended or offered for Boiler Hood or Type I ❑ . sale. If, however, the building or Improvement is sold within one year of com- Canopy Type II ❑ �./ a� F�-�- SUMMARY OF FEES pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground • prove for the purpose of sale). - BUILDINGPERMIT $ ;4C) .6D SMIP $ • ❑ I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System tractors to construct the project (Section 7044,Business and Professions Code: PLAN CHECK $ PERMIT The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑D-100,000 BTU 0100,000 BTU PLUMBING $ ISSUANCE $ builds or improves thereon,and who contracts for such projects with a con- tractors) license pursuant to the Contractor's License Law). 1 am aware that Exhaust System 0 Multiple 0 System Repair/Alteration PLAN CHECK 25% $ ENERGY P.C. $ proof of their Worker's Compensation insurance should be provided to me. PLAN RIRI $ GRADING $ IDELECTCAL 'I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBGFire Dampers CHECK 50% $ MICROFILM $ Date ¶-19-WA Owner.fCAA)fl 47/t Heating System& Ducting Registers I hereby certify that I have read this application and state that the above 00-100,000 BTU 0100,000 BT MECHANICAL $ TOTAL FEE $ 3D.a 1` information is correct. I agree to comply with all city and county ordinances PLAN CHECK 25% $ and state laws relating to building construction,and hereby authorize repre- sentatives of this ty t0 enter upo the above-mentioned property for inspection purposes \ Q p�- Signature C.–, �P Date -11- 6 r+ • Drivers' License or SS 9fx, '' Reinspection Fee I $15 _ Issue Fee $ 3 01 00012448-00012448 TOT 30.00 0865-46,rev.5/88 White - Building; Canary -Applicant; Pink -Accounting;Goldenrod -Assessor DATE: 08/19/88 TIME: 08:07 I , CONSTRUCTION AND PLANNING PO( SPA APPROVALS Permit Date - Inspector APPROVALS Permit# Date Inspector - '1. Temporary'Electrical Service or Pole , 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steell Reinforcement 56. Rough Plumbing & Pressure Test ' 6. Electrical UFER:Grnd. 57. APPROVAL TO COVER-GUNITE 7., FOotings • . • 58. Electrical Conduit-Undrgrnd. I , 8.' Foundation • I 59. Gas Pipe, 0 Undrgrnd.,Test • 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System _ . 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection - 62. Backwash & Receptor-Final 12. Sewer Cap,: 63. Heater & Vent-Final I 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 151 Rough Electrical-Conduit 66. Solar System-Final !16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 1& Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78, FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing • 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventers 43. Backflow Irrigation • 44. Landscape Irrigation System 45. Sound Attenuation , • 46. Handicap Regulations ' 47. FINAL STRUCTURE & BUILDING Ov4k 48. Special Requirements Completed G" 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co • 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. ' (.2 11S COSTA MESA CONST UCTION PERMIT PERMIT NO. TRACTRNO. LOT O UNIT NO. 2q Project Address I40 ' ��Z//t A� � (('�)s��� .�� /�p �����p � �9 2_ ' 0 �L�I 1�8��3 - • Asplicont's Mailin Add`re,`s t&Ca- 3 b•r"LiK/Il' `�111L TYPE OF CONSTRUCTION ` -+LW U ADD U ALTERATION LI REPAIR 171E 7/: / / ' Owner's Name ^-' Phone�T l't'7 CI CONVERSION LI DEMOLISH ❑ OT! R a ii Mr A.B.