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Home My WebLink About779 19TH ST - Building PermitsCITY OF COSTA MESA B{/ILDING DIVISION 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us FOR INSPECTIONS CALL: (714) 754-5626 PERMIT NUMBER: BC09-00275 PERMIT TYPE: B COMBO STATUS: ISSUED Sub Type: COM_ALT DATE ISSUED: 09I10/2009 ISSUED BY: RMD ; �:: , Joe AooResS: 779 W 19TH ST CM.; .. • Suite/Unit: APN: 42420103 . , ,i .. , ZOOlflg: , , Vicinity: EXTERIOR OF BUILDING � �� - -- Primary Occ: B � ConstType: V-B , ��SQ.�FT:�� 0 � �� Valuation: SB,000.00 r SCOPE OF WORK: REPAIR STORE FRONT OF SINTLE STORY COMMERCIAL BUILDING AND RETRUN TO ORIGINAL FORM DUE TO AUTOMOBILE ACCIDENT. REPCACE 3 OUTLETS AND 2 SWITHCES, LIKE FOR-LIKE.. ,. OWNER: 19TH ST LLC .� Address: RAYMOND A DE,ANGELO �� Unit: ANAHEIM, CA Phone: ��'s' � � - , " < City/State2ipr '4721 E COPA DE ORO DR ,� � " . APPLICANT: BROWNE,JILLIAN� �, ;:'; '�,,. �� Address: � - -� .;� �� ' „ ..',�. , : �-�, Unit: ' Phone: 714-544•7732 . � � � � City/Stale/zZip: � � ' � � � ' cON7RACTOR: ALTERNATIVE EARTH SYSTEMS INC License No. 654690 ' Phone: 714-544-7732 � Address: 14261 PROSPECT AVENUEUnit: � Cell: - City/State: TUSTIN, CA ZipCode 92780 ARCHITECT: � Lieense No. ENGINEER: ABI ENGINEERING CONSULTANTS INC License No.0046505 COMBINATION PERMIT FEE SUMMARY Building Plan Check: Building Fees: Electrical Fees: � � Mechanical Fees: Plumbing Fees: � SMIP Residential: SMIP Commercial: Bldg Std Admin Fund TOTAL FEES: •'Refer [o fee receipts for all feea paltl for project $99.61 ' $15325 $29.00 . $0.00 $0.00 $0.00 $1.68 $1.00 , $284.54 � PHONE: PHONE:949-510-8874 NOTICE: The work authonzed by this permit shall comply wiN all applicable handicap access requiremenLs under California statutes and related regulations. (Ord. No. 92-28, § 1. 12-21-92) EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. INSPECTIONS: In order for the work authonzed under this pertnit to be considered legal, such work must comply with all applicable codes, and all required inspections and final approval must be obtained. Failure to obtain inspections and final approval will resWt in the expiration of this permit. COOE � INSPECiIONTYPE ORT NI TmALS LODEt INSPECTONTYPE �� INTI71AL5 1618 Fixed System Final Fire Prevention 206 Final Mechanical 1266 Pool Spa Final 208 Final Plumbing � 200 Final Re-Root 210 Final Electrical �m Z I 201 Final0locWReWining Wall 272 Final Fire Prevention 202 Final Faclory Fire Place 220 Final Planning Approval ///�� 203 Final Sign 222 Final Site � 204 Final Demolition 250 Final Building/Occupancy � N WORKERS' COMPENSATION DECLARATION: I hereby aHirm under penalry ot perjury one of ihe following declarations: ❑ I have and will maintain a certificate of consen[ to self-Insure for vrorkers' compensation, as pmvidetl for, by section 3700 of the Labor Cotle, for the pertormance of Ihe work (or which Ihis permit is issuetl. �I have antl will maintain workers' compensation insurance, as requiretl by secibn 3700 0( ihe Labor Code, for ihe peAormance of the work (or which this permit is issued. My workers' compensation Insurance carrier and policy number are: arr�eF I�iEFFF_e�U�nl 1�/J�t/,eh�/✓C� (This seqon neetl rrof O/e mmde�� he peimR it valued at one �untlied �llars (S100J orless ) Policy.Numbec _�(p 00006 i�ii �1 Gj l ❑ I certify fhat in the peAormance o( the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I shoultl become subject to the vrorkers' compensation provisions of Section 3700 of the Labor Co , I hall orihwi[h comply with these provisqions. �r� � /�l0'�'� tanl ignaWre [*'}Oa16�'+� WARNI : FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS U WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL ° PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATrORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby affrm that I am licensed under provisions of Chapter 9(commencing with Section 7000) o( Division 3 of [he Business and Professions Code. and my license is in full force and eflect. ��n,—��t 6 o ecwssra� I� . Cn,. .k/.ar �/l' +rc�.r.�.Q �%—/O—O � i Co Vaclor'a S' naWre' �Oale CONSTRUCTION�NG AGENCY: ❑ I hereby affirm tha[ there is a constructbn lending agency for the peAormance of the m.ork for wfiich this pertnit is issued. (Sea 3097, Civil Cotle). Lenders Name: Lender's Address: Signalure Da�e OWNER-BUILDER DECLARATIONS: I hereby affirtn ihat untler penally of perjury ihat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the Following reason (Sec. 7031.5, Business and Professions Cotle: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statemenl ihat he or she is licensetl pursuant to ihe provisions of the Contractors License Law (Chapter 9(commencing wilh Section 7000) ot Division 3 of the Business and Professions Code) or that he or she is exempt therefrom antl [he basis for lhe alleged exemplion. Any violation of Section 7037.5 by any applicant for a permit subjects the applicaM to a civil penalry of not more than five hundred dollars (3500).): ❑ I, as ovmer ot the pmperty, or my employees with v2ges as their sole compensation, WILL DO THE WORK, and the structure is nol intentled or o((ered for sale (Sec. 7044, Business antl Pmfessions Code: The Contrac[ors License Law does not apply to an owner o! property who builds or improves thereon, and who does such work himself or herself or through his or her own employees, provitled thal such improvements are not intended or oHered for sale. If, however, the building or improvement is sold within one year of cOmpletion, the owner-builder will have Ihe burden o( proving I�at he or she did not build or improve for purpose of sale.�. ❑ I, as ovmer ot the property, am EXCLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to cons[rucl the project (Sec. 7044, Business antl Professbns Code: The contractors License Law dces not apply to an owner of property who builds or improves thereon, antl vfio cont2cts (or such project with a contracta(s) license pursuant to lhe Contractors License Laws.). ❑ I am exempt under.sec. Business and Professions Code (or lhis reason: 3051<6 (3/07) Owner ID verified by driver's license. ❑ Yes ❑ No Driver's License No. Expires: Verifcation of Ownership by (rype of tlocument, i.e. - property tax bill or tleed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certily that no excavation frve (5) or more leet in depth iNo wfiich a person is required ro descend, will be made in conneclion with work authonzetl by this pertnit, and that no building sWCWre, scaffolding, falsework, or demolition or dismantling thereof, will be more lhan ihirty-six (36) (eet high. (Chap. 32, Grp 2, M 2, Sec. 347, TiUe 8, Califomia Administ2tive Cotle). ❑ As owner-builder, I will not employ anyone to do work which would require a permit (rom the Division of Industrial Safery, as noted above, unless such person has a permit to do such work lrom the tlivision. ApPlitan(s SignaNre Date Division of Industrial Sa(ety Permit Number. _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. will the applicant or present or fuWre building occupant neetl to file and certify a Business Plan for emergency response to release or threatened release o( a hazartlous material? ❑ Yes ❑ No (Seclion 25505 of the Califomia Health and Sa(ety Code requires, wilh some exceptions, that a Business Plan be fletl with the Costa Mesa Fire Department by every business which has at any one time during a reponed year a quamiry of hazardous matenals equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feel ol compressed gas al standard temperalure and pressure). 2. Does or will the applicanl or present or Wture building occupant neetl to file a registration form for awtely hazardous materials? ❑ Yes ❑ No (Section 25533 of lhe Cali(ornia Health and Safety Cotle, with some exceptions, requires regislration with the Costa Mesa Fire Department by each business which at any one time has on hand a quantity of acutely hazardous materials equal to or grealer than a weight ol 500 pounds, or a volume of 55 gallons, or 200 cubic leet of compressetl gas al standartl tempera[ure and pressure). 3. Does or vnll the applicant or present or future building occupant need to prepare an RMPP (Risk Management antl Prevention Program tor acutely hazardous materials)? ❑ Yes ❑ No (Section 25534 0! the Califomia Health antl Safety Cotle provides t�at the Cosla Mesa Fire Department may require the preparation, certification and filing with the Fire Depariment of an RMPP by businesses which are requiretl to register acutely hazardous malerials with the Fire Depanment. 4. I( an RMPP is presently required, has Section 25534 ot lhe Cali(omia Healt� antl Safety Code been (ully complied vrilh? ❑ Ves ❑ No 5. Does or will Ihe applicant or pre5ent or fulure building occupant require for the vrork which is Ihe subjecl of this application a permit (or such construction or modification from the SoWh Coast Air Quality Management Dislrict or from any other air pollution control district or agency? ❑ Yes ❑ No (Sectbn 658502 of the Califomia Govemment Code requires thal ihe requestetl intormation be fumished on applicalions for noo-residential building pertnits). 6. Will any part o( the facility to be constructetl under Ihis permit be within 1000 feet from the outer boundanes of a school? ❑ Yes ❑ No Qf "yes", the facility must meet the requirement of Sections 25534 antl 42303 of the Califomia Health and Safety Cotle). 7. If a permit from ihe South Coast Air Quality Management District or other air pollution wntrol district or agency is requiretl for the work which is the subject of ihis application, have all of the disclosures prescribed by California Health and Safety Code Section 42303 been matle? ❑ Yes ❑ No 8. (If "yes", attach certificate of compliance trom Ihe appropnate air pollution control oKcer). CERTIFICATE OF COMPLIANCE: I certify that under penalty o! perjury the information qiven above is cortecl. I agree to comply with all state laws and city ordinances regartling Hazardous Materials antl Emissions. S�gnaWre Da�e CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I cetlity untler penalty of perjury that I have read Ihis application and state Ihat lhe in(ormation given is correcL I agree to comply with all state laws and ciry ordinances relating to builtling construction, and authorize representatives o! Ihe City of Costa Mesa to enter upon the above-tlescribetl property for inspection purposes. I agree not ro occupy or allow ocwpancy of any building authorized by Ihis permit until final inspection. Si na1 � I Owner(s) Da1e ' � Q '� �4lm�ihiMmrfzPE'An1ii i a f"— T MIw�J (�ia) �sa-sz�a • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us 77 FAIR �FiIVE, GOSIA MtSA, GA 9Zti'Lti ELECTRICAL PERMIT Job Address: 779 W 19TH ST Status: ISSUED Suite No Vicinity: Parcel Nunmber: 42420103 ApplicanC PRAUM, STEVE Address: 1049 MELROSE � �. _�: ' � �� . , � � O� '�_ - Phone: (714)231-7501 � /' / - /. -, PLACENTIA,�CA'� � - " � Zip: 92887 , . � /, �� . � � . _ - � - �,.'%�%% ' , � �ii�i , . , ' i - . Owner.�, �19TH'ST LLC � � � , � ' :- _ Address�j%RAYMOND A DE ANGELO /: , ; � � ANAHEIM, CA; '-'� �� Phone: �,,, i.''", . 4721 E�COPA DE ORO DR 2ip: 928073833 // � - � j,; ' • Contrector: ORANGE ELECTRICAL CONTRACTORS . Address: 1049 MELROSE . . --- , � � � Phorie: (714)980-2300 � i ;�; � , PLACENTIA, CA %- - Zip: 92887 - � �. " License: 747129 � � � Applied: 06/OSI2003 Issued: O6/O6/2003 �' `� � '`� �� , ,SCOPE-OF PERMIT � '. � � CONVERT EXISTING OVERHEAD ELECTRICAL SERVICE TO UNDERGROUND FEED. � ..._ ..- -' ._, . .. ... . _, . _.. . ._.. - � ,� � FEE SUMMARY , . � ' � - �Quantiry ' ._ - . , , , _ - i" % , . ISSUE FEE ` $0.00 `' T D' t S� t (L' hf Temp service test $0.00 Res. a/c-package ` �� $0.00 , New,Res(1-2unifs), '� $0.00 0 NewRes�(3+unifs)� �� $0.00 0 Pool /�Spa�. " �� > $0.00 0 Lighting Fixts -� �-� � \�, ^$0.00 � 0 ReceptOutlets • ��:$0.00 0 Switches� =` �., " �50.00 ,+..,, 0 �� NonResAppl��,, � /� $0.00�� 0'• Res Appl �� A,�� / / �$0.00;� :� •> 0 0 Service to 200a - �` � $30.50 ` �� 1 Service to 7000a�� _ �� $0.00�. �, 0_ Service over 1000a A� � - $0.00 `i � 0 � Motorsto thp � �� $0.00��,' ; ,; 0 - MotorstotOhp �� $0.00.��-� �� 0; � Motors to SOhp ��,� $0.00 � ", 0 ' MotOrS to 100hp "$0,00 - �- 0 Motors over 100hp 50.00�-� �� 0 Communication drops $0.00 ' � 0 „ Subpanelto200a 30.00 0-�_._ Pole Light Pkg $0.00 0 Sign Circuits $0.00 0 tv:f� emp is , ys em ig mg Busway,/t00 n � Standing Sectlon , Misc Electrical Equipment Transformers up to 1 kva/kw �::..':.:.......up to 10 kva/kw ..........:....:.up l0 50 kva/kw .....:...up l0'100 kva/kw .....�.. .....over 100 kva�kw- ............. . ,Low Voltage Equipment - - low Voll Wiring System / Ckt Misc. Conduit Misc. Conductor " Circus ( gen or ride) - , Circus�(mech ride or lighls) . ChrisVnas Tree Stand� � Fireworks Stand ONer Electrical Fee Quantity ' $0.00 0 $0.00 0 $0.00 0, $18.20 1 '� ' $0.00 0 : $0.00 : � 0' " $O.00�i, r0 $O.00,a, 0 � $0.00 0 $0.00 0 $O.W' 0 $0.00 0 $0.00 ' 0 $0.00 0 , $0.00 0 = $0.00 , 0' $0.00 . 0 $0.00 � Investiga0on Fee - , � �. � � $0.00 . Plan Check Fee ��. -' $0.00 -_ � Reinspection Fee $0.00 v� � NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statUtes and relatad regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically ezpire and become vold if work is not commenced wlthin 180 days, or if work is suspended or abandoned for a period of 180 days. � INSPECTIONS: In order tor the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all requlrad Inspeetione and final approval must be obtained. Failure to obtain inspections and final approval will result in ihe expiration of this permit. FOR INSPECTIONS CALL: (714) 754-5626 zawae �eroo� WORKERS'COMPENSAnON DECLARAnON: I hereby effirtn under penalry of perjury one of Ihe following declarations: ❑ I heve and will maintain a certificete of wnsent to self-Insure tor workers' compensatlon, es pmvidetl tor by section 3700 oi ihe Lebor Code, for ihe peAartnence of Ihe work for which this permit Is issued. � I �eve entl will meintain workers' compensation insurance, es required by sectlon 3700 of the Labor Code, for the peAormence of the work for which thls partnit Is Issued. My warkers' compensatlon Insurance wrder end policy numEer ere: Carrier. _� 1 ATLI �'.i J O Policy Numher. I%�I –Q � (This sectlon need not be completed il fhe permit is velued at one hundretl dollers ($100) or less.) ❑ I certity that in Iha pertormfl ce of �ha work tor w�ich ihis Dertnit is issued, I ahall not employ any person in flny manner so es to become subject to iha workers' compensetion laws of Celif la, an �ae thet If I shoulA become sub�ect to the workers' compensation proNsions ot Sectlon 3700 of the Labor Code, I shell fonhwlth compty with Ihese provision Q Applicant Signature: � Dete: �� 1� �� c�— WARNINO: FAILURE TO SECURE WORKERS' COMPENSATIIXJ COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVER TO CHIMINAL PENALTIES AND qVIL FlNES UP TOONE HUNDRE� TNOUSAND DOIURE (5100,000), IN NDDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDEO FOR IN SECiION 3]OB OF THE 1A80R CODE, INfEREST, AND ATTORNE'/'S iEES. LICENSED CONTRACTORS DECLARATION: I hereby ettirm that I am licensed under provisions a he er 9(commencing with Secilon 7000) af Division 3 ot Ihe Business entl Professlons Code, entl my license is in full rorce end eNect. uc. a 74—I 12 � �� c�ass a (� GonlrecrofsSigneture: , Dete: –�'i–� CONSTRUCTION LENDING AGENCY: ❑ I �ereby aNirm ihat Ihere is e construction lentling agency for Ihe perfortnance of ihe work for which this pertnit is issueA. (Sec. 3097, Civil Cotle). Lenders Name: Lenders Address: SlgnaNre: Date: OWNER-BUILDER DECLARATIONS: I �ereby ettirm Ihet under penelty ol perjury t�at I em EXEMPT FROM THE CONTRACTOHS LICENSE LAW tor the lallowing reason (Sec. 7031.5, Buslness entl Professlons Cotla: Any ciry or counry which requires e pertnit to conslrucL alter, improve, demolish, or repair any structure, O�or to its issuance, also requires ihe epplicaN for such pertnil to file e slgnetl statement ihat he or she Is Ilcensed pursuam to the prodslons of the Comrectors License Ww (Chepter 9(commenGng wlth Sectlon 7000) of Dldslon 3 of Ihe Business entl Profeuions Cotle) or that he or she is exampt theretrom and the besis for the ellegad exemption. Any violation ol Section 7031.5 by any epplicanl for a permit subjects the applicent to a civil penalry of not more ihen five huntlretl dollars ($500)J: ❑ I, es owner ol the property, or my employees wlih weges es Iheir sole compensa�ion, WILL DO THE WORK, end the struciure Is not intentle7 or otfered far sale (Sec. 7044, Business and Professions Code: The Contractors License Law does not apply to an ownar of property who builds or Improves thereon, and who does such work himself or hersefl or Ihrough his or her own employees, proviAetl �hat such Improvements ere not Intentletl or oHereC tor sala. If, however, the building or improvement is so10 within one year of completion, I�a ownerbuildar will hava.the burtlen of proving Ihel he or she did not 6uild or improve for purpose of saleJ. � ❑ I, es owner oi �he proDeRy, am E%CLUSIVELV CONTRACTING WI7H LICENSED CONTHACTORS to construct t�e proJect (Sec. 70a4, Business entl Professions Cotle: The comractors LJcense Lew does not eppty to an owner ol property who �ulltls or impmves Ihereon, and who contracts for such project with a coNrector(s) license pureuent to the Coniractoro License Lews.). ❑ I am exempt under sec. Business and Professions Code for this reason: Signeture: Date: Owner ID venfietl by drivers license. ❑ Yes ❑ No Driver's License No. Expires: Veritication of Ownership by (type of document, I.e. - properry taa bltl or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICA710N: ❑ I hereby certify ihat no excavatlon five (5) or more teet in deplh into which a person Is required to descend, wlll be mede in conneciion with work euihorizetl by thls permit, antl that no builtling structure, sceffolding, talsework, or demoli�ion or tlismentling thereot, will be more than thirty-six (36) teet high. (Chap. 32, Grp 2, Art 2, Sec. 341, Tiile 8, Cfllifomia Atlmini5�retNa Cotle). ❑ As owner-builder, I will not employ enyone lo do work which would require e permit trom the Division ot Indusirial Safery, es noted above, unless such person has e permit to tlo such work from Ihe divlsion. Signeture: Date: Division ot Intlustnel Safery Parmi� Number: CER7IFlCATE OF COMPLIANCE AND AUfHORVJITON OF EMRY: I certify untler peneliy of perjury �hat I heve reatl �his epplicalion and state ihai �he intormetlon given is correcl. I agrae to compy with ell stete lews end ciry ordinances relaGng to builtling construcqon, end euthonze representutives ot the Ciry of Cwte Mese to enter upon the ebove-des 'bed properry for inspectian purposes. I agree not to ocapy or allow occupancy of eny building euthonzed Dy Ihis pertnit until final inspeciion. Signeture OI Legal Owner(s) 4 Date V�= b `� 1 O� AnNOr Authodzed Applicanl Date LpDE I, INSPELTIONTYPE PdIE INTRIALS 1616 FixeE System Final Fire Praventlon 1266 Pool Spa Final 200 Finel Re-Roof 201 FInaI8lack/Retaining Well 202 Final Factory Fire Place 203 Final Sign 204 Final Demdition CQOE� INSPECTIONTYYE 206 Final Mechenical 20B Finel Plumhing 210 Finel Elec�dcel 212 Finel Fire Prevention 220 Final Planning Approval 222 Final Site 250 Final Building/Occupancy � IL�J4� It� PflOJECT ROONESS: %% 9 W 1 9 TH ST OWNEfl'S NAMk: O' TOOLE LAWRENCE J TR nooaess: 17fi92 I{iVINE BLVD TUSTIN,CA 92680 646-2785 AXCM/ENGINEEN: flEG.NO.: PD�NESS: UNIT: UNIT: PEflMITTEE: AAA PLUMHING & HEATING ( 714 ) 642-5667 aooxcss: 511 FULLERTON NEWPORT BEACH CA 92663 UCENSED LONTNFCTOB UECIAMTION: I �ere0y atiirm lhat I am licensea unAe� O�ovisions ot ChaO�er 9(commencing wi�� Seciion 7UW� of Division 7 0l t�e Business an0 Pmlessions CoOe. antl my littnu is in IWI lorce antl efieci. c�rruc.:0064�^9_4 sureuc.:z61469/, cuss: C36 -�:ie: .S— Y � �� SignaWre: �`�V�. . . �C— /� WONREPS'COMPENSRTIONOECLABRTION: I�ereDyallirmi�atl�aveaceniliwteoicansemtoselbinsureoraceniliwt alWarkers' Compen5dtion Insurance. or a cendietl cooY ��ereol ISection 3800. LaE. C1. POLICY NO.: E%P. OATE: COMPRNV: Q Cerli�ie0 m0Y �5 hereEy Wrnis�etl. ❑ tenili¢G coDY �s hleG wit� t�e ciry Builaing Dids�on. �aie: Fpplitani: � E%Eh1PfI0N FHOM WONMEPS' COMPENSITION OECIAXRTION: (ihis sectlan �reeC not he mm0leteE iI the paml i5 fa one AunEreA �5100� a kss�. I cenily �hat in tne Der�ormance ol ine �wrk for wNGh tnis permil is 6we4 I slWl not emDloy any p¢rson in any rtlaMer 5o d5 to Oecame supect laC��e Worpker-s' Com�p`en5aiion LavS o� Calilomia. /��/ /�/�� Dale: �J - L� � ! % Siqnalure:��L!