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Home My WebLink About590 19TH ST - Building Permits(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 BUILDING PERMIT .lob Address: 590 W 19TH ST Suite: Vicinity: Status: ISSUED Applied: 04/25/2002 Issued: OS/76/2002 Parcel Number: 42214147 Zoning: Applicant: WATANABE, HIROJI -- --- _ �Ssue� sv: 11 �� 1`�� Address: 17802 LA SALLE AV ; - � � - ��%'�'_'� �'�'' �<-� � �- U � � i,!%''�_ � _ _� _�- —=' -_.\ j//-� � - ^ Phone: 310 532 6000 �'� -_�� GARDENA.CA,'i/ ' :� , �" Zip: 90248 �, � . A �� i . i � �� / � /�� Owner. OELKE HERBERT G TR %MC N�,4UGHTON KENT A'i �� Address ,%MCNAUGHTON KENTSUITE 150-� - � -= � -- � �� ` , r , � �'. _ . �.. �",- \ �-, CORONA DEL MAR CA � : � � : Phone � , �„� -: - v � � � ' �i2600EPACIFICHIGHWAY_ � � Zip 92625-2117 ��V�V�A�� .� ,�• j:;.�:/ ��::�\ �/�\\\`�\� �%� � / `j ;..� �.� � Contractor: � JAPAN-CONSTRUCTION CO �1��/` � / �� -�Address: 17802�LA SAILE AVE \ -��,! \� � . �� ' ; ;� �. '� Phone::�"'310-532-6000 � °��, i ' V "�� \� • � r `� ` - - GARDENA CA `� � � �� Arch : Address: `Zip: . .� , : \� C,� �\�-. Zip:.. 90248i � License:-a 416238 � � �- - _� . J � ,� �`� - � 1U� r �- _ � , -�,i" �� Eng. � - i � . � �\, \ � -,"� ``� ' � ' ' � � � � .. ' / , r v. ; . _ . /�.dd(BSS? V � � i �. � �1 i � � t ��,� `t i � l .�Phone: -� - . . �.. � �%-\ � � , /i �` Phbne: ' , . . -� - _ '�.,✓ �\:��` ',i . .i�t /..:., '. ,- - _ , � " : '6icense: < - '� � License: �� , �. �� ' � A ' � � ' �. ,i� �' � SCOPE OF PERMIT _, F,_,,,.y � � � ' ' � �.� � . ,�' ��,;;r�;,,..y �,-�.-. . , _ . , . � '� TENANT IMPROVEMENT FOR SUSHI SHIBUCHO RESTAURANTl WORK TO INCLUDE NEW DISABLED ACCES3,RESTROOM ;�� AND ONE ADDITIONAL RESTROOM. � -- - � - - - - - - - � - - _ _ - � � . _ J � i . . � �� /: � � ,�, , , FEE SUMMARY �lj'�: � _�.,� �'i , � � � � !' t ', Plan Check $254.31 -- _ — � - � �; ` Calc Valuation �t'; , szs;000.00 Permit $391.25 ' � ' ' ' ,% �` � Claim Valuation � 'J - S25,000..00 � SMIP Res: $0.00 {� �% ' %�� " ' �'' � ' , i;11�:` i � SMIP Com: $5.25 � - _ — ". � �, ' � i ��• � � � � Other. $0.00 ,; __; , � � � Inspeclion: � �$0:00 _--�i , �i �/ � i %' �� «.� .: .�, � , � r '�� o , � •-> l /�j � / ,�Total:' tiS650.81C .�� t ..�� .• � a �� ,/,� ) �� ./' '� 4,^S � ''�,.� „ J:i'-L. b.. ri��, \r' \ \ .� ' �� /i_ �. e lv � ri//� �� ` ��;� � �� i� �'�� .� "' PLANNING & ZONING �� `�� , SETBAC S.` � �� '`_ � • ., � __, i� " ,�� ✓ � i .A �//,/ � �� -_ - _ � s�� , � � � MAINSTRUCTURE Front '0=0, �/�,' Rear -.0 0�'=`�- ._ Left 0 0':--� Right`� 0'0' i � ��tr i /��I^�. - _ - - : _--' _ \ \`-;'� /� � � � � .._ � r r ,', "" . � ; l " C�' i �/ ACCESSORY Front ` -0= 0_ �� Rear :._ 0-�0 _-�.� ; � - ,� �Left „ - 0; 0.-� \ � � � Right' O�Oo� � -�. � -� � / /� ��/ PARKING Existin �0,�� Re uired: .0, � i �Pro osed:...� -0 �� - � � '' " ,: �' �� _�— .Jt.`.,. �_ ��{l.. ��' �"��' _ _..� . , NOTES: _ _ _ -- _ ;,��'�. - " NOTICE: The work authorized by this parmit shall comply with all applicable handicap access requiremenis under California regulations. (Ord. No. 92-28, § 7, 12-21•92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is susF for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with�all.a p required Inspections and final approvel must be obtained. Failure to obtain inspections and final approval will resul�� expiral FOR INSPECTIONS CALL: (714) 7545626 24a8�48 (8�W) orabandoned Ne codes, and all of this permit. WORKERS' COMPENSATION �ECLARATION: � � I hereby aflirtn under penalry of pa�ury one ot ihe following declarations: �. • ❑ I have end wlll maintain a certificate ot consent to seN-Insure for workeis' compensetion, es provided tor by section 3700 ot the Lflbor Coda, for ihe pedormence of the work for which Ihis pertnit ig issued. ❑ I have and will maintain worKers' compensation insurance, as requireG by sectlon 3700 of Ihe La6or Code, for �he pedorcnance of �he work Por which �his pertnit Is issued. My workers' compensatlon ��surance carner entl policy number are: � �7/ Carder: � Palicy Number. ��Lb 3Z� � (Tliis secNon need nof be comp/e�ed i! the permif is velued at one hundred di llaro ($100) or less.) ❑ I cetlity ihat in Ihe pertortnence of the work for which this pertnit is issued, I shall not employ any person in eny manner so as ro become subjectto the workere' compensatlon laws ot Celifomia, end egree thet if I should becom suti�act to t e workers' compensation provisions of Section 3700 of Ihe Labor Gotle, I shell fodhwith comply with these provisions. I �—� ApplicantSignature: �� Date: �//��Z WAPNING: FAILURE TO SECURE WORKERS' PENSATION COVERAGE IS UNLA FUL AND SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED THOUSAND OOLIARE ($100,000). IN ADDRIIXJ TO THE COST OF COMPENSNTION, DAMAGES AS PHOVIDED FOR IN SECTION 3N60F THE LABOR CODE, INTEREST, ANO AiTORNEV'S FEES. LICENSED CONTRACTORS DECLARA710N: I hereby attirm that I am licensetl untler provisions of Chapter 9 torce and effed. Lic. p �� .� Contracmr's Signature: ?G with Section 7 0) of Division 3 of ihe Business and Professions Cade, and my license is in full Clau # Date: _�� 6 2 CONSTRUCTION LENDING AGENCV: � ❑ I hereby aRirm that there is e construction lentling agency for the peAormance of the work for which this permil is issuetl. (Sec. 3097, Civil Code). LentleYs Name: Lendefs Address: Signature: Dale: OWNER-BUILDER DECLARATIONS: I I hereby affirtn ihat untler penalry ot perjury that I em EXEMPT FROM THE CONTRACTORS LICENSE LAW tor �he tollowing reason (Sec. 7031.5, Business entl Professions Cotle: Any city or counry which requires a pertnit to wnstruct, alter, improve, demolish, or repair any strucNre, prior to its issuance, also requires the applicant for such pertnil to file a signed statement that he or she is licensed pureuant to ihe provisions of the Coniractors License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Prolessions Code) ar that he or she is axempt iherelrom and the 6asis for the alleged esemption. Any violation ot Section 7037.5 by any applicant for a pertnil subjects the epplirant to a civil penelty of not more ihen five hundred dollersl($500).): ❑ I, as owner of iha property, or my employaes with wages as their sole compensa�ion, WILL DO TME WORK, and ihe siructure is not intended or ofleretl for sale (Sac. 7044, Business and Profeseions Code: The Contractors License Law does not apply to an owner of property who builds or improves thereon, end who does such work himself or herself or through his or her own employees, provi0etl ihet such improvemenis are not intended or oHered �or sale. N, however, the building or improvement is sold within one year of comp�etion, ihe owner-builtler will have the burden of proving that he or sha diA not build or imD�ove for purpose of sala.�. ❑ I, as owner of Ihe properry, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRAC70RS to consiruct the project (Sec. 7044, Business and Professions Cotle: The contrectors License Law does not appty to en owner oi property who bulltls or Improves ihereon, and who contracts tor such project with a contractor(5) licanse pursuant m the Convec�ors License Laws.). I ❑ I am exempt under sec. � Signature: Owner ID veritied by drivafs licensa. Business antl Protessions Code for ihis reeson: ❑ Yes ❑ No Dnvels License No. Venfcation of Ownership by (type of document, i.e. - properry tarz bill or Oete: Expires: DIVISION OF INDUSTRIAL SAFEn' PERMI7 CERTIFICATION: I ❑ I hereDy certify �hat no exca�etion five (5) or more teet in dep�h into which e person is required to descend, will be made in connection with work authonzetl by Ihis pertnii, and ihat no builtling siructure, scaHolding, talsework, or tlemolition or dismantling thereof, will be more ihan thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Title 8, Califomia Atlminisirative Code). i ❑ As owner-builder, I witl nol employ anyone to do work which woultl ri quire a permit trom the Division oi Intlustriel Sefety, as noted ebove, unless such person hes e permit to do such work from ihe division. . Signature: Division of Industnal Safery Pertni� Number: pate: CERTIFlCATE OP COMPLIANCE AND AIJT}iORIZATON OF EN7RY: I cenity untler penalry ot perjury ihat I have reatl this applicalion and stete that ihe information given is correcl 1 agree ta comply with all s;ate laws anG ciry ordinances relating to building construction, and authorize representatives ot the Gry of Coste Mesa to enter upon ifie ebove-described property for inspection purpases. I egree not to accupy or allow accupency of eny building authonzed by this permit until tinel inspection. �ODE t. INSPEC710NTYPE 1616 Fi:ed System Finel Fire P�evention 1266 201 202 203 Pool Spe Final Final Re-Roof Finel BIocWRetaining Well Final Feqory Fire Place Final Sign 204 Final Demolition CODE• INSPELTONTYPE 208 Final Mechanical 208 Finel Plumbing 210 Final Electrical 212 Final Fire Prevention 220 Final Planning Approval 222 250 Finel Site Final Building/Occupancy Date ��i/2 Date 6 PAg IIQ�LS (714) 754-5273 • Fau (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DFiIVE, COSTA MESA, CA 92626 Job Address: 590 W 79TH ST Suite No Vicinity: Parcel Nunmber: 42214147 ,, , Applicant: WATANABE, FIIROJI . Address: 17802 LA SALLEAVE � � PLUMBING PERMIT ,. - Phane: 310-532-6000 Status: ISSUED Applied: OS/16/2002 Issued: 05/16/2002 ISSUED 6Y: I! II 0� � `"- , V � '_ � � �GARDENA, CA - , . Zip: 90248 ' ' �' � � � . _ ., .. , �� , " , , , - _ ' . .� - �. . � �;�� . _ .. , .. / .,� �, Owner: �OELKE,�HERBERT G TR %MC NAUGHTON, KENT A � � � .�� , ` ��; �� Address %MCNAUGHTON; KENT SUITE 150 � � . � , � � CORONA DEL MAR, CA Pbone: �� , � " , _ � 2600 E PACIFIC HIGHWAY Zipi : 92625-2117 ' � � ' _ , . � Contrector. JAPAN CONSTRUCTION CO ��'� Address: 17802 LA SALLE AVE � ' Arch / Eng : Address: - � .. Phone: 310-532-6000 GAIZDENA, CA Zip: 90248 - License: 416238 . . . �- .-. _ , i .. - . . _ Phone: , .' ' -- - -' _' ZiP. -- - � ' . � - . �� - License: � " � � i � SCOPE OF PERMIT TENANT IMPROVEMENT FOR " SUSHI SHIBUCHO RESTAURANT" WORK TO INCLUDE NEW DISABLED ACCESS RESTROOM AND ONE ADDITIONAL� RESTROOM. REF.: 802-00554 , _ 2 TOILETS, 2 WASH BASINS, 2 COMMERCIAL SINKS. � . �, ISSUE FEE Backflow irrigation Backflow Preventer � , Bathtub Clarifier System Connect Qce,Soda,etc) Dental Units Dishwasher Drain. Floor Drain, Rainwater Drain, Roof Drinking Fountaln Expansion Tank Gas Earthquake Valve Gas (1-4 outlets) Gas (Over 4 outlets) Gas Repipe Gas Serv'ice Interceptors (Grease, Oil) Interceptors (Sand Auto ) AMT $23.50 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $9.80 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $O.QO $0.00 $0.00 QTY FEESUMMARY AMT QTY LaundryTub/Washer � $0.00 0 Landscape IrrigaUon $0.00 0 P-Trap $0.00 0 Pressure Regulator $0.00 0 Process Piping (per 10 k) $0.00 • 0 . Receplors . $0.00 0 SepticTank $0:00 0� Sewer Cap for Demo $0.00 0 Sewer Connect $0.00 � , 0 Sewer Private Line � $0.00 0- Shower $0.00 0 Sink, bar $0.00 0 Sink, commercial $19.60 2 Sink, Floor $0.00 0 Sink, kitchen $0.00 0 Sink, service/mop $0.00 0 Spa (private) $0.00 0 Spa (public) $0.00 0 � Sump Pump" � � ' . Swimming Pool � Trap Prlmer Urinal Vacuum Brkr BkFlow(1A) Vacuum Brkr BkFlow(5+) Wash Basin -' Wash Basin Set Waste and Vent System Water Closet (Toilet) Water Heater / venl Water Piping Qnst or Rep.) Water Re-pipe Water Service Water SoRener OTHER VIOLATION PLAN CHECK . REINSPECTION TOTAL CALCULATED FEES: NOTICE: The work authorized by this permit s�lljpqp��J.J��p�eQ�(ijpp� requirements under regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: 7his permit shall automatically expire and become void if work is not commencad within 180 days, or if w for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply w required Inspectlona end final approval must be obtained. Failure to obtain inspections and final approval will result'in FOR INSPECTIONS CALL: (714) 7545626 . f� zaae-as (vool i r, ,r AMT $0.00 $0.00 $0.00 $9.80 $0.00 $0.00 $19.60 $0.00 $0.00 $19.60 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 QTY 0 0 0 1 0 0 2 0 0 2 0 0 0 0 0 :alitornia S`tatutes and related �rk is s�� d or abandoned �` h�all applicable codes, antl all ie expiration of this permit. \ WORKERS'COMPENSAnON DECLARAnON: I hereby effrtn under penalry of perjury one oi ihe following declawtions: -, Q�'I have and will maintain e certificate ot consent to self-Insure for workers' compensation, es provided for by section 3700 of the Lebor Code, for ihe peAortnence of the - work for which this permit is issuetl. - i [� I have and will m5in[ain workers' compensetlon Insurance, as required by sectlon 3700 of the Lebor Code, for tha peAortnance of the work for whlU this partnit is Issued. . My workers' compejisatlon Insurenre cardar end policy number ere: � (Thls: ❑ I bYARNING: FAILURE TO SECURE TMWSAIJD OOLLARE ($100.000�, Policy Number. �l the permit is valued et one hundred dollers ($100) or IessJ. I of ihe work for which this permit isyss ued, 1 shall not employ eny person in eny manner so as ro become subleCt to Ihe worker9' i, and agree ihet if I should beC �� sutiiecl ro the workers' compensation provislons of Sectlon 00 ot e Labor Coda, I shell torthwith � , \` D`et� /O�Z ,COMPENSATI E GEISUNLAWFULPNDSHALlSUBJECTANEMPLOVERTOCfiIM1 PENALTIESANDGVILFlNESUPTOONEHUNDRED 'ION TO TME COST OF fAMPENSATION, DAM4GE5 AS PROVIDED WF IN SECTION 37080F THE LABOR CODE, IPf�EREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLAHATION: I her ' at I am censed under provisions f Cha t 9( mencing with Sedion 7000) of ' ion 3 f t�e 8usiness and Professions Code, and my license is in full c q l 2 � Class A � C ac o s nature: ^ � �� — CONSTRUCTION LENDING AGE Y: � ' ❑ I hereby aNirtn that there is e construction lending agency for the performance of the work for which ihis pertnil is issued. (Sec. 3097, Civil'Code). Lenders Name: Lender's Address: Signeture: � Date: OWNER-BUILDER DECLARATIONS: � I hereby ettirtn �het untler penelty o� perjury thai l em EXEMPT FROM THE�CONTRACTORS LICENSE LAW for the tollowing reason (Sec. 7037.5, Business entl Protessions Code: Any ciry or counry which requires a pertnit to construct, alter, improve, demolish, or repair eny sirucNre, prior to its issuance, also requires the epplicant for such permit to tile a signetl stetement that he or she is licensed pursuant b the provislons of Ihe Contrectors License Lew (Chep�er 9(commencing with Sectlon 7000) of Dlvlslon 3 ot ihe Business and Professions Code) or ihat he or she is exempt therefrom and ihe basls for the ellaged esemption. Any violation of Sedion 7031.5 by eny applicant for a pertnit subleds tha applicant to a civil penalry of not more than five hundred dollare ($500).): ❑ I, as owner of ihe property, or my employees wi�h wages es Iheir sole compensalion, WILL DO 7HE WORK, an0 ihe siructure I5 not intentleC or ottered for sale (Sec. 7044, Business and Professions Code: The Contractors License Law Uoes not apply to an owner of property who builds or improves ihereon, and who does such work himself or herself or through his or her own employees, provided Ihat such improvemenis ere not intended or oflered tor sale. If, however, the building or improvement is sold within one year of completion, the owner-builder will have the burtlen ol proving Ihat he or she did not build or improve for purpose of sale.). ❑ I, as owner of the pmperty, am EXCLUSIVELV CONTRACTING WI7H LICENSED CONTRACTORS to construct the project (SecJ044, Business antl Pmfessions Code: The crontractors License Lew doas no� epply to an owner ot pmpeny who builds or Improves thereon, and who contracis tor such pmject with a contrector(s) license pursuant to ihe Contractors License Laws.). ' i ❑ I am exempt under sec. Business and Professions Cotle tor this reason: Signature: � Date: Owner ID venfietl by dnver's license. ❑ Ves ❑ No � Drivefs License No. Expires: Venfication of Ownership by (type of document, I.e. - property tes bill or deetl): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: I ❑ I hereby certify [hat no excevation five (5) or more feat in depth in�o which e person is required to descend, will be made in connection wi�h work authorized by ihis pertnit, and that no building struclure, sceHolding, talsework, or demolition or dismantling Ihereot, will be more ihan thirty-six (36) feet high. (Chap. 32, Gry 2, Art 2, Sec. 341, Title 8, Califomia Administrativa Code). ❑ As owner-buildar, I will not employ anyone to do work which woultl require e Dermit from ihe Division of Indusirial Sefety, as notetl above, unless such pereon has a permit to tlo such work from the division. I Signature: Date: Division oi Intlusirial Safety Pertnit Number: Will iha applicent or present or fuWre builGing occupant need to file end certity a Business Plan for emergency response to reiease or threatened release of e hazardous matenal? ❑'Yes ❑ No (Section 25505 of the Celifomia Health and Sefery Code requires, with some exceptions, that a Business Plen be filed with the Costa Mese Fire Depariment by every business which has at any ona time dunng a reported year a quantiry bf hazartlous matenals equal to or greater than a weigM of 500 pountls, or a volume oi 55 gallons, or 200 cubic feet of compressed gas at standard temperaNre and pressure). .............................................................................................................................................................................................................................................................................................................................................................................. Does or will the applicant or prasent or future 6uilding occupant need to file a regisiration form for acutely hazardous meterials7 ❑ Ves ❑ No (Section 25533 of Ihe Californie Health and Safery Code, with some exceptlons, requires registration with the Gosta Mesa Fire Department by each husiness which at any one time has on hand e quentiry of acutaly he�rdous matenels equel to or greater t�en e waight of 500 pounds, or e vUume oi 55 gallons, or 200 cubic feet of compressed gas at stendard temperature end pressura). ....... . ...........................................................................................................................:....................................................................................................................... .................................................................... Does or will the applicant or present or future building occupant need to prepare an RMPP (Risk Management end Prevention Program for acutely hazardous materials)9 of en the Costa Mesa Fire Depatlment may require Ihe prepara�ion, cehitication and filing with Ihe Fire cutely hazardous materiels with ihe Fire Deoartmant. 