HomeMy WebLinkAbout594 19TH ST - Building Permits-----_.. . _-- ._.,
� _ ( � ., �:,��. �����<:,,,�,�
� qTY OF COSTA MESA - ._, r•--..- �
BYILDING DIVISION ' '
77 FAIR DRIVE, COSTA MESA. CA 92626 •(7�4) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754•5626
PERMIT NUMBER: 610-00238
PERMIT TYPE B_ROOF2
APN: 42214120
STATUS: ISSUED
DATE ISSUED: 08/12/2010
ISSUED BY: CAC
JOB ADDRESS:-594:W=19TIi=ST CM� Suite/Unit:
Vicinity: , -
Squares: 1680 , Valuation: $20,000.00
SCOPE OF WORK: TEAR OFF BUR ROOF AND INSTALL BUR. CLASS A
OWNER: IN-N-OUT BURGER Address: 13502 E VIRGINIA'AVE
PHONE: City/State/Zip: BALDWIN PARK, CA
APPLICANT: SADLER,KIM
PHONE: 949-675-2360
CONTRACTOR: SADLER ROOFING COMPANY
Address: 125 GRAND CqNALUnit:
Ciry/State2ip: BALBOA IS , CA 92662
ARCHITECT:
ENGINEER:
FEE SUMMARY
Reroof Plan Check: $0.00
Reroof Permit Fee: $32125
Reinspection Fee: $0.00
Bldg Std Admin Fund $1.00 .
Address: 125 GRAND CANAL
Ciry/State2ip: BALBOA IS , CA
License No.
License No.
PHONE
- —_......__.---�
. . ., .,. •.-i�,��.:,::t
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Unit "'
Unit: :
LicenseNo. 284857 � �•'i�-����
949-675-2360
CELL:
PHONE: ,
PHONE:
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_ : . . ._ .-�
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l9iit: ....... . .
TOTAL FEES $322.25 �
HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3N 8I2010 - PER CMMC Sec. 13-279 �;,-;i_ ;
Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal
New Years Day Memorial Day Independence Day Labor Day Thanksgiving Day and Christmas Day
_ �.3�
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Calitornia statutes and related
regulations. (Ord. No. 92-$8, § i, 12-21-92)
EXPIRATION: PERMIT HXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. ..
INSPECTIONS: fn order for the work authonzed under this permit to be considered legal, such vrork must comply w'+th all applicable codes, and a!I
required inspections antl final approval must be oblained. Failure to obtain inspections and final approval will result in the expiration of this permit. ;
C D�E�. INSPEC110NTYPE ORT INIITIRL LODEI INSPECPONttPE U_� ' �IN701�15�
1818 Fixed System Final Fire Prevention 206 Final Mechanical
1268 PoolSpaFinal � 208 FinalPlumbing '����'
200 FinalRe-Roof X 3•��-I� Nii10UUn`-' 210 FinalElectrical __ _____
—�— i
201 Final8locWRetaining Wall 212 Final Fire Prevenfion ••�t� �
202 Final Faetory Fire Pla� 220 Final Planning Approval °`e.d« rt+� `.lOiitldys i
--r
203 FinalSign 222 FinalSite ~fr J
204 Final Demolition 250 Final Building�Occupancy
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalry of perjury one of the following declarations:
❑ I have and will maintain a cehifcate of consent to sel4lnsure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of the work for which this permit is issued.
1 have and will main�ain vrorkers' compensation insurance, as requiretl by
s bn 3700 of lhe Labor Code, for the pertortnance of the work for which this
pertnit is issuetl. My vrorkers' compensation Insurance carner and policy
�, oe' ;�i �i�'./1_G{ � /L� r1/�
is val✓ed ar wre nundretl tloYars
❑ I certify that in Ihe peAormance of lhe work for which this permit is
issuetl, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of Califomia, and agree lha[ if I shoultl
become subject to Ihe vrorkers' compensalion provisions o( Section 3700 of
the L or Code, I shall f hlwi�p y' these provision;. ,/ �
�
Ap01¢ nfs5ig lure Date
WARNING: FAILURE TO SECURE WORKERS' COMPENS COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLL4RS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
Owner ID verified oy tlrive� > license. ❑ Yes ❑ No
Driver's License No. Expires:
Verifcation o! Ownership by (type of document, i.e. - property tax bill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ 1 hereby certdy that no excavation frve (5) or more feel in depth into wfilch a
person is requiretl to OescenQ will be made in conneclion with vrork authonzetl
by Ihis permil, antl that no building structure, scaffWtling, falsework, a demolition
or dismantling ihereo(, will be more than thirty-six (36) (eet high. (Chap. 32. Grp
2, An 2, Sec. 341, Title 8, Califomia AtlministraMe Code).
❑ As ovmer-builder, I will nol employ anyone lo do vrork which would
require a permit from the Division o( Industrial Safety, as noted above. unless
such person has a permit lo tlo such vrork from ihe tlivision.
Appliwnl's SignaWre �ate
Division of Intlustnal Safety Permil Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will ihe applicant or present or future building occupant need to fle and
certify a Business Plan for emergency response to release or lhrealened
release of a hazardous material? ❑ Yes ❑ No
(Seclion 25505 of Ihe California Health antl Safety Code requires, with some
exceptions, that a Business Plan be filed with the Costa Mesa Fire
Depanment by every business which has at any one time dunng a reported
year a quantiry of hazardous materials equal ro or greater than a weight of
LICENSED CONTRACTORS DECLARATION: 500 pounds, or a volume of 55 gallons, or 200 cubic (eel o( compressetl gas
I hereby aKrtn ihat I am licensed untler provisions o( Chapter 9(commencing at standard temperaNre and pressure).
with Section 7000) of Division 3 of the Business and Pmfessions Cotle, and p, Dces or will the applicant or present or future building oaupant need to file
my ' e e is i ull r e n0 etfect. �� _ a registralion torm for acutely hazardous matenals? ❑ Yes ❑ No
a# � las; � (Section 25533 of lhe Califomia Health antl Safery Cotle, with some
}L ezceptions, requires registration with the Costa Mesa Fire Department by
/ �ach business which at any one time has on han0 a quantity o( acutely
—- com nors neWre _ ale hazardous materials equal to or greater than a weight of 500 pounds, or a
�-- - -volume of 55 gallons, or 200.cubic_teet of compressed gas at standard
CONSTRUCTION LENDING AGENCY:
❑ I hereby aKrm that there is a consWclion lending agency for the
perfortnance of the woM for which this permit is issued. (Sec. 3097, Civil Cotle).
Lentler's Name:
Lentler's Address:
SignaWre Da�e
OWNER•BUILDER DECLARATIONS:
I hereby aKrm that under penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5,
Business and Professions Cotle: Any city or county which requires a permit to
construct, alter, improve, demolish, or repair any structure, pnor to its
issuance, also requires lhe applicant for such permit to file a signed statement
lhal he or she is licensetl pursuant ro lhe provisions o! the Contractors
License Law (Chapter 9(commencing with Sedion 7000) of Division 3 of the
Business antl Professions Code) or that he or she is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5 Dy any
applicant for a pertnit subjecis the applicant to a civil penalty of not more than
five hundred dollar5 ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
compensation, WILL DO THE WORK, and the stmcNre is not intendetl or
offered for sale (Sec. 7044, Business and Professions Code: 7he Coniracbrs
License Law does not apply to an owner of properly who builtls or improves
thereon, and who does such vrork himself or herself or thmugh his or her own
employees, provided Ihat such improvements are not intended or oRered for
sale. I/, however, the building or impmvement is sold within one year ot
comple[ioq the ovmer-builtler will have the burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I. as owner of lhe property, am EXCLUSIVELY CONTRACTING WITH
LICENSED CONTRACTORS to conslruct the project (Sec. 7044, Business antl
Professbns Code: The contractors License law dces not apply to an owner of
property who builds or impmves thereon, antl wfio contracts fa such project vnth
a contracta(s) license pursuant to the Contractors License lavrs.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
305]-A6 (3I07)
temperaWre and pressure). -
3. Does or will Ihe applicant or present or future builtling occupant need to
prepare an RMPP (Risk Management and Prevention Program tor awtely
hazardous materials)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Safery Code provides that the
Costa Mesa Fire Department may require the preparation, certifcalion and
filing with the Fire Department of an RMPP by businesses which are required
to registei acutely hazartlous matenals with ihe Fire Department.
4. It an RMPP is presently required, has Section 25534 0! the California
Health and Satery Cotle been fully complietl with? ❑ Yes ❑ No
5. Does or will the applicant or present or fuWre building occupant require for
the work which is Ihe subject of this application a pertnit (or such consWction
or modifcation fmm the South Coast Air Duality Managemenl District or from
any other air pollution wntrol disirict or agency? ❑ Ves ❑ No
(Seclion 658502 of the Calilomia Govemment Code requires ihat the requestetl
infortnalion be (umished on applica[ions for non-resitlenlial building pertnits).
6. Will any part of the facility ro be constructetl under Ihis pertnit be vrithin
1000 feet from the outer boundaries of a school? ❑ Yes ❑ No
pf'j�es", Ihe facility must meet [he requirement of Sections 25534 and 42303
o( the Califomia Health and Safety Code).
7. If a permit from the South Coast Air Qualiry Management District or other
air polNlion control district or agency is requiretl lor t�e work which is the
subject ot Ihis application, have all of the disclosures prescribed by California
Heallh and Safery Code Section 42303 been made? ❑ Yes ❑ No
8. Qf'yes", attach certificate of compliance from Ihe appropriate air polWtion
coNrol o(ficeq.
CERTIFICATE OF COMPLIANCE: I certity that under penally of peryury the
information given above is correcL I agree to comply with all state laws and
city ordinances regardinq Hazardous Matenals and Emissions.
Daie
CERTIFICATE OF COMPLIANCE AND AUTHORI2ATION OF ENTRY: I
certify under penalty of perjury Ihat I have read this application and stale that
the inlormation given is correcl I agree to comply vrith all slate lavrs and city
ortlinances relating to builtling consWction, and authonze represeNatives of
Ihe Ciry of Costa Mesa ro enter upon the above-descnbed property for
inspection purposes. I agree not to occupy or allow occupancy of any building
aWhorizetl by Ihis permit until final inspection.
5 natore of Legal Owneqs Dale
`/� �, .� /�,'��— � I l� � �
� AnOlor qulho �tl-App ¢anl Dale
�
�
Applicant to /ill in all SpaceS e%cePt lhoSG wl�lli� hldvy Go�El� Ilnes antl sign all appropriale Ceeia�ations.
PERMIT
Address • ^`� �'
Arch/Eng. ����Qr 1•'Q-�� h License No.
Address o� t _ ,f
Contracror'sNam�t�4�K��a one .;Jg'SS�
Addresslmailing) I3.SO�P.U�rb{Pw ��e�wfH �fk.
Ciry License No. � - �-'���g
LICENSED CONTRACTOR DECLARATION � .
I hereby affl�m thal 1 am;�icensetl untle� provi5lOn50t Charte� 9(commencing
with section 7000) of Divislon 3 of the Bu5ine55 antl Proles5ion5 Cotle, and
my license is in tu force antl eifect. • �
IJCCl15¢ CId55 v L�C 11507 .`15gao ��
�ate �S�O-�CS SignaturG
WORKERS' COM7ENSATION DECLARATION
1 hereby aHirm that I have 5 certificate oi consent lo seli-insure or a certificate
�f Workers' Compensation Insurance, or a certifietl copy thereof (Section
800, Lab. ' ' _� �
PolicY,No. ��R�`��� � "ComPanY���LLgt�I.— L —�
Certifietl copy Is hereby;furniined. -' t' �' � �/.
CerNtie�C copy Is fl1eA with Ne�city Bui,�$m D�lv_isiQ n..t o
a[e ' APpllcant F���A VUVa ,Y
EXEMPTI N FROM WORKER$' COMPENSATI�ON DECLARATION '
(This seGtion neetl not be completetl it the permlt I5 for one huntlretl (5300) o�
less). i - � ' '
I ce�tify that In lhe perfo�mance of the work to� wM1ich thi5 p¢rm�t Is IssUetl, I�
snall not employ any person in any manner so as to become subject to the
Workers' Compensation l.aws ot California. 1
. �ate - Signafu/¢
'NOTICE: 1/; dttor making this tleclaration, yowshoWC Gecome subject to the
��, Workers' CompensatiOn provisions of th¢ Labor Cotle, you mu5t fOr[nwith
I comO�Y w�th Such provision5 or Ihis pe�mit shall b¢ tleemetl �evoketl.
CONSTRVCTION LENDIN6 AGENCV
I nereby ai�i�m Ihat tbere i5 a construction.lentling ag¢ncy for the performance
ot the work fo�which this permit i5 ISSuetl (Section 3097 Civ. CJ
lRntler'S Name , .
Lentler's Atltlresr �
OWNER BUILDEN OE�LARATION • �
I hereby aitirm that 1 am exampt trom the Contractor's License Law tor the
followinW� reason (Section 7031.5 Business antl Protesslonal Cotle: Any ci[y br
�nuntv nicn .eouires a oermil to consGuct, alter, improve, Gemolish or repair
to tfle a
� �ne, Co^
s of
Of
�h¢I¢fYORI dntl tM1¢ ba51i'tOI'[f10 dll¢g¢a exempllon, qny vmmuvn � ea�.u�u
031.5 by any applicant for a permit subje<ts the applicant lo a civil
enalty of not more than five huntlretl tlollars (E500). -
.L� I, as owner of the properry or.my employees.witn wages as their sole
compen5ation, will tlo the wo�k, antl ihe struc[u/e I5 not intentletl Or offeretl
to� zale ($eclion 7044, BusinCss antl Professional Cotle: The Contractor'S
License Law tloes no[ apply [o an ownet of a property who builtls or irtiproves
thereon, ana who tloes sucn work himseli/herself or through hls or her own
em0loy¢es, provitletl that such Improvements are n0[ intentletl or offeretl fo�
sdl¢. If, nowevet, the Duiltlln9 or Improvement is soltl within one year of mm-
pletion, Ihe owner will have th¢ bu�tlen of Proving h¢/She tlitl not buIIC or iT-
ptove fo� tne pu/pose ot sale). ' '
❑ I, as owner Of the property, am ¢zUusively cont�actin9 with Iic¢nsetl con-
tra[tors lo <ons[tuct the project (Settlon 7044, Business antl PrOfe55lons Cotle:
The Contractor'S License Law does not apply to an owner of property who
bulltls or improves thereon, antl who'contracts for such projects wlth a con-
[rattor(51 license pur5uant�'to Lhe�Contracto�'S License Law). I am aware that
proof �ol Iheir Worker'S Compensation insuranc< should ba provitletl to me.
❑ I am exemo� untler Sectlon B. & P. C: for this reason
Date U�
I Ite�eby ce�lify that- I have
Information, is correct. I agre�
antl state laws relatin bu
sentatives of this y
Inzpection purpo .
Signature 'ti
Drivers' License or 55 � -
I, CMf 0865-46, rev. 30/84 White
itl this application antl state that the above
� complv with all tity antl muntY ortlinancez
n9 constructlon, antl hereby authorize repre-
r upo` tbe �above-mentionetl rp�rop>erty tvor
/
_. _ _ O '�_ , - .
TVPEOFCONSTRUCTION � NEW ' �ADD ALTERATION � REPAIR �
❑CONVERSION ❑DEMOLISH'OOTHER Ap#�y�� `_
DESCRIPTION OF WORK/USE OF BLDG. u��% �b*-�o �'-0*n'u'"'� cY
S Main Building:
TVPEOFPEHMIT GRADINGI�I FOUNDATION STRUCTVRA� T FrOnt � �
❑ TENANT � ELECTRICAL�1 Ki' PLVMBING �I MECHANICAL 8 Rear �
❑ �OTHER '. / t ' - 1:` ,' ' � � A
PROJECT DESCRIPTION S���F,r7. .�F•_��'�- - ' OCCUPAN�C�v/�� ����— K Right ��j
CONSTRUCTIONTV7E vNS. ��� VALUATIONS� $' Left �'S�
ZONE GRADING CU. VDS. � ACRES Ping. Ref. # �-g�
Remarks: Z- ` 'S(pZ,7U PlanningNotes:
' HOLD
Bar Sink
Backflow Preventer
Backflow IrrigatiOn ' /i
Bathtubs � � %
Clarifiers • �
DIShN35hCf
Drinkino Fountains " �
Floor Droins
Floor-Sinks
Gas Service
1 n Ierceptors
Kitchen Sink
Lavatories
P-Trap .
Roof Drains
` i
Outlets2,
i Fee $15
Boiler
Duct- UnderGround
Duct - Structural
Duct � Ventilating
Exhaust System � Multiple
FirepUFact BIL IC80 #
Heating System & Ducting
� �0.100,000 BTU 0100,000
Reinspection Feo � $15
Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor
nnirv� }
Showers
Service Sink
Sewer., Cap - " � �
Sewer Connection : �"'
Solar Collectors
Solar Pipin9 �.'' "�
Solar Tank ti
Swimming Pool w/Spa ( �
Urinal - � '
Water Closet �
Water Heater
Water Service
Auto-Wash
Laundry Trays
Issue Fee
Hoodlor Type•I �I
Canopy Typell ❑
FEES
�
���-�7 ii.'��.
Zone
Accessary Building:
Parking Req./Provided �y
ELECTRICAL '
ic Washer � ' Transformer ❑ 75-50 KW
tion Pole Sub. � 50 + KW
Unit.,r� Meter ❑upto100amps �
ier �� �� Meter ver 700 amps ��
7Gas .�Electric Sub Panel
�^ � %{� Motors�0.7HPOiX-8
�' � , Ina Solar �9-15 HP ��76-
' � Q FI%LUfES � '
Device Boxes � � .
Z �j Outlets� � . � ' '�
(� C) Q Switches .` , �
�� Garbage Disposal' '
' C�i Generator �0-5 KW �5�15 KW
R .'
Refrigeration System
�0-t00,0006TU ❑100,000
System Repair/Alteration
Pire Dampers
Registers .
Issue Fee
� % �
5 3 _ • •
��
$ 3
DEVELOPMENTSER
:2onin8 APProved By-
' Building Approved By
Appliption Issued Bv-
. BUILDING PERMIT �$
PLAN CHECK � $
' PLUMBING % � S
. PLAN CHECK 25% $
ELECTR�ICA� , $
� PLAN CHECK 50% $�
MECHANICAL � �� $�
PLAN CHECK 25% $
::-�
FEES
Microwave - ' - � � ?
Pole�Light.� � �
Ran9e�� � ' S
I �
Si9n - .,
! Standing Sections �
Trash'Compactor -
♦ .
R
Issue�Fee '�f $ 3 �
iK Y' ,'�i , .'12. - . .i /-� _. ,
SMIP ,
' PERMIT
'_ I$SUANCE
• ENERGV P.C.
f GRADING
�. MICROFILM
� TOTALFEE
$ �QSl1
5
$
$
$
$
2
O
N
1
N
G
R
E
Q
M
T
s
- .
- ,j'TRUCTION AND PLANNING ' - � � ��POOL 'A
PPFi�VALS Permit# Date Inspector AppROVALS Permit# Date Inspector
i T�mporary Electrical Service or Pole � � 52. Pool & Equipment Location
.1' �2. Soil Pipe-Undrgmd. , � ��� �% ' � 53. Steel Reinforcement � �
� 3. Electrical, �onduit U4ility-Undrgrnd; ' 54. Forms �
4. Electrical ConduiT-Undr r v�/ G 55. Electrical Bonding ,
� .
5, Steel.Reinforcementi ' 56. Rough Plumbing & Pressure Test
,�
6. �Electrical UFE�R Grnd. tr . 57. APPROVAL TO COVER-GUNITE '
7.'Footings; ' . , , � 58. ElectricalConduit-Undrgrnd. - �,�
8. Foundat ion •� S� G�S�b' �� 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd'. . ' � f�0 � 7� 60. Backwash Lines, P-Trap, � Undrgrnd.
