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Home My WebLink About615 19TH ST - Building PermitsPR0.IECT AUOBESB: G 1 S W 19 TH S'I' OWNEWSNRME: CIfTCK"N-WOK nooeess: �15 W 19,TFI ST , COSTA MESA , CA92627 (714)990-3473 . RflCH/ENGiNEEH: q00flESS: ' "' uxir: , ; - � CI:TY OP CUSTA M�SA - BUII�D'INC PEiIMIT � PL•:RM DIO; F' 04,6210 " � PERMIT r10: .F '. 04G218 � .PLAN'CHECK NO: 025�U-90 S GOVT: Dl SUYP: IJ CON�'TRUCTION TYPF• PERt4IT TYPE• L•"]R '� PURFUSE• "TH � BEO.NO.: . � , • � � UNR: PEpMiTTEE: MAST�R PROTE.CTION ( 71.A ) 990-3473 nooeess:- (�?1 LUN11R AV . . gR}•� CA.92G21 LICENSEU CONTMC70R OECUMTION: I �er¢Gy afiirm t�at I am Iicenu0 un0er pmNslans ol Clupter 9(cammencinq wi�� Sectian 7000) of Division 3 of tAe Businew antl Pmtessians CoOe, antl rtry lic¢nse irin tu0 tarce anU eRect, cirr uc.: 0 3 6 3 G i sreTE ucj: 41. '7 9 p 7 (,c,uss: C-1�` Oate: �'��'RO I Sipnature: ��` •1' ��M"�' WOBNERS' COMPEXSATION OECWMTION: I hereby alfirm that I have a cetli6cate ol co ent to ull-insure or a cenificate of WOMers' Compensation Insurance, or a certilieU caDY ��e�eof (Section 3800, La�. C). - raucr xo.: i l 2 2 0 4 0 ocr. o�re: 0 3/ 1 5/ 9 0 cornrnxr: STF�TE FUNL Certitied copy is hereby IumisheE. � Ceriified coDY is fileC with the ciry BuilEinq Oivision. � Oate: �� 'QC�i 1 Appliwnt: . . . IXEMPf10M FlIOM WOPNEHS' COMPEXS11710N �EClAMT10N: (1�¢ sectian neeC not Ea completN il IAe pertM i e hunOreE �5100) or lar). I certiry t�at in the Oehormance ol Iha work for w�ic� tAis permR is issue0, I shall not employ any Dersan in mannar so az to became suEiect to tne Woders' Compensation Laws of Calilomia. ' Oate: SiOnature: ^ � � - NOiICE: tl, atter maWnp this Ueclaration, you 5Aou10 Oecoma suhlecl to t�e Workars' Compensation pmvi5ions oi the LaDor ' Cotle, you must foM1hwith camDly xit� suc� proNsions or t�is permit s�all Ea Eeemetl revoked.' � CONSTBUC710N LENDING 11GENCY: I here0y aflirm t�at Ihere is a construdion lendinp apency tor the pedormance of the work far whic� ihis permil is issued (Section 3097. Gv. C). ' � IENDER: . aooeess: ' . � - OWNEP BUILUEB OECUMTION: I hereby aflirm that I'am exempt irom the Contactors' State License Law for the followin0 reason ; �Section 7IX11.5 Business antl Professional Cotle: My ciry of caunry whic� requiies a Dermit to consimct, alter, improve, Aemalish, or 2Dair any stmdure, Dnor Io its issuance, alw requires Ihe aDDlicant tar suc� permit to file a sipneE statement that �e/s�e is Iicense0 pursuant to t�e provislons of Ihe Contracrors' Stale License Law �C�apter 9(commencinp wit� Seclian 7000) af DNision 3 af Ne Business .�� antl Pmfessions Cotle) or that Ae/she is exempt tAerefmm anE Ihe hasis for Ihe allepe0 exemD��on. My violation ol,Section 7031.5 by any applicani tor a permil sublects the ap0licant to a ciNl penalry of uot more Ihan five huntlred tlollars (f500�. ' I, as owner of ��e Oroperry'or my employees wit� wa0es as.tAeir sole� comDensation,'will Eo ihe woB, and the ❑ stmcture is not intende0 or oiferetl br sale (Section 7044, Business antl Pmfessional CoOe:' T�e Contracrors' State License law Ooes not apONto an ownera/a D�operry who builtls orimpmvesthereon, anE who Eoes such work �imsetl/�ersellar IhrouOh � Ais or �er own emD�oyees, D�a�iAetl ihat such improvements are not intentle0 or offereA for sale. II, �owever tAe builtlin0 or -improvement is soltl within one year af completlon, ihe owner will Aave the �urden'oi D�aNnA he/she tliE not bui10 or improve tor the�purposa oi sale�. ' . � � ' ' I, as owner ot the propeM, am exclusively contracting with licensetl contractors ta consimct the D�alect (Section 7044, Business . `❑ ' anA Prafessions COAe: The Comractors' Stata Licensa Law Coes nat aDPry ro an owner of Omperty who hmlAs ar impmves Iher¢on an0 who contracts for such pmjects with a contractoqs)license pursuant to Iha Contractors'.S�a�e license Law�!I am awara Ihat proof al Iheir Worker's Compensation' insuranca s�oultl be provitletl to mef � � • �' I am exempt untler Sectlan: " B. 8 P. C. � for this reasan: ; � , ' � Date: � Owner. . I Oo hereby certity that I am aware of and untlerstand t�e requirements oi California Health anA Safety CoUe Sections 25505, 25533, antl 25534 antl that I or any fuWre �uilOinA occupam will/will not (circle one) nead ro camDN with sai0 state coAes an0 the requirements for a permit for constmction or modification from ihe Air �uality Manapement D,isirict. FesiAential canstmction aDPlications are exempt fmm these pmvisions. , � �. , � � . Date: Applicant: i I herehy certiy that I have read tAis aOD�ication an0 state that the ahove iniormation is correct. 1 a0ree to comply witA all ciry antl counry , ortlinances antl state Wws relatinA �o huil0inp constmctian antl hereby aNhonze representatives al Ihis ciry ta enter upon [he above-mentioned praperry tor inSDection Ourposes. / ' � � Date: � � ��/ Signature: �.a� , Driver's License ar Saiai Secunry x: ' 1601ifi W�iie—BuilEinQ; Green-Code Enlomemenl: Cenarv—Ap011cant: Pink—Revenue; GalEanrotl—Aasessor J�. � � . . . , ' , U JOB DE5CR7PTION :: FIRE PROT. /SYS�., E'OR KITCHEN Ii00U s DUCT • SQ F1': , � , r . CL,AIM VALUE: ' 20U.00 CALC-VALUE: ' , � GROUP .00C: Et-2 '/ Ct�MMLN'tS: DI�NE " i�")F jf i�- i�' � if iE iF if �f if iE 3f'f: i�' if �f af iC' if if i(' if iE if'K' iE �.E if i('?� i� if if'K if'k' 3f'K' if' 1f if'lE'N"K' i%iE ih iE'1f i%'1f' i!' �(' 1('1f jf'K' if 3f'K' i�' �F if �f -)C' i("K' Y%'X' 9E 3'E if # �t �!' 1f jf . 2 O N I� N G R E Q U I R E M E N T S , ' � S E T B A C K.S � /L�FT; MAIN BUILUING ---------- ---�----- ACCESSORY BUILDING -------�- FRNT:' FT IN R�AR: FT IN . FRNT: FT IN REAR: �PT IN', F'i r1N� RGi1T: FT IN' LF.FT: FT I.N RGHT: FT , IN PARKID7G RE�: �' PROV: PARCL'L: 42421107 'l.NE: � REF NO:,�� , PLANNING NOTCiS> , � • . . . . .. . � ' "' . . . ._ _ . . . . . . . _ ,_ .. _ 1(�iC' fFlE iE if'�'k iE �JE')f if if iE 3f if j%�i(- iE if iE ?:-if 3E tE if if �1(' if ff if if'.(-iF if if id' if'� # IE it i` iE if if 9'F if if j(-!( # if ik if it �1! 1!'.ff'� iF 3E iC"%� �f # if �f iE iE ie iE� jF iF �E 1E � iE yE L G: V E L O P M E N'P S E R V]: C E S R E Q U L R E M E N T 5� 2ONING APPROC�F.D �BY, DA'lF.: BUILllING'APPRGVED BY : � llATE: ' ' APPLTCATION ISSUEU DY: � �. � DATE: �Z�D iEitiliEiFiE3EiEiElEiFiE9k�t#iFiE?£M-9Ekf4'��t�'il��F='�� F%iF3Fi�FiFilifklEK�it9ElEjEf(�iF�FX-� �f 1E �K 3F %� if fE 3(�'A� *%if iE 3F tE i.` iE'lE 9E iE f(-1! jh 3E # 1F �c 1f fElf ?F # 1E %iE� �lk iE iE # iF �lE jf ik 1F fE �E if �E fE iE 8E iF 1(� 1F�iE �IE iF it 1f i! �Y,�lE iE iF iFlE iF!! f(-if � iP �K� iE �)E!F iE if fE iE LLGAL.[ZATION:N ' F G E S U',M M A"R,Y ' STRUCTURAL SEGMENT:N ;. � � � BLDG FMT �PLUMBING L•LECTRIC MFCHANIC FIRE �SMIP/RES GRAllING PERMIT .'= � � 15.00 658 SMIP'/NON-RES, � �LAr� . ' . ; ., . � 9 . �s ' • r.ssor•, rr•.r ' - ,� - � }JU:CI.DING-D'!V-> - �FF_RMIT ISSOE t' PLAN-CHECK� TO'PAL PAID ! �• DUE TOTALS,----> _25:00 0.00 , 9.75 ; 24.75 24.75 � .00 REVFNUE DIVISION TO'PALS--> 'COLLECTEDi ; 15:00, UV�:R/SF10RT: ' .UC �.� BLDG ,PM'P PLUM➢ING, ELF.CTRIC MECHANIC FIRE SMIPLTOT �GRADING PLAN-C}IECY, , . � . _ - � 1 5 . � 0 ' t � � i . � . . � ' � � I if iF d( �7F 3E �1(-%df- 3E 3E �F :: 1E ii 3E �7E 3E ?F iE �!E �%� iE�iE-k' 3t%iE 3f 1E i( %jF iE iE iE if 9E iF iF �It iE 9k iE i(� �1E �%it� �� X� �Jf �1f iF i6 iE 1E �IF �Y. �lt dE iF # iE �%# �%�Ik i't iP'9E �IF iE 3E i( i!� fE iE 9E fF�-7i� ' ' T i�l D I. V I iJ U A L F L: E B R G A� K� D O W N ' � � TYY. L•; ' Q'fY , U ti S C R I P T:l: O N ; UN7T' COST , TO'I'AL .COS'C F7:17: ; 1^5 � �GIRL: EQU:CP PE6 (i'I20M BLDG VAL TABL�) 1.00 15.00 � , . �Nn or r•r•.r:,s . - . . . _ . _� �1 J . _ : . � � . �i•.; r . , . . . :Lr . , , _ .. . , . . �. � '. . . � i � � . ' . P f 1 r ' � t 01 OQD54b72-00054672 T4T ,15.06 DATE: 02/22/90 TII1E: 1.2:52 ; r u CONSTRUCTION AND PLANNING �' POOI PA qPPROVALS Permit# Date Inspector qppROVALS Permit# - Date Inspector 1. Temporary Electrical Service or Pole � � 52.' Pool & Equipmen[ Location 2, Soil Pipe-Undrgrnd. � ' ," 53. Steet Reinforcement . ' � 3. Electrical Conduit Utility-Undrgrnd. � 54. Forms �. � 4. Electrical Conduii�Undrgrnd. � . �� 55. Electrical Bonding � � 5. Steel Reinforcement r � 56. Rough Plumbing & Pressure Test 6. �lectrical UFER Grnd. 57. APPROVAL.TO COVER�GUNITE 7. Footings - � 58. Electrical Conduit-Undrgrnd. 8. Foundation � -� 59. Gas Pipe, � Undrgmd„ Test � ' 9. Water Pipe�Undrgrnd.' .. ' .. 60. Backwash Lines, P�Trep, � Undrgrnd. � 10. Structural Floor SYstem 61. APPROVALTO DECK � 11, property Sewer Line & House:Connection , 62. Backwash &.Receptor�Final ' 72. 5ewer Cap ' ' -` 63. Heater & VenTFinal . 13. Fioof Drains - ' 64. Plumbing System - Final i 14. Rough Plumbing - i 65. Electrical-Final � 75. Fough Electrical-Conduit � ' 66. Solar System-Final � 16. aough Electric Wiring , 67. Fencing & Access ApProval 17. Rough Wiring Sign . . 68. APPROVED FOR PLASTERING - 18. Rough Electrical-T Bar Ceiling �' . 69. POOI:/SPA SYSTEMS FINAL � 19.'Rough Heating & Air Coniiitioning ` � - FIRE DEPT. REQUIREMENT 20..pough 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. Foof Sheathing • 74.� Overhead Hydrd 26. T-Bar Ceifing �Structural) & Monocoat � , 75; Dry Chemical 27. Frame and Flashing � � � 76. Dry Standpipe - ' 28. Lathing & Siding " ' 77. , FIXED SYSTEM FINAL . S-2cJ-Gj � 29. Insulation � ' � ' 78: FIRE PREV. FINAL 5zcj 30. drywall-Nailing � � ' HEALTH DEPT. REQUIREMENT , 31. Plaster Brown Coat ' • 79. FINAL INSPECTION 32.�Electriwl Power Meter�Final , 80. �fOOD CERTIFICATE ISSUED 33.=Final Electric •� Notes: �. � 34. Final Heatin9 & Air Conditioning _ : ' - 35. Finel Gas Pi�pe�Test - 36. Hood or CanopY , ' ' „ � 37..Final Factory Fireplace � ' � � .38. Final Plumbing , +. - , , 39. WaterService-Final .� 40. Gas Service-Final ' � ' - - • ' 41. Solar pomesticFinal � ' ' -� � , . 42. Backflow Preventer � - ' 43. Backflow trrigation � . , _- 44. Landscape lirigation System _ �� - . - � 45: Sound Attenuation � � � • � -- - 46. Handicap Regulations � �.. _ _ � ' . 47. FINALSTRUCTURE&BUILDING I � " - ' 48. FINALPLANNING " - �� n: 49.� Electric Release to Edison � ��' � 50. Gas'Release to Southem California Gas Cn ' i%-- '- . , 51. CERTIFICATE OF OCCUPANCY '" ' No. Daie poolieant tn Iill in all maens evecel �nn�e wlenin nwaw nn.tlw: I�nna ane slon all aeorooriate aeclaratlone �iTv oF COSTA MESA CONST 10 ERMIT . Proj�� Address - � � � � � ' P.{iPlicant'i Maili ddress � Ownpr's Name Phone Address Z Arch/Eng. _ � � � icense No, Address Contractor's Nam� Phone 2� Z' Address (mailing) � � Ciry License No. LICENSED CONT.HACTOR DECLARATION ' I hereby altirm that 1 am Ilcensetl untlar provisions of Charter 9'(commenUng with sectlon ]000) of Divislon 3 of tne BuSiness antl Professions Code, antl my ��cense Is In full force antl eflect. Liceq�¢ Class ' License No. Da[e Signa[ure '�ORKER$' COMPENSATION DECLARATION ' ' �er¢by atfirm that I have a cer�iticate oi tonsent to selt-insure or a certificate �� ^/orkers' Campensation Insurance, or a rertifiea cooY thereoi (Sectlon 3800, �,jb. C.) - Poilcy No. Company BCes[iflea copY is hereby furnishetl. CertitieG copy is (iietl with the city Builaing Division. Date Applican[ EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Tltis soc[iOn neetl not be completetl i( tlte OGrmlt is fo� one huntlr¢tl (§300) or less). I certiy thal in the pertormance of the work (or which thls permR is Issuetl, I shall mt employ �y person in any manner zo �p become subject to lhe Workecs' om n t �f Laws ot Califomia.A� (// Date ✓ Slgnaturc �e�rf�� ' 'NOTiCE. I�, att Takin9 this tleclaratlOn, YOu ShoUld becom!'Subject t0 tnB Wo�kers' Compep5ation prOvlsiont Ot the Labor Cotle, y0u must for(hwith comply witb suCh provision5 or IM1IS pormit shall be daemetl /evoketl. CONSTRVCTION LENDING AGENCV I nereby afflrm that thero is a tonsiructlon lentling agency tor tna performance of '[he wOrk Ior,which [hii permit is ISSu¢tl (SectiOn 3097 Civ. C.) Lentler's Name �enqer'z Aatlress � OWNER BUILDER DECLARATIOfi I h¢reby alilrm that. I am oxompt lrom the Cantra<tor's License Law lor thn (nlln..J..n .menn lG�tlnn >031 5 Ruclne552ntl Pr[�fesslollal Cotle: AOV CIIV OI signatl zWtement tna[ ho/sbo is n<en VaCtOr'S Licen58 ldw (Chaplel 9 (cort 3 01 the Business antl Proteisions �m anA the baiis lor thc allegeG exen by any applicant tor a permll su ot not more tltan fivo huntlretl tlollars '. owOo/ of Ihe prOPerty o� my em{ sation, will tlo lh0 work, antl tho Stn � (Section 7oa4, Businesz antl Prote Law tlous nat apply to an owner of a , antl wh0 EoeS suGh work bitnsoll/h n, th0 ow0er wi fortlm pUrpoSe as owner oi tne U I am Datg 2 state t [o a tivil as lhai� So10 '� os or 115 OI Such (mprov8ment5 are not InlonpeO or otlerea �or Itling or ImpravOmBnt i5 Toltl wltM1ln Onc yeal Ot COm- avC Iha burtlen oi prOving h¢/Sh0 ditl not builtl or Im- dlnl. �party, am oxtlusivuly contractinq with Ilconsotl con- rtoj¢ct (Secllon 7064, Businesi antl Protesslons Cotla: uw aoes nol apply [o an owner at Pwpe/ty who on, antl who concracts for such pro)ects with a con- t to [ne ConVactor's Littnse I�w). 