HomeMy WebLinkAbout2606 ELDEN AVE - Building PermitsJob Address:
2606 ELDEN AV
- - Zip: . 92627.4603, _
Status: ISSUED
Suite:
A
Applied: 11/10/2005
Vicinity:
KITCHEN AND GARAGE
2606 ELDEN AVE # A�-
Issued: 11/10/2005
Primary Occ:
R3 IType
of Construction: V -N
-
Parcel Number:
93794030
Zoning:
Applicant:
MACHADO, KATHY J
' OWNER -BUILDER
:0
Address:
2606 ELDEN AVE # A
.Phone: 949-929-4375
ISSUED BY:
SCOPE OF PERMIT
PERMIT FOR AUTO ACCIDENT REPAIR DAMAGE TO GARAGE AND KITCHEN TO UNIT A. WORK TO INCLUDE: LATH, PLASTER INSULATION,
WINDOWS, DOOR AND DRYWALL REPAIR. -
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $6,500.00
Permit: $139.25 Claim Valuation: $6,500.00
SMIPRes: $0.65
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total:' $139.90
SETBACKS , ,
MAIN STRUCTURE Front 0--0 -Rear -0-0.
ACCESSORY Front 0.0 Rear 0.0 _
PARKING 'Existing: . 0i Required: 0
COSTA MESA, CA
- - Zip: . 92627.4603, _
Owner:
MACHADO, KATHYJ��'
Address
2606 ELDEN AVE # A�-
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Phone:
COSTA MESA, CA
Zip , 92627-4603
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Contractor:
' OWNER -BUILDER
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Address:
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Zip:-
se: 000000
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- , Phone:
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- License: _
- - -• - - License:
SCOPE OF PERMIT
PERMIT FOR AUTO ACCIDENT REPAIR DAMAGE TO GARAGE AND KITCHEN TO UNIT A. WORK TO INCLUDE: LATH, PLASTER INSULATION,
WINDOWS, DOOR AND DRYWALL REPAIR. -
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $6,500.00
Permit: $139.25 Claim Valuation: $6,500.00
SMIPRes: $0.65
SMIP Com: $0.00
Other: $0.00
Inspection: $0.00
Total:' $139.90
SETBACKS , ,
MAIN STRUCTURE Front 0--0 -Rear -0-0.
ACCESSORY Front 0.0 Rear 0.0 _
PARKING 'Existing: . 0i Required: 0
NOTICE: The work authorized:by this permit= shall. comply.with allapplicable, handicap access, requirements under.Califomla 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 wlihin'7130.days, or If wozsused or abandoned
for a period of,180 days.
:INSPECTIONS: .Imorder for the work authorized under this,pernit to:be considered legal,rsuchwork,mustcompty. witle 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: 1(714),7845628
PLANNING & ZONING
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'1Right %0.0 .
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Right
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,_ Proposed. -
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NOTICE: The work authorized:by this permit= shall. comply.with allapplicable, handicap access, requirements under.Califomla 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 wlihin'7130.days, or If wozsused or abandoned
for a period of,180 days.
:INSPECTIONS: .Imorder for the work authorized under this,pernit to:be considered legal,rsuchwork,mustcompty. witle 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: 1(714),7845628
DECLARATIONS
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalty of perjury one of the following declarations:. r-
❑ 1 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. - .
❑ 1 have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which tits permit is issued.
My workers' compensation Insurance carrier and policy number are: -
Carder: Policy Number:
(This section need not be completed It the permit is valued atone hundred dopers ($100) or less.)
. 5I� �isrti that in the pedormance of the work lorwhicli this per it Is issuetl; I shall not employ any person In any manner so as to became sublect to Ilia workers'
mpensation laws of allfo�nla./ d agr a that if I should b ome su ject to the workers' compensation provisions of Sac on 3700 of the Labor Code. I shall forthwith
complyAJOEEawith
e hUfe es r e.0 Dole:�
WARNING: FAILURE TO Cl) E WORI(E ' Q ENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN WIAYER-'O'CR�AL PBNALTES AND CIVIL FINES UP TOONE HUNDRED
THOUSAND DOLLARE ($100,000), IN AD THE CAST OF ODMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION Me OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 0 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full
force and effect. Uc. N Class x
Contractor's Signature: Date:
CONSTRUCTION LENDING AGENCY:
❑ 1 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).
Londers Name: Lenders Address:
Signature: Date:
OWNER-BUILDER DECLARATIONr"�
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) o1 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
-sub' cta applicant to a civil penalty of not more than five hundred dollars ($500).),
I, es owner of the property, or my employees with wages as their sole compensa 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 app 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 Ucense 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 Ucense La s.).
❑ 1 am axe t nder c. Business and Professions Code for this reason:
� Date:
Owner lDv rift by tlriY I se. as 0N suer ,Ligecye.f+ fEXOfras�w/l/-f>i
nershi y e
Verification of Owo1 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 6, California Administrative Code).
❑ As owner-builder, I will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Masa Fire Department by every
business which has at any one time during a re rtod 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 ocuupanl need to lila a registration form for acutely hazardous materials? ❑Yes ❑ No
(Section 25533 of the California Health and Safety Code, with some exceptlons, 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 cublc feet of
compressed gas at standard temperature and pressure).
......................................................___......_.............._.._.__—ildi.............upent._.................__...................._.....................................enit..............................___._..._......__...__.........__...._._.._..._
3 Does or will the eeppplkanl or present or future building oaupant need to prepare en RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ NO
(Section 25534 of the Califomla 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.co....mplied..with'?** ❑Ves ❑No
........._.........................._._............._..._............._........_futur-_._..._____.............._....__..............._................................................................................................_............__.................__._.....__...._........_._
5 Does cur will the applicant or present or future building occupant require for the work which is the subject c this a plication a8Permit for auto constmction or modificauon
from the South Coast Air Quality Management District or from any other air pollution control distract or agency? � Yes LJ No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
........................................._.._._._............... _......................... _......
............__..........................__..................._....................................................... ......._............. _...___.._....
8 WIII any pan of the facility to be constructed under this permit be within 1000 feel from the Outer boundaries of a school? ❑ Ves ❑ No
(If'yes", the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
.................___._.......___..._..____........ _..... .................. _.............................. ........................................ _.............. — ......
_—_._....____......__
7 If a permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application, have all of the disclosures Described by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
................._ .................... erti.._._.__ "............... air �........................__........er).........................................................................................._....................._....__........_...._..__.....—__.._....
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 aggyyeee l0 omply with ell state laws and city ordinances relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
ab Cnbetl rope y or i e tion purpos . I ogre of to Occupy or allow occupancy of any building authorized b This pernylunfit final inspection.
S70-nat0re'OfCajiBrOWdai Date
And/Or Authorized Applicant Date
CODE r, INSPECTION TYPE - '"r QdIE" INITIdLS "" " -CODEI - INSPECTION TYPE - - '2AIE IllIDbl$
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pool Spa Final 208 Final Plumbing
200 Final Re-Root - 210 Final Electrical
201 Final BlocIdRetalning Well 212 Final Fire Prevention
202 Final Factory Fire Place ' m - 220 Final Planning Approval '
203 Final Sign 222 Final Site
204 Final Demolition 250 Final BuildingtOccupancy
(714) 754.5273 • -Fax (714) 754-4856 •-www.cLcosta-mesa ff ftTRICAL PERMIT T7FAIRDRIVE, COSTA MESA, CA 92626
Job Address: 2606 ELDEN AV
Suite No A
Vicinity: KITCHEN AND GARAGE
Parcel Nunmber: 93794030
Status: ISSUED
Applied: 11/10/2005
Issued: 11/10/2005
Applicant: MACHADO, KATHY J
Address: 2606 ELDEN AVE # A
Phone:, 949-929-4375 - ISSUED BY:
COSTA MESA, CA Zip 92627-4603 - -
Owner: MACHADO, KATH"Y,J /
Address 2606 ELDEN AVE # A _ _ - - •`
- Phone:
Oji \
COSTA MESA, CA ,/' �� � Zip: 92627-0603
r?.
Contractor: OWNER -BUILDER
Address: v
.. Phone:
IZip:
License 000000.
" SCOPE OF PERMIT
ELECTRICAL PERMIT FOR AUTO ACCIDENT REPAIR DAMAGE TO GARAGE AND KITCHE A. "
' REF#: B05-02031
WORK TO INCLUDE'l LIGHTING FIXTS 3 RECEPT OUTLETS AND 1 SWITCHS.
ISSUE FEE
'Temp service test "
Res. a/c package '
New Res (1-2 units)
New Res (3+units)
Pool / Spa. '
Lighting Fixts
Recept Outlets
Switches
Non Res Appl, ,A
Res Appl
Service to 200a
Service to 1000a
Service over 1000a
Motors to 1 hp
Motors tol0hp
Motors to 50hp
Motors td 100hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intended Pole
NOTICE: The'work. authorized by this -permit, shall comply with all applicable handicapaccess• requirements under -California statutes -and related
regulations: (Ord: No. 92-28,'§ 1, 1241=92)
,EXPIRATION: This:pernit shalliautomatically expire:and.become void if work Isnot commenced within 180.days, or if work Is suspended or abandoned
-for a period. of 180 days.
.INSPECTIONS' Inorder'for the-work-authorized:under,this. permit to:be oonsidered'legal, such work must compy.with all applicable es, and all
;requlred:inspectlona and final approval must be.obtained' Failure to obtaln Inspections and .final approval .will result In the expiration of- is permit.
,FOR-INSPECTIONSICALL::(714) 75456265
z"646 AM)
FEE SUMMARY
Quantity'-�_"�,.
- -
.. Quantity .
$23.50
- ---
- --- - Temp Dist System / Lighting
- $0.00
0
$0.00
^'
- - 'Busway /100 ft "- -
-' $0.00
0
$0.00
Standing Section
$0.00
0
$0.00
0
Misc Electrical Equipment
$0.00
0
$0.00
0
Transformers'up to 1, kva/kw
$0.00
0.
$0.00
0
................up to 10 kva/kw
$0.00
0 '
$1.10
1
--., ,�4.`....:..........up to 50 kva/kw
$0.00
0 '
$3.30
3
='" `. .................... up,to 100 kva/kw
$0.00
,' �0
''$1.10
- 1
:' .. .......over,1100 kva/kw
$0.00.
0
`$0 00
0 ?
_
- , Low,Voltage Equipment , ,
$0,06 j
/ 0-"",.
$0.00 `
I * � 0 tfi -
Lo"Volt Wiring System I Ck't:.
-- $0;00.
0 -
\ - 0 °'`
Misc Conduit
$060
s
-,o
- $0.00
'
_ �0 '_ >,
Misc. Conductor
$0 00,' ,%,
0-
$0.00_,
�- 0�"�
Circus (gen of ride)-•
$0.0,0-_.
- ,0 i
$0.00
6-
0 z
�� -
Circus (mech�ride or lights)"
,-$0.00 -
0
$0.00 .'
0
Christmas Tree Stand `
'$0 .00,
- 0 -
A "�
Fireworks Stand`
�� $0,00
, '0
,$6:00
�/; 0 -
- Other Electrical Fee
x$6.00. ,=
01
$0.00
0 ' -
' Investigation Fee --,A -�
/ %$0.00-
$0.00
- -0
_�, PlanCheckFee"'
x$0.00
$0.00
-0: - -
_ Reinspection F
$0.00
$0.00
0�
$0.00
0
_ _ .-i,_�.,��!�'�
- TOTAL CALCULATED FEES $29.00
$0.00
0
NOTICE: The'work. authorized by this -permit, shall comply with all applicable handicapaccess• requirements under -California statutes -and related
regulations: (Ord: No. 92-28,'§ 1, 1241=92)
,EXPIRATION: This:pernit shalliautomatically expire:and.become void if work Isnot commenced within 180.days, or if work Is suspended or abandoned
-for a period. of 180 days.
.INSPECTIONS' Inorder'for the-work-authorized:under,this. permit to:be oonsidered'legal, such work must compy.with all applicable es, and all
;requlred:inspectlona and final approval must be.obtained' Failure to obtaln Inspections and .final approval .will result In the expiration of- is permit.
,FOR-INSPECTIONSICALL::(714) 75456265
z"646 AM)
DECLARATIONS 1179
WORKERS' COMPENSATION DECLARATION: '
I hereby affirm under penally of perjury one of the following declarations: _ 1`
❑ 1 have and.will maintain a car ificate of consent to self -Insure for workers' compensaflon, as provided for by section 3700 of the Labor Coda, for the performance of the
work for which this permit Is issued. '
❑ 1 have end will maintain workers' compensation insurance, as required by section 37066f the Labor Code, for the performance of the work for which this permit is issued.
My workers' compensation Insurance carrier and policy number are: '
Carrier: _ Policy Number:
(This se need not be completed if the permit is valued of one hundred dollars ($100) or less.)
I the performance of the work for which this permit Is issued -I shall notarmploy,any -person in any manner so as to become'subject to the workers'
Compensaflon laws of Califo s, and agree that if I shout become subject to the workers' Compensation provisions of Section 3700 of the Labor Code, I shall forthwith
I6Lthese o on �I C
Spplkenl Signature: IDete:
WARNING: FNLURE TO SE RE WO OMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRI PENALTIES AND CNIL FINES UP TO ONE HUNDRED
THOl1SPND DOLIARE (5100,000), IN TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 7706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full
force and effect. Lic. a Class a
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY: '
❑ 1 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: Lenders Address:
Signature: Date:
OWNER -BUILDER DECLARATIONS:
I hereby affirm that under penalty of perjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he or she Is licensed pursuant to the provisions of the Contractors License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
BusinewAnd 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
(f-'bleCstNe applicant to a civil penalty o1 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
himgelLor 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
so�df yjj&ane 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, asy wrre�• f 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.).
w•
❑ I em exam t der, C. Bu mess and Professions Code for this reason:
Wre. :
Owner ID vis 'tied by drive lice es ❑ No .DrtveYs LI' o= — r
Verification of Ownership by (type of document, i.e. - property tax bill or deed):4 --y'-
_ �hx N
DIVISION OF INDUSTRIAL -SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certify that n excavation five (5) or more feet in depth into which a person is required to descend, will be made in connection with work authorized by this
permit, and that no building structure'; scaffolding, falsework, or demolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title B, California Administrative Code).
❑ As owner -builder, I will not employ 6riyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has e
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present or future building Occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ 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 ❑ 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 appplicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program for acutely hazardous materials)?
❑ Yes ❑ No
(Section 25534 of the California Health and Safety Code provides that the Costa Mesa Fire Department may require the preparation, certification and filing with the Fire
Department of an RMPP by businesses which are required to register acutely hazardous materials with the Fire Department.
..
........................................................................................................................................................................................................................................................................................................................................................................................
4 If an RMPP Is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No
.............__.........................._................................................_._........._..._____...................._.................__.................._..................__......................................................._.._.._..........__...............__.............._..............
5 Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication 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, Yes U No
(Section 65650.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
......_...__.........................._.._................................_.......___..._........______..............._............_._.__._._......__.._...._.........__....................................................._............._..__........_._.__.........—.._.
8 Will any pan of the facility to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
(If yes-, the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
7 If a .permit from the South Coast Air Quality Management District or other air pollution control district or agency is required for the work which is the subject of this
application, have all of the disclosures prescribed by Califomla Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
.......................................................... ...................................... _............. ............................................... _...................................................... ................................_....................................... ....__.................._.................._............_._......... _...
B (II 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: 1 certify under penalty of perjury that I have read this application and state that the information given is
correct. I JIgW to cc ,ply with all state laws and c' y ordin nces relating to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above -d Ibad pr e I for 1 ppa 1 ur{wsa agree of to occupy or allow occupancy of any building authorized by�thispermit until final inspe idnn.
7 (gnature Of Legal Owners) `�w / I—DS)e
And/Or Authorized Applicant Date
CODE 0 INSPECTION TYPE . • ' :. PATE - INTMA<5 7"" ' - COPE 0 INSPECTION TYPE gr!¢, INITTALS
1616 Fixed System Final Fire Prevention - 206 Final Mechanical
1266 Pool Spa Final 206 Final Plumbing —�/—
200 Final Re-Rdof • • 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 '
(714) 754-5273 • Fax (714) 754.4856 • www.ci:costa-mesafFN3MBING PERMIT -77 -FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 2606 ELDEN AV
Suite No A
Vicinity:
Parcel Nunmber: 93794030
Applicant: MACHADO, KATHY J -
Address: 2606 ELDEN AVE # A
Phone: 949-9294375
COSTA MESA, CAS - �)�^� Zip: 926274603 "
Contractor: OWNER -BUILDER
Address:
Status: ISSUED
Applied: 11/10/2005
Issued: 11/10/2005
ISSUED BY:
926274603
Phone:
Zip.
--License: 000000
I .
PLUMBING PERMIT GAS LINE FOR
UNIT A.
---. . ,-,.: •
_ ;
- -
Owner:
. MACHADO, KATHY J
Address "
2606 ELDEN AVE # A - -
i
Phone:
i%
COSTA MESA, CAS Zip:
�
r
Contractor: OWNER -BUILDER
Address:
Status: ISSUED
Applied: 11/10/2005
Issued: 11/10/2005
ISSUED BY:
926274603
Phone:
Zip.
--License: 000000
I .
PLUMBING PERMIT GAS LINE FOR
UNIT A.
:KMI I..
REPAIR DAMA E TO GARAGE AND KITCHEN FOR
REF#: 805.02031 .,
---. . ,-,.: •
_ ;
- -
- -,
�
r
:KMI I..
REPAIR DAMA E TO GARAGE AND KITCHEN FOR
REF#: 805.02031 .,
---. . ,-,.: •
_ ;
- -
- -,
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 .
- _-Landscapes Irrigation
-$0.00,
0,=
- Swimming Pool
$0.00
0
Backflow Preventer •
$0.00
0
- P -Trap "- --
$0.60
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 0)
- $0.00.
0
Vacuum Brkr Bkflow(14)
- $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
Dishwasher
. '$0.00
0
Sewer Cap for,Demo ,; ,. _
$0.00
0
Wash Basin Set' ,"'
1$0.001
$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
$0.00
0
Drinking Fountain
$0.00,`
2 0 'i'r'-�
„�rSink,
bar",
'$o.00.
1-:0.;.
.ice +-' ..Waley -Piping (Inst or Rep.)
$0.00
0
Expansion Tank
$0.00
0
'.' Sink, commercial
-$0.00
0
. WaterRe-pipe
: $0.00
0
Gas Earthquake Valve
-x$0.000�
v "Sink, Floor
$0.00
'0
��„Water Service, -.
$0.00
0
Gas (14 outlets) `
-.$6.15-/
"1 ��'\ 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-
::o %�
VIOLATION
$0.00
Gas Service
-$0.00
• 0.'
_
_Spa (public)
-$0:00"
--0
\ `� PLANCHECK,'/
$0.00
Interceptors (Grease, Oil)
$0.00
0;
_
REINSPECTION
$0.00
0
Interceptors (Sand Auto)
$0.00:- _
0
TOTAL'CALCULATED FEES:
$29.65
' , 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: Nof92-28, §1, 12-21=92)
°EXPIRATION: This permitshall automatically.expireand become void if work Is not commenced within 180 days, or if work is suspendedror a-' bandoned
fora period of 180 days.
INSPECTIONS: 'In.order for.the work:authodzed.under this:pennitto.be.considered legaljsuch.work-must comply with aI g plicable codes, and all
rrequlred inspections and finatapprovalmust.be.obtained. Failure to.obtain inspections and final approval will result in theexpiration of this permit.
fFOR INSPECTIONS',CALL: 1(714),754-5626
za+a+a (ter
DECLARATIONS
WORKERS' COMPENSATION DECLARATION: - •
I hereby affirm under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self-Insure for workers' compensatlon, as provided for by section 3700 of the Labor Code, for the performance of the
work for which this permit Is issued.
❑ 1 have and will maintain workOrs' compensation insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit is Issued.
My workers' compensation Insurance carrier and policy number are:
Cartier: Policy Number: '
(This
so a& not be completed if the permit is valued at one hundred dollars (8100) or less.)
..dertify at 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'
$ 7coiripensadon laws of Caflfomla, and agree that If I should bee �subje t to me workers' compensation provisions of Section 3700offtthe
•Labor Code, I shall forthwith
car! comply with thesep �� / �� are.'
Applkanf Sign jiite"t-� x�/�
WARN NG: FAILURE TO SECURE WORKERS' CQh1
c TPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMP OYER TO CRIMINAL PENALTIES AND CNIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE (5100,000), IN ADDITION IIeCOST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST. AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professlons Code. and my license is In full
force and effect. Uc. 9 Class M
Contractors Signature: Date:
CONSTRUCTION LENDING AGENCY: ,
❑ 1 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 Oflperjury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions
Code: Any city or counry,which rellihes It 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 Cade) 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
subje ts'the applicant to a civil penalty of not more than five hundred dollars ($500).):
1, 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 contractors)
Iae pursuant to the Contractors License Laws.).
�Bys�y` I,(a� axe der c. / nBusiness and Professions Code for this reason:
Sig
atur _
Owner ID verified by dm r li�v6. ❑ Yes ❑ No Dde°Istiidensa'No_
Explr�:;j
Verification of Own hi I y (type of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATIO :
❑ 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, 1 will not employ anyone to do work which would require a permit from the Division of Industrial Safety, as noted above, unless such person has a
permit to do such work from the division.
Signature: Date:
Division of Industrial Safety Permit Number,
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1 Will the applicant or present Or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ 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 2DO cubic feet of compressed gas at standard temperature and pressure).
........_........................_..._......................................................................_............................._......................__....................._.............................._._____._..._........._............_._......................._................_...........I......._......
2 Does or will tha applicant or present or future building occupant need to file a registration form for acutely hazardous materials? ❑ Yes ❑ NO
(Section 25533 of the California Health and Safety Code, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any
one time has on hand a quantity of acutely hazardous materials aquas 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 aeppplicant 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 en RMPP is presently required, has Section 25534 of the California Health and Safety Code been fully complied with? ❑ Yes ❑ No
............ __........_...._..._..._........__'__."__...................._.___...._.._._.............____...................____......._._...._.._..................... __.............. __._............. __.........
5. Does or will the applicant or present or future building occupant require for the work which is the subject of this a plication apemit for such construction or modification
from the South Coast Air Quality Management District or from any Other air pollution control district or agency? U Yes U No
(Section 65850.2 of the California Government Code requires that the requested information be furnished on applications for non-residential building permits).
...........__........................__............._....__.............................................__..............................._........................_......................._................................_._.__....................._..................................................__........................__...............
6 Will any part of the fadlity to be constructed under this permit be within 1000 feet from the outer boundaries of a school? ❑ Yes ❑ O
(11 -yes-, the facility must meet the requirement of Sections 25534 antl 42303 of the California Health and Safety Code).
...........__................_.._........._._—....._.............._........._......_..................._.._..._......_..__..............._.._...............___............_.._....._.._...................._._...............__..............___..—_.._..
7 If a permit from the South Coast Air Gualiry Management Dislnct ar other air pollution control district or agency is required for the work which is the subject of this
application, have ell of the disclosures prescribed by Califomia Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
..........._._.......................__.............._.__...........................................___..........................._._..............._................._._.................................._..._..._.._...................._............___........................._......................._.....................
6 (If yes', attach cartificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I comity 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 ordlnnces rel ting to building construction, and authorize representatives of the City of Costa Mesa to enter upon the
above-des, e/d pr�ope for InspO tion%Pure sas. I agre not to oc py or allow Occupancy of any building authorized y thiss mit until fin inspection.
,Slanature of [dgal Owner(s) Date
/An r Authorized- Rt, 1112= r<- 1
CODE 1. INSPECTION TYPE V6TF.' IiIDDAL$ -CODE INSPECTION TYPE gSTE.
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 BuildingtOccupancy
Applicant to fill In all spaces except those within heavy border lines and sign all approprlata declarations.
79SB
46. 50
CITY OF COSTA MESA r 1 _
PE RMIT N , ..
TRACT NO.
LOT NO. -,
. B
W.
.TL
:'CONSTRUCTION PERMIT' .
$�'
•
Applicent's.MeiliOg Addresa '
TYPE OF CONSTRUCTION
fvEw ADD ALTERATION' -
REPAIR
v ',' _
•- I
-
'�''tf -
❑'CONVERSION DEMOLISH ❑.OTHER
-
F
I Project Addreiss -
.❑
-
];j �jfl
SI
��y�}/'f 1_
OWner's INam6 rloWl '••"' �% BU/L�Phone •' ' g_bS_
- DESCRIPTION'OF WORK
ZONINGTi
Address 'en. -
TYPE OF PERMIT CT GRADING• FOUNDATION 11 STRUCTURAL
A. P.'O
ZONE i
Arch/Eng. License No.
❑ TENANT I]IELECTRICAL
PLUMBING ❑ MECHANICAL
'
pLNG. REF. qW'
•-BUILDING
Address' y •��' �3 - -
❑7OTHER , r
! --
TO BUILDING-
_REAR
'
PROPERTY INE
YARD (TO P/U
Contractor's Nam - hone 11
PROJECT DESCRIPTION SG. FT.'
OCCUPANCY
•�
pv"0A foil "-,IL
CONSTRVCTION TYPE
VALUATION$
(LEFT SIDE YARD
RIGHT SIDE YARD
-
V�
Address (mailing) r I,
���l2�( lZONEGRAGING
_ - I
CU. YDS. ACRFc
PKG. SPACE•REO.
PROVIDED
-
License No.
_
__
i LICENSED CONTRACTOR DECLARATIONI
Remarks: _ 6 (os
1
STREET WIDTH
= PARK FEE$
I'hereby affirm that 1 am Iicensesl under provisions of Charter 9 (commencing
-
- -
with section 7000) of Division 3 of the Business and Professions Code, and I
SPECIAL CONDITIONS:
- I
my license is In full force nd effect. ' !/�i
7
Cla 1�cansp No.
LJ C114
PLUMBING
,
OW-
�y-
Bar,Sink
Sewer Cap
ELECTRICAL
OR KERS' COfiI PENSAT ION DBFLARATION
ereby affirm that I have a certificate of consent to self -Insure or a certificate
Backflow Preventer - -
- --
Server Connection' - -
_,
Automatic Washer _
-
Meter ❑over 1 G amps
Workers' Compensation Insurance,:or a certifl co Y thereof(Sec n
- -Construction
Pole
Sub Panel
-
' 3800, Lab. C.), „
Ba&flow Irrigation
Solar_ Collectors
-
q,o
I Policy No. Company
Ii furnished.
-
z Bathtubs I
Solar Piping
_
Cooking Unit _
-
I Sub Pole
J`�. Certlfletl copy hereby
j� Certified copy Is filed with the clty,B IO g Io i
,
-
-SoWr
Dish Washer 'r-
Motors 110-1-1 HP E11%-8I'
Date . _ APPlicant �"
Clarifiers
Tank
EXEMPTION FROM WORKERS' COWIPENSATION DECLARATION
Dishwasher
Swimming Pool w/Spa
_
Dryers -'❑Gas ❑Electric
16-15+ -
Ina Solar 09-15'HP 0i6-15+-
• (This section need not be completed if the permit IS fqr One hundred ($100) or
(This
—
Fan'
.
Microwave
'
I less).. I -, i •
- 1 certify that in the performance of the work for which this permit is issued I
to become to the
1 Drinking Fountains
-
Urinal r
- -
-
F.A.U. '
s Pole
shall not'! employ any person in any manner so as subject.
workers^Compensatlon'Laws of California.!
-
Floor Drains] ,
-
Water Closet
,,"
Light
. Date - Signature
--;• Floor Sinks -' - - • - --
•
-Water-Heater— - -
-
� q
- 6�.
Fixtures
.. ....... •._
_ Range '
-
NOTICE: If. after making this declaration, you -should become subject to the
Workers" Compensation; provisions of the Labor Code,. you must. forthwith
comply with: such provisions -,or uthis
p p 'permit shall be 'deemed, revoked., �
( I Gas Service+ � Outlets _
-Water, Service
!�
Device Boxes t
I '
.Sign' �
, I
CONSTRUCTION; LENDING AGENCY I
,
'
Outlets
:Standing Sections
`
1
I hereby affirm that there Is alconstructlon lending agency for the performance
- • ! Interceptors ,
•1
-
I
' of the ]work for which: this; permit -is Issued (Section 3097 Civ. C)
-
- .
' -
i
Switches f j
,
Trash Compactor
{
Lender'si Name -' _ j -
- Kitchen'Sink _ 1 o
Lender's 'Address '- - - -
-
_
IcevatOrieS,� I
:
Garbage Disposal 1
-
'
OWNER BUILDER DECLARATION' j
I hereby atilrm that 1 am exempt from the, Con tractor's, License Law for the I
-r
_
Generator. ❑0-5 KW 0S-IS
KW
, '
1
following reason tion' 7031.5 Business and Professional Code: Any city or
P -Trap -. , , r
y-I
l
.(Sec
' county which requires a permit to construct, alter Improve, demolish olish or repair
any structure, prior to Its ISaa2nge,'8ISO requires the aDpiGnt./or such �ermit• j
.,.
RoofDrains j s' -
-
I '', I
-,
Transformer ❑ 75-50 KW
-
to file a signed statement that he/she is licensed pursuant to the.provis ons of
_
-
I ! , ❑5U+KW
I Reinspection Fee
$15
ha ConVactor•s.Llcense lawi(Chapter 9 (commencinglwlth',Sect loo- 7000) of
' Ton 3 of the Business and Professions Code)•'or that, he/she; as exempt
`- Ton
i ¢
- Showers t _
Reinspection•Fee •'
-
$15
I
1
-
Meter ❑up to 10O amps
I 'Issue Feel
s � ' $ 3
the, basis for the alleged exemption: Any, violation of Section
031(5 by any applicant fora , permlt- subjects the applicant to a' civil
penalty of not more than five hundred dollars (E500). ' • (,� 1 �- I
_
Service Slnk s I
_
` Issue Fee I
$ 3
" _ -
Zoning ApproVad By
I I - - -
DatO
El I. as;owner of the property or -my employees -with wages(as their sole
I + !
I
compensation- wllli do the work, and tne.SVugture.li not Intended or offered l
I I '. MECHANICAL
Application Approved By
Date !
I
for sale I(Sechon 7044, Business and, Professional. Cotler' The: Contractor's
License Law does not apply to an owner of a property .who builds or Improves
_ _
Boiler _' I
Refrigeration System I
I
I
Application Issued By
_
Data
thereon,land who;doesl such work himself/herSelf or through his or her own I
- '
j
employees, provided that such Improvements aretnot Intended or offered for
- t I
Duct: Under Ground
❑0-100,000 BTU ❑100,000 BTU.
:
I
Sale. If, however, the building or Improvement is Sold within one year of com- ;
{
_
SUMMARY OF FEES
pletion, the owner will have the burden of proving he/she did not build or im-
j I j
j
Duct - Structural I
System Repair/Alteration I
BUILDING PERMIT $
j SMIP
$
proveforthepurposeofsale), i
LJ 1, is owner of the property, am exclusively contract] ng'wit h; licensed con-
L
Duct_- Ventilating
PLAN CHECK. $
I {
;
PERMIT
l
i
tractors to.construct,the project.Section 7044,.Business and.Professlons Code:
License Law Res not apply to an owner of property who
-._,
�
_ _ _
I
ISSUANCE +
!
$ 1
The Contractor's
builds or Improves thereon, and who contracts for such projects with a con-
Exhaust System ❑ Multiple ❑
i
I
,PLUMBING $
tractors) license pursuant to the Contractor's License Law):
_
;
CHECK $
GRADING -�
r
$
❑ I.am exempt under Section B. 6 P. C. /or this reason
Firepl/Fact. Bit. ICBO #
)PLAN
1
$
' -
ELECTRICAL $
I
'Oner)
Heatin9' Ystem&Ductin9Date
MICROFILM
$ . j
'1 hereby'"certlfy that -'I -have -read thisapplication-andstate•tnat•the'above -
❑0-100,000 BTU ❑100,0006
-l!
- -
iPLAN CHECK' I $
' I
' `
1
informatlon is correct. I agree to comply wiin all city and county ordinances
I
MECHANICAL $
TOTA(JFEE' ,
$ i
and,state laws relating ,to building construction,' and hereby authorize repre-
sentatives oY Is! Ityi e rl upon t e above-mentioned prover y for
Inspection
Hood Oi Type I ❑
Cann T' a II ❑.
+ -
I Reinspection Feel _
$15
I
!PLAN CHECK $
+ { LESS
; ADVANCED PC
$
p { I �Jy�P
Signature
RegisteisIss,ue
Fee '/
$ 3
; I
1
I
Drivers''U fisc ISS $
{
r j
j
_ I
' FINAL'FEEI ;
$ {
-
CMF 0865-46 rev. 12/82 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
r ' - -..i--
PLANNING,
-.
:'n c-, i- POOL , .JPA
t
nCONSTRUCTIOWAND
7Dat,
D APPROVALS _` Permit-,# -
.Inspector
- `' -
� ;. Permit # -
.-Date,
la°spector
E
_
!'.,APPROVALS
Temporary Electrical Service oi`Pole, .� rJ
c , '•.;
; 52� Pool &:Egliipmeht]Loption
•
^
1 "y']C •-SIJ
Soil Pipe-Undrlq,nd.: u I - �: j -
; .71
C_ •. _-
' 53 Steel R"nfo_icement
Gr
-
•Ir`
- r
,_
- ..
3? Electr,icalConduif U'tilitv�Undr4rtid.l'[' ��
;
+'o
:_54 Forms', �_ o. ;t=.
-
";,' •v
I
_� _ _
,''
Ar' 4-. Electrical CollduitAWndrgrnd:. z . `_ _
c
i ;i `
E" 'ric1-136 Jing` - - -
nl 1 :.l
_
,.55�-
P'_:•
`'
SteeI!F einQcemli ti_-�il
1_+,_-_.._- .�
Rough Rluinbing:& Pressure, Test'
:o -•u4
•�,
n
_ r .
8. 'Elecv'cal UFER Gind.l I l
Qr
57"! APP,ROVALTO;COVER-GUNITE
;
n
7. Footings i f. 17 I �� I n 7 ,t" n;
- -j
1,: ,a I
58> Electrical:Conduit-Undrornd.
8. FouhtlIi ions I i ' -� �,'�
i c •
59. Gas Pipe,�O9Uridigrnd., Test
-�
�' ,
9. Wafer Plpe-Uridrgmd.p� ! o i; '
ry3
6p, gackwash�Lihes,�P,.Trap, O -
- -
- - t• •'
_Undrgrnd.
�-- .' '�`- r
10. Structural Floor SysteSn r,
? r
;
'° '-
APPROVAL TO DECK`--
,61.
11. Frroperty Sewer Line .& HousCnh.e,Ici.ion
62. kIwiash.&Receptor-Fn- a:
.B.a-
I
Sewer Cap
li+.12:
i
_c
63. FinafeaterVent
13f Roof!Dyains ! ; i - ,,
q I I
FJ
' ^64. Pluriibing System -Final•
1 ,
-
14. RougriPlumbing }.'I ;' 1 �� , I
i
''65. Electrical=Final'--=`
r15-Rougt Electrical=Conduit) T'�� li T
-r-F'--[
`7 �'
'66TSoiar System -Final j y
16. `Rough-Elec�riciWiring� r
I '1
+�:�
- f� --
�'�'-67.
Fencing &�Access,APProvaP--
'!'
17. jRough�Wiring
5ign�' - �+ '' ' t
j
' j I ' (
168.1 APPROVED FOR'PLASTERINGJF
-
18.;Rodgh:ElectriFFIT$anCeiling) M
,' ''`I
; i
169. POOL/SPA SYSTEMS FINAL
q 19. 0ough:Heating &IAir Conditioning:
I
'FIRE DEPT,IREQUIREMENT.
I
,1
APPROVALSI ; Permit #
' 20. jRougW..Factory Fireplace ` 'i i
i '
1
_
t , :. n , ,1 , I
21. Ducts; in Structure,
r I
,
I 1 r
I
- I
Underground Hydro
_ -
1 I I li
I
1
170.1
222. 1Ducts, Vehtilating ;. I r I I� i
i i i
j 1
71,! Product Piping O Gas 3Oil
I
I
li 23.Gas Pipe -Rough & Tesi t t .I
I
,_
'„_•,
.- -- __ -:--1---- - -- - - . . - - --
-172." Underground Flush
- -
-' - -
;
24. "Roof Framing_ 1 1 ys ,.,
,
, , :. I r
.�, • r
17:3. Undergrrid. Storage Tank �O Gas ❑Oil.
li
.I 1 r i 1 is
I ,
,
1
25,6Roof Sheathing > i '��
", i
r ' 174.i
Overhead Hydro
I I I
r26. n :Bar Ceiling `jStructuralL & Monocoaf
'- i ,: i
P ; !
75.1 Dry Chemical
1
:�
-27, ira
Fme and Flashing;
11 ! j
176.1 Dry Standpipe
28.' Lathing &Siding!
J7' FIXED SYSTEM;F.INAI_ -• .
,
I <'-
d 29.'!Insulation T - ", I p
'78! FIRE PREV. FINAL
AL
i 1; I
Nailing ! I ! 'I
I
I '
'Notes: , S
1
�4 I,31. Plaster Brown Coat i � �, � i
� I
I--- _! _I .l .i
, i
,132. tElectricalPower Meter; Final
i
l t -
7 33. Final Electric ry •
.
-'1 r_
.1- --_ •,. _
34. Finaleating&l'Air Conditioning ,
Y-
I•�
i_'.....'.-
1
Iry .I. -:I -i
35. Final Gas Pipe Test �., �" ^-i H
I (
i
"_ 'I •� �-
' �i
1'
n❑ r: m 1 q
:i �•
I i
36. Hood �o' 6Can oPK._I
I R 91
37. Final Factory Fireplace; i x =1 -
i r 1 13
1
38. Final Plumbing, I
/
39. Water tService-Fina l I 1 ! ''1
40. Gas Service -Fina+ i 1
'/21%8?
L`
1 !
A r
41. Solar Domestic -Final
42.Backflow Prreventei`
--11 •I.
'ion
43. Backflow) Ir igatio` 1 �; I,. 1
s
1 1
44. Landscape Irrigatiori'SYstem!
45. Sound ?Attenuations
46. Handicap Regulation3� (� ' 1
I Ir
iii
{ .',� : I I ;' " ,� •�'' .. - r, h �`•'
I
47. FINAL STRUCTURE & BUILDING)
486SpecialReq6irementsCompleted
I
I
I I
f II I I { M
I I
1
49. Electric ReleasetolEdisonr_�
50. Gas Release' o Southern California Gas Co
51. CERTIFICATE'OF OCCUPANCY
r
No 4 li I Date I I
est
I I
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations
CITY OF COSTA MESA !
PERMIT NO.
'TRACT NO.
LOT NO.
BL
,.
CONSTRUCTION PERMIT
ay
/�/� - /e�
-
'
9427 5%26/83,
w42 TL
I Applicants Meiling Address �c
'•TYPE OF CONSTRUCTION
EW LJ ADD LJ ALTERATION -LJ
REPAIR
Project Address- C -Z000' C 4- pN ,6`� % -
ElER
CONVSION 136E OLISH
❑OTHER
' Owner i NamO -N -
DESCRIPTION OF WORK
.TYPE
ZONINGE ULA I ON
_
-Phone'
Address- "- r -
OF PERMIT GRADING
FOUNDATIIO�N/'STRUCTU RAL:
A. P. 5W
`ZONE
1
Arch/Eng. ! -' ! - License No.
❑•TENANT ❑•ELECTRICAL
❑ PLUMBING. ECHANICALPLNG.