�
10. StrUctural Floor System . 61. APPROVAL TO DECK
11. Pro,perty:Sewer Line & House Connection , 62. Backwash & Receptor-Final
�12. Sewer'Cap •, jr��� �S- �i� 63. Heater & VenbFinal "
13. Roof Drains � �� ` 7.�� � (' 64. Plumbing System - Final �
14. Rough Plumbing -� 7�7/S1' 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring �� C� 67. Fencing�& Access Approval �
17..Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning ,'����y � 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 OGas ❑Oil-;
25. Roof Sheathing � � Q�r� 74. Overhead Hydro
26. T-Bar Ceiling (Structurel) & Monocoat 75. Dry Chemical
27. Frame�and Flashing ��� �J��p?/Z 'p t 76. Dry Standpipe
28. Lathing & Siding . 7 3�I }�5 77. FIXED SYSTEM FINAL
29. Insulation r/,�� fy's � , 78. FIRE PREV. FINAL
30. Drywall Nailing ' . 7�3I �'$ �� HEALTH DEPT. REQUIREMENT
31. Plaster�Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 9 • �80. FOOD CERTIFICATE ISSUED '
33. Final Electric - Ndtes: �, pL 'F ,�$ ��/�
34. �Final Heating & Air Conditioning 9��4 , � � �_ p�,p FOR SPE�1� �Q� -. TS - • - •
35. Final Gas Pipe-Test � 7/o �j� L D/�cX� L�
36. Hood�or Canopy sJ �� f- � K� �
37. Final Factory Fireplace � ' /
% L �� �O�c��ctevenU oJ'
38. Final Plumbing � ' � 9//L�� a„� er. i i` i a
39. Water Service-Final � -
�.,°, , � � ,r.T �
40. Gas Service-F.inal , � � i
41. Solarpomestic-Final r" � S g�Io �
42. Backflow Preventer j � �o �` �
43. Backflow Irrigation . � � . .�� ��` � .
44. ,Landscape Irrigation System :; ' . �� 0 l� ��� G"%- 7 r+:
45. Sound Attenuation ;�:� ' , u � Q � _
46. Handicap Regulations `' � L9 �yl.�
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed ; �
9 2�
49. Electric Release to Edison , �
50. Gas R�elease to Southern California Gas Co ` ��
� 51. CERTIFICATE OF OCCUPANCY � • ' ; 1 ' � t ; ' � ~
No. Date � � ,
�� _ . _. -. _ _ .. _. . _. . . , . �
City oYCosta Mesa
De�elopment Servires Department
Building Safety Division
P.O.Box 1200
Costa Meu, Califomia
CERTIFICATE OF OCCUPANCY No. ��47.li.:t�Q}
The Building located at rn. . ,n�L .- _
..c
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group A-2 Occupancy.
Use of Building Faah Ftv�rl R�t3l7raltt
Legal Description A.P. 422-141-20
(See reverse side for Metes and Bounds)
BuildingPermitNo G 19017 ElectricalPermitNo. G 19017 PlumbingPermitNo.� ri�T��'�9
P zo6sa
Mechanical Permit No. ^^ i��a� Number of apartments and/or guest rooms
'/� !�/J �
ISSUED T0: Building Official +� i�i ���
Tn_iLfhtl- A�ix3cr Tnn by ,�--, /� ^_'_1 d�f/''v�
�� /
17S(1� F.. Viminia Rrtm. Ralfic.rin Park �e �// �//'GS
r i7 0
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE remrned except by the
Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C.
CMF 1oi5-a6 rev. I/83 Whiie -Owner; Canary - Numerical File; Pink - Bldg. Permit File
\
AYV�icant to flll in all spaces except t�ose wit�in �eavy Dortler lines anC sign all appropriate tleclarations.
C�7Y 0� COSTA M S CO $I ON PERMIT
ProjecY Address, �' 1 �
Appl'rcant's Mailip9 Address � �" y�
Owner's Name � �' Phone $�
Address O ' ICb�ti�n �E �9 W�A/ }i2�, '
Arch/fing. jV2 ��1 N LicenseNo.
Address �� . �"�A\'�� U 1J�
Contractor's Nam ,-� c��-���a `{ Phone33g �
Addregslmailin91J�o2 -• =ILEjiMY' �q�q„iti IG
7
City License No. , � �
LICENSED CONTRACTOR DECLARATION
I hereby attirm [hal I am licensetl untler provi5ion5 ot Charter 9(commencin9
with sp�tion ]000) oi Oivision 3 ot tne Business antl Arofessions COOe, antl
my Ilc@nse is in tull torc�]n� eitect. ^ f'�a�q i��
UCBOSp�IdS� �� J C� '. L� dYOIUC�/
Date_ a • /�� L
WORI(ERS' COMPENSATION DECLARATION ryL{'any ✓���
� hereby attirm that I have a certiiicate oi consent to salf-insure or a certl i ie
�f Workers' Compensation Inzurance, or a certitietl copY thereof (Sectlon
3900, Lab. Q'}i�p�6L��/�S' �M,
PolicY No. l� p -1 ComPanY L'„-OJ`YTQ�A!'Sr.iOE, �
�Ce/(itietl copy is hereby tumishetl. �
Cer�' tl p�` iletl with the city Byjlqin �'visi6if. /�
Date ���� C J Applicant v��� /�(/ l
E%EMpTtON FROM WORKERS' COMPENSATION DEGIARATION
(This sec[ion neetl not be mmpletetl if the permit is for one huntlretl ($300) or
less)
I certiFy that in the pe�(Ormance of tM1¢ wo�k tor which lhis perm�t is issuetl, I
shall not employ any pevson in any manner so a5 to become subject to the
Workers' Compenwti0n Laws of California.
Date Signaturc
'NOTICE: If, af[er making thiz tleclaration, You shoultl become subjec[ to the
Workers' CompenSaUon provisions Of the Labor Cotle, yo0 must forthwith
comply with sucb provisions or tltis permit shall be tleemetl revoked.
CON57RUCTION LENOING AGENCV
1 M1ereby affirm fhat f�ere is a consl�uctlon lentling agency IOr [he perfo�mance
of [he wo�k for which this permi[ is issuetl ($ection 3097 Civ. CJ
LentleYs Name -
Lentler's AtlOress
OWNER BUILDEN �ECLARATION '
I hereby affirm that I am exempt frpm Ne Contractor's License Lnw for tne
folloWin9 reason (Section ]031.5 Business antl Professlonal Cotle: Any city or
coun[y which �equi�¢s a pe�mit f0 construct, alter, im0�ove, tlemolish o� repai�
any st�uclu�e, prio� t0 i[s i55uance, al5o �eqWres [pe applicant (or such permit
to til@ a signetl slal2men[ that he/She Is licensetl purzuant to Ihe provisions of
the ContractOr's LlcenSe Law (Cnapter 9(commenCing with Section 7000) of
'7ivision 3 of the Business antl Protessions Cotle) or that ne/she iz exempt
herefrom antl the ba5is fo� the allegetl ez¢mption. Any violatiOn of Sectlon
/031.5 by any applicant tor a Permit subjects the applicant to a civil.
Qenalty of not more than five huntlretl tlollars (E500). �
LJ I, as owner of the prooerty or my employees with wages as their sole
comDensation, will tlo the work, and lhe s[ructure IS not In[entletl o� ofteretl
tor sale (Sectfon 7044, Buziness antl Prolessional Cotle: The Gontractor's
Licens¢ �w tloe5 not apPly t0 an owner Of a propCrty who builds or imp�oves
therebn, antl who tloes such work himself/herself or through hiz or ner own
emplpyees, provltlea that such improvements are mt Intenaetl or o(ferea for
sale. If, however, tna builtling or Improvement is soltl within one year ot com-
pletiOn, the owner will have the burtlen Of P�oving he/She tlitl not builtl or Im-
prove fortne purpose oi zale). �
❑ �, as own¢v of the property, am ezclusively contracting with licensetl con-
fractprs to construct the Project (SeCtiOn ]044, Bu5ine55 antl PrOfe55Ion5 COtle:
The Contractor's Licenze ldw tloes no[ apply to an owner of proper[y who
bulltls or improves thereon, antl who contracts fo� sutb p�oj¢ct5 wlth a con-
[ractOr(51 license pursuant�to the Contractor's License Law). 1 am aware that
proof o( their Worker's Compensation insuranca shoultl ba provitleE to me.
❑� I am exempt untler Section . B. & P. C. tor this reason
Date Owner ' '
1 M1e�eby tetNfy.tndt 1 nave reatl tM1is application anC state tha[ tM1e above
Inlormation is correct. I a9ree to comply wi[h all city antl county orGinantes
antl s{ate laws �elating to builtling constructlon, dntl he�eby authorize �epre-
5entatHes ot this city •to ente on Ihe above-mentlonetl o or
inspettion pur .,�0 �� �
Slgnature Date
Orivers' License or 55 $
0
�� — Lii :O cS CY ' � .
TVPEOFCONSTRUCTION NEW ADD ,ALTERATION REPAIR
❑ CONVERSION ❑ OEMOLISH ❑ OTHER � Ap #
DESCRIPTION OF WORK/USE OF BLDG.
S Main Buildin9:
TYPEOFPERMIT GRADInIG�y FOVNDATioN STaUCTURAL T Front
❑^ TENANT ❑ ELECTRICAL .181 PLUMBING d MECHANICAC B Rear
LI �oTHER � %�
PROJECT DESCRIPTION St�. FT.� � oCCUPANCv C Right
K Left
CONSTRUCTIONTVPE � VALUATION$ - $
ZONE GRADING CV. VDS. ACRES �Ping. Ref. �
Remarks: Planning No[es:
i
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathmbs '
Clarifiers
Dishwasher �
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
InterceptOrs
Kitchen Sink
Lavatories
Roof Drains
Reinspection Fee
Duct- Under Ground
Duct - Struc[ural
PLUMBING
Showers
'- Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
. Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Waeer Service
Auto-Wash
FEES
$15 Imue Fea $ 3
MECHANICAL PEES
Hood or Type I ❑
Canopy Type II ❑ �
Duct - Vantilaling
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO # �
Heating System & Ducting
❑ a i oo,000 sru � i oo,000 sn
Reinspection Fee � $15
CMF 0865-G6, rev. 10/94 Whlte - Builtling; Canary - ApPlicant; Plnk - Accountin9; Goltlenrotl - Aszessor
Refrigeretion System •
00-100,OOOBTU ❑100,000
System Repair/Alteretion
Fire Dampers
Registers � �
laue Fee
S 3
Automatic Washer
Construction Pole Sub.
Cooking Unit ' "
Dishwasher
Dryers ❑Gas �Electric
Fan '
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �65 KW C
Fee
0311 9/17/B5'
. . ZonB
Accessory Building: -
Parking Req./Provided
Z
O
N
1
N
G
R
E
�
�M
T
�
r '
ELECTRICAI '
Transformer � 15-50KW
� �� 50+KW
' Meter �up ro 700 amps
Meter �over100amps
Sub Panel
'Motors �41 HP 07'h-8
Inc. Solar �g-15 HP 016-15+
Microwave
Pole Light
Range
; Standing Sections
5-75 KW Trash Compactor
$15 Issue Fee
DEVELOPMENT SERVICES RE�UIREMENTS:
Zoning APProvad BY .
Buildin9 Appraved By
SUMMARV OF FEES
BUILDING PEFiM1T $ SMIP '
PLAN CHECK $ -7r PERMIT
• PLUMBING $ /. OO �SSUANCE
PLAN CHECK 25% $ �• D O ENERGY P.C:
ELECTRICAL $� GRADING ,
PLAN CHECK 5p% $ MICROFILM�
MECHANICAL $ TOTAL FEE
PLqN CHECK Z5% $ �
$I
FEES
$ 3
. �CONSTRUCTION AND PLANNING P�� SPA
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
= 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
' 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms .� �
�:4. Electrical Conduit-Undrgrnd. , 55. Electrical Bonding
5. Steel Reinforcement � . 56. Rough Plumbing & Pressure Test
,• 6. Etectrical UFER Grnd. . 57. AP.PROVAL TO COVER-GUNITE �
7. Footings � � 58. Electrica� 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
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 � 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar SYstem-Final
76.� Rough Electric Wiring � 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
' 18: �Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19: Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts,.in 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 OGas ❑Oil -
" 25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing � 76. Dry Standpipe .
28. Lathing & Siding - 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. �Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
� 32. Electrical Power Meter-Final '��� 80. FOOD CERTIFICATE ISSUED
�4'.
33. Final Electric � Notes: - �
34. Final Heating & Air Conditioning � �. � -
35. Final Gas Fipe-Test ' � .
36. Hood or Canopy • � � �
37. Final Factory Fireplace
38. Final Plumbing �l�q�S G�t!%
39. Water Service-Final '
40. Gas Service-Final
41. Solar pomestic-Final '
42. Backflow'Preventer , ' '
GrZn • r, � �
43. Backflow Irrigation� � �{ ifo 2�S : �
44. Landscape Irrigation System '
45. Sound Attenuation , .
46. Handicap Regulations • ' �
47. FINALSTRUCTURE&BUILDING '
48. Special Requirements Completed
49. Electric Releaseto Edison. . _ . ' .
50. Gas Releise to Southem California Gas Co � � � .
51. CERTIFICATE OF-OCCUPANCY � . - -
No. Date
Applicant to till in all spaces except those within heavy bortler Iines anG sign all approoriate Eeclarations. '
CI7Y OF COSTA,Nf�S CONSTRUCTION PERMIT RMIT NO�.r i � 'TRACT NO. LOT NO. ' UNIT ,
ProjectAddrlss 3�� �✓.. �9 � • , .. . . ��J � ' � � , �./ , .
Applicant'S Mailing Address � -s � � �� `��! /f�y��' „ _ ' TYPE OF CONSTRUCTION, NEW � ADD ALTERATION , REPAI R —
OWner'S Name ������" �� � �l � Ph00¢�/�^�;� -� CONVERSION ❑ OEMOLISH ❑ OTHER p�p # . .
DESCFIPTIONOF�WORK/USEOFBLDG. '�' y�
Addieu I�-SfY G�' V.KQ/i-:N ��/�a��'^� %��'E�y Srr.� ; . � 7`� ��" . S Main Building: '
Arch/Eng' �LU��� ��'�'�G�" LicenseNo. ' TYPEOFPERMIT ' GRA�ING F❑iFOVNDATION STRUC7URAL - T Front
Address '�'���� G'. ��L��v/��/ ��•� C%l�ji���.� ❑ TENANT ❑ ELECTRICAL 1+� PWMBING ❑ MECHANICAL . g '
} .��I" ❑ �OTHER ' ' - A Rear '
Contracror's Nama I� � �/��N��'V - �3GrL Phone � Jd ;'Jd l . . - .
,�SL'J-G�� %!K6ii<'/iy� �C7A� .� PA.�L PROJECTDESCRIPTION 5c?.FT. oCCUaANCv C Right
Address (mailing) ' K
City LlCense NO. -s'� /r � , CONSTRUCTION TVPE �VAWATION $ g Left
, ZONE � GRADING CU. VOS. ACRES p�ng. Ref. #
LICENSED CONTRACTOR OECIARATION
I hereby�affirm that I am licensetl untler provi5ion5 0( Charter 9(mmmencing , Rema�ks: � �'_ /(>j �/�J '�� Planning Notes: �
witn section ]000) of Division 3 of the Business antl Prolessions Gotle, antl
my license is in full force antl effect. . ' ' l . ' -
Licenie Cla � Lic se No.'y�`{ �"�/
�ate�' ��-�� Signature ��•� - �
� WORKERS' COMPENSATION DECLARATION " Bar Sink - •
1 hereby affirm tbat I have a certificate of ronsent to self-insure or a certificate
of Workers' Compensation Insurance, or a certifietl copy thereot (Section gackflow Preventer
� 3800, Lab. C.) _ . - �
Cp ds7o �gi9 Y/.;-D�.Yk:9G iniGa�'% y
Policy No. p Compan Backflow Irri ation
� ❑ Certifietl copy is hereby fumished. , � . �
\ �.Qer[ ietl Copy� 5 tilefl with the city Bu�tljn �Qi� si �/ r i Bdthtubs
Date APOlicant L � V�
1 EXEMPTION FROM WORKERS• COMP NSATION DECLARATION Clarifief5 �
-^ (This section neetl not be completetl if the permit is fo� one huntlretl ($100) o� _.
`y less). - r, � Dishwasher
I ce�tify t�at in the pe�fo�mance of th¢ work for which this pe�m�t is issuetl, I
snall not employ any person in any manner so,as to become subject to the Drinking Fountains
Workers'ComOensation'Lawsof California. � �
. Date ' ' Signature � ' � Floor Drains
'NOTICE: H, a/ter makin9 this tleclaration, you shoultl become subject to the
Worke�s' CompEnzation p�ovisions of the Labo� Cotle, you must to�thwith FIOo� Sinks �
comply with such provi5ions o� this pe�mit shall be �tleemetl revoketl. •
CONSTRUCTION LENDING AGENCV GaSS¢rvice;
I hereby affirm that there is a mnstruction'lentling a9enry for Ihe.performancet
of the work -for. whicM1 this' permit is �issuetl (Sectlon 3097 Civ. C.)� Interceptors
Lentler's Name �
Lentler's ACar,ess ' ! ., Kitchen Sink'
OWNER BUILDER DECLARATION � � �
I hereby afiirm that I am exempt from the Contractor's. License Law tor the , Lavatories ,
following reason (Section �031.5 Business antl.Professional Cotle: Any city or . _
county which �equires a permit to construct, alteq iTD�ove, tlemolish or �epai� . P-hdp, .
any structure, prior to its,issuance, also requires the applicant for such permit .
to file a signetl statemenLthat he/she is IicenSetl pursuant to the provi5ion5 of � RoOf Df31n5
the Contractor'S Lic¢nse Caw (CM1apter 9(mmmencing with 5ection ]000) of_
.Division 3 of the.Business antl Professions Cotle) or that he/she is ezempt �
.thereirom antl the basis tor the allegea exemption. Any violatlon ot Section -
7031.5 by any apDliwnt�for.a permit subjects tne applicant to a civil
�endlty ot not more than tive huntl�etl tlollart (E500). �� .�
LI I, as owner of the pro0erty or my employeez with wages as their sole Reinspection Fee
compensation, will tlo the work, antl [he struc[ure is not intentletl or offeretl
for sale (Section 7044, Business antl Professional Cotle: The Contractor'S'. - ,
� License Law tloes no[ apply to an owner of a property who builtls or improves
thereon, antl,,who tloes such work himself/nerselt or throu9h his or her own _
employees, provitletl that such improvements are riot intentletl or offeretl�for Boiler .,
� sale If howeve� the builtling or improvement is Soltl wi[hin One year ot cOm- '
Outlets
PLUMBING . �
r � Showers . . '
$15
pletion, the owner will �have the burtlen of Orovinq ne/she tlitl not builtl o�'im- i DuCY- UndC� G�OUnd
'� rove'for lhe purpose of sale). '' � '
I, as owner of the property, am exclusively contracting with licensetl con- � Duct-S[ructural �
tractors to construct the project (Section 7044, Business ancl Professions Cotle:
The Contracto�'s License Law tloes mt apply to an owner of property who DuCt - VentilBting
' builtls or improves thereon,�antl who contract5 for such project5 with a con- '
tractor(s1 license vursuant ro the Contractor's License Law). I am aware thaf Exhaust Syst¢m ❑ Multiple ❑
proof of theii Wo�ker's Campensation insu�ance sltoWtl be provitletl to me. � � . __
❑ 1 am exemp[ untler Section B,. & P. C. tbr thi5 reaion t FifepUFact. BIL ICBO #
Date � � Owner' �� , � Heating SY5[em & Ducting
I nereby certity that I. have read tnis application antl state tnat ttie above ❑P700,0008TU 0100,OOOBT
informatlon is correcL-I agree to comply with all clty.antl county ortlinances ' ' ' '
dntl Stat¢ IawS relating to builtling construction,'antl hereby�autho�ize rep�e- �
sentatives ot this city to eMer•upon the above-mentionetl property (or � � : � �
inspection pu ose) � � �. � , fj ' �
Si9nature l� ' Date �',r� �
Drivers' License or 55 � � Reinspeetion Fee $15
CMF 0865-46, rev. ]0/84 White - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl -'Assessor ' '
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank '
Swimming Pool w/Spa
Urinal
Water Closet .
