HomeMy WebLinkAbout3590 HARBOR GATEWAY - Building Permits.. . .. .. . . . . .� . _ _ . , _ .. � ... : .�.,_ ..�. ,.
� CI" 'Y OF COS � A M; SA c
Development Services, Division of Building and Safety
CERTIFICATE..QF �OCCUPANCY
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This certificate is issued pursuant to the
of Costa Mesa cerHfies that at the Hme ot
approved for occupanty as follows: �
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3590 HarboY
Building Add�ess _ ��� `>
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Use Commercial {, �,�f �pj
Group
OwnerofBuilding Stra
Address 2�45 E.. Ch
aateway North
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,"CA 9286
3uilding Code, Section 308 adopted by the City
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refierem below described was inspected and
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=�Bldg; Penmit Number
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BUILDINGOFFICIAL-R1CIC A�-BI'OWri; C.B.�.Hen -E1-l.i<ngson,
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� REQUIRED TO BE POSTED IIV "A�CONSPICOUS PLACE
nspector
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City of Costa Mesa
Development Services Department
Building Safety Division
P. O. Box 1200
Costa Mesa, Califomia
The Building located
r a a.
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CERTIFICATE OF OCCUPANCY No.��
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances
for a Group E1-2 Occupancy.
Use of Building Office
able thereto ,
Legal Description 415-101-01
(See reverse side far Metes and Bounds)
B23846, 820709 E23809, E2225G
Building Permit No $20708 Electrical Permit No. SE23307 Plumbing Permit No.=��Q�.l
BE23307 E20726
Mechanical Permit No. M�7�d2 Number of apartments ,a_,n�d1/ojr guest rooms _
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ISSUED TO: Building Official �•
Bov Scouts ��'
3�11 S. Itear Street bY �
Santa Ana. CA , /�//�//>�
Date Y
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed rxcept by the
�, Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C.
CMF 1015-46 rev. 1/83 White -Owner; Canary -Numerical File; Pink - 81dg. Permit File ���
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� CI� ' OF COSTA ME�-� c
Development Services; 8�,;, ision of Building und Safety
CERTIFICA'TE�OFxOCCUPANCY
17vs certificate is issued pursuant to,tlie.iequirei
the City of Costa Mesa certifies thaY at'the lime
,tv; � � �y
inspected and approved for occupancy,as, �fyo'llows
Building Address 3590 �HayrbV or� Gatew
Use BENCO D,E TAL��/j�
Group B/A-3 T�p'eofGonstruction!
OwnerofBuilding Dent3�E�ero I se
Address ���� �. �
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BUILDING OFFICIAL-K�ldllll N�yell,
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� REQUIRED TO BE PC
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THL
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Code, Section 111 adopted by
� herein below described was
NumberBC12-00208
Use Zone
PLACE
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PERMIT TYPE
Sub Type:
CITY OF COSTA MESA
6111LDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • vrmv costamesaca.aov
B_COMBO
COM_ALT
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: BC11-00623
Jo6 AooRess: 3590 HARBOR GATEWAY N CM
APN: a7510t0a . . Zoning:
Vicinity: FIRST AND S�COND FLOOR
Const Type: . �� S�. FT: 0
STATUS: ISSUED
DATE ISSUED: 12/05/2011
ISSUED BY: RMD
Suite/Unit:
: Primary Occ: �
Valuation: $20,000.00
SCOPE OF WORK: 20,000 SF NON-STRUCTURAL INTERIOR DEMOLITION OF FIRST AND SECOND FLOOR TO BRING TO
SPEC UNITS IN PREPERATION OF FUTURE TI. REMOVAL OF NON-LOAD BEARING WALLS, INTERIOR DOORS, WINDOWS,
FINISHES, TOILET PARTITIONS, COUNTERTOPS, SINKS, AND TOILETACCESSORIES, REMOVE ANY NON-COMPLIANT
FIXTURES. NO OTHER
WORK AUTHORIZED UNDER THIS PERMIT.
PLANNING NOTE: INTERIOR DEMO ONLY. NO USE REVIEWED/APPROVED. FUTURE SUBMITTAL RE�UIRES PLANNING
REVIEW OF USE.
OWNER: STRATA LAND LLC Address: Unit: COSTA MESA,
CA
Phone: City/State2ip: 3590 HARBOR GATEWAY NO
APPLICANT: O'BRIEN, ROBERT
Phone: 415-408-8282
Address:
City/StatehZip:
CON7RaCTOR PROFESSIONAL COMMERCIAL INTERIORS INC License No. 821055
Phone: 415-0OB-8282 Address: 490 POST STREETUnit:
Cell: CitylState: SAN FR4NCISCO, CA
ARCHITECT: LPA INC
ENGINEER:
COMBINATION PERMIT FEE SUMMARY
Building Plan Check:
Building Fees:
Electrical Fees:
Mechanical Fees:
Plumbing Fees:
SMIP Residential:
SMIP Commercial:
Bldg Std Admin Fund
TOTAL FEES:
License No.C25664
License No.
$208.81
$321.25
$0.00
30.00
$0.00
$0.00
$4.20
$1.00
$535.26
HOURS FOR CONSTRUCTION ACTIVITY: EFFECT
Montlay Nru Fritlay - 7:00 am thru 7:00 pm. Saturtlays• 9:00 am thru 6:00 pm. P
New Years Dav. Memorial Dav. Indeoendence Dav. Labor
Unit: :
UNIT 652
ZipCode 94102
PHONE:949-261-1001
PHONE:
:R CMMC Sec. 13-279
Sundays and the following Federal holidays:
)av and Christmas Dav
regulations. (Ord. No. 92-28, § t, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION,
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must compty with all appliwble wdes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approvat will result in the e�iration of this permit.
cooer, iNsrErnoNrne
7676 Fized System Firta! Fire Prevention
1266 Pool Spa Final
200 Final Re-Root
201 Final 81ock/Retaining Wall
202 Final Fadory Fire Place
203 Final Sign
204 Final Demolition
pgg x � r�o � ixsaecnoxTrrE
206 Final Methanical
208 Final Plumbing
210 Final Elecincal
�. i ��1
6 '
212 Final Fire Prevention
220 Final Planninq Approval
222 Final Site
250 Final Builtling/O¢uparH,y
p9g x �
�NORKERS' COM�ENSA710N DECLARA7fON:
I hereby aKrm under penalry of perjury one of the (ollowing declarations:
❑ I have and will maintain a certificate of consent to sell-Insure for vrorkers'
cqmpensation, as pmvided for by seclion 3700 of the Labor Code, for the
peAormance ol the vrork fOr which t�is permit is issued.
❑ I have and vrill maintain vrorkers' compensation insurance, as required by
section 3700 0( Ihe LaDor Code, (or the peAortnance of the vrork for whiU t�is
pertnit is issued. My xrorkers' compensation Insurance carrier and policy
number are:
COrrier. � ��`�'-� o�c�.S ��"`6 �a
(ilvsscCOa�ne.Mno(Eemn letlEtliepPmufisvalueHatwrenv�4rtdcbfars(f1001akv.)
POlicy Numtier: O 4 —
❑ I certify t�at fn the perfortnance o( the work for which this permit is
isSuetl. I shall nol e any person in any manner so as to become subject
to t�e worke ' mp sation I of Califamia, and agree that if I should �
become s �ect t e wo compensation provisions of Section 3700 of
the LaDo Cod shall to h' with these provision .
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a�q�rss�y„w�o oms .
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAVJFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
P�NqLTIES AND CNIL FINES UP TO ONE HUNORED THOUSAND DOLLARS
(5700,000). IN ADDfT10N TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND
A7TORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of lhe Business and Professions Code. and
my license is in full force and eRect.
Lic. # O S � Class # �
�
ConkaGa.LS amre ate -
CONSTRUCTION LENDING AGENCY:
[] I hereby aifirtn that there is a cons[ruction lending aqency (or the
perfortnance of the work tor which this permit is issued. (Sec. 3097, Civil Cotle).
Lpntlers Name:
Lenders Address:
$ignaWre Da�a
OWNER-BUILDER DECLARATIONS:
I hereby aKrm that untler penalry of perjury that I am EXEMPT FROM THE
CONTRACiORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Code: Any ciry or county which requires a permit to
construct, alter, improve, demolish, or repair any s�ructure, pnor to i�s
issuance, also requires the applicant for such permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors
�icense Law (Chapter 9(commencing vrith Section 7000) of Division 3 of the
Business antl Pro(essions Code) or that he or she is exempt �herefrom and
the basis for ihe alleged exemption. Any viola[ion of Section 7037.5 �y any
applicant (or a Dermit subjects the applicant to a civil penalry of not more than
five �undred dollars (5500).):
� I, as owner of the property. or my employees with wages as their sole
compensation, WILL DO THE WORK, and the str�cture is nol intended or
oryered for sale (Sec. 7044, Business and Professions Code: The Contractors
Llcense Law does not appty to an owner of property who builds or improves
lhereon, and who Ooes such work himself or herself or lhrough �is or her ovm
em0loyees, provided that such impmvemenis are not intendetl or oHered for
sale. If, however. the building or improvement is soltl within one year of
completion, the owner-builder vrill have the burden ot proving thai he or she
did nn� build or improve for puryose nf sale.).
[] I, as owner of the property am EXCLUSIVELY CON7RACTING WITH
LICENSED CONTRAG70RS to construct the project (Sec. 7044, Business antl
Professions Code: The contractors License Law dces not appy to an owner of
property who builds or improves tliereon, and who contracts tor such projeci wilh
a coniractor(s) license pursuant to ihe Contractors �icense Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
Owner ID verifred by driver'Slicense. ❑ Yes ❑ No
Driver's License No. Expires:
Verifcation of Ownership by (rype of tlocument, i.e. - property tax bill or tleetl):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby certiry lhat no Excavafion five (5) or more feet in depth into which a
person is required lo tlescend, will be made in wnnection with wprk aut�onzetl
Dy this pertnit, and Ihat no builtlinp strucWre, scaHolding, falsework, or demolition
or tlismantling thereol, will be more than �hirty-su (36) feet high. (Chap. 3.2, Gry
2. M 2. Sec. 341, Title 8, Califomia Administrative Code).
❑ As owner-Ouilder, I vrill nol employ anyone to Oo work which would
require a permit from the Division of Industnal Safery, as noted above. unless
such person has a permit to Co such work from the tlivision.
Pypliunh SipnaWn
Division of Intlusinal Safety Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTFICATION:
1. Will the applicant or present or future buil0ing owupant need to file and
certify a 8usfness Plan for emergency response to release or threatened
release of a hazardous malenal? ❑ Ves ❑ No
(Section 25505 of the Califomia Health and Safery CoAe requires, with some
exceptions, that a Business Plan be filetl vrith the Cosla Mesa Fire
Department �y every business which has at any one lime dunng a reporleA
year a quantiry ol hazardous materials equal lo or grealer than a weight of
500 pountls, or a volume of 55 gallons, or 200 cubic teet of compressed gas
at standard temperaWre anG pressure).
2. Does or will Ihe applirant or present or tuture building occupant need b!le
a registration form for acutely hazartlous materials? ❑ Yes ❑ No
(Section 25533 of the California Health and Sa(ery Code, vrith some
exceptions. requires registralion vrith the Costa Mesa Fire Department by
each Dusiness which at any one time has on hantl a quantity of acutely
hazardous matenals equal ro or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic teet o( compressed qas at standard
tempereWre antl pressure�.
3. Does or will the applicant or present or fuNre building occupant need lo
prepare an RMPP (Risk Management and Prevention Program �or acutely
hazardous materials)? ❑ Ves ❑ No
(Section 25534 of the Calilomia Health and Safery Code provides Ihat the
Costa Mesa Fire Deparimem may require the preparation, certification and
fling vrith the Fire Department of an RMPP by businesses which are required
to r0gister acutely hazardous matenals wilh ihe Fire Department.
4. It an RMPP is presently required. has Section 25534 of the California
Health and Safety Code been fully complied with? ❑ Yes ❑ No
5. Does or will the applicant or present or Poture building occupant require for
Ihe work which is Ihe subjeCt ot this application a permit for such constmction
or modification from Ihe Sout� Coast Air Ouality Management District or trom
any olher air polWtion control district or agency? ❑ Ves ❑ No
(Section 65850.2 of the Califomia Govemment Code requires that the requested
infortnation be lumished on applications (or non-residenlial building permits).
6. Will any part of the faciliry to be constmcted under Ihis permit be within
1000 feet from Ihe outer boundanes o( a school? ❑ Yes ❑ No
Qf'yes', Ihe faCility must meet the requirement of Sections 25534 and 42303
of the Cafi(omia Health and Safery Code).
7. If a pertnii from the South Coast Air pualily Management DisMct or other
air polWtion coNrol district or agency is required for the work which is t�e
subject of this application, have all o( the tlisclosures prescribed hy Califomia
Hea11h and Satery Code Seclan 423D3 Deen made? ❑ Yes [] Nn
8. (II'yes', attach certifiwte of wmpliance from the appmpriate air polNtion
control officer).
CERTIFICATE OF COMPLIANCE: I certify Ihat under penalry of perjury ihe
intnrmation given above is conecL I agree to compy wilh all state laws and
ciry ordinances regarding Hazardous Materials and Emissions.
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRV: I
certify under penalry of perjury lhat I have read this application and state Ual
ihe informalion given is cortect. I agree to compy with all slate laws and city
orclinances relating to building construttion, and auNorize representatives ot
ihe City o( Costa Mesa ro enter upon the aboveEescribed property for
inspection purposes. I agree nol to occupy or allow occupancy of any building
authorized by this permit until final inspeaion.
Signalure ot Lagal pwneqs) Dale
3b5J<8(3N9) _ __ •
MMW AulM1rniiBtl AppliCdnl Delp
•
a
CITY OF COSTA MESA
BIIILDING DIVIS/ON
•
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 � vnvw.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) i54-5626 / .
1�
PERMIT NUMBER:��BC07-00087
PERMIT TYPE: B COMBO STATUS: ISSUED
Sub Type; COM_ALT DATE ISSUED: 08I0112007
ISSUED BY: SOK
�oa aooRess: 3590 HARBOR GATEWAY N CM Suite/Unit;_ ._
APN: 41570104 . � - Zoning: , , � , .
Vicinity: 1ST FLOOR ONLY , -- . Primary�Occ: •
Const Type: V-N %SQf FT; 5000 Valuation: 5100,000.00
SCOPE OF WORK: 5,000 S.F. INTERIOR TENANT IMPROVEMENT FOR "GC AMERICA"
OWNER: STRATA LAND LLC .- Address:
CA
Phone: � � ; �. City/State/Zip: �. 3590 HARBOR GATEWAY NO
APPLICANT: RIA TAJADA
Phone: 310•768-2700
Address: 879 W 190TH ST
Ciry/StatelzZip: GARDENA, CA
CONTRACTOR: SATOH BROTHERS INTERNATIONAL INC License No. 743636
Phone: 310•768-2700 � Address: 879 W 190TH STUnit:
Ceil: . City/State: . GARDENA, CA _
ARCHITECT: ,
ENGINEER: NISHIYA, KUIVIHIRO
License No. �
License No.0011264
COMBINTATION PERMIT FEE SUMMARY. = •
Building Plan Check: $161.49
Building Fees: - � ,- S993J5
Electrical Fees: $421.22 .
MechanicalFees: � � $44.45
Plumbing Fees: $72.50
SMIP ResidentiaC 50.00
SMIP Commercial: - _ $21.00
TOTAL FEES: $1;714.41
^Reter lo fee Yeceipts for ali fees paid for project � '
Unit: COSTA MESA,
Unit: :SUITE 910
SUITE 910
ZipCode 90248
PHONE:
" PHONE310-768-2700
NOTICE: The Work authonzed by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. �
INSPECTIONS: In order (or the work authonzed untler this permit to be considered legal, such work must comply with all applicable codes, and all
required inspBcttons and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration o� this permit.
CODE/, ixsrernoNTYPE
1818 Fized Sys�em Final Fire Prevention
1288 Pool Sp2 Final
Z00 Final RB�Rool
201 Final BIak�Retaining Wall
202 Final FaG�ory Fire Placa
203 Final Sig�
204 Final Demolition
Or1TE INTRULS �OOE/ INSGECTIONTYPE
208 Final MeChanicyl
ORTE INTI71�L5
208 Final Plumhing L���� U
210 �nal Electrical y�� ,(r���f � I�/ �� / 0 F
/�... v {C�CI��
272 Final Fire Prevention
220 Final Planning Approval
222 FinalSite
2so ✓Final Building�Occupancy�c ,Nai�,Nq I�/G /d $ E Mc
WORKERS' COMPENSATION OECLARAitON. 1 • '
I hereDy affirm untler penalty of peryury one of the following tlec�arations:
❑ I have and will maintain a certificate of consent to self-Insure (or vrorkers'
compensatioq as providetl for by section 3700 ot the Labor Code, (or the
pedormance ol lhe work for which this pertnit is issued.
C� I �ave antl will maintain v.orkers' compensatbn insurance, as requiretl by
secuon 370� ol the Labor Code, (or the peRortnance of Ihe xork Ip which Uus
permit is issued. My workers' compensation Insurance carrier and policy
numbe� are: c '\
�er � L�� �vf��
(ilus uppn neea nW Ee mnlpeted d tne pemY 4�dh�etl a� ma �uMrtd 4/ais (5100) a less )
Polic� mber: ���d �2 — %1��
❑ 1 certify thal in the peAormance of the work for which this permit is
issued, I shall not employ any person in any manner so as to become subject
to the workers' cOmpensation laws of Califomia, and a9ree that if I shoul0
Dewme subject lo tha workers' compensation provisions of Section 3700 0l
the Labor all forthwith comply with these provision .
g � 0
� Applkanfs $ipnaWre D e
�_ . _ _ _ _ �—_
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PEMALTIES AND CIVIL FIMES UP TO ONE HUNDRED THOUSAND DOLLARS
(8100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INfEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm that I am licensed under provisions of Chapter 9(commencing
�ith Section 7000) of Division 3 of the Business and Pro(essions Code. and
my license is in full force an0 eHect. �
�o_a �¢��i� �` a
O O
f � r's Signawre � e _
l_ _
CONS7RUCTION LENDING AGENCY:
❑ I hereby affum ihat there is a constmcCan lending agency fw the
peAormance of tha v.ork for which this pertnit is issued. (Sec. 3097, Civil Cotle�.
Lender's Name:
Lender's Address;
SIB^awre Dale
OWNER•BUILDER DECLARATIONS:
I hereby a(firm thaf untler penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW (or the following reason (Sec. 7031.5,
Business antl Professions Code: Any city or county which requires a permil to
consiruct, alter, improve, demoli5h, or repair any struGture, prior to its
issuance, also requires ihe applicant for such permit to file a signed statement
that he or she is licensetl pursuant to Ne provisions of the Contractors
License Law (Chapter 9(canmencing with Section 7000) of Division 3 of the
8usiness and Prolessions Cotle) or that he or she is exempt Neretrom and
Ne basis for the alleged ezemption. Any violation ot Section 7031.5 by any
appliwnt lor a permit subjecls the appliwnt to a civil penalry af not more than
(ve �undred dollars (5500).):
❑ I, as ovmer of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the structure is not intended or
ofteretl for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law dces not apply ro an owner of property who builtls or improves
thereon, and who does such work himself or herself or ihrough his or har own
employees, providatl lhat such improvements are not intenCetl or offered for
sale. If, hovrever, the building or improvement is Sold within one yeai of
complation, the owner-builder will have the burden of proving that he or she
did nol build or improve for purpose of sale.). ,
� I, as owner of�ihe property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to construct lhe pmject (Sec. 7044, Business and
Pmfessions Code: The contractors License Law dces not appty to an owner of
properly who Duiltls or improves lhereon, antl who contracts for such project with
a cmtracfa(s} license pursuant to the Contractors �'cense Laws.�.
❑ I am exempt under sec.
Business and Pro(essions CoAe for this reason:
Spnawre ' ' Dat�
]OS"l�a8 (YO)�
�
Owner 10 venfietl by dn�nse. ❑ Yes ❑ No
Oriver's License No. Expires:
Verification of Ownership by (rype of tlocument, i.e. - property taz bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION; '
❑ I hereby certify that no excavation frve (5) pr more feet in depth into wfiich a
person is required to descen4 will be made in connectbn wilh vqrk autlqrizetl
Dy Ws pertnil, and tliat no building slmcWre, scaffdtling, falsework, or demolition
or dismant7irtg thereot, will be more than thirty-5& (36) feet high. (Chap. 32. Grp
2. M 2, Sec. 341. Title 8, Califomia Administrative Coae).
❑ As ovmer-builder, I will not employ anyone to do work which vroultl
require a permit from the Division of InAusMal Sa(ery, as noteC above, uniess
such perSon has a permit to do such work from the division.
APo��woYs Slgnawm
Division Of Induslrial Sa(ety Permit Number. _
HAZARDOUS MA7ERIALS ANO EMISSIONS CERTIFICATION:
t. Will the applicant or present or future builtling occupaN need ro fle antl
certify a Business Plan for emergency response to release or threatenetl
release of a hazartlous material? ❑ Yes ❑ No
(Section 25505 0l the Califomia Health and Safety Cotla requires, with some
exceptions, that a Business Plan be filetl with the Cosla Mesa Fire
Department by every business which has at any one lime dunng a reported
year a quantiry of hazardous matenals equal to or greater than a weight of
500 pountls, or a volume of 55 gallons, or 200 cubic feet ot compressed gas
at standartl lemperature antl pressure).
2. Does or vnfl ihe apD���nt or preseni or fufure builtling owupant neeA to �le
a regist2tion fortn for aculety �azardous materials9 ❑ ves ❑ No
(Section 25533 0l lhe Califomia Health and Safety Code, with some
exceptions, requires regisl2tinn with IAe Cosfa Mesa Fire Department by
each business which al any one time has on hand a quantiry of acutely
hazartlous materials equal to or greater than a weight o( 500 pounds, or a
volume of 55 gallons, or 200 cubic feet ot compressed gas at stantlard
tempe27ure and pressure).
3. Does or will the applicant or present or future builtling occupant need to
prepare an RMPP (Risk Management antl Prevention Program lor acutely
hazardous matenals)? � Yes � No .
(Seclion 25534 ot the Cali�omia Health and Safety Code provides that the
Costa Mesa Fire Departmenl may require 1he preparation, certification and
filing with the Fire Department of an RMPP by businesses which are required
lo register awtely hazardous materials vnth the Fire DepaAment, .
4. If an RMPP is presenty requiretl, has Section 25534 of lhe Califomia
Heallh and Safety Code been fully complied with7 ❑ Yes ❑ No
5. Ooes or will the appl(wnt or present or future building occupant require tor
the work which is Ihe sobject of this application a permit for such consWction
or modification fmm the South Coast Air �ualiry Management District or (rom
any other air pollution convol distnct or agency7 ❑ Yes [j Nn
(Section 65850.2 of Ihe Califomia Govemment Code 2quires that the reQuested
infortnation be fumished on appliwtions fa rormsi0ential building pertnits�.