4 If an RMPP is presently required, has Section 25534 of ihe Califomie Health end Safery COOe been fully complied with7 ❑ Ves ❑ No .................................................................................................................................................................:............. ............................................ ............................................................................ 5 Does or wlll the applicant or presant or future building occupant require for Ihe work which is Ihe subject of ihis a plication a Permit for such construction or fmm the South Coast Air Oueliry Management District or irom eny other air polWtion coNrol district or agency� � Yes LJ No (Section 658502 ot the California Government Code requires ihat ihe iequestetl iniormation be furnished on applications for non-residential building permits). .................................................................................................................................................................:.............................................................................................................................................. ...................................... 6 Will any part of the faciliry to be constructed under this pertnil be within 1000 feet irom ihe outer bountlanes ot e school? ❑ Yes ❑ No Qt yes", the faciliry must meet Ihe requirement of Sections 25534 and 42303 of ihe Califortua Health and Safery Code). a have all ofthe disclosures CE: I certity ihat under penalty of and Emissions. Signature: or egency is requiretl for the v �n matle? ❑ Ves ❑ No control ofricer). ' ihe information given above is correct. I agree to comply with all state laws and ciry ordinances Date: CERTPICATE OF COMPLIANCE AND AUh10RIZATION OF EMRY: I certify under penalry of perjury ihat I heva reatl this application antl state Ihet the information given is correct. I agree to comply with ell state laws entl ciry ordinances relating to builtling consiruction, and authonze representatives of the Ci of Costa Mesa to enter upon the ebove-descn d property for inspectiong'\y� �ose ree not to occupy or allow occupancy of eny building au�honzed by ihis permit unti nel ins� tion. */�^_ �_ ��J \ � L //J/h7 CODE1, INSPECTONTYPE . � 7676 Fixetl System Final Fire Prevention 1266 Paol Spe Final 200 Final Fie-Rooi 207 Final BIocWRetaining Well . 202 Final Fectory Fire Place 203 Finel Sign 204 Final Demolition INTIiIRLS �ODE� INSPECTIONTYPE � 206 Final Mechanical � 208 Final Plumbing � 210 Final Electncal 212 Final Fire Prevenlion � I 220 Final Planning Approval � 222 Final Site ' 250 Final Building/Occupency Q[� IN(111RLS pta) �5a-5273 • Fax pl4) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 ELECTRICAL PERMIT Job Address: 590 W 19TH ST Suile No Viciniry: Parcel Nunmber: 42214147 Status: ISSUED Applied: OS/16/2002 Issued: OS/16/2002 Applicant: WATANABE, HIROJI - - ISSUED BY: � O� "_ _ � -- � � -"=,-. �� _ - � Address: 17802 LA SALLE AVE � � /� �� - � - - ��i ; r _ . _.? � %/ �� - . - Phone: 310-532 6000 \ �� < GARDENA; CA' � ' Zip: 90248 � . � , � ��\ __�\ � , i � . � I � � � / � � � � � , . . � � � � / "�� . . . , / A� /� � � � . , � . �V-� . � i � � A A _; � - ' ' � . - _' - � _ '�. / ,� ��. Owner. / OEtKE, HERBERT G TR %MC NAUGHTON KENT A. `�� ;��\ �., �, Address !%MCNAUGHTON, KENT SUITE 750 � � � � `�`�� :� � _ � � -i:; - -'-�\\�� ^.��\�;�� i" CORONA'DEL MAR;.CA Phone: ��>A\� �� j`�� \ � �i�;i �� \�� , - 2600 E PACIFIC HIGHWAY Zip: 92625-2117 �� % j �; AA . ,. /;-/, �\�\\ �\- � . -, V �`�\ , ,, , ' , ;, . ;, � � � � Contracmr. ' JAPAN CONSTRUCTION CO • ;� - �, �� %/ � � �t \ � .� � A'ddress: 17802 LA SALLE AVE � �� ', � .� � . � - - �Pho',ne: �370-532-6000 �., �� ' � ' ' ` , , _ � � � '�.', - . ;GARDENA,CA,�" � ` , , -�-�Zip: �90248�; " � ;� ._, � /;� � �?,�- � , � . /-.�✓� -- License: 416238 ' __ -��N \�._ � �_ . `: � _ '� ' �.. �'�� .. '. .: .. � , ,, - _ _ _'._. _ '_ _ _ __ , . ., ' SCOPE OF P_ERMIT - l , ' ' , }' ! . � � . . �.,.., .. - ,,., . � ' TENANT IMPROVEMENT FOR� �SUSHI'SHIBUCHO�RESTAURANTj W,ORK�TO�INCLUDE NEW DISABLED ,' �^ ! . ACCESS RESTROOM�AND ONE ADDITIONAL'RESTROOM: REP.: 602-00554 � �' ��, � � i 6 LIGHTS, 5 OUTLETS, 2 SWITCHES, 1 MOTOR FOR BATHROOM FAN. J "� � � 2 SIGN CIRCUITS�. , - : � �:� , � - j � � , i • ��_ - �- - �' ,�','l' .- ' i: , v � i i: :� _ _ _ � L -- ' ' �%�-'` _ i, , ,� i,� i; _ ,-� - .. � � FEE SUMMARY,%' ," - -� .i' ' �. . � ,Quantity ��__�,� Quantlty'�% j � � � , , ISSUE FEE � � $23.50 � Temp.Diat Systerti / Lighting �$0.00 0'!' ! � � . � Temp service tesl , $0.00 Busway I100 k � '�$0.00 <0: ,' ! - ` � ,- �� Res.�a/c package $0.00 -= �'��Standing Section :$0.00 „��0,� � � � New Res (b2 units)' � � . $0.00 0 - �� ^"� � Misc Electrical Equipment $0.00 ,"".- 0 � ' ' � r.,. New Res,(3+units) �, ,�$0.00 0 - , � � Transfortn�ers up to 1 kvalkw $0.00 �i 0 � � �� ' � Pool / Spa� .� . . . - ��$0.00 .. 0 , _ - ................up,to 10�kva/kw.,;;� _.4 $D.00� 0 � �� .' i _ � ;, Lighting Fixts - ' , $6.60� � ' 6. up to 50 kva/kw -- $0.00 0 � ' - Recept Outlets ��, //, �$5.50�� 5 � - " . - � � up to 100 kva/kw �_ �$0:00 A 0 i�`i � Switches � �. ��' $2.20' � � 2 "� . ' � �.......-� ......over,�00kva/kw j�$0.00�%/-0 , � Non Res Appl � � � � -' $0.00- � �0 �, � � - , Low Voltage Equipment � - j $0.00 ��0 i� ResAppl �� .�V "$0.00"- � �0�� - _ LowVoltWiring�Systein/Ckt ,/.$0.00% 0%� �� Service to 200a 50.00 -�; "`� � -0 - � - Misc. Conduit:' -' � C`; �� $,0.00� / 0. / Service to 1000a � � $0.00�� ,',� 0 ' - - - - Misc. Conductor � - � � \ \ C$0:00, �.,� 0 � Service over t000a , � $0.00 -' � � 0 � � -� �- ` i - Oirws ( gen ocride)�� - $0.00-J�0 Molors to 1hp �'$0.00 �� ' 0 �� , -� � � � � _ Circus (mech �Ide or lights) /$O.00i 0 Motors to 10hp $0.00,� � �� 0 � � ; '� � � �Chdstmas Tree Stand _-�;�/ $0.00 0 Motors to SOhp $0.00 ��.� -0 � . � ` �Fireworks Stand . ;(� C` % 50.00 0 Motors to 100hp $0.00 � 0� `_'<. �: � - - Other-Electrical,Fee �/ $0.00 Motors over 100hp $0.00 0 � - - - -�, _ " ' ' - " Communication drops $0.00 0 Investlgation Fee $0.00 Sub panel to 200a $0.00 0 Plan Check Fee $0.00 Pole Light Pkg $0.00 0 Reinspec5on Fee $0.00 Sign Circuits -$49.20 2 Temp Pwr Pole $0.00 0 TOTAL CALCULATED FEES 587.00 Intertned Pole $0.00 0 ' COMMENTS / SPECIAL CONDITIONS NOTICE: Tha work authorized by this permit shall comply with all applicabla handicap access requirements under regulations. (Ord. No. 92-28, § 1, 12-21-92) � a. EXPIRATION: This permi� shall automatically expire and become vold it work is not commenced within 180 days, or if w for a period of 780 days. statutes and related is suspended or ebandoned INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, end all requlred Inspections end flnal epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. FOR INSPECTIONS CALL: (714) 7545626 zaae-ee �amo) WORKERS' COMPENSATION DECLARATION: ' � I hereby aHirtn under penally oi perjury ane of Ihe following tleclaretions: � - ❑ I have and will melidaln a certificete of consent to setl-Insure tor workers' compensation, as provided tor by section 3700 of ihe Lebor Cotle, for the peAormenca of the work for which thi5 partnit is issuetl. ❑ I �ave antl will maint3in workers' compensatlon insurance, es reQulred 6y secGon 3700 af Ne Lebor Code, tor Ne perfortnance ol Ihe work tor which this pertnil is Issued. My workers' comDeflsation Insurance cerrier antl policy num6er ere: . Cartier: Poliry Number: �� -� ?fi bl (Th/s sectlon need not be canp/eted i! the permlf /s re/ue0 et one bundred dollars ($100) or Iess.J ❑ I certify ihat in the pertortnenca of the work for which Ihis pertnic Is issued, I shall not employ any pereon in eny manner so es to 6ecome subject to the woMers' compensetlon laws ol Celltomia, end agrea thet If I should bec � 6 sub�ect to the workers' compensatlon provislons ot Section 3700 of ihe Labor Coda, I shell torihwl�� comply with these provisions , / ApplicaniSignaWra: � � Date: �/b�% WARNING: FAILURE TO SECURE WORKE COMPENSATION RAGE IS UMAWFUL AND SHALL SUBIECT AN EMP�OYER TO CRIM PE TIES AND CML FlNES UP TO ONE HUNDRED TFKKISPND DOLLARE (5100,000�, IN ADDI ON TO THE CQST OF GYMIPENSATION, DAMAGES AS PROVIDEO FOR IN SECTION 37060F THE LABOR CODE, ItJrEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby atfirtn Ihet I am licensed undar provislons of Chapter 9(commencing with Sec n 7000) of Divislon 3 oi the 8usiness end Professions Code, and my license is in full force and ettecL Lic. N Class A Gomractof5 Signature: - Dale: (L2 / CONSTRUCTION LENDING AGENCY: � ❑� I hereby aMirm that ihere is e construction lending agency for the pedormance ol the work for which this pertnit is issued. (Sec. 3097, Civil Code). Lender's Name: Lenders Address: Signature: Date: OWNER-BUILDER DECLARATONS: I hereby aflirtn ihel under Denalty ot perjury ihet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW tor Ihe following reason (Sec. 7031.5, Business entl Professions Code: Any city or counry which requires a pertnit to construct, alter, improve, tlemolish, or repair any structure, pnor m its issuance, also requires Ihe epplicant for such pertnit to flle e si9ned statement ihet he or she Is Ilcensatl pursuant ta the provisions af the Comrectors License Lew (Chepter 9(commencing with Section 7000) oi Division 3 of ihe Business end Professlons Code) or Ihat he or she is exempt theretrom and the basis for the alleged exemption. Any vlolation of Section 7031.5 by any eppllcanl for e pertnit subjects the applicant to e civil penalry of not more Ihan tive hundred dollars ($500).): ❑ I, as owner of t�e properry, or my amployees with wages es Iheir sole compensetion, WILL DO THE WOHK, entl the structure is not intende0 or oflered for sale (Sec. 7044, Business end Professions Cotle: The Contractors License Law tices not appty to en owner of property who builtls or improves theraon, and who does such work himself or herself or through his or her own employees, provided that such Improvemenis are not Intended or ottered for sale. If, however, the building or Improvement Is sold within one year ot completion, the owner-builder will have Ihe burden ol proving Ihat he or she ditl not builtl or improve tor purpose ot sale.). ❑ I, as owner of tha property, am EXCLUSIVELV CONTRACTING WITM LICENSED CONTRACTORS �0 ConsimCt Ihe pr0leCt (SBC. 7044, Business entl Profession9 Code: The coniractors License Lew does not eppty to en owner of properry who builds or improves thereon, end who contrects tor such project wlih a comractor(s) license pursuant to Iha Contractors License Laws.). � I am exempt under sec. Business and Prolessions Code tor this reason: SignaNre: Date: Ownar ID venfied by drivefs license. ❑ Yes ❑ No Drivefs License No. VedOcation oi Ownership by (rype oi tlocument, I.e. - property tex blll or deed): DIVISION OF INDUSTRIAL SAPETY PERMIT CERTIFICATION: Eapires: ❑ I hereby certity ihat no excavation five (5) or more feet in tlepth into which a person is required to descend, will be made in connectlon with work euthorized by this pertniL and ihat no building siructure, scattolding, falsework, or tlemUition or dismantling thereof, will be more t�an thirry-sla (36) leet high. (Chap. 3.2, Gry 2, Art 2, Sec. 341, Title B, Cellfamia Atlministra�ive CoCe). ❑ As owner-builder, I will not employ anyone lo do work which woultl require a permit from ihe Division of Intlustrial Sefery, es noted ebove, unless suc� person has e permit to do such work fmm the division. Signeture: � Dete: Divislon ot Indusinal Sefery Permit Number: CERTIFlCATE OF COMPUANCE AND AUfHORVA710N OF EMAY: I certify under penalry of perjury that I have read this epplicatlon end state that the informatlon 91ven Is wrtect. I agree to comply wilh all state lews and ciry ordinences relating lo bullding construction, anO euthonze representatives of Ihe Ciry of Casta Mesa to enter upon Ihe ebove-tlescnbetl pmperty for inspection purposes. I agree not to occupy or ellow occupancy of any builtling euthonzed by Uis pertnit until final insDection. Legal COOE 1. INSPECTIONTYPE 1616 Fixed Sysiem Final Fira Prevention 1266 200 201 202 203 Pool Spa Final Finel Re-Roof Final8locWRetelning Well Final Fectory Fire Place Final Sign 204 Final Demolition _ . � /ljL Date y�6 Date COOE� INSPECTONttPE 206 Final Machanical 208 Final Plumbing 210 Final Elecirlcel 212 Finel Fire Prevenlion 220 Final Planning Approval 222 Final Site 250 Final Building/Occupanq PAIE Iti�ELi �na� ioa-5z�a • rax pta) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR DRIVE, COSTA MESA, CA 92626 MECHANICAL PERMIT JobAddress: 590 W 19TH ST Suite No Status: ISSUED Applied: OS/16/2002 Issuetl: OS/7&2002 Vicinity: Parcel Numbec 42214147 - _- -- - - __- ISSUED BY: // �� -%��„�_�,_.->,- ,__ �` �-'-� � Appliwnt: WATANABE, HIROJI�%', _ ---r �_ � �'��-�� Address: 17802LASALLEAVE. �� , -' . � , ! � � -�'�� ,.. �_�� j�'� . - � ' Phone.' 310-532-6000 ��, � i �� , �� GARDENA ,CA V ' .Zip _ � 90248 ./ t J l � � � A i,;/ _A _..- =. ;;;-, �� i _�� i , , � � . . - - - _ � �) � ` �i � Owner:,-' OELKE;.HERBERT.G-TR %MC NAUGHTON KENT�A-' � .I �A�� ;�,.A`,,.��, Address:'� %MCNAUGHTON; KENT SUITE 150 ��V� �� " � � . , � � A\ � � . / CORONA DEL MAR, CA � Phone: �� ' � . i., _ -, � �. A� ( � `�A,. �, �" 2600 E�BACIFIC HIGHWAY Zip: 92625-2117 �c ��A� � 1'��.,`, i , % � �� . � � � �.� �.`� / � ,A �' �� : i ., : ' Contracror. ' JAPAN CONSTRUCTION CO. - �' ` � \ �. � _ �\\�� ' , � Address: 17802 LA SALLE AVE - ': � ° -' �- � ;,_, • � �, � .� , ��> � . . . ..�Phone: 310-532-6000 � • � - �,.�� V'' � . GARDENA, CA -- � �-� ' �Zip � _ 90248 _ � - �. � . , � � _ � - ., .�. - ._ - - � � . � - -- License:416238 -' � \; ; � \ �.:•, ' . . �,, ' , . . _ -/c�" � ` SCOPE OF PERMIT \ �- • �� TENANT IMPROVEMENT FOR " SUSHI SHIBUCHO RESTAURANT" WORK TO INCLUDE NEW i DISABLED ACCESS RESTROOM AND�ONE ADDITIONAL RESTROOM.�REP.:'B02-00554 . .� . 1 BATHROOM FAN..�.' ; - -' "/1=� �C ,`.':L�� . �.,.:: ti:� �� -. - -- - _ - - - . -. . - - . � ISSUE FEE Inst FAU <100 k �BTU Insl FAU >100 k BTU Repair/Alt Cooling/Heat Inst / Rep. Recess Wall HV Refrig Sys <100 k BTU � Refrig �Sys, >100 k BTU Gas Piping Factory Fireplace � , Hood w/Mech�ExhausL ' ,� � _ , . �-_ �� , , � � FEE SUMMARY,, ^� � � ' ; , � � ;.� • Quantity . _�� . ��_�� . /,' . �• ;! � �"-.,. �j , „ `Quantity . 323.50. _ - - - �, Repair/,AltAbsorbtlonUnil j "$0,00 0� ' � $0.00 0 "- ' ' Repair,/AlfRefrigeratlon Unit � ;� �$0.00 0 � ; ; $0.00 0 Ventillation System , - $0.00 � - 0 � r $0.00 0 EvaporativeCooler � � -� � $0.00��0 ��. $0.00 0 � Commercial�lncinerator �; �� ,�$0.00 - 0 ' $0.00 0 . Domestic Incinerator �� $0.00� 0 i� $0.00 0 ..., �- �=Compressors / Absorption Systems �-/�/ � $0.00 0 ti � ^ Up fo 3 hp I 100 k BTU �'� $0 00 � 0! � � �' , $0.00 0 � " 3 T'o 15'hp%500 k BTU %�� "-� �$0.00 .�-0 a" � ,. � ° 15 To 30,hp�%�1;OOO�k;BTU --,��j i VAV Boz -� �, �� $0 00 0` , 30 To 50 hp / 1,750 k BTU -.� ./ Vent Fan / Single Duct /��/� �$0 00� �0 . � `�sOver 50, hp / Over 7 750 BTU% �� Appliance A�� `�/� ✓� $10 65��1\ � =�� ` �Boilers ' n '� � �� i �! 3oW�� ,_ \% $000;� FreDampers ,� � /�$000 0��_ ; _�" �Upto3hp_; i/ � �1� /� jau.w Smoke Dampers � � � : $0 00 0 �� _ � �� ,_-,-3sTo 15 hp =j v ;/ 50.00 Inst or Relocate Appl Ven) �� ti$0 00 �,0"�� =�- � 15 to 30�hp �� $0.00 Air Handlers < 10000c(m �� -- _ � $0 00 �� 0- � � , A �� 30 to 50 hp�� ,� � � $0.00 Alr Handlers > 10000cfm � '$0.00 �.0 � ; - � - , - _ A r, Over 50 hp-i � `, � � � j� $0.00 � FloorFurnace ��$0.00_ 0�-1.- � - �� Other,Mechanical�Fee,/ �� FloororSuspendHeater -$0.00`��0- _ � -�i�.,��,;, InvesUgaUonFee.�-,'<i� � $0.00 �� V - � - - Plan Check-Fee% �" , $0.00 � � ' - - , ;; �;. -,-; Reinspection.Fee' � $0.00 TOTAL CALCULATED FEES $34.15 COMMENTS / SPECIAL CONDITIONS E� 0 0 0 0 0 NOTICE:�7'he wo(k authorized by ihis permit shall comply with all applicable handicap access require� •under Califomia statutes and related regulations �(OrB�No. 92-28; § 1, 12-21-92) � s EXPIRATION: This permit shall automatically expire and become void if work is not commenc`ithin 180 days, or if work Is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all appliceble codes, and ell requlred Inepeclions end final epproval must be obtained. Failure to obtain inspections and final approval will result in the axpiration of this permit. FOR INSPECTIONS CALL: (714) 754-5628 zaae-as (erool WORKERS'COMPENSATON �ECLARAnON: �� I hereby aHirtn under penalry af perjury one of the following declaratians: � � ❑ I have end will maintain a cartificate ol wnsent to seN-Insure for workers' compensetion, es providetl tor by section 3700 of the Lebor Code, for the peAormence of the work tor �nhich t�is permit 14 iuued. ❑ I have end will maintain workers' compensetlon insurance, es required by seMion 3700 of the Labor Code, for Ihe pedortnance oi the work lor which this pertnll Is issued. . My workers' compensatlon Insurance cerrier and pollcy number eie: Certiec '•i PdiryNumber: � �3�i�� (Ihis section need not be completetl N Ne permi( is va/ued ef ane hundred dollars (S100J oi less.) ❑ I certify that in the pertormance of ihe work for which Ihis permit Is Issuetl, I shall not employ eny person in eny mannar so as to 6ecome subject to the workers' comDensetion laws of CeIlfOmia, and agree Ihet if I shoultl become il6jec� to Ihe workers' wmpensa�lon pmvisions ot Section 3700 of the Lebor Gotle, I shell fohhwith comply with Ihese provisio �+. �/// Applicent Signeture: � Date: �� /b� D 7 WARNING:FNWRETOSECUREWO�E'�OMPENSATION LAWFULANDSHALLSUBIECTANEMPLOYERTOCRIMINALPENALTIESANDGVILFWESUPTOONEHUNDRED TFiOUSAND DOLLPI7E (5100.000), IN ADD ON TO THE WST OF COMPENSATIIXJ, DAMAGES AS PROVIDED f-0R IN SECTION 3�060F THE UBOR CODE, IMEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: , I hereby aflirm Ihat I em Iicensetl under provision of Chapter 9(commencing wlth Section 7000) oi Divislon 3 ot the Business and Professions Code, and my Ilcensa is in tull torce and eflect. Lic. N ��' qass # Contrectofs SignaWre: Data: �� /� O �. / CONS7RUCTION LENDING AGENCV: ; ❑ I hereby effirm that there is e construction lentling agency tor the peAormanca of the work for which this pertnit is Issuetl. (Sec. 3097, Civil Code). Lenders Neme: . Lendef5 Address: Signatura: � Date: OWNER•BUILDER DECLAHATIONS: I hereby eflirtn t�at untler penelry oi perjury thet I em EXEMPT FROM THE CONTRACTORS LICENSE LAW tor Ihe following reason (Sec. 7031.5, Busineu end Professions Cotle: Any city or county which requires e permit to construct, alter, improve, demolish, or repair any structure, prior to its Issuance, also requlres Ihe applicant for such permit to ille e signetl statement ihet he or she Is Ilcensed pursuant to the provisions of tha Contrectors License Law (Chapter 9(commencing with Section 7000) of Dlvlslon 3 of ihe Business end Protessions Code) or thet he or she is exempt Iheretrom end the besis tor the alleged exemption. Any vloletlon of Sectlon 7031.5 by any applicent for a permit subjects the epplicant to e civil penalry oi not