Water Heater
Water Service
"Auto-Wash
.LaundryTrays , ' -
Issue Fee
Hood or Type I ❑ � '
Canopy Typell ❑
Refrigeration System � .
❑o-ioo,000sTu ❑ioo,000eru
System Repair/Alteration
Fire Dampers .
$ 3
�
• Isue Fea , , $ 3
r�_
Automatic Washer .
Construction Pale�Sub.
Cooking Unit
DisAwasher ;
Dryers ❑Gas� DElec
Fan • '
F.A.U.
Fixtures •
Device Boxes
Outlets
� - ; G130; 6/05/65
,� _ ,
- � Accessory Buililin9:
r
Parkinq�Req./Provide
. S.�G TL
, �
Zone
Z
O
N
' I �
- N
' G
� R.
' _ Q.
l M .
' S
ELECTRICAL t
Transformer �� 15'-50 KW �� �
� � o so+Kw
Meter ❑up to 1 W�amps
�Meter ❑over 100 amps
Sub Panel
Motors � 0.1 HP � 1'h - 8
Inc.Solar.�9-75 HP �16-15+
�Microwave � .
Pole Light '
� Range �
Switches � Sign
Garbage Disposal � ! Standing Sections
Generator DO-5 KW �5-15 KW �Trash Compactor
0
0
FEES I
�—
Reinspection Fae $15 Issue Fee $ 3
DEVELOPMENTSERVICESREQUIREMENTS: �
2aning Approved By � Date
Buildin9 Approved ey • Date
Application luued By �'� Date �s�.S��A� �J
SUMMARV OF FEES , I ' ,
BUI�DING PERMIT $ ' SMIP� i $ '
PLAN CHECK . � $ � PERMIT � ' , t
� PLUMBING� � $ S�•00 ISSUANCE , $ �
PLAN CHECK 25% $� .-3� ENERGV P.C. �$ �
' ELECTRICAL � ,$ I GRADING '$ . � t
� PLAN CHECK 50% $ ` MICROFILM ' $ /' �
- MECHANICAL ; , $ � TOTAL FEE � $ � U "� '
� ' P�AN CHECK 25% � $ ' �
_ _ � _ ` ' ' ' '�
. CONSTRUCTION AND PLANNING � . POOL & SPA
APPROVALS � Permit # � Date Inspector qPPROVALS Permit # Date Inspector
1. Temporary Electrical Service or P,ole �: 52. Pool & Equipment Location
2. -Soil Pipe-Undrgrnd. - 53. Steel Reinforcement ��
�
�
� 3. Electrical Conduit�Utility-Undrgrnd. 54'. Forms �.
4. Electrical Conduit-Undrgrnd. 55�. Electrical 8onding
5. Steel Reinforcement : � 56. Rough�Plumbing & Pressure Test �
6. ElectricalUFERGrnd.' 57: APPROVALTOCOVER=GUNITE _
. 7. Footings • � 58. Electrical Conduif-Undrgrnd. �
�g,- Foundation ', � - 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgrnd. . 60. Backwash Lines, P-Trap, O Undrgrnd.
10, Structucal Floor System � 61. APPROVAL TO DECK
11, PropertY Sewer Line & House Connection a�br�5 �� 62. Backwash & Receptor-Final
12. Sewer Cap -' , 63. Heater & Vent-Final
13. Roof, Dreins � �• - � � 64. Plumbing System - Final -
14. Rough Plumbing 65+ Electrical�Final -
15. Rough Electrical-Conduit � 66: Solar Systerri-Final �. � �
16. Rough Electric Wiring - � 67. Fencing & Access Approval
.17. Rough Wiring Sign ' _ 68. APPROVED FOR PLASTERING
18, Rough Electrical-T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating &�AiF 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 Ceifing (Structural� & Monocoat 75. Dry Chemicat �
27. Frame and Flashing � � - � 76. Dry Standpipe .
28. Lathing & Siding . . 77. FIXED SYSTEM FINAL
29. lnsulation . � . . 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 G� �"��i Gl�
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. Handirap Regulations • � � � ' '
47, FINALSTRUCTURE&- UILDING � -
48. Special Requirements Completed • � �
qg, Electrie Release to Edison ' � � � - - '
50. Gas Release to Southern California Gas Co ' ' , �
51. CERTIFICATE OF OCCUPANCY ' . '
No. � �Date ` � �
• 1�
a
Applicant to flll in all spaces except those within heavY Oo�Ee� Ilnas an0 si9n all appropriala Eeclara[ions.
CITWOF COSTA MESA CONSTRUCTION PERMIT .
ProjectAddress Sg4 W. 19th St. '
ApplicanYs Mailing Address 5�11—A W- I 2RIbEtt Rd. , La Habra
Owner'sName In & Out Berger - -anooe
Address Roy Williams Contractor
Arch/Eng. License No.
Address
e p- tr g. C -
Contiactor's Nam� �'-' �hon��.�8�.
.6D1- . am er t,:.,
Address (meilin9l ,
`Ca a ra, a. r -
City License No.
LICENSED CONTRACTOR DEGLARATION � '
I�hereby ai(irm tM1a[ 1 am licensetl untl¢r proviSlonS of Chart¢r 9(Commencing �
with Section ]000) O/ DiviSian 3 ot the Business antl Profe55ion5 Cotle, antl
my ticense is in (ull torce antl et(ect. .
Licenze Class — Lic No.
Date 9-3�1—A(. " Siqnature
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I nave a certifiwte of consent to se fins e or a certifiwte
of Workers' Compensation InsurSnce, or a certified tOpY �her¢of (SecHon
3800, Lab. C:)
Polity No. 0404438 Company
�Certifietl coOY is hereby furnishetl. ' � '
CeSifi�tl copy is fiietl with the city Bu� i ivis
�a[e �$6 APP��cant
EXEMPTION FROM WORKERS' CO PENSATION DECLARATION
(This seclion neea not be-como�eletl it the permit is for one nuntlrea ($300) or -
Iess)
I ce�tify that in the per(o�mance of the work for which this perm�t is Issuetl, I
sM1all-not employ any pe�5on in any manne� so as [o become subj¢ct to th0
Workers' Compensation Laws ot California.
�ate Si9nature
'NOTICE: It, aiter makin9 this aeclaration, you zhoultl become subject to the
Worke�s' Comp¢n5ation 0/ovi5ion5 0( the Labor Co�e, you must (ortM1with
comply with such p�ovi5ion5 Or this pe�mlt shall be tleemetl revoketl. ,
CONST0.UCTION LENDING AGENCV • "
I hereby af9�m that there IS a mnst�uction'lentlin9 agency fOr Ihe perto�mance
ot the work for which Ihis permit is I55ue0 (Section 309] Civ. C.)
�enAer's Name � �
Lentler's Adtlresz .
OWNER BUILDER UECLARATION �
I hereby afflrm that I am exempt irOm the ConVactOr's Ucense Law fOr [he
tollowing r¢ason (Section 7031.5 Business antl Professional Cotle: Any city or
counly whicn requires a permit lo construct, alter, improve, tlemolish or repalr
any structure, prior to i[s izsuanca, also requires the applicant tor such permit
to file a.signatl stacement that-he/she Is Ilcen58tl Oursuant to the provisions of
[he Contractor's Lic¢nse Law (ChaDt¢r 9(commencing with Sec[ion ]000) of
Division 3 of the Business antl Pro/essions Coae) or that he/sne is exempl
lhere(rOm antl the Oasls for the allegetl exemptlon. Any violation ot Sectlon
�31.5 by any applicant for a permlt subjecls the apPlicant to a civil
:ndlty ot not more Ihan five huntlretl tlollars (§500j.
J I, as owne� of the 0/operty or my emplOye¢5 with wage5 a5 [helr sole
compensation, will tlo the work, antl Ine structure Is not inlentletl or afferetl
for Shc¢ (SectiOn 7044, Bu5ine55 antl Pro�essional Cotle: Tho ConUactur's
License Law tlocs not apply lo an ownBr ot d property who bulltl5 O/ Impwve5
tM1ereon, antl -who tloes such work himseli/herself or through his or her own
employees, provi�e0 thdl such imprOvam¢nts are nOt inten�etl or offere0 10�
sale. It, however, th¢ bulltlin9 0/ ImprOvemenl iz soltl within one yea� ot com-
pletion, [he owner wlll have Ne burtlen Of provin9 h¢/S�e tlitl nOt builtl Or im-
prova tor the purposa O1 wle).
❑ I, as own¢r of [he prope�ty, am axclusively cont�actin9 wit� licensetl con-
fracto�s l0 construct the projeci ISettion 7044, BuSin¢sz antl Prot¢i5ion5 Cotla:
The ConVaclor's License Law <loes nOt appty to an owner ot prope�ty who
builtls or improves thereon,�antl who contrac[5 tor such prOjecti with a con-
tractor(s licens¢ pursuant�to the Contractor'S License Law). I am aware tnat
proof o� Iheir Wo�ker's Compensation insurance zhoultl be provitletl to me.
❑ I am exempt untler Section B. 3 V. C. tor tnis reason
Date Owner
I hereby certity tbat I bave reai
informatlon is correct. aqree to
antl state Iaws relati o builtlir
SQfltd[IV¢5 O( 'L11�5 C
ip5p¢CtioO pUlO
Signature
upon
oa�e June 14,
�OFCONSTRUCTION ICJd NEW L.� ADD LI ALTERATION I:J RE�AIR,
CONVERSION � DEMOLISH ❑ OTHER Ap ,�y
DESCRIPTIONOFWORK/USEOFBLDG. Ifls}all haatinn
TVPE OF PERMIT LJ GRADiNG
❑ TENANT ❑ ELECTRICAL
❑ -OTHER �
PROJECT DESCRIPTION! Sci3 {i.
CONSTRVCTIONTYPE '�
20NE GR
Rema�ks: •
Ba� Sink
. BaCkflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers �
Dishwasher � .
Drinking Fountains
Floor Dreins
Floor Sinks .
Gas Service Outlats
Interceptors
Kimhen Sink
lavatories
P—Trap
Roof Drains
Reinzpection Fee �� $75
Dut[- UnderGround '
Duct - Structural ,
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
Z P�(�G,�OO�BTU 0100,OOOBT
,� �riverz' Li ense or 55 � - ��+ �,�/�—. I I Reinspection Fee
MF 0865-46, rev. ]0/84 White - Builtli�9; Canary - ApPlicant; Pink - Atcounting; Goltlen�otl - As5e55or
S Mam 6wlding.
E
FOUNDATIO�N, STRUCTURAL T Front
❑ PLUMBING L^f`MECHANICAL B Rear '
A
' '.00CUPANCV C Right
VALUATION $ � g Left
ADING CU. VDS. ACRES ping. Ref. #
� Planning Notes:
FEES
$hOW2I5
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 �
laue Faa ' �I 5 3
Hood or Type I ❑
Canopy Typell ❑
Refrigeration Sysiem
❑aioo,000sTu Oioo,000
System Repair/Alteration
Fire Dampen � '
Registers
515 � � Isue Fee
0
53�2 6/21/85 �3,Op
Zone'
Accessory,Building:
. . Z
� O
- N
I
N
G
R.
Parking Req.IProvided � � E
�
M
T
$
ELECTRICAL , ,
Auromatic Washer � ,Transformer ❑ 15-50 KW—
Construction PoleSub. ' � SO+KW
Cooking Unit .Meter ❑up to 100amps
Dishwasher � Meter �over100amps
Dryers ❑Gas, �Electric SubPanel
Fan . Motors �0.1 HP 01 h- 8
F.A.U. Inc.Solar �9�75 HP �16-15+
Fixtures . Microwave �
Device Boxes Pole Light
Outlets Range
Switches 5�9�
Garbage Oispoul ; Standing Sections
Generetor 00.5 KW 05-75 KW Trash Compactor
Reinspection Fee �$15 � I �ssue Fea
FEES
$ 3
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By Date
Building Approved By Date /�
Applimtion Issued By /N� na�
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $ �
PLAN CHECK $ PERMI7
PLUMBING � $ �SSUANCE $ �
PLAN CHECK 25% $ ENERGV P.C. $ �
ELECTRICAL �$ GRADING 5 .
PLAN CHECK 50% $ MICROFI LM .$
MECHANICAL �Q.C�%� TOTALFEE $ �
PLANCHECK 25% $ ,Z �
. . . _ . , , . _7 �
) CONSTRUCTION AND PLANNING � POOL ?A -
APPROVALS Permit # -Date Inspector qppROVALS Permit # Date Inspecmr
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location �
"2. Sbil Pipe-Undrgrnd. . 53. Steel Reinforcement
� 3.'Electrical Conduit Utility-Undrgrnd. 54. Forms �
�.4. Electrical Conduit-Undrgmd. 55. Electrical Bonding
� 5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test
: 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Foot�ngs � . 58. Electrical Conduit-Undrgrnd. '
8. Foundation � 59. Gas Pipe, O Undrgrnd., Test
.9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Struttural Floor SYstem 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains ' 64. Plumbing SYstem - Final
� 14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical�Conduit 66. Solar System-Final -
16. Rough Electric Wiring 67. Fencing & Access Approval , .
17. Rough Wiring Sign � - � 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL �
19. Rough Heating & Air nditioni FIRE DEPT. REQUIREMENT
20..Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts. Ventilating 71. Product Piping OGas OOiI
23. Gas.Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.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. Plaste� Brown Coat 79. FINAL INSPEC710N
32. Electrical Power Meter-Final . 80. FOOD CERTIFICATE ISSUED
33. Final Electric Nntes:
34. Final Heating & Air Conditioning q•�� [,�/�
35. Final Gas Pipe-Test ,
36. Hood or Canopy -
37. Final Factory Fireptace
38. Final Plumbing
39. Water Service-Final
40. Gas Seivice-Final
41. Solar OomesticFinal _ . , '
42. Backflow Preventer ' � �
43. Backflow Irrigation
44. .Landscape Irrigation SYstem
45. Sound Aitenuation
•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. CERTIFICATEOFOCCUPANCY . .
�!n. � ' Date , � . �
- \I
i
Applicant lo flll In all spaeas except t�ose wlthln �eavy Eortler Ilnas anE slgn all apP/opriata
CITY OF COSTA MESA CONSTRUCTIOIaI PERMIT . PERMIT NO. �_ TRACT NO. LOT NO. 11N17 nin
P:ojeeiAddress -'�LJ� (q�►�' �?j�
�Applicant'sMailingAddress ll-J"V2 Se.,�.no.ti ��' �•(�.
Owner'sName �i^rf' �UT' �:�•'� "T• Phone'
Address .6� `1 t� `1 J�i 14 T{, e.plj�t L.(� CZ .
Arch/Eng. License No.
Address
Contracmr's Namadre�.kj� Cn� w:y'F,.1k� t�tr� pnone � 3" •Sn c./
Ad�ress Imailingl S� c'T�- S•. �•K^�- ✓' '
City License No. - � � S'7
LICgNSED CONTRACTOR DECLARATION '
I nereby aflirm that I am IiceMetl untler prOvisions ol Cllarter 9(commendn9
witn section ]000) o/ �ivision 3 of [he Business antl Professions Cotle, antl
my I��¢nse is in full (orce antl ef(e ct.
IJcense Class : C N Li<¢n No. C G� _
'Date `r� �-`}ti Signature
WORKERS' COMPENSATION DECLARATION • '
I her¢by aftirm tnat I have a certificate of consent to selfinwre or a certlficate
' Workers' Compensation Insurance, or a certifietl coDY thereof (Settlon
00, Lab. G.) �
�IiCY No. t�- srqi � ComPany . T�� 7 �...a � C
� Certifietl covY is hereby tumishetl. �
�_}'Certitietl copy i�filYetl wi[h the city Builtlip� Did on. /
Date a-2-�-^ APPlicant �/J �' �•/ '
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(ThiS sec[ion neetl not be complet¢tl if [he Oermit IS fOr one huntlretl ($300) or
less).
I cer�ity tha[ in tpe p¢rlo�mance ot thB work for which �bi5 p¢rm�t Is ISSu¢C, I
snall not employ any person in any manner so az to become subject [o the
Workers' Compenutlon Laws of Ca6tornia. ,
Date Signature
'NOTIGE: If, after making tnis tleUaratlon, you shouitl oecome sub�ect to tho
Workers' Compensation provi5ions ot the Labor Cotle, you must forthwl[b.
romply wi[h SUCh provi5iOn5 0� thiz 0¢�mit shall b¢ tleemetl rovoketl.
CONSTRUCTION LENDING AGENCV ' -
I nereby atlirm that there Is a conttructlon lentlin9 agency for the performance
oi the work 10r whlch [hi5 permil iz Issuatl (Secllon 3097 Clv. C.)
Lentler's Name
LCntlCr's Htltlreis
OWNER BUILDfH bECLARATION
I h0rnby aftirm that I am oxempt trom tne Contractor's License l.aw for the
follo�ving reason (Section 7031.5 Buslness antl Prolassional CoOe: Any clty or
county whicb rCqWrez a permit to ConsVUC[, alter, improve, Oemolizh o� raPai�
any SVucture, prlor to It5 Issuant¢, also reQuireT Ihe applicant tor suth parmit
l0 1llo.a Slgn¢tl SWtemBnt Ihat he/Sh8 Is IIC¢n5¢tl purTuant t0 [he prOvlslon5 Of
the Contractor'S Ucenso�Law (ChaO�er 9,(commenUng with SecUon 7000) of
DlvlsiOn 3 ot [hc Bu5ine55 an0 PrOlesSiOns Cotl¢) Or that'he/she is exempt
'�+etelrom antl the basis for the allegetl oxemption. Any violation ot Snctlon
31.5 by any aDPllcanl for a permit su�7ects Ine applicant to a clvil
�alty of not moro than hve huntlretl dollars (�500). �
J I, as ownar Of �tw property O� my BmplOyees witn wage5 as th07� zole
<ompensa[ion, will tlo tho work, antl tho sVucture is not IntenOetl or olleretl
for sale �Section ]044, Business antl Professlonal Cotle: Tne Contractor'S -
License Law tloes not apply to an owner of a property who�builtls or improvos
Ihe�eon, antl who tlOes Such wOrk nlTSnlf/he�sell O� Ih�ough his Or he� Own
¢mployee5, provltletl tnat sucA improvomants ara not intenaea or olteroG for
salp, if, however, [he �uiltlin9 or imProvement I5 soltl wilhin one year of com-
plotlon, tne owner will have tha burtlen of proving ne/shn tlle not buI1G or Im-
prove tor the purpose o( sale�.
❑ I, as owner o1 tne proPerty, am oxclutively contracting with Ilcensetl con,
[rattOrs t0 ConStrUct tha proj¢ct (Seclion 7044, Businesi dn0 ProleSSioni Cotle:
Thtl Contractor'S LlcenSa Law does not appty to an owner ot property who
bulltls or imOwves Ihe�eon, dntl wno COntrdtts for SUCh projaC[5 wlth a con- '
t�aclor(51 ➢cen5¢ pursuant to tha ConVacto�'s Litonse Law). I dm awar0 Ihat
. prOot o( thelr Worker'S CoTpenwtiOn insurance ShOultl ba provltloU lo Te.
� I am exempt untler Settlon 8. & P. C. for [hIs reason
� �ate
I nereby certify that I
iniprmation Is torrect. I
anq state laws relalin9
sentatives of this dty
in5pec[IOn PurOaies. '
Signature
Dr��ers' License or 55 �
CMF 0065-46, �ev. 30/84
Owner
itl this application antl state tnat the above
� comply with all clty antl county orElnances
n9 ConStrUCtiOn, anC herGby autho�lz¢ �epr¢-
r upon the above-mentioned proPerty for
��_� Date �24
.� �
TVPE OFCONSTflUCTION - LJ NEW LI ADD LI AITERATION LJ iEEPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG:
TVPE OF PERMIT LJ GRnoING
❑ TENNNT � ELECTRICAL
❑ UTHER
PROJECT DESCRIPTION S4.FT.—
I FOUNOATION LJ STRUCTVRAL
PLUMBING ❑ MECHANICAL
CONSTRUCTION TVPE VALUATION 5"
ZONE GRA�lNGCV.YDS. ACR
Remarks: Ci ,, i•l. _ _ I Y. n� C.....�%_s..
