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178 22ND ST - Building Permits
I, 4`ps�M@ 9 CITY OF COSTA MESA t -• -� BUILDING DIVISION c q � DEVELOPMENT SERVICES DEPARTMENT PERMIT NUMBER tII IP 0 4 PERMIT + po ✓05-00335 (714)754-5273 • Fax(714)754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE,COSTA MESA,CA 92626 BUILDING PERMIT Job Address: 178 22ND ST Status: ISSUED Suite: Applied: 03/01/2005 Vicinity: MESA CONDO BLDG Issued: 03/01/2005 Parcel Number: TPN00561 Zoning: -- Applicant: ASHMORE,VALERIE ISSUED BY: VA Address: 1835 WHITTIER AV UNIT F12 Phone: 800-784-8787 COSTA MESA,CA Zip: 92627 Owner: MESA HOA Address C/O JOHN COUTE COSTA MESA,CA Phone: 178 22ND ST UNIT B Zip: 92627-1787 Contractor 21ST CENTURY ROOFING INC Address: 1835 WHITTIER AV UNIT F12 Phone: 800-784-8787 COSTA MESA,CA Zip: 92627 License: 807430 Arch : Eng: Address: Address: Phone: Phone: Zip: License: License: SCOPE OF PERMIT REROOF CONDO BLDG:T/O EXISTING COMP ROOF, 1 LAYER 30#FELT,APPLY"40-YEAR GAF COMP ROOF."PITCH 5:12 30 SQUARES FEE SUMMARY Plan Check: $0.00 Calc Valuation: $5,000.00 Permit: $111.25 • Claim Valuation: $5,000.00 SMIP Res: $0.50 SMIP Corn: $0.00 Other: $0.00 Inspection: $0.00 • Total: $111.75 • PLANNING &ZONING SETBACKS MAIN STRUCTURE Front 0-0 Rear 0-0 Left 0-0 Right 0-0 ACCESSORY Front 0-0 Rear 0-0 Left 0-0 Right 0-0 PARKING Existing: 0 Required: 0 Proposed: 0 NOTES: 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 • 2446-46(6100) • DECLARATIONS11 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. q�q 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. rk mpensailon Insurance carrier and policy number are: Carrier: !!__/J/JLIn'L!�— Pddicypurnbyr. /7/911.01D (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 agreet if I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith cornpk5,h theseprU/ 4. A e ne ti Bets O 7 WARNING:FAILURE TO SECURE ORKERS'COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES uP TO ONE HUNDRED THOUSAND DOLLARE($100,000),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 licenand r provisions of Chapter 9(commencing with Section 7000)of Division 3 pf the Business and Pr sions Code,and my license is in full force and effect.L%a c4 3n k.it c i contractoda JI 4..j lir�v�"7d lKo • t �-(�S 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 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 0 No Drivers 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 ❑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 ❑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 apermit 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 Duality Management District or other air pollution control district or agency is required for the work which is the subject of this application,have ail of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑Yes ❑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. - f fur:Of Legal Owner(s)flol r O Spate•r An A thoriied'Ap'plicant IDafe`:-7t CODE# INSPECTION TYPg PATE INTRIAI S COOP t INSPECmON TYPE RALE RlSDAL5 1616 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final �t 208 Final Plumbing 200 Final Re-Roof "i,L'bS -usfrL 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 CITY OF COSTA MESA N r`, BUILDING DIVISION 1. 1 r,; PERMIT NUMBER r DEVELOPMENT SERVICES DEPARTMENT �.... 'S.' PERMIT ' �• P00-00371 °q^anmio A. (714)754-5273 • Fax(714)754-4856 77 FAIR DRIVE,COSTA MESA,CA 92626 PLUMBING PERMIT Job Address: 178 22ND ST Status: ISSUED Suite No Applied: 07/14/2000 Issued: 07/14/2000 Vicinity: UNIT A Parcel Nunmber: 93603043 ISSUED BY: Applicant: STARK, CHRIS silil. Address: 7229 VARNA AVE A►'° Phone: (818)407-1247 It• NORTH HOLLYWOOD,CA Zip: 91605 • - Owner: AUSTIN, THOMAS H Address 178 E 22ND ST#A A Phone: COSTA MESA,CA Zip: 92627 Contractor: ALAP ASSOCIATES GP Address: 7229 VARNA AVE Phone: (818)407-1247 NORTH HOLLYWOOD,CA Zip: 91605 License: 771905 - Arch / Eng : Address: Phone: Zip: License: SCOPE OF PERMIT WATER HEATER CHANGEOUT. • FEE SUMMARY AMT QTY AMT QTY AMT QTY ISSUE FEE $23.50 Laundry Tub/Washer $0.00 0 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 $0.00 0 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 Demo $0.00 0 Wash Basin Set $0.00 0 Drain, Floor $0.00 0 Sewer Connect $0.00 0 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 $12.30 1 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 $0.00 0 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: $35.80 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 WORKERS'COMPENSATION DECLARATION: I hereby affirm under penalty of perjury•ne of the following declarations: ❑ I have and will maintain a co to 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 -ed. Or have ..r:.•. :intern w• - 'compensation Insu..••_,as required by section 3700 of the Labor Code,for the performance of the work for which this permit is issued. ----MFNO -/'•mpensatio y -nce car'= number are: I Certiee -- • POIi jNumber._ 6f/(COOL/5—t/ _(Thissect/on need not be completed if th• •ermif is • ••at one hundred dollars($100)or less.) ❑ I certify that In the pe • - n .,,i for y ich this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of alit • at I should become subject to the workers'compensation provisions of Section 3700 of the Labor Code,I shall forthwith comply with these pr. 'sio'j ' CApplicant Signature: = 1101 —Date; 7 7—/9-6O WARNING:FAILURE TO SECURE WORKER COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL RNES UP TO ONE HUNDRED THOUSAND DOLLARE($100.000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706OF THE LABOR CODE.INTEREST,AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affirm that I am,licensed unser p_. ..is• apter 9(commencing with Section 7000)of Division.3.of.the.Business and Proles���}}}',,7.'-fCode,and my license is in full force and effect.Lic,x J LCIass.p—� C — L Contractor:. ej� LDate:. - 7—/jJl�"w iiii CONSTRUCTION L!ENDING.AGENC "Skil U I V/k?r.. ❑ I hereby affirm'thatlherols'a construction lending agency for the performance of the work for which this permit Is Issued.(Sec.3097,Civil Code). Lender's Name: 5/ )‘i& .. Lender's Address: • Signature: -----t.'J/ 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.). O 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). O 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? ❑Yes 0 No (Section 25533 of the Califomia 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 a ermit 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 IJ 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). fromCoast7....._.f--a ..tAir 7 Ifa a permit av the Southelos Quality Management Californiant or othert pollution controln district agency is required for the work which is the subject of this application,have all of the disclosures prescribed by Caliia Health and Safety Code Section 42303 been made? ❑Ves 0 No 8 (if'yes",attach certificate of compliance from the appropriate air pollution control officer). I 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 i regarding Hazardous Materials and Emissions. Signature: Date: CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF -Y: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 o •nan•-s relating to building construction,and authorize representatives of the City of Costa Mesa to enter upon the above-described property for inspection purposes.I a• ee n• to occupy or allow occupancy of any building authorized by this permit until final inspection. C CODES INSPECTIONTYPE PATE 1NTITIA6$ CODES INSPECTION TYPEQATE INTIALS 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 2446-46 Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. TRACT NO. LOT NO. UNIT NO. i i I T r 121 98--,6/rain 'I�l e J+ r CITY OF COSTA MESA • CONSTRUCTION PERMIT ! ! u. o , t+ w C.r I ,.+ 1 u w • co co I '. .s I 1 e. .. a - 1 t r-: j'v ��.3�.7.� i I v I • 1 ✓ 1 m c i v 1 - lot c. I re . c. , ,- 1 • I,- c . ., C ^. I t I c. . I u i ,,: I t- I `r, I c+ i e : 1 1 --Project Address t�R :E., �2� Sr. I Ismo�•• _ per_. ' TYPE OF CONSTRUCTION, NI NEW'❑rADD.UTALTERAT1ot=U REPA.IRrr - T1 1I I1 Applicant's Mailing Address �13« LAKE F.- * = ' ' L I �^ I .. I I Y i `: 1 cr^. i '+ 'I L ❑ CONVERSION ❑ DEMOLISH ,❑ OTHERa _ P - m 1 I = Zona r Owner's Name -, &NJ ' 1.]E-SSEes . - ' 'Phone C� 4Efeb I T �e I ( A P• #- ' -a I 1 ' ' ` I r I i c 1 F I I 1 T I _ DESCRIPTION OF WORK/USE OF BLDG. ^• K R. Address 12 4'. • P1gC t_PIC Ate- t�jSFA �(_CA,g2 1. ' , - - I T I I " I o ! - l R+ •s ' n S' Main Bull�liri9 l 1 hn 1 i 1 U I 'Accessory Bdlldl1 a = I � I LL 1 I cps •.ter ' • _ Z Arch/Eng., PPC:Mtt - til .11 y�gagense No.' ,VAC? _ TVPE,OF PERMIT ! .❑ GRADING: U FOl1LNDATibi; Er..Sf RUCTORAL 1 i A, T Rom rta I O I I I m t I sr 1 r I 1 ,; I ¢ r g I t' I m I� O 'j9 F. h' Si �� p�(j '�❑I TENANT �❑ ELECTRICA, _ PLUMBING L-IjMECHANICAL'- C 3 I G B i o rr c rr n 'n I eg .- I O 1:5 - i » H N a5^ 1enPQRP -i 1 �(JER I t'?'-C Q I Rea I r ' I ' I`C_ 0 I I R I 1 I ' I o 1, Address' sem' � 0. - i 1p OT I ca � 1 A ' _ I I Contractors Name' t'+AiCret i Q. "b�: 'Phone�{J i•-�gs l - i I i c 1 I ' 1 C Riglit I - 1 15 I `r I m 1 171 ,$.- 12, 1 .; 11; I m 1 $ 16 1C G I 1 �l� > • PROJECT DESCRIPTION SO: FT.' ^' OCCUPANCY) - - _ - Address(,mailing) V'krp" ` �• -CAVE: T - i d ; I i 1 I n Leftl mt _ l , CO N STRU CTION,TVPE 1VALUATION$ 1 ; I $' f I I 1 I 1 1 . 1 1 v 1 na-t i z lto I 1C R City License No. I ZI 1�; ' � 1 ZONE I ^ • I Ti ' GRADING CU.YDS' I I I ACHES I ^ I pLn Ref # I I I I Peiki_g Req.�Prov-" I s0 1 a I It, Er LICENSED CONTRACTOR DECLARATION 1 I O ' I I I - I I ^ ; . t I I I I I I I I - l Pint r I _ O, 1`herebylailirm that'Ifam'Iicensed.under provisions of Ghdrter,9(commencing Remarks: I I - I I I 1 I 1 I I I I I I m I PlanninglNOtes: 1 I I i I I E 1 11 I c 1 I ,'. Ia Nh with section 7000) of Division 3 of the Business and Professions Code,and , _ m license Is In full foie a effect. I I I 1 I J 1 y ' •-z11 - . %. I I r] i I I 1 I I I I 1 I 1 I I I 1 I 1 I I I C 1 1 1 1 1 1 1 1 1 1 1 CI 1 T 1 1 • 1` $ '- L'icense =ss ' ! I PLUMBING p FEES I 1 I I 1 I IIIIIII I I " > Date C l\"-84- Signature • I I I I -- I i 1 I I ii 1 I 1 I I 1 WORKERS'COMPENSATION DECLARATION I 1 i '-- I I I I I •- I I I I I , 1111 1 I I I I I i I _ I _ I I Bar Sink Showers ' 1 ELECTRICAL FEES h Wer ersirm that I alio a certificate of consent fi salcopy of-a certificate 1 f Workers' Compensation Inzurance,j_or certifietl copy thereof (Section _ I __Se[vice. ink) ' I ' ' O _r 1 I 1-Backflow.Preventer___ I ( I I -- 'Autbmetic Washer LT.ransformer-Q-15.50.KW� �ee0.-Ike.-C, - I I I I , , 1 I I—�-- —' Policy No. I I 1 I Company 'tag IPPRM. RIOS I ' BackflowIrriation I I Sewer Ca 1 1 1 I I 1 I I I ❑ 50+ KW 5,� -- . y I I 1 I I I g 1 P I Construction Pole Sub. 1 I I 1 1 ,0Oe s 6W.Certifiedr copy is hereby furnished. • LJ Certified copy Is filed with the city Building Division. 1 I Bathtubs I I 1 I I Sewer Connection I I I i Cooking U• nit I I I ;Meter Cup td 1001amps I I Date 1 1 I Applicant i ' I ' I 1 I I 1 I i I 1 r ' Clarifiers I 1 I I Solar Collectors I 1 I I EXEM PTi 'e need M WOc completed-if tedOMh -pSATION DECLARATION I Dishvrash. I I I I I IMeler ❑over 1100 empsl I 1 (This section not-be cpm pleteBR'the'parmit'iYf prone -`- -- less): 1 ( I 1 I I 1 I I Dishwasher I I I Solar Piping! I 1 I 1`�— Dryers OGas1 ❑Electric v I 'Sub Panel I I certify that in the performance of the work for which this permit is issued, I , 1 shall/not employ any Person in any manner soles to become subject to the I Drinking Fountains I 1 Solar Tank I I I I I 1 Fant 1 1 1 1 1 1 1 Motors 0oi HP 01 R-18 I I Workers',Compensation Laws of California.! I I I I , _ Date Signature I ' I Floor Drains) I I I Swimming Pool w/Spat I• 1 F.A1U. I I I I I I I Inc.Solar;❑9415 HP ❑16.15+ I NOTICE: If,after making this declaration,you should become subject to the Workers+,with; such satlph provisions_of ilhe Labor Code, you must forthwith 1 _ FIQor-Slnkt4_4 i__.._ _Urinal I I 1 I I�— — __ ,Eixtu[es�—�_i I I �Microwa I I I comply with, such previsions or this permit ishan 5G'deemed !evoked. T 1, ' I - CONST0.UCTION;L-ENDING rlAG ENCU_ p o i (�9 .� rJ 1 t ''"- I - ' ✓ 1 ✓ ✓ ' S `[ I 1 , -'• I t I I a I Gas Service I pOdtlets 1 0. �Wate�;CldSetl i I I Device Boxes i I I I I i 9 I I / I I I hereby affirm that there li a eonstrsictioe lentling agency for the dein:amen& - - - m ' ✓ m 01 • 0 _ Pole,Li hl of the 'work for which this yyr�rrrn�11..�,5 l issued (5ecti n 3097 Clv, CJ Interceptors'tors I _Water)Heat¢t I I P ' ' I Lender's' Namc-`' .