6. Will any parl o( the facility [o be constrocted under this permit De within
1000 feet from the outer boundaries of a school7 ❑ Yes ❑ No
(If yes", Ihe taciliry must meet the requirement ol Seclions 2553a anC 42303
of the Califomia Health and Safety Code).
7. II a pertnit from the South Coast Air Qualiry Management District or ot�er
air pollution control district or agency is required for Ihe work which is the
subjecl o( this application, have all of the disclosures prescribed by Califomia
Healih antl Salety Code Section 42303 been made7 ❑ Yes ❑ No
8. pf'yes", atlach certificate of compliance from the appropriate air pollWion
control oKcer).
CERTIFICATE OF COMPUANCE: I certify that under penalty of perjury lhe
intormation given above is correcL I agree to comply with all state law5 and
ciry ordinances regarding Hazardous Materials and Emissions. . -
Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application and slate lhat
the infottnation given is correcL I agree to compty wilh all state laws and ciry
ordinances relating to builtling construction, and authorize representatives of
the Ciy of Costa Mesa to enter upon the above-described propeqy for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this pertnit until final inspection.
$lonature o� r(s� WIe
��' � -�_
MOIIXAUV1IX�zlCAppl�fant DiC
�---
Application
CITY OF COSTA MESA
P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 82828-7200
DEVELOPMENTSERVICES DEPARTMENT
T_C_O_
for Temporary Certificate of Occupancy
BUILDING AND SAFETY
(Print/Type Only)
Address: .3� 9D ./�A2� ��A72 W��J. .t_/ � Permit Nu��
BusinessName: �' [.' . iaH�2iCA • in./e. Telephone: _
Business Type: %@.�.�?A C- ' Occ. Group:
Building Owner
Name: ,S'�'2�F1
Address: �i�90• /a//n-'��A2 �-��7i2aU�.'�-%
c�cy: G'ns�r� H;zs� . z�P:
Telephone: { ) —
This Use Woultl Be Described As:
❑ Newly Constructed Building ❑ Change of Owner
@'€xisting Builtling ❑ Change of Use
i i . S
Business Owner/Manager/Contractor
Name: I��T7o/-/� j32ojPh2ll-�
Address: `a7g• (.� /�j0=h � .
City: �iA27��,a./�i G/� Zip: �.25�8
Telephone: {3�� � 766 _ �7pD
❑ Change of Occupant
❑ Additional Occupant
/6
Request is hereby made for lemporary use and occupancy on the above projecl for a time period oi �! days only.
I am fully aware of Section 109 of the Uniform Building Code which states that no building or structure shall be used
or occupied until the Building Official has issued a Certificate of Use and Occupancy for the building, or portion of the
building. I also understand that the fee is for administrative costs. �S
It is understootl and agreed that this approval, if granted, will become void after � days, at which time a permanent
Certificate of Use and Occupancy will be granted or occupancy terminated if construction is not completed within 9! days.
J�'�
Reason For Request: Cash Deposit = Z hrS X$47� q�
� vi,��.,;,..�, �rr iZ<>�7 ��n,�,. n 7.' Ce%cr2.c i.zs. i,vs�.)
Signature: L//.l,� i(//�e�� ❑ Owner [�Authorized Agenl Date: /2-�0 -�
I�iC/o2 f�J�9�'Sffi2p �
❑ ENGINEERING
BY:
❑ PLANNING
BY:
DATE
DATE
Building Division (77a) 756-5273 • Code Enlortert
FAX (714) 7544858 • TDD (714)
� S�� SD/ -.Z.L�{_
❑ FIRE
BY:
&�f C.O. -
DATE
BY: � DATE �Z—Lo—'�
29i8�46
14) 7545823 • PWnnirg Division (71<) 7545245
d-5244 • wwH.ci.c05ta-m85a.ca.us
MECHANICAL PERMIT
Job Address: $59O HARBOR GATEWAY N
Suite No
Vicinity:
Parcel Number: 41510104
Applicant: SUSAN VARTERSIAN
Address: 9272 JERONIMO
104
IRVINE,C A
Owner: STRATA LAND LLC
Address:
COSTA MESA, CA
3590 HARBOR GATEWAY NO
Contractor: NEWALL BUILDERS
Address: 9272 JERONIMO
104
IRVINE,C A
Phone: 949 951-0620
Zip: 92618
Phone:
2ip: 92626
Phone: 949 951-0620
Zip:i 92618
License:700926
SCOPE OF PERMIT
REF 804-01777. STRADA MARKETING `
ISSUE FEE
Inst FAU <100 k BTU
Inst FAU >100 k BTU
Repair I Alt CoolinglFieat
Inst / Rep. Recess Wall HV
Refrig Sys <100 k BTU
Refrig Sys >100 k BTU
Gas Piping
Factory Flreplace
Hood w/Mech Exhaust �
VAV Box
Vent Fan I Single Duct
Appliance
Fire Dampers �
SmokeDampers �� " �
Inst or Relocate Appl Venl ��
Air Handlers < 10000cfm ��
Air Handlers > 10000cfm
Floor Fumace �
Floor or Suspend Heater .
�
$23.50
$29.60
$0.00
$0.00
$0.00
$29.60
$0.00
$0.00
so.00
50.00
$0.00
$3625
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
30.00
� ' FEE SUMMARY .�
Quantiry
2
0
0
0
2
0
0
0
0
0
5
0
0
0
0
0
0
0
0
Status: ISSUED
Applied: 12/OS/2004
Issued: 12/OS/2004
ISSUED BY: _�
Repair / Alt Absorb6on Unit
Repair I Alt Refigeralion Unit
" Ventlllation System
, Evaporative Cooler
Commerciallncinerator -
Domestic Incinerator
Compressors / Absorption SVstems � �
Upto3hp/100kBTU - , �
3To15hp/500kBTU , ,
. . � '� '15To30hp/1,OOOkBTU " �
� 30 To 50 hp / 1,750 k BTU '-
Over 50 hp7 Over 1,750 BTU � " .
Boilers
Upto3hp - ; , �
� � � 3To15hp � "
� 151030hp� . " % �:
�' 301o50hp - � ' , " �� �
. Over 50 hp - � . � '
Other Mechanical Fee � � "
Investigation Fee �
- Plan Check Fee ' ,
, Reinspection Fee . �
Quantiry
50.00 0
50.00 0
50.00 0
50.00 0
50.00 0
$0.00 0
$0.00., 0
30.00 0
' $0.00' 0 �
50.00 0 i
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
50.00
$0.00
$0.00
TOTAL CALCULATED FEES $118.95
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically ezpire and become void if work is not commenced withln 1 BO days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under ihis permit to be consldered legal, such work must comply with all applicable codes, and all
required Inepectione and finel approvel must be obtained. Feilure to obtain Inspec�ions and final approval will result In the expiration of this pertnit.
FOR INSPECTIONS CALL: (714) 754-5628
�'..�,��,.4�1:)]
WORKERS' COMPENSAnON DECLARATION: �� . • . . . ��
I �ereby eRirm under penalry of perjury one o1 ihe tollowing Aecleretlons: � �-
❑ 1 �eve end wlll malmein e certiNcete of consem ta sell-Insure br workers' compensaUon, es provided tor by section 3700 oi the Lebor Catle, for the petlormence of ihe
„/�.work for which Ihis permit is issued.
Ttil have arW wlil maintein workers' compensetlon Insurence, es requiretl by secUon 3700 af the Lebor CoOe, lor tlie peAormance ol Ne work for wNcti this pertNt la Issuetl.
My workery�ppnsation nce cer r entl pollty number ere: /�� � y�
Carc{ar. �i -�i polin.µ�m6er. p
(Th!9 sect/on need rrot be cwnpleted i! the peimltls velued et one hurMred dol/ers ($ f00) or IessJ �—•''�
❑ 1 certly Net in the peAortnance ol the work for whi ,this permit is issued, I shflll noI employ eny parson in eny menner so as to become subjen to Ihe workers'
canpensation lews ot C fomla, en0 agre h t II 'hould Decwne sub�ect m Ne workers' compensation proNslons at Sectlon 3700 W Ihe LeDor Code, I shell forthwith
comply with Ihese pm i ns.
�!ILSIpnBtutB�C�WORKERS'COMPENSATIONWVE�FUL.ANDSHAlLSUBJEGfANEMPLOVERTOCAIMINAL ��ES�GNLFl�UPTOONEMUNDRED
WARNINO: FAILURE T
TYIOUSAND OOLLARE (5100,000). IN ADDRION TO THE COSi OF COMPENSATION, DAMAGES AS PROVIDED F-0R IN SECTION 37080F THE LABOfi CODE, IMEREST, AND ATfORNE1"5 FEES.
LICENSED CONTRACTORS DECLARATION:
I herehy.atllrm.ihat I flm licensed dar pro�y sion of Chapter 9(wmmencing with Section 7000) of Divislon 3 0} ihe Business antlProtessions Cotle, entl my license Is In full
tocc,��.endeaect"C7c. a�%a"���.� �Cla e a dS
CONSTRUCTION LENDING AGENCV:
❑ 1 �ereby eHirm that Nere is a construction lending egency tor t�e peAormance ot the work tor which tNs permit is issuetl. (Sec. 3097, Civil CoCe).
Lendefs Neme: lentlers Adtlress:
Signetura: Dete:
OWNER-BUILDER DECLARATIONS:
I hereby eHirtn thet untler penelry of perjury t�el I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for Ihe lallowing reeson (Sec. 7031.5, Business entl Professlons
Code: Any city ar county which requires e permit to construct, elter, impmve, demdis�, or repair eny structure, pdor to Its Issuanca, elso requires t�e ep011cant lor such permit
to ille e signetl stetement Ihet he or she is Ilcensed pursuent to Ihe pravisions ol the Coniractors License Lew (Chapter 9(commendng wit� Sectlon 7000) oi Dlvislon 3 01 t�e
Business entl Professlons Code) or thet �e or she Is e:empt therelrom entl the besb br t�e allegetl ezemptlon. Any violetlon W Section 7031.5 by any appllcant tor e pertnit
sublecis the epplicent to e clvll penalry of not more then Ilve huntlreA dollars (g500).):
❑ I, es owner ol the properry, or my employees with wapes es Iheir sole compensation, WILL DO 7HE WORK, end ihe structure Is not Inientletl or oflared far sale (Sec.
7044, Business end Professions Code: The Conlrectors Ucense Law does not appty to an owner of properry who builds or improves thereon, anO who does such work
himselt or hersell ar through his or her own employaes, pmvided that suc� improvemenls are not Intended or ottered for sale. II, however, the builtllnp or impmvement Is
solA wi�hin one year oi completion, Ihe ownervDulltler will have the burden oi Orovin9 t�at he or she tlitl not build or imprwe tor purpose ot saleJ. '
❑ I, es owner oi the properry. am E%CLUSIVELV CONTRAC7ING WI7H LICENSED CONTRACTORS to consiruct Ihe prqect (Sec. 7044, Business and Professlons
Code: The contracrors lJcense Law tloes not appty to en owner W property w�o builCs or improves ihereon, end who canirects tor such prqect with a conirector(s)
license pursuent ro the Comranors License Lews.).
❑ I am exempt under sec. Business and Prolessions Cotle for this reason:
Signature: Date:
Owner ID verltletl by drivers Iicense. ❑ Ves ❑ No Drivefs LJcense No. Ezplres:
Venllcatlon of Owners�ip by (rype of Cocumen�, i.e. - properry tea EIII or deed):
DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICATON:
❑ I hereby certily Ihat na e:cevetion Ilve (5) or more leat in Aept� Into which e person Is required lo descentl, wlll De metle in connectlon with work euthodzetl by ihis
pertnl�, end thal no building strucWre, sraHoltling, lalsework, or Cemolition or tllsmantling thereof, wlll be more than ihirty-six (3B) teet Ng�. (Chep. 3.2, Orp 2, Art 2, Sec.
341, Title 8, Celilamia Administretive Cade�.
❑ As owner-builder, I will not employ enyone to tlo work which would require a pertnillrom the DlNsian ol Industrial Selery, as noted ebove, unless auch person hes e
permit lo tlo such work from the tlivislon.
Signature: Data:
Division ot Intlustrial Sefery Permit NumDec
CERTIFlCATE OF COMPLIMICE AND AUTHORI7ATION OF EMAY: I certity untler penfllty ol perjury thet I heve read �his Bpplicetlon entl atete Uet the iniortnation given is
correcc I egrae to compy with ell state laws end ciry ordinances relating to buliding canstructlon, end euihodze representatives of the Clry of Costa Mesa to enter upon the
ebove•descdbetl prflperty tor inspection purposes. I egree noI to occupy ar ellow occupency ol eny building euthorized by this pertnit until Mei inspection.
[tid�l� �CF9JS9il9J�IJ�
7618 Fixed System Final Fire Prevention
1266 Pool Spe Finfll
200 Final Re-Foof
201 FInaI8locWRetalning Wall
202 Finel Fedory Fire Place
203
204
Finel Sign
Final Demditlon
QE7E VlS�Lfi
GO�E� INSPECTIONTYPE
206 Finel Mechanical
20B Final Plumbing
210 Final Elecirical
212 Final Fire Prevention
220
222
250
Final Planning Approval
Flnal Site
Finel BuiltlinyOccupency
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa•mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626
PLUMBING PERMIT
1ob Adqress: 3590 HARBOR GATEWAY N Status: ISSUEq
Suite No
Vicinity:
Parcel Nunmber: 41510104
Applicant: SUSAN VARTERSIAN
Adtlress: 9272 JERONIMO�
104
IRVINE,C A
Owner: STRATA LAND LLC
Address
WSTA MESA, CA
3590 HARBOR GATEWAY NO
Contractor: NEWALL BUILDERS
Address: 9272 JERONIMO
104
Arch I Eng :
Address:
IRVINE,C A
Phone: 949 951-0620
Zip: 92618
Phone:
Zip: 92626
Phone: -949951-0620
Zip: 92618
License: 700926
Phone: '
. Z.P:
. . , � License: . . � ,
Applied: 12/08/2004
Issued: 12/0&2004
ISSUED BY:
SCOPE OF PERMIT ,'
REF 804-01777. STRADA MARKETING.1 KITCHEN SINK, 4 URINAL, 9 WASH BASINS, 9 WASH .
BASIN 13 TOILETS. � ' . �
FEE SUMMARY ,
AMT QTY AMT �aTY " , AMT �TY
ISSUE FEE $23.50 Laundry Tub I Washer $0.00 0 � Sump Pump $0.00 0
BackFlow irrig�tion, $0.00 0� - Landscape Irrigation �50.00 0 � �Swimming Pool ,� $0.00 0
BackflowPreventer '$0.00 0 . P-Trap �' $0.00 '0 � TrapPrimer , . � $0.00 0
Bathtub $0.00 � 0� Pressure Regulator 50.00 0 �. Urinal � $3920 4
Clarifier System '' $0.00 �,- 0 �� Process Piping (per 10 ft) " 50.00 � 0 - �. Vacuuin Brkr Bkflow(t-4) 50.00 0
Connect (Ice,Soda,etc) $0.00 0 Receptors � � 30.00 0� � Vacuum Brkr BkBow(5+) 30.00 0
Dental Units 50.00 0 � - Sep6c Tank �. $0.00 0 ' Wash Basin $88.20 9
Dishwasher $0.00 0 Sewer Cap for Demo $0.00 -, 0 Wash Basin Set $0.00 0
Drain, Floor $0.00 0 -- Sewer Connect �$0.00 0� Waste and Vent System $0.00 0
Drain, Rainwater $0.00 � 0�� Sewer Private Line $0.00 �0 Water Closet (Toilet) $127.40 13
Drain, Roof $0.00 0- � Shower �- � �� 50.00 0 � Water Fieater / vent $0.00 0
Drinking Fountain 30.00 0 Sink, bar , 30.00 0 � Water Piping (Insl or Rep.) $0.00 0
Expansion Tank $0.00 0 Sink, commercial , 50.00 � 0 Water Re•pipe $0.00 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 1241-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if vrork is suspended or abandoned
for a period of 180 days. �
INSPECTIONS: In oMer for the work authodzed under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inspeetlona and final epproval must be obtained. Failure to obtain Inspections and final approval will result In the expiration of this permit.
FOR INSPECTIONS CALL: (714) 7545628
26e&d8 (8�W)
WORKERS' COMPENSATION DECLARATION: �� �� � � �
I herehy aNirm untler penalry ol perjury one of the follawing declarations: � '
❑ 1 heve end will meinteln e cerUficete oi wnsent to self-Insure tor warkere' compensation, es proNded for by section 3700 ot the Lebor Code, lor the perlormance of Ihe
�.�Wark br whlC� t�19 pertnll Is Issuetl.
will malntain workero'
nof
valued et
i, as requiretl by SecUon 3700 0l Ihe Labor Cotle, for ihe peAomience at Ne work fw whbh Nls pertnit la issuetl.
numhur nrw�
-•,P_olicyNumOer: ,lJ��- ��y!
or less.) �L
❑ I certtly ihat In Ihe podortnence at t�e work for 1Hch Ihis permlt b luued, I shall noI employ eny person In any menner so es ta become suD�ect to the workers'
compensatlon laws ol C omla, end Yif I shoulC become sub�ect to the workers' compensatlon provlslons ot Sectlon 3700 ot the Lebor Cotle, I shell Iorthwith
compy wlth these provY
�����5 ,�� ..��u- �— -- _ ..oa,�_.-.._ ia �o �
W/61NIN0: FM.URE ECURE WORKERS' COMPENSATION COVEMGE IS UMAW FUL M1D SW1LL SU61ECf AN EMPLOVER TO CRIMINACPENALTIES AND CML FlNES UP TO ONE MUNDRED
TKKISPND DOILPRE (5100,000), IN ADOITION TO TME COST OF COMPENSATION, DPANGES AS PRONDED FOR IN SECfION 31W OF TME UBOR COOE, INTEREST, PND ATTORNEI^S FEES.
LICENSED CONTRACTORS OECLARATION:
ot Chapter 9(commendrg wiN Secilon 7000) of DiNsion 3 of the BuslOess endp rofessions Code, end my Iicense is in full
e�sss-x—� �i .
�-----'_"_ �ate: � �
CONSTRUCTION LENDING AGENCY: '
❑ I hareby aHirm thet ihere is e construction lending agency lor the peAortnence ol the work lor which ihis permit is issued. (Sec. 3097, Civil Code).
Lentlefe Name: Lendefs AtlAress:
Signature:
OWNER-BUILDER DECLARATIONS:
Date:
I hereby etllrtn thet untler penalry ol perjury ihet I am El(EMP7 FROM TME CONTRACTOHS LICENSE LAW for the following reeson (Sec. 7031.5, Buslness entl Professions
Cotle: Any Gry or counry w�ic� requlres e permil ta consWcL elter, improve, demollsh, or repeir eny structure, pdor to Its issuancs, also requlms the epplicent tor suc� pertnit
to Ille e signed stetement thet ha or she Is Iicensed pursuanl to t�e D��sbns of tha Contractars License Lew (C�apter B(commendng wlih Sedlon 7000) of Dlvision 3 of the
Business end Protesslons Code) or Ihet he or she is exempt therefrom end ihe Easis tor tha elleged exemption. Any Noletion of Sectlon 7037.5 by eny epplicent for e pertnit
su6�ects the epplicant to a civil penalty o1 no� more tnan five hunOretl Aollars (5500).):
❑ I, as owner of the property, or my employees with wages as their sde compenutlon, WILL DO T}1E WORK, and tha structure Is not IntenOetl or otfered tor sale (Sec.
7044, Business antl Professions Code: The Comractors License Law Ooes not appty to an owner of property who builds or impmves there0n, flnd who does such work
himsetl or hersetl or through his or her own employees, provitletl that such improvements are not Intended or oHered tor ule. It, however, the builtling or improvement is
sold within one year ol completion, the ov+ner-builtler will have the burtlen ol proving that �e or she tlitl not build or improve far purpose ot sale.). '
❑ I, as owner ot Ihe properry, am EXCLUSNELY CONTRACTING WITH LILENSED CON7RACTOFS lo consiruct lhe pro�ect (Sec. 7044, BuSiness and Professions
Cotle: TTe wntrectors License Lew tloes not aDPN �o an owner ol property who bullds or Improves ihereon, en0 who conirens lar such pro�ect wlth a conireMor(s)
license pursuant to the Contrectors License Lews.).
❑ I em exempt under sec. Business end Professions Code tor �his reason:
Signeture: Date:
Owner ID verifietl Dy drivers Iicense. ❑ Yes ❑ No DriveYs License No. Expires:
Vedflcetlon ot Ownership by (type oi tlocumant, I.e. - property tac bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
� I hereby certity thet no excavetion five (5) oi more teet In depth Inro which e person is reqWred to tlescend, wlll Ga made in connectlon wlth work euthodzed by t�is
pertnit, end that no bullding structure, scattoltling, telsework, or demolition or dismantling t�ereot, will be more ihen thirry-six (38) feet hiph. (Chap. 32, Grp 2, Art 2, Sec.
341, Ttle 8, Calltomle Administrative Cotle).
❑ As owner-GUIICer, I wlll not employ enyone to tlo work whlc� would requlre e permlt irom the Dlvision of IntlusMel Safery, as noted flbove, unless such person has e
pertnit to do suCh work trom the division.
SignaNre: Date:
Division ol Industrial Sefery Pertnit Number:
CERTIFlCA7E OF COMPLIANCE AND Allf}iORIZATION OF EMRV: I cenify untler penalry of perjury t�et I have reatl this epplicetion entl state thet the intortnetion gNen is
CorreCt. I agree to comply wlth ell state lews entl ciry ortllnances relatinp to bulldinp consWCllon, end authorize representetives ot Ihe City ol Casta Mesa to enter upan the
ebove-descdbed pryperty lor inspection purposes. I egree not lo occupy ar ellow occupanty ot eny building euthodzetl by t�is permlt until flnel inspectlon.
