HomeMy WebLinkAbout575 19TH ST - Building Permitshft""RES8: 575 W -19TH ST
OWNER'S NAME: LINCOLN PROPERTYCO
ADDBESS: 17011BEACH BL #400
HB CA 92647
•71.4)841-1419
ARCNIENGINEER:` -
ADDRESS:
REG.11
uxIT:CITY'OF COSTA MESA - SIGN PERMIT PERM NO;SB 046541
PERMIT NO: SB 046541 PLAN ,CHECK NO.: 03,1.32-90 S GOVT: :N SUPT?:• N
CONSTRUCTION TY.PE:, PERMIT TYPE: STR,.SIG • PURPOSE: OTH
UNIT:
PERMrrFEE:MARJANEH TABRIZI (714)722-7761
ADDRESS: 575 W 19TH ST
C.M.. 'CA 9262.6 +
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) cf Division 3 of the Business and Professions Code, and my license is in full fora and effect.
CITY LIC.: STATE LIC.: CLASS:
Date: Signature:
WORKERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self -insure or a certificate of Workers'
Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C).
POLICY NO.: EAP. DATE:
COMPANY: '
` Certified co .
ply is hereby furnished., ❑ Certified copy is filed with the dry Building Division. +
Date: Applicam:
I certify that In the performance of the work for which this permit hs_jngW1 shag nate ploy any person in an,ypadher so as to become
subject to the Workers' Compensation Laws pt California.
Date: 1S—`9O / SiOnatu •- a - -
NOTICE: If, offer making this tledaration, you uld he me subject to the Workers' ComDen n provision of the Labor
Code, you must forthwith comply with such provisio or this,permit shall be deemed rev
o
CONSTRUCTION LENDING AGENCY: I hereby affirm t there is a construction lending agency for the performance of the work far
which this permit is issued (Section 3D97, Civ. C),
LENDER:
- ADDRESS:
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason
(Section 7031.5 Business and Professional Code: Any city of cuunfy which requires a permit to construct, alter, improve, demolish, or
repair any structure, prior torts Issuance. also requires the applicant for such permit to file a signed statement that he/she is licensed
pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing wbh Section 7000) of Division 3 of the Business
and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars (3500).
I'
asuctuowner of the property or my empployees with wages as their sole compensation, will do the work, and the
Sirre is not intended or offered for Sale(3emion 7044, Business and Professional Gods: The Contractors' State License Law
does not apply to an owner of a property who builds or improves thereon, and who does such work himself1herself or through
his or her Own employees, provided that such improvements are not intended or offered for sale. IL however the building or
improvement is sold within one year of completion, the owner will have the burden of pruning he/she did not build Or improve
for the purpose of sale).
I, as owner of the property, am exclusive contracting with licensed contractors to construct the project (Section 7044, Business
❑ and Professions Code: The Contactors' State License Law does not apply to an owner of property who builds or improves thereon
and who contracts for such projects with a contractor(s) license pursuant to the Contractors• State License Law). 1 am aware
that proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section: B. S P. C. -
for this reason:
Date -4 -/5 --fa I owner s
1 do hereby certify that I am aware of and understand the requirements of Calif Ila Health and Safety Code Sections] 00. 25533, and
25534 and that I or any future building occupant wiWwill not (circle one) nee o comply with said state codes and th€ requirements for a
permit for construction or modification from the Air uality Managem ¢tract. Residential construction applications are exempt from
thea provisions.
Date: Applicant:
I hereby certify that I have read this application and state that the above information is correct. I agree I comply with all ci} and county
ordinances and state laws relating to building construction and hereby amhorbe re esentatives p this cdy to enter upon the ve-mooned
property for Inspection purposes. 1
Date: �4 I i) Signature: - -�
Driver's License or Social Security x:
164146 White-Bulldinp: Greep—Ccde Enforcement Canary—Applicant Pink—Revenue: Gol mod—Aseaeeor
JOB DESCRIPTION ;'WALL SIGN, SQ -FT:'
CLAIM VALUE: 500.00 CALC—VALUE: ' 500.00 GROUP OCC: B-2` /
COMMENTS:•WALL SIGN
#####If iE%###3f N##IE####k1E%")F#IF#####iF#########if#########if#####IF IF####%fE 1E iE#14,#iF#%IE•iF#1E dF#
S I'G N I N F O R M A T I O N
DIISTRICT: I TY.PE:.GROUND (2) ILLUMINATION: EXT CATEGORY: NEW
DIMENSIONS: 3FT 04IN X 14FT,OOIN AREA: 94.00SQFT LETTER HT: -1-8"
STREET. FRONTAGE 1: 570.00 STREET 1: W 19TH ST
STREET FRONTAGE 2: 566.00 STREET 2: ANAHEIM AV
PARCEL: 42422120 ZONE: R4 LOCATION > FRONT: REAR:
BUSINESS NAME: PARK CENTER PLACE APART. > LEFT: X RIGHT: X•
O T H E R T O T A L S G R O U N D S I G N
THIS ACTIVITY 94.00SQFT OVERALL HEIGHT: 5FT OIN
THIS SITE ..94.00SQFT GROUND CLEARANCE:-:- OFT. - OIN -
ITEMS OF INFO 1 PLANTER AREA: 100.= SQFT
ITEMS FOR ACTIVITY: 1 BLDG SET BACK: 20FT
COPY VERBIAGE PARK CENTER -PLACE APARTMENTS
+
PLANNING NOTES: TWO IDENTICAL SIGNS
D E V E L O+ P M E N T S E R y�jI C E S R E Q U 1,R E M E N'T-S q
ZONING APPROVED BY _ 1� 1 DATE:.
BUILDING 'APPROVED BY _ _ DATE:
APPLICATION ISSUED BY: DATE:
LEGALIZATION -N F E E S U',M M A R Y STRUCTURAL SEGMENT:Y
BLDG'PMT PLUMBING -.ELECTRIC MECHANIC SIGN SMIP/RES , GRADING
PERMIT 15,00 94.00
SMIP/NON-RES
PLAN 9.75 .50
ISSUE FEE
BUILDING—DIV--> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS'----> 109.50 " 0.00 9.75 119.25' 119.25 .00
REVENUE DIVISION TOTALS---> COLLECTED: 119.25' OVER/SHORT: 00
BLDG PMT PLUMBING ELECTRIC MECHANIC SIGN SMTP/TOT GRADING PLAN—CHECK
1.5.00 94.00 1 .50 9.75
I N D I V I D U A L F E E B R F- A K D O W N
TYPE -QTY D E'S C R I P T I O N UNIT COST TOTAL COSI'
NO FEES WERE SELECTED FOR THIS PERMIT
S
�5 f cae-0--,
01 00056209-00056212 T Q T
DATE: 03/15/90 TIME: 16:27
119.25
CONSTRUCTION AND PLANNING
• Date
APPROVALS . Permiri#
Inspector
- POC ;PA
APPROVALS Permit #
.Date
Inspector
1. TemporaryElectrical Service or Pole
52. Pool & Equipment Location
.2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
' :3.=Electrical Conduit Utility-Undrgrnd.
54. Forms
' 'A. Eiectrical Conduit-Undrgrnd.
55. Electrical Bonding
S�aSteel Reinforcement
56. Rough Plumbing & Pressure Test
_
6r*ElectiicalUFER-Grind.
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.•
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 .1
'
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
'APP.ROVALS • Permit #
20. Rough Factory Fireplaces -. , -
21c Ducts, in Structure -
70.' Underground Hydro_: -
22.- Ducts, Ventilating
71.- Product Piping CGas ❑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)-&"Monocoai
75: Dry Chemical
27. Frame and Flashing
r
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
397 Water Service -Final
_ 40.'Gas Service -Final
41: Solar Domestic -Final
42. Backflow Preventer
43. Backflow Irrigation
-
^44. Landscape Irrigation System ••
- -
45. Sound Attenuation
_•46. Handicap Regulations •. -
�• ,.
_•,47. FINAL STRUCTURE &,BUILDING
48:'FINAL PLANNING
r� -
49. Electric Release to,Edison
•> ? �- - .-
50. Gas Release to Southern California Gas Co
i 51. CERTIFICATE OF OCCUPANCY
No. Date
_ Applicant to fill In all spaces except those Within heavy border lines and sign all appropriate declarations.
PERMIT NO. TRACT NO. LOT NO. ., UNIT Nn
CITY OF COSTA MESA CONSTRUCTION PERMIT S 3 %l 7 74/I
Project Address —5J
Applicant's Mailing Address 101 LINCOLN CENTRE DR MMCA TYPE OF CONSTRUCTION I 1 NEw 1 1 ADD
P Owner's Name PRMC / LINCOLN PR__ 0PERTY phone 645-2816 ❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG. —
Address-`Z5_h_19TH ST. LUN 18 MF4A
Arch/Eng. C.RAJ —COMBS ASSOCIATFSicenserNo. 38951
Address 1..511_MONROVTA AVF N_R_
J Contractor's Name__P_BMC Phone 645-2916
Addrew(mailing) 575 W 19TH ST- C -M_ '92626
1, City License No. 38951 (STATE LICENSE /1299124)
7 LICENSED CONTRACTOR DECLARATION
I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing
with section 7000) of Divi Sion 3 of the Business and Professions Code, and
my license is in fuforce and effect.
Ucensa, plass 9 Li S�Pse Nn�f 2-99-1-24
O Oat® `/'3— � Signature
'y WORKERS' COMPENSATION DECLARATION
•reby affirm that I have a certificate of consent to self -Insure or a Certificate
Workers' Compensation Insurance, or a r I t er f ctio
.00, La PSi1 2754956 , f� �-� £ ��S XOT
ePolity N panaYl'�p1�1.CIy�p��_es�I.s. vrinK
Cerrtdi tl co RyT is filetl with the city B Ildin ,tDip} Iysui L.� I�tLW s Vsa
Date/—d' / Avpncant N/ /% ClQ� P
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section need not be Completed if the permit Is for One hundred ($100) or
less).
1 comity that In the performance of the work for which this permit is Issued 1
Shall not employ any person Inany man r so as to ecome subject to lite
Worker Co p nsation Laws of Ca li torn
Date Signature
NOTIC : If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of the work_=for which this permit i$ issued (Section 3097 Civ. C.)
Lender's Name
Lender's Address -
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason, (Section 7031.5 Business and Professional Code; Any city or
county which requires a permit to construct, alter, improve, demolish or repair
any structure, prior to its issuance, also requires the applicant for Such permit
to file a signed Statement that he/she Is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
„vision 3 of the Business and Professions Code) or that he/she is exempt
irefrom and the basis for the alleged exemption. Any violation of Section
31.5 by any applicant for a permit subjects the applicant to a civil
enoity of not more than five hundred dollars ($500).
I, as owner of the property or my employees With wages as their sole
Compensation will do the work, and the structure is not intended or offered
for Sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property Who builds or improves
thereon, and who does such work himself/herself orthrough his Or her own
employees, Provided that such improvements are not Intended or offered for
safe, If, however, the building or Improvement is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or Im.
Drove for the purpose of Salo).
❑ 1, as owner Of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044, Business and Professions Code;
The
Contractor's License Law does not apply to an owner of property who
buil
ds or Improves thereon, and who contracts for such projects with a con-
tractors) license pursuant to the Contractor's License Law). I am aware that
proof of their Worker's Compensation insurance Should be Provided to me.
❑ 1 am exempt under Section B. & P. C. for this reason
Data
Owner
ALTERATION LJ REPAIR
TYPE OF PERMIT LJ GRADING LJ FOUNDATION IJ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SO. FT. OCCUP9�NCY—
CON STRUCTION TYPE VALUATIONS 460,
ZONE GRAOINGCU.YDS. ACRES_
Remarks:
Sink
fit -Lis
Preventer
Irrigation
rinking Fountains
loor Drains
loor Sinks
as Service Outlets
Sink
Roof Drains
Reinspection Fee 1 $15
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact Bit. ICBO #
Heating System & Ducting
hereby certify that I have read this application and State that the above ❑0-100,000 BTU C1 100,000 B1
Information is correct. 1 agree to comply With -it city and county ordinances
and state laws relating to building construction, and hereby authorize repro.
sentatives of t is City to enter upon the above-mentioned property for
Inspect Ion pur ses.` n
Signature pa[ �O
Drivers' License or 55 # Reinspection Fee $15
CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink . Accounting; Goldenrod - Assessor
A.P. # q
2 11
S
I Main Building:
E
T
Front
D! 1
B
A
Rear
C
Right
ELECTRICAL
SLeft
N
O!
Ping.
Ref. #
TOLD FOR SPECiA
Planninq Notes: 5
9462 II/13/B7 103.62 TL
—01 -
�. K /Cf I Zone
Accessory Building:
-) .
4b1.45
G
N
ELECTRICAL
FEES
N
G
R
TOLD FOR SPECiA
ed
E
O
OCOZ WaAR-
J1
.Tl! /$L awed_
M
T rO1 • /VLGt Co
S
)MBING
FEES
-) .
Showers
ELECTRICAL
FEES
Service Sink
Automatic Washer
Construction Pole Sub.
Transformer ❑ 15.50 KW
❑ 50+ KW
Sewer Cap -
Sewer Connection
Cooking Unit
Meter ❑up to 100 amps
Solar Collectors
Dishwasher
Meter Cover 100 amps
Solar Piping
Dryers ❑Gas ❑Electric
Sub Panel
Solar Tank
Fan
Motors 1-101 HP OVA - 8
Swimming Pool w/Spa
F.A.U.
Inc. Solar 119-15 HP 016-15+
Urinal
Fixtures
Microwave
Water Closet
Device Boxes
Pole Light
Water Heater
Outlets
Range
Water Service
Switches
Sign
Auto -Wash
Garbage Disposal
Standing Sections
Laundry Trays
Generator ❑05 KW 05-15 KW
Trash Compactor
Issue Fee
$ 3
Reinspection Fee
$15
Issue Fee
$ 3
iANICAL
FEES
DEVELOPMENT SERVICES REQjJ�Fj�Jy1ENTS:
Approved By �Y�,�'r
Building Approved ByDate------�}�--1��--���a1�--
Application Issued By
Date
- Dat
3
r
lel
Hood or Types ❑
Canopy Type ll C3Zoning
Refrigeration System
00100,000 BTU 0100,00OBTU
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
SUMMARY
$
$
$
$
$
$
$
$
QF FEES
O SMTP $
PERMIT
ISSUANCE $
ENERGY P.C. $
GRADING S
MICROFILM $
TOTALFEE $,
a Sb
J
�Z
'
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
$ 3
CONSTRUCTION AND PLANNING
APPROVALS Permit#
Date
Inspector
POOL & SPA
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-Un&grnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings 1•.
58. Electrical Conduit-Undrgrnd.
8. Foundation
-
59. Gas Pipe, 0 Undrgrnd., Test,
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, 0 Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK ,
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
64. Plumbing System • Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT '-
APPROVALS Permit # -
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
'
22. Ducts, Ventilating
71. Product Piping 0Gas 0Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank 0 Gas 0 Oil
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes: HOLD'.FOR'SPE%AL t(nttuli(Irry���� y
34. Final Heating & Aii Conditioning
35. Final Gas Pipe -Test
36. Hood or Canopy
37. Final Factory Fireplace
38'. Final Plumbing
39. Water Service -Final
_.... '
40. Gas Service -Final
'41. Solar Domestic -Final
42. Backflow Preventer
k 43. Backflow Irrigation
- -
44. Landscape Irrigation System
,145: Sound Attenuation
' 46 Handicap Regulations
47•..FINAL STRUCTURE & BUILDING
y a�
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF�COSTA �IESA CONST IUCTION PERMIT /q
Pict A dress
Applicant's Mailin Address '
Owner's Name 1-I hone �OLiJr-o�I�e
Address
Arch/Eng. - License No. '
Address
- Contractor's Nam -17V r Phone �-1
a 1'7
Address (mailing) 392a r�rS Idi11t-A40.0ALLI'ut-
CityLicenseNn �ISL19 f
LICENSED CONTRACTOR DECLARATION
I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in 1 I ore 44 effect. �:�
License Cla s .7L.�'f4 License No.
Date Signature
WORKERS' COMPENSATION DECLARATION
ereby affirm that I have a certificate of consent to sell -Insure or a certificate
Workers' Compensation Insurance, or a certified copy thereof (Section
.a 00, Lab. C ����M�y����
Policy No. 1M�K+IVO-R.��1CompanyCer�r�slls-+'OriLl)�(e..
Certifiedd COPY Is Is helrebyed fu nishedthe oilYy(psy Ir�I OW Qioy
Date.-. Applicant /.o%,f�Cl..�-s l'R L�L�-�?�J
EXEMPTION. FROM WORKERS' COMPENSATION DECLARATION
(Thissectlon need not be completed if the permit is for one hundred (5100) or
less).
I certify that in the performance of the work for which this Permit is issued I
shall not employ any person in any manner so as to become Subject to tete
Workers' Combensatlon laws of California.
Date Signature
'NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Cotle, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is Issued (Section 3097 Civ. C.)
Lender's Name
Lender's Address
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, improve, dem Olish or repair
any structure, prior to Its issuance, also requires the applicant for such permit
to file a signed statement that he/she Is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9.(commencing with Section 7000) of
''vision 3 of the Business and Professions Code) or that he/She is exempt
!refrom and the basis for the alleged exemption. Any violation of Section
31.5 by any applicant for a permit subjects the applicant to a civil
Banally of not more than five hundred dollars ($500).
' I, as Owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure is not Intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or improves
thereon, and Who does such work himself/herSelf or through his or her own
employees, Provided that such improvements are not Intended or offered for
Sale. If, however, the building or Improvement Is Sold within one year of com-
pletion, the owner will have the burden Of proving he/she did not build or Im-
prove for the purpose of sale).
D I, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the Project (Section 7044, Business and Professions Code:
The Contract Or's License Law does not apply to an Owner of property who
builds or ImproveS thereon, and who contracts for such projects with a con-
tractor(SI lion w pursuant to the Contractor's License Law). I am aware that
proof o their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section B. 6 P. C. for this reason
Date Owner
I hereby certify that I have rea,
information is correct. I a9r t
and stale laws relating to u I
sentativesQQI his cit n r
inspection RUI6ezes.� Y711
1M
Drivers' License or SS cir
the above
'l vtlinances
eereore-
oerly for
TYPE OF CONSTRUCTION ^NEWT --SIJ ADD LJ ALTERATION LJ REPAIR .
❑ CONVERSION 1-1DEMOLISH ❑ OTHER
-DESCR`PTION OF W`O^R��C/USE OFF B-L�}G. S �Clr O: ID M
Q( `'Y'Y� ✓x-C.L,Cr �fCT�]IT (i�y?C77�1,rs•�•n�S—!_���
A P. �jS -
'. Zone
S
Main Building: - AccessorYBuilding:
Z
TYPE OF PERMIj GRADING LJ FOVNDATIDN 5T UCTU RAL
1❑I TENANT RWl ELECTRICAL � PLUMBING ❑ MECHANICAL
O -OTHER
T
Front -
O
B
Rear -
N'
A
C
Right
N
G
PROJECT DESCRIPTION SG. FT. OCCUPANCY��=
CONSTRUCTION TYPE VALUATION $)s_-,uJ
ZONE GRADING CU. YDS. ACRES
K
S
Left
-
R
Ping. Ref. Parking Req./Provided
E
O
Remarks: ^
Planning Notes:
M
o -C) 'F
S
PLUMBING
FEES
Bar Sink
Showers
ELECTRICAL
FEES
Backflow Preventer
Service Sink
Automatic Washer
Construction Pole Sub.
Transformer D 15-50 KW
11 50+ - KW
Backflow Irrigation Sewer Cap
Bathtubs
Sewer Connection
Cooking Unit
Meter ❑up to 100 amps
Clarifiers _
Solar Collectors -
Dishwasher
Meter Dover 100 amps
'
Dishwasher
Solar Piping $ g't
_
Dryers DGas ❑Electric
Sub Panel
Drinking Fountains
Solar Tank
Fan
1. Motors 00.1 HP V1$' -B
Floor Drains
Swimming Pool w/Spa
F.A.U.
Inc. Solar 09-15 HP 016.15+
Floor Sinks -
Urinal
Fixtures
_ - Microwave
Gas Service ,_Outlets
'Water Closet
Device Boxes
Pole Light
Interceptors
Water Heater
Outlets
Range
Kitchen Sink
Water Service
-
Switches
Sign
Lavatories
Auto -Wash
Garbage Disposal
! Standing Sections
P -Trap
Laundry Trays
Generator 130-5 KW 05-15 KW Trash Compactor
Roof Drains
.
Reinspection Fee
$15
Issue Fee
$ 3
Reinspection Fee
$15 Issue Foe
$ 3
' MECHANICAL
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By Date
ata
Building Approved By Data—
Application Issued By
Boiler Hood or Typal ❑
Canopy Type I I ❑ -
Duct - Under Ground
Duct - Structural
Duct
Duct -Ventilating
Refrigeration System
DO-100,0,00,gfu 0100,0006TU
SUMMARY OF FEES
.
BUILDING PERMIT :2 SMTP $MIT
PLAN CHECK $ ISS
PLUMBING $ (,.00 ISS $
Z ENERGY P.C. $
PLAN CHECK 25% $ !!��,, '�,-��n((,,JJ
ELECTRICAL $ GRADING $
PLAN CHECK 50% $ MICROFILM $
MECHANICAL $ TOTAL FEE $
PLAN CHECK 25% $
z• �s
29112-0
Exhaust System ❑ Multiple D Syst Repair/Alteration
F irepl/Fact. Bit, iCBO # Fire Dampers
Heating System & Ducting Registers
00-100,000 BTU ❑100 BT
I
Reinspection Fee
$15 Issue Fee
$ 3
CMF 0865-46, rev. 10/84 White - Buil ng; ana y APPlicanl; Pink - Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING
ANPROVALS Permit# Date
Inspector
POO 'PA
APPROVALS Permit #
Date
Inspector
'i /Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, 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
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas 0Oil
23. Gas Pipe -Rough.& Test
l
.i _
72. Underground Flush
24. Roof Framing -
73. Undergrnd. Storage Tank 0Gas ❑Oil
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final/
'
42. Backflow Preventer
,
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
�� 3
48. Special Requirements Completed
49. Electric Release to Edison
-
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
CITY OF COSTA MESA- CONSTF
Project Address 57,S'W
ant's Mailipg Address
' ner'sNa``mIe�,, F�FNeO�N��r
Address -F
PERMIT
No.
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
-PERMIT NO _ TRACTO. LOT NO. UNIT NO. 860C F�.j ri�� 'r'f
!/C C i-/2'A,g, . ,-
TYPE OF CONSTRUCTION NEW LJ ADD 1 ALTERATION REPAIR •��I^• - '
❑CONVERSION ❑ DEMOLISH 1:1OTHER A.P. # 0V 2 — a/..` Q if Zone
DESCRIPTION OF WORK/USE OF BLDG.
vtilTE �O-�L� t✓( i'P7ir S Main Building:Accessory Building:
TYPE OF PERMIT
.�tt��GRADING FOU DATI J_N STRUCTURAL' T Front r _ ' Q'�"+•-�.
'❑ R1
TENANT ELECTRICAL N PLUMBING7LC MECHANICAL rl B Rear '` s Y- 2.2 y 2 'IO bf
❑ OTHER j' A
- PROJECT DESCRIPTION SQ. FT _ OCCUPANCY C Right '('0
/ t
CONSTRUCTION TYPE VALUATIONS �i; d-� $ Left 4o
ZONE- GRADING CU. Vow ACRES Ping. Ref. # Parking Req./Provided •��
Remarks: G, ea N1Ve PDD L, wvfla- &W Planning Notes: - /DfTht !2� Sir — ,� /1n..xt137C
Address-
(� n
Contractor's Name_f'1LgNI�� r..d /v' 1 Ph°n�/
q S9,7
Address (mailing) o f S rr a-f-��
City License No. 417. V ZA4
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I- am licensed under provisions of Charter 9 (commencing
with section 7000) of Division of the Business and Professions Code, and
my license is in full ! 41 e ./f� '�1 81-C _z_ License Clajs J Lice s No.`s 7
DatA '`l— signature
a�
s, WORKERS' COMPENSATION DECLARATION
`\ 1 hereby affirm that I have a certificate of consent to self -Insure or a certificate
r< of Workers' Compensation Insurance, or a certified copy thereof ((Section
W� '°00, Lab. 77-A �� �li/vi.a
icy No. ompanY �—
Certified copy is hereby furnished.
U Certifiedpy�L'Ly led with the city it I Dl
covl
Date��I "D/ Applicant
EXEMPTION FROM.WORKERS' CO E SATION DECLARATIO
(This section need not be completed if the permit Is for One hundred (l ) or
less).
I Certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
Date Signature
NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you most forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.)
Lender's Name
Lender's Address -
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business And Professional Code: Any city or
County which requires a permit to construct, alter, improve, demolish or repair
any structure, prior to Its Issuance, also requires the applicant for such Permit
to file a signed statement that he/she is licensed pursuant t0 the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 Of the Business and Professions Cotle) or that he/she is exempt
therefrom and the basis for the alleged exemption. Any vi OlatiOn of Section
7031.5 by any applicant for a permit 4ubjects the applicant to a civil
,fly o1 not more than five hundred dollars ($500).
as owner of the property or my employees with wages as their sole
.pen cation, will do the work, and the structure is not intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or improves
[hare0 n, and who tloes Such work himself/herself or through his or her own
employees, Provl ded that such imProve men is are not in'ended or ofieretl for
sale: If, however, the building or improvement is soltl within one year of com-
pletion, the owner will have the burtlen of Proving he/she ditl not builtl or im-
prove for the our po se of sale).
❑ I, As Owner of the property, am exclusively contracting with Iicense, con-
tractors to construct the project (Section 7044. Business and Prot essi o ns Cotle:
The Contractor's License Law tloes not apply t0 an owner of pro perty who
builds or improves thereon, antl who contracts for such projects with a con-
tractors "cense pursuant to the Contractor's Ll Ce rise Law). I Am aware that
proof of their Worker's Compensation Insurance shoultl be Provided to me.
❑ I am exempt under Section B. & P. C. for this reason
Date
I hereby certify tha
Information is cprrec
and state laws relath
same
'Yet O IS ci
In speCtion r se
Signature
Drivers' Uc rise or 5:
CMF 0865.46, rev. 10/84
Owner
the a
Bar Sink,
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Dish Washer
Drinking Fountains
Floor Drains
Floor Sinks
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fee $15
Boiler
Duct- Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Bit. ICBG #
Heating System & Ducting
2 ❑0.100,000 BTU 5a100,000 e
Reinspection Fee 1 $15
White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spy
Urinal
Water Closet
Water Heater
Water Service
Auto -Wash
Issue Fee
AANICAL
Hood or Type 1 ❑
Canopy Type 11 ❑
Refrigeration System
00-1000 FU 0100,000
Sy n Repair/Alteration
ire Dampers
Registers
Issue Fee
ES
Z
O
N
I
N
G
R
E
Q
M
T
S
ELECTRICAL FEES
Automatic Washer
Construction Pole Sub.
Transformer ❑ 15-50 KIN
I] 50 + KW
Cooking Unit
Meter ❑up to 100 amps
Dishwasher
Meter Dover 100 amps
Dryers ❑Gas ❑Electric
Sub Panel
Fan
Motors m0-1 HP CL1 X - 8
F.A.U.
Inc. Solar 09-15 HP El 16-15+
Fixtures
Microwave
Device Boxes
Pole Light
1 Outlets
Range
3 Switches
Sign
Garbage Disposal
Standing Sections
Generator 00-5 KW 05.15 KW
Trash Compactor
$31
1
Reinspection Fee
$15 Issue Fee
FEES
DEVELOPMENT SERVICES
Zoning Approved By
Building Approved By
Application Issued -By
REQUIREMENTS:
Date
Date
Data
-
• BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
SUMMARY OF
$ A L(j -
$ TI •
$ISSUANCE
$ r T
$
$
$
$
ES
SMIP
PERMIT
ENERGY P.C.
GRADING
MICROFILM
TOTAL FEE
$
$
$
$
$
$.
_
-
$ 3
S 3
CONSTRUCTION AND PLANNING
' !
APPROVALS Permit #
Date
Inspector
POOL &SPA
APPROVALS Permit #
Date
Inspector
1-,T,emporary 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 Grni .
57' APPROVAL TO COVER-GUNITE
y
7. Footing`s ` -
58. Electrical Conduit-Undrgrnd. _
B. F66ndation --
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd..
60. Backwash Lines, P -Trap; 0 Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK'
+b'�
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
`
12. Sewer Cap
63. Heater & Vent -Final r
13. Roof Drains
64. Plumbing System - Final
1
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67. Fericirig & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
-�
19. Rough Heating & Air Conditioning
FIRE DEPT, REQUIREMENT
APPROVALS Permit
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas 0Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank OGas ❑Oil
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monccoat
75. Dry. Chemical
27. Frameand'Flashing
76. Dry:Standpipe
28. Lathing & Siding •
-
77. 'FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREY. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT:y•,
31. Plaster Brown Coat
79. FINAL INSPECTION
-
32. Electrical Power Meter -Final
r
80. FOOD CERTIFICATE ISSUED
•�
33. FinalElectric-
Notes: {D)FOR-77,71L
it,
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
='
36. Hood or Canopy
37. Final Factory Fireplace
'
38. Final Plumbing
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
43. Backflow Irrigation
--
r.
44. Landscape Irrigation System
- �,•
45. Sound Attenuation
46. Handicap Regulations
,• -• .'
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
M"
!Z Ir
•r ,' /
r
49 Electric Release to Edison
r )
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANC`
No. Date
��
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CONSTRUCTI N PERMIT PEWIT NO. / TRACT NO. LOT NO. UNIT NO.
Project Address .-575 W- /f%?7" zJ„
Ffpplicant's Mailing Address 16,/0r*Z-� L�pa
Owner's Nerme 4.0/e'X. / PY-4—e u Phone %i� — Tz 1
Address�6i5L 8r�➢�1r ?,�/O �✓/Qi laid B' [CCi.Y?— •�sJOG5( 91
Arch/Eng. License No.
Address
Contractor's Nam _ h C- - Phone��r%/—Z2��
Address(mailing)�r—� �0/ �7,,C (.T:.IJ i'•
City License No� r✓�'- tis'
LICENSED CONTRACTOR DECLARATION
1 hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) -of Division 3 of the Business and Professions Code, and
my license is in full force and effect. q q
License Class License No. 7- / ! f iL
Date Signature
WORKERS' COMPENSATION DECLARATION
hereby affirm that I have a certificate of consent to self -Insure or a certificate
Workers' Compensation Insurance, or a certified copy thereof (Section
.00, Lab. C.)
Policy No. Company
HCertifiid copy is hereby furnished.
Certified copy Is filed with the city Building Division.
Date Applicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thissecllon need not be completed if the permit is for one hundred (5300) or
less).
certify that in the performance of the work for which this permit B issued I
shall net a ploy ahy person in any manner so d5 [ tse subject to the
Workers' ion Laws of California _ ��
DatO Signature
NOTICE: If, after making this declaration, you shout become subject to the
Workers' Compen sat ion.,.pro visionsOf the Labor Cotle, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.)
Lender's Name
Lender's Address
OWNER BUILDER DECLARATION
I hereby affirm that -I am exempt from the Contractor's License Law for the
following reason (Sectlon 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, improve, demolish or repair
any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
'Division 3 of the Business and Professions Code) or that he/she is exempt
•refrom and the basis for the alleged exemption. Any violation of Section
31.5 by any applicant for a permit subjects the applicant to a civil
.laity of not more than five hundred dollars ($500).
L] 1, as owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure is not Intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law doesnot apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such improvements are not Intended or offered for
sale. If, however, the building or improvement Is sold within one year of com.
plet On, the owner will have the burden of proving he/she did not build or im.
r e for the purpose of sale).
.I, as owner of the property, am exclusively contracting with licensed con.
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License taw does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a•con.
tractor(s) license pursuant to the Contractor's License Law). I am aware that
proof o their_Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section q.7. C. for this reason
Date
inspection purposes.
Signature ' R
Drivers' Llcense or S;
CMF 0865-46, rev. 10/84
- Owner _.X gz L �,
have read this application and state that the above
agree to comply with all city and county ordlnances
o building construction; and hereby authorize repre-
tienter t the above-mentioned property for
2306 8/29/86 18.00 'TL
r
YPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR
PLUMBING
FEES
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
A.P.
Zona _
7•. DESCRIPTION OF WORK/USE OF BLDG.
•
S
Main Building:
Accessory Building:
Showers -
FOUNDATION STRUCTURAL
TYPE OF PERMIT GRADING 1-1T
E
Front
ELECTRICAL
Z
D
ENANT El ELECTRICAL ❑ PLUMBING 1-1MECHANICALB
Service Sink -
N
�❑
THER� Qr /flLC E}�/377�(9 1w j a1!ZjW ..S
A
Rear
_
I
PROJECT DESCRIPTION SO. FT. ✓eC7— T/r~OCCUPAN Y
�T---
K
Right.
I
N
G
CONSTRUCTION TYPE VALUATIONS ,f'FiiJll
S
Left
Clarifiers
R
ZONE - GRADING CU.YOS. ACRES
Ping. Ref. #
Parking Req./Provided (
E
Meter ❑over 100 amps
_
Dishwasher ' -
Solar Piping
Remarks: i
Planning Notes:
Dryers ❑Gas ❑Electric
M
Drinking Fountains
Solar Tank
T
Fan
S
White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor_
PLUMBING
FEES
t-
BarSink '
Showers -
_
ELECTRICAL
FEES
Backflow Preventer
Service Sink -
Automatic Washer
Construction Poli Sub.
Transformer ❑ 15-50 KW
- - ❑ 50+KW,
Backflow Irrigation Sewer Cap
Bathtubs
Sewer Connection
Cooking Unit
Meter. ❑up to 100 amps
'
Clarifiers
Solar Collectors
Dishwasher
Meter ❑over 100 amps
_
Dishwasher ' -
Solar Piping
Dryers ❑Gas ❑Electric
Sub Panel -_
Drinking Fountains
Solar Tank
Fan
Motors 00-I HPEll X-8
Floor Drains
Swimming Pool w/Spa
F.A.U.
Inc.Solar ❑9-15 HP 1116-15+
Floor Sinks -
Urinal
i
ixtures
Microwave
Gas Service Outlets
Water Closet
Device Boxes
Pole Light
Interceptors
Water Heater
Outlets
Range
Kitchen Sink - -
Water Service '-- -
Switches -
Sign -
Lavatories
Auto -Wash
-
Garbage Disposal
Standing Sections
P—Trap
Laundry Trays
Generator 00-5 KW❑5-15 KW
Trash Compactor
Roof Drains
Reinspection Fee $15
Issue Fee
$ 3
Reinspection Fee
• $15
Issue Fee -
$ 3
MECHANICAL
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
Approved By Date
Building
Building Approved ByDate
Application Issued By - nai
Boiler
Hood or Type I ❑
Canopy Type I I El
Duct - Under Ground
Duct - Structural
Refrigeration System
130.100,000 BTU 0100,000BTU
Duct - Ventilating
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK .50%
MECHANICAL
PLAN CHECK •'25%
SUMM/
$ t!
S
$
$ -
$
$
$
$ -
p/Ry�p/F� FEES
�Z SMIP _ $
PERMIT
ISSUANCE
ENERGY P.Cr $
GRADING - $ -
MICROFILM- $ �Q /1/J�
TOTAL FEE $ _1 X6
Exhaust System ❑ Multiple 1:1
System Repair/Alteration
Firepl/Fact. Bit. ICED #
Fire Dampers
Heating System System & Ducting -
00.100,000 BTU 1:1100,000 BT
Registers
-
_
Reinspection Fee $15
Issue Fee -
$.3
White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor_
CONSTRUCTION AND PLANNING
APPROVALS Permit
Date
Inspector
POOL &SPA
APPROVALS Permit#
Date
Inspector
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-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing-& Pressure Test
6. Electrical UFER Grnd.
57. APPROVAL TO COVER-GUNITE
o,
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. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
-
16. Rough Electric Wiring
67. Fencing & Access Approval'
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit # _
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
'
22. Ducts, Ventilating
71. Product Piping ❑Gas ❑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 Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
"
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes:
34. Final Heating & Air Conditioning
.•
35. Final Gas Pipe -Test
• • ''
36. Hood or Canopy
-
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
"
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Cc
-
r
51. CERTIFICATE OF OCCUPANCY
No. Date
t4
CITYUF'COSTAMESA CONSTRUCTION PERMIT
Project Address S%Jr W q
Applicant's Mailing Address 67-7 ..SG7jipOL ..S—
Owner's Namer ZA/Ar � Pho es3'7�2
Address
Arch/Eng. License No.
Address
Contractor'sNama .TB EIEGTi28- P_nej3z-/X"
License
I hereby affirm that 1 am licensed under provisions of Charter 9. (commencing
^ with section 7000) of Division 3 of the Business and Professions Code, and
4.' my license is in full force and effect.
Licari lass 01 O Lice
Date - S"9nature =s�t
I WORKERS' COMPENSATION DE LARATIONP
hereby affirm that I have a certificate of consent to self -Insure or a certificate
Workerss'Compenlsation Insurance, or a certified copy thereof (Section
1
tamdotlNSATrbN
C s aJ �J �o%Com ny ishereby furnished.�s tiled witM1 the citDivisi
ApnlicanOM WORKERS' COMENSAT ON DECLARATION
(This section need not be Completed if t e permit is for one hundred ($100) or
less).
1 certify that in the performance of the work for which this Permit is issued. 1
Shall not employ any person in any manner so as to become Subject to the
Workers' Compensation Laws of California.
Date Sighature
NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit Shall be deemed revoked.
\ CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a construction lending agency for the performance
y of the work for which this permit IS issued (Section 3097 Civ. C.)
Lender's Name
Lender's Address
Q OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
fallowing reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, improve, demolish or repair
any structure, prior to Its issuance, also requires the applicant for Such permit
to file a signed statement that he/she is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/She is exempt -
'lerefrom and the basis for the alleged exemption. Any violation of Section
)31.5 by any applicant for a permit subjects the applicant to a civil
enalty of not more than five hundred dollars ($500).
❑ I, as owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure is not Intended or offered
for sale (Section 7044, BusinesS and Professional Code: The Contractor's
Licen Se Law does not apply to an owner of a property who bulldS or Improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such improvements are not intended or Offered for
Sale. If, however, the building or Improvement is Sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or im-
prOve for the POIPOSO of sale),
❑ I, as owner of the property, am exclusively contracting with licensed can -
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License I_Ow does not apply to an owner Of property who
builds or Improves thereon, And who contracts for such projects with a con.
tractor(S) license pursuant to the Contractor's License Law). I am aware that
proof of their Worker's Compensation Insurance should be provided to me.
❑ 1 am exempt under Section_B. b P. C. for this reason
Cr
Date
ihereby certify tha
nformation is correc
and
state laws it
sentatives of ci
inspection
Signature
Drivers' Llce se or S:
IF 0865-46, rev. 10/84
. Owner
have read this application and state that the above
afire@ to comply with all city and county Ordinances
I b Itling construction, and hereby authorize repre-
[O ter upon the above-mentloneAProperty
for
�( Dated
to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
TYPE OF CONSTRUCTION .I9!!kNEW LJ ADD LJ ALTERATION LJ REPAIR
[:]—CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
SUMMARY OF FEES
BUILDING PERMIT
$
A.P. qµ, Zp
PLAN CHECK
S
Main Building: Accessorydl
PLUMBING
TYPE OF PERMIT q� GRADING FOUNDATION STRUCTURAL
'❑ T.ENANT 114 ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SQ. FT. OCCUPANCY
CONSTRUCTION TYPE VALUATION 5
ZorvE GRADING CV. VOS. ACRES
T
Front
$
ENERGY P.C.
0
B
A
Rear
N
C
Right F
N
K
S
Left
G
R
Ping. Ref. 0 Parking Req./Provided
E
Remarki:
Planning Notes:
e,M
Q
R
JUS
APR iECMLU
T
S
y PLUMBING
FEES
EI2
ter -
FEES
Bar Sink Showers
Backflow Preventer Service Sink
utomatic Washer
Construction Pole Sub.
