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Home My WebLink About867 19TH ST - Building Permits� City of Costa Mesa Development Services Department Building Safety Division P. O. Box 1200 Cos�a Meu, California CERTIFICATE OF OCCUPANCY No. ��s�� The Building located at 8�7 W. 19th St�.3t T� c.n� has been inspected and found to comply with the provisions of all C for a Group R-1 Occupancy. Use of Building Taimrlrv Rnrnn of Costa Mesa Ordinances applicable thereto Legal Descriptio� APlkd�A_191-l1d �� ISee reverse side for Metes and Bounds) Building Permit No AP lA�dd Electrical Permit No. R 1�FA'i Plumbing Permit N Mechanical Permit No. M� a�� Number of apartments and/or guest rooms ISSUED T0: BuildingOfficial ��i /� � �-'Uv/'�- A+lnaa Rru.a�a Anarf�rtinnl- s ' '-' - � 1 —i ' ' � by �� i l%.s�i�r.'L. �7�1 Takc� C'anf�nr fT^itm: F.1 �Ihm� rn o� �° (�� /�� This Certificate of Occupancy SHALL BE posted in a conspieuous place on the premises am! SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CntF 1015-46 rev. 1/83 White - Owner; Canary - Numeriwl File; Pink - Bldg. Permit File � City of Costa Mew Development Services Depanment Building Safety Division P.O.Box 1200 Costa Mesa, California CERTIFICATE OF OCCUPANCY No.00��O The Building located at 867 4JFST 19'14i SI`f�ET 13U7SAIt�'G �F has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group F�1 Occupancy. Use of Building APARii�t�PPS � Legal Description 424r191-04 ' (See reverse side for Metes and Bounds) Building Permit No RP1Af142 Electrical Permit No. E19081 Plumbing Permit No �18042 Mechanical Permit No. T� Q�t� Number of apartments and/or guest rooms ISSUE'D T0: BuildingOfficial �'J� /�- ' I -��C DtFSA BR1�ZE: APAI7IS+IE:f�TS �, bY�l/, C � i.�,�� — ��Zoi i,� c� Du.. �zoo. a, �nRo. cA. o� �G �-a�.�/�� This Certificate of Occupancy SHALL BE ported in a conspicuous place on the premises and SHALL NOT BE remov¢d except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. ChtF 1015-46 rev. 1/83 White-Owner; Canary - Numerical File; Pink -Bldg. Permit File _<. � . Ciry of Costa Me�y Development Services D¢partment Building $afety Diy{sion P. O. Box 1200 Costa Mesa, Califqrnia CERTIFICATE OF OCCUPANCY No. Q�+�b��l� The Building located at a�7 ruccn tamu cmvc�m aTrrrr7n*r t:r has been inspecteq and found to comply with the provisions of all City of Costa Mesa Ordinances appticable thereto for a Group R-1 Occupancy. � Use of euilding AP�lYIBYEi�PfS Legal Description_ 424-191-09 _ _ _ (See reverse side for Metes and Bounds) Building Permit No BP18041 Electrical Permit No. �9080 Plumbing Permit No. �18041 Mechanical Permit No. ''R�925� fVumber of apartments � and/or guest rooms iSSUED ro: BuildingOfficial �� (` � ! 7�� I-1�SA SF�ZE APAFi'if�PIS bY �'''��/ L .-•1/lt1•1sEZ/%1�--� Zsoi r� cnv��:x na.. stzoo. Ec. �. c�.. o� � G��'� /�/� This Certificate of Oeeupancy SHALL BE posted in a conspicuous place on the premises arnl SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CMF 1015-46 rev. 1/83 White - Owner; Canary � Numerical File; Pink - Bldg. Permit File City of Costa Mesa Developmenl Services Department Builtlin9 Safety Division P. O: BOa 1200 Costa Mesa, California CERTIFICATE OF OCCUPANCY Na. OG2372 The Building located at RS7 47RCT 1Wf4i G'I`RF:F'P Ri1TTniTIf: #I) has been inspected and found to comply with [he provisions of all City of Costa Mesa Ordinances applicable thereto for a Group R-1 Occupancy. Use of Building AP p� TPf!C Legal Description d�d_1Q1—(14 ISee reverse side for Me[es end Baundsl Building Permit No.�l�nd� Electrical Permit No. F:10df19 Plumbing Permit No9A1Rl140 Mechanical Permit No. j�i; �� Number of apartments and/or guest rooms ISSUEDTO: BuildingOfficial �� J�i'� ro�ca n�r.m. anawrnr�umc b /'� %(1 ��"� C� y` // � ��m TA7(F hF'i�PT4'R f1R H7(1(1 FT. �Y1M� CA. Dace ��{�/� �%i"J This Certificate of Oeeupancy SHALL BE ported in a conspicuous place on the premises and SHALL NOT BE remwed exeept by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CnnF 1o15-a6 rev. 1/83 White -Owner; Canary - Numerical File; Pink - Bldg. Permit File City of Costa Mesa Development Services Department Building Safety Division P. O. Box 7200 Costa Mesa, Califomia CERTIFICATE OF OCCUPANCY No. �i�'�5�� The euilding located at H@� Fl&SP 14'ig1 STREE.T BIJIIAING C has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group R-1 Occupancy. Use of�Building AP�1�fiPfS Legal Description 424-191-04 (See reverse side for Me[es and Baunds) Building Permit No.RP189�9 Electrical Permit No.F.1R913 Plumbing Permit No.$P18939 Mechanical Permit No. !�� Q�4� Number of apartments - and/or guest rooms ISSUEDTO: BuildingOfficial �77// �i (�� h1F.SA RRRF:7.R APAiYIP _1F�Pf'S � �, / C � � A � by .� 1�. VI �w �,Y— a.azol �: c�rt� rZg_ .��n. Fr. �mun_ cA. oace �(SGt� /'�% c�S This Certificate of Oecupancy 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 1a15-a6 rev. 1/83 White - Owner; Canary - Numerical File; Pink - Bldg. Permit File City of Cos[a Mesa Dev?lopraent Services Department Building Safety Division P. O. Box 1200 Costa Meu, California CERTIFICATE OF OCCUPANCY No. OO�� The euilding located at 867 WEST 19'tYi S'PREE.�P SITIIAING :}A has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group R-1 Occupancy. Uss of Building APAF�'�7TS Legal Description 424-191-04 (See reverse side for Metes and Bountls) Building Permit No. RP]RO'�7 Electrical Permii No. R12�917. Plumbing Permit No. SP18037 Mechanical Permit No. M7 ql AA Number of apartments and/or guest rooms ISSUED T0: BRF.F:ZE APAR7S�SF�F1,S ?32n1 LAi�: CQsr1�:R nR.. �2�n. rr. �mRn. CA, Building Official by This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed ezcept by the Building Official of the City of Costa Meu unde� Sec. 307 (e) U.B.C. CMF 3015-46 rev. 1/83 White -Owner; Canary - Numerical File; Pink - Bldg. Permit File >-. 1_ � �� ' S67 iv. 19th St. Unit "B" � i - - ��gp—� � � � —a��v»2 - gPl/33p/� pG59284 B � y � - 518433 Sewer $B00. � Unit B) 1 � - y s� J �; � _ E19408 ./ ��• ��TT B� "'i 9��g5 � - ,,,.,- �:. - � es , �iee� ihiit A �, � ' , S �30 I fIs 'C 69284 A - r/ /7 � - S18437 Sewer $$00. � - (Unit A) E1891� MISC. iUNPP A). ! �y�/gs" BP183Q7 � � � c� ��— _ M19144 �/S/S s� BP18037 � 9th St. �� ' �67 W. 1 Unit C --73P180397G� � � � _�► 9/" 1'C69284 $362,685 �I 1 ��5 � o I 7 $800, � �lt Cl _ Eiss� �o%�s� 03� c�rr c> _ � � Dl19344 �2�� a � 867 W. 19th St. Unit "D" � - � I _ SP180 0 NEW APT $515,000 � y 3-�a/�� PC69284 D ; � 518440 Se�er $800. - G��i�/�"-� (Unit D) i r - r419 4 � Fi1G (au.�.SD) - y}S�&s BP18040 I � - E19409 ��• ��TT D� - � a /�s, :� � ; ■ 867 v�. 14th St. Ihiit# "E� �� _ �„ _ BP180 NEW APf $362,232 9�G�� f PC69289 E 1 � � 518 1 Sewer $800. � r ��'S' iCfiit E) _ � _ F19 30 NIISC. (UNTT E) � � 9�G��.f apieoai � - M193 0 � (6-E) � 9�>/8s � _ d67 "r7. 19th St. [lnit "F" � �, _ BP18 42 NEW APT $241,941 `%�G�BS� PC69284 F / � _ Sl 942 SE[�R $800. /��7��5� (lkiit F) � / � E19081 MISC• (�IT F� ' p/3o�� BP18042 ' � � - I�II935 (1-F1 — 9�S�P.� � � - II67 i+7. 19th St. Unit "G" � �l cl�13/�43 Carport $4,000 �- G/ 8s� PC6926� G.� : • 96 2 FC�� (��T �L _ y�� _ a6� :9. 19th St. .:"s�� _ -}a . �- �9�j-G��S� � $12,96H �' � � - - 518443 � SES�R $800. � - �{�/7�5 (tfiit H) � - M1935 /5_��r (H- ) � / - E19693 FffS�. �UNPP H�� sho�� 867 W. 19th St. "J" � ,. . ... i � siaoai9/S�c�r�, 54,000 � PC769284 _ E 641 FIS'N�5 (UNI'f J� � �%�/$� , yrESP igrx STREET, 867 comp i-2i-59/Lw (i698i) comp 8-26-65/vcB (24956) Plbg. NCr%�?-�l Elec. NC� _ I Q BP173� 5�,� DF110 $1000. � BP17402 SE•7ER CAP DE!"n � � _ BPE?,0091 POOL 6 SPA �/� � - 7P�0579 BA�'If.kl � � %��l �l.��s%�� _ PM � 8072533 _ REROOF _ � � — PM# B 072534 — REROOF � � PM$ B 072532 REROOF • � JobAddress: 867 W 19TH ST ; Suite: C Viciniy: PrimaryOcc: R-1 HotelslApts/Res>70Occ Parcel Number: 42419104 App�icant: PAUL POWDERLY Address: • - ' Type of Construction: V-1 Zoning: Phone: �714-514-3028 Zip: Ownec MESA BREEZE APARTMENTS CTD �� Address °kWELLS FARGO BANK, N-A CHRISTINE CREIGHT ' �` � SANTA ROSA, CA ' "� - Phone: , 200 B STREET . , . � -� � Zlp:-5 f 95401��}--ci �Slatus: . ISSUED Applied: 12/052005 Issued: 12/OSl2005 ISSUED BY: � � Contracror: ROYAL�ROOFING CO - , - � `.� .' - � Address: �81-11COMMONWEALTH . � �-�';,� - '� . . � � -, - Phone: 800-400-7692 "- � - � BUENA PARK, CA , - � � �Zip:�' 90627 � � License: 678705 - � Arch : Address: , Zip: . Phone: '"� License:, � . ., T/OOF EXISTING AND RERObF 4500SF 12UNIT ,f Flan Check °"'-$0.00 � � Permit �� -�$1`1�7.25 SMIP Res: � ��`,�, $0.50 SMIP Com: ', $0.00 Other: $0.00 Inspection: $0.00 Eng: Address: - � ' .:�;�.�.._ . .._'PFione: . . , . .. . � . .,,License: " SCOPE OF PERMIT ENT W/COMP SHINGLES. � . � , � „ -- FEESUMMARY-��_.� , , " � -.a Calc Valuation: , ss,000:oo �:' � s { ' Claim Valuation. � ss,000:oo .:.,;--^='"�^--M-.*,,w,,.�,. ,, - . - `.- . _ r�.. � . Total: $111.75 PLANNING & ZONING SETBACKS � � � ' � ,.� MAINSTRUCTURE�Front 0.0�, Rear."�;0-0 ` Left�0;;0,�•�—",ku;"`.'�Right' �'0=0'—" --� � ..� �- . . .-e_l+5�,, - ` -:ci_ �.� ,� ' ACCESSORY� -��, Front � 0-0 . � Rear 0.0 , Lefl��.„0-0 �_ Right . 0-0 . . , . . . . ,� s,,.,, , . PARKING � �Exislind: 0- Reauired:. 0 - � , Pr000sed ,0 b.-�' � . , ,,, � ..,,-_ � ....... ;�.., . . � . _ � _ ,' .. . .. =�i .3 � ' . . 't:' ' � �� 3. `' �" _ i .. . ... Nra"_ * ir- � � "'--ryr'6t-��-- -�. "' _"' .,. .. • _ � �^r � .. _._ _........._....,., ! _" ' '�'—"r—^�" _ ' , "' . . � NOTICE: The work authorized by this permit shall compty with all applicable handicap access requiremants under Califomfa statutes arW related regutations. (Ord. No. 92•28, § 1. 12-21-92) ` � EXPIHATION: This permit shall automatically ezp(re and become void il work is not commenced within 780 days, or it work is suspanded or abandoned for a perlod ol 180 days. INSPECTIONS: In order for the work authodzed under this permlt to be considered legal, such work must compty with all applicable cadea, and all I requlred InapeMiona end final approval must ba obtained. Failure to obtain InspeoNonsendik�et�app�ovel�wlll��esult�in lhe expiratlon of this partnit. FOR INSPECTIONS CALL: Q74) 7545828 � z„we �aw� WORKERS' COMPENSATION DECLAFiAT10N: -� I hereby effirm under panelry ot perjury one ot the followfng tledaratlons: ❑ 1 have anC will mainlein e cenlficete of conseN ro sel4insure for workars' compensetion, es pmvided for by section 3700 oi the LeDor Code, lor the pertormance o1 the work 1or which �hi5 pertnl� I9 issuetl. • ❑ I have entl will maintaln workers' compensatlon insurance, as required by section 3700 of the Lebor Code, for the pertortnance of the work for which Nls pertnit is iswed. My workers' compensetlon Insurence cartier end pollcy number are: � Certier: Policy Number. (Thls sec8on need not be completed i1 rne permiNs velued ef one nundred dalars ($1 ) or less.) � I certi pertortnence ol t eA for which Ihis pertnil is IssueE, I shal� not employ eny person In any manner ao as ta become sub�ect to Ihe warkers' compe tion la s ol Celifaml , an apre thet il l shouid Eecome sub�ecl to the workers' compensetlon provislons of Section 3700 of Ihe Lebor CoAe, I shall fanhwllh comptywi eD�sions. / ApP�kant Slpne r- ' o •' �_`Q / oate: I 2"{�T �UJ WARNINO: FAILURE TO SECURE WOfG ' COMPENSATION COVERAGE IS UNLAW FUL M1D $MALL SUBIEC� PN EMPLOYER TO CRIMINr1L PENALTIES M10 CML FlNES UG Rl ONE HUNDRED TKK1S4N0 DOLURE (510D.00O�.IN AODITION TO THE C0570F COMPENSATON, DAMAGES AS PilOVIUED FOR IN SECTION 3]OB OF THE LABOR COOE, INTEREST, PND ATTORNEY'S FEES. LICENSED CONTAACTOHS DECLARATION: I hereby aHirm ihat I em IlCertSaQ uydqr �ro ns ot Chapter 8(commencinp wlth Section 7 0l Divlslon 3 ot the Business end P ofessions Cotle, and my Ilcense Is in full lorce entl eHect. Llc. La � b L U Cieu x (` r �4 Contredofs Slgnature. � Dete: / ?�L1� �n CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirm ihat t�ere is e Consiruction Ientling agenty lor Ihe peAortnance of Ihe work Por whic� this pertnit is Issued. (Sec. 3097, CiWI Code). Lentlers Name: LentleYs AAdress: Signature: OWNER•BUILDER Date: I hereby aHlrm thet und9r'penalry ot per�uayR�,hgl I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reeson (Sec. 7031.5, Buslness enC Prolessiore Cotle: Any clry or courAWwhich requires e perAlO to construct, elter, Improve, Oemolish, or repair eny sirucNre, prior to its Issuence, elso requires the applicant for such pertnit to flle e signad statemeflFl�lMq•ar shelg„�ensetl pursuant b the provisions of the Contrectors Ucense Law (Chepter 9(commencing wlih Sectlon 7000) oi D'Mslon 3 of t�e Buslness flnO Professions Code) a}`VietJ� or shg, Is exempt theretrom end t�e besis for iha alleped exemptlon. Any violatlon M Section 7031.5 by eny applicant for a permit suE�ecls the epplicant to a ciWl penalry of not piore than tive hundred dallars (5500).): O �, as owner of the property, or my employees with wages as Iheir sde compensetlon, WILL DO THE WORK, entl Ihe structure Is not intended or oNeratl tor sele (Sec. 76M14, Business antl Professions Cotla: The Contractors License Lew tloes not apply to an owner ol property w�o builds or improves t�ereon, and who does such work hlmself or herself or Ihrough his or her own employees, provbetl ihet such imprwements ere not Intended or o%ered tor sale. II, howevar, the building or improvement is soltl within one year o1 completion, the owner-0uilder will hava t�e burden ot proving that he or she did not builG or imprwe for purpose oi uleJ. ' ❑ I, as awner af tha properry, em EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTORS to construct Ihe project (Sec. 7044, Business and Protessbns Code: The contraaors License Lew does not appy to an owner of pmperry who �ulltls or impmves thereon, antl who contracts lor suU pmject with a contracror(s) licen5e pur5uent to ihe ContraCtors Licensa Lews.). ❑ I em exempt untler sec. Business end Professions Code for this reason: Signature: Date: Owner ID verlfietl by tlriv8f51icen5e. ❑ V89 ❑ NO DnvefS Licen98 No. Vedficatlon of Ownership by (rype o� dacument, i.e. - praperty lac WII ar tlee0): Expires: DIVISION OF INDUS7RIAL SAFETY VERMR CERTIFlCATION: ❑ I hereby certify Iha� no exwvetion fne (5) or mora teet in depth into wNch a person Is required lo descentl, will be mada in connectlon wlth work authorized by this pertnit, entl that no Duiltling structure, sceHdding, lalsework, or demdlUon or tlismantling thereof, will be mora than thirry-six (38) teet ttigh. (Chap. 32, Grp 2, Ar12, Sec. 341, Title 8, Callfomia Atlministrative Catle). ❑ As owner-builder, I wlll nal employ enyone to da work which would requlre e pertnit tmm the Dlvislon ot Industrial Satety, es notetl ebove, unleu such person hes e permit to tlo such work from the dlWslon. Signeture: Date: DiWsion ot Industrial Satery Permit Number. CERTIFlCATE OF COMPLIANCE AND AUiHORVJITON OF ENfAY: I certify unCer penelty of perjury Ihe� I have read this epplicetlon end state �hat the infortnetion gNen is correct. I egree to comply wlth ell slete laws and ciry ortlinences relating to building wnstructlon, end authodze representatives ol the Ciry of Caste Mese to eNer upon Ihe ebove-descrlGed praperty lor inspection purposes. I egree not to occupy or ellow occupency of eny building euthorized by this Oermll until finel inspectlon. COOE �. INSPECTIONTYVE 1616 Fixetl System Final Fire Preventlon 1288 Pool Spe Final 200 Finel Re-Roof 201 Final BIacWRetaininp Well 202 Final Fectary Fire Place 203 Final Sign 204 Finel Demolition �g I�d� - l z- o,i- O f"`" Date ' COOEI INSVECTIONTYPE Q�¢, �¢ 206 Finel Mechenical 208 Finel Plumbing 210 Finel Elecirical 212 Finel Fire Prevention 220 Final Plenning Approval 222 Final Slte 250 Finel Builtling/Occupancy Job Address: 867 W 19TH ST , SlaWs: ISSUED Suile: A Applied: 12/08/2005 Vicinity: UNITAROOF Issued: 12/OS/2005 Primary Occ: MR Type of Construction: V-N Parcel Number: 42419104 Zoning: o,pplicant: POWDERLY, PAUL ' 8141 COMMQNWEALTH " �� Address. . • ,, I„ ^ Phone: 714-521-0100 ISSUED BY: I��U� � BUENA PARK, CA Zip: 90621 '� Owner: MESA BREEZE APARTMENTS"LTD Address %WELLS FARGO BANK; N A CHRISTINE CREIGHT � � SANTA ROSA, CA' � � ' - 'Phone: . , � 200 B STREET� �, ; »„ r'^ ��,.�:,� Zip 95401 � � , , .. . s ' i'-__ , . , ..,•, :. �, _- Contracror. ROYAL�ROOFING CO�, � __ ` � ,�;� "` ` =�= � " , , Address: �� 8111��COMMONWEALTH �-� ,_ � . . � i ' , � . �.=�-,�� Phone: 800-400-7692 � � ' BUENA PARK, CA : � 2ip: 90621 � . . " License: 678705 � � �� .- � % ' ��. � Arch : .� . . ' Address: •�' �-.' - =J : � ' : p � .' �,.,.� � ,.Z1p; . {..,, � � ` i .: a,'. - T/O EXISTING COMP'SHINGLE REPLACE SHEATHIIJG AS NEI Phone: � t . . ' License. - - ~ $CC I:LAYER OF INSTALL 30# FELT Eng: Address: �� : � ze � .. - �;:��,'. Phone: ' .. �. �, �� .E--- �;>�. `.. � License. ��' �; � ,s< ' SHINGLES ON UNIT A';^�APP,ROX 2400SP�. REPAIR AND , , i � � r�°�� , � FEE�SUMMARY ;� - � FlsnCheck. '�"i: $0.00' � ' �. . � "�� `� 3` �-� CalcVali Permit: : , $9Z.25 z � ' Claim Ve SMIP Res � �_�.$0 50q � °, � �,� �_" SMIP Com. .,, ,' $0�00 _ � ;. _T r'" a : �.Y°�, .. . , ,, , Other. • : $0.00 ' :.' :`...__ :. ; .: ` In,spection: � $0.00 � -: � - �� ':Total: � � $97.75 � � s � \, � 33,800.00 1: " $3,800.00 r�'; SETBACKS :�� "`,r, ��` ?�- ,� MAIN STRUCTURE Front 0 0��" Rear� 0 0�� Left 0'0'�'� �� Right ' 0-0 - ��s,. '�' � 3�� ' . v� . ,,-'zt - ACCESSORY ��' Front-' 0-0 -'n`Rear.� 0.0 �� ' left 0.0 .�. , Right 0-0' - , � � , . . . � , , _ -,, i�� ,¢�'^ � � ,� . PARKING `Existina: 0 .Reauired . 0= . � -:Pwoosed `'0 � � �.a g� � -�-1. d ;,�°�.- � �',. � ; �a� "` � � , � ; :.- � � 3� ,�y , ti r�' - _ � � �, � '_' ' , ^ .,.., u. `�., � ,� w'.:,-. z�„�„""� , '� NOTICE: The work authorized by ihis permit shall compty with all applicable handicap access requirements urMer Califomia statNes an0 related � regulations. (Ord. No. 92•2B, § 1, 1241-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 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 compty with all appRcable codes, arM fl0 requlred inepeetiona end flnal approval must ba obtained. Failure to obtain inspeclions and tinal approval will resutt in the expiration o} this pertnit. FOR INSPECTIONS CALL: (714) 7545826 eewao �aw� WORKERS'COMPENSATON DECLARAnON: � � . I hereby aKfm under penalry of perjury one of the I011owing daclarations: � . ❑ I have and will ma�ntaln e certificete of consent to sell-Insure for workers' compensation, es providetl for by sectlon 3700 of the Labor Cotle, for Iha peAormance of t�e work for which this pertnit Is issued. ❑ I have and will malntain worker9' compensetlon Insurance, as reQulretl 6y sectl4n 3700 of tA�e Lebor Cotle, for the pedormence af Ihe work for which thls pertnit Is issuetl. My workers' compensatlon Insurence carrier entl policy number ere: Certier: Policy Number. (Th/s secUon need not be completed i/ the perm/t !s ve/ued et one hundred tlallers ($100) or /ess.) �j Lcertity thgiiufpa-poQormance o a—We�lc tor which this permit is issuetl, I shell not employ any person In any manner ao as to become sub�ect to the workers' �compenSa�lon laws of,Celifamla, d ep 4a t�et it I Should become sub�ad lo t�e workers' compansetlon pmvislons oi SecOon 3700 of the Lebor Cotle, I shall torthwith comptywitNMes �r6hslons. Applirant Signaj � De� a L'�� 7�d5 WARNIN(3:�fAICURE TO SECURE WO ' COMPENSAiION COVERAGE IS UNIAWFUL AND SHALL SUBJECT AN EMP�OVER TO CRIMINAL PENALTIES AND CIVIL FlNES UP TOONE HUNDRED TIIOUSAND �OLLARE (5100��L IN ADOITION TO THE COSi OF COMPENSATION, OAMAGES AS PROVIDED FOR IN SECTION 31060F THE LABOR COOE, IMEREST, AND ATTORNEVS FEES. LICENSED CONTRACTORS DECIARATION: I hereby aMirtn ihaLle�nsed under provis ns o Chapter 9(wmmencing with Section 7000) of D'Msion 3 af the Businp�s eU� PjPfessions Cotle, end my license is In full force end etted l%Cv � �Cles� s��V:7'P Contrad�oYs�S g a re'iIi �a,p � C� Date: _-�---,-,. r � r'_"'.,, � f � ��T —O� CONS7RUCTION LENDING AGENCY: ❑ I hereby aHirm thet t�ere is a construction lending agency for the peAormance of the work br which t�is permit is issued. (Sec. 3097, Civil Code). Lenders Name: Lenders Adtlress: Signeture: I hereby afflmhthaLund@r�l Code: Any'ciyaCGounry�v b lile e signed steteme�� Business and Pmfessio�s subjects iha applicant to a Date: '.hat I em EXEMPT FROM THE CONTRACTORS LICENSE LAW far the following reason (Sec. 7031.5, Business end Grofesslans 3rtnit 10 wnstruct, alter, improve, demolish, or repair eny structure, pnor Io its issuenCe, elso requires the epplicant tor 5uch permi� :snsetl pureu&�l b tha provisloos ot the Gontrectors Llcanse Law (Chapter 9(crommencfng with Sectlon 7000) M Division 3 of Ihe or she Is exempt theretrom entl the besis tor tha alleged exemption. Any violatlon ai Section 7031.5 Dy eny appllcant tor e pertnit I more Ihen Me hundred dollers ($500)J: ❑ I, as owner at the pm0erry, or my employees wlth wa9es as Ihelr sole wmpensatlon, WILL DO THE WORK, and Ihe slrucNre Is not intended or oflered lor ule (SeC. 7044, Business and Professions Code: The Contractors License Lew does not appty to an owner of property who builds or improves thereon, en0 who does such work himself or hereelf or throuqh his or her own employees, provided thet such improvements ere not Intentletl or ottered for sala. If, however, the buil0ing or improvemenl is sold within one year ot completion, iha owner-builder wiil have the burden ol proving that he or she did not build or improve for purpose of sele.). � ❑ I, es owner of ihe Property, am EXCLUSIVELY CONTRACTING WITH LICENSED CONTRACTOHS to construct the p�oject (SecJ044, Business end Protessions Cotle: The contraC�ors Llcense Lew does not epply to en owner of property who bulltls or Improves thareon, and who contrects for such pro�ect wllh e coniractor(s) licanse pursuant ta �he Contractors License Lews.). ❑ I em exempt under sec. Business end Pmfessions Cotle Por this reeson: Signeture: � Date: Ownar ID varified by dri�els license. ❑ Ves ❑ Na Drivels License No. Verilicetion oi Ownership by (rype of dacument, i.e. - properry taa bill or tleeA): DIVISION OF INDUS7qIAL SAFETV PERMIT CERTIFICATION: Expires: ❑ I hereby certlty tha� no exwvetion tive (5) or more feet in depth into which a person is requlred to descend, will be maGe In connectlon wilh work authorized by this permit, and Met no building structure, scaHolding, talsework, or demolition or tlismantling iheraoi, will be more than thirry-six (36) teet high. (Chap. 32, Gry 2, Ah 2, Sec. 341, Ttle B, Californla AOministrative Cotle). � ❑ As owner-builder, � will not employ anyone to tlo work which wauld require e pertnit from ihe Division of Indusirial Sefery, as noted above, unless such person hes e pertnit to do such work tram ihe division. SignaNre: Date: Division of Industrial Seiey Permit Number: CERTIFlCATE OF COMPLIANCE ANO Al7IHORQATON OF ENTRY: I cenity under penalry of perjury Ihat 1 have reatl Ihis eppliCation and state Ihat the inlortnation given is correct. I agree to comply with ell state laws and ciry ordinances relatlng ro Duilding consWction, antl eut�otlze representetives ot the Gry ot Caste Mesa to enter upon the above-descnbed property �or inspection purpases. I egree not to acupy or allow occupancy of eny building authorized by this permil until final insDedlon. Legal Owner(s� � � �,� CODE �. INSPECTWNTYPE 7616 Fi:etl System Ginal Fire Prevention 1288 Pool Spa Flnel 200 Final Re-Rool 201 Flnal BIocWRetelning Wall 202 Final Fedory Fire Plece 203 Final Sign 204 . Final Demolition � II� ..gr � t � cooer ixsvernoxme 208 Final Mec�anicel 208 Final Plumbing 210 Final Electrical 212 Finel Fire PrevenHon 220 Final Planning Approval 222 Finel Site 250 Finel Building/Occupency :, �, �, ,,, ,.,_..� ... . ...... . .. . _. .--- ... -- ou��vu�v r�rtnn i Job Address: 867 W 19TH ST Suite: D Vicinity: UNIT D ROOF Primary Occ: MR Parcel Number: 424 � 9 � �4 qpp�icant: POWD/�ER�Y, PAU� Atldress: �I�� l�ry�ry�p/�iC�.�,�,� �'t✓1%'.��i% ��',�C� Status: ISSUED Applied: 01/032006 Issued: 01/03/2006 Type of Construction: V-N Zoning: Phone: (\�y'"I / � �u � 3��SSUED BY: \' % ziP �j DInZ I Owner: MESA BREEZE APARTMENTS LTD Address %WELLS FARGO BANK, N A CHRISTINE CREIGHT SANTA ROSA,CA � � �Phone: j ,200 B�STREET ' � i' _ � - , - �Zip: Contraaor: - ROYAL ROOFINGCO Address: 8111 COMMONWEALTH � , . . . '��:' ", Phone: � � BUENA-PARK, CA . Zip: 90621 � � � . License: Arch : Address: Zip: t ,- Phone:� ' � 'i,. - 'License: - � 95401 ' 800-400-7692 678705 Eng: ., Address: Phone: License: SCOPE OF PERMIT T/O EXISTING ROOF AND REROOF W/COMP 30 YEAR COMP SF4INGLES ON APARTMENT UNVT D, A?PROX 2400SF. REPAIR AND REPLACE SHEATHING AS NEEDED. � � � ' � �- Plan Check: $0.00 Permit: $125.25 SMIP Res: $0.52 SMIP Com: $0.00 Other> $0.00 Inspection: $0.00 - -. FEE SUMMARY Total: $125.77 � . ,.,c`��PLANNINGBZONING SETBACKS • MAINSTRUCTURE Front �0=0 ,i•��,:_:ReaP �0-.0 , -� �� - _ � � - i, � ACCESSORY . Front 0- 0 ; =�� •�, -Rear - 0- 0 _ � �� ,. - �' .. PARKING � '� � , Exlslina:' � �0. �� Re uired: � 0 . „ Calc Valuation: 55,zoo.00 Claim Valuation: $s,2oo.00 Lefl 0-0 � :Righi 0-0 � Left 0- 0 � Pruoosed: 0 Right 0-�0% � NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutas and related ! regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned tor a period of 180 days. INSPECTIONS: In order for ihe work authorized under this permit lo be considerad legal, such work must comply with all applicable codes, and all required Inspeetions and tinal epproval must be obtained. Failure to obtain inspections and final approval will result in the expiration o( this permit. FOR INSPECTIONS CALL: (714) 7545628 zwa+o lo'w� WORKERS' COMPENSATION DECIARATION: � • �' � _ I Irereby affum under penalry of parjury one W the foilowing tleclara[ions. ^ - � I have and will malntain a cenificate of consant to selbinsure for workers' compensation, es provided for by section 3700 oi the Labor Cotle, for the pertormence ot ihe work far whlch this permit Is Issued. � �..- ( I have antl wlll maintain workers' compensation Insurance, as required by sectlon 3700 of Ihe Lebor Code, for the pertortnance of Iha work for which this permit is issued. l�My workers' compensa�or� Insurance carner end policy number are: ve/uetl et one Pd'wy Numbevc"�`-` `Y orlessJ (�— ❑ I certify t n Aormance of Ih9�wo�tD�which this permit is issuetl, I shall not employ any person in any manner so as to becoma subject to ihe workers' compen tlon laws of California, end agree t At if I s�oultl become sub�ect to the workere' compensetion provisions of Section 3700 oi the Labor Code, I shell forthwith comply wi h provisions. � ,�w�M.s�y �-� ��--e ,Q p � O oe�e: � 3—C�� V�pRNING: FAILl1PE-TO SECIIRE WORKE ' OMPENSATIdJ COVEMGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYE�F .TOCRIMINAL PENALTIES AN� GVIL flNES UP TOONE HUNDREO TKKISAND DOLLARE (5100,000), IN ADDI71 O THE COST OF COMPENSATION, �AM4GES AS PROVI�ED FOH IN SECTION 3/O60F THE LABOR COOE, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: antl eNect. Lic. ot Chapte� 9(commencing with Section 7000) of Divlsion 3 0l ih rBusin s aryS.Q essions Code, entl my license is in full Class X ��5� c0 Data:�..i� �3 —[i(o CONS7RUCTION LENDING AGENCY: ❑ I hereby aHirtn ihat there is e construction lentling agency for the peAormance of �he work for which t�is permit is issued. (Sec. 3097, Civil Code). Lender's Name: Lentlefs AOOress: Sig�aNre: Daie: OWNER-BUIID�R DECLARATIONS: I h@reb}"Attirm theyu7(�e_r:�pA�i�lt'y�'61+peNYO''�hat I�pm EXEMP7 FROM THE CON7RACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Buslness end Professions Cope�. Any city or county which requires e pertnit'to construct, alter, improve, demolish, or repair any stmctura, prior to Ns issuance, also requires the applicant for such pertnit to (le a siqned tementthat�e ocshe�l911censetl pursuam to the provisions ol the Comrectors Ucense Lew (Chepter 8(commencing with Section 7000) 01 Dlvlsion 3 ot the Busineu antl� 8)�oeMeAh84r she is exempt therefmm antl ihe basis for ihe elleped exemption. Any violation oi Section 7031.5 by any applicant for a permit sublacts ihe��flcenl in g,ryyj}�pqj� otnotmae Ihan five huntlred dollars ($500).): ❑ I, as owner of the property, or my employees with wages as their sole campensation, WILL DO THE WORK, anC �he struc�ure I5 not intendad or oHered tor sale (Sec. 7044, Business and Professions Cotla: The Contractors License Law does not apply to an owner ot O�oPerty who builds or improves lhereon, entl who tloes such work �imseit or herself or Ihrough his or her awn employees, provitletl Ihet such improvements ere not In�ended or oNe�ed far sale. II, however, the builtling or improvement is sold within one yeer of completion, ihe owner-builder will have the burden of proving tha� he or she tlid not build or improve for puryose of sale.). ' ❑ I, as owner ot the property, em E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS lo consiruct the project (Sec. 7044, Business end ProfeSsions Cotle: The comractors Licanse Lew does not apply to an owner ol propeny who builds or Impmves Ihereon, antl who coniracts br such project with e comracbr(s) license pursuent Io ihe CoNractors License Wws.). ❑ I am exampt under sec. Signature: Owner ID venlied Dy drivers licensa. ❑ Ves ❑ No Business entl Protessions Code tor t�is reason: Vedfication oi Ownership by (type of tlocument, i.e. - property ta�c bill or tleetl): Drivefs Licensa No. Date: Expires: DIV�SION OF INDUSTRIAL SAFETV PERMIT CERTIFICA710N: ❑ I hereby certity that no eacevation five (5) or more feet in tlepih into whic� e person is requirad to descend, wiil be matla in conneciion with wofk authonzetl by this pertniL and that no Duilding strucWre, scaHoltling, felsework, or demolition or dismantling ihereof, will be more than thirty-six (36) feet high. (C�ap. 32, Grp 2, Ar12, Sec. 341, Title 8, Califomia Adminlsirative Coda). ❑ As owner-builtler, I will not employ anyone to do work which would require e permit from �he Division of Industnel Safery, as notetl above, unleu such person has e permit to do such work from the division. Signature: Data: DiviS�a� of Industdel Sefety Permit Number: CER'nFlCATE OP COMPLIANCE AND AlliT10RVJ1TON OF EMAV: I cenify unaer penalry of perjury Ihat I have read this applicetion and stata that the inlormation given is I corre�� I agree to Comply with all stete laws and city ordinances relating to huiltling construc�ion, antl authorize representatives of �he Ciry of Casta Mese to enter upon ihe e v-n Aescnbed properry tor inspe�iion purposes. I egree not ro occupy or ellow accupancy ot any building authonzed by this permit until final inspection. CO�Ej, INSPECTIONTYPE 1616 Fixetl System Final Fire Prevention � 1266 200 Pool Spa Final Final fie-F1oof 201 Final BlacklRalaining W ail ppp Final Factory Fire Placa 203 Final Sign 204 Final Demolition Peff. � ; . �Zf ��D�ate � � Date CODE� MSVECTIONTYPE 206 Final Mechanlcal 208 Fine� Plumbing 210 Final Electrical 2M12 Final Fire Prevention 220 Finel Planning Approval 222 Final Site 250 Final Building/Occupancy IiAIE INTRULS Job Adtlress: 867 W 19TH ST StaWs: ISSUED Suite: E Applied: 11/14I2005 .Vicinity: BUILDING E Issued: 11/14/2005 Primary Occ: R � Type of Construction: V-N Parcel Number: 42419104 Zoning: Applicant: POWDERLY, PAUL � Adtlress: 8111 COMMONWEALTH , , - - Fhone:_ � 800-400-7692 ISSUED BY: BUENA PARK, CA - _ - � - -- � Zip: .90621 �c.' .,., �.. ,�,c: —' � ' - - _ .. , _.,� : ' . '! - .. `_ : ;/�/ �• � �� ' ��'- Owner: MESA BR,EEZE APARTMENTS LTD ' /� ��-_, ; Address %WELCS FARGO BANK, N A'CHRISTINE CREIGHT � "� � � � - �� ,% SANTA ROSA, CA � �'�.- � '; �� -- - Phone: � - � 200 B STREET -, � ' , �' � = _ =- - - � Zip:;.=95407�� , , -� � • � ` ' -- - _ - - - - - , � . .. i ' - / i:.%r,i'i'". . �\.'. . � Contractor. �`'ROYAL ROOFING;60-'� _ ;�� :,� Addiess:� 81�71-COMMONWEALTH �. ' ' � � o � � � .� , . � :�,�, � ��., , A , �'i . '�%/,/ Phone: 800-400-7692 ' �: � : ` . �' ' ' �-• BUENAPARK;CA . -- Zip:� 90621 � � :�License: 678705 � �'�•,� �� • . - Arch : - . � � - � Eng: ' , : ,�. � , . . Address: ,,,� , . - - � ' Address: � �- � �, �. � . . . •, Phone: �;. �,- �!r.;i:' � . .. � Phone: �. � . ' _ �, , , ` " tr . . , � � � � � . . 3; � ' � �� License: � , , Zip:,.. .. . ; : �, � , •Cicense: " _ � �� . «- - � , . "� -'- , � . . ��, i . . � , SCOPE OF PERMIT TEAR OFF EXISTING f200F. INSTALL 1 LAYER OF 30# fELT, 30 YEAR COMPOSITION SHINGLES, AND REPAIR/REPLACE SHEATHING AS NEEDED FOR BLDG. E, 43 SQUARES r� , _ _ . . __. . _ .,. _ _ _ _" _ . __ _ � � . - .. . A_..•-- �. r-. r,rr �+ � ,. — � � . � _� '. : � :' : r''FEE SUMMARY� -= � ' � Plan Check:j ' $0.00 - `' ' "" '' ' � Calc Valuation: s�,000.00 Permit: `$139.25 r'� ,�� ` Claim Valuation: , s�,000.00 � SMIPRes:, � $OJO � -.�-` . '• ; . `" � � � V SMIP Com: , . $0.00 '-_ - _-'-_ - . - .- . .' :.: ,•- . :. _.. -� - � Other. $0.00 Inspection: . $0.00 � TotaL• � $,139.95 � - i . , '� ' � PLANNING &'ZONING SETBACKS � � � ' =� � '�. _ ':�I" ^, � , ' .. : � , � �� ; MAINSTRUCTURE Front 0-0� � ��Reai '0-0 . ;�� ,�"LeN �0-0" ` "Right i0-0 •� ' ' � � _ - ' " ��" :. , . . ; i� i � \ ' i � ACCESSORY�.�; Front, 0--0 --�,;Rear � .0-0 ; . -Lefl- 0-0 ., _�Ri� ' 0-0 -, i. - " _� �= -.li� � PARKING . Exislin ": - 0 i- � Reauired:_=' 0- _ - ', Pr000sedt- �0= ' � � /. �,'�. ��, i � - i �, � . � - _ _ -- � ` � �, /,; �' �; , i, - � ' � � . ;:� �' � �- _ .. � ,i' _•• ., �� .�,��_ � i=: - � . f ' i _ ^ ] . i. . -� / / i , �. .. . . . . . . i ... : / _ / i �'. 1` - ` - / !% �. _ � -' _._- -�r - �� I NOTICE: The work authorized by this permit shal! canply wqh a!I applicaWe handicap access requlremants untler Ceiitomia siatutes and refated regulations. (Ord. No. 92-28, § 1. 12-21-92) — •• , . — --- . -_ -- � E%PIRATION: This permit shall.automatically�expire�and�become void if work is not commenced wlihin 1 BO�deys, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS:� In:orderfor the�xrork authorized under ihis permiYto be considered lagel, such work must comply with all epplicable codes, and all requlred.lnap9ctlona and.flnal�,epproval�mustbe�obtained. Failure-to oblaiminspections antl final approvafwill resutt in1�e expiretion of this permit. FOR.INSPECTIONS CALC: (714) 754-5626� anna�+e �aov� WORKERS' COMPENSATION DECLARATION: � � �� . I hereby aflirm under penalty of perjury one of Ihe following Oecleretions: '� ��-�' '' �� ❑ I heve and will meintain a cetlilicate o1 consent to selbinsure tor workers' compensetion, es provided for by section 3700 of the La6or Coda, for the pertortnance of Ihe wark toi which Ihis pertnit Is i55ued. �� • 1 �� 1 heve antl will malntain �wrkers' compensation insurance, es requiretl by section 3700 of Ne Lebor Catle, lor Ne perfortnance of 1ha wwk for which this permit is iswed. My workers' crompensatlon Insurence cartier and pollty number are: . . � �Cerner: � � Policy Number. � � j(�Tti's�section need not be comple(e0 i! the permif is valued ef one hundred dWlars ($100) or less.) V . �cenity ihet in the peAormence af the work foi which'Ihis�'partnit is is'sued, I 3hall not emplo`y any person in eny menner so es to becoma subject lo Ihe workers' compens '� ws Iltomie, t if I should become subject to the workers' compansetion provislons'of Saction 3700 of Ihe Labor Coda, I shall foit�with camplywith se.prov' ns.—� —�.. APPlicanliSigne�� .� ' ' O Date: �-1 =�"�� W��A. W.IN(3::FAILUFE TO SE� E WORKEF ' O�M ATION COVERAG i[AWFFIMND SHALL SUBIECT AN EM'%OY�ER.TO CHIMINAL PENALTIES AND CML FlNES UP RJ IXJE HUNDRED THOUSAND DOILARE (5100,000), IN ADOITION O THE COST OF COMPENSATION, DMNGES AS PROVIDED WF IN SECTIIXJ 3�Ofi OF THE LABOR CODE, IMEREST, AND A7TORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: at Chepter 9(wmmencing with Sec�ion 7000) at Divisionlof,the.Business antl PSo�ssions CaAe, end my license Is in full CONSTRUC710N LENDING AGENCV: " ❑ I hereby eflirtn that there is a wnsiruction lending egency for Ihe pedormanca of ihe work br which this Dertnil is issuetl. (Sec. 3097, Civil Cotle). LentleYs Name: LentleYs Adtlress: SlgnaWre: Date: I hereby eHirm that under pe��nelty of parjury tt�`ieP6•�p,��EMPT FROM TME CONTRAC70R5 UCENSE LAW for the tollowing reeson (Sec. 7031.5, Business end Professlon: Code: Any.ciry or wunry tlR7lctivequires a.pertnit to c%r stiu6l, el�er, improve, demalish, or repair eny structure, pnor 10 its issuance, also requlres Ihe epplicant for such perml� to file e signed stat9mknt.thal he or she Is�licensetl pursua_nyo ihe provisions oi the Contreclore License Lew (Chepter 8(cammencing with Sectlan 7000) of Division 3 of ihe Business end Professlons Cade)"or'Ihat�pe or she Is�xempTiherelrom antl tha basis for �he elleged exemption. My violation of SeMlon 7031.5 Dy any epplicant far e pertnf subjects the epplicant to e clWl penalry of not m- then five hundred dollars (5500).): ❑ I, es owner of the properry, or my emplayees with wage§ as their sole wmpensetlon, WILL DO THE WORK, anC the siructure Is nat intendetl or otteretl tor sele (Sec. 7044, Business antl Professions Coda: The Coniractors Ucense Law dces not apply to an owner oi property who builds or improves thereon, end who does such woAc himself ar herself or through his or her own employees, provided Ihat such improvemenis are not intendetl or ottered for sale. tl, however, the building or improvement is sold within one year ol completion, ihe owner-builtler will have ihe burden ol proving that he or she did not build or improve for purposa of sale.). - ❑ 1, es owner of the property, em EXCLUSIVELY CONTRACTNG WRH LICENSED CONTRACTORS to consiruct Ihe praject (Sec. 7044, Business antl Professions Code: The con�rectors Llcense Lew does not apply to en owner of propany w�o bullds or improves t�ereon, entl who contracis for such proJect with a contractor(s) license pursuant to the Contractors License Lews.). ❑ 1 am exempt under sac. Business end Prolessions Code tor this reason: Signeture: Date: Owner ID verifiad by dnvefs license. ❑ Ves ❑ No Dnvels Licensa No. Eapires: Venfication af Ownership by (type of daumenL i.e. � properry tex bill ar tleetl): DIVISION OF INDUSTRIAL SAFETV PERMIT CERTIFICA710N: ❑ I hereby certify that no ezcavetion five (5) or more feet In depih into which e person is required to descend, wlll be made In connection with work euthodzed by t�is permit, en0 ihat no building siructure, scaHolding, falsework, or demolition or dismanlling thereof, will 6e more ihen thirty-six (36) teet high. (Chep. 32, Grp 2, Art 2, Sec. 341, Ttle e, Celifomia Administrative Cotle). ❑ As owner-builder, I will noi employ anyone to tlo work whic� would require e Oertnit from the Division ol Industnel Sefery, as notetl eDove, unleu such person hea a pertnit lo do such work trom the division. Signature: Date: Division oi Indusirial Sefery Permit Number. CERTIFlCATE OF COMPLIANCE AND AUTHORVATON OF EMRY: I cenify �nder penalry ot perjury that I have read this epplication and stete Ihet the inlortnation given is correct. I agree to comply wil� ell stete laws and ciry ordinances relating m building construction, end authonze representatives ot tha Ciry ot Costa Mesa to enter upon the ebove-described property for inspecti u oses. I agree not to acupy or allow acupancy ot any building authonzed by ihis permit until fnel inspection. CODE �. ' INSPEC710NTYVE ` . • . ' " ' ' PdIE . •' �E1.5 : • 1616 Fixetl Sysiem Final Flre Prevention ' � 1266 200 201 202 203 204 Pool Spa Final Final Re-Root � � Final BIocWRetaining Well Final Factory Fire Place � Final Sign Final Demolition COUEI MSPECTIONTYPE . . �- � 206 Final Mechanical 20B Final Plumbing 210 Finel Electdcal. � � 212 220 222 250 Final Flre Preventlon FineFPlanning Approval i .