REF. 9W.�
BUILDING' '
i
1 Address - f "' -
❑'OTHER ' •.l •r -
PROJECT DESCRIPTION( SO,FT-'
/
TO BUILDING
PROPERTY I E
r
REAR YARD (TO P/U
q
S SJrµ�
° OCCUPANCY
Contractor's Names' hone 'r[/
'
{Addre55(mailing) 'ovZ aZ g3 S'! •e/'FN 2 R✓ -
CONST,RU CTION TYPE
VALUATION$ i
:LEFT SIDE YARD
RIGHTSIDE YARD-
No: yds ! 9 y
ZONJ= I I GRADING CU. YDS. 'ACRES
-
PKG. SPACEREQ.
I
PROVIDED
License _�.'ZO
-
-
. LICENSED CONTRACTOR DECLARATION -
Remarks:
,
•-
STREET WIDTH ,
PARK FEE$
I•hereby affirm that I'am licensed under provisions Of Charter 9 (commencing
with section 7000) of division 3. of the Business and Professions Code, and
SPECIAL CONDITIONS:
- 1
. my license is In fur ;Or an effect.'
9
i _ , _
-
LJcense leis G� U nse to O
PLUMBING
r
Data - - - ignature
Bar Sink' I
Sewer Cap
-
ELECTRICAL !
OR KE RS' COMPENSATION DEC RATI
.,• ',,(reDy affirm.thatl have a certificate.of consent to salftinsure or.a certificate -i..
-
Backflow Preventel- -�- - ^
- -
Sewer Connection --
Automatic Washer
-
.Meter Dover 100 amps
Workers' Comp ansation !or a certified: copy thereof (Section
-
_
-
Construction Pole
- - -
Sub Panel'
I
insurance,
3"�0, Lab. C.) 1 " J j !
I Backflow Irrigation
Solar Collectors
f Policy No. ' ' Company.,;
- -
Cooking Unit
Sub Pole -
I
❑.Certified copy is hereby furn[shed. -
Bathtubs ; a
Solar Piping
,
'
i hg Certified copy is filed with the city Building Division.
+
- -- f
Clarifiers ;
Solar Tank =
Dishwasher I
Motors DO -1 HP ❑1'h$
I
!
FData ,Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION r
,
- Dryers"C]Gas ❑Electric
'
- :Ina Soler, ❑9-15 HP -❑16-15+
Dishwasher �,
-
Swimming POO( w/Spa
(This section need not be completed if the permit Is for one hundred ($100) or
-
•. ��
Fan I !
Microwave
I less): 1
• I certify that In the performance Of the work hic his pe i[ is Issued I
Drinking Fountain's
,
Urinal I
)
i shall' not employ any person in any mann o as ec s j
/,. --Water-
,
; F.A.U. I !
! Pole Light
'
! Workers'] mR�nsaOool Laws of Calitornl ; ,
Floor Diains -,k
Closet'
I
' Date• ..YY SSSignature
['NOTICE: If, after making this'deelarat n, you s ould--b ome object tot a
y.
;- Floor Sihks. - - -'- --
-
- Water Heater'
t' Fixtures i
I Range _ _ •-_
_ '
Workers" Compensation; Drovlsions.of the Labor Code. you. must.. forthwith,
. comply with' such -.provisions or ,this permit f shall be tleemed: revoked
_
Ges Servit¢' ' tOutlets
-- -
Water Service
Device Boxes ' I
5r9n
. CONSTRUCTION -LENDING AG ENCV I
-
-
-
Outlets
f
I
I
I hereby affirm that there is a construction lending agencyrtor the performance
Interceptors
Standing Sections I
of the work for. which- this: permit -is Issued ,(Section 3087 Civ. C.)
' ' I
- •,
-
Switches
,Trash Compactor
Lender's' Name : _ -
I Kitchen Sink, _. I
c ., ,.
I
I
_
Lender's Address - - - .. I .
I r '
Lavatories�t •1
_"
-
, t a _
Garbage Disposal I
I 1
,
OWNER BUILDER DECLARATION, j I
1 hereby' affirm' that I a'm exempt'from the Contractor's License Caw for the !
*Code:
Genera[or� ❑0-5 KW 05-15 KW
!
P-TFep r I . .
' ,r, .
following reason (Section 7031.5 Business and Professional Any city or
, r'
county which requires a permit to construct, alter Improve; demolish or repair
'any structure; to Its Issuance, also requires the applicant for such permit
-
ROOYDreins
-
Transformer 015-50 KW
i
!
prior
to file a signed statement that he/she Is licensed pursuant to the provisions of
i
I�50+ KW!
I , 1 I
ReinsPettign Fee $15'
_
the Contractor's License Law (Chapter 9 (commencing•wilh Section 7000) Of
-Avislon 13 'of the Business' and ' Professions Code) or that' he she is exempt
't-•efrom
-
Showers
- -
1
Reinspection;Fee ;
$15
Meter ❑up 100'amps
,
and the basis for the alleged exemption. Any violation oft Section
�'J1.5
-: -
t0
'Issuer Fee. 1
$ 3
by- any applicant for a' permit' subjects the . applicant to a', civil
balty of not more than five hundred dollars ($500). ;, r
Service Sink
- Issue Fee
$ 3
Zoning Approved By I
I Date
,
I, asrowner of the :property or my employees wages as their sole :
e structure,with
compensation'and not d Or ered
BContractor's
MECHANICAL
-
Application Approved By
1
ate
n1117044,1eBusi Business. and, Professional. Code:; The :
for,
•
I
License Law does not apply to an owner of a property.who builds or Improves
thereon,land who does,such work himself/herself or through his or her own
Boiler
'
Refrigeration System
Application Issued By !
) Date ��'�
- - r-
�s I
--s.vrr��
r employeas, provided that such Improvements are not Intended or offered for
I If, however, the building Improvement Is sold within of com-
-
Duct -Under Ground
❑0-.100,000BTU ❑100,000BTU
SUM ARY OF FEES
1 i -
sale. or one year
pletlon, the owner will have the burden of proving he/she did not build
j for the purpose of sale)', i F .
Duct -Structural
System Repair/Alteration
BUILDING PERMIT $,
I SMIP
$ t
move
LJ I, is owner of the property, am exclusively contracting•with licensed con-
-
1 1
tractors to construct -the project(Section 7044, Business and _ Professions'Code:.t
Duct - Ventilating, '.
_ - _ _ _
PLAN CHECK $
PERMIT
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 ❑ Multiple 0.
PLUMBING $
ISSUANCE
$
tractors) license pursuant to the Contractor's License Law).
-
'PLAN CHECK( $,
j GRADING ?
$
1'am exempt under Section B. 6 P. C. for this reason
Firepl/Fact. Bit. ICBO #
I
I
-
r
I
l
$
Date owner; - i
Heating System & Ducting
9
;
,ELECTRICAL'
PLAN CHECK $
! I MICROFILM
$'
I hereby certify that r havd atl this -application an tate that th above �
- +-
0-100,000 BTU•El 100,000
f s
- - - - •.
I -''
- f I 1
: TOTAL'FEU
$ '
information is corre 1 agr t0 mply wit a city and.county ordinances ,
•
'MECHANICAL $
,(J.J
•= f t
and state laws re ng to Itli c ruc My -authorize reDre-
sentatives of/t .city{ ove-mentioneof property for
�;
Hood Or T YDeI �' I
Cann ❑�
Reinspection Fee'
$15
'
tPLAN CHECK $
,00 LESS
j Inspection our es. < �7
3
T e II I 1
f
r
' I
1
.02 ADVANCED PC ;
$ f
S19nalure Da
-SS
I
)
Registers
,
Issue Fee
$ 3
, {
- :
i
�^ •r
Drivers' Lice se or $
,' I
FINAL -FEEL ,
$ !
CMF 0865-46 rev. 12/82 White - Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor
ONSTRUCTION'AND'PLANNING_POOL
'A -
.�- •' --
���� t'Date
�•i APPROVALS Permit #JLC o
Inspector
-
-
- - APPROVALS Permit,#
Date
.Inspector
- -
_
i
1: Temporary,Electrical Service or -Pole
F
'52 Pool &:Equipment Location
-
2? Soil Pipe-Undrgrnd
53'• Steel Reinforcement -
a'31 Electrical Conduit Utilitd-Undrgrnd.
54. Forms `
'
4: Electrical Conduit-Undrgrnd - - '
_
- "
:55.' Electrical Bonding - -
5. Steel Reinforcement
c - ^r-
.56. Rough Plumbing &Pressure Test
-
6: Electrical UFER Grnd.' j
-
577 APPROVAL TO COVER-GUNITE
t '
7. Footings - ' ' -
.. -
58. Electrical Conduit•Undrarr.rl.
`-
8. Foundation • ; i" _ _ �• `n�-59.
Gas Pipe,.0 Undrgrnd:, Test
9. Water Pipe ,Undrgrnd.
-
.;60. Be.ckwasti Lines,�P Trap, O Undrgrnd.
r
10. Stiuciural Floor System
Z
61. APPROVAL TQDECK
11. Property Sewer Line &.House Connection!
•_
k -'
:62. BackwaW8& Receptor -Final
,.
12. Sewer Cap
63. Heater &-Vent-Final .
13. Roof Drains- -
-
-
;64. Plumbing�System.,-Final -
-
-
14. Rough Plumbing'
"65. Electrical -Final - - -
15, i,Rbugh Electrical'Conduit'I :'j ':�
I -T r
'766TS(;&-S__-yste_Final-
,
,1.6: Rough;Electric Wiring,•
67.1 Fen i' g &AccessApproval
--
_
17. Rough Wir n Signs '
=
{
FO R'PLASTERING
_-
:68.:APPROVED
-
' 18. Rou h:ElectricafTrBar Ceiling
9,
-
{
=` I "; i
' " ' `
169q PO FINAL
'
,..� •g _ ,
_
19' Rough.Heating &i Airiponditioning
�-2
I FIRE DEPT. REQUIREMENT
APPROVALS. Permit
. 20. RoughFactory Fireplace �•�. 'I
'
(
21. Ducts, in Structure.! 1
i i
70. Underground Hydro
22. Ducts, Ventilating
171 Product Piping O Gas 0 Oil ,
23.,Gas Pipe -Rough & Test ;- -
I72.
.:
_Underground Flush
;'24. Roof Framing' i -
I ��
_ -
173: Undergrnd. Storage Tank:0 Gas, 0 Oil
'
25.'Roof SheathingI
i., i;
% I
174. Overhead Hydro
26. ;TCBar Ceiling 1StrUuc6all& Monocoaf I
I '
-i
1751 Dry Chemical
27. (Frame and Flashing,
{
I
176. Dry Standpipe -
' 28.,"Lathing & Sidings
177: FIXED SYSTEM FINAL
29. `Insulation' rill
78. FIRE PREV. FINAL
.
30. Drywall Nailing > I ' ' I
! I
Notes
31. Plaster Brown Coat
f
• 32. Electrical'Power Meter -Final a
!
' { -•
r
33. Final Electric
34. Final Heating& Air Conditioning
'�?
35. Final Gas Pipe?Te3t
36. Hood orCan'opY
ireplace
37. Final Factory Fireplace-
38. Final Plumbing{ l { i i _++! ', 1�
38.
I I
l j;, `
��'-
39. WaterrService-Final
40. Gas Service -Final i
I
'
'
,'
I
I
41. Solar Domestic -Final '
_ __
_'_ __i_
_
42. Backflow Preventer -
43. Backflow Irrigation'
-
44. Landscape Irrigatiori�Systeml
45. Sound 'Attenuation-
;-
46. Handicap Regulations',
47. FINALSTRUCTURE:&BU. IWING
48. Special Requirements Completed
49. Electric Release to'Edison
r t ,
•'
56. Gas Release to Southern California Gas Co
,
t
I I I {. .�,
51. CERTIFICATE OF.00CUPANCY
No Date i
i '
•Applicant to fill In all spaces except thou within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA• ,•
CONSTRUCTION PERMIT
Applicant's Mailing Address . / C leA
Project Address Z L 6 b 0L fir /4 Aug- J3 c� /
Owner's N�ame �� v hone
/�Z 567
Address � '
Arch/Eng.., License No.
Address
Contractor's Nam Q4(JAZ4,1�L-455-7r.T �h.
Address ( mailing) v-��� GMK• •-�• u'�
License No. • __ '
LICENSED CONTRACTOR DECLARATION
1 hereby affirm that 1 am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3_ of the Business and Professions Code, and
my license is In full Torce.eRtl eT ec 1 /. s
Licen C ss' V� LlcenuN G
it r, Signature
WORKERS• OMPENSATION DECLARATION
1 hereby affirm that I have a certificate of consent to self -Insure or a certificate
Yorkers' Compensation Insurance, or a certified copy thereof (Section
J, Lab. C.) i
wIlcy No. - - Company •
eCertified copy Is hereby furnished.
Certified copy is filed with the city Building Division. 1
At. Applicant
EXEMPTION FROM WORKERS' COM PEILA I ECLA RATION
(This section need not be completed if thworEhoics
dred ($100) or 1
less). ,Icertify that I the personriceofthe rmit Is Issued 1
hall?erwn In any ms blect.to tale ,
Laws of Cali for;
n .
I hereby affirm that there is a'construction lending agency fdr the performance
3f the work for which this permit is Issued .(Section 3097' Civ. C:)
Lender's Name _
Lender's Address
OWNER BUILDER DECLARATION'
I herebv,affirm that I am examol from the Contractor's License Law for the
Dlvizion ,3 of the Business and Professions' Code)'or'that he/she. is exempt
-efrom and the, basis for the alleged exemption. Any violation -of Section
5 by -any applicant for a' permit* subjects the: applicant to a. civil i
Ity of not more than five hundred dollars ($500). ' . , -
t✓ I, as owner of the prooerty or my employees with wages as their sole ,
compensation will.do the work, and the structure Is not Intended or offered
for sale YSec/ion 7044. Business' and Professional Code: The Contractor's
TYPE OF CONSTRUCTION NEW LJ ADD Ll ALTERATION LJ REPAIR
❑ CONVERSION ❑ I OLI ❑OTHER
DESCRIPTION OF WORK - 2auif
TYPE OF PERMi 7 GRADING FOUNDATION. STRUCTURAL.
❑ TENANT i��j ELECTRICAL ❑PLUMBING ❑MECHANICAL
1:1
PROJECT DESCRIPTION SD. T. - OCCUPANCY H
CONSTRUCTION TYPE .5. VALUATIONS
ZONr GRADINGCU.YDS. ACRFc
Remarks:
Irrigation
Sewer Cap ' .
Sewer Connection
Solar Collectors
Solar Piping ;
Solar Tank
Swimmina Pool w/Soa
Drinking hountains I Urinal '
__LDra- los Water Closet L ri
Floor Sinks - - Water Heater. -
Gas Service' ' 'Outlets ` Water Service _
I Interceptors
Kitchen Sink.. f
Lavatories.,•
P -,Trap'
Roof Drains'
Showers - Reinspection Fee $15
Service Sink - Issue Fee $ 3
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
em Dloyees, provitletl that Such Improvements are'not Intended or offered Tor
sale. If, however, the hat su g or Improvement is sold within one year of coo- '
pletion, the owner cal 11 have the burtlen of proving he/she did not build or im-
rove for the our Dose of sale). '
I, as owner of the property, am exc lu S way co nt ract l ng• With licensed C.I
t recto rs to construct the project.(1Section 7044, Business antl Profesilons Cotle:
The Contractor's License Law tloos no[ apply to an owner of property who--'
builds or Improves thereon, antl who contracts for such projects wlih a <o n-
tract.rIs) Iice rise pursuant t. the Contractor's License law).
❑ I am exempt under Section B. a, P. C. for this reason
I
Boiler -
REAR YARD (TO P/L)
Duct- Under Ground
RIGHT SIDE YARD
Duct -Structural
_
Duct -Ventilating -
PARK FEE $
Exhaust System ❑ Multiple
.Microwave
Firepl/Fact. Bit. ICBG #
Date i Owner I
Ieheraby certify at I haw ad this application and state -that the above--
Information is c pec . I a to comp) with a city and county ordinances
and -state laws tat g ulltling co and hereby authorise padre-
sentatives oft s Ity n the above-mentioned pr part for
Inspection D
�•
f
Heating System & Ducting ,
❑0.100, 000 BTU 0100,000
Boxes
Hood or Type I ❑ ,
CanopyType II ❑
'
Registers
Signature
Pink - Accounting; Goldenrod - Assessor -
$15
$ 3
I __ 7597 4/21/83- 5y.90 .TL
PLNG. REF. -0
'Meter LJ over 1UU amps
TO BUILDING
'To BUILDING LINE
REAR YARD (TO P/L)
LEFT SIDE YARD
RIGHT SIDE YARD
PKG. SPACE.REO.
PROVIDED
STREET WIDTH
PARK FEE $
otic Washer.;
'Meter LJ over 1UU amps
Action Pole
Sub Panel
g Unit
1 Sub Pole 1
Sher
'Motors ❑0-1 HP ❑1'h -B '
[]Gas XElectric" .-
-Inc. Solar ❑9-15 HP C3 16-15
-
.Microwave
Pole Light I
'S _
,Range A �_
Boxes
Sign
'
Standing Sections
s
Trash Compactor r I
Garbage Disposal ,
I I
f 6
Generator 00-5 KW 05-15 kW
-
Transformer 015-50 KW
050+ KW
Reinspection Fee
Meter pto 100 amps
•Issue Fee
$ 3
Zoning Approved By
Date
Application Approved By
Date
� �
Vt S�
L
�•�
Application Issued BY
Date
rY
SUMMARY OF FEES
BUILDING PERMIT $
SMIP
$
PLAN CHECK $
PERMIT
1'
e
PLUMBING $
ISSUANCE
$ '
,PLAN CHECK, $
t
GRADING
$
ELECTRICAL $
0
-32
$
'PLAN CHECK $
—Z-
A D
MICROFILM
$
MECHANICAL $
TOTAUFEE
$ '
PLAN CHECK $
LESS
ADVANCED PC
$
i
FINAL FEE
$
CONSTRUCTION AND,PLANNI c
- �'
_ j r - ?_" P,OOLB' \
- -< '-
�' = ' 1-
APPROVALS Permit#--�
mate
Inspector
=APPROVALS 'Permit.#
Date
Inspector,
_
' i�- Temporary'Electrjcal Service or�Pole
&Equi'mnt 'Loc on.,,00
• e 1
21 Soil Pipe-Undrgrnd _
53 Steel Reinforcement
5! Electrical CdnduiiUtility-Undrgrrid._ s
; -
- - _ ;
¢4:i _Forms
4: Elr, �'
t4 �
X557 Electrical -Bonding.,
jectrical.Conduit=t'Jntlrgrnd.=:�
,
c nr
5. Steel Reinforcement '' „ `,�; I
_ :rya
`
';56.. Rough Plumbing -& Pressure Test
I
6: IEledtrical UFER Grnd.1 cf �.; I �-
�.;•^
.57.� APPROVAL TO,COVER-GUNITE°
,_'
7. Footings I ! ,i • { { ,•,M I •.
_
m-
:5 8. Electrical Cpriduit-Und_ror_nd. _
''' J.
__
.
8. Fountlatior I °
`,
i�F
"59. GasPipe;_�:Undrgrnd ;Test
1 _.
9. Water Pipe-Uridrgrnd'. _
- I
`' '- `
;60. Backwash Lines„P-Trap, O'Undrgrnd.
10. Structural FOor System
E
APPROVAL TO -DECK
-
,
.61.
11. property Sewer Line &.,House Connection.�,
�;
�,
q;
�E62. 'Backwash &%Receptor -Final
i
.�
12. Sewer Cap ! -'
o= 3
63 ht
,
-
13. �Roof,Drain's ,
1
o
.'64, Plumbing. -System - Final
14. Rough Plumbing' `- � '
65. Electrical -Final
-
`"15. -Electricl-ondulf
.� SolrRough 'Sys,tem-Final--
. 16.'Rough.Ele6tricWiring,I . !i
�.c• I
` d
j t-
X67: Fencing &=Access Approval
�}.17.IYRougfi•Wiring Slgn° N { " i:' I
I. (; ; „
`''' _ !'
X68 APPROVED FOR PLASTERING
,i'
I 'I
l I
'
r
,
18. RoughElectri'calaT_Bar Ceiling `�
" { ;_
_
•= 4 0
69.1 POOL/SPA SYSTEMS FINAL!
'I 19.'Rough_Heating & Airrconditioning
^
{FIRE DEPTyREQUIREMENT
'
APPROVALS, ' Permit #
20. Rough Factory Fireplace
I
21.iDucts,'inStructurei'�
I70.,UndelrgroundHydro
1;,22.;Ducts, ;Ventilating;. tc i ��
i� i
I
171.1 Pro duct Piping O Gas ❑Oil
• 23.-6s:kp'e-Rough & Test I ,'s • j
I
i
�''_
!72.' Underground Flush _
-24. Root Framing I ,'
I '�i= i1�=
I I `
i;? r; t
;73. Undergrnd. Storage Tank;O Gas: O Oil
25_ }Roof Sheathing I �'r I'•'= i
; r.
' I �'
; 74! Overhead Hydro
>
;
, I -
-26. IT bar Ceiling `(Structural)y & Mon "coat- l
I ' ! ,.1 ^
+ '
175 Dry Chemical
27. Frame,and-Flashingl 1 i li ii
_
l
176. Dry Standpipe
i
28.''LatHing & Siding, I ,
i; I' (
I
I j I
1771 FdXED SYSTEM+FINAL
i
l
29. Insulation ' I
I) I�
I
I I
176. FIRE PREV. FINAL
;
2
i
30. ,Drywall Nailing "
l '
Notes: 1
!•-3j,,PlastedBrown Coatl I_-
32.Elecirical Power Meter -Final
J 33 Final Electric
34. Final Heating&IAir Conditioning
35. Final Gas Pipe=Test
36. Hood or'Can'QPY'--
0
7
37. Final Factory Fireplace
-
38. Final Plumbingi
39. Water''Service-FiI nal ( I I''�
k l
40. Gas Service -Final
41. Solar D"omestic-Final I !I'
, - �
_ }_ I
I
..
_t-
42. Backflow Preventer.-
�Q
'
L:. -;
43. Backflow Irrigation
ftnl .1
44. Landscape IrrigationiSystem
'
45. Sound 2Attenuation,'r
46. Handicap Regulations!
n
47. FINAL STRUCTUREI& BUILDING'
48. Special Requirements Completed
49. Electrlc Release tolEdison
I ' I I I -t
50. Gas Release to Southern California Gas Cn
1 N
51. CERTIFICATE'OF OCCUPANCY •; _
�_._. -!
_ _1__ -_
�.-. ^i
No .� ' 1 Date
_ Applicant to fill In all spaces except those within
""City OF COSTA MESA p IT cap, TRgcT i
CONSTRUCTION PERMIT fl G� s%r� 114IT
Applicant's Mailing Address
Pig
Project Address
Owner's Nameo�/y, '
Address �!'E-''/7 A42 Ar C•�''
Arch/Eng. n� a Lic se No. ' ?Zia,Address
r'C''t[
Contracto's Nam onerh' L� y
'Address(mailing) 29�j! F /% _
License No.
LICENSED CONTRACTOR DECLARATION
I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my Ilcen se'is in full force ano effect. _
Ucense Class License No.
Date Signature
WORKERS' COMPENSATION DECLARATION
ireoy affirm -that 1 have a certificate of consent to self -Insure or a certificate--
Workers' Compensation Insurarfce„ or a certified, copy thereof ($eotlon
-000, Lab. C.)
Policy No. Company. '
BCertified copy is hereby furnished.
Certified copy Is filed with the city.Building Division.
_Dater Applicant
EXEMPTIONFROM WORKERS'COMPENSATION DECLARATION
(This section need not be completed If the permit is for one hundred ($100) or
less). - - '
I certify that in the performance of the work for which this permit Is Issued 1 i
• shall, not employ any person in any manner so as to become subjectto the
Workers' Compensation Laws of. California.
Date Signature
NOTICE: If, after making this declaration, you should become subject to the
. Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions .or this Permit ,shall be deemed revoked..
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 . (Section 3097 Civ: C.)
Lender's' Name
Lander's Address
OWNER'BUILOER DECLARATION'' '
I hereby affirm that I am exempt from the Contractor's. License Law for the
following reason (Sectlon•7031.5 Business and Professional Coact Any city or
county which requires a permit to construct alter Improve; demolish or repair
any structure, prior to Its1ssuanca, also requires the'applGnl for such permit
from and the basis for the alleged exemption. Any.violation of, Section
S by.anyapplicant for a permlt'subjects the applicant to a civil
ty of not more than five hundred dollars ($500).
'as owner of the property or my employees with wages' as their sole
ensation will. do the work, and, the structure Is not Intended or offered
ale (Sec/Ion 7044, Business and Professional. Cotler. The' Contractor's
w Law does not apply to an owner of a property who builds or Improves '
sale. If, however, the building or Improvement Is sold within one year of com-
pletion, the owner,wlll have the burden of proving he/she old not build or Im.
rove for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed con.
��'tra tors to cc nil r uct the project(Secti a n. 7044, Business and. Prof asst o ns Code: _
The Contractor's License law does not apply to an owner of property who
builds or Improves thereon, and who contracts for such projectswith a con-
tractor(s) license pursuant to the Contractor's License Law).
0 IPam exempt under Section B. & P. C. for this reason
r
Date Owner -
have -rca
border lines and sign all appropriate declarations.
LOT NOgGOOB
O.. B
TYPE OF CONSTRUCTION LJ NEW LJ ADD (J ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESACftIPT NOFWO K '� oNbONIMfVp�f l.Li /% -
TYPE OF 'PERMIT LJ GRADING AFOUNDATION STRUCTURAL .
❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL
❑.OTHER - -
PROJECT DESCRIPTION SQ. FT. - OCCUPAf•ICY4 _ r
CONSTRUCTION TYPE VALUATION $ _,"_
ZONE ( GRADING CU. YDS. tt ACRES
Remarks;H(^A ft� Lo•. o� 5.-). ..O ✓N, l ':moi -.9/
Bar Sink
Sewer Cap
Backflow Preventer -'
Sewer Connection-
Backflowlrrigation
Solar. Collectors•
Bathtubs
Solar Piping
' Clarifiers 7
Solar Tank
Drinking Fountains I
Floor Drains '
Floor Sinks
Gas Service ' Outlets'
Kitchen Sink
Lavatories'
P. Tiap
Roof Drains
Showers .-
Under Gr(
Structural
Exhaust System 0 Multiple 0
Firepl/Fact. Bit. ICBG 4h
Heating System & Ducting
I I 104100,000 BTU 0100,000 BTI
., Hood or Type LJI
Drivers' LIcpAU or SS I I "`a"•`j
CMF 0865-46 rev. 12/82 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
58hU• 3/17/H3 �03•ilE i,
I —V.S
A. P. P. tW 4 _'*7 - _Z Z— I — V.�
X_ 4 -
ZONE K 4LL/�
-IZONE
PLNG.REF.SW��pO-�I��'
BUILDING —oil
111 BUILDIN rn eTr�rG ice
TO BUILDING
LINE ZS 7f
PROPERTY LINE ZS LD
YARD P/ e,
-REAR YARD (TD PPROPERTY Ct
LEFT SIDE YARD 9��0 If
RIGHT SIDE YARD —d -A
_PKG. SPACE RED. LI S
PROVIDED Zv 5
STREET WIDTH 501 (A.)
�p
- PARK FEE $ IZ�,3a`.
SPECIAL CO NDITIONS: .. �.
.KEIYILN
__ ,
I
- 5 -
'Water Service "
ELECTRICAL
Automatic Washer _ .I
Meter Elmer 100 amps
Construction Pole
Sub Panel _
Cooking Unit
Sub Pole
Dishwasher
Motors ODA HP 01X-6• ,
Dryers OGas OElectric
Inc.Solar 116-15HP 016-15+
Urinal- :5.• '
.i
""
nnc,ow0ve
WategCloset
F.A.U.
'Pole Light
Water Heater- A
Fixtures
.Range
r _
'Water Service "
•t bevice Boxes
,Sign
Outlets-.
Standing Sections
- _
Switches;•
Trash Compactor
Garbage Disposal
' Generator 00-5 KW 05-15
KW
v
Transformer 015-50 KW
Rainspection Fee
-•S15'
V .I t ❑50+ KW
Reinspection Fee S75
Meter Dup to 100 amps
Issue Fee
f $ 3
Issue Fee,
$ 3
Zoning Approved By
Date
2
AANICAL'
:.e'
Application Approved By U
1 ate
_�c'
Refrigeration System
Application Issued By
Date
3-;/s'
04100.000B,TU 0100,0000TU'
�i ` - 1
SUMMARY OF FEES
'
System Repair/Alteration
BUILDING PERMIT g
546' 3s SMIP
PLAN CHECK $
9.30 PERMIT
I
^I
PLUMBING $
ISSUANCE .
$ l '
• -
PLAN CHECK $
i 1 i GRADING
i $
f
;
(7
i
I
(
d
ELECTRICAL $$
CHECK $
I MICROFILM
$,:
y:P1AN
.MECHANICAL $
' TOTAL FEE
$ ,
_
I Reinspection Feel
;$15/
I
`PLAN CHECK 1 $
i t LESS -
i
58J
ADVANCED
PC $ • d
Issue Fee
$ 3 _
1. ._ 1 I
I i FINAL FEE
$ ,
j: -CONSTRUCTION;AND:PLAN
;Date
_,,; : - '" _"•POOL 'A
APPROVALS Permit#+
Inspector
z -.
AP.PROVALS-. .Permit #
DateInspecfor.
_
I
_ -
;U Teinporary•Electrical Serviceor,Pole U'
' '•
- -
:52 Pool &' Equipment Location' _
.,•
ci 21 's6il Pi a-Undr r d:. s o
P g . i-
`
=
'.53 Steel Reinforcement
r
'
-
r-,
,
�- 37 Electrical Conduit Utilitv-Undrgrnd!..;
154.' Forms
Al 0: Electr�ical'Conduiti-Undrgrnd' n
55. Electrical.Bonding''
57 Steel Reinforcement• - -
iJ_,� j
'-B1-�Ij
56. Rough & Pressuie-Test
,
_Plumbing
6' Elebtrical•UFER'Grnd.i � -
f{_Zfa_y3
�' `V''1
571,' APPROVAL TO COVER-GUNITE-
7. Footi'ngi "' i •� "-� a� i
1{�w -r.�j
y l
-'58' Elei trical'Conduit-Urtdrornrl.
7j :
8. Foundation ,.Sj _ 2 ' �'.
H- '
_•'yri rM
.'59. Gas Pipe,-O-,Undrgrnd., Test '
9. 1 attar Pipe-Undrgtnd.',
st _
60. Backwash Lines, P -Trap, ❑Undrgrnd. •
".
10. Str'ucturaj Floor'System
61. APPROVALTOPECK
11. Property Sewer Line '& House Connection
-
e,
62. Backwasfi'&Receptor-Final -'
r 1
•.O -
12. Sewer Cap I 1 '. '
- I_
63. Heater & Vent -Final - - •
.-
13. Roofbrains:� ' - •
� � � „ �
'
I
-
.64. Plumbing System - Final ..
14. Rough',Plumbing
"65. Electrical'' -Final,
15: Rough Electrical -Conduit -i. - ---
j f r
r '77 -r
66. Solar System -Final
`•�16`. Riiu h ElectricWirin
9 9
-
-167 Fe`ucing-&FAccess Approval
-_ -- --
-- - -
_ . •r' I
Rough'Wir ng'Sign,•1.
68 -APPROVED FOR PLASTERING
k�17,
18i 'Rough Electir ca l -T Bay Ceiling;
r j
1
`69. P00 VSPA SYSTEMS FINAL
j; 19. RoughyHeating &'Air Conditioning •�
I •� '
I
FIRE DEPT.'REQUIREMENTt
APPROVALSI I Permit #
'r
20. ',Rough Factory Fireplace 1 -,
I
�; 21. Ducts, in Structure _ t �, �(
I '
i I I
70.� Underground Hydro
`
(
I
22 Ducts, Venfila2ing
t71.; Product Piping ❑ Gas OOil
'I'23r'Gas.Pipe-Rough & Test . f ', '+• 1
'
�72rUndeiground Flush
24. Roof Framing`.
73.Undergrnd.StorageTanklOGas OOil.
25. 'Roof Sheathing
s t
D S- -
'S+
74. Overhead Hydro
+_26: T -Bar Ceiling (Structural). & Monocoat i
- ` ,
i
75. Dry Chemical
27. 1Frarrieand Flashing,
D�
;QA3
76., Dry Standpipe
28. ,Gthin6 &-Siding' ,. -
I I
~
.77.' FIXED SYSTEM FINAL
. 29_i`Insulation = - 1
178. FIRE PREY. FINAL
' 301 Drywall Nailing
Notes: i1
•� 31.,Plaster Brown Coai ,� 1 1 i
'
�,I j
' t• '
I
1
,'321�Electrical'Powa MeteriFinial
;
g
.' 33. Final Electric --) _. ,�
_ _�
I ',
34. Final Heating & Air Conditioning
I
I
-
r-
35. Final das'Pipe
- - �- -
36. Hood or Canopy ~i '
I :
7• j ,� - -
.' .., n
37. Final Factory Fireplace'_, =_ ; c,.. p
' - .•
38. Final PlumLng•I.�ii-
39. Water Sewice•Final• -•1 ' "�' I
I I','
40. Gas Service Final'
41. Solar 0`oinestic ,F inch 1' ,
42. BackfUPreventer
, �, ISI
43. Backflow, Irrigatio'n'
44. Landscape" Irrigation_System I
-
,1
•,
I
' 1 - -
-
I -
I
45. Sound' Attenuation ' IF I ''
46. Handicap Regulations
47. FINAL STRUCTURE_'&BUILDING ;
,S �,•-'D'�_
j i
48. Special Requirements G6rripleted
.:111,2AHI
.I
Vs
49. Electric Releaselto.•Edison'•
50. Gas Release to Southern Callforr is Gas Cn
51. CERTIFICATE OF'OCCUPANCY
No I' I I Date
Applicant to fill In all spaces except thaw within heavy border lines and sign all appropriate declarations. _ __
CITY OF COSTA MESA p IT -N TRACT NO. -� , ,LOT NO. B j 6793;_4/06/63i , , 5.0ilL ,TL
CONSTRUCTION PERMIT - g75:3' i
I I ,
Applicant's MailingAddress Q l TYPE' OF CONSTRUCTI ON; NEW ADD ALTERATION REPAIR Il - ' •`
1. - .�C��ir,'+ �l {-IC �. , ❑ CONVERSION :❑ DEMOLISH ❑ OTHER ' - r
Project Address f � - ^ - - � ' -
- /�7 �' �J`-F/ '- p g � DESCRIPTION OF WORK - -
Owner's Name sow— hone - 1 G RM"LATInatct -
Address CX�' 1
TYPE OF PERMIT U GRADING'0 FOUNDATION 0 STRUCTURAL
r ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL -
t ❑ BOTHER " I
PROJECT DESCRIPTION' SO. FT- OCCUPANCY
CONSTRUCTION TYPE VALUATION $'
-
20NJ=GRADING CU. YDS. (ACRES
A. P.'10-' - ZONE '
Arch/Eng.*--Licensei No, t
-_
Address' � ' -
PLNG. REF. -' BUILDING -
TO BUILDING-
P PE YLINE ,REAR YARD (T0 P/U _
Contractor'sNam hone` `rz SS
'
Address (mailing) -
LEFT SIDE YARD RIGHT SIDE YARD - -
-
License No.
PKC. SPACE REO. PROVIDED
__
LICENSED CONTRACTOR DECLARATIONI
Remarks: ' ,
STREET WIDTH _. 'PARK FEE .$ I
(.hereby affirm that -I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license Is In full force and affect. -
boanse Class' I
- I License No.
Date'( ' Signature I
CORKERS' COMPENSATION DECLARATION' -
ereby affirm that Lhava a cart)}Irate of consent to. self-Insureor-a certificate -
Workers' Compensation Insurance,i or a certified copy thereof, (Section
3800, Lab. C.) r
Policy No. Company
B Certified
-copy Is hereby furnished.
Certified copy Is filed with the clty.Bullding Division. ,
Date Applicant -
EXEMPTION'FROM WORKERS' COMPENSATION DECLARATION
(Thissectlon need not be completed if the permit Is forgone hundred ($100) or ,
less) � -
1 certify that In the performance of the work for, his permit is Issued I
shall. not employ Any person in any maan�nnerr�s'y��''�".•f�come sublect.to the
Workers• f e all n Laws of Callt. r.!L! "" L
Data Signature l
comply lWnn sucn . provisions or tors permit snan ca.deemed revoked.
CONSTRUCTION LENDING AGENCY -
of hereby [ the woirk that tth�ere Ironstruction -lending l!Issued !G 9en�tor thy: Civ.ormance
C.),
Lender's Name'
Lender's Address ' c -
OWNER BUILDER DECLARATION 1
1 hereby. affirm .that I am exempt from the iContractor's, License Law for the
mndred dollars ($500): t I y I
'ty or -my employees with wages as theli sole
k, and, the struct ureds not in to ntied or offered
less and Professional Code:i The Contractor's
an owner of a property who builds or Improves
York himself/herself or through his or her own
'Improvements are not Intended or offered for ,
or Improvement Is sold within one year -of com- m
me burden of proving lie/she did not bull[ or im-
Sink
kflow Preventer, -
a
MING
Sewer Cap
Sewer Connection'- -
Solar Collectors_
Solar Piping
Solar Tank
Swimmina Pool w/Soa
Floor Drains
Water Closet
Floor Sinks --
Water Heater - -
Gas Service Outlets
Water Service '
Interceptors
-
Kitchen Sink
,Sub Panel
Lavatories
-
P -Trap) ; -
Motors O0-1 HP 131X$
Roof Drains -
- -
Showers
' ' Reinspection Fee ;
Service Sink
.: Issue Fee -i
r
MECHANICAL t
Boiler +
m '
Duct-' Under Ground
Refrigeration System ,
❑0-,,100,000 BTU 0100,0000TU
` Duct c Ventilating ,
The Contractor's License Law does not apply to an owner of property who i
bullds or Improves thereon; and who contracts for such projects with a con- 1 Exhaust System ❑ Mult
tractor(s) license pursuant to the Contractor's License Law): I
❑ I.am exempt under Section B. & P. C. for this reason Fiiepl/Fact. Bit. ICBO #
)Heating: System & Ducting
- -F- ❑0.100,000 BTU 0100,(
Hood or Type 1 ❑'
Canon.. TJne 11 M -
Date, i ' 1 Ownerl i
Drivers' L19A oriSS
CMF 0865-46 rev. 12/82 . White - Building; Unary - Applicant; Pink
I I , I Registeis j
ig; Goldenrod - Assessor
Reinspection Fee-
' Issue Fee
1
SPECIAL CONDITIONS:
awncnes
I .Trash Compactor
ELECTRICAL '
]Automatic Washer._ ..
' Meter_ ❑Over 100 amps
Construction Pole
,Sub Panel
Cooking Unit
Sub Pole .
Dishwasher 1
Motors O0-1 HP 131X$
Dryers CIG -as ❑Electric
dric.Solar 09-15HP ❑16-15+
Fan.
; ,Microwave l
F.A.U.