COOE 1. INSPECfIONTYVE
1616 Fi:etl Sysiem Final Fire Preventlan
1266 Pad Spa Final
200 Final RaRoot
201 Final BIocWReteining Well
202 Finel FeCtory Fire Place
203 Final Slgn
204 Final DemdlUon
QdIE III�d15
��
COOE � INSPECTION TYPE
206 Final Mechanical
20B Final Plumbing
210 Final Electrical
272 Final Fire Preventlon
220 Final Planning Approval
222 Final Site
250 Final Building/Oaupenry
_, uate 1
PdIE �
.5 J
(��a) 75a-5z�3 • Fax (��a) 754-4656 • www.ci.costa-mesa.ca.us 77 hAIH UHIVt, IiVJIA MCSH, GA tlLOLti
Job Address:
Suite No
Vicinity:
Parcel Nunmber:
ApplicanC
Address:
Owner:
Address
ELECTRICAL PERMIT
3590 HARBOR GATEWAY N
41510104
DAVIS, PHILLIP
STR4TA LAND LLC
COSTA MESA, CA
3590 HARBOR GATEWAY NO
Contractor. E.I.E. ELECTRICAL
Address: 4770 VON KARMAN AV
ISSUE FEE
Temp service test
Res. a/c package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fixls
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over 7000a
Motors to 1 hp
Molors to 10hp
NEWPORTBEACH,CA
Phone: 949 222-0999
Zip:
Phone:
Zip: 92626
Phone: 949-222-0999
Zip: 92660 �
License: 678825
ISSUED B
Status: ISSUED
Applied: 12/23/2004
Issued: 12l23/2004
SCOPE OF PERMIT
20,156 S.F. INTERIOR TENANT IMPROVEMENT FOR'STRATA MEDIA, INC". WORK TO INCLUDE:
ADD INTERIOR PARTITIONS, UPDATE EXISTING RESTROOMS AND ADD 1 RESTROOM. ELECTRICAL,
MECHANICAL AND PLUMBING WORK.
REF: 804-01777
ELECT. PERMIT IS FOR: 156 FIXTURES, 48 OUTLETS, 17 SWITCHES & SERVICE UPGRADE-200
AMP.
$23.50
$0.00
$0.00
$0.00
$0.00
$0.00
$12728
$42.44
$18.70
$0.00
$0.00.
$30.50
$0.00
$0.00
$0.00
$0.00
Quantity
0"
0`
Q \�
156
48
17
0
0 :-
1,
0 ;,
0 �
0
0
FEESUMMARY
- ' � � Temp Dist System / Lighting
Busway /100 ft � :� .
SWnding Section
Misc Electrical Equipment
" Transformers up to 1 kva/kw.
................up to 10 kva/kw -
.................up to 50_kva/kw
.................up to 100 kva/kw �
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System / Ckt
- Misc. Conduit '
� Misa Contluctoc � . ,
, . Circus�( gen or ride) -
Circus (mech ride or lights)
Christmas Tree Stand
Quanlity
$0.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 , 0
$0.00 ' 0
$0.00 0
$0.00 0
$0.00 , 0 �
$0.00 ' 0
$0.00 0
' $0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenis under California statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order For the work authorized under this permit to be consideretl legal, such work must comply with all applicable codes, and all
requlred Inspeetlone and final epprovel must ba obtained. Failure to obtain inspections and finel approval will result in the expiration ot this permit.
FOR INSPECTIONS CALL: (714) 7545626
zaaaea �eroo�
WORKERS' COMPENSATION DECLARATION: �
I hereby eNirtn under penalry ol per�ury one of the following declaretions:
❑ I heve antl wlll malntaln e certificate of consent to self-Insure 1or workers' compensetion, es O�ovitled for by section 3700 ot Ihe Labor Code, lor the paAormance of Ihe
work lor which this permi� Is Issuetl.
❑/I;have anddd,,,wll eln aln work compensation insurance, as required by sectlon 3700 0l Ihe Lebor Code, for ihe OeAormance of Ihe work for which thls pertnit Is Issuetl.
//My wo� m setlon I surence c sr end policy number are:
Cartier: Pollcy Number: � a 6Q j� "_ �`�Ll
This secfion need not be crom lefed il fhe r
( p pe it is velued at ane hundred dollers ($100) or less.)
❑ I ce � at in the pe nce of e work tor icp this permit Is issue0, I shall not employ any person in eny manner so as to ecoma subject to ihe workars'
compensatlon lews 1 Ilf ia, n thet It I sAe Id becoma sub�ect lo the workers' compenselion proWsions ot Settion 700 oi t e Labor Code, I s�ell lorthwith
Comply wi�h Ih on5. �^
�pllcent Signeture: i.Date� �
WARNINO: FAILURE TO SECUR <ERS' WMPENS ON C VEMOE IS UNUWFUL rWD SHALL SUBIECT AN EMPIOYER TO CRIMINAL P �PLTIES D CIVIL NES UP TOONE HUNDRED
TTqUSMID DOLLARE (5100,000�, IN ADDITION TO TME T OF COMPENSATION, DMAAGES PS PROVIDED WR IN SECTION 3%OB OF THE IABOR COOE, IMEREST, AND ATTORNE`fS FEES.
LICENSED CONTRACTORS DECLARATION:
Section 7000) ol Division 3 of tha Business and Professians Cade, end my license Is in lull
.,.___-.� �.,_
CONSTRUCTION LENOING AGENCY:
❑ I hereby aHirm ihat there is e construction lending agency for the perfortnance ol t�e work for which ihis permit is issued. (Sec. 3097, Civil Code).
Lender's Neme: Lentler's Atltlress:
SignaNre:
OWNER-BUILDER DECLARATIONS:
Date:
I hereby aflirtn Ihet under penelry of perjury Ihet I am EJ(EMPT FROM THE CON7RACTORS LICENSE LAW tor the following reeson (Sec. 7031.5, Business entl Professlons
Code: Any ciry or counry which requires a permit to construd, alter, improve, demolish, or repair any stmcNre, pnor to its issuance, also requires �he applicant for such permit
to file e signed stetement that he or she Is Ilcensetl pursuant ta iha provisions of Ihe Contrectors License Lew (Chepter 9(cammencinq with Section 7000) ot Division 3 of the
Business end Prafessions Code) or that he or she is exempt therefrom and ihe besis lor the elleged azemptlon. Any violatlon of Sectian 7031.5 by eny epplicant for e parmit
sub�ects the epplicent lo a clvll penalry of not more ihen tive hundred dollars ($500)J:
❑ I, as owner of ihe pmperty, or my employees with wages es thelr sole compensatlon, WILL DO 7HE WORK, and the structure is not Intended or oMered lor sale (Sec.
7044, Business antl Professions Code: The Contractors License Law does not apply to an owner ot properry who builds or improves ihereon, and who tloes such work
himselt ar hersetl or ihroug� his or her own employees, provitlatl that such improvements ere not intended or affered for sele. It, however, the huiltling or Improvement Is
sold within one year of comple�ion, the owner-builder will have the burden ot proving thel he or she tlitl not build or improve for purpose ot saie.). •
❑ I, as owner oi Iha property, em E%CLUSIVELV CONTRACTNG WIT1 LICENSED CONTRACTORS to construct the prqect (Sec. 7044, Business entl Professions
Cotle: Tha comractors License Lew does not appty to an owner of proDerty who Dullds or impmves thereon, and who contracis for such project wlih e comrecmr(s)
license pursuant to iha CONractors License Laws.).
❑ I em exampt untler sec. Business and Prolessions Code lor this reason:
Signeture: Date:
Owner ID veritied by drivefs Iicense. ❑ Yes ❑ No Orivets License No.
Vedilcatlon ot Ownership by (type of document, i.e. � property tat blll or deed):
Expires:
DIVISION OF INDUSTRIAL SAFETY PERMR CERTiFICA710N:
❑ I hereby certify Ihat no excavation flve (5) or more feet in tlept� in�o whic� e person is required to tlescentl, wlll be made in connection with work euthonzeC by this
permit, end thet no bullding siructure, scalloltling, talsework, or demolition or dismanlling thereoi, will be moro than thlrry-six (36) faet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Tltle B, Celllomla ACmIN5lretive Code). �
❑ As owner-bullder, I wlll not employ enyone to do work which would require e pertnil Irwn Ihe Dlvision ot Industrial Sefery, as noted ebove, unless such person has e
permit to tlo such work irom Ihe division.
Signe�ure: Daie: �
Division oi Intlustrial Sefery Permil Number:
CERTIFI PJ:iANCE AND AIlTHORIZATION OF ENTRV: I certiy under penalty ot perjury that I have read this epplication and state ihet the informetlon given is
o comply withlf3tata.I �ws and city ordinances relating to bullding consiruction, end euthonze representa�ives of ihe City of Cosia Mesa to enter upon ihe
ebove-tlescn d pr a�for i pe - �Sec��agree not to acupy or allow occupency of eny building authonzed by Ihis permi� until finel inspection.
CODE �. INSFECTONTYVE /
1676 Fixed Sysiem Final Fire Prevenilon
7266 Pool Spa Final
200 Finel Re-Rool
201 FInaI BIocWRetaining Well
202
203
204
Final Fectory Fire Place
FinalSign "
Final Demolitian
�g �v�
COOE I INSPECTION TYPE
206 Final Mechanical
208 Finel Plumbing
210 Finel Electrical
212 Finel Fire Prevention
220 Final Planning Approval
222 Final Site
250 Final Builtling/Oaupancy
P� 1t�L5
,� `_lf�I•
(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us P FAIR DRIVE, COSTA MESA, CA 92626
BUILDING PERMIT
Job Address: 3590 HARBOR GATEWAY N
Suite:
Vicinity:
Parcel Number: 41510104
Applicant: TERRY JACOBSON
Address: 3111 SECOND AV
SUITE 3
CORONA DEL MAR, CA
Owner. STRATA LAND LLC
Address
Zoning:
Phane: 949-759-8587 X101
Zip: 92625 ,
�COSTA MESA, CA � " . . - Phone: 714-48&8856
-" 3590 HARBOR GATEWAY NO � Zip: 92626
Contractor: NEWALL BUILDERS
Address: 9272 JERONIMO
104
IRVINE,C A
, Zip: 92618
Phone: 949 951-0620
License: 700926
Status: ISSUED
Applied: t0118/2004
Issued: 12108/2004
/ '
ISSUED BY:
�.
;�
Arch : JACOBSON ASSOCIATES INC Eng:
Address: 3111 SECOND AVENUE , � Address: ' '' •�
SUITE 3 . 'Phone: �949-759-8587. . . -.. ' Bhone:
CORONA DEL MAR, CA - .
� Zip: 92625 License: C8352 ��; license:
20,156 S.F. INTERIOR TENANT IMPF
EXISTING RESYROOMS AND ADD 1
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other.
Inspection:
Total:
9
$2,101.94
$3,233.75
$0.00
$105.00
$0.00
$0.00
$5,440.69
°MENT�FOR "STRATA MEDIA,INC"..WORK TO INCLUDE: ADD INTERIOR PARTITIONS, UPDATE
iTROOM. ELECTRICAL, MECHANICAL AND PLUMBING WORK. �
FEE SUMMARY ,
� . -Calc Valuation: 5500,000:00
, ,,,
- - = - -- - � Claim Valuation: � ' . Ssoo.000.00'
. . . - .. , . , _ � i . : � . ,
�;'
i , ,� (� �
� � " ' �: �'
._ _ �; _;
.�.... i , ,' : ,
.., ,,;� . ;`
..;r' - .. . - ' '%.,/� . .
�� �
� .:31c'' ��;!, � �
, , "/ . �' �., � PLANNING &�ZONING � ' , �:; i� , - i,%
'. SETBACKS �� � � � . � ' ? " �
MAINSTRUCTURE�Front 0-0 �, '-Rear���.0-0 ' ��"left> � ,0.0 - RighL - 0 0- � = ��
- _ _ _. _ . - . , r,. � .
ACCESSORY Fronf 0- 0�� Rear 0- 0 :' Lek � 0- 0� Right 0- 0 '
PARKING Exisryng: o - 'Requlred:_ .�0' � � Pr000sed: � 0 �
, � .
�
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirer
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatirally expire and become void if work is not commenced within 780
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be cansitlered legal, such work m�'
requlred Inapaetions and finel epproval must be obtained. Failure to obtain inspections and final approval
FOR INSPECTIONS CALL: (714) 7545626
zaawe �eroo�
under Cali(ornia slatutes and related
or if work is suspended or abandoned
st comply with all appliceble codes, and all
will rasult In the expiratlon of �his permit.
WORKERS' COMPENSA710N DECLARA710N: .
l hereby attirtn untler penalry of perjury one of tha following tleclarations: � ' �' ' �� .
❑- I have end will maintain a certificate of consent to selt-Insure for workers' compensation, as provided for by section 3700 of the Lebor Code, tor ihe pertortnence of ihe
work for which this pertnit is Issued.
�I ve antl wlll maintain workers' comp9�satlon insurence, as requiretl by section 3700 ot ihe Lebor Code, for t�e rtortnance o} t�e work fo� which this permit is Issuetl.
rke�; cpmp9nsation In�Surance Garner and policy number are: / �j O, �7
I(:HFrier. � ��� {T� A,T% �i olicy Number. _1 7 �S / � /
��(��ctlon need not be completed ll the pe��f (s veluetl et one hundretl dollers ($f 00) or less.)
❑ I certify that in �he perforrpence ot the work for which this permit is Issueq I shall not employ any person in any mannar so as to become subject to the workers'
co ' laws of Cp4fomla, and a tha should becane sub�ect to ihe workers' compensation provisions of Sectlon 3700 of ihe Lebor Code, I shall forihwith
with t se pm 'k' ns. / /'� ,/
licant Si re: Da : /� �� (/ j�'
WA G: FAILURE TO CURE WORKERS' CAMPE SATION CAVEFAGE IS UNL4WFUL AND SHALL SUBJECT MP TO CRIMINAL PENALTIES AND CIVIL FINES 11P TOONE HUNDqED
THOUSAND DOLLARE (S 00,000�, IN ADDITION TO TME COST OF WMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEI^S FEES.
LICENSED CONTRACTOFS DECLARATION:
' fihapter 9(commencing with Section 7000) oi Divisio ot Ihe Business antl�jofessions Cotle, and my license Is In tull
�� lass N ��J
, �,—_'""_ . / - � �
CONSTRUCTION LENDING AGENCV:
❑ I hereby aHirm that ihere is a consiruction lending agency for the pertortnance of ihe work for which Ihis permit is issued. (Sec. 3097, Civil Cotle).
Lenders Neme: Lentler's Address:
Signature:
OWNER-BUILDER DECLARATIONS:
Date:
I hereby aHirm ihat under penelty of perjury that I am EXEMP7 FROM THE CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Business and Professions
Code: Any cily or counry which requires a pe�it to constmct, aHer, improve, demolish, or reDair any sWcture, prior to its issuance, also requires ihe applicant for suc� permit
to tile a signetl stetement ihat he or she Is liGansetl pursuant to t�e provislons ot ihe Contrectors License Lew (Chapter 9(commencing with Sectlon 7000) of Division 3 of ihe
Business and Protessions Coda) or that he o� she is eaempt thereirom end iha basis for the ellegetl eaemptlon. Any violation of Section 7031.5 by eny epp�icant for a permit
subjeds the epplicent to e civil penetly of not more ihen tive hundrea tlollars ($500)J:
❑ I, as aw�er ot the property, or my amployees with wages as thetr sole compensatiw�, W0.l 00 THE WORK, antl the strucNre Is not infefWetl or ottered br sale (Sec.
7044, Business and Protessions Code: The Contradors License Lew dces not apply to an owner of property who builds or improves the�eon, entl who does such work
himself or herself or Ihrough his or her own employees, providetl that such Improvements ere not intentled or oflered for sale. If, however, ihe building or improvement is
sold within one year of completion, the owner-builder will have the burden of proving thet he or she did not build or improve for purpose of sale.). •
❑ I, as owner of the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and Protessions
Cotle: The coniractors License Law tloes not epply ta an awner ot property who builds or Improves Ihereon, and who contracis tor such project wiih e conirector(s)
license pursuent to the Coniractors LicB�se Laws.).
❑ I am esempt untler sec.
Signatura:
Owner ID verified by tlnver's license. ❑ �es ❑ No
Business entl Protessions Code for this raason:
Verification of Ownership by (type oi tlocument, i.e. - property taz bill or deetl):
DIVISION OF INDUS7RIAL SAFETV PERMR CERTIFICATION:
Drivefs License No.
Date:
Ezpires:
❑ I hereby certily that no excavetion five (5) or more feet in depth into which a person is required to descend, will be matle in connection with work authorizetl by ihis
permit, end that no builtling siructura, s�nolding, falsework, or demolition or dismantling ihereof, will be more than thirry-six (36) feet high. (Chap. 32. Grp 2, Art 2, Sec.
341, Tltle 8, Califomia AtlminlsVative Code).
❑ As owner-Duilder, I will not employ anyone to tlo work which would require a permlt from ihe Division of Industnal Safery, es noted above, unless such person hes a
pertnit to do such work from the division.
Signature: Date:
Divisian oi Industnal Sefery Permit Number:
CERTIFlCATE OP COMPLIANCE AND AUTHONIZATION OF ENRiV: I certity untler penalty of perjury ihat I have read this epplication and stata ihet the infortnetion given is
correct. I agree to comply with all state laws and ciry oMinances relating ro �uiltling construction, and euthodze representatives of ihe Ciry of Casta Mesa to enter upon ihe
above-described property for inspection purpOses. I egree not to occupy or allow occupancy of eny building authonzad by ihis permit until finel inspection.
NL
COOE�, INSPECTIONTYPE
1616 Fixed System Final Fire Prevention
1266 Pool Spa Finel
200 Final Re-Root
201 Final BIxWRetaining Wall
202 Final FeCtory Fire PlaCe
203 Final Sign
204 FinabDemOlition
PAg Uii�LS
i�
��
CODE� INSPECTIONTYPE
206 Finel Mechenical
200 Final Plumbing
210 Final Eledriwl
212 Final Fire Prevention
220 Final Planning Approval
� PdIE II�lEL4
222 Final Site 'e �C7
250 FinalBuildinyOccupancy � Z'C6T-� YJ�
i
� Applicant to fill in all spaees ezcept those wit�in heavy borEer lines antl sign all aDOroD��ate tleclarations.
CITvoF"CQS'r�MEsa �ONSTRUf,�TI N PERM T
. Project qddress dY) r� -7 ����+r� �
/ • C �Z- �
Applicant's Mailin Address \� - ,
Owner's Name�C� �1�'� Phone
Ad�res� :.�+
Arch/Eng., License No.
Address
Con[rector's Nam / � ` Pho ��C
Address (m 'I' 1 ..7� ^C1�GK� !.� nca
Ciry License No. ���LCJ
LICENSED CONTRACTOR'DECLARATION �
I hereby affirm that 1 am licensetl untler provislons oi Charter 9(commencin9
with section 7000) of Di slon 3 ot [he Business antl Professlons Cotle, antl
my Ilcense is in ful /orce ntl fect. _
`�- License Class License No.
� Date Si nah re
WORKERS' COMPENSATION DECLA'RATION '
I hereby a/firm that I have a certiflcate ot wnsent to self-insure or a certificate
i of Workers' Compensation Insurance, or a certifietl copY��hereo( (Sactioro
� 3800, Lab.-CJ O.. �p.Nn
PolicY No�t%�i—��% UN/T.�.��3Crw anY ! V
, Cortifletl!copy is he�tl.
'fietl with the In9 ivi
Date � Applicant
EXEMPTION FROM WORKERS' COMPE TIO ION
(TM1is sectiomneetl not be completetl it the permit is (or one hun ($300) or
less). '•
I certity tha[, in the pe�fo�mance of the work for which this perm�t is iz5uetl, I
� Shall not employ any pe�son in any manner so as to become subject to tne
Workers' Compensation Laws of California. ,
Data Signature
, 'NOTICE: I(, aiter makin9 this tleclaratlon. You shoultl become subject to the
Wo�ker5' Compensatlon provisions ot the Labor Cotle, y0u mu5f forthwitM1
comply with such provisions or this permit shall be aeemetl revoketl.
CONSTRUCTION LENDING AGENCV �
1 hereby afti�m that there i5 a Construc[ion lentling agency fo� the perto�mance
of tne work tor which this Oermil is issuetl (Seclion 309� Civ. C.)
Lentl¢r's Name
� LenEer's Atltlress
OWNER BUILDER OECLARATION
I hereby atfirm tnat I am exempt from ehe Contractor's License L.aw tor che
followin9 reason (Sectian ]031.5 Business antl Professianal Cotle: Any ci[y or
.......e.. ..,n�.n .e...d.e. � ee....b m �nncr.u�l alen. imnrnvn. tlem�lish or reoair
Division 3 ot the Business antl Professions Cotle) or that ne/sne is exempt
�herelrom anG the ba5i5 fOr the allegetl ezemption. Any violatlon oi $ection
�031.5 by any applicant tor a permit subjects lhe applicaM to a civil
�enalty of not more than fiva huntlretl tlo�lars (5500).
I, as owner of the property or my ¢mployees with wages as their sole
compensatlon, wiil ao the work, antl the structure iz not intentletl or ot(eretl
�or sale (Section 7044, Business ana Pro(essional Cotle: The Contractor•s
License law tloes not apply to an owner ot a O�operty wno builtls or improves
thereon, antl who tloes such work himself/h¢rse11 or through his or her own
emplovees, provitletl tnat sucM1.improvements arc not intenaea or oiferetl for
sdle. 1f, howevGr, the bulltling o� imprOvement Is soltl within one year ot com-
pletlon, tne owner wi11 have the burtlen oi proving he/she tlitl not bulltl or im-
p�ova fo�(he purpose of sale).
❑ I, as owner of the p�o0erty, am ezclusivery contracting with licensetl Con-
Iractor5 to mnsttuct the project ($ection ]044, Business antl Profe55ions Cotle:
The ContractOr's License Law tloes mt apply to an owner ot pwperty who
bulltls or imowves thereon, antl who contracts tor such projects with a mn-
Iractor(5) license pursuant to tM1e Cont�actoi's Licenze Law). 1 am aware that
proof o� Iheir Wo�ker'S Compensation insurance shoultl be provltletl to me.
L� I am exempt untler Section B. 8 P. 0. �or this reason
Date Owner
a
above
� aosa� � , � � _ _ ..._.
TVPEOFCONSTRUCTION W ADD ALTERATION REPAIR
❑ CONVERSION ❑ OEMOLISH ❑ OTHER
DESCRIPTION OF WOPK/USE OF BLDG. _
TYPE OF PERMIT�/ LJ GRApIN(} IJ FOUNDATION LJ STRUCTVRAL
❑ TENANT ��i c�CTRICAL ❑ PLVMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION S�.FT. oCCUPANCv_
C O N ST RUCTI ON TYPE V ALUATI ON $
ZONE GRADINGCU.V�S. ACRES_
Remarks:
8ar Sink
Backflow Preventer
Backflow Irrigation
aa.n.��n� �
Floor Drains
Roor Sinks
.�i25 $2lVIC2
Interceptors
Kitchen Sink
Lavatories
P—Trep
Roof Drains
ReinspeRion Fee
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
�lltl2[5 Y�/8t2f CI052L �
� Water Heater
Water Service
Auto-Wesh
$15
Duct- UnderGround
Duct - Structural
Duct - Ventilating
Exhaust System � Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑4100,000 BTU �100,000
Siqnature Date�/� -� I qeinspection Fee $15
Driver5' License or 5 �
' 0865-46, rev. 10/84 White - Builtling; Canary - Appliwnt; Pink - Accounting; Goltlenrotl - Assessor
laue Fae
Hood or Type I ❑
Canopy Typell ❑
Refrigeration System
❑aioo,000sTu ❑ioo,00a
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
FEES
A.P. #
S Main Building:
E
T Front
8 Fear
A
C Right
K Left
$
Ping. Ref. #
Planning Notes:
utomatic Washer
onstructwn Pale Sub.