Transformer ❑ 15-50 KW
1150+KW
Backflow Irrigation Sewer Cap
Bathtubs Sewer Connection
'Cooking Unit -
Meter ❑up to 100 amps
Clarifiers Solar Collectors
'Dishwasher
Meter ❑over 100 amps
Dishwasher Solar Piping
... -Divers ❑Gas ❑Electric ,'Sub
Panel
Drinking Fountains Solar Tank
'Fan
Motors 00.1 HP ❑ 1'h - 8
Floor Drains Swimming Pool w/Spa
•F:A.U.
Inc. Solar 09-15 HP ❑16-15+
Floor Sinks Urinal
` Fixtures
Microwave
Gas Service - Outlets Water Closet
' Device Boxes
Pole Light
Interceptors Water Heater
v'Outlets
Range
Kitchen Sink Water Service
/'Switches
Sign
Lavatories Auto -Wash
- Garbage Disposal
Standing Sections
P -Trap Laundry Trays
Generator 0-.' KW ❑5-15 KW
{❑
Trash Compactor
Roof Drains
opeurikuPJ19
to
O
D,
•
�J
Reinspection Fee
$15 Issue Fee
S 3
Reinspection Fee
$15
Issue Fee -S
3
MECHANICAL
FEES
Duct- Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Bit. ICBG #
Heating System & Oucting
❑0.100,000 BTU ❑ 100,000 BTi
Reinspection Fee 1 $15
White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
Hood or Type ❑
Canopy Typell ❑
Refrigeration System
00-100,000BTU 0100,000BTU
System Repair
Fire Dampers
Registers
Issue Fee - 1 $ 3
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved By\
I
SUMMARY OF FEES
BUILDING PERMIT
$
SMIP
PLAN CHECK
S
PERMIT
PLUMBING
S
ISSUANCE
PLAN CHECK 25%
$
ENERGY P.C.
ELECTRICAL
$
�3+Da GRADING
PLAN CHECK 50%
$
MICROFILM
MECHANICAL
$
TOTALFEE
PLAN CHECK - 25% $
$
S
$` 3 47d
CONSTRUCTION AND PLANNING
APPROVALS Permit #
Date
Inspector
POOL & SPA
APPROVALS Permit 9P-
Date
Inspector.
1. Temporary Electrical Service or Pole
1
52. Pool & Equipment LpccatioO.',
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 & Pressurle.Test
6. Electrical LIFER Grnd.
57. APPROVAL TO CGVER-130NITE
7. Footings
58. Electrical Conduit-UPdrgrDd.
8. Foundation
59. Gas Pipe, 0 Undrgr'n'cl., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System.
61. APPROVAL TO DECK
11. Property Sewer Line &_House Connection
..
62. Backwash & Receptor-Final
12. Sewer Cap
63. Heater & Vent-Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical-Final
15. Rough Electrical-Conduit -_
66. Solar System-Final
16. Rough Electric Wiring SC
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit 4h-
h
,
20. Rough Factory Fireplace
21.
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas 0Oil
23. Gas Pipe-Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank CGas 0Oil
25. Roof Sheathing _
74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter-Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes:At - Wf
34. Final Heating & Air Conditioning
t
35. Final Gas Pipe-Test
36. Hood or Canopy
r CL � /! c
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
,
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
•44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
"
49: Electric Release to Edison
.t
50. Gas Release to Southern California Gas Cor
a
51. CERTIFICATE OF OCCUPANCY
No. Date
l
8
I
Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.
• TQ4(`T rl/1 1l1T r.111 ,,n„r �.i.
CITY OF COSTA MESA liUIV� HUI.I II'UN rLHIVII I
Project Address .� 1 5 I ,
132E ST_Q� W5 Plc ce 5 ,y2)a
ApplicAnt's Mailing Address e
Owner's Name �_0 A M C. Phone
Address JJL_I-.44r^In e1eokr'06 Fnft1pre�tY
Arch/Eng. License No.
Address 1�
Contractor's Name—PJL .{rD�%Ohonea�l.e
Address (mailing) �WSTarLw
City License No. _
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) Of Division 3 Of the Business and Professions Code, and
my license is In'full
Date f e—d e
ffect.
4
LceneCI Cense
Signature AAOWORP
NSATION 1 hereby affirm that I have a certificate of consent t0 self -Insure or a certificate
-f Workers' Compensation Insurance, or a certified Copy thereof (Section
:00, Lab. C.)� ,. /'�
olicy No. Company Uhf 3SZ6 5TgTC6
8 Certified co is hereby furnished. t
Certj}i cop filed with the city d ng 'v
Date 1 Applicant
EXEMM�r FR M WORKERS' COMPE A 14 DECLARATION
(This section need not be completed if the permit is for one hundred ($100) Or
less).
I certify that in the•performance of the work for which this permit is issued I
shall not employ any person in any manner so as to become subject to tike
Workers' Compensation Laws of California.
Date Signature
NOTICE: If, aftermakingthis declaration, you should become subject to the
Workers' Compensation provisions of the Labor code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a construction lending agency for the performance
of the work for which this permit is Issued (Section 3097 Civ. C.)
Lender's Name
Lender's Address
OWNER BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, after, Improve, demolish or repair
any structure, prior to Its Issuance, also requires the applicant for such permit
to file a signed statement that he/she Is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she Is exempt -
therefrom and�the basis,for the alleged exemption. Any violation of Section
931.5 by any applicant for a permit subjects the applicant to a civil
nalty of not more than five hundred dollars ($500).
J 1, n Owner of the property or my employees with wages as their sole
comp¢nsa tion, will do the work, and the structure is not Intended Or offered
for sale (Section .7044, 'Business and Professional Code: The Contractor's
License Law does not apply to an owner Of a proberty who builds Or Improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such Improvements are not intended or offered for
sale. If, however, the building or Improvement is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or Im-
Frove for the purpose of sale).
idas owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's . License Law ddoes not apply to an -owner of property who
builds or improves thereon, and who contracts for such projects with a can -
tractors license pursuant to the Contractor's License law). 1 am aware that
proof V their Worker's Compensation Insurance should be provided to me.
❑ I am exempt untler Section B. 3 P. C. for this reason
Date Owner
I hereby certify that I have real
in for motion Is c ct. I agree to
antl state laws la g t ildin
sentatives of c1 t ler
inspection our s
Signature
Drivers' License or SS it
I state that the above
and county ordinances
TYPE OF CONSTRUCTION Akn1NEW U ADD
LJ ALTERATION LJ REPAIR
❑ ❑ ❑
DEVELOPMENT SERVICES REQUIREMENTS:
CONVERSION DEMOLISH OTHER
Zoning Approved By
A P .1s
DESCRIPTION OF WORK/USE OF BLDG.
date
Building Approved By
'
Oate
S
Main Buildi
Data / ,�%•
-
SUMMARY OF FEES
TYPE OF PERMIT GRADING FOUNDATION
STRUCTURAL
T
Front
❑ TENANT ❑ ELECTRICAL:❑ PLUMBING
❑ MECHANICAL
B
PERMIT
PLUMBING
$
Rear
❑ OTHER
PLAN CHECK 25%
A
ENERGY P.C. $_
ELECTRICAL-
$ W73
C
Right
PROJECT DESCRIPTION SQ. FT. -
OCCUPANCY
K
; $
CONSTRUCTION TYPE VALUATION
S
Left
ZONE GRADING CU.YDS.
ACRES
Ping. Ref. #
Remarks: R 7 c , ""
Planning Notes:
Backflow Preventer 1 -
Backflow Irrigation
Bathtubs,
Clarifiers '
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Kitchen Sink _
Lavatories
P—Trap .
Roof Drains
Reinspection Fee $15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑, Multiple ❑
Firepl/Fact. Bit. ICBO #
Heating System & Ducting
C10-1 00,000 BTU 0100,00013T
Reinspection Fee 1 -$15
CMF 0665-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
Showers
Service Sink
Sewer Cap .
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater '
Water Service.
Auto -Wash
Issue Fee
Hood or Type ❑
Canopy Type 11 ❑
Refrigeration System
00-100,00013TU 0100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
F
S 3
$ 3
Automatic Washer '
Construction Pole Sul
Cooking Unit
Dryers LJGas LJElectric
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator 00-5 KW ❑5-'
0296 1/16/67
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL -
Transformer :❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter Dover 100 amps
Sub Panel . ' '
Motors 110-1 HP❑1'/r-8
Inc.Solar ❑915 HP ❑16-15+
Microwave
Pole Light
Range
Sign
Standing Sections
5 KW Trash Compactor
8.00 TL
FEES
Z
O
N
I
N
G
R
E
O
M
T
S
Reinspection Fee
I $15 I I Issue Fee
I $ 3
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
date
Building Approved By
-
Oate
Application Issued By
Data / ,�%•
-
SUMMARY OF FEES
BUILDING PERMIT
$
SMIP
$ -
PLAN CHECK
$
PERMIT
PLUMBING
$
ISSUANCE
S -
PLAN CHECK 25%
$
ENERGY P.C. $_
ELECTRICAL-
$ W73
GRADING
$
PLAN CHECK 50%
$ -
MICROFILM
; $
MECHANICAL
$
TOTAL FEE
$
PLAN CHECK 25%
$ -
CONSTRUCTION AND PLANNING
APPROVALS Permit#
Date
Inspector
POOL & SPA
APPROVALS Permit#
Date
'
Inspector
1. Temporary Electrical Service or Pole
N�
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, 0 Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit# _
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas OOil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank OGas 0Oil
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
��
,��
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
43. Backflow Irrigation
-
44. Landscape Irrigation System
45. Sound Attenuation
r
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
-
50. Gas Release to Southern California Gas Co
..
51. CERTIFICATE OF OCCUPANCY
No. Date
CITY OF COSTA MESA CONSTRUCTION PERMIT
Project Address �C—
Applicant's Mailing
�Add�1�r �'sS 4549a 1y_ 1y _ i� B
Owner's Name 4Iv—.v
/J—r/,A7as[/�ef.�Tj—/,Phone
Address L&'t Z Agoa 10 70
Arch/Eng. 45:! �A,_.0 Aw1"&M_12S ,cense No. C 6 3
Address
Contractor's Nam R MG
Address (mailing)i0d!�s'?rt
City License No. 3 a
LICENSED CONTRACTOR DECLARATION r` -
I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 Of the Business and Professions Code, and
my license is in full force and ffect, ^ is f�1 ,
License C{ass License Nd...916�1 y
Dale?/ % %
Signature!//LOi?d",AMM/
WORKE S' oMPENSATION DECLARATIO
hereby affirm that I have a certificate of consent to self -Insure or a certificate
1 Workers' Compensation Insurance, Or a'certified copy thereof (Section
,800, Lab. C ) n //�J a (� 't 1(Q] �,, AA
Policy No. iye 6'r 1-60It6 �' C InTPdnY �� V V
¢rti tietl copy is hereby furnished. �• I
Certitietl p 'letl wllh the city Building hizio9,.
Date APPlicanlrM i
EXEMPTIO F OM WORKERS' COMP.ENSATrON DEC ON
(Thissection need not be completed if the permit is for one hundred ($100) or
less).
certify that in the performance of the work for which this permit is Issued I
shall not employ any person In any manner so as to become subject to tike
Workers' Compensation Laws of California.
Date Signature
NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of the work for'.wtµeM1 nhisr p0r �Yis�s�ed. SectLon 3097 Civ. C.)
Lender's Name �Qr, Va b
Lender's Address M-(AL}�� /Y; U� N
OWNER BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Rusiness and Professional Code: Any city or
county which requires a permit to construct, alter, improve, demolish or repair
any structure, prior to -its issuance, also requires the applicant for such permit
to file a signed statement that he/she Is licensed pursuant t0 the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 Of the Business and Professions Code) or that he/she is exempt
kerefrom and. the basis for the alleged exemption. Any violation of Section
331.5 by any applicant for a permit subjects the applicant to a civil
malty Of not more than five hundred dollars ($500).
LJ I, as owner of the property Or my employees with wages as their sole
compensation, will do the work, and the structure {s not intended or offered
for sale (Sectlon 7044, Business and Professional Code; The Contractor's
License Law does not apply to an Owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not buiitl Or im-
prove efor the purpose Of sale).
❑ I, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the Project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a con-
tractor( s1 license pursuant to the Contractor's License Law). I am aware that
proof off their Worker's Compensation insurance should be Provided to me.
❑ I am exempt under Section B. & P. C. for this reason
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
PERMIT NO. TRACT O. LOT NO. UNIT NO.
�� � -7 _ �s�
Date
I hereby certify that I
information is correct. I
and state laws relating
sentatives of this city
inspection purposes.
Signature
Drivers' License or SS 9f
CMF 0865-46, rev. 10/84
Owner
ve read this a
ree to emmniv
White
that the above
laity ordinances
iuthorize repre-
f orooerty for
TYPE OF CONSTRUCTION LI NEW LJ ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TYPE OF PERMIT LJ GRADING LI FOUNDATION LJ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SO. FT. OCC UPAN>
CON STRUCTION TYPE VALUATION$ Z
ZONE ( GRADINNGCU.YDSS. ACRES
—
Remarks: )49> _c 4r- G Lo L/ z—�/• wr
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Dishwasher
Orinkina Fountains
Floor Drains
Floor Sinks
Gas Service
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool W/Spa
Urinal
Outlets Water Closet /
Water Heater
FE
Reinspection Fee /I $15 I I Issue Fee 1 $ 3
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Bit. ICBO #
Heating System & Ducting
❑0-100,000 BTU ❑ 100,000
Reinspection Fee I $15
long; Canary - Applicant; Pink - Accounting: Goldenrod - Assessor
Hood or Type ❑
Canopy Type II ❑
Refrigeration System
00-100,00OBTU ❑1oo,000 BT
System Repair/Alteration
Ff're Dampers
Registers
Issue Fee
I F
A.P. # Zf-'L'
S Main Build,
E
T Front
B Rear
A
C Right
K
S Left,
Ping. Ref. �h
Planning Notes:
Automatic Washer
Construction Pole
Cooking Unit
Dishwasher
Dryers ❑Gas ❑
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator❑0-5 K
Fee
DEVELOPMENT SERVICES R
Zoning Approved By
Building Approved By -
IC7E 7/_-E/
Accessory Building:
Ay� ill
! D
Parking Req./Provided
Zone
Z
O
N
I
O e07/L(s N
G
R
E
O
/t T
S
ELECTRICAL
Transformer ❑ 15.50 KW
❑ 50+ KW
Meter ❑up to 100 amps
Meter Dover 100 amps
Sub Panel
Motors 00-1 HP❑1h-8
Inc.Solar 09-15 He 016-15+
.Pble Light
Range
Sign
Standing Sections
5 KW Trash Compactor
$15 Issue Fee
E IREMENTS:
FEES
$ 3
7-7--e7
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
$
$
$
$
$
$
$
$
SUMMARY OF FEES
SMTP
PERMIT
ISSUANCE
ENERGY P.C.
GRADING
MICROFILM
TOTAL FEE
$
$
$
$
$
$
�•�
—7
$ 3
CONSTRUCTION AND. PLANNING
APPROVALS Permit#
Date
Inspector
POOL & SPA
APPROVALS Permit#
Date
Inspector
1: Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
-
60. Backwash Lines, P -Trap, 0 Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
'
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit -
66. Solar System -Final -
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING"
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas 00d
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank OGas 0Oil
_
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
i
27. Frame and Flashing
76. Dry Standpipe
CC1
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
.t
36. Hood or Canopy
,
37. Final Factory Fireplace
- •� ; z �'
38. Final Plumbing
-
39. -Water Service -Final
40. Gas Service -Final
?'
41. Solar Domestic -Final
- -�
.42. Backflow Preventer
43. Backflow Irrigation
44. 'Landscape Irrigation System
-
45. Sound Attenuation�-
46. Handicap Regulations
v r
47. FINAL STRUCTURE & BUILDING
-" •� , /
48. Special Requirements Completed
, Y-
49. Electric Release to Edison
- +.
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
pl
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. /
CITY OF COST
Project Address
Applicant's M Ili
Owner'sim
Address lli�
Address l 1 t
Contractor's Nam � G• •P Z
Address (mailing) L% V N :
City License No
CONTRACTOR
hAO liDELv!aC- a �I hereby afffmthat I arlicensed under poisnt-hyte(comm
cing,
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect. ,
License C ass �f. �sLiiccense No. /,S?,
Date �Zi �7 Signature`r,«-sar/fgrJti.IN
WORK RS' OMPENSATION DEC LA RATI � r ,
' hereby affirm that I have a certificate of consent to self -Insure or a certificate
f Workers' Compensation Insurance, or a certified copy thereof (Section
,800, Lab. C.) 10
Policy No. 1��Company `
*Date_
copy is hereby furnished.
Ylt�ertifletl o y's filed w'IAt pplicanty RuilPl�ty,p{yisipn.
/EX EM PTI N F OM ORKE RS' COMPMP�ION LA ATION� -
(This section need not be completed if the permit is for one hundred ($100) or
less).
I certify that in the performance of the work for which this permit is issued, I;
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
Date - Signature
NOTICE: If, after making this declaration, you should become Subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with Such provisions or, this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of the work for 'which this permit is i5s etl ection -3097 Civ. C.)
Lender's Name A.,
Lender's Address M F/ A y 4 ` �r_
OWNER BUILDER DECLARA ION �-
I hereby affirm that%l-am exempt from the Contractor's LicenseLaw for the
following reason -(Section 7031.5 Business and Professional Code: Any city or
county which requies'a permit to construct, alter, improve, demolish or repair
any structure, prior,to its Issuance, also requires the applicant for such permit
to file a signed statement that he/She Is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
'Division 3 of the
Bbslness and Professions Code) or that he/she Is exempt -
hereirom and the basis for the alleged exemption. Any violation of Section
031.5 by any applicant for a permit Subjects the applicant to a civil
�e nalty of not more than five hundred dollars ($500).
LJ I, as owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure is not Intended or offered
for sale (Section 7044, Business and Professional Code: The .Contractor's
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such Improvements are not Intended or offered for
Sale. If, however, the building or improvement Is sola within one year of com-
pletion, the owner will have the burden of proving he/she did not build or im.
rove for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed con.
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License taw does not apply, to an owner of property who
builds or. improves thereon, and who contracts for such projects with a Can.
tractor(s1 license pursuant to the Contractor's License Law). I am aware that
proof off their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section S. & P. C. for this reason
Date Owner
I hereby certify that I have read this application and state that the above
information is correct. I agree to comply with all city and county ordinances
and slate laws relating to building construction, and hereby authorize repre-
sentatives of this. cityentre ,,ppon the above-mentioned property for
Inspection purposes. -
Signature W1 10( A - Date 1/12
Drivers' License or SS # (/ �
CMF 0865-46, rev. 10/04 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod -Assessor
0678 (/22/87'
8098.60 TL"
',TYPE OF CONSTRUCTION NEW ADO ALTERATION
' ❑ CONVERSION ❑ DEMOLISH E1OTt1ER
A.../.)ESCF�pTIO �V O C U A F R
/
REPAIR
p.p-# 4-'7,Z(-01
.-11?Zone
S
Main Building: Accessory Building:
ss--�� --
TYPE OF PERMIT GRADING Lld'FOUNDATION TRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER.
PROJECT DESCRIPTIONFT. OCCUPANCY
CONSTRUCT ON TYP VALUATION $
- GRADING CU.YDS. ACR 5
T
Front 1�
#E
O
B
A
RearAVIISS
IS -
N
I
C
_
Right
N
S
•ZONE
Left p
'
G
Ping. Ref. # y1Parking Req./Provided
E
,Remarks: -
_
Planning Notes: TwazrI
M
. C. L7Z 3
— �306 Ll
s
'
PLUMBING
-FEES
HM E MUM
MQUInffita 1S
Bat Sink - -
Showers
(ELECTRICAL
FEES
Backflow Preventer
Service Sink
Automatic Washer
Construction Pole Sub.
Transformer 0 15-50 KW
❑ 50+KW
Backflow Irrigation Sewer Cap
Bathtubs
Sewer Connection
Cooking Unit •-
Meter ❑up to 100 amps
Clarifiers -
Solar Collectors
Dishwasher -
Meter ❑over 100 amps
Dishwasher
Solar Piping
Dryers ❑Gas ❑Electric
Sub Panel
Dfinking Fountains
Solar Tank
Fan.
Motors 00-1 HP ❑1'f. - 6
Floor Drains
Swimming Pool w/Spa
F.A.U.
Inc. Solar ❑9.15 HP ❑16 -15+ -
Floor Sinks
Urinal
Fixtures
Microwave
Gas Service Outlets
Water Closet
Device Boxes -
Pole Light
Interceptors
Water Heater .
Outlets
Range
Kitchen Sink -
Water Service -
Switches
Sign
Lavatories
Auto -Wash
Garbage Disposal
Standing Sections
P -Trap
Laundry Trays -
Generator 00.5 KW 115-15 KW
Trash'Compactor
Roof Drains
Reinspection Fee, $15
Issue Fee
$ 3
Reinspection Fee
fill
$15
Issue Fee
$ 3
MECHANICAL
FEES
Boiler
Duct -Under Ground
Hood or Type 1 ❑
Canopy Type II ❑
,-
-
DEVELOPMENT SERVICES QUUIR
Zoning Approved BY MC
Building Approved ey
Application Issued By
MENTS: -
Date/LaaL�
Date-�L-�-1-
Dat
Q/7
Duct - Structural
Duct - Ventilating
Refrigeration System
❑0-100,000 BTU 0100,000BTU
SUMMARY
BUILDING PERMIT $3.�00
PLAN CHECK $
PLUMBING $
PLAN CHECK 25% $
ELECTRICAL $
PLAN CHECK 50%. $
MECHANICAL $
PLAN CHECK 25% $
OF FEES
SMTP $
PERMIT
ISSUANCE - $
- ENERGY P.C. $
GRADING $
MICROFILM $
TOTALFEE $
2/S 6o
eeei'86o
Exhaust System ❑ Multiple[] System Repair/Alteration
Firepl/Fact. Bit. ICBG# Fire Dampers
I
Heating System & Ducting Registers
00-100,000 BTU 0100,000BT
Reinspection Fee
$15 . Issue Fee
$ 3
CMF 0865-46, rev. 10/04 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod -Assessor
.' CONSTRUCTION AND PLANNING
APPROVALS Permit#
Date
Inspector
POOL & SPA
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
"
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd.•
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, 0 Undrgrnd:, Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, 0 Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
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
APPROVALS Permit # -
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping El Gas 0Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
'
24. Roof Framing
73. Undergrnd. Storage Tank ❑Gas 00il..q
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: HOLD. FOR SPECIAL MUMMY$
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test -
/�v 151"Srm
36. Hood or Canopy
",n' _Aras
wrr zA'r'f Gpla4��r
37. Final Factory Fireplace
!pG /�� .� .r./.•' '
38. Final Plumbing
-
39. Water Service -Final
or
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
43. Backflow Irrigation
"`•
44. Landscape Irrigation System
'`..`"_" • • ""
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements CompletedA4
7• �1
AA
.. '
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
l
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CONSTRUCTIQN PERMIT
Project Address � g_
Applicant's Mailing Address e 4�,
Owner's Name Phone /S
Address
Arch/Eng. License No.
Address - " �
Contractor's Name ��� �rT� /1Lr.G`jj���Pho ne
Address (mailing) Lfs�✓ c & — A®u•.r��i��
City License No.
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full f re and effect.
License Cl s Li
Date_ Signature
WOR RS' COMPE NSATIO L ATION 1
1 hereby affirm that I have a certificate of consent to self -insure or a certificate
of Workers' Compensation Insurance, or a certified copy thereof (Section
ii=
AA �r/(/G� Company 0i:w. PY Is herebwit hrt hehcty Bl 1 in9�e . �ApplicantROM WORKERS' C he NSATION DECLARATION
(Thissection need not be completed if the permit is for One hundred ($100) or
less).
I certify that in the performance Of the work for which this permit is issued. I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
Date Signature
NOTICE: If, after making this declaration, You Should become subject to the
Workers' Compensation provisions of the labor Code, you must forthwith
comply with Stich provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.)
Lender's Name _
Lender's Address .
OWNER BUILDER DECLARATION
I hereby affirm that'I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, improve, demolish or repair
any structure, prior to -its issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 of the Business -and Professions Code) or .that he/she is exempt
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars ($500).
❑ I, as owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of A property who builds or improves
thereon, -and who does such'work himself/herself or through his or her own
employees, provided that such Improvements are not intended or offered for
sale. If, however,.the building or improvement is sold within one year of com-
pletion, the owner will have the burden of Proving he/she did not build or im.
prove for the purpose of sale).
❑ I, as owner of. the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7024, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a con-
tractors license pursuant to the Contractor's License Law). I am aware that
proof o� their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section B. & P. C. for this reason
Date Owner
I hereby certify that I have read
information is correct. I agree to i
and state laws relating. to dInc
sentat do of tr ci e_11ntry
inspection pu
Drivers' License or
IPE OF CONSTRUCTION �Ew LJ ADD
.❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.'—
!
ALTERATION LJ REPAIR
TYPE OF:PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTURAL-
".
TRUCTURALl, ❑ TENANT ❑ ELECTRICAL t�PS,UMBING ❑ MECHANICAL
50 ❑ OTHER
PROJECT. DESCRIPTION SO. FT. OCCUPANCY-
-CONSTRUCTION TYPE VALUATION $
ZONE" GRADING CU. YDS. ACRES_
Remarks:;
.• bar Sino
Preventer
Dishwasher
Drinking Fountains
Floor Drains - l
Floor Sinks
Gas Service ZOutlets
Interceptors
Kitchen Sink - -
Lavatories
Roof Drains ,
Reinspection Fee f $15
Boiler
Duct- Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Bit. ICBO #
Heating System & Ducting
[10. 160,000 BTU El 100,000 BTI
Reinspection Fee 1 $15
LCMF 0865-46, rev. 10/84 White - Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor
PLUMBING
Service Sink
Sewer Cap '
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service.
Auto -Wash
Laundry Trays
Issue Fee
Hood or Type ❑
Canopy Type 11 ❑
Refrigeration System
130-100,000BTU ❑l
System Repair/ at
Fire Dame s
Issue Fee
A. P. #
S Main Buildi
E
T Front
B Rear
A
C Right
K
S Left
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas .❑Electric
Fan
by F.A.U.
Fixtures
o Device Boxes
J Outlets
Switches
Garbage Disposal
Generator.110-5 KW C
6787 4/27/87 rn.Rn TL
Zone
Accessory Building:
Z
O
N
I
N
G
R
Parking Req./Provided E
O
M
T
S
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter ❑over 100 amps
Sub Panel
Motors ❑01 HP❑1X-8
Ina Solar 09-15 HP'❑16-15+
Microwave
Pole Light -
Range
tonding Sections
5-15 KW Trash Compactor '
$ 3 Io
/ _
�— Reinspection Fee $15 Issue Fee
o
FEES
DEVELOPMENT SER VICES REQUIREMENTS:
Zoning Approved By
Building Approved By
$ 3
FEES
$ 3
PLANCHECK 25% $-
SUMMARY OF FEES
BUILDING PERMIT
$
SMIP
$
PLAN CHECK
$
PERMIT
PLUMBING
'$
•�I.OD ISSUANCE
$
PLAN CHECK 25%.
$
�. S`D ENERGY P.C.
$
ELECTRICAL
$
GRADING
$
PLAN CHECK 50%
$
MICROFILM
$7
MECHANICAL
$
TOTALFEE
$
PLANCHECK 25% $-
CONSTRUCTION AND PLANNING
APPROVALS Permit #
Date
Inspector
POOL & SPA -
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 Con(luit-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, 0 Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor-Final
12. Sewer Cap
63. Heater & Vent-Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical-Final
15. Rough Electrical-Conduit
66. Solar System-Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit
20. Rough Factory Fireplace
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 17Gas ❑Oil
25. Roof Sheathing
74. Overhead Hydro
26. T-Bar Ceiling iStructural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
t
28. Lathing & Siding
77. FIXED SYSTEM FINAL
t;•
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: Gg4.7kila"6z' 7'-Ly-6r7 U?/
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test.-
36. Hood or Canopy
Ij
37. Final Factory Fireplace.
38. Final Plumbing
-
39. Water Service-Final
�
40. Gas Service-Final
41. Solar Domestic-Final
'
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. ,Special Requirements Completed
49. Electric Release to Edison
'
50. Gas Release to Southern California Gas Co
,
51. CERTIFICATE OF OCCUPANCY
No. Date
`\ .
City of Costa Mesa
Development Services Department No.
Building Safely Division CERTIFICATE OF OCCUPANCY 901.')75
P.O. Box 1200
Costa Mesa, California
The Building located at 575 WA.Pilh 19th Strep
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group R1 Occupancy.
Use of Building AOartments
Legal Description 4245221-01 thru -19
(See reverse side for Metes and Bounds)
Building Permit No B 26925 Electrical Permit No. E 28745 Plumbing Permit No. P 29227
Mechanical Permit No.
ISSUED TO:
?incola ?r000tcg coiii'uny
16192 �o'-_av_c
Suito 1EiD
d� inlcon 'ouchtaCk 92647
Number of apartments 15 and/or guest rooms
Building Official
by
Dec 2. - ror i
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C.
CMF 1015-46 rev. 1/83 white - Owner; Canary - Numerical File; Pink - Bldg. Permit File
CITY OF COSTA MESA
Project F1,bdre6',�_E371C
Applicant's Mailing Address
Owner's Name
Address ( S2- _ R
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
C :� I(U 4 r^ TRACT
L'i• NO.
L-I ZT N� 0 C- UNIT .,�NO.
s4afF' 2 AZ
TYPE OF CONSTRUCTION &dNFw LJ ADD LJ ALTERATION U REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER T�tp
DkSpCL/-G10�F-f1 K/USE OF BLDG. 6 Slut-•
I• aRa:�csl� �]I����•/�Il�l1�' -_lam ,
I1 ,
City License No. '
r` LICENSED CONTRACTOR DECLARATION ,LO -3895/
1 hereby affirm that I am licensed under Provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect. a(Q U7
, 1
License rl�ass __ License No. /
Date 1�L� `7 signature L.ATI /d�
WORKERS'COMPENSATION DECAR
I hereby affirm that I have a certificate of consent to self -insure or a certificate
of Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. /IC��.) // [ .s�
Policy No.tn/LZ-49/-60404/ L pany L 6 . MI&L
Certif ietl copy is'hereby furnished.
Ad-
Certif ie c0 py is filetl with the city Buil tljag Oivtsion. I
Date z��8j Applicant_ - ./M.hdl•Yav
EXEMP ION FROM WORKERS' COM PE NSATIO D CL{1RATION
(Thissection need not be Completed if the permit is for one hundred ($100) or
less).
1 certify that in the performance of the work for which this permit is Issued, 1
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
Date Signature
NOTICE: If, after making this declaration, YOU Should become subject to the
Workers' Compensation -provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a constructidn lending agency for the performance
of the work for wLLcathl�pCni A issued C(Section 3097 Civ. C.)
1 Lender's Name
1 Lender's Address.s p o / MQ[ / r
OWNER BUILDER DECLARATION
I hereby affirm:that,l'am exempt from the Contractor's License Law for the
following reason -(Section 7031.5 Business and Professional Code: Any city or
county which requires;a permit to construct, alter, improve, demolish or repair
any structure, prlor -to its issuance, also requires the applicant for such permit
t0 file a signed statement that he/she Is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Profes$ions Code) or that he/she Is exempt
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
' penaltyI, of not more than five hundred dollars ($500).
❑ as owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law doesnot apply to an owner Of a property who builds or Improves
thereon, and who does such work himself/herself or through his or her own
employyees, provided that such improvements are not intended or offered for
sale. It,however, the building or improvement is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or im.
Sfor the purpose of sale).
LJ 1, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project(Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property -who
,builds or improves thereon, and who contracts for such projects with a con-
tractor( license pursuant to the Contractor's License Law). I am aware that
proof of/ their Worker's Compensation insurance should be provided to me.
❑ .I am exempt under Section B. & P. C. for this reason
U Date Owner
I hereby certify that I have read this application and state that. the above
information is correct. I agree to comply With all City and county ordinances
and state laws relating to building construction, and hereby authorize repre-
sentatives of thiscity t enter upon the ilbove-mentioned pr pert for
inspection purposes: 17 Date ( 2- 8
( Signature
Drivers' License 0r[55
TYPE OF PERMIT LJ GRADING CiF
❑ TENANT ❑ ELECTRICAL ❑ PL
❑ OTHER 170
PROJECT DESCRIPTION S FT.
CONST UC ION TYPE
- ZONE •GRADING
.R emarks:
Bar Sink
Backflow.Preventer
Backflow Irrigation
Clarifiers
Floor Drains '
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P -Trap
Roof Drains
Reinspection Fee 1 $15
Boiler
Duct - Under Ground
Duct - Structural
Duct- Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact Bit. ICBO #
Heating System & Ducting
❑ 0.100,000 BTU 13100,000 BT
Reinspection Fee 1 $15
NDATION L`TSTRUCTU
GING ❑ MECHANICAL
VALUATIONS
YDS. AC
PLUMBING
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank -
Swimming Pool w/Spa'
Urinal
Water Closet
Water Heater
Water Service -
. Auto -Wash
Issue Fee
Hood or Type I ❑
Canopy Typell ❑
Refrigeration System
00-100,000BTU 1:1100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
CMF 0865-46, rev. 10/84 White - Building: Canary - Applicant: Pink - Accounting; Goldenrod - Assessor J
7,
A.P. # 2
S Main Buildi
E Z
T Front
e Rear '�
A
C Right
K Left
S
Ping. Ref. # B
Planning Notes:
0669 1/2;)/H/ 1
22l — O� -fPnn tti _ 9 Zone
1L� Accessory Building:
lV 3l O
`DC7
L_ N
N
� G
toR
Parking Req./Provided E
T
i-$6
ELECTRICAL
FEES
SUYMARY OF FEES
$ '` S93.00,
$ 2, Lf70•B6
$
$
$
$
$
$
Automatic Washer
Construction Pole Sub.
Transformer ❑ 15-50 KW
❑ 50 + KW
3 • �S
/OZ • �S
_
Cooking Unit -
Meter ❑up to 100amps
-
Dishwasher -
Meter ❑over 100amps
Dryers ❑Gas ❑Electric
Sub Panel C
FaA
Motors ❑0-1 HP 01 %- 8
F.A.U.
Inc. Solar ❑9.15 HP ❑16-15+
Fixtures
Microwave
Device Boxes
Pole Light
Outlets
Range
-
Switches '
Sign
-
Garbage Disposal
Standing Sections
Generator 00.5 KW 05-15 KW
Trash Compactor
-
$ 3
Reinspection Fee
$15
Issue Fee
$ 3
FEES
DEVELOPMENT SERVICES REO11IRE 78,
Zoning Approved BY tL/y
BuildingApproved By
Anulicetion Issued By _ _ _�-
'
"' Date 1 -7
Date
-14 N nam f
n
-1 -
1 -Building
Z(
Z -Z E
BUILDING PERMIT
AAs. PLAN CHECK
PLUMBING
PLANCHECK25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
SUYMARY OF FEES
$ '` S93.00,
$ 2, Lf70•B6
$
$
$
$
$
$
SMIP
PERMIT
ISSUANCE
ENERGY P.C.
GRADING
MICROFILM
TOTAL FEE -
$
$
$
$
$
$
3 • �S
/OZ • �S
_
$ 3
CONSTRUCTION AND PLANNING
APPROVALS Permit #
Date
Inspector
POOL & SPA
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location.
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure•Test
6. Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, 0 Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
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
APPROVALS Permit # • -
�.
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
'
22. Ducts, Ventilating
71. Product Piping 0 Gas 00il
'
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank 0 Gas 0 Oil.
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL '
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT -
31. Plaster Brown Coat
79. FINAL INSPECTION
'
32. Electrical Power Meter -Final
33. Final Electric
80. FOOD CERTIFICATE ISSUED
Notes: HOLD. FOR SPEEL" REQ 'R,
34. Final Heating & Air Conditioning
-
35. Final Gas Pipe -Test
36. Hood or Canopy
37.' Final Factory Fireplace
..
38. Final Plumbing
-�'•'
ve
39. Water Service-Finali;'
-
40. Gas Service -Final
T
41. Solar Domestic -Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
'
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
-, - • -
-
48. Special Requirements Completed
•r
49. Electric Release to Edison
i
50. Gas Release to Southern California Gas Co
t
51. CERTIFICATE OF OCCUPANCY
No. Date
Ah
Applicant
to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
-,.CITY
-
OF COSTA MESA CONSTRUCTION PERMIT
PEAUIZ N
TRACT NO.
LOT NO.
UNIT�Iy0 .
�A
'
1�
A �7s z��.�75/S
' Pro'ect ddress T -"" n d
Ap(licamt's Mailing Address �/ �• O U/h v_t •v
S .57� aa7S
Owner's Name, �y 1�, �/� Phone•
Address &9-4 'G/Nr�/n LP/j YO.!// Tn s/P/' �/ J'(V �1�
ry-
- 919 61nE/.•
%/lip ��'
TYPE OF CONSTRUCTION NEW AOD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OT}y��R
DESCRIPTION OF WORK/USE OF BLDG. KQ/ENG
A.P. # Zone
S
Main Building: Accessory Building:
Arch/Eng. License No. /
Address
TYPE OF PERMIT�'El y GRADING FOUNDATION STRUCTURAL
+ ❑ TENANT /el ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
OTHER
'PROJECT DESCRIPTION SQ. FT. OCCUPANCY—
CON ST RUCTION TYPE VALVATION$
ZONE GRADING CU.YDS. ACRES
T
Front
0
A
Rear
N
I
-y' / ?
Contractor's Nam« �/ G�LECiQ-/C Phone
Address (mailingl�/��' �h�/ $i: e!>U/nq f �l¢
�G./aSp
City License No. i O
LICENSED CONTRACTOR DECLARATION
I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing
with section 70001 of Division 3 of the uzlness and Professions Code, and
my license is in full force entl effect. p
License Cla s Li No.
C
Right
N
K
$
Left
G
R
Ping. ng. Ref. # Parking Req./Provided
E
Remarks: &D 6� E�t/r 8
Planning Notes:
M
T
PLUMBING
FEES
1
Date f Signature
I
Q
WORKERS' COMPENSATION DEC RATI N
I hereby affirm that I have a certificate of consent to self -Insure or a certificate
Bar Sink Showers
ELECTRICAL FEES
of Workers' Compensation Insurance, Or a certified copy thereof (Section
3800, Lab.
Policy No. V74/(. a315/ r�i� Comp C -Q
copy is hereby furnished. r
Backflow Preventer Service Sink
Automatic Washer Transformer ❑ 15-50 KW
❑ 50 + KW.
Construction Pole Sub.
Backflow Irrigation Sewer Ca p
Bathtubs - Sewer Connection
/
Cooking Unit IONMeter .2rup to 100 amps 1tP
�Certified
Certi}ie o Is filed �VOwith the city i in9 Division
Date tt?0 Applicant
EXE MP IORKERS' CO ENSATION DECLARATION
(Thissection need not be completed if the permit is for one hundred ($100) or
less).
that in the performance the work for which this permit is issued, I
I certany
shall not employ any person In any manner so as to become subject to the
Workers' compensation Laws o/ California.
Clarifiers Solar Collectors
Dishwasher Meter Dover 100 amps pp
Dishwasher Solar Piping
Dryers ❑Gas ❑Electric Sub Panel
Drinking Fountains Solar TankFan
Motors ❑0-1 HP❑1h-8
Floor Drains Swimming Pool w/Spa
F,A.U. Inc. Solar 09-15 HP 016-15+
Date Signature
NOTICE: If, after making this declaration, You should become subject to the
Floor Sinks Urinal
'
FiXtures Microwavecin
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
Gas Serviie Outlets Water Closet
',
1y Q)yTLr- Pole Light
of the work for which this permit is issued (Section 3097 Civ. C.)