- Final Site Finel Builtling/Occupanty PdIE � II�ELS ��ia) �sa-s2�s • Fex (�ia) �sa-aess • www.ci.coste-mesa.c�ILDING PERMIT » FAiH unrvt, cosin mrsn, cn szazs Job Address: 867 W 19TH ST Suite: B Viciniry: ROOF, BLDG B Primary Occ: R-1 Holels/AptslRes >10 Occ Type of Conslruction: V-N Parcel Number: 42419104 Zoning: npp�icant: POWDERLY, PAUL Address: 8111 COMMONWEALTH . �� Phoue: �800-400-7692 BUENA PARK, CA � .. - �-- '-� 2ip: 90621 ' . Owner: MESA BREEZE APARTMENTS LTD Address %WELLS FARGO BANK, N A CHRISTINE CREIGHT ' SANTA ROSA, CA ' � � Phone:' " ' ' 200 B STREET , - . . - � , 2ip: _95401 , � Contractoc ROYAL ROOFING CO " Address: � 8111 COMMONWEALTH � ' - - Phone: 800-400-7692 ' BUENA PARK, CA Zip: 90621 .. . Arch : Address: � . Zip: � License: 678705 Phone: � ' License: Eng: Address: Status: ISSUED Applied: 12/15/2005 Issued: 12/15/2005 0 Phone: License: SCOPE OF PERMIT � �,t�TEAR OFF EXISTING ROOF. INSTALL 1.LAYER 30# FELT, 30 YEAR COMPOSITION SHINGLES AND REPAIRlREPLACE SHEETING AS NEEDED. "' 4,300 S.F. FOR BLDG. B. APT. COMPLEX. � �� . � -. _. _,-. .. _ .. _ � . . . . . ... � ,� , � � FEE SUMMARY . � �� Plan Check: $0.00 - Calc Valuation: 5a,zoo.00 Permit: �' $167.25 �� Claim Valuation: ° sa,zoo.00 SMIP Res: $0:82 �_; .SMIP Com; $0.00 � �,� :. . ,_._ �. . � � . ...- . , _.. � • _ . '_ �,. 3 - • Other. : $0.00 - , Inspection: � $0.00 � � � ' . � - , , Total: $168.OZ 4 ' � � �`= ` PLANNING & ZONING � � � � SETBACKS . - ' 'r;� MAINSTRUCTURE Front �0-�0 -�,Rear .�0•0 � Le(t �,:0-0 . ':�.Right,.,,0-0. � � _ . - . '� , ' _ - ._ . ACCESSORY Front 0-0" ��Rear ��0=0, �'� : �Lek ��0-0.` �_' ' �Right '; 0-0 �� '; E . � r . ��,; ' .., ,. PARKING �:Existin . �0�,. Reauiied 0 Pro se :.0 � � � � � ` , i � � � , , , �. .. . ,. ,. - 0 0 NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related regulations. (Ord. No. 92-28, § 1, 12•21•92) EXPIRATION: This permit shall automatically expire and become void if woik Is not commenced within 1 BO 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 conslderetl legal, such work must comply with ell epplicable codes, and all requlred inapeetlona and final approvel must be obtained. Failure to obtain Inspections and final approval will result in the expiration ot this permit. FOR INSPECTIONS CALL: (714) 7545828 r<_, _�ar.n:m WORKERS'COMPENSAnONDECLAiiA�ON: ' , , I hereby aMirm under penelry ot perjury one 0� Ihe following declare�ions: � ' ❑ I hava and will maintein a certlficate of consent to self-Insure tor workers' compenseNon, as provided for Ey section 3700 of the LeUor Code, tor the pertormance ot t�e work for which ihi5 partnit is Issued. • ❑ I have and will mainteln workers' compensation insurance, as repuired by section 3700 Of ihe Labor Code, for ��a perfortnance of I�e work for which this pertnit is iswed. My workers' compensatlon Insurance Certier end paliry number ere: . Cerrier: Policy Number: (This section need not be complefed il fhe OB�i� Is veluetl af one huntlretl tlollars ($100J or less.) Mr4�e71o(mence af the Work lews ot G�Iltomla, entl aBreA OOLLRRE (3100.0001. LICENSED CONTRACTORS DECLARATION: ch Ihis permit is issue0, 1 shell not employ any parson in eny manner so as to become subject to Ihe workero' I should become sub�ect to the workero' compensation provlsions of Sectlon 3700 oi the Lebor CoCe, I shall tort�with _ a. x l Z�-- C� �� SHALL SUBJECT PN EMPLOYER TO CRIMINAL PENNLTIES M1D GVIL FlNES UP TOONE HUNDRED i PqOVIDED FIXi IN SECTION 3)OB OF THE IABOR CODE, INTEREST, AND ATfORNEV'S FEES. I hereby eNirm ihat I am li ensed under prov ' s of ChaD�er 9(commencing wlth Section 7000) ot Division 3 of the Busine en rpfessions Code, and my license Is in full _o�brce e d ifect^CICTA:� � Glass p ��7 • ntractofsSigneWre: �� ----" - _ �-..� `�j � �' � _ �Tv--r��E�� e— CONSTiiUCT10N LENDING AGENCV: ❑ I hereby aHirtn t�a� �here is e consirucNon lending agency for ihe pedortnance ot the work br which �his pertnit is issue0. (Sec. 3097, Civil Code). Lentlels Name: Lendefs Address: Signelure: OWNER-BUILDER DECLARATONS: Date: I hereby affirtn thet under penelry of perjury that I am E%EMPT FROM THE CONTFiACTORS LICENSE LAW for the tollowing reason (Sec. 7031.5, Busine55 end Professions Code: Any ciry or counry which requires e pe�it lo wnstruct, alter, improve, tlemolish, or repair any ahucNre, priar to its issuance, also requires Ihe epplicant for such permit to lile a signed statement that he or she Is IiGensetl pursuant to the provisions ot the Contrectors License Lew (Chapter 9(commencing wlih Section 7000) oi DlNsian 3 ai the Business and Professions Code) or Ihat he or she is exempt therefrom and the besls for Ihe allegetl e:emption. Any violation of Seclion 7031.5 by eny applicant for e partnit sub�ecis ihe epplicant to a civil penalry of not mare then tive hundred dollars ($500).): ❑ I, as owner oi Ihe property, or my emplPyees with weges as their sola compensation, WILL OO THE WORK, antl the structure Is not Iniended or otteretl tor sale (Sec. 7044, Business and Professions Code: Tha Contractors Licanse Law tloes not appty to an owner of properry who builds or impmvas thereon, and who does such work himself or herself or ihmugh his or her own employees, provided that suc� Improvemenis are not in�ended or oHeretl for sele. If, however, ihe building or improvemant is sold within one year ot complation, Ihe owner-builder will have the burden ol proving that he or she did not build or improve for purpose of sele.). ' ❑ I, as owner of the praPerty, em E%CLUSIVELV CONTRACTNG WITH UCENSED CONTRACTORS to canstruct the Orolecl (Sec. 7044, Business and Professions Code: The wn�rectors License Lew tloBs not epply to an owner ol properry w�o builds or Improves thereon, end who coniracts lor such projacl with a contreaar(sj licensa pursuant to the Conirectors License Lews.). ❑ 1 em exempt under sec. Business and Professions Code for this reason: Signature: Date: Owner ID verified by tlnvels license. ❑ �es ❑ No Drivefs License No. Expires: Veniication of Ownership by (rype ol docume��, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certity thet no excavation five (5) or more feet In depih into which a person Is required to descend, will be mede in connection wlth work authorizetl by thls pertnit, and Iha� no building siruc�ure, 5�i�ading, lelsework, or tlemolition or dismantling thereot, will be more than thirry-sia (36) leet high. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8, Celifomia Atlministrative Code). ❑ As owner-huiltler, I will not employ enyone to do work which would require a permit from Ihe Division ol Intlusirial Salery, es noted above, unless such person �es e permit to do such work trom ihe division. Signalure: Dale: Division of Industrial Sefety Pertnit Number: CERTIFlCATE OF COMPLJANCE AND AUTHORVJITON OF ENTAY: I cenily under penalry of perjury the� I have read �his epplication and staie �ha� the Infortnellon given is conect I agree to compty wit� ell state laws end ciry ortlinances relating to tullding consWction, antl authodze representatives of the Ciry ot Costa Mesa to enter upon the eb9ltn-0eecriped pmperty lor inspectioy.pu�oses. I egree not to occupy or allow occupancy of eny building euthonzed by this pertnil until final inspection. COUE �. INSPECTIONTYPE 1616 Fixed System Final Fire Prevention .7266 _ Pool Spa Final 200 Final Re-Root 201 Final BIocWRetaining Wall 202 Finel Factory Fire Place 203 Final Sign 204 Final Demolitlon PAg . ItII�ELi r��i/I► 1�i% � [i'1'1��L`6i]iMlhl:i(1» lZ'lc'� 06 _Date- . . PAffi � Itl�El,4 206 Finel Mechanical 20B Finel Plumbing 210 Finel Elecincal 212 Finel Fire Prevention 220 Finel Plenning Approvel 222 Final SIIe 250 Finel Builtling/Occupenry 9 (714)754-5273 • Fax(714)754-4856 . CITY OF COSTA MESA svao�N6 onr�s�oN DEVELOPMENT SERVICES DEPARTMENT PERMIT ELECTRICAL PERMIT Job Address: Suite No Vicinity: 867 W 19TH ST POOLAREA Parcel Nunmber: 42419104 Applicant: MOREAU, JOYCE Address: -,, ,� a." - _ - ' . . : - - - Owner: � �'?Addres � �'� A �l ;"' i i -�. � ; l�:� _ � PERMIT NUMBER " E99-00532 77 FAIR DRIVE, COSTA MESA, CA 92626 Status: ISSUED Applied: O6/21/1999 Issued: O6/21/1999 ISSUED BY: ��T_ ij �' '` - _. __ .Phone: (949)642=2870 � - � ', i �."� � , . , ' Zlp: . - - - ' \� � �- , � � , � '�\ �� t , � - - • - - - ' - - � � .= �\ � BREEZE APARTMENTS . - � � �� i -_ _ � � •,ti � v�� , . ._ %, �, �V�\ AKE CENTER DR # -�� Phone: � � � � � �� , RSIFIED:PROJECTS INC Zip: 92630 -�� - �� \�� :'. i! . � NEW GFCI Y Phones , ' ' ,-Zip: f � r� �. � � License: !-�,.,'. � _ �, i �: .l\�\\�� \\ \�\1 �/% `� :, / � >� , / � � \\ , �... �\\ � . +''�`� � � �� ; ; i - � . . ... i: �� \ , ' � � , . � �.��', ' . . . ' ��,• . , , . . , ._ . ... � .- . � - .�\ SCOPE OF PERMIT i �.. PUBLIC POOL. � � ,'• ��, . � �' ,� ' . , ' FEE SUMMARY � � ` ' + � � <�; � � Quantity ,� . � Quantity ' � - � , ' ' � - ' , - � \11SSUE FEE , . . $22.00 � . � � :�. . --�Temp Dist System /,Cighting . $0.00 0 ' . -� � i , �� r '�, �Ternp service test, � $0.00 ' -� � "`��._ _ �,�A_„ � Busway /100 k - � � � � $0.00 0 . � „�' � Res.�.a/c package, $0.00 � - . _ _- Standing Section� � � $0.00 0 ' � ' � New��Res (1-2 units) , � $0.00 0 � Misc Electrical Equipment $0.00 0%' � 1� � New�Res (3+units) ' �� $0.00 - 0 Transforrners u`p to 1 kvalkw ��. $0.00 Oy �,',' ; � , �,�! � Pool'/,§pa - �� .� $0.00 � 0 ....... :...up to t0�kva/kw , $0.00 0'. - ' � Lighting�Fixts� ��,_ �� ;.,� $0.00 0 . � . - _ .......... ......up to 50 kva/kw 1 $0.00 .0^�� ,' _ � '��l Recept Outlets� � '. � � , $1.00 -7 • - _ .up to 100 kva/kw �, $0.00 , %0� �� Switclies�� / "� �' $0.00 � -0 � � ..:.. .. .. over 100 kva/kw $0.00 - " 0 � � ` � � Non Res Appl �-' ��$0.00 0� � � Low Voltage Equipment $0 00%��0 �✓ �� Res AppI�U'� � $0.00 0 � - ' ' Low Volt W ring System I Ckt � , $0.00; � �� 0 � � � � '� Service to 200a� �� $0.00� �. 0,.,'., L? -. %�. ` -Misc. Conduit'�._. , ;,, -- .--$0.00� 0 � � � !, �� Service to 1000a� � 50.00 � r 01.' ` � ; � - Misa Conductor � $0 00 / � � 0 ; ; � Service over 1000a� / �j 30.00 � 0 . - � Circus ( gen or ride) _: � $0 00 �'/ 0 �� Motors to 1 hp �� $0.00 - 0 �'� �� Circus (mech ride or lights) �� $0 00' � 0 ��; � Motors to 10hp � � "� ' $0.00 � 0 ` � �� . Chdstmas Tree Stand . � $0 00 � ' 0 � Motors to SOhp � � � �� '$0.00 �� , 0 � � - ' `� - _ . Fireworks Stand � �$0.00 � ,0� � Motors to 100hp �=:A $0.00 ,� ) - �0 � � -- Other Electrical Fee _ � "$0.00 ; i,`/ Motors over 100hp '� $0.00 � ' 0" � , . , , ' % j�' Communication drops �� $0.00 � � 0 � � ' �Investigation Fee . $0.00 j' Sub panel to 200a $0.00�,�- � 0��-� �-.� � Plan Check Fee ,- ,';$0.00 Pole Light Pkg $0.00 � �� 0- _ � - � . �� Reinspection Fee , ,=- $0.00 Slgn CircWts $0.00 � 0 _ „ ' � � � Temp Pwr Pole $0.00 0' . -- .,. TOTAL.CALCULATED PEES $23.00 Intermed Pole $0.00 0 � - COMMENTS / SPECIAL CONDITIONS NOTICE: The work authorized by this permit shall comply with ell applicable handicap eccess requirements under California siatutes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned for a period of 180 days. INSPECTIONS: In order for the work authorized under this permlt to be considered legal, such work must comply with all applicable codes, and ell requlred Inapectlone and final epprovel must be obtained. Feilure to obtain inspectians and finel approval will result in the expiration of this permit. i FOR INSPECTIONS CALL: (714) 7545828 z WORKERS'COMPENSAnONDECLARAnON: �� I hereby ettirm under penelry at per�ury one oi ihe following declarati6ns: �, . • ,.. ❑ I heve end wlll maintein a cenificete of conseN to self-Insure for workers' compensetion, es.provided toi by sectlon 3700 of the Labor Cotle, for the pertormence of Ihe wark tor whlch this permit is issued. - " ' � ❑ I have and will mainWin workers' compensatlon insu2nce, as required by sectlon 3700 of the Labor Code, for the pertortnence of the wo�C for which this permit Is issuetl. My workero' compensation Insurance carner and policy number ere: Cerrier: Policy NumDer: (This sectlon need nat 6e completetl il fhe permlNs velued e( one hundred dWlers ($100) or less.) �' ❑ I cenify Ihat In the peAortnance of the work for which ihis pertnit is Issued, I shell not employ eny persan in any manner so es to become subject to Ihe workers' compensation laws ot Califomie, and agree that if I shoultl become sub�ect to the workers' compensation provisions ot Sectlon 3700 of ihe Lebor Code, I shell forihwith comply wilh these provisions. Applicant Signeture: Dete: WARNING: FAILURE TO SECURE WORKERS' COAAPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOVEF TO CRIMINAL PENALTIES AND CIVIL FlNES lIP TOONE HUNDRED THOUSAND DOILARE ($100,000), IN ADDITION TO TME COST OF WMPENSATION, DAhL1GES AS PROVIDED FOR IN SECTION 3]W OF THE LABOR CO�E, IMEREST, AND ATTORNEV'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby eMirm that I am licensetl unUer provlslons of Chapter 9(commencing with Section 7000) of Division 3 oi the Business antl Protessions Code, and my license is In full larce and eflect Lia q Class p Con�reqofs Signature: Dete: CONSTRUCTION LENDING AGENCV: ❑ I hereby ettlrtn ihat there is e consiructlon lentling egency for the peAortnance ot the work for which ihis pertnit is Issued. (Sec. 3097, Civil Cotle). Lender's Neme: Signeture: _ Lendefs Address: Date: OWNER-BUILDER DECLARATIONS: I hereby eHirm ihet under penalTy o1 per�ury thet I am EXEMPT FfiOM TME CONTRACTORS LICENSE LAW for �he following reason (Sec. 7031.5, Business antl Prafessions Cotle: Any ciry or county which requires e permit to construd, alter, improve, demolish, or repelr eny structure, prior lo Its Issuence, elso requires the applicant for such permlt to file a signed stetement ihat he or she Is Iicer.sed pursuent to the provisions of the Contrectars License Lew (Chepter 9(wmmencing wlth Section 7000) o� Divlslon 3 oi Ihe Business antl Professions Code) or that he or she Is exempt iherefrom end the basis tor the allegetl axemption. My Nalation o1 Secllon 7037.5 by eny appllcant for a pertnit sub�ects Ihe epplicant to e civil penelry ot not more Ihen five hundred dollers ($500).): ❑ I, es owner ot t�e property, or my employees with weges as their sole compensetlon, WILL DO THE WORK, and the structure is nat iniendetl or oHeretl for sale (Sec. 7044, Business and Professions Code: The Contractors License Law tloes not epDN to en owner of proDerty who builds or Improves thereon, end who does such wark . himselt ar herself or ihragh his or her own employees, provitletl ihat such Improvements ere not intentletl or ofleretl for sele. If, hov+ever, tha building or improvement is old wlihin one year omplelloq Ihe owner-bullder will have the burden oi proving Ihat he or she did not huild or Improve for purpose oi sale.). ' I, as owner af e pwp rry, em EXCLUSIVELY CONTRAC7ING WI7H LICENSED CONTRAC70RS to consWct the pro�ect (Sec. 7044, Business and Pmfessians Coda: Tha c tractar 'censa Law does not epply to en owner oi property who builds or improves thereon, and who contrects for suc� project with e coNracmr(s) license pur ent t e Contrecrors Lfcense Lews.). Owner Business entl ProFesslons Cotle for ihis reason: Ves ❑ No DAverb Litense No. by (rype o� documenl, i.e. � property taz bill or daed): DIVISION OF INDUSTRIAL SAFETY PERMR CERTIFICATION: ❑ I hereby certlly that no excevetlon flve (5) or more feet In tlepth into which e person Is required to descend, will be mede In connection with wark authonzetl by I�Is pertnit, end that no building strucmre, scettolding, falsework, or demolltlon or dlsmantling thereof, will be more than Ihirry-six (36) feet high. (Chap. 3.2, Gry 2, Atl 2, Sec. 341, Title B, Califomia AdministratNe Cotle). ❑ As owner-bulltler, I will not employ anyone to do work which woultl require e permit from Ihe Division of Intluslrial Safety, as noted above, unless such person has a pertnit to do such work fram ihe divlslon. Signeture: Dete: Dlvisian at Industnel Satery Pertnit Number: CODE t. INSFECTIONTYVE - 1616 Fizetl Sys�em Finel Fire Prevention 7288 Pool Spa Final 200 Finel Re-Root 201 FIneI BIocWReteining Well 202 Final Factory Fire Plece 203 Final Sign 204 Final Demolition 2N&4fi Peg. 1H�i COOE1 INSPECTIONTYPE 206 � Finel Mechanicel 208 Final Plumbing 210 Final ElecMcal 212 Final Flre Preventlon 220 Final Planning Approvel 222 Final Slte 250 Final Building/Occupancy AOp�ieant to /ill in all spaees CirY OF.COSTA MESA �JCONSTR CTION PERMIT �' Project Address 8.6 I �• �� %��'�%�� Applicant's Mailing Address ' Owner'sName DlV�F/EO �ieO�Ed�hone_ Address Arch/Eng. _. License No. , Address � �/��, Contractor's Nam B��«-"F ��/G � Phone �L� Addresslmailingl� �' s � �W S, fJ, Lp Ciry LicenSe No. �Z-% � � � L'ICENSED CONTRACTOR DECLARATION � . � � 1 her¢Dy.a�(irm Ihat I am lic¢n5¢tl untle� p�ovision5 oT Charte� 9(commencing witb section 7000) of Division 3 of the Business antl Professions COGe, antl � my Iicense is in eull tor�e a tl,gttect. 3�j.�i933 Licenzj Clas�s ' ��' �� l�-- �s ��]^ - DateJO�Z�'o� S9 f /��""`�"' - �� ORKERS' COMPENSATION DECIARATION . � iereby affirm chat I have a ceriificato of consent [o self-Insure or a tertificate , of Workers' Compensafion Insuran<e, or a certi(ietl <opy thereof (Section _ 3800, L.xD. C.) �ON� ' Policy No. �'��,��/y�� Company . � CertiflEtl c�o,gY �5 fjr iletl wAPPhcanlY Byrytl�w'+ � Date 3 � � � ' EXEMPTION FROM WORKERS' COMPENSATION CLARATION (TnisseGtion neeE not bC completetl if [he pe�mit I5 /o�bne huntlretl (E300j-o� � less). : ' � ' . I certify that in the performance ot the work for which this perm�t is issuetl, I � sball not employ any pe�son in any manne� so a5 to become subject to the � Workers' Comp¢nsation Laws Of CaIlPornia. ' . Date ' � Signature 'NOTICE: If, after making this tleclaratlon, you snoultl become subject to the �. Workers'. Compansation� provisions.,ot the laboc Code, you must forthwith compty witb� such pvovisions o� this pe�mit shall be �tleemetl revoketl. CONSTRUCTION LENDING AGENCV�� ' `�" ' 1 hereby aifirm [hat [here is a constructlon lentling aqency lor the:performance of the work for w" thi�s iL i ' uetl (Sectlon 3097 Civ. CJ Lentl¢Y5 Name - E � Lentler's Atltlress � , , �� ' �. OWNER BUILDEH OECLARATION � ' � 'I, I hereby affirm lhat I am•exemp[ from the Con[ractor's �icense Law tor the ' following reason (Section ]031.5�Bu5fnes5 antl Professlonal Cotle: Any City or � . counTy which requlres a permit to construct, alter„improve, tlemolish or repair -...., ....� �..e .. i�. �,. uc i«uwnrn alm re.oulres [he aoolicant (or SUG� Oe�mit the Cwtrac(or's License Law (Chapter 9(commencing with Section �000) of DiviSion 3 ot Ihe Busin¢55 antl PrOtessions Cotl¢) o� that he/she is exer�pt therefrom antl the bazis for the alle9etl exemption.'Any violation oT Section ]031.5 by. any dpplicant fOr a permit subjecl5 the. applicant to a civil . penalty ot not more [�an (ive nuntlretl tlollars (E500). . ❑ 1, as.owner of tne property or �my employees'.with wages as Iheir sole compensation, wlll tlo the work, antl the structure is not Intentletl or otteretl � for sale, (Seclion ]044, Buslness anG Professional Cotle: TM1a Contractor'S License Law tloes not apply lo an owner of a property who builtls or imOrovez thereOn, ana wno �tloes such w0/k nim5¢H/her5elf or MrOugh hi5 or he� own employees, pwvitl¢tl thal SUGh Improvement5 are nOt IntentlGtl o� o(feretl for � sale. 11, however, tne builtling or improvament is soltl within one year ot com- OletiOn, tbe owner will have the bu�tlen of Proving he/she tlitl not bulltl ar im- , prOve forthe purpose ot Sale). ' ❑ I, a5 owner of the property, am exclusively contractlny with Iicensetl con- tractors to construct Ne Oroject (Section �Oa4, eusiness anC Professions Cotle: . The Contractor'S License Law does not apply to an owner ot Oroperty who builtls or improves thereon, antl wno tontracls for such projects with a mn- Vacto�(sl licerze Dursuant�to l0e Contractoi's Licenze ldw). I am aware that proof of their Worker'S COmpenSatlon in5urance sttoultl be provitlltl to me. � I� 1 am exempt untler Settion B. 6 P. C. for this reason Date '� � Owner I herGby certity [hal 1 have rea information is correct. I agree ro antl state laws relating to builtlu sentatives of �tnls city to enter -in50ecllon pu o 5 Siqnature Driv¢rs' License or 55 this application antl state tnat tne aoove omPly with all city antl county orEinances conitructlon, anU nereby autho�ize rep�¢- upon the above-mentionetl property for _ �ate '�.J anO sign all appropriate tleclarations. a TVPE OF CONSTRUCTION L�4 NEW IJ ADD LJ ALTERATION' IJ REPAIR ❑ CONVERSION O DEMOLISH ❑ OTHER� � - q.p. # DESCRIPTIONOFWORK/USEOFBLDG. �� ' S Main Buildin9: E _. TYPEOFPERMIT GRADING 'FOUNDATION STRVCTURAL ' T Front �❑ TENANT � ELECTRICAL ❑ PCUMBING ❑ MECHANICAL _ A qear '❑ OTHER � PRWECT OESCRIPTION SQ: FT. oCCVaArvcY C Right K Left CONSTRUCTIONTYPE � VALVATION$ $ ' ZONE - GRADING CU. VDS. ACRES P��y. Ref. # Remarks: , ' (�"7�A(7-N`-i . � PlanningNotes: Sink A Preventer Irrigation Showers ' Servite Sink " ' Sewer Cap � Sewer Connection Solar Collectors _ Dishrvasher � Drinking Fountains Floor Orains . Floor Sinks � � - GasService � Outlets� Interceptors � Kitchen�5ink t Lavatories , ' ' � � P—Trap � • ' � ' Roof Droins � � ' Reinspec[ion Fee $15 Duct - Under Ground Dutt-Structural � . Duc[-Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # - Heating Syscem & Ducting -, ❑aioo,000sru�ioo,aoo Reinspeaion Fee � S75 CMF 0865-4fi, rev. 10/04 White - Bulltlin9; Canary - Applicant; Pink - Accountin9: Goltlenrotl - ASSe55or Solar Pipmg Solar Tank Swimming Pool w/Spa Urinal Water Closet � Water Heater " Water Service Auto�Wash ; Laundry Trays � � Issue Fee : IANICAL Hood or� Typel ❑ Canopy Typell ❑ 9 ' � . , 5632 6/27/85 � - Accessory Building: Parking Req./Provided Automatic Washer � Construction Pole Sub. Cooking Unit Dishwasher . _ Drvers ❑Gas ❑Electric Fan � F.A.U. Fixtures Device Bozes Outlets ' Switches _ Garbage Disposal . Generamr �0.5 KW Retrigeration System ❑6100,OOOBTU ❑100,OOOBTU System Repair/Alteration Fire Dampers laue Fee $ 3 $ 3 Reinspection Fee 5 � Leo� TL 2ane ' • e . ELECTRICAL • Transformer ❑ 15-50 KW ❑ 50,+ KW , �Meter ❑upto�100amps � Mete� ❑over 100 amps '. � ,Sub Panel� Momrs �0-1 HP �1'F, - 8 .Inc. Solar �9-15 HP �16-15+ Microwave � • � � Pole Light � Range Sign ; Standing Sections ;�^1 Trash Compactor Issue Fee DEVELOPMEN7 SERVICES REQUIREMENTS: Zoning Approved By Building Approved 8y FEES $ 3 2 O N I N G R E. � M T S SUMMARV OF FEES . BUILDING PERMIT $ SMIP $ PLAN CHECK . S PERMIT PLUMBING� $ ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ � GRADING $ PLAN CHECK 50% $ MICROFILM $ T' /L� MECHANICAL $ � TOTAL FEE $ � PCAN CHECK 25% ,$ � CONSTRUCTION AND PLANNING PO�� & SPA APPROVALS Permit # Date Inspector p�ppROVALS Permit # Date Inspect�r 7. Temporary Electrical Service or Pole ' 52. Pool & Equipment Location 2.j Soil Pipe-Undrgrnd. . , � ' S3. Steel Reinforcement 3. Electrical Conduit Utility-Undrgmd. � '� 54. Forms � � 4:.Electrical Conduit-Undrgrnd. _ ; 55. Electrical Bonding , 56. Rough Plumbing & Pressure Test � 5,.Steel Reinforcement ' � 6� Elecirical UFER Grnd�. 57. P,PPROVAL TO COVER-GUNITE 7. Footings � ; � 58. Electrical ConduibUndrgrnd. .�S; 8. Foundation ' . 59. Gai.Pipe, O Undrgmd., Test � 9- Wate�� Pipe-Undrgrnd. .. , � . 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Svuctural Floor System " 61. APPROVAL TO DECK 11. Property Sewer Line�& House Conriection - � 62. Backwash & ReceptorFinal . 12. $ewer Cap "� . � . 63.'Heeter & Vent�Final � 13. �Roof Drains �� . � 64. Plumbing System - Final . 14: ,Rough Plumbing �' � 65. Electrical-Final 75. Rough Electrical-Conduit - 66. Solar SYstem�Final � 16. Rough Electric Wiring ' 67. Fencing & Access Approval � 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING � 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS�FINAL 19�. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. DuCts,in Structure 70. Underground Hydro 22. Ducts, Ventilating � 71. Product Piping �Gas ❑Oil � 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing � 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31,.�.Plaster BroWn Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electfic �,,(o � Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test , 36. Hood or Canopy 37. Final Factory Fireplace 38. Finai Plumbing 39. Water Service-Final 40. Gas Service-Final � 41. Solar pomestic-Final , 42. Backflow Preventer . 43. Backflow Irrigation . 44. .Landscape Irripation System 45. Sound Attenuation 46. Handicap Fiegulations 47. fINALSTRUCTURE&BUILOING 48. Special Requirements Completed 49. Electric Release to Edison ' � 50. Gas Release to Southern California Gas Co � � 51. CERTIFICATE OF OCCUPANCY � - No. Date Applicant to till in all sDaces ezcept enose within neavy bortler Iines ana si9n all apD�oprlata Ceclarations. CITY OF COSTA ME�SA/ CONSnTR1MUCTION PERMIT - PERM!T "o. ' �� TRACT�NO. LOT NO. UNIT NO. Project'Address (�S.L%� �l) ��}7 ) � Applicant's Mailing Address '�� - � 0� � Owner's Name M�A ��'�' -�-'` �� Phone 7�3u'� nddreu Zi %c. � LA'1<<� �`�Lh Cl. i�N �-°'v ArchlEng. ��'�`��W��LicenseNo. Address Contractor'sName�%1V�1-2.Q\�l(s'D ��•� Phone� Addresslmailingl��a� �� C-�Z�L�n ��-b"� Ciry License No. � � LICENSED CONTRACTOR DECLARATION ' ' � I_hereby affirm ina[ I am licensetl untler Orovisions o1 Charter 9'(commencin9 wi[h 5ection 7000) of Divislon 3 ot the Bu5ine55 antl Pro(e5sion5 Cotle, antl ' my license is in full ce antl e(fecL . Ucense C15ss ' � License No. 3� � � Date � !�5'9 t � `�^ /)/i "ORKERS' COMP,ENSATION DE A��C� iereby aftirm that 1 have a certificate ot consent to self-insure or a certlticate r Workers' Compensa[ion Insurance, or a certl/ietl {c,�oO�Y thereof'(Section ' 3800,' Lab. C.) ./1 �� 1 2�7 G�� Company �"` ��" wn � Policy No. ��' TJ ( eCertitietl coPY Is I�letlbw thrthehC�tY Builtl�' 9 D+'vlsio ^ Date �� AOPlicah( 1J 1 1- �1 V � ' EXEMPTION FROM WORKERS',COMPENSATION DECL ATION (Thissection neeC nol be com0�etttl if the Dermit i5'for one huntlratl (5300) or less). ' I certlfy lhat in the performance o( the work for whlch this permR isdssuetl, I zhall not employ any person in any manner so as to become SuOject to Ihe Work¢rz' Comp¢nsation Laws of California. - . Date � Si9nature ' 'NOTICE: It, atter making Nis tleclaration, you shoultl become subjecl to the Workers' COmpenwtion Provision= of the LabOr COGe, you mu5t fort�with � comply with suGh p�ovi5ion5 or this permit shall be tl¢¢matl revoketl. CONSTRUCTION CENDING•AGENCV ' � � I nereby aillrm that t�ere ii a construction lentling agency tor [he performance of the 'work ior which this Oermit is Issuetl (Sectlon 309] Civ. CJ �, LenAer's -Name - -- Lentler's Atltlress _ OWNER BUILDEN DECLARATIOfi ' ' 1 hereGy attirm�that I am exempt irom the Contractor's License Law for the tollowing reason (Section �031.5 Business antl Profe55ional CotlelAny ciry or county wnich requires a permit to construct, alter, improve, tlemolish or re0air. any zf�ucture, ptlOr to its iz5udnce� alm reqW�eSlhe ap0�icant f0� SUCh pe�mit � to fiie a si9netl sta[ement tha[ ne/she is licensetl Oursuant to [he pmvlsions of � the Contractor'S Ucense law (Chdpter'9 (commen<ing wlth Section 7000).0( Jivision 3 of the Business and Protessions CoOe) or tnat he/ine Is ezemOt .hetetrom antl [he ba5is to� the dllegetl exemption. AnY viOlalion o( Seclion 7031L5 by any apDlicant for a permit subje<[s th¢ applicant lo a civil �enalty of not more tnan (ive huntlretl tlollars (5500). I, as owner ot tne prooerty or my employees with wa9es as thelr sole .compen5ation, will tlo the work, 8ntl [ne SVucture is no[ intentletl o� oH¢r¢tl for sale (Section 70a4, Business antl Professlonal Cotle: TOa Contractor's � Licenze Law tloes not appty to an owner of a oroperty who bulltls or Improves ' thereon, antl who tloes such work.h�mself/h¢rzelf or lhrou9n his or ner own em010yee5, provltletl that Such improvements a�a noLintentlatl o� of(eretl for sale. If, however, tne builUing or improvement is zoltl within one year of com- pletlon, the Owner will have the qurtlen of proving he/sh¢ Oitl nOt bulltl Or im- prova fo� thC Purpose oT sale). � � � ❑ I, as owner ot the property, am exclusivety contracting with Iitensetl con- IldCtOfS LO CO�Ii[NCl [M1¢ O�OjCCt ($eCtiOO 7044, BlI5111¢55 dntl PIOfB5S10115 COtl¢: The Contractor's License !�w tlpes not apply to an owner of O�operry who Duiltls o� improves thereon, antl who mnttacl5-fo� such projec[s with a con- Vactor(s1 Ilcanse pursuant to fhe �ontracror'S License Law). I am aware [hat proof of their Worke�'z Compensy[ion insurance shoultl be provitletl to m¢,� ❑ 1 am exempt untler Section B. & P. C. for this reason Date � Owner, certlty Ihat I.have_reaU.this m is correct. I agree to com❑ ISi9nature � v . — / Driver5' Licenso or�55 � CMF 0865-46, rev. 10/84 White - Buildin9; TYPE OFCONSTRUCTION LKNEW U ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTFiE ` ' � DESCRIPTION OF WORK/USE OF BL� �r '� TVPE OF PERMIT GRADING FOUNDATION STRUCTVRAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL , ❑ OTHER PROJECT DESCRIPTION 50. FT. � � occuP/ -0ONSTRUCTIONTVPE � VALUATIONS. 20NE GRA�INGCV.VDS. AC Remarkz: � � � Bar Sink Backflow Preventer Backflow Irrigation Bathtubs 0 iking Fountains i �r Drains i x Sinks Service �.Outlets rceptors hen Sink • �....,o< i Showers ' Service Sink � Sewer Cap Sewer Connection` Solar Collectors � $olar Pipin9 ' Solar Tank � Swimming Pool w/Spa Urinal � Water Closet Water Heater � • Water Service �Auto-Wash � P-Trap ' ' Laundry Trays - ' Roof�Drains � � - Reinspection Fee $15 � Isue Fee Boiler • Duct - Under Ground Duct-Structural ' Duct - Ventilaling Exhaust System ❑ Multiple Firepl/Fact.8lt. ICBO # Heating System & Ducting , � ❑aioo,000aTuOioo,oao ,,._ ..._....Date� � . . . GReinspection Fee � $15 - Applicanh Pink - Accounting; Goltlenrotl - Assessor Hoodor Typel ❑ � Canopy Typell ❑ Refrigeration System ❑0-700,OOOBTU ❑100,000 System Repair/Alteration ' Pire Dampers Issue Fea � A.P. # }�s S Main Buildi E . T Front B Rear A C Righ[ K Le t s Pln9. Ref. # � Planning Notes: N Automatic' Washer Construction Pole Si Coaking Unit Dishwasher Dryero ❑Gas ❑EI Fan F.A.U. Fixtures — Device Boxes Outlets Switches Garbage Disposal Generamr �0.5 KW 9647 3%20%85 73.i�•_tl Zona �- Acceuory Building:; � � I !' ' 2C�' c l b l Parking Req./Provided � '� ELECTRICAL � Transformer ❑ "15-50 KW � '� 50�+-KW_% � 1J �. Merer ❑up to 100 a'm'ps:-� Merer ❑over 100 emps" i -L_ Suh Panel � � Motors �U7 HP �1X� 6 Inc.Solar �9-15 HP 016-1 - Microwave- - - Pole Light Range � Sign ; Standing Sections 15 KW Trash Compacmr S 3 ' Reinspeetion Fee S75 luue FEES � T DEVELOPMENTSERVICESREQUIREMENTS: I Zonin9 APProved BY , Building Approved By ;� S 3 n 0 5+ i i i Z - O N ' I ` N � G R E Q M T S FEES � � " SU M R F FEES � ��) �� BUILDING-PEFMIT $ SMIP $ �_!-�7'_ — ' PLAN CHECK $ - �PERMIT ' ' ' � — - PLUMBING $ � ISSUANCE . $ PLAN CHECK 25% $ ENERG�' P.C. ,$ ELECTRICAL $ GRADING $ . PLAN CHECK 50% $ MICROFILM ' $ — MECHANICAL $ TOTAL FEE � $ � � PLAN CHECK 25% $ ' ' � CONSTRUCTIAN AND PLANNING PG, _& SPA � APPROVALS Permit# Date � Inspector ,.APpROVALS Permit# Date� Inspector 1. Temporary ElBctrical 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-Undrgmd. . � .- 8. ,Foundation ' � . 59. Gas Pipe, O Undrgrnd., Test � 9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, � Undrgrnd. �� r '10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewei Line & House Connection ' 62. Backwash & Receptor-Final -12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains � 64. Plumbing Systerri - Final � 14. Rough Plumbing 65. Electrical_Final 75. Rough Electrical-Conduit 66. Solar System-Final --'' 16. Rough Elec[ric W�ring 67. Fencing & Access Approval ��- 17.� Rough Wiring 5ign 68. APPROVED FOR PLASTERING - 18.� Rough Electrical-T Bar Ceiling � 69. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # � 21. Ducts, in Structure 70. Underground Hydro 22: Ducts, Ventilating 71. Product Piping �Gas 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 (5tructural) & Monocoat 75. Dry Chemical 27. Frame and Flashing � �U� 76. Dry Standpipe � 28.� Lathing & Siding , 77. FIXED SYSTEM FINAL . 29. Insulation � �. 78. FIRE PREV. FINAL . 30. Drywall Nailing "� • HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat � 79. FINAL INSPECTION 32. Electrical Power Meter�Final� 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning � S- ,/% ._ R.cr- 35. Final Gas Pipe-7est � _ . 36. Hood or CanopY . 37. Final�Factory Fireplace . � �� I . _ 38. Final Plumbing ' � � 39. Water Service-Fi�nal , - 40. Gas Service-Fin81 41. Solar pomestic-Final , , � 42. Backflow Preventer -�•' ` 43. Backflow.lrrigation ' � � , , ' 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 arouthem Califomia Gas Co " 51. CERTIFICATE OF OCCUPANCY ' _ _. ._, ', No. Date , ' , � , , , � r\1 V �iTv�F COS7a mEGSa .CONSTRUCTIOON•PERMt�IT+ Projec�;�ddress ��/�' wEs% � / � �i • ' i _. .. . . //i_l w/ -/�/dlL�/ / � Address � � �" ' � , Arch/Eng. b�N4� �'b�$ LicenuNo. 1Of83 .Address �I�Z2•L�•4GOGIri p1L<<l'1�. (7Li�7E'71J��Ea1�Q.-0��V��2 ��, Contractor'sNam QTL45 R%��'s Phone�� Address (mailing) ��5• �• U��'� O�jQ/�ifjF Ciry License No: � SS 4� 8Q '�� ' LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensetl untler provizlonz ot Cnartor 9(commencin9 with section ]000) of Division 3 of the Business antl Professions Cotle, antl my license is in fu11 to =e a� ltect. � O �.IC205C d55 t� Lken- No. � 3 � �ate Signature W00.K RS' OMPENSATION DECLARATION 1 hereDy af(irm that I nave a certificala of consent to self-insure or a certlticate f Workers' Compensa[ion Insura/nce, or a certlfietl copY thereof (Section, POOc�Y No. � �V ��Xy}'3=` GomPanY ��'T � CertifieC copy is hereby turnlshea. Dateertiiletl copy fs tiletl wAPPI <dotY_�uptlln��Dyisl� � �-ff' � EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section neetl no[ be compleletl if the permil is for one huntlretl (SI00) or Iess). ' • 1 c¢rtify Inat in [he pertormance o( the wo�k fOr whlch this pe�m�t i5 i55uetl, 1 shall not emPloy' any person In any manner so as to become subject to tne Workers' Compensation Laws oi Calitornia. . Date SignaWre 'NOTIGE: If, atter making this tleclaratlon, you shoultl become subjec[ to the Wo�kers' Compensation provi5ion5 of lM1e LabOr COtlC, You must (orthwith compty with such provisions or this permit shall be tleemetl ravoketl. CONSTRUCTION LENOING AGENCV . ' I hereCy attirm that ehere is a mnstructlon lentlln9 a9ency tor tne periormance ot the woB tor whicn this permi[ Is Issuetl (Sec[ion 309] Civ. CJ � Lentler's Name Lender's Atltlreis OWNER BUILOEH �CCLARATIOfJ I hereby attirm that I am exempt irom the Contractor•s License Law for the rollowing reason (Section 7031.5 Business and Profe55ional Code: Any city or county which requires a permlt to consVuct, alter, improve, tlemollsh or repalr any structure, prlor to Its issuance, also requires the applicant for such permlt to file a signetl slatement thal he/She Is litense� pu�sudnt to [he prOvlsions of 'the Contrac[or's License Law (Chapter 9(commencin9 wlth�5ection 7000) ot Division 3 of the Business antl Professions Cotle) or that he/she is exempt therefrom an0 the basis for the allegetl exemptlon. Any violation of Sectlon 7031.5 by any applican[ tor a permit subjects the applicanl to a civil penalty ot not more than fiva huntlretl tlollars (E500). I❑ 1, as owne/ of the prop0rty or my amploye25 wlth, wages as their sole compenSatiOn, will tlo th¢ wo�k, antl [he structure is not. in[entletl o� otteretl ��i to an owner ot a properry wno owws or irnprove> n work himsel(/harself or Ihrough his or her own mh improvaments are not intentletl or offeretl for n9 or improvement Is soltl within one year of com-. : the buraen of proving.he/she tlltl not bulltl or im- t0 flll 111 dll SDdtlS ihose within heavy bortle� lines antl fign all approDriate TRACT NO�, LO'NO. ` , UNIT NO. 8E!!po✓c � , TYPE OF CONSTRUCTION � NEW LJ ADD U ALTERATION LJ REPF\IR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER � �ESCRIPTION OF WORK/USE OF BLDG. �n%ME�:l6L "' �tJ /n iN S TYPE OF PERMIT - GRADING, p❑� FOUNDATION TRUCTURAL — ❑ TENANT � ELECTRICAL�c�FLUMBING ❑ MECHHNICAL ❑ -0THER PROJECT DESCRIPTION Sq.FT. oCCUVANCv CONSTRUCTIONTVPE VALUATION$ IX•QUD ZONE - . GRADINGCU.YDS. ACRES Remarks: nC J�t' • �� .