1 am aware tnat Compensalion InSUrdnce shoultl be provitlOU ro me. :tion _ B. 6 P. C. tor th15 rea5on Owner have rea TYP�F OF CONSTRUCTION LJ NEW I�ADD IJ AITERATION Ll REPAI R U CONVERSION ❑,DEMOL:ISH ❑ OTHER q p,� _ L DESCRIPT ON F WOR USE OF, G. n1� � �' S Main Buildin '�.-s�,..in �; � w.��.' � � c�. � 9: TYPE OF PERMIT GRADI FOUNDATION �ST�SLRAL T Front ❑ TENANT ❑ EIECTRICAL ❑ PLVMBING ❑ MECHANIC/IC-'- A Reaf ' ❑ �OTHEF _ . • '. PROJECT DESCRIPTION SO.FT. OCCVPA Y C Right � K CONSTRVCTIONTYPE V'NI VALUATIONS g LC([ � ' ZONE ' GRADING CU.YDS. ACRES . Ping. Ref.9IE . Remaiks: ' . ' ' �- Planninq Notes: Sink Preventer. Irrigation � � =1oor Oreins Floor Sinks , � 3as Service Ol1I�CL5� Interceptors ' ` Kitchen Sink Lavatories � � P-Trap � Roof Drains � Reinspactian Fae $15 Boiler Duct - Untler Ground Duct - StrucNrel Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑ ai oo,000 sru O i oo,000 ISigqalure �ate� I I qeinspection Fee I $15 Driyers' Licun - � .. -�^oca_a6..rev. 30/84 White - Builtling: Canary - Applicanh Pink - Accauniin9: GOltlenrotl - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Tank . - Swimming Pool w/Spe Urinal ' Water Closet Water Heacer We[erServite Auto�Wash , laue Fee Hood or Typel ❑ Canopy Typetl ❑ Refrigeration System Oaioo,oaoeTu ❑ioo,000aru System Repair/Alteration Fire Dampers - Registers ' ' Isue Fee FEES � Automatic Washer Construc[ion PoleSub: Cooking Unit �IShW25h21 Dryers �Gas ❑Elecl Fan F.A.U. , Fixtures. Device Boxes Outlets • Garbage Dispoul Generetor �0-5 KW OL`42. �/�:7/8`u !7, ; . . Zo�a �, Ac�ory Building: qeq.'/Providetl A10 In —� ELECTRICAL ' Transformer ❑' 15-50 KW ❑ SO+KW Meter ❑up to 100 amps . Meter �over 100 amps �c ' � Sub Panel " � Mo[ors �61 HP 01 X- 8 Inc. Solar �9-15 HP �16-15+ $ 3 Reinspection Fee $15 FEES �DEVELOPMENTSERVICESREQUIR Zoning Approved By��' Building Approved By .�.6� Appliwtion luuad Bv' � 5 3 Microwave Pole Light Range Standing Sections Trash Compactor luue Feo FEES L ��r 2 O N I N G R E Q M T SUMMARV OF FEES ' BUILDINGPERMIT $ Ii/�i�."�� SMIP _ g .S� PLAN.CHECK � $ uL��—� PERMIT � . PLUMBING $ �SSUANCE � $ PLANCHECK '25% $ ENERGV�P.C.� $ ELECTRICA�, $ GRADING S PLANCHECK 50°6 $ " MICROFILM S �yf .� MECHANICAL. � 5 ' TOTALfEE $ l7.VV PLAN CHECK `:25% $ ' . .CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit # Date Inspector p�ppROVALS Permit # Date Inspector 7..Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. St.=el Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Elec[rical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement • 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE • 7. Footings � 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test ' 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final . 15. Rough Electriral-Conduit 66. So�ar System-Final � 16. Rough Electric Wiring $7. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 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 OOiI 25. Roof Sheathing - 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical •` 27. Frame and Flashing 3 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT ' `-; 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED • 33. Final Electric Notes: • 34. Final Heating & Air Conditioning ' , 35. Final Gas Pipe-Test - 36. Hood or Canopy 37. Final Factory Fireplace � 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final � 42. Backflow Preventer ' 43. Backflow Irrigation 44. Landscape Irrigation Sysrem , � 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING 3 � - . 48. Special Requirements Completed . 49. Electric fletease to Edison � + 50. Gas Release to Southem Califomia Gas Co _ . „ 57. CERTIFICATE OF OCCUPANCYf, No. Date .- City of Costa Mesa Development Serv�ces Oepartment Bu�lding Safe[y Division P. O. Bax 1200 Costa Mesa, Califomia CERTIFICATE OF OCCUPANCY No.QG�b�� The Building located at �� IfTPC1' lq�h S}rac�t has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group �t-1 Occupancy. Use of Building .R23t3u7Cd21t Legal Description 424-211-07 ISee reverse side for Me[es and Bounds) a�aoio,�za2�a,�2iooa,azze�9 r��izi�,sEzaoio Building Permit Noa��a5'±.R21441 Electrical Permit NoPr.7997a F��na�Plumbing Permit No�se919�p�?��3 Mechanical Permit No�"•�1?1Q- N��648 Number of apartments andlor 9uest rooms Fir� Pennit :w.F22523 iSSUEDTo: BuildingOfficial Neale Clark L1� G3cio &80 Ncwport Centrr Suite 200 by ��mort Beach. CA Date March 19, 1986 �This Certificate of Occupancy SHALL BE posted in a conspicuous plaee on the premises and SHALL NOT BE removed except by the Building OHicial of the City of Costa Mesa under Sec. 307 (e1 U.B.C. _ �MF 1015-46 rev. 1/83 Wh�te - �wner; Canary - Numericel File; Pink � Bldg. Permit File 0 ) Applicant to flll In all sDaees ezeept I�ose wit�in CI'fYdf.COSTAMESA/--�-ti�.O.}NST U�C`TIP PERMIT ' .�'roject Address � �Tr a IN ��v,� ✓� � � Applicant's Meiling Address ��3�� y'rn' S�• G. M. Owner'sNamo t2� Phane� "D ��iD Address �Q- I �� N'6 � ArchlEng. — � ( License No. �Obb y %lddres5 � �� 'p � � 9 �' Sf • �S>A" M61A Convactor's Nam �w Phone Address (mailing) � `�� City �icense No. LICENSED CONTRACTOR DECLqqqTION-. I h¢reby atilrm lbat I am Iiconsetl untlar provisions of Charter 9(commenCin9 wi[b se<tlon �000) of DWlifon 3 of tne 8usiness antl Protessfons Cotle, antl .iny Iicense Is in full force antl etiect. • License CIa55 � LicenSe No. Date 519nature WORKERS' COMPENSATION DECIARATION � � nereby aHirm tnat I have a certifica(e ot consent to self-insure or a cerUflcatg. Worke�s" Compensation Inw�an�¢, Or a certifietl copy thereot (SeCtlon ]0, Lab. G.) ^ , ✓olicy No. Company e'Certifietl copy is hereby /umizhetl. ' ' Certitietl capy Is tiletl with the city guilding Division. Date Applican� = � EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section neCtl no[ be Complatetl if th¢ permit iz tor one huntlretl (S100) or Iess). I certify that in tne pertormance ot the work for wnich this perm�t fs issuetl I znall not employ any parson in any manne as to beco gubject lo t�e Workq� �/ y��o.�mp e� 5 .taw5 0( Ca�l(prnia. �n� /� Date/1L.�yiT�';�—Signature F/ �� ___l,e`�-- 'NOTSCE: It, atter making this tlecla tion, you 5 oultl become subject ro tne Workeri' CompOnsatlon prOvlslons ot NG.ldbo�.Cotle,�you musl-lorthw7[h comply with suclt prOvlslons or this pe�mil Shall De Oeemetl revoketl. CONSTftUCT10N LENDING AG@�yCV 1 hereby atfirm Ihat thGre Is a Conitruction lentlinq agency tor Ihe p¢rfo�mance ot the work IOr wnich thiz Oe�mil is iisuetl (SeCtion 3097 Civ. C.) l.entler's Name Lentler's Haaress OWNER BUIIDEH OECLARATION � I tiereby aftirm that I am axempt irom the Con[ractor's License Lnw lor the �/ollowing roason (Soction 7031.5 6usinnss antl Professional Cotlo: Any city or county whlch �eqWrps a p¢rmlt lo COnst�utt, alte�, Improve, demoliih or repdir any'structurc, pNor to Its Issuancc, also requlres the applicant tor such permit . l0 iile a si9netl Statem¢nt Ihdt hn/She is Iicensetl pursuant to the ProviSiOns af the Contraclor's U<onze Law (Cbapter 9(tommentlng witb Sectlon 7000) o( Divlsion 3 ot lne Bu5lnesi anU PrOt¢i5ion5 Cotle) or [hat he/she i5 oxempl vrofrom and t0e basls tor tha allegetl exomOt�on. Any violatlon ot Sactlon 11.5 by any applitant lor a p¢rmit Subjectz lne appli<ant to d clvil Jalty ol not moro than fivo huntl�eC tlollars (E500). L�•I, 55 owner of the P�op¢rty Or my aTO�oyee5 with waqes as IhOi� sole tompensation, will tlo the work, antl the strutture is not intentletl or otfereC tor salo (Sec[ion 7044, Buslnozz antl Vrolessional Cotle: The Contractor'i Li<ense Law tlocs not dPPly to an qwner 01 a prOperty wno builtl5 or ImprOves thereon, antl wno tloes SUGb wOrk himsell/h¢rself o� Ihrough h15 Or har Own employae5, Provltle0 tha[ such Improvoments are not in[¢ntletl o� offere0 for salo. , howavoq tho Duiltling or imOrovemenl is zoltl withln one year of tom- plet n, tM1e ownOr wlll havo thu byrtlen ot proving he/ShE tlitl nOt builtl o� Im- p� 81or [ha purposa OI sal0�. 1, as owner of the property, am excluzively mntracting with Ilcenzetl con- tractor5 to consl�ucl Ihn pro�ect (56ction 7046, Bu51ne55 antl ProteSilons Cotle: Tho Contractor's Llcense 12w do0s no[ appty to an owne� of properly wh0 bulltlz or imorovas thereon, antl who contracts for su<h projetts witn a con- [ractor�51 Ilcense pursuant to [he Con[rdtfot's License Law). I am awdre [hat proo( o! [heir Worker'S Compensdtlon Insurance shoultl be provltletl to me. ❑.1 am exempt unEer Sactlon ^ B.�&,�P. C. tor this reason Datex. Owner 1 he�eby cerifY.that I hava �ea� InfofmdtiOn i5 corrocl. I agr¢e IO� antl state laws rela Ing to Duiltlir SentativUs 01 [h� Ily to en� InsOeCtio urp es Signature� Drivers' License or 55 � ❑on antl'siate tnat tne aoove' all city antl county orCinances �, antl hereby authorize revre- bove-mentionetl oroper O r Date �0 / ��/� �E OF CONSTRUCTION LJ NE4 ❑ GONVERSION ❑ DEMOLISH DESCRIPTION OF WORK/USE OF B antl sign all apvroorlale tlaelaralions. ADD UGl ALTERATION LJ REPAIR TVPEOFPEFiM1T LJ GRADING VJ FOUNDATI�I Cj35TRUCTURAL ❑ TENANT 'V� ELECTRICAL�PLUMBING �GI MECHANICAL ' ❑ OTHER J PROJECT DESCRIPTION 5a. F7. �E„N a�,(,+ oCCUrarvcV CONSTRUCTION TVPE � �_{a� � VAWATION $• �%-5� J6D ZONE GRAOINGCU.VDS. ACRES Remarks:� • ' Bar Sink Backflow'Prevencer Backflow Irrigation Bathtubs Floor Oroins Floor Sinks uas Service Interceptors Kitchen Sink Lavatories P-Trep Roof Drains Service Sink . Sewer Cap Sewer Connection ' $012f C0112CLOf5 Solar Piping Solar Tank Swimming Pool wlSpa Urinal Ouilets 4Vater Closet � � Water Heater � Water Service Auto-Wash Reinspoction Foe � $15 Boiler . Dutt - Under Ground Duct - Structural Duct - Ventilating Exheust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting� ❑a i oo,000 aTu O i oo,000 Reinspection Fea I $15 CMF 0865-46, rev. 30/84 White - Builtling; Canary - Applicant: Pink - Accounting; Goltlenrotl - Azzessor Issue Fae . � '' Hood or Typel ❑ , Canopy Type II ❑ � Refrigeraiion System _ ❑6700,OOOBTU ❑100,OOOBTU System Repair/Alteration Fire Dampers Registers H Iswe Fee $ 3 S 3 -n 1 _j �.L� � A.P.�' Lf�Z, - S Main Building: E� n � T Front /v A Rear C Right I g Left �z� Ping. Ref. # p ' Planning Notes: • � Q Automatic Washer Construction PoleSub. Cooking Unit � Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. F ixtures _. Device Boxes OuLIeLS • c:�...