Lender's Name
Interceptors Water Heater Z
�O utlets nge
Lender's Address
OWNER BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional prove Code: Any city repair
county which requires a permit to construct, alter, improve, demolish or repair
any structure, prior to its Issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
-Division 3 of the Business and Professions Code) or that he/she is exempt
therefrom and the basis for the alleged exemption. Any violation of SectionIT
7031.5 by any applicant for a permit subjects the applicant to a civil
Brialty of not more than five hundred dollars ($500).
LJI, as owner of the property or my employees with wages as their sole
Compensation, will do the work, and the structure is not Intended or offered
for sale (Section 7044, Business and ' Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. It, however, the building or improvement is sold within one year of Com-
pletlon, the owner will have the burden of proving he/she did not build or Im-
prove for the purpose of sale).
0 I, az owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or Improves thereon, and who contracts for such projects with a con-
Kitchen Sink - Water Service -
Switches Sign '
9
Lavatories Auto -Wash
-
• Garbage Disposal Standing Sections �p
9 I%
P—Trap :. Laundry Trays
Generator E10-5 KW 0515 KW Trash Compactor '
.
RoOf,Draids
(-
Reinspection Fee
$15 Issue Fee
$ 3
Reinspection Fee
p
$15 Issue Fee $ 3
- MECHANICAL
FEES
Boiler
Hood Or Type I ❑
Canopy Type II 13Zoning
DEVELOPMENT SERVICES REQUIREMENTS:
Approved By Date
Building Approved By 'Data
Application Issued By Dat
Duct - Under Ground
Duct - Structural
Refrigeration System
❑0-100,000 BTU ❑100,000 BTU
Duct - Ventilating
SUMMARY OF FEES
Exhaust System ❑ Multiple ❑
System Repair/Alteration
tractor(s) license pursuant to the Contractor's License Law). I am aware that
proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section B. & P. C. for this reason
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT -
PLUMBING $ - - ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $
'ELECTRICAL $ _ u GRADING $
PLAN CHECK.,50% $ MICROFILM $
MECHANICAL $ TOTAL FEE $
PLAN CHECK 25% $
Firepl/Fact. Bit. ICBO #
Fire Dampers
Date Owner
I hereby certify c th I have read this application and state my the above
Information is cor ct I agree comply with all city and county ordinances lna nces
and state laws r at g to bu' Ing construction, antl hereby authorize repre-
sentatives Of city to t r up n the above-mentioned property for
Inspection pu V -41,z
Signature Data
Drivers' Licens or 55 —
Heating System & Ducting
❑0-100,000 BTU ❑100,000 BT
Registers
-
Reinspection Fee
$15
-
Issue Fee
$ 3
/\r:� 865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
_ e
CONSTRUCTION AND PLANNING
APPROVALS Permit # ,
Date -r
r
.Inspector
�-
POOL &SPA
APPROVALS Permit#
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
'
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundations
r
f1 •
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.,.r
••
-
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
a
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
Fencing & Access Approval -
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit # _
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas 0Oil
23. Gas Pipe-Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank O Gas 0 Oil
25. Roof Sheathing
74. Overhead Hydro
26. T-Bar Ceiling (Structural).&.Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe '
'
28. Lathing & Siding
77. FIXED SYSTEM FINAL I
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
34. Final Heating & Air Conditioning
Notes:
35. Final Gas PiPQ.Test'700PAz
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service•Final
40. Gas Service-Final
-
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. -Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48." Special Requirements Completed
49. Electric Release to Edison
-
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Gb Applicant
to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
678E 4/27/.'?7 P44.DCEJ TI
"
CITY Of COSTA,MESA CONSTRpUCT�ON PERMIT.
Project Address• ,/� �- r� iL-
PERMIT NO.
2822
TRACT NO.
LOT NO.
UNIT NO.
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
/ DESCRIPTION O F WORK/USE OF BLDG.
21�� /lei I�i./-!
• Applicant's Mailing Address �- ��.// 4t
Owner's Name L�NC2'N 6nJ���-�S' y/i-.S�J/-[I
hone
Address
A.P.! _ Zone
S
Main Building: Accessory Building:
Arch/Eng. License No. -
Address
If
%YPE OF PERMIT GRADING CJI FOUNDATION STRUCTURAL
\\\ ❑ TENANT ❑ ELECTRICAL ;W1 ❑ MECHANICAL
THER
P OJECT DESCRIPTION 50. PT. OCCUPANCY
CONSTRUCTION TYPE VALUATION 5
ZONE GRADING CU.YDS. ACRES
T
Front 1
0
B
A
Rear
N
I
Contractor's Nam �,,�� �
Phone 3 ,�
Address (mailing 3V as NF_ /tib` ,(io�rri:•r wA 9rF/OS
City License No. u�,
LICENSED CONTRACTOR O CLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is in full f rce64np effect.
C
g -
Right
N
K
S
Left
G
R
Ping. Ref. # Parking Rect./Provided
.E
'.,Remarks • `"
Planning Notes:
Q
M
-
T
License C/�I �sfs�— cense
S
Date Signature
PLUMBING
FEES
itli.
WOR RS' COMPENSATION D CLA RATION
I hereby affirm that I have a certificate of consent to self -insure or a certificate
Bar Sink Showers
-
-ELECTRICAL FEES
of Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. �C�.)�/
Policy No; bba[ dd-�0-b= Company �qq�`r
ertified copy is hereby furnished.
'Backflow Preventer Service Sink
Automatic Washer Transformer' ❑ 15-50 KW
Construction. Pole Sub. ❑ 50+KW
`
Backflow Irrigation Sewer Cap.
Bathtubs ', Sewer Connection
p
Cooking Unit - Meter ❑up to 100 amps
Cerci d co I filed with the city B mg ion.
Date Applicant /� / /
EXEM 10 FROM WORKERS' CO�EN ATIO Q
(This section need not be completed if the permit is for one hundred (S1 00) Or
less).
I certify that in the performance of the work for which this permit Is Issued, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
Clarifiers Solar Collectors
VD
Dishwasher Meter ❑over 100 amp -
Dishwasher- Solar Piping
'OJ
Dryers ❑Gas ❑Electric Sub Panel
Drinking Fountains Solar Tanki
_
Fan Motors ❑0. P ❑1'h 8 -
Floor Drains Swimming Poolw/Spa
F.A-U. Inc. $o g-15 HP ❑16.15+
Date Signature
NOTICE: If, after making this declaration, you should become subject to the
Floor Sinks Urinal
Fixtures OWeve
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with Such provisions or this permit Shall be deemed revoked.
Gas Service Outlets Water Closet
3Z p
Device Boxes Pole Light
g
CONSTRUCTION LENDING AGENCY G
I hereby affirm that [here i5 a construction s issue agency for the performance
of the work for which this permit is issued (Section 3097/Civ. C.)
Lender's Name �-'
Interceptors Water Heater
p
r •
Outlets Range
Kitchen Sink Water Service
%j qIJ o
Switches - Sign
-
Lender's.AddresS
OWNER BUILDER DECLARATION ,<
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code:`Any city or
county which requires a permit to construct, alter, Improve, demolish or repair
any structure, prior to its issuance, also requires the applicant for such permit
to file a signed Statement that he/she is licensed pursuant to the f)rovisions ofROD(
the Contractor's License Law (Chapter 9(commencing with Section.7000) of
-Division 3 of the Business and Professions Code) or that he/she is exempt
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
�e nalty of not more than five hundred dollars (5500).
LJ I, as owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure Is not intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or improves
thereon, and who does Such work himself/herself or through his or her own
employees, Provided that such improvements are not Intended or offered for
sale. If, however, the building or Improvement is sold within one,year of com-
pl et i on, the owner will have the burden of proving he/She did not build or Inn-
for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed con-
Fn
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for Such projects with a con-
tractclS) license pursuant to the Contractor's License Law). I am aware that
Compensation insurance should be provided to me.
Lavatories Auto -Wash
o'
Garbage Dis Osa
9 P- Standing Sections
P -Trap LaundryTrays
Generator 00-5 ❑5-15 KW Trash Compactor
ns
Drains
-
0 06
r
.
Reinspection Fee $15 ' Issuo Fee
$.3
Rein ecticn Fee $15 Issue Fee $ 3
MECHANICAL
FEES
Boiler
Hood or Type I ❑
Canopy Type II ❑
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By /// Date
Building Approved By - 12 CDate �
Application Issued By Date
Duct - Under Ground
Duct -Structural
Refrigeration System -
00-100,0008T 100,000 BTU
Duct - Ventilating
SUMMARY OF FEES
BUILDING PERMIT $ $MIP $
Exhaust System ❑ Multiple ❑
System pair/Alteration
proof off their Worker's
❑ I am exempt under Section B. & P. C. for this reason-
PLAN CHECK $ PERMIT' -
OID
PLUMBING $ ISSUANCE $
- ENERGY P.C. $ '
PLAN CHECK 25% $ Lk�.Z(
ELECTRICAL $ GRADING $
PLAN CHECK 50°k $ _ MICROFILM $
MECHANICAL ,$ TOTALFEE $ •2S
PLAN CHECK 25% $
Firepl/Fact Bit. ICBO #
re Dampers
Date Owner
I hereby certify that I have read this application and state that the above
information is correct. agree to co all city and county ritr ordinances
and state laws relating to onztru on, by authorize repro-
senlaliyes of t cit o er upon a nlionetl property for
inspection p [
Signature' Dateys(
Driver cense or SS
Heating System & Ducting
❑0.100,000 BTU ❑100, T
Registers
_
Rei et.cn Fee $15 Issue Fee $ 3
CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting:
Goldenrod - Assessor
CONSTRUCTION AND PLANNING
APPROVALS Permit #
Date
Inspector
POOL & SPA
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, 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
(-,W
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
'
20. Rough Factory Fireplace _
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping OGas OOil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank OGas ❑Oil
25. Roof Sheathing
74. Overhead Hydro ..
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
-
76. Dry Standpipe
r'
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
-
Z5Q• 7
36. Hood or Canopy
37.'Final Factory Fireplace
38. Final Plumbing
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
'
42. Backflow Preventer
-
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
••
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
�• '
50. Gas Release to Southern California Gas Co
`
51. CERTIFICATE OF OCCUPANCY
No. Date
1
City of Costa Mesa
Development Services Department CERTIFICATE O F OCCUPANCY No. B 0J,c 3, 7 6
Building Safety Division
P. O. Box 1200
Costa Mesa, California
The Building located at 575 W 1 Af h RhrPnt. Nfjj h Ft
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group Q1 Occupancy.
Use of Buildin
Legal Description A2A-991—nl f•hrrt —1Q
(See reverse side for Metes and Bounds)
Building Permit No B - 26926 Electrical Permit No. E30005r E287{irumbing Permit No. P 2833P,
Mechanical Permit No
ISSUED TO:
Lincoln 2roaarty CoonanY
13152 ^,ach ,1-vr. ta. 1, --OE
Flurl�in o.l ,;!d;, h, -;,or7
Number of apartments ->1 and/or guest rooms
Building Official Yi 1 1 i a n i' :An rn rr
by
Date Oec.frllhr+,r A, ""lli
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 307 lel U.B.C.
CMF 1015-46 rev. 1/83 White - Owner; Canary - Numerical File; Pink - Bldg. Permit File
Applicant
to fill in all spaces except those within heavy border lines and sign all appropriate aecla rations.
-'—'
067U I /22/87
. .. 1971069
CITU OF COSTA MESA 'CONST PE T
Project Address
R T N
�� '�
TRACT O.
-
LOMi. UNIT NO.
I% S
'
Applicant•YMailin Addres
Corer's �ame PhO
Address
Arch/En icense N
Address
TYPE OF CONSTRUCTION M NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OT�I- ER u
�ESCRIPT�IO�1N•►�OF K/USEOFBLD1. 7: u�{� Lyis
Z � �. _
L[�
A p # �J /1 Q�-ryl/u,(� ,-I Z°na R
4N
S
Main Building: Accessory Building:
TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL
-1 TENANT ❑ELECTRICAL ❑ PL MECHANICAL
❑ OTHER
PROJECT DESCRIPTION OCCUPANQV
.CONSTRUCT ON TYPE � VALUATION $ (7
ZONE GRAOINGCU.YDS. ACRES-
T
Front
Z
B
A
Rear F314 A
N
I
Contractor's Nam Ph ZZ S
Address (mailing)
City License No.
LICENSED CONTRACTOR DECLARATION �, [, # 3a9 S� -
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect. �/s�aQ�'7
License lass License fro.^ L_L-L1
Oate- F+� Signature � Ai Iv^
C
_
Right /
N
K
$
Left '
C'
Ping. Ret. Parking Req./Provided
R
E
Remarks:
Planning NOtes3sr r f oO
M
_ L
T
S
PLUMBING
'FEESHOW
OR SPECIAL REQUIREMENTS
Bar Sink r Showers _
_ ELECTRICAL FEES
WORK RS' COMPENSATION OECLARATIO
1 hereby affirm that I have a certificate of consent to self-insure Or a certificate
�.1
of Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. C.) ((�� ..yy ,, 0n
Policy N°dxe2-691-46yDYLO Company ��41dtl_ MU A-44-
q Certified copy is hereby furnished.
�Q Certifie copy's filed with the city Building Derision.
Backflow Preventer - Service Sink -
"
Automatic Washer Transformer ❑ 15-50 KW
Construction Pole Sub. 050+KW
-
Backflow Irrigation 'Sewer Cap
Bathtubs Sewer Connection
.
Cooking Unit Meter ❑up to 100 amps
Date I7 Applicant 7stf Gs.ah�^i q�
EXEMPT ON F OM WORKERS' COMPENSATION ARATION
(This section need not be completed If the permit iz for one hundred ($100) or
less).
less).
that In the performance of the work for which this permit is issued, I
shall not employ any person in any manner z0 as to become subject to the
Workers' Compensation Laws California,
Date -Signature
Clarifiers Solar Collectors
Dishwasher Meter Clover 1 DU amps
Dishwasher Solar Piping
Dryers ❑Gas []Electric Sub Panel
Drinking Fountains Solar Tank
Fan Motors 00-1 HP ❑1X-8 .
-
Floor Drains Swimming Pool w/Spa
F.A.U. Inc. Solar ❑9.15 HP ❑16-15+
You r Cod become subject t0 the
NOTICE: C after making rov. ions f the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit Shall b0 tle¢m¢tl revoked.
Floor Sinks Urinal
Fixtures Microwave
Gas Service Outlets Water Closet
Device Boxes Pole Light
CONSTRUCTION LENDING AGENCY
1 hereby affirm thathere: is a construction lending agency for the performance
of the work for which this permit is ued Section 3097 Civ. CJ
Lender's Name
Interceptors Water Heater
Outlets Range ' '
Kitchen Sink Water Service
Switches - Sign
g
, A'
Lender's Address (�Q( MQ y' sblz 7Y I • l
OWNER BUILDER' DECLARATION
1 hereby affirm that-l'am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter improve, demolish or repair
any structure, prior to.its Issuance, also requires Lite applicant for such permit
to file a signed.statement that he/She Is licensed pursuant t0 the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 Of the Business and Professions Code) or that he/she Is exempt
therefrom and the basis for the alleged e%emption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
enalty of not more than five hundred dollars ($500).
I, as owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure is not intended of offered
for sale (Section 7044, Business and Professional Cotle: The Contractor's
License Law does not apply to an owner Of a property who builds or improves
thereon, and who tloes such work himself/herself or through his or her own
employees, provided that Such improvements are not intended or offered for
sale. If, however, the bulltling or improvement is sold within one year of com.
.- pletion, the owner will have the burden of proving he/she did not build or im-
prove for the purpose Of sale).
❑ I, as owner of the property, am exclusively contracting with licensed con-
to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law oes' not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a con-
-tractors) license pursuant to the Contractor's License Law). I am aware that
proof o their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section B. & P. C. for this reason
Lavatories Auto-Wash'
Garbage Disposal Standing Sections
P-Trap Laundry Trays
Generator ❑0.5 KW ❑5-15 KW Trash Compactor
Roof Drains
-
r
Reinspection Fee
$15 Issue Fee
$ 3
Reinspection Fee $15 loos Fee
MECHANICAL
FEES
Boiler -
Hood of Typal ❑
Canopy Type II ❑
DEVELOPMENT SER CE RE UIREMENTS:
Zoning Approved By
Building Approved By a
Application Issued By -Dat
I
Duct -Under Ground
Duct -Structural
Refrigeration System
❑0-100,000 BTU ❑100,000 BTU
Duct - Ventilating
SUMMARY OF FEES
BUILDING PERMIT $ 23.00 $MIP
PLAN CHECK $ PERMIT
ISSUANCPLUMBING $Date
Exhaust System ❑ Multiple ❑
System Repair/Alteration
Firepl/Fact. Bit. ICBG #
Fire Dampers
Owner
certify that I have read this application antl state that the above
Information is correct. 1 agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize repre-
zentatives of this cit to enter upon tne, above-mentionetl property for_
Inspection purposes.
Signature yffi Date !
Drivers' License or SS # —��
Heating System & Ducting -
❑0-100,000 BTU ❑100,000BT
RegistersPLAN
CHECK 25% $ .ENERGY
ELECTRICAL $ GRADING
PLAN CHECK 50°6 $ MICROFILM $
MECHANICAL $ TOTAL FEE $ 1' 6
PLAN CHECK 25% $
_
Reinspection,Fee $15 Issue Fee $ 3
CMF
0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting;
Goldenrod - Assessor
F�
.CONSTRUCTION AND PLANNING
APPROVALS Permit #.
Date
Inspector
POOL & SPA
APPROVALS Permit#
Date
p�,
Inspector'
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms _
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd:
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, 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
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar*Ceilin 9
69. POOL/SPA SYSTEMS ,^
,.
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit
••
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydra
22. Ducts, Ventilating
71. Product Piping 0Gas ❑Oil
23. Gas Pipe-Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank 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: BO1.Q
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37: Final Factory Fireplace
'-
r
38. Final Plumbing
-"
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventers
43. Backflow Irrigation
44. Landscape Irrigation System
'-
45. Sound Attenuation
r A:. --
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
.. ".
48. Special Requirements Completed
�t7 0 8
M
49. Electric Release to Edison
'
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
r
Applicant to fill in all spaces except those within heavy border Imes and sign all appropriate declarations.
CITY OF COSTA MESA, COJNSTR PION PERMIT PE Rp41T alp. TRACT NO. LOT NO. UNIZNO.
Project Address % Gz
Applicant's Mailing Addr ss
Owner's Name '�'� ��"'�' / Phone
Address
Arch/Eng. License No.
Address
Contractor's NameG Phone --:"7 y
Address (mailing)—&—e71
e7 �— - - -
City License No. U e���.�lJ
LICENSED CONTRACTOR DECLARATION
1 hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code and
my licens is in full fTe and effect. n/ (a-
Licens s f LICen ll
Date Signature go
WORKERS COMPENSATION DgilLARATION
hereby affirm that I have a certificate of consent to self -insure or a certificate
i Workers' Compensation Insurance, or a certified copy thereof (Section
4800, Lab. / Z/y
Policy No. JJb Comp
❑ Certifi co is hereby furnish¢tl.
erE filed with the city i sio
Date Applicant
EXEM 10 FROM WORKERS' COMP NSATION DECLARATION
(This section need not be completed If the permit is for one hundred ($100) or
less)
certify that in the performance of the work for which this permit is Issued, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
Date Signature
NOTICE: If, after making this declaration, you shoultl become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.)
Under's Name
Lender's Address
OWNER BUILDER DECLARATION
1 hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code; Any city or
county which requires a permit to construct, alter, improve, demolish or repair
any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars ($500).
❑ I, as owner of the Property or my employees with wages as their sole
compensation, will do the work, and the structure Is not intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement Is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or im-
prove for the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensed con.
tractors td construct the project (Section 7044, Business and Professions Cotle:
The Contractor's License Law does not apply to an owner of property who
builds or Improves thereon, and who contracts for such projects with a con-
tractors ncense pursuant to the Contractor's License Law). 1 am aware that
proof o� their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section B. & P. C. for this reason
Date Owner
Drivers' Mcahse or SS :v,
this application and state that theabove
Amply with all city and county or mantes
construction, and hereby author ze pre-
agon the above-mentioned ert/ for
TYPE OF CONSTRUCTION i!J NEW U ADD LLALTERATION LJ REPAIR•
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
SUMMARY OF FEES -
A.P. #
S
Main Buildl
TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
E
T
B
A
Front
Rear
PROJECT DESCRIPTION SQ. FT. OCCUPANCY
CONSTRUCTION TYPE VALUATION$
20NE GRADING CU.YDS. ACRES
C
KLeft
$
Right
PLAN CHECK 25%
Ping. Ref. #
Remarks: Px n(]' RjC>ep� / T N ) GG7� (u ,1- dd l 4j'
Planning Notes:
3ar Sink
3ackflow Preventer
3ackflow Irrigation
3athtubs
clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service` Outlets
Interceptors /
Kitchen'Sink -
Lavatories
P—Trap„
Roof Drains -
Reinspection Fee $15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Bit. ICBG #
Heating System & Ducting
❑0.100,000 BTU ❑100,000
Reinspection Fee 1 $15
CMF 0865-46, rev. 10/84 White - Bulltling: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping -
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto -Wash
Laundry Trays
Issue Fee
Hood or Type ❑
Canopy Type 11 ❑
Refrigeration System
❑0700,000BTu ❑100,000BT
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
EES
$ 3
FEES
$ 3
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL '.
Automatic Washer Transformer ❑ 15.50 KW
Construction Pale Sub. ❑ 50+KW
Cooking Unit 51 Meter ❑up to 100 amps
Dishwasher Meter ❑over 100 amps
Dryers ❑Gas ❑Electric Sub Panel
Fan Motors 00-1 HP 01 % -.8
F.A.U. Inc. Solar 1:19-15 HP -E] 16-15+
Fixtures Microwave
Device Boxes Pole Light
Outlets Range
Switches Sign
Garbage Disposal Standing Sections
Generator 00-5 KW 05.15 KW I I Trash Compactor
Reinspection Fee $15 Issue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved By
Application Issued By -n -
g
FEES
$ 3
Z
O
N
1
N
G
R
E
O
M
T
S
PLAN CHECK 25% $
SUMMARY OF FEES -
- - - - - -
BUILDING PERMIT
$ SMTP
$
PLAN CHECK
$ PERMIT
'
PLUMBING
$ ISSUANCE -
$-
PLAN CHECK 25%
$ ENERGY P.C.
S
ELECTRICAL
$ GRADING
$
PLAN CHECK 50%
$ MICROFILM
$
MECHANICAL
$ TOTALFEE
$ _Jf•�t/
PLAN CHECK 25% $
CONSTRUCTION ANDrPLANNING _
.a
APPROVALS Permit.#
„I
•' r . (-.
Date
-11 f;),',
's
Inspector
I •-
k_ Ii Ch ;POOL &SPA
fAPPRQY/•['LS; Permit #
`
Date
I
Inspector
1.:Temporary ElectricallService or Pole
52. Pool & Equipment Location
,
2. Soil Pipe-Undrgrnd.�
53. Steel Reinforcement -
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
'
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Fdotings
58. Electrical Conduit-Undrgrnd.
8. Foundation
n
59. Gas Pipe,;❑ Undrgrnd., Test
9. Water•Pipe-Undrgrnii__
60. Backwash Lines, P -Trap, ❑ Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
•r
67. Fen ir)g & Access Approval
17. Rough Wiring Sign
r y
68.• AP ROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #-r'
"
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
'
22. Ducts, Ventilating
71. Product Piping O Gas ❑ Oil
'moi
23. Gas Pipe -Rough & Test
72. Underground Flush -
24. Roof Framing
73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing
74. Overhead Hydro I
26. T -Bar Ceibng (Structurai) & Monocoat
75. Dry Chemical r
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
I.
29. Insulation
78. FIRE PREV. FINAL
-
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT f
31. Plaster Brown Coat
FINAL INSPECTION
- ✓"•
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
otes: _ t'•j
34. Final Heating & Air Conditioning -1
35. Final Gas Pipe -Test
36. Hood or Canopy
37. 'Final Factory Fireplace
'
38. --Final Plumbing
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
,•,43. Backflow Irrigation
i -
'.• 44. Landscape Irrigation System
- �• i �� •' '
.45. Sound Attenuation
-
46. Handicap Regulations
'r
47. FINAL STRUCTURE & BUILDING
f �e
48.;Special Requirements Completed
4�
-49.,Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
_ _
P'
1.06 (j Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CONSTRUCTION PERMIT
Project Address ✓ 7� /fit /�
�--�„ Applicant's Mailing Address E'Sr
O(yner's Na�mmee� Z/NCe1II eQ r1L1 e5 Pho eJ�L7
Address I-ItR/ us'�'n�Ll—1 E'/n Y"ia 2/1 !*S fErd,zY . it
Arch/Eng. License No.
Address /
Contractor's Name �%/� �4G-CTR/C ��11 Phohe 39
/ Z'
/,
Address (mailing) v+-7' 6---56-A"7111 5y-.(2e)Il//1LL. Ielf
City License No. O y / a S9
LICENSED CONTRACTOR DECLARATION
1 hereby affirm that I am licensed under provisions Of Charter 9 (commencing
with section 7000) of Division 3 Of the uslness and Professions Code, and
my Incense is In full force and effect.
Lii ` f SAV /cens(e C/IDss Lice o
Date�"Q
Signature
WORKER ' COMPENSATION DECL RATION
hereby affirm that I have a certificate of consent to self -Insure or a certificate
' Workers' Compensation Insurance, or a certified copy thereof (Section
800, Lab. C r
Policy No.✓ 7
Y
IyZ 9/S/,5 t, epi Co Q i -i7iU
Certified copy is hereby furnished.
Certyt ie c p Is fiI it wltn the city U i Div si
Date r0 Applicant G
EXEMP ION FROM WORKERS' GOM ENSATION DECLARATION
(This section need not be completed If the permit Is for one hundred ($100) or
less).
certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
Date Signature
NOTICE: If, after making this declaration, you should become Subject to the
Workers' Compensation provisions of the Labor Code. you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is Issued (Section 3097 Civ. C.)
Lender's Name
Lender's Address .
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, improve, demolish or repair
any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he/she Is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt
"herefrom and the basis for the alleged exemption. Any violation of Section
'031.5 by any applicant for a permit subjects the applicant to a civil
olty of not more than five hundred dollars ($500).
LJ I, as owner of the property or my employees with wages as their Sole
compensation, will do the work, and the structure is not intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such Improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of com-
pletion, the.owner will have the burden of proving he/she did not build or im-
prove for the purpose of sale).
❑ I. as owner Of the property, am exclusively contracting with licensed con.
tractors tO construct the project(Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or Improves thereon, and who contracts for such projects with a con.
tractor(s1 license pursuant to the Contractor's License Law). I- am aware that
proof .o their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section B. & P. C. for this reason
Date
and state law a atlng
sentatives of t city
inspection ' es,
Signature
Drivers' Ll ce Se or SS 9
GMF 0865-46, rev. 10/84
. Owner
have read this application and state that the above -
agree comply with a 1 city and county ordinances
o b Ing construction, and hereby authorize repre--
to er�uptthhre above-mentioned or ort far
"✓nye" r'/ix� Date (�
-.. j-a87Y6 I ....._...- -- -- -0-
TYPE
.. 0.TYPE OF CONSTRUCTION NEW LJ ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHtR
DESCRIPTION OF WORK/USE OF BLDG.
TYPE OF'PERMIT GRADING LJ FOUNDATION LJ STRUCTURAL
❑ TENANT 21ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SO. FT. OCCUPANCY—
CONSTRUCTION TYPE VALUATIONS—
ZONE—
ALUATION$ZONE GRADINGCU.YDS. ACRES—
Remarks: 1112692(,
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Servic� Outlets
Interceptors
Kitchen Sink ,
Reinspection Fee 1 $15
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
F i rept/Fact. Bit. ICED #
Heating System & Ducting
00.100,000 BTU ❑ 100,000 BT
Reinspection Fee I $15
White - Building: Canary - Applicant: Pink - Accounting; Goldenrod - Assessor
dBING
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service -
Auto -Wash
Laundry Trays
Issue Fee
Hood or Type ❑
Canopy Type I I ❑
Refrigeration System
❑o-loo,000 BTU 1:1100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
FEES
$ 3
9198 6/C2/"7
A.P. # I Zone
S Main Building: Accessory Building:
E
T Front
A Rear
C Right
S Left
Ping.,Ref. # Parking Req./Provided
Planning Notes:
Garbage Disposal PM Standing Sections
Generator 00.5 KW 115-15 KW Trash Compactor
7' q2
I I Reinspection Fee 1 $15 1 1 Issue Fee 1 $ 3 1 1
DEVELOPMENT SERVICES REQUIREMENTS:
ELECTRICAL
Automatic Washer
Construction Pole Sub.
Transformer ❑ 15.50 KW
❑ 50+KIN
Cooking Unit
Meter up to 100 amps/
Dishwasher
Meter ❑over 100 amps
all
Dryers ❑Gas ❑Electric
Sub Panel
Fan
Motors 00-1 HP❑1'h-8
F.A.U.
Ina Solar ❑9.15 HP E]16-15+
Fixtures
Microwave
SUMMARY OF FEES
Pole Light
Outlets
Range
Garbage Disposal PM Standing Sections
Generator 00.5 KW 115-15 KW Trash Compactor
7' q2
I I Reinspection Fee 1 $15 1 1 Issue Fee 1 $ 3 1 1
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Date
Building Approved By
Date---j-��
Application Issued By
Date_W=��b_J
SUMMARY OF FEES
BUILDING PERMIT
$
SMIP
$
PLAN CHECK
$
PERMIT
PLUMBING
$
ISSUANCE
$
PLAN CHECK 25%
$
ENERGY P.C.
$- '
ELECTRICAL
$
GRADING
$
PLAN CHECK 50%
$
MICROFILM
,$
MECHANICAL
$
TOTALFEE
$
- PLAN CHECK 25%
$
CONSTRUCTION AND PLANNING
APPROVALS Permit
';Date -
4,6
I:nsd6Lter
,. .; POOL & SPA
.'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 r
/
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, 0 Undrgrnd., Test
9. Wate ' Pipe-Undrgrnd.
- 1
A-•
60. Backwash 1ines, P -Trap, ❑ Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11- Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final
13. Roof, Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
�� g
Fencing & Access Approval
-
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit# _
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas 0Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank 0 Gas 0 Oil
25. Roof Sheathing
74. Overhead Hydro '
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing &Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION:
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
36. Hood or Canopy
37. Final Factory Fireplace
-
38. Final Plumbing
39. Water Service -Final
40. Gas Service -Final
'
41. Solar Domestic -Final
-
42. Backflow Preventer
43. Backflow Irrigation
i
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
i
47. FINAL STRUCTURE & BUILDING
f
48. Special Requirements Completed
`
t
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
i
No. Date
} -
,
Applicant to fill 1. all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA ��M%E/S�[[' CO
NSTRUCTJpN PERMIT
ProjectAddcros L+—I�L ��J,
.applicant's WailingAddress AN2292—A I�/O'✓U'
Owner's Name 4-,n III Phone r2i/ %,P;
Address
Arch/Eng. License No.
Address
/Y. !y>
Contractor's Name Phone �••-��J'
Address (mailing) I �{�i.}d N,t �(,%ty�✓�
City License No. 19O
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
I
license i5 in fur fo antl effect. _p
License CI n se
Dat. Signature
WORK RS' COMPEN5ATION DECLARA ION
I hereby affirm that I have a certificate of consent to selftinsure or a certificate
,f Workers' Compensation Insurance, or a certified COPY thereof (Section
rol0'cY No. ��� Company !T. of
ertifierl copy Is hereby furnished.
Cer i i tl c (.Js ('led with the city Bud 9
Date I' Applicant
EXEM TION FROM WORKERS' Cali NSAT ION D C
(This Section need not be completed if the permit i5 for one hundred ($100) or
less).
I certify [hal in the p¢rf Or mance an the work for which this permit is t to t, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
Date Signature
NOTICE: If, after making this declaration, You Should become subject to the
Workers' Compensation provisions of the Labor Cotle, You must forthwith
Comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY 7
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.)
Lender's Name - ---
Lender's Address
OWNER BUILDER DECLARATION
I hereby affirm that 1 OM exempt from the Contractor's License Law for the
following reason (SOtlloh 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter Improve, demolish or repair
any structure, prior to Its issuance, also requires die applicant for Such permit
to file a signed statement that he/She Is licensed pursuant to the provisions of
the Contractor's License taw (Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt
therefrom and the basis for the alleged exemption. Any violation of Section
031.5 by any applicant for a permit subjects the applicant to a civil
¢natty of not more than five hundred dollars ($500).
❑ I, as owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure Is not intended or offered
for Sale (Section 7044, Business antl Professional Code; The Contractor's
License L.aw does not apply to an owner of a properly who builds or Improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such Improvements are not Intended Or offered for
sale. If, however, the building or Improvement is sold within one year of com-
pletion, the ownur will, have the burden of proving he/She did not build or im-
prove efor the pu,Pose Of Sale).
I, as owner of the property, am exclusively contracting with licensed con.
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who Contracts for such projects with a Con-
tractor(S1 license pursuant to the Contractor's License Law). I am aware that
proof o!1 their Worker's Compensation Insurance should be provided to me.
❑ 1 am exempt under Sectlon B. 8 P. C. for this reason
Date Owner
I hereby certify that I have rea
information is correct. I agree to
and State laws relating to b
sentatives Of t 1(y e
inspection P
Signature
Drivers' L¢ense or SS 2e
above
TYPE OF CONSTRUCTION f)4aNEW U ADD U ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
Showers
A.P.
S
Main Building: .
TYPE OF PERMIT GRADING�+.� FOUNDATION STRUCTURAL
F -1,L TENANT ❑ ELECTRICAL ZOLUMBING ❑ MECHANICAL
❑ OTHER
E
T
13
Front
Rear
PROJECT DESCRIPTION SO. FT. OCCUPANCY
CONSTRUCTION TYPE VALUATIONS
ZONA GRADING CU.YDS. ACRES
C
KLeft
$
Right
212 Bathtubs
Ping. Ref. #
Remarks: n / C4 7 /
Planning Notes:
FEES I
!.6795 4/27/87
Parking Req./Provided
Zone
3211,75 TL
Z
O
N
I
N
G
R
E
Q
M
T
S
Bar Sink
Showers
ELECTRICAL . FEES
Backflow Preventer
Service Sink
Automatic Washer
Construction Pole Sub.
Transformer ❑ 15-50 KW
❑ 50+KW
Backflow Irrigation Sewer Cap
1g, O A
212 Bathtubs
Sewer Connection.
of
Cooking Unit
Meter ❑up to 100 amps
Clarifiers
Solar Collectors
Dishwasher
Meter Uover 100 amps
a Dishwasher
Solar Piping
Dryers ❑Gas ❑Electric
Sub Panel
Drinking Fountains
Solar Tank
Fan
Motors El g.4i,❑1%-8
Floor Drains
Swimming Pool w/Spa
F.A.U.
Inc. ar 09.15 HP ❑16-15+
Floor Sinks
Urinal
Fixtures
AlFic,owave
Gas Service Outlets
Water Closet
o+
Device Boxes
Pole Light
Interceptors
Water Heater
Outlets
Range
1 Kitchen Sink
Water Service
491, 14. u
Switches
Sign
Lavatories
Auto -Wash
6
Garbage Disp_os
Standing Sections
P—Trap
Laundry Trays
Generator ;' -5 KW ❑5-15 KW Trash Compactor
Roof Drains
Reinspection Foe
$15
- Issue Fee
$ 3
Reinspection Fee
$15 Issue Fee S 3
MECHANICAL
FEES
DEVELOPMENT SERVICES REQUIREMENTS: -
'Zoning Approved By Date -
Building Approved By Date// �n_�_�_ ��_�__/oma
Application Issued By Date 7 t ` rl 0
Boiler
Hood or Type ❑
Canopy Type 11 ❑
Duct - Under Ground
Duct -Structural
Refrigeration Syste
❑0-100,0 U 0100,000 BTU
Duct - Ventilating
BUILDING PERMIT
PLAN
PLUMBING CHECK
- PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
SUMMARY OF FEES
$ SMIP $
$ !� •0U ISSUANCE $
$- IG '5• i 1 ENERGY P.C. $
$ GRADING $
$ MICROFILM S
$ TOTALFEE S -7 5-1
$
Exhaust System ❑ Multiple ❑
stem Repair/Alteration
Firepl/Fact. Bit. ICBG#ERMIT
Fire Dampers
Heating System & D Ing
❑0100,000 100,000 BTL
Registers
'
Reinspection Fee
$15
Issue Fee
$ 3
CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING
APPROVALS Permit #
Date
Inspector
POOL & SPA
'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, 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 ,
(�/2 d7
Crto
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.f Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping OGas ❑Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank OGas OOil
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. ElectricalPower Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes: _ _ �•
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
36. Hood or.Canopy
-
37t Final Factory Fireplace
38. Final Plumbing
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
-
43. Backflow Irrigation
44. Landscape Irrigation System
'45. Sound Attenuation
46. Handicap Regulations,
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
-
49. 'Electric Release to Edison
r,
50. Gas Release to Southern California Gas Co
'
51. CERTIFICATE OF OCCUPANCY
No. Date
J
City of Costa Mesa
Development Services Department
Building Safety Division CERTIFICATE OF OCCUPANCY No. O U S.� 7 9
P. O. Box 1200
Costa Mesa, California
The Building located at 575 pt tOrh
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group Rl Occupancy.
Use of Building Apartments
Legal Description 424-221-01 thru —09
(See reverse side for Metes and Bounds)
Building Permit No B 26927 Electrical Permit NoF2A7d7. cognn�Iumbing Permit No. P 28229
Mechanical Permit No
ISSUED TO:
Lincoln Proowrry rmmman,r
16152 Beach, Blvd., Ste. 140
Number of apartments 21 - and/or guest rooms
Building Official William m
by
�.. Date December 4, 19A7
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C.
CMF 1015-46 rev. 1/83 White -Owner; Cana Numerical File; Pink - Bldg. Permit File
9
�i
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate Oectarations.
CITY OFboSTA MESA C ST C ON PERMIT
Project Address I1
Applicant's Maikng Address U
Owner's Name hone
Address
Arch/En ke�ns/9 No.
Address g Mc�� ", E— �]�
Contractor's Name_.�1- 1Mr,1li.,r• ^^11 /1�• ,►gyp Phdn�
Address (mailing)
City License NO lcwaK L4'Y/1 �.µ�j�Q�7 pQ
LICENSED CONTRACTOR DECLARATION.8,^'#JO /SY
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect.
Ucens'C)aass scans. N0.259_t
Date—��/� SIg t %fl/
WORKERS'COMPENSATION DECWRATION o
I hereby affirm that I have a certificate of consent t0 self -insure or a certificate
rf Workers' Compensation Insurance, or a certified copy thereof (Sect Ion
380Q Lab. CJ aeo I,_ U I Y1 k �� _/_„ Q
Policy Nofsl�z-b7/-O8 //0 /f/-/t%DOmpdny 1 Q.Q ,C.t / y�
Certified copy Is hereby furnished.
Certl fed co Y is filed with the city BulldiAg PWSion.
Date Applicant l(1:Lsff• —
EXEM TIO FROM WORKERS' COMPENSATION LARATION
(This section need not be completed if the permit IS for one hundred ($100) or
less).
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person In any manner so as to become subject to the
Workers' Compensation Laws of California.
Date Signature
NOTICE: If, after making this declaration, you should become Subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that,there is a construction lending agency for the performance
of the work for ich s per�r1it is i ssued,.(Se Ctign 3097 Civ. C.)