Cooking Uni[
D ishwasher
Dryers �Gas ❑Electric
\
9668 9/i75/3� ' .
Zone
Accessory Building:
ELECTRICAL ,
Transformer � 15-50 KW
� ❑ 50+KW '
Fan
F.A,U.
Fixtures
D2V ICE BOXQS
Outlets
Switches
Garbage Disposal
Generator �0-5 KW �5�15 KW
Meter ❑up to 100 amps
Meter ❑over100amps
Sub Panel
Motors�0�1 HP�ih-8
Inc.Solar 09-15 HP �i6-15+
Microwave
Pole Light
Range
Sign
; S[anding Sections
Trash Compactor
$ 3
Reinspection Fae $15 luue Fee
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
2oning Approved By
Buildin8 APP�oved 9y
Appliwtion IauBd By_ /
$ 3
Z
O
N
I
N
G
R
E
O
M
T
S
FEES
$ 3
SUMMARV OF FEES �
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT � ,
PLUMBING $ ISSUANCE $ -
PLAN CHECK 25% $ ENERGV P.C. $�
ELECTRICAL $ � GFADING $
PLANCHECK 50% $ MICROFILM $
MECHANICAL $ TOTALFEE $ ��
PLAN CHECK 25% g � �
\�
-, _ , . . _ �1
� '
� CONSTRU�CTION AND PLANNING POOL & SPA ,
• APPROVALS Permit# Date Inspector . qppROVALS Permit# Date Inspector
e
1. Tempor�fy Electrical Service or Pole y � 52. Pool & Equipment Location
.2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
-3. Electrical Conduit Utility-Undrgrnd. • 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5: Steel Reinforcement - 56. Rough Plumbing & Pressure Test -
. 6. Electrical UFER Grnd. . . 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
�:
8. Foundation '` . 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgrnd.' 60. Backwash Lines, P-Trap, � Undrgrnd.
70. 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.StoregeTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric ' Notes:
34. Final Heating & Air Conditioning �
35. Final Gas Pipe-Test '�
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer, �
'43. Backflow Irrigation
44. .Landscape Irrigation System
45. Sound Attenuation ,
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed �
49. Electric Release to Edison ,
1 50. Gas Release to Southern California Gas Co , � �
51. CERTIFICATE OF OCCUPANCY
No Date
. _ � ,
ciTY OF COS7A MESA CONSTRUCTION PERMIT
Project Address 3S90 HI%�.2 q� l� �,
Applicant'sMaili Addiess �2-'¢�.� ��ru�s ��
Owner's Name ��� �-�TS o� ���LLl� phone
Address
Arch/Eng. ' License No.
Addresz
Conttactor's Name�-+lLL ElSGT12_lG � IA.�`_. phone ��'��
1240 .�/ �J � 2S kk /} Rti�t ` ��/
Addresslmailing) � , "I
City License No.
LICENSED CONTRACTOR DECLARATION ' �
I ne�eby affitm Ihdt I am licensetl untler provi5iOn5 01 Charte� 9(commencin9
with sectton 7000) ot DlviSiOn 3 ot the Busine55 antl PrOf¢TSiOns Cotle, antl
my license is in full force antl eftect.
Liceni�/%c�� -/O � L'r�.. o r�,.A39io� ,
Date�,_� _— ' �/J e .
WORKERS' COMPENSATION DEC�(M�ATION �
' hereby atfirm that I have a certiflcafe of consent to self-Insure or a certificate
' Workers' Compensation Inswance, or�a certifietl copy tbereof (Se<tlOn
soo, ian. C,Z1Ao !1 �A '� 1 Gn1 A
Policy No. � �Compa
�Certitietl copy is hereby furnished:
Ce "" c y.iitileG with [he city �I g DI ''
Date J"� �' APpliGant
EXE TION FROM�WORKERS' C NSATION DECLARATION
(Thissecfion neetl not be comple[etl I he p¢rmit is fOr One huntl�eC ($300) or
less).
I wrtify lhat in the performance of tne wOrk tor whiCh thls pe�m�t I5 issuetl, I
shall noi employ any person in any mann¢r s0 as lo become subject to [he
Workers' Compensation LnwS oi C511fomia. ' ,
Date SignaturG
'NOTICE: If, after making thts tleclaration, you shoultl become subject to tha
Workers' ComOensa[ion provisions of the Labor Cotle, you must Porthwith
comply wilh such O�ovision5 or thiz pe�mit shall ba tlaemetl, revoketl.
CONSTRUCTION LENDING AGENCV '
I hereby affirm thal there i5 a mn5truction Ientling agency for tne performanG¢
of tne work toF� whlch IM1Is perypit iq�su tl($p,�jls�309] Civ. GJ
Lentler's Name n� ��� l� �� Yl1Vu_I
Lentler's Htlaress
OWNER BUILOER DECLARATION
1 hereby aftirm that I am exempt irom the Con[ractor'S License Law tor Ihe
(ollowing reason (Section �031.5 BuSiness antl Professional Cotle: Any city or
county which �equir¢5 a pe�mit lo cOns[�utt, alter, improve, tlemolish or repal�
. any sVucture, pdor to its issuance, also requlres the appliwnt for such permit
to fiie a signetl statemen[ that he/She Is IlcenS¢tl pu�suant to th¢ ProviSions of
the Contractor's License Law (Chao�er 9(commencing with Section ]000) of
�ivision 3 of the Business antl Professions Cotle) or thal he/she iz ezemOt
M1crofrom antl [he basis'(or [he allegetl ezemption. Any vlolation ot Section
031.5 by any applicant for a permil subjects tM1e applicant lo a clvil
enalty of not more than five huntlre0 tlollars (§500).
� I, as owner ot Ihe property o� my Bmployees wltM1 wd9es as thoi� Sole
compensa[ion, will tlo the work, antl the structure is not in[entletl or ot/eretl
for sale (Secfion 7044, Business antl Professional Cotle: Tbe ConVactor'S
License Law tloes notapply to an owner of a property who bulltls ar improves
thereon, antl who Aoes such work himself/herself or [hrough his or her own
employees, provitletl that Such improvemenl5 are nol In[entlBtl o� offetetl for
Sale. If, howevet, the builtling o� improv¢ment IS soltl wlthln one yea� ot com-
pletion, the owner will nave tha burtlen of proving he/she tlitl not builtl or im-
, p�Ova fo�tne purpose of Sale). '
❑ I, as owner ot the v�operty, am exclusively contracting with Iicensetl con-
tractors [o consbuct [he project (Section 7044, Business antl Professlons Cotle:
Tlte'ContraGfo�'s Llcense Law tloes no[ applyrto an owner of OroOerty who
builtls or imoroves thereon, ana who contracts for such projects with a con- -
tractor(s1 license pursuant�[o the Contra<tor's License Law). I am aware that
proof of their Worker's Comp¢nSatlon Insuranc0 shoultl be provitled [o me.
❑ I am exempt untleo Sectlon B. & P. G. !or this reason
AoO���ant to fill in all spaces exceot those within neavy bortler lines anC sign all appro0��ate aeclarations.
PERMIT�QO �� / TRACT NO. LOT NO. UNIT N6.
� �� y
Date Owner ' ' �
�-Lhereby certity tbat I have reatl lhls application antl 5tate lhat [ne above
intormatlon'is carrect. I a9ree [o comply with all city antl county ortllnances
anA state laws r¢lat g to builtling c n ructlon, antl hereby authorize repre-.
sentatives Of 4s ty t- e ter the abov¢-mentionetl prp perty fyj.
in5pecfion py po ' q/�../G'
Si9na[ure�/ c -✓ � _ Da[e %///Q✓
�—T—
TVPE OF CONSTRUCTION �NEW lJ ADD U ALTERATION l=1 REPAI R.
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORKYUSE OF BLDG.
TVPE OF PERMIT�j ••LJ GRAOING LJ FOVNDATION LJ STRVCTURAL
� 0 TENANT �I ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ �OTHER' � � . �
PROJECT DESCRIPTION 54.F7. oCCUaANCv_
CONSTRUCTION TYPE VAIUATION $
ZONE GRADINGCU.VDS. ACRES_
Remarks:
Sink
Preventer
Irri9ation
Dtinking Fountains
Floor Orains
Floor Sinks
Gas Service
Interceptors
Kitchen Sink
Lavatories �
P-Trap
Roof Drains
$hOWEfS
Service Sink
Sewer Cap .
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Outlets Water Closet -
Water Heater
Water Service
Auto-Wash
Laundry Trays .
A.P. #.
S Main Buildi
E
T Front
e Rear
A
C Right
K Left
S
Ping. Ref. �p
Planning Notes:
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers OGas ❑Electric
Fan
F.A.U.
Fixtures
0646 9/23/95
Zone
Accessory
ELECTRICAL �
Transformei ❑� 15-50 KW
❑ 50+KW
Outlets''. � � '
Switches
Garbage Disposal •
Generator �0-5 KW 05-15 KW
/ .
• 'v
fleinspaction Fee I $15 I � I• Issue Fee I $ 3 I ~ '
Reinspection
' � � ' MECHANICAL � FEES .
Duct- UnderGround
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple �
Firepl/Fact Blt. ICBO #
Heating System & Ducting
Ob100,000 BTU 0100,OOOBT
� � � peinipection Fee � I
O' S' L' 0 55 � �� �
F 0865�46, rev. 10/84 White - Builtling; Canary - ApPlicant: Pink - Accpunting; Goltlenrotl - Assessor
$15
Hood or Type I ❑
� Canopy Typell ❑
Retrigeration System �
❑4100,OOO�BTU ❑700,000
System Fiepair/Alteration
Pire Dampers
Registers � �
- 7 ZoninB APProved BY_
i
" Building Approved By
� � Application luued By_
i•
luue Pee � I $ 3
Merer ❑up ro 100amps
Me[er �over 100 amps �� I
Suh Panel 5
Motors �0.1 H h� 8
Inc.Solar 09-15 HP �16-15+
Microwave
Pole Light C6�
Range
Sign
; Standing Sections
Trash Compactor
$15 � � luue Fee
�
REQUIREMENTS:
.�
.�
8! `o' .
FEES
3a
$
2
O
N
I
N
G
R
E
Q
M
T
S
' SUMMARV OF FEES '
�•BUILDING PERMIT $ � SMIP $
PLANCHECK�� �. $ PERMIT
� PLUMBING � $ ISSUANCE . $'
� �PLAN CHECK`, ,25% $ , ENERGY P.C. $
rELECTRICAL.��'r $ �� GRADING � $
PLAN.CHECK' 50% $ �7'(/��.�-O ' MICROFILM $�
MECHANICAL� �• $' TOTALFEE $ Or�O
PLAN CHECK '25% $� , ,
r
CONSTRUCTION AND PLANNING
�� APPROVALS Permit #
,
1. Temporary Electrical Service or Pole
-�2. Soil Pipe-Undrgmd. -
�3. Electrical Conduit Utility-Undrgrnd. '
4. Electrical Conduit-Undrgrnd. �
� 5. Steel Reinforcement
6. Elecirical UFER Grnd.
7. Footings �
8. Foundation
9. Water Pip¢-Undrgrnd.
10. Structural Floor System
�1;1, Property 5ewer Line & House Connection
12. Sewer Cap
:,13. Roof Drains �
14. Rough Plumbing
15. Rough Electrical-Conduit
16._ Rough Electric Wiring .
17. Rough Wifing Sign
�18. Rough Electrical-T Bar Ceiling
19. Rough Heeting & Air Conditioning
20. Rough FaCtory Fireplace
�21. Ducts, in Structure _
22. Ducts, Ventilating
23. Gas Pipe-Fough & Test
24. Roof Framing
. 25. Roof Sheathing ,'
26. T-Bar Ceiling (Structural) & Monocoat
27. Frame and Flashing . �
28. Lathing & Siding
' 29. Insulation
.� 30. Drywall N�iling
31. �Plaster BroWn Coat
32. Electrical Power Meter-Final
� 33.'Final Electric
' 34. Final Heating & Air Conditioning
35. Final Gas 7ipe-Test �
36. Hood or Canopy
37. Final Factory Fireplace
3S. 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 & BUILDI�NG
48. Special•Requirements Completed�
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
Date
Date
POO iPA
Inspector AppROVALS Permit# .
52. Pool & Equipment Location
53. Steel Relnforcement
�! 54. Forms .
55. Elec[rical Bonding
56. Rough Plumbing & Pressure Test
' e 57. APPROVAL TO COVER-GUNITE
58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, � Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
� 61. APPROVAL TO DECK
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final
.65. Electrical-Final
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit # -
70. Underground Hydro
71. Product Piping OGas ❑Oil
72. Underground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe '
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT �
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes: %�Q,�/C55 �nJD�/1 �p �
. i i
g
Date �Inspector
I�
I /
� �
PB0.IECTROOflFS$. 3590 HARHOR GATEWAY N uNir:
OWNEfl'SNAME:OIF�I�SC�lE COUNTY COUNCIL
noosess:HOY SCOUTS OF AMERICA
3590 HARHOR GATEWAY NO
COSTA MESA,CA 92626
pqLNIENGINEEH:HANDI,�EY ENGINEERING flEc.No;C23012
nooRess: 130 EL CAMINO REAL uNir:
TUSTIN CA 92680
PENMRTEE:HECK�R & LEE CONSTR( ION ._ 4) 572-6061
aooness: 1320 MILLER S C
ANAHEIM 92806
LICENSEO CONTNACTOB DECU1qpTI0N: I hereEy at m tlwi I am li nSeG ur ' visiors o� GuO� (wmmenting with Seclion
70W) ol Orvision 9 0l the BusineSs an0 Pm(es�o{�5 e�nG my li nsC is' I nU .
CRY LIC.: STpTE �L7IC.P y
Oale: —/ � � � � � 7 Signatu : —
WOBRERS' COMPENSpT10N OECIpqpT1UN: I hereby a e c nilka�e af nsenuo selbinsure a certificate ot Workers'
comoensaro�i� jr(��6i(9etti�oov mereai ISec on 7eoo. ta / 0 9 3
i ecll
voucr xo.:STATE E%P. DATE:
COMPRNY: }�
❑ Ceniliea cooY �s nere0y furnisnea. L CertitieE copy is file0 wiN 1 ' d'mg Oiv¢wn.
Dale: I' Z �' I 3 ppplican
E%EMPf10NFflOMWOPNEflS'COMVfNSR710N0ELLAflR710N: � secWnneeUno�tewmpkteGilNeparti�bbrme�untliNI57001a1ess�.
i certity Mat in f�e Oe�a��� a<<�t �✓ork tor wAictt tltis 0ermif a isSaeE. �.WN rpt ¢mpby arry person in any manrur So as �0 6ecome
suUlect lo I�e Workers' Compen9alion LawS ol Califomia.
Date: Signalure:
NOTICE: II, a�ier making Ihiy QQ��araiion,-yUu Should Detom¢ Su�jett IO I�¢ Wofkers' Compenuiion DrOvision5 at I�e LaOor
Cotle. you mu5i lorthwit� cqmpry wilh such pmvisions or tNs permit shall Ue tleeme0 revoke0. .
CONSTBUCTION LENOINC RGEN�y; I �ere�y allirm iha� I�ea i5 a cans�mcti0n IenOinq agenry lor I�e Detlorman[e ol I�e work lor
wnicn ihis permii is issuee �Sectfon 3W7. Gv. C).
LFNDEfl:
RODPESS:
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO: B 060761
PLAN CHECK NO; 09212-92 S
CONSTRUCTION TYPE: V—N PERMIT TYPE; STR PURPOSE; ALT
JOB DESCRIPTION ; INSTALL DOOR, DRYWALL TO CRETE FILE ROOM SQ FT; 1,000
CLAIM VALUE: - 1,000,00 CALC—VALUE: 1,000.00 GROUP OCC; B-2 /
COMMENTS• X
*�r*�tr�r*��r��r�r�e�rr�r�r�r�rx�t��r*�r*�r*x�*�t�r��ex *�r�r�r�r�t�r�t*+t�r*+t�r***x �r�t�r*r**�**�**�r�*****�*�r**
� Z O N I N G R E Q U T A E M E N T S
sErsAcxs
------------ MAIN HUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT; FT IN REAR: FT IN FRNT: FT IN REAR; FT IN
LEFT; FT IN�RGHT: FT IN LEFT: FT IN RGHT; FT IN
PARRING REp • ;PROV: PARCEL: 41510104 2NE: PDZ REF NO:
PLANNING N01'ES> T�NAiJT IMPROVEMENTS TO ENCLOSE AN EXISTING UNIMPROVED AREA
> FOR CONVERSION TO A FILE ROOM,
�rx�t�t*r*�r�ex+r*�r�r�r�r�r�r�r**��r�r�r**��*�r��r�r�r�r�t�*�e�r�r��r��r�r�r�r*�r�r�t**�t�r�t�t*�e*�t�r*�t�t�t*x�t�*�r*�r*�*
D E V E L O`P M E N� T. S E R V I C E S R E Q U I R E M E N.1'. S
20NING APPROVED BY"� : � SCG DATE: �'�� �R3
BUILDING APPROVED BY�; DATE: �—:`y
APPLICATION ISSUED,BY: � DATE; 1'�1G ��13
1fiFikMaflflfMif�EififkiEiFiFffiFiF�lElFif iFifMlf3fiEiF3EiE1E7F{ iF�E
it iF iF M iF k iF iflf iF �F fF iF iF if if M ikik k iF ilif if if it 1f �f �f 1F �F k If k if iE if !f 1f if If if if k k iF k k iF iF if if ik k if k M iE if iE iE 3F if ik 3F if iF ik ik M iF ik if if iE iF if if iE
LEGALIZATION;N '� fi E E S U M M A R Y STRUCTORAL'SEGMENT;Y
�
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
OWNEP 9UILOEF OECIAMTION: 1 nereCy aflirm tlwI I am e.empt Irom tlre Contranoa' State �icense Law lor t�e followinp reason P EAM I T 2 S. 0 0 �' `
�Sec�ion 7Q3L5 Business antl Prol¢ssional Cotle: Any ciry ot wunty w�ic� repuires a permit to wnstmct, aller, impmve, DemolisR or '
iepair any stmcmie. priar to its �ssuance. also re7uires tne apolicant lor sucn ve�m� to ne a sqnea statement mat ne/she is Iicense0 SMIP /NON—RES
Dursuam �o Ihe pmvisions ol t�e ConUactors' Siate License Law �Chapter 9(commeircinq vnth Section 7000) al �ivision 3 of the Business P LJi%j 1O . i rJ � , rj 0
ana Pmlessions Catle� or I�at �e/5he is exempt IAerelmm antl t�e basis lor I�e all¢qe0 exempiion. Any violation ol Sec�ion 7031.5 6y I S SUE FEE
any applicam ia� a permii suoieets me appiiwnt io a civii penatty ai not more than �ive nuntlren tloiiars It6006 BjJ I LD I Ni�i—D 1 V—>
I, as owner a� tne orooenv a� rtn' em ioyees witn wao�s as meir mie wmpensatian. vtil eo tne work, ana me TOTAI�S---->
❑ simcmre b not imeneea nr ollere0lor sale ISCction 704a, Business anE Pmlessional CoEe: The Comraclors' Sla�e License Law
Coes nol appN �o an own¢r ot a Dmpeny wlq GuilGs or impmves iMreOn. anG wAo tlow 5ucli work �imsell/herull or t11mu0h
. his or ner own emD�oyeFs. prOvideO Nat suc� imOrwemenis are not intenGea ai ollereG lor sale. If, however t�e building or
imprOvement is So�a wi�hin me year ol compelion, the mmer vrill tuve t�e OurOen ol provin0 ���e Eb froi �uilE ot improve
lor I�e Ourpos¢ 0� sa�el.
I. af awner ol the O�opetly, em eatluSiveq wntractinq wil� IiCenS¢G fAniraclors �o wn5tmci l�e proltti (Seclion 704E, Bu5ine55
❑ anG Prafeuions Coae: T�e Canlraclors' S�are Liceme Law aces not appy �o an ovmer ol propeity who bmWs or improves thereon
anE who conVactS for SUc� 0�%��5 wi�� a conVa[�or(S�license pursuanllo Ihe Con�raclors' State License law),I am aware
Inal v�ool ol Iheir Worker's Campensation insurance snoula oe D��dea to me.
� I am eaemD� un0er Sec�ion: B. 8 P. C.
lor I�is reason:
Dale:
I ao nertoy cenily ihdt I am aware o� an0 un
25534 antl Itul I or any IWure OuilOing Ottu{
Oermit foi conslmcii0n or moUdipaiion bom
Inese provisions.
Date: — Apqicam:
I here�y c¢r�ity Ihal 1 �ave reatl Ipis ap0�iwti0n aM SIaV
mainances antl stale laws relating �o GuilEing consimclio�
pmperiy loi inspection Ourposeg.
oate: _� "' 2 ` � _L si9namre
Oriver s License or $acial Secuqty ,:
ie , ofCalitor e ana Salery Cotle Secu ns 25505.25533,ana
nee o wilA SaiG Staie cotle5 an Ihe r¢puirem¢n�s�ora
� mem Ust s0entul wnsirunion apo�i t'wns are eKempt Imm
aEov¢ inla 1 n i5 mrtecl. I agree �o campty vnlh all ciiy antl counry
ry aul�onie e5enlalivesolthisti�yloent¢rUponl�e abOve-m¢nlioned
i6<b<6 Whne—Builtling: Green—Cotle Enlo¢emem; Canary—Applicant; Pink—Rev¢nue: GolEenroG—Assossar
PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
25.50 0.00 . 16.25 41.75 41.75 .00
REVENUE DIVISION TOTALS--> COLLECTED; 25,50 OVER/SHORT; .00
BLDG PMT PLUMHING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
25,0� ,5�
iflfMkiliFifMiFlFiFititM�kkkkMkkiFiFikiFlfklkiFlFlFiflFMlFiFifkifif�EkiEikilikilikifkil�EiEikiEififlfitilkiF3fikiFlFiEM*iEiEifiFif�kikiflkk
I N D I V I D U A L_ F E E B R E A IC D O W N
TYPE QTY D E S C R I P T I O'N UNIT COST TOTAL COST
/�
SFC 1000 ALTER BY VALUE COMMERCIAL NOZONE 1.00 1,000,00
END OF FEES
�
� �Y
n
�CONSTRUCTIOR:ANDPLANNING
APPROVALS Permit,� Date
J
i. Temporary Eiectrical Servicepr Pol�
f-2. SoilPipe-UndrgrRd. � - '
i 3. Electrical �nduit UUhtY•Untlrgrnd.