more than tive hundred dollars ($500).): ❑ I, as owner of Ihe pmperry, or my employees with wages es �helr sola compensation, WILL DO THE WORK, antl the strucWre is not Intended or oflered for sale (Sec. 7044, Business end Pmtes5ions Code: The Comractors License Law does not apply to an owner ot property who builds or improves Ihereon, antl who does 5uch work himsalt or herself or througn his or her own employees, provided ihat such improvements are not Intentled or oNeretl �or sale. If, howevar, the building or improvement Is sold within one year of completion, the owner-builder will heve the burden of proving that he or she tlid not build or improve tor purpose of sale.). ❑ I, as owner of ihe property, em E%CWSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct the prolect (Sec. 7044, Business entl Professio�s Cotle: The contractors Llcense Law aoes not appty to an owner ol property who builds or improves thereon, and who con�racts br such pmject wlih e contrector(S) license pursuant to the Con��actors License Lews.). ❑ I am exempt untler sec. Business and Professions Cade for this reason: SignaWre: Date: Owner ID varifietl by drivefs license. ❑ Ves ❑ No � DriveYs License No. Expires: Venfica[ion oi Ownership by (rype of tlocument, i.e. - property tex bill ar tleetl): ' DIVISION OF INDUSTRIAL SAFET�' PERMR CERTIFICATION: ❑ I hereby certity that no exca�ation five (5) or more Feet in depth into which a person is required lo descend, will be matle in connection with work aut�orizetl by this permit, and ihat no builtling strudure, scaflolding, falsework, or�demolition or dismantling thereof, will be more than t0irty-six (38) leet high. (Chap. 32, Gry 2, Ar12, Sec. 341, Title e, Callfomia Atlminisirative Cotle). ❑ As owner-6uilder, I will not employ enyone to do work which would require e pertnit irom the Division of Indusinel Sefety, es notetl ebove, unless such person has e pertnit to do such work from the division. Signature: Date: Division of Industriel Sefety Permi� Numbec HAZARDOUS MATERIALS AND EMISSIONS CERTIFlCATON: 1 Will the applicant or present or tuWre building occupanl neetl to tile entl certity e Business Plan br emergency response to release or threatenea release of e hazardous metedel4 ❑ Ves ❑ No (Sedion 25505 of Ihe Celilomia Heelth end Safery Cotle requires, with some exceplions, thet e Business Plan be filetl with the Coste Mesa Fire DeDartment by every business which hes et any o�e time dunng a reported year e quantiry of hazardous materials equel to or greater ihan a weight ot 500 pounds, or a volume ot 55 gallons, or 200 cubic feet of compressed ges et standard tempareture antl pressure). ......................................................................................................................................................................................................................................................................................................................................................................................... 2 Does or will ihe applicant or present or future building occupant need to file a registration form tor acutely hazartlous metarials7 ❑ Yes ❑ No (Seciion 25533 0l the Califomia Healih antl Safery Code, wl�h some exceptlons, requires registratlon with the Costa Mesa Fire Department by each business which et eny one time has on hand a quantiry ot acutely ha�rUous meteriels equal to or greater than e weight of 500 pounAs, or a volume ot 55 gellons, or 200 cubic �eet ot compressed gas et stanGard temperature and pressure). ......................................................................................................................................................................................................................................................................................................................................................................................... 3 Does or will the applicant ar p�esent or tuture building occupant need to prepere an RMPP (Risk Menagement and Prevention Program for awtely ha�Nous materials)7 ❑ Yes ❑ No (Section 25534 of the Celitomia Heelth entl Safary Code provitles that the Coste Mesa Fire Depertment may require the preperelion, certification end filing with the Fire Depertment of en RMPP by Dusinesses which ere requlred �o reqister acutely hezertlous materlels with the Fire Depertmenl. ..d.......lf en �RMPP is Presenity repuifed,�has Section�25534 of the Calilomia Healih end Safery Code been fulty complietl with7.....0 Ves...........O.No...._. ................................'—'................. .............. _, _........ _ _............ _...... _. _. . _.......... _........................... _..."_""'........ _..... _. _............. _...... _................ _ _...................................... _......................."_....................' _'................. _.. _.... 5 Does or wlll the eppllcant or p�esem ar future building occupant require for Ihe work whic� is the subject oi Ihis a plicetion a Permit for such construction o� motlitcation from tha South Coest Air Oua6ry Manegement Distnct or from any other air pollution control district or agencyt � Ves LJ No (Section 658502 of the Celifomia Govemment Coda requires t�at Ihe requestetl informetion be IurNsheO on epplications for noo-residentiel builtling pertnils). 6 Will any�pan�oi�the laciliry to be constructed under ihis �permit be wlthin�7000 feet from ihe outer bountlarles of a school?��Yes ❑ No �� (If'yes", ihe facillry must mee� the requirement oF Sections 25534 and 42303 of the Califomia Health end SaFery Code). e (If "yes', atlach certificate of cc CERTIFICATE OF COMPLIA� regarding Hazartlous Meterials Signeture: oi aisma or e9ency �s reqmrea ior ma � 42303 been made7 ❑ Yes ❑ No mce trom the appropnete air pollution con�rol otticer). �� I certily thet under penelry of perjury the Information given above is correct. I egree to comply wi�h all state laws and city ortlinances Emissions. __ _ Date: CEHTIFlCATE OF COMPLIANCE AND AUTHORIZA710N OF EMRV: I certify under penalry of parjury that I hava reaA this application an0 stete ihat ihe Information given is correcl. I egree to comply with ell state laws end ciry ortlinances releting to bullding consWction, and authorize representetives of Ihe Ciry of Costa Mesa to enter upon the ebove-descnbed property for inspection purposes. I egree nat to occupy or allow occupency of eny building authorized by this permit until final inspection. CQOE I. INSPECTION TYPE 1876 Fiaetl System Final Fire P�evenllon 1266 Poal Spa Finel 200 Final Re-Roof 201 FIneI BIocWRetaining Wall 202 Finel Factory Fire Place 203 204 Final Sign Final Demolition PAIE i ItQIDALi COOE I INSPECTION TYPE 206 Finel Mechanical 20B Finel PIum6lnq 210 Final Eledrical 212 Final Fire Preventlon 220 Final Plenning Approval 222 Finel Site 250 Final Building/Occupancy Date / � /6 O "7 Date PAg. 1� L-U-nA 3�!_ City of Costa Meu Development Services Department Building Safety Division P. O. Box 1200 Costa Mesa, California CERTIFICATE OF OCCUPANCY No.p01�59 The Building located at 590 4d�t 19thStC�tt has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group 82 Occupancy. Use of Building Restaurarlt C Legal Description 422-141-19 ISee reverse side for Meres and Boundsl P33686,P33421 Building Permit No B 33053 Electrical Permit No. E 33243 Plumbing Permit NoP��S.P.a�Q� Mechanical Permit No. M 33598i M 33733 Number of apartments and/or guest rooms Fire Prevention Perniit [�o. F 33815 ISSUED T0: Pierre �ntoliao 530 F1. 19th Street Costa P1zsa. CA 92627 Building Official William T. Howard by"�%� �.� � /' �f�/i�� l� -- - � Dace June 9, 1988 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Buildinq Official of the City of Corta Mesa under Sec. 307 (e) U.B.C. CMF ]O75-a6 rev. 1/83 White -�wner�; Canary - Numerical Pile: Pink - Bldg. Permit File � ACPllcant l0 flll In all spaCes eKceO< <hose within heavy DorCer Ilnas anE si9n all apProD��ale Eecla�ations. CITY OF COSTA MESA CONSTRU�TION PERMIT ProjeqtAddress' W � App il cant's�ilir�3Address �� WS�� . a , n - - ' ---- ` o, � Address • � �' � Arch/Eng. License No. � Address " Contractor'sNam D �- t �J phon �3j� 6 of Address (ma �'^^� 4 Q a�.7' i N �3 Ciry License No. ~� LICENSED CONTRACTON OECLARATION ' {- 1 hereby aftlrm that 1 am Ilcentetl untler provislonz of Charter 9(commencing � ivlth sectlon �000) ot Divlsion 3 01 Ihe Businesz antl Pro1¢SSlons Cotla, an0 my li<ense is in f W I tprce ana eHect. ', - IJcense Class Llcensa No. Date Si9nature WORKERS' COMP(NSATION DECIARATION •ereby aHlrm that � have a certllicate of consent to saH-Insure or a certificate Wo�ker5' Compenzation Insurdnte, o� a[ertifletl copY the�eof (SeGtion _a00, Lab. C.) Polity No. Company BCertlfietl copy h rye�¢by tumlSM1etl. � � Certifletl capy I5 }�letl wlth t�e city Builtling Divlilon. Dale ApPlicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This sectlon neetl np� ba completetl It tne permit Is for one hundretl 300) or ' less). I certlfy that In the p¢rtOrmanca 01 [ e ork f0� whlc hIs pefm ' ISSuetl 1' shall not employ aqy person in an n er so as t eco ec[ to t�e Workers' �y sz ��yus of Ca �ate �%��9nalui NOTICE: 11, aiter making lhis tleclaratlon, you zhoultl become subject to the Workers' COmpensa(ion provlSionS ot [he Labor Cotl¢, y0u mu5t fOrthwlth comply wilh such p�ovisions o� this pe�mit Shall be tleemeU �evok¢tl. CONSTRUCTION LENOING AGENCV 1 hereby attlrm that thera Is a constructlon lentlin9 agency for the performance Of t�0 work �or �yhith [hIi plrmll i5 iisued (SeCtIOn 309] Civ. C.) Lontler's Name Lentler'S Atltlress OWNER BUILOEN �ECLARATION 1 hereby a1/1rm Ihdt 1 am oxompt frOm Ihe COnlydct0/'s Lltense Law for (he following rcason' (Sectlon 7031.5 Buslness antl Professlonal Code: Any dty or wuntY �'hlcn requiras a permlt to con5trutt, alter, Improve, tlem011sh or repalr any Structu�e, pNOY to Ils ISTuance, also requir¢s tha appllcant �Or suCh permlt to 171e a slgn¢tl statemenl thal na/She IS IlcenSQtl pu�suant lo lne prOvlsions ot the Contractor'f Licenie Law (Chapter 9(commen<Ing wltn SatUon 7000) oi "'vision 3 of Iha Buslnoss antl Prolesvons COtl¢) o� thdt he/ih¢ Iz ex¢mpl �.rolram antl the basl5 f0� th¢ alleg¢tl ex¢mp(lon. Any vlolatlOn of SectlOn 31.5 by dny appli<ant 10r a pe�mit subjetti tne apP��ant l0 a Civll enalty o1 not more tnan tivo nuntlretl Oollars (E500). � I, as owner o( the vroperty or my emploYees wlth wages as their soln compensatlon, will oo tho work, antl Ne structure Is not InlanEea or ot(erea for sala (SeGtlon 7044, BuSlnaii antl ProfesiiOnal COtle: The Contra<[or'S Llcense Law tla¢5 �ot apply to an Owner o1 a p�operly wM10 builtls oi lmp�Oves thoroon, ana who tloes sucn work nlmselt/herself or lhrough hIs or her own emploYaes, provltleo tnat such Improvemenls are not IntenCetl or otferea for sale. 11 howuver, the Dulltling or Improvement is soltl wlthln one year of com- pletloq tno owncr �yill have tho Durtlen o1 proving he/sM1c tlla not bulltl or Im- tova forthe purp05e olsale). I, as owner o1 the property, am exclusivery contracting wlth Ilcensetl ton- V ctoRto con5[NCI the prOjUct ISUC[ion 7044, Busina5i anG Rote55iOn5 COtla: The Contractor'z License Law doe5 nat apply Io an owner ol pro0¢rtY wno builtls or Improveg �nereon, ane wno contracts for such projects witn a ton- tractor(51 IicansB pUrsuant to thC Contrat[or'S Llcense Law). I am aware Nat prool a( lnelr Warker'S Compensatlon Insurance shoultl be D�ovltletl lo me. ❑ I am exempt untler Section B. 6 P. C. for tnis reazon .�' nc9 Owner " Ity that I have reatl thls application antl state that the above 'B 3�5 � t�a► r v, et, r� TYPE OF CONSTRUCTION NEW ADD P.LTERATION REPA�R t ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p,.�6 DESCRIPTION OF WORK/USE OF BLDG. S Main Bi TVP^E OF PERMIT GRA�ING FOUNDATION STRUCTURAL T FrOnt U TENANT ❑ ELECTRICAL ❑ PLUMBIMG ❑ MECHANICAI B qeaf Q OTHER A PROJECT DESCRIPTION S�.FT.—� ��— OCCVPAt�Cv � C Right CONSTRUCTION TVPE V ry VP.�VATION S I I�.i �i4 g Lef[ ZONE GRADING GU. VDS. ACRES Ping. Ref, $- Remarks: (� y�� fk (�1, (�e �_pr '��Z„�pj4 PlanningNo P 3ar Sfnk 3ackflow Preventer 3ackflow Irtigation 3athtubs �larifiers Dishwasher Drinking Fountains Floor Drains' - Floor Sinks Gas Service OuUets Interceptors Kitchen Sink " Lavatories ' , P—Trap ' ' . � Roof Drains � . Reinspection Fee $15 Boiler • Duct- UnderGround Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑ ai ao,000 sru O � oo,aoa ientatives o �s city to er u n e aoove-menuonea pr oert ior inspectlon 0 s 3 Si9nature Date � Drivers' �icense or 55 � Reinspec[ion Fee CMF 0865-46, rev. 30/84 WM1It¢ - Builtling; Candry - Appllcant; Plnk - Accountln9: Goltlonrotl - ASsessOr $15 Showers Service Sink Sofar Collectors Solar Piping Solar Tank Swim'ming Pool w/Spa Urinal Water Clout Water Heater Water Service Auto�Wash Isue Fea Hood ar Type I ❑ Canopy Type I I ❑ Refrigera[ion System Oaioo.000eru Oioo,000 System RepaidAlreretion F ire Dampen Fegisters Iswe Fee FEES 53 S 3 I �: — — ��_I��i�� .A��ii. � ' � '��ii�'i�'.�Y%1 `'��►�� .:J �.�.��w�''•"%r�•�z' Automatic Washer Construction Pole Su6. Cooking Unit Dishwasher Dryers ❑Gas ❑Elec Fan F.A,U. Fixtures Device Boxes Oullets Switches Garbage Disposal Generetor �0�5 KW C ELECTRICAL Transtormer �� 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over700amps Sub Panel MotorsO0.7 HPQ7X-8 Inc. Solar 09-15 HA �7615+ Microwave Pole Light Range KW � Reinspection Fee � $15 DEVELOPMENT SERVICES RE�I 2oning Approvad By Building qpproved By Appliration luued By Standing Sections Trash Compactor Issua Fee SU� �M�AHsVo OF FEES BUI�DING PERMIT 5 ��= SMIP PLAN CHECK S PERMIT PLUMBING 5 ��UANCE PLAN CHECK 25% 3 ENERGV P.C. ELECTRICAL $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL B TOTAL FEE PLAN CHECK 25% $ o/�: FEES 5 I� 3 $ $ 5 $ Z O N I N G M T 5 �CONSTRUCTION AND�PLANNING POOL & SPA �+ � Date Inspector Date Inspector �APPROVALS Permit # APPROVALS Permit # . 1: �Temporary EIeG[rical.�ervice or Pole 52. Pool & Equipment Location. .: . � � 2. Soil Pipe-Undrgrnd. 'L' � 53. Steel Reinforcement • , � � 3. Electrical Conduit Utility�Undrgrnd. 54. Forms � • � , 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding - ' 1 � 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test � ' 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. � i l , 8. Foundation 1� �' 59. Gas Pipe, � Undrgrnd., Test `� 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVA� TO DECK � 1 t. Property Sewe� line & House Connection 62. Backwash & Receptor-Final ' � 12. Sewer Cap 63. Heater & Vent-Final 73. Roof Drains ' 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final � 75. Rough Electrical-Conduit 66. Solar System-Final ' 16. Rough Electric W�ring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL �� i 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT " _ .r 20. Rough Factory Fireplace APPROVAIS Permit# - . - 21. Ducts, in Structure . 70. Underground Hydro 22. Ducts, Ventilating 71. Produc[ Piping O Gas f] Oil� 23. Gas Pipe-Rough & Test 72. Underground Flush � 24. Roof Framing 73. Undergrnd.StorageTank O�Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro .. � - 26. T-Bar Ceiling (Structurall & Monocoai p � 75. Dry Chemical 27. Frame and Flashing � 76. Dry Standpipe I.� � 28. Lathing&Siding �� 77. FIXEDSYSTEMFINAL-��. 29. Insulation �¢ 78. FIRE PREV. FINAL �, � 30. Drywall Nailing � 8g HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ��- 79. FINAL INSPECTION ' . 32. Electrical Power Meter-Finai 80. FOOD CERTIFICATE ISSUED ' 33. Final Electric Notes: HOLD FOR SP.`---„>> ��QUIREMEN7: � 34. Final Heating & Air Conditioning '" 88 �� 35. Final Gas Pipe-7est Yy Q� "' .-,-.� O C y,_ �K¢� . 36. Hood or Canopy r� � 37. Ei�al Factory Fireplace �� Bg Z�L,e, � 'B . ' 38. Final P.lumbing _ ' 39. Water $ervice-Final ' 40. Gas Service-Final . 41. Solar pomesticFinal � j� � � ,` d2. Backflow Prever�ter . � � ' 43. Backfldw Irrigarion � !' r'� � � . � 44. Landscape Irrigation System � � �i • 45. Sound Attenuation • ' ` 46. Handicap Regulations j . . 47. FINALSTRUCTURE & BUILDING i,.: . " � 48 � Special Requirements Completed � , . 49 � Electric Release to Edison 6 � 8 ' 1 %� 50. Gas Reiease to Southern Califomia Gas Co , �; • 51. CERTIFICATE OF QCCUPANCY No. ��' .:: �bate - � AVO��ant to fiil in all zpae¢s CI7�►oF cOS7A MES CONSTRUCTIQN PERMIT ..�- ' %i • Project Address APP�icEnt'S Mailin �idr�� /5"5/f Owner's Name `-'� ""' �� F�f�io e � Address Arch/Eng. License No. Address Contractor's Nam hone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby attirm tnat I am Iicens¢tl untler provislons ot Charlor 9(tommenNn9 with section 7000) of Divislon 3 ot [he Business antl Pmfessions Code, antl my Iicense is in,tull force antl e(fect. License Class LIC¢nie No. Date Si9nature WORKERS' COMPENSATION DECLARATION I hereby aHirm thal 1 nave a certificate of tonsent to seltinsure or a certificate of Workers' Campensation Insurance, or a tertltietl copY tnereo/ (Section 3800, Lab. C.) Policy No. Company Certifietl copy is hereby IumiSh¢tl. Cer[itietl coOY is filetl with tne clty BuilCin9 Divlsion. Date APP�� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section ne¢C nol be complat¢tl i1 Ihe pOrmlt Is 7or One �untlretl (5300) or less). I<¢rtify tltat i Ihe� e�formanCe Ot Ih o�k tOr ich nl �m�t IS ISSuetl, 1 hall not e oy a er50n in any n¢r O o ec e zubjec[ �o [he orkeR' e Lews of Calit tn Si9nature N TICE: 1, atter aking tnfs tletlardtlOn, yau Shaultl ecome subj¢ct t0 the W rkers' ompCnSation O�ovision5 of Ihe LabOr COdC, You must forthwi[n mmply wilh suclt provisions or this pormlt snall be tleame0yrevoketl. CONSTRUCTION LENDING AGENCV !'-' I M1ereby atllrm that there Is a construttion lentlln9 agen<y for the performance ot tho work tor whicb 1h15 permit I5 issuetl (Sectlon 309] Clv. C.) Lenaer's Name Lentler's A�tlre55 OWNER BVILDEH OECLARATION I her¢by alfirm [hal I am onnmpt irOm tho Conl�aelor'S Lle¢nse Law 10� the following reason (So<tion 7031.5 Buslneis anC Protesilonal Cotle: Any city oi county whlch repuires a permlt [o construcq altar, improve, tlemolish or rnpal any structure, prior to itz Issuanco, also roquirez tne applicant tor such permll �� niw a cionxtl statement t�al he/ihe Is Iitrnsotl pursuant to tbe proWsions oi rom ana mo oa 5 by any appl ;y of not more It as owncr ot tn ensation, will tic ale (Settion 70� se Law tloes not �n, antl who tlo oyoos, provltleU I f, howovar, Ihe n, [ho owner wi fortho purpOse as owner ot tne bullds ar Improves [r tractor(s7 bcense purs proof of [heir Worke ❑ I am e mpt tl¢r Date I hereb cerY y that intorma ion rs rrect antl state laws latln sentatives of s cit inspection vurp Siqnature Driverz' License or 55 Cant for d pelmll Tubfects llla appllcan[ [O a crvu an five huntlratl tlollars ($500). ; prOpCrty or my emplOyms wlth wa905 as lheir so10 tno work, anG [he structuro Is nol intontletl or otferod 4, Buslnasz antl Professional Code: The Contra<tor's apply to an Owner Of a p�oporty wh0 builtli or ImO�OVCs �,s such work nimseH/narsoll o. throvg n his or M1er own �at such Improvomonts aro not IntenAetl or oHereO /or �uiltlin9 or improvement is soltl wilhin ono yoar ot com- I have tha burtlen ot orovin9 ho/she ala not bulltl or Im- �1 Salo). property, am axclusivaly con[tacting wlth IiC<nsetl con- ie project ISeclion ]044, Buslnass antl Profeisions Cotla: nse law does not apPly to an ownar ot Oroperty wno eroon, antl who coM�acts fo� SUCh Oroject5 wltb a Wn- iant to the Contractor's Llconse Law�. 