Sink
Preventer
Irrigation
v�mrnmi v �
Drinking Founlains
Floor Drains �
Floor Sinks
GasService Outlets
Interceptors
Kitchen Sink '
Lavatories � �
Roof Drains
Reinspeetion Poo � � $75
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating '
Exhaust System ❑ Multiple
Firepl/Fact. Blt. IC80 #
Heating System & Ducting
❑a� oo,000 sru � i oo,000
Reinspeetion Fee � $15
White - 8uiltling; Canary - APGliwnt: Pink - Accountin9: Goltlenrotl - Aizessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank '
Swimming Pool wlSpa
Water Closet
Water Heater
Water Service
Auro-Wash
laundry Trays
laue Fee
Hood or Type 1 ❑
Canopy Typell ❑
Refrigeration SyStem
04100,OOOBTU ❑700,000
SVstem Repair/Alteration
Fire Dampers ,
Fegisters
laue Fee
FEES
$ 3
FEES
1
S 3
A.P. �p
5 Main 8uildi
E
T Front -
B Rear
A
C R�9ht
K Left
'S
�PIu9. Ref. dr'
Planning Notes:
�
' � . 9606 -9/05/tl5
ZOIIf
Accessory Building:
' Parking Req./Provided
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dryers ❑Gas ❑EI
Fan
F.A.U.
Fixture5
Device Bozes
Outlets
Switches
Garbage Disposal
Generetor OQ5 KW
Fee
n
ELECTHICAL '
Transformer ❑ 15-50 KW -
❑ SO+KW
, Meter ❑up to 100 amps
Merer ❑overi00amps
Sub Panel
Morors �67 HP � I K- 8
Inc.Solar �9-15 HP �16�15+
Microwave - '
Pole Light �
Range
; Standing Sections
5 K W Tresh Compactor
$15 Issue Fee
�5;c"c TL
FEES
S 3
Z
O
N
I
N
G
R
E
Q
M
T
S
DEVELOPMENTSERVICESREUUIREMENTS: '
2oning Approved BY nate
Building Approved By Date
Appliration laued By Date
� � ; SUMMARV OF FEES
� BUILDING PERMIT $ -� SMIP $ ��
PLAN CHECK � $� PERMIT �
PLUMBING $ ISSUANCE 3 �
� i ENERGY P.C. $ �
PLAN CHECK 25% $ ,
� ELECTRICAL�� . $� GRADING � $�
PLAN CHECK 50% $ � MICROFILM $
MECHANICAL S TOTALFEE $� ���
PLAN CHECK 25% $ _ � ;
CONSTRUCTION ANDPLANNING POOL" 'A
A�PROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
�1.� 7emporary Electrical Service or Pole 52. Pool & Equipment Location �
2. Soil Pipe-Undrgrnd. ' .� 53. Steel Reinforcement
�
-�3. Electrical Conduii Utility-Undrgrnd. ' 54. Forms � :�
4. Electrical�Conduit.Undrgrnd. . . 55. Electrical Bonding "
' -
5�. �Steel Reinforcement ���• 56. Rough Plumbing &-Pressure Test /, j
6. Electrical UFER�Grnd.' 57. APPROVAL TO COVER-GUNITE
b
7..Footings � �•� ' 58. Electrical Conduit-Undrgrnd.
�8.� Foundation "� ' 59. Gas Pipe, O Undrgrnd., Test �
9. Water Pipe-Undrgrnd. i ' 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
a-
12. Sewer Cap � �, � 63. Heater & Vent-Final �
�
13. Roof Drains � � g4. Plumbing System - Final �
14. Rough Plumbing � 65. Electrical-Final
%
15. Rough Electrical-Conduit 66. Solar System-Final
76. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. �Rough Factory Fireplace _-- APPROVALS Permit #
21. DuCts, in Structure � 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing �' 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing � rhead Hydro �
26. T-Bar Ceiling (Structural) & Monocoat � 75. y Chemical - 1�
27. Frame and Flashing ry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation . 78. FIRE PREV. FINAL
30. Drywall Nailing ' HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION � -
32. Electrical Power Meter-Final � 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: '
34. Final�Heating'& Air Conditioning �
35. Final Gas Pipe�Test � �
36. Hood or Canopy � �
37. Final Factory Fireplace - � .
38. Final Plumbing . . �
39. Water Service-Final - �
40. Gas Service-Final '
41. Solar pomestio-Fina� -
42. Backflow Preventer � ' �
43. Backflow Irrigation . '
44. �Landscape Irrigation System
45. Sound Attenuation , ' �
46. Handicap Regulations � �
47. FINAL STRUCTURE & BUILDING �
48. Special Requirements Completed � .
,
49. Electric Fielease to Edison
50. Gas Fielease to Southem California Gas Co � �
51. CERTIPICATE OF OCCUPANCY � .
No. Date
ApPlicant to fill in all s0aees except tnosa wit�in �eavY �ortler lines anO si9n all appro0/�ate tlecla�ations. n
CIT O,FCOSTAMESA CONSTR�IICTIONPERMIT � PE,�Mi�-,NO.��/, TRACTNO. LOTNO. �Nj�6, , "'" ": 0600' 4/p3/Ej5 ;13au .`i�.
Proiect Address �� �.L� ��% �"Gh - �' � L'J l `� ��JL/ �_ . . �
tAppli" f�MailingAddress Ir�s�2 E�.VI/'S�n14�CVG � , TYPEOFCONSTRUCTION � NEW ADD, ALTERATION �REPAIR �
n� - �/ ❑ GONVERSION ❑ DEMOLISH ❑ OTHER q,p, #' • , � � i � � Zane,
O�ner's.Name . rn -1`(' Otc}' U-/ �' Ph�n�.� i5lS SSi7 •
� DESCRIPTION OF WOFK/USE OF BLDG.
Address ���,� �S�t�/��� f�. ✓//'s�nK ♦.�wi.. IQi/.k �'/i. 5/70L � � S Main Building: Accessory Building:. �
Arch/Enq.L4��—�0- 5 Lsicens No. CS� ��] � TVPE-OFPERMI GRADING ' FOUNDATION STRUGTURAL � T Front � _ �� � - - ' -�. �
Address - � y � �' /OS�4 QdF �SQ/I�erc � ye`p, ❑ TENANT �.ELECTRISAL �, PLVMBING ❑ MECH�ANICAL , B RCaf � • . ' . - . � . . . � '' N
i� -• �rfe� .�S�SP( Si1i7 ❑ �OTHER • � -}�C�Y ' A I
� Convactor'sName �' � P o < �1 , . . ' � C Right i ' . ' � - N
Address (mailing) : 1 SSOj.' �. V7�4 �A 1n GINt•: Sa��ww. wYi K PROJECT DESCRIPTION 5Q. FT.' oCCUPANCY K �eft G
.� SCbg � CONSTRVCTIONTVPE ' � VALUATION$ $ ;: � � ' -
� City Cicense No. ' '_ ZONE GftADING GU. VDS. � ' �ACRES � , � � �- ' R� �
( LICENSED C�ONTRAGTOR DECIARATION i Ping. Ref. # Parking Req./Provided ' ' Q
�, I:hereby af(irm tnat I am licensetl untler provisionsof Charter-9 (commencing Remarks: ' ' � � � Plarining Notes: ' � . '-. �'-
I with section 7000) of Division 3 0( the Bu5ine55 antl Profef5ion5 Cotle, antl ' _ , M
my license�is in iull orce antl ettect. , ��u�o � � � , _ � • , � � , T �
�' tJcens$ Cla?�5' Lic nse No. � � � � , • � �
. PLUMBING' FEES S
Date�� .�-=Y r � Si9nature . ' ' � . � .
WORKERS' COMPENSATION DECLARATION � 80� Sink � ShOw2R ' ' I � '
1 hereby attirm that I have a certificate bf consent to self-Insure or a certiiicate � ELECTRICAL , . � FEES I'
�f Worken' Compensation Insurance, or a certi�ietl�copy thereot (Section gackflowPreventer � � -ServiceSink � --. � -?- - - � f '-' - '� - -� .
3800, Cao. �c.) - ' - "" �- �' �-- � - iy • � Auromatic Washei � - Transformer � 15�50 K_W
c$' Ci,-79�1 � La�'��.�I„dleme�IL �
� Policy No. � Companp t� S� , Backflow Irri9ation Sewer Cap� � i Construction Pole Sub. , 0 50+ KW
�Certifietl"copy is he�eby tumishetl. � _ � -
Certifieg copy is tiled with the city Bu�DI ion. ��/, Bath[ubs Sewer Connection, Cooking Unit Meter ❑up to.100 amps
Dace` ,�+�' J'Si'S APPlicanl V . . . • ' �
EXEMPTIOf� FROM WORKERS' COMPENSATION DECLARHTION Cld�ifi¢�5 � $Old� COII¢Ct0�5 � Di5hWe5h¢� Meter ❑OVE� 700 dmp5 ;
-(Thi55ection neetl not be completetl if the-permit i5 for One huntlretl (E300) or - � - _ - �-
less). - � � Dishwasher ( Solar Piping , � i � Dryers ❑Gas ❑Electric -Sub Panel .
' 1 certify that in the pe�tormance of the wo�k tor�which this permit i5 issuetl, I - � � . � - ^
shall not employ any person in any manner so as to become subject ta the Drinkiny Pountains � Solaf Tank ' Fan ' � �
Wo�kers'�Compensation taws of Calitomia.. � . ' Motors �0.1 HP O1'h-S ,
. Date � ' Si9nature ' � � Floor Drains � � ' Swimmin9 Pool w/Spa ' . F.A.U. . . .
�NOTICE: It, atter making Ihis tleclaration, you Shoultl' b¢come subject to the ' , InC. SOId� �9-15 HP �16-1$+
Workers' Compensation provisions of the l.abor, Catle, you must forthwith Floo� Sinks , Urinal • - • � - . - - • - -- _ . _ '
comply witM1 such' p�ovisions o� �this permlt shall be tleemetl revoketl. � �� ,FixtU�¢5 � . MiC�OiNav¢ -'l ' '
�
CONSTRVCTION LENDING•AGENCV' ' ' �+ � . � � -. Gas$erviCe Outlet5 �. Watef�CloSet � DeviC28oze5 ' � '
- 1 hereby aftirm that the�e isa construttion�lentling agenty �tor the performance - " � . POI¢ Liyh�
of the work for which this permit is -issuetl (Sec[ion 309] Civ. CJ Inte�ceptors Watet HeatEr, - Outlets ' '
Lentler's' Name; � - Range �
Lenaer'vAtlaress � - KitchenjSink; � WateiService � Switches ' ' ' �
OWNER BUILDER DECLARATION ' = � ' � ' - - _ - ' _ Sign ,
' 1 hereby atfirm that I am �exempt from the ContractorY:License Law for�the Lavatories . Auto-Waih � Garbage Di5po581 '
following reason ($ection ]031.SBusiness and Prote55ional,COCe: Any city or ; Standing $¢ctions
county which requires a permit to <onstNcq alter, improve, tlemolisn or-repalr P-Trep .- � Laundr T.ra s' ' �' �0.5 KW �5-15 KW
any sVucture, p�io� to its issuSnc¢, also requires the appli<ant t0/ such perml[ Y � - Generator T/d5h COrtlpdCtOf i
.to tile a�si9netl statement�thdt'he/she is licensetl,pursuant to the provisions of ROOf D�dins • � �' - ' �
roe Contractor'S License Law (ChaO�er 9.(commencing wlth Section 7000) of - {
Division 3� ot the Bu5ine55 antl Professons Cotle) o� [hat he/She is exempt , � � � . , ,
'herefrom anE the basis tor the allegetl exemption. Any violation. oT Sectlon '.„ ., . . � '
7031"5 by any applicanl tor a Oermit, subjects tlte applicant ato a civil ; � '-
,�enalty ot not more Ihan five huntlretl tlollar5 (5500). ' - ' , � �," � � �
LJ I,- as owner of the property or my employees with wages as their sole Reinspection -Fee ` $15 Issue Fee $ 3
' compensation, w�il'tlo me work, antl the svucturo is not in[entletl or ofleretl �Reinspection Fee $15 Issue Fee ' $ 3 �
' for sale'(Se<tion �044, Business antl Protessional Cotle:,The Contractor's ' � MECHANICAL FEES
License Law tloes not�apP�Y to an'oWner Of a property who builtl5 or Improve5 1
' thereon, antl wno tloes such work himselt/herself or throu9h his or ner own � � . , � DEVELOPMENT SERVICES REQUIREMENTS: , �
' employees, provitletl that such improvements are not in[entlea or oReretl for Boiler � � . Hood or � Type I.❑ _
sale. If, however, the builtling or Improvement is zoltl wlihin one year of com- � . Canopy Type I I�❑ � � Zoning Approved By �' Date �
pl¢tion, the owne�_ will have the burtlen of proving he/she tlitl not builtl or im- � Duct - Under Ground � . . guilding Approved 8y � Data
��rOva for the pu�pose of sale). ' �
I, az owner ot the proDerty, am exclusively contractM9 with Ilcensetl con- Duci - Structural Refrigeration System �;� Appliption Iss� ued By Dat
� Gactors to construct the project (Section ]044, Busioeis antl Professions Coae:
The Contractor's License L.aw tloes not apply to an owner of property who Duct - Ventilatin ' ' ❑0-100,000 BTU ❑100,000 BTU � , ,
buildz or imp�oves mereon, antl who wntracts br such � 9 � - �- - SUMMARV OF FEES ,
projects witb a con- ' - �
tracror(si license pursuant'to rne Contractor4 License Law). I am aware that Exhaust System ❑ MWtiple �' System Repair/Alteration � � BUILDING PEflM1T '$ SMIP ' ;$
proot o4 their Worker's Compen5ation inzurance shoultl be O�oNtletl to,me. , � , r
PLAN CHECK . $ PERMIT
. L7 �I am exempt untler 5¢ctlon , e. S P. G. tor this reason FirepVFact Bit. ICBO # Fire Dampers� pLUM81NG $ �SSUANCE �$ �
� Date Owner ' ' i � Heating System & Ducting Registers i pLqN CHECK 25% $ ENERGV P.C. $
� I nereby certity that 1 have reatl this applicatlon antl state tnat the above -❑6100,OOOBTU �100,0006T � -- �- • ' ELECTRICAL $ �' •�� GRADING $
information iz correct. I agree to comply with all city antl county ortlinances ,
antl state laws relati builain9 construcHon, and hereby authorize repre- ; . ' � ; PLAN CHECK 50% $ � MICROFILM ,$ •
sentatives of -IK t. enter �upon the bove-mentionetl Orop¢rty fo� ' � i �
, insoection our ses. /� � ' n- � , MECHANICAL $ � � �i�
Signature �L ' � Date �� � d � � � TOTAL FEE $
Drivers' License or�SS � Reinspection Fee $15 . ��ue Fee § 3 PI.AN CHECK 25%,' $ . •
CMF 0865-46, rev. 10/84 White - Builtlin9: �anary - Appllcant; Pink - Accountln9: Goltlenroa - Assessor ' I
�,
`, =
. ��
�'� ��NSTRUCTION AND PLANNING � � POG� ,� SPA
_, FAPPyOVALS Permit # Date Intpector AppROVALS Permit # Date . Insp>cTm'
�.1. 7'einporary Electrical Service or Pole / . 52. Bool & Equipment Location
'"2. Soil Pipe-Undrgrnd. _ ' ` - / � 53. Steel Reinforcement �
3. �lectrical Conduit Utility-Undrgrnd. - - 54. Forms
4� Electrical Conduit-Undrgmd. 55. Electrical Bonding . .- .
5.,Steef,-Reinforcement ��. � .� 56. Rough Plumbing & Pressure Test ��
6. �lectrical UFER Grnd. ' 57. APPROVAL TO COVER-GUN�TE -
�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 T0 DECK .
11. Property Sewer Line & House Co'nnection 62. Backwash & Receptor-Final .
12. Sewer Cap ; � 63. Heater & Vent-Final
13. Roof Drains ' 64. Plumbing System - Final � �
14. Rough Plumbing' 65. Electrical-Final
15. Rough Electrical�Conduit , 66. Solar System-Final �
16. Rough Electric Wiring . 67. Fencing & Access Approval ' � �
17. Rough Wiring Sign - 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling -� 69. POOUSPA SYSTEMS FINAL -
19: �Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �
20. Rough Factory Fireplace APPROVAIS Permit #
21. Ducts, in Struaure ' �70. Underground Hydro
22. Ducts, Ventilating . � 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough'& Test 72. Underground Flush
24. ROof Framing _ 73. Undergrnd. Storage Tank 0 Gas ❑ Oil
25. Roof Sheathing , 74. Overhead HYdro .
26. T-8ar Ceiling (Structurap & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. L2thing & Siding � 77. FIXED SYSTEM FINAL
29. Insulation • � � 78. FIRE PREV. FINAL
30. DrYwall Nailing HEALTH DEPT. REQUIREMENT
31. Pl2ster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final . 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Fi�al.Weating & Air Conditioning �
35. Final Gas Pipe-Test . � � � .
36. Hood or Canopy ' . .
37. Final Factory Fireplace .
38. Final P.lumbing � J
39. Water Service-Final '
40. Gas Service-Final � - �
41 . Solar pomesticFinal • - ' . -
42. Backflow Preventer �
43. Backflow Irrigation i � - � ' � . �
44, Landscape Irrigation SYstem � � '
45. Sound Attenuation �
. �
46. Ha�dicap'�Regulations � �- � ' �
47. FINAL STRUC7URE & BUILDING � �
48. Special Requirements Completed - � � � �
49. Electric Release to Edison , � - .- � . ' � ' , � S ' . �
50. Gas Release to Southem Celifomia Gas Co � � . . � �
� �
51. CERTIFICATE OF OCCUPANCY . _
No. ' ' Date ' , -
. - - t
f ' .�
Applieant to flll in all spacas except those wit�in heavy bortler linei anC sign all apPropriata tleclarations.
. CITY oF Cos7A MESA CONSTRUCTION PERMIT •
. Project AddreSs h Q� L✓ � l�'�
ApplicanYs Maili'ngA AFddress LL, e � G/rv /�
Owner'sName R-=-w � � B� �7V��'�hphone� � r'1"�'7
Addreu /�!'i ��' � U/ /% .i//.�//Z /7A'�bW/M�'
Arch/Eng.'U� �'�B�• ��S�G'� License No.
Address � L� G � ���Y� .
Contractor's Nam �'�' �Kd �� b Phone 7!d'-�''Y7
Address Imaiiin9l ���� �` �` v/��`i�/A /)ALb{y/iY��
City License No. 3r:1 ��
LICENSED CON7RACTOR DECLARATION
1 hereby affirm that I am Iicensetl untler provislons of Charter 9(commencing
with section ]000) oi Divlsion 3 oi the Business antl Pro�essions Cotle, antl
my Iicense is in tul/l �torce antl etfect. � �/ O/
License Class (� LlcenS¢ NO V`� ��
Oate 4���� $ignaturp
WORKEftS' COMVENSATION OECLARATION -
' hereby affirm [hat I have a cerliti[ate ot consent to seH-insure or a certificate
Workers' Compensa[ion InsUrance, or a certifietl copy thereof (Settion
.00, Lab. C. p
PolicY'No.P� �U�G % /I.3 ComPanY%NO✓i�RiN4 /+�b�lNi%
�Certifietl copy Is hereby fum�shetl.
Cert�p".fietl ropy s filetl with the city ilding s ,Y
Date -`'��/• S_ APPllcant �'l ` � � ���v
E%EMPTION FROM WORKER$' COMPENSATION DECLARATION
(Thissection neetl not ba complatetl ii the permit is tor one huntlretl ($100) or
less�.
I c¢rtity tha[ in [he per/ormanca of the work fo� which this p¢rT�t is Isspetl, I
shall not employ any person in any manner so as to become subject to the
Workers' eompensation Laws of California.