T
'4. Elactricel COnduit�Untlrgrnd.� ' -
� 5: Steel ReirVorcament ''
6� �@lectrlca� UFER Grnd ."
_7: �FaOtin<y . .
, 8. Fourtdatiqn ' 'F• . '
9. 1�Vater Pipe-Undrgrnd. _ .
' �0. StructuraL Floor System y . ' �
11, prpperty $ewer Lire•&. House Copncct� -
12. Secver CaP _, F T Tfj� • •I .
__i
13, Roof DrainS .
14. Rough Plumbing �
n
15. Rough ElectrfCai-Contluit �
16. Rough�lectr±cWiring
77. Rough Wirin9�Sign
18. Rough Elettriaai-T Bar Ceilin9
19. Rough H@at�ng & Air Condi;ioring
- - '^' ' -
Z0. ROugh.hact�ry Pireplace �.: �� � �
' . -�T---T:.'
21. DoRs, in Stiucture � •• • ' + '�
22. Ducts,�/erttilating S .
23: Gas Pipe�Rdugh & Test � 'c ; • �
�
24. Robf framing ; " =' _ � _,
25. Roof 5heathing . �+ • '
II 2@. T�Bar Ceiling (Structuraq &?iAonoco� `. _�,
� 7�. F�9meand "-'�-n9/1,,.✓_-.a�.i' � � . 2.jjlQ,
�v�i � `
28. Laihir� $ �:ding'" "' �'
_ . .. . ;
29. InSularion � - •�
30. Drywall N3r'ling ��,Z%'C�
� 31. Ptasrer�Brqwn Coat ; � �
32. Elecvilal Pewer Met�rFinAl _
, .
',
33. Pinal Electr�ic . ' �., -
3A. Final Heating & Rir Condrtioning '
I - [ :.
35, Final Gas �pe�TeCt �- ' � ,.
36. Hood or CanopY . 1 �' x .
- . -
37. Pinal Factory Fireplac@ ' " ; ? -
3S. Final Flumbing � �=�
y 39: kReter Service-Final__ � �
1
i40. Gas Service-Final *� . � •
41. Solar pomeStirFinat ' �- '
42. Backflow Preventer - • • �
43. Backflow Icrigaiion ' ' � -
.
44. landsopeirriqation System ,- '
45. Sound Attenuation '
46. Handicap Regulations - '
4T, FINAL STRUCTURE & BUILDING
l%s
48, PtNAL PLANNING
49. Etectric Release to Edison "
50. Gas Release to Southern Cali4ornia Gaz Co
51. CERTIFICATE OF OCCUPA CY
No. Oace
POO�..SPA
Inspector APPROVALS Permit #
52. Pool & Equipment Locat�on
53. Steol Reinforcement
54. Forms
55. Electrical6onding
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER•GUNt7E
56. Eloctrical Conduit•Undrgmd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-7rap, O Undrgrnd.
61. APPROVAI. TO DECK
62. Backwash & Recepror�Final '
63. Heater & Vent-Fir.al
64. Plumbing SYstem - Final
65. Etectrical�Final ,
66. Solar System-Final
67. Fencing & Access ApP�uval
68. APPROVED FOR PLASTEftING
69. POOI/SPA SYSTEMS FINAI
FIRE J�.EPT, REQUIREMENT
T I 1'1 _ .� - ��
; � „." APPROVA,(�S" ' Permit #�,--..
'"' ��. ' 70.C'Underground H�rdro !
i c -
, 71. ProductAipin9�Gas �]Oi�
- '� , 72. Underground F10s1�� -
` x�: 73,. Undergmd. Sto<a��an�C O Gas :'Dd
"�^� 74: Overhead HydcA �
�` '.�� ` _ 76.�Dry,Chumical -- � . . _
L�� 76. DryStandpipa-�� �
0
��` �� 72. FIXED.SI�ST�f"�FINAi _
I� 78. FIRE PREV. FlfdAl
I
HEALTN DEP'T: REQUIFi,EMENT
t. -
� . 7g. FINALINSPECTtON : �
� I' �• 80. FOOD CERTIP�EATE (SSUED
. n !' _. .,
�- .
-^ i •�.',"�"�_'
._ t ._
� • .
T ,F y
.
C _ .
i
Oate inspector �
r
. ,
0
PB0.IECTAOOI�S�C:�.�3,S�`9-O HARBOR GATEWAY N
OWNEP'SNRME:Oi(HIVGE COUNTY COUNCIL
noosess:BOY SCOUTS OF AMERICA
3590 HARBOR GATEWAY NO
COSTA MESA,CA 92fi26
AXCHIENGINEEfl:HANDLEY ENGINEER
noonEss: 130 EL CAMINO
TUSTIN
PEXMITTEE:HECKER & LEE ON
aooncss:��EIMILLE ST
�ICENSED LONTHRCiOfl DELUflFTION: I �ere�y a��irm tlul I a
7000) ol Oivision 3 0l Ihe BuSine55 and Pmles io atle. antl m
CITY LIC.: SQTRTE LIC_6 � 4 3
oare: _, _ �� ^ / � Sig Wre: _/
�ave a
UNIT:
NEG CZ3OS2
80
4) 72-6081,
2 8� c �
�POLICY NO.:' - � - � - - - - E%P. DRTE: - �
camPaNr:STATE }(_,
� ❑ Cenifietl cooY �s nereby fumishetl. L Cenilie copy is Iiled i1h the ciry B- ing iv '.
Oate: 1 ^ � � _ � J AODlican�:
E%EMPfION FBOM WOflKEflS' COMPENSATION OECLAMTION: �This sec�ion neeG na� Ge comDletM il lhe perrmi is �or one hurbrM �E700) or less�.
I cenify t�at in ihe pedormance ol I�e work lor wnicn t�is permit is isSueQ I shall nol emDloy any p¢rson in any manner so as lo become
su�lect �o Ihe Workers' Compensaiion Laws ol Cali�omia.
Da�¢: Signaiur¢:
NOTICE: II, after making Ihis Oeclaralion, you shoulU 6ecome sublett Io Ihe Wofkefs' ComDensa�ion provisi0n5 0� IAe Labor
CoOe. you musi Iorthwiih tompiY wi�h suc� pmvi5ion5 ar ��is permii SAall �e tleem¢tl tevakeC.
CONSTflUCTION LENUING AGENCY: I here�y atfirm Ihal ihere is a wnsiNction IenEing aAency lor ihe petlormance ot tAe work for
wnich Ihis permit is issuetl (Sec�ion 3097. Civ. C�.
LENDEN:
nooxess:
OWNEP BUILDEN OECIAHRTION: I here�y allirm that I am exempt imm the Contractors' Staie �icense Law lor the I011owinB �easan
�Section 7031.5 Business an0 Pro�essianal Code: Any city ol counly which requires a De�mi� to consimc�, alier, im0�ove, tlemolish, or
repair any simcNre. prior ro its issuance. also repuires ihe aDDlicant for such oarmit to lile a signed statement Ihat nelsne is licensed
pursuam m ��e pmvisions o� ��e ConVacmrs' Siale license Law (C�apter 9 �commencinp wiih Section 7000) ol �ivision 3 of Ihe Business
and Prolessions Cotle) or ��ai he/s�e is exemp� Iherelmm anA the �asis lor �he alleged ¢xempiion. Any violation of Seciian 7031.5 �y
� any applicantlor a permil subiecls Ihe apv�icant to a civil penalty al nol more Inan five �undred Aollars (5500�.
I, as owner af IAe propeny or my emyloyees with wages as ineir sole compensation, wiil eo tAe work, an0 Ihe
❑ slmc�ure is no� imen0e4 or o�lered lor sale �Seciion 7044, Business antl Pm�essional CoOe: The Comracmrs' S�aie License Law
UoeS no� aDDty �o an Owner oi a pmpetly w�o build5 Or impmves IhereOn, antl w�o tloes SUCh work himSeA/herself Of �hlough
nis or ner own employees, pmvidetl ihat sucn impmvemenis are not intenaetl or ollereU Ior sale. II, nowever the huilOinA or
�" impmvemen� is sold wi�hin one year ol comple�ion, Ihe awner will �ave Ihe burtlen o� pmvinA �e�she Uitl not builtl or impmve
forihe purpose of sale�.
I. as ownerol the propeny, am exGusively coniractinp wiih licensed conlraciors to conslmct ��e pmlecl (Section 7004. Business
❑ and Pmlessions Coae: T�e ConVac�ors' S�ate Litense Law Ooes n01 aOGly Io an owner o� D�op¢rty w�o builds or impmv¢5 �her¢on
antl who conVacts �or such pwle��s with a coniraclor(s�license pursuanllo IM1e Contraclors' S�aie License Law),I am aware
that pwof ol i�eir Warker's Compensalion inmrance shoNA be DroviOetl to me.
� I am e�empl wder Sectian: B. 8 P. C.
lor �pis reason:
Oa�e: Owner.
I Oo hereby certily Ihal I am aware of and understand Ihe requiremenls ol C
25534 ana ��at I or any lulur¢ builtlmg occupant wilVwill no� (ciaie one) nee
permi� lor cons�mction or modi�ica�ian Imm t�e Air Ouality Managemeni Oi
ihese provisions. �1
Oa�e'. Nppl¢an _
I here6y cetlilyi�al I havereaat�is applicalion and ale�ha� Ihe
orainancesanGslatelawsrelatingio�mltlingcan9m ionanOheret
pmpetly �or inspetlion purposes. -
Jla�e: � � 2� � � � Signa re: _
Unver's License or $acial Securiry •:
Io
sections 2ssos, zss33. ane
reawremems for a
pplicalions exempt Imm
t6at�46 Wpne-Builtling; Green-Catle Enbrcement: Canary-AOOlicam; Pink-Pevenue: GOIEanroa-Nsseswr
CITY OF COSTA MESA — BUILDING PERMIT ,
PERMIT NO: E 060762 PLAN CHECR NO: N , ,
CONSTAUCTION TYPE; V—N PERMIT TYPE: ELE PURPOSE: ALT
JOB DESCRIPTION ; INSTALL DOOR, DRYWALL TO CRETE FILE ROOM SQ FT:
CLAIM VALUE; CALC—VALUE; GROUP OCC; B-2 /
COMMENTS: REF: B60761
**�r*x�rx*�*�t�r�r�r**x+t�r�r**�r�r�r*�r*�r��t�t�r*�t*+t�t�r*�t�t*�r�r��r*�r��r��r�e�r*�r�r�t+r�r�r�r�r�t�r�r�*��*�r*�t�r*x �r
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
PARKING RE(� • PROV; PARCEL: 41510104 ZNE; REF NO;
PLANNING Nf51'ES> •
i
it if iF 1F if i!!F!k k 1F if ik it k ik iF ikik if iF if ik it iE ik 1F iF iF iF k if if k iFiFiE ik 1k if 3F ik k k ik iE if 1f it IE if k k!t i! iF iF 1E ih iF it ik iE 1E if aE iF if if IE ik �E iE it 1k 1E IE iE iE iE
D E V E L O P M E N T S H.R V I C E S R E Q U Z R E M E N T S
ZONING APPROVED BY _ .� DATE•
BUILDING APPROVED BY :�
APPLICATION ISSUED BY;
iF if if iF if if if 1t M�f i! M 3F iE fE iE �F �F*if iE if�F'iF
if it iE if iFlE if �E k k M Ik �E ik iE IF if iF 1E ik if iE 3f iE
��—' DATE; �—
DATE • ` d�
i(�1EififlEifiFiEififiF3Fi iEiE
if it k iE i! iF k ik iF k if iflF iE Ik it 1F iE if 1! iE iE iE if if i! if 1E iF * i6
LEGALIZATION;N F E E S U M M��t Y STRUCTURAL SEGMENT;N
V
BLDG PMT PLUMBING ELECTRIC MECHANZC FIRE SMIP/RES GRADING
PERMIT 1.50
SOi SMIP/NON—RES
PLAN
ISSUE FEE 15,00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 1.50 15,00 0.00 16.50 16,50 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 16,50 OVER/SHORT: .00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
16,50
at if ik i! if iF iF ik if k if if iE �F iE ik �t if �f iF iF iF if if iF ik jf ik if !f iF it IE 3f if iE �E IF 1E k if iF k M 1E ik iP �lkiE if M iEif if iF M 1E iF 1f �E iE iE if if iE if iEif 1E If iE �f �F ik 3! iF iF 1E �E
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
ELE 1 FIXTURES LIGHTING 1 ST 20 EA, ,75 ,75
ELE 1 RECEPT/SGIITCH 1 ST 20 EA, ,75 .75
END OF FEES
CONSTRUCTION AND PLANNING POO�_v SPA ,
APPROVALS Permit # Date Inspector qppROVAL5 Permit # Date i�spector
I
� t. Temporary Elettriral Service or Pole.�_ _ 52. Pool & Equipment Location
/ -2, ,So�l Pipe-Untlrgrnd, � ' 53. Steel Reinforcement
i �3. �-iectric`ai Condvii�ltiliTY-��drgM�. 54. �orms
�"¢. Electricaf�ont��it�Vndrgrnd. " . 55. Elcctrical Bonding
';5.: Sieel ReinYorcAment � -• 56. Rough Plumbing & P�essure Test - .
b�'C�ectric�Al{JF��,Gmd. ,� 57. APPROVALTOCOVER�GUNITE
� � :
�.7. F,oqtings,• r � 58. Electrical Conduit�Undrgmd. ��
''-�;:�ound6tian '_ � � � 59. Gas Pipe, O U�drgmd., Test �
;�9.. 4jater P�e-Undrgmd._ .� • ! 60. Backwash Lines, P-Trap, O Undrgmd. �
�� 70. StructuraPFloar System_ �- - �� 61. APPROVAL TO DffCK _
,' i t, �Pr'pperty Ser wer Lit�e & 0�use Connectioa 62. Backwash & Receptor�Finat - . '
� 12. Sewer Cap �-. �' - j. -� : •-- 63. Heater & VenFFinal '
13. Roof Drains. 64. Plumbing System � Final ' �
74. Rough Plumbing ,'�� - +� 65. Electrical-Final
' �
15. Rough EleCtr�1`,al-Contlu�t. , ' 66. Solar System�Fi�al
I6. Rough�lectric Wiring 67. Fencing & Access ApP�oval .�
17. Rough 6Niring�ign . fig. APPROVED FOR PIASTERING
18. Rough Elecvical•T 8ac Ceiling 69, POOL/SPA SYSTEMS FINAL
19_ Po�gh Heaun9 & Air Conditioning .� , FI�iE [f1EPT. REQUIREMENT
�•
20`, floughyfact¢ry�i�eplace � .`-,'i �`- , K '� - . � App�}pVFCLS "� Permit# �
21. Du�yts. io Stsuctu�r8 ,•. .. '. � ; f; �� 70. � Undergrbufrd HXdro '
22. DNcts,;Gen4ilating � ���'- , �, -' . . 71, ProducFPipin9O�Gas �Oil
23. Ges PiPe�RoUgh & Test � r r �� !• ' 72. Underground F,[1�51i
24. ROof Framirig , �' - T _' �.. 73, Undergrnd. Stord9e Tank O Gas ❑ Oil
25. Roof Sheathing • t '� •� ^ - _ � 7d: pverhead Hydro
26: 7-8ar Ceiling (Structura�l & Monocoat _ � ��.' z 7�. Dry Cheaiical � .
27: Frameand Flastung ;'� - 76. Dry Standpipe �
� 28. t,8thing& Siding-; V : t = �`' .�� ..` 7Z. FIXED�Syj'iTEh1�INAL - �'
� 29. Insulation • �. � `�� 7$, FIRE PREV. FINAL '
30. Drywali Nailin9 , � i�, �; HEALTI=1 DEPT. RE�UIREMENT
! 31. Plasterj3rown Coax .: i -� 79, PINAL INSPECTIDN • �
{ . . .. � . . ~ � ---
� 3�. Electricai �o�.ver Mzte�ti��nal `- �- I ` 8Q_ FOOD CERTIFICATE ISSUEQ
- � - � , . ----=-;-- -
. , 33, F�rnal Electdc • . . Nates: :
��. 4 , ;
•- 34. Final Meating & Air Conditionirly � _ -
3�: Final Gas Pipe�Test � � � :�; . ,c • � � . .
� 36. Hotid qr CanoPY " ' • . c ' � ` ..
! 3i Final FaCtory FirePlaGa . - �T � � - ,
38. FinalPlumbing �� ` ' -
� �1 �
- 39. Water Service-Final , � ` ,
. 40. Gas Service•Final � � �
� 47. Solar pomesticPinal ' ' I ; .
42'. Backfl¢w Preventer . ��
43. Backfibw Ifigation ' t � . - •
. 44. Landscape Irriqat'ron System � • � T = - •- • _ .
.r
45; Sound At�enuatio`n J F �, ` ' . . : ; . ' : . '
' 46.• Handicap Regulations . J. � � •
J� �-
47-. FI�VAL STRUCTt1RE & BUILDWG _ ��\`'�' " � �
� 4$. FL(VAL PLANNING �� �
t �
49. Electric Retease to Edison t j^ t '
. 50. Gas Retease to Southern California Gas Co � y�' � � � ' •
51. CERTIFICATE OF OCGUPASVCY � - - '
No. Date
�,
� !G
�fY,dF COSTA MESA
ProjectAddress 3_5°x
Appltcant's Mailing Address
C
Owner's Name -
Address �j' � �
� ��� .`�
Applicant io till in a11 spaces ezceDt those within heavy 6order lirtes and s19n all approo��ate tleGarations. '
CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NU. D531 7/:�li ' •' ,
YJ .� :l�/n � rnt�K/' !A
'Arc Eng. " �v,.e-� �'Cicense No. �- «l��- .1
Address Z-�%� N�w![�v� _ ��D. . n1�A.. '��1�
Contracror'sNam>��N��� ��+T"�• � Phone$S%-�iS)
AddresslmailinglZ4�S K�D H'�� AUE F-%d� Cd�ji1� WI�M}
City License No. 0 � SiO�3
LICENSED CONTRACTOR DECLAFATION
I M1ereby affirm Ihat I am licensed untler provizlons of Charter 9(commencinq
wi[h sec[ion 7000) of Division 3 of Ihe Busin¢55 anC Profe55ions Cotle, antl
my license �s {n full torce an %ect. ����' ^
oate`( C� a"s _$"� 5—q t e�f(��.��+-iv�"—•e�!,S.Gd---� ...�
WOFKERS' COMPENSATION DECLAR TIR ON
�1 hereby atfirm that I have a certificate oi consent to self-insure or a certifiwte
oi Workerz` Compen5d[ion Insurance, or e cer[iti¢tl copy thereof (Sec[lon
3800, Lab. �C) c
Policy No.�R{?�S8s�ps CompanyW�LLIR�'�1-YAiS10 /NS(lf2
�Certitietl copY is hereby /umisheG. '
C �f'y��wpy filetl with [he city Bui Ing Divisio ��
Da[e�`-=-LY -2'� APPlican[�
EXEMPTION FROM WORKERS' COMPEN5.4 ION DECLARATION
(This section neetl not be comple[etl i( the permit is for one huntlretl (5300) or
less). � '
I certify that in the periormance oi the woik,for whicM1 this perm�t Is issuatl, I
shall not employ any perzon in any manner so as to bec subject to tne
Worke ' p ns ion Lawz ot Califor9�q �A�, �
Date Signa[ure _�-+�� �
"NOTIC : If, atter making this tleclaration; y sn u tl become suDject to the
Workers' Compensation provisions ot the LaboY Cotle, yo4 mu51 iotihwfih
Comp�Y with sUch provlsions or thi5 permi[ Shall ba tleem¢tl revoketl.
CONSTRUCTION LENDING AGENLV
1 hereby afflrm tnat tM1¢re is a constructlon lentling agency fo� the performance
Of tne wOrk tor w�c�h�permit is issuetl (SecHon 309� C(�. C.)
Lentl¢r's Name �
�entler's Adtlress
OWNER BUILDEN �ECLARATION
I hereby aftirm that I am exempt trom the Cootractor's l.icense �aw for tbe
followin9 reason (Section 7031.5 Business antl P�ofesslonal Cotle: Any city or
county which requires a permit l0 construCt, alt¢r, imp/ove, tlemo�ish Or repdir
any 5tructUre, p�io� lo its issuance, also �equires the apPlicdnt tor su<h P¢rmrt
[o file a signetl slatement Ihat.M1e/she Is Iicensetl Pursuant to the provi5lons oi
the Cont�actor'S License Law (Chapter 9(commencing with 5ectio� �000) of
Division 3 0( the Business antl Pro/essions Cotle) or [ha[ he/5he is exempt
[hereirom antl [he batis for [he allegetl exemptfon. Any vlolation ot Sectio�
7031,5 by any applicant tor 9 PerTit Subj¢cls the applicant to a civil
�enalty of not more than (ive nuntlretl tlollars (E500).
LJ I, as owner of the property or my empioyees wim wa9es as the�r sole
Comp¢nsatiOn, will tlo the wo�k, an0 the sbucture is no[ infentletl or offeretl
for sale (Sec[ion ]044, Busin¢55 antl Professwnal Cotle: The ConVactor'S
Licenie Law tloes not apply to an own¢� ot a property who builtls or Improvez
t�ereOn, antl who tloes SULh wOrk hirtiself/ber5elf ortn�OUgh hi5 or her own
employees, provltletl tnat such ImProvemen(s are not intentletl or oHeretl for
Sale. It, howeveq the tluilGin9 or Improvement Is soltl Within on¢ year of mm-
pletion, ttle owner will have the burtlen ot proving h¢/She tlltl not bulltl or Im-
�rova to� the putPose ot sale).
1, as own¢r of the property, dm excluiivCly corttraGting witll IItEnS¢tl con-
[ractors [o construct the prolect (Section 7044, Busine55 antl Professions Code=
The Contractor's License Law does not apply t0 an owner of property who
nWltl4 or Improvns thereon, antl who contracts for suth proiecfs wltn a con-
[ractor(51 litanse pursuant [o the ConVac[or'S License Law), i dm aware Ihat
proof oi thei� Wo�ke�'s Compensatio0 insurant¢ shoultl be provitletl to me.
