HomeMy WebLinkAbout3555 HARBOR GATEWAY - Building Permits, � � 6 �'
City of Cosla Mesa
Develonment Services Department
Building Safery Division
P. O. Box 1200
Costa Mesa, Califomia
CERTIFICATE OF OCCUPANCY No. ���-�7�
The Building Iocated at �SS�. u��1v,r r.afrn.,a:r crn,1-h Ttn;* n
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group n_� Occupancy.
Use of Buildin
��egal Description_ dl5—(101—(ld
(See reverse sida for Metes and Boundsl
Building Permit No T»G�RA Electrical Permit No.F.��F�d Plumbing Permit No. p�ti�1l1
Mechanical Permit No. Number of apartments and/or guest rooms
ISSUED TO: BuildingOfficial n;li w,�.,a.a
r .T c�.,�.4tw,m f
3555 Harbor Gat�aay South, Ste. G by _�. . \ �,: ti ' - , -�., — -
�
M..a.-. �n..r... I+r O'1G7� i '
" Date � / -. � C �
7his Certificate of Occupancy SHALL BE posted in a conspicuous place on the prerriises and SHALL NOT BE removed ezcept by the
Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C.
CMF ]035-46 rev. 1/B3 White � Owner; Canary - Numerical File; Pink - Bldg. Permit File ,
��
City of Costa Mesa
Develonment Services Departmenc
Building Safety Division
P. O. Box 1200
Costa Mesa, Califoroia
CERTIFICATE OF OCCUPANCY No. ����C+�
The Building located at 'lSSS F7arhnr GapeIIrtV. U[llt G
has 6een inspected and found to comply with the provisions of ali City of Costa Mesa Ordinances applicable thereto
for a Group ' Occupancy.
Use of Buildinq . AGVECt19i.tla Ag�ncy
Legal Description 4154091-04
(See reverse side for Metes and Bountlsl
Building Permit No B 27366 Electrical Permit No. E 27431
Mechanical Permit No. Number of apartments
ISSUED T0:
ing Permit No.
and/or guest rooms
BuildingOfficial Ldilliam T. Hoaacd
r..i_ RnqETrsttom
3315 e^airview Rped by �� - �--• —
r.,ar,� Mc±sa. C�1 92626
Date Februarv 20, 1987
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
B�ilding Official of the City of Costa Mesa under Sec. 307 (e) U.B.C.
CMF ]015-46 rov. 1/83 White -Owner, Canary � Numerical File; Pink - Bldg. Permit File
City of Gosta Mesa �
Development S2rvice5 Department
Building Safe�Y Division
P. 0. Box 1200
Costa MesS, Califomia
The Building lowted
CERTIFICATE OF OCCUPANCY
3555 South liarbor Gatesray, Suite A
No. GLuSJ3
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group B"'Z Occupancy.
Use of Building
Legal Description
Building Permit N
Office
4$5-091-04
B-11378
ISee reuerse side for Metes and Bounds)
lectrical Permit No. �u3�Z Plumbing Permit No. P-11426
Mechanical Permit No. �"'u419 Number of apartments 0 and/or guest rooms �
iSSUEDTO: BuildingOfficial XI/• �� / -('�.�/�
QOCJ.JeSG4erstr�a and Sons �/j� �/ ,,�
by // . l ' �%!//GL�'.� �L
331� Fai=viEw Roacl. Costa n�sa, CA (i �% r�/�����
' Date
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building OHicial of the City of Corta Mesa under Sec. 307 (e) U.B.C.
CMF 1015-46 re�. 1/83 Whi�e - Owner; Canary - Numerical File: Pink � Bldg. Permit File
'
�
It
a
City of Caaa Meu
euilding Safety Department C E R T I F I C A T E O F O C C U P A N C Y •
P� eox ,�� i�?° � 319 2
Costa MeSa, Califarnia
The Building located at 'Zr,G� R�r;irrr !'aPr�-acr Grn.4h. �.i+�o n
has heen inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group �—Z Occupancy.
Use of Buildina Ltt'fAr?.or �11teY�tt2oT1'3 — OifiC? .
Legal Description 139-021-23� 67r 82o I3� 7°. 35
(See reverse side for Mates and Bounds)
Building Permit No ''L"���% Electrical Permit No. �4145 Plumbing Permit No. P• :l�'�
Number of apartments �'•�— and/or guest rooms "0—
ISSUED TO: Building Offi,c�/ial
by � i' ,'` •
['. ,7_ .4�r?r�tmm and Son� V. C. At�
Date �.�9 lf7.[
This Certificate of Occupancy SHALL BE posted in a conspicuous place on th�e,premis�
Building Official of the City of Costa Mesa under Sec. 306 (e1 U.B.C. �
Form BU 3a Rer. I1/]O
�
SHALI, NOT BE removed except by the
City of Costa Mesa
Building Safety Department
P.o. eox t2oo
Corta Mesa, California
�
CERTIFICATE OF OCCUPANCY
��
���.c>,�
The Building located at '?'; ; -�i�,.-• f��•^..�-..., �'�..; :� "'i;.'(.-; •)
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicabie thereto
for a Group �-.� Occupancy.
Use of Building �,�--�-:. ;,- -----�--��. � ,;%:�n,,.:., • _ r.�,.
r.�.r' t�;rr.t { � 'ir"..
Legal Description ' 9";, `•.,`' ••"� `"/.'::�"._ .7�, ...i.'i'i.','1 .�•f.7'. 7..
ISea reverse side tor Metes and Boundsl
Building Permit No ���1`������" Electrica� Permit No. ^'��-'•,'%"��Plumbing Permit N
Number of apartments and/or guest rooms -
�. _. _
...,, ' / -S.'� ?. .�
ISSUED TO: Building Official
.:' �
. , " � � � - --
� b � _ . ,. ,� .� .��
Y J�-�II
� � �. �. . ,y�,'.rtq.., ,.• r G"l' i " . n_..��, - w. . .
. . ye %� ..-.. ��`iI»� �9��'.i.^.P ii::V.��i'�QP. 1li ".:!:��'^.'
Date � /.-Y �. !.J � � •, .
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C.
Form BV 34 Rav. 11/70
��
City of Costa Mesa
Building Safety Dapartment
P.O. Boz 1200
Costa Mesa. California
�
CERTIFICATE OF OCCUPANCY
c� � � ��
)..c)i/
The Building located at �': ;'": i'—�:�.,-- �"� <� -» rn:�F� f��io-�� '-' '�
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto '
for a Group �� •� Occupancy.
Use of Building •tr -_--ir_ _ ����.��_ r,...,7 �,,,. —1�rr�-. -: a.�t.,....
Legal Description ' '.i ' ':`7 ' '.^ �" _ �7_::° .7'�. .'i'
(See reverse side`for Metes and Bounds)
Building Permit No ' �^'%'•-��^l Electrical Permit No.���•�'�"%��—�a��9� Plumbing Permit No. ��� "�����
ISSUED TO:
Number of apartments -4`-- and/or guest rooms —:'.•-
Building Official
..•:.'...��'�� -..�i?.�
.
ey i . , ' ,.�/d�l,,-- �
Ge ' ' _��i�a-t C7 `'.^�; 'Vo C. :'�::'�" .'.`ail:�ixz�� IIi�r��:'!a�. II:��__ ;;r�-
� Date %�,��ill'•�47 ��J
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed ezcept by the
Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C.
Form BU 34 Rev. ] 1/70
City of Corta Mesa
Building Safety Dapertment C E R T I F I C A T E D F O C C U P A N C Y
�.� �i�
P.O. Box 1200 '�S .'. •: l/
Costa Meu, California t �
The Building located at "�'i " �%m•� t=h^� -�.+ � �-.��� r��N� �
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group Occupancy.
Use of Building . 4,,,.�.. •., _ _ .. ,... �,., f... c�, . , •.�.
Legal Description " " ' �'� "� '^ '.�': '�� ' `
� � � ISee reoerse side'for-Meies anil Bounds)
Building Permit No -'����T,+�' ��r��� Electrical Permit No: ��"'15� �� ��=9^ plumbing Permit No:�- �-� '
, ::
Number of apartments '��" and/or guest rooms •-�— �/
ISSUED T0: Building Official
by = _ � � .,r.- s%,.
=.��i_5-r- ' �'} `Va (°e h � �10,— �t, � ..:�,... � ...:
'— ,.u�•-ZS%'_._ F!._r.s__, . � i�=T�x,-.
� Date .� � 1 l.'.9. �� f 4 t' 7�
This Certificate of Occupancy SHALL BE posted in a eonspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 306 (el U.B.C.
Form BU 34 Rev.
n.
;._.
-„
City of Costa Mesa
Development Services Depar[ment
Buildin9 Safety Division
P. O. Box 1200
Coste Mesa, California
CERTIFICATE OF OCCUPANCY No.�t`Y�1c1LI�.��
The Building located at 3555 FIARB(lR C•ATEWF�SC SOIPPH i1NIT 8F
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
fora Group B-2 Occupancy.
Use of Building Of£1C2
Legal Description 415-091—Og
(See reve�se side far Metes and Bounds)
Building Permit No �'AE�1881� Electrical Permit No.��-18815 Plumbing Permit No.
Mechanical Permit No. -"+ti7F'-1 H91 S Number of apartments and/or guest rooms
ISSUED T0:
C.J. �TFgIn 6 90NS
Building Official �� K i (�i1.1G
by v i (,� ��%usr�
3555 HARBOR C�.Y So. ��fi��. COSTA ME'SA, CA. �O �NI /�cJ s
Date _
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises a�d SHALL NOT BE removed except by the
Building Official of the City of Corta Mesa under Sec. 307 (e) U.B.C.
CMF 1015-46 rev. 1/B3 White � Owner, Cenary - Numericel File; Pink - Bld9. Permii File
�3
City af Costa Mesa
Building Safety Department C E R T I F I C A T E O F O C C U P A N C Y
P.O. Box 1200
Costa Mesa, California
The Building located at �--�-+ _'��_ : � �
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group — Occupancy.
Use of Building •-'�� -.� ' _ _
-Legal Description _ - 1—,
,, (See reverse side for Metes and Bounds)
Building Permit No - ���� Electrical Permit No. Plumbing Permit No
Number of apartments� -.�•- and/or guest rooms
ISSUED TO: Building Official
� ' ,
r bY " 7i . l' .i.. •_
. , .,. _,..i.;�sa.� ar_. ✓�t.., t. C .•:;:-<<•,; - �� i � ''- . _--• '
. Date � f . �,i�.'t ���� "`s-
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 306 (e) U.B.C. :
Form BU 34 Rev. 11/70
,.�... � �
City of Costa Mesa
Builtlin8 Safety Depenment C E R T 1 F 1 C A T E O F O C C U P A N C Y
P,O. Box 1200 �
Costa Mesa, California
The Building located at � • -
has been inspected and found to comply wi[h the provisions of all City of Costa Mesa Ordinances applicabie thereto
for a Group Occupancy.
UseofBuildi�a •• • - ' �� .� ,
Legal Description ' �� '
, (See,rgverse side for Metes and Boundsl
Building Permit No � Electrical Permit No. • Plumbing Permit No.
Number of apanments and/or guest rooms
ISSUED T0: Building Official
by % • '
Date ' � �
This Certificate of Occupancy SHALL BE posted in a canspicuous place on the premises and SHALL NOT BE removed except by tbe
Building Official of the City of Corta Mesa under Sec. 306 le1 U.B.C.
Form BU 34 itev. ii!!0
t, �
r ra�; _
.� +
Ciry of Costa Mesa
euilding Safety Department �
( P.O. Box 1200
Costa Mesa, California
� i �� '` �
If LL
CERTIFICATE DF OCCUPANCY
l� t�
. The Building located at qFSK Har�Mr f.
has been-inspected and found to comply w
� for a Group A—� Occupancy..
Use of Building
Legal D
x
��" �43�
the provisions of all City of Costa Mesa Ordinances applicable thereto
reverse side for Metes and Bounds)
Building Permit No p—��F/a-9Ad� Electrica� Permit No.�Aa(1G+1Ft-9S7? plumbing Permit No.�—a���+��—'���
' rri9oa
Number of apartmentll —rt— and/or guest rooms �_ �F1-1i10
ISSUED T0: Building Official
b `�?''C , `� ��;.L�-�.
Y
r.' .T_ �mt,Ym� ,c c�ma II V. C. Iu.''wt,onG�k�� I�i� iQn D3a�ar
I4 Date ..t U 'L /} Yi
This Certificate of Occupancy SHALL BE posted iol`a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Seci 306 (e) U.B.C.
FOIm BU 34 Rev. ilno ' iV
��
/�f/��_ AVP����< <a ���� In ill apeces azcapi those wlt�in hvavy CerEer Ilnes anE ti9�_all aDD!oD�late 0acla�itlOns. 1�1
, CITY OF COSTA MESA � � , , . PE IT Ng. TRACT NO. � LOT NO. . ' � . .. ' � � „ t
CONSTRUCTIONPERMIT � � �=(�7 � , • � , � " � ' - �
AppliCenY3MellingAddfess TVPEOFCONS7RUC710N ' New - noo AITE TION -HEPAIR ' , � � � �' , • ' � 6]3d (��QSI� I."Iq�L3 •T�
PfOject Addfess r� ❑ CONVERSION ❑ DEMOLISH ❑ OTNER ' � ' ' � , ' ' .
Owner'sNama honeC��'%� DESCRIPTIONOFWORK ��� �=0�/�H� _ ,
� Addreu �7% 1� � . : . • . . . � �
i TVPEOF�ERMIT GRADING � FOVNDATION STRUCTURAL A.P.M� IS � �D ZONE '
� AICh/Eng�.J � _ � ' LitBn58 N � �!� � �TENANT �ECTRICAI �UMBING �CHANICAL ' BUILDING � �
(fG�%TN�J �� �% G PLNG. REF. qW -
Add�E55 G �y � , ❑,�OTNER . ' ' � � TO BUILDING
COntIBCtOf's Nem q � - PhOn811S"`� tR=' PRaECT DESCRI7TION Q. FT. OCCVPANCV ' P PE V � I ,RE RD (TO P/U �
AddfB55lmeifing) Y���� �1�'�'�����'L 7"�2' `'"" CONSTRUCTIONTYPE VAWATION$ ��O(�7. LEFTSIDE VARD � R HTSIDE VAR �
� ZON� � GRADINGCV.VDS. ACRFS PKG.SPACEAEQ. PROV
Licanu No. _���'+' ' — � . '
LICENSED CONTRACTOR DECI.ApATION pemarkt ' � �. 28 STREET WIDTH � , ARK FEE S' �
MI hereby affirm t�at I-am IlcenseE unOar Orovisloni of Chnrten9 (commenUn9 .G
witti section 7000� of Divislon 3 oT the Buslness anE Pro/eszlons Cotle, SrIG � '; �Z •C 3�•J SS/� Z SGECIAL CONDITIONS: Qr /
Vmy Ilcense,iz In f I lorca anE a}fec�. � ^�,'
LJcense Cla �� � PLUMBING ' ' �(�y1/S � /7W[�/� �• Uc%� ��
�ta l%� � 519 t • ni �� Ar�no.. .
�Y IRKERS'COMPENSATIONDECLARATION; ' � � ' BerSiok , ' SewelC2p , , ELECTRICAL �
V . nereby afflrm that I have a-certlfi�te o/ consent to seHansure or a tertificate-� � � - - - - - - -- Auromatit Wesher � - � _ .Meter , ov¢� 10U,artlps ._ _ _ �
ot Workars• Compensation Insura��e, or a urtifletl coDY thareof ($ectlon � Backflow Preventer'- � SeW2r Conn2Ction -' � ' . _
3Boo, Lab, c.) �'�j����j ' ' I���(����� �//� �y� n_ � _1 -� Backflow irrigation Solar Collectors ' ' Canstmction Pole 1 � Sub Panel i � �
Policy No. �S2ZL 1 �I�ComDany 1LIfd1�S11�.W��% � . . -� � , CAoking Unit � ' ' Sub Pole , �� i �
f�y'1f� rtifle0 CoOY IS hereby turnlShBC. � I � Bathtubi $olar Piping
IJCertj(i!O <O i Ilatl wIM thebity.�JL�Cinq DIv15,�Q� \ , �
Date �,t•5'� qppilwntSL_)(�AM�.Q,p'�� ���D, � Clerifiers ' � ' SotarTank � Dishwasher � � Motors �04HP ❑1Y,�
. EXEMPTION FROM WORKERS' COMPENSATION DECLARATION � � - � DfyefS ❑G85 ❑Electtic ��'InaSoler �9-15 HP;O1645+
(Thissectlon neatl not be completetl iT tha permit B for ane huntlroE (s100�� or Dishwasher . �' Swimming POoI w/Spa .
less). � , - . � - • Fan � Microwave
I certliy.that In t�a parformance O� tha work }or which this OermR Is Issuetl 1 Drinking Fountains Urinel ; j
shall. nOt emO�oY any person In a�Y manner So as ta betome Subjett to ti�e -. � F.A.U. � � .POIB Lighl •^�
Workers'. Compensatlon Lawi af Galitornla.; , FIOor DreinS� . Watfr�G05¢t :-^`
Date ' ❑gnaturo ' ' � Fixtures � '
� NOTIGE: If, after making this tlaclaratlon,�you shoultl•become subjoct ta Me ' FIOor Sinks � ` � • Wat2� HeatC� ' ' '- ' - � • - Renge . _. . . .
� Workers', Compensalion D�o��ilons of Ihe Labor CaEe, you muil forthwilh ' . '' . ' • -
ComO�Y •'�'��h' Suc� -prod5ion5 of this%permit Shall DB ;CeemeO' revokaE. Ges ServiCe Outlets Wetef ServitC . .- - DCvice BOXes . Sign '
CONSTRUCTION LENDING A6ENCV " ' OutlBts �
I heroby aHirm that there Is a constructlon IanEing agancy lor tne er/ormance IntCrcCpto�s' ' ' _ � • Slanding SectiOns '
� of the work for Uqti� this er it _Ij� Iitue etqon 30�7 Civ. C.) - . . �
l.enaur's� Name .�L1jS�'d�L 1-"1'�� - Kitchen'Sink� � - - : Swilches Tmsh Compac(or � ;
' l.enaer's Atltlras• �011 Av� �V�..��.t� '��O ' _ . . _ - � . . .
� OWNER BVILDER DECLARATION '�,(�j�� �, ���l�t - � i L'avetOrieS� � ' , . Gefbage Disposal � �
1 hereby�aftlrm that I am'axempt /rom lbeTLntracto'S Llc� Law }or tha � _ __ , - , - _ , - Gen2ra[Or �0-5 KW �545 KW � • � ' �
followin9 reason'(SecUon 7031.5 Buslnass antl Profeszional CoOe: Any ciry or . ' P-T�ap; � .. �.- - � - � � i
' county wtlicb.req Wros a permlPto �onstruct, alter improve; tlemolish or rapalr , , - , _, . T�anifo�mCr � �5-50 KW • '
•�ny ztrutture, prlor to Iti Isivanc0. alm roqulroi t�e aDO���ant for Suth peirtlll Roa( D�ains ' •' � ' ' - ,
.�;,;file a Slgnatl italement that he/s�e is Iitensatl pursuant to t�o Grovlsions o/ _ , . ❑5U + KW � -
.�..�; Contractor's Licnnse Law (Chap�er 9 (commencing with.$ectlon 7000) o/ - I- . . _ - ' �Reinspettion Fea $16
;., evislon 3-of t�e Business anO� R�o/eulons COEe) or [hat he/sha Is examPt . ShOwEro • ,� ReinSpeetion Fee §75 !
` iRereirom antl tha basli lor the allegetl axamptlon. Any vtolatlon of Sacdo� '.. . ' � ,� - Meter �up to 1008mpe ' laue Fee S 3
J031.5 by;�any aDO���E�� for a Permit sub7ects.lha applicant ro a civil � � ' S 3 �-
�enalty ol not more tnan ilve nundrea tlollars (5500). Seivice Sink � � �. laue Fee � ZoninB MP�e�d gY Dat�
I; as'�owner oP tha;Oroparty P� my employeos wk� waqes as thelr so�a - � ' w
compensation wlll tlo the work, a�Q the ztructura Is not intontletl or ofleretl �_ �- MECHANICAL � • qpp�j�tion Approved By at6 3� 3a - d'3
for ule.(Secfion 7044, Businatt antl �rotasslonal CoOa: Tho Contractor's � � • . �
l.lcense Law Ooes not apply to�an owner o/ a property who bu11Es or itnprovei Boilur Refrigeration Syst2m • i �t
t�eroon,�antl w�o tloes�such worK �ImseH/�arsal/ or throu9h his or �ar own � �-� ' r ' Applifation laued By � -DatO T��� � Z
I amploY eas, o�a��tletl that such'Imp�ovoments are nol inlenaoa or offerotl for ' . ❑0.100,OOOBTU ❑100,000ETU� , �
' sale. If, howevar, the bulltlin9 or IR�Provement Is soltl within ane year of com- i Duct - Under'Ground ,, . � . � SUMMARV OF FEES • � �
, ptetlon, t�e owner-wllt have the burtlen of provin9 ha/sha Citl nol �uil0 0� IT- � . . , � y
��rove ror tne purposa of saie). , � 1 � . . . . � � Duct -Structurel System Repeir/Alteration � BUILDING PEPMIT $ �Sb � SMIP $ � "?J
I, Ss owner of the property, ain exclusivery contrahtln9�.N'��h Iicensatl con- '� i Dutt: V2ntilatin '
'� tractorsto construct tne pro�ect (Saat�on �044, Businass antl Professlons Cotfo: ' 9 - --� - J. _- ' �PLAN CHECK� $� PERMIT � '
''� The Contrattor'S Llcen3e Law does nol appty to an owner o! property wbo ' _
. Eulms or Improvas tnereon, antl Who contracts for such pro�ects wit� a con- � Exheust System ❑ Multiple �' � ' ' � ' PLUMBING $ - , �SSUANCE .$. '
tractor(s) Ilcense pwsuant to the Ca�tractorY Utense Law): � � . . , PLAN CHECK � $. . GRADING �� E
❑ I am axempt untlar Settloi , ; B. & P. C. fOr this roato� - Fiiepl/Fatt. Blt. IC80'M� '� ; ' ; , . . � i . � � , ; $ :
� Date � ' , ' Owner � ' � � Heating,System & Ducbng q '� ; ' I � , .ELECTRICAL , $� ' . ..
�P hereby �certlfy-teat-i� have�reatl this applicatlon antl state'ttiat'the'above : � �0.100000 BTU �100j000 - - - 'PLAN CHECK� $ . MICROFILM $ j
1 Intormatlon Is correct. I agrea to Comply with all tlty antl county orEinances � �" . � ' � " �. ; I ' � : ' TOTAL FEE ,$� �
; antl�ztate laws mlatln9 to GullAinq constructlon, antl hareby authorize repra• Hood of , • • � - MECHANICAL $� ; � i . �
sentatives of �,Ihis �ci �,�' to enter • uDon the above-mentlone0 pro0erty tor TypB I ❑ � � • Reinspection Fee' - � � , • �
' Cana '� T e II ❑� 'i $15 �PIAN CHECK � ` $; � ADVANCED PC -' $ �
Inspectlon Durpose ' , � . . � i . . � ;
• 51 .. , D'ate ' �� � � � � � , �, i . • - , � . � � . �
i � Registers � � I Iswe Fee . S 3 i { 1 � � FINAL FEE • $ 1�3S 83
riv rs' License �55 � ) I
I CMF 6 rev. 12/B2 White - 9uiltling; Canary - Appliwnt; Pink - AccounHng; Goltlanrod - Assessor ��/ � g�
�
�? �CONSTRUCTIONANDSPLA NING� r'��' `w � .x--•' �- ;oo� ' ;��-� i�SPA�� - _ -c �__ G "
r APPROVALS �� Permit�#�� <'Date n .Inspector � , �APPROVALS• Permit �h - - Date I�nspector. .
.. i ,° >> � - - �- -
'}' �1,, Temporary•Electrical Service or�Bole � �. ' �` o�^ ' �52 � Rool &'Equipment Location. "„ _ � ' - � • .� ,-. ;
f) f n S '
7 �'
i•.' 2t Soil Pipe-Undrgrnd. - ' V � , . . � , _ - �� 53' S[eel Reinforcement ��" _ ' , � :
- 3: Electcical Conduit Utilitv-UndrgrnA., a: � � ° . - = ,54:; Forms �, � _ - - . '; -
�? 47 Electrical Conduit-Undrgrnd; - > ,-_ � - . ; , � � ` , • 55�� Electrical�Bonding�` , _ _ ' ' - '
5: Steel ReinforcemCnt ' � � ; " � : � � : � , 56., Rough Plumbing;& Pressure Test - :
8. Elect�ical UPER Gmd.� � r ��` �• 57:' APPROVAL TO COVER-GUNITE. i
, _ .
7. Footings � � ' ' ' ; p ' � �, i' ' � '' . 58.', ElectricarConduit•Undro.�d, , - . _
8. Foundation ' - . � ; � ; � � � • �59. Gas Pipe; O Undrgrnd:, Test , � � _
9. iNater Pipe•Undr�rnd. � ' _ - � - 60. Backwash f.ines, P•Trap,�O�Undrgmd. . � - _ , ,
10. Structural Floor $ystem . �� -. 61. APPROVALTO_DECK
11. Property.SewerLine&�HouseConnection _ . , �62. Backwasli&Receptor-Final�. . � •�
12. Sewer Cap ,� �� � � • . . ' 63. Heater & Vent-Final� � . -
13. Roof Drains ' � ° � - g4. P.lumbing`System - Final � � ' ' �
1 i -
14. RoughPlumbing' ' , W-. � , - �65. Electrical-Final� - � � �� • � -
' � ---- -- -- - -- - - - • - -- --_._... . - - --
-. �� 15:'Rb�gh' Electrical-�nduit- "- "' "' , r , , , ' - '-
�-'-j�- 66.� Solar System-Final . . �
; N.16�•'Rough,Electiic Wiring � ! � �-�s-; - , = - ! � � ' � 67.:i Fencing & Access�Appioval� -- � - - -�
yi .l �� in.. .� i • _
„17.Rough�WiringSign; ' ri� ':�;1 •!=j !? � � 68.�APPROVEDFORPLASTERWG�� ' - �
- . _�r.. : . . . , _
- � �; -� . . . - , , - . . -
' � 18. Rough.Electrical�-7.Bar;Ceiling��,.�. ' : �- �' � � . � - 69.! POOL/SPA SYSTEMS FINAL -- - -�
� '; 19. �Aougti Heating & Air Conditioning -' , T � � � - � i FIRE DEPT. �REQUIREMENT � � �
� �
; � 20.' Rough-Factory Firepiace� r�; ; t . � 1 � APPROVALS � I Permit #�� - _ �
, � 21. Ducts,-in Structur¢� � '� � � � ; • ; � � 70.� Undeiground Hydro �� ' ' � � . �
�.
c ,-- . . ' : - ' , .
", �22. Ducts, Ventilating . ��' ' . i � 71., Product Fiping O Gas ❑ Oil ' �
� ^;23. Gas Pipe-Rough & Test � � _ � � � T � � � 72. Undeigro'und Flush �
� ��24. �Roof Framing: . ', �: � , •, � - � ',� � � � 73., Undergmd. Storage Tank � Gas ❑ Oil� � � �
< � 25. ,Root Sheathing � �. � � ' � ',� � r� � ' ; . , , 74., Overhead Hydro �• . • �
- ° 26. T-Ba� Ceiling (Structurall, &tMonocoaY' � . I �;: " � � ' ' 75.' Dry Chemical , . . - -
u -
. �.27. Frameand Flashing , ; ;� i� � i � 2_� B , 76. DryStandpipe � . � =- - � �
" 28. Lattiing & Siding . � . , , � � • � 77.� FIXED SYSTEM FINAL• �; '
P �
` �� 29. Insulation � � � , � � 1 � � � � � � � 98.' FI�RE�PREV. FINAL - � r �
( � I �
� ' � � � , , , - ,
',`,.i' 0. �D'rywall Nailing :�: •' ' �� � { i i ' � Noies:j - � , � . , � �'.
� ,y. , ' � , _ _ ' - . - '
° . 31. Plaster Brown Coat!, , � � f �-- �- -�� � , � � � � � , � ,
, .. ' ' . ' i . � ' � . � .. , , . .
� Y 32. ;Electrical Power Meter-Final .� , ! i � � � � , � ' -
�
^ ` 33. Final Electric . � � � � � j � � . � � � � � �
- 34. Final Neating &:Air Co�nditioning ��" � � I ! � � � � � � ' � �
, �i
35. Final Gas�Pipe-`Te'st� � � � � , -' .! � ' . t � ,; ' ^. . . - . , - �-
/ � � .I � �- � ��i �_.i � ' -
36. Hood or C�i+oPv_ r ' - _ � � � _ ! � i , � , -' � ' - - ` . -�
37. Final Factory Fi�eplace ` .' � i) :'�'1 � i a • :_ � � - , � - � �. � i � � , � - . � � .
�
� • ' ' . ' , ' - � � _ ' . 1 � . -
38. Final Plumbing � • o- �� I � _ ' � � � :. � �
39. Water Service-Final', ' � � �:� � I , ' � � 1 , -, � ' � - ! ..
i � I.. .� ��
. . , . �r.�J �., i . - t I �.�. ,
40. Gas Service-Final" i � Y , 1 , �• � -
�. . . ; � .� . �� i �:
41. Solar pomestic-Final � .. '� j:� i , . � . ' I-_ '- -. �' � -- . �.,; '' ,. tF , ,
+ � • �'-�`- --+---�-� ..�_
42. Backflow'Preventer r, � � �.;,� t^•�_ j_ . r_I_� ' � _ j ' _r _� ' . .� •j�
43. Backflow Irrigauon� �- � � u' � . y�,- � ;'� `JI' � ' � w� . � "
vr �
i.
44. Landscape`Irripation•System ��'• � �ti_,', � , � � = � �� � , � ` � .� � � � � � ' ' � '
,
45. Sound! Attenuation � Y!� � � � I `� � , � �' � i �;� ! �: j � � � .' . - . - ' _
r _ � -'t I
46. Handicap,Regu�aLions ' •h r��� ic ' � " �� ' � ' � ; ' I ' � �I �. , � ' - � , ._ '
�, 7 1 � i '
47.�FINAL; S�TRUCTURE&'BUIID)NG'� ,� 4�.�_��, �` � � i j � �, , , �- � �
48. Special Requirements Comple't�d� , � � } _' ' I ' ' � � � ; � " �� - .
_ '
,i
49. Elec[ric Release to Edison' i • .' � �i � � I � ,� _ � _ _ � _ � ' R . �� � '
�i i i� 1 i( i'---'-- - �
' '_;. , ,
50. Gas Release to Southern Califo'rnia Gas Co i �� ' � � � � � � ' , '� - � � ��
� � � �.
51. CERTIFICATE QF OCCUPANCY �J� ; , ' ' ' _, _ ! _ �__ �_ .� �. ' ' ° ' , '
� ' `, � .
No � �I ' � Date , ' � ! ' 1. �
_
� _
_ - ADO��U�t to lIII in all spum _wee0� tbox wH�in heavy po�Eer Ilnes an0 fiqn all approp�late CaGlarotlanf. .
T OF COSTA MESA i pERM1T NO. . TriACT NO. . LOT NO. B � � � � � •
Su1TE,3-�E
CONSTRUCT�ION PERMIT � . � �lAJ� P 7N�v� +.--" . - • .� i 3 _ � ; . � . . � ' a t�' , , '. � .. 6735, u/05iA3 �. ; � �I �.� _�
. � �.
AppliCent'SMeilinAd`O�055-t' ��Q Q 'ryPEOFCONSTRUCTION� NEW ADD ALTERATION� REPAIR� � - - ' � � ' , � -� � �'
. PlojeCt Addf955 �S`�� T'^`� ^' ����y � ' � CONVERSION '❑ DEMOLISH ❑ OTHER. � ' ' . � , . ' ! � - : � • ' . � � ' � �
OwneriName -' � '�hone DESCRIPTION'OFWORK . � � ' .
' . . � I G R U TI
Addfe53� ' - � 1 - �' � � " ' ' _ �� TyPE OF PERMIT ' GRADING FOUNDATION STRUCTURAL - A. P� qW . � ZONE . - - '
AlCh/EOg. � -r I Ipcen58 NOJ ' ' ❑ TENANT ❑'� ELECTRICIIL � PCUMBING. ❑'MECHANICAL � �PLNG. REF.91E � - ' BUILDING. - � , � k.
; �� . A�.VJT' � v�� � '_ ' � I ' � t �.TOBUILDING . . . • ' • i t ' •.i
Add18is i -���OTHE0. � : . : . • . P PE Y INE � � REAR VARD (T0 P/U- . � �
M" � GU I • • PRQIECT DESCRIPTION SQ. FT. ' OCCUPANCV � !LEFT SIDE VqqD ' � RIGHT�SIDE VARD � "�
Contractoi's Nem /�� hone
� ' �Z �Gr LI/A� � CONSTRUCTIONT.VPF � ' ' � � VALUATION . �
Addresslmailing) � - ' �' $ !Fe � PKG.SPACE.REQ. • . ' PROVIDED ' ' �.
I . � ' • � ZON€ � i GRADING CU. VDS. ACR i �� � � �
� L'iCenm No: __. . ' ; . . - ' ' . ' • � ! ' .
I ; UCENSEO CONTRACTOF DECLARATION � ' • ' , Ramarks: • z ' � Y� � �, , j , -- STREET WIDTH - . ' ,PAqK FEE S I f i ' �'.�
1'hereby,alflrm Mat I. am IlcenseG untler provlslons of C�arter,9 (commencing '
Q With.cettlon 7000) 01 Divlslon 3, 01 tha BuSiness an0 Aofeaslons COOe, antl ! . � j ' � � ` : SPECIAL CONDITIONS: � � � ' _ -� � � , �
`' my Iltense_is in full fo1S e an eyect. �7�7 "� �
Ucensa s ' L'��CC. w ii�ense.No' � ! !� , ' ' t PLUM8ING ,- . . ! . t i . '. . , , ; - • . , . I � �
� �ate �� � Slg atu e ' f ' . � - ^ ,
BarSiak ' SewerCap � ' ELECTRICAL
� 'ORKENS' COMPENSAT�ON DECLAHATtON • ' � � _ _ . .. � Z OO • I ' � � :,
ereby.alflrm that I have a mrtlflwte o1 consant to seif-insure or a cartlfiwte. � 88Ckflow Preventer '-. '- ' - Sewer Conne[tipo' - -' ' -- - P�utomatic Wazher � .� Meter over 100 smps _ :,
� Workers' Compensatlon Insuran<e,'or a cnriifinA�coOY thareot (SecUon' ' ' ' '- y
' 3800, LaD. � ' ' - '- Conrtruction Pole' ^ Sub Panef ^ . ' �
.G.� �8, .1 � y/ � i ���T��� i ,. � , Backflow Irrigation � Solar Col lectors ' �
PoIICY No. / OrN ry _ ... _
[] Certinee copy Is nereDy turnishetl company . . � ; gathtubs � ' � Soler Piping ; � ' Cooking Unit � �Sub Pole . . � � .
Q4 CertH ea le4 with tha dty e�} n�q _D�v�lsl � , . � Disliwasher � Morors ❑0-1 HP � 1'6-8 �
Date�,�� - ADO���?nt '��^�' � �� � • � Clarifieri Solar Tank . � : � ` . � � . , , i
1"" '•
�i EXfiMPTION�FROMW�RKERS'COMPENSATIONDECLARqTION I . - -- - Diyels ❑GaS:OElettfic ' � Inc.Solafj0945HP�O16-15+ � �
(7his sectlan neatl'not oe compbtetl ii the Dermit Is for one nuntlmtl (S1oa) or ��� • DishWasher . � � Swfmming Pool w/Spa ' e � .
leceitify thal In the per�ormance of the work for whlch this DermR is issuetl 1�+ Drinking Fountain5 ' � Urinal : ` , � . Fan � " i'� � �Microwave ' � !
' znall not emD�oy any parwn In any manner zo as to become subject. to t�ie. '( ' � , F.A.U. � ' ' '�POIe Li ht � ' '
, Workers' CompensationlLawsof Califoinia.� � j FloarDiains' � � 'Z , 9 .
Dale ' . . ' Si9nature � � • ` : , . . I . Wetef�pozet� �� � . � � i ;
r
NOTICErIf, after,maklP9-thls�tleclaration, you shoul0. became su07ect to�the �,- - � Floor Sihks p- --' � -' �- � -- ^Weter Heater � � � _ ; _ Fixtures � _�' �p{ _ 9a _� ' ' , '
, . " ' _ .- : . _ � - � _. . Ran I i "' ' .' �
� Workers'� Compe05atlon ProWsions,oT the LaGor COGa„you musLforthwith, ' � ��.- l Y' � DevicE Boxes ' � ' i '
compty wlth such;provlsions-or„tni5.;0ermit�s�all� be Oeametl ravokeC: � G2iSeNic¢ 'Outlets� - �WatC�$2rvice,, , �Sign ' ' � '
�CONSTRUCT10N�lENO1NG AGENCV' - '� , �� '� ' ' ` ' ` � - � , �
�' I hereby aftirm that theYe Is a;constructlon IenGing agencY.for the performanca Int2rcept0�5 � �� �"' �• ' �� ��. � Outlets � : � ; Stending SectiOns � ; �
'. of [ha wo�k tor wh�ch- thisr parmit Is IttueO .(Sectiou 3087• Civ_ C �• ' '` ' � ' � - i � ; ; � �
� ,i � - - � i _ i . ' ' : � - ' . Switches � , � ' '
' Lenear's+ Name-- - - , y ! Krtchen.Sink� -. _ ,_ � � _ _ � � . � ' � I ITrasli Compactor �
� Lentlar's AtlGrau . �'� , : '• i � •r ! ' i 1 ' - _ ~ _ __ _ _ ' � " '
Lavatonest; 1 - ' � Gartiage Disposal � � � : ; � ' • �
� OWNER�BUILDER OECLARATION � } I' J-. ' . � i' . Z_� pQ ' i
; 1 heroCy,aftirm [hat 1 am'exempt�from the Contract0�'S License Law tor the � . :, � - .�,- � Gen2raton �0�5 KW �5-15 KW � 1 � � �
, followinq reason (SectlOn� 7031.5'Business antl Protas5lonal:Cotle: Any ciry or: P-T�ap� ��1 ..f' � . ,> >• ' r
coUnty whic� requlre5 ? DBrmit to construct, alt¢r Improve; UeTOliSh'or'repair � - , .. . � ' � � , , 1
Trensformer
any structure, prior la Its 95suance, atso raqulras l�e applicant for sucn �ermit ;- Roof Drains ; � - ' - � , ❑ 15-50 KW � ' { . � � �
� j0 flle a 5ignetl 5tatamaP���hat he/she is IlcenseE pursuant to thelDroviS ons of , ' - ' � � � �' ��' • . � � - - �
i,, :,�• Contractor's License Law'(CM1apter 9 (commandng;with.Sactlom7000) oT �. � ' ��- ! ! . � � � � �- . � �5U+ KW � iReinspection Fea � $15' I
.j°Aslon;3"of tne Buflness antl:ProTessions'Cotla)'or thatlhe/she-Is:exempt ShowCrs � 11• �� RainspeCtion'Fee ;$15 � •
, ,�,�'vy`Cvetrom antl the' bas15 tor [he allegeA ezem0tion: Any, vlolatlon'oT SecHon . . ; � � � � : Mete� ❑up to 100�amps �Issue Fea � � � � $ 3 i
"U31.5 Dy' any ap011c8nt for{ a permit sub�acts'tna •applicant to a" civil , � • � i ' )
� �enalty of not more tban ilve nunCrea do116rs (s500): � � ' . • � � �rvice Sink � % ; Isue Fee - � ; E 3. � • � , - • �
� � � � 2oning ApProved By �pate
LJ I; as owner of� Ihe Droperty or:my employaez,wit� wages�as their sale . , . � � � �
1 compensatlon' will.tlo Ne work, antl thestructure.is not IntentleC or o(feretl � �; � + (�, MECHANICAL •, � � ' : � i � �
lor ule '(Sec{ion 70a4: eusinesz, antl, Professional Cotle: � 7he, Contractor•s , � � - ApPlirdtion Approved By ' � ' �ate � � •
� Lltenie Law tloes not apPly to an owner o/ a property who builEs or Improves 8oil2r. � ' ' j � t RCfrige�ation Systertl ! � � 1/•S 1 ' S ; 1
' t�eraon,.antl who COGSISuch wO�k hIT581//herielf p� tnrOu9h Itls o� he/ own � �� : . . S APplltltiOn I4UBE By ' ' ,DBtB
, em0�oy ees, proWAetl lhi� such improvemants are'not intendatl or offeretl tor , - � ❑6100,OOOBTU ❑100,0008TU ��
. sale. I}, hOweveq the G4��4��9 or improvement I5 5oltl withln one'year of com- , DUct = Undef�GfOund � � � � � . i � ' � � . � SUMMARY OF FEES ' '
�, pletlon, the owner�wlll have the burtlen of proving he/she tl1U not bWltl or Im- ' - . � � ( � . � : .� 1
rove for tna w ose of sala '. � � � ' ' Duct - Structural i. S stem Re eir)Alteration � ' ' ;$
� p �• t e ! � � ! I , i ?' P ' ��� BUIIDING PERMIT $�� � ' 1 SMIP � I ?
� I, as ownu of [he pio0erry, am exelusively tonlracting,wltn;IlcensaE con- . . � � , � � a
.t�aCt06t0 cOOs[tu[t.Ne'P�ojatt (Section Z044, Buziness antl Prolauions Cotla:_1 _ .. Dut[ .Ventiletin8- . . _ . =, . -` _ _ ! _- _ _ .PLA_N CHECK� � $ � 7 PERMIT � . '
Tne Contrattor's LlcanRe law does not apD�Y to an owner of propeity wno . � ) I$$UANCE , .$�
� DWltls or improves'thereon, antl who contracts for suc� projects with a con- � ExhauSt SyStEm ❑ Multiple �' 1 . ' � PLUMBING � ' $ -� �� � �
� tractor(s) Ilcense pursuant to tha Contractor's License Law). • � � • • i ' , ' , � �
, O�I'am axempt untler Section � I B. & P. C. for this reason ' FirepVFatt. BIL ICBO �h � i � � i _ �P�N CHECK; $! 3•'U(l � GRADING � �$.
, Date � � , Owner'� ` % � ' Heating,System & Ducting i + ' � ' _ ;ELECTRI.CAU � $� : � j t , $ i �
' 1'�hnrn�y�-certlty t�abl �have-reaG this�appllcatlon-antl state that-ttie�abave -� - � �O�tO��,�00,8TU��tU0;0�OBT� - - � �-•- �--� , - - , �PLAN CHECKt $ � , i MICROFILM t $ _ �
� inlormation Is correct. 1 agree [o comply with all clty.antl counly ortlinances �' � • � � : ` ' ' . � � � � � y ; � � TOTAL�FEE� $ � �
antl state laws ralatlng to builtlin9 �onstructlon, anA hereby aut�orize repre- � � HUOd a� � � � � :MECHANICAL' � $ � � �
Santatives of'this � ty t0 ante� U � th ov tioneC orov �Y � � Ty(JB I 0' , ? � ' � , j , �
? Reinspec[ion Fee' S15' ! � LESS {
te Y� l ���� T a II ❑. ' 1 � PLAN CHECK qDVANCED PC S-
'Inspectlon DurPo ' � $' . . � •
j Sl9nature i _ . � � . � r .- i � . � . ' i � I � � ' '
} — 7 Registers ! laue Fee : S 3 � : � � 7 �
Drivers' License or SS ¢ i ' � 1 1 FINAL FEE �' �$ 2'�Q
CMF 0865-06 rav. 12/82 White - Builtling; Canary - AVPlifanh Pink - Acmunting: Goltlenrotl - AsseSsor - � - - � 4�
\
C _ .
� l `1 ', 1
! � , � . ' �. � • .� , �� = POO aPA -
rCONSTRUCTION AND�PLAN tN � - . ,��� , , , - � � � � ` � � �'
,� r. �- >:�Date �' �.Inspector � . Oate � �InspecMr �, �
'�APPROVALS r� Fermit'#� - - -APPROVALS �_ Permitql� , �-
.�" _ .m. �c" F. � ' .t . .
� �1: Temporary�Electrical SerJiceo`rPole!� , � �� ; _ . .,E'� �52. Pool &Equipmerit Location -, - -
�
� 2? �Soil Pipe-Undrgrnd= a' i F `� - �. � ^ ` 53.' Steel Reinforcertient � �
: �' `
�� 3! Electrica�l Conduit�U[ilitv-UndrgmA� � i; w - �� _ - � i �54: Forms' _ '; � � - � :,� �� :
z 4: Electrica� Conduit-Undrgrnd� - ' `� � � ` �o � ;, 55J Elec[rical Bonding ' � - - . - � � `�j
5: Steel Reinfor' � - �-- � , �
cement ., � �i � �: ' � � ��' � �56. Rough Plumbing & Pressure.Test ?' � �
6: 'Electrical UFER Grnd.' �^ �� : �> � 57. APPROVAL�TO'COVER-GUNITE" - '
.-J. Footings � I�. '�': �'�.� i C o � �, a; : `58:� Electrical��pnduit-Undro.�d." �._ '
� 8. Foundation ' � '' ' P � :+ � � - • � 59. Gas �Pipe, O`Undrgrnd_, Test =
',f • .�, - , -
'9. Water Pipe iUndrgrnd.'' � � �_ � `' '' r _ ' 60. Backwash Lines,�P•Trap,"O Undrgrnd. - ; ,� �
'10. Stiuctural Floor System ; �� "' � - ��< i 61. APPROVAL TO DECK � ` '
11. Roperty Sewe�.Line'& HouseConn`ec[ion� . . 82. Backwash.& Recepior-Pinal ` � " ,
� r.
12._ Sewer Cap - '� ' ; � �� � � " • 63. Neater & Vent-Final - � � �
r' - �
13. RooflDrains -• •:� � ��''' � � � ��fi4. PlumbingSystem-.Final � • ' � `
� ,
, 14'. Rough Plumbing' :; � _ � � 65. Electrical-Final ' � �
+ -
��15. Rough'Elearical=ConduiYr ��-' - � -r •- - � - �,- " 66. Solai�System-Final � ' - - -
` ;�;1.6.-`Rough-Electric Wiring, , { � �� '`-' �_ "� •�; �-' � ' =; � � - '67.! Fencing & Access _Approval � : �� � -. `. . � �
ti 17.'Rough'Wiring�Sign; � ;n � ' ' �. ' ; ; : _ � ' . gg.� APPFOVED FORP,LASTEfiING ' � � ,
- �18:-Rough;Electrical-T:,Ba%�iling�; � i � � ; `, � 69. POOUSPASYSTEMSFINAL �-
� �
'� 19. Rough.Heating &,Air Conditioning �� '•_ � � � ; ; FIRE DEPT. RE�UIREMENT
n� 20. �Rough Factory Fireplace� !�, �� ? � i � � j ` APPHOVALS. ', Permit # � �
� ; 21. Duc[s,�in Str4cture�. ��' � � �� '' � � � � , 70.. Underground Hydro �, � � � � - �
z _� , :
� .C22.1 Ducts, Veniilgting : ,� � � !i �� � ' � 71.�. Product Piping O Gas ❑ Oil . ' � �
.�
='-2#' Gas�PiPe-Rough & Test ° � ' '�% �� � �� � � � � 72,; Undeiground Flush � ` '
' #'24. �Roof Framing; � � � ? � .I �,,,- i� � � ' "! i - '- f = I ? i'� '�3.i Undergrnd. Storage Tank�O Gas ❑ Oi6 � � �
25. Roof Sheathing i � � r � j �i � �' ' � � . � . � � t ' 174. Overhead Hydro � � ' ,
- f26. T�Bar Ceiling (Struc[ural�i & Monocoat' � � '' I ^ � � 75.� D ,ry Chemical � - � - � � • � ' � � -
27. :Frame and FI hin ' , � � � � , � . � � �, � �' `
�� as 9 � � � �i , � , � . � 76.� Dry StandPipe ' .. " ..
� 26. Lathing & Sitling� � u � � � .) ' i � I � � � .77•• FIXED SYSTEM PINAL � �
., �� 29. lnsuiation �� ': j u "' � ' � �� �i i � � � � � '�78 � FIRE PREV. FINAL - � �r
� i � � � �
i
. 30. D'ryidall Nailirig � > �: I � ; � i . . ,Notes:�. ' ' �. ( , . . � �
° ' � • - - � - -- .. . . .
: '�'31. Plaster Brown Coat � � I 1 �� '� I � i 1 i � � � � ! � � , � , � . 1.
.� �+32; �Electrical�Power Meter�Final � �I ;; . �. 1 1 � 1 f i f ' ' ` I' -
, , �
��� 33. iFinal Electric i i i i� ' `;__�+.. � � � � , t � � � '^ •
_L _„-
' 34. Finai Hea�ting & Air Co�nditioning' � j � � i ' . � ' � I . � , ' �
, � r� c� r. i i F: - I c y � I � � .
35. Final GailPipe=T,esiy �u � w � m � `.� � i � I,_ �,° � t � � � ' � -, i �� � � �- ��ti � . . . - . _ � `. -
. 36. Hood or CanoPY �� �"�' I �; I ` � i� � � �' - � e � i I � . '; � - i , i 2 �.. . �i - - li - . ' c '
37. Final Factor.y Fireplacem � = • o� �� ` � �� � ' ' � ' � i- i i �,�, - "
i i m� _� n ' i .; : r
38. Final Plu;mbing , � i i � pi I{ �� ;� ., : -
39. Water Seivice-Final� � � I �' j �i 1 !� j � � '. � � � , � ' �.' . ,
�
40. GasService-Final I � I I �' � �' � � i � i I � ' '"' ' � ' .
' 41. Solar pomestio-Final i ' I � �i -,- --� -1 ----t- � -a � - � !� ' ''� ' . . . .
42. Backfloti�'Preveriterl ul � � -j,��- ' � � i � ' � I� ' � � ' � - .-' , �
� � I - r - - - �
= - : i ; ��. " ' :� � , -
43. Backflow�lrngation, TIr � I , ��:����. i-, � � I'�.' . , , . '! � . � � � �
i �
44. Landscape Ir,rigatio.n�System � � �j4 ; - � `- ; � � . , � : � - '^ � i -
._�
45. Sound!�'Attenuaiion � " -' I � �` I ; i � i � � i � � . � _ ' - . . _ � �
� i i i � i
46. Handicap�Regulations �' � ^ ( � ' i� � ' �' _ , � ' � . , ' • - - '. r:
��
47. FINAC STRUCTURE & BUILD�NG � i� � � j:� , � � 1 . •
48. Special Requirements Completed� � � ' � � � � , - ^ � - • � • •
I
49. Electric flelegseao Edison � , u r-.�_L _'__ !. -� - . � � _ _ �_ ,_ + ' � 'i`� . � ' � .
� � � - ,
50. Gas Release to Southe�n Califomia Gas Co � � i j ; ' I � � � � ' �
�51. CERTIFICA7E OF'OCCUPANCY � r � _ �_ '._ _ ' _' -' . �_ _ . _ . ' � � �
i r -�- � � � � . , �
, �
No � �' ' � � Date ,- ! . • It I � � � � • � i � . ' .
�
�--'--'•- --- - . .- -
�� � � .y .--' -- - . � . . . _ .
' � AOP��cant �o till in all spaces within heavy borCe� lines anG zign all a0D/opriata tlacla�ation5 Ai O� �EKM�r � 6 7(,/
' C�TY-OF COSTA MESA PERMIT NO: ' - ' TRACT NO. ' �,OT NO..- �BLDG. O. ' � � 'K � � , . /-O .. . . .
CONSTRUC710N PERMIT � S � '' � � '� , , • . . . •
Project Address - ,� �,(6p� 6,{J�PG/�y So4I//, � TVPE OF CONSTRUCTION �.• ' � � •� ;_{ -� � • � � �
� - . '' ,. . _� __ 6950. 4/08/83 .. . " 9.UU
OWner r Phone �NEW � ❑'ADD ❑ALTERATION " � ."
'AddfeA- � - � ~��'� � -- ❑REPAIR.❑CONVERSION ❑DEMOLISH, T�
�I, , , � - - - � ZONING REGULATIONS
Arch/Eng. . License No. ❑ OTHER' -
MV Add�C55 " -- - SCRIPTION OF WORK ��� A'�"�
Q � / � ZONE ' PLNG. REF: � � �
!Y�� ContractorCpy� - e - � -Phone( . ,t,o TYPE OF PERMIT ' � " - � D . . TpBU ILp iry G .
+ Add�Ess � ' SETBACKC LST. PROPERTV LINE -
O E �4�'1� JT• - �P.C� N ❑ GRADING '❑ FOUNDATION � � STRUCTV RAL SIDE VARD .
LICENSED� CONTRACTOR DECLARATION.. ' ! 0 TENANT �❑ �ELEGTRICAL ❑CLUMBING �MECHANICA �5 EDFE VAR
I hereby affirm that I am Ilcan5e0 untler provlsions of Charter 9(com- , piGH7 ' ' ' '
-mentln9 with section 7000) ot� Division 3-of� fhe Business antl '�'OTHER. ' -
Protessions Cotle; antl my Iicense Is In full force antl effect. - ' � REAR VARD (TO P/L) - '•' '
p PROJECT DESCRIPTION
Litense Clasz 0 License NOT�`fp��` • ' - -"' ' PKG. SPACE REQJ ' PROV IDED � ��- � -
Datey'S'93 ' Si9nature'- -/O .SQ.FT. ' /6{)'. . • .. � . - . _ . . . . . ..
� WORKERS' COMVENSATION DECLARATION - . .' ���CUPANCY'_CONSTRUCTION TVPE � STREET WIDTH PARK FEE E
I hereby afTirm ttiaf I have a<ertifiwte ot consent to self-insure or a VALVATION ZONE ZONING APPROVED BY DATE
--•tifiwte oi Workers' Compensation Insurance, or a certifietl copY .._ ._ . _._ _
•eof �5g�t' n 38p0, l�ab. ). GRADING CU. YDS. ACRES SPECIAL CONDITIONS: '''-'
cv NN."�9S/4oY1�Coma��Y�bD✓7" INOC}+.✓./y _ ' . _ _ . _ " . ._ . . . .
_ _.
_Cy Certlfietl wpy is hereby furnistietl. _ _ . . ` . REMARKS: �- ^ � � " -
❑ Certi�ietl copy is filetl with the city Builtling Division. . ' , -' ' - , " " ,"_ - ' ' '
EXEMPTION FROM'WORKERS"'COMPENSATION'DECL'ARATION �`' � ' � �� - � • ��. . � � � � � " �" '
..� .. . ._ .�
_(Tnls sectlon neetl_not be,mmpletetl If tne permit is for one huntlretl � ��� � � �, ' , �••. , �.
(5300� or less). : . " " '- ' .. : : . - � - - - - - ' _
I. C¢rt fy tnat In the_per(ormante of thE work fot which this permiC is , ., . ,
issuetl, I shall not:employ any person in any manner so as to become PLUMBING- ' ' , PCAN CHECK �' � ' EIECTRICAL -- � - � PLAIV�CHECK
. SU�j¢Ct ro the Worker5' COmp¢nSatiOn laws of Califomia.' ' - ' ^ ' ,
Date SlgnaWre BATHTUBS" ' '- " SHOWERS -' �- - - � - - - -
NOTICE: If atter �makinq this tleclaration, you shoultl become subjec[ � TOILETS.. URINALS ' � � - GENERATOR � 0-1-KW' 1-10 KW� �
to the Workers' Compensation provislons of the Labor Cotle; you must � � TRANSFORMER —� -
torthwith compty with such provisions or this permit shall be UeemeO �.°.VATORIES �OVBIE LAVS - - •APPLIANCE --�0-50 KW_50.. KW � '
r¢vOk¢0.. _ . _ ` � � ,
CONSTRUCTION LENDING AGENCV ' KIT. SINKS -' -DISHWASHERS �- - MOTORS. -_ 0-1 HP•_1d0 HP '
I hereby affirm that there is a construction lentling agency tor the perv SERVICE SINKS � � SUMPS - - . _(INC. SOLAR) __ 30-50 HP 50 + HP'.' ' ' ��
formance ot the work tor which tnis permit is issuetl (Section 3097 �
'Civ: CJ. ' � t�'NO/VE . � �.� . - � FLOOR.SINKS .,-, �.." FLOOR DRAINS'-' - - FIXTVRES � - ��OUTLETS -SWITCHES `- � -- -
- - -Lentler's�Name. ' � � - °
Lentler's Atltlress ^�� ` ' � �� - � �' ��� � �RINKING FDUNTAINS'- � - i- • - GASTUBESIGNS- . _ . -. . . _ � � _ _
'OWNER'BUILDER DECLARATION_ ''- - ? � - "'�`;� " . �" - � 1 . . , POLE �IGHSS�- � '
I hereby'affirm that I am exempt trom cha,Contractor's License Law'for- INTERCEPTORS�"' ' ' CLARIFIERS ' -- - �- -� - --- - -
�the tollowing�reasom(Seotiom7031.5:Business antl Professlons COCe:' �'SWIMMINGPOOL: - -PTRAP� - � - - _ '
Any city or county which reaWres a permit to construct, alter, -PO�ES ' METERED' ' SUB" - -
'improve; tlemolish or repair any s[ructure,-prior to its�issuance;also re- yyqTER SERVICE " _ALTERATION�-�- - - - -PANELS � MAIN - - .�SUB ' �
quires the applicant for such pe�mit to tile a siqnetl statement that he - �-
•Is Iicensetl pursuant ro the provi5ionso( the ConVactor'S�License Law- - GAS SERVICE ' ' ".-OUTLETS ^ "' - -' � � - - - -
'^�apter 9(commencing with Se<tion 7000) ot Division 3 ot the SERVICE qMP �. -
:iness antl-Prdessions Cotle) or that he is exempt [herefrom.antl tbe- yyqTER HEATERS ^- BTU OUTPUT, - �� • - -- - �. -.. _ .. ..
I5 for Ihe allegetl eaemOtion. Any violation of Section ]031.5 by ' ' '
of noPmo e�than tiveh ntlretlbtlolla�s (E500).��� to,a-tivil penalty SEWER�CONNECTIONS �' �-- � - � -.• -- .-- - �_ ,.� . _
❑'I,-as'bwner of'the property(or my employees wltb wages'as their -SOLAR TANK � � -- - • COLLECTORS• - - - � - . . - . . ._ . .
sole compensa[ion, will tlo the work, antl the structure is not Intentletl
or o(feretl for wle. (Sec[ian 7044,-Business'antl Professions'Cotle: The 'SOLAR'PIPING SYS. ' -' �i "' ' - - - - �SSUE FEE - - � - � - . .
Contracior'S License Law tloes not apply to an owner ot a pro0erty _APPLICATION APPROVED BY. �
who bulltls or improves tFereon, antl who tloes such work hlmselt or' '^ 155VE FEE - "" .• ' '' '' - .�.�.OATE.
through his own employees, provitletl tha[ such improvements are not
in[entletl or otferetl for sale. If; howeveq the�builtling'or Improvement MECHANICAL PLAN CHECK . -"' - �
is soltl within one year o( completion, the owner will have the bur0en SUMMARV OF FEES, .
ot provin9 he tlitl not builtl or improve"for'tbe -purpose ot saie). -HEATING SVSTEM 0-100,000 BTV " BUILDWG - ... , ._'
❑-I, as_ owne� ot [he.property, am exclusively con[racting with_ qND OVCTING . PERMIT E , � SMIP. S
licensetl conVactors to cons[ruct the Oroject (Section 7044; Business �100,000 + BTU p�AN CHECK E PERMIT � �
antl Professions-Cotle:-The Contractor's License Law tloes not apply ro , ISSUANCE �f'- �
an owner ot Oroperty who builtls or improves thereon, antl who con- REFRIGERATION �� 0-100,000 BTU � � PLUMBING f � '
trac[s Irom��zuch-p[o�ect5 with a contractor(s) litesnetl.pursuant ro SVSTEM . . .. __ _ 0J, ' -' GRADING S
the Contractor's License law). ' 300,000 + BTU - PLAN CHECK E - ,
� I'am exempi untler Section " - - B. & P: Gfor ihis - �- - • - - � � ' � -E � '
� BOILERS -BTU � . ELECTRICAL E ' -
rea5on� " ' - . " _ :.. .� 'MICROFILM'$•..•
SVSTEMREPAIR,ALTERiiTION � - PLANCHECK $ .. _
Date Owner .. ..MEGHANICAL f_� .� ' TOTAL FEE E
1 h¢rEby certifythat 1 have reatl this appliwtion antl slate that the above EXHAUST SVSTEM - MULTIPLE ' '' . �.- LE55 AO-' �
information'is correcL I agree ro comply-with-atl ti[y antl county -QQ - PLANCHECK. E - VANCEPC E -
orCinances anU sta[e laws relatin9 �o construction, antl hereDy authorize CX Klir S/A/G qC ' , . , -� ��
r¢pr¢5¢ntative5 of this city Lo enter upon'the above mentionetl - _ - . - � ' • � . �. .
property for i spection purp s¢s. � C . O 00
Signalure��l��^"' Date ��� r�� � ' � - - , , FINAL FEE E �
Driverz' License or 55 � �ISSV E FEE_ . „ _ _ � 00 . . . . . . .
CMF 0865-46 White-Builtling; Gnary-Appliran[: Pink-Accounting; Goltlenrotl-Asseszor
' � \,
_ '` ...+��F: . ,�: . . _ . _ _ _ � . .
CONSTRUCTION AND PLANNIN,G�.��/�-���j( ' ' POOL & SPA� � ; �', �� • '� ` ' � • �
APPROVALS Permit # �'�� Date Inspector qppROVALS , - Permit #'�� �' Date. Inspector
`" ' ` : L.
.1._,Temporary Electrical $ervice or Pole 43. Pool & Equipment Location>-; r'S: 1.;.;�,;,�.;h't•,`��•:-, :�`•'.•.),P;;�
. _2.� .Soil ipe-Undrgrn . � 44. Steel Reinforcement � - � - - - '•" ��
3.- Electrical Conduit Utility-Undrgrn . . • • -�• ' - t `, q5. Forms ' - - -
4.- Electrical Conduit-Ondrgrn.. ' 46. ,Electrical Bondiiig � � -�- -� � � - -'
. . tee ein orce _ � 47. Rough Plumliin & Pressure`T�st - ` - � `'' � �• '"'
� 6. Electrical UFER Grn 48. APPROVALTO COVER-GUNITE� '- ' '- "'- -� V�• �'
_ 7. Footings 49. Electrical Conduit-Undr rn � -
8- - Foundation-• � - - - _ � -' - - 50. Gas Pipe, ❑ Undr rn, Test . ' ' -
9: - Water Pipe-Undrgm . - ' 51. Backwash Lines P-Tra �❑� ndr m• ' ` -
10. Structural Floor System � � - � � 52. APPROVAL TO DECK� �� � ' � �
� 11. Property Sewer Line.& hlouse Connection. � . 53. - Backwash�& Rece tor-Final ' � � �
12. - Street�Sewer Connection • - =� � = � �� ' - -- - - • 54. 'Heater & Venf-Final c ,.
- - _.. - . ,...,�;.�.. ..,:� ... .:c......,
13. Rough Plumbing _ .� � -, -
. . _ . .---- � `- - � - �
14. Rough ElectricConduit �� ' ' •-� ' �'56. - Electrical-Final - �• ' � �
15. Rough Electric-Wiring " ' 57. - Solar System-Final ' " ' - '
16. -"Rough Heating & Air Conditioning � - �_ - - � encing & Access Approval
17. Ducts in Structure,-� - - �' --� - 9• APPROVED FOR PLASTERING � •
� � 18. ' Ducts, Ventilating '- - -- � ' - - - � ' . - ' � . . . _ � _ .
79. Gas Pipe-fiougfi & Test � � •� � � �• � -- - � � � 60. - POOUSPA SYSTEMS FINAL -. . ' . � !' �
20. - �Roof Framing - - .. .- � -- - - - - - . . . _ . � .. .� ,. . . , � , . , . „ .'
21. Roof Sheathin � .. . . . -- - - - � ' . . ' ' �- . . . . . - • i
22. Frame and Flashin - • - - ' NOTES: � ' .
23.- lnsulation - � - - �� ' -
24. Lathing &-Siding- -� � - - - �- - - -
25. - Drywall Nailing - � - . - -��- - -
26. Plaster Brown Coat- - - � � � - � � - - ' � � �
27. Electrical Power Meter-Final -- � - - � - - - � - - � "' � � � � � �
28. ' Final�Electric ' - � - � � � � � - � ' � � � �
29. ' Final Heating & Air Cpnditioning - - - - - - ' � �
-30.- Final Gas Pipe-Test - •- � - � � - - - - � • �
31. Final Plumbing -- � - ' ' '
' ��321 WaterService:Final', � - �
- �-�33: Gas Service-Final �' - � �
34. Solar pomesticFinal � � ' - � -
35. Landsca e S rinklin S stem � "�' �
36. Sound Attenuation ' - ' � � - �
37. Handicap Regulations -
38. FINALSTRUCTURE&BUILDING
39. Specia�RequirementsCompleted ��
40. Electric Release to Etlison ' " � �
41. Gas Release to Southern California Gas Co. - �
42., CERTIFICATE OF OCCUPANCY � ' � - �� ' - ' ��''`���' � �
i
�No Date � � _ . .. ;
' AD7��v�t to �ill In all spaees except t�om within heavy Dortlar Ilnes antl sign all ap0�ooriate Geclarotlonz.
I CITY, OF COSTA MESA! - . . _. .. - . ; • .. _- `- - - . _ . . . . . . _ . � . .�. ._ .' � .—_ ._ ._ . - , --+. — ---.. _ _._._ _ �-- ,
: 1 � _ P IT Ng. ' /�? � TRACT NO - „ . LOT NO.� .. . .. - �BL � . I r � � � � c.; . ' � � . ' � � .1 . «• ---
' CONS`TRUCTION PERMIT , `- � i � . �: I , �� = �o �' `?��:7 , :. .;. .: L ` { � i � , - . 1 : i ;. �. �+: ; ` - '"i i
r • . GL .wit • . �,: G' A.v � . . � .. � �742 .�/q5/.83, i 350.20: T.
.�AlicanYSMailingAddress �•TVPE-0FCONSTRUCTION� ! NEW � ADD ALTERATION .REPAIR . - . _ . . ; , � � . .
PfojBCtAddfM3� �-5-!l:J =NARIIGR GA%4.f�A-y- '7.'� � �-` � � :O CONVERSION'❑ DEMOLISN ❑ OTHER' ' �` - . , � . , � � _.� ; � � 7 � , � �
. G i �.%�,�5/GFfw�s!RGM � -P ' �DESCRIPTION:OF WORK ' •r�% -� � � � �� � �
Owner'rNeme . , _ , hane _ � � - - , . . , _ _ ' NI G� EGU' 71 - -
_ 1 ' f . ,� r . -� .. . i �:� . .. .� � : . . � . a i' i
AddfBSi ' � -. T,VPE�OFPEflMIT- GRADINGi 'FOUNDATION� �-STfiUCTURAL - A.P.�3W ' � ' 20NE � - � � � �
ry� w
' AfCh/Eng - ! � • LiCen52 NO. � ��O TENANT� �qELECTRICAL .❑ Pt,UMBING ❑;MECNANICAL � � � � - j•BUILDING� - � - �
'. . - . ; � . � � � � _ -.PLNG. REF. qIE-
Add�253 • ' r � � � • • � . . ' � .� . - 1 Q.�OTHER �.: � _ . � r R ' ' . � [•, i � _ , . . .
/ .TO BUILDING` ' � , �qEAR VARD (TO P/L) ' '
CAntrectOlsNem+� M.��ToNtifo.�✓:��r ��P;,o„�S�'3%�J .;PRQIECTDESCRIPTION� S�.FT.�� ' �OCCUPANCY' � PR PE V INE �
AddleSslmeilingl�����--W��STM/A�fTLPiPF G%%iI%R�/'GAO✓/L• � ' CONSTRUCTIONTVPE � � � VAWATION$ ' �L'EFTSIDEVqqD � ; RIGH7�SI�EVARD . _. ; y� _
����6�9%�y - � � - ' ; ZON� ' � � GiiADI1JGCU.VDS:� 'ACRE� �PKG.SPACE.REQ. ' I PROVIDED ^ � J ! r- 1��7
License No. - - 1 , + � . � . �
IICENSEO CONTRACTOR DECLARATION � � , ' � ' "Ramarks: � d � �y.. � �[ ' ' ' - ` �STREET WIDTM � I ; � � PARK FEE $ : '� � �
M1 hereby afflrm that I am Ilcensatl untlar provisians of'Cbarter 9(commencing ' L d�' 1/� M� r1 'r 6 7'T.� t
with sectlon 7000) ot Divislon 3 of the BuSineu anG Professlons Cotla, antl �� � � � � i SPECIAL CONDITIONS: � ( � �' �' t.
^ my,license Is in full orce antl aTfect. ; - . ; , ; , ,
� V Vicenie Class '� 4 � Lican � No 3�-�6 4��{ ' , �, { PLUMBING �•� � 1 I � � i � �
. � - ,. : , t ' . � , .. . ; ' � � i !' ; � - �
ate ��'s-h'? Sl9nature � - i BaiSink � � . SewerCa'• . � . . � �
� NORKERS' COMPENSATION LA�RATION � � � ? : ( + ' • .' ' � - --. . P I : ' � . ELECTRICAL � ' ' { '; j �
\ . I heraDy'aTiirm that I.�ave a EertlflWtBAi COnsent.to 581f-InSura.oi a.certlTlrata - ' .L_ . `_- _ ' ' _ I _ _ AutOmetiC Wazh2r _�. .1 _ � � .�MetC� Over 10�) amps.___„L _
.u' ; BackflowPreventer ' Sewer Connection" , : ` ±._ BO 1
oi Workars'�Compansatlon Insuranta.;o� a cartiTletl�copy thereof (Sactlon � - � - - � (
i � � i , � - � � � - -- - , , Construction Pole '
� •, 3800, lab. C. ' j , , . ga i � Soiar Collectors l . � ; � � �Sub Panel � j i
N; 7U So� � ' r en,i. ,r� ' y�,r oti. � Backflow Irn tion - ' + , _ �
� � Policy No. Company . ; , . . � - � Cooking Uni[ . I � i Sub Pole � ' `
� Q Certlflea-copy Is hereby Tumishetl. . ; � -' , Bathtubs � Solar Piping . . . r . . , ? j ; i
127.Certifletl copy is Tlletl with the city Bulltlin Dlvision i � I Dishwasher , � ' ,Motors DO-7 HP ❑1'h$ � �
oateJ� ' Sl -rr 3 ` qopikant � � �-�� —� , • Clarifiers .� I i Solar Tank . � ( . , . . i �
EXEMPTIONFROMWORKERS'C6 PENSATIO� CLARAE TION '~� , ' ~ V Dryefs ❑Gas� �Electric ��, ,InaSOlef_�9n15HP �1645+ Iv �
(This SBction neetl not be como�etetl f the permit Is or one huntlretl (5100) or � DishWesher � , , Swimming Pool w/Spa ' . .
' .. � . -- - . , • . � ; , Microwave I � ' +
lecertlfy �that in the performance ot the work for which this pe�m�t I5 155ue0 1 Drinking Fountains U�inal � � Fan �
, shalP not employ any persan in any manner so,as to become sub)ect.to ti�e � , . F.A,U. � Pole�Li ht
,Workars'(Compensaqon'LdwsotCalifomla.. ' , � FloorDrains . � .WaterCloseti � ' � 9 � +
Date � " , Si9nature ' � - � � � ' ' • . � : Fixtures.' _ . ' � I
NOTICE:If;attermakirigt�irtleclaratibm,you�shoultl�become�su�jecttothe- � - FIoa�Sinks-�---- - ^- ------� -WatCrHeatef�---I'"''' '-�'�-�,-' '" (J � -- � •,- ...�RengE. �
� Workers•� Compansatlon provislons of the Labor CoCe, you.must.forthWitb, � , . � ,_ . - - . -- � DeVICe 6o�%CS ' ' �� i �
� comply �with� Suth provlsions:or this'-Oermlt �Shall be �tleametl' revoketl. i � G83ServtCe ' ;OUtlets . -WBte�ServiCB � Il � _ y ' �Sign, � � '
CONSTRUCTION(LENDING��AGENCV � - .' � j t '
I hereby affirm that therB Is alconstruction lentling agency�for the'performan<e �,� i, InteroCptors ; a, i , � �, � ��� � Outlets . Standing SectiOns l 1 Oa �
' ot the work for . which- this permtt Is � issuetl •(Sectlon 309Z; dv: C.7� - - - � M
� Lentler's' Name �� � " � � � � ' � ' , �� Switches ' ' . �Trash Compactor � � , ' Q �
KitchemSink .
�� �Lentler's Atltlrass. ' ` ' � ' � , `� I : i - . .
' OWNER BUILDER DEGLARATION. � .�+ ' Levatatiesi .. � � - ' � ' Gar6age Di5po5al � � � � y� � •
__ ._ I hereby�aTfirm that I am'exempt from tne�Contraetor'S,Llcensa Law tor the �. • �-� . Gen¢rato[ �0-5 KW �5-15 KW � � � I � �
--- -' tollowln9 reaion.,(Sectlon-7031:5=eusinazsantl ProtesslonalECotle:-Any_city,or, P-��aP� ' :1'� . - ' '� } � ' • �� � - 1 �
� county which, req Wres a permit to cons[ruct, alter, improve; tlemolish or repalr P� - - _ _. - -- — T�0n5fOrmB�,_�15-50 KW 1 '
my stru5ture, prlor to its issuance„also reqWres the�appllcanCfor such parmit � RoOf D�ams J - : • z, �: - - - Y--a ._--, . �-. _�(_ �,._ _ � _ �
o tile a slgnetl 5tatemenYthat he/5he is ticensetl pursuant to the'proWsions of �� �' '- - ' - T � ' v � ' ' I *_-
�the Contiactor's�Licanse Law�(Chapter 9 (commencin9'with Settion:7000) of ' ' { - t � L ' : r � ' � ' - - � • ❑5U+ KW � ' ry • ' �Reinspec[ion Fea � ` �
� �Ivlslon;3rof the',Business antl�Professlons Cotle)bI that' he/she;is�exempt ' � Showers f {' 1 ��; � y . � Reinspec[ion�Pea � --,$7$ , � • ' �
; thereirom�antl the; basis for the allegetl axemption. Any_violation of'Section � � - ' ' ' ' " . " MetEr ❑up to 100�amps { ' � ' 'Iszue Fee, � � ' $ 3 �
J033i5 by any appl{cant for" a: permiC subjects The applicant to a= civll � � ' S' : ! t l _- " '
' enalty of not more than Bve huntlre0 Collars (5500 : , � : : ; Service Sink I �� � �- " ' . Isue Fee'' ` , ;�S 3 '
� , .. . �. � ` . { . i . , . " i . r : ' 2oning APProvad BY � I 1 • Date ' ' � � ,
� I,"5s•owner of�t�e�Droperty o� my amploY�s wit� wa9es�as their sole � ' • �
� compensatlon' will tlo the work, antl�the,structure Is not Intentletl or offeretl j i � � � i ?�^� �MECHANICAL ; � j ✓'r j', � � ' i ' � I 1 j �
Tor saler(Sec�lon 7044j BusinessianE{ProfeSSlonal,CoCe:iThe;Contractor'S i ' ApplieationApprovedBy , - . Date 7
.License Lnw Eoez not aDPly to'an owner of a p�operty�,w�o bulltls O� irtlprove5 ' � � - i - '� � RCf�i 2�dti0� S St¢Ifl � j ' *'. � '� ' � ' - � � � � �4
I thereon,(antl who tloes su<h work himself herseif or throu h his or her own i Boil¢[ ; � � 1 '� 9 V . t ! � ; � 1
I / 9 G' ( i f'��.- APPlimtion Issued BY "Dete --=1r���
Iemployeas, provitletl that such'�improvements are;mt intentletl or offeretl for . ❑0-100,OOOBTU ❑700,OOOBTU� �'i'• � � � ; .
sale. If howeveq the builtlln or Im rovement Is solG within one' earrof <om- i ' Duct -� UnderiGround ; I� i , � , � � '� , , � �
; pletion, the owner�will have the burCan ot proving he/sha tl(tl not builtl or Im- ' � . ; � ' � � � I � � ; � ! j SUi MARV OF FEES � � , 1 : � '
��ovetoLthepurposeof�sale)t � ; . j :� � ; . Duct-Structural . � SystemRepair/Alteiation ; �BUILDINGPERMIT $, ' • �SMIP � �
LJ I, as owner of the property, am excluzlvely contracting'wltKlicensetl com ♦ - � � . � � �� I � � ;$� � �
�_tractorsto construct.the,project (Section 7044,.Business.anC Professions Cotle: � � Duct - Ventilating__�_� _,'- _� i _�._' _ : � ; i .PLAN CHECK � $� � � PERMIT � ; 1 � 1 ' �
The Contrattor'S Llcense Law does not apply to an owner of property who ' ' - ' ' � ! � � 1 ' � � I
! builtls or im roves t�areon, antl who contracts for such � ��A � �� � � ISSUANCE � $'
p pro7ects with a com � , Exhaust System ❑ Munipie O� � � �I � jPLUMBING � � $' ' I t
i Iractor(5) Iicense pursuant to the Contractor:s Llcenza Law). : . � ; � ; � 1 i , � � ' � � ! �
i � I�am exempt untler 5i ctbi ; ; B. 6 P. C. for this reaion i � Firepl/FaCt. BIt. IC80 # � + � � � � ' PLAN CHECK� � $ � 3 GiADING , '$' �
r - � , � . . '•ELECTflICAL� $ �
�• Date � � ' � Owner � ' � ' ' I Heating�Syst2m & Dutting , � j � � ; . , � � $ � � .
' ` , jPLAN CHECK; $ �� MICROFILM
' 1' �ereby: certlfy-tha[^I� have�reatl^this applicatlon-antl-state ttiat�the above - -�� �0700,000'BTU 0100;OOOBT - - -, , , r
� into�matlon is correct. I agree to comoly with ali dty. antl county ortlinances , � , . ��� i� � ��' ; . I �. .� -�,�$ � TOTALjFEE� J$ i � '
antl state laws relatin9 to Duiltling construction,'anO heraby authorize repre- � � . , - � � � �MECHANICAL ; $ �
' sentatives of .this ItYj to enter pon the above-mentionetl + HOOd�O� T B I ❑; � 1 � t � i ! ; , �
; inspectlon o r o . y . o/operry for �P {- t Reinspection Fee i $15 � i lESS ; ; , (
� 1 r Cano . T� e II ❑% ` 1 i �PLAN CHECK� � $� i ADVANCED�PC '$, i
, SignStura �� � � ' � � � Date� �f���� 3 ' ' : I � . i i � . � � ' . , � � � } � �
, Driver ensa or55 . r Registers � � } i laue Fee. S 3 • . � . � ! ��
( � � . FINAL FEE i $
. . . . . . . . . . . . . � �
i � . ! .
" _- "' _.. ._ "__'_'_" _" ' _' .'_ _' " _ __ - � . . _ _ _' __ - . ' . . . .
CMF 0865-46 rev. 12/82 Whita - Bulltling; Canary - Appllcant; Pink - Accounting; Goltlenrotl -Assessor
�
CITV�OF COSTA MESA
CONSTRUCTION PERMIT
kddress
ill in all s
MIT NO.
_yc
No.
witnin �eavr �ortlar lines anC sign all
TVPE OF CONSTR
�NEW ❑ AOD
❑ REPAIR �I
❑ OTHER �
K
rwress - � � - � - � -
Contracto - � Phone 1 7ypE OF PERMIT . " - � , -
� AddIMS � �. . ❑ GRADING ❑ FOUNDATION--O STRUCTURAL
�LICENSED CONTRACTOR DECLARATION - � TENANT ❑ ELECTRICAL ❑VLUMBING-OMECHAN
;1 hereby a/firm In:.t I am Iicaniatl untler provislons of Cnartar 9(com- �• � � .
mencing wilh seclion 7000��o/'Dlvision 3-of the Buzinezz antl ❑OTHER
�Professions Cotla, �a my Ilcensa is In �ull for antl �.�• pROJECT ESCRIPTION _
'Litens �C�las�s�,� � � � - enie No. , ' .' - ' "
�Date-JT�- 519nature . -- . �SQ. �. ' '. ' . �
V��/�'P1��0.KER5' COMVENSATION DECLARATION. . OCCUPANCV cry�71 STRUCTION TVPE �_ �
?"�iW:`lcaterofrWorkeri'hComPensaUon�InsuraP�ae�orta a4rtN{etlewPY . VAWATION ' w�_ZONE .' _'.-.�
�"': eof (Se�IjoQ-.j9pp ��,. C.�mpanY GRADING CU. VDS. ACRES
'vaucv t�o.L> K�d /`1 �.� — - - -'- - - - - - —
,� Gerlltietl copy.is�hereby (umishetl. _ . _ _ _ . _ REMARKS: � ,�•� _
'.� Certifietl cOpy is�111etl with the Nty Builtlin9 DivlSiOn. �
EXEMPTION FROM WORKERS"COMPENSATION'DECLARATION - ---- - - --
(This section neetl nol be completetl if the pe�mit I5 tar one buntlretl _ �
SE3001 or less). � - . � � � ' - ' " " ' � '
certtry thdt in th¢ performance of t�e work tor w�lth this permit is
'Issuatl, I shall not-amploy any person in any Ynannar so as lo become VWMBING PLAN CHECK '
SubjBCt tolhe Worker5' Compensation.l,aws of G�Hornia. ' . "' ' �� '
''Date Si9nature BATHTUBS-' - ' -"'SHOWERS'
MOTICE: H after making thB decl6rallon, yoV snoultl bOCOTe subj¢ct ��TOILETS • � • ,��URINACS' -
�to the Workers' Compensation provi5ioni of tne Labor CoOe; you muzt - - -
torlhwith tomply wlth suth provislons or tnis Permit 5ha11 be tleemetl LAVATORIES DOUBLE LAVS -�
�ravokCtl._. _ . -_ - - -- - KIT.-SINKS '" DISHWASHERS
�CONSTRUCTION LENOING AGENCV �
,I heroby aHirm.that there 15 a conslructlon leqtling a9enty tor th¢ per SERVICE SINKS . � �, SUMPS '' -
'formance o7�the`work�tor which thlt permitj�s issuetl (Sectlon 3097 - � � � • • =
!Civ: C.). - - l�\�,�s - - - ' � � ,- -` ° 1' FLOOR SINKS � ' � FCOOR DR'AINS `'
.Lentler'S NamG fV
�Lontler's Atltlress � DRINKING'FOUNTAINS' � -'
OWNER'BUILDER OECLARATION --INTERCEPTORS CLARIFIERS � _�
I heraby aftirm thae I am oxempl Irom thn Contra<tor'S Licenso Lnw lor _
lhe-lollowln9 r0azon (Section 7031-.5 Bu5ine54 antl-Pro/esslon5 Cotlo: �SWIMMiNp POOC - P'TRAP - --'
'Any City or county whiGh requirCs a perrq�< <O COnSlru<l, alt¢r, --
Improve, tlemolish or repair-any structwe, prio� lo its Issuance, also ra- yyqTER SERV ICE ' ACTERATION' '
qy,4.,1(i^,S tne ap4���ni tor such pormit to tilo a� si9�ati itatam¢nl that ha _ .
pf,„y:r,y�setl purzuant to the� provislons ot the CPntractor's Llcanfe Law ' GAS SERV ICE � OUTLETS �
cr 9(commencing with Section 7000) OI DlviSion 3 OI th0
�n'�ss anA�Aofes5ion5 COtla) or thal he i5 axempt thertirom antl Ihe �yyqTER HEATERS" '-' BTU OVTPUT
basis lor thc alle9etl exemptlon. Any vlolatioP o( Settlon ]031.5 by
any appllcanbb� a De�mll SUDjocls� Ihe appl�cant to a Clvil penelly '$EWER CONNECTIONS" � �"'
of nol more than Iive huntlrGtl t1011ars (E500). ��
,�'I; ss ownar ol Iho-Oroporry, Or'my employeo5 with wage5 ai lhelr SOIAR TANK �COLLECTORS '-
SOIe_compenwllon, wlll tlo the wo�k, antl [he 4�ructure Is not Intentletl
or oflerotl lor salc. (Section 7044, Buslness antl Aofessions Cotlu: T�a �- SOLAR PIPING�SVS. -� - -
�,
�Contractor's License Law tloes not apply, to ?� owner oi a properry
who bWltls or Improves ther¢on, dntl who tloCs such work hlmsell or � ISSVE FEE �� � � �"-""'
through his own amployecz, provltletl t�at such Improvements are not
intentletl or oflcretl lor sale. II',-howevei, th6 builtling o� ImprovemenC MECHANICAL PLAN CHECK
is Soltl wilhin one ycar ol COMplOtlon, tho Owqcr will hdv0 lha burtlen
oi proving be -tlitl not Duild or improve !o� Mo purpose of sale)C ryEATING SVSTEM 0-100,000 BTU
.� I, as ownor -oD tna proporty, am oxcluf��oly-.contracting.with �qND DVCTING " •�
Iltensetl conVactors lo construct lhe projBct I�ction 7044, Business ]00,000 � BTU
entl ProleSsiore�Cotla: The Con(ractor'z Llcansa Ww tloes nol appry to
an owner ot properly who builtls or Improves �h¢r¢on, and who con- REFRIGERATION Od00,000 BTV
tracts from-sucb.projacts witb a conUactor�5)-Ilwsnetl.pursuant to SVSTEM � - I. -- �
the ConVa<[or's Licenso law�. 300,000�$TU
❑ I am exempt'untlor Setllon ' - B. & P. C. lor lhis BOI LERS BTU
reason - - - - ' - .
� � SVSTEM REVAIR,ALTERATION
Date Owner
I h¢r¢by C¢r[ilytha[ I �ave rea� Ihis application antl Stdle tlta[ Ih¢ abovc EXHAUST $VSTEM MVLTIPLE
InformaUon-IS cOrr¢ct. I agree Co COmpIY with ali City antl Counly .
brtlinanCeS antl state laws �elating to cOnStructian, and hereby au[hOrizO �.
repre5ehtat s f't�ls city to enter upon the above'mentionetl ;�
prop¢rty lo � 5� U� n urposes. -
Slgnature � Date �SSUE-FEE � - --U .. _.
Drivers' License or 55 �
CMF 0865-46 White-Builtling; Canary-AppliGant; Pink-Accounting; Goltlenrotl-Assessor
ZI
A.P. � 41 S •
ZONE T�n/'
REAR VARD (TO i
' GKG. SPACE RE�.
� STREET WIDTH
-" �20NING'APP0.0VF
� -SPECIAL CONDITI
I
6083. 8/a6/82
PLNG.REF.