�'LE. it'UC3LRILCT SIAAlI+L�las l - • a- 1 .r I J 1 P 1 -: 1 1 n - m I •r- 1 T Outlets i 1 I 1 I I I Range I I I I I I I _ 1 Lender's Address t �l.l ''AWA SAi ttA '�-tA ` Kitchen$ink > I 1 _Wates Serv¢R 1 Y I Q I S 1 0 Switches; I I I I I I Sign I I I I I I I OWNER BUILDER DECLARATION I ' C_ 1 ' _ - - I hereby aiflrrri'that I am exempt tram the Contractor's'License Law fort the , i I Lavatories, 1 t �l i - 1 ^ I ` 1 7' I -4 1 m ii i I r Garbage Disposal ! I I 1 • Stand ing!Settions I I I I I 1 following reason (Section.7031.51 Business and.Professional CodevAny city or I - _ _ county which requires a permit'to construct,alter,Improve,demolish or,repair P 1Trap, ,j m 5 14 I - I r 1 t I -O 1 Y 1 m + I C 1 m Generator 065 KW 05.15 KW I Trash Compactor cony structure, prior to Itstisivance,alzo'requireslthe appllcanttfor-such permit - - _ _ n- I I •to file a'signed statement that he/she Is licensedlpursuant to.the provisions o1 j 't u -+ I I - C; n `to u ; 0 I- ' 1 ?the Contractor'LLlcense Law(Chapter 9(commencing with Section 7000),of: 'Roof-0rain5' 1- O I - -i I -� I I I F- I C T I C 1 I i I I I I I I I I II I .Division) 3.of the,Business and Professions Code) or that he/she-is exempt . . • n- G I 1 F _ `hero!tom,and the basis for;the alleged exemption-:Any violation-of Section I I ' I 1 rrI I n- 1, I - I rt I - L I I 1 I SIS I I n IIIIIIIIIIIIII I I /031-.5 pay, any applicant for a permit. subjects thelapplicant'eto a civil I r - - I _ t enaity oLnot more than five hundred dollars(5500).' n 1 = i - R • 1- I -r 1 ' 1 " F- I 1 O I ' I'3 ' 1 I I I I I I I I I I I I 1 I 1 LU I:'ai owner of the propertylor my'employees•with wages as their sole I -Reinspection Feer $15, + = i Issue Feet 1 T a $n• -compensation, will do the work,and the structure'isinot intended Or offered ' '- I '- 1 I I I I I <'r I I i - I I I for sale' (Section 17044, Business and Professional Code: The Contractor's ' ' • `T ' - 1 _,I 1 I 1 'MECHANICAL I I ' 1 I r- I FEES Reinappetion Fee I 1 $1,5 I ( Issue 1 I License'Law does not apply to an owner of a property who builds or improves - - ----- - - - -— ---- - - - - DEVELOPMENT SERVICES REQUIREMENTS: F I Fee; 1 $ 3 thereon; and who'does such work-hlm5C8/herself-orthrough his orlher own I ' I -& I _ 1 I I I , I I K 1 I 1 i I I 1 I , employees, provided that such-Improvements are not intended or offered for ' , Boiler --I RI Hood Ort Type I ❑ T 1 T I, sale, If,jhowever, the building:Or improvement Is sold within one year of com- I I 0800 Type I I ❑ Q O Zoning Approved By Date Canopy I vp I l 1 I I 1 1 I I I I I l I I pleliv,llhe owner will,have,the burden of proving,he/she did not build ort Im- I Duct=(indef.Ground I I I I 1 1 I - I I Building Approved By ���s Date Prove'for constrposo of sale). I , I r ' - • 0. i `/✓t/\ date ,(�� ❑ l,laslowner o/ the property,am exclusively contracting with licensed con- I Duct-Structural I I I I Ref1!igeration Syste' I I m ' I ApplltatiOn Issued By 1 9 _ I 1 I ' I I �!•I'���"/ tractors to construct the project Section 7044,Business and Professions Code: - I I The Contractor's License Law does not apply to anlowner jof ects-'property who Duct-Ventilating i • 1 1 . ❑011100,000 BTU 1❑100,000 BTI 1 I I I (SUMMARY OF FEES I I builds or Improves thereon,and'who contracts-for such projects-with-a-con-t- - - ------ . - -- . F. I I i I I I tractor sl license I ) I 1 Ezhausi System 0 Multiple❑ I System Repair/Alteration I l- I 1 BUILDINGIPERMIT I 1 • I I ( pursuant to the;Contractor's License Lava . I ov aware thatI $ ill $ OroOt o their W. kerI Compensation Insurance should De provided to me. t 1 1 I PLAN:CHECK $ 1 ;PERMIT ❑ 1 am exempt under Section B.& P.C.for this reason I Firepl/Facttlt. ICBOt# ' I I I I I I I 1 I I I I I I ISSUANCE $ I I 1 I - I _ PLUMBING $ I 1 Date 4 1 Owner I i I i Heating System& Ducting 1 1 1 1 1 1 I 1 1 PILAN ICHfl ECK 25%� $ 1 I 'ENE RGY1 P.C. $ I 1 ! -I hereby certify that i have read this-application and-state-that-the.above-J-- -- 00-100,000.BTU 0100,0008 _ -1 ' I '—I I--�--: ELECITRICAL I $ nLJ•� F ! 'GRADING $ ' 1 I information is correct. I agree to comply with all city and;county ordinances i F 1 , i 1 1 �\ and state laws relating to building construction,and hereby authorize repre- F I I 1 F 1 ' PLAN CHECK 150%, $ 1 Z. F i MICROFILM $ sentatives of this city enter pon he above-mentioned :property ;for I t I I ' 1 I , 1 1 l I I ( I ...if,‘ inspection purposes. MECHANICAL $ �� �V Signature s/l3iA JQ• , date 6-t t"S� . l TOTAL FEE $ Drivers' License or'SS 9F • Reinspection Fee $15. • Issue Fee $ 3' PLAN CHECK 25% $ CMF 0865-46,rev.4/84 white-Building:Canary-Applicant;Pink-Accounting;Goldenrod-Assessor CONSTRUCTION AND PLANNING POOL ,.SPA ♦APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. b/�/ 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 UF ER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. B.'Foundation - 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. I 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection ' 62. Backwash & Receptor-Final . 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating& Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing , 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System. 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY -. No, _ Date _ • , Applicant •to fill in all spaces except those within heavy border lines and sign all appropriate declarations. . . '•9• ' o'•.A' r CITY O-FlOSTA MESA CONSTRUCTION PERMIT. PERMIT NO. TRACT NO. LOT NO. UNIT NO. -. r C Z Project-Address 'fl E '2-22111?° ,.5COSL11 NSR ' 2-9 (?1 / 1 i �\ TYPE OF CONSTRUCTION KNEW LI ADD U ALTERATION U REPAIR P99P I I /A7/f7/. .sn Cn TL. Applicant's Mailing Address �p� pP��F\� �E C h ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone • Owner's Name AUa1..1 Li" V.,,, PhonneeCg6A DESCRIPTION OF WORK/USE OF BLDG. Ate SEW—E as-1:W - Address ate -. PP1Ct ��tc_Ix�r�A.,,�l�si�t Cel `GC^�'� _ e r gial. S Main Building: Accessory Building: �y. Milltty License No. I Psi TYPE OF PERMIT II GRADING . FOUNDA ION . STRUCTURAL E Front Z Arch/Eng. p.a�ILj 7T 0 Address �34 E V1 AZ's za5 CM w� - ❑ TENANT an.ELECTRICAL 0 PLUMBING 0 MECHANICAL Rear N p Bontractor's Name VRtt{T L. tID( Phone9.'1'4'tS1 ID-OTHER 1 PROJECT DESCRIPTION SO. FT. OCCUPANCY C Right N Vl � Address lmailing)� �S (-Ars ST 11e.- tom K G 9. 0 -CONSTRUCTION TYPE VALUATION $ _ - S Left City'License No. 313m4 RZONE GRADING CU.YDS. ACRES Ping. Ref.# Parking Req./Provided E I LICENSED CONTRACTOR DECLARATION - Op 1 hereby affirm that I am licensed under provisions of Charter 9(commencing Remarks: Planning Notes: • M with section 7000) of Division 3 of the Business and Professions Code, and T my license is in full foragtl effect. • DateLicense Class " i 1 No.. S Date 1(-ZZ 84 SignaturPLUMBING FEES WORKERS'COMPENSATION DECLARATION Bar Sink Showers ELECTRICAL I hereby affirm that I have a certificate of consent to self-insure or a certificate • •f Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink Automatic Washer Transformer ❑ 15.50 KW �- ,800, Lab. C.) ry,�s� Policy No.in-10'bs7a —3 CompanyE Fear k L✓,Q5 Backflow irrigation Sewer Ca ❑ $0+KW 9 P Construction Pole Sub. Certified copy is hereby furnished. . Certified co y 1 iI d with the city aging .Bathtubs ■ Sewer Connection ®■ Cooking Unit Meter lgsyp to 100 amps S r Date IA-2.71_a��-- Applicant .,�. �Z EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Clover 100 amps -(Thissection need not be completed If the permit is for•one hundred($100) or - mss). Dishwasher Solar Piping Dryers (]Gas ❑Electric Sub Panel • I certify that In the performance of the work for-which this permit is Issued, I shall not employ any person In any manner so as to become ubject to the Drinking Fountains Solar Tank Fan Motors❑0-1 HP 01%-B Workery Co gjns o Laws of Califoy . Date [t. /" _Signature JIJ��.0 Floor Drains Swimming Pool w/Spa' F.A.U. 09-15 HP 016-15+ 'NOTICE:If,after making this declaration,you should become bject to the Inc.Solar Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal comply with such provisions or this permit shall be deemed revoked. - • Fixtures .- Microwave _ . . CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Cla set Device Boxes • I hereby affirm that there is a construction lending agency for the performance - Pole Light • of the work for Visit this permit is issued {,Se��ioq 3p97 Civ. C.) Interceptors Water Heater Outlets Lender's Name ORP/.NG$ COAST ' S/'W s4.G� Range Lender's Address I7770 Qb4S AWE CQsr i neA _ 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 following reason (Section 7031.5 Business and Professional Code: Any city or 9 P ,Standing Sections f county which requires a permit to construct,alter,improve,demolish or repair P-Trap - Laundry Trays - Generator ❑0-5 KW ❑5.15 KW Trash Compactor my era structure, tar to Its issuance,he/, also requiresicensthe applicant for such permit I 1 to file a signed statementLnsethat hapte Is (comm pursuant to the provisions/ of Roof Drains the Contractor's ei Busi Law(Chapter 9 (commencing with Section x)of reo 3 of the basis and Professions Code) or that is exempt therefrom and the basis for the allegedderexemption. Any violation of Section - (031.5 by any applicant for a permit subjects the applicant to a civil mnalty of not more than five hundred dollars($500). . LI I, as owner of the propertystyoror 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 Reinspection Fee I $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's - MECHANICAL FEES he.Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑ sale. If, however, the building or improvement Is sold within one year of corn- Canopy Type II 0 Zoning Approved By Date pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground - Building Approved ByDate rove for the purpose of sale). Z U I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By 7 Date I I 1 tractors là 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 thatBUILDINGTPERMIT $ SMIP $ ( Exhaust System 0 Multiple 0 System Repair/Alteration proof oftheir Worker's Compensation Insurance should be provided to me. PLAN CHECK $ PERMIT 0 I am exempt under Section B.& P.C.for this reason ' Firepl/Fact.BIt. ICBG# Fire Dampers • PLUMBING $ ISSUANCE $ Date Owner Heating System& Ducting • Registers PLAN'CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above - 00-100,000 BT.0 ❑100,0008 _ ELECTRICAL $ Si (90 GRADING $ _ Information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ Z.�� MICROFILM - $ sentatives of this to enter u on he above-mentioned property for - , inspection purposes Signature - r - Date_" 2 p'7_ "l MECHANICAL $ TOTAL FEE $ I O-SO \1 z' Drivers'License or SS* Reinspection Fee I $15 • Issue Fee $ 3 PLAN CHECK 25% $ CMF 0865-46,rev.10/84 White - Building: Canary - Applicant; Pink -Accounting; Goldenrod - Assessor • - ' - CONSTRUCTION AND PLANNING - POOL _SPA • 1APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector ilj. Temporary Electrical Service or Pole 52. Pool & Equipment Location } 2. Soil Pipe-Undgrnd. 53. Steel Reinforcement , : 3.'Electi:ical Cpnduit Utility-Undrgrnd- • •-� 54. FoEms. : i '1 :4! 'Electrical Conduif-Undrgrnd. . 55. Efectrical Bonding 5. Stee)-Reinforcement, •• _ 56. Ro(gh Plumbing & Pressure Test i. :; 6. •` Electrical UFER Gr.ridr 57. APPROVAL TO COVER-GUNITE s,i .• • •7.•Footn '• 9 � ,. - 58. electrical Conduit-Undrgrnd. - 8: FOundaiion . ;;;) ' \ , 59. Gas Pipe, 0 Undrgrnd.,Test r 1 . ,. i • 9. ,Water Pipe-Undrgmti. 1 } I ' 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. 'Str•uctural Floor System '-X ` 61. 'APPROVAL TO DECK -11. Property Sewer Line & House Connection : ' . I '.'; 62. Backwash & Receptor-Final • 1.2!`Sewer Cap` - 63. Heater & Vent-Final ' 137 Roo•f,Drains ;, 64. Plumbing System - Final „S •14:•Rough Plumbing.;. i. 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.E 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 O Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro c ., 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 -4 31. Plastet Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 1/4 , !Y., '80. FOOD CERTIFICATE ISSUED 33. Final Electric % . - 49'4Notes: /P/�//'sy YJ��� a, fc ��K 34. Final Heating & Air Conditioning r((r"+ ', e � j'fy•f04420Y-14-4•7_,�l et -�_tt re../.,�•7640 35. Final Gas Pipe-Test - _'_/idei 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation . 44. Landscape Irrigation System 45. Sound -Attenuation 46. Handicap Regulations , 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co - . 51. CERTIFICATE OF OCCUPANCY - INC. _ Date , •Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. • • CITY OE.COSTA'MESA . PERMIT •NO. TRACT NO. LOT NO. � BLDG NO. ' � - ' < CONSTRUCTION PERMIT2in l/ G -lam �d�-� Zlc 3 9964 4/19/84 478.x7 TC J. h 'Project Address • ' ., / TYPE OF CONSTRUCTION bS NEW U ADD U ALTERATION REPAIR ^ • - ?C.. �Apjilicant'sMailin Address '221 �J�J�/Qw✓7QI�z/S 6- ❑ CONVERSION ❑ DEMO ISH El OT �R A'P' l�Zfo- 714/e /S Zone / py �> y 95Zy DESCRIPTION OF WORK C�J�o0 fit Z Owner's Name J t� 5"a� C, / Phon6X� ��1t + /` S Main Building: Accessory Building: Z • Address I a /Np/71v19FtJ</S N• g • TYPE OF PERMIT 4� GRADING 'N FOUNDATION - /J�Q� l �'I ,I ® STRUCTURAL T Front 2 2( re • N Arch/Eng. yC e� eek -icense NO. -/L�!_�t�, �— ❑ TENANT YZ`1 ELECTRICAL�/ttI PLUMBING �`1 MECHANICAL�� B /I Address 23 E. /'7YY Sr 205 4/ 0 OTHER / 7 K Fx. /00 F/CG A Rear jr N A. s Name Phone 95I-94SI PROJECT DESCRIPTION SQ.4T.4 n (' OCCUPANCY ' Lf-I C Right ' G Address(mailing/ 2�9�� LAKE" �RESZ -SO T CON ST CT�/yON TYPE ' VALUATION$ 7S 6 _ S _Left -377 E y 92j3U ZONE /' GRADING CU.YDS. ACRES Ping. Ref.