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HomeMy WebLinkAbout397 LA PERLE LN - Building PermitsO p MfS i p 0, L �, � � �fi , � _ CITY OF COSTA MESA B!/ILDING DIV►SION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(7'14) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: 610-00167 PERMIT TYPE B ROOF2 STATUS: ISSUED APN: 42531112 DATE ISSUED: 06I71/2010 ISSUED BY: KJB JOB ADDRESS: 397 LA PERLE LN CM Suite/Unit: Viciniry: � . 4 Squares: 0 - � � - . Valuation: $5,000.00 SCOPE OF WORK: REMOVE EXISTING COMP AND HOT TAR ROOF. COVER WITH 30 YEAR COMP SHINGLES. ROOF PITCHE IS 3:12 AND 5:12. REPAIR AND REPLACE SHEATHING AS NECESSARY. � � � OWNER: NELSON, RUTH MENNINGER TR Address: P O 80X 208 � - - Unk: A-8 PHONE: - . _ � � , � Ciry/State2ip: PALOS VERDES, CA , APPLICANT: CAUCHOIS, R4YMOND � - Address: 17171 ROTTERDAM LN UniL : PHONE: 714-962d250 ., - City/StatelLip: HUNTINGTON BEACH, CA- - CONTRACTOR: ACCURATE ROOFING ., _ � . . . . License No. 726093 Address: 17171 ROTTERDAM LNUnk: � PHONE: 714962d250 Ciry/State/Zip: HUNTWGTON BEACH, CA - �� - � 92647 CELL: � , ARCHRECT: ENGINEER: FEE SUMMARY Reroof Plan Check: Reroof Permit Fee: Reinspection Fee: Bldg Std Admin Fund TOTAL FEES - License No. License No. $o.00 $111.25 , ` � $0.00 $1.00 PHONE: PHONE: HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279 Morday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the followirg Federal holidays: New Years Day, Memorial Day, Independence Day, Labor Day, Thanksqivirq Dav and Chnstrnas Dav 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. COOEi. INSPEC110NTYPE UATE IN7171AL5 COOEN INSPECTIONTYPE DRTE INTITIRL 1616 Fixed System Final Fire Prevention 206 Final Mechanical 7266 Pool Spa Final 208 Final Plumbing 200 Final Re-Roof �� �� 210 Final Eleciriral 201 Final Bbck/Retaining Wall 212 Final Fire Prevention 202 Final Factory Fire Place 22o Final Planning Approvai 203 Final Sign 222 Final Sile � 204 Finat Demolition 250 Final Builtling/Occupancy WORKERS' COMPENSATION DECLARATION: I hereby affrm under penalty of perjury one of ihe following declaretions: ❑ I have and will main[ain a certifwte of consent to self-Insure for workers' compensation, as provided for by section 3700 0( the La6or Cotle, for the peAormance of ihe vrork for which this permit is issued. ❑ I have and will maintain workers' compensalion insurance, as required by section 3700 of the Labor Code, for the pedormance of the work (or which �his pertni[ is issued. My workers' compensation Insurance carrier and policy number �a+re�' 1 1` �j Carrier J1 ����.%fl (IDissecYionnee�pot0em�le(¢y��he�eiryQrs�lu a(o eh�tlre0{lpllars(5f00)orless) Policy Number: �` f � � U U ❑ I cerli(y �hat in the pertormance of Ihe vrork for which ihis permit is issued, I shall not employ any person in any manner so as to become subject to the wor (ers' compensation laws of California, antl agree that if I should be e bject b the workers' compensa�ion provisions of Section 3700 of t i b Co , I shall forthwith comply with these provisions. �.v �/�-/ � , ApP6tan1'sSignaWre Da�e WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLAR4TION: I hereby affrm Ihat I am licensed under provisions o( Chapter 9(commencing wi[h Section 70 Q) of Division 3 of the Business and Professions Code, and my lice e is i/ full force and eflect. �57 Lic b � Class # � J ontratlor's SlgnaWre Date CONSTqUCTION LENDING AGENCY: ❑ I hereby affirtn Ihat ihere is a consWction lending agency for Ihe peRortnance of tha work for which ihis pertnit is issued. (Sec. 3097, Civil Code). Lender's Name: Lentler's Adtlress: Da1e OWNER-BUILDER DECLARATIONS: I hereby a((irm Ihal under penalry of perjury Ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county which requires a permit to consWct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applican� (or such permit to file a signed statement lhat he or she is licensetl pursuant to ihe provisions ot the Contractors License Law (Chap�er 9(commencing with Section 7000) of Division 3 0( the Business and Professions Code) or lha[ he or she is exempt therefrom an0 the basis for the allegetl exemption. Any violation of Sec�ion 7031.5 by any applicant (or a permit subjects the applicant [o a civil penalty of no[ more than five hundred dollars ($500).): ❑ I, as owner of ihe property, or my employees with wages as their sole compensation, WILL DO THE WORK, antl ihe structure is not in[ended or oHered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an owner o( properly who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provided that such improvements are not intended or oRered for sale. If, however, the builtling or improvement is soltl within one year ot completion, the owner-builder will have the burden of proving that he or she did not build or improve for purpose of sale.). ❑ I, as owner of the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to construct the projec[ (Sec. 7044, Business antl Professions Code: The contractors License Law dces not apply to an ovmer of property who builds or improves thereon, and who contracts (or such projecl vrith a coniractw(s) license pursuant to lhe Contractors License Laws.). ❑ I am ezempt under sec. Business and Professions Code (or this reason: 305]-a6(3/0]) Ovmer ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verification of Ownership by (type of document, i.e. - property lax bill or deed): DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION: ❑ I hereby certi(y that no excavation five (5) or more feet in depth into which a person is required to descentl, will be made in connection with work authorized by this permit, and that no builtling strucNre, scaftolding, falsework, p tlemolition or dismantling thereof, will be more Ihan thirty-six (36) feet high. (Chap. 32, Gry 2, M 2, Sec. 341, T�le 8, Cali(omia Administrative Code). ❑ As owner-builder, I will not employ anyone to do vrork which would require a permit fmm the Division of Industrial Safety, as noted above, unless such person has a permit to do such vrork from [he division. Appliwnfs Signalure Dale Division of Industrial Safely Permi[ Number. HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will Ihe applicant or present or future building occupan[ need to file and certify a Business Plan for emergency response to release or threatened release of a hazardous material? ❑ Yes ❑ No (Section 25505 of the Califomia Heal[h and Safery Code requires, with some exceptions, lhat a Business Plan be filed with the Costa Mesa Fire Deparlment by every business which has a[ any one time dunng a reported year a quantity ot hazardous materials equal to or greater than a weighl of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at stantlartl temperawre and pressure). 2. Does or will the applicant or present or tu[ure building occupant need to fle a registra[ion form (or acutely hazardous materials? ❑ Yes ❑ No (Section 25533 ot 1he Califomia Health and Safety Code, with some exceplions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazartlous matenals equal ro or greater than a weigh[ of 500 pountls, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature antl pressure). 3. Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management and Preven[ion Program for acutely hazardous materials)? ❑ Yes ❑ No (Sec[ion 25534 of the Califomia Health and Safety Cotle pmvides that the Costa Mesa Fire Department may require the preparation, certi(cation and fling with the Fire Deparimen[ of an RMPP by businesses which are required to regisler acutely hazardous materials with the Fire DepartmeN. 4. If an RMPP is presently required, has Section 25534 of the Calitomia Health and Safety Code been fully complied with? ❑ Yes ❑ No 5. Does or will Ihe applicant or present or future building occupanl require far Ihe work which is ihe subject of this application a permit for such construction or modifica�ion from Ihe South Coast Air Quality Management DisMcl or (rom any other air pollution control distnct or agency? ❑ Yes ❑ No (Section 65850.2 of the Califomia Govemment Code requires that the requested infortnation be fumished on applications fa non-residential building pertnits). fi. Will any parl of the faciliry to be constructed untler this permit be wilhin 1000 feel (rom the outer boundaries of a school? ❑ Yes ❑ No Qf'yes", ihe (acility must meet Ihe requirement of Sections 25534 and 42303 of the California Health and Safery Code). 