1 am aware tnat �'s CompansaUon insurance shoultl beR rovitleG to me. 5¢ction „B. 3 P� Q� fi� lhli reason I ha 1 a9 to r to Owner aDove tnose within neavy Doraer tines anG slgn all aoD�aoriate aaclarations. TRACT NO. LOT NO. UNIT NO. TVPE OF CONSTRUCTION L'J NEW LJ ADD L1r.�ALTERATION LJ REPAIR i❑ CONVERSION ❑ DEMOLISH 0 OTHER q,p, q� DESCRIPTION OF WORK/USE OF BLDG. S Main Building: TYPE OF PERMIT GanDiNG oUNDATiON STRUC7V aA� T Front ❑ TENANT ❑ ELECTRICAL �UMBING ❑ MECHANICAL A Rea� ❑ OTHER . PROJECT DESCRIPTION 5�. F7, occuvArvCv C Right K Left CONSI'RUCTION TYPE VALUATION $ $ ZONE GRADING CV. VOS. ACRES p�ng. Ref. # Remarks: �% 2 nG2 Plenning NoteS: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers rinking Fountains loor Drains . loor Sinks as Service Outlets Kitchen Sink Lavatories Dreins Reinspection Fee � $75 eoiier Duct � Under Ground Dutt - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact.8lt. ICBO � Heating System & Ducting ❑ a i oo,00a sru O i oo,000 Reinspaetion Fee � S15 CMF 0865-46, rev. 30/84 White - BuilCing: Canary - Applicanq Pink - Accounling; GoltlenrOtl - ASSe55o� Showers Service Sink Sewer Cap Sewer Connection $olar Collectors Solar Piping Solar Tank Swimming Pool wlSpa Urinal Water Closet Water Heater Water Service Auto�Wash Issue Fee $ 3 Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Elec Fan F,A.U. Fiztures Device Boxes Outlecs Switches Garbage Disposal Generator �0.5 KW C ni 2one . Acceszory Building: 5�6-DD4D4575 TGT ELECTRICAL Transformer ❑ 15-50 KW ' ❑ 50+KW 5 KW Meter LJup to 100 amps � Meter ❑over100amps � Sub Panet Motors�P1 HP �1X-8 Inc.Solar 09�15 HP �16-15+ Microwave Pole Light Range Sign Standing Sections Trash Compactor Reinspection Fee $15 Issue Fae IANICAL FEES Hoodor T DEVELOPMENTSERVICESREDUIREMENTS: YPe I ❑ Zoning APProved By Canopy Type II ❑ . .. _ Buildin8 APProved BY n _ �a �A Retrigeration System ❑4100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers Iswe Fee � S 3 SUMMARV OF BUILDING PERMIT $ PLAN CHECK $ �f PLUMBING $ /�� PLAN CHECK 25% S ELECTRICAL 5 PLAN CHECK 50% $ MECHANICAL S PLAN CHECK 25% $ FEES $ 3 SMIP $ PERMIT ISSUANCE S ENERGV P.C. $ GRADING S MICROFILM S TOTAL FEE 5 % • D6 N I N G R E U M T $ CONSTRUCTION AND PLANNING POOL & SPn APPROVALS Permit�# ' Date Inspector ppPROVALS Permit# Date Inspector 7. 'femporary Electrical Secvice or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. � 53. S[eel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement! j 56. Rough Plumbing & Pressure Test 6. Electrical UFER Gind: . 57. APPROVAL TO COVER-GUNITE 7. Footings ' 58. Electrical Conduit-Undrgrnd. � ', 8. Foundatiori .� 59. Gas Pipe, O Undrgmd., Test 9. Water Pipe+Undrgrnd..� , 60. Backwash Lines, P-Trep, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line�& House Connection 62. Backwash & Receptor-Final 72. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains � 64. Plumbing System - Final ' 14. Rough Plumbing 65. Electrical-Final 15. Rough Electriral-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 j 69. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace � APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush � 24. Roof Framing 73. Undergrnd.StorageTank �Gas ❑Oil r 25. Roof Sheathing 74, Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe � 2S. Lathing & Siding 77. FIXED SYSTEM FINAL �� 29. Insulation 78. FIRE PREV. FINAL .. � 30. Drywail Nailing HEALTH DEPT. REQUIREMENT -,� � 31. Plaster Brown Coat 79. FINAL INSPECTION � f; 32. Electrical Power Meter-Final S0. FOOD CERTIFICATE ISSUED (� 33. Final Electric Notes: � J' %i 34. Final Heating & Air Conditioning � � i� 35. Final Gas Pipe-Test � J ; _y� 36. Hood or Canopy � 37. Final Factory Fireplace � 38. Final Plumbing . • 39.` Water Service-Final ' 40. Gas Serv�ce-Final � . 47. Solar po;mestic-Final . 42. Backflow Preventer - ' . � �, � 43. �Backfl'�w Irrigation � • �'� , .,44. `Landscapei Irrigation System � � '� '� � I i � g5. Sound Attenuation � � 46. Hahdicap Regulations ' . � �% . 47. FINAL STRUCTURE & BUILDING � ' - , , ' i ti_•.. 48 �Sgecial Requirements Completed i ' �� „" �_ > 49. Electric Release to Edison �-":� . 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY-,; � � � No. Date � � �� AOPlicant to flll in all soaces except those within neavY boracr lines antl sign all aDorooriate Oeclarotions. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMI O_ �,�.� � TRACT NO. LOT NO. UNIT NO. Proj@c[ A;ldress � 1nn l � � :� �a ST. 9PPlicant'sMaili•ng.A,d�dre�ss ��y�t.��7 �. � ST, Ownpr'sName .�,11.d_� ^��r.rC,-��__Phone —� l Address Arch/Eng. License No. Addreu � ,(�,.., Contractor's Namz�/ �1�_��fL �^-- phone � Address Imailing) �Cw'��J',�,� � City License Na. �-/�.y [�_�.. tgj - LIC�NSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensetl untler provisions of Charter 9(commencing wlth section ]000) of Division 3 of the Busine55 antl Professions Cotle, antl my Iicense is in tu11 (orte and ettect. Lice�se Class � ice se No. Date�!�g� Si9nature WOqKERS' COMPENSATION DECLARATIO ' I hereby atiirm that I have a certiticate ot consent to selt.lnsure or a certiticate of Workers' Compen5ation Insurance, or a certifi¢tl <opy thereot (SectlOn 3800, Lab. C.) Pollcy No. Company BCertifieC copy is hereby furnishetl. Certitietl copy is Bletl with the cfty Builtling DiviSion. Oate APplicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thig SCction neetl not be mmpletetl it the permit is for Ona huntlretl ($100) or less). I cer��(y Ihat in ttte per�ormaqce O� tne work to� which fhls pe�mR is issued 1 snall not employ any person in any manner so a to me subject to [{�e Workers' C mp sa on Laws oi Califor / Date Si9nature �` �� NOT�CE. It, ter aking this tletla�ation, you snoul�¢come SubjCct to the Workers' Compensation Provisions of the Labor Cotle, you must forthwi[h combly wi[h such p�ovisions o� thi5 Pe�mit Shall be tle¢med revOked. CONSTRUCTION LENDING AGENCY I h¢roby aHirm that there i5 a con5truction lentlinq agency for the pertormance ot lhe work for which this permit is issuetl (Sectlon 309] Civ. CJ Lentler's Name Lenper's Atltlress OWNER BUILDEH dECLARATION - .�: 1 hereby aftirm that 1 am exempt from tne Contractor's License Law for tne fo110wing reason (Sectbn 7031.5 Business antl Professional Cotle: Any tl[y or couhty which �¢Ouires a petmit to conrt�ut[, alteq imp�ove, tlemoliSh o� repab any sVucture, prbr to its issuanco, also requires the avp��cant tor zuch p¢rmil t0 til¢ a signetl sta[2men[ that he/ihe I5 IiCenSetl pur5udnt to the plovl5ion5 of the Contractor's License Law (Cnap[er 9,(<ommenNng with Section 7000) of Division 3 ot the Business antl Professions Cotle) or tnat he/she is exempt 'therehom antl the basis for Ihe alle9etl exemption. Any violation of SeCtlon 7031.5 by any applicant tor a p¢rmlt Subjects the aOPIiCaM to a tivil �enallyof not more tban tive huntlretl tlollars (5500). LI �, as owner of the Property or my em0loyees with wages az their sole COTOensa[ion, will tlo Ihe wo�k, antl the Structute Is nOt intentletl or offer¢tl for sale (Section 7044, Busin¢ss antl Professional COAe: Tne Contractor'S Li<@nse Law tloes not apply to an owner of a property who builtls or lmproves t�ereon, an0 who tloes sucn work nlmseH/nerself or through his or her own ¢mployees, provitlea that such imprOvemen[5 are nOt iotentle0 or offeretl for � 581e, If, however, the builtling or improverlient is soltl Within one Year ot com- pl¢lion, tne owner wlll have the burtlen Of proving he/Sho tlid not builtl or Im- �oye for the purpose ot sale), I, as owner o1 the properfy, am ezclusively contractinq with licensetl con- , traCtors t8 canstruct tne pro�ect (Section ]044, Business antl Professions Cotle: Th@ Cmvacror's License Law does mt dppty to an own¢r of property wh0 bui�tlz or imOroves tnereon, antl who coneracts for suth projectz with a con- traCtor(s bcense pursuant to the Contractor's License Law). 1 am aware that prool o� their Worker's Gompen5ation insurance shoultl be provitlea to me. � I am exempl untler Section B. d. P, C. for this reason Date Owner I hereby certify tnat I have read this application Info�mation is correct. I agree to como�Y with all < antl state laws relatin9 [o builtling conSVucHon, ai sentatives of tnis city to e ter upon the abovi Inspection purpos 5. Sighature ��„ /y�_� Dri�ers' License or SS � �/ above TYPEOFCONSTRUCTION LJ NEW LJ ADD LJ.ALTERATION LJ REPAIR �CONVERSION ❑ �EMOLISH ❑ OTHER DESCfiIPTION OF WORK/USE OF BLDG. TYVEOFPERMIT GRHDING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION 5�. FT. oCCUaArvCV CON STRUCTION TYPE VA�UATION $ ZONE GRADINGCU.VDS. ACRES Remarks: .�")� T"]i�� LJd!i Bar Sink f Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor prains Floor Sinks GasServ'ice Ouflets Interceptors Kitchen Sink Lavato�ies � P—Trap Roof Drains Reinspaction fae $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/FacL Blt. ICBp # Heating System & Duccing ❑ o-i oo,000 eTu O i oo,000 sr Reinspection Fee � $15 CMF 0865-46, rev. Ip/B4 White - Bu(Itling: Canary - APPlfcanh Pink - Accoun[ing; Goltlenrotl - qssessor Showers Service Sink Sewer Cap Sewer Connection Solar Collecmrs Solar Piping Solar Tank Swimming Pool w, Urinal Wacer Closet Water Hearer Water Service Auro�Wash Laundry Trays laue Fee � $ 3 A.P. # S Main Buildi E T Front B Rear A C Right K Left $ PIn9. Ref. # Planning Notes: Automatic Washer Construction Pole Sub. COoking Unit Dishwasher Dryers ❑Gas �Elec Fan F.A,U. Fixture5 Device Boxes . Outlets Switches Garbage Dispoul . Generator �P5 KW C i 0205 5/p9/80 - � Zane Accessory Building: � Parking Req./Provided ELECTRICAL _ Transformer ❑ 15�50 KW ❑ 50+KW Meter ❑up ro 100 amps Meter ❑over 100 amps Sub Panel Motors �0-1 HP � 1 h-.8 Inc.Solar �9-15 HP �16-15+ Microwave Pole Light Range Standing Sections Trash Compacmr Reinspection Fee $15 luue Fee IANICAL FEES Hood or Type I ❑ • DEVELOPMENT SERVICES REQUIREMENTS: Canopy Type 11 ❑ Zoning Approved By Building Approved By „c� Refrigeration System ❑0-700,OOOBTU ❑100,000 System ftepair/Alieretion Fire Dempers Registers Issue Fee � $ 3 14��5 TI FEES 5 3 . SUMMARV OF FEES BUILDING PERMIT $ SMtP $ PLAN CHECK S --�77�-+�—/��} PERMIT PLUMBING $ � ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRAOING $ PLAN CHECK 50% $ MICROFILM S MECHANICAL � TOTALFEE $ � �� PLAN CHECK 25% $ __ 2 O N I N G R E Q M T S CONSTRUCTION AND��PLANNING POOL & SPA . APPROVALS Permit�# Date Inspector AppROVALS Permit# Date Inspector .r 1;aTemporary Electrical�Service or Pole 52. Pool & Equipment Location 2� Soil Pipe-Undrgmd. 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. Foundationi �;_ _� 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. APPRO�UED F,OR PLASTERWG. � 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT .� 20. Rough Factory Fireplace ' APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro �� 22. Ducts, Ventilating - 71. Product Piping � Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush ,� 24. Roof Framing 73. Undergrnd.StorageTank �Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro �_ ' 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical !� 27. Frame and Flashing 76. Dry Standpipe � .. `ti i 28. Lathing & Siding . 77. FIXED SYSTEM FINAL 1; 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 'r•. 31. Plaster Brown Coat 79. FINA� INSPECTION - � �r 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED - �Y 33. Final Electric Notes: � � � 34. Final Heating & Air Conditioning -�� 35. Final Gas Pipe-Test i /�: 36. Hood or Canopy • i 37. Final Factory Fireplace ,� ' -� ( . 38. Final Plumbing � r•' ✓ i, � � ' � i. 39�. Water Service-Final ' �"' ' � - '- , " ; . 'i' •,40. GasService-Final „' ' •. � � r 41. Solar pomesticFinal � ' 'j' ; , 42. Backflow Preventer � i' ''� " � j' f • � �� . � 43. Backflow Irrigation �� ,. "� `- l f 44. Landscape Irrigation System � i �� .�" �) ��; -" �, � 45. Sound Attenuation �. `! -'� ( � i 't �46. Handicap RegulaCions i t � ' ' ' .. v � "�7 � y 47. FINAL STRUCTURE & BUILDING ' � { � .._ ' ' ,� � � - 48: Special Requirements Completed � [; . 49. Electric Release to Edison : 50. Gas Release to Southem California Gas Co i �,� �:j ' 51. CERTIFICATE OF OCCUPANCY - No. Date - � 1 Applicant to f111 In all spaees axcept tnose within heavy bortler lines ana si9n a11 apo�opriate eeclarations. CITY :COSTA MESA CON.'ST1RUCTION PERMIT PERI�(J NQ7 7� n � TRACT NO. LOT NO. UNIT NQ. Proje�ddress � �' iJ a ` ' • i �%Tµ .�T ,� � �2�.£�'J u�.�P7or%iu.t� �a'� pMlican?s Mailing Address Owner's Name ��1 ��- ��Q-«� � Phone Address Arch/Eng. License No. Address Contractor's Nama �SQ�E7�� MCG�: • �O Phone�� %j '�I Address Imailingl ��,M,�AC �17�%�A�O C' G% ii'LZ City License No. Q�ML�'�� LICENSED CONTRACTOR OECIARATION I he�eby aftirm Uat 1 am licensetl untler provision5 01 Cnarter 9(commenCinq wit� section ]000) ot Divislon 3 of the Business antl Professions Cotle, antl my license is in full torce ana effect. ucens class �+ �!� Licen o.d�—,�� Date � • 1�i - P�i Si9�ature WORKERS' COMPENSATION DECLARqT10N � I hereby aitirm that I have a certiticate ot consent to zeH-insure or a certltiwte a� Worke�s' COmpenSation Insurance, O� a certifi<tl CopY lnereof (Sectlon 3800, Lab, C.) _ Poli�y No. Company eCertifiea copy Is hereby furnishetl. Certifietl copy is flletl with the city Bulltlin9 Division. Date APPlicant EXpMPTION FqOM WORKERS' GOMPENSATION DECLARAT�ON (Th�ssection neetl noE be completetl if the permit is for one huntlretl ($300) or lezs), 1 certify tbat in tne perfo�manca Of [he work for which thl5 permR I5 issuetl I snary not employ any person in any manner so as ty become subj¢ct to [he Date �' � �'� • C�S Si9nature ' �" NOTICE: If, atter makin9 this tletla�at on, y0u oul become Subjac[ to fhe Workers' Gompensation Provisions o( the lvbor Cotle, you must /orthwltb coTply wilh SUch p�ovisiOns o� this pe�mit shall be tleeTetl. revoketl, CONSTRUCTION LENDING AGENCV 0':� I hereby affirm lhat there is a mnstructlon lentling a9enty tor tne performan<e of tne work tOr which tnis Petmil is issuetl (Sectlon 3097' Civ. CJ Lentler's Name � Leqtler'S Atltlress OWNER BUILDEH UECLARATION �' 1 hereby aftirT that I am exempt irom the CantraCtor'S License L.aw for the tollowin9 reazon (SecNon 7031.5 Business antl Pro(eizional Cotle:'Any dty or �aUnty which �equi�e5 a pe�mit to <Onstruct, alter, Improve, Oemoli5h or reDair any structure, prlor [o its issuance, also reqWres the applicanl for such permi[ to {il¢ a 5ignetl stdtement that he/sh¢ is Iicrnsetl pur5uant to tltN provlsion5 ot th� Cootractor'S License Law �Gnapter 9(commencing with Section 7000) of DiyiSion 3 of lhe Bu5ine55 antl Pro(esilons Cotle) o� thdt he/She'Is ex¢mpt the�efrom an0 Ihe ba5is tor the allegetl exemption. Any violation of Sectlon 7031.5 by any applicant tor a permit su�jecls [he apP�i<ant to a civil eenalty of not more than five huntlrea tlollars (5500). LJ I, as owner of the oroperty or my empioyees wim wages as their sole compensation, will tlo the work, antl t0e structura is not intentletl or otferetl for �le �Section 7044, Business and Professional Cotle: The Contractor'S Litense Law Ooes not appry to an owne� oi a p�op¢rty who builtls or (mprOves thpreon, antl who tloes such work himselt/herseli or through his or her own ¢rtfployees, provitletl IM1at sUch improvement5 are not int¢ntletl or offeretl tOr ule. If, howeveq tha buildinq o� improvement is Soltl wl[bin one yea� of COm- 0�4tlon, the ownm will have the burtlen of p�ovin9 he/she tlitl not builtl o� IT- �ove tor the vurpose of sale). I, as owner of the property, am ¢xClusively contractlng with li<ensetl Con- tractors to mnstruct the project Section ]044, Business antl Protessions Cotle: Tqe Contractor•s Licenze Law �oes not appry to an owner of OroPerry who builtlz or improves tnereon, antl who contracts /or such projectz with a con- tractor(s1 I�cense pursuant to the Contractor•s Licensa Law). I am aware lM1at proof of [hei� Worke�'S Compensatlon insu�ance Shoul� be p�ovitletl to rtle. ❑ 1 am exempt untler Sectlon B. & P. C. for this reason Date Owner � hereby tertify tbat I have �eatl [nIs appliwtion dntl State that tne dbOve iniormation is correct. I agree to <omply with all city antl county ortlinances antl z[ate laws relatin9 [o builtlinq constructlon, antl hereby authorize repre- zentatives ot t�is tlly to nter upon the above-mentionatl property 1or In2pection purpo s. Siqnature (/� � Date �� Drivers' License or SS � .� — TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAIR �CONVERSION ❑ DEMOLISH ❑ OTHER '�ESCRIPTION OF WORK/USE OF BLDG. TYPEOFPERMIT GRNDIrvG FOUrvDATION STRVcruaaL ❑ TENANT ❑ ELECTRICAL �PLVMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SO.FT. OCCUPANCv CONSTRUCTION TYPE VALUATION $ ZONE GRADINGCU.VDS. ACRES Remarks: LI I ll/I �Gw �%�Q1.1�1 i ii f/�� J� / � Sink Preventer Irrigation king Fountains ir Orains m Sinks Service /,� Outlets Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee � $15 Boiler Duct - Under Ground Duct � Structural Duct - Ventilating ' Exhaust System ❑ MWtiple � Firepl/Fact. Blt. IC80 # Heating System & Ductin9 ❑ 0-100,000 BTU O 7 00,000 BT Reinspaction Fee � $75 �F 0865-46, rev. 30/84 While - Bulltling; Canary - AppliGdnt; Pink - Accountin9: Goltl¢��otl - AzsesSo� Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash Laundry Trays Issue Fee Hood or Typel ❑ Canopy Type I I ❑ Retrigeration System Oaioo,000sTu ❑iao,000 System RepaidAlteration Fire Dampers Registers Issue Fee 5 3 $ 3 � . A.P. �p S Main 8uildi E T Front B Rear A C Right K Left 5 Ping. Ref. # Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit D ishwasher Oryers ❑Gas ❑Elec Fan F.A.U. Fixtures ; Gerbage Disposal Generetor,�0.5 KW Fee 8849 4/15/0: Zone Parkin9 Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100amps Sub Panel Motors DO-1 HP �1'h - 8 InaSolar �9-15 HP �76-15+ Microwave Poie Light Range Sinn Standing Sections 5 KW Trash Compactor $15 luue Fee DEVELOPMENT SERVICES REQUI REMENTS: Zoning Approved By Building Approved By /\ 41075 TI fEES $ 3 2 O N I N G R E Q M T S SUMMARV OF FEES BUILDING PERMIT 5 SMIP $ PLAN CHECK $ ��jj-- PERMIT PLUMBING $ -� .ISSUANCE $ PLAN CHECK 25% S � ENERG� P.C. $ ELECTRICAL $ GRADING $ PLANCHECK 50% S MICFiOFILM � S ��[� � MECHANICAL $ TOTAL FEE $ _71_� PLAN CHECK 25% $ __ rONSTRUCTION AND P�ANNING � � POOL & SPA . APGROVALS Perrriit.'