� �J �� PLUMeING FEES ❑ I�, as owner ot the�property, am excluslvely contracting wlth Iicensetl con- tractors to construct the project (Section ]044, Businesz antl Professlon5 Cotle: The ConVac[or's License Law does not apply [O an owner oi prop</ty,wh0 builtls onimoroves thereon, antl who coniracts for'suth pro7ectz wltn a con- tractor(s) llcense�pursuant�to.the Contractor's License'L•aw). I am aware that proof. o( their Worker's Compensation in5urante shoultl be provitletl to me. ❑ I am exempt untler Section � 8.' & P. C. for this reason � Date � Owner � � �' �J t hereby certify that I have reaC this applicatlon antl state Ihat the above L- intormation is correc4 I agree to comply wltn all clty antl county ortlinances antl state laws �elating t0 builtlinq conStructlon, antl h¢reby authoNie r¢pre- Isentatives of his ci y to e upon the bove-mentionetl pro erty for _ _. �,, in5pectlon�P 5 s. �M � � � S \� Signature �/ry// Date •+ Drivers' License or 55 � Reinspec[ion Fee CMF 0865-4fi, /ev. 30/84 White - Bulltling; Cdna�y � Appllcant; Pink - Accountin9: Goltlenrotl - Aszesso� Bar Sink Backflow Backflow Bathtubs Clarifiers rinking Fountains , loor Drains ' � laor Sinks � as Service �U��CIS rtercepmrs � itchen Sink ' avatories � -Trap ',00f Drains Reinspection'Fee $15 Boiler Duct - Unde� Ground Duct-Structural � ' Duct - Ventilating Ezhaust System ❑ Multiple ❑ F.irepl/Fact. Blt. ICBO # . Fleating�System & Ducting ❑0.100,000 BTU� OO,OOO BTi $15 Service Sink ' Sewer Cap � Sewer Connection ' Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash Issue Fee Hoodor Typel ❑ ,. Canopy Type I I ❑ t � Refrigeration System ❑aioo,000eru ❑ioo,000e System Repair/Alteration Fire Dampers � Registers Issue Fee ��. y�� Cp+ _/ �. / r A.P. # � S Main Buildi E T Front / B Rear / A -0 Fight K Left S Ping. Ref. # Planning Notes: " � Automatic Washer � Construction PoleSub. Cooking Unit Dishwasher Dryers ❑Gas ❑Elec Fan ' F.A.U. Fixtures - Device Boxes Outlets Switches Garbage Disposal - � Generator �0-5 KW � $'3 FEES $ 3 I Reinspaction Fee - DEVELOPMENT SER Zoning Approved By _ 8uilding APProred ey �2�� '_��2:�ies. . . ' � �. , 'cJ��o�� 1._ � .� (f zona � . ,5 el..' Accessory Building: z O �� N 1 huc,�G . q Parking Req./Provided � E U M T S ' ELECTRICAL ' Transformer ❑' 15-50 KW � � 50+KW � Meter ❑up ro 100 amps ' Meter ❑over 100 amps Sub Panel 5 KW Motors�i % - 8 IncSolar 09-15 HP �16-15+ Microwave ' " Pole Light Range Sign • I Standing Sections Trash Compactor ' FEES $15 � � luue Fee . ' � $ � SUMMARV OF FEES �� BUILDING PERMIT $ (�•�C� SMIP �$� �. Z�p PLAN CHECK � $ ��-� � PERMIT ��. PLUMBING $ In •OO ' �SSUANCE $ PLAN CHECK 25% $ � ENERGV P.C. $ ELECTRICAL $ � Z •OC`� GRADING 5 � PLAN CHECK 50% $. � � MICROFILM $ � t i MECHANICAL $ � :TOTALPEE' $, �' L PLAN CHECK 25% $ ' � , � , '1 CONSTRUCTION AND PLANNING � POOI ;PA � � ��, 'APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector >. 1. Temporary ElecVicgl Service or Pa1e 52. Pool & Equipment Location 2. I Pipe-Undrgrnd. 53. Steel Reinforcement ;" ., � . , 3.��ilectrical6pncluitUtility-Undrgrnd. 54. Forms +.J� 4.'�Elect�icAl Coniluij"-Undlgrnd. � 55. Electrical Bonding 5:�Steel�Reinforc�ment� ;�,; �'�� ' 56. Rough Plumbing & Pressure Test 6: ,El4ct'pical I�FER GrRd:� ' 57. APPROVAL TO COVER-GUNiTE .$ �.�..,)' 7.,'Footings,` � . � ' ' 58. Electrical Conduit-Undrgmd. ' �' 8. �FouAdation „�,: ;� i � "59. Gas Pipe, O Undrgmd., Test l" �� r 9: Wa4e� Pipe-Undrgrnd. �; �: � j�^ 60. Backwash Lines, P-Trap, O Undrgrnd. . 10�,:;Stcuctural Floor Systeqi ��;' `'- � 61. APPROVAL TO DECK �� (�{�.;, 11. Property'Sewe`r Lin��&'House Copnection � 62. Backwash & Receptor-Final � 12.� SeJve� Cap�, . ,,,, ;;. ! % ��, � � 63. Heater & Vent-Final :� � 13. Rqo'R'Dr�ins ,� ".,, 64. Plumbing System - Final 14. Rpuyh Plumbing:•, '�' 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final -�16. �Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling � 69. POOUSPA SYSTEMS FINAL � L. 19. Rough Ffeating & Air Conditioning FIRE DEPT. REQUIREMENT , i• 20. Rough Factory Fireplace APPROVALS Permit # � 21. Duc[s, in;Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil 23. Gas Pipe=Rough & Test - 72. Underground Flush r;- 24: Roof Fc�ming I 73. Undergrnd. Storage Tank 0 Gas ❑ Oil . 25. Roof Sheathing � ' 74. Overhead Hydro 26. T-Bar.Cei�ing (Structural) & Monocoat 75. Dry Chemical 27. Frame ar�d Flashing 76. Dry Standpipe 28. Lathirig�&�5iding 77. FIXED SYSTEM FINAL ' 29. Insulation ; 78. FIRE PREV. FINAL 30. Drywail Nailing � HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION � 32. Electrical Power Meter-Final � t) 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test � 36. Hood or Canopy � 37. Final'Fac[ory Fireplace .38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final ; � 41. Solar pomestic-Final 42. Backflow Preventer • ' � "� 43. Backflow Irrigation - 44. ,Landscape Irrigation System ' ' � 45. Sound Attenuation ' �� ; ' 46. Handicap Regulations , 47. FINAL STRUCTURE & BUILDING � � '� 48. Special Requirements Completed 49. Electrie Release to Edison _ , 50. Gas R�elease to Southern California Gas Co ' � 51. CERTIFICATE OF OCCUPANCY '� No Date ` , � f ADP��ant to fill in all z0aces axcaD< <nasa wlt�in �eavy Gortler Iines anG sign all apOropriate Oaclarat(ons. ciTY OF cOSTA MpES�A� CONSTR CTIcO�N PERMIT Project Address L�.Y� � • ��s]I . Applicant's Mailing Addren n�� V-= �� . Owner's Name M�� 152�' �Z� A��T Phone 4—�4-c_ Addreu •23'�-� � LA1Cl-� CE�1�L- �^ `�Y'%-n �, �l ��_L 'n_e -A\ Arth/Eng. �'�`^� �W � ( License No. Address Convacror'sNama��1E�-i�\�FO Qi�A'l7Cti Phone %��—SS�S Addresslmailingl��2n� �K'� CF,`��i�L�itt _{�1'�(1�"� City License No. LICENSED CONTRACTOR DECLARATION � I hereby aHirm that I am licensed untler provisions o( Charter 9(commencing with section 7000) ot Division 3 ot the Businexs antl Professions Cotle, antl my license is in (ull rce antl ettect. Licen 3 syl l'ycens�j_ S� ( Date� 5'9 t � f�� z ��— WORKEHS' COMPENSATION DECLARATION � I hereby aftirm that 1 have a certiticate ot con5¢nt to selNnsure ar a certl(Icate �( Warkers' Compensation Insurance,'or a certitietl copy thereof (Section ' i800, LaD. C•)n ", 1 3�G (� M/11n PolicY No. L�r�r {� ComPanY L� ��' 1 W,1 � eCertifietl coOY �5 he�¢by tumishetl. ' Certif" c y is filetl with Ihe city Buil0lqTqiyipian. � �ate�_.�� Applicant N � V EXEMPTION�FROM WORKERS' COMPENSATION DECL ATION (This section neetl not be completetl if [he permil 15 (or one h ntlree (E300) or less) I certi(y Ihal in lhe performance ot the wo�k for which thls perm�t i5 issUetl I shall not employ any person in any manner zo as to, become subject to l�e Workers'�Compensation Laws ot California. , . Date � Si9nature ' � 'NOTICE: If, aiter making this tleclaration, you shoultl become subje<t [o the Workers' Compensation provizions of Ine Labor Cotla, you must fortnwith comply with such provlsions o� thi5 pOrmlt shall be ,tleemetl revoketl. CONSTRUCTION L�NDING AGENCV 1 hereby affirm [ha[ tnere Is a construc[ion lentling agency tor tha performance of the work tor which this permit is issuetl (Saction 3097 Clv. C.) . Lentler's Name Lentler's Atleress � _ � OWNER BUILDEN DECLARATION � 1 nereby aHlrm that I am exemp[ from the Contractor's License Law for the lollowin9 reason (Sectlon �031.5 Busina55 antl Professional Cotle: Any city or county wbich requires a permil lo ConStruct, alter, improve, tlemolish or repair � any strutture, orlor to Its issuance, also requlres thn aDP��ant tor sucn permit to tiie a si9netl statement Ihat ne/she Is Iitensetl pursuant to the Provisions o� the Con[ractoYS License Law (Chapler 9(Commencin9 with Sectlon 7000) of Dlvision.3 of the Business antl Professlons COUe) or that ne/sha is exempt therebom antl tne basis ror tbe allegeC exempUon. Any vlolalion ot SecHon ' ]031.5 by any apPli<ant for a Permit SUDjects tna aOP��ant to a civil �enalty of not more tnan fiva huntlreC tlollars (y500). . LJ I, as�owner of tho property or my emvloyees wltn wages as ineir solo compensation, will Oo tho work, and Uie structure Is not Intentletl or olferetl � for sale (Section 7044, Business and Protessional Cotle: Tbo Con(ractor's LicenSe Law tloes no[ appty to an owner o1 a property wbo bulltls or Improves the�¢On, antl who does zucn work himselt/he�SClf o� lhrough hi5 0� hor own employoes, provitlea that such Improvements are not Intentlotl or otfaretl for sale. It, however, tne builtling or Improvement is soltl wlt�in one year of com- pietion, tne owner will have tha buraen oi proving he/she tlltl not bulltl or Im- �iOve for the purpose of Salaj. U I, as owner o( tne property, am exclusively contractin9 with Ilcansaa con• , ttactors to construct the plojecl ISeclion 7044, BuSIne55 antl PrOtaSsiOns Cotla: The Contractor'S UcenSe l.. w does nOt aOPly to an owner o1 property wh0 �� builtls or improves the�eon, antl�who contraCtS for such DrojaClS witb a con-•� tractor(51 Ilcense pursuan[ to the Contractor'S Licens0 L.aw). I dm aware that proo� of their Worker's CompensaHon insu�ance Shoultl b0 p�ovitlotl lo me. ❑ I am exempt under Section B. 6 P. C. lor thls reason Date Owner _ I nereby certify that I have reatl t�is a inf[erma[ion i5 Calf¢Ct. I d9I¢C [O <OrtIDIY tate that tne above tl county ortlinances eby authorize repre- lonetl oroperty to� Date 3I/�� TVPE OF CONSTRUCTION I�l NEW IJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTIONOFWORKIUSEOFBLDG.�-n��r _ ,r- TVPE OF PERMIT LJ GRADING Lyt�OUNDATION LJ STRVCTURAL ❑ TENANT ❑ ELECTRICAL I��LUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION 5�. FT. oCCUPAN�V CONSTRUCTION TVPE VALUATION $� ZONE GRADINGCV.YDS. ACRES_ Remarks: Q' /�{ Bar Sink Backflow�Preventer Backflow Irrigation Bathtubs � Clarifiers � Dishwasher Drinking Fountains floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink � � � Lavatories � . P—Trop Roof�Drains � Showers Service Sink �� Sewer Cap �� Sewer Connection Solar Collectors Solar Piping Solar Tank � Swimming Pool w/Spa Urinal - - Water Closet . — Wnter Heater ' Water Service FEES Reinepoetion Fea � $15 I I Isue Fee ' � S 3 Duct�UnderGround Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. BIL ICBO �h Heating System & Ducting ❑o-ioo;000 sTu ��oo,000 Reinspection Fee I Driv¢rs' LiCenSe Or 55 � ' � � CMF 0865-46, rev. 10/84 White - Builtling: Canary - Applicant: Pink - Accounting; Goltlanrotl - Assessor $15 Haod or Typel ❑ Canopy Typell ❑ Ref rigeration System ❑0.100,000 BTU ❑ 100,000 BTU System Repair/Alteration Fire Dampers Registers Issue Fee � � $ 3 A.P. qW S Main Building: E T Front 8 Rear A C Right K _ . Ping. Ref. # ` Planning Notes: Automatit Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Elec Fan F.A.U. Fixtures ' Device Boxes 9645 3/20/D5 zone Accessory Building: i i�l ELECTRICAL Transtormer ❑ �15-50 KW. ❑ 50 +:�CVV` � Garbage Dispossl Generacor �0'5 KW �5�15 KW -. Reinspection Fee $15 DEVELOPMENT SERVICES RE�U Zoning APProved'By��j Building Approved By _6 Apulication Issuad Bv I I Meter Uup to 100 amos� Mete� ❑over 10 Sub Panel Motors O0.1 HP Inc. Solar �9�75 Microwave � Pole Light Range LJ1R^-6 - HP �1675+ Standing Sections Trash Compacror laue Fee 7'ao:� TL FEES $ 3 2 O N 1 N G R E � M T S � SU R OF FEES O BUILDING-PERMIT $ � � SMIP $ ��_ PLAN CHECK $ PERMIT � PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. 3 ELECTRICAL � $ � ' GRADING $ PLANCHECK 50% $ � MICROFILM $ MECHANICAL $ TOTAL FEE $ 13,�t3 PLANCHECK 25% �$ ' ' - CONSTRUCTION AND PLANNING POOL a S°A � . APPROVALS Permit# Date Inspector p�ppROVALS Permit# Date InspPc*or I I i. Temporary Electrical $erVice 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 Reinforceme�t . 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE :7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe,.O Undrgrnd., Test .9. Water Pipe-Undrgrnd. " 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing SYstem - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical�Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 77. 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 �Gas ❑Oil 25. floof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. ,Frame and Flashing . LJ � j K_ 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing - HEALTH DEPT. REQUIREMENT N 31. Plaster Brown Coat �� 79. FINAL INSPECTION 32. Electrical Power Meter-Final � 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning � 35. Final Gas'Pipe-Test . 36. Hood or Canopy 37. Final Factory Fireplace 38. Final�Plumbing � 39. Water Service-Final . 40. Gas Service-Final � 41. Solar pomestic-Final - 42. Backflow Preventer ' 43. Backflow Irrigation 44. Landscape Irrigation System , 45. Sound Attenuation 46. Handicap Regulations • 47. FINAL STRUCTURE & BUILDING i 48. Special Requirements ComP�eted � 49. Electric Release to Edison � 50. Gas Release to Southem Celifornia Gas Co , . � 57. CERTIFIGATE OF-OCCUPANCY � ." �, Nn. Date ' l� Applicant to fill in all spaces exceD� CITY oF COSTn MEoSA C NST/�R��UCTION PERMIT ProjectAddress n67 �• �`�TR �r ' C�� Applicant's Mailning Address � Owner's Name -Y ✓E�S F E Phone— - Address ArcH/Eng. _. � License No. � � � Address - � ' ' �/��. Contracmr's Name �y' F JGGj�/�_phonde _Tq L/� Address Imailing) �- S� �r1�L�✓��j S y, •/ y7D5� City License No. ' ��-�9 LICENSED CONTRACTOR DECLARATION � I hereby atfirm tnat I am licensetl untler Orovisions o( Charter 9(commen<in9 with section 7000) of Division 3 of the Business antl Professlons Cotle, antl � my iicense is in fuu tQrce a er�e�c. � � �S3%33 Licens% �C.la�ss �y Lice e ly� . Oate "�u�, —, Si9natute �� a ��--e - VORKERS'COMPENSATION DECLARATION I hereby affirm tnat I have a certificate of consent to self-insure or a certifiwte � of Workers' Compensation Insurance, or a certifi¢tl copy thereof (Sectlon 3800,�Lab. Q � � Poiicy rvo.7�'��'��6�/' companv ��oNM,/T Certifietl copy is heteby furnishetl. Certitietl co y i fletl wlth Ihe city B Itl DI o. � � , Oate ��'�� AOP�icant � . EXEMPTION FROM WORKERS' COMPENSATION CLARATION � (This section neetl'no[ be completetl if the perrtmit is f r one hunCretl ($100) or less)- . : � . ' I certify �tnat in the performan<e o( the work for which thiz permR is Issuetl, I shall not employ any person in any manner so as to become subject to the � Workers'�Compenwtion l.aws o( California. � . Date � ' Si9nature 'NOTICE: If, after making this tleclaration, you shoultl become zubject to the Worklrs' CompenSdtiOn� provision5 ot the Labor Cotle, you must torthwith . comply with such provisions or this permit shall' be tleemetl revoketl. CONSTRUCTION LENDING AGENCV ' ' 1 hereby affirm that there is a'construction'lentling agency for the performance of the work for wqi th' pe mi 's ' suetl (Se<tion 3097 Civ. C.) . Ltntler'z Name �� C � Lentler'SAtltlress O � �L$ ' . OWNER BUILOER DECLARATION ' � ' I herebv afflrm that I am-exemo� froT the'Contractor's llcense Law tor the to that 7031.5 by any ap011cant tor a permit subjects tne appucan[ ro a avn �enalty of not more than five huntlretl tlollars (E500). LJ I, az,owner of tne�property or my ertio�oyees�witti wages as tneir sole compenzation, will! do [he work, antl the s[ructure I5 not intentletl o� offeretl for sale (Section 7044, Business and, Professional Cotle: The Contractor'S License Law tloe5 not appty to an owne� ot a property who builtls o� Improves tM1ereon,�antl who�tloes sucb work himsel(/herself or through his or her own employee5, provitleE that such Improvemen[5 are no[ intentled or offe�eC tor sale. If, however, the builtling or improvement is soltl wl(hin one year of <om- o�etion, tne owner.wiu have the bu�tlen Of Ptoving he/She Di0 not builtl o� im- prove torthe Ou�pOse ot sale). ' ❑ 1, as owne� ot the Oroperty, am exclusively cont�actiny wi[� IicenSeC con- t�acto�s to wnstruct Ihe 0/oject (Seciion 7044, Bu5ine55 dntl ProfeSsions Cotle: The ConVactor's License Law Ooes not apO�Y �o an owner ot pro0erty who � builtls or improves tnereon, antl who contracts for such' projects witn'a mn- � tractor(sl license pursuant�to tiie Contractor's License Law). I am aware that proof oi tneir Worker's Compensation insurance zhoultl be prOvitletl t0 me. _ �J 1 am exempt untler Section , � B. S P. C. tor this reason Date ' - ' Owner 1 hereby �cerllfy that I.have reatl tnis ap0�ication'antl state tbat the above '' infOrmation is correct. I agree [o Comply with all city antl county ortlinan[e5 antl state IawS r¢latinq to builtling mnstruc[ion, antl hereDy autnoriie rlpre- sentatives of 'tnis �ci y to en er u on the above-mentioned property 9f�or inspection purp �5 Date / �d�� 0� Siqnature � , Driverz' License or 55 � �eavy bortle� Iines ana sign all apo�ooriata tleclarations. TYPE OFCDNSTRUCTION �i.NEW LIA�� L� ALTERATION IJ�REPAIR ❑ CONVERSION ❑ DEMOLISN ❑ OTHER - A p.* � DESCRIPTION OF WORK/USE OF BLDG. ��'�r - ' S Main Buildin9: TYPE OF PERMIT ' GRADING ��FOVNDATION STRUCTURAL � T Front �.O TENANT � ELECTRICAL ❑ P�UMBING ❑ MECHANICAI. Rear �' B ❑ �OTHER � � � A PROJEC7 DESCRIPTION 5�: FT. ' oCCUVArvCv � C Right K Left . CONSTRUCTIONTVPE VALUATION$ ' ' $ ZONE GRADING CU. VDS. ACRES p�ng. Ref. # ftemarks: . ' ' Planning Notes: I 3ar Sink � 3ackflow Preventer - -' Sackflow Irrigation � Bathtubs Clarifiers Dishrvdsher . Drinking Foun[ains � Floor Drains Floor Sinks Gas Service �Outlets Interceptors �� Kitchen�Sink '�- � Lavatories , ' P-Trap . • Roof�Drains Reinspection Fee $15 Boiler , Duct - Under Ground Duct - Ventilating Exhaust System � Multiple Firepl/fact.Blt.IC80# � Heating System & Ducting ❑ ai oo,000 sru O i oo,000 Reinspec[ion Fee 'I $75 CMF 0865-46, rev. 10/84 White - Builtlinq; Canary - AO��?nt; Pink - Accounting; Goltlenrotl - Assessor Showers Service Sink ' -' � Sewer Cap Sewer Connection � Solar Collectors Solar Piping Solar Tank • Swimming Pool w/Spa Urinal ' ' Water Clout Water Heater ' WaterService � Auto-Wash ' laua Fee Hood or Typel ❑ Canopy � Type I I ❑ � Refrigeration System � ❑a�oo,000eTu ❑ioo,000 Syztem Repair/Alteration Fire Dampers Registers laue Fee FE $ 3 $ 3 5633 6/27/B5 .. ' •�+0�0 TL � Zone Accessory Building: � .. . . � .. t 2 O � N I �' N � - G ' R Parking Req./Provided � E' n M � _ T S ELECTRICAL Automatic Washer Construction Pole Sub. Cooking Unit � Dishwasher � Dryers ❑Gas ❑Electric . Fan � P.A.U. fixtures ' - � Device Boxes ' Outlets � Switches Garbage Disposal Generator �0-5 KW �5-15 KW L:1 15�50 KW � SO+KW , Meter ❑up ro 100amps ' Meter ❑over 100 amps � Su6 Panel 'Motors 061 HP � 1 X- 8 Inc.Solar �9-15 HP �16-15+ Microwave Pole'Light ' Range Si9n � ; Standing Sections ' Trash Compactor - �'Reinspectian Fee �$15 ' � laue Fee DEVELOPMEN7 SERVICES REQUIREMENTS: Zoning Approved By BUilding Approved By AppliptiOn Issued BV FEES $ 3 SUMMARV OF FEES � BUILDING PERMIT $ ' SMIP $ PLAN CHECK $ PERMI7 � ' PLUMBING $ � ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. �$ ELECTRICAL $ � GRADING $ PLAN CHECK 50% $ . SO MICROFILM 5 � '/ '� MECHANICAI $ TOTALFEE $ � PLAN CHECK 25% $ ' � i CONSTRUCTION AND PLANNING � PUUL & SPA - APPROVALS Permit # Date Inspector ,qppROVALS Permit # Date Inspncror 1. Temporary Electrical Service or Pole , 52. Pool & Equipment Location � 2. Soil Pipe-Undrgrnd. 53. Steel Reintorcement 3. Electrical Conduit Uiility-Undrgrnd. � '� 54. Forms ' 4. �EleCfrical Conduit-Undrgmd. 55. Electriral Bonding 5.-Steel Reinforcement . � 56. Rough Plumbing & Pressure Test � 6..,Electrical UFER Grnd. 57. F?,PPROVAL TO COVER-GUNITE ' 7:.-Footings • •- � ' � 58. EVectricat Conduit-Undrgrnd. � � 8. Foundation . . �� 59. Gas�Pipe, O Undrgmd., Test ' _� 9. Water Pipe-Undrgrnd. �� " 60. Backwash Lines, P�Trap, O Undrgrnd. i 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. Rou9h Electric Wiring ' 67. Fencing &,Access Approval � � 17; Rou9h 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 APPROVAIS Permit # 21. DucYs, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro ' 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31�.' Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric . � �,(e � Notr.s: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test . 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41 . Solar pomestic-Final 42. Backflow Preventer � 43. Backflow Irrigation 44. �Landscape Irrigation System � 45. Sound Attenuation 46. Handicap Regulations . � 47. FINAL STRUCTURE & BUILDING 48. Speclal Requirements Completed 49. Electric Release to Edison 50. Gas Release to Soutflern California Gas Co • 51. CER7IFICATE OF OCCUPANCY -, . Nn. � � Date � 1=rroject Address Applicnnt's Mai Owner's N�am�e^� Address C �.L Address � ConVactor's Nnn Adtlress (mailing) City Licenie No. LICENSE� CON 1'hereby a7lirm t with sectlon 70C my II<ense is irh/i � No. ADD��ant to ftll in all soaees axcept lhose wltnin heavy boraer Iines ana sign all apo/oo��ate aeelarations. TVPE OF CONSTRUCTION � NEW IJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. h'P� ��.) , TVPE OF PERMIT GRADING FOUNDATION STRVCTURAL , ❑ TENANT ❑ ELECTRICAL PLVM I/N�Gr_4� GC�-1('[�Cq,s � ❑ �OTHER lJl \v..�Cij c.l, I PROJECT DESCRIPTION Sa. F7. OCCVPArv v CON STRUCTION TVPE VALUATION $ � 20NE GRADINGCU.YDS. ACRES 4CTOR DECLAR TION I am Iicensetl untle rovisions of rt 9(commencln9 Remarks: of Division 3 of th Business an rof zsions Cotle, antl � Date a.J ��_ � �» Si9�ature �d65 �`^' `�`�� WORKERS' COMPENSATION DECIARATION I here�y attirm that I have a certitiwt ot consent to salf-�ns e or a certHiwte of Workers' Compensation Insurance Or a certifietl cop hereo( (Settlon 3aoo. �b. ��y�� 3 Policy No. WU� Co any ❑ Certifietl copy is hereby turnishe0. �:� � R�7. CerC � nT �ii jiletl with tbe city Bu Itll Divlslon. Date ��1��L'� APPlicant � EXEMPTION FROM WORKERS' COMPENSATION DE LARATION (Tbis seetion neetl not be completetl it tha permit I5 for one huntlretl (5100) or lesz). I ce�tify tltat in [he Oettormance of th0 work fot which this pe�m�t is iSSUGtl, I snall not employ any person in any manner so as to become subject to tha Workers' ComOensdtion. �y�ys ot CalHomid. . Da[e Si9nature � 'NOTICE: It, after making this tleclaratioa, you shoultl become subject to tho WO/k¢rs' Comp¢nSaliop provisions of th< Labor COtle, you musl fOrthwlth comply with� suc� provi5ions or lnis pe�mit zhall be tlG¢me0 revoketl. CONSTRUCTION LEryDING A6ENCV � 1 hereby afilrm that there is a'constructlonienaing agenty tor tne oeriormance of the ;wo�k fOr wn��h [his p¢rmlt Is Issuetl (Section 309] Clv. C.) Lentler's Name - - �antler's AtlEreSs � _ OWNER BVILDER �@CLARATION I her¢by a/firm Ihal I am exomPt 7�om the Contrac[or'S License Ldw 10� lh0 following rcason (Sacqon 7031.5 Buslness antl Profo55ional Cotle:'Any tlty or counlY which requires a pCrmit lo cOnitru<l, alter, Im0/ove, tlGmolish or ropalr , dny sl�uGture, prlot to itz Issuan<o, a150 rCqul�e5 [ho applican[ Por SucM1 pe�ml[ � to flle a signetl statemCnt that hn/she Is Iicensod pursuant [o Ne provisions of 4M1e Contrac[or's LI<enye Law (Chapter 9(commencin9 wlth SecHon ]000) oi livision 3 of lhe Bus��ezs antl Protesslons Code) or that he/she IS exempl ncrotwm antl the bagis for lhe allegetl axemption. Any vlolalion of SacUon /031.5 by any ap01i<ant fOr a permit Subjecls tltC a0�litant to d Clvil .�cnalty of no[ more than five huntlretl tlollars (5500). ' LJ I, as owner of ih0 property or my employoes with wages as thelr solo � compensatlon, will ao (he work, ana thu structure Is not Intentletl or olteratl (or sale (Section 7044, BusinGis antl PrOfesslonal CoAe: The ContraGtOr's Licenie Law tloe5 n0[ aOP�Y �o nn owner ol a property wna bulltl5 Or Imp�ovoz theroon, ana who tloes such work hlmselt/herselt or tnrou9h hiz or har own emplo�ces, provitletl [hat suGh Improv¢monls are not intentl¢G o� oHerctl for sale. I however, Ine bulltling or Improvement Is soltl witnin one yoar ol com- pletlon, tna owner will have the burtlan of oroving ne/she Eitl not builtl or Im- prove iot the purpose Ot Tale). ❑ I, as owner of the propercy, am exclusivoly conlratting with licensetl con- tractors to conztruct t4e projecl (SecHon 7044, Butiness antl Professlons Cotlu: - Tha Con[ractor's Llcense Law does not apply to an owner of property who � builtls or Improvas tnereon, antl wno coniracts lor such Drojects with a con- traclo��s� Ocenze'pursUdnt�t0 tne Conl�actor'S LICen58 L.aw). I dm awdr¢ that proo( o thelr WorkeYs Coinpensation {nsurance shoWtl be orovltletl to me.i ❑ t am exempl untler 5�cilon B, & G. C. �or this r¢asan n • Dale Owner I hareby certify tna I have rea iniormdtion IS Correc I agree to antl Slat¢ laws reldti to builtlu SenW[ives ot thiz ci b to enter inzpecUon purposes. Si9nature _� Drivers' License or 5! CMF 0865-46, rev. 10/84 t state Ihat lh¢ abOva ana countv ortlinances Sink Preventer I rrigation. Jrinking Fountains Floor Drains Floor Sinks . Gas Service� Interceprors Kitchen Sink Roof Drains - " � Rainspaction Fae $15 Boiler " Dutt - Under Giound Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple FirepUFact BIL ICBO d`- . Heating System & Ducting � 00.100,000 BTU �100,000 Reinspec[ion Fee White - Builtling: Cdnary - ADPlicant: Pink - ACCOunting; GolqenrOtl - ASsesSor $15 ES $IIOWElS Service Sink - Sewer Cap Sewer Connection Solar Collectors � Solar Pipin9 ' Solar Tank Swimming Pool w/Spa Urinal • Water.Closet Wacer Heater Water Service Aum�Wash Laundry Trays � , Issue Fee g 3 �ANICAL - FEES Hood or Typel ❑ Canopy Type II ❑ Refrigeretion System � � ❑0.100,000 BTU ❑100,000 BTU System fiepair/Alteration F ire Dampe�s Registers laue Fee �� $ 3 A.P. qW S Main Build E T Front B Renr A C A�ght K Left S Ping. Re(. # � Planning Notes Automatic Washe� � Construction Pole Sub. Cooking Unit . � Dishwasher Dryers ❑Gas ❑Electric Fen F.A.U. Fixtures Device Boxes OuUets Switches , Gerbuge DiSposal Generaror �0-5 KW �5-� 1128 4/IS/85 17037 Zon Z O N I � N G R Parking fleq./Provided E Q M — S ELECTRICAL � Transformer ❑ �15-50 KW � ❑ SO+KW Meter ❑up m 100 amps Meter ❑over 100amps Sub Panel � Motors 061 HP �1'h - 8 Inc.Solar 09-15 HP �16-75* ' Microuvave Pole Light Range ; Stunding Sections Trash Compacmr �'Reinspection Fee � 515' I luue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By FEES S 3 SUMMARV OF FEES ' BUILDING PERMIT $ SMIP $ ' PLAN CHECK $ PERMIT � PLUMBING $ /y in ISSUANCE $ PLAN CHECK 25% § �•� ENERGV P.C. $ ELECTRICAL § � GRADING $ - PLANCHECK 50% $ � M�CROFILM $ � —7 �'] MECHANICAL '� ,5 TOTALFEE $ � PLAN CHECK 25% � $ ` CONSTRUCTION AND PLANNING PO. & SPA Date Inspector Date Inspoc*or �APPROVALS Permit# APPROVALS Permit# i , 1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement � 3. Electrical Conduh Utility-Undrgmd. 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. Waier 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 FOR PLASTERING 18. Rough Electriral-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 Structu�e 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 (Structurai) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL .29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing � HEALTH DEPT. REQUIREMENT 31. �Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: . 34. Final Heating & Air Conditioning 35. Final Gas Pipe-TeSt 36. Hood or Canopy 37. Final Factory FirePlace 38. Final Plumbing 39. Water Service-Final � 40. Gas Service-Final 41. Solar pomestic-Final . 42. Backflow Prevente� � 43. Backflow Irrigation , � 44. Landscape Irrigation System 45. Sound Aitenuati0n 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. CERTIFICATEOF OCCUPANCY . �Nn. Date Applican� lo fill in all ipaces axcept �ho�e within heavY �orCar Iines an0 sign all app�oDriate Eeclaratlons. �ITV OF COSTA'MESA CONSTRUCTION PERMIT PrOjEct Address `�� • i�in '�i�u'�'i Applicant's Mailing Addreu z121 S. GRAND AVE. ,$ANI'A ANA owner's Name DIVERSIFTm P%�T�fS Phone � 3453 Address 2 ZOl I.AKE CIIdT�t DRIVE� EL TORO Arch/Eng. Licenu No. Address � Cuntractor's Nam SIEI2[2A FNV�.RC[�NfAI' Phone 957-8�1 FNVr Address Imailing� 2121 S. GRf�[`]D AVE. D citv Licnnse No, 24912 LICENSED CONTRACTOR DECLARATION I ne�eby affirm [hat I am licenietl untlGr proviSlonS Of Charter 9(Commancin9 with section ]000) of Division 3 of lho usiness antl Professions Cotle, antl my Iicense is in f�ll force an0 effect. LJcense Cla{�s CZO L� 4051 4 Date Signature NORKERS'COMPENSATION DEC R 1 N I hE/eby atfirT that I have a certific ¢ of con5¢nt [o sel(tin5ure Or a certificat¢ of Workers' COMp¢n5ation' Insuran e, or a certifietl copy thereof (Sectlon ' 3800, Lab. C.) N0107123�+IC FN2MERS Polity No. Com ny }pn�yCertifietl copy is hereby turnishetl. 'CY`Ce�ti�ietl copy jz tiletl with the city Iltli iv�s Oate ��$� Applicant EXEMPTION FkOM WORKERS' CO ENS T ON RATI N (ThizsocUon neetl not be <om0�etetl If ha permit is fo� one untlra (E100) or less). � I certify that in tne pertormance of the work (ar which this permk is Issuetl I shall not employ any person in any manner so as to became sub7ect to li�e Wo�ke,�•�R�B�,sa[ion Laws of California. � Da[o SI9naWro NOTICE: Ii,'aftyr making this tlectaralion, you shoultl become subject lo the Workers' CompCnSation Drovizions ot the Labor Cotle, you muSt forthwith compry with� such provisions or tnls vermit shall be tleemotl revoka0. � CONSTRUCTION LENDING AGENCY . . I Ite�¢by affl�m that there IS a cOnst�ucllon Ientling a9ency for the per(ormance of th0 work 1pr whith th15 Oermit Is ISSu¢tl (SecHon 3097 Clv. C.) Lpntler's Namn ' Lentler'S Aatlrpsz OWNER BUIIqER DECLARATION ' I herabv aHirm that I am exemot from the Contractor'z License Law for the � 7031.5 by any applicant for a permR suD�ects the appncant to a c�vu penalty oi not TOr< Man fiv0 huntlratl O011ars (5500�. LJ I, as owner o1 tne� property o� my employees wim wages as Iheir soln tomponsalion, will tlo the work, antl tha structuru ii not In[entletl or ot(eretl for sale (Sectlqn ]044, Business antl Protesslonal Cotle: The Contraclor'i Llronsa L.aw tloes not apply to an ownor o/ a property who bulltls or imp�ovet thereon, antl who tlo¢s such work hiTivll/horself or thrOu9h his or her own employ ees, provitletl t�at such Improvomants aro not intentletl or offoratl tor sale. If, howeve�, lh0 builtling O/ ImprOvement Is soltl within ona year ot cOm- plGtiOn, tha Owh¢� wlll hav¢ [ha bUrtlen Of prOvin9 h¢/S�e tlitl not bulltl Or im- �fOva ior the p4�pOse of sale). U I, as owner p( the property, am ezclUslvely contracling with li<onsetl con- tractors to cons�ruct tne vroject 1Sectlon 7044, Business antl Profnsslons Cotle: Tne Contractor's License Law doat not apPly to an owner of property who � builtlz or Imprq�es thereon, antl w�o contracts for tu<� projects witn a con- tractof(5) Ilceni9 pyrzuant t0 the COntrdttot's Llcen58 Ldw). ❑ I_am oxempt untler Section B. & P. C. for this roason Date I nei Inior Owner 'J SZ TYPEOFCONSTRUCTION "�I.�NEW IJ ADD LI ALTERATION U REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p,�j6 DESCRIPTION OF WORK S Main Bu E TVPEOFPEHMIT GRAOING FOUNDATION STRVCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING C�AECHANICAL B Rear ❑ �OTHER . - A PROJECT DESCRIPTION 5�. FT. OCCVPANCV C Right K Left CONSTRUCTIONTVPE VAIUATION$ ' $ ZONE GRAOING CU. VDS. ACRES Ping. REf. # Remarki: - B�1 IAUNDRY ROQ`1 Parking Req. Sink Preventer Irrigation Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlats Interceptors Kitchen Sink � - '=Trap � RoofDrains Reinspoction Feo $25 BO�ICf Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. IC80 # Heating System & Ducting ❑0-100,000 BTU 0100,000 BP Si9nd[ure •IV 1 " U' V- - Date I, I Drivers' Li< � 0 55 � - - Reinspection Fee CMF 0865-46 rey, ]/g3 W��te - Builtling; Gnary - AOO��wnp Pink - Accounting; Goltlenrotl - Assedsor $25' Showers Service Sink Sewer Cap Sewer Connection Solar Cotlectors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service ' Issue Fee Hoodor Typel ❑ Canopy Typell ❑ � Refrigeration Sys[em ❑4100,OOOBTU ❑100,000 System Repair/Alteration IsSue Fea FEES $ 3 FE $ 3 Use of Building Plannin9 Notes: Automatic Washer � Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A,U. Fixtures Device Boxes ' Outlets Switches Garbage Disposal Generator 045 KW �5-75 4636 6/II/85 IOo50 TL Zone Accessory Park.Fees $ EIECTRICAL Transformer ❑ 15-50 KW � 50+ KW Meter ❑up to 100 amps ' Meter ❑over100amps Suh Panel Motors�0.1 HP�1h-8 Inc.Solar 09�15 HP �16-15+ � Microwave Pole Light Sign Standing Sections Trash Compacmr FEES O N 1 N G R E U V I H E � Reinspection Fea �$25 � �ssue Fae ' I $ 3 � PUBLIC SERVICES REaUIREMENTS: Zoning Approved By Date Appliwtion Approved By Date Application luued By Date_ � J�_ SUMMARV OF FEES . BUILDING PERMIT $ � SMIP $ , PLAN CHECK $ PERMIT � PLUMBING $ ISSUANCE $ . PLAN CHECK $ � ENERGV P.C. $ ELECTRICAL $ GRADING $ PLANCHECK , $ MICROFI�M $ , MECHANICAL $ �� TOTALFEE � $ I�.SO PLAN CHECK � $ � I • Sv � -, . �' CONSTRUCTION AND PLANNING � � P� �& SPA APPROVALS Permit # Date � Inspector qppROVALS Permit # Date Inspector ' 1. Temporary Electrical Service or Pole , , 52. Pool & Equipment Location ' 2. Soil Pipe�Undrgrnd. ' . 53. Steel Reinforcement 3. Electriral 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 - 11. Property Sewer Line & House Connection � 62. Backwash & Receptor�Final 12. Sewer Cap t ' 63. Fleater & 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 Approvai 17. Rough Wiring Sign . 68. APPROVED FOR PLASTERING i 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. Storage Tank � Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINA� 29. Insulation . 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT � 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final ' � � 60. FOOD CERTIFICATE ISSUED 33. Final Electric . Notes: 34. Final Heating & Air Conditioning /J 5'dxj' (�/� _� 35. Final Gas Pipe-Test � � 36. Hood or Canopy - 37. Final factory Fireplace ' 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final � 41. Solar pomestic-Final �� 42. Backflow Preventer � 43. Backflow Irrigation ' 44. ,Landscape Irrigation System 45. Sound Attenuation � - 46. Handicap Regulations . ' 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed � 49. Electric Re�ease to Edison ' - � 50. Gas Release to Southem Califomia Gas Co , � ' 51. CERT�FICATE OF OCCUPANCY No. Date ADP�icant to fill in all z0acas CiTY oF COS7A MpESn COIySTRUCTION PERMIT ` Project Address Q:� 7�� yth- •s`i �RLIND2� ApplicanYs Maili7n�g 'Address ' ' � Owner's Neme {� ✓�'� � �� , ��E��Phone " Address Arch/Eng. — License No. Address �-,,p�_' Con[rattor's Nam ' P�ne �J�Z�cO Address (mailing) /1 � -1 Q S D City License No. =c��! � � LICENSED CONTRACTOR DECLARATION � ' I h¢reby atfi�m that 1 am Iicensetl untle� O�ovi5ion5 of Charte� 9(commencing viitb section 7000) ot Divlsion 3 of tne Business antl Professlons Cotle, antl - my Ilcense is in tull t ce ana eifect. ' q�� Lic¢n C'la'ss�f License No. 3�/_.J-� Da[¢��16�1i_ Signalure � VORKERS'COMPENSATION DECLARATION her¢by atfi�m that I �avB'a ce�tlfi<at¢ ot consent to selt-Insu�e o� a certitiWte o� Workers' Compensation Insu�dnce, or_d Ce�tifletl.copy the�eot (Section 3800, Lab. �G'L� BO�6�// Company �� Policy No. �� `.L Certifietl copy is hereby fumishea. Cer)ifietl co y 7 tl with the Uty B}�} d pivi lo - at¢_;^�%'� �� Applicant_v" ��=� �� EXEMPTION FROM WORKERS' COMPENSATION O LARATION (TM1is section rieetl not be completotl lf the permit Is for.one hunOretl ($100) or ' .less): � � ' ' I certlfy that in ine per(ormance of the work tor whlch this perm�t is issuetl, 1 snall no[ employ any person In any manner so as to become subject to the Workers' Compensatlon�Laws ol CalifOmla. r � . Da[e ' � Slgnature . 'NOTICE: If, after making this tleclara[lon, you shoultl become subject to the � Workers'.. Compensation provisions ot the. Labor Cotle, you must forthwith . comply with' such provislons or this pevmit '.shall be tleemetl revoketl. CONSTRUCTIOIV LENDING AGENCV,• . ' � � 1 hereby affirm that there is-a construction le tling agency for the pertormance , of tho Wark for w ch thl�/y It i as uetl (Sectlon 3097 Civ. CJ , , �entler's� Name ��O �T� � Lender'S Atltlress 70 - OWNER'.BUILDEft DECLARATION �- ' I hereby atfirm that I am exempt from the�Contractor's License l.aw for the tollowin9 reason (Section �031.5 Buslness antl Professlonal Cotle: Any ciry or caunty which requi�es a permit to con5truct, alte�, improve, tlemolish ot reoair .any ztructure; prlor to its issuance, also reqWres the apo��ant (or such permit �'to tile a si9netl statemenl that he/sne Is licensea pursuant to the provisions ot. 1e Contractor's License Law (Chapter 9.