�.d� . Generator na�+ 10/ I �/'�5 Zone Parking Req./Provided ELECTRICAL TFansformer ❑ 75-SOKW' � , ❑ 50+•KW_ � Meter �up to 100 artips Meter ❑over 100 amps Sub Panel '� � Momrs �0.1 HP � 1%�- 8' Inc. Solar �9-15 HP �16-15+ Microwave " Pole Light � Range ; S[anding Section5 KW Trash Compacror � Reinspection Fee �'$15 I � laue Fee DEVELOPMENT SERVICES RE�UIREMENTS:D 2oning Approved 8y � 4 Building APP�ovad By _ li:oc. 'I:. FEES 0 $ 3 ' � SU �Q RV OF FEES -BUILD�NG PERMIT $ _ I ��e � SMIP y ��o�� PLAN CHECK $ PERMIT , PLUMBING �� $ ISSUANCE $ , PLAN CHECK � 25% $ � . ENERGY P.C. $ ELECTRICAL , $ GRADING • $ PLANCHECK 50% $ MICROFILM $ � .MECHANICAL; $ TOTALFEE' $ � � PLAN CHECK 25% $ . . , Z O N 1 N G R E � M T 5 :�ils'ONSTRUCTION AND PLANNING POOL 'PA ,,-,�'APPROVALS Permit# Date Inspector qppROVALS Permit# ' Date Inspector �7. 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:,ElectricalUFERGrnd. 57. APPROVALTOCOVER-GUNITE � 7. Footings 58. Electrical Cqnduit-Undrgrnd. B.�Foundation �k� zt� 59.GasPipe,OUndrgrnd.,Test 9. Water Pi.pe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10�. Structural Floor System 61. APPROVAL TO DECK �11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap , . � , 63. Heater & Vent•Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Fina1 ' 75. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring . 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar.Ceiling ' 69. POOL/SPA SYSTEMS FINAL � 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro � 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Ftush 24. RoofFraming ' 73. Undergrnd.StorageTankOGas ❑Oil - 25. Roof Sheathing � 74. Overhead Hydro 26. T-Bar Ceiling (StrucWral) & Monocoat 75. Dry Chemical - �27. Frame and Fla"shing ��-� � � � 76. Dry Standpipe 28. Lathing & Siding C' i�� 77. FIXED SYSTEM FINAL 29. Insulation S�� 78. FIRE PREV. FINAL 30. Drywall Nailing 2.�$� ��; 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 ROLD FOR SP�CIAL REQUQtiiIVIF.N15 35. Final Gas Pipe-Test � ��, ..,o 36. Hood or Canopy ' - � ! ^�. 37. Final Factory Fireplace ' � � � 38. Final Plumbing • 39. Water Service-Final '... -�IZ�y�Xi (z.�i(d OLC E,�(C,�� wY1�-l. AT W�L.L � 40. Gas Service-Final " 41. Sola�.DomesticFinal ' 42. Backflow Preventer • 43. Backflow Irrigation �� 44. �Landscape Irrigation System ' 45. Sound, Attenuation 46. Handicap,Regulations ' 47. FINAL STRUCTURE & BUILDING . 2r 48. Special Requirements Complefed . � 49. Electric Release to Edison � 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY �� No Date ..w .. � � i .� f4� t . i_ ui i AOOlieant to flll in all spacei eteept t�ose wlthin �aary EorEar Iinas anG sign all ap0�opriate Eaclaratlons. CI7V pF.COSTA nnESA CON R TION ERMIT ' Project Ar+�ress� • P.{��licant's Maili ddress 6 Z/ Owqer's Name � Phon � � � Address Arch/Eng. L icense No. Add�ess � Contractor's Nam V rL Addresslmailingl�—�i Q^ 739 u�one�Zb ) G Ciry License No: LICENSEO CONTRAC R DECLARATION � I hereby affirm that I am Iicansetl untler provislons ot Char[or 9(commoncing ,with� secllon 7000) Of �ivislon 3 oi the Hu5(ness antl PrOfCSsions Cotle, antl my license is in (ull force ana eftect. Lice�s¢ Class License No. Da1@ ' Signature WORKERS' COMPENSATION OECLARATION ;�;��ereDy atfirm tnaf I have a certi(iwte ot consent to selt-insure or a certi(Icate d`•'� Workers' Compen5ation InSUrance, Or�a certiti¢tl cOPY thereof (SeCtiOn . ��;�Joo, Lab. CJ Poli�y No. Company BCerti/ietl caPy is �ei¢by fumithe0. tertifiea copy is tiletl with the city Builtlin9 Division. Date Applitant EXffMPTION FROM WORKERS' COMPENSATION DECLARATION (Thii section neetl no[ be compl¢te0 i( lhe permit iz for One huntlretl (SI00) or Icss), 1 certify that in the perfo�marl<e ot [he wOrk for whlch tnls Oe�m�t I5 issuetl, I sball not employ a y Oerson in any mann s s to Deco(ne subject to ihe workers' q en ws of Calitom Datp _'��[h�519naWre //� �NO71C :, tte making this tleclaraL n, y snoultl become subject to the Wo�kers' COmpnOsation Provi5ion5 ot. thG Labo� COtle� you muzt fOrtnwilh comply witn such provisions or tniz permit shall be tleemeC revoketl. CONSTRUCTION LENDING AGENCV " � ' I he�eby at(bm that the�e i5 a con5truction Ientlin9 agency for the performance ot tM1e work IOr whiGh thii p¢rmit IS ISsuetl (5¢Ctlon 309] qv. C.) t.entler's Name Lentler's Aatlress OWNER BUILDEH �ECLARATION I h�reby aHirm that 1 am exemp[ Irom tnu Contractor's License Law for tne /ollowing raason (5ection 7031.5 Bu5lnass antl Professlonal Cotle: Any tlty or coUnty which requires a permlt to <onstruct, alter, im0�o�e, aemolish or repair any sVucturo, prior to its issuan<e, also reqWres the appli<ant for zuch perml[ ' to tiie a signca statement that he/she Iz Iiconsetl pursuant to Ihe�provisions ot tna Contractor'S Licenso Law (Chapter 9(tommenUn9 with Sectlon ]000) 01 '�IHSiOn 3 0l [he Bu5ine55 antl Profess�oni Cotle) or Na[ h¢/she,i2 a%empt erefrom antl the basis tor the alle9etl azomption. Any vlolation of Sactlon )31.5 by any appliwn[ iOr a permit subfacts the appllcant l0 d civll �enalty ot not more than five huntlretl tlollars (5500). ' I, as owner of tne propertY or my Cmployees wl(n wa9as as ihalr sole compensaUon, will tlo Ne work, antl the sVucture is not Intentlea or olferetl br sala (Soc[ion 7044, Businoss anG Prolossional Cotle: Tha Con[ractor's LlConsc l. w tloes not apply lo an owner ol a prOperty Who builtl5 O� improves tnereon, and who tloes sucb work bimteN/h¢r5elf ot tNough ni5 0� hOr Own eTO�oyces, prOvltletl that Such ImprovOm9nts a�e-not IntenAetl o� offp�¢d fOr sale. It, nowevar, the builtling or imProvement I5 zoltl within one year ot com- OlBllon, lM1a ownet will have tn0 burtlen ot prOvin9 he/ih0 GIO nOt build o� IT- prOva for thC purppse ol salo), '. ❑ I, a5 ownC/ ot the property,�am exclu5ively mnlraCting witn liGensatl COn- Va�(ors lo <ons[ruct Ih0 pro�¢cl (Section 7044, Businesi antl ProlessiOns COCe: The Contractor's License Law does not apply to an owner ot oroperty who builtls or improves theraon, antl who contracts tor such'projects with a con- tractor(5 Iicense pursuant to tne ConVactor's Licenie Law). 1 am aware that �of o� thelr WorkePs Campon io i sur nce snoultl be provitletl to me. I am exempl unaer Sectlon B. & P. C. br tbis reason Date OWner 'tate that the above �tl county ortlinances eby authorize repre- Io�etl y� p� y O� s 3 ._...... . _. . - - ....., ...,. . - c`� 6 4�S - — . . , TVPE OF CONSTRUCTI�N NEW ADD P.LTERATION REPAIR ' ❑ CONVERS�ON ❑ DEMOLISH � OTH A p.� ��' �j DESCRIPTIONOFWORK/USEOFBLDG. ��r'��G ��L� ' S Main Building: TVPEOFPERMIT GRADING FOUNDATION STRUCTURAL T Ffont '� O TENANT ❑ E�ECTRICAL ❑ PLUMBING ❑ MECHANICAL , B Rear � ❑ �OTHER - - � . %� PROJECT DESCRIPTION 50. FT. OCCUP Y -C Rlght a� CONSTRUCTIONTVPE VALUATION � �g Left �.�, 20NE G RADING CU. YDS. A RES p�ng. ftef. � • Remarks: �'�'� �,�---rl/ � -�7�'� ' Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtuhs Clarifiers . Dishwasher, ' Drinking Fountains Floor Dreins � Floor Sinks � Gas Service Outlets Interceptors Kitchen S�nk ' • Lavatories . . � P—Trap Roof Drains ' Rainspection Fae $75 Boiler Dutt - Under Grountl Duct-Sttuctural i Duct � Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting �0.100,000 BTU �100,000 Signature wwV�� Date I I Reinspection Fee Dri�ers' Li<ense or 55 � � ' CMF 0065-46, rev. 10/84 White - Builtling: Canary - Applicant: Pink - qcmuntln9: Goltlenrotl - qssa55or $15 Showers ServiceSink � Sewer.Cap � Sewer Connection � Solar Collecrors Solar Piping i Solar Tank Swimming Pool wlSpa Urinal - Waier Close[ Water Heater. Water Service � Auto-Wesh Laundry.Trays - laue Fee ,Hood or Typel ❑ Canapy Type I I ❑ Refrigeration Sys[em . ❑6700.00OBTU ❑100,000 System Repair/Alteration Fire Dampers Registers n � Issue Fee � FEES § 3 FEES $ 3 0 � Automatic Washer' Construc[ion Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Elea Fan F.A,U. Fixtures Device Boxes Outlets Garbage Disposal Generator 00.5 KW Fee Zoning APProved BY_ Buildine APProved By 9396 8/3d/8S � Zone Actessory Builtling: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50�KW ❑ 50+.KW Met¢r ❑up to 700 amps Meter ❑over100amps Su6 Panel Motors �0-L HP � 1 X�- 8 InaSolar 09-15 HP �1E15+ Microwave - Pole Li9ht � Range ! Standing Sections 15 KW Trash Compactor $15 luue Fee .:4oJ FEES $ 3 Z O N 1 N G R E Q M T S SUMMARV QF FEES BUtLDING PERMIT $ �� SMIP . $ _rJU PI.AN CHECK $ �� PERMIT PIUMBING $ ISSUANCE $ PIAN CHECK 25% $' ENEFGY P.C. $ � ELECTRICAL $ GRADING $ PI,AN CHECK �, 50% $ MICROFILM' $. MECHANICAL . $ TOTAL FEE $ � :�3- PIAN CHECK 25% $ ' ' i'� CONSTRUCTION ANDPLANNING POO SPA APPFdOVALS Permit # Date Inspector qppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ,�F: 2. Soil Pipe'Ur)dfgrnd. � "� 53. Steel Reinforcement '- � t <: � 1 � t3r'ElectFical'Cdnduit Utility-Undrgrnd. ,�: 54. Forms •„•, � ' , , 4•.,,ElectricaPCoriduit Undrgrnd. . 55. EVectrical8onding , �: � 5,;:Steel Reinforcerrieii�', 56. Rough Plumbing & Pressure Test f. �� 6�'Elec[,rlioel'UFERGrrid. 57. APPROVALTOCOVER-GUNITE � �,,. ' T 7?'Footipgs �%�i' .�; � � � 58. Electrical Conduit-Undrgrnd. �� ' `� 8.'�fourida;ion' �' ' i h 59. Gas Pipe, O Undrgmd., Test e� i� .r ::. 9: Wat,er Pipe-Undrgrne, ��" 60. Backwash Lines, P-Trap, � Undrgrnd. �; �� ' 10, 8truc[ifr'a�l Floor SyStem h 61. APPROVAL TO DECK ` �� ., 1.1. Property Sewe� line & House Connection 62. Backwash & Receptor-Final 12. Seo4ertCa( „ • w� 63. Heater & Vent-Final •: i :r. 13. Roof� Drains� �� ; � 64. Plumbing System - Final '': 14. RoughPlumbing`y.!� � 65. Electrical-Final �,'., ' 15. Rough Electrical_Canduit 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 St}ucture - 70. Underground Hydro �22. Ducts, Ventilating . 71. Product Piping O Gas ❑ Oil 23. ,Gas Pipe-Rough & 7est . 72.' Underground Flush � 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oi{ 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Struttural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation . , 78. FIRE PREV. FINAL 30. Drywall Nailing ' HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat �' 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric . Notes: . . ' 34. Final Heating & Air Conditioning ' 35. Final Gas Pipe-Test � � - 36. Hood or Canopy 37. Finai Factory Fireplace . 38. Final Plumbing � 39. Water Service-Final � � 40. Gas Service-F.inal . 41. Solar pomestic-Final ' � 42. Backflow Preventer � i � 43. Backflow Irrigation"' .