7. If a permil from the South Coast Air Qualiry Management District or o[her air polWlion conUol distric[ or agency is required (or the work which is Ihe subject of this application, have all of the disclosures prescribed by Califomia Health and Sa(ety Code Section 42303 been made? ❑ Yes ❑ No 8. pf "yes", anach ceAifcate of compliance from the appropriate air pollution control oKcer). CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the information given above is correcL I agree to comply with all state laws and ciry ordinances regarding Hazardous Malerials and Emissions. Sgnawre Date CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify untler penalty of perjury [hat I have read this applicalion and state that the information given is correcL I agree to comply with all state laws and ciry ortlinances relating2o builtling consWction, and authorize representatives o( the City o( Cosia Mesa to enter upon the above-described property for inspection purposes. I agree no[ to occupy or allow occupancy of any building authorizetl by thi permit until fnal inspection. n f Legal 0 Dale '\ /��� �2�/-/ V Nn0/ �Aul�orizetlAOP���n� Ddle �nnnFssaem�axo: 397 LA PERLE LN oxthxsr�weiv�u�wvn: CANTRALL DAVID L mwrcss P O HOX �108 r PALOS VERDES,CA 90274 �- 642-9280 wv�. Yuia�o .00nEss: urcxrtett ox wow�n: �pCM.OR FNd'8100PE54: ca+m�crarswu�: HERTZ POOL 6 SPA CWINACTORSY11W0 23385 VIA SAN GABRIEL �ooaess: LAGUNA HILLS 9 2 6.`aFr� UCENSED COMflACfOPS OECLAP�TION: I Mnby alfrm p�y e (Cammanvq wil� &eclbn ]OW) tl Gyisun 3 d Ihs Pmtmovu emuc.No.:067622 uc.cuss: uc.No.: I —7� IQ � � �� . i �T CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: B 078679 PLAN CHECK NO: 02924-96 L CONSTRUCTION TYPE: PERMIT TYPE: STR ucxo: JOB DESCRIPTION : 7— PILASTERS FOR POOL FENCE urr: (714)770-5285 uc.�o.: 600926 UM: fcmwA ivWer pwiebn� af Gheqr B Tb in hA ba end aMw. EXP: OS/97 OWNEP BUILOEN DECUHATION: I Iwoby eKvm vaWy d thm 1 mn em�np han Ne Catl�enm liow� law for tlr 'Ibw+q nemn l5seion'!W 15 &vi�ua end Prd COEa: NY a aowuY Mdi� �apimw s Dmme to oombiicl. epar.'vnPwa. and'eh. a r�pi enY MCM. 0� b U evuoe. �M ao� lar w�ch omN �0 6� � eP� petwnx� tlW M n Ne .�,..e �a io u�. poh.o� a me cwr.ao� �.. Icned> a loo�+e�o .un s.eo� r000l d n.eo� a a u. Buvirie�s vd Pratevabre CUNI a tIW he a ehe e uemN tAwdmn eM �M Wus la Ne e0epsd uamqion. MY vnletun d Satlion �W 1.5 M�Y � la a w� � iM eGVr� w a tlH V�Y d ml maa IAm (m lesdaA dNen �f500p. � I.novmvdtMpapMYumY�MWM�hweWbNaiWemm�.w9dotMvk.udtMMiclun'snaletlxdeE «on«.e �«.w (ser�on �aa.9uam. ena Piamaon. eoa.: m.eavema. u�.. �ew aoe. na wWr�o.� aw�.r d p�q.ny wAo WiEe a in0�n I�waan. md who doee vutl�.'�M 1'cnae! a MnM a Nruqh h's a Aw own amNoY+e�. A�b �IW wcA imqwemsv ue ml'vqeMM a afleed la Wa, tl. M.yaw.IM dutlinp a inp�v.ematl u wtl MIJn on� Ymr d campblun. N+ ow�..a��a.� �:n new me w� a wa�+o ne «.ne ed m w�e a�c�ws ia m. w'o�. a we�. ❑ �. m ox+rr d ina wwero. em e.tl�viWr ���eaYn �mn 4m�nb canvenm a mw.w N. pd� (awion 1ou. Bustru ene Pmisaame CaEe: TM Gaumava l"wna law don np epply b n onw d popsiy Ma dnlm a inqww Owean vd who oOnVMs br v�N pqeC� wCM1 e mNaCa(�) li[onfsd pnump b IM CaYexM liwroa leri). � I em vemq uda SrLm: B�8 P.C.. b Nu �amc o,i.: o..»: I Eo haaby cMM Met I em ews d md Ws¢Wq IM �Mu'vam�raa d CaOuris Ileelh W SdW Cods Safbu P3SM� 25.'.'R�. eM PSi1�, rtl Nm I a ary hAu� dWJnO ��. W/ wa nal (vc4 aa) nssd b mm�/y wih mJ m� mb� ad IM rpWaman br • osmY laaaumwion a mod'drmionhdnNSM� Oitlrid. R�ddaNwl mm4utlion eppimionan u�mq ham Nws Detv. bpceN: W OPREfl'8 COYVENSATON DECLM�TON: I Mr�try tlfiry� v�yr ppWty d pwWy vr d Ne b0owbp JxLralbm: � I hm uM wil muMen e cmWisie M wn+ru io utlLwv� br wMsi mmprutlion. m pwk�E In W 8wbn �100 d �M lebor COM, tar �he poRamwca N tM xarlc fw x}ich ihn pary�d u p��, � � new end xie m.imen wawe�s' mmro�ion mw�.nw. m�n�ub M seion a'roo a tlw lena. cod.. w �n. o«�amem� d �h. WOI�I /d M�11f�11114 V�M M mYld. �AY Mk!!�� -OYIIwI1W 1011 NYIfNC� QTR �Id V�i MITbM Y1: C�: aa+.y ra�n.: �/Thb..elmn..dnab.cvnd���n.wm�ero.ar amen InruJ �] � csnh mm in m. oNm�w,ca a u. wak mr an� us o�+ b w�ed. mo�or mn o� b^^r mww n n �o pacaro wEpe �o tM wa4a�' wrownc� tl Cefdmiu. W pre i�I 4wk�.vne amjW to iM xabn' W�mlip: F�Nun ro uew wrtr�'romWwunn i wn n�.. w ro o�. n�ww ww.w eww. l+f� SKCM J1(6 0/ IM I160/ COdr I/IIM/G 41A�tM� \ CONSTilUCT10N LENDINU AOENCY: I heraEy elfir prlamame W IM xak br whitli �hb M^^i u'ssi�ed LENOER'8 NAM LENDEN'S �DO I�aWy� ' md ewe �hm N vW �IWI rbl� �rr uM1M�'roWmIIW V�tlu uM IIN COl1 O/ C011p1YfbR WIIIf�� 4 pON01' bI lll pmNy d paeju�y �hel Ihas b e m'W�uaian lad'mp epenry br tM ]OJI. Cw. CJ. 'udpmmbn e canw. I epras to oomp!/ MtA J ay md cavVy wdhwne� 'a� npawYeYw� d Ihie etY ro etls Wm IM ebws�meminrE pnpsry Due: / —/ / K w (5151�B.WP) WlNs-Buildip 8 Salaly. G�sam +M: Cerwy-Appicem: P"vik-qwwxro: Gddxnod-Aswoor PERM NO; H 078679 GOVT: N SUPP; N PURPOSE: ADD SQ FT: 525 CLAIM VALUE: 525.00 CALC—VALUE: 525.00 GROUP OCC: R-3 / \ COMMENTS: PILASTERS TO CITY STANDARD (EARTH TOOTH DEPTH) � if 44 iE iE iE 1E k iF iE if iE 1f iF IF M 1E 1f 1E if 1f iE ik ik i! 1E if 1E 1k 1k ik ik if k ik 1E iE 1f 1t 1E if 1k ik iE 1k 1f 1f 1k if If ik k 1i 1k k 1E i! 1F IE 1E 1f iE 1E 1E 1h 1E 1E iF 1k 1E iE k!k iF 1E 1f 1E 1F iE Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSOAY HUILDING --------- FANT: 10 FT IN REAA: 6 FT IN FRNT: FT IN REAR: FT IN LEFT: FT 1 IN RGHT: FT IN LEFT: FT IN RGAT: FT IN PARKING REQ: PROV; PARCEL; 42531112 ZNE: R2MD REF NO: PLANNING NOTES> 132 LF OF S' HIGH SOLID PVC (SIMULATING WOOD) FENCING WITH > 6' HIGH BLOCK PILASTERS APPROX. 15' O.C. AROUND EX. POOL, 1EiE k if fE i! 1k 1E 1E 1Eif if iE if if iF 1E if if 1E iE iE If iF iF 1E 1t 1F iF 1F 1f 1E iE If IF �kk k 1f 1E iE if iE iE af if 1E ff �t1k 1f iFif it if if if 1E iF �t 1E 1F 1F if ik �1E iE 1E it i! 1E if if �f iE it it it iE D E V E L O P M E N T S E R V I C E S R E(j U I R E M E N T S ZONING APPROVED HY . HUILDING APPROVED BY : APPLICATION ISSUED BY; �� �r�r�r*�r�����r*�r�r*�r�r**�r�r** LEGALIZATION:N F E E S U M M A R Y DATE: DATE: DATE: *r�e*�**it �t STRUCTURAL SEGMENT:Y BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 23.75 � 50 PLAN 15.44 �� �. �, SMIP/NON—RES •�, . � HUILDINGEDIV—> PERMIT ISSUE PLAN�CHECK TOTAL PAID DUE TOTALS----> 24.25 0.00 ',�,�,15.44 39.69 39.69 ,00 REVENUE DIVISION TOTALS--> COIiI.fiCTED: 39.69 OVER/SHORT: ,00 BLDG PMT PLUMBING ELECTAIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 23.75 'i, , .SO 15,44 1F 1E 1E 1E k i! k iF iF k if if iE 4 fE fk 1k k 1k ik 1! 1E 1F �F iE 1f 1E iE 1E k!f fk iE fE iE 1E 1E ff if 1k i! if if if if iF k iE k 1E if if 1f if 1E 1f 1f if 1E k k iE 1E iF if iE iF 1F ik iF ik iE 1F 1f 1f 1Elf 1! iF I N D I V I D U A L�..`� F E E B R E A K D O W N TYPE QTY D E S C R I P T I''O N�; UNIT COST TOTAL COST SFR 525 ALTER BY VALUE RESIDENTIAL NOZONE 1.00 525,00 !�END�OF FEES ' IRED L� � ;lh',� � - �-� �' r: �'r ( - CONSTFUCTION AND PLANNWG� PC . SPA - '' APPROVALS Permit # � Date Inspector qppROVALS Permit # Date Inspector / 1. Temporary Electrical Service or Pole 52. Poo� & Equipment �ocation ' 2. $oil Pipe�Undrgmd. - 53. Steel Reinforcement • � � 3'�Elgctrical Condoit Utility�Und,�gmd. 54. Forms � - "'4'. Electrical Conduit:Uridrgrnd.- 55. Electrical Banding .i �5, Steel Re��forcement� 56. Rough Plumbing & Pressure est '•6.,",Electritel UFER Glntl. 57. APPROVALTO COVER•GUNITE .1='7;CFooting5 �� -, '�_Z��p 6C�/�G 58. Eloctrical ConduibUndrgmd. I '.�;8. Foundation �" 59. Gas Pipe, O Undrgrnd., Test _ :� 9. Water Pipe�Undrgmd. :. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structucal Ftoor Syster''� 61. APPROVAl.TO OECK 17. Property Sewer Line & HouseConnection 62. Backwash & Receptor•F.iQal � 12. �Sewer Cap = ' 63. Heater & Vent-Final . -� � 13. Roof Drains . • 64. Plumbing System � Final , 14. Rough Plumbing 65. ElectricabFina� 75. Rou9h Electricai-Couduit � . 66. Solar System�Final � - • 16. Rough ElectriaWiring 67. Fencing & Access Approval � 77. Rough Wirin9 Si9^ T . � 68. APPROVED FOR PLASTERING 18. liough Electrical-T Bar Ceiiin9 69. POOL/SPA SYSTEMS FINAL � 19. Rough Heating^& Air Conditioning - PIRE DEPT. REQUfREMENT - . . � r r r. y . . 20. Rough ,actory Fireplace • - - �� � . ' - �-• .. AppROVALS •� Permit # • Y Y y� 27.'Ducts, in Stryctu{e � .. .. " - , 70.�Undergrt_�o.ur�d Hydro ' ��' 22. Ducts, Venti�ating + - -� 71. Produit Pi in {7'Gas O Oil P 9 23. Gas'Pipe�Rou9h &'Tesc - ,:, � _ _ ' _ 7y, Undergro,und Fau"sh. . . 