-�/�-� � ��'��f✓�� NO710E: it, atter making t�is GecWra�ion, you shoNA Oecome suEject to �he Workeri Compensaiion Drovisiom o e Labor CoOe. you mu5i IOMM'ni� COm01y wilh Sut� OrOvi5�on5 ar ltn5 permil StIaO �E UeemeO revokea. LONSTBOCTION 1EN01NG RGENCY: I �ertDy affirm I�ai Iller¢ i5 a consVutlion ICnGinp apency �Or l�e petlOrmante ol II10 xrod fof wttic� Inis permn is issuetl ISection 3W7. Gv. CI. LENOEN: RDOflESS: OWNEB BUILOEB oECNMTIUN: I �ereby atfirm i�at I am evempt Imm ine Contractors State License Law lar Ihe iWlowinq reason �Secuan 7031.5 Business anC Pmtessional COGe: Any ciiy al coun�y w�ic� repuire5 a permi� �o constmct, alter, imD�%'e. 4emolisR or re�air any sirUtNre. o�ior lo its iuuarice. aL50 rlpuires ihe apPliWnt lor wth Dermii to liie a sipneE statement ihat nPJShe is IiRns¢a DursUani m I�e provi5ion5 oi I�¢ Conlratiors $Wle LitenSe Law (ChdD�e� 9 �camm¢ntin0 ��h $eclion 7000) o� Divi9on 7 al ��e Business anE Aolessians CoGe) or ihat �els�e is eaempi therelmm ana t�e Gasis lor lAe alleAeO exemption. Fny vioWtion ol Section 70�7.5 hy any aD0lkant lor a permil suEl��s ttre aDP�iWnt to a civil penalty of nol mOre Ihan hve hunJreA Ualldrs (5500�. I. as owner oi IAe D��nY w rtry employees with wa0es as Neir sale compensation, will tlo Ne work. an0 the ❑ simcwre is nat imentlea or ollere0 for sate (Sec�ion 70a4. Business and Prolessional CaOe: T�e Comracmrs' Slata License Law GO¢5 n0i apply �o an Ownef ot a pmpetly wlq UuilaS ar impmvCS tMrCOn, and w�a tl0e5 SUC� xrork �imSUl/�Cr5Bl1 or I�roup� Ns ar ner own employees. OmviOeA tlWt sucn imDmvemenis are not inlenEed or offere0 for sate. II, nPxCver Itle EuilAinp or imprwemenl is sold wi�Nn one ywr ol completbn. ihe owner will luve t�e GurEen ol prwinp he/she Gitl not OuiIJ or impmve for t�e Duryose ol Sale�. � I. as owner a� Ihe DrOpetly. am exUuSiveN conirac�ing vnt� Iirense0 comractors to ConSlmci Ihe prqec� (Sectbn 7094, Busine5s ❑ aM Profesvau Cotle: The Cantractors' Siaie License Law aces nm aDPN �o an owner ol pm0erty wlw Owltls or imD�a�es ��erean anC who Coniracl5 �or Sut� pro1��5 wii� a mnirat�or(5) IitenSE pursuanl Io �h0 ConVaCI0r5' State License Lawl. I am aware Inai prool o��heir Worker's fAmp¢nsa�ron insurance ShoulO Oe pronEeG Io me. � I am exempt untler Section: B. 8 P. C. br mis reasan: Date: �e� i ao �ere0y cenily ihai I am aware of ana unaerstand Ine requiremenis of Calilomia Mealih ana Safety CoOe Sections 25505, 25533. an� 2553d anG Ihal I Or any lulure OuilEing actupanl vnlllwill n0i �tircle One) nee� l0 comON �^�h Said Slaie cotles and Ihe ieQuir¢menl5lor a Oerrtn� for consimction or mUdlication Imm I�e Air Ouahry Management Oistrict. fl¢siAenlial conslmetion applitations are eKemp� imm ihese pmvi5ion5. Oate: � � AOPlicant: IhBreDy Cerlilyihal I have reatll�i5 apDlicalion and Slale lhal Ihe a�aveinl0rmaii0ni5 COrr¢C1. I aAree l0 COmply wilh ailCity and COUnry o�dfnancPS anG slaie laws relalinq to �uiWmg con9mclion antl �ere�y aulAa�ie reD�e3Pn�alives of IMs ciiy Io enter upOn I�e abov0�menlioneG o�ooeny brinsnneciion n�ioases. � /D -iL-•¢:�' D � p� SiqnaWre'. ��/'�`�LL ��%!% orive�'s License or Sociai Sewriiy .; f64Fa6 Whi�e-Bmltling: Gieen-Catle EniorcemenL Canary-AOO��enl Pink-Revenuo: GolUenrotl-Auossor CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: P 051996 PLAN CHECK NO: N CONSTRUCTION TYPE: PERMZT T.YPE: PLU JOB DESCRIPTION : REPLACE WATER'LINE •7•• �• 1 •� � �• � •�^a • SQ FT: CLAIM VALUE; CALC—VALUE: GROUP OCC: B-2 / COMMENTS: WATER RE—PIPE *�e *****�r�r***a�*******�e�*��r�****+��r*****�r�*x �e*�e**�r�+�**�***�r***� �r��r�r*�e*�r* �**+�****** Z O N I N G R E Q U I R E M E N T S sETBAcxs ------------ MAIN BUILDING ---------- --------- ACCESSORY HUZLDING ----=---- FRNT: FT IN REAR; FT IN FRNT: FT ZN REAR; ' FT IN LEFT; FT ZN RGHT: FT IN LEFT: FT IN RGHT: FT IN PAAKING REO• PROV: PARCEL: 92420103 ZNE; REF NO: PLANNING N(STES> � IF iF �F If 1F af iF if 1F 1F If IE iF �F iF 1E af if if iF 1F if if �E �F if iF if iP iF IE IF iE IE iE if jE aE if iF if if if iF * iE if if iF K� 1E �F 1F i4 iF 1F aF iF af iE iE iE iE iF iE IF IE 1f �f iF iE IE IE IF iF �f IE iE if D E V E L O P M E N T S E R V Z C E S ,ft E Q U I R E M E N T S ZONING APPROVED BY - DATE: BUILDING APPROVED BY : DATE: APPLICATZON ISSUED BY• ' DATE• �F� IfiFlFkifiFiFiEiFlfKikiFiEifiEiFififlflEif �IF'iFiF7fiFifiFlE�filiEikiE7Fi ifif iE1ElfiEiEifitifi�iflF%iF�FiF3FM1EiEiEiFiFifiEiEiEiEifiElEiEiElEifiEiF3(�3EiEiFiEiF ififiFiEififlE�E1F1EifiFiFiFlEiEif�fiFiEiFlFifiE�fifk�FififiFiFifiEik � LEGALIZATION:N F E E S U M M A R Y- STRUCTURAL SEGMENT:N PERMIT BLDG PMT PLUM�Ioo ELECTRIC MECAANIC FIRE SMIP/RES GRADING ' '�5; SMIP/NON—RES PLAN ISSUE FEE 3.00 , BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 2.00 3.00 0.00 5.00 5.00 .00 REVENUE DIVZSION TOTALS--> COLLECTED• 5,00 OVER/SHORT: 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 5.00 aF iF ff k IE 1E �f iE If if IE af if jF if iF 1E iF 4 iE if M itiF M if if �k ft �E IE 1F M iF If iF ik Ik iF 1F if 1E af )f iF 1f if ik aE 1E 1E iE iE 1f if 41E iE 1f #f iE If If iE iF iE iE �E k IFiE 1E if fE iP IE k If lE I N D 2 V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST PLU 1 WATER RE—PIPE 2.00 2.00 END OF FEES V QS OPOE6Ql0—QOO8G�19 �a� y � 5,itn DP.TE: US/u9;9? TIhIE: 15:15 � - � ' r CONSTFUCTION AND PLANNING POOI PA ' APPROVALS Pcrmit # Date Inspector qPPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location �2. Soil Pipe-Undrgrnd._ � , 53. Steel Reinforcement - -� � 3.: Electrical Conduit Utility�Undrgrnd. 54. Forms • ..4. Electrical Condui[•Undrgrnd. 55. Electrical Bonding ' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test ," �� 6. Electriwl UFER Grnd. c 57. APPROVAL TO COVER�GUNITE z;7: Footings - 58. Electrical Conduit-Undrgrnd. � J_8. Foundation '� �� 59. Gas Pipe, O Undrgmd., Tes[ ' • 9: Water Pipe-Undigrnd. . i 60. Backwash Lines, P-Trap, O Undrgrnd. � 10. Structural Floor System ' � 67. APPROVAL TO DECK 1�1. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap ` 63. Heater & Vent-Finai 13. Roof Drains �� - 64. P�umbing System - Final T 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. flough Electriral�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20: Rough F,actory Fireplace - � : . �APPROVALS' . Permit # ' sr �,.f 21' Ducts, i� Structure .. .. �"' . -' � � � ' "1� � �� ' . , .70. Underground Hydro 22. Ducts,Yentilating�� • _ s� ' �,71, ProductP.ipingOGas ❑Oil 23;_Gas Pipe-Rough & Test , , - . � 72. Undergiound F�ush .. ' 24: Roof Framing � •� • � - � . 73> Undergrnd. Smre�e Tank`� Gas ❑ Oil • 25. Roof Sheathing :. "' ' " - � ; ' 74. Overhead`Hydro 26..T�Bar Ceiling (Structural) & Monocoat �� - � � r 75: Dry Chemical � � V ` � _ 27i Frameand Flashin9 ` '' �� 76. Dr Stand.i e' ' '� u •,i . >. , Y P�P . i-: _ 28. Lathing�& Siding - •� •� 77; FIXED SYSTEM'FINAL I" ' 29. Insulation + •� . � � ., r ' ' 78: FIRE PREV. F�INAL .1 � i�30. Drywall�Nailing �t � . �•�� _ � . � HEALTH DEPT. REQUIREMENT 31. PlasterBrown CoaT �,- ,. � j " 79. FINAL INSPECTION '' � 32, Electrical Power Meter-Final � • � � � 80:,FOOD CERTIFICATE ISSUED � _ . 33=Final Electr,ic ' � � �: � � � � f', t Notes: � ' . , .° 34: Final Heating & Air Conditioni_ng � I �(< �. - i . � .. � 35^Final Gas Pipe-Tesy �_ ` � � Ey •. � ' " r 36: Hood or CanoPY . � � ^c , {• 37-Final Factory Fireplace. � �:`' � � � ' ' ' - �. • ' 38. Final Plumbing � ; � � Ct [_� . � : - 39. Water Service�Final � -- ,C� !f (�;; ' `� ' " �„40. Gas Service-Final ; � ti . , _, _. � � s.41. $olar pomesticfinaP: . � •• _ < « " � �. .c. v; 42.•Backflow Preventef . ' � ��. . = � � . 43. Backfiow Irrigation � '^ - " �. 44. Landscape Irrigati0n SYstem ,j;r u- . - � . • ,. , � . , _ . ., : - . . 45' Sound Attenuation j' � �' • - ' �, ` 46.. Handicap Regulati8ns �' �� . . � . " • 47.,FINALSTRUCTURE&BUILDING - • - _ � ;. 48._FINALPLANNING ' ` � : + ' • 49.',Electric Release to�Edison ; � ` .. . � 50, Gas Release to Southern Califarnia Gas Co : i � �� ' � . �� 51. CERTIFICATE OF, OCCUPANCY , , . 'r� - . . • ( � No Date f��9 Aoplleant la fill In all spaces except tM1ose wit�in neavY DorOer'lines antl slgn all app�oDrlate 0eclaratlons. a7Y oF cOS7A MESA CONSTRUCTION PER�IT . •� Project Address � �• �� T�� r Applicant's Mailing Ad ress ; Owner's Name ' Phone Address Arch/Eng. license No. T_ Address ��,(� ��7� Contracror'S Name��`+ ��fL Phone 3¢bL�7 Address Imalingl ��4 Sd�EBlO.G /.� �O C/iC Ciry License No. � 99 y� , LICENSED CONTRACTOR DECIARATIpN I hereby aftirm tbat 1 am Iicansetl untlar p�ovi5lOn5 01 Chart¢r 9(Commenting with secUon ,7000) of Divislon 3 ot the Buzinest antl Protessions Cotle, antl my Iicensc is in full 1 ce ana elfact. /��(� J(�/J1 UC9p5C CId55 D �SC NO.J��GLrLL_- Datr _�� Signdt ure WORKERS' COMPENSATION DEC ATION ' hereby affirm lhat 1 have a certiticate ot ton5enl to self-insure or a certlBwte �Workers' Compensation Insurance, or a certi(ietl coOY thereof (Section J0. Lab. C.) . � Policy No. � Company ' � eCerHlietl wpy Is hereby furnishetl. ' ' Certitiea copy is Illetl�with the city Builtlin9 Divisfon. Daip Applitant � EXpMFTION FROM WORKERS• COMPENSATION DECLARATION (Th�S zectlon neetl not be completeC H tho permit is for pne huntlretl (y300) or lessj, I ceriity tha[ in [be pOrfO/manCe of the wOr r hi 1[his pe�m�t is issuetl, I shal� not employ any oerson In any s o become suEject to the Wo�ker5' om pan on Ldws o! Cdlit mid. � Dat¢ y� L�Y� S9nature ' 'NOYICE: If, after makin9 this tletlara ' , you sh ultl be<o e subject to the Workers' Companwtlon orovisions oi the Labor Cotlo, You must tortnwlth comply with su<h provisions � or 'this permit shall be ticemetl revokeC. CONST0.UCTION LENDING HGENCV ' 1 hereby af/itm Ihdt there i5 a constructlon 1¢ntling agency fOr tne p¢rformance ot Ih0 work 1or which thi5 Plrmit IS issuetl (Section 309] Civ. C.) Lenaer's Name Lander's Aatlress - OWNER BUILOEH �ECLARATION I he�aby aHirm that I am Oxompt from th0 ConVactor's LlcensC Law fOr tna following reason (Soction 7031.5 Business antl Proiesilonal COGe: Any city or roi�mv wnich reouires a oarmit to <onstruct. alter. improva. aemolizh or ropalr rolrom antl the oas�s ror tne ane 13.5 by any dpP�iWnt /or a p� dl[y of not TOre than 1Iv0 huntlre I, as Owner of tho p�op¢/lY Or npensaUon, will tlo the work, ant salo (S�ction 7044, Business a en5e L. w tlOCs not appty to an ov reon, antl� wllo �oei SUCII wOfk I pl0y ofl5, ProVidetl thal Su<h Impri :. If, howeve�, the builtli0g or imi ❑on, lhe Owne/ wilPhave Ihe bur ve for the purpose ot sale). I, as owner oi tne property, am :tors lo mnztrucl tne v�oject ($ec a ConVactoYS'License Law does Itls or ImO�o�as tnereon,-antl wn _tor(sl liwnse pursuant�to the�Cc �or o( thelr Worker's Compensat I am exempt untler Section— nployOCi with wage5 as tlteir zole ructure Is nat intentlntl or olforetl fassional Cotle: The Contrattor4 a propBrty wbo builCs or ITPrOv¢5 iM1erSelf or throu9h bi5 or,har own ts ara nol fntentlatl or ofieretl Ior eni IS Soltl within One yadf ol com- ' proving ho/sno aia not builtl or Im- ; �¢ly contracting with Ilcenmd ton- 44, BU510¢SS dntl PrOfe25i0O5 COd¢: iply to an owner of property who a<ts lor such p�o�e<ts with v con- • ir's License �aw). I am aware that urante shoultl be o�o�idea to me. B. & P. C. �Or thi5 reason . Date Owner - � AereOy certity [nat 1 M1ave rea0 fhis application antl ztate that the above intormation is correct. t agree to comPlY with all tlty antl county ortlinances antl state laws relatln bu' tling mnStruCtiOn, antl hereby authorii¢ repr¢- seqtatives oi tni y Oter upon [he above-mentionetl Property for ��spection pur ses � . � Pi� C.1 TVPE OF CONSTRUCTION I�NEW U ADD LJ ALTERATION LJ REPAI R ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.p.�y DESCRIPTION OF WORK/USE OF BLDG. - S Main Buildi E TVPE OF PERMIT , GRADING FOUNDATION STRUG7URAL T Front ❑ TENANT �q ELECTRICqL ❑ PLUMBING ❑ MECHANICAL B ❑ �OTHER A Rear PROJECT DESCRIPTION 5�. FT, oCCUPANCv C Right CONSTRUCTIONTYPE VALUA710NS g Lef[ ZONE GRADING CU. VDS. ACRES Ping. Ref. # Remarks: '� �/�/„� ' Planninp Notes: 3ackflow Preventer 3sckflow Irrigation 3athtubs� � Clarifiers Dishwasher �rinking Fountains Floor Drains Floor Sinks 3as Service � � Outlets Interceptors Kitchen Sink � � —_ Lavatories �. P—Trap . Roof Drains � ' Reinspection.Fea $15 Boiler � � . • Duct-UnderGround Dutt - Struttural Duct - Ventiiating Exhaust System ❑ Multiple Firepl/FacLBIt.ICBO� r Heating System & Ducting O a i oo,000 eTu � i oo,000 1 SlgnaWre Dace I I Dri�ers' �icen r 55 � . Reinspection Fee CMF 0865-46, rev. 30/84 White - Builtlin9: Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor $15 $hawers Service Sink Sewer Connection SolarCollecrors - Solar Piping Solar Tank Swimming Pool w/Spa Urinal Weler Cloul Water Heater Water Service Auto-Wash laue Fee Hood or Typel � Cenopy Typell ❑ Refrigeration System ❑0.100,OOOBTU 0100,000 System Repaii/Alteration FE Automatic Washer Construction Pole Sub. Cooking Unit � Dishwasher - ' ' ( Dryers (_1Gas L7Elec Fen F.A.U. � 515E G/I':/9: Zone ' AcceSsory Building: Parking Req.IProvided , ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Device Boxes � Oullets' (p Switches� / Garbage Oisposal . - Generator �0-5 KW �5-15 KW ' r _ �-�� Meter LJup to t00,amps Meter �over 100 amps Sub Panel . Moror: Oat HF O1 x- a Inc.Solar �9�15 HP 016-15+ Microwave Pole Light Range ; Standing Sections Trash Compactor • Reinspection Fee g15 ' Issue Fae FEES '• � . DEVELOPMENTSERVICESREQUIREMENTS: .. . Zonin9 APProved BY ' Building APGrovad By - V A Registers . laua Fee $ 3 ' � . Z O N I N G R E Q M T S FEES $ 3 � . .�� ,SUMMARV OF FEES . BUILDING PERMIT , $ ' SMIP ' $ �'M1 PLAN CHECK . $ PERMIT � PLUMBING $ �SSUANCE S � PLAN CHECK ,25% $ �� ENERGV P.C. $ � ELECTFICAL � $ � GRADING . $ � , PLANCHECK 50%� $ «• MICROFILM , $ � MECHANICAL S TOTALFEE § -� PLAN CHECK 25% $ ' , , • Y: CONSTRUCTION AND PLANNING APPROVALS Permit # 1. Temporary Electrical Service or Pole 2. Soil Pipe�Undrgrnd. - 3. Electrical Conduit Utility-Undrgrnd. "4. Electrical Conduit-Undrgcnd. 5. Steel Reinforcement � 6� Electrical UFER Grnil. � 7. Footings 8. Foundation . 9. Wa[er Pipe-Undrgrnd. • 10. Structural Floor System 11. Property Sewer Line & House Connection 12. Sewer Cap 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 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 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 46. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co No. Date Date POOL 'A Inspector qppROVALS Permit# ' 52. Pool & Equipment Location 53. Str.el Reinforcement � 54. Forms 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 5). APPROVAL TO COVER-GUNITE 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, � Undrgrnd., Test 60. Backwash Lines, P-Trap, 0 Undrgrnd. . 61. APPROVALTODECK 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 xj 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: {,�(�a. :.�_�,Y,%�.;if�,rv..c .� �-lj- ��O G'd(�Li�'1 kg� P��;r? � Date � Inspector 6za�� o AOP�ieant to /111 In all soaces exeeot thosa witnin neavv OorCer lines anE siqn all aoorooriate tleclarationz: G�ITV OF COSTA MESAQ CO STRUCTI N PER IT ProjectAddress 7� /' � �� S� �� Applicant's Mailing yAdd�re�s,s � Owner's Name 6.�lLS�Z' �Phone Address Arch/Eng. License No. AddreSs �p� �'` COf1IfdCIOf�� NamP V�✓� � Phnyna ,��, _�J XIA� Address Imailingl ��+ -SU B�1d.G �G� GZJ City License No. �77 % � LICENSEO CONTRACTOR DECLARATION I hereby allirm thal 1 am Iicensetl untler provisions ot Cnartar 9(commencing with section 7000) o/ DlviSion 3 of the Business antl Professlons Cotle, antl my license is in fWl (y�c a%�tl etlec[. {7� License Clazs � �+ is No. �JUZ�� Oate SignaWre 1RKER5'COMPENSATION DECLA TION �,reby ailirm Nat I nave a certititate o{ consent to self-Insure or a certifitate . Workers' Compensation Insurance, pr a certifietl toOY thereof (Section 3800, Lnb. C.) ' Policy No. Company BCe�tifietl copY IS h¢reby fu�nishetl. Certi(letl cOpy I5 filetl with tne city Bulltlln9 DlviSion. Date APPlicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION ,(This sectlon neetl not be completetl if tpe permit is /or one hunaretl (E300) or less). I cerlity thdt in the p¢rf0/mance of thG wor ' h hii p¢rT�t is issuetl, I shall not employ any person in any ma o a t ecome subjec[ lo the Worker5' OJ})P¢oGitlOn LdwS Of Cal{to! d. Date �J��1�� Si9nature 'NOTICE: 11, after making this GeclaratiOn, ou shoultl bacome subject to t�e Workers' CompenSaHon prOviSions ot (he Ldba� Cotle, y0u must fortnwltn compry witn sucn provlslons or Ihig permit snail be tleemetl revokeG. CONSTRUCTION LENDING AGENCV �' 1 I�ereby atiirm that there Is a cons(rucBon lentling a9ency lor tne periormance ot Ihe work fOr whiCh thls permlt is ISSuetl (Saclion 3097 Civ. GJ Leneer's Name _ _ , LenCer's Atlaross OWNER BUILDER OECLARATION I noreby a/firm lhat I am nxempt irom the Contractor's License Law for the following reason (Seclion 7031.5 Business antl Prolesslonal Cotle: Any city or � counry whiGn requir05 a parmit to con5truct, alt¢r ImO�ovo, tlCmolish or repair "anY structure, prlor lo its issuance, alsD requires t�e applicant lor such permit [O file a signatl slatmnlnt tnat h¢/she IS IlcOnsatl pur5uant to th0 provl5ion5 01 �e ConVaclor's Ucense Law (Cnapter g(commencing with 5ectlon ]000) of vlslon 3 of lha BuSlnesS antl Prole55lon5 Cotlp) or that h¢ Sne i5 exempt ,erotrom antl the basls for the allegetl axemptlon. Any viola�lon oi Seclion 1031.5 by any apolfcant for a permlt subjects the appllcant to a Uvil �enally of not more than tive �untlretl tlollars (5500�. �, ds owno� of Iha pmperty,or my emplOyoos wlth waga5 d5 [hei� sole comp¢nSatiOn, will Co �h¢ wo�k, an0 [he ZtrUctu�a i5 not Intentl¢tl O/ o(feraC ior sale (SCctton ]044, Businesz antl Professional Cotle: Tha Contractor's Lic¢nse Law tloei not apply to an owner Ot a property wno bulltli Or ImO�oveS chereon, antl who tlaes sucn work himselt/horselt or through his or her own ¢mployae5, provi0C4 Ihat Su<h ImOrovQments ar0 nOt InleOtl¢0 0� otter¢0 fot sale. 11, however, tne builein9 or improvement is soltl within ona year of com� pletion, tho owno�. wlll have th¢ bu�Eeh Of P�oving h0/sno tlitl nOt bulltl Or im- �rove tor lhe purpoSo oi sale). I, as owner ol tho pro0erty, am exUusivety conVactln9 witn Iicensetl con- tfactoR to <OnsV u<t tha prO�ect ($ettlop ]044, BuSlnCss antl Profe55ion5 COtle: The Contracror's License Lnw tloes �bt apply to an owner oi property who builtls or Improves tnereon, antl who tontracts for sucn projectz wkh a wn- IVactor(sl Ilcense pu�suanl�t0 Ihe Conlra<to�'s Llcnns! Law�. 