� ' 44. ,Landscape Irrigation System 45. Sound- Attenuation 46. Handicap Regulations 47. FINAL STRUCTUFE & BUILDING , � 48. Special Requirements Completed � 49. Electrie Releese to Edison, ' _ � � 50. Gas Release to Southern California Gas Co � � 51. CERTIFICATE�OF OCCUPANCY No. _ Date ' ' AODlieanl lo flll in all ipaeas except t�ose wil�in �eavy bortler Iines antl fign all aDD�opr(ate tlecla�ations. CITV [�f COSTA MESA C��O/N STRU TI PERMIT Proj¢c;.AQd"ress• �L(J/�, . �� _ . _ mPP�icant's Mailin%��J/1 d�r�e�ss 6 4� �(•�� Owner's Name �J=[ �� Phone(¢�E_✓J[{f Addreu Arch/Eng. K • Litense No. � I Address • Contractor's Nam �Phone Address � moilin9) City License No. LICENSED CONTRACTOR DECLARATION I hereby aftlrm lhat I am Iicensetl untler provisions ot Charter 9(Commendng witn section 7000) of �ivision 3 of the Business antl Professions Cotle, antl my license iz in full force antl elfe<t. Lice�se Clais License No. _ Dafe Signature . VdORKERS'COMPENSATION DECLARATION hereby atfirm lhat I nave a certHicate ot consent to selhinzure or a certlficate �( Worker5' Comp¢nzation Insurance, Or d certl(ietl coOY there0l (Section 3800, �ab. C.) Pr,olify No. ' Compdny y Certifietl cOPY i5 hereby (urnisbetl. ,� LJ Q¢rtifietl copy is fi1Ctl witn the city Builtling Dlvision. Dat@ Appli<ant EX�MPTION FROM WORKERS' COMPENSATION DECLARATION (This section neetl not be completetl it lhe permit Is tor one huntlretl (5100) or Iess). I cer[ity tha[ In the per(ormance of t�e work for ich tnis permR is issuetl, I ihdll not e P� Y any p¢rsOn In any n o berom ^5ubjeci t0 the worker C t' ws of Califo i Data _� 519nature ��a 'NOTICE If, fter makin9 tnis tleclaratlon, you sboultl become sub�ect to the Wo�kers' Cornponsation p�ovi5ions of th¢ �abo� COtlu, you must tortM1with comply with such provisions or tnis permit shall be aeemetl ravoketl. CONSTFUCTION LENDING AGENCV '� � ' - I horeby atiirm ihat there is a constructlon lentlin9 agenry for the pertormance of IM1¢ work tor whicn this Dermlt fs _issuatl (SeClion 3097 Civ. C.) l.entler's Name LCO�yCf'S AtlCIC55 OWNER BUILDEH DECLARqTION I hereby al(irm [hat I am exempt from the ConVactor'S License Law for the /ollowing reason (Section 7031.5 Businoss antl Profasilonal Cotle: Any city or munty which roqulres a Darmlt to construM, alter, improve, tlemolish or repair any structure, prlor to its issuance, also retluires lha aDPlitant for such pormit to Iile a Slgnatl Sfat¢ment [hal h0/ihe I5 IicenSatl pulsudn[ [o th0 ProvISIOnS of the Contractor's License Law (CnaD�er 9(commencln9 with 5¢ctlon 7000) oi Dlvlsion 3 0l lhe Buiiness anU Profes5ions Cotle) or that he/sne Iz oxampt IheY¢Irom antl l0e bails tor the allegetl exempUOn. Any viOlalion oi 5¢ctlon 70j1.5 Dy any ap0��ant for a Pe�mit sub�«ls lhe apP��ant IO a clvil �erlalty of nol more than five huntlre0 tlollars (E500). ' I, as Ownor Of Ihe proparty Or my ¢mployee5 wlt� wages as tM101� Sofe coR�p005allon, wlll Oo the wO�k, dntl th0 st�uttur¢ IS not� IOt¢ntl00 0� OfltrOtl f0/ Sale (SecUoO 7044, Buslne55 antl PrOf¢SSlonal Cotl¢: Th0 Conlracto�'S License Law tloos not apPIY �o an owner of a properry wno bullds or }mproves thoreon, antl who tloes such work himseli/hersnlf or t�rou9h his or her own employ¢es, provitlatl tnat such ImOrovemen[s a�e not IntenCetl or o�teratl t0/ sal�howaver, lna Dulltling or ImprOveTent I5 saltl within Ona year Ot COm- ple( , the owner wlll have the burtlen Ot proving he/she Gltl nOt builtl or IT- r e �or Ina purpOsa of sale). . I, as owner of the pro0¢rty, am exClusivety contractlng wilh IlcanSCtl con- Vartor5 to COnslruct lhe prO�ect ($oCtion ]044, Buslness antl P�otesSlOns Cotl<: The Contraclor'S License l�w dOeS nol apply to an owne� 01 prOPOrty wno bu��tlz or improves tnereon, ana who contracts lor such projects with a con- tractor(s1 Ilcenso pursuant [o the Contractor'S Liwnta Law). I am aware that P�Oof o( their Worke�'s Compe05atlon insu�ance Shoultl ba Orovltlatl to ma. ❑ I am exempt untler Sectlon B. R,P. C. �or this reason Date Owner 1 her¢by ¢r y IM1at I have r¢atl Ihis application dntl ila[e [hat the above IntOrmdtlon is correct. I agree [O cOmply with all clty dntl coun[y ordindnces ana state laws �alatina lo builtlin9 COnsVUCtion, antl h¢rebv auth0/iie r¢pre- Si9nature _�j �i"' OrWers' License or 55 � TVPE OF CONSTRUCTION LJ NEW LJ AOD I—J ALTERATION Ll REPAIR ❑ CONVERSION ❑ DEMOLISFI ❑ OTHF�� DESCRIPTIONOFWORK/USEOFBLDG. / TYPEOFPERMIT Gi2ADING FOUNDATION STRVCTVRAL ❑ TENANT ❑ ELECTRICAL Q P`�Jjv1�B�N= � �v10ECHANICAL ❑ �OTHER �' (•w ] . PROJEC7 DESCRIPTION 5c�. F7. oCCvaAN —� CONSTRUGTION TVPE VALUATION S f�DO.I ZONE GRADING CU. Y�S. ACRES Remarks:- • Bar Sink Backtlow Preventer - Backflow IrrigatiOn Bathtu6s Clarifiers Dishwdshen Drinking Fountains Floor Drains Floor Sinks Gas Service OuUets Kitchen Sink Lava�ari¢s P-7rap Roof Drains Reinspenion Fea $15 Boiler ' Duct - Under Ground ' Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fac[. Blt. ICBO # Heating System & Ducting ❑a100,000 BTU 0100,000 Reinspection Fee � $15 GMF 0865-46, �e�. 10/B4 Wbite - Builtlin9: Canary - qppp�ant: Pink - Accountin9; Goltlenrotl - qssestor Service Sink - Sewer Cap Sewer Connection • Solar Collectors Solar Piping Solar Tank � Swimming Pool w/Spa Urinal. Water Closet � Warer �Heater Water Service Auto�Wesh Issue Fee Hood or Typel Canopy Typell Refrigeration Syrtem ❑aioo,000aTu �ioo,000 System RepairlAlteration � Fire Dampers Registers ' laue Fee FEES g 3. FEES - $ 3 A.P. ql� '. l- S ' Main uilding: � E T Front A Rear C .Right , K Left S Ping. Ref. � Planning Notes: ' Automatic Washer Construttion Pole Sub. Cooking Unit Dishwasher Dryers �Gas ❑Elec Fan ' F.A.U. Fix[ures D2VIC2 BOXCS Outlets Switches Garbage Disposal Generator Q0�5 KW C Reinspection Fee � 3456 II/01/85 Zone Accessory Bui 0 EIECTHICAL ' � - Transforme� ❑ 15-50 KW '� • ❑ 50+KW � Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel . Momrs �47 HP �l'h - 8 ' Inc. Solar �9-15 HP �16-15+ Microwave � . -- Pole Li9ht Range . ; Stentling Sections 5 KW Trash Compacmr $15 Issue Fee c:a3E Tl. FEES $ 3 Z O N I N G R E U M T S DEVELOPMENTSERV�ry�,,E,SA�/Qy�(J�IfENTS: . � (� 2oningAPProvedBY IV�a�(l�� oat - 1l(/%J Building Approved By Date APPlintion laued BY � Daa �� -�� SU RY C�F FEES BUILDING PERMIT $ U SMIP $ � S� PLqN CHECK $ PERMI7 � � PLUMBING $ ISSUANCE $� PLqN CHECK 25% $ ENERGY P.C. $� ELECTRICAL $ GRAOING $� PLANCHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ �� P�.4N CHECK 25% $ CONSTRUCTION ANDPLANNING POl .SPA �� Oate Ins ector APpROVALS Permit# P APPROVALS Permit# /� Date Inspectar / .�emporary Electricat Service or Pole 52. Pool & Equipment Location � 2.' Soil Pipe`-UndFgmd. ' 53. Steel Reinforcement �y �3. Electrfcal Cpnc�uit Utility-Undrgrnd. . 54. Forms .�� :"}' 4/Elect�ical�Conduit-Undrgrnd. '' 55. Electrical Bonding � , 5. Steel Rertmfyrcement 56. Rough Plumbing & Pressure Test '� .� . . i 6.'_Electrical UFEfi Grnd. 57. APPROVAL TO COVER-GUNITE N, �. � 7��ootings; .�. � �� 58. Electrical Conduit-Undrgrnd. ' � �; ' '1 � 8:..�Foundation �• F'� 59. Gas Pipe, O Undrgmd., Test * 9� �Water Pipe-lfndrgrnd. .' �r . 60. Backwash Lines, P-Trap, O Undrgrnd. 10.•Sfructural Floor 5Ystem r 61. APPROVAL TO DECK 11. Property Sew �ei^Line & House Connection i 62. Backwash & Receptor-Final '�� 12. SewerlCap �� 63. Heater & Vent-Final 13. Roof'Drains ;' ; 64. Plumbing System - Final �� ' 14. Rough Plumbf(ig 65. Electrical-Final . 15. Rough Electrica�-Conduit 66. Solar System-Final 16. Rough Elec[ric Wiring 67. Fencing & Access Approval . ' 1�.'Rough Wiring Sign 68. APPROVED FOR PLASTERING 18.�Rough Electrical-7 Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19., Rough Heating & A�r Conditioning FIRE DEPT. REQUIREMENT 20.' Rough Factory Fi�eplace ' APPROVALS Permit # ' 21. •Duc[s, in Structure ��.� 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil 23.•Gas Pipe-Rough &:Test �� 72. Underground Flush - 24: Roof Fram'r'ng :;, �' � <:% � 73. Undergrnd. Storage Tank O Gas ❑ Oil '25'. Roof Sheathing�, � , ' 74. Overhead Hydro 26. T-Bar,Ceiling (�t�ural) &'Monocoat 75. Dry Chemical 27. Frame�end Flashing ',� ,: � 76. Dry Standpipe r a- ' 28. Lathirjg & Siding 77. FIXED SYSTEM FINAL 29. Insulation .' 78. FIRE PREV. FINAL 30. Drywell Nailing ,�� HEALTH DEPT. REQUIREMENT 31. Plaster��Brown Coat „ � 79. FINAL INSPECTION 32. Electrical Power Met�r-Final 80. FOOD CERTIFICATE ISSUED 33. Final+Electric � Notes: �. " 34. Final, Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hoodmr Canopy r 37. Final,Factory Firep�ace. -' 38. FinahPlumbing ., 39. Water�Service-Final ,_ 40. Gas�Service-Final - . , 41. Solar pomestic-Final � � � 42. Backflow Preventer � . � �� 43. Backflow Irrigation 44. .Landscape Ir�igation System � � 45. Sound Attenuation � 46. Handicap.Regulatidns � - 47. FINALSTRUCTURE&BUILDING - 2� A8. Special Requiremenu Completed 49. Electric Release to Edison 50. Gas Release to Southem Califomia Gas Co • 51. CERTIFICATE OF OCCUPANCY • No. � - . Date . . ' � t . Aoo��ant Io llll In all svaces ezeept tnosa wilnin neavy boraar Iinas ana sign all aovroo�iata Geelarations. CI ,T2i3OF COSTA MES ONST C O F�RMIT •—��, yPioject Address ��,Applicant's Mniling Address Z Owner's Ndme . � hon Addreu Arch/Eng. Litens o. Address / Contractor's Nam U , hone �� tl �. Address (mailing) � I City Licenae No: LICENSE4 CONTRACTOR DECLARATION I heieby a}(�rm that I am lieunsetl untler provisim o C r 9(commencln9 wi[h sectiqn 7000� ot Divislon 3 ot the Business a tl essions Cotle, antl my Ilcense is In tull force antl eftecL � License Gldss License No. � �ale Si9nature IWORKER$• COMPENSATION UECLARATION I hereby af�{�m that 1 have a certiilwte ot consent to selfinsure or a certiticate f Wotkery' Compensation Inwtance, or a certitietl mpy thereot ($eCtiOn 800, Lab. C.) ' Policy No. Company I B Certifietl copy i5 hereby fumisnetl. Certifietl copy Is filetl witlt the city Builtlin9 Division. Da[e APplitant EXEMPTIbN FROM WORKERS' COMPENSATION DECLARATION (This sectiOn neetl not be completetl if th¢ pe�mit i5 tot one huntlr¢tl ($100) Or less). 1 certity tha[ in [he pertormance oi Me wo�k �or whicn thit perm�i is issuetl, 1 snall not @ ploy persOn In any map� er�2' to becom�subject [o Ihe Worke n Laws of Calltorn�e� Date .�� Si9nature ��V 'NOTIC If, a/ t making IniS tlecla�aHon, you shoultl becoma zu�j¢cl to th0 Workers' CO ensa[ion provi5ions ot the LabOr Cotle, you must Iorthwitn comply witn zuch provisions or tnls permit snall be tleemetl rovoketl. CONSTRVCTION LENDING AGENCV � 1 hereby afllrm tna[ there is a construction IenCing agency tor tne per(ormance o/ the work tor wtrk7 lhis permlt is issuetl (Sectlon 3097 Civ. C.) Lentler's Name �TI Lentler's Atltlress OWNER @UIL�EN�DECLARATION I M1e�eby dHirm tha[ I am exampt trom tne Cont�aclor'S Llcenza Law t0/ IItO tollowing� rcason (Section ]031.5 Business antl Professional Cotle: Any dty or county whlch requires a permlt lo cons(ruct, alteq Improvn, tlemolish or re0air any sVucture, P�IOr to i[s I55uance, dlm �equlres th<applicanl t0� sUth pe�mil i0 �118 d 5190pd S�dI2TCOl �hdl i18�5h2 �5 I�CC058d pUf511dO� t0Ih8 p�OV�51005 Oi lhe Contrector'S Lltenso Luw (Chapter 9(Commpncing wilh $eCUon 7000) oi DWision 3 of tne Business antl Professions Cotle) or that he/she is exampl '4erelrom antl tbe basis for the allegetl exemptlon. Any violatlon ot SecHon �31.5 by any appliCan� /Or a pGrmH Subje[t5 Ihe applitant t0 a civil e0alty oi nol more than �wC huntlred tlolla�s (E500). ❑ I, as Owner oi [he prOpe�ty or my ompl0y0es wlth wage5 as their 5010 compensation, will tlo the work, antl the structure is not IntenOetl or otieretl for sale (5eclion 7044, BuSiness an� Protessional Cotlo: Tne Contractor's License I:�w tloas not apply to an owner ol a property wno builtls or improvus thereon, antl wno aoes such work hlmself/narsolt or throu9h nis or har own employees, provitleE ihat such Improvemenls are not Intenaetl or ott¢reA for 581e. It, howover, the builtllnq or Imo�ovemont is sole wiNin one year of com• pletion, tno owner will have the burtlen ot praving he/sne tlIE not builtl or Im- ove tor (ha purposa ot sal¢). 1, as owner o( tbe property, am exclusively conbaclin9 with licensetl con- V to/s l0 con5t�uct [he O�Oject ($ection ]044, BuSin¢sz antl Prof¢SZIonS COtle: Tho Con�ractor'S License Lnw does nol appty to an owner of property who bulitls or improves thereon, antl wno contracts for such projects wltn a con- tractor(5 Oconm pursuant to the Contractor's Llcenre �aw). I am aware that proof o� (hei� Worke�'s COTpensatiOn fnsu/anca Shoultl be provitletl t0 me. ❑ I am exerppt unper Section � �—yB; & P. C. for this reason Date Owner � I heretiy �er❑ tnaf 1 nave reaC th oP��atlon antl Informat�on fs correct. 1 agree [o compty witM1 all city a antl state iawc rnlatino to builtlino conSVuction. antl hF Si9nature Drivers' �i<en ar 55 $ above TYPE OF CONSTRUCTION LJ NEW�D LJ ALTERATION IJ REPAIR � ❑ CONVE(3510N ❑ DEMOlISH OTHER p�p..