Pole Light
Fixtures
Range _
Device Boxes
Sian
awncnes
I .Trash Compactor
Garbage Disposal
t
Generator 00-5 KW 05-15 KW
�-
Transformer❑15-50 KW
050+KIN
l
'Reinspection Fee
$15'
$15
Meter ❑up to 100amps
' 'Issue Fe a•
$ 3
$ 3
Zoning Approved By
Application Approved By —
Application Issued By
Date
� ata
'Date
��[[
T
G 8
G
I ' I
'BUILDING PERMIT $
PLAN CHECK'• $
(PLUMBING $
PLAN CHECK j $
'ELECTRI' CAL $
'PLAN CHECKS $
MECHANICAL $
CHECK S,
j SUMMARY OF FEES !
.' SMTP ! !
PERMIT
•. ,'OD, ISSUANCE
( GRADING
MICROFILM
t TOTAL'FEEE
LESS
AD ANCED PC
FINAL FEE;
l
I $ j
,
$
$ '
�' $ $
'
,
$
$ 1
'
$OO
I
I
S
'
$15PLAN
PLAN }�G; ` : y-- -• c
--- -
- ` -,--POOL ,PA
OCONSTRUCTIONAND
�✓�h j,. `Dater^'-
> 'APPROVALS Permit:#
Inspector
- _
,'%APPROVALS `Permit#
Date
-
.Inspector
'' 1: Temporary Electrical Service or Pole_ !
- -3 ;,
i56
;'52: Pool &`Equipment Locetion�',
�-
-
- _
i- 2! ,Soil Pipe-Und r g r Ad moo'. ; `-';
r--- i i.`•
�; I �
';53° Steel Reinforcement '
_ I?
,; , ,-
_• . 1
31 Electrical Conduit Utility Undrgrrid Nr
.` o
t• '
,541 Forms
Y A: Electrical Conduit-Undrgrnd� '; o
- >
�•
55` Electrical Bonding
a
_
5: Steel'Reinforcement` -- ;,
•-
%�
Rough �&Pressure Test -
m . rI
,;-
.,56: _Plumbing
6. Electrical' LIFER Grnd.' ! °•' I i �'
.57: APPROVAL'TO COVER=GUNITE-.
i
-
7. Footings•'58�
Electrical;Conduit-Undramd.-
- c•
8. Foundation ! „I ! '•� I °'
"
''59 Gas lPipe ;�O-Uridrgrnd Test='
9. Water Pipe-Undrgrnd. I !
-.
a
,60. Backwash Lines, P;Tra'p, Elndrgrnd.
10.'StructuralFlo-or System T`� t
� �
?;
1.61. APPROVAL TO DECK
11. Property Sewer Lne&'House Connection
-
62. Backwash &• ReceptorFfnal=' `
1 I
n-
12. Sewei:C'ap i '' ! ' -
;:r,
f 1
(�f,'
i _ -
'63. Heater &Vent -Final
• , r' ,
13. Roof bra' 1 G
%1
-
.64. Plumbing-System;;Final--.
,.';
14. Rough Plumbing
+
65. Electrical=Final"-
c:_ •_ g ._ R• I .. I I! - I
15r Rou t' Electricel•Conduit-"
--�--i--f
-
�- -- -i
T' ,
"'66r Solar System.Final""---•
.
r 16. ;Rough Electric Wiriog, I I
!I
+�-T. -
l.,
'-1 - II
I
-�6Z. Fencing &•Access�Approyal -rJ'
- ' -
•� r _
--
-_ r.
II I. r.1, I: t n l
i. L• I
!
I
„`117.
�
1
X68.' APPROVED FOR PLASTERINGNi
rt$
,
t 18. :Rough Electrical`T'Bai;Ceiling I '
_
0
69. POOC/SPASYSTEMS'FINAL
I ,
a 19�rRough Heating &'Air Conditioning �' I
'. i ;
i I �;
FIRE DEPT..REQUIREMENT,r
APPROVALS : Perm it' -#
20.1 Rough Factory, Fireplace' I I 1' !`
i
_
21_ Duct's; in Structure,, `I I �I i�
I
I
76.1 Underground Hydro
!
822. D,ucs, Ventilating
71.; Product Piping O Gas OOil1!
Pipe -Rough
-r1
I
72. Underground FlushX23:Gas
I i
I
24. ERoof Framing°, ; '!`,;; I I
• I I.�'
. I - I
173.1 Undergrnd.StorageTankiOGas .O Oil
9 25. !Roof Sheathing 1 ' ! I 1tj -
' I _. I ,
74., Overhead Hydro
Ck
L 1 x
T -Bar Ceiling (Structurall, & Monocoat� i
-_
� � : ,
1r�
75. Dry Chemical
,26.
i _
1 27. u rame and flashing _ . I I I. 11 I
i ; " I
76. Dry Standpipe
28.Lxthing & Siding,
77. FIXED SYSTEM FINAL '
9_;,Insulatiori ? I y °'
I I� I i
I I
I
178.! FIRE PREV. FINAL
�_Y
k'30. Drywall Nailing ,f
1Notes:i
' 31. Plaster Brown Coat I 1 - �-
! I
-
- - _.r_ -- -r- -- -- --- - - -.
•-32. IElecfrical Power Meter -Final
l
13
33. jFinal Electric_ i I + ' a
j
i
._3,
_,1 _
- •L
34. Final Heating &Wr Conditioninni g '�
!
I
I I "`• II
35. Final Ga!'Pi,pe-Test. •�i1, m
nl '� I'
I i-'
-
�' i r r
36. Hood or Canopy�,1
e .Iv
37. Final Factory Fireplace:
38. Final Plumbing
39. Water,Service-Final
40. Gas Service -Final
,.,
41. Solar Domestic -Final-}--?---{
_
42. BackflowlPreveriterj j ! I
I
!
`_ ;'I •� ` -
4;
_! _
_ _,
_
orL1 �'v i
43. Backflow; IrrigationI;
I ;%I :
In :c II
_ I i i c :
^-
F'
I
44. Landscape Irngation;SYstem
- I , i '-
r
I _ I _ - -, < r_
1 ,•,
45. Soundl ttenuation ' ! ° I '41 I ' •
))
_
- - - `
46. Handicap Reguiations I
47. FINAL STRUCTURE & 61JILD iNG
48. Special 01quirernerits Completed
1
' 1
i I � t•' .} • I, a -
R 1 I I I I I
1
`I
I I
49. Electric Releasejto Edison!
:
:_'
J_
_'. -
50. Gas Rtlease io Southern California Gas Co
51. CERTIFICATE OF, OCCUPANCY •i
_' I I_'
___ _J_'
No i! i I r Date
Applicant to fill In all spaces estop) loose within heavy border Tines and sign all approoriats declarations.
�- - -' - _ '"
• CITY OF COSTA MESA
PERMIT.
PEr�y^I NO n/. ..
Ti
NO.
LOT NO.
BLDG.
CONSTRUCTION
Applicant's Mailing Address
TYPE OF CONSTRUCTION NEW _. ADDALTERATION I I REPAIR
�•
❑ CONVERSION ❑ DEMOLISH
_roject
❑ OTHER
- •'
PAddress
N
Owner's Na 0 2 hon ce
DESCRIPTION OF.WORK .nunOH/AI rI>H
-..
I
_
G REGU A [I N I '
a.,,�
G I
-
Address
-TYPE OF FERMtT GRADING
FOUNDATION STRUCTURAL
A. P, sW ZZI I%3
ZONE G� -
Arch/Edg. f ��' is LiC¢nes Op
❑TENANT ❑ELECTRICAL LUMBI❑ MECHANICAL
UILDING _ �1 I/
PLNG. REF. sz—oo�' JC
Address) tv' J
_
' ❑ OTHER _
- .
_ ,
TO BUILDING
PE TV 1 5.S 'O P
REAR YARD (TO P/U '
S'9 �J 'OCCUPANCY M-%
COntractoKs Nam hon
C
PROJECT DESCRIPTION SOI FT. '/
1 =-"j
LEFT SIDE YARD Qs/
flIGHT:SIDE YARD LI -0 fl
Address (mailing)
CONST RUCTION TYPE
VALUATION$'
�_ I -
ZONE GRADINGCU.YDS.
ACRFc
PKG. SPACE RED.Sr
PROVIDED Zv
License No. __
LICENSED CONTRACTOR DECLARATION - 1
Remarks
1
STREET WIDTH •�� / IN
PARK FEE'$
I"hereby affirm that 1. am licensed under provisions of Charter,9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
SPECIAL CONDITIONS:
'
rry license Is In full force and effect.
License cldaa License No.' `
HOLD EOR SPECIAL REQUIREMENTS
PLUMBING ; I
Date Signature i- ' " r
Bar Sink
Sewer Cap I
ELECTRICAL
WORKERS' COMPENSAYION DECLARATION "
- - - - 1
Iereby'afnrm tnat.Lhave a cerufitate of consent to self-insure -or. a certificate
Backflow Preventer - -' -
Sewer Connection --- - -
-- Automatic Washer
__ Meter_ over 100 amps ...
Workers' Compensation Insurance,;Or a certified copy thereof (Section
-
- _
Construction Pole
,00, Lab. C-) i
Backflow IrrigationSoler
Collectors
,Sub Panel,
Policy No. I Company
CertifiedcopyIs hereby furnished. I
i Bathtubs
Solar Pi pi 1
Cooking Unit
Sub Pole I ,
8 I
Certified copy Is }Ileo With the city Building Division. 1
i
I
-
Clarifiers
-
Soca ank
Dishwasher
Motors E30-1 HP 01%-8Date
Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
_
Dryers ❑Gas. ❑
1][31i;-15+Electric Inc. Solar: 9-15 HP 1[31i;-15+(This
' Dishwasher '
mm8
iin Pool w/Spa
section need not be completed If the permit is for one hundred ($100) or
less) ,
I certify it hat in the parlor mance of the work for which in lS permIt Is issued I
shalLnot employ any person In any manner so as to become subject to the
-
Drinking Fountains
-
Urinal ,
Fan;
Microwave '
'Pole
Workers' Compensation -Laws of California.
Floor Drains
-
Water ose
F.A.U.
-Light '
Date Signature '
NOTICE: If, after making this -declaration, you should become subject to the
- Floor Sinks - -
-
-Water H t
Fixtures
Range I
Workers' Compensation provl Sions of the Labor Code. you�must,forthwith
comply with' Such provisions or this* permit! shall, be Ideemed revoked.'
- -
-
Gas Service 'Outle
- -
t Se ice ` •' :
Device Boxes
Sign +
CONSTRUCTION LENDING AGENCY . ' ., ; . I
I herebyaffirm that there Is a,construction.lendin agency for the erformanco
9 9 Y p
'issued
'—
Interceptors
,
Outlets
Standing Sections
of the work for which -this, permit Is ,(Section 3097 Civ: C:I.
Lender's Name' ' -_
-
Kitchen Smk r
t
Switches
Trash Compactor
I -
Lender's Address - - I
OWNER BUILDER DECLARATION -I - $ ; - I , 1
_
'. I L¢yatorie5 f
. )
Garbage Disposal
{
;
-
I hereby affirm that I amexemptfrom the Xontractor's�License Law for the
- P—Tra
� 1
Generator ❑0-5 KW ❑5-)5 KW
i
following reason.(Section.7031.5 Business and Professional jCode: Any city or
P, r"
; I
county which requires a permit to construct, alter Improve, demolish orrepair
"any structure; prior to Its Issuance,'also requires theapplicantfor such permit ,
-
Roof Drains! ' I
"_
Transformer 015-50 KW
I j
. to file d signetl state ment'that he/She Is licensed pursuant to the provizinni of
the Contractor's License Law'(Chapter 9 (commencing.with,Section 7000) of
7
❑50+ KW. ,
'Reinspection Fee $1B
vislon 13 of the Business and' Professions Code) or that: he/she -is, exempt
Showel4 1
�, ReinspectionlFea
. '$15
-
refrorri and the' bails fpr the alleged exemption. Any violation of{Sectl(
- •,
-
Mat¢r ❑up to 100 amps
ssue Fee•
G 31-5 by -any applicant for a'permit-Subjects-the-applicant to a'civil
ifnalty of not more than five hundred dollars ($500):
-
Service Sink
.: "
- Issue Fee $ 3
_.
,�
d •with their '
Y
Zoning Approved By -
Data
I -as .owner of' the ,property or my employees wdges;as sole
compensation will, do the work, and the structure is not Intended or offered
_ - M
-
ANICAL' '
-
Application ApproJed By
I 3� •��h- 1
ata
for sale I(Section 7044, Business, and f Professional, Code:. The Contractor's
• License Law tloes not aDPIY to.an owner of a property who builds or Improves 11
- ' I -
Boiler I .- ;
Refrigeration System ' ' '
1
'
Application �'
i 1
thereon,•and who does;SUch work himself/herself or through his or her own I
1 .,
Issued By
Date
employ ees, provided that Such Improvements are not Intended or offered for
Sale. If, however, the building or Improvement IS sold within onoyear,of com-
'
Duct -Under ound
❑0-,100,000 BTU C3 100,000 BT U,
' I '
pletion, the owner will bees the burden of proving he/She did not build or Im-
ro or the purpose of Sale). I
1
'
Duct - Structural
System Repair/Alteration+
SUMMARY
BUILDING PERMIT $
OF FEES
'
I SMTP $
I, as owner of the property, am exclusively tontracting-with,licensed con•I
tractors to t he ect(SectIon 7044„ Business Professions. Cod a:.
Duct�Ventilating :
1
PLAN CHECK, $
I 1
construct prot and. -
The Contractor's License Law Res not apply to an owner of property who
builds or Improves thereon. and who contracts for such projects with a con-
_
_ I
_ _ _
$
PERMIT 1
ISSUANCE $
Exhaust System ❑ Multiple ❑,PLUMBING
tractor(s) license pursuant to the Contractor's License Law):
❑ lam exempt under Section I • B. & P. C. to this reason ,
-
Firepl/Fact. Bit. ICBG Vh 1
I
{
,
'PLAN CHECK! $
GRADING ! $ '
'
Heating -System & Ducting
ELECTRICAL $ I
I $
Date ' 1 i Owner' I 1 ,
I -hereby. certify -that -1' have -read his( application and -state that the -above '-
-r
00.100,000 BTU-0100,000BT! -
-
,PLAN CHECK $
MICROFILM { $
information Is correct. I ogre ply with all city and county ordinances
antl'itate laws relating 0 construction land pereby author r pre-
I
1 +
I
',MECHANICAL $
TOTAL $ '
❑,
I
r
Ito
sentatives oflthis'city 'enter; upon the above-mentionetl o rt }or
1
Hood or Type I {
D i
{
Reins euYioti Feal
i D
$15
LESS
inspection / 1 +
Canopy T' e II i
7
1 7
) ADVANCED PC r
Signature
• Drivers' Lice - 1
Registers I
i Issue Fee I
$ 3
I
�' �C{-vii y/��I�S
,
1$
1 I
ocss 9P I
S
1
l'
FINAL FEEL $
CMF 0865-46 rev. 12/82 White -Building; Canary -Applicant; Pink -Accounting;
Goldenrod -Assessor
BIpJ /S
CONSTRUCTION, AND PLANNING'3 t s
'"
i-c'c: -c _ -POOL-, A _ �• :T_
r. .
y rAPPROVALS Permit;#= " _ ° u. s.Date
Inspector
APPROVALS-'Permit3W
:Date
Inspector.
raEletricI SerGicrPole
n
r.2ITem
5., Fool &:Equipmint Loca"o- '
t
2! Sod Pipe`-lJniirgrnd}' ; s °�_ �-
7'
,� `
X53 Steel Reinforcement
1
2r
1
y 3! Electrcal Cond&t'Utility Undrgrnd
`-
54 Forms-
r.„.
,.
t' ! n Electrical Olpntluii-UnQrgrnd�
'55 ElectrirahBo'nding;
.
-
5:' Steel Reinforcement) { S �' ( s
a=
p F'
-
q �. _
..'"_
`56 Rough Plumbing•& PressureTest
I n ;.. n ,'r,
_
6:lecvicah UFER Gfid' ! R'_ - I i `-i `^,
`d_L
�.y•� °
x.57'- APPROVAL'TO.COVER GUNITE'
r
7. F;oot!'ngs' I % '� i t i 4;
= `' -' '!'•
` '
:�58' ElectrlcaPCpnduiYUndrornr{-._ !
r o. _
i
8. Fpuhdatl0ri? i °
�°
X59. Gas�Pipe,'O:Un'drgrnd:;Test' -
�-
q 'I i. - 1
d 1
,� 1 .
,I
9.4W,ater Pips-Undrgrnd.i- j 1
- '
S..
X60. Backwasb'Lines; P-Trap,'0'Undrgind.a
-
10. pt! ,' r4 0
61. APPROVALTO'DECK
1;62.
11. Property Sewer Line & HousevConnection;
<
a
Backwash Receptor -Final:
.I 1..1
'r
12.'!Sewei.•Gap; •• 1 063.
-Final
-I pr
1,!
.1
13. •Roof Drains '' ' =
1- I,;, r -. f
"' !
o
r, I
-
.'64. Plumbing;System -Final- _
-
-
14. "Rough,Plumbing r�,.11 ! I E - I
65. Electrfcal-Final
15 'aRough' Electrical=ConduitFT
SolariSYsiem-Fin'al---' "_- ' ' 1' -
I'
i6: rF%ugh Electric Wiring. ,I !67.f
Fencing &Access,ApprovaP
�• .I, m:
I
Wiiirig!Signi' ;� -Sr :' I� jI
APP'R'OVED FOR'P.LASTERING
r�17_'�Rough (
I
68.'
18. Rough_Electrical^T Bar Ceiling
- ' I
-- I ' -
'6g,, POOL/SPA SYSTEMS FINAL_'
'i II, I h l
f
Ihlwl
1
--
!{ 19. Rough'Heating &Air Conditioning
h 11!
--FIRE DEPT. !REQUIREMENT:
I
�. ,,a .. n 1 I Y �' • r 1 ,
1- 1
j I -{
APPROVALS. j Per
_�
~IJ
,
_mit:#
20: IRough•Factory Fireplace!
4
-
c ? !
21. bucts,in Structure; i
! I
70: Under round Hydro
9 Y
i'-
A I I I'.
I
j
_
`22:'bucts, Ventilating "� I' �;
I I
I
77.1 Product Piping O Gas ❑ Oil
-.
-
df23:-Gas:Pipe-Rough & Test
I
I
Underground Flush
I I
I
+72,1
:'-24.-'--Roof Framing' ' •` ! �,,, !
I
, 1 r. ! 1: i c�
�; I .• {:
X73.' Undergrnd. Storage Tank as O G 0 Oil
t
'
.1 II n 1 11^• I
r-3.1 1 r
,a Rgof SheatF in` It
jos I` {
i;, t
;74.' Overhead Hydro
_
,`
26. jf�Ba� Ceiling Structural), & Monoc °' 1
9 1 1 oat
. j
! 1 r� _
y _ 1 `•
! X75 ,.DrI Chemical
r
-
4' 1 I I
27. -Frame and Flashing It ;,
: {
- I �'
;76.x, Dry Standpipe -
I
I J{
I
28. !,Lathing &Siding' o I �I !' I
I
I
-� �•
FIXED SYSTEM -FINAL
1
177..:
' 29.�Insulatiori g_ i t 1 h Il 1
I I
i 1 1
178. FIRE PREY. FINAL c
1
30. Drywall Nailing :' ; i ,! +
I t 1
Notes: +
,
I I
1 1
31! Plaster Brown Coat ! _ I I '1 11
'Electrical Power Meter=Final
1-32.
33. Final Electric
34. Final Heating &'Air, Cpnditionin
r
� I.
If 1 r Ir
35. Final GaslPipe=Tes't;
I C-
36.Hood or�t-
I
37. Final Factory Fireplace �• j r 1 n
= I • i j
!
1
k It 1 I I I'
IT I
I _-
' , •
38. Final Plumbinl I ! o� -
i
- {
i
I I i I'._
r s
39. Water Ser'vipeFinal;'
40. Gas Service-Finilr
41. Solar Domestic -Final
1
42. Backflow, Prevgoter,
4--_
^T
.
43. Backflow IrrigalfonlI^
I
r.r -I i
l _
q�.• I_ -I "I r -)a I I �_I
44. Land cepirrigationSystem-
_
45. Sound Aitenuaiion
46. Hand! ca pl Regulations, !
Iii ! �-
I
i I
1 ,x+11
I '•1 �) I
j'`I
t !„�1_,:L
47. FINAL STRUCTURE•&BUILDING '
I =t
�'I
! 1
'fit
r I.•1,. :I I I�
=1
'
I I i
48. Special Requirements Completed'
-'
I I !
I-
I
1
49. Electric Release,to,Edfsonl-'tj
1
r_t
�_'�
i Y _I_ ;__!._� _ _♦-y
50. Gas Release td Southern California Gas Cu
I
!
51. CERTIFICATE OF,OCCUP,ANCY t.
_i r
.4_.
No
Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.
! CITY OF COSTA MESA
PER IT NO._
TRA T NO •' , s
LOT NO.
BL
CONSTROCTION PERMIT
I �
i -
Applicant's Meiling Ad rens -
TYPE OF CONSTRUCTION
Z NEW LJ ADD LJ ALTERATION
'REPAIR
-
- -
4'� ��
El CONVERSION ❑ DEMOLISH ❑ OTHER
Project Addreu
DESCRIPTION OF WORK `�d��os-'r IIJI UH
-
Owner's Name1� hon
_
REGULATIONS
7L 7[
Addreu, -'
-
TYPE OF PERMIT GRAOING. FOUNDATION- STRUCTURAL
A. P. yW 41,41- G -Z I -D3
ONE Z ; .'
Arch/Eng Licennsse No -
❑ TENANT. ❑,ELECTRICAL PLUMBING. ❑ MECHANICAL
.PLNG. REF.'M 'y �-�_'
BUILDING, _ '
O -�• --
:-'•. `'
TO BUILDING
.Address'
.❑,'OTHER
�'�•�O' •OCCVPANCY
/1"I
PE Y LINE
REAR" ARD (TO P/U 11 -
Contractor's Nam hon A
M(COry
PROJECT DESCRIPTION' SQ, FT.
�/ - -
LEFT SIDE YARD /_1„Dq
RIGHT SIDE YARD 5 Q'f7
Address (mailing) 177 D
I-
STRVCTION TYPF y�Iv.i VALVATION$
lO
ZONE - GRADING CU. YDS- ACRES
PKG. SPACE REQ. s 5'
PROVIDED Z
License No.
-
_
LICENSED CONTRACTOR DECLARATION -
Remarks: ' - _
-
STREET WIDTH 5O
LA.) PARK FEE'S
I hereby'affirm that I am licensed untler provisions of Charter -9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
I
SPECIAL CO ,lqM$:.
,A--
my licanie;is In full force and affect. I -
ucenze Class' License No.
PLUMBING
H(]
,
Date' Signature
Bar Sink Sewer p
ELECTRICAL
"'ORKERS' COMPENSATION DECLARATION 1 '.
+reby:affirm that I have a certificate of consent to self -In Sure.or ace tificate-;
-
- - - _
Backflow Preventer r n von -
_
- Automatic Washer _ - _ i
•Meter.- over 100 amps
Workers' Compensation Insurance, or a certified copy thereof (Section
-
-
Construction Pole
Sub Panel I I
4800, lab. C.) -
Backflow Irrigation So Collect s
Policy No. Company
- -
Cooking Unit
Sub Pole 1 I
8 Certified copy is hereby tarnished.
Bathtubs lar Pip g -
Certified copy Is filed with the city. Building Division.
SoI
Dishwasher
Motors 00-1 HP 01%-8
Date Applicant
Clarifiers rT
-
-
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION
Dish Welsher Swimming 00l w)$pa
Dryers ❑G2S ❑Electric
:Inc.Splar ❑9-15 HP 016-15+
(This section need not be completed If the permit Is forgone hundred ($300) or
—.
Fan;
,
Microwave
less)
1 certify that in the performance of the work for which this permit Is issuetl I
In manner so 'as to become subject. to the
Drinking Fountains rival
F.A.U.
shallim employ any person any
Workers' Compensation Laws of California. 1
-I
Floor Drains. W er goset'
i
Pole Light '
Date d9nature -
- -
Floor Sinks - - Wa r Heater - - )--
-
Fixtures I
- -
'Range
' NOTICE: If, after making this declaration, you should become subject to•the -
Workers' Compensation provisions of the Labor Code, you must forthwith
- i
Device Boxes
Sign '
comply with• such . provisions>or , this' permit shall be deemed revoked:
Gas Service' Outlets W er Service - I }
9
CONSTRUCTION I LENDING AGENCY
-
Outlets
Standing Sections
I hereby affirm that there is a construction lending agency for the performance
Interceptors . , 7
-(S
. of the work for which- this• permit Is Issued -(Section 3097 Civ. C.)
-
Switches
Trash Compactor
Lender's Name-
. - Kitchen Sink
Lender's Address'•+
Lavatories, , I ,�
Garbage Disposal
j
OWNERiBU1LDER DECLARATION
I hereby affirm that I am exempt) from the:Contractor's.License Law for the
I
Generator El KW ❑5-15 KW
)
1 _ I _ -
P L -
following reason'(Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter improve; demolish or repair
-Trap
Transformer ❑ 15-50 KW
i I
- -
c r
any structure, prior to Its Issuance,.also requires the applicant for such permit'
to file a signed Statement'that he/She is licensed pursuant to the provisions of
Roof Drain 1 1
❑5U+ KW'
KW -
Reinspection Fee $15' !
- - =
t a Contractor's Ucense Law;(Chapter 9 (commencing.wlth'Section 7000) of
slon of the Business and Professions Code)' that he/she IS'exem Pt '
. •
Showers ti Reinspection, Fee
t.
$15
,3
efrom'antl the basis for the alleged exemption: Any violatllon�of Section
' r
Meter ❑up t0 100 amps
Issue Fee. S 3
&5 th any applicant for -a permit -subjects the applicant to a civil
penalty of not more than five huntlretl tlollars (E500)- -' . I
- I •_ -
Service Slnk ! issue Fee
$ 3
___ _
Zoning Approved By
' Date _
LJ 1,--:as:,wner of the property ormy employees with wages. as their sola
co m pensatIon wIII do the work, and the structure Is not Intended or offered
i - - - MECHANICAL
.- : - I 1 i
-
M
Application Approved By vV
'
ate 1
for Sale 1(SecfIon 7044', Business' and l Professional, Cotler. The Contractor's
Ucense Law does not apply to an owner of a Propertylwho bullds or Improves
_
,
goiter Refrigeration System
1 ,
I 3 /`5
thereon,iand Who 'does such work himself/herself or through his or her own !
t I I j
,
Application issued By
!y
Date
. employees, provided that such -improvements areinot Intended or offered for
. sale. It, however, the building Or Improvement is sola wlthl0 one year of conn-
- - - ❑0-100000BTU ❑100,000BTU:
Duct'- Under. Ground i , f
- I SUMMARY OF FEES
elation, the ownerlwill have the burden of proving he/she did not build or Im-
rPve for the purpose of.sale)'. I '
Duct - Structural I Sy stem Repair/Alteration ''
;BUILDING PERMIT $
I
SMIP ;.$I
'. as owner of the property, am exclusively contractingiwith'llcensed con-
i ,
1. '
tra tors to.construct the project.( Section 7044,. Business. and. Professions Code:
t I.
Duct _Ventilating __ „___ -. ,-{ _ ,__ __ ..Y L _
PLAN CHECK- I $'
i PERMIT I -
The Contractor's License Law does not apply to an owner of properly who
builds or Improves thereon, and who contracts for such projects with a con.
;
Exhaust System ❑ Multiple ❑' ' 1 + i
1i
PLUMBING - $
ISSUANCE' $ I, -
tractor(s) license pursuant to the Contractor's License Law).•-
El I am exempt under Section B. & P. C. for this reason 1
- j '
Firepl/Fact. Bit. ICBO 5i�
,
' PLAN CHECK $
GRADING ,I I $ I '
I
_
Heating System & Ducting ; t'
E
;ELECTRICAL $ !_
$ 1
I 1
Data Owner •
I' herebyy certify that'I have read this application and state that the above •'!•
' 1
0,04 00,000 BTU ❑IUU,000BI - - I-- - -
t
-PLAN CHECK, $
I MICROFILM $
irt(ormation is correct. I agree to comply wlth all city and county ordinances I
laws to b her
I I ; ' ! I
MECHANICAL $senta
TOTAL FEE,
I ( $-{
and' staterelating ng const ruction,:and authorize repre-
- of phis (city vier, upon the above-mentioned pro rt y for
Hood or' Typal D I I , ;
I Reinspection Fee''
$15
I LESS I !
inspection
inspection P I I
o
CgnO T ell �'
_
i
! ADVANCED $-
I'
•_Accounting;
Goldenrod - Assessor
/_ `/J
6
-
r? UCONSTRUCTIONEAND PC'ANNtNG, - r vr� • r
-,.-� -
- ='�-,� -,, <"_POOL ?A o_ - *•.
r'
-
o
' -.-_, , V. Date , -
^ APPROVALS „ Perinif# -
Inspector
'e
=APPROVALS •., Permit'#
Date
Inspector,
.
_
_
t Tem porarnEle'ctrical SerJice 6gP61e
D , -
,� <
X1.52. 9 Pool & Equipmenf Location-
�� 2. Soil pipe=UndcgrAd
53Steel Reinforcement
y 3.,Elect�iral CondwtjUtilitJUndrgr�d. ;
`, -
� -_
..5.4 Forms -
}
�.
4- Electrical Conii'urt Undr reds t> ° (-� r
` -
R o
( 55' Electrical Bondin
-
5? Steel' Reinfprcemb6t .y' r - ` ' o
y i
'; =
' 56. Rough P-lumbing &Pressure Test
6: rElect(icaNUFER Grnd,' i �= 7j
- _
57`.' APPROVAL TO•COVER-GUNITEi,
7. F ngY.t ^, 41- 1 I -7y 1
°^
` ''
--58` Electrical-Condwt=Undrarr,.{
-
,•tQotis
. i, -
,
8. Fguridatign r!,r �� { -
%
° - _
i '-59. Gas �Pipe,'(3�Undrgrnd., Test -
_
-
9.,Wite' Pipe-LlndYg
d :? + i '
o
=
j :'60. Backwash';Lines,'p-Trap, O Uncirgrnd.-
10. -Structural Fl000Systerl { I
?5
;'61. APPIROVALrTO DECK
11Jr6pg'rtySewer Une&`Housec6nnection.
-
e^
:.62. Backwash'&Receptor-Final
1
.
1. a.,: _
1 - 63. Heater &:Dent-Finaf-
t1 I I
13.'48of drainsPlumbing,Systein
--Final,
14. Rougli'Plumbing' 1.'65.
Electrical -Final--- •• -
-
'" I
r15-.---Rough"Electrical-Conduit i
te' r
r �_.
7 (
- 66.,Sola�;SYstem--Final
--
r
,
1�76.;IRough Electric Wiri In90 :,'
r`-., (. i n
I_j n i-: +i
-�67..i F.encing�&-AccessrApproval(!-a
.. ..
S 7:: Roug aWitiog;Sign
I'
68. APPRO.V,ED FOR PLASTERING
-'
r
] o .' j .
.,
I .
`i 18.rRough,,Electrical;,T,Ba Ceiling!
1, q I
. i ;_
1' I .
•'69.1 POOL/SPASYSTEMS FINAL
19.•'Roudh Heating & Air!Conditioning
y {
- ! = 1
i -'
i I FIRE DEPT.'REpU1REMENT
'.
II
I'
� APPROVALSI 'Permit # �-
20. 'Rough:Factory Fireplace
i I 1
I
I I i �
'
i
Y, 21. in Structure
90.1 Underground Hydro
- ' 1 L
+
lD'uc[s,
�L22..'Ducts,Ventilating �f;''.
i ;� �� !
' ( ';
;
Gas ❑Oil
i-,
'F23.:Gas'Pipe-Rough &Test
I
(-j1aProductPiping
L,72. Underground Flush'
1 I -!--;'
•'
r_
24. Roof Framin 9-
l
i "� {
i c --
Ira
I
1 `
Undergrnd. Storage Tank ❑,Gas-,0,0il
•'
-, t'.' n
I II -g i! ` ,
. r1 -
I
,73.,
"
1
25. JRoof
SheatF in 9
1 i i
Ili'
I 1
' Overhead Hydro '
i
_
, y
I 1,
l s
l 174.E
•i
26. T -Bar Ceiling (Structural), & Monocoat' I
l (", l r -
I I
: j75.� Dry Chemical
I,
Frame and Flashing; 3 t !(
i
; l -!• ,
�' I'� I
Dry Standpipe
I.27.
I
,76.E
28. Lathing&'$iding r ��
i.• }
t ' s
77.E FIIXED SYSTEM FINAL
j
,!; 11
\I
i� 29.jfnsuiation _ �• - i ••�
; ' I
}
1781 FIRE PREY. FINAL '
I I
,
=30 Drywall Nailing ; i ! i li it
_
I I
tNoies:' i (
,
IP laster Brown Coat
,!,'31-.
X32. IElectrical Power Meter. Final
33_�Final Electric ! I f
ri J j�!_Jt.
34. Final Heating &jAir. Conditioning
35. Final GasiPipe=TesP '- I, �
-' i,
' E 1� '
c i � f <
r,"
, 0
36. Hood or'CanopV°' �,
-
-,.
r 1.-,-; ' ••i
n, I'
1.^. ,_ I•
I I I
11 I I � I, n q .r r=
37. Final Factory Fireplace`
38. Final?lumbinif 1_TI 1 .I
'
x ,
39. Water.Service-Fineb
40. Gas Service'Final,-_'-
1 7
41. Solar Domestic FHnal i
42.BackfliowPr66nter
43. Backflow, Irrigation'
44. LandsrcaPearrigatio`n;System
r
45. Sound -Attenuation
;,
I
";
I !
I ; ! ', ! j : ° ; ' �; _ •_ ,
46. Handicap Regulations
s
47. FINAL STRUCTURE.&BUILDfNG;�'-
,
48. Special Requirements Completed
49. ElectricRelease'folEdisonh
50. Gas Release to Southern California Gas C.o
51. CERTIFICATE(OF OCCUP,ANC'�l
No. I, t Date ` •
- t-�--'
Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations.
•CITW'OF CdSTA MESA -
PERMIT NO. -
TRACT NO. -s LOT NO. BLDG. NO.
- -- - -
�-- -
!CONSTRUCTION PERMIT
3,59.0
7/.21/82'1 .', i..' 11,00
TYPE OF CONSTRUCTION
%5 NEW ❑ ADD- ❑ ALTERATION
REPAIR ❑CONVERSION ❑DEMOLISH
!
t'• t �'
- - - -
I.
i Project Address r 2' o6 �Ld �' M7
Owner - p/j PhOne 4/9/
'Address ;41 r0
7-60C.. -,f,
❑ OTHER
..
ZONING REGULATIONS
Arch/Eng. License No. .
DESCRIPTION OF WORK
- -
-
P.P. #
ZONE - PLNG. REF. #-
'.Address
Contractor_ L3 - _ _ _ Phone -
TYPE OF PERMIT,- • - - '+ -BUILDING
s
❑GRADING❑ FOUNDATION -OSTR VCTURAL -
'0_TENANT ELECTRICAL ❑PLUMBING ❑MECHANIC
-
SETBACK C ST.
ID VARD---.-
_ SED
TO BUILDING
PROSE RTV LINE'
Address- --- - - -
LICENSED CONTRACTOR DECLARATION `
of
1 hereby affirm that, I am licensed under provisions Charter 9 (com-RII
7000) Division 3 of Business and
OTHER
GEi-IT
mencing with section of -the
license is in full force effect
�0
REARVARD-(TO"P/L)'
-
Professions Code, and my and
- PROJECT DESCRIPTION
License Class' - --- License No. -
- - '' -"
��SQ. FT.
-
PKG. SPACERED.-
-PROVIDED' -
1
.Dale-- Signature -
4-- - --
STREET WIDTH "- _ -"�
-"- - --
EE"$„
-PARK FEE-$,-:7-"-
WORKERS' COMPENSATION DECLARATION
WORKERS'
:_OCC UPANCYI_•• CONSTRUCTION TYPE
_ _
_ -ZONING APPROVED BY---
,,;
- - -
DATE
I hereby affirm that 1 have a certificate ut consent to self -Insure ora
VALUATION ZONE
certificate of Workers' Compensatlon Insurance, or a certified copy-
_ __- -- _ c _--
--
'SPECIAL- CONDITIONS:--
""-- -- - -
!hereof (Section 3800, Lab. C.).
GRADING CU. YDS. ACRES
y No. Company
-
_. __ - -_
_ _, _ _ _.• t_
x`.rartified copy is hereby furnished. _ - -,
REMARKS:
akifietl copy R filed with the city Building Division.
,is'k
EXEMPTION- FROM WORKERS' COMPENSATION DECLARATION
( need ri of be completed If the permit is for one hundred
r
.. . .
5100 or less ;____r- _.__ -_
$10 ) or less):--
s
) )
-__
-
-
certify that in the performance of the work for which this permit is
issued, - 1 shall not employ any person In -any manner z0 as to -b come
PLUMBING,. - PLAN CHECK-- —
- - -
---
ELECTRICAL— `- PLAN
CHECK -
subject to the Workers' Compensation S of Californf
BATHTUBS -- - - SHOWERS ' -
- '-• '-O,
-' -- --
--
Date 7_ Z/-�'� Si9nat ure - - - - -
NOTICE: If after making this declaration, you should bac a subject
TOILETS,,.URINALS - - -
-
GENERATOR- 0-1'KW_
1-10 KW
to the Workers' Corripensatlon provisions of the Labor Code, you must
forthwith comply with such provisions or this permit shall be deemed
- _
LAVATORIES DOUBLE LAYS -
- - --
TRANSFORMER
-APPLIANCE - - 10-50 KW_'50
f- „'i -. •')
+ KW; - -
revoked.
-LENDING - - -- --"--
KIT. SINKS- -- - -DISHWASHERS -
--
-MOTORS --- 0-1-11P-_1-10'HP�
- --
CONSTRUCTION' AGENCY
I hereby affirm that there is a construction lending agency for the per.
formance the work for which this is issued (Section 3097
SERVICE SINKS , , .. SUMPS -. - _-_
_ - -
.IINC..SOLAR) _I0-50 HP
50 + HI3_-
of permit
Civ. CJ._ _ _._ - - - - - - -
-FLOOR SINKS ----FLOOR DRAINS
FIXTURES - - -OUTLETS---SWITCHES
- — - _-
Lender's Name
- -
• - --- -- - --- -- --
--DRINKING FOUNTAINS - -P. _ -
- -� - -
. GAS TUBE SIGNS-
- - -
L onde,Is'Address
-INTERCEPTORS - - CLARIFIERS -"-
- -- -
POLE -LIGHTS -- - --
- - - - - -• --
OWNER BUILOER.DECLARATION_ _
hereby affirm that I am exempt from the Copt rector's License Law for
SWIMMING POOL - PTRAP--- --
- - -
-
POLES -' METERED-
_
- - -
SUB -
lhe_following reason (Section_7031.5 Business and Professions Code:
Any city or county which requires a permit to construct, alter,
_.WATER SERVICE - ALTERATION- -
-
PANELS - - -MAIN -
SUB
- -
Improve, demolish or repair any structure, prior to its issuance, also ro-.
quires the ap,.licant for such permit to file a signed statement that he
_ _
-GAS-SERVICE'- '-- OUTLETS
_ -: _ -`.:.