203.30 7L
IE
PROVIDED
PARK FEES
ELECTRICAL -' " " P�AN'CHECK�
50. FT. .. _ - 5(1 FL �. �. .
GENERATOR - Od KW_1d0 KW _
TRANSFORMER
APPIIANCE' 30-SO�KW_50 t KW _
MOTORS-- ' ' OQ HP_1-10 HP '_
pNG SOLAR� 30-SO��HP=- 50 + HP _
-GAS TUBE SIC
, POIE l'IGHTS
�
�
fPOLES T METERED � SUB -
iPANELS ' - -- MAW -- SUB - � _
'�SERVICE ' ' � � AMP -
_.. _ �._ . .. _ ._. — --i
�
_ "�. "' " ' ' " . 1
Y' _. ' .. _ _ t
'� ISSVEFEE ' ^ - - �-+
- APPLICATION HPPROVED BV � -DATE - �2,
SUMMARV OF FEES � - � �
'�BUILDING �� �
PERMIT S I2-2 �.D SMIP . b.� �_C�- �
�PLAN CMECK _S�Z PERMIT �
ISSUANCE E
iPLVMBING S � ��i �
P�AN CHECK §� � - GRADING_ E"�' fr,
' � ,1� ,'?+.
iELECTRICAL $ '- ' --' , S ^ -�
' ' MICROFILM E " �'� �
'PLAN�CHECK § -
� TOTAL•FEE �q�,Q � �
MECHAMCAL E' � -' �"✓-�'- �
� ' " ' LE55 AD- �- - ' •
� PLAN CMECK y- ' VANCE PC 'E _
j ` , . . . . � . . � '
1 �}
_. ` _` � . _ , FINAL�FEE.S_�a�7�
CONSTRUCTION AND PLANNING POOL & SPA ' ' ._ '. � � . �
Date Inspector " , � - � ' - Date Inspectai �
APPROVqLS Permit # � APPROVALS � _ Permit # �
1. Temporary Electrical Service or Pole 43. .Pool & Equipment Location ' � - -- �
2. _ Soil ipe-Undrgm -� 44. Steei Reinforcement' - � - - � • - - - � -
.3. Electrical Conduit Utility-UndFgrn � . 45. Forms - � • - � - - �
. A._ .Electrical ConduirUndrgrn �• " "� 46. �. Electrical Bonding �- - � � " --
. tee em orce 47. Rough'Plumbin & Pressure Test � - - - - - - � '�
6. Electrical UFER,Grn . l� . - � 48. APPROVAL70 COVER-GUNITE � - � � '�'
7.. ootings. '- � 49. Electrical Conduit-Undr m �� � ��
_ 8. .Foundation . ' 50. , Gas Pi e, ❑ Undr rn, Test � � �
9. _Water.Pipe-Undrgm _ ' " 51. Backwash Lines P-Tra ❑ �ndr rn' '" - - M1
10. Structural Floor SYstem � �52. •��APRROVALTO DECK � - -"' � - - " �
`- 11:1�_ Property SeweP'Line &'House Connection _ .53. Backwash & Rece tor-Final • ' � � ' � � '
_12. . Street Sewer Connection - ' " - - � � 54. Heater & Vent-Final ' ' �
.13. Rough Plumbing - • � ' " . . • ' . ' _ . ...
� 14. Rough ElectricConduit - ' - ' "'- ' �56. Electrical-Final � �
15. Rough Electric-Wiring - - 57. Solar System-Final- � ' ' ' "
76. Rough Heating & Air Conditioning - - -� - � encing & Access Approval -
' 77. Ducts in Structure " APPROVED FOR PLASTERING . � - ��
- 18. Ducts,Ventilating-� - - � ' "' - _. _ �. � _ ._ . .
79. Gas Pipe-Rough &Test p ' . ._ 60. POOUSPA SYSTEM$ FINAt`� � � � • �'
- 20: -Roof Framing " � - - - ' - � � � � ' � ' - '
21 �. Roof Sheathin -" ' - � - - � � ' � ' � ��
i, . �
� 22. Frame�and Flashin ,p. cSt � �. / NOTES: ' "
23. Insulation - -/� t e -� - � � - � � ��
. 24. Lathing & Siding - � - - � - - -- � - - - - - - -. _ . .
25: Drywall Nailing /C Sc ^;,. - $ ,Q�j ' ' � ' � � - •
� 26: Plaster Brown Coat � - ' � � � � �
27. - Electrical Power MeterFinal- � - � " ' � � -- �
. 28. -Final Electric- � - - - � � � • ' ' ' � �
• 29. Final Heating & Air Conditioning _ - - - - � � - � ' � - � - ,
� 30. Final-Gas Pipe-Test � - - " � � - � -
31. Fin�l'plumbing � � � ' -
' 32. Water Service-Final � - - - - - ' � � ' ' ' ' ' � � � �
� 33. Gas Service-Final � ' � � �' � � ' � �
� 34. Soler pomestic'-Final'� ' ' " - � � �
' 35. L.andsca e S rinklin S stem' ` � ' � � ' � � � ' "
, 36. Sound At[enuation � � � ' � - ' � � ` ��
� 37. Handicap Regulations � ' � � � �
� 38. FINALSTRUCTURE&BUILDING /0 ' • � �
• 39. Special Requirements Completed ' � �
; .40. Electric Release to Edison ' -
� 41. Gas Release to Southern California Gas Co. ' ��.� •
� 42. CEpTIFICATE OF OCCUPANCY /���� � �- , , � ,
��.. r'vo. 3333 Date L��'� C�
�
, �
' APPlicant to flll In all
., CITY OF COSTA MESA ' veg�pir rvc
1 •EQNSTRUCTION PERMIT t' — L
N' � Prolect Address - - _ � . ^
��
�
Addres
Arch/Eng.
Adiiress -
License'No:
wlthin heavy DorEe� linas antl sign all apOrop�iate Oecla�ations. `
�r- + i,� Y
TRACT NO.' LOT NO. BLDG. NO. '
iU �YPE OF CONSTRUCTION
❑ NEw ❑ ADD � ALTERATION
- ❑ REPAIR��O CONVERSION ODEMOWSH
❑ OTHER � rN/3�'I �� /H/Aav,
DESCRIPTION OF WORK
L . � ZONE
� Contractor � M - ,� • N Phone '� - 7/ �TVPE OF PERMIT � ' � � `
'.�Addre55 - SE7 AC C S .
O WE � / T.di/C � IYA/ .G� f� � ❑ GRADING�y' ❑ FOUNDATION 'O STRUCTURAL 51 VARD -
GCENSED CONTRACTOR'DECLARATION� - ❑TENANT.y��LECTRICAL OPLUMBING OMECHHNICA �"
I bereby affirm thct I am iiconsea unaer provisioni ot Char[er 9(com-' . �$�IDE V
Mencing with sectlon 7000) of OIvi510n '3 O/ the 'Buslness anC ❑ OTHER ' - • - - . - _ _ �GHT
Professions Cotle, antl my Iitense is In tull force antl eHecL ' ' i REARVAR�ITO
PROJECT.DESCRIPTION-
LltenSe pass � � � Licanse No. � �q�� � � � . -• ,i , PKG. SPACE RE�.
Oafe �-�y'.N � 519na[ure SQ1 FT. ` ,� ' ` '"_
WORKERS•COMPENSATION LARATIO� �-�OCCUPANCV_CONSTRUCTIONTVPE
�''hereby aftirm that I have a c rtifitate of consent to self-insura or a yALUATION 20NE
:j6'"rtifiwte -of Workers' Compensatlon Insurance, or�a certifletl topy J ' - -
'�:,�''`iereo( (Secti n 0 Lab. G.)�. t GRADING�CU!VDS. �� ACRES �
�PoIicY No. "d ''v 'ComPanY GOM/NR'ALUiL �'NJO�✓ . . - . _ . _
❑ Certlfietl�coOY'�5 hlreby tumishetl. - - -- -- -- � REMARKS:' � �-� - - . -_ �
�Ce�tifietl cOpy IS filetl witn the city Builtling DiviziOn. _
EXEMVTION FROM WORKERS' COMVENSATION DECLARATION - '� -� " ' ' ` " '
(This� sectlon heetl not.be completeU it Na.permit-is4or one hundretl _ _ . , . , _ . , _ .
(E100) or leul. . . . ' - � - �
1�certi(y thaLin-the pe�to�mance of th¢ work tOcw�lGh this peimii I5 _
Issuetl, I shall not emo�aY any person in any manner so as to become PLUMBING ��-. �. � ;�. PLAN CHECK �
subj¢Cl t0 the�Woike/z'�CompenSdtiOn Ldws of Cal7tornid.- -- --
Date � Signa[ure � BATHTUBS SHOWERS '
NOTICE: Ii after making Ihis tle<laration, you shoultl become'subject TOILETS�^ ,,�,�� ,�•�VRINALS - j
to [he Workers' Compensation provisions of tne Labor Cotle, you must �VATORIES OOUBLE lAVS- �� -' �
forthwitn comply with suth proviiiOns or this pe�mit shall be deemetl �
�evoketl.-- �-- -- --= -•� ' " KIT.SINK$ DISHWASHERS �
CONSTRUCTION LENDING AGENGV - -
Ihe�ebyatti�mthatther¢izatOnstructlOnlentlin9agencyfo�tneper- $ERVICESWK$ '' $VMPS� "
to�mance of the.work fa� which thls permit i5 iiiuetl (Section 309]
C1°• C•�' -' FLOOR SINKS FCOOR DRAINS �
Lentler's Name
Lentler'S Atltlress � � DRINKING FOUNT/iINS ' �' � �
OWNERBUILDERbECLARATION '- - ' `� � INTERCEPTORS CIARIFIERS
I �erebY aHirm thal 1 am azempt trom Me ConbactOr'S Lic¢n5e f2w for
the Pollowing reason (Section ]031.5 Business antl'Professioni Cotle:� SWIMMING�GOOL PTRAP� ���`-�
Any_City o�_ county whiCh r¢quir¢5 a p¢rmil to consVuct, alter,
Improve, tlemolish or repAir any-structuFe, prior [o it5 issuance, also re- yyqTER SGRV ICE ALTERATION � i
2, �Ires ttfe aprli�ant.for'such permit to file a signetl ztatement tM1at he
y;?�,,censetl pursuant to [he pro475ions�ol"the Conl�ac�or�s Citense Law'" GAS SERVICE � OUTLETS _ �,._ ,.__ _
any��appll�Bt !or a pe�mit subjects t�e ap0�«Ent [o d cNli"pendlty' SEWERCONNECTION$ �
of not mOra than five huntlretl tlollar5 (5500). '
❑ I, as owner ol the property, or my amployees with waqes as lheir SOLAR TANK COILECTORS
5010 CompensaUon,�will',tl0-tho work, antl.tne.SVUCture IS not Intendetl. " ,�—
or offered for sale. (Se<tion 7044, Business antl Profeisions Cotle: Tha SOLAR PIPING SVS. ��
Cont�dctor'S License-Law tloes noLappty. t0 an owner ot.a p�operty. .. . . i� ._
wno builtls or improves thereon, antl w�o Uoes such work himself or ISSVE FEE
throu9li-M1is own amployees, pmvi�otl that Su<h improvements arc nol
Inlentletl or olle�ed for zal¢. If, however, th! builtlln9 or Impwvement MECHANICAL PLAN CHECK
is�soltl� within ono.year ot comple[ion, Ihe owner will �ave tne burtlen.
of proving he tlitl not builtl or improve lor lhe purpose of ule�. HEATING SVSTEM Od00,000 BTV
O'I"-as'owner-ot-tne property: am'exclu5ively' contracting with - qND DUCTING "�
licensetl cOntractors to construct ihe proj¢Ct (SettlOn ]044, Bu51ne55 ]00,000;+ BTU
antl"Prote551on5"Cotl¢: T�¢"ConVaC[or'S'Cicense Cawtloesnotapply'to'
an owner of property who builtls or improves lhereon, antl who con- REFRIGERATION 0-100,000 BTV
t�aGts frOm-sucb'pro)etts'wi[h a'wntrattor(5)' IitlSnetl'pu/suaM l0 ' $VSTEM " " - " -' ' -' --
[he ConVacior's LJcense law). 300,000,+BTU
❑ I am exempt untler Section - �� � B. 6 P. C. tor tnis � BOILERS BTU
rea3on ' ' - "" ' ' ' - ` '
� SYSTEM REPAIR,ALTERATION
Date - Owner- - - - -
I.h¢r¢by C¢rtify [hdt I.hav¢ reatl tltis appliWtion an45tate that the dbovG EXHAUST SVSTEM MUl
Mformation is correcQ I agree to comply with all tity antl county
brtlinances.ane state laws relating to construction, antl hereby,authorize
representative5 ot this city [o enter upon the above mentionetl
property_ta .ins ction r0o .._ _ .. o /y=�� ��
Signa[ura Date p
Dtivers' ' nse or 55 �SSUE FEE -" '
CMF 0865-•16 White-Bui�tling; Gnary-ApP����t; Rnk-Acwunting; GOIEenrotl-Assessor
6390_ 8/�9/g2
R
STREET WIDTH PARK'FEE E
ZONING APPROVED BV - DATE
.: i�
SPECIAL CONDITIONS: � . �
�
. � i.
�ELECTRICAL PLAN CHECK � � � � , ,
' �GENERATOR'" 0-1 KW_1-lO�KVJ „1� �
TRANSFORMER `:�
APPLIANCE 30-50'KW_SO+KW. ' - -
1
MOTORS A�C- 0-1 HP_1-lO�HP -' ' " " ,� "��
- (INC: SOLAR) " ]0-50 HP=50 � HP � D� � i
'FIXTURES OUTLETS� SWITCHES
' GASTUBE'SIGNS-� - "'- -' ''- A
��POLE LIGHTS' - "" ' " ' - . �, "'t
. _ 1
:POLES METERED SUB
�PANELS��� - -MAIN " SUB,�, �, , t O j
� .SERVICE' "' "" AMP -'CM"
� __ ' ' "" " _ " ' _' �_ "i
_ '. _ .�- `.� _ ' ' ' '_ ''_ , . , ' ' _ ;',..
' _ ' _ " _ ' _ ' . 1.. ' _ - � f
�� ISSUE FEE" " " -- - ' ' '�
'APPCICATION APPROVED BV ' ' /'DATE - '�
. SUMMARYOF,FEES ,� ��'
BVIIDING"'" ' " -- - ' ' " ' I
_ 1PERMIT _ _ E _ _,y-_ SMIPs� i •E� �
'PLAN CHECK S 'PERMIT '
' ISSVANCE- E -' '
�PLVMBING ^f_- _ '_' Tr - . ' �
- GRADING S�
�PLANCHECK �S'�� � �_ �� j ''7! `�' 1 . . �
•ELECTRICAL §� .�a ' . s -
;.MICROFILM E -
PLAN CHECK� y � "� ' . . , � ' �
MECHANICAL E �� ; i � 1-�- -TOTAL�FEE 5� �� � �
PLAN'CHECK -S " - - "LESSAD- ,. _
� VANCE PC E _
' • � ., � ' . � 1
. , -FINAL FEE S _
�
:■
,.
CONSTRUCTION AND PLANNING POOL & SPA . . , �
� /�SS Date Inspector ' - . �r,, , _ Date, -� Inspector' '
APPROVALS Permit # APPROVALS 'a „Permit�.#��� � �- �_ > ��
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location - -•-� � �
2. Soi ipe-Undrgrn " " , � _,...� . -,�,�� , - 44. ,Steel•Reinforcement- - - - ,
. 3. Electrical Conduit Utility-Undrgrn 45. Forms '-
4. Electrical Conduit-Undrgrn - � 46. Electrical Bonding '
tee ein orce - 47. Rough Plumbin '& Pressure•Test _
6. Electrical UFER Grn 48. � APPROVAL TO COVER-GUNITE �' ' ` •
7, ootings � '' 49. Electrical Conduit-Undr m �� - -� �
. 8. Foundation ' � 50. ..Gas P.i e, ❑ Undr m Test ' '
9.. Water Pipe-Undrgm 51. Backwash Lines P-Tra 0� ndr r ��
, 10. Structural Floor SYstem 52. APPROVALTO DECK � " " �` � ' - � - � � • '
�' 11. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final
12. Street Sewer Connection � � ' ' � _ 54. Heater & Vent•Final - '
13. Rough Plumbing ' - �� " ' � - � •
14. Rough ElectricConduit - � - • `56� Electrical•Final � -� .
� /5. Rou h Electric-Wiring � � ' � ' - - - 57. Solar..System-Final ' '
16. Rough Heating�& AirConditioning. - • encing & Access Approval '
-. 1.7.. Ducts' in Structure_ APPROVED FOR PLASTERING '
78.� Ducts, Ventilating • - - ' ' • _ _ , . . .
. 19. Gas Pipe•Rough &Test �- �� 60.. POOUSPA SYSTEMS FINAL - _ -
20.. Roof Framing -- ' ' ' ' � '
21. . Roof Sheathin � � -- � " � ' . _ . � � - . � . _
� 22. Prame and Flashin � - � . �
NOTES: ' •� '
� 23: Insulation '�� - ' "` � �'� '
' 24. Lathin & Siding ' ' � � ' - - _
' 25. Drywall Nailing - - - .- - -- , -- - . - . . .. . � �`
' �26: Plaster Brown Coat - � - � � � -
.. 27: Electrical Power Meter-Final ' � G � - ' • � ��� �
. 28. - �Final Electric� L. '
29:�._ Final'Heating..& Air Conditioning � � �� � -
30. final Gas Pipe-Test � ' � � '
31.. Final Plumbing ' � - ' ' -
32.. Water Secvice-Final ' ' - ' � � ' '
� 33. ��Gas Service-Final � � � ' ' � � �
34. Solar pomesticFinal •� - ' • � � ' ' '
' 35. Landsra e S rinklin S stem � '� �� � � - ' '
36. Sound Attenuation ' � - � � �
, 37. Handicap Regula[ions � � � � e � � �
� 36. FINAL STRUCTURE & BUI LDING " � � - -
39. Special Requirements Completed" � ' - � � - ' ' ' ' '
� 40. Electric Release to Edison - �/ L '� � -'-"'
� 41. Gas Release to Southern California Gas Co. �
- � �
: 42. CERTIFICATE OF OCCUPANCY .
� . 1 ^ �
. • � No Date - - � r . _�.�_ _
`d '� ,1.�- - -
. � - I . '.�,�'t.e-, _ I �
� CITY OF COSTA MESA
�CONSTRUCTION PER
� . Project Address '
Owner - �; S
� ,`Addrew - �- - ' - -
� � Arch/Eng.
t Address " '
AVPlicant to flll in all soaces within neavy Cortler Ilnez antl slgn all aporopriate aeclantions.
PE�t MIT NO. TRACT NO. LOT NO. BLqG-N O.
MIT f��.Ll�7 � F-
J �HIC /HY'JL! TYPE OF CONSTRUCTION
�'� hone ' ❑ NEVJ ❑ ADO � � ALTERATION ' � n.. �
- ❑ REPAIR ❑ CONVERSION ❑DEMOLISN ��
LiCense NO. ❑ OTHER � � �- � `
� : DESCRIPTIONOFWORK _
� CantrectorD� ��+ � �L ��/jJ Phone�+l/-(>`r TVPE,OF PERMIT � � - `
\ ' Address Z p �� A%E ❑ GRADING �,❑ FOUNDATION ❑ STRWCTURAL
,LICENSED�CONTRACTOR DECCARAT.10 ❑ TENANT ❑ ELECTftICAC �PLUMBING OMECHAI
I here0y affirm thct I am Iicansetl untler provislons ot Charter 9(com- � i � �
mencing with �sectlon 7000) of �Divizlon -3 of [he� Business anA ❑ Ol'HER
Professlonz Coae, a censa is In full torc antl elfec
ucense i s- � License`n}p ' PROJECT DESCRIPTION• _� _.
.���o /lYit<C- 1" �5�. FTl . •• • :�
'Date _ � '- ' - -
"'00.KER5'COMPENSATION�DECLARATION -. �'OCCUPAfVCY_CONSTRUCTION_TVPE
iereby atfi�m that I havE d clrtifiWte of Consant to self-InSure o� a VALUATION' � � ZONE
tifiwte of Workers' �Compensatlon Insurance or-a �certltletl copy. . .
A.P. 5
ZONE
A�,.'�, 61,92 8/ 1 7/82 . 2A.00 TL
" . _ - _ ' � 1 ' " ` ..; __
' 20NING REGULATIONS -- � -
' ' ' - - PLNTGp. RUEFL. p�� -' --- � '
CK LST. PROPE�RTV LINE� � ' �
'ARD ' - � � - - _ _
�
iq . .. . . - . .. . .
REAR VARD (TO P/L)
PKG.SPACE�REQ. �'
.nereot(Seyti},ryjeR�y� .S7"AiF-C'.o�il� GRADINGCV:VOS. ' �� ACRES SPECIALCONDITIONS:
PoII<Y No. �/Y(J omPanY ' -' " " -' � - - "-
��.Certifietl.coPY..iS.h¢rebY fumi5hetl. . . ' _ _ "' " REMARKS: - , -�\ `� -, i '� V \+� �.
'�� CertlfleC cOpy is tiletl wi[h th¢ City Builtlin9 Divizion.
EXEMPTION�FROM WORKERS' COMPENSATION DECLARATION "- ' - ' "' ' - ' �- ' - -
�(This sectlon.neetl mt be completetl if the permit Is for one huntlretl _ _ 3
'(5300) or leul. 1 '' " ' '.,� .� ". --" -
J.C¢rtlfy that.in the perfOrmance Ot th¢ work for which this permit is
Issuetl, 1 shall not emPloy any per5on In any manner so as to become PLUMBING �i,PLAN CHECK ' -' ' -
subject to the Workers_Compensation Laws ot Calitornia. � • - '
� .BATHTUBS � SHOWERS ' - -" -'"
-,Date Signature
NOTIGE: It after making [his tleclara[ion, you sboultl become suD�ect TOILETS �i• URINALS -' ' 0
to the Workers' Compensation pro'visionz of the Labor Cotle, you mu5t �� � �
forlhwith comply with such provisions or this permit snall be tleemetl �VATORIES �OUBLE LAVS '� Q
48voketl. . _. . .
CONSTRUCTIONLENDINGAGENCV � -KIT.SINKS' ' " "DISHWASNERS' '
I hereby affirm that there is a constructlon lentling agency tor the per SERVICE SINKS ; SUMPS ' -
forman<e of `the work tor.whith thi5 per,mlt i5 155uatl,(Section�3097 � � '��
Civ.-C.�. ' - ' ' ' ' "'�G � ' - FLOOR SINI(5 � �' FLOOR DRAINS "' "! " "'
;L:enderfs Name� � • t �� � • �� `
�Lender'S Atltlress + � DRINKING FOVNTAINS' ' '- ' '
�OWNER BUItDER'DECLARATION-'- - ' ' ' INTERCEPTORS �- � CLARIFIERS '
I tleraby aflirm l�at 1 am exempt from Iho ConlracfOr'S LiCanSe Law lor _
.rsuant [o tbe provlsion
commencing with Sec
RWessions'Cotle) or tY
alle9ea=exemption. Ar
: - tor •a- permit' subject
lnan five huntlretl tloll
er ot the property,�or-
ation, will_Go the work
' sale. (Section ]044, �E
License Law tloes not
r improves the�eon, a�
�wn ¢mPlOyees, provitle
iferea for sale. Ii, how
.one year ol com0letio
e tlitl not builtl or ii
a
s ot'[he Contracto�'sLicense Law
tlon �000) of Divislon 3 of tbe
at he iz ¢xEmpbtherefrom antl th¢
y violation of Section 7031.5 by
� tne'applicant-to�a-civil penalty
3rs (E500). -
my employees wlth wages a5 th¢Ir
, ana the structure is not intentletl
u5ine55 and Profe551on5 Cotle: The
apply t0 an owner_ ot a property
0 who tloes such work tiimself or
tl that such improvem¢n[s are not
ever, [he builtlinq o� improvertien[
n, the owner will have the burtlen
nprove fo� [he putpose ot 551e).
am-exclusivelv contrattino with
an owner o/ proper[y wh0 builtls or imp�ove5 the�eon, antl who con-
[�ac�s from- suth� projecis wil� a�contractor(5) IlceSnBtl-pur5uan[ to
the ContraClot'S LlcenSe Law�.
� I am exempCuntler'Section '" "'B. &'P. C: tor this
1
reason
Oate Owner
1 hOrEby terlifythat I_M1ave read [nis appli<alion antl State that [he abOve
Informatlon is mrrecL 1 agree to comply with all city antl counry'
brtlinances antl state laws relatin9 to consttuctlon. antl hetebY autho�iie
SWIMMINGPOOL � 'PTRAP ^ ' " '
WATE - � ATION' - ' '
ASSE0.V1'CE UTLETS - - � -'
ERS �'" BTU OUTPUT ' '/
SEWER CONNECTI
SOL'AR'TANK" '
io�uc rtt
MECHANICAL PLAN CHECK
HEATING SYSTEM 0-300,000 BTU_
AND DUCTING ' ' • "" �
300,000'+ BTV _
REFRIGERATION 0-300,000 BTU_
$YSTEM 100,000 + BTU _
BOILERS BTV
SVSTEM REPAIR,ALTERATION
EXHAUST SYSTEM MULTIPLE
property for i ctlon pyrpos . �/
Signature a
Drivers' License o 55 - � ' ISSUE FEE
CMF 0865-46 White-Builtlin9; Gnary-Applicant; Pink-Accounting: Goltlenrotl-Assessor
�
PROVIDED_,'
PARK FEE $ ; "�
' � oaTE •� � '- �
' Y, " I y
� "' " " " '' ' ' " i
�ELECTRICAL � -PLanrCr�ECK. - I-�-
i50. FT.•••V . . . . - - ' ' -
'GENERATOR '--0-1KW_1-lOKW '
ITRHNSFORMER - � � i . �'
APPL'IHNCE '�30-50KW_SO�+KW_
1
,MOTORS' - 0-1 HP_1d0 HP - -
•pNC.50LAR) _ 30-SOHP=-.SO+HP
`FIXTVRES ' 'OUTLETS SWITCHES � �
I
� GAS TUB&SIGNS `-• •-' � � i
POLE LIGHTS "- " � - - • � - - �
POl.ES METERED� 5 B -
�PHNEL$"� -"' ' MAIN '- - "SUB -__ ....
,SERVICB-' ---- -- - -AMP
_- " "' _' ' "' " ' . _ . .. - .l
>_._ ' '
ISSUE'FEE ' --- -"' "-' - -� - - _— ^- �
�
''APPI'ICATION�APPROVED BV- - � - ��DATE —
SUMMARV OF.FEES ., � �y.
BUI�DING -� • - - -- -- — _
PERMIT S . , SMIP,�. ,i,-E ^
�PLANCHECK $� �PERMIT. � � '
-ISSUANCE� $� ''�'�
�PLVMBING `A� .
-PLP,NCFIECK iy .-� -�GRADING��$�'�'��
ECECTRICAL E� � " - �$ 1
' , 'MICROF117N� E � �
• PLAN CHECK - § - � �. � - -
' � TOTAL FEE E �
+MECHHNICHL S �
� PLAN CHECK E � � LE55 AD- • � :
" ' VANCEPC $_
! � , FINAL FEE Seq.���
CONSTRUCTION AND PLANNINQG,'�,1�I POOL & SP� . ..
APPROVALS Permit #�_ Date Inspector qppROVALS .. Permit # "• -- Date- Inspector
1. Temporary Electrical Service or Pole � 43. Pool & Equipment Location • -
Soi �pe-Un rgrn ' B�o �;d 44• Steel Reinforcement
3. Electrical Conduit Utility-Undrgrn 45. Forms
4. Electrical ConduitUndrgrn 46. Electricat Bonding � -
tee e�n orce 47. Rou h Plumbin & Pressure Tesr -
6. Electrical UFER Grn - 48. APPROVALTO 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-Tra -� � ndr rn ' �
10. Structural Floor System � 52. . APPROVALTO DECK ' "'
11. Property Sewer Line & House Corinection 53. Backwash & Rece tor-Final �
.12.- �Street Sewer Connection . � ' - 54. Heater & Vent-Final
13. . Rough Plumbing . .8 �O P1 " ' -
14. Rough ElectrioConduit ' ' ' - � �56. Electrial-Pinal - �
15. Rough Electric-Wiring - - -� 57. Solar System-FinaV - �
16. Rough Heating & Air Conditioning - - - � encing &-Access Approval �• �
� 17: -Ducts in Structure�• '- APPROVED FOR PLASTERING '
18: �Ducts, Ventilating �- . ' - .
� 19: Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL� - ��
20.- Roof Framing - i � '
21. Roof Sheathin � .- �
NOTES: �
22: Frame and Flashin � � / ��
23. Insulation - � - y,L
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 lr 47 � ' ' �
, 32. Water Service-Final �- � - '
33. Gas Service-Final - - - �
, 34. Solar pomestic-Final � ' � ' ' ' � �� � '
35. Landsca e S rinklin S stem '
36. Sound Attenuation � �
37. Handicap Regulations - - �
38. FINAL STRUCTURE & BUI�DING • �
' 39. Special Requirements Completed � ' � �
- 40. Electric Release to Edison � - �
47. Gas Release to Southern California Gas Co. �
42. CERTIFICATE OF OCCUPANCY '
No Date
;�\ Appltcant to fill In all s0ac
,;:�OF COSTA MESA vgRp�� No.;/
C NSTRUCTION PERMIT M 5`c
ProlectAddress 3555 Harbor Gateway
Owner!`7 Co,-..o�rrnm F_ Cnn Phone
�
heavy borGer lines anC sign all app�opriala Eeclarations.
"- TRACT NO. LOT NO. � BLDG. �.�
O.' TYPE OF CONSTRUCTION
� ❑ NEW �DD ❑ ALTERATION
gC�j ❑ REPA R ❑ CONVERSION ❑DEMOLISH
❑ OTHER
DESCRIPTION OF WORK
�, coot.acco.Dial-A-Tem Inc. rna�630-666 .TvaeoFveaMir
naa���126 Fountain ti�1 Anaheim _ ❑cRno�Nc ❑ FOUNDATION ❑ST
LICENSEO CONTRACTOR DECLARATION O TENANT ❑ ELEGTRICAL ❑PLUMBIN(
I hereby afflrm lhat I am Ilcensetl untler provlsions ot Charter 9(com- ,
mencing wlth settlon 7000) "of Dlvislon 3 of the Buslness antl ❑ OTHER
Protessions Cotla, antl my licenze is In /ull tor antl effect. � pROJECT DESCRIPTION
Litense Clau C- Z � Llcense No?3164Q
Date Si9na(ure � SQ. FT.
W^QKERS' COMPENSATION �ECLARATION � OCCUPANCV_CONSTRV TION TVPE
eby a/firm that I have a certificata of tonsent to self-insure or a VALVATION E
Iwte o/ Workers' Compensation Insuranca, or a certlfie0 copy
tn��eof (Section 380p Lab. C.). GRAD�NG CU. VDS. ACRES _
aon�yrvoRT-fl"{fi'94 comoa�vnial-A-Tem�_ - -
❑ Carti(Ie0 <opy is hareby furnizhetl. �� � - REMARKS:
�' Certifletl copy 15/lletl wtth the city BuilGing Divlslon.
EXEMPTION FROM WORKERS' COMPENSATION�DECLARATION
(Thls sectlon neetl not be completetl if the permit Is for one nuntlretl. _
�E1001 or less). ' -
cert(ry that in tne parformance of [he work for whlch this permlt is
4 Issuetl, I shall not employ any perion in any manner so as to becoma P.LUMBING PLAN CHECK
subject to Ihe Workers' Compensatlon Laws of Callfornia.
�Date ' Si9natura BATHTUBS SHOWERS
NOTICE: If after making this declaratlon, you shoultl become subject TOILETS URINALS
to the Workers' Companzafion provisions of the Labor Cotle, you mus[
forthwith comply wlth such provislons or this permit shall be tleemetl LAVATORIES DOUBLE�LAVS
� revaketl. ' � KIT.SINKS � DISHWASHERS'
CONSTRUCTION LENDING AGENCV
� I hereby affirm tha[ there Is a conztruttion lentling agency for the per- SERVICE SINKS SVMPS
S formanCe Of the work tor which this permit it ISSUBtl (SeCtion 3097 _
Civ. C.)._ �� ,�,FLOOR SINKS FLOOR �RAINS
a Lentler'S Name �` " �
�" Lentler'S Atltlress - � - DRINKING FOVNTAINS
4 � OWNER BUILDER.DECLARATION ' INTERCEPTORS CLARIFIERS
� hereby affirm that 1 am exempt trom.tFe;Contractor'rLicenSe.Law for -
�tne tollowing reason (Section 7031.5 8u5�ness an0' Piofesslons Cotle: SWIMMING POOL P TRAP
Any tity or county,wnlcn requlres.a'permlt to construct,.alter; - �
Improve, tlamollsh or repair any structure, prior to Its 6suance, also re- yyqTER SERVICE ALTERATION
� -es the applicanl !or such permit to fila a sl9netl statement tha[ he
:ensetl pursuant to tne provisions of the Contractor'S License Law GAS SERV ICE OUTLETS
apter 9(commencing with Section 7000) at DlviSion 3 ot tha
buslness antl Prolession5 Cotle) br that he I5 exempt fherefrom antl the' y,rqTER HEP.TERS BTU OUTPUT '�
�.ba51s for the alle9etl exemptlon. Any violation ot Sectlon �031.5_by ��-�-
any appliwnt for a permit-subjects'the"Sppliwnt to a civil penalty � SEWER CONNECTIONS q -�
ot not mOrE tM1an iive huntl�etl tlolla(5 (5500).
3 ❑ I, as owner of the property, or my employees wifh wages as their SOLAR TANK COLLECTORS
sole tompensation, wlll tlo the work, antl the structure Is nobintentletl
Q or offeretl for sale. (Sectlon 7044, Business and Professlons Cotle: The SOLAR PIPING SYS.
Contractor's LI<ense- l.aw-tloes not apply to an owner of a.property . .
� � who builtls or Imoroves [hereon. antl who tloes such work himselt or ISSUE FEE
Intendetl or offeretl �or sale. If, however, tne bWltllp9 Or Imp�ovemeni
I5 soltl withln one year of completion, Ihe owner wlll have.the burtlen
ot proving he tlitl no[ builtl or improve for the purpose ot sale).
❑ I, as bwner of t�e property; am exclusively conlrattlng wi[n
�IICGn58tl cOntrdt[O/5 to conStNct [Fle prO�ac[ ($action ]044, Business
antl Protes5ion5 Cotle: The Contractor'S License Law tloes noi apply to
an awner ot property wno builtls or improves Ihereon, antl who con-
�tracts from such pro)ect5 with- a contrattor(s) Ilcesnetl pursuant to
the ConVacror's Llcense Law).
❑ I am exempt untler Sectlon B. 3 P. C. for this
reason ' �
• Date " Owner - � -
I hBr¢by Certify thdt I have reaE thii application antl State that [he dbove
informat" orrec I aqree to comply with all city antl county
brtlinan es an s a I' g to consVuc[ion, antl hareby authorize
represen to enter upon the above entlonetl
pro erty- nspect ose5. D3/ y�
gnat Date � �
MECHANICAL PLAN CHECK
HEATING SVSTEM 0-300,000 BTU1
AND DUCTING 300,000 + BTU _
REFRIGERATION 0-100,000 BTU
SYSTEM 100,000 + BTU _
BOILERS BTU
SVSTEM REPAIR,ALTERATION
EXHAUST SYSTEM MULTIPLE
Driver Cense or 55 / ISSUE FEE
CMF 0865-46 White-Builtling; Canary-ApPliwn[; Pink-Accounting; Goltlenrotl-Assessor
ecurity National Bar�1�84 9/01 /B2.
094001-04-2-0372
0
A.P. �
ZONE
REAR VARD (TO P/L)
PKG. SPACE RE�.
STREET WIDTH
SPECIAL
REGULATIONS
PLNTGp. gRUEF�. p�
PROPE�RTV LINE
PROVIDED
PARK FEE $
DATE
ELECTRICAL PLANCHECK.
GENERATOR 0-1 KW_ 1-30 KW _
TRANSFORMER
APPLIANCE '30-SOKW_50+KW_
MOTORS - p-I HP_1-30 HP _
(INC. SOLAR)-• 30-50 HP 50 + HP _
FIXTVRES OUTLETS 'SWITCHES
GAS TUBE SIGNS' - -
POLE LIGHTS -- "� ,
��PANELS � MAIN
ISSUE FEE
APPLICATION
AMP
15.00 TL
OVEDBY -- DATE
SUMMARY OF FEES
BUILDING" - -
PERMIT E SMIP $
PLAN CHECK S � PERMIT � ,
ISSVANCE
PLUMBING S
GRADING S
PLAN CHECK $ . . .
ELECTRICAL E S
PLAN CHECK $ MICROFILM $
MECHANICAL S� tOD TOTALFEE$ � �
PLAN CHECK $ � _LE55 A�-
VANCEPC'$_
,FINAL FEE §�
CONSTRUCTION AND PLANNING � - � POOL & SPA . " '
���/�y� Date Inspector � � � • Date Inspector � }
APPROVALS Permit # -L7-�-'�°-1- APPROVALS Permit #
1. Temporary Electrical Service or Pole ' 43. Pool & Equipment Location
. Soi ipe-Undrgrn 44. Stee� Reinforcement �
3. Electrical Conduit Utility-Undrgrn � 45. Forms -
4. Electrical Conduit-Undrgrn 46. Electrical Bonding �
. tee ein orce ' 47. Rough Plumbin & Pressure Test
6. Electrical UFER Grn _ �, 48. APPROVALTO 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-Tra ❑ Undr rn
10. Structural Floor System 52. APPROVALTO DECK
� 11. Property $ewer Line & House Connection - 53: � Backwash & Rece tor-Final �
�. Street Sewer.Connection � - 54. Heater & Vent-Final
.,i. Rough Plumbing
14. Rough Electric-Conduit �56. Electrical-Final
15. Rough Electric-Wiring ' 57. Solar System-Final •
16. Rough Heating & Air Conditioning • encing & Access ApProval
17. Ducts in Structure APPROVED FOR PLASTERING
18. Ducts, Ventilating
19. Gas Pipe-Rough &Test � 60. POOL/SPA SYSTEMS FINAL '
20. . Roof Framing � �
21. Roof Sheathin .
22. Frame and Flashing NOTES:
23. Insulation �, D 'T ' �' -
24. lathing & Siding � . p.-
25. Drywall Nailing �
- 26. Plaster Brown Coat _ -
27. Electrical Power Meter-Final
?8. Final Electric �
! Final Heating & Air Conditioning Z
S0. Final Gas Pipe-Test
31. Final Plumbing
32. Water Service-Final
33. Gas Service-Final
34. Solar pomestic-Final
35. Landsca e S rinklin S stem '
_36. Sound Attenuation
37. Handicap Regulations - �
38. FINALSTRUCTURE&BUILDING
39. Special Requirements Completed
40. Electric Release to Edison '�, �•
41. Gas Release to Southern Califo?'nia�Gas Co.
42.- CERTIFICATE OF OCCUPANCY
. .
No -- Date . , . . _ . ti.
Aov���ant ta till in all spaces within naavy Doraer Iines ana sign all apPropriate aeclarations.
_ CITY'OF COSTA MESA_ ._ Peam`T JYO/� TRACT NO. LOT NO. BLOGI NO. -' '
, .Lt{NSTRUCTION PERMIT T o ,
.rrojectAdtlress S-�3�3 ARBoR �Ttw� . S TVPEOFCONSTRUCTION � �
' OWnEr Rr Phon2 ' -O NEW ❑ ADD ❑ ALTERATION '
Addre55 � ❑ REPAIR ❑ CONVERSION ❑OEMOLISH
ArchlEng. Licenie No. ❑ oTHER �
Addr¢55 DESCRIPTION OF WORK'
�. Contrector ' � � Phone (a3a �� � TVPE OF PERMIT - " � ' ' ""
AddtCss �/2 -oc�NT- � � /4NA�i / ' � ❑ GRADING� ❑ FOUNDATION � ❑ STf
LICENSED CONTRACTOR DECLARATI � � _Q TENANT ❑ ELECTRICAL OPLUMBING
I heraby affirm that I am Ilcense0 untler provisions ot Charter 9(com-
mencing with sectlon 7000) of Divliitln 3 of [he Business antl _ ��OTHER
Aotezslons Cotle, ana'my'Iicense is' in tull force antl e(fect. _PROJECTDESCRIPTION �
Llc¢yp e Q z G'Z"� �cens�. � �� -
DatQ � Si9natura - ^ � Sq. FT. '• . , ,
4V0 KERS' COMPENSATION DEC ARPTION OCCUPANCV_CONSTRVCTION TVPE
I•'•eby affirm Ihat I have a tertlfitate Ot consent to selt-insure or a�.VALUATION ZONE
< cate oi Worker5' ComD¢�sxtlon InSurance, or a certifietl�copy . .
t ,T (Sectlon 3800, Lab. C.�. "-� GRAOING CU. VDS. ACRES _
Poucy No. Company �-- '
❑ Cartifietl copy ii h¢reby furnl5hatl. REMARKS:
�y}'� Certi(ietl copy'is flletl with the tlty Builtling-Division. -
£%EMPTION FROM WORKERS' COMPBNSATION DECLARATION - - � -• -
(Thls sectlon need not be completotl if the permit I5 for one huntlretl . -� . �-
SE3001 or lessl. . . . . __. - � ' ' -
� certlfy that In Iha performance of�tha Work for which this permit is
. ..7643 9/14/82� �
'_' '. , . , : �, . . .
A.�. 9
ZONE
REAR YARD (TO P/L)
' PKG. SPACE REO.
STREET WIDTH
ZONING APPROVED BV
SPECIAL CONDITIONS:
Itsuetl, I snall not emPloy any person in any manner so as to become �PLUMBING " PLAN'CFIECK '
subjett to Ihe Workers Compen5ation Law6 ot Ullfomia. ' .
Data � - ' S19nzture � � BATHTUBS' ' -SHOWERS �
NOTICE: If alter makin9 this declaration, You shoultl become.subject TOILETS , VRINALS ' �"
to the Workers' Compensation provlsions P� the labor Cotle, You mus[ �
forthwith comply wlth such provislons or this permit snall be tleemetl ^LAVATORIES DOUBLE'LAVS " "�
revoketl. . . ___ ... . . KIT: SINKS- - � ' OISHVJASHERS "'
CONSTRUGTION LENDING FGENCV " ` '
I bereby affirm tnat there is a consVuctlon �entling agency for the per- SERVICE SINKS , SUMPS '' " - �'
formance of the work for whic� tnls permit is iszuetl (Section 3097
Civ. C.). _ __ - .. . __ - - FLOOR SINKS ' ' ' FLOOR'DRAINS � � �� �
Lentler'S �Name
LenCer's Atltlross � - ' ' ' DRINKING FOUNTAINS' ' ' "-' " "' ^'
OWNER BUILDER DECLARATION INTERCEPTORS^ ' CLARIFIERS �
I hereby atfirm thal I am exempt from the Contractor'S License Law tor
t�o followin9 reason (Section 7031.5 Bus��esz antl Professions CoEe: SWIMMING POOL - P TRAP '�' --' •'
Any 'tlty- or 'COunty which reqWres a Pe�mi[ to COnStruCt, alt¢�,
improve, tlemolish or repatr any structure, Prior to its Issuance, also re-. . yyq-�ER SE0.V ICE' - ALTERATION '
qWreS tne appllcant for suGh OermR to fi18 a signetl statement that hG
IS��" 'vsetl purzuan[ to [he provisions ot [pe ConVactor's License Law -GAS SERVICE " '- 'OUTLETS �
(f ar 9' (commencing'with Sectlon 7000) of Division 3 of the '
B :5 antl Pro(e55ion5 Cotle) o� tnal ne is exemp[ [herefrom.antl the . yyqTER HEATERS •• - BTU OUTPVT
baa.. mr-the allegetl exemption. Any violation of $ection 7031.5 by t�.. -
any applirant for a oermit-su��ects the'applicant to a civil'penalty _SEWER CONNECTIONS - � t'�'� "
of not more than five huntlretl tlollars (Eg00).
❑ I, aiowner of lhe property, or.my ert�Ployees�witb wages-as their� SOI:AR TANK� -- - COCLECTORSi'
sOle compensation, will tlo the wOrk, antl the St�uctu�e IS not IntenOetl �
or offeretl for wle..(Settion 7044,-Buzlness antl Aofesslons-Cotle: The• SOLAR PIPING-SVS' '' ' "- - �
Contractor'S License Law tloes not apply to an owner of a property
wh0 builtl5 or imprOves Iher¢on, antl-wh0 tloe5 Such�wo�k himself or ISSUE FEE ' � -
throu9h his own employees, provitlotl [hat such improvements ara nol
intendetl or ofteretl for sale. If, however, Ihe builtlinq or improvemen[ MECHANICAL �� PLAN'CHECK �
is soltl within one year oi completlon, the owner will have the burtlen �
of prOvin9 -he_Ultl .nol Ouiltl or improv6 for the purpose of saIGJ.
❑ I, az owne� of Ihe properly, am e%�luslvely con[�acting with
Iicensetl conVactors to mnsVuct'the'pro7ect'(Sectlon ]044fBUSin¢55
ane Profezsions Cotle: The Contractor's License Law tloes not apply to
an owner'o( prOp¢rty' who builtls O/'ImpfoveSlhErCOn, dntl who con-
traG[s from such projects with a contractor(s� Iicesnetl pursudnt to
the Contractor2 LJcenSe Caw). " - � �
❑ I am exempt untler Section B. & V. C, tor this
reason _
Date Owner
1 hereby certify that I nave reatl this applicaCion antl state that [he above
information is correcL 1 agree_[o comply w�th all ci[y antl county
ortllnances antl state laws relatln constructlon, antl hereby authorize
representativez of this citX ��ter upon the above meniionetl
propPrty for ¢t n p es.
$Ignature �' �'� ��"� Odte � � R2
HEATING SYSTEM 0-100,000 BTJY_
AND DUCTING ' IOO,Oq +; TU
REFRIGE TIONc 0-300, 0'
SVSTEM Q gTU.
BOILER B
SVSTEM IR,ALTERA ION
EXHAUST SVSTEM MULTIPLE
/iE /NtOecilen/ '
Drivers' Lice e or 55 � �� ' ISSUE FEE
CMF 0865-46 Whlte-Builtling; Canary-ApP����h P�nk-Accoun[ing; Goltlenrotl-Assessor
I
ELECTRICAL� �
10.00 TL
7F,• . ,
REGULATIONS �• �
PLNTGp. RgUEFL. $ �
PROPE�RTVNLINE . .f
PROVIDED�'� ��
PARK FEE b �
, .DATE �•� '
PLAN CHECK ' I -
aliA .
"����n���K 0-1KW_1-lOKW
TRHNSFORMER
IiPPLIAfVCE �30-50�KW_50+KW
' MOTORS " ' 0-1 HP_1-30 HP-
�(INC.SOILAR) 10-SOHP SO+HP
FI%TURES OUTLETS SWITCH
GAS'TUBE'SIGNS ' .
' -" PANELS �- � MAIN T
' " SERVICE � - - �
C ^+. ' _ .` e . . _ _ _
ISSUEFEE � - --
' ' ' qPPLICATION-APPROVED BV , �� � . IDATE•
SUMMARY OF FEES. ' �
. BVILOING ' ' .- - �
PERMIT , .S � _SMIP� . �b �
PLAN CHECK' S PERMIT �
' ISSUANCE 5 � � �
' PLUMBING E � '
PLAN CHECK S GRADING S �
� ELECTRICAL $ � S
�PLAN CHECK E � ' MICROFILM E
MECHANICAL $� IQ � TOTAL FEE E -
PLAN CFiECK $ - LESS.AD- - �
, VANCEPC 5
. FINAL FEE § /O
/o.°� - - -- -
CONSTRUCTION AND PLANNING V / POOL & SPA . � � �=' �' t � � �
.�
AppROVALS Permit# M`'tD'� Date � Inspector qppROVALS� �' ,.Permit,# � Date �:Inspector '
_ . . i.
1. Temporary Electrical Service or Pole ' � 43. Pool & Equipment Location� � -��
`� Soil ipe-Undrgrn �, . • • 44. Steel Reinforcement �" � -' - � - �
3. Electrical Conduit Utility-Undrgrn - . 45. Forms - ' "
4. Electrical Conduit-Undrgm ._ 46. - Electrical Bonding� ' ' - � ' -
. tee ein orce � 47. Rough Plumbin & Pressure TesY � �� � ���
6: Electrical UFER Grn 48. APPROVAlTO COVER-GUN17E - � •�
7. Footings � - � ' 49. Electrical Conduit-Unclr rn ' '
8. Foundation -� • � 50. Gas Pipe, � Undr m, Tes{ � �
9. Water Pipe-Undrgm 51. Backwash.Lines .P-Tra ❑ ndr rn �
10. Structurel Floor System 52. : APPROVAL TO DECK '
11. Property Sewer Line & House Connection � � � • • 53. Backwash & Rece torFinal "" - � ` � � � -
12. � Street Sewer Connection 54: Heater & Vent-Final �
13. Rough Plumbing � � ' -
14. Rough ElectrirConduit - - •�56. •Electrical-Final � � �
15. Rou h Electric-Wiring ' - 57. Solar System-Final'
16. Rough Heating & Air Conditioning -- - . . encing & Access Approval - •
17, Ducts in Structure • 9• APPROVED FOR PLASTERING
18. Ducts, Ventilating � � � - � �- - - � ,
19. GasPipe-Rough&Test ' - 60. .POOUSPASYSTEMS�FINAL'� . � �- � � • �
20. Roof Framing �• � � � � �
21. Roof Sheathin ' � � - � - � . . . . . , - -
22. � Freme and Flashin , NOTES: __ : •
• 23. � Insulation � ' � ' ' ' ' - � ' - � - - � -• - - -'
24. Lathin & Siding � - ' -- - �
25. Drywall Nailing ' ' ' � '
26. PlastenBrown Coat ' ' � •
�. 27. , Electrical Power Meter-Final � � � � ' '
28, Final Electric � �� �l - - ' '
29. - Final Heating & Air Conditioning. d � - � � � - '
30. • Final Gas Rpe-Test - � -
31. Final Plumbing - Z � - - ' ' � '
32. � Water Service-Final - � � ' � � ` � � �
33. Gas Service-Final � � '
34. Solar pomestic-Final • � ' ' � • �
35. L.andsca e S rinklin S stem � ' '' � '
36. Sound Attenuation • ' -
37. Handicap Regulations � - � '� r. . .. . . . , -
38. FINAL STRUCTURE & BUILDING "�` '
39. Special Requirements Completed �
40. Electric Release to Edison � � '
41.� Gas Release to Southem California-Gas Co. ' - �
,42. CERTIFICATE OF OCCUPANCY � �
' No Date , , . _ .
Aov��cant to /ill in all soaees exeeo� tnose wltnin neavr �oraer Ilnes antl sign all apo/ovriate tleclaratlons.
CiTv oF COS7A+I McECS,�q CONSTRUCTION1�,P,�ECRM_IT
Project Address 7u_� � ' �/ �A • �E F�
Applicant's Mailing Address �-� �' 1—ILT T�.JII,E
Owner's Nume �T �� Phone
Address
Arch/Eng. License No.
Address
Contractor'sN�m ` / Phone b�0
Address (mailing) - 3�`��$VL��E
City LicenSe N4 Q ��Z�'
LICENSED CONTRACTOR OECLARATION
1 hereby a11i�m [hdl I am licensetl untler provislon5 ot Charter 9(cOmmendng
wi[h section 7000) of Diyizion 3 ot the BuSiness antl Professions Cotle, and
my Iicense is in lull force/a�ntl efiect.
I.ICCOSC CId55 �'�` , LICCOSB NO 3\6
�te Signature
' �RKERS' COMPENSATION OECLARNTION
� � hereby altirm that I have a certiti<ate oi consent to seli-insure or a certHicate
(b of Workers' Co pensalion Inw�ant¢, or a cerUtiGtlrqpy the�eof (SOctlon
\3800, Lab. G. ^s'7 S�uRIJ�
Policy No. COmpany
\� ,!'�GeRifietl cioPY1'S_file0 Wilh thehcitlY Itlin9 D� sl
�a[e.J..,�'d�`f7 APPlicant O�'� � p ��--�'
E%EMPTION FROM WOqKE0.5' COMPENS ON DECLARATION
M (Thissection neetl not be completeC if [he pe�mit it tor One puntlreC (E300) or
Icss).
I certi�y tnat in lne p¢rfOrmance of thG wo�k fo� whith thls pe�m�t iSISSueQ I
shall not employ any person in any manner so as to become suDject to [he
Workers' Compensatlon L.nws of California.
Date �_Si9nature
NOTICE: If, afler making�(hiz tleclarallon, you shoultl become subjacl to the
Workers' Compensatlon provislons ot the Labor Cotle, you musl forthwl[n
comply with such prov�sion5 or [nis permit Shall be tleemetl rovoketl.
CONSTRUCTION LENDING AGENCV
I hereby affirm that there is a tonztruction lentlin9 agency for Ihe performance
01 thC work ror wnit4 [his permit IS issuetl (Set[ion 309] Civ. C.)
Lunaer's Name
�entler'S Atltlresz
OWNER BUILDEH OECLARATION
1 horeby afilrm that I am exempt irom Ihe Conbactor's Llcense Law for the
following reason (Sactlon ]031.5 Business antl Profo551onal Cotlu: AnY city or
counry whiclt rUqWres a bermit to Construct, alter, imProve, tlemolish or re0al�
�ny slructure, prior to itE issuanca, also requiret the apD���ant tor such oermit
� Iiie a signe0 siatement Ihat he/she Is Iicensetl Pursuant [o the provlslons ot
. e ConVaccor'S Licensa I�w (Chapter 9(tommen<in9 witn 5ectlon 7000) ot
JlviSion 3 0l lha Busin@55 antl PrOfe55ion5 Cotlo) Or lha[ h¢/She is BZBmpt
IhCtefrom antl th0 baSii f0� �ho allegetl <xemplion. AnY viOlatlon ol $ecHon
7031.5 by any apD���aqt for a permll Subjects NB applicant to a CIVII
�nnalty of nol more than }ive nuntlretl dollars (b500).
I, as ownar of the property or my amployeoz with wa9es as [helr sole
compensation, wlll tlo Ihe work, antl tne structure is not intentletl or oiferotl
f0� sal¢ (Section ]064, Bu51nos5 antl Prole55ional Cotle: Th0 Gontracto�'S
License Law tloes nol aOpIY to an owner o( a prooerty wno builtls oe Imoroves
thereon. antl wno tlocs sucn work nlmselt/hersell or throu9h his or ner own
employees, prOvltl¢tl lhat Sucn imp�ov¢ments are not IntentleC or ollorea for
sale. It, howevar, tne bu4ltling or improvamenl is soltl wilhin one year o1 tom-
pletlon, Ihe owner will �ave lho bu�Ean Of Proving he/Sbe Qltl nOt builtl O� Im-
prove for th¢ purpose ot Eale).
❑ I, as owner o1 the pr0oerty, am exclusively contracHng with Ilcensetl con-
t�attors t0 const�uct the project (SeclloO 7044, Busina55 antl P�ofeislon5 Cotla:
The ConVacror'S Licensq �w doas not apply to an owner ot properry who
builtls or Improwz therapn, antl wno wntracts /or such projects with a con-
tractor(s) imense pursuant to th¢ Contracmr's License Law). I am aware that
proo/ of their Worker'S COmpensatlon in5uranc0 S�oultl be provitleG to me.
❑ I am ezempl untle� $e�(iOn .B. & P. C. tor thl5 �eatOn
Date —
I hereby cer❑
information is
antl state laws
sentatives o(
inspectlon p�/I
Orivers'
Owner
that I have reatl t�is application antl state t�at tne above
�rect. I agree lo comply wlth all clty anC �ounty artlinances
IaUng to builtling construction, antl herepy authorize repre-
;�<pity/�to nen[er upon •the above�mentlonetl proparty for
eNc (.! `� oa�z %2 -.3 "�
A__ .. .
�_���i�—� � � �S��—
TVPE OFCONSTRUCTION NEW ADO LTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLOG. O���z
TVPEOFPERMIT�( LIGRADING LJ FOVNDATION U STRVCTURAL
❑ TENANT f�'� ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
FROJECT DESCRIPTION SQ. FT. OCCUPANCY_
CON STRUCTION TYPE VALUATION S
ZONE GRADINGCV.�'D5. ACRES__
Remarks:T1� l�� 'I Jc�l)MI
C7✓� t IX.
Bar Sink
Backflow Preventer
Batkflow Irrigation
Bathtubs
Clarifiers . �
Dishwasher
Drinking FOuntains
Floor prains
Floor Sinks
Ges Service OuUets
Inteiceptors
Kitchen Sink
Lavatories
P—T.rap �
Roof Drains
Reinspection Fee $15
Boiler
Ducl- Under Ground
Duct - Strucmral
' Duct � Ventilating
Exhaust System ❑ Multiple 0
Firepl/FacL Blt. ICBO #
Heating System & Ducting
❑ o-� oo,000 aru O i oo,000 eT�
Reinspection Fee $75
CMF 0865-46, rev. 30/B4 White � Builtlin9: Canary - ADP����[; Pink - Accountin9; Goltlanrotl - Azsessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecrors
Solar Piping
Solar Tank
Swi�nming Po01 wlSpa
Urir;ni
Water Closet
Water Heater
Water Service
Auto�Wash
Lsundry Treyz
laue Fee
Hood or Type I ❑
Cenopy Type II ❑
Refrigeration System
❑aioo,000eTu ❑ioo,000
System Repair�Alteration
Fire Dampers
Registus
Issue Fee
A.P. dk
S Main Building:
E
T Front
B Rear
A
C Right
K Left
S
Ping. Ref. #
Planning Notes:
Automatic Washer
Constructi0n Pole
Cooki�g Unit
Dryers GGas ❑Electric
Fan
F�A.U.
Fixtures
Device Bones
Outlets
Switches
Garbage Disposal
Generator 00�5 KW �5-15
o�3a 12/�3/c� <<o' "
Zone
Accessory Building:
Z
O
N
I
N
G
R
Parking Req./Provided E
Q
M
T
S
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+ KW
Merer �uA to 700amps -
Mefer ❑ov¢r100amps
Sub Panel
Motors �0.1 HP 01 h- 8
Inc. Solar �g-15 HP 016�15+
Microwave
Pole Light
Range
Standing $¢ctions
Trash Compactor
$ 3
Reinspection Fae $15 luue Feo
FEES
DEVELOPMENT SERVICES RE�UIREMENTS:
Zonine APProved By
Building Approved By ��
Apolication laued Bv A
$ 3
SUMMARV OF
BUILDING PEFMIT $
PLAN CHECK $
PLUMBING $
PLAN CHECK 25% $
ELECTRICAL S �• =0
PLAN CHECK 50% $ • �OO
MECHANICAL $
PLAN CHECK 25% $ '
FEES
$ 3
SMIP $
PERMIT
ISSUANCE $
ENERGY P.C. S
GRADING $
MICROFILM $ �
TOTALFEE $ �
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcemen[
3. Electrical Condui[ Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. ElectricalUFERGrnd. 57. APPROVALTOCOVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
17. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
72. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
74. Rough Plumbing 65. Efectrical-Final �
15. Rough Electrical-Conduit 6. Solar System-Final
16. Rough Electric Wiring y 7. Fencing & Accets Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT '
20. Rough Factory Fireplace APPROVALS Permit # _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71 . Product Piping O Gas ❑ Oil; �
23. Gas Pipe-Rough & Test 72. Underground Flush � �,
24. Roof Framing � � 73. Undergrnd. Storage Tank O Gas ❑ Oil ''
25. Roof Sheathing 74. Overhead F{qdro
26. T-Bar Ceiling (Structural) & Monocoat � •: ��. . 75. Dry Chemical •
27. Frame and Flashing � � • 76. Dry Standpipe �
28. Lathing & Siding , , 77.• :FIXED SYSTEM FINAL �-
29. �nsulation 78. FIRE PREV. FINAL ... -
30. Drywall Nailing , � , HEALTH OEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION . �`
32. Electrical Power Meter-Final . 0. FOOD CERTIFICATE ISSUED
33. Final Electric y, tes: ••
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test �
36. Hood or Canopy
37. Final Factory Fireplace :
38. Final Plumbing � 4 ,
39. Water Service-Final � � � '
40. Gas Service-Final , � . . -
41. Solar pomestic-Final "'
42. Backftow Preventer "' ' �
. r`
� �
43. Backflow Irrigation . � � �
`� t.,
44. Landscape Irrigation SYstem � `- {,�
..
45. Sound Attenuation • . �p
.. �� i�
46. Handicap Regulations . � ' �
47. FINALSTRUCTURE&BUILDING � • , � .
48. Special Requirements Completed � •
49. Electric Release to Edison ,
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY .
No. Date
m
�
ADP���ant to fill In all spaces ex<ept those wlinln heavY boraer Iinas an0 sign all aDVrooriate aeclarations.
CITY OF COSTA MESA C9/NSTLRU/C��ON PER�I� ��� p
ProjetAddress -�Ss� T/UYJnAni'6 �i�dr.
�Applitant'sMailingAddress �2j�2 �-� ���
Owner's Name ��-�ra Phone �/�93Z57
Addreu
Arch/Eng. License No.
Address �
Coniractor's Nam L Phone
Address Imailing) �'S�� ��`""""�s'�' �f` �' ,'���
CityLicenteNo. �Sy��
LICENSED CONTRACTOR DECLARATION �
I hcreby alfirm that I am Iicensetl untler provisions o( Cnarter 9(commentlnq
with section ]000) ot Division 3 01 thn Businass ontl Professions Cotle, anO
my Ilcensu Iz in full forc ap Ft�tect.
LJca�Y CI 55 ���v Ice e No. 2 ��
•C %L� i.[M/� �%If���
RNERS' COMPENSATION DECLAR ION
. uereby attirm that I �ave a certifiwte ol onsent l0 SelNnsure or a certi(Iwta
o( Workers' Campensa[ion Insurance, or a certlf atl coOY thereof (Section
3800, Lab. S)^• n ^
Policy No. Ld2� �D �Q� � Company �•�� •
❑ Ccrtifietl copy is hareby furnishea.`
��e/2 /�P`y„s/file0 wi[h the city B}y� J,g J�(�Ai�
Date O (iJ qpplicant lf� -� �--�— -
EXEMPTION FROM WORKERS' COI�i1PEN5 IONAT OECLARATION
(This section nee� not bo completetl if th¢ permit Is for one huntlretl (5300) or
Iess).
I cerNfy that in llte performance of ihe work for which tnis permtt i5 issmd, I
snall not employ any person in any mannor so as to become subject to the
Worker5' CompenSatiOn Laws o/ Californla.
Dale Si9nature '
NOTICE:.11, a1t¢r making [nis tleclaratlon, you ShOWd becoma Subj¢ct to Ine
Workers' Compensation pwvisions oi the Labor Cotlo, you must fortnwilh
Compry wil� suth provisions or thiz parmlt Sball b! tle¢metl ravok¢0.
CONSTRUCTION LEN�ING AGENCV
I ha�nby eHi�m thdt Ihere Is a conStruClion IonCing aqenty to� tne peifo�rOdnCC
of Ihe work for which thii permit is IssueC (Secllon 309]'Civ. CJ
Lentler's Name � �
Lentler.'s Aatlress
OWNER BUILDER UECLARATION ' �
I hereby aHirm that I am exempt from the Contraclor'S Llcense Law tor [ne
following reason (Snction 7031.5 Buslness antl Profe55ional Cotlei Any city or
. county which requires a permit to conseruct, alter improve, aemoiisn or repair
, •y Structure, prlor to its Issuanca, also �aqWres ��o appli<ant for Such Oe�mil
tile a signetl stdtCment that M1e/sne IS Ilcensetl pursuant to tha provi5ion5 01
Contractor'z License Law (Cnapfer 9(commencing with Sectlom]000) oi
��vision 3 ot tha Busin¢55 antl Profe55ions COtlt) o� that he/She is ex¢mpt
iherafrom antl t�e basis tor the alleqetl exemptlon. Any violation of Sectlon
7031.5 by any applicant for a permlt 5ubject5 th¢ applicant to a civil
�enalty of not more tnan (ive huntlretl tlollars (5500).
I, as owner of the property or my om0�oyees with wa9es as their sole
Compensation, will tlo Ihe wolk, dnd Ihe Slruclufe i5 not Intentletl Or offefetl
tor sale (Section 7044, Business antl Professional Cotle: The Contractor's
Licenu law tloes nol apply to an owner ot a property wlio bWltls or improves
thereon, antl wno aoes such wo�k �imielf/he�selt Or tnrough hi5 0� ner own
employBeS, p�ovitletl lhal Suth imprOvement5 are not Intehtl¢tl o� of(¢red fo�
sale. If nowaver, tna builtling or imp�ovamen[ I5 Soltl within one year of com-
. pletiOn, Ina Owner wlll nav¢ the burtlen o1 proving h0/She tlitl not builtl or Im-
�rove �or Ihe ourpose ot Tale). '
� 1, ai owner o1 the oro0erty, am exclusively contractlng with IlcenseU con-
Vatmrs to conSV utt lba project f5ection 7044, Business anC Protessions Cotla:
Tna ConVa<[or's License Law does not dpplY to an owner o1 O�oPerty who
bulltls or Imorovus tncreon, antl wno conVacts ior such projects wlth a con-
lratto�(51 licens¢ pursuant to the Con[�actor'S LlGonsa Law). I dm aware [hat
oroof o! [heir Wo�ker'S Compensallon insu�anco shoultl bo provitletl to m0.
❑ I am exempt untler Sectlon' B. & P. C. �or (hii reason
Dato _
'I hereby certi
Information Is
dOtl SldtO w5
sentalives
insp¢ction p
Si9nature
Drivars' LlcenS
. Owner
have reaa thls aOPlication antl state lnat the aGove
agree to comply with all city dntl county ortlinance5
o builtling cons[ructlon, and heraby authorize rapre-
t/o//�e�nte upon the'abova-mentbnetl proparty t{o1r
!lJ�� Date �Z �'"�
/�'
CMF 0865-46, rev. 30/84 White
TVPE OF CONSTRUCTION 'L'J NEW IJ ADO LI ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG. �
TVPEOFPERMLT GRADING�UNDATION STRUCTVRAL
❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL
❑ OTHER .
PROJECT DESCRIPTION Sq. FT. oCCUaArvCV
CON STRUCTION TVPE VALUATION $
ZONE GRADING CLL VOS. ACRES
RCTdIK2: K �l/_C�C
J O (/J( J
1
� Bar Sink , .
Backflow Preventer
Beckflow Irrigation
Bathtubs ' -
Clarifiers '
Dishwdsher . .
Drinking Fountains
Floor �reins
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink ..
Lavorories '
P—Trap
Roof Dreins •
Showers
Service Sink
Sewer Cap
Sewer Connection -
Solar Collectors� � . . -
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auro-Wash
Reinspection Fee � $75 � I laue Fee � $ 3
Duct - Under Ground
Duct � Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/FecL Blt. ICBO �
Heating System & Ducting �
❑4100,000 BTU 0100,000
Reinspec[ion Fee � 515
Canary - Appliwnt; Gink - Accountin9; GOIOenrotl - ASSessor
A.P. #
S Main Buildi
E
T Front
B Rear
A
C Right
K Left
$
Ping. Ref. #
Planning Notes:
�. �. �a�.i'�c�s .
• 8851 12/17/B6
� Accessory Building:
� Parking Req./Provided
Autamatit Washer
Construction Pole Sub.
Cooking Unih
Dishwasher �
Dryers �Gas ❑Elec
F.A.U.
Fiztures
Device Bozes �
OULIetS
Switches
Garbage Disposal
Generator DO-5 KW
' � 0 a r+� . 1 �.
Zone _ , _
�
ELECTRICAL � � �.
'. Transformer ❑ 75-50 KW �
❑ 50+KW
Merer ❑up ro 100 amps �
. �.Meter ❑over 100amps
Sub Panel
Motors O0.1 HP � 1 Y, - 8
Int.Solai �9�15 HP �7645*
Miuowave
Pole Light
Range
I I Standing Sections ' � -
5 KW I i Trash Compactor �
Reinspection Fee �$15 Issue Fee
IANICAL FEES
DEVELOPMENT SERVICES REQUIREMENTS:
Hood or Type 1 ❑ � Zaning Approved By
Cenopy Typell ❑
Building Approved By ��
Refrigeration System
Oo��oo,000eru ❑ioo,000
Syscem Repair/Alteration
Fire Dampers
Registers
Issue Fae � 5 3
S3
SUMMARV OF FEES •
BUILDING PERMIT $ �SMIP � . � $ -
PLAN CHECK $ � PERMIT
PLUMBING $ �SSUANCE $
PLAN CHECK 259G $ ' �o ENERGV P.C. $_
ELECTRICAL S GRADING . $ - �
PLAN CHECK 50%_ $ MICROFI�M $ —�/��--/��
MECHANICAL $ TOTALFEE � $ LCL.1��L
PLAN CHECK 25% $
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# • Date Inspeaor qPPROVALS Permit# Date Inspector
1. Temporery Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. (2-/�i-� L� 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. �54. Forms �
4. Electricat Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe; O Undrgrnd., Test
�
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor SYstem 67. APPROVAL TO DECK � � �
11. Property Sewer Line.& House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
73. Roof Drains 64. Plumbing SYstem - Final
14. Rough Plumbing �-(�7f(. (,Ijcp 65. Electrical-Final
15. Rough Electrical-Conduit . 66. Solar System-Final
i 6. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign � f$. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit �W ,
21. DuCts, in Struc[ure 70. Underground Hydro
22. Ducts, Ventilating 71. Produci Piping O Gas ❑ Oil .
23. Gas Pipe-Ftough & Test 72. Underground Flu'sh
24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas ❑ Oil
25. Roof Sheathing ' 74. Overhead Hydro -
'26. T-Bar Ceiling (Strueturall-& MonocoaY �" - .' ' 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 Faaory Firepiace . . . '
38. Final Plumbing �_Zq-� („�� �� � � � ,
39. Water Service-Final � � �'
r'
40. Gas Service-Final - � - �� - ". � � . - � � ' ' _ _ ':;
. . �_�.u'� _Y�"�j' y�
.}i': t -_..v< 1 s -�iTs� Y
41 . �Solar pomerticFinal � � '� ' '•. �"' � � '� � � � � � �
42. Backflow Preventer � '- �
„43. Backflow Irrigation . - • , ' � "
�, �
. 44. Landscape Irrigation System � � . .. �� �
45� Sound Attenuation . •
46. Handicap Regulations � � � ,
47,. FINALSTRUCTURE & BUILDING • � �
�'._
48. Special Requirements Completed ' . ' � '
49.-Electric Release to Edison - .
50. Gas Release to Southern California Gas Co �y
51. CERTIFiCATE OF OCCUPANCY , � ,
No. � Date �.,,
s
�
: �
AOP���ant �o flll In all spaees
CITY OF COSTA M A ' NS�I HU ' I N YtHIVi I�
i
ProjAYt Address
� y 7
Applicant i Mailing A.d1dress
Owner's Name G� Ld �'�. ��'��+, �P��������p�,�� �Zphone
Addreu 2J'��Gi rr�^`i�cv`��Gt�.
Arch/Eng. wn, � License No. G
Address �(�(2� —
Contractor's Name � � hon / �
Address (mailing) - � � '"
City License No.
LICENSED CONTRACTOR DEGLARATION
I hereby at/irm that I am licensetl untler provisions oi Charler 9(commencing
wi[h sec[lon ]000) of DlviSion 3 of Ihe Busine55 antl Professions Cotle, antl
my license is in full force antl etfecL / ��O
'cense Class icense No.
rte �� �% �� Si9nature
WORKERS' COMPENSATION DECLARATION
1 hereby a(Brm inat 1 nave a certificate o1 consent to selLinsure or a tertiiiwte
of Workers' Compensation Insurance, or a certlfietl copy [hereof (Section
3800, Lab. C.) . �
Poli y No. �!���� ��� ComOany �/�%F HJ�-.�
ertifietl copy is hereby furnishetl.
Da�eerti ie ��p�� eE wfAtppbcadL�Bui�lsio� /i
yG ../
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This settlon neetl nol be completetl if the permit is tor one M1untlred (5300) or
less)
I certify that in thC per(o�mance ot the work /Or wM1ich [nis pe�m�t is i55uetl, I
shall not employ any person in any manner so as [o betome subject to the
Workers' Compensation Laws of Calitornla. ' '
Date Signature
NOTICE: 1t, after making this tleclaration, you shoultl become subject to the
Workcrs' ComOensation provisions of the Labor Cotle, you must forthwilh
comply with such Drovlsions or thiz permlt shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
I hereby afflrm that there is a mnstruction lentling agenty tor the performance
of the work for whicn this Oermit is ISsu¢tl (SecOon 3087 Civ. C.)
LEntler's Name
Lentler's Atltlress �
OWNER BUILOER DECLARATION
I hereby alflrm [hal I am exemp[ trom tha Conitactor'S Litense Law (or the
tollowin9 r¢ason (Settion ]031.5 Busine5s antl Pro(e55ional Cotle: Any city or
^ounty whlctl requires a pe�mit to const�uct, alter, improve, tlemOlizh or repair
ny structure, prlor to its�issuance, also requires the aoPlicant for such permit
.O lile a Si9netl statement [hat he/she �s ncensea oursuani ro me proviziOns ot
the Con[ractor's License Law (Chapter 9(commencing with Section 7000) of
DiviSion 3 of the Business antl Professions Code) or roat he/sne is exem0<
tlte�efrOm antl [he basis tor the allegetl exemption. Any viOldtlon o( Section
7031.5 by dny applitan[ fo� a permi[ subjects thC appllcant t0 a civil
�ena�ty of not more Ihan five huntlretl tlollars (y500).
1, as owne� of the p�o0erty Or my emplOyees wlth wa9e5 as thei� sole
Compen5dlion, will tlo the work, antl the structure is no[ intentletl o� o(fer¢tl
for sale (Section' 7044, Business antl Professional Cotle: The Convactor's
' License Ldw Coes not apply to an owne. of a properry wno bulltls or improves
[hereon, antl who does such wo�k M1imself/he�selt or throu9h his or h¢r own
employees, prOvitletl tha[ suth Improvemenl5 are not intentletl Or offeretl for
sale. If, hOweveq th¢ Dulltling or improv¢Tent I5 soltl within one year o( mm-
-O�etlon-, the owner will have the burtlen of proving he/she tlt0 not builtl or im-
�rove for the purpose of sale).
I, as owner oi the property, am exUusivery contracting wi[h Iicensetl con-
, tractors td conztruct the project (Section 7044, Business antl Proteszions Cotle:
The Confractor's Li<ense Law tloes not apply [o an owner o/ property who
builtls or improves thereon, antl who contracts tor suth projects with a con-
t�actor(51 h<ense pursuant to Ihe Contractor'S Lit¢n5¢ Law). I am awa�e that
proof o( thei� Worker's Compensation inzurance shoultl be prOvidetl to me.
❑ 1 am exempt untler Sectlon B. 6 P. C. for tbis reason
Date owner _
I hereby certify that I have reatl ehis
infOrmation IS correct. I agree to compl
antl sta[e laws relatlng to buildinq cons
sentatives of this cit to .enter upon
inspection purpos � A�
Siqna[ure /4
Drlvers' License or 55 �
[hat the above
lhose wit�in �eavy Dortler Ilnes anG si9n all approp�iate tleclaralions.
TRACT NO. LOT NO. UNIT NO.
-1DSda[. 45 l�
TYPE OF CONSTRUCTION LJ NEWq LJ aDo
❑ CONVERSION ❑ DEMOLISIi IlJ OTHER
DESCRIPTION OF WORK/USE OF BLDG. —
REPAIR
TVPE OFPERMIT LJ GRADING LJ FOVNDATION L`rSTRUCTURAL
TENANT ❑ ELECTRICAL ❑ PWMBING ❑ MECHANICAL
� OTHER
PROJECT DESCRIPTION 5c1 FT ��-DO nrr annirv
CONST T�nNTvog VqlunTIONS 7.9fi8.
ZONE_�t—•GRADINGCU.YDS. ACRES—
Remarki:
Bar Sink
8ackflow Preventer
Backflow Irrigation
Bathtubs
rinking Fountains
l0or Drains
loor Sinks
as Service Outlets
Kitchen Sink
Lavatories
Roof
Showers
Service Sink
Sewer Cap
Sewer Connec[ion
Solar Collecrors
Solur Pipin
Solar nk
S mming Pool w/Spa
Urinal
Water Closet
Water Heater .
WaterService -- �
Auto�Wash
Reinspection Fea I $15 I I laua Fee I, $ 3 I
� MECHANICAL FEES
Boiler '
Duct - Under Ground '
Duct - Structural
Duct - Ventilatin9
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Du �
❑ a 100,000 8 100,000 BTI
oate_,'�-/4.�
. Reinspection Fee $15
CMF 0865-46, rev. 10/86 White - Builtling; Canary - Appllcanq Plnk - Accounting; Goltlenrotl - Assessor
Hood or Typel �
Canopy Type I I ❑
Refrigeration S G�
�aioo, u ❑iao,000
m Repair/Alteretion
Fire Dampers �
Registers -
laue Fae � $ 3
A.P. � S _
S Main Buildin9:
E
T Front
8 Rear
A
C Right
g Left
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Fan
F.A.U.�
Fixtures
Device Boxes
Outlets
Switches
Garbage Disp�
Fee
2
'.(
on �� TL
e/ � y/E ;zo�a .,(�jq', I 9 TL
Accessory Building: '
— Z
O
N
I
N
G
R
Parking Req./Provided E
Q
C9+� M
T
� S
ELECTRICAL �� � '
Transformer ❑ 15-50 KW .
� ❑ 50+KW
Meter �up to 100 ampS�
Meter Oover 100 a s.
Sub Panel . " -
KW LJ5-15 KW
DEVELOPMENT SERVICES
Zoning Approved By
Building Approved 87�,�-F
FEES
Motors -1 HP 01'f. � 8 .. '
Inc. lar 09-15 HP 076-75+
icrowave � '
Pole Light ' .
Range i
Sign �'- ' � '
Standing Sections
Tresh Compac[or ,
Issue Fee ' � $ 3
ICS/�A��i . n..eo7�7'U.
SUMMARV OF FEES � � �� y
�`��BUILDING PERMIT $ �i S�.S� SMIP ^y � ✓ b
�L� PLAN CHECK $ � I• l 3 pERMIT�
PLUMBING $ ISSUANCE $
PLAN CHECK �- 25% $ ENERGY P.C. $
ELECTRICAL � $ � GRADING '$ -
PLAN CHECK 50% $ MICROFILM .$ "'
MECHANICAL $ � TOTALFEE , $ �
PLAN CHECK 25% $ '
. CONSTRUCTION AND pLANNING POOL & SPA
APPROVALS Permit # Date Inspector AppROVALS Permit # Date � Inspector I
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location '
2, Soil Pipe-Undrgrnd. 53. Steel Reinforcement y�
3. Electrical Conduit Utility-Undrgrnd. 54. Forms I
�
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding .
5. Steel Reinforcement . 56. Rough Plumbing & Pressure Test (
�
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE '
7. Footings � 58. Electrical Conduit-Undrgrnd. '
8. Foundation � 59. Gas Pipe, O Undrgrnd., Tes[
9. Water Pipe-Undrgrnd. . 60. Backwash Lines, P-Trap, � Undrgrnd. �
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final ' .
12. Sewer Cap 63. Heater & Vent-Final - .
13. Roof Drains 64. Plumbing System � Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final �
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ,
20. Rough Factory Fireplace � APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating � 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing , 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing . � 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � ��
27. Frame and Flashing • 76. Dry Standpipe . �
28. taihing & 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
47. Solar pomestic-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. �ate
AVplicant to /ill in all spaces exce0t t�ose wit�in neavy Eortlar Ilnes anC sign all approD��ate Ceelaretions.
CITYOFCOSTA 2M�,E-,$Cp�C C NSTRUC IONPERMI PER TNO. TRACTNO. LOTNO. � UNIT
ProjectAd�ress _�+�JJ ��R-��w� � . � a7�3/ � . ,
ApNliCenYs Mailing AddresT �LT �J uSE� C�.-• TYPE OF CONSTRUCTION NEW � ADD ALTERATION REPAIR
� ❑ CONVERSION ❑ DEMOLISH OTHER p� p y�,
O�wner"s Name F�����n.�M Phone DESCRIPTION OF WORK/USE OF BLDG.
Address /�
Arch/Eng: 1�� '�E�'�L License No. �-�� V�
Address
Contractor's NamP��y-��=� Y �� �—r���- Ph^on�e'���6� b
Address (mailing) 'L""�.'� �%�%.,n � "%�� � �K-V 1 � � �Z�
Cit� ��icense No. Oli Z54
LICENSED CONTRACTOR DECLARATION
1 hcreby affi�m [hat I am licensetl untler provi5lOn5 of Chart¢r 9(CommOncing
with section ]000) of Division 3 of the Business antl Prof ns o e, ntl
my Iicense is in full tor<e antl eflect.
��LICBOs¢ I 5 C� � , L BOS¢ r�
'late��� 5{g t 1 � �4u
� ORKERS• CO PENSATION DECLARATION
� . hereby attirm that I nave a certificata ot consent to self-insure o a certiflcate
Oof Worker5' Compensation Insu�ance, o� a ce�ti(ietl copY the�eof (Seciion
3800, Lab. C (�,�-p.1
Policy No. �� ��� ompany vCr `v �
Certitiatl copy is hereby furnishea. �
Cer i I c .(iletl wrth the <it ' i i i . �
a[e - Applicant
EXEMPIO_�RKERS'COMPENSATION DECLARA N
(Tnis section neetl mt be completed i( [he Oermit is for one hunare E300) or
Iess)
I certify that in the performance of tne work tor wnicn this permR is Issuetl t
snall not employ any person In any manner so as to betome subject to l�e
. Workers' CompensaUon Laws of Califomia.
Date Si9nature
NOTICE: It, after making Ihis tleclaration, you ShoUltl become subject to the
Workeri' Compensation provisions oi tne Labor Gotle, you must tort�with
� camply wi[h sucn provisions or this permit iball be tleemetl revoketl.
CONSTRVCTION LENDING AGENCV -
I hereby altirm that there is a conztruction lentling a9enty for the performance
of the wark fOr whlch thi5 OGrml[ is issuetl (Sectlon 3097 Gv. CJ
Lentler'S Name
LenOer's Atltl�ess
OWNER BUILDER UECLARATION
I Itereby afflrm that I am exempt trom Ihe Contractor•5 Cicense Law for tne
following r¢asOn (Seclion 7033.5 Business antl Pro(e55ional COde: Any <Ity or
coun[y which requir¢5 d permlt [o construGt, dlt¢r, improve, tlemoliSh Or repai�
any structure, pNor to its Issuance, also redulres the applitant tor such oermlt
file a signetl Stdtement thdt ho/She Ii Ilcen58tl purSWnt [O the provi5ion5 of
: Contrac[or's License Law (Chapter 9(tommancing with Saction 7000) of
�vtsion 3 0l t�e Business antl Protesslons Code) or tbat ba/she I5 exempt
Iher¢(rom and tne ba5i5 tOr tne alle9etl nzemptlon. Any violdtiOn of Secllon
']031.5 by any aDO��<ant for d p!/mIt SubjlClS tho appllcanl to a Clvil
�enalty ot no[ mora than five buntlretl tloilars (5500).
I, as owner of [he p�op¢rty o� my Cmployeez witn wage5 a5 thair 501¢
compensation, will tlo Ihe work, antl Ihe strut[ura is not intentletl or offeretl
' for sale (Section 7044, Business anU Pro�essional Cotle: The Gontractor•5
license l.aw tlo¢5 not appty [o an owne� oi a property who builtlz Or improves
' thereon, antl who tloes sucn.work nlmself/h¢ri¢II Or throu9h �is o� her own
employ ees, provitl¢tl tnat such improvem¢nts are not intenaetl or oiferotl for
sale. Il, however, tne builtling or improvemant i5 Soltl within on0 yGar ol com-
pletlon. th¢ Own¢r will have the burtlan Of Proving h¢/She tlitl not bulltl or im-
p�Ova f0/lhe purpo50 Of sale).
❑ I; as owner o� the.D�operty, am ezclusivaly contracting with li<ensetl con-
t�actors to construcl the project ($ection 7064, Bu5ine55 antl PrOtesslan5 COtl¢:
The ContractorY License Law d0ls not apply to an owner of prope/ty who
Duiltls or improves tnereon, ana who contracts tor suth projectz with a con-
tractor(s) ucense pursuant m tne Contractor'z License Law). I am aware that
proo/ o( thelr, Worker's GompenSatlOn in5u�ance s�oultl be provitlud lo ma.
❑ I am exempt unCer Section B. 3 P. C. 1or [h6 raazon
�ate
Signature �`{!jf¢�
Drivers' Lic�ense or 55
CMF 0865-46, rev. 10/04
Owner
upon
TVPEOFPERMIT �LJ GRADING LJ FOUNDATION LISTRVCTURAL
❑ TENANT � ELECTRICAL ❑ PLUMBING ❑ MEGHANICAL
❑ OTHER
PROJECT DESCRIPTION Sq. F7. oCCUaAr�Cv_
CONSTRUCTION TVPE VAWATION S
20NE GRADINGCU.VDS. ACRES_
Remarkt:'�iiJ IY-n ���/f'i �Q � /Z%.�T�
Bar Sink
Back(low Preven[er
Backtlow Irrigation .
Bathtubs
Clarifiers ' '
Dishwasher� �
Drinking Fountains
Floor Drains
Floor Sinks
i�id5$CIVIC2 ' �I1lIEi5
Sink
Roof Drains
fleinspeaion Fae � $15
Duct - Under Ground
Duct - Slrutturel
Duct - Ventilating
Exhaust System � Multiple
Firepl/Fact. Blt. IC80 51E
Heating System & Ducting
❑4100,000 BTU 0100,000
Reinspection Fee � $15
White � Building; Canary - AppliWnt; Pink - Accounting; Goltlenrotl - Assetsor
Showers
Service Sink
Sewer Cap
' Sewer Connection
$olar Collecmrs .
$olar PiPing .
Solar Tank
Swimming Pool w/Spa
Urinal
Wetef CIOut
Wacer Heater
Water Service
Auto�Wash
laue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeretion Syztem
oa,00,000eru o,00.000
System Repair/Alteration
Fire Dampers
Registers
laue Fee
FEES
S 3
$ 3
S Main Bmlding:
E
T Front
A Rear
C Right
K
g Left
Ping. Ref. dp
Planniny Notes:
' , 2732 2/23/87
' 2one
Actessory Building:
Parking Req./Provided
� . ELECTRICAL
Automatic Washer '
Construction Pole Sub.
CAoking Unit
Dishwasher
Dryers ❑Gas ❑Elecvic
Fan
F.A.U.