# LE is--/ os Park.Fees $ g / U Cit License No. 3 30 S LICENSED CONTRACTOR DECLARATION Remarks: Parking Req./Provided 5- I I hereby affirm that I am licensed under provisions of Charter 9(commencing [ R with section 7000) of Division 3 of the Business and Professions Code, and AC, 2p 2 _ 3C fit. 23'T,1O/,� Use of Buildin 9' E my license Is In full force and effect. I 'J License Class �t LI nit-S-1,N 577 S Is PLUMBING I FEES Planning Notes: E Date 4-18-g1 Signature --- N Bar Sink Showers , j� r a G WORKERS'COMPENSATION DECLARATION I I HOLD rOR 3(LCI1,L REAL` 2EmENT T 'hereby affirm that I have a certificate of consent to self-insure or a certificate Backflow Preventer Service Sink S of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) Backflow Irrigation Sewer-Cap "' . ELECTRICAL - FEES I- Policy No. Company STAIE PARrt G.15. . V Certified copy is hereby furnished. ' ' 2. Bathtubs I Sewer Connection t I Automatic Washer Transformer 0 15-50 KW /` ❑ Certified copy a filed with the city gupdin Ms' n 0 50+KW Date 4-IP»8q Applicant •than" Clarifiers Solar Collectors Construction Pole Sub: EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Dishwasher , Solar Piping I' Cooking Unit I Meter Kup to 100 amps G (This section need not be completed if the permit is for,one hundred ($100)or , . less). ^ DrinkingFountains - I certify that in the performance of the work for which this permit Is Issued I' ' Solar Tank . • I Dishwasher :�. Meter Dover 100 amps / shall not employ any person In any ma r s0 as o become su lett to the Workers' pomp ns io Laws of Califo Floor Drains •, - Swimming Pool w/Spa Dryers Was ❑Electric ' Sub Panel Date `'f-1-r� Signature—ti .�`s-A- X( /—�1/ 4(/J� NOTICE:If,after making this declaration,you should lfecdme s0'bject to the Floor Sinks - Urinal - 3 Fan Motors 00-1 HP 01%-'8 3 Workers' Compensation provisions of the Labor Code, you must forthwith '—comply with such provisions-or this permit shall be deemed revoked. ' Gas Service 5 Outlets 2 Water Closet 6I F.A.U. Inc.Solar 09-15 HP 016-15+ 1 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance Interceptors I Water Heater 2- � 9 Fixtures - Microwave�i of the work foLLy�hich is er t is��5qetl IISecion 3097 Civ. C.) Lender's Name ( J•AY SAl'llw1CS,.0S I I Kitchen Sink I Water Service /� Device Boxes Pole LightLender's Address (100 AAOArl5 hi; GeSTA rI KiALavatoriesOWNER BUILDE0. DECLARATION 3 2g Ouets Range S 60 I hereby affirm that I am exempt from the Contractor's License Law for the p.Tra •following reason (Section 7031.5 Business and Professional Code: Any city or P 23 Switches Sign • II county which requires a permit to construct,alter Improve,demolish or repair - any structure, prior to its issuance, also requires the applicant for such permit Roof Drains I I ' Garbage Disposal Standing Sections ' to file a signed statement that he/she is licensed pursuant to the provisions of _ __ the Contractor's License Law(Chapter 9 (commencing with Section 7000)of I. Division 3 of the Business and Professions Code) or that he/she is exempt Generator 00-5 KW 05-15 KW 'Trash Compactor , !,i„: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 enalty of not more than five hundred dollars($500). Reinspection.Fee $25 Issue Fee $ 3 1....1 I, as owner of the property,or my employees with wages as their sole MECHANICAL • • Reinspection Fee $25 Issue Fee $ 3 compensation, will do the work,and the structure is not intended or offered FEES - - for sale'(Section 7044, Business and Professional Code: The Contractor's — PUBLIC-SERVICES REOUnIREMEfJTS: • License Law does not apply to an owner of a property who builds or improves Boiler • Hood or Type I 0 i �'1 S 7�/ /� 3^!i-ill thereon, and who does such work himself/herself or through his or her own I Canopy Type II ❑ Zoning tionApprovedApproved By V' /If.�F. / Date employees, provided that such Improvements are not intended or offered for Duct-Under Ground - 5.-1-2-7-If, however, the building or Improvement Is sold within one year of com- ,y - Application By r Date pletion, the owner will have the burden of proving he/she did not build or im- '/ prove for the purpose of sale). Duct-Structural 1 Refrigeration System Application Issued By l r <i ( Date 1//..9713-di LJ I,as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044,Business and Professions Code: Duct-Ventilating 4100,000 BTU ❑100,000 BTU '-H SUMMARY OF FEES The Contractor's License Law does not apply to an owner of property who ' - " 'BUILDING PERMIT ' $ ' 36 Z O61 SMTP $ Jam. Si builds or Improves thereon,and who contracts for such projects with a con- Exhaust System 0 Multiple 0 System Repair/Alteration tractor(s) license pursuant to the Contractor's License Law). PLAN CHECK $ �� - ,,pp/��f PERMIT • ❑ I am exempt under Section B.&P.C.for this reason I Firepl/Fact.Bit. ICBO#NRBXaI _ ',PLUMBING $ ISSUANCE $ - Date - Owner ' Heating System& Ducting . - it — PLAN CHECK $ ,'S ENERGY P.C. $ I hereby certify that I have read this application and state that the above I 4100,000 BTU al 00,000 BTU— • ELECTRICAL $ 34,4 GRADING $ - information Is correct. I agree to comply with all city and county ordinances - - / / Qy and state laws relating to building construction,and hereby authorize repre- PLAN CHECK $ O4 MICROFILM $ sentatives of this city to enter on the above-mentioned 'property for Inspection pun. g MECHANICAL $ / t76D '7 Signature Date Date1-If3- I� TOTAL FEE $ 1+/'` ��� ' Drivers' License or SS IA Reinspection Fee $25 Issue Fee $ 3 PLAN CHECK $ 3 7iC ..--- •—• CMF 0865-46 rev. 7/83 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod-Assessor - • - CO NSTRUCTION AND PLANNING POOL...SPA APPROVALS Permit# Date Inspector APPROVALS Permit Date Inspector • f• 1. Temporary. Electrical Service or Pole '- 52. Pool & Equipment Location • 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement (: 3..Electri' al,Conduit Utility-Undrgrnd. 54. Forms 4..:Electrical2Conduit-Un{irgrnd• 55. Electrical Bonding 5..Steel R•eirjforcement , 56. Rough Plumbing &-Pressure Test • -. .6.' Electical'UFER Grnd. . . / 57. APPROVAL TO COVER-GUNITE " 7: Footings �` a 1�t1.,�J g F!•1- 58. Electrical Conduit-Undrgrnd. 1 8.-Fodndation r . - 59. Gas Pipe, O Undrgrnd.,Test 9. Water Pipe-Undrgrnd.• 6(16/31.. LED 60. Backwash Lines, P-Trap, 0 Undrgrnd. 101SVuctural Floor System -_ - 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection : 62. Backwash & Receptor-Final • • 12.`Sewet,.Cap., . . - - 63. Heater & Vent-Final 13.'Roof Drains . - 64. Plumbing System - Final • 14;f Rough:Plumbing - , '. Sitl t (O1) 65. Electrical-Final • 15. Rough Electrical-Conduit66. Solar System-Final 6. Rough Electric Wiring 19914 e-(` 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 1/%,¢t Mr FIRE DEPT. REQUIREMENT 30. Rough Factory Fireplace /S/gq 447C APPROVALS Permit# x'21.' Ducts, in Structure 70. Underground Hydro 22. Ducts;Ventilating' 71. Product Piping 0 Gas 0 Oil • -c F3. Gas Pipe-Rough &'Test 72. Underground Flush , 24 Roof Framing' ,. -✓• -I 73. Undergrnd.Storage Tank U Gas 0 Oil'. 25. Roof Sheathing )/3//J/ 71 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing ' : 11/2/St S 76. Dry Standpipe 28. Lathing &Siding77. FIXED SYSTEM FINAL 29. Insulation . 78. FIRE PREV. FINAL 30. Drywall Nailing 9h4/P}•. C--,w HEALTH DEPT. REQUIREMENT 31-. Plaster Brown Coai•' )bA4�Sc oS 79. FINAL INSPECTION • •32: Electrical Power Meter-Final . 80. FOOD-CERTIFICATE ISSUED • 33. Final Electric •- J I • �lf��l( C� Notes: %0414 Pal 44. C•45 !n6p 91$ Lie 34. Final Heating & Air Conditioning t,/z4I K coG --' .. f /i(/f D-✓ 7 / 35. Final Gas Pipe-Test )0/42( , Ceti N- . �- /L„ An., ll 36. Hood or Canopy �jf�-+ (� ill 37. Final Factory Fittplace'.: , 1(/Zo,/j'[ C-&W 38. Final:Plurr}ging . flitiu . L(w 39. Water Ser-vice-Final - c1 i rft/, //./��'� • 40. Gas Service-Final , i//L • - 41. Solar Domestic-Final .' ., • 42. Backf low Preventer - - 43: Backflow Irrigation 44. .Landscape Irrigation/System 45. Sound Attenuation , • 46. Handicap Regulations, 47. FINAL STRUCTURE &.BUILDING / $AV-P5 ( I 48. Special Requirements Completed /fritir 49. Electric.Release to Edison •• 50. Gas Release to Southern California Gas Co ' - 51. CERTIFICATE OF OCCUPANCY/ q� • No. •' _ /b/3 ' Date et-i 5 J i 7/w ' • IW J,4 07.. Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. . ddd AAA PERMIT NO. - TRACT NO. LOT O. UNIT NO. - 5284 8/01 /24 Pon: '' CITY OF COSTA MESA CONST• U(CIION PERMIT •//tom m l Z� Project Address 17S /GJyv� � • &A... `� / r • [{�N LJ ADO ALTERATION U REPAIR • Applicant's Mailing Address I ' . i TYPE OF CONSTRUCTION L� Ew 2.4)(- ��� t.V1, ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone Owner's NameX �r " v a hong t•ee DESCRIPTION OF WORK/USE OF BLDG. Address • / l 0 .- 4 �Y S Main Building: Accessory Building: Arch/Eng. License No. TYPE OF PERMIT U GRADING ❑ FOUNDATION L,YSTRUCTURAL T Front 0 Address _'���7 , ••�/ice ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING U MECHANICAL B Rear N Contractor's Nam' i:4�O/"42liini WPhone "M&"fr ❑ OTHER C Right N i T, PROJECT DESCRIPTION SQ. FT. OCCUPANCY K G M Address(mailing)City LicenseNo. ,5 , CONSTRUCTION TYPE VALUATION$ S Left R W _ I 0 ZONE • GRADING CU.YDS. ACRES Ping. Ref.# parking Req./Provided E �,. LICENSED CONTRACTOR DECLARATION p - Q I I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: � 'Zr7Q Zi Planning Notes: M with section 7000) of yDivision 3 of e Business and Professions Code, aM1tl my licen a is in f I I and effect- n'fj /,, T been$ I ss ice No /Ef�'T114? S. Date �A1� signatureI (%� �• PLUMBING FEES A • WORK S'COMPENSATION DE LARATION Bar Sink Showers ELECTRICAL FEES I hereby affirm that I have a certificate of consent to self-insure or a certificate f Workers' Compensationq ^ Insurance, or a certifie copy thereof (Section Backflow Preventer Service Sink 1800, Lab- �'y` /^ryi G� ,/ y� Automatic Washer Transformer 15-50 KW Policy No. ,I'C ! ,�/o Company r lt � S- Backflow Irrigation Sewer Cap Construction Pole Sub. - 0 50+KW 8 Certified copy is hereby furnished. Cer'-1'7finycopy is filed with the city Building O.iLvlsi tJ Bathtubs Sewer Connection - Cooking Unit Meter Duro to 100 amps Date 1 f JI Applicants l l`,'Q��};,�� ,r EXEMPTION FROM WORKERS'COMPENSATION DECLARAT ON 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 DO-1 HP 01%-8 Workers' Compensation Laws of California. Date _ Signature Floor Drains Swimming Pool w/Spa F.A.U. Inc Solar 09-15 HP 016-15+ NOTICE:If,after making this declaration,you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal Fixtures comply with such provisions or this permit shall be deemed revoked- Microwave - CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes Pole Light I hereby affirm that there/s a construction lending agency for the performance - ' of the work for wFTc ,yll1 ipermit 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 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 any structure, prior to its issuance, also requires the applicant for such permit Generator 00.5 KW 05-15 KW Trash Compactor to file a signed statement that he/she Is licensed pursuant to the provisions of Roof Drains the Contractor's License Law(Chapter 9(commencing with Section 7000) of - Division 3 of the Business and Professions Code) or that he/she is exempt • 'herefrom and the basis for the alleged exemption. Any violation of Section • '031.5 by any applicant for a permit subjects the applicant to a civil -0 enalty of not more than five hundred dollars($500). I, as owner of the property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee $ 3 compensation, will do the work,and the structure is not Intended or offered - Reinspection Fee 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 Boiler Hood or Type I 0 DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such Improvements are not.intended or offered for yp Zoning Approved By Date sale- If, however, the building or improvement is sold within one year of com- Canopy Type II 0 pletlon, the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground Building Approved By Date rove for the purpose of sale). U I,t as owner the property,rojectam exclusively 7044, contracting with licensedionode- Duct-Structural Refrigeration System Application Issued By Datcr hetprs construct the project (Section Business and Professions rt Code: The s Contractor'smproLicense Law does notapplytrto an owner property who Duct-Ventilating 00.100,000 BTU 0100,000 BTU SUMMARY OF FEES builds or ls rhu fit and won cactrr's for such w) I projects with a con-tractor(s) license orker's to the a License be I ov aware that Exhaust System 0 Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $ proof oftheir Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# PLUMBING $ ISSUANCE $ Date Owner 1 Hing System&U D❑100,000 BTI,ucting PLAN CHECK 25%" $ _ - ENERGY P.C. $ I hereby certify that I have read this application and state that the above Information is correct. I agree to comp) '•lith all city and county ordinances ELECTRICAL $ GRADING $ anestate laws rely ng to building co 'r tion, and hereby authors rept PLAN CHECK 50% $ MICROFILM $ sentatives of t s city to enter r.. a above-mentioned pro rty f r y�� inspection purpo- .....0n . U 7/2/i Sy MECHANICAL $ �$� -0 Signature /L// /'(//✓`""' Date / LaC "TOTAL FEE $ Drivers' License or SS* Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ N CMF 0865-46,rev.4/84 White-Building;Canary-Applicanp Pink-Accounting;Goldenrod-Assessor CONSTRUCTION AND PLANNING POOL _ SPA APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement • 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE •- - 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation • 59. Gas Pipe, 0 Undrgrnd.,Test -9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, ❑ Undrgrnd. • 10. Structural Floor System - 61. APPROVAL TO DECK • 11. Property-Sewer Line & House Connection , 62. Backwash & Receptor-Final 12. Sewer Cap - 63. Heater & Vent-Final • • 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# • 21. Ducts, in Structure 70. Underground Hydro . 