# Lf-] /a,/ — o7 Zone LT /c D SCRIPTION OF WO K/US OF LDG. OC COIY {"��� Address (O�Z L-•m • Ca MC- /7�10 :g. [L./1" , S Main Building: Accessory Building: Arch/Eng. — License No. TYPE OF PERMIT LI GRADING LI FOUNDATION 1Gll r,�r STRUCTURAL T Front 93 / 0 Address — ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear 0t N Contractor's Name r (y . Z r Phone ❑ OTHER C Right r ,a,-1(y / 7 f N PROJECT DESCRIPTION SQ. FT. OCCUPANCY Address(mailing) - CONSTRUCTION TYPE VALUATIONS 7 ri L'C $ L t f G City License No. -ZONE GRADING CU.YDS. ACRES R LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: I . r �,.p� y� / 11 1 PlanningNotes: (�� /-s — r O with section 7000) of Division 3 of the Business and Professions Code,and Vv.Nc l/1/CJ�.F— �6SW sO YT Ol�. aLJCD f max r✓u /V.� M my license is in full force and effect. nOak- /1 ,t �'' T License Class License No. [, w� CoC/r f ax' Ll ��'`' S Date •.Signature - _ . PLUMBING FEES 1 VVV WORKERS' COMPENSATION DECLARATION Bar Sink Showers '•ereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink .00, Lab. C.) Automatic Washer Transformer 0 15-50 KW ' Policy No. Company Backflow Irrigation Sewer Ca 0 50+ KW A Certified copy is hereby furnished. p Construction Pole$ub. Certified copy is filed with the city Building Division. Bathtubs Sewer Connection Cooking Unit Meter Cup to 100 amps / Date Applicant / EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collect Dishwasher Meter Clover 100 amps (This section need not be completed if the permit Is for one hundred ($100)or less). Dishwasher Solar Pi ' g Dryers ❑Gas DElectric Sub Panel I certify that in the performance of the wor w is permit is issued, I shall not mpl any person In any m a ome subject to the Drinking Fountains Sol ank Fan Motors❑D- -• ❑1%-8 Workers' n Laws of Califon Motors Date Signature Floor Drains wimming Pool w/Spa F.A.U. Inc.So ■9-15 HP 01615+ NOTI :If,a ter making this declaratioou Th•. • become subject to the — Workers Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures comply with such provisions or this permit shall be deemed revoked. - ' rowave CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes I hereby affirm that there is a construction lending agency for the performance Pole Light of the work for which this permit is Issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Name - - _ _ Range Lender's Address Kitchen Sink Water Service OWNER BUILDER DECLARATION Switches Sign I hereby affirm that I-am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal following reason (Section 7031.5 Business and Professional Code: Any city or 9 P Standing Sections county which requires-a permit to construct,alter,improve,demolish or repair P—Tr Laundry Trays Generator ❑a ' KW ❑5-15 KW any structure, prior to Its issuance, also requires the applicant for such permit Trash Compactor to file a signed statement that he/she Is licensed pursuant to the provisions ofof Drains the Contractor's License Law(Chapter 9 (commencing with Section 7000) of nivision 3 of the Business and Professions Code) or that he/she is exempt . arefrom and the basis for the alleged exemption. Any violation of Section 31.5 by any applicant for a permit subjects the applicant to a civil .. +penalty of not more than five hundred dollars($500). O I, as owner of the property or my employees with wages as their sole Reinspection Fee III $15 Issue Fee $ 3 compensation, will do the work,and the structure is not Intended or offered _ - Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License Law does not apply to an owner of a property who builds or Improves _ thereon, and who does such work himself/herself or through his or her own - DEVELOPMENT SERVICES REQUIREMENTS:/�ye� employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I 0 ��1 ! Q./. �J4 / 4 8 sale. If, however, the building or improvement Is sold within one year of cam- Canopy Type II 0 Zoning Approved By P/Or/IVJw(/ (tet a--"Date/( `T pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By J, Date / fJ fpr a for the purpose of sale). {` { 11 7 I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration Syste Appliption Issued By Date �— �_ r ors to construct the project (Section 7044,Business and Professions Code: The Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00-100,000 0100,000 BTU builds or improves thereon, and who contracts for such projects with a con- SUMMARY OF FEES tractor(s) license pursuant to the Contractor's License Law). I am aware thatBUILDING PERMIT $ 3 8• 5 f Exhaust System 0 Multiple 0 Syst epair/Alteration SMTP $ C7, .