# Date Inspector qppROVALS Permit# Date Inspector 1';�emporary Electrical,Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd � v 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. Footing; �-� 58. Electrical Conduit-Undrgrnd. 8. Foundatidn `�:-�� 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe�Undrgrn8." � 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 i.,;.r ��.-; �_. �; 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling . 69. POOL/SPA SY,STEMS FINFIL% �r��r-�. .i".) %� 19. Rough Heating & Air Conditioning � FIRE DEPT:�REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # ✓ i� 21. Ducts, in Structure 70. Underground Hydro '�r 22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oif� 23. Gas Pipe-Rough & Test 72. Underground Flush ��' . 24. Roof Framing 73. Undergrnd.StorageTank �•Gas ❑Oil � 25. Roof Sheathing � 74. Overhead Hydro ' ' "' 26. T-Bar Ceiling (Structurel) & Monocoat 75. Dry Chemical �_� 27. Frame and Flashing . ,�_, 76. Dry Standpipe� ,7 ,7t 28. Lathing & Siding 77. FIXED SYSTEM FINAL • 29. Insulation 78. FIRE PREV. FINAL � t,. �' 30. Drywall Nailing HEALTH DEPT. REQUIREMENT .� 31. Plaster Brown Coat � � 79. FINAL INSPECTION �- �% 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISS ED �'� 33. Final Electric Notes: � j' ' �� '! 34. Final Heating & Air Conditioning , � Q� y` � ` O� ,� /: 35. Final Gas Pipe-Test ��, 36�. Hood or Canopy � �u v; :n �, 37�' Final Factory Fireplace � ' �`. �� S�, ;� 38' Final Plumbing " �� ` e;� � ,:� W . r. �� r , '' '•h r� W t 39. Water Service-Final . , . 40. Gas Service-Final G �; " • � �: "; �41. Solar pomestic-Final / . � .'i.• V "• +� � ' � l .Li ��42�.� Backflow Preventer ^ ',V ' ,J ' ,^ y+� J .� 1- .l �43.�Backflow Irrigation �� !'� ✓, V �1J •-• �� 44.f Landscape Irrigation SYstem °j % ' �7 I.!! t� � S�' 1.,� :..' �• � i � � 45. Sound Attenuation � �-' 7^ 46� Handicap Regulations G � S U - ��. ' n i7 in .� 47�FINAL STRUCTURE & BUILDING „ • �' (/{� � � 48'.� Special Requiremenis Completed � � "'(/ - i! - 49: Electric Release to Edison . �` '�i 50. Gas Release to Southern California Gas Co ' e. y. 51. CERTIFICATE OF OCCUPANCY ��• � No. pate - � � � AVV��ant to fill in all soaces exeeo< <�ose with(n neavY bortler Iinei anC slgn all a00�op�late Caclarations. �CITV OF COSTA ONSTRUC�_OSN PERMIT P�9,MIT�i„ � � TRACT N0. LOT NO. UNIT NO. Project Address �' Applicant's Maili dd ess ' Owner'sName �� "�N� Phone Q Addryss Arch/Eng. License No. Address Contractor's Nam Phone Add�yss (mailin9) City License No. LICpNSED CONTRACTOR DECLARATION I her¢by a(tirm Ihat I am Ilcenietl untle� provi5lon5 of Charter 9(commencing witn sec[ion �000) of DivlSion 3 of the Business antl Professions Coae, and my I{�¢nse is in full forca antl eitect. License Class License No. Data Signature WORKERS'COMPENSATION DECLARATION ' I Itereby affirm that I have a certifitate of consent to Selt-0nsure or a certificate ot Workers' Compensation Insurance, or a certifietl coPy tnereof (Section 380p, Lab. C.) Poli�y No. Company BCertifietl copY iz nereby furnishetl. CGrtifietl coOY �5 filed wit� the city Buil0in9 Division. Dat4 Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This sectiOn neetl not be COTpletetl if thB pBrmit IS for one huntlrBtl (5300) o+ less). I Car��ty th in th pertormdnce o( t wo�k fo� hic th pe�m�t Is Issuetl, I shall not ploy ny person in any ar�ner�so to be mo subject to the Worker�ocA�od Laws of Calif r�p..0 . .� w� Date no nee: q aneqmawng inis aeaara�mn, you snowa oacome suo�eci w ena Worket5' Compensation pmNilonS Oi Ipe Labor COtl¢, you mu5t forthwith Comply with Such provislons or this permit Shall be tleCmetl r¢voked. CONSTRUCTION LENDING AGENCY I hot¢by a19rm tpat lht�e Is a const�uctiOn lentlln9 ag¢nty (or the p�fOfmance of [hn work tor wnich thls Oermit is ISsuetl (Section 3097 Civ. CJ Lender's Name Lender's AtlOress OWNER BUILDEH OECLARATION I hOrcbv aHl�m thal 1 dm aXempt irOm tha Contractor'S LlcenSC Caw t0� the roir ana [ne oasis ror �ne anegeo exampuon, qny v�oiauon o� wuu.n Il by any apP��anl for a permit subj¢Cts [he appliwnt to d tivil y ot not more than fivo nuntlretl tlollars (E500). 1, as owner o( tne property or my employees with wages as their sol9 qpenSatloO, will tlo lha work, a0tl Iho Structu/e Is not intantletl or otter¢0 taln (Section 7044, Business antl Prolessional Cotle: Tha Contractor's ens¢ Law tloes nol applY lo an owner of a property wM10 builAS O/ Improves reon, antl who aoes such work himSelt/hersel/ or through hls or he� own ployee5, providetl lhat suth imprav¢menl5 dre not IntenOetl Or Otteretl lor � I/, however, lha bu(Itling or ImprovomOnt IS soitl wlthln Ona year Of com- tion, tnc owner will have the burtlen ot provin9 �e/she ala not builtl or im- ve for tne purposo ot 5alu). I, as owner oi the prooerty, am exdusively <ontractlng with Iicensetl con- :tors lo mnstruct tho projecl (Sec[ion ]044. Businass antl Protes5ions Cotle: � Contractor's License Law does not apply to an owner of property wno Itls o� improves thn�eon, antl who conHacls lor such prOjects witn a con- :tor(s) license pursuant to the Contractor's Utense Law�. 1 am aware that ro( Of tn¢ir WOrket's Compensatlon Insurance ihoultl be pr ICetl to me. I am exerypt untlw Section �-1 B. 3 P.�C. f�ihis reason Date Owner have rea TYPE OF CONSTRUCTION lJ NEW' J AOD �7 ALTERATION LJ REPAIR � ❑ CONVER ON ❑ DEMOLISH ❑ OTHER �}- DESC IPTIO�F WORK/ E LDG „ i wv A� k7 �c�— �" t�� vti � �, s TVPEOFPERM� GRADING �LyIFOVNDATION STRUCTVRAL ❑ TENANT ❑ ELECTRICAL 1� PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ.FT. OCCUPANCV C O N ST R V CTI ON TYPE V A L UATI ON $ Remarks: Bar Sink Backflow Preventer BaCkflow Irrigation Bathtubs Dishwasher Orinking Fountains' Floor Drains- Floor Sinkt Gas Service Outlets Interceptors Kit�hen Sink Lavamries Drains Reinspaction Fee GRA�INGCV.YDS. ACRES_ $15 Duct - Under Ground Duct - Structural Duct - Ventilating Ezhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑P700,000 BTU 0100,000 anq state laws ting to ou-� nq c nit Lo , ano nereby author ze re e- sentatives ot t i i� e r u n e a ve-mentionatl erty Inspection purp Si9nature Dat - D' LI c Reinspection Fee \ CMF 0865-46, rev. 30/84 Whi(e - Builtlin9; Canary - Applicant: Pink - Acmuntln9; Go1Gen�otl - Assesso� $15 Showers Service Sink Sewer Cap Sewer.Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinel �/'/8L2f CIOSCL Water Heater Water Service Auto-Wash Issue Fea Hood or Typel ❑ Canopy Typell ❑ Refrigeration System ❑aioo,000eru ❑ioo,000eTu System Repair/Alceration Fire Dampers Reg�sters r Issue Fee $ 3 $ 3 A.P. $'+ S Main Build E T Front B Rear A C Right K Left S Ping. Ref. � Automatic Washer Construction PoleSu Cookin9 Unit ' Dishwasher DryerS ❑Gas ❑Eli Fan F.A.U. � Fixtures Device Bozes Outlels SW1�CIlCS Garbage Dispoul Generator �0.5 KW Fee Qi Parking Zone TGT �.� N 1 " N G R � E Q M , T _ S ELECTRICAL Trensformer ❑' 15-50 KW ❑ 50 + KW Meter ❑up to 100 amps Me[er ❑over 100 amps � Sub Panel Motors 00.1 HP � 1:5 - 8 Inc.Solar 09-15 HP �16-15+ Microwave Pole Ligh[ � Stonding Sections 5 KW Trash Compactor $15 Issue Fee DEVELOPMENT SERVICES REUUIREMENTS: Zoning Approved By BuildinB APvrovad By � Appliption Issued By SUMMARV OF BUILDING PERMIT $ PLAN CHECK $ - PLUMBING $ %•0� PLAN CHECK 25% S ELECTRICAL S PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK � 25% $ - - FEES $ 3 SMIP $ PERMIT ISSUANCE S ENERGY P.C. $ GRADING $ MICROFILM $ T07AL FEE $ � � CONSTRUCTION ANDPLANNING POOL&SPA �" Date Inspector Date Inspector APPROVALS Permit # APPROVALS Permit # 1.iTemporary Electrical�Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. �� 53. Steel Reinforcement � 3. Electrical Conduit Uility-Undrgmd. 54. Forms� 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding �� 5. Steel Reinforcemerit �,' 56. Rough Plumbing & Pressure Test • 6. Electrical UFER Grncl.� 57. APPROVAL TO COVER-GUNITE i 7. Footings 1 58. Electrical Conduit-Undrgrnd. � 8. Foundation {.�', 59. Gas Pipe, 0 Undrgrnd., Test r 9. Water PipefUndrgrnde� 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 71. Property Sewer Line.& House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing I 65. Electrical-Final 75. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign C 68. APPROVED FOR PLASTERING � 18. Rough Electrical-T Bar Ceiling ,. 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # ,I 21. Ducts, in Structure 70. Underground Hydro �'' 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil ' 23. Gas Pipe-Rough & Test � 72. Underground Flush � �... 24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil �' ��' 25. Roof Sheathing ' 74. Overhead Hydro �y; • ' 26. T-Bar Ceiling �StructuraH & Monocoat 75. Dry Chemical 'r � 27. Frame and Flashing 76. Dry Standpipe / •� ;i 28. Lathing & Siding 77. FIXED SYSTEM FINAL � 29. Insulation 78. FIRE PREV. FINAL �� ; J . 30. Drywall Nailing HEALTH DEPT. REQUIREMENT � /1I 31. Plaster Brown Coat 79. FINAL INSPECTION � `� t ^. �'. 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSIIED �• i�,i , 33. Final Electric Notes: � i-' +^.; 34. Final Heating & Air Conditioning f, 35. Final Gas Pipe-Test , '"�'�� 36. Hood or Canopy �' 37. Final Fac[ory Fireplace , 38. Final Plumbing 39.�Water Se�vice-Final . � ' � 40. Gas Service-Final - , 41. Solar pomestic-Final . �. , 42 � Backflow Preventer � • 43. @ack{low Irrigation ' • � ' .: . , 44. • landsrape,lrrigation System - � � � � t. � . 45. Sound Attenuation � � , �� .� �46. HandicapRegulations jj �� '•• /. 47�..FINAL STRUCTURE & BUILDING � ' ." �' „ f�.• 48r;Sp�cial Requirements Completed , ' , 49. Electric Release to Edison �, ' 50. Gas Release to Southern Califomia Gas Co ./' . 51. CERTIFICATE OF OCCUPANCY_ ' . � No. Date ' � � � • , <1 1l Applicant lo fill in all spaces except tnose within heavy Goraer Iines ana si9n all approD�iate tleclarations. CITY OF COSTA'�SA CONSTR.UCT N PERMIT PE , IT N TRACT NO. , LOT NO: .UNIT N0, • Sy0 • j 4q�.. ��3s`3t'l -Project.Address . Appiicant'sMailin Address p�• TYPEOFCONSTRUCTION rvEw nDD ALTERA7iorv REPAIR � - ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p. # Owner's Name Phone DESCRIPTION OF WORK/USE OF BLDG. Addreu Arch/Eng. Licenu No. Address Contractor'sNa el ��G� Phon � �� Addresslmailing) �� . Ciry License No. � r LICENSED CONTRACTOR DECLARATI I hereby atti�m thdt I am Iicensetl untle� rovis of C �ter 9(comm¢nNn9 with seclion 7000) o ivi5ion 3 of [h Bu5' e antl rotesslons Cy tle anC my license iz i II antl eifect � �� (� 'J Licanse s _ e No. Q !1 Date s Si9natu WORKERS' COMPENSATIQNDEC�1fjLATlm'N � 1 hereby a/firm tnat I have a certificale4/ con eii[ to self-insure or a certiticate ' o� Workers' Compensation Insurancq� or ceii'F�eG copy RI reof (Section 3800, Lab,/,F. n/�/�� J 1 Policy N ��d Comp y� ❑ Certifietl copY Is hereby iurnis tl. 1 �C¢ t Ie1tl.��=jtE$etl wlth,the C uIl }5jo/ oate p' �f� Applita � EXEMPTION FROM WORKERS O SA�I N IHRATION (This zeciion neetl not be comple[ea if th permit is for one huntlretl (5300) or Icss). I certify that in the pertorman<e of th 'work tor which this perm�t is Issuetl, I shall not employ any person in anyyinanner so as to become subject to the Workers' Compensation �aws of CaMYornia. • Date Si9nature NOTICE: 1f, afte� making [his tlecldra[iOn,.you Shoultl bCCome subject to the Workers' Compensation Orovisions of [M1e Labor Cotle, you must forthwith comply with such provisions or this permit zhall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV 1 hereby aitirm that Uere is a construction lentlin9 agency for the pertormance ot the work for which tnis permit Is issuetl (Section 3097 Civ. C.) Lentler's Name LenCer's Aaaress OWNER BUILDEH DECLARATION ' I hereby atfirm that I am exempt lrom the Contractor's License Law tor the tollowin9 rea5on (Sec[ion 7031.5 Business antl Professional Coae: Any city.or county whi<h requires a permi[ to conslruct, alter, improve, tlemolish or repair any 5[ruCture, pri0/ to It5 isSuance, alm require5 the applicant for such perTit to fil¢ a Slgnetl stalemtnt [hat h¢/Slte i5 IicenSed pursuant to Ihe p�ovisions o1 the ContraCtor's LiG¢n5C Law (Chapter 9(commencing witn SectiOn 7000) ot Oivision 3 ot tne Busines5 antl Protessions Cotle) or that ne/she is exempt .h¢�ef�om antl thG ba5is for tne all¢getl exemptiOn. Any violatiOn of $ection 7031.5 by any apP�icant fo� a Pe�mit subjects the appli<ant to a civil �enalty of not more than five huntlretl tlollars ($500). LJ I, as owner of the property or my employees with wa9es as their sole ' compensation, will tlo the work, antl [he structure is not intentled or ofteretl �� tor sale (Seclion 7044, Business antl Pro(essional Cotle:'The Contractor's Llcense law tloes no[ apPly tn an Owner Of a prope�ty who builds o� improves thereon, antl who tloes such work hlmself/herself or throuqn nis or nor own employees, provitletl that such imProvemen[5 are not intentletl or offeretl tor sale. 11, however, th¢ builtllnq or improvement IS zoltl within one year of com- pletion, the owner wlll have tM1e burtlen of proving he/she tlitl not builtl or im- �Ove Por [he purpose Of sale). LI I, as owner of the proPerty, am exclusively contractinq with Iicensed con- bactorsto const�uCt the project (Section ]044, Business antl Profe55ion5 Cotle: The Con[�actOr's LiG¢nse Law does not apply to an owne� of proper[y who huiltls or imoroves tnereon, antl wno tontracts for such projects with a con- tractor(sl i�cense pursuant to tne Contractor's License Law). I am aware that proof of lh¢Ir Wo�ke�'S Compensation insurance shoultl be prOvitl2U Io me. ❑ I am ezempt untle� Sectipn B. & P. C. fOr thi5 reason i Date x sentat imoet f state tnat the above antl countv ortlinances TVPE OF PERMIT LI GRADING U FOUNDAT�f�y LI STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PI.UMBING y� MECHANICAL � ❑ OTHER PROJECT DESCRIPTION SQ.Fr. OCCUaANCv_ CONSTRUCTION TVPE VALUATION $ ZONE GRADINGCV.VOS. ACRES_ Remarks: BarSink - Backflow P�eventer , �' Backflow Irrigation Bathtubs . � Clarifiers , . Drinking Fountains Floor Drains Floor Sinks � GasService OuNets Sink Drains Reinspection Fee $15 Boiler Duct- UnderGround Duct - Structural Duct - Ventilating Exheust System ❑ Multiple Firepl/Fact. Blt. ICBO # � Heating System & Ducting ❑ai oo,000 eru � i oo,000 qeinspection Fee CMF 08fS-46, ru�. 10/84 Whit¢ - Builtlin9; Canary - Applicant; Pink - Accountin9: GoldenrOtl - Assessor J $75 .Sf10WCf5 . Service Sink Sewer Cap Sewer Connection _ Solar Collecmrs �; Solar Tenk �J � Swiinming Pool wl: Urinai ' � IWater Closet - �-Water Heater .Warer-Service Auto-Wash Laundry Trays Issue Fee Hood or Typel ❑ Canopy Typell ❑ �i rigeration System 0.100,OOOBTU ❑1 � System Repair/Alteration Fire Dampers Registers Issue Fae I� $ 3 S Mam Bwldi E T Front B Rear A C Right K �eft S Ping. Ref. # Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit - Dishwasher Dryers ❑Gas ❑Eleci Fan F.A.U. Fixtures Device Bozes Outlets Switches Garbage Disposal � Generator O65 KW C 5�15 KW 2one Parking Req./Provided ICAL Transformer ❑ 75�50 KW ❑ 50 + KW Meter ❑up ro 100 amps Meter ❑over�100amps Sub Panel Motors �0-1 HP � 1'h - 8 Inc. Solar �9-15 HP �16-15+ Microwave Pole Light Fiange Standing Sections Trash Compactor = Reinspection Fee $15 Iuue Fee � DEVELOPMENTSERVICESREOUIREMENTS:. j� Zoning APProved By V Buildin9 Approvad By Appliqtion IssUed By � BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ E�ECTRICAL S PLAN CHECK 50% 5 MECHANICAL �$ I N G R E Q M T $ FEES $ 3 SUMMARV OF FEES SMIP $ PERMIT , ISSUANCE S ENERGY P.C. $ GRADING $ �% ICROFILM 5 � TOTALFEE lS CONSTRUCTION AND PLANNING , . POOL & SPA AP ROVALS :' Permit',�# Date Inspector qppROVALS Permit# Date Inspector � mporar ctrical5ervice or Pole I 52. Pool & Equipment Location ' i.i 2. � il Pipe-Undrgrnd. � 53. Steel Reinforcement '^� _' �cu ^. ,�: Electrical Conduit Utility-Undrgrnd. i 54. Forms _r5',�.� �t4. Electrical Conduit-Undrgrnd. , �� 55. Electrical Bonding r��w :Y? 5. Steel Reinforcement �;1 � � 56. Rough Plumbing & PressurKe„ Test � - '�-�: Electrical UFER Grnd. 57. APPROVAL TO COVER=�'iU�IITE ,� � =}. Footings . 58. Electrical Conduit-Undrgrn,'d.,,... , 'B. � undation � i� . 59. Gas Pipe, O Undrgrnd., fest�=�-� � 9.• ater Pipe-Undrgrnd. �i 60. Backwash Lines, P�Trap!.:� WSQrgmd. � � , _... �1�. Structural Floor System 61. APPROVAL TO DECK `,,�, !�f 1.1 �. Property Sewer Line & House Connection � � 62. Backwash & Recepto�-Final , 1i2. Sewer Cap � � 63. Heater & Vent-Final � . 1'�3. Roof Drains � 64. Plumbing System - Final - T.4. Rough Plumbing �. 65. Electrical-Final �15. Rough Electrical-Conduit . 66. Solar System-Finai � 16. Rough Electric Wiring � ' ' 67. Fencing & Access Approval ' . Rough Wiring Sign �f ! �� ' 68. APPROVED FOR PLASTERING - ��.' Rough Electrical-T�� Ceif+ng 69. POOL/SPA SYSTEMS FINAL � 19. Rough Heating & Air Conditioning �� • FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS � Permit# _ i �21. Ducts, in Structure �� . 70. Underground Hydro ��2. Ducts, Ventilating . � 71. Produc4 Piping O Ga5 ❑ Oil 23. Gas Pipe-Rough & Test ' 72. Underground Flush 24. Roof Framing . 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing -� , 74.' Overhead Hydro � 26. T-Bar Ceiling (Structural) & Monocoat . 75. Dry Chemical . � 27. Frame and Flashi_pg• � 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-Finab�� • . � � 40. Gas Service-Final � , - � ' . 41. Solar pomesticFinal , � . ' � �42. Backflow Preventer � . , 43. Backflow Irrigation . ' , C 44: Landscape Irrigation System . ' �.�' � ' � , ' � .45� Sound Attenuation � �' � • , " : � . �46. Handicap Regulations • " ' 47. FINAL STRUCTURE & BUILDWG , � � � � - . - . . f 48. Special Requirements Completed � � � �9. Electric Release to Edison . � 50.�Gas Release to Southern California Gas Co ' ' � 5L CERTIFICATE OF OCCUPANCY . - N0. � Date � � _ � , , � '. �.,, . ',.� ' . Applicant to fill in all ipaces eacept t�ose within neavy GorEer lines an0 si9n all appropriate tleclaratians. CITY OF COSTA ME�$G �CONST �C�Ofj� PERMIT ProjAct Address � Sd �Applicant's Mailin Address Owner's NameQ�^ hone � �% Address Arch/Eng. ' License No. Address Convacro'sNam � (CD ,r ' php e�3f� �Z Addresslma�� 7'I' ' � �� City License No. �' ,� LICENSED CONTRACTOR DECLARATION 1 hereby affirm tha[ I am Iicensetl untler provlslon5 of Charter 9(commenUng with section 7000) of DlviSion 3 of the Business antl Pro(essions Cotla, antl my license is in tu force ntl eltect. �,� C�O lJcen a " � p�/� ic�nse Na. T Date�� 519 t !� " WORK R' COMPENSATION OE RqTION I hereby aftirm tnat I have a certificate oi �onsent to selt-insure or a certificate of Wo�kers' CompenSatiOn Insutance, o� a certlfietl coOY tnareof (S^eciion �3800, �ab.�G.�, _�� V Cort�pany �—�� ' `^V Y (Polity No.� �.�_ � .❑ Certifietl co y is hereby fumishetl. �� CerY ' o y' liled with the dty B D' isi� - Date APPlicanL�� %�V�� — EXEMPTION ipOM WORKERS' COMPprySATION OECLARATION (Thi55ection neetl not be completetl if th@ per �� o� one huntlretl ($100) or less). 