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof•Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27:Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation - 78. FIRE 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 117±4061 Get/ 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. Back flow Preventer 43. Backflow Irrigation • 44. ,Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date BN FORM 116 ` , \ BIA FORM 1486 F? 1) ki INSULATION CERTIFICATION 1 , .. . <I This is to certify that, in conformance with the current energy regulations (California Adminis- ,) 'Y trative Code, Title 25, State of California') and approved plans, insulation has been installed in ,) u � the building located at: -" • \S COSTA MESA ORANGE $); I Gd Canty 3 UNITS 4 '.f 178 E. 22 ST C.,1 C \.1 street No. (If Awll.bb) street let Nab" Tract No. 1%1) C. /i DESCRIPTION OF INSTALLATION 1 }� ` // ROOFS 1:,' LL '<, Type of Material Manufacturer Thickness__R Value**______ V 1 <¢ EXTERIOR WALLS OWENS–CORNING FIBERGLAS .\ Type of Material FIBERGLASS BATTS Manufacturer JOHNS MANVILLE Thicknns 39" R Value•'11 f (Or Trude N.ae %' CEILINGS ( BATTS: OWENS–CORNING FIBERGLAS I F . C. C: Type of Material FIBERGI ASS BATTS Manufacturer JOHNS MANVII I F Thickness 61/4" R Value**19 C 7,, (Or Tad* Name) `.lit C cf Sq. Ft Covered )/)) E I" BLOWN: el/ C � Type of Material Manufacturer Thickness No.Bags_ �j (Or ma Pb..) .C 8; ' Wt/Bag Sq. Ft Covered R Value••_ FLOORS :) ; (IType of Material Manufacturer Thickness R Value`•— C to Tee. Name) 1(p.'i• LI �, SLAB ON GRADE '17,, Manufacturer• s Thickns 's_ R Value r! Type of MaterialL Width of Insulation Inches(Orroll Mr) 9,P C \l ` FOUNDATION WALLS (if required) i, L Type of Material Manufacturer Thickness_R Value"— `� (Or Tad. Nam) 11 `1 11 REMARKS (if desired) I it ��1) ;(f ; ) ( IP; General Contractor (Builder) License Number !,-� By Title Date V 1 (l[l. Sub-Contractor (Insulation Applicator) ACCENT INSUI ATION CO. License Number 274283 ( ‘le (lora en. Y.een Etc. '(stab "SAYE" N term s etw.l lY.brbr) b )Pi)_ Pit;- Title ViCP President Date SEPT 26. 1984 t ,d \'1 ('California AdmineCaEneny Neither., Standards, declares. E%CEen free, sec. 10173 of *a Health .ad Safety Cede b Cede the State ��.% m\• ' hnti,. d., "Cempllance. Upon completion .f the Installation al Insulation. a cord al Califenie, certifying Net the IesulatIon has been iestallod In conformance with the i1 tagalnregulations m.nh e1 these re ations shall be completed and entailed by "Na rnas Maly ficate of weponry similar certification that a ly aN 1 _ \`t the Insulation eppllwnr and by the builder. Tb i. Insulation compliance sirurted MMI. motel, apartment home, bens. ll be nosed wtior otter residential I,)� card shell sed al a censpious remerre within the dwelling."1 bellbf Is habitable shell be lewd by pad, • buntline depanmeet mobs. the structure at least satisfies the minlmme energy Insulation I / (^tmaterialValue Is the neater* el the resistance of a ',Oldie.or ',Oldie. standards established pursuant he the SapM ". ` d •„. component to the poison.f hat. The resistance valve (SI of mess-type �: ItInsulations shall Set Include any Vein fee nfi.cxr. bele.) %J)- OPr . Ill Form 116 —m BUILDING NEWS, INC., 3055 Overland Ave., Los Angeles, Calif. 9O034-213)870-9871 'y )) 'a� Form 14B6-1486—a) -1 BUILDING INDUSTRY ASSOCIATION Of CALIFORNIA, INC., 1571 Beverly Blvd., Los Angeles, Calif. 90026213)625.5771 %f' �_` car' -`fi_r, w =.\,�.p M ee!- _\�er/�serlm w w w - A w wi w �w •�l d�a_` bi_ 1-_II_-- �_ _ Ii BN FORM 116 .1 BIA FORM 1486 )) • INSULATION CERTIFICATION This is to certify that, in conformance with the current energy regulations (California Adminis- i'' i trative Code, Title 25, State of California') and approved plans, insulation has been installed in N ,) the building located at: •" COSTA MESA ORANGE Y• pb Cam* 3 UNITS \', 9 1 178 E. 22 ST C SIMM Me. (If Avell.ble) abet IA Martie Tract TMC M. )) L Li DESCRIPTION OF INSTALLATION 2 — i. ROOFS ' II • Type of Material Manufacturer Thickness___R Value"— 1 U %( EXTERIOR WALL� OWENS-CORNING FIBERGLAS fl '.\ Type of Material FIBERGLASS BATTS Manufacturer JOHNS MANVILLE Thickness fl' R Value* 11 ..) ( (Or Trod. Kean) l' CEILINGS �' F �( BATTS: OWENS-CORNING FIBERGLAS t. •V' Type of Material FIBFRGLASS BATTS Manufacturer JOHNS MANVII I F Thicknnct 641" R Value••_19— = IC (r,� (Or Trade Ne..) NitCf Sq. Ft Covered— /';) F BLOWN: d Type of Material Manufacturer Thickness No.Bags-- �` i� .. (or bade bp) :) ' Wt/Bag _ Sq. Ft. Covered R Value**_____ FLOORS 1). s li Type of Material Manufacturer Thickness___R Value••_ \.; 's (Or Trade Mara) L SLAB ON GRADE IV Type of Material Manufacturer Thickness_R Value**____ L t (Or Trade Mar) \ !! L . Width of Insulation Inches P'- L ®�1 FOUNDATION WALLS (If required) b\� L Type of Material Manufacturer Thickn�ct R Value"__ t (Or Trade Mari if 'i Pi 1) ' k``,i REMARKS (If desired) �) I Oi; General Contractor (Builder) license Number ' :1 .� 'i. iid ram e Dab I;1 rt` Sub-Contractor (Insulation Applicator) ACCENT INSUI ATION CO. license Number 274283 i '� Myr ae, Wean Etc. .(fade "MC M ase a Omani C1rba� `\}�. r.Ds. • Title Vice President Date SFPT 26. 1984 ' 1 ' (•Callfr,lo Adminl,,Mly. Cod., EnMY Unitarian Standards, declares, EXCEafn fern Se,. 0875 N Ole 141M aad1' fa111h Code N the Stahl /. ' •.tit lac ft . Uwe completion d ..r Iestaled In co Insulation, a card al California raulrem Mal M.... r vn dem Mho' co pIn conted an •. witut. it thea lthm.11 N Mem rr endHe,. .hall be . las Ins and e,ompli bye "Na certificated arrancy r ole filar ,codification theta rely ,am. �l)1r I. \w IM Ins be aapllcbr end nby, Os bond.. Th.. Imolat. compliance tanned Mwl, motel, owrtee,t house, beer or erne miduWol t� I. mrd shall be nerd et • sempinsa• locale, within rim dolling.") deelli Is habitable shall be Issued by sed, o building department �)' �� t Value b the measure N the resistance d a raMbl et betidinge,bu ab shorten at Mast satisfies Se ebleu 11•10017 Insolation Ii l" pe srnd00ds established anent M MIs does..' I ` . component is Me 1,012000 el heel. TM resistance valve R) e. ros.tyw ) Inselmisns shell net triode any solve fou reflective facing.) I )} "'If/illForm 116 —m BUILDING NEWS, INC., 3055 Overland Ave., Los Angeles, Calif. 90034---(2131870-9871 v11tt - Form 1486—c BUILDING INDUSTRY ASSOCIATION OF CALIFORNIA, INC., 1571 Beverly Blvd., Los Angeles, Calif. 90026-213)625-5771 Pj!)' '1 DIX DEVELOPMENT GRADING & DRAINAGE CERTIFICATION Property Address : 178 E. 22nd Street, Costa Mesa Owner: Alan Webber Contractor: Dix Development Contractors License #372519 Grading plan drawn by Robin B. Hamers & Associates , Inc. (approved on 6-12-84) I hereby certify that the grading and drainage at 178 E. 22nd Street complies with the approved set of grading plans. The grading plans for this site was de signed to flow the water run off at a 2% fall away from the structure, which is then picked up at a 1% fall and • split in two directions. A portion falls to Alhambra parkway drain and the remainder to the pump station which is located at the rear of the property. r* BRENT L. DIX 22865 LAKE FOREST DRIVE • LAKE FOREST, CA 92630 • (714) 951-4951 DEVELOPERS OF RESIDENTIAL/COMMERCIAL/INDUSTRIAL PROPERTIES '? t) ' CITY 0' TSTA M-eSA PAhr. FEES 8968 4/19/8+ 2644.53 • TL Q EFee Payment ReceiptlJ� N! 9 4 6 Project Address 1 ,U r 22- S ` A.P. Number 4240 — 61. 1 — I 5 Park Area Building Permit Number Owner's Name A layl W1,e r ++ n Mailing Address 22_t Z %a 4vtnc*OLiS J IAL.tn�iw�ttvt %ea.t.►� FEE: Single Family * \ Num&ir of Units JJ y 2-Bedrooms or Less _ @ $ 861.76 = 3-Bedrooms @ 1,205.67 = 4-Bedrooms @ 1,545.62 = 5-Bedrooms+ @ 1,810.50 = Multiple Family •• Bachelor or Studio @ 474.37 = 1-Bedroom @ 573.18 = 2-Bedroom — @ 881.51 = 7-1n14-4.53 • 3-Bedrooms+ @ 1,229.38 = G, ,G)�� 1 7� Total Fee '•• 2(oLt4,,53 Planning Department Appltlyal Date , ��1a a'y By ! \ V S//J,r Applicant's Signature �Ir�IC'-4,1, ^j��,�J�' • City Ordinance 72-44 •• City Ordinance 72.45 ••• City Resolution 78-116 CMF 0174-32 Rev.6/79 White—PiiCU�S�. r nning;Canary—Planning;Pink—Finance;Goldenrod—Applicant U k OWNER WATSON, GEORGE DATE 9-3-58 ._ JOB ADDRESS 187—A E. 21st Street BUILDING PERMIT NO. 733b • 11 OEZAILSCONTRACTOR Arhiitage Builders VALUE $ 9,453.00 P. levo. 1 LOT TRACT FIRE ZONE DESCRIPTION OF WORK Sin. Fam. Dwell. & Att. Gat GR^UP I & J TYPE V ZONE R1, PLAN NO. IN.,:ECTIONS DATE SUBCONTRACTOR PERMITS ISSUED DATE NUMBER Trenches cors Steel Floor Syst m Steel Reinforce Chimney Re-Rod Bond Beam ,/gta —.23: .Frame and Flashing £'i6Lathing, In Out Plaster, brown coat Underground soil S W/G Pipe Tesyy}LS' l0 Li—sr Top Out te'8'3t _ - Furnace Oh' /p-.t-V$' - Gas Vents i Rough Plumbing /147/-c'8-2./^n/1--kfl/A,'.S - 9-3--set /4/66c Cesspool Septic Tank Prop. Swr. Line House Con.'- St. Swr. /3 —/.- S r /$' <f/7 Sprinkling System D Heating Finalk /2...2i.-4"Q P' bing Fixtures, Final 11 A. 6'/ 12-29 4t F 1Gas Test 14-4:41.4 m n ER' I Construction Pole T/ Underground Power /,1 .) •Rough Wiring //h4 ft Vi?./3. foss to-. '- sa 7277 d i� Fixtures, Final Z p7 h -24-1V � OCCUPANCY L nnW -7 /O1/'‘ Form 210-5M—I-57 '�' 7g1A VI / r •• �, s Applicant to-fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY QF CdSTA'MESA -, S ' - •• PERMIT NO. , TRACT NO. LOT NO. BLgG.NO. • ,• CONSTSJCTIO_NP�RNI1a /rte /i G — 8e 2( ��[J . p * Project Address NI* AtrI fS '4' TYPE OF CONSTRUCTION NEW U ADO U ALTERATION REPAIR 8963 4/I9/meq 417.+e;/ Tl Applicant's Mailing ddra55 2. W = Q -., ' sto e_• U CONVERSION ❑ DEMOLI$-1 0 OTHER A.P.# //��V/_/4/ AZone D2. ��/' • DESCRIPTION OF WORK r;V 9 CZ.i� 7• W /l v Owner's Namem - 4" dc • - ' PhonMet,ISZ �jT .-�7 a r�,y S Main Building: - - Accessory Building: _ _ Z `\ ''Address Z2( fNyp/J>dr2CI$ •• MS. TYPE OF PERMIT LYGRADING 11L4 FOUNDATION Ud STRUCTURAL E Front A /�,. J>...... . 0 ' - . Arch/Eng. 4-",plrBLOC° License No. "Llv7T ?T/�tG N /� ❑ TENANT ® ELECTRICAL ® PLUMBI MECHANICAL B I Ad ss n4 G- l7 7'`/57- 205 C.H• ❑ OTHER - t , A Rear 3 N Cont ctor's Name Phone�J I 945/ PROJECT DESCRIPTION SQ �l�f� S e • OCCUPAN Q/ K Right S/ _ G CONST TI N TYPE VALUATION$ Tr $ Left j Address(mailing) 22865 WkE P5'(`SR. LA}'E' iaf.�7 {�yy/C /n _ l S ' E R QV 9 �� 92. ' ZONE •< GRADING CU.YDS. ACRES Pin Ref.# Park.Fees $ �• O City License No. -a.1 S:::.1- 9LE �,3 — rJ ,3 Q/{ s S� U (�•1 LICENSED CONTRACTOR DECLARATION Remarks: Parking Req./Provided Z s/Z r v • I l� I hereby affirm that I am licensed untler provisions of Charter 9 (commencing ^ �J (�Cr with section 7000) of Division 3 of the Business and Professions Code, and Y,c. 2Q3-6)3 (.L^• rcz_ �3/'suUse of Building: C'a��� E . my license is in f II force and effect. 3 / '�� / Planning Notes: M License Class • I ens- o. 7ZS I'Q PLUMBING I FEES ' Date 4 - -- Signature 1ii7 Ilk - E Bar Sink Showers •�� �..... ter nrnrttDIIP iFNTC N WORKERS'COMPENSATION DECLARATION I HOW first py yr Lint e•.•,c'•-- • T 'hereby affirm that I have a certificate of consent to self-insure or a certificate Backflow Preventer Service Sink S Workers' Compensation insurance, or a certified Copy thereof (Section. - - . ,00, Lab. C.) .