Fixtures
Device Boxes
OuHets
Switches
Garbage Disposal �
Generetor �0�5 KW �5•15 KW
❑ 15-50 KW
� 50+KW
Merer Llup ro 100 amps
Meter �over 100amps
Sub Panel
Motors � 0-1 HP � 1 Y, - 8
Inc. Solar 09�15 HP 016-15+
Microwave
Pole Light
Range
Sign
S�anding Sec[ions '
Tresh Compactor
' Reinspection Fae I$15 I I Ittue Feo
DEVELOPMENT SERVICES REUUIREMENTS:
ZoninB Appraved By
Building Approvad By n
ApplicatiOn Issued BV �
7090 Tl
FEES
S 3
Z
O
N
1
N
G
R
E
Q
M
T
S
SUMMARV OF FEES �
BUILDING PERMIT $ SMIP §
P�AN CHECK $ PERMIT
PWMBING $ �SSUANCE - $"
PLAN CHECK - 25% $� ENERGY P.C. $
ELECTRICAL $ GRADING. 5
PLANCHECK 50% $ MICROFILM 5 �
MECHANICAL $ TOTAL FEE $
PLAN CHECK 25% $
a
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
e
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. Elec[rical Conduit-Undrgrnd. 55. Electricat Bonding
5: Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Gr�d. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAI TO DECK
11. Property Sewer Line & House Conneaion 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains � 64. Plumbing System - Final
74. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Coaduii 66. Sotar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling ���? �j 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit �p _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas OOiI:. -
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro - ��
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � � �
27. Frame and Flashing 76. Dry Standpipe '
28. Lathing & Siding 77. FIXED SYSTEM FINAL �
29. Insulation � � 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION .
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED -
33. Final Electric Notes: � �
34. Final Heating & Air Conditioning ,
35. Fina� Gas Pipe-Test
36. Hood or Canopy ' ' . • ,
37. Final Factory Fireplace � • � ,. .. .
�
38. Final Plumbing ��' • • ' • �
39. Water Service-Final � �� � � �
40. Gas Service-Final - � „ "
41. Solar pomestic-Final ,
42. Backflow Preventer � '
43. Backflow Irrigation j � . ,
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 Southem California Gas Co � '
57. CERTIFICATEOFOCCUPANCY •T
No. Date
�.,�.._.� . ; . . ,
ADp��cant to fill In all SDicts ezeep< t�O3e wlt�ln �eavy Eo�Ger Iines anG Si9n all aonroorlats Eaelanllons.
i CITY OF COSTA MESA . ' � � _ . PE IT NO/� �[ / TRACT NO. � LOT.NO. . �-9 , , - • , . � - � � '
CONSTRUCTION PERMIT. , "; �--tD % T /' .�/.� � ' � � 6729 � 4/C�5/H3 � ��5;83 TL
AppliCent'S Melling Addlezs � � h E OF CONSTRUCTION ' NEW�j,r ADD TE TION REPAI R �' �� ' . T ' �" ' ..
ProjectAddress� ���"'' ���� ���C���,,�{�C'��. ❑ CONVERSION ❑ DEM, ��11�5r ]SI OTrIER_ � - ,- . . " � ` � ' � . , ' ' ' � . � .
OwnBfSNeme ( -' ���+�7 �hOneraip-��O � DESLRIPTIONOFWORK �=SG="t"_ �r� -'�--��"''• . 1 G E u� T s� � � � � •
Addfess ^ _ . TV�PE O-F PERMIT GRADING � FOUNDATIO STRVCTURAL A. P.9W . �J "� / ZONE � � � �
. w
AfChlEng: LicenE@NO. � ',C4TENANT�LECTRICAL PLVMBING �MECHANICAL � � PLNG.REF.SM�, � " _BUILDING .- � • � -
��.'I�'
LJ �OTHER y �-E �- REAR YARD��TO P/U ' �
Addrea ' ' � - TO BUILDING .
Contrectoi i Nam � � � Phone �i- � PRQIECT DESCRIPTION, 5�. F. � OCCUVANCv LEFT SiDE VAqD ' R� S�D - R �� '
� ( r �y�/t � CONSTRUCTIONTVVF��.VALUATION$ ' '
� Address (mailing) ' ., . . . '
�� ;��A ZON� ��„� GRADINGCU.VDSSy �- ACRE ' PKG.SPACEREQ. Pfl0 D _
Cicense No. � ' � �
LICENSED CONTRACTOR DEGLARATION Ramar : � C, ' STREET WIDTH � � PARK FEE $
1 hateDy�aHhm that 1 am licensetl untler provislons of Charter 9(commencfn9 -
wlth Sactlon 7000) 01 OIVISIon 3 0/ the Business antl Protesiions Cotle, antl , ' Z ' f �.. / �s--S3 SPECIAL CONOITIONS: G'. � { •�°
;�Icanse'Is In f. �II f.orca anE a}tact. - � • � '/� �/yyy���
� 'P'� 4 4�� � C s �) . A . No - i ; PLU BING ' � �+c5 /v�- � �''r-'r�• C+�. I ��i v�.
\ �� ���� Si9nature . . , . ,
WORKERS' COMPENSATION DECIARATION • ' • BeI Siok � ' Sewer Cep � I ' ELECTRICAL
_ I hara�y ztflrm that I,hdve a certltiWte.o4consent to Selhinsura or a certltl�'ate - Backflow Preventer - �-- $Bve2r Conn2[tion -- -'- • Automatic Washer_ •_ � Metef �over 70� amps �
07 Workers' Compansatlon Insur5nc0, or a certifletl copy there t(Sectlon - � � � �- � ,-
Q Construction Pole ; � Sub Panel� *��
3800, tab, cJ I ' n�Lu d �y� • . Backflow Irrigation � ' Soler Collectors%� � � � - � . ' �
Po;,�„ Na. �T .�i54713q7 Company ' , �; Cooking Unit Sub Pole t;
Ce itietl coov �s hereey turnisriee. � ; ` � ' ' Bathtubs ' Solar Piping ' :. . � . , , � ,
rqiie oyyli tilea with the city. Ia��Dl���n. a,/�� . � � i� � Dishwasher Motors �0-1 HP � 1'h-8
_Date _�I��bO ' AOPIiWnt ,�,' M iii��J 1 .t3TQ � � ciarit�ers i SolarTank '. � . . � .
EXEMiTION',FfiOMWORKERS'COMPENSATIONDECLARATION ' � Di5hNA5hff ' : . ' SWimmingP001'W/Spe ' DryerS ��Gai� �Elebtfib •InGSolaf �9-15HP 01645+ j '
� (Thissectlon neetl not be com0letetl If the permit Is tor,one huntlretl (5300) or �
� less) � i � • � � Fan � Microwave `� �
I I certHy that In the pertormance oi the work for whlch thfi perm�t is issuatl I . Drinking FOunteins Urinal � �
�' shall not employ any person In any manner so"as to become subje<t to ttie � . F.A.U. , Pol2 Light �
WorkerY Compenuuon'Lawz of Caufomla.� � � . � Floor D�ains � ' . Water Clout - ' f '-
Date � ' �ignatura � Fixtures ' ' '
� NOTICE: If, after maklrig thls tleclaratlom, you shoultl� eecome iub�ect to tha Floor Sinks �� �. Weter Heater -- .� - _ _ Range _ _ �
Workers' Campensation provi5ion5 0/ .the Labor Gotle, you. must /orMwith � � � � Dfvic¢ BOxes I � ' � �
ComDb wlttl iuth proviSloni br � td�s ,permit �Shall be deemetl revokeG., . � GasService 7 Outlafs Water Service ';� •, � , _ . i �Si9�,
CONSTRUCTION,LENDING AGEN��" � � - i ' - i � � � - � ,
Y 9 9 Y �P Intefceptors' OutlBtS •
I herob altirm that Mere is a conitruct�on,lenAln a enc for tha� artormance � � � � .� � .'.� � i Standing Sectians � �
o/ the ,work for, Gh� jhi5; per 15�{ 55ued��,5ac tlon 30B7- Civ. CJ - ' � .
LonCer's, Namee � �-�'h�bYO �P[ri1 •L�iViAO' � � ^ ' KitchenSink ' . ' � - ' • Switches, , � ; TrashCompactor � '
' Lanedr's' Atlara���� v- • • -�� � I.avatories,: ' � . � • -• ' � � Gartiage Disposal ' + � �
OWNER BUILOER OECLARATION � � �f✓pT'a. �f�(�� ' �- � �
I haraby affirm that 1 am exempt from �he�Contractor'itifcen e Law � fhe �, p_Tre ' � `, - Generator �0-5 KW �545 KW � � ' �
' tollowin9 reason (Seciion 7031:5 �Bui�ness antl Protes5ional,Cotla: Any dty or � � P� ' ' - ' '
a;.�ty whicb rea Wres a permit to coPstruct, alter improve; Cemolistror'repair � � ., .� . . - � i
�,r.�ttrutture, prbr lo its'6suance, also requlras t�e appllcant•for fuch permi£ Roof DrainS ' � � --� '( � ' r '. Transfarmer �15�50 KW � � �
?�"�e a slgnetl ztatement that he/she is Ilcensetl pursuant to tha provisions oi ' . ' ❑5U+ KW� ' � ' � - �
i71a Contiactor's Lltense Law (Cnapte� 9(commentlng.with Section 7000) oi -' . - . "� � IRsinspaetion Fee §15 j
DlNsion 13 of the,Business anE! ProTRssions Cotla)'•or that �e/zhe-is exempt ShowE�s ^� � fleinspection Fee' $15 � , , �
therefrom �antl the ba515 ior the allege0 exemptlon. Any vlolatiod of Saction -; ,' � , � , , , - M¢ter ❑up t0 700 ampi j Igue F00. � S�3 !
]031.5 by"'any aDP����t for a`pe/mit subJects'the.appliwnt to a cWtl '� .•ti • '
enalty ot not more than iive nunered dollars Service Sink, .. � '' � S 3 • � - -
(E5oo7: . ' -- ' ' r , Isue Fee ` , Zoning APPmved BY � Datd
; � I, as�owner ot the praperty or RiY employees with�wa9es'as their sole � - - � ' MECHANICAL - ' � � - � ,�Q� �!3
I compensation' will'tlo the work, antl.the.structure Is nol IntentleC or otferetl - - .,. i': � 1 i Applitltion Approv0d By ate
�f0� sdll�(Sec�ion 7044', Bu57n¢sz'antl Professlonal.COEe:�ThefCon[racto�'s ,h � � � � � � � . � � , .
� Llcense Law Eoes not aDON to�an owPer oi a prope[ty.who builCs or Improms , go��e� � �t� (, �'� Refrig¢ration $y5tBn1 � � � t�
! thereon,�antl who'Aoes; zuch work himself/herself or throug h hii or her own � � � � � � :� Applieation laued By ; Date T- ����
emD�oy ees, provitletl that such9mpro�emant5 are�not Intentletl or oReretl for ' , , ❑4.100,OOOBTU ❑100,OOOBTU - � �
sale. If, however, the Euiltlin or Improvament is ioltl wlthin ona ear of com- Duct - Und¢� Ground ' . . , �
9 Y � � , � � : i SUMMARV OF FEES I • i
pletlou, the owner wlll have the burtlen of proving he/she tlIA not Duiltl or Im- . � � i ,
�rova for tne purpose of sale�. ' ..« t � Duct -Structural � � System Repeir/Alteration BUILD�NG PERMIT $�S d SMIP � � 1$ I , ,.i.3
LJ I as owner of lhe property, am ax�lusively contractln9 wltndi<ansetl con- � � Duct - Ventilatin �" � ' ' �PLAN CHECK $ i PERMIT '
'rt�ac[ors to con5truct.the,Droject `SacUon.7044, Busina55 antl Professions Cotle: 9. _ `.. __ .� . _. _ _ _ �• ,
The Contra<tor'S Cicanse Law does not apply to an owner of property who . I , � �
bulltls or Improves tnereon, antl who contracts tor such projects with a ton• , Exhaust System � MWtiple �, ' � � i, � 'PLUMBING i $ ISSUANCE ' $'
tractor(s) Iicense pursuant to the ConVactor's License Law). � • � ' � GRADING I �$�
❑ Y:am ezampt unOer Sectlon B. & P. C. /or this reason � FirepVFact. Blt. ICBO � � ' , P�,N CHECK; ' $ � �
Date � � � Owner� , ' • � ' � - Heating'System&Ducting ,� - ' � , !ELECTRICAL' S ' � � � � $ f '
i 1 � � • MICROFILM ' $ ; i
, I M1ereby certHy l�at-l-have reatl_th�s apPllcatlOn antl�stata�ttiaCthe abow--;-- ❑6100,OOOBTU�100,OOOB - - �P��NCHECK� ' $ _ � � � -
Informatlon is correct. I agree to como�Y with all tlty antl county ortlinancas � � � , �^ ' � � MECHANICAL � ' • TOTAL'FEE � -
, antl•,s[ata laws ratatlng to builtling cOnstructlon,�antl heretiy authorize repre- , HOOd or � � ' � � � 1 ' - � . $� � . � � � � $ { � '
sentatives of �thls tlt �; o anter � up n the above-m0�ntionetl property Sor , � � T1;P8 � � . , RBinspection Fea, •' $75 � � i ` � LESS �� , ' �
� I rI� ��o T e II ❑� � . �., .PLAN CHECK• $
,, InsPettlon DurPoses. �Date 'f` i � , � . ; . � . � � . - � , ADVANCED PC $ ;,_' _�
i Signature ' t � Registeis � � � Isdue Fee �� S 3 � . � � I� �?�� �
rivars' lJcen r,55 �- ' ' ' . � � ; t . � . FINAL �FEE i $ Ls7i� —
�
: �
� "'_'_ ' _"'__." " _ " __' "' __ _ ' ' " . ' _ _ '_ _'. _
_"__ '�' _ " � _,
CMF 086546 rev. 12/82 White - Builtlin9: Canary - AOPliwnt; Pink - AtcounHng; Goltlenrotl - Assessor � ' ' ' - -'� " -' - ' ' --- - - -"' - - - --- - -
. .._
�
,_
-- �, .' ' S'
=dCONSTRUCTION.AND�PLA N �,} '+o�_ . x_,.�'.�'-`: ,-`':,' '-&SPA. -- _- -" . � =
+.Date � Inspector � � Date Inspector �,
:�APPROVALS , Permit-#�� - •, AP.PROVALS`,' Permit.� •
. m : . n . . . . .
' �1: Temporary Electrical Service or;Pole u � •"• `'r, � 5' •� 52: Pool &�Equipment Location ' , ._ � � . � . �
c: -- �:. � - - . .
� � 2f �Soil Pipe-Undigrnd.. - - `� ; , i 4:, � .53; Steel �Re'infoicement �� � . - ' -, .
�
� 3; Elecfrical'Conduit Utilitv-Undrgrnd:. �,: •, • ��, � 54. �Forms • � � , .. - - _ " , - �• u �i �
� 4: Electrical Condui;-Undrgrnd; ="L � �, ` _ ; �, � , ��55:� Electrical�.Bonding � - � � _ '
5: Steel. Reinforcement � � =' J ; ` ' - :� � :" _ �t � 56.• Rough Plumbing �& Pressure T.est ' , ' �
6: IElectrical UFER Gmd. °- ^ ' ' 57; APPROVAL'TO COVER:GUNITE ' ''-
� � ��_
7. Footings . I ' "� a; - ' � - 58.� Electrical Coriduit�Undrar�d. . � . �
. F•
8. �Foundation : , ' , � � : � � • °} y �r � �, -'59. Gas'Pipe, O�Und�grnd., Test � . . . _ � .
9. Water Pipe.Undrgrnd. • , � � E , - - = � � � ' ;sp, gackwash �Lines, P-Trap, O �Undrgmd.' - '
70. Structural Floor System � ' ' ��� � 61. APP.ROVAL TO DECK �- � � ; -
11. Property SeWer Line & House"Connection �- ' .. - - �' � • - ' - ;
_ � , . �.: �. .62. 'Backwasfi & Receptor-Fina4' _ , � ,.
12. Sewer Cap i ., . i ` � . _ - . . . � -
_ '63. Heater & Vent-Final
13. Roof Draint , ' o � °� � � � � - � � _ �
i . � j I . 64. Pfumbing�System °,Final � _
q 14. Rough.Plumbing � , � _ _ I � � �� . • - - � 65. Electrical-Final ' ��� � ' � • ` � �
15'.'Rough Eiectriral-Conduit- "� --�."'�"' � � i T ' - � 66.i Sola� System-Final- � ! � �- - - -- _' • " � ,_
� � " . '"� �: - ` - .
- �:16.'`�Ftough-Electric•Wiring, , ; r ;�� ���; . ; � ,-�-,'-- -'` ',:-j" 67� Fencing & Abcess APP�oval - ' � _ - : _ -
" 17.. ��Rough:Wiring�Sign, � �, • �'' . v � - � . ' 'gg' APPROVED FOR PLA5TERING' ' � � � •
I•ii'� t,_��1��1 i _ 1 �
18f'Rough Electrical=T;Ba� Ceiling ' � � _ ' � 69! POOUSPA SYSTEMS FINAL • � - -�
.; `19. rRougli.Heating & Air Conditioning {, ( � Q � `� � ' � �FIRE DEPT.�REQUIREMENT _ - ' � ' � �
'^ � " � � � I . t � . i �
* � 20,lRough,Factory Fireplace ' �. .;`' �` � . � ' ' ' APPROVALS, . Permit # ' � ` � „ ' �
. 21. MDucts; in Structu{e: � . ; ! � , � � �. , . � � � ` , , ` .- . � .
� � , 70 � Undergrountl Hydro ,
o�. .
22. �Ducts, Ventilatin � ; ' � �
� g� ' c i � �� , � � � � �71 � Product Piping O Gas OOiI � � - ,' I
��
��-23. Gas:Pipe-Rough &,Test i ' �•. � � ' �- � T I � J2, Undeiground Flush �' " ' �
� �'�24..Roof Fram�ng', � ; ^ � � � ;r=; !%.a � j .3 � .d � , . - h3.. �Undergrnd. Storage Tank O�Gas,O Oil : • ' '
� � 25. Roof Sheathing � . � : (��� �;;.1 ^ � ' � ' ! i _ ` � �' �74. Overhead Hydro ' _ - i , �
�
S - , ,
: � 46. fT;Bar Ceiling (Struc[wal�, & Monocost� � � � �, � - j � ' � ; i75.� D'ry Chemical : ' ` - ' � , ,
• �� 27. Frame and'Flashing. _ : � ,,. � �� i t�Z,,S3 � ,76! Dry Standpipe � • -, � .
' � 28. vlathing & Siding� : � , �_' � ;�; � � � � � , � ' `77.� F�IXED SYSTEM_F,INAL _ . � ' � �=' ' �
' 29,�Insulation � � , ' � , .i ,', � I � '� � 1 �78. FIRE PREV. FINAL - � � ' ' � '
`-30. Drywall Nailing � '���� �., I ' ;i� � � i � � . I � j �Notes: ' ' �,
° - � - � - -- - -r --- - - - ' - - � - - �
`- � 31. Plaster,Brown Coat� � ! ,i �� � � � i - � � � , I � � ' - ,
< � 32. ;Elec�rical�Power Meter-Final i •.�� ��! i � � I � � ; ' � � I . � � . . � .I � .
r I �' i
33. �Fina�l Electric � � _ � �� � � � � � � �, � � � ' I` � � � ,
�
34. Final Heating &� Air Conditioni�g � �!� ' i � � � � ' � i � �
35.FinaIGaSPipe=Teit`�`;�`�:rpj;. j• '�c �,.�� 'r :�ty� � 1 _. -'�� , c : - _
I i � � �
36. Hood'or CauoPY � o _ ;, t - - , j x j � � . .
n ,H. .�,.. '� .;d i.�i��' -' '� ' _ `
37. Final Facto�,y�F�irePlace� � -` � �: � �; il � 1 e � _ . � . � , : � �.'' n � .
38. Final Pluqibing i � ! � o) '' ' � ' ' � ` ' ' . � � �
J•' �` i i i i i. i
39. WateriService-Final . ' . ..' `� } � � ' � .� . � � i , `' .- i .,.�,
' °� ' �
40. GasServioe=Finzl ! � ! i� ' � � -' ' � � �
� i � .. f i t �' ' r
41. Solar po'm'estio-Final � '? j ;�I •��, ( -} ? � _�- ' --,-k_ _ t � ' � ' � '��.
42. Backflow @reventer . �': : ..'f .�' �"� � � ' i � • :
�' ' : I . J^. � _ ' _r. _ . . }_ .- , . .� .
43. Backflaw lirigatio'n � � , ; '� •%> ir - - - , � � � , � � � ' �• ' .
pN,_i- I
44. LandscaPelri�igation:SYstem�. ' �,.'� - � �. � : , � � ',, �. � ' � ' , -
� i
45. Sound��AfYenuation :!-t,'•i � <���' r �` �'�' ' �.' _ ' � � _ , ' ' � � : _ • • ^,: .
,�, � . i !' i . .
46. HandicaP�Regulations� � I � } � =� � � � � i ' � i ' � - � . , ; �
47. FINALSTRUCTUR�& BUILDING� � � � � � � � �
,
ff-IJ-63 8 ;
- . , � . w � � - � • .�% �, ' r
48. Special Requirements Compieted ��- � . ; _ ' i � � . � ..
. - ., , ..� � �
49. Electric Release to�Edison i � � ' ' ' � � , , �
� i! . ; - - - �-`
� t � '•� i'_ i . . _1 T_' ' � " . �
� �
50. Gas Release to Southem Califorriia Gas Co : � � I � � � . � � � , � � -�
51. CERTIFICATE'OF, OCCUPANCY ';� ' � � � _ ♦•? '
I i � I�;� i_ _�. .� i_ f'_,' .' '+ l` . t..
No. �. Date � . ' � ' � � � I '
'1- ' �a. .� -... �l_ - - ' .
I - - . - -- - -- - - /'
�_ _ .
"� AGplicant to fill in all s0aees wil�ln �ea
OF�COSTAMESA PERnny7No. ��
i&RLCTION PERMIT 1� � o �
Rrch/Eng. �� �� �/�-(�� � License No.
Address 3�C•T� M� -.ry-1�-i—`�Q—f� ilY1Y �i]-�.
Contractor •/U)� y�', �j �, ' TPhor
I hereby affirm that 1 am licensetl unaer provisions of Charter 9(tom-
mencln9 witn S¢CllOn 7000) ot DiviSiOn 3 Of tne' Business antl
Rolessions Cotle, ana my Iiceel5e is in full torte antl effect.
License Clazz LlcenSe No.
Da[e Si9ndture � �
WORKERS' COMPENSATION DECLARATION -
I hereby atfirm that I bave a certitica[e o( tonzent to self-Insure or a
'fi�te of' Workers' Compensation Insurance, or a ttrtltietl copy
�o( (Secllon 3800, LaO. C.).
F.,..cy No. Company
❑ Certifi¢0 topy i5 herl�y �u�nl5hatl. - � - � - -
❑ Certifietl copy is file0 wilh the city Builtlin9 Divlilon.
EXEMPTION FROM WORKERS' �OMPENSATION DECIARATION
(This section n¢etl not be completetl it the permit is lor one huntlrea
(y300) or 1¢ss).
1 certify Ihat In the pe�fo�mdnC¢ 01 the work fo� w�ic� this permii i5
issuatl, 1 Shall not �mplOy any per5on in any mdnnCr so as to become
subject to t�a Workers' Compensatlon Laws ol California.
Oate Signature
NOTICE: if after making this Oeclaratlon, you shoultl become zubjett
to [he WOrkers' Compen5ation proy�SiOns Of [he Labor COtl¢, yoU must
forthwitn comply wit� SUGh provis�on5 or thiz permi[ shall b¢ tl¢Cmltl
revoked. -� - - _. . .
'C,�JNSTRUCTION LENDING AGENCV
I,hereby affiqn that lhere Is a cop3truction I¢ntlin9 aqency tor the p¢r-
formante'of`the work for�which'(his:permit�6 issuetl;(Section.3097
Civ. CJ.
Lentl¢r'S Name
lx�.tler's Atltlress
OWNER BUILDER DECCARATION -
1 he�eby af(ir�n lM1at 1 am exempt f�om th¢ Con[�acto�'S LICenS¢ ldw for
[he following reason (Section 7031.5 6usiness antl Protessions Code:
Any citY or county which requires a permit to construct, alt¢q
Improv¢, demollsh or �epair'any StructurE, prior [o It5 i55uan<e, also re�
..���.ac rno anniirant lor such oermif �n fiie r zianetl s[atement that h¢
Jter 9(commencing w�Ut SQ�[Ion �000)`oL•Divlsion 3 Ot; ne
iess antl ProfeSsionS Cqtle) or thal he is ezemp t therefrom antl [ne-
, for the allegetl exemp[ion.'qny violatlon of; 5ection 7031.5 by.
any appli�nt for a permit 5ubje�[s the applitanC to'a tivil penal[y
ot not more [han fiv¢ huntlretl tlo�lars ($500j.
❑ I, az owner of Ue property, or my employees with wa9es as cheir
5012.comp¢nsation, will Go tne woYk, antl the StruCtu�e Is nol intentlea
or o(feietl.for�sale. (Sfction ]044, Busineks antl•P(ofessiops Cotle: The
Contrdctols� Llcense Law tlOeS not applY -�o �an rowner Of.a p�operty
who builds or improves thereOn, 8ntl who tloei Such wo�k himself o�
ihrou9h his own'employees,-provitletl that such iTprovement5 ar¢ not
intenaetl or offereA-for.sale:-I1, however, tne bWltlir9 or Improvemdqt
is soltl within one yea� oi� compl¢tion, [he Own¢� will have:thC bu�tlen'
of provin9 he tlitl not builtl or improve Por the purpose oi sale).
❑ I,-as owner ot [he�proper`y am.exclusively cq�tracting wilh
Ilcenzetl_.cont�acto[5'�to,constr,uct Ihe•project (Sectton 70,pR; Business
antl P'ofessions Cotle: The Contrat[or's Llcense Law tloes not appry to
an owuer of prOperty who builtls o� imprOveS th¢r¢on, aritl who con-
t�acts f�om Suth p�ojecti with a contrattor(5) IVCCSOP��jiUlSlldfIL�SO'
the Contractor's License Law):'�� � _ �_.. .1
❑ 1 am exempt untler Seclion "' - B. 6 P: C. tor [nis
reason + " � �
Date - Owner - ��' \'�
that I M1ave r¢atl tnig appliWtion dna �.
cortecL I agree [O comply with a
Stat¢ Idws relatlng t0 conslrUGtion, a�
Da[e
lines ana siqn all aoVrov��ate aeelantio�
10�7C. � �f.� �r ��._.
7VP� OF CONSTRUCTION
:� LEW ❑ ADD ❑ ALTERATION
❑ REPAIR ❑ CONVERSION ❑DEMOLISH
❑ OTHER
DESCRIPTION OF WORK �//�-n �
TYPE OF PERMI�J . � /'
❑ GRADING ❑ FOUNDATION Cd'STRVCTURAL
❑ TENANT O ELECTRICAL ❑PLUMBING ❑MECHAI
❑ OTHER
PROJECT D RIPTION I .p
SQ. FT. Pi SQ._ �GGl'6F5 �� pi
OCCUPANCY ��� O�V,s�TRUCTIONTVPE�
VALUHTION f�Q.ZONE
GRADING CU. `(.p5. ACRES
REMAl2K5:
PIUMBING
BATHTU85
TOILETS
LAVATORIES
KIT.SINKS
F
�NTERCEPTORS
SWIMMING POOL
WATERSERVICE
GAS SERV ICE
�LAN CHECK
SHOWERS '
URINALS
DOVBLE LAVS
DISHWASHERS.
SUMP$ � �
FLOOR ORAINS
CIARIFIERS
PTRAP
ALTERP.TIO�
OVTLETS
BTU OUTPUT
SEWER CONNECTIONS
SOI.AR TFNK COLLECTORS
SOLAR PIPING SYS.
ISSUE FEE � -
MECHANICAL PLAN CHECK
HEATING SVSTEM 0-300,000 BTU_
AND DVCT,NG, .. .�00,000 * BTU_
REF0.IGERAT�ON `�0-300,000 BTU_
'SVSTESM'` i_ �180,000 + BTU _
� ]
flOILERS `!. '� ', � BTU
SVSTEM REP�AIR}HITERATION
EXHAVSTSVSTEM MULTIPLE
ISSUE FEE
CMF 0865-46 White-Builtling; Qanary-Applicant; Pink-Accountinq; Goltlenrotl-Assessor
_ . ! o5aa �izaiai 6�:9. :
_ • , : '�, ^
� 7G, �', 3�
ZONING REGULATIONS � TT—I
A.P. �
ZONE D �
gn���j,,1
S5EpTEBACK C/L ST. TT
L�EFTVARD l ��_G
10
1 E�5pYi �� .
RIGHT ,�.Z..�i
REAR YARD (TO P/L)'
PKG. SPACE REp. �
STREET WIDTH �p
ZONING APPROVE� B\
SVECIAL CONDITIONS�
�
PROVIDED
OARK FEE §
)LD FOR SPECIAL REQUIREMENTS
—3Fi� �-zS�z �Z
ELECTRICAL aLarv cHECK
¢rv�nni�n pyKW_1-lOKW_
TRANSFORMER
APPLIANCE 30-SOKW_SO+KW_
MOTOftS 0-I FIP_1-10 HP _
(INC. SOLAR) �0-50 HP 50 * HP _
FIXTVRES � pUTLETS SWITCHES
GAS TUBE SIGNS - -
POLE LIGHTS _ , _ _ , - .
PANELS MAIN SUB "
SERVICE AMP
ISSUE
BY ��� Y - DATE
� - SUMMARYOFFEES
BVILDING ���J �� QQ
PERMIT 5171�_ SMIP S�.�C,.QS1
PLAN CHECK S PERMIT -
PLUMBING $ �SSUANCE S
GRADING S
PLAN CHECK $ • ,
ELECTRICAL $ � b
PLANCHECK' $ MICROFILM E
MECHANICAL E' TOTAL FEE E���
PLAN CHECK & LE55 AD- -
VANCEPC�$_
C .> > ` : C� �. ' ry q
" � �. � FINA�FEE�;§_��
- �- - � �
—'-- ``"— - AOD���ant to ftp In a11 soaces exceo< ihose within heavy bortler lines ane sign all avProDriate aeclarations.
eiTY G'r'COSTn nnESA CONSTRUCTION PERMIT
�PjotECt Address 3�+�+.`• Harho^ Gate��ay South
Applicant's Mailing Address 3555 Har�or Gateway South
Owner'sName _�-�7=—�Se�P1"ctt"Offl Phone 545-0�'IO
,Address —3:iiti�airviet�+_,�n.sia �iesa �
Arch/Eng:_N�P�lill t� :Stall]2o LicenseNo. �-�Q559
��es� q�fi Tnw�R fniinYry ' Oranoe �S-S�•37p7/
cg tr to��l � �hot,n J_.11�.J�23
ztd'a�� e �3�/� e
City License No. '�Ir74S -
LICENSED CONTRACTOR OECLARATION
I hereby affirm that I am Iicensetl untler provisions ot Charler 9(commencinq
witn section 7000), of DivlSion 3 ot the BUsiness antl Protesslons Gotle, antl
my Iicense is in tull forceantl eti�L �� I �
Licens Cla s ce N
'�ate Si9nature
�JHKERS' COMPENSATION DECLARAT��N
lfer¢by atfirm that�l have a certificate of cOPSCnt to selt-Insure or a certificate
of Workers' Co�^y��W IP ran or a cer[jL�L opY,�h ere� (Sectlon
3800, �ab. CJ `' —b `� � ��`7I e j'VVI(7`
Policy Nm �� ComPaPY��j�
❑ LerHBetl copy is �ere0y furnishetl. '
CD'�eef(j/I¢{t�coPY.�if��letlwAPDlcantY� DI n.0.t /?..�
l:/ I(o r�[o T/ (.i'1Ll.CP�
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thissection neetl not be completetl if Ihe permi[ is tor one huntlretl (5300) or
less).
I certify that In the per(Ormance of th¢ wOrW �Or whiCh thi5 pe�mi{ is i55uetly I
snall �not employ any person in any manner, so as to become subj¢ct io the
workers' Compensation Laws'ot California.
Date • Si9nature �
FIOTICE: If, atter making [hidtleclaration, you ShoulQ become suoiec� to tne
Worke�s' Compensation provisions Of [he Ldbor Cotle, you must to�thwith
compry with such. provisions or' tnis permlt shall be aeemetl revoketl.
CONSTiiUCT10N LENDING AGENCV
I M1er¢by aHirm that there is a mnst�uction le�tlin9 agency fo� the perto�mance
of the work lar"wh' this�permit iz �ssuetl (Section 309] Civ. C.)
L'enaer's Name
Lentler'S Atldress .
OWNER BUILDER �ECLARATION �
1 har¢Dy dtflrm that 1 arn exempt irom the Contractor's License� L.aw�for the
following reason (Sectiori 7031.5 Business a�tl Protesslonal Cotle: Any city or
county w�lcn �equires a p<rmit to cOnst�uct, alter imprOve, tlemolisb o� repair
any structure, prbr to its issuance, also reqWrlS the applicant fo� such perTit
to file a Signetl staternent tnat he/She is IicenseU pu�suant to the provisions of
§e Contractot's Wtense Law (Chapter 9(commen<in9 with Section 7000) of
JiviSion 3��of the Busine55 antl P�ofes5ion5 Cotle) Or that he/She is eaempt
therefrom ana lhe basi5;for the allegetl exemption. Any vfolation ot Section
]031.5 by any applicant (or a permit subjects the aOP�icant to. a civil
�enalty of not more than five huntlretl tlollats (5500).
LJ I, as owner of the property or my ert�P�oyees with wages as their sole
compensatiOn, will tlo the work, antl IM1e sUucture Is not intentletl o� offeretl
for 5ale (Section 7044, Business antl Profe551ona1 Cotle: The Contractor's
�icense Law tloes not apply to an owne� of d Property who builtls or improves
thereon, an� wno tlaes such work hlmseli/nerself or through his or her own
employees, provitlea tnat such improvements are not intentletl or oiteretl for
sale. If, however, the builtling or imProvemCn[ I5 soltl within one y¢ar of com-
�pletion, the owner will have the burtlen Oi prOving h¢/She ditl not builtl or iT-
�rove for the purpose ot sale).
I, as owner of the property, am exclusively contracting with licensetl con-
' t�actorsto con5[ruct the project (Section ]OA4. BuSineSS antl Profession5 Cotle:
The COn[rac[o�'s License Law tloes, not apPly to an owne� ot property who
� builds o� improves�lhereon, antl who confracts for such prOje[ts with a con-
� tractor(s) i¢enze'Oursuant to tne Contractor's Ucense Law). I am aware that
pro0f O( t�ei� Worker'S Compensation inSNrdnte Shoultl be provitletl to m¢.
� I am ¢xempl undet-SectiOn B. b P. C. tor thl5 reason
� Date. Owner
I hBreby certity that I have reatl Ihis appPcation antl sta[e that Ihe above
Informatlon is correct. I agree to comply with all dry antl county ortlinances .
antl state Iaws relating to buJtlmg constructlon, ana hereby authorize repre-
t tl f this cit ' to enter u on th6 above-mentlonetl ptoperty for
.� — 26 S� � � 108
TYPE OF CONSTRUCTION NE
❑ CONVERSION ❑ DEMOLISH
J Aoo
OTHER
A
�LTERATION LI REPAIR
Lerior Alterai.ion AP *,
� � S Main Build
TYPryE� OF PERMIT LI GRA�ING LJ FOUNDATION . STRVCTURAL T Front
LI�J TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 6 Rear
❑ OTHER A
PROJECT DESCRIPTION Sp. FT. � 5GA OCCUPANCV_B� � Rig
CONSTRUC�J,QJVTYPE �-� VAWATION$ ��,454.00 g Left
ZONE U1 G(3ADING CU. VOS. '' ACRES p�ng. R2f. #
qemarks: - # 3 ��0 � � � Planning Notes:
h ' . : � . - l'.�.�n.�
Sink' .
<flow Preventer
<flow Irrigation
�tuhc
Jrinking Fountains
FloorOrains '
Floor Sinks
�as Service , Outlets ,
Interceptors �
Kitchen $ink '
lavarories . .. -
P-TreP. .
Roof OrainS �
Reinspection Fee $15
Boiler , ' . �
Duct - Under Ground '
Duct - Svuctural
Duct - Ventilating '
ExhaustSystem ❑ �MWtiple
Firepl/Fact. Blt. ICBO �
Heating System & Ducting
❑ ai oo,000 aru O � oo,000
I5¢O d v85 O p — – �_
inspectiom purposes
Signature � ' � ' � � Da[e 1z ._i� �E� ,
Drivers'-License or 55 � Rainspection Fee
CMF 0865-46, rev. ]0/84 White - Builtling: Ca�ary - Applitant: Pink - Accounting; Goltlenrotl - Assessor
$15'
ShOwers
Service Sink '
Sewer Cap-
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank �
Swimming Pool w/Spa
Urinal
Wdie1 CIOSei
Water Heater
Water Service -
Auto-Wash ' -
Laundry'Trays
laue Fee
Hood or Typel ❑
Canopy Type I I '�
Refrigeration System
Oo�ioo,000aTu ❑ioo,000
System Repair/Alteration
Fire Dampers
Registers
9
$ 3
FEES
Automatic Washer
Construction Pole Sub.
Cooking Unit '
Dishwasher •
Dryers �Gas �Eleci
Fan
F.A.U. '
Fixtures
Device Boxes �
Outlets. . '
Switches
Generator
� JJ O OI Zone
• Accessory Building:
. Z
O
, N
i
N
G
R
Parking Req./Provided E
o A � lf�t�Ts M
T
S
ELECTRICAL .
' Trensformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps .
Meter �over100amps
Sub Panel . -
Motors � 0� 7 H P � 1 X- 8
Inc.Solar �9-15 HP �16-15+
KW OS-15 KW
FEES
Pole Light � ' ' .
i Range
Sign - �
• Standing Sections � .
Trash Compacror .
I Reinspection Fee �$15 � I laue Fee
DEVELOPMENTSERVICESREQUIREMENTS: �
2oning APProved BY��� «.��
/��' Y�ir'�y'`—
Buildfn9 APProved By ��� ���- ���`�
Issue Fee . ' $ 3 '
- � $ 3
�
- SUMM RV OF FEES � '
BUILDING PERMIT $ /.��• SD . SMIP ' $- /, S I
PLAN CHECK $ 2 S' r6 -pERMIT "
PLUMBING $ �SSUANCE � $
PLAN CHECK 25% S ENERGV P.C. $ -
ELECTRICAL $ GRADING $ ,
PLANCHECK 50%. $ � MICROFILM $ �p� ��
MECHANICAL " $ � TOTAL FEE $. 1Sj'�-�La1
PLAN CHECK 25% $` •
CONSTRUCTION ANDPLANNING , POOL&SPA
APPROVALS � Permit# Date Inspector� AppROVALS Permit# Date .Inspector
t
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test �
6. Electrical UFER Grnd. 57. APPROVA�TO COVER-GUNITE
7. Footings � 58. Electrical Conduit-Undrgrnd. �
8. Foundation . � � . 59. Gas Pipe, O Undrgrnd., Test .
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
77. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
73. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing t, .� G� 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring � �L�jb�.�(� C, �67. Fencing & Access Approval
- 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. RoughElectrical-TBar�Ceiling 69. POOL/SPASYSTEMSFINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush .
24. Roof Framing 73. Undergrn�i. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro -
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing -� 76. Dry Standpipe ''
28. Lathing & Siding � � 77. FIXED SYSTEM FINAL
29. Insulation � 78, FIRE PREV. FINAL '
30. Drywall Nailing . �� HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION �
32. Electriral Power Meter-Final ' 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: . �
34. Final Heating & Air Conditioning �, (.� 1
pwi
35. Final Gas Pipe-Test
36. Hood or Canopy � �
37. Final Factory Fireplace
38. Final Plumbing ' .
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final �
42. Backflow Preventer
� 43. Backflow Irrigation �
44. Landscape Irrigation System
45. Sound Attenuation ' .
46. Handicap Regulations � -
47. FINALSTRUCTURE&BUILDING Z ' �
48. Special Requirements Completed - •
49. Electric Release to Edison •
50. Gas Release to Southern California Gas Co '
51. CERTIFICATE OF OCCUPANCY •� .
� . - . .
No. Date • �, �y +'
�
ADo�icant to fi11 in a1l spaces exceot those within heavY Doraer Itnes antl sign all appropriate Geclarations.
� �CITY OF COSTA MESA CONSTR �CT_IO`N PERMIT
Project Address �-� �,Q/ ���.1� 5� �
Applicant's Mailing Address � � V ���RFL[f
Owner's Name 9��'y'T�t%M � Phone
`Address /�����/ p��
Arch/Eng. S.J' r��' ' TS�1�_LiGense No.
Address '�� n �V �D �L'� ' '
Contracror's NameS� �Y ���a�L Phone �C
Addresslmailing) �3 �lMJO�t��(C31�..-r� -�2J�ra�
City License No. � �11 �T
IICENSED CONTRACTOR DECLFRATION
1 h¢reby atfitm that I am licenzetl untle� provisionS Of Charter 9(commencing
with section ]000) of �ivision 3 ot t ie Buziness antl Professions Cotle, antl
� my license is in full orc antl effect. ( T� ,
1 ' bense lass � Li s� V
� te Si9nature ' -
I' ..ORK RS' COMPENSATION DECLARATION
�I hereby aitirm that I have a certiticate ot mnsent Co selt-insure or a certificate
ot Wo�kers' Compenza[ion Insu�ance, o� a certi(ied copy [nereot (SeCtion
\ POOc�y Noyi ��� � Company �� �
�Certifietl copy " hereby furnisheC.
Cer i' c f' tl with the ciry u" tl Dlyl n.
Date Applitant...���.L �� �
EXEMPTI N FR WORKERS' COMPENSATION DECLA ATION
(Thissection neetl not be completetl if the permit i5 f0/ One huntlretl ($100) or
less).
I certi(y Ma[ in [he per(o�mance of the work tor Which this perm�t is i55uetl, I
shall.not employ any person in any manner so 8s to become subject to the
Workers' Compensation Laws of Califomia. ,
�atei � Signa[we
� NOTICE: If, atter making this tlecla�ation, you shpultl become subject to tbe
Wurkers' Compensation p�ovision5 O� the Ldbor Cotle, you musi torthwith
comply with such provision5 0/ tM1is Oe�mit shall be tleemetl �evoketl.
CONSTRVCTION LENDING AGENCV '
I hereby affi�m that there:is a mnst�uction lentlin9 a9ency ton the Oe�formante
of tM1e work for whicn this Dermi[ is issuetl (Section 309] Civ. C.)
1 Lentler's Name
Lender's ACtlress �
OWNERBUILDERDECLARATION '
� I hereby attirm that I am exemDt trom the Cont�actor's License' Law for tbe
�
following.reason (Section 7031.5 Business antl Pro(essional Cotle: Any city or
'�unty which requires a permit to construct, aiter Improve, tlemolish or repair
� ztructu�e, prior to its is5uance, alw requires the applicant for zuch pe�mit
tile a signetl statement that tte/she is licensetl pu�suant to the p�ovi5ionsbf
�e Contractor's License Law (Chapter 9(commeqcing wi[h Section ]000) of
.Division-3-of tne$u5iness antl��Professwns Cotle) or thathe/sne is exempt.
therefrom antl the'basis for the alleqetl exemptiOn. Any violatlon of Sec[Ion
7031.5-by any applicant tor a permit subjects the applicant to a civil
�enalty ot not more tnan five huntlretl tlollars ($5p0). �
LJ I; as; owner ot tne, property or my employees with wages as meir sole
coinpensation,.will tlo the work, antl the structu�e i5 not intentletl or o(te�etl
(or' sale (Section- 7044, Business antl Protessional Cotle: The Contractor's
License- Law tloes not apply to an owner of a�prop¢rW wno builtls or ImDroves
- h k h' self/hersel� th h M1is or ner own
�� i .
TYPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR �
❑ CONVERSION� ❑ DEMOLISH OTHER ' q.p, # �
DESCRIPTION OF WORK/USE OF BCDG: '� � � � -�
S Main Building: �
TYPE OF PERMIT GRADING FOUNDATION ❑ STRUCTURAL T Front
❑ TENANT � ELEGTRICA�' ❑ PLUMBING ❑ MECHANICAL A Rear
❑ OTHER �
PROJECT DESCRIPTION 'Sc]. FT. - oCCuvaNCv C�Right - �
' K Left � •
CONSTRUGTIONTVPE � � VALUATION$ $
ZONE GRADING CU. VDS. ACRES� � p�ng. Ref. �i-` '
Remarks: �' g a 5 �� ' Planning Notes: �
' PLUMBING . . _ FEES �
Bar Sink , , Showers ' � � � '
Backflow Irrigation
Bathtubs . �
Clarifiers -
Dishwdsher -
Drinking Fountains
Floor Drains . .
Floor Sinks � '
Gas Service
Outlets
Kitchen Sink _
Lavatories
P—Trap •
Roof Drains
Reinspection' Fea,
thereon, antl wno tloes suc wor im or rou9
employees, provitletl that such imOrovements are �ot intentletl o� otteretl fo� BOil2� .
sale. It, however..the builtling or improvement is sola within ona y¢ar of com-
-pletion, Ne owner will have the burtlen of proviqg he/she ditl not bulltl or im- Duct - Under Ground
�rove for the purpose of sale). _ , ' ,
LJ I, as owner.of'the property, am exclusivety cbntracting with licensetl con- Duct-Structufal
tractorsto construct tne project (Section �044, BUsiness antl Professions Cotle:
The Contractor's License Law tloes not apply t0� an owner of Droperty who � Duct - Ventilating
builtls or improves thereon, antl who contracts �or such projects wltn a con-
frat[or(5) license pu�suant to �the ContracioYs Licenre �aw). I am aware that Exhd�52 $y5LCrt1' ❑ MultiplC �
proot of their Worker's.Compensation insuranc¢ snoultl' be provitlea to me. . .
❑�1 am exempt untler Se<tion � ,_ � B. & P. 0. for thi5 reason � Fir¢pl/Fdtt. BIL. ICBO �I`- '
Date Owner ' Heating System & Ducting
I hereby �certity,.that -I have �reatl �this applicatiOn antl state that the above �� ❑a100,0�0 BTU �100,���61
intormation is c rrecL-I agree to comply with all �ity ana county ortlinances !�. _
antl state laws� lating to b ' q cons uttion, antl.hereby auth rize � pre- -
sentatives o Fi s cit to ent r upon the.above-mentionetl pr pert t r. �. �.. �"�
inspection p � �
Si9nature Dat � . . . �
Drivers' Cicense or 55 �' Heinspection Fee '$15
i i _
CMF oes5-46, rev. 10/04 - White - BWltling; Canary - Applicant;�Pink - Acrounting; Goldenrotl - Aszessor ,
Service $ink '
Sewer Cap
� Sewer Connection �
. Solar Collecmri
� Solar Piping - '
, Solar Tank
Swimming Pool w/Spa :
Urinal
Water Closet '
, Water Heater
_ Water Service _ �
, Auto-Wash ', -
Issue Fee
Hoodor Typel ❑ :
Canopy Type II ❑ ;
aefrigeration System
❑6100,OOOBTU ❑100pC
System Repair/Alteretion :
�FireDampeh � �.�
Registers
' , r
.. . la�e Fee
�
FEES
AOiOffIdLIC Wd5h8f
Construction PoleSub.
Cooking Unit ' 1 ' ,
Dishwasher -
Dryers ❑Gas ❑Electric .
Fan
F.A.U. � �
Fixtures � �
Device Boxes .
OuUets
Switches . .
Garbage Disposal
Generator �65 KW �5-75 K
a
�'�'o� '�tU- TL
ELECTRICAL _ -
Transformer ❑ 15-50 KW
❑ SO+KW
Meter ❑up to 100 amps
Meter ❑over100amps
Sub Panel . �
Mators �P7 HP � 1 X- 8
' InaSolar'09-15 HP 016-15+
Microwave '
Pole Light - - �' ^ �
Flange
� $ign
Standing Sections
W Trash Compactor
u
' I Reinspection Fee I. $15 ' I Issue Fee
DEVELOPMENT SERVICES REQUI REMENTS:
Zanin9 APProved By
8uilding Approved By
APpliwtiOn luued By
I
-- N
R
E
Q
M
T
S
FEES
= $ 3
0
.
0
- - - SUMMARV OF FEES � , - �
� � BUILDINGPERMIT $ �SMIP � � $:
' PLAN CHECK � $ PERMIT � ,
PWMBING $ " � ISSUANCE . $; _ _
'� � PLAN CHECK 25% $ --y-�}�— ENERG�' P.C. $>: �
� : ELECTRICAL , $ � GRADING $ . ' - ;`
� PLANCHECK 50%�, $ � �i1�% _MICROFILM $�
� MECHANICAL �S � , TOTAL FEE $ `��
PLANCHECK -25% $ � - ,
CONSTRUCTION AND PLANNING , POOL & SPA �
APPROVALS Permit# � Date Inspector .AppROVAIS 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 .
57. APPROVALTOCOVER-GUNITE 9
6. Electrical UFER Grnd. �
7. Footings 58. Electricaf Conduit-Undrgmd. ��
8. Foundation . 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
71. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
72. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
75.� Rough Electrical-Conduit 66. Solar System-Final ,
16. Rough Electric Wiring �1 ^ 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling �� �G 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT •
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Procluct Piping �Gas ❑Oil �
23. Gas Pipe-Rough & Test 72. Underground Flush �
24. RoofFraming 73. Undergrnd.StorageTank�Gas ❑Oil
25. Roof Sheathing 74. Overhead Hydro • -
26. T-Bar Ceili�g (Structural� & Monocoat , 75. Dry Cfiemical ,' , � '
27. Frame and Flashing 76. Dry Standpipe
28.. Lathing & Siding 77. FIXED SYSTEM FINAL ��
29. Insulation 78. FIRE PREV. FINAL "' �
c.
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat • 79. FINAL INSPECTION '
32. Electrica� Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric .� Notes:
34. Final Heating & Air Conditioning ' ,
35. Final Gas Pipe-Test � � 'I'�
36. Hood or Canopy
37"Final Factory Fireplace ..
38. Final Plumbing ' . --
39. Water Service�Final • � �
40. Gas Service-Final ' �
�.
�41. Solar pomestic-Final ' . - .
42. Backflow Preventer - � � - •
43. Backflow Irrigation � � . "' . � . �
44.',Landscape Irripation System . - � � ' ' �
45. Sound Aitenuation �. . � � �
46. Handicap Regulations . � - ' �
47.•FINALSTRUCTURE&BUILDING ,: � ' � , � �
48. �Special Requirements Completed � � - . � � �
49. Electric Release to Edison - ; -
50. Gas Release to Southern California Gas Co . ' ,
51. CERTIFICATE OF OCCUPANCY ,
No. Date � ' , _ , _
�
i a
Applicant to fill in all spaces eacept t�osa wit�in heavy bortler lines anO s gn all ao�ropriate eclarations.
CITY OF COSTA3ESA C STRUCT40Jjl YF,HMIC^�PW �
Project Address l t14�-bor
P.pplicant'sMailingAddreu � � � � � Q.
Owner'sNa ��-��'-e'rs"�'��O'�'"� �Phon '
Address � � � Q � r' (fi L�,LJ ��-N �
_q
Arch/Eng. License No. ,
AdJress
COntractor'c Nama -4 L� f ��- _ � e �(�� C Phone �1
Addresslma���,l � � /J Pr�. � � �l'l///7C(;ct.
City License No �� 7�- �
LICpNSED CONTRACTOR DECLARATION
I her¢by aftirm that 1 am licansetl untler provisions of Cbarter 9(commencing
with s¢�{ion ]000) o/ Dlvlsion 3 of the Buziness antl Prolessions Cotle, antl
my Iicense is in full r<e antl etiecL � 3/� �
Licens Class ��Q �� � en no.
�ata �'�i'�'�-r� �
/ORKERS' COMPENSATION DECLARAT)
I hereby aftirm thdt I have a certi(icate of Co1n nt to zalf-Insu�e o� a C¢rtlficate
of Workers' Compensation InsUrance, or a certlfie copy [hereot (Seption
3800, Lab.� C`_.) '
PoIICy No�a.Ct'�C�7�� Company �� ' �
CertitieU coOY is he�eby furnishotl.
atgert�tl t'ppY26jUea w�inlPPl cao{Y ui 1rt '' ie �
�F 75 (e
EXQMPTION FROM WORKERS'.COMPENSATI EGLARATION.
(Tbissection neetl nol be completetl i( the per I 5( r one huntlretl (S30 or
Iess), '
I certi(y that in the pe/fo�manG¢ 01 the rk fo� wnich thii pe�m�t i5 issuetl, I
SM1all nOt employ any pe�son i� any dnne� so as to become SUDjett l0 the
Workers' Compensation� Laws of ifornia. �
DatO Sig ure
N071GE: If, atter making t' tleclara[ion, you shoultl becOme subject [o tne '
Wo�ke�5' Compenyytion- vi5ion5 ot the Ldbo� Cotle, y0u mu5t fOrtnwitlt
comply wlth SUCh p�- SiOns o� thls pe�mit Shall be tleemetl revoketl.
CONSTRVCTION L DING AGENCV '
I hereby aiflrm that ere is a<onstruction lentling agency for the performance
ot (ho work f whiCh [his perTit .is i55uetl (Section 3097 Civ. C.)
LP�tler•s Name �
Le�der's Ailtlress
OWNER BUILDER DECLARATION � '
I h8reby affirm that I dm exempl from the Con[�ac[or'S LlcenSe Law fOr the
following reason (Section 7031.5 Business ana Professional Cotic Any city or
munty whlclt �equires a p¢rmif t0 cOnstruct, alter, improvB, tlemoli5h o� �epair
•ny structure, prior to its issuance, also requires the applicant tor such permit
e file a signetl statement thal he/she is IirenseQOursuant to the Orovisions o(
.ie [nntractm's 1 icense Law fChaoter 9(commencinq wlth Sectlon ]600) of
[h¢Yefrom an0 thC ba5i5 fo� th¢ allegetl exemption. Any vlolation oi Sectlon
70j1.5 by any ap0licant tor a permlt subjects lhe appllcant [O a civil
�endlry of not more than fiv¢ huntlr¢tl tlollar4 (E500j. '
LJ I, as owner ot the property or my employees with wa9es as their sole
compensation, will tlo lhe work, antl the sVucture is not intendetl or offeretl
tor �le �Section 7044, Business antl Professional Cotle: The Contractor's
License Law Coes not apP�Y t0 an owne� of a property who builtls or improve5
thereon, ana who tloes such work himself/herseli or tnrough niz or her own
empl0yee5, provitletl Ihat such improvements are no[ inlenUetl o/ offeretl to�
zal@, It, however, the bulltlin9 ur improvement is Soltl wlthin one year of com-
plelion, tne Own¢r wlll nave the burtlen ot proving he/she Ultl not builtl Or im-
�oye 10� the purpose oi Sale). . '
I, as owne� oi [he p�operty, am ezcluSivNly cont�aGting wlth licensetl con-
tratlors to construct the pro)ect (Sectlon 7044, Business antl Profe55ions Cotle:
ThB COnl�actor's License Law tloes n0[ appry to an owner ot property who
builtls or improves thereon, antl who contracts for such projects witn a con-
tfaCtol(51 liG¢nse OufSudnt�to Ihe ContrattOr'S Litense LaW). 1 am awafe that
Proot o( their Worker's CompenSation insurance shOultl b0 p/ovitletl to me.
❑ I am exempt untler Section B. & P, C. tor this reason
Date Owner �
I nereby certity that I have r¢atl this application antl state that the above
���Ormatlon is correct. I aq�ee to compty with all clty anC county ortlinance5
anq state laws relating to builtling constructlon, antl hereby authorize reore-
Sentdtives of thja city"'!p en�efiyIIan (he dbove-mentlOn¢tl ProOerty tor
TVPE OF CONSTRUCTION LJ NEW L�I ADO LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTIONOFWORK/USEOFBLDG. �AMMI�.RL1A:.
TVPE OF PER T � LJ GRA�ING L1 FOUNDATION IJ STRUCTURAL
❑ TENANT ELECTRICAL ❑ PLVMBIIVG ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION- 5q. FT. oCCuaANcv—
CONSTRUCTION TVPE VAlUAT10N $
ZONE GRADING CU.YDS. ACRES—
o....�.�..'71 � �ti � � r.� _ .-. a r""�
Bar Sink
Backflow Preventer
Backflow Irriga[ion
Dishwasher .
Drinkin9 Fountains
Floor Drains
Ploor Sinks . .
Gas Service �
Kitchen Sink
Lavatories �
P-Trap
Roof Drains ` -
Reinspectian Fee $15
Duct - Under Ground
Duct - Structurel
Duct - Ventilating
Exhaust System ❑ MWtiple ❑
Firepl/Fact. BIL IC60 #
Heating System & Ducting
❑0.100,000 BTU �100,0008T'
Si9nature � "���� a Y-O
D� s'�LI s o 55 � _�� Reinspection Fee $15
CMF OB65-46, rev. 4/84 White - Bulltling; Canary - AppliCant; Pink - Atcounting; Goltlen�otl - ASsessor
Showers
Service Sink -
Sewer Cap
Sewer Connection
Solar Collector5
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet . �
Watei Heater
Water Service
laue Fee
Hoodor Typel ❑
Canopy Type I I ❑
Refrigeration System . . .
Oo-ioo,000eTu Oioo,000er�
System RepaidAlteration �-
laue Fee
FE
$ 3
$ 3
�358 3/04/86
PI � 9 Q Y�� C� BZ.Z`j b"7 .
A.P. # - . Zone,
S Main 6uildin9: � Accessory Builtling:
E
T Front �
A Rear _
C Right
K Left
S
Ping. Ref. # � Parking Req./Prov"ided �
Planning Notes: . ,
0
ELECTRICAL
Fluromatic Washer Transformer ❑ 15-50 KW �
Constructior Pole Sub. . � 50 + KW
Cooking Unit ' Meter Oup to t00amps
Dishwasher Meter �over100amps
Dryers ❑Gas ❑Electric Sub Panel
Fan � Motors�0-1HP�1'/:-8
F�A�U. ' IncSolar �9�15 HP �i6-15+
Fixtures ' . - � Microwave ' �
Device Boxes Pole Light
Outlets Range
Switches Si9n
Garbage Disposal
Generator �0-5 KW 05-15 KW
Standing Sections
Trash Compactor
I Reinspection Fee I$15 � I Issue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning APProved By
Building Appraved By
Aoulication laued Bv n
SUMMARV OF FEES -
BUILDING PERMIT $ SMIP
PLAN CHECK $ PEFMI7
PLUMBING $ ISSUANCE
PLAN CHECK 25% $ ------���---���--- ENERGY P.C.
ELECTRICAL $ � GRADING
PLAN CHECK 50% $ MICROFILM
MECHANICAL $ TOTAL FEE
P.LAN CHECK Z5% $
$
I�:o�O
FEES
$ 3
Z
O
N
I
N
G
R
E
Q
M
T
S.
1
CONSTRUCTION AND PLANNING - � � . 4 �& SPA
APPROVALS � Permit # � Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole ' - 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. . � 53. SteeP Reinforcement .
3. Electrical Conduit Utility-Undrgrnd. � ' 54. Forms
4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding � �
� 5'.'Steel Reinforcement 56. Rough Plumbing & Pressure Test
6.��Electrical UFER Grnd. � . , 57. APPROVAL TO COVER-GUNITE -
7: "Footings - - 58. Electrical Conduit-Undrgrnd.
B..�Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgmd.� � -' 60. Backwash Lines, P-Trap, � Undrgmd.
� 10. Structural Floor System � 61. APPROVAL TO DECK
11.'Property Sewer Line & House Connection 62., Backwash & Receptor-Final , .
12. Sewer Cap � � 63. Heater & Vent-Final • � .
13. Roof Drains 64. Plumbing System - Final � -
14. Rough Plumbing - 65. Electrical-Final ,
15. Rough E�ectrical-Condui[ - ' 66. Solar System-Final
i 6. Rough Electric Wiring � � �,�� � . Fencing & Access Approval -
�
17. Rough Wiring Sign �� � � � - 68. APPROVED FOR PLASTERING � '
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL �
19� Fiough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Faaory Fireplace APPROVALS Permit #
21. Ducts, in Structure , 70. Underground Hydro
.22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test ' 72. Underground Flush .
24. Roof Framing . ' , 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing - 74. Overhead Hydro '
26. T-Bar Ceiling (Structural) &�Monocoat _ 75. Dry Chemical �
27. Frame and Flashing � 76. Dry Standpipe
28. Lathirig & 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 � � � � es: �
34. Final Heating & Air Conditioning � _ � `,�
35. Final Gas Pipe-Test . , �
36. Hood or Canopy � � � .
37. Final Factory Fireplace
38. Final Plumbing � .
39. Water Service-Final � ' �
40. Gas Service-Final . � •
41. Solar pomestic-Final
42. Backflow Preventer � '
43..-BackflowJrrigation ,. , ' _
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 Relesse to Southern California Gas Co , . �
�51. CERTIFICATE OF OCCUPANCY
No. Date '' � � -
AOV��Unt to fill in all spaces ezcept t�ose wit�in �eavy OorCer Ilnes anE sign all apDrooriate Geclarationz.
. . . . . . _ . . ._ - . . _ . .. . .. . . _ .. _. ' _ _ ' _ _ ' " ' _ ' ' ' '.. . .
� CITY OF COSTA MESA' .� ' � , P�E wIT NO , /, /_ TRACT NO. LOT NO. . , - BL . � • � � • � '
� CONSTRUCTION PERMIT � . . _ . L� � C4�I.T i � , _ � • . ' '. . � . . ' . ' - ' ' ' ' ^ .
Y ,. ; ,
AppiiCenYSMeilingAddfezs ' �, �'� �PE�OFCONSTRUCTION, NEW ADD ALTERAT.ION .REPAIR , , - _ � 1 , U7�=.3 .��I1��7I`j:i�� ' .;%�.�� ��
Pfoject Addr055 � -rS HRIPOQQG/II�iwAy 'SL/TG I% ` ❑ CONVERSION "O DEMOLISH ❑ OTHER=: ' � � ' - ' . .. " � ' � � � � � '
Owner i Name G � S,tG/% S�l�Uri � � ��Phone � � . DESCRIPTION OF WORK � T � r : ' . - _ ^�
' _ _ ' . ,. � � � ., I G U ' TI
Addresa ' . : ' , TVPE�OFPEHMIT ' GRADING� 'FOUNDATION .STRVCTURAL ' �+.P s1E � ZONE � • " "' '
� ,
Afch/Eng. " , � ' LiCOnSBNO.; �OTENANT �ELECTRICAL.D�PLUMBING ❑MECHANICAL� ' PLNG.REF.tW., � ..BUILDING . �
Addt¢55� J ' � � � � � � � �,�OTHER ' - � � ' � � TO BUILDING ' " '- r ' , � .
TM aH�N f"Li_'c�> a' SSY-37/� ; PRQIECT DESCRIPTION 5�. FT. - �' " OCCUPANCV R PE V IN I �REAR VARD �TO P/U
Contiactor's Nam� � hone � , , � � -
�'b✓�LfjM/�?u:t�' �%J�Y��NO'RU✓L� � CONSTRUGTIONTVPF � VALUATIONS �LEFTSIDEYARD � R�GHT�SIDEVARD �
� Add�ESS�Irt1816ngI��y� ' - ' ' ' PKG.SPACE RE�. ' � PROVIDED � - �
�� /.9'/ J � r � � ZONE -� , ' GRADINGCU.VDS. ' ACRF$ _ �
License No. d � - . � . . � . -
�LICENSED CONTHACTOR DEGLAFATION , � F � � Ramarks: �[ aG'- �/</tH /T %� � � � � ' - STREET WIDTH • � � . ,PARK PEE,S � - '
I hareby aftirm thet 1 am Iicensetl untler Drovlslons ot C�arter 9(commencin9 , . . � � . . ,
with sectlon 7000� of Dlvlsion 3' of the Business anA Professlons CoOe, an0 �„� � j� ' � , � '- � ' , SPECIAL CONDITIONS: ' � ��- 1 �
�, my Ilcense is In full farce antl elfect. � ' ' � -� •
\ ucensa blau � �' - /U . • � Licens No.ja"S 9 �� : � . . PLUMBING , j � � • � � , ' � � � �
'�ate �'�' � 3 Si9nature ' � . •� ' l r, f
� VORKERS'COMPENSATION� CIAAAT N � ' � ' BeiSink ' i SewefCep � ' ' ELECTRICAL ' ' ' - ;
OI.herebyaffirm that.l.�ave a certlflcate ot cousent to zel}a�zure oi a.certlfiwte - � g�kflow'PrBvanter• -Sew¢rConnection —' ' - - - - �� Automatic WaSher ;,. _�__ ' _ �Mater over,l0� amp5 � _ , O ' '
\of Workers' Compensatlon Insurance,. or a cerSitleC, coOY t�ereof (Sectlon - �- , ;
3800, LiD. CJ , j I � Construction Pole � ,Sub Panel �
� : � Backflow Irrigation . Soiar Collectars �
Poucy No.N��} O �� CompanyCCHrI . VMON . , _ - � � - - - . Cooking Unit ! ' � j 'Sub Pole ' '
❑ CerUilea copy Is nereby turnlsriea• � I � 1 � ' Bathtubs , t ' $olar PiDing ; � I . � , � � , � '
.�� Certl/ieG copy li tiletl wlth the city BuiIC q Dlvlsi n. � � � Di5hN25her i �MotOrs 004 HP � 1 X-8 '
• Date S�'-� � � � Clerifiers ' ; So_I_,ar Tank _ . �
��' ] ApPlicant .�
EXEMVTION�FROM WORKERS' PENSATI DECLARATION � 1 , DiShwdsher` � � � ' SWimming Pool w�Spe Dryers ❑Gas ❑EleCtflC
(Tbissectlon neetl nat be completetl U tha permit Ii Tor. one �unOreE (5300) or ) ��aSolar O9 ;15 HP �16-15+ �
less). � . ' , . � . . . . i -- . Fan' . � 'MicrOwave . � • :
1 certHy't�at In tha performanta aT the work for whl<h thli permk Is iisuea I D�inking Fountains Urinal � � � . . ! �
. shall�. not emD�aY any person in any manner so as So Decome sub7ect. to tha I � , F.A.U. ' � . �Pola Light i � �
Workers' Compensatlon',Laws o1 Cali�omlaJ � � , . � FIOOr DteinS; . Wate� Closet '
Date� • �lynature - � - � / Fixtures
NOTICE: If, after making t�is Oeclard��a�: You� 5hou10 becdma subjact tathe Flaor Sinks � - - WatewHeater - � � - . - - b - - . . — �,Range _ __..�;t„_ ,.., . a �
Workers'� Compensation provisions a� t�e LaGor Cotle, you mustiforthwith � � 1
comD�v �wHh, sucn provislons or Mis pormlt :shall ba ;tleemea. revokea.�.: -: � Gas Service ` 'Ouilats �� INatei Service � " - , Q Device Boxes : i � Sigo. OO •
� CONSTRUCTION LENDING" AGENCV - ; , . � ' ' � Outlets �
I nereDy affHm tnat tnero Is a const.uttlon Ienaing agency for tha parPormance, , Interceptorz " • j � - /O � Standing Sections : O
oi the work for which t�is_ pennit Is'IisueO (Se[tion 309Z. CIv. CJr SwitchCs � � � � '
: Lender's� Name" . , - � KitcFen Sink '.. � ' � - � Trash Compactor , Q
l.ender'S AAOrMs, ' " - - � - � 1 �� - - . ' , ' . .
OWNERBUILDERDECLARATION ' � � = ! � , ��atOfi25 . .' I _ . . , _ , GerbageDi5po521 C , �'
' I heraby�atilrm that I am'exampt from tha Contractor's.Ucense Law for the ' � - , � - Generator �0-5 KW 05-15 KW . , '
tollowing reason�(Sactlon��7031.5 BUSiness antl Profe551onal:Cotle: Any city or. � - � �P-Tiap ' � - '(; � _ � . � � � t � i
'county wfiich reqW�es a pe�mit'to cO�rt�uct, alte� improve, tlemoll5h or roDair .. _ - . , _ TfanSformer Q �S-$0 KW ' �
•ny structura; prior to Itstissuance,'also raqulras t�e apPlicanl ior such permit � r� RoOf D�ains' ' • . '- ; , � ' . ,
ille a slgne0 5tater118n[ t�at h¢/Sh8 �5 Ilcens9tl pwsUant [o thalprOvizlons ot . " � � --
e Contractor's�Litensa Lew�(Chapter 9 (coTmencing wlth�5e[tlon 7000) Oi + : z - ` � ' " " � � ❑$U+KW � � qeinspection Pee '
ivision .3� �of the'Business antl'. Protassions�. Cotle) or, t�af he/She,Fis exempl - Showe�s �, :�, Remspeetion Pee $15 .. , '
' Iheretrom �antl the, batls for tha allegetl exemption: Any vlo�atlomof. $actlon I , �. . . " Metet ❑up t0 100 ampa ' Ilssue Fea� �� � '$ 3 '
;,],031.5 by_any appliwnt /or'�a�.permiY subJects tha�appliwnt to a civll �����eSin& ' � � " �
:'�enalty of not more Man fiva huntlreG tlollars (E500). �"� �� ; 3 �� � � i , ,� �, • laue Fee � E 3 � Zoning Approvad By � , ' Date � � 7
I; �as �owner of'� tha property or'-my emploYeeS.with wages,ai thair sole 1, � _ � � ' , MECHANICAL - ' ' � i � � � � � � I
� compensaHon' witl.Co the work, antl� �herstru<ture� Is not IntentleC or otfere0 � _ � . � , , Application Approved By � � Date --'y��/f�
� for sale (Sec�lon 7044, Business,antl'Protesslonal.Cotle:IThe Contra<tor'S . � - •�
' LJcansa Caw tloes nol aOP�Y �o an ow�er of a propertylwho builAs or Improves gOiIC� � {'�' � � REfrigeratiOn SySteiTt • � � ; � ��/�3 i
� tM1ereon„antl who ;Coes,such� work fi�mself/herself or throug� hls or her own � � � ' � � Application laued By � ' � � DatB L ;
. employees, provitletl that such�impro�ements are'not Intentletl or offereC for '•� . �4100 OBTU ❑100,0008TU � , � , �
� sale. It, howevaq the tiulltling or Imp�ovement I5 5010 within one year,of com- , i Duct -' UndEi Ground � � � � ., , � �, � „ . .
, platlon, the owner,will have the Durden of proving he/she Citl no[ bulltl or Im- : . �
t ' SUMMARV OF FEES , �
'� romfo�thepurposeoTsale)�. � 1 ' � -? � � I i � ' " Duct-Strunural f � � � SystemRepair]Alteration � � , ,BUILDINGPERMIT $ � ' � j SMIP ; I� $ � �� � �
I, as owner of the property, am axclusively contractlng:with!Iicensetl <om � � � � �, � � ' . 1 � -, � � ' � � Y
�tractorzToconstructtheDroiect 5ectlon7,o44,eusinessantl.ProfasslonsCotle:� _� Duct:Ventilating.,_ (,,,.�_ _ _ ,��_ , _ .r _ti I I iPLANCHECK� $ � PERMIT I 1 . �
T�e Contractor's Licanse Law �oes not apply to an owner of properry who f � • � . i ' ' � $ ' � ISSUANCE j$ i ' I
� bulltls or improves,thereon, antl wh0 contracts for such projects wlth a con- � ExhauS[ System ❑ Multipie ❑ �. �! � � � PLUMBING � � �
' tractor s Iicense pursuant to [ne Contractor'S Llcenze Law : . i � . : . , � $ .
� > > � f j � � I GRADING
. O Y;1am exempt untler Saction— ; ' B. 6 P C!or tnis reaion � � Firepl/Fact. Blt. ICBO � � � � � �. ' j .PLAN CHECK, $ � I ; �
' � � ELECTRICAL ' $�� � I ' $
. Date � ' Owner � � � ' � ' Heeting�System & Ducting � � � � � �� � f ' � � MICROFILM $ ' � �
; I hereby,-certify that•I.hare-reatl tn�s�'appllcatlon antl-state that-the-above -,• -1- �0�100,OOOBTU-0100,OOOBT � • -.v-- -� �PLAN CHECK� � $� � � . �
informatlon is correct. 1 a9ree to coTD�Y with all city,antl munty ortlinances � � f : 1 � .�~ ! ' � � 1 � � � ' . TOTAL FEE� '$ �
� antlFstace laws relating to builtling constructlon,�antl �ereby authorize repre- , � , , , � � MECHANICAL � $ . . � �.
I senCativez ot rt�ls �city � to antq n upon the�, above-mentlonetl property for � Hdod of Type I ❑i, � I Rainspeetion Fae j ' $15 � ' � I' � ' LESS + ' ' � �
� � , �PLAN CHECK� � �
. ' inspection pqr�pops s. / � ' � Cano � T e II �i � i + . � i $, 1 1
; Signature Sk'f-a' /�I�4;(.�: r! I i � Date�'S "f�' I � � � . . � � ADVANCEDPC '$
: Drivers' nse or55 � �� ���� � � i t � Registers ' � � �' Iswe Fee � � ' , �
� � � � �� S 3 � I � r � FINALFEE� $ ���2' •��
' .._ .._ _ '__. ` _ _ _".._ '__ _ _'..... __ _ ._ _'___., . . . .. _ ' _ -. . .. . . , .
CMF 0865-46 rav. 12/02 White • BUIItlIng;�Canary - Applicant; Plnk - Atcounting; GOltlenroC - Assessor - - - ' " " .
/ l
� -- o , �- . � , � ec, a sen --- : -
�� ��CONSTRUCTION ANDjPLANNING .� ' � : -, - - � . . �� �- � ^ ' "
' � r� ' ' ' ti �- �Date � ,Inspeetor -� � �. . � p � = Date In`spector.
•�APPROVALS . Permit#�• �'� . � _,APPROVALS : Permrt# � r
.1 'Tfi1> 1 V � . . .. - . - .
' ^' 4; Temporary,Electrical Service oi.Bole ' � �, � � `� ; ; ' c� ' ;�.52� Pool &.�Eguipmenf Location ' � . ' + � - � � ;
i - n � 1 _ - < - -
i'
n� z? Soil Pipe-Undrgrnd:- t� ' `s `.$ � , "� ; ^ I � s p -� n �;53 Steel �Reinforcementy { � �� '� ' ' � ' �'
I- ... � � i • i �- = o - � �_ .r . . � ^,
� 3. Electrical Conduit,Utilitv-Undrgrnd � � s , . x �` , �54 Forms :' � ^ ' �� - � + - � � �
� ,4�. Electrical Condurt-Undr'gmdz � � � Q� �� ':55c Electrical Bonding " - i :, - � - : � �
-, . � , . _ . _ ,�_ . - - . _ -
c_ - i i
5'. SteellRelnforcement ,� � � ; - � � � : � j � - ' �' �. - �56, Rough Plumbing�& Pressure'fest .- � ' ; `
6: �Electrical UFER Grnd.: �` °� � ;` � �?� `� 57. APPROVAC TO COVER-GUNITE
, .,
7. Footings � ' � ' ; = < < u , � , . � � � , . - �" - : : - - - _ _ '_ .
� � o� '.
��r,, � .'58. ,ElectricafCpnduit-Undrarorl: r
8. Foundation ( ' - 'r . __, _�, .
� _ � J � ; ' ' �: � =59. Gas Pipe�O-Undrgmd:; Test-��_ . �
�
�
9. Water Pipe-Undrgmd. � f ?� �� < p � 4- �' gp. �Backwasli Linei, P-Trap,�0 Undryrnd.: ' � - �
10. Structural Floor SYstem ; ' � � � ; � ' � _ G; � 61. APPROV;4L TO. DECK � ° 'x �` - s � , , � i
11. Property Sewer Line &iHous a'Connection; -: � ! f r `� - ; ',62. Backwash�& Receptor Final�- � ^�' �. . _- �
12. Sewer CaP � i ' . � ,„ � � - � � . :; . � . _ - ', � � �
.� , i � , I �i i �� ��� i `'63. Heater&Vent-Final.. . . ':* � �
13. �Roof;Drain's � ' � � • � ' � � ' • � � � .
� � � : I ' '; . � � 64. Plumbing;System�- Final� ;�. ' � ' �
74. �Rough Plumbi'ng • ' i �- � 7 � ' - ' � 65. Electrical-Final` r � - �� � �-` T ' �
I '
'15: Rough�Elec[rica�-Conduit ; �-� .f^.-� -�-� ' '-' '- ",66� Solai�SYsiem-Final' -'� '� - -' '
T n 1. � � i
� ''• 16: �Rough�Elecfric Wir'i� g� �,k�s� I�-�-} ' - �� """ , � -67:{ Fencing &�Access�Approval,- ' - -' - - '= "`- '-- � , -�'
ti-� Z � �=��=c= � � �
_ �'17. �Rou9 �Wiiin'g Sign�? ,_ � � ': ; j� � . � I ^ � ` ', ` '„� 68.� APPROVED FOR-PLASTERING , i ; -- .
r
° ��' 18: `Rou Fi Elec2rical;,T�Bai Ceilin � . i r -' . I ' � � ; . � ' . - . . _
�� s ; s� , � _y,-2, _ ! '� �_ �69.' P,OOUSPA SYSTEMS�FINAL � � ' �
� � Y9. Rough�Heating�&iAir Conditioning '' � , � �� I I ' � � , i ; ' ; FIRE DEPT. REQUIREMENT - ' � � � � ^ ! -
„' 20. Rough Factory Fireplace� I � P'� ; � � j ', ' � � APPRO,VALSI I Peimit`# ' . �
�', .�, i � � f � � i '
' :� ,� 2L ;Ductsin Struucture�; � i ,, � ; � I� �� I � j � i � • �70.. Underground Hydro , � ' '; i �, � �. � ' '
a. - ' � . � i - ,
"22.'DucEs, Ventilaiing � �� j' � if -i ! � ( � � j 1 �71., Product Piping O Gas ❑ Oil � ' , -� ,' �
_,23. �Ges Pipe-Rough & Test ;, � � ��� ;� �� � i^ � j � � 72., Unde g ound Flush ,�� , T
.�
. �� 24. �,Roof,Framing� � I ; I ' � �:� i;, . � � : � � , _ ',, ;_ � -� ; . �, �73.i Undeigrnd. Storage Tank O Gas .� Oil. � � �
25. �Roof Shesthing , ; j � � j �(;� i� � � � .� � - ( t' ' � ' ^ � � 7q•: Overhead Hydro � � . ._ � ; . � � � , �
Q ��y26. ? :Bar Ceiling (Structurai� & Mono�coatJ � � � I � � '� j,` ' � ; � ', �75.� Dry Chemical _ � � � - � , j ,.
�
��27. ��Frame and Fla'shing� � I � ! �� �� ( , � � � � i _ � � i76.� Dry Standpipe � � . � ' - ' , i
`{ 28. ; L',athing & Siding'� i? f � � ' �' ' ��' �, j 77,! F�IXED SYSTEM FINAL � - � '
, > V I �f � + � � ', 1 '! �
_�� 29..rf�sulation "- ' I i , j,: f I �� �� I I �' I; i i i7g! FIRE PREV. FINAL � i � �� ��'
".'30. �Drywal�l Nailing � � � � �l � � � � I � . �Notes:� � � ' . � � � I
i
^..: i : i i< ' � - �� 0. _T _ 1""r _I�_ .� -_ � ( � , _ � _ '...�_" _ """_". _ _"
' � 31. �Plaster Brown Coet � � � � G -� � ; � � i � � ' '
' ff • i ' ; I� � ' 1 I - 1 I � • . � �
� ��32. �,Elect�rical�Power Me,ter=Fins1 ' � ' � � . � • � � I - •'
- � , . � � i r p � � � , - � � i . � � . - � � .
�� 33.;Final Electric �� _i�_ � � � � • .
34. Final Heating &�Air, Conditioning ' � � � � ' � ' ' , � ' �
� e,�i:.�: � I � �
- o � r. � _ . .' > c rr - -
35. Fnal GaiiPipe:TesL �., i,, �r; - I +� I' ;.. `� ,� , � 4 ; y _ . - - , ' '
36. Hood "or �Can'opY � o �, �. i1 �; -�� , ; - j - ' � � � . � .- i : , i .. i - - . .. . .
9 II �.i- �� im i-( nl I. �' _ I') t! � i `I • . .
37. Final �ac[ory' Fireplacen �_� ol �� �', �r _ i �, i � �_; � • � ` ��
� �
38. Final Plumbin ^I , � ' �
b' �9� � I^� ��I I�' '� ' I ��! � � 1` �,Dr ��
39. Water Seivice-Final� � �"� '� � � � f ; '_ '
i d � I � 1 I �� � � �� � � I'��: �
40. Gas Seivice-Final ' ! � � � (� � , ' I , � ,, ' � ' � �
�� �� � I i i i ; i
41. Solar po'mestio-Final � � ' ; ' �'� � �
i_.,. � 1 � � j i" "'_'_ .'_� ___.' _1_ .`_' t �. ._ _ �. �
42. Backflow;Preventer, { � I � ��,n�. � -- ---�-. � . } - -- - � - -! ; . - .
� �~..� ,
43. Backflow liiigation ' � 4�1' = �' I � T' �� � � � � � ' � �
��.« =i� I � . � � `, '
44. LandscaPe Ir,riQation SY�tem' � ��iy j'� �" . � � ' � 'r � � � � � � !'� : � ' � � _ .y _ • _
..I 1 1 I `� 't • I t 'L+ .l� . • ' I . I . . , � , _ •
45. Soundd'Qttenuation d �;' I � ; � � q � � : � _ � ' � : , � � � '� ' � �
46. �'i8f1C1iC3P,f�CgUlatiOflS � � Q 1 � � �cc. i I -p. � .o� � � � � `� �f i � � " -� . ';�� �i 'n �� .
47.� FINAL STRUCTURE & BUILDING i ' `• � � = � ��_ � � � � ' ' � f � ° � .'
i
4S.SPecialRequiremeritsComPieted " . � � �`'"� f ' � i ' . � I�'' • . •-'• .. ,. .
� � � + � ��
49. Electri� Release'to Edi'son� � � '� ' ! _! �_ _ � � � I � _ �_ .. �'r =�� � � � � � . � , �.
u � � � I I !� �- ��--�-' ----r Y-�-�-t--. 'd
50. Gas Release to Southein Califbmia Gas Co � � I � i � � � , � • , �� . ,.t� � '" �:� , � � � •.::
51. CERTIFICATEOF'OCCUPANCY �T ' ' , ' ' '�' ' _' ' � . ? , � ' � r
i i � -- - -�-� --��_�: _;. _�
No. �'� +� I ! Date � � � � j � . I 1' . '; j .I . . . . ,
-.r.l[_A__-J'�-�i J-� _ l _�...,�.� L r_
\
. . ADP���ant to till In all spates ezcapl l�ose wit�in �eavy �orEar Ilnas anG sign all appro0riate Eeelarations.
CtTY OF COSTA MESA V AG1C � Q�EL
CONSTRUCTION PERMIT MT3-A
Pi01�t Addreff aQ �
Applican['sMailingAddress. �'MI oJ�( �
Owner's Name C_� • SEGFfS+nC nw-d Saw _ anone 1�s �(IQ
Addreu �i�l�i �A1QXi(�' � G'�F\ /��.�A-
Arch/Eng. �'�9 ���N� " Lpice�nse No. C 6Z71 -
Addiess -��9 �WV eND C�xJu�Wl !W� �2eNAf
rrz
Contractor's Nem� -�'a��N • �hone 975-01 Ll
Address Imailingl � 2� ���TW � ����
Ciry License No. n22 9 3$
CICENSED CONTRACTOR DECLARATION '
Lhereby aHirm Nat 1 am Iicensetl untler proWslons of Charter 9(commencing
wlth,section 7000) of Olvislon 3 of tha Businatt antl Professlons Code, antl
my Iicunse Is ln full force antl eftect.
�� �.,;�ensa Class - ' ��£.� . � 5 199
ti`;� Z 4 S Si9nature ��
&, , . .
WORKE 5'COMPENSATION DECLARATION
I hereby aHlrm that 1 �ave a car[Ifiwta o( <onsent to seitansure or a certlflcate
of Workers' Compensation Insurance, or a certifietl copy thereof (Sectlon
�3800, Ldb. C.
voncv No. ��T 8q7 1347 comoa�v (Al1DJv37X�A��AGI�Md!/7Y
Q CertHietl copY �5 heroby furnishetl. � .
ki Certif etl 4op Is �iletl witn the city BFiRLn�visi
Date�fL/B�.qDP���ant�S � -
� EXEMPTIO FROM WORKERS' COMPENSATION DECIAR ON
(This saction neetl not be complatetl 1! the permit is for one huntlretl (E300) or
less).
I certity tnal in the per/ormance of the work tor which this perm�t Iz Issuetl I
shall not employ any parson In any manner so as to becoma subject fo t�e
Workers' Compenutlon Laws ol California.-
Date Signature
NOTICE: I1,ialter making this Ceclaralion, you shoultl become 5ubject to the
WOrkers' ComOBnsati0n provislOnS Of the Labor Cotle, you mu5t 10r[hwith
comply wit� suc� Orovislons or tnis permit shall be tleemetl revoketl.
CONSTRUCTION LEN�ING AGENCV
I hereby atfirm thal tnere is a construction IenCing agency for the performance
ot tho work /or�yvhlch���pormlt Js.�ssuetl (Se�on 3097 Civ. CJ
LenEer's Name r��r/� P Kbv f�sGA
Lentlar'T Atltlr85� �l �w L✓p ff �70 CJ�'A �Ef
OWNER BUILDER DECLARATION
1 herebv at/l�m thdt I am nxemOt I�om lM1e Contraclor's LI[ense Law tor thB
�� NR*.,�unty whlch repuirei a pe�mit to
r strutture, prbr to Iti 155uante
f�:•file a tlgneC statament thal he/
0
e Contractor'S License Law (Cha
Dlvision 3 al the Businass antl F
[herefrom antl tha basis for the a
7031.5 by any applicant for a
panally of nol more tnan five hun�
I. as
ty or my em0�oyees wlt
<, antl tho structure Is n�
oss antl PrOfoszlOndl Co
3nsa l.aw tloai not apD�Y lo an ownar of a proDerty wno ow�as or improves
�eOn, antl wh0 tl095 such work hlTs¢I1/he�s¢I1 O� tbrou9h bls o� her ow0
oloy eas, provltletl that wch Improvamants are not intentletl or o/fereC far
� If, �owever, the bulltlin9 or Improvement I5 solG within one year of com-
:lon, tha ownar wlll have tha burtlen o1 proving he/she tlitl not bulla or Im-
ve forthe purpoza otsale).