�s
SERVICE - - -- -aa� ---AMP - -mo
aw_
Is licensed pursuant to lhe..provislons of .the. Contractor's License Law-
(Chapter 9 (commencing with Section ]000) of Division 3 of the
WATER HEATERS - ---BTU,OUTPUT -
-
- -- -
- - -- -
Business. and -Professions Code) or that -he is exempt therefrom and the
9
basis for the alleged exemption. Any vl plait on of Section ]031.5 by
-SEWER CONNECTIONS - - ---- ---
--- --
- - -- -- - -- - --
- - - - -
a,r jpplicant for a -permit subjects. the applicant.to a. clvii.penalty
"••
more than five hundred dollars ($500).
as Owner of the -property; -
SOLARTANK--- COLLECTORS- �-
L - - -
-- -- - - ---
- - -- -
will d0 the work, and the structure is not intended
r,
or offered for sale -(Section 7044, Business and Professions Code: The-
SOLAR PIPING SVS: - -
- -
- ISSUE FEE - -
- - - - - G -
3 -all
Contractor'S License Law does not apply to an owner of a property
Contractor's
who•bullds or improves' thereon, and -who does such work himself or
- ISSUE FEE'
'
APPLICATION APPROVED BY
-- _ .-DATE- - - -
through his own employees, provided that such Improvements are not
-MECHANICAL PLAN CHECK
- -y
SUMMARY OFFEES
intended or offered -for sale. -If, however, the building -or improvement -
have the burden
Is sold within one year OI completion, the owner will
-
- -
- -
-BUILDING- -- - - --
-- - --•--
of proving- he -did not build or Improve for the purpose of sale).
HEATING SYSTEM 0-100,000 BTU
PERMIT s --
SMTP,},-
01, as owner of the Property, am exclusively contracting with
AND DUCTING �' _
- r _ _- _
_
-s,
licensed contractors to construct the project (Section ]044, Business-100,000+BT
V'
PLAN CHECK $-
PERMIT
and Professions Code: The Contractor's License Law does not apply ro
_ -
-
ISSUANCE'
an owner of property who builds or Improves thereon, and who con-
REFRIGERATION 0-100,000 BTU
PLUMBING s
-•11.f .,
tracts from such projects with a_contractor(s)-IlcesneU pursuant to
-„SYSTEM -
100;000+`BTU'
t-- _- _
1 _ _ _
'PLAN'CHECK-E - - -
•v
_ GRADING _�E _
the Contractor's License Law).
•, {,
1• ; s ,
0. 1 amexempt under Section B. L P. C. for thisBOILERSBTV
- - - - - --
- -- -
- ELECTRICAL - Is
reason
_ _ _ -, _
SYSTEM REPAIR, ALTERATION -
_
?LAN CHECK s r _
t- MICROFILM s- _
- ,
- '
Date Owner
EXHAUST SYSTEM MULTIPLE
-MECHANICAL 5- _ _
1
TOTAL'FEE S_••
LESS AD- '•
_
1 hereby certify that 1 have read this application and state that the above
information ls•correcl: I agree -to comply with all city and county
PLAN CHECK=s - -
-VANCEPC' $_ - -
ordinances and state laws relating to construction, and hereby authorize
-. - • ; r _
representatives -of this city --to enter- ufi the above -mentioned
I
L property for ins a tion pose
- -%-Z/��
'-
FINAL FEE s /l
Signature Date
'
FEE -
_ -ISSUE FEE- _ _ - - . _ -
- _ _ - .-
_
Drivers' License or SS
CMF 0865.46 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor
. CONSTRUCTION AND PLANNING
APPROVALS Permit #
POOL & SPA '. _ •i
Date Inspector' `- - - - Date Inspector..
ROVALS - Permit # _.
1.
Temporary Electrical Service or Pole _
__� , 43.
Pool & Equipment Location - •' - - -
.2.
Soil ipe-Un rgrn_
_ 44.
Steel Reinforcement - - - -
3.. Electrical Conduit Utility-Undrgrn. _
_
45.
Forms . - '- -
_-.4.-
Electrical Conduit-Undrgrn
- -- 46.
Electrical Bonding- - '
Steel. Reinforce-
47.
Rough Plumbin' & Pressure Test - _--
_
6.
Electrical UFER Grn _ _
48.
APPROVAL TO COVER-GUNITE-
_ 7.
Footings -
49.
Electrical Conduit-Undr rn
8.
Foundation
50:
Gas Pipe, ❑Undr rn, Test
_ .9.-
Water Pipe•Undrgrn__ _
51..
Backwash Lines P-Trap.❑Undr rn
10. .
Structural Floor System.
52.
_
APPROVAL TO DECK
-11 . Property.Sewer.Line.& House Connection.
53.
Backwash &Rede for -Final
12.
Street Sewer Connection
-54.
Heater & Vent -Final' _
. 13.
.Rough.Plumbing _55.
Plumbona qv tam - Final
14.
Rough Electric -Conduit
I - - - - '56.
Electrical -Final
15.
Rough Electric -Wiring
i - 57.
Solar System -Final
16.,
Rough Heating & Air Conditioning
- -_
encing & Access Approval
17.
Ducts in Structure
-
APPROVED FOR PLASTERING
18.
19.
20.
Ducts, Ventilating- - - -
Gas Pipe -Rough &Test'
Roof Framing - - - - -- -
- -
- - - - - 60.
•- - - - - - - -
- - -- - - - -- --_
POWSPA SYSTEMS FINAL
- - - 'Y
21.'
22:!
Roof Sheathing-
Frame and Flashin -
- -
'NOTES:
23.,
Insulation - - - - - -
- -- -
- - - - -- - - '
24.;:
Lathing & Siding - - --
-- - - -- -- -' - - -- - '
. 25.
Drywall Nailing - -
- - -
-
• 26.
Plaster Brown Coat- -
- - ---
- '
' 27.
Electrical Power -Meter -Final - - --
--- - - --
--
28.'
Final Electric --
29.
Final Heating & Air Conditioning - -
30:
Final Gas Pipe -Test
31.'
Final Plumbing- -- -
-
- �••
32.
Water Service -Final - -
- - - - -
- - --
33:
. Gas Service -Final -
34.
Solar Domestic -Final-
' 35.
Landscape Sprinkling System
-
-
36.
Sound Attenuation •'
. -_ .- -_ - ` .
-- _ ... ',.
' 37.
Handicap Regulations
38.
FINAL STRUCTURE & BUILDING
39.
Special Requirements Completed
-
' 40.
Electric Release to Edison
41.
Gas Release to Southern California Gas Co.
42.
CERTIFICATE OF OCCUPANCY
No Date
,
SF_y
R
i
9938 1/16/60 130.64 TL
COSTA MESA BUILDIN— SAFETY DEPARTMENT APPLICAI.—N FOR STRUCTURAL PERMIT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
MR
6�
0
U
U
RECEIVED VY PERMIT 7�jp 49496
N
For Applicant to Fill in Completely — Use Ink Only
BUIL DINGESS Zi W /U
A.P. NO. — — OADD3
TENANT�I� I— �Jre /
BUILDIN
ADDRESS
UNIT OR
MAILING^
ADDRESS /d C end
SPACE NO.
d L
T
/n� EL.
�
LOT BLK.
�_ Aq-rZ 73/
CITY C.A� � NO.
CONSTRUCTION
NEW ADD ALT R REPAIR MOVING] DEMOLISH
QQ
LENDER OW �C� J����/
BRANCH
OV4NEO
ADDRESS
, J VALUE$
ARCHITECT TEL.
SE lr 0
�I
OR ENGINEER
ADDRESS
ZONE ee TYPE GROUP
APPR V
CONTRACTOR
BY DATE
ADDRESS
TEL.
CITY NO.
STATE CITY
APP O T ACKS /
LIC. NO. LIC. NO.
_
SIZE NO.OF BLDGS.
IFR M C/ ST T)
OF LOT NOW ON LOT
I
RONT
USE OF
EXISTING BLDG.
Separate permits are required for
L. SIDE /FT. /
electric, plumbing and heating work:
REAR
USE OF BUILDING AND WORK TO BE PERFORMED
PLANNING ACTION
DATE
APPROVED
RV
I hereby acknowledge that I have read this application and state
that the above information is correct and agree to comply with
all laws regulating building construction, and I shall not employ
Q Z 'C
any person In violation of the workman's compensation laws of
the State of California.
SQ. FT.
1 hereby certify that I am properly licensed as a contractor under
the State of California Business and Professions Code, Division 3,
THE AMOUNT SHOWN UNDER VALUATION IS FOR
Chapter 9, and that such licenses are In full force and effect, or I
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLY:
am exempt from the provisions of the State of California Business
end Professions Code, Division 3, Chapter 9.
VALUATION PERMIT FEE E t ��
Signature o
PLAN CHECK b �-
7— lt7
Permittee
�+TAX b o.
Or
—ZaTOTAL
Authorized Agent Date
PAID s13o
MR
6�
0
U
U
Applicant to fill in all spaces within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA
PERMIT NO.
TRACT NO. (Q BLDG. NO.
CONSTRUCTION PERMIT
p-52
��
I 3014
8/07/61 24.00
Project Address XZ,4 17iC/✓
TYPE OF CONSTRUCTION
❑ NEW ❑ ADD ❑ ALTERATION
❑ REPAIR ❑ CONVERSION1,9 DEMOLISH
❑ OTHER
ZONING REGULATIONS
OwnerJ'9S' A/F Phone
Address fj /� F_ Cone ♦7 j1 D r- 1, _,-7A
-
Arch/Eng. License No.
DESCRIPTION OF WOR -,_-- �7^'^'
A.P.
Address
:V- a- A/7z—�Zj,._
,�.". r.
TYPE OF PERMIT
❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑PLUMBING 0MECHANICAl.
ZONE PLNTGp.
a
SETBACK C L ST.
SID YARD
YWn
g0.UEF�. p�
VROPEIRTYNLINE
- Contractor (i ,() p D CV PhdneL J6 -J yT
Address 3 f 3.w( Jr Z, - Y
LICENSED CONTRACTOR DECLARATION
that I licensed Charter 9
I hereby affirm am under provisions of (Com-
section 7000) Division 3 of the Business and
❑ OTHER
RIGHT
I
.anting with of
Professions Code, and my license Is In full force and effect.
-
REAR YARD (TO P/L)
_ / ���
PROJECT DESCRIPTION
PKC.
LlcenS CIa55 Lice seN
�a of
SPACE REQ.
PROVIDED
Date / Signatures
54. FT.
STREET WIDTH
PARK FEE$
WORKERS' COMPENSATION D CLARATION
I hereby affirm that 1 have a d tificate of consent to self -Insure or a
OCCUPANCY '1 CONSTRUCTION TYPE
J
ZONING APPROVED
DAT!448/
/
certificate of Workers' Compe nsatlpn Insurance, or a certified copy
VALV ATION LONE
the (SS¢¢ctiQn 3 La DD
(o
GRADING CU. YOS.^RES
SPECIAL CONDITIONS:
n .,cy 10"i5'7% -O8 ]SCumpanY
-
A
artifietl copy is hereby furnished.
REMARKS:
-ertified copy is filed with the city Building Division.
�1
EXEMPTION FROM WORKERS' COMPENSATION DELLA ATION
.a
It
(This section need not be completed if the permit is for o hundred
jpaas-
or leu 1.
S$1001
cert((fy that n the performance of the work for whl .this permit is
_
issuedI shall not employ any person in any manne o as to become
PLUMBING PLAN CHECK
ELECTRICAL PLAN
CHECK
Subject t0 the Workers Compensation Laws of Cali rola.uwl�LILINU
BATHTUBS SHOWERS
TOILETS URINALS
GARAUE
GENERATOR 0-1 KW_
-
1-10 KW -
Date Slgnature
NOTICE: If after making this declarationou should become subject
slo
to the Workers' Compensation proviof the Labor Code, you must
TRANSFORMER
-
forthwith comply with such provlSlo or this permit shall be deem etl
LAVATORIES DOUBLE LAVS
APPLIANCE 10-50 KW
50 + KW
revoked.
CONSTRUCTION LENDING ENCY
- -
KIT. SINKS DISHWASHERS
MOTORS 0-1 HP -1-10
HP
I hereby affirm that there I com ruction lending agency for the per.
SERVICE SINKS SUMPS -
(INC. SOLAR) 10-50 Hp_
50 + HP -
formance of the work to which this permit is Issued (Section 3097
FLOOR SINKS FLOOR -DRAINS
FIXTURES OUTLETS
SWITCHES
Civ. C.).
Lender's Name
Lender's Adores
_ __
DRINKING FOUNTAINS
GAS TUBE SIGNS
-
INTERCEPTORS CLARIFIERS
.POLE LIGHTS
'
OWNER BUI ER DECLARATION
I hereby of that I am exempt from the Contractor's License Law for
SWIMMING POOL P TRAP
POLES METERED
UB
the /olio ng reason (Section 7031.5- Business antl Professions Code:
Any y or county which requires a permit to construct, alter,
Imp r ve, demolish or repair any structure, prior to Its Issuance, also re-
WATER SERVICE ALTERATION
PANELS MAIN
SUB
quires the applicant for Such permit to file a signed statement that he
GAS SERVICE OUTLETS
SERVICE
AMP
Is licensed pursuant to the provisions of the Contractor's License Law
(Chapter 9 (commencing with Section 7000) of Division 3 of the
WATER HEATERS BTU OUTPUT
-
Business and Professions Code) or that he Is exempt therefrom and the
,•Os for the alleged exemption. Any violation of Section 7031.5 by
SEWER CONNECTIONS
- -
applicant for a permit subjects the applicant to a civil penalty
of more than live hundred dollars ($500).
SOLAR TANK COLLECTO Pilo
� I, as owner of the property, or my employees with wages as their
sole compensation, will tlo the work, and the Structure Is not Intended
or offered for sale. (Section 7044, Business and Professions Code: The
SOLAR PIPING SVS. �pi
-ISSUE FEE
-
Contractor's License Law does not apply to an owner of a property
-
ISSUE FEE
APPLICATION APPROVED By
DATE
who builds or Improves thereon, and who does such work himself Or
his own employees, provided that such Improvements are.not
MECHANICAL PLAN CHECK
SUMMARY
OF F S
ithrough
Intentletl or offered for sale. If, however, the bullding or Improvement
Is sold within one year of completion, the owner will have the burden
of proving he did not build or Improve for the purpose o/ sale).
BUILDING
� �/�
HEATING SYSTEM 0-100,000 BTU
PERMIT $
/$ $_..��
❑ I, az owner of the property, am exclusively contracting with
AND DUCTING - -
licensed contractors to construct the project (Section 7044, Business
100,000 + BTU
PLAN CHECK $�_� �
PERMIT
and'Professions Code: The Contractor's License Law does not apply to
ISSUANCE $
an owner of property who builds or improves thereon, and who con.
REFRIGERATION 0-100,000 BTU
PLUMBING $
tracts from such projects with a contractor(s) Iicesned pursuant to
SYSTEM
GRADING $
the Contractor's License Law).
100,000 + BTU
PLAN CHECK $
❑ 1 am exempt under Section B. 6 P. C. for this
BOILERS BTU
ELECTRICAL $
$
reason
SYSTEM REPAIR, ALTERATION
EXHAUST SYSTEM MULTIPLE ,
PLAN CHECK $
MECHANICAL $ -
MICROFILM $
'TOTAL FEE $
-
LAN
Date Owner
I hereby certifythat I have read this application and state that the above
is correct. 1 agree to comply with all city and county
PLAN CHECK $
EP
VANCE PC $_
ordinaAD-
nces relating [e
ordinances antl state ruction, and hereby authorizeced
tenst
his
representati vey of, 1,15 city to enter upon the above mentioned
fodl in ctlon p, po
Signa lrty
1l l e Date /
ISSUE FEE
FINAL FEE $
/yv
Drivers' Li ense or SS ¢
CMF 086-5-46 White -Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor
CONSTRUCTION AND PLANNING
APPROVALS Permit #
Date Inspector
- �. POOL & SPA . cS
Date Inspector
APPROVALSPermit :0 -
1.
Temporary Electrical Service or Pole
43.
Pool & Equipment Location -
2.
SoilPipe-Undrgrn
44.
Steel Reinforcement
3.
Electrical Conduit Utility-Undrgrn
45.
Forms
4.
Electrical Conduit-Undrgrn
46.
Electrical Bonding
5.
Steel ein orce
47.
Rough Plumbing & Pressure Test
6.
Electrical UFER Grn
48.
APPROVAL TO COVER-GUNITE
7.
Footings
-
49.
Electrical Conduit-Undr rn
8.
Foundation
50..
Gas Pipe, ❑ Undr rn, Test
9.
Water Pipe-Undrgrn
51.
Backwash Lines P -Trap.❑ Undrqrn
10.
Structural Floor System
52.
APPROVAL TO DECK
11.
Property Sewer Line & House Connection
53.
• Backwash & Receptor -Final
12.
Street Sewer Connection -
54.
Heater & Vent -Final
13.
Rough Plumbing
-
14.
Rough Electric -Conduit
56.
Electrical -Final
15.
Rough Electric -Wring - - ;,,"r
57.
Solar System -Final
16.
Rough Heating' & Air Conditioning—
b8.
Fencing & Access Approval
' 17.
Ducts in Structure _ -
APPROVED FOR PLASTERING
18.
Ducts, Ventilating
60.
POOL/SPA SYSTEMS FINAL
19. Gas Pipe -Rough &Test _
20. Roof Framing
- 21.
Roof Sheathing
NOTES:
- 22. Frame andFlashing_
23.
Insulation-
24.
Lathing & Siding
25.
Drywall Nailing
26.
Plaster Brown Coat
27.
Electrical Power Meter -Final
28.,
Final Electric
29.
Final Heating & Air Conditioning
30.
Final Gas Pipe -Test
31.
Final Plumbing
-
32.
Water Service -Final
33.
Gas Service -Final
34.
Solar Domestic -Final
35.
Landscape S Hnklin 4 System
36.
Sound Attenuation
37.
Handicap Regulations
38.
FINAL STRUCTURE & BUILDING
39.
Special Requirements Completed
40.
Electric Release to Edison
41.
Gas Release to Southern California Gas Co.
42.
CERTIFICATE OF OCCUPANCY
No Date
t - Applicant to -fill In all spaces except those within heavy border linea and sign all appropriate declarations.
CITY OF COSTA ME?4 p IT. Ny TRACT NO. _LOT NO.. BL
CONSTRUCIjON•PERMIT C - 7 $-Z
;r
Applicant's Mailing Address TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR
Protect Addrsin `` ❑ CONVERSION ❑ DEMOLISH ❑ OTHER
Owner's Namehone V DESCRIPTION OF WORK
x
Address -
Arch/Eng. License NO.
_
Address'
TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL
❑TENANT 'ELECTRICAL ❑ PLVMBING ❑,MECHANICAL
❑ OTHER I - _
PROJECT DESCRIPTION, SQ. FT. OCCUPANCY
CONSTRUCTION TYPE VALUATION$
,
ZONEGRADING CU.YDS. ACREc
A. P. sY•
PLNG. REF. -A% c
TO BUILDING NE
P P Y I
/
Contrect0 ' N� C��a����0y --Phnne� G��I
I .2 G�� (`J7 '�-o•f
Address lmailing)-
License No. 7-�i _
LEFT SIDE YARD
pKG. SPACE REO.
_
LICENSED CO TRACTOR DECLARATION
Thereby affirm that I'am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
Remarks: )
STREET WIDTH
_
,
SPECIAL CONDITIONS:
I hereby affirm that there Is a construction lending agency for the.performance
of the work for which this permit Is Issued (Section 3087 Civ. C:)
Under's Name -
Lender's Address a
OWNER BUILDER DECLARATION'
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
Date
I he
Infor
Law does not apply to an owr
-and who does such'work hl
as, provided that such Impro•
however, the building or Imp,
the ownerlwill have the burch
r the purpose of sale)�
owner of the property, am et
to construct the project(Sectl
,tractor's License Law does ,
r Improves thereon, and who
) license pursuant to the Cont
exempt under Section—
Owner _
r certify that I'have rea51_th
wages as their sole
ttended or offered
The Contractor's
builds or Improves
yyh his or her own
tletl or offered for
n one year of com-
Id not build or lm -
an owner of property who 1
r such projects with a con -
se Law).
— S. & P. C. for this reason
Floor Sinks
-
Gas Service Outlets '
Interceptors
Kitchen,Sink;
Lavatories -
P—Trap
Roof Drains
Showers '
Service Sink
Duct- Under,Ground
Duct - Structural
Duct: Ventilating _
Exhaust System ❑ Multiple
Firepl/Faet.BIL.ICBO$
Heating System & Ducting '
00-100,000 BTU ❑ 100,000 B'
ction, and hereby auth ze pre- I Hood or T e I ❑t
e above-mentlonetl per for Carso .Type 11 ❑ '
Inspeptl0 Lir
:Signature ' Date '
y ;Drivers' Ucense r SS Registers
CMF 0865-46 rev. 12/82
- Accounting; Goldenrod - Assessor
Water Heater
Water Service
Boxes
-679e - E;7L' 'TL
ZONE
BUILDING
Q91.,,11 11, er .
REAR YARD (TO P/L)
RIGHT SIDE YARD - -
PROVIDED .
PARK FEE$ -
�_._ • Meter_LJover100amps _
Sub Panel S
Sub Pole
Motors 00-1 HP ❑1%-8 ,
xtric� Ina Solar 119-15HP 1116-15+
Microwave
Pole Light
Range _
I
Uuliets
Standing Sections
Switches
Trash Compactor
'
Garbage Disposal
Generator 110-5 KW 1:15-15 KW
-
Transformer 015-50KW
1:15U+KW
-
Reinspection Fee SW
„ Reinspection Fee -
$15
Meter ❑up to 100 amps
Issue Fee
3,
' Issue Fee -
$ 3
Zoning Approved By
Application Approved By !
Application Issued By )
'Date
I ate
Date
b —3
4ANICAL'
Refrigeration System
D 0.100,000BTU 11100,006BTU
BUILDING PERMIT $'
,PLAN CHECK- $
.PLUMBING , $;
PLAN CHECK $
'E LECTRICAL$'
,PLAN CHECK- I $
MECHANICAL $:
,PLAN CHECK $
!
SUMMARY OF FEES
I SMIP $
PERMIT
! ISSUANCE $
' GRADING $
t7
$ � '
MICROFILM $
I TOTAL FEE $
LESS
ADVANCED:PC } $
1 FINAL FEE $ oa
System Repair/Alteration
`
-
-
+ Rei,npeRion Fee.
$15
-
Issue Fee -
$ 3
I
h 1=NSTR.UCTIONiAND:PL'ANNING ' `
=�, `
�- . "' POOL,-`--""A
'Date
Permit+,- •Date
APPROVALS "�77 �- - P
Inspector
k •
3APPROVALS =Peimrt#
Inspector
.r
T.imporary Electrical Service or Pole -
,1/'
�.'
.,52",Pool &Equipment Location
.2' 'Soil Pipe-Undrgrnd,'
_" ',53
Steel Reinforcement' _
. -
z'
<'- 3' Etectrical Conduit Utilitv-Undrgrnd.--54.
Forms - -
C�11. Electrical Conduit-Undrgrnd:= P.
i'-',
55� Electrical lBo'nding -
Y
iy
5 Steel Reinforcement }
' = `
. J -
56.. Rough Plumbing-& Pressure Test
.
6: Electrical UFER Grnd.� '- • ° -
,
•+
_ -
57'.1 APPROVAL TO'COVER-GUNITE
-
7. Footings, 1 i ; : ;
-
_
58: Electrical Conduit-Undrarnrf..:
.
8. Foundation
59. Gas (Pipe,:❑ Uridrgrndt, Test...
-.
9. Water Pipe;Undrgrnd. '
-�� -
- 60. Backwash unes,.P-Trap,'O Undrgrnd.
10. Structural Floor System
." -=
61. APPROVAL TO DECK
11. Property Sewer Lined &.House Connection
Backwash & Receptor-Final
12. Sewer-Cap 1
-; `
'63. Heater & Vent-Final.
13. Roof!Drains '
-
64. Plumbing System, Final
,
14. Rough Plumbing ! I -
- -
65. Electrical-Final '
d 15=Rough-Electrical:Conduit- 1
- ! _I_
I" *"
66., Sglar System-Final 1
"iI3!,Rough_Elec ric Wiring., N ! • ,� _ _
:,.
�_� �.
is •-..,
-
• _ -
Fencing &�AccessgApproval
,. y 1
, _
X67.,
17. Rough Winng'Sign£' �• " !
I '. ,
` "_
68.. APPROVED FOR PLASTERING
I
,�
18: Rough'Eleatrical;T,Bar 6il,ingi '
: • y 1
fT '
69. POO L/SPA SYSTEMS FINAL
-
n 1.9. Rough-Heating &V it Conditioning
- I
I • :
FIRE DEPT. REQUIREMENT
APPROVALS' I Permit.#
20: Rough-Factory Fireplace'
-)
1
. 21. Ducts, in Structure
--.
r j
I l 1
70. Underground Hydro
- -
s i22. Ducts, Ventilating 6
I j
I
71. Product Piping O Gas ❑ Oil
F23. Gas Pipe-Rough & Test o i , , ? I
i '
I^ r
72.1 Underground Flush
'-24..Roof framing'
•o
1 -
�"' i -•
73. Undergrnd. Storage Tank' O Gas ❑'Oil
1
25. Roof Sheathingi - -
r - _
{' - 1 •'
74
74. Overhead Hydro
-26. T-Bar Ceiling (Structural). & Monocoat I
_ i
r '"I 175.1
Dry Chemical - -
a 27. Frame and Flashing I
96. Dry Standpipe - -
0 28. Lathing &Siding � � � ;I
77.1 FIXED SYSTEM FINAL
29. ;Insulation
p_
178. FIRE PREY. FINAL -
-
„ 30. Drywall Nailing y
� ! !� a �
I I �
'i i
,Notesa
31. Plaster Brown Coat I Ij Il
i I
r
;) 32. Electrical Power Meter!Ffnal
33. Final Electric
34. Final Heating &;Air Conditioning
l i
'35. Final Gas Pipe-Test. •
36. Hood or Canopy''+ ..
37. Final Factory Fireplace
38. Final Plumbing I
39. Water Service-Final! i 1
•
40. Gas Service-Final I i
c
;
1
; i
41. Solar Domestic-Final
42. Backflow Preventers
j
43. Backflow.lrrigatlon�
�-
44. Landscape Irrigation,System
45. Sound-Attenuation ^ 1;
46. Handicap;!Regulations
-
-
1
47. FINAL STRUCTURE & BUiLIDING li
' 48. Special Requirements Completed'
49. Electric Release'to Ediion� !
_�
_ ._ _
__ •... ' �.;: '
50. Gas Release to Southern California Gas Cu
!
: •'
51. CERTIFICATE OF;OCCUPANCY
No Date
_
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations
CITY OF COSTA MESA
CONS,TRUCTION PERMIT
PERMIT NO. j .
TRACT NO. •.
I LOT NO.
BLDG.,NO.'
t
"
4310 "/'_
_
-
,
Applicant's Mailingg A/ddresscit
Project Address. -U^6(e r�lFyU /AuE _ �
-r2M CAr �A/�cll P �s
Owner's Name _ hone37--K-3_'5
Address Z..�' 1_7 Ili 5171 C' M'
TYPE OF CONSTRUCTION NEW ADD ALTERATION - REPAIR
❑ CONVERSION ❑ DE LISH ❑ OTHER
DESCRIPTION 07f� WORK
%�
-
IREGULATIONS
TYPE OF PERMIT U GRADING LJ FOUNDATION LJ STRUCTURAL
❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑. OTHER
PROJECT DESCRIPTION SD. T. OCCUPANCY
CONSTRUCTION TYPE VALUATION$ I
ZON)= GRADING GU. YDS. ,ACRES �
-
A. P 10 -
ZONE
Arch/Eng.' License No.
Address -
PLNG. REF.* BUILDING
-
r
To
TO BUILDING." 'REAR YARD (TO P/U _'
P PE Y I E
Contractor's Nam FL's �GT' hone� py2-9 79
Address,) mailing) ,7j 8� �Q ci2, t�iC/�,
l b �l3 -
License No: -
'LEFT SIDE YARD RIGHT•SIDE YARD '
PKG.SPACE REO. PROVIDED
I
'
LICENSED CONTRACTOR DECLARATION - '
Remarks: -
�'
STREET WIDTH '
' •PARK FEE $
-
f hereby affirm that 1 am licensed under provisions of Charter.9 (commencing
^
with section 7000) of Division 3 of the Business and Professions Code, and
l
SPECIAL CONDITIONS:
'
1
-
I
'
my Iicense,is in ful rcePn ffect.
I1 . CI f' _` Lice a No G 1
Datil—`-•_" Signature
WORKERS' COMPENSATION DECLARATION-
ereby affirm that I have a certificateof consent to.salfdnsure or a certiflute_
Workers' Compensation Insurance, or a certified, copy thereof (Section
„d00, Lab. C.)
PLUMBING --
Bar Bar Sink I Sewer Cap
I
ELECTRICAL
'
.. _ _ -
- Backflow'Preventer _ I " Sewer Connection - r. ,
_. Automatic Washer... - .. .�_ Meter ❑over 1,00 -amps
-
Backflow Irrigation
Solar_ Collectors
Construction Pole
I Sub Panel
Policy No. Company
8 Certified copy is hereby furnished. • I (
Certified copy is filed with the city Building Division. I
Data - - Applicant I
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(T his section need not be completed if the permit Is for one hundred ($100) or
less)
I certify that In the performance of the work for which this permit is Issuetl I
shall not employ any person In any manner so as t beq come subject to the
Worker Cgmpen5atlon. Laws of Califo ia. �./J•s.Q'Gf/��_N
Date G `"ate Signature �j^{y�G4 L�
NOTICE: If, atter making tMo tleclarall6n, you should become subject to the
Workers' Compensation provisions,of the Labor Cooe; you must forthwith
comply ,with such provisions_ nor, this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY I
I hereby affirm that there Is a.con5truction lending agency for the performance
of the work for which this' permit Is , Issued __(Section 3097 Clv. C.)
Lender's Name -
Bathtubs
Solar Piping
_
Cooking Unit
Sub Pole
I
Clarifiers Solar Tank _
Dishwasher 1 Motors ❑0-i HP ❑1X$
-
Dryers ❑Gas• ❑Electric -- .
.I nc. scaler'❑9-15 HP ❑16-15+
Dishwasher i Swimming Pool w/Spa 1
I
Drinking Fountains Urinal �1
Fan Microwave I
':
-
Floor Dfains, Water .Closet ,
F.A.U. Pole Light I
-
Floor Sinks Water Heater - -
- '
- Fixtures ' 1 .Range" _
Gas Service Outlets - Water.Serdice
Device Boxes Sign ,
1
Interceptors -
Outlets Standing Sections
g
Kitchen Sink. - '
Switches Trash Compactor
Lender's Address.
OWNER BUILDER DECLARATION,
I hereby'affirm that I am exempt from the Contractor's License Law for the
following reason (Section' 7031.5 Businessand Professional Code: Any city or
county which requires a permit to construct, alter Improve, demolish or repair
any structure, prior to Its Issuance, also requlres the applicant for such permit
to Ills a signed statement that he/she Is licensed pursuant to the provisions of
,the Contractor's License taw (Chapter 9 (commencing with Section 7000) of-
=-M•dslon 3 of the Business and Professions Code) or that he she Is exempt
'-)-'refrom and the basis for the alleged exemption. Any vlolatlon of Section
'l1.5 b . any applicant fora' permit subjects the applicant to a. civil
_ enalty aYnot more than five hundred dollars ($500). -
1, as.ownor of- the property or -my employees with wages as their sola
compensation well 0 the work, and the structure' is not :Intended n offered
ly tonan antl; Professional Coda: The Contractor's
for sale Law doe of apply
License taw awes not apply town owner if a property who builds or Improves I
such work himself/herself sarelf or through his or her own
thereon, and who does that
that such -improvements are not within o or eofferedar'of c for
e le. I , ho ever. the
sale- If, however, the building a Improvement is g h she di one yearof cum-
pletlon, the owner;wlll have the burden of proving he/she tlitl not build or Im-
Eve for the purpose of sale). I ;
- -
Lavatories, -
Garbage Disposal
-
-
p_Tia p• \ - '
Generator ❑0.5 KW ❑5-15 KW
- - -. -
Roof Drains ' -
-
Transformer ❑' 15-50 KW
,
❑5D+ KW Reinspection Fee $15'
'
Showers ' _ - Reinspection Fee S15
Meter, up to 100 amps Issue Fee $ 3
Service Sink' I Issue Fee S 3
•u -
_
Zoning Approved BY I Date
Application Approved By j I ate
I l
Application Issued BY I -'' Date
c
.' MECHANICAL y 1
Boiler "�
-
Refrigeration System
❑0-100,0008TU ❑100,000 BTU,
Duct Under Ground 1
SUMMARY OF FEES
, ,
BUILDING PERMIT $, SMIP I $ 1
1
Duct - Structural
System Repair/Alteration
. I, is owner of the property, am exclusively contracting with licensed con- 1
.tractorsto construct the 'project (Section 7044, Business. and Professions Code:
The Contractor's License Law does not apply to an owner of property who I
builds or Improves thereon, and who contracts for such projects with a con-
-PLAN CHECKI $
PLUMBING $'
PERMIT
, I ISSUANCE I
$
I
Duct -.Ventilating -: 1 t-
_.,l_ _- '
Exhaust System El Multiple ❑
'tractors) license pursuant to the Contractor's License Law). I
I
❑ I am exempt under Section B. & P. C. for this reason
' 1 '
PLAN CHECK• $,
ELECTRICAL; $
I ,
PLAN ¢HECK $
;MECHANICAL $'
'PLAN CHECK $
GRADING (
;
MICROFILM -
1 ! TOTALIFEE'
LESS I
ADVANCED PC j
$ ' '
'
$
$
$
,
$ '
Fifepl/Fact: Bit. ICBO 9P'
Date Owner•
hereby certify -that I have -read this ' application and state that the above
information Is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize repro-
Inspection of 'this 'city to liter upon the above-manlionetl property fo•Zr i
inzpectlon pu ps - D_Z
-
Heating.System&Ducting
E10-100,000 BTU 010 .000
7
i
—T- -- - _ -
-
Hood or Type I ❑
T e II ❑
Reitszpeetion Fee
$15
Regi
Registers
-
Issue Fra
$ 3
'Signature Date 1
Drivers' IJc se or,SS $
i
I
FINAL FEE'
$ '3
CMF 086546 rev. 12/82 White - Building; Canary - Applicant; Pink _ Accounting; Goldenrod -Assessor
9
T'
?CONSTRUCTION AND PLANNING- -'
APPROVALS. Permit#L Date• �
Inspector
POOL 'A
APPROVALS Permit
Date
Inspector
?. Temporary Electrical Service or Pole-
52. Pool & Equipment Location
• 2: ,Soil Pipe-Undrgrnd:. - ,
53. Steel Reinforcement
3. Electrical ConduitUtility-Undrgrnd.
54. Forms'
•4. Electrical Conduit-Undrgrnd'. - -
-
55. Electrical Bonding - - - -
5. Steel Reinforcement i
56. Rough Plumbing .& Pressure Test
-
6. Electrical UFER Grnd. -� --
57. APPROVAL•TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrarnrl.
B. Foundation
-
59. Gas Pipe, 0 Undrgrnd., Test'
9. - Water Pipe-Undrgrnd.-Trap,
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 Wiririg Sign.
68. APPROVED FOR PLASTERING
18. "RoughElectrical-T'Bar Ceiling
- •
69. POOL/SPA SYSTEMS FINAL
19.'Rough Heating & Air Conditioning
_
FIRE DEPT. REQUIREMENT -
APPROVALS Permit '
20. Rough Factory Fireplace,
21. Ducts, in Structure,
70. Underground Hydro
22. Ducts, Ventilating _ ,
71. Product Piping 0 Gas OOil
X23. 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
i
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
,
Notes:
31. Plaster Brown Coat
'
32. Electrical Power Meter -Final
33.•Final Electric
34. Final Heating & Air Conditioning
'
35. Final Gas Pipe -Test
-
36. Hood or Canopy
_
`-
37. Final Factory Fireplace _
38. Final Plumbing
39. Water Service -Final' '
40. Gas Service -Final
41. Solar 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
_
CMF 0865-46 rev. 12/82 White - Building; Canary - Applicant; Pink - Accounting: Goldenrod - Assessor
vo, uaye vnpvaa, {
_ -" _- _ - _ , , _ Applicant
_MHA
to fill in all spaces except those within
_ _ p p
heavy borderlines and sign all a
Y 9 pProorlate declarations.
_
9491 5127/63 41.75 TL
Kit-chen'Sink
CITY OF COSTA MESA
CONSTRUCTION PERMIT �j2b2)
f
PERMIT NO.
S 24
TRACT NO.
•LOT NO.-
I BL
lY1
1
1
N
•�
-
-
Applicant's Mailing�AdS1�ss� '
PfOjebtAddress opGG 'e'V-
Owner i Name .TC4iii1( 6ifc.,ic hone P
TYPE OF CONSTRUCTION- LJ r4EW'LJ ADD LJ ALTERATION REPAIR
❑ CONVERSION ❑ _ DEMOLISH ❑ OTHER
r -DESCRIPTION OF WORK
_ _
- '-ZONING,REGULATIONSi
Date
-TYPE OF PERMIT - GRADING -111 FOUNDATION -STRUCTURAL
�❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑MECHANICAL
❑ OTHER -. -
- - -
PROJECT DESCRIPTION SG. FT. OCCUPANCY
CONSTRUCTION TYPE 'VALUATION STI
-
ZONE • GRADINGCU.YDS. ACRES
r
A. P..5M'
•ZONE '
,
Arch/Eng.' _ License NO. 1
Address '
PLNG. REF.* '
' _ 'BUILDING, - _
11.
TO BUILDING
V I '
REAR YARD (TO P/L) -
-
_'-
- �-. F .QCT' a 48 7yrt
Contractor's Nam hon
-
'LEFT SIDE YARD
,
RIGHT SIDE YARD
D ,d
Address (mailing) P•a,/a 0/ %J9%� !}J �lCj/O��L 7
i7/
License No. 1 %a%
PKC. SPACE'REO.
PROVIDED ,
__
LICENSED CONTRACTOR DECLARATION
Remarks: _
-
STREET WIDTH '
- PARK FEE$
Service Sink 1
;. Issue Fee ' $ 3
I;hereby affirm that I am licensed under provisions of'Charter,9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
(
I, as lowner of the property or my employees with wages as their sole 1
-_
SPECIAL CONDITIONS:
ISSUANCE
compensationwlll.do the work, and the structure'Is not Intended or offeretl_
7044; Professional -
my license is In full force and �� ��
license Class ense No
Date Signature
WORKERS' COMPENSATION DECLARATION
ereby affirm that I -have a certificate of. cc nsen Lto selfansure or a certifl Ute68ckflow'Preventer-
Workers' Compensation Insurance, or a certified, co y thereof (Section '
..600, tab. CJ !
y �•G 'w
PLUMBING
' $
Boiler
Bar Sink Sewer Cap
,
ELECTRICAL ,
- Se Wer Connection -
-
Automatic Washer_... -,
�Meter-El over 100 amps' -
Backflow Irrigation
-
Solar Collectors
-
Construction Pole
- '
'Sub Panel ;
$ '
'Policy No. Oi company
[] Certified copy is hereby furnished. i `
Bathtubs
- -
Soler Piping
CookingUnit
'Sub Pole I
rttf copy is d with the city BuI1dIn Dlvlsion 1
Gate�rL��Y ADPIIUnt T_(�'�/ 1 _
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section need not be completed N the permit Is for.one hundred ($100) or
:less):. , I I '•
I certify that in the Performance of the work for which this permit Is issued I
shalbnot employ any person In any manner so as to become subject,to the
Workers' Compensation. Laws of California. I
Date ' Signature ' ;
; Clarifiers- t
Tank
Dishwasher
Motors E10-1 HP K1 1 %-B i
_ _ _Solar
Dish Hasher Swimming Pool w/Spas
Dryers ❑Gas. ❑Electric
Y
'
'Inc. Solar* ❑5,15 HP 16-15+
-
Drinking Fountairis Urinal
Fan
;Microwave + '
!