�� proof o their Worker's Compensation Insurance uld be provided to me. _ _ PLAN CHECK $ 7 -SMO-3 0 I am exempt under Section . & P.C.for this reason Firepl/Fact.Blt. ICBG# Fire Dampersft PERMIT PLUMBING $ ISSUANCE $ Date Owner A.---- Heating System& Ducting Registers - PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read pplication and state that the above 00-100,000 BTU 010 0BTL GRADING $ information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ and state laws rela '•• to bu construction, and hereby authorize repre- MICROFILM $ sentatives of t to 9 upon the above-mentioned rope t for PLAN CHECK 50% $ inspection pure. Signature Dafer1/4�/ tr 7 TOTAL FEE $ 4 4-' MECHANICAL $ 03 Drivers' LicenW'55# _ - Reins ction Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865-46,rev.10/84 White - Building; Canary - Applicant; Plnk -Accounting; Goldenrod - Assessor CONSTRUCTION AND,PLANNING POOL &SPA APPROVALS Permit Date Inspector APPROVALS Permit Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. • 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. �A 57. APPROVAL TO COVER-GUNITE 7. Footings 1t.. Fr&S al 7/16/87 807,79 07, 58. Electrical Conduit-Undrgrnd. 8. Foundation _/ 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. .Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# - 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping ❑Gas 0 Oil • 23. Gas Pipe-Rough &Test 72. Underground Flush • 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof.Sheathing • 74. Overhead Hydro • - , 26. T-BarCeiling (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 3 @'�L �,(e< ten..o't! 35. Final Gas Pipe-Test 4 "/ �/ /-' 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final ' 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System • 45. Sound Attenuation 46. Handicap Regulations / 1419 47. FINAL STRUCTURE & BUILDING (/4Cala 3'�1_d� QYraffie.0 48. Special Requirements Completed // I 49. Electric Release to Edison- • r. 50. Gas Release to Southern California Gas Co - • - t, 51. CERTIFICATE OF OCCUPANCY it i fr No. Date AY TYPICAL 6" CONCRETE BLOCK FENCE • ' dEtiGSM CopingOptional ' Channel Block With 1.5/80 I i I GENERAL- NOTES Horizontal Top of all 1 FencesII I I I I MORTAR: One Port Plastic Cement. and Three Parts Sand For Fences li•a L.» GROUT: One Pmt Cement Three and >t �' One Half Parts dond Van.Ban a/E-0 et 1'•a-O.C. b cit: = I I COPING: One Pert Cement,Three ForFenasHigher Than 5' i!➢ u ' 1 1 : Parts Sand CONCRETE: Well Mind C2-I/2:3-V2 Vert.Ban 3/6"m n sr'O.C. ■ a = I I I Max. of 7-1/2 Gallons of Fill CNN Solid With Grout II i z Water Per Sock of Cement . Whet.Steel Occun s Reinforcing Steel Steal Shell 11 i 'a I I I .I PR GROUT MAYBE POURED OM THE TOP Conform to SaaA•15 39 y O OP THE FENCE IN CELLS WHERE STEEL AS.T.M. III z ~ I �o ...AND AREAS OfHORIZONTAL REIN• AR StNI to M Lapped 4 ~ FORCEMENT SHALL BE CLEAR,CLEAN e 21w orb Code ' ' I FREE OF ALL MORTAR DEBRIa,ETC • NATURAL GRADE I f it. , - �a TWO WO BARS �rt ►° P •. . .. . . • .. • . CONTINUOUS TOP .. SBOTTOM el : • Ie—WIDTH ', v TO 16' O.C. MAX. �, ;, .' e•1.,_. BELOW ART • .. I 110QIiaTEEL MUST SE TIED IN . F ' ' OE PTH OF E ARTHTCOTH PLACE AT TIME OF TRENCH a' a. • ILI THE NEIGTH OF FENCE INSPECTION. a' : : : 4 •-•• LOW • SBOTTOM OF FOOTING. • N • r w W_-I I-'°' i =w SCALE: V2", I' , ' ( FOOTING REQUIREMENTS CHART • 1 WALL HEIGHT 5' __ . J 4' 3' WIDTH 14 i 140 I _IZ`."