(commenNng wi[b Section 7000) o�� ivlsion 3'ot the Busin¢SS antl Profesvons Cotl¢) o� Ihat Ite/she is exempt �heretrom antl [he basis lor the alle9etl exemption. Any violation o( Section � ]031.5 by any_ ap0��cant for a permit subjec[s the applicant• to a. civil �enalty ot not more tnan five huntlretl tlollars (g500).' - I, a5 owner of the prOpe�ty or my employ¢¢5•with wag¢5 as thei� sole � comvensation, will ao the work, antl thestructure Is not intentleG or ofteretl for sale (Section ]044, BuSiness antl Professional Cotle: The: Contractor's . LlcenSE Law tloes not apply lo an owner of a properly who builtls or improves thereon, antl who tloes such work himselt/herseli or throu9h nis or her own ' empbyees, provitlea tM1at sucM1 Improvaments ara not Intenaetl or offeretl for sale. If, however, the builtling or improvemen[ fz soltl wlthin one year oT com- ple[IOn, tna Owner will have lh¢ buttlen Of proving he/She tlitl not builtl o� im- , �rOve for the OurpoSe o(�wIC). 1, a5 owne� ot [he property, am exclusively conNactiny wlth IicenSetl Con- tractors to conseruct cne pro�ect (Section 7044, Business antl Profeszions Cotle: . Tne Contractor's License I�w do¢s nOt apply l0 an owner ot property who builtls or improves tnereon, anrl who contracti tor such'projects wich a con- ' Vactor(51 licens¢ pvrsuant�tdb�e Contrac[or's LicenSe Law). I am aware that proof oi lhei� Worker'S Compensation in5uranc¢ shoultl be prOvitleG to me. ' �] 1 am ¢xempl untler Sectlon B. 6 P. G�Or this reason Oate Owner I hereby certity�thal I have reatl-Inis applicatlon antl ztate tbdt the above infor1nation is mrrect. 1 agree to comply with all city.antl county ortlinances antl state laws relatin9 to builtling construction, antl hereby autnorize repre- sentativa5 of [ is cily to enter upOn the abOve-mentionetl property tor ins ection ur � ' , / _�r� V P Signature �;�� Date Y o� Drivers' LI SS gk� �� + — � =vt tnasa witnin heavy Eoraer tines anG_si9n ail appropriate aeclaratians.� � T,RACT NO. LOT NO. ' UNIT fy0.. TVPEOFCONSTRUCTION �.NEW LJADO LIALTEi2ATION LJREPAIR�� ❑ CONVERSION Q DEMOLISH O OTHE ' � DESCRIP_TIONOFWORK/USEOF,BLDG. A�P� O TVPE OF PERMITe� LJ GRADING LJ FOUNDATION LJ STRUCTVRAL ❑ TENANT 1�7,ELECTRICAL ❑ PLUMBING ❑ MEGHANICAL - � ❑ -OTHER � PROJEC7 DESCRIPTION� S�.FT. oCCUCANcv CONSTRVGTION TVPE VALUATION $ ZONE ' � GRADING CU. VOS. ACRES � Remaiks: , Sink Irrigation Floor Drains Floor Sinks � - � i GasService� ,Outlets Interceptors Kitchen Sink Lavatories , P—Trap ' Roof Drains - ' Reinspection Fee $15 Boiler Duct- UnderGround Duct-Structural � , Duct - Ventilating _ . � Exhaust System ❑ Multiple ❑ Firepl/Fact. BIL IC80 # Heating System & Ducting " ❑0.100;000BTUOt00,0006T Reinspection Fee � $15 CMF OB65-46, rev. 10/84 Wnita - Builtling; Canary - APpllcant Pink - Atcounting; Goltlenrotl - Assessor ServiceSink' - Sewer Czp , Sewer Connection Solar Collecrors Solar Piping Solar Tank Swimming Pool w� Urinal Water Closet - Water'Heater Water Service Auto-Wash ' FEES 0 A.P. # S Main Buildi E T. Front B Rear A C Right K Lett S Ping. Ref. qW Planning.Notes: Aummatic Washer Construction Pole Sub. Cooking Unit � , Dryers Gas � �Electric ia ,F.A.U. Fixtures � - Device Boxes Outle[s ' .r ! , Switches • Garbage Dispoul ' . - , -Generamr �0.5 KW � laue Fee ' $ 3 IANICAL FEE Hood or Typel ❑ Canupy Typell ❑ � - Refrigeration Sys[em ❑o-ioo,oaosru ❑ioo,000eTu System Repair/Alteration ' Fire Dampers ' Registers , , Issue Fee � � $ 3 Fee Zone Accessory Building: ' Parking Req,/Provided ELECTRICAL � Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑upto�100amps Me ❑over 100amps _ ._ Sub Panel �. 'Motors Q0.1 HP �1 h - 8 Inc.Solar �9-15 HP �16-15+ 'MicrOwave Pole Lighf � Range � . ; Standing Sections 5 KW Trash Compactor $15 , Issue�Fee DEYELOPMENTSERVICESRE�UIREMENTS: � 2oning Approved By Building Approved� By FEES $ 3 SUMMARV OF FEES � � , - BUILDINGPERMIT '$ ' SMIP, $ �!� PLAN CHECK $ PERMIT � PLUMBING ,$ ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ .J�O.d�D GRADING $ PLAN CHECK 50% $ �3. �� MICROFI CM $ � O MECHANICAL $ TOTALFEE $ •Oa PLAN CHECK 25% $ ' � � Z O N I N G R E Q M T S GONSTRUCTION AND PLANNING � P� -& S°A APPROVALS Permit# Date Inspector p�ppROVALS Permit# ' Date Inspec*or 1, Temporary ElectricBl Service or Pole � 52. Pool & Equipment Location 2. Soil P,ipe-Undrgr�d. .� " 53. Stee{ Reinforcement :� 3.•,Electrical Conduit Utility-Undrgind. 54. Forms ' 4-. Electrical Condurt-Undrgrnd. � ' S5. Electrical Bonding �..� 5�'Steel"Reinforcement•� � 56. Rough Plumbing & Pressure Test �� 6: 'Electrical UFER�Grnd: � 57. APBROVAL TO COVER-GUNITE , • 7.'Footings � ;� . � 58. Electrical Conduit-Undrgrnd, - ��'�. $.' 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 Conhection � � 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 7� 68. APPROVED FOR PLASTERING ' 18. �Rough Electriral-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Duct:, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil � � 23. Gas Plpe-Rough & Test 72. Underground Flush � 24, Roof Framing )3. Undergrnd.StorageTank OGas ❑Oil � 25. Roof Sheathing 74. Overhead Hydro • 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Prame'and Flashing 76. Dry Standpipe 28. 4athing & 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 Q � � Notes: �� ; �� 34. Final Heating & Air Conditioning� - � 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, Salar pomestic-Final !' � , � 42. Backflow Preventer � � .. � 43. Backflow Irrigation i � 44. Landscape Irrigation System - 45. Sound Attenuation 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING . 48. Special Requirements Completed 49. Electric Release to Edlson • 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY - ' Nn. Date . . � ��, • �� ADDlicant to fill in ali svaces except those witnin neavy boraer Ilnes antl s19� all appropriate tleclarations. q7v SF COS7A MEsq , CONSTRUCTION PER.�Ma..IT ' `"'"%j ""' ' "'" ""' '�"' ProjenAddress �XD� �. �� V� � , 'ApplicanYs Mailing Address �ll3�� C�'�n Y'%� • TVPE OF CONSTRU TION NEW aoD M�YA C3\��Zi �O1TC Phone�!�'Y'�� NVERSION ❑ DEMOLISH ❑ OTHER Owner's Name r � DESCRIPTION OF WORK/USE OF BLDG. _� ` ' ALTERATION LJ REPAIR Address Arch/Eng. � W � License No. TYPE OF PERMIT GRADING FOVrvDATIOrv S7RUCTURAL Address ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL Contracror'sName��L��w'� R'��T�Phone76�-3u� ��THER Addresslmailingl�-��` t A'�` ��L �•� PROJECTDESCRIPTION SQq./F�T.�{ OCCVa.4NCV� , . , � CONSTRUCTIONTVPE� VAL'UATIONS12.�� City LiCense No. ZONE GRADING CU. VDS. ' ACRES_ LICENSED CONTRACTOR DECLARATION . 1 hereby at�irm thal 1 am Ilcensetl untler provi5ion5 of Charte� 9(commencing Remarks: wi[h section ]000) of Dlvislon 3 of Ine Busine55 an0 Prof¢ssions Cotle, and my Iicense is in full tor antl efiect. 1 � 0� l�censeCldIsz_ '� ' Li�o _ Date '�T� 4 � 5�9 t�� b�� . WORKERS' GOMPENSATION DEC ARATION BBf Slnk I hereby aHirm that I have a certiilcate oi consent to selLinsure or a certiticate of Worke�s' Compensation InSurance, o� a certitietl copy thereof ($ectlon Backflow Preventer 3800, La�. C.) n � Policy No. �� _I Company F�.�r-mont Backfl0wlrrigation �Certifietl copy is her¢by futnishetl. Certifi �tl�c�J��' is filetl with the city Builtlin i'vrsio /� ' Bathtubs Date�17_—APPlicant ��V � �1 � 1 EXEMPTIOA FROM WORKERS' COMPENSHTION �ECLA ATION Clarifief5 (Tnis section neetl not De completetl if the permit is for one hvntlretl (E300) or less). - . Dishwasher I ce��ity thal In [he per(o�mance o( the wo�k for which this perm�t ISlssuetl, I snall not employ �any person in any manner so as to become subject to tho Dfinking Fountains Workers' Compensation Laws o( Cali(ornia. •_ . Data Signature " FIOor Drains �NOTIGE: It, a/tei makinq [bis tleclaratlon, you shoultl be[Ome suDject to thB Workers' Com0ens3lfon provi5ion5 0( tne Labor Cotle, you must torthwith FIoOr Sinks comply with suc� O�ovl5iOn5 0� 'thi5 permil •shall be tleemetl �evoketl. CONSTRUCTION LENDING AGENCY � ' Ga55ervice OutletS�� 1 hereby afflrm that there is a constructiori lentling agency for the performance ' , ot the work tor which thls permit is issuetl (Section 3097 Civ. C.) Int¢rcepLOrS Lender's Name � , Lentler's.AEtlress � , Kitchen Sink _ OWNER BUILDER OECLARATION ' I hereby afti�m Jhat I am exempt trOm the COn[�acto�'S Lic2nse Law f0� the Lavatories , any sttucture, pnor to tile a signetl stat� 'the Gontractor's Lic Division 3 ot [he F Iherefrom antl the ]031.5 by any ap �enalty oi not more I, as owner of mmoensation. will � to con t for a p five nuntlre aaoertv ar owner k him Sale. It, M1owavcr, ihe bullGln9 or ImPra pletion, the owner will nave the bu�tlei �rove for the purpose of sale). I, a5 owner Ot the Oroperty, am ew VaclOrsto const�ucl the project (Sectio The Coniractor's License Law does m builtls or imDroves tnereon, ana wno � tractor(51 license pursuant to the Cont proof o4 their Worke�'S Compensalior ❑'1 am exempl untler Seclion Date �Owner _ I nereby cer[ity that I have reatl tnls information iz wrrecL I agree to comP antl state lawz relating to builA�ng con sentatives oi thisfyty to entQr uyyi ons Cotle) ar tnac ne/sne is exemp� exemption. Any,violation o( Section t subjects the ap0�icant to a civil � �Ilan (5500).' employees v✓ith wages as their iole ° structure is not IntenCetl or otferetl Profeszional Cotle: The Contractor's ot a oroperiy wno builtls or Improves selt/herself or through his or her own nents are not intentletl or otterea for �ement is soltl wiNin one year of mm- of provin9 he/she tlitl not bulltl or im- usively contracting witn ncensed con- 7044, Business ana Protessions Code: [ appry ro an owner of property wno mVacts for. such Orojecis with a con- ' �ctor'S l.itense Law). I am aware [ha[ insurance shoultl be provltletl to me. 8. & P. C. for this reason P—Trap Roof Drains Reinspection Fee . eouer Duct - Under Ground Duc[ - Structural Duct - Ventilaiing Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting . ' ❑ 0-7 00,000 BTU.O 100,000 BTl ISigna[ure < /i— — , Fiainspection Fee $15 � ' �CMF 0865-46, rev. 30/B4 WM1ite - Bulltlin9: Canary - Applicanp Pink - Accounting; Goltlenrotl - Assessor Showers Service Sink Sewer.Connection Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet ' . Warer Heacer Water Service Auto-Wash Laundry Trays a.P. �f`- ' �— — � — S Main Building: E T Front A Rear C Right K Ping. ftef. # � Planning Notes: - Automatic Washer - Construc[ion Pole Sub. " � Cooking Unit Dishwasher � 'Z Dryers ❑Gas ❑Elec' Fan � C} (x) F.A.U. Issue Fee $ 3 FEES Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System ❑aioo,000eTu ❑ioo,000 System Repair/Alteration Fire Dampers Registers • ' luue Fee $ 3 Device Boxes Outlets Switches Garbage Dispoul Generator O0.5-KW 9646 3/20/�5- - QO�o2� il. Zone Accessory Building: �' G f hl b 2 � G� p IDiO� i, i bi Parking Req./Provided ' ` ELECTRICAL ' - Transformer ❑ 15-50 KW; � ❑ 50+'ICW � �Meter ❑upto100amps Meter ❑over 100 amps � 5KW I Rainspection Fee ' $15 DEVELOPMENTSERVICESREQI Zoning Approved By Buildin9 APProved By Apolimtion Issued Bv Sub Panel • Motors�0.1 HP�7X-8 Ina Solar �9-15 HP 016-75� Microwave - - — — Pole Light � Range Sign Standing Sections Trash Compactor Issue Fee � � SUMMARV OF FEES BUILDING PERMIT $ �g,. 5U SMIP• $ .`�O PLAN CHECK $ � •�Z PERMIT PLUMBING $ 32--5� � ISSUANCE $ PLAN CHECK 25% $ 7• ��I ENERGV P.C. $ ELECT,RICAL $ " GRADING $ PLANCHECK 50°,6 $ MICROFILM $ ' � MECHANICAL $ TOTAL FEE � $ � PLAN CHECK 25% $ � 2n5.'Z�1 C�NSTRUCTION AND PLANNING �� POI�� &�SPA '' APPROVALS � Permit# Date Inspector AppROVALS Permit# Date Inspecror • 1. Temporary Electrical Service or Pole � 52. Pool Si 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 Conduif-Undrgrnd. 8: Foundation . 59. Gas Pipe, O Undrgrnd., Test � 9. Water Pipe-Undrgrnd. �� 60. Backwash Lines, P-Trap, O Undrgrnd. -10. Structural Floor System 61. APPROVAL TO DECK •11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final - 12. Sewer Cap 63. Heater & Vent-Fi�al 73. Roof Drains � 64. Plumbing System - Final � 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final " 16. Rough Electric Wiring 67. Fencing & Access Approval - -' 17.. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL ' 19. Rough Heating & Air Conditioning FIRE DEPT. RERUIREMENT . 20..Rough Factory Flreplace 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 0 Gas ❑ Oil 25. Roof Sheathing � 74. Overhead Hydro . 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � '27. Frameand Flashing��i�' . ` `j 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: � ` S 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace . � . 38. Final Plumbing 39. Water Service�Final 40. Gas Service-Final � ' 41. Solar pomesticFinal . . ' 42. Backflow Preventer , � � - 43. Backflow Irrigation , - - � 44. ,Landscape�lrrigation SyStem � 45. Sound Attenuation . ' 46. Handicap Regulations - 47. FINALSTRUCTURE&BUILDING � . 48. Special Requirements Completed � �JS . 49. Electrie Release to Ediso� - 50. Gas Release to Southern California Gas Co � � ' 51. CERTIFICATE Of OCCUPAfy,Cy t S. � C � No. �352- Date � � . ��rr bP CO&TA MESA C�ON Project Address Applicant's Mailinpg �Address Owner's Name �K!S/4 L£i Address 2 3 z� r- L�Q.�[�' V PERMIT �1 � No. Aop��ant to fill in all spaces except tnose within heavy Dortler lines ana sign al1 apvropriate tleclarations. BERMIT NO. ._ TRACT NO. LOT NO. UNI �rca.u�Z., �. (/� Address � — I Contracwr's Nam -��q' � P/h�one � Z�Z � Addresslmailing) �- �' O�y'_.tL��Nr(;/ - ICity license No. <T LICENSED CONTRACTOR DECLARA � ON � ( I her¢by aHiim that-,I am.licensetl untler p�ovi5ioh5 of Ct rt r (commencinq T with section 7000) of OiviSion 3 of th Buslness antl ro e ions Cotle, an \` my Ilcense is In tull (orceZantl tiec . � .j��' � LJcense CI ss� Licen o. J r Date Si9nature WORK S' OMPENSATION �ECLAR ION • ' ' nereGy ailirm that I have a certificate o( consent to selt-ins re or a certificate i Workers' Compen5ation Inzurance, a certitletl <op hereot (Section J800, Lab. ) � Policy No.�� Com ny 4Certifietl cop is hereby fumishetl. > `�A Certif' �s filetl with the city Buil 1 g Dlvision dL Date Applitant - E%EMP ION ROM WORKERS' COMPENSATION DECLARATION (ThiS sec�ion neetl not be compleletl�if the p0rmit Is fo� one huntl�etl (§300) o� less). I c¢rLty thal in [b8 Pe�tormance ot the wOrk fOr which th15 peim�t i5 issuetl, I shall not employ any person in any manner so as to become subject to the Workers' Compensatlon' Laws o( California. , � , Date ' � Signature 'NOTICE: H, a/ter makin9 Ihis tleclaration, you shoulC become zubject to tne Workers' Compensation provisions ot the Labor Cotle, You must forthwilh mmply ,with, Such prOvisions 'or this' pe�mit �shall b¢ �tleemetl revoketl. CONSTRUCTION�LENOING AGENCV�) � 1 hereby afFlrm that [here is a constructiod IenCing aqency tor the performance of t�a �work TOu which this permit is ISsuetl (Sectlon 3097 Civ. CJ Lentle�'s Name � � . � - Lenae�'S�A_tltl/ess ' � OWNER BUILDER �ECLARATION � ' ' 1 he�¢by, altirm that I am exertfPt t�om th¢ ContrdG[o�'S LicenSe Law tor�the (ollowing reason (Section �031.5 Business antl Professional Cotle:-Any city or county which require5 d Pe�mit lo conSt�uCt, al[e�, Improve, demolish o� �e0air any structure, prior to its issuance, also iequires lhe applicant for sucn permit [O file a Si9neC Statement [hat he/she is Ilcenutl pursuant ta the provisions of t�e Contractor's License Law (Chapier 9(commencing with Section ]000) of 'livision 3, ol [he�8usinezs antl Profe55wn5 Code) or [ha[ he/she is exempt �erefrom antl the basis for.the allegetl exempilon. Any violation of Section J31.5 by any applican[ for'a permit subjects•the applicant'to a civil .� enalty of not more than five nuntlretl tlollars (E500). � I; a5�owne� of the property�or my.employees witlt wages as their Sole ' com0ensation, will tlo the work, antl the st�uctu�o Is not i�tentletl o� ofteretl for sale, (Seclion 7044, Busine55 antl PrOtessional Cotle: Th¢ Cont�actor'S LicenS¢ Ldw tloes not apply to an own¢r ot d property' wlto_builtls or improve5 thereon; and wno does such work himseli/herself or through his or her own ¢mployees, O�ovitl¢tl tha[ such Improvements are n0[ intentletl O� offeretl;fo/ Sale. H, nowever, tne bulltling or improvement is soltl wlthin one year. oi mm- pletlon, the Owner will nave [he burtlen of ptoving hG/She tlitl not builtl o� iM- prov9loi Ihe purpOse ot Sale). ' � , �❑ I, as �owner o/ the OrOPerty, am excluslv¢ty cont�acting with IicenSetl con- � bulltli oi improve5-thereon, antl who conlracts fo� Such Orojects with a con- + tractor(s1 llcense pursuan[ to tne Contractor's Litenze Law). 1 am aware tha[ o�oor o( their Worker's Compensation insurance snoultl be proviaetl to me. � ❑ 1 am exempi untler Section . B. & P. C. for thiz reason Date � � Owner.— 1 hereby certlfy that 1 have reaa in infOrmation I5 mrrect. I agree to wn TYPE OFCONSTRUCTION NEW LJ ADD LJ ALTERATION LJ_REPAIR ❑ CONVERSION ❑ DEM LISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. � TVPEOFPERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELEGTRICAL PLU�/ry�1�BI�N�G �❑ M�EnC H^A�}NICAL�, n ❑ OTHER � %YC.IxJIII l�I�QA J� PROJECT DESCRIPTION Sq.FT. ' ' oCCucAN� v^�., CONSTRUCTIONTVPE VALUATION$ Q� .� ZONE GRADINGCU.VDS. ACRES Remarks: � Sink <flow Preventer cflow Irrigation Drinking Fountains Floor Diains' � .FloorSinks_: � - . - . GasService � Outlets. Interceprors ' - Kitchen Sink .. " Lavamries � - � .. P—Tiap . Roof Drains ' - ' �- Reinspec[ion Fee � �$1! � BOIIEf ' � Duct - Under Ground � Dutt - Structural , Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Hea[in9 System & Ducting � ❑ ai oo,000 e ru O i oo,000 eT �sentative5 ot mis n[ w encer•u t aoove-menuonea u�� — � inspeGtiOn purpose . � �� . Signature L �ate Drivers' License or 55 � Reinspec[ion Fee CMF 0865-46, rev. 30/84 White - 8uiltling; Canary - Applicant; Pink - Accountlng; Goltlenrotl - Assassor $15 Showers Service Sink Sewer Cap Sewer Connection Solar Collecrors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal � — Water Closet . �� Water Heater . � Water Service " � � Auto-Wash � - � laue Fee $ 3 � Hood or � Type I ' ❑ Canopy Type I I ❑ Refrigeration System ❑a�oo,000eru p�oo, System Repair/Alteration Fire Dampers � Registers ' , i Issue Fee i BTU $ 3 A.P. � S Main Building: E T Front A Rear C Right SLeft Ping. Ref. # Planning Notes: Automatic Washer Construclion Pole Sub. Cooking Unit Fan F.A.U. Fixtuies Device Boxes � Outlets Switches Garbage Dispoul Generator �0-5 KW II27 4/15/85' Zone Acceuory Building: � Parking Req./Provided . i =` . . ELECTRICAL � � Transformer ❑� 15-50 KW ❑ 50+KW Meter ❑up to 100 amps MetC� ❑Ov2� 1OO drt1p5 • 17037 TL Z O N I N G R E Q M T S FEES � Sub Panel ' � � � Motors �0-1 HP 01'h � 8 InaSolar �9-15 HP �16-15+ Pole Light . Range , Sign ; Standing SeCtion: 5 KW Trash Compactor I I Reinspection Fee I$15 I I luue Fee' DEVELOPMENTSERVICESREQUIREMENTS:• � 2oning Approved By Buildine APP�oved By _ �-� SUMMARV OF FEES � ' BUILDING PERMIT • $ SMIP ' $ ' PLAN CHECK • $ ,''L^ PERMIT . � PLUMBING $ � ISSUANCE $ , PLAN CHECK 25% �$ Z• ENEfiGV P.C. ' S ELECTFICAL $ � � � GRADING $ � PLAN CHECK 50% $ � MICROPILM $ MECHANICAL ` $ � TOTALPEE $ ��-.37 PLAN CHECK 25% $ ' � � � � � ! CONSTRUCTION AND PLANNING '. PO� .SPA �!� ApPROVALS Permit # Date Inspector AppROVALS Permit # Date insper.sor � 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location '2, 5oil Pipe-Undrgrnd. �� 53. Steel Feinforcement 3..E�ectrical 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. Faundation �� ' 59. Gas Pipe, O Undrgrnd., Test � 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 1�1. Property.Sewer Line & House Connection ��' � 62. Backwash & Receptor-Fi�al 12. Sewer,Cap" � �. � � 63. Heater & Vent-Final 13; Roof Drains 64. Plumbing System - Final � 14. Fough Plumbing 65. Electricat-Final 15. ROugh Electrical-Conduit ' 66. Solar SYstem-Flnal 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 79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test �72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank �Gas ❑Oil 25. Roof Sheathing 74, Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation � 78. fIRE PREV. FINAL 30. DrYwall Nailing ' HEALTH DEPT. REQUIREMENT 31: Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-7est 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. Batkflow Irrigation 44. Landscape Irriqation System 45. Sound Attenuation , 46. Handicap Regulations 47. FINALSTRUCTURE & BUILDING 48. Special Requirements Completed 49. Electrie Release to Edison � � 50. Gas Release to Southern California Gas Co ,51. CERTIFICATE OF OCCUPANCY No. Date � AOGlicant to fill in all spaces except thase within heavy bortler lines anG sign all app�apriate Oeclarations. � � , PERMIT NO. � . TRACT NO. LOT NO. UNIT N6. ;irY OF,COSTA nn sn CON�SpT.�R,( U�CTION PERMIT ! ' i.' ,.. -. RolectAddress �� ; �I'^" �. . �� . �� . � � � _: �• � �.TVPE OFCONSTRUCTION �NEW ADD ALTERATION REPAIR Applicant'sfylailingAddress �- ' � � � . � � , ❑ CONVERSION ❑ DEMOLISFI �❑ OTHER A p # - Own�r'sName 1%��%�� Phone— � �'DESCRIP710NOFWORK/USEOF'BLDG: %P�TM�N Address � - . . . . , � �. . - � . � . � . . S� Main Building:, � E Arch/Eng. - License No.' - TVPE OF PERMIT GRADWG ' O FOUNDATION ❑ STRUCTV RAC T Fmnt � AddrEss ' ' � � ' ' ' �' � ' ❑�TENANT �ELECTRICAL ❑�PLUMBING ❑MECHANICAL . B Rear -. ' B/P/SCO� �LEGY�i /G. . � 9 � O'�OTHER - � A Contracmr's Nama Phone � � - C Ri ht . �PROJECT DESCRIPTION SQ:FT.� OCGUPANCV 9 AHdress Dnailin9) �� S. �i3-i,eVi�IV Sf1-.' 9r7d S� ' - � ' ' � K Left ` CONSTRUCTIONTVPE VALUATION$ � '$ City LiCense No. OdZ.�O � ZONE -� GRADING CU.VOS. �ACRES ' LICENSED CONTRACTOR DECLARATION ' � ' Ping: Ref. # I hereby aRirm tnat I. am licensetl untler provi5ions of Chartec 9(commencing Remarks: _ C ' Z� i . Flanning No[es: with section �000) of Oivision 3 of Ihe Business antl Professions Cotle, antl , , my license is in full �oice antl'eftect. , . '� � • , Cicense c ass G � D mens-eyp � �3 �-� � � � , Date � 37� /� � h' � `�f�C� ?-�' , ' ' PLUMBING � � • FEES WORKERSCOMPENSATIONDECLARATIO— N��' . � . garSink � . Showe�s � � � � hereby atfi�m that I bave a certi(itate ot consent to zelhinsure o� a ce�ti(icate - � ao99 , . 5/�3/B5 = G43o60 � Zane . .��uni„��,� . i . . �* . . ,. ' _ - Z O ' N � . , N G ' R Parking Req./Provided � � E , _ Q - M T S f Workers Compensation Insurance„or a, certrtietl coOY. thereof. (Section � gackflow'Preventer"' ' Service Sink ' ' - ��"' ' ' " - '- " 3800, Lab. CJ ' � ' ' • -' � Automatic Washer Poiicy No. IA/ �%.��(� -OD/b�i/Company ��4��r -gackflowlrri ation � � . . - �Certifietl copy is hereby tumishetl. 9 Sewer Cap� Construction Pale Sub. CerY�R&c��tlfcvop . is iile0 with che city Bw i Divi b��/� � � �� - Bathtubs � � Sewe� Connection � -Cobking Unit Date��c � APPlicant ��h� �t�'�✓`-y� , . - , EXEMPTION FROM WORKERS' COMPENSATION CLARATION Cl3rifiers � ; � $olar Collecmrs _ , Li � E/ �Dishwasher � . _ (This section need not be'completed if the pe�mit is for'one huntlretl ($300),or ' Dishrvdshet � � � less). i � _ , ; � Solar Piping • � Dryers ❑Gas ❑Electric I certtty that In the performance of the work for wnlch tnis perm�t is issuetl, I . - . , . snall not employ any person in any manner so as to become subject to the ' Drinking Fountaiqs Solar Tank � - Fan ' � ' Workers' Compensation,Laws oT Galifornia. � � � ' ' • . Date� ' ' Signature ' Floor Drains ' , Swimming Pool w/Spa � � ' F.A.U. ' � �NOTICEi lf, a(te� making this tlecla�ation, you shOultl become subje<t t0 the Workers'i �ompensation•. provisions of the .Labor Cotle, you. mu5t.fortM1wich_ . ' Floor Sinks� ,-- --- � �- - Urinal -^' - "' q Fixtures � ' ' � comply with� such provisions or this permit �shall be tleemetl revoketl. � _ ' . / CONSTRUCTION.LENDING'AGENCV�: `+ ' '� � GaSSerVice Outlet5' WateYCl05et . ' ' I hereby atfi�m thai tbe�e i5 a con5tructlon lentling� a9ency tor the pe�fo�mance ' D2VIC¢ BOx¢5 � of the work for• wbith thi�psr5pi ' S etl�:(Sectlon _309] Civ. C.). Interceptors � - _��T Wate� Heater� � - .�� Outlets Lentler's Name� UHL C!J - - - ' Lentler's AtlGress -riG, D � /(f/C_5 f/_� L U[J � 1 :, ' Kitchen Sink - . - � Water Service � � � � Switches OWNER'BUILDER OECLARATION � ' ' " • ' ' - . . i � I hereby'af8rm that I am exemptfrom the�Contractor'S�Llcense Law forthe � Cavato�iei � Auto-Wash � '' ' Garbage Disposal � following rea5on (Section.7�31.5 Business antl Protessional COEe: Any city or _ � county which requires a permibto construct, al[er, improve, tlemolish or, repair - ' p-Tra'p � i �. L,aundry Trays . � Generator �0-5 KW 05-15 K any structure, prior to Its,is5uance, also �eqUi�es tM1e applicant fo� such petmit � rn fi�e a sianetl statement that �he/she is licensetl pursuant to the provisions oi � q��;,,� , _ - ', , � . � a � permit sul ntlretl tlollar5 i or mv'emc ' thereon,_antl who'tloesi 4uch woi employees, Orovitletl th5t such in wle. If, nowever, the builCing ot pletion, the owner:will M1ave-the I •� rove for tne purpose of salej. 1. a5 ownev of the property, a ; t�actorsto const�uctthe proj¢ct (' � The Contractor's License Law tl builtls or improves th¢reon,'and' tractor(�} license pur5uant to ti�e proof ot �heir Worker's Comper ❑ I�am =xempt untler Section— � Date Owner ' S' nature � :t5 [he appllcaOt to a civil • i00J. 'eei.with wages as their sole ue is not intentletl or offeretl - �nal Cotle:� The; Contractor'S -' perty`who builtls or improves � rlf o� through his or he� own a not intentletl or offcretl for �soltl within one year�of mm- ng he/she tlitl not build or Im- , :oneractiny�wich licensetl con- '�usiness antl Pro(essions Cotle: ' '.o an owner ot property who /or'such projectz with a con- icense l.aw). 1 am aware that :e Shoultl be prOvitletl to me. — B. & P: C. for this rea5on is application antl ztate that the above � iply with all city antl county ortlinances ' �nstruction, antl hereby authoriie repre- �rl thB above-mentioned O�operty fo� '� Reinspection Fee ` I$15 l Boiler' . " � � � Duct - UnderGround . ' Duct - Structural Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ductin9 , 00.100,OOO,BTU 0100,OOOBT . � ; I�9 - _ _ . _ i - . Drivers' Li_ � ' I I Reinspection Fee , $75 CMF 0865-46, rev. 30/84 White - Builtlinq; Canary - APPliwnt; Pink - Accounting; Golaenrotl - Assessor c Issue 0 Hood or Type I � ❑ ' CanoPY TYPe I I ❑ � ' ' Refrigeration System ' ❑0-100,000 BTU ❑ 100,000 6T System Repair/Alteration � - FireDampers�, � ' Registers , i , i Issue Fee ELECTRICAL � ' FEES Transformer ❑ 15-50 KW ' � , ❑ 50+KW �Meter upto�100ampsi � Meter ❑over 100 amps _ jttj Sub Panef � - ��Motors OO-1 HP O1'f, - 8 ' � �Inc.Solar �9-75 HP, �16-75+ 'Pole Light , Range � Sign. Standing Sections ' Tresh Compactor � $ 3 Reinspectian Fee $15 laue'Fee FEES DEVELOPMENTSERVICESREQUIREMENTS: ' ' 2oning Approved By Building Approved By Aooliption lu�ued Bv �� . —�. ��. �. - - , SUMMARV OF FEES . ' . BUILDING PERMIT .$ SMIP: . �$ ' � , PLAN CHECK ,$ PERMIT � � . � � PLUMBING $ � �SSUANCE �$ PCAN CHECK 25% �$ ' � ENERGV P.C. $ ECECTRICAL ,$ �D GRADING $ . PLANCHECK 50% .$ ' �0��-D MICROFILM �$ ' � MECHANICAL �$ ' TOTALFEE $ a -3 $ 3 � PLAN CHECK 25% $ - � CONSTRUCTION AND PLANNING � FOG_ ,. SPA � Date Inspector Date Inspc,cmr APPRO�ALS Permit# APPROVALS Permit# ,� ,•1. Temporary Electrical Service or Pole ' 52. Pool & Equipment Location • -; ' 2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement - 3..,Electrical Conduit UtilitY-Undrgrnd. 54. Forms � 4:'Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5: Steel Reinforcement 56. Rough Plumbing & Pressure Test � 6, �Electrical UFER Grnd'. � 57. APPROVAL TO COVER-GUNITE 7:,Footings 58. Electrical Conduit�Undrgrnd. - ' 8. Found2tion ' � 59. Gas Pipe, O Undrgrnd., Test 9� �Water Pipe-Undrgrnd. ' 60. Backwash Lines, P-Trap, O Undrgrnd. 70. Structural Floor System 61. APPROVAL TO DECK 11. PropertY Sewer Line & House Connection - 62. Backwash & Receptor-Final 12. Sewer Cap . 63. Heater & Vent-Final -•' `v+ 13.'Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final � 75. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring `� � �7 �1 _ 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 # . 27. Ducts, in Struaure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas � Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. FrameandFlashing 76. DryStandpipe 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 ' 1 80. FOOD CERTIF�CATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning � 35. Final G2s Pipe-Test 36. Hood or Canopy 37. Final Fa�tory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer ' �� .. . 43. BackfloW Irrigation � 44. .LandscaPe Irrigation System . 45. Sound Attenuation � � 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed � 49. Electric Release to Edison ' �,. 50. Gas Release to Southem Califomia Gas Co � _ . 57. CERTIFICATE OF OCCUPANCY • ' %!" " Nn. ' Daxe . ' ' � " ' C17dOF COSTA MESA' - • - � ' CONSTRUCTION PERMIT , A�plicant to fill in all ipaces exeepl those within �eavY bortler lines anC sign au approprlale tleNarations. 4G3rJ 6/ I 1/85 �'v. .. o3oGi; nco..�r n�r� . . � 'ronrT n�n I nr nln al n _ - • - -� .. _. -. � 1 Prpj¢ct Address ' -$�� .F'fiP 19 TH STRFFT TYPE OF CONSTRUCTION �" MEW I.J ADD LJ ALTERATION LJ REPAIR - Applicant'sMailingAddress �Z1Z1 S. GT2AND AVE. ❑ CONVERSION ❑DEMOLISH ❑ OTHER /�.p,# ' ' . Owner's nla��QDIVERSIFIED PRQTECPS DEVQ.OPME�one 768-3453 DESCRIVTIp��p F WORK - , tlh;(1'1' . S Main Building: Adtlress E - 7YPE OF PERMIT GRRDING�� FOUNDATION 57RUCTURAL .�+ T' Flont ' � A�Ch/Eng.' � Licensf No. ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING �ECHANICAL $- — , , , � A Rear Adtlre55, � � ❑ �OTHER . ' � - ' � ' Contractor's Nam SIEI2RA II�V7RQ�AI'' SYS1��o�1C. 957�991 pROJECT DESCRIPTION. Sp. FT. �" 'oCCVPANCv C Right K Left AddresS (mailirt9) Z1Z1 S. GRAND AVE. � COIV STHUCTION TYPE � VALUATION $ S City Licenu No. 24912 zoNe GRADING GV.YDS. ACRES ' Ping. Ref. # LICENSED CONTRACTOR DECLARATIO Remarks: �� ' Park,in9 Req./Provided � I ha,reby' aifirm that 1 am licensetl untler r visi 5 ot harter 9(commendng Bp1HO��2 ' ' w��h section 7000) of Dlvision 3 0( t usl ss Profes '�ns Cotle, antl � � � ' " . ' i . � Use of Building: . my Iicense�ls In full force antl effect. ' Llcenza C�tys ' � LI 405194 � . . � PLUMBING , ' FEES P�anning Notes: ' . Date � �1 - Signature � . NORKERS' COMPENSATION DE LARATION Bdr Sink � Showeri , hCreby affirm that I have a certifitate of consent lo selLinsure or a certificate � Backflow Pr2venler '' SCrvice Sink ' � ' of Workers' Compensatlon Insurance;� or a certlfietl copY'thereot (Section-� - -- — - 3800, lab. CJ t ' Backflow Irrigallon � Sewer Ca . i concv NoN0107123(X�C c aov - � P ' . ' ' - ❑ Certliietl copy is hereoy tumisned. , , Bathtubs � ' Sewer Connection j ,,, Automatic Washer � ' �.}Q�{ertifietl co y is tiletl with the Ut 'I DI i Date �1P�R5 qppiican ; Clarifiers ��G � , Solar Collecrors - Construction PoleSub. EXEMPTION'FROM WORKERS' C MPEN TION E LARq, ON � - " Dishwasher . � � "� ' " (This section neetl not be <omplete if the permit iz for one huna etl (S100j or � .'1 � � Sola� Piping` -� Cooking Unit ' ' Icsg�. ' � � ' Drinkin FOunta�ns � � - 1 cprHty that in the Per(ormance of Ihe work for'which lhis permR is issuetl I 9 . ' ' Solar Tank • - Dishwasher sha�� not emoloy any perzon In any manner so as to become subject to t{te � , ' Workers' Compensatlon laws of California: � Floor Drains� ��Q - � ' Swimming Pool w)Spa j ' Dryers �Gas� �Elec[ri� Da�e $ignature . NOTICE: It,'after making this Oeclaration, you shoultl become subJect lo the � FIOof Sinks ��' ` ' Ulinal . • ` • Fan Warkers' Compensation provisions of the Labor Cotle, you must forthviith ` - -- - - COqlpiy with Such plovlzlon5 Or �tM113 'p8rmit spall ibe tleeTetl fevok¢tl. , CidS $¢fvlC¢ . : �utl¢t5 - � CONSTRUCTION LENDING AGENCV � � � ' . � Water Closet � _ � F.AW. � . I hereby aiflrm that there Is a,construction lentling agency tor the performanco ' Interceptors � Water Heater � y Pixtures:° � ot tho lwork �tor which this permit, is� i55u0tl'.(SecHOn.3097 Clv. 'C,) , '� , - . � L.ehtler's Name - � KitcFien Sink i - Water Service � '� � Device Boxes • ' � LRntleYs Atltlrass ' ' ' ' � � � � � � ' ';OWNER BUILDER DECLARATION ' �� ' ' 1 ' '�Lavatories : � _ � . i � , . � ; OUtletS � � ' t�hereby.affirm Ihac I am ezempt from the Contractor's License Law for tne • � .. '� ' � following reasob (Section 7031.5'Buslness antl ProfesSional CoOe: Anypity or P—T�ap- , � . ' ' � r . _ . �! �Swi[ches_ �-Tn¢retrom antl tne basis for the allegeq ezemptlon. Any,violatlon of Snction 7031.5 by any applican[ for a permib subjecls the appllcant fo a civil � e�alty o( not more lhan fiva nuntlred tlollars ($500J. ' � I, as� owner of the� property or. my employees with wages as their sole � 6ompensation, wili Oo thB wo�k, antl tAe Structu�e i5 nOt Inteetletl or otteretl for sale (Section 7044, Bustness antl ProfeSsionai Cotle: The. Contractor's License Law tloes not app1Y to.an;owner ot a property wno builtls or ImprovCs Ihe�eon, antl wno tl0l5 SUCh wo�k himselt/Ita�S¢If O/ tnrou9h his o� her own . amployees, piovitletl tnat sucn Improvements ara not intentletl or otfaretl for sale. I1, however, the builCing or ITProvem¢nt Is soltl within one y¢ar of coT- PIQ[IOn, the owne� will Itave the burtle� of O�oving h0/she tlitl not builtl or iT- �Ove for the pUrpoSe of Sale�. , 1, as owner of the property, am exclusivety coritracting wit� (icensetl con- t�dctorsto construct the proje<t (Section ]044, Businoss antl Professions Cotle: The Confractor's License Law tloes not appry to an owner of properry who b411tls or improves thereon, antl who conVacts for such projects wltn a<on- traclor(s) license pursuant to the Contractor's License Law): � ' Q I�am ¢xertiPt untler Section B. & P. C. fo� thi5 /ea5on • De[e Owner� � � � . .., m,,. , !� iY � _ , Si9nature ,� Drivers' LI ens¢ or 55 � CMF O8G5- 6-rev. ]/83 ' White -�Builtling; ( ApPllcanh Pink i Drains _ i Reinspection Fee.� �4 $25 Boiler • Dutt- UnderGround ' Duct-Structural • �uct - Ventilating Exhaust Sysiem ❑ Multiple ❑ Firepl/Fact. BIL ICBO.# Heating System & Ducting �P100,OOO,BTU �100,OOOBTi ,3s,mv an.� w�Fxnr.Y Reinspec[ion Fee ' $25 enrotl-As5e5sor' - --' A Issue Fee . $ 3 Hood or. Typel; ❑ ' . Canopy Type I I ❑ � � Refrigeration System � .! 00.100,000 BTU ❑ 7 D0,000 BT System Repair/Alteration - � Issue Fee ' I $ 3' .'I Generatoi �0.5 KW OS-15 . � Zone . Accessory euilding: � • Z . O � N ' 1 N . � G , R E Park.Fees $ � i 0 � � ELECTRICAL � � ,Transformer ❑ 15-50 KW ❑ 50+KW - Meeer �up to 100 amps Meter ❑over 100 amps � Sub Panel I_ - I,MotorsOQ1HP�1'h-8 , Inc. Solar �9-15 HP �16- Range $iJ❑ Standing Sections i Trash Compactor , � Reinspection Fee I$25 � Issue PUBLIC_SERVICES REQUIREMENTS: APProved By A I .' � FEES $ 3 I R E M E N T 'SUMMANV OF FEES � � BUILDING PERMIT $ SMIP $ � � PLAN"CHECK $ PERMIT ' � PLUMBING �- $ ��SSUANCE $ .PLAN CHECK $ ENERGY P.C. $ �/� �ELECTRICAL . $ G(7ADING $ ; ' PLAN CHECK $ '1 MICROFILM $ �v� k` MECHANICAL� $ �7-3�OC7 TOTALFEE $ • S`�'`"t� ` PLAN CHECK '$ ' I O. O C7' i .'- .'�.. _ . .� . ...• _ L ._ ' _ . __ . � i ',� CONSTRUCTION AND PLANNING - - PO�_ & SPA � - Date �Ins ector � APPROVALS Permit # � P ,'- APPROVALS Permit # Date Inspector , 1. Temporary Electrical Service or Pole , . ' 52. Pool & Equipment Location �'.2.' Soil Pipe-Undrgrnd. -. ; � , , .53. Steel Reinforcement � '3. Electrical Conduit Utility-Undrgmd. . 54. -Forms _ ' - � . � .� 4.� Electrical ConduibUndrgrnd.� . ' 55. Electrical Bonding - _5.' Steel Reinforcement �- . . 56. Rough.Plumbing & Pressure Test � • 6. Electrical UFER Gmd. ' 57. APPROVAL TO COV,ER-GUNITE 7. Footings � � - , , � ' ' 58. Electrical Conduit-Undrgrnd. . � �� 8.� Foundation . � '-;�� 59. Gas Pipe, O Undrgrnd., Test �. 9. Water Pipe-Undrgrnd. '�; ,, . . 60.-8ackwash 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�- Fina� � 14. Rough Plumbing ' . 65. Electrical-Final � 15. Rough Electrical-Conduit � � � - 66. Solar System-Final - i-; 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 ; `/�y�y �i� 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. Undergmd. Storage Tank O Gas ❑ Oil 25: Roof Sheathing - . " , � 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry,Chemical � 27. Frame and Flashing � . � 76. Dry Standpipe � . 28. Lathing & Siding , , ' 77. FIXED SYSTEM FINAL 29. Insulation � , ' � 78. FIRE PREV. FINAL . 30. Drywall Nailing . � ' HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat , � 79. FINAL INSPECTION 32: Electrical Power Meter-Final � 80. FOOD CERTIFICAT.E ISSUED � • . 33. Final Electric ' , Notes: y 34. Final Heating & Air Conditioning , LJ �' � - �� 35. Final Gas Pipe-Test. � - . � - - f 36. Hood or� Canopy � . . - � � . � - - � � 37. Final Factory Fireplace ' - � � 38. Final Plumbing � , ; , , � 39. Water Service-Final ' , � • 40. Gas Service-Final ' , � � • ' 41. Solar pomestic-Final � • _ 42. Backflow Preventer ' , � 43. Backflow Irrigation � � � ' ' , . � , . 44. ,Landscape Irrigation System . ' � � ' • ' ' 45. Sound Attenuation • ' ' � � �� 46. Handicap Regulations _ ' _ ' ' 47. FINALSTRUCTURE&BUILDING ' � � . ; • 48. Special Requirements Completed � • , - � -' ' � 49.� Electric Release to Edison - - - - - - � , 50. Gas Release to Southem California Gas Co �-. . ' � � 51. CERTIFICATE.OF OCCUPANCY ' � . . . . . No. � Date " � , � � . � 1�l Applicant to fill In ali spaees ezceD�+��ose wlenin naavy Dortler lines anG sign all appropriate deelantions. - rl„ _ _ " . . _ . .. -�CIT,Y OF COSTA MESA CONSTRUCTION P�RMIT PEPMIT NO_ �Z TRACT NO. xLOT NO. UNIT N0. ��Ok � _ , �j.