❑ 1 am exempt untler $ectioa g, & P. C. tor ftlis �eason
Date
I hereby certi(y that I
Intormation is correct.
antl state laws relating
S¢ntatives of thi5 ci�y
inspeclion purpo
S�9na[ure
Driver5' Lic¢n5e o� 55 �
CMF 0865�46, rev. 1�/84
_ Owner
have read thl5 application antl state that tM1e above
ag�ee to comply with all city dntl county ortli�ances
o builtlin9 construction, antl hereby autho�ize repre-
[o e�nt irl up�ve-mentioneC OropertY for
Y� Date -%�
TYPE OF CONSTRUCTION iLJ NEW iJ ApD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ �EMOLISH ❑ OTHER
OESCRIPTIONOFWORK/USEOFBLDG. �'��« �-�r
TYPE OF PERMIT U GftN�ING �J FOUNOATION L...I STRUCTURAL
❑ TENANT ❑ EI.ECTRICAL ❑ PWMBING ❑ MECHANICAL
❑ OTHER
PROJECS DESCRIPTION 5q.F7 oCCuaANCv �
CONSTRUCTIONTYPE�.'AS� '� VALUATIONS������"'
ZONE �P GRADINGCV.YDS. ACRES
Remark5: ��# l„r.Z�-&J S �. �
` � ��%. YS
PLUMBING FEES
S�nk
Preventer
Irrigation
prinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Roof Drains
ReinSpeccion Fee $15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
FireplfPact. Blt. ICBO #
Heatin9 System & Ducting
❑ 0.100,000 BTU � 100,000 BTI
Reinspection Fee I $15
WhiSC - Builtling; Canary � qpplicant; P{nk - H<Count�ng; Goltl¢n�Otl - HssessOr
Shower5
Service Sink
Sewer Cap'�
Sewer Connection
Solar Collecrors
$olar Piping.
Salar Tank-
Swimming Pool w/Spa %
Urinal�� +
Water Closet
Water Heater
Water Service
Aum-Wash
laue fea
Hood or Typel ❑
CanoPY TVPe 11 ❑
B
�
A.P. #
S Main Building:
TFront �
ARear
C Right� �
g Lefc � /
Ping. Ref. #z�
Planning Notes:
/
Automatic Washer
Construction Pole Su6.
� Cooking Unit
Dishwasher
� Dryers ❑Gas ❑Elec'
Fan
F.A.U.
Fixtures
, . Device Boxes � -
Refrigeration SYstem
Oo-ioo,000eru ❑ioo,000eru
System Fepair/Alteration
Fire Dampeis
Registers -
Ga�bage Disposal
Generator 065 KW
$ 3 �!"
� Reinspectian Fee
FEES.
�DEVELOPMENTSER
Zoning APProved'BYti
Building Approved By
luue Fee ' � $ 3
2one
Building:
�
i Parking Req./Provided;
ili'.P1lJ ,7
IICAL
Transformer ❑ 75-50 KW
��,50"+ K W �
to 100,amps
�r 100'amps
Sub Panel �"
Motors DO-1 HP O1 h� 8
Inc.Solar �9-15 FIP �16-15+
Microwave '
Pole Light . "
Range -.
FEES
', Standing Sections � �.
15,KW �; Trash Compactor . • -
�
$15 luue Fea $
BEQU EMENTS: `� ,
� Date�/ �J
T n � _ . . �-1�
SUMMARY OF FEES .
BUILDING PERMIT $ 2,G�_�__L�SMIP . � �
PLAN CHECK� � $ ' PERMIT
PLUMBING $ ISSUANCE
`PLANCHECK 25% $ ' ENEFGV P.C.
,ELECTRICAL - $ � GRADING
PLAN CHECK � 50% $ MICflOFILM
MECHANICAL $ TOTALFEE
PLAN CHECK 25% $ _ _ � �
2
O
N
I
N
G
R
E
Q
M
T
S
'� g _ �I7. C7C7
' CONSTRUCTION ANDPLANNING
• APPROVALS Permit#
1. Temporary.:Electrical Service or Po'Je
2. Soil Pide-Undrgrnd. `'�;
3; Electrical Conduit Chility-Undrgrnd,
,:
4: Electrical CotlduiS�Untlrqmd.
�for.L•eme'nt'',� �'
r„i/'j�/n�4tr f
I:UF�ER��Gtnd. �
� � r.
<J r 1
�•
on� ..,' .,.A,
ie-Urfdrgrrid.
10i�tiuctural Floor-�System
11•. Property Sewer Line & Hause C�pnection
12i,,Sewer Gap' .i, �.�� i:. '', i.
,'
13.' Rooi.Draihs �: � "
14. Rouyh Pluml�ing' ��
15. Rough Electriral-Conduit
16. Rough Electric Wiring
17: Rough Wiring Sign
18. Rough Electrical-T�Bar-Geiling
79: Rough Heating & Air Gonditioning
20. Rough Factory Fireplace
21. Ducts, in Structure
22. Qucts, Ventilating �-�
' 23. Gas Pipe-Rough & Test
24. Roof Framing .
� 25. Roof,Sheathing Y(_
26. T-Bar`Ceiling (Stru tura on coat
27. Frame and Flashing ,,,,�"
28. Lathing & Siding .
29. Insulation
30. Drywall Nailing � � �p� �
31. Plaster Brown Coaf -
32. Electrical Power Metei-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. Solzr pomestic-Final � �
42. Backflow Preventer .
43. Backflow Irrigation
44. .Landscape Irrigation System' '
45. Sound Attenuation "
46. Handicap Regulations
�.�INALSTRU T RE BUILDING
.Q Fr [ u
48. Special Requiremenis Completed
49. Eleciric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTI ICATE f�1F OCCUPANCY
No. � ' Date
Date Inspector
��
�
POOL & SPA
� APPROVALS Permit #
52. Pool & Equipment Location
53. Steel Reinforcement
54. Farms
55. Electrical Bonding
56. �Rough Plumbing & Pressure Test
57. APPROVALTOCOVER-GUNITE
58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
61. APPROVAL TO DECK
62. Backwash & Receptor-Final
63. Heater & Vent-Final�
64. Plumbing System - Final
65. Electrical-Final
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit#
70. Underground Hydro
71. Product Piping O Gas ❑ Oil
72. Underground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISS�JE
Notes: ��/5'�45 �. dsc..�.�.�--Ce�+-
1 �
�YL.RSC�b=i�►r 1 � +�:
J�
a � 4 �� CJ , f/M �
f7GS• ���f C7��
�
��
Date � Inspector �
nr
� ' ��i
� O�
a F
i
AGO���anl to fill in all
'CITY OF COSrA MESA• CONSTRUCTION PERMIT �/
�.�ProjectAddress'35��� �`fa.¢aoR G.a-rcwav �U���1
IApplicant'sMailingAddress � 9376 Nq.ect�`i.OD �ilMc(..v (�Ro�+E
�',Owner'sName BSN ��^�Gt �Cf. Phone
' Address ' . -
I Arch/Eng. ' Licenu No.
�41ESiF.'c�N FlEGTR.tqL r�G41 c0•
Contractor'sNam Li:/1 O��P�o��-sa� Phone ��`�5300651
_�
Addreulmailingl q��G �yu�[CrJN�41 �Grt�co:e.y �+.'t�.�.e 9264/
City License No.
LICENSED CONTRACTOR DECIARATION �
I hereby affl�m that I am Iicensetl untler provisions o( CharlCr 9(commenUn9
�with section ]000) of Division 3 of the BuSiness antl Protessions Cotle, antl
my license is in full force ana effect.
LlcenseClass C'—/V ' LlcenseNo. y�%FOP+�
�ate �/�.�66 s�y�ature
.YORKERS'GOMPENSATION DECLARATIO
I hereby at/irm that I nave a certificate oi consent to seli-insure or a certlficate
of Worke�s' Compensation Insurance, or a certifietl copy t�ereof (Section _
3800, Lab. C.) __
Policy No. Company
eCertifietl mpy is hereby turnis�etl.
. Certifietl wpy is filetl with the city Builtling Oivision.
Date Applicant
EXEMPTION FROM WOFKERS' COMPENSATION DEGLARATION
(This section neetl not be completetl it Ne permit is for one nuntlreA (5100) or
less). '
I[ertify that in the P¢rfo�mance of the work fo� which tnis pe�m�t is i55uetl I
shall not employ any person in any manner so as to ewme subject to t�e
Workers' Pe saCp n Laws of Californi
Date _��2f�J' b Signature � �
'NOTICE: H, atter makinq this tleclaratlo , y0u Shoultl Decome subject to the
Wo�kers' Comp¢n5dtion p�ovl5ion5 ot th¢ Ldbor COtle, y0u must forthwl[h
tomply with sucn orovlsions or tnis permit shall be tleemetl revoketl.
CONSTFUCTION LENDING AGENCV ' � �
I nereby ai/lrm tnat there is a construction lentlin9 a9ency tor Ihe performance
o( the work for whicn th15 permit i5 ISSuetl (SeGtlon 3097 Civ. CJ ,
Lender's Name '
Lentler'S Htltlress
OWNER.BUILDEN �ECLARATION �
i neret�v affirm that I am exempt irom the Contracror'S License Law tor the �
01
ie a
retrom antl Ihe basis tor the allegetl exemptlon. AnY vlolatlon of 5¢ctlon
I1.5 Dy any applican[ for a permit subjects the applicant to a civil
.alty of not'more than five huntlretl tlollars (E500�.
I, as owne� bi thc property o� my employees witn wag¢5 as their sole
npensatlon, will tlo [ne work, antl the ztructure is not Intentletl or offeretl �
,sale (Section 7044, Business_ antl �Prolessional Cotle: The ContractorY
ensa Law tloe5 nOt apply t0 an-owner Of a pro0erty who bulltl5 or Improve5
reon, antl who aoes such work hlmselt/herselt or throu9h his or har own
ployces, proviAetl Ihaf suCh Improvements are not In[entletl or oi�eretl for
�. It, however, the bWltling or Improv¢mont is SoIA within One y¢ar of com-
tlon, the owner will have tne burtlen ot proving he/she tlitl not bulltl or im-
rve fo� lhe purpose Of sale).
I, as owner o1 the�proPerty, am ezcluzively mntracting witb licensetl con-
:tors to construct the project (Section 7044, Business antl Protezsions Cotle:
9 Cont�actoYs License Law does nol appty to an owner of Oroperty who
I45 0/ imp�oves th¢reon, antl who contracts to� such'projecl5 wlth a con-
ctor(sl Iicense pursuant�to Me�Confrac[or'i Licanse Law). I am aware tnat
�of of their WorkeYs Compensatlon insurance shoula be provitletl to me.
I am exempt untler Sectlon B. & P. C. for [his reason
Date Owner
I hereby certify that�l hava reatl this application and state lnat [ne�above
iMormation i5 torrect. I agre¢ t0 mmply wi[h all city antl coUnty ortlinance5
antl state laws relatin9 to builtling construction, ana hereby authorize reore-
sentatives of t�is city to e r upon the above-mentionea property for
inspection purp es i� , . ��
// Date
except those within neavy EorCer Ilnes ane sign all aooroo��atv eeelarations.
TRACT NO. LOT NO. UNIT N0. '
_� .
TVPE OF CONSTRUCTION `� 'NEW ADD ALTERATION REPAIR
❑-CONVERSION ❑ DEMOLISH ❑ OTHER - A p ,�
DESCRIPTION OF WORK/USE OF BIDG. � � �
S Main Buildi
TVPE OF PEHMIT�pr� GRADING FOUNDATION STRUCTURAL T Ffant '
❑ TENANT 1CJ�ELECTRICAL ❑ PWMBING ❑ MECHANICAL � A Reef
❑ �OTHER ' . �
PRWECT DESCRIPTION 50. Fr. oCCUaANCv C Right
' K Left
CONSTRt1CT10NTVPE VALVATION$ g
ZONE GRADING�CLL VDS. ACRES .p�ny. R¢f. #
Remarks: � � Planning Notes:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs '
Clarifiers ,
Dishwasher, �
Orinking Fountains
Floor Drains '
FloorSinks .-
Gas Service
Interceptors
Kitchen Sink
Lavamries . �. :
Outl¢t5
Roof Drains � '
Reinspaction Fee � $15
Duct � Under Groundi �
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact.8lt. ICBO #
Heating System & Ducting� '
❑ ai oo,000 eTu O � oo,000 et
Signature
Drivers' License or 55 $ I I Reinspectian Fee I $15
CMF 0865-46, rev. 30/84 White - Builtlinq; Canary - Ap011cant: Pink - Acmuntlng; Goltlenrotl - Assessor
��
$hOW2fi
Service Sink � -- �
Sewer Cap
Sewer Connectian '
Solar Collectors �
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal �
Water Closet .
Water Heater '
Water Service �
Auto�Wash - -
LaundrvTrevs -
•
laue Fee
Hood or Typel ❑
Canopy Type II ❑
Refrigeration System .
❑O�t00,0008TU, 0100,000
System Repair/Alteration
Fire Dampers
Registers '
' s'
Iwue Fee
" 6643 I /�72/'aG � ' �%
Zone
' Accessory Building:
Z
O
N
I
� N
G
N
Parking Req./Provided - ' E
Q
M
- T
S
' - Automatic Washer � - -
Construction Pole Sub.
Cookin9 Unit
Dishwasher
s , Dryers ❑Gas ❑Electric
$ 3
Fan
F.A.U. �
Fixtures
Device Boxes �
Outlets'
Switches
Garbage Disposal
Generator �0.5 KW C
�
ELECTRICAL • FEES
Transtormer 0 15-50 KW'
❑ 50+KW
Meter ❑up to 100 amps
Meter ❑over 100amps
• Sub Panel � �
� Motors�0.lHP�iX-8
Inc. Solar �9-15 HP �16�15+ '
Microwave- ' '
Pole Light . I
Range
I I; Standing Sections
5-15 KW I Trash Compacmr
Reinspection Fee $15 Issue Fee
DEVELOPMENTSERVICESFE�UIREMENTS:
2oning APPraved By �
Building Approved By
APPlicatiOn laued By
$ 3
�
. � i SUMMARV OF FEES
� BUILDING PERMIT $' SMIP $
PLAN CHECK $ PERMIT,
� PLUMBING $ ISSUANCE $
PLAN CHECK 25% $� � ENERGV P.C. $� �
ELECTRICAL � $ '� GRADING � $
� PLAN CHECK 50% $ � ' MICROFILM $
MECHANICAL • $' TOTALFEE $ / �
PLAN CHECK 25% $ , . �
�j
� CONS7�2UCTION AND PLANNW. , . _JL & SPA
!{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; Electrical Conduit Utility-Undrgrnd. . 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
- 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
- 7. Footings -- 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14: Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar SYstem-Final
�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 Struc[ure , 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing � 74. Overhead Hydro �
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and F�ashing 76. Dry Standpipe
26. 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 (p-(/� L�'� Notes:
34. Final Heating & Air Conditioning (�
35. Final Gas Pipe-Test �
36. Hood or Canopy ,
37. Final Factory Fireplace
38. Finai 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. 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
AOP����t to fill (n all soaees exeeDt those witnin heavy bortler Ilnas ane sign all aoo�opriate tleclaratians.
CIrY OF COS7n MESA CONSTRUCTION PERMIT �
_ Projett Address ?f �J �O �
Applicant'sMailingAddress N�
Owner i Nam�e �I C a�� Phone �
Address �a-��� S ' ����—� •
Arch/Eng. ��K• ��� icense No. G' �2�2
Address Z��`�U n%�N/f'�-W
�U
Contrector's Nam CW�SiK�%. Phone 5�1 "�
'Address (mailiny) 2 111�.:� • M ' j.�
Ciry License No_ � � S� � —
LICENSED CONTRACTOR OECLARATION �
I M1ereby aHirm thd[ 1 am Ilcensetl untlBr provi510n5 ot Charler 9(Commencing
with section 7000) of Division 3 0! tha Buslness antl Professlons Cotln, anU
my Ilcense iz in (ull lorca �o/fect. `/�
Ucensc Cla}s, _ L4cens� No� ��
Datc��Y�Y $I9natur0
WORKERS' COMPENSATION DECLARA ION
I hereby affirm tnat I hava a cerUfiwte ot consent to 5eH-insure or a cortltiwte
of WO/ke�5' Cyompen5ation' In�jsu,��anca, Or a co�tifl¢tl copy the�eof ($ectlon
3800. Lab. F.4. ` S��'6 �' �//LL
PoIiCY No. V !� ComPan /� ���� ��y
� Certi}1etl mpy;s heetlbwitnrtnehctly Buil Division./� /�
Oa[e� �� � ApP�iGdnt �L.�.^�" •Ly' �
�
E%EMPTION FROM WORKERS' COMPENSAf10N DECLARAiION
(Thissec[ion ne¢tl not be completetl if [Oe permlt Is for one huntlretl (b100) or
less).
1 cerlify thal in fh¢ pe�lormance o! the wo�k (Or whlch tbis permit I5 Issuetl, I
sllall nOt emplqy any p0lSOn In any man f SO as lo beComB subjecl t0 thB
Worker5:�orpy�ns3tioy,Laws o! Calito� _ _ /i /j
'NOTICE: Ii, after making tnis tleclaration, yoGShdGltl bocome sub�ect to t�e
Wo�kCrs' Comp¢n5ation pwvi51on5 ot tha LabOr COtle, you muSt lorthwith
comply with 3ucM1 O�oviSions o� this parmll shall be tle¢matl rovOked.
CONSTRUCTION LENDING AGENCV '� •
I herety at(irm that there is a construction lentling agency for tha performance
ot [nu work for whi tnis mi[ is Issuotl (Section 3097 Clv. C.)
Lentler's Name �,[�')/���
Lentler's AUtlreEs .
OWNER BUILbER �ECLARATION' '
I �ereby aftirrq that 1 am ezamp[-from the ConVactor's Llcense Law for Me
following reason (Section ]031.5 Businezs antl ProfeSsional Cotle: Any city or
COunty whicb require5 d permlt loYonStrucl, alt¢r, ImOrove, tlemolish o� reDair
any itructure, prlor to i[s issuance, also requires the applicant for zuch permit
to lilo a signetl SlatCment lhdt he/she iS'licensetl pursuant to the provi5ioni o1
the Contrac[or's LlcenSe L, w(Chapter 9(commnncing with Sectlon 7000) of
Dlvision 3 of the Businoss antl Professions Cotlo) or that he/she is exempt.
themhom antl the ba5i5 tOt the allegetl axCmpHon. Any violatlon ol Section
7031.5 by any applicant for a Permlt subjecM thn apP��<dnt to .a Clvil
. enalty o/ no[ more Iban tive huntlretl tlollars (5500). '
'� 1, as owner ot tho propmty or my ¢mpioyoos wltn wa9es as thelr sole
com0enution, w{li ao tho work, antl tho sbucture Is not IntentleC or offaretl
lor wlo (Section 7044, Buslness ana Protesslonal Cotle: The ConVactor's
Llc¢n5e law AbeS nOt apP�Y �o an Owne� 01 a property who bullGs or ImprovGs
theraon, antl Who tloes sucn work hlmzelf/�orself or through hls or har own
emo�ayees, prq��tletl tnat such improvemants aro not Intentlea or oiforea for
sdle. It, ItOwever, [he bWltling o� imprOvement Is soltl within one y0a� of COm-
pl<tlon, tM1e, oWne� will have Ihe burtlen ot proving hG/She tlitl not builtl o� Im-
1L,/Ova fo� Ihe purpose of sale). �
L_I I, as owner of tne property, am exclusively contracting witM1 Iicensatl <on-
tractors to conEtruct Ihe Dr0)ect ($ectlon 7044, Businesz antl Protesslons Cotle:
The Cont/actor'S Lic¢nzo L.aw tlo¢5 n0[ apply�t0 an owne/ of p�00e�ty wh0
builas or imoroves tnereon, ane wno tonVacts for such oro7etls witn a con-
tfactor(SI IlcenS¢ OurSuanl to the ContfaGtof'S LICBns¢ Ldw). I am dwar8 that
o�ool of lneir Worker's Compensation insurance shoultl be provldatl to me.
❑ 1 am exemp� unUer Section B. 6 P. C. tor tnis reason
Date Owner
I hereby ttrtf�y that I hava r¢a0 this appllcaUon antl state that tho a0ove
Intormation is correct. I agraa to comply with all city antl county ortlinances
antl state laws ralating lo bulltling consVuctlon, antl heraby authorize mDre-
sentatives of tnis dty to en[or upon tho a0ove-men[IoneO proparty for
InSpeGtlOn phrflges. / , .a� � , � //1 Ci
_-. 709 p ' " _
TVPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR
� ❑ CONVERS�ON ❑ DEMOLISH ❑ OTHER ' A.p..�j6 /t�_ J`f
DESCRIPTION OF WORK/USE OF BLDG. � �� l��L�� J
S Main Building:
E
TVPE OF PERMIT GRADIrvG FOVrvoATlorv STRUCTURAL T Front
❑ TENANT- ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL A Reer '
❑ OTHER
PRWECT DESCRIPTION 5(t. F7. oCCVPArvcv C Right � '
CONSTRVCTIONTVPE 'VALUATIONS� �.STL� � S L2ft '
ZONE' C.RADING CU. VDS. ACRES Ping. RQf. ik� —�
Remarks: �i .�, .1 — � . ' PlBnninq NOt¢5:
3ar Sink
3ackflow Preventer ' -
3ackflow Irrigation
3athtubs �
Clarifieis
Jishwaiher,
Drinking Fountain5 �
Floor Dreins
Floor Sinks �
Gas Service Outlets
Interceptors '
Kitchen Sink�
Lavatories �
P—Trap
Roof Orains
e
Reinspection fee $15
Boiler
Duct- Under Ground�
Duct - Structural
Dutt � Ventilating
Exhaus[ System ❑ MWtiple
Firepl/Fact. Blt. IC80 #
Heating System & Ducting
❑0.100,OOO�BTU 0100,000
� I DHmrs' Litense or 55 � I I Heinspeetion Fee
CMF 0865-46, rev. 30/84 White - BUlleing; Canary - qppliwnt; Pink - Actounting; Goldenrotl - Azsesmr
$15
Showers
�Servite Sink ' '
Sewer Cap
Sewer Connection '
Solar Collettors •
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal'
Weter Closet
Water Heater
Water Service � -
Auto-Wash • �
Issue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0.700,OOOBTU 0100,
System Repair/Alteration
Fire Dempers
Registers
Issue Fee
FEES
S 3
�53
Automatic Washer " '
Canstruction PoleSub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elettri�
Fan
F,q,U.
Fikiures
Device Boxes �
Outlets
Switches
Garbage Dispoul
Generator O0.5 KW �5�
� Reinspection Fee
—
DEVELOPMENT SEI
Zoninq APProved BY.
BuildinB Approved B'
Application laued 8y
; ' -
0582� . - �Io�E 1
� ' ' • Zona P/1/ �
� �a - .
d�
Perkin9 Req./Provided
ELECTRICAL 1
"; Transform¢r � 15-50�KW
' ❑ 50�+�KW.'