1 dT awaro that pro01 Ol thelr Worker's CompensaUoq insuranco shaultl be provitletl to me. ❑ I am exempt untler Section B. & P. C. for this reason Da[e _ I h0/eby infmmabc antl state sentatives inspecHon Si9na W re Drivers' L that 1 hav¢ 'rect. 1 aore� 55 I this applica[ion ane state that the above comply w�tn all City antl CountY ortlinantes g consiruction, antl hareby authorize reore- upon the abov¢-mentionGtl property for ��/— Date ,f /SXG '' -� , a 37� ___.t5 , TVPEOFCONSTRUCTION NEW ADD � ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p,�6 OESCRIPTION OF WORK/USE OF BLDG. S Main Building:, E TVPE OF PERMIT ' GRADING FOUNDATION STRUCTURAL T Front � � TENANT .I� ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ' A Rear /� ❑ OTHER ' PROJECT DESCRIPTION Sq. FT: OCCUPArvCv- C Right K Left � CONSTRUCTION TVPE VALUATION S $ 20NE GRADING CU. VDS. ACRES p�ng. Ref. �/+ , pemarks: '� n� 7.� Planning Notes: $Ink Preventer Irrigation Drinking Fountains Floor Drains Floor Sinks - Gas Service '•� Interceptors� — Kitchen Sink �' Lavatories � Roinspaction Fee � � $15 Boiler Duct - Under Ground Duct-Structural ' Duct - Ventilaling ' ' Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑0.100,000 BTU �100,000 Reinspec[ion Fee I $75 0865-46, �ev. 30/84 Whit¢ - 8uiltling; Canary - AppliGdnl: Plnk - Accounting; Goltlanrotl - Asse55o� $hOwClS Service Sink Sewer Cap Sewer Connection $OIBf C.OIIQCtOfS Solar Piping Solar Tank Swimmin9 Pool w/Spa Urinal Water Clout Water Heater Water Service Auto-Wash � Isue Fee Hood or Typel � Canopy Typell � Refrigeretion System � ❑o-�oo,000eru Oioo,aooeru System RepaidAlteration Fire Dampers Registers Issue Fea $ 3 53 Automatic Washer Com[ruction Pole Sub. Cooking Unit lectric Fan F.A,U. � Fixtures Device Boxes . Outlets Switches Garbega DisposaT�" Generator �0�5 KW [ 0 �IE� c]/i�;': Zone Actessory Building: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW ' Meter ❑up to 700 amps Merer ❑over100amps Z Sub Panel Motors OO-1 HP O1'/, - B Inc.Solar �9�15 HP �16-15+ Microwave Pole Liah� � Sign ; Standing Sections 5-15 KW Trash Compactoi F.EES Z O N I N G R E Q M T S Reinspaction Fee $15 Ittue Fee $ 3 � DEVELOPMENTSERVICESREQUIHEMENTS: 2oning APProvod BY Date � Building Approved By � /� Date�7' Application luued By ,( E � Data �'/ ��a10 . SUMMARV OF FEFS � BUILDING PERMIT $ SMIP S � PLAN CHECK $ PERMIT — PLUMBING $ �SSUANCE $ PLAN CHECK 25% $ ENERGY P.C. S ELECTf71CAL � $ � GRADING 5 � PLAN CHECK 50% $ %� MICROFILM 5 �s� � MECHANICA� $ , TOTAL FEE � $ �' O� ' PLAN CHECK 25% $ , "CUNS'TRUCTION AND PLANNING APPROVALS Permit # 1. Temporary Electrical Service or Pole 2. Soil Pipe-Undrgrnd. 3. Electriral Conduit.Utility�Undrgrnd. � 4. Electrical Conduit-Undrgrnd. 5. Steel Reinforcement � 6• Electrical UFER Grnd. 7. Footings , 8. Foundation ' 9. Water Pipe-Undrgrnd. � 10. Structural Floor System " 11. Property Sewer Line & House Connection 12. Sewer Cap 13. Roof Drains 14. Rough Plumbing 15. Rough Electrical-Conduit 16. Rough Electric Wiring 17. Rough Wiring Sign 78. 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 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 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 Irri9ation 44. Landscape Irrigation System 45. Sound Attenuation - 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATEOFOCCUPANCY lo. Date Date , .. . . s f.. .1'' POC SPA Inspector AppROVALS 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 ConduibUndrgmd. 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines, P-Trap, O Undrgmd. 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 Approva� 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 ,'� Nates: . a-L� �GG i-,) B� X�S d - ' " `7- %�-- b`� �'�,'� '7' -- i � - b'� � le� �-�' � Date � Inspector AOP��cant to fi11 in ail spaces except thos¢ within heavy Cortler Ilnes anG sign ail aporoD��ate aeclarations. CITY OF COSTA MES CON$TFtJ�.j�T/ION`�E_RMIT - Project Address 7 �� r/�«��r J� Applicant'sMailing dre��r%�� -7`J��%-f� � Owner's Nam�e7 `�' '��"t� Phon - Address � J � �v�� -•-"SL• - � ` Arch/Eng. License No. Address - Contractor's Nam � G Phone a Address (mailing) � City Licen N .� LICENSED CONTRACTOR DECLARATION , � 1 hereby affi�m thai I am licensetl untle� provisions af Cha�ter 9(commencing with section ]000) of Oivision 3 ot the Business antl Professions Cotle, antl my license is in tull (arce tl et t. Licen CI ��n w��c§ps o. Dat 5'g t � WORKERS' COMPENSATION DECLARATION - hereby affirm that 1 have a certiticate of consent to zelf-insure or a certlticate ' Workers' Compensation Insurance, or a�certifietl copy-thereof (Section .800, Lab. CJ ' � Policy No. Company � eCertlfietl copy is hereby furnisned. ' � � . Certifletl copy i5 til¢tl with th¢ city Builtling Division. Oate Applicant EXEMPTION FROM WORKERS' COMPENSATION�DECLARATION (Thi55ectian need nat be com0�etetl it the p¢rmi[ is /or one'huntlretl ($100) ar Iess). ' . � ' � I certify that in the perfovmance oi tM1e woik for which his perin�t is i55uetl, I shall not-.mplo any e son in any man zo/�as t eco ubject to.the Workets om ?�tl ws o( Califomi . . Oate �� Signature _ . 'NOTICE: Ii, atter making this tleclaration, yo sh E become subjacl to the Workers' Compensation provisions of the Labor Cotle, you must forthwith- comDly with such provisions or this permlt! shall be tleemetl revoketl. CONST0.UCTION'LENDING AGENCV -. ' I M1ereby atfirm tM1at ihere is a mnstruction lentling agency for the performance of the work tor whiGh fhi5 Permit is issuetl'.(Section _3097 Clv. ,C:) Lentler's Name' - - Lentler's AtlOress • _ , OWNER BUILDER �EGL•ARl1TION - ' I hereby affirm tfiat I am-exempt trom tne Contractor's Licen3e Law tor the � foilowin9 reason (Section �031.5 8usiness antl Professional Cotle: Any clty"or ' county .which requires a permit to construct, alter, improve, tlemolisn or repair ,any sVUCture, p�ior to its asuanc¢, also requires Me applicant to� suCh pe�mit to file a sl9netl statement that he/sne is licensetl pursuanl to Ihe provisions ot the ConVactOr's License L"aw (Chapter,9 (commencin9 with Section 7000) ot 'pivision 3' of the BuSiness antl Professions Cotle)- or that he/she is exempt ierefrom' antl the basis for the alleqetl exemption. Any vlolation of Section 031.5 by any dpplicant for a permit Subjects the applicant to a civil : enalty o( not more lhan five huntlretl tlollars ($500). � ,� I, as owner ot the property or my employees with wa9es as their sole � compensation, will tlo the work, ana the�structure is not intentletl or offeretl . for sale (Section 7044, Business antl Professional Lotle: The Contractor's License Law tloes not apply to an owner of.a property wno builtls or improves thereon, antl who tloes such wo�k himselt/herseli ov th�ough hi5 or her own employees, provitleC Ihat sucM1 improvements a�e not intentletl o� o/feretl for sale. If„howeveq the builtling or improvemenf is soltl within one year of com- pletion, [he ownet will have [he burtlen of p�oving he/sh¢ tlitl not builtl or im- prova for the purpose of sale). �- -- - ' �❑ 1, as owner of'the property, am exclusivety mntracting with licensea con- . traciors to construct the project (Section �044, Business and Professlons Cotle: � The Contractor'S LicenSe Law does mt apply to an owner ot property wM10 builds or improves thereon, antl �who contracts for such projects with a con- tractor(511icense pursuant to ine'Contractor'i License Law). I am aware that' proof o1 lnei� Worker'S Compensation insurance Shoultl be provltletl to me. ❑ I am�exemp[ un0er Section , B. & P. C. for tnis reason Date Owner _ I hereby'certity that I have reatl thi intorma[ion is torretL 1 agree to com antl zta[e laws relatin to uil i q co Sentatives of this c t e � r up< Inspection puroases. 5" t e a TYPE OF CONSTRUCTION LvJ NEW lJ ADD t ❑ CONVERSION � O DEMOLISH ❑ OTHER _ DESCFIPTION OF WORK/USE OF BLDG. TVPE OF PERMIT ❑ GRaoiNc FOUNonTi ❑ TENANT _❑ ELECTRICAL -❑ PWMBING ❑ OTHER PROJECT DESCRIPTION Sc]. FT. TERATI ON J STRUCTURAL ECHANICAL ' CONSTRUCTIONTVPE ' VAWATION$ ' ZONE GRADINGCU.YDS. A( Remarks: _ /�/�`� //� Sink 'cflow Preventer 'cflow Irrigation ' nubs Dishwasher ' ..' Drinking Foun[ains " Floor Drains ' Floor Sinks . GasService Outlets � Inrerceptors " - Kitchen Sink _ .. .- P-Trap � ' ' � Roof Drains ' , Reinspection Fee . ' $75 Boiler � Duct - Under Ground . Duct - Strucmral Duct - Ventilating Exhaust System � Multiple � Firepl/Fact.�BIt.ICBO# . Heating System & Ducting �, 4bi oo,000 eru O i oo,aoo sr� Iigna ur -- - Drivers' License ar 55 $ I I Reinspec[ion Fee I $15 CMF OB65-46, rev. 30/84 White - Builtling; Canary - Applitant; Pink - Accountin9: 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 � Auto-Wash � Laundry Trays Q679 v/I�/86: - , ' 1 ,� R _ • — A.P. # - S Main Building: - � � � — E T Front B Rear A — C Right ' — K _ g Left — Ping. Ref. # r f Ptanning Notes: ' Auromatic Washer � Construction Pole Sub. Cooking Unit, ' - �Dishwasher - -- - Dryers ❑Gas ❑Electric Zon¢ _ ory Building: � ELECTRICAL � Transformer ❑ 15-50 KW . ❑ 50+KW � Meter ❑up to 100 amps � Meter �over 100 amps' - Fan F.A.U. Fixtures: Device Boxes . Outlets � Switches � �j t; Garbage Disposal .�S' Generator �65 KW 05�15 KW �� laue Fee Hood on Typel ❑ Canopy: Typell ❑ Refrigeration System2 � ,.J� ❑0-100,OOOBTU ❑700,000 System Repair/Alteration Fire Dampers Registers Issue Fee $.3 $ 3 Motors �0-1 HP �1'h-6 Ina Solar �9'15 HP 016-15+ Microwave ' � Pole Light � � Range $ign ; Standing Sections � Trash Co'mpactor Reinspection Fee '' $15 Issue Fee � DEVEL07MENTSERVICESRE�UIREMENTSi � � Zoning Approved By � Building Approved By .• Application Issued By Z O N � N G R E Q M T ` S FEES $ 3 SUMMARV OF FEES ' BUILDINGPERMIT $ SMIP . $ PLAN CHECK ' , $ ' �PERMIT � ' ' ' PLUMBING ' $ ' ISSUANCE � $ ' � PLAN CHECK .25% $ � ENERGY'P.C. $ �� EIECTRICAL ' $ � GRADWG $ � � . PLANCHECK 50% $ MICROFILM $ MECHANICAL $ ,TOTAL FEE $ � PLAN CHECK 25%; $ � I � . CONSTRUCTION AND PLANNING APPROVALS Permit # 1. Temporery Electrical Service or Pole 2. Soil Pipe-Undrgrnd. , 3. Electrical Conduit Utility-Undrgrnd. 4. Electrical Conduit-Undrgrnd. 5. Steel Reinforcement 6. Electrical UFER Grnd. 7. Footings �-� , 8. Foundation ' 9. Water Pipe-Undrgrnd. 10. Structural Floor System 11. Property Sewer Line & House Connection 12. Sewer Cap . 13. Roof Orains 14. Rough Plumbing 15. Rough Electrical-Conduit 16. Rough Electric Wiring 17. Rough Wiring Sign 18. 'Rough ElectricabT 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 � 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 Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 3S. 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 Date Date POO L iPA Inspector qppROVALS Permit# 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVALTOCOVER-GUNITE 58. Electrical Conduit-Undrgrnd. � 59. Gas Pipe, O Undrgrnd., Test - 60. Backwash Lines, P-Trap, O Undrgmd. 67. APPROVALTODECK 62. Backwash & Receptor-Final 63. Heater & Vent-Final 64. Plumbing System � Final 65. ElectYical-Final 66. Solar System-Final 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIREDEPT.REQUIREMENT APPROVALS Permit # Date �Inspector 70. Underground Hydro .�=12.�dL Uf/) 71. ProductPipingOGas ❑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 r NoteS:a-ao-a�•- �b�.o, �,ror Naacao ov. c..:,n �/'ZFiD�.6 � Lw[ri .. Applicant to fill in all spaces excepl t�ose wit�in heavy Eortle� lines antl si9n all aOP�opriala tleclarations. ' CITY OF COSTA MESA CO ST TIO PERMIT . Project Address �� 9- �� -7- Applicant's Mailin dress�� (,lV.✓ � Owner's Name P•h,�on-e� Address �� /Ne��-��i� ,�Gq / � "7 Arch/Eng. . License No. Address Contrac[o�'s Name � Phone Address (maiiing) �� CitY LicenSe No. "�� i�-/ ��`- ---� - LICENSED CONTRACTOR DECLARATION I hereby al11�m [ha[ I am licensetl untllr p�ovi510n5 of Charter 9(mmmencing with 5ection 7000) of Division 3 of the Business antl PrOfessions Cotle, antl my license is in full forte an ff¢ Liten C`la�• �� d/� Ic � No. r Date � / 5'q t �L� WORKERS' COMVENSATION DECIARATION 9ereby aHlrm that I nave a certiticata of consent to self-insure or a cerlificate ' , Workers' Compensation Insurance, or a certlMetl copy thereof (Sectlon JB00, Lab. C.) � Policy No. Company BGer[ifietl copy I5 hereby furNShetl. ' � � Ce�tifietl copy i5 flletl with the city Builtling Dlvlzlon. Date Applicant � EXEMPTION FROM WORKERS'GOMPENSATION DECLARATION- (Thissection neetl not be complatetl i( the permlEis for one huntlretl (E300) or Iess). I certify that in tne performan<a ot the work Por which 'S permft is Issuetl, I Shall not emplOy any per5on in any manne O') t0 come S�t lo the WorkeR' CiTnPe.neqtlBnXa`Ns oi California Da[e •� iir�sc� Signa[ure 'NOTICE: I(, after making this tletlaratlon, you hou become subject to the Workers' Compensa[lon Orovisions of [be Labor Cotle, you must fort�with COmO�Y �+'�th such provisions o� Ni5 p¢rmit� Shall be tleemetl ravok¢tl. CONSTRUCTION LENDING AGENCV ' _ - I hereby affirm [nat there iz a wnitruction I¢ntling agency tor the pertOrmdn<G � OI tne work tor whicb' thi5 permi[ is ISSuetl (Section .309] Civ. CJ , Lentler's Name . Lentler's Atltlress OWNER BUILDEH �ECLARATION ' � I hereby altirm tnat I am.exempt irom the GonVactor's License l_aw for the following reason (Section 7031.5 Buslness antl Professional Coae: Any city or County whicn requi�es a permit [o con5truct, alte�, improve, tlemoli5h or re0air� any Structure, p�lo� lo it5 issuance, dlm �equire5 the apD�icant for Such permif 'O If0^'S�911^�`5'd�CT2lll�aw fChdOl¢I191COTTBOCIOq WIIh SQCIIOf1 7000) o/f r.: .qh¢ref�om antl Ihe basis for [he allegetl exemp on. ny vio a iOn o ec ion `.:%031.5 by any applicant for a permii subjects the applicant to a civil enalty of not more than tive huntlre0'tlollar5 ($500). � I, as owne� of the 0/operty o� my ¢mployees with wage5 a5 thel� sole compen5a[ion, will tlo ihe work, antl the s[ructure is not intentletl or otteretl br wle (Section 7044, Business anC Professional Cotle: Tbe Contractor's License Ldw tloes not aoP�Y.to an owner ot a property who builtls or imp�oves thereon', antl' who tloes zuch work-himseii/herselt or through his or her Bwn empl0yee5, provitletl [hat such ITP�ov¢ments are nOt Intentletl or offeretl (or SdIG. Ii, hOwev¢r, Ihe builtlin9 o��improvement I5 sold within one yea� ot cOm- pletlon, the ownor will M1ave the burOen of proving ho/iM1e tlitl not builtl or im- prove for lhe pur0o5e of sale). , ❑ I, as owner ot the property, am exclusively <ontrac[inq with licensetl con- I t�act0/s to cOnstrutt [he p�oject ($ectiOn 7044, Bu51ne55 antl Profezsion5 Cotle: The Contractor's License l2w tloes not apply to an owner ot property who : builds or imp�oves thereon, antl who conVactz to� such p�ojeGts with a con- [ractor(51 Ilcense pursuant�to the Contrattor's License Law). I am aware that proof o� their WOrke�'s Compensalion insu�ance ShOultl be OrOvitletl to m¢. ❑ 1 am exempl untler Section B. & P. G. for [his reason � Datc Signature lit Drivers' License or 55 Owner have rea � TVPEOFCONSTRUCTION UGNEW U ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑�DEMOLISH ❑ OTHER q,p.# DESCRIPTION OF WORK/USE OF BLDG. . S Main Building: E TVPE OF PERMIT GRADING FOUNDATION STRVCTURAL T Ffant ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICA� A Rear ❑ �OTHER - � C Rlght ' PHOJECT DESCRIPTION Sa. FT. OCCUPAN K CONSTRUCTIONTVPE - .VALUATION$�� $ Left ZONE GRADING CU.YDS. ACRES P�ng. Ref. # Remarkz: /(J �'J� Planning Notes: 6ar Sink Backflow Preventer Backflow Irrigation Bath�ubs Claiifiers . . Dish�.vasher . Drinking Fountains Floor Orains Floor Sinks Gas Service Outlets Kitchen Sink ' Lavatories- - • P-Trap Roof Drains � ' Reinspection Fee PLUMBING Showers ,. Service Sink Sewer Cap Sewer Connection Solar Collectors. . - Solar Pipin9 !`' Solar Tank Swimming Pool w/Spa Urinal �/'/di2f C1052[ � Water Heater ' � Water Service � .Auto-Wesh .- LaundryTrays'� � $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple � Firepl/Fact. Blt. ICBO # Heating System & Ducting � IB�100,000 BTU �LI'60,000 BT Reinspection Fee � $15 CMF 0865-46, rev. 10/84 White - Builtling; Canary - APPlicanh Pink - A[counfin9: Goltlenrotl - Asseszor Issue Fee' IANICAL Hood or Typel ❑ Canopy , Type I I ❑ � 7eJf "'geration Sys[em `-r `�y $�0-100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers . Iswe Fee FEES Automatic Washer Construc[ion Pole Sub. Cooking Unit � Dishwasher ' Dryers �Gas ❑Elec Fan � F.A.U. � ' Device Boxes ' � ' Outled � Switcfies � �• Garbage,Disposal � ' " - Generamr �0-5 KW 05�15 _ � �. l � $^3 I fi ', ' Reinspection Fee FEES � , DEVELOPMENT,SER 2aning ApproveA By_ Building Approved By $ 3 oe�e 3ii3ie� Zone' :cessory Building: � - ELECTRICAL Trans(ormer ❑ 15-50 KW ❑ 50+ KW Meter Llup to 100 amps � Meter ❑over 100amps- -- , Sub Panel Motors �0.1 HP O1'r5 - B Inc.Solar �9-15 HP �16-15+ 2 O N I N G R E Q Pole Light ' . Range Sign . ! Standing Sections � Trash Compactor $15 � ��Izsue Fee CES RE�UIREMENTS: $ 3 • � "� � SUMMARV OF FEES ' � � BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT � , PLUMBING ' $ � ISSUANCE $ PLAN CHECK 25% $� � ENERGV P.C. $� ELECTRICAL $ �GRADING � $ ' " PV1N CHECK 50% $ �-�-�y'� MICROFILM $ MECFIANICAL $ �J.� .70TAL FEE $ D - PLAN CHECK 25% $ I �..� ' CONSTRUCTION AND PLANNING POO. , SPA APPROVALS Permit# Date Inspector qPPROVALS Permit# Date Inspector 1( Temporary Electrical Service or Pole , 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical�Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical 6onding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation ' � 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. PropertY Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap , . " 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing . 65. Electrical-Final � 15. Rough Electrical-Conduit � 66. Solar System-Final � 16. Rough Electric Wiring 67. Fencing & Access Approval ' 17. Rough Wiring Sign 68. APPROVED fOR PLASTERING 18. Rough Electrical-T Bar Ceiling : 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace ' APPROVALS Permit# 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating �1?�f C� G,6..7 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing , 73. Undergrnd. Storage Tank � Gas ❑ Oil 25. Roof Sheathing � 74. Overhead Hydro , 26. T-Bar Ceiling (Structurat) & Monocoat 75. Dry Chemiral � 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. Plaster Brown Coat . � 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED � 33. Final Electric Notes: G�� ` 6 �� alY'A / 34. Final Heating & Air Conditioning �r-zb-ad Gu) �' �� J 35. Final Gas Pipe-Test A� 36. Hood or Canopy ,�� r�_�` 37. Final Factory FireplaCe Q.�p-�L �(�HQ� h �� vR �„� 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 Ed�son . - 50. Gas Release to Southern California Gas Co 51. CERTIFICATEOFOCCUPANCY No. Date Applicant to fill in all s0aces encept lnosa within �eavY �orEar Ilnes anG slgn all ap0�opriate tleelarations. 