��y�. ,,/ IL� 1 O, r'a ' Prolect Address G�� =�`-y-'f"1' W. % 9 �� _�f J l C/ -I � . . . .. Applicant's Mailing Addressp /2�� ,� �/�-=�`�+- CCN \ '� TYPE OF CONSTRUC710N raEw nDD ALTERA7i,�oN � REaAiR • n �, Owner'S Name �'�A D"�L T-�\ Phone 7�� 3�i� � CONVERSION ❑ DEMOLISH ❑ OTHER �LL�(� ' A P,�y _ /1 I� O(+ Zone r� OESCRIPTION OF WORK/USE�OF BLDG. � Address 2�� - C��R-'Y� ��' f�� (�'e(1� � � S Main Building: � Accessory euilding: Arch/Eng. ��-��W��N�LiCen5eN0. TVPEOFPERMIT GRADING FOVNDATION TRUCTVRAL . T Front � - O Address -��p�� ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL Rear �" /� . CAnVactor'SNamP�1U�CLC1P�l� P\��1�.I�Phonel_�rS ❑'OTHER A ��yy VI �. N �� ,?�, PROJECTDESCRIPTION 5�. pT. oCCVaarvCV C Right 1�1 N 23.LU I P A�' L C-�� i `/' ,� �� K y G Address�mailing) CONSTRUCTIONTVPE v � VALUATIONS_r�riy___tz�— S Left � G' � R ( CiLyLiCenSeNo. 20NE GRADINGCU.YDS. ACRES �tr � LICENSED CONTRACTOR OECLARATION Ping. Ref. # w-�-8 Parking Req.�Ptovided QS ((� E I hereby aftirm [hal I am Iicenzetl untl<r provi510n5 ot Charter 9(�ommencing Remarks: Z ,�� Planning Notes: n I wi[h section 7000) o! Dlvlsion 3 of the Buslnesi antl Professlons Cotlo, antl � r�� M my Iicense'is in tull f ce and eifect. . T � �icense cia s — cons io S �� / ^ PLUMBING FEES Date� Si9nature WORKERS' COMPENSATION DECLARATION Ba� Sink ShOw¢r5 • I hereby aftirm tnat 1 hava a cerN/icato ol consenl to selt-insura or a tarUtlwte ELECTRICAL FEES oi workers' Compensation Insurance, or a certifletl cpoY tharaol (Snctlon . gackflow Preventer Service5ink � - 38oa�, Lao. C. 1'�`�, �p ^{— Automatic Washer Transformer � 15-50,KW � Policy No. �Yl��'� � Company KA-1C rnaI 1` Backflowlrrigation SewerCap ' ". . � ❑ 50+�FW � eCerlitietl copy i5 h¢reby furnisnetl. "' . ��StructiOn POI¢ Sub. _. Certifie co n filetl with the cfty Builtlin Div"sio Bathtu6s Sewer Connection- Cookin9 Unit Meter ❑up ro 100 arpps Date � Aoolicant� Clarifiers SolarCollecrors Dishwasher � Meter ❑over100am s EXEMVTIO�RKERS'COMPENSATIONDECL ATION P (Thi55ection neetl not be comO�aletl it tne permiDis tor one huntlratl (E300) Or - ' iess). , Dishwdsher Solar Piping Dryers �Gas �Electric Sub Panel �� I cer[ity thal in [he Oerfo�mance of thC wo�k tor wM1ich [his p¢rm�l i5 i55uetl, I . shall not employ any- perzon in any mannar so as to oecomn subject to the Orinking Founteins Solar Tank �� Fan • �� Workers' CompanwliOn Lawi o/ CalifOrnid. MOtOrs �0-1 HP �1X-�$ . Data Signature Floor Drains Swimriling Pool w/Spa F.A.U. 'NOTICE: It, atter making ihis tleclaration, you snoultl bacome sub�ect to the Inc. Sola��9-15 HP �76-15+ Workerzt Compensation orovisions of the Labor Cotle, you must lorthwitn F.loor Sinks . Urinal - Fixtures - Microwave ' ' comply with suc� p�ovi5ion5 Or this pe�mlt Shall b¢ tleem¢tl �ovoketl. CONSTRUCTION LENDIfiG AGENCY (�id5 SCrviC¢ �ullElS ' Wp[¢� CIOS¢t J%' Z ' Device Boxes . Pole Li ht 1 h¢r¢�y attirm lha[ there is a cons[ruction lentlin9 agency !or t�a periormance 9 of Ihe work far which this permlt is ITsuetl (SecUon 3097 Clv. CJ Int¢rC¢ptOrs Wdt¢r HEdt¢r Outl¢IS � Lentler's Name � . Range Lentler's Atltlrezz Kitchen Sink Water $ervice Switches �! �� , OWNER BUILDER �ECLARATION - Sign 1 here�y affirm t�at I am exempt frOm tbe Cantracto�'S.Llcense Law tor Ihe LdvdtO�i¢5 � _ AUlO-Weih ' Gd�b2 ¢ Di5 OSdI♦ . following'reason (Section ]031.5 Business anG Professional Cotle: Any city or 9 P ; Standing Sections • county whicn requires a permit to constru<t, alter, improve, tlemolish or rnpatr P-Trap � Leundry Trays Generetor �0.5 KW �rr15 KW ' any Structure, p�io� to Its issuance, dlso reqW�es lhe applicant for Sucb pe�mil T�ash Comp2Ct0� to /ile a sign<tl slat¢ment that h¢/She Is IicenSCtl pul5uant to Ih¢ prOvi5ion5 Of qp0( Df2ini � . - the Contractor'S License Law (Cbapter 9(commentin9 with Section 7000) of ' . . Division 3 of lhe Business antl P�olesSionT Cotle)'or thal hC/she is ezempt - Ihe�e(ram �anB the basis for Ne alle9¢tl exemption. Any violatlon o1 $ection - . , ' 7031.5 Dy any appliGant for a pe�mit Subjec[s lha applicant to a Clvil t� �enally ot not more Ihan five huntlretl tlollars (E500). 3 � -- LJ I, as owner ot [he Orop¢rty or.my emplOyGes witn Wd9e5 a5 thair sole RBinSpaetion Fea $15 IaUn Fee § ' ' � tomoensation, will ao che work, antl the structure is not Intentla0 or olferatl ReinspaelioniFee`� �� S75 Issue Fee for sale �Settlon 7044, Business antl Professional Cotlo: Tho Cm[ractor'z . MECHANICAL � FEES " $ 3 License law Coes not apply lo an owner ot a proparty whD builtli o� Improv¢s thereon, ana who tloes zuch work himself/nerself or through his or her own . DEVELOPMENT SERVICES�REUUIREMENTS: employees, provitletl tnat sucn improvements are not intendatl or oHerea for Boiler Hood or Type I ❑ . . , sale. Ii, however, the builaing or improvement Is sola within one year oi com- � C,anopy Type II� ❑ ' 2oning Approved By� -' �Date � p � plelioq the owne� will have the burtlen Of proving he/sh¢ tlIC not buHtl or im- DuCt - Und2� GrouOd � Building ApproVOd By D3t¢ V prOv! for the Ou�pose of SaleJ. ' , � , ❑ 1, as owner of the oroperty, am exclusively contracting with Iicensetl con- Duct - Structural Refrigeration System Appli�tion ISSued By , Dat t�actors to construct Ne project (Section 7044, Busines5 aptl PrOte55ion5 COtle: a The Convacror's License law tloes mt apply to an owner oi Oroperty who � Duti - Ventilating l �0-100,000 BTU ❑100,000 BTU . � •� ' SUMMARV OF FEES buildz or imOroves Ihereon, antl who contracts fo� Such proj¢cts with a con- - -= -- �{ • tractm(s Ocense pursuant to tne Contracror's Llcen58 Ldw). I am aware tnat Exhaust Syscem � Multiple � ^ System Repair/Alteration � BUILDING PERMIT $ 1� SMIP $� proof o� their Worker's Compensation Inmrance snoultl bo orovitlea to me. �QL p�,qN CHECK'' $ 5� �5 PERMIT ❑ I am exempt untler Section , B. & P. C�or this reason Firepl/Fact. BIt. IC809W Fire Dampers � PLUMBING $_�_`_� ��UANCE $ Date Owner Heating System & Ducling Registers ❑0.100,OOOBTU�100,0008T PL.4NCHECK, 25% $ a�•�-� ENEFGVP.C. $ I hereby certify that I have r¢atl Mis avP��on antl state tnat tno above . - ' GRADING �$ informatlon is correc[. I agree to�comPry wilh all Nty antl counly ortlinances .� ELECTRICAL 5 antl state laws relatin9 to builtling conttru lon antl hereby authorize r¢pro- MICROFILM $ ' sentatives oi tni tltY to ent pon e manlionetl oroperty fm - 7L.P�N CHECK� 50% $ ins0ectlon p se �' 3 (9 � ' ) Signature Date . MECHANICAL $ TOTALFEE $ • Drivers' Ucenu or 55 � - Reinspeetion Fee S75 Issue Fee $ 3 PLAN CHECK 25% $ • / p �, CMF 0865-66, rev. 10/84 White - Builtling; Canary - Applicanh Pink - Accountlng: Goltlenrotl - Asiessor � �.�f � � , . T �� '{:ONSTRUCTION AND PLANNING - POOL & SPA . ,, . t1PPROVALS � Permit# Date Inspector p�ppROVA�S 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 7. 4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding 5: Steel Reinfortement �r a 56. Rough Plumbing & Pressure Test� - 6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE . 7. Footings � �� 58. Electrical Conduif-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 17. Property Sewsr 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 6S. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heatinc� & 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 OOiI 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing i 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 � a� � 78. FIRE PREV. FINAL 30. Drywatl Nailing p' y v HEALTH DEPT. REQUIREMENT � 3T � Plaster Brown Coat � � '79. FINAL INSPECTION 32: Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: •34. Final Heating $� Air Conditioning -) �Q�, L .r.�� rt l.� .35. Final Gas Pipe-Test ; � ��L �f' � �� E 36. Hood'or CanopY _ � � U , � �IG (�[i 37. Final Factory Fireplace � r�T L/�� VI( (�L 38. Final Plumbing , d5� C.�� r � �.�✓f174/�Yw� 39. Water Service-Final ' - GI� �% � 40. GasService-Final 4 �� 41. Solar pomestiPFinal ' 42. Backflow Preventer � ' 43. Backflow Irrigation � � i 44. Landscape Irri9ation System � 45. Sound Attenuation � - 46. Handicap Regulations . 47. FINALSTRUCTURE&BUILDING 9� � 48. Special Requirements Completed � 49. Electric Release to Edison ' � � 50. Gas Release to Southern California Gas Co � ' 51. CERTIFICATE OF OCCUPANCY . . _ ' '- , Nn. Date . � � i� Applicant to fill in all sDaces eifv.�F CosTA nnE�p CONS7RUCT ON PERMIT `'aaject Address �5�7 w� 1�n� ' �T� e�s �-� A9plicant's Mailin Address Owner's Name ��S � � Phone— Address Arch/Eng. _. -License No. _ Addreu - `��` Conttactor's Name�� E �L�-GnC�G phone.�l�' �lLt Address�mailing) z L -� S �" � Ciry License Na. - ��'7 � 9 LICENSED CONTRACTOR OECIARqTION � I hereby'affirm that I am licensetl untlgr provi5ions o( Charter-9 (commencln9 with secUon 7000� of Division 3 of the Businuss ana�Protessions Cotle, antl , my license is in full f ce ettect. • � p License ass � � � � � Lice 3� /� Oate 7' Si9nature �-N� 'NORKERS' COMPENSATION OECLARATION ' , � hereby aftirm that 1 have a certificate oi consent to self-inzure or a certiticate .f Workers' Compensation ,Insurance,, or.a cer,tifletl copY thereot (Sectlon. J_ 3800, Lab. C: �9�Nli�� PolicY No. �� COmPanY . �ny' Certifietl coPy IS hereby furnishetl. �sl Certifietl cOpy 15.111atl w�th the city Quil n ivl;i , Date T l� rJS qppp�anl d ! ' EXEMPTION FROM WORKERS' COMpENSATION LARATION -(This section"neetl nat be completetl if [he Oermit is fo� one huntlr0tl (5100) o� less)' I certify that in the pertorman<e Of tb� work tOr which thi5 plrT�t i5 i55ue0, I zhall not employ any person in any manner so as to become sub�ect to Ihe ' Workers"Compensation Laws of California. . � . Date � Si9na[ure � 'NOTICE: If, after makin9 this tletlaration, you shoultl�become subject to the Workers: Compensation p�ovi5iOn5 ot [he Labo� COCe, you must to�tttwith comply wi(h. sucn provisiohs or this permit snall be tleemed revoketl. �CONSTRUCTION LENDING�AGENCV�� ' ' " ' I; I nereby affirm ttiat there is a mnst�uction lentling agenty fo� the perfOrmdnce I of the work, far, hi 1 thi "s '.issuetl, (Section 309� Civ. C,), I LenOer's Name � � �entler's Atltlress� D L�j`fj� �� L✓Q. L � � OWNER BUILDER DECLARATION � ' � I hereby affirm;that I am ezempt irom the Contractor•s License Law for the ' tollowin9 reason (Section-7031.5 Busi�¢ss antl ProfeSsional,Cotle: Any tlty or county which requires a permit to construcq alter, improve, tlemolish or reoair � any st�ucture, p�Ior to it5 issuance,'alio i¢quires the applicant'tor such Oermit to fi�e a siqnetl statement that he/she Is licensetl pursuant to the p�ovisions of ne rnnr.arinr'c i ice.nse Law fChaoter 9(commencin4 with�5ection ]000) of .�erefrom antl the basis (or the alle9ea exemption. Any,violaUon ot Sec[wn 7031.5 by any� ap0lican[ for a Pe�mit subjects [he �applicant to a Civll ! '� enalty of not more than five huntlretl tlollars (E500). , I, as'owner of the'property oi my employees with wages as their sole • compensation, will tlo the work, antl the structure is no[ intentletl or otferetl � for sale (Section 7044, Business anq�ProtessionaLCotle: The Contra<tor's' License Law tloe5 not apply to an'owner ot a property who builtl5 or ImprOves � thereqn, ana who aoes such work �iMself/herself or through his or her own employees, provltled tha[ such improvements are not infentletl or of(ered (or sale. If, howeveq the builtling or improvement is soltl within one year ot com- � pletion, the owner�will have Ihe burtl@n of provin9 ne/she tlitl not builtl or im- �ovG fo� [he purpose of Salej. . ' ert am e i el con[raCtin with � licensetl con- wner oi tne ro xclus v 9 LI I az o P P Y. Y trac{ors td construct the project (Secti�n �044, Business antl Professions Cotle: • The ConVactor's Licenre �aw does qot apply to an owner of Oroperty who builEs or improves tM1ereon,-antl who �oM�actS /or sucn projec[5 with a con- tractor(sllicense pursuant to tiie ConYractor'S License Law). I am aware that proof of their Wo�ke�'s Compensatiop in5urance 5hou10 b0 provitletl lo'me.. ❑ I am exempt uniJer Section B. & P. C. for this reason Date � Owner' � ' ' . I hereby' certity-that I have reatl this application anC state that the abova informatlon iz correct. I agree to comply with all <ity antl county ortllnances antl.5tate laws �elatin9 to builtling construction, antl hereby authO�ize repre- sentatives ot;this •city.to e ter uppn }he above-mentionetl property for inspection pu� Bse , y Signature Date �� 2 Drivers' License or 55 # • tnose witnin neavY Goraer lines antl sign all appro0rlata tleclarations. TRACT NO. LOT NO. UNIT'�. _ TYPE OF CONSTRUCTION �J NEW I.J ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOUSH ❑ OTHE � q,p,.hF DESCRIPTIONOFWORK/USEOFBLDG. . ��rM�N _ . . - • S Main Buildi TVPEOFPERMIT GRAOING 'FOUNDATION �STRUCTVRAL T FrOnc ❑ TENANT �ELECTRICAL ❑ PLVMBING ❑ MECHANICAL , A Reaf ❑ �OSHER ' ,. C Right PROJECT DESCRIPTION 54: FT. oCCUPANCv � K CONSTRVCTIONTVPE VALUATION$ g Left ZONE GRADING CV. VOS. ACRES Ping. Ref. # Remarks: ' ' � , P � �y � � � , Planning Notes: Sink Preventer Floor Sinks GasService Outlets' Interceptors '' - '" Ki[chen'Sink � � �avatories , � '� ' � P-Trep K � . � Root Drains ' � � Reinspection Fee ,$15 Boiler ' ' � � Duct - Under Ground � Duct - Structural , Duct-Ventilating . _ - Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting � ❑ ai oo,aoo Bru O i oo;000 eT Reinspaction Fee $15 CMF 0865-46, r¢v. 30/84 White - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor Showers Service Sink Sewer Cap ' Sewer Connection $O�df COIIEC[OIS � Solar Piping Solar Tank Swimming Pool wlSp Urinal � Water Closet � - � Water Heater Water Service Issue Fee Hood ar Typel ❑ Canopy Typell' ❑ Refri eration S stem 9 Y ❑67000008TU C SVstem Repair/Alter Fire Dampers Registers . ' Issue Fea Automatic Washer ConStruc[ion Pole Cooking Unit Dishwasher � _ Dryers ❑Gas ❑ F,A,U. Fixtures Device Boxes Outlets 3 y r• 5 e �� a�uo Tl 3�se _ 354.60 TC ' -' , 'IZane AccessOry Buildina: ELECTRICAL Transforrijer LJ 15�50 KW ' o so.+ Kw ; �Meter�up to 100 amps� .Meter ❑Over 100 amps , Sub Panel � Motors QO-i HP �1'h- 8 � Inc.Solar 09-75 HP 076-15+ . Pole Light Garba9e Disposal ; Standing Sections � Generator �0-5 KW �545 KW Trash Compactor FEES Z O N I N G R E � M T S �,Reinspection Fee �$15 � � luue Fee . � $ 3 � DEVELOPMENTSERVICESREQUIREMENTS:� � 2oning Approved By ' Date � Building APProvetl By ' Date Appliwtion Issued By Dat�� Z 3 � SUMMARV OF FE � � � ES BUILDING PEFMIT $ SMIP $ � PLAN CHECK $ PERMIT � PLUMBING � $ � ISSUANCE $ , PLAN CHECK 25% $ � ENERGV P.C. $' , ELECTRICAL $ � GRADING $ - PLANCHECK 50% $ ,��D,GjD . MICROFILM $ 'Z� �'1� MECHANICAL $ TOTAL FEE $ � PLAN CHECK 25% $ • ' , ONSTRUCTION AND PLANNING _ PO, b SPA Date Inspector qppROVALS Permit# Date Ins Pcmr r . APFROVALS Permit# P� 1. Temporary Electrical Service or Pole ` 52. Pool & Equipment Location � 2. Soil Pipe�Undrgrnd. �,� y ; 53. Steel Reinforcement -� ' 3. Electrical Conduii Utility-UndrgFnd. '' , 54. Forms �� 4rElectrical Conduif-Undrgmd. ;� � 55. Electrical Bonding � � � 1 1 5. Steel,Fieinfprcement,�,:_ �� 56. Rough Plumbing & Pressure Test 6.� Elect'rical UFER�Grnd. 57. APB,ROVAL TO COVER-GUNITE ' 7-.rFootings . �,! ,, 58. ,Electrical ConduibUndrgrnd. � S.��Founiiation y� " 59. Gas'Pipe, O Undrgrnd.,Test 9;.Water Pipe-Undrgrnd,. »- � 60. B�'ckwash Lines,.P�Trap, � Undrgrnd. ''� 10. StrucCural 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. Plum6ing System - Final � ,;, 14. Rough Plumbing �,., 65. Electrical-Final �� 15. Rough Electrical-Conduit 66. Solar System-Final 76. Rough Electric Wiring 67. Fencing & Access Approval � 77. Rough Wiring Sign �� . � 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # . 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing � 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro � 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. InsulAtion 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REnUIREMENT 31.�Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final ! 80. FOOD CERTIFICATE ISSUED 33. Final Electric � Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy � 37. Final Factory Fireplace 38. Final Plumbing 39. Water Servic2-Final 40. Gas Service-Final � 47. Solar pomesticFinal � t '� 42. Backflow Preventer ' '� � : �43. Backflow Irrigation � � 44. .Landscape Irrigation System 1 45. Sound Attenuation 146. Handicap Regulations , �47. FINAL STRUCTURE & BUILDING � �48. Special ReqUirements Completed � '49. Electric Release to Edison � �r q�50' Gas Release to Southern California Gas Co ,� - •�� _. � � �' r�51.. CERTIFICATE OF OCCUPANCY � " � . - Nn. Date � • . - � I Applicant to flll ln all spaces except thosa wit�in neavy DorEe� Iines anC sl9n au soarooria�e aecianuo�s. I I'2G 4/ I 5/85 � io 3% T�� CITY oF COSTA S ST �TION PERMIT Project Address ARplicant's Mailin Address � Owncr's Name Phone - Address � \ Arch/En9.� icense No. Address � Contractor's Name hone o� Address (mailing) ( ' City License No. LICENSED CONTRACTOR DECIARATION 1 h¢reby aftirm thal I am licensetl untler prOvi5iq�5 Ch rt¢r 9(commencing with seclion �000) ot Divislon 3 the Busineu P tei5ioni Cotle, antl my Iicense is in ull t e antl fte� I� lJtense CI ss �' �i n e� Da[e � Si9natur¢ WORKE 5' OMPENSATION DECLARATION here0y aifirm that I nave a certilicato of conzen[ to selPinsure or a cerliticate . ,t Workers' Compenzation Insurante, Or a cer{j}ietl cOpY � reof ($ection , 3800, Lab. C.2,�_y�1.�� Comp n Pollcy No. XuhJ✓<-v ❑ Certiti tl copy is hereby turnisned. , . �Cer I � tl �j 5%� etl wi[h Ih¢ city Buil i iyision. � � Date�t_GL1_ APPlicant � EXEMPTION FROM WORKERS' COMPENSFTION DECLARATION� (Tnissection�neetl not be completetl if the permit is for one hundretl (y300) or less). 1 cerUfy that in the P¢r(ormanca ot Ihe work toY whlch [hI5 0l�T�t is Issuetl, 1 snall not •employ any person in any manner so as to become subjett to the Worke�s' Compensation laws of California.- ' ' - Date Signature • 'NOTIGE: It, atte� making this tlecla�ation, you SltOultl becoma Subjec[ [o [he Worker5' Compensa[ion provlsions ot [he Labor Cotle, you must torthwith comply with Such p�ovlsion5 Or [hIs Oe�mit Shdll be tleometl revoketl. CONSTRUCTION�LENDING AGENCV . I hereby affirm lhat tnere I5 a construction lentllqg agency for the parformance� � Of tne work for whlth Ihls permit is issyetl (Se<don 3097 Civ. C.) Lentler's Name Lentlor's AtlUress OWNER BUILDER DECLARATION I nereby af8rm that I am exempt 1rom the Contiactor's Licenm Law for the tollowing reason (Section 7031.5'Buzlness antl'P�a(essional Cotle: Any tl[y or CounlY which requirez a Oe�mit to con5trucl, alteq imprOve, tlemOlish o� repair anY svucture, prior to Its issuance, also requlre¢ the app�icant for such permit to III¢ a siqnotl slatem¢�t that h0/Sne is IICenS¢rJ pu�iva�t t0 t�e p�OVISiOns o( . �ha ContrdttOr'S Li<ense Law (Chapt¢r 9(Commencing wi[n SectlOn 7000) ot 11vi51on 3 ot the 8u5In055 8ntl PfofosSiOnS Cotle) or thal ho/sh0 Is exempt ncrnirom and the ba5i5 for t�n allegetl ozemption. Any violation of Suction .]031.5 by any applicant for a, permit subj��ts (he applicant lo a civil , enalty ol not more than five huntlred tlollars (y,500). � I, as owner of Iha proparty �or my amployees wlth wa9o5 as thoir sole � �compen5alion, will tlo tne work, antl the structure Is not intentletl or oiferetl i fo� sale ($ection 7044, BU51ne55 antl P�ole55ional Cotle: Tha ContraCtOr'S Licenso law tloe5 nOt ap01y lo nn owner of a p�ope�ty who builtls or Imp�ove5 tnoreon,.antl who�tloes sucn work hlmself/hergelt or througn hIs o. har own employoe5, prOvltletl thTt suth Improvemenls ahe nOt IntenUetl or olteretl fOf . sala. li, nowCveq th¢ builtling a� ITp/ovam¢n[ {5 zoltl wlthin Onu Yea/ ot com- pletion, lho owner w111 have tno burtlen ot prov�ng he/she OIA not bulltl or Im- prove for the purposa ol sal¢j. ❑ I, as own¢r of the pro0erly, am oxclu5ively conVac8n9 �+'��h Iicansetl con- trattors lo construc[ the pro�ect (Section 704a, Businezs anE Professions Cotle: The ConVactor's License Lnw do¢s nol apply to an owner o1 p�opOrty who � builtls or Improves therean, antl wno tonVactg for sucn projects with a can- bdctor(sl Ilcense pursuant to ihe Contractor•s Litense Law). I am awar¢ that proof of tneir Worker's Compensatlon inzurance shoultl be provitletl to me. ❑ I am oxempt untler Section B. & P. C. for this reason Date Owner I her¢by certif that I have reatl th s ap0��alwn antl stat0 Ud[ the above Iniormatlon is co ect I a9ree to 0 0� with g11 city.antl county ortlinances antl slale laws r I ing to builtli n ruction, antl nereby authoNze repre- senta[Wes ot thi 'ty ro ente po e above-mentlon¢tl pert for inspectlon Du os � Siqna[ure � Date Drivers' License or 55 � rcnrvu i� �.J i-1 I _ I �..,.. ��.... I �... ..... I �i.�y�y�. 5 i TVPE OF CONSTRUCTION NEW ADO ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER -DESCRIP,TION OF WORK/USE OF BLDG. G_ �� TVPE OF PERMIT � ❑ GRADING�.rI FOUNDATION QLJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL 'r�y�.�PLVMBING ❑ MECHAN/�ICA�L ❑ �OTHER � 1 s�C/� LQQ�A�%.C.B� PROJECT DESCRIPTION Sa.FT. oCCuannCv C O N ST RUCTI ON •T V PE V A LUATI ON 5_� ZONE GRAOINGCU.YDS. ACRES_ Remarks: Sink <flow Preventer <flow Irrigation Floor Orains Floor Sinks Gas Service Interceptors Kitchen Sink �avatories P—Trap Roof Drains � Outleti Showers Service Sink - -' Sewer Cap Sewer Connxtion Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water.Closet Warer Heater Warer Service Auto-Wash FEES Reinspection Fee � $15 Isue Fee . $ '3 ' MECHANICAL � fEES IDuct-UnderGiound � Duci - Structural . Duct - Ventilating Ezhaust System ❑ Multiple Firepl/FacL Blt. ICBO # Heating System & Ducting : ❑a�oo,000 eTu Oioo,aoo Hood ar Type I � Canopy Type I I ❑ Refrigeration System . 00-100,000 BTU 0100,000 System Repair/Alteration Fire Dampers Registers Reinspection Fee �.� 515 � � laue Fee � $ 3 CMF 0865�46, rev. 10/84 White - Bulltling: Canary - qpplicant: Pink - Accounting; Goltlenrotl - Assessor A.P. ql� S Main Building: TFrorit - A Rear C Right g Left. Ping. Ref. # Planning Noces: Aummatic Washer Construction Pole Sub. Cooking Unit Dishwasher • Dryers ❑Gas �Elecvic Fan F.A.U. Fixtures Device Boxes Outlets Zone Accessory Building: Z Q . N 1 - - N . , G R Parking Req.IProvided E i � • M • T - 5 � ELECTRICAL ' Transformer ❑ 15-50 KW ❑ 50+KW Garbage Disposal Generator 00.5 KW OS-15 KW � Reinspaction Fee I DEVELOPMENT SERVICES R Zoning Approved By s��m��e nvv.o�a ev — ADolitation Issued Bv $15 Meier LJup to 100 amps Meter ❑over100amps Sub Panel Motors �0.1 HP �1'h - 8 Inc.Solar �9�15 HP �16 Microwave ' ' Pole.Li9ht � Range $ign ; Standing Sections Trash Compacmr Fee FEES S SUMMARY OF FEES BUILDING PERMIT $ � SMIP , $ ' � PLAN CHECK � $ PERMIT PLUMBING $ � ��UANCE � $ .. PLAN CHECK 25%. $ 2-� . ENERGY P.C. $� ELECTRICAL � $ � GRADING $ PLANCHECK 50% $ MICROFILM 5 MECHANICAL S TOTAL FEE 5 1 �-37 PLAN CHECK 25% S � � � CON5TRUCTION AND PLANNING PO. .& SPA ' Date Ins ector APPROVALS Permit# P APPROVALS Permit# Date Insp?r.tor 1. 7emporarY Electrical Service or Poie 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement � 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test . 6. ElectricalUFERGrnd. � 57. APPROVA�TOCOVER-GUNITE 7. Footings - 58. Electrical Conduit-Undrgrnd. 8. Foundation '� 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-7rap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property 5ewer Line & House Connection '�r. � 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-Fina1 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 5tructure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Fram�ng 73. Undergrnd.StoiageTank �Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. DrYWall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICA7E ISSUED 33. Final Elect�ic Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Cznopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Finaf 40. Gas Service-Final 47. Solar pomestic-Final 42. Backflow Preventer ' 43. Backflow I�rigation 44. Landscape Irrigation SYstem � 45. Sound Attenuation 46. Handicap Regulations 47. F1NAL STRUCTURE & Bl71LDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co , 51. CERTIFICATE OF OCCUPANCY Nn. Date ApP��ant to fill in all spaces except those within heavy boraer Iines antl sign all approo��ate Eeclarations. CtTY flF COSTq MESA - CONSTRUCTION PERMIT Project ABdress —__�{��yth STREEI' . Applicant's Mailing Address Owner's Name DIVII25IFIED PRQTECIS ohone �68-3453 nddress 23201 LAKE CFNPER DRIVE Arch/Eng. License No, Address � � ' Contractor's Name SIERRFI ENVIR�IrAL Phone 957�991 nddress Imai�ingl 2121 S. GR4ND AVE. SMTfA ANA city Licnnse No. _ 24912 - LICENSED CONTRACTOR DECLARATIO 1 ' ' 1 hereby aHirm tnat 1 am licensetl untl pr vi5ions of Charter 9(commentlng witn zection �000) of Division 3 of .tl usi ezsl � Protessions Cotle, antl my license is in (un torce an�P�e<t. � 4p5194 • Licenze Clasg i�p `ate � Si9nature � ORKERS' COMPENSATION DECL RATION - . hereby affirm that 1 have a certifica of consent to zelf-insu e or a tertlficate ot� Workers' Compensation Insuran , or a tertifietl copy thereof (Section 3800, Lab. C.) � Policy NoN��l.%��C ' C ny �.,6srtitietl <opy i6 hereby furnishetl. ' � � �`�Ertifietl copY i5 tiletl with the city iv' i Date S/1�R5 � qpp�icant �EXEMPTIONFROMWORKERS'C MPENS 10 D ARAT N� (This section neetl not be completetl ( the permit is for o e huntlr tl($300) or � less) I certify� that In the periormance of tbe work for which t is permk is issuetl I shall not employ dny pe�5on in any manne� so a5 to become subject t0 t�e Workers' Compensetion Laws oi Calitomia.� Date ' Signature NOTICE: It,'after Makin9 this tleclaraHon, you shoultl become subject lo ihe ' Workers' Compensytion provisions ot the Labor Cotle, you must torthwlth complY'�'�th such provisions or this permit•shall be tleemetl revoketl. GONSTRUCTION,LENDING.AGENCV � ' ' 1 nereby atfirm Ihat �here is a constructlon lentlin9 a9ency�for the performance Of the work tor -�yhich this, perTlt is ISsuetl (Section 3097 Civ. CJ Lentler's Name__ � ' Lentler'S Atltlress � ' � OWNER BUILDER DECLARATION � ' 1 hereby affirm'thqt I am�exempt from the Contractor•s License Law tor the tollowing �eason ($¢ctipn��031.5 Business antl P�ote55ional Cotle: Any City o� county whicM1 �eqyires a pe�mit to Const�uct, dlter, imp�ove, tlemolish Or repai� � any structure, prior to its issuance, also requires tne applicant tor sucn permit � file a signetl sta{¢ment that'he/she iz licensetl pursuant to the provisions of � e Contractor's License Law (Chapfer 9(commencin9 �+�th Section ]000) of �Ivision 3 of the Business antl Professions Cotle) or that he/zhe iz exempt therefrom antl tha basis for the alleqetl ezemptlon. Any violation of $ection � 7031.5 by any app�icanc for a permiY supjects the� applicant to 'a civil �e�dlty o( not mo�¢ than five huntl�etl t1011a�S (y500). 1, as owner of the property Or my employees with wage5 a5 [heir sole compensa[lon, will tlo the work, antl the structure is not intentled or ofFeretl for sale� (Sec[ion 7044, Busine55 antl Pro(essional Cotler The Contractor's . LicenS¢ law tloes not apply to an owner of a property�wha builtls or improves thereon, antl',who tloes such work hlmself/herself or.throu9h his or her own "tl t t' t tl tl ft r tl/ � SU : 6-E � TYPEOFCONSTRUCTION EW ADD ALTERATION- REPAIR ' ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p,# DESCRIPTION OF WORK � - � S Main Build E TYPEOPPERMIT GRADING - FOUNDATIO�pNyyy STRVCTURAL T Froni ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING L'�'1MECHANICAL A Aear ❑ OTHER � PROJECT DESCRIPTION 5�. FT. � OCCVPANCY C Right K Left CONSTRUCTION TVPE VALUATION $ S ZONE _ GRADING CU.YDS. ACRES ping. Ref. # rtemartz: - $Pl$041 ' Parking Req./Pi Bar Sink Backflow Preventer Backflow Irrigation Bathtu6s ' ��; Clarifiers , Floor Drains ��' Floor Sinks � • • Gas Service OuUets . - Interceptors � Kitchen Sink , f la'vatories, � . � . - P—Trap � Roof Drains Reinspection Fee I $25 IBoiler - , employees, provi etl that such imp�ovemen 5 a�e no in en e or o e e or Duct - Under G�ound sale. If, howeveq the builtling or Improvement is soltl within one year of com- ' _ _ pletlon, tne owner y�j�1 have the burtlan of provin9 he/she tlitl not builtl or im- rove for the purpose of sale). Duct - St�uctUral � 1, as owner oi the property, am exclusively contracting with licensetl con- tractors to mnstrucc the project (Secilon 7044, Business antl Professions �otle: � Duct - Ventilating The Contrattor's License Law does not apply to an owner oi property-who - . builtls'or Improves tneieon, antl who contracts for such projects with a con- Exhaust System ❑ Multiple ❑ tractor(s) license pursuant tdthe Contractor's License L.aw). � ' ❑ I am exempt untler Section B. & P. G. for this reason � Firepl/Fact. BIt. ICBO # i Date ' Owner I hereby certi t f have rea� information Is or �( I a to' antl state laws e tj t I sentatives of � in5p¢Ctlon pur 5@ Signature Orivers'.Lice oY S � 'CMF0865-46 v:7/83' �Whife- Builtling; Canary -APPlicant; 0 Heating System & Duc[ing ie above ❑0.100,OOOBTU �100,OOOBTi ]inances ' " !e �ep�e- :rtY 1for ,'3i��OCO 7J�!l1.JAf.IiF✓EN�CZ7• Heinspection Fee $25 Accounting; Goltlenrotl - Assessor- - PLUMBING Showers . Service Sink' Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w Urinal lNBLCf C�OSES' Water Service Use of Building: � FEES Planning Notes: 6' _ Issue Fae ' � $ 3 Hood or Typel ❑ � Canopy Typell ❑ , Refrigeretion Sys[em � ❑o-ioo,000sru ❑iao,aoo System Repair/Alteration ' 0 ', luue Fee ' I $ 3 � �_. " 4634 6/II/B5' 2one. Accessory Building: Park.Fees $ � ELECTRICAL ' • Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. � 50,+ KW Cooking Unit } Meter ❑up to 100 amps �ishwasher Meter ❑over100amps Dryers ❑Gas ❑Electric Fan F,A,U. Fixtures Device Bozes OUtlets . Switches Garbage Disposal Generator 00.5 KW 05-15 KW Momrs �0-1 HP O1'/: - 6 Inc.Solar��9-15 HP Oi6-75+ Microwave ' . Pole Light ' Range Standing Sections Trash Compactor 76.00 Z O N I N - G R E Q U I R E N E N _ T FEES � Reinspection Fee �$25 � �ssue Fee • I $' 3 I PUBLICSERVICESREDUIREMENTS: � � 2oning Approved By Date Application Approved By ' n Date _�_ Applicetion 13sued By !NJ Date___�{ -j_�_ � SUMMARY OF FEES . � , � BUILDING PERMIT $ SMIP � $ � � PLAN CHECK $ PERMI7 PLUMBING $ ' ��UANCE � $ PLAN CHECK $ � ENEflGY P.C. . $ � ELECTRICAL $ GRADING $ � PLAN CHECK $ MICROFILM $ �1 �� ..,�,� MECHANICAL $ (n�✓•�� TOTALFEE � $ � PLAN CHECK � $ � S-OO . _' "" ' " � . . _ � ._. ..... . � .. ... • , . . V �. ... . . . . ' ".�. . . . . . -• CONSTRUCTION AND PLANNING. -' ' � . P . & SPA APPROVALS Permit# .,Date ' Inspector -qppROVALS Permit# Date Inspector �1.� Temporary Electrical Service or Pole' 52. �Pool & Equipment Location i _ , ' 2. Soil Pipe-Undrgrnd. � , 53. Steel Reinforcement � 3. Electrical Conduit Utility-Undrgrnd. ' - � 54. Forms . ' � �' � _ � 4: Electrical.Coriduit-Undrgrnd. ' � 55. Electrical Bonding- �. 5. Steel Reinforcement . " � � 56. Rough Plumbing & Pressure Test � � � 6., Electrical UFER Grnd. � ,. ' � 57. APPROVAL TO COVER-GUNITE ��- � 7. Footings , � � . 58. Electrical Conduit-Undrgrnd. 8.� Foundation , . ' '' 59. Gas Pipe, O Undrgrnd., Test .. � .. ::- . . 9. Water Pipe-Undrgrnd. � ,- � 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System -• _ 61. APPROVAL TO DECK 11. Property Sewer Line & House Co'nnection 62. Backwash & Receptor-Final 12. Sewer Cap , ` 63. Heater & Vent-Final 13. Roof Drains � 64. Plumbing System - Final � 14. Rough Plumbing � ' 65. Electrical-Final 15. Rough Electrical-Conduit . ' - '- 66. Solar System=Final i 6: Rough Electric Wiring , , 67. Fencing & Access Approval 17. Rough Wiring Sign � � 68. APPROVED FOR PLASTERING 18.. Rough Electrical-T Bar Ceiling � �' 69. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning ' ��s��j �� 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 � S0. FOOD CERTIFICAT.E ISSUED • . 33. Final Electric ' Notes: � 34. Final��Heating & Air�Conditioning - .cjl��'j' (,�EO 35. Final Gas Pipe-Test " � � �� , � � 36. Hood or Canopy . � � � � ' 37. Final�Factory Fireplace � . , � - � - . - � 38. Final Plumbing � i . 39. Water Service-Final � � 40. Gas Service-Final � � � 41. Solar pomestic-Final . 42. Backflow Preventer , ' - 43. Backflow Irrigation , - . ' . � • � �44. ,L.andscape 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 ._ No, ' Date ' � I • ApPlieant to fill in all s0aces exee0t t �- CtiTY OF cOSra MES!�A�� CONSTRUCTION PERMIT�[J ., ProjectAddress. r�, (�� • / , Applicant'sMailingAddress %3�� rC�-s'N�_ �� bwner's Namo M�� LS ��; - Phone �g 3457 Address .Z 3�.0 ` �A k-lr `L�cTI 1�L n� �' r� � Si �' Arch/Eng. -�ZYZOR'N � W EATLPN�Dp �,� J License No. Address Contracror's rvama D\�l�(LS\F'l @.9 �(Zu.� Phone ��-? Addresslmailingl a�%^-� �A�u$ ��M'�- �� 2f]l� � City License No. (�-� LICENSED CONTRACTOR DECLARATION V�'� I hereby affi�m [bat I am licensetl und¢r provi51on5 af Charte� 9(commencing l witb seclion ]000) of Dlvision 3 of the Business antl Professions Cotle, and �� my Iicense is in full for e an eftect. ' License Class� '� license No. �'-�, u� � � Date Signatvre ' WORKERS' CO SATION DECLARA I I hereby affirm tnat I bave a certificalo of consent to self-insure or a certificate of Workers' Compensation- 7Insurant¢, or a certitietl coOY/`thereoyf (S"ection 3800. Lab. CJ� /,1 /.1 1� �� 1 0%1�1 �` � Policy No. Y�'�' � Company Certifietl copy i5 hereby fumlSM1etl. r i Certifi o%( 75 (il¢tl with the city Builtling ��siqn, i��' � Date �ITApPlicant �� r � EXEMPTIO FROM WORKERS' GOMPENSATION DECLAR ION (This section neetl not be complefee H Ine petmit B tor one'huntlretl (E100) or less). � � I ce�tlfy that in the pe�to�mance of [he wo�k fo� which thi5 pe�m�t is ISSuetl I� � shall nof employ any person in any manne� So a5 [o become subject to t{te' Workers'. Compensation l.aws of Calitornla.i . Date ' � Si9nature ' `� 'NOTICE: If, after making tbis tleUara[ion, you shoultl become subject to tde Worke�s' Compensation provisions of the Labo� Cotle, you must tOrthwith comply witM1 such proviSlons o� thi5 pe�mit Shall be tleemetl �evoked. CONSTRUCTION LEPoOING AGENCV� ' I hereby affirrn Ihat Ihere is a const�uction I¢ntling agency (or tM1e perto�mance of [he work for wnicn t�i5 permlt is issuetl (Section 309] Ciy. CJ LentlEr'S Name, BUILDER bECLARATION . atti�m Ihat I am exempt trom the reason (Section 7031.5 Business: �hich r¢quires a pGrmit to canStrucl lure. orior to itz Issuance, also req [herefrom antl the 7031.5 by any ap �enalty oi not more I, as owner of comoensation, will (or sale (Section ] LicenSe Law does n [hereon. antl�who � Law lcl 355 dlllJ for [he pletion, the owner will have p�ovB �o� the'pu�0ose ot sal¢). ❑ I, as owne� oi the proDer[ t�actor5to wnsVuct the proje The ConVac[orY License La builtls or improves tM1ereon, VdCtO/(Si IIC¢n5¢ pUISudOf ��O proot of [heir Wo�ker'S Co ❑ �I am exemp[ untler Sec[io TYPE OF CONSTRUC ❑ CONVERSION DESCRIPTION OF within neavY �orAer lines ana sign all aDP�oPriate aeclarations. iACT NO. LOT NO. . UNIT N6./ ` iYIL�` GDI E �P NEW ADD ALTERATION REPAIR DEMOLISH ❑ OTHER �LC7 �.� �- � q p# i I, _ I( IK/USE OF BLDG. f p P�� -�J/ __ 5 Main Building: 1� II TVPE OF PERMIT LJ GRADING FOUNDATION STRUCTURAL T FfOnt Iu � ❑ TENANT ❑ ELECTRICAI ❑ PLUMBING ❑ MECHANICAL B Rear I� ❑ �OTHER ' %� PROJEC7 DESCRIPTION 5�. FT. oCCUaANCv - C Right I G CONSTRUCTIONTVPE ��"� VALVATION$ �L<ZZ�Z g L¢ft �� ZONE � GRADING CU. VDS. ACRES Ping. Ref. #�j—� Remarks: �y��jq��. �� (_ ��`J i Plannin9 Notes: Sink Preventer Irrigation Clarifiers Dishuvasher Drinking Fountains Floor Drains Floor Sinks Gas Service / (� Kitchen Sink [ractor's LicenSe Ldw fof thB �vdtOfi25 rotessional Cotle: Any city or r, improve, tlemolish or repalr P—Trap [ne a00�icant for zuch pe�mit - oursuant to the_ orovisions ot � Roof Drains i� a Pa�mit Sub�ec[5 Ine appucane �ro a uvu huntlretl tlollars (y500). . nty or my employees wilh wages as their solo �k, antl tne Structu�e is no[ intenGetl or otf¢retl ness antl V/o�essional Cotle: The Cont�acto�'S � an owner of a property wha builtls or improves work bimselt/herself or througb his or her own � imP�ovemenls are not Intentle0 or otferetl for or improvement is soltl within one year o� com- tne bu�tlen of O�oving he/She tlitl not builtl or Im- y, am excluSively conl�acting with licensetl con- CL ($CCllOfl %O4A� BUSIf1E55 dlltl PfOf¢SSIOf15 COCB: w aoes not apply to an owner of property who antl who [ont�acts for such projects w�tlt a con- Me Contracior'S License Law). I am aware that mpensatlon insurance shoultl be p�ovitletl to m¢. n B. & P. C. fo� thi5 reason Date Owner Signature ` /� '-' // Drivers' License or 55 � _ thls aoP�kation antl state that the aCove >mply with all city antl county o�tlinances con ctlon, antl hereby authorize repre- t Ove-men[ionetl prop— erty tor 3 �i ii�l'i Date Reinspection Fea , � $15 Duct' Under Ground Duct - Strucmrel Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑0.100,000 BTU �100,000 Reinspection Fee � $15 �—CMF 0865-`46, re,v, 10/84 White - BWltling; Canary - APplicanh Pink - Accountln9; Goltlenrotl - Assessor Showers Service Sink . Sewer Cap . � Sewer�Connection ,- $012f CO11¢G[Of5' �' Solar Piping Soler Tank � Swimming Pool w/Spa Urinal . Water Closet Water Heater Water Service Auto-Wash Isue Fae Hoad or Typel� ❑ Canopy . Type I I ❑ Refrigeration System ❑0.100,OOOBTU ❑700,000 System Repair/Alteration � Fire Dampers Registers Issue Fee ! FEES "AutomaticWasher .