1 cerlify that in the pertormanc Work fo� which 1h15 perT�t i5 issuetl, I snall not employ any person any mapner so as to become subject to the Worken' Compen5a[ion Laws of Califomia. Oa[e Si9nature NOTICE: 11, after maKing this tleclatatio�, you shoultl become subject to lM1e Workers' Compensation provisions of Iqe Labor Cotle, y0u must forthwith mmply wilh such provisions or I5 permit shall be tleemetl revoke0. CONSTRUCTION LENDING NGY I hereby afflrm that tnere is constructiory lentlinq agency for the performance oi th¢ work tor whiCh this Oermit is issuetl (Section 3097 Civ. CJ Lentler's Name � Lentler's Aatlress OWNER BUILDER OECLARATION � I hereby affirm that I am exempt irom tne Contractor's Litense l.aw 1or tne following reason (Seciion �031.5 eusingss antl Professional Cotle: Any citY or county which iequires a Pe�mll to constYuct, alte�, improve, demolish o� �epair any sVucture, prior to its issuance, alSo reqWres the applicant ror such p¢rmit to tile a signetl slatement that he/she is IicPnsetl pu�suant to the prOvisions ot tne Contractor's License Law (Chapter 9(�ommencing with Section 7000) of Oivision 3 of fhe Businezs antl Professions Cotle) or that he/she is exempt (herefrom and the ba5is for Ihe allegetl ¢gemption. Any violation ot Section ]031.5 by any applicant for a perm�{ subjects the applican[ to a civil �enatty of not more than five huntlretl tlollars ($500). - I. as owner of Ihe Orope�ty o� my employees with wages as their sole comoensation, will tlo the work, antl the structure is not intendetl or otteretl for sale (Section ]044, Business anG Professional Cotle: The Contra<for's ' LicenSe law tloes not apply to an owner oi a proper[y wno builtls or improves thereon, antl who tloes such wo�k him5elf/herself o� Ihrou9h his or her own employees, pwvltletl Ihal such improveM1�ents ar¢ not In[¢ntletl or o((ere0 (o� sale. 11, however, t�e builtling or Improyement I5 soltl witnin one year of com- pl¢tion, the owner will have [ne burtlan of p�oving he/Sh¢ tlitl no[ bulltl or Im- �rove tor tlte Purpose ot sale). I, a5 owne� ot the prope��y, am ezclusivaly contracling with IiG¢nsetl COn- [ractors lo cons[ruc[ lbe project (Sectioq ]044, BuSinesS antl Profession5 Cotle: Tne COnVaCtor'S License Law does not apply to an owner ot property who builtls or improvez tneraon, antl who <ontracts for zuch projects with a mn- tractor(sl ucense pursuant to tne Contractor's License Law�. I am aware that proot o( [heir Wo�ker'S Compensatlon insurance shoultl be provitle0 to TB. ❑ I am ex¢Tpt untler Seclion B. & P. C. lor th15 reason Date state Signature CJ ' Drivers' License or 55 owner co above nances � �• �v�� TYPE OF CONSTRUCTION L�J' NEW U ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ �EMOlISH ❑ OTHER � p.p. � DESCRIPTION <tW(7QK/USE F BL G. _ •.7riLlP�.� S Main Building: E TVPE OF PERMIT G� RaDiNG FOUtaDATiON STRUCTURAL T front d TENANT ❑ ELECTRICAL ❑ PLUMBING �MECHANICAL A R¢af ❑ OTHEti C Right PROJECT DESCRIPTION 5a. FT. OCCUPANCv K CONSTRVCTIONTVPE VALUATION$ S Left ZONE GRADING CU. VDS. ACRES Ping. Ref. # Remarks: �_ �. �}} � 2�� L.� 1 Z /�� Planning Notes: Sink Preventer Irrigation Dishwasher � Drinking Fountains F�oor Drains Floor Sinks . GasService Outlets I ntercenmrs Kifchen Sink lavamries P—Trap ,Roof Drains Reinspaction Fee ! $15 Duct- UnderGround Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Fiiepl/Fact. Blt. ICBO # Heating System & Ducting ❑ ai oo,000 sTu O i oo,000 eT Reinspection Fae � $15 CMF 0fl65�46,+ev. 10/84 Whife - 6uiltling; Canary - Appliwnt; Pink - Accouniing; Goltlenrotl - Assesso� 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 laue Fea Hood or Type I Canopy Typell Refrigeration System ❑P700,OOOBTU ❑100,OOOBT System Repair/Alteretion Fire Dampers Registers _..r�n. C�O Gr luue Fae FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dry¢rs ❑Gas ❑Elecl Fan F.A.U. Fixtures Device Boxes Outlets Garbage Disposal Generator �0-5 KW �5�15 Zone Accessory Building: Z O N I N G R Parking Req./Provided � E Q aFrFiv� - , M T �' S ELECTRICAL FEES Transformer ❑ 15-50 KW ❑ SO+KW Meter LJup to 100 amps Meter ❑over100amps Sub Panel Motors OO-i HP O1 Yh - 6 Inc.Solar C]9.15 HP �16-15+ Microwave Pole Li9ht Range Sign Standing Sections � Trash Compactor $ 3 I �— Reinspection Fee $15 Issue Fee FEES G DEVEIOPMENTSERVICESHEQUIREMENTS: 2oning Approved By Building qpproved By Appliwtion Issued BV � BUILDINGPEFiM1T $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% $ ELECTRICAL S PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ $ 3 SUMMARV OF FEES SMIP $ PERMIT ISSUANCE $ ENERGV P.C. $ GRADING $ .�� MICROFILM $ � � TOTALFEE $ I � CONSTRUCTION AND�PLANNING AFPROVALS Permi ,# i 4' � 1:`.Teni�orary Electrical:Service or Pole �� 2. Soil Pipe-Undrgrnd. 3. Electrical Conduit Utility-Undrgrnd. 4. Electrical Conduit-Undrgrnd. 5. Steel Reinforcemen;_ ;^ 6. Electrical UFER Griid� 7. Footings 9j'Water Pipe-Undrgrnd. 10. Structural Floor Sysiem _ 11. Property Sewer Line & House Connectio � .A 12. Sewer CaP . !. 13. Roof Drains. 14. Rough Plumbing 15. Rough Electrical-Conduit 16. Rough Electric Wiring 17�. Rouyh Wiring Sign � }: 1�8; �Rough Electrical-T Bar Ceiling 19. Rough Heating & Air Conditioning 20. Rough Factory Fireplace 21. Ducts, in Structure 22. Ducts, Ventilating ti, 23. Gas Pipe-Rough & Test 24. Roof Framing 25. Roof Sheathing 26. T-�ar Ceiling (Structuraq & Monocoat 27. Frame and Flashing 28. Lathing & Siding 29. Insulation 30. Drywall Nailin9 31 . Plaster Brown Coat 32. Electrical Power Meter�Final . 33. Final Electric 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Tes[ 36. Hood or Canopy 37: Final Factory Fireplace 38'. Final Plumbing 39 'Water Service-Final , . � � 40. Gas Service•Final �'�� 41. Solar pomestic-Final � 2. Backflow Preventer �43: Backflow Irrigation , 44: � Landscape Irrigation System � 45..Sound Attenuation . '46. �landicap Regulations 47�..FINAL STRUCTURE & BUILDING 48: Special Requirements Completed 49: Electric Release to Edison 50. Gas Release to Southern California Gas G 51. CERTIFICATE OF OCCUPANCY � No. Date POOL & SPA Date Inspector qppROVALS Permit# 52. Pool & Equipment Location,c�� 53. Steel Reinforcement s,j . 54. Forms ' ' w.- 55. Electrical Bonding �,v: � 56. Rough Plumbing & PressurerTest ._, 57. APPROVAL TO COVER-GUNITE 58. Electrical Conduit-Undrgrncil.l 59. Gas Pipe, O Undrgrnd., TesL� ... 60. Backwash Lines, P-Trap, O Undrgrnd. 61. APPROVAL TO DECK 62. Backwash & Receptor-Final � i � 63. Heater & Vent-Final , 64. Plumbing System - Final 65. Electrical-Final . 66. Solar System-Final 67. Fencing & Access Approval ' 68. APPROVED FOR PLASTERING � 69. POOL/SPA SYSTEMS FINAL FIRE DEPT. REQUIREMENT APPROVALS Permit# � 70. Underground Hydro � 71. ProductPipingOGas ❑Oil� • 72. Underground Flush 73. Undergrnd. Storage Tank O Gas ❑ Oil 74. Overhead Hydro ,.. 1 � 75. Dry Chemicel '.� 76. Dry Standpipe , 77. FIXED SYSTEM FINAL � ; 78. FIRE PREV. FINA� - HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION � . 80. FOOD CERTIFtCATE ISSUED Notes: ' /i7/� G� i � , � :� �, i . . . ..- � :'r . �fl, . f . � � � Date Inspector � i- ' � ' '�' �_ :� - r - I., ; . _, �. . � % • . i � � ITY OF COSTA ,M��E$q�{ QCON$T_RUCQTI�N P� IT Project Address a�I 4 y�Z� �I/— --� qpplicant's ��liny Address . - Y.`_w�Ti..7w1.•._� ..._ Appiicant to fill in all spaces except those within neavy eorticr Iines an0 sign al1 apDropriate tleclarations. PERMIT NO. TRACT NO. LOT NO. UNIT NU r Arch/Eng. License No. Address Contractor's Nam � e hone � , Addresslmailing) %�OZ%2 r� Sf C��'�•^ � 4 9-�s�8 Ciry �icense No. LICENSED CONTRACTOR DECLARATION ' I hereby aifirm that I am licensetl untler provisions ot Charter 9(commen<in9 with sectlon 7000) of Divislon 3 ot tne Business antl Protessions Cotle, antl my IlcenSe is in lull torce antl effect. LicenS¢ Clas^-- 5.—_� � � �Lice e==� Date U�i-i�RYt Si9nature WORKERS' COMPENSATION 4 CLA ATION " I nereby aifirm that I have a certificate oi consent to selt-insure or a cerUficate 'oi WOrkers' COmpensation Insurance, or d Certifietl copy theteof (SeCtion 3800, Lab. C.) W<�T Rw�r.riC«ti PO�Y t�o.XW V8R'33.33 9S' CompanY �� s. (_^_.�. '� Certifietl copy is hereby turnisnetl. Certifie copy i5 filetl with the tlty�B ulltling Di sian �— Date�-�7—$g Applican+V---� � • EXEMPTION FROM WORKERS' C PE ATION DECLNRATION (This g¢��ion neetl no[ be <ompleteC it the permit is for one huntlretl (5300) or less). I certi�y [hat in the pe�formance of the work fo� which Ihis pe�m�t i5 iSsuetl I shall not employ any person In any manner so az to become zubject to t�te Workgrs' Compenwtion Laws oi California. Date Signature NOTICE: If, att¢r making this tleclaratlon, you shoultl become subject to tne Work@�5' Compensdtion provislon5 Of the Labor Cotle, yoU mu5t tortbWith Comply �yi[h such provisions Or lhis permlt shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV I Ite�eby affl�m that [here is a Cons[�uction Ientling agenCy for tlte pertormance of tpe work for which this Oermi[ Is Issuetl (Section 3097 Clv. Q) Lentler's Name Lentl¢r's Atltlress OWNER BUIIDEN �ECLARHTION . I hereby affirm that I am exampt trom tlte Con[ractor's License Law lor the ' folloWing reason ($ection ]031.5 BuSiness antl Professional Cotle: Any city or county whlch requires a Permit to cOnstruct, alter, improve, tlemoli5h or re0dir any structure, prior to its issuance, also reqWrez the applicant for such permit t0 lile a si9netl Stalement thdt ne/she I5 licensetl pursuant t0 Ne p�ovisio05 of , t�e Contractor's License Law (Chapter 9 �commenUng with 5ection 7000) of ;;�AJivision 3 of [he Business antl Protezsions Cotle) or that he/zhe is ezempt �': y�ere/rom antl the basis for the alle9etl exemption. Any viola[ion of Sec[ion ��;%031,5 by any applicant f0� a pe�mlt Su�jects the appliCant to a civll � Qenalty of not more [han (ive nuntlretl tlollars (E500). LI I, as owner of [he property or my employeez with wa9e5 as [hei� sole compensation, will tlo the work, antl the structure is not intenCetl or ofteretl tor Sale (Section ]044, Business and Professional Cotle: The Contractor's License Law does not apPIY to an owner of a property who builtl5 or improves thereon, ana who Ooes such work himseli/herself or throu9h his or her own employees, providetl tnat such Improvements are not intentlatl or offeretl for sale. If, M1owev¢r, the bulltling or Improvement is soltl within one year of Com- pletibn, the owner will have the burtlen Of proving he/she tlltl nOt builtl or irt�- provb �or the purpose ot sale). ❑ I, as owner ot tM1e property, am ezclusively contracting wlth Ilcensetl con- Vactors td mn5t�uct the projec[ ($eCtiOn 7044, Business an0 ProfesSions Cotl¢: The ConVactor's License Law tloes not apA�Y to an owne� ot property wbo builqz or Imoroves thereon, ana who contracts for such projects witn a con- tracior(S I�cenze pursuanf to the COntracto�'S License Law). I dm aware [hat p�oo( o� thei� Worker's CompensaHon insurdnce shoultl be provitl¢tl IO me. ❑� am exempt untler Section B. & P, C. tor this reason Date Owner . I hereby Rrtify that I have reatl in/ormation i5 CorrecL I agree t0 c antl rtate laws relatinq to builtlinq 5¢O[dtiVBS 01 IhiS CItY f0 En�ef $ignetu�e OrivGrs' L n5e or CMP oe65-a6, �ev. lo/ea a TVPEOF ON3R�Tt� NEW ADD LTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER 7-^ p, p# DESCRIPTION OF WORK/USE OF B�DG. T..l� - S Main Building: TVPEOFPERMIT GRADING ❑FOUNDATION STRUC7URAL T Front ❑ TENANT ELECTRIG0.L ❑ PWMBWG ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION SQ,FT. OCCUPANCV � C Right K Left CONSTRVGTIONTVPE VALUATION$ $ ZONE GRADINGCU.VDS. ACRES PIng.Ref.# Remarks: Q'� '� Q�� Planning Notes: Sink <flow Preventer cflow Irrigation Drinking Fountains Floor Drains FIOOf $if1k5 Gas Service Outiets Interceptors' Kitchen Sink Lavarories • P-Trap � Roof Drains Reinspection Fee $15 Boiler �uct - Under Ground Duct - SVucturel Duct- Veniila[ing Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑aioo,00a sru Oioo,000 _ oate f -2i -�� T ReinSpectiOn FBB � $15 Whife - Builtling; Cana�y - APplica�l; Plnk - Accountin9; Goltlenrotl - As5es50r Showers Servite Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash Isue Fee Hood or Type I ❑ Canopy Type II ❑ Refrigeration System Oa�oo,000eru Oioo,000 System RepairlAlteration Fire Dampers Registers Issue Fee $ 3 $ 3 9470 4/27/Bb ZOne Accessory Builtling: Perking lieQ./Provided ELECTRICAL . Auromatic Washer Transformer ❑� 15-50 KW Construction Pole Sub. � 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher ( Meter �er100amps Dryers ❑Gas C lectric Suh Panel �C�r- Fan Motors HP 01'/:•- 8 F.A.U. � � Inc,Solar �9-15 HP i]16-75+ Fixtures Device Boxes Outlets Switches Garbage Disposal Generotor �0.5 KW 05-15 KW Microwave � Pole Light Range Sign ' / Standing Sections Trash Compactor � Reinspaction Fae - �$15 � ' luue Fee DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved By Building Approved By Application Issuad Bv �' SUMMAHV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING S ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ �,�I.3O GRADING $ PLAN CHECK 50% $ _ �Q.I � .MICROFILM $ MECHANICAL $ TOTALFEE $ PLAN CHECK z5% $ 219045 Tl FEES 3 2 O N I N G R E � M T $ r � � • ' ' POOL & SPA ;CONSTRUCTION AND PLANNING �' C i-' C� i .) ��' Date Inspector Date Inspector 'APPROVALS Permit#_i_� ��) � �• ��4��.%�P?ROVALS Permit# 1, 7.. Temporary Electrical'Service or Pole "+ 52. Pool & Equipment Location 2:��Soil Pipe-Undrgrnd. "� 53. SteBl.Reinforcement . 3. Electrical Conduii Utility-Undrgrnd. 54. Forms � 4. Electrical Conduit-Uniirgrnd. 55. Electrical Bonding � . i 5. Steel Reintorcement._� � 56.�fiough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57='APPROVALTO COVER-GUNITE 7. F,00tings j�} 58. Electrical Conduit�Undrgrnd. 8. Foundation . � 59. Gas Pipe, O Undrgrnd., Test 9. Wat�_�Pipe-Undrgrnd�1•;: � 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK � 11. Property Sewer Line1&�iouseConnection 62. Backwash & fleceptor-Final 12. Sewer Cap � � 63. He�er & Vent-Final 73. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. ElectriC31-Final . 75. Rough Electrical-Conduit 66. Solar System-Final i 6. Rough Electric Wiring S a , �67. Fencing & Access Approval 17. Rough Wiring Sign ' � �$. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL � n 79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ;r' 20. Rough Factory Fireplaca APPROVALS Permit # 21. Ducts, in Siructure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush �� ;� 24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil �" 25. Roof Sheathing ' 74. Overhead Hydro . n� 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ' ' 27. Frameand Flashing 76. Dr Standpipe �N Y U �I 28. Lathing & Siding 77. FIXED SYSTEM FINAL � j�� 29. Insulation � 78. FIRE PREV. FINA� rr �i 30. Drywall Nailing �, HEALTH DEPT. REQUIREMENT � 31. Plaster Brown Coat i FINAL INSPECTION _� [� � 32. Electrical Power MeterFinal g ' . FOOD CERTIFICATE ISSUED �� 33. Final Electric otes: �^ � 34. Final Heating & Air Conditioning Ii' 35. Final Gas Pipe-Test '� i 36� Hood or Canopy r- L �l ,� 37.. Final Factory Fireplace . ` �� y�- 38� Final Plumbing , • � " , + ` � f .•:.'1 39. WaterService.-Final �. ( J� � /�Y: �: ;i, � '� . r,, ' � 40. Gas Service-Final � if '�•. . � � � r j� �� r� r� I� � �•41. Solar pomestic-Final j � �' .� �y `� 1�' � „ .' :42. Backflow Preventer � i �' , � ; � � 3. �y. � i ,✓1 �: 43. Backflow Irrigatiort � i � � � � �r!= � --"' '" t i ,�� ' 2 7s "44. Landscape Irrigation System '� „ '' ' � ' (1� L.1 r i 45. Sound Attenuation ' .� /"' -�, _,n�� '� -- ''r � • 46. �Handicap Regulations ; r� �' "G ; �J; - : i�,,! 47. FINAL STRUCTURE & BU�LDING ! �`' ' '�' % � � �L '� .I� ..�' ' (. t nl� 48. Special Requirements Completed `'' ^^ 'ti' ' '. ! � ._.' ; � I �l � 49-Electric Releaseto Edison � "t : ' " ? � .�r � �' 50. Gas Release to Southern �alifomia Gas Co � .� � �.� . 5i. CERTIFICATE OF OCCUPANCY � i No. Date � � , _ •.t . , \ , .._- - -- . �'`✓ � � l Aoolicant to lill in all soaces axceD< <�ose within heavy Eoreer Iines ana si9n all aDPropriate avclanHons. CI7Y OF COSTA n�ESA CON$TRIJCTION/PaMIT Projec[ Address �� 9�� cQsr�o r ra (�'., Applicant's Mniling Address Owner'sName � �� Phone Atldress Sa �+'t � Arch/Eng. License No. Atldress CAntractor'sNam < < Phone� �6 Atldiess (mailing) � � ^ City License No. 2 �i LICENSED CONTRACTO DECLARATION I he/eby affl�m thal I am licensetl untler provlsiOni o/ Charter 9(commencing wlth zection 7000) of Division 3 0l tha Business antl Prote55ions Cotle, antl my II<ense is in tull torte a tl eHect. License asi ' �ce No Dgte Stgnatura WORKERS' COMPENSATION D AR TION I hereDy atfirm that I have a cer ' i te o consent [o selt-insure or a certiticate ,of Workers' Compensdtion In nce, or a certifietl pY �eYeof (Section 3800, Lab. CJ �l2�/� �� C� �g POIi<y N . � Compdny J� fietl copy IS h¢reby tumisnatl. �% //A , Certi� copy Is til¢a with the city B i" B vls t �/J' p � Oate APPlicant 1 '�'�� EXEMPTION FROM WORKERS• C NS �ON DECLARATION (This section neetl mt be completetl f e par (t is for one �untlretl (SI00� or lezs). � cert{ty [hat in [h< perto�mance of the wo�k fo� whlch thii pe�T�t i5 issuetl, I s�all not employ any perzon In anY manner so as to become subject to tha Workers' ComOensation Laws ot Califomla. Date Signatute NOTICE: It, after making this tleclaratlon, you snoultl Decome subject to tha �'/olkefs' COmDenSdtiOn provlslon5 ot [bG Ldbor Cotle, y0u mu5[ foflbwith comply wltn such provizlons or this parmit sna11 ee tleametl revoketl. CpNSTRUCTION LENDING AGENCV � neraby attirm that [�ere Is a construction lentling agancy for the performanca .of tbe wark tor which this permit is issuetl (Section 3097 Clv. C.) Lantler's Namo lenaer's aaaress OWNER BUIL�ER OECLARATION I h9reby alfi�m that I am exempt trOm [ha Con(raclor's Llc¢nse Law for tne �ollowin9 reason (Section 7031.5 Businass antl Prole55ional COEe: Any city or County �+�iCh taqUlraS a plrmit t0 canStrutt, after ITprovo, demoll5h ot repalr ..., ...