Date Signature
'NOTICE: It, afte� making this tlecla�ation, you snoultl b!<Om¢ subjecl t0 tha
Worke�z' Compensation provisibns of [he Labo� Cotle, you must Porthwith
comply wilh Su[h p�ovi51on5 or this permit snall be tleem¢tl �evOketl.
CONSTRUCTION LENDING qGENCV
I hereby affirm that tnere is a construction lentling agency for the performance
ot the work tor which this p¢rmi[ ii issuetl (SectiOn 3097 Civ, C.)
Lender's Name
Lentler's Atltlress
OWNER BUILDEH DECLARAYION
I hereby affirm that I am exempt from the Contractor's Litense Law for the
followin9 reason (Section 7031.5 Business antl Protessional Cotle: Any clty or
couniy which requires a permit to conslruct, alter, improve, tlemolisn or repair
any structure, prlor to Its issuahce, also requires the applicant tor such permit
to file a signetl StatCment that he/she is licensetl purivant to IM1e prOvisiOns of
the Con[ractor•5 License Law (Chapter 9(commencing wl(h Section 7000) of
�ivision 3 of the Business anV Professions Cotle) or that he/she Is exempt
?refrom antl the baSis for the alle9etl exemptlon. Any viOldtion ot Section
31.5 by any applicant tor a permit subjec[s tha appliCant to a civll'.
.nalty ot not more [nan tive hUntlretl dollars ($500).
❑ I, as owne� of [he prope�ty o� my ernPloyees wlth wage5 as their sole
compensatlon, will tlo lhe wOrk, antl the SVuc[ure IS not intentletl O/ offeretl
for sale (Section 7044, Business antl Professional Cotle: The Contractor's
License Law tloes not apply to an owner of a property who builtls or improves
thereon, antl who aoez such work himselt/herself or through nis or her own
employees, provitletl thal Su<h improvements are not In[entled O/ ofter¢tl to�
sale. If, however, the builtling br imP�ovement I5 Soltl within one year of com-
pletion, [he owner will have the bu�tlen OT p�oving h¢/she ditl not builtl or irt�-
�rove torthe Ourpose oisalo).
I, as owner Of Ihe properry, am ¢xclusively ContracUng with lic¢nsetl con-
traCto6 to const�uct th¢ p�qeq (Se<tion 7044, Business antl P�ofessions Cotle:
The Contractor'S LlcenSe Law tloes no[ apply to an owner ot property who
builas or improves Ihereon,-antl who contratts tor such projecls witn a con-
tractor(51 Iicense pursuant to the Contractor's Llcense Law). I am awar¢ (hat
proot of th¢ir Worker's Comp¢nsation insurance Shoultl be provitletl to me.
❑ I am exempt untler $ectlon B. & P. C. for fhi5 r¢a5on
Date
Own¢r
have r¢a
, , �� �� ....... .._. __. .._. .,,. , �.
TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p, #
DESCRIPTION OF WORK/USE OF BLDG. �
S Main Building:
E
TVPEOFPERMIT GRADING FOUNDATION� STRUCTURAL T FfO�t
❑ TENANT ELECTRICAL ❑ PLVMBING ❑ MECHANICAL A Reaf
❑ OTHER
PROJECT �ESCRIPTION 5�. PT. OCCUaArvCv C Right
CONSTRUCTION TVPE VALVATION $ g� Left
ZONE GRADING CU. VOS. ACRES p�ng. Ref. �
Remarks:. �.�,..lp %/ %cy.,p/i /'/l , rjL _ �PlanningNotes:
Sink
Preventer
Irri9ation
Drinking Fountains
Floor Drains '
Floor Sinks
Gas Service
I nterceprors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fee
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
/ Urinal
Outlets Water Closet
- Water Heater�
Water Service
Auto-Wash
Laundry Trays
$15
Dutt-UnderGround�
Duct - Struciural
Duct - Ventilating
Exhaust SyStem ❑ Multiple_0
Firepl/FacL Blt. ICBO #
Heating System & Ducting
� o-i oo,000 eTu O i oo,000 sT
��v��a����
T Reinspection Fee $15
Drivers' Lic¢n5¢ o� 55 �
I CMF 0865-46, rev. ]0/84 White • guiltling; Cana�y - AppllWnt; Pink - Accounting; GOltlanro0 - ASse55o�
laue Fee
Hood or Typel ❑
Canopy Typell ❑
Refrigeration System
❑aioo,000sTu ❑ioo,000
System Repair/Alteration
Fire Dampers
Issue Fee
Automatic Washer
� ConstructionPaleSub.
Cooking Unit
D ishwasher
i' Oryers ❑Gas ❑Elec�
'�� Fan
F.A.U. '
Fixtures
Device Baxes
Outlets
Switches
Garbage Disposal
Generetor �0�5 KW C
D065 9/ 13/85 �co0' P!
zone
Accessory Building:
Z
�
N
1
- N
G
R
Parkin9 Req./Provided E
Q
� M
• T
S
ELECTRICAL
Transformer ❑ 15�50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter ❑over100amps
Sub Panel
Motors�0.1 HP�1'f.-B
Ina Solar 09�15 HP � 16-15+
Microwave '
Pole Light � � �
Range '
; Standing Sec[ions
15 KW Tresh Compactor
S 3 I
�— Reinspection Fee $15
FEES
DEVELOPMENTSERVICESR �I
2oning Approved By
Building APProved By j'�
<
I
Ek£CTRICAL / B
PLAN CHECK 50% $
MECHANICAL $
$ 3 PLAN CHECK � 25% $
Issue Fee
REMENTS:
FEES
$ 3
RV OP FEES
SMIP � $
PERMIT
�_ , ISSUANCE $ �
ENERGY P.C. $
',�,Z��[)() GRADING $
� MICROFILM $ '
� TOTALFEE $ a�, ac�
�CONSTRUCTION AND PLANNING POOI 'PA
� �APP.ROVALS Permit# Date Inspector � qppROVALS Permit# Date Inspector
r
�. Temporary Electrical Service or Pole 52. Pool & Equipment Location
!2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit•Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings , 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection • 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final -
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit . 66. Solar System-Final .
16y,fiough Electric Wiring '67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18�. Rough Electrical-T Bar Ceiling' �'_ 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT '
20. Rough Factory Fireplace . � APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro .
22. Ducts, Ventilating � i 71. Product Piping O Gas ❑ Oil -
23. Gas Pipe-Rough & Test .� �72. Underground Flush
24. Roof Framing � ' 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro �
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical _
� 27. Frame and Flashing . , 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 7$. FIRE PREV. FINAL
' 30. Drywall Nailing � HEALTH DEPT. REQUIREMENT �
�,31. Plaster Brown Coat ' 79. FINAL INSPECTION
- 32. Electrical Power Meter-Final � 1 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test ' - �
36. Hood or-Canopy � - . �
37. Final Factory Fireplace �
38. Final Plumbing ' . -. , �
39. Water Service-Final . " .
40. Gas Service-Final + � - .
41. Solar pomestic-Final • ,
42. Backflow Preventer ' � . '
43. Backflow Irrigation � • .
� 44. Landscape Irrigation System � � '
45. Sound Attenuation �
�
46. Handicap Regulations � � �
47. FINAL STRUCTURE & BUILOING �
48. Special Requirements Completed : �
49. Electric Release to Edison �
50. Gas Release to Southern California Gas Co �' � -
�
51. CERTIFICATE OF OCCUPANCY • ' .
No. ' `Date ' � I . � �
l. �
fill In all soaces withln
CITY OF COSTA MESA
CONSTRUCTION PERMIT
AddreYs �D 5r.n 907
Arch/Eng. License No.
Addregs
Contractor a , G/_ _ei_._ Phone
1 heleby atfifm lhal I am IICGnSetl untl0r pfovl5lof15 Of ChdlteY 9(COm-
manciny witn section 7000) of DIVISIon 3'ot tne Business ana
R'olcsifons Cotle, anC my Itcense fs fn full lorce a U effect.
Llcenu Cla s G Lite s o �
DatO � g2 SI9 � �
WORKpRS•COMFENSATION �ECLARATION
I hereby aftlrm [hat I have a certlfltato of consent to salt-Insure ar a
cnrtlficdte of Workers' Compensatlon Insurance, or a certlfietl copy
thereot (5¢ction 3800, Lab. C.). �
ICY No. Company
Cert���¢� copy IS nereby (uroishltl. -
�I CO/li}�etl cOpY �5 �Iletl wi[h the city Builtling OivlSiOn.
E%EMPTION FROM WORKERS' COMPENSATION DECLARATION
(TbIS 5@�tion neatl nOt be complet¢tl it tha perTi[ is to� one huntlr¢U
SE300) or less�.
certtfy that in the performance of the work for which this permft is
Issuetl, � shall not ¢mploy any p¢r5on In any manne� so as to beCome
Date ' / � �/-�' Si9nature
NOTICE: If atter mdking this tleclaratlon, you ahoultl become subject
t0 the WOrktts' Compinsatlon P/avlSiOns ot the Ldbor Cotla, you muzt
fo�Ihwith camplY �+'��h Such DrOvliioni Or Ihis permil Shdll b@ deemetl
reWk¢.y,
CONSTpUCT10N LENDING AGENCV
I hereby affirm Ihat thcro is a construttlon lentling agenty tor tne oer-
formance of the work lor which this permlt is issuotl (Section 309�
Clv. C.),
Lentler'S Name
Lontlar's Atltlress
OWNER BVILDER DECLARATION
I herebY atfirm that I am exempt irom the ConVacror's Licensa Law for
the follow�ng reazon (5ection 7031.5 Business antl Prolessions Cotle:
Any City or County whith reqWreS a permit t0 ConsVuct, alt¢r,
improve, tlemolish or repair any strucWre, prior to'its issuance, also re-
qW�eS [hC appliWnt lo� Su<h permit to iile a Signetl slatement that hC
Is IicenEetl pursuanl to the provisions ot tne Contractor'S Llcense Law
fChapt¢r 9(commen<in9 witn Section 7000) of DiviSion 3 of lhe
8us(ne55 antl Pro1¢ssion5 Cotle) or that he fs exempt thCr¢(roT antl th¢
5is iOr the allegetl ¢xempHon. Any violation ol .'>ectlon ]031.5 by
r a0pliwnt for a permit subjects Ihe applicant to a civil penalty
nol mo�e than tiy¢ hunOretl tlollarz (S500j.
L] I, d; owner of tne property, or my ¢mployee5 with wa9es a5 their
sole <omoenzation, wi11 ao tne work, antl the 5[ructure is no[ inten0etl
br otferetl for Saie. ($ection ]044, Business antl (hofessions Cotle: The
Con��aC[or's Licens¢ Law tloes no[ aOPb to a0 owner 01 a property
w�o b471tls or imptov¢5 thereon, antl wM10 tloe5 zuch wo�k himself o�
lhrOu9ry hiz own employees, provitlBtl that Such improvemenls a�e.not
in[endetl ar ofieratl IOr sale. If, howeveq Ih¢ bUiltling or ImO�ovement
Is soltl within ona year ot completlon, the owner will hava the burtlen
ol Proying he tlitl not builtl or improve tor the purpose ot ule�.
❑ �, dS Owne� ot t�e prop¢r[y, am BxCluSivery cont�ac�ing with
an Owqe� ot property wh0 DUIItlS or ImOroveS thereon, anC wh0 con-
ba<ts Irom such pro�ects with a�ontrattor(5) Iicesnetl pursuant co
the Con[ractor's Licenso Law).
❑ I am Exempl untler $eGllon B. 8 P. C. fOr thiz
reason
Date Owner �
I her¢by�ertityt�dl I pave �eatl thi2 app1lW[Ion,and StatG lnat the abov¢
inlormdtbn is <orrect. I a9ree l0 comply with all cily anU manty
Or0lnaqce5 antl stala IawS relatin9 t0 COnst�uctio�, dnC he�eby autho�lie
ropre5entatives of lhis city to enter upon tbe above rt�entionetl
property tor 1 ctlon s. .- � ^t
Slgnalyre Da[e 11
Eo�Oer Ilnes antl si9� all a00ro0��ata tleela�itio�
TRACT NO. ' LOT NO. BLOG. NO.
7VPE OF CONSTRUC710N
❑ NEW ❑ ADO ❑ ALTERATION
❑ REPAIR �SCONVERSION ❑DEMOLISH
❑ OTHER
❑ESCRIPTION OF WOHK
TVPE OF PERMIT
❑ GRADING ❑ FOVNDATION ❑ STRUCTURAL
d TENANT �I ELECTRICAL ❑PLUMBING ❑MECHANIC
❑ OTHER
PROJECT DESCRIPTION
50. FT.
OGCUPANCV�CONSTRUCTION TVPE
VALVATION ZONE
GRAOfNG CU. YDS. ACRES
PLUMBING PLANCHECK
TOIlETS URINALS
IAVATORIES DOUBLE LAVS
KIT.SINKS DISHWASHER$
SERVICESINKS � + SUMPS
FLOOR SINKS FLOOR DRAIN'.
DRINKING FOUNTAINS �
INTERCEPTORS CLARIFIERS
$WIMMINGPOOL PTRAP
WATERSERVICE HLTERATION-
GASSERVICE OUTLETS
WATER HEATERS BTV�OUTPUT ,
SEWERCONNECTIONS
SOLARTANK COLLECTORS
$OLAR PIPING $V5.
ISSUE FEE
MECHANICAL PLAN CHECK
HEATING SYSTEM 0-300,000 BTV _
AND DVCTING 100,000 + BTU _
::EFRIGERATION 0-100,000BTV_
SVSTEM 300,000+gTU�_
BOILERS BTV
SYSTEM REPAIR,ALTERATION
EXHAUSTSVSTEM MULTiVLE
I Drivers` License or 55 � � � �SSUE FEE
CMF Og65-46 White-Builtling; Canary-Appliwnt; Pink-Accountin9: Goltlenrotl-Assessor
0964, 7/02/82
A.P. _,
ZONE
REAR YAFD (70 P/L�
VKG. SPACE REQ.
STREET WIDTH
ZONING APPROVED BY
:PECIAL CONDITIONS:
ELECTRICAL
� 16.00 Tl
PLNTGp.gRUEF.� �
PROPE�RTVNLINE
PROVIDED
PARK FEE E'
DATE
PLAN CHECK
crvtns+i �rH 0-1 KW__ 1-10 KW �
TRHNSFORMER
APPLIANCE 10-SOKW_SO+KW�
' MOTORS 0-1 HP 1-30 HP _
- (INC SOLAR) 30-SO��HP 50 � HP ,_
FI%TVRES y OUTLETS SWITCHES
GASTUBESIGN$ - '
POLE LIGHT$
PANELS MAIN SVB
SERVICE F
155UE FEE ' ' .
APPLICATION APPROVED BV
SUMMARV OF FEES
BUILDING
PERMIT § SMIP b_
PIANCHECK S PERMIT
ISSVANCE E_
PLUMBING S
PIANCHECK S% GRADING E_
E�ECTRICAL S�(�_ $-
PLANCHECK § M�CROFILM E_
MECHANICAL $ TOTAL FEE S _
PLAN CHECK § LE55 AD-
VANCEPC S_
FINALFEE S�
CONSTRUCTION AND PLANNING POOL & SPA �
APPROVALS Permit# �'y�'�3 Date Inspector qppROVALS Permit# Date Inspector
t. Temporary Electrical Service or Pole 43. Pool�& Equipment Location �
Soi ipe-Undrgrn 44. Steel Reinforcement •
3. Electrical Conduit UtilityUndrgrn 45. Forms �
4. Electrical Conduit-Undrgrn .IU_gZ CL+, 46. Electrical Bondin
. tee ein orce 47. Rou h Plumbin & Pressure Test -
6. Electrical UFER Grn 48. APPROVALTO COVER-GUNITE
7. Footings 49. Electrical Conduit-Undr rn
B. Foundation 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgrn � 51. Backwash Lines P-Tra ❑ ndr rn � - '
10. Structural Floor System 52. APPROVALTO DECK
1 i. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final �
12. Street Sewer Connection � - 54. Heater & Vent-Final
13. Rough Plumbing
14. Rough Electric-Conduit 56. Electrical-Final
15. Rou h Electric-Wiring �� - 57. Solar System-Final �
16. Rough Hea[ing & Air Conditioning / I • encing & Access Approval
17. Ducts in Structure APPROVED FOR PLASTERING
16. Ducts, Ventilating ' . �
19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL �
20. Roof Framing
21. Roof Sheathin '
22. Frame and Flashin NOTES:
23. Insulation •
24. lathing & Siding
25. Drywall Nailing � -
26. Plaster Brown Coat
27. Electrical Power Meter-Final '
28. Final Electric ��52 -
29. Final Heating & Air Conditioning '
30. Finai Gas Rpe•Test '
31. Final Plumbing
32. Water Service-Final -
33. Gas Service-Final
34. Solar pomestic-Final
35. Landsca e S rinklin S stem
36. Sound Attenuation
37. Handicap Regula[ions
38. FINALSTRUCTURE&BUILDING
39. Special Requirements Completed
40. Electric Release to Edison '
41. Gas Release to Southern California Gas Co. �
42. CERTIFICATEOFOCCUPANCY
No Date
-�1
AOV�icant t0 fill in all s0aces excepl thoza
�f • CiTv oF COSTA M{E�S�A/ CONSTR�CTION PERMIT �.
. ProjectAddress U�7 �' �� '
YCpplicant's Mailin P:ddreu � � 4� w��
Owner's Name - ' � � �� 8o�r� S�`k't�k5 �
�
Addreu 3 O � -Vlf' �SQ.i • ' !,p�
Arch/Eng. � +, � .�1� Licenu No. � ��7 0 -
Addreu ��I3J C �A/ns� �M' x�n�orr.. Gpb�i .lLVc�G '
�Contracror's Name i��'� � Pho e��
Addresslmal�ingl � �SO,Z,p�,Ui�o�w�iavC f�sc�w.,.'✓ark. �
� CitY�License No. � �s��° p '__ _ . ' r .
LICENSED GONTRACTOR DECIARATION '
` I hereby,a(firm that I am licensetl untler provislonsof Charter'9 (commencin9
� with section 7000) ot Division 3 of the Business antl Professlonz Cotle, antl '
my licen5e iz �� �ull fo% �e antl effect. Ury�
License Class V . ^ --� J, �
Date� �,�'� 5�9�
WORKERS' COMPENSATION DECLARATION
I hereby a(firm that I have a certlficate o( consent to selt-insure or a certi/icate
�� Workers' Compenwtion Insura�ce,�or a certlfietl coPy thareof (Section
'00, Lab. C.)� • T ,�`,,,�
�IICY No. r (� %56-79�.� ComPanYY�KE*r�\ �'�'�^'L�Y.
eCertifletl copY is neraby furnishetl. � ' ,
Certi ietl copy 15 fi1eO w{th the city By��ing�� vi5ip n^� n
Oa[e � �'"Gr � AOP��cant_{L1z,..d=n✓'C'a'M✓�
EXEMGTION FROM WOf1KER5' COMPENSATION DELLARATION
(Thissection �eetl nat-be campletetl if the permit�is for one huntlretl (5100) or'
less): • : � � �
1 certify �[hat in the performdnte Ot the work fo� which this perm�t is i55uetl, I
shall not' emP�oy any peroon in any mann¢r SO d5 to become subjec[ to th9 '
Workers'�Coinpensation;LawS of California. ' �
Date - 5(gna[ure �
��NOTICE: I(, afte� making this tlecla�ation, you slioultl'b¢come Subj¢ct to the
Worker5' COmpenSation provi51on5 of the Laboi Cotle, You mu5t torthwith
comply witn, sucn provisions oi this permi[ ihall be tleemetl revoketl.