- Construction Pole Sub. Cooking UniT � Dishwasher , 'Z Dryers ❑Gas ❑Electri � Fan" :L: ' F•A.U. Fixtures g Device Boxes . � OIItICti • - ' 964�� 3/2f7/flti — Accessory Building: � Parking Req./Provide ELECTRICAL Transformer ❑ 15�50 KW ❑ 50+KW • Switches � . . Z O �' �Garbage Disposal �- .Generator �0.5 KW �5-15 KW U .:5 . . ' 1 • $ 3 � . . �, Reinspection�Fee � $15 FEES � DEVEL�OPMENT SERVICES.REQU 2�zng�APProved BY__ �r � Buildin9 App�oved By —L- Application' Issued 8v' $ 3 Meter ❑up to 100 amps Meter �ove� 100 amps Su6 Panel � Momrs OO-1 HP O 1 X- 6 IncSolar �9�75 HP �i6-15+ Microwave Pole Light Range Sign � ; Standing Sections Trash Compactor , Issue Fee I,j.'>c�oLF i O N 1 N G R E Q M T S $ 3 .r __,�.� � � . SUMMARV OF FEES y �6UILDING PERMIT�, $ I O�/�i SMIP $ �.5•3�.. �(:PLAN CFIECK $ 2 �-{ -bS PERMIT . /�- r fPCUMBING $ I�IS�CO ISSUANCE , ff '� f'�,PLAN CHECK 25% $ � 3•OC7 ENERGV P.C. $ ('(' ELECTRICAL $ GRADING $ �� PLAN CHECK 50% $ MICHOFILM .$ y�.�-� G,..�M�CHANICAL $ TOTAL FEE $ �'1 � �PLAN CHECK 25% $ - . I �5.� I % • CQNJTRUCTION AND PLANNING � POOL & SPA ,� �' I �",APPROVALS � Permit # Date Inspector AppROVALS Permit # Date ��Inspr.ctor .' 1. Temporary Electrical Service or Pole � 52. Pool'& Equipment Location a �'2.,_Soil Pipe-Undrgmd. 53. Steel Reinforcement ". 3. Electrical Conduit Utility-Undrgrnd. _ 54. Forms - • - 4. Electrical Conduit-Undrgrnd. ' 55. Electrical Bonding 5. Steel Reinforcement ' 56. Rough Plumbing & Pressure Test .6. Electrical UFER Grnd. - 57. APPROVAL TO COVER-GUN�TE - -7. Footings 58. Electrical Conduif=Undrgrnd. 8' Foundation � 59. Gas Pipe, O Undrgrnd., Test . 9. Water Pipe-Undrgrnd. 60. Backwash Linef, P-Trap, O Undrgrnd. � J 10. Structural Floor System ' 61. APPROVAL TO DECK . � 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 1�2. Sewer Cap 63. Heater & Vent-Final - 13. Roof Drains � � 64. Plumbing System - Final 14. Rough Plumbing N' G 65. Electrical-Final 15. Rough Electrical-Conduit - 86. Solar System-Final � , 76. Rough Electric Wiring ' 67. Fencing & Access Approval � 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18.,Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL - 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT . 20. Rough Factory Fireplace . APPROVALS Permit # � 27. 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 � (�s '� 74. Oveihead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � 27. Frame and Flashing , v 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 , 7 S� v� 79. FINAL INSPECTION 32;- Electrical Power Meter-Final 80: FOOD CERTIFICATE ISSUED 33. Final Electric . Notes: � 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test � �/ �' � � 36. Hood or Canopy � 9�- g�(��T�'ti� �[G � 37. Final Factory Fireplace q 3�rs- � y� �f�L/�T (/CiCl��'Zt DiGli., 38. Final Plumbing y�s/ ��,Q� .r-�{�i(. v�� 39. Water Service-Final � 40. Gas Service-Final . 47. Solar pomestic-Final � 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation SYstem ' 45. Sound Attenuation � 46. Handicap Regulations � � � 47. FINAL STRUCTURE & BUILDING 9 � �j 48. Special Requirements Completed � !, 49. Electric Release to Edison , - - 50. Gas Fielease to Southern California Gas Co � � � � 51. CERTI `IFATE OF OCCUPANC C `/r � - Nn. � ' Date � �� ' .. . ! ,. _ � I w AOPlieant to flll in all spatts eacept those within heavy eoraer lines ana sign all approvriate Oeclantions. CIFY oF COSTA jM'��ESg _GO%S7�1CT�1'ON PERMIT . Project Address ��7� � ��/J y 2 Applicant'sMailinaAddrPac !•�• �)� 3�7 ^7� y��..0 Owner's Name ��s� ' - � .� - � Phone.J�� Address �.3�'d � L��'t PN (2 (� LPY/S �f�/�f.Sr Arch/Eng. ��ST D� �^ License No. Z6 $� Address �,3 Q � /J:. n /�� Contrector'sName `e' /�-' �s'T!' - Phone ��g�- Addresslm�'�'�gl -O. /7O)C 3//��i �ir�' � City Cicense No. �� Z-6��,{� ' � UCENSE� CONTRACTOR��ECIARATION ' I hereby aftirm that I am'licensetl untler rovisions oi C rter 9(commencing � with 3ection �OOS af Division 3 of th usiness antl Cotessions Cotle, antl . �I my license is in ( JI (orce an et �t .f � License I ss - Z� �- �� Licen e No��.�i,��5_� Date Siqnature L-� ��`� WORKE 5' OMPENSATION DECIARATION'. - I hereby atfirm tM1at I have a certiflcate p( consent to selt-insure or a certificat¢ of Workers' Compensation Insurance„ or a wrtifietl copy thereof (Section 3800, Lab'. C. . ,-�/+C � ' P^olicy No. �191 l.�+J�� Company �y Certifietl moY �s hereby fumisnea. , . f(9 Gertifie�$� cDpyjS f�letl with the city A i"ng Division. Date �(f��55 Applicant (Tnissection neea not oe mmpie�ea irme permYt Is to��one �umrea'�g1uu) or less). ! I certity �that in Ihe pe�tormance of the y�ork fo� wM1ich this perin�t is issuetl, I snall nat employ any person in any manner so'as to become subjedt to the Workers"Compensation�LawsofCalifo�nia. ' , „i� . Date � ' Si9nature � � �NOTICE: If, after making this tleclaration, you shoWB become subject to the Wo�ker5'� Compen5ation Orovisions of {he Labo� COEe, y0u must forthwith _ comply ��with such prOvisions or -this pe�mit , shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV� �. "' , I hereby atfirm that ttiere is a'constructip� lentling aqency�tor the'performance of the -,work for, which this permir is,issuetl (Section 3097 Civ. CJ Centler's, Name, - Lentler's,Atltliess' � ' OWNER BUILDER �ECLARATION ' - ' - • � ' I hereby affi�m that I am exempt f�orry the Gont�actor'S LicenSe Law for the . followin9 reason (Section 7031.5 Busihess antl Professional Cotle: Hny ciry or"' county which requires a permit to construct, alter, improve, tlemolish or repair any st�ucture, prior to its issuance, also requires the applicant for SucM1 permit to file a�siqnetl statemenYthat M1e/she {s Ilcensetl pursuant to the piovisions o� the Contrzctor's License Law (Chapter 9(commencin9 wi[h Section J000) of •Oivision.3 oi the,Busine55 antl Profebsions Cotle)'oY that he/she is exempt 'therefrom antl the basis tor the allegetl exemption. Any�violation of Sectlon 7031.5 by any applicant for a perMit subjects tne applicant.to a civil enalty of not more than five nuntlretl tlollars ($500): � I, asi owner oi U�e properly.or iTy employees with wages� as [heir solc mm0ensation, will tlo tne work, antl Ne structure is not intentletl or ofteretl tor Sale� (Section 7044, Business and P�ofe55ional Cotle: The Cont�actor'S � LicenSe Ldw tloes no[ apply to an owner of a property who builds or improves • tbereon; antl wno tloes sucn work himselfjherseli or through his or her own employees, provitle0 Ihat such improvements are not intentle0 or offeretl tor sale. If, howeveq the Guiltling or Improvement is soltl within one year of com- Oletion, the owner' will ihave;the burtlen of proving he/she tlitl not builtl o� im- p�ove forthe pur0ose otSaieJ. � ❑ 1, as owner ot the property, am eXUusively cantracting wiYh IicenSetl con- t�actors td consttuct the pwject ($ecti0n 7044, Business dntl Prote55ion5 Cotle: The Contractor's License Law tloes not apply io an owner ot property who • builtls o� improves iheieon; antl who cont�acts for su[h-projects with a con- tractor(s) license pursuant�to the Contractor's License Law). 1 am aware [hat ' , proof of tM1eir Wo�ker'S Compensation insutance Shoultl be prbvitletl to<me. ❑ I am ezempt untler Section , � B. & P. C. tor tM16 rea5on � � Date Owner i , I hereby certify t at Lhave reaA this�application antl state that the above-- information is corr cL I agree t comply,with all city antl county ortlinances antl state laws rela g to buil g Cory {�uct�on, antl he�eby authorize reore- sentatives of Ihis y co e �up roe above-mentionetl pr ert fo� in50ection purpo5e5 �G , 5' t Ddte L � � , . � I125 4/15/.85 TVPE OFCONSTRUCTION Q� NEW U�ADD�LJ ALTERATION LJ REPAIR — .O CONVERSION ❑ DEMdLISH ❑ OTHER _— q,p,# DESCRIPTION OF WORK/USE OF BLDG. � Q�'�'� � - � � . , � - S Main Buildin TVPE OF PERMIT GRaoING FOUNDATION $TRUCTV RAL T Front ' O TENANT ❑ ELECTRICAL PWM61N� ❑��yM�ECH�A.f�(/�C AL A Rear - ❑ �OTHER : C.t.10.N/A CX/`. PROJECT DESQRIPTION S�.FT. � � oCCUPAN �v^ C Right � K Left CONSTRUCTIONTVPE VALUATION$ A� $ ZONE � ' GRA�ING CU. VDS. ' ACRES Ping. Ref. #, aemarks: ' - _ � j ' � , ' Planning Notes: Bar Sink � Backflow Preventer - � Backflow Irrigation Bathtubs Clarifiers � . Dishwasher ' R Drinking Fountains Floor Orains � Floor Sinks ' _ - -.. Gas Service ,Outlets Interceptors - � Kitchen Sink�. ' ' i �„�....�o� . - . . . �=v m 4aof Dreins �• � - . �Reinspac[ion-Fee - Boiler. � Duct-UnderGround Duct - Structural � Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact.Blt.IC80# � Heating;System & Ducting ' ❑aioo,000eTuOioo,000 i9na ure I Drivers' License or SS � Reinspection Fee $15 CMF 0865-46, rev. 10/84 White - Builtliqg; Canary - APPlicant; Pink - Accountinq; Goltlenrotl - Assessor ServiceSink -- SeWer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank ' Swimming Pool w/Spa . Urinal�� - - L_. .�_. .� . . Water Heater WatervService �Auto-Wash Laundry T.ra� � Issu¢ Fee Hood or Typel ❑ Canopy � Type II� ❑ , Refrigeration System ' ❑0-100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers� ' ' ' Registers ' - � . � ' Issue Fee A,utomatic Wasfiei Construction Pole Sub. Cooking Unit � Dishwasher Dryers ❑Gas ❑Electric~ Fan � F,q.U. Fixtures' � ' ' ' ' D¢viC¢ BOxes � O utlets � Switches Garbage Oispoul Generator �0.5 KW C 1 ZonB t Accessory Buildin9: ' Parking Req./Provided � i ELECTHICAL ' - Transformer ❑ 15-50 KW , ❑ 50+KW Meter LJup to 100 amps '� � Meter ❑over 100 amps �Sub Panel .. ' ' MotorsC]0.1 HP �1'F,-8 � IncSolar'�g-15 HP �i6-15+ - Miciowave " ' ' Pole Light . � ,Range ' I � I; Standing SeCtions � 15 KW I Trash Compactor $ 3 , Reinspection Fee $15 FEES �DEVELOPMENTSERVICESNEQUIR Zoning qpproved By Building Approved By ' $ 3 luue Fee � 7:37 .tl �� 2 O N I N G R E Q M T S $ 3 Appli�tion Issued By ' ' Dam � I� i ' ' SUMMARV OF FEES . . ' BUILDING PERMIT, $ SMIP ' $ � PLAN CHECK �$ ',,`t� PERMIT � • - PLUMBING $ � ISSUANCE $ f 7 ENERGY P.C. $ � � � PLAN CHECK 25% $ � �L ELECTRICAL , $ � � GRADING $ PLAN CHECK 50% $� � MICROFI LM ,$ ��1 � MECHANICAL � $ TOTAL FEE �$ ��•3 1 PLAN CHECK 25%. $ . � . ,s ,' CONSTRUCTION AND PLANNING ' POOL e SPA � ApPROVALS Permit# Date Inspector AppROVALS Permit�i-` Date Insper.r�r . 7. TBmporary Electrical Service or Pole 52. Pool & Equipment Location . 2, Soil Pipe-Undrgmd. . 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms - � 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5.� Steel Reinforcement . 56. Rough Plumbing & Pressure Test - -6. �E{ectrical UFER Gmd. 57. APPROVALTO COVER-GUN1iE - .' 7. Footings. ' � 58. Electrical Gonduit-Undrgrnd. ' 8. Fvundation �� 59. Gas Pipe, O Undrgrnd., Test � 9. W2ter Pipe-Undrgmd. 60. Backwash Lines, P-Trap, a Undrgmd. 10. Structural Floor System 61. APPROVAL TO DECK • 11. Property Sewer Line & House Connection S 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 ElecVical-Conduit - 66. Solar System-Finaf 16. Rough Elearic Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducis, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe�Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oii 25. Roof Sheathing - 74. Overhead Hydro 26. T-6ar 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 3D. Drywall Nailing ' HEALTH DEPT. REQUIREMENT 31. Pla4ter Brown Coat ' 79. FINAL INSPECTION 32. Electriral Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electrlc 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. 8ackflow Preventer 43. Backflow Irrigation ' 44. �Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations � 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed 49. Elettric Release to Edison � � . �50. Gas Release to Southern California GasCo 51' CERTIFICATE OF OCCUPANCY No!' Date - � AOPlicant to till in all � CITv OF COSTa MpESA IC,�(j�NSQTRUCTION PERMIT � Projett AddrMs 6 b� �V .��I'� 8c-o4 �i , Applicant's Mailing Address � ' ' - ' Owner's Name - � 5� %/E/� �7�TSPhone— - E� Address Arch/Eng. _ License No. Address . ' Contractor'sName dR�S�� C ��'-JG phone��. Address�meiling) t��b� � �!h�✓�� 5/}. �/1%O[� City License No. � �%�� 9 LICENSEO CONTRACTOR DEtLAFATION � ' � I �ereby affirm that 1 am licensgtl untler provisions ot Charter 9(commencing wlth section 7000) of Division 3-ot the Business antl Professions Cotle, antl my license is in tull'force antl eftect. � � License iasIsl-4' L'� � �icense �83 .�3 Date��LLG� Signatur@ .WORKERS'COMPENSATION pECIARATION ' 1 1 hereby aftirm that I have a cerljfj�dt¢ Of consenf to self-insure or a certiticate of Workers' Compensation InsVrance, or a certltietl copY thereot (Sectlon �3800, Lab.�C. , ron�r No.�/ �-76'�L3S-o0/6/l/ �omaany �60�//lt,/T 1 Certifiea cooY �s hereEy tumishetl. � Certij�ed c, o z fllea with the city il ing Div'sl�j�� \. Date ��/� � APP�icant �� n^��""r�'� • . � \ E%EMPTION FROM WORKER$'�OMPENSATION ECLARATION _ �'(This sectlan need nof be complete,E if the permit is for one huntlretl (5100) or less). 1 \I certity that in th¢ Pe�formance of the work fo� whl<h this pe�m�t is i55uetl I - sball:not� employ any person in any manner so'as to become subject to t�e Workers'� Comoensation' Laws of CalHomia. . . Date Siqna�ure ' "NOTICE: It, after making this tl¢claralion, you sboultl become subject to the � , Workers'. Compen5dtlon .provisibns of the Labor Cotla,-you must forthwith comply wlth s�cn O�ovisions o� this pe�mit Shall De �tleemetl �evoketl. � CONSTRUCTION LENDING 4GENCV ' - I nereby aifirm that there ii a conztruction lentlin9 agency for the'performance- o( the work for w h_Ihis It is ssueC (Section 3097 Civ. CJ l.entlar's� Name � LenOer'sAtldresz� 5G'70 45 ' �✓O '�� OWNER BUILDER �ECLARA710N ' ' � , 1 he�eby atfl�m�tha[ I am exert�pt from the Contra<to�'s License Law tOr the followin9 reason'(Settion 7031�.5 Businezs antl Protesslonal Cotle: Any clty or county whiGh requirGz a permit to const�uct, dlt¢r, ImprOve, tlemolisn o� �epai� any structure, pr{or to its issuance, also requlres the applicant /or such permit to flle a slgnetl statement that he/sne Is licensetl pursuant to the provisions ot [he ContraCtor's'LiGense Law (Chapter 9(commencing,with Section 7000) of "� DIVISiOn 3 Of the Bu5ine55 anU-Professions Cotle) or tha[-. he/ih¢ is e%empt , � there(rom an0 the bas{s for the alle9etl exemption. Any violalion of Sec[ion � 7031.5 by any applicant tor a permit subjects the appllcant to a civil • '� endl[y Of not more than (ive hUnCretl tlollars ($500). I, as owner ot the property or my'employees witlt wages as their sole � , compensation will tlo the work, Sntl the structure Is not intentletl or ot(eretl tor sale (Sec{ion 7044, BuSiness antl Professional Cotle:� The Contractor's , ' Licenu Law tloe5 not apO�Y �o an owner ot a prope�ty who builtls or Improve5 � thereon„antl who tloes such work bimself/herself or Ihrough M1is or her own employees, provitletl that such improvements are�.not intentletl or ofieretl for 5a1e. If, howaver, lhe builtlin9 or improvement Is soltl within one Year of com- plelion, [he owner wlll have tn¢ bu�tlen of prOving he/she tlitl not builtl O� im- prove tor the purpose of salej. � ❑ I, as owner of the property, am excl�sively contractiny with licensetl can- i tractors to construct the Oroject (Section 7044, Business antl Professions Cotle: The Contractor'z License Law does not appry to an owner o( property who ' builCs or improves thereon, apd w�o contracts tor such projec[s with a mn- tractor(sl Iicense pursuant�[o t{�e Contractor's License Law). I am aware that proot o( tlteir Woike�'s Compensation insu�anca shoultl b¢ provitled to me. ❑ I,am ¢xempt untler Section- B. & P. C. for this reason Date Owner ' I hereby� certity that I'have reatl'this appliWtion antl state that tna aoove ��, � infoimation is correct. I agree to comply with all dtY and county ortlinances antl state laws relating to builtlin9 constructlon, antl hereby authorize repre- � sentativ¢s of [hi tl[y to enter�upon the above-mantlonetl property /or , insp¢Ction pWp s '/�yr � 51 �� Date Ov within �eavy Doraer Ilnas antl si9n a1l.aooroDriate tleelarations. TVPE OF CONSTRUCTION � NEW I.J P.DD LI ALLTERATION IJ REPAIR '❑ CONVERSION ❑ DEMOI_ISH O OTFIER � q,p.'� � DESCRIPTION OF WOFK/USE OF BLDG. %��rM�N . � . - S. Main Bu TVPEOFPERMI.T. � GRADING FOUN�ATION ❑ STRUCTURAL T Front ❑ TENANT I�ELEGTRICAL ❑ PLUMBING ❑ MECHANICAL � � A Real ' ❑ �OTHER . ' � � � � PROJECT DESCRIPTION SQ. FT. � OCCVPANCV' C Right K Left 'CONSTRUCTION TVPE VALVATIOIV $ $ ZONE GRAOING CU. VOS. ACRES p�ng. Ref. # Remarks: � Planning No� Sink Irrigation Claritiers Dishwasher Drinking Fountains Fl�oor Drains; ' Floor Sinks � - Gas Service Outlets Interceptors � Kiichen�Sink -- Service Sink � Sewer Cap ' ' Sewer Connection; . � Solar Collectors _ Solar Pipin9 Solar Tank ' � � Swimming Pool w/Spa � Urinal ' -' ' ' WaterCloset, � Water Heater � � Water Service � FEES �.BVdfOf125 ' - ` AUSO-WdSh P—Tiap, ' LaundryTreys � Roof Drains "" ` - � ' Reinspection Fee � $15 , � Issue Fee , .� $ 3 ' � : MECHANICAL � � , FEES Bailer • Duct - Under Ground Duct - Svuctural Duct - Ventilating. Exhaust System ❑ Multiple ❑ FirepilFact. Blt. ICBO # Heating System & Ducting � ❑ o�i oo,000 sru O i oo,000 er 9nature � Drivers' Llcense or 55 � I I Reinspeetion Fee I $15 CMF 0865-46, rev. 30/84 White • guiltling: Canary - Applltant: Pink - Atcounting: Goltlenrotl - Assessor Hood or' Typel ❑ ' Canopy Type II ❑ � Refrigeration System � _ ❑aioo,000eru ❑ioo,000sr System Repair/Alteration F ire Dampers Registers Issue Fee $ 3 - - - 4832 6/•13/85 r - - - Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Construction Pole Cooking Unit Dishwasher._ . Fan F.A. U. Fixtures Device Boxes OUtlets ' Switches Garbage Disposal Generator �65 KW D�r15 334oB0- TL � ZOnB — _ � . Z . O N I N � , G R E � • M T S FEES Transformer lJ 15�50 KW ' � � ❑50+KW � � Merer up to'100amps _ _ ,Meter ❑over 100 amps �_ . . . � �Sub Panel' � � Motors �0.1 HP O1 h- 8 Inc. Solar �9-15 HP � I6-15{ Microwave � � � •Pole Light Sign ; Standing Sectio�s � Trash Compactor Reinspection Fee $15 Issue Fee DEVELOPMENT SER VICES REQUIREMENTS: Zonin9 /1PPro'ved By Building Approved�By Aaoliotion luued Bv � m-� � 0 SUMMARV OF, FEES . , BUILDING PERMIT $ SMIP $ PLAN CHECK $ , PEFMIT � . . PLUMBING� ' $ ISSUANCE $ PLANCHECK 25%'$ ENERGVP.C. $ � ; ELECTRICAL $ � GRADING �$ PLANCHECK 50%�$ ��D•6D MICROFICM $ o� : MECHANICAL ,$ TOTALFEE $ -3 �o� ; PLAN CHECK 25% $ ' � � � I� CONSTRUCTION ANO PLANNING ' . POOL & SPA � APPROVALS Permit # , Date Inspector APPROVALS Permit # Date Inspecror i. 1, Temporary Electrical Service or Pole y 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 7r Footings . � 58. Electrical Conduit-Undrgrnd. 8, Foundation ' 59. Gas Pipe, � Undrgrnd., Test 9:'Water Pipe•U�drgrnd�. � 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 - y 13. Roof Dreins - 64. Plumbing System - Final- 14, �Rough Plumbing. 65. Electrical-Final 15.'Rough Electriral-Conduit 66. Solar System-Final 16. Rough Electric Wiring /o � � �` 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, pucts, in Structure 70. Underground Hydro 22, pucts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush �24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structurel) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31�.� Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter•Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning - - 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace . 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. 5olar pomestic-Final . 42. 8ackflow Preventer ' ' 43. Backftow Irrigation � 44. Landscape Irrigation System 45. Sound Attenua[ion 46. Handicap liegulations 47. FINAL STRUCTURE & BUILDING 48. SPecial Requirements Completed 4g. Electrie Release to Edison . �' � 50. Gas Release to Southern California Gas Co . ,., .. ' 51. CERTIFICATE OF OCCUPANCY ' ' " � Nn. Date � �. ' � . I� � I AOVllcant to fill in all CITV OF COSTA MESA CONSTRUCTION PERMIT Project Address �, �F+7 IS�.L�rh ST - Applicant's Maiiingqdcfrp Ll S. GRAI U1VII25 ohone Owner's Name Address ��a(11 iAKF ('FNI'FR i1RTVR Ff '111R(1 A�ch/Eng. ' License No. Address Convector's Name STFRRA FTMRlTB�fFNfAT Phoae Q5�- Address (mailingl �»1 4('RAAII1 AVF- SA�lI'A ANA Ciry LicPnse No.� 49�9 LICENSED CONTRqCTOR DECLARATI I nereby aftirm that 1 am Iicanietl untlar ovisi ns of Charter 9(commencing with setllon 7000) of Divislon 3 of i Busi ss anG ProfeSslons Cotle, and my Ilcense is in tull torce an�re�c. � 405194 Llcense Class . i� Data - Si9nature WORKERS' COMP�NSATION DE LARATI N ' I hereby ai(irm that I have a certlf' ate o( consent to f�ins e or a tert(ficate of workers' Comp6nsation insurance, ar a certifietl cooY �h¢reot (Section 3800, Lab. C.) POIICY No. �l��lZ3�' C anY- F�S Certitietl copy is hereDy furnishetl. ertifietl <opy is filetl wit� the city Iltli Date Appilcant � EXEMPTION F ORKEpS' C MPEN TIO CLARAT ON (Thissection neetl not be com0lata If the permit is (or one huntlretl (E100) or less). 1 cerUty that ,in the performanca ot lhe work tor whicn this perm�t Is issuea I shall not emO�oy aryy p¢rsan in any manner so as io become subject lo t�1e Workers' Compensation Laws of Cali(omia. Data �L118�_S�9�alure NOTICE: Ii, a�lei rt�aking [his tleclaratlOn, y0u shOultl become Subject to lhg Workeri' Compens;({On provi51on5 oi [he laEor Cotle, y0u muit forthwtth COmply willt Such D�oviiloni or thli -p0/mlt Shdll b¢ tleemetl rOvoketl. CONSTRUCTION LENDING AGENCV I hereby afflrm that tnere is a construction IenCing agency for tha porformance ot tha work for �yhiGh thl5 parmil is ISSu80 (SecHon 3097 Civ. �C,) Lontler's Namn Lentler'S Aatlress ' � OWNER BUICDER DECLARATION � �. I horeby affirm tha� I am exempt Irom tho Contractor's Llcense Law for the tollowing reason (Sectlon 7031.5 Buziness antl Professlonal Cotlo: Any city Or county which roqujres a permit to construct, alter, Improve, aemolish or repalr any StruGturG, Prior to its Issuance, a150 reqWmS the applicant.far tuCh permit to Bla a signetl statament lhat hn/she Is Ilcanse0 pursuant lo tho provisions Oi the Contra<tor's LlCense lsw (Chapter 9(comman<in9 witn Sectlon 7000) of Divislon 3 of tne Businesz antl Profeisions Cotle) or that he/she is oxempt therolrom antl lhe basis for�the allogetl exemptlon. AnY vlolalion of Soction 7033.5 by any applicant for a permit subjects the aOP��ant to a<Ivil �enalty ot not morO lhan five huntlretl tlollars (y500). I, as owner of Iha Droperty or my em0�oye85 wiln wagei a5 IhBir Sole tompensation, will tlo the work, ana tne stNcturo is not Intentle0 or offeretl for ulo (Section '1044, Businesz antl P�o/esslonal Cotle: The Contractor's Liconse law does qot apply to an owner of a property who builtls or improvas lherBOn, antl who does such wOrk himiell/he�self or through hiz o� har own omploy oes, provided that suc� improvoments are not IntenEeC or offnretl lor sala. If, howover, the bUlltling or ImprovemOnt ia soltl within On0 yoar ot com- oienon, cne ownet �yp� have the bu�tlen 01 Proving h</She tlitl not bulltl o� IT- �rove tor tho purPose oi sala). 1, as owner of the Oroperty, am exclu5ivoly contracting with Ilcensetl <on- [ractor5t0 Construtt the project (Sectlon ]044, 6usine55 an0 Protes5ioni Cotle: Tho Contrattor's �icans¢ Law doos not applY to en owner oi property who builtls or improves thereon, antl who conVa<ts for such projecls with a con- tractor(s) Iicense pqrsuant to t�o Contractor's U<ense Law)-. ❑ I am axempt undyr Sect(on 8. & P. C. for tnts reasan // Date S�gnature - � ' . Drivers' LI nse or 55 � CMF 0865-46 rev. 7/83 owner �y� r¢atl th15 pPliwtlon antl J¢E.9 o y with all Nry a ro�ne ctlon. ana ni ihose within heavy Eortler Itnes ana sign all aporoD��ata aaelaratlons. �� TVPEOFCONSTRUCTION ��YY�NEW UADD LJALTERATION LJREPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p, �6 DESCRIPTION OF WORK . S Main Bui E TVPE OF PERMIT GRADING FOUNDATION STRVCTURAL T FrOnt ❑ TENANT ❑ ELECTRICAL ❑ PLUMBIN� MECHANICAL B Rear - ❑ �OTHER ' � A �ROJECT DESCRIPTION Sa. FT. oCCVPANCv C Right K Left , CONSTRVCTIONTVPE VALUATION$ S ZONE GRAOING CU. VDS. ACRES Ping. Ref. # Remarks: $p1�jQ . Parking Req.l i 3ar $ink 3ackflow Prevenrer 3ackflow Irrigation 3athtu6s Clarifiers Dishuvaiher ' Drinking Fountains Floor Drains Fioor Sinks Gas Service OuUets Interceprors . Kitchen Sink Lavatories P—Trap; Rooi Drains Reinspection_Fee $25 Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. IC80 # H�eja �ng System & Ducting . L70.100,000 BTU � 100,000 BT v- r v/ _ Date Reins ection Fee � P White - Builtlin9: Canary - APPlicant; Pink - Atcountinq; Goltlenrotl�- Assessor $25 Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool wlSpa Urinal � Water Closet Warer Hea[er water Service laue Fee Hood or Typel ❑ Canopy Type II � Refrigeration System ❑6100,OOOBTU ❑100,000 System Repair/Alteration Issue Fee FEES S 3 ES $ 3 Use of Building: Planning Notes: m Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers �Gas ❑Elec Fan F.A.U. Fiztures Device Boxes � Outlets Garbage Disposal Generator 00.5 KW �5-15 3720 5/29/85 IZane Acceuory Building: Park.Fees $ ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Merer ❑up to 700 amps Meter ❑over100amps Sub Panel Mo[ors �61 HP � 1'f. - 8 Int.Solar �9-15 HP �16,15+ Pole Light Standing Sections Trash Compactor :3eGi; � Z O N I N G R E O U R E N E N T S FEES Reinspection Fee $25 Iszue Fee $ 3 ' PUBIICSEHVICESREDUIREMENTS: 2oning Approved By Date Application Approved By Date Application Issued By- /k/� D'ate J�2 9�1�1 - % SUMMqRY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING � § ISSUANCE $ � PLAN CHECK $ � ENERGY P.C. . $ ' ELECTRICAL $ GRADING $ PLANCHECK $ MICROFILM $ r MECHANICAL •$ 7S ��% O TOTAL FEE � PLANCHECK . $ � '�� /�Q•Q� GJ,3�,Q�% � CONSTRUCTION AND PLANNING � POOL & 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-Undrgmd. � 54. Forms ° r 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 • � s� 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 �z•� SeWe� 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 � � 6S. .APPROVED FOR PLASTERING 18. Rough Elearical-T Bar Ceiling � � 69. POOL/SPA SYSTEMS FINAL 19, fiough Heating &'Air Conditioning FIRE DEPT. REQUIREMENT � 20. Rough Factory Fireplace APPROVALS Permit # 21. DuCts, in Structure 70. Underground HYdro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test � 72. Underground Flush '24. Roof Framing 73. Undergrnd.StorageTank �Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro � 26. T-Bar Ceiling (S[ructural) & 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: y� �V �r (� � 34. Final Heating & Air Conditioning l ds- L�,n 35. Final Gas Pipe-Test �� ' � 36. Hoodor'Canopy 37. Final Factory Fireplace 38. Final Plumbing ' � 39. Water Service-Final 40. Gas Service-Final ' 41. Solar pomestic-Final � � - , 42. Backflow Preventer � i 43. Backflow Irrigation ! 44. .Landscape Irrigation SYstem � r� 45. Sound Attenua[ion 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 . � �� No. Date /�oDlicant to fill in all svaces except tM1ose within heavy nortler Iines a�O sign au acaroPriata aeeiant�ons. JGG:3 jf i�(�/ii� r ��e ; y- CfTY�OF'COSTA M5�ESJ�A CO1N,S`TRUCTION PERMIT PERMI NO. TRACT NO. LOT NO. , ' UNIT NO. . Project Address «"� w. � �� • . � �O �'. � � � . ' ' . � r I '! ,A'ppliCant'SMailingAddre55 23Z�1 �� =YL'9h. TYPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR ( f�n ❑ CONVERSION ❑ DEMOLISH ❑ OTHER �`I Owner's Name 'y�� = ��T� Phone �6� 3�f� A•P. # L-� - q �— 2ona f�,l-� DESCRIPTION OF WORK/USE OF B DG. C Address �2�� LA\U�i�f-�1 . �,�%, �c'a0a,�� . /19� (' � . � E MainBuiiding: AccessoryBuilding: �. Arch/Eng. �� License Na. ' TYPE OF PERMIT GRADING FOUNDATION STRUCTVRAL � T Front � G�_ � O "' AddreSs ❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL A Reer � N Contractor'sNamr��«�l'l-�E� �-O�G�phone 7(�% 3�f$�3 �'oTHER � C Right � b� N Atldress (mailing) 23Zv �� li��'(� C.E�L �C�-" 'f�'Ano,�'R. PROJECT DESCRIPTION Sa. FT. _ oCCUaANCv GONSTRUCTION TVPE VALUATION $ SI SyC�Ci g Left I'�� G I I G City LiCenS¢ No: 20NE � GRADING CU. VDS. ACRES R �ICENSEO CONTRACT00. pECLARATION Ping. Ref. #��j - _ Parking Req./Provided E � hereby affirm that I am licensetl untle� provisions ot Charter 9(comm<ncin9 Remark5: ' ' Pldnning NOt¢S: n � With section 7000) ot DiviSion 3 of Ihe Business antl Professions Cotle, antl M iny Ilcense is in full.t rce antl effecL c}. S.o 9 •SPECIAL RE UIREMENTS T� ��icense Class — �Icens N . S � pate 'i,��i g"j�5i9 t - PLUMBING - FEES WORKERS' COMPENSATION pE L RATI N ' Bar Sink ShoW¢i5 � � hereby afiirm tnat 1 have a certificate of consent to selt-insure or a certHicate ELECTRICAL FEES "*: �Of workers' Compnnsalion Insurance, or a cerUnetl copy thereof ( e<tlon BackflowPreventer Service5ink 3800, Lab. C. �} q% ' ' ' . Automatic Washer Transformer' ❑ 75�50 KW policy No. �'� ""� `� Company '� ��en� Hackflow Irrigation Sewer Cap � ^ ConsVuttion Pole Sub. � ❑ 50 +`KW Q Certifietl copy is hereby furnishetl. I-� Certl(ietl Is filetl with tne'city Builtll D`I�{isior� �. � Bath[ubs Sew`er Connection .. ' OO Cooking Unit Meter ❑up to 100,amps_. pate � � APP��a^< �� `� r�U � Claritiers �XEMPTION FROM WORKERS' COMPENSATION DECIA TION Solar Collectors .� DiShwashef Meter Oover 1008mp5 � {Thls s¢ctio� �eetl not be mmpieted ii tfie Pe�mit {5 tor ona hundretl (b100) or iess). • . Dishwdsher Solar Piping Dryers ❑Gas ❑Electric Sub Panel , � certify that in the pe�fo�mance of the wO�k }ot whi�h this pe�m�t is ISsueQ I , - ghall nOf employ any pe�son IO any manner so as% o become subjet[ to the D/inki�9 FOuntBi05 � $Old� Tank Fdn� �_ Workers' Compensation I_aws of Califomia. ' . '� . Motors �0-i HP �1Y., 8• . pate Signature -� ' Floor Dreins � Swimming Pool w/Spa ' - F'.li,U. Inc.Solar 09-15 HP O7G15+ ' °ryOTICE: If, afte� makin9 ihi5 tletlaration, You shoultl become subject to the , Workers' Gompen5dtion pfovi5ion5 of th¢ Ldbor COtle, y0u Tust forthwitll FIOOf $ifiks Ullfldl Fixtu!¢5 MicIOW2v¢ �amply �witn such proviSionS o� thls pe�mit shdll be tl¢emetl revoketl.- - " ' � 1 CONSTRVCTION LENDING PGENCV � ' � � " �' GdSS¢NiC¢ ' Outl¢t5 Wat¢�CIOS¢t �i . ' � hereby aifirm that t0ere is a constructlon lentlin9 aqency tor the performance � � Devic¢ Boxes: 4 Pole.Light pf the work for which this Permit is issuetl (Section 309] Cfv. C.) Interceprors ' Water Heater Outlets � - � � UenOer's Name � Range �entler's AGaress Kitchen Sink Water Service CO Switches � � ' '�g�y� � % � OWNER BUILOEN DECLARATION ^ ' � - ' � I hereby affirm [hat I am ¢xBmpt from the Conlracto�'s Lic¢nse taw for Ihe L3v3tOYi¢5 , AutO-WdSh � �' followin9 reason (Section 7031.5 Business ana Professional Code: Any city or Q'� Garba9e Disposal ., ' ; Standin9 Sections � county wh4ch requires a permit to consvuct, afceq impruve, demolish or reoair P-Trep Laundry Trays Generator �65 KW �5-15 KW. . � any 5lruclWe, prbr to its issuance, al5o rCquires the applicant for such Oermit Trash Compactor'� to fiie a signetl statement that ne/she is licensetl pursuant to tne O�ovisions of q0of D�ains . - - ' � � - � the Contractor's License Law (Chapter 9(commencin9 �'�Ih Section ]000) o( -^ / Division 3 ot the BUsiness antl P�ofessions Cotle) or that he/she is ex¢mpt . -� . therefrom antl [h¢ basi5 fOr (h¢ allegetl eXemptlon. AnY violation o( Sectlon � � ' , ' . � ' - , , ' , • � 7031.5 by any applicant tor a Oermit subjects' the applicant to a civil ��enalty of not more tban five huntlretl tlollars (E500). • � ` - I, az owner of tbe property or my'employees with wages as their sole Reinspection Fee $15 laue Fee . S 3 "' �' . � [ompensation, will tla the wo�k, antl the StructU�C i5 not inte0tletl o� o(fe�etl ' tor sale. (Section 7044, Business antl Protessional Cotle: The Contractor's MECHANICAL � - Reinspection Fee" '�� 515' � Issue Fee, $ 3 FEES ' �� License Law tloes not appry [o an owner o� a proper[y who bul�tls or improves _ : ihereon, antl who tloes suc„ work himself(ne�self or through his or her own ' � DEVELOPMENT$EHVICE$ REQUIREMENTS: employees, P/ovlCetl tha[ Suc� �mprovem¢�t5 are not intentletl or ofiered'�or Boiler Nood or Type I ❑ . � . _ sale. Ii, however, the builain9 or improvement is sola within one year of com- C2nopy Type II ❑ Zoning'Approved By ^ � �^ Date � pletion, the ownet will have the burtlen of Provin9 tte/She tlitl not builtl o� im- DUCt - UOdE� G�OUnd � 3 Building Approved By Date prove for the purpose of Sale). � ' , - ��! . ❑ I, as �owner ot th¢ prOperty, am exclu5ivery conVacting with licensetl con- Duct -$tructural , Refrig¢ration System , Appliration Issued By f�V `'�• DBt IidClOR10 GO[�SlryCl lhC pfOjCCI ($¢CQOR i�44. BUS�f1E55 dfltl PlOiC55�005 COd¢: • The Con[ractor'S License Law tloes not aPPly t0 an owner o1 property wno Duct- V¢ntildting ��-100,0008TU ❑100,0008TU __ � builas or improves thereon, antl who contracts tor such orojects with a con- � � . SUMMAR OF FEES p/ �� vactor(s1 license vursuant'to ine convacrors License Law). I am aware that Exhaust System ❑ MWtiple ❑ System Repair/Alteration � ' BUILDING PERMIT $�� SMIP '� $_,�yQiy_Z proot oi their Worker's Compe�szlion Insu�ance Snoultl be pwvitletl to me. ; I . ❑ 1 am exempt untler Section B. & P. C. fo� thls veason Firepl/Fact. BIL ICBO �k fire Dampers �Z-PLAN CHECK ";$ . KOZ.(c�S pERM1T . - PLUMBING � �' $ �Z�'F7'�`'7 ��UANCE $ pate owner � Heating System & Ducting Registers � p�qN CHECK.-25% $-� ^• ��-O� ENERGV P.C. $ , � h¢reby certity thaC I have reatl this application dntl State that the above ❑0�100,OOOBTU �100,000BT _, � . i�formatlon is correc[. I agree to comvly with all city antl county ortlinances ELECTRICAL�• $ GRADING $ d�tl. Slate laws relatin9 to buildng c9q5 r �on, and he�eby authoNie repre- . ' - MICR�FILM $ , gentatives o atY, to e �� e a -memioneC properry tor PLAN CHECK' S0% ,$ r MECHANICAL ' $ � TOTAL FEE $ � inspectio urpos t. Dale �3//v��sl �� z Z,,�3 S�S�atu Reinspection Fee $15 Issue Fee $ 3 PLAN CHECK 25% $ � Drivers' License or 55 # - GMF �865-46, rev, 10/84 White - Builtling; Canary - qp011can4 Pink - Accountinq; GO�tlenrotl - Aszessor � � � � ..I �' , �: _ ;CONSTRUCTION AND PLANNING � POOL & SPA ,'APPROVALS � Permit# Date - Inspector AppROVALS Permit# Date Inspector �. 7. Temporary Electrical Service or Pole 52. Pool & Equipment Location � 2. �Soil Pipe-Undrgrnd. y� �� 53. Steel Reinfor,cement _ 3. Electrical Conduit Utility-Undrgrnd. 54. Forms ._ ' • 4. Electrical Conduit-Undrgrnd. 55. Electrical 8onding _ � 5. Steel Reintorcement 56. Rough Plumbing & Pressure Test � �.- 6. Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE _ 7. Footings ' 58. Electrical Conduif-Undrgrnd. 8: Foundation t� t�s �v . 59. Gas Pipe, � Undrgrnd., Test � 9. Wate� Pipe�Undrgmd. /Nif��j� �" 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Structural Floor System .Y 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 �/s �� L�� 65. Electrical-Final 15. Rough Electrical-Conduit� 66. Solar System-Final � 16.. Rough Electric Wiring � - 67. ,Fencing & Access Approval 17. Rougti 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 77. Product Piping � Gas ❑ Oil 23. Gas Pipe-Rough &�Test 72. Underground Flush 24. Roof Framing � 73. Undergrnd. Storage Tank O Gas � Oil 25. Roof Sheathing ' ' � �'� 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Mo�ocoat 75. Dry Chemical � 27. Frame.�and Flashing fq�j%£- �� 76. Dry Standpipe , 28. Lathing & Siding � �� 77. FIXED SYSTEM FINAL 29. Insulation '� 9� (% 78. FIRE PREV. FINAL 30. Drywdll Nailing � � HEALTH DEPT. REQUIREMENT � � 31. Plaster Brown Coat� (,� 79. FINAL INSPECTION •32: Electrical Power Meter-Final � 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes:31 34. Final Heating & Air Conditioning � 35. Final Gas Pipe-Test � � '� � 36. Hood or Canopy ' �� QjJ�(�$ . 37. Final Factory FirepVace � 38. Final Plumbing 3 �� (�l% -/ "p ,OU�/v � �� m-!� 39. Water Service-final . L� �/ ��'�� y`IJ 40. Gas Service-F,inal E r Q,Bp�.��j�%- G 41. Solar Pomestic-Final . � � �� 42. Backflow Preventer G � �I(% J �(J�(,' 43. Backflow Irrigation . � '� � 1� ( nj dy �(�7V!'�•.S 44. Landscape Irripation SYstem j,�{� �,�0�/t„� �% � 45. Sound Attenuation C � 5 a� t1� �d9Q, ��%�d(i �✓L'. 46. Handicap Regulations . � G�„$� NLd..� - 47. FINALSTRUCTURE&BUILDING �b. �, 48. Specia� Requ'vements Completed / � � � 49. Electric Release to Edison • -- � - � 50. Gas Release to Southern California Gas Co - � � 51. CERTIFIC/�T�QF OCCUPANCY '��! . . , N�. � �� Date � y+� , . - - - I ,� , Aop��cant to fill in all soaces except %, GiT%oFCOST E n CO �RUCTIONPERMIT PE MITNO. . • Project Address �,�� Applicant's Mailin Address � Owner's Nam ..Phone Addreu 2� �Arch/Eng. icense No.,.�2(oS. Address Contractor's Name Ph e Addresi (mailing) � � City License No. �LICENSED CONTRACTOR OECIA TION � I hereby atfirm that I am licensea untl' provisions�oi C art r 9 commencing � with section 7000) ot Division 3 of tn Business antl rof ssi ns Cotle, ana my license is In II i an fT I� Liten- I s � Licenze Date Si9nature WORKERS' COMPENSATION DECLARATION i ' '� hereby,atiirm Ihat I havc a certificate of consent to selt-insure or a certificate �f Worke�s' Compensation Insu�ance or a certifietl copy tne�eot (Section 3800. Lab. �',^, .\��2 Co ny ' � Policy No. V`�� -•� �Cerlifie cop is hereby furnishetl. Certif' p s tl wi[h the city Bui I Division Da[e � APPlicant L EXEMPTION FROM WORKERS' COMPENSATION DECLARATION ' (This seclion neetl not be cOmO�etetl i( the permlt is tor,one huntlr¢tl ($100) Or less). • � • I certity,tha[ In lhe performance of the work fo� which thii p¢rmR is isSuetl I snall not employ any person.in any manner so�as to become subject to t�e workers' Compensatlon'Laws of California.