- Backflow Inigation - Sewer Cap , • ELECTRICAL FEES Policy No. )Company BATF crP'R l bits, '- _ - I ! _- Certified copy is hereby furnished. _y Bathtubs I Sewer Conniption ' Automatic Washer Transformer 0 15-50 KW • Certified copy is filed with the city B,�Iltling I5i n. 0 50+KW Date 4—(2,-84 Applicant- ear,l/ ,� �y` ]7�1 Clarifiers ' • Solar Collectors Construction Pale Sub:v ' EXEMPTION FROM WORKERS'COMPENSATION DECLA 2ATION i p, , (This section need not be completed if the permit is'for one hundred ($100)or I Dishwasher Solar Piping I Cooking Unit I Meter qup to 100 amps (p lass), - '^ DrinkingFountains ., I certify that in-the performance of the work for which this permit Is Issued,-h Solar Tank Dishwasher -Meter Cover 100 amps ' shall not employ any person In any mann so as_t bec me subje t to the • Workers' ompenspptiyyn Laws of Cantor& - Floor Drains ,, Swimming Pool w/Spa I 1 Dryers Was ❑Electric 1 Sub Panel i — Date 4- Iii-AY Signature ' En NOTICE: If,after making this declaration,you should become s ject to the - Floor Sinks Urinal ' Workers' Compensation provisions of the Labor Code, you must forthwith Fan - • Motors❑0-1 HP ❑1'h-B 3 comply with such provisions or this permit shall be deemed revoked. Gas Service Outlets 2 Inc.Solar ❑g-15 HP 016-15+ / CONSTRUCTION LENDING AGENCY Water Closet - • ♦ F.A.U.'- , _ I hereby affirm that there is a construction lending agency for the performance Interceptors • I Water Heater -t Fixture3- Of the work for y(hlch this permit Is gra (Section 3097 Civ. C.) `Z Microwave �/Q ' Lender's Name f�1SPG.1 nE- CQIn6T SHVKl65 rh LOA4f - I Kitchen Sink I Water Service • — •' /4 Device Boxes Pole Light Lender's Address I-761] c AU, cos?A YFGA OWNER BUILDER DECLARATION 3 Lavatories D 2a Outlets.' -• Range " /O I hereby affirm that I am exempt from the'Contractor's License Law for the s following reason (Section 703).5 Business and Professional Code: Any city or P-Trap ]23 Switches • Sign - 1/ J ba county which requires a permit to construct,alter,improve,demolish or repair -- /Y any structure, prior to its Issuance, also requires the.applicant for such permit • -- Roof Drains' GarbageDisposalStanding Sections / • to file a signed statement that he/she is licensed me pursuant to the provisions of - the Contractor's License Law(Chapter 9 (commencing with Section 7000)of ; -- • - ' nlvision 3 of the Business and Professions Code) or that he/she is exempt _ • Generator ❑0.5 KW 05-15'KW Trash Compactor trefrom 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 Reinspection Fee _ e annalty of not more than flue hundred dollars($500). Pe I $25 Issue Fee S 3 , ❑ I, as owner of the property or my employees with wages as their sole MECHANICAL - • Reinspection Fee - $25 Issue Fee $ 3 compensation, will do the work,and the structure is not intended or offered - FEES .. - for sale (Section 7044, Business and Professional Code: The Contractor's - _ - - - PUBLIC SERVICES REQ(1IREIIQE S: License Law does not apply to an owner of a property who builds or improves Boiler Hood Or Type I 0 • - 71 S /, / •• thereon, and,who does such work himself/herself or through his or her own Zoning Approved By TV' ' //Kc- e ! ,. Date 3 f 2-i'� employees, provided that such Improvements are not intended or offered for I Canopy Type II' ❑ y /.,•Gc/,7Ly sale, If, however, the building or improvement is sold within one year,of com- Duct-Under Ground 3 y Application Approved By - - Date S7A^2?-4- pletion, the owner will have the burden of proving he/she did not build or im- eLove for the purpose of sale). Duct-Structural I Refrigeration System Application Issued By • (,¢ Ar/ Date ',���":e - LJ I,as owner of the property, am exclusively contracting with licensed con • - tractors to construct the project (Section 7044,Business and Professions Code: Duct-Ventilating 0.100,000 BTU 0100,000 BTU ^- • /.� SUMMARY OF FEES S •3Z The Contractor's License Law does not apply to an owner of property who - - builds or improves thereon,and who contracts for such projects with a con- Exhaust System 0 Multiple ❑ System Repair/Alteration _ BUILDING PERMIT $ 3 �. 00 SMTP $ _ trabtor(s) license pursuant to the Contractor's License Law). PLAN CHECK $ PERMIT 0 I am exempt under Section B.&P.C.for this reason Firepl/Fact.Bit. IC80#)y PLUMBING $ 33,0 Q ISSUANCE $ Date - Owner Heating System& Ducting PLAN CHECK• $ ^� ENERGY P.C. $ I hereby certify that I have read this application and state that the above I IRO-100,000 BTU 0100,000 BT / GRADING $ information Is correct. I agree to'comply with all city and county Ordinances , , ELECTRICAL $ and state laws relating to building construction,and hereby authorize repre- PLAN CHECK $ 1 cc; MICROFILM $ •�p G sentatives of this city to enter upon the above-mentioned property for /Oi/ 7 inspection P se Signature r y56-2`�e�T�G Date 1--IR-IM . MECHANICAL $ I�r Q'7� TOTAL FEE $ Drivers' License Or SS Reinspection Fee $25 Issue Fee $ 3 • PLAN CHECK $ 3 •/-5 CMF 0865-46 rev. 7/83 White-Building;Canary-Applicant;Pink-Accounting;Goltlenro - ssessor �_ r • . CONSTRUCTION AND PLANNING POOL ?A APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector -1;. Temporary Electrical Service or Pole 52. Pool & Equipment Location r 2: Soil Pipe-Undrgind. 0//tf j 53. Steel Reinforcement I. , 3. Electrical Conduit Utility-Undrgrnd. 54. Forms • 4.'Electrical.Condriit-Unilrgrnd. 55. Electrical Bonding . . ...?Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UE ER Grnd. _ 4.127b-t, 1---„, 57. APPROVAL TO COVER-GUNITE • • 7. Footings . - (27jg4 ,21:. 58. Electrical Conduit-Undrgrnd. 8.'Foundation 59. Gas Pipe, 0 Undrgrnd.,Test ' , 9. pater Pipe-Undrgrnd.. t/24/B`(' GCV 60. Backwash Lines, P-Trap, 0 Undrgrnd. 4 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 a(z4(2w (,V 65. Electrical-Final " ' 15. Rough Electrical-Conduit 66. Solar System-Final • . 16. Rough Electric Wiring g / exo 67. Fencing & Access Approval 17. Rough Wiring Sign ( 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar(Ceiling , 69. POOL/SPA SYSTEMS FINAL 1 19. Rough Heating & Air,Conditioning /yti4y 9��( . , FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace Vs/pr d APPROVALS Permit# . 21..Ducts, in Structure L. - 70. Underground Hydro 22 _Ducts, Ventilating' ' ' ' 71. Product Piping 0Gas 0Oil 2 Gas Pipe-Rough & Test - - 72. 'Underground Flush - . 24. Roof Framing , • 73. Undergrnd.Storage Tank 0 Gas 0Oil'. 25. Roof Sheathing 7/3)414 :hi' 74. Overhead Hydro 26. T-Bai'Ceiling (Structural) & Monocoat 75. Dry Chemical 27'. Frame and Flashing 9/L49. A.' 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29: Insulation S 78. FIRE PREV. FINAL 30. Drywall Nailing - 4/i&/B4. c r, HEALTH DEPT. REQUIREMENT 31'. Plaster Brown coat l41!Vr.,2‘)-5 79. FINAL INSPECTION . 32. Electrical Power Meter-FinalI• ),q80. FOOD CERTIFICATE ISSUED • 33. Final Electric • 0. �� Notes: 7/e, ict? C�n �� /Li,�t , b 34. Final Heating & Air Conditioning it 426,1 7/a' /��(. ce45�t/ -7` T �r9Pi a 35. Final Gas Pipe-Test /��y/// �4 rJ ^COcs r\ S� ,9 ti��c- 42R_4�� 36. Hood or Canopy _ 7./7-`116 S Jaf DR 6A-c c '21A-cc- 27� 37. Final Factory Fireplace,: it/24/42y GEO AAA Nm[Q- h&-4 m S r, CanS'S 38. Final Plumbin _3 g _ 1//1G�J'cf Gt9 .�+,-.•.-�� aF r 9 _�6 3) a 3 39. Water Service-Final- 9-/7-11i- Sri: 9 77/9-/ QlC to. LA-t�l is �S 40. Gas Service�Final //„ t�/ el - gyp` 645 NSN bal. LEO 41. Solar Domestic-Final' . 42. Backflow'Preventer 43. Backf low Irrigation • 44. Landscape Irrigation System • 45. Sound Attenuation 46. Handicap Regulations 1.47. FINAL STRUCTURE & BUILDING tAa bs epi 48. Special Requirements Completed ,/ /gc' 7D� 49. Electric Release to Edisbh "�"� 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPA/� i$ / c'Dz� No. /NO Date A City of Costa Mesa 1 ' n Development Services Department (Z.(�. W V Building Safety Division CERTIFICATE OF OCCUPANCY No. v P.O.Box 1200 Costa Mesa,California The Building located at 178 East 22nd Street B has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group RI-al Occupancy. Use of Building COIld -t111IIU Legal Description 426-061-15 (See reverse side for Metes and Bounds) .0 ilding Permit No G12803 Electrical Permit No. G12803 Plumbing Permit No. G12803 Mechanical Permit No. G12803,M14290 Number of apartments 0 and/or guest rooms 0 ISSUED TO: Building Official is % (]t-- Alan Webber by -) / C �' 221 Indianapolis, Huntington Beach, CA Date 3' I This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 lel U.B.C. CMF 1015-46 rev.1/93 White-Owner;Canary-Numerical File;Pink-Bldg.Permit File job40?O2_ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MrSA CEONSTRUC,T10 ER JIT 8 - PERMIT i,Ot 9D - •-TRACT NO. LLI AL. UNIT NO. 52E5 8/0 /a(1 Bo1'a TI Project Address 8 ff--(j2—��VLL�f /'' p IIr�1IM/)II ONS r // CKJ Applicant's Mailing Address $ ' I.r/h L TYPE OF CONSTRUCTION UJ'fJEw U ADD U ALTERATION U REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone Owner's Name _4I • / :one DESCRIPTION OF WORK/USE OF BLDG. - -- - - - --- - - - - --- - - I - - - - Address l S Main Building: Accessory Building: Arch/Eng. License No. TYPE OF PERMIT U GRADING ❑ FOUNDATION ❑f.TRUCTURAL T Front - 0 Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING CHANICAL BB Rear N 00 Contractor's Nam BUJ I s r ❑ OTHER - g Ld' P ne - a C Right N ^ i , PROJECT DESCRIPTION SO. FT. OCCUPANCY . G Address(mailing) y / 1� K Left /�� CON ST RUCTION TYPE VALUATION$ $ R City License No. 0 . tC� ZONE ' - GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Provided E - I hereby affirm that • Q am licensed under provisions of Charter 9 (commencing Remarks: • 1203 Planning Notes: M with section 7000) of Division 3 of t e Business and Profesiions Code,and T my license is in ful fo and effect. y��/J Licen - . s _ 'Al ic• I r, "' S. Gate S+ Signature TEM/ / ���I r— PLUMBING FEES - WORKERS'COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink Showers • ELECTRICAL FEES of Workers' Compensation Insurance, or a certif'ad copy thereof (Section • Backflow Preventer Service Sink 3800, Lab. q'1�,Irn .f./�/�Ip� -1',� - Automatic Washer Transformer 0 15-50.KW Vl'Ul'1Uf-71U Y'I Wit cT.t'U • 0 50+ KW Policy No. / Company Backflow Irrigation Sewer Cap - Construction Pole Sub. l • 8 Certified copy is hereby furnished. Cerci fy cfpy is filed with the city Builtlir�g�Dlvi;io '/s_ ° Bathtubs Sewer Connection Cooking Unit Meter Duo to 100 amps Date 3 Applicant COMPENSATION IT EXEMPTION FROM WORKERS'COMPENSATION DE ARATION 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 ❑1%-8 Workers' Compensation Laws of California. , • Date Signature • Floor Drains Swimming Pool w/Spa F.A.U. NOTICE:If,after making this declaration, you should become subject to the Inc.Solar 09-15 HP 016-15+ 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 Pole Light I hereby affirm that there construction lending agency for the performance g of the work for whic p' er it is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Range Lender's Name 9 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 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 any structure, prior to its issuance,also requires the applicant for such permit Generator 00-5 KW 05-15 KW Trash Compactor .any file a signed statement that he/she is licensed pursuant to the provisions of Roof Grains the Contractor's License Law (Chapter 9 (commencing with Section 7000) of . Division 3 of the Business and Professions Code) or that he/she is exempt . therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil - penalty of not more than five hundred dollars($500). OI, as owner of the property or my employees with wages as their sole Reinspection Fee $ 3 $15 Issue Fee 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: 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 0 Zoning Approved By Date pletion, the owner will have the burden of proving he/she did not build or im- Duct- Under Ground Building Approved By Date Drove for the purpose of sale). p U I, as owner of the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By 4*� Datn J 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 ❑ Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $ proof of their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# PLUMBING $ ISSUANCE $ Date Owner _ - Hea ' g System&Ducting � PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify tha I have read this application and state that the above I 100,000 BTU 0100,000 BTI. 4 1�jqrJ ELECTRICAL $ GRADING $ - information is corr= t. I agree to compl th all c y and county ordinances and state laws rd. ing to buildin: on-up c • a , hereby autho ize re re- PLAN CHECK 50% $ MICROFILM $ sentatives of th. city to enter 'fen th: abmentioned pr ert /qf Cf� j1 inspection purpo re `-t - /y�1 SS/ U 10 Signature I iiI.a Reinspection Fee $15 Issue Fee $ 3- PLAN CHECK 25% $ /I Al \ CMF 0865-46,rev.4/84 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod -Assessor ' CONSTRUCTION AND PLANNING POOL&SPA • r APPROVALS Permit,# Date ' Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location -2. Soil Pipe-Undrgrnd.- • • 53. Steel Reinforcement 3..Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd:- 55:-Electrical Bonding 5. Steel Reinforcement 56. -Rough Plumbing & Pressure Test . 6. Electrical UFER'Grnd^ 57. APPROVAL TO COVER-GUNITE ' • 7. •Footings - - 58. Electrical Conduit-Undrgrnd. , ' 8. Foundation - • - " , 59. Gas Pipe, O 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 - I 68. APPROVED FOR PLASTERING , 18: Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating &Air Conditioning FIRE DEPT. REQUIREMENT 20.. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure • • 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough & Test - • 72. Underground Flush 24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas ❑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 ii(zatiat- t.LO , 35. Final Gas Pipe-Test • - • , l , 36. Hood or Canopy [ - - . • 37. Final Factory Fireplace 38. Final Plumbing' ' 39. Water Service-Final • 40. Gas Service-Final 41. Solar Domestic-Final - 42. Backflow Preventer . ' ' 43. Backflow Irrigation _ . 44. ,Landscape Irrigation System - 45. Sound Attenuation • , , 46. Handicap Regulations _ , 47. FINAL STRUCTURE & BUILDING - I • - • 48. Special Requirements Completed - I I - •49. Electric Release to Edison - -- - - • - - - -. - • 1 50. Gas'Release,to Southern California Gas Co ' .` • 51. CERTIFICATE OF OCCUPANCY - - - No. - - `Date / / I • r BN FORM 116 - BIA FORM 1486 '� :11 4. • INSULATION CERTIFICATION f%) ( \ I c. This is to certify that, in conformance with the current energy regulations (California Adminis- i ?/ trative Code, Title 25, State of California*) and approved plans, insulation has been installed in : - the building located at: t; l I COSTA MESA ORANGE 1� ;1 rt. 0-e oboe 3 UNITS 9 1( 178 E. 22 ST \ 'n ' C :I SS bN.. (Il MOWS Send W Near Tract N.. �%lI (. DESCRIPTION OF INSTALLATION (%) i( ROOFS i t Type of Material Manufacturer Thickness_R Value**__ 'Y OWENS-CORNING FIBERGLAS \f EXTERIOR WALLFIBERGLASS BATTS JOHNS MANVILLE Type of Material Manufacturer ThieknRee 3Y2° R Value**_LL ��) ( -. (Or.Trade N.m.) (f; CEILINGS '1,1 I g.\( BATTS: OWENS-CORNING FIBERGLAS 4 Type of Material FIBERS, ASS BATTS Manufacturer JOHNS MANVII LE Thickneee 6l/t" R Valuer 19 ' /4 (Mr Tiede Ms) - }l. I 'tt;5 Sq. Ft Covered F�J ��� BLOWN: (L ; Type of Material Manufacturer Thickness_ No.Bags-_ J) T' I Wt/Bag SG. Ft Covered R Value•t_ \...) i i FLOORS I'J). ej:I: Type of Material Manufacturer Thickness R Value•— \.) I ,� (o Trade Item) r.) I SLAB ON GRADE Type of Material Manufacturer Thickness Value**._Value•• 1 f� (sir Trade Mia.) `� I Width of Insulation Inches J 1 !if I FOUNDATION WALLS (If required) ` ) '. Type of Material Murer Manufacturer Thickness R Value**_ C, I ii (`\. REMARKS (If desired) ��l) l Et 11 General Contractor (Builder) License Number 9) f ByTitle Date ., - _ i` 1 • Sub-Contractor (Insulation A C NT INSUI ATI ON CO. License Number 274283 Applicator) (mels b, Yetis, Flc.) iO (Slee 11YM Mb ro "fE" a sel On.h.d.� ''i (Ina b' ' e_ Title Vire President Date SFPT 26. 1984 ii\ (•Colllwnlo Administrative Coda, Energy Insulation Standards, d.tlaresm EXCERPT hem Sec. 111175 el the Nealth nod Safety ride el the Stale 1%)/11`( b. 'Compliance. Veen c.mit plati.n e1 f . inttelbHa. an el Insulation, a cord of Collf.rnl ortItying that IM Insolation has boon installed in conformance with des Jr I ,nqulninant. e1 these maul/diens shall be completed and sunned by "Ne O.dlRceb d *talent, sir shriller ertlflcoHae that a e..iy tan• l M. Insularism applicator and by the builder. This Insulation •tructed bbl, motel, apartment m ment heels, hew* or ether ldendal )) card shall be peered at a remplceous location within the dwelling.") drellln. Is habitable shall be missed by s . building deportment it re n ,-" sinless tstr.atp .t least seHanwarn es sib seiningwarnlaserlatiee / )' (••E Vain It the ensure M the resistance al a nimbi or building tbnda,ds established meteont te this daps.,." '•j to-pen.,? to Ma noonnoonel hoot. The resistance rale* IR) of mo✓type /�) IInsulatl.m, droll eat tentacle eny vele* ter reflective lacing.) f' ) If{J Form 116 —m BUILDING NEWS, INC., 3055 Overland Ave., Los Angeles, Calif. 90034—(213)870-9871 • v �! 1 Form 1486—m BUILDING INDUSTRY ASSOCIATION Of CALIFORNIA, INC., 1571 Beverly Blvd., Los Angeles, Calif.90026-2131625-5771 �/.)1 I. :• 1 :CS/ w - :,...V---•" b► ...'.t`4.9,-.•'7"!, .w. ,',..-r,•• ..0-!e v :e•.' ..,‘'r s'• ) 2 2 tic, _ �4 �� � Twining Laboratories f f 40 i A i o cSauF�ezn �nCi oznia, �nc. co AP AP A91. 3310 Airport Way/Malting Address P.O.Box 47/Long Beach,CA 90801 /(213)426-3355/(213)636-2386/(714)8284432 TESTING BRANCH OFFICE: 1514-13 North Susan Street/Santa Ana,CA 92703/(714)5542645 February 18, 1985 EXAM. NO.85-2206 COMPRESSION ITZTS ON GUNITE CYLINDERS Jack Hubbard 6289 Marina View Dr. Long Beach, CA 90803 PROJECT: Swim Pool ADDRESS: 2165 Canyon DR. Costa Mesa. CA ARCHITECT CONTRACTOR Mission Pools ENGINEER SUBCONTRACTOR Reagon & Kramer McBee Gunite Co. SAMPLE FROM: • Floor & bond beam, all shallow Pool. SPECIFIED MIX 4.0 to 1 STRENGTH 2,000 DATE CAST 2/11/85 SLUMP SPECIMEN SIZE 6x12 DATE TESTED 2/18/85 2/18/85 SPECIMEN NO. 1 2 COMPRESSION 7 days 7 days TOTAL LOAD, LBS. 107,000 77,250 POUNDS PER SQ.IN. 3,780 2,730 AREA, SQ.IN. 28.27 7 day average: 3,260 COMPLIANCE 7 day tests comply with speOifications. MADE BY DELIVERED BY_ RECEIVED ON SPECIMENS Morrell J. Hubbard 2/15/85 DISTRIBUTION: Z� Jack Hubbard - 3 Building Dept./Costa Mesa Bldg. Dept. bh4 • ALL REPORTS ARE SUBMITTED AS THE CONFIDENTIAL PROPERTY OF CLIENTS, AUTHORIZATION FOR PUBLICATION OF OUR REPORTS. CONCLUSIONS. OR EXTRACTS FROM OR REGARDING THEM IS RESERVED PENDING OUR WRITTEN APPROVAL AS A MUTUAL PROTECTION TO CLIENTS.THE PUBLIC AND OURSELVES. z/yfr- �C— Gunite ( P Post .ensioned Concrete ( ) REPORT OF INSPECTION ON Masonry ( ) Fireproofing ( ) Concrete ( ) Reinforcing Steel ( ) BILL TO: Address: OWNER: ceatt te- PROJECT: .v-t c, r e 'U -0,_) t� //23, 5SJ Address: a°(/4�`/ ,��yufy,� - ✓� Permit �No. 3�f4T /"/�4( Architect: (OJ Contractor: 721,7,60..J21,7,60..J.441-72 /t �cpd/ Address: Address: ev4.(,ccGL,)`ccq�(GG c Engineer: ,,,prJeat . /fi1G1i4yLEiL Subcontractor: fyL— �,R-2.+ neat, ft , 4'c- Masonry or ipeLtoc-rats �Q lack.Ata,4,6,4Z, Concrete) Inspector: Address: Mix. Used: y.D. / Vo Ads-: Admixture: Designed Strength, PSI : A COC The following inspection was performed in accardance with the approved drawings: Cu.Yds. No. of DATES Placed Cyls. Remarks .�/11/Y' N 441. g �� _,t.. :-et r7v(/LF �JYt ��v`r�e 4vn r6c. ....412 d. J Q—t M.� 6 ..7 /fnc/3' U ,�dr�' iC/ ua ni.414r/.r •enttZe l tae- ,y Copies of Reports to: (Indicate which Bldg. Dept. 6 furnish address of any not listed) D1X DEVELOPMENT GRADING & DRAINAGE CERTIFICATION Property Address : 2165 Canyon Drive, Costa Mesa Tract 12070 Owner: Alan Webber Contractor: Dix Development, Inc. Contractors License #372519 Grading plan drawn by Rbbin B. Hamers & Associates , Inc. I hereby certify that the grading and drainage at 2165 Canyon Drive complies with the approved set of grading plans. The grad- ing plans for this site was designed to flow the water runoff in the side yards and back yards at a 2% fall away from the buildings which is then picked up in a common (1% minimum fall swale) , which is then run through the curb in an Alhambra drain. The front yard water runoff is routed in a common flow line in the center of the driveway which is then run into the street gutter flow line. Brent L. Dix Dix Development , Inc. BLD/rb 22865 LAKE FOREST DRIVE • LAKE FOREST, CA 92630 • (714) 951-4951 DEVELOPERS OF RESIDENTIAL/COMMERCIAL/INDUSTRIAL PROPERTIES • ,Applicant to fill in all spaces except those within heavy border lines and sign all appropriate tleclaratlonf. —` • CITY OF-t' STA'fv1ESA - PERMIT NO. TRACT NO. LOT NO. BLDG.NO. CONSTRUCTION PERMIT in ,, � L G -� �a — y� .�j. 3 G 6962 4/19/d4 478.97 Ti. FlPrnlect Address / • A-.1 C� TYPE OF CONSTRUCTION LT'NEW U ADD U ALTERATION U REPAIR • Applicant's Mailin Address 2Z G : _.i a. • 0 CONVERSION 0 DEMOLISH,0 OTHE �ryj� A.P.q)6 Zone R AI DESCRIPTION OF WORK �ie at C ''-{-/ ��ng O�/� /� - I n Owner's Na e "I '4 N•� B�iC PhowY �� - ��lI S Main Building: Accessory Building: Z Address ��pp • -"se---" ,.. w QQ TYPE OF PERMIT ❑J^ GRADING FOUNDATIONh Imo' STRUCTURAL T Front �Q3 - 0N Arch/En /dC /C 'LO&t OA•C.EfTSLicense Na. V7 ❑ TENANT ® ELECTRICAL ® PLUM BI. Ifs` L1b MECH ANICA�`y-�,, B • G/''5.y N 9� /+ �7 !/\/' f-' Rear Addr'e55��' ,�3 �- 17TN �. �•�• ❑ -OTHER G7 S'- ��G A - Con[r>iccorsNam y L��-A'fEtiY Phone 9S(-At 1 PROJECT DESCRIPTION Sr. 'V , - OCCUPANCY Q• / K Right /5 a/� G Z-286.5 LME PC .E$(' DR f Ike � es- CONST C N TYPE -aF VALUATION$ 7S/ 9 S Left S / R EZ Address(mailing) ^� E ' 'V City License No. 31 04 92.6 ' ZONE GRADING CU.YDS. ACRES Ping. Ref.#i,�3 -/D '3 Park.Fees $ n 5/ G / LICENSED CONTRACTOR DECLARATION Remarks: Parking Req./Provided Z!52/2 . S Q !1 I 1 I hereby Ionaffirm 7 that I am licensedion under provisions of charter 9 (commencing C- ^ /9) ^^ 12�as- J R with section 7000) of Division 3 of the Business and Professions Code, and L �7-cu 1- !I-•�`• Use of Building: ( E my license is in full force and effect. .7 M License Class_$d L-Is`anseeNq.3,?SI� PLUMBING I FEES Planning Notes: E Date4 Igo signature r • y,• I Bar Sink I Showers -----. N WORKERS'COMPENSATION DECLARATION T ,,\\__ : ereby affirm that I have a certificate of consent to self4nsure or a certificate Backflow Preventer Service Sink HOLD FOR SPECIAL REQUIREMENTS S sl1'y Workers' Compensation Insurance, Or a certified copy thereof (Section _ h, 00, Lab. C. Backflow Irrigation Sewer Cap - ELECTRICAL - -• FEES Policy No. �Pt-24.44-r- company c,'t'Artc PARA 145` - �E_Certified copy is hereby furnished. - 2 Bathtubs I Sewer Connection - &' ` II- Automatic Washer Transformer 0 15-50 KW' Ll Certiile sgop ig/sled with the city y Itli iv onL_S_ Q Date 4-IPS-I''r+ Applicant_\7 .}, ,Li31 Clarifiers - Solar Collectors ' Construction Pole Sub. ❑ 50+•KW EXEMPTION.FROM WORKERS'COMPENSATION DECLARATION Dishwasher Solar PipingCookingUnit Meter up to 100 amps (This section need not be completed if the permit is for one hundred ($100) or, I j:9- _ I I P less). Drinking - Fountains I certify that In the performance of the work for which this permit is Issued,I Solar Tank I Dishwasher - Meter Dover 100 amps f - shall not employ any person In any ma so •• •nn^come�ubj¢ct to the , workers' CQ{ppg0 s;;flan Laws of Califor Floor Drains Swimming Pool vv/SpaI Dryers I�Gas ❑Electric 'I Sub Panel 6 -� Date Signature �-i - • 'I NOTICE:If,after making this declaration,you should become sub ect to the Floor Sinks Urinal 3 Fan Motors 00-1 HP ❑1'/,-8 Workers' Compensation provisions of the Labor Code, you must forthwith'-' comply with such provisions or this permit'shall be deemed revoked. Gas Service 5 Outlets 2 Water Closet (2_ I F.A.U. Inc.Solar 09-15 HP 016-15+ / _ CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance Interceptors' I Water Heater a- —12 Fixtures Microwave 07- #‘0of the work for hich this permit Is iss ed ( •ction 3097 Civ. C.) Lender's Name w, :- 1-_ ++ ' - •-. r t i Kitchen Sink I ,Water Service • - 1( Device Boxes Pole Light • Lender's Address neo PN tt.5 AVF .COSTA Lavatories •� OWNER BUILDER DECLARATION 3 6 - ZS Outlets Range 5 O I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or P-Trap - - • - Z3 Switches Sign 4 ea county which requires a permit to construct,alter improve,demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit Roof Drains 1 Garbage Disposal Standing Sections ' / to file a signed statement that he/she is licensed pursuant to the provisions of . , the Contractor's License Law(Chapter 9(commencing with Section 7000)of Generator 00-5 KW 05.15 KW Trash Compactor 3 -s ',ision 3 of the Business and Professions Code) Or that he/she is exempt 'llefrom and the basis for the alleged exemption. Any violation of Section • k11.5 by any applicant for a permit subjects the applicant to a civil $ 3 JXnalty of not more than five hundred dollars($500). Reinspection Fee . $25 Issue Fee - �❑ I, as owner of the property or my employees with wages as their sole Reinspection Fee $25 Issue Foe $ 3 compensation, will do the work,and the structure Is not intended or offered MECHANICAL FEES for sale (Section 7044, Business and Professional Code: The, Contractor's -- ----------- -' -- --- - - -- - - -- ----- -- - - PUBLIC SERVICES REQUIREMENTS: pKL 3 I1 -a License Law does not apply to an owner of a property who builds or Improves Type I 0 // y thereon, and who does such work himself/herself or through his or her own Boiler I Zoning Approved By ,(� �V, Date employees, provided that such Improvements are not intended or offered for Canopy Type II. ❑ ` �j 5,--/- y- /� g4 sale. If, however, the buildingor improvement is sold within onoyear of com- Duct- Under Ground 3 ApplicationJ p Approved By Date diction, the owner will have the burden of proving he/she did not build or Im- ��11lir grove for the purpose of sale). Duct-Structural I Refrigeration System - Application Issued By /p / Date ��' . U I. as owner of the property,am exclusively contracting with licensed con- 0.100,000 BTU ❑100,000 BTU • tractors to construct the project (Section 7044,Business and Professions Code: Duct-Ventilating SUry7�ry1qP Y OF FEES The Contractor's License Law does not apply to an owner of property who - O1,BUILDING PERMIT $ Jea SMTP $ S. 32- builds or improves thereon,and who contracts for Such projects with a con- ' Exhaust System 0 Multiple 0 System Repair/Alteration _tractor(s) license pursuant to the Contractor's License Law). PLAN CHECK $ 7 PERMIT 0 I am exempt under Section B.