Lenwh
der's Name. A-- /w )C� c Al AA Q^
Lender's Address QL2/ 44LLC'-�1��0 i 2e. • g
OWNER BUILDER OEC BAR ATION
I hereby affirm that,l•am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, Improve, demolish or repair
any structure, prior to Its isS t nce, also requires the applicant for such permit
to file a signed statement that he/she Is licensed pursuant to the provisions of
the Contractor's LCan
so Law (Chapter 9 (commencing with Section 7000) Of
-Division 3 of the Business antl Professions Code) or that he/she is exempt -
t_./031.5 brorny anynd hpplicant f basis r le aallPerm It exemption
theyapplicant to on of acclon
ivil
'nnaity Of not more than five hundred dollars ($500).
LJ I, as owner of the property or my employees with wages as their sole
compensation, will do the work, and the Structure Is not Intended or offered
for sale (Section 7044, Business and Professional Code: The _Contractor's
License Law does not apply to an owner of a property who builds or Improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such improvements are not Intended or offered for
sale. If, however, the bullding or Improvement is sold within one year of COM-
• pletion, the owner will have the burden of proving he/she did not build or im-
Eprove for the purpose of sale).
I, as owner. of the property, am exclusively contracting with licensed con-
tractors to construct the project(Section 7044, Business and Professions Code:
The Contractor's License law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that
proof off their Worker's Compensation insurance Should be provided to me.
❑ 1 am exempt under Section B. & P. C. for this reason
Date Owner
I hereby certify that I have read this application and state that the above
information is correct. I agree to comply with all City and county ordinances
and state laws relating to building construction, and hereby authorize repre-
sentatives of this city to Anter on' the above-mentioneo property for
inspection purposes. /5�/r'�N-!/, �y��,,�� Z
Signature a 1!03w Date
Drivers' License or
Canary - Applicant; Pink - Accounting; Goldenrod - Assessor t
CONSTRUCTION AND PLANNING
APPROVALS Permit #
Date
Inspector
POOL & SPA
APPROVALS Permit #
Date
Fctor
1. Temporary Electrical Service or Pole
i
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.
i
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK --
11. Property Sewer Line & House Connection
62. Backwash & Receptor-Final
12. Sewer Cap
63. Heater & Vent-Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical-Final
15. Rough Electrical-Conduit
66. Solar System-Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical-Y Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit•..-
'
20. Rough Factory Fireplace
21. Ducts, in Structure
i
70. Underground Hydro
--
22. Ducts, Ventilating
71. Product Piping 0Gas 0Oil
23. Gas Pipe-Rough &4 Test •
72. Underground Flush
24. Roof Framing
I
73. Undergrnd. Storage Tank 0 Gas 0 Oil
25. Roof Sheathing
74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
-
28. Lathing & Sidingi
77. FIXED SYSTEM FINAL
29. Insulation. '
t/•g�
78. FIRE PREY. FINAL
30. Drywall Nailing 1
7./%
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter-Final
80. FOOD CERTIFICATE ISSUED �,
•- `
33. Final Electric
Notes: t Ow FOR SPECUL ftw4mmmT8
34. Final Heating & Air Conditioning
•/ '
35. Final Gas Pipe-Test
0•
36. Hood or Canopyi
37. Final Factory Fireplace
- -
38. Final Plumbing
39. Water Service-Final
- ••
40. Gas Service-Final
41. Solar Domestic-Final-
42. Backflow Preventer
'•. _, =! '
43. Backflow Irrigation
- '-
44. Landscape Irrigation System
- -
45. Sound Attenuation
i-
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
��%
48. Special Requirements Completed
/C b
/ y�. lel
.i' `• -
49. Electric Release;to Edison
„ ' -
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
//
'54Applicant to fill in all spates except those within heavy border lines and sign all appropriate declarations.
CITY,OF COSTA QQ�EtSA CONSTRpU ION PERMIT Tp^ T "'^ nT Nn r .,
Project Addre{s, L� /
Applicant's Mailing Addresst..>�% Iy- �l, d/.///o/J/./•O
Owner's Name 9fW Phone y�—s7y
Address
Arch/Eng. License No.
Address
Contractor's Nam y� Phone-!'IYt�• .
Address (mailing)
City License No. Qw?_h
LICENSED CONTRACTOR DECLARATION
1 hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in for fore na effect. '
Licens ass �� L $
e N
Date Signature
WOR ERS COMPENSATION qE LARAT
1 hereby affirm that I have a certificate of consent to self -insure or a certificate
of Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. C) c�i
Policy No.ILO, e r��T � Company � P._� �R
rtifietl copy is hereby furnished���,�
CeStyflpp copy�s filetl,with the city By1�jn9 D_�, __, _,00
EXEMPTIOIYF ROM WORKERS' COMPENSATION OECLAKA LION
(This section need not be completed if the permit is for one hundred ($100) or
less).
Icer that In the pertOrmance of the work for which this permit is Issued, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
DateSlgrn. Lure
NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with Such provisions or this permit shall be deemed 'revoked.
CONSTRUCTION LENDING AGENCY '
1 hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 ICiv. C.)
Lender's Name
Lender's Address
OWNER BUILDER DECLARATION /.
I hereby affirm that I am exempt from the Contractor's License Law for the
following, reason (Section 7031,5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, improve, demolish or repair
any structure, prior t0 its issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Sectlon7000) of
'Division 3 of the Business and Professions Code) or that he/she is exempt
therefrom and the basis for tho alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars ($500).
❑ I, as owner of the properly or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered
for sale (Section 7044, Buslnoss and Professional Code: The Contractor's
License law does not apply to an owner of a property who builds or improves
thereon, and who does such work nimse if/herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of com-
pletion, the owner will have the burden of proving he/she Old not build or im.
prove tar the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a con.
tra Ctor(51 license pursuant to the Contractor's License Law). I am aware that
proof off their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section - B. & P. C. for this reason
Date Owner
I hereby certify that I have road this application and state that the above
information is correct. I agree to comply.with all city and county ordinances
CMF 0865-46, rev. 10/84
P egg 22 y
I
I
I 1I
Backflow Preventer
Service Sink
TYPE OF CONSTRUCTI ON ADD LJ ALTERATION LJ REPAIR
Automatic Washer
Construction Pole Sub.
Transformer ❑ 15-50 KW
❑50+KW
El CONVERSION 11 DEMOLISH ❑ OTHER
A.P.
DESCRIPTION OF WORK/USE OF BLDG.'
Sewer ConnectionS
ON
•
S
Main Builds
TYPE OF PERMIT GRADI FOUNDATION STRUCTURAL
T
Front
El TENANT ❑ ELECTRIC LUMBING ❑MECHANICAL
B
Solar Piping
El OTHER
A
Rear
Drinking Fountains
C
Right
PROJECT DESCRIPTION SQ. FT. OCCUPANCY
KLeft
Floor Drains
CONSTRUCTION TYPE VALUATION$
$
F.A.U. -
ZONE GRADING CU:YDS. ACRES
Ping.
#
Rearks: �7 .-. / C2 -. '
m
ninRef.
Plang Notes:
FEES
6794 4/27/87
Zone
Accessory Building:
Parking Req./Provided
321.75 TL
Z
O
N
I
N
G
R
E
O
M
T
S
Bar Sink
Showers -
Hood or Type I ❑
Canopy Type I I ❑
ELECTRICAL FEES
Backflow Preventer
Service Sink
Duct - Under Ground
Automatic Washer
Construction Pole Sub.
Transformer ❑ 15-50 KW
❑50+KW
• Backflow Irrigation Sewer Cap
$
Bathtubs
Sewer ConnectionS
ON
Cooking Unit
Meter ❑up to 100 amps
Clarifiers
Solar Collectors
$
Dishwasher
Meter ❑over amps
AL Dishwasher
Solar Piping
41 &4
Dryers ❑Gas ❑Electric
Sub Pane
Drinking Fountains
Solar Tank
$
Fan _
M2!!s 00.1 HP❑1''A-8
Floor Drains
Swimming Pool w/Spa
$
F.A.U. -
nc.So(ar 09-15 HP 016-15+
Floor Sinks
Gas Service Outlets
Urinal
Water Closet
$ 3z1' 7S
Fixtures '
Device Boxes
Microwave
Pole Light
Interceptors
Water Heater//''"�
Outlets
Rang
Kitchen Sink
Water Service
7e
a 4
Switches
Sign
Lavatories
Auto -Wash
. /
Garbage Disposal
Standing Sections
P—Trap
Laundry Trays
Generator ❑ - KW 05.15 KW
Trash Compactor
Roof Drains
p`)
Reinspection Fee
$15
Issue Fee
$ 3
Reinspection Fee $15
Issue Fee $ 3
Reinspection Fee . I $15 I I Issue Fee - . I $ 3
Building; Canary - APPIIcanF Pink - Accounting; Goldenrod - Assessor
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved By
Boiler
Hood or Type I ❑
Canopy Type I I ❑
-
BUILDING PERMIT
$
Duct - Under Ground
SMIP
Duct - Structural
Refrigeration System
100. 100,000 B 100,000 BTU
$
-
Duct - Ventilating
PLUMBING
Exhaust System ❑ Multiple ❑
Syst epair/Alteration
ISSUANCE
$
PLAN CHECK 25%
Firepl/Fact. Bit. ICBG#
Fire Dampers -
ENERGY P.C.
$ - - -
'
Heating System & Ducting
00.100,000 BTU ID , 00 BT
Registers '
GRADING -
$
PLAN CHECK 50%
$
Reinspection Fee . I $15 I I Issue Fee - . I $ 3
Building; Canary - APPIIcanF Pink - Accounting; Goldenrod - Assessor
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved By
PLAN CHECK 25% $
-
SUMMARY OF FEES
-
BUILDING PERMIT
$
SMIP
$
PLAN CHECK
$
PERMIT
PLUMBING
$
ZSSS•OD
ISSUANCE
$
PLAN CHECK 25%
$
&S.-7
ENERGY P.C.
$ - - -
ELECTRICAL 1
$
GRADING -
$
PLAN CHECK 50%
$
MICROFILM
$
MECHANICAL ,
$
TOTAL FEE
$ 3z1' 7S
PLAN CHECK 25% $
CONSTRUCTION AND PLANNING
APPROVALS ,Permit#
Date
Inspector
POOL & SPA
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 Condi uit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFE Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P-Trap, 0 Undrgrnd.,
10. Structural Floor System
61. APPROVAL TO DECK
I?- Property Sewe-r Line & House Connection
62. Backwash & Receptor-Final
12. Sewer Cap
63. Heater & Vent-Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
- ���j'�
L
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/S�A SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit # _
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas 00il
23. Gas Pipe-Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd:Storage Tank OGas OOil
25. Roof Sheathing
74. Overhead Hydro
26. T-Bar Ceiling JStructural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe _
28. Lathing & Siding
77. FIXED SYSTEM FINAL
'
29. Insulation 1
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: C/ .7 �/ ��✓Ur r. fJ '��
34. Final Heating & Air Conditioning
r•
35. Final Gas Pipe-Test
..
36:, Hood or Canopy
.
37. Final Factory Fireplace
'
38. Final Plumbing
t
39. Water Service-Final
.40. Gas Service 'Final
-•
- -
41. Solar Domestic-Final
`
-42. Backflow Preventer
43. Backflow Irrigation
••
44. Landscape Irrigation System
-
45. Sound Attenuation
i
-46. Handicap Regulations,
i
.
47. FINAL STRUCTURE & BUILDING
,r
48. 1 Special Reduirements Completed
r
49.Electric Release to Edison
t
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. i Date
F
4
CD
Applicant to fill in all spaces except those within heavy border lines and Sign all appropriate declarations.
CITY aF COSTA MESA CTTRUCTION PERMIT T
Project Address r
Applicant's Mailing Address E• 5�� - 44!14- fQ-
Owner,'s Name- f" t/ 6is
Address �O1L1;106 �"-t-r�.�r�5��i��1�
Arch/Eng; License No.
Address r
Contractor's Name • / 'e-z—g-0 7C p on�i3a /�61
Address (mailing) tC_. .5C%70o� ..SJz'•
City License No. — tLIas8
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of Business a d Professions Code, and
my license is in full force and effect./j /j�. o
Licen Cl n / D / :F4.fia N�_�n /Q•Sa
Date Signature �•✓
WORKERS' COMPENSATION DEC RATI N ,
I hereby affirm that 1 have a certificate of consent to self -insure or a certificate
of Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. C.)
Policy No. s2/S:/L/n uZ Com ny
Certified copy is hereby turns shec.
Certif ie c y is filed with the cityOte
ng Division.
Date b Applicant
EXEMPTIO FROM WO RKERS'CONSATIO DECLARATION
(This section need not be completed ifpermit is for one hundred ($100) or
less).
I certify that in the performance of the work for which this permit is Issued, 1
shall not employ any person in any manner so as to become Subject to the
Workers' Compensation Laws of California.
Date Signature
NOTICE:'If, after making this declaration, you should become subject to the.
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with Such provisions or, this permit shall be tleemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.)
Lender's Name
-Lender's Address
OWNER BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Cotle: Any city or
county which requires a,permit to construct, alter, improve, demolish or repair
any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
'Division 3 of the Business and ProfessionsCode)' or that he/she is exempt
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
8nalty of not more than five hundred dollars ($500).
I, as owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or Improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such improvements are not intended or offered for
Sale. If, however, the building or improvement is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or im-
rove for the purpose of sale).
1, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds .or improves thereon, and who contracts for such projects with a con.
tractors) license pursuant to the Contractor's License Law). I am aware that
proof o1 their Worker's Compensation insurance should be .provided to me.
❑ 1 am exempt under Section B. & P. C. for this reason
PEE1 L NQ � q `
FACT NO.
LOT NO.
UNITiR10.
Backflow Preventer
Service Sink -
TYPE—OF CONSTRUCTION NEW LJ ADD 0 ALTERATION REPAIR
❑ CONVERSION ❑DEMOLISH ❑ OT ER
DESCRIPTION OF WORK/USE OF BLDG.���A� ee'
'
A.P. #
S
Main Building:
TYPE OF PERMIT, / GRADING FOUNDATION STRUCTURAL
1:1 TENANT i?J ELECTRICAL ❑PLUMBING ❑ MECHANICAL
❑ OTHER
T
B
A
Front
Rear
PROJECT DESCRIPTION SG. FT.OCCUPANCY
' CONSTRUCTION TV PE VA WATION$
ZONE GRADING CU. YDS. ACRES
C
KLeft
$
Right
Date
Ping.
Ref.
Remarks: ryen� QGY%es, T g7 jI to7
'
Planninq Notes:
FEES
9197 6/CC/ 7
Zone
Accessory Building:
Parking Req./Provided
7k7,_'G T-
Z
O
N
I
N
G
R
E
Q
M
T
S
Bar Sink
Showers
ELECTRICAL FEES
Backflow Preventer
Service Sink -
Automatic Washer Transformer ❑ 15-50 KW
Construction Pole Sub. ❑ 50 + KW
Backflow Irrigation
Sewer Cap
Bathtubs
Sewer Connection
Cooking Unit Meter .QLp to 100 amps 190
Clarifiers
Solar Collectors
Date
Dishwasher Meter ❑over 100 amps _
Dishwasher
Solar Piping
Dryers ❑Gas ❑Electric Sub Panel
Drinking Fountains
Solar Tank
SUMMARY OF FEES
/ Fan Motors ❑0-1HP❑1%-8
Floor Drains
Swimming Pool w/Spa
BUILDING PERMIT
F.A.U. Inc. Solar 09-15 HP 016-15+
Floor Sinks
Urinal
Fixtures Microwave
.+
Gas Service Outlets
Water Closet
Pole Light
Interceptors
Water Heater
ISSUANCE
Outlets Range
Kitchen Sink
Water Service
-
S191�witches - Sign
Lavatories
Auto -Wash
$
Garbage Disposal Standing SectionsUU [7
P -Trap„ -
Laundry Trays
PLAN CHECK 50%
Generator 00-5 KW 05.15 KW Trash Compactor
Roof Drains
S
e _ t•,,,- _ _- _ A _.
Reinspection Fee 1 $15 1 1 Issue Fee I S 3
ler
Under Ground
Structural
Exhaust System ❑ Multiple ❑
Firepl/Fact. Bit. ICBO #
Date _ Owner - Heating System & Ducting
I hereby certify t I have read this application and state that the above ❑0.100,000 BTU ❑100,000 BT
information is rr t. I agree comply with all city antl county ordinances
antl state la re ing to bu" ing construction, antl hereby.
repre-
sentatives t city to ;er upon the above -men tlo ned property for
Signature i/C. - Date d
Drivers' Lic se or SS Reinspection Fee $15
IF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
Hoodor Type ❑
Canopy Type I I ❑
Refrigeration System
110-100,o00BTU 0100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee I $ 3
I Reinspection Fee
I $15 I Issue Fee
I $ 3 '
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Date
Building Approved By
Date
Application Issued By-
Datfl
SUMMARY OF FEES
BUILDING PERMIT
$
SMIP
$
PLAN CHECK
$ -
PERMIT
PLUMBING
$
ISSUANCE
- $
PLAN CHECK 25%
$
ENERGY P.C. $
ELECTRICAL
$
GRADING
$
PLAN CHECK 50%
$ f
MICROFILM
S
MECHANICAL
$
TOTAL FEE
$
`V7,3d
PLAN CHECK 25%
$
CONSTRUCTION AND PLANNING
APPROVALS Permit #
I
Date
:'?f
�I,nspe*,ctor
r
- POOL &SPA
APPROVALS Permit #
Date
Inspector
1'. Temporary Electrical Service or Pole
!
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. i
53. Steel Reinforcement
3. Electrical Conduit Ufility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd.
i
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation - r
.,
59. Gas'Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60.• Bawl ash 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
i
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
Q. Fencing & Access Approval
17. Rough Wiring Signs
68' APPROVED FOR PLASTERING
18. Rough Electrical-TiBar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit z#__
20. Rough Factory Fi eplace
21. Ducts, in Structure
i
70. Underground Hydro
22. Ducts, Ventilating:
71. Produci Piping 0 Gas 00il
23. Gas Pipe -Rough &Test
72. Underground Flush
24. Roof Framing I
73. Undergrnd. Storage Tank OGas 0Oil
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
;
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing I
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
179. FINAL INSPECTION
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes: -
34. Final Heating & Air Conditioning
I
-
35. Final Gas Pipe -Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. WaterService:Final
-
40. Gas Service -Final
i
i
41. Solar Domestic -Final
42. Backflow Preveriter
43. Backflow Irrigation
44. Landscape Irrigation System -
45. Sound Attenuation
46. Handicap Regulations
47i FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
,
49..Electric Release to Edison
- -
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
s I
\I
' - Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTAA,CON))SIF3tJCTION PERMIT
Projeyct'Address J�S �I /
Appljcafnt's Mailing Address
n j a
Owner's Name .�lnit,la:.d 1 0!' o e •-� y -r
Address
Arch/Eng. License No.
Address
Contractor's Nam Phone
Addresslmailingl-Vex t
Cit
-
City License No.
LICENSED CONTRACT DECLARATION
1 hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of Janusiness and rofessions Code, and
my licensis in for antl effect.
Licens s Lice a le
Date Signature
WORK RS' O PENSATION DE ATVON-
itat I have a certific to of consent to self -insure or a certificate
of Workers' Compensation Insurance, or if carts tie copy in ieof (Section
3800, Lab. )� va,3 o
Polity No. CO
Cant letl opY i5 hereby furnished.
Ce)!P d Is filed wI[h the city i I
Dat Applicant
EXE PTI N FROM WORKERS' COMENSATION DECLARATION
(This section need not be completed If t e permit is for one hundred ($100) or
less).
I certify that in the performance Of the work for which this permit is Issuetl, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
Date Signature
NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit Is issued (Section 3097 Civ. C.)
Lender's Name
Lender's Address
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, improve, demolish or repair
any structure, prior to its Issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt
therefrom and the basis for the alleged exemption. Any violation of Section
'031.5 by any applicant for a permit subjects the applicant to a civil
ort lty of
tnot more than five hundred dollars ($500).
❑ 1, as owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure is not Intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law doesnot apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however,.the building or improvement is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or im-
prove far the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project(Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who cent 'acts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that
proof o their Worker's Compensation Insurance should be provided to me.
❑ 1 am exempt under Section S. & P. C. for this reason
Date Owner
this application and state
omply with all city and co
construction. and herebv
the
M
Drivers' Ucgbse or SS ji:
CMF 0865-46, rev. 10/84 Wh
rif, To
V�
PLUMBING
FEES
TYPE OF CONSTRUCTION NEW LJ ADD U ALTERATION` REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG
A,P•#
S
Main Building:
TYPE OF PERMIT ❑ GRADING FOUNDATION ❑ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
T
A
Front
Rear
PROJECT DESCRIPTION SO. FT. OCCUPANCY
CONSTRUCTION TYPE VALUATIONS
ZONE GRADING CU.YDS- ACRES
C
K
$
Right
Left
Ping. Ret. #
Planning Notes:
4454 E/::/'." Ca: T' -
Zone
Accessory Building:
Z
O
N
I
N
G
R
Parking Req./Provided E
Q
M
T
S
Applicant; Pink - Accounting: Goldenrod - Assessor
PLUMBING
FEES
Bar Sink -
Showers
ELECTRICAL
FEES
Backflow Preventer
Service Sink
Automatic Washer
Construction Pole Sub.
Transformer ❑ 15-50 KW
- -❑ 50+ KW ,
Backflow Irrigation Sewer Cap
Bathtubs -
Sewer Connection -
Cooking Unit-
Meter ❑up to 100 amps30.
00
Clarifiers
Solar Collectors
Dishwasher
Meter [Dover 100 amps _
Dishwasher
Solar Piping
Dryers ❑Gas ❑Electric
Sub Panel
Drinking Fountains
Solar Tank
Fan
Motors ❑0-1 HP 111 Yi - 8
S
Floor Drains
Swimming Pool W/Spa
F.A.U.
Inc. Solar09-15 HP ❑16-15+
Floor Si nks'. -
Urinal
,Fixtures
Microwave
Gas Service Outlets
Water Closeti
Device Boxes
Pole Light
Interceptors !
Water Heater
Outlets
Range
Kitchen Sink
Water Service
1' Switches -
Sign '
Lavatories
Auto -Wash
1
5 Garbage Disposal
Standing Sections
S
P -Trap';;,
Laundry Trays
' Generator ❑0.5 KW ❑5.15
KW Trash Compactor '
Roof Drains
VL' 'v
1
t—
Reinspection Fee
$15
Issue Fee
S 3
Reinspection Fee
$15 Issue Fee
$ 3 1,7
MECHANICAL
FEES
SERVICES REQUIREMENTS:
Zoning Approved By Date
Building Approved By Date
Application Issued By / Dat
-
Boiler Hood or Type ElDEVELOPMENT
Canopy Type 11 ED
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Refrigeration System
E10-100,000BTU 13100,000 BTU
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
SUMMARY OF FEES r
$ SMIP $
-
$ PERMIT -
$ ISSUANCE $
$ ENERGY P.C. $ -
$ � GRADING $
$ MICROFILM $
$ TOTALFEE $._79.00
$
_
Exhaust System ❑ Multiple ❑ System Repair/Alteration
Firepl/Fact
Heating System & Ducting Registers
00-100,000 BTU❑100,000BT
Reinspection Fee
$15 Issue Fee
S 3
Applicant; Pink - Accounting: Goldenrod - Assessor
CONSTRUCTION AND PLANNING
1 -�
'APPROVALS Permit•#
Date �,
kr. .
i
Inspector
J.: POOL & SPA
fAPPRO,V4LS Permit#
Date
Inspector
1f.;Tempoiary ElectricaGService or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.["-
53. Steel Reinforcement
,
3. Electrical Conduit Utility-Undrgrnd.
i
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
-
56. Rough Plumbing & Pressure Test
• .
6. Electrical UFER Grtid ,,
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, 0 Undrgrnd., Test
9. Water.'Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, 0 Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
i
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
Solar System -Final
16. Rough Electric Wiring
7. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas 0Oh
23. Gas Pipe Rough & Test
72. Underground Flush
'
24. Roof Framing
73. Undergrnd. Storage Tank ❑ Gas 0 Oil
25. Roof Sheathing
74. Overhead Hydro
-
- -
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
-'
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREY. 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
-
;rl
35. Final Gas Pipe -Test
36. Hood or Canopy
37. Final Factory Fireplace
'
38. Final Plumbing
I •
i r
39. -Water Service -Final
40. Gas Service -Final
t- • '
I,
141. Solar Domestic -Final
-
1.42. Backflow Preventer
,,43. Backflow Irrigation-
- 't
• X44: Landscape Irrigation System
Sound Attenuation
J �
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
- ' 1., I•';'
48.:Special Requirements Completed
-
49: Electric Release to Edison
50. Gas Release'to Southern California Gas Co
-•�' -•
51. CERTIFICATE OF OCCUPANCY
No. Date
-
City of Costa Mesa
Development Services Department
Building Safety Division CERTIFICATE OF OCCUPANCY No. 001 'S Q 0
P. O. Boz 1200
Costa Mesa, California
The Building located at 575 W, 19th gtrapt, Unit D
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group Rill Occupancy.
Use of Building Apartments
Legal Description 424-221-01 thru —19
(See reverse side for Metes and Bounds)
Building Permit No B26928 Electrical Permit No. E 28748 Plumbing Permit No. P 28280
Mechanical Permit No.
ISSUED TO:
Lincoln Property Company
16151 Beach, Blvd., Ste. 140
Huntington Beach, CA 92647
Number of apartments 16 and/or guest rooms
Building Official
by
Dale December 4, 1987
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 307 lel U.B.C.
,CMF 1015-46 rev. 1/63 White -Owner; Canary - Numerical File; Pink - Bldg. Permit File
14,
_ ApPlica nt to fill in all spaces except those within heavy bolder lines and sign all appropriate eeclzradons.
"
-
0672 1,/22/87 1632e45 Th
-
CITY OP COSTA MESA NST
'Project
R T O.
WGT N PERMI f� Q /�
lJ+� �o t
TR CT NO.
TWO.
T N
1 4� • Xe--
UNIT NU.
_
Address '
)
Applicant's M sling Add 1'
Owner's a e ho
AddressttWlc
Arch/En en No.
Address Z�O
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
-
❑CONVERSION F-1 DEMOLISH 1:1 OTHER
DE_ SCRIPTIO�LQF WOp K/USE OF BLDG.--5-^-
-f6irt-S-Ir' If 1]C. _
TYPE OF PERMIT OR FOUNDATION STRUCTURAL
❑ TENANT ❑ ELE TRICAL PLUMBING ❑ MECHANICAL ..G
• ❑ OTHER W
q
A.P. # -� 4 I�
Zone- ��
S
Main Building:
Accessory Building:
T
Front '1� (�
-
O
B
A
Rear !
N
C
Right /
-
N
Contractor's Nam ri
Address (mailing) G
City License No.
LICENSED CONTRACTOR DECLARATIO 65.1 0 3 gqS/
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full ro ce and effect. QO / ^ 1 ,
License lass License NO.4? / O( 5�
PROJECT DESCRIPTION SO.
•' CONSTRUCTIONTYPE
ZONE �•'4
_T—
Remarks:
• C • t L
F OCCUPANCY __.:-�-_
VALUATION$ SG -3
• GRADINGCU.YDS. ACRES
7 •- �,/' _
K
S
Left 141 8
G
R
Ping. Ref. # _g'c�• -'L�
Parking Req./Provided
E
Planning Not s: L•
M
T
T
Date Signature t-.—
PLUMBING FEES
\
WORKERS' OM ENSATION DE I I
I hereby affirm that I have a certificate Of consent to self -Insure or a certificate
Bar Sink
Showers
- ELECTRICAL
-
FEES
Automatic Washer
Construction Pole Sub.
Transformer ❑ 15-50 KW
1:150+ KW
-
�• Workers' Compensation Insurance, or a certified copy thereof (SectionBackflow
40
,Cy No� Company J1'ht/ (VELI'
Certified copy is hereby furnished.
Certifi cop Is filed with the city Building DI ton �-
njaLo
Preventer
Backflow Irrigation
Bathtubs
Service Sink
Sewer Cap
Sewer Connection
Cooking Unit
Meter ❑up to 100 amps
Date Applicant I r
EXEMPT ON RO WORKERS' COMPENSATION DELL IOKT N
(This section need not be completed If the permit Is for one hundred ($100) or
less).
I certify that in the performance of the work for which this permit is Issued, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
Clarifiers
Dishwasher
10rinking Fountains
Solar Collectors
Solar Piping -
Solar Tank
Dishwasher -_
Meter Clover 100 amps
-_
Dryers ,Gas ❑Electric -.
Sub Panel -
Fan
Motors El )-I HP 1:11 'h - B '
F,A.U, -
Inc. Solar ❑9-15 HP ❑76-15+
Date Signature _
NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, You must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.)
Lender's Name �
Floor Drains
Floor Sinks
Gas Service Outlets
-
Interceptors
Swimming Pool w/Spa
-
Urinal
Water Closet
Water Heater
Fixtures
MICrOW3ye
Device Boxes
Pole Light
9
Outlt
es -
Range
Lender's Address -
Kitchen Sink
- Water Service
Switches
Sign
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
couhty which requires a permit to construct, alter improve, demolish or repair
any structure, prior to its issuance, also requires tke applicant for such permit
IO file a signed statement that he/She is licensed pursuant l0 the provisions of
the Contractor's License Law (Chapter 9(commencing with Section 7000) of
Division 3 of the Business and Professions Code) or .that he/she is exempt
therefrom and the basis for the alleged exemption. Any violation of Suction
7 5 by any applicant for a permit subjects the applicant to a civil
.y of not more than five hundred dollars ($500).
as owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure is not Intended or Offered
for sale (Section- 7044, Business and Professional Code: The Contractor's
Li cause law does not apply to an owner of a.property who builds or improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale, If, however, Me building Or Improvement is Sold within one year of cam-
- pletion, the owner will have the burden of proving he/she did not build or im-
prove far the purpose of sale).
❑ I, as owner Of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property Who
. builds or Improves thereon, and Whocontractsfor such projects with a con-
tractor(sl license pursuant to the Contractor's License Law). f am aware that
Lavatories Auto -Wash
IP -Trap Laundry5
Tray
Roof Drains
Reinspection Fee $15 ISSeB Fee $ 3
MECHANICAL FEES
Boiler - Hood or Type I ❑
Canopy - Type II ❑
Duct - Under Ground
Duct -Structural Refrigeration System
Duct - Ventilating ❑0.100,000 BTU ❑100,000 BTU
- --
- Exhaust System ❑ Multiple ❑ System Repair/Alt¢ration
Garbage Disposal
Standing Sections
Generator 00-5 KW ❑5-15 KW Trash Compactor
Reinspection Fee
p
$15 Issue Fee $ 3
DEVELOPMENT SERVICE EO R NTS: p'
Zoning Approved By - Date
Building ApprOVBd By Dete / 27
Applintion Issued By Dat
-
SUMMARY OF FEES
_
BUILDING PERMIT '$' - 5q3, oa SMIP - $- �S -
proof off their Worker's Compensation Insurance should be provided to me.
❑ 1 am exempt under Section B. & P, C. for this reason
Firepl/Fact. Bit. ICBO #
_
Fire Dampers
PLAN CHECK $
PLUMBING $
PLAN CHECK 25% $
ELECTRICAL $
PLAN CHECK 50% $
MECHANICAL $
PLAN CHECK 25% $
• PERMIT -
ISSUANCE S
ENERGY P.C. $
GRADING $
MICROFILM $
TOTAL FEE. $ 6 Z,�
'
Date Owner
and state that the above
I hereby certify that I have read this y with all
in d state on is correct. I agree to comply with all city and county riteordinances
and state laws relating to building construction, and hereby authorize repre-
Sentatives of this city to eL_ALpon the abovg-mentionetl pro erty for
Inspection purposes. - i
Signature Date %
DriversLicense or SS gr
Heating System & Ducting
❑6100,000 BTU ❑100,000 BT
Registers
Reinspection Fee $15
-
Issue Fee $ 3
:MF 0865-46. rev. 10184 White - Ruildina: Canary - Applicant: Pink - Accountina:
Goldenrod
- Assessor
I
CONSTRUCTION AND PLANNING
APPROVALS Permit #
Date
Inspector
POOL & SPA
APPROVALS Permit #
Date
.Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
'
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
I
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
1
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd.
I"
57, APPROVALTO COVER-GUNITE
`
7. Footings
58. Electrical Conduit-Undrgrnd.
l
8. Foundation . ,
59. Gas Pipe, ❑-Undrgrnd., Test
'
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, El Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final _
12. Sewer Cap
63. Heater & Vent -Final
13, Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final -
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Ri Wiring Sign -
Rough
68. APPROVED FOPLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL -
-
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT -
APPROVALS Permit #
"
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro ,
- -
22. Ducts, Ventilating
71. Product Piping 0Gas ❑.Oil -y
+
23. GI as Pipe -Rough & Test
72. Underground Flush -
24. Roof Framing
73. Undergrnd. Storage Tank O.Gas 00i
25. Roof Sheathing
I
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Flame and Flashing
76. Dry Standpipe
28. Lathing & Siding
I
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREY. FINAL _
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION 4--
L.32.
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes: HOLD FOR SPECIAL R&QUa&M
34. Final Heating & Air Conditioning
i'
09
35. Filnal Gas Pipe -Test
9
36. Hood or Canopy
.• ' �. ' -"
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service -Final
- -
40. Gas Service -Final
41. Solar Domestic -Final
-- - --"'
42. Backflow Preventer
I
! .'
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
,
48. Special Requirements Completed
49. Electric Release to Edison
'
50. Gas,Release to Southern California Gas Co
-
51. CERTIFICATE OF OCCUPANCY
No Date
I's-
L,
Y
L
elft
CITY OF COSTSnGF�A C2rRUCT;11 N PERMIT
Project Address iCJ'
Applicants Mailing Address
Owner's Name './S.C4�El.—!"1'��"f+ �� Phoney/ SZ
Address V
Arch'/Eng.. License No.
Address
Contractor's Nam
/ o
Address (mallinn)/ ?K2 -0-.A
City License No.�,�� /
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my li*eeS�.s In f II f rc and eff�LA
LIC'micense Nc -DateSig tWOROMPENSAT ION rON
I herebyaffirm that I have a certificate of consent to self -Insure or.a certificate
of Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. C.) •'"'11 ���� bL/ s --yam
Po' y No.. C;2sw Company
Certified copy is hereby furnished.
Cert' yigQcgpy is jJ(etl with the city fjyl]tp inq DDS
EXEMG}IONIFROM WORKERS' CCETMIT111 N DECLARATION
(This section need not be completed if the permit Is for one hundred ($100) or
less)
I cer. tify that In the p¢rf rson i e an the work for which this permit Is issued,to
I
shall not employ any person in any manner so as [O become subject to the
Workers' Compensation Laws California.
Date _Signature
NOTICE: Compensation atter making this ions f the you shoultl become subject to the
Workers' hprprovisions Of the labor Cotle, you must forthwith
comply with Such provisions or this permit Shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the p6§tormance
of the work for 'which this permit is Issued (Section 3097 Civ. C.)
Lender's Name
Lender's Address
OWNER BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
to
owing reason (Section 7031.5 Business and Professional Code: Any city or
my which requires a permit to construct, alter. Improve, demolish or repair
structure, prior to its issuance, also requires the applicant for such permit
'ile a signed statement that he/she is licensed pursuant to the provisions of
Contractor's License Law (Chapter 9 (commencing with Section 7000( of
Ision 3 Of the -Business and Professions Code) Or that he/she Is exempt
rafrom and the basis for the alleged exemption. Any Violation of Section
11.5 by any applicant for a permit subjects the applicant to a civil
ally of not more than five hundred dollars ($500).
I, as owner of the property or my employees with wages as their sole
ipensation, will tlo the work, and the structure Is not Intended or offeree
sale (Section 7044, Business and Professional Code: The Contractor's
ante' Law does not apply to an owner of a property who builds or Improves
reon, and who does such work himself/herself or through his or her own
ployeas, provided that such improvements are not intended or offeree for
t Ifm, m
however, the building or improvement I5 sole within one year of com-
Ji , the owner will have the burden of proving he/she did not build or I-
ve for the purpose of sale).
1, as owner of the property, am exclusively contracting with licensee con.
:tors to construct the project (Section 7044, Business and Professions Code:
Contractor's License Law does not apply to an owner of property who
Ids or improves thereon, and who contracts for such projects with a con-
:tor(s1 license pursuant to the Contractor's License Law). I am aware that
of Of! their Worker's Compensation insurance should be provided to me.
I am exempt under Section B. 6 P. C. for this reason
Date Owner
I hereby certifv that I have rea
or SS
got to fill in all spaces except those within heavy border lines and sign all appropriate declarations
PERMIT NO.
Sr
TRACT NO.
LOT NO.
UNIT•.A{p,
Duct - Under Ground
TYPE OF CONSTRUCTION NEW LJ ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
A.P. 46
S
Main Builds
TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL
❑ TENANT ❑ ELECTRICAi Jl;�t`PLUMBING ❑ MECHANICAL
❑ OTHER
T
13 A
Front
Rear
Fir mpers
PROJECT DESCRIPTION SO. FT. OCCUPANCY
CONSTRUCTION TYPE VALUATIONS
•.ZONE GRADING CU. YDS. ACRES
C
K
S
Right
Left
Ping. Ref. #
Remarks:
Planning Notes:
j.
PLUMBING
_FEES
-
SMIP
PERMIT
ISSUANCE
ENERGY P.C.
GRADING
MICROFILM
TOTALFEE$�
Bar Sink Showers
Hood or Type 1 ❑
3ackflow Preventer - Service Sink
Duct - Under Ground
Automatic Washer
Backflow Irrigation Sewer Cap0
Refrigeration System
Construction Pole Sub.
Bathtubs Sewer Connection
Oo
Cooking Unit
Clarifiers Solar Collectors
Fir mpers
Dishwasher
Dishwasher Solar Piping
Od
Dryers ❑Gas ❑Electric
Drinking Fountains Solar Tank
Fan
Floor Drains Swimming Pool w/Spa
F.A.U.
Floor Sinks Urinal
-
SMIP
PERMIT
ISSUANCE
ENERGY P.C.
GRADING
MICROFILM
TOTALFEE$�
Fixtures
Gas Service Outlets Water Closet
e. J
Device Boxes
Interceptors Water Heater
Outlets
Kitchen Sink Water Service
of
Switches
Lavatories Auto -Wash
So
Garbage Disposal
P -Trap Laundry Trays
Generator 00;.54W 05 -
Roof Drains
!,,+
Reinspection Fee I $15 I I Issue Fee
Boiler
Hood or Type 1 ❑
Canopy Type I1 ❑
Duct - Under Ground
Duct - Structural I
Refrigeration System
Duct - Ventilating
00-100,000 BTU ❑1(
Exhaust System ❑ Multiple ❑
System Repa' terati
Firepl/Fact. Bit. ICBG#
Fir mpers
Heating System & Ducting
Registers
❑ 0.100,000 BTU ❑ 100,00
Reinspection Fee • 1 $15 I I Issue Fee
' 0865-46, rev. 10/64 White Building; Canary - Applicant; Pink - Accounting; Goldenrod -Assessor
6793 4/27/87
Zone
Accessory Building:
Parking Req./Provided--
ELECTRICAL
Transformer ❑ 15.50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter ❑over 100amps
Sub Panel
Motors 00.1 HP %- 8
c. Solar 5 He 016-15+
Micr ve
ole Lig
Range
Sign
Standing Sections
15 KW Trash Compactor
244025 TL
$ 3
Reinspection Fee
$15 Issue Fee
$ 3
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved By
Application Issued By-
1&5
Date
Date-,
Data!=
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
SUMMARY OF FEES
$
$
$ i0/ fi,e�s. p -D
$ 4lsr%457
$
$
$ -
s
-
SMIP
PERMIT
ISSUANCE
ENERGY P.C.