24.:Roof Fr�ming• .« .__ .. �_ Y - � 73. Undergend. Storgt�T Tank O Gas ❑ Oil 25. Rodf Sh;�athing � y _ � �-� _ � �: • 74, Ovetheaa Hydpo`'' �-�,, 26. T-Bar. C¢iling (Sviuctural) & A�onocoat - �: a � _ 75. Dry Chemicul y �� ! - -- ,� '+ � 27."Framea�d Flashing.' ' _ _ 'S _ 78. Dry`StaadpipeF � � ' � � ;`, b : 28.ILathing & Sic�ing_ , , - - •- •r 7h FIXED�3YSTEiW:FINPlL �. r 29. Insulatipn � ' " � _ ' " r`-' ' � 7$. FIRE PREV. FINAL ' " .� � 30. Drywall�Nailm9 �r. 1 �- � - -HEALTHDEPT.-REQUIR:EMENT 31. Plaster 6r'owp Coat `, . ' r, . �.k � 79. FINAL:It�SPECTION ; � � - _. _ ,. --��;---- _ 32. �Electricaf Power Me{eCFinal � ', 8p. FOOD CERTIFICATE VSSUED 33..Final EI$ctric_ =: i rt � r ` . 7�. � Notes: _ � - 34. Final Heating'& Air`Consiitioning_; - � �� ' �- " r�'��_ � . 35.'Final Gas Pip�Te"st �. ' -r' ^ ^ ' . . - ". n =- -•- - � - . � ^ rr � - . � -, � .. M1 � - : � . . . . . 36. � Hoad or-CanoPY F. � - - s ^ ��. _ - 37. �Final"Fabiorv FirepYac7 _ - � '� � � ' ', : � ... _ . � 38. Final PlUmbing = �� �,_, �� � �_. , �;. � � - , 39. Wat2r Service�Finat'- � ' - • `- �T. ' _ ' a �fi i - � 4Q. �as Service-Final � t _ ,. -`� T , " ' . �>- .��. -.C' � t , _ 41. Solar pomesticFinal : ' .:� ., ^ . _ " � y r '� 42. Backflow Prevente� ; � " ` , , - 43. Backflow Irrtgation= ' ' • � l� � 44. Landscape Irrigatio,`n, Sys[em: ,- , G . ; ,- r . , - " - _ , 45..Sound Attenuation: - � T - - � ^ - - i . ,� y' _ - v. 46. Handicap,Regulations _ .�,; , " � �� 47. EINAL STRUCTURE & BULLDING ' • , _ ' _. , 46.`FINA�PLANNING�. _ = �' ' : .! 49. Electiic Release to Edison + "� � r 50. Gas Release to Southern California Gas Co . - 51. CERTIF�CATE OF OCCUPANCY . ' _ � . : - No Date \ -- �..__ _ - ,_ AGO���ant lo fill in all spaces except lhose wit�in neavy bortler Iines antl si9n all appropriate tleclaralions. �I7Y OF COSTA IVIES'A� CONSTRUCTION PERMIT UN�-r .rProject A�dress 3`Y�7 Lh PEl2�t L/tNE � 'Appliwni's Mailing Address � , G er's Nam�e p ��� `�_ �h�/tREL�- phone Address =-4-.:� Lh �r LE L/`/�E. Arch.•,�Eng. .: �T 6/ T I/- �E <hE License No. Address Se� E is � s r.t�r.�Po�r R a<<, l4 Address (mailing) — � City License No. � y� _ LICENSED CONTRACTOR DECLARATION I 1 hereby aifirm that I am Ilcensea untler provisions ot Charter 9(tommentlng wltn section 7000) ot Division 3 of the Business antl Protesslons Cotle, antl my Ilcense is in lu olrc/e/�9 ntl eitect. �% Licon CI N�'• // �CQCSP`N�� Date 1L� %i' 7 c'anwr . �.y'/� � �/L � "1RKER5'GOMPENSATION DECLARATION rreoy a(tirm that I have a ceriificate ot consent to selt-Insure or a tertificate Workers' Compensation Insurance, o� a certl(ietl co thereof (Section 3800, Lab. G.) /O "/( /% -t� . Polity NO. H�� � lZV ompa BCertifietl mpy is hereby fumishetl. � � . CertiNetl wpy ii ith the city B' Oiv' ion. Date� v � ApO�icant � E%EMGTION FROM W RKERS' COMP NSATION DECLARATION (This sec[ion neetl not be completetl if [he permit is far One huntlre� (5300) ar I¢55). I certify that in the perto�mance of Ihe work fOr which t�is pCrm�t is issuetl, I shall no[ employ any Oerson in any manne� so as to become subject to the Workers' Compensation Iaws of Calitomia. Date Si9na[ure NOTICE: Ii, aiter, makin9 this tleclaration, you shoultl become subject to the Wotke�s' COmpensation p�ovlsion5 Oi Ihe Labor Cotle, you musl fortbwlln comply with such prOviSions Or tnis pe�mlt sM1all be deemetl revOketl. CONSTRUCTION IENDING AGENCV �'. . - �• � I hereby atflrm that there is a construction lentlin9 agency for the'per(ormance of Ihe work fOr which [his permit i5 issu¢tl (SeGtlOn '9097' Civ. C.) Lentler'S Name Lentler'S Adtlresz - . OWNERBUILDER OECIARATION I hereby atflrm that I am exempt from Ihe ConVactor's Li<anze law (or the followinq �eason ($eclioq �031.5 Business antl Pwfessional Cotle: Any dfy or county which requires�a'permit to wnztruct, aller, improve, tlemoiish or repair , any SVucture, priot to its is5uance, also requires [he applicant for such•permit �, to tile a signetl statamen[ [hat he/sne is licensetl puriudnt to [he proviSiOns ot '�. ^ Conlractor's Licen'sc Law (Chap[er 9(commencing with Section ]000) of �ision 3 ot Ihe BuSinesS antl Professions Catle) o� tha[ M1e/5hG iz exempt ,refrOm anE the basis for the alleged exemptlon. Any viola[iOn of SectiOn .J31.5 by any ap0licant fo� a permit subject5 th¢ applicant to a civil �nalty o( not more than five huntlretl tlollars (E500). LJ I, as owner ot the oroperty or my employees with wages as their'sole mm0ensation, will Oo the wo�k, antl the StrUctwe is not int¢nOeC o� off¢r¢tl for sale (Section ]044, Business �antl Pwfessional Cotle: •The Contiactor'S LicenSe I.dw tloes not appty to an owner of a property who buil�s o� improves th¢reon, antl wM10 tloe5 such work himseH/herself or [h�augh hIs or h¢r own Cmployee5, provitl¢tl tha[ such improvements a�e not intentletl or offeretl'for sale. It, nowever, the bWltlin9 or improvement is soltl wi[�in one year oi com- pletlon, tne owner wi11 have the burtlen oi proving ne/she tlitl not builtl or im- �rOveforthe Ourpose otiale�. U I, as owner oi the prooerty, am excluslvely mntracting witn Ilcensetl <on- t�actors t6 con5[ruct the pro�ect (Section ]094, Business and Protesslon5 Cotle: The Conlrattor's License law does not aPPly to an owne� ot O�oOerty wh0 builtls o� ImOroves lheteon, antl who contraGts fo� such prolects wilh a con- Iracto�(sl Imense pursuant [o IhC ConlraGtor's License Law). I am aware tha[ proof Of Neir Worket's Compensalion Insurance ihoultl be prOvitletl lo me. ❑ I am exempt untler Section B. & P. C. for this reason Date Owner I h¢reby certify IhaL I hav¢ reatl informatlon is coriqcL I agree to ( Si9nature-� Drivers' Lfcen e or 55 CMF 0865-46, rev. 10/84 the above iances repre- v tor 8P ��) `�►b I ' iiis � " TYPE OF CONSTRUCTION NEw noo ❑ CONVERSION ❑ DEMOLISH ❑ OTHER _ --DESCRIPTIONOF WORK/USE OF BLDG. 7VPE OF PERMIT �RADiNc , ❑ TENANT ❑ ELECTRICAL ❑ OTHER PROJECT DESCRIPTION 5�. FT.L CONSTRUCTION TVPE V U VALUATION $ GRADING CU. VDS. A( 0 ALTERATION LJ REPAIR iiFOUNDATION L.rSTRUCTURAL PLUMBING ❑ MECHANICAL Remarks: Bar Sink Backflow Preventer Backflow Irrigation� Rat6tuha _ ' rinking Fountains loor Orains loor Sinks � es Service S--OuHets itercepmrs _ itchen Sink '' avatories " '� -Trap .00f Dreins ' - Reinspection Fee $15 Boiler Duc[ � Under Ground • Duct - Structural Duct - Ventilating � Exhaust System ❑ Multiple Firepl/FacL BIL IC80 � Heating System & Ducting ❑o-i oo,000 eTu o i oo,00g Heinspection Fee � $�5 White - Builtlin9; Cana�y - Applicant; Pink - Accounting; Goltlenrotl - Assesso� PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping � Solar Tank Swimming Pool w/Spa Urinal Warer Closet ' �� Water Heater ' Auto-Wash Leundry Trays Issue Fee 1ANICAL Hood or Typel ❑ Canopy Type I I ❑ \ Refrigeretion,System ❑0-100,0� System Re Alterati Fi ampers Registers Issue Fee A.P. # . y2s� S Main Building: TFront a's � � ARear , �5' � C Right 5� SLett ���$'� Ping. Fef. # (,��2 - Planning Notes:H�LD Automatic Washer Construction Pole Cooking Unit Dishwasher Dryers �Gas ❑ Fan . , F.A.U. Fixtures Oevice Boxes � Outlets Switches Garbage' D isposa I Generetor �0-SJ! 5 3 FEES Reinspection Fee DEVELOPMENTSER 2oning Approved By_ BuildinB APProved By Appliwtion Issued Bv_ $ 3 �654 12/02/87 '� � `�.� Zone Accessory Building: ��� . - '7j'7� � Parking Req./Provided 5 ELECTRICAL Transformer � 75-50KW ❑ 50+KW Meter LJup to 700 amps Mecer ❑over700amps Sub Panel Motors �0.1 HP O1' InaSolar09-1 P��16-15+ �9, _'u a FEES - r e ugnc Raage; Sign . Standing,Seciions � ❑5:75 KW Tiesh Compactor ' ! � - $75 luue Fee $ 3 1/SRKfFIFEM/fALI _ . /7�7-f BUILDING PERMIT 5 PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ FEES a $MIP $ 6• Sq S PERMIT ISSUANCE $ ENERGV P.C. $ - GRADING $ MICROFILM .$ �[ Q/� TOTAL FEE $ ✓ � � {�:� 2 O N I N G R E Q � CONSTRUCTION AND PLANNING POOL & SPA � APPROVALS Permit # ' Date Inspector p�ppROVALS Permit # Date Inspector 1. Temporery Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. �/,�� �� L� 53. Sceel Reinforcement � 3. Elecirica! Conduii Uiilliy-Undrgrnd. ' 54. Forms � 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding � 5. Steel Reinforcement (^y y 8'j rj, (�% ' 56. Rough Plumbing & Pressure'Test 6. Electrical UFER Grnd. G.N • 57. APPROVALTO COVER-GUNITE 7. Footings ' G, �1/ • 58. Electrical Conduit-Undrgrnd. ` 8. Foundation 1 8"1 G• N' 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System �, 61. APPROVAL TO DECK .'