1, as owner of t�e property, am ezclusive�y contractin9 with IlcenSeE con-
:torstb tonilruct the pro7ect (Soctlon 7044 Busine55 antl Professlons Cotla:
i Contractor's LlcenSa Law doas not apply to an owner ot property w�o
Itls or Improvez tnereon, anE who contracts for such projects with a ton-
:tor(s) Ilcense O��suant to the Contractor's Licenze Lawl.
I am exemD� unEar Sectlon 8. & P. C. for thls reason
Date
Signature �
Drlver5' Litense a
CMP OB65-46 rev.
. Owner
have rea
TYPE OF CONSTRUCTI(!N LJ NEW LJ ADD �SLALTERATION LJ REPAIR
� ❑ CONVERSION ❑ DEMOLISFI ❑ OTHER q,p,.�6 � _
DESCRIPTION OF WORK �/�Akr I�P�V���T
. � - S MeinBuilding:,
E
TVPEOFPERMIT�i1 GRADING�9 FOUNDATION- STRUCTURAL T Front
�TENANT J�t ELECTRICAL ILJ�vLUMBING �'MECHANICAL A Reer .
❑ OTHER '
PROJECT DESCRIPTION 5(�. F 3I ZH JF� OCCVPANCv B'Z C Right
CONSTRUCTIONTVPE '��N VALUATION$ ��S�I%I g Left �
ZONE GRADING CU. VDS. ACRES ping, qef. #
Ramarkr. � ��� K 7- 4-A ParkingReq./Provid<
, ' ' , UieofBuilding: �
. PLUMBING � , fEES Planning Notes:
Preventer -�
Irrigation
Floor Dreins
Floor Sinks
Gas Service Outlets
Interceptors �
Kitchen Sink
LBVOiOfIQS
P-Trap
Poot Drains
Reinspection Fee $25
Boiler
Dutt - Under Ground
Dutt-Structurel �
Duct - Ventilating
ExhausiSystem ❑ Multiple❑
Firepl/Fact.8lt. ICBO �/h
Heating System & Ducting
❑0.100,000 BTU �100,OOOBT
- I I Reinspeetion Fee I §25
W�ite - Builtling; Gnary - AGPliwnt; Pink - Accounting; GOltlenro0 • Aisessor
Showers
ServiceSink �
Sewer Cap, -
Sewer Connection
Solar CollettOrs
Solar Piping
Solar Tank
Swimmin9 Pool w/Spa
Urinal
Water Closet
Water Heater
Water Servica �
laue Feo
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration Synem
❑0.100,OOOBTU ❑100,000
System Fepair/Alteration
Issue Fee
Automatic Washer
Construction Pole $ub.
Cooking Unit
Dishwasher �
� Oryers �Gas ❑Elec
Fan
S 3
$ 3
r.ta,u:�
Fixtures . . '�
Device BoxeS
4425 2/16/84
� 2one
Accessory Building: ,
' �
Park. Fees $ ,
I
�
� ELECTRICAL '
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up m 100amps
Meter ❑over700amps
Garbage Disposal
Genera�or �65KW �5-15 Kw
Fee
Sub Panel ' '
Motors �0.1 HP � 1 Yh - 6
Int.Solar �9-15 HP � 1615+
Microwave
Pole �ight
Range
$[ending Sections
Trash Campactor
$25 � luue Faa
389.34 � 7�
FEES
$ 3
N
1
N
c
R
E
I
R
E
N
E
N
T
PUBLICSERVICESREUUIH NT {�
Zoning APProved BY —� •L'��"l Date � � �
Building Approved By � Date
Applimtion Issued By Date
, ' ' SUMMARV FFEES �./
�' BUILDING PERMIT $ 3� SMIP $ � �r
PLAN CHECKs�f% g S3. pEFiM1T
, PLUMBING $ ISSUANCE $
PLAN CHECK 25%� $ ENERGY P.C. $
ELECTRICAL $ GRADING �$
PLAN CHECK 50% .$ MICROFILM $
MECHANICAL $ TOTALFEE �$ ,3�93�f
PCAN CHECK 25% $ _ �
' � �CONSTRUCTION AND PLA-��.%` � � L & SPA . �-, � , -
. .
'APRROVAL$ ,' Permit# �-�7 Date Inspector AppROVALS Permir# �Date", Inspector��
� . . . . . - - - �
•'' 1. Temporary Electric8l Service or Pole '" 52. Pool & Equipment Location '
i. .
� 2. Soil Pipe-Undrgrnd..� - " - � . 53.- Steel Reinforcement � � �
i_.
' 3. ElectricAl,Conduit U[ility-Undrgrnd' ' 54. Forms - .�
' 4. Electrical Conduit-Undrgmd�. -� � _ 55. Electrical Bonding � - � . _ _
5.. Steel Reinforcem`ent �,�' • 56. Rough Plumbing & Pressure Test - '�
6•' Electrical UFER Grnd. . 57. APPROVAL TO COVER-GUNITE .
� .
•`J. Footings"-,�� ' ' ' " , � 58. Electrical Conduit-Undrgrnd. �
'��8. Foundation ` � 59. Gas Pipe, 0 Undrgrnd., Test
�� 9.. Wa[er' Pipe-Undrgrnd. � . 60. Backwash Lines, P-Trap, O Undrgrnd. �
�:10.� Structural�Floor SYstem �� � 61. APPROVAL TO DECK � -
id� Property Sewer�Line & House Connectio� �• 62. Backwash & Receptor-Final . �
• 12. Sewer Cap '•' �+ 63. Heater & Vent-Final '
� -
13. Rqof�D�ains �- � 64. Plumbing System - Final - �
14. Rough Plumbing � - . 65. Electrical-Final � • �- "
15. '�iough 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-7 Bar Ceiling; 69. POOUSPA SYSTEMS FINAL - �
19. Rough Heatirg & Air Conditioning FIRE DEPT. REQUIREMENT -� �
i�
20. Rough:Factory,Fi�eplace r APPROVALS Permit# , �
21. DuCts, in Struc[urB 70. Underground Hydro -
� '22. [)ucts, Ventila'ting ,'•I � � 71. Product Piping OGas ❑Oil �
� 23. Gas Pipe-Rough & Test �� - 72. Underground Flush ,
x
24.�RobfFraming ' , ' 73. Undergrnd.StorageTankOGas ❑Oil, � , ,
. 25. Roof Sheathing '�' � 74. Overhead Hydro -
26. T,-Bar Ceiling (Structural) & Monocoat ,'7r 75.. Dry Chemical
27�. Frame;and Fla"shing �' 3 � S y�T g 76. Dry Standpipe . •
..28. Lathiog & Siding , 77. FIXED SYSTEM FINAL .
�29. Insulatlon' � �� 78. FIREPREV.FINAL �
� 30. Drywall Nailing " HEALTH DEPT. REQUIREMENT
31:� Plaster Brown Coa4 79. FINAL INSPECTION
�32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED '
33. Final Electric � Noter. `
.
34. Final Heating & Ai� Conditioning _
.
35. Final Gas Pipe-Test � d
36. Hood�or Canopy � . �
.
37. Final��Factory Fireplace � =
38. Final Plumbing � � . �
39. Water Service-Final � � ,��J-(Sy � ��
, .
40. Gas SePvice-Finat , � .
��
41. SolarpomesticFinal . -'
i
42. Backflbw Preventer � ' � .
�
43. Backflow Irrigation� � . , -
44. Landscape Irrigation System
45. Sound Attenuation � ' •
46. Handicap Re'gulations 3/����j :
�
47. FINAL STRUCTURE & BUILDING J�7 �
48. Special� Requirements Compleied . ' , ' ' "
49. Electric Release to Edison , �. � ' . � �
50. Gas Release to Southern California Gas Co . .
51. CERTI IGATE OF OCCUPAN Y - � �
No. ..�C`���. Dateu2 �� �._ /
AOC���ant to flll In a11 spaces except those w7thin heavy ba�tlar Iin¢s antl si9n all approp�iate tlaelarationt.
� CITY OF COSTA MESA� � - -
CONSTRUCTION PERMIT � �
Prolect Address ''l' G ' ' J
Applicant's Maiiing Address , �i� �D (y//Ni.�'i' fi'A/J4/H��n �
owner's Name LT SEC-. E�5T.00/n ahone
Address
Arch/Eng. License No..
Address
Contracror'sNam=�'Mi2Yf l'Onl.^•iiiQA�/�F Phone '�
Address (mailin9) ���=CO CY�ihi ST 1��%�HE/�1 %S�J6
City License No. �%�� 7� ,
LICENSED CONTRACTOR DECLARATION
I hereby atfirm that I am Iicensetl untler ProviSions of Charter 9(tommencin9
wlth section 7000) ol DIvlSion 3 of thu Business antl Professlons Cotla, antl
my�license is in fy�l (orce andeflecL . �,� t..� �
�°`-ate Z�f%'"iy Si9nahrp� �. .
3�ORKERS'COMPENSATION DECLARATION '
1 hereby atflrm [hat I have a certificate of consent to selLinsure or a certl(iwte
ot�Workerz' Compensation Insuranc¢, or a certifietl copy thereot (Section
3800. Lab. C. p ���/T.
PolicY No.Mi 73/���� ComPanY�
Lq Gertifietl co�pOY a t Ietlbwlthrthehcl�tY tl�in9 Div s'on. • .
Date Z f �'�d � Appllcdn��✓+ �� /�A�+�
EXEMPTION�FROMWORKERS•COMPENSATION�UECL ATION
(Thissection neeC not be comple[ea if tne permit is for one huntlretl (S300) or
less).
I certi(y that in the performan<e ot the work for which this perm�t is issuetl, I
shall not employ any person in any manner so as to become subject to the
Workers' Compen5ation Laws of CalltorNa.
Oate 519nature
NOTICE: If, after makin9 this tlecla�atiOn, y0u shOuld become subject to the
Workers' Compensation provi5ionz•of Ihe Labor Cotle; you mu5t forthwlth
comply with mc� �provisions or this permit shall be'tleemetl rnvokeU.
CONSTRUCTION IENDING'AGENCV ' �
I hereby afflrm that tnere Is a constructlon ivntling agency lor [�e pertormanca
o! the .work .for,v/hitpithis permlt is Issuetl (SacHon 3097 Civ. C.).
LpnCer's Namn _/�/oNiL
Lentler's Atltlress -^ �
OWNER BUILDEH DECLARATION ' ' '
I hereby af(irm thal 1 am exempt from the Contractor's License I..aw for the
following reason �Sec[ion 7031.5 Buslness antl Professional Cotle: Any <ity or
that
.therefrom ana t�e basiz for t�e allegetl exemptlon. Any violation of Section
7031:5 by any applicant for a permit 5ubjects the apP����t to a c(vil
�enaity of not more than five huntlred tlollars (g500).
I� d5 OWI1Cf O: LIIC property Of my employees WIIh waqes as tnelr SOIG
mmpensation, will Oo the work, antl the structure is not intentletl or otferetl
for sale (Section ]044, Business and Protezsional Cotle: The Conlractor's
Llcense Law tloes not appry [o an owner o( a property who bwltls or improves
thereon, antl who tloes such work himz¢If/h¢rseH or through his or her Own
em0�oy eez, provitletl that Such imp�ovemen[5 ar¢ not IntentleU o� offeratl fo�
sdle. II, howeveq the builtling or ImOrovement is soltl within one year of com-
pletion, the owner will nave the burtlen ot proving he/she tlitl not builtl or im-
�rove for tne purpota o( sale).
1, as owner of the property, am ¢xtlusivaly contracting with licensetl cOn-
tractors to construct the orojact (Section 7044, Business ana Pro(essions Cotla:
The Contractor's License Ldw-does nOt apply [O dn Owner Ot propefty who
builtls or improves thereon, antl who cOntratts for such projecls with a con-
Vactor(s) licensa pursuant to tne ConlractoYs Liceni¢ Law�.
❑ I am exempt untler Sectlon B. & P. C. 70� [nis teasOn
Date
Drivers'
Owner
certity that 1 �ave reaE lhls appli<ation antl state that tha above
)n I5"cOrf¢Ct. 1 dgfle IO comply with dll Clty antl COUnty ortllnancez
laws ralating to builtli�9 conit�uClion, antl hereby aulh0/iie repr0-
of Mis city [o enter upon tbe above-mentioneA property tor
p ses. �,
Data L- /7 �
icense or 55 � •
TYPEOFCONSTRUCTION LQ NEW U ADD LJ'ALTERATION lJ REPAIR
'�❑ CONVERSION ❑ DEM/p� L�IS/H� ❑ OTHER q,p.#
DESCRIPTION OF WORK ,L����J'« p
- S Main Building:
TYPE�OFPERMIT GRADING FOUNDATIO(�Ny STRUCTVRAL T Front ''
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING 1ap MECHANICAL B Reaf
❑ OTHER A
PROJECT DESCRIPTION Sq. F7. OCCUPANCv C Right � .
K Left
CONSTRUCTIONTV7E VALUATION$ $
ZONE GRAOING CU. VDS. .ACRES ping. Ref. � �
Remarks: � m ' Parking Req./Provided
� Use of Building:
. ' . � VLUMBING . FEES Planning Notes:
Sink
Clarifiers ' �
uisnwasner y
Drinking Fountains
Floor Drains' �
Floor Sinks
GasService Outlets
Interceptors' �
Kitchen Sink �
Roof Drains �
Reinspection Fee � � $25
Boiler '
Duct - Under Ground
Duct - Strucmral
Duct - Ventilating �
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heeting $ystem & Ducting
❑0.100,000 BTU �100,000
Reinspection Fee � §25
CMF 0865-46 rev. ]/83 White - Builtling: Canary -Appliwnl: �ink - Accounting: Goltlenrotl -Asussor
Showers
Service Sink �
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9�
Solar Tank
Swimming Pool w/Spa
Urinal .
Water Closet.
Water Heater
Water Service -.
0
Issue Fee
Hood ar Typel ❑
Canopy Type II ❑
Refrigeration System
Br0�100,000BTU ❑100,000
System Repair/Alteration
Issue Fee
S 3
FEE
S 3
Automatic Washer
Construction Pole Sub.
Cooking Unit �
Dishwasher '
Dryers ❑Gas ❑Elec
4%Q4 2/21/84
I Zone
Accessory Building:
Park. Fees $
EIECTRICAL �
Transfarmer �� 15-50 KW
❑ 50+ KW
F.A.U.' _ '
Fixtures '
Device eoxes
Outlets
Switches
Garbage Disposal
Generator �0.5 KW �5�15 KW
Meter LJup'tot00amps
Meter ❑over 100 amps �
Sub Panet
Mo�ors 00�1 HP Oi %- 8
Inc.Solar �9-15 HP 016-15+
Microwave '
Pole Light
Range
Standing Sections
Trash Compactor
�21.75 T�.
0
FEES
O
N
1
N
G
R
E
�
U
I
R
E
M
E
� Rainspeaion Fee � �$25 � �ssue Fee � $ 3 I
PUBLICSERVICESREQUIREMENTS: '
ZoninB AVPraved By Date
Ap0lication Approved By ' Data�
Application Issuad By Data�2_.Z
SUMMARV OF FEES
BUILOING PERMIT $ SMIP , $
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE � $
PLAN CHECK $ ENERGV P.C. $ �
ELECTRICAL $ GRADWG $
PLAN CHECK �$ MICROFILM �$
MECHANICAL $ � TOTALFEE $ ��
PLAN CHECK $ �
CONSTRUCTION ANd PL/ NIF�� �`. ,L & SPA �
APPROVALS Permit �N � �- Date Inspector , APpROVALS Permit # Date " Inspector
. 1. Temporary Electrical Service or Pole: . � 52. Pool & Equipment Location
� 'l
� ., �
� 2. Soil Pipe-Undrgmd. � - , _ �y � � 53. Steel Reinforcement �
3.�'Electrical Conduit Ufilit.y-Undrgrnd. � 54. F.oims •
4.�Electrical Conduit-Undrgmd. ' � . 55. Electrical Bonding •
5. Steel Reinfoicemeot� � - !� 56. Rough Plumbing & Pressure Test � �-
. ,
6..ElectricalUFERGrrid..� . �� . �57. APPROVALTOCOVER-GUNITE ''�
7. Footin8s ., � � ; _. .h ' 58. Electrical Conduit-Undrgrnd. - .
8. Foundation '-' - - ° 59. Gas Pipe, O Undrgrnd., Test ��
•; - �.
9. Water Pipe-Undrgrnd.. ,' �� 60. Backwash Lines, P-Trap, O Undrgrnd. ,%
10. Str6ctural Floor System - . / 61. APPROVAL TO DECK
17. Property Sewer Line:& House Connection �62. Backwash & Receptor-Final
12. Sewer Cap , " �r? 63. Heater & Vent-Final �
13.�RoofDrains ��� . , 64. PlumbingSystem-Final _
14:;Tiough Plumbing � � � 65. Electrical-Final
15. Rough Electrical-Conduit - 66.'Solar System-Final
76. Rough Electric Wiring , � -- 67. Feucing & Access Approval �
17. Rough Wiring Sign F t' 68. APPROVED FOR PLASTERING
18. Rough Electrical-T 8ar Ceil�ng ; 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air CAnditSoning �/��y�Y FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace .;'r APPROVALS Permit #
21. Ducts, in Structure ' i � � 70. Underground Hydro
22.,Ducts; Ventilatin � '
9 .� 71. Product Piping �Gas ❑Oil
23. Gas Pipe-Rough & Test 1} - 72. Underground Flush �"
24. Roof`Framing � � 73. Undergrnd. Storage Tank O Gas O Oil•
25. floof.Sheathing �' - 74. Overhead Hydro
26. T-BarCeili�g (Structur211 �Monocoat' 75. Dry Chemical
V
�7-'�Frame and Flashing � .� , ' 76. Dry Standpipe
2A. 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 Me[er-Final ' 80. FOOD CERTIFICATE ISSUED �L
33. Final Electric � Notes: •
34. Final Heating &�Air Conditioning � l��
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 pomestio-Final . . � '
42. Backflow Preventer J ��
'.�
43. Backflow Irrigation � � � � _
44. ,Landscape Irrigation System � � � � � �
45. Sound Attenuation ' � . -
46. Handicap Regulations _
47. FINALSTRUCTURE&BUILDING . �
48. Special Requirements Completed ' . �
49. Electric Release to Edison �. , C
50. Gas Release to Southern California Gas Co ' �(
51. CERTIFICATE OF OCCUPANCY, �
No. Date '
. (
\
�
�
CITY OF COSTA MESA
CONSTRUCTION PERMI'T
TAG K • .V�D.EL
Applicant to fill in all ipaces exeept t�ose wilhi�,heavY �orCer Iinef anE sign all approD��ala tleclarations.
Project Address �Q 'RA�x��'�w'� ��•
Applitant'S Mailina AAArn<c `6���z W7 �1)/JICEi �
Ovuner'sName �� x�T'E�Sr��MPhone
Address �t
Arch/Eng. '�� ` �s License No.
Address
Contracror's�vam= ��p/��������A �� �e� 1�'65/6S
Addresslmailin9lsa��_`"""� �� ��'V'�
City Licnnse No. DO SO
IICENSED CONTRACTOR DECLARATION
1 hereby affirm that I am Ilcensetl untler provislons of Cnarter 9(commencing
with sec[lon 7000) of Dlvision 3 of the Buslness antl Professions Cotle, antl
my licenie is in full (or� anqetfect. , /�/ ���
'cense I ss G .S !O l.icense ��
ete ���r i �L Si9nature :4✓ �C�L�
WORKERS' COMPENSATION DECLARATION
I h¢reby aftirm that I hdv¢ a cerUlicate o! con5ent t0 sel6insure or a cerUfiCdtO
of workers• CompensatQion pIn/s�urance, or a cort/lfl�e/tl ,co/py �th�/ereot �(S/ec/tlon �
3800. Lab. L�1/'�ID 7II�o �K�'�CL'/ �NJ .�/ •
Policy No.«�� Company
�Certifietl copy Is hereby lumishea. .
Certl(letl copy�is filetl with Ihe city Bu' I �Ivisl��
Date • � Applican[
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl not be completetl if the permit is for one huntlretl (5300) or
Iess). •'
I certify that in the performance of the work tor which this perm�t Is issuetl 1' •�
shall not employ any person in any manner so as ta become subjett to t�e
Workers' Compensation Laws ot California. �
Date ' Si9nalure
NOTICE: 1f, after making this tleclaration, you shoultl become suDject to the
Workers' Compensation provisions of the Labor Cotle, You must forthwith
comply wlth such provisions or ,Ihis permit snall be tleemetl rovoketl..
CONSTRUGTION L'ENpING AGENCV ' � ' '
1 hereby afflrm that thera is a'constructlon lentling agen<y tor the performance
of the work '/or wblch thls permit IS.Iisuatl (SecHOn 309] Clv. CJ .
Lentler's Name
l.entler'S Adtlress �
OWNER BUILDER DECLARATION ' -
1 hereby affirm that I am exempt from the Cdntractor's Liconse L'aw for the
as
zale. If, however,
pletion, l�e owne
�rove for the pur�
I. as owner of
lJ I,am oxemp[ untler
Date
Signature
Orivers'�,License r 5
CMF 0865-46 rev.-7/83
tna alle9etl exemption. Any violation oi Sectlon
tor a permlt subjects the applican[ to a civll
e huntlretl tlollars ($500). � '
perfy or my emploYees�with wages as their sole
�ork, antl the structure is nol intentletl or ofteretl
isine55 antl 'Prote55ional Cotle:. ThB Con[rdc[Or'S
to an ownar ot a property wno builtls or Improves
h wOrk himsel(/herself or through h15 Or h¢r own
.ch ImOrOVBm¢nts ara not int¢nAetl or offeretl tor
ig or Improvement Is sola within one year of com-
�. the burtlen Of prOving he/sh¢ ditl na[ bulltl Or IT-
I.
rty, am exclusively contracting with IlcanSetl con-
lecl (Section ]044, Business antl Professlons Cotle:
aw does not apPly to an owner of Oroperty who
, antl who contracts tor such pro)ects wlfh a con-
r the Coniractor's Llcense law).
m B. 6 P. C. for this reason
_ Owner
I have reai
I agree to
to builtlir
� to entcr
TVPE OF CONSTRUCTION LI NEW LJ AOD LI ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p,.�6
DESCRIPTION OF WORK
S Main Building:
E
TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL T FrOnt
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING! ❑ MECHANIGAI_ A Rear
❑ �OTHER C Rlght
PROJECT DESCRIPTION $Q.FT. OCCUPANCV K
CONSTRUCTIONTYPE VALVATION$ g Left
20NE GRADING CU. VDS. ACRES Ping. Ref. �
Remarks: Parking Req./Provi�
Use of Building:
. PL11M61NG FEFC P�anning Notes:
Sink
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Kitchen Sink
Lavatories--
P—Trap
Root DrainS
Reinspection Fea ' � $25
Duct - Under Ground
Duct-Structural �
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. IC80 #
Heating System & Ducting '
❑ ai ao,000 eTu O i oo,000 ar
� —'"—r � I I ReinePection Fee �' $25'
W�ite - B W Itlln9; Canary - Applicanh Pink - AccounUn9: Goltlenrotl - Asse55or
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/S�,
Urinal
Water Closet •
Water Heater
Water.Service �
laue Fee
Hood or. Type I ❑
Canopy Type I I ❑
Refrigeration System ,
❑0-100,OOOBTU ❑100,000
System Fepair/Alteration
Issue Fee
. 4589 2/21/84
Zone
Accessory Building:
I
Park.Fees $
ELECTRICAL .
Automatic Washer � Transformer ❑ 15-50 KW
❑ SO+KW
Construction Pole Sub.
Cookin9 Unit - ,-� Me[er ❑up to 100 amps
Dishwasher " Meler �over100amps
Dryers OGas' �Electric
Fan
F.A.U.
Fixtures
Device Boxes �
Outlets
Switches
Garba9e Oisposal
Generator �0.5 KW �5-15 KW
'Sub Panel
Motors�0.1 HP �1X-8 �
Inc.Solar��9-15 HP 016-15+
Microwave .
Pole Light �
Si9n
Standing Sections '
Trash Compactor '
- $ 3
Reinspection Fee $25 �uue Fee
FEES
PUBLIC SERVICES REQUIREMENTS:
� ZoninB APProved By
_ APPlication APProved BY q T.
5 3 � '
'- BUILDING PERMIT
_ PLAN CHECK
PLUMBING
, PLAN CHECK •
, ELECTRICAL
PLAN CHECK �
MECHANICAL�
PLAN CHECK
15.50 T�
FE
$ 3
SUMMARV OF FEES �
$ SMIP $
$ PERMIT
$ ISSUANCE $
g t oZ, 5— ENERGV P.C. $�
` $ GRADING $
$ � ' MICROFILM - $ ' •
$ � , TOTAL FEE $ I S�S�
O
N
1
N
G
R
E
Q
U
R
E
E
N
T
CONSTRUCTION AND PLANNIN.. � . �� & SPA .
APPROVALS Permit # Date ' Inspector qppROVALS Permit #� Date Inspector
7. Temporary Electrical Service or Pole . 52. Pool & Equipment Location
� 2. Soil Pipe-Undrgrnd. 8/� 53. Steel Reinforcement `
� 3. Electrical Conduit UtilitY-Undrgrnd. . . - 54. Forms � � - ,"'i,
4. Electrical Conduit-Undrgrnd. .y '- _ � 55. Electrical Bonding �
.5.;Steel Reinforcement' �� ' � 56. Rough Plumbing & Pressure Test ,
6.'��Electrical UFER Grnd:' 57. APPROVAL TO COVER-GUNITE �
7. Footings ' _ 58. Electrical Conduit-Undrgrnd. �� �
� ' $. �Foundation � - . 59. Gas Pipe, O Undrgrnd., Test '
9.•Water:Pipe-Undrgrnd. ,� 60. Backwash Lines, P-Trap, O Undrgmd. - ,
10.��Svuctural Floor System � � . 67. APPROVAL TO DECK -� _
1�.1.:Property Sewer'Line & House Connection . - 62. Backwash & Receptor-Final � ' �
12.;Sewer Cap �':� ' ' ' 63. Heater & Vent-Final - �
73..Roof Drains :, � , � , 64. Plumbing System - Final .
14. Rough Plumbing ; ' � � �S � 65. �Electrical-Final �
i
15. Rough Electrical-Conduit 66. Solar System-Final � ' �
. 76. Rough Electric Wiring 67. Fencing &�Access Approval .
17. Rough Wiring Sign - - 68. APPROVED FOR PLASTERING �
18. Rough Electrical-T Bar Ceiling - 69. POOL/SPA SYSTEMS FINAL .
19. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT
�20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure ' ' 70. Underground Hydro
, 22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil
i 23. Gas Pipe-Rough & Test , 72�Underground Flush
24. Roof Framing • . 73. Undergrnd. Storage Tank � Gas ❑ Oil
� 25. Roof Sheathing � - � 74. Overhead Hydro '
' 26. T-Bar Ceiling (Structural) & Monocoat � 75. Dry Chemical � � .
� 27. Frame and 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: FWL�A�, p(�.6. OdC SuOSQ.t:i TO G'�i.di6 Q39CS
34. Final Heating & Air Conditioning �� ,����� _ 3/ 8y �A
', 35. �Final Gas Pipe-Test . -
36. Hood or Canopy � � � :
37. Final Factory Fireplace � -
38. Final Plumbing � ' � p � �
39. Water Service-Final '
40. Gas Service-Final � • � ' �
41. Solar pomestic-Final _ , . �
42. Backflow Preventer � .
43. Backflow Irrigation , � � - �
44. �Landscape Irrigation System , � � .
45. Sound,P,ttenuation � ' �
. 46. Handicap Regulations , '
47. FINALSTRUCTURE&BUILDING ' , .
48, Special Requirements Completed . . � �
49. Electric Release to Edison -
50. Gas Release to Southem California Gas Co ' � �
51. CERTIFICATE OF,OCCUPANCY�"- � "' �'^;� . ' �
- No. � Date- ' ., �. _ ` � . .. l .
� f1T2'�AFCOSTAMESA
CONSTRUCTION PERMIT
Applicant to fill In all spaees except t�ose within heavY bortler Ilnes anO sign all appropriate tleclarations.
ApplicanYs Mailing Address // - �' � "� �� �
Owner's Name G� SiLC—iC�IS`lifOrl ahone
Addreu � � � .
Arch/Eng. : License No.�
Address�
Contractor'sNam�f% ��'�%s'�"��L�f Phone l � �� �
Address�Imailingi���%U� w�S%rl'i,vSJd.A .r?if/>d.v 6'i�94✓�L
Ciry License No. Q�� y E 9
LICENSED CONTRACTOR DECLARATION '
I-hereby atfirm that �I am Ilcensetl untler provislons of Chartor 9(commencing
wlth sectlon 7000) ot Dlvislon 3 of t�a Business antl Protesilons Cotla, antl
my Ilcense is ln full force antl effect. i •
_I 'lcense Clxss � U Llcense No.� -s
P te�� -/6 •'.Yi Signatur
� JRKERS' COMPENSATIO -0 CLARATIO � '
I 1 hereby afflrm that 1 have a<ertifiWte of consent to S81hlnsura or a<ertltiGdte
� of Workers' Co pensa n 1ns�urante.or a certlfletl <opy thereof (Sectlon
� 3800, Lab. C.) ��i � 4-�0�3
Q P011cy No COmpeny S�/�r/� rvNd
� ❑ Certifietl copY is hereby furniihetl.
.�j Certltietl copy is (Ilatl with lhe Nty ulltl IvlSion_ _/
Date� APPlltan� �"c���
�EXE PTION FROM WORKERS' QDRiPENSATIQ ECLARATION
(This section neetl not Ee campletetl it the permil Is far one huntlretl (5300) or
1255).
� I certify that in tne perlormanca ot the work for whlch Ihis parm�t ii issuetl I
3 shall noc employ any person In any manner so as to become subject to t�e
Workers' Compansatlon Laws of Californla.
Date Signatura
NOTICE: If,iatter making this tleUaratlon, you SnoulC become subject ta the
Workers' Compansatlon proWsions of tha Labor CoCe, you must forthwith
comply wlth SucM1 provislons or this Oermlt shall be Geemetl revokeE.
CONSTRUCTION LENDING AGENCV
1 hareby affirm that thera I5 a<onstructlon Ientling agency for the par(ormance
of Me work tor whicn tnis permlt-is�lssuetl (SecUon 309� Civ. C.)
LGntlar's Nama
Lentler'z Atltlress �-
-OWNER BUIIDER DECLARATION �
I herabv aHirm that I am exemof from the Contractor's' License Law for the
or
7031:5 by any applicant for a permlt subjects the applicani to a civil
�en2lty ot not more than five huntlretl tlollari ($500�.
LJ I, as'ownar of the property or my amployeet wlth wa9e5 as their sole
compensation will tla tne work, antl the structure Is not IntenCetl or offeretl
for sale (SeCflOn 7044, Bu51nB55 antl PrOfe5510na1 Cotle: Tna Contrac[or's
Llcense Law tloes not apply to an ownar o} a property wno bulltls or Improves
thereon, antl who tloas such work himzelf/hersel! or through his or her own
employ ees, provitletl that such ImOroremanls are not Intentletl or o/fered for
ule. If, however, the bulltlin9 or Improvament is zoltl within ona year of com-
pletlon, the ownav, wlll have Me burtlen o} proving he/she tlIC not bulltl or im-
�ove for the purpose of sale).
�J I, as owner ot tha property, am exclusively contracting.wlth Ilcense0 con-
trattors tb construct t�e project (Sectlon 7044, Buslnezs antl Professlons Cotle:
The Corltractor's LI<ense Ldw doei not apPly to an owner of property who
bulltls or Impraves t�ereon, antl who contra<ts for such pro�ects wlth a con•
tracto�(s) Ilcense pursuant to tha Contractor's License Law). '
❑ I am exempt unEer Sactlon B. & P. C. for this reason
Date Ownar
f Ihis appllcation anE state thaS the above
comply with all clty antl county ortlinances
9 construttlon, antl hereby authorize repre- �
�upon tha above-mentionetl property for
Date3"-/.S "y%
�-//38�
TVPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR
L_❑ CONVERSION ❑ DEMOLISH ❑ OTHER �T� L
A.P. #
_DESCRIPTION OF WORK �
. ' � - S Main Building
TYPE OF PERMIT GRADING FOUNDATION STRVCTURAL T� Front �
,❑ TENANT �ELECTRICAL ❑ PLVMBING � MECHANICAL B Reaf �
, �"O �OTHER � � - � %�
PRWECT DESCRIPTION SQ. FT. �� OCCUPANCV C Right
K Left
� CONSTRUCTIONTVPE ' VALUATION$ g "
' ZONE GRADING CU. VDS. ACRES ping. Ref. #
Remarks: _ �',7J'7g Parking Req./Prov
' ' ' � • � . UseofBuilding:
, . PLUMBING . FEES Planning Notes:
Sink
Floor Drains
FloorSinks �
3as Service Ouclets
Interceptors
Ki[chen Sink
Levatories
P—Trap
Roof Drains
Reinspec[ion Fee $25
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventileting
Exhaust System ❑ Multiple ❑
Firepl/Fact Blt. ICBO #
Heating System & Ducting
❑6100.000 BTU 0100.0008T
orivers'yJ ense 55 ,�' �� ' I I Reinspection fae I $25
CMF 0865-46 rav. 12/83 White - BuIlElnq; Ganary - Appllwnt: Pink - Attountin9: Goltlenrotl -Assessor
ShOWCIS
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
V�BICf CIOSEL
Wecer Hea[er
Water Service .
Isue Fee
i •
$ 3
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers �Gas ❑Electric
Fixtures
Device Boxes
Outleti .
Switches
Garbage Disposal
Generator 00.5 KW
4432 2/16/84
2one
Accessory Building:
Park.Fees $
ELECTRICAL
Transformer ❑ 15-50 KW
� 50+KW
Meter ❑up [0 100 amps
� Meter �over 100 amps
' Sub Panel aGGAroP
Motors 00.1 HP 1 h- 8
Inc. Salar �9-15 HP �16-15+
� Microwave
Pole Light
Range
Sign
Standing Sections
5 KW Trash Compactor
IANICAL Reinspection Fee E25 Issue Fee
FEES
Hood or T PUBLIC SERVICES RE�UIREMENTS:
ypel ❑
CanoPY TYPe I I ❑ 2oning APProved By
Building Approved B� �% /'
Refrigeration System
❑0.100,OOOBTU ❑100,000
System Repair/Alteration
Issue Fee � I $ 3
96.65 7L
Z
O
N
'
N
G
R
E
Q
U
I
R
E
M
E
N
T
" S
EES •
r
%
� � i
ffi 3
� SUMMARV OF FEES
BUILDING PEFMIT $ SMIP $
�� PLAN CHECK '$ PERMIT
PLUMBING - $ ISSUANCE $
y PLAN CHECK 25% .$ ENERGV P.C. $
ELECTRICAL '$ 64'-�� GRADING $
, PUINCHECK 50% $ �D-fr � MICROFILM $
,� MECHANICAL $ � TOTAL FEE $ q`f' 6r
PLAN CHECK 25% �$ � �
I '� � �GbNSTRUCTION AND PLANNING- - P & SPA- . -�
�� � � Date Inspector - � Date • Inspector
� APPBOVALS ,� Permit.# � APPROVALS Permit #- � _ . -
_� 1� "femporary Electrical Service or Pole . 52. Pool & Equipment Location -�
�c 2: Soil Pipe-Undrgrnd. _ - 53. Steel Reinforcement � � ' � - � �
�' 3. Elecirical Conduit Utility-Uridrgrnd." . � �54. Forms . ' . � - ' " �
' 4. Electrical Conduit-Undrgrnd: � - . � � � 55. Electrical Bonding � ',
5.: Steel Reinforcement _� � - 56. Rough Plumbing & Pressure Test
6: Electrical UFER Grnd. ' 57. APPROVAL TO COVER-GUNITE� ,
7. Footings . � � � _ _ . 58. Electrical Conduit-Undrgrnd. , -
8. Foundation � � ' � - 59. Gas Pipe,�O Undrgmd., Test - -' - , -
9. Water Pipe-Undrgrnd. ' 60. Backwash Linet, P-Trap, � Undrgrnd. ,
10. Structural Floor System � . 61. APPROVAL TO DECK
11. Property SeweF 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 Electrica�-Conduit' � �// �- 66. Solar System-Final -- ` ' , -
76. Rough Electric Wiring . -. � 67. Fencing & Access Approval - �� ' •� � . ' ' � '
17.�Rough•Wiring Sign � " 68. APPROVED FOR PLASTERING .
18. Rough Electiical'-T Bar Ceiling 3� 69. POOUSPA SYSTEMS FINAL �
19. Rough Heating & Aii Conditioning FIRE DEPT. REQUIREMENT ,- .
� 20. Rough Factory Fireplace. ' . � � APPROVALS Permit # ' �
21. Ducts,.in Structure.� 70. Underground Hydro '
22. Ducts, Ventilating � 71. Product Piping O Gas ❑ Oil �� �;
23. Gas Pipe-Rough & Test � . 72. Underground Flush . � '
'24. RoofFraming 73. Undergrnd.StorageTank�Gas ❑Oil - ;
25. Roof Sheathing � 74. Overhead Hydro -
� 26. T-Bar Ceiling (Structural) & Monocoat ' 75. Dry Chemical �
�27. Frame and Flashing : ' • 76. Dry Standpipe _' -
28.�Lathing&Siding,� 77. FIXEDSYSTEMFINAL � �
29. Insulation .. 78. FIRE PREV. FINAL �
30. Drywall Nailing HEALTH DEPT. REQUIREMENT '. �
31. Plaster Brown Coat 79. FINAL INSPECTION �
�32. Electrical Power Meter-Final .3 �j �j 80. FOOD CERTIFICATE ISSUED
�33. Final Electric ' Notes:
" 34. Final'Heating &'Air Conditioning - �, � �p ��.� L',���rT• Z�'S /�/!2S
35. Final Gas Pipe-Test . , , � � ,
p . L°.C..
36. Hood or Canopy� � • � � � _
37. Final Factory, Fireplace, � I � � � - . . - ,; i
38. Final Plumbing ; . ' ' �� ' � ,
39. Water Service-Final . ' � - � ' � ''
40. Gas Service-Final • � � '
41. Solar pomesticFinal � . _ � �
42. Backflow Preventer ' .
43. Backflow Irrigation ' . . � . �
44. .Landscape Irrigation System i • � ' � , �
45. Sound� Attenuation� ,. � . ' - �- . '
1�
46. Handicap�Regulations � � , - � ' � � �
47. FI�NALSTRUCTURE&BUILDING ' ' •
� � _
48. Special Requirements Completed, � , ' '' {�
�
49. Electric Release to Edison � ' - - � ' - , :
�50. Gas Release to Southern Glifornia Gas Co � . � ��
51. CERTIFICATE OF OCCUPANCY �- . � � � -- , ,
, � -
No. " Date � � - .
-
ROP4 NO. e�0001Y0
t�.ad�
T
23.'t5"
.1bd��
'_i�____"_'_"T'_ �
-� �� 4„
�
¢o"
I,,S�ii
U ZoJ� D
�111�
�'e�iGil
4'
. i sS"i-�J r� i NJ r�
FK-�• } �i�7Es
�543�
� ,� _P OVEp
1 CRY OF COSTA M� �
PLANNINCi D�T.
wu� ro kco. oer. m
I��� ��
0� IIA1�lDM
.�zs"-zo hr���LES�i
hrE�_ p�rT��v
t^tc-r1iYE SG�Eh�S
�'i�VIGrL Pdit¢�
•V� �J�-Rrc
tJai Jv
.IZ�i"Tr�IGIL
_;��—hiar� �U�s ro c-xrE��
is" 6E�.o�-+ GFoJr�v
LF✓EL
P�o�T �/t �1•J �-iiD� �I �V�
A�����.���
Ci �of ,C^onsta Mesa Building t�ept.
8Y �`� ' J DATE�� 19�
TNESE PLANS MU37 BE ON iOB AT ALL TIMES MAKE
NO CHANGES WITHOUT PRIOR APPROVAL OF DEPT.
THE�ISSUANCE OR GRANTING OF A PERMIT OR F.?PRO:'AL Of
PLAI�15 AND SPECIFICATIONS SHALL NO7 BE CONSTRUED TO BE A
PERMIT iOR. OR AN APPROVAL OF, ANY VIOIATION OF ANY OF
THE PROVISIONS OF THIS CODE. NO PERMIT PRESUMING TO GIVE
AUTHORI7V TO VIOLATE OR CANCEL iHE PROVISIONS Of 1M15
CODE SHALL BE VALID, E%CEPT IN SO FAR AS THE WORK OR USE
WHICH R AUTHORIZES IS IAWFUt.
iHE ISSUANCE OF A PERMIT BASED UPON P1.4N5 AN�
SPKIiICATtON= SHALI �OT PREVENT T4e BUILOWG OfNCtAI
FROM THEREAPTER REQUIRING THC CCRRECTION Of EFRDP.S IN
SAID PLANS AND SPECIFICATIOVS OR FROM PREVENTING
6UILDING OPERATIONS BEING CAfi°IED ON THEREUNDER WHEN
COSTA MESA CA.
(714) 540-28.�^ � �
FOR l6����CTI���
CALL
754-5626
or
754-5627
Permit #�s�s-3 %�'
THIS NUMBER MUST °ACCOMPANY
ALL INSPECTION REQUESTS
FlLENET / MARY KAY COSMEl1CS
INFORMATIONAL SIGNS
�, i
NOTE
ADDITIONS, DELETIOtJS, OR CORRECTIONS SHALL
BE APPROVED BY THE PLANNING DEPARTMENT
U ���� �PE�� � � �r� � �s
�. NELII��G V-lELD SE�r-�15 � U�.I IJ� PLJ�iFi.
z. r'iJ�arf c,r�� �r-�rr�E� saJ��E rJbir�U
v��r� r��aort ��r��,-�o�D Fr��S.
3. 1'�IUhI OE��CR�"'��h�GE pltGK- �II�YL LLrjTE1C�IJG.
��Ck�� LE�'TE�GiJ TS �irlov-�IJ
1 Slcal`�
� TRUCK �
ACCESS
SEP 2 1 1988
2 SIV�S
TRUCK'
EXIT
� � � �
r=-�
STS
1 s�yri 1
ORDER
PICK-UP
1 PARKING //
��
���
N
� cr
ciTv oF cOSTA MESA CO S RUCTION PERMIT �
Project Address 3 s} j �.'a,4�;,P. �p�,�c,.� � C .
Applicant's'Mailino AAdrnss '
Owner's Name ��c ` C crt �,c . Phone ?.�0 -+r,vtl
n � ��
Address �� S e ��+� o d .�
Areh/Eng. � icense No.
Address� , ' - -
Contractor's Name p� R.I Js t L �rie` '9 (v3 -y�(� �
Address (mailing) - �C�-[ � 1.)A • !i �.. T�N<:�,,,,, ' ,
Ciry License No. �� /�L ' '
�LICENSEO CONTRACTOR DECLARATION
I hereby aftirm tM1at I am licensetl untler provisions ot Charter 9(cammencin9
with section ]000) ot Division 3 of the Business antl Protessions Cotle, antl
my license is in full (o�ce/a�ntl effect.
License Class C- �`�' Li ense No. � y 4 gyq s
Date ��%�2���SSi9nature ��
WORKERS' COMPENSATION DECLARAT/ON � '
I heveby affirm that I M1ave a certificate of r�nsent to self-insure or a certificate
of Workers' Compensation Insurance, of�a certifietl mpy thereof (Section�
3800, Lab. C.) �
Policy No. • Company
❑ Certifietl copy is he�eby furnishetl. �
❑ Certifietl copy is tiletl with the city Builtling Division. ,
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION �ECLARATION
(Thissection neetl not be completetl if'the permit is for one huntlretl ($100) or
less).
I certity that in tM1e perfo�mance of the work fo� which tM1is perm�t is issued, I
snall not employ any person in any manner so as become subject to the
Workers' Gomgeq�atipp Laws oi Calitornie��_ _
. Date ( v 1 f S Signature � � � .
'NOTICE: If, after makin9 tnis tleclaration, you oWtl become subject to the
Workers' Compensation provisions of the Ld r Cotle, you must forthwith
comply with such provisions or this per it snall be deemetl rewketl.
CONSTRUCTION LENDING AGENCV `� -' �
I hereby atfirm that there is a conSVuction lentling a9ency fo� the performance _
of the work for which this permit is issuetl'(Section 3097 Civ. C.)
Lentler's Name
r�
Lentler's Atltlress _
OWNER BUILDER OECLARATION
I he�eby affirm that I am exempt irom the Gontractor's License Law for the
followinq reason (Section 7031.5 Business antl Professional Cotle: Any city or
county which requires a permit to construct, alier, improve, tlemolish or repair .
any shucture, prior to its issuance, also requires the applicant for such permit
� tile a signetl statement that he/she is licensetl pursuant to the provisions oi
,e Contra[tor's License Law (Chapter 9.(commencing with Section 7000) of
�ivision 3 of the Bu5ine55 antl Profe55ions Cotle) o� that he/She is exempt
theref�om antl the ba5is for Ihe alle9etl-exemption.'Any violation ot Section
]031.5 by ariy applicant for a permit subjectr the ap0licant to a civil
penalty of not more than five-huntlretl dollars ($500). � .
❑ I, as owner ot the property•or my employees with wa9es as their sole
' compensation, will tlo the work, antl the structure is not intentletl or oiferetl
for sale (Section 7044. Business antl Professional Cotle: �The Contractor's -
License Law tloes not apply to an owner of a property who builtls ar improves
thereon, and who tloes such work himself/herself or through'his or her own
employees„Providetl that 5uch improvements a�e not intentletl or otteretl for
Sale. It, howeveq the builtling or improvement i5 Soltl within one year of'com-
pletion, the owner will have the burtlen of proving he/she tlitl not builtl or im-
p�ov¢ fo� the pu�pose ot sale). . �
❑ I, as owner ot Yhe property, am exclusively�contractinq with licensetl con-
tractors to construct the project (Section 7044, Business antl Professions Coae:
nt to iill in al1 soaces except those within heavy Eortler lines antl sign all approDriate tleclarations.
ERMIT NO. � TRACT NO. LOT NO. ' . UNIT N , �
� .� / � A {J • � . �iz - .. . i
TYPE OFCONSTRUCTION •� LJ NEW LJ ADD L�'J+ALTERATION ,LJ REPAIR
❑ CONVERSION ❑�DEMOLISH ❑,OTHER �
DESCRIPTION OF WORK/USE OF BLDG. � - -
TVPE OF PERMIT ❑ GRADING � FOUNDATION ❑ STRUCTURAI.
❑ TENANT �,ELECTRICAL �❑ PLUMBING� ❑ MECHANICAL ,
❑ OTHER
PROJECT DESCRIPTION SQ.FT. OCCUPANCY
CON STRUCTION TVPE VALUATION $ _
ZONE � � GRADINGCU.VDS. ACRES_
4ar Sink
Backflow Preventer �
Backflow Irri9ation
Bathtubs
Clarifiers �
Dishwasher
Drinking Foun[ains .
Floor Dreins
Floor Sinks � -
Gas Service � Outlets
Interceptors
Kitchen Sink
Lavatories
P.-Trap
RoofDrains� - .- �
Reinspection Fee� � � $15
Boiler. '
Duct -. Under Ground'
Duct 'Structural
The Contracto�'i License Law tloes not appty to an owner ot property who Duct - Ventilating � '
builtls or improves ihereon, antl who contracts for such proiects with a com - � � '�
tractor(sl license� pursuant to the Contractor's License Law). I am aware that Exhaust System 0. Multiple C
proof o{ their Worker's Compensatlon insurance Shoultl be provitletl to me.
❑ I am exempt untler Section B. &.P. C. for this reason Firepl/Fact. Blt. ICBO #
Date Owner ' Heating System & Ducting
I' hereby certify,that I have reatl-ttiis application antl state that the above ❑0�100,OOOBTU �100,000B'
information�is mrrect. I aqree to comply with all city antl county ortlinances
antl state laws relatin9 to builtling consVuctlon, antl hereby authorize repre- �
sentatives of this city to enter upon the above-mentionetl property for. .
inspection pur s. �
� Siqnature � _.�'-- �Date'10=�1�8� �
IDrivers' License or � � � � Reinspection Fee , $75
AF 0865-46, rev. 30/84 White - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor
PLUMBING
Showers '
Service Sink
Sewer Cap �'
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank �
Swimming Pool w/Spa
Urina�
Water Closet -
Water Heater
- Water Service
Auto-Wash - �
Laundry Trays
Isue Fee
iANICAL i
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0-100,OOOBTU ❑100,i
System Repair/Alteration
Fire Dampers �
Registers
Issue Fee
$
A.P. #
S Main Building: '
E _
T Front
'6 Rear� � � �'� � �
A
C Right
g Left
Ping. Ref. # �
Planning Notes: ' �
Automatic Washer
Construction Pole Sub.
Cooking Unit
- �56s iaiaiie5
Accessory Building:
i,aa iL
Zone
Req./Provided '
ELEC7RICAL , '
Transformer ❑ 15-50'KW
❑ 50+KW
Dryers LJGas LJElectric �
Fan
F.A.U.
Fixtures -
Device Baxes
Outlets
Switches
Garbage Disposal
Generator �0.5 KW �5-15'KW
'� Reinspection Fee ' ' $15
DEVELOPMENT SERVICES REQI
Zoning Approved By `
Building Approved By
AppliwtiOn �Issued BV
Meter ❑up to 100 amps
Meter ❑overt00amps
Sub Panel � �
Motors �0-7 HP 01'/z'- 8
Inc.Solar 09-15 HP �i6-15+
Microwave ' ' '
Pole Light
Range
Sign
;Standing Sections
Trash Compactor � � '
luue Fee
� � SUMMARVOF
� BUILDING PERMIT, $
� PLAN CHECK $ '
PLUMBING � $.
PLAN CHECK 25% $'
ELECTRICAL� , $��
' PLAN CHECK 50% $' �
MECHANICAL $
PLAN CHECK= 25% $ - �
1
2
O
N
1
N
G
: R
E
Q
M
T
s
FEES
$ 3
FEES
SMIP $
PERMIT
ISSUANCE . $
ENERGY P.C: $' '
� GRADING � $�
MICROFILM� $� �-/��i�_
TOTAL FEE ' $' _1_' �� —
I _ CONSTRUCTION AND PLANNING ��
i APPROVALS Permit #
� 1. Temporery Electrical Service or Pole
:2. Soil Pipe-Undrgrnd. �
' 3. Electrical Conduit Utility-Undrgmd.
� 4. Electrical Conduit-Undrgrnd. na PO
5. Steel Reinforcement _
6. Electrical UFER Grnd. .
7. -Footings
8. Foundation • �
9. Water Pipe-Undrgrnd.
10. Structural Floor System
11. Property Sewer Line & House Connection
12. Sewer Cap �
1�3. Roof Drains -
14. Rough Plumbing
15. Rough Electrical-Conduit
16. Rough Electric Wiring �
17. Rough Wiring Sign. .
: 18�. Rough Electrical-T Bar Ceiling
19. Rough Heating & Air Conditioning
20` Rough Factory Fireplace
21. Ducts, in Structure
22. Ducts,�Ventilating
23. Gas Pipe-Rough & Test
"24. Roof Framing •
25. Roof Sheathing '
26. T-Bar Ceiling (Structural) & Monocoat
� 27. Frame and Flashing '
28. Lathing & Siding �
� 29. Insulation -
30. Drywall Nailing �
31. Plaster Brown Coat '
, 32.��Electrical Power Meter-Final �
' 33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test ,
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing . '
39. Water Service-Final . �
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer �
43. Backflow Irrigation �
44. Landscape Irrigation System ���
45. Sound Atterivation ��
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed ,
49. Electric Release to Edison �
I50. Gas Release to Southern California Gas Col
No. Date
Date
f & SPA
Inspector AppROVALS Permit#
52. Pool & Equipment Location
- 53. Steel Reinforcement,
54. Forms
55. Electrical Bonding �
56. Rough Plumbing & Pressure Test
57. APPROVALTOCOVER-GUNITE
58. Electrical ConduibUndrgrnd. �
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
61. APPROVALTODECK . .
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final `
65. Electrical-Final
66. Solar System-Final .
� . encing & Access Approval
6S. APPROVED FOR FLASTERING
69. POOL/SPASYSTEMSFINAI
FIRE DEPT. REQUIREMENT
APPROVALS Permit # �
70. Underground Hydro
71. Product Piping O Gas ❑ Oil
72. Underground Flush � . �
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL '
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION � I
B0. FOOD CERTIFICATE ISSUED
r.
0
Date I Inspector
a
�
n
qppllcant to flll in all spaces except tM1ose within �eavy bortle� lines an0 sign all approp�iate Gecldrotions. ' _--
� OF COSTA MESA � -� PE IT NO. ' _ ��\CT NO. I:OT NO. BLD . . .
��TRUCTION PERMIT . + ��—� �
`, �A 6486 3/19/84 173.4� TL
4rojeCt Addre55� � NPR I`'� TYPE OF CONSTRUCTION NEW � ADD ALTERATION HEPAIR
Applicant'SMailingAddre55 ��S �A��QVI�`I� /1' ❑ CONVERSION ❑ DEMOLISN O R q,p,.hS � � _ 'Zone ' •
Ownef'SName � J a���`'��`7hon(�^`S� DESCRIPTIONOFWORK . �
S Main Building: Accessory Buildin9: 2
� Addreu 3�� ���Y,�� TVpE OF PERMIT- GRAowG FouNDn7lON STRUCTURAL � ' T Front . ' '- ry
A_ ArchlEng.�� ��Licen52 No. TENANT ❑ ELEGTRIGAL ❑1 P'LU,MBING ❑ C ICAL - g . - 1
l7� .. . �il �U� U A Rear N
Address - - �OTHER .
� Contracror's Nam���TSKNF'�:b� Phone� PROJECT DESCRIPTION Sp. FT. CUaArvCY C Hight . G
� � �J• 5•/� CONSTRUCTIONTVPE VALUATION$ g Lef[ - E
� Address (mailing) �� �Q- �
O CityLicPnseNo.O 0� �.� ZONE �GanDINGCU.vDS. ACaES PIng.Ref.SW . Paik.Fees$ U
LICENSED CONTRACTOR DEGLARATION Remarks: � • � P2rking Req./Pfovided . ��
'� ' I^nereby affirm that I am Iicensetl untler provisions of Charter 9(commencing - . ,. q
�.with iection ]000) ot Divizlon 3 of the Business antl Professions Cotle, antl , ' � � � UseOf Building: ' � E
my Iicenie is Ip �f W f sce antl eifecL 3� �4� .
( � 4 PLUMBING FEES Planning'Notes: � M•
� License Clasi�" ' License No. '
Date'���1-C+� � S'9 t e � '�2C1� . . . . . . . ' . . N
:WORKERS' COMPENSATION DECLARATION' � Ba� Sink ; � Showers ,
' I hereby aftlrm that I have a certlfieate of consent to selt-Insure or a certlticate ` �� T
of Workers' Compenaation Insur6nce,� or -a-certifietl-copy� [hereot (Section- � Batkflow Preventer Servite Siok �_ _ S
3800, Lab. ),/1 'J(�(^� � � �+ (� Backflowirrigation � Sewer . � � ELECTRICAL - . � FEES
PalicY No. ��,Y '-"`�' ' Co nY 7A�'rJNIJ � . , '
1 � ' ' B�IhtObS � � � Y Of10 � fl i �
Certitietl c py is nerooy furNsnea. ' i . Auromatic Washer , Tran'sformer ❑ 15-50 KW �
f < is q¢il with the'city ' i ' i ' ' . � � 50+ KW
ate ' npoii�ant � - _ Clsrifiers � Ilecrors � i Construction PoleSub. . ' ' ,
E%EMPTI N FROM WORKERS' COMPENSATION DECL ATION -- � Dishuvas r' �' Solar Piping - � Cooking Uni[ - '� 'Meter'Oup to't00amps •� ' -
(Th{ssection neetl mt ba complet¢tl if the permitis tor one h ntlretl (5100) or . • �'� i�
less). � � SolarTank � � Dishwasher : Merer �over100am �
' I<ertify•that in the performanca of the work tor whlch this perm�t is'issuetl I � ' D' in ns i � py . ,
shall', nOt employ any pBlsOn In dny TannCf so d5 [O become Subjett to t�la • -
Workers' Compensation laws o/ California., , , t I ains Swimming Pool w%Spa � Dryers OGas' �Electric 'Sub Panel ' ' '
Data Si9natur¢ � � , � � - , _
NOTICE: If; a(ter making lhiz tleclara[ion. You s�oultl become iuDject to tbe O m i � , Urinal Fan � Motors �0.1 HP �1 X-�,8
Work¢rs' Compensation'provisions o(.the labor-Cotle,-you must'torthwlth , �� -- - -�
comply'with such provislons�or.t[bls; Oermit 5hall ba tlaemetl revoketl. • � Ga5S2rvice I ��Outlets�. • WaterCloset � F,A,U. �IncSola���9-15HP�16-15+ �
CONSTRUCTION LpNDING AGENCY ' ` ' i: ' ' - ' .
' I hereby attirm thal there id a tonstruction lentlin9 agency for the peiformance � Interc¢pto(s � Wate� Heater , Fixtures ' . • { Microwave � - �
of the .work tor, 'which tnis ermit is issuetl (Section'3097 Civ. C.) � � '
Lentler's Name ' � �r � � - Kitchen Sink .= y ! - � ' Wacer Service � Device Boxes �� . Pole Light ' ' i
Lentler's 'AOtlres� ' �� � � � '
OWNER BUILOER qECLARATlOf1 � ' - : � : � , - Lavatolle5, � �� -� ` ; � � - ' OutletS � Range - - i � �
I he�2by d(firT thal � am exeinpt (roT the Cont�aclOr'S Lic¢nse I..aw for'tha . ' P_T�d � -'
fpllowing reason (Sectlon7031.5 Buzinessantl Pwfessional.Cotle: Any city or � P, �� ' �� - � ' Switche5' Sign • ' t.
� / county w�ich requires a permit to construct, alter, Improve, tlemolish or.rapair � - _ - - .
any struciure, prlor [o i[s Issuance, also requires tha appliwnt for such permil , ROOf Dreinsi C, : � - i �' Garbage Disposal ' � ' Standing,Sectipns � �, �
'� file a'slgnetl stateh�enEthat he/she is licensetl�pursuant to the provislons of ' - � •
ie Contractor's License Law (Chapter 9 (mmmencing with Section ]000) of �" � '_ , " _ . ' - ,
iivision• 3 of the,B�siness antl Professions Cotle)�or tha[ he/she is examp[ � • . G¢neret0� OP5 KW 05-15 KW � Trash Compactor � ;
therefrom anG Ihe besis for.tha allegetl exemption, qny vlolation of Section . �y� ' ' _. � -, - �! . . i
]031.5 by any•app�icdnt tor a� pe�mit subj¢cts the applicant to a civll Re105 BCtion FBe ° � � ' $? �
� enalty of not more than fivo huntlretl tlollars (g500). '' -' P . � i$25� Issue Fee � ' --
�� I,� as' owner of the property �op my.employees with wages as thalr sole . MECHANICAI �- Reinspection Fee ' � $25 � laue Fee � ' ' .$ 3
mmpensallon, will tle the work, anG the'strutture is not intendetl or offeretl ' �' � �'�� � ' - � FEES � � �
tor sale, (Se<fion 7044, Business antl� Professional Cotle: The Contractor's - PUBLIC SERVICES REQUIREMENTS: � . ' ' •
Llcense law tloes not apply to an owner of a property who•builtls or improves gOiler 7 - � ' HOOd or Type I ❑ - - � ' -
therlOn, antl.wh0 tlp¢5 SUCh wo�k him5elf/he�self o� thrOugh his o� Te� own ' ' ' , ZOning ApprovBd By V ate 3/Y�SY
e m p l o y a es, provitletl t h a t s u c h I m pr ovements are n ot'intentletl or o(feretl,for CBnopy Type I I ❑� . 1
D ct = Under Ground , � - -
u
sale. If, however, the bulltlln9 or improvement is-soltl within one year of com- . - 'Appliwtion Approved By ��/ Date ���p��
pl¢tion, }h¢ OwneS will.hava Ihe bur0en oi O�oving h¢/she tlitl not builtl o� Im- ,
rove tor the purpose of sale�. i - Duct - Structural Fiefrigeretion System ' ' Appliotion laued'By � �oata-Z'� S—i��
� 1, as owner of ine property, am exclusivety mntracting with licensetl wn- ' . i ❑0�100,000 BTU ❑100,000 BTU � � �
trattors to conttruct iha orojnct 1Section �044, Bhsiness antl Professions Coae: � Duct - Ventilating . •- SUMMAR OF FEES � p
The Contractor's LiCense Law does noLapO�Y to an owner ot property who . -. - - - - � � • 9p
builtls or improves thereon, antl who contracts tor such projects witn a con- � Exhaust System ❑ MWtiple ❑ System Fepair/A�tera[ion � BUIL�ING:PERMIT $ • .y SMIP $� �
. traclor(s) Iicense purguant to,the Contractor's License Law). ' ' PLAN CHECK $ '� tPERMIT � '
❑'I am�ezempt unCgr Section B. & P. C. �or this reason ' FirepVFact. Blt. ICBO�# ' ' � p�,UMBING $ ISSUANCE $
Date � Owner' ' Heating System & Ducting - PLAN �CHECK � $ � ENERGY P.C. $ �
I hereby certi that i reaa tnls apo��cation antl state that the above ❑0.100,OOOBTU �100,0008 ELECTRICAL $ GRAOING $
� information cor I' gr to compry with all tlty antl countY ortlinances -"
antl. state la s relal to b Iding tons ruction, antl hereby authorize repre- PLAN CHECK $ MICROFILM $
5¢ntdtivet O tb�5 �( u th¢ dbove-mentionetl yfo < ty t I, �
Inspeccion pu os .� I\� _ MECHANICAL $ TOTA� FEE $ ��o
� S�qnature Date Reinspection Fee $25 laue Fee $ 3 PLAN CHECK $
! Drivers' License or 55 � ' �
� CMF 0865-46 rev. 7/83 Whl[e - Bulltling; Canary - APPlicant; Pink -�Acmunting; Goltlenrotl - Assessor ' � � .. � ,
/ �
, . .. . a •
.s . ,.�.
-� � : ..
CdNSTRUCTION AND PLANNING � . ' . � � P� . & SPA .
. APPROVALS� �Permit# .Date Inspeitor- ,APPROV,ALS Permit# �� Date Inspector
. , '.
1. Temporary�.Electrical Service or Pole � ' 52. Pool & Equipment Location �
2. Soil Pi.pe-Undrgrnd. � � �„ij_ ., '�� �, � 53. �Steel Rei_nforcement' � , .
-.3. Electrical�Conduit•Utility-Undrgrnd. . _ ' • - � � 5A.--Forms. � - - - '
� �
4.,E�Iectrical�Conduit-Undrgrnd. . � - - . 55. Electrical8onding � � �
,
"5J'Steel Re^forceme�t ' � � - � - . _ 5 56. Ro�gh Plumbing & Pressure Test �
6: Electiicaf UFER Grnd. • ' 57. APPROVAL TO COVER-GUNITE --
w
7. �Footings � 7 ` � ' ' _- . 59. Electrical Conduit�Undrgr,nd. ' � ' r
8. Foundation : . � � _ ' � � � � 59. �Gas Pipe, :O Undrgrnd., Test � `
9. Water,Pipe-Undrgrnd: ` � � � _• 60, Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System - � � � 61.- APPROVAL-TO DECK . �
11. Property Sewer Line & House Connection ' � � 62.. Backwash�& ReceptorFinal � ,
12. Sewer�Cap . � _ � y , �63. Heater&,Vent-Final ��
131 Roof:Drains ' J . • � 64.� Plumbing System • Final �-
14. Rough Plumbing,� 65. Electrical-Final �
15. Rough Electrical-Conduit - "-.- 66. Solar System•Final -
p16. Fiough Electric Wiring . , � --; `67. Fencing & Access Approval '
�, �
17. Rough Wiring Sign . � '' `.� j' 68. APPROVED'FOR PLASTERING
18. Rough Electrical-T Bar Ceiling ' .69. POOUSPA SYSTEMS FINAL �
,�9. Rough Heating &.Q,ir Conditioning ��� ,' FIRE DEPT. REQUIREMENT "
20. Rough Factory Fireplace ; '��' ;` APPROVALS Permit�
�'7. Ducts, in Structure ' . , ' "" _ � % ?=� 70. Undergeound Hydro .
�?2�. Ducts, Ventilating . � ' 71. product Piping OGas� �❑Oil '
23. Gas,Pi'pe-Rough & Test' � � ; � • 72. Underground Flush .
24. Roof�Framing-�j '' ' ._ �.; '' � . 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathin}. j 74. Overhead Hydro
.. 26. T-Bar Ceiling (Structurap & Monocoat � - r � . 75. �Dry Chemical .
2�. Frame and Fla'shing � 76. Dry Standpipe
28. Lathing & Siding ' �• - � 77. FIXED SYSTEM FINAL
29. �nsulation � ' � 78. FIRE PREV. FINAL
30. Drywall Nailing �' � � HEALTH DEPT. REQUIREMENT
31. Plast�r Brown Coat � � � . 79. FINAL INSPECTION
32. Electrical Power MeterFinal , � �! ' 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. Fiq�l Plumbing - � , � - � ' � �� � � '. .
39. Water Service-Final ' , . � � , ' �'� . '
� �
40. Gas Service-Final • ' � � � 1" 1�-i
41. Solar pomesticFinal • �� � � -'=� !'^
y .
42. Backflow Preventer , . .
�'
. i , �r.�
43. Backflow Irrigation ' � � , � ' � � , '� � �
; �1
44. Landscape Irrigation System • . � � f' ��
45. Sound Attenuation � . ' � .
46. Handicap Regulations - � . '
47. FINALSTRUCTURE&BUILDING . •
48. Special Requirements Completed , ' � • � ' �
• � V"
49. Electric Release to Edison - - -- � - �•' ' '� -
� �•
50. Gas Release to Southem CaliforniaGasCo - � . ', '�'•. �K � � 5
51. CERTIFICATE OF OCCUPANCY � _ _ _'_._ . _ ' _ . y ". �} � , ::�
No. Date - ' � -
� _ --�
�_ _ __ � , ApPlicant to fill In all SDateS exceD< <hOie wilhin
� CITY OF COSTA MESA , �. . PERMIT NO: TRACT I
CONSTRUCTION PERMIT ' �—//�g/
G ' � if w So✓'t/1
Project Address � � TYPE OF CONSTRUCTION� ' NEv
AppliCant'SMellingAddfC35�.f � 'W�' � /�N �CONVERSION ❑DEMOLISH
OWner'S N2me -��T S�F/i/�SrTC'H 'phon2 - DESCRIPTION OF WORK
Eortler Ilnas ane sign all apv�oV��ate tleelantionz.
J ADD ,� ALTERATION IJ�REPAIR
OTIiER `
Address� TVPE OF PERMIT GRADING :OUNDA710r1 LJ STRVCTUf2AL
Aroh/Eng:� LiC2nse NO. ❑ TENANT � ELECTRICAL ❑ PLVMBING ❑ MECHANICAL' '
Address � � ' ❑ �OTHER � ' � �
� ����� �i
Contrector's Nam✓T� �G/1�+/���EC1LG� ahone.2_L�CL'2 PROJECT DESCRIPTION SQ. F7. - oCCUPANcv—
Address�lmailing✓�40/-�✓/fS7h��S%G/I �%'JTO�N��G✓i= CONSTRUCTIONTYPE VALUATION$ �'
City LicenSE No. ��'�'�b � � ZONE ' GRADING CU. VDS. 'ACRES_
�LICENSE� CONTRACTOR DECLARATION Remarks: ��y �r, "
1 hereby affirm thaf I am licensetl untler provl5ions of Charter 9(commencing
�with section 7000) of Divlsion 3 of tha Buslness antl Profession5 Cotle, antl '
my Iicense Is in (ull torce antl ef�ect. .
I �Icense Class_�- License No(i�17� �� PLI
i '�te � � � -'r`f Si9nature , .
RKERS' COMPENSATION CLARA N Bat Sink
Q .areby aftlrm that I have a certlflcate oT <onzent to selt-insure�or a tertificate Backflow Preventer �
'� of Workers' Co pens lon Insuran e or a certlfletl copy thereot (Sattion
3800, Lab. C.) G!! '4O^�'� � Becktlow Irrigation -
Poncy rvo Company S!/}1'iL % vr�. .
J�Certitietl copy I5 hereby turnlshed. � Ba[htubs
Certitlea copy IS tiletl with the clty B1u�il IvlSio .
`I Date,} -� 6 P�_ AOP���z^' ¢ ` x Clarifiers
��EXEMPTION FROM WORKERS' O PENSATI N CLARATION _ Di5hwd5hef
(This section neetl not be completetl"If the parmlt`is-Yor one huntlretl ($300) or
less). Drinkin Fountains '
I certlfy that In the performance of the work for which this perm�t is issuatl I 9
shall not employ any person In any manner so as to become sub�ect to t�e
Workers' Compensation Laws of Callfornla. FI00� D�ains .
Date Sl9natUte '
NOTICE: It,iafter makin9 this tletlaration, you shoultl become subject to the Floo� Sinks �
Workars' Compensatlon provl5ions of the Labor Cotle,.you must forthwlth.
comply wi[h such provisions or this' parmit � snall be tleemetl revoketl. Gas Servic2 Outlets �
CONSTRUCTION LEN�ING AGENCV
I h0reby atfirm thdt [here is a conttruttiOrl lentling agency tor th9 perfOrmance Int¢rc¢ptOfS '
of the work for whl<h this parmit is Issuetl (Section 3097 Civ. C.)
Lentler's Name '�' Kitchen Sink •
Lentler's Atltlress ��
OWNER BUIIDER DECLARATION Wvatotie5
t hereby afflrm that I am exempt lrom the Contractor's License Law tor [ha p-Tre
followin9 reason (Settion �031.5 Buslnass an0 Professional Cotle: Any city or P
�county which requirez a parmlYto construct, alter Improve, tlemolish or repalr
any structure, prlor to Its Issuance, also requlres t�e applicant for such permit RoOf D�ains
'lle a signetl 5tatement tnat ne/she is Iicensetl pursuant to the provisions of
'ontractor•i License Law (Chapter 9(commencing with Se<tlon 7000) ot
slon 3 of tne Business antl Professlons Cotla)' or tnat he/she is exempt �
tirerafrom antl the basis for the allegetl exemptlon. Any vlolatlon of Sectlon
7031.5 by any applicant for a permit subjects the applicant to a civll qeinspec[ion Fee $25
�enalty oi not more than five huntlratl tlollars (E500).
I, as owner o7 tha Droperty or my employees with wagas as their sole
mmpensation wlll tlo the work, antl the structure is not intentlatl or of(eretl MEC
for sale (Sec�lon 7044, Buslness antl Professional Cotle: The Contractor'i _
LI<ense l.aw tloes not apply to an owner ot a property who �bulltls or Improves Boile� '
tM1e�eon, antl,who tloes suth work himself/herselt or through his or her own
employees, provitletl that sucn Imorovements ara not intentletl ar otfaretl for Duct - Under Ground
sale. If howaver, [ne bulltling Or ImproveTBnt I5 Soltl within ona year of cOT-
pletlon, the ownar wlll have tha burtlen of provin9 ha/she tlitl not builtl or im-
rove for the purpose oT sale). Dutt - Structural
� I, as owner o! tha property, am excluslvely tontractin9 with Iicensetl con- Duct - V¢ntilatin
tractors Id construct the project (Section 7044, Business antl Prote55ion5 CoOe:. 9
The Contractor•s Llcense Law does not apply to an owner of O�oOerty who
builtls or improves thereon, antl who contracts for such pro�ects with a con- ExheuSt System ❑ Multiple ❑
Iractor(s)Iicensa pursuant to the Contractor's License Law).
❑ I am exempt untler Section 8. & P. C. for thl5 reason Firepl/Fact. Blt. ICBO �
Date
I heraby certity that
Informatlon Is correct
antl ztate laws relatln
sentatives of this c I
Inspettlon p Oa
Signature
_ Ownar
hdvB rad
to
Drlvers'(Licbnia or 55.� �{
� (, �� � Reinspection Fee $25
Bulltling: Canary - Appllwnt;, �Ink - A<countin9: Goltlenrotl - AsSessor
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinel
Water Closet
Water Heater .
Water Service
laue Fee
Hood or . Typo I ' ❑
Canopy Typell ❑
Refrigera2ion System
❑aioo,000sru ❑ioo,000
System Repair/Altera[ion
laue Fee ,
0
$ 3
S 3
A.P. #
S Main Building:
E
T , Front
A Rear
C Right ' '
gLeft
Ping. Ref. sW
Parking Req./Provided
Use of Building:
Plannin9 Notes:
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers �Gas ❑Electric
" 4433 2/16/B4 �
5.�+0 TL
' Zone' •. . '
Acceuory Building: 2
• O
� N
' .�
� � � N
_ G
- � R
- � E
Park.Fees $ �- � ' a
U
' , I
, , R
" E
' N
E
ELECTFICAL
Transformer ❑ 15-50 KW
❑ SO+KW
Meter ❑up to 100amps
Meter ❑over100amps
Fan
F.A,U. .
Fixtures
Device Boxes . .
Outlets
Switches
Garbage Disposal
Generator �0.5 KW �5�15 KW
I Reinspec[ion Fee I $
PUBLIC SERVICES RE�UIREMENTS:
Zoning Approved By
Building Approved By
Applimtian Issuad By
Sub Panel
Molors�61 HP 01'/:-8 '
Inc.Solar �9�15 HP �16-15+
Microwave .
Pole Light
Range
Sign
Standing Sections
Trash Compactor
Issue Fee
FEES
$ 3
� SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT ,
PLUMBING . $ ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL $ 4�� GRADING $
PLANCHECK 50% $ .�0 MICROFILM $
MECHANICAL $ TOTAL FEE $ �' �b
PIAN CHECK ZS% $ _ � '
0
�
�
i."�CONSTRUCTION.ANDiPLqNNING � . � ` � -��, P�' ��$PA - � r • , •;. i
- � � - � - � .Date � �Inspector � � �� �� i-Date'- Ins e`cfor'•,
�.,APPROVALS �- Permit.#_ �7��}�i I�� APPROVALS Permit#� P
.�,+: - -
1. iemporary Electrical Service or Pole ; � 52. Pool & Equipmenf Location' � � �
. . _ . , , . i ,.
� 2> Soil Pipe-Undrgrnd._ , ' - _ ' • ' ' ' 53. Steel Reinforcement - - � -
�'- 3:. Electrical Conduit Utility-Undrgrnd. � � . �54. Forms, _ : � - ''
' m
� 4. Electrical Conduit-Undrgrnd. _ � . 55. Electrical Bonding. �
„ �.
5. Steel Reinforcement. � � � � 56. Rough Plumbing & Pressure Test - - -
6. Electrical UFER Grnd.� - � . 57. APPROVAL TO COVER-GUNITE. � � �
- ,
7. Footings � ' � - . � 58. Electrical Conduit-Undrgrnd. , ' �
8. Foundation _ . � �� , -59. Gas Pipe, O Undrgrnd., Test . ' �
9. Water'Pipe-Undrgrnd. .� - , 60. Backwash Lines,-P-Trap, O Undrgrnd. �
i
10. Structural FloorSystem , . 61. APPROVALTO�DECK .� -
11. Property Sewer Line & 1-louse Connection 62. Backwash & Receptor-Final. '� � � �
72. $ewer Cap ' , � � � , 63. Heater & VenbFinal � � . � ' � � � =
�
13. �ypof Drains ' . � � � , � � 64. Plumbing System - Final , � � - �; �'
14. Rough Plumbing � � � � 65. Electrical-Final - . ' - � �
�
� 75t Rough Electrical=Conduit-"' - - " 66. Solar System-Final � � ' � '. ' �'
16. Rough Eleciric Wiring�. � , ` � y� - 67. Fencing & Access Approval " ' '� '" '" �
17:. Rough Wiring Sign _ � 68. APPROVED FOR PLASTERING � . .
,.
� 18. �Rough Electrical-T�Bar; Ceiling ? � . 69. POOUSPASYSTEMS FINAL' - , � -
i
19.' Rough-Heating & Air Conqitioning ; � FIRE DEPT. REQUIREMENT �
. � � .
j.20. Rough.FactoryFireplace ' � . � ' ' APPROVALS� Permit# � � �
�
• 21. Ducts,�in Structure, �. , ' i 70. Underground Hydro ' � � � , . ' '
�
t'.22. �Ducts, Ventslafing � i d i � , 71.� Product Piping O Gas ❑ Oil . � �';
23. Gas Pipe-Rough & Test � ' '. 72.' Underground Flush. . � ' �
�i.
� 24. Roof Framing, � �� ' � , 73. Undergmd. Storage Tank O Gas ❑ Oil - � ' � �
25. Roof Sheathing � 74. Overhead Hydro � �_ � ' �
`� � 26. T-Bai Ceiling (Structural)'• & Monocoat - 75. Dr,y.Chemical � � � i ..
. 27. Frame and Plashing - , � � 76. Dcy Standpipe � � i �,: ,
i
.. � 28. Lathing & Siding , - � . • 1 77. FIXED SYSTEM FINAL ' � �
� 29. Insulation ; } � � . � 78. FIRE PREV. FINAL ' �
` 3-30. D,rywall Nailing i � � � HEALTH DEPT. REQUIREMENT � �
��� 31. Plaster Brown Coat � � � � - 79. FINAL INSPECTION T '
-? 32. Electrical Power Me4er�Final 80. FOOD CERTIFICATE ISSUED . '
r 33. Final Electric ' � e C.C.. Notes: � !
34. Final Heating &`Air�Conditioningi'' � +
35. Finaf Gas �Pipe-Test • - - � - , � � � - � � . . � �
� c
36. Hood or'�Ganopy� � � . . � , ' _ , � � ' , � - -
�
37. Final Factory Fireplace � � , , � , . � , � ,� �
38. Final P.lumbirig � + • . - � �
� .
39. WaterService-Final' ' ' , � . � � ° �
u
40. Gas Se�vice-Final ' 1 , � � � � ' ' . � ' ` ' � � �
i
41. Solar pomesticF,inal � . _ -. .-_ - � ; . •
t � e
42. Backflow�Preventer! , � � , . - �
43. Backflow�lrrigation' � � , � -
, � .
44. Landscape Irrigation Syste`n � � . • '
� ' . �
45. Sound • Attenuation� , � , � , � � � �
46. Handicap�Regulations ' � � � � � - � - -� .
�
47.FINALSTRUC�URE&BUILDING � i _
48. Special Requirements Compleied' � , , . � � � `' � � � �
49. Electric Release to Edison � , � '- � � � �. � � . � �
,
50. Gas Release to Southem California Gas Co �� � ' � . _ '�
51. CERTIFICAT-E•OF'06CUPANCY -' � � • - - - � - - - � � , '
No. . : . _- - � Date' � ' � , , , . � . � _ .
Pfl0.1ECTRODNESS: jSSS HARBOR GA'fEWAY S u"�T: MT3—B
owNen�sxnme: C.J. SEGERSTROM 6 SONS
nooxess: 3315 FAIRVIEW RD
COSTA MESA
CA 92626
(714)546-0110
APLHIENGINEER: TOM CAMPOS 6 ASSO. pEc.No: NONE
aoosEss: z382 S.E, BRISTOL ST �"�T C
SANTA HEIGHTS CA 92707
PEflMITTEE: WATSON CONSTRUCTION ( 714 ) 662-7933
aooness: 1260 LOGAN AV 1
COSTA MESA G/�%�2626
UCENSEO LONTNRCTON OECLABATION: I h¢reEy a�hrm Ihai I am Iiren5e0 un rOvi5ion5 al CAaplef 9(tOm n' p wii� 5¢tlivn
70110� of Division 3 al t�e BuSineu anG Prolessions COOe. aM rtry littn5e � lull lorce anG eflect.
cirvuc.:047413 sTn,euc.:546538 uss:
Daie. s � -S � 9_� SignaWre: _
WONNENS' COMPENSATION UECLABATION: I �er¢Gyal�irm I�a� I ha niliwte oi cansem io ulbinsure or a cenificate ol ' kers'
Compensation i s ra c a c�jnAie8�/Q DY ��e�eof (Sectian 3800 . 1.
�OIICYNO.: �����4�+—JV E%P. : Q�O �92
mrnNr: STATE FUND
ten�rea coov �s nereey mm�snea. [IS cenn�ea cooy rs nea w�m i iry BulAing Div¢ion.
oaie: 5—/ J— 9/ aoor��c
EXEMPTIONFflOMWOPKEflS'COMPENSRTIONOECIAMTION: (�N5 ,� :eOnotGeCOmpklWilUepamtbloronehuMre0�S10D�orless�.
I c¢tli�y IM1ai in I�e perlarmante oi �h¢ woM1 lor xTith Ittis Oetmf . I Sliall noi Cmploy am/ person in airy manner so az lo �ecame
su�le�� �o t�e Workers' Compensation �avn ol Catifomu.
Oaie: Signamre:
NOTICE: II. after maiting tllis aeclaralion, you stwulG 0¢tame suElecl lo I�e Worker5' CAmDensalian D�ovisions of t�e LaEor
Coa¢. y0u mu5t �Orllnvil0 CamDN �^'��� Sut� OrPn5ian5 ot INS Oermil ShaA G¢ CeCmeE revokeU.
CONSTPUCTION LENUING pGENtV: I nereUy atlirm t�at ��ere is a cominrctian IenEing agenry lor t�e performance ol t�a work for
wnich this oermit is issuM �Section 3097, Gv. CI.
LENOEfl:
AUOPESS:
CZTY OF COSTA MESA — BUILDING PERMIT PERM NO: B 05207
PERMIT NO: B 052078 PLAN CHECK NO: 01656-91 L GOVT: N SUPP; N
CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ALT
JOB DESCRIPTZON : OFFICE/WAREHOUSE T.I. (COMMERCIAL) SQ FT: 1,679
CLAIM VALUE: 13,000.00 CALC—VALUE: 12,914.84 GROUP OCC: B-2 /
COMMENTS; CONVERT AN ALL OFFICE SPACE TO OFF/WHSE
��*�r***�r�r*�t*+r+r*�t***�t*+�+e�*�+�*�***x�*�e�r+��*****�*�r�r*r**�r+t**�+t�t***��r+t******+r�r**�r+r�**
Z O N I N G R E Q U T R E M E N T S
s s T B A c x s
------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT; FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ• PROV; PARCEL: 41509104 ZNE: PD1 REF NO:
PLANNING N(5T'ES> INTERIOR REMODELING TO REMOVE WALLS AND RELOCATE DOORS
i
*��******�***�r�x*�����*�,��*����*�***���**����+��+���*����*����x�*+�,�+���«+���+�***�**�*
D E V E L O P M E N T 5 E R V I C E S R E Q U I R E M E N•T.'S
20NING APPROVED BY •�• ___ DATE: /
BUILDING APPROVED BY : DATE: —f � /
APPLICATION ISSUED BY: • DATE: .S � %
ifiFififiFikaFiEifiFiFiFifififlFk3FiFaFiFif ififiFiElEif±Flfafi(; 3fif
iFMiEiflFififiFkifiFiFiFifkiFlfMkiEifMiFk4iFafk�1Fi41EiF iEkk7FiE iF*if iEMiEifMNifK�fflEiEikifiFiFifiliFlEiE1f1F1FkififiEiElFMkiEififiEif
LEGALIZATZON:N F E E S U M M A R Y STRUCTURAL SEGMENT:Y
OWNENBUILUEHDECLABR710N: I�ereGyallirm�AallameeempUromt�eContracmrs'SbteLiceiueLawlon�elollpwingreamn BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES '' GRADING
(Section 70.7L5 Business anA Profesvwal CoEe: Arry tiry ol county whkAi repuires a perrtui to construcl. altei, imprwa, Gemolish, o� p$RM I T 19 9, 0, 0 �
reDair any Simt�ure. priot 10 iR i55uanu. also repuire5 i�! appFcani �ar Suth pefmil l0 �ile a ApneG Sialemen� Ihal �d5he is Iiten5e0 '
pursuanl la Ihe pmvisions oi ihe Comractws' Sute License Law (Chapler 9(commencinp wiin Sectwn 7000) ol �ivision 7 oi t�e Busineu SM I P/NON—RES
ano Pmiesslons Coael or tmt ne/sne is eKempt tnereimm ana me oasis �or me anepea eremofon. any vioiation a� Section �o9t5 Ey PLAN 9 3. 6 0 Z.% 1' �
any apPlicam for a permit su�jects t�e appliant to a civil De�aliy ol not more ��an five hunAaO tlollars (5500�. ISSUE FEE
i, as avmer ol me ompeny or my em oyea .im wapa as meir sole comoenuiion, win Eo tne wark. antl the BUILDING—DIV—> PERMIT ISSUfi PLAN—CHfiCI( TOTP.I. PAID DUE
O s�mcmre is no1 intenaee or olfereE lar sale I�tlon 70aa, Buuneu anE Pmlessional COEe: The Coniractars' State License Law 7'OTAL S----> 14 6, i i 0. 0 � 9 3. 6 0 2 9 0. 31 2 4 �. 31 " . � �
' Eo¢5 n0� a00tylo an owner0l 3 pr00e�y w�o bui105 orimprov¢5 I�ereOn, antl w�o tloes Suc� xrork AimSelllAersell orlhroUph , ;
his or �er own employees, pmviGeE i�ai suc� �mprovements are nat mienae0 or ollereG br sale. II, �owever I�e �uilUinp or REV$NU$ DI VZ S ZON TOTALS--> COLLECTED • 14 6. 71 OVER /SHORT • r V�
impmvemem is solU x�ihm one year ol compietion, I�e owner witl Ilave It1e �urden of provinp �eh�e Gid nol Euild or imprmo ,
mrineo���seo�uie�. BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHEGK
i. as owner ol the pmpeny. am exclusively comraciinq v+itA Iicense0 coniractors to cansimct Ihe D�alecl (Seclion 70A4, Business 14 9. 0 Q 2, 71 �� ..