�y DESCFiIPTION OF WOfiK/USE OF BIDG. �� 5 Main Building: TVPEOFPERMIT GRADING FOUNDATION STRUCTVRAL T Ffont ❑ TENANT ❑ ELECTRICAL LUMBING ❑ MECHANICAL � B Rear ' � ❑ �OTHER • • A PROJECT DESCRIPTION SQ. F7. oCCUPANCv C Right K Left CONSTRUCTIONTVPE VALUATIONS S ZONE GRADING CU. V�S. ACRE$ Ping. R@L qlE Remarks: � ' , , � ��Q� Planning Notes: Sink Preventer Irrigation �rinking Fountains Floor Drains � Floor Sinks � Gas Service OuUets Interceptors Kitchen S�nk Lavatories P—Trap Roof Drains Reinspection Fee � §15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exheust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting� ' ❑0.100,OOO�B7U 0100,0008T Reinspection Fee � $15 CMF 0865-48, rev. 30/84 Wnite - Buliaing: Canary - qppliwnt: Pink - Accounting; GOltlenroA - Asse55or Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank � Swimming Pool �y�5pa Urinal Water Closet Water Heater Water Service Auto-Wash Laundry Trays Isue Fea Hood or Typel ❑ Canopy Typell ❑ Refrigeration System ❑Pi00,0008TU ❑700, System Repair/Alt¢ration Fire Dampers Re9isters laue Fee g 3 FE 5 3 'Automatic Washer Construction Pole Sub.' Cooking Uni[ � Dishwasher Dryers ❑Gas ❑Elect Fan � F.A.U. � Device Boxes Outlets Switches Garbage Disposal Generetor 065 KW 8810 2/05/B6 io�i' Tl. Zone Acceszory Building: - Z O �• N I N G R Parking Req./Provided E M S ELECTRICAL Transformer ❑ 15-50 KW i ❑ SO+KW Meter ❑up l0 100 amps Mecer ❑over 100amps Sub Panel • Motors � 0.1 HP � 1 Yh - 8 Inc.Solar �9-15 HP �76-15+ Microwave Pole Light � � � Range ; Standing Sections 5 KW Trash Compactor FEES � Feinspection Fee � 515 � � laue Fee - � S 3 � DEVELOPMENTSERVICESREQUIREMENTS: � ' 2oning APProved BY Date Building APProved By Date Application Issued By Dat� , SUMMARV OF FEES ' � BUILDING PERMIT $ SMIP $ � PLAN CHECK $ PERMIT PLUMBING $ `� ISSUANCE � $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLANCHECK 50% $ MICROFILM $ MECHANICAL � $� 'TOTAIFEE $ ^� . PLAN CHECK 25% $ - � � �ONSTRUCTION ANDPLANNING POOI PA � � �� Date Ins ector ��4PPROVALS - Pern+it # P APPROVALS Permit # Date Inspector � 1. Tem"porary 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. S[eel 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 73. 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. Undergraund Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil �23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing ' 74. Overhead Hydro � 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYS7EM FINAL 29. Insulation � 78. FIRE PREV. FINAL 30. Drywall Nailing . HEALTH DEPT. REQUIREMENT - 31. Plas[er 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 ' 3 J' jG ,,�� 39. Water Service-Final 40. Gas Service-Finai 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation � 44. .Landscape Irrigation 5Ystem � � 45. Sound Attenuation . 46. Handicap-Regulations 47. FINALSTRUCTURE & BUILDING 46. Special Requirements Completed 49. Electrie Release to Edison , _ _ 50. Gas Release to Southern California Gas Co � � � 51. CERTIFICATE OF OCCUPANCY No. � Date � � CI?V OF COSTA MESli 'P.6jQctAddress �r�� .F+PP�'tant's Mai-li-n7g�A�dd�r�eu OwnBr's Name 1.Ll10E_ "Arch/Eng. � License No. Address .� -�� A� �• ��/ Contracmr'sNam ✓ Phonel�PlL_L-�� AddresslmailinglE� • City License No_ � �a— 'Z Z • LICENSED CONTRqCTOR DECLARATIOIV U � I he�eby aHirm thal I am IlcenSetl untler proviSiOns oi Charter 9(commencing with sec[lon ]000) of Dlvislon 3 of [he Business antl ProleSslons Code, an0 my Iicense is in full force antl effect. LJCBOSC CId55 (_ICCOSC NO. Date Signature WORKERS'COMPENSATIONDECLARATION - ' hereby afflrm tnat I have a certificate oi con5¢nt to sell-insure or a<ertificate Woikers' Compensation Insurance, or a cer[ifiea cOpY �hereof l5ectlon J0. Lab. C:) " - . : PolitY No. �'CompanY eCertifi¢d m0Y �5 nereby turnished. • .�. " Certifiea copY iz filetl wi[h the ci[y;Builtlin9 Division. Date APP�icant EXEMPTION FROM WORKERS' GOMPENSATION DECLARqT10N (Tnis section neetl no[ be completetl it tM1e permit ii for one huntlretl (5100) or Iess). � : I cerlity lhat in lhe pe�fO�mance of ('fie wo�k (o� wNch thl5 pE�mR Is ISsuetl, I Shall not eTPloy�any,pe�sOn in any mann¢/ zo a5 t0 ba<Ome su0j¢c[ lo the Worker5' ComOenwtion Laws of Cdli(Omia. ' Date �� Si9nature - 'NO710E: II, altcr making this deUaratlon, you ihOultl bCcome SUCje<t to Ihp WOrkers' CoTpensatiOn provisions of l�¢ Ldbor Cotle, y0u mu5t,forthwit0 comply with such p�ovisions o� thi5 Oermit ihall b¢ d@lmetl /evOketl. CONSTRVCTION LENDING AGENCV I noreby aflirm that there is a construction Ientlin9 agenq for the pertormancC of the work tor whith this permit is issuetl (Sectian 3097 Civ. GJ Lontle�'s Name Lentler's Atltlress OWNER BUILDEN �ECLARATION 1 horoby afflrm tbat I am exCmPt trort� th¢ Contract0/'s Litenso l.aw for the following reason (Sattlon 7031.5 Buslness antl Prolezzional COGe: Hny city Or County whlGh requirls d OerTlt [o constfuct, all¢r, ITpfove, tleTollsh Of rCPdir any structure, prior to Its issuance, also requires lhe apPlicant tor such permit to 1i10 d signod SlatCmCnt tbdt he/she i5 lit¢n580 PufSudnt [o [he pfovlsions Of the Contractor'S License l. w(CnaDter 9(commencin9 with SecUon 7000) of Oivision 3 0l [ha BuSiness antl Profezsions �otle) or thal hn/she is exempt �er¢t�Om a0A the ba5i5 tor the allegld ¢zemPtfOn. A�y violalion Of SectiOn )31.5 by any applicanl tor a permit subjec[s [he applicant ro a tivil enaltY ot not mora tban fiva huntlrea tlollars (E500�. � I, a5 own¢� of [ne property or my aTO�DYe85 witb wd9Cs as lheir sole eom0on5ation, will no tne work, antl lhe Sl�ueturo IS elot IntentlCE o� 01terOE lor sale �Soctlon 7044, Business antl vwtessional Cotlu: The ContractorY LltenSe 12w tlOes nol apply to an owner of a Oroperty wno bu(Itl5 or ImD�ovas lhe�¢On, an0 wh0 tloe5 suGh wo�k himself/herself o� Ihroug b h15 0� har own employoas, provitlatl tllat suCh inl0mvem¢nt5 ar0 not IntenCatl O� ottere0 �or sa10. ��, however, lhe bulltlin9 or improvement (s soltl wfthin ono year oi <om- pletlOn, the Ownef wlll have tne DurOen of prOving he/S�o tlitl nol builtl o� Im- �rove �or tha purposo ot zale). , as owner of tM10 property, am extlusivery contracting wlth IlcenseC con- tfaclOfS to Conslrucl lh0 prOject (Section 7044, BuSIneSS antl PrO�es51on5 Cotle: Tbe ConttaCtor's Lltense Law does not apply t0 an owmr Ot prOperty wno builtls or Improvas tnereon, antl who mntracts tor such o�ole�ts wit0 a com _ baclor(sl Ilcanse pursuant�to tne Gontractor'i License Law). I�am aware that prool oi thei� Worker'S COmpapsatlon in5u�ancB Shoultl be P�OW�etl to me. ❑ 1 am exemol untlor Section 9. & P. C. lor [ni5 reason Date /f sentatives ot tn t ip5petqon OUIP ei Signature Drivers' License or 55 L Owner I have reai 1 ag�ee to to builtl7p to eNB� L /, above TVPE OF CONSTRUCTION LJ rvEW LJ ADD ❑ CONVERS�ON ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BIDG. � ies antl sign all aooropr a e ec . f NO. UNIT NO. - ALTERATION L.l REPAIR TVPE OF PERMIT LI GRA�ING /�FOUNDATION �STRUCTURAL ❑ TENANT �LECTRIGAI �LUMBING ❑ MECHANICAL ❑ OTHER ' PROJECT DESCRIFTION 5�. F7. OCCUaANCY �' CONSTRUCTIONTVPE �VALUATIONS ZONE GRHDINGCU.vDS. ACRES— Remvks: Sink Pteventer Irrigation Drinkin9 Fountains � Floor Drains Floor Sinks � GasService Outlets Sink �/ Roof r Showers Service Sink Sewer Cap Sewer Connection Solar Colfectors Solar Pipin9 � Solar Tank Swimming Pool wlSpa Ur"�nal Water Cbse[ Water Heater Water Service Auto-Wash Reinspection Fea I $75 � � Issue Fee � a 3 Boiler ' I Hood or Type I ❑ Dutt - Under Ground ��P� TYPe �� Exhaust5ystem YS�Multiple Firepl/Fact. Blt, ICBO �k Heating Sysrem & Ducting ❑0.100,000 BTU 0100,000 Reinspection Fee � 515 ftefrigeration System oa�oo.000eru ❑ioo,000 System Repair/Alteration � Fire Dampers Registers CMF 0865-46, rev. ]0/84 White - Builtling: Canary - Appllwnt: Pink - Accountin9; Goltlenrotl - A55essOr - Issue Fee S 3 A.P. � S Main Bu E Front T B Rear A C Right K Left $ Ping. Ref. # Automatic Washer Construction Pole Sub. Cookin9 Unit D{Shwasher ' Dryers ❑Gas ❑Elec F.A.U. Fixtures Device Bozes 2ona Accessory Parking Req,/Provided ELECTRICAL � 7ransformer ❑ 15-50KW ❑ SO+KW Meter ❑up to 100amps Meter ❑over100amps Sub Panel �� Momrs 0.1 HP � 1 X� 6 Inc.Solar �9�75 HP �1615+ Microwave Pole Ligh�, , Range Garbage Disposal ! Standing Sections Generator 00.5 KW �545 KW Trash Compactor Reinspection Fee $15 Issue Fee � DEVELOPMENTSERVICESREQUIREMENTS: - •-� Zoning Approved By � Buildirig Approwd By �.. APpliration Istued Bv �"" i BUILDING PERMIT $ — PIAN CHECK $ ' PIUMBING $ 4 PLAN CHECK 25% $ , E�ECTRICA� $ � PLAN CHECK 50% $ MECHANICAL $ , PLAN CHECK 25% $ 2 O N 1 N G R E Q- M 7 $ FEES 6 S 3 SUMMARV OF FEES SMIP $ PERMIT 30^ I$SUANCE $ 7, S/9 ENERGV P.C. $ .��_ 6 r GRADING $ �'J, �j �• MICROFILM $ 9' � TO7AL FEE $ �_ � . i�. 69NSTRUC710N AND PLANNING ` `' . . . , 'P.001 PA --"' Date 'Ins ector �' �dPPROVALS Permit # P APPROVALS Permit # �\ Date Inspector ' 1. Temporar,y�lectrical Service or Pole 52. Pool & Equipment Location �'� i 2. Soil Pipe-Undrgrnd. � � �j 53. Steel Reinforcement ;� 3: �Iectrical,Conduit Utility-Undrgrnd. �/ (� 54. Forms :��" � j� 4:'Electiical,Cortduit:Und'rgrnd. 55. Electrical Bonding � � ' 5.; Steel Reinfo�c�ment� _/ 56. Rough Plumbing & Pressure Test - i ' '� 6. 'EI€ctrical UFER.Grndt' �� 57. APPROVAC TO COVER-GUNITE ;� . 7-.' Footings�' `" .'�, �. �S 58. Elecvical Conduit-Undrgrnd. � �I ` ��: 8�. �Foundation � '� ,�/ 59. Gas Pipe, � Undrgrnd., Test ' , •'r � � 9. Water Pipe-Undrgrnd�.�,"�, , �� .j/ �f' 60. Backwash Lines, P-Trap, O Undrgrnd. ,�+ ,r � �.. . . '.� �,, 10. Structural Floor Syste'm'� 61. APPROVAL TO DECK , i� .� 11. Property�Sewei Line'& ElouseConnection 62. Backwash & Receptor-Final 72. Sewer'Cap • J%" �. 63. Heater & Vent-Final �%% �• 13. R6of.D(ains • � 64. Plumbing System - Final 14. Rough Plumbing� i�,� ��l&f fi5. Electrical-Final � � 15. Rough Electrica6ConduiS . �; 66. Solar SNstym:F.inal - If. �16. Rough Electric Wiring � / " 67. Fencing &'Accese Approval �' ' �� 17. Rough Wiring Sign . 6S. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL(SPA SYSTEMS FINAL 19. Rough Heati�9 & Air Conditioning �; FIRE,DEPT. REQUIREMENT 20.� Rough Factory Fireplace .' APPROVALS Permit # r 21. Ducts, in Structure '' 9�'L 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 OOiI � 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar: Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frar�'ie end Flashing • 76. Dry Standpipe 28. Lath�ing'�'Siding . 77. FIXED SYSTEM FINAL �� ,i - 29. InsuJation � 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat � 79. fINAL INSPECTION . 32. Electrical PowerlyleterFinal ' /��' � 80.• FOOD C�RTIFICATE ISSUED � � 33. Final Electric , . • Notes: � 34. Final Heating & Air Conditioning -' ;�� ' �� 35. Final G�as Pipe-Test ' z� (. /flL / -�a . yf � ! 36. Hood or CanopY �- �� G`� 37. Final Factory Fireplace " � 38. FinalPlumbing � ��f� .�� 39. Water Service-Finai 40. Gas Service-Final ' 41. Solar pomestic-Final � . ' 42. Backflow Preventer � �, „-Lt ' • 43. Backflow �rrigation . � ' 44. landscape Irrigation System � • < 45. Sound Attenuation 46. Handicap Regulations � 47.,FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electrie Release to Edison ', 50. Gas Release to Southern California Gas Co ;� - � ' 51. CERTIFICA7E OF OCCUPANCY • � • ' . No. Date , � '� , ; � t � � _; .» . ADolicant ta Iill In all spaees aMcaOt tnose witnin heavy GorGar Ilnes antl sign all aovropriate aaclantionf. CIZ,V OF COSTA MES . CONST � I ERMIT . Project Address, _ �Appliwnt's Mai � Address G / P, 2- � Owner's Nam� � G,i ' Addreu Arch/Eng. � �Lkense No. Addreu � / .