.� 11. Property Sewer Line & House Connection ' 62. Backwash & Recep[or-Final •' 12. Sewer Cap 63. Heater & Vent�Final • 13. Roof Drains 64. Plumbing System - Final , 14. Rough Plumbing 5. Electrical-Final 15. Rough Electricai-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 ❑ Oii 23. Gas Pipe-Rough & Test 72. Underground Flush �� � 24. Roof Framing 73. Undergrnd.StorageTank �Gas ❑Oil 25. Roof Sheathing �� 74. Overhead Hydro � 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical R� 27. �Frame and Flashing �� b� 76. Dry Standpipe - � 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation � � &� �� 78. FIRE PREV. FINAL 30.DrywallNailing � � y� �� �,� HEALTHDEPT.REQUIREMENT ' 31. Plaster Brown Coat � 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED � 33. Final Electric Notes:� , yy� 34. Final Heating & qir Conditiod �� A . [ 35. Final Gas Pipe-Test . , d � � y�, 36. Hood or Canopy r��'d� N 37. Final Faccory Fireplace 88 �„ rt�' � 38. Final Plumbing - �' p �, _ � / r 39. Water Service-Final -� " � (�� � � i Z2 .r 40. Gas Service-Final � � V 41. Solar pomestic-Final • • ; y � �� � 42. Backflow Preventer � � �� �J ( � � � � � ��, 43. Backflow Irrigation . -� �� % j µ � S 44. Landscape Irrigation System r`'� n. Il� `� i a 45. Sound Attenuation �i " �" �r ' � � 46. Handicap Regulations �'� % ' � u' . -i e� r. /� 47. FINAL STRUC7URE & BUILDING � � � ' '. '.n '=' ..� i ^'d �i . �1 n. 48. Special Requirements Completed v� ��i �` � ! 49. Electric Release to Edison �U •^� � 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY +� � No. Date , � • , APD���ant to fill in all ipaces except t�ose wit�in neavY bortler linas anE sl9n all aperoprlata tleelarations. ciTY OP COS7A MESA .CON TR UCTION PERMIT PEqMIT NO. ' TRACT NO. 'LOT NO. UNIT N0. ProjedtAddress �i Z.� �G �, Applicant'sMailing ddress -G- 0% lOb Ivi • ry S Owner's Name �A"v � ''^ 0.�'L p/hone SYB- f/if3 Address 39i La {�PK�c �K iiiSf� ��5� ArchlEng.� LicEnse No. f/ 5 2S� Address Convacror's Name ^(�'t Q^^ Pho e �� ' � 6 Address(ma�'��� �� � x I�U�S�q✓i ��7i9� City License No. � �J � S � I.ICENSED CONTRq�TOR DECLARATION I hereby al/irm that � am Iicensetl untler provisions of Charter 9(commencing with section ]000) of Divlslon 3 of tha Busineis antl Professlons CoOe, antl my Iicense is in lull fQrca antl efiect. Ucense el s i2 LI e se n �b Z Date �� �'% � S9 at yl WORKERS' COMPENSATION DECLFRATION hereDy attirm that I ryave a certifitata of consent to self-Insure or a cmtlticate .t Workers' Compan�tlon Insurance, or a certitietl copY tnereot (5 ction 3800, lab. C.) � Policy No. �UK�U�,.�.n. � Compan � Certifietl coOY is hereby turnlshetl. Certitietl copy i}flletl with [he city Buil Div' f Date' ��1%�• APPlicant �- EXEMPTION FROM WORKERS' COM7ENSATION DECLARATION (TniS seG[iOn neetl no( be comple[etl if the parmit iz }or One huntlratl (E300) or Iczs). I certity that in [h¢ p¢rformance o/ the woik for which tM1ls pe�m�t IS I55ueU, I Shdll not employ any p¢�Son in any mann0r 50 as to becom0 Sub�ect lo th! WOrkeri' CompenSaliOn Ldws oi Ca1lfOrnia. Date Signa[ure NOTICE: If, aiter making t�is declara�ion, you ShOultl become Sub�ect [o the Workers' ComDensatlon provisions of the Labor �otle, you must ronnwitn comply with sucn provislons or this permlt Shall be acamea revokea. CONSTRUCTION LENDING AGENCV 1 hnreby atlirm that [ryero Is a constructlon Iontlin9 a9ency for tna parformance of lne work for W��cn [bI5 permlt Is ISSunE (SecUon 3097 Civ., C.) LenOer's Name Lentler'sAdtlreis- - OWNER BUILDEN GECLARATION � I hertby aflirm Ihal I am ozempt from the ContrdCtor'S LlcenSC Law fprthe � following reason (Sectlon 7031.5 Buslnass antl Prptessional Cotlo: Any ci[y'or I COunty whicn reqW/as a pBrmit to Cons[�uct, dlt¢� Improve, tlemollih o�"r¢pai� Iany structure, prior to its issuan<e, also requires t�e applicant for such peimlt to fiie a signetl statement that he/she iz Iicensetl pursuant to tne provlsions ot the Contractor's Ucanse Law (Chapfer 9(commendng with SecUon 7000) ot 71vl5ion 3 ot lh¢ Bu5InB55 antl Profe55ion5 Cotle) or t�at be/She is examp[ he�e�rom antl the 4dii5 1or Ihe allegetl ¢xemOtion. qny violdUon ol Sectlon 7031.5 Dy any applicant tor a permit subjetts Ne� appltcant to a civil ,� enalty ot not mor¢ Ihan tive huntlr¢tl U011ars (f500). I, as owner o1 (hG property Or my employee5 wit� wag¢5 as thei� sole compenzation, will qo me work, antl tltG sl�uGtu/e is not intenaetl or o(terea for sale (Section 7044, Business an❑ Protessional Code: The Convactor's �IcenSe Law tloes nOt apply to an owner of a proOertY who builtl5 O/ improves thereon, antl wno aoes su<h work himself/harsell or tnrough his or her own employees, Orovitletl that zuch imProvements are not intentlo0 or offeretl for sale. It, nowever, thp buildin9 or improvement Is soltl witnin ona yoar ot <om- oletlon, the owner W�II have tne burtlon ol proving he/sne tlitl not builtl or Im- provs lorthe Durpose O15ale). ❑ I,'as owner of lne proper[y, am ezcluslvely con[racting wlth Ilcensetl con- traclor5 to con5t�uct (he project (Secllon ]044, BUSinoss and PrOlession5 CotlO: Tho Con[ractor's License Law Ooes m[ apply to an owner oi property who bulltli O/ ImOrOvaS the�eDn, antl who coMtacts �or such 0/ojeCtS wi[h a con- traclm�sl I�cenm pursuanl [o tne Contractor'i llcense Lnw�. I'Bm aware tha[ prool o( lhelr Worker's COmPensatlOn insuranca inoultl b0 provitlatl to me, ❑ I am exertipt untlor Sactian B. d P. C. lor this rea5on Data Owner 1 hereby certily thdt I have reaE this applicalion and state that the above inlormatlon is corrnf� . I a9ree to compty with all Uty antl <ounty ortlinances antl state lawz ralalyr�g to builtling coniVu HOn, antl hereby authO�lie r0pre- sentatives o� this�C�ty to en[er upon o above-mentloneM property for Slgnature _�7 A �w. Drivers' License or 55 9T CMF OB65-46, rev. 30/B8 0 TVPE OF CONSTRUCTI^ON U NEW�ADD LJ ALTERATION LJ REPAIR '� �' ❑ CONVERSION U DEMOLISH O HER A,p.�l, . DESCRIPTIONOFWORK/USEOFBLDG. ' ' � ' S Main B I E TVPE OF PERMIT GRADING FOUNDATI� ST0.UCTURAL T Ffont ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL 6 Rear ❑ OTHER %� PROJECT DESCRIPTION SQ.FT.' oCCVaAN V C Ripht K Left CONSTRUCTIONTVPE � 'VALVATION$ '� $ 20NE GRADING CU.YDS. ACRES Ping. Ref. $b qemarks: �� � � Planning Notes', i Preventer Irrigation Drinking Fountains � Floor Drains ' Floor Sinks � Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof D�ains Reinspectian Fee � $15 Duct- Under Ground Duct � S[ructural ' Duct � Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO 51�'+ �! Heating System & D�cting ❑4700,000 BTU 0100,000 Reinspaction Fea � $15 Whlte - Bulltling; Canary - Appll<ant; Plnk - Accounting; Goltlenrotl - AsseSsor ShOWers Service Sink ' Sewer Cap Sewer Connection Solar Coltectors Solar Piping Solar Tank Swimming Pool w/Spe Urinal Water Closel Waier Heaeer Water Service Aum�Wash Wundrv Travs Isue Fea Hoodor Typel ❑ CanoPY .Type I I ❑ Refrigeration System Oaioo,000eTu Oioo,000 System Repair/Alteration � Fire Dampers � Registers ' laue Fee S 3 Automatic Washer Construction Pale Cooking Unit Dishwasher � Fan Fixtures Device Boaes Outlets Switches Garbage Disposal Generator �0�5, 5 ' ' � Zona . . . Parkin9 Req./Provided ELECTRICAL Trensfarmer ❑ 15-50KW ❑ 50+KW Meter �up to 100 �amps Mecer ❑over 100 amps , Sub Panel' MotorsOO-1.HP�1'f.-6 � Inc.Solar 09�15 HP �16-15+ MiCrowave � � . Pole Light _ Standing Trash Co I Rainspaction Fee '$15�' I IssuE DEVELOPMEN7 SERVICES REQUIREMENTS: Zoning Approved 8y Building Approved By � _ .. . . . _ f'� ' - SUMMARV OF FEES BUILDING PERMIT $ SMIP PLAN CHECK � $ - PERMIT PLUMBING , $ ISSUANCE - PLAN CHECK 25% S ENERG� P.C. ELECTRICAL $ - � GRADING PLANCHECK 50% $ � MICROFILM MECHANICAI $ � TOTALFEE PLAN CHECK 25% $ % ZT , $ FEES $ 3 Z O N I N G R E Q M T S CONSTRUCTION AND PLANNING POOL & SPA . . APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms � 4. Electrical Conduit-Undrgmd. 55. Electrical Bonding . � 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test + 6. Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE 7. Footings ., 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. PropertY Sewer Line & House Connection 62. Backwash & Receptor-Final � 12. Sewer Cap 63. Heater & Vent�Final 13. Roof Drains ' 64. Pluinbing 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 Electricat-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # _ 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing ' 73. Undergrnd. Storage Tank O Gas ❑ Oil " 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insula[ion 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 �j �� 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 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY . � No. Date A�plicant to /i11 in au sDaces ezcept thosa witnin neavY borEer Ilnes anE sign all aoPmo�iate tleclanlionz. CiTY.OF COS7A MESA CONST UCT[,ION PERMIT ProjeMAGdress � CKyt dpplicanYs Mailing Address •U • �?' ��D �; ��W L)Y'r Owner'sName t � ..� Phonest�fr���&j Address �1 LA Q'� � t-'`� ' Arch/Eng. - License No. Address � Contrector's Name � � � hone , '� 6 � Addresslm++'�'n�l 'G, b5 (oQ �i�� �iL;�j,� Ciry License No. � �% � � LICENSED CONTRACTOR DECLARATION � I he�eby at(irm [ha[, I am licensetl untle� p�ovi51on5 of Charte� 9(commencin9 witn section �000) of Div�sion 3 01 the Bu inezs antl Profeszions Cotle, antl ` my license is In f���wc�force antl etiect. �� Licon CI • � � Ic �5e No. %Z \ Dale ��� Signature �. WORKERS' COMPENSATION DECLARATION . ' hereby aftirm lhat I nave a certilicate o1 consent to self-Insure or a certlflcate � �f Wbrke�s' Compensation Inzurance, o� a cerUfi¢tl —CfOpY theteof ($e tlon - 3800, Lab. G.) (���' ' ComPan �A 1 t �� = PoIICY No. ,Bf���p Certifietl copy Is hereby furnishetl. Certlfie� cP py I fileA with the city Buil Dlvis Oate �'�e � �� - Applicdnt � i E%EMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection neetl not be campletetl it the permit Is for one nuntlretl (5300) or lezs). ' 1 certlfy [hat In the �performance Of [he work for whic� tbis pe�mR is Bsuetl, I Shall no[ employ any pe�son In any mann¢r so as to bGCome subj¢Ct to Ihe Workers' C e Laws of California. Dale Signature ' NOTICE: It, after.making this tleclaratlon, you shoultl become-suDject to the WorkGrs' Comp¢n5ation provisions ot the Labor Cotle, you musl (orfhwith comply wilh such provisions or tnis permlt shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV I nereby atfirm that tnere iz a construction lentling a9ency for the performance of th¢ work for which this permit i5 ISSu¢tl (Section 309] Civ. C.) Lentler's Name Lentlor's AOCr¢Ss � OWNER BUILDEH DECLARATION I hereby aftirm that I am exempt trom tne Contractor's License �Law tor the following reason (Section 7031.5 Business antl Professlonal Cotle:.Any clty or county whlcM1 requires a permlt to con5truct, alteq Improve, tlemolish or repai� any structur¢, prio� to its issuance,•also �equlre5 the applicaM tor such Oermit to flle a signetl stalement that h¢/she Is Ilcensetl pursuant to the provisions of tne Con[ractor'S License Law (Ghapler 9(commencin9 with Section ]000) ot DlviSiOn. 3bf [he Business antl Prote55lon5 Cotle) o/ Ihat he/she is exempt - � [herelwm antl tne ba5is for t�e alle9etl exemption. Any violation of Section ]031.5 by any applicant for a permlt subjects the. applicant to a civil ' enalty of not more tnan five huntlretl tlollars�(E500). ' .� 1, az owner of the property or my employees witn wages az tnelr sole comp¢nsalion, will tlo the work, antl Ihe structure is not intentle0 or o(f¢r¢tl ' lor sale (Section 7044, Business antl Professional Cotle: The Contrac[or'S License law tloes no[ apply to an owner ot a property who builtls or impmves thereon, ana wno tloes such work himself/narseif or through nis or her own employees, prOviUetl lhat such imprOvemen(5 dre not Intentletl or otferetl f0� 581G: II, howeve�, lh¢ builtling or imp�ovement Is Soltl within one y¢ar 01 com- pleHon, the owner will have tha burtlen of prOving he/sh¢ tlitl not builtl or im- prova for [he purpose of sale). ' ❑ I, as�owner o/ tne property, am exclusively contractin9 witn licensetl com traCtorsto construct the O�oject ($ectlon 7044, Business antl Professlon5 Cotle: The ConVactor's LicenSe Law tloes not apply ro an owner ot.property wno builtls or Imoroves thereon, antl wM10 contracts tor such projects wlth a con- tractor(s �icense pursuan[ to tne Contractor's �icense Law). 1 am aware that proof o� thei� Wo�ker's Compensallon insurance Shoultl be provitled to me. ❑,I am exempt untler Section- � B. S P. C. for tnis reason Date - Owner ' � 1 nereby certity tha have reatl this application antl state that the above . in(orma[ion is corre . agree lo mmply with all tity antl county ortlinances �antl-slate laws rela ng to builtling Wnstruction, antl hereDy auihorize repre- sentatives of this c' to en[¢r u o t above-mentionetl property for InSpectlon purp0 , y� � r � Si9nature � ' �a�z / � �rivers' Utense or 55 � TYPE OF CONSTRUCTION LI NEW_��ADD, LI ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH L'J o1'HER q,p,� -DESCRIPTION OF WORK/USE OF BLDG. - • S Main Building: TYPE OF PERMIT GRHDING FOUNDATIQf`j. STRUCTURAL � T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING� �MECHANICAL B Rear � ❑ OTHER � A .. PROJECT DESCRIPTION Sq FT ��p� ' C Right ' '1 OCCUPANCV � K iCONSTRUCTION TYPE v VALUATION $ 9��� '� g Lefl � ZONE GRADING CU. D5. ACRES . . Ping. Ref. �II' Remarks: � / Q Plannin9 Notes: Sink Preventer Irrigation Drinking Fountains Floor Orains ' � Floor Sinks Gas Service OuUets Interceptors Kitchen Sink � P-Trap Roof Drains Reinspection �Fee Showers . Service Sink Sewer Cap � ' Sewer Connec[ion . Solar Collectors Solar Pipin9, Solar Tank Swimming Pool w/Spa Water Closet . Water Hearer -� Water Service � � AuLO�WeSh � LaundryTrays � $15 � Issue Fee Dut[- Under Ground Duct-Structural • � Duct � Ventilating � Exhaust System � Multiple ❑ Firepl/Fact. Blt. ICBO # �a[ing System & Ductin9 0-100,000 BTU O 100,000 BT ReinspeRion Fee � $15 CMF 0865�46, rav. ]0/04 White - Builtlin9: Canary - Applicant; Pink - Accounting: Goltlenrotl - Assessor Hoodor Typel ❑ Canopy Type II ❑ FEES - Automatic Washer Construction Pole Sub. � Cooking Unit � .. � - Dishwasher , - Refrigeretion System ❑o-i oo,000 er u"O i oo,000 System Repair/Alteration F ire Dampers Registers � Issue Fee $ 3 FEES 42a6 I/28/G.: Acressory Building: � Parking Req./Provided 2uo�-� Zone _ � � ELEC7RICAL � � � Transformer ❑ 15-50 KW - � 50+KW �ryers uoas ueieccric - Fan F.A,U. � Fixtures �evice Boxes OuUets Switches ' - Garbage Disposal ' Generator �0�5 KW 05-15 KW Meter � IJ up to 100 amps Merer �over 100 amps� . Sub Panel Motors �0.1 HP � 1 F, - 8 . Inc.Solar �9�15 HP �16-15+ Microwave - Pole Light Range Si9n Standing Section Trash Compactor I Reinspection Fee �$15 I I Issue Fee DEVELOPMENTSERVICESREQUIREMENTS: Zonin9 APProved BY . 8uilding Approved By Aooliwtion Issued Bv - �^- . Z O N I N G R E Q M T S FEES 3 • . SUMMARV.OF FEES . - . BUILDING PERMIT� $ SMIP $ - PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE � 5 . , PLAN CHECK .25% $ � ENERGY P.C. $ ELECTRICAL $�• � GRADING . $ PLANCHECK �50% g MICROFILM $ � MECHANICAL $ TOTALFEE $ PLAN CHECK Z5% $ � . CONSTRUCTION AND'PLANNING POOL & SPA APPROVALS . Permit# Date Inspector p�ppROVALS 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-Undr9rnd. 55. Electrical Bonding 5. Steel ReinEorcement 5fi. Rough� Plum6ing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Fooiings - 58. Electrical Conduit-Undrgrnd. . '8. Foundation . 59. Gas Pipe, O Undrgrnd., Test � � '9,' Water Pipe�Undrgrnd. . . ' 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final . 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing ' � 65. Electrical-Final ' 15. Rough Electrica6Conduic � , 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 /,� ��p � FIRE DEPT. REQUIREMENT _ - 20. Rough Factory Fireplace � APPROVALS Permit # _ . 21. Dutts, in Structure 70. Underground Hydro � 22. Ducts, Ventilating 71. Product Piping OGas ❑Oi�l � 23. Gas Pipe-Rough & Test . 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical " � 27. Frame and Flashing -� 76. Dry Standpipe y. . 28. Lathing & Siding � - 77. FIXED SYST,EM 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 . ; �,i 33. Final Electric � - Notes: � ' 34. Final,Heating & Air Cor�ditioning �� �+G� � i � �_ �-s 35. Fin�.