-
Floor Drains
WaterGoset
FAU- I'
'Pole Li ht ' I , '
i
NOTICE: Compensation er -tms tlons of on, you ffiouldCode,,you subject h the•'.
Workers' th, suc provisions of the Labor. hall byou must forthwith
' comply with, such permit .shall be 'tleeme0i revoked:
- • - - - - - -
- �� Floor Sinks-,- •- � -Water Heater• -' ^: �
_Fixtures,' _
I
_ flan e-
9 . - f
-
Gas Service -Outlets
.• Water Service - -
Device Boxes
-
Sign' V
tractor(s) license pursuant to the Contractor's license Law):
LENDING AG NC
CONSTRUCTION LENDI a. AGENCY' i
I hereby affirm that there is a:constructlamlentling agancy.for the: pertormahce'.
Interceptors ' -
-
Outlets '
. �
Standing Sections
CMF 0865-46 rev. 12/82 White - Building; Canary - Applicant; Pink - Accounting: Goldenrod - Assessor
vo, uaye vnpvaa, {
of the work for which -this, permit is Issued (Section 30971 Civ. C.)
- tl •=
- -
Generator El 015 KW 05-15 KIN 1
Lender's Name'
Kit-chen'Sink
1'
-Lender's Adere s
BUILOER DECLARATION
Lev ,
)OWNER
Issue Feel
I hereby affirm that I am`exampt from the.Contractor'S License Law for the'
following 7031':5 Business Professional Any
) e P—Tr'l
P, ' c
Date
reason (Section and jCode: city or
County which, requires a permit to construct, alter Improve, demolish or repair i
`any structure; prior to Its Issuance, also requires the'applicant'for such permit'
; -
_
- ROOf;Dr3lns - . • '-'
_
"' �I •1
Application Issued By
.t�ohefile a signed statement that he/she Is licensed pursuant to the provisions of
nate
_
,. he Contractor's License Law (Chapter 9 (commencing with Section -7000) of
yq Islon;3 of the'Business and' Professions Code) or that, he she, exempt
(
-
Showers (i
'
RBIOSpedtlOn Fea �' !$15
4efrom and the basis for the alleged exemption: Any-vlolatlon-ot Section
'applicant
s�
BUILDING PERMIT $.
'._
I SMIP . I
s .31.5 by.any applicant for, a • permit -subjects .the to a- civil
enalty of not more than five.hundred dollars ($500). 1 ; • , . _ I , I
Service Sink 1
;. Issue Fee ' $ 3
PERMIT
(
I, as lowner of the property or my employees with wages as their sole 1
,PLUMBING $
I I
ISSUANCE
compensationwlll.do the work, and the structure'Is not Intended or offeretl_
7044; Professional -
' j a MECHANICAL • '
for sale .15eciio0 Business and Code: The, Contractor's
License Law does not apply to an owner of a property who builds or Improves
"tloes
' $
Boiler
Refrigeration System (
,
$
thereon, and who such work himself/herself or through his or her own
'
'
MECHANICAL $
� � �
employees, provided that such Improvements are not Intended or offered for
i sate. If, however, the building or Improvement Is sold within onoyear'of cam-
$ '
Duct'- Under,Grou lid 1
LJ0-100AOOBTU 0100,0006TU
-
LESS
j ADVANCEDPC
t $ '
pletion, the owner will have the burden of proving he/she did not bund or Im-
rove for, the purpose of sale). ; :
Duct -Structural 1
I
System Repair/Alteration
Ll 1, is owner of the property, am exclusively contractingwith licensed con-
$
Ltractors.to. construct the project ISection.7044, Business and Professions. Code:
_
Duct - Ventilating - , _. _'
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 ❑ Multiple El
1
tractor(s) license pursuant to the Contractor's license Law):
El %am exempt antler Section B. & P. C. for this reason
Firepl/Fact. BIL ICBG iR
1
Date I - owner - �' - 1
Heating System &Ducting
Ll-herebys certify that 1 have read -this application -and state that the -above^
' ^
E10-100,000 BTU ❑100;000
"'- -- -
Information is correct. I agree to comply with all city.and county ordinances j
and,stat9 laws relating to buildin construction, and hereby authorize repro- ;
sentatives of 'this "to en upon the above-mentioned property for
I
1
Hdod or Type 1 ❑'
- Reinspection Feer
$15
,cit
Inspection Dur ses. ) G-
� e II ❑' t
Cano TVP
r
i t O! = - 3 1
519nature
I j
I Issue Fee I
$ 3
CMF 0865-46 rev. 12/82 White - Building; Canary - Applicant; Pink - Accounting: Goldenrod - Assessor
vo, uaye vnpvaa, {
, ;
1
Generator El 015 KW 05-15 KIN 1
Transformer El 15-50 KIN
1 j
' 1350 t KW -
., ;Reinspection Fee 1 $1.5
Meter ❑up to 100'amps
Issue Feel
l $ 3
Zoning Approved By
Date
I
Application Approved BYate
Application Issued By
nate
2
SUMMARY OF FEES
Z5.0�
s�
BUILDING PERMIT $.
I SMIP . I
$
'PLAN CHECK $'
/o '2-
PERMIT
,PLUMBING $
-
ISSUANCE
$ r
'
PLAN CHECK $'
GRADING
' $
'ELECTRICAL. $
i
•
$
PLAN CHECK' $
MICROFILM
i $ l f
MECHANICAL $
� � �
' TOTAL FEET
: ,
$ '
PLAN CHECK I $
-
LESS
j ADVANCEDPC
t $ '
'
FINAL FEE
$
C1 PLA
-Ii�.:-POOL )A-_:
6CONSTRUCTIOWAND'�
APPROVALS ° Date
rl r
-APPROVALS- Penrnit.:i
Date
Inspector.'
I nilp
• I Temporary Electrical Service or-Pold'
s'
62� Pool &.tqui'p�net Location
no
L -o
n� Soil Pipe-Undr 'grn'd*.,
5
153,7 Steel Reinforcement'
12,
t
p
- 3:7 6ectri6l Conduit._Utilitv-Undrqrnri.:,.54r.
Forms.
5
4: Electrical Conduit-UndirgrndU
Electrica [,,Bonding
.55.-.
5- Stiiel Reinforcement
'`56 R &Preisur6 Testough Plumbing
6. 'Electrical UFER Grnd." j
11
5711 APPROVALTO COVER-GUNITE
7. Footing's, A
:ca:nu-c1rarnd_
&ctrfC6ditUn
•55$'
8. Foundation
:$9. Gas Pipe,0-Undrgrnd:' Test
9. Water Pipe-Undrgrrid.,'i
rt
_
60. Backwash Lines,.P-Trap, 0 Undrgrnd. -
10. Structural Floor System
6v "TobEC'K
61. APPR AL.
11. Property Sewer Li
Ol.?
v.&pReceptor-Final
12. Sewer Cip
%
Heater .63. H e
t Vent -Final
13.1 Roof',Drains
64. rlumbing.System;Final
14Rough Plumbing
-'Eiiii . Elic'trica&ina'ln'
15.- Rough Electrical -Conduit,
_66iSolar
,Syite-m:FinaI__%_
W,ir'.
Electric in L
,J6 Rough Ele.
Fencing ccess Approval
1,ic
l.
;Rough Wiring Sign•
"R
68., 14 -PLASTERING
AP qYE D FOR
-
ca Y,�ai Ceii
1$ Rough Electri' I- r, Ceiling
65.: ROOUSPA SYSTEMS FINAL
1pl` Rough.Heating &fAir Conditioning 1!
FIRE DEPT. REQUIREMENT
h
Penmit
26. F60 Factory Fireplace. I
•APPROVALS
21. Ducts,:.in StructureN'
Underground Hydro
22. Ducts, Venfilziiing
71.1 product � Piping b Gas 0 Oil
I
.P ough
23. Gas' ip6-R Test
t-
'gr
72.1 Under ound Flush
IQ4. 'Roof Framing'-
n ir 1
73.: Unde{grncl. Storage tank .0 Gas 0 Oil,
25. Roof Sheathirig
1
7.4.: Overhead Hydro
4-26. TwBar Ceiling (Str'cturaii. Mo :iat'�
U
g noF
75 DryChemical
27. Frame and Flashing
76.; Dry Standpipe
28. Lathing N -Siding I r,
i642
77.1 FiXItDS'YSTEM2FINAL
2 Insulation 5
1
FIjREPREV. FINAL
178.j
.'�O. Drywall Nailing
j
jNot'es:;
Plaster Brown Coat
T_
131.
'32. Electrical Power Meter'Finall
,33. Final Electric
34. Final Heating &jAW Conditioning
35. Final das:Pip1e.f6st`
36. Hood or Can4)w7t 1 1, 1
37. Final Factory Fireplace cc 1 of
:.1
t�
38. Final Plumbiri g
7;
er r, vice -Final:
39. Water Service-Final:
40. Gas Service -Final
41. Solar Domestic -Final
t
42. Backf lo wjPreventer
43. Backfl ow:, Irrigation,
44. Landscape lrrigatibn`Sysie'm j'
45. Sound; Attenuation >
L]
46. Handicap l I 1 1
r
i 'Regulations rj
M
I r 1
47. FINAL STRUCTURE & BlU_I L'DI*NG
1
48. Special Requirements Completed ll
% 7
49. Electric Release to Edisonj 1
50. Gas Release to Southern herh6lifolmiaGas6o
1
51. CERTIFICATE OFIOCCUPANCY
J _L
.... __L I -
No Pate
Applicant
to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
_ _ _ _ _ ___
CITY OF COSTA MESA
CONSTRUCTION PERMIT
it
I _ wt
58i9j 3(17%83' " 26:50 7L
PER IT NO. _n TRACT NO.
%
LOT, NO.
BL
,5'/poS�
,NEW
Transformer ❑ 15.50 KW
- , -' ' I'i a :•. , !
p - • t - ' ' I '
Applicant's Mailing Address I
Project Address' '�60��N
l4 e(J�
Owner's Name . Phone - �
- TYPE OF CONSTRUCTION ` ADD' ALTERATION,' REPAIR a
_❑ CONVERSION CONSTRUCTION
❑ OTHER +'
DESCRIPTION OF WORK
ZONING REGULATIONS '
Address 2?4�iSIIIY 0"41-
-TYPE OF PERMIT GRADING FOUNDATION 'STRUCTURAL
El TENANT 1:1 ELECTRICAL .111 PLUMBING ❑-MECHANICAL
' c
PROJECT DESCRIPTION SQ. FT. '- OCCUPA v
-.;
i CONSTRUCTION TYPE VALUATION $
ZONE GRADING CU.YDS:'ACRFc
ZOE 1 - +
A. P:# N
'
_ _
Arch/Eng.+ - License No' j
Address':❑,'OTHER
Contractor's Nam - hones "1 i
Address (mailing) -'
PLNG. REF. _ BUILD - j
'
•-PROPERTY BUILDING- E ! _ , 'RE R VAR l I
`
- - - - - ' '- I 1
__
Showers ---i .. 1 '� '
-
LEFT SIDE YARD i IG TSID
$15
PKG. SPACE RE ` ROVIDED
a signed pursuant provisions
The Contractor's License Law (Chapter 9 (commencing with Section 7000) of
,'vision 3' of the ands Professions Code) -or that he/sheds exempt
License No: �f'�%711� ' I
LICENSED CONTRACTOR DECLARATION
Chereby'affirm that Lam licensed under provisions of'Charter 9 (commencing
Remarks: + -
1 _
STREET WIDTH i PARK FEE $
Meter ❑up to 100amps
(
- -
It
with section 7000) of Division 3 of the Business and Professions Code, and
I I ' '
SPECIAL CONDITIONS:
my license'is In full force and'effect. +
License Class I License No. I I
i !
:: ' Issue Fee ! I
-
j i PLUMBING
Date ' ' Signature ' ` '- !
WORKERS' COMPENSATION DECLARATION
'ereby.affirm that I have a certificate of consent.to self -Insure of a certificate—
Workers' Compensation Insurance, or a certified copy thereof (Section
! I
e800, Lab. C.) I I
Bar Sink 1 Sewer Cap
- - -
ELECTRICAL -
'
-- - - - .- _ _ -.
Backflow -Sewer Connection_ -
Automatic Washer_'..._ � _ •Meter -Dover -1 00 amps, -
T' -'- -- -
enalty of not more ($500). , ;¢
i 1
i -.- -
Backflow Irrigation I Solar Collectors_
Construction Pole ;Sub Panef i
' '
I
Policy No. ' Company - 1
eCert Hietl copy Is hereby furnished. 'j ' , i ' , I
Certified copy Is filed with the city Building Division. 1 d'
Applicant j _,_
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION'
(This section need not be completed If the permit is for, one hundred (E300) or
less).. i I ,
I certif,'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 1
Workers'( Compensatl on; Laws of California.; ' j
I Date Signature j ' ' I
NOTICE: If; -after- inakiog'[his declaration, you should become subject to -the -I
Workers', Compensation provisions of the Labor Code, you must forthwith
comply ;.with, such ;provisions or this - permit , shall be ,deemed revoked.
CONSTRUCTIONLENDING AGENCY '
I hereby affirm that there is a:constructiomlending agenoy:for the performance) +
of the [work for which .,this permit-is:issued-(Section 3097• Civ. C');
t r �o - ' -
Lend'er's Name!- - _
.I - - I
j Bathtubs ; Solar Piping !
Cooking Unit I I j ' Sub Pole
I I
_• C_lari_fie_rs t _ _ I Solar Tank ' - l
Dishwasher ( (Motors ❑0-1 HP El 115-8
i
I
- Dryers ❑Gas ❑ElecGrric '-' •lnc.Solar ❑9;15 HP ❑16-15+ ' ,
I,- as Towner of the)Property or my employees with wages -as their sole i
)
Dishwasher ( i Swimming Pool w/Spa ;
I
-
Drinking Fountains I 'Urinal
Fan; 'Microwave i 1
I
I - -
Floor Drains [ i WaterCl Os¢t� - - j- !
F.A.U. j .Pole Light 1_ i
+
-
--
_ l _
- - - FI00r Sinks-'� -- - � - Water Heater � - - - ^ - - -
-
1 i'Range[ I 1
Fixtures , A
- -- - -I--- - - .-
I
_. - .
/ ! �. '
Gas Servic`eS -Outlets - ,n iWater Service + - -f [
,
Device Boxes I Sign'
9
Interceptors • I _ - ;� ' - ,7 _
•' - - - - -
'
Outlets I Standing S¢ctiOns !
i
Switches I i i p 1
Trash Compactor
- i ` ,.
Kitchen'Siilk' ., j -r -. - �' - t-'
-
OWNEWBUILDER DECLARATION_' i , I [ 1
b fit th t f in t t ' 'LI f the (
•' ( (' I i I �' 9
Garbage Disposal I 1
I
❑ ❑ [ ' '
I here y a rm at I am exemp rom e.Con rac or s cense Law or e i
following reason (Section 7031';5 Business antl Professlo6allCode: Any city or
'county which requires a permit to construct, alter improve' demolish or repair
-
�'
_f I
P -Trap; ni I '-
_ I,. q.
_ T j i7 I
Generator 0-5 KW 5-15 KW
r
I
Transformer ❑ 15.50 KW
any structure, prior to Its Issuance, also requires the applicant for such permit
to file statement -that he/she Is licensed to the of
_
Roof Drains; _
,•
1
' 05U+
'
'
- - - - - ' '- I 1
__
Showers ---i .. 1 '� '
'
7 Remspectignf Fee
$15
a signed pursuant provisions
The Contractor's License Law (Chapter 9 (commencing with Section 7000) of
,'vision 3' of the ands Professions Code) -or that he/sheds exempt
KW'
+
'
Reinspection Fee I
'
Meter ❑up to 100amps
(
'Issue Fee I
It
;Business
{-=�srefrom and the basis for the alleged exemption. -Any, violation'of Section
_
' i -
` ;_ „
.,,
Service Smk 1 (
i !
:: ' Issue Fee ! I
$ 3
42131.5 by -any applicant for al permit, subjects the applicant to a. civil-
than five honored dollars •
',
- -. - ,
B
- -
'
enalty of not more ($500). , ;¢
i 1
1
, (.
e
Zonin A roved
9 PP Y
' Date
I,- as Towner of the)Property or my employees with wages -as their sole i
• I I
I
I [
I
j
V. „ MECHANICAL' 1
7 _
compensation will -do the work; and the structure is not Intended or offered
Professional. '
Application Approved By
'Date
i
_ _
gpiler ., I [
•'%
Refrigeration System "
Bu to an l antl, Cotle:! The' Contractor's
for sale Law owner a property who builds or Improves I
License law tloes not
of apply
Application Issued By I
J
Date ? /S-[' .,,J
s, such work if
tnrreo. ; s, who does, such work himself/herself or through his or her own '
Intended or offered for
employees, provided that such -improvements Is
If however, the building improvement is s
'
- b I
Duct 'Under, Ground ;
-
i
❑4100,000 BTU ❑100,000 BTU-
+
)
1
SUMMARY
FEES
,
sale- or
he within one year,of Som- t
pletiof the owns ose 11 have the burden of proving he/she tlitl not build or im- t
r�oya-for the purpose of Sale): t I i
I
'BUILDING PERMIT
$
r7
LL—
OF
SMTP
$
i r SO
, I
DUct -Structure) System Repair/AlteratlOn -
i ( j (
Ifd' h.licensetl
I
i
1 1
i t
!
%
Duct- Ventilating ! _j_„ I
's __-�_ +
I, as ownei m the property, am excl usivaly tontractingjwit con-
-tractors to cc nst r uct A he! project (Section.7064,.Business antl P.rofesslons Code: _
`PLAN CHECK'
$
�
� PERMIT
1
'
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- `
i
'PLUMBING
$
ISSUANCE'; t
$ 1
1
Exhaust System ❑ Multiple ❑'I
i I
tractor(s) license pursuant to the Contractor's License Law):
❑ Lam exempt under Section B. & P. C. for this region 4
'PLAN CHECK
$
I GRADING 1 ,
I
$
'1
Firepl/Fact. Bit. ICBO # !
,
l,
:ELECTRICAL
I I
PLAN CHECK. I
'
$
i
$I
Z !
MICROFILM
; I
$
$
[ '
Date I 1 Owner; i 1 i -.
9 -hereby, -that -I 'have-read•this that the above•-
--
Heating[System&Ducting !
❑0-100,000 BTU'❑100,000BT - - - •- -'-f '-
certify application and state
information is correct. I agre o moly with all city and county ordinances ..
to
r t !
t
MECHANICAL ,
$
TOTAL'FEE'
;
1
$ ,
I
Hood or ' '
TY,PeI ❑ I
Deno -T a Ih ❑, '[ t
i
Reinspection Fee
I
i
$15
i
and.state laws relating n constru<tion,lantl.hareby authorize repre- I
sentatives of Ithis !city nter upon the above-mentioned pr per for
Inspection our o , 1 'I '
Se i I
I
PLAN CHECK' ;
$
i
+
1
' LESS
+ ADVANCED PC
$ -;
•
1
Registers t (
i
( Issue Fee
$ 3
Sig atI '�%ro/1 (
Driver IJcerA rISS # 1 i
l
I j `
1
(
i -
I ,r
I FINAL FEE 1
$ 1
CMF 0865-46 rev. 12/82 White - Bulltling; Canary -&PhEa nt; Pink - Accounting; Goldenrod - Assessor
1
c1CONSTRUCTION,AND',%' NNING,�;;= -. :-'-'
.'`--I: .
.';c�,?,+ ,4:_.:_POOL PA,,�-- �..::
--:-�, c
-�• •,
t• O - -' r °' [�J.$-(a}'%% ; `Date •
> .'APPROVALS Permir#=
,Ins actor
.•r p
-
APPROVALS -Permit - '
, Date'
Iris eetor
P, -
,#_
^' Temporary Electrica`I SerJice or Pole
"T' .,`
Pool & Egwpmen"t, Locations
WY Soil Pipe=Undrgrnd._ ��_ { I
�- `-
at
SteelR'e'inforcement
r 37 Electrical Conduit Utility Undrgrndr
; _
-
`54r Forms r - _-
- I
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_
4 Electrical Conduit-Undrgrnd� - ` °
.c
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a,,, -
'�55°- ElectncaGBonding' ; �`•��
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5 Steel Reinforcement + r,:
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'x -.'
56. Rough PI`umbing-& Pressure Test `
='
_
u`
6.IElectiicalUFERGrnd.+ 's,'=, ��•'
•`
��57'APPROVALT000VERrGUNITE�
rl�
z,'-
.
7. Footings 1;1 ' I ns -
is 4
_-58�
'Electrical-Coriduit•Undrornd.,--
,j S
8. Fountlation I ' �..-i' I c o 1 �'y'
-,
+;59. Gas ipe' El Undrgrnd Test-
1 I
9: Water Pipe -U drgrnd.
'--60. Backwash` Lmes •P, Trap ❑ Undrgrnd - .
-
10. Structural Floor System ; f
,
_
,.61. APPROVAL:TO DECK
11. Property Sewei One ,& House Connection
.j
X62. Backwash &,'Receptor -Final_-= -
12. Sewer Cap i 1 :'
�. .V
I
_
13. Roof -DrainsI I
;-.
64. Plumbing System., Ina
14. Rough Plumbing I `.1'765.
Electrical=Final '_' 1;_.
I'15 'Rough-ElectrlcaI-Conduit's r. ' -T ..i
1"T.
_ _i.-1 -
_66TSotar;Systefi-Final - -'-
Q 1 ti
`-16.°R6ugh-Electric Wiring; : � ';T -
-" j-,�, �
%-i , � � m' �'J67Fencing
&-Access Approval - -•r- -
-- -
--; ;
.
RoughWirin
fl
APPROVED F1Z.OR'PLASTERING
1.
c
.68.
-
I,I 18.E Rough`Electrical T1Ceilings �
1 ,
j "-l`.
I m i
P9.�' POOL/SPA SYSTEMS_FINAL I
_
Q 19. 'RoughrHeating &{Air Conditioning'
'FIRE OEPT.'REQUIREMENT
APPROVALS' ' Permit #
- -
20: Rough;Factory Fireplace
I
I 1
f I ' I
' Ducts„in Structured r ' !
(l
I
'
` -' I I - '
21.
e� <. 1 I i! ,1 i
{
I i
{
107.E UndeI
rground Hydro I(
t -
st22. 'Ducts, Ventilating.71.,
! 1
Product Piping 0 Gas 00il
23. Gas 'Pipe -Rough & Test
(
;,7, 2.Flush
Roof Framing
I it+3 i
I
`° I {:
173. Undergrnd. Storage Tank O Gas 0 Oil
1
I'24. 1; .'
I
C..'
?
P 25. Roof ShekHirig
I I I j,^-
I
I
{', (� ' =
X74.1 Overhead Hydro
I
26. ,T�Bar Ceiling (Structural). & Monocoat (
I '
' i
T
75: Dry Chemical
-
4.27. Frame and Flashing { :'7 I�76.i
Dry Standpipe
28. NL'athing &'Siding1 c I { 1 11 11 I
I
e l I
FIXED SYSTEM FINAL _ : I
I
!
{77•;
29. Insulation •-, I I
a 2 �.
11!
1 I
78., FIRE PREY. FINAIL
i
n I ?. 1
I
�'30. Drywall Nailing
I I I
{ { I
INotes: I ,
Y-�31. ll -aster Brown Coat i, { {� I
{ 1 T
T
II
2. ,Electrical'PowerMeter;Flnal
62.
p 33.IFinaI Electric
34. Final Heating &IAir', Conditioning
-I I
35. Final Gas�PipeTesi;�lN1�316 i
36. Hood or CanoPY=Ia nl 1
I�'�'•I
I''I"I_l�1'
-i r'-_ -��
I
37. Final Factory JJir, place,=-
�I
38. Final Plumbing
i I. I I •. t e
I
i I I' 1 -
39. Water Service-Finall-
n
40. Gas Service -Final
f
41. Solar Domestic -Final 1 '
' ,
42. Backflow,Preveriterl
43. Backflow Irrigation r' I I
1'`
- I
'' '•
_
_
1
44. Land s•capedrrigatnSy�tem
I 'r1
I
45. Sound TAtten' NtGh ? I r' -
14
I
i
46. Handicap Regulation's{
i
I
47. FINAL STRUCTURE & BUILDING'S '`
i ly I
`,
i I I t - •'
48. Special Require-; en'ts Completer) '
1 { �•�
`` I I
i i ,_, ,
i
49. Electric Release�to Edison) ; {
1 __s.._ .I
_#-1__ _
t__.1 1 _ 1 _, _
50. Gas Release to Southern California Gas Fn
I l
i I
I I j t 1 I_ .' I I,
51. CERTIFICATE0ROCCUPANCY
No J ii { I Date
I
COUNTY OF ORANGE
BUILDING DEPT.'-.- .. No......�.6.
636 No. Broadway Permit .
Santa Ana, California Application for Building Permit
Phone: KI 2-6211 AND FOR A
Certificate of -Use and Occupancy j p
rDate.. /-�'Z... ._�.../- ........................
OWNER'S. NAME------- V -.1. t _T..d..1c3... ..Q.I:� Ll-FI-[Y_Q.---.............. ........................--..... PHONE
MAILING ADDRESS... •. Lam.. .CSkC aS.:- ------ 15.. t ..........---------
-- .. '.CITY:.L ....... ..
Name ..
Address
City
State
Lic. N
PROPOSED USE:---
2. JOB LOCATIOMDL4?-P'lm ....... .... --- ---.....-----
(House No.) '(Name of Street) (Town or School I)isfrict)µ�
3. LEGAes and DESCRIPTION:
Lo se reverse stdc' ---'-------.Block .... � --.. Tract.it::..e�.%..�a._:...................
---------------.------------
( P sof. form)'
4. CORNER LOT (K-), INTERIOR LOT (— )� THROUGH LOT ( ) SLOPE OF LOT ( / )
5s SIZE OF BLDG.:.��..O..A...3.T....... AREA:.-7..�'d)./S. _.SIZE OF LOTJS.9.XJ4P......---.AREA:-.9.-a.Y. 0.Q..:.
l:
6. HEIGHT. OF BLDG ------ -- .---
............... :------ CEILING HEIGHT:... ................... NO. OF STORIES..... ..........................
7.
S. EXTERIOR IOR FAMILIES
WALL CONSTRUCTION: old:`(. Bedroom ,NTEIOR WALL.COVERINGche . n
...... - -- Q�'� �
(Frame, Stucco, Etc.) � p `t Q (PlasterDrywall, Etc.) 0u
9. SETBACKS: Front Yard From CenRe: rtes' Line of Stieet..(>_�;._.........j7..--.........................----..---................................ -_-
' _ - en Bldgs. on Same Lot----.. ..'.....................
lo. A COMPLETE PLOT PLAN.IS REQUIRE/D,;SHOWINGaALL STRUCTURES Nearest Side Yard........... ��3 S.g.
RES;AND USE OF EACH:
11. For rn /' pi f,//
(a) Footing: Width-� --------------- ----------Depth, to Groun ._---......1..%,...Width of Wall.:..�...............:.........
Accessory II
Bldgs. and b Size of Studs:sq.X..`'!.._'......:S acid t........._'•CC _Material of F1oorC
Similar O - P g----�-----.-.... .- .................f:?.:`V-'
Structures: '
(c) Size of Floor ,Joisis: ........... -- Spacing.:_ ------------'7 ..._:..._...... CC
' d Size of Rafters:.:._h�..'.. X 'L ...S acro "CC I :
12. VALUATION OF PROPOSED ,WORK: '.Including all labor, plumbing, electrical wiring, heating, fire sprinklers, painting and
sewage disposal $--------- ........: _
1 HEREBY CERTdV 114AT TO THE BEST�OF:MY KNOWLEDGE AND 'BELIEF THE INFORMATION IN, THIS
APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF
THE COUNTY OF ORANGE AND THE ;STATE OF. CAJAFORNIA APPLICABLE THERETO
.
Signed.: ............... .... ........................- ---- -------------
. i � .
Plans. Filed:.....././.:...�...:...Sl---...........-_:..............
By:.. '----- ----------------------------------------------------------- ------------------------------------------- ... .
_ (Authorized Agent),
FOR DEPARTMENTAL USE ONLY
FEES: ' BY
QHE KING
TYOUP.!....xES.�L....- APPLICATIONS HEALTH ........:.........
Bldg. Permit $------------. ...... -
' Plan Check $............ Q..t�.'..... PE..---. --------------------- ` FIRE
r<- ° ZONING ..................!'
Total - $...... DIST.. PLANSAND MARSHAL.:.. ..i.....— - Receipt No. - MAP.. -=----------
P - ...f SPEC'S....... ...---......CL - STATE ................................
Paid to ...... SHEET IJO....
f t� •••- �- - - CORRECTIONS ENGINEER.
'Date ................................... 1(_ L�$�.: ........_:.-:...i----:.. -` ` ................. VERIFIED ........................ CAL_ ............:......................
--.
PER WIISSOEMBB'Yir-fIJ_.
TOR
DATE. l 2 J
................._................
........... ....... ... .. ._..... ..........
VVV ....... .. ... ` V
5 M—e31 --
Job Address: 2606 ELDEN AV
Suite: B
Vicinity:
Parcel Number: 93794031
Applicant: SHANE SANDFORD
Address: 3316 EGERER PL
BUILDING PERMIT
Zoning:
ISSUED BY:
Phone: 714-412-8628 -
Status:
FULLERTON, CA
Zip:
92835
Owner:
MUELLER, KURT H
Address
.2606 ELDEN AVE #B
-
- -
.Phone:
'COSTA MESA, CA
- Zip:
92627
Contractor:
SOUTHLAND CUSTOM RESTORATIONS
'Address:
3316 EGERER�PL
-
Phone:
714-412-8628
FULLERTON, CA
Zip:
92835
License:
745562
Status:
ISSUED
Applied:
06/29/2004
Issued:
06/29/2004
Arch : Eng:
Address: Address:
Phone: Phone:
Zip: License: License:
_ SCOPE OF PERMIT
REPAIR STUCCO DAMAGE AND REPLACE STUDS:
FEE SUMMARY
Plan Check: $0.00 Calc Valuation: $2,500.00
Permit: $83.25 - - - Claim Valuation: $2,500.00
SMIP Res: $0.50
SMIP Com: $0.00
t Other: $0.00
Inspection: $0.00
Total: $83.75
PLANNING & ZONING
SETBACKS
MAIN STRUCTURE Front 0-0 - Rear < 0-0
ACCESSORY Front" 0-0 - Rear 0-0
PARKING Existirig:" -0 Required: 0
NOTES:
' Left 0-0_ ;Right,- 0-o '
Left 0-0 Right 0-0
Proposed: 0 ,
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
taa646 (6roo)
DECLARATiONS
WORKERS' COMPENSATION DECLARATION:
I hereby Shim under penalty of perjury one of the following declarations:
❑ 1 have and will maintain a certificate of consent to self -Insure for workers' compensation, as provided for by section 3700 01 the Labor Code, for the performance of the
work for which this permit is issued.
❑ 1 have and will maintain workers' compensation Insurance, as required by section 3700 of the Labor Code, for the performance of the work for which this permit Is Issued.
My workers' compensation Insurance carder and policy number are:
Carder. Policy Number:
(This section need not be completed if the permit Is valued of one hundred dollars ($100) or less.) '
2/ 1 certity, that in the performance of the work for which this permit Is Issued, I shall not employ any person in any manner so as to become subject to the workers'
compensation laws of California, and agree that It I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith
comply with these provisions.
Applicant Signature: �1—� Date:�/� P / y
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOU ARE (5100,000). IN ADDr1ON TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECnON 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES,
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license Is In full
force and effect. Lic. B -r..i Class 4 L7
Contractors Signature: �� Date:. se A 5 -
CONSTRUCTION LENDING AGENCY:
❑ 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code).
Lenders Name: Lenders Address:
Signature:- Date:
OWNER -BUILDER DECLARATIONS:;,
I hereby affirm that under penalty of perjury that) em EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professlons
Code: Any city or co6nry which requiresra Perini t 'conot ruct, 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 IIcegs d pursuant to the provisions of the Contractors Ucense Law (Chapter 9 (commencing with Section 7000) of Division 3 of the
Business and Professions Colla) 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 holmore 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 bullds 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 o1 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 Llconm 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.).
❑ 1 am exempt under sec. Business and Professions Code for this reason:
Signature: Date:
Owner ID verified by drivers license. ❑ Yes ❑ No Drivers License No. Expires:
Ver flcatlon of Ownership by (type of document, I.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 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 thlrty-slx (36) feet high. (Chap. 3.2, Grp 2, Art 2, Sec.
341, Title B, California Administrative Code).
❑ As owner -builder, I will not employ anyone to do work which would require a permit from the Division of Industrial 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:
I Will the applicant or present or future building occupant need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous
material? ❑ Yes ❑ No
(Section 25505 01 the California Health and Safety Code requires, with some exceptions, that a Business Plan be filed with the Costa Mese 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).
_.......__.....__......_ ............._._...... t or pre....._.._.._....................ildi................................................_...............frau........... foracu......................_...—__._...___.....__......_____........................._...._.._...............
2 Does or will the applicant or present or future building occupant need to file a registration form for acotety hazardous materials? T_[]—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 aqua 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 materiels)?
❑ Yes ❑ No
(Se34 ction 255of 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? ❑ Ves ❑ No
...._.............__............___........................._.......................................................................................-...................._..............................__........................._.___.._.._....._.__.—...._........_................................................................
5 Does or will the applicant or present or future building occupant require for the work which Is the subject of this a plication aLJ ppemit for such construction or modification
from the South Coast Air Quality Management District or from any other air pollution control district ar agenuyt Yes No
(Section 65650.2 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? ❑Ves ❑ No
(If yes', the facility must meet the requirement of Sections 25534 and 42303 of the California Health and Safety Code).
—__......_..__.___.............................-_._.........._._.�...____._._.____._....._._..__.............__—..........................__........
7 If a pemil from the South Coast Air Quell N Management District or other air pollution control district or agency is required for the work which is the subject of this
appllcatlon, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
6 (II yes', attach certificate of compliance from the appropriate air pollution control officer).
CERTIFICATE OF COMPLIANCE: I cenify that under penalty of perjury the Information given above is correct. I agree to comply with all state laws and dry 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.
Signature Of Legal Owner(s) Date
/9/�
And/Or Aut ooze plicent Date
CODE A INSPECDON TYPE g�¢, INIMALj CODES INSPECTION TYPE gag gNTRIAL5
1616 Fixed System Final Fire Prevention 206 Final Mechanical
1266 Pod Spa Final 206 Final Plumbing
200 Final RB -Roof 210 Final Electrical
201 Final Slock/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
- _ Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. -- _ 4
T
- _ -
O;
-•- Q1: TL
CITY OF COSTA MESA
PERMIT NO.
TRACT N0.
LOT NO.
BL
1
9N28" 5t26/33
�•
_ -
CONSTRUCTION PERMIT ; ' I
_
C7
,
_'
-
;
r
Applicant's Mailing Address' - -
TYPE OF CONSTRUCTION
W EADD' LJ ALTERATION L3
REPAIR
T -
❑ CONVERSION ❑ DEMOLISH
❑ OTHER
e
'
Project Address-
-
1
Owner's Name hone -
DESCRIPTION OF WORK
-
-
ZONING
REGULATIONS
Address,TYPE
OF PERMIT LJ GRADING._
'FOUNDATItttONtyy�-STRUCTURAL
A. P. sls
ZONE - -
Arch/Eng. - " - � � , License NO.
1 ❑ TENANT ❑ELECTRICAL
❑PLUMBING LR MECHANICAL
_
PLNG. REF. 9W
"BUILDING
Address!
❑OTHER '- -
/
^
q��{�q!
Contractor S Nam isyy- r ne L1J�1 V
: PROJECT DESCRIPTION SQ- FT
` - iOCCUPANCV
TO BUILDING
PROPERTY IN
: REAR YARD (TO P/L) "
Address (mailing) • .�,rfyt�)- /2(isQ -
CONSTRUCTION TYPE
1
; VALUATION $
LEFT SIDE YARD
- RIGHT SIDE YARD
I
'
r,
ZONE - GRADING CU,YDS. ACRES
.P KG. SPACE] REO.
PROVIDED
,
�(/�
License No: -
i
__ -
LICENSED CONTRACTOR DECLARATION
Remarks: .. s7 L
�- ..
STREET WIDTH
,PARK FEE $
'
[hereby affirm that -i am licensed under provisions of Charter 9 (commencing
'
with section 7000) oyplvislon 3 Of the Business and Professions Code, and
j
SPECIAL CONDITIONS: -
my Iicanse'is in ful r tl. gifted•
License Glass Lic e N
r
PLUMBING -
'9 tSignature49
Bar Sink
Sewer Cap
ELECTRICAL
IKERS' COMPENSATION DECLARATIO
-.areby'afflrm.that I have a certificateof consent to self -Insure or a certificateI
Backflow Preventer '
_.
$ewer Connection
_
Automatic Washer- ' - -
- lMeter ❑over 100 amps'
of Workers' Compensation Insurance, or d certified' copy thereof (Section
380q Lab. CJ - f t
Backflow Irrigation
' Construction Pole
'Sub Panel '
i
PoIICY No, - Company r ! ,
Certifies is hereby furnished. j
Solar Collectors ,
_ -.. _ _ _
Cooking Unit
•-
_
,Sub Pole .
7 --
; Bathtubs
Solar Piping
ftlfled copy is filed with the CRy Building Division. 1
Dishwasher
170-1 HP 01 X-8
Date ' Applicant
! Clarifiers
Solar Tank ;
-
,Motors
EXEMPTION FROM WORKS MPENSATION DECLARATION .
I Dishwasher -"
_
Swimming Pool w/Spa -
7 Dryers OG85 OE,lec[ric
Int. Solar 09-15 HP 016-15+
feted I or
(This section need not be completed If the permit i5 for One hundred ($100)
less):. • '
1 certify that In the performance of the wor or w t - permit i ssued I
-
Drinking Fountains
1
Urinal 1 i ,
Fan
'Microwave
S, not employ any rson In any me so b sub" ct. to the
t
-
F.A.U. I
Pole Light '
emp
Worker Laws of Califor J
; Floor Drains _ "t
Water Goset
`t
ysa
Date /' Signature
NOTICE:'If, after makirig this-declarat _ you Should bec-m subject t the --
Floor Sinks +' - -- -
- -
- Water Heater -`
-
' _--
Fixtures I- - -
Range-. - - F-- .. -
- -
Workers'. Compensation provi510n5,0f the Labor Code, you must forthwith
-Outlets
Davit¢ Boxes
comply :With' such provisions of this epermit shall be deemed revoked.,
; Gas Service
_Water Service,Sign;
CONSTRUCTION LENDING AGENCY
-
'
-
Outlets I
'
I hereby affirm that there Is a.construction lending agency for the erformanoe
'� Interceptors r ]
_ - - •'
i
Standing Sections
of the work for this, permit Is ,issued -(Section -30 7. Civ: C.)r
Switches
r
which-
Lender's' Name-—- 1
''-
KitchemSink.