CONSTRUCTION LENDING _AGENCY � '.^ :•� � '
I hereby afti�m that tM1ere I5 a�constructlon Ientlinq agency for the perto�mance _
of tne work for which tNs permit is IssueO (Sectlon 309] Civ. C.), �
Lentler'S Name �
Lentler's Atldress - = � � �
OWNER BU�LDEH UECLARATION � � �
I he�eby a(f�rm tha[ I am exemOt (rom the COnlrac[or'S�Lic¢nze Law to�•the
followin9 reason (Section-7031.S�Business antl Professional Cotle: Any city or
counry wniGn requires a permlf do �onstruct, alter, Improve, tlemoiish or repair
any structure, Prior to Its issuance,�also requires the applicant for such permit
'� to file a,5i9PBtl stalemen[ thdYhe/she I5 Ilcensatl pu�sua0t to the provisions o/
the Contractor's LicenS¢ l.aw (ChaPter 9(commencln9 wkh Section ]000) of
Divisian, 3 of the Business antl Rrofessions Cotle) or that he/she is exempt
[heref�om aPtl Ihe ba5i5 fo�'the alle9etl exemption. Any violdlion�of Section
'�031:5 by any ap0�icant tor a Permit. subjects tne aOP���ant �to a civil -
�alty of no� more than five huntlreU tlollars (E500). - '. ,
� 1, as' owner oi the property or. my :employees �witn wagos. as their sole
. ompensatio�, �+��� tlo the work, a�tl the.ztructure is not intentletl or o(feretl
to� sale. ($ectlon ]044, Bu51ne55 an�- Pro�esSional Codeo The, Cwtractor's
License LaW tloes not apply to an owner oi a property who bulltls or improves
thereon, an0 �+'ho tloes Such work himself/he�selt'or thrOuqh his or h¢r own
employees, provitletl that sucM1 imProvomenfs are not in[ende0 or offeretl for
sale. If, however, the bulltling or impwvement I5 soltl within one year of com-
O�etiOq the Owner will hav¢ Iha burtlen of proving he/sh¢ tlitl not builtl or im-
��rove to� Ih0 Purpose ot saleJ. ' , ' -
U I, as owqer ot [he property, am extlusivery contractin9 wfth licensetl con-
, t�actors t0 Construct the projCct (Section 7044, Buziness antl Professions Cotle:
Tne Cuntractor's License Law dOes not appiy to an owner of prope�ty who
,�builtls or IrYiProves thereon, antl who cont�acts 1or sdcM1 Projects with a con-
tractor(s1 I1Lense pursuant�[o lhe Contractor's Llcense Law). I am aware that
prwt o( the�r Worker's Compen5ation insUrant¢ shoultl be provltletl to ma.
❑�I am exernot untler Section B. h P. C. fOr thi5 reason
� .
Dafe Owner
1 hereby celtify .that I.nave read thi5 application antl state that dhe above-�L -
Informatlon is correct. I agree to comply with all clty antl county ortlinancas
a�tl statfl la++s relating to builGinq mnstruction, antl hereby autnorize re0re-
sentatives o� lhis en er u on o above-mentlooetl property �for
lnspection pUrD s � / . r, ,! /
� Date 7'Y ��(1
unes antl Si9n all approD��ale
TYPE OF CONSTRUCTIO . LJ NEW ' LJ ADO I-I �ALTERATION LJ REPAIR '
❑CONVERSION.�DEMOLISH�OOTHER - q-,p.# " �
DESCRIPTIONOFWORK/ EOF,BLDG. �nr6_.-_-t SPPujLg C{�,TIO+�
�'�� �, � i S, Main Buildin
TVPE OF PERMIT ' G ADING , FOUNDATION STRUCTV RAL , _. T Front '�
- ❑ TENANT ❑ ELECTRICAL �LUMBING ❑ MECHANICAL � � B qear ='
❑ -OSHER ' � � . . . - � ' � ' A
C Right
P,RQIECT DESCRIPTION Sq. F7. - OCCUPara v�— K �
.'CONSTRUCTIONTVPE � VAWATION$ D':%D g Left
• ZONE GRADINGCUYDS �ACR S
3r Sink �
3ckflow Preventer��- � ^�
3ckflowlrrigation . �
athtub's
aritiers '
ishwasher ; •
rinking Fountains '
oor Drains .
Gas Service
Interceptors'
Kitchen'Sink '
Lavatories , -
P-Trap'
Roof. Drains �
a
. . � Ping. Ref. # .
- � � Planning Notes:
i ' �
PLUMBING '
Showers ^
- Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping �
Solar Tank
Swimming Pool w/Spa
Urinal -
Water Closet .
Water Heater -
_ Water Service
r ' . I r
�Fee ' $15 � � Issue Fee
� � _ MECHANICAL , � •
Boiler
Dutt - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. BIL ICBO #
Heatin9�$ystem & Duc[ing '
❑ o-i oo,000 eru � i oo,000 sn
��
9gnature
, Orivers' Lice�s¢ or 55 � ' �ieinspection Fee $15
CMF 0865-46, r6�. 30/84 White - BU��tling; Canary - Ap0licant Plnk - ACCounll09; Gol�enrOtl - Aszesso�
Hood or Typel I
Canopy Typell �
Refrigeration System
❑0-t00,0008TU ❑
System Repair/Altera
Fire Dampers�
0
Issue Fee
0,000
�
Constructian Pole
Cookin9 Unit ,
�63U IiSTrr73ri
� � � - '
Parking Req./Provided ' �
. . � .
ELECTRICAL � � ,
' � Tran'sformer � 15-50 KW
❑ 50+KW
Dryers LJGas OElectric
Fan
F.A:U. .
Fixtures - --
Device Boxes '
Outlets
Switches
Garbage Dispoul
Generator �0-5 KW �5�15
Meter �upto,t00�amps ,
Meter ❑over 700 amps �
Sub Panel �
Motors � P 7 H P O i X-�8
Inc. Solar 09-75 HP 016�15+
Pole Light
Range �
1
Z
O
N
�
N
G
R
E
Q
M
T
S
; Standing Sections ; � ,
Trash Compactor ,
§ 3 I
� Reinspection Fee $75 Issue Fee
FEES
, � DEVELOPMENTSERVICESREQUIREMENTS:t
2oning Approved By
Building Approved By
' Aooliption Issuad Bv �
$ 3
$ 3'
�
i
�
SUMMARV OF FEES ' '
BUILDING PERMIT $ � %•.SO � SM�P � �,$ � �:S G
PLAN CHECK $ pERM1T �
PLUMBING $ � )�UANCE $
PI.AN CHECK 25% $ ENERGV P.C. $ �
ELECTRICAL $ � � GRADING $ ' �
PLAN CHECK 50% . $ MICROFILM � $ ' �
MECHANICAL $ � TOTAL FEE $ �'z'�
PLAN CHECK 25% ' $ ' '
,
I �� C¢NSTRUCTION AND PLANNING � , ' POOL t >
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Insp>crnr
1. Temporary Electrical Servic¢ or Po1e � : 52. � Pool & Equipment Location _ �
. 2. Soil Pipe-Undrgrnd. ' � :. • -53. �Steel Reinforcement
� 3. �Electrical Condui[ Utility-Undrgrnd. � 54. -Forms -
�4: Electrical Conduit-Undrgmd. _ 55. Electrical Bonding �
1 5. Steef•Reinforcement . '_ - ' 56. Rough Plumbing & Pressure Test ,
�, 6•� Electrical UFER Grnd. . 57. APPROVAL TO COVER-GUNITE
f.7. Footings • , 58. Electrical Conduit-Undrgrnd. •
� 8. Foundation • . , • - 59. Gas Pipe, � Undrgrnd.,.Test �
9. Water� Pipe�Undrgrnd. ` " 60. Backwash Lines, P-Trap, � Undrgrnd.
.�
10. Structural Floor System . � 61. APPROVAL TO DECK
'11�. Property $ewer Line & House Connection • ' -62. Backwash & Receptor-Final
12. Sewef Cap�� � " � � 63. Heater & Vent-Final '
( 13. Roof Drains " � 64. Plumbing System - Final -
2
14. Rough Plumbing . � 65. Electrical-Final
15. Rough Electrical-Conduit � 66. Solai System-Final
1�6. Rough Electric Wiring ", 67. Fencirig & Access Approval - �
�
17'• Rough Vt%iring Sign ' � 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL -
b9� Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20�'Rough Factory Fireplace , APPROVALS Permit #
21. Ducts, in�,Structure. � 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test . 72. Underground Flush .
' .24. Roof Framing � . 73. Undergrnd. Storage Tank � Gas ❑ Oil
i"� '� Roof Sheathing 74. Overhead Hydro
•.26. T-Bar Ceiling (StructuraQ & Monocoat 75. Dry Chemiral
27. Frame and Flashing 76. Dry Standpipe - -
28. Lathing & Siding . 77. FIXED SYSTEM FINAL . �
� 29. Insulation � 78. FIRE PREV. FINAL
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat � 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
l 34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test ' '
36. Hood or Canopy � �
' 37. Final Factory Fireplace .
r
� 38. Final Plumbing C�.'y,�� �,i4?� Q/� /� (i�
.. �.3�. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final � , ' .
42. Backflow�Preventer . . � ' ' �
43. Backflow Irrigation ' '
44. .Landscape Irrigation System �
45. Sound Attenuation -� � � . �
46. Handicap,Regulations � �
47. FINALSTRUCTURE&BUILDING � �
48. Special Requirements Completed � � � "
49. Electric Release to Edison � � - ' � ' . �� � �� ,i
50. Gas Release to Southem California Gas Co � ' � •
� '
57. CERTIFICATE OF OCCUP.ANCY ' _ _- ;. .. . , - ' � �
� Nn. . . : Date � . � � .
Applicant to fill in all spaces ezcept thosa wit�in �eavy
CITY OF Cosrn ME�S/A CONST�UCTI.ON PERMIT
Pro ect Address ��/ �'� � 9 ty' ,
� . .�� Z.L� - � . d +jx7t�k'v5s
'Applicant's Mailing Address /
Owner's Name �N �N. /l✓� � �j✓RGldi%i ����'
Address � '�'� �� —f� P
Arch/Eng. �G%T�P ,ObS/ G/✓ License No. �
Address �'� � CCy ✓�.f� V �
Contractor'sNama '�G61/¢4� %aj'Q o�e354�CS'.0 J
Address (mailing) �jrC:� G! viRGi.✓/i� /)/yG/�t��.✓ �iy,�
City License No_ ,� �� �
LICENSED CONTRACTOR DECLARATION
I hereby at(irm Ihat I am licensetl untle� O�ovi5ion5 of Charter 9(commencin9
with settlon ]000) of DivlSion 3 of the Business antl Prote55ion5 Cotle, and
my Iicense is in tull )(�o,rce antl effect. ' �'
License Class F..,/ • tic¢n5¢ NO. �,
EZ�"�`4� 4/�a ca ��� �
Date h�_� �!�G�Signalure �� 6 !�
WORKERS' COMPENSATION D A ATION
� hereby affirm that I have a certificate of consent to seli-insure or a certiticate •
Workerz' compensation Insurance, or a certitietl copy j,hereo! (Section
oo. Lab. C.) /NUVJ�H'��"
.No'cYNo.G��%�/�i/4)' ComPanY-f..,,•�nwwa�ii,Jv .
Certi(iea copy is hereby furNzhetl.
Cer I(ietl coPY is tiietl with the city BWItlin Dlvision.
Date � %�Po���anl�!�� � �1+ �
EXEM TION FROM WORKERS' COMPENSATION �ECLARATI�
(Thissection neetl nat be como�etetl if the permit is tor one huntlrea (E300) or
less).
I certiy that in [he performance ot the work for which ihis perm�t is Izsuetl, I�
Shall nol employ any pe�son in any manne� so as [o become subject to the
Workers' Compensation Laws of Calitornia. .
. Date $I9natur¢
`NOTICE: If, after making ehis tleclaration, you shoultl become subject to tne.
Workers' Compensation provisions ot [he Labor Cotle, you must torthwith
comply witn such provisions or this permit shall be aeemetl revoketl.
CONSTRUCTION LENDING AGENCV
I he�eby aftirm that there i5 a Consi�ucUon lentling agency for the perto�mance
of the work tor which thls permi[ is issuetl (SectlOn 3097 Civ. CJ
LenCer's Name ,
lentler's Atltlress _ � ,
OWNER BUILDER bECLARATION -
I h¢reby afti�m that I am ¢xempt frOm the Contracto�'s Lit¢n5e Law for the
followin9 reason (Section 7031.5 BuSiness antl Professional Cotle: Any city or
counly which requires a pe�mit [O cOnst�uc[, alter, improvu, tlemolizh o� repair
any sVucture, orlor to its issuance, also reqWres the applicant for such permit
to tile a Signetl Sta[emenl that M1e/she Is IicenSetl pursuan[ to the provisions ot
the Contractor's �icense Law (Cnapter 9,(commencing wi[h Section 7000) ot
Division 3 ot the Business antl Profe55ions Cotle) or thal he/SM1G Is exempt
'he�elrOm antl the basis for [he alle9etl exemption. Any violation oi Sec[ion
131.5 by any applican[ for a permit subjects the applicant to a civil
inaltY of not more than tive huntlretl tlollars (5500).
L� I, as owner of the property or my employees wich wages as their sole
compenSation, will tlo the work, antl the st�ucture is not intentled o� otteretl
tor sale (Section 7044, Business an0 Professional Cotle: The Contractor's
LicenS¢ Law tloes not apo�Y �o an owner of a property wno builtls or imvroves
thereon, antl who tloes sucn work hlmself/herself. or tnrou9h his or her own
employCes, provi0etl that such improvements are not intentletl or olferetl (o�
sale. II, however, the builtlin9 or improvement is soltl wi[hin one year ot com-
pletlon, the owner will have tne bur0en oi provin9 he/she tlltl not builtl or im-
�rove tor tne pur0ose of sale).
I, as awner o� the property, dm exGlusively ContraGting with Iicensetl con-
VactOrslo consVuct the O�oject (Section 7044, Business and Professloni COtle:
The CmVactoYs License Law does not apply to an owner of proPerty w�o
builtls or improves thereon, antl who contracts for such projects wlth'a con-
tractor(sI license,pursuant to the Contractor'S License Law). I am aware that
proof of [heir Worker'S Compensation insurance shoultl be prOvitled to me.
❑ I am exempt untle� Sectlon �B. & P. C. for thi5 reason
Date Owner
1 herGby certify IhaL � hav¢ r¢a
informatlon is correct: I agree to
and state laws relating [o builCir
5entatives of thi5 city lo ent¢r
inSpeGtlon pu)poses. /
SignatureTA�.�'t�l/tw N
Drivars' License or 55�� ��
tnis application antl state that the above
omply with all city antl county orUinances
construction, anC nereby aulhorize repre-
upon thi� bove"mentionetl oroperty tor
/ �
Date 9.i/'7. �f
—�' �O�
anG slgn all appropriate Geclarations.
TYPE OF CONSTHUCTION LJ NEW LJ ADD LJ ALTERATION LJ REPAI R
❑ CONVERSION ❑ SH ❑ OTHER
DESCRIPTION W USE OF. BLD �L- ��C� L✓A'GV
rB -s,� �.,� � � �L �
TYPE OF PERMIT FOUNDATION L!7 $TRUCTURAL �
❑ TENANT ❑ ELECTRICAL ❑ PlUM61NG � MECHANICAL '
❑ OTHER
PROJECT DESCRIPTION 5�. FT. �" oCCUPArvCv
CONSTRUCTION TVPE VALUATION $�
ZONE GRADING CU. VOS. A 5
Remarks:
Sink
Preventer
Irrigation
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
I .lV.l1l1f1Ai �/
Roof Drains -
Reinspection.Fee � $15
Boiler
Duct - Under Ground
Duct-Strutturel •
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducting� �
O a i oo,000 sTu O� oo,000 sT
Rainspeaion Fee I $75
CMF 0865-46, rev. ]0/84 Wnite - Building: Canary - APpllcant: Plnk - Accounting; Golaenrotl - Assessor
Service Sink
Sewer Cap �
Sewer Connection
Solar Collecmrs
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal -
Water Closet
Water Heater
Water Service
Auto-Wash
laue Fee
Hood or Typel ❑
Canopy Typell ❑
iefrigeration Sys[em
74100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers .
laue Fee
A.P. # L�
S Main Bui
E
T Front
A Rear =
C' Right '
K
Ping. Ref. #
Planning Notes:
Auromatic Washer
Construction Pole Suh.
Cooking Unit
Dishwasher ,
Dryers ❑Gas ❑Eleci
Fan
F.A.U.
Fixtures -
Device Boxes
Outlets .
Switches
Garba9e Disposal
Generator �65 KW C
$ 3
Heinspection Fee �
FEES
DEVELOPMENTSER
Zoning Approved By J
Building APProved By
Aoolication Inued Bv_
$ 3
. , y_� _.
�i t�i
03�9 9/17/85
_ zo�e
� Accessory euilding:
Parking Req./Provided
ELECTRICAL -
Transformer '� 15-50 KW .
� 50+ KW
Meter LJup to 100 amps I
M¢t2� �over 1008Tp5
Sub Panel
Motars �Pl� HP � 1 h- 8
Inc.Solar �9�15 HP �16-15+ I
Microwave
Pole Light .
Range
; Standing Sections
545 KW Trash Compacmr
$15 luue Fea
n6oE2 TL
FEES
$ 3
Z
O
N
1
N
G
F
E
Q
M
T
s
SU RV OF FEES �i,
BUILDING RMIT $ ��% SMIP . $; D'�`
PLAN CHECK $ 2 �` �Z PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK � 25% $ ' ENERGY P.C. $•
ELECTRICAL $ GRADING $
PLANCHECK'S0% $ �MICROFILM $;
MECHANICAL� $, � TOTALFEE $ ��`�Z
PLAN CHECK 25% $ ' .
(5�� �
� CONSTRUCTION ANDPLANNING POOL �A
APPROVALS Permit#- Date Inspector AppROVALS Permit# Date Inspector
� 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location �
� 2. Soil Pipe-Undrgrnd. -' � 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. • 54. Forms -��
4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test,
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
' 7. Footings _ - 58. Electrical Conduit-Undrgrnd. .
8. Foundation . 59. Gas Pipe, O Undrgrnd., TesY
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
70. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
'� 12. Sewer Cap ,� � 63. Heater & Vent-Final
13. Roof Drains � 64. Plumbing System - Final �
14. Rough Plumbing � � 65. Electrical-Final
15. Rough Electrical-Conduit _ 66. Solar System-Final .
16.'.Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING
' 18. Rough Electrical-T;Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL
19, Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT � �
20: �Rough Factory Fireplace ' APPROVALS Permit #
21! Ducts, in Struc[ure � 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.StorageTankOGas ❑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 HEAITH DEPT. REQUIREMENT
31. Plaster Brown Coat �� 79. FINAL INSPECTION
n
��32. Electrical Power Mete�}Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric ' � Notes: - '
34. Final Heating & Air Conditioning, - �
35. Final Gas Pipe-Test , '
36. Hood�or Canopy �
37. Final'Factory Fireplace - � -
38. Final Plumbing • • ' �
39. Water Service-Final
40. Gas Service-Final , �� . �
41. Solar pomeSticFinal � � -
�
42. Backflow Preventer � ' � �i ��
�
43. Backflow �rrigation � ,
44. Landscapelrriga'tionSystem"� . _ . � .
45. Sound Attenuation ��'��
46. Handicap Regulations � � �
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed " ' , .
49. Electrie Release to Edison � !
�
i.
50. ,Ga's Release to Southern California Gas Co (��. '
51. CERTIFICATE OF OCCUPANCY ' � �,� -
No. " � - Date � .
�
AOp�icant to flll in all sDaces ezeapl l�ose wlt�in �eavY �ortlar Ilnes an0 slgn all approp��ate 0eclarations.
�OF COS7A IV��y. � NSTR�JCTION PERMIT
. Project Adtlress '��
Applicant'S Mail/in9 A d ss S�Z `� GI~//i
Owner's Name / N� � ' B ✓ � �. �g?� q "-- Yi°
Addrew � 2 L". V�/1 �'//✓/ L�{�L/ �
Arch/Eng. V� �� '��� a� License No.
Address L�. �o!e L Gr �'/f'[��iv ✓ i✓,4'
Convacwr'sNam= �� G��—� B�ph ne �?��'
Atldreulmailing) �'��r0% �-• ✓�i°G�"%'v /�LV �"�
City LicenSe No. .3� OG Q '��'��
410ENSEO CONTRqCTOR DECLARATION
I hareby afflrm lhat I am Iicensetl untlar provi5ions ot Charter 9(<omm<ntlng
witn section 7000) ot Divislon 3 of lno Businass antl ProteSsions Cotle, antl
my Iicense Is in tull fqrte antl eHect.