& P.C.for this reason I Firepl/Fact.Bit. ICBG#NRB2eI M _ PLUMBING $ 3 3,o ISSUANCE $ Date owner _ - Heating System& Ducting PLAN CHECK $ 7 S Z" ENERGY P.C. $ • I hereby certify that I have read this application and state that the above I 40.100,000 BTU 0100,000 BTL— ELECTRICAL $ 0 GRADING $ information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction,and hereby authorize repre- - S', - 40 MICROFILM $ sentatives of t city to ante up n the above-mentioned property for PLAN CHECK $ Inspection Pur s. t21..... or ,/ 0 �q Signature a, Date 4-1&-PA MECHANICAL $ TOTAL FEE $ �7t� /, Drivers' License or SS's : Reinspection Fee I '$25 Issue Fee . $ 3 PLAN CHECK $ 3. 2 a CMF 0865-46 rev. 7/83 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod -Assessor __ _ _ - _ • •CONSTRUCTION AND PLANNING POO' WA -APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector i • 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location r/ f • 2. Soil Pipe-Undrgrnd. 4/2//fyer 53. Steel Reinforcement • 3. Electrical CohduittUtility-Undrgrnd. 54. Forms 1 4. Electrical',Conduit-Undrgrnd. 55. Electrical Bonding 5' Steel Reinforcement 56. Rough Plumbing & Pressure Test 1 6/Electrical UF ER Grnd. J/' r 57. APPROVAL TO COVER-GUNITE • 7. Footings • y-,47/( `b,S 58. Electrical Conduit-Undrgrnd. . • 8.' Foundation t , 59. Gas Pipe, 0 Undrgrnd.,Test 9.•-Water Pipe-Undrgrnd. GM.In ' Up 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural•Floor System APPROVAL TO DECK y 61. 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 8424 140 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring f J&i/� ao 67. Fencing & Access Approval . 17. Rough Wiring Sign 7 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar•Ceiling 69. POOL/SPA SYSTEMS FINAL .19. Rough Heating & Air;Cpnditioning 9/70//q 1PC FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace • Si/S./'c( mc i/,roc APPROVALS Permit#, 21. Ducts, in Structure - 70. Underground Hydro 22. Ducts, Ventilating' ° 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe-Rough 8E-Test - 72. Underground Flush -• s . Roof Framing • 73. Undergrnd.Storage Tank 0 Gas 0 Oil- Y2t4 r.5. Roof Sheathing_ . •��//�ct A J 74. Overhead Hydro 26. T-Baf'Ceiling (Siructurall & Monocoat 75. Dry Chemical 27. Frani¢and Flashing 9bilk - t 76. Dry Standpipe 28. Lathing& Sidingc ' 77. FIXED SYSTEM FINAL 29. Insulation 3 78. FIRE PREY. FINAL 30. Drywall Nailing ; , 9/16/04-Lvd...- HEALTH DEPT. REQUIREMENT •31. Plaster Brown Coati,• _ ' Ip/,Z/J .3.S 79. FINAL INSPECTION 32. Electrical Power Meter-Final80. FOOD CERTIFICATE ISSUED . 33. Final Electric ( Notes: bile/ iMa# 64,6 rtio De_ fa 34. Final Heating & Air Conditioning I rWJ"1 ` fo- - - • • ' 35. Final Gas Pipe-Test 00 36. Hood or Canopy 37. Final Factory Fireplace' ti/moldy GRo 38. Final Plumbing - - I1/4O/I'1 UP 39. Water ServicCFinal •. .. • f-PV Seer 40. Gas Service'Pinal- - ��a 41. Solar Domestic-Final 42. Backflow Preventer ' • 43. Backflow Irrigation , 44. .Landscape Irrigation System . 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING - ./ 1cy�125 r, S . -iii L 48. Special Requirements Completed // ,/gS' ato • 49. Electric Release to Edison 50.'Gas Release to Southern California Gas Co 51. CERTIFICF�TE OF OCCUPANCI� ct---�/t � y No. - 70cq Date °;( `jlJflr,',ie I -4‘'- (1902— Applicant to fill in all spaces except thosewithin heavy border lines and sign all appropriate declarations. CITY OF COSTA MENC NSJTJ{{���JyUI(��ITIO PE M� PERMIT NO TRACT NO. LOT NO. UNIT NO. • • 5256 8/01 /84 Rail; . ti Project Address `�'" ' (J IMI t •0-NEW 1 /ltd. I / ,i TYPE OF CONSTRUCTION 'LJ NEW LI ADD ❑ ALTERATION U REPAIR ' Applicant's Mailing AddrP�s f/� �i� - X. Il.:..-C It w.a yl ID CONVERSION LI DEMOLISH F3 OTHER A.P.# Zone Owner's Name 1)1yn/✓�'3Ji'C�s'�1/./G .• rll • 5� ho�e�,y . DESCRIPTION OF WORK/USE OF BLDG. .Address 7J2 ?)5. I'-"" rU - • S Main Building: Accessory Building: Arch/Eng. _ License No. TYPE OF PERMIT U GRADING ❑ FOUNDATION /❑S TRUCTURAL E Front • O Address • ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING L ' ECHANICAL B Rear N Contractor's Nam /l �..i2 A, r/f•Ph.ne ❑ OTHER • C Right N CCKK�� / �� r1 �- Ci� . . PROJECT DESCRIPTION Sq. FT. -. OCCUPANCY Qo Address(mailing) G K Left • G CON STRUCTION TYPE VALUATION$ $ • City License No. �/� - ZONE GRADING CU.YDS. ACRES R ( LICENSED CONTRACTOR DECLARATION Ping. Ref.# Parking Req./Pr Ovided EQ. I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: i '; 129) OS • Planning Notes: M ' with section 7000) of Division 3 of the Business and Professions Code,and G 1 s l my license is in ful f•. • and effect. V�Li $ License a '�# s�/ [ , y�Li••:..e o. PLUMBING FEES Date ant Signature WEN I .. r_ ' i WORKERS' COMPENSATION DE LA RATION • Bar Sink Showers ELECTRICAL FEES • (---.hereby affirm that I have a certificate of consent t self-insure or a certificate • f Workers'CC)ompensation Insurance, or a certriIfi tl copy thereof (Section Backflow Preventer Service Sink • 3800, Lab.CYL lvU'lr'/ / - Automatic Washer Transformer 0 15-50 KW Policy No. M1 -J 1 Company `` WC'2 ✓' Backf low Irrigation Sewer Cap Construction Pole Sub. 0 50+KW 8 Certified copy is hereby furnished. Certifl'.e py is filed with the city Blasting Iwsio •}• (/+ Bathtubs Sewer Connection - Cooking Unit Meter Cup to 100 amps Date I� � ant Yl� - `)�/ ' EXEMPTI N FROM WORKERS'COMPENSATION CLARA ION • Clarifiers Solar Collectors I Dishwasher ,Meter Dover 100 amps s). ection 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 ❑1'h-8 Workers' Compensation Laws of California. Date Signature Floor Drains Swimming Pool w/Spa F.A.U. NOTICE:If,after making this declaration, you should become subject to the Inc.Solar 09-15 HP 016-15+ Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal comply with such 'provisions or this permit shall be deemed revoked, - Fixtures Microwave CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes I hereby affirm that the s a construction-lending agency for the performance Pole Light , of the work for wh 0f41ip permit is Issued (Section 3097 Civ. C.)' Interceptors Water Heater Outlets Range Lender's: Name Ill" Lender's Address - Kitchen Sink Water Service OWNER BUILDER DECLARATION - Switches Sign I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Garbage Disposal 'Standing Sections following reason (Section 7031.5 Business and Professional Code: Any city or • — county which requires a permit to construct,alter,improve,demolish or repair P—Trap • ❑0-5 KW❑5-15 KW Trash Compactor any era signed prior tom Its hat he/,also requires the tcapplicant for such permit p P to file a 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 hivision 3 of the Business and Professions Code) or that he/she is exempt ' „,aerefrom and the basis for the alleged exemption. Any violation of Section E`031.5 by any applicant for a permit subjects the applicant to a civil . - eenalty of not more than five hundred dollars($500). I 3 —. Lo I, as owner of the propertyrtyoror 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 1 - - Reinspection Fee $15• Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL FEES License Law does not apply to an owner of a property who builds or improves _ thereon, and who does such work himself/herself or through his or her own - - -- DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for Boiler Hood or Type I ❑ Zoning Approved By Date sale. If, however, the building or improvement is sold withinnone year of com- Canopy Type I I ❑ pletion, the owner will have the burden of proving he/she did not build or Im- Duct-Under Ground • Building Approved By Date prove for the purpose of sale). � 0 I, as owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By vi'C211445 Date 1 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 ❑ Multiple 0 System Repair/Alteration BUILDING PERMIT $ SMIP $ proof o// their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT 0 I am exempt under Section B.& P.C.for this reason Firepl/Fact.Blt. ICBG# PLUMBING $ PERMIT ISSUANCE $ Date Owner A Heating System &Ducting PLAN CHECK 25% $ - ENERGY P.C. $ I hereby certif that I have read t' -pplication and state that the above 1 ($t�00,000 BTU 0100,000 BTL 4 ELECTRICAL GRADING $ information is orrect. I agree to c. 'pi with all city and county o dinances $ and state la s relating to •uiltlin: cons uctlo fall and hereby author ze re re- PLAN CHECK 50% $ • MICROFILM $ sentatives of is C y to -�, upon'the .•,ve-menti•ned pper S'1--1 MECHANICAL Q�) inspection pu / J✓1 MECHANICAL $ TOTAL FEE $ e''t^/ SignatureJII� �I►1�L..I11... Date �,�) Drivers' Licen e or 5$3 � Reinspection Fee $15 Issue Fee $ 3 PLANCHECK 25% $ • CMF 0865-46,rev.4/84 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod -Assessor CONSTRUCTION AND PLANNING PO(. A 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. . 55.7Electrical Bonding 5. Steel.Reinforcement 56: Rough Plurbing & Pressure Test - • 6. Electrical UF ER 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 & 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 i 80. FOOD CERTIFICATE ISSUED . 33. Final Electric Notes: 34. Final Heating & Air Conditioning kit )Pt. Ca) 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 L . 42. Backflow Preventer • 43. Backflow Irrigation 44. Landscape Irrigation System ' 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING ' 48. Special Requirements Completed 49. Electric Release to Edison • - - , - - 50. Gas Release to,Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY \I No. - Date ' • Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTAMESA CONSTRUCTION PERMIT I_�PE•RMIT NO. TRACT NO. LOT NO. UNIT NO. 5844 8/07/84 15.00 TL ProjectfEl Adgress /MESA r' 22 . r Sr It 1a' A'pplicant's Mailing Address TYPE OF CONSTRUCTION NEW ❑ ADD H ALTERATION ❑ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P.# Zone Owner's Name A4`i/L) w13-044&4 _ Phone &94-W6{. DESCRIPTION OF WORK/USE OF BLDG. Address .2106 F'iitaFe« Cos fel MA 5.4 S Main Building: Accessory Building: Arch/Eng. License No. TYPE OF PERMIT ill GRADING ❑ FOUNDATION ❑ STRUCTURAL T Front - - ZO Address /l ElTENANT LIELECTRICAL ❑ PLUMBING ❑ MECHANICAL BA Rear • N C U]flGt ❑ OTHER Right Contractor's Name /A�_ n Phone PROJECT DESCRIPTION SQ. FT. OCCUPANCY C - N Address(mailing) KLeft G C ON ST RUCTION TYPE VALUATION$ S R City License No. ZONE GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION . Ping. Ref.# Parking Req,/Provided E Q I hereby affirm that I am licensed under provisions of Charter 9 (commencing Remarks: Planning Notes: M with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. • T License Class License No. S. Date Signature PLUMBING FEES ' WORKERS'COMPENSATION DECLARATION ' Bar Sink Showers ' hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES f Workers' Compensation Insurance.,or a certified copy thereof (Section , • Backflow Preventer Service Sink - 4800, Lab. C.) I Automatic Washer Transformer 10 15-50 KW - - Policy No. Company - Backflow Irrigation Sewer Cap Construction Pole Sub. 0 50+ KW 8 Certified copy Is hereby furnished. - Certified copy is filed with the city Building Division. Bathtubs • Sewer Connection Cooking Unit Meter ❑up to 100 amps Date Applicant Clarifiers Solar Collectors • Dishwasher Meter Dover 100 amps • _EXEMPTION FROM WORKERS'COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). Dishwasher Solar Piping • Dryers ❑Gas ❑Electric Sub Panel I certify that In the performance of the work for which this permit is-issued, I Shall not employ any person in any manner so as to become subject to the Drinking Fountains • Solar Tank Fan Motors 00-1 HP 01%-8 Workers' Compensation Laws of California. Date Signature Floor Drains Swimming Pool w/Spa F.A.U. - 09-15 HP 1016-15+ NOTICE:If,after making this declaration, you should become subject to the -- I - 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. rMicrowave 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 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 - .any structure, prior to Its issuance, also requires the applicant for such permit Generator 00-5 KW 05-15 KW Trash Compactor to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains ' the Contractor's License Law (Chapter 9(commencing with Section 7000)of r. Division 3 of the,Business and Professions Code) or that he/she is exempt j . - ?