� . � . Date 5�9�ature `NOTICE: 1f, after makin9 this tleclaration, you stioultl become subject to lhe Wo�kers' Compen5ation p�ovisions Of �the ldbo� Cotle, y0u mu5t f0/[hwith comply��with� such O�OvisiOns or this pe�mit �Shall be tleemeC �evoketl. CONSTRUGTION�LENDING"AGENCV" : i ' � 1 hereby affirm thal there is a'construction lentlin9 ageucy for the performance of the �wOrk tor� which Ihis Oermit i5'i55uetl, (Section 3097 Civ. C.) Lentler's, Name. , - Lentler'i AtlOress � _. OWNER eUILOER UECLARATION ' ]031'.5 by any appiicant �or a pe �enalty oi not more than five hunarei LJ I, as owner ,of the' property bc � compensatlon, will tlo the work, antl br sale- (Section 7044, Business ar License law tloes not apply to an ow fhere6n„antl wno tloes such work-h employees, pwvitletl thdt such imprc wIB. H, M1oweveq the bulldinq or ImF pletion, the owner! wlll �M1ave rthe bwc prOve for the Ourpose of sale). ❑ I, as owner oi tne property, am e The Conttactor's ucense ww vot builtls or improves thereon, antl m tractor(s1 license pursuant�to tne C proot o( lheir Worket's CompenA ❑ I am exempt untler Section— Date Owner'_ I hereby cerilty tha 1 hav¢ reatl� information is correc I agree to 0 antl state laws relatin to builtling sentatives ol this cit to enter- insp¢Ction pu�po5¢5. 5' L m the Contractor's License Law for tne '�iness and Profeszional Cotle: Any city or �Struct, alter, improve, tlemoliSh or repair so reqWres the applicant for such permit is licensea pursuant to tne provisions o1 r 9(commencinq wlth Section 7000) of essions Cotle) or tnat he/she Is exempt etl exemption: Any violatiom of Section rmit. subjects the appl_cant to a<ivll I tlollars ($500). • my-:employee5 with wage5 as thei� Sol6 • the structure is noC intentletl or otteretl , tl Professional Cotle: The Contractor's ner of a property who builtls or improves � imSClf/herself or Ihrough his or h¢r own ' vements are not intentletl or offeretl for rovement is soltl within one year of com- en ot proving M1e/she tlItl not bulltl ov Im- xclusively contracling with Ilcensetl con- • lon ]044, Business antl Professions Cotle: noc apply to an ownei of property who ✓contracts for such orojects with a con- • rtractorY �icensa Law�. I am aware that �n in5urance zhould be p�Ovitletl tO�me., B. & P. C. for th6 reason . within heavy bortler anO si9n all approDriate tleclarations. 0 TVPE OFCONSTRUCTION ILi.NEW LJ A�D LJ ALTERATION LI REPAIR ❑ CONVERSION�❑ DEMOL�ISH ❑ OTHER , DESCRIPTION OF WORKlUSE OF BLDG. TVPE OF PERMIT GRADING�p� FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL p� PLUMBIN MECH NICAFj L _ ❑ -0THER gjL,�T PROJECT DESCRIPTION Sq. FT. � �oCCvaarvC/v�� '.CONSTRUCTION TVPE � VALUATION $ QJL/ • �� ZONE ' GRADINGCU.VDS. ACRES Rema�ki: Bar Sink BackflowPreventer i Backflow Irrigation - Bathtu6s � ' Clarifiers � . rinking Fountains loor Drains � loar Sinks.� - - - as Service Ou�� Lavatories � � P—Trap 1 ,Roof Drains ' � Reinspection F.ee '$15� Boiler '- ,'. . -. Duct-Under'G�ound � Duct - Structural Duct - Ventilating, ' Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑a100,000 BTU O 100,000 BT Ligna ure — --_...��_...�_ Drivers' License or 55 � , I I Reinspection Fee I $15 CMF 0865-46, rev. ]0/84 White - BWltling: Canary - Applicanh Pink - Accountlng; Goltlenrotl Assessor Showers Service Sink ' Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Poot w/Spa Urinal �Warer Closet � . � Water Heater � ' Water Service . Auto-Wash Laundry Trays�. � luue Fea Hood or Type I ' ❑ Canopy Typc I I. ❑ Retrigeration System ❑0-100,OOOBTU ❑100, System Repair/Alteretion Fire Dampers Registers Issue Fee � A.P. # S Main Bu E T Front B Rear A C A�ght K Left S Ping. Ref. # Planning No' Aufomatic Washer � Construction Pole Sub. Cookin9 Unit � Dishwasher Dryeis ❑Gas ❑Electric Fan F.A:U. ' Fixtures - ' ' - Device Boxes � OUSIQLS Switches . Garbage Dispoul Generetor �0-5 KW �5-' . , � $ 3 FEES � $ 3 1124 4/15/85 � • Zone Accessory Building: Parking Req./Provided ELECTRICAL � Transformer ❑ 15-50 KW ' ❑ SO+KW Meter ❑up to 100'amps Meter ❑over 100 amps _ . 5KW Sub Panel Motors �0.1 HP O 1 h� 6 Inc.Solar �9-15 HP �16-15+ Microwave� � Pole Light ' Range Sign Standing SeCtions Trash Compactor , ��Reinspection Fee �$15 '� � Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: 2oning Approved By Building APProved.BY . Aoolication Issued Bv � �11 � 17.37 T FEES $ 3 Z O N I N G . R E. Q M � T $ SUMMARV OF FEES � BUILDING PERMIT, $ SMIP� , $ ' PLAN CHECK $ PERMIT PLUMBING $ ��l'J�Zj �SSUANCE $ PLAN CHECK 25% $ �' �7 ENERGV P.C. .$ ELECTRICAL $ ' GRADING $ PLAN CHECK 509G . $ � MICROFILM $ MECHAMICAL �� $ TOTAL FEE .$ � 7• 37 PLAN CHECK 25% $ _ " � ". CONSTRUCTION AND PLANNING PO� _ h SPA }' APPROVALS Permit # Date Inspector AppROVALS Permit # Date InspPct�r I 1. Tempor3ry Electrical Service or Pole �- 52. Pool & Equipme�t 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. Wajer Pipe-Undrgrnd. � - 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK � 11. Property Sewer Line & House Connection �I � 62. Backwash & Receptor-Final ! 12. Sewer Cap � 63. Heater & Vent-Final 73. Roof Dra�ns 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 6S. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough FOctory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping �Gas 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. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final EleGtric , Notes: 34. Final Heating & Air Conditioning 35. Final Gas P�Pe-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. 6ackflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL S7RUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison � 50. Gas Release to Southern California Gas Co V 51�. CERTIFICATE OF OCCUPANCY . � N�. Date :� 1 � Q Applicant to /III in all EITV OF COSTA ME} ($La-7 C1O'INSTR CTION PERMIT Projeet Address -Vp / W� � � � 14pplicant's Mailin^g Address � ' Owner's,Name . J��✓ELS/ G'/�p. PROSEC75phone_ Addrew � � - � � Arch/Eng. _- ,' - � - Licenu No. Address �`Q '�, Contiactor'sNamei3ti°�SfOE EtKT.t'ACrSN�.phone�T�ld Address Imailingl yS�F/o Sp, �MR✓/fJV S. /q'. /��-7a¢ , City License No. ��-7� / g � LICENSED CONTRACTOR DECIARATION I hereby affi�m that I' am licensetl untle� provi5loni o( ChartGr 9(commencing with Section 7000) oi Division 3 oi the Business antl Prot¢551 otlB, antl my license Is in tull force a effect. S %� LicenseClass' O LI e e Date �T%1�dS Signature WORKERS' COMPENSATION DECLARATION � 1 hereby aftirm that I have a dertificafe o( consent'to self-insure or a certlficate ot Workers• Compensation Insurance, or a,c¢riiBetl <opy thar¢of (Section 3800, Lzb. C:) PolicY No.l!%G•7�'µ��0��/ ComPanY ��Nhu.T , ��Certifietl copy is hereby fumishetl. Certif�?cogy}s filetl with ehe city Buil�ng�s�. NyJ _ ._ Date 5 �2S APplicant L�A M�C32I�GAe. EXEMPTION FROM WORKERS' COMPENSATION D LARATION (ThiS section n¢etl not De compiet¢tl it the pGrmil IS fOr One huntlretl (5300) or I¢55). I certify that in the performance of the work tor which thVs perm�t is Issuetl I shall. not� employ any person in any manner so as to Gecome subject to t�e Workers' CompensatiOn laws ot California. , . Date� ' Signature� 'NOTICE: If, a(ter making this tleclaralion, you shoultl,become subject to the . Workers' Compensalion' provision5 of th¢ LabOr COtl¢, y0u mus[ forthwith comply with- such prOvi5iOn5 or this permlt .s�all be tleemetl rewketl. CONSTRUCTION-LENDING'AGENCV' I hereby atfirm that there I5 a const�uction Ientling agency to� tbe�pertormante of the work tor whiqq„lh�,ygr� i; jssuetl (Section 309] Clv. C.) Lentler's Name �/T'L e0 APNL LenOer•sAatlress ��p�� /i//esNy�S r�i/p� 'L,A OWNER�BUILOER �ECLARATION � � ' I hereby atflrm [hat I am exemp[ from the�Con[�acto�'s LlcenS¢ Law 10� the tallowing rea5on (Section 7031.5 BuSinesS antl Pro(es5londl COae: Any city Or , county which requires a permit to cOnst�uct, alter, improve, Cemoli5h or repal� any structu�e, prior to its issuance, also requires the ap0��cant tor zuch pe�ml[ tn fiin a zianetl statemen[ that h¢/she is Iicensetl ou�suant to Ihe D�ovlsion5 of 5 by.any appl �y of not more tl d5 OWIICI Oi [Y ansation, will'tic ile (Seclion 70� ;e Law ooes not in, antl �who do yee5, pravitletl f, however, lhe n, the owner wi forthe purpose as owner of the lor a permit subjects the applicant to a civll : huntlretl Oollars (5500). perty or my employees with wages•as their sole �ork, antl the structure is not intentletl or otteretl siness antl Professional Cotle: The Contractor'S to an own¢r Of a p�ope�ty who builtls o� Imp�oves i work hiTself/he�self o� through his or har own ch Implovements ar8 nOt Intentletl Or Offered fo! ig or improvoment Is soltl wlthin one year oi com- the burtlen ot proving he/she tlitl not builtl or Im- )� rty, am exclu5ively con[ractiny wlth licensetl con- ect (Section 7044, Business antl Professions Cotle: The Contractor's License Law does not apply to an owner of property who builds or improves'thereon, anA who contracts for such projects wltn a con= tractor(sY license pursuant�to ti�n�Contractor's License Law). I am aware that proof of their Worker's Compensa[ion Insurance shoultl be provitletl to �.me. 'L7 I_am exempi unCer Section B. 3 P. C. for this reason Date - Owner 1 � • � I her¢by -certi(y Ihat I have reatl this applicatiOn antl state Ihat the dbove information is'.wrrecL I aqree to comply with all city'antl county ortlinances antl statC-laws relating to builtlin9 constructlon, antl nereby aulnorize repre- sentati ¢5 of [his 'cit 'to enter upon the above-mentionotl prOperty for tnase � heavy borEer lines antl sign all apPropriate Ceclarationz. a TVPE OFCONSTRUCTION C�}'NEW LJ ADD LJ ALTERATION LJ REPAIR - ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p � DESCR�IPTION OF WORK/USE OF.BLDG. � —��T £�r ' , � - � S 'Main Building: TVPEOFPERMIT GRADING ❑FOUNDATION O�STRUCTURAL " T Front' ❑ TENANT �ELECTRICAL ;O PLVMBING ❑ MECHANICAL ' . B Rear ❑ATHER' � � , � �: PROJECT DESCRIPTION� 5q. FL � oCCVaANCv � C Ri9ht 'CONSTRUCTIONTVPE VAIUATION$ - � g Left . ZONE GRADING CV.YDS. ,ACRES Ping. Ref. # Remarks: , ( �(� �j!'�' . . ' Planning Notes: Bar Sink � ' � � Backflow Preventer � — Backflow Irrigation ' Bathtubs . : Clerifiers ' Drinking Fountains Flooi Drains � � Floor Sinks • Gas Service Outlets Interceptors Kitchen Sink Root Drains ' Reinspection Fee '$15 Boiler ; Duct - Under Ground ' Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting , ❑ o-i oo,000 eru O i oo,000 Iinspecflon putp S Y� � �y-/ Signacure Date.� �- O�l Drivers' License or 55 � Heinspection Fee CMF 0865-46, rev. 30/84 Wnite - Builtling; Canary - Applicant; Plnk - Accounting; Goldenrotl - Assessor $15 ServiteSink ' � Sewer Cap- � Sewer Connection Solar Collecrors Solar Pipin9 ' Solar Tank ' Swimming Pool w/Spa � Urinal - Water Clout Water Heater Water Service � ' Auto-Wash _ ' 'LaundryTrays ' ' laue Fee Hood or Type I ' ❑ Canopy Typell ❑ Reirigeration System . ❑6100,OOOBTU ❑100 Syscem Repair/Alteratior Fire�Dampers Registers . Issue Fee FEES ! $ 3 A 2842 5/l3/85 — Accessory�Building: Parking Req. � � ELECTRICAL � Automatic Washer ' Transformer ❑ 15-SO KW � ❑ SO+KW Construction Pole Sub. � Cooking Unit ' , Meter up to 100amps Dishwasher Meter �over100amps Dryers ❑Gas'�Electric � Sub Panel � Fan � ' Motors �0-1 HP �1 h- 8 F.A.U. . ' IncSolar �9�15 HP 016- Fixtures ' -" Microwave � Device Boxes �Pole Light Outlets Range � • Switches Garbage Disposal Generaior �0.5 KW �5-15 KW ; Standing Sections ' Trash Compactor � Reinspection Fee �$15 � � Issue Fea DEVELOPMENTSERVICES REQUIREMENTS: Zoning Approved By Building Approved By „_,_�_ ' ' � 'Gk,. 409060 Tl�� Z O N I N G R E � M T S FEES $ 3 � SUMMARV OF FEES � BUILDING PERMIT $ SMIP $ PCAN CHECK $ ' � PERMIT . PIUMBING. $ �SSUANCE $ PCAN CHECK 25% .$ , 1 • ENERG�' P.C. $ E�ECTRICAL $ Z7�1 • ZU GRADING $ , PLANCHECK 50%,$ I 'JS.(ep MICROFICM .$ MECHANICAL $ TOTAL FEE $ 41��-1 �Q PLANCHECK 25%'$ � CGNSTRUCTION AND PLANNING � PO� _ h SPA APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspecror � 7. Temporary Electrical Service or Pole , 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. � � � 53. Steel Reinforcement .' � 3. Elect[ical Conduit U'tility�Undrgrnd, 54. Forms 4. Elect7ical Conduit-Updrgmd. �' 55. Hectrical Bonding �' 5. Steel.�Reinforcement ' � � 56. Rough Plumbing & Pressure Test ,- 6• Elect�ical UFER:GPndJ � 57. QPPROVAL TO COVER�GUNITE ' 7. Footings :1 ;. � 58. EJeFtrical Conduit-Undrgrnd. � 8. Foundation , f � � �� . � 59. Gas�Pipe, O Undrgrnd., Test , 9. Watei;Pipe-UndrgPnd: � 5: . 60. Backwash Lines, P-Trap, O Undrgrnd. ' 10. Struc{ural Floor�Sy,stem . =� 6t. APPROVALTO DECK 11: •Property Sewer Line & House Copnection : 62. Backwash & Receptor-Final s 12. Sewer Cap ;!. ; � � 63. Heater & Vent-Final , 13. Roof Drains �` �� "�� 64. Plumbing System - Final �;� 1 14: Rough Plumbing;,� 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final ' 16. Rough Electric Wiring � v7 � Cl 67. Fencing & Access Approval 17. -Rough Wiring Sign 68. APPROVED FOR PLASTERING - 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19..Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ' 20. Rough Factory FirePlace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & 7est - 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26: T-Bar Ceiling (Structurel) & 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. FiEQUIREMENT _ 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final �- � 80. FOOD CERTIFICATE ISSUED 33. Final Electric - Notes: 34. Final Heating & Air Conditioning � 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final / 41. Solar pomestic-Final I 42. Backflow Preventer 7 - 43. Backflow Irrigation ' I + 44. .Landscape Irrigation System 45. Sound Attenuation � . 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDtNG 48. Special Requirements Completed � �49. Electric Release to Edison . " 50. Gas Release to Southern California Gas Co � , - 51. CERTIFICATE OF OCCUPANCY � ' �Nn. Date � ' ' AOP��ant to ftll in all soaee: exeeo� inose within heavy Dortler Iines antl sign all aporooriate —CITV OF COSTA MESq� � CONSTRUCTION pERMIT ' Project Address . Applicant's Mailing Addr@ss� Z121 S. GRAND AVE: Owner's Name DIVERSTFrID PRQIFCIS � Phone ��3453 Address ' Arch/Eng. Licenu No.� Address • Contractor's Nam SI�A � Phone 957-$991 Address Imailingl Z1z1' S. GR[1ND AVE. � ciry.License No. 24912 . UCENSED CONTRACTOR DECLARATI � . � � 1 h¢reby affirT that I am Iicensetl untle ovis ns ot Char[¢� 9(commencing , wlth section �000) of Division 3 of Bus ess tl Pro(es ons Cotle, antl i my Iicense is in fuu torce entl ai� 4Q5914 �I License Class' 'c �ate 5 1 861qnature' /ORKERS'COMPENSA710N D CLARATION. I herebyaffi�m tM1at I hav0 d ce�tlficate of consent to elf-in4ure o� a certiticate -ot Workers' Compensali0n Insurance, or a�ttrtifietl' copY �thereof �(Sectlon - 3800, Lab. • PolicY t�o. �107123�TC � com y FA�S _QAertifietl copy Is hernby tumishetl. ' i '�'�iCertffLeC1cPFy ts f(letl wtth the c(ty i� v� Date S� LS� qpplicant � -EXEMPTION FROM WORKERS'.CO PENSA ION DEC ARATI �� (Thissection neetl not be completetl i the permitiis tor on huntlretl ($300) or less): � i � � • I certify that'in th¢ Pe�10�mdnce of Ihe wOrk fOt'whlch thi5 Oe�m�t Vs'issuetl I shall not employ any porson In any manner so as to become subject to t�te Workers; Compensation I,a�ys ot California! , I Date- ' ° Si9nalure ' • � NOTICE: It, atter making this tleclaration, you shoWG become subjeEt to t�e ` Workers� Compensatlon p�ovlslons of'the'Cabor Cotle,'you must fortbwlth' compry � with such . provisions or this . permit shall be tleemetl revoketl. CONSTRUCTION;LENq�NG.AGENCY I hereby atfirT Ihal thlr0 is a conSlruction Iantlin9 agGnGy tor the pertormanCe , of the work for •which. this permi✓�is issuetl �(Section 3097 Civ. CJ, Lentler's Name � ' Lentler's Atltlress� � � ' - � ' OWNER BUILDER DECLARATION ' � 1 hereby atfirm that I am.ezemPt from the C6nlractor's Li<ense Law tor the � followin9 reason (Sectlorl 7031:5 Buslness antl ProfeSsional�Cotle: Any city or county wNch requires a permR to construct, alter, improve, demolish or repair � '�ny sVucture, prlor to It¢ issuance, also reqWres the apP�icantlor such permit �(ile a signetl 5[dtemenLthat ha/5hG iz Ilcensed pur5uant to'the provi5im5 of � thereirom ana tne oasiz tpr Ne allegetl exempuon. nny vio�auon ot Sectwn 7031:5 by any ap0��cant for a permit subjects the applicant-to 'a civil .� enalty of mt more than (��e huntlretl tlollars (y500�. � I, as owner ot the prOp¢/ty o� my ¢mployees with Wagez a5 thei� sole 2ompensaHon, will tlo the work, antl the'structure is not intentleG or of(eretl : for sale (Section 7044, Bu5ine55 antl Prof¢SSiondl Cotle: The Contracto�'s � TVPE OF CONSTRUCTION L_ EW LI ADO LJ AI.TERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER- DESCRIPTION OF WORK TVPEOFPERMIT. GRA�ING FOUNDATIyOyNyy STRVCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING 'C�"MECHANICAL ❑ �O7HER PROJECT DESCRIPTION SQ.F7. oCCUPArvCV CONSTRVCTION TYPE VALUATION $ � ZONE ._ . _ GRADINGCU.VDS. :ACRES Remarks: $P1�9 � ' . Bar Sink Backflow Preventer � Backflow Irrigation Bathtubs ' " � Clarifiers � Dishwasher � "' ' ' � Drinking Fountains Floor D�ains� i f w, FlOor Sinks � ' Gas Ser'vice , Outlets - IOtE�C¢pt0l5 -. • Lavatories . r P,—Trap ' Roof Drains' ' ' � , _ t , �_Reinspection�Fee � ' $25 Llcense l.aw tloes not apply to an ownBr Of a prope�ty who bulltls or improves gOil¢� '' � � � thereon, dntl who tloes Such work hlmself/herself'or through his or her own � employees, provitletl tnat such Improvements are not intentletl or oHeretl for Duct - Under Ground sale. I�, however, the builtling or improvement is soltl within one year of com- I ' pletion, tM1e owner wlll hav¢ tne burtlen Of prOving he/She tlitl not builtl or IM- ' �rove tor the purpose ot sale). ' Duct - Structural ' 1, as �owner of the properry, am exclu9vely contracting witti Ilcensetl con- Iractor5 t0 cons[�utt Ihe b�oj¢ct (Sectlon 7044, Busine55 antl Protesslonz Cotle: / uct - Ventilating The Contractor's licenso Law does. not apply to an owner of property who '. . ' - builds or improves tnereon, antl who contracts tor such projects with a con- � � ExhOust Syst2m ❑ Multiple �' tractor(s)license pursuant to the Contractor's License Lawj. • ❑'I am exempt unaer $actlon B. & P. C. tor this reason . Firepl/FacL BIL ICBO # �ate Ownor' HOating System & Ducting I hereby certif t t I ave atl thls applicatlon antl state Inat the above t ❑0-100,0006TU �100,OOOBTI iniormatlon is or ect. agr comp pr/Wlth a11 city antl county ortlinances - ' ' - -' antlstate law r ati ep� l Fuctlon antl hereby authorize repre- sentatives ot 5 � e-mentionetl'property.tor � �f'j��p�J�j�( wpµ ��¢�,1{L^(yj insoectlon p ' Signature � � Date � privers"L ense or 55 qF Reinspeetion Fee $25 CMF 0865-46�rev.-7/83 White - Builtling; Canary - Appliwnt: Pink - Accountin9:�Goltlenwtl - Assessor ieirvu - � Showers Sewer Cap � Sewer Connection Solar Collecrors ��Solar Piping' ' - So�ar Tank Swimming Pool wl Water Closet. Water Heater Water Service Issue Fee 1ANICAL - Hood or Typel ❑ Canopy Typell ❑ ' Refrigeration System ' �aioo.000eru ❑ioo,000 System Repair/Alteration IsSue Fee 1Q.P. �h S Main Buildi E T Front ' B Rear A C Right K g Left Ping. Ref. dk Parking Req./Pr< Use of Building: Planning Notes: Automatic Washer � Construction Pole Sub. Cooking Unit', '�� UiShwasner , Dryers ❑Ges� DE Fan F.A.U. Fixmres ' Device Boxes � Outlets Switches Garbage Disposal Generator �0.5 KN 0 2one � Accessory'Buildin9� � Park. Fees $ � � t � O N I N G R E Q U I R E M E . ELECTRICAL � FEES 'Transformer ❑ 15-50 KW ' � , ❑50+KW � - -- Meter�uptot00amps-�^� + � Mecer ❑over100amps . ' 'SubPanel � � � � Motors�61 HP �1X-�8 .Inc.Solar 09-15 HP �16-75+ � � Microwave �Pole Light � � Sign • � � Standing Sections . ❑5-75 KW ' � Trash Compactor , $ 3 • Reinspection Fee $25 •�ssue FEES � PUBLICSERVICESREQUIHEMENTS: � � � Zoning Approvetl By Application APProved BY , �. $ 3 $ 3 � • �SUMMARV OF FEES � . BUILDING PEFMIT $ ' SMIP ' $ PLAN CHECK $ ` FERMIT PLUMBING $ ' ISSUANCE $ PLAN CHECK $ ' ENERGV P.C. $ ELECTRICAL $ ' GRADING $ , PLANCHECK $ ' MICROFILM $ MECHANICAL. $ �•�� 70TALFEE � $ 7�'�� PIANCHECK � $ IS•OO i ' CONSTRUCTION AND PLANN�NG . � �& SPA APPROVALS _Permit# ' �� Date �Inspector- AppROVALS Permit#� Date Inspector � 1., Temporary Electrical Service or Pole - 52. Pool & Equipment Location - 2. Soil Pipe�Undrgrnd. � � ' 53. Steel Reinforcement 3. Electrical Conduit Utility�Undrgrnd. � 54. Forms . . . +' � 4. Electrical Conduit-Undrgrnd. : 55. Electrical Bonding . , 5. Steel Reinforcement •- - �� - . 56. Rough P-lumbing & Pressure Test •6. Electrical UFER Grnd. ' � ' 57. APPROVAL TO COVER-GUNITE , 7. Footings . . " � . - �- � 58. Electrical ConduirUndrgrnd. � 8. Foundation � ' � � " 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. � ' _ 60. Backwash Lines, P-Trap, O Undrgrnd�. 10. Structural Floor System . �� , 61. APPROVAL TO DECK 71. Property Sewer Line & House Connection �;.;� , 62. Backwash�& Receptor�Final , 12. Sewer Cap � � . �� ' � 63. Heater & Vent-Final 13.RoofDrains _ ';� . 64:-PlumbingSystem�-Final � 14. Rough Plumbing ' 65. Electrical-Final - 15. Rough Electrical-Conduit, � � ' '- - � ' 66. Solar System-Final� � ' - 16. Rough Electric Wiring � � , - - ,67. Fencing & Access Approval �� ! 17: Rough Wiring Sign , , i 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 • , � � i APPROVALS Permit # - 21. Ducts, in Structure , 70. Underground Hydro � � 22. Ducts, Ventilating , � 71. Product Piping O Gas ❑ Oil - 23. Gas Pipe-Rough & Test :� � 72. Underground Flush � 24. Roof Framing ', � , -_ 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing ' 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat � . 75. Dry Chemical • 27. Frame and Flashing � ' 76. Dry Standpipe 28. Lathing & Siding �� 77. FIXED SYSTEM FINAL 29. Insulation . �' . � 78. FIRE PREV. FINAL 30. Drywall Nailing� . � �. � - , HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat . 79. FINAL INSPECT�ON , 32: Electrical Power Meter-Final . 80. FOOD CERTIFICATE ISSUED , , 33. Final Electric � � ' � Notes: 34. Fin'►al, Heating & Air Conditionin9 • e�ls/� �p , , � 35. Final 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 ' , � � 44. .Lan[Jscape Irrigation System , � - � . 45. Sound Attenuation � � ' - � � ' 46. Handicap Regulations . � � 47. FINALSTRUCTURE & BUILDWG , _ � 48. Special Requirements Completed ' ' , � 49. Electric Release to Edison � � � - - , - ; 50. Gas Release to,Southern California,GasCo �• ' 51. CERTIFICATEOFOCCUPANGY . . . .. . ' • � ' No. ' Date � � - \' • Applicant to till in all spaces exeept those wit�in heavy Eortler lines antl sign all aDVropriale Eeclarations. _ _, , 9642 sieoia:� i�;,;,�; r. � CITV,,Of COSTA M A CONSTRUCTION PERMIT . PEFMIT NO. � TRACT NO. LOT NO. UN/IT1 NO. � � ProJEctAddress' � �7 i_u. �� .. ' " �� ' u� l..i ^ 1 . 'Applicant'S Mailing Address �3 �-U ` �.q�C2 C�'�Y- �%-0v TYPE OF CONSTRUCTION NEW �ADD ALTER�ON REPAIR {� '%LS•�i-3�fS� ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ��5� a q,p, # - /�2L+ _ -�/�, 2one �!(,..� Owner's Name M�.$� �� Phone DESCRIPTION OF WORK/USE OF B G. - Address �� `A� C'p'��Z�� '2'pq ��'(� . S Main Buildin/g:� Accessory Building:_ ' Arch/Eng. ��B,r� l�� '��T�� LicenseNo. TVPEOFPERMIT GRADwG FOV DATION STaUCTUR.aL T Front IU�CY�� LI �� O Addre55 ❑ TENANT ❑ ELECTRICAI ❑ PLVMBING ❑ MECHANICAL A Rea� � N. Convacmr's Name��l�� p��'�� Phone 76� 3�'S� �'OTHEa . . C Righ[ � N Address (mailingl � � 2-0 � �'�-` CLT��-�L �7n^ ��.Cv � PROJECT DESCRIPTION 5�. FT. OCCUaANcv �—� K � � y CONSTRUCTIONTVPE v—�� VALUATION$3/n� $ Leit � G1' .G City License No. - ZpNE GRADING CU.YDS. ACRES !� R �� LICENSED CONTRACTOR DECLARATION Ping. Ref. # -BL.�- Parking Req./Provided oJ �� E �I hereby af(irm lhat I am ticensetl untler provi5lons of Gharter 9(commencin9 Remarks: _ � Planning Notes FOR SPEC[AL R -n°� with section �000) of Division 3 of [he Business antl Professions Cotle, antl " my license is in tull t rce and efiect. T � License Class licens o. Q'3�0 I . • S � Date 3'�4� 5'g t ' ��—�— ' ' PLUMBING � FEES • ' � � � � WORKERS' COMPENSATION DEC RATION Bdr Sink Showers \ I nere�y af(irm lhal I have a certiilcate ot consent lo selt-insure or a certifiwte ELECTRICAL FEES ol Workers' CompenSdtiOn Inzurance, or a ce�tllletl coov thereot (SecUon _ gackflow Preventer � �� Service Sink . � . -' 3800, Lab. CJ Q�j �: : , h../_ Auromatic Washer Transformer ❑ 15�50 KW aoiicy No. �- `�� company �� ( rf�'10/! ` Backflow lrrigation Sewer Cap ' � Consvuction Pole Sub. � 50+ KN/ 8 Certifietl copy is hereby fumisnetl. .� � . • � Certifie y is Oletl with the city Builtlin9 vis�ip n. Bathtubs Sewer Connection � r ` Z Cooking Unit Meter ❑up to 100 amps Date /aoPlicSnt ' � ' �V' P�O� , - . . - ' ' EXEMPTIO FROM WORKERS' COMPENSATION DECLA ATION Clafifier5 Solar ColleCtors ' DisFwaShe� , �` Meter ❑over 100 amps • (This section neetl not be mmpletetl it Ihe permit is 1or One huntlretl ($100) or � iess). ' � Dishwasher Solar Piping 2 Dryers OGas ❑Electric Sub Panel , . I certity that in the periormance oi the work tor whlch this perm�t Is issuetl, I � ihall not employ any person in any manner so as to become subje<t to the� Drinking Fountains Solar Tank Fan Motors �0.1 HP 01 h- 8 Workers' Compensation Laws of California. ' -' . Date ' Signature ' � Floor Drains Swimming Pool w/Spa F A.U. �� InaSolar �9-75 HP 016-15+ 'NOTICE: Ii, after making thls tleclaration, you shoultl bemme subject to the ' ' Workers' Compensation provisions of the Labor Cotle, you must torthwith FloorSinks .. Urinal � - - Fixtures - � Microwave � ' ` - � COmply with suGh O�ovl5ion5 0� this� permit shall be'tleeme0 �avoketl. CONSTRUCTION LENDING AGENCV ' -� ' � Ga5$¢fvlC¢ �utlEtS 'WatC�CbS¢t � �� D¢viC¢BOxes� • �� POIeLi ht I hereby affirm Ihat tnere ii a construc[ion lentling agency for Ihe performance 9 of the work fo� whiGh thls Oermif is . issuetl (Section 3097 Clv. C.) �nt¢�c2ptOf5 f Water Heater, -(]� � Outlets � � � , Range � Lentler's Name . , Lentler'sAaaress � Kitchen Sink Water Service . � Switches �� • Sign OWNER BUILDER DECLARATION - - -- . I hereby aftirm that I am exempt from the Con(ractor's License Law tor the Lavatories ' Auto�Wash � � Garbage Disposal ' ; Standing Sections , lollowing reason (Section �]o31.5 BuSiness antl Profes5ional CoOe: Any city or - county whicn requires a permlt lo construct, alter, Improve, tlemolish or repalr � P-Trap � Laundry Trays ' . Generator �0-5 KW 05-15 KW Trash Compacmr any structure, p�ior t0 its•IsSuance, also reqW�es the aOP��cant for such pe�mit to tile a sign¢tl s[atemenl Ihat he/She is Iicen5e0 PurSuant to the provision5 ot � R001 D�dins � ' ' ' ' � the Contractor'Z LicenS¢ Law (Chapter 9(mmmencin9 with Settion 7000) ot - � .Division 3 0( the Bu5ine55 antl Profe55ion5 Cotle) o� that he/she is exempt ; . Iherefrom antl tne basis for the all¢qetl exemption. Any violation oi Section _ , -. � . 7W1.5 by any applicanl for a Pe�mit Subjec[5 [he apP�icant [o a civil ' � . eenalty ot not more than tive hunaretl tlouars �5500). . . , , - � . $�3 . LJ I, as owner of the Property o� my employeM with wages as thel� Sole ReinSpectiOn Fee - $15 ISSue FBB compensation, will tlo the work, antl the structure Is not intentletl or ofteretl Reinspe,ction{Fee'•• $15 Issue Fee $ 3 tor sale (Section 7044, Business and Protessional Cotle:� The Contractor's' .� ' MECHANICAL '' FEES � License Law tloes no[ app1Y [o an owne� ot a property wno�builtli or ImprOves tdereon, antl•wno aoes su<h work himseli/hersetl or through his or her own goiler . ' Hood or Type I ❑ - • DEVELOPMENT SERVICES REQUIREMENTS: n employeez, provitleC Ihat such imProvements ara not intentle0 or oHeretl tor Zoning Approved By ' � Date ��+� sale. If, however, the builtlin9 or improvemen[ is soltl within one year of com- Canopy Type I I ❑ . .. . C� p1¢tioq tne owner will have tlie burtlen ot proving he/she tlitl not builtl or Im- Dutt - Under Ground - Building Approved 9y ` prOv! for tM1e pu�0oie of sale). DdtO ❑ i, is owner oi the property, am exclusivelY conlractin9 with licensetl con- Duct- Structural Refrigeration System � Applieation Issued 9y Dat traCtors to conSHuct the Droject ($ection 7044, Business antl Pro�esslons Cotle: - ,� � The ConVactor's License Law tloes not apply to an owner ot prooerty who Duct- Ven[ilating , ❑0-100,000BTU ❑100,000 B7U ,,, SUMMARV OF FEES ' builtls or improves the�eon, antl who conVacfs lo� Such projects with a con- .� tractor(s) license oursuant to the Contractor's Licenze Law). 1 am aware that � Exhaust System ❑ Multiple ❑ System Repair/Alteration BUILDING PERMIT $_�.t�� SMIP � $ 25.39 proot of their Worker's Compensation insuran<e snoula be provitletl to me. $AI..�PLAN CHECK $ Z57.� ' pERM1T � . ❑ 1 am exempt untler Section B. & P. C. for tnis reason Firepl/Fact. Blt. ICBO # Fire Dampers ' �PLUMBING $ �� "rJ •� ISSUANCE .$ Date � Owner � Heating�Sys[em & Ducting Aegisters p�qN CHECK 25%' $ ��1 ��U ENERGV P.C. $ I hereby certity tnat i have rea0 Ihiz appiication and state that the abova ❑0.700,OOOBTU �100,0008T � , � � , ELECTRICAL ' $ GRADING $ Information is correct. I a9ree to comply wlth all tlty antl county ortlinances antl state laws relating to builtlinq construction, antl hereby authorize repre- � ' PLAN CHECK 50°6 $ MICROFILM $ � sentatives o( aty e r pon < abOve-mGntioned pw0erty for . . . y3�f,/ Inspection p o� ) -3 �� MECHANICAL $ TOTAL FEE �$ 1��'�'��'� Si9na[ure Oate • Orivers' License or 55 � � Reinspection Fee $15 Issue Fee $ 3 P�AN CHECK 25% $ 1� 3.(p CMF 0865-46, rev. 10/84 Wnite �- Builtling; Canary - Appllcant; Plnk - Accountlng: Goltlenrotl - Assessor " '' � � ' � � � _�r CON�TRUCTION AND PLANNING POOL & SPA . ,��;�PPROVALS � Permit # Date ' Inspector AppROVALS Permit # Date Inspecror 1. Temporary Electrical Service or Pole � � 52. Pool & Equipment Location 2: �Soil�Pipe-Undrgmd. " - 53. Steel Reinforcement ' � � 3. Electrical Conduit Utility-Undrgrnd. . 54. Forms � � 4. Electrical Conduit-Undrgrnd. , � 55. Electrical Bonding � , 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. - 57. APPROVAL TO COVER-GUNITE 7. Footings S& 58. Electrical ConduiE-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. Backwasfi & Receptor:Final 72. Sewer Cap 63. Heater & Vent-Final 7 3. Roof Drains � 64. Plumbing System - Final , 14. Rough Plumbing 7/� � .� 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 Electriral-T Bar Ceiling � 69. POOUSPASYSTEMS FINAL ' 19. Rough Heating & Air Condltioning FIRE DEPT. REQUIREMENT . 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating ' �r 71. Product Piping OGas ❑Oil 23. Gas:Pipe-Rough &-Test 72. Underground Flush 24. RoofFraming r�� 73. Undergrnd.StorageTank�Gas ❑Oil 25..Roof Sheathing ,' � $ �� 7q. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 3�� Jv� 76. Dry Standpipe 28. Lathing &�Siding' ` (�,r 77. FIXED SYSTEM FINAL 29. Insulation - �j �' (�� 7g, FIRE PREV. FINAL 30.. Drywall Nailing �- HEALTH DEPT. REQUIREMENT 37. Plaste� Brown Coat. 79. FINAL INSPECTION 32:� Electrical Power Meter-Final � 80. FOOD CERTIFICATE ISSUED 33. Final Electric � Notes: 34. Final Heating & Air Conditioning �� `C •1,3 �u � �� 35. Final Gas Pipe-Test f/f' ��'�, �% 'f, S `F S 36. Hood or CanopY � U��'�'S , 37. Fi�al Factory Fireplace y� � �f�� j�Q.y�t�„ �� 38. Final Plumbing � ' 9 3 0/ �Lh / L � 39. Water Ser'vice-Final � 40. Gas Service-Final . - 41. Solar pomesticFinal - ' ' - 42. Backflow Preventer � : 43. Backflow Irrigation . 44. .Landscape Irrigation SYstem 45. Sound Attenuation ' . 46. HandiCap Regulations • 47. FINALSTRUCTURE&BUILDING Z �� 48. Special Requirements Completed � � � 49. Electric Release to Edison - - ' � - � � � 50. Gas Ftelease to Southern California Gas Co . 51. CERTIFICAT�7E OF OCCUPAN Y ;' No. ��7 %9 Datel�_ - � - Applicant to fill in all spaces exee0< <hose within heavy EorGer Ilnes anE zign all aOVropriate tlaclarations. cir,YOF CosTa Sa CON TR� TION PERMIT 'Project Address �� 9ppiicant's Mailing Address - � Owner's Na � hone Address �:.e Arch/Eng.� � icenseNo._ _- � Address � Contractor's Name � ' P one � Address �mailing) City License No. � LICENSED CONTRACTOR DEC�ARAT ON 1 her¢by a:ti�m lhaYi am licensetl untle� vision5 of Cha� � (co mencin9 � with section 7000) oi OH(ston 3 of the siness antl Pr e ions Cotle, antl 'rt�y IlcenSe is i tull F antl ffeC I . �icense as� License N . Date Siqnature WORKERS' COMFENSATION DECLARATI N hereby affirm that I hava a certiti�ate of consent to solf-Iniure or a certificate � .t Workerz' Compensation Insurdnce, or x certifietl <opy thereaf (Sectioq 3800, Lab. C��OSn� Policy No. � � COmp n � �Cer[itietl copy is nereby tumis�etl. ' ' Cer�yfikp�eOdy�)YNletl w�i�th�Phca^`y guiltl 9 ivision. � . � Date `I11 1 1 DS . EXEMVTION F0.0M WORKERS' COMPEN TION DECLARATION (This section need noi be com0�etetl if the permit Is for one huntlretl (5100) or less�. • • I certiry that in the per(ormance o( the work tor whicn this perm�t is issuetl I snall not employ any person in any manner so'as to become�subject to t�e , Workcrs'�Compensation laws of California., , ' � i� � - . Date � Signature � ' � 'NOT.ICE: If, after making this tleqarallon, you shoultl. becoitte subject to [he Workers' Compensation provisions pf tne Labor Cotle, you must torthwith comply with� such prOvl5ion5 0� thi5 permit snall b¢ tleemetl revoketl. CONSTFVCT.ION LENDING'A6ENCV� -�� ' 1 hereby attitm that there K a mns�ruttion lentling a9ency to� the p¢rfOrmance of lha work for which tnis permit is issuetl _(Sectlon 3097 Civ. C.) LEntler's' Name Lentle�'s'AOtlress � - � � � OWNER BUILOER �ECLARATIOIV ' ' I hereby affirm that I am exempt from the Contractor's LicenSe Law for�the ' following reason (Section 7031.5 Business and.Professional Cotle: Any city or .,.��..r.. ..�e��n .anwrec a oermiL[o cnnstruct. alter. imorove. tlemolizh o� �epair the orovisions oi ' Division 3 of the Business ana �roressions eoae7 or [nac na�sne � ne nN� theref�oT antl tbe basis tor'[he 811G9etl exemption. Any vlolation ot Section 7031.5 Dy any- applicant for a permit subjects lne applicanLto a civil �enalty ot nol more than five huntlretl tlollars ($500). � LJ I, as owner o{ the property or my employees with wages as their sole tompensation, will tlo the work, anA the structure is not intentletl or offeretl lor sale (Section 7044, BusinezS antl-Protezsional Cotle: The Contractor's ' LicenS¢ Idw tloes no[ apply to ampwner of a p�oper[y who builtls or improve5 thereon, antl who�tloes sucn work hlmself/herselt or lhrou9h hls or her own . employees, p�OviOetl that such ir�OrOv¢ments are not Intentletl Or o(feretl (O/ Shce. If, Itoweveq the builtling or imProvement is'soltl wi[hin one year ot com- � pletlon, the owner will have'the burtleu of proving he/she tlitl not builtl or im- prove �or the purpose of sale). , ❑ I, as owner of the pro0er[y, dm ezclusively contracting wi[h licensetl con- tractoR to mnst�uct the project ($ectlon ]044, Busine55 antl Profe55ions COtle: The Contractor's License Law does not apply to an owner of property who bulltls or improves thereon, antl who contracts for� sucn projects wlth a mn- tractor(s1 Ocense pursuant'co�ihe'ConiractorY Llcens2 LawJ. I am aware that proot of their WorkeYs Compeq5ation insutance shoultl be pwvitletl to me. ❑�I am exempt untler Section 8. 6 P. C. (or Nis reason Dalc Owner . I hava reatl is application antl state tnat the above I a9ree to o ply with all city and county ortlinances t0 buJtl� q o truCtion, antl hereby dutho�ize rep�e- to ent u n the above-menUonetl �r pert for I�ignaiure p� Date �� I I I P Drivers' License or.55 � Reins eetion Fee CMF 0065�46, rev. 30/86 White - 6ulltlinq; Canary - Applican[; Pink�- Accountln9; Goltlenrotl - Assessor 3a , �, � . TVPE OF CONSTRUCTION NEW � ADD ALTERATION REPAI R ❑ CONVERSION ❑ DEMOLISH '❑ OTHER q,p, # . � ' � DESCRIPTION OF WORK/USE OF BLDG. A n � _ ' ' S Main Building: � E TVPE OF PERMIT GRADING} �❑�FOIINDATION STRUCTURAL � • T Ffont ❑ TENANT ❑ ELECTRICAL �`1 PLUMBING ❑ MECHANICAL � B Rear rfl � n %1 .�— A ❑ �OTHER '�11� It�CX%W�-C.O -- t PROJECT DESCRIPTION Sq. F7: - oCCUaA�NyC�v � � C Right 'CONSTRVCTION�T.VPE VALUATION$ CY..x/•�O S �eft ZONE GRADING GU. VDS. ACRES Ping. RCf. # •� Remarks: ' � Planning Notes: . � PLUMBING ' � . FEES Preventer._ ' ' Irrigation Clarifiers Drinking Fountains Floor Drains Floor Sinks Gas Service � I nterceprors � Kitchen Sink Lavatories �� r—irap � ,RooEDrdids' f- Reinspection Fee Duct - Under Duc[ - Strucv •Outlets .. �$15 Exhaust System U Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting , ❑ai oo,000 aru � i oo,000 $15 Showers Service Sink � Sewer Cap Sewer Connection Solar Collectors � Solar Piping� Solar Tank $wimming Paol wl Urinal - Water Closet �Water Heater � 'Auto-Wash = laue Fee I t Z _ S 3 Hood or Typel ❑ Canopy Type I I ❑ . Refrigeration System i _, , ❑0-100.000 BTU ❑100,000 BTU System Repair/Alteration Fire Dampers Registers � Issue Fee � .I $ 3 _ . .1123 4/15/85 - � I7o37 TI Zone � Aicessory Building: . � . � 2 O , � , N . ' , N - .. G R Parking Req./Provided - E Q � . . . . � .. � ' M . ' ' i_ ' �. . S • i ELECTRICAL � Automatic Washer ' T ' Transformer � 15-50 KW Construction Pole Sub. . � 50+ KW Cooking Unit ' Meter ❑up to 100 amps Dishwasher Meter ❑over100amps' Dryers ❑Gas ❑Electric Sub Panel � Fan � Momrs DO-1 HP � i%- 8 � F.A.U. InaSolar �9-15 HP �16-15* Fixwres ' ' Microwave ' ' Device Boxes Pole Light Outlets Range . Switches Garbage Dispoul Generator DO-5 KW �5-15 KW Standing Sectiom. Trash Compactor � . I u FEES � Reinspection Fae -� $15 � � luue Fee � • I .