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 Requi�ements Completed ' 49. Electric Release to Edison 50. Gas.Release to Southern California Gas Co � � 51. CERTIFICATE OF OCGUPANCY � , No. Date � ' . +�C . vi O ciTY OF COS7A M7ESA CO/NSTR�ICTION PERMIT ProjectAddLess �S�-7_`�j . ����� . �,�- �AppliCanYs Mailing dress � � Jc/ " � Owner's Name . ��'✓� � C ��', 2E�p�q¢ �C� Address ��/�'I�r� Arch/Eng. � License No. � Address Contractor's Name Phone Address (mailing) City License Na � LICENSEDCONTRAC OR ECLA ATION� � 1 hereby affirm tM1at I am licensetl untler'provisions af Charter 9(mmmencing with section ]000) of Division 3 of the Busine5s antl Protessions Cotle, and my license is in tull fA rce antl ct. [�/ ) LicenSe Class `— � License No �� �%� % � Date � -%' a � Signature �� WORKERS' COMPENSATION DECLA9 TION iereby aftirm that I have a certificate of consent to zeif-insure or a certiiicate Workers' Compensation Insu�ance, o� a certifietl copy the�eot (Section a800, Lab. C.) Policy No. Company ' ❑ Certitietl copy is hereby furnishetl. ❑ Ce�tifietl copy is filetl with the city Builtling pivision. Date APplicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection neetl not be completetl if the permit is for one huntlretl ($100) or Iess). I certify that in the pe�to�mance ot the wark for which this perm�t is isiuetl, I shail not employ any person in any manner so as to becomg subject to Workers'�,Cpfnp-n@at�ior � aws ot Califomia /� /f Date �� L� VT k�gnature ����.y_L compiy wi[n sucn provisions or inis permit snaii oe aeemea revoKea. CONSTRUCTION LENDING AGENCV I hereGy affirm that the�e is a const�uction lentling a9en[y to� the pertormance af the work fo� which this permit i5 issuetl (Sectian 309] Civ. C.) Lender's Name LentleCs AaEress � _ OWNER BUILOER OECLARATION ' I hereby affirm thai I am ezempt from the Contractor's License Law tor the tollowing reason (Section7o31.5 Business antl Prafessional Cotle: Any city or county whicM1 requires a permit to construct, alte�, improve, tlemolish o� �epair any structure, prior to its issuance,�also requires the applicant for such permit to tile a si9netl statementthat he/she is licensetl pu�suant to the provisions ot the Contractor's License Law (Chapter 9(commencing with Sectlon 7000) o( livision- 3 ot the Business antl Professions Cotle) or that he/she is ezempt ieretrom antl the basis for the alleged exemption. Any violation ot Section .031.5 by any applicant to� a permit subjects tM1e applicant to a civil �enaltyot not mare than five nuntlretl dollars ($500). � I,�as owner of the_property o� my employee5 with waqes as their Sole compensation, will tlo the work, antl Ne structure is not intentletl or offeretl for sale (Section ]044, Business antl Protessional Cotle: The Contractor's License Law tloes not apply to an owner of a prope�ty who builtls o� imp�oves 'thereon, an0 who �tloes such work himself/M1e�selt or through his o� her own employee5, provitletl tM1at such improvements are not intentletl or affetetl to� sale. If,�howeveq the builtling or improvement is soltl within one year of com- ,plefion� tM1e owner, will M1ave the bu�tlen of p�Ovin9'M1e/SM1e tlitl nof builtl O� im- 'prove for the purpose of sale). • ❑ I', as owner of the Droperty, am-exUusively contracting with licensetl con- . tractors to construct the pwject (Section ]044, Business antl Professions Cotle: The ConVacto�'S License Law tloes not apply to an owner of property who builtls or improves thereon, antl who wntracts for such projects with a con- � tractor(s) ucense pursuant to the Contractor's License Law). I am aware that - proof ot their Worker's Compensation insurance shoultl be provitletl [o me. ❑ I am exempt under Section B. & P. C. for this reason , Date � Owner - I hereby certity that �I have reatl thi5 applicatiOn antl state that the above infnrmatinn is mrrect. I aa�ee to comolv with dll citv antl [ounty ortlinances Signature - - / Drivers' License or 5` CMF 0865-46, �ev. 30/84 enter u�on the � Builtling; Canary nt ta fill in all soaces except tnose within heavy �ortler Iines antl sign a11 appropriate tleclarations. ERM�JVO� ��/ � , TRACT NO. ' �LOT;NO.� UNI�G., . c TYPE OF CONSTRUCTION LJ fVEW � LJ ADO� LJ'ALTERATION IJ REPAIR � r .❑ CONVERSION ❑ DEMOLISH ❑ OTHER� ' � DESCRIPTION OF WOR�K/USE OF BLDG. '' � t- � . � � TVPEOFPERMIT ❑ GRADING� ❑ FOUNDATION STRVCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANIGAL �❑ OTHER PROJECT DESCRIPTION Sq. FT. ocCUaANCv , CONSTRUCTION TYPE �VALUATION $ � ZONE GRADINGCU.VDS. ACRES' Remarks: � t `% � )1 � / - . ' � _ Sink Preventer� Floor Sinks , . - . 3as Service/, �� ,Outlets � Interceptors . Kitchen Sink` . . ._ Lavatories �t, � � P—Trap, Roof Orains • ," ReinspeMion Fee , $15 Duct - Under Ground Duc[ - Structural . Duct - Ventilating � Exhaust System � Multiple ❑ FirepUFacc Blt. ICBO # Heating System & Ducting , ' ❑0.700,000 BTU 0100,OOOBT aby authorize repre- ionetl prope�ty /o� oa�:�,�_�_�_.'� � keinspection Fee anp Pink - Accounting; Goltlenrotl - Assesso� •I $15 Showers Service Sink � Sewer Cap � - Sewer Connection ' Solar Collectors �Solar Pipin9' ' Solar Tank Swimming Pool w/Spa Urinal . Water Closet � � Water Heater WaterService � Auto-Wash � Issue Fee IANICAL Hood or Typel ❑ Canopy Type I I ❑ - ` �' t - � , ; i : f ° .` '_� ' " '9.1 ' �nFr.181987 A'.P. # S Main Building: TF�ont � ARear C RigFt SLeft � Ping. Ref. # � Planninq Notes: i � . Automatic Washer � " Construction PoleSub. Cooking Unit , Dishwasher . Dryers �Gas lectri Fan� � , F�.A.U. � � � rixtures � Device eoxes Outlets ' Switches Garbage Disposal Generator �05, ��"" " "�ene Acc o i � 2 O � � N ' . N G . � Parking"Req./Provided � E Q ' � M T S ELECTqICAL - Transformer ❑ �15-50 KWu � � '�'50+K Meter,l�'Iupto100am s Meter,�bver100amps �'la Sub Panel � " Motors � 0� 1 H P � 1%- 8 .,, Inc.Solar �9-15 HP �i6-75+ Microwave - � Pole Light � Ranae i I I Standin9 Sections 5 KW � Trash Compactor $ 3 ' Rainspection Fee ,$15 Issue Fee FEES �DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved By Building Approved By ��� netngeration System ' , � ❑0.100,000 BTU ❑ 100,000 BTU " System Repair/Alteration I � Fire Dampers � � Registers , ' . i ' • Issue Fee . - I , $ 3 � _FEES . . ' , SUMMARV OF FEES - BUILDINGPEFMIT� $ SMIP $ - PLAN CHECK $ PERMIT . � PLUMBING $ ISSUANCE � $ . PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAC $ GRADING $ �� ' PLANCHECK �50% $ -�� MICROFILM _ $ _J�� MECHANICAL $ � � TOTAL FEE $ ` PLAN CHECK 25% $ , ' " ' CONSTRUCTION AIVD'PLANNING �,i � � �r:.� POOL & SPA,' � �._. � " � , Datet Inspector,; � - . Date Inspector ��PROVALS � Permit:# " , i APPRaVP4S Permit# , b 1 f '�'i . � .Y► . 1.`:Temporary Electrical;Serviceor Pole t j� -� 52. Pool�Equi rnent Location ' � r_ 2' �Soil Pipe-Undrgrnd. ; " •��p 53. Steel'Rei yforc2ment � � ����"� 3. Electrical Conduit Utility�Undrgrnd. . 1 54. Forms� �C' �' i ' �.1�"� 4. Electrical Conduit-Undrgrnd. . 55. Electrical Bonding '�' i � 5. Steel Reinforcement �. �` � � 56. Rough Plumbing & Pressure Test . � ���" 6. Electrical UFER Grnd. � � 57. APPROVAL TO COVER-GUNITE ' ,..� x`'� - `,'i 7. Footings '� ' 58. Electrical Conduit=Undrgrnd. 8. Foupdation . 59. Gas Pipe, O Undrgrnd., Test �. •` , �.. 9. Wat2r:Pipe-Undrgrnd:-:' } � ' �`60. �Backwash Lines, P.Trap, 0 Undrgrnd. ' ' � • . �_.� - . 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connectionl 62. Backwash & Receptor-Final 72. Sewer Cap � 63. Heater & VenbFinal � ,_, f � 13. Roof Drains' 1 , � 64. Plumbing System - Final . 14. Rough Plumbing� / ��� , 65. Electrical-Final ' � 15. Rough Electriral�Cond\it� ' 66. Solar System-Final ,� 16. Rough Electric Wirir{g-��z� � � _ -�� 67f�Fencing & Access Approval � � 17. RoughWiringSign � ��=� -- �`��-68. APPROVEDFORPLASTERING 18. Rough Electrical-T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL � 19. Rough Heating & Air Conditioning ' FIRE DEPT. REQUIREMENT I �r � 20. Rough Factory Fireplace ' APPROVALS Permit # _ 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing � 73. Undergrnd.StorageTank OGas ❑Oil . 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structurap & Monocoat 75. Dry Chemical 27. Frameand Flashing 76. DrYStandpipe +� � 28. Lathing & Siding . 77. FIXED SYSTEM FINAL :% 29. Insulation 78. FIRE PREV. FINAL � 30. Drywall Nailing HEALTH DEPT. REQUIREMENT �,. 31. Plaster Brown Coat . FINAL INSPECTION � � 32. Electrical Power Meter-Final � .�'�/� . FOOD CERTIFICATE ISSUED� :`, 33. Final Electric �3 N s: � / � C �� - �� � �3���' F . 34. Final Heating & Air Conditioning . ' � �'' � 35. Final Gas Pipe-Test � �� - 36. Hood or Canopy ����"` �� � ,.-=Y' , 37. Final Factory Fireplace � � ''��n .r �--+ 38. Final Plumbing C Sy �� �l,' �, � �39r Water Service-Final � "` � �„', ��- - ✓ � � 'i 40. Gas Service-Final % � � � " L .• /`fi _ l` \,� 41. Solar pomesticFinal � � � � `-f ..� 0.42. Backflow Preventer „� � � � � � � , ; _ , Y43� Backflow Irrigation }'�• ��!