'CiTY OF COS7A MEsa C�-O7NS�RUCTION PERMIT . ProjegYKUtlri�¢ � � ! �y �✓Es��' /�'rµ Sf��:f7" %+PO��can['s Mailing Address '� ��x 7� A�Dk� n� 4'A�C'�� Owner'sNa/m�e FF� Phone�//�`��'Lz1�' Address a� �% �/I�SLIiN�% /f /�i{f SL �f(. %j/��'/.JC%�E Arch/�ng. C-3��license.No. _ � H � Address Contrgcror'sName�^�/�'/ �EN7R`f �� Ph e � '�� Addreulmailingl� •:� Ox 7 LO�� +e�� c�� u�e�� rvo. 37� LICENSED CONTRACTOR DECLARATION ' I hereby affirm Ihat I am Iicensetl Untl¢t provi51on5 of Charter 9(COmmencin9 with Eection 7000) oi Division 3 of �the Bustness antl Profess(ons Cotle, antl � my IlGense iz in (uil torce antl effect. ' lJcenEe Class L�cense No. Date Signature WORKERS' COMPENSATION DECLARATION � � hereby aHirm that I have a certifiwte of consenl to ulf-insure or a tertiBcate - WOrkerz' Compensation Insuranc¢, or a certltletl copY thereot (Settion 100, I,.ab. C.)'. , Policy No. Company BCertiiietl copy is Oeroby fumisM1etl. � _ ; Cerfifled copy is filetl wlth the city Builtlin9 Divislon. �.�. Date Appli<ant EXEMPTION FROM WORKERS' COMPENSATION �ECLARATION {Tnis nection' neetl not be completetl it the permit is for one huntlretl (5300) or less). , I cer y tbat in.the perto�mdnce of th¢ work for which thi5 perm�t is issuetl, 1 sba nol employ any persOn In any er 50 as to ma sUbject [o Ihe rker CM nsatlon l.aws or Iit r . ate Pa�5i9nalu � �NOTI E: If, afte� mdking thi5 tlecid on, y0u shOultl become Subj ct to th¢ Workers' Compensation prOvision the LabOr Cotle, you muzt forthwith' compiy with such orovislons this permit shall be tleemetl revokeG. CONSTRUCTION LENOING AGENCY � 1 hereby atfirm that there is a construction lentling agency for tne per�ormante of tpe work for which this permit is issuetl (Section 3097 Clv. C.) Lender's Name LenEpr's Atltlress OWtVER BUILDER DECLARATION .1 het¢by atfirm thal I am exemPt trom tbe COnt�actor's Licens@ 1„aw to� th¢ lollowing reason (Section 7031.5 6usine55 antl Protessional Coae: Any city or coun�y �yhich reduires a pe�mit to construct, altCr ImprovE, Oemolish o� repai� any Structure, prior to its issuance, alsoaeqWres t�e applicant tor such permit to file a signetl statement that ne/she Is licensad pursuant to the provlsionYof the Contractor'S LicCnse Law (Chdpter 9.(commencing with Section 7000) of Diviiion 3 of the Bu51ne55 anB Profes5wn5 Cotle) or that he/sh¢ is exempt '�.''"y�031{5 bYaanYhaP0lieaot �tohe�allpeemltxsubPec�s theYaPPlicant to a�clivil �: "'�Senalty of not more tnan ilve huntlretl tlollars (E500). n I, as owner ot the praPerty or my employoes with wages as their sole . compensation, will tlo the work, antl the structure is not intentletl or otferetl f0/ Shce ($ection ]044, Bu5ine55 antl Profe55iOnal-Cotle: TM1e ContraCto�'S" Liceryg¢ �aw tloes nOt applY to an Owner of a propGrty who bu(IC5 or Imp�oves ther¢on, antl who tloes tu<h work M1lmselt/herselt or through �I5 or her own employces, P�ovitletl Nat such improvements ara not intentletl Or oHeroG for sale. Ii, however, the bulltlin9 or improvement Is Soltl within one year of com- pletion, the�owner wlll have the buraen of proving ne/she tlitl not bulltl or im- �rove for Ine purposo of sale). ' I a5 owner of t0e property, am exclu5fvely contract(nq wfth Ifc¢nsetl Con- Vac(ors to <onsbuct the oroject (Section ]044, Business antl Proiessions Cotle: The ConVactor's License Law does not appry to an owner of proper[y who bulltls or Impraves tnereon, antl wno contracls for such orojects wltn a con- tractor(sl license pursuant�ro the Contractor'S LicenSe Law). I am aware that proqi o( thei� Worke�'s COmpensation inSU/anca zhoultl be prOvitled to me. ❑ I am exempt untler Section B. 8 P. C. tor this reason Date CMF OB Owner I nave reatl this� I d9rEe to Compl to builtling cons � co er,y�br uoon above iances repre- y tor � TYPE OF CONSTRUCTION I� NEW I_I ADD LJ ALTERATION LI REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG.' TVPE OF PERMIT LJ GRADING LI FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL.�`ELVMBING ❑ MECHANICAL � O OTHER PR0.IECT DESCRIPTION Sa. F7.�— oCCUPANCv_ CONSTRUCTION TVPE �✓�Y� VALUATION $ ZONE GRAD�IVGCU.VDS. - ACRES_ Remarks: � � Bar Sink Batkflow Prevenier � Backflow Irrigation Bathtubs Clarifiers � Dishwasher Drinking Foun[ains Floor Drains FloorSinks ' � Gas Service � Outlets Incerceptors ' Kitchen Sink S Lavatriries P—Trap � Roof Drei s I � l /N ctJl?� , Ji Service Sink - Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool wlSpa Urinal Water Closet Water Heater Water Service Auto-Wash LaundryTrays . Fee ! $15 r � . Issue Fee Boiler Duct- Under'Ground� Duct � Strucmrel Duct - Ventilating Exheust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑ a100,000 BTU � 100,000 BT7 : or 55 � � � I Reinspection Fee 10/04 White - Builtling; Canary - Applicant; Plnk - A<counting; Goltlenrotl -,Asse�or 1, S15 Hood or Typel ❑ Canopy Typell ❑ Refrigeration System ❑4100,000 BTU 0100,000 System Repair/Alteration Fire Dampers ftegisters Iswe Fee 3 0 S 3 A.P. # S Main Buildi E T Front B Rear ' A C Right K Left S Ping. Ref. # Planning Notes: �onsttuction Nole Sub. ,C�oking Unit, rt , T� Dishwasher Oryers �Gas ❑Elec F,an � � F.A.U. � Fixtures Device Boxes Outlets ' 6049 12/18/175 ;'�•,. 7� Zone �Accessory Building: Z O i N 1' N G R Parking Req./Provided E Q M T $ ELECTRICAL Transformer ❑ 15�SO�KW . ❑ 50 + KW Meter ❑up to 100 amps � Meter ❑over 100amps Sub Panel Motors�0�1 HPOIY,-8 Int.Solar �9-15 HP 01G75+ Microwave Pole Light Range � awncnes Sign Garbage Disposal ; Standing Sections �� Generator �0.5 KW �5-15 KW Trash Compactor Reinspection Fee $15 Issue Fee . DEVELOPMENT SERVICES REQUIREMENTS: Zoning APP.roved By Building Approved By �� FEES 5 3 _ ' . SUMMARV OF FEES � BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT ' PLUMBING $ ISSUANCE $ PV1N CHECK 25% $ ENERGV P.C. $� ELECTFICAL $ � GRADiNG $, P�P,N�CHECK 50% $ MICROF�ILM $�� i MECHANICAL $ TOTAL FEE $' ""' � � " PLAN CHECK 25% $ � • � CONSTRUC710N AND PLANNING . . POO. ;PA � 'Date Inspe tor " �� ' Date Inspector i� APPROVALS Permit_# , APPROVALS Permit# -7. �Temporary Electrical Service or Pole ' 52. Pool & Equipment Loca[ion i .2� Soil Pipe=Undrgrnd. �lL�/ 53. Steel Reinforcement � � �� 3. Electrical Conduit Utility-Undrgrnd. 54. Forms , 4. ElectricaLConduit:Undrgmd. 55. Electrical Bonding 5. Steel Reinforcement �. 56. Rough Plumbing & Pressure Test , .6� Electrical UFER Grnd. - 57. APPROVAL TO COVER�GUNITE � 7. Footings � 58. Electrical Conduit-Undrgrnd. 8. Foundation ' �� 59. Gas Pipe, 0 U�drgrnd., Test , 9i Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, O Undrgrnd. - . ,10. Structural Floor System 61. APPROVAL TO DECK � 11 . Property Sewer Line & House Connection � J /7�yL 62: Backwash & Receptor-Final '7.2�. Sewer Cap ', 63. Heater & Vent-Final , . ' 13. Roof Drains � � 64. Plumbing System - Final _ 14. RoughPlumbing ,,su� 65. Electrical-Final 15. Rough Electrical-Conduit _ . 66. Solar System-Final _ �16� Rough Electric Wiring � 67. Fencing & Access Approval c• 17-. �Rough Wiring Sign � ' 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling . 69. POOL/SPA SYSTEMS FINAL , 19. Rough Heatin9 & Air Conditio�ing FIRE DEPT. REQUIREMEIdT 20. Rough FactorY Fireplace APPROVALS Permit# 21. Ducts, in Structure .� 70. Underground HYdro � - 22. `Ducts, .Ventil0ting ; , 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. Oyerhead Hydro 26. T-Bar Ceiling IStructural) & Monocoat 75. Dry Chemical 27. FrameandFl2shing 76. DryStandpipe ' - 28.,Lathing & Siding 77. FIXED SYSTEM FINAL ,� 29. Insulation - . 78. FIRE PfiEV. 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: �a f ' y•� su,� Z� - 34. Final Heating & Air Conditioning � � � 35. Final Gas Pipe-Test � � y0a �-i aY ra 36. Hood or CanoPY � y./ ylfP /�O .✓.L� e� Yl e ac � 37. Final Factory Fireplace ' . y� �� " � 38. Final Plumbing � � � � � 7 � � - 39. Water Service-Final � ' � �� 40. Gas Service-Final ' � � 41. Solar pomesticFinal , 42. Backflow Preventer ' , � 43. Backflow Irrigation - , � � , � 44. Landscape Irrigation System � 45. Sound Attenuation � ' 46. Handicap'Regulatio�s ' - 47. FINAL STRUCTURE & BUILDING 48. Special RequiYements Completed , � 49. Electric Release to Edison _ . 50. Gas Release to Southern California Gas Co � 51. CERTIFICATEOF-OCCUPANCY No. Date � ADGlicant to /III In a11 spaces azeept inose witMn neavY Dortler Ilnes anO�sign ali aoprooriate ae<larotlons. CiTY oF COS7A MESA CONSTRUCTION PERMIT P�oj¢ct Address 7 �� '�-!��t �� -��y� Applicant's Mailing Address ��_� A ✓. Owner's Name - ��£R ' phone � �r� Adqreu �i�.s -r�l/SLflN� / [[ Arch/Eng. License No. �`� AAqress E�n9-I2V �/lQ'�6T�� Contractor'<N�m=-�i�-�-��L'x'��-�Phone 6222�j Address (m�;��i 74a- /J 7 OY� ALOL[J iwPY City License No. -�? (Zg.� LICENSED GONTRACTOR OECLARATION 1 hbreby affirm tnat I am Iiconsetl untler provislons ot Charter 9:(�pmmenUng � with section 7000) of Dlvision 3 of the Business antl Professions Cotle, antl my Iicense is in full force ana effect. Llcense Class LI[ensa No. Date SlgnaWre 'YORKERS'COMPENSATION DECLARATION � �ereby af/irm Ihat 1 have a certifiwte ot consent to ulf-insure or a certlfitate � Workers' COmpensafion Insurance, or a certifiea copy thereot (Sec27on ' 3800, ldb. C.) " ' ' Policy No. � Company eCertifietl Copy IS hereby furnished. Certi(ied copy is fiieC with tne city Builtlin9 Division. Da[e � APPlicdnl EXEMPTION FROM W00.KER5' COMPENSATION DECLARATION (Th755ectiOn neetl not be completetl if tho permlt is fo� one hu0tlretl ($100j o� less). . ' I c8rtify that i�.the perf0/enanGe of lne wo�k tor whicb S pGrm�t is ISSu¢Q I shall not employ any person in any m nner to as ta a subjec[ to the Worker l�5 On ws o( Cali r �- DaGe � ignature 'NOTI[ : 11, after iaking thls tletla n, ou shoultl ecoma subje to tha WO�kerS' CompenSatlon p�ovlSlons o ttl¢ 12bOr Coae, vou T�thwi�h mmply wllh such provisions or ii permil shall be tleemetl revoketl. CONSTRUGTION LENOING A NCV' �� I npreby affirm [ha[ there is a construction lentling agency for tha performanco of tha work for which tnis permit is issuetl (Section 3097 Civ. C.) Lentler'S Namu . � LenGer's Atltlrasi � OWNER BUILOEN UECLARATION � 4oreby dililT that I dm exOTpl irORl th8 Contrdctof'S LICGnSe Ldw fOr It18 � /ollowing rwson (Sectlon 7031.5 Businoss and Protesslonal Cotln: AnY,tlty or county whlth requires a permit to construct, alter, Imprava, tlemolish or repair any sVucturo, p`Ior to its Issuance, also reqWres the applicant for such pnrmil m a�n �<innad fatement that he/she is Iicnnsetl Du�sudnt to th0 OroWziops Ol 7031.5 by any applicant for a Permit subjact5 the apD��cant to a civil e�alty of not more tnan fivn huntlretl tlollars (E500). ' as ownor of the proparty or my emP�oyeCs with wa9ot as tbelr solo �mpensatlOn, will Oo Iha w0/k, antl iho Structu/0 Iz no[ IntCntlotl o� o�ICrotl tor sale (Sottlon �044, Businoss anq Prolessional Cotle: The Con[ractor's Li�ense Law Coes not app�y to an owner ol a property who builtls or improvas lhareon, antl who tloes su<h work nimselt/herseH or Ihrou9� his or her own erhployees, provltletl tnat sucti imProvemenlz ara no[ intentloa or offeretl for sale. If, nowever, the builtlin9 or improvemont is soltl wit�in one year o1 com- C�etlon,-tho owncr will bavo t�e Curtlen o7 Provin9 he/Sne tliU nOI bulltl or im- �OVB �or [Ile,putp050 ot ShceJ. � � I,�as owner ot the ptopGtry, am ¢XCIuSivery Cont�actin9 with Ilcen500 co0- � trbetors�[o consVuct [he pro7act (Se<tion 7044, Business antl Professions Cotlu: Tho Contractor's Liconsa law tloes not appy to an owmr o� propurty wno., bUI1tl5 or Improves thereon; antl who contracts for such pm�ects with a �on- tfector(5j I1cen5e pur5uanl�lo IhC Conlra<[Of'S LiC¢nsa Ldw). I am awale that PrOOf o( IhN� Worke�'s Comp¢nsation iniurance ShOuIU ba p�ovi0etl to mB. ❑ 1 am ¢xempt untler 5¢Ction B. E P. 0.�or [his red50n Ddte � - � O�+�er � I h¢r¢by c¢�tlfy [hat I have reatl [his applicatlon antl Sldte that the abOve Information is correct. I agrae to comply wRh all ci[y antl county ortlinancas �ntl state laws relatin9;to 1� Iltlmg mnsVu<tlon, antl hereby authorize repr¢- sentatives Of,.,[ni5,city t0�{l11�¢r u000 the dbove-mintionetl property'(o� � TVPE OFCONSTRUCTION LINEW U ADD IJ ALTERATION IJ REPAIR ❑ CONVERSION ❑ DEMOLISFI ❑ OTF� R DESCRIPTION OF WOR G�6.0+N Ni �D ��in;C=j� ��D%� TVPEOFPERMIT GaADING FOUNDA71oN ❑ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL ❑ OTHER �ROJECT DESCRIPTION Sq.FT. � OCCUPANCV CONSTRVCTIONTVPE - VALUA710N5 20NE GRADINGGU.YDS. ACRES Remarks: � � �'—�O Bar Sink Back(low Preventer Backflow Irri9ation Dishwasher ; Drinking Fountains Floor Drains � Floor Sinks Gas Serviie ? OuUets Kitchen Sink Lavatories � �(QqYL� P-Trep 'D/�/Ly ' Rool Drains ' Reinspection Fea � $15 Boiler ' ' Duti-UnderGrOund � Duct - Structural Duct - Ventilating - Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO'# Heating System & Ducting ❑aiao,000 eTu Oioo,000 I .s�Yi�a�u�� .�+ -��— Reinspac[ion Fee $15 CMF p865-46, rev, 10/84 While - Buiitling; Canary - Applicanl; Pink - ACCOanting: GOltlenrOC - ASsessor Showers Service $ink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar 7enk Swimming Pool wl5pa Urinal �VdtC! C�OSCI �Water Heater - Water Service Auto-Wesh - Issuo Fee Haod ar Typel ❑ CanoPV TVPeII ❑ _ fiefrigeration System Oaioo,000sTu ❑ioo,000e� System RepaiAAlteration Fire Dampers Registers , ' luue Fea A.P. qW S Mnin Buildi E T Front g Rear A C Right K Leh S Ping. Ref. # � Planning Notes: A'utomatic Washer� Construction Pole� Cooking Unit /. Oishwasher ' Fan F.A.U. Device Boxev� aeae ain�i�� . Zone . Acceszory Building: 2 O N I N 6 R Parking Req./Provided E Q M _ T s ELECTRICAL � Transformer ❑ 15-50 KW ❑ 50+KW ' Meter ❑up ro 100 amps - MetenQover700amps � ❑Electric .SubPanel � �„ Motors �0.7 HP �i%.-6 � � tna Sotar C79-15 NP � I6-15+ Microwave ' Pole Light ' Generetor L70�5 KW LJ5�15 KW t , " V $ 3 .i " � $ 3 Sign • ; Standing Sections Trash Compattor Fee SERVICES RE�UIREMENTS: FEES $ 3 Buildine APProJed By� � Date��f�j�/�— a APpliwtion luued By � DatB�L_(_ f � �.� � ' SUMMARY OF FEES � �� BUILDINGPERMIT�' $ SMIP $ � - �� PLAIV�,CHECK � $ ' PERMIT , - i PLUMBING � �$ � ISSUANCE 5 PLAN;CHECK. 25% $ ENERGY�P,C. $ r� ELECTRICAL� . $ ' GRADING S ' PI..AM�CHECK� 'S0% $ MICRORI.M S � - • ' MECHANICAL. $ - TOTAL FEE $ � � . PLAN�CHECK - 25%� $ � CONSTRUCTION AND PLANNING POG_ � SPA APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole . 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. �s J7�!(e (,IEA 53. Steel Reinforcement 3. Electrical Condui[ Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. , 55. Electrical Bonding • 5. Steel Reinforcement , 56. Rough Plumbing & Pressure Test 6• Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 17. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63.� Heater & Vent-Final 13.'Roof Drains � 64. Plumbing System - Final 14. Rough�Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit - 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling . 69. POOL/SPA SYSTEMS FINAL '19.,Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: . G 6 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test � L � � T � � 36. Hood or CanopY � .�- � �/ � 37. Final Factory Fireplace ' 38. Final Plumbing '�i�/� �!� ` ;. � � �� ,� � / 39. Water Service�Final � � �'"-� ' ' O✓ o /' •' > OGTI 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 Release to Southern California Gas Co 51. CERTIFICA7E OF OCCUPANCY No. Date '/ � -- AoO��cant to fi11 In all sDaees axeapt tnose witnin heavy Ooraar Ilnos antl sign all approprlate tleclantlons. "�� M NO. TRACT NO. � LOT NO. UNIT U. � � CIT`V oF cOS7A nnESa CONSTRU,C�ION'PERMI � � �O �17D . _ `�; . , � C/ -Pro�ect Address Applicant's Maili g Address ' Owner's Name � � �(�., � Phone � � � Address `�'�2 I �� j(�--"D Tn7�� Arch/Eng. / ,��_ �� "� Liten� N�o�. .C��- Address ��`[� �`e• ��yr ' Ju i`N�1.� � Contracror's Name�fiL� �� K Pho: e�a-�9Ra' r.v-- Addresslmailingl� %SL-�OL�1E� ��' City License Na. ��554 LICENSED CONTRACTOR DECLARATION ' I hereDy affirm lhat I.am Ilcensetl untler provisionzoi Cnartor 9(commencing with 5¢ction 7000) of Division 3 of the Business anU Prof¢nions Cotla, antl , my license is in ( orm antl effect. Q/ Licanse Class �sEsD �/r� Oate �1La�'J L 5'9 t y ./ � WORKERS' COMPENSATIO DECL RATION � - I hereby aifirm tnat I have a cetc��lca�e of consenl to sel!-insure or a tertitiwte of Workers' Compensation Insurance, or a certitietl copy tnereot (Section 3800. Lab. C.) � ' ' .. . . . . . . Policy No. ' � � Company BCertitietl copy is hereDy furnishetl. � � � Certlfietl covY �s (iletl with the city Builtling Dlvision. � Date � APplicant EXEMPTION FROM WORKERS' COMPENSATION OECLARATION (This section ne<tl not De complet¢tl if fhe parmit Is for one huntlretl (E100), or less). I tertlfy tha[ in th¢ perto�man<e Ot th¢ work fo� wltic� tnls p �m�t i5I55uetl, I snall not employ any parson in any a e so as t ec subject to the Workers' Com enj� t/'�^ Laws of Call i ' ' Date �YLZSi9natur - ' �NOTIC : If, after making this tlec rati you 5 tOultl become subjecl l0 the Wo�ke�s'. Compen5a[ion provi5ion he Labo� Cotlo, you mu5t tOrthwiltt comply with such provisions �o� his p¢rmit shall Ee' tleemeC reJok¢tl. � CONSTRVCTION LENOING AGENCV � • I hereby altirm tliat there Is'a construc[ion lentling agency for the�performan<o Of the work for� which thi5 permit is Issuetl (Se<UOn 3097 Civ_ CJ Lentler'S Name � - _ Lentler'S'Atltlress � - • � - OWNER BUILDEft �ECLARATION , -" ' I hereby atilrm that I am exempt trom the Contractor's Licanso Law for tna tollowing reason (Se<lion -7031.5 Businesi antl Professlonal Cotle: AnY cltY or counly whicn requires a permit to co�struct, alter, ImO�a�e, aemollsh or repatr ' any sVucture, prb� to its Issuanc¢, also �eqWreS [he applltdnt tOr sucb parmit to file a-slgnetl Stat¢ment thdt ho/sh0 i5 II[en5¢tl puriudnt to [he plovl5iOn5 a7 N¢ Contractor's Licensa Luw (Chapter 9(commancing with Stttlon 7000) ol - Division 3 of tne Busin<ss antl Protesslons Cotle) or that ne/she Is exempt therefrom antl lhe basis for the allegetl ax¢mption. Any viOlation-of Se<tlOn •7031.5 by any ap0�ican[ ior a' permi[ sUbjects th0 dpplicant la d Uvil •� enalty ot not more than flve buntlretl tlollars (5500). � I, as owner of the property�or my�employcns with wages as their sole CompenSdtiOn, will tl0 Ihe work, antl the structure I5 not IntentleC or oHerotl � for sale (Section 7044, Business antl Professional Cotle: Tha Coniractor'S License law tloes not apply lo an owner of a properly� who builtls or improves the�eon; antl�who�Uoes such wo�k M1ImS<If/he�self or tnrougn hI5 Or her own employees, proviUetl thal zucti improvCments ara not IntentleU or olleratl tor Sale. If, hOwever, lhC Oulltling or Imp�ovBment I5'soltl wltnin ona yCa� o� com- pletion, �the ownOr wlll hav¢ the burtlen o� p�ovin9 �e/sh0 tli0 nOt Duiltl or Im- prave for the,purposa ot salo). • ❑ 1, as own¢r o1 the p�oOe�ty, aT ozcluiivOty ConVaCting witb IIC¢n58tl COO- VactO/s �o wnztruct tha prOject (Section ]044, Bu57neYs antl Proi¢Szions Cotle: The_Contracfor'S License Ldw doe5 no[ appty to dn own¢r o1 proparty wh0 -builtls or improves tnereon, antl wno wntracts for-such.projacts wltn a con- traclor(s1 Ocense pursuant ro tba Contractor's LicanSe Law). 