GRADING
MICROFILM
TOTALFEE$�
$
$
$'
$
$
/
24+ 15-
$ 3
CONSTRUCTION AND PLANNING
APPROVALS Permit#
Date
Inspector
POOL & SPA
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, ❑ 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
7111F
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/$PyF)SYSTEMS FINAL
19. Rough'Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit # _
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping ❑Gas ❑Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank OGas ❑Oil
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
r
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: 711,11F
34. Final Heating & Air Conditioning
`Vitt 3 ] Tua r Bsr 04 t,�
35. Final Gas Pipe -Test
•_ r
36. Hood or Canopy
37. Final Factory Fireplace
38: Final Plumbing
39. Water Service -Final
-
40. Gas Service -Final
! ,
41. Solar Domestic -Final,
42. Backflow Preventer
• 43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation•
v
i
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
,
51. CERTIFICATE OF OCCUPANCY
No. Date
�, ,
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF-CQSTA MESA CONSTRUCTION PERMIT
Project Address 0•
'w Applicant's Mailing Address 'L141 E•.SG'/7� s7- ��-.te eA
Ownr's Name 24&eO4.4/ Ti L"6- 77� P,pS 57/-ld7.i
Address
Arch/Eng. License No.
Address
Contractor's Name <Tt3 EA E; -C7 -/P -/G 1"r 3 a -71P16 Z
Address (mailing) J W. 15 • 5x1121 IST 0//1//A/,J'9-, C"Y�
City License No. � u � as8
LICENSED CONTRACTOR DECLARATION
I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of a Business d Professions Code, and
IN my license is in full rce and of fec
(� License Cl }ss / e e Ny:3o%gS�
Date R R 7 5 9 t i �'Ts-A�f-
WORKERS' COMPENSATION DE LARATION
1 1 hereby affirm that I have a certificate of consent to self -insure or a certificate
r Of Workers' Compensation Insurance, or a certified copy thereof (Section
1800, Lab. C.) S�FEGo
IPolicy No.99 Itt 81151511 d Company
Certified copy is hereby furnished
Certif'e o IS filed with the city mg Dlvisio
Date �� Applicant J
EXEMPTION FROM WORKERS' CO NSATI N DECLARATION
(This section need not be completed if the permit is for one hundred ($100) or
less)
1 certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
Date Signature
-NOTICE: If, after making this declaration, youshould become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.)
Lender's -Name _
Lender's Address
OWNER BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, improve, demolish or repair
any structure, pr or to its issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of
the Contractor's License.Law (Chapter 9 (commencing with Section 7000) of
Division -3 of the Business and Professions Code) or that he/she is exempt-
lerefrom and the basis for the alleged exemption. Any violation of Section
31.5 by any applicant for a permit subjects the applicant to a civil
laity of not more than five hundred dollars ($500).
I, as owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered
for sale (Section 7044, Business.and' Professional Code: The Contractor's
License Law doe, not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale, If, however, the building or improvement is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or im-
prove efor the purpose of sale).
1, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044, Business and Professions'Code:
The Contractor's License Law does not apply to an owner of property. who
builds or improves thereon, and who contracts for such projects with a con.
tra Ctor(s) license pursuant to the Contractor's License Law). I am aware that
proof off their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section B. & P. C. for this reason
Date Owner .
I hereby certify that I have read
Information is corre I agree to
and state laws re in to build!�gg
sentatives of t cyty to ant (�
Signature C
Drivers' Lic se r SS
CMF 0865-46, rev. 10/84 White - Be
this application and state that the above
amply with all city and county ordinances
construction, and hereby authorize repre-
ipon ,a a�bove-mentioned prop rTy for
y,.../ Dale
TYPE OF CONSTRUCTION i!!� NEW LJ ADD
❑ CONVERSION ❑ DEMOLISH ❑ OTH R
DESCRIPTION OF WORK/USE OF BLDG.
J ALTERATION LJ REPAIR
-
A.P. #
S
Main Build!
TYPE OF PERMIT �GRADING ❑ FOUNDATION ❑ STRUCTURAL
El TENANT 1/Jy ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
T
B
A
Front
Rear
PROJECT DESCRIPTION SO. FT. OCCUPANCY
CONSTRUCTION TYPE VALUATION$
ZONE GRADING CU.YDS. ACRES
C
KLeft
S
Right
Ping. Ref. #
Remarks:
Planning Notes:
!�Ilk C71C'AllTY` 0Z
Bar Sink
Backflow Preventer -
Backflow Irrigation
Bathtubs
Clarifiers
Floor Drains
Floor Sinks
Gas Service
Interceptors
Kitchen Sink
Lavatories
P -Trap,
Roof Drains
Outlets
Reinspection Fee d x$15
oiler
Wet - Under Ground
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Bit. ICED #
Heating System & Ducting
❑0-100,000 BTU 0100,000
Reinspection Fee 1 $15
Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
2-9
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors _
Solar Piping
Solar Tank '
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto -Wash
Laundry Trays
Issue Fee
Hood or Type ❑
Canopy Type I I ❑
Refrigeration System
00-100,000BTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
FEES
$ 3
$ 3
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher -
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
9196 61m-31-7
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL -
Transformer ❑ 15-50 KW
❑ 50+ KW.
Meter up to 100 amps
Meter ❑over 100 amps
Sub Panel
Motors El 0-1 HP ❑1 % - 8
Inc. So lar ❑9-15 HP 016-15+
Microwave
Pole Light i a
I Outlets - Range
t Switches OSign
Garbage Disposal Standing Sections
Generator 1-10-5 KW ❑5-15 KW Trash Compactor
r e2
7-
M
i
Reinspection Fee $15 Issue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved By
SUMMARY OF FEES
BUILDING PERMIT $ SMIP
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE
PLAN'CHECK 25% $?/'-yj�--�[�J ENERGY P.C.
ELECTRICAL $ —� i n • J--tL GRADING
PLAN CHECK 50% $ MICROFILM
MECHANICAL $ - TOTAL FEE
PLAN CHECK 25% $
70.:'7 TL
Z
O
N
I
N
G
R
E
Q
M
T
S
FEES
$ 3
CONSTRUCTION AND PLANNING
APPROVALS Permit #
Date S
U ''
-Inspector
,. f ,
POOL & SPA
'APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd.
57. APPROVALTO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
1,�,
59,. 'Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. J
-- I'
�
60� Backwash Lines, P -Trap, ❑ Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final ,
12. Sewer, Cap
63. Heater & Vent -Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
1
C, -
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit # _
j
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas []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 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
9. FINAL INSPECTION
-
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
(Heating
D�
Notes:
34. Final & Air Conditioning
35. Final Gas Pipe -Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. WateriService-Final
-
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
-
43. Backflow Irrigation
44. Landscape Irrigation System
-
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48.,Special Requirements Completed
49. Electric Release to Edison
- +
50. Gas Release to Southern California Gas Cc
51. CERTIFICATE OF OCCUPANCY
No. Date
-
City of Costa Mesa
Development Services Department
Building Safety Division CERTIFICATE OF OCCUPANCY No. J U --'
P. O. Box 1200
Costa Mesa. California
The Building located at 47S ra 106 e�..--r• "-4
f
has been inspected and found to comply with the provisions oall City of Costa Mesa Ordinances applicable thereto
for a Group R1 Occupancy.
Use of Building AnarhmnnPa
Legal Description APA -271—n1 hhrt. —10
(See reverse side for Metes and Bounds)
Building Permit No R25A2A Electrical Permit No. E 29001 Plumbing Permit No. a 91`17'41
Mechanical Permit No
ISSUED TO:
Lincoln Property Company
ih152 3oach, Blad., Ste. 140
fluntinciton Beach, CA 92647
Number of apartments 21 - and/or guest rooms
Building Official
VA
Date fAocipmh�.r A. 1 AA7
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 307 lel U.B.C.
CMF 1015-46 rev. 1/83 White - Owner; Canary - Numerical File; Pink - Bldg. Permit File
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA TPUCT N PERMIT —
Project Address
Applicant's Mailin(9Address
Owner's ame , •WCFET-r h
11M!T
Address kuvb,
//
Arch/En 1' icense Nq_N A.(-•�'
Address n Z
Contractor's Name ^rwl oneT'`�j
Add
City I inerse (mailing) -C_:n —1
City License No. r� I /�
LICENSED CONTRACTOR DECLARATIONFJ•L• Fq5,
I hereby affirm that I am licensed under provisions of Ch er 9 (commencing
with Section 7000) of Division 3 of the Business and Professions Code, and
my license is In full force and effect.
License Sloss o License No,�R._9.-ice `r_
Data K4R 4�7 Signature Q� —
WORK RS' OMP I have ION DECte RATIO
I hereby affirm mp 1 have a Insurance of consent fi self -Insure er a f (Section ` cate
Workers' Compensation Insurance, or a certified copy thereof (SoctlOn
100, Lab. C. ,�w u. /1 II 1I_ Q IIAA11,A� /]
Policy No.15�,�G91-"Y041 IPompanY
Certified copy is hereby furnished. t
Date
ertified copy is filed with Applicant— city Building I r�OCJs, s'
EXEMPTION FROM WORKERS' COMPE 1SIDECti-KiRA-MON
(This section need not be completed I1 the permit is for one hundred ($100) or
ess).
I C¢rti fy that In the performance of th0 work for which this permit is Issued, 1
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
Date Signature
NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.,
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance
of the work for whi this p rmi[ is iss tl (Se4,on 3097 Civ. C.)
Lender's Name
Lender's Address - ngll92 (� t _— `Ql -
OWNER BUILDER DECLARATION
I hereby affirm4that.1 am exempt from the Contractor's License Law for the
following reason '(Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, improve. demolish or repair
any structure, prior to -its issuance, also requires the applicant for such permit
to file a signed statement that he/she Is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she Is exempt
'herefrom and the basis for the alleged exemption. Any violation Of Section
031.5 by any applicant for a permit subjects the applicant to a civil
analty of not more than five hundred dollars ($500).
❑ I, as owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered
forsale (Section, 7044,_ Business and Professional_ Code: The Contractor's
License Law does not apply to an owner of a property who builds or Improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement Is sold within one year of com-
pletlon, the owner will have the burden of proving he/she did not build or Im-
rpve for the purpose of sale).
I, as owner Of the, property, am exclusively contracting with licensed con-
tractorsto construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a con-
tractor(s1 license pursuant to the Contractor's License Law). I am aware that
proof Off their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section B. & P. C. for this reason
Date Owner
I hereby certify that I have rea
information Is correct. I agree to
and state laws relating to buildir
sentatives of this city to ntZ
inspection purposes `'�s�•
Signature.-_Yi]//
Drivers' License or SS YA.
thl
a
repre-
v for
Boiler Hood or Type 1 ❑
l
Duct - Under Ground Canopy Type 11 ❑
Duct -Structural Refrigeration System
Duct - Ventilating ❑0.100,000 BTU ❑100,000 BTU
Exhaust System ❑ Multiple ❑ System Repair/Alteration
Firepl/Fact Bit. ICBG# Fire Dampers
Heating System & Ducting Registers
❑ 0. 100,000 BTU ❑ 100,000 BT
Reinspection Fee
$15 Issue Fee $ 3
CMF 0865-46, rev. 10/84 White ' Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
ti 0673 _1/22P87
A.P. # -Z 2 I .-. 6P I
I- I `I I Zone
S
Main Building::
Accessory Building'
TYPE OF CONSTRUCTION M NEW LJ ADD LJ ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHHEEER�
DESOgjpT I? OF WQR K/USE OF BLDG. 1�1 lr�
TYPE OF PERMIT L.J GRADING 09"F-OUNDATION STRUCTURAL
❑ TENANT ❑ ELECTRICAL❑ P UMBI NG 13 MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SQ. FT I L2 OCCUPAN v
CON STRUCTON TYPE VALUATION
„ ZONE___ GRADING CU.YDS. ACRES'
Remarks:
ARear
•�—
. PERMIT
C
PLUMBING
FEES
Sink -
Showers
PLAN CHECK 25%
_Bar
Backflow Preventer
Service Sink
Parking Req./Provided
Backflow Irrigation
Sewer Cap
a GRADING
Bathtubs
Sewer Connection
$
Clarifiers
Solar Collectors
ELECTRICAL
Dishwasher
Solar Piping
Transformer ❑ 15-50 KW
❑ 50+KW
' Drinking Fountains
Solar Tank
Meter ❑up to 100 amps
- Floor Drains -
- Swimming Pool w/Spa
Meter, Clover 100 amps
Floor Sinks
Urinal
Sub Panel -
Gas Service Outlets
Water Closet
Motors 00-1 HP ❑1'h-8 -
Interceptors
Water Heater
Ina Solar ❑9-15 HP 1116-15+
Kitchen Sink
Water Service
Microwave
Lavatories
Auto -Wash
Pole Light'
P—Trap
Laundry Trays
Range
Roof Drains
Switches - -
Sign '
Garbage Disposal
Standing Sections
Reinspection Fee
1 $15
1 Issue Fee
$ 3
Boiler Hood or Type 1 ❑
l
Duct - Under Ground Canopy Type 11 ❑
Duct -Structural Refrigeration System
Duct - Ventilating ❑0.100,000 BTU ❑100,000 BTU
Exhaust System ❑ Multiple ❑ System Repair/Alteration
Firepl/Fact Bit. ICBG# Fire Dampers
Heating System & Ducting Registers
❑ 0. 100,000 BTU ❑ 100,000 BT
Reinspection Fee
$15 Issue Fee $ 3
CMF 0865-46, rev. 10/84 White ' Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
ti 0673 _1/22P87
A.P. # -Z 2 I .-. 6P I
I- I `I I Zone
S
Main Building::
Accessory Building'
E
!�T Front
$- 48 G9
ARear
•�—
. PERMIT
C
Right
$
SLeft
2,7,
PLAN CHECK 25%
Ping.
Ref. # RA -9 P; ZIL'-
Parking Req./Provided
Planning Notes:
$
a GRADING
$
PLAN CHECK 50%
$
ROLD FOR SPECIAL RE Ui.
$
ELECTRICAL
Automatic.Washer
Construction Pole Sub. -
Transformer ❑ 15-50 KW
❑ 50+KW
Cooking Unit
Meter ❑up to 100 amps
Dishwasher
Meter, Clover 100 amps
Dryers ❑Gas ❑Electric
Sub Panel -
Fan
Motors 00-1 HP ❑1'h-8 -
-
F.A.U. _
Ina Solar ❑9-15 HP 1116-15+
Fixtures
Microwave
Device Boxes
Pole Light'
Outlets
Range
Switches - -
Sign '
Garbage Disposal
Standing Sections
Generator ❑0-5 KW ❑5-15 KW
Trash Compactor
19�Ie-69 TL
FEES
Z
O
N
I
N
G
R
E
O
M
T
S
I I Reinspection Fee ,1 $15 1- 1 Issue Fee 1 $ 3 1 '1
DEVELOPMENT SERVICES
Zoning Approved By f
Building Approved By
MECHANICAL * $ TOTALFEE $ % ,6
PLAN CHECK 25% $
SUMMARY OF FEES
BUILDING PERMIT
$
2300 sMla
$- 48 G9
PLAN CHECK
$
. PERMIT
PLUMBING
$
ISSUANCE
$ -
PLAN CHECK 25%
$
ENERGY P.C.
$
ELECTRICAL
$
a GRADING
$
PLAN CHECK 50%
$
MICROFILM
$
MECHANICAL * $ TOTALFEE $ % ,6
PLAN CHECK 25% $
CONSTRUCTION AND PLANNING
APPROVALS Permit #
Date
Inspector
POOL & SPA
APPROVALS Permit #
Date
Inspector
1. Temporary Electric ,al Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd�
i
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER 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. Plumbing System - Final
14. Rough Plumbing
65. Electrical-Final
15. Rough Electrical-Conduit
66. Solar System-Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating &Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
"
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
'
22. Ducts, Ventilating
71. Product Piping ❑ Gas ❑ Oil
'
23. Gas Pipe-Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank OGas ❑Oil
,
25. Roof Sheathing
74. Overhead Hydro -
26: T-Bar Ceiling (Structural) & Monocoat
I
75. Dry Chemical
27. Frame and Flashing
76. Dry Standpipe
,
28. Lathing & Siding
-
77. FIXED SYSTEM FINAL'
29. Insulation
78. FIRE PREY. 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
34. Final Heating & Air Conditioning
Notes:j
-
oe
35. Final Gas Pipe-Test
36. Hood or Canopy
--•
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
' •'-;,
40. Gas Service-Final
41. Solar Domestic-Final
-
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System'-
45. Sound Attenuation
-
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
o`ro Gt
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
'
51. CERTIFICATE OF OCCUPANCY
No. 6 Date
N
i
r25S Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF -COSTA MESA C N TRUCTLONPERMIT „�o..�r TpxrTxlr, ��T,�r, ,,,,_ •�
Project Addrefs �/JJ�
Applicant's Mailing Address - 410o
Owner's Name //"ILQL�62W Zt'2—Phone
Address
Arch/Eng. License No.
Address ��������__
Contractor's Nam - SL�L�J
Address (mailing) ) de �,�-P�a�,f?-aU�— �i✓S
City License No. .Qy�/
LICENSED CONTRACTOR DECLARATION
1 hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full f ce`}n effect. /
License SS 1ens
Oat
e G/I—A Signature
WORKERS' OMPENSATIONE LAE LA A
hereby affirm that I have a certificate of consent to self -insure or a certificate
Workers' Compensation Insurance, or a certified copy thereof (Section
300, Lab. C r �j is
Po' y No. _gj��.sQLl.f Yl}� Company �j�
ert ifietl copy is hereby furnishetl. ����
Cert lfi tl cop liletl,wl[h the city Buil D'
Date Applicaet � —
EXE TIO ROMWORKERS'�DECLA0.ATION
(This section need not be completetl if the permit Is for One hundretl ($100) or
e
certify
I certify that in the performance the work for which this permit is issued, I
an
shall not employ any person in any manner so as to become subject t0 the
Workers' Compensation Laws California.
Date Signature
NOTICE: If,C alter making this ions f the you should become subject. to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed r<vok¢tl.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097. �C iv. OJ
Lender's Name ` 4
Lender's Address
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's Llcenee'L'aw for the
following reason (Section 7031.5 Business and Professional Code:,Any city or
county which requires a permit to Construct, alter, improve, demolish. or repai
that
W
S of
of
sIpt
ierefrom and the basis for the alleged exemption. Any violation of Section
331.5 by any applicant for a permit subjects the applicant to a civil
nnalty of not more than five hundred dollars ($500).
I, as owner of the property Or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or Improvement Is sold within one year of Com-
pletion, the owner will have the burden Of proving he/she did not build or Im-
prove efor the purpose of sale).
I.
as owner of the property, am exclusively contracting with licensed Con-
tractors to construct the project (Section 7044, Business and Professions Code;
The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a con.
tractor( license pursuant to the Contractor's License Law). 1 am aware that
proof d their Worker's Compensation insurance should be provided to me
0 I am exempt under Section B. & P. C. for this reason
Date
Signatu
Drivers'
Owner
that I have read this
)rred. I agree to comp
el g to bui cc
ity me i
or SS rf / C
CMF 0865-46, rev. 10/84 White - Building; Canary
TYPE OF CONSTRUCTION i•MW LJ ADD
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
LJ ALTERATION LJ REPAIR
ELECTRICAL
A.P. #
S
Main Building:
TYPE OF PERMIT GRADING FOUNDATION 0 STRUCTURAL
❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL
❑ OTHER
E
T
B
%t
Front
Rear
PROJECT DESCRIPTION SQ. FT. OCCUPANCY
CONS TRUCTIONTYPE VALUATIONS
ZONEGRADING CU.YDS. ACRES
C
KLeft
$
Right
Ping. Ref. #
Remarks_
'
Planning NOtes:
l
Sub Panel
3ackflow Preventer
3ackfi6w Irrigation
Bathtubs
Clarifiers -
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fee $15
Boiler -- - -
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System 0 Multiple
Firepl/Fact. Bit. ICBO #
Heating System & Ducting
E10-1 00,000 BTU 0100,000
Reinspection Fee I $15
Pink - Accounting; Goldenrod - Assessor
Showers
Service Sink
Sewer Cap'
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto -Wash
Laundry Trays
Issue Fee
Hood or _ Type 1 -❑ -
Canopy Type If ❑
Refrigeration System
00-100,000 BTU
System ReppiflrAlter.
Issue Fee
6792 4/27/87 321,75 TL
Zone
Accessory Building:
Z
O
N
1
N
G
R
Parking Req./Provided E
M
T
S
-
ELECTRICAL
FEES
Automatic Washer
Construction Pole Sub.
Transformer O 15-50 KW
.050+KW
b Tv
,o
Cooking Unit
Meter Oup to 100 amps
Dishwasher -
Meter Cover 100 amps
'
ea
Dryers ❑Gas ❑Electric
Sub Panel
Fan
Motors 00-1 HP ❑ -8
F.A.U.
I Inc Solar 09= HP 016-15+
Fixtures
Microwa
6J
Device Boxes
P ight
Outlets
Range
of
Switches - - -
Sign - - -
pZ 00
Garbage Disposal
Standing Sections -
Generator 00-5 KW -15
KW Trash Compactor
--Lao
$ 3
Et
Reinspection Fee
$15 Issue Fee
$ 3
FEES
DEVELOPMENT SERVICES
Zoning Approved By
Building Approved By
Application Issued Bylssuad
REQUIREMENTS: -
- -- Date-
_Date
pat
-
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL '
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
SUMMARY OF FEES
$ SMIP $
$ PERMIT
$ V ISSUANCE $
$ 63. 14�- ENERGY P.C. $
$ GRADING S
$ MICROFILM $
$ TOTAL FEE $
$
'
$ 3
CONSTRUCTIONPOOL
AND PLANNING
APPROVALS Permit #
Date
Inspector
& SPA
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location '
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement .
56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation ;
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, 0 Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains ,
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SP.A,SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit # _
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas 0Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank OGas 0Oil
25. Roof Sheathing
74. Overhead Hydra
26. T -Bar Ceiling (Structural) & Monocoat
75.. Dry Chemical
27. Frame and Flashing -
i
-
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: 71ZVI +7 Tu197-er'- (X_ C,gv_9
34. Final Heating,& Air Conditioning
/0-16-v%- 1IL" Cuxso COwsm, 8"Af4c
35. Final Gas Pipe -Test
36: Hood or Canopy
_
37. Final Factory!Fireplace
Q�
38., Final Plumbing
39! Water Service -Final
40. Gas Service -Final
Y
41. Solar Domestic -Final
,
42. Backflow Preventer
' 43. Backflow Irrigation
- 44. Landscape Irrigation System
45. Sound Attenuation
-.
- 46.E Handicap Regulations
47. FINAL STRUCTURE&BUILDING-
48.;Special Requirements Completed
'
49. Electric Release to Edison
- r
50. Gas Release to;Southern California Gas Co
- - -
51. CERTIFICATE OF OCCUPANCY
No. Date
,6` �1 / i
' LUV" C Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY O.F COSTA MESA CONSTRUCTION PERMIT
Project Addiess �_S Zr]• /97y-
ApplicanI's MeilingAddress £.4111414
Owner's Namrr O/JEi2T7 hone yr2S
Address7z!2/ 4ned& (ehf pr r!%C- fY157f� 01_1 d
Arch/Eng. License No.
Address
Contractor's Nam
Address (mailing) 1144 57— e-yaig 1 e7¢'•
City License No.
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) Of Dlvision 3 of t Businesstl Professions Code; and
my license is in full 1 fCe and effect. !p
ObLicense Cl s No. O
Ob Date Signature
WORKERS' COMPENSATION DEC RATION
1 I hereby affirm that I have a certificate of consent to salfAmure or a certificate
' Workers' Compensation Insurance, or a certified copy thereof (Section
olio. Lab. C)wr+/dr "�C'6
Policy No.5i,7 Co y ••
Certified Copy i5 hereby furnishetl.
O y� Cert' ie co is filed with the cit ing Divisi y
` Dtte Applican
EXEMP ION FROM WORKERS' C PENSATION DECLARATION
(This section neetl not be compleletl i1 the permit is for one hundred ($100) or
Ipss)
Certify that in they person
in of the work for whto this permit IS t to t, I
shall not employ any person )n any manner so as to become subject to the
Workers' Compensation Laws of California. -
Data Signature -
NOTICE: 11, altar making this declaration, you,¢come subject to the
Workers' Compensation provisions of the Laborr CodCode, you must forthwith
comply
CONSTRUCTION
with such provisions or this permit Shall be deemed revoked.
RUCTION LENDING AGENCY
hereby work that there is a is permit lending agency for the perlorv. C.)
of the work for which this permit is issued (Section 3097 Civ. C.)
Lender's Name
Lender's Address
OWNER BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to Construct, alter, Improve, demolish or repair
any St ruct ure,, prior to its Issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she Is exempt
'erefrom and the basis for the alleged exemption. Any violation of Section
31.5 by any applicant for a permit subjects the applicant to a civil
halty of not more than five hundred dollars ($500).
L3 I, as owner of the properly Or my employees with wages as their sole
compensation, will do the work, and the structure Is not Intended or offered
for Sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an Owner Of a properly Who builds Or Improve$
thereon, and who doe$ such work himself/herself orrough his or her own
h
,employees, provided that such Improvements are not intended or offered for
sale. If, however, the building or Improvement IS $Old within one year of com-
pletion, the owner will have the burden of proving he/she did not build or im-
prove for the purpose of sale),
❑ 1, as the
of the property, am exclusively contracting with licensed con-
tracl,rs to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). 1 am aware that
proof of their Worker's Compensation Insurance Should be provided to me.
❑ 1 am exempt under Section B. & P. C. for this reason
Date
Owner
I have read this application and state that the above
1 agree tg comply with all city and county ordinances
to but 9 construction, and hereby authorize repre-
to a upon the above-mentioned grope y for
Z P�
Z9 0-
rLUMMINU
rttJ
-
ELECTRICAL
TYPEOFCONSTRUCTION Z NEW LJ ADD Ll ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG. KF.SyDPit�G
A.P. q16 Zone
S
Main Building: Accessary Building:
PLAN CHECK
TYPE OF PERMIT y GRADING FOUNDATION STRUCTURAL
El TENANT J;!J ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
F-1 OTHER
PROJECT DESCRIPTION SO. FT. OCCUPANCY
CONSTRUCTION TYPE VALUATIONS—
ZONE GRADINGCU.YDS. ACRES
T
Front
0
B
A
Rear
N
C
Right
N
S
Left
O
R
Ping. Ref. # Parking Req./Provided
E
Remarks:
Planning Notes:
M
G E�jlJ/T >269 �9
MECHANICAL
s
Roof Drains
Reinspection Fee 1 $15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact, Bit. ICBO #
Heating System & Ducting
❑ 0.100,000 BTU ❑ 1 oo,000
Signature cv Date
Drivers' Licel se or SS Yf
I I Reinspection Fee I $15
CMF 0965-46, rev. 10/84 White - Building; Canary -Applicant; Pink -Accounting; Goldenrod -Assessor
Issue Fee
Hood or Type ❑
Canopy Type 11 ❑
Refrigeration System
00-100,000BTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
$ 3
$, 3
I Reinspection Fee 1 $15 1 1 Issue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved By
Application Issued By
$ 3
To -*&e /a /Obr 9 0
SUMMARY OF FEES
BUILDING PERMIT
S SMIP
$
PLAN CHECK
$ PERMIT
PLUMBING
$ ISSUANCE
$
PLAN CHECK
25%
$ ENERGY P.C.
$
ELECTRICAL
$ O GRADING
S
PLAN CHECK
s
50%
$v O MICROFILM
$
MECHANICAL
$ TOTAL FEE
$
PLAN CHECK
25%
$ / W_1l 1 -) /e�
To -*&e /a /Obr 9 0
CONSTRUCTION AND PLANNING
• APPROVALS Permit #
Date
Inspector
POOL & SPA
-APPROVALS Permit #
Date
Inspector
1: Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding `
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, ❑ Undrgrnd., Test
9. Water Pipe-Undrgrnd. i
60. Backwash Lines, P -Trap, ❑ Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line &House Connection
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
�1 '
J
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit # _
,
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 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 Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric see
no
Notes: 101,1018,7 ko 0 ne 1. Qre �e/n.
34. Final Heating & Air Conditioning
w' n P:n,3i,et1 l Mefrr
35. Final Gas Pipe -Test
K
36. Hood or Canopy
37. Final Factory Fireplace
0 l
38. Final Plumbing '
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final,
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
'
48. Special Requirements Completed
49. Electric Release to Edison
-
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF,OCCUPANCY
No. Date
City of Costa Mesa
Development Services Department
Building Safety Division CERTIFICATE OF OCCUPANCY No. U
-
P. O. Box 1200 `
Costa Mesa, California '
The Building located at c'7c _ t n_ . 4
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group R1 Occupancy.
Use of Building Aoartmanta
Legal Description 424-2.71-01 thrtt —1Q
(See reverse side for Metes and Bounds)
Building Permit No R7AQ'An Electrical Permit No. c 70147n Plumbing Permit No. 0 7f2777
Mechanical Permit No.
ISSUED TO:
Lincoln Prooectv Comnanv
16152 Beach Blvd., Ste. 140
Huntinaton Beach, CA 92647
Number of apartments and/or guest rooms
Building Official
EAF
Date Dc�nAmhc r A. 1 QP.7
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 307 (el U.B.C.
CMF 1015-46 rev. 1/83 White - Owner; Canary - Numerical File; Pink - Bldg. Permit File
L_vPncanfto fill in all spaces excePt those within heavy border lines and sign all appropriate declarations.
.CITY OF COSTA MESA CONS UCTION PERMIT
Project Address
.Applicant's Mailin Address
Owner's am on
FZ4
Address _ _ _
Address ttr s'
Contractor's Nam ems•
Address (mailing) In
City License No. CAp
LICENSED CONTRACTOR DECLARATION,5 j.. 3845/
I hereby affirm that I am licensed under provisions of C arter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force and effect. n
License QaSS_ License No.aL/ (Jl
Dale Signature
WORK RS' JCMpEr4SATION DECLARATIO
I hereby affirm that I have a certificate of consent to self -Insure or a certificate
of Workers' Compensation Insurance, or a certified copy, thereof (Section
800, /,r�jA, 4%L!/)
ollce No.d cop 's hereby
ere Company
certified copy is hereby furnished, /
Ce rtlf d co y Is filed with the city Building Ivuj2p.
Date Applicant
EXEM ION ROM WORKERS' COMPENSATION D AR ION
(This section need not be Completed if the permit is for O e hundred ($100) or
less).
1 certify that in the performance of the work for which this permit is Issued, I
shall not employ any Person in any manner so as to become subject to the
Workers' Compensation Laws of California.
Date —Signature
NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation Provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shait be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of the work for whici this per it issu d (Sect4on 3097 Civ. C.)
Lender's Name.
Lender's Address
OWNER BUILDER PECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
followingreason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, improve, demolish or repair
any structure, ort or to its issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
13nalty of not more than five hundred dollars ($500).
I, as owner of the property or my employees with wages as their sole
for sensation, will7044, Business and Professional and the structure snot Cotle:n The ed or Con[ actors
for sale (Section -
License Law does not apply 10 an owner of a property who through
his or improves
thereon, and who does such work himself/herself or Intended
his or her own
employees, f,ho ever, the
that such improvements are not ithin o or year
of
for
sale. If, however, the will
have
int or improvement is sold within one year of r Im-
pletlon, the owner will have the burden of proving he/she tlltl not build or im-
�rova for the purpose of sale).
-I, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project(Section 7044, Business and Professions Code:
The Contractor's License Law dyes not apply to an owner of property who
builds or Improves thereon, and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). am aware that
proof of their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section B. & P. C. for this reason
Date Owner
I hereby certify that 1 have read this applicati
information is correct. I agree to comply with a
and state lawsrelating to building construction
sentatives of this city to aer uoon the ab
inspection purposes.
Signature
Drivers' License or 55 9f
cold
} IVU 3O
inrsr,l rvti.
L I rvU.
UNIT NO
SUMMARY OF FEESBUILDING
�j—f-7�• 3•OG3 SMTP
PERMIT -
ISSUANCE
ENERGY P.C.
- GRADING
- MICROFILM
TOTAL FEE
I '
TYPE OF CONSTRUCTION NEW LJ ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER -
D�$G@I PT N F ORK/USE OF BLDG. Z,�{IT
�'
A.P. #
S
T
B
A
Main Building:
TYPE OF PERMIT GRADING
❑ TENANT ❑ ELECTRICAL
El OTHER —�Il
PROJECT DESCRIPTION SQ.'Fi-
CONST CT TYPE
' ZONE
FOUNDATION STRUCTURAL
❑ P��LLUM�����BsssssI,,N��G ❑ MECHANICAL
�sA p_ nwG4 ��
-Ci 'OCCUPA Y
-1. � ALUATION$�
GRADING CU.YDS. ACRES
Front .261' +v 6
Rear f
"-
C
Right
S
Left SSl
Ping. Ref.
Remarks:
Planning Note :d �s FLS)
PLUMBING
FEES
Bar Sink
Showers
Backflow Preventer
Service Sink
Automatic Washer
Backflow Irrigation
Sewer Cap
Construction Pole Sub.
Bathtubs
Sewer Connection
Cooking Unit
Clarifiers
Solar Collectors
Dishwasher
Dishwasher'
Solar Piping
Dryers ❑Gas ❑Electric
Drinking Fountains
Solar Tank
Fan
Floor Drains
Swimming Pool w/Spa
F.A.U. '
Floor Sinks
Urinal
Fixtures
Gas Service Outlets
Water Closet
Device Boxes
Interceptors
Water Heater
Outlets
Kitchen Sink
Water Service -
Switches
Lavatories
Auto -Wash
Garbage Disposal
P -Trap
Laundry Trays
Generator E30-5 KW El 5-15
Roof Drains
Reinspection Fee ` $15
Under Ground
Structural
Exhaust System ❑ Multiple ❑
Firepl/Fact. Bit. ICBG #
Heating System & Ducting
❑ o-1 oo,000 BTu ❑ 1 m000 BT
Reinspection Fee I $15
CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
Issue Fee
Hood or Type ❑
Canopy Typell ❑
Refrigeration System
00100,000BTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
3
-FEES I Reinspection Fee
DEVELOPMENTSER
'Zoning Approved By -
Building Approved By
I.
!vi 0674 I.1 /22/87
Zone
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter ❑over 100amps
Sub Panel
Motors 00-1 HP 01%-8
I'nc.Solar 09-15. HP ❑16-15+
Microwave
Pole Light.
Range
Standing Sections
Trash Compactor
$15 Issue Fee
1971,69 TL
�$1
FEES
$ 3
Z
O
N
I
N
G
R
E
O
M
T
S
PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
$
$
$
$
$
$-
$
$
SUMMARY OF FEESBUILDING
�j—f-7�• 3•OG3 SMTP
PERMIT -
ISSUANCE
ENERGY P.C.
- GRADING
- MICROFILM
TOTAL FEE
$-
$
$
$
$
$
"�`a•6�
"
% 6
$ 3
CONSTRUCTION AND PLANNING
APPROVALS Permit #
Date
Inspector
POOL & SPA
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, O Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK ,.
11. Property Sewer Line & House Connection
62. Backwash & Receptor-Final
12. Sewer Cap
63. Heater & Vent-Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical-Final
15. Rough Electrical-Conduit
66. Solar System-Final
,
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
-
68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit # _
_
20. Rough Factory Fireplace
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. Storage Tank 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: 8 . -..
REQEiRft
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy•
37. Final Factory Fireplace
- .7
38. Final Plumbing
39. Water Service-Final
.. !
40. Gas Service-Final
'
41. Solar Domestic-Final
42. Backflow Preventer'
43. Backflow Irrigation
".
44. Landscape Irrigation System
45. Sound Attenuation
I- :: -•
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
o*
.' .
48. Special Requirements Completed
49. Electric Release to Edison
-
50. Gas Release to Southern California Gas Co
'
51. CERTIFICATE OF OCCUPANCY
No. Date
- ,
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA CONSTRUCTION PERMIT pPRM1T NO. TRACT NO. LOT NO. IINIT Nn
Project Address
Applicant's Mailing Address
Owner's Name f hones
Address -
Arch/Eng. License No.
Address
Contractor's Nam " ne d
Address (mailing)
City License No./��s%/
LICENSED CON RAC OR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in ful or d effect.
License C s e se NO.
Dale�� ATIONrfl
WOR RS' OMPENSATION LA N
I hereby affirm that I have a certificate of consent to self -Insure or a certificate
�f Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab.G )G-��X`/— �y L �--�-
POI i , ab (&J V^' COm pang -a.
rtified copy is hereby furnished.
Cer i 4 is fl led with the city Bull l4i?ti OI y�
Dale Applicant�Tyjy�
E%EISFROM WORKERS' COMPEf N D CLAR ION
(This section need not be completed If the permit is for one hundred ($100) or
less).
I car lify that in the performance of the work for which this permit is Issued, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
Date Signature
NOTICE: If, after making this declaration, you Should become subject to the
Workers' Compensation PrOvi Slnns of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit Is Issued (Section 3097, CIV. C.)
Lender's Name
Lender's Address - — t - --
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, improve, demolish or repair
any structure, prior to Its issuance, also requires the applicant tor,such permit
t0 file a signed statement that he/she is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section -7000) of
Division 3 of the Business and Professions Code) or that he/she'is exempt
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
enafly of not more than five hundred dollars ($500).
I, az otiwner of the property or my employees with wages as their sole
compensaon, will do the work, and the structure is not intended or offeretl
for sale (Se clion 7044, Business -and Professional Code: The Contractor's
License law does not apply to an owner of a property who builds or Improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building Or Improvement Is sold within one year of com-
pletion, the owner will have the burden Of proving he/she did not build or im.
Ffor the purpose of sale).
❑ 1, as owner of the property, am exclusively contracting with licensed con-
tractorsto construct the project Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds Or improves thereon, and who contracts for such projects with a con-
tractor( license pursuant to the Contractor's License Law). I am aware that
proof of( their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section S. & P. C. for this reason
Date Owner
I hereby certify that I have real
Information is correct. I agree to
or SS yf
late •that the above
d county ordinances
aby authorize repree-
ioned Or arty
Data
?19 23 'I -
TYPE OF CONSTRUCTION _bC=OIEW LJ ADD
TYPE
LJ ALTERATION LI REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
ELECTRICAL FEES
A.P. #
DESCRIPTION OF WORK/USE OF BLDG
Automatic Washer
Construction Pole Sub.
Transformer ❑ 15.50 KW
❑ 50 + KW
Backflow Irrigation Sewer Cap DO
S
Main Building:
UY
Cooking Unit
E
Meter ❑up to 100 amps
TYPE OF PERMIT LJ GRADING 0 FOUNDATION
ElTENANT 1:3ELECTRICAJ,/ \\yy PLUMBING
EISTRUCTURAL
❑ MECHANICAL
T
B
Front
Meter ❑over 100 amps
aL Dishwasher
Solar Piping
Rear
❑ OTHER
Sub Panel
A
Solar Tank
Fan
C
Right
PROJECT DESCRIPTION SQ. FT.
OCCUPANCY
K
F.A.U.
CONSTRUCTION TYPE VALUATION
$
$
Left
ZONE GRADING CU.YDS.
ACRES
Ping. Ref. #
Remarks: Q
Gas Service Outlets
Planning Notes:
6791 4/27/07
Zone
Accessory Building:
Parking Req./Provided
321.75 TL
Z
O
N
1
N
G
R
E
0
M
T
S
Bar Sink -
Showers
ELECTRICAL FEES
Backflow Preventer
Service Sink
Automatic Washer
Construction Pole Sub.
Transformer ❑ 15.50 KW
❑ 50 + KW
Backflow Irrigation Sewer Cap DO
Bathtubs -
Sewer Connection
UY
Cooking Unit
Meter ❑up to 100 amps
Clarifiers
Solar Collectors
Dishwasher
Meter ❑over 100 amps
aL Dishwasher
Solar Piping
&Z It ,J
Dryers ❑Gas ❑Electric
Sub Panel
Drinking Fountains
Solar Tank
Fan
Motors ❑0-1 HP 1 %- 8
Floor Drains
Swimming Poo) w/Spa
F.A.U.