� f y , • ^44� Landscape Irrigation SYstem � . � � " , L iJ---� � LL45. Sound Attenuation ' � �-'. v �' F- 46. Handicap Regulations - � � ^ '�i ✓" , /''}/.l „ 47�FINALSTRUCTURE&BUILDING � �-'� 1� �-�' !~• �-r ��'.� ' .-� � ✓t � 48. Special Requirements Completed L, S �� ' 'r. 49. Electric Release to Edison -' %� �n � 50. Gas Release to Southern California Gas Co �� �,.� �, 51. CERTIFICATE OF OCCUPANCY � � • No. - Date � � r � • -� - � � i f � I� . � Apppcant to fill in all s a�e� exce t those within �eavY DorGer Ilnas ana s4 n a11 a 0655 �'�' /�'2/87 � Bo�l1 f V 0 9 DO�oDriate Eeclaralions. CITY OF COSTA MESA CO'N} ST�R)UCTc�IO.N PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. ' . � r Project Address 34'� �1=YeL/ C gt ,. 3 r v� r: � � � � AppliCant'S Maili ddress '�• �� � ' TYPE OF CONSTRUCTI�N • NEW ADD ALTERATION REPAIR �y39 ❑ CONVERS�ON ❑ DEMOLISH .� OTHER AP �y Zo�e Owner's Name p�� � �—Phone � � DESCRIP710N OF WORK/USE OF BLDG: Adtlress �{� Lw t� � T� u ' ' S Main Building: Accessory Building: E Z �:rCh/Eng. Litense No. TVPE OF PERMIT GRADING FOUNDATIOrv S7RUCTURAL T Front � 0 Addre55 �n� � ❑ TENANT EIECTR C ❑ PLUMBING ❑ MECHANICAL B qear N Contracror'sNam ��ti�� �• //�ti� Phone_ip.%?_Z�iG'I � oTNER ��y1,p�A� % . I PROJECT DESCRIPTiON SQ. P7, oCCVPANCY C Right N Addreu (ma ����� �J.� ' Gw Y�/L�r CONSTRUCTIONTVGE VALUATIONS.,%iO� -�� S Left G Cit License No. J R Y 20NE GRADING GV. VDS. ACRES Ping. Ref. # Parking Req./Provid2d E LICENSED CONTRNCTOR DECLARATION ' Q I hereby aftirm that I am licnnsetl untler provisions ot Charter 9(commancing Remarks: � Planning NOtes: M wlth sectlon 7000) of Oiviston 3 of t�e Huzinesz antl Professtons Cotle, antl my Iic¢nse is in ful orc antl eflecL ' C,r'_�, / T LiSense Class _ l�icensa No. J� S Da[e d��rl-f ' S9 [ a.w� C' %Yt�� PLUM8ING � FEES ' W4RKER5' COMPENSATION DECLARATION BarSink ShOwe�s ,'y,�erebv altirm Ihat 1 have a certificace o/ consent to selFinsure or a certi/icate ELECTRICAL FEES LT'' Workers' Compensation Insurance, or a certi tl copY thereot (Settion gackTlow Prevenier $ervice Sink ;`"=oo, Lab/. �) l' �f �{ r � �^ Auromatic Washer Transformer ❑ 15�50 KW i"'�olic Nd. �dN�% �lN1d7 Com any '�- Backflowlrri ation • � ❑ 50+KW n Y P 9 Sewer Cap Construction Pole S�b. rd Certitietl cOpy is hereEy tumiSheC. �� Cer ietl copy 1 � with the <ity euiltli ivisio . Bathtubs Sewer Connection Cookirg Unit Meter �up to 700 amps Oa� ApPliwn • EXEM TION FROM WORKERS' COMPENSATION DECLARATION Clarifi¢�5 Solar Cqll¢CtOrs Di5hwa5her Meter �over 100amp5 (Thiz section ne¢tl not be comple[etl if the Permit is for one huntlreG (SI00) or iess). Dishwasher Solar Pip' Dryers �Gas ❑Electric Sub Panel I certlty that in the oertormance ot the work tor which this oermk is issuetl I ' sha�l not employ any person in any manner so as to become subject to t�e Drinkin9 Fountains Sola ank Fan Mofors �0.1 HP �7'h � 8 WOrkers' Compensat(On taw5 of Cali(ornia. Date ' Slgnature Floor Drains imming Pool w/Spa F.A.U. Inc.Solar 09-15 HP �1615* ��OTI[E: It, after making this tlectaratlon, you snoulC become subject to the W4rkers' Com00n5allon provisions oi the LabOr COtle, you must (orthwlth PI00� Sinks U�indl Fi%fU�85 MiCrow2v¢ � cory�plY with SIICb prOWsions or Ihls pe�mit shall bG tleCmetl rOVOketl. CONSTRUCTION LENDING AGENCV GaSServiC2 OUtlEIs Wat¢fClOsel DeviceBOzeS I hereby aflirm tM1at lhere Is a construction lentling agancy for t�e performance Pole Light of tho wark for whicn thiz perTil is issuetl (Sectian 3097 Civ. C.) - In[ercep[ors Water Heaeer putle[s Ran e LenOer's Name 9 ' - 1 entler's Aaaress Kitchen Sink Wa�er Servite OWNER BUILDEN �ECLARATION Swi[ches Siyn I hereby attirm that•I am exempt from tbe Conlractor'S LicenSa Law br the LavatOries AulO-Wesh � : lollowln9 reazon (Se<tion 7031.5 Business anG Profassional Coda: Any ci[y or GarbagC Disposal Standing Sections �ounry which reqWres a permlt to construct, alter, improve, tlemolish or ro0air P—Trap �gundry Trays Generator �0-5 KW �5-15 KW Trash Com ttor apy structure, prlor to its Issuance, also roquires the aOPlican[ for zuch pormit Pa to tiia a si9netl statement ihat ho/sne is Iicensetl pursuant to tho provisions oi Roo( Drains t4e Contractor's U�ense Law (Chapter 9(<ommencing with SncHon 7000) of ;D�e ¢tlrom anG�tho ba515 fO�dthO alrlegetl'exemp�i�On. Aoy viOlation Of $BCtIOn �`=*rt31 5 by any appllGant fOr a permft Subj<Cts l�¢ a0Plicant to d tivfl - �a#`halty of not more tban iWe huntlretl tlollars (E500). �,�1 I, �s own0� of lhe prOPe�ly o� my Omploy¢Os with wdgas as thnl� Sol¢ Reinspection Fee '$15 ISSUe Fee $ 3 compensalion, will tlo che work, antl the structura Is not Intentletl or ottarotl Reinspaction Fee $15 luue Fee ' $ 3 lor salo (Section 7044, Businass antl Protessional Cotle: The Contractor's ' ' MECHANICAL FEES Liconse Law does not appty to an owner of a proparty w1�o builtls or improvos �Oeseon, antl who tloes sucb wo�k hlmseli/hersell Or tb�ou9h hls o� h¢� Own YPQ � � DEVELOVMENT SERVICES RE�UIREMENTS: einployCes, provitletl that sucM1 improvements are nOt Int¢ntletl or offe�etl tOr BOiI¢� HOOd O� T sdle. If, however, the bulltling or improvement is soltl wltM1in ono vea� of <om- C2nOpy TypB I I ❑ ZoninB %�PProved By nate pletlon, the owner will have tho burtlon ol proving hc/sne tlitl mt builtl or Im- Duct - Under Grountl � guildinB APP�ovOd By � Date�q��(�_ prt^�ove t0� the pur005t ot Sala). {� �..— .� .. � �.l I, as owner ol tne property, am ezcluslvely contrat[ing with II<ensetl con- Duct - Structural Refrigeration System Application laued By Datfl «aCtoR to coq5truct [he project (Section ]044, BUsin¢55 antl PrOtession5 CoOe: 7he ConVactor'z Licenze �aw daet not aoP�Y �o an owner ot o�operty who Duct - Venfilating 06700,000 BTU 0100,000 B7U SUMMAR OF FEES ' � builtls or improves thereon, antl who contracts for Suc� prolacls with a Com «aclo.(sl iitense pursuant to the Contracror's Licensa Law�. I am awarn that Exhaust System ❑ MW[iple ❑ System Repair/Aiteration BUI�DING PERMIT �$ SMIP $ • SZ7 Proof o( [heir Wo�ker'S CompensaHon InSurance shoultl b0 provitletl t0 me. _ PLAN CHECK � $ PERMIT ❑ I am axempt untler Section B. 6 P. C. for Ihis reason Firepl/FacL Blt. ICBO �k Fire Dampers PLUMBING $ ISSUANCE $ Date owner Heating System & Ducting Regisrers PLAN CHECK 25% $ ENEpGV P.C. $. i hereby certity th nave reaG t�is appiication ana state that the above ❑0.100,OOOBTU 0100,OOOBT ELECTRICAL � $ GRADING S Information is corr t. a9ree to como�Y �+��h all Uly antl county ortlinances � anG slate laws ral in9 to builEinq construcHon, antl hereby authorize r¢pre- PLAN CHECK 50% $ MICROFILM $ Santdtives ot thi tl [o e0t¢r v pn th0 abOv¢-TentioneG Proper[y f0r �nspectio�rpo �rZ�L a MECHANICA� $ TOTALFEE $ �OD Stqnatur — Oat p¢inspection Fee '$15 laue Fee $ 3 PLAN CHECK 25% $ ❑rivers' License or 55 �� CMF OB65-46, rev. 10/84 Whi[e - Builtling: Canary - AOPIIcanQ Pink - Accounting: Goltlenrotl - Asse55or CONSTRUCTION AND PLANNING - POOL & SPA APPROVALS ,. Permit# �Date Inspector AppROVALS Permit# Date Inspector 1. TemPorery 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 P�umbing & Pressure Test • 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings �-- 58. Electricat Conduit-Undrgmd. 8. FoUnda[ion • 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor SYstem 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Elecxrical-Finai 15. Rough Electrical-Conduit 66. Solar System-Final 16. RoUgh Electric Wiring � 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVEO FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace � APPROVALS Permit # _ 27. Ducts, in Structure 70. Underground Hydro ' 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test . 72. Underground Flush � 24. Roof Framing 73. Undergrnd. Storage Tank �IGas OOiI 25. Roof Sheathing 74. Overhead Hydro � Fi 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical F�� � �� 27. Frame and Flashing 76. Dry Standpipe �'� '� i ". 28. Lathing & Siding .� 77. FIXED SYSTEM FINAL `:j _. � 29. Insulation ' 78. FIRE PREV. FINAL ;�•� 30. Drywall Nailing HEALTH DEPT. REQUIREMENT �:. 37. Plaster Brown Coat 79. FINAL INSPECTION • 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED . 33. Fina� Electric Notes: 34. Final Heating & Air Conditioning ! 35. Final Gas Pipe-Test j l 36 �Hood or Canopy � , " 37. Final Factory Fireplace � � . - :, " � r 38. Final Plumbing ,.