_-,terefrom and the basis for the alleged exemption. Any violation of Section ''-'031•.5 by any applicant for a permit subjects the applicant to a civil - 'eenalty of not more than five hundred dollars'($500). . LJ I,-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 - Reinspection Fee I $15 Issue Fee . $ 3 for sale (Section 7044, Business and professional Code: The Contractor MECHANICAL FEES - — License Law does not apply to an owner of-a property who builds or impro -s -_ _ - thereon, and who does such work himself/herself or through his or her own Boiler Hood or Type I 0 DEVELOPMENT SERVICES REQUIREMENTS: employees, provided that such improvements are not intended or offered for _ sale. If, however,the building or improvement is sold within one year of com- Canopy Type II ID - Zoning Approved By nate pletion, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By - Date rove for the purpose of sale). - � n r, ( I,as.owner of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By y Oate— f 7 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 00100,000 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 $ SMIP $ proof of' their Worker's Compensation insurance should be provided to me. PLAN CHECK $ PERMIT I: I am exempt under Section B.& P.C.for this reason Firepl/Fact.BIC ICBG# - PLUMBING $ ('6- .00 ISSUANCE $ Date Owner, - Heating System& Ducting PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify that I have read this application and state that the above all 00,000 BTU 0100,000 BTL ELECTRICAL $ GRADING $ information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- PLAN CHECK 50% $ MICROFILM $ sentatives of this city to enter upo the above-mentioned property for inspection ou�r sQs. //JJ MECHANICAL $ TOTAL FEE $ b -Ca Signature Q1,, `� caterer/2 l9)4 Drivers' License or SS# � Reinspection Fee I $15 Issue Fee $ 3 PLAN CHECK 25% $ ' CMF 0865-46,rev.4/84 White-Building;Canary-Applicant;Pink-Accounting;Goldenrod -Assessor - C*STRUCTION AND PLANNING POO. 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. Electgica`I Conduit Utility-Undrgrnd. 54. Forms • 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding e 5. Steel Reinforcement • 56. Rough Plumbing & Pressure Test 4 -6. Electrical UFER Grnd. • 57. APPROVAL TO COVER-GUNITE j,. 7.-Footings - 58. Electrical Conduit-Undrgrnd. -8.•Foundation 59. Gas Pipe, ❑ 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 */A 13. Roof-Drains 64. Plumbing System - Final 14. RougliPlumbing • 65. Electrical-Final • 15.. Rough Electrical-Conduit 66. Solar System-Final 1t. Rough Electric Wiring 67. Fencing & Access Approval 17 Rough Wiring Sign 68. APPROVED FOR PLASTERING • 18. Rough Electrical-T Bar Ceiling I 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 )ASsr- 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer • 43. Backflow Irrigation - -. - • 44. ,Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed . 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY • No. Date • .......iir'R WNW ‘ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY Orc0sTA M C NSTTRU�C�TION PERMIT - P $MIT NQ a TRACT NO. LOT NO. UNIT NO. 4979 7/27/6/4 73.92 TL pp,yyjj Project Address I �•+ er Cit • /// r • PO, 130K 3 e3(, TYPE OF CONSTRUCTION NEW LI ADD U ALTERATION L I REPAIR F7}lplicant"s Mailing Address �,sp�p �/ �.•�y�j Nal to OvSC Phone 5 4.7701 ❑ CONVERSION ❑ DEMOLISH ❑ OTHE A.P.# Zone Owner's Name DESCRIPTION OF WORK/USE OF BLDG. 6Irtyf1 SecOgit 'rani Address n��2� zI _t$3ll�tA�gs isPOL.�S Si ' .. •-,Me S`w• •z.l rl bi - • rE Ad • S Main Building: Accessory Building: Arch/Eng. ��Tj,�b'tJ b• �m+-4S LicensecesNo. -31720 TYPE OF PERMIT I♦ GRADING N FOUNDATION II STRUCTURAL T Front O Address ^•,4f f' /7" S t�f•"r/W£S s4 &,/ ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear N /� 814(4-622j-- 4�—tz. ' ❑ OTHER Contractor's Name �'R•P• •AJ,St z� /P�hone/an' o�Z C Right N Address(mailing) P'0' 00/C .3, /{•B- (7, 9ZGo.S PROJECT DESCRIPTION SQ. FT. — OCCUPANC K. • G QZ�`/ / CON STRUCTION TYPE VALUATION$ Grn.00 $ Left R City License No. .J into ZONE _ GRADING CU.YDS. ACRES LICENSED CONTRACTOR DECLARATION - Ping. Ref.# r Parking Req./Provided E D I hereby affirm 7 that I am licensedion under provisions f Cha ter 9l ns ,(commencing Remarks: Planning Notes: M with section fu I of Division 3 of the Business and fesslons Code, and my license is in fu I force and effect. t • T License Cl ss — 2- — - AI. Licen 7 '_ - S' Date Pr Signature - _-Sr-_ ♦ PLUMBING FEES A WOR KE-S'C•MPENSATION DECLARATION Bar Sink hereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES 'f Workers' Compensation, Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink - .800, Lab. C.) /1_-,e Automatic Washer - Transformer 0 15-50 KW Cl Policy No.1�'4-19Z y,_3 Company Al,QQItA S •fai Backf low Irrigation Sewer Cap Construction Pole Sub. 050+KW �V edified copy is hereby furnished. t• 1 Certified opy 's flied with the city Bu ' g Divisi Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Vt` Date 727 4. Applicant " EXEMPTIONFROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors Dishwasher Meter Dover 100 amps I (This section need not be completed if the permit is for one hundred($100) or r _-- r� less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel 1� 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 004 HP 01%-8 Workers' Compensation Laws of California. Date Signature Floor Drains Swimming Pool w/Spa F.A.U. Ino.Solar 09-15 HP 016-15+ NOTICE:If,after making this declaration,you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Urinal - Fixtures comply _with such provisions or this permit shall be deemed revoked. Microwave CONSTRUCTION LENDING AGENCY • Gas Service Outlets Water Closet Device Boxes I hereby affirm that there is a construction lending agency for the performancePole Light of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Lender's Name p Outlets Range Lender's Address - Kitchen Sink Water Service Switches OWNER BUILDER DECLARATION Sign I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories following reason (Section 7031.5 Business and Professional Code: Any city or Garbage Disposal 'Standing Sections • county which requires a permit to construct,alter,improve,demolish or repair P-Trap • any structure, prior to its issuance, also requires the applicant for such permit Generator ❑0.5 KW 05-15 KW Trash Compactor to file a signed statement that he/she Is licensed pursuant to the provisions Of Roof Drains the Contractor's License Law (Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he/she is exempt -eretrom and the basis for the alleged exemption. Any violation of Section • 131.5 by any applicant for a permit subjects the applicant to a civil eenalty of not more than five hundred dollars($500).. U I, as owner of the property or my"employees with wages as their sole Reinspection'Fee I $15 Issue Fee $ 3 compensation, will do the work,and the structure Is not intended or offered -- - Reinspection Fee $15 Issue Fee $ 3 for sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL I FEES License Law does not apply to an owner of a property who builds or Improves S thereon, and who does such work himself/herself or through his or her own Boiler Hood or Type I 0 DEVELOPMENT SERVICES REQUIREMENTS: • employees, provided that such improvements are not intended or offered for yp Zgnin Approved B sale. If, however, the building or Improvement is sold-within one year of com- Canopy Type II ❑ 9 pp y Date prove for the owner will have the burden of proving he/she did not build or im- Duct-Under Ground • Building Approved By Date rove the purpose of sale). �/ �// I, as owner of'the property, am exclusively contracting with licensed con- Duct-Structural Refrigeration System Application Issued By Date tract tractors to construct the project (Section 7044,Business and Professions Code: pp The Contractor'smproLicense Law does not tract to an owner hta who Duct- Ventilating ❑0.100,000 BTU ❑100,0.00 BTU S-- � V OF/ FEES buildseor improves thereon,and who contracts for such Iprojects with a con- �• con- tractor(s) license pursuant;to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $ s SMTP $ ©a rel proof oftheir Worker's Compensation insurance should be provided to me. PLAN CHECK $ rl7 PERMIT ❑ I am exempt under Section B.& P.C.for this reason Firepl/Fact.Bit. ICBG# PLUMBING $ ISSUANCE $ Date Owner Heating System&Ducting PLAN CHECK 25% $ ENERGY P.C. $ I hereby certify'that I have read this application and state that the above 00100,000 BTU 0100.000137 j GRADING $ information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ and state laws relating to buildin construction, and hereby authorize repre- sentatives of tri city to ent p the above-mentioned pr pert f inspection purpose . (A. MECHANICAL $ ^7 .Signature kik Date 7 �7 g TOTAL FEE $ 73 /2.. Drivers' License or SS - a CMF 0865-46,rev.4/84 white-Building; Canary-Applicant;Pink-Accounting;Goldenrod-Assessor r y : CONSTRUCTION AND PLANNING POOL PA r APPROVALS Permit Date Inspector APPROVALS Permit Date Inspector 1 ' 1. Temporary Electrical Service or Pole. 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. -- 53. Steel Reinforcement 3rElectrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. - 55. Electrical Bonding 5. Steel Reinforcement- 56. Rough Plumbing & Pressure Test • .6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7, Footings, 1 58. Electrical•Conduit-Undrgrnd. 8. Foundation . i •' ' 59. Gas Pipe, ❑ 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 & 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 /j 94if- ,e ' 39. Water Service-Final // 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer • 43. Backflow Irrigation. - 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison - ', - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY " No. Date - I Consulting Structural Engineer Z 506 Old Newport Blvd. ��J Newport Beach, CA 92669 • 714 / 645-2022 9R Y TUCKER & ASSOCIATES, INC. October 31, 1984 Building Dept City of Costa Mesa Far Drive Costa Mesa, Calif Subject: Canyon Townhornes located at 2165 Canyon Drive, Costa Mesa. To whom It may concern, After reviewing the plans and the calculations for the project noted above and a site visit of October 30, 1984, 1 find that the 2 x 12 floor joists at 16" O.C. may be used in lieu of the 2.x 12 ee 12" o.c. shown on the plans for the 4 foot overhang The deflection at the end of the joists governs and was found to be .24 (L/200) . This is , structually acceptable. If you have any questions regarding this matter please do nt hesitate to call me at 714- 645-2422. Sin rely, • T iLd Jeer . Tucker Str r ural Engineer 56•<t "</".c- ter k Consulting Structural Engln•ar • • +. Job W EJ?-/o,1 506 Old N•wporl B. (n^ Newport Both. CA 9660 • 714 / 645-2422 Dile /O- 27-el- 1 " e 9' A Y TUCKER & ASSOCIATES, INC., Engineer p..,q G/a N)'ore 7bWN/..-/o.^- ss' G/ /EG/r F_T UNOF-/L ro.KJ2 /2JA:F cern r A P= /sg7 �2s— _ /23 t3 P C-"_ --r 9 (/-3 a) r-is- = 717 b/FT ,.L M. T /o' T • (12: 6744' /JJ/ - USF 2- ax/2- .# -- • &NB- 4 • • GALL 4s- NO2 e Fi/tF_-/o[_4c./-7 • A d = /ssv(/'•-(:),44-(2) = /2_z.'v • 4/. 6 0. 4x/a CgLL • r/0 or-' 47X 2- /`SLG -fT/LicJJ = 2-A33 y "�3.$) - Zs/ /of) as/ S Sas— P.ri '-Jo n-, TAL Pn'. H02 e: F.rina N 2 7 (9/ ) 74- /4 (9) f 27 1:-) T 49 t 2-;- 376 '4/.Tr/---4 — // 47-4 / - 3 � 4 y-4 o - SAF -(7 47...)c') L S- ` \N. TU F O No. lr l Q• Snot; RPL Consulting Structural Enginsar • Job • sy_ /oS ' -a 366 Old Newport Sib to ,Newport Beach, CA 92663 • 714 1645-2422 Date /a-z,3 4 9RY TUCKER & ASSOCIATES, INC. Engineer Az_Al • • Nal • / • T G 6x/o /3 --'/rnirs /o / or St-P,oar Lr»0 /J C-ONJ/a,c-t,cO Atri.vo- .O,00EG7L1' • b/`/ /=ZifT . .. -51 c.'O /r/02 o -A. o%- CX/2_ /2(06-.0 P /904d�z3- = /sz3 # • C-c-• = 4c &) -74- Ls 74 k`/i=ri • I R� n /la //G 9 4* t // /•• T • �d = .moo. Gz87 • { ,S2-Pi'l ass a -2x/z jM CITY OF STA MESA PARK FEES Crane Fee Payment Receipt N--° - 9 51 2187 6/1 3/84 13135.69 Tl Project Address l2I LO '4 A.P. Number L2 - — u4) 34 Park Area Building Permit Number Owner's Name n 011 ludob&x' Mailing Address fl4.IQ-n FEE: Single Family * Number of Units 2-Bedrooms or Less @ $ 861.76 = 3-Bedrooms @ 1,205.67 = 4-Bedrooms @ 1,545.62 = 5-Bedrooms+ @ 1,810.50 = Multiple Family ** Bachelor or Studio @ 474.37 = 1-Bedroom (p @ 573.18 = S •Ce) 2-Bedrooms __JJ____ @ 881.51 = (367gt.0.61 3-Bedrooms+ @ 1,229.38 = I ,�,�, ,p Total Fee i.. 6,1 3 5. (.Oa Planning Department Approval Date I 1. LLA. .St By LU% ZS1^-U"--IOO Applicant's Signature ' City Ordinance 72-44 " City Ordinance 7245 '••City Resolution 78-116 ym�;;;1ccc' CMF 0174-32 Rev.6/79 white—Planning;Canary—Planning;Pink—Finance;Goldenrod—Applicant UUIJ 91JILF d LI City of Costa Mesa Development Services Department CERTIFICATE OF OCCUPANCY No. C U i U O 3 Building Safety Division P.O.Box 1200 Costa Mesa,California The Building located at 178 East 22nd Street C has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group 811 Occupancy. Use of Building Conocu<niniun Legal Description 426-061-15 (See reverse side for Metes and Bounds) Building Permit No G12805 Electrical Permit No. 612805 Plumbing Permit No. G12805 Mechanical Permit No. G12805,M14291 Number of apartments 0 and/or guest rooms 0 ISSUED TO: Building Official t --77L Alan Webber 221 Indianapolis, Huntington Beath, CA by ,!/r ! �l lipr{�i� — Date .. / Yogi/1 l I.0 j This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 lel U.B.C. CMF 1015-46 rev.1/e3 White-Owner;Canary-Numerical File;Pink -Bldg. Permit File