1 am aware that proof o( their Worker'S COTpensation in5�rant¢ snoultl Da provitleG lo me. ❑ 1 am ezempt unaer Seclion B. 6 P. C. /or thls reason . Date Owner� � TVPE OF CONSTRUCTION IJ�NE� ❑ CONVERSION ❑ DEMOLISH DESCRIPTION OF WORKIUSE OF�B 1�na� rio e � r. TVPE OF PERMIT GRADirvG ❑ TENANT ❑ ELECTRICAL C ❑ OTHER u PROJECT DESCRIPTION 5�. Fy —S�L ALTERATION. U REPAIR J FOUNDATION U STRUC.YURAL PWMBING O MECHANICAL CONSTRUCTION TVPE ' 20NE � GRA�ING CU. Sink tflow Preventer tflow Irrigation Drinking Fountains Floor Drains Floor Sinks � ' Gas Service .Outleu Interceptors . Kitchen Sink Lavarories\ ' � P-Trap . Reinspection -Foe 515 Boiler � ' Duct'- Under Ground ' Duct - Structural Duct - Ventilating � Exhaust System ❑ Multiple Firepl/FacL Blt. ICBO �k Heating System & Ducting I"nereby 'certity_ that .I have reatl -this applicatlon anU state tnat the above .: ❑6100,000 BTU � 100,000 information is correct. I agree to comply with all city ana <ounty ortlinances antl'state relatin9 to builtlin9 cons[�ucUon, antl hereby authorize repre- Sentative5 oM1 ciry� try ent upon the aDova-mantione0 'propert fo� � inspection �._ iy � Dale Z BS ! Signa[ur `�i/7� o� i Reinspection Fee DNvers' �� 55 � CMF 0865-46, rev. 30/84 Whit¢ - Builtling; Canary - qpplitdnt; Pink - ACCounting; GOIUeniOtl - AS5055or $15 Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w Urinal Water Closet Water Hearer Wuter Service � A uto-W esh � Laundry Treys Issuo Fea Hood or Typel � � Canopy Typell ❑ Refrigeration System ' ❑aioo,000eTu ❑ioo,000s-r System Repair/Alteration Fire Dampers Registers � G Issue Fee C $ 3 FEES $ 3 A.P. 51t � S Main Buildi E T Front 8 Reer '��-' A - C Right - K Left - S - Ping�. Ref. #'� Planning Notes: e - ; '7325', 77pL/B5 i � 2one � . Pnrking Re4./Provided . L �f1f11UCivaume � - " ,� ' �2a' " z O N I N G q. 1 _ Q. � T , S ElEC7RICAl FEES Automatic Washer -- -• �Transformer ❑ 15-50 KW'� -- � ConstructionPoleSub.^' � ❑50+.KW , Cooking Unit � . Meter ❑up to 100amps � Dishwasher Meter ❑over 100amps • ' . Dryers ❑Gas� DElectric SubPanel �' Fan Motors�61HP�TX-•8 - � F.A.U. � �InaSolar �9-15 HP•�76-15+ ' Fixtures- . -� � - �Microwave -- - Device Boxes . . _ � Pole Light � � � Outlets • � ' _� , Range I . Switches ' ' .�� ' Sign ' � Garbage Disposal �. �. � Standing Sectians . Generator �0.5 KW �5�15 KW � Trash Compactor ' ��Reinspection Fee $15 � luue Fee $ 3 DEVELOPMENTSERVICESREQUIREMENT � �� (� � f.� Zoning APProved BY— .1c�16LDate � N � Building Approved By - Date 1 Appliwtion Issued BY � ! Dat `3J9• SUMMARV OF FEES � 3 � � l�� BUILDING PERMIT � $ . �.� SMIP � PLAN.CHECK $ � PEFMIT ' ' . � �PLUMBINGi � $ Y � �ISSUANCE , S PLAN CHECK 25% $-+• " ENERGY P.C. '$ ELECTRICAL $ ' GFiADING $ ' ' PLANCHECK 50% $ " � � MICROFILM $ MECHANICAL � $ - � TOTALFEE s � '�"L3.3'� PLAN CHECK 25% $. ' ' � � CONSTRUCTION AND PLANNING POOL & S°A �� APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspr.cto. I ' 2. 1. Temporary Electrical $ervice or Pole 52. Poo� & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms - 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test. 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd.� 8. Foundation 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd. -10. Structural Floor SYstem 61. APPROVAL TO DECK ,71. Property Sewer Line & House Connection 62. Backwash & Receptor�Final 12. Sewer Cap 63. Heater & Vent-Final 13:� Roof Drains 64. Plumbing System • Final 14. Rough Plumbing � 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final �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 OGas ❑Oil 23. Gas Pipe�Rough & Test • � 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing - 74. Overhead Hydro �26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing . 76. Dry Standpipe 26. Lathing & Siding 4 �� 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PFEV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31, Plaster Brown Coa[ R/p B6 p�' 79• FINAL INSPECTION 32. Electrical Power Meter�Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning .�:1. FOR SPECIAI. U 35. Final Gas Pipe-Test 36. Hood,or Canopy � .-� � �� 37. Final Factory Fireplace -� .�� 38. Final Plumbing ., 3, t5 c 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 Release to Southern California Gas Cv �:� �RT�FICATE OF OCCWPANCY .. . '✓ �, r Aoollcant to fi11 in a11 soaces except those witnin heavy eoreer linas antl.sign all aoP�opriate Eectaratlons. -rOF COSTA MESA CONSTRUCTION PERMIT � �% `'i�' !.0 • � lJ1 ST. � �fl'. . ,Project Address � �/� C` Applic2nt'sMailin9Address �T� �r-�wp✓�E�(J•�J�.� Owrter•sName �i�7f�L--� �U[F Phone�'��'QL Address � EW �" �� • Arch/Eng. �'� � �S � ' License Na.�s�Z� • Address [�� f7l, L'�i7F�ST f'FGV.�I. i%✓�'T. QG/�• Contractor's Nam��✓�+'P"�'�rl��l hon��¢ Addresslmailingl..L� �/�SL%J^W.� ✓�E+N sF�.a�- '�69C^'� City"License Na. �� S 4 . � LICENSED CONTRACTOR DECLARATION 1 hereby aftirm that I am licensetl untler provisions of Charter 9(commencing witn section �7000) of qiWsion 3 0l lhe Business antl Professions Cotle, antl my Ilcenze is in (u1l f antl efiect. ��6 Lic¢n5 Class � _Lice N Dale� �Siqnature' WONKERS'COMPENSq710N ECLA ATION � � � I nereby aifirm that I have a ce tific oi consenl lo Setl-Insure or a certititate o/ Workers' Compen5ation In nce, �or d certlffetl copy thereof (Section +' 3800, Lab. G.) ' � ' . ' � Policy No. - Comp2ny � eCertifietl coDY B here y IumiSheU. �.' Certifietl copy fs filed w�th the <ity Bliittling Oivizian. , Oate � Applicant � � ' EXEMPTION FROM WORKERS' COMPENSHTION DECIARATION - (Thiz section �eeC not be �pmplet¢a it lhe P¢rmit is fo� an¢ huntlrotl (5300) or less). I cerliry tnat in tbe Performance O �work (or wnich thl permlt is'Issuetl, I shall nol em0loy any @r5on in a maTt e� so a5 b me subj¢Ct to'the Workerj ' Go�j pen Laws ot Ca't r4f � Date _(,p�.JJ— Sl9natur _ ' 'NOTIC� If dite� makin� this tle ardtion, ou shOultl become subject to IhC Workers; CompenSaHon provisi ns ot t Labor Cotle, you must torthwltn '� comply wilh Such Dwyisions - pe�mit Shall be tleem¢tl revoketl. CONSTRUCTION LENbING �AGENCV ' ' � ' - �� I hereby afflrm that ther@ is a construc[ion lentling agency for the Per(ormance of lhe work for ' n t i permit tl Secf 3 97 C CJ Lentler's Name � _�_� ��At- 1"�� entler's Aadress��,�'%�O/L� �r aS0'E OWNER BUILDEN DECLARATION , - � � I hereby aifirm that I am ezempt trom the Conlractor'S License Law for the ipllowing reason (Sectio� 7031.5 Businezs antl Professional Cotle: Any tity or counly whlch requires d perTlt to Construcl, alteq improve, tlemollsh or re0air � any s[ructure, prior to �ts issuance, also requires che applicant for such permit � to file a slgnetl'slatement that. he/she is Ilcensetl pursuant to the provisions of tne Contractor's License �w (Cnapter 9(commencinq wllh Secilon ]000) of Oivision 3 oi the Busiq¢55 antl Profe55ion5 Cotle) Or thdt he/she i5 exempt the�etrom antl tM1¢ basi; f0� the allegetl ¢xempliOn. HnY violatio� of SecliOn 7031.5 by dny applicdnt for a permit subjects Ihe dpplicant to d civil enalty o( not more thary }iv¢ huntlr¢tl�dolldr5 ($500). ' � � I, as owner oi the property or my empioyees with wages as their sole compensation, will Co the work, antl the ztructurn is not Intentlea or olteretl for 5ale (Saciioni7044 Buziness and Professional Cotle: The Contractor•5' License.Ldw tloes not abply to an owner of a proporry wM10 builtls or improves thereon, antl who tloes such�work himseH/herselYor,throu9h his or her own employ¢es, provitletl th8t suth improvemenls are not Int¢ntletl or o(teretl f0/ ' sale. If, how¢ver, tne bUiltling or Improvemeni is soltl wi[hin one year of com- plction; the ownc� will have the bU/den O/ p�ovin9 h¢/She tlitl not builtl or iT- prov! tor Me purpose ot Sale). ! , ❑ I, as owner ol lhe Oroperty, am ezclusively contractlng with ilcensed con-' traclors to construct lhe pro7ect (Section 7044, Business antl Professions Cotle: � The Coneractor'z.License Law tloes.not apply to an'owner oi property who_ builtls or improves theleon, antl who�conVacts for such projec[s with a con- tratlor(s) Iicense pursudnl�to the Contractor's License Law). I am aware that prool ot tneir Worker's Compensation insurante shoultl be proviaetl lo me. ❑.1 am exempt untler $¢�tlon B. & R C. tor this reason _ � Datc Owner � I�hereby ceNifrlhet I"nave reatl this application antl state tnat the above in(nrmatiodis cor�ept.'.I aaree to comply wrtn all city antl counry ortlinantes OfIVelS' 1 CMF 0865-46, Of a �VPE OFCONSTRUCTION �NEW I-�ADD L� ALTERATION LIREPAIR � � 0 CONVERSION ❑ DEMOLISH ❑ OTHER , q,p, # DESCRIPTION OF WORK/USE OF BLDG. S Main Buildinc E TVPE OF PERMIT � GRADING FOUNDATION STRUCTV RAL T Ffant _ ❑ TENANT ❑' ELE/C/TR�,ICAL ❑ rPW�MBING ❑ MECHANICAL� 8 Rear ❑ OTHER ' �/�.t�fS� �/GC-!%-rUIG� . . � A , PROJECT DESCRIPTION Sc7. PT. - OCCUaA:.{�/ v� C Right CONSTRUCTIONTYPE VALUATION��/�'� g Lef[ ' . ZONE GRAOING CU. VDS. ACRElS p�ng. Ref. # Remarks: S �m I ' Z, � Planning Notes: 3er Sink Backflow Preventer - ' Backf�o�y Irrigation • 9athtubs Clarifiers . . . Dishwasher � � � Drinking Fountains � Floor Drains Floor Sinks -- ' ' - Gas Service ; Outlets . , Interceptors - Kitchen Sink , - Lavatories' P-Trap Roof Drains � � Reinspac[ion Pee�. $15 Duct - Under Ground . Duct - Strucmral . Duct - Ventilating . Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑06100,000 BTU 0100;000 Reinspaction Fee � $ib White - Builtling: Cdnary � App�ICant; Pink - Accounting; Goltl¢n�otl - ASiesso� BING .- , Sewer Cap Sewer Connection Solar Collectors _ � Solar Piping Solar Tank Swimming Pool w/Spa Urinal Warer Closet Warer Heater - Warer Service Auro-Wash , Issue Fee FEES Hood or Typel� ❑ Canopy Type It ❑ . Refrigeration System ' ❑0.100,000 BTU ❑100,000 E System Repair�Alteration Fire Dampers Registers , Issue Fea 0 s� %2.�2 E% I I /86 ELECTRICAL Automatic Washer � - Transformer ❑ 15-50 KW ConstructionPoleSub. - �50�+,KW Cooking Unit Meter Dup ttl 100amps Dishwasher . � __ . .r Meter ❑over 100 amps Dryers �Gas ❑Electric Sub�.Panel . � Fan ' � Motor5�0.7HP�1'h-S , F.A.U. ' InaSolar �9�15 HP 016-75+ Fixtures � ' Microwave � Device Boxes Pole Light • Outlets . Range ' Switches Garbage Disposal Generator �0-5 KW 05-15 KW Zone ' Standing Seciions Trash Compacror 5 3, , Reinspection Fee $15 luue Fee FEES DEVELOPMENTSERVICESREQUIREMENTS: � Zoning Approvetl By � Building Approved By Apoliration Issued Bv $ 3 SUM AR_QF FEES � � BUILDINGPERMIT $ ; �(J SM�P � , PLAN CHECK $ PERMIT PLUMBING . $ � � ISSUANCE PLAN CHECK 25% 3 ENERGV P.C. � ELECTRICAL $ � GRADING � PLAN.CHECK 50% $ MICROFILM ' MECHANICAL $ TOTALFEE PLAN CHECK .25%' $ � 29.38 YL� rc Z O N 1 N G R E Q M T S FEES $ 3 � � JSTRUCTION AND PLANNING i PROVALS Permit # .`Temporary Electrical Service or Pole ��2. Soil Pipe-Undrgrnd. 3. Electrical Conduit Utility-Undrgrnd. 4. Electrical Conduit-Undrgrnd. 5. Steel Reinforcement 6. Electrical UFER Grnd. 7. Footings _( S-%�,g` S: Foundation 9. Water Pipe-Undrgrnd. 10. Structural Floor System 11. Property Sewer Line & House Connection 12. Sewer Cap . 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 � � 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 Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbin9 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 N 51' CERTIFICATE OF OCCUPANCY No Date Date /.� POOL & SPA Inspector AppROVALS Permit# 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVER-GUNITE ,I' 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, � Undrgrnd., Test 60. Backwash Lines, P-Trap, O Undrgrnd. ' 61. APPROVAL TO DECK 62. Backwash & Receptor-Final 63. Heater & Vent-Final 64. Plumbing Sysrem - 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 0 AvO��ant to fill in all soaces excaD< <hose witnin neavy eorGer Iines ana sign all aoo�oo�iate tleelarations. CITY OF COSTA MESA CONSTR UCTION PER/MJ�IT� PERMIT NO. Tp CT NO. LOT O. UN1T' NO. P�oject Addresy �� 9 :� • � g� ST � i�L�/G�' 1 /+ppljcanc's Mail�iJ�� a,�N�a« 40 /St./�✓O ✓iE3r�J SEac� Ow"ner's Narne /�!dlST�`�- O �TBB� �� Phofie/J'¢�..��Z' Address �O��o � S1L1+�� l%l�„' �E4t �-so""'>� ArCh/Eng. , / �,/,�,,, � Licensc oCQs2 Address l-[Q3.�3�- l'� f�L /+s7 �T � Controcmr's Nam �SE � ��Phote ��/� Addresslmailing) � �SG.�'�� /E/✓ SF�it CityLicenuNo. 3'SS'.S�i • . LItENSED CONTRACTOp DECLARATION I ber¢by aitirm lhat 1 am licensetl untler provi5ions of Chartei 9(commencin9 with sectlon 7000j of Oivisfon 3 0( the 8usine55 antl Professfons Cotle, antl my Iicense is in full ce antl afiect. 'j, CiG¢� �y� CI�3� ' LiG ns �J Da�e� Signature � WORKERS'COMPENSATION CLA ATION I h¢reoy af(irm that 1 �ave a cert /tw f wnsent to self-insure or a certiHfate of Wotkers' Compansation Inzu ce, or a certifietl coOY [hereof (Soction 3800, Lab. G.) Po��cy No. Company ' � 8 Certifietl copy is hereby turnisheQ Certifietl copy is Bletl with [ne <ity Builtling Dlvision. � Date Applicant EkEMPT10N FROM WORKERS^COMPENSATION �ECLARATION ' (This section n¢etl not b¢ CompletOtl il N¢ permit i5/or one huntlretl (E300) or IC55). ' ��ertity tnat in the performance of t ork for whicn tnis p rm�t Is issuetl I slldll not emPloy any per50n In any Ta er 50 as to ¢c SubjBCt to t�le �^/Orker Co[qp er� ion Laws of Cali Da�¢��5_hb Si9nature 'NOTICE: It, after making this tlec ratio you oultl become subjact to lhe WOrkers•. Componsation provl5io ol e labor Cotlo, you must lorthwith co�nply wit1�� such provisiOns o is permlt snall bo tleemetl ruvoketl. � �ONSTRVGTION LEN�ING �AGENCV • 1 np�¢by affirm Inat Iher¢ i5 a conStruCtion Ientling agency foY lhe pnrtormdnG¢ of Iho wo�k fOr t i � t $acti 3� . CJ LenCer's Name Lentler's Atltlress � 7-L'> / / S OWNER BVILDEN �ECLARATION ✓Lr. I h¢reby afllrm lhat I am exempt irom the Contractor's Licensa aw for the � fqllowin9 reason (Section 7031.5 Bustness antl Profesifonal Cotle: AnY dfy or countv which roaWres a permlt to construct, alter, improve, tlemollsli or repalr , as as [hat any applicapt tor a permlt Sub(ect5 tho appllcant to e civll not more lhan tive huntlrCd tloltars (E500). wnCr o� lhe prop¢/ty o/ my empl0yaa5 wilit w�ges a5 Ihpi� SolO ' lon, will tlo the work, antl tha siructura is not intentletl or olteretl iectlon 7094. Business an0 Prote55ional Cotle: The Conbactor's w iloos nol apply lo.an ownBr Ot a prOperty wbo builOs or Improvas ntl� who aoes such work blmselt/he�self or ihrougb nls or hor own , providatl tllat Such Imprpvements ar8 nOt Intentl8tl Or oHCretl for �wever, the builtlln9 or improvement Is soltl witnin ono yoar ot com- ¢ ownM will bave tn0 burden ot proving h0/She OItl nOt Duiltl or Im- he p��po5¢ ot Shce). � ' vnCr of the O�operty, am exUusively contracting with Ilcenzotl ton- conslru<t LhG p�oj¢ct (SeGiion 7044, BUSino55 antl Prot¢SSions COtle: actor4 License lA'�+ doe5 not apPty t0 an owner o( property wM10 t It Oulltls of impwves thelNon, antl who ConVaCts tOr Such pro�ec 5 w h a Con- � tractor(5 ❑cansa punuant fo tno Contractor's Umnso Lawj. I am aware tnat , Ip�rOof o� tneir Worke�'S Comp¢nsatlon insuranca Shoultl be provitletl to' me. U I am exempt untle� Seciion B. 6 P. C. for thi5 r¢dson , Oate Owner I herebv cer�ify that I have rea� brivers• CMF OB65-� that 0 (3 2 414-7 �.� TVPE OF CONSTRUCTION NF ❑ CONVERSION ❑ DEMOLISH DES��1fTION QFvWlOJRI$/U�O� �7�- ftZ TVPE OF PERMIT� ❑ TENANT ❑ E CTRICAL C ❑ •OTNER PROJECT OESCflIPT10N 5Q. FT. � 7r '�O � 7 ADD ALTERATION REPAIR OTHER FOUNDATION LJSTRUCTURAL LUMBING ❑ MECHANIGAL i}'L C� • CONSTRUCTION TVPE VALUATION $ � ZONE GRADING CU. VDS. ACR Sink <flow Preven[er kflow Irrigation nuh's � ifiers - - - . iwasher , �king Fountains )r Drains Gas Service I n terceprors Kimhen Sink Lavatories P-Trap ' Roof Drains Reinspection Fee � $15 Boiler Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & D ting ❑0-100,000 BT 100,000 Reinspection Fee �� $15 White - Builtling: Canary - qppliwn[; Plnk - AccounHng; GoltlenrOtl - qssessor L Showers Service Sink Sewer Cap Sewer Connection Solar Collectors� Solar Pipin9 Solar Tank Swimmi ool wlSpa ur a�� Water Closet Water Heater Water Service Auto-Wnsh Laundry Trey Istue Fea Hoodor Typel CanoPY TVPb�' 3efri tion System i00.000B7U Qi00,000 System RepaidAtteration Fire Dampers Registers , � Itwe Fee � . , $ 3 $ 3 A.P. #� �'�R' S Main Buildi E T Front B Rear A C Right K Left S P�nq. Ref. q� Planning•Notes: Automatic Washer Construction PoleSub. . Cooking Unit � Dishwasher : Dryers OGas' �Electric Fan , F.A.U. Fixtures Device Boxes � Outlets ' SwiiCheS Gar6age Disposal Generamr �0- KW �5-1 7508 6%13786 Zone 9 Parking Req.�Provided ELEC7AICAL Transformer ❑ 15-501C1 ❑ 50+KW Meter �up to l00 amps Meter -�over 100 amps KW Sub Panel - Motors�0. PQ1k-8 Inc.S r�g.15HP[fi6�15+ Pole Light Fange Sign � Standing Sections Trash Compacror Reinspection Fee $15 � �, luue Fee — � DEVELOPMENTSERVICESRE�UIREMEN� Zoning APProved By Building Approved By Appliwtion laued 6y FEES $ 3 2 O N 1 N G R E Q M T S , .SUM� A�RV( �OF FEES � , BUILDING PERMIT $ ='�.-.t.L' J—L SMIP $ P�.AN CHECK $ PERMIT � � PLUMBING S �SSUANCE S � PLAN CHECK 25%' $ ENERGV P.C. $ , ELECTRICAL $ GRADING , $ PLAN CHECK 50%' $• MICROFILM 5 - i MECHANICAL $ TOTAL FEE $ �4, 0.3 PLAN CHECK 25% $ � ( TL ^ CONSTRl1CTI0N AND PLANNING POOL & SPA APPR�VALS Permit# Date Inspector qppROVALS Permit# Date Inspector 1. Te�nporary Electrital Service or Pole 52. Pool & Equipment Location 2. Sbil Pipe-Undrgrnd. 53. S[eel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Fnrms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical UFER G�nd. � 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 72. Sewer Cap � 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System�Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17'. Rough Wiring Sign 68. APPROVED rOR PLASTERIPIG 18.'Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL -19.;Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # ._ 21. Ducts, in Structure . 70. Underground Hydro 22. Ducts, Ventilating 71, Product Piping O Gas ❑Oil 23. Gas Pipe-Rough & 7est 72. Underground Flush 24. Roof Framing . 73. Undergrnd.StorageTank OGas ❑Oil 25. floof 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: G� 6 �#L �(,�� 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. Backfiow Preventer 43. Backflow Irrigation . . � 4?. Ltandscape Irrigation System 45. Sound �Attenuation � 46. Handicap Regulations 47. �INAL STRUCTURE & BUILDING � � �� 48. Special Requirements Completed 49. Electrie Release to Edison � 50. Gas Release to Southern California Gas Co ' '- y 51. G�RTIFICATE OF OCCUPANCY . . � , No, �"� Date . !'- --i ; _ — #�� , , ��7'i e C�STA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 317 GOSTA MESA. CALIFORNIA fOR APPI/CANT TO f/Cl /N COMPLETFLY TYPE OR PRINT _ COSTA MESA. Dr. Daniel Perr �,TY Santa Monica AR� "7ECT OF ;INEER W. TOIdBR ADDRESS 771 W 19th .S CONTRqg� E Robertson AODRESS 771 Weatl4th I]i6GGlbr�nN I N(lT / O� I9L1 LIC. A.P. N4. (f � � � SIZE 1 t G R�1�0 - NO.OF BLDC OF LOT ii� � . I HOw on �O' USEOF //////// E%ISTING BLDG. SETB�LK LINE FfiOM � cervreR oF sinEEi 60 REAR YARD o ` 5 SIDE YARD ILEFT ol� A�GHT DESCRIPTION OF WORK NI 7CX I II AL7ERATION I II ADDITION IEqING 20 R 193.�JM6 3� fERIOR WAL IROOF vvciNr �$CUCCO �ovEaiNr 1 I�I NEqEBV ACKNOWLEDGE THAT I HqVE READ THI6 APPLICATION AND STRTE TNqT THE ABOVE IS CORRECT hND AGPEE TO COM- PLY WITH ALL CITY OHDINANCE6 AND STATE LAWS REGULATING BUILOING CONSTRUCTION. � I� AUTryOftIZE�� NT � . �;�� b"dC��iaO'��,� -�<,✓ >o - .i 5_ j � 3 p FINP,NCE DEPT. !� CITY OF ^f�STA �4ESA APPLIGATION FOR PERMIT ' BUILDING fOR OFF/CE USf OMLY I RECEIPT NO. I %ERMIT �. oG RECEIVEO BT DATE qEGE1VED I DAT I65 EC G:f� . a ._ _99 _<,1� f�� - APPROYED COSTA MESA, CALIFORNIA ZONING P AN8 � � USE OF N / BUILDING r/ b^ � M e THE AMOUNT SHOWN UNDER VALUATION IS FON THf PIIqPOBE OF E9TFBLISH�NG A PERMIT FE6 ONLY. VALUATION � ^� J� D�� PERMIT FEE S y ri� �/� $ � PLAN CHECK $ � � .