Trash Compactor
'Lantlers Address 1
lavaiories' ,n
Garbage Disposal
i
OWNER• BUILDER DECLARATION r j
I hereby affirm that I am exempt: from the Contractor's License Law for the
- f
-
-
Generator 00-5 KW 05-15 KW
1
following reason (Section 7031.5 Business and Professional Code: Any city or
P -Trap' ( I
county which requires a permit to construct, alter Improve, demolish or -repair
'_Ea cc' also requires the applicant for such permit
env structure, or to Its
- -
ROOf;Dmms;
- - t - _
Transformer 015-50 KIN
or'
, ,-
- '
I
} 'Y a Slgnetl Statemen t'that he/She Is IICeoSetl.purWdof to the provisions of
IJcanse Law 9 (commencing Section -7000)
.
-
. ❑50+ KW i
,RainapeMiOn Fee
-
$15
$1.5
ntractor's (Chapter with of
Of
( Lr's`�.'.-•On f3 of the Busl ness and Pfofesslons Cotle)'oI that he/she•is, a xempt
Showers .
Reinspection'Fee'
f
$15
'-
and the. basis for the al legetl exemption: Any-vlolatlon"br Section
,-
Meter ❑up to 100'9mps
Issue Fee
$ 3
•7031:5 by. any aOPI ICant fora permit -subjects the applicant to a civil
! ena Ity of not more than five huntlretl dollars (6500). .�
Service Sink
_
Issue Fee
$ 9
Zoning Approved By
_
I, `as of, the tpro Darty Jr my employees with wageslas their Sole
-
1
.owner
I compensation' cal11 do the work, antl the structure. is not Intended or offered
'7044; Professional Code:
- - _ MECHANICAL
Application Approved By
! -
'Date
. for ea le ($ecflon Business and The Contractor's
License Law does not apply to'an Owner of a property who builds or Improves �
_.
Bailer
Refrigeration System
- .
t hereOn,'a.d who doas Such'W-IK hl msel f/herself or through his or her own
- �
0 - l
Application Issued By
Date
employyees, orovIdad that such Improvements are not Intended or offered for
IS
Duct - Under Ground '
❑0.100,000BTU O100,0008TU
{
.,
.sale. If, h -waver, the bui l dl ng or improvement Sold within one year of com-
,
SUMMARY
1 'i
OF FEES
'
pleti0n, the owner will have the bprtlen o/ pr-ving he/she tlitl not build or Im-
' nova for the purpose of sale). '. • 1
Duct -Structural i
System Repair/Alteration
PERMIT $
I
SMIP $
)
LJBUILDING
1, as owner the property, arit uslvely n Ilcansetl con-'
i
tion n
urine s antl. Professions Code:
tractors tr ((Section 7044,. and-
thea,
;-
Duct. -Ventilating'
PLAN CHECK $
PERMIT '
to o
Contractor's LI Low not apply to r s owner je property who
The Contractor's License Law tl Who
builds or Improves thereon, and .Who contracts /or such projects with aeon- .
Exhaust System ❑ Multiple 01
! J '
PLUMBING $' 1
ISSUANCE $
tractors) license pursuant to the Contractor's License Law): -, '
GRADING $.
i ❑ I am exempt untler Section . 6 P. C. for this reason
Firepl/Fact. Bit. ICBO #
; I
.PLAN CHECK' $.
-
1
I ' '
;Data - '' caner' 1 1
He ting'System & Ducting ,
.• - I i
l
ELECTRICAL' $
'' ' $
MICROFILM $
'
• I -hereby -cer 11 that ve-reatl' his applicatl n antl sta e•that.thee Dove
- 100;000 BTU 0100;000
_ __
.. -
4
PLAN CHECK $
' 1
'
,
;Information Is correct ag re o c Ply w(lh all city and county ord noncar
'
t : i
I
j $ �
TOTAL FEE $ '
antl state laws r I 9 to di rust ntl hereby authorize repre-
! : !
I
Hood or Type I 0'
;MECHANICAL
'I I !
sentativeI of R city nt ewetl property for
Inspection
Can- T tl ❑:!
Reinspection Fee' -
$15
7
PLAN CHECK $ ,2 g!`�—
eii� LESS
Dur se
e
ADVANCED PC j $
I Date CC
( Signature - !
DII VarS' LICBnse Or S$ '
Pink - Accounting; Goldenrods - Assessor
i e
CONSTRUCTIONAND'PL'ANNING ;.
: �, _.
- �•'r
'�r"
, -;i--POr' &SPA -
', - -
-
- -
-
'-� ° 1 1i `
•_APPROVALS Permit'# -- °7;
. Date ^
-Inspector
_ .aK " `• -- -
e
,APPROVALS: ._rmit�#
Date
I'n'spector
,♦ r
_
r.,
..r
_
1 Temporary Electrical Service or Po Ie
: 52o Pool &Equipment Locafion
21 'Soil Pipe-Undrgrnd` - I
c -
•'I
',531 Steel Reinforcement
- '
Electrical Conduit Utility-Undrgrnd: '
a
:54.: Forms,.
- -
_
0
_.
4: Electrical Conduit-Undrgr'rid `- `
c" ` -;
,55.7 Electrical Bonding -
5. Steel Reinforcement ' ;
`.
56. Rough Plumbing & Pressure Test-
, , r;.
6. Electrical UFER Grnd:°5T.;
l
APPROVALrTO•COVER-GUNITE
7. Footings •' i o '
v• '
-58.' Electriral[Conduit•Undrernrl.
- -
8. Foundation _ r
'"
'= ', •• 'K
,59. Gas Pipe,iOUndrgrnd., Test
9. Water Pipe-Undrgrnd::
60. Backwash' Lines, P-Trap, O Undrgrnd.
10. Structural Floor System i
v
61. APPROVAL TO DECK
11. Property Sewer Line & `House Connection
-
•'
= 62. Backwash &Receptor-Final . - -
12. Sewer Cap
63. Heater & Vent-Final
-
13. Roof Drains I ` i ,'
'
-
64. Plumbing'System - Final
- -
14. Rou h Plumbing -
9 9
--
65. Ele'ctrical'Firia'I .. ..
- '
^-15: Rough Electrical-Conduit - - • -' '
"•
r -; �-T
_66.' S61ar System--Final - - - - -
-
16. Rough Electric Wiring, ,, } •
- I o `
; ': =h I
-67. Fe-cing & Access Approval
17. R6ugh�Wiring;Sign•1 = -
_
68.E APPROVED FOR PLASTERING-
LASTERING18.RoughElectrical-T'Ba
'
1 Rou`g'hElectrica I-T 'baCeiling I� I
I ; i
`- �', .� �':'69.!
POOL/SPA SYSTEMS FINAL ,
� 19;^,Rough Heating &'Air Conditioning
_
' FIRE DEPT. REQUIREMENT:
APPROVALS! Permit #
20. Factory Fireplace !
?Rough
l
21. Ducts, in Structures y
I
70.1 Underground Hydro
--22. Ducts, Ventilating .
I '
° '
i I �
71 Product Pipnig O Gas OOiI
'
. � , �
, j
.
•, 23. Gas Pipe-Rough & Test '-'
;
I 1 I
72,1 Underground Flush'
44. Roof Fiaming
-,
, -. - I :
73.' Undergrnd. Storage Tank O Gas O Oil
• 25. Roof Sheathing
74,Overhead Hydro
w 26. T-Bar Ceiling (Structuralj, & Monocoat- '
:
T '
' 75., Dry Chemical
I
27. Frame and Flashing _
1
_
76.' Dry Standpipe
-
•, 28. Lathing & Siding' _ l
i (
, !
77.j FIXED SYSTEM FINAL
29. Insulation = I
!
78.E FIRE PR EV. FINAL
30. Drywall Nailing i I
I
(Notes:
31. Plaster Brown Coat
{ I
1
32. Electrical Power Meter-Final
b 33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas :Pip
36. Hood or CanoP.y' - , r,i N
,
- I
I ^ : • I- -- <<. _ .,
37. Final Factory Fireplace
38. Final Plumbing v I •..
i
- !
- I._, y
39. Water Service-Final •
I
/
�
40. Gas Service-Final I, I
I
I'
41. Solar Domestic-Final
42. Backflow-Prevente( -' ' hT,`
1_-�__• I `
_-_
---_ _-
_I_
43. Backflow Irrigation-
,
r
44. Landscape Irrigation System
45. Sound Attenuation
I
,
46. Handicap Regufations
I
47. FINAL STRUCTURE & BUILDING
- �•
,
48. Special, Requirements Completed I
!
I
49. Electric Release to Edison,
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No ;; Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations
CITY OF COSTA MESAPERMIT NO. . TRACT NO, I LOT NO. I BLD .
CONSTRUCTION PERMIT E (or, Z q 7599 4/21/63 55.90• TL
Applicant's Mailing Address /` TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
Project Address �"/�P"z �Illrrr��� tt �f\ ' ❑ CONVERSION ❑DEM LIJ�jf ❑ NER r
Owner's Nam T hp6 G�^ DESCRIPTION OF WORK L�r� �14 �!� ZONINGAEGULATIONS
Address TYPE OF PERMIT LJ GRADING DFOUNOATION LJ STRUCTURAL - A. P. ZONE --
Arch/Eng. _ License No. ❑ TENANT XELE TR CA ❑PLV MBING ❑ MECHANICAL PLNG. REF. 91t - BUILDING .
Address. •q _ ❑,'OTHER C _ TO BUILDING
COBLfeCLOf 5 Nam �"' ' one pI / rs PROJECT DESCRIPTION SQ., T. OCCUPANCY PR PE V INE 'REAR YARD (TO P/L)
Address(mailing) F26IL-Pfe— �'P-' IZ bU 1 CONSTRUCTION TYPE ,\!F—>• VALUATION$' LEFT SIDE YARD RIGHT SIDE YARD -
' - ZONE I GRADING CU.YDS. ACRPc PKG. SPACE REO. PROVIDED
License No.
LICENSED CONTRACTOR DECLARATION Remarks: STREET WIDTH PARK FEE $
I hereby affirm that I am licensed under provisions of Charter,9 (commencing _
with section 7000) of Division 3 of the Business and Professions Code, and _ SPECIAL CONDITIONS:
my license Is In full orce a d effect.
License a's License No c•`L�/' PLUMBING
-te— Signature '
rRKER 'CO COMPENSATION DECLARATION! I ; Bar Sink Sewer Cap' ELECTRICAL
..rereby.atfirm that { have a certificate of consent to sell-{nsure.oi a certif{wte- '. Backflow Preventer Sewer Connection'' -Automatic Washer - •Meter Dover AW amps -
of Workers' Compensation Insurance,, or a certified copy thereof (Section - _ = '
3800, Lab. CJ Backflow Irrigation Solar_ Collectors
-� ; Construction Pole .Sun Panel ' DQ
Policy No. t Company - - e- Cooking Unit 'Sub Pole '
H
Certified copy Is hereby furnished. Bathtubs j Solar Piping j ., I I '
Certified copy Is filed with the city Building Division. I , n , Dishwasher 1 .Motors ❑0-1 HP [11%
$ OQ9
Date I t ' Applicant ! Clarifiers _ ' _! - Solar Tank �' , _L i / I
E XEMPTION,FROM WORKERS' COMPENSA TO N� DF�E,CLARATION - - ! Dryers ❑Gas! lectriC ^ Inc.. Solar -09-15 HP ❑16-15+ OQ
(This section need not be completed if the per it is rgr'one hundred ($100) or Dishwasher I Swimming Pool w/Spa E
less) ' / / ( 1 i Fan 'Microwave
less).
nth performance of the wof for Ich this permit Is Issued I ( Dunking Fountains Urinal '
shall: not e- loy y person in any ma ver spy o become subject. to tRa j - 1 1 - F.A .U. Pole,Light Q ,
Workers' n•Laws of Calif or .. / - —� 1 Floor Drains Water Closeti I ' ' ' I
Date SI nature ' ' , 1
9 h J••. _- - _ Fixtures_ f__ _,'Ran e
NOTICE If, a ter making•this declare on, you should become�subjact to the -7 ' Floor Sinks - Water Heater,-' 9 - - � z
Workers'. Compensation provisions o the Labor ode -you must forthwl th ,
- ! Device Boxes i
comply UCT such , EN61N ns .or'this ,permit ,hall be deenietl revoked. Gas Service+ ;Outlets - •WateaService - t •Sign -
CONSTRUCTION LENDING AGENCY `i j _ - Outlets ' ' ! (f
I hereby affirm that there is a�constructiom len ding agency for the performance -' Interceptors _ _ "v ! - 1 n Standing Sections t)
of the .work for which. this, permit -is Issued (Section 3097 Civ. C.) _ -
Lender's: Name - - r
Kitchen =-' I . Switches Trash Compactor ( Q
"Lender's Address 1 .
OWNE R�9UILDER DECLARATION s i ! :< !„ LBva6ries - I - f , Garbage Disposal • , , Op
j I hereby affirm that I am -ex em pt,from the .Contract or's-License Law for the 1 , - - Generator, E10'5KW E15-15KW ,
following reason;(Section 7031.5 Business and Professional Code: Any city or P -Trap; 1 - - r
county which requires a permit to construct, alter. Improve; demolish or repair - _ , Transformer I O
p q P Hoof'Dialns- 015-50 KW C
env structure; rim to nt that he/she
also licensed
the suantcto the such permit - ' - _ - - - , J
'9e a Tsignedactor statement that he/she Iz licensed pursuant to the provisions of ❑5U+ KW
_ - - Reins ctlon Fee
In with tion 7 Pe 1
ontra r License it Sec 000 of 4 5
cto s V e se Law (Chapter
9 (commencing ) �- - $15 $
cion ' an the Business antl: professions exe Cpden. that' ha//She. -.Is exempt - Showers 'l I RelpepegtlOn Fee
therefrom � ,a they basis for the alleged exemption.- Any. applicant
'oo a cion ,� _ _ Metes p to 100 amps i issue Fee $ 3.
7031.5 by:.any applicant for -a •permit, subjects the •applicant to ar civil $ 3 _
enalty of not more than five hundred dollars ($5001: , I Service Sink Issue Fee .- % Zoning Approved ByDate
1, 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 - _ MECHANICAL I
for sale �(Secllon 7044, Business; and Professional Code:.The Contractor's Application Approved By /1�\ '' 'Date 1
License Law does not apply to an owner of a property who builds or Improves Boiler. - Refrigeration System 1 q lication Issued B /
thereon, and who does such work himself/herself or through his or her own - PP Y Date
employyees, provided that such improvements are,not Intended or offered for ! - ❑0-100,000BTU 0100,000BTU
sale. IT, however, the building or Improvement is sold within one'year of com- Duct Under Ground t SUMMARY OF FEES
pletlon, the owner will have the burden of proving he/she did not build or Im- - ' I I
grove for the purpose ofsale - ! i Duct - Structural _ System Re air/Alteration $i SMIP $ •,
LJ p P )'. ( 1 j P BUILDING PERMIT
I, as owner of the property, am exclusively contracting lwith . licensed con-
. tractors to construct.Me,project.(Section 7044, Business and Professions code: Duct -Ventilating , _ _ - - iPLAN CHECK $' PERMIT '
The Contractor's License Law Res not apply to an owner of property who
builds or improves' thereon, and who contracts for Such projects with a con- ( Exhaust System ❑ Multiple ❑ PLUMBING ' $ ISSUANCE $
tractor(s) license pursuant to the Contractor's License Law).• i 1 GRADING $
El$ I am exempt under 5ectlon B. & P. C. for this reason ' Firepi/Fact. Bit. ICRO # PLAN CHECK
,E ELECTRICAL' $ �,2 C)Q $
' Date Owner - - - - - Heating System & Ducting 1MICROFILM $
I
bite y -;fie I'have-read this application and state -that the above ❑0.100,000 BTU ❑100;000BT'' -- - PLAN CHECK $' —17.70
Information is coir t. I ee to comply with all city'antl county ordinances ` 1 ' TOTAL FEE $ and state laws el Ing building construction, antl hereby authorize repre- I V , ,MECHANICAL $
sentaliveI of h <I t4- abov®'mentionetl pr pert fpr Hood or Type I ❑' t
/ qqqq , Reinspection Fee $15 PLAN CHECK LESS i
(inspection p j 1 + Ca T e I I ❑ $ , ADVANCED PC $
519nature '. Date Z 3
,
Pink - Accounting; Goldenrod - Assessor
l
t7�ONSTRUCTIONAND:PIANNI G
°:'_T..�!
a>> ^ ;--.PO i, SPA
I- U n
yAPPROVALS Permit#
Dapector
v..APPROVALS-Permit#-
' - -
Date
Inspector
n j1; 1 empor`ary Electrlica`I
Service orEPole --",:
n n
cp ; r
1152 'Pool &.Egwpment Location
,
n
iV ♦iJ •. -. _Lug ,u '
2: Pipe-Undrgrnd.' �o_
Steel Reinforcement"
iSdil
.53'
-
- 3! Electrical CondurtUtility-Uhdrgrnd..' i
--
'-54'Forms --
a 4: Electrical Conduit-Undrgrnd. `_ L -_
`: "s 4
..'o = ••j ;_55
Electrical Bonding.::'
J°^
6: Steel".Reinforcement = ` I o-
^ =
56. Rough PlumbingF& Pressure`Test
'
6: 'Electrical UFER Grnd.! 'r ° '
C-
;5T.+APPROVAL TO COVER GUNITE
7. Footings �.j''
Electrical Cond'uit•Undrarno: .
•.
8. Foundation '' j _ 'J t
GasPipe, O. Undrg[nd:, Test,
9. Water Pipe-Undrdrnd:.; 9 '
_
- _
.,60. Backwash Lines, P -Trap, O'Undrgrnd.'.
-
. -
y,
10. Structural Floor System
_
'.�,
61. APPROVALTO-DECK-
11. Property Sewer Line &I '
House'Connection
-
z` -
- - -
•,62. Backwash& -.Receptor -Final
i
i
a
!
12. Sewer'Cap
!'63. Heater &Vent -Final
Roof'Drains
._; !
'
g '
--System13.
'64. PlumbingFinal•
,
14. dough Plumbing I -= -� `' I
`- -
!`65. Electrical'Final' - -
C 15. °Rough'Electrical=Conduit-,--�-' ±'-,'-i
66., Solar System -Final
-,
Rough Electric Wiring, ; i q
G 6. ''
=
-67i Fencing & Access Approval .
j7
17.1R0ugh Wiriig'$ignn S
68.1 APPROVED F,OR PLASTERING
f
u 18. fRou'h`Eleotiical;J'Bat, Ceilin 1 !' 1' I
9 ' gl
j _;' -- i
n ! c I..
I
' ... j
69. POOL/SPA SYSTEMS:FINAL
u ., , if '
^ I
I
i
i-
19. �Rouyh'Heating & Air Conditioning .I
FIRE DEPT. REQUIREMENT,
'
APPROVALS, I Permit
i 20. 'ROugh�Factor Fireplace ! I
21,Ducts,:inStructure
70.' Underground Hydro
-
22. Ducts, Ventilating `. , ,• ' I �:
'71 1, Product Piping ❑Gas ElOil
•,23. Gas Pipe -Rough & Test ,, , j I>�I
I
' t I
72,E Underground Flush
1'24. IR of -Framing ''"I ! _�� ' I �m i
� � �� j � �,�,
�n ; -: � „�,
�73.1 Urideigrnd.Storage Tank �OGas,.O'Oil
Q;
,
. 25. Roof Sheathing i `I I
' I ;Q
i E _
.74 Overhead Hydro
i •
'
,
u 26. T -Bar Ceiling (Structurall. & Monocoat"�
. I t I ;3 ;
75.. Dry Chemical
- -
�'27. 'Frame and Flashing- iii
' j
- !76.'
Dry Standpipe
I
28. kLathing & Siding I r I `; I
i ;
J (
77.; FIXED SYSTEM FINAL
29..�Insulation s i° '
II °I I
I I
j j I
178.1 FIRE PREV. FINAL
' 30. Drywall Nailing r 1
`
I
:Noi:es:l I I
I
!
r 314 Plaster 13r6avn Coati i 1 -
-� -�
j j _:.
-�-
I ,i
h 32. ,Electrical Power Meter -Final
i
1 I -
r
1133. Final Electric
34. Final feating &IAir, Conditioning;
35. Final Gas�PipeTestt'Ij ..j Ki
-I••�I:.i.`i"i�Irl.I
^l'S!.i'
r
-
I -`�
36. Hood or Cano PV � 1
0
37. Final Factory Fireplace ` c.j
38. Final Plumbing
x
39. Water Service -Final'
t
I
40. Gas Sefvice-Final I !
;
• ;
t ; a _
41. Solar Domestic -Final
r-
42. Backflov✓', Preventerl
43. Backfloy, rngatidn'
44. Landscape IrrigationiSystem
45. Sound,Attenuation ,- I = i
i j
I ��
.. I
2; i
46. Handicaps Regulations ; `
1
47. FINAL STRUCTURE & BUILDING ' 1 •
u i L r
48. Special R�quirerimen.ts Compleiedj
49. ElectricRelease;toEdisonl I ! '�
��.
I J_
I ' ' '• 1
50. Gas Release to Southern California Gas Co
J
51. CERTIFICATEOF(OCCUPANCY
No II 1 I Date
CIA
Applicant to fill In all spaces except those w';j in heavy border lines and sign all appropriate declarations
i CITY OF COSTA MESAi
PENO.
TRACT NO.
LOT NO.
B LOG.
NO.
I _ t
(•CONSTRUtTIONPERMIT -•
•
PI
�5�'
7359 4/td/93'
46.'50' ITL
Applicmit's Mailing A dress; OA
TYPE OF CONSTRUCTION LJ
NEW_LJ ADD;] ALTERATION I
REPAIR
''��p
❑ DEMOLISH
❑ OTHER
Project Addrets-
Q-�CONVERSION
-OF
Owner's Name - honed
DESCRIPTION WORK
_
INREGULATIONS'
L / /
-
1
Address •�(
'- TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL
A. P. � - - -
..
ZONE
�-
Arch/Eng.,—, Iy ,[s: License NO.
❑ TENANT Q ELECTRICAL
❑ MECHANICAL :
'
PLNG. RE F..gW_
- -BUILDING
f- C ' T/%- `. ;
-PLUMBING
-
-
Address .
r : _ 1
�U?�-ns
.-E].OTHER ,'
. -
-
TO BUILDING '
PR U V IN
REAR YARD (TO P/L) -
-
Contracior'• Nem> Phone
PROJECT DESCRIPTION SG. FT.
OCCUPANCY
_
Address (mailing) �� J9 y�,tml
•'CON STRUCTION TYPE -
- VALUATION$
_
•.LEFT SIDE YARD
RIGHTISIDE YARD
'
. License No. __ ��
ZONE GRADING CU.VDS. ACRES
-
PKC. SPACE REO.
PROVIDED
!
D
LICENSECONTRACTOR DECLARATION
Remarks:STREET
WIDTH
, 'PARK FEE $
1 -hereby affirm that I' am licensed under provisions of Charter 9 (commencing
,
with section 7000) of Division 3 of the Business and Professions Cotle, and
i I
SPECIAL CONDITIONS:
_
my licensees In fu I fort ad' effect. •
Li cense Class LicyJso No.1 9''�
PLUMBING
-`teIT. / sig i
Bar Sink
Sewer Cap
ELECTRICAL
'RKERs' C MPENSATION O RATION.
.arc by aHtrm that 1 nava a carf if cats of consent to sell4nsure or a certificate -
Backflow Preventer -
-'Sewer COnnettion --'
- _
- Automatic Washer - -
- -Meter ❑over 100 amps
-
of Workers' Compensation Insurance,, or a certified' copy Cher of (Section
Construction Polej
Panel
3800, Lab. C;�-r-,;, , 2i—•1-- % Q
Backflow Irrigation
Solar Collectors f
Sub f
90/ -Q3
Policy No, ry-( Y Company ✓i7,/�O -t'L! -iX
artified copy Is hereby furnished. ' '.
Bathtubs
- -
Solar Piping
Cooking Unit -
Sub Pole 1
Certified copy is filed with the city But i g islo
i
Clarifiers
Solar Tank
Dishwasher
Motors E10-1 HP 01A-8
Date - Applicant - -
EXEMPTION FROM WORKERS' COM SATION DECLARATION
_ _
y
_
Dryers ❑Gas.' ❑Electric
'Ina Solar ❑9-15 HP 016-15+
I. Dishwasher
Swimming POO; w/Spa '
- �Thlssection need not be completed If t permit Is for one hundred ($100) or
e.art lfy :that in the performance of the work for which this permit is Issued 1
' Drinking Fountains
Urinal I 1
Fan:
Microwave
shall not employ, any person in any manner so as to become subject to the,
FIOOr Drains
- -
F.A.U. ,
;Pole Light
Workers', Compensation(Laws of Callfornia.i I
Date °' Signature '
Wetar Cl Os_et, (
�
Fixtures -
i -- -- -
-
- • 'Range
,
�. Floor Sinks -
Heater, "-
a --
-Water
NOTICE: Ifpafter making this declaratlon',-you should become Subject to the ':
Workers': Compensation provislons,of. the Labor Code,you-must forthwith:
-or Shis,;permit be
..-
V
- _
Water,Service
Device Boxes
Sign
comply with, such provisions shall ;deemed revoked.. t
, Gas Service`' .Outlets
-
CONSTRUCTION LENDING AGENCY' '
Outlets
1 hereby affirm that there Is alconstructiorr lending agency for the performance
Interceptors
- 1
Standing Sections I
,
of the work for, which this permit Is issued ,(Section •3097 Clv. C.)'
Lender's, Name " -
-
. Kitche (Sink, - '
,= ! ' -,
a
Switches : I
.Trash Compactor
Lender's Address' ' •y 1 " ' - C ,
OWNERIBUILDER DECLARATION- 'r' ; �- .�
- ,
i 1
1
Garbage Disposal r ,
I
f
Lavetorie5�. f
_ ° '
I hereby affirm that I am-exemptfrpni the Contractor's, License Law for the
_ _-
P
Generator 00-5 KW 05-15 KW
following reason (Section 7031.5 Business and Professional Code: Any city or
_-
-Trap
.• -�
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:
f - -
TrantfOrmer ❑ 15-50 KW
I
1
' ''a a signed statementrthat he/she is licensed pursuant to the provisions of
❑5U+ KW • -
'Reinspection Fee
!
§75
_
-
ontractor's'Ucenw Law (Chapter 9 (commencing lwith iSection 7000) of
,on 3' of the Business and Professions Code) or'thaU he/she Is'exempt
r
- Showers r
_
Rainspection Fee
$15
-
I
j trwrefrom'and the. basis for the alleged ekemption.,Any violation ofl Section
Meter Oup to 100 amps
'Lelia pee
'$ 9
7031:5 by;any applicant for --a permit subjects the applicant to a civil
Service Sink'
-- Issue Fee:
$ B
-
I rulity Of not more than five hundred dollars ($500): _
�
Zoning Approved By
Date
'
1, as owner oil the property or my employees with wages as their sole
compensation' will -do the work, and. the structure Is not Intended or offered
'Professional
- MECHANICAL
- ,
Application Approved By '
s
Date
for sale (Section 7044, Business. and Code:;The Contractor's
License Law does not apply to an owner of a property who builds or improves
goiter 'r :
Refrigeration System
�'�
,
tneraon,,ana who does; such work ❑Imself/hersaN or through his or nor Own
Application Issued By
Date
employees, provided that such -improvements are'not intended or offered for
Duct -Under Ground
❑0.100,000 BTU ❑100,000 BTU
f
sale. If, however, the building or Improvement Is sold within one year,of com-
,
j I SUMMARY
OF FEES
pletion, the owner,w111 have the burden of proving he/she did not build or im-
rove for the purpose ail sale): .. ` ,
.. 1 i
1, as owner of the am exclusively contracting withilicensed con-
'
I
Duct -Structural I I
System Repair/Alteration I
'BUILDING PERMIT $
I
SMIP $
property,
'.t rectors to, construct -the -prof act (Section.7044, Bus lness. a nd- Prof ant o n s- Cod e:
The Contractor's License Law does not apply to an owner of property who—
M 4.
Duct Ventilating .. i..
g
�
' -
{PLAN CHECK; $
PERMIT 1
builds or Improves. thereon, and who contracts for such projects with ,con-
Exhaust System ❑ Multiple ❑ ;
PLUMBING
tractor(s) license pursuant to the Contractor's License Law). f
GRADING $
❑ I:am exempt under Section B. & P. C. for this reason
Firepl/Fact. Bit. ICBO 101
1
- (
PLAN CHECK:
• '
Heating System &Ducting j
-ELECTRICAL, $
$
! '
I 1 :
Date Owner'
I here by -certify-that lt,have-reatl this application antl state -that -the above-'
.j
r
06100.000 BTU ❑100000 BT
I
- - -
' I - 1 '; I
I $
PLAN CHECK,
I MICROFILM $ 1 -
- I-
1 r
• Information Is correct. 1 agree to comply with all city and county ordinances
}
..
.MECHANICAL $
TOTALIFEE� $
antl+state laws relating to building construction, and hereby author,,, repre-
for
Hood or T e I ❑,
YP
1 ,
sentatives of ! Is :citye an/I upon the above• me ntioned proper ,
ISIS
h
Canopy II ❑r
I Rei ction Fee
t nsPe I
$15LESS
(PLAN CHECK 1 $
I
11
netu�e pq k '. / t
.T . e
ADVANCED PC $
1
,
Dr9irers' Ll n1"or SS ' I 1
Registers
} Issue Fee; i
$ 3
I
,- FINAL FEE $
CMF 086546 rev. 12/82 White. Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor
Q i1CONS7RUCTION AND`PLA NTNG • _:--
.; o - ",.Por' '4 SPA ' •, I- -
'
E: , ,
' t••' I ` t - >�DateInspector`.Date
- y;APPROVALS Permit-#" _
s -
---APPROVALS, Permit*
-
'- 1
Inspector
•�?`� _
'•'- Teinporery'Electrical Service orPole '!'�':
`�` sF
;,� �g"o i
'52:-, Pool &r_Eq Oipment Location ". •t
2n?
-
I �•
7 1 1 n r
r
S:C
- -
-'
N 2? Soil Pipe;lJndrgrnd' c _ f ;°i
-n
! 53: Steel Reinforcement '
_
3! ElectrcaLCndwitv
54.. Forms "
' ;
y-
"t 4' Electrical Contluit-Undr rnd% t - i+
=3
;'55. Electrical Bonding
5. Seel Reinforcement- '' e - p
- i -
+: r
i 56. Rouges Plumbing_& Pressure Test
''-t 7 -
,
yr
6, Electrical'-FEBGrrid., . '=- I -
- >
-
57:" APPROVAL TO COVER-GUNITE-
-,
7. Foot -in ' .i '�. ; 'I ' , i'
`� `
''� -,
l E58' ElectricaFConduit-Undrarnrl.
8. Found 1 wnl iGas
Pipe r0}.Undrgcnd., Test'
9. Water Pipe-Uniirgrn"d.^I
60. BackwasFi•Lines;iP,•Trap, 0 Undrg?nd.:i
10. Structural Floor System
f
:.611. APPROVAL TO DECK -`
11. PrlipertySewe� Line;& House Con ection
-:4
f
cg "'
' 62. Backwash&�Recepfor-Final='
•`, ,;r'.
12"Sewer 6pI :� ( rr L-
5- --
' 63. He & Vent -Final
13.'R6of grains
Id.
;64. Plumbing System = Final,
14. .Rough.Plumbing'vi
-65. ElectricalAi-nal- '• -
1
1-15:= Rough`Electricaf-Conduit- `,-`,-T)
F--
---` j -- j
--66.j Solar System -Final
ic irg-X6. •Rough Electr
I
-
67.Fening&AccessApproval2
,`17. RoughiWiring Sign ;, j j' c ,
; = I I
w 1
'68.I APP -ROVED FOR PLASTERING
18. Rough 'Electrlcal T Bar3Cei ling' :j �� I
'� i
- •',- - j
i 69 i POOL/SPA SYSTEMS FINAL !
`• -
I
d
_
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT;
APPROVALS; i Permit #
i
20. Rough Factory Fireplace 1 j (� ;; 1
i
I j
21. Ducts,.in St'ructureG -' I I ' j� I
I
' I
70.j Underground Hydro
I
'I422. Ducts, Ventilating r e I
1 t
I j I
71-.I Product Piping 0 Gas Cl Oil
i
'23. Gas Pipe -Rough & Test I I 't?'I
,Y r }
1jt�
�7z-: Underground Flush
24. Roof Framing" I i I 1 !' ,I o 1
_ ' •+' r. I
I 1 _ I
73.1 Undeigrnd. Storage Tank O Gas 0 Oil;
;
25. Roof -Sheathing I 1 �> �;� �• = i
= (� ' I
r I -
' 71.E Overhead; Hydro
,.
-
26. T'Bai Ceiling (Structural), & Mono coat" I
1 ;,
§ I"
j ( 1 ?
95.i Dry Chemical
i.27. Frame and Flasihing 1 !
!
I -, i
76. Dry Standpipe
I
I
, ,
28. Lathing' &' Siding r i� i ' i ;� II
If
i I
1•P
I
77.) FIXED SYSTEM FINAL t. •
IPM W 1 . n ! I I
t
I
1
N, 29. Insulation ° ' = z ! `I j' '
1
( I i I
FARE PREY. FINAL i
! 1
178.j
30. Drywall Nailing 11
I
I i
.Notes:{
--
31. Plaster Brown Coat
T
r T
a 32. Electrical Power Meter -Final
I
i I i l
i! 33. Final Electric
34. Final Heating g &'Air,Conditioning, '1
I
'
I
u -.,�nl o. I r l ,. I •l
i ,
I
, I ,
35. Final Gas"Pip1e-Test !, ' ;t "'i I'
i I '
�';. • i'.
I I i - I ii _ - 'y
n 11 t_ t r •
- I f
�� 1 `
_• _
- ^
36. Hood or CanopYcl-' -
r ,I
37. Final Fe Lc ory Fireplace s, i " i ri
�t-
38. Final Plumbing i
39. Water Serl ice-Finali .i
1 I
I
I
`
�:
,
I
.,, .
40. Gas Service-Eiaal I
7 /,-;7/fl
41. SolarQomestic-Final
•-1� 1
42. BackflowPreven!ter
43. Backflow Irrigation, t j ,;
< '. c �
, • � I
�_; ,
I
44. Landscape Irrigation`System_j-
45. Sound:, 'u
1T
+Ii I,ua
46. Hand icap,;Regulations
47. FINAL STRUCTURE & BUILDING
1 I'
j I
I•
i 1
i I , i _ .�
48. Special1 Requiremeni s Completedi
49. Electric Release to Edison I
y
%'
I I
I i I ' + I - - '!I 1 '
-_1✓_
_
50. Gas Release to Si)uthern California
Gas Cn
u r I r
I
I
1 I
51. CERTIFICATE OFOCCUPANCY
No (i r' t Date t
t
! I t 1
'-- Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESApegTnl� TR 4QT NO. LOT NO. .
CONSTRUCTION PERMIT I4 S
Applicant's Mailing Address - TYPE OF CONSTRUCTION NEW LJ ADD LJ ALTERATION LJREPAIR
Protect Address f-00fN� �'� `� ❑ CONVERSION ❑ DEMOLISH ❑ OTHER
owner's Name 'Chone`5Y DESCRIPTION OF WORK �mwaDn hWIUMA
Address o2.35� E 2�S' C f
TYPE OF PERMIT GRADING - FOUNDATION STRUCTURAL
Arch/Eng, !TS�R7/��ULicense No. � ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑MECHANICAL
Address �7 , 1711 C. M � ❑OTHER
Contractor's Nam r- honatp_uEsaz PROJECT DESCRIPTION SO. FT. t5VO OCCUPANCY &4 -1
Address(mailing) Com/ ��� �0CONSTRUCTION TYPES VAWATION$-35P
'/Qi ZONE GRADING CU. YDS. AC:t
License No.
LICENSED CONTRACTOR DECLARATION
1,he/ebY affirm that 1 am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is In full force and ellect.
Llcense.Class License No.
Date Signature
WORKERS' COMPENSATION DECLARATION .
I hereby affirm that I have a certificate.of.cunsent to mif4nsura or a certificate
Workers' Compensation Insurance, or a certified copy thereof (Section
,0, Lab. C.) i, (
volicy No. - Company
BCertified Copy Is hereby furnished.
Certified copy Is filed with the city Building_ Division.
Date Applicant-
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thlssecllon need not be completed If the permit Is for one hundred ($100) or
less) I '
I certify that In the performance df.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.
Date ci9nature
NOTICE: it. altar making this declaration, YOU -Should become subject to the
Workers' Compensation provisions of the Labor Code, you must.forthwith
complY with such provisions or .this permit )shall be deemed revoked.
CONSTRUCTION LENDING AGENCY - -
I hereby afflrm that there is a construction lending agency for the performance
of the work for Which. this, permit IS Issued (Section 3097 Civ. C.) -
Lender's Name
Lender's Address '
OWNER BUILDER DECLARATION • ' _ '
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Sectlom 7031.5 Business and Professional Code: Any city or
rn,mty which requires a permit to construct'. alter. Improve. demolish or repair
Date
rom and the basis for the alleged exemption. Any vlolatlOn of Section
5 by any applicant for a permit subjects the applicant to a civil
Y of not more than five hundred dollars ($500). '
as 'owner of the Property or. my employees with wages as their sole
snsat on will do the work, and the structure is not Intended or offered
lle'(Sec/ion 7044. Business and Professional Code:•The Contractor's
se Law does not apply to'an owner of a property.who builds or Improves j
)n„antl who does such work himself/herself or through his or her own
I ee5, provided that Such Improvements are not Intended or offered for
/, however, the building or Improvement Is sold within one year of com-
n, the owner•wlll have the burden of proving he/she did not build or im-
for the purpose of Sale). I , '
as owner of the property, am exclusively contracting with licensed con-
rs to construct the project (Section 7044, Business and Professions. Code:
.ontractor's License Law does not apply to an owner of property who
or Improves thereon, and who contracts for such projects with a con- ,
r(s) license pursuant to the Contractor's License Law).
m exempt under Section B. & P: C. for this reason
the above -m,
above
lances
repre-
for
Remarks:
I
Sink
kflow, Preventer
kflow Irrigation
Floor Drains
'loot Sinks
-
Gas Service ' Ov
Interceptors•
Kitchen Sink'
Lavatories '
P -Trap'
Roof Drains
Showers •.
Service Sink
Boiler -
Duct - Under Ground
Duct - Structural
Duct,, Ventilating
Ist System U Multiple
I/Fact. Bit. ICBG !/k
tg'System & Ducting
00,000 BTU .0 100,000
or Type 1 ❑. '
Signature -
Drivers' Lica � or SS � - I Registe
CMF 0865-46 rev, 12182 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod -
Sewer Cap
Sewer,Connei
Solar Collecto
Solar Piping
Solar Tank ,
Swimming Po
Urinal,
Waterposer
Water Fleeter
Water Service
System
A. P. S)e �/ 1- 221,--s O•
P LN G. RE F.
TO B EILDING 'n0
LEFT SIDE YARD �1 i7f
PKG. SPACE REO. /L
STREET WIDTH
SPECIAL CONDITIONS:
0! .
Automatic Washer
,,. Switches,'
Trash Compactor
Construction Pole
+„
Cooking Unit
•
Dishwasher
Dryers ❑Gas ❑
I w)Spa
Transformer ❑ 15.50 KIN
'
Fan,
F.A.U.