� COntrattor's Nam Phone Address (mailing) City Licenu No. ` ' LICENSED CONTFACTOR DECLARATION I hereby afiirm t�at 1 am li<ansetl untler provislons ot Charter 9(commontlng with se<tlon ]000) of Diviilon 3 of tho Businesz antl orofeisions Cotla, antl my Iicense is In fu11 torce antl ettect. Lic¢nse Class Licanse No. Date Si9na[ure WORKERS'COMPENSATION OECLARATION 1 nereGy aftirm Ihat I bava a C¢rtificat¢ 01 consent to self-insUre or a certltlwt0 o( Workers' Compensation Insurance, o� a ce�tifletl copy IherGof ($ectlon 3800, Lab. C.) Policy No. Company BCertifietl coOY Is hereDy furnishetl. CertitieG copy is tiletl with the city Builtling Divislon. Date Applicant EXEM7TION FROM WORKERS' COMPENSATION DECIAHATION (This setiion neetl not be complet¢tl if the permlt is (or ona huntlr¢tl (5300) or lezs). I certi(y Ihat in Ih¢ Pe�(o�manCG of [he wo�k fo� whlch thi5 p¢rm�t IS IssueQ I shall not employ any oerson in any manner so as to become suDject to lhe Workers' Compensation Lawz ot California. Date Sl9nature �NOTICE: If, aiter making tnis tleclaratlon, you shoultl becoma subject to tho Workers' CompenutiOn provl5ion5 Of the Labor Cotle, y0u muSt fOrthwiln como�Y �+'��n zucn o�ovisions or thls oermlt shall ee tlenmetl revoketl. CONSTRVCTION LENDING AGENCV 1 hereby aftirm that tnera is a consVuctlon Iantlin9 a9ency for Ne oerlormance ot lhe work ior which [�is permlt is Issuetl (Saction 3097 Civ. CJ lPntler'S Name Lentler's Atltlress OWNER BUILOER DECLARATIOfJ I hereby affirm [�at I am exempt from thn Contractor's License Law tor the following reason (Sectlon 7031.5 Buslness antl Professional Cotle: Any city or cOunly which rlqulra5 a petmll f0 cOnitfuCl, dl[¢f Improv8, tlemoliSh Or repalf any structure, prbr to ils issuance, also reqWres t�a applicant for such permit [o file a Signetl Sldtement that he/Sh¢ is Iicensetl pu/suant to lhe ProviSiont of the Confractor'S License Law (Chdpter 9(commencing with Se[tlon 7000) 07 , pivision 3 ot the Busin¢55 antl P�otesSioni Cotle) o� that he/she i5 ex¢mpt Iheretrom antl Ne baSiz to� th¢ ailegetl exemptlon. Any violaHon o1 SecUon 703L5 by any applicant for a permit subjettz Ne appliwnt ta a tivil �enalty of not more tnan five huntlretl tlollars (5500). lJ I, as owner oi tnc oroperty or my employees with wa9es az their sole compensation, will Ao the work, antl tne structure is not InlentleA or otteretl (or wle (Section ]044, Business antl Pro(essional COCe: Tne Contractor's License Law tloes no[ appry to an owner of a property who builtls or Improvez thereon, antl who tloes such work himsel(/hersel( or through his or her own employees, provitletl tnat such improvements are not intentlea or offereC for ule. It owever, [na buitGing or improvement Is soltl within ona year of com- ple[i tne owner will hava the burtlen of proving h¢/she tlitl nOt bulltl or Im- pr for(he purpose ot Sale). I, as owner of tne.oroperty, am axcluslvaly contractin9 with Iicensetl con- Va<tolS lG con5truct th¢ projecl I$¢CUOn 7044, Bu5ina55 antl P�OtesSions Cotle: Tlle Con[ractor'S LicenS¢ l2w dOes nOt apPly [o dn ownCr of property wh0 nWina er Imorove5 thlrean. dntl wh0 contra<ts fOr Sut� projetts wlth a con- �il am exem t untl r xc� Oate _ Ov 1 hereby c tify at I have Informatio is cor ect. I agrei antl sta[a laws relatin9 to sentatives of this city e inspettion O�rpozes. Si9nature Orivers' LicenS¢ ar � the �Gontractor's Llcense Law). I am awara that penuNon insurance shoultl Go proviaetl to me. — s�6. -. B. & P. C. br Ihis reason . _..,r. .�� ...._. .--' -- � �--' ..... � ,..,. . G TVPE OFCONSTRUCTION NEW DD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH OTHER A p..�6 DESCRIPTION OF WORK/USE OF BLDG. S Main Building: - TVPE OF PERMITp� -GRADING FOUNDATION STRUCTURAL T FrOnt ❑ TENANT 1J^.�LECTRICAL ❑ PLVMBING ❑ MECHANICAL 'A Reer ❑ �OTHER C Rlgh[ PROJECT DESCRIPTION Sa. FT. oCCUaANCv K CONSTRUCTIONTVPE VALUATION$ g L¢ft ZONE � GRADING CU. Y�S. ACRES p��9, qe� q�6 Ramarks: �J i i w... . ,) i/ n. i n/)n w-H .% Planning Notes: $ink Preventer Irrigation king Founlains ir Drains ir Sinks $2fVICQ �ULI2L5 Kitchen Sink Lavetories P—Trap Root Dreins Reinspaction Fee ff S15 Ducl - Under Ground DUC[ - $tfuCtuf81 Duct - Ventilating Exhaust SyStem � Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑b100,000 BTU 0100,OOOBT Reinspec[ion Fea � � E15 CMF OB65-46, rev. 30/84 Whita - Builtling: Canary - qpp�icant; Plnk - Accounting; Goltlenrotl - Asussor — 2�2�� Service Sink - Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Wa2er Heaier Water Service Auto-Wash Laundry Trays laue Fee Hood or Typel ❑ Canopy Typell ❑ � I FEES " Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Ges DElec' � Fan F.A.U. - Fixtures Device 8oxes Refrigeration System ❑aioo,000sru Oioo,000eT System Repair/Alreration Fire Dampers � Registers S 3 Issue Fee � S 3 Switches Garbage Dispoul Generator �0.5 KW Fee Accessory B Perking Req./Provided ELEC7RICAL ' � Transtormer"0 15-50 KW - � � 50+ KW Merer LJu Meter ❑o Sub Panel Motors �( Inc. Soiar I Microwave Pole Light Range to 100amps �.r 100 amps HP 01'h - 8 �15 HP �16�15+ ; Stending Sectionz 5 KW Trash Compactor L Z� � $15 Isue Fee DEVELOPMENT SERVICES RE�UIREMENTS: ZoninO APProved By Building Approved By ��\ FEES $ 3 d Z O N I N G H E Q M T S SUMMARV Of FEES BUILDING PERMIT $ SMIP E PLAN CHECK $ PERMIT P�UMBING . $ ISSUANCE $ PLAN CHECK 25% $ —�—� }�— ENERGV P.C. $ ELECTRICAL $ �C-�•dV GRADING $ ' —7fi7�� MICROF.ILM $ PLAN CHECK 50% $ �5L1_U__ � MECHANICAL S TOTAL FEE $ 7 � PLAN CHECK 25% $ � :j CONSTRUCTION AND PLANNING "APPAOVALS Permit # 1. Temporary Electrical Service or Pole .2. Soil Pipe-Undrgrnd. 3. Electrical Conduit Utility-Undrgrnd. , �4. Electrical Conduit-Undrgrnd. ; . 5. Steel Reinfoicement � 6• Electrical UFER Grnd. �' 7. Footings � � � 8:� Foundation � . , 9. Water Pipe-Clndrgrnd. 10. Structural Floor System 1��1. Properry Sewer Line & House Connection 12. Sewer Cap 13. Roof Drains ' 14. Rough Plumbing .75. Rough Electrical-Conduit _ '16. RoughElectricWiring ' -17. Rough Wiring Sign � " - 18. Rough Electrical-T Bar Ceiling 19. Rough Heating & Air Conditionin'9 , 20. Rough Factory Fireplace 21. Ducts, in Structure 22. Ducts, Ventilating 23. Gas Pipe-Rough & Test 24. Roof Framing - 25.'Roof Sheathing . 26. T-Bar Ceiling (Structural) & Monocoat 27. Frame and Flashing � . � 28. -Lathing & Siding � 29.�Insulation . � 30. Drywall Nailing • 31. Plaster Brown Coat ' 32. Electrical Power Meter-Final 33. Final Electric 34. Final Hea[ing & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final � 41. Solar pomestic-Final 42. Backflow Preventer � 43. Backflow Irrigation - 44. Landscape Irrigation System 45. Sound Attenuation � � 46. Handicap Regulations � , 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed , 49. Electric Release to Edison 50. Gas Re�ease to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY " No. Date Date POOL SPA Inspector p�ppROVALS Permit # 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms 55. Electrical Bonding � 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVER-GUNITE 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines, P-Trap, O Undrgrnd.. 61. APPROVAL TO DECK 62. Backwash & Receptor-Final 63. Heater & Vent-Final 64. Plumbing System - Final 65. Electrical-Final 66. Solar System-Final 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOL/SPA SYSTEMS FINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # 70. Underground Hydro 71. Product Piping O Gas ❑ Oil 72. Underground Flush 73. Undergrnd. Storage Tank O Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL 7S. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED 0 0 r' Date I Inspector �� . Costa 1Vlesa Building-i,apartment 348 APPLIpCATION FOR PERMIT � 111 EAST 20th STREET p U I L D �� N G � _ COSTA MESA� CALIFORNIA �� FOR APPI.ICANT TO FiLL IN J�OR OFFICE iJSE ONLY - �� _ R ceLip� o.. 2Permit No. Address �t h/• l9� 3i� - ��v % TY liOSt& MBSfly ritL�OTll18� Recefved by Date Rec . /Date Issued Nearest /� // . . `�! � � CrossSt. //iee�i ��''t0..-.....� Building � ��/_��/ � � ,/ Address r" Owner _ ,�., .V .��+— � Costa Mesa, California Mail q, �� nddress �'Z�' Q EA.� F:.��-.. /'in.-? Nearest � T,el. Cross St. City �1i r.evl..,�- �3�1. No. 1,1�,�.. �y Zo I No.of I Type = i Group Architector ' Lic. Plans Engineer No. Approv, by Date ynaare� _ CORRECTIONS , Address � �'°' j . Descr ption I No. I Block I Tract , _ (AttachMetesandBoundn)��(e� �Sa�`�j �. � No. of Bldgs. � Sizeof Lot �O.A� �� (/� I Nowon Lot /)/�[ Useof - " I No.of I No.oT Existing Bldg. , i Fa'miliea Rooma Setback Line from � Rear Vard Center of Street n. �M Side Yard � "-- "' " - - DESCRIP7.ZON OF WORH - New I Alteration I I Addition I ' Repair I I Moving I � Demolish I � °�' �� Building No. oi / / Sfze � Rooms J Stories hrior Wali�^/� Root �ering ajrQ�,G( � Covering ��j ApPROVALS �se of New c�,/ _Building ��e�/.�r V/(�N�I�Ys FoundatlonLxatfon Inspecto� I 8-Z Forms, Materials, / Under-Pinning Frame: Fire Stopa, Braeing, Bolts I hereby acknowledge that I have mad this Application Lath. Int. _ and state that the above is rnrrect and agree to rnmply Lath. Ext. with all Clty Ordinances and State I.aws regulating _ building c%etlon. � � � / � � Signatureof i�r`� �� P�aster,lnt. _ Permittee 4i.1.L.�i/ // • Plaster, Ext _ AuShorized Agt. �� Masonry Reintorced Valuation Permit Fee $ i $ �' � �D Plan Check $ Bond Beam _ Total u ' � Fee $ � � �/� FINAL FORM 204 G-H 2M 5-54 � _ .. . - -. ' / . . .^ '. ' �� n �� .._.� .. .' . i. .= ' • • � . , f . . . ,I`. —_ - .. „ `�, . � ti� �r �3. , � ^ _ :1 �._� .. 1 . _ _ .. . - I __ � � J , ' � ' . ..' � . . � � l � .a � .� �� . .1 � .. �. . . f1 : ' i• � � /CI_ J.. ... �... _ .. . ' � 1.. � .. . ./: . � � .» � � � . . . p -'� i_ • ' r'��. � . �� R, \ �♦ .. . � 1 � � . � . � F � �f � - �• - PLOTPLAN :-��`'• -r' i�-�`z;�. - _-- --• : . ,, ri'1; :1 t t'� rt ";;": irer;rj : _.�,_Show looal/on;'Hnd``dis�a�i�s fram f. i i` � � ' �, � : :�f, . ^ � { ' - property�Iine and between buildinga - � _ .._ . � �.:•,__ ni�a�: . �c❑ . .. , , -...._._,._ __'_ "__ "' ' "'_" " "' :JDii ... I:.l � .„ . �t �� '��" '_ '� _ ' __ 1�_ " �� ..'"_ .� . . . pR i . ,:1 . , . :.I �� , c.}c^ r: ry+n. nn;':an' ..i_',._',v: ' 7� ' . �I _ �� . . _ � 1 . - . �'r' •''' ''�. �. ,1 . . . . � , �1., _ . ' i � �rSIJ_.,y... ,., - � - ' . .. '.ii:. .___.___'Y..___'_ '__'..:__-'...__'- _rl ' _ . —�'� �. � , . . , .. � � ., , � ...,: .'ifr , r � �. � . ... ' � . , . . . ' ' , i ) '1'. � ' . ' .. . r ., , , . , � .7n' . .- . � ,_... -�• ' i�- - _ ,-� � . � � .�:. � � . . _ . �� . ' _ . � ' � •,-�:ri:;7 •i �n�-.:� - . . - . - - ' � � ,. • ' _ ' '_ _ .: r•a � .., . 7 - ' . I 1.. - - � _'-- ...--- -�.�.---- ---'---- ._.._.�_---- -- --- —"- .