Inc. Solar -15 HP 016.15+
Floor Sinks
Urinal
Fixtures
Microw e
Gas Service Outlets
Water Closet
d
Device Boxes
P Li9 ht
Interceptors
Water Heater
Outlets.
Range ,
Kitchen Sink
I Water Service
64;
Switches
Sign
9
' Lavatories
Auto -Wash
00
Garbage Disposal
Standing Sections
.P -Trap
Laundry Trays
Generator 130-5 KWI-FIK-15
KW
Trash Compactor
Roof Drains
J
Reinspection Fee
$15
Issue Fee
S 3
Reinspection Fee
$15
Issue Fee $ 3
•
MECHANICAL
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By Date
I Building Approved By Data
Application Issued By Dat
Boiler
Hood or Type I ❑
Canopy Type 11 ❑
Duct - Under Ground
Duct - Structural
Refrigeration System
00-100,000 BTU 0100 00 8TU
Duct - Ventilating
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
SUMMARY
$
$
S ZS$
$
$
$
S
$
OF FEES
SMIP $
PERMIT
ISSUANCE S
ENERGY P.C. $
GRADING $
MICROFILM $ 2J.
/
TOTAL FEE S 3 2J.15
'
Exhaust System ❑ Multiple ❑
System Repair .ration
Firepl/Fact. Bit. ICBG #
Fire pers
Heating System & Ducting
❑0.100,000 BTU 13100,000B
egisters
_
Reinspe, Fee
$15
Issue Fee S 3
CMF 0665-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING
APPROVALS Permit#
Date
Inspector
POOL & SPA
APPROVALS Permit#
Date
Inspector
1. Temporary Electrical. Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, 0 Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
�! f7
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
-7- 67
•Pjp,
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. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit # _
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas El Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank OGas 0Oil
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical
27. Frame and Flashing
_ 4-_ -
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:8 7-" I,rfhsTe 0 ((FAT-09WFDRAU CY--, _?1
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
36. Hood or Canopy
.
37, FiI`Factory Fireplace
-
,,38�Final Plumbing
oto F
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
,42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
• 46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
F'
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
-
51. CERTIFICATE OF OCCUPANCY
No. Date
F
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA %S
r!//. CQfRUC�N PERMIT
Project Address _ .J
Appljcdfit's Mailing Address •�� oL vS%I
Owner's Name y NE7�/
L/� ER.
S PRone� -S
Address lam/ o61tV_7o/n ey_Rfry r.-iro572E�ie (7/6 f C'
Arch/Eng: License No.
Address
Contractor's Name �1 _�R`�-f
Address( mailing) 4 E �:-J7CXJ/$%� C_,6U/,t/- C47f--
j City License No.
LICENSED CONTRACTOR DECLARATION
do I hereby affirm that I am licensed under provisions of Charter 9 (commencing
r with section 7000) of Division 3 of th Business and,,Professions Code, and
1 my license is in full orce and effect.
�+ Licens Cl s LI Se o.
Date Signature
WORK RS COMPENSATION DEC RATION
C hereby affirm that I have a certificate of consent to self -insure or a certificate
If Workers' Compensation Insurance, or a certified copy thereof (Section
1, 3800, Lab. C.)
Policy No.9e!Le/'2 Co ans'¢ 6C0
Certified COPY is hereby funis hetl.
Certi ie p is filetl with the Cit ins Divisio
Dae ApPlicant
EXEMP ION FROM WORKERS' COM ENSATION DECLARATION
(This section need not be.com pletetl if a permit Is for one hundred ($100) or
less).
I certify that in the Performance of the work for which this permit is issued, I
Shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
Date Signature
NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with Such, provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.)
Lender's Name
Lender's Address
OWNER BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, improve, demolish or repair
any structure, Prior to its issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and -Professions Code) or that he/She is exempt
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
penalty of not 'm Ore than five'hundred dollars ($500).
❑ I, as owner Of the property Or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered
for Sale (Section 7044, Business and Professional Code: The Contractor's
License Law doe= not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. It, however, the building or improvement is sold within one year of com-
iF, the owner will have the burden Of proving he/she did not build or im
drove or the purpose of'sale)— - - - -- -- ---
, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project(Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of Property who
builds or improves thereon, and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that
Proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section B. & P. C. for this reason
Date ,Owner
I hereby certify .that. I have read this application and state that the above
information is cc' ct. I agree to comply with all city and county Ordinances
and state laws ins to bu ing construction, and hereby authorize repre.
sentatives of h city to er upon the above-mentioned prope y for
inspection s s. J47
Bar Sink -
Showers
Backflow Preventer
Service Sink
Backflow Irrigation
Sewer. Cap
Bathtubs
TYPE OF CONSTRUCTION NEW LJ ADD
11 ALTERATION LJ REPAIR
Solar Collec
Kitchen Sink _ .. Water Service
- El CONVERSION ❑ DEMOLISH ❑ OTIJFR
Lavatori Auto -Wash
A.P. #
DESCRIPTION OF WORK/USE OF BLDG.-IS�1�C
GE''
-
S
Main Buildi
TYPE OF PERMITr� ❑ GRADING FOUNDATION
STRUCTURAL
T
Front
'❑ TENANT U ELECTRICAL ❑ PLUMBING
❑ MECHANICAL
B
❑ OTHER
A
Rear
C
Right
PROJECT DESCRIPTION SQ.FT.
OCCUPANCY
K
CONSTRUCTION TYPE VALUATION
$
S
Left
ZONE GRADING CU.YDS.
ACRES
Ping.
Ref. #
Remarks: F
Q .-((Q Fa.s� _ 0700
Planning
Notes:
/3/-,b(r Pwoflr a2
-PLUMBING
FEES
Bar Sink -
Showers
Backflow Preventer
Service Sink
Backflow Irrigation
Sewer. Cap
Bathtubs
Sewer Conn
Clarifiers
Solar Collec
Drinking Fountains I Solar Tank
Floor Drains Swimming Pool w/Spa i
Reinspection Fee $15 Issue Fee $ 3
Floor Sinks , - Urinal
DEVELOPMENT SERVICES REQUIREMENTS: ,
Zoning Approved By Date
-.Building Approved By . _ -Date-7�/"'�
Application Issued By Date
Gas Service Outl Water Closet
— -
Interceptors. Water Heater
Kitchen Sink _ .. Water Service
-
Lavatori Auto -Wash
Roof Drains
Reinspection Fee I $15 I I Issue Fee
Boiler I Hood or Type I ❑
.. Canopy Type 11 ❑
Duct -Structural '
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Bit. ICBG '#
Heating System & Ducting
❑0-100,000 BTU❑10 00 BT
i
Signature O Date ' �
Drivers' Lice Se Or SS RetHspection Fee
CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
$15
Refrigeration Syst
00-100,0 U 0100,000
�m Repair/Alteration
Fire Dampers
Registers
Issue Fee
Automatic Washer
I I I Construction Pole Sub.
Cooking Unit -
Dishwasher -
Dryers ❑Gas 'Electric
Fan ..
F.A.U.
Fixtures
Device Boxes
Switches
-
Garbage Disposal
Generator 00-5 KW
1941: 7/2-/2"
AM
Zone WL�
Accessory Building:
jN
1
N
G
R
Parking Req./Provided E
M
T
S
ELECTRICAL
Transformer ❑ 15-50—KW
❑ 50+KW J
Meter. Oup to 100 amps 5�
Meter Dover 100 amps
Sub Panel
Motors 110-1 HP D
nc.Solar 1-19-15 HP 016-15+
Microwave
Pole Light
Range
Standing Sections
5 KW I I Trash Compactor
$ 3 1
Reinspection Fee $15 Issue Fee $ 3
FEES
DEVELOPMENT SERVICES REQUIREMENTS: ,
Zoning Approved By Date
-.Building Approved By . _ -Date-7�/"'�
Application Issued By Date
— -
SUMMARY OF FEES -
BUILDING PERMIT $. SMIP $
PLAN CHECK $ PERMIT. _
PLUMBING. - $ ISSUANCE ;$
PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL 920.00 - GRADING' $
PLANCHECK 75^0%' $ MICROFILM $
MECHANICAL $ TOTAL FEE
PLAN CHECK25% $ 1.6 h
$ 3
'
,;CONSTRUCTION AND PLANNING
!-
APPROVALS Permit #
Vit.. .r,r
Date
Inspector
-
POOL & SPA
'APPROVALS Permit #
-
Date , Inspector
-�
e-
;fit.; Temporary Electrical Service or Pole
r
52. Pool & Equipme t Location
-,2. Soil Pipe-Undrgrnd.
eent�._-
53. Steel Rei nm
31 Electrical Conduit Utility-Undrgrnd.
54. Forms 1k,_
,04. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
%5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd.
i
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.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor-Final
12. Sewer, Cap
63. Heater & Vent-Final
13. Roof Drains -
-'
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical-Final
15. Rough Electrical-Conduit
66. Solar System-Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign -
-
68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
-
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro _
22. Ducts, Ventilating
71. Product Piping ❑Gas ❑Oil
23. Gas Pipe-Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank O Gas 0 Oil
25. Roof ISheathing
74. Overhead Hydro
26. T-Bari 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 a
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION _
32. Electrical Power Meter-Final nc�
�� aO�
80. FOOD CERTIFICATE ISSUED
.,.
33. Final IElectric
d
Notes: �0 R r: •" ,'r.7 6 Sri
34. Final'Heating & Air Conditioning
i
leo 1. hts MdSF .5 ter er rrel
35. FinallGas Pipe-Test-^
36. Hood or Canopy
37. Final;Factory Fireplace -
38. FinallPlumbing
39. Water Service-Final
i
'
40. Gas Service-Final
41. Solari Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sountl Attenuation
,
46. Handicap Regulations
. 47. FINAL STRUCTURE & BUILDING
i
48.,Special Requirements Completed
,
49., Electric Release to Edison
,
50. Gas Release to Southern California Gas Co
,! I
51. CERTIFICATE OF OCCUPANCY
No. Date
City of Costa Mesa pp QQ
Development Services Department
Building Safety Division CERTIFICATE OF OCCUPANCY No. O O 1 v v J
P. O. Bon 1200
Costa Mesa, California
The Building located at 575 19. 19th Street. Building .T
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group R1, Occupancy.
Use of Building Rrnr./T.altndry/nffi rra
Legal Description 424-221-01 thrii —19
(See reverse side for Metes and Bounds)
Building Permit No A 9tCgA4 Electrical Permit No. r 9gV7Z Plumbing Permit No. n a" "
Mechanical Permit No. r' o't = n '10 -.1 1'' Number of apartments and/or guest rooms
ISSUED TO: Building Official
(Iinrnln Prnnart, r'mmnanv
16152 Beach Blvd. , Ste. 140 by
Hnntinntnn Raarh- rA 09Fd7
Date December 4, 1987
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed exceAt
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 - Bldg. Permit File
Applicant to fill In all spaces except those within heavy'border lines ane sign all appropriate declarations
-CITY OF COSTA MESAO UC N PER $I Irl
Project Address
P RMIT
(p
TRA
T NO,.
�cF
_LOT NFO.g G
1
UNIT NO."a"
,
e 0677 I/22/B7
442,56 TL
Applicant •& M 1111,19 Addre Q
Owner's•iam 2Pho (
Address
TYPE OF CONSTRUCTION W NEW LJ ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OT
'- gF$CRIPTIj/pLj};I.
t;:PK/USE OF BLDG. -V /At NPJ2Zr
II7J��r�r �((/
A,P- # j - v` 1 r Zone
S
Main Building: Accessory Building:
Arch/En
AddressP!s.❑
icense
TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL
TENANT ❑ ELECTRICAL ❑ P UMBINGp�❑Jr MECHANICr�ga L7�p�y ��
❑ OTHER Ps •` C 1 paws
PROJECT DESCRIPTION fegutou-- !�. oCC UPAt•�Cv
CONSTRUCTION TYPEjt-,-s's VALUATION$ /
ZONE GRAOINGCU.YDS. ACRES
T
Frons `Q�
A
0
B
Rear
N
Contractor's Nam Z
—
A
C
Right •�
I
N
Address (mailing)
City License No.
LICENSED CON RACTOR DECLARATION B, L •# 3 51,7s/
I hereby affirm that I am licensed under provisions of Charter 9 commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license Is in full for and effect.
K
S
Left
s
G
R
Ping. Ref. qW Perking Req./Provided
E
Remarks:-
Planning Notes:
M
• C�_ L
S
License Class_ License No.�
Data Signature �—,"ti'^s
PLUMBING
FEES
HOLD FOR SPECIAL REQUIREMENTS
Bar Sink -
Showers
ELECTRICAL
FEES
W00. ERS' COMPENSATION DECLARATIO
1 hereby affirm that I have a certificate of consent to self -Insure or a certificate
- Backflow Preventer
Service Sink
Automatic Washer
Construction Pole Sub.
Transformer ❑ 15-50 KW
❑ 50+KW
I Workers' Compensation Insurance, Or a certified copy thereof (Section
300, Lab. C.) LL -
Policy No. 1�/ii �l�9/�V'0 �l Company
Backflow Irrigation Sewer Cap -
Certified copy is hereby furnished. Ir
Certlfi copy 15 filed with the city Build isusron-
S
Bathtubs
Sewer Connection
Cooking Unit
Meter ❑up to 100 amps
-
Clarifiers
-
Solar Collectors -
Dishwasher
Meter ❑Over 100 amps
Date WORKERS'
Applicant /aOfff
(T EMP ION F OM WORKERS' COMPE pe l�N D Ared ( .
(This section need not b8 completed pleled If the permit Is for one hundred ($100) or
lessr h
Certify that In the performance th0 work for which this permit is Issued I
an
shall not employ any poison in any manner so as to become subject to tlta
Workers' Compensation Laws California.
Data Signature
Dishwasher
Solar Piping
Dryers ❑Gas ❑Electric Sub Panel
drinking Fountains Solar Tank
Fen Motors 00-1 HP ❑1'Fi - 8
Floor Drains
Swimming Pool w/Spa
F.A.U.
' Inc. Solar ❑9-15 HP 016-15+
NOTICE: If, after makiki ng this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such prOvlsion5 Or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of the work for which t Is permit is Issu tl ( Cct Ion 9097 Civ. C.)
Lender's Name
Floor Sinks
Urinal
Fixtures
Microwave
Gas Service Outlets Water Closet
Device Boxes !^ Pole Light
Interceptors Water Heater
Outlets Range
Kitchen Sink
Water Service
' Switches -
Sign
I
Lender's Address __( (.tU'i--� /j/((( 61�/( A<hs+ • rg
OWNER BUILDER DECLARATION
I hereby affirm that I. dm exempt from, the Contractor's License Law for the
fallowing reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, improve, demolish or repair
any structure, Prior Writs Issuance, also requires the applicant for Such permit
to file a signed Statement that he/she Is licensed pursuant to the provisions Of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/She is exempt
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
malty of not more than five hundred dollars ($500).
I, as owner of the properly Or my employees with wages as their sole
.mpensalion, will do the work, and the structure is not intended or offered
for sale (Section 7044 Business and Professional Code: The Contractor's
License Law does not apply to an Owner of a Property who builds or improves
thereon, and who doe% such work himself/herself or through his or her own
employees, provided that such Improvements are not Intended or offered for
sale. If, however, the building or Improvement is Sold within one year of com-
pletlon, the owner will have the burden Of proving he/she did not build or im-
DYriove for the purpose of Sale).
lJ 1, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a con-
tractor( sl license pursuant to the Contractor's License Law). I am aware that
proof of! their Worker's Compensation Insurance shoUld be provided to me.
❑ 1 am exempt under Section B. & P. C. for this reason
Lavatories Auto -Wash
Garbage Disposal
Standing Sections
'
P—Trap ' Laundry Trays
Generator ❑0-5 KW ❑5-15 KW Trash Compactor
Roof Drains
Reinspection Fast
$15 Issue Fee
S 3
_
Reinspection Fee
$15 Issue Fee - $ 3
MECHANICAL
FEE$
fillillililif
_
DEVELOPMENT SERVICES OUIfjE NTS:
Zoning Approved By f� Date /—�/�
Building Approved By Dete
Application Issued By C (� Dat ZLg
Boller Hood Or Type ❑
Canopy Type 11 ❑
Duct - Under Ground
Duct - SlructUra Refrigeration System
Duct - Ventilating ❑o-100,000 BTU 0100,000 BTU
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%.
MECHANICAL
PLAN CHECK 25%
SUMMARY OF FEES
$ '563S $-O SMIP $ 7 o6
$ PERMIT
$ ISSUANCE $
$ ENERGY P.C. $
$ GRADING $
$ MICROFILM $
$ TOTALFEE $
,
$
Exhaust System ❑ Multiple ❑ System Repair/Alteration
Firepl/Fact. Bit. ICB05P Fire Dampers
Date OwnerHeating
1 hereby certify that I have read this application and state that the above
Information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize repre-
sentatives of this city Snl LUpon the above-mentioned P1 ,arty for
inspection purposes.
Signature Date
Drivers' License or 53
System & Ducting Registers
❑4100,000 BTU [1100,000BTL
Reinspection Fee $15 Issue Fee $ 3
CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting;
Goldenrod - Assessor
CONSTRUCTION AND.PLANNING
APPROVALS Permit #
Date
Inspector
POOL &SPA
APPROVALS Permit#
Date
Inspech�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-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, ❑ Undrgrnd., Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, ❑ Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final '
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
.�
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit # _
-
- •
-
`
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
L�
22. Ducts, Ventilating
71. Product Piping ❑ Gas ❑ Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank CGas ❑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: HOLD FOR SPECIAL REQUIREMENT
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
.�6. `f'
((//
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service -Final
•
40. Gas Service -Final
'- '.'
41. Solar Domestic -Final
42. Backflow Preventer
-. - -
43. Backflow Irrigation
..-%•
44. Landscape Irrigation System
45. Sound Attenuation
i '--
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
2j�
.... -•
48. Special Requirements Completed-
94111
mpf..
`- - �•
Jr
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
,
51. CERTIFICATE OF OCCUPANCY
No. Date
,+
l
r-
00
'T Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.
a i} i.TYOFCOSTAMESA CONSTRUCTION
PERMIT
Project Andress .�7� �� / � q ,r
Applicant's Mailing Address/ E.-�"'KpoL
Qvuner's Na�me� L-/w/COL.,f/ 7 PE�6i pne 5 -.•,QRS
Address /10 / 11224 Zt2 atiltL-i9-
Arch/Eng. License No.
Address y
-—
Contractor's Name V Bpne33.s1—/8b-P—
Address(mailing)//�z E00� SA, Ce r (_-7f
City License No. �/�
LICENSED CONTRACTOR DECLARATION
1 hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is In full force antl effect. - D
License CI ss L G License No. -3/�SO
Date Signature
WORKERS COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure or a certificate
of Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. pOC.)CI L, �j
Policy No.2Z �` ?/ V Company
ertified copy Is hereby furnished.
Certi f"ed o Is filed with the city Building Division.
Date Applicant
EXEMPT O FR M WORKERS' COMPENSATION DECLARATION
(This section need not be completed if the permit i5 for one hundred ($100) or
less).
I certify that in the performance of the work for which this permit is Issued, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
Date Signature
NOTICE: If, after making this declaration, you Should become Subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with Such provisions Or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby afflrm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.)
LAnder's Name
Lender's Address
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit l0 construct, alter, improve, demolish or repair
any structure, prior to its Issuance, also requires the applicant for such permit
to file a Signed statement that he/she is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars ($500).
Lj I, as ownar of the property or my employees with wages as their sole
compensation, will do the work, and file structure Is not intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or Improves
thereon, and who does such work himself/herself or through his or her own
em ployecS, provided that such improvements are not intended or offered for
Sale. If, however, the building or Improvement Is Sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or im-
i�rove for the purpose of sale).
L I, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the projectISectlon 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or Improves thereon, and who contracts for such projects with a con.
tractor(S license pursuant to the Contractor's License Law). I am aware that
proof V their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section B. 6 P. C. for this reason
Date Owner
I hereby certify that I have read this application and State that the above
information is correct. I agree to comply with all city and county ordinances
and state laws relating to building construction, and hereby authorize repre-
sentatives of this city to enter upon the above-mentioned property for
inspection purposes.
Signature Date sP
Drivers' License or SS
E 7-9 3 /3 1I I' 1
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLOG.-PEr�Q<A-Ti0/V
TYPE OF PERMIT - LJ GRADING LJ FOUNDATION LJ STRUCTURAL
1:1� TENANT IJ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SO. FT. OCCUPANCY
CON STRUCTION TYPE VALUATION $
ZONE GRADINGCU.YDS. ACRES_
Remarks:
&.0 6-. QER/K /7 -
Sink
<flow Preventer
<flow Irrigation
Ing Fountains
Drains
Sinks
Itchen
Reinspection Fee
a 6933
PLUMBING
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collector
Solar Pip'
wimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto -Wash
Laundry Trays
$15 Issue Fee
Boiler
Duct- Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Bit. ICBG #
Heating
❑0.100m ❑1
0
Fee 1 $15
Hood or Type
Canopy TYP 0
efriger t6n System
13
0,000 BTU ❑ 100,000 BT
system Repair/Alteration
Fire Dampers
Registers
Issue Fee
CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 11
A.P. #
S Main Buildi
E
T Front
B Rear
A
C Right
K
S Left
Ping. Ref. #
Planning Notes:
171,1 7/',
Zone
Accessory Building:
Z
O
N
N
G
R
Parking Req./Provided E
Q
M
T
S
.FEES
I
ELECTRICAL
FEES
Automatic Washer
Construction Pale Sub,
Transformer ❑ 15-50 KW
_ El50+KIN
Cooking Unit
Meter ❑up to 100 amps,
/ Dishwasher
Meter ❑over IDO amps
Dryers OGas ❑Electric
Sub Panel
Fan
Motors❑01 HP❑l%-8
3 F.A.U.
Inc. Solar 119-15 HP 1116-15+
t
Fixtures
Microwave
Device Boxes
Pole Light
Outlets
Range
Switches
Sign
/ Garbage Disposal
Standing Sections
Generator ❑0-5 KW 135-15 KW
Trash Compactor
-3 4C /-3NP6
Ice
$ 3
Reinspection Fee
$15
Issue Fee
$ 3
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved By
Application Issued By
Data
Dates
Data
/-+n
SUMMARY OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. S
ELECTRICAL GRADING $
%
PLAN CHECK p1196 s§ 'mac— MICROFILM $11
MECHANICAL S TOTALFEE e$
PLAN CHECK' 25% $
�./}q�
_
$ 3
• CONSTRUCTION AND PLANNING
APPROVALS Permit #
Date
Inspector
POOL & SPA
APPROVALS Permit #
Date
Inspector
Ter�tporary 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.
B. Foundation
59. Gas Pipe nO 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 i
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. POO USPA SYSTEMS FINAL
19, Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit # _
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas OOil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank OGas 00il
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
8�02'.ANotes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
3D-
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
A
51. CERTIFICATE OF OCCUPANCY
No. Date
t
0•
M
Owner's Naq�tle `� v P
Address
Arch/Eng. License No.
Address
Contractor's Nam b e
Address (mailing) _ „—,
Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. •�,
+'� TRA_CTOR DECLARATION
I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Profe;sionsss CVe, and
my license is In full fore and effect. _ /II `M1 CV
Date Signature r- /S X s'r V�
WORKERS' COMPENSATION DECLARATION
' hereby affirm that I have a certificate of consent to salt-insu r a certificate
I Workers' ompensaflo Insurance, or a Certified copy (hereof (Section
18 U.
C Lab. '/.i,/
Policy No. Company
[] ertifietl Op rs h re by fur niche o.
¢rtifl tl co leo with the city Br i in9 131 visi n.
Date Applicant rJ '
EXE PTIO F O WORKERS' COMP NSA ION DELLA TION
(This section need not be completed if the permit is for one neo (5100) or
less).
I certify that in the performance of the work for which this permit is,issued, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
Date Signature
NOTICE: If, after making this declaration, You should become Subject to the
Workers' Compensation provisions of the Labor Code, You must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance
Of the work for which this permit is issued (Section 3097 Civ. C.)
Lender's Name _
Lenger's Address
OWNER BUILDER DECLARATION- -
1 hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031,5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, improve, demolish or repair
any structure, prior to its issuance, also requires the applicant for such permit
to file asigned statement that he/she Is licensed pursuant to the Provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) Or that he/She is exempt
herefrom and the basis for the alleged exemption. Any violation of Section
031.5 by any applicant for a permit subjects therapplicant to a civil'
renalty of not more than five hundred dollars ($500).
LJ I,as owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herSelf or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or Im-
oye for the purpose of sale).
�
6 I, as owner Of the property, am exclusively contracting with licensed con.
trattorS to construct the project (Section 7044, Business and Professions Code;
The Contractor's License Law does not apply to an -owner of property who
builds or improves thereon, and who contracts for such projects with a con-
traCtor(S) license pursuant to the. Contractor's License Law). I am aware that
proof oftheir Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section B. & P. C. for this reason
Date Owner
I hereby certify that I have read this applicat
Information Is correct. I awes to comoly with a
sto enter po the above-mentioned prc
pectian purpo �7
Signature 'T Date I
givers' License or SS I I Reinspection Fee
Building; Canary -Applicant; Pink - Accounting; Goldenrod - Assessor
TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR
ELECTRICAL FEES
❑ ❑ ❑
$
CONVERSION DEMOLISH OTHER
A,P.#
DESCR I PTION OF WORK/USE OF BLDG.
ISSUANCE
'q Cooking Unit Meter ❑up to 100 amps
Clarifiers - Solar Collectors
S
Main Builth
Dishwasher Solar Piping
E
Dryers ❑Gas ❑Electric Sub Panel
TYPE OF PERMIT El GRADINGLJ FOUNDATION STRUCTURAL
T
Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL
B
F.A.U. Inc. Solar 0 9- 15 HP 016-15+
❑ OTHER
A
Rear
Gas Service Outlets . Water Closet
C
Right
PROJECT DESCRIPTION 50. FT. OCCUPANCY
_
Outlets Range
CON STRUCTION TYPE VALUATIONS
S
Left
ZONE
GRADSvInWNAG CU.YDS. ACRES
Ping.
Ref. #
Remarks:
Ia rt n 1111 p
Planning Notes:
FEES
s 1828 '7/f7/7i-
But
7/17/71
But
Parking Req./Provided
.. r
Zone
Z
0
N
I
N
G
R
E
Q
M
T
Bar Sink Showers
ELECTRICAL FEES
Backflow Preventer Service Sink
$
Automatic Washer - Transformer ❑ 15-50 KW -
,�,.• Construction Pole Sub. ❑ 50+KW
Backflowlrrigation Sewer Cap
Bathtubs Sewer Connection
ISSUANCE
'q Cooking Unit Meter ❑up to 100 amps
Clarifiers - Solar Collectors
ENERGY P.C.
Dishwasher Meter ❑over 100 amps
Dishwasher Solar Piping
GRADING
Dryers ❑Gas ❑Electric Sub Panel
Drinking Fountains Solar Tank
`' Fan Motors 00-1 HP ❑l
Floor Drains Swimming Pool w/Spa
MICROFILM
F.A.U. Inc. Solar 0 9- 15 HP 016-15+
Floor Sinks Urinal
TOTAL FEE
Fixtures Microwave -
Gas Service Outlets . Water Closet
Device Boxes Pole Light
Interceptors Water Heater
_
Outlets Range
Kitchen Sink Water Service
- Switches Sign
Lavatories
Garbage Disposal Standing Sections
.P—Trap
' Generator 110-5 KW 05-15 KW Trash Compactor
Roof Drains
Reinspection Fee $15
Boiler
Duct- Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Bit. ICBG #
i/ ;H Ing System & Ducting
1160100,000 BTU ❑ 100,000 BT!
$15
Issue Fee
Hood or Type ❑
Canopy Type 11 ❑
7eration System
0,000BTU 0100
System Repair/Alteration
Issue Fee
$ 3 `
Reinspection Fee $15 Issue Fee
FEES
TDEVELOPMENT SERVICES REQUIREMENTS:
Zoning�Approved By
Building Approved By
• Aopltcation Issued By (2).
BTU
/BUILDING PERMIT $
PLAN CHECK . $
PLUMBING $
PLAN CHECK 25% $
` ELECTRICAL $ .
PLAN CHECK 50% $
MECHANICAL $ .
$ 3 PLAN CHECK 25% $
$ 3
SUMMARY OF FEES
SMTP
$
PERMIT
ISSUANCE
$
ENERGY P.C.
$
GRADING
$
MICROFILM
$
TOTAL FEE
$ ,�'�
CONSTRUCTION AND PLANNING
„APPROVALS Permit# Date
Inspector
POOL SPP`
APPROVALS Permit 4#
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
0
i
.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
F
62. Backwash & Receptor -Final
12. Sewer Cap- -
63. Heater & Vent -Final
'
13. Roof Drains
64. Plumbing System - Final I
"
14. Rough Plumbing -
65. Electrical -Final
15. Rough Electrical -Conduit-
66. Solar System -Final '
16. Rough Electric Wiring
-
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT .
APPROVALS Permit #
20. Rough Factory Fireplace
21: Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating .
71. Product Piping O Gas 0Oil
23. -Gas Pipe -Rough &Test
72. Underground Flush
,24. Roof Framing
73. Undergrnd. Storage Tank ElGas ❑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: -,7,;Z 7 _ F -
34. Final Heating & Air Conditioning
-
35. Final Gas Pipe -Test ,
"
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service -Final
-
40. Gas Service -Final
41. Solar Domestic -Final M
42. Backflow Preventer-
i
43. Backflow Irrigation
44. Landscape Irrigation System
-
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Com Feted
49. Electric Release to Edison
-
50. Gas Release to Southern California Gas,co
-
51. CERTIFICATE OF OCCUPANCY
No. Date
I -
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA,CO STR� D�'IC1TION P !MILT,,..
Project Addles ✓� K/ • I� `•'1
Applicant's Maili Address G
Owner's Ma1me y�
Address !l/71 SZ tK-V%- iii! 1t�E�
Arch/Eng. License No. 7IQ M4
Address
Contractor's NameSAj(; � , Phone .10— 1�}�
Address (mailing) Ind �Sl.ITP lf(8
City License No. 02144
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
With section 7000) of Division 3 of the Business and Professions Code, and
15 my license Is in full force nd of ect,
License Cl s j e No. L7 r0
Oate Signature
WORKERS'C0 PENSATION DECLARATION
�- I hereby affirm that I have a certificate of consent to self -Insure or a certificate
of Workers' Compensation Insurance, or a certified CODY thereof (Section
3800, Lab. C.
Pogcy No. >/b.;Z/ Company- O�!%tiL T•� • -
Certified copy is hereby furnished.
Certif p s ile with the city Bu'Itlf 9'D iSi�
Date Applicapt--—U---'�—+��^�"�"�
EXEM PT IO FROM WORKERS' COMPENSATION DECLARATION
(This section need not be completed If the permit is for one hundred ($100) or
less).
I certify that in the performance of the work for which this permit is Issued. 1
Shall not employ any person in any manner s0 as to become subject to the
Workers' Compensation Laws of California.
Date Signature
NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
Comply with Such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY -
I hereby affirm that there Is a construction lending agency for the performance
01 the work for which this permit is issued (Section 3097 Civ. C.)
Lender's Name _
Lender's Address _
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit t0 construct, alter, Improve, demolish or repair
env Structure. prior t0 Its Issuance, also requires the applicant for such permit
therefrom and the basis for the alleged exemption. rany wmauw x v
7031.5 by any applicant for a permit subjects the applicant to a civil
genalty of not more than five hundred dollars ($500).
lJ 1, as owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or Offered
for Sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or improves
thereon, and who tloes such work himself/herself or through his or her own
employees, provided that such improvements are not Intended or offered for
Sale. If,.hOwev.1 the building or Improvement is sold within one year of com-
bletion, the owner will have the burden of proving he/she slid not build or Im-
l¢--r�ove for the purpose of sale).
IJ 1, as owner of the property, am exclusively contracting with licensed con.
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or Improves thereon, and who contracts for such projects with a con-
tractor(z1 license pursuant to the Contractor's License Law). I am aware that
proof o their Worker's Compensation Insurance should be provided to me.
0 ) am exempt under Sectton B. 6 P. C. for this reason
Date Owner
1 hereby certify that I have read this application and State that the atove
information Is correc . I agree to comply with all city and county ordinances
and State laws relati g to building construction, and hereby authorise repre-
sentatives Of this c y to a pon the above -men Honed pr ert for
Inspection purpose ! /
SI nature Date
TYPE OF CONSTRUCTION M NEW LJ ADD
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG. —
ALTERATION LJ REPAIR
TYPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER 11
PROJECT DESCRIPTION SQ. FT. OCCUPANCY_
CON ST RUCTI ON TYPE VALUATION $
ZONE - GRADINGCU.YDS. ACRES__
Remarks:
Bar Sink
Backflow Preventer
Backflow Irrigation
Drinking Fountains FI -
Floor Drains r -
s
Floor Sinks
Gas Service Outlets
Interceptors,
Kitchen Sink
Roof Drains
Reinspection ��F��ee $15
Boiler VUvr 7
Duct- Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepi/Fact. Bit. ICBG #
Heating System & Ducting
00-100,000 BTU ❑ 100,000 BTR
g
Drivers' License or 55 # Reinspection Fee
CMF 0865-46, rev. 4/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
$15
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Issue Fee
Hood or Type ❑
Canopy Type 11 ❑
Refrigeration System
00.100,000BTU 0100,000
System Repair/Alteration
Issue Fee
r
3529 Fl/' -/ % 12,1:1 T:
A.P. # 1 Zone
S
Main Building: Accessory Building:
Cooking Unit
E
T
Front
Z
O
B
A
Rear
N
I
C
Right
N
K
Left
G
R
Ping. Ref. # Parking Req./Provided
E
Planning Notes:
Q
M
Sign
T
S.
Standing Sections
Generator 00.5 KW ❑5-15 KW
ELECTRICAL FEES
Automatic Washer
Construction Pole Sub.
Transformer 0 15-50 KW -
0 50+ KW
Cooking Unit
Meter 0up to 100 amps
Dishwasher
Meter ❑over 100 amps
Dryers OGas ❑Electric
Sub Panel
Fan
Motors 001 HP Ell % - 8
F.A.U.
Inc. Solar 09.15 HP 016-15+
Fixtures
Microwave - -
Device Boxes _
Pole Light
Outlets
Range
Switches
Sign
Garbage Disposal
Standing Sections
Generator 00.5 KW ❑5-15 KW
Trash Compactor
$ 3
FEES Reinspection Fee $15 Issue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
1 7 52Building Approved By
Application Issued By �1
BUILDING PERMIT $
OF FEES
SMTP $
PERMIT
ISSUANCE $
_ ENERGY P.C. $
GRADING $
MICROFILM $
TOTALFEE $
$ 3
PLAN CHECK $
PLUMBING $
'. PLAN CHECK 25% $
ELECTRICAL $
PLAN CHECK 50% $
MECHANICAL
PLAN CHECK 25%A
$ 3
OF FEES
SMTP $
PERMIT
ISSUANCE $
_ ENERGY P.C. $
GRADING $
MICROFILM $
TOTALFEE $
$ 3
. CONSTRUCTION AND PLANNING
APPROVALS -Permit#
Date
Inspector
POOL a SPA
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 Reiriforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
B. Foundation
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. Electrical -Final
-
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
-�
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough' Electrical -T Bar Ceiling
-
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in St=%9MreBO7,4 py 'V4v %
�/ /��
L
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0 Gas OOil
23. Gas Pipe -Rough & Test
72.' Underground Flush
24. Roof Framing
73. Undergrnd.Storage Tank OGas 00il
25. Roof Sheathing
74. Overhead Hydro
26. 7 -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 PREY. 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
¢j
35. Final Gas Pipe -Test
Q�
36. Hood or Canopy
37. Final Factory Fireplace
-
38. Final Plumbing
'
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
,
42. Backflow Preventer
43. Backflow Irrigation .. .
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
vy '
Applicant to fill in all spaces except those within heavy bottler lines and sign all appropriate declarations.
'( OCORAIT kin) I TO, r.111 I 1 r\T N/1
pN
V
IN
CITY OF COSTA MESA CONSTRUCTION PERMIT
Project Address � �J
Applicant's Mailing
Address
vw/ •� e7N�
Cner's Nam/ U"� Phone
Address p.���
Arch/Eng. ����C✓���d4—y.�License No.
Address
Contractor's Nam on.
Address (mailing)
City License No
LICENSED CONTRACTOR DECLARATION
1 hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in fulAorce arld effect.
Dale =7. Signature
WOR RS'1 0MPENSATION DEC R N
I hereby affirm that I have a certificate of consent to self -Insure or a certificate
of Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. �.) —V t �L
o
No.'— Company — /
Certified copy is hereby furnishetl.
tj Ce riffled copv_is filed with the city Bilislinq.0111si
E%EhfYYTfO-r//FROM WORKERS' COMPENSATION OECLARATIOfT
.(This ction need not be completed if the permit Is for one hundred ($100) or
less).
I certify that in the performance of the work for which this permit Is Issued I
shall not employ any person in any manner so as to become subject to t)Pe
Workers' Compensation Laws of California.
Date Signature
NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemetl-revoked.
CONSTRUCTION LENDING AGENCY • •.
1 hereby affirm that there is a construction tending agency for the performance
of the work for which this permit is issued (Section 3097, CIv. C.)
Lander's Name
Lender's Address
OWNER BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's Llcan o,lWw for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to Construct, alter, Improve, demolish or repair
any structure, prior to its Issuance, also requires the applicant forrsUch permit
to file a signed statement that he/she is licensed pursuant to the Provisions of
the Contractor's License Law (Chapter 9 (commencing with SectiOni7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
Penalty of not more than five hundred dollars ($500).
❑ I, as owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure Is not Intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law tloesnot apply to an owner of a property who builds or Improves
thereon, and who does such work himself/herself or through his or her own
employees, Provided that such Improvements are not intended or offered for
sale. If, however, the building or improvement Is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or im.
Prove for the purpose of sale).
❑ I, asowner of the property, am exclusively contracting with licensed con-
tractor, to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or Improves thereon, and who contracts for such projects with a con.
traclor(51 license pursuant to the Contractor's License Law). I am aware that
proof o their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section— B. & P. C. for this reason
Date Owner
I hereby certify that 1 have rea
information is correct. I agree to
and state laws relating to buildir
sentatives of city t r
inspection p�
Signature
Drivers' License or SS :p License or SS'p
CMF 0865-46, rev. 10/84 White 7E
above
PE OF CONSTRUCTION EW U ADD U ALTERATION U
R PA R
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TYPE OF PERMIT L GRADING LI FOUNDATION U STRUCTURAL
❑ TENANT ❑ ELECT RICAL—WLUMBI NO ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SO. FT. OCCUPANCY_
CONSTRUCTION TYPE VALUATIONS
ZONE - GRAOINGCU.YOS. ACRES_
Remarks:: �/ �2
Sink
Preventer
Irrigation
Dishwasher'
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service 2 Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fee 1 $15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Bit. ICBO+
Heating System & Ducting
00-100,000 BTU ❑10 OBT
Reinspection Fee I . $15
�r
Canary -Applicant; Pink -Accounting; Goldenrod -Assessor
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto -Wash
Laundry Trays
Issue Fee
1ANICAL
Hood or Type ❑
Canopy Type 11 ❑
Refrigeration System
❑0-100,000 100,000
Syst epair/Alteration
ire Dampers
Registers
Issue Fee
6768 4/27/67
A.P. 46
S Main Building: Accessory Building:
E
T Front
A Rear
C Right
K
S Left
Ping. Ref. + Parking Req./Provided
Planning Notes:
Zone
66x75 TL
Z
O
N
1
N
G
R
E
Q
M
T
S
ELECTRICAL FEES
Automatic Washer
Construction Pole Sub.
Transformer ❑ 15-50 KW
❑ 50 + KW
04
Cooking Unit
Meter ❑up to 100 am
Dishwasher
Meter El over 100 YIPS
Dryers ❑Gas ❑Electric
Sub Panel
Fan
Motors -i HP ❑1%:-8
F.A.U.