., , ; . , , , 12�.' • THICKNESS 10 10 e e DEPTH OF EARTHTOOTH . . . 24' 20' 16' . . .. 12' ' SPACING OF EARTHTOOTH. .\ 12' 14' 16' ' 16' _ OWNERS NAME: .- City of Costa Mesa, California PERMIT D NUMBER:.- 1Y0- a' Building Department • SIGNATURE: _ — ,sin. p..:1.JV.r.at CeSISO Pima:. 4 �PP�O�BED • Cityofof�C�osta Mesa Building Dept. BY•--=�1_L'f'1' �5,,�, TTIff .r, .. .. ICA ,- AI I T:',.FF.i,;+vc {1 i.•r DEPr k gat, C1TyL617.11t4G-7 ti - : s.-. OF PLKi. swig— INI710 tag) r... . i . it.. . . ✓. ,IS dr It OF :. :fin: .. .✓! :USE F.CT toa cc) ScFTIFKAr;ri, s 3t'..I, ' • ndaly ?r,r-73U"O:d ?•a.S AND B FROM TF:ERE.:fTER kEO�NC,Fr7R;:4'Cn!: lri5 ,;o u;N ;;;ICTAL • SAID PLr,N$ AND cJiRI,Vy IO COOK FOV CP EVENTI IN CZ SAILDIIPL OPERATION$ BEING TIONS OR FROM YREVErG CARR! CE OFflas j IN VIOLATION OF THIS EN ON ,HEREUNDER WHEN wATHE CITYCODE OR OF qNY OTryER ORDINANCE OFf a 5 ._9 • 2 ' .aet.es 111111141114111 ...,:, 4 MOMS 1t 38 l(4. Q. ,. . ,,) ,i. ,. • I illiili �J,STREET 4 _ • . w • . PARTY WALL AGREEMENT +. THIS AGREEMENT, made and entered into this )4ffi> day of L)La-"1 ,. l9S by and betweenl\+ P Pr hereinafter referred to as "LAND GVER", and C<ADp i hereinafter referred to:as "ADJACENT .PROPERTY GJNER". It is hereby agreed that a party wall will be constructed on the property line between HO O •Zi ST_ frN D 1 y (Address of Adjoining Properties) in the City of Costa Mesa, County of Orange, State of California, as per map recorded in Bock , Page of Miscellaneous Maps, in the office of the County Recorder of said County. The party wall shall be permitted to encroach IN WITNESS 6HEREOF, the parties have entered into this Agreement the day arca year first above written. LAND OWNER ADJACENT PROPERTY (}NER `--(Signature), (S. nature) a 7 � !dame (Typed or Printed) - Name (Typed orPrinted) G / 1 EOTA, PU20,01 . f59x 112.ev (Address) (Address) 1 (+ tom» .,_.. _ .4,C 1 - _ -.-.. '.- .. .• '....- ... _ ' r> s .., . + E — �ncant to fill in all spaces except those within heavy order lines and sign all appropriate declarations. �� "��' P RMIT N TRACT NO. LOT NO. UNIT NO. L CITY( hFCOSTAMESA CONSTRUCTION PERMIT S3 A.P.# Zone • Project Addeess /V0 . /67 C..M Fe rI S Main Building: Accessory Building: • ,, Applicaa['s•Mailin Add/rpis X062 a p �/a. C TYPE OF CONSTRUCTION U NEW LI A�D Li ALTERATION LJ REPAIR t E Z /tarsi PEZf4 Phone G'`/•2700 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER T Front O Owner's Name e.f2'1 • DESCRIPTION OF WORK/USE OF BLDG. A Rear N I Arch/Eng. a C . C. �(,, �' :5 _License No. /0/ 83 TYPE OF PERMIT GRADING FOUNDATION ❑ STRUCTURAL CI Right G 5ZZ #4C4C{A .$ I d • 4 ❑ TENANT ELECTRICAL PLUMBING ❑ MECHANICAL $ Left R Address - �� ❑ .OTHER Ref. # Parkin Contractor's Name Phone �-7� Ping. gReq./Provided E // PROJECT DESCRIPTION 5D. FT. OCCUPANCY 1Li M PlanningNotes: Q Address(mailing) �/ � CONSTRUCTION TYPE VM VALUATION$ M / City License No. TZONE GRADING CU.YDS. ACRES S. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: /tE • 3 � r.., with section 7000) of Division 3 of the Business and Professions Code, and l �tw my license is in full force and effect. ?L v. �1 -SS/ ELECTRICAL FEES License Class ' License No. T s---. v •-- PLUMBING - I Automatic Washer Transformer 0 15-50 KW Date Signature FEES RKERS'COMPENSATION DECLARATIONii• 0 SO+KW t sereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers Construction Pole Sub. Workers' Compensation Insurance, or a certified copy thereof (Section Cooking Unit Meter ❑up to 100 amps p • 0, Lab. C.) • Backflow Preventer. Service Sink I$ S Policy No. - Com• pany Backflow Irrigation Sewer Cap I Dishwasher Meter Clover 100 amps Ai0 8 Certified copy'is hereby furnished., • Certified copy'ls filed withththe city Building Division. 