+L_ 70TAL FEE 5 �� — \, Ciiy of Costa Mesa Devebpment Services Departmen[ Builqinq Safety Oivision P.O.Bos 1200 Cos�a Mesa, California CERTIFICATE OF OCCUPANCY No. OOb��b The Building located at 777 19th RYrnet. Unit 107 has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto fora Group P? Occupancy. Use of Building C:nrtttnarr_iql Legal Description 4�d—�nl—ll'i (See reverse side for Metes and Bountlsl Building Permit No AME31478.BF.31C4�I�ectrical Permit NoHME31478�BE314pj�mbing Permit No. Mechaniral Permit No ISSUEp T0: Larrv 0"Lbole 17632 Irvine Blvd. . `�'��ntxn,CA 92680 Number of apartments and/or guest rooms Building Official William T. Ho�ard 1 bJ y ✓'. , "r i> . Date RaF�nis�rv 1Fi, 19Rf3 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the ��uilding Official of the City of Costa Meu under Sec. 307 (e) U.B.C. CMF 101$.q6 rev. I/83 White - Owner, Canary - Numerical File; Pink - Bldg. Permit File Aoo�lcant o i i��e�hose witnin neavy Eortler Iines ana sign all avvrooriata tleclarations. c4Tv OF COS7a ES CO��N1STRUCTION R IT /+ Projecl Address �� W ( 4�"� �� Li iJ � T l..i Applicani's Mailin1g Andndreu �� o Owner's Name _6LT`��`'�— � L t hone g ao��' Address � � � w � � Z� Arch/Eng. License No. Address Contractor's Nam hone Addreu (m� �'�9� Ciry License No. LICENSED CONTRACTOR DECLARA710N I nereby at(irm that 1 am Iicensetl untlar provi9ons of Charter 9(commencing with section ]000) of Division 3 of tne Business antl Professions Cotle, antl my license is in full force antl eftect. License Class License No. oale Signature �� WORKERS' COMPENSATION DECLARATION ' lereby aitirm that I havo a cer[iticate ot consent to selt-inzure or a certlflcate Worke�s' CompensatiOn Insu�ance, or a ce�tl(ietl coOY thereof ($ection , .d00, Lab. C.) � PolicY No. CotnPany eCertifietl copY is hereby furnlshetl. Certi(letl copy Is tiletl with the city Buileing �ivision. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Tnis section neetl no[ be Completetl if [hy permit is for one huntlretl ($300) or less). I certify lhat in tne performance of lhe viork for wnich tNs perm�t iz issue shall not ¢mploy any p rson In any manne� so as to beCome subjgF�t WorkG�y.�.ompen Laws ol CalifQ r9�a T c Dale L�.1�1b�_ Signature .J1L`t�—Rti�Q `�1�-L � yJ NOTICE: It, aftar making [h15 tl¢Cla�atio�� ypWShOUItl become su ject t0 th¢ Wa�ke�s' Compen5alion O�ovlsions oi the Labor Cotle, you mu5t forthwith comply with such provi5ions or [his pe�mit Shall be tlGemetl �evoketl. CONSTRUCTION LEPoOING AGENCV I hereby aHi�m thal Ihare Is a wnstructiOn lentlin9 dgency tor Ne pe�formanCG ol Ihe work 1or wM1lch thiz permil ii i55ueE (Section 309] Civ. C.) Lantle�'S Name Lentler's Atltlress OWPlER BUILOER DECLARATION I h¢rebv aHirm that I am exampt 7mm �ha Contractor•5 License Law for the LJ I. d5 C tractors b The Con' builtls or tractor(z) .pHrooi o( Lx.l am. �e Date � �- , I her¢by � informati lo �Is Issuant8, also �¢qWres Vla dppl6anl �or zucn permn �menl �hat ho/zne IS Ilcpnsetl puRuant to lh¢ provi5iOn5 ot mse Law IChaDter 9 Immmencina with Sectlon ]000) 01 any applicant for a pormit subjetts tne applicanl to a clvll ot marc tban fivo huntlretl Qollars (5500). rnar of tho Oroperty O/ my employee5 with wages a5 thei� So18 m, will d0 the wOrk, antl Ih¢ zt�uc[ure IS nOl IntentlGO o� o�fe�0tl action 7044, Business antl �ro(essional Cotle: Tha Conlractor's v aocs not apply to an owner ot a oroperty who bulltls or Improv¢z tl who does suCh wo�k himselt/har5eli Or Ibrough hi5 0� ner own providotl lhat Such imDrovoments aro not in[enGed or offeretl for vaver, lhu �ulltling or imp�oy0ment is Soltl wlthin on¢ year oi cOm- owner will have tM1e burtleq of proving ne/she tliO not builtl ot Im- a purposa ot sale). n¢r of the prOperly, aT oxCluSivery contracting with IlcenSetl COn- '.onstrutt the p�ojacl ($eclioh 7044, Business antl PrOfessions Cotle: CtOr's Llc¢f15C Law does nOt applY to an nwner oi oroperty who nproves lncruon, anC wno Contracts ior zuch projects with a mn- censn pursuant ro tna Contractor's Licanse Law). I am aware that �eir Workar'S COmpensatlon in5urance Shoultl be provitleC to me. mp[ unCer Section B. 6 P. C. for Ih�ejson Signature A P1KK Drivers' License or 55 CMF 0865-46, rev. 30/04 � Owner �L 1 have reatl this I a9roe to compl to bulltling con5 � to enter upoq TYPE OF CONSTRUCTION LI NEW U ADD LJ ALTERATION IJ REPAIR ❑ CONVERSION ❑ OEMOLISH ❑ OTHER q,p, q�6 DESCRIPTION OF WORK/USE OF BLDG. S Main Building: E TVPEOFPERMIT GRA�ING FOUNDATiON STRUCTVRAL T Fronl ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL A RCef ❑ OTHER C Righl PROJECT DESCRIPTION Sa.FT. OCCUaArvCV K CONSTRUCTION TYPE VALUATION 5 S Left 20NE GRADING CU. VDS. ACRES Ping. ReL �I`- Remarks: Planning Notes: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs rinking Fountains loor Drains loor Sinks `as Service DUIICLS Sink Roof Drains Reinspactian Fee Sts Boiler , Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ firepl/Fact. Blt. ICBO �h Heating System & Ducting ❑ o- i oo,000 eru O i oo,000 er Rainspection Fea � S15 Whit< - Builtling; Candry - APPlicant; Pink - Accountin9; GOltlenrOtl - Atseszor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swlmming Pool w/Spa Urinal Water Cloret Water Heater Water Service Auto�Wash Laundry Trays Isue Fee Hood or Typel ❑ Canopy Typell ❑ Refrigeration System ❑o-iao,000eru ❑ioo,000sr System Repair/Alteretion Fire Dampe�s Registers Issue Fee FEES Zone Acceuory Building: �i On0 f107—OOD04107 T��T 2e,� N I N G R Parking Req.IProvided • E � M T $ ELECTRICAL Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. � 50 + KW � Cooking Unit - D ishwasher Dryers ❑Gas �Elec[ric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator 00.5 KW 05-15 KW Meter LJup Lo 700 amp5 Meter ❑over 100 amps Sub Panel Motars �0.1 HP O7 h� 8 Inc.Solar �9-15 HP �76-15+ Microvrdve Pole Light Range Sign Standing Sections Trash Compattor S3I � Reinspection Fae $75 Issue Fee FEES �DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved 8y 8uilding Approvad By Aaolication Issued Bv FEES $ 3 SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ . PERMIT PLUMBING $ ISSUANCE 3 PLAN CHECK 25% $ ENERGY P.C. 5 ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ � � b TOTALFEE $ PLAN CHECK 25% $ CONSTRUCTION AND PLANNING POOL & SPA - APPROVALS Permtt # Date � Inspector qppROVALS Permit # Date Inspector � rr 1.0 Temporary Electrical: rvice or Pole 52. Pool & Equipment Location • 2. Soil Pipe-Undrgrnd. �' S3. Steel Reinforcement � 3. Electrical Conduit Utili[y-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test ., 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7.� Footings , 58. Electrical Conduit-Undrgrnd. �;`�'� ��, 8. �Foundation 59. Gas Pipe, O Undrgrnd., Test t 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring-Sign 68. APPROVED FOR PLASTERING 18. Rough Electr�cal-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL �9:� Rough Heating & Air Conditioning FIRE DEPT. REnUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical - 27. Freme and Fla_hing 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 WSPECTION �J� 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: ' ' r,� 34. Final Heating & Air Conditioning � 7ti 35. Final Gas Pipe-Test ' 36. Hood or Canopy 0� � 37. Final FaCtBry Fireplace � .-I 38. Final PWmbing i � 39. Water Service-Final ' 40. Gas Service-Final , � I . 41. Solar pomesticFinal . � , ' � , 42. Backflow Preventer ' � ' • , � � 43. Sackilow Irrigation . _ � i � 44. Landscape Irrigation System � ��• � ��' I 45. Sound A[tenua[ion � � • �. ' ` 46. Handicap Regulations ' • � ` 47. FINAL STRUCTURE & BUILDING � -• '� ti _• • 48: SpeciBl Requirements Completed , . , � 49. Electric Release to Edison '� 50. Gas Release to Southern California Gas Co , 51. CERTIFICATEOFOCCUPANCY; + No.�_ ' Date ` 'f ADolleant to /ill in all soaces except those within heavy borEer Iines ane sign all aooropriate tleclarations. C�ITY OF COSTA MESA CONST�UCTION PER IT 1/U 1 PE IT NO. _[RA T NO. LOT NO. UNIT "Prolect Address 177 W- ��l ��T�, y�"� N qpplicant's Mailing Address ow�e: s Name /4 �_.S-rle -c.FT L/}N o�n)C7 Pnone 7- C�% Addreu Address / �� r l v it Contraclor N T�jQIQY---Ii� Y i�0 77P $pY� �.%(�`� Addresslmailing"-�/«lc/ �/i(LFA'Qkp/O.SAN tAnJ �J1P ��PA�n CitY License No. O r� �7 �6 ��ENSED CONTRHCTOR DECLARATION � I bereby affirm Ihat I am licensetl untler provisions of Chartar 9(commencing with sectlon 7000) of Division 3 of the Business antl Protessions Cotle, antl my i��ensa Is in tull for an0 eftec[. 3 7� V�ense Class 7 License Date /_—� {— 5�9 t � � �� `� WpRKERS' COMPENSATION DE ARATION I h6reby atfirm that I have a certificate of consent to self-insure or a certificate of `Alorkers' Compansation 4nsuranc¢, or a certified copy thereof (Settion 380Q. �b. C.) � � POIf�Y No. Company 8 Certifietl coPY is hereby furnishetl. Certifletl coPY is filetl with the city Builtlln9 Division. Date APP��cant EXEMGTION FROM WORKERS' GOMPENSATION DECLARATION (Thissection naetl not be comple[etl it the parmit Is for one huntlretl ($100) or less). ��grti(y (hat in the perto�mance of th¢ wo�k to� which thi5 0¢�m�t I5 i55uetl„I ' shall not employ any perzon in any nn¢r so as to becOme ubject t0 th¢' Wofkers' ompensa on �dws of Call r a. Date � — ��Si9natu�e NOTIGE: If, afte� mak�ng this tlBGlar on, you shOultl becomB sub ct to the WOYkers' Compensalion p�ovisions o the LaDor Gotle, you muzt for[hwith corr�P�Y �+�th zuth provi5ion5 0� tnis permit Snall b¢ tleemetl revoketl. CONSTRUCTION LENDING AGENC�' I hereby alfl�m that [hlre.i5 a con5l�uctlon 1¢ntling a9ency fo� Ihe performdnce of' the wark for w�ich [his permit Is issuetl (Se<tion 3097 Civ. CJ �entler's Name Lentl¢r's Hdtlre55 OWNER BUILDER DECLARATION I hereby aHirm ihat=Pam exemp[ from the Contractor's License �aw for tha ._.� .......... ...�..... ��.�..... vn�� 5 a��anncc ann am(essinnal Lotle: Anv citv or to constluct. altCr. �mp/ove, aemoiisn or DiY�Sion 3 Of the Buslness aOtl Protessions Cotl¢) or tllat h¢/Sn¢ I5 ex¢mpt therefrom antl the basis for the allegetl exemptio�. AnY violatlon of Section '031.5 by any apP��ant �or a permit Zubjects the applicant to a civil ehal[y of not more Ihan five huntlt¢tl tlollars ($500). ❑ I, as owner ot the property or rYiY emO�oYees with waqes as thel� sole coTPensatiOn, will tlo the work, antl the 5[ructure is no[ Intentled or of(eretl (or sale (Sectlon 1046, Business anC Professional Cotle: The ConVactor's License Law tloe5 not�apply to an owner of a property who builtls or impYoves thereon, antl who tloes such work himself/herself or tnrough his or her own emPloyees, provitletl that such improvements are not inlentletl or offereU for yy�g. It, however, the builtlin9 or improvement iz 5o�tl wlthin one year of com- pletion, the owner wlll nave the burtlen of provin9 he/she tlitl �ol builtl or Im- prOve fo� ltte purposa of zale). ❑ I, as owner of the pro0erty, am exclu5ivety contractlng with Iicensetl cOn- traCtors to <onStruG[ the prolect (SeCtiOn 7044, Business antl Profe55ion5 Cotle: ThC Contractor's License ldw does not apply to an owne� of property who Duilas or improves the�eon, antl who contracts for sucn projects with a con- tratior(51 IiCense pursuant to the CoMtacto�'s LitenSe law). I am aware that praoi of thei� Wo�ke�'s GompenSaHon insurance shoultl be provitletl t0 me. ❑ I am exempt untler Section B. & P. C. for this reason Date Owner 1 nereby certily that �I nave reaa tnls appli infp�mation is correct. 1 agree to compry wl1 antl state laws relating to buil0inq wnstru<t sen�ativ¢z of (hi5 <ity to enter upon� the 5igna[ure Dri�er5' LI so or 55 � CMF 0065-46, �ev. 10/84 ' � 6� ��%0 W I'�tsa O �W • 7YPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR � ❑ CONVERSION ❑ DEMOLISH ❑ OTHER p.�E /Z •�2.U( DESCRIP�ION OF WORK/USE OF D. V �S . S MainBuildin9: T�'PEOFPERMIT GRADING ' FOUNDATION STRUCTURAL T Front ❑ TENANT LECTRICAL ❑ PLVMB NG[� �❑ MECHANIGAL G�� ; 8 Rea1 ❑ OTHER � % � vL+j � '� A PROJECT DESCRIPTION SQ. FT. CVPANCY ` ' C Right � CONSTFUCTION TVPE VALUATION $ 3iQ(�% � S Lef[ ZONE GRADING CU. VDS. ACRES p�ng. Ref. � / Remarks: � Planning Notes: � Sink Preventer Irrigation Floor Drains Floor Sinks 3as Service Oudets Interceptors Kitchen Sink Lavatories '—Trap Roof Dra Fleinspaction Fee, $75 Duct-Under Ground Duct - StrUc[urel . Duct - Ventilating Exhaust System ❑ Multipte Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑0-700,000 BTU �100,000 Reinspection fee " � $�5 Builtlln9: Canary - APPlitanp Pink - AccOun[ing; GOltlenrotl - A5u55or Showers .. � Service Sink Sewer Cap Sewer Connection $OIdI COIICCtOfS Solar Pipin Solar T k Pool wl5pa Water Closet Water Heater Water Service Auto-Wash Issue Fee Hood or Typel � Canopy Typell ❑ Hefrigeration System - ❑4100,OOOBTU ❑100,000 System RepairjAlteration F ire Dampers Registers - Issue Fee i $ 3 r $ 3 Automatic Washer Consbuction Pol¢Su6. Cooking Unit Dishwasher � Dryers ❑Gas ❑Elec Fan F.A.U. Fixtures Device Boxes Outlets � Switches Garbage Dispoul Generator �0.5 KW �5-15 I Reinspection Fee I$15 I DEVELOPMENT SERVICES RE�UI Zoning APProved By�_�p� � � Building Approved By ��.,i+—�•r ,. � se90 Eia2�s� r�..� Zone Accessory Building: 2 • O � N I N G R Parking Req./Provided E Q M T S Transformer L] 15-50 KW O 50+ KW Merer ❑up to 100 amps Merer ❑over100amps Sub Panel Motors �0.1 HP � 1 h- 8 Inc.Solar �9-75 HP �ig-75+ Microwave Pole Light Ran9e Sign Standing Sections Trash Compactor Issue Fee � SUMttM''ARY OF FEE3 eU1l.D�NG PERMIT $ ---J�L�' � SMIP . ' PLAN CHECK $ PERMIT PLUMBING $ ' ISSUANCE PLAN CHECK 25% $ ENERG�' P.C. ELECTRICAL $ .6o GRADING PLAN CHECK 50% $ � SD MICROFILM MECHANICAL $ , ;� TOTALFEE - PLAN CHECK 25% .$ $ 3 $ t� 3. 5 S S �$ � 5 I 'CONSTRUCTION ANDPLANNING ` APPROVqCS Permit # 1. Temporary Electrical $ervice or Pole 2. Soil Pipe-Undrgrnd. � ' 3. Electrical Conduit Utility-Undrgrnd. 4. Electrical Conduit-Undrgrnd. 5. Steel Reintorcement 6. Electrical UFER Grnd. 7.� Footings ' �8. �Foundation � � .' 9: Water Pipe-Undrgrnd. � . �'� 10. Structural Floor System, -�' c 11. Property Sewer Line & House Connection 12. Sewer Cap 73. Roof Drains '==t ��" �� 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 27. Ducts, in Structure 22. Ducts, Ventilating 23. Gas Pipe-Rough & Test . 24. Roof Framing � 25. Roof Sheathing ., � � 26. T=6ar Ceiling'�Structuraq ,& Monocoat 27. Frame and Flashing � � 28. Lathing & Siding 29. Insulation 30. Drywall Nailing 31. Plaster Brown Coat 32. Electrical Power Meter-Final 33. Final Eiectric 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. HandicapRegulations 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed .49. Electric Release to Edison 50. Gas Release to Southem California Gas Co' 51. CERTIFICATE OF OCCUPANCY Date Date I Inspecto: f y' , cd•. r , , "f � � POOL & SPA APPROVALS Permit # 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms � � - 55. Electrical6onding 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVER-GUNITE 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, � Undrgrnd., Test� 60. 8ackwash Lines, P-Trap, O Undrgrnd., 61. AP7ROVAL TO DECK� _ �� 62. Backwash & Receptor-Final '.� ' 63. Heater & Vent-Final � i � � 64. Plumbing System - Final �• i 65. Electrical-Final � 66. Solar System-Final . ,67. Fencing &�Access Approval �68. APPROVED FOR PLASTERING � ,69� P00 L/SPA SYSTEMS F I NAL FIRE DEPT. REQUIREMENT APPROVALS Permit# 70. Underground Hydro � � ' 71. Product Piping O Gas ❑ Oil 72. Underground Flush 73. Undergrnd.StorageTank OGas ❑Oil 74. Overhead Hydro � 75. Dry Chemical• 76. Dry Standpipe � � 77. FIXED SYSTEM FINAL ^ r 78. FIRE PREV. FINAL � � HEALTH DEPT. REQUIREMENT 79. FINAL 1NSPECTION 80. FOOD CERTIFICATE ISSUED Notes: b � � Date �Inspector c 0 e • •� �TV OF COST E C NSTR �TION PERMIT- Project Address �, , �� „ � • , � l"I�fo�2 IGU�'i..�E ' - D � � J ` � A4ldreu q�- ArcMEn� �'`� Q,��' License Nq. G'�, � � ��'iV�il lGN Addresj Z„ Contractor'snlam D�- �hone '��8"�4��1" Address (mailingl ' � � �%1'Ev�l 5 �i�' e�r' Ciry License No: 3 ss 'J� LICENSED CONTRACTOR DECLARATION I hereby affirm Ihat I am Iicens¢tl untle� provi5ions of Charter 9(commencing with z¢<tlon 7000) ot Dlvision-3 of tho Business antl Professions Cotle, antl my licenze is in full force antl eifecL � /� License CJass L�c e� No. �� oate�i 1 71.i� .�-. c'��a� Lt ./il"� _ WORKERS' COMPENSATIO�DE RATION I hereby atiirm that I have a c ' cate o( consent to selLinsure or a certificate o( Worke�s' Compensation Insuranca, or a Certlfietl coOY tnereot (Seciion 3800. Lab. C.) ' . ' . �. Policy No. Company BCertifi¢tl copy is her¢by fUrniShetl. Certltietl ropy B flletl wifh [he city Builtling Dlvision. Date APplicant EXEMPTION FROM WORKERS'.COMPENSATION DECLARATION (Thissection neetl na[ be complatetl if the pe�mlt I5 tor one huntlretl (SI00J o� less) I certify that In lhe performance�oi the work for which thls perm�t Is Issuetl, I shall not emplOy any pe�5on in any�9(� er So as [o be,{ome subject to the Workers'•.Comperysat�n Lawsof'Cali�rrti�f� -��Qr�//t_/ �NOTIC�: If, after making this tleElaratlon oJ shoultl become subject to the Workers' Compensatlon provisio e Labor Coae, you must torthwith compry with such ptovisions or his permit shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV . 1 hereby altirm that there is a construttlon lentling a9ency tor the Performance of the work for� which this pormi[ is Issued (Section 3097 Civ. CJ Lentler's Name � Lentler's AOtlress _ OWNER BUILDER UECLARATION ' I hereby atfirm that I am exempt from'the COntractor'S License Law fot tne following reason (Section ]031.5 Buslnass antl Profe55ional Cotle: Any city or county which requires a permit to construct, alter, imorove, tlemolish or repair any st�uclure, p�lo� lo Its Issuan<e, also reqWres Ihe applitant for Such parmit to file a signetl statement that he/she Is Ilcensatl pursuant to Ihe provisions of the Contractor'S Licens¢ Law (Chapter 9(Commencin9 with Sectlon ]000) o( Division 3 of Ihe Business antl Protessions CoOe) o� that ne/she is exemo� Iherefrom 5ntl the ba5is for the allegetl exemption. Any violation of Section 7031.5 by any applican[ tor a permlt subjects the appli<ant to.a civil �enalty of not more tnan five huntlretl tlollars (g500). ' I, as owner of the property O/ my ¢mployee5 with wages as thei� sole mmvensation, will tlo the work, antl the structure is not Inlentle0 or o(feretl for sale (Seclion 7044, Bu5ine55 antl PrOf¢ssional Cotle: The Contractot's l_icenze law tloes not apply to an owner ot a proDerty who builtls or improvez tnereon, and wno tloes such work himseli/herself or through hls or her own employees, OroviUetl tha[ zuch improvements are not intentle0 or oftereU for sale. 11, nowever, th¢ builtlin9 or imProvement Is soltl'wltnin one y¢ar of com- OIeIiOn, the own¢r wlll have the bwtlen Of proving he/She tlitl not'builtl or im- prove for tne purposa of sale). - . ' � ❑ I, as owner oi the oroperty, am exUusivety <ontractln9 wlth licensetl con- Vactorsto conztruct th¢ Oroject ($ection ]044, Business andProte55ions Cotle: The Contractor's License Law d0¢5 not aOPly to an owne( of property who builtls or improves thereon, antl who contracts tor'such projects with a con- tractor(51 IiCense pu�suant to Ihe.Cont�acto�'s License. Law). I am aware that proof o( their Worker's Compensallon inzutanc¢ zhoultl be O�ovitletl to me. '� I am exempt untler Seclion _ B. & P. C. fo� this reason Date Owner I hereby certlty that I have reatl this appliwtlon.antl state that the above information is correct. I agree to comply with all tlty antl county ortlinances antl state 5 relating to builain9 �onstruction, antl hereby authorize repre- Sentative o hi5 City t90 ent u00n Ihe abOve-mentionetl property tor inspectio e �J/ 5ianat e /"/.