❑ and Pm�essian5 CoOe: Tne Camractors' State license law dces nol appty to an wmer of Dmperty who bmitls or impwves ��ereon �. a��
anOw�oconiracls�orsuc�prqeti5wit�aconlractorls)IicenSeDursuanllo��eConVanors'StaieLicensnLawl.lamaware iEitM3FiflEiEikifififlEiEiEifjFifiE3lifklFk�FifIfIFIEiEilikiElFikiFifrtit�flf3fifif{E{EiFif{FiE{t{p1f{(.{(�{(�{F�(.{t{p{(.�(.{(.{(.{Fjp{F{(.{F{(.{(.{(.*{(.'{(..{(..K.a(.'jp{F
t�ai D��� al ��eir Worker's Compensatmn inswance SMNG Ee proviEeE to ma. j N D I V I D U A L F E E B R E A K D 0 W N � i'' .'�
� I am ezempl under Sec�ion: B, d P. C. �, � ���
mnmsreason: TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
Daie: Ovmer. S FC
I Go hereUy certify iha� I am aware ot ana un0erstanG i�e repuiremems oi Calilomia HeatN an0 Salery COUe Sections 255U5, 25533, antl SF'C
2553A ana Ihal I or any INure Uuildinp ocNpani will/wiil nol (cirtle one� nee0lo camply wiltl SaiA s�ale co0es antl Ihe reQuiremen�s lar a
permil �or conslmclion or motlilicalion Imm IM1e Air Oualily Managemeni Oisiricl. Re5i0enlial [onS�mclion aOVlicalion5 are exempt Iwm
Inese pwvisions. ' �
oaie: noorcam:
I hereby t¢r�ity ��al l �ave reatl this applitalion antl Siale Ihat Ihe aUov¢
• ortlinances and state laws relating to �uilEing cons�mction anU nere0y aut�
� pmoetly �o� inspec�ion Dulrposes.
Oal'. � ^ / J —�/� Si9nature: %'
� ).
t6a1<6 W�i�e—Buiitling; Green—Caae Enlo¢ement: nary—A�
is carrect.
Pink—Revenue: Goltlenrotl—Asseswr
and
995 OFF—INT. ALTER TYPE V—N —AVER 10.12 �10,069,40
689 R LTER TYPE II V—N —AVER 4,16 • 2,845,44
, :1 �,� END bF FEES
yv�. _ .
, � �, �:� a r
-,._ 1 ;, ;
' „FhAY�ti �`;ry� ; .�
, �J 'iik!`�� (� (`7k {�¢�(�
''�/1����Y'� 4Q`Iii.R�:�U�%"'-' .
CONSTRUCTION AND PLANNING '��" SPA r `
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspe ior
� �
t. Temporary Electrica4 Service or Pole� : 52. Pool & Equipment Location `/
2. Soil.Pipe-Undrgrnd. - ,' 53. Steel Reinforcement
" 3. Electrica� Cond`uit Utility•Undrgmd: � 54. Forms
4. Electric8l:ConduiY•Undrgrnd.. ' ' . 55. Electrical Bonding -.
r
- 5. Steel,Re nfarcemenL ' 56. fiough Plumbi�g & Pressure Test
- 6.jElectrical UfER Grnd. • 57. APPROVAL TO COVER�GUNtTE
7.�;Footings''j,��r�. _ � 58. ElectricalConduit�Undrgrnd. .
� 8. Foundation� , � 59. Gas Pipe, O Undrgrnd., Test .
' 9. Water Pipe�Undrgrnd. . � / � 60. Backwash l.ines, P-Trap, O Undrgrnd.
•10. Structural.Eloor System. •� � / ��' 61. APPROVALTO DECK ' '
��11: Property Sewer Line &�House Connection ' 62. Backwash & Receptor-Final � - - �
12. Sewer Cap . . � 63. Heater & Vent-Final '
,q�;.
13. Root Drains _� 'U , 64. Plumbing System - Final
14. Rough Plumbing � ' 65. Electrical-Final � 7
15. Rough Etectrical-Conduit.' � 66. Solar System-Final �
16. Rough Electric Wiring , ''. 67. Fencing & Access Approval
17. Rough Wiiing Sign �" 68. APPROVED FOR PLASTERING
'18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
' � ' �. .
20. �Rough Factofy Fireplace � "�' s - � _ • APPROVALS; -Permit # � '' `�
�:
21.�DuC[5, in Structuie,. � • . _ - -.70. Underground.Hydro ^
22. Ducts, Ventiiating,' - •! -�77, product Piping O�Gas ❑ Oil
23. Gas Pipe�Rough & Test � ; ,- � ,• ' ' .� � � ' ' `
72. Undergrou,nd Flusli - .� , ; j�- -
24: �Roof Framing ^ - •• - '+ -- ' �` � � �73.LUndergmd�. Storage,Tank O Gas ❑ Oil . - .
25. Roof SNeathing � i u' � ;a r`74.?Overhead Hydro^ `_ � '
26. T�Bar Ceiling �Str.ucroralj & Monocoat -- . ` _ 75:- D,y Chemical - - � � `
27.: Prame and Flashing' •, ; , , 76: Dry Standpipe ' ,, - � � • .-
28. Lathing & Siding • .�r,�' _ . • • - 77,: FIXED SYSTEM-FINAL' ''
'29. Insulation '. -:• . . �'�' � •, � � - '.
� � •. �� 78.. FIRE PREV. FINAL . �, c�
r30. DrywallNail�ng � ,�� �I . HEALTH�DEPT:REQUIREMENT �
31. Plaster Biown Coat, , - � � ' � �(; :� r79' FINAL INSPECTION � � `� =
•ti
� 32::Electrical Power Meter�Final : �- �;-�� .�80.rFOOD CERTIFICATE ISSUED .
,'
i
.33. �Fin�l Electric �� � �, i �_ ' I � - } ' ' Notes: ' ; � _ '
�34. Final H¢ati�g & Air:Conditioning, - � � � �< > a. � � •
�
35.'.Final Gas Pipe-Test ,,; , �-' �,� ' /O ,
�36. Hood or-Canopy� � • .� . ' j•�% - >; � � � �
.�
37. Final Fectory Fireplace� � • - r � , � '� - ' .
. , � . .,
`38: Final Plumbing �_ . •
"39I�Water Setiice�Final• ' � • ' � - '' � �
� ^ . �
40.'Gas Service-F.inal , . - " • - _,.. ". "- �'-' � . ..._" ` . .
. . ,� tr, . � �
-41. Solar OomesticFinal �. ' • : - .
:� �
42. Backflow Preventer' -'• � � � I �, • - -
z
43. BacktloW ��rigation� - � • � �
r �. _
.44. Landsc2Pe Irrigation System• � � �'- . � � - � �
�45.:Sound Attenuation �� - >
.46. Handicap Regulatio�s - ' . � . ;
`47.�FINAL STRUCTURE & BUILDING ` �� ��l� •
� W �t
48. FINALPLANNING � � •_VG �`�('iC. '
:49. Electric Release to Edison � i� ��• : �
-50. Gas Release to Southem Calitomia Gas Co ' . a .;I .` �� �� . •
51. CERTIFICATE OF;OCCUPANCY � , t z_ , � � � , �
No. Date
PH0.IELTADOflE55: 3SSS HARBOR GATEWAY S ux�T: MT3—B
owxexsenme: C.J, SEGERSTROM 6 SONS
aooaess: 3315 FAIRVIEW RD
COSTA MESA
CA 92626
(714)596-0110
AflCHIENGINEEH: TOM CAMPOS 6 ASSO, pEc."a.: NONE
aooness: z382 S.E. BRISTOL ST uxir: C
SANTA HEIGHTS CA 92707
PEXMITTEE: xOLLIS ELECTRIC ( 213 ) 371-4939
aoosess: Z p g 0 5 MADRONA
TORRENCE CA 90503
LICENSEO CONTBPCTOB UECIAFATION: I hereby affirm t�at I am I� nseU unUer pmvisions ot Chapter 9(commencing wiih Sec�ion
70001 0l �rvision 3 0l Ihe Business antl Pmfessions Code, antl my c nse is in lull f c n0 effecL ,
c�rr uc.: 0 3 9 2 7// S�TFTE LIC.: .�. 13 814 �ss�C 0 '
��' Z'J (�1�_ Signature: ��� � _ _
WOBRENS' COMPENSR710F� UEClA8FTI0N: I �ereby aifirm ihat I haue a cenificate ol nsen� Io Sell�in5ure of a Cetlilicale a� Workers'
Compensation a$c�j. or c�jnid i �Q �he�r {o(Section 3800. Lab. 1.
POLICYNO.: ��Jl—�++�J�'`�� E%P.OATE: 4IZZIyZ
comvaxr: FREEMONT .tn
❑ CehiheU copy is hereby Iumi50etl. U^ Certilietl copy is ' wi� t�C cily ii ng Divisione
n�„-_S Z-3 'f I nova�a�c S
E%EMPTION FPOM WOflMEPS' COMPENSATION OECLABATION: Qhis seclion neeU nol Ge co Ieietl il Ue perma is lor one hunAreO �5100� or leu).
I cerlily ��at in Ih¢ pedOrmante ol �h¢ work for whiC� �his permi� is i55ueQ I Shall n01 employ any person in any mannef 5o as �0 became
su0iecl lo ine workers' ComDensatian Laws of Califomia.
Date: Signamre:
NOTILE: II, alter maWng I�is Oeclaraiion, yau 5�ou10 became SuDle�� �o t�e Work¢r5' ComDensation prOvisions o� Ihe Labor
CoOe. you must lonnwith comply witn sucn provisions or tliis p¢rmil 5�all be aeEmed revokeC.
CONSTBtILTION LENOING AGENCY: I hereGy aHirm Ihai t�ere is a con5im[lian IenEing aAency for the peAarmanc¢ a� [he wark fo�
w�ic� I�is Oermit is i5suetl (Sec�ion 3W7. Civ. C�.
LENDEH:
noon¢Ss�+
"h,
OWNEP BUILDEB OECLAflRTION: I �ereby atlirm �ha� I am exempi Irom Ihe Comractors' State License Law �or �he �ollowing reason
(Sec�ion 7031.5 Business antl Pm�essional CoOe: Any ciry o� county which repuires a permii Io cons�mc�, al�er, impmve, demolis�, or
repair any slruclure, prior lo ils issuance. also requires Ihe applicant �or such permi� Io lile a 5igne0 s�a�emenl �ha� he/she is licensea
pursuant to Ine pmvisions ol ihe Comracmrs' Slaie License Law (Chapler 9(commentinA w��h Section 7000) oi Oivision 3 ol ihe Business
ana Prolessions Caae) or that helshe is exempt inerefmm and ihe basis lor Ihe alleAetl exemption. Any violation of Section 7037.5 by
any apDlitant Ior a Dermit su0�ecis ihe applicant to a civil penalry ol nal more Inan live Aun4reU Oolla�s (5500).
I, as owner ol Ine owoeny or my employees vnih wages as iheir sole campensation. vnll tla Ine work, and Ne
❑ suucture is noi imen0etl or olferea inr sale (Section 70a4, Business an0 Pmfessional COAe: The Cantractors' State License Law
' Ooei n0i a07�Y �o an awnef of a pmperty wAo Ouii05 or impmve5l�ereon. anU who OoeS Sut� wofk him5eli/hersell or I�mugA
�is or �er own emDloyees. O�ovitletl ihat sucA improvemenis are not imen0e0 ar otlerea for sale. Ii, however ihe builaing or
impmvement is sol� wiihin one year o� compleiion, t�e owner will have Ihe OurAen oi proving �e/She Oid no� Uuiltl or impmve
br t�e Ourpose ol sale�.
I, as owner ol ihe pm0erty, am e�clusively coniracting with IicenseA coniractors m constmct ihe pwlect (Setlion 7W4, Business
❑ ana Pmlessions CWe. The CanVactors' State License Law Ooes nal apply to an owner ol pmperty who OmIGs or impmves thereon
an0 w�0 coniracls br such D�ole��s wilA a contrac�or(s�license Dursuanl l0 Ihe Coniractors' Slaie Litense Law�. I am aware
I�at prool of t�eir Workei s ComDenution insurance should be pmvitle0 to me. -
� I am eKempt un0er Section: B. 8 P. C.
lar ��is reason:
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO; E 052177 PLAN CHECK NO; N
CONSTRUCTION TYPE; PERMIT TYPE: ELE
PERM NO; E 05217
GOVT; N SUPP: N
PURPOSE: ALT
JOB DESCRIPTION : OFFICE/WAREHOUSE T.I. (COMMERCIAL) SQ FT:
CLAIM VALUE: CALC—VALUE: GROUP OCC: B-2 ./
COMMENTS: REFERENCE BUILDING PERMIT tIB52078
*�t**+r�***�*��x �**�t***�t***�r�r**��t**+�***x*+�****�**�t��*�tx x�**r��***�t�*+��+�****�t��tt**�c**
. Z O N I N G R E Q U I R E M E,N T S
' �S E T B A C K S
i
------------ MAIN HUILDING ----
FRNT; FT YN REAR: FT
LEFT: FT IN RGHT; FT
PARKING REG • PROV;
PLANNING NOTES>
i
*x+r**�**<*�e*+r*+��r*�*��+�*�t*+r*�r+�**
D E V E L O P M E N T
20NING APPROVED BY
-- --------- ACCESSORY BUILDING ---------
IN FRNT: FT IN REAR: rT IN
ZN LEFT; FT IN RGHT: FT IN
PARCEL: 91509104 ZNE: REr NO;
*+r�rx��******�*�e���r****+�*****+�**�r�**�t�t�rx**�r�r*�r�
E R V I C E 5 R E Q U I R•E M E N T S
DATE:
BUILDING APPROVED BY ; / DATE:
APPLICATION ISSUED BY• •C� ��� DATE: ^—���
iEifiEN�IbIFiFiFififlfafiEifiElEifiFlf�EifiEiFiFiFiF � iFTF TFiF 7F3FiiifiFiF'iF�F7FiEiFffiflElFiF1f�)kif r iflf
iR*lf±tlflfak3ElfiFifififiFafiflfafifififdffEiFltr�kifiEifk�lEiflEiF3E*!F!t%ifif�lf i61FiEiE361E3lIfiEifiEjElElEiflEiEiFi!�iFIFi(•itiE3F�F1fiE3F1f3F�fiEif
LEGALIZATZON;N �F E E S U M M A R Y STRUCTURAL SEGMENT:N
HLDG PMT PLUMBING ELECTRIC �MECHANIC F�IRE SMIP/RES GRADING
PERMIT 6.75
503 SMIP/NON—RES
PLAN ,
ISSUE FEE 15.00
BUILDING—DIV—> PERMZT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 6.75 15.00 0.00 21,75 21.75 .00
REVENUE DIVISION TOTALS--> COLLECTED: 21.75 OVER/SHORT: 00
HLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADZNG PLAN—CHECK
Zi.�%rJ
ff aF if if If iE iF %3f 1f iE if if �f �f 3F ii if iE iE if IflE iF iF )f iF iF iE �f if iE if �E 1f if if iE iE 3k if iE it iE if 3f If 1E 1F if 1E if if If 1E jE fE 36 iF aE if iFif �E iF iF * iF if if 3f i6 �E IF iE ff fE �E if
I N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
Date: Ownec . ELE
I Uo hereDy cerlily ��a� I am aware ol and unaer5iantl �he reQuirements ol Cali�ornia Health antl Salely Code $ec�ions 25505, 25533, antl I EL E
2553a anA Iha� I or any WWre builtlinq occupanl will/will no� (circle one) nee0lo comply wiih saitl s�a�e coJes and �he repuirements for a ELE
permil �ar consimclion or moai�ication imm ��e Nir Qualily Management Dislrict. Resitlential cons�mction apDlications are exemp� fmm
mesc Pmvisions,
�ate: Npplicanl:
I hereby cerlity IAat I haveread Ihis a0�licalion an0 Sla�e�ha��he a0o inlorma�ion' correci. I agree�o comply wilh all ci�y anE counry
,oi0inance5a�-telaw5relali�consimclionanaherebya �urizereDres tativeso�/hiscirytoenle�uDonlhea0ove-men�ionetl
properly loi �nspetli0 Durp0ie5
—9N±. � 7'j � I Signalure:
6iver's L�k'e►e or $ocial Secu�iry ro:
i6<Pu6 W�ne—Builtling: Green—Cotle EnlorcemenL Canary—Ap0licnnt: Pink—Revenue; GolOenrotl—Assessor
'2 FIXTURES LIGHTING
1 RECEPT/OGTLET
6 RECEPT/SWITCH
1 ST 20
1 ST 20
i ST 20
END OF FEES
EA. .75
EA. .75
J
1.�0
4.50
J1 04C37S7}—GC�37n'1 3,r'7j' -
�Air: OS/i3/91 T_;�E: 0$:.i4 •
�
,
�
CONSTRUCTION ANDPLANNING � PO SPA '4 �
APPROVALS Permit # - Date Inspector qppROVALS Permit # Date Inspector
N
1. Temporary Electrical Service'or,Pole 52. Pool & Equipment Location ' �'''�
2. Soil,Pipe-Undrgrnd. ,; 53. Steel Reinforcement !
3. ElectricaCCondui[ Utility,Undrgmd. ' 54. Forms -•
4. ElectriCal ConduibUndrgrnd: -- 55. Electrical Bonding
' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7.'Footings- 58. Electrical Conduit�Undrgrnd.
8. Foundation �-� " 59. Gas Pipe, O Undrgrnd., Test �--•� �
9. Water Pipe-Undrgrnd. ; _� " 60. Backwash Lines, P-Trap, O Undrgrnd. ��
- .
10. Structural Floor System 61. APPROVAL TO DECK .,
11. PropertY Sewer Line & House Connection -' 62. Backwash & Receptor-Final -' -
. r'
12. Sewer Gap ,, ' _ 63. Heater & Vent-Final -� -
_ �
13. Roof Drains� `' 64. Plumbing System - Final
�
14. Rough Plumbing ' '�'� 65. Electrical-Final
15. Rough Electrical�Conduit 66. Solar System-Final
76. Rough Electric Wiring 67. Fencing & Access ApProval
17. Rough Wliing Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Geiling 69. POOL/SPA SYSTEMS FINAL
19.�Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Pactory fiieplace ' �: �. . - � APPROVALS ' Permit #
21. Dutts, in�Structure. -• . 70. Underground Hydro •
22. Ducts, Ventiiating � - - `' �71. Produc[;Piping OGas ❑Oil
23. Gas Pipe-Rough 8i Test • _ .r 72. Underground Flush
24. Roof Framing • • 73. Undergrnd.Storage.Tank OGas ❑Oil
25. Roof Sheathing , � 74. Overhead Hydro; �
26. T-Bar Ceiiing (Structural) & Monocoat - • 75.-.Dry Chemical - � '
27. Frame and Flashing . . . .. 76. Dry Standpipe -
28. Lathing & Siding . � -�� � � � • 77. FIXED SYSTEM,F.INAL' . ' �
29. Insulation - �� �` � 7g, FIRE PREV. FINAL � -
30. Drywall Nailing - � i � . HEALTH�DEPT. REQUIREMENT
31. Plaster Brown Coat� .. � I��I 79. FINAL INSPECTION � -
32. ElectriCal Power Meter-Final • � -1 80. FOOD CERTIFICATE ISSUED
33. �Final Electric , -- -�'�j� Nofes: '
�34. Final Heating & AioConditioning- . • ,�i.�= : � � �
.„ ..
35.'Final Gas Pipe�Test' �_/. � , ' ,
36. Hood or Canopy � � �fj �
37. Final Factory Fireplace � � '� ; ' �
:_ �
38. Final Plumbing � �� -
39. Water 5ervice-Final' ' � ,
�40. Gas Service-Final , - � , � �
�41. Solar pomesticFinal � � '
' 42. BackfloW Preventer , . � � .
43. Backflow Irrigation• ' u. � . - -
. j
44. Landscape Irripation SYstem . . �
45. Sound Attenuation - . ' � •
46. Handicap Regulations � � , �
47. FINAL STRUCTURE & BUILDING � , � '
48. FINAL PLANNING . � `'! '
,'
49. ElectriG Release to Edison ' � �'��' �,
50. Gas Release to Southem California Gas Co � I (aj',
51. CERTIFICATE OF.00CUPANCY . • •�
No. Date
__
� • �?S�j�1-/ �1 n P/',/1 /'nT�o���jy t77/ Applicant to flll In all spacas exeapt those wit�in
,r l7Clrc.�/�c. Ct/�( r.ai ir7
CIT40F COSTA mESA P MIT NO. ' TRACT I
CONSTRUCTION PERMIT L���y� Q�GE T{tT3 -/3� ' 3
Do�tler Ilnes antl sign all app�opriate tleclaratlons.
PrOjCCt Address �^ � TVPE OF CONSTRUCTION NEW U ADD �'.J.ALTERATION , LJ REPAIR
AppliCent'SM811ingAddlCSi, � Mi���'� ✓�' �QUWG ❑CONVERSION ❑DEMOLISH ❑OTHER ' -
Owner's Name C•1 ��•��/�o�h� ry�8 ohone �6'DI1� , DESCRIPTION OF WORK WA�� QCr',o0�'L � � G�_�,{p � p/�yJ
�i'SIS �AIRV/Ek1 l_.O'�7> MEyI N1�N W . -
Addfess, TVyP�E OF PERMIT� GRADING FOUNDATION STRUCTURAL
Arch/Eng.� ' LIc2nSCNo. I�ITENANT ��ELECTRIGAL ❑PLUMBING ❑MECHANICAL
�Addre55' � ❑ �OTHER . ' '
Contractor's Nam �QVIOW Phone '� �-I PqOJECT DESCRIPTION SQ. FT. ' OCCUPAn�Cv �Z
� Addfess�meiling) ?+�����}iELS��� � �RV�� CONSTRUCTIONTVPE �N VALUATIONS 6395
\n22,93� zoNe ' GRADINGCU.VDS. ACRES
Ci[y Licenu No.
� LICENSED CONTRACTOR DECLARATION Ramarks: � ^$�
I hereby, afflrm that I am Ilcensetl untler provislons of'Cnarter 9(commencin9 �
\wlth section 7000) of Dlvizlon 3 of tha Business antl Professlons Cotle, antl �
my Iicanse Is In tull (orce antl effect. �8 n� PLI
(�, Llcense Cla s� .LI e o. � �
V� Date�— Si9nature
Bar Sink
WORKERS' COMiENSATION DECLARATION
I hereDy afflrm thaEl havo a certlflwte�of consent to salMnsure or a certl/icate� � gatkflow Pr2vent2�
of Workers' Compensatlon Insurance,' or a certifietl copy thereof (Sectlon
3800, Lab. C.1 • � Backflow Irrigation
Po��cv rvo. G.T847(397 Comaanv �N��/,(l INQyMN/7Y
A Certifietl copy 15 hareby turnishetl. � n� 88thtUbS ' '
!]9�Certl}i9tl c�yyJz filetl with the tlty Bulltli ivi5ib � // �
3
�ate � �( �4 ApP���ant .�F�� Clarifiers
EXEMVTION FROM WORKERS' COMPENSATION DECLARAT DiShwaihef '
(This section neetl nol be complatatl i( Iha permit Is for one huntlratl (5100) or
Iess). Drinkin Fountaini
I CBrUfy tnat In Ihe peAo�man<e Of th0 wo�k fo� whlGh thi5 pe�T�t IS ISSueC I 9
Shall not Bm0�0y any OBf50n In any mannar So ai t0 become subject t0 t�IB �
Workers' Compensatlon Laws oi Gali/ornla. Flaor Drains
comply wlth sucn provlslonz or m�s+0ermrt snan na aeemeo revoKaa.
CONSTRVCTION LENDINO AGENCV p
Luna1er's WNamefor yTl� �oynspte�rmlt �Ise iss�i}S . �( �I'on �3097r1Civ�a C )
C 1CI KE'+el- LS
Lentlar's AUCre:s � I�M�N BL✓Or Srs 770, ��7VA/1:5a/1
OWNER BUILDER DECLARATION -
I hereby afBrm that I am exampt from the Contractor's.�icense Law lor the
tollowing reason (Sectlon 7031.5 Builnass anC Professlonal Code: Any tlty or
as owner of
9fI5dI100, wlll
on
the applicant to a
with wagei as thelr
s not intentletl or a}
in5a Lew OOes n0[ epO�Y �O an ownar o� a p�oparty wno owws er improws
'eon, antl who tloas such work himself/herself or lhraugh hls or her own
eloy eas, ptovitlatl that such �Improvements are not IntenEetl or offere0 for
If, howevar, the bulltlin9 or ImOrovement Is soltl wlthln ona year ot com-
lon, the owner w�ll have t�e burtlen of provinq he/she tlitl nat bulltl or Im-
ve for tbo pur0osa o/ sale). - .
I, es owner ot the proparty, am exclusively contracting wit� Iicensatl con-
Rors t0 COnst�uct tho projecl (Sectlon 70a4, Business antl Professlons COCa:
�. Contractor's License Law dae5 nOt apply to an Owner ot praperty who
tls or ImOroves tneraon, antl wno contracts for sucM1 pro7ect5 with a con-
�,tor(s) Ilcansa Oursuant to tne Contractor's License Law).
I.am exemOt untler Sectlon B. & P. C. for this reason
Date
a and s[ate that the abova
city antl county ortlinances
antl hereby authorize rapre-
v@-m6ntlonatl DlODBlSV fOf
Floor Sinks � - - �
Gas Service Outlets
Interceptors
Kitchen Sink �
Lavatories �
P-Trap �
Roof Drains " �
Reinspection Fee
Boiler
Duct • Under Gri
Duct - Structural
$25
Exhaust System ❑ Multiple
Firepl/Fact. Bit. ICBO #
Heating System & Ducting �
❑0700,000 BTU 0100,000
L19nature �" uam -• �. -,
Drlvers �I e se c Reinspection Fee '$25
�� CMF0865-46 rev.32/83 Whlte-Builtlin9:Canary-Appllcant:Plnk-Accountinq;GolEenrotl-Assessor
Showers
Servite Sink � "
Sewer Cap
Sewer Connectiori
Solar Collectors !
Solar Piping
Solar Tank �
Swimming Pool�w,
Urinal
Water Closet
Water Heater
Water Service
Isue Fee
iANICAL
Hoodar Typel ❑
Canopy Type I I ❑ •
Refrigeration System
04100,OOOBTU ❑100,000
System Repair/Alteration
Iswe Fee
:
4.P. 5W �
S Main Building:
E .
T Front
A Rear .
C Right
K Left
S
Ping. Ref,dp
Parking Req./Provid¢
Use of 8uilding:
Planning Notes: �
�
Automatic Washer
Canstruction Pole Sub.
�Cooking Unit
Dishwasher
Dryers �Gas ❑Elec
Fan
F.A.U.
4963 2/C5/34
I Zone ��
Accessory Building:
ELECTHICAL �
Transformer � 75-50 KW
❑ 50+KW
Device Boxes '
' Outlels
• Switches � -
Garbago Disposal '
Generetor �0.5 KW �5-15 KW
S 3
Reinspoction Fea
FEES
PUBLIC SERVICES R
ZoninB APProved BY _
BuildinB APProved By
APalication laued Bv_
$ 3
I O.i. 02• '
2
O
N
I
' N
G
. R
E
U
u
I
� E
, . E .
Meter LJup to 100 amps
Meter �over700amps
Sub Panel
Motors O0.7 HP O1 Y, - 6
Inc. Sotar �9-15 HP 016-15+
Microwave
Pole Light
Standing Sectians
Trash Compactor
$25 � �ssue Fea
3 3
SU MAR O� FEES �
BUILDING PERMIT $ � SMIP � $ . �$—D
PLAN CHECK $ �D r ��. pERMiT '
PLUMBING $ ISSUANCE S
PLAN CHECK 25% $ ENERGY P.C. $
E�ECTRICAL $ � GRADiNG $
PLAN CHECK 50% $ MICROFILM $ �
MECHANICAL $ TOTALFEE �$ _/D3/��
PV1N CHECK 25% $ � � �
� CONSTRUCTION AND PLANNING �� � • . POOL & SPA - - .
�--APPROVALS Permit # Date Inspector . . AppROVALS , Permit # �- � -� ' Date Inspector
i s
1,. Temporary Electrical Service o� Pole !- 52. Pool & Equipment Location ', _ _ .
�. ! : 2: Soil Pipe-Untlrgmd:. � ` ' ' - � �53: Steel Reinforcement , �
",�- 3: Electrical Conduit Utility-Undrgrnd.� . 54. Forms � . • ~+
r; . .. . . ' ". ' .. '
� ;, �� 4. Electrical Conduit-Undrgrnd,, _ - � � . 55. ElectricaLBonding • ' _ -
� rn �. _
, 5. St�eel Reinforcement �', •� -' 56. Rough Plumbing & Pressure Tesf � :� �
6. Electiipl UFER Grnd �=: � 57- APPROVAL TO COVER-GUNITE '.
� 7�:Footings ` ' - ' ' .58: Elec[rical Conduit-Undrgrnd. �: ' - -
. 8.�"Found'ation . �J _ � � 59. Gas Pipe, O Undrgrnd., Test � ` � `
_�i.. . .
9. -Water PipetUndrgrnd. �� : • . . . 60. Backwash Lines, P-Trap, O Undrgmd. _ �
10. Structural Floor System -'' - - 61. APPROVAL TQDECK ' --
�-. �' 11: Property Sewer Line & House Connection '•• �_ 62. Backovash & Receptor-Final •
:s•
• 12. Sewer Cap ' �. . ` _ � , _ 63. Heate� & Vent-Final . � .
. ,
� 13:-Boof Drains � ' . � 64. Plumbing SYstem,- Final � , i'
14. �Rough Plumbing . ' � 65. ElectFical-Finab � � � � '
� 15. Rough Electrical=Conduit ' - ' " 66. Solar System-Final - � ' � ,
�'i 6. Rough Electric Wiring - - . ''" 67. Fencing & Access Approval ' -
.�17. R'ough Wjring Sign �. ' � * 6$. APPROVED FOR PLASTERING �� � � �
.�
_ 78. •Rough Electrical-T 8ar Ceiling , . 69.' POOL/SPA SYSTEMS FINAL � �
�! 19. �Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �
20. Rough Facmry Pireplace �� ' � � � • , APPROVALS Permit # ' ,
21. Ducts, in Structure � . , �70. Underground Hydro ' '
.. 22..Ducts;,'Ventilating , � 71. Product Piping O Gas �❑ Oil � '
�
23. Gas Pipe-Rough & Test . � 72. Underground Flush � �
24:. Roof Framing � • - 73. Undergmd. Storage Tank � Gas ❑ Oil � '
25. Roof Sheathing " , 74. Overhead Hydro
26. 'fsBarlCeiling (Structural) & Monocoat � i 75. Dry Chemical ��
27. Frame and Flashing 76. Dry Standpipe �
28. ,Lathing &�Siding . . � ' 77. FIXED SYSTEM FINAL ��
�'29. Insulation �� l. � J8., FIRE PREV,. FINAL �
30. Drywall Nailing � � 8 , �HEALTH DEPT. REQUIREMENT ,
31. Plaster�Brown Coa�,:l � ' 79.' FINAL INSPECTION '
32. Electrical Power Meter-Final � 80. FOOD CERTIFICATE ISSUED
,' 33. Final Electric Notes: � �
� 34. Final Heating & Air 6onditioning , ' , .
35. Final Gas Pipe-Test � � • � . � ' � - �
. , -
36. Hood or Canopy' ' ' j I . ' � - ' • �
,�� i- . i , , . .
• 37. Final. Factory Fireplace -� •/� ' . � � � . � . - � . , �
38. Final Plumbirig� : t ' � - - . i , . � ' . -
.
39. Wa4er.Service;Final � � - , : . , � - �'
40. Gas Service-Final' � � � � '
41. Solar pomesticFinal � � , - - -- � - � - �
.� .
42. Backflow Preventer' _ _ . � � _ _i �. , _
43. Backflow Irrigation � � _ � � - �
44. ,Landscape Irrigation Sy,stem � • � ;
45. Sound' Attenuation� 'i � � � , ' ' �
46. Handicap Regulations � 6z &v � � �
�•
47. FINAL STRUCTURE & BUIL'DING C�� � ,' � •
48. Special Requirements Completed � , ' ' � �
49. Electric Release to Edison � � � � � ' �� �- ,
50. Gas Release to Southern California Gas Co �_ � �, � , ; � . '
�
51. CERTIFIGAT�E OF OCCUPANCY � � - - = - - - � - ' - '
� ,
No Da`te � - _ . - - -� � - � - - - - . . . . _
�
L��/ �U�r GV��'/G E
AGP���ant to fill in all ipaeei ezeepl I�ose wit�in heavY eoraer Iines antl sign all aocroDriate aeclarations.
CITV O�COSTA MESrA U.fIV�5/1 /F/S�U/G 1/U�N YtHMI I /'//JJj/
Project�Address ��7 �/ ���1'C/6}-_—/ .`� � 7" �"
Applicant's Mailirg Addren Sy�Q �
` / G
Owner's Name C.r� Phone Q
AdAress � ! � ' � �+ t � '
ArchlEng, ic€ V G � ��5��
1
Address N
Contracmr's Nam P one
Addreu Imailingl / p �
-City License No. �(2{(J-./ �
LICENSED CONTRACTOR DECLARATION
I hCrGby ailirm tndl I am Iicensetl untler provi510n; of Chdrler 9(commencinq
wltn 5oction 7000) of Division 3 ot tne Busine55 antl Professions Codo, antl
my Iitenso is In f force ana oflect. �
Ucenze CI � icr e No.
DatC 99�ature
WORKE0.5' COMPENSATION DECLARATION
J hereby a/tirm Ihat I bave a cerSifica[e of consent to self-insure o� a certifitate
of Workers' Compen5dtion Insurance, or a certi�jetl copY thareot (Settion
3800, lab. C.) /�
vo�icy rvo.���� -ZS�S4�g� Company4{M.3�1�`.4 �C.
�Gertifietl Copy is hereby fumBhetl. ' .
Cer}yfiGq,copy,i5 iiletl wi[h th¢ cit il ing D' i i
Dale l{ 17 hF. APPlicant�
EXEMPTION FROM WORKERS' COMPENSAT�ON DECLARATION
(TbissectiOn neetl n0[ be compleletl il the permit ig to� one huntlr¢tl (S300) or
less).
I certlty that In the p<rlo�manca Oi th¢ work Por� Whlctt thii peimR IS ISSu¢tl I
snall not employ any person in any manner so as to become su07¢ct to t{�a
Workers' CompCnsalion Laws of Califomia.
Data Si9nature
�NOTICE: 11, aftar making this tleclaratlon, you sh0ultl become subject lo tne
Wo�ker5' COmpenSatiOn Provl51or15 Of [he ISbO� CotlC, y0u must lorthwith
como�Y �'��n such provlsions or tnls o�rmit shail be tleemetl rovokeG.
CONSTRVCTION LENDING AGENCV .
I hereby alllem lhat tM1era is a<onstruetion Ientling ageney tor tne performanee
01 the wOrk tor which lnis parmit is Issueq (5¢�(�on 3097 Civ. C.)
LenOer's Nama -
LenCer's Atltlress
OWNER BUILDEN UECLARATION
I nereby alflrm thal I am exem0� ��Om [he Contractor'S Lltenso Law for Ihe
followinq reason (Section 7031.5 Business and PrOtassional Code: Any city or
county whicb requims a parmit to construct, aller �mprove, tlemolisn or repair
�ny 5V uClufe, pdOr to It5 Isivanc¢, also fequire5 [�e applicant 10/ SUCh pofmil
file a signetl statement tha[ he/zne is licensea pursuant to tne provisions o1
e ConVactor's License Law (GhaO�er 9(comme�cinq witn Section 7000) of
�iviSion 3 Ot tbe Buslnas5 antl Prote55ions Cotl@) or that ne/sh� is exertlpt
lh¢retrom antl lh! baSiS t0� [he all¢9etl exemptiPn. Any viOlation of Settlon
]031.5 by any applican[ fo� a pe�mi[ Subjects the applicant t0 a civil
penal[y of not more lhan five M1undretl t1011ars ($Sp0). .
LJ I, as owner ot the property or my employees with wa9es as their sole
compensation, will tlo the work, antl the structure is not Intentletl or ofleraC
f0/ sal¢ ($ection 7044, Bu5ine55 antl Prof¢isioqal Cotle: The ConlraG[o�'S
License Law tloez not app�Y �o an owner of a properry wM10 builtl5 Or Imp�Ov¢s
Ibereon, antl who tloCs suth wo�k himself/hErs¢I} o� Nrough his o� her Own
em0�oyees, O�ovitletl tnat sucn improvements are not intentletl or olforetl lor
sale. If, �owever, Ihe bulltling or improvement is Soltl wlthin one yoa� ot cOT-
pletion, Ne Owner will nav¢ [he burtlen ol proving ho/she tlltl not builtl o� Im-
prove Iorlhc ourposa oisalo).
❑ 1, as owner ol tna property, am extluslvely cOntra<ting wlth Ilcensetl con-
l�at[O�s t0 conStruct tho D�olect ($uttlon 7044, B�siness antl PrOlessioni COde:
� Tne ConVactor'i Li<enin Law tlOes nol apply t0 an owne� oi property who
buil0s or imDrov¢5 lharoon, antl wh0 conVacts io� such projects wilh a con-
t�aclor�s) OCBnse pursuanl to Ine ContraGto�'s LlcenSe I.ew). I am awa�a lhdt
prool o( tneir Wo�k¢r'S Compan5alion InSurancQ sho�l� be prOvi48tl t0 ma.
❑ I am exempl untler 5ectiOn B. 8 �. C. lor lhh reaion
Date
� Signature
Driv¢rs' Lit �
CMF 0865-46, �ev. 10/84
I ha reatl Ihis lic on and stale that tha abova
to ca wi all �i(y anG wunty ortlinancos
iltling SV ion, antl hereby authoriie repra-
ente po e above-mentionee properry for
oate-�Z /�
_.
TVPE OF CONSTRUCTION LJ NEW L-J ADo
❑ CONVERSION ❑ OEMOl15H ❑ OTHER
� /�
REPAIR-
A.P. #
S Main I
E
TVpE�OF PERMIT IJ GRADING LJ FOUNDATION LJ STRUCTURAI T FrOnr�� �
�� TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Pear
u OTHER A'
PROJECT DESCRIPTION SQ.FT, pCCUPANCV C Right
^^ K
C CONST UGTIONTVPE� VALUATION$�(/.� g Left
ZONE GRADING CLL VDS. ACRES p�py, ReL'N'
Remarks: � — � � Planning Notes:
3ar Sink �
3ackflow Preventer �
3ackflow Irrigation
3athmbs .
Clarifiers . . .
Jishwasher
Drinking Founlains
Floor Drains
FloorSinks ' � �
Gas Service . Outlets
Interceptors
Kitchen Sink .
Lavamries
P-Trap _ �
Roof Drains � -
� C —
Reinspection_Fee $15
Ducl - Under Ground
Duct - Svuctural
Dutt - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Duccing
❑0.100,000 BTU 0700,000
painspection Fee � $15
Canary . qpplicant; Pink - Accounting: Goltlenrotl - Assessor /�
Showers
Service Sink
Sewer Cap
Sewer Cannection
Solar Collettors _
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Wa2er Heaeer �
Water Service
Auto-Wash ��"
i �
- ^�1v � � 2one �
ng:- -- - � � �y Accessory Buildinq:
Z
u: ..,4 O
N
I
- N
, G
R
Parking Req.fProvided E
EES
Automatic Washer
Construction Pole
Cooking Unit
- .Dishwasher
Oryers ❑Gas ❑
Fan
F.A.U.
Fixtures
� Device Boxes
�1�� � ��/
���
—�����
3efrigeralion System
❑0.100,000 BTU 0100,000
System Repair/Alteration
Fire Dampe�s '
Registers
Fee
E 3
ELECTRICAL
Transformer ❑ 75-50 KW
. ❑ 50+KW
Meter LJup to 100 amps
. Meter.Dover700amps
lectric � Sub Panel
� Motors�o-lHPO1'r4-8
Inc.Solar �9-15 HP 016-15+
Disposal
�r 00�5 KW 05-15 KW
Microwave
Pole Li9ht
Range .
Sign
; Standing Sections
Trash Compactor
Fae . � $15 �. � Isue Fee
.Zoning APVraved BY_(,1G
Building Approved By _
' Applimtion Issued 9y_
�B I PER T
P A CHECK
P U BI
'� P�1AN EC�
y. ELECTRICA�
�rS
FEES
�
5 3
� Date �'��
Dat "a__4_ �'� "�L
U RV FEES / �/T
� ->S � $ �
` -j PERM�T .
'aSSUANCE $
_ r �ft�.E�NER�TP. . $ '
� GRADING S
$ MICROFIL � $ ��/� ��
�j -�—C��./�TOTA� FEE $ _.��Z
.�
COfNSTRUCTION AND PLANNING ; F .& SPA '
APPROVALS � Permit # Date Inspector AppROVALS Permit # Date Inspector
1� Temporary Electrical Service or Pole 52. Pool & Equipment Location
� 2. Soil Pipe-Undrgrnd. 53. Steel Feinforcemen[ �
3. Electrical Conduit Utility-Undrgrntl. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test �
6� Electrica� UFER Grnd. 57. APPROVAL TO COVEfl�GUNITE .
7. Footings 58. Electrical Conduit-Undrgrnd. .
8: Foundation � 59. Gas Pipe, 0 Undrgrnd., Test
9. Wa[er Pipe-Undrgrnd. 60. Backwash Lines. P-Trap, O Undrgrnd.
70. Structural Floor System . 61. APPROVAL TO DECK
11. Property Sewer Line & House Conriection 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
i 6. Rough Electrlc Wiring 67. Fencing & Access Approval
d7. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling � 69. �POOUSPA SYSTEMS FINAL
19. Rough Hsating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating . � 77. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof�Sheathing ' ° 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. �athing & Siding � 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL- .
30. Drywall Nailing HEAL7H DEPT. REQUIREMENT
31�-Plaster Brown Coat 79. FINAL INSPECT�ON
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric � Notes:
34. Final Heating & Air Conditioning G:� - �
35. Final Gas P�Pe-Test
36. Hood or Canopy
37. Final Factory Fireplace � , -
38. Final Plumbing . .
39. Water Service-Final
40. Gas Service-Final .
41. Solar pomestic-Final
42. Backflow Preventer � .
43. Backflow Irrigation �
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations .
47. FINAL S7RUCTURE & BUILDING � .
48. Special Requirements Completed
49. Electric Release to Edison - •
50. Gas Release to Southem California Gas Co .
51. CERTIFICATE OF OCCUPANCY
No. Date .
City of Costa Mesa
Development Services Department
Building Safety DiviSiOn
P. O. Box 1200
Costa Meu, California
CERTIFICATE OF OCCUPANCY No.
The Building located at 3555 HARAOR GATEWAY SOUTH Ste. A
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group �2 Occupancy.
Use of Building
Legal Description
IB59632
Building Permit No 836561
Mechanical Permit No.
��.-,ti�.n
OFFICES - CRITFRION SPACE PLANNING
(See reverse sitle for Metes and Bounds)
lectrical Permit No. E36774 Plumbing Permit N
ISSUED TO:
r� SFc,�a.s�xcr.�n s so�
9555 HARBOR GATEWAY SOIJTH Ste. G
mRTd MFSA C`L Q�Fi�Fi
Number of apartments and/or guest rooms
Building Official - �� %���
by '���/�
Date �`�e� 23, 1992
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C.
CMF 1o15-a6 rev, i/83 White-Owner; Canary � Numerical File; Pink -Bldg. Permit File
�
.
(714) 75a-5273 • Fax (714) 754-4856 • www.ci.costa-mesa�rtDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 3555 HARBOR GATEWAY S
Suite: A �
Viciniry: SUITE A METRO POINTE
PrimaryOcc: B Eal<SOIOKcelBar<50
Parcel Number: 41508134
App�icant: MC CALLUM, GERI
Address: 3555 HARBOR GATEWAY S
SUITE G
COSTA MESA, CA
Owner: C J SEGERSTROM & SONS
Address 3315 FAIRVIEW RD
COSTA MESA, CA
Comracror. OW N ER-BU I LDER
Address:
Zip:
Arch :
Address:
Phone:
Zip:
License:
Type of Construdion: IIIN
Zoning:
Phone: 714-435•2054
Zip: 92626
Phone:
Zip: 92626
Phone:
License: 000000
Eng:
Address:
ISSUED BY:
Status: ISSUED
Applied: 03/152006
Issued: 03/152006
Phone:
License:
SCOPE OF PERMIT
INTERIOR ALTERATION TO REMOVE A NONBEARING PARTITION AND ADD 3-SIDE LIGHTS. PLANS ARE WAIVED PER SECTION 106.3.2
EXCEPTION.
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
Total:
$0.00
$111.25
$0.00
$1.05
$0.00
$0.00
$112.30
SETBACKS
MAIN STRUCTURE Front 0. 0
ACCESSORY Front 0-0
PARKING Existina: o
Rear 0- 0
Rear 0. 0
FEE SUMMARY
PLANNING 8 ZONING
Lefl 0- 0
Lefl 0- 0
Re uired: 0 Pr000sed: 0
Calc Valuation: s5,000.00
Claim Valuation: ss,000.00
Right
Right
o- o
ao
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, 1241-92)
EXPIRATION: This permit shall automatically expire and become void il work is not commencetl within 180 days, or if work is suspended or abandoned
for a period ol 180 days.
� INSPECTIONS: In order for the work authonzed under this permit lo be considered legal, such work must comply with all applicable codes, and all
requlred Inapectiona and Iinel epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
�
WORKERS' COMPENSAnON DECLAfiAnON: -
I hereby eHirm untler Oenalry of perjury ona ot the tollowing declaretions:
❑ I heve and will meintain e cenificete ot consent to self-Insure for workers' compensatlon, as pravided for by section 3700 0l Ihe Lebor Code, lor the pertortnance of Ihe
work fof which ihi5 pertnii is issuetl.
❑ I have arW will maintain wqkers' canpensation insurance, as requiretl by sectbn 3700 of Ihe Lebor Code, lor Ne peAortnance of the work for whid� ihis pertnit Is issued.
My warkers' compensetion Insurence cartler ane policy number are:
Carrier:
nof be complefed i! fhe permit is valued al one huntlretl tlol/ars (S 100) or /essJ
Policy Numher:
9y I ceM1lly t�el in the peAo ance of the work tor which this pertnit is issued I shall not employ eny person In eny manner so as to become subject lo Ihe workers'
compensatlon laws ol Illomia, end egrea thai ii I shoultl bec e sub�ect to �he workers' compensetion provislons of Section 3700 0l t�e Lebor Code, I shall toR�with
comply wlth Ihese 0� o. %�'� /—
l�pplitant SI� gnetule�� / • / � Date' . � — � ��V�
WARNINO: FAIIURE TO $ECUFE WORKEF$' COMPENSATION COVERAGE I$ UNLAWFUL AND SHALL SU&IECT AN EMPIOVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED
THOUSAND DOLURE (5100.0OO�.IN ADDIiION TO THE COST OF WMPENSATION, DAAIFGES AS PROVIDED FOF IN SECTION 37W OF THE LABOR CODE, INTEREST, AND ATTOHNEYS FEES.
LICENSED CONTRACTORS DECLARATION:
I hareby effirm ihel I em Iicensetl untler provisions of Chapter 9(commencing wllh Section 7000) of DlNsion 3 ot the Business and Pmlessions Cotle, and my license is In tuil
torce antl eHect. Lic. a Class a
Contrectofs Slgnaiure: Dete:
CONS7RUC710N LENDING AGENCY: �
❑ I hereby aHirtn thet there is e constructlon lending egen�y tor the peAormance oi Ihe work lor which �his permit is issuetl. (Sec. 3097, Civil Cotle).
Lendefs Name: LentleYs Atltlress:
Signature: Date:
OWNER•BUILDER DECLARATIONS:
I hereby aNirtn thet untler penalry ot perjury t�at I em E%EMPT FROM THE CONTRACTORS IICENSE LAW tar Ihe following reasan (Sec. 7031.5, Business antl Professions
Cotle: Any ciry or wunry w�ich requires e pertnit m wnstruct, alter, impmve, tlemolis�, or repair eny structure, prior to its issuance, also requires t�e epplicent for such partnit
to file e signed stetement that he or she is licensetl pursuem to the pravisions ot the Conirectors Licensa Law (Chapter 9(commencing wit� Section 7000) 01 DMsion 3 ot the
Business and Professions Cotle) or ihal he or she is e:empt iherelrom and Ihe basis for the elleged exemption. Any violation ol Section 7031.5 6y any epplicant tor a pertnit
subjects tha epD�Icani Io a ciWl penalry ot not more than frve hundred dollars (5500).):
❑ I, as owner of Ihe propeny, or my employees with weges as their sole compensation, WILL DO THE WORK, antl t�e siructure is no1 intentletl or ofleretl tor sale (Sec.
7044, Business and Protessions Cotle: The Contractors License Law does not apply to an owner of properiy who builds or improves �hereon, antl who Coes such work
himsell or herselt or through his or her own employees, provitletl �hat such improvaments are not intended or oflered for sale. If, however, ihe 6uilCing or improvement is
sold within one year ol completion, iha ownar-builder will have iha burden of proving ihat �e or she did not build o� improve for purpose of sale.).
❑ I, as ownar of the property, am EXCLUSIVELV CONTRAGTNG WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business antl Prolessions
Cotle: The comractors License Law does not appty to an owner of propeny who builtls or Improves thereon, and who coniracts for such project with a coniractor(s)
licen5e pur5yaqt l0 ihe Contraclors LitenSe Laws.). '
❑ I em e m de^r sec� Businass and Professions Cotlo for this reason:
S\gl18�11l9. J'T-�//� I �
Owner ID'venlied by ddvers license. � Yes ❑ No Ddvefs License Nop
Verilicetion ol Ownership by (rype ot documem, i.e. - properry taz bill or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION:
❑ I hereby ceriify that no excavation tive (5) or mora feet in depih inio which e person is required to descend, will be made in connection wi�h work euthonzetl by this
permil, and that no builtling struciure, scettolding, talsework, or demolition or tlismantling thereof, will be more then ihirry-six (36) faet high. (C�eD� 3.2, Grp 2, Art 2, Sec.
341, Title B, Celifomia Atlmfnistrative Cotle).
❑ As owner-builAer, I will not employ anyone to do work which would require e pertnit from the Division ol Industnel Sefery, es natetl ebove, unless such person hes a
permit to do such work irwn the division.
SignaWre: Date:
Divisian oi Industrial Sefey Permit Number:
CERTIFICA7E OF COMPLIANCE AND AllTTIORIZA710N OF EMRV: I cenity under penalty of perjury that I have read ihis e001ication end state ihat the Intortnetlon given is
correcl. I agree to wmply wlih ell siate laws antl ciry ardinances rela�ing lo bullding consiruc�ion, entl euihodze representetives of the City ol Costa Mesa to enter upon Ihe
ebove�descnbed propeRy for inspection purpwes. 1 egree not to occupy or allow occupancy ol eny builtling euthorized by this permit until finel inspectian.
CODE �, n+sveenonTrre
1618 Fixatl System Final Fire Prevemion
1268 Pool Spe Finel
200 Finel Re-R001
201 Flnal Block/Relalning Well
202 Finel Fectory Fire Place
203 Final Sign
pp4 Finel Demolitlon
P� II�ELS
CODEr INSPECTIONTYPE
206 Final Mochanical
20B Final Plumbing
210 Final EleCincal
212 Flnal Fire Preventlon
220 Final Planning Approval
222 Final Sita
250 Finel Building/Occupency
QdIF. IIi�E64
n
(7�a) �54-52�3 • Fex (��a) 75a-aess • www.ci.coste-mesa.ca.us 77 YAIM UMIVC, GVJ I A MCJA, GN tlLb[b
BUILDING PERMIT
�ob Address: 3555 HARBOR GATEWAY S
Suite: G
Vicinity:
Parcel Number: 41508134
Applicank MC CALLUM, GERI
Address:
Zoning:
ISSUED BY:
, Phone: 774-435-2053
Zip:
Status: ISSUED
Applied: 02I052001
Issued: 02/OSI2001
Owner. C,J"SEGERSTROM & SONS
., ��\
Address 3315FAIRVIEW�RD � _ � _
�-'-/ � � `
i -/ % �`. . . . � Phone: � � � � � ��.
�
'. COSTA MESA„CA �-' - Zip: 92626 - � _ , �
i - � i � ;'" � � - .
� . �� . ;-, , ���, ���.
Contractor: �
: �� //��
�Addressi�; �.��:� �/� AA\
� ,� �,' �". � � Phone'� �� 4 �" �. �����`�
,
� '-� pp►'� �, ,A� �
. � Zip � . ..: License: _ �` - \� A �
� �' � � � \�
, Arcli . _ ' • : - . Eng:. � � , , � � � �� \
, �
Address: � � � � � Address: � � � , ��i� �
i: - � .. ' . - - __ .�`
. , . Phone: � . / ,, Phone: ,
�1
�� �,
� �Zip: . -.� - - License: � . Cicense: - � `�
i �
� � j . � � � SCOPE OF PERMIT � � ��,' �,
' TENANT IMPROVEMENT. ADD OFFICE SPACE TO AN EXIS�TNG LEASING OFFICE.' -� � �� ��,` ,
�, �
��PIan�Check:
` ` Permit: . �
����SMIP Res: ,
SMIP Com:, �
�, �� `\ Other:, �,
�Inspection: �
,� � /
V�.�� � �
���Totaf: � $650.81�,
$254.31
$391.25
$0.00
$525
� $0.00
$0.00
FEESUMMARY i � '� �
;
` � Calc Valuation: i - - 82s,000,.�oo %
' � Claim Valuation: �� i �� � 32s,000.bo�
` �i,� _� -�� �,7- ,
_ //i�' ;�:�; i�r�'�!
, - i;� ���,� �'��
,. , �� ,i � �
;% � ���/
� i �i
� . :.,,:,:� '` ' ��
� ' ., - ._ � j,� �� �%
��.� j� , _ . ���� �� p
SETBACKS�� �� �� � ��\��� � �
��\ ��-.� �` ,���
MAINSTRUCTURE�FFont`�0-0 /_� Rear, �00��
�\\\, \� �, _ � .
ACCESSORY Front-�, 0.0 ���/� Reai `-Oc0
\ � � � � '
PARKING Existinq:�o-'�� Reauired[ �o,
��'._, ,
�
NOTES: �� -. - . -
� Left _ �0- 0 - ' -
Left 0- 0
Proposetl: -0�
� \ _ � -
i� , /��_ /,
�//' .�\�.��/ �
. / Right ; 0- 0 j //
_ ��� '� . . /i
: A Right�. � -0- 0%�
� `, A ��(/
� '%. �
/,% � /
/i c�',
NOTICE: The work authorized by this permit shall comply with all applicable hendicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permil shall automatically expire and become void if work Is not commenced within 180 days, or if work is suspended or abandonetl
for a period of 1 BO days.
INSPECTIONS: In order for the work authorized under ihis permit to be considered legel, such work must comply with all applicable codes, and ell
requlred Inapectlone end final epprovel must be obtained. Failure to obtain inspections and tinal approval will result fn the expiratiortof this permit.
FOR INSPECTIONS CALL: (714) 7545626 /
244&481fl�00)
WORKERS'COMPENSATON �ECLARAnON: .
I hereby ettirtn under penalry ot perjury one ol the tollowing tledaratlons: � �
❑ I heve end will melntain e certificate ot wnsent to sell-Insure tor workers' compensation, es provided for Dy sectlon 3700 0l Ihe Lebor Code, lor Itie pertormance of the
work for which t�is permit is lssuetl.
❑ I have end will mainWn workere' compenSaUon insurarim, as repuired by seclion 3700 of the LaDo� Cade, lor ihe pertortnance at the woAc for whkh this p¢rmlt Is Lswetl.
My workers' campensaHon Insurence carrier antl pdicy number ere:
Certier: Policy Numher.
(This secNon neetl nof be complefed I! fhe permltls ve/ued et one hwWred tlW/are ($100) or Iess.)
❑ I certity thet in Ihe peRormnnce ot the work lar whic� ihis pertnit Is issuad, I s�ell not employ eny pereon In eny manner so es lo becomo sublect to tha workers'
compensation lawa of Calllomla, end egree thet If I should become sub�act to iha warkers' compensetlon provislons of Sectlon 3700 0l Ihe Labar Code, I shall forihwith
comply wilh Ihese provislons.
Applicent Slqnewre: Date:
WARNINO: FAILURE TO SECURE WORKERS' COfdPEN$ATION COVERnOE IS UNUwFUL AND SW1LL SUBJECT PN EMPLOYER TO CRIMINAL PENALTIES FND GVIL FlNES UP TOONE NUNDPED
THWSAND DOLURE (St00,000), IN ADDITION TO TME COST OF COMPENSATION, DAAUGES AS PROVIDED FOR IN SECTION 3]OB OF THE LABOF CA�E, IMEREST, AND ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby eMirtn that I em Ilcensea unOer proNsions ol Chapter 9(commencing with Section 7000) of Divislon 3 0l Ihe Buslness entl Profeulons Gode, entl my Iicense is in full
IOfCO 0fld BflBtL LIC. M C1895 M
Concrectors signeture: Date:
CONS7RUC710N LENDING AGENCY:
❑ I hereby eHirtn Ihet there is a consiructlon lentlinp epency tor t�e pertormance oi the work tor which t�is permit is Issued. (Sec. 3097, Civil Code).
Lenders Neme: Lenders Addreu:
Signature: Date:
OWNEH-BUILDER DECLARATIONS:
I hereby ettirm that under penelry of pe�ury that 1 am EXEMPT FROM THE CONTRACTORS LICENSE LAW tor Ihe following reason (Sec. 7031.5, Buslness anC Professions
Cotle: Any ciry or counry which reQulres a pertnit to construn, alter, imprwe, demWis�, or repair any sWcture, prior to its luuance, elso reqWres the applicant br such pertnit
ro fila e signetl stetement thet he or s�e is I�ensed pursuam ro the provisions ot the Contrectors Llcense Lew (Chapter 9(commenGng wIN Sectlon 7000) at Divislon 3 of the
Business and Professians Catla) or that he or she is e:empt Iherefrwn and Ne basls for t�e allegetl e:emptlon. Any violetion ol Sectlon 7031.5 by eny epplicant tor a pertnit
subjects the applicant�to e�c}vil penelry ot not more than five huntlred dollars (SSW).j:
�,� �i '.. , i- �
❑ I, es owner ot the properry, ar rtry employees with weges as their sWe compensatlon, WILL DO THE WORK, end Ihe structure Is not Iniendetl or oNeretl tor sale (Sec.
7044, Busineu endProfeSslona Code:,iTe Contradors License law doas not epply to en owner of property who builds or Impmves thereon, end w�o tices such work
himsetl or herself or t�rough hfs ai.her.own employees, O��dad Ihal such impmvements ere not Inientled or oflered tor sale. tl, howaver, tha builtling or improvement is
sold within one yeer ot complelioq the awner-builtler will have ihe burden of proving ihat he or she tlitl not build or improve for purpose of sale.).
❑ I, es owner ol the pmperty, em EXCLUSIVELV COMRACTNG WIT}1 LICENSED CONTRACTOHS to conSlmct ihe project (SecJ044, Business antl Prolessims
Code: The contrectors Llcense Lew does not epply to an owner ol property who builds or Improves ihereon, antl w�o contracis lor such praJect wit� a contractor(s)
license pur ant to the Contractors License Laws.).
❑ I am exe unAer se : Business and Protessions Code for this reeson:
SignaWre: Q�i Date:
Owner ID veritietl by Onvers Iicense. ❑ YBS 0 No Dnvers License No. � xpires:
Verllicetlon at Ownership by (type al dwument, i.e. - properry tas hill or deed):
DIVISION OF INDUSTRIAL SAFETV PERMR CER7IFICA710N:
❑ I hereby cetllty ihet no excavetion flve (5) or mora teet in tlepth into which a person Is requlred to descend, wlll be made In connectlon wlih work euthonzeC by this
permit, antl thet no buildlnp structure, scaHoldinp, talsework, or tlemolitlon or tlismantling theraof, will be more then ihirty-slx (38) teet hig�. (Chap. 3.2, Grp 2, Art 2, Sec.
34 i, Tltla B, Calibrnle Atlminisiretive Code).
❑ As owner-6uilder, 1 will not employ enyone to do work which would require e parmit trom the Dlvision ot Indusidel Sefery, es noted ebove, unless such person has e
permlt to tlo such work lrom Ihe tliWsion.
Signeture:
Division ot Industriel Safery Pertnil Number:
Da�e:
HAZARDOUS MA7ERIALS AND EMISSIONS CERTFICATION:
1 Will t�e eppllcant or present or tuture bulidinp occupant need to file an0 certify e Business Plen lor emergency response to releese ar threetened releese of a harardous
material7 � Yes ❑ No
(Section 25505 ot the Celilomia Healih end Safery Cotle requires, with some ezceptlons, ihei e Businosa Plan bo liled wlih the Coste Mesa Fire Depertment by every
business which has et eny one time during e reported year a quentiry ol hazerdous materials equel to or greeter than e welghl 01500 pountls, or a volume ot 55 gailons,
or 200 cuDic feet ol compressed gas et stendard temperaNre antl pressure).
.........�_.........._—._..._._ _ .......__.._ .......................__................._.......................� .......�_.. _
2 Daes or will t�e aDPlicant or present or futuro building occupanl need to lile e registretion lorm lor ecutoly hezerdous meterials? ❑ Ves ❑ No
(SeCtlon 25533 01 Ihe Celltomle Heelih entl Satery Code, wlih 5ome exCeptlon5, requlres regl5irelion wil� the Co9Ie Mese Flre Depertmenl by each business whlU et eny
one lime has on hend a Quentiry o1 acutety �azerCous materiels equel to or greeter then e welght ol 500 pounds, ar e volume ot 55 gellons, or 200 cubic feet ot
compressetl gas ai stendartl tempereWre end pressure).
..._._..""'—""' _"_"_......_....._" ............. ........._""'_"'—" '
3 Does or wlll the epplicent or present or luture builtling occupant neetl to prepare an RMPP (Risk Menagement entl Prevention Program lor acutaly haeartlous materials)?
❑ Ves ❑ No
(Section 25534 of the Celilomle Heelth and Salery Code provides that the Costa Mese Fire Departmenl mey require tha prepareGon, certiliwtion antl tiling with the Fire
Depertmant ol en RMPP by businesses which ere requiretl Io register ecutety hazardous metenels with ihe Fire Depenment.
...................._.................__..._.......... ' __""'__'_'_'............_.._................_.................................................. .........._.._........ _........__"._.�.. _
4 II en RMPP I9 presently requireU, has Section 25534 of the Calilomia Hefll�h entl Safery Cotle been fully complieA with? ❑ Ves ❑ No
.................................................................._...................................._..................................__............._...."'................._................................................................................................_............................_.....................__.............__.
5 Does or wlll the epplicent or present or luWre building ocCupan� reqWre for �he work which Is Ihe sub�ect o� this e plication e Permit br such wnstructlan or modiflwLon
from the South Coest Alr Ouality Management Distdct or irom eny other elr pollution contml distdct or egency? � Yes �J No
(Section 658502 of Ihe Celifomla Govemment Cotle requlres that the requested intortnation be lurnished on ep011wtlons tor nomresi0entlal Dullding pertnits).
................................................................._......... ..............................................._........................................................................................................................................... ........................ ............................................................._.
y p ry ���� pertnil be vnthin t0001eei from Ihe outer bountleries ol e school? ❑ Ves ❑ No
6 W ill en a� ol �he taclll to Ee constructed undar Ihis
Qf'j�es", the faciliry must meet the requlrement of Sections 25534 and 42303 of the Califomia Health end Safey Code).
............. . . . ............................__............................._............._._......__...._._.....'_"'.._........_.__._............_.__...................._........_...._......_............................................_..._......................__.._.............._.__"""_
7 tl�a yertnil from the South Caest Alr Quality Menegement District or other eir pollulion control district or agency is required for Ihe work which is Ihe subject of this
epplicetlon, have ell of the Cisclasures prescribed by Califomia Health and Satery Code Section 42303 been mada4 ❑ Ves ❑ No
.........................................................__..................................""................__....._._......_.._._.__..................__.........................._.............................................................._...............................—....................____.._.._.....
B (If'yes", atlech certlficate ol compliance irom Ihe apP�opriate air pollution wntrol oHicer).
CERTIPICATE OF COMPLIANCE: I ceNfy that untler penalry of perjury Ihe infortnation given above Is correct I epree to comply with all s�ate laws and ciry ortlinances
regardinq Harartlous Ma�erials end Emissions.
Signature: Date:
CERTIFlCATE OF COMPLIANCE AND AllTXOHIZATIONOF ENTRY: I certity under penalty of perjury iha� I have reatl �his epplicetion end state ihat ihe infortnation given i5
conect. I egree lo comply wilh ell stete laws entl ciry orClnences releting to building constructlon, and euthorize representatives of the City of Costa Mesa to enter upon Ne
ebova-descdbeG property for inspecUon purposes. I egree not to occupy ar ellow occupancy of eny builUing euthorized by this parmit until finel inspection.
GL $ig�yp . e wner(s)� �/�'�� ate
iJ C� / \
A tl/Or Authorizetl ApPlicant �� Date
�If�� INSPECfIONTYPE
� 7616 Fixetl System Finel Pire Preventlon
1268 Pool Spe Finel
200 Finel Re-Rool
201 FIneI BIxWRetnlning Well
202 Final Factory Fire Plece
203
204
Final Slgn
Finel Demolltion
unie' �
CODE 1 INSPECTION TYPE
206 Flnel MeChanlcel
20B Finel Plumbing
210 Finel Eleclrical
212 Flnal Fire Preventlon
220 Final Plenning Approvel
222 Final Site
250 Finel Bullding/Occupency
Peff.
�
Iti�
(71a) 754-5273 • Fa�c (714) 754-4856 • wwvr.ci.costa-mese.BUILDING PERMIT n FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 3555 HARBOR GATEWAY S
Suite: E
Vicini[y:
Parcel Number: 41508134
Appliwnt: MC CALLUM, GERI
Address:
Owner: C J SEGERSTROM & SONS
Address 3375 FAIRVIEW RD
COSTA MESA. CA
Contractor.
Address:
Zip:
Arch :
Address:
Phone:
Zip:
License:
Zoning:
Phone:
Zip:
Phone:
Zip: 92626
Phone:
License: " �
Eng:
Address:` � .
Status: ISSUED
Applied: 07/03I2001
Issued: 07/03/2001
ISSUED BY: I
Phone:
i
License:
' SCOPE OF PERMIT� � �'
TENANT IMPROVEMENT FOR SUITE E. RECONFIGURE INTERIOR AND CONVERT�ONE RESTROOM TO A SHOWER.
, —
Plan Check:
Permit:
SINIP Res:
SMIP Com:
Other:
Inspection:
�
Total:
$254.31 _
$391.25 � ..
$0.00
$5.25
$0.00
$0.00
$650:87
_ ���,,; -
FEE SUMMARY �,
_ _ Calc Valuation:
� - � �- -Claim Valuation: �'.
�` '
-- " -
/ // j
�
"�, i �
� �:: � _ '� � /
- - .��i
' ., �
. �" �• :t• ;_ , ,:,7, . � �� � _
_ - _ �:G� �
�� / ,� A\� � o � PLANNING & ZONWG �%� C/� � �
SETBACKS �.� �� � ��� � , '% � VG� �
� ��/��i��� ��� .- �� � o � :�% _ /��� �
MAIN STRUCTURE Front - 0-.0 i��, Rear 0- 0 ��- Left. 0:0� .�. Right ^ 0;0 � �: '
. . i� . . . / i /
` ��� -- - �\ ,�i� _ i
ACCESSORY Front -0 0�._ �:/� Resr �-0-0 Left 0.0 .' .�� Righ't ���0 � �
� �.
/i ;
PARKING Existinq: �0,� �_ R�. � ' .�' ..Pr000sed:�,_,�' " �/,%%' �
�„^ ,�
NOTES: ,` - - - - - _�-�i.i � ;
szs,000.00
� $25,000.00
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92) i
EXPIRATION: This parmit shall automatically expire and become void if work Is not commenced within 180 days, or il work is suspentled or abandoned
for a period ol 1 BO days.
INSPECTIONS: In order for ihe work authorized under lhis permit to be considered legal, such work must comply with all applicable codes, end ell
required inapectlona and flnal approvel must be obtained. Failure to obtain inspections and flnal approval will result in ihe expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545626
2448d8I�D)
WORKERS' COMPENSATON DECLAiiA710N: � �
I hereby effrm under penalry of perjury one ot the lollowing declaretlons: � •
❑ I heva end will maintain a ceniticeta of consent lo sell-Insure far workers' compensetlon, as provitleA for by section 3700 of the Lebor Cotle, for the pertormance of the
wofk �or which I�is permit is i55ued.
❑ I have end will malntein workers' campen5etion insurance, fls required by section 3700 of I�e Lebor Code, far the pertartnance of the wark tor whicn ttiis pertnit is issuetl.
My workers' compensatlon Insurance cartier a�W pdky num6er ere:
Cartier: Policy Number
(This section need not be aompleted tl fhe permltls valuetl et one hwWretl dollers (5100) or IessJ
�certily thet In the perfortnence ot t�e work lor which ihLq pertnit L9 Issued, I shell nol employ eny pereon in any menner so es to become su6Ject to ihe workers'
compensatlon lawa of CelifOmi end epree Ihat II I shoultl become sub�ecl lo t�e warkers' compensalion provisions of Secli9n 3700 of the Lebor Code, I shell forthwiN
compry with these provisi yJ I
ApD�lcant Slgnature: .�Y -r�Ay Date: � 13 � O\
WARNIN�: FAILURE TO SEWRE WORKERS' WMPENSpTION COVEMQE IS UNUWFUL AND SWW. SUBJECT AN EMPLOYER TO CHIMINAL P NALTI 5 M!D CM� FlNES UP TOONE HUNOREO
T110USAN0 DOLURE (5100,OW), IN ADIXiION TO TNE O�ST OF OOMPENSATIIXJ, OMUGES AS PROVIDED FOR IN SECTION 3N80F THE LABOR CODE, IMEREST, AND ATTORNEYS FEES.
LICENSED CONTAACTORS DECLARATON:
I hereby eHlrm tha� I em Ilcensetl untler provlslons ot Ghepter B(cammendng wlih Sectlon 7000) of DlNsion 3 of the Business entl Professlons Cotle, and my license is in full
force en0 eHect. Uc. M Clau a
Contrectofs Slgnatura: Date:
CONSTAUCTION LENDING AGENCV:
❑ I hereby aHimi Ihat there Is a construction IenOing egenq tor Ihe pertormance ol the work lor whic� Ihis permit is issued. (Sec. 3097, Civil Cotlej.
LenOers Name: Lendels AtlOress:
Signature: Date:
OWNER-BUILDER OECLARATIONS:
I �ereby effirm thal under penalry of per�ury thet I em EXEMPT FROM TNE CONTiiAC70RS LICENSE LAW far t�e following reason (Sec. 7031.5, Business and Pratesslons
Cotle: Any ciry or rnunry which requires e permit to construct, elter, Improve, demdlsh, or repair any structure, prior to its issuance, alm requires Ihe applicant for such pertnit
ro file e signed stetement thet ha or she Is Iicensed pursuam to 1he praNslons oi the Contredors LJcense Lew (Chepier 9(commenGng wiN Section 7000) af Division 3 oi Ihe
Business and Protessians Cade) or Ihat he or sha is exempt therefrom and the Gasis lar the ellegeC exemption. Any violation ot SecUan 7031.5 by any applicant for a pemut
su6jects the applicant to e civil penalry of not mare Ihen fne hundred dollars (5500).):
❑ I, as owner oi the property, or my employees wit� weges es their sde wmpensetion, WILL DO TT1E WORK, en0lhe sirudure is nat intended or oflered for sele (Sec.
7044, Business and Profeuions Code: The Coniractors Litense Lew does not epPH to en owner of property who builds or improves �hereon, and who tloes such wark
himself or herself or through his or her own employees, providetl t�at such improvemenls are not Intended or oNered tor sale. II, however, ihe building or impmvement is
sold within one year ol complation, the owner-builder will have the burden ol proving t�at he or she did not builtl or improve tor purpose of saleJ.
I, as ownar of the properry, em EXCLUSIVELV COMRACTING WfTH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Pmfessions
Cotle: The contrectors License Lew does not flppty to an owner ot propeny who builds or improves thereon, end who comracts for such pmject with a contractoqs)
license pursuam to the Comreaors License LewsJ.
❑ I am exempt u c. Business and Proleuions Cotle for this reason:
Signawre: � ii //�/�L Date: Z- �� `L
i� -T
Owner ID veniietl by tlrivefs licensa. ❑ Ves ❑ Na Ddvels License No. 1 - ,'res�
Verification of Ownership Dy (rype of tlocument, i.e. - O�operry tav Dill or deed):
OIVISION OF INDUSTRIAL SAFETV GERMR CERTFICATION:
❑ I hereby catllty that no excavetlon fNe (5) or more feet In depth Into w�ich e parson Is raqulred ta descentl, will be made in cnnnection wit� work authorizetl by ihis
permit, end Ihet no bullding structure, scalfoldinp, telsework, or Oemolitlon or Elsmenlling thareol, will Ge more ihan ihlrry�slx (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, 71t1e B, Callfomia AdminislretNa Code).
� As owner-bullder, I wlll not employ enyone Io tlo work whic� woul0 require e permit irom Ihe Dlvislon ol Industrial Safery, es noted ebave, unless such pereon hes e
permlt to do suc� work Irom Ihe division.
Slgnature: Date:
Divislon ollndustriel Sefery Permll Number:
CERTIFlCATE OF COMPLIANCE AND AUTMORQATON OF EHTRY: I certify untler penalry ot perjury Ihat I have read this epplication antl state that Ne infortnaLon given is
corred. I agrae to compty with ell stete laws and dry ordinantes releting to buil0ing construciion, end euthorize represenWtives of the Ciry of Costa Mesa to enter upon ihe
ebove-descrlbed property lar inspecllon purposes. I epree not to occupy a ellow occupency al eny building euthonzed by �his pertnit un�l final inspection.
COOE I. INSFECTONTYPE
1616 Fi:etl System Final Flre Preventlon
1266 Paol Spe Finel
200 Flnel Re�Roo1
201 FIneI8lock/Retalning Well
202 Final Fectory Fire Place
203 Finel Sign
204 Finel Demoliiion
�7.11�
CODE 1 INSPECTION TYPE
208 Final Mechenical
20B Final Plumbing
270 Finel Electricel
212 Flnel Fire Prevention
220 Final Planning Approval
222 FinalSite
250 FInelBuilding/Occupency
PAIE I�L3
(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, WSTA MESA, CA 92626
ELECTRICAL PERMIT
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
3555 HARBOR GATEWAY S
G
41508134
Applicant: MC CALLUM, GERI
Address: '
/���; % -
i:
��;. � .
owner:' C'J SEGERSTROM &"SONS
Address -'.3315 FAIRVIEW RD � �
/ \
� COSTA-MESA,.CA
,� ;
��
Contractor: �; - OWNER BUILDER
� �
�
Address � � ' - �
� �
.� � , �., , , ,
Phone: 714•435-2053
Zip:
Phone:
ISSUED BY:
�
Zip: 92626 �
Phone:
Zip:
License: 000000
Status: ISSUED
Applied: 02/052007
Issued: 02/OS/2001
� � � � ' SCOPE OF PERMIT � �•"� � �'�, ;
� REF: 801-00164. TENANT IMPROVEMENT FOR LEASING OFfICE. FOUR OUTLETS FOR NEW OFFICE �� I�� �
`� ' ` : SPACE - � _ . . - . , � �
' . ,� �\ . . , ' i `' �
� � � -11
� � FEE SUMMARY , � � � `' '
�
:.� � � ` �,�- Quantity � Quantity // l ' 1 � �. ��
��ISSUE,FEE-� 823.50 TempDisCSystem/Lighting 50.00 0 ;�/ / . = - !7
;
Temp service test `. 50.00 - Busway I700.ft � �-50.00 0--��� . � �'�/
Res) a/c package, , 50.00 Standing Seotion � $0.00 0/� � �� ��� �,n
New Res (7-2�units)� � � 50.00 0 � Misc Electrical Equipment $0.00 ,-,0� /" <� � /�!/�
New Res (3+uuit3) / � �� , 50.00 0 �. � T�ansformers up to 1 kvalkw 50.00 -� .0� � � � � �
Pool / Spa �_ �, ` � �, =_,50.00 0 . . � � up�to 10 kva/kw 50.00 '„' 0 � � � �
, .......... .....
Lighting Fixts, ` ,- .�50.00 0 . �• ...........:.....up to 50 kva/kw 50.00 i�� 0. i' i,"� /
ReceptOutlets'� � � $4:40: - --4,. , .........:upto100kva/kw�--.-$O.00j� 0? -' ���'
Switches '��V� ^ 50.00 � 0 � ....... .. ..... over 100 kvalkw� - SO 00 0 �
Non Res Appl � V�� �'' S0.00 , - � �0 ., , - � Low Voltage Eqwpment , �$0 00 ���0 /1
Res Appl A�� ✓� 30.00, A�0\, . - � , Low Volt Wiiing System / Ckt= $0 00� /Oi � �
Serviceto200a ��� 50.00� � �0V":. - ��Misc:Conduit . '; -�� �50,00�,��,CO �
Service to 1000a �� � � $0.00 �,��� 0��, �, ��� �`'�� _. Misc, Conductor '� � � �' S0.00� 0� �/
Service over 1000a ����, $0.00 � / , � 0� , �
Motors to 1 hp �,� , $0_00 V � i / 0 � �
Motors to tOhp ��$0.00� "0 �,'� .� �
Motors to SOhp $0.00 :� �, 0 �� � � '
Motors to 100hp $0.00 �� ��0 _ �
Motors over 100hp 50.00 � . 0 - ' , - .
Communication drops 50.00 0 ' -_ '
Sub panel to 200a 50.00 0 -'
Pole Light Pkg 50.00 0
Sign Circuits 50.00 0
Temp Pwr Pole $0.00 0
Intermed Pole 50.00 0
Circus ( gen orride) _ \,� $0.00 i 0'
Circus (mech ride,ar lights) A`.�$O.00i� �0�
Chn5tma5 Tree_Stand'. A � 50.00��� �0
Fireworks Stand -" ` � � " 50:00� 0
`,�OtherElectiicalFee -- %�$0"00
� i
Investigation Fee � ..- - 50.00
�Plen CheckFee $0.00
Reinspection Fee $0.00
TOTAL CALCULATED FEES E27.90
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall compty with all applicable handicap access requirements under Calilomla statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become voitl if work Is not commenced wilhin 1B0 days, or If work is suspended or abandoned
for a period ot 180 days.
INSPECTIONS: In order for the work authorfzed under this permit to be consldered legal, such work must comply with all applicable codes, and all
required Inepeetiona and final approvel must be obtained. Failure to obtain Inspectlons and final approval will result in the ezpiratlon.of lhis permit.
FOR INSPECTIONS CALL: (714) 754-5626
204&d8(B/00�
WOAKERS' COMPENSAnON DECLAfiAnON: � � '
I hereby aHlrm under penalry oi perjury one of tha tollowing tlodaretions:
❑ I have end will malniain a ceniflcate ot consent to selt-Insure for workers' compensatlon, es proWded lor by section 3700 0l tha Wbor Cotle, tor Ihe peAartnence of the
work for which this pertnit Is issueU.
❑ I �ave end wiil maintain workers' compensatlon Insurence, es require0 by secUon 3700 of tha Labor Code, for the peAortnance ot Ihe work for whicf� Ihis pertnit is Issuetl.
My workers' compensation Insurance cerrier flnd poliry number era:
Cerder: Policy Number.
(Thls secfion need not be crompleled il (he permit !s velued al one hundred dollers ($100) oi /ess.)
❑ I cenity ihet in Ihe OeAormance of tha work for which Ihls permit Is IssueO, I shell not employ any person in any menner so es ta become subjoct to the workers'
compensation laws oi Calitamia, end agrae that il I sfrould 6ecwne sublect ta t�e workers' compensatlon provisions ol Seclion 3700 0l ihe Lebor Code, I shall torthwith
comply wlth these provisions.
Applicent SlgneNre: Dete:
WAHNINO: FAILUFE TO SECUPE WOfiKERS COMPENSATION OpVEMOE IS UNUWFUL M1D SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CML FlNES UP TO IXJE HUNOPED
TMOUSAND DOLLARE (5100,000� IN FDDITION TO THE COST OF COMPENS4ilON, OAMAGES 0.S PROVIDED FOP IN SECfIIXJ JN80F THE LABOR CODE, IMEREST, rWD ATTORNEI"S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm t�et I em Ilcensed under praNslons ot Chapter 9(commencing with Section 7000) oi Dlvision 3 0l the Business and Professions Code, end my license is in tull
forca end eilect. Lic. M Cless a
Conlreclole Slgnature: Date:
CONS7RUC710N LENDING AGENCY:
❑ 1 hereby ettlrm that there is e consiructlon lending egency for Ihe peAormance ol ihe work for w�ich thls permit Is Issuetl. (Sac. 3097, Civil Cotle).
Lentler's Name: Lentler's AtlOress:
Signature:
OWNER-BUILOER DECLARATIONS:
Date:
I hereDy aflirm Ihat under penalry of perjury �hat 1 em EXEMPT FROM THE CONTRACTORS LICENSE LAW lor the following reason (Sec. 7031.5, Business antl Professlons
Code: Any ciry or counry which requires e permit to wnsiruct, elter, improve, tlemolish, or repair any strucWre, pdor to its issuance, also requires ihe applicaN tor such permit
to fle a slgned stetement thet he or she b IkenseA pursuant to che provisions oi Ne Cantraqors License Lew (Chepter 9(commencing with SecUon 7000) oi DMsbn 3 ot the
Buslness and Pmtessions Cade) or that he or she is exempt Nerelrom and Ihe basis for ihe ellegetl eaemption. Any violatlan of Seclion 7031.5 Uy eny applicant tor e pertnit
sub�ects the eppOcant to e civil panalry of not more then Me hundretl dWlars (55W).):
❑ I, as owner oi Ihe properry, or my employees wlih weges es their sde compensatlon, WILL DO THE WORK, antl the structure is not intenAeA or oHeratl tor ula (Sec.
7044, Business antl Professions Code: The Goniractors Licensa Lew tloes not apply to an owner ot property who builds or improves t�ereon, end who does such work
hlmself or herselt or Ihrough his or her own employeas, provided that suc� imprwements are not in�endetl or oHered tor sale. If, however, Iha builtling or impmvement is
sold within one year of wmpletion, Na owner-builder will have the �urtlen of proving that he or she diC not build or improve for purpose ot sale.).
❑ I, es ownar ol the property, em EXCLUSIVELV CONTRAC7ING WI7H LICENSED CONTRACTORS to cons�rud ihe project (Sec. 7044, Business antl Prolessions
Code: T1ie contractors License Law tloes not appty to an owner ol property who bullas or Improves Ihereon, antl who contracis for suc� projeci with a wntractor(s)
license purs nt to the Contractors License LawsJ.
❑ I am e e n er sec Business antl Professions Code lor Ihis reeson:
SlgneNre: � / � � Date:
i
Owner ID ventietl by dnvets license. ❑ Ves ❑ No Drivefs License No. Expires:
Vedflcatlon at Ownarship by (type oi tlocument, I.e. - Oroperty tex bill or deed):
DIVISION OF INOUSTHIAL SAFETY PERMR CERTIPICATION:
❑ I �ereby certity NeI no excavation Me (5) or more teet in deplh ima which a person Is requlred to descend, wlll be matle in connection with work euthodzed by this
pertnit, end that no building siructure, scattdCing, falsework, or tlemWition or dismantling ihereot, will be more ihan thirty-six (36) leet high. (Chep. 32, Grp 2, Art 2, Sec.
34i, Title 8, Cellfomia AdminlstreWe Gade).
❑ As owner-builder, I will nal employ anyone to Co work which would require e permit trom the Divislon ol Industriel Selary, es notetl ebove, unless such person has e
permit to do such work Irom tha diNSion.
Signeture: Dete:
Dlvislon ot Industrial Selery Pertnit Number:
CERTIFlCATE OF COMPLIANCE AND AUT}fOR¢ATIONOF ENTRV: I certity under penalry ol perjury thet I heve read this eppliwtion end state thet t�e intortna6on given is
correct I egree to compty with ell state laws entl Gry ordinences relating to building construction, en0 euthodze representaGves at the City oi Casta Mesa ro entar upon the
ebove-tlescribed property tor inspection purpases. 1 egree not ta accupy ar ellow occupancy oi eny building euthonzed Dy Ihis Oermit until fnal inspection.
A, ig tura OLL _egel �er(s , � i ate
��� /YI � c� a S�O
And/Or Aut onzed Applicant � Dale
GppE �. INSPECTOHT'PE p�jf,' �
1618 Flaetl System Final Fire Prevention
1288
200
201
202
203
Pool Spe Finel
Finel Re-Rool
Finel BIocWRelaining Wall
Final Fedory Flre Place
Finel Sign
204 Finel Demolition
COOE� INSPECTONTYPE
206 Finel Mechenicel
208 Flnal Plumbing
210 Finel ElectAcal
272 Finel Fire Prevention
220 Final Planning Approval
222 Final Slte
250 Finel Bulldinq/Occupency
PNOJECT RODRESS: 3 S S 5 HARBGF� GATEWAY S
.—ow�E"�s""ME: C.,7. SEGERSTROM S SONS
noneess: 3555 NARBOR GATEWAY SOUTH
STE. G
COSTA MESA 92626
935-2053
AflCH/ENGINEEfl: flEG.NO.:
ROOflES$:
uxiT: A
UNiT:
PENMITTEE: C�T SEGERSI'ROM ( 714 ) 546-0110
aooness: ] 31 S FAIRV I EW RD
COSTA MESA CA 92626
LICENSEo CONTPACTOB OECUBATION: I nereDy atlirm itut 1 am IirenseG unAer o«ons ol COapter 9(commencin0 wit� Seclion
7000� ol �ivision 3 0l Ihe Business antl Ptafessions Coae. and my license is in lullforce and eflect.
ciTr uc.: aTnte uc.: tuss:
Dare: Signamr¢:
WONI(EBS' COMPENS�TION OECIANATION: I here�y aHirm rtw11 have a cetliliwte al wnsent to selNnsure or a cenificate ol WOY�ers'
Compensation Insurance. or a cenilieE copy t�ereoi (Section 3800. Lab. C�.
70LICY NO.: EXP. O�TE:
camraNv:
❑ Certilie0 copy i5 �ereEy fumisAeO. ❑ CertifieA wpy ¢ fileO wii� Itrc ciry &NEing Division.
�ate: ApWiwnL
EXEMPfION FflOM WOflIIENS' COMPENSNTION OECLAMTION: (R� seclion meE not Ee mmpkteU it Ihe perml's M me hunCrtq (5100) a ka�.
I certity t�at in ihe petlarman[e 01 I�e work tor wltic� Iks p¢rmit is i55ue0. I slull no� ¢mploy any person in any manner so a5 io became
suble�� �o I�e Work¢r5' CAmpensalion Laws ot California.
Da�e: SignaWre:
NOTICE: II, aiter makinA �his declaration, you shoul0 become suDject to t�e Workers' Compensation provisions of t�e Labor
Code, you musl forihwil� tomD�Y'�^�h Suth O�ovisions ar t�is p¢rmii Shall GB Ceemetl revok¢E.
CONSTBUC710N LENUING RGENCY: I hertGy aifirm ttwt t�ere is a wnsiruction lentling apency for ��e Derformance ol Ne work for
which ��is p¢rmil i5 i55u¢a (Setlion 3W7. Civ. C�.