Inc. -r ❑9-15 HP ❑16.15+
Fixtures
Icrowave
Device Boxes
Pole Light.
Da
Outlets
Range -
OD
Switches
Sign
Zi0 p
Garbage Disposal
i_
Standing Sections '
J
Generator 00-5 05.15
KW
Trash Compactor
$ 3
Reinspection Fee
$15
Issue Fee $ 3
FEES
DEVELOPMENT SERVICES
Zoning Approved By
Building Approved
Application Issued Byy
REQUIREMENTS:
Date
Date„
to ''//��
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
SUMMARY
$
$
$
$ _._7��
$
$
$
$
OF FEES
SMIP $
PERMIT
y ISSUANCE $
ENERGY P.C. $--
GRADING $
MICROFILM $ /!
TOTAL FEE $ 66.1 J/
$ 3
CONSTRUCTION AND PLANNING
APPROVALS Permit #
Date
Inspector
POOL & SPA
APPROVALS Permit #
Date
Inspector,
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
cOGl
[,�
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.
6 �7
L
60. Backwash Lines, P -Trap, O Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
'.
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
I
FIRE DEPT. REQUIREMENT
APPROVALS Permit # _
i
20. Rough Factory Fireplace
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 ElGas E 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
4V JW -f7'
-
36: Hood or Canopy
37: Final Factory Fireplace
38. Final Plumbing
r b:/
j
- •, - �'-
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
,
42. Backflow Preventer
43. Backflow Irrigation.
..
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48.'Special Requirements Completed
49. -Electric Release to Edison
-
50. Gas Release to Southern California Gas Co
-
51. CERTIFICATE OF OCCUPANCY
iNo. Date
City of Costa Mesa
Development Services Department
Building Safety Division CERTIFICATE OF OCCUPANCY No. L V
P. O. Box 1200
Costa Mesa, California
The Building located at S75 Woat 1QI h ¢trout. PLIAn. r
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group tdl Occupancy.
Use of Building Anartments
Legal Description 424-221-01 thru —14
(See reverse side for Metes and Bounds)
Building Permit No B26931 Electrical Permit NoF!30007, E29370lumbing Permit No. P?3233
Mechanical Permit No
ISSUED TO:
Lincoln Prooertv Co.
16152 Beach Blvd., Ste. 140E
Huntington Reach, CA 82647
Number of apartments 22 and/or guest rooms
Building Official I,ii.ila,n-,j.._:
by %l »
December 8, 1987
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 307 lel U.B.C.
CMF 101546 rev. 1/83 White - owner; Canary - Numerical File; Pink - Bldg. Permit File
Applicant to fill m -a n'xpecvn•smpr'tm ........ best., eines and sign
CITY OF COSTA
Project Address L
Applicant's M iii
Owner's N me1`
Address Il
Contractor's Nam t
Address (mailing) �J.,�r15eL
City License No. TTEX i rs/y
LICENSED CONTRACTOR DECLARATION B rL.YT 3d -/SI
I hereby affirm that I am licensed under provisions of Charter B (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full forced effect. - �C
License Class _y� nLicense No. y
Date I///7_ d -i= Signature» ��
WORKER5' OMPENSATION DEC RATI
I hereby affirm that I have a certificate of consent to self -insure or a certificate
of Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. C
PolicyNo. 2� b9i.noa�i (_Company
Certified copy is hereby furnished.
DatCeertifhe�}cop'
i,file
tl withthe city Building v(�pu-
d�Applicant
EXEMPTI N FROM IN KERS'CO �N DEC
(/Ax ON
(Thissection need not be completed it the permitis forOnehuGntlretl
($100) or
ess).
c%tlfy that In the performance of the work for which this permit is Issued, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
Date Signature
NOTICE: If, after making this declaration, you should become Subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of the work for whi this ermit iss le (Section 3097 Civ. C.)
L.ender's Nam e•A 17
Lender's Address t' e�¢�/17,m.e.-/�/ A, ' $—
OWNER BUILDER DECLA ATIO
1 hereby affirm that am exempt from the Contractor's License Law for the
following- reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, Improve, demolish or repair
any structure, prior -to Its issuance, also requires the applicant for such permit
to m,. a cia d ct,,tem.nt that halshe is licensed pursuant to the provisions of
Division 3 of the Business and Professions Code) or that he/she is exempt
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
�e natty of not more than five hundred dollars ($500).
LJ I, as owner of the property or my employees with wages as their sole
compensation; will do the work, and the structure is not intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such Improvements are not intended or offered for
sale. If, however, the building or Improvement is Sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or im.
prove far the purpose of sale).
❑ I, as owner of the property, am exclusively contracting with licensed con.
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License law does not apply -to an owner of property'who
builds or Improves thereon, and who contracts for Such projects with a con-
tractor(sl license pursuant to the Contractor's License Law). I am aware that
proof o their Worker's Compensation insurance Should be provided to me.
❑ 1 am exempt under Section B: &-P. C. for this reason
Date Owner
1 hereby certify that I have read this application and state that
information is correct. I agree to comply with all city and county
and state laws relating to building construction, and hereby auto
sentatives of this city I enter upon the above-mentioned or
inspection purposes. '
Signature Date
Drivers' License or SS io�`._--- -
(��
0675 1/22/87 20770�� Ti
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OT R l
j
�ESCRI TIO OF RI�USE OF BLDG F r s ,rte I
A.P.# .�.
+7_4
I_QI Zona
S
Main Building: Accessory Building:
T��'Y...PPEEIII OF PERM GRADING FOUNDATION TRUCTURAL
TENANT ❑ ELECTRICAL ❑ PL%ABING ❑ MECHANICAL
OTHER Ib
PROJECT DESCRIPTION SD. FT CCU PANCY
CONS RUC ION TYPE.+aseze;� VALUATION$
ZONE 1 `� RAIDINGG�rCU. YDS. ACRESPing.
T
FronL'�J-��Aa Ali -0
B
A
Rear F5•'��
N
1
K
Right 27-5 _
G
S
L¢ft `% -T- _
R
I
Ref. #es: (>` Parking Req./Provided
E
Remarks:
Planning Not h
\\ �!g
Y cd
O
M
/• ?
n
PLUMBING
FEES
. .
Bar Sink
Showers
ELECTRICAL FEES
Backflow Preventer
Service Sink
Automatic Washer
Construction Pole Sub.
- Transformer ❑ 15-50 KW
❑ 50+ KW
Backflow Irrigation Sewer Cap
Bathtubs
Sewer Connection
Cooking Unit
Meter, Cup to 100 amps
Clarifiers
Solar Collectors
Dishwasher
Meter Cover 100 amps
Dishwasher
Solar Piping
Dryers ❑Gas ❑Electric Sub Panel
Drinking Fountains
Solar Tank
Fan
Motors 00-1 HP❑1'F,-8
Floor Drains
Swimming Pool w/Spa
F.A.U.
Inc. Solar 09-15 HP 016-15+
Floor Sinks
Urinal
Fixtures
Microwave '
Gas Service Outlets
Water'Closet
Device Boxes
Pole Light
Interceptors
Water Heater
Outlets
Range '
Kitchen Sink
Water Service -
Switches --
- Sign
Lavatories
Auto -Wash
Garbage Disposal
Standing Sections
P -Trap
Laundry Trays
Generator 00-5 KW 05.15
KW Trash Compactor
Roof Drains '
Reinspection Fee
$15
i Issue Fee
$ 3
Reinspection Fee -
$15 Issue Fee $ 3
MECHANICAL
FEES
Boiler
Hood or Type I ❑
Canopy Type 11 ❑
_
DEVELOPMENT SERVICESR
Zoning Approved BY
Building Approved By
Apptici tion Issued By
IR E S:
ate �� Z/—
Date
tjx Dat 'Z
Duct -Under Ground
Duct - Structural
Refrigeration System
00-100,000 BTU C100,000BTU
Duct - Ventilating
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK .50%
MECHANICAL
PLAN CHECK - 25%
SUMMARY OF FEES + _
$ �02SSo SMTP $ 5�rSS
$ PERMIT
$ ISSUANCE $
$ ENERGY P.C. $
$ GRADING $
$ MICROFILM $-
$ TOTAL FEE, $ 2rO7Z OS
$
Exhaust System ❑ Multiple El
System Repair/Alteration
Firepl/Fact. Bit. ICBG #
Fire Dampers
Heating System & Ducting
❑0-100,000 BTU ❑ 100,000 B
Registers
.
Reinspection Fee
$15
Issue Fee
$ 3
CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
CONSTRUCTION AND PLANNING
APPROVALS Permit #
Date
Inspector
POOL & SPA
APPROVALS Permit #
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd:
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, 0 Undrgrnd.; Test
9. Water Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, 0 Undrgrnd:
10. Structural Floor System
61. APPROVAL TO DECK
11, Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final -
13. Roof Drains
64. Plumbing System - Final ;
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT'
APPROVALS Permit #
20. Rough Factory Fireplace
27. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas 0Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
'
24. Roof Framing
73. Undergrnd. Storage Tank 0 GasO 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
oe
35. Final Gas Pipe -Test
36: Hood or Canopy
- -
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service -Final
- '""•
40. Gas Service -Final -
-
•i ;
' 41. Solar Domestic -Final
42. Backflow Preventer
'
43. Backflow Irrigation
•„ ,..•- "
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
•! '' - •-
47. FINAL STRUCTURE &BUILDING
i
%f•':�. '
48. Special Requirements Completed
�� 8 $'
49. Electric Release to Edison
... .
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESA _CONST �1TION PERMIT
Project Address PERMIT NO. TRACT NO. LOT NO. IIN IT Nn'
P---� ��r� r
Applicant's Mailing Address /
Owner's Name, -PM /�22 J
Address
Arch/Eng. License No.
Address IS
Contractor's Name I�8 /%(G o e Z
Address (mailing) � >7LL7L Xr7- 4�,jI U.•.cJ /4'
City License No. Q�&Irr]
LICENSED CONTRACTOR DECLARATION
1 hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 ofthe siness and Professions Codeland
my licens is in t Pffir pqd effect.
I Ucen ass C/ Licen
Date Signature14 sa
-"OR E 'COMPENSATION DECL RAT10
ireby affirm that 1 have a certifica of consent to self -Insure or a certificate
Workers' Compensation Insurance, or a certified copy thereof (Section
X800, Lzb. g�Je ,7 J.�AJ61�
Policy No. Comp
❑ C4rtifie co is hereby furnished.
er c filetl with the city(Sion ✓
Date Applicant '
EXEM FROM WORKERS'CO ENSATIO DECLARATION
(This section
n neetl not be completed if he permit is for one hundred ($100) or
less).
certify that in the performance ofthe work for which this permit is issued,
Shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
Date Signature
NOTICE: after making this declaration, you become subject to the
C
Workers' Compensation provisions of the Laborr Cod Code, you must forthwith
comply with such provisions or this permit shall b¢ deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. CJ
Lender's Name
Lender's Address
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, improve, demolish or repair
any structure, prior to its Issuance, also requires the applicant for such permit
to file a signed statement that he/she Is licensed pursuant to the provisions of
she Contractor's License law (Chapter 9 (commencing with Section 7000) of
ision 3 of the Business and Professions Cotle) or that he/she is exempt
refrom and the basis for the alleged exemption, Any violation of Section
,31.5 by any applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars ($500).
❑ 1, as owner of the properly or my employees with wages as their sole
compensation, will do the work, and the structure is not Intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or im-
rove for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a con-
tractors) license pursuant to the Contractor's License Law). I am aware that
proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section B. 8 P. C. for this reason
Date Owner
I herebv certify that I have rea
this
IaylCrginting to byndmg cons
9 is city to nter upon
I Drivers' Lic)'nse or 55 $ —
CMF 0865-46, rev. 10/84 White
above
TYPE OF CONSTRUCTION ,.In NEW LJ ADD ,
:❑ CONVERSION ❑ DEMOLISH ❑ OTHER
'DESCRIPTION OF WORK/USE OF BLDG.'
LJiALTERATION LJ REPAIR
FEES
A.P. 916
S
Main Building:
TYPEOF PERMIT0 GRADING M FOUNDATION U STRUCTURAL
E]ry TENANT Jr ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
T
B
A
Front
Rear
PROJECT DESCRIPTION SQ. FT. OCCUPANCY
CONSTRUCTION TYPE VALUATION$
ZONE ACRES
C
S
Right
Left
Ping.
Ref.+
�y}��GRADI/N�GCU.YOS.
Remarks: GD Cr P�'�/Y
Planning Notes:
$ 3
• .- PLUMBING
FEES
3ackflow Preventer
3ackflow Irrigation
3athtubs
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Sas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fee $15
Boiler
Duct- Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICSO+
Heating System & Ducting
❑0-100,000 BTU 0100,000
Reinspection Fee 1 $15
ilding; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
Service Sink -
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto -Wash
Issue Fee
Hood or Type ❑
Canopy Typell ❑
Refrigeration System
110-100,DDOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
44_. --/:'/_7
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
Automatic Washer Transformer ❑ 15-50 KW
Construction Pole Sub. 050+KW
Cooking Unit - Meter ❑up to 100 amps
Dishwasher Meter EJ over 100 amps
Dryers ❑Gas ❑Electric - Sub Panel
Fan Motors ❑0-1 HP❑1%-8
F.A.U. Inc. Solar 09-15 HP 016-15+
Fixtures - Microwave
Device Boxes Pole Light
Outlets Range
Switches - Sign
Garbage Disposal Standing Sections
Generator ❑0-5 KW 135-15 KW Trash Compactor
ICE4 T_
FEES
Z
O
N
I
N
G
R
E
Q
M
T
S
$ 3
' .Reinspection Fee [ $15 Issue Fee $ 3
FEES
_
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By Date
Building Approved - Data
Application Issued By Dat .3/
SUMMARY OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ _ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAL $ GRADING $
PLAN CHECK 50% $- MICROFILM S
MECHANICAL $ TOTAL FEE $
PLAN CHECK 25% $ .
$ 3
CONSTRUCTION AND PLANNING
t r
'APPROVALS Permit'-
#
-
Date
i.�--
=
InspectorDate
- ;�
r: ,`•; POOL &SPA
"APPROVALS Permit #
Inspector
1 ✓emporary Electrical Sqrvice or Pole
52. Pool & Equipment• Location
,
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding '
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footir)gs
58. Electrical Conduit-Undrgrnd.
8. FPundation
..
•I
59. Gas Pipe, ❑Undrgrnd., Test
9. Waiei_Pipe-Undrgrnd.
60. Backwash Lines, P -Trap, ❑ Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final'
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final '
16. Rough Electric Wiring SCS,
u
67.-. Fencing & Access Approval
17. Rough Wiring Sign
f'
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
-
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS ' Permit# _
_
'
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro _
22. Ducts, Ventilating
71. Product Piping 0Gas El 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 Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
.f
33. Final Electric
j� '7
Notes: 704k '6`lfr C . Mks `Y•
34. Final Heating & Air Conditioning
/ SB ' ;i
35. Final Gas Pipe -Test
36. Hood or Canopy
37. -Final Factory Fireplace
38.. Final Plumbing
-�
39. Water Service -Final
,
40. Gas Service -Final
- -
,41. Solar Domestic -Final
•, i i`
r'�42. Backflow Preventer
'
43. Backflow Irrigation
yr
i
:44. Landscape Irrigation System
J '' "-l�•, " ' i
45. Sound Attenuation
46. Handicap Regulations
- r
47. FINAL STRUCTURE&BUILDING
48.;Special Requirements Completed
F --
,i i
.49., -Electric Release to Edison
50. Gas Release to Southern California Gas Co
f . "
7-
51. CERTIFICATE OF OCCUPANCY
No. Date
- -
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA MESS NSTRUC IIOON PERMIT
Project Address
Applicant's Mailing Address (l-SGf�i1"J L— - �/✓3Ff
/ _� c
Owner's Name h CsdLN��^Z 7�'/r
Address
Argh/Eng. _License No.
Address
Contractor's Nam Z72_� 1 R /F, Phone
Address(mailingV2- E'- -r�O�L S%. LU/l/. "oY , Cil'
City License No. 0 S8
LICENSED CONTRACTOR DECLARATION
i, I hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of tF�a.,gus lness a�Professlo ns Code, and
my license is in full fo/rce and effect. /` p
Licensy. Clams r�/ Lic 0.
Date ciL
l
WORK R ' COMPENSATION DEC RATION
1 hereby affirm that I have a certificate of consent to self -insure or a certificate
! of Workers' Compensation Insurance, or a certified copy thereof (Section
I 3800, Lab.^�u,N. a✓sis�a
Policy Nor, Comp y
Cert.fietl copy is hereby furnished.
Cert. ie y is tiled with the city n Divis'on-
Da a Applicant
EXEMP ION FROM WORKERS' COMP NSATION DECLARATION
(This section need not be completed if th permit is for one hundred ($100) or
less).
certify that in the performance of the work for which this permit is issued, I I
shall not employ any person in any manner So as to become Subject to the
Workers' Compensation Laws of California.
Date Signature -
NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with Such provisions or thit permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY '
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is Issued (Section 3097 Civ. C.)
Lender's Name
Lender's Address
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code; Any city or
county which requires a'permit to construct, alter, improve, demolish or repair
any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 0 (commencing with Section 7000) of
Division 3 of the Business and Professions Code) or that he/she is exempt'
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars ($500).
J 1, as owner of the Property or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or improves
thereon, and who tloes such work himself/herself or through his or her own
employees, Provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of com-
pletion
; the owner will have the burden of proving he/she did not build or im-
prove efor the purpose of sale).
I, aS owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that
proof .o their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section B. & P. C. for this reason
Date - Owner
I hereby certify that I have read this application and state that the above
information is corrt I agree to omply w` all city and county ordinances
and state'laws , s ti to build' g construction, antl hereby authorize repre-
sentatives of 1I s lty to ant upon the above-mentioned pro rt /for
Inspection Pur 9 S/ tY
Signature Date
rz 2-1737/
TYPE OF CDNSTRUCTI ON 4 ANEW U ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTH}� R I A,P, 4:
DESCRIPTION OF WORK/USE OF BLDG. K�SyA�.tJ�-�
S Main Building:
TYPE OF PERMITIIIyyy GRADING -0 FOUNDATION ❑ STRUCTURAL T Front
❑ TENANT yJ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear
❑ OTHER / A
PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right '
K
CONSTRUCTION TYPE VALUATION $ $ Left
ZONE GRADING CU.YOS. ACRES Ping. Ref. #
Remarks: - A6/—'/7/ ZW -a?/ Planning Notes:
Sink -
Preventer
Irrigation
ing Fountains
Drains
Sinks
Outlets ,
Lavatories /
P -Trap
Roof D In
Reinspection Fee f $15
Boiler
Duct - Under Ground '-
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICED
Heating System wet'
Ing
❑4100,00 Li 100,000
Reinspection Fee
Drivers' Lice se r SS 5r I I
CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
$15
Zone
Accessory Building:
Parking Req./Provided
FEES
$ 3
Z
O
N
I
N
G
R
E
Q
M
T
S
LUMBING
FEES
-
Showers
ELECTRICAL
Service Sink
Automatic Washer Transformer❑ 15-50 KW
1u -tion Pole Sub. ❑50+KW .
Sewer Cap
Sewer Connection
Cooking Unit Meter Oup to 100 amps
Solar Collectors
Dishwasher Meter ❑over 100 amps
Solar Piping
_
Dryers ❑Gas []Electric Sub Panel .
Solar Tank i
Fan - Motors 1:10-1 HP 011A - 8
• Swim Pool w/Spa
F.A.U.Inc. Solar 09-15 HP 016-15+
mal
Ale Fixtures Microwave
Water Closet
>- Device Boxes Pole Light
Water Heater
&11 Outlets Range
Water Service -
2- Switches Sign,
Auto -Wash
Garbage Disposal Standing Sections
Laundry Trays
,_ Generator 00-5 KW 05-15 KW Trash Compactor
%!o-''j///���l-oAr,C60ET�GTorZS
Issue Fee
S 3
'
Reinspection Fee
$15 Issue Fee
CHANICAL
FEES,
DEVELOPMENT SERVICES REQUIREMENTS: -
Zoning Approved By �`jj,.y' ,fin Date —
Building Approved By -'/Z�+ ' Y ✓ _ Date
- Application Issued By - DateJ
Hood or Type ❑
Canopy Type 11 ❑
Refrigeration Syste
❑0 -loo TU 0100,000BTU
SUMMARY OF FEES
BUILDING PERMIT $ SMIP $ _
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $ -
PLAN CHECK 25% $ ENERGY P.C. $ _
ELECTRICAL nQ/ OICL' 00 GRADING $ _
PLAN CHECK �50H%$JU MICROFI LM -
MECHANICAL $ TOTALFEE $ _
PLAN CHECK 25% $, 1`l1PA�
ystem Repair/Alteration
Fire Dampers
Registers
-
Issue Fee
$ 3
FEES
$ 3
Z
O
N
I
N
G
R
E
Q
M
T
S
CONSTRUCTION AND PLANNING
'.
...APPROVALS Permit #
� D ate
Inspector
POOL & SPA
.APPROVALS Permit #
Date
Inspector
,
y1. 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, 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
t
65. Electrical -Final
15. Rough Electrical -Conduit
66.. Solar System -Final
16. Rough Electric Wiring
-1y41
J C
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit # _
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22, Ducts, Ventilating
71. Product Piping 0Gas OOil
'
23. Gas Pipe -Rough & Test '.
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank 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 Domestic -Final
'
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
-
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
n
Der
N
1
N
�— Applicant
to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
679!1 4/27/97
344°25
,CITY OF COSTA MESA CONSTRUCTION PERMIT
s3
Project Address t
/
Applicant's Mailing Address
Owner's Name / one A zl%
Address
PERMIT NO.
2423
TRACT NO.
LOT NO.
UNIT
O.
TYPE OF CONSTRUCTION EW ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑DEMOLISH ❑ OTHER
DESCRIPTION OF WOR K/USE OF BLDG.
A,P,+
_ Zone
S
Main Building: Accessory Building:
Arch/Eng. ' License No.
Address
TYPE OF.PERMIT GRADING FOUNDATION STRUCTURAL
❑ TENANT ❑ ELECTRICALS;JTLUMBING ❑ MECHANICAL
❑OTHER
PROJECT DESCRIPTION 5Q. FT. OCCUPANCY
CONSTRUCTION' TYPE VALUATION$
ZONE GRADING CU.YDS. ACRES
T
Front
U
Rear
N
Contractor's Nam.M4
Address (mailingl� 1
�.s
City License No. Q S"'/
LICENSED CONTRACTOR DECLARATION
1 hereby affirm that I am licensed under provisions of Charter 9 (commencing
With section 7000) of Division 3 of the Business and Professions Code. and
License Clpssse No.
my license is ip ful Or no effect. ^e
Date �i �ry t _e
A
C
Right
N
KLeft
$
G
R
Png. Ref. # Parking Req./Provided
E
Remarks: 3 /
-
Planning Notes:
M
T
S
PLUMBING
FEES -
Bar Sink
-
Showers
ELECTRICAL
FEES
SS'g
WORK RS' OMPENAT IO
I hereby affirm that I have a certificate of consent to self -Insure or a certificate
Backflow Preventer
Service Sink
Automatic' Washer
Construction'Polesub.
Transformer -❑ 15-50 KW
❑ 50+KW
f Workers' Compensation Insurance, or a certified copy thereof (Section
0, Lab. �C.} �� -��— G ���
y No. (d.C(L-�3C /ya G Company t5;� �/%
Backflow Irrigation Sewer Ca
9 P
J
ertified copy is hereby furnished.
Ce t'f' d o I 0ed with the city Suit
Bathtubs
-
Sewer Connection
01
Cooking Unit
Meter 0 u to 100 amps
Date =.�_ Applicant
EXEM TIO FROMWORKERS'CO ENSATIO DEC ION
(This section need not be completed if the permit is for One hundred ($100) Or,
less).
1 certify that In the performance of the work for which this permit is Issued, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
Date Signature - - - --
NOTICE: If, after making this declaration,Inc.
Should become subject to the
Workers' Compensation provisionsoffthe M1e Labor Code, you must forthwith
�revo etl.
comply with such provisions or this permit shall be tleemetl k
CONSTRUCTION LENDING AGENCY �./
I hereby affirm that there is a construction lending agency for the performance
of the work for Which this permit is issued (Section 3097'4Civ. C.)
Lender's Name ^_�
Lender's Address
OWNER BUILDER DECLARATION
'•1 hereby affirm that I am exempt from the Contractor's License' Law for the
-following reason (Section 7031.5 Business and Professional Code: 'Any city or
county which requires a permit to construct, alter, Improve, demolish or repair
any structure, prior to its issuance, also requires the applicant for Such permit
to file a signed statement that he/she is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (comComencing with Sectionr7000) of
Division 3 of the Business and Professions tle) or that he/she isexempt
therefrom- and the basis for the alleged exemption. Any violation of Section
11.5 by any applic8nt for a permit subjects the applicant to a civil
llty of not more than five hundred dollars ($500).
I, as owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure Is not intended or offeretl
for 'sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply t0 an owner Of d property who builds Or improves
thereon, and who does such work himself/herself or through hisor her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of com-
pletion, the owner will have the burden Of proving he/she did not build or im-
rove for the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project(Section 7044, Business and Professions Code:
The Contractor's License law does not apply to'an owner of propertywhoDuct
builds or Improves thereon, and who contracts for such projects With a con- tractors) license license pursuant to the Contractor's License Law). 1 am aware that
- -
Clarifiers
Solar Collectors
Dishwasher
Meter Dover 100 amps
Dishwasher Solar Piping
o U
Dryers ❑Gas ❑Electric Sub Panel
JDrinking Fountains Solar Tank
Fan Motors H 1X-8
Floor Drains Swimming Pool w/Spa
F.A.U.
Solar -15 HP 1316-15+you
- _ - - -
Floor Sinks Urinal
Fixtures Micre
r o v
Gas Service Outlets Water Closet
/
Stl 00
Device,BOxeS a Light
Interceptors Water Heater
Outlets-,. r
Range
1JL Kitchen Sink water Service -
0 0.
Switches Sign - - -
Lavatories Auto -Wash
rj N
Garbage Disposal Standing Sections
P—Trap Laundry Trays
-
Generator ❑0-5 KW 5-15 KW Trash Compactor
RF
OODrains
°U
• t
- - -
ReinspeWon Fee
$15 Issue Fee
$ 3
_
Reinspection Fee $15 Issue Fee
$ 3
MECHANICAL
FEES
SERVICES REQUIREMENTS:
nvy
Zoning Approved B Date
Building Approved By Date
�V1 e
Application Issued By Dat
goiter
Hood or Type I El
Canopy Type II ❑
Duct - Under Ground
Duct -Structural
Refrigeration System
❑0100,000 BTU 0100,000BTU
- Ventilating
SUMMARY OF FEES
BUILDING PERMIT $ SMIP $
Exhaust System ❑ Multiple ❑
System R r/Alteration
proof of their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section 'B. & P. C. for this reason
PLAN.CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
$ PERMIT
$ 7 ,OD ISSUANCE $
$ (0 g.`LJ� ENERGY P.C. $ -
$ GRADING $
-
$ MICROFILM $
$ZS
TOTAL FEE $
$
_
Firepl/Fact. Bit. ICBO #
ampers
Date Owner
certify that I have read this application and state that the above _
Information is correct. I agree o comply with all city and county ordinances .
Information
and state laws rel n9 t to n, antl hereby authorize repre-
sentatives of c1 o upon a ab (��antioned operty for
inspection our
Slgnatur Date
Drivers' License or SS
Heating System & Ducting
❑0-100,000 BTU ❑100, T
Registers
-
-
Issue Fee
Reinspection Fee $15. $ 3
;MF 0865-46, rev. 10/84 White - Builbing; Canary - Applicant; Pink - Accounting;
Goldenrod - Assessor
'
CONSTRUCTION AND PLANNING
APPROVALS Permit
Date
Inspector
. POOL & SPA
APPROVALS Permit
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, ❑ 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
10,60 2
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/SPCA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
"FIRE DEPT. REQUIREMENT
APPROVALS Permit
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping O Gas 0Oil
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank ❑ Gas O 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: 0/�6,4
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
I ?
36. Hood or Canopy
'
37.'Final Factory Fireplace
�
38: Final Plumbing
39. Water Service -Final
40. Gas Service -Final
'
'41. Solar Domestic -Final
r
42. Backflow Preventer
-- -
43. Backflow Irrigation
t'
44. Landscape Irrigation System.
-
45. Sound Attenuation
-
46. Handicap Regulations
,
47. FINAL STRUCTURE & BUILDING
'
48. Special Requirements Completed
-
49. Electric Release to Edison -
-
50. Gas Release to Southern California Gas Co
'
51. CERTIFICATE OF OCCUPANCY
No. Date
• 5-75 W• / 5-4• Applicant to fill in all spaces except those within
CIT`% OF COSTA MESA CONST UCTION PERMIT PERMIT NO. TRACT
Project Address F 2 C 6 Z
Applicant's MailinJ)gg�Address �—y, , ^ �7TYPE OF CONSTRUCTION.- Es
N:rs%�i�) /�ai/-1//�'-S Phone CONVERSION ❑ DEMOLISH
Owner's Name DESCRIPTION OF WORK/USE OF B
Address
Arch/Eng / License No. TYPE OF PERMIT GRADING
Address 1�� /QD�✓/����le z4�'r �v - r'l❑TENANT ❑_ELECTRICAAL ❑
Contractor's Name/_S. xL( �`�Phone • `Kv OTHER 0C17
Address
C�T PROJECT DESCRIPTION -SQ. FT._
Address (mailing) `� J � -7"=: �f� ' CONSTRUCTION TYPE
r -
border lines and sign at
JIADD LI ALTERATION
OTHER
declarations. _
REPAIR
FOUNDATION ❑ STRUCTURAL
LUMBING ❑ MECHANICAL
OCCUPANCC'Y`_
VALUATION 3146 CK-'
City License No. ZONE GRADING CU.Y
LICENSED CONTRACTOR DECLARATION -
Automatic Washer
Construction Pole Sub.
Remarks:
1 hereby affirm that I am licensed under provisions of Charter.9 (commencing
with Section 7000) of Division 3 of the Buiines5 and Professions Code, and
rte' L C
P�QF14,,;LytQL�R / N..
.
my license is in full forEnd effect49:03
License Cl `- _/ _ Li6ense N &2 9J
Oate1_�� Signature „
'
Bar Sink
IRKERS' COMPENSATION DECLARATION -.
ireby affirm that I have a certificate of consent to self -insure or a certificate
Workers' Compensation Insurance, or acertified copY-thereof (Section
3800, Lab. C.) 74/ !yam/ (7�' 1
Policy No. IA/co Cpy) 403 �a�or`rtpany OfY'NF'Q --71- �Sr•INQ:k� P
®Ceriif ietl copy is hereby furnished.
Certified cop Is tiled with the city Builtli�ny QiJisi
Applicant .sZ Z'7 'r/� ea-�*
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION-
EXEMPTION
Backflow Preventer
Backflow Irrigation
Bathtubs
, Clarifiers .-
(Th section need not be completed if the permit is for one,hundred ($300) or
less). - - - -
I certify that in the performance of the work for which this permit is issued
shall not employ any person in any manner so'as to become subject to the
Dis s er
rinking Fountains '
Workers' Compensation Laws of California.
Floor Drains
-
Date Signature
NOTICE: If, after making this declaration, you should becomesubjectto the
Workers' Compensation provisions of the Labor'Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Floor Sinks
Gas Service Outlets
CONSTRUCTION LENDING AGENCY �'
I hereby affirm that there is a construction lending agency for the performance/
of the work for which this permit is issued (Section 3097 Civ. C.)
Lender's Name r
Trash Compactor
Interceptors
Kitchen Sink' "-
Lender's Address - - -
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt'from the Contractor's License Law for. the
following reason (Section 7031.5 Business and Professional Code: Any city or
Lavatories
P—Trap
county which requires a permit to construct, alter, improve, demolish or repair
any structure, prior to its issuance, also requires the applicant for such p rmit
Roof Orai
'n file a signed statement that he/she Is licensed pursuant to the provisions of
,, Contractor's License Law (Chapter 9 (commencing. with Section 7000) of
rision 3 of ,the Business and Professions Cotle) or that he/she is exempt.
S
. arefrom and the basis for the alleged exemption. Any violation ofection
7031.5 by any applicant for a permit subjects the applicant to 8 civil
nnalty, of not more than five hundred dollars ($500). .
I, as owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such improvements are not intended or offered for
.sale. If, however, the building or improvement Is sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or im-
�Tve for the purpose of sale). - i '
LI, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project(Section 7044, Business and. Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or improves' thereon, and who contracts forsuch projects with a con-
tractors license pursuant to the Contractor's License Law). I am aware that
of their Worker's Compensation insurance should be provided to me.
$ 3
Reinspection Fee,
$15
Boiler
Duct - Under Ground -
Duct -Structural
Duct - Ventilating
'
Exhaust System .❑ ` Multiple C1proof
_ Firepl/Fact. Bit. ICBG #
❑ I am exempt under Section B. & P. C. for this reason
Date Owner _
I hereby certify that I have read this a
information is correct. I agree to comply
and state laws relatinq to building const
a
Heating System & Ducting
00-100,000 BTU ❑ ,000
sgna[ure��s- o _ `•` s I 'e inspection Fee
Drivers' License or SS #
CMF 0865-46, rev. 10/84 White - Building; Canary - Applican It; Pink - Accounting; Goldenrod - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swim g Pool w/Spa
nal
Water Closet
Water Heater
Water Service
Auto -Wash
Laundry Trays
Issue Fee
AANICAL.
Hood or Type l' ❑
Canopy Type 11 ❑
Refrigeration System
E10-1 00,000 BT 100,
Syste pair/Alteration
ire Dampers
Registers
Issue Fee
A.P. #
S Main Buildi
E
T Front
B Rear
A -
C Right
K
S Left
Ping. Ref. #
Planning Notes:
Bui
-/97 645cGL 'A
Zone
Z
O
N
1
N
G
R
E
Q
M
T
S
ELECTRICAL FEES
Automatic Washer
Construction Pole Sub.
Transformer ❑ 15-50 KW
1150+KW
Cooking Unit
Meter Cup to 100 amps
Dishwasher
Meter Dover 100 a
Dryers ❑Gas ❑Electric
Sub Panel
Fan -
Motors -1 HP ❑1% -Is
F.,9,. U. _
In olar 09-15 HP ❑16-15+
Fixtures
Microwave
Device Boxes
pole Light
Outlets
Range
Switches ' -
Sign '
Garbage Disposal
Standing Sections
Generator -5 KW ❑5-15 KW -
Trash Compactor
I
$ 3
Reinspection Fee
$15 Issue Fee
$ 3
FEES
DEVELOPMENT SERVICES
Zoning Approved By
Building Approved By
Application Issued By
REQUIREMENTS:.
M
-
Date
Date
'Data
i BUILDING PERMIT,
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL
PLAN CHECK 25%
' SUM ARY OF FEES
•$- t
$
$
$
$-
,$. ,MICROFILM
$
$
SMIP $
PERMIT - -
ISSUANCE $
ENERGY P.C. $
GRADING $.
$
TOTAL FEE $�
'
$ 3
CONSTRUCTION AND,PLANNING
APPROVALS Permit#
Date
Inspector
POOL & SPA
APPROVALS Permit#
Date
Inspector
1:.Temporary Electrical Service or Pole
52. Pool & Equipment Location
2.' Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical, Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd.'
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
- 60. Backwash Lines, P -Trap, 0 Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -7 Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro i
22. Ducts, Ventilating
71. Product Piping 0 Gas 00il
23. Gas Pipe -Rough & Test
72. Underground Flush
24. Roof Framing
73. Undergrnd. Storage Tank ❑Gas 00il
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
r • -
6 J' in r
36. Hood or Canopy
37: Final Factory Fireplace
'
?6n
38. Final Plumbing
r �� _ y ,
39. Water Service -Final
40. Gas Service-Finalr�'
"
,41. Solar Domestic -Final
•42. Backflow Preventer
43. Backflow Irrigation
r'.•
44. Landscape Irrigation System
45. Sound Attenuation
-
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
,
49. Electric Release to Edison
(d
I .
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
-
City of Costa Mesa
Development Services Department
Building Safety Division CERTIFICATE OF OCCUPANCY No. 0 C s., C .)
P. 0. Box 1200
Costa Mesa, California
The Building located at 575 67. 19th Street, Blda. H
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group .t'. Occupancy.
Use of Building naprit•mnntc
Legal Description424-221-01 thru —14
(See reverse side for Metes and Bounds)
Building Permit No ,. -R 76932 Electrical Permit No7.30008, E2937plumbing Permit No. 023?.34
Mechanical Permit No. Number of apartments and/or guest rooms
ISSUED TO: Building Official Nilf.iam T. 9owainf
Lincoln Proclerfv
16152 IdeaubhBoulevard by
Suite 140E
Huntington Beach, CA 92647 Date December 11, 1987
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Costa Mesa under Sec. 307 lel U.B.C.
CMF 1015-46 rev. 1/83 white -Owner; Canary - Numerical File; Pink - Bldg. Permit File
Q�
---__
Applicant
to fill in all spaces except those within heavy border liiics and sign all appropriate declarations.
�
0676 1 /22/B7
?077.05 TL
CITY OF COSTA-MESA ON F{IACT ERMM-
I�
Project Address
Applicant's Mailing Address
Owner's Name Ph0
Address I`
NU �
o`'YI
TRACT NO.
'T
LOT NO.
I-l2 N . G
UNIT N0.
-
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION' ❑DEMOLISH ❑ OTIR
QfSC PTIf]dlO�./JSE OF BLDG. L Y
��/
A p. # ,-�rl �1 1 �O�
one
Y
S
Main Building: - Accessory Building:
Arch/En cense No.
Address A.
Contractor's Nam o '2.2
Address (mailing)
City License No, ON
LICENSED CONTRACTOR DECLARATION g. L. 3�gSl
1 hereby affirm that I am licensed under provisions of Charter (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full force antl effect. K / 7 /�
OC %
License No.T_
TYPE OF PERMIT GRADING FOUNDATION TRUCTU RAL
❑ OTHERT ❑ ELECT ICAL ❑ PLUMBING ❑ MECHANICAL
74
PROJECT DESCRIPTION SO FT OCCUPANCY//'-- ''//'
CONST CTION TYPE •� i�_ VALUATION $-7% T�-�
ZONE _ GRADING CU. YDS.'-, ACRES-Ping.
T
Front "��
0
BA
C
Rear
N
N
Right
K
$
Left
G
R
E
Ref. # p/� p Parkin
PASO - Z� g Req./Provided
Remarks:
Planning Notes:
O
M
- -
/'• %/// ? — S%/' ♦ _
C— q J V h L.
_
T
$
License Vass p
Date 1�'7 '1- 0 7 Signature f?/t�+•`� -
;"
PLUMBING
FEES
UK r'
�`
U11W41�
,
Bar Sink
Showers
-
-
ELECTRICAL -
FEES
WORK RS' OMPENSATION DEC RATIO '
I hereby affirm that I have a certificate of consent to self-insure or a certificate
Backflow Preventer
Service Sink
Automatic Washer
i
Constructwn PoleSub.
Transformer ❑ 15-50 KW
'❑ 50+KW
-
of Workers' Compensation Insurance, or a certified copy thereof (Section
3800, Lab. C ) / .I ..,{.. ,J-
Policy No.l-Q7-49/-Do 6J Company !J �( �4m
�Certifietl copy is hereby with thehad.
Certiflad copy is filed with the city Bul g.DWluon.