�n�.. n.in. m uc iczuance_ alm reauires t�e aool{canl lor Such p¢�mll �eralrom antl the basis tor tbe alle9ea axompUon. qny vioianon o� xcoon )31.5 by any appll<an[ fo� a Permit sub/ects tbe aDP��ant to a dvll y.e.,nalty of not more than five nuntlretl tlollars (5500). lJ I, as ownor oi t�o oroperty or my emo�oyees with wagos as thalr sola tompenzatlon, will tl0 lho work, an0 the struclura Is not InlenCetl or oiteretl (or saln (Secllon 7044, Business antl Professional Cotle: The Contractor'S Lic¢nsa Law tloes not apply to an owner o/ a property who bulltls or improves t0oreon, antl who tloes SucP work �Imselt/bersBl� m tNou9b AIS or ber own empl0y ¢es� provlGetl that Sutlt ITP�ov¢ments a�e nOt Inl¢ntleE Or otta�etl (O/ sale. H, howov¢r, the bulltling Or Improvoment i5 soltl wi[hln One yCar of com- D�eUon, the owner wlll nave [ha burtlen oi proving ne/she tlitl not bullG or Im- pfOVe torthe purpo5a o� Shce). ❑ I, ds ownar ot t�a O�aGe�ty, am exc1u51vely cont�aCting witn Iicentea con- t�act0/5 to con5trucf t�a p/alect ($ection J04d, 8usiness antl Protasslons Gotle: Tno ConVactor's �icensa Law doe5 not appty to an ownnr of proparty who bulltlz or improves thereon, antl who contracts lor sucn projocts with a con- tractor(zl Iicense Pursuant to the ConVactor's Licanze Lawj. I am aware that pro01 0( t�elr Worke�'s Compensation iOsu�anG! ihoultl be prOvitletl t0 ma. ❑ I am exempl untler SecUon B. & P. C. for lhis reason Date Si9nature Orivers' L CMF 0865-4E r Owner that I have reatl [nis application anU state lhat [ha a0ovo �.ece_ I aaree to comolv with all tltv antl countv oralnances � 338 S TVPE OF CONSTRUCTION • NEW ADD ALTERATION REPAIR ❑ CONVERS�ON ❑ DEMOLISH ❑ OTHER p,p.q� DESCRIPTION OF WORK/USE OF BL�G: S Main Buildi E TVPEOFPERMIT GRHDING FOUNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Reaf ❑ OTHER C Right PROJECT DESCRIPTION S�.F7. oCCVPANCV CONSTRUCTIONTVPE VALUATION$ 7OO g Left ZONE GRADINGCU.VDS. ACRES ping,Ref.� Remarks: � /' � � _� . .., n � _ _ /. Plannin9 Noies: Sink Preventer IrrigatiOn Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories Roof Drains Reinspaction Fee $15 Bailer Duct-UnderGround Duct - Ventilating Exhaust System ❑ Multiple Pirepl/FacL Blt. ICBO # Heating System & Ducting ❑ ai oo,aoo sru � i oo,000 � Date� ��!O Reinspec[ion Fee o S� � 10/H4 Whii¢ - Builtling; Canary - Applicant; Plnk - Rccountln9: GOItlBn/otl - AsSessor $15 Showers Service Sink Sewer Cap Sewer Connettion Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Claset Water Heater Water Service AULO-WBSII Isue Fee Hood or Typel ❑ Canopy Typell ❑ Aefrigeration Syz[em ❑aioo,aoosru ❑ioo,000 System Repair/Alteration Fire Dampers Registers Issue Fee FEES S 3 $ 3 Automatic Washer ConstruCtion Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device 8oxes Outlets Switches Garbage Disposal Generetor �0.5 KW �5-1 Zone Acceuory Parkin9 ELECTRICAL , Transtormer ❑ 15-50 KW ❑50+KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors 00.1 HP � 7 y- 8 IncSolar 09�15 HP �1675+ Microwave Pole Light Sign Standin9 Sections S KW Trash Compactor � Reinspection Fee �$15 � � Issue Fee DEVELOPMENT SERVICES RE�UIREMENTS: Zonine Approved By � Building Approved By � Appliration laued By- FEES $ 3 Z O N I N G R E � M T S SUMMARV�OF FEES . /{ � BUILDING PERMIT $ ��_i SMIP $ v � PLAN CHECK $ PERMIT PLUMBtM1IG $ ISSUANCE $ PLAN CHECK 25% 5 ENERGV P.C. S ELECTRICAL $ GRADiNG S � PLANCHECK 50% $ MICROFILM $ _� MECHANICAL $ TOTALFEE $ �1 - PLAN CHECK 25% $ dl CONSTRUCTION AND PLANNING � qpPROVALS Permit # 1. Temporary Electrical Service or Pole z, Soil Pipe-Undrgrnd. " 3. Electrical Conduit Utility-Undrgrnd. 4. Electrical Conduit-Undrgrnd. 5. Steel Reinforcement 6. Electrical UFER Grnd. 7. Footings ' > �� 8. Foundation -- L �- � 9. Water Pipe-Undrgrnd. 10. Structural Floor System 11. Property Sewer Line & House Connection 12. Sewer CaP . 73. Roof Drains � ' 14. Rough Plumbing 15. Rough Electrical-Conduit 16. Rough Electric Wiring 17. Rough Wirfng Sign 18. Rough Electrical�T Bar Ceiling 19. Rough Heating & Air Conditioning 20. Rough Factory Fireplace ' 21. Ducts, in Structure . '22. Ducts, Ventilating . 23. Ges Pipe-Rough & Test 24. floof Framing 25. fioof Sheathing , 26. T-Bar Ceiling (Structural) &'Monocoat 27. Frame and Flashing 28. Lathing & Siding 29. Insulation 30. Drywall Nailing 31. Plaster Brown Coat 32. Electriral Power Meter-Final 33. Final Elearic 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-Finat 47. Solar pomestic-Final � i 42.. Backflow Preventer F- •i "43•. Backflow Irrigation '44.`,�Landscape Irrigation System 45. Sound Attenuation �.. 46. Handicap Regulations , ✓ 47. FINAL STRUCTURE & BUILDING 4$' Spefiai Requirements Completed , �49:'Electric Release to Edison ' 50. Gas Release to Southern California Gas Co 51. CEFTIFICATE OF OCCUPANCY Date Date n i 0 0 ' POOL & SPA Inspector qPPROVALS Permit � ; 52. Pool & Equipment Location � 53. Steel Reinforcement 54. Forms 55. Electrical8onding 56. Rough Plumbing & Pressure Test , 57. APPROVAL TO COVER•GUNITE 58. Electrical Conduit-Undrgrnd. � 59. Gas Pipe, O Undrgrnd., Test . 60. Backwash Lines, P-Trap, � Undrgrnd. 61. APPROVAL TO DECK 62. Backwash & Receptor-Final ' 63. Heater & Vent-Final 64. Plumbing SYstem - Final � 65. Electrical-Final _66. Solar System-Final 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT � .� APPROVALS Permit # 70. Underground Hydro � � 71. Product Piping O Gas ❑ Oil 72. Underground Flush �' ' 73. Undergrnd. Storage Tank� O Gas ❑ Oil . 74. Overhead Hydro � ' • 75. Dry Chemical ' �" � 76. Dry Standpipe .i� " .� 77. FIXED SYSTEM FINAL' ' 78. FtRE PREV. FINAL � � Date � Inspector � � � 2' ,2 � HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION � y 80. FOOD CERTIFICATE ISSUEO Notes: � ��. I �f l City of Costa Mesa Development Services Department Building Safety Division P. O. BOa 1200 — Costa Mesa, California CERTIFICATE OF OCCUPANCY No. OOC��JO The Building located at 590 Y3ES"P 191'H 57`tZF:EP has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group Fi-2 Occupancy. Use of Building OFEIC� ' S7U2c Legal Description 422-141-19 (See reuer5e side for Metes and Boundsl Buitding Permit No RP-1S�91 Electrical Permit No. F 15A1(1 Plumbing Permit No. TaP-15'i91 Mechanical Permit No. Number of apartments and/or guest rooms ISSUED TO: Building Official �i /� . ( .X�� _ j� NA7'172�SS bY � / C ` � !�• YL6 1600 DOVE ST. ;P330. [V'c:v�]P(]iZT SEACEt. C'A. �/�� L/9�// �T Y This Certificate of Occupancy SHALL BE pbsted in a conspicuous plaoe on the premis�es and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CnnF 1o15-a6 rev. 1/83 White - Owner; Cav��• - Numerical Fi�e; Pink � Bldg. Permit Fila Applicant to fill in all spaces except tnoza within heavy bor0er lines anE si9n ali apOropriate tleclarations. :iTY Of COSTA MESAf� CO�N�$] TRUCT�QN�PE/RMIT. PERMIT NO. _ TRACT NO. ,�O,LNO, �,.r UNIT NO. Project Address ��/ yS�I� rr� � 7riCL� ' ApplicanYs Maili�n Ad/d1ress ' Owner's Nam ��.t Phon� S J� Addreu ��Qv ildyG _ t S//i/c 330 �� Arch/Eng. License No. Address — ContractoR's Nam . , d Phone �'� Address (mailing) d � ��T t0� Ciry Ljcense No. LICENSED CONTRACTOR DECLARATION � 1 hereby affirm that I am licensetl untler provisionz oi Charter 9(mmmencing with section 1000) oi Division 3� of the Business antl Profeszions Cotle, antl , my license�is i II tor,e antl•e ct. I ,,�' , r�j License Class Li ns ��'�`"� � � � Date � Si9natu�e � WORKERS' COMPENSATION DE LARATION ' hereby affirm that I have a certificate ot consent to self-insure oi a certificate ' Workers' Compensation Insurance, or a cer[ifietl copY thereoT (Section .800,'Lab.- . -' ' ' Policy No. Company eGertitie cq¢ y is h§� �by umisnetl. ' ' � Cer[ifjlyy(yy js yl h the cit �iltg D'" f�� —, EXEMPTA�.IN FRO'M WQRKERS' COMPENSRTION DECLARATION (Thiz section neee'not 1�! com0�etetl i( the permit is for one huntl�etl ($100) o� - less). / 1 certify that in Ne Pdrtormance ot the work for which this perm�t is issuetl, I. shall,-not employ any person in any manner so as to become subject to the ' Workers' Compensation Laws of California.�, , Date Si9nature NOTIGE: If, after making this tleclaration. You shoultl become subject to the . Workers' Compensation provisions ot the Labor Cotle, you must �orthwith comply -with such p�ovl5ions or thi5 pe�mit shall beftleemetl revoketl. CONSTRUCTION LENDING AGENCV � � I hereby a(firm that there is a mnstru<tiOn lentling agency'fo� the perfo�mance of the iwork far, wh'<h this permit is issuetl (Section 309� Civ. CJ LenEer's Name � . Lentler•s AtltlreSs � � ' . _ ON/NER BUILDER DECLARP.TION�� ' - � '� ' I hereby af(irm that I am exempf trom the Contractor's License Law for the � foilowing reason (Sectlon 7031.5; Buslness antl Professional Cotle: Any city or county wM1ich requires a permit to construct, alter, improve, tlemolish or'repair � any structure, prlor to ics issuance, also requires the applicant tor�such�permit -to tile a� signetl sW[ement thaLhe/she is licensetl pursuant to the provisions ot the Contractor's License Law (Cnapter 9(commencmg with Sectlon 7000)bt. Olvision 3 of the Busine55 antl P�ofe55ionz Cotle) o� that hE/She is ezempt nereiroin and the basis tor the allegetl ezemplion. Any violation of Section .'03LS .by any. applicant for-a permit subjects the applicant-to a civil �nalty ot not more than five huntlretl dollars ($500).' LJ I, as owner of the' property or my employees with wages as their sole mmpensation, will tlo the wo�k, antl the sVucture i5 nOt in[¢ntle0 or of!¢retl tor sale (Section 7044, Business antl Professional Cotle: The Contractor's � Licenu law tloes not apply [� en owne� ot a property who builtls or imProves ' thereon; antl. who tloes such work'himselt/herseli or through his or her own ' employees, provitletl that such improvements are not intentletl or oReretl tor sale. If„howeveq the �uiltling cr imOrovement is soltl within one year of com- pletion, the owner wlll have tM1e burtlen of prOving h¢/She tlitl not builtl or Im- �/Ove tot the pu�pose of sale). ' I, as.owner of the property, am excluslvery contracting with licensetl ton- tractorsto consVuct tne proj¢ct (Section 7044, Busine55 antl Protessions Cotle: . The ConVactor's License Law tloes not appry to an owner of pro0erty who -builtls or imDroves tnereon, antl who contracls for such orojects with a mn- Iractor(51 license pursuant to tM1e Contractor'S Litense Law). I am aware tbat ptoot of their Wo�ker'S Compensation insu�ance shoultl be provitl¢tl to me. � ❑ I am exCmpt unGer $ection , 8. & P. C�or IhiS reason Date Owner I.J 11 --� �-+ l � L ' - TVPE OF CONSTRUCTION NEW AD� ALTERATION REPAI R ❑ CONVERSION ❑ DEMOLISH ❑ OT A.P.# `LZ- DESCRIPTION OF WORK/USE OF BLDG. �'A� � S Main Building: E TVPEOFPERMIT GRADING ❑FOUNDATION STRUCTVRAL T Front � - ❑ TENANT ❑ ELECTRIGAL ❑ PLVMBING ❑ MECHANICAL B'Rear ❑ �OTHER . . - A , , PROJECT DESCRIPTION 54. FT. o�� oCCUPANCv � C.Right • �.�,/� K CON STRUCTION TYPE .�ATION $_r l X AJ 5, L¢ft ZONE GRADING CU.YDS. ACRESct— p��y, Ref. # � Remarks: , �/� / � / n �-, . / Plannina Notes: � Sink kflow Preventer ' kflOw Irrigation � itubs ' ;�:o.. . Drinking Fountains � , Floor Drains Floor Sinks ' � GasService � Outlets� . Interceptors� ' � Kitchen Sink ' � , ' Z ,Lavatories- � � -, ' "Reins�ctian Fee�•. $15 � Boiler , . � � Duct - Undei Ground DUct-$tructurel ' Duct- Ventilating • Exhaust System ❑ Multiple ❑ Firepl/Fact'BIL ICBO # Heating System & Ducting ' I hereby.certiry that 1 have reatl tnis appliwtion antl state that the above ❑0.100,000 BTU �700_0006T intormation is correct. I aqree to comply with all city antl county ortlinances antl. state laws relatinq to builtling construction, antl hereby authorize repre- � sentatives of this cit to entery pon Ihe aJ� ove-mentlonetl ,pro0erty for ' in5pection purpose� /�J n� // ��/ Si9nature L//a.0 1( � oate�� Drivers' �icense or 55 � // ' Reinspection Fea CMF0865-46,rev.4/84 White-Builtling; Applicanh-Pink -Accounting; Goltlenrotl -Assessor $75 ShOwers Service Sink � Sewer Cap � Sewer Connection Solar Collectors' Solar Piping � � SolarTank _,� Swimming Pool w/Spa; Urinal Water Closeti � Water Heater Water Service Iwue Fee � i Fiood or Type I ❑ Canopy Typell ❑ Refrigeration System . � ❑0-100,OOOBTU ❑700,000 System Repair/Alteration ti laue Fee FEES L Automatic Washer ' Canstruction Pole Sub. Cooking Unit � : Dishwasher - ' Dryers ❑Gas ❑Electric Fan' ' F.A. U. Fixtures Device Boxes ` � Outlets ' ' . � 8727 9/24/84 11`, — � Zone Accessory Building: ' ' 2 O � N I N _� G . R Parking Req./Provided - E� Q - M - T S. ELECTRICAL � �FEES �. swimnes� . .= Garbage�Disposal`;� '� ' � Generatoi �0-5 KW �5-15 KW � �r r , , r ;: /% . ' / ' . .J . $ 3 FEES $ 3 v $15 - DEVELOPMENT�SER�V\I�C/E' � Zoning APProvedrBY Lr�� Building A{iproved 6y� _ -f � Transformer_.� 15-50 KW_ � � 50+KW Me[er ❑up to 100 amps Meter ❑overi00amps Sub Panel ' Motors OO-1 HP O1'/: -,8 Inc.Solar109-15 HP 0'16-15+ Pole Light ' . Range i Sign Standing Sections � Trash Compactor • Issue Fee � $ 3 JTS: .,_._ 9_ /9- ' � - SUMMARV OF FEES BUILDWGPERMIT. $ �Ie.�Jd SMIP • $ �•� . PL.AN CHECK $ 3�• � Z� �PERMIT � PWMBING , $ / 5-00 ISSUANCE $ , PLAN.CHECK- 25% $ � •OO ENERGV P.C. $ ELECTRICAL � $ GRADING $ �!PIAN CHECK 50% $ ' MICROFILM $ , MECHANICAL $ TOTAL FEE $ �� •�2 �PLAIJ CHECK z5% $ � � � CONS7RUCTION AND PLANNIiVG , �APPROVqLS Permit# � � Date � 1. Temporary Electrical Service or Pole „ f. � . � . 2. Soil Pipe-Undrgrnd. �� r,� . 3. �Electrical Conduit Ut�y-Undrgrnd. i 4. Electrical Conduit-U rgrnd. ,�' 5. Steel Reinforcement•,,. 6. �Electrical UFER Grnd. � . " � 7. Footings i � 8. �Foundation � � � F �, 9. Water Pipe-Undrgmd. �'�j '� 4 � ' i0. Structural Floor System ' . 11. Property Sewer Line'& House Connection ', � , 72. Sewer Cap 13. Roof Drains 14. Rough Plumbing � C�' p 15. Rough Electrical•Conduit � � 16. Rough Electric Wiring 17. Rough Wiring Sign . 18. Rough Electrical-T Bar Ceiling 19. Rough Heating & Air Conditioning . 20. Rough Factory Fireplace Zl. Ducts, in Structure 22. Ducts, Ventilating 23. Gas Pipe-Rough & Test . 2C. Roof Framing 25. Roof Sheathing 26. T-Bar Ceiling (Structural) & Monocoat 27. Freme and Flashing �� 28. Lathing & Siding �� 29. Insulation 30. Drywall Nailing � o � b 31. Plaster Brown Coat 32. Electrical Power Meter-Final 33. Final Electric 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy � ,' 37. Final Factory Fireplace 38. Final Plumbing � �p�/ 39. Water Service-F.inal � 40. Gas Service-Final ' ' 41. Solar pomestic-Firial 42. Backflow Preventer ' 43. Backflow Jrrigation . . . � 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 0. Date ! � '. i: i* � 0 POG . SPA _ Inspector pppROVALS Permit# 52. Pool &'Equipment Location � � � 53. Stee�l Reinforcement ' , 54. Forms , - 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVAL l'0 COVER-GUNITE 58. Electrical Conduit-Undrgrnd. - 59. Gas Pipe, O�Undrgrnd., Test • ' � 60. Backwash Lines, P-Trap, � Undrgrnd. 61. APPROVAL TO DECK 62. Backwash & Receptor-Final � 63. Heater & Vent-Final 64. Plumbing System � Final ./B/i � 65. Electrical-Final . - 66. Sola} System-Final � 67. Fencing & Access Approval . 6S. APPROVED FOR PLASTERING � 69. POOL/SPASYSTEMSFINAL FIRE�DEPT. REQUIREMENT APPROVALS Permit # � 70. Undergrourid Hydro 71. Product Piping OGas ❑Oil 72.-Underground Flush 73., Undergrnd. Storage Tank O Gas ❑ Oil 74. Overhead Hydro 75. DryChemical 76. Dry Standpipe ' 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL � HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED (�Ot¢5: 7� 2]-tlY //n 4,��iiA w. n i' Date � Inspector � i _ . CITY OF'COSTA ProjEct Addres�_ APplican['s Mailing Aoolicant to fill in all sDacas axceot tnose wltnin heavy Goraer iines an0 sign all aDPropriata aeclarations. PERMIT ��„�E�..,. � I O ,...,..� �.... �.,....,. �� . �— TVPEOF�ONSTRUCTION NEW ADD ALTERATION REPAIR �/ ❑ CONVE0.510N ❑ DEMOLISH ❑ OTHER � l�hon�,�bY DESCRIPTION OF WORK/USE OF BLDG. ArcNEng.- LicenmNo.� �� Address Contractor's Nam T`L�G�rV� E �0�"}� Pnone s�"�170 Addresslmailing) �T�� - � Ir�1{'�( qZ7� Ciry License No. �� j� LItENSED CONTRACTOR �ECLARATION ' I nereby af(irm that 1 am licensetl untler provislons of Charter 9(commencing w�th seclion 7000) o/ Division 3 of lhe Business antl Protessionz Cotle, antl my Ilcense is in t �(orc antl effect. � LiCens Clas LI[e se No. Date� Si9nature WORKERS' COMPENSATION DECLARATION I hereby aifirm that 1 have a certifitate of consent to seH-Insure or a Certi(iCate of Workers' Compansa[ion. Insurance„ or_ a<ertifietl copY t ereof (Section 3800, Lab. F. ,�1 g.�.(�/_ R Po��cy No. ��N_,.._�?:-��" Ompany `� � — BCertifletl copy li hereby furnistied. I` Certi ' c y is 1 ith tne citY B i on �� Date Applitant � EXEMP ON FROM W RKERS' COMPENSATION D LHR TION (This section neetl not be com0letetl If Ihe permit Is for one huntlretl (y100) or less). I Sertlty that in the pertormanca ot tne work for which this permk is�issuetl, I sh811 no[ employ any person in any manner so as to become subject to the WOrkers' Compenwtlon Lawi of Califomia. Date Signature N4TICE: If, atter making this Oeclaratlon, you shoultl become zubject to ihe WO�ke�s' COmpenSa�ion provi5lon5 of tlte Ldbo� Code, you must torthwlth comply with such provisions or this permit shall be tleemetl rovoketl. LONSTRUCTION LENDING AGENCV I hereby affGm that tnere is a construction lentlfn9 a9ency for tne pertormance of the ,work }ot which thiz permit is isSueC (Section 309] Civ. C.) LenEer's Name- Lentler's ACtlress OWNER BUILDEH DECLARHTION--�� I hereby affirm that I am exempt from the Contractor's License Law tor the r..u....,:.... .e��.. ru��inn �n91 S Rucine<c antl Prnfeitinnal Cotle: Anv citv ol a permit to cons[ its issuan<e, also �nt tnar M1e/she Is rom antl the ba5is (or the alleg 5,by any applicant fo� a Pe y of not mo�e �han five hun0�e< a2 owner o( the property o� ;nsatlon, will tlo the work, anE ec (Section 7044, Business an 01 to mse law tloes not apPly to an owue� v�ov=� v reon, antl wno tloes Sutb w0/k himself/her5elt or �hrOu9h his Or h¢� own oloyees, provitled tha[ such improvemenls are not in[entletl or pffered for �. If, however, lha builGin9 cr {mprovement I5 soltl within one year ot com- �.ion, tne owner wtll �avE Ne burtlen of proving ne/she tlltl nof builtl or im- va for the Ourpose of sale). I, as owner of the property, am exUusivety contracting with Iiconsetl con- :torsto construct the project (Section 7044, Buziness antl Protesslons Cotle: : Conlractor's License L,aw does not apply to an owner of property who las or imvroves thereon, anA who contracts ror such projects with a con- :tor(s1 Ilcense Oursuant fo the Contractor's Li<ense Law). I am aware that of of Iheir WOrke�'s Compensation insurance shoultl be provitletl to me. 1 am ezempc unaer Section B. & P. C. tor this reason Oate Owner that I have reatl thfs appllcaUon-ana state that the above �rect. I agree to comply itn all city antl county ortllnances latin9 t builtli s ction, antl hereby authorize repre- eky upo qe above-mentlonetl ro0erty�r �s. Signature Date Reinspection Fee Drivers' Licens¢ or 55 � CMF 0865-46, rev. 4/84 White - 8uiltling; Canary - Appliwnt; Pink - Accounting; Goltlenwtl - Assessor TYPE OF PERM17 LJ GRADING L� FOUNDA710N U STRUCTURAI. ❑ TENANT �LECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER � " PRWECT DESCRIPTION 5c1. FT. � ocCUPANCv_ COfVSTRVCTIONTVPE � VALUATION$ � ZONE GRADING CU. VDS. ACRES__ Remarki: Bar Sink Backflow Preventer • Backflow Irrigation Bathtubs Jrinking Fountains Floor Drains Floor Sinks Gas Service �UiICtS Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspaction Fea $15 Boiler Duct- Under Ground Ducc - Structural Duct � Ventilating Exhaust System ❑ Multiple Firepl/FacL BIL ICBO # Heating System & Ducting ❑6100,000 BTU 0100000 $15 Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service . � Isue Fee Hood or Typel ❑ Canopy Typell ❑ Refrigeration System 00-100,OOOBTU ❑100,000 System Repair/Alteration Issue Fee § 3 $ 3 A.P. # S Main Building: E T Front A Rear C Right S Left Ping. Ref. # Planning Notes: Auromatic Washer Cons[ruction Pote Sub. Cooking Unit Dishwasher Dry¢rs ❑Gas ❑Electric F.A.U. Fixtures Device Boxes Outlets Switches Gar6age Disposal Generaror �0.5 KW 15K 9035 9/2B/84 Zone Accessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15�50 KW � 50+KW Meter �up to 100 amps Meter ❑over100amps Sub Panel MotorsDO-1HP�1Y.