LENDER:
RODflESS:
OWNEB BUIWEN OECLAMTION: I trere0y atlirm ihat I am exemp� Imm tM Contnpars' State Liceme law for Ilre lollowinp reason
�Seaion 70]7.5 Business anA Professional CoOe: Any ciry ot rAunty wliic� repuir¢5 a Dermil to constmct, alt¢r, improve, Gemolish, or
repair any SimcWre. D�� �o rts iSWance, aLso repu"vM t�e apWKanl lor wU per�rvl to file a signe0 siatement Ihal t1Pls�e R IitenSM
Dursuam io �ne D�a�isbns ol tne Cantrapors' Sta�e li�¢nse Law (Ctwo�er 9(rAmm¢ncinp vnth SectiOn 7000) o� Division 9 0l I�e Business
anG Profe55ions CaUe) ar rtWt �dsne o e.empt tAertlmm ail0 t�e ba5i5 for I�e atleA� exemD���� �Y �datial al $eGtion 7031.5 Oy
any apDlicant for a permil suhlecls I�e aD�litant lo a civil Denalty ol not mare ItWn five huntlre0 Oollars (5500).
CITY OF COSTA MESA — HUILDING ?ERMIT PtRM NO: IB 059632
PERMIT NO: IB 059632 PLAN CHECK NO; N GOVT: N SUPP; Y
CONSTRUCTION TYPE; PERMIT TY?E: OTH STR PURPOSE: OTH
JOB DESCRIPTION ; INSPLCTION FOR CERTIFICATE OF OCCUP, SQ FT:
CLAIM VALUE: CALC—VALUE; GROUP OCC: B-2 /
COMMENTS; REF:H36561 CHECRING FOR OCCUPANCY
1f ?E iF iE iE i! Ir iE iE i! it iE 1f it if iE # iF iE iE rt it%it #!! it?E if i(� if iE iF if it iE �lk iE # iF iF i! ik if 1t# i! IF iliE 1t ff iE iE iE iE # iE iE* if # fE k iE # fE # iF it iF iE iE # iF # 3F K� iF
2 O N I N G R E Q U I R E M E N T S
S E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR; FT IN FRNT: FT IN REAR: FT IN
LEFT; FT IN RGHT: FT IN LEFT; FT IN RGHT; FT IN
F'ARRING RE • PROV; PAftCEL; 41509104 ZNE; REF NO;
PLANNING N T'ES>
i
*�r�rt***x�-�#�x��*#*****�r***x#xx����r�*�r*�r***�r+t�c�tx��*x-ux��r*�r***x-rt�**�r*�#a�#*�*x�ib��c�x�#�x�**
D E V E L O P,7 E N T 5 E A V I C E S R E Q U I R E M E N'�' j S
ZONING APPROVED BY DATE: %:
BUILDING APPROVED BY
APPLICATION ISSUED HY
iF i6 if ik if iE 1F iE iF fflE iFlF �k 3f !6 iE 3hlE iFlf
iE iE it fE if iE iE if iF iE if 1E # if M� iE if iE if 3E if
LEGALIZATION;N
�3LDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 30.00
PLAN
ISSUE f'EE
FIRE SMIP/RES GRAD'ING
5MIP/NON—RES
i, as owner ai me D�openy or my em iayees wim waAes as tneir mie campensation, will Ao tne work, antl me BUILDING—DIV—% PERMIT ISSUE PLAN—CHECK TOTAL PAID DU$
❑ s�mcmre is no� immeea or oaerea iar saie 1�ctwn 70aa: Buzness anG Pmfe55ional CoEe: The fqntrectori 5um �icense Law TOTAL S----> 3 0. 0 0 0, 0 0 0. 0 0 3 0, 0 0 3 0, 0 0 , 0 0
� tloes na1 apoly Io an owner ol a o�a0eny who Ouiles or impmves inereon, anC wno daes sucn work nimsell/nerself or inrouph
his ar hei own employees, o�ovitle0 tnat sucn imprwemems are not inten0ea or allerea lor sale. II, howaver ihe Culltlinp or REVENUE DI V I$ ION TOTALS--> COLLECTEA ; 30 , 00 OVER /SHORT ; � �
impmvemenl is 5010 wi�hm One year of tomD�elion, Ihe owner vnll �ave I�e EurO¢n oi pmvinp �e/shB dia n01 Guild or imprOve
mnneo��ooseoiuiel. BLDG PMT PLUMBZNG ELECTRIC MECHANIC F'IRE SMIP/TOT GRADING PLAN—CHECK
i, as owner at ine orooenY, am exclusively coniractinp vnt� licensetl conlractors to canslmcl �he pwject (Section 704<, Business 3�,��
� an0 Prafessions Caae: The ConUacmrs SWte L[eme Law Eoey npt aDW �o an wmer oi praperry who Ou�las or imOroves Iher¢on �
andw�oConlraCls�orSuc�Orojeclsvnt�aconlractor(s�lic¢nsepurSuanllol�eContra[tors'SlateLicenselaw�.lamaware 1�'�"x-'x'M'M'i�`k�k�('M'k�l"IF��if'K�fF1F1hik1E1F#kkitiflE3EihifiFiEiEiEiliEkiflEil�lEif1E{�{({(�*{(��({(�*�(.-�*{(..µ�7p�(.{�..7p�(..X.*.*.*.*.X.{p##3'rJE##ik#ic
mai orooi ot meir wor�er's comce�satro� �a��a�ce snowa ee wmaam to rtre. I N D I V I D U A L F E E B R E A K D O W N
� 1 am exempl unEer Seclion: B. 8 P. C.
io�mis�ea:on: � C TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
te: ��� �`%� o+me�: �' ZNS 1 HUILDING RE—INSPECTION FEE 30. 00 30. 00
I do nere0y cendy �nai I am awaa ot ana uneerstana ine rtquircments of Calnomia Meaun ana Safery Coae Sections 25505, 25533, antl EDID OF FEES
2553n and tna� I or any IWure Gui�dinq occupant wiiVwi�l nai (tirtle ane) nee0 to complY wii� sai0 state cotles anE t�e reQuiremenis lor a
permil lor conslmctian or modili[alian Imm I�e Air Oua01y Manapemenl DiSlrici. flev0¢ntial cOnsimction applications are exempl Imm
�hese provisions.
�aie: Ap06wn�:
I her¢by cetli�y Iha� I �ave reatl I�is application an0 5tate ��at i�e ab0 inlormaiion is cOrret�. I agree IO Comply wiih all Ciiy antl county
orainancesanaslatelaw5relaW tobuAOin tonsvuct6nanA IMr¢er nlative5afrtdtd Ioenterupont�eaGWe�mentioneE
9 9 N
pmper�y tor in5p/etl�ion ur0ose5.
�Ie:/O `-�/� �� Signdiure /( O ��lf'A��.��L///!/l
Driver's License or Sotial Securiry 9
�6at�A6 White—BuilEinq: Green—CaEe Eniorcement: Canary—Appliwnl: Pink—Pevenue; GolOenroO—Assessor
�£�NSTRUC710N AND PLANNING POOL & SPA ' �
I�PPROVALS Permit # ' Date Inspector APpROVALS Permit # Date Inspector
. 1. Temporary Electrical Service�or Pole -52. Pool & Equipment Location
2, Soil Pipe•Undrgrnd. 53. Steel Reinforcement -
3, Electiical Conduit Utiliry•Undrgrnd. 54. Forms
4, Electrical CondulhUndrgrnd. 55. E�ectrical Bonding
5. Steel Reintorcement 56. Rough Plumbing & Pressure Test
6. Electriwl UFER Grnd. 57. APPROVAL TO COVER•GUNITE
7. Footings 58. E�ecuical ConduibUndrgrnd. '
g, Foundation 59. Gas Pipe, O Undrgrnd., Test '
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, 0 Undrgrnd.
10. Structural Floor System �' 67. APPROVAL TO DECK
��, Property Sewer Line & House Connection 62. Backwash & Receptor�Final •
12. Sewer Cap 63. Heater & Vent�Final
13. Roof Oraint gq. Plumbing SYsiem - Final � �'
14. Rough Plumbing 65. Electrical�Finai
15. Rough Electrical-Conduit 66. Solar System-Final -
76. Rough Electric Wiring ' 6). Fencirig & Access Approval •
17, Rough Wiring Sign 68. APPROVED FOR PLASTERING
1$. Rough Electrital-T Bar Ceiling 69. POOLlSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVAIS Permit #
21. Ducts, in Struct�re 70. Underground Hydro
'22. Ducts, Ventilating 77. Product Pipin� OGas ❑Oil
23. Gas Pipe�Rough & Test ' 72. Underground Flush �
24, Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T�Bar Ceiling (Structuraq & Monocoat 75. Dry Chemical •
Z7, Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding � 77. FIXED SYSTEM FINAL�
29. Insulation � 7g, FIRE PREV. FINA�
i
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat � j ( 79. FINAL INSPECTION
32. Electrlcal Power Meter-Final ; . 80. FOOD CERTIFICATE ISSUED
33. Pinal Eleccric � Notes:
34. Final Heating & Air Conditioning �
35. Final Gas Pipe-Test �
36. Hood or Canopy �
37. Final Factory Fireplace �� �
I � _
38. Finai Plumbing � � �
39. Water Service-Final � �
40. Gas Service-Final I �
41. Solar pomestirFinai I � �
42. Backflow Preventer .
43. Backflow Irrigation
44. Landscape Irripation SYstem
� 45. Sound Attenuation �
46. Handicap Regulations �
L
47, fINAL STRUCTURE & BUILDING � z �Z � �
48. FINALPLANNING �
49. Electric Release to Edison � �
50. Gas Release to Southem CafiSornia Gas Co � ' , ' .
51. CEfiTIFICATEOF•OCCUPANCY
No. Date
Applicant to fill in all soaces exeeot those within heavy boraer Iines anE sign all approvriate tleclarations.
Ci vo TA SA CpNSTRUCTIOIV'PE RMIT
�.o;e � ress� Harbor Gateway S.Costa Mes+
�Applicant'sMailingAddress 35 5 Har C)i a e�i aay 5ie.)
�Owner'sName 6.J. Segerstron�SonsPno�e
'Aad,ess 3 31 5 F a i r v i e��� , o�F�e s a�f7�b-�-�
'a��niE„9. N a r d i n i& S t a n 1 e y L1Ce se No.
aaa�ess 926 Town&Country,�range�2�fi$—
Contracror'sruameCo-4Je11 ContractorsPnp�e5 = 1
Address�mailing) 3554 BUSIfI@SS' Pdl^k Dr.CostaMesi
City License No. �� 4 z 9 2 �
LICENSED CONTRACTOR DECLARATION
I M1ereby aftirm that 1 am licensetl untler pro��slons of Charter 9(commencin9
with sectlon ]000) ot Division 3 0� the BUsiness antl Protessions Cotle, antl
my license is in tull force�tl effecY. -
Licen CI �3 -Nc� No. � �
Dafe �� 59 t v
WORKERS' COMPENSATION DECLARATION
I hereby aifirm Nat �I have a certificate of mPsent to selt-insure or a certiticate
of Workers' Co ensation Insurance, or a ce�tlfietl copY thereof (Section
3800, l.ab. C.)�Q=�
Polity No. CompanY �TRT���'�
� er[ifietl copy is �ereby furnishetl.
Cer�J ietl cop s etl with the city Buil i o�na �
Date' /� $'� Applicant ��� • -
EXEMPTION FROM WORKERS' COMPEN5ATION DECIARATION
(This section neetl not be completetl if [he permit is for one hundretl (5100) o� •-
less).
I cer[ify tltat in Ihe perto�mance of the worK �o/ which thi5 permit is i55uetl, I
shall not employ any person �in any manne/ so as to become subject to the
Workers' Compensation Laws ot California. �
Date Signature _ �
NOTICE: If,after making this.tledaration, you 5houltl. become suDject ro the
Workers' Compensation provisions of the Labor Cotle, you must forthwith
comply with such ,provisions o� tM1is pefmit shall be tlEemetl rewketl.
CONSTRUCTION LENDING,AGENCV
1 hereby affi�m that there is a const�uction IePding agency to� the perPo�mance
af the work for which this permit is issuetl (Section 3097 Civ. CJ
Lender's Name
Lentler's Atltlress _ � � � _
OWNER BUILDEft �ECLARATION
I hereby aftirm that�l am exempt from the Contractor's Litense Law tor the
followin9 reason (Section ]031.5 Business a�tl Professional Cotle: Any city'or
county which requires a permit to construct, alter, improve, tlemolish or repair
any slruchre, prior to.its issuance, alzo reqq�res the applicant tor such permit
to tile a si9netl statement that he/she is licensetl pursuant to Ihe proviswns of
the Contractor's License Law (ChaO�er 9(commencing with Section 7000) o(
• DiviSiOn 3 ot the Business antl P�otessions Cotle) or thdt he/she Is ezempt
the�etrom antl [he basis fo� the allegetl�exemption. Any violation ot Section
7031.5 by any aOPlican[ for a permit subjects the applicant to a civil
.�enalty of not more Ihan (ive huntlretl tlollars (5500).
LJ I, as� owner of the property or my err�Pioyees with wages as their sole
mmpensation, will tlo'4he work, antl the stYucture is not intentletl or otferetl
for sale (Section ]044, Bu5ine55 antl Professional Cotle: The Contractor'S
Liconse �aw tloes no[ zpply to an owncr ot a Property who builtls or improves
thereon, antl who tloes such work himselt/herselt or tnrough his or her own
empioyees, provitled that such improvemen[s are not intentletl or offeretl for
SaIC. •If, however; the builtling or improvemEnt i55oltl witM1in one yedr of mm-
Dletiom, ihe owner will nave the burtlen of proving he/she tlitl not builtl or im-
�rov0 for [he purpo5e of sale�. �.'.�
.1, as owne� of the property, am ¢xclusivety cont�acting with licensetl con-
, tracrors to construct the proiect (Section ]oda, Business antl Professions Cotle:
The Contractor's License Law does mt apPly to an owner of property who
builtls or improves 4M1e�eon, antl, who conVdc[5 for such projects with a can-
tractor(sl'ucense pursuant to the Contractor's License Law). I am aware that
proot of thai� Workec's Compensalion insVranGe Shoultl be provitletl to me.
❑ I am exempt untler Section B. & P. C. for this reason
Date Owner
certiry tnat�l have ?eatl this ap
m is correct. I agree to comO�Y '
Signafure ��'f
Drivers' License or 55
state that the above
�tl county ortlinances
'eby autho�iie repre-
[ionetl property tor
Date /Z�5'�'�'
TjYPE OF CONSTRUCTION LJ NEW LJ'ADD Llil ALTERATION IJ REPAIR
''�� ❑ CONVEft510N' ❑ DEMOLISH ❑ OTHER I nt�r i Ar q,p, # _ �
��, DESCR7PTION OF WORK/USE OF BIDG. �
5 Main Building:
�TVPEOFPERMIT GRADING ❑FOUNDATION STRVCTVRAL T Front�
4 ❑ TENANT ❑ ELECTRICA� ❑ PLUMBING ❑ MECHANICAL B R¢a�
;i ❑ oTtiER � A
PROJECT DESCRIPTION SQ. FT.j��� �� '�J''��� ocCUvqpry v-�y q-�- �9— C Right
:"CONSTRUCTIONTVPE 3-" VALUATION$T�e`L'-' g Left �
•�, ZONE GIiADING CV. VDS. � ACRES Ping. Ref. #
Remarksv . , � � Planning Notes:
. -. . ... .� --� � . r�Q � i .
3ar Sink . " -
3ackflow Preventer • �
3ackflow Irrigation�
3athtubs � , � �
Clarifiers' -
Dishwasher -
Jrinking Fountains .
Floor Drains .
Floor Sinks . �
.�id5 $CNIC2 �U[ICtS
Interceptors '
Kitchen Sink -
Lavatories � �
P—Trep
Roof Drains ' . .
Fee � $75
Boiler
Duct- Urider Ground
Duct-Structural � ,
Duct-Ventilating , � �
Exhaust System �❑ Multiple ❑
FirepVFact. BIt. ICBO # A
Heating System & Ducting �
❑ U 7 00,000 BTU O 100,000 BT
IReinspection Fee �'^ I � $15
CMF 0865-46, rev. 10/84 White - Builtling: Ca�ary - qpplican4 Pink - Actounting; Goltlenrotl - A55essor
Showers
Service Sink
Sewer Cap :
Sewer Connection '
Solar Collectors
Solar Pipin9 -
Solar Tank
Swimming Pool w/Spa
Urinal t
W3S2f CI052L
Water Heater
Water Service -� •
Issue Fee
Hood or Typel ❑
Canopy . Type I I ❑
Refrigeretion Sys[em
❑o-ioo,000aru ❑ioo,oao
System Repair/Alteration
FireDampers .
Registers -
Issue Fee
a
_rcts
� AutomatieWasher
Construction-Pole Sub.
. Cookino Llni[ . � 1
$ 3
$ 3
Dishwasher �
Dryers �Gas C
Fan. '
F.A.U. '
Fixtures
DCViCC BO%25
Outlets
Switches- -
Garbage Dispoul
Generator �0-5
Parking,Req./Provided .
- ELECTRICAL � _ '
_ � Transformer 0 15-50 KW �
, ❑ 50+KW
, Meter ❑up to 100 amps �
- Meter:❑over100amps
lectric � Sub Panel '
^ � nnoto,s oo-, .Ha o, i- a
Inc.Solar �9-15 HP �16-15+
Microwave.
• Pole Light .
Range
� ' � - Sign ' " ' -
' Standing Sections
1��5-15 KW Trash Compactor
Reinspectian Fee ' � $15 luue Fee
.DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
� Building Approved By
Application Iuued By
BUILDING PEFMIT $ -5 �b SL
PLAN CHECK $ ' � i• ��
PWMBING � $ -
PLAN CHECK 25b $
ELECTRICAL S �
PLAN CHECK 5096 $
MECHANICAL $
PLAN CHECK 25% �$'
�
%2 3 �
Z
0
N
1
N
G
R
E
Q
M
T
S
iE5 6 N�
SMIP $'
PERMIT
ISSUANCE ' $
ENERGV P.C. $
GRADING $
MICROFILM $
TOTAL FEE � $
'CONSTRUCTION AND PLANNING POOL & SPA �
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. ' 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms , �
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement <;� ` 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVALTO COVER-GUNITE
7. Footings �� 58. Electrical Conduit�Undrgrnd. - �
8. Foundation !. .;.�� 59. Gas Pipe, O Undrgrncl., Test ,,
9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System'.• 61. APPROVAL TO DECK ' .
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final'� �
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical�Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
' 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL ���
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �
�
20. Rough Factory Fireplace APPROVALS Permit # _
• i
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas OOiI
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas ❑ Oil
25. Roof Sheathing - 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical •
�27. Frameand Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing �_3�g9 , HEALTH DEPT. REQUIREMENT -�
31. Plaster Brown Coat 79. FINAL INSPECTION '
32. Electriral Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: '•
34. Final Heating & Air Conditioning M . `_ y� _ '
35. Final Gas Pipe-Tes[ 2 �_ ��
36. Hood or Canopy ''�
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final ?'�
40. Gas Service-Final �
41. Solar pomestio-Final ,� ' � �
42. Backflow Preventer �
•:�
�
43. Backflow Irrigation �
44. Landscape Irrigation System
45. Sound Attenuation � � ��
r
46. Handicap Regulations �.�
47. FINALSTRUCTURE&BUILDING • •�
• fiJ
48. Special Requirements Completed „
�;:
49. Electric Release to Edison ' r; i+�
50. Gas Release to Southern California Gas Co � i✓
51. CERTIFICATE OF OCCUPANCY ? t,.
r,�'i
No. Date -. y�
- i
, �. .�
�
YJ `O� .��/�� Applicant to fill in all
r—
CITY OF COSTA�� CO� CTION ERM�I�T �A PERMIT NO.
'Groj€'�'1lddress �� �
ezcept lhose within heavy DorOe� Ilnes an0 sign ail apProO/�ate tleclarations.
TRACT NO. l0T NO± i in�ir Nn ._,
�APPlicant's Mailing Addre55 'f� �{�f.�17��. 1K�J��� ' TVPE OF CONSTRUCTION Ll NEW I_I AD� �ALTERATION U�RE�AI R
/' ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p,�
Owner's Name ��.• S � Phone DESCRIPTION OF WORK/USE Of BLDG.
'Address ��S Fa►wn� - �.M. s Main Buildi
E
�rch/Eng. Licensf No. TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front
Address ❑ OTHERT � ELECTRICAL ❑ PLUMBING ❑ MECHANICA� . A Rear ; �
Coniractor's Nama�� r�y �G Phone O '
PROJEC7 DESCRIPTION Sa. FT. OCCUParvCY C Right�
Addresslmailingl`'�3 �AN��i���'� ' �N� K
CONSTRVCTIONTYPE VALUATION§ S Left '
Ciry License No. O I�� � ZpNE GRAOING CU. VDS. ACRES p�ng. Ref. #
LICENSED CONTRACTOR DECLARATION � -
I M1e�oby aftirm that 1 am licensetl untler provisions of Charte� 9(commencinq Remarks: �� �A+P� �"�' �#. ���` Pl3nniny NOt¢5:
with section 7000) ot Division 3 ot the Business ana Prafessions Cotle, antl
my litense is in f W fo� /ea�ntl ef(ect. /� �
Licen -��% �_ �v License No �� Ov`
Date ��+�� ctona+i�rn '
WORKERS' COMPENSATION DECLARATION i Bar Sink
I hereby attirm that I have a certificate of consCnt to selt-insure or a certiticate
ot Worke�s' Compensation InSurance, or a certifietl topy ther¢of (Section Backflov
3800, Lab. C ���r���/ ,�,.-�,A
PfollicyNo.� �T� Company��"�"'�S �� Backflov
.F.y C¢rtifi¢tl capy is �e�eby fumishetl. �7 /J
➢9• Cer " i),.{oXj5� �iled with the dty Builtli , f'En � Bathtub!
DateJ�(�i�C1ZL APPlican'
EXEMPTION FROM WORKERS• COMP SATION DECLARATION Clarifier!
(This section neetl not be wmpl¢tetl if the permit is for one huntlretl (5100) or , Dishwdsl
less). ,
I certi that In the� performance of the work for tnis rmR is Issuetl, I
sM1all n employ any person in any manner bec e su t t he Drinking
Worker5' ompensation LawS of Cdliforni _ � ��
�NOTICE: Ii, tter m
Worke�s' Co ensa
comply with ch
CONSTRUCTIO I
I hereby affl�m th
af tne work lor
�entler's Name _
ientler's Atltlress- _
OWNER BUILOER
I herebv affirm [ha
�g tltis tletlaration, you shoultl become subject to Me
pravisions of the Labor Coae, you must torthwith
�visions or this Oermit Shall be tleemetl revoketl.
IDING AGENCV
e i5 a con5lruction lentling a9en<y for the performanG¢
ith [his permi[ is issuetl (Section 3097 CIv. C.)
ARATION '
�m xempt from the Con[ractorY License Law for the
on 31.5 Buslness antl Professional Cotle: Any cl[y oi
a pe� t to con5truct, alt¢/, Imp�ove, tlemOliSb m �epal
Its issu ce, also requires lhe appliGant f0/ such Oermll
nf that hhe is licensetl ourzuant [o [he orovi5io�s 01
' �ivislon��3�of tne�Buslnes
therefrom and the batis f�
7031.5 by any applicant
�enalty of no[ more Iban'f
� LJ I, as owner of the pr
compensation, wlll tlo the
for Sale ($ection 7044,�F
. License Law tloes not appl
' theraon, antl who tloes n
em0�oyee5, provitletl [hat �.
sal¢: If, however, the buil�
pletloq the owne� wlll ha�
�rove tor tne purpose oi sa
I, as owner of the�pro{
�i
bulltls or Imp�oves Lt
tractor(sl ucense purs
proof of Iheir Warke
❑ I am exempt untler
Date
the alle tl'exemptlon. Any violation of Section
for a pe� il 5ubjecl5 [he applicant to a Civil
e hundretl tl lars (SSoO).
pertv or my e o�oyees with wa9ez as tnelr sole
vork, antl the st cturo Iz not intentletl or offerotl
isiness antl Prole onal Cotle: The ConVactor's
to an owner of a pr erty who builtls or Improvaz
h work himselt/M1¢r5G ar thrOugM1 his o� hBr own
mh improv¢m¢nts are n t IntenOetl or otteretl (or
ng or improvement i55o1 wlthin one year bf com-
: the buraen oi proving he e tlitl not builtl or im-
[y, am exclusively Contractin wrth IlcenS¢tl Con-
:ct (Section ]044, Business antl oteszions Cotle:
w does not apply to an owner o /operty wM10
antl who contracts fo� such projec with a con-
the Contracio�'s License Law). I am ware that
npensation insurance shoultl be provitletl [o me.
i B. & P. C. fo� Ihis �easOn
Owner —
have reaa tnis
Signature— ✓L�LsL,
Drivers' License or 55 �
CMF 0865-46, rev. 30/84 White - Builtlin9: Canary
tate that the above
tl county ortlinances
:by authorize repre-
ionetl praperty for
oat�Z—Y3 �P
Preventer
Irrigation
er
Fountains
Floor Orains '
Floor Sinlis
oas Service Outlets
Interceptors
Kitchen Sink
Lava[ories
P—Trap
Roof'Drains �
Reinspection Fea $15
Boiler '
Duct - Under Ground
Duct -SVuctural
Ducl - Ventilating
Exhaust System � Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑0.100,000 BTU �100,000
II Reinspection.Fee I '$15
�licant: Pink - Atcounting; Goltlenrotl - Assessor
PLUMBING
$hOwers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
� Solat Piping
Solar 7ank �
Swimmin9 Pool w/Spa
Urinal
ater Closet
Water Heater •
Water Service
Auto-Wash
Laundry Trays
Issue Fee
Hood or Typel ❑
Canopy Typell ❑
Refrigeration System
❑0�100,ODOBTU ❑100,
S�a em Repair/Atteration
Fire Dampers .
Registers
Issue Fee
9
$ 3
FEES
$3 �,
�
• _ . _, . Zone _ .
Accessory Building: � '
Z
' O
, N
� I
' ' N
, G
� R
. Parking•Req./Provided E
Q
• , M
.. T
S
Auromatic Washer
Construction Pole Sub. .
Coaking Unit .
Dishwasher ,
Dryers �Gas ❑Electric
Fan
F.A.U.
ELECTRICAL
Transformer .� iS50 KW
❑ 50+ KW
� Meter ❑up tv 100 amps
Meter �overi00amps
��..���� , i
Device Boxes
Outlets
Switch¢i
Garbage Disposal �
Generator �0-5 KW �5-15 KW
Su6 Panel �
Motors �67 HP �1'f, - B
Inc. Solar �9�15 HP �1615+
Microwave
Pole �ight
Range
Standing Sections
Trash Compactor
� Reinspection Fee I$15 � � Iszue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
2oning Approved By
Building ApproVed By ��_ �
FEES
� � -. SUNTMARV OF FEE9J � •
BUI�DING PERMIT $ SMIP $ �
PLAN CHECK $ PE(iMIT , �
PLUMBING $ -ISSUANCE � $ .
PLAN CHECK 25% '$ ' ENERGV P.C. $'
ELECTRICAL � � S � GRADING $ �
PLAN CHECK 50% $ ' MICROFILM $
MECHANICAL $ � TOTAL FEE $ �
PLANCHECK'25% $ .
d Co_Q �1 VGU211�+-lUu1L1��7 t i+ B .S.-�
�'�D dA'e: tz!?i/�' TIPiE: 1St�-
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit # '' Date Inspector qppROVALS Permit # Date Inspector
1:.Temporary Electrical $ervice or Pole � 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement .
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Untlrgrnd. 55. Electrical Bonding
5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd��' 57. APPROVAL TO COVER�GUNITE
7. Footings • 58. Electrical Conduit�Undrgrnd. '
6. Foun'dation 59. Gas Pipe, O Undrgrnd., Test � �
9. Wate� Pipe-Undrgrnd:� 60. Backwash Lines, P-Trap, O Undrgrnd. '
10. Structural Floor System 67. APPROVAL TO DECK
1 t. Property Sewer Line & Flouse 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 l�,I/t 67. Fencing & Access Approval .
17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling �„�� . POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace � . APPROVALS Permit # ''
21. Duc[s, in Structure 70. Underground Hydro �
22. Ducts, Ventilating 77. Product Piping �Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing � 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74, Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe .
28. Lathing 8i 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 jd�j'4 Notes:
i';
34. Final Heating & Air Condi[ioning
35. Final Gas Pipe-Test '" �
36. Hood or Canopy ,
37. Final Factory Fireplace . .
38. Final Plumbing ' ' ,
39. Water Service-Final �
40. Gas Service-Final �
�41. Solar pomestic-Final �
� 42. Backflow Preventer � � �
� 43. Backflow irrigation �
'44. Landscape Irrigation System 9 ,
� 45: Sound Attenuation -
�46. Handicap Regulations �
47. FINALSTRUCTURE&BUILDING '
48. Special Requirements Completed .
49. Electric Release to Edison '
50. Gas Release to Southem California Gas Co �i *
51. CERTIFICATE OF OCCUPANCY : • �
No. Date �. � � j��•
- _ � .. . . - �� .
CITY•OF COSTA MESA
�• COI(ISTFiUC��QXP�
Address �
ArchlEng.�
Address
Contractor
Address
I h0reby afflrm that I dm Ilci
mencin9 with� SactlOn ]00(
Profezsions Cotle, anr�tl� my
License Class
_ . I.L).GC1. .._. .
Apo���ant to fill in a11 spates wlthin heavy bortler Iines ana slgn atl aoGroD��ate aeclar
TRACT/N,O.,. LOT N�L BIDG:
�N T �f � _ . . i_ I � . . , I . `!� 7 Vi � �i �_
r ����
�i Iy L '
,� •licenu No. -- �
- Phone g 3
.ARATION_ '
untler provlsions of Charter 9(com-
Divislon 3 of tha Busineis antl
ise I5 In full torce a effect.
�Lic6i5�1No
/ )
WORKERS' COMVENSA�N D2CLARATION .� .
''^reby affirm that I ave a ceitlticate ot consent to self-in or.a
flrzle Ot WorkErS' Compensation InSUrance, or a�cer[Ifiatl copy
.of (Sectlon 3800, Lab. CJ.
7oiicy No. � � ' Campany - '
Certifietl topy is hereby furnishetl.
Certitietl copy IS flletl with the city BUiltling DiviSiOn.
MPTION FROM WORKERS' COMPENSATION DECLARATION
(This secHon neetl not be tompleletl if [he permi[ is (or one huntlretl
(E300) or less). �
1 tertify.that in tha performance of the work for which this permit is
issuetl, I shall not amploy any person in any manner-so as to become
.SUEje<t to tha Workers' Compensation I�ws ot Calitornla. ..__. ,
Date Si9nature
TVPE OF CONSTRUCTION �
❑ NEW,_ ❑ ADO �ALTERATION ���
❑ REPAIR ❑ C6NVERSION ❑DEMOLISH
❑ OTHER
DESCRIPTION OF WORK �
TVPE OF PERMIT , -
❑ GRADING ❑ FOUNOATION �STRVCTURAC
❑ TEfJANT ❑ ELECTRICAL ❑PLUMBING ❑MECHAI
O OTHER
PROJECT DESCRIPTION , ' . . _
,SQ. FT: �' ' �
OCCUPANCY ONSTRUCTION TVPE
VALUATION ZONE
GRADING CU. V.OS. ACRES
PLUMBING'� -"' 4- p�qrv CHECK �
BATHTUBS� � - SHOWERS
NOTICE: If after�making this tleclaration, you snowa become subjett - TOILETS ,-� - URINALS " "
to the Workers' Compensation provisions ot the Labor Cotle, you must LAVATORIES DOUBLE LAVS'
f0/thwitn comply witn suc� p�ovl51on5 or [his pe�mit Shall b0 tleem0tl
revoketl.. � - - -- - - - - KIT.SINKS" - 'DISHW!>SHERS
CONSTRUCTION LENDING AGENCV
I hereby af(Irm [hat there IS a<Onztructlon lentling agency for th¢ p¢r- SERVICE SINK$ SUMP$ .
formance of tne work for which this permit is issuetl (Sectlon 3097
Civ. C.). - ' - ' ' "- ' ' '� -' ' "" " FLOOR SINKS � ��FLOOR DRAINS '
Lentler's Name
Lentler's AtlOress DRINKING FOUNTAINS ' � - '
OWNER BUILDER DECLARATION ' " - - -- ' ' INTERCEPTORS � `� CLARIFIERS � �
I Oereby aHirm, Ihat I am exempt (rom the Contractor's License Law tor
the followin9 r2ason (Section 7W3:5-6usinezs antl �Professlons Cotle: -SWIMMING POOL- P TRAP -'
Any city or county which requires a permit to construct, alter,
�improve, tlemolisn or repair any structure, prior�fo its issuance, also re- ' yyqTER SERVICE ' ALTERATION"' '
quir¢5 Ihe apFlicant fo� such permif to tile a signetl statam¢nt that he
`- Ilcensetl pursuan[ to the provislons of-the Contractor4 License Law GAS SERV ICE � OUTLETS
a0ter 9(commencin9 wit� Section ]000) of Division 3 of the
.iness antl Prdessions Cotle) or that he is exempt therefrom antl the �- yyqTER HEATERS' '- BTU OUTPUT' "
sis for tne allegetl ezemption. Any violation of Section 7031.5 by
-any aOPliwnt �fora permit zubjetts the apP���nt to a-civil-penalty - SEWER CONNECTIONS '' ''
o( nol more than live hunUretl Aollars (5500).
❑� I, as owner o( lhe property, or my employees wi[h wages as their SOLAR TANK "- ""� COLLECTORS
5012 CompenSatiOn„wlll tlo lhe work, antl the st�ucture i5 not Int¢ntletl
�or offeretl for sale. (Section ]044, Business antl Professions Cotle: The' SOLAR PIPING SVS. � � �
.Contfac[Of'S licen5e Ldw tl0¢5 nOt apply to an owner of a property .__ _ _
wh0 builtls or improves tM1ereon, antl wh0 tloes such wo�k hims¢If Or �SSUE FEE �� �
thrOugh hI5 Own ¢mployee5„prOvitl¢tl [hat such improvements are no[ -
intentletl or otfered for zale. It, howeveq the builtlin9 or improvement MECHANICAL PLAN CHECK
is soltl within one year ot completion, the owner will have the burtlen �•
of proving he tlitl not builtl or improve for Ihe purpose of sale). HEATING SVSTEM 0-300,000 BTV
� � I, as owner- ol [M1e property, am ezclusively- con[raccing with -�qND'DUCTING '"""'� �' "' ''
licensea contractors to consiruct the project (Section ]044, Business 100,000+BTU
antl Profe55ions Cotle: The Conlracto�'S License Law tloes not appry to
an owner of property who builds or improves thereon, ana who con- REFRIGERATION 0-300,000 BTU
tracts from� such-projects with a� contractor(s)-licesnetl pursuant to SYSTEM - �- - -- - - •-
the Contractor's Llcense Law). 100,000 r BTU
'�'I ain exempl untl¢r Sectlon - ' B. &"P. C. for this ' BOIlERS BTV ��
�reason - -- - - ' -
Date Owner SVSTEMFEPAIR,ALTERATION
I h¢rtby certi(y thdt I have reatl thiz appliwtion antl State lhat the abov¢ EXHAVST $VSTEM MULTIPLE
enen:marinn w mrrecL I aaree to mmolv with`all titv antl'counlv
rry ori >u � v��v _ j� . r .�.� Q
.ure� oate '� �
t- � �- ISSUEFEE - ----
's' Licer�e or 55 #
0865-46 White-Builtlin9; Canary-Applicant; Pink-Accounting; Goltlenrotl-Azsessor
� �. '�i �, . � ` �
i�. � ' � ' F � ,
2 2 198P �' ,;-. ,
�,(1r1, ULATIONS ' �
Cl� _ '
� PLNTGQ. RgUEF�. p�
L T. 7ROPE�RTY LINEIi.
REHR VARO (TO P/L)
PKG. SPACE RE�.
STREET WIDTH � �
SPECIAL GONDITIONS:
6VIDED
RK FEE $
" I ' I ELECTRICAL �- aLAN Cr�ECK
GENERATOR 0-1 KW_1-10 KW _
TRANSFORMER
APPLIANCE 30-SOKW_SO+KW_
'-MOTORS - p-1 HP_1d0 HP _
-(INC.SOLAR) -;O-SO�HP�y50+HP_
"FIXTURES -' OVTLETS SWITCHES
'GAS TUBE'SIGNS ' ' -
POL'E LIGHTS " ' '
PANELS " MAIN'.� SUB' '
SERVICE- ' 'AMP
ISSUE'FEE ' ' '-" '
-' APPUCATIONAPPROVED'BV (�/L -pqTE�
SUMMARYOFFEES � . r�
BUI�DING q �'l�
PERMIT E � SMIP ,.�Sye`+!
PLAN CHECK S -PERMIT -
� ISSUANCE $
PLUMBING E � GRADING � 5 �
' PLANCHECK'$" , - �.��� ;C
� ELECTRICAL 5 - �S
� ' ' MICROFILM 5���
' 'PLAN'CHECK` $ - ,
MECHANICHL S TOTAL�_FEE�$ �
PLAN CHECK E-- LE55 AD- __
VANCE PC $ _'
��` "C�j��'•.'.f�"C ' FINALFEE.E /�V •�e
CONSTRUCTION•AND PLANNIN�G j' /� � ' � POOL & SPA . ' � : . ,� , ; ,' � �• "
APPROVALS . Permit # �L+ YJ` � Date Inspector qppROVALS . � P,ermit # ' � + � � � ' fl�e • •'�- �� I�nspector
�
1. Temporary Electrioal Service or Pole• :. ' � 43. Pool & Equipment Location ' - • - � • • �- � -
Soil ipe-Undrgrn �' �- � ... 44. Steel Reinforcement '- ' - - ' � � - �
.3. Electrical Conduit Utility-Undrgrn%jl•� : , :•��•�. 45.' Forms �- � •� � ' --•- - `-=' �- - �
4. Electrical Conduit-Undrgm . ' �-' 46. Electrical�Bondin ' �
. tee ein orce 47. Rough Plumbin & Pressure Test � - - '
6.. Electrical UFER Grn - � 48. APPROVALTO COVER-GUNI-TE'� ' -' '- ��-- - - � ' -
7. Footings _ 49. Electrical Conduit•Undr rn � -
_ 8. Foundation .. - 50. Gas Pipe, ❑ Undr m, Test � �
9. Water Pipe-Undrgm � ' � 51 . Backwash Lines .P•Tra '�"❑ ndi rn�' ' ' ' '
10. Structural Floor System 52: AP.PROVAL TO DECK �-' -- '--
11. Property Sewer Line & House�Connection 53: Backwash�& Rece-'torvFinal � � -' • '
_. 72. Street Sewer Connection ' -- 54. Heater & Vent-Final �
. 13. Rough Plumbing _ �
14. Rough Electric-Conduit - - - _ �56: Electrical-Final � �
15. Rough Electric-Wiring �- - - ' - � • � 57. Solar System-Final � - '
16. Rough Heating & Air Conditioning ' -- - -� • encing & Access Approval -
b7. Ducts in Structure.. - ' APPROVED FOR PLASTERING '� '- �
18. Ducts, Ventilating - � � � _ . '._ � _ . . . _ _ , . '"
19. GarPipe-Rough&Test � � � 60. POOL/SPASYSTEMSFINAL ' � � �
- 20.- �Roof Framing - - - ' - � � - - " - '
21. Roof Sheathin � - � - - �- _ - - - " - . . �
22.- Fremeand�Flashin - NOTES:' , , . . . . �
23. Insulation - " � ' - ' � - �
24. Lathing & Siding - ' ' ' ' -- � � - - - - - • � .
25. Orywall Nailing - ' ' � � ' -
- 26. Plaster Brown Coat ' � � - � � �
27. Electrical Power MeterFinal- - - - ' � - - � -
28. Final Electric - - - � - �
29. Final Heating & Air Conditioning � " � � • ' � � .
30. Final Gas Pipe-Test �� - �
-. 31. Final Plumbing - �
, 32. �Water Service-Final � - - � ' ' ' -
`33.: Gas Service-Finab - � - � � � ' '
34. Solar pomesticFinal ' �� � '
35.• Landsca eS rinkiin S stem. �� • � - - �
36. Sound Attenuation ' ' - • " ' �
37. Handicap Regulations - ' - - ' �
38. FINAL STRUCTURE & BUILDING � ' 3� • $ � - � �
39. Special Requirements Completed � � � � - " -' ' ' -
40. Electric Release, to Edison ' •' � � �
41. Gas Release to Southem Califomia Gas Co. ' - � �
42. CERTIFICATE OF OCCUPANCY �./ //y � �
� ' ' No. ��3� Date '� "``' � .
'
I z
• Y(�"' �/f!'/CI 9Bo52 7L
COSTA �AEBA BUIeDING—SAFETY DEPARTMENT ; , -
� � P.O. BOX IY00 , ..
�� Costa Mesa,� CaHtomia .� l �� �a b�
, � ' � � ' � � ' I TRACT NO. PERMIT NO.
REC'D BY G 3�
� EIECTRICiAN� /� lOT NO � DATE ISSUED
AODRESS �BUILDING USE•;
an m. rw,S _ G . . ��/�f -�l
..
STATE LICENSE NO CUSS —
aunoiNc — Jr r
CITY LICENSE NO. �ODRER
NO. lilM �ACN ��O COSTA MESA, GIIfORNIA
Dwallinq, Sq. h. = NEARES7
[noss si.
Garoqe, Sq. Fr. OWNER
Qr /
First 10 Outlatt, sach �� A�DOREA l {� � �i�4CH
QOuilat�, Additionol � � an �� TE�. No. 333
� � Firsf 40 FizNns, aach �� OO � HEY OY (�CIU OWlEOGE TIUT 1 MAVE READ TMR MRI•
UTION AljC�S��CTE THAT TME ABOVE IS CORRER AND AGREE
J �3 FixNras, Addiliwwl �!� 7 �p7AilYyWITH Atl C11Y ORDINANCES AND STATE UN5 REC�
TI EIECTNIGI WI0.1NG.
� �
Wa prye CE0.TIFY TXAT I VOSSESS TXE ABOVE VAIID STATE OF
O GLIfOQNIA ttA531FIGilON OR I AM TNE LEGAL OWNER OF
� Fan � ME SINGLE FAMIIY RESIDENTIAL PROPERTY DESCRIEED AlOVE.
a
Z Wa- s+a�ow.. ot
W ►E¢MIREE
� Oven, Domeafic - � NO. IT�M �ACM !!ff
F Pole, Consrruction�q Sipn 6 1 Tron�. 2.00
� Ronga, Dop�efi�` 7ronatortnan K�N
1 ,�(
M'K @. D
K �
�
7 � Gan�rolort KW
o , ' m, d - _-�? t
� "
— Morora �Sae Schedula�
!n �, � -
= HP �
F �s u -
HP � Sub-Total Fee�
HP APPROVALS
IMf►lROt DATE
Mefen, w. TEMP. PpIE �
UNDERGRWND CONDUIT I G I9� �
VermO Fee 3 pp
� �� I G I 1�
Su6-Total Fwa � fIXTURES � �
oOWER I I
Tolol fOGs UTIIIiV CO. NOTIFIED �
�/�` FINAL
`- ` CMF0313-46,rav.7/75 sLDG. PERMIT NO.
For items not listed refer to Fee Schedule
�
�y�� ��� � �G ib�/-�> , . . .
„�/,�r� a.��L�� iQ� �-es-�v
�� � .. �,�,������ �� ..
����
�������- ���y ��/ �
�'XG z���s� -. / - ' -
0
c
� p.00licant to fill in all spaees wlthin heavy Eoraer Iines ana sign a11 aoProv��ata Ceclantions.
CITY OF COSTA MESA PERMIT NO. TRACT NO. 'LOT NO. �B�DG. NO.
CONSTF�UCtiION P�RMIT � o2S�o� 3
Address �p0 CRGJYEyL/iN�Ef NPTC
Arch/Eng. pA.0 / Q KL�Q �-.£S License No.
Address �� 4� y/� f}�QAo,e7tooP �`OS�
Contrector ,�d ti,Iq Sn.✓ �/ .. � A lltGR_ Phane
LICENSED COIVTRHCTOR DECLARATION
I hereby aff{rm that 1 am IlcenSeC untler proviilons of Charter 9(com-
mencing with sectlon ]000) of Division 3 of the Businesi antl
Rotesslons Cotle, antl my license Is In full forca antl ef(ett.
License yC—lass'p � — � � License No '�
Date� 51g t �
WORKERS' COMPENSATION DECL ATION �
I hereby aftirm tha[ I have a certifi ate of consent to SelLlnsure or a
'flfate of Workers" Compen5ation Insurance, or a tertlfletl copy
_.�CY NO. NRIYUV/v ComPany
❑ CertifieA copy is hereby turnishetl. --
Certifietl copy is filea witb the dty Builtling Divislon.
%EMPTION FROM WORKERS• COMVENSATION DECLARATION
�This sectlon neetl not ba completetl It t�e permit I5 for one huntlreU
E100� or less).
I cert ry thatin the pertOtmance ot.th0 wOrk.fOr w�ICh tnis permil i5
issuetl, I shall not employ any person in any manner so as to become
subjett to the Workers' Compensatlon Lnws of California.
Date Sl9nature
NOTICE: If atter making [his tleclaration, you shoultl become 5ub�ec[
to th0 Wo�ke�5' Cor�penSatlon p�ovlSiOns Of the Labo� Cod¢, y0u must
forthwith tomply with suth provisions'or thiz permit shall be tleemetl
revOk¢tl. � . •
CONSTRUCTION LENDING AGENCV
I nereby a(tirm that there is a construttion lentllnq a9ency for the perv
(ormantt ot the work for wbich this permit is Issuetl (Saction 309I
�Civ. C.1. � . . .
LentlGr's Nama
p_ Lentler's Atltlress
"�O pWNER BUILDER DECLARATION
I hereby affirm tnat I am exempt from the Contractor's Llcensa Law for
� [he followiog reason (Section 7031.5 Business antl Protessions Cotle:
� Any city or county which require5 a permil to conStruGt, alteq
^ ImprOv¢, tlemolizh of tepdir dny structufe, priOr to Its issuance, a150 r¢-
�� auires the aooli�unt tor zuch Oetmil to file a slgnetl statert�¢nt [hat he
Oess 3ntl Profe55ion5 Cotl¢) or that M1e IS exCmpt Ihelelrom alttl [h2
,i ror the alleg¢tl exemptlon. Any violation ot Section ]031.5 by
any applicant for a permit zubjects tbe applitant to a civil penalty
ot not mOr¢ than five huntlretl tlollar5 (5500).
❑ I, as owner of the property, or my employces with wages as their
sole compensation, will tlo the work, antl the SVucture is not intenaetl
or offeretl (or sale. (Sectlon 7040, Buslness antl Rotessions Cotle: The
COntractor'S Lit¢nse Law tlo¢s noi appty t0 an owner ot a prop¢rty
who builtl5 or improve5 thereon, antl who tloes Such work himselt o�
th�ougb his own employees, provitl¢tl �that Such ImprOv¢ments a�e not
intentletl or offeretl for sale. If, however, the builtling or Improvement
Is soltl wlthin one year oi complotlon, the owner wlll have the.buraen
ot provin9 he ditl no[ Duiltl or improve for the purpose of zale�.
❑ I', as owner of the property, am exclusively contracting with
iicensetl conVactors to consVuct the o�oieti (Sectlon 7044, BuSiness
and Professions Cotl¢: The Contrdt[or's LICBnS¢ law DoeS not apply ro
an owne� of proper[y who builtls o� ImprOves the�eon, antl wh0 con-
Iracts from SUGh p�ojeGtS with a cont�acto�(s) IlceSn¢tl pursuant to
the Contrattor's License Law).
� I am exempt under Section B. & P. C. for this
reason
Date Owner
that 1 hav0 reatl Ihis appliwtion antl Slat¢ that the abov¢
wrrecL I agree to comply wi[h all city antl county
state laws relatin9 �o construction, antl nereby authoriza
,of this city to enter upon the above mentioned
�TYPE OF CONSTRUCTION
�NEW ❑ ADD ❑ ALTERATION
❑ REPAIR ❑ CONVERSION ❑DEMOLISH
❑ OTHER
DESCRIPTION OF WORK
TVPE OF PERMIT
❑ GRADING ❑ FOVNDATION ❑ STRUCTURAL
❑ TENANT �ELECTRICAL OPLUMBING ❑MECHFV
❑ OTHER
PROJECT DESCRIPTION
SQ..FT.
OCGUPANCY_GONSTRVCTIONTVPE
VALUATION ZONE
GRADING CU. VDS. ACRES
REMARKS: IS �,
PLUMBING
BATHTUBS
TOILETS
LAVATORIES
KIT. SINKS
SERVICE SINKS
FLOOR SINKS �
DRINKING FOVNTAINS
INTERCE7TOR5
SWIMMING POOL
WATER SERVICE
GAS SERV ICE
PLAN CHECK
SHOWERS
VRINALS
OOUBI.E L:AVS
DISHWASHERS
SVMPS
FLOOR DRAINS
CLARIFIERS
P TRAP
ALTERATION
OUTLETS
BTU OUTPVT
SEWERCONNECTIONS
SOLAR TANK - COLLECTORS
SOLAR PIPING SVS.
ISSUE FEE
MECHANICAL PLAN CHECK
HEATING SYSTEM 0-300,000 BTU_
ANDDVCTING 100,000+BTU_
REFRIGERATION 0-300,000 BTU_
SYSTEM 100,000 + BTU _
BOILERS ' BTV
SVSTEM REPAIR,ALTERATION
EXHAUSTSVSTEM MULTIPLE
$Ignature Da[e � � -
Drivers' L" se or 55 � ISSV E FEE
��
`�CMF OB65-46 W te ' tlirty; Ca ry ueli¢a`t; P' k= c n in G e tl- sess
� V
G
; 1 - � , ' e
. � C".. ._.,
A.7. iF
ZONE
�
a I 462 - I/29/82 B.OD -Tl,,
ONING REGULATIONS �
PLNG. REF. $
REAR VARD (TO P/L)
PKG. SPACE REQ.
STREET WIDTH
ZONING APPRpVED BY
SPECIAL CONDITIONS:
�ELECTRICAL
PROVIDED
PARK FEE
PLAN CHECK
GENERATOR 0-1 KW_1-10 KW _
TRANSFORMER
APPLIANCE 30-50 KW_50 t KW _
MOTORS 0-1 HP_1-30 HP _
(INC.SOLAR) ]0-SOHP SO+HP_
FIXTURES' OUTLETS SWITCHES
GAS TVBE SiGNS
POLE IIGHTS '
PANELS MAIN SUB
SERVICE �inp AMP
ISSUE FEE � '
APPLICATION APPROV ED BY'
DATE
SUMMARV OF FEES
BUILDING
PERMIT $ $MIP $ _
PLANCHECK $ PERMIT _ '
ISSVANCE S
PLUMBING 5 "GRADING S
PLAN CHECK $
ELECTRICAL $� $
PLAN CHECK $ MICROFILM § '
MECHANICAL $ TOTAL FEE $
PLANCHECK S " VANCEPC $_ '
FINALFEE $�
CONSTRUCTION AND PLANNING � POOL & SPA ' • - � • ,
APPROVALS Permit #� Date Inspector qppROVALS - Permit #�' Date ' tnspector ��
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location �
2. Soil ipe-Undrgrn 44. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrn 45. Forms
4. Electrical Conduit-Undrgrn 46. Electrical Bonding
. tee ein orce 47. Rou h Plumbin & Pressure Test
6. Electrical UFER Grn - 48. APPROVALTO COVER-GUNITE
7. Footings 49. Electrical Conduit-Undr rn
8. Foundation ' 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgrn 57. Backwash Lines P-Tra ❑ ndr rn
10. Structural Floor SYstem 52. APPROVAL TO DECK '
11. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final
12. Street Sewer Connection 54. Heater & Vent-Final
13. Rough Plumbing � '
14. Rough Electric-Conduit �56. Electrical-Final
15. Rou h Electric-Wring �� 57. Sol& System-Final
16. Rough Heating & Air Conditioning � encing & Access Approval
17. Ducts in Structure 5. APPROVED FOR PLASTERING
18. Ducts, Ventilating
19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing
21. Roof Sheathin �
22. Frame and Flashing NOTES:
23. Insulation � -Q'v �
24. Lathing & Siding
25. Drywall Nailing
26. Plaster Brown Coat '
27. Electrical Power Meter-Final z G �� � �
28. ' Final Electric
29. Final Heating & Air Conditioning
30. Final Gas Pipe-Test '
37. Final Plumbing
32. Water Service-Final
33. Gas Service-Final
34. Solar pomestic-Final
35. Landsca e S rinklin S stem
36. Sound Attenuation
37. Handicap Regulations �
38. FINALSTRUCTURE&BUILDING
39. Special Requirements Completed
40. Electric Release to Edison �
41. Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY
No Date -
�
Applicant to fi11 in al1 spaces witnin heavy eorCer lines ana si9n all aDo�oorlate deelaratlon
CITV OF.COSTA MESA' c IT NO. � TRqCT NO. LOT NO: BLDG. NO.
; • CONSTRUCTION PERMIT ��v7L� 8 s �
Addres
Address
� T���xwwVPE OF CONSTRUCTION
p PhOn2 g� NEW ❑ ADD ❑�ALTERATION
/�REPAIR ❑CONVERSION ❑DEMOLISH
LiCense No. ❑ OTHER
DESCRIPTION OF WORK
wnuncw��,)y�ihai �y . w�. rnon ��5- TYPE OF PERMIT �
Address .; � ay.uµ�N " -❑ GRADING' O 'FOUNDATION ❑'STRUCTURAL
LICENSED CONTRACTOR DECIARATIO - � ❑ TENANT O ELECTRICAL �PLUMBING ❑MECHANI
I hereby aftirm lh�t I am Ilcensetl unCar provisions of Chartar 9(com- , . .
'menting wltn sectlon ]000) of DIvi5lon 3 ot [he Business antl ��� OSHER� - -
Professions Cotle antl m Iicense is in full force anptl ef(ect. pROJECT DESCRIPTION
ucenseClass �"" 3 u ense.No.��7 =��% . � �'
Dale % "a �� � �k/� stgnaeure� � �r SQ. FT.
WORKERS' COMPENSATION DECLARFTION • - OCCUPANCV_CONSTRUCTION TVPE.
P„�ereby attirm that I have a certificate ot consent [o sel4insure or a VALVATION ' �� ZONE
>;�.ifitate of Workers' Compensation InSura�re, or a certl(iatl-copy - - , - - -
ti�'/eo/ (Sec lon 3 00 Lab. CJ. � � A F� GRADING CU. VDS. ACRES
-PolicY No. CbmPanyn�/��i�`��4Yjt
❑c/ Cartifietl copy is hereby fumishetl. . _ _ . . - REMYIRKS.' - - - - � i �'
iA Certifietl copy is filetl with the city Builtling Division.
EXEMPTION FROM WORKERS' COMPENSATION"DECIARATION '
_(This 5¢ction neeG not be compl¢tCtl if the pe�Tit is fo� One huntlretl _ - _
(g100) or less). ' -
I_certify that in 1he Performance_of the wOrk.for which this permit� is _ _,_
issuetl, 1 snall not employ any person In any manner so as to berome PCUMBING� �� . � �� - PCAN CHECK
.Subject to th¢ Wo�ke�s' Compensdtion 12w5 ot Calito�nia. _ � ,.� ' _ _ .. ' . . _
Date Signature B.4THTUBS SHOWERS
NOTICE: If after making [nls tleclaraHon, you shoultl become subjet[ ' TOILETS �i) i URINALS -- - -
to the Workers' Compensation provisions of the Labor Cotle, you must _ __ _
fortM1wltn comply�with such provisions or this permit shall be tleemetl �AVATORIES � DOVBCE'L'AVS
revoketl.. . ' ' " __ < '- ' ' - ' ' '"_ ' ' ' _ _
CONSTRUCTION LENDING AGENCV � KIT.SINKS - DISFIWASHERS -
I hereby al�irm tha[ Ihere is a constructlon lending agenGy tor fhe per- SERVICE SINKS'� � � J�� SVMP$
formance of [he work for which this permit is issuetl (Sectlon 3097
�C��� ��1� � - �" � � FLOOR SINVCS FLOOR DRAINS ' �
Lentler's Name
Lentler'sAtldress � DRINKING�FOVNTAINS � ---"'-^' -
OWNERBUILOEROECLARATION ' '-" - ' -INTERCEGTORS CLARIFIERS M
I hereby affirm [hat I am exempt t�om the ContraCtoYS Lit¢nze Law to� �
[he following reason (Sectlon 7031.5 Business antl ProfeSsions COCe: ' SWIMMING POOC- - PiTRAP - ' '
Any city Or County which reqWreS a permi[ to construc[, alter,
Improve; tlemollzh or repalr'any structure; prlor to It595suance, also re- -yyqTERvSERVICE -� � ALTERA710N�-
qulres the ap4���nt lor sucb permit to tilC d signetl statement that he
❑censetl pursuant to tne provi5ions of'tne Contractor'stiltense Law' GAS SERV ICE � OUTLETS
�a0tar 9(commencing wi[h Section 7000) o( DiviSion 3 0� the
;iness antl Prdessions Cotle)'or"tnat'he 15 exempTtheratrom antl the- yyqTER HEATERS "" BTU OUTPUT� ��--
I �asis for tne allegetl exemptlon. Any violation o( Sectlon 7031.5 by
or
or
antl
� �a civll penalty
h wa9e5 a5 their
: is not Intentletl
�sion5 Cotle: The
�r oi a prOperty
wOrk Itimself or
vements are not
ioltl wlthin.one year ol com0lelion, tne owner ww nave me ouraen
O�ovinq M1e Oitl not builtl or improve for the pu�pose of sal¢).
-1, as� owne� of lhe properly, am excluziv¢ly conVactin9 �with
ensetl contractors to construct tlte project ($ectlon ]044, Business
tl� Prof¢s5ion5 Cotle: The Cont�actor'S License Law tl0¢s not apply to
owner of property who builtls or improves thereon, antl who con�
ctS trom-such-Orojecis� with�a contrattor(s)-Iicasnetl� pursuant t0
: COOIIdCIOf�S LIC2f152 LdWJ.
'I'arti exempl untler'Se2tlon - -� B. &'P: Cfor thiz
_Owner
thal I.hav¢ reatl this application antl 5[ate that [h¢ above
mrtecL -1 agree fo wmply wi[h alf City dnd tounty
state laws relatin9 to construction, anC nereby_authorize
of� thii clty to enter upon the above mentionetl
�sp tion, purpos¢5. [ _ _ J. f,
� Date�^���X �s�
SEWER CONNECTIONS -/-
SOLARTANK � '(
SOLAR PIPING SVS.
� �SSUE FEE ' � �
MECHANICAL �
HEATING SVSTEM 0-100
AND DUCTING � 100,0
REFRIGERATION . 0-100
SYSTEM' ' - 100,0
BOILERS E
SVSTEM REPAIR,ALTER.
EXHAUSTSVSTEM � f
Driv¢rs' Litense or 55 � � '� � ' ' -'�SSUE�FEB " - —
CMF 0865-46 Wnit¢-Builtling; Candry-Applicant; Pink-Atcounting; Goltlenrotl-HSSesso�
.LECTORS, " -
_.. .- - — �: G
�N CHECK
0 BTU _
+ BTV
0 BTU
+ BTU
1
ION
LTI Pl E
�
A.P. �
ZONE
0165 I/04/82 •��
ZONING REGULATIONS �
REAR VARO (TO
PKG.SPACE REq.
8.00 , TL
PLNTGp. gRUEF�. p� -. � �-
PROPE�RTV LINE''
i . ..
PROVIOED ��
, PARK FEE E. � �
20NINGAPPROVEDBV , I .OATE
SPECIHLCON�ITIONS: ' � �.
. . _ . ' _ . �� ::
ELECTRICAL - �' 'P�arv cHECK �
GENERATOR -�0-1 KW_ 1-30 KW _
TRANSFORMER
APPI_IANGE 10�50KW_SO+KW_
'MOTORS' - 0-1 HP_1-10 NP _
-pNG SOLAR) - � 10-50 HP_50 � HP _
'FIXTVRES - � OUTLETS - SWITCHES
-GASTUBESIGNS- -" ' - ' -
POCE LIGHT$ "` ' ' ' ' - '
A
POLES VV V METERED SUB
PANECS- - MAIN-- "- SUB . ,-'� '
'SERVICE' � ' " ' AMP ' '-
_. . _ _ ' .1 . .. ' "
' '_' " "' � " ' _ ' _ ,:' '
APPLICHTION APPROVED BY - �'-- DATE' ' 1
� SUMMARV,OF FEES � � ,
BWICOING ' " ' ' -' '-
VERMIT S ��SMIP.' . S
PLAN CHECK S ' PERMIT:-. � � ,1'� � �
>- ---ISSUANCE $ - -
PLVMBING E � _GRADING �f �� �
PI.ANCHECK S' , ,.. . . •�.$"y
ELECTRICAL E , � � � �
PLAN CHECK $ - - -' MICROFILM E '
-MECHANICAL E - ' - - �' TOTAL FEE,$ "- ' � �
'PLAN CHECK" b -- - �1- LE55 A�- _ _ � �� _ .�
YANCE PC S _ � '
. �i� " . i': 'r ..� �Q �
_ ' _ ' " " FINAL FEE § "�' J I
CONSTRUCTION AND PLANNI� � 08 . _'_ POOL & SPA . � „ ., • �
Date Inspecto'r �� Date Inspector
APPROVALS Permit # � APPROVALS : .iPermit # -
1. Temporary Electrical Service or Pole 43. Pool & Equipment Lowtion - � �-- - �� •
. Soil ipe-Undrgrn 44. Stee� Reinforcement
3. Electrical Conduit Utility-Undrgrn 45. Forms
4. Electrical Conduit-Undrgrn 46. Electrical Bonding --
tee ein orce 47. Rou h Plumbin & Pressure Test `' �� �
6. Electrical UFER Gm ti 48. APPROVALTO COVER•GUNITE - "�- �� � - ��
7. ootings 49. Electrical Conduit-Undr rn
6. Foundation 50. Gas Pi e, ❑ Undr rn, Test
9. Water Pipe-Undrgm 51. Backwash Lines P-T1a ' E�' dr m •'� ��
10. Structural Floor System 52. APPROVALTO DECK - "' " ' ' - -�
1 t. Property Sewer �ine & House Connection 53. Backwash & Rece tor-Final
12. Street Sewer Connection 54. Heater & Vent-Final
13. Rough Plumbing � ' � � - � •' • - - - -
14. Rough Electrio-Conduit --- �56. Electrical-Final �'
15. Rou h Electric-Wiring -• - 57. Solar System-Finai
i 6. Rough Heating & Air Conditioning • encing & Access Approval
17. Ducts in Structure APPROVED FOR PLASTERING
16. Ducts, Ventilating
19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing � �� 5 � �
21. Roof Sheathin
22. Frameand Flashin NOTES:
23. Insulation
24. Lathing & Siding . . .
. 25. Drywall Nailing .
26. Plaster Brown Coat
27. Electrical Power Meter-Final ' � '
26. Final Electric
29. Final Heating & Air Conditioning
30. Final Gas Pipe-Test • � _ � .
31. Final Plumbing �¢
32. Water Service-Final ' -
33. Gas Service-Finat � '
34. Solar pomestic-Final
35. Landsca e S rinklin S stem
36. Sound Attenuation
37. Handicap Regulations - Y. , -
38. FINALSTRUCTURE&BUILDING - _
39. Special Requirements Completed
40. Electric Release to Edison �
41. Gas Release to Southern California Gas Co. '
42. CERTIFICATEOFOCCUPANCY .
No Date , . _ ,
w ApPlicant to fill in ali spaces wit�in �eavy bortler linas an0 sign all appropriata Ceclarations.
"-GTVQOF COSIA M,ESA PERMIT NO. TRACT NO. LOT NO. BLDG o. I I 49 %�O6IBL7
� CONSTRUCTION PERMIT E y/`�S ...-- 28.24 TL
..
Project Address 3 � � � ! (,.Lj j�p./f �/ r1 '% 7ypE OF CONSTRUCTION • + , -
' Own2! ' Phone ❑ NEW ❑ A�D ❑ ALTERATION
' Addrea � � ' ❑ REPAIR ❑ CONVERSION ❑DEMOLISH '
ArchlEng: - ' License No. ❑ oTHER ZONING REGULATIONS ""
�-Address � w ' . DESCNIPTIONOFWORK. Q'P•`�
'"(�qntracto(J +\lr.i/�/(/f��(/ ��f[�PhOnP��y"37/ ' , _ ' ... ZONE PINTGp. REF. # . '-
"TVPE OF PERMIT - SErBACK ST. PROP��A'�VNLINE
�'Address ( - /f ' - "�f � /�Jj-[�y ../� /i//%��i�i!_ ❑�GRADIN �❑� FOUNDATION -� STRUCTURAL SIDE VARD � - - � -- - —. - -
'LICENSED CONTRALTOR DECLARATION'J � ' �' � � I.EFT . ': � ;
I hereEy aiflrm Ihtt I am IlcenSeA untler provlsions ol Charter 9(com- � TENANT.�ELEGTRICAL' ❑PLUMBING..�MECHANICA 5ipE yq .. .
' RIGHT
mencinq- wit�-5ection 7000�. ot-Dlvitlon..3 0/ the .Businoss.'ailtl _�OTHER ' '
Professlons Cotla� and my Ilcense is in tull force antl effecL , , REAR VARD (TO P/L) " - ' '-- •
1 �_ ._. /. . - �- PROJECT�DESCRIpTION _ . . '
Licente Clas; � �L�cons No. ' _ ' � ' PKG. SPACE REQ. - " PROVI�ED '- ' -'-
Date � i -' ! '� +r5T9natur . _ �.- %N.� �i�- �5�. Ff. � ' ', I _ ' - . . ... ' _ i
WORKERS:COMPENSAT�ON�ECLARATIOIV� . _ . . � � ' STREET WIDTH PARKFEE,-S. -
OCCUPANCV , � �NSTRUCTION TVGE
�reby affirm tnat I hava a terUflcate o/ tonsant to sal/-Inium or a VALUAT,ION ZONE ZONING APPROVED'BV - ' -DATE- �- -�
❑�'ate of Worken' �m0ensation Insuranta, or aserlillotl.copy� t -
.eof (SecU n 3800, �b. C.�. � , GRADir1G CV. Y,OS. ' ACRES � ,SPECIAL'CONDITIONS: - ' ' '
PoIICY NoA/ J14.;t:.t ComPanv C:oMh. -.////L!/,✓. ' - - . - - - - ' ' - - - . . , _
❑ Certified coPY is her¢by iurnishetl._ ' �� REMARKS: ' � -
�Certlfietl copY iz tile0 wlth tha clty Builtlin9 Dlvislon. ._ � ' - _ i � .t� p\\', , ` '�i '- - -" ' .. ^- '-'�
EXEMPTION'FROM WORKERS' COMiEN5AT10N DECLARqTION - - � � �
(This section neetl not be completeU H Ne permit 6(or one huntlreE . �•�- � - , .: �-„ �'? �
..`E300) ol leu): � - _ _ ' ' '_' " _' " ' " " _ _ ' � _ . " _ '
� C¢rLfy that in the pe�fOrmante ot lh¢ work for wblGh this p¢rmit IS
' IsSuaG,- I§hali nol emploY dny per5on (n any'mann¢r zo a5 to bCtOm¢ 'PCUMBING ., '' � PLAN'CHECK�-- ELECTRICAL -- - PLAN CHECK - - - -
Subj¢Ct to th¢ WorkGrs' Compensation Lawi ot GIItoTid. �� " ' � '
Da[e SlgnaWre ' � BATHTUBS ' -'SHOWERS' ' ' - � � - � - - - _
�NOTICE: H atter makiP9 this tleclaration, you shoultl becom¢�subjoct � TOILETS - , . ,. URINALS-• - �- - 'GENERATOR �- 0-1 KW=1d0 KW �
,to the Workers' Compensation provitlons ot iho Labor Cotlo, ybu must TRANSFORMER � . D 1
forthwlt� comply with such provlzlons or thiz p¢rmlt shall be tlecmetl LAVATORIES DOUBLE�LAVS - APPLIANCE- - 10-50 KW_SO+.KW -
r<vOklG._ , ' .
'CONSTRUCTION LENDING AGENCV � - KIT-. S�NKS - - DISHWASHERS - - - MOTORS -- - 0-1 HP_1-30 HP� - � - �
1 h¢reby aifirm that thG�o ls a conrt�uGtlon lentli�g a9eaty tor thc per- SERV ICE SINKS � SUMPS- -- -� .'(�HC.50lHR� _' �0�50 HP 50 t NP '
,fOrmancG O7 the wOrk iOr whicn Ih15 permit is ISSuetl ($ectlOn 3097 �' �' '
CIv:CJ. �- ^- - -• - - - ' - 'FLOOR'SINKS FLOOR'DRAINS' - ' �FIXTURES /`/' OUTLETS�'-SWITCF7E5�`�
Lentler's Name
� ' ' -"' - "' ` ` ' F �� ORINKIIVGFOUNTAlIVS ^ --' � � - - � - - �GASTVBESIGNS-
Lentler'S Atltlress ' ' - - -
OWNER BUILDER OEGLARATION- - - - -- - INTERCEPTORS"� - " CLARIFIERS " - POLE LIGHTS� - - - -- - - --- " - -
I �ereby aHirm that I an� exempt lrom tha Contracmr's LlGense Law ior - f � ' �
the-tollowingreason-(Se«lon-7031.5-Business.antl_ProteziionS.Cotle: -SWIMM�NGPOOL- -�-�PTRAP- - - '
Any city or county which rGquir85 a permit to construct, alter, ' POLE$ '"' "'METERED "'SUB --""- -- -- �
improve,-demolisb�or rePair any structure,prior to its issuance, also re• yyqTER SERVICE -'- ALTERATION- - <�--- � PANELS �- MAW - � �SUB - -
6����e5 tne apFli�ant fOr Su<h permit to fila a Si9�ed StalemCnt thdt ha � '_ --
'ensetl pursuant�to the provislons ot the Gontraclor's License law � GAS SERVICE "'" ' OUTLETS � SERVICE - � AMP _
�ter 9(commencin9 witn Sncllon �000) of DWislon 3 0/ the +• �� OC '- "Q� '
.ness anU� Adession5 Cotlo) or-tha( he Is exampt tnaretrom anC tna - yyqTER�HEATERS� BTU OUTPUT � =- "- �� L-: - . ._ .
ba515 for Ihe alle9etl exemption. Any violation oi SaCtlon 7031.5 by ' �
any applicant br a-permit sub�acts lbe applicant�to a civil ponalty� SEWER CONNECTIONS ,t-- � � ' . ' -
bi not more than (ive nunaretl aollars (5500�. '� ' - ' " a
❑ I; as owner ol tne property, or my emptoyeei wlth�wagas as thclr SOLAR TANK - COIIECTORS - -� - � - � . __ _ �_ _
sole mmpensaHon, wiil tlo ihe wa�k, antl lha zt�uCW�e IS not intentletl •�
'or offeretl tor ule. (Settion ]044, Busine55 antl ProfeSslons Cotla: Tho' SOLAR PIPING SVS. ' " -- - �ISSVE FEE -- - � � - - � - -� - OQ �
�Contrdttor'S Llc¢nz¢ LdH' tloM not apply to dn OwOer OI a property . � '
w�o builtls Of ITD�Ov¢4 lh¢/80�, dOC WIlO tlOCS SUGb WOfB'111�Y1581f O� ISSUE FEE ' ' " ' � - APFLICATION APPROVED BV _ .. ____. _ OATE __ _
tbrough nis own employees, provitlatl that sucb Improvements aru not - I
intentletl or offered tor sale. I(, howeveq the builCing or'Improvement MECHANICAL � PLAN CHECK � - - ' -� '� -
is solA within one year o� tomptetlon, t�e owner wip have the burtlen SUMMARV OF FEES' � ,, �
o(' proving-h¢ "tli0 no[ builtl or ImprOve' (Or'tne pUrpose of 'salej':' " HEATING SYSTEM 0-300,000 BTU ' ' BUILDING� - _.. _ ' _ ' _ _ , _ _ . _
.� I,-as owner_ot�the_property,.am exUusively con(racting_with qNDDUCTING ' ._ PERMIT y SMIP, _ y�� j
littnsetl cwVactors to construct the project (Sectlon 7044, Business � 100,000+BTU � �p�p,NCHECK S PERMIT.. �
antl Professlons Cotle: -1 he Conlracror's License Law tloe5 not apply to_ � _ ._ _ _ISSUANCE E . �
an owner of property Wh0 builtl5 or imp�oves fhereon, dntl who con- REFRIGERATION 0-100,000 BTU � � PLUMBING �§ � �
tratts�fram such projeG�s wi[h a COn[raCto�(s),Ilcesned pu�5uant to _$VSTEM . _ . _ "GRADING 5'
theContractor'SLicense��+). � ]00,000+BTU' " 'PLANSHECK S - ' . . ' ' "'-
❑ � am exempt untler Sectlon - -B. 6 P: C. for this � - - • - _ . .a " E �-
BOILERS BTU ' ELECTRICiiL 5� • - ' ' - -- - -
�eazon � `MICROFILM y' ��
SVSTEM REPAIR, ALTERATION - � PLAN CMECK S
�Date Owncr �� � TOTAL FEE E' � �
I herlbytertilythdt 1 ha+C reatl [nis application antl itet0lhat Ihp abovC EXHAUST $VSTEM MULTIPLE MECHANICAL E - - -
information'is corrett.'� �9ree to comply with all tI[y antl county ; PLHN CHECK 5 -'LE55 FD- � _ .
ortlinance5 antl State IawS �elatlng to conztrucpon, antl hCreby authoriza VANCE PC E_ - -
r¢p�¢sentatives'Of jpls CItY �o epl¢rvpon thG 9bove mentlonetl - � -� •�
propCfty foR ��SpyEtioq PuryoSe�/
SlgnaturG x�'�-• � ����� �"!� Dato7 ^ �� } � _ , F�NAL FEE
/ (/ �?/
� -.
CMF 0865-46 White-Builtling; Unary-Appliwnt; Pink-Accounting; GOltlenro0-Assessor
CONSTRUCTION ANDPLANNING �, POOL&SPA
APPROVqLS Permit# �4�y3 Date Inspector �qppROVALS Permit�
L Temporary Electrical Service or Pole 43. Pool & Equipment L-� "�"
Soi ipe-Un rgrn 44. Steel Reinforcement
� 3. Electrical Conduit Utiiity-Undrgrn 45. Forms
4. Electrical.Conduit-Undrgrn - 46. Electrical Bonding _
. tee ein orce � 47. Rough Piumbin & I
_ 6. Electricai UFER Grn __ 48. APPROVALTO CO
7. ootings � 49. Electrical Conduit-U
- 8. Foundation - � . _ 50,�.GasPine f-lllndrm
9. Water Pipe-Undrgrn
_ 10.. Structural Floor System '
11. Property Sewer Line & House Connection.
� 12. StreetSewecConnection _ �� � -
.. 13._. .Rough Plumbing
14. Rough ElectricConduit /
' 15. Rough Electric-Wiring
16. Rough Heating & Air Conditioning �
17. Ducts,-in Structure
18. � �Ducts, Ventilating
.19. Gas Pipe-Rough & Test
20. R4of Framing
21. Roof Sheathin
� . 22. . Frame and Flashin
- 23. Insulation
� 24. Lathing & Siding �
25. Drywall Nailing - �
�26. Plaster Brown Coat �
27. Electrical Power.Meter-Final
nal
0
37. Handicap Regulations -
38. FINALSTRUCTURE&BUILDING '
39. Special Requirements Coinpleted
40. Electric Release to Edison
41. Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY
. -�
� � Nd= � Date
Tes4
UNITE
� � � ov. � neaier a venrnnai
5. Plumbina Svstem - Final
' Z -' - C C. '56. Electrical-Final '
- - -' ' � 57. Solar SYstem-Final
� - - - - -. • encing.& Access Approval
. APPROVED FOR PLASTERII
- 60. POOL/SPA SYSTEMS FINAL
. NOTES:
� /
. ..
. y_r �\
�Date Inspector
,
�
Applicant lo flll In all,spacas within �aavy bortler Iines anG sign all appropriate Ceclarollons. �'j`f C � �ty�l„Qn �p 1�' ��
CITY OF c[? TA MESA P IT O / TRACT NO. LOT NO. BLOG. NO. �=)7 > �'KD a vQi _
CONSTRU�TION PERMIT �" 10 � S�_"C � . • ;
Project Address ��(„ �.p e.u.� � � �' TVPE OF CONSTRUCTION ��� � Sµ�. ,�,t„""�' : � � 89Ei2 . I 0/ I I/t7? ; 1� a ��.
SL
Owner C. . @GF.AS LdN h+� Phone 4(� (( ❑ NEW ❑ ADD ❑ ALTERATION -- S�L - E ' ' � ' -
Addr24 ,���5 �� ' QLL7 � S' S ❑ REPA�R O-CONVERSION �❑DEMOUSH � .
� OO7HER � ' ZONINGREGULATIONS
Arch/Eng: - iicense No. � - _ .
. DESCRIPTION OF WORK '4'P' �
AddIe55 - . � - '� - - 20NE � PLNG: REF. � � '
Contracmr (��,y�� �,� � Phone� ��-TVPE.OF PERMIT _ � � " Tpg�/��p �ry G ' - � � �
SET AC VROPERTV I.INE. �
AddfeSS � ❑�GHAOING ❑'FOVN�ATION ❑STRVCTURAL ' I YARD ' ' " ^ •
LICENSED CONTRACTOH DECLARATION� � ❑ TENANT ❑ ELECTRICAL OPLUMBING ❑MECHANIC ����HT �
I hareby aifirm that I am Iltensetl under provisloni ot Charter 9(com- , . -
menNng with settlon 7000) o( DIWsIOn 3 0( the Buiineis antl� ❑ OTHER . .
Professions Cotle, anU my Iltanze Is In full force anU e(fect. pROJECT DESCRIPTION � REAR vARD (TO P/L)
�Llcense Class � lJcense No. , � PKG.�SPACE REQ. � � ' � PROVIDED '
� Date Si9nature � - � ' SQ. �.' . , . .. - ' . " ' -
V6ppKERS'COMiEN5AT10N DECLARATION ' ' OCCVPANCV_CONSTRUCTION TVPE STFEET WIDTH 7ARK FEES ' _
-•by afTirm that I have a certlficate of consant la ult-Insura or�a VALUATION ZONE ' Z�N�NG APPROVED BV DATE
it'ate of Workers' CAmpanSdtion Insuranca, or a certlflatl capy � � � - � �� � . . , ,. .
t. soi (Section 3800, laD. C.). , GRADING CU. YDS. ACRES SPECIAL CONDITIONS: •_
PoIICY No. , .. CompanY .. . _ . . . . . - �
❑ CertifleU copy i5 hereDy furnishetl. - - - , ' REMARKS: ' . - . . . ,_ , . __ „ . ,
❑ Certlfl¢U copy is filetl wi[h the clly Builtlln9 Dlvlsion. , .. .. ,, .
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION - � ' ' � ��" "' " , �
(Thlz section')neetl not De completatl ii the permihis /or one hunared � . , , � ' .• .
IEcertify thatsin t�e.pertormance of the work�(or_whith thli permit Is � � ' �
issuetl, I shalt not emPloy any Oerson in any manner so as to bacome ��PLUMBING � � , � � PLAN CHECK ' ELECTRICAL ' PLAN CHECK'_'
subject to [he Workers Compensat�i Laws ot G_-l�i�fo�r�n}Ia.+��.: '. .. .
oated'���/�Y�2 519�ature���n%�'��S'�'^+�`� BATHTUBS SHOWERS � ' �' - �
NOTICE: It after making this tleclaration, you 5 u1G become.subjec[ ' TOILETS � ' . URINALS "' '' GENERATOR �� 0-1 KW_1'QO KW, "" ' - ' -'i
tu the Workers' Compensat(on provlslons of the Labor Cotle, you must TRANSFORMER . � �
forthwith comply with suth provisions or tnls permit shall be tleemetl �VATORIES DOUBLE LAVS ' APPLIANCE '•30-50 KW_SO+KW �
t
revoketl. ' � - -�• ' � - ' KIT.SWKS " DISHWASHERS ' "' ""' 'MOTORS • - -
CONSTRUCTION LENDING AGENCV " " '0-1 HP=1d0'MP
I hereby affirm that there is a construction Ientling agency for fhe per- SERV ICE SINKS � � SUM75 ' '�" (�NC. SOLAR) . 30-50 HP �_� 50 + HP�� ' �"�
Tormante of [he work for which this permit Is issuetl (Section 3097
Civ. C.): ' � " � ' FLOOR�SINKS� FLOOR'DRAINS �- � � �� FIXTURES 'OUTLETS "' SWITCHES� ' '
L¢ntle/'S Name ' ,
LenGer'SAtltlross ORIIVKINGFOVNTAINS ' � � ' " GASTUBESIGNS ' � � . - �
OWNER BUILDER DECLARATION " INTERCEPTORS � � CLARIFIERS �� � ' POLE LIGHTS ' "" � .
1"hereby aftirm that I am axempt from.the Contractor's LicenSe Law for
the following reason (Sectlon 7031.5'Buslness antl Pro�essions Cotle: �' SWIMMING POOL'� P'TRAP" -" � .
Any city or county which reQWros a permit to construct, al[er, POLES ��METERED � SUB
improve, tlemolish or repair any structure, prior to Its Issuance, also re- yyqTER SERVICE ALTERATION � �� : PANElS ' ' 'MAIN SVB
qW"� lhe appli�nt !o� Su<h permit to file a Signetl statem¢nt tha[ he - - - -
i( �setl pursuant to the provlsions of the Contractor's'Llcense Law GAS SERV ICE� � OUTLETS � - SERV ICE '' '� �' " � AMP - � ��
(, er 9(commencing witn Section 7000) of Divlsion 3 ot lhe
B�_ .ess aniJ PrdMsions Cotle) or that ne Is exempt therefrom antl the yyqTER HEATERS � -BTU OUTPUT' ' '' ' • ^ , -
basis for the alle9etl exemptlon. Any vlolatlon of Sectlon 7031.5 by -
any appllwn[ for a permit zubjec[s the aOPllcant to a Clvll penalty SEWERCONNECTIONS ' '� �' "' '' ' � �
of not more lhan five huntlretl tloilars (E500�.. ?
❑ I, as owner of the property, or my employeas with wagas as lheir SOLAR TANK COLLECTORS ' ' "- ' - � -
sole compensation, will tlo the work, antl the structure Is not Intentled �
or ofteretl for wle. (Seclion ]044, Business antl Profeisions Cotle: The SOLAR PIPING SVS. -�' ISSUE FEE '' '
Contractor'S Licensa Law tloes not apply to an.owner ot a property . � - - qppLICATION APPROVED BV DATE
who bulltl5 0� imp�oves the�eon, antl who tlOes SUCh wo�k hlms¢If o� ISSUE FEE � '
tbrough his own'employee5, prOvitl¢tl Ihdt sUch Imp�ovemenl5 a�e noL
intendetl or oHeretl for sale. Ii, nowever, tha bulltlin9 or improvement MECHANICAL PLAN CHECK SUMMARV OF FEES
is soltl wifhin one year of Complelion, th¢ owner will havB M¢ Uurtlen . ., ,. -'
of provin9 he tlitl not Duild or Improve for the DurpoSe of sale). HEATING SVSTEM 0-300,000 BTU �BUILDING � - � .
❑ I, as owner of the property, am ezclusively contracting with . _ PERMIT f SMIP E ,
AND OUCTING �
licensetl contractors to construct the projnct (Section ]044, Buslness 100,000+BTU PLANCHECK E PERMIT
antl R'o(essions Cotle: Tha Contrattor•5 license Law tlaes not apply to � � .- ISSUANCE S �
an own¢r of pro0erty wh0 builtls o� Imp�ove5 the�eon, antl who con- REFRIGERATION 0-300,000 BTU PLVMBING E �
trat(s from such projects with a contrattor(5) licesnetl'Oursuant [o SVSTEM '-' - . GRADtNG S
the Contractor•5 License Law�. 100,000 + gTU PLAN CHECK E, � �
❑ I am exempt untler Section 8.6 P. C. for thii BOILERS BTU 'ELECTRICAL S� ' s
reaion PLANCHECK E MICROFILM 5
SVSTEM REPAIR, ALTERATION ' TOTiiL FEE S
Date Owner MECHANICAI S
I hereby certify [hat I nave rea0 this aOPliwUon antl state [bat the above EXHAUST SVSTEM MVITIPLE ' - � CE55 AD-
information is correct. I agree to tomply with all city anE county � PLAN CHECK E VANCE PC E
o�0inance5 antl state Idws rClatin9 �o cOnst�uCtlon, an0 h¢reby autho�ile � � �
representa[ive5 of I�Is tlty [o enter upon lhe above ment(Onetl - ' ��.��
p�op¢rty (o sDectlo purp05¢5. ..
5lgnature _� �J"�� ���'� Date �� FINAL FEE S
Drivers' L'cense ar 55 x �) ISSUE FEE ,
CMF 0865-46 Whlte-Builtling: Canary-Appliwnt; Pink-Accountin9: Goltlenrotl-Asse55or
" • . ' .. .[. . . . ' 1' u.
^ CONSTRUCTION AND PLANNING � POOL & SPA _ � - > , -?' • '
APPROVALS Permit � F-51i� Date ' lospeetor � pppROVAIS :t, ' �- Permit # � ' ' � Date� - Inspecto� '
1. Temporary Electrical Service or Pole ` � � ' , 43. Pool & Equipmerit LocaCon ' ' � - - - - - - ' - � - - -� �-
� i ipe-Un rgrn. �,' ��- �� Steel Reinforcement� - s
. Ieclrical.Conduit Utility-Undrgm___ . 45., Forms - � - - � �- - - - '
' 4. .Elec[rical Conduit-Undrgrn _ . 46. Elec[rical Bondin _ ,, � - -- - - - - - -
tee ein orce - � 47. Rou h Plumbin & Pressure Test �� - - - �'
_6. Electrical UFER Grn "48.' APPROVALTO CAVER�GUNITE `�
7. ootings _ ' 49. Electripl Conduit•Undr rn � �'+� �
� - 8. -Foundation _ ' 50. - Gas Pi ❑ Undr rn; Test ' � � - �
' 9. Water.Rpe-Undrg�n . � � ' - 57.� Backwash Lines P- re r r ' � ` - -- - - �
10.. StructuretFloor.Svrtem • 52. APPROVALTODECK- ' --- ' •
L1. Roperty Sewer.Line &,House Connectiori _ " . 53. . Backwash & Rece tor-Final ' � � ' � �
_72.- Street.Sewe[ Connection _�._� _" ' ' --54.- Heater& Vent-Final � � � �
13. Rough Plumbiog -- , - � - - - - - �- -- -- - - - - - . .
14. Rough Elec[ricConduit �-�-- � � -- - - - °56.� Electripl-Final -- � • �� , �
15. Rough Electric-Wirin � � - � � � � - � - 57. - Solar System-Final� ' " ' � ' ' �' ' �
16. Rough �Heating & Air-Conditioning� -- � - - - encing & Access Approval �
17.- Ducts in Structure � ' APPROVED FOR PLASTERING • � �
- 18.• Duc[s:�Ventilating. . • . --- - . . .. . .- ---- . _. , - -,. -
19. Gas Pi'pe-Rough & Test ' - __ 60• .POOL/SPA SYSTEMS FINAL ,, "� , . �
20.; �Roof Framing - � � - ' ' ' ' � � ' ` ' � ' ' '
21.� Roof Sheathin -' � � � � � - -� ' �: � � . � � r. _�,•• r .