2. Bathtubs // Sewer Connection 'COr CYf Dryers Maas DElectric Sub Panel 3 co Date Applicant ' I �q •-•. EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors iv Fan s Motors 00-1 HP 011A Cr 00 (This section need not be completed if the permit is for one hundred ($100 or less). ) / Dishwasher Solar Piping 2`t.c F.A.U. Inc.Solar ❑9.15 HP ❑16-15+ 3 by I certify that in the performance of the o or this permit is issued I, ' Fixtures shall not emp y,an person In any' ann'r so • •ecome subject to the • Drinking Fountains - Solar Tank /3 _ Microwave Cr 7.>- Workers' C ayy craws of Calif•m,is r _ Date I. Signature Floor Drains I '4 Swimming Pool w/Spa ' Device Bozes - Pole Light NOTICE:If,after eking this declarat - ,you sh• Id become subject to the - -- Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Dutlets Rang¢ comply with such provisions or this permit shall be deemed revoked. I p CONSTRUCTION LENDING AGENCY / Gas Service Outlets '3 Water Closet D e0 / ' SWitches Sign / t Zj I hereby affirm that there is a Construction lending agency for the performance - of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors / Water Heater ^�00 / Gerbage'Disposal Standing Sections 3 O Lender's Name — - Lender's Address / Kitchen Sink / Water Service u. a Generator 00-5 KW 05-15 KW Trash Compactor OWNER BUILDER DECLARATION . I hereby affirm that I am exempt from the Contractor's License Law for the 3 Lavatories / Auto-Wash (/ 0 Bq' following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct,alter,improve,demolish or repair P—Trap Laundry Trays any structure, prior to its issuance, also requires the applicant for such permit ' - to file a signed statement that he/she Is licensed pursuant to the provisions of Roof • Drains ) • e Contractor's License Law(Chapter 9 (commencing with Section 7000) of 'r vision 3 of the Business and Professions Code) or that he/she Is exempt •efrom and the basis for the alleged exemption. Any violation of Section Reinspection Fee I $15 . Issue Fee $r•3, IVO 1.5 by any applicant for a permit subjects the applicant to a civil / .Ity of not more than five hundred dollars($500). I DEVELOPMENT SERVICES REQUIREMENTS: as owner of the property or my employees with wages as their sole Reinspection Fee $15 Issue Fee $ 3 compensation, will do the work, and the structure is not intended or-offered . ZoningApproved By nate for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES . • Building Approved By Date License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own Application Issued By at �7 employees, provided that such improvements are not Intended or offered for Boiler • Hood or Type I CI sale. If, however, the building or improvement is sold within one year of com- Canopy Type II ❑ pletion,the owner will have the burden of proving he/she did not build or im- Duct-Under Ground - S MAR OF ES pre for the purpose of sale). 'BUILDING PERMIT $ SMIP II as owner of the property, am exclusively contracting with licensed con- / 'uuct-JF utaral Refrigeration System $ Yr3ctors to construct the project (Section 7044,Business and Professions Code: ,PLAN CHECK $ PERMIT The Contractor's License Law does not apply to an owner of property who Duct-Ventilating ❑o-100,000 BTU ❑100,000 BTU - .� .