` Date' 24' � -_�� to fill in all spatts except TYPE OF CONSTRUCTION �NEW LJ ADD LJ ALTERATION LJ REPAIR i� ❑ CONVERSION ❑ DEM LISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. ��« ' E[. L �/•!C •• '-_� TYPEOFPERMIT GRADING FOUNDATION STRUCTURAI. ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJEC7DESCRIPTION 5 T. �OCCuw CONSTRUCTION TVPE� VALUATION $ 20NE GRADINGCV.VDS. AC Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtuhs Clarifiers Drinking Fountains � Floor Drains FloorSinks ' . . Gas Service �� Outlets Interceptors � Kitchen Sink ' ' � � Lavatories , �� , � P-Trap Roof Drains . � � Reinspeaion Fee I $15 Boiler " Duct - Under Ground' � Duct=Structural ' ' ' Duct - Ventilatin9 EzhaustSystem ❑ MWtiple_� Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑ ai oo,000 eru O i oo,000 sT� Reinspection Fee � $75 C', Showers Service Sink Sewer Cap� � Sewer Connectit Solar Collecmrs Solar Piping _ Solar Tank '� / Swimmin9 Pool Urir.al Hl2t2f CIOSEL Water Heater Wat'er Service laue Fee IANICAI Hood or Typel ❑ � Canopy Type I I ❑ , ie(rigeration System ❑0.100,OOOBTU ❑100,000 System RepairlAlteration Fire Dampers Registers ' laue Fee FEES A.P. iW L-.�. S Main Buildin� E T Froni � B Rear - A C Right 51 � SLeft � Ping. Ref. # 'Z Planning Notes: Auromatic Washer Construction Pole Cooking Unit Dishwasher Oryers ❑Gas ❑ Fan F.A.U. Fixtures d � � � _ ' / ` _ �� /i24 /i�'�� *---': 1 Outl¢ts^ Switches - Garbage Disposal ' _ GenArator O0.5 KW �5-151 /� , 2one Parking Req./Provided ELECTRICAL ' Transformer -❑ 15-50,KW ' ❑ 50 +�K W Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors �61 HP �1%-8 Inc. Solar 09-15 HP �16-15+ Microwave " Pole Ligh[ - Range , _ Sian � Standing Sections Tresh Compactor . .. � .. � $ 3 a- • /"� ' ✓ . 'Reinspection Fae $15 laue Fee FEES' DEVELOPMENT SERVICES REDUIREMENTS: - 2oning Approved By `� i Building Approvad By Aoolication Isued Bv _ _. � $ 3 2 O N 1 N G R E Q M T $ FEES $ 3 '' ' � �, SU MA Y OF FEES BUILDING'PERMIT $� ��•�' SMIP $ a3'S� PLAN CHECK $!'� PERMIT PLUMBING � 5 ISSUANCE $ PLAN CHECK �25% $ ENERGV P.C.� $ ELECTRICAL . $ � ' GRADING - $ P�AN CHECK 50% $ MICROFILM $ -' MECHANICAL $ " ? ' .TOTAL FEE $ �' ��'�� PLAN CHECK 25% $ - . � i CMF 0065- , ev. 30/84 Whlte - Bulltling: Canary�- Appllcant: Pink - Accounting; Goltlenrotl - Assessor • , . ' ' � � � , � , GONSTR},iCT10N AND PLANNING POOL & SPA , - ' APPROVALS• Permit# Date Inspector pppROVALS Permit# Date Inspector i, T�i!tporary'�Iecvical Service or Pole � 52. Pool & Equipment Location � � 2. Soil�Pipe-Undrgmd. 53. Steel Reinforcement ' I'� -3. 6lectrical Conduit Utility-Undrgrnd. 54. FormS 4._Electricaf Conduit-Undrgrnd.� . 55. Efeccrical Bonding . 5. Steel Reinforcementg";��R ,�� 56. RoughPlumbing&PressureTest , 6. Electrical UFER Grnd. . 57. APPROVAL TO COVER�GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. � $. Foundation S ��3� 9 59. Gas Pipe, O Undrgrnd., Test �9. Water Pipe-Undrgrnd. . 60. Backwash Lines, P�Trap, O Undrgrnd. � T0. Structural Floor System 61. APPROVAL TO DECK 71, Property Sewer Line & House Connection � 62. Backwash & Receptor-Final ' 12.'Sewer Cap � 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final � 15.. flough Electriral-Conduit 66. Solar SVstem-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 Conclitioni�g FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace � APPROVALS Permit # 27. DuCts, in Structure . - 70. Underground Hydro 22. Ducts, Ventilating � - 71. Product Piping O Gas ❑ Oil � 23. Gas Pipe-Rough & Test , 72. Underground Flush � 24. FioofFraming 73. Undergrnd.StorageTankOGas ❑Oii �25. Roof Sheathing � �S �� 74. Overhead Hydro 126. T-Bar Geiling (Structural) & Monocoat 75. Dry Chemical � 27. Frame and Flashing � gG �� 76. Dry Standpipe 28. 4athing & Siding 77. FIXED SYSTEM FINAL 29. Insulation � 78. FIRE PREV. FINAL 30. C)rywall Nailing %� (� � HEALTH DEPT. REQUIREMENT ,�`, plaster Brown Coat . 79. FINAL INSPECTION �� :s2. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric , Notes: � a �T/Q�� d�� C� 34. Final Heating & Air Conditioning � 35. Final Gas Pipe-Test �--to w�_ � 36. Hood or Canopy - �/�/G�/ �/.� 0�/ ��- � Ot T//ti '�S /2.Ila 37. Final Factory Fireplace �� _ ,� � � � � ^ � 38. Final Plumbing , o �1.�. `�i { . 39. Water Service-Flnal _ V � S /z • .� ' 40C Gas Service-Final , �� 3 � 41, Solar pomestic�Final , - s a� � �"� � \ 42. Backflow Preventer� � � ' �� S 5 S. 1 7. r 43. Backflow Irrigation ,_ � t: � D ��t.31- 44. Landscape Irrigation System�., S �L� ' � 5' /2y ,� 45. Sound Attenuation ,� --�- �-�- � . 46. Handicap Regulations � � 8 G � ec ' 47. FINALSTRUCTURE&BUILDING /� �p- �u, yy� O I / �- �`��48. Special Requirements Completed 1 q MM 49.� Electric Release to Edison � �" �-� !.� G � i • i 50' Gas Release to Southem California Gas Co b; � J � C 51. CERTIFICATEOFOCCUPANCY . .� ` 1 Lt�!o. � Date ', ll /.? �j ,C Sr (�.Oi i �-, , � � AVDlicant to flll In all spaees excepl Ihose witnin neavy eoraer Itnas ane sign all aoo�opriate tleclarations. CITY OF C06TA ME3I�As� �CONSTRUCTION PERMIT Proje2t Addresy�J / /��' S� , �� Applicant's Maili'nAg A�d.'dress � U� h��'� Owner'sName �=L-�-1.. � t� Phone�z' Addreu T/(•'+t'L Z2�11/�7'f. � �i1(Y- �yifi inl Aroh/Eng. _ License No. Address Contracror's Nam Phone Address (mailing) City Li[ense No. LICENSED CONTRACTOR DECLARATION 1 be�eby altirm Ihal 1 am Iiceps¢tl Unde� provl5iOn5 ot Chartor 9(COTmencin9 with sectlon 7000) o/ Divisio� 3 01 lhe Businass antl Profossions Cotle, antl my Ilcense is in full lorce antl 0H¢ct. Llcense Class Licensa No. Dale Si9natUre WORKERS' COMPENSATIOf� OECLARHTION I nereby altirm tnat I have a c4rtiflcate of consenl to Sel/-Insure or a cerBficate t Workers' Compensation Iqsurance, or a certitiatl coOY ��ereof (Sett(on ,800, I..ab.'C.) Poli<y No. _ Company 8 Certifletl coOY �5 hereby furnishetl. Certifietl copy is fileG with (he city Builtling Dlvision. Date APblitan[ EXEMPTION FROM WORKERS' COMPENSATION �ECLARATION (Thissection neetl not be compietetl if the permlt 6 for one huntlretl (5300) or Iess). 1 Ce�fi/yjbat !n the pe�foirtfaq�g o1 the w k b� which thiz pe�m�t 141(SUCtl 1 shall N� om0�oy any porson In anv ner so as to Oecoma subje�j/t Wo�ker5' Compen5alion provl5lon5 Of Ihe ldbor Cotla, you mu5t forthwith comply wi[n Su<h provl5lo05 or IhIS pe�mit Shnll be tlaemetl revoked. CONSTRUCTION LEPoDING AGENCV I horeby a111rm that Ihere I5 a Construction lentling agoncy for tho pertormance ot [ho work ior whiCh th�s permit iz issuetl (Se<tlon 309] Civ. C.) Ixntler's Nama Len�er'S AtlEress OWNER BUIL�EN UECLARqTION 1 hereby afflrm Nal I am axempt irom tne Contractor's License Law for the following reasan (Section ]Oj1.5 Business antl Protesslonal Cotle: Any dty or county wnlCh r¢qul�es a pe�Tit to con5truct, alter, ITp�ove, tlemalish or �epaii any strutturo, prior to Ils iss4ance, also reqWres the applicant tor such parmit to file a zianotl Slatement Ihat h¢/She i5 IicPnS¢tl pur5udnt lo IhG pfovlsions Of .Divizlon 3 ot the Buslnezt antl Professlons Coae) or [na� ne/sna is exempc ��heretrom antl th¢ Dasis tor Ihe alle9¢d exemplion. Any viOlation Ot Section �"%�D31.5 by any applican[ tOr a Permit subjects Ih¢ app�icant ta a Civil �$endlty ot no[ mo�e than (ive huntl�etl tlolla�s (5500). � 1, as owner a( the prop@rty br my employees with wa9es as their sole Campen5ation, will tlo Ihe wO�k, antl [he Structure IS nOt Intentletl o� otf¢r¢0 for sale (Section 7044, Business antl Profeszional Cotle: The Contractor'S LiG¢n5e ldw tlo¢s nol dpply [b an Owner Of a property who builtls or improves lhereon, antl who tloM such wOrk himSeH/horself o� thrOu9h his o� her own employees, provitle� tnat SUGh Improvements are not InlentlBtl o� oHaretl fo� sdle. Il, M1owovar, tha bullainy or improvemont I5 zoltl within ona year of com- pleliOn, tbe owner will have �ne burtlen o7 proving he/sh¢ tlitl not buIIG or im- rOve ior�he pur005o ol5ale), 1, as owner of thu property, am exclusively contrac[Ing wilh Ilcansetl con- ractors to tonstruct the proje�t 15ection 7044, Buslnass antl Protessions Catle: The Contractor'S License ldw does not dPPly lo an owne� 01 properly wh0 bui105 0� improvas thcreon, 8ntl who Con[�at[5 fo� suth prOjOGts with a con- `tractor(s) bconsu pursuant to the ConVactor's Llconse law). I am awara thaf prool 01 [bair WorkeYi COTpe�ns�(atl InSuranCO snoultl be prOvltletl to me. ❑ I am ¢xempt Untlel 5¢ctiOq +�'._�� _ B. 6 P. C. tOr this rea50n . Oatc �� Owner ��y3b1 o-�SJ+y_ I here y crtify that 1 have reatl this application antl/stata at tne abov IMormafl n is GOrBct. 1 ag�e@ to cOmply with all Uty antl cou ty o�tllnanCGS antl stale' lawi relating to buptling const�uction, antl hme y authorize �ep�e- sentatWez ot tNs tlry (o ent¢r�upon the above-m 1 etl Oroparty for inspettion purqq,5psy,� � ' � ate Signature ��1 16 Orivers' License or 55 � CMF 0065-46, rev. ]0/B4 Whita - guiltling; f.5 l�l E 3 J 47 8 "P"'`' "�` 70 �� 7 �TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR � ❑ CONVERSION ❑ DEMOLISH ❑ OTHER p,p,# �, �'U DESCRIPTION OF WORK/USE OF BLDG. S Main Buildi E TVPEOFPERMIT GRADING FOUNDATIO�Nj STRUCTVRAL T Front �TENANT �ELECTRICAL ❑ PLUMBING CSMECHANICAL 6 Reaf ❑ OTHER A PROJECT DESCRIPTION 5a. F. 0 oCCUa.a C�' - C Right K CONSTRVCTION TYPE VALUATION $_+ % S�� g LCft 20NE GRADING CU. V�S. ACRES Ping. Ref. � aemarks: � (�p /�,,. fr 7., Planning Notes: Bar Sink Back(low Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks GasService Outlets Interceptors Kimhen Sink Lavarories P-Trap Reinspection Fee $15 Duct-UnderGround Duct - Snucwral Duct-Ventilating - Exhoust System ❑ Multiple FirepUFact. BIL ICBO # Heating System & Ducting ❑0.100,000 BTU � 100,000 Reinspec[ion Fee ' - APPIIWnt; Pink - Acmuntin9; Goldenrotl - ASsesso� Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Poal w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash Isue Fee � 3 ��7� �2�08�87 — � � . ZOne L Accessory Building: Parking Req./Provided P.utomatic Washer Construction Pole Si Cooking Uni[ Dishwasher � Dryers �OGas ❑E Fan F.A.U. Fixtures Device Boxes Outlets SWIlChCS Garbage Dispoul Generator �0.5 KN lectric ELEC7RICAL Transformer ❑ 15-50 KW � 50+ KW Meter ❑up to 100 amps Merer ❑over100amps Sub Panel Motors OO-1 HP 01 %� 8 Inc. Solar �9-15 HP 016�15+ Microwave Pole Light Sign Standing Sections 5-15 KW Trash Compactor B 178a 55 ' •t,l� FEES Reinspection Fee I$15 Issue Fee $ 3 IANICAL FEES Hoodar Typel ❑ DEVELOPMENTSERVICESREQUIREMENTS: [y CanoPY TVPe l l ❑ 2oning APProved BY �� y/ Date �a '6 Building Approved By l,�„q Date - -- Retrigeration SVs[em ❑0.700,OOOBTU ❑t00,0006TU System Repair/Alteration FireDampers • Registers 515 Issue Fee 1 $ 3 Z O N 1 N G R E Q M T $ SUMcMsA�1RV'O'F FEES BUILDING PERMIT 5� SMIP $ ' S� � PLAN CHECK $ PERMIT - . PLUMBING g �SSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ � GRADING $ PLANCHECK 50% $ �. O MICROFILM $ MECHANICAL S ( �� TOTAL FEE $ � PLANCHECK 25% $ �•i � �� CONSTRUCTION AND�PLANNING � POOL & SPA . APPROVALS Permit # Date Inspectoi qppROVALS Permit # Date Inspeccor � i. Temporary Electrical Service or Pole 52. Pool & Equipment Location � 2. Soil Pipe-Undrgrnd. . 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement '�56. Rough Plumbing & Pressure Test � 6. Electrical 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 67. APPROVAL TO DECK 17. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final � 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final � 15. Rough Electrical-Conduit 66. Solar Sys[em-Final 16. Rough Electric Wiring 1 ,g-� 67. Fencing & Access Approval 17. Rough�Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough.Electrical-T Bar Ceiling _9_�� 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. RE�UIREMENT '� j 20. Rough Factory Fireplace APPROVALS Permit # ," _ � 21. Ducts,in Structure 70. Underground Hydro 22. Ducts, Ventiiating � 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush � -. _ 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil �� 25. Roof Sheathing 74. Overhead Hydro 6. 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. F�NAL . Drywall Nailing HEALTH DEPT. REQUIREMENT ' r 31. Plaster Brown Coat 79. FINAL INSPECT�ON • '� � 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED � � 33. Final Electric. �6 Notes: � . . � 34. Final Heating & Air Conditioning i�/� • .� 35. Final Gas Pipe-Test � . 36. Hood.or Canopy � � 37. Final Faaory 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 At[enuation . - ' � 46. Handicap Regulations 47: FINAL STRUCTURE & BUILDING �6 ' - " 48. Special Requirements Completed " ' . 49. Electric Release to Edison , . � 50. Gas Release to Southern California Gas Co � �' 51. CERTIFICATE OF OCCUPANCY� No. �Date . � � City of Costa Mesa Development Services Department Building Safety Division P. 0. Boz 7200 Costa Mesa, Califomia CERTIFICATE OF OCCUPANCY No. OO�`4�� The Building located at 777 WE+st 19th Street, Unit 106 has been inspected and found to compiy with the provisions of all City of Costa Mesa Ordinances applicable there[o for a Group ua Occupancy. Use of Building �`nmmoriral Legal Description d�A��(11—h'i (See reverse side for Metes antl Bounds) Building Permit No BEd32885 Electrical Permit No. � 32885 Plumbing Permii No._ Mechaniral Permit No. Number of apartments and/or guest rooms ISSUED T0: r.ar.-v n�mnnla 17632 Iroine Blvd. m„aran. �a Q�FRC1 Building Official William T. Hot�ard ' , _ / by ..`� � a-'� /� G „ � Date Jutte 7, 1988 7his Certificate of Occupancy SHAIL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CMF 1 W 5-46 rev. 1/83 White -Owner; Canary - Numericai File; Pink - 81dg. Permit File AOD��ant to fill in all spacey axCeD� tnose withln heavy Cortler Ilnvs a�G sign all aOP�opriale Oeclarations. CITY pF CO3T{�',pQ/E/S-7n CRN�,S]TR CC/TyIO-LN PERMI_T_ :}-�� ' Projee[F.ildress . I � I � ""f7� � 1 l "�--- W�^ Appli�9nt's f�IB,li g Add es �/�� , Owr�e�s Nam� � o o �" Phone �� Address � � ArchlEng. N license No. Address Contractor's Nam F Phone Address (mailing) City �icense No. LICENSED CONTRACTOR DECLARATION 1 hereby aftirm tijat I am licensatl untler vrovizlons ot Charter 9(commoncing with 4¢ction ]OOd) ot Division 3 of Ihe Buzinau antl Profez5ions Cotle, anU my license is in full force antl eifect. Licenge Class license No. DaIC $i9natura WORKERS' COMVENSATION DECLARATION � I ne�eby aHirm Ibat 1 have a certilitdt! ot consept to sefl-InSUre o� a cartiOGate f WOrkers' Compensation Insurance, or a c¢rtifie� copY thereof (Sectlon 800, Lab. C.) Policy No. Company Ce�tifietl coOY �5 he�eby fu/nisnetl. Certifietl copY 75 filetl with the city Builtling bivision. Date Applicant EXEMPTION FROM WORKERS' COMPENSATIpN OECLARATION (This:ection neetl not be completetl it the permit i51or one hUntlretl (5100) or less). I rorti(y that in Ihe oer(ormance of lhe work tor whicn this perm�t Is Issuetl, I shall hot employ any person in any mauper so ;s ta�be�+ne subject to the Work@rYCfpinpeP�tion Lawsof CalHo�nl#� L Yla \V Date NOT��E:'1!, atter mdkln9 this tlBtla�atiort, you Shoula �ecortle SubJeci [o [4B Workers' Compensdtlon provisions Of lhe LabOr Cotla, you mvst torlhwith comply witn sucM1 provizions or tnis permit shall be tleemetl rovoketl. CON$TRUCTION LENDING AGENCV I hareby aHirm [hat there is a constructlon lenaing agen<y for tne parformance ol Ihe work tor which th15 permlt iz IssUetl (Suctlon 3097 Clv. CJ lEna@r's Name ' LentlCr•5 Atltlress OWNER BUIL�EH UECLARATION I her�by altirrn �hdt I am ¢xempt Hom the Con[raclor'S Llcense Lnw tor the /oilowing roason ($oction 7031.5 Businass antl Protostional Cotle: Any dty or [ounry whlch r¢quir¢5 a p¢rmit to <onst�utt, alter, imp/ove, tlemollsh Or �epdir any 4(ructure, prbr to its issuanco, also requiras tha apo��<ant tor such pormit l0 1lle a signCtl Stdtement lhat ho/sho Is IICYnS¢tl PUISudn[ to the prOVISiOns o/ the Contractor'S License Law (C�aO�er 9(commendn9 with Sectlon 7000) of Divis�on 3 of lhe Bu5ine55 antl PrOlesslon5 Cotle) or that he/She is ¢xaTO� �e�eirOm antl Iho basii for [be all¢getl exGmptiOn. Any viOlatlon oi $ectlon 131,5 by any appllcant Por a permit subj¢cts Iha applicant to a civil .y�alty o1 nOl mOre than iiva huntlrCtl O011ars (5500). �'� a5 Ownor of tha OrOpprty or my emplOyeet with wd985 as th0ir solo compensation, wlll Oo tha work, antl lhe slructure is not intentletl or oHer¢O for ;ala (Sectlon 7044, Business antl Pwtessional Cotle: Tha Contraclor's LiGeqS¢ �aw tloes nOt apply to an Owner Ot a p�operty wh0 builtls or Imp�oV¢s tnar@On. antl who tlo¢5 such wOrk ItImSeH/herself or through his or her Own employees, provi08tl that SUCh improvem¢nls dre nOt Intentl80 0� offOretl for Sale. �i, nowaver, the builtling or improvement is soitl within one year of cOm- ple80n, thG owne/ wlll have NB burtlen Of proving hC/S�e tlitl nOt builtl O� Im- ,�Ov! tor the purpose of sale). LI I, as owner of ihe prOPerty, am axclusively Contrac[Ing with Ilceniea cOn- Ilatl015 t0 COOStluCl thG pfOj¢C[ (SCCIiOn 7044, BUSIf1855 dOtl Pl0(BTSIOOS COtlB: Tho COnVac[o�'s LlcenSe Law does not apply t0 an owner of p�operly who bWlas or Improvas thereon, antl who concractz for such projects witn a<on- tractar(s) ucenie pursuant to the Contrac[or's Liconsn �aw). I am awarn that proo} of thelr Worker's Compensatlon insurance snoultl be provitletl to me. �� am ezem0� untler Section .B. 6 P. C. tor thii reason Date Signature .�`��7�'4 Drivers' License or 55 CMF OBg5-46, rev. 30/84 Owner antl �E 32885 � �c 7VPE OF CONSTRUCTfON. NE ❑ CONVERSION ❑ DEMOLISH DESCRIPTION pF WORK/USE-OF J AOD OTNER TVPE OF PERMIT LJ GRADING U FOVNDATION LJ STRUCTURAL �, TENANT �ELECTRIGAL ❑ PLVMBING ❑ MpCHANIGAL ❑ OTHER PROJECT DESCRIPTION 5 T. oCCUaA/ry, �Cv�_�ry CONSTRUCTIONTVPE�,�� VALUATIONS�,'�'.�'%" ZONE GRADINGCU.VDS. ACRE�� Remarks: `'Y„ � /7 —� ,� ��[J P Bar Sink Back(low Preventer Backflow Irrigation 8athtubs Clarifiers • Dishwdsher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors � Kitchen Sink Lavatories P-Trep Roof Drains Reinspection Fee � $15 �uct- Under Ground Duct � Sttuctural DUct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. B�t. IC80 # Hea[ing Sys[em & Ducting ❑ ai oo,000 eru O i oo,oao Heinspection Fee � $15 White - 9uiltlin9; Cana�y - Appliwnt; Pink - ACCounting; GOltlenrotl - Asse55o� Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank $wimming Pool wl5pa Urinal Water Clout Water Heater Water Service Auto-Wesh Laundry Trays I�sue Fae Hoadar Typel ❑ Canopy Type I I ❑ Fiefrigeration System ❑0.100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee FEES $ 3 $ 3 A.P. vW - S Main Building: E T FrOnt ARear � Right g Left Ping. Ret. �h Planning Notes: , /�� Auromatic Washer Construction Pole Sub. Cooking Unit Dishwasher � Fan F.A.U. Fixtures '2O Device eoxes Ou�le[s Switches Garbage Disposal Generator �0�5 KW 8188 4/05/8� Zone Accessory Building: Parking Req./Provided EIECTRICAL Transtormer ❑ 15-50 KW ❑ 50+KW Metei ❑up to 100 amps Meter ❑over 100 amps 15 KW Sub Panel Motors �0.1 HP 01 :4 � 8 Inc.Solar �9-15 HP []16-15+ Microwave Pole Light Range Sign Standing $�ctions Trash Compactor �4�oCii Ti FEES 2 O N I N G R E U M T S Reinspection Fee $15 Issue Fee $ DEVELOPMENTSERVICESRE�UIREMENTS:�/y� �.. .� S oD 2onin9 APProvad BV — (/�/G!'f'AtB CX) Building Approved By Date Appliption Issued By Data� SU MARY OF FEES BUILDING PEFMI7 $ O SMIP - $ .�.3s- PLAN CHECK $ I .% C� pERM1T PLUMBING $ ISSUANCE 5 PLAN CHECK 25% S ENERGY P.C. 5 ELECTRICAL g S GRADING S PLANCHECK 50% $ MICROFILM $ i MECHANICAL $ TOTALPEE $ PLAN CHECK 25% $ 543. �8 � +�},� � ONSTflUCTION AND PLANNING � `• ° POOL & SPA � � Date .