-8 ' Inc.Solar �9-15 HP �1G75+ Microwave . Pole Light Range Sign ' Standing Sections W Trash Compactor � Reinspection Fee �$75 � � Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: 2onin9 APVroved By Buildfng Approved By Appliqtion laued By �'Y1f1 26.40 r� FEES � $ 3 SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ - ENERGV P.C. $ ELECTRICAL $ � •�D GRADING $ PLAN CHECK 50% $ 7. 47C� MICROFILM $ MECHANICAL $ TOTALFEE� $ 2�•�C� PLAN CHECK 25% $ Z O N I N G R E a M T S. � �,-'CONS7RUCTION'AND�PLANNING POOL & SPA . ; kPPROUAIS Permit # Date, � Inspector ' qppROVALS - Permit #� Date Inspector ' 1. Temporary Electrical Service or Pole' � � 52. Pool & Equipment Location � �2. Soil Pipe=Undrgrnd. � � "53. Steel Reinfoicement . � i � ;3. Electrical'Conduit Utility-Undrgrnd. • ' � 54. FOrms � ' - 4. Electrical,Conduit-Undrgrnd. � � �' �55. Electrical Bondirig ' : , • ` ' 5. Steel qyinforcement � � 56. Rough Plumbing & Pressure Test �'-- 6. Electrical UFER Grnd. • - - 57. APPROVAL TO�COVER-GUNITE � 7. Footings � , . � , 58. Electrical Conduit-Undrgrnd. � , � 8. Founqation �, , - 59. Gas Pipe, � Undrgrnd., Test ' �f, 9. Water pipe-Undrgrnd. �� _ " � 60. Backwash Lines, P-Trap, 0 Undrgrnd. 1�0. Structural Floor System- �, - � 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final • 72. Sewer �yp - , ,' � �. 63. Heater & Vent-Final 13. Roof brains � 64. Plumbing System - Final ^ 14. Rough Plumbing 65. Electrical-Final ' - 15. � Rough Electrical-Conduit� - - - 66. Solar System-Final --- 16. Rough Electric Wiring _ 9 67. Fencing & Access Approval • - 17. Rough Wiring Sign• - 68. APPROVED FOR PLASTERING . � 18. Rough�Electrical-T Bac Ceiling ' . ! 69. POOC/SPA SYSTEMS FINAL � � 19. Rough Heating & Air Cqnditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace � APPROVALS Permit # . " 21. Ducts, in Structure 70. Underground Hydro � � 22. Ducts, Ventilating � �� ' 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush -� 24.�Roof Framing ' . 73. Undergrnd.StorageTank �Gas ❑Oil 25. Roof Sheathing � 74. Overhead Hydro 26. T-Bar Ceiling (Structural) &-Monocoat 75. Dry Chemical 27. 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 �� L' �� '% � 80. FOOD CERTIFICATE ISSUED 33. Final Electric � Notes: 34. Final Heating & Air Conditioning ' • � � � � 35. Final Gas Pipe-Test � _ � - 36. Hood or'Canopy � � 37. Final Factory Fireplace ' - � 38. Final plumbing . • - ' 39. Water Service-Final 40. Gas Service-Final ' . 47. Solar pomestio-Final � _ � � 42. Backflow Preventer 43. Backflow.lrrigation , .. ' 44. �Landscape Irrigation System ' 45. Sountl 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. CER7IFICATE�OF OCCUPANCY . _ No. Date - - , ' _-�__� _ . . ` 6 . Aoo��caM to fill In all fOacCs aacepl lhow witnin neavy �orEer,Ilnes ana sign ail aoo�ooriate aeciantlons. c�oF cosTa MESA CONSTRUCTION PERMIT . Project AddreSs %✓ �'� `f� Applicant'sMailingAddess /�.� �r+��%� r (2 "jJ' SJrU Owner's Name ✓�/rV I�Lw.a• Phone Address 2-z�� Arch/Eng. License No. Address (� Contractor's Namc_�. � tJ / hone �� . Address (ma'I' g) �� G�"r /� �� Ciry License No. '�q % Z LICENSED CONTRACTOR DECLARATION I herGby�a(flrm that I am Iicensetl untler provislons of Charter 9(commencing with socllon 7000) ot Divlsion 3 ot the Business antl Professions CoOe, antl my Iicensa is in fu �/or�a tl etfect. Llcen50 Clas _ �se„No. �//l� Dale Signature �� , WORKE S' COMVENSATION DE RATION I hereby affirm that 1 have a cerHtfcate ot mnsent to selftinsure or a cerUfiute OI Workers' Compensation, Insurance, or a c¢r[ifietl coOY the�eof (Section '800, Lab. C $ � / olicY No. �. �4 �? �� ComPanY � ic -.��4Mi ��tifietl Copy is he�eby furnizhetl. rtJ fietlyq py' ❑lea wiih tne ci[y ii ng i i �ate_yL��T Q� A�oOcant Cr— EXEMPT ON F OM WORKERS• COMPE SAT ON O C A ATION '(This sect on neetl not be comple[etl if Ne permit is for one huntlretl (5300) or lezs). I certify that In the pertOrmance Of the wo�k fo� wnich this Oe�m�t ii i55uetl, I Shdll nol employ any pe�sOn in any manner So a5 to becOme zubject to [he Workers' Compensation Laws o( Califomia. ' Date Si9nature 'NOTICE: 11; aiter making tnis tleclaration, you shoultl Decome subjec[ to tha Wo�ker5' Compensation proviSiOns o1 Ihe ldbo� Cotle, you mu5t forthwi[h comply wilh Such provizlons o� this permit Shall b¢ tlGGmeU �evoketl. CONSTRUCTION IENDING AGENCV ' 1 hCreby aftirm Ihat th¢�e Is a conslruction ientlin9 agency fo� Ihe Oer/ormdnG¢ oi [he wark for which thl5 p¢rmit is issuetl (Se<tion 309� Civ. CJ l.entler'z rvame Lontler's Atldreis OWNER BUILDEH UECLARATION � I heroby alfirm that I am ezempt Irom the ConVactor's License I�w tor lha lollowing roason (Settion 7031.5 Buiiness antl Professional COCe: Any clty or tounty whlch requires a permlt to conitruct, atter, improve, Uemoli5h or repair , any strutture, pdOr l0 Il5 ISSuante, also requir¢Slhe applicant 1or such pe�mit lo IIIO a slgneE Statem¢nt thdl he/ihe i5 IicenS¢d pufsuanl t0 Ih0 pfOVl5ion5 O/ [he Conlractor's Llcanse Law (Chapter 9(commen<in9 �+'��n Saction ]000) of Division 3 ot the Business antl Profezsions Cotle) or t�at ne/she is ezempt thCrelrom anU lha ba5is for tha allegetl exemption. Any violation oi Seclion >031.5 by any applicant fOr a permit sub�ecti th¢ appliCant lo d Clvil nalty o/ nol more than /ive nuntlretl tlollars (5500). � � I, az ownCr o/ tha pro0erty O/ my employees wi[h wages az [hoir sola componsation, wlll tlo tne work, antl the sducture Is nol IntenEea ar oHeretl br sab (Section 7064, BuSinezs antl Professional Cotle: The Contrac[or's License Law tloes nol applY to an owner of a property who bu11Es or improves thoreon, antl who tlOCs such w0/k hlm5¢I//he�self or tnrO�gh his or her Own employces, provltlad that Such ImprOvemenl5 are not Intentletl or OHeretl tor sale. If, however, thu bulltling or Improvemen[ Is soltl wit�in one year ot com- pletlon, tha owner will have the burtlen of provin9 he/she altl not builU or im- ��Ova fo� the pu�poso 01 sale). I, as own¢r Ot [ha p/operty, am ex<IuSively cont�acting with IlcenS¢tl COn- tractors to cons[ruct [he projact I$¢CIIO� 7044, BUSi�¢55 dOtl P�O�8551005 CO48: The COnVactO/'S LlcBnse Law dOes nol dPPly to an owner of pro0erty who builtls or Improves thermn, antl who contracts for such projects with a con; tractor(s1 Ilcense pursuant�to [ne ConVattor'S License Law). I am awara that proof of lheir Worker'S Comp¢nsallon Insurance ShOultl be prOvlC¢E [o me. ❑ I dm ex¢mpl untle� $e<tlOn B. & P. C. fOr tbi5 rea5on Data Owner � I hereby certity,❑ I have reatl this applicat info/mation i5 co c. I agre9 o comO�Y �+'��h d antl state laws lati to I�nq construc " sontatives Of ci y t t�'/upon t inspectlon pu sei. i Signdture Oriver5' Lice s¢ or 55 3e �ep�e- y �or TVPE OFCONSTRUCTION LJ NEW LJ ADD L1d'ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHF�R q.p. # DESCRIPTION OF WORK/USE OF BLDG. Le+-4 ni.nc I— S Main Building: TVPEOFPERMIT GRA�ING— �OUNDATION� STRVCTURAL ' T Ffont ❑ TENANT ❑ ELECTRI�AL �LVMBING ❑ MECHANICAL B• Rear ❑ �OTHER' ' ' A PROJECT DESCRIPTION Sa. FT. OCCUaaNCV C Right K Left CONSTRVCTIONTVPE VALUATION$ $ 20NE � GRADING CU. VDS. � ACRES p�ng. Ref. # Remarks: . ' Planniny Notes: 3ar Sink 3ackflow Preventer 3ackflow Irrigation 3athtubs Claiifiers '715hN25hC1 �rinking Fountains Floor Drains Floor Sinks • 3as Service � OuUets Interceptors Kitchen Sink � Lavatories � P—Trap Roof Drains � Reinspection Fea $15 Duct - Under Ground. ' �uCt = $[NCtUf81 Duct - Ventilating Exhaust System ❑ Multiple Firepl/Pact. Blt. ICBO # Heating System & Ducting ❑0.100,000 BTU 0100,000 u RefnSpectiOn FBB � $15 CMF 0865-46, rev. 30/84 Wnite - Builtling: Canary - Appliwnt; Gink - Accounting; Goltlenrotl - Assessor Showers Service Sink ' Sewer Cap Sewer Connection Salar Collectors Solar Piping � Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater - Water Service Auto-Wash laue Fee Hootlor Typei ❑ Canopy Typell ❑ 4efrigeration Sys[em 70.100,OOOBTU ❑700, System Repair/Alteration Fire Dsmpers Registers . � Issue Fee FEES $ 3 Construction Pole Cooking Unit Dishwasher Fixtures Device Boxes Outletz Switches Garbage Disposel Generacor �65 KW 5589 12/10/FJ5 Zona Parking Req.lProvided ELECTRICAL � . � Transiormer ❑ 15-50 KW , ❑50+KW Meter �up to 100 amps Meter ❑over100amps Sub Panel Motors �41 HP O1 Y, - 8 Inc. Solar �9�15 HP �1615+ Microwave � - � Pole Li9ht Sign ; Stending Sections 5 KW Trash Compacror . 0 � io'u T�. FEES Z O N I N G R E Q M T S ' Reinspection Fee � I$15 � I Issue Feo � ' $ 3 I DEVELOPMENT SERVICES RE�UIRE � 2oning Approved By Data Building Approved 6� Date1� ApPliration Issued By Date SUMMARV OF FEES BUILDING PERMIT $ ' SMIP $ PLAN CHECK . $ PEHMIT, PWMBING � $ � ISSUANCE 3 P�AN CHECK 25% $ ENERGV P.C. $ � ELECTRICAL §� � GRADING $, PLANCHECK 50% $ MICROFILM $, MECHANICAL S TOTAL FEE $ � PLAN CHECK 25% $ I�"'- . � . ._ . . . v . .:. _ t�. . _ . t�� CONSTRUCTION AND PLANNING � POOL E \ I APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector 1. Tempo�ary 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 - Finaf . 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/SPASYSTEMS�FINAL 19. Rough Heating & Air Conditioning , FIRE DEPT. REQUIREMENT. � 20. Rough Factory Fireplace APPROVALS Permit # - 21. Ducts, in Structure 70. Underground Hydro � 22. Ducts, Ventilating . 71. Product Piping � Gas ❑ Oil 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. Diywall 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 /�Si � 36. Hood or Canopy � 37. Final Factory Fireplace � � - 38. Final Plumbing � � 39. Water Service-Final - . . . � � �' � '�-'� ' �.40. Gas Service-Final � � 41. Solar pomestic-Final ' 42. Backflow Preventer . � � � 43. Backflow Irrigation� � 44. Landscape Irrigation System 45. Sound Attenuation • - 46. Handicap Regulations � � � 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed � i 49. Electric Releese to Edison , ,, 50. Gas Release to Southern California Gas Co � 51. CERTIFICATE OF OCCUPANCY �� No. Date � . �� \I � ' M� pJ �7 Av�licant to fill in all spatts except Ihose witnin neavy bortler lines ana sign ali aDP�opriate Ceclarations. �COSTAMEsa CONSTRUChTIONPERMIT � ddress 590 W ! 9 r T Applicant's Mailin8 Address � � �-✓ C7a�`/f Owner's Name r� e/lP fJPNfO i/70 Phone ��8 3 j7 bu JB Address S� W «r h$ T �. � Arch/Eng. License No. Address Contractor's Nam � Q Phone AdtlrNss (mailing) City License No. LICENSEO CONTRACTOk DECLARATION 1 hereby affirm tha[ I am licensetl untler proviiioni of Charter 9(commencing with section 7000) ot Division 3 0� the Business antl Professions Cotle, antl my IlCense is in fWl /orce antl eftect. Ucense Class License No. Dale Signahre WORKERS' COMFENSATION DECLARATION 1 hereby affirm that I have a certificate o( consent to seli-insure or a certi(i�ate of Wo�kers' Compansation InSurance, o� a certifletl copy thereof ($ectlon 3800, Lab. C.) �olity No. ComOany 8 C4rtitietl copy is hereby furnishatl. CertifieE copy is filetl with the clty Builtling Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section neetl not be campletetl if tne permit is tor One huntlretl ($300) or less). I certify that in th¢ perfo�mance Of the work fo� wM1lch this perm�t is ISzuetl I Shall not employ any Oerson in any mdnne� so a5 to become subjec[ [o t{�e Work¢rs' Cq+� p�e) sati n Laws of Califo a. Da[e _'��Ccii��5i9nature �/� NOTIC : f, �f��er rnaking LhistleclaraHon, u shoultl become sub�eci to th¢ Worke�s' ComOensation provisionz of lhe Ldbo� Cotle, you must forlhwith comply with such p�ovi5ion5 0� this perTit Shall be tleemetl �evoketl. CONSTRUCTION LENDING AGENCV I nereby afti�m that lhere is a copst�uC[ion lentlin9 agency fo� the pe�fo�mance of the work for which thi5 pBrmit is issuetl (SeCtion 309] Civ. G.) LPntl¢r'S Name Lentler'S lltltlress OWNER BUILDER DECLARATION I hareby affirm that I am exempt irom the Contracror'S License Law tor the follo�yj�g reason (5ecfion 7031.5 Business antl Professional Cotle: Any ci[y or counly wnich requires a oermlt co construct, alter, improve, tlemolish or repair any S[ructure, p�lOr to It5 issuanc¢, also reqWtes fhe apO��Cdnt for Suth p¢rTit to /iie a 5i9netl slatement that he/sM1e iz licensetl pursuant to the provi5ions of the Contractor's �icense Law (Chapte� 9.(commencin9 witb $ec[ion ]000) of DiviSion 3 of [he Businezs ana Profe55ion5 Cotle) or lhat h¢/She is enempt the�0from antl tM1C basis for the allegetl exeTption. Any viOlation of $ectiOn >03L5 by any dpplicant tor a permit subjects the applicant to d civll �alty of not moro than five huntlretl tlollars (g500). �� as owner o1 the Oroperty or my em0loye¢s with wa9es as tneir Sole �' �mp¢nsation, will tl0 th¢ work, antl [he structure is nOt inlentl¢tl o� of}eretl Ifor sale (Se<[ion ]044, Businezs antl Professional Cotle: The Conlractor's License taw tloes not appty [o an owner ot a property who builds or improves therppn, antl who tloes such work himself/herseli or througn his or her own �. employee5, provid¢tl thal such imOrovement5 are not Intentletl o� otteretl f0/ I SaIG. It, howev2r, tbe builtling or imOrovem¢pt is Soltl wi[hin one yea� of com- � pletlon, the owner wlll have the burtlen Of P�oving he/she qitl not builtl o� IT- prooe torthe purpose otsaleJ. �s owner of the properry, am excWsively wntractlng with Iicensetl con- trac{or5 to constrpcl the project (5ection ]044, BUSiness antl Professions Cotle: The Contrattor's Lfcense Law do¢5 not appry to an ownCr o( proPerty wM10 builtls or improves thereon, antl who contracts for such p�ojects wifh a con- Iractot(s) ncenu pursuant to tpe Contractor'S License LawJ. I am awarQ lha[ pro0f o( thei� Worke�'S Compensd[ion in5urance Thoultl be Orovitletl to m¢. ❑� am exempt untler Section B. & P. C. for tnis reason Data Owner 1 hereby cer i( that I have reatl this a IicaY InPormation Is mrrect. I agree to compry with a antl state laws relating to builtling constructipn sen[atives ot this citv to enter u0on the ab Signature / lOi Orioe�s' License Or 55 CMF 0865-46, rev. 10/84 nces �._��y f-a;Pv�e o/' �! �PE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p *, '��L... DESCRIPTION OF WORK/USE OF B�DG. T—�^��✓'� d r � S Main Building: TVPEOFPERMIT GRADING ❑ FOUNDATION STRVCTURA� T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL 8 Rear ❑ OTHER %� PROJECT OESCRIPTION Sq. FT. OCCVPANCv Z- C Right K Left CONSTRUCTIONTVPE S� VALUATION$ $ � ZONE GRADING CU. VDS. ACHES p�ng. Ref. # � Remarks: � E` � 3•3 OS'� C�� 7— p�jt Planning Notes: Preventer Irrigation Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee � $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. BI[. ICBO # IHeating System & Ducting �aioo,000eruOioo,000 Reinzpection Fee � $15 Wnite - Bulltling; Canary�Applicant; Pink - AccounUng; Goltlenrotl - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Hearer Water Service Auto�Wash Laundrv Trays Issue Fee Hood or Typel ❑ Canopy Typell ❑ Refrigeration System ❑aioo,000eru ❑ioo,000eru System Repair/qlteration � Fire Dampers Registers . Issue Fee FEES $ 3 9922 5/04/8� Zone Accessory 8uilding: Parking ReqJProvided ELECTRICAL Autometic Washer . Transformer ❑ 15-SO KW ConstructionPoleSub. • �50�+KW Cooking Unit Meler ❑up ro 700 amps Dishwasher Meter ❑over100amps Dryers ❑Gas ❑Electric Sub Panel ' Fan Motors�0.1 HP07'f,-8 F,A.U. 7At�Solar �9-15 HP �i6-15+ Fixtures Device Bozes � Outlets Switches Garbage Disposal Generator �0.5 KW �5-15 KW Microwave Pole Ligh[ Range Standing Sections Trash Compacmr � Rainspection Fee �$15 � � luua Fee DEVELOPMENT SERVICES RE�UIREMENTS: Zoning APProved By Building Approved By ��-q,��' Application luued By ��].�t�wAl/N � B' SUMMARVOF BUILDING PERMIT 3 PLAN CHECK $ PLUMBING S PLAN CHECK 25% $ ELECTfiICAL $ PLAN CHECK 50% $ ' MECHANICAL $ � • 00 PLAN CHECK 25% $ ZS SMIP S PERMIT ISSUANCE 5 ENERGV P.C. $ GRADING $ MICROFILM $ TOTALFEE $ 26,25 TI FEES $ 3 2 O N I N G R E Q M T $ CONSTRUCTION AND PLANNING POOL & SPA i Date Inspector . Date Inspector APPROVALS Permit# APPROVALS Permit# 1.�; emporary Electrical Servics or Pole i 52. Pool & Equipment Location , 2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. , 54. FormS 4. Electrical Conduit-Uridrgrnd. 55. Electrical Bonding 5. Steel ReinforcemenZ 1 56. Rough Plumbing & Pressure Test � 6. Electrical UFER Grnd,; ' 57. APPROVAL TO COVER-GUNITE � �7._Footings ; %. 68. Electrical Conduit-Undrgrnd. �8; Foundation � / 59. Gas Pipe, O Undrgrnd., Test r 9.;Water Pipe-UndrgmdL; � 60. Backwash Lines, P-Trap, O Unilrgrnd. i 10. Structural Floor System � 61. APPROVAL TO DECK 11. Propertv Sewer Line & House Connection 62. Backwash & Receptor-Final r ., 12. Sewer Cap "" � 63. Heater & Vent-Final 13. Roof Dreins 64. Plumbing System - Final � 14. Rough Piumbing 65. Electrical-Final 15. Rough Electrical-Coaduit ' 66. Solar Sysiem-Final . . 16. Rough Electric Wiring � � 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING c ,_ ��18.r Rough Electrical-T Bar Ceiling � � 69.� POOL/SPA SYSTEMS FINAL �� i9: Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMEPIT I� 1 20. Rough Factory Fireplace APPROVALS Permit # ' � r i, 21. Ducts, in Structure 70. Underground Hydro _ 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test ' 72. Underground Flush / � / 24. Roof Framing 73. Undergrnd.StorageTank OGes ❑Oil �� 25. Roof Sheathing �74. Overhead Hydro �� ' - 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical `'� � .� 27. Frame and Flashing �,f � 76. Dry Standpipe �y� - 26. Lathing & Siding � 77. FIXED SYSTEM FINAL � �;� n, � , 29. Insulation r 78. FIRE PREV. FINAL r 30. Drywall Nailing HEALTH DEPT. REQUIREMENT M 31. Plaster Brown Coat � 79. FINAL INSPECTION ��- `�} 32. Electrical Power MeterFinal ! 80. F000 CERTIFICATE ISSI)ED 33. Final Electric Notes: ' 34. FinaF�}ieating & Air Conditioning � 35. Final'Gas Pipe-Test ; �36. Hood or Canopy �� .� 37�Final Factory Fireplace . 38. Final Plumbing 39_;Water Service-Final v 40. Gas Service-Fina� :�i � ., . 41. Solar pomestic-Final ' 42. Backflow Preventer . . � 43. Backf�ow Irrigation -. � 44. Landscape Irrigation System • ' 45. Sound Attenuation � ��. 46. Handicap Regulations �i,. i � '47. FINALSTRUCTURE&BUILDING J 48: Special Requirements Completed � i . 49. Electria Release to Edison 50. Gas Release to Southern California Gas Cn 51. CERTIFICATE OF OCCUPANCY� , No. ' Date � ,_ �