� ��' ISSUANCE builds or improves thereon. and who contracts for such oroiects with a con- PLUMBING $ $ tractor(s) license pursuant to the Contractor's License Law). I am aware that Exhaust System 0 Multiple 0 tem Repair/Alteration ELAN CHECK 25% $ ' • ENERGY P.C. $ proof of their Worker's Compensation insurance should be provided to me. i 0 1 am exempt under Section / /� B.& P.C.for this reason Firepl/Fact.BIt. ICBG# Fire Dampers 'ELECTRICAL $ _L 4:10....24— GRADING $ ///IP ��AJ `�/� HeatingSystem& Ducting PLAN CHECK 50% $ 4 I4.3 MICROFILM $ Date /t7/ Owner / 9 a'" Ant cc: col MECHANICAL $ 'Z •an I hereby certify that I have read this application and state that the above 100,000 BTU 0100,00087E i TOTAL FEE $ information is cor -ct. I agree to comply with all city and county ordinances PLAN CHECK 25% $ •15 ZOi-••S and state laws , a i to buinyconstruction, and hereby authorize repre • - sentatives of is ci . to f/r'Rpon the above-mentioned pro erty for ISignatture pur•oses. . Dat• Drivers' Licenr r 55 9f _ - /7 0� \. , Reinspection Fee $15 Issue Fee 01 00012320-00012323 TOT • t� 0865-46,rev. 5/89 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod - Assessor DATE: 08/17/88 TIME: 15:42 .,- 4111F- :I CONSTRUCTION AND PLP0 ANNING APPROVALS Permit # Date Inspector APPROVALS Permi .# Date Inspector ,.., . L-rTemporary Ele��trical Service or Pole 52. Pool & Equipment Location ,1.2. Soil Pipe-Undrgrnd. flZ ! N LEJ 53. Steel Reinforcement • - - V 3. Electrical Conduit Utility-Undrgrnd. " • 54. Forms -- { 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel IReinforsemenV 56. Rough Plumbing & Pressure Test ,t 57. APPROVAL TO COVER-GUNITE `; ,, 6. Electrical LIFER Grnd. - Fj'�Z' fN_ T. Footings } 58. Electrical Conduit-Undrgrnd. •1 f 8' Foundation - r - 59. Gas Pipe, 0 Undrgrnd.,Test ' 9. Water'Pipe-Undrgrnd. inst..3 ,LEO _ 60. Backwash Lines,P-Trap, 0 Undrgrnd. ' .1 t 10: Structural Floor System - 61. APPROVAL TO DECK ; 11.. Property Sewer Line & House Connection 62. Backwash & Receptor-Final .' 1 12. Sewer Cap ;i 63. Heater & Vent-Final 13. Roof Drains • 64. Plumbing System - Final - 14. Rough Plumbing / pg / - 65. Electrical-Final - , if3. Rough Electrical-Conduit - 66. Solar System-Final C16. Rough Electric Wiring ���19 / Gf�67. Fencing & Access Approval (171. Rough Wiring Sign `1-` rY Gp"'�`� 68. APPROVED FOR PLASTERING tie, Rough Electrical-T Bar Ceilag69. POOL/SPA SYSTEMS FINAL i 11;9. Rough Heating & Air Conditioning ' - FIRE DEPT. REQUIREMENT 1- 2©. Rough Factory Fireplace ' ' APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating F1 ��,I' ..t0 71. Product Piping 0 Gas 0 Oil - 23. Gas Pipe-Rough & Tet • �� r ar 72.-Underground Flush /- • �1� G 24. Roof Framing I,1.' ,� 73:- Undergrnd.Storage Tank 0 Gas 0 Oil r 3 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 Cgat; 79. FINAL INSPECTION 32. Electrical Power- titer-Final �"/ /' ; OOD.GERTIFICATE ISSUED f �' r 33. Final Electric �/4X %• Notes:l F-kilf €4 taf �4L - 34. Final Heating & Air Conditioning II�L -// G CC�r ' L 35. Final Gas Pipe-Test " y//7/C'! /0-3/-Se CAeec-* /-hfu/e f teZ 36. Hood or Canopy • �r ' Gt t i:. / R 37. Final Factory Fireplace 9/� f7 _/�%f�3'''?7 / _,�r-q XeG-/T: r/�y�� 38. Final Plumbing /7a�#2/(1 w c /-7( ,ri, Aae d -&tevyd .,���`�2 39. Water Service-Final //AV/fin •- 40. Gas Service-Final -r 41. Solar Domestic-Final r- 42. Backflow Preventer _, /1 67 -'r 7 . er `1 r . , 43. Backflow Irrigation j' - p r �,‘ :.' , , 44. Landscape Irrigation System i� r�/-, i 45. Sound Attenuation 46. Handicap Regulations • ` • 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed ' 49. Electric Release to Edison " ~ i t 1 50. Gas Release to Southern California Gas Co : - (. :'i:l' r),; 51. CERTIFICATE OF OCCUPANCY ,^ -`s i - (is I„ No. Date , . -- r1 tr' w V