Backflow Irrigation
Sewer Ca P
.Bathtubs
Sewer Connection
Cooking' Unit,
Meter ❑up to 100 amps
Date___YI0N F OM Applicant �a ALA'2 ✓VL -
EXEMP ION FR7-O�M/W—O RKE RS' COMPE NSA ION L ATION
(This section need not be completed if the permit is for One hundred ($100) or
less).
certify that in the performance of the work for which this permit is issued, I
Shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
Date • Signature
NOTICE: If, after making this declaration-, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
Clarifies
$01st Collectors
_
Dishwasher -
Meter Clover 100 amps
Dishwasher _ Solar Piping -
Dryers ❑Gas ❑Electric Sub Panel
Drinking Fountains Solar Tank
-
Fan Motors ❑0-1 HP ❑1Ya-8
Floor Drains I Swimmin o6 w/Spa -
F.A.U. - Inc. Solar 09 -15 HP 016-15+
Floor Sinks Urinal
Fixtures i Microwave
Gas Service Outlets
Water Closet
Device Boxes
POIe Light
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance
of the work ,.for tw�� Is�e�r�m� ,iz issued (Section 3097 Civ. C.)
Lender's Name r ]}fi n
Interceptors
Water Heater
Outlets
Range `
-
Kitchen'Sink- -- - -
-
Water Service - -
Switches'. - - "-
Sign
"
-Lender's Address- f/ (� / /�j,b(,(•}T<I {ify r a
OWNER BUILDER DZ�ATION
I hereby affirm that--1 am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires,a permit to construct, alter, improve, demolish or repair
any structure, prior to Its issuance, also requires the applicant for such permit
to file a signed statement that he/she Is licensed pursuant to the provisions of
the Contractor's-License Law (Chapter 9 (commencing with Section 7000) of
Division 3 oftheBusiness and Professions Code) or that he/she Is exempt
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant t0 a civil
nna1ty of eat more than five hundred dollars ($500).
Ll I, as Owner of the property or my employees with wages as their sole
compensation, will d0 the work, and the structure is not intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License law does not apply t0 an owner of a property who builds or improves
his or her own
or intended
thereon, and who does such work ovem nts are
employees, Provided d teat such Improvements are not Intended or offered for
sale. If, however, the building or Improvement is sold within one year of com-
pletion, the owner will have the burden Of proving he/she did not build or im-
prove for the purpose of sale). -
❑ 1, as owner of the property, am exclusively Contracting with licensed con-
tractors to construct the project Section 7044, Business and Professions Code:
The Contractor's License Law =s-not apply to an owner of property who
-builds or Improves thereon, and who contracts for such projects with a con-
tractors) license pursuant to the Contractor's License Law). I am aware that
proof of their Worker's Compensation Insurance should be provided to me.
❑ I am exempt under Section B. & P. C. for this reason
Lavatories Auto-Wash
Garbage Disposal
Standing Sections - `
p-Trap LaundryTrays '
ra y
Generator [10-5 KW E)5-15 KW Trash Compactor
Roof Drains '
-
,
-
Reinspection Fee
$15 Issue Fee
$ 3
Reinspection Fee
$15 Issue Fee $ 3
MECHANICAL
FEES
Boiler _
Hood or Type ❑
Canopy _ Type I I ❑
DEVELOPMENT SE RR VIC R ME NTS:
Zoning Approved By Date
! O
Building Approved By Date Z
Application Issued By Dat
Duct - Under Ground
Duct- Structural
Refrigeration System
❑0.100,000 BTU ❑100,000 BTU
Duct - Ventilating
SUMMARY
BUILDING PERMIT $
PLAN CHECK $
UMBING
PL$
PLAN CHECK 25% $_
ELECTRICAL $
PLAN CHECK 50% $
MECHANICAL_ S
PLAN CHECK 25% $
OF FEES
OZS S $MIP $ S
PERMIT
ISSUANCE $
ENERGY P.C. $
GRADING $
MICROFILM $
'
TOTAL FEE $ 2 077. Os
f
Exhaust System ❑ Multiple ❑
System Repair/Alteration
Firepl/Fact. Bit. ICBG #
Fire Dampers
Date Owner
1 hereby certify that 1 have read this application and state that the above
information is correct. I agree di comply with all city and county riz finances
and state laws relating to building construction, and hereby authorize yfor.
sentatives of this city enter upon the gbove-mentioned property for
Inspection purposes.
Signature Date
- Drivers' License or SS
F-Fli
Heating System & Ducting
❑0.100,000 BTU ❑100,00087
Registers
Reinspection Fee $15 Issue Fee $ 3
MF 0865-46, rev. 10/84 White - ullding; Canary - Applicant; Pink - Accounting;
Goldenrod - Assessor
r-
CONSTRUCTION AND-PLANNING
APPROVALS Permit#
Date
Inspector
POOL & SPA
APPROVALS Permit#
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipinent Location -
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
'
6. Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
-
8. Foundation -
59. Gas Pipe, 0 Undrgrnd., Test
9. Water Pipe-Undrgrnd.
a
--
60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor-Final
12. Sewer Cap
63. Heater & Vent-Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical-Final
15. Rough Electrical-Conduit
66. Solar System-Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit # .�
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro
22. Ducts, Ventilating
71. Product Piping 0Gas 0Oil
23. Gas Pipe-Rough & Test
72. Underground Flush'`"
24. Roof Framing
Undergrnd. Storage Tank 0 Gas 0 Oil::
25. Roof Sheathing
74' Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat
75. Dry Chemical 1e '
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: HOLD FOR SPECIAL REQUIRWEn;g'
34. Final Heating & Air Conditioning-
35. Final Gas Pipe-Test
36. Hood or Canopy!
37. Final Factory Fireplace
38. Final Plumbing.
" 1 .• i
39. Water Service-Final
"-
40. Gas Service-Final
<.' .
r .
41. Solar Domestic-Final
42. Backflow Preventer
`=` •- -�
•
43. Backflow Irrigation
-
-
44. Landscape Irrigation System
- t -
45. Sound Attenuation,
46. Handicap Regulations'
•- �;� •• -
47. FINALSTRUCTURE & BUILDING
48. Special Requirements Completed
)-� FAM
49. Electric Release to Edison
C.:
50. Gas Release to Southern California Gas Co
'
51. CERTIFICATE OF OCCUPANCY
No. Date
V
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
'
CITY OF COSTA WEES[A`� CO��NS�TR�U�CTION PERMIT
Project Address L/�L(/SLL7 �1
PER IT NO. 2'
Z� Z 7
TRACT NO.
LOT NO.
UNI N .
6789 4/27/E7 . 3:36e 75
TYPE OF CONSTRUCTION EW LJ'ADD LJ ALTERATION LJ REPAIR
yI��I CONVERSION ❑ DEMOLISH El OTHER
/� DESCRIPTION OF WORK/USE OF BLDG.
Applicant's Mailing Address '/ l/
7
Owner's Name �� Phone n�-G
Address
A.P. �je Zone
S
Main Building: Accessory Building:
E
Z
c4
i,
1
IVs
t
N
Arch/Eng. License No.
Address
TYPE OF PERMIT LJ GRADING EJ FOUNDATION El STRUCTURAL
❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL
❑ OTHER
:-PROJECT DESCRIPTION SOFT. OCCUPANCY
1- CONSTRUCTION TYPE - VALUATION $
ZONE GRADINGCU.YDS. ACRES'
-%
T
Front
D
B
Rear
N
Contractor's Name n
Address (mailing)
City License No. ��
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of the Business and Professions Code, and
my license is in full ey[f flett.
tJ
A
K
_
Right
I
N
S
Left
G
R
1
Ping. Ref. # Parking Req./Provided
E
1,Remarka:
Planning Notes:
M
S
ense
Licen lass
Date Signature
WOR ERS COMPENSATIOb RA 10
I hereby affirm that 1 have a certificate of consent to self -insure or a certificate
of Workers' Compensation Insurance, or a'certified copy thereof (Section
3800, Lab. ��p'
ggyCy No.(o--drt�l�--�i Company 'L
ertified Copy is hereby furnished.
Cer ifi cop f 1 d with the city�jslin to n.
Date Applicant
EXEM 10 ROM WORKERS' E 10 oECLAR TION
(Thissection need not be Completed if the permit is for one hundred ($100) or
less).
certify that In the performance Of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
PLUMBING
FEES
I Bar Sink Showers
ELECTRICAL FEES
Backflow Preventer Service Sink
Automatic Washer Transformer ❑ 15-50 KW
❑ 50+KW
Construction, Pole Sub.
Backflow Irrigation Sewer Cap
P
1)
Bathtubs Sewer Connection'
a
Cooking Unit Meter ❑up to,100 amps'
-
Clarifiers Solar Collectors -
_
Dishwasher Meter Dover 100 amps
- -
`Z Dishwasher Solar _Piping
0 0
Dryers ❑Gas ❑Electric Sub Panel ,
Drinking Fountains Solar Tank _
_ /
Fan Motors ❑0.1 HP Ell 'A 8
•r = Floor Drains Swimming Pool w/Spa
F.A.U. - Inc. Solar ❑9-15 HP 1:1,16115+
Date Signature
NOTICE: If, after making this declaration, you should become subject to Me
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY `j'
1 hereby affirm that there is a construction lending agency for the performance
of the work far which this permit is Issued (Section 3097 Civ. C.)
Name
Floor Sinks Urinal
Fixtures Microwave
Gas Service Outlets Water Closet
/•
Sbd,o
Devite.Boxes Pole Li h
9
Interceptors Water Heater
Outletsrt
eLender's
ZKitchen Sink Water Service
09
Switches - - Sign -
g
'
.
Lender's Address
OWNER BUILDER DECLARATION
1 hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, Improve, demolish or repair
any structure, prior to Its issuance, also requires the applicant for such permit
to file a signed statement that he/she Is licensed pursuant to the provisions Of
the Contractor's License Law (Chapter 9(commencing with Section 7000) of
Division 3 of the -Business and Professions Code) Or that he/she is exempt
therefrom and the basis for the alleged exemption. Any violation of Section
7031.5 by any applicant for a permit subjects the applicant to a civil
penalty of not more than five hundred dollars ($500).
LJ I, as owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner of a property who builds or improves
thereon, and who does such work himself/Herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or Improvement is Sold within one year of cam-
pletion, the owner will have the burden of proving he/she did not build or im-
rove for.the purpose of sale).
I, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who Contracts for Such.projects with a can.
tractor(s) license pursuant to the Contractor's License Law). I am aware that
proof of their Worker's Compensation insurance should be provided to me.
❑ I am exempt under Section B. & P. C. for this reason
Lavatories Auto -Wash
V b
Garbo9 a Dis Osal
P Standing Sections
P -Trap Laundry Trays
Generator'00-5 KIN ❑ KW ' Trash Compactor ,
ROOF Drains
- -
ReinspectlOn Fee
$15 Issue Fee
S 3
.
Reinspection Fee $15 Issue Fee $ 3
MECHANICAL
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
Zonin A roved B
pp y Date
Building Approved By Date
Application Issued By �Date—
-
Boiler Hood or Type I ❑
Canopy Type II El9
Duct - Under Ground
Duct -Structural Refrigeration System
Duct - Ventilating ❑0-100,000 BTU ❑100,000 BTU
SUMMARY OF FEES
BUILDING PERMIT $ SMIP S
PLAN CHECK $ PERMIT
.PLUMBING $ 110.00 ISSUANCE $_
Exhaust System El Multiple ❑ System Re it/Alteration
_
Firepl/Fact. Bit. ICBO # ampers
Date OwnerHeating
I hereby certify that I have read this application and state that the above❑0-100,000
information Is correct. I agree to comply with all city and county a it Minces
and state laws relating to b g cons ton, and hereby authoriEa rears-
sentatives Of anth above -me toned property for
inspection pur��Date;]���
Sign_
' Driv License or S5
System & Ducting Registers
BTU CO3OOBT
PLAN CHECK 25% S ENERGY P.C. $
ELECTRICAL $ .GRADING $
PLAN CHECK 50% $' MICROFILM $
MECHANICAL $ 336.75
PLAN CHECK 25% $ TOTAL FEE
_
_
Reinspection Fee $15 Issue Fee $ 3
CMF
0865-46, rev. 10/84 White - Building: Canary - Applicant; Pink - Accounting;
Goldenrod - Assessor
CONSTRUCTION AND PLANNING
APPROVALS Permit#
Date•
Inspector
POOL & SPA
APPROVALS Permit#
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test -
6. Electrical LIFER Grnd.
57. APPROVALTO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, [] Undrgrnd., Test
9, Water Pipe-Undrgrnd.
60. Backwash Lines, P=Trap, C) Undrgrnd.
10. Structural Floor System
61. APPROVAL TO DECK
11. Property Sewer Line & House Connection
62. Backwash & Receptor -Final
12. Sewer Cap
63. Heater & Vent -Final
13. Roof Drains
64. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
-FIRE DEPT. REQUIREMENT
APPROVALS Permit
20. Rough Factory Fireplace
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 []Gas ❑Oil
25. Roof Sheathing
74. Overhead Hydro
26. T -Bar Ceiling (Structural) & Monocoat
75. Dry Chemical -
27. Frame and Flashing
76. Dry Standpipe
28. Lathing & Siding
77. FIXED SYSTEM FINAL
29. Insulation
78. FIRE PREV. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
(*;;7 Zr tt*� c)e_ wo
36. Hood or Canopy
37. Final Factory Fireplace
r
38. Final Plumbing
39. Water Service -Final
'
40. Gas Service -Final
41. Solar Domestic -Final
' 42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
X45. Sound Attenuation
_
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
'
,r.
48.+Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
_
1
Applicant to fill in all spaces except those within heavy
CITY OF COSTA MESA CONSTRUCTION PERMIT
•-'< std•
Project Address
Applicant'; Meiling Address
Owner's Name P on
Address
Arch/Eng. License No.
Address
Contractor's Name
Address (mailing)
City License No.
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (commencing
with section 7000) of Division 3 of usiness and Professions Code, and
my license is in -f force and of tett. CJ J
Licens I sp Li se N O
Date d ATIO
WOR COMPENSATION' E IO
RATN
hereby affirm that I have a cert iff ateto of consent to self -insure or a certificate
' Workers' � Compensation Insurance, or a certified
Copy thereof (Section
.800, Lab. ��%�'� Comp
ertifted�cfo•y is hereby furnished.
Cer ' i filed with the city q Di on
Date Applicant �
EXEM 10 FROM WO KERS-COMAENSATION DECLARATION
(This se ction need not be completed if the permit is for one hundred ($100) or
less).
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensation Laws of California.
Date Signature
NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
Comply with such provisions or this, permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.)
Lender's Name
Lender's Address -
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, improve, demolish or repair
any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
" ivision 3 of the Business and Professions Code) or that he/she is exempt
erefrom and the basis for the alleged exemption. Any violation of Section
131.5 by any applicant for a permit subjects the applicant to a civil
Penalty of not more than five hundred dollars ($500).
LJ I, as owner of the property or my employees with wages as their Sole
compensation, will do the work, and the structure is not intended or offered
for sale (Sects on .7044, Business and Professional Code: The Contractor's
License Uw does'not apply to an owner of a property who builds or improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement is sold within one year of coin-
. potion, the owner will have the burden of proving he/she did not build or im-
Erove for the purpose of Sale).
I, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law does not apply to an owner of property who
builds or improves thereon, and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's License Law). I am aware that
proof o their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section B. & P. C. for this reason
Date
I hereby certify that
Information Is C
and state laws el r
sentatives of Ci
inspection p A
Signature
Drivers' Lice se or S'_
Owner
I have re
I agree
to bu it
to ter
tion and state that the above
all City and County ordinances
i, and hereby aut hyrize repre-
Dove-mentioned =P.A� for
and sign all appropriate declarations.
0. UNI O
E 3000g'
f .
'Reinspection Fee
TYPE OF CONSTRUCT]ON NEW ADD
❑ CONVERSION ❑ DEMOLISH ❑ OTHE
ALTERATION
REPAIR.
FEES
DESCRIPTION OF WORK/USE OF BLDG.
/UQA''(�7
REQUIREMENTS:
A.P. #
3
Date
Date�
D
S
Main Bu
�'
TYPE OF PERMIT GRADING ❑ FOUNDATION
STRUCTURAL
E
T
Front
r �'
❑ TENANT ELECTRICAL ❑ PLUMBING
❑ MECHANICAL
B
.YJ
❑ OTHER
A
Rear
$ 3
C
Right
PROJECT DESCRIPTION SQ. FT.
OCCUPANCY
K
CONSTRUCTION TYPE VALUATION$
S
Left
'ZONE GRADING CU.YDS.
ACRES-
Ping. Ref. #
Remarks:
Planning No
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof "Drains
Reinspection Fee $15
Boiler
Duct - Under, Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Bit. ICBO #
Heating System & Ducting
❑0-100,000 BTU 0 100,000
Reinspection Fee 1 $15
IF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor
Showers
Service Sink -
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto -Wash
Laundry Trays
Issue Fee
Hood or Type 1 ❑
CanopyTYpell ❑
Refrigeration System
❑0-100,000BTU 0100, 000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
,
Accessory Building:
Parking Req./Provided
,ELECTRICAL
Automatic Washer Transformer ❑ 15-50 KW
Construction Pole Sub. 1 050+KW
Cooking Unit' - Meter' El up to 100 amps -
Dishwasher Meter ❑over 100 amps
Dryers ❑Gas ❑Electric Sub Panel
Fan Motors E10-1 HP 111%-8
F.A.U. _ Inc. Solar 09-15 HP Ell 6-15+
Fixtures - Microwave
Device Boxes Pole Light .
Outlets Range
Switches Sign .
Garbage Disposal Standing Sections
Generator 00-5 KW 05-15 KW Trash Compactor
Z
O
N
I
N
G
R
E
Q
M
T
S
$31
�—
'Reinspection Fee
1 $15 1 ee
$ 3
FEES
-DEVELOPMENT SERVICES
Zoning Approved By
!Building Approved By
Application Issued By
REQUIREMENTS:
r
3
Date
Date�
D
•
BUILDING PERMIT
PLAN CHECK
PLUMBING
PLAN CHECK 25%
ELECTRICAL
PLAN CHECK 50%
MECHANICAL_
PLAN CHECK 25%
SUMMARY OF FEES:
$
,$ _ _.PERMIT
$
$
$
$
$ _
$
SMIP
ISSUANCE
ENERGY P.C.
GRADING
MICROFILM
TOTAL FEE
-
$
$
$
$
$
$ /L
$ 3
-�'
CONSTRUCT IONAND�PLANNING
r' +'
POOL&SPA "
=- -�: .% -„
APPROVALS Permit:#
Date
..
Inspector
r
I;fiPPRiO.VALS Permit #
j Date
Inspector
1 :'Temporary ElectricafService or Pole
52. Pool & Equipment Location
Z.- Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd.
54. Forms
4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement;,---,
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grind.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, O Undrgrnd., Test
9. Witei Pipe-Undrgrnd.
•'
60. Backwash Lines, P -Trap,❑ Undrgr`nd.
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 JL')
JrVNI-
67,' Fencing&,Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit#
20. Rough Factory Fireplace
21. Ducts, in Structure
70. Underground Hydro '
22. Ducts, Ventilating
71. Product Piping OGas 0Oil•
23. Gas Pipe -Rough & Test
72. Underground Flush
,
24. Roof Framing
73. Undergrnd. Storage Tank OGas ❑Oil
`
I
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:
w OAC i
34. Final Heating &Air Conditioning11
L /
T S T tccorCY
35. Final Gas Pipe -Test
36. Hood or Canopy
37.�Final Factory Fireplace
38. Final Plumbing -
t
39. Water Service -Final
-
I
40. Gas Service -Final
41. Solar Domestic -Final
i t
.42. Backflow Preventer-
43. Backflow Irrigation
"144.' Landscape Irrigation System
'45., Sound Attenuation
. 46. Handicap Regulations
i
-47. FINAL STRUCTURE&BUILDING
I� ' r•
, ,l
48.'Spe6ial Requirements Completed
'49 'Electric Release to Edison
50. Gas Release to Southern California Gas Cb
51. CERTIFICATE OF OCCUPANCY
No. Date
-
- +
JLD6_14. Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.
�- r— 7fnoir Nn I TRArT NO I I nT NO I I ml.T un
N,
0
CIT. Y.0F COSTA MESA CONSTRUCTION PERMIT
Project Adlress ✓ '
Applicant's Mailing Address �/ SChOd SfL7 IL
Owner's Name 4//A1� A/
41/)L.
Address l0/ 4+/hnI/n /2ir� .T/K rp57i2 Ci%/ eft'
Arch/Eng. License No.
Address
Contractor's Name r a Eire T/2/C on��-����
Address (mailing) 11f4 IE�_S/= nGr/4 S%` ( /I
City License No.
/a'�SO
LICENSED CONTRACTOR DECLARATION
I hereby affirm that I am licensed under provisions of Charter 9 (Commencing
with section 7000) of Division 3 of the Businees and Professions Code, and
my license is in full tote and effect.
License 1 ss 0 Lice No It S
Date ��� Signature
ig t aaIf?,
WORK RS CO PENSATION DEC RATION
hereby affirm that 1 have a certificate of consent to self -insure or a certificate
Workers' Compensation Insurance, or a certified copy thereof (Section
10, Lab .�C�.)) OO C
Policy No X u%L. 13751_56 --l-Conn, nye S �Co
!E99EKERS,yfurnished.ith the city Idin Dlvlsi
AppntRKERS' CiSPAPENSATI13N DECLARATION
(Thissectlon need not be completed if the permit is for one hundred ($100) or
ess).
I certify that in the performance of the work for which this permit is issued I
shall not employ any person In any manner so as to become subject to t11e
Workers' Compensation Laws of California.
Date Signature
NOTICE: If, after making this declaration, you should become subject to the
Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.)
Lender's Name
Lender's Address -
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct, alter, improve, demolish or repair
any structure, prior to its issuance, also requires the applicant for such permit
to file a signed statement that he/she is licensed pursuant to the provisions of
the Contractor's License Law (Chapter 9 (commencing with Section 7000) of
division 3 o the -Business and Professions Cotle) or that he/she is exempt
refrom and the,basis for the alleged exemption. Any violation of Section
.1.5 by any applicant for a permit subjects the applicant to a Civil
,,arty of not more than five hundred dollars ($500).
L] I, as owner of the property or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered
for sale (Section 7044, Business and Professional Code: The Contractor's
License Law does not apply to an owner Of a property who builds or Improves
thereon, and who does such work himself/herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. If, however, the building or improvement 1% sold within one year of com-
pletion, the owner will have the burden of proving he/she did not build or im-
prove efor the purpose of sale).
1, as owner of the property, am exclusively contracting with licensed con-
tractors to construct the project (Section 7044, Business and Professions Code:
The Contractor's License Law tloes not apply to an owner of property who
builds or Improves thereon, and who contracts for such projects with a con-
tractor(s) license pursuant to the Contractor's IJcense Law). I am aware that
proof o// their Worker's Compensation insurance should be provided to me.
❑ 1 am exempt under Section B. & P. C. for this reason
Date
I hereby certify th
information is corre
and state laws relat
sentatives of this I
inspection purposes.
Signature .
. Owner
have real
ng
this application and state that the above
Imply with all city and county ordinances
cans ctlon, antl hereby authorize repre-
spo a ab ve- relbnetl prop rtp for
Date 4 S o
F_ 2-5372
TYPE OF CONSTRUCTION b NEW U ADD U ALTERATION U REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTf�ER
DESCRIPTION OF WORK/USE OF BLDG.
TYPE OF PERMIT GRADING LJ FOUNDATION LJ STRUCTURAL
1-1TENANTELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SQ. FT. OCCUPANCY_
CONSTRUCTION TYPE VALUATION $
ZONE GRAOINGCU.YDS. ACRES_
Remarks:
z
A.P. #
S Main Buildi
E
,T Front
B Rear
A
C Right
K Left
Ping. Ref. #
Planning Notes:
I545 7/-/ II
Zone
Accessory Building:
Z
O
N
N
G
R
Parking Req./Provided E
Q
M
T
S
Bar Sink
Showers
SUMMARY OF FEES
ELECTRICAL
FEES
Backflow Preventer
Service Sink
$
Automatic Washer
Construction Pole Sub.
PLUMBING
Transformer ❑ 15-50 KW
❑ 50+KW*
ISSUANCE $
Backf low Irrigation Sewer Cap
-
Bathtubs
Sewer Connection
Cooking Unit
/(o
Meter ETup to 100 amps
00 00
Clarifiers -
Solar Collectors_
/$
TOTAL FEE ( $
Dishwasher
$
Meter ❑over 100 amps
00
Dishwasher
Solar Piping
Dryers ❑Gas ❑Electric
Sub Panel "
Drinking Fountains
I Solari
Fan
Motors 00-1 HP ❑1X-8
d0
Floor Drains'
Sw' ming Pool w/Spa
F.A.U. -
Inc.*Solar ❑9.15 HP E316-15+Floor
Sinks.
rival
ixtures
Microwave
00
Gas Service Outlets
Water Closet
'y'' Device Boxes
Pole Light
.27
Interceptors-
Water Heater
Outlets
Range
8(p /0
Kitchen Sink -
Water Service -
Switches 205-15
Sign.
Lavatories
Auto -Wash
�6 Garbage Disposal
Standing Sections
P -Trap •
Laundry Trays
Generator ❑05 KWW_Trash
Compactor
Roof Drains
?
OD
RelnSpection Fee
$15
Issue Fee
$ 3
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Bit. ICBO #
Heating System & Ducting
110-100,000 BTU ❑100 BT
Drivers' nse or SS I I Reinspection Fee 1 $15
CMF OB -48, rev. 10/84 White - Building: Canary - Applicant: Pink - Accounting; Goldenrod - Assessor
Reinspection Fee $15 Issut
IANICAL FEES
Hood or Type I ❑ .....SERVICES REQUIREMENTS:
Canopy Type 11 '❑ Zoning Approved By
- _ Building Approved By
Refrigeration System
❑0100,000 ❑ 1 oo,000
Fire Dampers
Registers
Issue Fee 1 $ 3
$ 3
7�gr go
SUMMARY OF FEES
BUILDING PERMIT
$
SMIP $
PLAN CHECK
$
PERMIT
PLUMBING
$
ISSUANCE $
PLAN CHECK 25O%,
$q�.
ENERGY P.C. $
ELECTRICAL ;ndv:
�
!-vim= GRADING $
PLAN CHECK 50%
$
MICROFILM
MECHANICAL
$
/$
TOTAL FEE ( $
PLAN CHECK 25%
$
_ /rIWJ7 i
$ 3
7�gr go
CONSTRUCTION AND PLANNING
APPROVALS Permit #
_
Date
Inspector
POOL & SPA
APPROVALS Permit#
Date
Inspector
1. Temporary Electrical Service or Pole
52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd.
53. Steel Reinforcement
3."Electrical Conduit Utility-Undrgrnd.
54. Forms
. 4. Electrical Conduit-Undrgrnd.
55. Electrical Bonding
5. Steel Reinforcement
56. Rough Plumbing & Pressure Test
6. Electrical LIFER Grnd.
57. APPROVAL TO COVER-GUNITE
7. Footings
58. Electrical Conduit-Undrgrnd.
8. Foundation
59. Gas Pipe, 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. Plumbing System - Final
14. Rough Plumbing
65. Electrical -Final
15. Rough Electrical -Conduit
66. Solar System -Final
16. Rough Electric Wiring!
-
67. Fencing & Access Approval
17. Rough Wiring Sign
68. APPROVED FOR PLASTERING
18. Rough Electrical -T Bar Ceiling
69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning
FIRE DEPT. REQUIREMENT
APPROVALS Permit
i
20. Rough Factory Fireplace
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 ❑ 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 PREY. FINAL
30. Drywall Nailing
HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat
79. FINAL INSPECTION
32. Electrical Power Meter -Final
80. FOOD CERTIFICATE ISSUED
33. Final Electric
Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe -Test
-"
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service -Final
40. Gas Service -Final
41. Solar Domestic -Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
'
51. CERTIFICATE OF OCCUPANCY
No. Date
PERMIT TYPE B_ROOF2
APN: 42422123
JOB ADDRESS: 575 A W 19TH ST CM
Vicinity: BLDG A
Squares: 0
PERMIT NUMBER: B13-00041
STATUS: FINALED
DATE ISSUED: 02/27/2013
ISSUED BY: CAC
Suite/Unit: A
Valuation: $9,375.00
SCOPE OF WORK: TEAR OFF BUR AND INSTALL REMOVE AND REPALCE PLYWOOD AS NEEDED INSTALL ROSIN SHEET AND 4 PLY
BUR MINERAL SURFACE CAP SHEET
NOTE: RESIDENTIAL RE -ROOF: For projects exceeding $1.000 in valuation final approval of permit shall not be granted until
access to dwellina unit(s) is provided for verification of the installation of smoke and carbon monoxide alarms by the City
Inspector. See Attachment w/Inspection Card
OWNER: SEDONA LLC Address: 17682 MITCHELL NORTH #200 Unit:
PHONE. City/State/Zip: IRVINE, CA
APPLICANT: STEVE SCHNIERER Address: 22512 ASPAN ST Unit:
PHONE: 866-144-5325 City/State/Zip: LAKE FOREST, CA
CONTRACTOR: MONTROSS WEATHERPROOFING SYSTEMS INC License No.
499050
Address: 22512 ASPAN STUnit: PHONE: 949-855-7807
City/State/Zip: LAKE FOREST, CA 92630 CELL:
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
$0.00
Reroof Permit Fee:
$181.25
Reinspection Fee:
$0.00
Bldg Std Admin Fund
$1.00
License No. PHONE:
License No. PHONE:
'OTAL FEES $182.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal holiday:
New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day
PERMIT TYPE B_ROOF2
APN: 42422123
JOB ADDRESS: 575 G W 19TH ST CM
Vicinity: BLDG A
Squares: 0
PERMIT NUMBER: B13-00040
STATUS: FINALED
DATE ISSUED: 02/27/2013
ISSUED BY: CAC
Suite/Unit: G
Valuation: $9,375.00
SCOPE OF WORK: TEAR OFF BUR AND INSTALL BUR
NOTE: RESIDENTIAL RE -ROOF: For projects exceeding $1,000 in valuation final approval of permit shall not be -granted until
access to dwellina units) is provided for verification of the installation of smoke and carbon monoxide alarms by the Citv
Inspector. See Attachment w/Inspection Card
OWNER: SEDONA LLC Address: 17682 MITCHELL NORTH #200 Unit:
PHONE: City/State/Zip: IRVINE, CA
APPLICANT: STEVE SCHNIERER Address: 22512 ASPAN ST Unit:
PHONE: 866-444-5325 City/State/Zip: LAKE FOREST, CA
CONTRACTOR: MONTROSS WEATHERPROOFING SYSTEMS INC License No.
499050
Address: 22512 ASPAN STUnit: PHONE: 949-855-7807
City/State/Zip: LAKE FOREST, CA 92630 CELL:
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
$0.00
Reroof Permit Fee:
$181.25
Reinspection Fee:
$0.00
Bldg Std Admin Fund
$1.00
License No. PHONE:
License No. PHONE:
'OTAL FEES $182.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal holiday:
New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day
PERMIT TYPE B_ROOF2
APN: 42422123
JOB ADDRESS: 575 F W 19TH ST CM
Vicinity: BLDG A
Squares: 0
PERMIT NUMBER: B13-00039
STATUS: FINALED
DATE ISSUED: 02/27/2013
ISSUED BY: CAC
Suite/Unit: F
Valuation: $9,375.00
SCOPE OF WORK: TEAR OFF BUR AND INSTALL BUR
NOTE: RESIDENTIAL RE -ROOF: For projects exceeding $1,000 in valuation final approval of permit shall not be granted until
access to dwellina unit(s) is provided for verification of the installation of smoke and carbon monoxide alarms by the Citv
Inspector. See Attachment w/Inspection Card
OWNER: SEDONA LLC Address:17682 MITCHELL NORTH #200 Unit:
PHONE: I City/State/Zip: IRVINE, CA
APPLICANT: STEVE SCHNIERER Address: 22512 ASPAN ST Unit:
PHONE: 866-444-5325 City/State/Zip: LAKE FOREST, CA
CONTRACTOR: MONTROSS WEATHERPROOFING SYSTEMS INC License No.
499050
Address: 22512 ASPAN STUnit: PHONE: 949-855-7807
City/State/Zip: LAKE FOREST, CA 92630 CELL:
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
$0.00
Reroof Permit Fee:
$181.25
Reinspection Fee:
$0.00
Bldg Std Admin Fund
$1.00
License No. PHONE:
License No. PHONE:
OTAL FEES $182.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal holiday:
New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day
PERMIT TYPE B_ROOF2
APN: 42422123
JOB ADDRESS: 575 E W 19TH ST CM
Vicinity: BLDG A
Squares: 0
PERMIT NUMBER: B13-00038
STATUS: FINALED
DATE ISSUED: 02/27/2013
ISSUED BY: CAC
Suite/Unit: E
Valuation: $9,375.00
SCOPE OF WORK: TEAR OFF BUR AND INSTALL BUR
NOTE: RESIDENTIAL RE -ROOF: For projects exceeding $1.000 in valuation final approval of permit shall not be Granted until
access to dwellina unit(s) is provided for verification of the installation of smoke and carbon monoxide alarms by the Citv
Inspector. See Attachment w/Inspection Card
OWNER: SEDONA LLC Address: 17682 MITCHELL NORTH #200 Unit:
PHONE: City/State/Zip: IRVINE, CA
APPLICANT: STEVE SCHNIERER Address: 22512 ASPAN ST Unit:
PHONE: 866-444-5325 City/State/Zip: LAKE FOREST, CA
CONTRACTOR: MONTROSS WEATHERPROOFING SYSTEMS INC License No.
499050
Address: 22512 ASPAN STUnit: PHONE: 949-855-7807
City/State/Zip: LAKE FOREST, CA 92630 CELL:
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
$0.00
Reroof Permit Fee:
$181.25
Reinspection Fee:
$0.00
Bldg Std Admin Fund
$1.00
License No. PHONE:
License No. PHONE:
'OTAL FEES $182.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal holiday:
New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day
PERMIT TYPE B_ROOF2
APN: 42422123
JOB ADDRESS: 575 D W 19TH ST CM
Vicinity: BLDG A
Squares: 0
PERMIT NUMBER: B13-00037
STATUS: FINALED
DATE ISSUED: 02/27/2013
ISSUED BY: CAC
Suite/Unit: D
Valuation: $9,375.00
SCOPE OF WORK: TEAR OFF BUR AND INSTALL BUR
NOTE: RESIDENTIAL RE -ROOF: For projects exceeding $1,000 in valuation final approval of permit shall not be aranted until
access to dwelling unit(s) is provided for verification of the installation of smoke and carbon monoxide alarms by the Citv
Inspector. See Attachment w/Inspection Card
OWNER: SEDONA LLC Address:17682 MITCHELL NORTH #200 Unit:
PHONE: City/State/Zip: IRVINE, CA
APPLICANT: STEVE SCHNIERER Address: 22512 ASPAN ST Unit:
PHONE: 866444-5325 City/State/Zip: LAKE FOREST, CA
CONTRACTOR: MONTROSS WEATHERPROOFING SYSTEMS INC License No.
499050
Address: 22512 ASPAN STUnit: PHONE: 949-855-7807
City/State/Zip: LAKE FOREST, CA 92630 CELL:
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
$0.00
Reroof Permit Fee:
$181.25
Reinspection Fee:
$0.00
Bldg Std Admin Fund
$1.00
License No. PHONE:
License No. PHONE:
'OTAL FEES $182.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal holiday:
New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day
PERMIT TYPE B_ROOF2
APN: 42422123
JOB ADDRESS: 575 C W 19TH ST CM
Vicinity: BLDGA
Squares: 0
PERMIT NUMBER: B13-00036
STATUS: FINALED
DATE ISSUED: 02/27/2013
ISSUED BY: CAC
Suite/Unit: C
Valuation: $9,375.00
SCOPE OF WORK: TEAR OFF BUR AND INSTALL BUR
NOTE: RESIDENTIAL RE -ROOF: For projects exceeding $1.000 in valuation final approval of permit shall not be granted until
access to dwelling unit(s) is provided for verification of the installation of smoke and carbon monoxide alarms by the Citv
Inspector. See Attachment w/Inspection Card
OWNER: SEDONA LLC Address: 17682 MITCHELL NORTH #200 Unit:
PHONE: City/State/Zip: IRVINE, CA
APPLICANT: STEVE SCHNIERER Address: 22512 ASPAN ST Unit:
PHONE: 866444-5325 City/State/Zip: LAKE FOREST, CA
CONTRACTOR: MONTROSS WEATHERPROOFING SYSTEMS INC License No.
499050
Address: 22512 ASPAN STUnit: PHONE: 949-855-7807
City/State/Zip: LAKE FOREST, CA 92630 CELL:
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
$0.00
Reroof Permit Fee:
$181.25
Reinspection Fee:
$0.00
Bldg Std Admin Fund
$1.00
License No. PHONE:
License No. PHONE:
'OTAL FEES $182.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal holiday:
New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day
PERMIT TYPE B_ROOF2
APN: 42422123
JOB ADDRESS: 575 B W 19TH ST CM
Vicinity: BLDG A
Squares: 0
PERMIT NUMBER: B13-00035
STATUS: FINALED
DATE ISSUED: 02/27/2013
ISSUED BY: CAC
Suite/Unit: B
Valuation: $9,375.00
SCOPE OF WORK: TEAR OFF BUR AND INSTALL BUR
NOTE: RESIDENTIAL RE -ROOF: For projects exceeding $1.000 in valuation final approval of permit shall not be granted until
access to dwelling unit(s) is provided for verification of the installation of smoke and carbon monoxide alarms by the Citv
Inspector. See Attachment w/Inspection Card
OWNER: SEDONA LLC Address: 17682 MITCHELL NORTH #200 Unit:
PHONE: City/State/Zip: IRVINE, CA
APPLICANT: STEVE SCHNIERER Address: 22512 ASPAN ST Unit:
PHONE: 866-444-5325 City/State/Zip: LAKE FOREST, CA
CONTRACTOR: MONTROSS WEATHERPROOFING SYSTEMS INC License No.
499050
Address: 22512 ASPAN STUnit: PHONE: 949-855-7807
City/State/Zip: LAKE FOREST, CA 92630 CELL:
ARCHITECT:
ENGINEER:
"W111 if i,IL1 Zvi
Reroof Plan Check:
$0.00
Reroof Permit Fee:
$181.25
Reinspection Fee:
$0.00
Bldg Std Admin Fund
$1.00
License No. PHONE:
License No. PHONE:
OTAL FEES $182.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal holiday:
New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day
PERMIT TYPE B_ROOF2
APN: 42422123
JOB ADDRESS: 575 H W 19TH ST CM
Vicinity: BLDG A
Squares: 0
PERMIT NUMBER: B13-00034
STATUS: FINALED
DATE ISSUED: 02/27/2013
ISSUED BY: CAC
Suite/Unit: H
Valuation: $9,375.00
SCOPE OF WORK: TEAR OFF BUR AND INSTALL BUR
NOTE: RESIDENTIAL RE -ROOF: For projects exceeding $1,000 in valuation final approval of permit shall not be granted until
access to dwelling unit(s) is provided for verification of the installation of smoke and carbon monoxide alarms by the Citv
Inspector. See Attachment w/Inspection Card
OWNER: SEDONA LLC Address: 17682 MITCHELL NORTH #200 Unit:
PHONE: City/State/Zip: IRVINE, CA
APPLICANT: STEVE SCHNIERER Address: 22512 ASPAN ST Unit:
PHONE: 866444-5325 City/State/Zip: LAKE FOREST, CA
CONTRACTOR: MONTROSS WEATHERPROOFING SYSTEMS INC License No.
499050
Address: 22512 ASPAN STUnit: PHONE: 949-855-7807
City/State/Zip: LAKE FOREST, CA 92630 CELL:
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check:
$0.00
Reroof Permit Fee:
$181.25
Reinspection Fee:
$0.00
Bldg Std Admin Fund
$1.00
License No. PHONE:
License No. PHONE:
OTAL FEES $182.25
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3/18/2010 - PER CMMC Sec. 13-279
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal holiday:
New Years Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day and Christmas Day