5861 311711:33
'REAR YARD (TO P/L) -I Sf-
RIGHTSIDEYARD 2,(p/—
PROVIDED 2 1 5
PARK FEE$ i21
Meter Uover 100 amps'__
Sub Panel _
.Sub Pole ”
x03:'16 T_
Motors UO -1 HP Ul%-8
tric tnc,Solar, 139-15HP 016-15+ 1
-microwave ,
Pole Light ,
Range
,,. Switches,'
Trash Compactor
Garbage Disposal
•
_ Generator' 1:10-5 KW [)5-15 KW
Transformer ❑ 15.50 KIN
'
1 050+ KW
Reinspection Fee $15
Reinspection Fee
; $15'
'Meter ❑up to 100 amps
Issue Fee'
-$ 3
Issue Fee„ tv $ 3
Zoning,Approved By
Application p.PProved BY W411L''
trte- I _
APPlicati on,lssued BY
/
�-h R
Date
nate
' nete
S-- gig
tion System
`
)00 BTU ❑ 100,000 BTU
. .
I '
11
-BUILDING PERMIT $
�; • PLAN CHECK $
PLUMBING $
SUMMA$ OF
S'46 �
--giL•-3
FEES '
SMIP
PERMIT
ISSUANCE •
1
$
$
epair/Alteration
_
-
PLAN CHECK, $
GRADING
$
•
,ELECTRICAL. $.
�'$
t
/,PLAN CHECK $
MICROFILM
$
-
'
'MECHANICAL $.
a�BLAN CHECK, i $I
s. I
i
7 i
,
TOTAL FEE $'
-
1
LESSt 93
ADVANCED PC $ U
FINAL FEE, $
ReirBprlction Fee N
$15
Issue Fee
$ 3-
.:-.
+? "CONSTRUCTION;AND;PCAN ING o ,
:: ^ -: - -, . - POOL-& ^"A
. _ n-
- -
Date
-- -
Inspector
ate
�-APP.R&TS Permit #'
-Inspectors
�'
APPROVALS ,_-P,ern,._ -AE '
_
�1 Temporary�Electrical Service or Pole
','
op '_ '-`
; 52:,Eool &:Equipment Location' -
-- -
--
n -
-
oa 2. 'Soil Pipe-Undrgrnd..' a -• -- . "
7i
a" I a"
53 Steel Reinforcement
-
=
3' Electrical Conduit.UFilitv;Undrgrnd. �
"54: Forms.
�,� Electrical Conduit-Undrgrnd r '-
' '
is
55" Electrical Bonding,
L
c Steel Reinforcement
83
56.. Rough Plumbing & Pressure Test
6: Electrical UFER Grnda -
^
y-J16- 6
0
B r
57" APPROVAL TO COVER-GUNITE
1
_
7.Footinsr•I --.;"' ��
9 ' • c `: v
-
58° Electrical;Conduit�Undramd.-
6. Foundation i�
h•,�_,�`
�yy�
• 59. Gas Pipe,'O Undrgrnd.; Test'
9. Wit-6 Pipe-Undrgrnd. ' - 1
t I
s
' 60. Backwash' Lines, P-Trap; O Undrgrnd.
,
10.Struetural Floor System �-ei�
y-22y-$3
61. "APPROVAL.'O-DECK -
11. Property Sewer Line &iHousetonnection
.Backwash.&Receptor-Final
12. Sewer Cap- .j j !
-_
` 63. Heater & Vent-Final
13. Roof�b6ins I _ i
.-64. Plumbing SYstem Final
14. Rough Plumbing ` `•
--65.
Electrical=Final'-' -
I. 15.'Rough-Electrical-Conduit-r--T''"�'-''
-i .'1 - -r
i -I` ,"
_66.-So,lar-Syste`m-Final-.
- -
-- -
16. ;Rbugh Electric Wiring,
i-•T '
-'67. Tencin &.-Access A - ioval
-
!`17:'Rough Wiring Sign,!
68.. APPROVED �i -
FOR PLASTERING_
I• ..
18. 'Rough Electrical-Tm'.Ba7Ceiling
` 1" I -
X69.' POOL/SPA SYSTEMS FINAL
19. Rough,Heating & Air Conditioning{'.
1
' 'FIRE DEPT. REQUIREMENT
APPROVALS Permit#
20. iRough Factory Fireplace i
l
i
21. Ductsjn Structure,,. '' ! { � (
I `
j !
70.' Underground Hydro
`
{ ,
I
'22.Aucts, Ventilating
171.1 Product Piping El Gas OOil
x!.23. Gas Pipe-Rough & Test { ' i
j '
72.� Underground Flush'
24. Roof Framing ; - j I " ! !
F 1
i _, -
73. Undergrnd. Storage Tank El Gas ❑Oil
i
i
25. ,Roof Sheathing
D.S
74. Overhead H dro
y
'4.26. T-Bar Ceiling jStructurao,& Monocoat-
i I '"
I I
, 75. Dry Chemical t -
_ -
27.-frame and Flashing
:q
76.E Dry Standpipe
28. uLathing & Siding r. �; l i I
77. FIXED SYSTEM FINAL
11 29. Insulation •• ; ° ' ,I '
1
'%,4.`�3
78' FIRE PREV. FINAL
-
30. Drywall Nailing > ; I
A ;
`, r
Notes: c
31. Plaster Brown Coat I -1-
D I
- -�.
' " -� - - - - " - -
3Z:_;'Elecfrical Power Meter-Final'' i
1
33Clhnal Electric
34. Final Heatin g"& Air Conditioning
CA-
35. Final Gas Pipe-Test - ' l r
;`3 !'•�
- - T
- _
36. Hood or Canopy _ `.
37. Final F.actocy Fireplace:
38. Final Plu' 7�`'
39. Water Servipe-F,•inal! -.
40. Gas Service-Final
41. Solar DomesticFin`al
42. Backflow;PJeventer'
43. Backflow Irrigation'
44. Landscape Irrigatic;n-System'
-
-
45. Sound"Attenuation-
46. Handicap Regulations l-
47. FINALSTRUCTURE&BUILDING.,
r5•-
- �,
' ,
its Completed,
48. Special Requitem_erl.
aseto Edisonj49. Electric Rele_
_
50. Gas Release to,Southern California Gas Co-
,
51. CERTIFICA; EOFIOCCUPANCY -
- _
j
No I' , i .'Aare
CITY OF COSTA MESA' r
--CONSTRUCTION PERMIT
Applicant's Mailing Address S
Project Address 9A)096
Owners Name 7I9'ss,
Address .a3 H - &, 01
Arch/Eng.
Address' 7 _ C.
Contractors Ni
Address (mailing) 1 S3 9
License No. ' e5 /7 .? 1,1
No.
i
Applicant to fill In all spaces except those within
PEF f ITINO.n/^ n TRACT I
1 - U XX
LICENSED CONTRACTOR DECLARATION "
I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license Is In fu force and effect.
ucenie Cuss -:3k- License No.. 3j7 -T+/i
border lines and sign all appropriate declarations.
TYPE OF CONSTRUCTIONLJ NEW 7J ADD
LJ ALTERATION LJ REPAIR
'
❑ CONVERSION ❑ DEMOLISH
❑ OTHER
-
Solar Piping
.DESCRIPTION OF WORK
Clarifiers _ _
1
_ Solar Tank _
EXEMPTION FROM WORKERS' CO 5AT16N DECLARATIONDishwasher1
(This section need' not be complatatl I a Der mit Is fof One hundred ($100) or
!
Swimming POO( w/Spa
TYPE OF PERMIT U GRADING
P FOUNDATION U STRUCTURAL
A. P. qW
❑ TENANT ❑ ELECTRICAL
PLUMBING
❑ MECHANICAL
NOTICE: If, after making this declaration, you should become subject to the
❑,-OTHER
Water Heater -- -
Workers' Compensation provisions of the Labor Code, you must forthwith
comply 'with such provisions Or This _permit shall be deemed revoked.
PLNG. REF, 4W
_
(water Service
CONSTRUCTION LENDING AGENCY -
/
TO BUILDING
PROJECT DESCRIPTION 50. FT.
-
OCCUPANCY
PROPERTY LINE
CONSTRUCTION TYPE
VALUATION$
'LEFT SIDE YARD
ZONE GRADINGCU.YDS.
-
,ACRES
PKG. SPACE REO.
Remarks:
'county which requires a permit to construct, alter Improve, demolish or repair
`any structure, prior to Its Issuance, also requires theapplicant for such pa rm it
to file a signed statement that he/she Is licensed pursuant to the provlsi ons of -
t¢ Contractor's iiconse Law (Chapter 9 (commencing with Section -7000) oft
;:- sion 3 o the Business and Professions Code) or that he/she'is exempt
.;- from and the basis for the alleged exemption. Any. violaion oC Section
Roof Drains -
STREET WIDTH
'•
Showers -
Reinspection Fee
sPe
_
Servi6e Sink r
SPECIAL CONDITi
'11ERiN( S• COMPENSATION DECI TION ' I , (Bar Sink I I I Sever Cap
eeby affirm that 1 have a cartificate,of.consent to self -insure or a certificate-
Workers' Compensation Insurance,'or a certli copy hereof (S tion
4800, Lab, C'.)/', •�
Policy No. 21i/ LIpZ Company
ertified copy is hereby furnished./
Backflow Preventer Y
- Sewer Connection "
Backflow Irrigation '
Solar Collectors
- o -
Bathtubs !
Solar Piping
Certified copy is filed with the city Bu Ing Ivl �
Date Applicant
Clarifiers _ _
1
_ Solar Tank _
EXEMPTION FROM WORKERS' CO 5AT16N DECLARATIONDishwasher1
(This section need' not be complatatl I a Der mit Is fof One hundred ($100) or
!
Swimming POO( w/Spa
Drinking Fountains I
-
Urinal
-
less) I
I certify that In the performance of the work for which this permit is Issued I
In to become to t(se
Floor Drains
Water Closet
-
shall. not employ any person any manner so as subject
Workers', Compensation Laws of California.
Date I Signature
NOTICE: If, after making this declaration, you should become subject to the
Floor Sinks
Water Heater -- -
Workers' Compensation provisions of the Labor Code, you must forthwith
comply 'with such provisions Or This _permit shall be deemed revoked.
/ Gas Service -Outlets ..,/
_
(water Service
CONSTRUCTION LENDING AGENCY -
/
Interceptors
-
I hereby affirm that there Is a construction lending agency for thgerformance
of the work for which this permit Is Issuetl (Section 3097 Civ. C.)
Kitchen Sink'
_
Lender's Name'
_ _
Lender's Address -
OWNER BUILDER DECLARATION
'License
Lavatories . t
_ 'J
-
I hereby affirm that I am exempt from the'Contractor's Law for the
following reason (Sectlon,7031.5 Business and Profeulonal,Code: Any city, or
P. -Trap
P
- -
-
'county which requires a permit to construct, alter Improve, demolish or repair
`any structure, prior to Its Issuance, also requires theapplicant for such pa rm it
to file a signed statement that he/she Is licensed pursuant to the provlsi ons of -
t¢ Contractor's iiconse Law (Chapter 9 (commencing with Section -7000) oft
;:- sion 3 o the Business and Professions Code) or that he/she'is exempt
.;- from and the basis for the alleged exemption. Any. violaion oC Section
Roof Drains -
,
'•
Showers -
Reinspection Fee
sPe
_
Servi6e Sink r
,
Iaua Fee
by any applicant for a Permit subjects the applicant to a=civil
•i anally o/ 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 (Secflon 7044; Business and Professional Code:' The Contractor's
License Law does not apply town owner of a property who builds or Improves
thereon. -and who does such work himself/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 com-
pletion, the owner will have the burden Of proving he/she did not build or Im-
for the purpose of,sale).
F I, as owner of the property, am exclusively c6ntracting.with' licensed con-
Ft,
.tractorsto construct the project Section -7044, Business and Profeulons Code:
The Contractor's License Law does not apply to an owner of properly who,
builds or Improves thereon, and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law).'
❑ 1 am exempt under Section B. & P. C. for this reason
.. MECHANICAL
,
Generator 130.5 KW CIS -15 KW
Boiler Refrigeration System
Duct - Under,Ground_ ❑6100,000 BTU O100,0008TU
-
Duct - Structural !
System Repair/Alteration 1
$15
Duct - Ventilating
Meter El up to 100 amps
Exhaust Syst, em ❑ Multiple ❑
$ 3
Fiiepl/Fact. Bit. ICBG ik
Date Owner
Zoning Approved By
Application Approved B
By �M
Application Issued By
Heating•System & Ducting
1
,-'
1--herebythat ('have
on read this application ano state -that the-ab-
nforreanon is correct. r agree
e di comply with all and here county ordinances
and state laws rotating to building construction, antl hereby authorize repro-
{sentalives of -this ;Nty I en r (upon N veVrlenlionetl to it for '
I Inspection Du s !
Signature
/ f
Drivers' LI nse or 55 •¢ '�+� -, _ )
-`�-[DO-100,00011100,0001:11L
700,000 BTU'
[DO-100,000ove�
i
- I- - 'j - •' --�
I
Hdod or T 81 ❑1 '
yp I ',
CeI 1 T a II ❑i
I
, I Reinspection Fee
I
r
Registers I I !
� , I
•
E � Issue Fee '
( j
CMF 086546 rev. 12/82 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
7360 4/1 b/'13 46,bil TL
ZONING REGULATIONS -
ZONE
_ mur n;ur
REAR YARD (TO P/L)-
RIGHT SIDE YARD
PROVIDED
,PARK FEE -$
C
-/�
O<
Automatic Washer •' - - - _
Meter LJ over IUU amps
Construction Pole1 j
.Sub Panel
Cooking Unit '_ '--�
Sub Pole
Dishwasher ''
',Mot6rs 00-1 HP ❑l% -S
.
Dryers ❑Gas' ❑Electric
Inc.Solar 09-15 HP 1116-15+
Fen .,I; , -
'Microwave
F.A.U.
Pole Light
_
Fixtures _ _- I
Range-
_
Device Boxes
Sign
Outlets
Standing Sections
_
Switches
Trash Compactor
6
Garbage Disposal
Generator 130.5 KW CIS -15 KW
Transformer ❑15.5OKW
❑50+KW
Reinspection Fee $15
$15
-
Meter El up to 100 amps
Issue Fee'
$ 3
$ 3
Zoning Approved By
Application Approved B
By �M
Application Issued By
Date
' I D ate
' Date
,
'
�� a
' I SUMMARY OF FEES
BUILDING PERMIT $I ' SHIP
'PLAN CHECK, $ ' ! PERMIT '
.PLUMBING $1 ISSUANCE I
PLAN CHECK $' ,SZ�I GRADING
; I I ,
ELECTRICAL $ I
TN CHECKS $ I I i MICROFILM
IMECHANICAL $i ! V I TOTAL FEE'
PLAN CHECK: 1 $I , LESSED,PC
I I FINAL FEE ;
$
$
$ '
$ 1
$
$ i 1
$
$
I
I
$15
$ 3
1
�;CONSTRUCTION;ANDSPLA ING' i' ' " 1 -'
';' (�� r. •7Date ,
- �-
iIrispector
,. -= P004 �yPA ..
- - - - `.
,_ •'
Date
r
Irispe'ctor
,- APPROVALS `Permit #- �,
'APPROVALS .' Permit.#
_ _ _ _
_
r 7 Temporary Electrical Ser3ice or�Pole -` +'
.
r52:. Pool &'.Equipment Location'-• .
-
-
x;21 Soil Pi a-Un r rnd' v '-
D 9 ,
` >
53.' Steel Reinforcement
` !• ,
1
. 3.' ElectriFal Foriduit Utility-Undrgrnd.
54r Forms'. - --
', _,
_ .. ..
,-•,
ik' 4: Electrical'Coridmt Undrgrnd, ; ? _
1
_
_
55 Electrical-Bonding
5 St el R' mforceme t^ 1'�" ?
I.
n _
"56.• Rough Plumbing& Pressure Test
t
6' ElectricallUFER Gnid.'�! ` • ` -
- 1
: 57.' APPROVAL TO COVER-GUNITE-�
. -.1
z
7.Pgs 1�.� 1 '"
.I,^p
;
Electrical'Coriduit•Undrar),d-
.;=_•y�_^
le
B. F-ouriifatiori �.�'i.' ' - `=
- _
'59. Gas Pipe; El Uridrgrnd., Test --
:-•?� • -
I
"
9. Water�tpe-Undrgrnd.y
��/
' ,'
60. Backwash. Lines,PTrap,OUndrgrnd.
r
7�a%I?3
y
10. S[ruciural Floor System `'%moi''
61. APPROVAL TO DECK
11. Property Sew, Line & House Connection
62. Backwash &Receptor-Final '
werCap
i
3
;63. Heater&'Vent-F.irial
-.a
13. R�gofiE rains
_
- 64. Plumbing-System -Final -
• �
14. Rough:Plumbing �'/ - !
c
` -
- 65. Electrical-Final _-
= !Ir
t•
15'Rough`Electrical=Conduit-T-;"-'--'----
I;
----''-'--
I >;
6§. Solar.System-Final-l-
-,
rl I
j
;
'Hi 6. Wough.Eleciiic Wiring,^
i_-,
_167.
3.en
17.;kough�Wiririg ,Si9n n 1 ': ' ,
. • �' '
J
68.1 APPROVED FOR PLASTERING
_
1
:
S. houajhbectrlcal„TBai.Ceiling '
69..POOL/SPASYSTEMS-FINAL
-
-
19. 'R'ough-,Heating &'Air Conditioning
d I
FIRE DEPT. •REQUIREMENT•
APPROVALS Peimit'#
20. 'Rough,Factory Fireplace' ' i
1 ` I
I
I
-
21. •Ducts,lin Stiuctur'ev '^ I 1 .i 1
I
'
70.1 Underground Hydro
-
_ y � , I
l
1
y2 Ducts, Ventilating l 'I }
`
j j I
7.Y' Product Piping ❑ Gas OOil
-i•_ - ,
123. Gas P.iPa-Rough & Test -; �� '
T I
i I -
1
+ i i.l
-7z. Underground Flush '- -
- -
- -
24. 'Roof Framing° 4
73.IUnder grnd.Storage Tank OGas .00il
' 25. Roof. Sheathing ! 1 t .; -
I '
' L - -
74. Overhead Hydro -
1
-26. � --Bar Ceiling (Structurap. & Monocoat ' ;
•
75. Ory Chemical -
, .
Frame and Plashing
j
76.! Dry Standpipe
w'27.
1
t.
28. ,Lathing & Siding
77.1 FIXED SYSTEM-FINAL
-
I`29_�Insulation
78.' FI,REIPREV. FINAL i
'730. Drywall Nailing
i
l (
Notes:
I,
01. Plaster Brown Coat • + 1 I
i ( t
' j
t l -- -- -
a'32. Electrical ,Power Meter:Final
33, Final Electric
34. Final Heating & Air Conditioning
,
35. Final Gas Pipe-Test)
36. Hood or CanoPV_!
' - i
1
- 1
•, - - -- -
37. Final Factory Fireplace^ 6i-
,
�1
38. Final Plumbing ! , I ?
8'A rpT
46"/t'
39. Water Service-Final; ( l '�
!
1 I
I •5
i
_ I. .
40. Gas Service-Final (
41
41. Solar Doltestic-Final
,_
42. Backflow Preventers
43. Backflow Irrigation; '• I
I .' !
-� -
- i
,:.v ., _.
,
44. Landscape Irrigation System
45. Sound) Attenuation-
46. HandicaplRegulations', I `j I
I�
'
`•j -: I ` - - ` :-
_ I
47. FINAL STRUCTURE & BUILDING
1
48. Special. Requirements Completed]
I <:
49. Electric Release io Edison, `
-•._ ___
-__-
I - .� _ .:-
,_
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OFOCCUPANCY_
I I
r_-t _ ,-.;_
-I_ _ i_
No h Date
!
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations
''CITY OF COSTA MESA --7•
--- -` _.
• P R IT Nf�.� TRACT NO. LOT NO; , -
r
j----. -• 1-'
- 94?9' 5726/13'.
- - .--.
�'•7�' ITL
CONSTRUCTION PERMIT'
. TYPE OF CONSTRUCTION .
EVN/ ADD ALTERATION -LJ
"REPAIR
Applicants Mailing Address
-
Protect Address: '�`� - L' i
❑ CONVERSION (❑ DE OLISH ❑ OTHER:
Owner's' hone
DESCRIPTION OF WORK
i
-
,.
ZONING REGULATIONS
.Name _ _
i -
..'
Address 1 -
TYPE OF PERMIT GRADING i' FOVNDATION/// STRUCTURAL -
A. P. 9Wt
..
ZONE
I , ;
_
Arch/Eng. - Licensa No
❑TENANT ❑ELECTRICAL
❑'.PLUM BING MECHANICAL
PLNG. REF.�*W
.BUILDING',
--
Address � •' ' -
O,ATHER '
/
_
TO BUILDING -.
-
-
-�
_
PROPERTY I - -
_ •REAR YARD (TO P/L)
-
Contractor's Nam'/L• 4Ak Eva Sa1S��hrin
PROJECT DESCRIPTION SQ: FT.
'- OCCUPANCY
Addre551rtiailingl-
CONSTRUCTION TYPE '
�' VALUATION$
'LEFT SIDE YARD
, RIGHT SIDE YARD
_
7
Lidense No. �f7' ��✓ %�
ZONJ= GRADINGCU.YDS:
ACRES
PKG. SPACE; REQ.
1 PROVIDED
-
- -
__
LICENSED CONTRACTOR DECLARATIONRemarks:
S 7
-
_ '
STREET WIDTH
- PARK FEE $
I hereby affirm that I' am licensed under provislons of Charter 9 (commencing
with 'section 7000) of Division 3of the Business and Professions Code, andSPECIAL
CONDITIONS:
my license is In full eapd sac.I.
license Gass enO r en
PLUMBING
Date-- 7 Signature
WORKERS' COMPENSATION DECLARATION'
Bar Sink
Sewer Cap !
ELECTRICAL
}
7sreDy a/flrm.that 1. have a certificate of consent. to self -insure or a certificate
88ckflOW'Preventer _ '
'Sewer Connection, _
Automatic Washer '"
'Meter _Oover.100 amps
_•-#'.Workers' Compensation Insurance, or a certified copy thereof (Section
Construction Pole
'Sub Panel
:`,10, Lab. C.)
,
Backflow Irrigation
Solar C_ollecto_rs
Policy No. - Company
Cooking Unit
Sub Pole
❑_Certified-c6py is hereby furnished. ;
Bathtubs }
Solar Piping
t
'Motors
rtified copy is filed with the city Bullcling Division, Ii
Dishwasher
❑0-1 HP 01'hS
ate Applicant
Clarifiers -
Solar Tank
Dishwasher - ••1
Swimming Pool w/Spa ;
r Dryers ❑Gas' Electric
_
Inc.Solar ❑9-15 H_P ❑16-15+
EXEMPTION:FROM WORKERS''COMPENSATION DECLARATION
(This section need not be Completed If the permit Is for one hundred ($100) or
less) 1
` I certify that In the performance of the work I whl his D rmlt Is Issuea I
Drinking Fountainrs f
Urinal
- Fen i
i 'Microwave
shall not employ any person in any man O as ec su bjec t lite i
Workers', Laws
-- - j -
Floor Drains
- - -
F.A.U. )
Pole Light I
• i 1
C ansa of Californl
Date '' Signs eve
_
Floor Sinks �- --- -
Water Closet
-
Water Heater^ -
-
I Fixtures •-
—
Range
;
NOTICE: If, -after mak ng this tletlere n, -you Sh ultl`becom ubjecl to e =
Workers'. Compensation provisions ,o the Labor Code, you., must.. Ith '
- i ,.
-
Device Boxes ' 1Si
comply with; such Provisions 'or this permit shall be ,deemetl' r oketl.
Gas Service' 'Outlets - 1
y -Water Service . _ •, i _
9 n'
CONSTRUCTION; LENDING AGENCY
,
�
Outlets
I
, I hereby affirm that there I5 alconstruction lending agency for thelperformanca
- Interceptors -
P - _ ' 'r '
Standing Sections
of the 'work for; which. this, permit is ,issued <(Sectlon 3097- Civ: C.)
Switches
Lender's' Name.
Kitchen Sink ,y -
_ ;
:Trash Compactor
`
Lender's Address _ i `
-,
( - rGarbage
Dis Disposal
,
1
OWNEWBUILDER DECLARATION 1 r
Lavatories -
I hamby'affirm that I am'exempLfrom the, Contractor's License Law for the
P -Trap : ^ I
; ,
Generator, ❑0-5 KW 05-15
1
KIN
following reason (Section' 7031:5 Business and Professional' Code: Any city or
county which requires a permit to construct, alter Improve, demolish or repair
'also
_
-
Transformer E115-50 KW
,
I
any structure, prior to Its Issuance, requires tae applicant for such permit
ROof•DlalnS
to file a signed statement that he/she I5 licensed pursuant to the provisions of
the Contractor's License Law'(Chapter 9 7000)
-
-
050+ KW
Reinspection Fee $15
(commencinglwlth Section of
3 -of. the Professions' that he/she Is
..
Showers
- Reinspection Fee
$15
D) on }Bust ness and Cotle) or -exempt
rom and the, basis for the alleged exemp 1 n. -Any violation ofSection
Meter ❑up t0100 amps
$ 3 1
d5 by any applicant for a permit subjects the applicant to a' civil
ay five
Service Sink - l
Issue Foe
$ 3
Zoning
Issue Fee
of not more than hundretl dollars ($500).,, 1
-as
;. •:
Approved By
Date
I, owner ofj the 'property ormy employees with wages as their We
tlo the work, stru Lure oHeretl
compensation a is not offere
_ r , MECHANICAL
-
Appliretion Approved By
Date
,
n ) and Ie Professional
• for sale (Section 7044, Business)antl1e t The, Contractor's
Code: The,
r
f� ,
S'
License Law does not apply [pan owner o/ a property who builds or Improves
Boiler
Refrigeration System
Application Issued By
V. ' _nate
thereon, and who does, Such � work himself/herself or through his or her own
employees, provided that such -improvements are -not Intended or offered for
.� -�+
Duct +Under Ground
❑D-1 DG,DDD BTU ❑10Q,GGG BTU
l 1
-
• sale. It, however, the building or Improvement is sold within one year of com-
,
'
SUMMARY OF FEES
pletion,,the owner,will have the burden of proving he/she did not build or Im-
';
prove fors the purpose of sale). •- -
,s
Duct -Structural i
System Repair/Alteration
BUILDING PERMIT $
SMIP I
$-
Li 1; owner of the property, am exclusively contratting'witWilcensed con-
tractorsto construct.tha'project (Section.7044, Business and Professions Code:.
does
_
.. Duct: Ventilating ..- : ._t-.
-,
_ _ _
'PLAN CHECK $
PERMIT
The Contractor's License Law not apply to an owner of property who
builds or Improves thereon, and who contracts for such projects with a con- .
Exhaust System ❑ Multiple ❑:
:
.PLUMBING $
I ISSUANCE
$ '
tractor(') license pursuant to the Contractor's License Law). i
- -
{ GOADING
1
$
❑ 1 am exempt under Section I B. S P. C. for this reason
'; Fire pl/Fact. Blt. ICBO #
I J
PLAN CHECKS $�
,
I !
.'
` `
ng�System & Ducting
•L�
-T
ELECTRICAL $i
'• -
$
Date' - Owner
rF-hereby certify-that-I:have-read i pplc Ion antl-st that 'above'
I P700,000'BTU'�100,OOOB
-'-
- --J- -' -
1
PLAN CHECKi $
'
MICROFILM
$
Information is correct. I agree to comply with all city antl County tlinances i
! , i
$
q TOTAL FEE. .'
$
andpstale laws rel ti to b ildl const uct1,2nn ann�d,,'hhereby authorize repro- 1
Hood of Type 1 ❑`
, - -.
,MECHANICAL
___lam— ;
!
•.
untatives of ;t I tl 1 t ntlonetl Property for
Inspection our es.
Cano T e II ❑'
Reinspection Fee
i
$15
PLAN CHECK. $�
7 O0 LESS
,
-' ,-„a'_:
.
i
I ADVANCED PC
$
SC'C%�L .
Signature Data
•5 '- ' '
i i
Registers
{ }r
Issue Fee i
$ 3
.� ,
i J
'g'�
Drivers' License or * -
,
i FINAL FEE'
$
CMF 0865 16 rev. 12/82 -
it g; Accounting:
Goldenrod -Assessor
-
-CONSTRUCTION;AND:PL'ANNING'- +'�
;.� _
- j�- '; - POOL.Y '`A-
- -
'Date •
-'1 �� nZ&I .Date ;
. APPROVALS - Permit,
,Inspector
-
P'erm,.#
?
Inspector '
T ri c _
9
-APPROVALS'-
i1y Temporary Electrical Service dr,Pole52,
00 &Equipment Location-
-Reinforcement
2.;Soil Pipe-Undrgrnd°53
Steel-
,-
r
3. El'ectrica'l Conduit Utiliiv Undrgrnd.
- - i,
_
-54: forms •• -
-
2
r',
;
;4 4: Electrical Conduit-Undrgrnd)155.
Electrical Bonding
5, Steel' Reinforcement `� _
-
:- -
`56. Rough Plumbing & Pressure. Test .
6. 'Electrical LIFER Grnd. '-= `,
57`.- APPROVAL TO.COVER-GUNITE
4.
7. Footings - r c g� -
_
,.� --
:�58. `Electrical Conduit-Undrornrf.
8. Foundation�L?59.
I
Gas Pipe; O.Undrgrnd., Test'
- ....• 1
s�
•;
- .'-
9. Water, Pipe-Undrgrnd.: - -
i'60. Backwash Lines; P-Trap, OUndrgrnd.
t
10. Structural Floor System
61. APPROVAL TO DECK-
c
11. Property Sewer Line &:House:Connection
82. Backwash'& Receptor-Final
12. Sewer Cap^.,
�-
63. Heaters &-Vent-Final--
_
<-
13. Roof!Drains
PlumbingSystem =Final - _
�•
14. Rough Plumbing' •' '-'
�'
65. Electrical=Final-
' 15.--Rough Electrical--Conduit - "- T
"+-'T' -
,
' --
�
- -- -
ah, - -
66.i SolarlSystem-Finil-
-
-
. 1
J-1'6.
a_i'6.'Rough Electric Wiring
'I'}` I -'...
p7.. Fencing &Access Approval:
-
17. Rough Wiri'nlSig-n'? I :
!1 !
_ i
'68, APPROVED F.,OR PLASTERING
I
18:'FtoughElectrical-T,Bar Ceilingl
69. POOL/SPA SYSTEMS'FINAL -
-
19:; Rough. Heating&AIrtondlLoning i
�_
!
; j FIRE DEPT.
APPROVAILS' Permiti,# ''
( 1 `� �"
- I•
20. Rough-Factory Fireplace I
I i I
' I 1
21. Ducts, in SiPucture-. ' 1 -•1 'I „
I
70. Underground Hydro
" 22. Ducts, Ventilating
X71. Product Piping O Gas ❑Oil
'
-- .•. •,
1
' 23.'Gas Pipe-Rough & Test ;, I 'I
72. Underground Flush _ ,
'24. 'Roof Framing 'i
I -
- I
73., Undergrnd. Storage Tank ❑ Gas ❑ Oil,
1
,
25. 'Roof Sheathing I=
74. Overhead Hydro
26_.T-Bar Ceiling (Structural), & Monocoat
75. Dry Chemical -
27. Frame and Flashing i , I I j 'I
'76.. Dry Standpipe
28. ,Lathing & Siding. ;, ' I j I '; II 1
I I i
I
177. FIXED SYSTEM FINAL
29_ `Insulatio ! .i ` ; ! �� ,i
` 1
78.j FIRE PREV. FINAL
30. Drywall Nailing
iNotes:f
31. Plaster Brown Coat
Meter-Final
32.:Electrical Power
33. Final Electric
34. Final Heating &IAir, Conditioning I
nl� lel
35. Final GasiPipe-Tesfl
36. Hood or, CanopYp'-1-
,
37. Final Factory Fireplace,-, I , : •.I
! - I
•W I 1
Y`' - - - -
I ` ^ ' '
I - -
38. Final Plumbing
39. Water Serpice-Filnali
40. Gas Service-Final
I
;
41. Solar Domestic-Final
42. Backflow,Preventerl _ I •,,�_
-i �
_ '-
- -
-1 _ -
43. Backflow Irrigation
44. Landscape Irrigation;System
45. Sound. Attenuation
_P SIJ t l;•l. I
1" 1
,
-
46. Handicap;Regulations
47. FINAL STRUCTURE & BUILDING •.
!•-- 1
I
'
48. Special Requirements Completed;
49. Electric Releaselto Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
:
_'}
I _�
No I' I Date
to fill In all spaces except those within heavy border lines and sign all
CITY OF COSTA MESA'
CONSTRUCTION PERMIT
%pplicant's Mallin Address --��L//tt �[ y. ' �• TYPE OF CONSTRUCTION
4oject Address Address TYPE
/��/t,,p s—_ l� / ❑ CONVERSION ❑DEM LI
�r'' Phonate
T-56-
b DESCRIPTION OF WORK W
Waitress �nU F' �� T�•/ S% CGSI'/4 /li/ES'4 TYPE OF PERMITr�r{ LJ GRADING
krch/Eng. License No. ❑ TENANT LECTRICAL
Waitress -OTHER
;ontrector'sNam p /hone 2_—!�Cyq-7T. I PROJECT DESCRIPTION SO-
lddress(rn linn) PO4-O C(="C' I4.V7. �-lO�� CONSTRUCTION TYP
LJ ADD LJ ALTERATION- LJ REPAIR
OTHER
FOUNDATION 0 STRUCTURAL
PLUMBING ❑ MECHANICAL ' PLNG. flEF.
ZONE GRADING CU.
_icense No.
Roof Drains
Remarks:
JCENSED CONTRACTOR DECLARATION I
hereby affirm that 1: am licensed under provisions of Charter 9 (commencing
RIGHT SIDE YARD
with section 7000) of Division 3 of the Business and Professions Code, and
ay license is In full f ce a d fact. ?6.T'/ 3/�
Joan" Clan — License No.
alleged exemption. Any violation of Section
'
late Q Signature
YORK 5' C MPENSATION DECLARATION
Bar Sink
Backflow Preventer
hereby affirm that Lhave a certificate ofconsentto self -Insure or a certificate
Workers' Compensation Insurance, or a certified copy thereof (Section
Backflow Irrigation
•'
A, Lab. C.) '
rollcY No. Company ' '
' Bathtubs j I
3 Certified copy Is hereby furnished.
Certified copy Is filed with the city Building Division.
in
Date
CONSTRUCTION LENDINI
1 hereby affirm that there Is a
of the work for, which t
Lender's Name
Lender's Address
OWNER BUILDER DECLAr
I hereby affirm that I am -ex
following reason .(Section 70
county which requires a Derr
,any structure, prior to Its In
to file a signed statement IN
the Contractor's License Law
Division'3 of the Business I
Y from and the'basls for
5 by any applicant f
! .ty of not more than five
LJ I. as 'owner of'the drop
plicant
RS' COMPENSATAOIN DECLARATION
aletetl it the per for one hundred (E100j or
ice of the work//r h this permit Is Issued I
In any mannppe spa t becomesubject.tnlba.—
of Callforv.01 , I I
you should -become subject -to the
Labor Code, you must forthwith,
,ermlt ;shall be deemed revoked::
lending agency for the performance,
r Issued -,,(Section 3097, Civ: C.)
i i
Drinking Fountains
Floor Drains
Floor Sinks '- -- - --
Gas Service Outlets
Interceptors, ,
a, also requires the applicant for such permit
ucense Law poen not appy to an owner or a property wno pUllps or ImprOV¢s Boiler
thereon, and who does such work himself/herself or through his or her own -
employee5, provided that such Improvements are*not Intended or offered for
sale. II however, the bulitlin9 or Improvement Is sold within one year of com-Duct - Under Ground
pletion, the owner will have the burden of proving he/she did not build or im-
rove for the purpose of sale)'- Duct - Structural
I, as owner of the property, am exclusively contracting iwith licensed con-
tractors to construct the project (Section 7044, Business and Professions Cotler. Duct -
Ventilating..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 can. Exhaust System ❑ Multiple ❑
tractor(s) ilcense pursuant to the Contractor's License Law).
❑ lam exempt under Section B. d P. C. for this reason Firepl/Fact. bit. ICBO 50
Date Owner Heating System & Ducting
I hereby cart[ y t I hav read this application and state that the above ❑0-100,000 BTU-0100,000BT7
Information 1 e to comply with all city and county ordinances
and state lawJ uiltling hereby repre-
1griaXn construction antl authorize Hood or Type
nt n-lha—aIIo -mentioned ¢rty
ofy e
Isantatives
pr
forinspection Cano T eII
ou
Data
❑Signature�
: Drivers' Llc or 55
•Applicant; Pink
MICROFILM
$ i
MECHANICAL $
TOTAL FEE.
$
PLAN CHECK $
ADVANCED PC
$ �
' 1
FINAL FEE
$
0 �-CONSTRUCTIOWAND.PLANNING' - ",--! ;'�'it..
- =.,.
i,qo=- :. ? :-POOL•R• -^A =,.n -
: _
% t £T q). _<; : Date
j- fAPPROVALS Permit#
°Inspector
r -
' - ' ' , ,.� ' -
-APPROVALS;' Perm.. #
Date
Inspector
_
n• .1-. Temporary Electrical Service or`Pole+
- -
"� - - ''
52FPool &:Equipment, Location
h f _
-
2! Soil Pipe-Undrgrnd, F _ 5; "�',
-'.>
��,6 ._
;,534 Steel Reinforcement.
" •'i
�,.
.� I Electrical Conduit Utilitv-Undrgrnd.'I i�;
., �I -
` $"
54. Forms,
^t 41 Electrical Conduit-Undrgrnd r z '';
I
f a
Electrical Bondin -` -
.i55
5. Steel Reinforcement l '
'+
I
`-
Nt ; _- _
'`56.. Rough Rlumbi�g & Pressure`Test -
r n ,
I
t
8: ,Electrical UFER Grnd. ,:
_
r: • "-'
5,7. APPROVAL. TO%COVER-GUNITE
-; IJ
7. Footings ! ! ' a
-
'
,�
:'58: Electrical Conduit"Undrarnil-
c
8. Foundation ' ;,z I o,
' `
-i F
59 GasiPipe; ❑:Undrgrnd Test
•,'i
_
_�
9. Water Pipe-Uridrgrnd. , '
_ _
I'g0, Backwash. Lines, -P-Trap, ❑-Undrgrnd. -
X
10. 6tructural'Floor System ;"• -
-
61, APPROVAL TO'DECK -
11. Property Sewer Line & House'Connection,
6
a-
r
62. Backwash '&`Receptor -Final
12. Sew eSCaP
63. Heater,&•.Vent-Final-
13. Roof Drains 'j :,
yo
'64. Plumbing?Systert - Finaly
"
!
14. Rough PIumbingI I'- 1
-3
X765. Electrical=Final- -' -
,�-15. "Rough^Electrical--Conduit. r I I •
1
66.i SolirrSysteni--Final 7 -
•.6. ,
f
67.I Fencing 8i Access,Approval
, ^^
`17. Rough Wiling Sign: -'. - " "-
I ^ �' ;
I -`
; �68.j APPROVED FOR PLASTERING
I ,. r
, ,.
•
FI
18. -Rough Electrical T.Bai,Ceiling, '�
-
`- i-
k
69., POOL/SPA SYSTEMS FINAL
.19.:13 ugh Heating &'Air Conditioning
FIRE DEPT, REQUIREMENT_
= =
-
APPROVALS Permit #
-
20. Rough: Factory Fireplace'•
, - i
i I
>
21. Ducts,'in Structure- "� ' !I 1
i i i
i ; i
70.! Underground Hydro
! , I
;22. Ducts, Ventilating `" I { !�
f i
!
71,i Product Piping 0 Gas ❑ Oil .