- Inspector � Date. Inspector �' APPROVALS (�Permit # � _ ,, - APPROVALS Permit # � i ��1�;Temporary Electrical Service or Pole 52. Pool & Equipment Location ��2.� Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Elec[rical Conduit Utility-Undrgrnd. 54. Forms � 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test � 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. F"oetings `"� � 58. Electrical Conduit-Undrgrnd. 8. Foundation�. '- 59. Gas Pipe, O Undrgmd., 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 � � 72. Sewer Cap 63. Heater & Vent-Final 73. Roof Drains - ' 64. Plumbing System - Final 74. RoughPlumbing . 65. Electrical-Final .� 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 3 "•� �`. 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING ' 18. Rough Electrical-T Bar Ceiling ,J 69. POOL/SPA SYSTEMS FINAL ��" 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �[!i � �-L O U 20. Rough Factory Fireplace APPROVALS Permit #�� •- 21. Ducts, in Structure " - . 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil � 23. Gas Pipe-Rough & Test 72. Underground Flush � 24. Roof Framing ' 73. Undergrnd.StorageTank�Gas ❑Oil � 25. Roof Sheathing 74. Overhead Hydro �� 26.'T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical .r ' � 27. Frame and Flashing �� $g �•� 76. Dry Standpipe . � 7 28. Lathing & Siding 77. FIXED SYSTEM FINAL '-� 29. Insulation 78. FIRE PREV. FINAL ' � 30. Drywall Nailing HEALTH OEPT. REQUIREMENT 37. Plaster Brown Coat 79. FINAL INSPECTION i'� 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED ,� ;� 33. Final Electric� Notes: � � � on ('� 34. Final Heating & Air Conditioning �' (�� n 35. Finai Gas Pipe-Test �� -� , '`�� 36. Hood or Canopy �i , 37. Final Factory Fireplace � " ,.�• 38. Final Plumbing 39. Water Service-Final - ' 40. Gas Service-Final . 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation n_ 44. -Landscape Irrigation System •�1' / 45. Sound Attenuation �'1 i 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING � 7�p' �. '"- 48. Special Requirements Completed . . 49. Electric Reiease to Edison � 50. Gas Release to Southern California Gas Co •. �, 51. CERTIFICATE OF OCCUPANCY � � No. Date � { AOD��ant to flll In all spaces except those within hvavy eorticr Iinez ana sign all aoProprlate tleclantions. CITV OF CGSfiA M6^$A/� CONSTR UCTION PE�MIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. Project qddress � � / �ll ( � � � � � Appli��('s Mailfng Address �- -- F' � Owner'sName �-A RR�� n� /-C. Phone�3X8& Address �— Arch/�n9. ~� License No. Address Contractor's Nam N hone Addre9s (mailing) Ciry License No. LICENSED CONTRACTOR DECLAqATION 1 nereqy aflirm that 1 am ticensetl untler provislons al Charter 9(Wmmancin9 wi[h sq<[ion ]000) Of Division 3 Of tho Business antl Profess(onz Cotle, antl my Iicense is in ful� 1or<e antl eHect, Licensp Class l.icense No. Dale Si9na[ure WORKERS' COMPENSATION OECLARATION I hereGy atlirm that I have a certlfiWte ot tonzent ta Self-insure or a certHicate t Workers' Compensation Inzurance, or a certlfietl <o0Y thereof (Sectlon 300, I,.ab. C.) Policy No. Company eCer�{(�etl copy is Oereby turnishetl. CeRi(lea copy is tiletl with tne city Builtling Division. Date APO��carlt EXEMpT10N FROM WORKERS' COMPENSATION DECLARATION (Tnis sCction nead no[ be com0�ateC it Ibe Dermit is (or one huntlretl (5100) or less). I cer[i�y [hat in tne Oerfo�manca O/ tne work� 1�0�� W=+h.i�t��hA��[,h,`is pe�rtiit i5 755ue0, I shall not m0 oy any person in any e�apn er` ` ``.` ema subject to lhe Work 5' o lon Laws oi CalifoYMe. Date _S9�a[ure Y NOTIC : II, a ter making this tleclaration, you snoul ecome iub7ect to the Workets' Compensation Provi5ion5 of tne Ldbor Cotle, you mu5t forthwith comply with such provisions or this parm(t thall be tleemea revoketl. CONS7RUCTION LENDING AGENCV 1 M1ereby afflrm lhat tpare is a mns[ructlon lentling agency for the performanco af thg work for which t�is permit is ftsued (Sec[ion 3097 Clv. C.) Lentler's Namo Lentler's Atltlress OWNER BUILDEH UECLARATION I hereby aHlrm tnat I'am axempt irom tha Cantractor's Licensa Law tor tha tollowing reazon (Section�]031.5 Buslneis antl Professlonal CoCe: Any citY or counlv which reaui�es a aetmit [O conilruct. alle�. improve, tlemollsh or wpah also on 3 of ihu Business antl Prolesslons Cotle) or that ne/snn Is enempt rom antl tbo bazis for the alle9ed axomptlon. Any violation ot $octlon 5 by any appllcant for a permit zubjects [na apPlicant [o a civll '.y of not more than tive huntlretl tlollars (5500). as owner ol lhe p�o0erty Or my omployeo5 wltM1 wages as lhalr sole on5ation, wlll tl0 the wOrk, antl lha Slructure IS not in[¢ntletl Or otier80 �la (Sectlon 7044, Business antl Professional Cotle: Tha Contra<tor's S¢ Law tloes not apply to an owner ot a property who builds or improves �n, antl wM10 tloe5 5uch work blmSOH/bariolt or thrOugh �ii or bar own ryce5, Provitletl that such Improvom¢nts ate nOt intentl¢tl o� olleretl fo� �.t, �owaver, tho builtlin9 or improvement I5 soltl within ona ycar of com- n, tba ownar Will have lh¢ OUrtlan oi provfng M1C/Sbe tlitl nat bWld or im- tor tha purposa Ot sale). os owner ol tt�e prOpe�ty, atYi excluSively Conl�actin9 with Iic¢nzotl con- i!s t0 ConStrUct Ihe proj¢ct (SlCtion 7044, Buslne55 anE Prot¢SSIonS COde: .onVactor's License La'�v doe5 not dpPty to an owner o1 propCrly wh0 � or ImOrovos tnoreon, antl who conVacts for such projects witb a con- ir�s7 bcense pursuant [o the ConVactor's License Law). I am aware that 01 thelr Worker'S Comp¢nzation Insurance shoultl be provltlOtl t0 ma. m exem0� under Seciion B. & P. C. tor lhi5 cgaSon Date ��OR Owner < I hereby certity that I have reatl this applicatl information Is correct. I a9�ee to comO�Y `��h al antl state laws relating to builtlin9 conStructlon, a seniatives ol this city to enter upon 1h9� abov Drivers' Littnse or "55 $ �.� ° 0865-46, �ev. ]0/84 Wbite - Bui Pink 7YPE OFCDNSTRUCTION LJ NEW LJ ADD IJ ALTERqTION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER p.P .A6 DESCRIPTION OF WORK/USE OF BLDG. S Main Buildi E TYPE OF PERMIT GRA�ING FOUNDATION STRVCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 6 Reer - ❑ OTHER %� PROJECT DESCRIPTION SQ. F7. oCCVPANCv � C Right K CONSTRUCTIONTVPE VALUATIONS g Lefl ZONE GRqDING CU.YDS. ACR Ping, Ref. �h a�maras: Piannina No[es: Bar Sink Backflow Preventer Backflow Irrigation Drinking Fountains FloOr Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories Roof Drains Reinspaction Fea � $15 Boiler Duct- UnderGraund Duct - Structurul Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact Blt. ICBO # Heating System & Ducting ❑P100,000 BTU 0100,000 Reinspection Fee Goltlenrotl - As5C55ar $15 Showers Service Sink Sewer Cap Sewer Connection Solar Co�lecrors Solar Piping Solar Tank Swimmin9 Pool w/Spa Urinal Water Closet Water Heater Wo�er Service Auto-Wesh laue Fee Hoodor Typel ❑ Cenopy Type I I ❑ Refrigeration System ❑o-�oo,000eTu ❑ioo,000 System Repair/Alterati0n Fire Dampers Registers Issue Fee FEES $ 3 FEES S 3 Automatic Washer Construction Pole Sub. Cooking Unit . Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Davice Boxes Ouclets Switches Garbage Disposal Generator �0�5 KW �5-15 2one Accessory Building: ELEC7RICAL Transformer ❑ 15-50 KW ❑ SO+KW Meter ❑up to 100amps Meter ❑over 100 amps Suh Panel Morors O0.1 HP O1'f. �.8 Inc.Solar �9-15 HP �16-15+ Microwave Pole Li9ht Range Sign Stending Settions Tresh Compattor � Reinspaction Fea � � $15 � � luue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approv9tl By Buildin8 APProved By Appliptian Issued Bv FEES $ 3 SUMMARY OF FEES Bq11,IL I PER U�/ g '� SMIP $ �+�a�� 'S 3�-oJ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. S ELECTRICAL § GRADING S PLAN CHECK 50% $ MICROFILM 5 MECHANICAL $ TOTAL FEE $ 30.00 PLAN CHECK 25% $ 2 O N I N G R E � M T $ D10GDD534i-DDDD5341 TC�'!' 3�,�t3 CONSTRUCTION AND PLANNING POOL & SPA qPPROVAIS Permif.5�k Date �Inspector qpPROVALS Permit# Date Inspector 1.�;femporary Electrical $�rvice or Pole 52. Pool & Equipment Location u 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement _ 3. Electrical Conduit Utiliry-Undrgrnd. 54. FormS ' ' . 4. Electrical Conduit-Untligrnd. 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 n. 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 70. Structural Floor System 67. APPROVAL TO DECK 71. Roperty Sewer Line & House Connection 62. Backwash & Receptor-Final , 12. Sewer Cap t� 63. Heater & Vent-Final �� 13. Roof Drains: �. • 64. Plumbing System - Final 14. Rough Plumbirg 65. Electrical-Finai 15. Rough ElecYr.ical�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. flough Factory Fireplace APPROVALS Permit # , 21. Ducts, in Structure 70. Underground Hydro ` 22. Ducts, Ventilating 71. Product Piping OGas OOiI 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT !'� 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Eiectrical Power Meter-Final 80. F000 CERTIFICATE ISSUED �� 33. Final Electric Notes: . . � 34. Final Heating & Air Conditioning .;� 35. Final Gas Pipe-Test � .-; 36. Hood or Canopy ' 37. Final Factory Fireplace � � � 38. Final Plumbing � ; 39. Water Service-Final ' 40. Gas Service-Final � � � � 41. Solar pomestic-Final , 42. Backflow Preventer � � �✓' ' 43. Backflow Irrigation� - � ;' � . � 44. Landscape Irrigation System • � 45. Sound Attenuation . - 46. Handirap Regulations ' 47. FINAL STRUCTURE & BUILDING G�� ' � � <. 48. Special �Requirements Completed � � . ' 49. Electric�Fielease to Edison . ^ :'� • a� 50. Gas Release to Southem Califomia Gas Co � j 51. CERTIFICATE OF OCCUPANCY - - No. Date _ , . l ,F \ Ciry of Cosca Mesa Developmen[ Services Department Building Sateiy Division P. O. Bon 1200 Costa Mesa, Calitomia CERTIFICATE OF OCCUPANCY No. OO't}�� a 7ne Building located at 777 41est 19th E',trest. Unita 101 +F ]09 . has been inspected and found to comply wi[h the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group � Occupancy. Use of Building Office Legal Description 429-201-03 (See reverse side for Metes and Boundsl Building Permit NoR�`7 27371 Electrical Permit No. �1 27371 Plumbing Permit No Mechanical Permit No. BEHY127371 Number of apartments and/or guest rooms ISSUED TO: Larrv O'ZUolo 17632 Irvin� Blvd. �stin, CA 92680 BuildingOfficial-��`'''r�- � =- ' - _ by � Date M�1rch 10, 1987 This Certificate of Occupancy SHALL BE pOsted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CMF 1015-46 rev. 1/83 Whice -Owner, Canary - Numerical File; Pink - Bldg. Permit File \� -. - C /• �5 1� C'<TYOF COST CONSTRU�TJ�3N P` R�yM�IT _ R�ctAd�res _ /��,_'�2�jy�^ . L Aoo�ican�' ailinoAddreu r��LK Address'•_�_�( - -� � •'�a � ArchlEng. ^ L � �icenu No. � Address �� ) AC�J �LOyi1}�i- j�lY. �U1.:�/J�'J �/a Contractor's Nam��-1/^�T�� 1`ti �� pll0llC 1��1..y� Addr@ss (mailingl �^"�� S,S.�.' C%2�� Ciry License No. � _(2%%�i - LICENSE� CONTRACTOR DECLARATION ' I ner@by aftirm tnat I am licenzea untler provisions ot Charter 9(commencing with u<tion 7000) of Divizlon 3 of tho Busineu antl Professions Cotle, antl my IiCense is in fu orre ana effect. �/ / L1cen CI �±-- � Li e se No. b Dalc(��(-�/� 5�9 t e - WORKERS' COMPENSATION OE L RATIO I heraby affirm,that 1 nave a certilic oi con to self-insu or a cmtillcate �I workers' Compensation Insurance, or a certifletl copy Ihoreoi (Sectlon l800� �.ab. C.) Polity No. Company �CCrtitie0 copy is hereby furnishetl. C@ttiti¢tl coOY �5 tite0 wiih tAe city Builtling Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSqT10N DECLARATION (This s¢�(ion neetl nOt be completetl il th0 permR i5 tor On0 nuntlr¢tl ($100) or lezs�. I cerqly [hat In t�c Parfo�mance of thB wo�k fOr whlch ih15 pCrm�t Is iSSuetl 1 shall not employ any person in any m neL so as to pepome subj�ct to �e Workess' ComneuaLon Laws of Califom� fJ A. '3.\_ J� � Data �'� � Si9nature NOTIC : It. altor making Inis tleclaratlon y sh Decoma subje t o the Workers' COmponsaUOn provi5ion5 of Ihe bor , you musl f bwlN tomply wilh Such p�ovl5iOn5 0� [his perTlt Shall bB tlGemetl revoketl. CON$TRUCTION LENDIfJG AGENCY I heraby aftirm that thare is a construcHon lentlin9 agen<y tor tne performance Of Ihe work for� which this peymit i5 issuetl (Sec[ion 309] Civ. C.) Lentler's Name - � � N Lentle�'S Atltlress �� OWNER BUILDEH UECLARATION I h¢reby aHirm [ha4'I �am exampt trom lho Contractor'i Llcensa Law (or Ine tollowing reasun (Sactlon 7031.5 Buslnoss antl Professional Cotle: AnY tlty or <ounty wNch reqWres`a permit to construct, alter, improve, tlemolish or re0air any structure, prloi to Its Issuance, also requlres the applicant tor such pormit t0 171e a slgnatl slalUment that ha/She f5 I(ceqSCtl pul5udnt to thC proviSiOns o/ t�e ConUactor's l.iconse Law (Cbapler 9(commencin9 with SocHon �000) of .Dlvl4ion 3 ot the Business antl Prof¢55ion5 COAe) or that he/she is azempt ;:��031�5 bY�anYhaPP�aantorft�he�allPeemtX ubPects thaYaPPlic�ant to dec'Ivil ��!'.Senalty of no[ more than five huntlretl tlollars (E500). ❑ I� az owne� of th¢ P/o0erty or my employee5 with wd9e5 as thei� Solo comp¢nsation, will tlo Ihe work, antl the SVuciure is no[ intentletl or otfered for sale (Section 7044, Businesz antl Profezzional Catle: The Contractor's Llcehse Law tloe5 not apply [O an owne� Of a praperty who bulltl5 O/ irtlprOveS thereon, antl wno tloes sucn work nimself/nerzell or tnrouqn niz or ner own employee5, provltletl lhat such Imp�ovOmantS a�e nOt Int¢�tle0 0� offe�etl f0� sate. If, however, tna bulltlin9 0� improvemant is soltl wltnin one yca� of COm- pletion, the owner wlll nave tne burtlon ot provin9 he/she tlIE not builtl or Im- plOvO �Or ttle purposa OI sale). ❑ �, a5 ownCr of [he Oroparty, am oxcluSlvBly ConVacllnq wi[b Ilc¢nSBG COO- tractorsto consVucl lne project (SetUon 7044, Business antl ProtessionS Cotle: Tha COntractor's LICOnse Ldw does not apply to an owner O� property who builtls or improves tltereon, antl who contracts tor suclt pro�ects wltb a mn- Vactor(s) ucense Oursuant to [he Contraccor•s �icense L.aw�. I am aware that proof of thelr Worker's Compensation insurance shoultl be provitletl to me. ❑� am exempt untlar Sectbn 8. & P. C. for this reason Date I M1¢rCby cErtily (ha inlormation Is corroc antl state laws relatii sentetives ( tnis ci Inspection p Si9nature Driveri' Lice 5 or 5 CMF 0865-46, rev. 30/84 r — Owner I have reatl this apolicatlon anU stato that the above I agree to comply wl(h a�l city antl county ortlinantas to builtlin9 consbucpon, antl heroby authorize repre- r(pL1ye,nter� po/n tha abovo-mentionetl Propy��Jrty��/Iy(/ � p�./X Datu��0' O ( �` '� to41�1 in ill soaces ezcev< <nos�vy Ca�Cc� Ilnes antl sign ill approD��ate tleclaratlons. � �j t�i�o0\ IJ ( � /✓N/A�/"rrl4 L�6.� ��I/ d- /l7 TYPE OFCONSTRUCTION NEW AD� LTERATION RE4AIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ��^^^ ,,,,,,��- DESCRIPTION OF WORKNSE OF BLDG. -TQN4.6ti��C�"P"', .� TVPEOFPERMIT GRADING FOVNDATION STRUCTURAL ❑ TENANT � ELECTRICAI ❑ PLVMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION i �� oCCUaArvcv ` CO N STRUGTION TYP� V A WATION 4�Q�� '�� ZONE GRADINGCU.VDS. ACRES- Bar Sink 6ackflow Prevenrer Backflow Irriga[ion 9athiubs Clarifiers Dishvrasher '• D�rinking FOuntains Floar Drains Floor Sinks Gas Service Outlets Interceptors � Kitchen Sink � � Lavatories P-Trep � "''' � Roof Drains �' Reinspection Fee $15 Boiler Duct - Under Ground Duct � Structural Duct - Ventilating Exhaust System ❑ Multiple FirepVPact. Blt. IC80 # Heating System & Ducting ❑0-100,000 BTU O70p,000 Reinspection Fee I S15 Whi[e - Buildin9; Canary - AO��Canh Pink - Accounting: Goleenrotl - Assesso� Showers Service Sink Sewer Cap Sewer Connection Solar Collecmrs Solar Piping Solar Tank Swimming Pool wl UrinBl Water Closet Warer Heater � Water Service Auto-wash Issue Hoad or Typel Canopy Typell Refrige�ation System ❑o-ioo,000eru ❑ioo,000 System Repair/Alterotion Fire Dampers Registerz � � laue Fee FEES � e A.P. # S Main Bi E T Front 8 Rear A C fiight K Left S Ping. Ref. #E 2446 2/18/fJ7 aqa_ar, 1� b . d � Zona �I Accessory Building: Z O N I N G R Parking Req.lProvided E Q M - /' __ � / T AutomatiC Washer Construction Pole Cookirtg Uni[ Dishwasher Dryers �Gas ❑ Fan F.A.U. IICAL Trans(ormer ❑ 15�50KW ❑ 50+KW Me[er LJup to t00amps Meter �over.100amps Electric • Sub Panel . Motors OO-1 HP O7 %- 8 Inc. Solar 0g.15 HP �16�15+ ,Device Boxes Outlets (� Switches . / � Garbage Disposal Generator D0�5 KW OS-15 $ 3 I � Reinspection Fee $75 FEES DEVELOPMENT SEHVICES RE�i 2oning Approved By i Building Approved By S . ADolitetion Issuod BV $ 3 Pole Light Fange Standing Sections Trash Compacror luue Fee EMENTS: SU/MbMA'N�V �OF ,�y�J BUILDING PERMIT $ =-1� r `�PLAN CHECK $ 6 �PLUM8ING � S PLAN CHECK 25% 3 ^ ELECTRICAL $�� PLAN CHECK 50� g —��. Ion�A MECHANICAL 5 °'�y"" PLANCHECK 25% g lS-OD FEES S 3 �. � a./O SMIP $ PERMIT ISSUANCE S ENERGV P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ �� .. CONSTRUC710N AND PLA�NNING '_ POOL & SPA . APPROVALS Permit # Date Inspector � pppROVALS Permit �k ' � Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe�Undrgrnd. 53. Steel Reintorcement .. 3. Electrical Cpnduit Utility-Undrgrnd. 54. Forms 4. Electrical COnduit-Undrgrnd. 55. Electrical Bonding „ 5. Steel Reinfprcement 56.. RoGgh Plumbing & Pressure Test . 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE � 7. Footings 58. Electrical Conduit-Undrgrnd. 6. Foundation �' , , � `, r 59. C�aS P�Pe, O Undrgmd., Test 9. Water Pipe-Undrgrnd. : • • 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Structural Floor System ��' (V 61. APPROVAL TO DECK .• ' 71. Property Sewer Line & House Connection � 62. Backwash & Receptor-Final 12. Sewer Cap . 63. Heater & Vent-Final � 13. Roof DrainS 64. Plumbing System - Final �. 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Condui[ 66. Solar SYs[em-Final . 16. Rough Electric Wiring _yw��' � 67. Fencing & Access Approval • 17. Rough Wiring Si9� 68. APPROVED FOR PLASTERING 78. Rough Electrical-T Bar Ceiling �,�� ✓� 69. POOUSPA SYSTEMS FINAL � " 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT � 20. Rough Factory Fireplace APPROVALS Permit # _ �� 21. Ducts, in Structure 70. Underground Hydro J� - 22. Ducts; Ventilating . 71. Product Piping OGas ❑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 . 3 b� 76. Dry Standpipe ' - , r. 28. Lathing &$iding 77. FIXED SYSTEM FINAL � 29. Insulation 7$. FIRE PREV. FINAL 30. Drywall Nailing S HEALTH DEPT. REQUIREMENT i 31. Plaster Brown Coat 79. FINAL INSPECTION �. 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE �SSUED 33. Final Electric .r�_F� � Notes: • 34. Final Heating & Air Conditioning � G � � ,%j/JF C6� ��- � ' ' 35. Final Gas Pipe-Tes[� . 36..Hood or Canopy , .�, v �� .. 37,�Final Factory Fireplace �' ' �;';�., . �: Z � ~ .- :._ ..i 38; Final Plumbing •. _ : '��: -- ' :t� . �Water Service-Final i ��, � , � , -; �f, 40. GasService•Final 7•;_ ' ' .;1= ;"'�jt,r S�- t, ' �, �4]. Solar pomestic-Final !�, 5�... n�� u) :. l� I;. � '. �42. Backflow Preventer '. , . .' � .: .l . � i. � [: � .. 1 7 . -"� -�.� f43. Backflow Irrigation � ..'� � .��': i�` %' . ..,-. .,, � � - ; , i �. .,' �.,,. . ' ' iA4l Landscape Irrigation System � � , . , -. "'� •'� -' � ��- r. ` .t � '�45. Sound Attenuation �-• � . �• �;�.�'i- - �' -^ ' - � i 46:_-Handirap Regulations - �' � � ( -;: `} `; � � 47�. FINAL STRUCTURE & BUILDING ? r�� g'^' �' `?: Y .. : 1 I V �l � •: � .. . . • � 48:�Special Requirements Completed �, ,,�" • i;�-,:,. , � �`49 `�Electric Release to Edison '" ' = _ `' -1, ' 50. Gas Release to Southern California Gas Co �-• �,- 51. CERTIFICATE OF OCCUPANCY No. Date M