�. .... � �.u:. Aoolicant to fill in all soaces exceot tnase within heavv bortler Iines ana sian all acoraorlate tleclantions C�ITV OF COSTA ME�$ASCONSTRU IOcI� PERMIT RMIT NO. TRACT NO. LOT NO. UNIT NO. B4%I ' I I3OIAE7 I Go.. . Project Address �0� J � �/ �, � � Applicent:s Mailin Addfeis 4 . TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR �� / � ❑ CONVERSION ❑ DEMOLISH ❑ OTHER _ q,p, q�6 . Zone Owner's Name Phone DESCRIPTION OF WORK/USE OF BLDG. Addreu 5 Main Building: Acceisory Building: Ar[h/Eng. _i ic¢n e o. TVPE OF PERMIT GRADING FpUNDATION STRUCTURAL T Front - � 0 Addf2i5 - Z� • ❑ TENHNT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL A RCaf N ❑ OTHER � Contracror's Nam ./ �� Phone' 2 G pROJECT DESCRIPTION SQ. FT. OCCVaarvCV K Right � G Addrei5lmUiling) CONSTRUCTIONTVPE VALVATIONS S LCf[ City Licenu No. , ZONE GRADING CV. VOS. ACRES , ' R IICENSED CONTRACTOR DECLARATION Ping. Ret. # Parking Req.IProvided E I hereby aflirm that I am Iicensetl untler provizions ol Chartor 9(commen[ing Remarks: � QQ ' Planning Notes: . ' M with sec,tlon 7000) of DivI510n 3 ot tha Bu51n¢55 antl Pro(nS5iOn5 Cotle, antl . _ my Ilcense is in full torce antl eftect. ' . ' ' ' . ' T Licenze Glass Litense No. , S Date Signature PLUMBING FEES � WORI(ERS' COMPENSATION DECLARATION Bdr Sink ShOwen ' ' � - I hereby a1Brm tnat I have a certifiwte oi cansent to ulainsure or a certltlrvte ' - - ELECTRICAL FEE$ o/ Worke�s' CompensaU'on Insurante, or a certifietl cooY tnareot (Sectlon BackflowPreventer " ServiceSink � 3800, Lab. C.) . Automatit Washer Transformer ❑ 15-50 KW Poiicyrvo. Company Backflowlrrigation SewerCa ' , � ❑50+KW . P Construction Pole Sub. 8 CerNfieC capy is hereoy furnizhetl. Certitietl cooY is flletl witn the city Builtling Divisian. BathNbs Sewer Connection � Cooking Uni[ Meter ❑up to 100 amps Date .q�Pliwnt - - • - — � ' ' EXEMPTIONFfiOMWORKERS'COMPENSATIONDECLARATION Clafifiefs� SolarColleCtorS DiShwashef Meter-�over100amp5 _ (Thissection ne¢tl not be complatatl If tne permlt Is /or One huntlrOtl (§300) or iess). Dishevasher -Solar Piping - -� Dryers �Gas ❑Electric� Sub Panel � I certify that in tne performancebi lho work tor whith this Oerm�t Is izzuetl I - shall not employ any person in any mannor so as to eecome subject to t�te . Drinking Fountains . Solar Tank Pan ' � Workers• Compensation Laws of California. - Momrs �47 HP �1X-8 Date ' Signaturc ' � Floor Dreins � �Swimming Pool w/Spe F.A.U. _ Inc.Solar �9-15 HP �16-75+ �'NOTICE:�If, afler making this tletlaretlon, you shoultl become subject to the . Workers' Compen5ation provision5 Ot Ihe Labo� Cotla, y0u mu5l forthwlth ' FIOO�SiOkS' U�indl Fi%tu�¢5 Microwave [omply with such p�OviiiOni Or tnls pe�mil Shall be tlenmetl revokOtl. CONSTRUCTION LENDING AGENCV GasServiCe Outlets WetelClose[ ' DeviCeBOxeS PoleLlht I neteby affirm that IhlrC is a consVuction lantlln9 agancy lor tna pGrformance 9 of lhe work tor which tnis Oermlt Is � issuutl ($¢ctlOn 3097 Clv. G.) InLCICCPt0�5 Warer Hea[er � Outlets Range Lpntler's Name Lentler's Aatlress Kitchen Sink -� Water Service Switches � ' Sign OWNER BUILDEH UECLANATION � 1 hereby aHlrm Ihat I am exempt ifOm Iha COntractof's LICen50 law for th0 L8v8tOfi¢5 ' AOLO-W85h (�i8fb8 2 DIS 0581 following rcason (Se<lion 7031.5 Buslness anU Professional Cotle: Any city or . ' 9 P, ; Standing S¢ctiOns counry whicn requires a permit to construct, altar, Improve, aemolish or repalr P—Trap Leundry Trays ' Generator �0-5 KW �5�15 KW TraSh Compactor � any structure, prlor co its issuanco, also reqWres tho applicant for such pormit to flle a signatl 5[atem¢nt tn2l ha/She is IICOnSCtl pursuant to lhe provi5ion5 of qoof'Drains ' � the Contrac[or's Licensa Law (Cnapter 9(commencln9 wilh Section 7000) of _ _ � Divislon 3 of the Buslneis antl ProfeiSions GoGo) or that"�o/she is exempl [hC/ef�oT antl thC ba515 fOr Ihe allegotl exemptlOn. Any violatlOn ol SoCtlOn 7031.5 by any appliCant for a permll Sub�oCts Ihe dppliCant lo a tivil �Cnalty ot nol more lhan Ilw huntlred tlollars (5500). pJ 3 � I,��s ownn� ot th¢ P�Op¢r�y or my employe0i with wage5 as lhoir sole ReinSpBction FBe $15 IsSUe Fee coriiPensation, will tlo lne work, an� tha sVUGturo I5 nol Inlontlutl or olloratl RBinSpBCti00 FBB $1$ IS5110 FBB ' $ 3 for, saln �Saction �044, Business ana Prolesslonal Gatle: The Contractor's � MECHANICAL ' ' FEES � Llcens¢ law tlocs not apply lo an owner of a properry who bulltls or'Improves - thereon, antl wno tloes such work himsall/horsolf or throu9h nis or her own � DEVELOPMENT SERVICES REQUIflEMENT$: employoas, provltlatl that such improvaments are not Intondetl or oHoretl tor BOil2� Hood or, Type I ❑ sale. It, nowaveq the ouiltlln9 or Improvement Is sole witnin ona year ol com- ' - Canopy ' Type I I ❑ 2oning Approvod By Date pletlon, tho owner wlll have [M1a burtlan of Proving hc/sho tlIC not bulltl or im- � Duct - Undet Ground . . � � . p ove �or the purpose ol sale). Building Approved By Date � I, as owner of tha property, am exclusivery contracting with II<ensetl con- Duct - S[ructural qefrigeretion SyStem � Appliwtion Issued By Data �� trattors lo'construcl [he project (Sectlon 7044. Buziness antl Pro/essions Cotlo: _ Tne ConVactar's License Law tloos not appry m an owner ot property who Duct - Ventilating �a100,000 BTU ❑100,000 BTU � � SUMMARV OF PEES builds or Imp�oves lhereon, antl who cOnt�aCtS fo� Such projeGts with d Con- , tractor(s1 Ilcense pursuant to tna Contractor's LI<ense Law). I am aware tnat Exhaust System ❑ Multiple ❑ System RepairlAlteration .BUILDING PERMIT $ SMIP S proof o/ th¢ir Worker's Compensatlon Insurance shoultl bo pwviaetl to mo. . PLAN CHECK $ PERMIT . � ❑ I am exempc'u tler Section B. & P. C. (or this reason Firepl/Fact BIC ICBO # Fire Dampers PLUMBING $ ISSUANCE 5 oate' Owner Heating System�& Ducting � .Registers �- PLAN CHECK 25% $ ENERGV P.C. $ 1 nere y certi y tnat I nave reaa tnis application antl state that tna abovo ❑a700,000BTU �100,OOOBT ' � GRADING $ iniormation is correcL I a9ree to compy witn a11 clty antl county orainances ELECTRICAL 5 antl state lawi rel � g builtling COnilru<tlOn, antl herCby dUtnorize r¢pr¢- - ' , M�CR�FILM $ sentatives of 1 c enter uporw the above-menllonea prp perty � r . • • - , PLAN CHECK 5096 $ p inspection pu se p` /�/p��/(�1i , MECHANICAL $ Si9nature i� ./.._ (7 TOTALFEE S ID� Drivers' License or SS � / �Reinspection Fee -$15 Iwue Fee $ 3 P�,4N CHECK 25% $ CMF 0865-06, rev. lO/84 WM1I[C - 9:IIIUIfAJ: Gdl12ry - HPPIICdlII: YIl1K -/iCCOUl1[Iflg: tiO14BOI00 - HSSBSSOf � CONSTRUCTION ANP PLANNING' POOL & SPA APPROVALS Permit# � Date Inspector AppROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undr�rnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcemeni 56. Rough Plumbing & Pressure Test . 6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation '- 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. � �� 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Structural Floor Systsm `: 61. APPROVAL TO DECK 1 t. 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. Rou9h Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring , 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # ._ 21. Ducts,in Structure 70. Underground Hydro � 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil � 23. Gas Pipe-Rough & Test 72. Underground Flush � 24. Roof Framing 73. Undergrnd. Storage Tank OIGas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro ' ' 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ,�_ 27. Frame and Flashing 76. Dry Standpipe ' �28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric / Notes: 34. Final Heating & Air COnditioning 35. Final Gas Pipe-Test _ . ; ! 36. Hood or Canopy , 37. �Final Factory Fireplace � ; • ' 38. Final Plumbing � 39. Water Service-Final 40. Gas Service-Final � 41. Solar pomestic-Final ' � 42. Backflow Preventer ' ' ' " ' , . 43. Backflow Irrigation ! i ' ' 44. Landscape Irrigation SYs[em • � 45. Sound Attenuation � , � � � 46. Handicap Regulations . 47. FIfVAL STRUCTURE & BUfLDING 48. Special Requirements Completed � 49. Electric Release to Edison � ' i " 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY _ , No. Oate • . -�_.�.-. Aoolicant lo �ilfin all sDaces exceDT[nose wit�in �eavv Oortleriinas anA.si9n all apDroD��ate tleelaretions. 61TY OF COSTA��Ay CON$TRU(� I(�. PERMI PERMIT NO. TFACT NO. LOT NO. UNIT N6. �� _ ,, . � � � `_~" /5 il�� `7' /� �S'� �'.%/� 02. /l0 � 4292 I I / I �/8� " �f I o0f , . Project AddreSs , � - TVPE OF CONSTRUCTION ' NEW ADD ALTERATION REPAIR ' Applicant's Maili Address _ • ' � - �� y�� O/ ��one • ❑ CONVERSION ❑ DEMOUSH ❑ OTHER p,p,*t . " ' 2one - Owner's Name �� //� DESCRIPTION OF WORK/USE OF BLDG�. - ' �Addiess, � K/— . . �. � S Main Building: " � ' Accessory euilding: Arch/Eng. LicenSeNo. TYPEOFPERMIT GRADING FOUNDATIO�N — STRUC7uRA� T Front p � Addte55 � ❑ TENANT ❑ ELECTRICAL`❑ PLUMBING LJ MECHANICAL ' A Reaf � - . � ' N ❑ OTHER � Contracror's Nam �'G'�l �Cv Phone � � C Right ' . - ' ' , ' N iO � 9 "�j � i3�� MC��! PRQIECTDESCRIPTION 5�. FT. oCCUPAivCV K _ , G M Address Imailin L�f J � ,` CONSTRUCTIONTYPE VALUATION$ S' Left City License No. 7%L � ZONE GRADING CU. VDS. ACRES ' � ' R � LICENSED CONTRACTOR DECIARATION ' - Plny. R2f. # Pa�king Req./P�OvidCd � . E I nereby aftirm [hat I am licensetl untler proviSiOns of Cha/ter 9(commen<in9 Remark5: Planning NOt¢5: . - n with sectton 7000) oT Division 3 of the Business antl ProfeSsions Cotle, antl , . M my Iicense is in tull orce antl effect. . ' ' � T S Licens�i��» "'��J �� PLUMBING " FEES - � � Date ��' WORK RS' COMVENSATION DEGLAt1ATION 82/ Sink Showers � I hereby affirm that I have a certificate ot consent to selt-insure or a certificate� . E�ECTRICAL FEES ` of Worke�s' Compensation Insurance, o� a certi/ietl copy the�eof (Sectian gackflowPreventer ServiceSink - �- ' - - 3800, Lab. c}.! Q� ., Automatic Washer Trensformer ❑ 15-50 KW , Policy No. T��` Company r � y� � Backflow Irrigation SewerCap � '% Construction Pole Sub.' ❑ 50+ KW C tifietl copy i5 hereby tumishetl. • � ertitie o ileGwith the city Bui ' s' . Bath[ubs Sewer Connection Cooking Unit Meter �up to 100 amps Date � � � APP�icant Clarifiers ' Solar Collectors ' Dishwasher ' Meter ❑over 100am s ' EXEMPT ON F OM WORKERS' CO ENSATION DECLARATION ' , P (Thissection neetl not be completetl if he permit is for one huntlretl ($300) or . - — iess). - Dishwasher � Solar Piping , Dryers ❑Gas ❑Electric Sub Panel I certify that in the pertoimance Of the wo�k tor which this pe�m�t is is5uetl I . snail not employ any person in any manner so as to become subject to tf�e Drinking Fountains �� Solar Tank -/ � Fan Motors DO-1 HP �1'/:�� 8 Workers' Compensation Ldws of Calitornia. , �ate 5ignature Floor Drains Swimming Pool w/Spa • . F.A.U. . Inc.Solar �9-15 HP �76-15+ 'NOTICE: If, after makin9 tnis tleclaratlon, you shoultl become.subject to the Workers' Compensation provisions of tne Labor Cotle, you must �orthwith FIoo�Sinks U�inal � Fixtures Microwave ' � - - complY with sucb provi5ion5 0� this p¢rmit snall be tleemetl revoketl. . CONSTRUCTION LENDING AGENCV � � ' '- GasServiCe Outl¢t5 Wdt¢�CIOS¢t - . I hereby affirm thai there is a construction lentling agenty for the performance Device Boxes Pole Light of the work for which this' permit is issuetl (Section 3097 Civ. CJ, InterceptOfS ' ' Wdt¢f H¢dt¢r Outl¢t5 Rdng¢ Lentler's Name � . Lentler's AtlCress .' Kitchen Sink Water Service Switches OWNER BUILDER OECLARATION ' ' - . Sign I hereby aftirm that 1 am ezempt trom the Contractor's License. Law for tna Lavatories _ Auto-Wash • Garbage Disposal ', Standing Sections tollowinq reason (Section 7031.5 Business antl Professional Cotle: Any city'or county which requires a permit to construct, alter, improve, tlemolish or repair P—Trap � Laundry Trays ' Generetor �0-5 KW �5-75,KW any st�u[ture, priot to it5 issuance, also requir¢s the applican[ fo� such pe�mit T/35h COfIlpaCiO� . to tile a signetl statement tnat he/she is licensetl pursuant to tne provisions ot Roof Orains - ' tM1e Contractor's License Law (Cnapter 9(commencing with Section ]000) of Division 3 oi the Busine55 antl Protesslons Cotle) or that he/sne is exempt - . - - therefrom anE [he basis.for the allegetl exemption. Any violation ot Section - 703L5 by any applicant (or a"permit subjects the applicant to a civil �enalty of not more than five nuntlretl tlollars (§500). � $' 3 � ' LJ I, as owner ot tne property or �my employees with wa9es as their sole Reinspection Fee $15 Issue Fee compensation, will do the work, anE the structure is not inientletl or offeretl Reinspection Fee $15 Issue Fee $ 3 for saie (Section �044, Business and vrofessional Cotle:'The Contracmr's- , MECHANICAL � FEES License Law tloes not apply to an owner o( a property who builtls or improvez . . tM1ereon, antl who aoes such work himselt/nerself or inrough his or her own Hood or Type I ❑ DEVELOPMENT SERVICES REQUIREMENTS: emploYeeS, p�ovitletl that SUGh improvement5 are not intentletl or of/eretl for BOile! , sale. It, however, the buiming or imorovement is soltl within one year of com- Canopy