Z
O
- , N
i
N
. G
R
. E
Q
• M
T
. S
.FEES
Meter LJup to 100amps
Meter ❑over 100amps '
Sub Pnnel
Motors�61 HP �1h-8 •
Inc.Solar �9-15 HP 016�15+
'Microwave . ' -
Pole Light � �
Range
Sign
; Standing Sections
5,KW 7msh Compacror •
$15 � � laue Fee
��En�EMENTS: �
lJ��
S 3
SUMMARV OF FEES
BUILDING PERMIT s 2-5.0o SMIP ' $ c��
PLAN CHECI( $ �� • 2� PERMI7
PLUMBING § ISSUANCE $
PLAN CHECK � 25% $• ENERGV P.C� $
E�ECTFICAL $ iGRADING $
PLANCHECK 50% $ �MICROFILM $ —��/�/—�y�—
MECHANICAL $ TOTAL FEE $ �! '+`�
PLAN CHECK 25% $ '
� CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspec� r qppROVALS Permit# Date Inspector
1. Temporary E�ectricBl Service or Pole •' 52. Pool & Equipment Location
.
2. Soil Pipe-Und,grnd. � • '� 53. Steel Reinforcemen[
i
3.':Electiical-Conduit Utility-Undrgrnd � " 54. Forms
4. Electrical Gondurt-Und"rgrnd. ; 55. Electrica,l Bonding
5., Steel Reinforcement_ �e " ���� %z 56. Rough Plumbing & Pressure Test �
.
6.yElectiicalUFER„Gmd4. � 57. (aPPROVALTOCOVER-GUNITE �'.�,'�
7�Footings. �� t'• .j, fpi� �� � 58. Elearical Conduit-Undrgrnd. ��,�-
8.; oundationf "� a.� �� ';,: �'�; 59. Gas Pipe, O Undrgrnd., Test
9. CWater Pipe-Undrg�nd, �< �; ?�, 60. Backwash Lines, P-Trap, O Undrgrnd. •
10��Structural Floor�System ''i �, ! ,�4.' 61. APPROVAL TO DECK
11:. Property Sewer Line & House Conriection %'` ' 62. Backwash & Receptor-Final
w. 'id
�12C e'iOef �P �., ' �. � ;;' '/!' C 63. Heater & Vent-Final -
13 =�Roof�Drains� �• • " : � � i � 64. Plumbing SYstem - Final +
14.1Rough Plumbing}- ~ ' � � 65. Electrical-Final �
15. Rough•ElectricalEConduit , 66. Solar System-Final •
1;6:;�Rough Electric Wiring 67. Fencing & Access Approvai
17�. Fough Wiring Sign, 68. APPROVED FOR PLASTERING �
78.' 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 Struc[ure � 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oii
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. Lathin'g & Siding 77. FIXED SYSTEM FINAL `�
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailin9 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. WaterService-Final � '
40. Gas Service-Fina�l . .
41. Solar pomestic-Final ' , •
42. Backflow Preventer� � � . J
43. Backflow Irrigation ;
44. .Landscape,irrigatio �System
45. Sound Attenuatiori ' �
. -
46. Handicap Regulations , �
47. FINAL STRUCTURE & BUILDING ' ,a�
48. Special Requirements Completed �.L
49. Electrie Release to Edison � , ,� �"
50. Gas Release to Southern California Gas Co � . � '
51., CERTIFICATE OF OCCUPANCY i�,;
No. ' � Date ' � �
Cf
.4VD���ant lo fill in all spaces axceo� tnoso within neavY borCer Iines antl sign all avurooriate tleclaratians.
CITY�OF COSTA MESA C',OepNS�T�,,R�UCTION PERMIT PERMIT NO. � TRACT NO. LOT NO. UNIT NU.
�n ..� i. w� / /
.ProjectAddress 35�0 mmoa� G�}J�f4/a�' �(IOKr/i
Applicant's Mailing Address 24�� ��� �� �� � C' �'
Owner'stvame �`r- sC��Y PhoneS�6—u99C
Address 3g// S. ��K ST S'�'�� ��A
rc Eng. �Lu��� �F��� License No. C� ZCO Z+
Address 2�i0-0rA�NEW/�/�% $L✓,b•. �VEM/�b/Pi �'/f..
Contraccor's Name ltal'vyr1•� ��7" ��' Phone '�7' 71lS�
Addreu (mailing) �9/S /��!��'�" A�• � Z� C, w1.
City License No. �� rG��
LICENSED CONTRACTOR �ECLARATION
I he�eby atfirm that 1 am licensetl untl¢r provislon5 0( Charter 9(commCnCing
with section']000) ot DiviSiOn 3 of the Bu5ine55 antl ProfesslOnS Cotle, antl �
my Iicense is in tull torce an tte�t. �' 33 7(� I
License Class' � � License
Oate S �G � ,Si9na[ure
IORKERS' COMPENSATION DECLARATION'
, hereby aftirm that 1 have a certificate of consent to selt-insure or a cerUflcate
of Workers' Compensation Insurance; or a-certifietl copy tnareof (Settlon
3000, Lab.�l t'�-
PolicY No. �O�Sg��� ComPan✓1(/L=�'t� 7�s/O ��u�
�❑ Certifietl copy IS hereby fu�nishetl. �" �
�1�Certifietl copy� iiletl wilh [he city Bui, Division�� �
Date T-/G^d"S� ApplicantT.
EXEMPTIONFROMWORKERS'COMPENSA�O DECLARATION
�Tnis section neetl nat Ga completetl if tbe permit is for one huntlretl (5100) or
Iess). '
I certity that in tne Oe�fo�manGe ot th¢�wotk fo� which Ihis permR I5155uetl, 1
Shall not employ any p¢rSon In any manne� so as to become subj¢Ct t0 th¢
Workers' Compensation Laws o( California�.
Date Si9nature
`NOTICE: H, ailer makin9 this tleclara[ion, you shoultl become subject to the
Workers' Compensalion provisions of'the Labor Catle, You mus[ forthwith
compty wilh such O�Ovi5ion5 or�this �permit shall be deemetl ravok¢tl.
CONSTRVCTION LENDING AGENCV- �
I hereby ai(Irm Nat there iz a construction IentlMg agency tor tha performance
of the work for wnich• t is peCrmlt--is issuetl' (Section 3097 Civ. CJ
L¢ntler'S Name ���,(BALri
Lentler's Atltlress
OWNER 9UILDEH dECLARATION � �
1 hereby affiim that 1 am exempt trom the Contractor's License Law tor Ihe
followin9 reason (Section 7031.5 Business antl Professlonal Cotle: Any city or
county whicn requires a permR to construct, alter, improve, tlemolish or repair
any structure, prlor to its issuance, also requires tne applicant lor such parmit '
to file a signetl statement that he/she is licensetl pursuant to the provisions ot �
.the Contractor's License Law (Chapter 9(commencing wl[h Sectlon 7000) of
Division 3 of the Business and Professions Cotle) or that ne/she is exempt
iher¢frOm antl lh¢ basis tor th¢ allegetl exemption. Any, violatiom0f Sec[lon
]031.5 by dny applican[ to� a pe�mit Subjects the applicant to•a Civil
�endlty of not more than five huntlretl tlollars ($500).
I, as Owne� of the p�ope�ty or my em0�oyee5 with waqef a5 thei� sole
comoensation, will tlo tne work, antl the� ztructure is not Intentletl or ofteretl
tor wle (Section ]044, Business.antl Grofessional Cotle: The Contractor'S'
License !2w tloe5 nOt apD�Y [o an own¢r of a properry who builtls o� improves
fhereon, antl wM10 Goes such work M1imsel�/herselt or tNough hls or hor own
employee5, provitletl lhat such.im0�o�ements are not In[entletl or offeretl for
Sale. If, hOwev¢r, th¢ builtling or imp�ovemen[ is soltl within one yea� ot cOm- '
pletlon, the owner wlll nave th¢ Durtlen of provin9 he/she tlitl not builtl or Im-
prove for thc purpose ot sale). '
❑ 1, as owner of the Droper[y, am exclusively contracting with Iicensetl <on-
tractor5 to construcl Ihe project (Section �044, Busin¢55 anG Pro/essions Cotle:
The� Conlractor's LlcenS¢ lvw tloes not apO�Y ta an owner Of'proPerty wh0
builtls or improv¢5 Ihereon, ana who tonVac[5 Por zu[h projetts with a con-
Vactor(s) Ocanse oursuant ro ihe Coniractor's License Law). I am aware that
prOof o( Ibeir WOrke�'S Compensalion insurante shoultl be provitletl to me.
❑ 1 am exempt untler Sectlon B. & P. C�or Ihls reason
Date Owner �
�I hereby certity that I have reatl tbis apolication antl state that tne above
informa(ion is wrroct. I agree to ��comO�Y w�th all city and county ortlinances
antl state laws relaNng to builtling construction, and hereby autborize re0re-
s¢ntatives Of thi5 City. to Cnter u on the above-men[ioneC .Prop¢rty for
inspection purp - A� � � �,i�� ��
Signature � �'S/K/' �� Dato
Drivers' LicenSe or 55 �-/
��
TYPE OF CONSTRUCTION Ifi7'NEW U ADD LJ ALTERATION lJ REPAIR
❑.CONVERSION ❑DEMOlISH ❑OTHER ' Ap*, �S_ JQ' .�
DESCRIPTION OF WORK/USE OF BLDG. �L�� L� ''�NA
• u� S Main Buildi
E
TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL' T Flonl
❑ TENANT ❑ ELECTRICA� ❑ PWMBING ❑ MECHANICAL - B Rear
��OTHER. �� �T�L� � ' A
PROJECT DESCRIPTION 5�. FT. ' oCCUPnrvCv C R�ght
CONSTRUCTIONTYPE VALUATIONS �sYJ06� g Le(t
ZONE GRADING CU. VOS. � ACRES p�ng. Ref. #
Remarks: - � PI3Mip9 NOt¢5:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtuhs
Clarifiers
7rinking Fountains
°loor Drains . �
=1oor Sinks -
3as Service Outlets
Interceptors -�
Kitchen Sink . '
Lavetories �
P-TraP . . . . .
Roof Drains �• � '
Reinspection Fee � $15
Boiler `;
Duct - Under Ground
Duct - Structural
Duct - Ventilating- �
Exhaust System 0 Multiple
Firepl/Fact. 81t. IC80 #
Heating System & Ducting
❑ o-ioo.000 eru O i oo,000
Feinspection Fee � $75
1F 0865-46, r¢v. 30/84 White - Builtlin9; Canary - Applicant; Pink - ACmUnting; GOltlenr00 - ASSBSsot
$howers
Service Sink
Sewer Cap
Sewer Connection
Solar C011ecmrs �� �--
Solar Piping �
Solar Tank
Swimming Pool w/Spa
Urinal ,
Water Closet
"Water Heater '" '
Water Service
Issue Fee
Hood or Typel �
Canopy Type 11 ❑
Refrigeration System ,
❑aioo,000eru Oioo,000
System Repair/Alteration
Fire Dampers
Registers , ,
luue Fee
$ 3
$ 3
�
o F r—eoN r
Automatic Washer
Construction Pole Sub.
Cooking Unit -
Dishwasher - ��
5734 6%21/86
,J
• AccessOry Building:
�
41 �.75
zo�a pp 1
ELECTRICAL �
Transformer ❑ 15-50��KW
❑ 50+'KW
Fan
F.A.U.
FixWres
Device Boxes
Outl¢[5
Switches
Garhage Disposal �
Generator �0�5 KW 05-15 KW
I Rainspection Fee ' $15
DEVELOPMENTSERVICESRE
Zoning Approved By
Building Approved By
Application laued By /
Merer LJup m 100amps
Meter Oover 100 amps
Sub Panel ��i'
Motors00-7 HP �1X'-8
Inc.Solar 09-15 HP 016�15+
Microwave
Pole Light
Range
; Standing Sections '
Trash Compactor
Issue Fee
Z
O
N
I
N
G
R
� E
� T M'
Nb s
FEES
$ 3
SUMMARV OF FEES
BUILDING PERMIT $==-��5`G.` '-. SMIP S . SO
PLAN CHECK � $ PERMIT
PLUMBING � $ ��UANCE $ .
PtAN CHECK 25%� $ ENERGV P.C. $'
ELECTRICAL $ � GRADING $
PLANCHECK 50% $ ' MICROFILM $
MECHANICAL $ � TOTAL FEE ' $ ,�
PLAN CHECK �25% $ ' �
TL'
1
- CONSTRUCTION AND PLANNING PV.,� & 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: ElectricalConduit�Utility-Undrgfnd. � 54.�Forms• ��
4..Electrical�Conduit-Und�grnd. � 55. Electrical Bonding
5. Steel�Reinforcement�_ � 56. Rough Plumbing & Pressure Test �
6.•Electrical UFER Grnd.-' 57. APPROVAL TO COVER-GUNITE
7.��Footings ,� ', �a�Ig'` �Q - 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 Sysiem 61. APPROVAL TO DECK
11. Property'Sewer Line-& HouseConnection 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
1G 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 0 Gas ❑ Oil
25. Roof Sheathing ' 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing 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 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-Finai �
40. Gas Service-Final
41. Solar pomestic-Final � '
42. Backflow Preventer . '• �
,43. Backflow Irrigation � . � , . '
4�',4. Landscape Irrigation System �
�45. Sound Attenuation '
�6. Handicap Regulations , .
47. FINAL STRUCTURE & BUILDING 6��.t: �8'G
48. Special Requirements Completed
49. Electric Release to Edison � �
; J�
50. Gas Release to Southern California Gas Co . `�'�
5� . CERTIFICATE OF OCCUPANCY - � '!
No� Date � " ' ' , '
e
AOp���ant to flll in all spates axeeDt tnosa wltnln �eavy eorEer Ilnas ana slgn al1 approprlate tlacbnUons.
CiTiLOF C6'SrA M S CO TRUCTI f� PERMIT
. Project Address r d� �ClaJa O
Applicant's Mailing Address � ` c'n �
Owner's Name U v \C phone
Addreu
Arch/Eng. License No.
Addreu
Contrector's Nama ��� �P��7 b�ITPhone ?�U 7is'��f
Addresslmailing) IDizZ OnnJ��
Ciry License No. � 2 � / '
'LICENSED CONTRACTOR DECLARATION
I hereby affi�m that 1 am lican58tl untl¢r provislons ot Chdrte� 9(commCncing
with sec[lon 1000)'of Dlvision 3 of the Business antl Pro1¢5tions Cotla, antl
my Ilcense is in lul/l(p 2�e an etf t. / �
LJC¢l15 CId55� ✓ � ",��50 NO. j� ��
Dale �� - -1g� 5'9 l ///
WORKERS'COMPENSATION DECLAR ON
I hereby atfirm that I nave a cerHtitate of consent to snlf-insure or a certlficate
of Worke�s' Compensation Insuranca, or a cer[ifietl Copy thareof (Settion
3800, �ab. C
Polity No. � G��%�I _G{%company _ O/1�� Ih�U�uriG
�Certifietl cooY is hereby furnishetl. . � ,
Cerf iea py i ti tl wtth the city B il6i g DIVIsy"[�n.
�ate — APPlicant�• �PC h)��11M rv7 f��
EXEMPTIO FROM WORKERS' COMPENSATIO DECLARATION
(Tnis section neetl not be completetl if [he perml[ is for one huntlretl (y100) or
less). _ ' � .
I cerlify thal in.the perto�mance of the wOrk tOr whlCh thi5 perm�t i5IS5u¢tl; I
shall not employ any pe�ion in any mann¢r so as to become su�je[t [o the
Workers' Compl,nsytinn-Caws of Califomia.
oate ' S�9�ature
'NOTICE: 11, atler makin9 this tleclaration, you shoWtl becom¢ subject to lhe
Wolkefs' COmp¢n5d[ion pfovl5iOn5 Of Ih¢ Ldbof COtle, y0u must forlhwilh
comply wftn sucn provisions or this permit snall be tleemetl r¢vokeC.
CONSTRVCTION LENDING AGENCV '
1 hcreby aifirm that there Is a constructlon Ientling agency tor the pertormancc
of tne work tor w�ich this permit is issuutl (Sectlon 3097 Civ. CJ
lEna¢�'s Name
Lentler's AGdress
OWNER BUILDEH �ECLARATION
1 hereby atfirm that I am exempt from the Contractor's License Law for the
followin9 reason (Section 7031.5 Business antl Professlonal Cotle: Any city or
county which rGqWres a permlt to consl�uct, alter, improve, tlemolish or repair
any struclure, prlor to its issuance, also requlres tha apDlicant (or such permlc
to tile a SigneE statem¢n[ that he/she I5 Ilcensetl pu�Suant to the pwvl5ion5 ot
t�e Contractor•5 License Law (Chapier 9(commencing with Section ]000) of
Division 3 of the Business antl Professions Cotle) or tha[ ne/she is exempt
ther¢trom antl the DasiS for the all¢getl exemptlon. Any vlolation ot Section
]031.5 by any a0�liwn[ for a permit subjects the apP���ant to_a civil
'� en9lty ot not mo�e than live huntlretl tlollar5 ($500).
I, as owne� of tne pro0erty o� my employee5 with wages as [hei� sole
comoensation, will tlo the work, antl the structure is not intentlea or oiferetl
ior zale (Section 7044, Business antl Protessional Cotle: The Contractor's
License Law aoes not appty to an owner of a property wlio builtls or improvas
thereon, antl who tloes sucn work himself/nerselt or through his or her own
employee5, Provltletl that such iTprovement5 ar¢ nol intentletl or oHeretl fo�.
sale. Ii, howev¢r, [he builtlin9 or improvement is soltl within one year of com-
pletion, tne owner will have the burtlen of proving he/she tlItl not buila ar Im-
prove forthe purpose of saie).
❑ 1, as owner of the OroDerty, am ezclusively mntractlng with Ilcensetl con-
IractOrs to coni[ruct tbe prOject (Settlon 7044, Busiuess antl ProfeSslons Cotle:
The Conlractor's License Law does not appry ta an owner o1 property who
bulltls or Improves tnereon, antl who contracls tor such projects wlth a con-
tractor(zl Ocense Oursuant�to tne�Contractor'S License Law�. I am aware that
pro�t o1 thei� �Worker'S COmpensatlon insu�ance shoultl �e prOvitletl to ma.
❑ I am exemD� untler Sectlon B. 6 P. C. tor tNs reason
Data Owner
I hereby certity that I have reatl this applicaUon antl state lhat lhe above
information is correct. I a9ree to comply with all Gty antl county ortlinantez
antl state taws relating to builtlinq wnstructlon, antl hereby authorize repra-
sentatives ot tnis city to enter ypp n the above-mantionetl oroperty tqr
inspeGtion pu�po�� ���jJ ,{_ O
5lgnature � � iN/// � (?a /�
Oriverz• Litense ^ `5 �_
T E OF CONSTRUCTION J7S,1 NEW LJ A�D LJ ALTERATION LJ REPAIR
CONVERSION ❑ DEMOLISH ❑ OTHER qp #
DESCRIPTION OF WORK/USE OF BLDG.
S Main Building:
E -
TVPEOFPERMIT GRADING�q� FOUNDATION STRUCTURAL T FrOnt
❑ TENANT ❑ ELECTRICAI o� PLVMBING ❑ MECHANICAL B Reef
❑ OTHER %�
PRQIECT DESCRIPTION SQ.FT. OCCUPANCV C Righ[
K Lett
CONSTRVCTIONTVPE VA�UATION$ $
20NE GRA ING CU. VDS. ACRES Ping, R¢(. �/k
Remarks: - � �� n4% Planning Nores:
Backflow Preventer
Backflow Irrigation
Bathtu6s
Clarifiers
Dishv.asher
Drinking Fountains
Floor Drains �
Floor Sinks
Gas Service Outlets
Kitchen Sink
Lavatories
?-Trap
Roof Drains
Reinspection Fee 515
Duct-UnderGround
Duci - Structural
Duct - Ventilating
Exheust System ❑ Multiple
Firepl/Fact. Blt. ICBO �I`-
Heating System & Ducting
❑P700,000 BTU �100,000
Reinspaction Fee � S75
CMF 0865-46, rev. SO/84 White - Builtling: Canary - Applicant; Pink - Accounting; Goltlenrotl - Assezsor
PLUMBING •
$hOw2f5
Service Sink
Sewer Cap
� Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Sw'�mming Pool w/Spa
Urinal
lNBtEI C1052L
Wa2er Hea�er
Water Service
Auto-Wash
laue Fee
Hood or Type I ❑
Canopy Type I I ❑
Refrigeration System
❑aioo,000eTu ❑ioo,000
System Repair/Alteration
Fire Dampers -
Registers
Issue Fee
FEES
Automatic Washer
Construction Pole Sub.
Cooking Unit -.
14r,3 10/J3/t15
2onB
Accessory Building:
ELECTRICAL
Transformer ❑ 15-50 KW
❑ SO+KW
Dryers LJGas,�LJElectric
Fan
F.A.U.
Fixtures
Device Boxes
Ou[le[s
Switches
Garbage Disposal
Generator 00.5 KW �5-15 KW
Meter lJup ro 100 amps
Meter Qover 100 amp5
Sub Panel
Morors 00.1 HP � 1 Y, - 8
Inc.Solar �9-15 HP �16�15+
Microwave •
Pole Light
Range
Sign
; Standing Sections �
Trash Compactor
$ 3
Reinspection Fea $15 luue Fee
FEES
DEVELOPMENT SERVICES HEUUIREMENTS:
Zoninp Approved By
Building Approved By
Aoolication Issued Bv � n
S 3
,., :
y
:,:,:
2
O
N
I
N
G
R
E
Q
M
T
�
FEES
$ 3
SUMMARV OF FEES ;
BUILDINGPERMIT $ SMIP $
PLAN CHECK $ PERMIT
, PLUMBING $ � ISSUANCE $
PLAN CHECK 25% $ S ENEFG� P.C. $
ELECTRICAL' S GRADING $
PLAN CHECK 50% $ MICROF,ILM $ �
� MECHANICAL $ ' TOTAI FEE $ �
� PLAN CHECK 25% $
; CONSTRUCTION AND PLANNING POOL & SPA -
�� APPROVALS Permit# Date Inspector AppROVALS Permit# - Date Inspector �
1. Temporary Electricgl Service or Pole 52. Pool & Equipment Location
�..2.. Soil Pipe-Undrgrnd. .(p/!f �y- �p 53. Steel Reinforcement
� 3. Electrical Conduit Utility�Undrgrnd. � . 54. Forms '
, 4:�,Electrical Conduit-Undrgrnd. 55. Electrical Bonding
' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd. �
�- 8. Foundation •� 59. Gas Pipe, 0 Undrgrnd., Test '
� 9. Water Pipe-Undrgrnd. _ 60. Backwash Lines, P-Trap, � Undrgrnd.
.10. Structural Floor System . 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection �Q/y��� � 62. Backwash & ReceptorFinal ,
�12. Sewer Cap 63. Heater & Vent-Final . �
13. fioof Drains � Zo�d�� Lfiii 64. Plumbing System - Final
° 14. Rough Plumbing � 2A aEj G� 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
i. �
iB�.iRough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL �
�.