' 22. Frame and Flashin � � NOTES: ' ' ' ' '_ "
23.. Insulation � . . . .. ' t . ' . ,-.,., - - '
24. -Lathin & Siding _ - - - - - - -, - - -- -
25. DrWvaIl Nailing - - - - - - -- -- - - - � , .,
-- - - - - _ --
26. - - Plaster Brown Coat � - ' ' ' � � � � � � �
_.. _ _ ... - -- - '
27r_Elec[rical.Power Meter-Final_ � � � " � - � � �-�
• 28:'�'final-Electric -- . . . - _ ' . . . - , . . . . >
29.i -Final Heatiog & Air Conditioning . > _- _� . � � � - ' � ' � � � ' .
.-30. Final Gas PiPe-Test � ' . . . � . . , . .. . . . . �.
. 31.._. Final.Plumbing _ ' ' "' ' � '' � '" � �
, �32. �iNater'Service-Finaf- � . . - - - . .� -- - ' ` . . . . i
�'93;=:^Gas$ervice-Finai'-� :- � ' ' ' '
34. $olar pomesticFinal ' " - ' ' �
: 35. landsp S rinklin S stem _ � ' - � ' � ' '
' •36. Sound Attenwtion � • � ' ' � � � • - �
37. Handicap Regulations • - � ' � � • � � �
; 38. FINAL STRUCTURE & BUFL•DING • � ' •
39. Speciat Requirements CompleteH - � � � " " ' - - ' ' �
40. Electric�Release to Edison ' � �-"� " " --"' '
41. Gas Release to Southern California Gas Co: i � - �
� 42. CERTIFICATE OF OCCUPANCY
' .No._ , � : Date -' �-- -- - - � . .
i_ , : _, .... .--- --•--•�_ -.
_.. ._. _
. . - �--"- -..
� _ .. . .
�� Applicant lo flll in ill ipaeas wilM1ln heavy borOer lines an0 sign all appra�
CITY OF COSTA MESA � aeanniT rvo TRACT NO. LOT NO.
CONSTRUCTION PERMIT M (0 �T �p' 9 .
�
\
M
(�1
1'1
OWn�r �
Address
Areh/Eng.
Address
Ceclarations.
µIA TVPE OF CONSTRUCTION
4� � NEW- , ❑ ADD ❑ Al_TERATION
❑ REPAIR ❑ CONVERSION ❑OEMOLISH
Litenip No. ❑ OTHER
. DESCRIPTION OF WORK�DIO A'/II LOA/D
a�,o� P-r��,�Y '� 675✓�_
6y47 4/OB/g�
wnvaccor�pMl�O O D N rnone(jQ, �TVPEOF.PERMIT �
Addfe55 D f�1 S E � � ❑ C�RADING ❑ FOUNDATION ❑ STRUCTURAL
tICENSED CONTRACTOR �DECLARATION - ❑ TENANT O ELECTRICAL' OPLUMBING �MEGHAI
I hereby afiirm that 1 am licensed untler provlslons of Charter 9(com-
mencing wit� section' 7000) of Divislan 3 of �he Businezs antl ❑ OTHER
Professlonz Cotle; antl my Iicense is In tull force antl eitecf, pROJECT DESCRIPTION
Litense Class ='� a � Lltanse r7 .��SQ02 '
Date��f.E'] ' ._519natu,P �!J'.f.Yw� /�. / - - SQ. FT. 7���� � .
`•'00.KER5' COMPENSATION��DECLARATION � . OCCUPANCV_CONSTRUCTION TYPE
+reby af(irm tbat I have a certiticale of consen( to selt-Insure or a VALVATION ZONE
Ificate of Workers' Compensation Insuran<e, or a cerUfietl copy - , -� - �
...ereof (��iqn �Q�� ¢. CJ. ; `R f,y��� f�O���.y GRADING CU. VOS. ACRES
Policy N �Z�Y S Company "
��Certitietl topy is hereby furnished. 'REMARKS: � .
❑ Certifietl COpy i5/Iletl wifh th¢ city Builtling DiviEfon. .
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION ' � '
(Thls se<tlon neatl not be completetl if tna.permit is tor one buntlretl . ,
(5300) or less�. � � - ' �• ' ` -
1 tertiry that m tne performance o( the work for q.hith this permit is -- .
issuetl, I shall not emQloy any person in any manner so as to become PLUMBING � PLAN CHECK �•
subject tO�the Workers CompenSdtiOn Laws of Gllfbrnid.. . .
Date Slgnature BATHTUBS SHOWERS
NOTICE: I( atter making this tleclaration, you shoultl become subjact TOILETS VRINALS '
fo the Wotke�s' CompenSdtiOn provi5ions of [h¢ Labo� COEe, you muzt ,
forthwith comply wltM1 such provlsions or this perr�it shall be tleemetl LAVATORIES DOUBLE LAVS'
revoketl..'-" � - '- '
CONSTRUCTION.LENOINGAGENCV KIT.SINKS- DISHWASHERS
I hereby affirm thal t�ere is a consVuction lentling agency tor the per- SERVICE SINKS- . SUM75 �' ''
formante of tne work for which this permit is IsgueA (Section 309�
Civ.'CJ.-� �(/ � � � ��� - ' ' � . FLOOR SINKS �. .' � FLOOR DRAIN$' ' ` � "
Lentler;s Name �•'-�N�' � � - '• '�
Lentler'S•Atltlress,�" ~ DRINKINGFOUNTAINS`. -' '
OWNERBUICDERDECLARATIOIJ " "' � TERCEPTORS C'ARIFIERS � ��
�.y which requVes a
r repai� any SVut[un
tor such permit to fl
to the provislans ot
r the allegetl ez¢mption. An'
Hi�nT for"a permit subjects
more than'five huntlretl tlollt
owner Of the propGrty, or�i
f1055
ctOr'i�Li<ense Law.for
mq-protessions Cotle:
�o construcq alter,
eo Its Issuance, also re-
�eq ztatement thai he
t�dcto�'s LlcenS¢'Ldw
oi DlviSion 3 Of thG
npt theretrom antl't�e
of 5¢«ion 7031.5 by
ant to a clvil penalty
es iditti wagei as t�eir
ucture is not intentletl
�Ofeisions Cotle: The
IN L
SWIMMINGPOOL ' PTRAP "- '
WATERSERVICE AILTERATION '
GASSERVICE �� OVTLETS � �
WATER HEATERS � BTU'OUTPUT.:
SEWERCONNECTIONS � - �-
SOLAR TANK COLLECTORS
SOLAR PIPING SVS. � �
wh0 build5 or imProves thereon, anG who tlOes su�h work himzelf or ISSUE FEE � �' �
throu9h his own.emploY¢es, provitletl [ha[ sucb Imp�ovem¢nts d�e nOt.
inten0etl or otfereC for zale. It, howeve�, Ihe builtli�g or improvemunt MECHANICAL PLAN CHECK
.is soltl within_one year.ot completion, Ihe owner �y�ii have tne burtlan - -
of proving he tlitl not bulltl or imProve for thp purpose of sal¢). HEATING $VSTEM 0-300,000 BTU_
❑ I;'as owne� ot the property, am ¢xtlusively �conlractin9 -with qry0 DVCTING
licensea cOntrac[ors [o conzlruCt the project (SeCejon 7044, Business 300,000 + BTU _
antl Professions'Cotle:-The Contractor's LicenSe LdW tloes not apply to
an owner of proper[y who builtls or improves t�e�eon, antl who ton- REFRIGERATION 0-100,000 BTU
Vactz from-such Projectrwith�a contractor(s) Ii�¢5netl pursuan[ to -SVSTEM " - - -
[he Contractor•s License Law�. 100,000 + BTU
�� I am exempt�untler Section� B. & P. C: (or this gOILERS BTV
rea5on -. .. . - - " - " "
Date- � Owner - SVSTEM REPAIR,ALTERATION
_I hereby cer[ifytbat 1 have reatl t�is appliration antl state lhat the aDove EXHAUST SVSTEM MULTIPLE
intormation is correct. I aqree to comply witb all city antl county
ortlinantes antl ilate IawS rela[ing to const�uctiOn, dqtl nere�y authOrile
representa[ives�of this city to enter upon-the above mentionetl y;
property f0� spection,pu� oses.
Si9nature-���'• u �� � � Date ^'r� 83
�orivers'��icenseor55$ �� � �ssVePee �-- - � - �� -�
CMF 0865-46 White-Buiitlinq; Canary-ApO���n[: Gink-Accountin9: GOltlenroU-ASsessor
A.P. �
ZONE , PLNG. 0.EF.'�
REAR VARD (TO P/L)
PKG.SPACEREQ.� PROVIDED
STREET WIDTH � PARK FEE E .
SPECIAL
ELECTRICAL ' PLAN CHECK
_"__'..._ _......" '_ "
SfJ. FT.
GENERATOR 0-I�KW_1-10KW
TRANSFORMER .
APPLIANCE 30�50KW_SO+KW -
MOTORS ' ' Od'HP_1-lOHP '
QNG�SOLAR). 30-50 HP 50 * HP
FIXTURES ' OUTLETS SWITCHES .
GAS TUBE SIGNS' ^ � �
POLE CIGHTS ' - ' ' " ' - ' - - - '
PANELS MAIN . ' ' SUB
SERVICE- ' ' ' AMP-
� " ' _ _ . . _ _ .
7.0�
' ' - -ISSUE FEE ' - ^ - -' "
' ' " APPCICATION APPROVED BV -��DATE-
SUMMARV OF FEES -�
BUILDING - ' - -
PERMIT S ., 'SMIP�..•'.. S :
PLAN CHECK S PERMIT
- -- - - �� ISSUANCE�- E
PIUMBING E ' '
y �� PLANCHECK S GRADING, E ,
ELECTRICAL E - - .' ' ' ' S .
PLANCHECK S' � ��MICROFIIM f
' MECHANICAL E� TOTAL FEE E' .
PLAN CHECK' E '' LE55 AD- 1' '
VANCE PC'$"'
� • • � e0
, _ . . FINAL FEE S
� d� - � - . . _ � .
CONSTRUCTION AND PLANNING POOL & SPA, ,� :� `
Date Inspestor ' �� � �� `� Date . Inspector
APPROVALS Permit # �I ��T .APPROVALS . Permit # -
7. Temporary Electrical Service or Pole 43. Pool & Equipment Location• �•�"�- � --•� . w: 1. "• �_. ,�:' ,t`...,�'-, '
2. Soi ipe-Undrgrn - 44. Steel Reinforcement ��".`: • -�
3. Electrical Conduit Utility-Undrgrn - �=, 45. Forms
4. Electrical Conduit-Undrgrn - 46. Electrical Bonding � '
. tee em orce � � 47. Rough Plumbin & Piessure`Test ' � • � �� � • � '� �� •�
6. Electrical UFER Gm 46. APPROVALTO COVER-GUNITE `''`�-'•� '' '� "'"• �•
7. Footings 49. Electrical Conduit-Undr rn �' �
. 6. Foundation _ '� � 50. Gas Pipe, ❑ Undr rn, Test _.
9. Water Pipe-Undrgm ^ 51 . Backwash Lines P-Tra �" �0 ' ndF rn .
10. Structural Floor System 52. APPROVAL TO DECK " ' � � " � � � � ' ' •� -.�' ' � " �
11. Froperty Sewer Line & House Connection 53. Backwash & Rece tor-Final �
12. -_Street Sewer_ Connection �' 54. Heater & Vent-Final _
13. Rou9h Plumbing ' ' " � �
14. Rough ElectricConduit - ' '• �' •� `56. Electrical-Final �
15. RoughElectric-Wiring � 57.- SolarSystem-Final - �
16. Rough Heating�& Air Conditioning � - • encing & Access Approval . �
17. Ducts in Structure APPROVED FOR PLASTERING "
18. Ducts, Ventifating � � � �- � _ ,
19. Gas Pipe-Rough & Test ' � 60. FOOL/SPA SYSTEMS FINAL '
20. Roof Framing � � � � �
21. Roof Sheathin � � �
22. Frame and Flashin NOTES: • � ' ' .
23. Insulation � ' - - ' � Q
24. Lathing & Siding -
25. Orywall Nailing � �
26. � Plaster Brown Coat -
27. Electrical Power Meter-Final ' ' - ' ' � � � �
28. Final Electric � � ' � ' � ' '
29. Finai Heating & Air Conditioning . � • - � -
30. Final Gas Rpe-Test � ' � ' - ' .
31. Final P.lumbing ' � �
� �„32. Water Service-Final � � ' ' � � � � �
- '33: Gas Service-Final� - � " '
34. Solar pomesticFinal ' - �
35. Landsca e 5 rinklin S stem � � '
36. Sound Attenuation - ' �
37. Handicap Regulations • � ' � �• � � � -
38. FINALSTRUCTURE&BUILDWG �� • - �
39. Special Requirements Comp�eted ' � ' ' � � '
40. Electric Release to Edison � � � � � � - ' � � ' - ' - '
41. Gas Release to $outhern Califbrnia Gas Co. � � � -
42. _CERTIFICATE OF OCCUPANCY _ _ . � �
� No ' Date -- - .
. ;,. � . .
. . . . . � +! . . . . . .. . . _ . .
City of Costa Mesa
Developmem Ser�ices Departmen[
Building Satety Division
P.O.BOx 1200
Cos[a Mesq, Califomia
;�9`"�'�
CERTIFICATE OF OCCUPANCY No. �`-�'Y
The Building located at 355.i :l�r'��r 8._.ce���v. Unit G
has been inspected and found to comply with the provisions of all City of Costa Mesa O�dinances applicable thereto
for a Group ^9 OccUp3ncy.
Use of Buildi
Legal Description 41 S—
ISee reuerse side for Metes and Boundsl
Building Permit No 8 25798 Electrical Permit No. E 25869 Plumbing Permi[ No. P 25863
Mechanical Permit No. M 25864 Number of apartments and/or guest rooms
ISSUED T0;
C.J. Seaerstrom
LF��5 Fairviea Road
Co3ta M�sa. CA 92626
Building Official
by
Victor Newton
Date Maech 17. 1087
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Build�ng Official of the City of Costa Mesa u�der Sec. 307 (e) U.B.C.
CMF 1015-46 rav, 1/83 White � Owner; �anary - Numerical File; Pink - Bld9. Permit File
� i ,
���
Aoolieant to /ill in all soaces ezceot those witM1in heavv DorCer Ilnes anC sian all aoorooriate Eeclarations. � _ ----
�'� �� OF COSTA MESA C NSTR U TION PERMIT PERMIT NO. TRACT NO. LOT NO. �UNIT NO. .
ProjectAAcjress�.`?rs`%��a'"�'��v `.�-e� S1'¢� 5 �d��� �S G . ' 5291 10/1�6/86 252047 TL
� ��.�Q � TYPEOFCONSTRUCTION � NEW AOD A TERATION REPAIR �
AppliCani'S Mailing Addreu � ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ���% A.P. � '��S — O 9� Q Zone �Q
Owner's Name � - S q Phone S9rTEN�O . DE$ IPTION F WOR /USF OFQ LDG.
Address �^��5 �rUi al ) C��. ' ' �/ �—`- Cx�c�`��-��/�G �$ / ' � S MainBuilding: ' AccessoryBuilding: � -
Arch/Eng/�" a �� � � s icense No. C��Os�`� � TY.PE OF.PERMIT ❑ GRADING LJ F6urvoATION STRUCTURAL T FronL ' � . O
Address � �= ^ �- Q �TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear � N
ContraCtor'SNam ��-�� /�`� L �phon -��-377� -❑ OTHER , � A � �
lw$�n �S � F�j'n � PROJEC7 DESCRIPTION 54. FT. OCCUPANCV �Z K Right G
Address�mailing� �-�p CONST\R CTIONTYPE� VALUATION$ 3�,000 g Left R
City License No. �4' 1� ' ��: 20NE `j��� GRADING CU. VDS. ACRES Ping. Ref. # � � Parking Req./Provided E
LICENSED CONTRACTOR DECLARATION Q
� I hereby aHirm [hat I am licensetl untler O�ovision5 of Charter 9(comm¢nUn9 Remarks: GI �. ' 7/ � � Pl2nning No[es: M
ith S¢Ction ]000�'Oi pivision 3 ot the Business antl Prolesiions Cotle, antl
my license is in tW torce antl e(tect. � � -' T
Q LicenseCiaz/s - ' Lice rvo. ��QdO •PLUMBING -FEES S
\ Date.��+�p-� Si9nature ' i �
WORKERS' COMPENSATION DECLARATION Bar $ink - . . Showers . - � . / . ' � � -
I hereby affirmmat 1 nave a certiticate of mnsent to zelf-insure or a certifi<ate � ELECTRICAL , FEES
of Workers' Compensation Insurance, or a certl(ietl copY thereof (Section , Back(low PreventeL Service Sink �
3800, Lab. CJ � �
Auromatic Washer Transformer ❑ 15-50 KW �
Policy No. �x`����g� Company 57�� �tio 8ackflowlrrigation SewerCa � � � � � � .� 50+KW -
P Construction Pole Suh.
❑•Certifietl copy is hereby tumisnetl. ' � � . '
C1d Certinea cg py i tuetl witn tne Ury Buii�1y q oiv�ision. Bathtubs Sewer Connection Cooking Unit Meter �up to 100 amps
Dale �l% ��+ �� APplicant /�✓ �...�f , •
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Cld�ifi¢f5 . $Old� COII¢cL0�5 - �i5hwd5h¢� M2t¢� Oover'100 amps
(This seclion neetl not b¢ mmplatetl if the Oarmit i5 for one huntlrltl (E100) or .
iess). � Dishwasher - Solar Piping . _ � Dryers ❑Gas ❑Electric Sub Panel ' � V
1 certily Ihat in the perfOrmanca ot [ne work for which this pe�m�t i5 i55uetl I .- '
shall nol Employ any pe�son in any manner so as to become subject to t�e Drinking1FOUOtdinS $Oldf Tdnk F2n
i Wprkers'CompensationLdWSotCaIHOInia. MOtOfS��-1HP 1h-$ .
Date• Si9nature � Floor Drains' � Swimming Po w/Spa F.A.U. `
NOTICE:It,atter making [his tlecla�ation, you Shpultl be<ome Subject to Ih¢ - _ �00.Sola� -1$ HP �i6-15+
Workers' Compensation provisions of Ihe Labor Cotle, you must fort�wi[h FloorSinks ' Urinal ' � FizWres � `
comply wilh such p�ovisions or Ibis pe�mi[ snall be tleemetl �evoketl. Mic avC
CONST0.UCTION LENDING, AGENCV ('i85$ENiC¢ OuL12L5 � W �CI052L DeviceBoxes
1 nereby a}Ilrm thai there is a construc4lon IenGing agency for the per(ormance � Pole Light . �r
of thC work for whlCh [hi�s pOrmlt is issuetl (Section 3097 Civ. C.) IOL¢IC¢ptOIS ' � Wdt¢I H¢dt¢f Du[IQIS �
I..entler's Name j0 Range �
�enaer's Aatlress. � Kitchen Sink ' . Waler Service - Switches . ' Sign � � �
OWNER BUILDER DECLARATION '
1 hereby aifirm that 1 am exempt from the Contractor's Ucense Law for the . Lav2tories AutO-Wash Garba e Di5 oul -
following reason (SecHon ]031.5 Buslness antl Professional Cotlo: Any city or � 9 P Standing $ections . r��
counry w�ich requires a permlt ro consVuct, alter, improve. tlemolish or repair P-Trap , Laundry Trays Generamr ❑ KW 05-15 KW ' �
' any st�ucture, pNonto Its IsSuance, also requir¢Slhe appliwnt tor Such pe�mit Trash Compactor
to fil¢ a slqnetl statem¢nt that he/She I5 Ilcensetl pur5uant to the pfovision5 Of ROO1 DfdinS � � ' • •
the Contraclor's License Law (Chapter 9(commencinq with Section ]0�0) of � .
Division 3 oYthe Business antl Professions Cotle) or that he/she is exempt - . , -' -' - --
the�elrom dntl Ihe basi5 tor the alle9etl. ex¢mption. Any violatiOn ot Section � � •
. 7031.5 by any applican[ for a pCrmit 5ubject5 th¢ applltant to a civil
��enalty ot not more tnan tive huntlretl tlollars (E500). I
I, as owner ot'the property or my employees witb wages as their sole einspection, Fee $15 . Issue Fee � . $.3 ' ' ' � � t �
compensatlon, will Go Ihe work, antl the structure is not intentletl or ofteretl Reinspection Fea ' $15 luue Fee ' $ 3
for sale (Section' �Oa4, eusiness antl Protessional Cotle: The Contractor's � ' MECHANICAL � -FEES /
License l.aw tloes not apO�Y �o an owner of a property who builtls or improves
thereon, antl wno tloes sucn work nimzelt/nerself or throu9h hls or her own ' � / DEVELOPMENTSERVICESRE� IREMENTS: �
employeei, provitletl tnat such imp�ovement5 are not intentletl or offeretl for Boiler � Hood or Typ21 ❑ L .
sale. It,.however,'tne bWltlin9 or improvement is soltl within onc year of com- - Canopy Type I I ❑ ZoninB %�PProved By Data /u �� b� g�
pletion, ihe owner will have tha bu�tlen of prOvin9 h¢/sh¢ tlIU not builtl o� Im- DuCt - Und2� G�Ound • ' BUilding Approved By �d -�G^ '
�rove tor the purpose ot sale). , - - Date
LJ i, as owner of tne prooerty, am exciusivery contractin9 witn ucensetl con- Dutt - Structural Refrigeration System . Appliration Issued By '' Dat
fractor5 t0 construct tha proiect (Sectlon 7044, BuSiness antl PrOfe55ion5 COGe:
Th¢ ConVactor's License Law does not apply to an owner oi oroperty who Duct - Ventilating � �0-100,000 6 100,000 BTU � . � SUMMARV OF FEES � '
builtls or'improves thereon, antl who contracts to� suc� projatts with a con- � , 2 YS-
tractor(s1 ucense oursuant to the Contractor's License Law). I.am aware tnat Exhaust System ❑.Multiple 0. Sys � epair/Alteration BUILDING PERMIT $���•�� " SMIP $
proOf o( their Worker's Compensatlon insurance snoultl'be provitled to me: _ �y''� pLAN CHECK�G• $ �S i•O'a pEFiMIT � � .
❑ I am-exempt untler Section �_ B: & P. C. for tHis reason Firepl/Fact.,Blt. ICBO # � Fire Dampers PLUMBING $ ISSUANCE $-
Date ' owner � Heating System & Ducti Registers � �, _ � - ENERGV P.C. $
� PLAN CHECK 25%�$ � !
I hereby certity that I nave reatl tnis application antl statu that rne above ❑6100,OOOBTU ,000BT $ GRAOING $
intormatlon is wrrect. I agree to comply wrth au tity antl county ortlinances ' ' ELECTRICAL
antl state laws rela(ing to builtling conztruction, antl hereby au[norize repre- � MICROFILM $
sentatives ot this city� m enter upo the above-mentionetl properry for - - PLAN CHECK 50% $
' insoection purpose MECHANICAL $ TOTAL FEE $
5iqnature � ' Date /D-/6O� . . '2S �
Orivers' License or 55 � Reinzpection Fee $15 Issue Fee . $ 3 PLAN CHECK 25% $
\.mr 000J-Vo, � v. av/ow wn�[e - nu�imng; �,a��e�y - qppi�cany rinn rN.wunln�y; lao�ennrpa - h�ssessoi
_� � �
CONSTRUCTION ANDPLANNING POOL&SPA
APPROVALS Permit # -`"' Date Inspector APpROVALS Permit # Date Inspector
7. 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 Conduix-Undrgrnd. 55. Electrical Bonding - �
5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test .'
6. Electrical UFER Grnd. � 57. APPROVAL TO COVER�GUNITE I
7. Footings 58. Electrical Conduit-Undrgrnd. •
8. Foundation 59. Gas Pipe, O Undrgrnd., Tesi .
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structurel Floor System 61. APPROVAL TO DECK
11. Properfy Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap � 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical�Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval �
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical•T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT -
�
20. Rough Factory Fireplace APPROVALS � Permit # �
21. Ducts, in Structure 70. Underground Hydro 4
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough $� Test 72. Underground Flush
i 24. Roof Framing . 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing ' 74. Overhead Hydro '
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing � 76. Dry Standpipe .
28. Lathing & Siding 77. FIXED SYSTEM FINAL . •
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT .
31. Plaster Brown Coat 79. FINAL INSPECTION .
32. Electrical Power Meter-Final 60. FOOD CERTIFICATE ISSUED �
33. Final Electric Notes: �y�� j�. 'L'� Ej
34. Final Heating & qir Conditioning � � O
35. Final Gas Pipe-TQst ��./�.�
36. Hood or Canopy
37�.. Final Factory Fireplace - ' ,
3$. Final Plumbing . �
39. Water Service-Final �
40. Gas Service-Final ; �
41. Solar pomestic-Final . �
42. Backflow Preventer � � . .
43. Backflow Irrigation f
, ,� • �
44. .Landscape Irrigation System �
�
'A5. Sound Attenuation � � �.
�46. Handicap Regulations "
4Z. FINALSTRUCTURE&BUILDING
46'. Special Requirements Completed . � �
49. Electric Release to Edison '
50. Gas Release to Southern California Gas Co .
51. CERTIFICATE OF OCCUPANCY ,
No. Date � ' ' �
AVO���aRt to fill In all spaees eacept thase within heavy borOer lines ana sign all apvropriate aeclarations.
'^, �,' ' _
� CI7V c3F'COSTA MESA CON TRU/�CTIO/I� PFERMIT ����rrr'
'u°�oj2ctAddress _���� ��-�'Ud/�' [ri(7`B�v
i
Applicanti� Mailin�g Ad-d7r-ess� � � I� - ��12L�./�e
Ofvner's Name 5�.�.���l. �r�[T9_.^^ • Phone
Address
Arch/Eng. � �icense No.
Address
Comrector's Nam ' yf,�, , Phone 7�z91
Address (ma I'ng12�b U C� � II�L
City License No. a6�/� �e '
LICENSED CONTRACTOF2 DECLARATION
A 1 hereby affirm that I am licensetl untle� O�ovislons ot Chart¢r 9(camm¢n<in9
- wi[h section ]000) of DiviziOn 3 07 the Buslness antl Profe55ion5 Cotle, dntl
`) my Iicense is in full tor e antl eite t. w
� License class '� L ns o. `3O 6 V'
Date ��%^% ^ � 5'9 t �.^
� W00.KER5' COMPENSATION DECLAR ION
I hereoy atfirm that I have a certificate ot onsent to sel�-insure or a ccrtificate
ot workers' Comoensation Insurance, or a certitietl copy therefj� (S�ettion
3800, Lab. yj � Mn J� ry)/ n A . // // .
PolicY No. L J/d d7 ComPanf^^� �� •�7�L YJ
ertitietl copy is hereby turnishea
Certitietl copy Isj il tl with the Ut mg Divislo
Date /C —Z� �Kf APPlitanl�//�j���1�
EXEMPTION FROM WORKERS' COMPENSA,T/ ON DECLARATION
(This section neetl no[ be COmplete0 If tne pe�dOt IS (or one huntlretl (5300) or
Iess).
I certity that in the perlormance ot the work for which this permH is izsuetl I
shall not employ any pe�son In any manner So di to E¢Come subjec[ to t�e
Workers' Compensation Laws of Calitornia.
oate Signatura
NOTICE:�If, aiter making this tleclaration, You shaultl becoma subject to the
Worke�s' Compensation provislons of tM1e LabOr Cotle, you mu5t forthwith
comply wilh Such O�ovlsion5 0� thi5 p¢rTl[ shall bG deemetl �evoketl.
CONSTRUCTION IENDING AGENCV �
I hereby aiflrm that there Is a construction lentlin9 a9ency tor the periormance
oi the wo�k to� whiCh thiz pe�mit is Issuatl ($ettion 309A Civ. C.)
Lentle�'s Name
� Lenaer•SAdtlr¢5s ' ��
OWNER BUILDER OECLARATION � �
I hereby aiflrm thai I am exempt trom the Contractor's Llcense Lnw for the
following reason (Section ]031.5 Business antl Professlonal Cotle: Any dty or
county whith �equires a pe�Tit [o construct, alte�, impvOve, �emolls� or repai�
any structure, ptlor to its Issuance, also �equlre5 the applitant (or�5uch pe�rtlit
to file a signetl Statement Ihat he/She IS lit¢nsetl pufsuant lo It1e provi5ion5 Of
roe Contraclor's License Law (Chapter 9(commencing wi[h SecUon•7000) of
Divlsion-3 of tne-Business•antl'Protessions Cotle)'orthat ne/she�is exempt
thereirom antl tne ba5is for the allegeE exemption, qny violation of Section
7031.5 by any applicanl tOr a permit subjec[s the applicant to a Civil
eenalty of not more than (ive huntlretl tlollars ($500).
LJ I, as owncr of tha proper[y or my employuez wlth wages ds th¢ir sole
compensation, will tlo Iha work, antl the structure Is not Intentletl or ofteretl
for sale (Section �044, Business antl Protessional Cotle: The Contrac[or's
License: Law tloes nol apply to an owner ot a prooerty who builtls or Improves
thereon, antl wno tloes such work himself/herselt or through his or her own
�� employ¢es, provitletl that such ImprOvementi ar0 not Int¢ntl¢tl or oliered for
sale. If, however, the bulltlin9 or imProvement Is soltl withln one year ot com-
pletion, the owner will have the burtlen of proving he/she tlid not builtl or Im-
p�ove tOr the purpose ot sale). '
❑ 1, as owner of ihe property, am exclusively contracting with Ilcensetl con-
tracto�s to construct the p�oj¢cl ($ection 7044. BU51lIB55 dllC PlOi255I0115 COGB:
The Contractor's License Law tloes not apply to an owner ot proparty who
builtls or imp�oves the�eon, and who cont�aCtS fot such projec[s wlth a con-
tractor(s) bcense pursuant to the ConVattor's License Law). I am aware [hat
� proot ot tneir WorkeYs Compensatlon Insurance shoultl be provltletl to me.
❑ I am_exempt untler Section B. 6 P. C. tor this reason
Date Owner
I hereby certify that I have reai
above
TVPE OF CONSTRUCTION "CJ NEW U qDD LJ AL
❑ CONVERSION ❑ DEMOLISH ❑ OTHE
DESCRIPTION OF WORK/USE OF BLDG.
/A�f..�._'�
TVPE OF PERMIT �LI GRADING �yLJ FOUNDATION LI STRVGTU
❑ TENANT 'O EIECTRICAL�C`LPLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SQ. FT. OCCUPANC\
CONSTRUCTION TYPE VALVATION S _
.ZONE 'GRADINGCU.VDS. ACRES.
Remarks: � aJr'C�'�
Bar Sink
Backflow Prevencer
Backflow Irrigation
Rnffituhs
Dishwasher -
Drinkin9 FOuntains,
Floor Orains
�Sinks SCr✓tG6
Gas Service �Outlets
Interc¢ptors �
Kitchen.Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fee
u
$hOwers
Service Sink
' Sewer Cap � �
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool'w/Spa
Urinal
� Water Closet
Water Heater .
' Water Service -
Auto-Wash
Laundry Trays
$15
Duc[- Under Ground
Duct - Structural . �
Duct - Ventilating
Exheust System ❑ Multiple ❑
Firepl/Fact. BIL ICBO #
Heating System & Ducting
❑0.100,000 BTU 0700,000BT
sentaUve Is Uty to te' upon tne'aoove-menuonea property or ,
, inSPeclion,P o s. /Q�O— A
�. Signature Da[e d Rainspection Fee
_D" ' L' S# — .
CMF 0865-46, rev. 10/B4 White - Builtling; Canary -.Applicant; Pink - Accounting; Goldenrotl - Assessor
$15
Issue Fee,
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0-100,000 BTU ❑100,000 BT
System Repair/Alteretion'
Fire Dampers
Registers �
Issue Fee
REPAIR
A.P. # .
S Main Buildi
E
T Front
8 Rear
A
C Right
K Left
S
Ping. Ret. #
Planning Notes:
- Automatic Washer
Consttuction Pole Sub.
� Cooking Unit
Dishwasher
Dryers OGas ❑Eleci
Fan
F.A.U.
� Fixtures
�. — Device Boxes �
. Outlets ;'� '
$ 3
FEES
$ 3
6558 10/20/86
. � ��
Zone
Accessory Building:'
. Parking-Req./Provided
r .
ETLECTRICAL � ' -
� Transformer ❑ 15-50 KW
❑ 50+KW
ispaul
❑65 KW OS-15 KW
Meter Uup to 100 amps
Meter � Dover 100 amps
Sub Panel
Motors O0.1 HP O1 :4 - 8�
Inc.Solar 09-15 HP �1�6�
Microwave
Pole Light
Range
15+
�•.
15.50 TL
FEES
Standing Sections `
Trash Compacror � '
I Reinspection Fee I$15 f I luue Fee
DEVELOPMEN7 SERVICES REQUIREMENTS:
Zaning Approved By
Building Approved By
Aouliwtion laued Bv n
$ 3
Z
O
N
I
G
R
E
Q
M
T
S
SUMMARV OF FEES .
BUILDING PERMIT $ SMIP $' ' �
P�AN CHECK � $ —���7—� ��,� PERMIT ' � �
PLUMBING � $ � ISSUANCE $ .
PLAN CHECK 2596 $ ENERG� P.C. $
ELECTRICAL $ GRADING $
PLANCHECK 50Yo $ MICROFILM $ �/ ]�
MECHANICAL $ TOTAL FEE $ ��
PLAN CHECK 25% $ � .
�� _�— _ — �
CONSTRUCTION AND PLANNING POOL & SPA
Date Inspector Date Inspector
APPROVALS Permit # APPROVALS Permit # -
1: Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. /Q L�"Y� �i� 53. Steel Reinforcement � . �
3. Electrical Conduit Utility-Undrgrnd. 54. Forms � '
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test '
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe�Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd. '
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Veni-Final
13. Roof Drains 64. Plumbing System - Final
14. �Rough Plumbing 'j(% L� 65: Electrical-Final
15. Rou9h Elc,ctrical-Conduit 66. Solar SYstem�Final _
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �
20. Rough Factory Fireplace � APPROVALS Permit # _
21. Ducts,in Structure 70. Underground Hydro �
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil �
23. Gas Pipe-Rough & Test 72. Underground Flush �• �
24. Roof Framing 73. Undergrnd.StorageTank �Gas ❑Oil
25. Roof Sheathing . 74. Overhead Hydro .
26. T-Bar Ceiling (Structural) & Monocoat . 75. Dry Chemical
27. Freme 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 8rown 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 •� i
37. Final Factory Fireplace . '� �
38.�FinalPlumbing /Q-(d-�(F [,��
39. Water Service-Final �
,. .
40. Gas Service-Final � '
41. Solar pomestic-Final � � .
42. BackflowPreventer � �- �
�
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 ' ' � , � � �t�_
I
Applicant to fiil in all zoaees except those within neavy eortler lines antl sign all apv�oDriate aeclarations.
�'�GTT�OF COSTA MESA �CO STRUCTION PERMITSv/tx' �� PE �� 9a� TRACT NO. LOT NO. UNIT N6.
�~ ProjectAddress �.SS� ���A��A�SOLTJ'�
//yt� �� ��`� CjT �5/�Q TYPE PCONSTRUCTION NEW ADD ALTERATION REPAIR
Applicant�SMailingAddres5 � """"' ❑CONVERSION ❑DEMOLISH ❑OTHER Ap#
Ownor's Na'ine , Phone DESCRIPTION OF WORK/USE OF BLDG. -
Adtlress � S Main Buildi
E
Areh/Eng: � LicenseNo. TVPEOFPERMIT GRADWG ❑FOUNDATIO STRVCTURAL T Front
�� ❑ TENANT ❑ ELECTRICAI ❑ PLVMBING �MECHANICAL B
Address ' � � Rear
Contracror'sName ��rA2T CilN2/�70N/NtL,oneLt�"3zA� � OTHER /a
PROJECT DESCRIPTION SQ. FT. � OCCUPANCV C Right
Address (mailing) %�`�d .Q/—c% GUGY/ ST liNA/./�c'/ K
� � . CONSTRUCTIONTVPE VAIUATIONS g Left
1e�` City�LicenSeNo. ���[77 ZONE � GRADINGCV.YDS. ACRES
" LICENSED CONTRACTOR DECLARATION � PIOg. R2F. #
�p I nereby afiirm that I am licensetl untler provision4 of Charter 9(commencing Remarks: , Planning Notes:
� with section 7000) of Division 3 of the BUsiness antl Professions Cotle, antl
my license is in full force antl etfect. ���jjj��'���--ppp///��� �
\ License C�I ss G� 2 ic se No�
�i Date �� Si9nature B�
� WORKERS'COMPENSATION DECLARAT�ON �
1 hereby aftirm that I have a certiticate ot wnsent to sel(-insure or a certificate
M of Wo�ke�s' ComOensation Insurance, o� a�certitietl copy thereot (Section
` � e 3800, Lab. C ) � �LYJ �C /NO•E"M
� Policy No.�C9��7� Compa }�
�CertHletl copy is M1ereby furNshetl. ' / i
Certitle copy is filetl with tne city Bull J vi i
Date APPlicant�/1 /��
EXEMPTI N OM WORKERS' COMPENSATION DECIAR ION
(This section neetl not be completetl it the permit is fo� one huntl�etl ($100) or
iess).
1 certify that in the periormance oi tne work�tor whicn this permk is issuetl, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of Cali(omia.
�ate Si9na[ure
NOTICE: It, a�ter. making this tleclaration, you should become subject to the _
� Wo�ken' Compensation provisions. of the Labor Cotle, you must torthwith
wmply with such, p�ovisions o�� this� pe/mit shall be tleemetl revoketl.
� CONSTkUCTION LENDING AGENCV '- � � �
1 hereby aftirm that there is a const�uction lentling agency fo� the performance
o( tbe work for which this permit, is �ssuetl (Section 3097 Civ. C.)
Lentler's Name
� �
Lender's Atltlress_
OWNER BUIL�ER.OECLARATION
I hereby affi�M that I am exempt from the ConVacto�'S License�Law for the
following reason (Section 7031.5 Business a�tl Professional Cotle: Any ciry or
- nrw����� ��v�����av�,�����...����,.�,...,,-
any Struc[ure, prio� to its issuance, also requires the applitxn[ to� such pe�mit
[o tiie a si9netl statement tnat ne/she is Iice�setl pursuant to the provisions ot
the Cont�aclo�'S License Law (CM1ap[er 9(<ommentin9 with Section ]000) o�
�- Division 3- ot�the� Business antl Professon4 CotleJ orvthat he/she is exempt
the�ef�om and' [he basis,tor the allegetl exemption. Any viOldtion ot Section
7031.5 by any applicant for a permit subjects the applicant to a civil
penaltybt not more than five M1untlretl tlollars ($500).
�❑ I; as owner of the oroperty or my emPloyees with wages as their sole
� compensation, will tlo the work, antl ihe structure is not intentletl or offeretl
for'sale (Section ]044, Business antl Professional Cotle: The Gontractor's
, License Law tloes not apply to an owner oi a property who builtls or imoroves
thereon, ana wno tloes such work himselt/hersel( or throu9h his or her own
emplOyees, provitletl tnat such improv¢ments are not in[endetl o� offeretl tor
Sale: i(,'howeveq the buil�ing or improvemd�< i55oltl within one year ot com-
,ple[ion,�the owner will have tlte burtlen of p/oving he/sh¢ tlltl not builtl or Im-
p�ovG fo� tbe pu�pose of sale).
❑L 1, as owne� of the property, am excluSiVely mntractinq with lirensetl.con-
tracto¢t6 construct tne projec[ (Section ]Oa4, 9usiness antl Professions Coae:
The. Contractor's. License Law does not apP�Y.to an owner, ot p�operty who
builds-or improves thereon', antl who.contlacts.for such projects with a con-
tractor(s1 i�cense pursuant to the Contractor;s license,Law). I,am aware that.
, Proof of their Worker's Compensation�insurance�should be provitled to me:
�
❑ 1 am exempt untler-Section 8. & P. C. tor this reason�
� Date Owner '
I hereby certi(y �that 1 have reatl this application antl state that the above
inrormation;is mrrect. I a9ree to comply w�th all ciry antl county ortlinances
antl state laws r ti/R�jo tiui in conSt�uEtion� antl her¢by autho�iie repre-
senfa[ives of th s ity/�io-� ¢r pon. thd � ove-mentlonetl properTy t r
in5pectlan pu�p e yI, ' �
$ignafure - r Date
Drivers' License or 55 ��
Bar Sink
Backflow Preventer
Backflow Irrigation �
Bathtubs � � � .
Clarifiers .
Dishwasher� _
Drinking Fountains
Floor Drains '
Floor Sinks '
Gas-Service �. Outlets
Interceptors
Kitchen Sink .
Lavamrie5 •
P—Trep
Roof Drains '
ReinspeCtion�Fee $15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑ ai ao,000 sTu O i oo,000
Reinspectian Fea � $75
CMF 0865-46, rev.�30/84 White Builtling; Ca�ary - Applicant Pink - Accounting; Goltlenrotl - Assessor
Showers
Service Sink
Sewef. Cap ' .
' Sewer Conneciion , '.
Solar Collectors "
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
i Water Closet '
Water Heater
WaterService - .
Auto-Wash
Laundry Trays
Issue Fee
Hood or Typel ❑
Canopy Type I I ❑
Retrigerotion System
❑0-100,OOOBTU ❑100,000
System Repeir/Alteration
�Fire Dampers � �
Registers �� � �
laue Fee
` ..
.� ;
1'
$ 3
FEES
$ 3
Automatic Washer �
Construction�Pole Sub.
Cooking Unit
Di'shwasher
Dryers �Gas ❑Electric
Fan
F.A.U.
Fixtures �
Device Boies ,
Outlets
Switches
Garbage Disposal
Geaeremr �65 KW �5-15
5782 10/22/86
Zane
Parking
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter. ❑over 100 amps
Sub Panel
Momrs 00.1 HP � 1 X- 8
' Inc.Solar 09-15 HP �16-75+
Microwave '
Pole Light
Fange
Standing Sections
Trasfi Compactor
Fee �$15 � � luue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved By —_��
23000 'TL
FEES
$ 3
Z
O
N
I
N
c
R
E
Q
M
T
S
� • SUFMIARV OF FEES �
BUILDING PERMIT $„ SMIP � $ '
� � � PLAN CHECK � $- PERMIT � �
PWMBING • $ ISSUANCE ` $ � _
• PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAI $ - GRADING $
PLAN CHECK 50% $ ��q MICROFILM $
� MECHANICAL $ _____��L_CLCL TOTALFEE $ �
PLAN CHECK 25% $ ,
' �...:
CONSTRUCTION AND PLANNING POOL & SPA �
APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement �
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test �
6. Electrical UFER Grnd. � 57. APPROVALTO COVER-GUNITE
7. Footings . 58. Electrical Conduit-Undrgrnd. �.
8.'Foundation 59: Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural� Floor System 67. APPROVAL TO DECK
i t. 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
i6. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING .
18. Rough Electrj,Cal�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. RougFi Heating & Air Conditioning l�y_� LF,� FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # _
21. Ducts, in Struaure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil
23. Gas Pipe;Rough & Test 72. Undergiound Flush R,
24. Roof F�aming � �� . 73. Undergmd.StorageTank OGas ❑Oil ` •
�
25. Roof Sheathin� 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Freme;and Fl�shing 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 �2lf.�� [C,j�
35. Final Gas Pipe-Test
36.' Hood or Canopy ' '. � ,
.r .. ,
37. Final Factory Fireplace � �� ' '
t.
38. Final Plumbing � j �'; " �
39. Water Service�Final � .', ; A �. '
40. Gas Service-Final _ �' � ,
.41. Solar pomesticFinal �. ,,. � �
•42. BackflowPreventer ,' '',� ��� '
.43. Backflow Irrigation � - � ' ,�, -
44' Landscape Irriqation SYstem � � � � ,
45. Sound Attenuation . � -
46.'Handicap Regulations ,: ^ � �
i �
47. FINAL STRUCTURE & BUILDING � . � � �, .
48. Special Requirements Completed � ,
49. Electrie Release to Edison � - " ' r
50. Gas Release to Southern California Gas Co • �
�
51. CERTIFICATE OF OCCUPANCY � - . • '
No. Date
�.
%
��
�
Aoplicant to /ill in all spaces execo� tnose witnin heavy eoraer lines antl sign all aoo�opriate tleclarotions.
CI7Y OF COS7a MESA CONSTR�CnT__I.O_�N� �PE/RMIT
Project Address ��r"� ���7 "'�P�y-�r' 1 ST'� 6
Applicani'i Mailing Address �3 1����-g�� ��IiJE.
Owner's Napir� G�y'��xF'OM Phone
AddreSs
Arch/Eng. C���� �-��'�«- Licenu No. 331OGa4
Address� �3 VPtJ��I'T ����� Q.�-�� �
Contractor's Name �g�'Y ��-��'�L Phone lA�— L���
Addresslmailingl�� �'��0��«"� !��'J���
Ciry License No. Q� �Z ��
LICENSED CONTRACTOR DECLARATION .
I hereby affirm [M1a[ 1 am licensetl untler p�ovislons of Charter 9(commendng
with SectiOn 7000) ot Division 3 of the Buslness antl Protessions Cotle, antl
my Iicense is in full fo ce antl effect. . 33 ���
LJcenie CI ss � icen e No.� .
Date Siqnature _
WORKERS' COMPENSATION DECLARATION i
`�ereby aftirm t�at I �ave a certificate of consent to 5elLinsure or a certificate
. Workers' Compensallon Insurance, or a certifletl coOY thereof-�Section
_d00, LaD. C.j �,(�5�,'� ' � ���„ (yp
Policy No. �t„b1_ Company fS�LO'��1��-
�Certi(ietl copy is hereby furnishetl. 1
Certifle � 5 tiletl wrth the City B'Itlinq�D '� I-,I�-
Date-���— Applicant x�An
EXEMPTION FROM WOFKERS' COMPENSATION DECLARA�
(This 5ection neetl not be complete� if the permit is for one huntlretl (g100) or
less).
I c¢rtify thal In tne perfOrmance of tM1e work tor�which [his permR is issuetl, I
shall not employ any pe�son in any mdnner 50 as to become subject to the .
Workers', Compensation Laws o( Calitomia.
Dafe Si9nature
NOTICE: If, af[er making this tleclaration, you snoultl become subject to the
Wo�ker5' Compensation provisions ot the Labo� Cotle, y0u must fOrthwittt
comply wittt such p�ovlsions' o� thi5 pe�mit Shall b¢ tleemetl �evoketl.
CONSTRVCTION LENDING AGENCV� � ' �
I hereby atflrm lhal there is a consVuction lentlin9 a9ency Por the performance
01 [hu work for wnich. this permit iz issued (Section 3097 Civ. CJ
Lentler's Name -
Lentler's Atltlress
OWNER BUIIDER OECLARATION�� -
I her¢Ey attirm that I dm exempt from the Cont�actor'S License Law (or the
tollowing reason (Section 7031.5 Business antl Professional CoOe: Any city or
counly which requires a permit to construct, alter, Improva, tlemolish or reoair
any structure, prior to its iszuance, alzo requires tne applicant tor such permit
to tile a sign¢tl itatement that �he/she is Iicense0 pur5uant [o [he 0/ovi5ion5 of
the Contractor's License Law (Chap[er 9(commencing wlth Section ]000) of
'•ision 3 of th¢ Business and Professions Cotle) or that he/ihe i5 ¢xempt
�r.{rom anE the basis tor Ih¢ alleqetl exemption. Any violation of Section
53.5 by any ap0licant tor a permit subjectz-the_applicaN to a civil
�+enalty o( not more than five huntlretl tlollars (E500).
LI I, as owner of the property or rtiy emoloyees witn wages as their sole
� tompensa[ion, will Uo the work, antl the structure is not intentletl or offeretl
. for Sal¢ (Section 7044, Business antl Professional Cotle: The ContraCtor'S
' License Law tloes not apply to an owner of a property who builtls or improves
� thereon, ana who aoes such work nimselt/herself or Ihrough his or her own
em0loyees, O�ovitle0 that such improv¢ments ar! not intentl<tl o� otteretl f0/
sale. If, however, the Culltling cr improvement is soltl within one year of com-
plotion, the owner will have the Du�tlen O( p�oving he/she tlitl not build or im-
�rove forthe Ourpose of sale).
I, a5 owne� 01 the pro0erty, am ezclusively contracting with licensetl con-
tractors to construct the project (Section 7044, Busin¢ss antl Pwfessions Cotla:
The Contractor's License Law tloes not apply.to an owner of property who
builtls or improves thereon, antl who contrac(s far such proiects wilh a con-
tractor(51 license pursuant to the Gontractor'S License Law). 1 am aware that
prool of thei� Wo�kei'S ComOensation insu�ance should be p�ovitled to me.
❑ I am exempt untler Section B. & P. C. (or this reason
Date
Owner
I hereby certify that I-have reatl this application antl state that the abova
information is correcL I a9ree to comply wrth all city antl county ortlinances
antl Sta[e laws elating to builtling ConStruCtion, and hereGy dutho�Ize repre-
sentatives ot tl is city [ er. uqon the above-mentlonetl prop rty r
InSpection pur I �
Signahre Date
Drivers' �License or 55 �
TVPE OPCONSTRUCTION LJ NEW �ADD U ALTERATION. LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q.p, #
�ESCRIPTION OF WORK/USE OF BLDG. T=-
S Main Buildi
TYPEOFPERMIT GRADING FOUNDATION STRUCTURAL T Front
❑ TENANT � ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear
' ❑ �OTHER C Right
PROJECT DESCRIPTION S�.FT. oCCUParvCv K.
CONSTRUCTIONTVPE VALUATION$ S Left
20NE GRADING CU. VDS. . ACRES p�ng. Ref. #
.Remarks: �f�Nb ��p��7 R ,����'JQ � � P.IanningNotes:
Sink
Preventer
Irtigation
Drinking Fountains
Floor Drains ,
Floor Sinks � � - '
GasService Outlets
In[ercep[ors'
Kitchen Sink -
Lavatories �
P—Trap
Fioof Orains
Rainspeetion Fee � $15
Boiler
Duct- Under Ground
Duct � Structural
Duct � Ventilating
Exhaust Sys[em ❑ Multiple
Firepl/Fact. BIL ICBO #
Heating System & Ducting
❑0100,000 BTU 0100,000
Reinspection Fee � $15
CMF 0865-46, rev. 4/B4 White - Builtling; Canary -APolicant; Pink - Accountin9; Goltlenrod - Assessor
Showers
Servite Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Issue Fee
Hoodor Typel ❑
Canopy Type I I ❑
Re(rigeration System
❑0.100,OOOBTU ❑100,000
System Repair/Alteration
Issue Fee
EES
Automatic Washer
Constiuctior Pole Sub.
Cooking Unit
Dishwasher .
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures �
Device Boxes
Outlets
Switches
Garbage Disposal
Generator 00.5 KW �5-1
5586� 10/20/B6
.r .: ..
Zone •
Accessory Building:
Parking Req./Provided
ELECTRICAL�
Trensformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps �
Meter Oover�100amps .
Sub Panel
Motors DO-1 HP �1'h - 8
Inc.Solar �9-15 HP �76-15+
Microwave
Pole Light
Sign
' Standing Sections
5 KW Trash Compactor
$ 3 ��
Reinspection Fea $15 luue Fee
FEES
DEVELOPMENT SERVICES RE�UIREMENTS:
2oning Approved By
Building Approved By
Aooliotion laued Bv � n
$ 3
SUMMARV OF
BUILDING PEFiM1T $ �
PLAN CHECK $
PLUMBING 5
PLAN CHECK 25% $
ELECT(iICAL $ ��
PLAN CHECK 50% $ 2• .�i
MECHANICAL $
PLAN CHECK 25% $
j2.60 TL
Z
O
N
I
N
G
R
E
Q
M
T
S.
FEES
$ 3
SMIP $
PERMIT
ISSUANCE $
ENERGV P.C. $
GRADING $
MICROFILM $ �
TOTALFEE $
CONS�TRUCTION AND PLAf�NING
� � APPROVlALS Permit# �
/
1. T��Spo�ary Electrical Service or Pole.
�.
2. Soil Pipe-Undrgrnd. �
3.• Electrical Conduit,l�{ility-Undrgrn'd.
4.•E`lectrical Conduit-Undrgrnd. .
I Reinforcement.+ � '
6.'Electrical UFER Grnd.
..7. Footings .. !
8.'Foundation � � `� '= � . �
9. Water Pipe-Undrgrnd:� �•
10. �Structural Floor System
71. Property Sewer Line,& House ConFlection
12. Sewer Cap +. � �
13. Roof Drains� _. • �
14. Rough Plumbing .
15. Rou9h Electrical-Conduit -
16. Rough Electric Wiring .
17�. Rough Wiring Sign �
18. Rough Electrical-T Bar Ceiling,. ,
79. Rough Heating,& Air Conditioning•
20. Rough Factory Fireplace �
21. Ducts, in Structure . ,
22. Ducts, Ventilating � .
23. Gas Pipe-Rough & Test
24. Roof Framing
25. Roof Sheathing �
26. T-Bar Ceiling (Structural) & fvlonocoat
�.
27. Frame and Flashing ".
„
28. Lathing & Siqing
29. Insulation
30. Drywall Nailing
31. Plaster Brown �at '
32. Electrical Power Meter-Final
33. Final Electric
34. Final Heating & Air Conditioning �
35. Final Gas Pipe-Test
36. Hood or Canopy '
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service�Final '
40. Gas Service-Final -
41. Solar pomestic-Final
42. Backflow Preventer � �
43. Backflow Irrigation . . .
44. �Landscape Irrigation System
45. Sound Attenuation .
4fi. Handicap Reyulations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to $outhem California Gas Cc
51. CERTIFICA7E OF OCCUPANCY
Date
P00 iPA
Date Inspector AppROVALS Permit#
52. Pool & Equipment Location '
�� � .. 53. Steel� Reinforcement � -
� � � 54. Forms; . . �
� � 55. Electrical Bonding _
� ,56. Rough Plumbing & Pressure Test
� � 57. APPROVALTOCOVER-GUNITE
� � . 58. Electrical Conduit-Undrgrnd.
' ' 59. Gas Pipe, Q Undrgrnd., Test
' . - 60. Backwash Lines, P-Trep, O Undrgrnd.
• �� . 61. APPROVAL TO DECK
- 62. Backwash & Receptor-Final
63. Heater & Vent-Final
�64. Plumbing System - Final '
65. Electrical-Final •
D 66. Solar System-Final '
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit#
70. Underground Hydro
71. Product Piping OGas ❑Oil
� 72. Underground Flush
. - 73. Undergrnd. Storage Tank � Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
� 78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION -
, . FOOD CERTIFICATE ISSUED
-/l-�C4 No[es: .n� .i_ rl .>. //9�,,,.� _
1: "'
Date � Inspector
0
CI I'Y OF
. Projc.t ;Q
• Applica0u
Owner's �
Address
Arch/Eng.
Address
Contrac�o
u
Address ( r
City Licer
LICENSED GONTRACTOR DECLARATION
I he�Cby aHirm thal I am licensetl untler provislons ot Cnarte� 9(commencing
' with uction 7000) ot Division 3 of the Business ofessions Cotle, antl
my license is in fu or etfect. �p
` Licen Cla s _��� � �.L(_6.�
� Dat� 5%— Si9nature
"ORKERS'COMPENSATION
� ereby aHirm that I have a certif cate of c sent to zelf-insure or a certiiicate
� . WorkeR' CompensatiOn InSurance, Or a c¢rtlfietl cOpy thereof (Section
I .3800, Lab.� /1 - �///l � �
�" PolicY No. � � I —� (-`�omPdnY (/C �vL�
�Certlfiee opy is hereby furnishetl. ,
Cert ' copy i ' h the city Builtlin
, Date Applica
EXEMP ONF M ORKERS'CO PENS 10 DECLARATION
(Tnissection,neetl not be completetl if the per or on �rM�Etl (bl 0) or
Iess).
I certify that in the Performance of the wo hf<h this perm�t i5'i55uetl, I
shall not employ any person In an n s� as to become zubject tq [he
workers' Comoensation Laws �for-ia .
. DaCa • 9nature
'NOTICE: If,afte ing tbis tleclar i , ou shoultl become subject to the
Wo�ke�s' C nsdtion provi5ion5 f the LabOr Cotle, y0u must /orthwlth
comply w such p�ovi5ion5 0� this pe�mib sh , aeematl-revoketl.
CONSTRUCTION LENDING AGENCV
I hereby af/irm mat there ii a constr ' en9� ayen y tor the oertormance
� of the work for which t' rmit s ' ection 309� Civ. C.)
Lentler'd Name -
Lentler'z Atltlre
OWNERBUILDER OECLARATION�
1 hereby aifirm that' I am exempt irom the Contr s License Law for the
fo�lowing reasoP (Seclion ]031.5 Businessqn � fessional Cotle:.Any city or
county which requires,a permit to cons(r al r,7mprove, Oemolish or repair
any st�ucture, rlo� to Its issuance, a e uU [he applicant for Suth pe�mlt
Applicant to fill in all soatts exce0< those within �eavy Eoreer Iines antl sign a11 aporoDdate aeelantlans.
',�he Contractor's U�ense Law a01er ncMg wlth Section 7000) of
�;�imsion 3 of the Busin n� Prote 5 Ge) or that ne/she is exempt
'..aherefrOm antl th¢ b 10� lne alleg x¢mptlon. Any violation of Section �
�]031.5 by any nt for a permk subjects the appli<ant� to a civil
�enalty of not re than five huntlretl tlV(1�ars'(5500). ' ��
LJ I, as owner of the property or my employoez witn wag�s as their sole
comp¢nSatlOn, will tl0 the wo�k, antl Ihe' StrUctu�e I �ntl¢tl O/ ofte�etl
' for sale (Seclion 7044, Business antl Profe '�Cotle: The Contractor'S'
License Law Aoes not appry to an own Pt rly who builtls o� Improves
thereon, antl who tloes such wor If er itnrough his o� her own '
employees, provltleC that su prov ts noC mten0etl or offeretl for
salc. It,, however, the b g o� imp Me sbftl wi[hin one year of com-
Olelion, the owner ave [�e bur en ot provin9 ha/she tlltl not bulltl or Im-
prove tor the p of sale). - '
❑ I, as owner of tM1e pro0erty, am extluzively cting with Iicensetl con-'
tractorstd consiructthe project (Section 7 ness antl Professions COCe:
The ConVactor'S License Law does ly owner ot property who
builtls or Improves Ihereon, antl co r such projects with a con-
LldCIO( 5 �IC2052 O�fSOdOI IO COOI! L 5 LIrn� 6�LdW . I dfil dWdlE Lhdl
proof o� [heir Worker,'S pen5atlon ins aC�shoultl be provi0etl to me.
❑ 1 am'exempt under Section� B. & P. C. for tnis reason
N
Date
this
the above
xtlinances
TYPE OFCONSTRUCTION IJ NEW IJ ADD �4LTERATION lJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHE � _
DE R T N WORK/USE LDG. Q'� �
Le ' O �`.` ��—
TVPEOFPERMIT GRADING FOUNDATIO STRUCTURAL
❑ TENANT �ELECTRICAL ❑ PLVMBING MECHANICAL
❑ OTHER
PROJECT DESCRIPTION 5�. FT. 6 oCCUPtaNCY
CONSTRUCTIONTVPE �'�-� VALUATIONS��OO �
ZONE� GRADINGCU.YOS. ACRES
Remarks: '�,i i+ -i�' ��h � _�� ,
L �J
I
. : . PWMBING , FEES
low Preventer
low Irri9ation
Drinking Fountains
Floor Drains �
Floor Sinks
Gas Seivice
Interceprors �
Kitchen Sink
Lavatories �
Reinspection Fee
Showers
Service Sink
Sewer Cap. _ �
Sewer Connxtion
$0121 COII¢CLOfS
Solar Pipin9
Solar T
S ifn i g Pool''w/Spa •-
Urin
VV8 1052Y � ' '
ter eater
Water Service
Auto�Wash
- Laundry Trays �
�
$15 Issue Fee - $ 3
Boiler .
Duct - Under Ground �
Duct - Structural
Duct-Ventilating �
Exhaust System ❑ Multiple
Firepl/FacL Blt. IC80 #
Heating System & Ducting
❑ 0.100,000 BTU � 100,000
IDriver C¢ense or 55 � �-�— I ( Reinspeetion Fee '. I S75
CMF 0865-4fi, rev. 30/84 ' White - Buittling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor
Hoodor Typel ❑
Canopy Type II ❑
Refrigeretion System '
❑0.100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers '
Registers �
Isue Fee ' $ 3
0
A.P. �W
S Main Building:
E
T Front
ARear
C Right
K Left
S
Ping. Ref. #
Planninn Notes: M.�
2523 5/p7/F35 . 39.» TL
2one
Accessory Building:
- Z
0
ELECTRICAL ' ,
Automatic Washer �' � Transformer ❑ 15-50 KW �-
Construction Pole Sub. ' � 50+. KW
Cooking Unit � Meter ❑up to 100 amps
Dishwasher ' � Merer ❑over100amps
Dryers ❑Gas ❑Electric Sub Panel �
Fan Motors �0.1 HP O1 54 - 8
F.A'.U. Inc.Solar �9-15 HP 016-75+
Fixtures . Microwave - - -
Device Boxes Pole Light �
Outlets � Rarige � � •
Switches L
Garbage Disposal
Generator �0-5 KW 05-15 KW
� Reinspection Fee
�
DEVELOPMENT SER
Zoning Approved By �
Building Approvad By
$15
; Standing Sections
Trash Compactor
luue Fee
I'
� N
G
R
` E.
Q
M
+T
$
FEES 'n
�
$ 3
SUMMARY OF FEES �
BUILDING PEFiMIT • $ IGie� SMIP $ � �
PLANCHECK $ IZe�'rJ pERM1T �
PLUMBING $ � �SSUANCE $
PLAN CHECK 25% $ � ENERGY P.C. $
� ELECTRICA� $ 7•Y� GRADING $
� PLAN CHECK �50% $ � MICROPILM $ �
MECHANICAL $ "t%� TOTALFEE $ 3�
� PLANCHECK 25% $ � � zS '
�
,
� , dONSTRUCTION AND PLANNING �� P� .& SPA
� �� APPROVALS Permit #�- Date Inspector AppROVALS Permit # Date Inspecidr
�?, l�mporary Electrical Service or Pole � 52. Pool & Equipment Location
2: Soil Pipe-Undrgrnd., 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.� 54. Forms '
4. EI �ctriCal Conduit-Undrgrnd. 55. Electrical Bonding �
, 5. Steel Reinforcement ' -; . 56. Rough Plumhing & Pressure Test "
6• ElectricalUFER�Grnd. 57. APPROVALTO�COVER-GUNITE •'
7. Footings � � 58., Electrical Conduit-Undrgrnd. � :
- 8. Foundation � 59. Gas Pipe, �.Undrgrnd., Test •
9. Water Pipe-Undrgmd. � 60. Backwash Lines, P-Trap, O Undrgmd.
10. Structural Floor System 61. APPROVAL TO DECK
__. 11. Properry Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap ' . , � 63. Heater & Vent-Final
13. Roof Drains '� " � 64. Plumbing System - Final
�
b4. Rough Plumbing 65. Electrica6Final
15. Rough Electrical-Conduit �66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. flough Wiring Sign 68. APPROVED FOR PLASTERING
� 18. Rough Electrica6T Bar Ceiling 69. POOUSPA SYSTEMS FINAL �
- 19. Rough Heating &.4ir Conditioning � FIRE DEPT. REQUIREMENT
- 20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro �
22., Ducts, Ventilating - 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72.- Underground Flush '
24: Roof Framing . . 73. Undergrnd. Storage Tank d Gas ❑ Oil �
25. Roof Sheathing � 74. Overhead Hydro
26. T-Bai Ceiling (Structural) & Monocoat � 75. Dry Chemical
27. Frame and Flashing �� � 76. Dry Standpipe
28. La[hing &�Siding , 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing S y HEALTH DEPT. REQUIREMENT �
31. Plas[eY Brown Coat � 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric v Notes:
34. Final H¢ating & Air Conditioning 5 („��
35. Final Gas Pipe-Test . � � �
36. Hood"or Canopy . �
37. Final Factory Pireplace
38. Final Plumbing
39. Water Service-Final
40. Gas�Service-Final '
41. Solar pomestic-Final
42. BackElow Preventer � - a1
43. Backflow Iriigation � �
44. �LandscaPe Irrigation System � '
45. Sound Attenuation �
46. HandicaP Regulations � . . � �
47. FINAL STRUCTURE & BUILDING 8. S �
48. Special Requirements Completed •
49. Electric Release to Edison _ � r . , �''
�
50. Gas Release to Southern California Gas Co ' .
51. CERTIFICATE OF, OCCUPANCY � '.
No. � ��Jr� Dat� � , � � ,
City of Costa Mesa --
Development Services Department C E R T I F I C A T E O F O C C U P A N C Y No.
` Builj in9 Safety Division
' ' p. O. Box 1200
Cosia Meu, Califomia
The Building located at 3555 Harbor Gatewav South� Site B
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group R� Occupancy.
Use of Building nffica/W"harehouse '
Legal Description 415-091-04
ISee reverse side for Metes and Bounds)
Building Permit No, n 5�n7R Electrical Permit No. Plumbing Permit No.
Mechaniral Permit No. Number of apartments and/or guest rooms
ISSUED T0: BuildingOfficial ?bnv C:De Baca
r .T. cc,nurarrom !C Sons / - '
3555 Harbor Gateway So. by .% �� ��"" /� %f/�" � ��
�nar:, r�aa. ra S1A�26
ATTN: Geri Dace cX3tot�r 31. 1991
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. � �
CMF 1o15-a6 rev. 1/83 White � Owner; Canary - Numerical File; Pink � Bldg. Permit File
_ '3s?s,s : A�
oF cosra nnesa
iTR��CTION PERMIT
Addrev
Address
Contra [or
u�c vH/�=-.
t to �III in all soaces wi
P MIT NO.
�' �i.�
�-�-}da. ' 1
`cnnc Phona
eNPumort R�an
License No.
LOT NO. I' 8
TVPE OF CONSTRl7CTION
}� NEW ❑,A�D. ❑ ALTERATION
❑ REPAIR ❑ CONVERSION �DEMOLISH
❑ OTHER
DESCRIPTION OF-WORK
° S011'tYllanrl Hf R rnone � — L TVPE OF PERMIT �
AddIeSS �❑ GRADING . ❑ FOUNDATION ❑ STRU,�C(TURAL
LICENSEO CONiRA TOK-OECLARATION - O TENANT O ELECTRICAL �PLUMBING LfMECHqNICA
1 hereby affirm t�at I am Ilcens¢tl untler Drovlsions of Charter 9(com- .. . .
menting wlth section 7000) ot DIVISIOn 3 of tne Busin855 antl '❑ OTHER
Roteulons Cotle, ,antl my ucense is in full forca antl eftect. pROJECT DESCRIPTION �� � �-� - ��
Litense Class � - LI se N0. 1 1 d(ld(1 .
Daul i—R—R1 Si9nature . ' J SQ. FT. � —
�
WORKERS' COMPENSATION OECLA0.ATION - OCpVPANCV_CONSTRUCTION TVPH
I hereby affirm that I have a cerliflcate of consent to self-Iniure or a VALUATION ZONE
c•-'�fifale of Workers' Compensatlon Insuranca, or a•certifietl copy
vi (Sectian 3800. Lab. C.). GRqDING CU. VDS. ACRES
No.TT(`R—D1=1(19riComPanYTlni/��ra Tna_ (`n - ..
(u certNietl copy is here0y fuYnishetl. � -- — ' -REMARKS� ' � - dG
�y7( Certlfietl copy 15 filetl with the city Builtlin9 Dlvision.
EXEMPTION FRpM WORKERS' COMPENSATION DECLARATION ' - �i �.ZL�iN
(This section neetl not be complatatl i£ the Oermlf Is �or one huntlretl � i
S§300) or lessl. , � � _ —.
tertlty that in the performance oi the work for whlch this permil is _
Issuetl, I shall nof emPloy any person in any manner so as to become PLUMBING. - PLAN CHECK
suEject to the Workers Compensatton Laws of Calitornia.
Date Si9nature
NOTIGE: If at[er makin9 tbis tleclaratlon, you zM1oultl become subje<t ' TOILETS ' �-
to the Workers' Compensation provl5ions ot the Labor COCe, you must
farthwlth ComD�Y w�th sucn provisions or thls permit shall Ee tleemeU LAVATORIES
ravoketl. � � � - . _
�ONSTRUCTION LENDING AGENCV KIT. SINKS
I hereby atfirm that there Is a cons[ructlon lentlin9 agenty tor the per- SERVICE SINKS. �
tormante of the work for whi<b this permit Iz Issuetl (Sectlon 309]
Clv. C.. � . - �-.
LenGer.s Name •r� ' � — - FLOOR SINKS
Lentler'S Atltlress DRINKING FOUNTAINS
OWNEH BUILOER DECLARATION �� INTERCEPTORS
1 hereby a((Irm that 1 am exempl from.thB Contractor'S License law tor
the following reason (Sectlon �031.5 Bu51nes5 antl Professions Coae: SWIMMING POOL -
Any tlty or county which reqWret a permit to con5truct, alter,
Improve, demolish or repair any structur¢, prlor to Its Issuance, also re- yyqTER SERV ICE
qulres the appliwnt (or zucn permlt to fila a signetl statement tnat he
is Iicensetl pursuant to the provislons of the Contractor's License Law GAS SERVICE
�:�;�pter 9(Commen<ing with Se<tlon ]000) of DivlSion 3 Of [be
W;�>;,.,ness antl Prdessions Cotle) or that he is exemGt theretrom antl the weTro ururcoc '
I, as
wno builtls o�
or a permrt sub�ecis tne appll�
an iive huntlred tlollars (5500).
of the property, or my emplayi
on, will tlo the work,�antl the st
�le. (Section 7044. Business antl
. avn I.eneuy SEWER CONNECTIONS
wages ai t�elr SOLAR TANK
s not Intentletl
ons Cotle: T�e SOLAR PIPING SYS.
Of a p/Operly
ork himseli or ISSVE FEE
mmnoeo or onerea mr saie. iq nowever, me owmmg or imOrovemem
is soltl wilhin one year ot completion, the owner will have the bur0en
o( proving he tlitl not build or Improve for the purpose oi sale).
❑ I, as owner ot the prOPe�ty, am exUu5lvely conVacting wilh
Ilcensetl cOntra<tors t0 construct the project (Soctlon ]044, Business
anC Profasions Cotle: The Contrattor's LlcenSe Law tloes not appiy to
an owner of property who builtls or improves tberaon, antl who con-
tracts Irom such projec[s with a contractor�s) Iitesnatl pursuan[ to
the Contractor's Ucense Law).
❑ 1 am exempt untler Se<tlon B. 6 P. C. �or tnls
reason
Date Ownes
1 h¢reby clrtify thdt I nave radtl tbii aDP���tion.antl SfatB thal th¢ abova
information is correct. I agree to comply with all city antl �ounly
ortlinances antl state laws relatlng to mnsbuction, antl hereby authorizo
representative of thi city to enter upon t�e above mentionatl
property �pec � urposes. _ ,n /_
Signa[ure� ����� Date_" $-81
SHOWERS
URINALS
DOUBLE LR1V5
DISHWASMERS
SUMPS
FLOOR DRAINS
CIARIFIEfiS
P TRAP
ALTERATION
OVTLETS
BTU OUTPUT
MECHANICAL v�Aiv CHECK
NEATING SYSTEM 0-100,000 BTV �
ANDDUCTING �OO,OOO+BTV�
REFRIGE(3ATION 0-100,000 8TU_
SYSTEM � �OO,OOO+BTU�
BOILERS BTU
SVSTEM REPAIR�ALTERATION
EXHAUSTSVSTEM MVLTIPLE
Drivers' LicenSe or 55 � ' ' ISSUE FEE
CMF 0865-46 White-Builtling; fanary-Applicant; Pink-Ac<ounting; Goloenrotl-Astessor
l
•'i ' \ _
�_ '
ZONE
REAR YARD (TO P/L)
PKG. SPACE REQ.
57REET WIDTH
ZONING APPROVED BV
SPECIAL CON�ITIONS:
9312 !2/09/81
JG HEGULATIONS
PLNTGp. gR(E�F�. p#°�N,
PROPE�RTV LINE
PROVIDED
PARK FEE E
e
ELECTRICAL aLAN CHECK
SQ. FT. 5(]. FT_ '
GENERATOR 0-1KW_2-lOKW�
TRANSFORMER
APPLIANCE 10-SOKW_SO+KW�
MOTORS p-I HP_1-10 HP _
(INC. SOLAR) 30-SO HP_SO + HP �
FIXTURES OUTLETS SWITCHES
GAS TUBE SIGNS � -
POLE LIGHTS �
SERVICE
MAIN . SUB
AMP
9.00'
APPLIC.`ATION APPROVED BV DATE
SUMMARV OF FEES -
BUILDING � '
PERMIT $ SMIP E
PLAN CHECK S �'f
PLUMBING $ '
GRADING E
PLAN CHECK § .
ELECTFICAL $ $
PLAN CHECK $ MICROFIL.M $
MECHANICAL $.9•OO � TOTALFEES
PLAN CHECK $ LESS AO- . .
VANCEPC $_
FINA� FEE S OO
� I.�
- .�
, � i�
CONSTRUCTION AND PLANNISJG
APPROVALS ' ' Permit #
1. Temoorarv Electrical Service or Pole
11. Prope
72. Street
13. Rougl
14. Rougl
15. Rougl
16. Rougl
17. Ducts
18. Ducts
Pipe-Undrgrn
ural Floor System
'ty Sewer Line & H
Sewer Connection
Air
23. Insulation
24. Lathing & Siding
25. Drywall Nailing
26. Plaster Brown Coat
27. Electrical Power Meter-Final
28. Final Electric
29. Final Heating & Air Conditioni
30. Final Gas Pipe-Test
31. Final Plumbing
32. Water Service-Final
37. Handica
cu. hiectnc Fteiease to ttlison
41. Gas Release to Southern California
42. CERTIFICATE OF OCCUPANCY
No Date
, POOL & SPA �
Date Inspector � - _ `' �
APPROVALS Permit# -
43. Pool & Equipment Location
� 44. Steel Reinforcement
45. Forms
46. Electrical Bondin
47. Rough Plumbin & Pressure Test
48. APPROVALTOCOVER-GUNITE
49. Electrical Conduit-Undr rn
- 50. Gas Pioe. ❑ Undrqrn. Test
54. Heater
55. Plumbi
�56. Electri�
5y. APPROVED FOR PLASTERI
60. POOL/SPASYSTEMSFINAL
NOTES: •
- Date I � ,pecto� "
[!�5- �
r.�
�
�v
�
COSTA MF,�A BIi7LDING-SAFETY DEPAHTMEMT
• P.O. BOX 1200
81 91, I I/ I 2/81 � 4'3.00 TL�
_, Coata Mesa, Calirornia 56655-6
� � I I � I 1 � I TAACT NO. � c PERMIT H0.
REL'D BY 1 —
Contractor S0111"1113Rd H & AlY' COriCl IT1C �ot No. � h �%/ �
qddress 2g00 Ten le Avenue BUILDING USE DATE issueo
c��r Inn Beach CA z�P coa80806 /-/a "�/
State License No. 114040 Class. C-z0 eui�oiNe
City Licenu No. Tel. No. �ooxess 3555 HarbOr GdtG''�a8 SOuthq— Bld
N0. ITEM EAGM FEES COSTA MES�, C�UFORMIA, ��� ��
NEAREST /!� '•� �J
FAU, Wall, or Grav. cno55 5r. HdI'}JOi B1VCl. & Sunflaaer
Furn. Incl. Ducts and „� �l\ y
q vents 4.00 16 00 OWNEH C. J. S erstx�n & Sons
to 100 000 BTU
M�IL q{ ����
o�e� ioo.000 sTu �oopess 3315 Fairvi:ew Road
( Y
CITY N2 Yt 2aCh `(�jTEI.. N0.
Vent lif nOt incl. above) �},�� y
1 hereby ackno ledge that I have road this applica[ion
Sus ended Hea[er �-�� �
Alter or Rep�ace and'stateythat the above is corroct end agree [o comply
Appliance ,�w`W allyCity Ordinences and State Laws regulating HeaF
ver eet o -/���� �ing; Ventileting, Retrigeretion end Air-Conditioning.
gas PiPin9 fSl AC` I �••
BOILE RS OR \Y �' 1 certify [hat 1 possess the ebove velid State of Calit-
COMPRESSORS 'Q ��' omia classi(ication or I am [he legal owner of the single
�0 \ 6 0o farnily rosidcntial property described above.
3 H.P. o� less "v'
Over 3.. to \\ Signaturc ot
15 H.P. 'C � 1Y�
Permi[tee •
vantFan—Sin ie.oh�t'�
� �S 1y' REMARKS:
Ventilating�Hood
M� �.I\\.'�� -
b"
�PPROVALS IMSPECTOR D�TE
Ducts Underground
Ducts in Structure
Ducts Vcntileting
Heating — Rough
Hoods
Refrigeration Lines
Pressuie'{'est
$ub-To[ai 40 00 Air-Cond. Final
Ven[ilating Final
R��nspection Fee Heating Final
processing Pee 3 �� Refrigeration Final
Final Gas Test
TOTALFEES 43 0�
UtifitY Co. Notified
CMF044936 `. 7 BLDG. PERMIT NO. �� �
Y
\]_
L
� � ^ppliwnt lo flll tn all spaces within heavy UorGer Iines anE sign all appropriate tleclantlons. � _ _
CI�-0F COSTA MFSA pERM1T NO. TRACT NO. LOT NO. �BLDG. NO� � , .
� � CONSTRUCTION PERMIT
Address
License No.
Address
Coniractor� Phone
AAdrm
LICENSED CONTRACTOR DECLARAT�Vn
` h8feby dffifm [hat I aT IICBnSBC UnElf p�OVIzIOnS 0! ChaltBf 9(COT-
7nencin9 wilh sectlon 7000) o/ Divislo� 3 oT tne Busineis antl
Rofasslons CoOe, ,an0 my Ilcenze Is �� tull larce antl e/fetl.
�Llcense Class Llcense No.
Daie Signature -
WORKERS•COMPENSATION DECLARAT�ON
I hBrOby afti�m tha[ 1 hava a certlil�ate Ot consent t0 selNniure or d
'�Icaie of Workeri' Compensation InSuranca, ar a certlfiatl coOY
' of (Section 3800, lab. C.�. .
P�__y No. Company
❑ Certitietl copy I5 heraby turnliheC. �
❑ Certitietl copy I5 flletl with the city Build��9 Dlvislon.
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This seGtlon neeA not be Com0leteC If the-permit IS for one huntlratl
(E3001 or leal.
I cert(y that in the:periormance of the w4rk for which t�is permit is
Iisuetl, I ihall not emPloy any Oerson in a�Y ���er so as to bacome
subject to the Workers Compenutlon' Law4 of Ulltornia. —
D�a Si9nature
NOTIGE: If aftar making this tleclaratlon, You shoulE becoma suD)ect
to the Workeri' Compensatlon provisions Of the Labor Cotla, you must
forthWit� comply wit� such provlsions or this permit snall be tlaematl
revoketl. ' -
CONSTRUCTION LENDING AGENCV
I hereby at(Irm that thara Ii a wn5tructlaP lentling agency (or tne per-
to�mdnCG ot the wOtk f0/ wltiGh thli perm�� �z iuuatl (SeClIoO 3097
Civ. CJ. ' C ' . \ . L� . . � �.
LAntlO/'s NdmB
Lantler•s Atltlress
or <ounLy -wnitn rGqulre5 a
:mollsh or raoalr anv itruttur�
to tne orovlzlons of t
�
❑ I, a5 owner oi the prOperty, or my amP�oyee5 with wagas ai thelr
sole tompansatlon, wlll'tlo the work, antl the structure Iz not Intentle0
or o/feretl for sale. (Secllon ]044, Busine55 antl Rotesslons Code: The
COIIifdCtOf'S L�CCO50 Ldw tlOGi OOl dDDIV t� dn OWnC! O� d pIOpBlfy
thrOu9h his own employees, provltletl lhat sucn Improvemen[s are not
intentletl or of/ar¢tl 1or sdle. If, howav¢r, the bulltlin9 or ImprOvamant
is soltl wi[hin one year of complotlon, the ownar will have tne burtlan
of prOving he tlltl not bulltl or Improve �or the Ourpota o/ ule�.
❑ 1, as owner ol tho propnrty, am e%clusively contracting wlth
�icenietl contraclors lo construct t�a projPtt (Section 7044, Busineis
ntl Protessions Cotla: Tha Contractor's LlCense Law does not appry to
an owner o( property who bulltls or Improvas tncreon, antl who con-
ba[ts trom such pro�acti with a COntrada/(s) Ilcesnatl pu�zuant to
the ContractorY Llcenso Law).
❑ I am exempt untlGr SeCtion B. & P. C. for th15
reason
Date Owner
I �sreby certify lhatl have reatl this application antl ztate tha[ the abovG
IMormation is mrrecL 1 agrea to compiy �+��h all city and county
or0lnances antl slata laws relatinq to constru�tio�, antl h<r<by authodze
re0r¢SGntatives Of thi5 Nty to enter upon the above mentlonetl
prope:rty for in5pectlon purpozes.
Signiture -- Date
Drivers' Litense or 55 # - �
CMF 0865-46 White-Builtling; Canary-ApP����t: Pf�k-Accounting; G
TVPE OF CONSTRUCTION
❑ NEW ❑ ADD O ALTERATION
❑ REPAIR �O CONVERSION ❑DEMOLISH
❑ OTHER
DESCRIPTION OF WORK
❑ Gf2ADING ❑ FOVNDATION ❑ STRUCTURAL
❑ TENANT ❑ ELECTRICAL OPLUMBING ❑MECH/V
❑ OTHER
PROJECT DESCRIPTION. � '
S�.FT.
OCCVPHNCV�CONSTRUGTION TYPE
VALVATION ZONE
GRADING CV. YDS. ACRES
PLUMBING ' PLAN CHECK
BATHTVBS SHOWERS
TOILETS URINALS
LAVATORIES OOUBLE LAVS
KIT.SINKS DISHWASHERS
SERVICESINKS SUMPS
FLOOR SINKS � FLOOR DRAINS
DRINKING FOUNTAINS
INTERCEPTORS CLARIFIERS
SWIMMINGPOOL PTRAP
WATERSERVICE ALTERATION
GASSERVICE OUTLETS
WATER HEATERS BTV OUTPUT •
SEWER CONNECTIONS
SOLAR TANK COLLECTORS
SOLAR PIPING SVS.
ISSVE FEE
MECHANICAL . PLArv CHECK
HEATING SYSTEM 0-300,000 BTU
ANDDVCTING 100.000+BTU
REFRIGERATION 0-300,000 BTV
SVSTEM 700,000+BTU
BOILERS BTU
SVSTEM REPAIR,ALTERATION
EXHAUST SVSTEM MULTIPLE -
ISSUE FEE '�'''
A.P. #
20NE
REAR VARD (TO P/L)
PKG. S�ACE RE�.
'�f REET W IDTH
ZONING AVPROVED BY
SVECIAL CONDITIONS:
ELECTRICAL
PLNG. REF. �
PROVIDED
PARK FEE
PLAN CHECK
m�cnrivw 04KW_1-lOKW_
T0.ANSFORMER
APPLIANCE 10�50KW_SO+KW_
MOTORS 0�1 HP_3-30 HP _
(INC. SOLAR� 10�50 HP SO + HP _
FI%TVRES OUTLETS SWITCHES
GAS TUBE SIGNS
POLE LIGHTS
PANELS MAIN � SUB
SER V ICE AMP
ISSUE FEE �
APPLICATION APPROVED BV DATE
SUMMARV OF FEES . -
BUILDING
PERMIT f SMIP E
PLAN CHECK S PERMIT '
�LVMBING S �SSUANCE S
GRADING E '
PLAN CHECK 5
ELECTRICAL S a
PLANCHECK f MICROFILM E
MECHANICAL E TOTAL FEE E
PLAN CHECK 1 LE55 AD-
VANCEPC 5
FINAL FEE E
�
CONSTRUCTION ANDPLANNING � ' - POOL&SPA
APPROVALS Permit # Date Inspector ApppOVALS � Permit�#
1. Temporary Electrical Service or Pole . 43. Pool & Equipment Location �
2. Soil ipe-Undrgrn - ' � 44. Steel Reinforcement
3. Electricat �pnduit Utility-Undrgrn � � 45. Forms
4. Electrical �onduit-Undrgrn - 46. Electrical Bonding
. tee ein orce - - - 47. Rou h Plumbin & Preswre Test
6. Electrical UFER Grn - 48. APPROVALTO COVER-GUNITE
7. � Footings ' � 49. Electrical Conduit-Undr rn '�
8. Poundatiou �� � � �50. Gas Pi e, ❑ Undr m, Test
9. -Water Pipe-Undrgm � - 51. Backwash Lines P-Tra ❑ ndr m
10: Structural Floor System ' " 52. " APPROVAL TO DECK -
11. Property $ewer Line & House Connection - ' - � 53. Backwash & Rece tor-Final �
12.� Stieet Sewer Connection �' ' � 54. Heater & Vent-Final
13.� Rough Plumbing - �� - -
T4. Rough ElectricConduit - �56. Electrical-Final
�15. -Rough•Electric•Wiring �- 57. Solar System-Final '+� • � �
16. Rough Heating & Air Conditioning _ SL Ql • encing & Access Approval
17. Ducts in Structure � APPROVED FOR PLASTERING � �•
16. Ducts, Ventilating ' - - � �
19. Gas Pipe,Rough &Test � 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing '
21. Roof Sheathin ' • � �
22. Frame and Flashing NOTES:
23. insulation �
24. Lathing & Siding
25. Drywall Nailing
26'. Plaster Brown Coat
27. Electrical Power MeterFinal
28. Final Electric
29: Final Heating & Air Conditic
30. Final Gas Pipe-Test
31. Final Plumbina
37. Handicap Regulations �
38. FINALSTRUCTURE&BUILDING
39. $pecial pequirements Completed
40. Electric Release to Edison
47. Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY
No Date
i
i�
` _
Date _Inspecjor �I
i •;
�'•.