Type II ❑ 2oning Approved By Date ; pletion, tlte owner will have the burtlen of provin9 he/she tlitl not buila or im- Duct - Under Ground � Building Approved By p�ov¢ tor the Ourpose of sale). ' � , Ddt9 - ❑ I, as awner of the property, am exclusively contractin9 wich Iicensetl con- Duct-Structural • Refrigeration System ' , Applieation Issued By Date tractors to const�uct the projec[ (Section 7044, Business antl Professions Cotle: The ConVactor's License Law does not apply to an owner oi property who Duct - Ventilating ❑0.100,000 BTU ❑100,000 BTU ' ' SUMMARV OF FEES builtls o� Improves th¢reon, antl who cont�act5 to� such ptojects with a con- ' tractor(sl license pursuant to the Contractor's License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteration � BUILDING PERMIT $, SMIP $ proo/ of their Worker's Compensation Insurance shoultl be proviaetl to me. . . PLAN CHECK $ PEFiMIT ❑ I am exempt untler Sectlon B. & P. C. for this reason, Firepl/Fact. BIt. ICBO # Fire Dampers PLUMBING $ ISSUANCE $ Date ' owner Heating System & Ducting Registers pLqN CHECK 25% $ � ENERGV P.C. $ � I hereby certify thaf I have reatl �this application antl state that the above - �Q700,000-BTU �100,OOOBT � ' ' informatlon is mrrecL I a9ree to compty wi all city antl county ortlinances a i�� - �� r� ELECTRICAL $� . GRADING $ antl state laws relating t iltlmg co tr on antl hereby authorize repre- � ' � /L'j PLAN CHECK 50% $ MICROFILM � $ � sentatives ot this enter u above-mentionea prop erty tor� , . Inspection pu . • ��//�/ ��' �V �� MECHANICA� $; �I''� TOTAL FEE $ �� Signatwe � Da[e T� . Orivers' Lice or 55 � � Reinspeetion Fee $15 laue Fee $ 3 PLAN CHECK 25% $ CMF 0865-46, rev. 10/84 W�I[e - tlwwing; canary - qppucanr, nnn - saccounnng; amaenroa - iazsasso� . i CONSTRUCTION AND PLANNING � POOL & SPA APpROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector / • 1. Temporary Electrical Service or Pole` ': 52. Pool & Equipment Location r' 2. Soil Pipe-Undrgrnd. ; i� .6i'� �;: 53. Steel Reinforcement :��.� ( ' ! 3C-'Elecuic2l Condu� Utility-Undrgrntl. 54. Forms - � fi. '_tl.,ElectFicaf Conduif;U�drgrnd. � � �� 55. Electrical Bonding � �'� .. 5. Steel`'Reinforcement' " - "/ � 56. Rough Plumbing & Pressure Test �1 i � : 6.;•ElectPical UFE �Grrid. '. 57. APPROVAL TO COVER-GUNITE � �` ♦ � R. ;;.., 7. Footings -�t`� ��..' �)�. � 58. Electrical Conduit-Undrgrnd. '�� `� t 1., � �S��,Fbundation � % �a;y � ; ��!• 59. Gas Pipe, O Undrgmd., Test ' '� .`1 t 9;� Wate� Pi e-Undr r(�d. "� � � P 9 �,� '�r �.'�, 60. Backwash Lines, P-Trap; � Undrgrnd. C/ 10� Struetural Floor System �} f 61. APPROVALTO DECK 11�.�Property Sewer Line"& House Cppnection �� ; 62. Backwash & ReceptorFinal J2. SCwer Cap � .`'�'�' � , 63. Heater & Vent-Final - �� ` 13. Roof Drains �� ' � " 64. Plumbing SYstem - Final � - �� ,� <'(. 1MIRough 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-keating & Air Conditioning FIRE DEPT. REQUIREMENT 20..Rough Factory Fireplace • APPROVALS Permit # 21. Ducts, in Structure � �,.3. y( �t 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil � 23. Gas Pipe-Rough & Test � �� 72. Underground Flush - _ 24. Roof Framing� - „ 73. Undergrnd. Storage Tank O Gas ❑ Oil� � � 25. Roof Sheathing 74. Overhead Hydro : - •�� 26. T•Bar Ceiling (Structural) & Monocoat 75. Dry Chemical . :j, 27. �Frame and �Flashing � 76: Dry Standpipe � . �i 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 ,;,-'�!r' 33. Final Electric � Notes: � - -�, 'r 34. Final I-aatiug.�Air Conditioning � y� ' _� ' � 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. �andscape Irrigation System ' �s Co ' , CITY OF COSTA. ESA CO)N_ U ION PERMIT . Project A'ddress '�� ( �� AppliwnYf.Mailing ddr ss � � Owner's Na/Q'�e ' hone Address I�� Arch/Eng. License No. Address Contractor's Nam � P o T Address (mailingl l �^ - F'CR City License No. � � � LICENSEO CONTRACTOR DECLARATION I he�eby at��rm that I am licensetl untler prOvi510n5 of Cha�te� 9(comTenCing• with sectlon ]000) ot Oivision 3 of the Busine55 antl Profezslons Cotle, antl my license �s in (ull for< tl� c � -License C a 5' " nsa N� Date� �� SI9 t �� WORK H5' OMPENSATION DECLARATIO 1 hereby a(thm tM1at I have a certificate of consent to zelLinsure or a cerUflcate of Workers' Compensation Insurance, or a certi(I d copy chereoi (Se� \ 3800, Lab. C.) � Pnnnolicy No. —�-�� COmpany_ �� CertifieG copy is heruby fumishetl. \Ce�tified copy is tiletl with the ci[y Builtling DlviSion. Date Applicant ^ EXEMPTION FROM WORKERS• COMPENSATION DECLARATION �� (This sec[ion neetl not be Completetl i(�the permit i5 for one huntlretl (5300) or � Iess). 1 certify th�� in tne performance of the wo�k fOr which this perm�t is issuetl I shall not ertiPloy any pe�son in any manne� so as to b¢come subjett to t�e �Workers' Compensation Lawz of Calltornia. oare Si9nature 'NOTICE: Il. atter making this tleclaration, you shoultl become subject to the Workers' Compensation provizions o1 the l.abor Cotle, you must forthwltM1 mmpry wi�n such provisions or this oermit shall be tleemetl revoketl. CONSTRU�TION LENDING AGENCV ' 1 nereby afPrm that there is a construction lentling agency for the performance of the wJrk for whiCh this permit is i55uetl (Section 3097 Civ. CJ Lentler's Name Lentler's Adtlress OWNER BUILDER DECLARATION - I hereby af��rm that I am exempt from the Contractor's License Law for the followin9 reason (SecHon 7031.5 Buslness antl Professional Cotle: Any tlty or county wh�th require5 a permit to consVuct, alt¢q improve, tlemolish o� �epai� any s[ruclVre, prior to i[s issuanca, also requires the applicant for sucb permit [o file a SIQ�etl statem¢nl tha[ he/Sh¢ i5 IicenS¢tl pu�suanl [o Ihe provlsions of t�e Contraclor's License law (Chapter 9(commencin9 with Section ]000) of Division 3 of the Business antl Prolessions Cotle) or that he/she is exempt tM1erefrom antl the basis for the allegetl exemptio�. Any violation of Section ]031.5 by any applicant tor a pe�mit subjects the applitant [o a<ivil �enalty of not more than five nuntlretl tlollars ($500). 1, as oH'�er of the Property o� my employe85 with wages as their sole mm0en5at{On, will tlo the wo�k, antl the st�uctu�e I5 not int¢ntletl or offerEtl tor sale (5eation �044, Buziness antl Professlonal Cotle: The ConVactor's "I License La�' tloes not apply to an owner ot a property who builaz or Improves thereon, aP� wno tloes such work himself/hersel( or througn bis or Iter own employces� Provitletl tha[ sucM1 �mprovements aro �ot intentlotl or oRCretl for sale. If, ho�✓e�er, the bulltling or improvement Is sold within one year of com- pletion, the owner will have the burtlen of proving he/she tlltl not build or Im- �rove for the purpose of sale). I, as oWner a( the property, am exclusively cont�aGting with IicenSetl con- VactOrs t0 �onstruct [Oe project (Section ]044, BuSiness antl Profession5 Cotle: The ConVa<tor's License Law tloes not apply to an owner ot propeRy who builas or fmprovez thereon, ana who contracts tor such projeccs with a con- tractor(51 Ucense pursuan[ So the Contractor's Llcense Law). I am awar¢ that proot o( thelr Worker'S Compen5a[lon in5uranCe shoultl be providatl [o me. ❑ I am Cx2mpt untler Section B. 6 P. C. for [hi5 �Gason Date Owner ' I ner � cerlity th t I have ��jtl this application antl state that the above inf maHor� is corre t.�l a9cee/t6 <omply with all dty antl covnty ortlinances an crarw iaws rela M/to 6uIIWna const�uction. antl M1erebv authoriz¢ raore- Ihe n l Drivers' LIGeRse or 55 � ,�`�( �/� CMF 0865-46, lev. 10/84 White - BUlltling; Canary �� _...,,, .n sparos DorCer ��e- .cae TYPE OFCONSTRUCTION LI'NEW LI ADD LI ALiERAT10N LI REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ pTHER � ' q,p,.� DESCRIPTION OF WORK)USE OF BLDG. � S Main Buildi .TVPEOFPERMIT GRAOING FOUNDATION ❑STRUCTURAL . T Front ' ❑ TENANT ❑�ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Ree! ❑ �OTHER ' � A PRWECT DESCRIPTION 5�. FT. oCCuaarv v C Right CONSTRVCTIONTVPE � VALUATION$'�� S Left ZONE GRAD G CU. VpS. ACKE$ ping. Ref. # Remarks: y �` � � � Sr� `+ 'w� � Planning Notes: Sink Preventer Irrigation Drinking Fountains Floor Drains Floor Sinks � Gas Service Outlets I nterceprof5 Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fee $15 Duct-UnderGround - Duct - Structural Duct - Ven[ilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑o-i oo,000 eru o i oo,000 an Reinspection Fee � $15 Pink - Accounting; Goltlenrotl - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Automa[ic Washer Construction Pole Sub. � • Cooking Unit Dishwasher � Issue Fee . iANICAL Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System ❑aioo,oao aru�Oioo,000 sr System Repair/Alte�ation Fire Dampers � Registers Issue Fea $ 3 $ 3 as LlElectric Fan F.A.U. Device Boxes Outlets Switches Garbage Disposal. Generator �0.5 KW s ' '_-�,A 8222 '.I /28786 , , ,; � Zone Acc¢ssory Building: Parking Req./Provided � ELEC7RICAL , Transformer ❑ 15-50 KW . 0 50+KW Meter ❑up to 700 amps Meter ❑over100amps • Sub Panel • MotorS �0.1 HP 01 `h - S ' Ina Solar �9-75 HP �16-75+ Microwave ' � Pole Light � Range I I', Standing Sections 5-75 KW I Tresh Compactor � Reinspection Fae I$15 I � Issue Fee DEVELOPMENTSERVICESREQUIREMENTS: Zoning APProvad BY � Building Approvad By Aoolimtion lauad 9v �'.� 0 ��So�6 TL FEES S 3 Z O N I N G R E Q M T S SU ARY FEES � BUILDING PERMIT $ • S l/ SMIP g ' PLAN CHECK $ PERMIT � PLUMBING $ �SSUANCE $: PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING � $ PLANCHECK 50% $; � MICROFILM� $� MECHANICAL $ TOTAL FEE : $ � PLAN CHECK 25% $ , d , CONST,RUCTION AND PLANNING /ARPROVALS Permit # _ / 1.:Temporary Electrical Service or Pole"' - .i 2. Soil Pipe;Undrgrnd. / l .-. � �3:�Electrical Conduit;Otility�Undrgr,nd.-' .. � 4. Electrica6Conduit-Clndrgrnd. �' ` 5. Steel'Reinforcement• s-� 6. Electrical UFER GrncJ. ,., J• � 7. Footings . -' t � � - 8. Foundation � - ,- ; 9. Water'Pipe-Undrgrnd. , --r i � i� 10. Structural Floor System ' 77. Property Sewer Line�& House Corinection i � 12. Sewer CaP . '` f i 13. Roof Drains ` � � 14. Rough Plumbing ' ' 15. Rough Electrical-Conduit _ 16. Rough Electric Wiring 17: Rough Wiring Sign 18. �Rough Electrical-T Bar Ceiling 19. Rough Heating & Air Conditioning 20. Rough Factory Fireplace � 21. Ducts, in Structure .; 22. Ducts, Ventilating .23. Gas Pipe-Rough & Test , ,,. 24. Roof Framing � 25. Roof Sheathing . i . 26. T-Bar Ceiling (Structural) & Monocoat 27. Frameand Flashing � 2g.in[riing&Siding • 29. Insulation � . 30. Drywall Nailing � �31. Plaster Brown Coat �� 32. Electrical Power Meter-Final• 33. Final Electric � 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test`- 36. Hood or Canopy 37. Final Factory Fireplace � 38. Final Plumbing � 39. Water Service-Final 40. Gas Service-Final ' � 41. Solar pomestic-Final 42. Backflow Preventer � 43. Backflow Irrigation � 44. Landscape Irrigation System � 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed 49. Electric Release to Edison , � 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY lo. Date Date POOL a _. A Inspector , qppROVALS Permit# 52. Pool & Equipment Location 53. S[eel Reinforcement 54. Forms 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVER�GUNITE 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines, P-Trap, � Undrgr 61. APPROVAL TO DECK 62. Backwash & Receptor-Final 63. Heater & Vent-Final 64. Plumbing System - Final 65. Electrical-Final 66. Solar System-Final . 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit# 70. Underground Hydro 71. Product Piping OGas ❑Oil 72. Underground Flush 73. Undergrnd. Storage Tank O Gas ❑ Oil 74. Overhead Hydro � 75. Dry Chemical 76. Dry Standpipe • 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: Date Inspector l , � . ..