` �- T- '", i 39. Water Service�Final . _ /%';. � . '. - 40. Gas $ervice-Final � ' ' � � � � 41. Solar pomestic-Final � . - � �, - 42. Backflow Preventer r ; •/ ' . + ' � .' � 43. Backflow Irrigation ' � " � � . 44. Landscape Irriqation System . � � ., , � � ' , � . 45. Sound Attenuation � � �� .% ' • i 46. Handicap Regulations � . • � ' • ,', 47. FINALSTRUCTURE & BUILDING ` ' ��� -i ,� '� -' � ,� . 48: Specia� Requirements Completed '"� ' �, 49. Electric Release to Edison � � Yi 5o. Gas Release to Souther� California Gas Co , 51. CER7IFICATE OF OCCUPANCY -- No Date _ r 1 _ � �. CITY OF COSTA MESA � CON5TRU6TION PERMIT ��v���ant to flll In ali spaces oxceot lhose within neavy e PEqMIT NO. , TRACT NO: Project Address �1 � � �� ���-� � � Applicent's Mailing Addr Ss , � � , Owner'sNama ��• ��'�� Phone- Addreu Arch/Eng. Licenu No. -- Address Contractor'sNam �� i�' hone Addresslma'I'ngl.i��%g N �Z '�� �/�, �'/��03 d� � City License No. LICENSED CONTRACTOR DECLARATION I hereby a/firm tha[ I am Ilcensetl untler prov�slont of Charter 9(commencing -'th saction 7000) ot Dlvision 3 of the Business antl Professlons Cotle, antl Iicenza Is in full fo e ana ef ct. :ense�ciass �'� Lice e Z 2�' q 7� oaceTc y �i c '�— WORKERS' COMPENSATION DECLA ATIOJ I h¢reby afflrm tnat 1 hav¢ a certifiwte ot conp�nt [0 5aH-InSuru or a certlficate of WorkerY Compensation Inmrance, or a cerUfletl coDY �hereof ( ectlon � 3800, Lab. C.) . Policy No. Company eCertlfietl <opy is hereby furnishetl. • �Da[�e I(i iletl with the city B i' tli Applic E%EMPTION FROM WORKERS' CO P NSAT1 N DECLARATION (ThiS sa<tlOn neetl not b¢ completetl i( th permN is for Onn huntlreE (E100) or less) l I certHy that In tha performante of th¢ rk }or which thl erm�[ IS ISSuOtl I shall not emplOy any p¢Ron ar 5 d bP e subject to t�e Workerp, COTPerls� �pn �Si9n r ur lifo a.� Date w �b �� '�t NOTICE: If,�afler making t�is tle arati , you oultl becoma sub7ecl to t�a Workers' Compensation provi5ion f ne W r Cotla, you.must forthwlth comply with suth O�ovislons or perr� t shall bn aeemetl revoke0. CONSTRUCTION LENDING AGENCY I hereby aHirm lhat Mare Is a conSVuction lentling agency�for the performance ot tne work far which this permit is.issuetl (Section 3097 Civ. CJ LenCer's Nama' -- -- l,:ontlor's Atltlress OWNER BUILDER DECLARATION - � hereby affirm t�at 1 am azompt from [be Contractor's Licensa l.aw for lno nllowing reason'(Section 7031.5 Buzinass antl Prolesslonal CoOe: Any Aty or .ounty whi<h roqulras a permll to construct, alteq improve, tlemolish or ropalr env structu�e. o�lot to Il5 ISSudntl. alm �eOuires lhe aoolitant lor such oo�mlt antl tha ba5i5 for tne : any applicant for a not mora lhan tive hun LJ I, as ownor ol tho.propor[y "or my amployees wi[h wagos as tnolr sole componwHon wlll Uo tha work, antl the ztr4cturo is not Intentled or oNeretl for sale (Sec4lon 7044, BuSiness antl Profeuional Cotlo:' T�o Conlractor's Llc¢nse Law tloes not apPly to an owner of a property who bulltls or improves thereon, antl,who tloos,sucn work himzelf/h¢rietl or through his or hnr own emD�oy ees, provitletl t�at such Improvements are,not intentletl or oflareC tor SLIa. I/, howBvO/, Ihe Oulltling or Improvome�� Is soltl wil�ln one yea� of com- platlon, lne owner will have lhe DUrEen ot proving he/iha tlitl nol builtl Or IT- �rove fort�e purposa o}Sal¢�. � I, as owner of Iha property, am eztlusiveiy �ontracting witn Iicanietl con- tractorstd construct tha Orojacl (Sectlon 704{, BuSinasS antl Profeisions CoOe: �The Contractor's lJcensa Law does nOt app�y to an owne� o! p�operty who builOs or Improves thereon, antl who Contra�ts for SUG� pro�e<ts with a con• Vactor(s) Iicensa pursuant [o tne Contractor's L�censa lawl. ❑ I am axemD� undar Sectlon—_ 8. 6 P. C. tor this reason Date Owner' ' 1 hereby cartify that I have reatl thls appll�t�on antl ztata that the abova informatlon it corract. 1 agree [o comO�Y '���h a�l city ana county ortlinances antl�state laws ralatin9 �o builtling constru<t�on, antl hereby authorize raDre- zentatives ol' s clty' t en � upon the above-mantloneO proparty for InSDectlor� u�sr�� � �� . 7._Q— 5(L an0 si9� all appro0riale tleelarations. TYPE OFCONSTRUCTION L1NEW U ADD U ALTERATION IJ REPAIR ❑ CONVERSION ❑ DEMO H❑ OTHER p,p, �6 DESCRIPTION OF WORK � ^ � /� �` � ' �C S Main Building: E TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MEC NICAL � 8 Reaf ❑ �OTHER -�On —[ A � C Right PROJECT DESCRIPTION 5�. FT. � oCCVPA Cv— CONSTRUCTIONTYPE V LUATIONS �3d S Left 20NE GRADING CU. VOS. � ACRES ping. Ref. # avmarks: !/�rf � � Parking Req./Provii Use ot euilding: 3ar Sink 3ackflow Preventer 3ackflow IrrigatiOn � 3athtubs Clarifiers Dishwasher Drinking FOuntains Floor Dreins � Floor Sinks Gas Service Outlets Interceptors " Kitchen Sink Lavatories � P—Trap Roof Drains Reinspection Fee $25 Bailer' � Duct - Under Ground Duct - Stru[mral 0 ExhaustSystem ❑ Multiple Fiiepl/FacL BIL ICBO 41E Heating System & Ducting ❑ 6100,000 BTU �� 100,000 0 Dyl �e V' LI a o 9� � � �7 I I Reinspection Fee �, I $25 MF 0865-46 rev. 12/83 White - Bulltlin9: Wnary - APpllcant; Pink - At<ounting; Goltlenroa - Assessor Showers Service Sink Sewer Cap Sewer Cannection Solar Collectors Solar Piping Solar Tank Swimming Pool wlSpa Urinal Wacer Closet Wa2er Heacer Water Service � Issue Fea Hoodor Typel ❑ Canopy Typell ❑ FEES $ 3 Notes: � � Automatic Washer Construction Pole Sub. Cookin9 Unit Dishwasher Oryers ❑Gas ❑EIeC Fan F.A.U. Fixtures Device Bozes Outlets Garbage 5621 �3/OB/84 Zone Accessory Park.Fees $ �ELECTRICAL � Transformer ❑ 15-50�KV ❑ 50+KW S Meter Dup to 100 emps Meter �over100amps,;, Sub Panel Motors �0.7 HP 01 h- E Int.Solar �9-15 HP �lE � MiCrOwave Pole Light ��; 35.50 TI FEES "� �' ' aign �_. - � Standing Sections � , ,�'� 5-15 KW Trash Compactor ,' � Reinspaction Fee � $y5 �ssue Fee FEES PUBLIC SERVICES REOUIREMENTS: • ZoninB APProved BY • Buildin9'APProved BY t . � Refrigeration System , ❑0-t00,0008TU ❑100,OOO,BTU System Repair/Alteration ' �� Issue Fee �• $ 3 (/p � MARV O F BUILDtNG PERMI�S� PLAN CHECK � $ PLUMBING, ' $ � PLAN CHECK 25% ,$ 1 ELECTRICAL � $ � PLAN CHECK 50% $ � MECHANICAL $ PLAN CHECK 25% �$ O N 1 N G R U 1 R E N E N T 4� � J� � . )Ste �• - - r' .� ES � SMIP ' . g •' �r -?S� . r� PERMIT ' ISSUANCE �; 5 � ; ENERGV P.C: "$� , "' GRADING ; $ � " � � MICROFILM ,$"��� ' �-�j55--- TOTALFEE $� .. _ . _? /-�= C' / _'_' ��'CONSTRUCTION AND PLANN, . OOL & SPA � � � � Date � Inspector - - Date Inspector , APPROVALS Permit # APPROVAIS Permit #� r = 1, Temporary Electrical Service or Pole � 52. Pool & Equipment Location . - �• 2� Soil Pipe-Undrgrnd. � 53. Steel Reinforcement - .. ' � 3. Electrical Conduit Utility-Undrgrnd. � 54. Forms ' ; � . 4. Electrical Conduit-Undrgmd. � 55. Etectrical Bonding -' . - 5. Steel Reinforcement 56, Rough Plumbing'& Pressure Test " � , 6: Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings � ' 56. Electrical Conduit-Undrgrnd.. - � 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. ' 60. Backwash Lines, P-Trap, � Undrgrnd. ' 10. Structural Floor System � 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection � � � 62. Backwash & Receptor-Final . 12. Sewer Cap -63. Heater & Vent-Final � � 13. Roof Drains 64. Plumbing System - Final - ` 14. Rough Plumbing 65. Electrical-Final �� � • ��, 15. Rough Electrical-Conduit 66. Solar System-Final " - � - i 6. Rough Electric Wiring 67. Fencing & Access Approval - . 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING - 18. Rough Electripl-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL , 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ' � ' 20.'RoughFactoryFireplace APPROVALS Permit# 21. Ducts, in Structure 70. Underground HYdro � � � 22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil � ' , .� 23r?Gas Pipe-Rough & Test ` 72. Underground Flush ' 2,�. Roof Framing . 73. Undergrnd. Storage Tank 0 Gas ❑ Oil � 5� Roof Sheathing 74, Overhead Hydro - . 26. T-Bar Ceiling (Structurap & Monocoat 75. Dry Chemical ; ; 27. Frame and Flashing 76. Dry Standpipe � 28. Wthing &$iding 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�lrrigation . � , , � . , � 44. .Landscape Irrigation System - - � ,. , ,� 45. Sound Attenuation " - � � . ' � 46. Handicap�Regulations � , . � � . 47. FINAL STRUCTURE & BUILDING 'K' _ S BU%L / W 48. Special Requirements Completed � � 49. Electrie Release to Edison . 0_' � � 50. Gas Release ro Southem California Gas Co W i � J� �%C 51. CERTIFICATEOF OCCUPANCY • �, , � ��_Q%c�. No. Date _ , � � .. -