Applieant to fill in all spacea within
CIl1�F COSTA MESA PERM r
�COiVSTRUCTION PERMIT j�
owner [; • �' • ,�� � , ' ,(',p.�� Pnone
Address ��,3/ ,iCLthw.,,,.'p.w Y, �� .�.2.�� . `%h
ArchlEng. License No.
CAnLfeCtOr
LICENSED CONTRACTOR DECLARXTIOrv
I hereby atfirm Nat I aT IiG<nsetl Unde� p�oviSiOnS Of ChartGr 9(Com-
menUng wiN-settion ]000) o( Dlvlsion 3 of the Buslness antl
Professions Cotla, antl my Iicensa is In �utl force antl eftect.
' /99 � ^, o
Lltense Class �' ' � lJcensa No.
Date 'P� ��� �� Signature �•
WORKERS• COMPENSATION DECLARATION -
I her¢by af(Irm that I have d Cert(�icate of COnsent to Se�f-insu�e o� a
-`%ficate of Workers' Compensa[lon Insura��e, or a certitied copy
'of (SectiOn 3800. LaD. CJ. •
,Y No. /A // .2 tl F ComPanY ���_.✓
❑ CertitieC mpy i5 h!rlDy fu�ni5hetl.
� Certifietl copy is fileE with the clty Builtling Division.
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This settion neetl not ba completetl i( �the permit is for one huntlretl
(5100) or less). ��
1 CBrtrty that in [he performance of the work tpr w�ich. thlS permil is
Issuetl, I sha11 not employ any pnrzon In any �ynner so as to become
subje<t to the Workers' Compensation Laws ot �Iitornia.
Date Signature
NOTICE: If atter making this tleclaratlon, yoy shoultl become subject
to lhe Workers' Compenzalion provlsions of th¢ �pot Catla, you must
fOrt�aith comply wlth Such provl5ion5 or thl5 perTil Shall be tleemetl
revoketl.
CONSTRUCTION LENDING AGENCV
I h<reby a(tlrm Ihat there IS d COnitruCHon Ieqtling dgtnty tOr the per-
tormancG of the work for which IbiS permit IS ISsucO (Section 309]
Clv. 0.).
Lentle�'S Ndme
Lentler's �AtlUres; ' ' ' -
OW NER BUILDER DECIARATION � �
I nnrrnv a/firm tM1at I am ¢zemot trom the Conlrauor'i Llcenzo�Law �or.
or
Is IlCenz¢tl pulsuant t0 th0 provliloni Ot in¢ CbnVdClor'S Llctnse Ldw
apter 9(commencing witn SetNon 7000) of DIVISion 3 0l the
n¢ss antl Prd¢ssions Cotle) or [hat he Is eXempl thOr0lrom antl th0
; for lM1c allegetl exemption. Any dolation oi Sectlon �031.5 by
any applicant for a permit subjetts the appq�anl lo a tivil penalty
of not more tban live huntlretl tlollars (y500),
❑ I, as own¢r ot the propGrty, o� my am010y¢es wilh wagei as thM/
sOle compinsalion, will tl0 tho wo�k, antl Ihn =(ruCturB is nOl Intendcd
or ofl¢retl fo� sale. (SeGtian 7044, BuSin¢ss antl AOitssiOns Cotla: The
tM1rough Mis own employee5, provlao� tnat sucp Improvemen[s ara not
Intentletl or otferetl for zale. It, howevur, the bullGing or improvemont
iz soltl wlthin ono year of compbtlon, tha owner will hav¢ [he burtlen
ot proWn9 he tlitl not builtl or Improve for the purposn oi salo).
❑ I, as own¢� Ot t�e pr00¢/ty, aT Cxclutivety contrdtting with
licensetl contractors (o wnstruct the project (5¢�tion 7044, Business
ane Prolessions Cotle: The Contractor's Llcenze �aw tloes not apply to
an owner of prOperty who builtls o� ImprOv¢3 lheteon, dntl who con-
traGts (rom such pro�¢Cti'with a coOtrac[o�(5) IIC¢Sn�d pu�suant to
tM1e Con[ractor's License Law).
❑ I am exemp[ untler Section B. 6 P. C. �or this
reason
Date Owner
I her¢by certi(y [hal I have reatl t�is.appli�atlon anE stata Ihdt [he abOve
intormation is wrrecl. I aqree to comply with all City antl county
ortlinances antl stale laws relatlng [o constructiOn, antl hereby authorize
Fepresen[a[ives of this city lo enler upon Ihe above menllonetl
property for pecU purposes. . .
Signature ���V' � � _ Date � /°1-QJ
bortler Ilnas anG si9n all apD ata avclarations.
TRACT NO. I.,OT NO. BLDG. NO.
/o�'^G� 5 g-3oG
TVPE OF COOISTRUCTION
� NEW ❑ P.DO ❑ ALTERATION
❑ REPAIR ❑ CONVERSION ❑DEMOLISH
❑ OTHER
DESCRIPTION OF WORK
TVPE OF PERMIT
❑ GRADING � ❑ FOUNDATION ❑ STRUCTURAL
❑ TENANT ❑ ELECTRICAL �PLVMBING ❑MECHAI
❑ OTHER
PROJECT DESCRIPTION .
5�. FT.
OCCVPANCV_CONSTRVCTION TVPE
VALUATION � ZONE ` `
GRADING.CU. VDS. ACRES
REMARKS: ' �� � �
PLUMBING "PLAN CHECK
BATHTUBS SHOWERS
TOILETS 6' URINALS '
LAVATORIES �j DOUBLE LAVS �
KIT.SINKS DISHWASHERS
SERVICESINKS SUMPS �
FLOOR SINKS � FLOOR DRAINS
DRINKING FOUNTAINS
INTERCEPTORS � CLARIFIERS
SWIMMING POOI PTRAP
WATER SERVICE ALTERATION
GASSERVICE 7 OUTLETS �„p,�
WATERHEATERS�p BTUOVTPUT
SEWER CONNECTION$ �,
SOLARTANK CO�LECTORS
SOLAR PIPING SYS. - /��2L�y �
ISSVE FEE
MECHANICAL PLANCHECK
HEATINGSYSTEM 0-]00,000BTV_
ANDDVCTING 100,000+BTU_
REFRIGERATION 0-300,000 BTV_
SYSTEM 100,000 + BTU _
BOILERS BTU
SVSTEM REPAIR,ALTERATION
E%HAUSTSVSTEM MULTIPLE
ISSUE FEE "
O�iV¢�5' Lic¢OSC o� 55 � / ' ) '
CMF 0865-46 While-Builtling; Unary-Appli�nh Pink-Accoun[ing; Goltlenrotl-ASsessor
A.P. �
ZONE
3667 3/cQ/EI
�
:ONING REGULATION
PLNG.REF.qf
REAR VARD (TO P/L)
PKG.SPACE RE�.
STREET WIDTH
� ZONING APPROVED BY
SPECIAL CONDITIONS:
ELECTRICAL
PRO V I DED
PARK FEE
PLAN CHECK
GENERATOR 0-1 KW_ 1-10 KW _
TRANSFORMER
APPLIANCE 30-SOKW_SO+KW_
MOTORS 0-1 HP_1-30 HP _
(INC. SOLAR) 10-50 HP 50 + HP _
FIXTURES OUTLETS SWITCHES
GASTUBESIGNS ' .
POLE LIGHTS "
PANElS MAIN SUB
SERVICE ' AMP "
Ip4.r'� dl.
APPLICATION APPROVED BV � ' DATE
SUMMARV OF FEES
BUILOING
PERMIT 5 SMIP E
PLAN CHECK $ PERMIT
ISSUHNCE S
PLUMBING S� • GRADING E
P�AN CHECK S '
ELECTRICAL E b
PLANCHECK g MICROFIWI $
MECHANICAL b TOTAL FEE $
PLANCHECK E VANCEPC'S_
FINALFEE 51L���
, _��_
CONSTRUCTION AND PLANNING
APPROVALS Permit # -
1. Temporery Electrical $ervice or Pole
rn
8. Foundation �
9. Water Pipe-Undrgrn
10. Structural Floor Systpm
11. Property Sewer Line & House Connection
12. Street Sewer Connection
13. RoughPlumbing�,,,�����p� �
14. Rough Electric-Conduit �
15. Rough Electric-Wiring " � "
16. Rough�Heating & Air �nditioning
17. Ducts, in Strucwre
18. Ducts, Ventilating
19. Gas Pipe-Aough & Test
20. Roof Framing
21. Roof Sheathing
22. Frame and Flashing
23. Insulation -
24. Lathing & Siding
25. Drywalt Nailing
26. Plaster Brown Coac
27. Electrical Power Meter-Final
31
nal
I
Final
37. Handicap Regulations •
38. FINALSTRUCTURE&BUILDIN
39. Special Requirements Completed
40. Electric Release to Edison
41. Gas Release to Southern California
42. CERTIFICATE OF OCCUPANCY
No Date
�
Date
7s� i✓ /
POOL & SPA '
Inspector '
APPROVALS Permit #-
43. Pool & Equipment Location
44. Steel Reinforcement
45. Forms
46. Electrical Bonding �
47. Rough Plumbin & Pressure Test
46. APPROVALTO COVER-GUNITE
49. Electrical Conduit-Undrarn .
56. Electrical-Final
57. Solar Svstem-Final
60. POOL/SVA SYSTEMS FINAL
NOTES:
0
�
Date
I nspect,or
e
f�`� c�.g-i �cv,u y
ADV���ant to fill in all ipaces within �eavy Eo�Eer lines antl si9n all app�opriate tleGla�alions.
�CITY OF COSTA MESA ' PERINIT NO. TRACT NO. ' LOT NO: � -BCDG.-NO.
CONSTRUCTION PERMIT ,� � 9��� '
. Project Address � ' (j � � ' RTnVPE OF CONSTRUCTION �
� OWn2r - ' Phone ' `- ' �pi�NEW .O ADD. - O ALTERATION
:'Address'-' -•�' - -� - '� �- � � - • --- - - - �O�REPAIR-0 GONVERSION--�DEMOLISH v
� � A�Ch/Eng ' _ '( "_' _- - :''� LiCense-No"'- - - � 07HER �� + '
,-Addre55 DESCR PTION OF WORK �✓ b �A4 �A'r'�.
� � , �_
I 'Contrector�� - T �-y ' ;,' ' 'j, - Phone ,SVPEAF.PERMIY, - .,. "" �- `�-�
\ q�Jdfess � ' -" - - ' '" -- p �"' ❑ GRADING .- -O'FOUN�ATION �'STRUC
1, LICENSED �CONTRACTOR DECLARATION�- ---- '-� • � O TENANT- � ECECTRICAL�-OPCUMBING �I
�� I hereby atfirm thtt I am Iicensetl untler provlslons ot Charter 9(com- .� �� �.+ ;�
r mehcing'with' sectlon •7000)--ot }-Dlvislon�3 of-the 6usines5- antl� - � O7HER-� �� �-^
Professions Code antl my Ilcense is in full force antl si(ect.� ' "' ' � �
i . _.' - S '- - ''-'"^ ".. --��./�R.Q/_ .'PROJECT�DESCRIPTION -' .�''__'_ '
�- . l
'_' ` _' ' ' _..._" . _.__ �,._
. , ,,��� ,�;e:•-�• , �.O.t:3073000�
: � . �,_, - 3036 `3/09%H2 � .00 GA
- ' '__ _ . ' '. ' .. ._ _ ... ';�, -,
�� _" " .i � ^- -- .,-..
ZONIPIG REGULATIONS�� �i :,�u; � -
f A.P. 9f . _ . n . ..'. . . '„ _ f' "'
ZONE � � �PLNTGp RgUEFp,�,��
+SgETBHCK L T. PROPERTY�LWE'� - �
. "'. ,LEDETVARD '_ __ . _ ' .� '�-i�. �.. _ , " ' ' ;
NICA SIDE VA _ ' ' .," ' . _ _ _.._ .� `• • , -
1 RIGHT ' �:+.�1�'�r � .Z
""' ' REAR VARD (TO P/l)_' _ _ " _'_ ..-",�„�-i _'._- ,
� q�:�:ny arnrm mac i nave a cer[incaie or wnseni co seir�msure�or a� V'ALUATION ''}`�" �' ZONE ' v� � �� ' `� � �' 1
� �.��;Ute'Ot'Wo�ke�5` Compensation-InsuranGa,-o�-a Certi}Ietl•COpY' - - �-- - - --- � .-- --- - � - -� - � � � --
I th :-bf (Sectian 3800, Lab. CJ. � : GRAD�NG CV. VDS. �• � ACRES � 'SPECIAL CONDITIONS: �, ' �,,, •; r� �
PoIiGY No. "'" _ :.� _ ComPanY� _ _..�. "' _ . " '_ _ . __.. _ _' ', _ ' _" _ " ' "-! - _" _ _ .-,. . _
r
�-Certifietl�copy is hereby furnished.- - - • _ -. . . _. . . _._ ,.... ' 'REMARKS t + . , ._ ._._' ^. ._ , ��r � _ �
i ri i
���. Certifietl copy Is �filetl with the citY Bwltling Drvision. � Q"' ��� � '�� � ��� , tiii;y %,� ,a.(
,EX6MPTION FROM WORKERS'��COMPENSATION-DECLARATION' " - pf: � rG�'" -' ` � " ""' -'"-- -" - '" ' - ' - � - !
�(This section neetl. notbe.completetl if the,permiLis for. one hunareG . _ _ 1�., �� __„ ._ _ __ �_ .. _ . _ _ _ _ _.,_ _ ''�__ _� _e�� ' - �
.(S1tl01 or less). . � ' ' ' • � �. . . _. . - � .
'I. ceftity t�at.in th¢_performance oi.the work (or_which this,.permiUs -- �
IssuBtl, I shall not employ any perzon in any manner so as to.become � PIUMBING� r�_ ��" PLAN CFiECK ��- �4 + iELECTRICAL - -` ���PLAN�CHECK; .���
subject to the.Workers' Compensation Laws.oLCalifornia. . ' , ' ' " ' '
+ ... BATHTUBS . .._ �- - SHOWERS "_ """_ ' '_ _ r. _� " � _"'_" "" "'; "" .' . - • . � - -' .�
Date ' Si9nature " ' '
.N0710E: If after making this tleclzration, you ShoWtl become subjeU. - TOILETS�- ���n� -�,VRINAL'S --' --'�•`-- -" "GENERATOR" py'KW_1-10�K4V, ,�', ^�r i
to tpe Workers' Compensation provisions of tne Labor Code, you must � � ' - TRANSFORMER •- ��' � �
tortl�s`/Itn Compb with sucb provislons or this permit shall be tleemed LAVATORIES DOUBGE'LAVS--` -"'�'"' -' `-"�'APPLIANCE' ' 30-50 KW_50+KW" ""' 4'
�evOk¢tl._._ "'._ _ -'_' ' �_'_ "`___ _ ... _ . ,
' CONSTRUGTION LENDING AGENCV � �KIT:�SINKS�' y-- -DISHWASFIERS-" - � '-- - '�MOTORS- -- ""p=1-NP'_Sd'0 HP'"'- "�-" � - -' `
'1 heteby aifirm that there Is a consVuttion lendin9 agency tor the per SERVICE SINKS �'� "` SUMPS-"' ` "'� '-' -' -'•<<NC.�SOLAR)--1PSO�HP-=-SO�+�HP�• - -- - i
, forrr�ance of tne_ work for which this permit is Issuetl (Sectlon 3097 �-�• �'� t
' . � .
�CIJ:C:)' ._ .._. . __�,._. _.�._..._ ..." """" .-e-.__ .,..
Lender's Name FLOOR SINKS ~� �� FLOOR DRAINS p ' �'FIXTURES - "OUTCETS" SWITCNES'"' " 1
�Lender'S Atltlress ORINKIfVG FOUNTAINS' -�7 "'--�' �"'-' '�"'--""-"' �GAS'TUBE'SIGNS'" - '"-" '-'- 1 -' -""" " �
OWNER-BVILDERDECLARATION """''- ' ' "-' "" ' '' "- "'- "' � '° ------
INTERCEPTORS CLARIFIERS � "� `- ' POLE LIGFITS'"-"- -"--'- '"" "' -`- -� " '
I hereby affirm that I am exempt (rom the Contrac[or's Lic¢nse Law for � I �� - �t
the following'reason'�(Sect�on �031-.5 Businessantl ProfeSSlonsCotle: SWIMMING�POOL- ' 'PTRAP-"' - ' - ' '"' - -^ ' "--" '
Any city or county which requires a permit ta construct, alleq � � � �POLES �METERED +SUB�..'� � � �
imprbve, tlemolish or repair any struc[ure; prior to,its'issuante, also re• �yyqTER SERVICE ALTERATION -� -. � �� ' - PANELS ' -'-MAIN ' � - '.SVB - - ' -
qu ':,;the ap.litant tor SUCh permit to file a Signetl StatemEn[ Ihat he - - � •• " '"
1 �'t . :
is �3¢tl'pursuan['to the provision5-of'the COntractor'S License'Law --' - - - --� - • - - - .
(G`� �ar 9(commencing with Sectton 7000) of Division 3 of the GASSERVICE � OUTLETS 'SERVICE- F\MP'
Bu{f��is"antl'FrWesslons'Cotle)'orShat'he'is'exempt theretrom antl tM1e" ' yyqTER HEATERS ` '"BTU OUTPOT'""""' `, ' " - "' -"" '--'"-�' - ' ' '" ' ' - �
basis for t�e allegetl exemption: Any, violation of Section 7031.5 7y '� � ' r �
any'appllranY(or'a permit subjects'the applicant-to�aciviP�penalty "SEWER�CONNECTIONS - "" - �""'- - • ' ' -""' ' '" - — - " � ' �"
of nJ[ more than five huntlretl tlollars (y500). �� •�
'' """_ "'_ "'_ " ""_ _ _'"' _ .` . _ " _. �.
.._�".�t-.. �
'� 1, as owner of the property, or my employees with wa9e5'as thelr SO�AR TANK - ,_ - � COLL'ECTORS� l`-'- '-" " -' - -- ` - ' '"- "-'�- "-�-"'� ^' " '
. � i . _" - .,_�.�.r �
Sole.COMpenSatioa„will tio t11e_wo[k, anG,fhe 5V uctu�e is_pot;infentletl ' " ' '
_""__" _"____ .__�___ ' . _�-.- .. .." "_" �.._"." �
or otferetl for sale. (Sectio� 7044, Business antl Professions Cotle: The SOLAR PIPING SVS. .� � � '�ISSUE-FEE �
ConVactorJs.License. Law tloes noLaPPly_to.an.owner of a property. .. __. __ , ___.J_- . . ,.t . ._ - !qppLICATION'APPROVED�BY- - - -�'-DR�TE � '- �
wno builtl5 or improves tnereon, antl who tloes such work himSeH or ISSUE FEE
l Ihro�9h_hi5.ow0.¢mployees, ptovitled.thdt SUCh ITprovem¢n[5 arE not �' '� _ - _�
�,J intentletl or offeretl tor sale. Ii, howeveq the builtlin9 ar improvement MECHANICAL = PLAN CHECK � SUMMARV OF,FEES -,� � .G
N is.soltl_within one year_of completion„Ihe owner will have lhe burden - - ' ' -�' `± _ _« � 't- __ ^
nl of plovin9 M1e tlitl not builtl or �mProve for the purpose of sale). HEATING SYSTEM 0-300,000 BTU BUILDING- -
� ��' I-�as owner ot �the �property, �am-exclusivery contracting-with �PERMIT 5 % p•' SMIP'.y 1 8'
� '-ANDDOCTING-' - ' �,
IICenSetl'cm[ractors to mn5truct the project (SeCtion ]044, Busine5s ]00,000�+8TU ;pLANCHECK E �PERMiT � .
antl��Pofessions Code: �The�Contractor's-bicenze•Law�tloei not appry to- ' - -' - ---- - -- � --- -ISSUANCE E- - — �
I an oWner of property who builtls or improves thereon, antl who con- � REFRIGERATION 0-300,000 BTU tPLVMBING $ �,r��• �. � •yb� ,',-�
tratt5'from such-projects��with a contractor(s) �Iicesned-pursuanbto SVSTEM� - -- �•' -! - -- - - , - -� ---- - - GRADING-B' '
the Contractor`s License Law). � . �300,000,?BTU � � �PLANCHECK �E_� _ �.�' ��ji f� �'�; , -� �r;�.� . _�;;. '
❑ I 3m Cx¢mpt untlEr Sectlon - - B. & P. C. fo� [his - - ' - - "' -" ' - ' ""-' - a '
� , BOILERS BTU � �ELECTRICAL'E �„ ,•� . � �
reason" .."- " ' ' ._.� _. .. ' " - ' - . _'�"_ 'MICROFILM S`
.SVSTEM REPAIR. ALTERATION � : �,. *PLAN CHECK"-$" - _ �
Date Owner � ' � � - � TOTAL�FEE�B•' , !
MECHANICAL'=$ ' " '+ - i
I hereby certNy tha I have reatl this application a C State that the above EXHAUST SVSTEM MULTIPLE j � t��. u• ;�,• �e ^ � LESS AD- - �• ''
intormation is c i�ect. I agree to comply w� zll city a�C county� �� ; PCAN'CHECK- E'"-- ' -- 'VANCE PC S- �� -
ortlindnces antl <e laws relating to tonst�uct' antl here0y autho�il¢ '
representafives r tni city to e ter up the abave m ntio d , }�E� (,�%� i'tlE'/��' -C 17°`'�.eUf�L'
P�oPe�tY. � �� sP � n.P s C /� �� .
Signatur Date - �' , ._ .. .__ �8�: .. ._ FINAL FEE, $
DriveR' License or 55 � ' " ' - �SSUE FEE -' � - --- - - - - - - - --- - - � - --- - - -
CMF �865�16 White-Builtling; Canary- Pink-Accounting; Goltlenrotl-Assessor
,,,,,�-+` "
�.
Applicant Lo fill in al1 soacas within hnvy boraer lines ana sign all avP�ooriate tlaclanUons.
CITY OF COSTA MESA ' v RMIT N. ' TRry� T NO. ' LOT N BLDG O.
CONSTRUCTION PERMIT —,O Q ' IO�j1 (� Q� ?j �cl �� 0446 6/30/�2 455.46 `rL'
Project Address � � �
� � TYPE OF CONSTRUCTION .
OwnerG .' PhO�¢ �NEW ❑ ADD ❑ ALTERATION � ' - � � � . .
�AddreA�, � Q� " ❑ REPAIR ❑ CONVER510N ❑DEMOLISH ` " ZONING REGULATIONS � � -'
rc /Eng. License��No. � � ❑ ort�ea � '
DESCRIPTIONOFWORK P"P'�� Z � �
`Addre55 � .r. � 20NE � PLNG. REF. �
�Contracror - � - Phon � � TYPEOPPERMIT' " ' ����i �ING
SETBAC N
�AddfeSS � ' _ ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL � I VARD � .
WCENSED CONTRACTOR DECLARATION �� �
I hereby affirm th:.f I am Iicenietl untler provislans ot Charter 9(com- �TENANT �� ELECTf11CAL OPLUMBING �MECHANICA S�Ip Hy - - i _
mencing with se<llon 0000) o/ ,Dlvlsio0 '3 of the Buslnezs -antl- �❑ OSHER .- - .'. R G T
Protesslons Cotl antl my Iicensa Iz In tull /orce a offecL REAR O � �' . ' .
License iass , - �� se�Ny PROJECT DE CRIPTION- . _ _ _ , _ ' ' _
/ SQ.FT.� ��' � 'PKG E PROVIDED,
Date ��— Signatur '- ' . - ' - - � ' - --
WORKERS' COMPENSATION DECLARAT19 . .' � OCCUPAIVCY' � NSTRUCTION TVPE _ STRE T W TH PqRK FEE S. ,
I her<Dy affirm tnat I hav¢ d C¢rtificate oVEonsenl lo saH-insure or a VALUATION ZONE �ZONING APPROVED BV DATE
'Hfiw[e of Workeri'-Compensalion Insurance, or a cerU(latl copy - _ . _ . . '
eot�5a� op,,�yq��aE C.). . GRAOINGCVnVDS. � ACRES �SPECIALCONDITIONS: ..
.cY Ne (_��f'1L710�'ComPanv LiO�2lPLT►1�i1� ' - _ _ ' '� .�O _ D L "
U Certifietl COpy is hereby fumizheU. - - - - REMqRKS: ' ' . _ _ . . _ . _ . _ .. . _ � , . _ _
❑ CertifiGtl Copy I5 tiletl wi[h Ih¢ tiry Build��9 DiWslon. ' ' '
E%EMPTION FROM WORKERS'�COMPENSATION DECLqRATION ' ' - � - �
(ThiS'se<tion neetl not.be mmpletetl. if ths Permit is for one huntlretl
SE300) or lessl. ' perinit is • ' ' ' -~ - - _. � _ ; _ �
certifylhat in the�performance o( lhe wOrk for which lhis
issuetl, I shatl not employ any perzon in anY manner so as to be<oma PLUMBING .' •� PLAN CHECK ' EL'ECTRICAL" ' PLAN CHECK '
subject to-0�e Workers'.Compen5dtion Laws ot Cdlifornia._ _ ' _ •
Date Si9nature BATHTUBS -� ""�SHOWERS " '" - ' ' - ' - y
NOTICE: If after making this tleclaration, You shoultl become�subject -TOILETS � •��URINALS' " - 'GENERATOR 0-1 KW=1-10 KW '
lo th0 WOrkers' CAmpensation p�ovlsions o7 tM1e Labor Cotle, you muzt � TRANSFORMER �t
forthwltn comply wlth such provisions or this permil shall ba tleemetl LAVATORIES DOVBLE LAVS ' APPLIANCE ' 30-50 KW=50 *�KW -
/Gvoketl. � __ '� .. . . _.. . ..
CONSTRUCTIONLENDINGAGENCV ' KIT.SINKS ' DISHWHSHERS' 'MOTORS Od'MP_1'AOHP� '
I hereby ailirm tnahthem I5 a wns[rucUon.lentling agency tor tbo per _SERVICE SINKS � 'i SVMPS - � ONC.150LAR) 10-50 HP'_�'i0 + HP ' '
tormince,oLthe^work for_wbith thi5 perfn�t is;.i55uetl (Sattlon 3097' ''
CIv:CJ.- "�� a`�- •� ' - - �' FLOORSINKS- �FLOOR'DRI11N5 - � ` !FIXTVRES� "'tOUTLETS' SWITCMES '-' '�
L¢ntler'S WmC '� . '
Lenaar•sAtltlress, ,� - ORINKINGFOUNTAINS�' ' " "' GASTUBESIGNS - . - -
OWNER BUILDER DECCARATION 1 "" � '` � � ' " - .� ' - - ' �
I haraby aflirm that I amOxempt iromlhe.Contracmr's LI<enze Lawdor �NTERCEPTORS � �- CLARIFIERS 'POLE UGHTS -
tne following reason (Settion �031.5 BuSinazi�antl,Profesilon5'Cotle: SyyIMMING"POOL"' " PTRAP ` . " -
Any city.or county'whicl4requires�a,0ermit to�construct,.alt¢r, POLES � METERED SUB
improve, tlemolisn or repair any-strutture, Prior tB its�issuance, alio r¢-' 'yyqTER SERVICE� '�.� ALTERATION - ' PANELS MqIN -SUB ' �
qul[e5.the ap.11Unt tOr suGtijp2rmit�to�file a signetl statament�that h¢' • -
is Iicansetl' pursuant ro tne prOviiiAns-of the Contractor's'L`icen5e Law GAS'SERVICE �� �� OUTLETS �' SERVICE �- �AMP �
� (�r�,?ter 9.(commencing witn Section ]000) of,�Division 3�'ai the� � - _
['1" T]55 antl P'ole55iorh' Cotle) or�thaChG15'exempt theretrom antl the yyqTEQ HEATERS' - ' BTV OUTPUT " - - ^ ' - - ' - - - - -
G-'��fb.ior tne allegea exemptlon. Any'viola�ion of Section 7031.5 by �
aity xpplirznt for a� permi[ subjects [he aPP�iwnt to a-civil_Oenalty SEVJER'CONNECTIONS ' � - - � - - - - - � -_-
of nol more than five M1untlretl aollars.(b500).'' •�ti .�� _ - -
❑ 1, 55 owner b( ihe O�oDerty;.or my emP�oyees with wagei as-their . ' SOCAR TANK - � � - ' - COLLECTORS ' - - - � � � - � - - - - -
Sole,COTpenution; will ao the'Work, antl'the structure�iz ml intentletl' ' '
or offered tor wle. (Section'7044, Businezs antl Profezsions Cotle: The -SOL'AR PIP�NG SVS. � � - �' �SSVE'FEE - � - � - -
Contractor'S:ticense+Law tloes not apply to an owner-of"a property_ - -
who builtls or impr_o'ves thereon,•antl who does�such work,himselt;or ISSUE FEE .� '� -" ' 'APFUCHTION APPROVED BV -�DATE -- -�• �
th�ou9h hls Own empl0yee5, O�ovitlefl' [hat such_iTprov¢epents are not �
Intentic0��or oflerea tor sale�. Ii, nowever, t1�e builtlin9�or improvement MECHANICAL � � . PL•AN CHECK �-
Is sold withln one year of tOmpletion, the owner will have tne burtlen -'- � SUN� ARV�OF FEES. �
ot provin9 he ditl not tiulitl or -improve �o� the purpoie of sale). . -'BUILDING - �[ . � 7 •� /'
HEATINGSYSTEM 0-IOO,OOOBTU PERMIT yaJ/ •�D� SMIP - E�% ��Q_
❑�I,�as owner o� tne o�ooe�cy,•am.excius�veiy contracting.wilh. qNDOUCTING ' %��.�� -- ' .
Iitensetl conVactors to Construtl Ihe proje« (�ttlon ]044, Bu51ne55 ]00,000 + BTU PLAN CHECK f L-LR_LCG PERMIT �
antl Profe55ion5 Coae: Tne Contractor's LlEense Law tlo05 not apply to � ISSUANCE S
dn owner of property who builCs or Impr0�e5 thereon, antl who con- REFRIGEFATION 0-100,000 BTU ;PLUMBING E . y
tratb from-Suth �proj¢Cls with a contra<tor(s)- IiC¢snetl pursuant to $YSTEM .
300,000 � BTV ` • PLAN CHECK GRADING� E
the ContractoPs License Law). E, , � „� ,
� I amexempt untler Settion ' B. & G,C.lorthis BOILERS BTU ELECTRICAL E- 'S ,
rGason - -- - P�ANCHECK 5 MICROFILM S
SVSTEMRE�AIR,ALTERATION - �
Dato Owner ' � TpTAL FEE E' � �
1 Oereby tertifythat I have rea0 this application antl state that the above EXHAUST SVSTEM MULTIPLE ' MECHANICAL E ,
fnformation is correct: I agree to'comply �+�th all city antl county , PLAN CHECK S �LE55 AD• � .
o�0inance an te Iyws relatlng to con5t�u[tlon, dntl hGreby au[ho�Iie ' ' _ VANCE PC E-� "
reprez¢ntal o ltlf city to enter upon the ab viy*� e�tly� ed �. �, '� '' }�
p�operty to� Sp Uo�' o e � �.�,/f�v_>��[�_ � , �- 'wl � . � , � ��\
� Slgnature D t _�v V ' � ` , :\ • , � FINAL FEE�5.�6_!�
Driver5' licenie or 55 � �SSV E FEE - � _ .
CMF0865�46 Whi[e-Builtling;Canary-ApPlicant;Pink-Accoun[ing;Goltlenrotl-AsieSsor ��[P�.//� /0�38
// (7
,
'. " 't✓.�,a i�.. a� � . � ii ��, �„'� c• t ,_ � .uA
CONSTRUCTION AND PLANNIN ;'', ." � � : � , �_. � , -.. � FOOL & SPA ' i - r,y�n „ �, •� . -� �� �,�
APPROVALS Permit # �_ Date Inspector �� " - - - - - - - ' - � - �Date -- Inspecror
�9 APPHOVALS i � _ ,;f.. � Permit#
. , . . _ -- - - - - - - - --
1. Temporery Electrical Service or Pole - ' , , � �� ' ' -q3. .. Pool & Equipment Location ` � ��` - -'�'---`- -� � ' - ' - - - - -
--�--- ---- ----�------------- _. ---__. . ..- . . . . ;
�- ' N��IJIt: i�1�:IJ] _ _� �.____ ' � "
._Soi�_ ipe-Un_.r9rn ,_..,,.. _,._�__ a 4 . Steel Remforcement, -- - -- ------- - ---- ��i
E:3.,.:_ElecVical_Conduit.UtilitY-Und[9rn..�,�� -'� ^�-�--_---_. __ -.- __45:_:.Forms�.,.�...i � } --•----- --- -----�------ '.-- _-- -
�.4. _.Electrical_Conduit?Und�yrn ""- - !, g_ " ' ' ' " " �
^---��..-----------._46._ Electrical.Bondin 1-----------=----_�_,�.c---`-`-•--'-�----'�
tee ein orcea a�+��i�a - �- . �' "' ""' �
�_ :,�., � �,.` �'�;;;�.:i..� at_��_ . . 47. Rou ti' Plumbin & Pressure Test--- ---- -- ---- -'- --:------'-. �I
�6.__Elect[ical_UFER Grn • � "' � �� �� ' "-- " �� ' - "' ' 4g" APPROVAL TO COVE -G � � �� ' ` -
__� - --' - - - - . , R UNITE----� �-,��-=- c=- . �
' 7 Footin s • - �� n � 49. Electrical,Conduit-Undr rn" �'��r� �..:.,�<�o�� • ,�i,� c .� .. ,. � .�„� � i�, �o,-:a �f
-'-__� . .. . � .. ._. . .
�_.._._ ._.9--'.,_....� �� --�..�_-.-----' �
t- B.-F.oundation •.� , ""� �",�.� "' ' ? 50.,�,Gas•P.ipe,,O:Undr rn,TeSt .,_. "o• �'b1 „ '� • + � ' �, �
j. _9..-Water.P.ipe:Undrg"rn _ " � � ` � - _� 51. Backwash Lines •P-Tra -fl' � ndr tn �' ""' --- — ! -
�10.,Stcuctural,Floor_System_�� _ ' �� ' � �. !____ __ __ ;, , r• •„52.:., APP.ROVALTO.DECK-- -' - .� '_ .. : J � �
�_.1]:•,.Propec,ty_$ewe�:Line:&,House_Connection=� _� -`�-�c _53.-Backwash & Rece torFinal""''•' �r � _:��- o :_,� .^ •, � : ,a � . ;.�, �.�; h
.:w-n:unw �r-i.. f ... 1�
;_12. _:Street.Sewer_Connection_ ' :(----- � -= +���� - �-54.- �Heater & �Vent-Final, ' � ' % � : -'��'��
� --
,. :
!�13._ .Rou9h.P,lumbing__� - 'fu__ _' `_------ _-,.._.;_-- � "�--=,�' .'--- - '�1'
_.___ .� . ,. .
--- � -- . .. . ...i
� 14. Rough Electrio-Conduit �--- - - 56-Electripl-FinaF--'� � +�' ��n o c � .�. i. � : p
I 15. Rough Electric-Wiring � �� - � ��--- -- � --- -- �-57-- -Solar�System-Final-,� : "';' "'.' ,, ,, . _ ��
� ----- � -�--- -'�- _ ,�,. � �,. .,�
� �.- . . --- � -- � . .,.. . , . ' , �
T6., -=Rou h'Heatin & Air Gonditionin - . � _ _enang &.Qccess_Approval � •� �� � �� ��= >
�` 9 9 9 - - -� --- - - - .., n � ,� . i ,...
, 17.r--Ducts'-inStiuctu}e,� . - - � _;r'T-l.___L.- �---" _� _ _ _APPROVED�FORPLASTERING' , , '- ` °i� ' � t cJO' �I�I
16- Ducts; Ventilatin9--� � - - - -���� '�- �- �- . - -- . - �'u _ ---. _ _.�_ _. _ � ��c 'J
. � - -_ - - -�-' ���.---POO.USPA'.SYSTEM �e�,,.. .�,. . .. .r� : � �r t3�iro:
' 19.' Gas Pipe-Rough &�Test -.. � � . �:�,-�;:.._ ; 4 , � - - - A ,� r,n c �_ � � r� � � �. � ., � � .
- - - ----- ." S FIN L� +
I 20� "{i00f�Ffemin9__ _'._ _"'_'' ' .�. _ ... . na . i�. ..r•_ J. , .�,. �. Pr .. �o: � .. �,.. ,r' �
�o
' _ _ ' ' " -'__ ' . _ " ;I
: 21: RoofSheathin �. _ _... :, .��. .. F---r_.- �--------�--- - ------- ------ - ..... �.,:� - �,.��� � - _ , t:
' ' . a � . �,i��� �,,�no
°NOTES: � i . r, . � ., � �. , ��
22: - Frame�and�Flashin ��¢� - Z - -7--9--8.2- - - " � - ' ��7"� �� �� i
f23� -Insulation-�- - - - - - - -- -- ��- - - - - -- - _.�.,- - p - - ��
� �24: -Lathing�&Sidin9- - - . . . . . -r.-'.. — - - -- - --- -- - ' ' - - - - � - ;�
� 251-Drywall-Nailing _ --:,._,.,_ /-,-� - � ---- - '...�..lV. ;
!- 26�--Plastei-Brown�Coat - . ' � • � �'—' �- -�--y'--- - . - 1 =¢� , . - , - _-- - - - :,i
, , .
' 2T.� -Electr,ical�PowervMeterFinal - ��� � "'�"' ' � ' - � �� '� � � � ` �
. _ � ;!
• ' -- - --- �-- � -- - -- - -- - - - ,
� . .. . ..._.... . � � _ - .,:, .���,: ..., . _._ _ .: . _ .
. . . . ._ .. . ... . . . ..�
r 28. - Final Electnc----- -.. -.. _ �_ �._ . . � �.::�, � ir - .., - , . �
- -' ---- - - ' � - .
1 29. -Final-Heatin & Air Conditionin ' ' - ' ' " � ""' - � � � �� � - � � '
A . i� . �h . . �.�(1.. . (� 1.� �H il�4 1 [ .1 I� 1 ,�
9 9----- -�'- -{ � �
—"-, --. �. _� . �-- -- �'�..
�-30! Final,GasPipe-Test -� - -----�r---� --�- --- -- `8� - /k' C �� c� �c%�e . ...�-..,'�•�- ���<<�'i II
' 31.. Final Plumbing- - - - -- --------- - �-' -�--- � � ----- -- � - -`- � O . - � '. - i� �i' � - i n -
jf
' 32: - Weter Service-Final - - : - - --- - :-_..1------ � �, -- --- -- -..-• - �Po_ C?'.T�� c �� � . : .'. ; _ , � . �.� o 'f
� 33�. Gas Service:Final--• -- - - - --- -- _--_ -=- ' --- - - -- - - 2041 ` , S . . , . . � ''..' �
� 35. landscao e Sin k'Rnl S ste � �,,` : , ' '� � _, i • � ` _ , ;,r• •� " } - I�
.
.. � � .. . � ,: : : .,.. . . '� .. , .
� m ir- I �r.^�� . . I� ,�
i36. Sound Attenuation ^ ., � _ , � � ,�.� � . i �---- � �' - � , .. � .. fi - . .� � r., , � � (,� - ,. .. � .. �
I 37. HandicaP,Regulations - - . •.rr,r,. � � r-- ..- :�. . �,�o . n��� :,. ,n , . �. , N
� ; � ,
� 38. FINALSTRUCTURE&BUILDING >�""'�"��,^ � , � - % ""� �'�''"' ��� � � '� . � , •
��
I 40. Electac,Releaserto Ed on leted . _....�� `� ,.,J:, � -� -� -� ---- , i„ ,rna�i o,a�mi.,:w,_�r�.H �{ ........ ..... _ ., -- --------- . _ . . ., ' �'
P � 9 P 1 . . � .. � , �
..._ - - ---- ----- -------. .._ i�
i 41. GasRelease.to�SouthemCaliforniaGasCo.�_�. ! ! '-°'' �'�s "����'����"�a`•? ".,c.. . . �,,, � �.���,� !�
1 42. CERTIFICATE OF OCCUPANCY - �Jy _ �/� - '�
No .3:� J Z:' Date d r`�- :C, /-- - . . . . . , � 11
i -- ---- -- -- --- - - -- -
� _ _ .
,
`- - � ' � - - ..
- ----- ----�� -- -'-- -- - -- - --- --� � -- ---- - -- --.-.' -'.-.. " - -�-- . . '`.
Y
�
�
�
ApD���ant to fill f� all spaces except t�ose wit�in heavy DorEer Iirtes anE sign all appropriale Eeclanlions.
Ci7Y OF COS7�nriM�ESsA• �(%'ONSTR�UJCTION PERMIT
ProjeclAddress 3s7J� /YALR..t C-+.�TLt��iad. .-�r,�.l �C,.sTG
Applicant's Mailing Address -�^+�
Owner's Name ` Phono S46!_t„7A �
ddres /l '���6" ^ �
�wg, �ryM1A/� � C • � License No. �
n
Address 3!(9/ /7//� N + 1 /� {��
Contracror's Nam ' - �Phone 0`��
Address Imailingl 3S5 �/ JSi-.6t.c /�2.�_ o.
City License No. y.�.9a0 �
LICENSED CONTRACTOR DECLARFTION '�
I hereby altirm ina� I am Iicensetl untler prOvislOns o1 Charte� 9(commanNng
wVlh 5¢CliOn ]000) Of DivlilOn 3 Of lh0 Bu5in855 dntl Pr01e5510n5 COtle. dntl
my Iicense is In tull lorce antl etlect.
Licenze Class �ce e No.
'iate /[J-F�_ Signahre '
JRKERS'COMPENSATION DECLARATION
_�ereby aitirm that I have a tertl/itdte of consent to 501i-insura or a<ertiflWte
o/ Workers' Compnnzation Insu�anc9, Or d CertlOaO cOPY Ihareo/ (Sattlon
3800, LdD. C ^ �s ' �,a7����
Polity NO. ��1��-/`p7 Company
ertitietlq,<oppyy �is here�y furnishetl.
Date�Llfr�d.�Jf��etlwlth[hecityBuil�isio� - A/�
Applicant.� f��
EXEMPTION FROM WORKERS' COMPENSATION DEGLARATION
(Thissection neetl not ba complated It tha permit is tor one hunerea (E100) or
IC55).
1 certify that in lhe pertormanCG Ot [he wo�k for whith Ihls pOrmR Is Issuetl I
snall not employ any porson in any manner so as lo Gecomo subjact lo t�e
Workers' Compansation Laws of California.
Data � Signaturo
NOTICE: II, atter making Ihls declaraUOn, y0u shOWC become SubjBGt t0 tho
Workers' COmpensalion proN51on5 ot th0 IaDor Catle, y0u muit fOrthwitn
comDly with� such Orovisions or tnis parmlt ihall be tleemotl revoketl.
CONSTRUCTION LENDING AGENCV
1 bereby alllrm tbat Inern ii a construttlon bnEing agency far the performanca
OI tha 'wOrk fo� wnicn t�Der� Is Issuatl ($¢CUon 3097 Clv. CJ
Lentler's Name
Lentler's Atltlress
OWNER BUILOEN DECLARATION
1 hereby affirm that I am ezempt trom the Contractor's Lltens¢ Law for tha
followin9 reason (Saction ]031.5 Bu5ine5zantl Professional Cotle: Any citY or
county wbith rGquires d pefmlt l0 COnitfutl, altef, ImprOve, Demoll5h of fepolr
any structure, prior to itz Issuanco, also reqWres the aoP���ant /or sucn parmit
� file a si9netl statement-that hc/shc is Iicensetl pur5uant to tha provlsions a(
e Contncror's L��enze Law (Chap[er 9(commenc(ng with Se<Uon 7000) of
�vision 3 ot the BuSinoss antl Profassions Cotla) or tnat ne/she Is axompt
[h¢refrom antl tbe bails for the allegetl exemption. Any vlolation o/ SecUon
]031.5 by any applicant for a permit subjec[s the appli<ant lo a civil
ena�ty oi not more tnan five nuntlretl Ooliars (SSoo).
� I, as ownur of tho properly or my amployees with wa9es as tholr sola
compensation, will tlo tho work, antl the structure is not IntanOotl or oHereC
tor sale (Section 7044, BuSiness antl Protessional Cotlo: The Conlractor's
Licenie Law tloes not apply to an owner o/ a property wha bulitls or improves
IhereonQ an0 wno tlOes such wOrk nimsell/hOrsell Or IntOUgh hls or her own
....._ ......an..n e�� .���e i.00.��omn�ta are not Inten�etl or offereU for
1, however, the b
n, the owner wlll
for tne purpose o
a5 owner of the [
Duiltls or imOroves m
tractm�sl Lcense purs
proof of [heir Worke
❑ I am exemo� untler
or improvement I5 soltl wilhin one year ot com-
ie buraen of proving he/she tlitl nol builtl or Im-
�, am extlusively contracling witn Iicensetl con-
t 15eclion 7044, Business antl Professlons CoCe:
does nol apPly to an owner of property who
itl who contracts ior such orolects wltn a con-
ne ConVacror•5 License L.aw). I am aware that
oensation insuranGe ShOultl b0 o�o�iaea to me.
- B. 6 P. C. �or tnis reason
Date Owner
I hereby certily that 1 nave reaa this applicatlon antl stato tnat thn abova
IMorma[lon I5 correct. I agren lo compry with all clty antl county ortllnances
dntl'S[atc laws relating to builtlinq conStruttlon, antl h¢reby duthorlie /up/e•
sentatives Of this city to enter upon lh above-menllOnatl Oroperty tor
InSpattlon putDosaS
Slgnature � � � Dato �o-�
Drlvars' License or 55 � 9
TVPE OF CONSTRUCTION �fNEW LJ ADD U ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
� DESCRIPTION OF WOR USE OF BLDG. _G�Q�
� c' �t�/� _ � e � r �r,� . .Q„_9'-e r
TVPEOFPERMI��FOUNDATION STRUCTVRAI
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION 5ci. F7. oCCVVANcv �
- CONSTRUCTION TVPF VALUATION 5 9 ��
20NE GRADINGCU.VDS. ACRES
Remarks: . �L 6 � Q �
i
Bar Sink
Backilow Preventer
Beckflow Irrigation
Dishwasher �
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service OuUats
Ki[chen Sink
Lavatories
P-Trap
Roof Drains
Rainspection Fee � $15
Duct- Under Ground
Duct - Structurel
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact BIL ICBO � '
Heating System & Ducting
❑ai oo,000 eTu � i oo,000
Reinspection Fea � S15
0865-46, rev. 5/88 Whlte - BWltling; Canary - Applitant; Pink - Accounting; GolCenrotl - Assessor
ShowMs
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pooi w/Spa
Urinal
Wat¢r Closet
Wa[er Heater
Water Service
Auto-Wash �
Leundry Treys
laua Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration Syrtem .
❑o-ioo,000eTu ❑ioo,000
System Repair/Alteration
Registers
Isue Fee
$ 3
FEES
$ 3
A.P. #'+
S Main Buildi
E
T Fron�
B Rear
A
C Right
g � Let[
Ping. Fief. �
Planning Notes:
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Eleci
Fan
F,A.U.
Fixtures
Device Boxes
Outlets
Switche5
Garbage Disposal
Generator �a5 KW C
2one
Accessory Building:
Parking Req./Provided
ELECTRICAL
Traniformer ❑ 15�50 KW
❑ 50+KW
5-15 KW
� Reinspection Fea � 515
DEVELOPMENTSERVICESRE�I
2oning APProvad BV G
Buildine APOroved 9y.
Application laued Bv�
Meter Llup to 100 amps
Meter ❑aver 100 amps
Sub Panel ='
Motors �0�1 HP �1'r5-8
Int. Solar �9-15 HP �16-15*
Microwave
Pole Light �
Standin9 Sections
Trash Compattor
luua Fee
SUMMARV bF !
BUILDiNG PERMIT $ OO
PLAN CHECK $ �
PLUMBING $
PLAN CHECK 25% $
ELECTRICAL $
PLAN CHECK 50% $
MECHANICAL $
PIAN CHECK 25% $
N
1
N
G
H
E
�
M
T
S.
FEES
$ 3
SMIP $ • si%
PERMIT
ISSUANCE $
ENERG�' P.C. $
GRADING $
MICROFILM $
TOTALFEE $ //, ,.30
01 00016424-OQ016431 T n T i i9,'a0
DATE� ?0/06188 TIME: f2:�2
CONSTRUCTION AND PLANNIN� �L & SPA
` APPROVA�S Permit# Date Inspector p�ppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgmd. � '� 53. Steel Reinforcement '
r3. Electrical Eonduit UtilitY-Undrgmd. 54. Forms �.
i_
�4. Electrical.Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test i
6. Electrical UFER'Grncl. . 57. APPROVAL TO COVER-GUNITE
7. Footings �'. � �� 58. Electrical Conduit-Undrgrnd.
,i
8. Foundation � � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgmd. � 60. Backwash Lines, P-Trap, O Undrgrnd. _
10: Structural F�oor SYstem ' 61. APPROVAL TO DECK
11. Property.Sewer Line & House Co�rinection 62. Backwash & Recepior-Final
12. Sewer Cap � i . 63. Heater & Vent-Final .
13. Roof Drains • i 64. Plumbing System - Final
74. Rough Plum6ing 65. Electrical-Final •
� 15. Rough Electrical-Conduit 66. Solar System-Final
.16. Rough Electric Wiring 67. Fencing & Access Approval
,17. Rough�WiringSign ' 68. APPROVEDFORPLASTERING
18. RougMElectrical-7 Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79. Rough Fieating & A�r Conditioning FIRE DEPT. REQUIREMENT
�
� 20. Rough'Factory Fireplace APPROVALS Permit #
c-
21. Ducts,in Structure 70. Underground Hydro
i�
22. Ducts, Ventilating � i1 71. Product Piping O Gas ❑ Oil
23.� Gas Pipe-Rough & Test ' 72, Underground Flush .
24. Roof Framing �Y, � 73. Undergrnd. Storage Tank � Gas ❑ Oil �'
� 25% Roof� h�eathing "' 74, Overhead Hydro
26. T-Bar�,Ceiling (SVucwral) & Monocoat 75. Dry Chemical �
27. FraRi end Flashing �� , 76. Dry Standpipe '
. 28. La(�'ing`& Siding � � 77. FIXED SYSTEM FINAL
i
29. InsulaLpn ,� j . 78. FIRE PREV. FINAL
,30. Drywall Nailing T� � , 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. . . i�"t'
40. Gas Service-Final �
41. Solar pomestic-Final � � �
i� �'
42. Backflow Preventer � ��
J ;•
43. Backflow Irrigation ' � .J �
44. landscape Irrigation System /'�'' '
45. Sound Attenuation �`� -
/
46. Handicap Regulations �
47. FINAL STRUCTURE & BUILDING � . � �
?R. Soecial Requirements Completed �
49. Electric Release to Edison �`
,� /
50. Gas Release to Southern California Gas Co �/ • �''
. 51. CERTIFICATE OF OCCUPANCY - - �., {•„
No Date � �'
�— �� AVP��Cant to BII In ali spaces wit�ln �eavy OorEer Iines antl sign all aOP�oGrlate Eecqratlons. /I/ l/' ���„ _��� /�l��
. CITY OF COSTA MESA- . PE MIT NO
TRACT NO. LOT NO. �BLDG. NO. �',� ���> ���"�Y, 1 �7
CONSTRUCTIONPERMIT 8 �094001-02-2,_0274
�ProjectAddress3SSS Harbor Gatewa SO. TVPEOFCONSTRUCTION �- 3B9S ]/Q�/82 33•�0
Ownel SORShO�e ❑ NEW �CADD ❑ ALTERATION " " �� - , - . .
AddfEa 900 C$ ne Lane NeW OTt BC�l ❑REPAIR ❑CONVERSION.�DEMOLISH
Arch/En� U1dOI1 CORLTaCtOl�e�s=N�� � OTHER ZONING qEGULATIONS
AddfESS D SCRIPTION OF WOR JYAGt- A•P' �
2500 Michelson Dr Irvine Et�Ec> fYc. U.�/i>S ZONE PLNG.REF.$
coove�m� Dial-A-Tem Inc Phone630-66 TVPE FPERMIT Tp U p�N
AddfCss SET AC PROPE�RTV LINE
ountain W$ Anaheim ❑GRAOING ❑ FOUNDATION ❑STRUCTURAL I VARD
IICENSED CONTRACTOR DECLAqq7�ON ❑ TENANT ❑ ELECTRICAI. OPLUMBING�,MECHANIC g�p .y -
I hareby al/irm that I em IlCensatl unqar provlSlons oi C�artet 9(com- �� . RIG T .
mencing wlth seCtlon 7000) of Oiyision 3 of lha Buslness antl Q OTNER - - ' REAR^VARD (TO P/L)
Rotesslons Cotle,. antl my, Ilcense Is In fuu force and effec4 � pROJECT DESCRIPTION +. �
LI[Bns C�I Iss - �� �4n �PKG.SPACE RE�. . PROVIDED
Date �" / Y °1n^'�"'^ �G�� � � � � SQ. FT. ' � STREET WIDTH , PARK FEE 5 � �
WORK 0.5'COMPENSATION D�LARAL101� OCCVPANCY�CONSTRUCTION TVPE _
1 hereby a/firm that I have a certltic8te o( consont to salLinsuro or a ��D ZONING APPROVED BV , OATE
cerUfiwto oi Workers' CompeniaUoq Insurance, or a cerNfleE copy VALUATION �97%, ZONE -
thereoi (Se I n_ lap .). GRADING CU. VDS. ACRES SPECIAL CONDITIONS:
P^"^.yNo.�� ���-1�C.ompanyPaClf1C Comp .. . ._
� ��rtlfled copy is hereby /urnlshetl. REMARKS: .
� artl/ietl copy I5 filetl wit� the city Builtlln9 Divislon. �
EXEMPTION FROM WORKERS' COMPENSATION UECLARATION - � -
(Tbli saCtlon nBBE not be Completetl i/ tha.permlt is for one �untlratl
SE1001 or less). �
cert(fy that in the performance at the work for which thli peimit is
Issuatl, I shall not emPloy any person In any manner so as to become PLUMBING � PIAN CHECK ELECTRICAL PLAN CHECK
sub7ect to tha Worker5 Compansatlon �ws of Cali(ornla. BATHTUBS SHOWERS
Date Siqnature
NOTICE: II a1[er makin9 this tleclaration, you snoultl becoma suD7oct T��LETS VRINAlS - GENERATOR 0-1 KW_1-30 KW
lo the Workers' Compensatlon provlsiOns of t�e Labor COUe, you mu5t TRANSFORMER
forlhwith Comply wllh 5uth provislon; or this permit shall be tleemetl �.VATORIES DOUBLE LAVS- - APP�IANCE 10-50 KW�_50 � KW -
revOketl. - .
CONSTRUCTION LENDING AGENCV KIT.SINKS DISHWASHERS MOTORS p-1 HP_�1-10'HP
1 hereby a/flrm lhat thore is a con5truttlon lentling agency tor the per SEFVICE SINKS SUMPS - � ONC SOIAR) �0-50 HP�_50 + HP
brmante of the work /or whlth this Oermit Is ISsuotl (Sattlon 3097-
���• C'�' FLOOR SINKS FLOOR DRAINS • FIXTURES OUTLETS" SWITCHES' '
LenOer's Name
Lentler't AOGress DRINKING FOUNTAINS " GAS TVBE SIGNS' �
OWNER BUILDER DECLARATION '' INTE(3CEPTORS CLARIFIERS 70�E LIGHTS ' ' '
I nereby aHirm that I am exempt from Ihe Contractor's Ucense Law for
tho followlnq roa5on (Sectlon 7031.5 Buslness an0 Prolosslons Cotlo: SWIMMING POOL P TRAP - -
Any city or county which requlras a permlt to tonstruct, aller, POLES METEFED SU8
improve, tlemollsh or repair any structure, prior to its is5uante, also re- yyqTER SERVICE ALTERATION� PANELS MAIN SUB -
qulres the applicant tor suth permit t0 file a signetl slatement that he -
Is Ilcensatl pursuant [o the promsion5 of-the Confra<tor's License law GAS SERVICE OUT�ETS SERVICE - 'AMP '
(Chaptar 9(commencing witb Section ]000� o( �ivision 3 of the ,
Business antl Proleision5 Coee) or that he Is exempt therevom anE the yyqTER HEATERS BTU OUTPUT• � '' '' -'
b+��s for the allegetl exemption. Any Wolation o/ 5ettion 7031.5 by �'
appllwnt'for a permit suD�ecti the appliwnt to a civil penalty SEWER CONNECTIONS -� `� '
�t more than fiva huntlraC tlollar¢ (E500).
�. :, as owner of ihe proDer[y, or my employees witb wages as t�elr SOLAR TANK � COLLECTORS - '-
sole compensatlon, will Co tha work, an0. the strutture is not inientletl
or offeretl tor sale. (SecUon ]044, Bubiness antl Profezsion5 Cotle: T�e SOLAR PIPING SVS. �SSUE FEE
Cantrattor'z Licensa Law Coes not apply to an owner of a proPerty APPLICATION APPROVED BY - � - � DATE
who builtls or Improws thereon, antl w�o Ooes suth work himiell or ISSUE FEE
ihrough bls own employeas, provitletl that suth Improvemen[s are not _
IntenCetl or ol/cretl for sale. It, howaveq tha builtlin9 or ImDrovement MECHANICAL PLAN CHECK SUMMARV pF FEES .
IS Soltl witM1in ona y0ar of completlon, the owner wlll ndve the bu�tlan '
of proving he tlitl not bulltl or improve 1or the purpose of sale�. HEATING SYSTEM 0-300,000 BTV � PERMIT G $ SMIP 5
❑ I, as owner'of tne proPerty, aM exclusively contracting with qND DUCTING / -
Ilcensatl con[ractors to canSVuct the projett (Sectlon 7044, Busine55 100,000 + BTU �i d� PLAN CHECK E PERMIT
antl Profe551on5 Cotlo: The Conlractors Uconse Law tloas not apply to ISSUANCE S�
an owner o/ property who builtls or improvos thareon, antl who con• REFRIGERATION 0-300,000 BTU PLUMBING E
tratls �rom suth pro)ects wltn'a'mnbattor(s) Ilcesnetl pursuant to SVSTEM '� '� GRADING E
the Contractor's Llcense Law). /�� 300,000 + BTU J PLAN CHECK E _ �
� I am exempt untler Saction B. & P. C. lor this Bc�ILERS BTU ELECTRICAL 5 ' S
reason � ' 7LAN CHECK § ' MICROFILM g
SVSTEM REPAIR,ALTERATION —�+������.
Date Owner MECHANICAI E1-�' tGY TOTAL FEE �
1 hereby Cartifythdt 1 hdvB �Odtl this appp�t�pn antl stata that tha abovo EXHAUST SVSTEM MULTIPLE LESS AD- ��
IMormation is mrtect. I agree to cqmply wltn all tlty antl counly VLAN CHECK § VANCE PC S_
ortllnances an ws relating to con5truction, antl hereby authorize
re resentatl 1 In cit o� ntsr u on the above mentionetl
p�operty tor s flTs. p . . '/� ��Q
Signature Date FINAL FEE S� � �
Orlvors' L nnse ot 55 $ ' � ISSUE FEE � OO -
CMf outio-ab Wnl[B-Bullaln9; tanary-Appllcanq vinN-Attounung: �emenrea-roae» ��
CONSTRUCTION AND PLqNNING �� �"' POOL & SPA
APPROVALS Permit # -� Z� Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 43. Pool & Equipment Location
Soi ipe- ndrgrn 44. Steel Reinforcement
3. E�ectrical Conduit Utility-Undrgrn 45. Forms
4. Electricai Conduit-Undrgrn - 46. Electrical Bonding
. tee ein orce 47. Rou h Plumbin & Pressure Test
6. Electrical UFEF 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-Tra ❑ ndr rn •
10. Structural Floor System 52. APPROVAL TO DECK
11. Property Sewer Line & House �nnection 53. Backwash & Rece tor-Final
12. Street Sewer Connection 54. Heater & Vent-Final
13. Rough Plumbing -
14. Rough Electric-Conduit • �56. Electrical-Final
15. Rough Electric-Wiring 57. Solar System-Final
16. � Rough Heating & Air Conditioning • encing & Access Approval
17. Ducts in Structure APPROVED FOR PLASTERING
18. Ducts, Ventilating
19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing �
21. Roof Sheathin �
22. Frame and Flashin NOTES:
23. Insulation
24. Lathin & 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 pomestic-Finai
35. landsca e S rinklin S stem
- 36. Sound Attenuation
37. Handicap Regulations �
38. FINALSTRUCTURE&BUILDING
39. Special Requirements Completed
40. Electric Release to Edison �
41. Gas Release to Southem Califordia Gas Co. �
42. CERTIFICATEOFOCCUPANCY
No Date
� APV���ant to fill in all spaees within heavy boraer lines ana sign a11 apDropriate tleciantions.
CI�OF COSTR`MESA "' - PERMI ry0� / . TRACT NO. LOT NO. ' BIOG.� . � � - - . . . .�
� CONSTRU�TION PERMIT � y% ' 0651 ' 7/01 /82 ' : 34.p0 TL
� ProjectAddress Sss'"S`�%/� O $Q TVPE OF CONSTRUCTION � � ' . L���: �� . _ � � . _ ,-
' Ownef �� G �� � Phone ❑ NEW ❑ ADD �.ALTERATION `� � . � ' � - � . - ,
�'�Addl04 -� �----�"��- - _ _. O_REPAIR ❑CONVERSION ❑DEMOLISH
- - � . ' " ZONING REGULATIONS -
, Arch/En�— License No. - ❑ OTHEa -
AddfC55�- - _ . . _. _ DESCRIPTION OF WORK A'P' �
� , _ _ _ � . ' 'ZONE -' ' ' - ' PLNG. REF. � , ' -
Contracror'� ,�J� /��DEL /�L Phone '�% TVPE OF PERMIT - � - ' - ' - - Tpg�/ I Diry G - -
1 SETBACK G ST. PROPE�TV LINE" ' ,
O � AddlCss - L - �D LF " T - ' :�WN ❑ GRADING ❑ FOUNDATION ❑ STRVCTURAL SIDE,rYARD - - �- - - - - � ,
L.EF
LICENSED CONTRACTOR DECLARAT,ION � 9O� �� O TENANT O�.ELECTRICAL �PLUMBING ❑MECNANIC 5IpE VA �- . . 'i
� I hereby affirm th:.t I am IlcenseG untler provisions o( Cha�ler ( - � � � RIGHT '
mencing- with sectlon 7000) ot Diviilon 3 of Ne BuSiness antl . Q OTHER ' ' '�
Prot¢ssions Cotle, antl my c¢n is in full forca n� REAR VFiRD (TO P/L) '�
PROJECT DESCRIPTION
Licensefla;�s ' P`�- �LicenS�- � ry ' , �" " � - ' PKG'SPACERE�. -- ' PROVIDED - - �
Date Ce7/�L -ag�ar��. � �i� .'SQ: FT. . , . _ - . ' _ " ' I
E p . a�OCCUPANCVa _ � .ONSTRUCTION TVPE , S�REET WIDTH'-�' � :- PARK FEE'$",. ,, �. �
'WORK RSLC MPENSATION.DECLARAT,ION __. _ . . .' - � ZONING APPROVED BV - "' - ' DATE �
�� 'eby atfirm that I have a certlflcate of consent to selLinsure or a , VALUATION �- ^ ZONE 9 r.
'fate of-Work¢r5'-CompenSaUOn Insurance, or a certlfietl copy
�� of(Se<t�lqn3Q00,Lab.C). � ��-�- � GRADING.CV.�VDS. ACRES SPECIALCONDITIO�NS '-- - ' �
Pollcv No:�/Y/7-S�l 4..�F1%itomPanv ��I L. . ��%yl� - ' - _ ' ' ' ' _ .. _ . _ � . . . .
c❑� Certlfietl copy is hereby (urnishetl. �P� REMARKS: � � � ' �
�c�.Certifietl copy I5liled with the clty Builtling Division. - � � ' ' '-� - '- i � _;, ��� : � -" - � �
EXEMPTION"FROM WORKERS' COMPENSATION•DECLARATION' ' -'- ' - � � -- -
(This section neetl not be completetl if the permit is for one huntlretl � �- � ' a {
SE300) or Iessl. � . . ' . . . .' ' _ ' " � ' � '" ' '_' __ " _ __ " ' "
i certlfy that In the pertormante of the work for whlch this Oermit is
i55Uetl, I ihall not emPloy any oerson in any manne� so as to b¢Come � PLUMBING ' "� PLAN CHECK ' ' ELECTRICAI -'" - " PLAN CHECK -' -' -
Subject to the Worker5 CompenSatiOn Laws ot CalitOrnia.
Dale Si9nature � BATHTU85 �%-"" "SHOWERS " " ' ' ' - '- - -- -
NOTICE: If after making this tleclaration, you shoultl betome zubjacl TOILETS �. � ...VRINALS �- -i GENERATOR pq�KW=1-IO�KW - '
to the Workers' Compensation Orovisions of tne LaCor Cotle, you must �� TRANSFORMER j �
forthwith comply with su<h pwvisions or this permit shall be tleemetl LAVATORIES Z µDOUBLE CAVS LB APPLIANCE ''- 70-50 KW_50 + KW- -� -
CONSTRUGTION CENDING AGENCV �~ ' � � KIT. SINKS' - ' '- 'DISHWASNERS - - �MOTORS - -�0-1 HP_1-30 HP� ' � t
' ",'
I hereby affirm that there Is a construction lentling agency tor the porv SERVICE SINKS � r-- �� SUMPS• � -- . � UNC..SOIAR) . 30-50 HP=50 + HP - .-
tOrmanc¢ of. the work.lor`which tnis permlt is issuetl (Settion 309]
Civ.`CJ. � -' � - - -- =- - � - � - - - � • '�FLOOR'SINKS' `� -'FCOOR DRAINS' ' - ' 'FIXTVRES - �OUTL'ETS- SWITCFiES"'-�' ' - - �
'I..entl0/'s Name - • ` � �
'� � " " � " '-' ' � " '- � "� DRINKI,NG FOVNTAINS`- '- - ' �' "- GASTUBE�SIGNS� - �� �
L¢ntler•5 Atltlres5 . • _ , . . . • • - . ` � ' � ' ' ' -"-' - -""- '
OWNER BUILDER DECLARATION --- - � - •� - ' INTERCEPTORS �� �' �- CLARIFIERS-' ' ' i � " POLE LIGHTS' -- - -' ' - - �
I her¢by affirm that I am exempt from the Contrac[or's Lic¢nse L. w for '
tha�lollowing reason (Soctlon 7031.5 Business�antl ProfeSsionS�Cotlo: SWIMMING POOL"' --P�TRAP-�� �• - . �
Any city or county which requires a permit to consVuct, alter, . � � i .POLES ' '��METERED ' SUB . �
Improve, tlemolish or repairany struc[ure, prior-[o�itsissuance, also re- yyqTER SERVICE"- '" 'ALTERATION' ' ' -•PANELS - • �MAIN SUB
qWres lhe ap�.11canl for such permit to file a si9netl statement tM1at ha - �
Is �nsetl pursuanl to the provisions of the Contractor'S LicanSe�Law GASSERVICE -` �OUTLETS 'Z-. SERVICE- �-- - -- -- - --� AMP- - � - - - '
( ter 9(tommentin9 with Setlion ]000) of Dlvision 3 ot the
6 ess�antl Rdessions Cotle) or tha[ he is exempt [M1erefrom antl fhe �� yyqTER'HEATERS- - BTU OVTPVT ' - - �- -- - - -
basis for the allegetl exemption. Any violation of 5ec[lon 7031.5 by
any applicant (or�a permit subjecfs�the-applicant to-a�civil penalty� SEWERCONNECTION 7j - -- � � -�- -� � - - �
bf nol more [han five M1untlretl tlollars ($500). � '
❑"I,- as "owner of the'properry, or my employees with waqes'as [helr ' SOLAR'TANK' � ' � - 'COLLECTORS ` - �
sole compensation, wlll tlo the work, antl the structure Is not Intentletl "�� '��' �
or'olfered fo'r sal¢. (Sectlon �044, Business zntl Ro�e55ions'Cotle: The SOLAR PIPING SVS: ISSUE FEE' '-- �'�' ' - � - - 1
Contrattor's License Law tloes no[ appry to an owner of a property
who builtls or ImOroves thereon, antl who tloes such work himsell or ISSUE FEE � �� -- � -"- "" ' :.4PPL-ICATION P.PPROVED BV -- - -DATE-
through his own employte5, provitletl tha[ Such improvem¢nts ar¢ n0[ "
int¢ntl¢tl or offerGd �or sal¢. It,'howeveq'the builtling O/ imp�ovem2nt � MECHANICAL PLAN CHECK SUMMARV OF F,EES
I5 Soltl witM1in one year ot completion, the owner will have the burtlen � , �
of proviri9 he tliE not builtl or'improve-for'the Durpoze of zale�. - -- - -- � BUIL�ING- - — � � - �- • _ -- " ;
❑ I, as_owner�ol the proDerty, am.exclusively contracting wi[h HEATINGSVSTEM 0-100,000BTV PERMIT E SMIP, . � 5
licensetl mnVactors to construct lbe ro'ect Section 7044, Business � ANDDUCTING � � - - -� -- . . . _ _ - . .
P 1 ( 100,000+gTU 'PLANCHECK E PERMIT.
• antl Professions Cotlr. The Contractor•s License-Law tloes.not apply to_ .� ,$_ DO. . ISSUANCE E '
an owner ot property who builtls or improves thereon, antl who con- REFRIGERATION 0-100,000 BTV PLUMBING -. .;��
traclz_trom-such. pro�ects. with. a contractor(s)_licesnetl pursuant [o SVSTEM - ._. _ '�GRADING `�E-
the Contracror'S license Law). 100,000 + gTV � PLAN CHECK S �• �- � .-,
�' I am exempt�untler Section- ' �-8. 6 P. C. tor tnis BOILE0.5 � BTV � ELECTRICAL b -- ''' s
reason - - - � �PLANCHECK $ ' � . �MICROFILM-S '
Date. Owner SVSTEM REPAIR,ALTERATION , �� - �
�MECHANICAL- E `�TOTAL FEE 5, _.
I he�eby certifythat I M1ave reatl tnis application antl state tha[ tne abovc EXHAUST SVSTEM MULTIPLE ' �E55 AD- - •� ��
Intormatlon Is corvett. I agr¢¢'t0' Comply wiih all Clty antl counry ' PLAN CHECK� S ' VANCE PC E�_ "' -
ortlinances antl state laws relatln9 to cons[ruction, antl hereby authorize �,�' ���, . _, .
representatives f� tnls tlry to ¢nter� [M1e above m nHo otl � ' " � . .' ' '
prop¢rty for <fion purpo ////`��� /`///�A
Slgnature ����-�� �(�����✓�pale � �� � - - ' FINALFEE § 3�.00 ,
Driverd' License or 55 � .� ISSUE FEE - - � _ _ . . ,.
CMF 0865-46 White-Bulltling; Canary-Applicanh Pink-Accounting; Goltlenrotl-A55essor
• .
CONSTRUCTION AND PLANNI�'� �" � . - POOL & SPA '. ��� . �- ,� ♦
APPROVALS Permit #�.tr.�_ Date. Inspecioi qPpROVALS ' Permit:# -� Date Inspec;or
1. Temporary Electrical Service or Pole � 43. Pool & Equipment Location �-' " '- � ' '•
Soil ipe-Undrgm ' ' 44. Steel Reinforcement ' ' '
3. Electrical Conduit Utility-Undrgrn 45t • Forms� � • - � � � �
4. _ Eiectricat Conduit-Undrgrn . . . .46. - Electrical Bonding - " � - • �
. tee ein orce . 47. Rough Plumbin & Pressure Test -� �-- --
6. Electrical UF.ER Gm - - 48. APPROVALTO COVER-GUNITE - ';', ' ��
7. . Pootings 49. Electrical Conduit-Undr rn' • � '�
- 8. Foundation_. . . � 50..� Gas�.Pipe, ❑Undr rn;Test � ' ��
9. - Water Pipe-Undrgm � - - � 51. Backwash Lines P-Tra � � ndi }n � � � ' ' " '
10. Structural Floor System 52. APPROVAL TO DECK � � -
.11. ._Property Sewer Line &.House Connection . 53. Backwash & Rece tor-Final - ' ' � � �
12. Street Sewer Connection " " ' ' � - - � - 54. Heatei & Vent-Final �
' 13. Rough Plumbing _ P2' � " - ' '
14. Rough ElectricConduit -� ' --' �� � '�56. Electrical-Final
15. Rough Electric-Wiring - "'� " ' " 57. Solar System-Final ' ' �
16. Rough Heating & Air Gonditioning" - "-- � - -� • encing & Access Approval
17. Ducts, in Structure �� AP.PROVED FOR PLASTERING- "" '-
18. �Ducts, Ventilating� � - -� � - � � ' �� � .� - .
19. Gas Pipe-Rough & Test ' - - - - - 60. ..POOL/SPA SYSTEMS FINAL _ ' � '
� 20. Roof Framing � � � - - - -= - ' � ' ' ' - - ' '
21: Roof Sheathin �- � - - - -- � � ' ' ��
22. Frame and Flashin � � � NOTES: - 9.t � . c � r. / � �c i %` �
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 --.�L-. � � �-
', 32. - Water Service-Final - � - - ' 7- ' � � - �
33.� Gas Service-Final • - � � �
34. $olar pomesticFinal • � ' ' ' � � � � �
. 35. Landsca e S rinklin S stem � �
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
Apvlicant to /lll in all spaees witnin neavy Dortler lines antl s(gn al1 aoV�ooriate aeclarations.
�CITY �'COSTA MESA PERMIT NO. -� TRACT NO. LOT IVO. BLDG. NO. �
;'CONS�RRUCTION PERMIT Ea 9� 3 '
Pro'ett Address c � �
� I j � " TVPE OF CONSTRUCTION .
i Own2t n S' � PhOne �� fJEW � � ADD �ALTERATION �t
f"Addr2a' -' "j - - " ' ' ' - - ' ❑IREPAIR��CO VER51 N ❑DEMOLISH-
° Ar2h/Eng. ' " - ' ' ' . License No. " - ' � OTHER -
DESCRIPTIONOFWORK � �
�:AHdress" ' - ' - ^ __. .. _ . . _
Contractor ' Ls �,' b_ Pfione �� TVPE OF PERMIT � � �
Addr2a � �� � f � , � /1 . P yy. - - �� GRADING,y� •O FOVNDATION O STROCTURAL
LICENSED CONTRACTOR DECLARATION - - •'�TENANT�ELECT0.ICAL �PLUMBING ❑MECHAI
I h¢reby atfirm th:.[ I am IlcenSetl untler provi5iOn5 Of Chdr[¢r 9(com- �
menNn9 wlth zection 7000)' of Dlvision 3' of the- Business antl �' � OTHER -' --' -� -
PrOfe5510n5 COtlG. dntl Ty IICBn58 IS In full (Orte dntl eff¢CL. - '
�" ' 3037�`'3/�9%82�
1 � :j;, _ _. _ _
�B� . � � .�- . .. - � .
ZONING REGULATIONS
A.P. �
�ZONE �PINTGp.RgUEF�.,p�
SETBACK C T. PROPE�RTYNLI�
�51� TVARD _,
D tense� la3i- 1 SI9 [ JJcens =`'-e>>Y'�' PROJECT DESCRIPTION .�, -'"' ._
y ���t� �71-� AOL SQ.FT. t.- 1
W�RKERS'COMPENSATIONDECLARATION - � - - --- �' - OCCUPAIVCV_CONSTRVCTIONTVPE �. �
'eby affirm thal I have a certiflcate of consent to self-insure or a'� VALUA7I�ON' ' - ZONE
It�at¢'Of WOrk¢r5"Compensatlon Insurante;-O� a' certifletl-copy' - �
�of (Sectlon 3800, Lab. C.�. ' GRADING�CU-. YDS. ACRES
POIicY No. ComPanY � .� .. -'- -�. . _ _. _ . . . . "_ _
❑ Certlfietl copy is h¢reby (urnlsh0tl. - - � - - - --- - - y � REMARKS:. -al - - - -- �
❑ C¢rtltiea copy I5 tilGa with th0 Uty Builtling DiviSion. '
E%EMPTION FROM WORKERS' COMPENSATION DECLARATION , r.. " �� �
(This section nnetl. not ba completetl.iLthe pMmit Js.for.one-huntlretl. .^ _.. _ _ �_�„ � .. _. . -
(E100) or less). „ ; � -- -
L<ertify.that.in.the performance.oLthe.work ior whlch this.permit is _
issuatl, I shall not emPloy any pnrson in any manner so as to become ' PLUMBING � PLAN CHECK t.
subject to the�Workers. Compensatlon Laws.ot CaliforNa. -. --- ' -
Date � Slgnature • BATHTUBS � SHOWERS
NOTIGE: If after making this tleclaratlon, you shoultl become'subjecf TOILETS�-'. ' � ��?VRINALS
[o the Workers' Compensation provisions of the Labor Cotle, you must LAVATORIES DOUBLE LAVS � �
forthwlttt comply with sucn p�ovl5lon5 0� th15 p¢rmit Shall b¢ tleemetl
�evoketl. -_.. � __ " __' ' _" __ ._ ".._ ... _ _,
CONSTRUCTION LENDING AGENCV KIT. SINKS DISHWASHERS � '
I hereby affirm Ihat the�o Is a con5truction I¢ntling aq¢ncy for tM1e pe�- SERV ICE $INK$ � .- $VMP$ �
formance of�the work IOr whi<h [his pe�mit IS issuetl (Sectlon 309]
C��� ���� ' ^ FLOOR SINKS ' FLOOR DRAINS
l.entler's Namei_ . _ _' _ '_ - _ ' ' _' -_' ' _ _ " _ ' ' '
Lentler's'Atltlress - DRINI(ING FOUNTAINS � �� � � �
OWNER BUILDER DEC�ARATION -' `� - - WTERCEPTORS CLARIFIER$~
1 her¢bv alfi�m tbat I am ¢xemOt from the ConVac[o�'S LicenSe Lnw for
or
basis tor the aIIC9etl er
any applicant br a pe
oT n0l more lhan �ive
❑ I, as owner Of the
sole compensation, will
a �pe�rtlit �torConStruct, alteq SWIMMING POOL
re� prior'to its issuance,-also re- yyqTER SERVICE
file a signetl Statemen[ Ihat he
tBe'Con[rac[or's'Cicense'Law GASSERVICE -
i]000) ot Division 3 ot Ihe �
�e 15 exempt therefrom antl the' �yyqTER HEATERS-
[he'a�D11Wnt to a'
or o(feretl for sale. (Section ]O4a, Business antl R'otessions Cotle: Tne
Contractor's License Law tloes.noLapply to.dn Owner._of.a.pro0e�ty_
who builtl5 or impraves lhereon, antl who tlOes such work himself or
throu9h his own employ2e5, provitletl that suclt.improvements are not
intentletl o� offeretl fOr sale. If, howeve�, tne builtling or imp�ovement
Is-Soltl within One yea� o7.Completion, th¢ Own¢c will have.the bu�tlen
of proving be tlitl not builtl or improve for the purpose o( sale).
� I,"as �owner of the �property, arti-exclusivery- contractinq-viith
li<ensetl mnVactors to Construct [he project (Section ]044, 6usines5
antl'Professions'Cotle: The Contractor's License-Caw�does�noi apply to
an owner of prop¢rty wh0 builtls o� imp�ov¢S Ih¢r¢On, antl who Con-
tractYtrom sucn p�o�ett5�with'a contra<tor(s)•Iicesnatl-pursuant to
lhe Contractor'S License Law�.
❑ I am exempCuntler Sedtion ' -- � � 8.�8. P C for this
ieason - - -
tha[J�have
�o�at�. �
SOLARTANK
SOLAR PI�ING $V5.
ISSUE FEE
MECHANICAL
HEATING SVSTEM 0-1
'ANDDVCTING ���
REFRIGERATION 0-1
SVSTEM-' -" " �Oi
BOILERS
SVSTEM REPAIR,ALTE
EXHAVSTSVSTEM __
ortlinances antl sc laws r �ting,to consVuctlon, a M1ereby autnorize,
representa[ives this � y tq e r upon In aboyyyEEE mentl etl .
property_ for et[ urpo9e (' �-3-��
Signalure ry
Drivers' Licensc or�55 � 'ISSUE FEE
CMF 0865�46 White-Builtlin9: ��ary-Applicanh. Pink-Accounting; Goltlenrotl-A55eisor
� ��
REAR VARD (TO P/L) ;� .
PKG.SPACEREQ. . PROV.IDED � ��
STREET WIDTH . PARK FEE S `� •.
ZONINGAPOROVEDBY.. � DHIE
SVECIALCONDITIONS: C� �
_ �.. � i
`i.
� . � . " _. ' '"' i ^ ., � .. _..
jELECTRICAL � � - aLArv CHeCK, , � .
50. FT. . . :. ' � 1
'GENERATOR� 0-1KW_1-lOKW � )
'TRANSFORMER
APPLIAIJCE 10-50 KW_50 + KW' - � - --` �
MOTORS �- Od HP_1-]0 HP� � ' � �- �
ipNC.50L-AR)� -10-50 HP'=^50 �'HP � - '- --- �
♦
'FIXTVRES'� OUTLETS SWITCHES - �
�GAS TUBE�SIGNS � �� � � � - � � ' � - -- �
�POLEL.IGHTS -. : - .
/iLIC1tN11VIV �-� SYNIVCL� MNIIV �UC '
OUTLETS ' �' . SERVICE- � ' "' AMP - : -
BTUOUTPUT__ . _. � . "`` ' _' " _. . ... .. _ _ _ '.' "'
.. �._' ' "' _' �.� _ ' . _ __".," "'" ` '_ , ' �
1 �� � �
COLLECTORS.._'_' r' _. �. "' _" " _ _ . _ '__ . r .. u �_. _ _" �
1 ' _ _ . " ' _
4N CHECK
JO BTU
.. _i.,__.
,* BTU �
)0 BTV �
'+ BTU� . ." "
U ;
ION •
�LTIPLE
� - . _ . .
u�v�.��c �u r., �
APPLICATION APPROV ED BV'- " "'- DATE" -' � 1
i
SUMMARV OF FEES � � -
�BUIIDING -'-' " ' " . .." ' "'-" '
PERMIT , _,_ E .� 'SMIP �t � � $' '
�PLAN CHECK $ PERMLT*'%
- — ' ' ' ' ' ' '"' -ISSUANCE E ' ' - '
'PLUMBING S :� i ` `-t.
GRADING� $ - - - - �
�PLANCHECK $' ' - ° '.� . � •.
�ELECTRICAL E •.. . •...` -. a_'.. . . .
'PLANCHECK E � _•� MICROFILM_S "
,MECFANICP.L $ ' -�- TOTAL FEE S" �
'�PLANCNECK- $ � '� VANCEPC S� � � �
. FE,� cv�iv�i� =eirY/�,eoTc�7- �
f _ � FINAL FEE 5 -
�
CONSTRUCTION AND PLANNING � POOL & SPA � �
��Z4'� Date Inspector - � - - - � - . Date: �� Inspector
APPROVALS Permit # � APPROVALS � , � Permit # � .
1. Temporary Electrical Service or Pole 43.� Pool & Equipmen't Location� - - -- --_
2. Soil ipe-Undrgrn � � 44. Steel �Reinforcement - � - - -
3. Electrical Conduit Utility-Undrgrn � � ' - 45. Forms - ' �
4. Electrical Conduit-Undrgrn 46. Electrical Bonding -- " !�
. tee ein orce 47. Rough �Plumbin' & Pressure Test. � �
6. Electrical UFER Gm � � '�• ' '48. ApPROVALTO COVER-GUNITE�- -
7. Footings 49. Elect�ical Conduit-Undr rn �
8. Foundation � � �� � ' ' �50. � Gas Pi e, � Undr in, Test � � � � '
9. Water Pipe-Undrgrn � 51. Backwash Lines P-Tra ndr rn� '� -- - -
• 10. StructuralFloorSYstem 52. APPROVALTODECK -"`-----=--- -
� 11-. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final � '
� 12. Street Sewer Connection '� � � - ' 54.. -Heater & Vent-Final � � � �
• 13. Rou h Plumbing � � --- '- -- � � � �
� 14. Rou h ElectrioConduit - ' �56. Electrical-Final - � �
15: Rou h Electric-Wiring- ' - ' ' - 57. Solar SYstem-Final ' ' ' �� �� - ' � -
�- 16. -Rou h Heating & Air Conditioning - - - . • encing & Access Approval � '
17. Ducts in Structure_ � APPROVED FOR PLASTERING '� '' ' �
18. Ducts, Ventilating . ' _ _
' 19. Gas Pipe-Rough &Test-- � � � 60. POOUSPA�SYSTEMS FINAC � • • � ' � ,
20. .Roof Framing ' _ � - � � • � � �
21. Roof-Sheathin � � � _ _ ' ' � . - � �_ "' � �
,� 22. Frame.and Flashin ' NOTES: � � � . � '
23. Insulation . � � ' � ` � � ` � � _.5.� 4- . E
24. lathing & Siding . ' L �- o. ,(A.) 5 � � o�.
.. __
, 25: DryWall Nailing � � � • �
_ 26. Plaster Brown Coat ' � v L
, 27. . Electrical Power MeterFinal ' "Vh •e✓ L t O�v� �- ��. v� Y.. �
�. 28. Final Electric_' � � � ' ' _u � � � � � � �
29. Final Neating & Air Conditioning . � ' ' ' � ' ' �^-
- 30. Final Gas Pipe-Test ' v_ � -'
31: Final_Plumbing ' � ' ' ' � �
32. Water.Service-Final. ' � ' ' ' � ' � ' ' ' • � " � ' '
_33. Gas Service-Final � � ' ' � � � � ' �
' 34. Solar pomestioFinal ' � � � ' � � � '
35. Landsca e S rinklin S stem � ��
' 36. Sound Attenuation � - ' � -
� 37. Handirap Regulatio�s � • � �
` 36. FINALSTRUCTURE&BUILDING � � - ' • � �- •
39. Special Requirements Completed � � ' - � -
' 40. Electric Release to Edison � a � � - � ` - '-- �
� 41 . Gas Release to Southem California Gas Co.
42. CERTIFICATE OF OCCUPANCY . _ � �
• . , . . ._ . . o. � .
No Date