� 1�9.,Rough�Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20:'Rough Factory Fireplace APPROVALS Permit #
21. �Ducts, in Struaure 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. O'verhead Hydro
26. T-Bar Ceiling (Structurel� & Monocoat 75. Dry Chemical �
27. Frame and Flashing .. 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation � 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat � 79. FINAL INSPECTION
32. Electrical Power Meter-Final ,, -80: FOOD CERTIFICATE ISSUED
33. Final Electric � Notes: �
34. Final Heating & Air Conditioning � �
35. Final�GasPipe-Test �2y�(, '(�� � � ,
36. Hood or Canopy � ' � �
37. Final Factory Fireplace '
38. Final Plumbing ,i ZJ' � ' �
39. Water Service-Final ,
40. Gas Service-Final � .
41. Solar pomestioFinal � � � ' � �
. �
42. Backflow Preventer '
43. Backflow Irrigation
44. Landscape Irrigation System '
45. Sound Attenuation , , '
46. Handicap Regulations _
47. FINALSTRUCTURE & Bl11LDING
48. Special Requirements Completed �
49. Electri�c Release to Edison �
(
50. Gas Release to Southern California Gas Co , �
51. CEFTIFICATEOFOCCUPANCY ' �
No. Date
►� i �
' Applicant to BII in all soaeas ezcev< <hose within heavy Doraer unas ana :�y� al� apPropNata Eeelarations. 8��60 �/�J�/u�= _ �
CITY OF COSTA MESA CONSTRUCTION PERMIT , PE M T NO.� � TRACT NO. LOT NO. UN�I'f N0. . „
36Yo y/�sCbc.0 6q-T��✓RY .UD.tT,4 �� . � . -
. Project Address . _ ' , .
.Applicant'S'MailingAddress °1����+��%��"%�a ST.4.dC19�PoG TVPEOFCONSTHUCTION NEW ADD ALTERATION REPAIR � � �
BO!' sCO4T3 OL /fM�/�r�A ❑ CONVERSION ❑ �DEMOLISH ❑ OTHER A P ,hy � � . � Za�e
Owner's Name Phone ^ DESCRIPTION OF WORK/USE OF eLDG.
Address 3�� �sJVTI� RE/j.Q dT S/MiTa ,p�yp q,g]Oy ' S Main Builtling: . Accessory Building: �
ArchlEng!aL4,[ocK �gRT,pejP,fIHP License No. ��/fA � TVPE OP PERMIT GRADING FOUNDATION STRVCTURAL T Front ' . 0
Addre55 "�'�� NEkJPO.CT /!i.✓p ��Er,�jo,Cr,Se�N � ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL B Rear � � ' N
�6%/NI%'1��.�. /�'f//fC . 7/Y ❑ .OTHER A I
Convactor's NamP Phone G.?O 3E7B0 . - �
PROJECT DESCRIPTION Sq. FT.� � OCCVPnNcv C Right � - N
Address Imailingl°'��20 CDiCOn14iO0 r'T d06 K . _- - G
w� ' CONSTRUCTION,TVPE VALUATION$ g Left
City LiCense No. �44 ��c� ZONE GRADING CU. Y�S. ACRES � � R
LICENSED CONTRACTOR DECLARATION Ping. Ref. # Parking Req./Provided � E
I hereby aftirm Iha[ 1 am littnsetl untlet provi5lons Of Chdrter 9(commin<in9 Remarks: Pl2nniny Not¢5: � . n
-with section 7000) of DiviSion 3 of lhe Busine55 antl Pro(essions Cotle, antl M
my license is in full force ntl eftect. � � - T
License Class � � Licen No. "'z ��^Z'x � S
ate Signature `b�r /il� PLUMBING FEES
ORKERS' COMPENSATION DECLARATION Bd� Sink . ShOw2f5 '
- nereby aftirm that I have a certificate oi consent to seli-insure or a wrtificate ' ' ELECTRICAL . . FEES
� of Workers' Compensation Insurance, or a certNietl copy thereof (Section gackflowPreventer � SeNiceSink -
3800, �ab. C.) � 15-50 KW
/,d0006�i�/� ,a��/'d�i� • � Elutomatic Washer Transtormer
PolicyNo. Company Backflowlrriga[ion SewerCa : ❑50+KW
�Certi(ietl copy is hereby fumishe0. - P COnst�uCti00 POI¢ Sub.
� Certifi c y is filed witn the city 8 �il ^g Div s' n. / Bathtubs ' Sewer Connection �' Cooking Unit , Meter ❑up to 100 amps
Date ����BG qpplicant ///m ��
Clarifiers
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION $OIBf COII¢CLOlS Di5hwd5h¢f Meter ❑OVE/ 1008mpS
(This sec[ion neetl not be completetl if tne permit is fo� On< huntlretl (E100) or ' -- -
less). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
I certify fhat in the perto�mance of [he work fo� whlch this p¢rm�t Is lssuetl, I _
snall not emoloy any person in any manner so as to become subject to the Drinking Fountains Solar Tank Fan � -
Motors�P1 HP �i'f,-8
Workers' Compensation Laws of CalilOrnia. .
Date Signature Floor Drains Swimming Pool w/Spa F.A.U.
'NOTICE: It, af[er making this tlecla�ation, you snoultl become subject to Ihe 1�0. SOId� �9�15 HP �16�15+
Workers' Compensation provisions ot the Labor Cotle, you must forthwith FloorSinks Urinal --
compty witM1 such provision5 or this permit shall be tleemetl revoketl. � Fixtu�¢5 ' . MiCroWavE ' '
CONSTRUCTION LENpING AGENCV ' GaSServiCe � Outleti Wet¢fC105¢t
I hereby atfirm that Ihere is a cons(rucflon lentling agency for [ne performance � Device Boxes POIe Light
of lhe work tor which [hls De�mlt is isSueA ($ection 3097 qv. CJ Interceptors - Water Heater Outlets
Lentler's Name Range
Lentler's Aatlress Kitchen Sink Water Service ' Switches Si n
OWNER BUILDEN DECLARATION 9
I hereby affirm tha[ I am ¢xempt flom the Contrdctor'S'Llcense Law to1 the LdvdtOfi¢5 AuLO�W85h
following reason (Section 7o3L5 Business antl Professional COCe: Any city or Garbage Dispoul : ; Standing Sections
counly which requires a permit to Construct, alter, imorove, tlemolish or repalr p—Trap Laundry Trays
any 5[ructure, prior to Its IsSuance, also �equire5 the appliCanLfo� such permi[ Generetor �Q5 KW 05-15 KW T�BSh COmpdCtO�
to file a signetl statement thdt he/she IS licensetl pu�suant to the provisions of � RoOf Dreins � � -
[he Contrac[or's License Law (Chaptor 9(commancing wl[h'Soctlon ]000) of ,
Division 3 of the Busine55 antl Protesslons Code) o� that ne/she i5�ezemOt . ,
theretrom antl the basis �O/ the alleqetl exemption. Any vlolation of $ection ' � . , � - '
7031.5 by any applican[ tor a permit subje<ts Ihe applicant to a civil
�enalty of not more than five nuntlretl tlollars (y500). ' �
1, as owner of tM1e prope�ry or my employees with wage5 as their Sole ReinSpBcti00 F¢9 $15 ISSUe Fee . $ 3
compensation, will tlo the work, and the Structure Is not intentletl Or otfered .
for sale -(Section �044, Business antl Professlonal Cotle: The Contractor's MECHANICAL FEES • Reinspec[ion Fee $15 Issue Fea $ 3
l.icense l.aw tloes not apply [o an owner of a property who builtls or ImOroves
thereon, ana who tloes such work himzelf/herselt or throu9h his or her own DEVELOPMENT SERVICES REQUIREMENTS: �
employees, provitle0 that such improvements are not Intentletl or olferea for Boiler ' Hood or Type I ❑ .
sale. It, however, the builtlin9 or improvemen[ I5 soltl wilhin One year of com- � CanOpy Typ¢ II ❑ ZOning Appraved By DatO
pletlon, the owner wi11 have the burtlen of proving �e/she altl not builtl or im- Duct - Under Ground ' ' Building ApproVBd By DetB��_
p�ov0 tor the pu�pose ot sal¢�.
❑ I, as owner of the oroperty, am exUusively mntracting with Ilcensetl con- Duct - Structural Refrigeration System y Applitetion ISSued By Oat��L1L5Z�H
tractor5 to tonztruct the project (Seclion 7044, Business ane P`ofesSions Cotla:
The ConVactor's License I�w tloes not appty m an owner of pro0erty who Duct - Ventilating �a100,000 BTU ❑100,000 BTU '
builtlz,or impraves thereon, antl who contracts /or such projects with a mn- - _ � SUMMARV OF FEES �
tractor(s license pursuant�to ine-Coneractoi'i Ucense Law). I am aware tnat Ji ExhaustSystem ❑ MWtiple ❑ System Repair/Alteration , BUILDWG PERMIT $ $
SMIP
proof o� their Worker's Compensation insuranca shoultl ba providetl to me. P�AN CHECK , $ PEfiM1T
❑ I am exempt untler Section e. 6 P. 0. br this reason FirepUFacC BIt. ICBO # Fire Dampers '� ' ISSUANCE ' $
Date ' ' owner ' HeatingSysrem&Du tin Registers PWMBING $,
� PLAN CHECK 25% 3. ENERGV P.C. $
I nereby certify-that I have reatl this applicatlon antl state that the above' ❑0.100,OOOBT' ' GRADING $
information is correct. I agree to compty wltn all city antl countY ortlinances ' �!!/.�i .�i9� ELECTRICAL §
ana state laws relaling to builtlin9 constructlon, antl heraby authotlze revre- 3,pa �/{� P�AN CHECK 50% $' MICROFILM $
sentatives ot this city to enter upOn the above-menllOnetl property to� ��,E,y ���,ypS
ins0ectlon purpysyc- . A� � �
Signature /O>++ �� Dated�� L MECHANICAL $ � ' TOTAL FEE $ � `O
Drivers• Li � Reinspeetion Fee $15 , � Issue Fee S 3� PLAN CHECK ' 25% $ �
CONSTRUCTION AND PLANNIN �,' POOL & SPA
� APPROVALS Permit # Date Inspector qppROVALS Permii # �Date Inspector '
1. Temporary Electrical�Service or Pole 52. Pool & Equipment Location
� 2. Soil Pipe-Undrgrnd. ' 53. Steel Reinforcement
3. Electrical Contloit Utility-Undrgrnd. 54. Forms ' .
�4. Electrical Contluit-Undrgrnd. � 55. Electrical Bonding
5.. Steel Reinforcement � 56. Rough Plumbing & Pressure Test ,
6: Electrical UFFR Grnd. 57. APPROVALTO COVER-GUNITE
7. Footings � �+� � 58. Electrical Cqnduit-Undrgrnd.
8: Foundation �"�; � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Uridrgrnd: " � • 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 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 t��_Zq_y� L�j FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace � APPROVALS Permit # �
1
27. 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. Lathing & Siding , 77. FIXED SYSTEM FINAL .
29. Insulation . 78. FIRE PREV. FINAL
30. Drywall Nailing - HEALTH DEPT. REQUIREMENT '
31. Plaster 8rown �oat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED �
33. Final Electric Notes: Q�,,�,5 ( 3'{ (A7� G1L TO GOV�F2 L-7'�G
34. Final Heating & Air Condiiioning Z,y �(, �,� � ��
35. Final Gas.Pipe-Test � � -
36. Hood or Canopy , �
37. Finat 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 Atten�ation ��
46. Handicap Regulations � ' ' �
47. FINALSTRUCTURE&BUILDING �
48. Special Requirements Completed , � ,
49. Electrie Release to Edison � � � ' � �
50. Gas Release tq Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY ' .
No. � Date . ' �
AOD���ant to till In all spaces except ihose within neavy eartler Iines ana sign a1l aoProoriate aeeiantions.
• CITY OF COSTA MESA CO� .S.Tr�R�U,,CTION PERMIT �EFiMIT TRACT NO. LOT NO. UNIT NO. -:J.�� ,�,/!.�i� ;� , _
. Prolect AddrMs 3sy� �'�^�� ���Y .i/dF!%�% � ���0 ,
Applicant'SMailin9/addreu Z�I� R�D V�I�L i�VE, ��--�2/00/(C.�.N9 TYPEOFCON57RUCTION NEW /�DD ALTERATION REPAIR
�OY �OU� Phon¢�GL'��_��V �CONVER90N ❑DEMOUSH ❑OTHaEF�/G� -f� qpyM, - 2one
Owner'sName DESCRIPTIONOFWOFiK/USEOFBLDG. `'L�
Address �8��—S'-$6f�C S!- ��1i�F !%'�1//F S MainBuilding: AccessoryBuilding: -
�[G�1/Eng.�����K pA� /P LiCense No. C' ���`.}� TVPE OF PERMIT GRADING FOVNDATION STRUCTURAL T Front � Q
Addre55 23V O NGW}�R% SLVD. �%�W'R7�Q'j' y�H ❑ TENANT ❑ ELECTFICAI ❑ PLVMBING ❑ MECHANIC�AL�...�n B Rear _ -� N
Convacror'S Nam��7q���NUTq�,E7i C�'�'�' ���'�phone�7� �SI -O'OTHER - LaJ/ G�-/ ic/G/f'L_ A I
Address (mailingl�— L!_LLl-�fp!��L'L �� ��D C' w�' PROJECT DESCRIPTION SO. FT. �� OCCUPANCv - Z K Right G
o/5G J CONSTRUCTIONTYPE VAWATIONS S �eft q
City License No. � - - ZONE GRADING CU. VDS. ACRES
LIGENSED CONTRACTOR DECLA0.ATION Ping. Ref. 9{`- ' - Parking Req:/Provid2d � E
1 hereby aftirm Ih9� � am Iicensatl untler provision5 of Charter 9(commencin9 Remarks: : , � � Plannin8 NOtes: � � � • �
with Section ]000) of DlvisiOn 3 Ot lhe Bu51ne55 antl Pr01e5510n5 Cotle, antl M
my license is in full force an eftecL �j � � . � ' T
License Class ��Litenso No.7 7� , S r '
a�e_��2� t G �/.! j �-aes�.� . ' . ' PLUMBING • FEES . �
,`- WORKERS' COMPENSATION �ECLARATI�, Bar Sink � Shawers
�I hereby aftirm that I have a certiticate of consent to ulf-inzure or a certifitate � � ELECTRICAL FEES �
ot Workers' Compensatiom�lnsurante, Or d CerUfieC copy ther¢ot Section � ,
-.---L Backflow Preventer Service Sink
� 3800, Lao.,C�'J� � �"��-�-.--r. ��o Auromatic Washer Transformer ❑ 75-50 KW �
! Ponnnlicy rvo.7q��S � company �'V ' Backflow Irrigation Sewer Cap � s' Construciion Pole Sub. ' � ❑ 50+ KW
l� �CerUtietl mpy is hereDy furniihetl.
Cettlfletl copy i f'letl wiN the city B ing DlviTiOn BdLhLubS Sewer Connec[ion ��`� ('qOkin Unit � Meter ❑U [O 1�0 eT 5
Date S-/ 2.� APPlitant ���✓~ � 9 P P
EXEMPTION FROM WORKERS' COMPENSA �O DECLARATION � - . Cla�ifief5 ' $olar Cqllectors � � - - DiSM1washer -- - � � Metfr' ❑Over 1008mp5 " �
(This section neetl Pa� be completGE if the perTit is tor One huntlratl ($100) or � .
iess)t Dishwasher � $olar Piping Dryers �Ges ❑Electric , Sub'Panel
I cerlify ihat In the Oe�to�mance o1 the wO�k ta� whlch thi5 p¢�m�l I5 Issu¢tl, I _ �
zhall nol emDloy t�Y person In any manner so as to bacome subject to the Drinking FOuntains Solar Tank Fan � �
Workers' Compensi��on Laws oi Calitornla. � Motors O0.1 HP O1X-8 �
. Oate 59nature Floor Drains Swimming Pool w/Spa F,A.U.
'NOTICE: If, after rnaking tMs tleCla�alion, yoU SnOUIC b¢COme fubjttt IO Lh0 Inc.SolBr �9-75 HP �16-75+ ,
Workers' ComOensa��on provisions'oi the Labor Cotle, you mus[ lortnwilh FIOor$inks ' U�inal Fixtur25
comply with such ProvlSions or [hI5 pOrrtdt Snall be tleOTBtl rewketl. Mic�Ovuev¢
CONSTRUCTION LENOING AGENCV GaSServiCO Outl2t5 WaterClOset � r ' '
I nereby aftirm that �here is a constructlon lentling agency for the perlorman<e � • Device BOzeS Pole Light '
of tha work tor �+'hich �his por�Il is issuatl ($ection 309� Civ. C.) �nterceptors Walef HEatCr ' � - OUtlets Ran e
Lenaer's Name - ���Lr• 9
Lentler'z ndtlress -- ' Kitchen Sink " Water Service ' ' � Switches Sign ' �
OWNER BUIL�EN OECLARATION ' -
1 M1oraby afflrm th�t I am oxempt Irom lho ConVactor's Licenso Law for tne Lavatorie5 � - , Auro-Wesh �
fol�owing reason (Seclion 7031.5 Buslness end Protesslonal Cotla: Any citY or Garbage Disposal ; Standing Section5
county whlch rCqU��es a pe�init to cOnslruCt, al[Cv, ITp�ovO, tlemOlisM1 o� ropalr P-T�d . �
any slructura, prior to its issuance, also reqWras [ha aoP���ant for such pormlt P �undryTrAys Generator 00.5 KW �5-15 KW Trash Compactor
to filo a slgnotl statement that ho/5ha is Ilcensatl pur5uanl lo tha provislons ot ROOf Drains
� tho Conlractor'S License Law (Chaptor 9(commoncing with Suctlon 7000) oi . ,
Divislon 3 Of the BuSin¢55 dntl PrafC5510ns CotlO) Or Ihdt ho/Sht Is Oxampt ,
lherefrom antl the basis tor tne allagetl exomVtion. Any violation of Section �
7031.5 �y any aPP���ant fo� a permil Subl¢<t5 tM10 applicanl�t0 a civll � '
�¢Odlty of not moYe Ihan tive huntlr<U t1011an (E500�. -
I, as owno� 01 Ihe propefty Or' my eTpIOyC¢5 wilh wd905 as [hell sole RBinSpeCtlOn FBe . ,$1$ ISSuB FBB ' - � 3 �
Compensation. will tlo lh¢ work, antl lho 5lructUre IS not intentletl or offEratl
for salo (Se<tion 7044, euslness antl Protessional Cotlo: The Contractor's � MECHANICAL . FEES Aeinspeetion Fee $15 Issue Fee $ 3
License Law tloes not apply to an owner of a Oroperly who builtls or improves �
thereon, antl who tloes zu<h work nimself/harselt or tnrough hls or her own , DEVELOPMENT SERVICES REQUIREMENTS: . ,
Cmployees, provltlitl that sucn ImpwvOT¢n[5 dre nOt Intcrltletl o� ottered �o� goiler � � HOOd Of, TyP21 ❑
sale. Ii, howeveq the bWltling or improvament Is soltl within one yoar of Com- Cpnopy Type II ❑ Za�ing Approved By Data
pletiOn, [ho Owner �'/��� �ave the burtlan O1 prOvin9 ne/sne tlitl not ouila or im- Duct - Under Ground
rom �or tne purpose ot sale). � Building Approved By Dete
� I, as owner o( the o�operty, am exclusively cantra<Ung witn li<onsetl con- Duct � Sttucmrel Refrigeration System AppliWtion Issued By ata '�
traCtOrS t0 ConStruCt thG Pr0}ect ($¢ctlon ]044, Business dntl R'oteisions COtlB: .
The Cantracrols Ucense Law doas not apply to an owner O7 property v+bo DUCt - V¢Otild�iny �al�,��� BTU ❑100,000 BTU '
builtls or improves thereon, antl wno conVacts for such projetts witn a mn- .SUMMARV OF FEES
tractor(s) ❑cense pursuant'to the �Contractor's Licensa Law). 1 am aware t�at BUILDING PERMIT
prooe o( tneir wdrker•s CompensaHon insurance snould ba provitletl m me. Exhaust System ❑ Multiple ❑ System Repair/Alteration � g SMIP $
❑.I.am exempt untler Sectlon B. b P. C. Por this reason � Firepl/Fact BIL ICBO # Fire Dampers . PLAN CHECK S PERMIT '
PLUMBING $ ISSUANCE $
Date ? Owner Neating System & Dutting Regiztus pLqN CHECK 25% $ ENERGV P.C. 3
I hereby certity-that 1 have reatl thfs application ane state tnat the above ❑0.100,OOOBTU �100,000BT � GRADING $
inrormation is mrrect. I agree to comply with au Uty antl countY orainances � . ELECTRICAL � S
antl stata laws re1a���9 to builain9 constructlo�, antl hereby autnorize repre- � MICROF�LM $�
sentativez� oi t�is ��Y• to enter upon [he above-mentioneG properry for PLAN CHECK 5036 $ �
inspectiOr� purp � ' � � �
Signature �� Date s�'� MECHANICAL , S TOTAL FEE 5
Orivars' license m« a �$ � Reinspectiou Fee $15 Issue Fee $ 3 PLAN CHECK �25% $
CMF OB65-46, rev. 30/84 White - Builtling; Canary - Applitan[; Pink - Atcoun[inq; Goltlenrotl - Assessor
� CONSTRUCTION AND PLANNING - � POOL & SPA i
APPROVALS Permit# Date Inspector qPPROVALS Permit# Date Inspector
♦
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location "
2. Soil Pipz-Undrgrnd, � 53. Steel Feinforcement
3?',Elecvical Cbnduit Utility-Undrgrnd:! � , 54. Forms
. 4. Elecvical Conduif-Undrgrnd. � 55. Electrical Bonding
' 5. Sxeel�Reinforcem'ent.�, ' � 56. Rough Plumbing & Pressure Test
6.i Electrical UFER Grnd. • 57. AP.PROVAL TO COVER-GUNITE '
7. Footings' � � 58. Electrical Conduit-Undrgrnd. �
8. Foundation� ;', � . . 59. Gas Pipe, O Undrgrnd., Test '
9.: WaYer Pipe-Undrgrnd; • � 60. Backwash Lines, P-Trap, � Undrgrnd.
10.�Structural Floor System � � 61. APPROVAL TO DECK
11. ,Property Sewer Lin� & House Co"nnection " 62. Backwash & Receptor-Final
72. 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
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T 6ar Ceiling 69. 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- 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & 7est 72. Underground Flush
24. Roof F�aming 73. Undergrnd. Siorage Tank � Gas OOiI
25. Roof Sheathing ; 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
.27. Frame�and Flashing 76. Dry Standpipe
28. Lathing & 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
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 STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison •
50. Gas Release to Southern California Gas Co �
51. CERTIFICATE OF OCCUPANCY �
No. Dace