IJCOOS¢ GId55 � I UCOlISC O �
Date� ��'-f�J Si9nature �^ � ^���
WORKERS'COMPENSATION DEC RATION
ereby attirm that I nave a certificate ol consenl to selLinzura or a Certititate
Work¢�5' Compensa[iOn IOSurance, o� a Certlfi¢tl coOY tho�eof ($ectlon
_.,00, Lab, C.) l / t'Q
licv No. `��%�/�'/ �%� Companv �NU✓ / A'L
ertitiea copY is hereby fumishetl. ' /ND h�v� /�
Cer ietl Soyy is ile�wi[h Ihe City B �iltlm DtWs'on[_ ��
Date ��` v��s APPlicant � �j/
ffXEMPTION FROM WORICERS' COMPENSATION DECLARATION
(This section need no[ be comple[etl It the permit I5 for one huntlreA (E300) or �
iess).
I cartity Ihat in the pe�/Ormance oi thp wo�k t0/ whi[h fbis parm�t i5 issuatl, 1
shall not eTPIOy any pe�son in any manner so as to beCOme subject t0 [he
Workers' Compensation Laws ot Callfornia. .
Date Signature
'NOTICE: 11, alter making [his tleclaratiOn, You shoultl become subjec[ lo lho
Workers' Compensation provi5ions oi the Ldbo� Co�e, you must fortbwilh
comply witn zuch provisions or tnis permit shall be tleometl revokotl.
CONSTRVCTION LENDING AGENCV
. I hareby ai(Irm thac thero Is a tonsiructlon Ientlin9 a9ency tor tho pertormance
01 Ihe work for which lhi5 Permit is ISsuetl (SecUon 309] Civ. C.)
�entler's Name
l.entler;s Atltlress -
OWNER BUILDER OECLARATION
1 hereby affirm [hat I am oxempt irom the Contraclor's �icanse Law for the
following reason (Section 7031.5 Busina5s antl Pro(essional Cotle: Any citY or
county whlch requi�es a pe�mit Io conSVuct, alter, ImproVe, tlemolish O� repah
anv structure. odor to its iszuance, also requires the applicant for such permit
15ion 3 of [he Buslness antl ProieSslonS Code) or ma[ ne�sne is exam�c
retrom antl the ba5is for Ihe alle9etl exemptlon. Any vlolaUon of Sectlon
11.5 by any applicant for a permit subjects the appli<ant to a civil
alty of not more than tiv¢ huntlretl tlollars (5500).
I, as owne� Of M¢ proper[y or Ty em0loyee5 with wages as their sole
lpensdtlOn, will tlo [hC work, antl the s[ruc[ure i5 not intentletl or ofter¢tl
sale (Section 7044, Bu4ine55 antl ProtessiOnal Cotle: The Cont�at[o�'s
ense Law tloes not app1Y to an owner of a property who builtls or improves
reon, antl who tloes sucn work himsel!/harzelt or tnrougn his or her own
ploy0es, proWdetl [hal SUCh ImprOvem¢nts a/o not Int¢ntletl Or ott¢r¢tl for
�. If, how¢ver, the builtling or imProvement I5 SaIE witpin one year of com-
tlon, thc owner wi11 nave tne burtlen of pwvin9 he/sna altl not builtl or Im-
va for t�e purpose ol sale).
t, as owner oi tne property, am oxclusively contratNng with Iltensetl mn-
;tors to conSlruCt Ihe OrO�ect (SecliOn ]044, Business antl Prof¢S5Ion5 COtlO:
; ConVaclor's Licanse Law does nOt appry to an owner ot D/Operty who
ICs or Improves tnareon, antl who contracts for such projetts witb a con-
:lor(s Ilcenu purivant to tno Contractor's license Law). I am aware tnat
iof O� In¢ir Worker's CoTpensalion Insu/ancB sboultl Da pwvitl¢G l0 Ta.
I am axempt untler Sectlon B. & 7. C. tor this reason
Date
I hereby certiy that I
in(ormation is Correct. 1
antl state laws r¢lating t
sentatives oi this city
inspection Our oses.
Sl9nature ��
Orivers' License ar 55 $
Owner
dale that the abova
tl couniy ortlinancas
Gby dutllOflEC rCD�B-
lonetl pprpperly for
�ate � /���"�J
TVPE OF CONSTRUCTION LJ NEW LJ ADD L1 ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH Q OTH R
OESCRI TION OF WO /USE OF LDG. / `'� `�'� %✓�����
%.3 D L. �, n��' Pi� G. 5(�� �//_5'��
TVPE OF PERMIT LJ GRA�ING LJ FOVN�ATION, LJ STRVCTU
❑ TENHNT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SQ.FT. OCCUPANC�
CON STRUCTION TYPE VALUATION $ �
20NE GRADING CU. VDS. ACRES_
Rema�ks: . .
Preventer
Irrigation
Dishwasher
Drinking Fpunlains
Floor Drains
Floor Sinks
GasService Outlets
Interceprors
Kitchen Sink .
Lavatories
Roof Drains
ReinspeMion Fea � S75
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/F�ct. Blt. ICBO �
Heating System & Ducting.
❑6100,000 BTU 0100,000
Fee . � $15
CMF 0865-46, rev. 10/84 Wnite - Bullaing: Canary - Appliwnt; Pink - q��puntln9; GOltlenroG - qssasior
Service Sink -
Sewer Cap �
Sewer Connection
$olar Collectors
$olar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heoter
Water Service
Auto�Wash
Leundry Trays
Isue Fee
Hoodar Typel ❑
Canopy Type I I ❑
Refrigeration System
❑aioo,000eru ❑�oo,000
System Repair/Alteration
Fire Dampers
Registers :
Issue Fee
FEES
S 3
$ 3
A.P. # J� a �
S Main Building:
A �
C Right ,2
g Left
Ping. Ref, dh
Planning Notes:
031� 9/17/85.
f ^ �.Q � Zone
Accessory Building:
i
Parking Req./Provided
/ l �A _�/i ...�00 ![
ELECTRICAL
Automatic Washer . Transformer ❑ 15�50 KW
Construction Pole.Sub. ❑ 50+KW
Cooking Unii Meter �up io i00amps
Dishwasher Meter �over700amps
Dryers ❑Gas ❑Elecvic . Sub Panel
Fan Motars O0.7 HP �7 %- 8
F.A,U. Inc.Solar 09�15 HV �16�15+
Fixtures ' Microwave
Device Boxes Pole Light
Outlets Range •
Switches
Garbage Disposal
Generator [65 KW OSt5 KW
� Reinzpection Fee
DEVELOPMENTSER
2oning ApProved BY_
Building Apvroved By
ApplicatiOn IssUed BY_
$15
Standing Sections
Trash Compactor
laue Fee
��oeltt TI_
FEES
$ 3
Z
O
N
1
N
G
R
E
Q
M
T
S
SU RV OF FEES
BUILDINGPERM $ �O $MIP $ /7.SO
PLAN CHECK $ � PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERG� P.C. $
ELECTRICAL $ GRADING $
P�AN CHECK 50% $ MICROFILM $
MECHANICAL $ 'TOTALfEE $ /��
PLAN CHECK 25% $ � ' ,
�� _
' � � CONSTRUCTION AND PLANNING . �PUO SPA
APPROVALS Permit # Date Inspector AppROVALS Permit # , Date Inspector
1. TemporarY Electrical Service or Pole 52. Pool & Equipment Location
�.2. Soil Pipe�Undrgrnd. � 53. Steel Reinforcement -
3. Electrical Conduit U[ility-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-Fina{ '
12. Sewer Cap . 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing ' 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final _
16: Rough Electric Wiring 67. Fencing & Access Approval ' �.
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
t
18. Rough Electrical-T'Bar Ceiiing 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 OGas ❑Oil
23. Gas Pipe-ftough & Test 72. Underground Flush -
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil -
25. Roof Shea[hing 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. F�RE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat � 79. FINAL INSPECTION
32. Electrical power Meter-Final 80. FOOD CERTIFICATE ISSUED �
33. Final Electric Notes:
34. Final Heating & Air Conditioning �
35. Final Gas PiPe-Test
36. Hood or Canopy
37. Final FactOry Fireplace _
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Fina� �
41. Solar pomestic-Final
42. Backflow Preventer . � . . �.��
43. Backflow Irrigation . �
44. �andscape Irrigation System ' �
45. Sound Attenuation � • '
46. Handicap Requlations
47. FINAL STRUCTURE & BUILDING �� �
48. Special Requirements Completed
49. Electric Release to Edison '� ' ' �
' '-
I
50. Gas Release to Southern California Gas Co . '
51. CERTIFICATE OF OCCUPANCY ' . i•
No.' Date � •
�
AOGlicant �o fill in all spaces except t�osa wit�in �eavy �or0er Iines anG sign all apDropriate Cec�arations.
CI7V OF COS7A MESA .C/ONSTRUCTION PERMIT
�� Project Address _n��� K , oC� ,{��� 59apw► q+�
ApplicanYs Mailing Address �o Z-�S •{y�Qr o^�D �V �-4�'
Owner's Name L!A/G OLIi P/toP �O Phone Z��
Address
ArchlEng. - Licenu No.
Addresz
Contractor'sName—���e-- �5;� T Phon "�`���
Addresslmailing) �\✓ . ( � �� qa
City �icenu Na. 3�% �O6 %
LICErySED CONTRqCTOR DECLARA'iION '
I herehy d/((rm that I am Iftanintl Untler provisfon5 Of Charter 9(ec�omman��
with sectlon 7000) of Division 3 of t�e Business antl Profes(lo ��tRR
my Ilcense is in tull brce antl attact. �t" � �
License Class ' �conso No.
�r-. r. c-� �
Dale 519 t - e
a —� —� �
W00.KER5' COMV NSATION.DECLARATION
i herepy aftirm tnat I have a certificate of consent to snlLinsure or a certifiwte
� WOrkers' Compansation Insurdnce, or a certi}iatl COPy N@reo�(Sectlon
00, LaD. C.)
.roI1cY No. � Q _r 7 �%�?�� a�Y �'CCI✓IYYbM
tifietl copy Is hereby furnisheC.
Gertitiea copy Iifj�tl with [he city BUlltling 4ivision� � _/
(Thi55¢ction n¢etl not be [om0�eteC if Ine permit is for one huna�etl (5300) o�
Iess). ' � � �
I celtity that in tbe 0¢rfOrmancB O1 tha work fOf wbiCh this Oelm�t ii iSSuetl, I
zhall qo[ employ any penon in any manner so a5 t0 Decome Subjact to [h0
Workars' Compenzation Laws of Califomia.
Date Si9naturo
NOTICE: If, aiter making this tlaclaratlon, you spoultl become subjact lo lha
Wmkars' Compensdtion p�ovl5lons of lh! Lnbo� CotlC, You musl tortbwith
comply witlt suGh O�OviSions o� this Oe�mit shall be tleemetl r0voketl.
CONSTRUCTION LENDING AGENCV �
1 here�y aflirm that thera is a constructlon Ientlin9 agancy tor the performance
of the work for which tnis permlt is i5suetl (SecUon 3097 Civ. CJ
Lentler'S Namo
LentlOr's AOOreis
OWNER BUILDEI2 bECLARATION
I hereby atfirm ihat I am exBmpt from thC Gontraclor'S LlcenSa Law for Ih¢
followin9 reason (Sec[lon �031.5 Buslnesz and Professional Cotle: Any clty oi
county wM1ich �equi�es a Pe�mit to con5truct, alter, ITP�ovO, Oemolish O/ �epai
anv s[ructure. prlor [o its issuanco, also requires the applicant tor zucn permil
OlviAon 3 of [n¢ Business ana �•roressions �ove� or umi � c�vm � en�v�
�hcrcirom anC tnG basi5 for the all¢getl ex¢mption. Any viotalion Of $ectiOn
f�`t�31,5 by any applicant to� a pe�mit 5ubjeCtS Ih¢ appliWnl lo a civil
;�enalry of not more tban five huntlretl tlollars (E500).
�� �, as owner o( the property or my employeez with wages as their sole
Comp¢nsation, will tlo the wOrk, dOtl the struct4re is not In[2ntletl o� ottG�etl
tor sale (Section ]044, Buziness and Professional Cotle: The Contractor'S
LlceqSe Law does nol appty to an owne� of a proporty who builtls Or Improve5
thCreon, antl who tloes such work himself/herself or tn�ou9n his o� her ow�
tmployee5, p/ovltletl [ha[ such improv¢ment5 ar0 n0[ inl¢ntletl or ofieretl f0�
sale. If, nowever, l�e bWltlin9 or ImOrovement is soltl within o0e yea� oi Cortl-
pletlon, tne owner wlll have tna burtlen ot proving he/sne tl(tl not builtl or (m-
�rOve tot the purpoia 01 sale�.
LI I, as owner of the property, am nxclu5ively contracting wlt� Iicenietl con-
tractOrs tU con5truct [he Oroject (SUction ]044, 9u51n8ss antl PrOfesSIo05 CotlB:
Tho ConVactor's License Law doos m[ app1Y to an owner of pro0orty who
builqs or improvns thereon, antl wbo contracts br such projects wilh a con-
tra<tor(s ucensa pursuant to the Contracror's Liconso I.aw). I am awaro that
proof o� lhelr Wo�ker'S CompanWHon InSuranCe SnoW� be prOvldetl to ma.
�� am exempt unCer Se<tion B. L P. C. tor tbis reaton
Date Owner _
I h¢r¢by C¢rtily Ihat I have redtl thls
Intormatlon is corract. I agree to comp
antl ;�at¢ laws relating to builtling pppon
senta�{�es ot this tlty to enter u�
fnzpe�tlon pu pose C�
Signdture
Oriv@rs' License or S #
catlon antl stale tnat tne above
h dll clty an� coun(y ortlinance5
lon� an0 tte�eby authOriza �ep�e-
,above-mantionetl property c/.�
Daiz J Z�—� I
m
..C.Go(,p7 L
tYYPE OF C�NSTRUCTION NEW AOD ALTERATION REPAIR
T❑ CONVERSION ❑ DEMOlISH ❑ OTHER q p#
DESCRIPTION OF WORKIUSE OF BLDG.
S Main Building:
E
TVPE OF PERMIT GRADING FOUNDATION STRVCTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECNANICAL B R2af
� ❑ OTHER %�
PjiOJECT DESCRIPTION SQ. FT. OCCUPANCY � C Right
, .� _�—,f K
j CONSTRVCTION TVPE VALUATION $� $ Left
ZONE GRA�ING CU.YDS. GC�i6�SDCi.OA ping, Ref. �
Remarks: C/r)l A�Ar��.. tVc.-r PlanninoNOtes:
3ackflow Preventer
3ackflow Irrigation
3athtubs
Clarifiers .
Jishwasher '
Drinking Fountains
Floor Drains
FloorSinks '
uas Service Outlets
IOlCIC2nlOf5
Kitchen $ink
Lavarories
P—Trap
Roof Drains
Reinspection Fee $15
Boiler
Dutt-UnderGround
Duct - Structural
Duct - Ventilating
Exhuust System ❑ Multiple
Firepl/Fact. Blt. ICBO 5{�
Heating System & Ducting
❑0•100,000 BTU 0100,000
Reinspection Fee
CMF 0865-46, rev. 30/84 W�ite - Builtling; Canary - Ap�i�cant: pink - Accountin9: Goleenrotl - Assessor
PLUMBING
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urina!
Water Closet �
Water Heater
Wacer Service
Auto-wash
laue Fea
Hood or Type I
Canopy Type I I
Re(rigeration System
❑0.700,OOOBTU ❑100,000
System Repair/Alteration
Fira �ampers
FEES
$ 3
Incomplete Insp2ction
$15 laue Fee �� g 3
8689 5/29/?7
8688 ' S/29/B7
2one
Accessory Building:
Parking Req./Provided
ELECTRICAL
Automatic Washer Transtormer ❑ 15-50 KW
Construction Pole Sub. ❑ 50 + KW
Cooking Unit Meter ❑up to 100 amps
Dishwasher Meter Oover 100 amps
Dryers ❑Gas ❑Electric Sub Panel
Fan . Motors�b7HP�1'rS-8
F.A.U. Inc.Solar �9�15 HP �16�15+
Fixtures � Microwave --
Device Boxes Pole Light
Outlets Range
Switches
Garbage DisNosal
Generaror 00�5 KW 05-15 KW
Standing Sections
Trash Compacmr
� Reinspection Fee �$15 I � Issue Fee
DEVELOPMENT SERVICES REOUIREMENTS:
2oning APProved 8Y
Building Approved By
Application luued Bv
�-
t+�� ^:,
FEES
$ 3
� f{LAF/� SUMMARV OF FEES
f�� BUILDING PERMIT g SMIP � , $
(+�S�.PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
,k PLAN CHECK 25% $ ENERGV P.C. $
� ELECTRICAL $ � GRADING $
P�AN CHECK 50% $ MICROFILM $ �
MECHANICAL § TOTAL FEE s 45-s"a
PLAN CHECK 25% $
2
O
N
I
N
G
R
E
�
M
T
S
CONSTRUCTION ANDPLANNING POOL&SPA
APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms -
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Watei Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
71. Property Sewer Line & House Connection 62. Backwash & Receptor-Final �
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains . 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit � 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil
. �
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
':25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
� 27. Frame and Flashing 76. Dry Standpipe -
28. 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 "'J • . '
36.�Hood or Canopy � � .
37. Final Factory Fireplace ' � � � •
t
38. Final Plumbing t . • � , '�% i; � � - ,
? �
39. Water Service-Final , '..• r �-- ; '
40. Gas Service-Final ' � " . -� . � � y
41. Solar pomestic-Final � ' ' . ,
� ,. .
��42.. Backtlow Preventer ��. �
i . ` ;� i.
43:'Backflow Irrigation ._ ` _'
, .
'44. Landscape Irrigation System . ��tSOfl'IpIB�E IlIS p,�(1 ' � �I��
45. Sound Attenuation � e .4: � i'_
46, Handicap Regulations .. �` ,_
47. FINALSTRUCTURE&BUILDING . ,�, - - ; �
46. Special Requirements Completed � .
��,
49: Electric Release to Edison • ,.
. i
50. Gas Release to Southern California Gas Co �, �
57. CERTIFICATE OF OCCUPANCY
No. Date
. _ �,
� ' "
_.� J _
.. :F . 2244s
� COSTA MESA BUILpING-SAFEiY DEPARTMENT
P.O. BOX 7200 COSTA MESA� CALIFORNIA 92620
For ApplleaM ro Fill In ComplHdy
TYPE OR PRINT
.����Na59 �. Ty�, ,
ADOR6iG
COSTA MESA. CALIFORNIA
`�`t FEE RECE(`VED
dU W 1 1 1864
fINANCE DEPT. •
CITY OF COSTA MESA
ArPLICATION FOR PERMR
SUILDING
For Offfn U» On�y
nici�rt no. �inr�r Ho.
� � , i �!!
CITY � � OL/�,F �jdqlj7 ZON[ � TYP OROUP r� �
MPROV6D
OR EN'OI 8R /d �E N�.LL%ZJ B7' DATB
�,� ZONINO , l -
�R� > oa�-_ ,6 �' _ L. • -i . ��,
=o . _� „o. o. �.:o�„.�. _
.�.. .�, o—
CONTHA R .f3'1kfh+! �C.k3"rW .ti•G �
p taaw�
ADDA �7 ��-� -6 ¢ �y�T G+4 -/ . �R�mox - �-
CITY I / ^ A. P. NO. /S �� �� l� y�
V
N0T6: NOEAVEOVHRHu'lOBH�LlHLl88T AN
�C.TNO. � � ry� •� �/3dCp.�� so• ro sioe a aeaR . 4
61ZE �J� No. o/eLDOt. . pLOWED (U. B. C. RE UIRlM6NT) �
OFLOT ��2 Y�Ir'• NOWONLOT 'I �
USEOP YARDEAPPROVED YAR08APPROVHD
EXIBTINO BLD�. MAIN BUILDING ACC6H80pY BUILDINO
- rli.. / (FROMClLOT [QTl„ //
88TBACKLIN6�R011 �IOy rR NT . �
cermrtoPerrsser. . O-O '..,— ,P6ARYAR r� �� .: � .•�.� /O� ...