,
GasrPipe-Rough & Test ° 1 I I i
I
(
72,! Underground Flush r
jf23.
I
i
jl'24. Roof Framingi i I ` ' 17
lCJ
711 Undergrnd.StorageTank O'Gas 0Oil
,I 25.1Roof Sheathing , I I ' -
'
74. Overhead Hydro
.,i�
1
,
-
•�-26..T-Bat Ceiling (Structural). & Monocoa't
!
75. Dry Chemical -
'Frame
27. Flashing' ; I 1i
: I I
i '
76., Dry Standpipe
-and ,I
N 28. 1Lathing & Siding p
I n
I i ii It i
i^ , 1 I
X77.; FIXED SYSTEM,FINAL
o
r
p8.! FIRE-PREV. FINAL
ae 30. Drywall Nailing n ��
f f
!
Not as: i - -
>
1
1
Plaster Brown Coat-
;F31.
�32. 'Electrical Power Meter.' -Final
-
33. Final Electric I
34. Final Heating &jA
Conditioning
35. Final GasiPipe-Test' I _i
,
c
.I,�
36. Hood or Ca noliY"i
37. Final Factory Fireplace
38. Final Plumbing'
39. Water Service: -Fina 1! _ I
40. Gas Service -Final I i
41. Solar Domesiic-Final
r i
42. BackflotN•Preventerl-
�r
43. Backflovv'lrrigation; I. ;
i I< 1
-�'_ !
I �.- `
,' I _;i'
>✓ =
44. Landscape IrrigationLsystem
..� Lr-rw
45. SoundAttenuation ' l :- ' il�'
1
.r i
46. Handicap'Regulations
47. FINAL STRUCTURE & BUILDING
!
I r - • •-
46. Special Requirements Completed) G
i
_ I
! I i ' , •
'-
49. Electric Release to Edison
50. Gas Release to Southern California Gas Cc
51. CERTIFICATE OF.000UPANCY
No " Date
ICITY'OF COSTA MESA CONSTRUCTION PER
Address 5413 E. La
Owner's Name Cttamull `_VkK - - Phone v-s� - rvv.�
Address 2606 Elden ST. , -#D-Costa Mesa 92627
Arch/Eng. -✓ License No.
Address
Contractor's Name PRO.HEATING & AIR •phone 779-6868
Address (mailing) 5413 E. La Palm -Anaheim 92807
City License No. 35251
LICENSED CONTRACTOR DECLARATION
I -hereby affirm that I'am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license Is in full force and effect.
License,C{a5 — Lic n q. 469637
Date t5/ L - Signature
^L ` WORKERS' COMPENSATION DECLARATION -
t,?p 1 hereby affirm that I have a certificate of consent to self -Insure or a certificate
(. f Workers_' Compensation Insurance, or a certified copy thereof (Sectlon
6. J� 800, Lab. CJI 2
,
Policy No. &HfR� Company Homeland
❑ Certified copy is hereby furnished. l l
Da certi(lep�RgyBlttiled with the city 'I In & AIR
Date 23/ U/ Applicant i� lJ t1CIi,1'1LW
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section need not be completed If the permit Is for one hundred ($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.
. Date Signature
NOTICE: If, after making this declaration, you shoultl become subject to the
Workers' Compensation provisions of the Labor. Code, you must forthwith
comply ,with such provisions or this permit shall be deemed revoked.
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 (Section _3097 Civ. C.)
Lender's Name'
Lender's Address
OWNER BUILDER DECLARATION '
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
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/she is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt
therefrom and the basis forthe alleged exemption. Any violation of Section
031.5 by any applicant for a permit subjects the applicant to a civil
enalty of not more than five hundred dollars ($500)., i
❑ I, as owner of the property'or my employees with wages as their sole
rn mennotinn will rn the wrrk. and the structure is not Intended or offered
ctiOn 7044, Business a
does not apply to an ON
arovided that
ever the buil
Js or Improves
lis or. her own
or offered for
pF,.on, the owner will have the burden Of proving he/she did not build or Ina -
far the purpose of sale).
lJ I, as owner of the property, am exclusively contracting with licensed con-
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
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
proof Oftheir Worker's Compensation Insurance should be provided to me.
❑ I am .exempt under Section _ B. it P. C. for this reason
Date
1 -hereby certify that 1
information Is correct. I
and state laws relating
sentatives Of Is city
inspection p r os s.
Signaturo
Drivers' License or SS q/
CMF 0865-46, rev. 10/84
Owner
ive read this applicatlon and state that the above
Tree to comply with all city and county ordinances
building construction, and hereby authorize repre-
q2lep upon the above-mentioned property for
'' - liate8/20/86
White - - Applicant; Pink - Accounting;
those within heavy border lines and sign all appropriate declarations.
3325 9/1B/86 ~' 15e50 TL
TYPE OF CONSTRUCTION. LI NEW LI ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER -
• DESCRIPTLON OF WORK/USE OF BLDG. Single family residence
Instal.]. A/C system
A.P. # - Zone
S
_
Main Building: Accessory Building:
TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL
1�1
❑ TENANT IA1 ELECTRICAL ❑ PLUMBING ® MECHANICAL
❑ -OTHER -
T
Front
'
Z
O
B
A
Rear -
N
I
C
Right -
-
N
PROJECT DESCRIPTION SQ. FT. OCCUPANCY
CONSTRUCTION TYPE VALUATION $
ZONE GRADING CU.YDS. ;ACRES
K
S
Left
G
R
Ping. Ref. # Parking Req./Provided'.
E
Q
Remarks:
Planning Notes:
M
RECEIVED
AUG Z 5 198h
T
S
' - l PLUMBING
FEES
PFICEIVED
Bar Sink I
Showers
ELECTRICAL
; FEES
Backflow Preventer
Service Sink -
-
Automatic Washer
Construction Pole Sub.
- Transformer ❑ 15.50 KW
❑ 50+KW�
Backflow Irrigation
Sewer Cap
Bathtubs
Sewer Connection
Cooking Unit
,Meter ❑up to 100 amps
Clarifiers
Solar Collectors
Dishwasher
Meter ❑over 100 amps
Dish Washer -
Solar Piping
Dryers ❑Gas ❑Electric
Sub Panel •-
DrinkingFountains
Solar Tank - -
Fan I
•Motors❑0-1 HP X]1 h-8
2'
Floor Drains, 1
Swimming Pool w/Spa,
F.A.U.
Inc. Solar'❑9-15 HP❑i6-15+
Floor.Sinks.i - -
.Urinal - �.
-
- Fixtures - --
- Microwave - w - y
-
Gas Smice Outlets ,-
Water Closet,
Device Boxes
Pole Light
Interceptors '
Water Heater
-
Outlets
Range -
Kitchen Sink `
Water Service
- p,
Switches
Sign
Lavatories' ""
Auto -Wash
Garbage Disposal
I Standing Sections -'
P—TrapLaundry
Trays -
Generator ❑0-5 KW ❑5-15 KW - .Trash Compactor
l
Roof Drains:.
- - - t
' Reinspection Fee,
$15''
Issue Fee
$,3
Reinspection Fee
$15 Issue Fee'
$ 3
,MECHANICAL
_
FEES
DEVELOPMENT SERVICES REQUIREME NTS:
Approved By Date l .
Building Approved By Date
Application Issued By nate
Bailer
Hood or Type ❑
Canopy Type I I ElZoning
I
DucF- Under Ground
Duct - Structural
Refrigeration System , -
X0.100,000 BTU ❑100,000 BTU
• (•T
/
_
Duct - Ventilating
PERMIT
r, PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
!' MECHANICAL
CHECK '25%
,SUMMARY OF FEES
$ SMTP $
$ PERMIT
-
$ ISSUANCE $ ,
ENERGY P.C. $
$
$ GRADING $_'
$ MICROFILM_:- $
$ d^S�OTAL
$
Exhaust System ❑ Multiple ❑.
System Repair/AlterationBUILDING
Fire I/Fact. Bit. ICBG#
p
Dampers
Fire Dam P
Heating System & Ducting
❑0.100,000 BTU [3 0-100,000 BTU
Registers
1
' I l-
-�.
E$S
Reinspection Fee $151
;oltlenrod - Assessor
ue FeePLAN
state
--�JONSTRUCTION AND PLANNING :
Date
APPROVALS Permit
-
Inspector
-
POOL ,PA
-
APPROVALS
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 LIFER 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 -
1.1. 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
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating.
71. Product Piping 0 Gas 00il .
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank []Gas 0Oil
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 �•7 t?
41. Solar Domestic -Final
42. Backflow Preventer
r,
X43. Backflow Irrigation
-44. Landscape Irrigation System i".3
..
X45. Sound Attenuation
546, Handicap Regulations..
-47. FINAL STRUCTURE &B,UILT) NG
48. Special Requirements Completed
49. Electric Release to Edison
r:50. Gas Release to Southern California Gas Co
e
c51. CERTIFICATE OF OCCUPANCY
No. Date
i -
_ .
Applicant to fill in all $Paces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA'
CONSTRUCTION PERMIT
Applicant's Mailing Add on d , U Q ice' cls ufDr u 1 h. rte
Project Addresse)J016 �L0J&'J u nn 'C
Owner's Name e R�NCy phone !'� �J
TYPE OF CONSTRUCTION W NEW U ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEM LIS ❑ THFR
DESCRIPTION OF WORK e Xi
�[��
H
contracting,wlthticensed con -
Business and Professions Code:
ULATIONS
TYPE OF PERMIT�j GRADINGLJ
❑ TENANT ELECTRICAL
FOUNDATION LJ STRUCTURAL
❑ PLUMBING ❑ MECHANICAL _
Address T r L/� T S�R M
Arch/Eng. _ License NO.
Address
❑;OTHER
PRQIECT DESCRIPTION SG. FT.
OCCUPANCY
Contractor's Nam U hone
22 fd
Address (mAling)3*72- OLf7>! �� I•ifli. /7Hy�%
C O N ST RUCTION TYPE
VALUATION$
License No.
ZONg GRADINGCU.YDS. ACRFS
LICENSED CONTRACTOR DECLARATION
Remarks:
-
I hereby affirm that I am licensed under provisions of Charter,9 (commencing
PARK FEE $
I
with section 7000) of Division 3 of the Business and Professions Code, and
my license Is In full 1 ce and effect. ••�� ,/
Z�
Application Issued BY
PLUMBING '
Ucense C s2- License No. '1 y -3
Date Signature
WORK RS' oM PENSATION DECLARATION
Bar Sink -
Sewer Cap
Backflow Prev¢nt¢r -
-
Sewer Connection
_-7-
'. hereby affirm that I have a certificate of. consent to solf-msure or a certificate
Q,, workers' Compensation Insurance, -or a certified copy thereof (Section
,'L •=JO, Lab. C.) I i I !
30
Backflow Irrigation
Solar Collectors f
- -
Policy No. ' Company
Bathtubs
Solar Piping - Y
Certified copy Is hereby furnished. 1 1
8
Certified copy Is filed with the city Building Division.
Date ' Applica 1
Clarifiers
Solar Tank i
EXEMPTION'FROM WORKERS' COMPENS 1 N DECLARATION
(Thissection need not be completed If the Der I Is for o hundred ($100) or
Dishwasher
Swimming Pool w/Spa
less)1 crtify lthat the performance of the w k or w this permit Is Issued I
Shall note loy person In any ma - SO. b come subject to the ,
workers' Laws of Cali for
Drinking Fountains I
Urinal
Eloor_Drei--ns'
-
Water Closet
Data ignature
' 'Flange _
$
NOTICEVif:-affir making this declare you should. to the
-Floor-Sinks
Water Heater, _I • --
-
, yompsubject
forthwith
Workers' with such Pr provislOre O the Labor Code, a deemed'
comply with such provi$loni'or this' -permit lshall bee-tleemed revoketl:Gas
Service Outlets, -
Water Service' '
CONSTRUCTION, LENDING AGENCY -
Interceptors -
I hereby affirm that there Is a construction lending agency for the performance
of the .work for which this permit -Is 'Issued (Section .3097 Civ: C.)-
_
Kitchen Sink
_
I antler's Name' _ -
_: t i
OW NE R,BUILDER DECLARATION I
OWNER
Lavatories
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason' fSection'7031:5 Business and Professional Code: Any city or
P.—Trap -
,
scant to a
noperty or my employees with wages as their sole
a work, and the structure Is not Intended or offered
Bu siness, and Professional Cotle:. The � Contractor's
Ily to an owner of a property -who builds or Improves
'such work himself/herself or through his or her own
such Improvements are,not Intended or offered Tor
Iding or Improvement Is sold within one'year of com-
ave the burden of proving he/she did not build or Im-
• U I, as owner Of the property, am ext
tractorsto construct the project(Sectio
•The Contractor's License Law does nt
builds or Improves thereon, and who t
tractor(s) license pursuant to the Contrz
❑ 1 am exempt under Section
Date ' Owner
�1 hereby certify h t I' a-roatl lois
Information Is rr IC vee to <om0
antl state laws al tin o bulltling co
sentative$ of h �c o of
Inspection p
' Signature
Drivers' U nse or SS
CMF 086546 rev. 12/
- Applicant;
Heating System & Ducting ,
e -above ❑0100;000 BTU 0100,000 BTL
finances
:a repre- Hood or Type I 11rty7or Cann T eII ❑�
Registers
Accounting; Goldenrod - Assessor
,
Reinspection Fee
Issue Fee
Generator El 0-5 KW C3 5-15 KW
7596 4/2 1 /.:3
3:1.91^. T'.,
ZONING
ULATIONS
A. P. #
ZONE
-
PLNG.REF. #
BUILDING
Meter p to 100'amps r
TO BUILDING -
PROPERTY LINE
REAR YARD (TO P/L)
i1 $ 3
LEFT SIDE YARD
RIGHT SIDE YARD
PKG. SPACE REO.
PROVIDED
-
STREET WIDTH
PARK FEE $
I
SPECIAL CONDITIONS:
Z�
Application Issued BY
{
ELECTRICAL
Automatic Washer
-Meter 0over100amps.'
,
Construction Pole
Sub Panel
S 00
Cooking Unit
Sub Pole
,
Dishwasher
-Motors 130-1 HP 01%-8
oo
Dryers ❑Gas TElaitric
Inc. Solar;❑g-,15 HP 016-15+
O
Fan •
;Microwave
ELECTRICAL $ 37,.2-0
01 F.A.U. -
Pole Light
Q
Fixtures
' 'Flange _
$
Device Boxes
Sign
TOTAL�FEE
Outlets i.
Standing Sections
PLAN CHECK $
Switches
Trash Compactor
Generator El 0-5 KW C3 5-15 KW
-
Transformer El15-50KW
5 00 '
• C1 50 KW''i
Reinspection Fee
$15'
Meter p to 100'amps r
Issue Fee
i1 $ 3
Zoning Approved By I
•Date
Application Approved BY}
^ate
f'cy �
' '^ate
Z�
Application Issued BY
• i SUMMARY OF FEES
'
BUILDING PERMIT $
SMIP
$
'
PLAN CHECK' i $
PERMIT
,
PLUMBING $'
ISSUANCE
$
'
PLAN CHECK $ +
GRADING
$
ELECTRICAL $ 37,.2-0
!
$
PLAN CHECK $ -/'%• ZQ;
MICROFILM
$
.MECHANICAL $
TOTAL�FEE
$
PLAN CHECK $
l LESS
ADVANCED,PC
$
FINAL FEE
$
r
+1:=�60NSTRUCTIONAND,PLANNING.;V<� '` �"�'
`
` r-� POOL,
r f=APPROVACS Permit# .3 ''`Dater
Inspector
- APPROVALS Permit#
Date=
IInspector,
, s I
riy empo�ery, Electrics l Serviice O'FPole
.. ;
!,52:'.'Pool &Equipment Location
1 7 'Soil Pipe,Undrgrnd. .` f o•
r- 5
r
-53? Steel Reinforcement
2o�,
4 3! Electrical Conduit•Utility Undrgrhri ' a"
- _
- • f I
54.: Forms
U'4: Electrical Conduit-Undrgrnd - _ n - '''
° r:_ -
G .
55 Electrical Bonding
-
,r l ,
5:,Steel'Reinforcement ;, '
-
;��'
56. Rough Plumbing.&�PressureTest
-
^'.,
_
�,•'
6: ;Electrical UFER Grnd.l ` = �•
�+
57=_APPROVALTO.COVER-GUNIT_E
-
7. •Footings, ' ' -w I - y m °'
°
('
58' Electrical -
Conduit-Uhdrornrl-
-
n
,
_
B. Foundation
Gas Pipe,:O:.Undrg[n'd., Test'
9. Water Pipe Undrgrnd.
r
X60. Backwash Lines, P -Trap, O Undrgrnd.
10. �Structusal Floor System �'`, _
°g.61.
APPROVAL TODECK ❑
_
11. Property Sewer Line &;House,Connect.ion.
-
',-62. Backwash& - Re-cepto-r -Final
j
_'
_
12. 1Sewer Cap
� j I
�-J'-
"6. iTeater, &Ve,nt-Final.
13. Roof Drains •' ' ' j _ _
o
:64. PlumbingSystein - Final ••;i.
" j
i
__
14. Rough Plumbing
9 9 •�" ' �
'
`
-
'65. Electrical=Final - -
' I
`r15.,Rough'Electrical=Conduiq,-'-_--T"
, -"
Y.",-"'�-"
66.1'Sola� Sysiem-Final �• ' - '
- -
:A6. Rbugh,Eled.ric Wlriog,
67 Fencing & Acce"ss.Approval,
17. !Rou liWirin `Si -n° `
9 9 9, �� {
; -'' 1 = 1 -
' '
I-;, I ° i
68.�
- -
APPROVED F,OR PLASTERING
-
r .1
o, ._ l
I
1 •
Av 8!Rough�ElectricalT',Bar Ceilings li i
{ (
I I
'
I
! € ''" !'
' - 1
' - • i • -
69.1 POOL/SPASY.STEMS'FINAL
_
19.'Rough�Heating &1/�ir�Gonditioning '?
f j= i ,
! • i
i FIRE DEPT.!REQUIREMENT
_. l
-
APPROVA'LS' Permit #---
V ! '
" 20. ;flough;Factory Fireplace; i �' (
{ i j
I {
1 21.',Ducts,.in Structure:
Underground Hydro
1,70,i
;i_22. j ucts; Ventilating
`71,1 Product Piping OGas ❑Oil
'h
a;23. Gas Pipje-Rough &Test c { j i�
'
1 ' I
i7 2.1 Underground Flush
=24.''Roof,Framin ti j �{ l
9
„�,�;-
��
;73. Under rnd. Stora a tank Gas Oil
y y
l
>
25. R of Sheathing { I j
_
OyerKead Hydro
j
i �4. ,
-26. 'ear Ceiling (Structural). & Monocoat- j
<j ' 1 .;I
•' �? 1
X75.. Dry Chemical
,27. +Frame and Flashin 9
'
Dry Standpipe
'
176., r
;
V, 28. Lathing & Siding.
X77.1 FIXED SYSTEM -FINAL
29. �Itnsulation rt'
I78! FIRE PREY. FINAL
,
230. Drywall Nailing i '' i ' {� l; {
. _
' {
I j i
INotesq j I f
Q1., Plaste4Brown Coat
--
- - -
S 132. iElectrical,Power Meter -Final
,
knal Electric_
33. Final I
34. Final Heating &Air Conditioning
35. Final GasPip e-T,esf"••j`I'^,
, m
1 j
36. Hood Or'CanopYC'
r;
I ,
37. Final Factory Fireplace' ! °-
r ,• I
38. Final Plumbing
39. Water ,Ser'vice-Final
I l •'' +I l
40. Gas Service -Final
41. Solar DomI.estic-Final
_'_
_ 7
42. Backflow;Preventer,
j I
43. Backflow Irri ationl
44. Landscape Irrigatlon•System I
45. Sounds i4ttenuaiwn , .^ 1 •:
,
�;� l
:I
_
^
46.�-
Hand ica pRegulations'
1
!
47. FINAL STRUCTURE&BUILDING,•
48. Special Requirernerits Completed {
I- j
° I I
; t i I j - t •,:
49. Electric Iielease!to Edison! I ,j t
I i
t -r
It '
--t
��_I { ! p,
fi f
, .. , I , ,
50. Gas Release to Southern California Gas Co
'
I
' �`•� I - I f`•
Al
51. CERTIFICATE,OF;OCCUPANCY 'j ''
_ '-
i ,i_�
No j i Date�'-,-
1_
a
1
31.5 by any applicant for a I permit subjects the applicant to' ` civil
finally of not more than flvo;hundred dollars ($500). ; - I I I
Service Sink Issue Fee
! -Date -
! vv rr rvr uu
leV,3 1 �
Applicant
to fill In all except those within heavy border lines and sign all appropriate declarations.
Boiler 1
-'
-Refrigeration System
-
❑0.100,000BTU ❑100,000STU
-
' CITY OF COSTA MESA. I _
_spaces
PERMIT, NO.
TRACT NO..
LOT, NO.
BLDG. NO.c.
' •
, '_
- CONSTRUCTION PERMIT
.,,
Firepi/Fact. Bit. ICBO #
•'"
,
SUMMARY OF FEES 1
•
Data -' '� Owner;,
1 -hereby certify the Ithave read t 1 apple lana nd at the 'above— -'/I0.100,000BTU"0100,000
information is correct agre to Comply with all cit an county ordinances
and state laws rata to Win n uctio pd here authorize repro-
• sentatNes of :t ,city: nt oned property for ,
I inspection our ses. / I
( Signature
- Accounting; Goldenrod -Assessor
1
Zoning Approved By
! -Date -
Application Approved By
-Date
t
/ /
-V•
Application Issued By
Date ��/ZL
,C3
• ;
I
SUMMARY OF FEES 1
BUILDING PERMIT
$
SMIP
$�
PLAN CHECK
$:
1 PERMIT
'PLUMBING
$
'i
, ISSUANCE
$ "
PLAN CHECK
$
GRADING
$
i ELECTRICAL
$)
$ ,
,PLA NCH ECK
$
MICROFILM
$ '
`I.00�
TOTAL'FEEI
$
MECHANICAL
$
I
'PLAN CHECK
$1
2'•r1O
LESS 1
ADVANCED PC
'
$
1 1
'
I
•
1
'00
FINAL FEE: �
$ t
F
C :,-
CONSTRUCTION AND,PL'ANNING' ` -
` --_Yr:
a. ",
' - : u . POOL, _ ,PA
i �°-
.'APPROVALS Permit"#_!a-L
- 'Date
�i''
Inspector
- ` - -
`APPROVALS Permit.#
- Date
Inspector.
_
_
" X.
Temporary, Electrical Service 6r'P61e i'
�
5i �.�ry
�, 52. -Pool &iEquipment Location
,•
2.
',Soil Pipe-Undrgrnd: �� I s_` -! o-
' "'-
�, -
53:- Steel Reinforcement
-
3.
Electrical Conduit,Utility-Undrg'rnd.' s;
,'
' 54.' Forms,,
_
n! 4.
Electrical Conduit-Undrgrnd :^� %�! � _
' -
55-.. Electrical.Bonding
-
5.SteelReinforcement
`+ r`,
56. Rough Plumbing&Pressure Test
6.
Electrical LIFER Grnd.;,
57, APPROVAL TO.COVER-GUNITE.
7.
Footings
58. VElectricaLConduit-Undrernrt..
8.
Foundation � " `-;
�
-�
?�
. .
Gas Pipe, 0Undrgrnd., Test
_.r
_-59
,
9.
Water, Pipe-Undrgrnd.r,"I ., ; �>
_
�„ -
j,60. Backwash Lines; P -Trap, 0 Undrgrnd.
_
10.
Structural Floor System
61. APPROVA_L'f0"DECK
11.
Property Sewer Line & House Connection
-�' -_�
• 62. Backwash &Receptor -Finan -
r
'
12.
Sewer Cap • `'
o
'-63. Heater &,Vent -Fina! •'"'
13.
Roof Drains ;� 1 -
`; ,
-�'
,
,'64. Plumbing Syster$-Final' - •
,
14.
Rough Plumbing I . o� !-
=
`"65. Electrical -Final£'
-
1'15.
Rough-Electrica!=Conduit66?SolarS
y stem -Final I`
•16'.
Rough, Electric Wiring
(T3?
6Z."Fencing &IAcce'ss;Approval "
- -
'• 17RoughWiri2'g
Sign y ,- .. 1
68. APPROVED FOR PLASTERING
16rhoughEleetr'ic'aIj:Bar,Ceilingl ;! I
_�--
69.,POOL'/SPASYSTEM SFINAL
- !
19''-Rough'Heating & Air Conditioning h
' ` 2;
'
J FIRE DEPT. REQUIREMENT
APPROyALSI Permitl#
26' Rou hr Factor Fire lace !
9 Y P
,
. 21.
Ducts,7in Structure
70.1 Underground Hydro
-
22.
Ducts, Ventilating ,_ j
+
71.i Product Piping DGas 00il
,23.
Gas Pipe -Rough & Test r ! ; .�
I
72. Underground Flush'
-
24.
Roof Framin " ,I -4
9_ '4 u . t
�'
= !';
+-
73. Undergrnd. Storage Tank El Gas ❑ Oil
I
�'
_
• 25.
Roof Sheathing 1 i ! '�:j �1
_ I ! yr
l
t ^
' 74, I Overhead Hydro I
"'
1
_;,
I ,
X 26.
T-Ba'r. CeilingIStructura0 & Monocoat=
= i
-'',^
I `
75.j Drly Chemical
-
i
'•27.
Frame and Flashing , I t'
76.; Dry Standpipe
'
28.
'Lathing & Sidingr
77., FIXED SYSTEM FINAL
'
Insulation a ', , f I
;
I
i
•78.1 FIRE PREV. FINAL
1.29.
.
30.
Drywall Nailing I i I,
I
(
I I j +
�Notesa
'31.
Plaster Brown Coat I{ ,i i
1-_.1
I -
I Tx,-
-,
32.
Electrical Power Meter -Final
I
1
,
33.
Final Electric
IL -
-
34.
Fina! Heating &'Air Conditioning
35.
Fina! Gas,Pi,pe-Test'- ,� 1 r `_ I .
�•` I
_
- I a _
(' i - I -' - - - -
36.
Hood or Canopy.
37.
Fina! Factory Fireplaces
"'-
38.
Final P-luinbing
39.
Water Service -Final'
40.
Gas Service -Final
41.
Solar Do'mesiic-Final
42.
Backf!ow!Preventer�
43.
Backflow'Ilrrigation� i (�'�'-_--�
- I
`' •;i ! ( `
_ ,__ _
-
44.
Landscape IrrigationSystem
45.
Sound Attenuation i
46.
Handicap Regulationsi-
47.
FINAL STRUCTURE &BUILDING
48.
Specia!'Re'quirementsCornpleted' ''
' 1 j•"
"'
' '
:
d
49.
Electric Release to Edison : i �,
�
_,_�_ _
_ _- !. _ ! �I_ •._�_ _ ,
__
50.
Gas Release to Southern California Gas Ce
51.
CERTIFICATE OF OCCUPANCY
No
Date
Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.
- -
CITY OP;:OS7A MESA ._ _
PERMI Q..-.�
'TRACT NO
LOT NO.
73&r' 4/ f 8 a,
i 46.50 ' .TL
CONSTRUCTION PERMIT
(/fJ
=
'
Applicants Meiling Address
TYPE OF CONSTRUCTION - •NEW ADD ALTERATION
REPAIR
_
b�. C `(-• -'
❑ CONVERSION ❑ DEMOLISH ❑ OTHER'-
Projeit Address,,
•'>ZONING
OwnersName 'K-- Phone 5V JPJ
DESCRIPTION OF WORK
REGULATIONS
Address. i
TYPE OF PERMIT GRADING FOUNDATION- STRUCTURAL
A. P. Ns. �!
ZONE
-
Arch/En g - �wG��n License No.
❑TENANT ❑ELECTRICAL
�y
PLUMBING. ❑MECHANICAL
-
BUILDING
.. !
Ae I
❑,OTHER ' I
.UO
PLNG. REF. -0
It, QT
Address -
TO BUILDING
PE Y I E
REAR YARD (TO P/L)
"
L'Ontrecl0r 5 Neml,pyncly
hone
PROJECT DESCRIPTION • SQ, FT,
OCCUPANCY
Addressl meifng)
CONSTRUCTION TYPE
VALUATION $
LEFT SIDE YARD
RIGHT SIDE YARD -
-2ZONE:
���
GRADINGCU.YDS,
ACRES
PKG. SPACE REO.
PROVIDED
License /
No.
_�_
LICENSED CONTRACTOR DECLARATION
Remarks:
-
STREET WIDTH
.. PARK FEE $
-
I hereby affirm that'I -am licensed under provisions of Charter 9 (commencing
- -
with section 7000) of Division 3 of the Business and Professions Code, and
SPECIAL CONDITIONS: I
F y license l5 inllllfo a ntl'effect.
J
License Class LI se No.'
PLUMBING
Date4 nai e -
Bar Sink
Sewer Cap
ELECTRICAL
WORK RS' CO PENSATION D LARATIO14
{p.. -reby affirm that 1 have a certificate of consent to self -Insure or a certificate
Backflow Preventer _
- --
/ Sewer Conrintion
�•
-
Automatic.Washer
:Meter- LJ over 100 amps.
-
Workers' Co mpensatlon Insurance, or a certl a coppy thereof (Se Ion
0, Lab. �/-,--/ - !/ •
Backflow Irrigation
_
Solar_ Collectors 1
Construction Pole
Sub Panel!
!
Policy No. : a �01 '�3 company ! A La. -fit
Certlfiev copy is hereby furnished. • ,
athtub;
Solar Piping
^
Cooking Unit
Sub Pole
Cerci lletl copy is filed with the city,Bullding Division.
aAppl
Clarifiers
Solar Tank ;
Dishwasher
Motors ❑0-1 HP �1'h-8
Date - KERS C -
ROM WORKS NSATION DECLARATION
EXEMPTion
-
Dryers ❑Gas ❑Electric
Inc. Solar 09-15 HP 016-15+
Dishwasher
-
Swimming POOI w/Spa '
feted I the
section neatl ;not be completed If the permit is for, one hundred (E300) or
e
' (This need,
Fan
;Microwave
1
ss).
I certify that in the performance of the work for which this permit Is Issued I
shall not amploy,any person In any me er so to come sub a
Drinking Fountains
9
Urinal
-
-'i
1
F.A.U.F.A U
,
Pole Light I
'
,Worker '. o p Ail 01 Califor/yam '
Floor Drains.'
'
Water Closet ;
.
Date nature y'�' -
Floor Sinks - - - -
-Water Heater -
—
- Fixtures
Range
NOTIC :'If, after%raking this tleclar n, you should become Subject to the -.
Workers' Compensation' provisions o the Labor, Code, youmust- forthwith
comply -provisions or this `permit snap be deemed revoked.,
-j' Gas Service rOutlets :[q/'
., i- -
,Water. Service .. _
_?
Device Boxes
,
Sign
IONN LENDING AGENCY'
CONSTRUCTION
I hereby affirm that there Is a construction agency for the
.�,
Interceptors . _
-
Outlets
Standing Sections t
s Issue Civ.
of the work /or which this permit Is Issued .(Section 3097 Civ. C.),
Lender's Name= _
Kitchen Sink; -
_
-
-
witches
;Trash Compactor
I
Lender's Address - I'
- -
LByatdrI S.,-
-
Garbage Disposal
(
l
OWNER,BUILOER DECLARATION -
I hereby,afilrm that I am exempt from the,Contractor's License Law for the •
_-
-
Generator ❑0-5 KW 05-15 KIN
following reason'(Sectlon•7031.5 Business antl Professional Code: Any city or
F -Trap r. 1 `
_
^
'county which requires a permit to construct', alter Improve, demolish or. repair
"any structure; to Its issuarice,also requires trio applicant'for such permit
_ . i; I -
Roof Drains - E•
- ` - 'y r
Transformer 15.50 KIN
prior
'to iiia a slgnetl statement that he/she Is Ilcensetl pursuant to tha•Provisl0ns of
- ;
-'
_
❑5U+ KW-
- -
the Contractor'sLJcense l.aw,(Chapter 9 (commencing with Section 7000) of
l :
Showers l
Reinspection Fee
Reinspection Fee
-
l $15 I
^.ivlsion 3 of the Business antl' Professions Cotle) or that he/she is:exempl
basis tor.the Any Section
..
,
,$15'
Meter El upto 100 amp;
'Issue Faee
$ 3 '
0rt'_:rafrom and the aliegetl exemption. violation of
`31.5 by any ap Pllcant TOr a permit -subjects the applicant to a civilSe
%'ye1'nalty of not more Ivan five huntlretl tlollars (E500): .)
i rvice Sink 1
_ lane Fee'
§ 3
Zoning Approved By
Data
I
I,'as •owner oi. the 1property or. my employees with wagesias their sole
r
-
compensatlon' will do the work, antl the structure IS not Intended Or offered
Tor 7044, Businoss antl) Professional Cotle:, The' Contractor's
_
' (
•Boller
MECHANICAL
Application Approved By
ate
sale .(Sec{ion
{ License Law does not apply town owner Of a property who builds or Improves
' _
1 -
Refrigeration System
- l
1
,
Application Issued By
i
Date
thereon, antl who tloes such work hl m3alf/Herself or through his or her Own
emplo ees, that such Improvements are not Intended or for
y
Improvement Is
-
:
Duct'- Under Grqund
❑0-100,000 BTU ❑100,000 BTU.
' 1
SUMMARY OF FEES
saIS . If, however, the building or arJofc
ever,th
g h within one y wild com-
-, Dletlon, the owner will Have the burden of proving he/she tlitl not build or im-
prove for the purpose of sale).
Duct -Structural j ?
System Repair/Alteration
'BUILDING PERMIT $
+
SMIP '
$
LJ I, as owner of the property, am exclusively contracting.With� licensed con-
tractorsto constructthe project(Section 7044, Business antl. Professions Code:-
Duct-- Ventilating_ - . _
_ _ _ _ _ _
,PLAN CHECK $
I
PERMIT
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- i
Exhaust System 13 Multiple ❑,
,.
!
/ -,
PLUMBING $
ISSUANCE
$ L '
tractor(s) license pursuant to the Contractor's License Law).
• -
e�lJ
;PLAN CHECK. $
- GRADING
$
Ellam exempt under Section _ B. 6 P. C. for this reason 1
I
Fiiepl/Fact. BIC. ICBG #
- 1
r
• r
L�+-Z=
,
!
'
'ELECTRICAL $- '
$
Date Owner( I !
'1"hereby^certify that-Lhave'reatl this application -arid state that the above -t'
-K
Heating'System&Ducting
0D100,DOO;BTU ❑100,ODOB
,
'
— -- -- - --
)
!PLAN CHECK $
1 MICROFILM
$
Information is correct. 1 agree to comply with all city and county ordinances
g p y
+ : ,
l'
'
MECHANICAL $ '
TOTA L'FEE
$ '
and'state laws relating to building construction land hereby authorize repro- l
i to C'aF'ove-mentioned for
Hood or Type I ❑., , 1
! `
Feel
1
�pLgN
I 1 '
LESS I
sentatives Ot s lcity/' a or' up property
Inspection p f. f
Cano . .T a 11 ❑:
Reinspection
•`$15
-• -
CHECK s $, l
t
ADVANCED PC
$ '
Signature aN
Pink - Accounting; Goldenrod - Assessor
a _ r
!7 LCONSTRUCTION,AND'PLAN-"�L^-
,- •.: ❑
, ^. - POOL. A
L
" r -Date -
APPROVALS m Permit.# r'
.
;Inspector
- „
Permit #,
Date
'Inspector;
,APPROVALS
,
rll;TemporaryElectrical SerJice&`Pole
..a
o; -
'52: Pool&`Equipment, Location
n.n.
f
_
^,2} Soil PipeUndrg�nd
T3n
Steel Reinfot
rceme
3? Electrical Fonduit.Uti.lity Undrgrnd. �� `.
;t
c.
541 Forms
4 Electrical Conduit-lJndrgrnd�% - :'
' n i
55:- Electrics l• Bon ding.:
,t : •f a. .-,.n '
1
5? 5[eel Reinforcement
-
^ `'
56., Rough Plumbing & Pressure Test '
-
6' Electrical LIFER Grnd ; i t J
-
57: APPROVAL TO COVER-GUNITE
».
,
7. Footings + a y_` =
.,
I
-l/58�
-
ElectricafCgnduit-Undrarnd..
+n r. 3 O _ s-
d
8. Foundation ry ' - _'r °
'x!59.
GasPipe,%0:Undrgrnd., Test' -
,. l
., -
f
9. Water,&ipe-Undrgrnd." 1 -
8',i
�jr/2i�RU
-
` -`
:•�60. Backwash: Line s,�P.Trap,'O'Undrgrnd.•,
1.
10. Struciural Floor System
61. APPROVAL TO DECK
c
1
11. Property Sewer Line:& HouseCOnnedion
-
-
+ 62. Backwash & Receptor -Final--
-
12.;;,S ver Cap• '
- t^,
•c
63. Heater &Vent -Final
13. Roof!Drams _ a'
;7
r;�64, PlumbingSystem;:Final'
14. RoughPlumbing ' �� `� •'-
' 65. Electrical -Final' - - -
G 15:'I oughFElectrical=Conduit's-66
Solar System -Final
41 6._ Rough -Electric Wirings c j
i :
='f'
67.'Fencing &Access Approval
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17. Rough Wiring Sign < ; • !
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68.j APPROVED FOR PLASTERING
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18.'FRough�Electri6lT;Bai,6il,ing! ii !!
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69.!POO L/SPASYSTEMS FINAL
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19.;Rough_Heating &'Air ConditioningAFIRE
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DEPT. REQUIREMENT
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APPROVALS: I Permit,#
20. jkbugh-Pactory Fireplace
t; 21. Ducts,ln Structure;; `; I
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X70. Underground Hydro
``22. Ducts, Ventilating
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:7,1.! Product Piping O Gas ❑Oil -
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x`23. Gas Pipe -Rough & Test_ .' ? .
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r72. Underground Flush'
IJ' -2r1. IRoof Framing`
-,7V Undergrnd. Storage Tank 0G as' d0il
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a. 25. Roof Sheathing
74.' Overhead Hydro ;
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6.
'�-• 6. ,T -,Par Ceiling (Structural) ,& M,onocoat
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' •75. Dry Chemical
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27. Frame and Flashing. i ' !I ' {
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i76. Dry Standpipe
" 26. Lathing &Siding'
FIXED SYSTEM FINAL
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%( 29. '1 ` ' +' ! i 'i !i
1 ` I78
FIRE PREV. FINAL
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y`30. !D_rywall Nailing r '° ; ji ij i
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INotas:'
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Ptaster Brown Coat
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32. 'Electrical Power Meter -Final I '� �:
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33. ,Final Electric
34. Final Heating &Air Conditioning !
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35. Final Gas'Pipe=Test I =' ;1
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36. Hood 6r1 1 _
Can,opY2` 1 ° 3 ^ j r•. ,
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37. Final Factory Fireplace:
38. Final Plumbing
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39. WaterSetvice-Final
40. Gas Service-Final1. i
41. Solar Domestic -Final I
42. BackflowlPreventer, I
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43. Backfi , Irrigation -' 1 1 "•
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44. Landscape I�rigation'System
45. Sound):Aitenuation
46. Handicap Regulation's
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47. FINAL STRUCTURE & BUILDING;.
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48. Special Requirements Completed
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49. Electric Release to Edison' 1
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50. Gas Release to Southern California Gas Co
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CERTIFII ATE FI OCCUPANCY
Not.
Date
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