�," " _4".r-f' 't i 11.�QID PT.
CID YAR LlPT D`-v�- RIOliT 7f-O _
5- -- s� ��� ; • ,
D�SCRIPTIONrOF WORK � 'L.BID . ^ ' �
,. . . . .., .,�, .
�' �.. � O . - RBAR �.
NGW /1LTgpAT10N ADDITION
c�l. .:. .::. : •.,r :.�o:- • D16'1'AfiCL� 86T.7. i : .. =BLT.-M IN� , � . -..r, � C C
n_�AIR MOVINO.T.; �-�. �DQMOL'I H'T- C^ MAIN BLD08. ACCES9. BLDOB.
BUILDINO ' G NO:OR':�" `� O V�.#-',^,:. J . _ ..DATe . . !. / ';
utZE 24n'4o ROOMB .�'.. RI �� y�_� '' C. .' f'� 7 . MPROVHD v�/ _`� W
- � �
EXTERIOR WALL •�.. .. ROOr y , �' � y. AP�RO� / /y'�
COVHRINO T%�1 .f'. COVHRINO �r%�J DATi lJ� I-� .�
UYiOR�UILDIt�Y WORK�TOBiP[R�OR � - -- �* r� -r'W a
� ... . �. � , .h . :S?`'�`0 t
G.¢' . .ro Ci
:TJt7�' _ V_-O'/�: . .. i d �lf;:. P:�F(t'T fr5'^-C ^ OT SS/ ^ ' � V.
a
�,� .,.^,r,c�a F' .,� C.f::"� � .. e::'.�6 F. CI_ .. �7!jR '� �
,^ �""__" '""',' _ "'' ' ^ BQ.Ff.,, . • � �� �l � [i
1 N6RReY ACKNOWL6D0[ TNAT.1 XAY� R�AD Y111/ A�►LIGTON �� TM[ AYOUIR tXOWN UryO[11 VALU�TION le IO TXi LL
ANO 6T�T6 THAT TI[ AlDV/.�0 CORR6CY ANG A0116[ 70 COY. �URNli 01 tl�AGUGXINO A P6RMIT !Q ONLY. � �,
PLY WITX - OqDINAMw,AXD�RA UYY� R[OYLATINO yALUATION yp� p �
Ou1Lo1Np2oNH1'q cflo '� PgRMiT PH8 O � �J'
/
HIGNATUR60
pe�„ne p -s/�ODO— a -- w
AUTXORIZ[D AO[NT - TOTA1 PHfi � �—
. . • �. �- ;
. - - - -�
- ,., -. .- -- - .- -: - . . , _ _ _ ._. _' .
. ., .�r COII(a.l'tlOri6: �... •caro.ir.�r � . �
... �: .. . . .....,...... ,. '.f•SIG'. j ..
, . '�: '. '...... c1.".'• C. -ct;n cC'.• -" _- —. : wv��':-,-.'___'.: �� "_'.__: "_t , `:
... - ' ' C1.1,':.'tT ......t . �•::.....j..�.....:.� � .......n.�... � . ... .. ... ....�..�� �- ��i ' .
- -- -� 1.---Ca�ercial-eide�+alke;-With-concrete driverray-appToaches,=;;_ _ r
to be installed by the owner,' at his expense, on W.' 19th,Street -. 1�
-�� --�and Anaheim Avenue, as per standard specifica£ions of the; City of �� :.
-- � - - Costs� Mesa. � ----- --- r,.. . - „
-�
2...-Subject to all.the requirements of the new�y adopted Costa Mesa '-
, --iriiiform Building Code:•`_ - ,-.-: :;--,._-,--'-,' ---- - ' _. -
_ - ._ _ -.3•---Curb-cuts _for. ,the_.purposes o£'ingress�:;gress_shall be .subject �-
� to��the approval�of the Traffic Erigineer. � ' ' : ' - , , `,�;
,4.- .'A.-�planter area shaTS be constructed-and-planted-. at the ----. - �&
corner.of, W.� 19th Street and Anaheim'Avenue subject to the�approval `;:•
of the Director of�Pla.nning. � - '- -, - - � - _ - - ;.
5• That-buiTding.design and structural materials_�ed be.presented :
Yor.approqal�to the_Director of Plauning prior to $uilding Permits �•'
. being issued. � . . .. , . . -- - ; . - - - . . ,; - - . -
-.-. 6.- -Tree planting:as.per standard_specifications of the`City_of_Costa
Mesa:" _ - . ,
, , � -- � - - - -- : -. - - --
---�:: -_-: .- . - -- --
- - - , - � - -
- .-_,\ -,c'-' -��.:-' .._. -. •--, '-..
� ��� �
----- �` _ -_ --f ---- -; : - - --
. .- - � ,
�::,..•.-,; '-n-. . . - -- -...<: - - --- - - ----�- - -- --
� .r' . __.�.-a ' "„ ,�'. �^.
., �. 4 -.�..�.�.�_. � .��.fiT� -t • - . ' . . . _ ._._.. '
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... • ' �. � _ . r. 1 i . .. � . ' ♦ 1
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�1 �.
""_" —'..._' "—� �"'_'__'_"_"' . "__ `' �_�_ 1"'t_""" _ I " ". _'_' .
�. .. . .... .�.1`I'C: ]A.1i'✓ � � v
' , _ . � �Y .� - . , . _�._. __ . . � _�_ �., �� ` . �.. . � '
' . ' � ' ._ �: . 't._ , , . � •
^_� " _ �,� ' . .... a '
, . , . . . - .. � . ' , ..- � .. 1.. �". i��.s ..-�� .
' 1• .�••• i�AS ' C`i91i: al
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� , ` ✓ J � M1
�„ Y 1 . �'.�+.
: � ��-. �-� — _ ��
� � " 22599
, COSTA MESA BUILDINGSAFETY DEPARTMENT
P.O. BOX 7200 COSTA MESA� CALIFORNIA OZE28
For Appl)caM fo Flll In Complefely
TYPE OR PRINT
COSTA MESA, CALIFORNIA
i_ ! i+ n. //
IJ STATB
rl 6erowcw uHs vnor
.
�
FEE RECEIVED
JUL 14 19,�
FINANCE DEPT.
�Pu6{�`l�OF F6i�PkW�SA
BUILDINf3
For OHIn Uw Only
) mN�/ �uesR � su��n�xxOw
'�} � ` vL.r ;',I./�._ f1
G�Y w l�� /.J/ uc�el�ilrtl �"7 ` O- � '
� j,L"� f A. P. NO. S_� P 1 <
' NOTe: NOEAVlOVERNAN08HALL�HLl88
DESCRIPTION OF WORK
BUILDINO
size
EXTERIOR WALL
��. i„� � ,�
u•
� f�� /C.%/•�
i x�n¢ev weKxowueas n
AND BTAT6 TMAT iM[ AGOV
PLY WITX ALL'CIiY•OROINA
em�o�no cowmpuRlon7/
� AUTNORI2[D AO[N!
MAV[ MAp'YNI� A��LIGTON
CORR[R ANO AOR6[ TO COY-
��1)D RAT{ L,A1M� RiOYtATINO
YARDB MPROVlD
MAIN BUILDINO
VM.$
YARDBAPPROVHG
ACGH880RY BUILDINO
�
Fr.
BET. MAIN Q
ACC888. BLDOB.
DAT6
APPROVBD
i o�r� /�� ���
P ' a
m
�
aG. P7. �
n�s �roue/r �Xown uHc�q v�w�noN u row n�[ �
rYRPOlI 01� iGiMYeNIMO A �6pY1T P6[ ONLY.
VALUATION m0 �
�� PERMITFEB �
s �dp w
3 cv o
TOTM.P6H
,
` 4f)850
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 7200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING )��
ADDRESS .��% {//� �T bSTA H/t�
OWNEFi /�(���D/(.D O/L CUMi/��j-,tJj�
ADDRESS /-! v/ �✓/� �IOD � �
CITV ��/y„yl s V/TY �S�71L:�✓J�S N�L �,i�
CONSTRUCTION
LENDER
BRANCH
ADDRESS
ARCHITECT /_�„ �.�1i TEL._ ,. ..
� �3-=,_;�:,�,o� sz� � �e.�o
. „ ,--_ . .: ,: �:.
�,>
APPLICATION FOR STRUCTURAL PERMIT
REC "DATE RECEIVED E I SUE�
S` /J�I' Q � PEFMIT NO.
A.P. NO. � O
BUILDING �c�4 �,U �97� S�T-
ADDRESS
FIRE
ZONE
. CONTRACTOR / ON ('J/" C%O eY
ADDRESS �/'���
TEL. ZONFy� NO.
CITV � ' NO. �� P�
o-H. STATE ' CITY �'�+ROS APPRC
� LIC. NO. ' LIC. NO. MAIN BUILDI
{i,� SIZE / �{ NO.OF BLDGS. (FFOM C/L STREI
d. OF LOT /iy X y� NOW ON LOT / RONT F'I
� USE OF
EXISTING BLDG. T 5 �
y
, F Separate permits are required for L. SIDE
� electric, plumbing and heating work. � AEAR �
� USE OF BUILDING AN� WORK TO BE PERFORMED
DISTANCE BET.
qMAIN BLOGS.
a /�y`"E/Zl02 i4% i/�`/Oe4/S ""R. *��e 7'
a C.U.P.
'7 . . � APPqOVE
�.
�
W _6�CLD F�€�
� I hareby acknowledge thai I have raetl this application and state
� thet the abova information Is corract and apree to comply with �
all lews reguleSing builtling construction, entl I shall not employ
Wany person in violation of the workman's compensation laws of
,S, the State of Celifornia.
3 I hereby canify that 1 am proparly Iicenud as a contractor untlar SQ. F
tha Stata of California Buslness and Professions Cotle, Dlvlsion 3, THE AMOUNT
Chaptar 9, and that such Iicenses are In full farce antl effect. or I THE PURPOSE
em exempt from <he provisions ot the State of Celifornia Business
antl Professionspotle, Division 3, Chepter 9. VALUATION
Sipneture of ��
Permlttee § / DQO
Authorixetl AOent .�% �(�,'�Q,(% ��
1 i
�U,�SSo1C✓ !�'GC_
T/O� VALUE
S
TV GROUP
DATE ' ��
) USE OF NEW I N'(:
�lS BUILDING A��r
BET. MAIN &
ACCESS.BLD
DATE
APPROVEO f
3
�
n
m
m
T. N
SHOWN UNDER VALUATION IS FOR m
OF E5iABLISHING A PERMIT FEE ONLV:
u
PERMIT FEE $ p
� N
PLAN CHECK $ �— o
TAX $ O LL
F
u
TOTALPAID $ .
I.
_ _ �___ _ ___
' 4�952
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING �
ADDRESS
OWNER � � O O/� CO •
MAIL �� �,�Y .TIA15 . . _
F
�
W
0.
Q
H
y
�
F
C
W
F
J
a
>
r
.a
a
w
a
�
a
z
.'Z
3
CITY x�llt�
CONSTRUCTION
BRANCH
ADDRESS
TE L.
ADDRESS
CONTRACTOq A/•' U
ADDRESS
� TEL.
pTV NO.
STATE CITV
LIC. NO. LIC. NO.
SIZE NO.OF BLDGS.
OF LOT NOW ON l0T
USE OF
EXISTING BLDG.
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING />ND WORK TO BE PERFORMED
I hareby ecknowletl0e thet I have raetl this appllcetion end state
that the above informatlon is correci and epree to comply with
all laws repulating builtlin8 consttuction, antl I shall not employ
any person in violatlon of Me workman's compensatlon laws of
tha State of Californ�e.
I hereby certify that � am properly Ilcensed as a contractor untler
the State of Californie Business antl Professtons COCe, Dlvlsion 3,
Chepter 9, antl that Such �icenses ere In full force antl aftoct, or t
em exempt from iha Provisions of the Stata of Cellfornio Business
antl Professions Cotla, rvlsion 3, Chapter 9.
5�a�et�,a o,� ��, ��. _ n _ . �
valu a t�etrt
DEC —S"�S�MSG00 340 23.00
P C TION FOR STRUCTURAL PERMIT
q VE pV DATE RECEIVED TE 1 SU
� _ � �`
�5—� PERMITNO. �
A.P. NO. I _ ^ �' �
BUILDING `�
ADD���, �f�0 � �LOCK �
. �
FIRE
ZONE
APPROVEO
VARDS
MAIN
DISTANCE BEf
MAIN BLOCS.
VAR. #
C V X„
VPE OUP U
CDATE R
J
NO.OF USE OF NEW
PtANS BUILDING
'ROVED VAF� P ROVED
LDING ACCL� OFV BUILDING
THEAMOUNTS
THE PURPOSE OF
VALUATION
s /s� �
BET. MAIN 8i
AGCESS.BID
DATE
n
m
i
m
m
N
VN UNDER VALUATION IS FOR m
-ABLISHING A PERMIT FEE ONIY: �
PERMIT FEE S a
N
m
PLAN CHECK E <j o
TAX 5 4� LL
✓ �
V
TOTALPAID E ��
..-- _-
4�95 '•
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 9262fi
For Applicant to Fill in Completely — Use Ink Only
BUILDING `�!/ `, ��T� �
ADDRESS J `� W �
OWNER ��'O�� O �` Ci� -
ADDRESS �A /�/` �IC�O
CITY
�//NA/S C�J j/�,7/�^��S NOL l�i7 7!'
r-�
CONSTRUCTION
LENOER
BRANCH
ADDRESS
ADDRESS
CONTRACTOR /�T%/✓
A�DRESS
TEL.
CITV NO.
F STATE CITV
� LIQ NO. LIC. NO.
{y SIZE NO.OF BLOGS.
4 OF LOT NOW ON LOT
a USE OF
� EXISfING BLOG.
y
FSeparate permits are required for
q electric, plumbing and heating work.
[.W. USE OF BUILDING AND WORK TO BE PEfiFOflMED
� "71
a
>
r
.�
a
w
n�
REC
FIRE
PAiD � �,***
DEC -5-75�M56�Q 339 1 �.50
�
FOR STRUCT'URAL PERMIT \
DATE RECEIVED '�
I�E ��-lS �.
NE NO.OF
PLAN$ •
VAR�S APPqOVED
MAIN BUILDING
DISTANCE BEf
MAIN BLOGS.
VAR. 3j'+
3
flM1T NO.
USE OF NEW
BUILDING
VARDSIAI
BET. MAIN &
ACCESS.BLP
DATE
�
� I hareby ecknowledBe t�et I heve reatl this appllcotion antl rtete '^
a thai the abovo Informetion is correet nntl aprea to comply with �
a ell lews reBulating bulltling constructlon, antl I shell not employ �
Z any person In vlolation of Me workman'e compensation lewa ot m
� the Stete of CalHornla.
3 I herob eartit thet I am SQ. FT. N
V y prope�ly Iicansotl es a contrector undor
the Stnto of Collfornia Businea nntl Profeulons Cotle, Dlvislan 3, THE AMOUNT SHOWN UNDER VA�VATION IS FOR m
Chapter 9, end fhet such Ilcenses era In full torce entl effxt, or I THE PURP06E OF ESTABLSHING A PERMR FEE ONLV:
em exompi }rom the provislona of tha State o1 Collfornia Businaaa '�
VALUATION PERMIT FEE § �
enE Profoselon COCa, Olvision 3, Chn tar 9. H
n
PLAN CHECK S
Sipnature of � o
Permlttae • 5 J LL
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Author Bont L�le� ' TOTALPAID E
� d.109.:
COSTA MESA BtlILD{NG-SAFETY DEPARTMENT
P.O. BO% 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING
ADDRESS � S �
OWNER /�(./Q,SON ��L Ci�J'
n��rncoa �v •
CITY N S �
CONSTRUCTION
LENDER
BRANCM
ADDRESS
t
TEL.
1
)AN20-76cn5;�0 674�` **TM�*5.50'1
APPLICATION FOR STRUCTURAL PERMIT � I
ECEIVSb BV DATE IiECEIYED neT� icciicn
AD
/ VALUE
i q
FIRE
ADDRESS ' ZONE VPE� GROUP
APPROVED
CONTRACTOR BY DATE I� � �
ADDRESS '
TEL. Z�N NO.OF USE OF NE
CITV NO. P��Z BUILDING
o-F. STATE • �-CITV YARDSAPPqOVEO VAROSAPPROVED
i LIC. NO. - LIC. NO. MAIN BUILDING ACCESSORV BUILDING
0.
W SIZE NO.OFBLDGS. �FROMC1LSTflEET)
O. OF LOT NOW ON LOT ONT FT. FT.
a USEOF F. v�F y
� EXI5TING BLDG.
y +
FSeparate permits are required for � sio FT. S�FT. �
electric, plumbing and heating work. ���/�)
G REAR FT. JV FT.
W USE OF BUILDING ANO WORK TO BE PERFORMEO
_F DISiANCE BET. BEf. MAIN &
� MAIN 9LDGS. ACC65. BLDGS.
/ VAR.� Q4TE
a ItlCI� �ISG /� � C.U.P. #` APPqOVED
� APPROVE J �Z�� � �
.%"
W HOLD FOR SP CIA REpUIREMEtv7'y
QI hereby ecknowladpe thet I nave reatl this epplicatian antl rtata �
y� Mat the above Informatlon ia correct and apree to comply wlth m
d all lews reBuledng bufltlinp eonrttuction, antl I shell not amploy � �
Wany parzon (n vloletlon of Me workman's compenxtion lew� of o
x ihe Stete af Californle. , m
3 I hereby certify that I am pro0erly �icensed aa a contraetor untlar SQ. FT. n
the SSeta of Cellfornie Business entl Profevions Code, Dlvision 3, THE AMOUNT SHO`NN UNDER VALUATION IS FOR m
Chaptar 9, antl that euch Ilcenses are In full force antl effeet, or I THE PURGOSE OF ESTABLISHING A FERMIT FEE ONLV: �
em exempt from the provbionsof theState ot Cai{fornia Busfnesa VALUATION PERMIT FEE $ �I � q
antl Profeselons tle, Div lon 3, Chepie� 9. . � /�Y m
� ^ PLAN CHECK $ ..i M
519�etura of {� ` ` ..� o
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u
Authori ent TOTALPAID S � O
City ot Costa Mesa
Building Safety DepaMment
P. O. Bon 317
Cotlo Mesa, California
CERTIFICATE OF OCCUPANCY N� 2035 C
The Building located ot rj,�► W 19Eh G$TF±et
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Grovp n i Occupanry.
�3IY/ �1.: •1 i�K ��!i
Legal Description �- P• y5- �Z-�2� 63
(Seo reverse side for Meta� and Bo�ndi)
Building Permit No. �� Elecfrical Permit No.- 2a�2 Plumbing Permi} No. ���
Floor Load Signs have been installed os Room Capacity Signs have been instaled as
required under Sec. 2308 U. B. C. . required under Sec. 3301 (1) U. B. C. _
17050. CERTIFICATE OF OCCUPANCY. (a) No apartment house, hotel, or lodging house shall be used or occ�pied
until ihe owner or operator has been issued a valid certificate of occupancy by ihe enforcemenf agency.
(b) A new ceAificate of occ�pancy shall be obtained whenever there is a change in:
1) �Occupancy classification of a building or porfion ihereof
2) The number of apartments or gvest rooms
3) Ownership
If Group H Occupancy, number of aportmenis and/or guesf rooms as required under Sec. 17050.1 (d), California
Adminisirative Code, Title 8, Chapter 9, Article 8.
Number of apartments and/or guest
ISSUED TO: Building Official
Si(�AL OIT, CO. _ bY , �if e
Date ��_ � �
This Certificafe of Occuponcy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed
except by t6e euilding Official of the City of Costo Mesa under Sec. 30b (e) U.B.C. eorm avas-iM-u-e�-s-s r