$ DEVELOPMENT SERVICES REQUIREMENTS: . Zoning Approved By Date i Building Approved By � Date � � Appliotion Issued By ' �'1'�O � Date �/ 0 0 SUMMARV OF FEES � � � � ' BUI�DING PERMIT.� $ � SMIP , $ ' PLAN CHECK � $ PERMIT P�UMBING 5 �y S� ISSUANCE 5 PLAN CHECK �25% $ _.� ENERGV P.C. $ � � GRADING $ ELECTRICAL $ � ' PLANCHECK 50°,6 $ MICROFILM $ MECHANICAL $ ' � , TOTAL FEE $ . ( ��.37 � PLAN CHECK 25% $ ' - �CONS7RUCTION AND PLANNING < POO� & SPA � APPROVAL$ Permit# Date Inspector qppROVALS Permit# Date . Insper.ror 1, iemporary Electric8f Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinfarcement 3. Electrical Conduit UtilitY-Undrgrnd. 54. Forms - � 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement . 56. Rough Plumbing & Pressure Test �� 6. .Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings . - 58. Electrical Conduit-Undrgrnd. . 8. Foundation � 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System . 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection �p ��_ 62. Backwash & ReceptorFinal 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 0 Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing � 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sneathing 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 6rown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: ' 34. Final He.ating & Air Conditioning 35. Final G2s 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 trrigation System 45. Sound Attenuation 46. Handicap Aegulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY Nn. Date AOP�ieant to iill in ail spacas axttvt tnose witnin neavy Dorticr lines ane sign al1 appropdate tleclaraUons. CIT.Y oFrCOSTA MpESA�J CIO,'NSTQRUCTION PERMnIT �iaject AddrMs n 6 / VV ' I/� 5�.� LJ�-�� #J� Qpplicant's Mailing Address � Owner's Name �lV�/�� 'ep��%S Phone_ Address Arch/Eng. _ License No.' , Add.ess Contractor'sName �S�E �L�T/�/G Pho�e'J'<9`QS7n Addresslmailingl �-`�� S. F/77.CV/EL✓r S.R. � City�,License No. /��%/ �%8 � LICENSED-CONTHACTOR DEC�ARATION . 1 hereby a/firm that I am lic¢nzetl untler provizions of Charter 9(tommencing with section ]000) of Division 3 of tne Business ana Professlons Cotle, antl . my license I5 in fun orce antl eHect. License lass_ � � _License No. 3 Date Signature , VORKERS'COMPENSATION DECLARATION � hereDy a(firm Nat I have a certi(icdt¢ O/ cOnS¢n[ [O SelNnsu�< o� a ce�tlficate �f Workers' Compensation Insurance, or a_ceriifietl copY. thereot (Sectlon � � 3800,� Lab. C.) ' � Poiicyrvo.W�'�G'�i3S-�O/GS4comcany �'tONf}L(.%� ❑ Certiiietl copy ii hereby furnishetl. � �4.Cert�etl/q�PX3tiletl wA�PI cantY �"�/9 D V =�� Date � n5 EXEMPTION�FROMWORKERS'COMPENSATIO ECLARATION (This settion neetl not be completetl if the permft i5 tor one �unaretl (5300) or ' lesz) ' I certify that in the performance of the work for which thiz perm�t is Issuetl, I shalt. no[ employ any Oerson in any manner so as to become subject to the Workers' Compensation Ldws ot Calitomia. � Date S9�ature `NOTICE: It, after making this aeclaraUon, you shoula become subject to the � Workers' Comp¢nsation Provision5 Of th¢ Labor Cotle, you must for[bwith. Compry with sucb p�ovi5ion5 or tnis pe�mil shall be tlaemetl revoketl. CONSTRUCTION LENDING AGENCV� • ' I hereby a/flrm that thera is'a mnstructton lentling agency (or tha performance of the work for �yhi t�is �it " uetl (SecUon 3097 Civ. C.) Lentler's Name - L LZ ' Lentler's Atltlress �(070 ( Dy ' OWNER'BUIIOER DECLARATION � I heraby attirm th5[ I am exampt from tha Conbactor's License Law tor the tollowing reason (Sec[lon ]031.5 Buslness anC Profesilonal Cotlo: Any clty or ' county whiGh �equire5 d Petmi[ to Construct, alte�, improve, demoll5h Or repal� any structure, Orior ro its issuance, alw requires tne ap0��ant for zuch permit � to tile a signetl Statement that ha/she i5 IiCen50tl purSudM t0 lh0 ProviSiOni Of the Contra<tor's Licenso law (Chapter 9(tommencin9 witb Sectlon 7000) of DiviSion 3 of the Bu5ine55 antl Professlons Cotla) Or Ihat ne/sha (5 exemp[ Inete(rom antl the ba5i5 for thG allegetl ex¢mptiOn. AnY vlolatiOn o( $eclion 7031.5 by any applicant for a permit zu�jects the ap0��anl lo a civil �enalty of not more than five huntlretl Oollars (E500�. , I,. as owne� of th¢ P�operty o� my employ¢!S wilh� wage5 as t�ei� Sole . tbmpensalion, wiil Eo tne work, anC [he.structure Is not intanOeC or otleretl tor sale (Section 7044, Businesr antl Professronal Cotle: The Contractor's License Law tloes not apply lo dn owuer o1 a p�operty who builtls o� Imp�ov¢S ' thereon,.antl who�aoes such work himselt/nerseli or throu9h h(s or h¢r own � employees, providatl that such improvementt are not IntenAetl or offeretl lor sale. Ii, hOweveq Ihe bulltlin9 or ImpwveTent is Soltl wlthin one Yea� ot com- pletlon, the owner will have [he burtlen o� provin9 he/She tlId not builtl or Im- �rove for the purpose ot sale). i, as owner of the propercy, am exciusivery contractiny with Iicentetl con- Vactor5 t0 mnsMuct the Oro�ect (Section �044, Businesz antl Rof¢SSiOns Gotle: The Contractor's License t2w doez not appty t0 an owne� oi prOPerly who bulltls or improves' cnereon, antl who contracts for sucn projects wlth a con- tractor(s) license Oursuantlo tiie ConVacror's License Law�. i am aware t�at proot ui thei� Worke�'S Compen5ation inzurance ihoultl be provitletl to ma. ❑ I am exemo� untler Section B. & P. C. for this reason Date Owner ' I hereby ce�tify that I have reatl this appliWtion dntl state that me-aGove informatiOn �s correcL I� a9�ee lo compty with all tlty antl county ortlinant¢5 antl ztate laws relating to buiiamg conztruction, and hereby authorize reprr sentatives ot this clty to enter upon the above-mentionetl property for :inspection purpyy�5. - ' ��_y�- : Signafure l � .� a��-� Dat¢�[J�L Drivers' LI"""" ' .. t � ��'-� TYPE'OFCONSTRUCTION NEW LJ ADD. LJ ALTERATiON LJ REPAIR ❑ CONVERSI�ON ❑ DEM LISH 'O OTHER - DESCRIPTION OF WORK/USE OF BLDG. �'1� TME TVPE�OFPERMIT GRADING FOVNDATION STRUCTURAL ❑ TENANT �ELECTRICAL ❑ PLVMBING ❑ MECHANICAL ❑ OTHER VROJECT DESCRIPTION 5�. FT. " OCCUaANCv � CONSTROCTIONTVPE ' NAIUATION$ � ' 20NE ' GRADING CU. VOS. ACRES , Remarks: 3ackftow Preventer - ' Backflow Irrigation � 8athtubs . ' Clarifiers , . ' Dishwasher . � Drinking Fountains . Floor Drains � Floor Sinks � Gas Service , Outlets Intercepmrs � Kitchen Sink Lavatories P—Trap ' � Roof Drains Reinspection $15 Boiler Duct - Under.Ground Duct - Structural Duct - Ventilating_ Exhaust System ❑ Multiple ❑ FirepVFac[.BILICBO# ' Heating System & Ducting �6100,000 BTU 0100,0008T Reinspection Fee � $15 CMF 0865-46, rev. 10/84 White - Building; Canary - AOP�icant; Pink - ACCountin9; GOItl¢nrOtl - ASseSSor P Showers Service Sink " Sewef Cap Sewer Connection � Solar Collectors Salar Piping Solar Tank Swimming Pool wlSpa . Urinal' ' Water Closet Water Heater Water Service Auto-Wash - Laundry Trays Isue Fee Hood or Type I ❑ " Canopy , Type I I ❑ i Refrigeration Sys[em _ Oaioo,000aTu ❑ioo,aooaT System Repair/Alteratian Fire Dampers . Registers Isue Fee $ 3 5 3 A.P. dp S Main Building: E T Front ARear C Right K Left � S. Ping. Ret. �lk Planning Notes: Automatic Washer � � - ConstructionPoleSub. Cooking Unit ' ' O ,Dishwa5her _ _ Dryers ❑Gas ❑Eleci Fan F.A.U. Fixtures � � � Device Boxes OuHets � Switches . �D Garbage Disposal Generator �65 KW [ 4833 6/13/85 Building: 275oS0 Tl Zone - Z O , N i �. N G R Parking Req.IProvided E � M T .. S ELECTRICAL ' FEES 5�15 KW Transformer LJ 15�50 KW ' � SO+KW Meter up to 100 amps Meter ❑over 100 amps . Sub Panel Motors�0-1HP�1h-8 � Inc.Solar �9-15 HP �i6-15+ Microuvxve • � Pole Light � Range ; Standing Stttions Trash Compacror . 1Reinspection Fee �$15 � � Iszue Feo � $ 3 � DEVELOPMENT SERVICES REUUIHEMENTS: Zo�i�B APOroved By Date Building Approved By Date Appliption Issued ey � h� Date �.3�6�.� SUMMARV OF FEES , BUILDING PERMIT $ SMIP $ � PLANCHECK �$ FERMI7 PLUMBING $ � ISSUANCE $ PLAN CHECK 25% � 5 ENERGY P.C. $ � ELECTRICAL . $ /S �D GRADING S � PLAN CHECK 50% $ ��.� C7 � MICROFILM S MECHANICAL $ TOTAL FEE § � � � PLAN CHECK 25% $ - � R(2NSTRUCTION AMD PIANNING POOL & SPA APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector r � �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. Electr,ical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7,, Footings . 58. Electrical Conduit-Undrgrnd. $, �Fou�dation �� 59. Gas Pipe, O Undrgrnd., Test 9,' Water Pipe-Undrgrnd. " � 60. Backwash Lines, P-Trap, � Undrgrnd. i 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 Dreins 64. Plumbing System - Final 14. Rough Plumbing- 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final i6. Rough Electric Wiring - �; �l 67. Fencing & Access Approval 17, Rough Wiring Sign 68. APPROVED FOR PLASTERING 18: Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 2q, Roof Framing � 73. Undergrnd. Storage Tank 0 Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31'.�Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final � ,D � 80. FOOD CERTIFICATE ISSUED 33. Final Electric � , Notes: 34. Final Heating & Air Conditioning � 35. Final Gas Pipe-Test - 36. Hood or Canopy 37. Flnal Factory Fireplace � 38. Final Plumbing ^ 39. Water Service-Final � 40. Gas Service-Final 41. Solar pomestic-Final . ' 42. Backflow Preventer � 43. Backflow Irrigation , 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirement: Completed 4g, Eleccric Release to Edison - � � 50. Gas Release to Southern Califomia Gas Co �� -; 57. CERTIFICATE OF OCCUPANCY " No. � Date ' ^ :. . , • CITY OF COSTA MESA � � CONSTRUCTION PERMIT AVV��ant to illl In all s0acas axeeot tnoze witnin neavy eoraer Iines ana sign all approD/�ale Eeclaratlons. ..�....._ ..,. r.,.,.r .�.. � .,r .�., o� ., _ . Proj@ct Address, t5b/ W. 1`1 '1'H S1'Hh�bT Applicant's Mailing Address 2121 S. GRAND AVE. Owner's Name DIVERSIFIED PRQTF.CLS " Pho�e 768-3453� Addreu �z01 Ita[CE CFNLER DRIVE EL •TORO Arch/Eng., License No.� ,4ddress Contrector's Nam _ SIEI2I2A II�IVIRCN�ff1�rB'L' ' Phone 957�991 �Ir Address (mailingl 2121 S. GRE4�ID AVE. ' ciry L�cense Mo. ' : 24912 UCENSED CONTRACTOR DECLARATIO I nereby a/lirm t�al I am iicensea unUe pr yizlon oi Charler 9(commencing with ¢¢�Ilon 7000) o/ Divlsion 3 al tl usine an ro/es5io 5 Cotla, antl my Il�ense is In lull (orco antl eflecl. LJcense Class � - �� co Oate Si9� IORKERS' COMPENSATION DEC RATION ; � , hereoypf6rm tn�t I have a certifica e ot cons nt to 501Nnzui or a certl6Ute ' of Workers' Compensatlon Insurance, o a ertl/letl toOY ��ereo/ (Settion 3800, Lab. C.) ' i Poli'cy No. • �1��123QN� � Com y �Certiiietl copy is hereby turrtisheC. . r[ifietl co y Is flletl with tlte'city 8 Isi n � Date � 5� �AS qoPlicant ' EXEMPTION FROM WORKERS' CO ENSATI N OECLARA 1 -' (This section neetl not be completatl if e p rmlt is for one huntlretl (E100) or ' lesz)�. � . II certiry'that in the vaAormance o/ t ork f � per z issuetl I snall not employ any Person in any nne e t�e � � Workers' Cor9�iry�5lon� l.aws o! Cal Dato /� S�9�a[ur NOTiCE: If, alter makin9 this tlecl ratlon. Y u snoultl ecoma 5 ject to the Workcrs' ComponsaUon proviAons o1 [he Lzbor Cotl , you m st torthwith comply with su<h provisions or tnls� oermit � shall be aeemetl rovoketl. CONSTRUCTION LENDING .AGENCV ' � � I herpby alfirm lhat there Is a constructlon lentlin9 agency for tha peMormanco ot lhe work IOr which thlz potmlt is issuatl ($ecHon 3097 Clv. C.) lon4or's Namn - Lentler's AtlCress, _ � � OWNER BUILDER OECLARATION I hereby, affirm that I am exempt lrom the' Conlractor's Llcanse Law for the �.` � 1"`�Division��3�of ` 4heretrom antl 7031.5 Dy an �enalty of not LJ I, as owne compen5ation, far �le (Set[ Licenie Law tl thereon; antl � ¢mploye¢s, ptt sale. If, howev pletlon„the ou �iOVO'ior Ihe F u 1, as owner tractorsto con plicant tor a permP than five huntlretl tlo the properry'or my fo the wo�k. antl the or 7VPE OFCONSTRUCTtON "^` `L'I NEW LJ ADD !J ALTERATION LJ. REPAIR - ❑ CONVERSION ❑ DEMOLISH ❑ OTHER /�,p,# DESCRIPTION OF WORK � � � 5 Main Building:� TVPE OF PERMIT�I GRADING FOUNDATION STftVCTURAL T FfOnt Q TENANT LJ ELECTf31CAL ❑ P�UMBING C�ECHANICAL g Rear ❑ OTHER A PROJECT DESCRIPTION SQ. FT.� oCCUPANCv C Right K Left CONSTRUCTIONTVPE VALUATION$ . $ ZOrvE GaADiNG cU. VDS. ACRES Ping. Ref. $� ttemarws: , BP18038 Parking Req./Provided Use ot Building: - . PLUMBING - . fEES P�anning Notes: � Bar Sink ' Backflow Preventer Backtlow Irrigation Bathtubs Clarifiers - �� Dishwasher - Drinking Fountains Floor Drains� Floor Sinks Gos Service � Interceptors Kitchen Sink Lavatories , P—Tiap ' Roof,Drairis� Reinspection' Fee no[ apply [o an owner ot a property wbo builtls or Impmves � Boiler � tloes such WOrk nim5elf/hersel( or thrpugn hi5 or her own ' etl tnat such improvements are not Intentlatl or oHeretl for Duct - Untler Ground tha bulltling or improvement is'soltl within one year of com- r will nave tha burtlen of proving he/sna tlltl not bulltl orim- � oze of saie). . • Duct - Svuctural rtoperty, am axcluSWely contractlng with Iicensod con- - ! project ($eCllOfl ]044� BI15i0055 dptl PrOf¢551006 COtlB: Q DUCt - VEM1LIIB[IO9 isa Law doos no[ appry to an owner of property who reon, antl wno contracts for such projecls witn a con- EHhaust System ❑ MUltip int to t�e Contractor's Ucense Law). 5ection B. 6 P. C. for thls rcason Fi�¢pl/Fatt. 81L ICBO�i1`- _ Owner Heating System & Ducting � � hava rnatl this application antl state that tna above ❑0-100,000 BTU 0100,00 11 a e to comp y wlth all tlty antl county ortlinancez lo �I 'ng truCtion, antl h¢rpby authoriz9 �epre- above-menUonetl .property tor 'O .h-�� W�N G,�y� IV �y Date � � � Reinspection Fee ' Whi[e - Builtling: Canary - Appliwnt; Pink - Accounting;�Goltlenrotl - Assessor I.J' 1 am enempl untlar Date � S�gqalure � Driyers' Li ense or •CMF 0865-46 rev. 7 Showers Service Sink � Sewer Connection Solar Collec[ors i ' � Solar Pipin9 - ' - - Solar Tank � Swimming Pool w/Spe Urinal ' ' ets Woter Closet � Water Heater �. Water Service . $25 �� e Isue Fee Hood or Typel ❑ ' Canopy Typell ❑ , � Refrigeration System ❑a�oo,000eru ❑ioo,000aru System Repair/Alteration i Issue Fee 5 3 FEES lo $ 3 ^ t Automatic Washer Construction Pole Sub, Cooking�Unit � � " Fan F.A.U. ' Fix[ure5 Device Boxes Outlets SW itCh¢5 Garba9e Dispoul Generator �0.5 KW �5-15 4632 6/II/85 Zone Park.Fees $ ELECTRICAL � Transtormer ❑ 15-50KW ❑ 50+KW � Meter' �up to 700 amps - Meter �over 100 amps Sub Panel Motors�0.1 HP�1'h-6 ' Inc.Solar �9-15 HP [�i6-15+ � Microwav¢ ' . Pole Light Range Standing Sections • Trash Compactor 5�.��- Tl Z 0 N 1 N �. G R E Q U I R E M E N T � S . FEES ' Reinspection Fea g� Issue Fee $ 3 PUBUCSERVICESREQUIREMENTS: � Zoning Approved By � Date Application Approved By Date APGlication Issued 6Y �� Date� SUMMARV OF FEES , ' BUILOING PERMI7 $ SMIP $ PLAN CHECK $ PERMIT - PIUMBING � $ ' ISSUANCE $ � PLAN CHECK � $ ENERGV P.C. $ ELECTRICAL § GRADING $ PLANCHECK $ MICROFILM $ MECHANICAL � $ S �J•OU. TOTALFEE � $ �O�'S� PLANCHECK � $ �Z' SO� i • CONSTRUCTION AND PLANNING . POu� & 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. Elecvical Conduit Utility-Undrgrnq. ' 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 Undrgmd., Test 9. Water Pipe-Undrgrnd. ' • �' ' 60. Backwash Lines, P-Trap, O Undrgmd. 10. Structural Floor System .� ,' . 61. APPROVAL TO DECK , 11., Property Sewer Line & House Connection . � ' 62. Backwash & Receptor-Final t 12. Sewer Cap " � '� •� 63. Heater & Vent-Final 13. Roof Drains � - 64. Plumbing System - Final . 14. flough Plumbing . � 65. Electrical-Final � � 15. Rough Electrical-Conduit � � 66. Solar System-Finai 16. Rough Elec[ric 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 � � f „/ FIRE DEPT. REQUIREMENT �1 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. Srorage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frameand Flashing ' 76. Dry�Standpipe 28. Lathing & Siding � � . 77. FfXED SYSTEM F(NAL 29. Insulation � � - ' 78. FIRE PREV. FINAL 30. Drywall Nailing � � ' HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ' 79. FINAL INSPECTION 32. Electrical Power Meter-Final � � 80. FOOD CERTIFICATE ISSUED 33. Final Electric � Notes: � 34. Final.Heating & Air Conditioning q`5-/�� G�j � 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 • _ . r 42. Backflow Preventer i� , • 43. Backflow Ir�igation . - � • � 44. Landscape Irrigation System ' � � � , � � 45. Sound Attenuation . � � 46. Handicap Regu�ations - , 47. FINALSTRUCTURE&BUILDING � 48. Special Requirements Completed ' . . � 49. Electric Release to Edison ��- - � - �: 50. Gas Release to Southem Califomia Gas Co � � � � � 51. CERTIFICATEOFO.CCUPANCY' '. � , � No. Date Aoo��ant to /ill In�all soaces excev< tnose within heavy bortler lines ana sign all aov�ooriate tleclarations. 'i COSTn pnnESA � CONST�R1lU�.,CTI1ON PERMIT � ProI�tAQtlress r7�� .�-�. �"ITf + �1 ' . . Applicant's�MailingAddress �Z32.i,� ��CL C�.�� 0�- �wner'sName M�� -s�r A'�� phone ��R-3¢S3 Atldress �2� � �� y ;��-0 V Arch/Eng. -� �A� �� Q�1�1'i�(� licenu No. � � . . Address Contractor'sNamP��V�st�'�tt� p12T.-S�L� Phone 7'6—.'F��1 Address (mailing) ✓Z3+�.0I' LAKC ��I1�L �1i�L '��.AV �� a City License No. � LICENSED CONTHACTOR OECLARATION 1 hereby aiflrm that I am licensetl untler provislons oT Cnarter 9(commencing � with section 7000) of Divlslon 3 of the Business antl Professlons Cotle, antl my license is in full t rce antl effect. a Licenze Clas ^` ��Cp�jy 0 0 1' Date � � � 5'9 t �Y � P� WORKERS' COMPENSATION DECLARATION I here�y aftirm tha[ I �ave a certifica[e of mnsent to selhiniu�e o� a certlficate of Worker5' Compensation Insu�ance, or a ce�tifietl coOY the�eof (SeCtion 3800, Lab. CJ i� m �} PolicY No. ��J�� COmPanY K'l�� ` •• 8 Certifietl copy is hereby furnishetl. �. Certlf w �s filetl with the Uty Bulltli�q Diy �sipT� �ate� ApPlitant 1 �1 V i�� ( • EXEMPTIO FROM WORKERS' COMVENSATION DEC RATION (ThiS Section neetl not be complatetl if the permit is fo� One ntl�etl (§100) o� less). 1 certity that in the pertormance of the work for which this perm�t is Issuetl, I snall not ¢mploy any perzon in any manner zo as to become subject to the Workets' Comp¢n5dtion Laws of California.. � _ Date Si9nature • 'NOTICE: Ii, atter making this aeclaration, you shoula become subject to the Wo�kers' Compensa[iOn provisions ot Ih< Labor Code, you must tonnwim comply with such 'o�a��slons or this oermit shall be aeemetl revoketl. CONSTRUCTION LENDING AGENCV 1 hereby a/flrm thdt lhere is a-constru[tion lentling agency (or tne pertormance ot the work tOr which tnis permit iz issuetl (Sectlon 309] Civ. C.) Lentler's Name Lentler's Htltlress � � � ' OWNEq BUILDER bECLARATION ' I he�eby affl�m tnat I am ezempt from the Con(ractor'S License Law /or [he following reason (Section 7031.5 Business antl Professional Cotle: Any clty or county which requires a permit lo construct, alter, improve, demolish or repalr any structure, prlor to its issuance, also requires the applicant for such permit to (ile a signetl statement lttat he/she Is Iicensetl pu�suant to (ha ProviSions o1 the Contractor's License Law (Chapter 9(commencing with Sectlon 7000) ot Division 3 0( the Busine55 antl Pro/e55ion5 Cotle)'o� that M1e/she is ezempt tM1ere(rom antl the basis for the alleqetl exemption. Any violatian of Saction 7031.5 by any applicant for a permit subjects the applicanl'to a civil �enalty of not more than five huntlretl tlollars (E500). LJ I, as� owner of ine properry,or my employees witti wages as thnlr sole compensation, will tlo the work, antl the structure is not Infendetl or o(feretl (or sale (Section 7044, Business ana Professional Cotle: The Contractor's License Law tloe5 not apply [o an owner ot a property who builtls o� Improve5 thereon, antl who tloes such wark him5¢If/herself ar throuqM1 his or h¢r own employees, orovitletl that such improvements are not intentletl or oiferetl for sale. II, however, Ihe bulltling o� Improvement is Soltl wi[hin one yea� of com- pletion, the owner. will have the burtlen Ot proving he/she Ai0 nol builtl or iT- prova for [no Ourpose of sale). ❑ I, as ownor of the Oroperty, am exclusively contractln9 with Ilcensetl con- tracto6 to construtt the Droject (Section 7044, Business antl Aofessions Cotle: The Contractor's License Law tloes not apply to an owner of pwparty who builtli or improve5 [hermn, antl who mnVactz tor such projects with a con- tractor(s) Il<ense punuant [o the Contractor'S Licens¢ Law). I am aware that prool of thelr Worker's Compen5ation insurance shoula be pravitletl to me. ❑ I am Cxempl untle� Section , 8. & P. C. tor thi5 r¢a5on �ate Owner I hereby ttrtity [na[ I have redtl this application antl state that the above in(ormation is correct. I agree to comv�Y with all city antl county ortlinancez antl state laws relating to builtling cons[ ction, antl hereby aul�orize repre- sentativez otj�� clty to en r h p�p ve-mentlonetl property for� insp¢CtiOn�T pose� � ///J � //9�� SignatureC //-- `� O [/-'V�X n ' Date Drivers' Licen or 55 �f ��- /^� �^+ TYPE OF CONSTRUCTION IlJ HEW � Aoo U n� ❑ CONVERSION ❑ DEMOLISH ❑ OTHER �.6 DESCRIPTION OF WOFK/USE OF BLDG. —,--- TVPE OP PERMIT LJ GRADING 'CJ FOINJDATION L_ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PIUMBING ❑ MECHANICAL � ❑ OTHEIi PROJECT DESCRIPTION Sp.FT. , OCCUPANCY CONSTRUCTIONTVPE V-'�� VALUATION$�Ib�- ZONE � GRADING CU.YDS. ACRES � Remarks: /nh n�.o � Sink <flow P.revencer cflow Irrigation king Fountains �r Drains rt Sinks Service �Outlets Kitchen Sink Lavatories P-Trap Roof Drains Service Sink SewerCaP . -- '�..- . Sewer Connection Solar Collecrors - Solar Pipin9 Solar.Tank � - � Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash ' FEES a.v. � �{ - S Main Building: TFront 3 � � ARear �� C Right /-f�� K Left I S Ping. Ref. # �j - Planning Notes: Construction Pole Sub. Gooking Unit �,. Dishwasher Dryers ❑Gas OElec Fne. r ' F.A.U. Fiztures ' Q Device Boxes ' ' � OutleLS ' . � `LO SwitCh¢5 � . Garbage Disposal � - �; Generator�00.5 KW ❑ Reinspection Fee $15 ' laue Fee a 3 . MECHANICAL FEE Duct-UnderGround Duct - S[rucwral • Duct � Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact BIL ICBO � Heating System & Ducting ❑0.100,000 BTU O100,0008T Hood or Typel ❑ Canopy Type I I O Retrigeration System . ❑a100,0008TU 0100,OOOBTU System Repair/Altera[ion Fire Dampers Registers Reinspec[ion Fee $75 � Issue Fee • $ 3 CMF 0865-46, rev. 30/84 White -- gulltling; Canary - Applitant; Pink - Atcounting; Goltlenrotl - Asseszor �3Gli.� . , i..-�/ � r r Accessory Building: Parking Req./Provided � r 1 y� ♦ u ELECTRICAL DEVELOPMENT SER VICES REQUI Zoning APProved By�� 9uilding AOProved By � —_—F. 2one � Z O N I N, �G (OS 1CYo Q M T. 5' Transformer Ll 15-50 KW ❑ 50�+:KW- _ Meter ❑up to 700 amp5 . Meter �over 100 amps Sub Panel f Motors �0-1 HP � 1'r5 - 8 Inc.Solar�09-15 HP �16-15- Microwave ' Pole Light Range Standing Sections Trash Compactor Issue Fee ' - '� SUMMARV OF FEES BUILDINGPERMIT- $ ._�io3—f^._ SMIP "Fjql_PLAN CHECK $ � PERMIT � '�PLUMBING� ', $ � �SSUANCE PLAN CHECK �25% $ �.il'�7 ENERGV P.C. ELECTRICAL $ GRADING PLAN CHECK , �50% .$ MICROFILM MECHANICAL ,$` TOTALFEE PLAN CHECK 25%' $ . � FEES $ 3 -w� � CONS'CRUCTION AND PLANNING � �.�1PPROVALS � Permit # : • 1.�Temporary Electrical Service or Pole • r. � 2, �$oil Pipe-llndrgrnd. 3. Electrical Conduit Utility-Undrgmd'. 4: Elec[rical Conduit-Undrgrnd. �5.�Steel Reinforcement 6. Electrical UFER Grnd. 7. Footings g: Foundation 9. Water Pipe-Undrgrnd. 10. Structural Floor System � �. 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. ?-Bar Ceiling (Structural) & Monocoat 27. Frame and Flashing 28. Lathing & Siding� I 29. Insulation ' 30.. Prywall Nailing 31. Plaster Brown Coat � 32: Electrical Power Meter-Final � 33. Final Electric 34. Final Heating & Air Contlitioning 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. .4andscape trrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING � 48. Special Requirements Completed q 49. Electric Release to Edison' � 50. Gas Release to Southern California Gas Co 51. CERTIFICAT.E OF OCCUPANCY . : Date Date � � � : � � � POO L & 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 Conduif-Undrgrnd. ' 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines, P-Trap, � Undrgrnd. 61. APPROVAL TO DECK ' 62. Backwash & Receptor-Final 63. Heater & Vent-Final 64. Plumbing System - Final �£ 65. Electrical-Final � 66. Solar System-Final 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT . APPROVALS Permit # � 70. Underground Hydro 71. Product Piping OGas ❑Oil 72. Underground Flush 73. U�dergmd. Stdrage Tank � Gas ❑ Oil �/ 74. Overhead Hydro 75. Dry Chemical (%!� � 76. Dry Standpipe (�v 77. FIXED SYSTEM FINAL �/ 78. FIRE PREV. FINAL �v HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: l,�p ' }^t-. � , 7 N.D �,/� a � Date jlnspecror �� CITY OP COSTA . Proje�t�Add�ess � . Applicant's Mailing Ownei's�N e �� Address 2 Arch/Eng. Address Contractor's Name{�� Address (mailing) _I. City LicenSe No. � LICENSED CONTR 1 her¢by aftirm Ihai with 5ection 7000) my Iicense is in fx11 HCTOR DECLARAT I am Ilcensetl untler I of �Ivision 3 of the n Applicant to fi11 in all spaces exeeoi those within neavy Doraer Iines anA si9n ail avP�opriate tleclarations. Date�((`1.��— Si9nature � �� 'LS WORkERS'COMPENSATION DECLARATION � herebya(firm that I have a certifi<ata of consen[ to selt-insure or a certlficate � ' Workers' Compensa't}io�n[ -Insuranca, or a certHletl copY thereot (SecUon � J00.-Lab. ��,�,^!T'J�� j I � Polity No. , w co any yn�y Certifie co y is hereby turnisnetl. A� Certif' y I}}iletl wlth Ihe city Bu tli DIvi510 DG ; ' pafe SZ APpllcant EXEMP 10 FROM WORKERS' COMPENSATION DECIARATION �This section neetl not be completetl if the permit is tor one huntlretl (5300) or less).- � � - I certity that In tne periormance of the work for which this permR is izsuetl I shall not emo�oy any person in any mannar so as to be<ome subject to t�e Worke�s' Compensdtion tdws of Calitomia. , . Date � Signature ' � 'NOTICE: If, atter making lhis tleclaration, you shoultl Gecome subject to the ' Workers' Compensalion proyisions ot [he Labor Cotle, you must for[hwitM1 compty .with such provliions or this oermit shall be tleemetl revoketl. � CONSTRUCTION LENDING AGENCV. � � ' _ I hereby atflrm thal tM1e�e Is a�conStruG[iOn I<ntling agency fo� the pertormdnc¢ of tbe work tor which this permlt is Issuetl,(Sectlon 309] Clv. C.) Lentler's Name ' � � Lentler's'Aatlre55 ' � � _ _ � OWPIER BUILDEN DECLARATION , ' � ' I hereby affirm�'that I am'exempt irom the Contractor's License Law for the . followin9 reason (Section 7031.5 Bu5ine55 antl Profes5ional COGe:'Any city or munty which �equir¢s d permlt to Const�uct, alter, improve, tlem011Sh o� repalr anv structure, prior to i[s'issuance, also requires the applicant tor such permit �Division 3 of tne Business antl Professions Cotle)'or that he she-Is exempt therefrom'and the basis Porthe allegetl exemption. Any-viola ion o( Section 7031.5 by any applicant for a' permit zubjects the Spplicant to a civll . �enally of not more than frve huntlretl tlollars (y500). LJ I, as' owner ot the• proparty �ormy employeos with wages as their sole � compensation, will tlo the work; antl the�structure is not intentletl or otferetl for sale (Section 7044, Buziness antl Professional Cotle: The Contractor's ' Littnse Law tloes not apply to an owner of a property who builtls or improves thereon, antl wM10 tloes such work hlms¢If/he�selt Or tM1�ouqh his or ner own ' employees, provitletl tha[ such Improv¢ment5 d/e not'Intentletl O/ otferetl-tor sale. It, howeveq the builtlin9 or improvement is soltl wi[hin one year of com- pletion, the owner will'�ave tha burtlen ot provin9 he/she tliC not bulltl or im- prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contractln9 with Iicensetl con- trac[or5to const�uct the project (SectiOn 7044, BuSiness antl P�ofes51on5 Cotle: The Contractor'S License Law does no[ dpPly to an owner of Oroperty who builtls or improves thereon, antl who contracts for such projects with a con- Vactor(st Ilcense pursuant to the ConVattor's License Law). I am aware that proof of lh¢ir Worker'S Compensalion insurance snoultl be provldetl to me. ❑ I am exempt untler Sectionr— 8. 6 P. C, for tnis reason Date ' I he•eby certify th A' information Is corre t I antl state Iaws relat n t senjatives ot tnis 't insoectlon purpose Signd[ur¢ Drivers' License or 55 qj Owner have rea� m TYPE OF CONSTRUCTION JQI NEW LJ ADD lJ ALTERATfON LJ REPAIR ❑ CONVERSION ❑ �EMQLISH ❑ OTHERy1 q.p.# DESCRIPTION OF WOFK/USE OF BLDG. 1� 1% . S Main Bu TVPE OF PERMIT GRAOINGp� FOUNDATION ' STRVCTVRAL T Front � � ❑ TENANT ❑ ELECTRICAL� �JC,]�t �PpLUMB/I�NG p❑�_ �M�,E/C� H,A,N'ICAL B Rear ❑ �OTHER � r1L(.�-ttV� . y,�l7�YALIAfY� A` PROJECT DESCRIPTION 5O. Fr. ' OCCUanrv v C Right CONSTRUCTION TVPE - VALUATION $ �O�J ��'e% g Lef[ ZONE � GRADING CU. VDS. _ ACRES p�ng. Ref. # Remarks: , � Planning No� BarSink � Backflow Prevente Backflow Irrigatio�� Bathtubs � � Clarifiers , Dishwasher i Floor Drains Floor Sinks-� � - � � Gas Service Outlets� � Intercepmrs; r �. - , Kitchen Sink' � . - Lavatories,.,� � � P-Trap ' Roof Drains � � Reinspection F.ee .$15 Boiler Duct � Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple_0 Firepl/Fact. Blt. ICBO # Heating System & Ducting Oaioo,000'eru Oioo,000er� i Reinspeetion Fee $75 CMF 0865-46, rev. 10/84 White - Builtling; Canary - ApPliwnt; Plnk - Accounting; Goldenrotl - Assezsor �¢NiC¢ JinK " Sewer Cap Sewer Connection Solar Collettors Solar Tank Swimming Pool w/Spa Urinal � Water Closet Water'Heater , ' Water Service � Auto-Wash , � ' „� . FEES laue Fee � $ 3 iANICAL � FEE Hood or Typel ❑ ' � Canopy Typell ❑ , . Refrigeration SVstem ❑0-100,000 BTU ❑100,000 BTU - System Repair/Alteration Fire Dempers ' � Registers , � '� laue Fee � $ 3 Automatic Washer Construction Pole Cooking Unit Dryers LJGas LJEI Fan F.A;U. Fixtures ' Device eoxes Outlets Switches Garbage Disposal Generator �0-5 KW G _ 112@ 4/15/85. ' .17037, . : Zana • Accessory Building: 2 O , N I - N . G R Parking Req./Provided - E Q = M � T S ELECTRICAL Transtormer ❑ 15-50 KW , ❑ 50+KW Meter ❑up to 100 amps Meter ❑Over100amps. ' Sub Panel Motors�0-1 HP�1h-8 Inc.Solar �9-15 HP �16-15+ Microwave • � Pole�Light ; ai9n i ; Standing Sections 5-15 KW Trash Compactor I i � Reinspactian Fee �$16 � � luue Fea, DEVELOPMENTSERVICESFEQUIREMENTS: 2oning Approved By ' ' Building Approved By _ ' _ _ i� FEES $ 1 � � SUMMAq'9 OF FEES • � BUILDING PERMIT, $ SMIP $ ' PLAN CHECK $ PERMIT : - PLUMBWG $ � ••�C7 ��UANCE $ PLAN CHECK 25% $ Z•Q� �I ENERGV P.C. $ EIECTRICAL $ � GRADING $ PLANCHECK 50% $ � MICROFILM $ � MECHANICAL $ � TOTAL FEE $ ��_ 3.� PLAN CHECK 25% $ ' � � CONSTRU,CTION AND PLANNING � POOL a SPA ApPR¢VALS Permit # Date Inspector qppROVALS Permit # Date Ins�ecmr 1. Temporary Elecirical Service or Pole- 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement _ 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. E�ectrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test - 6. Elettrical 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. APPROVALTO DECK 1�1. 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 P�ASTERING 18., Rough Electrir,al-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. Duczs, Ventilating 71. Product Piping O Gas ❑ Oil .23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame�and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Iqsulation 78. FIRE PREV. FINAL 3Q. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: � 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final � 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer • 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FfNALSTRUCTURE&BUILDIfVG 48. Speciel Requirements Co.mpleted 49. Electric Release to Edison � �- 50. Gas Release to Southern California Gas Co 51. CER7IFICATE OF OCCUPANCY � �n. Date �- Aop�icant to fill in atl soaees exceo� inose wilnin heavy bortler Ilnes an0 sign all appropriata tleclarations. r7Y OF COSTA nn SA CO� �STR C�'Tl,,IONj-P'ERM/I�T..�.� . �roje�SAddress �� `�" ' ��T�, `� ` �"? .�qpolicanYs Mailing Ad�ress ' ' Owner's Name ' ✓ S E� hone _ Address . Arch/Eng. __ License No. - Address ' � - � Contractor'sNameB��SGF�E �2EG7X/G Phone�� Address(mailingl � S. G'� s. d-7o City License No. ___Qa-% � / UCENSED CONTRACTOR DECLARATION ' ' � 1 hereby atfirm that 1, am Ilcensea untler provlsions ot Charter 9(mmmencin9 wllh section 7000) o( Division 3 ot the Buslness antl Professions Cotle, antl my license is in full /fOf• ce antl eftecL . ' L:iUn CI s� 1..� ��U �} LlcejKqf�.�� ' Date ��/�%J�- 59 I _C..�, �J'/��3'�a"�10� WORKERS' COMPENSATION DECLARATION I hereby afflrm that I have a certifi<ate oi content to self-insure or a certificate , ot Workers' Compensation Inzurance, or.a certifietl copY thereof (Sectlon _ 3800, Lab. C.) rou�v rvo./�/G�7L"�i3S 00/GY/comcany i}�oNAr-!T Certitietl copy is hereby furnisnetl. Da(eerfi�tl cpp is iletl wl�tP�hCd^`y Br�ItlI/ig OlvLslqw�� if � a/L/,�Z[.��.1 ' EXEMPTION FROM W00.KER5' COMPENSATION CLARATION ,(ThIS 5¢ctlon need not be com0�etetl If the pe�mit I5 for one huntlretl ($100) or less). ' ' � � • . I certify that In the performance of the work for which this perm�t is issuetl, I ' shall not employ any person in any manner so as to become suCject to the Workers' Compensation Laws of California. . . Da[e� Si9nature 'NOl'ICE: If, after making this tleclaraHon, you shoultl become subject to the Workers' Compen5ation provisions of the Labor Cotle,.you must forthwith comply wiM sucn provision5 or this p¢rmlt shall be �Oeemetl �evoketl. CONSTRUCTION LENDING AGENCV • ' I hereby afOrm that there is a construction'lentling a9ency tor the pertormance of the work for icn this ermit i Issuetl (Section 309� Civ. C.). LenEer's Name - � ��- �l%�� ' � �enqer'sAatlress� ��o7d ��.U/LS/%7�,r Vf�� OWNER BUIL�ER DECLARATION - � ' I hereby afBrm'[hat I am exempt trom the�Contractor's License Law for the followin9 reason (Section ]031.5 Buslneis and'Professional Cotle: Any city or � COunty which �epuires a pe�miYto ConStruct, alte�, improve, tlemolish or repair - any structure, prior to its �issuance, also requlres lhe applicant for such permit , � to (iie a si9netl statement that ne/she is Iicensetl pursuant to the provisions af the ContraGtor'S License Law (Chap[et 9.(commencing with Section ]000) o/ Division 3 ot the Business antl Professions Cotle) or that he/she'�is exempt � the�e(rom antl fhe basis for [he allegetl exemptiOn. Anyviolation'of $ection 7031.5 by any ap0�icant to� a permR Subjects the-aOP��cant to a civil �enalty of not more than (�ve huntlretl tlollars (E500). . I, �as owner ot the.property Or my�employee5 with wages.as their sole �compensation, wil( tlo the work, antl the structure is not intentletl or offeretl for sale'(Se<tion ]044, Business antl Professional Cotle: The Contractor's � License Law tloes not aOPly to an owner of a property who builtlz or improves Ihereon,'antl who tloes SUGh work hlm5el(/he�self o� through his or he� own � employees, providetl that sudh improvements are nof intentletl or offeretl tor , sale. It, bowever, the builtling or improvement is soltl within one year of com- pleilon, tne owner wi11 have the burtlen of proving he/she tlitl not builtl or im- '� �Ove for the pu�pose ot sale�. 1, x5 Owne� ot the property, am exCluSlvely cont�actiny wi[h�licensetl con- tractors to construct the project (Sectlon 7044, Business antl Professions Cotle: � The Contrac[o�'s Litense Law tloe5 n0[ appry to an owner of property who builtls or imo�oves tnereon, an� w0o'mntratts tor'zucn projecfs wifh a ton- tractor( I ❑cenie Oursuant�to the GonVattor'S License Law). I am aware Mat � Ip�roof of their Worker's Compen5ation inw�ance shoultl be provitletl to�ma. y� I am exempt untler Sectlon 8. & P. C. tor this reason 'Date ' � Owner' � '1 nereby certify that I�.have reatl'this applicatlon antl state that the above intorma[ion is wrrecL I.agree to comply wltn all city antl county ortlinances antl state laws relatin9 to builtling constructlon, antl hereby authorize repre- suntatives Of th,'{s city �to enter upOn the above-mentionetl O�oDerty foi inspection purpq6e,��e.,//� Slqnature L,f il�l,�.r� . '� � once S�K B� Drivers' License or S� �'� `�� «,� 2.� � • � � � - TVPE OFCONSTRUCTION !� NEW ADD ALTERAT16N REPAIR - ❑ CONVERSION ❑ DEMOLISH ❑ OTHE " DESCRIPTION OF WORK/USE OF BLDG. �%�'�TM£�% A P� ' � . - S Main Building: TYPEOFPERMIT ❑ GRADWG � FOVNDATION STRVGTURAL T FrOnt ❑ TENFNT �ELECTRICAL ❑ PLVMBING ❑ MECHANICAL B Rear "❑ �OTHER � � ' A PROJECT DESCRIPTION. 5Q. FT. ' oCCUaANCY C Right K Left � CONSTRUCTIONTVPE � � -VALUATION$ ' S . � ZONE - � GRADING CU. VDS. ACRES p�ng. Ref. # Remarks: � _ � ! �n � � � , � Planning Notes: Bar Sink Backflow-Preventer Backflow Irrigation Clerifiers � Dishwasher � Drinking Fountains - Floor Dreins' Floor Sinks ' � Gas Service Outlets Kitchen Sink - ' - � Lavatories � ' . '-Trap Roof Drains �- �� Reinspection-Fee `� �$15 nouer Duct`'Under Ground , Duct - Strucmrel DuLt - Ventilating ExhaustSystem � MWtiple Firepl/Fact Blt. ICBO # � Heating System & Ducting I � ai oo,000 aru � i oo,000 $howers Service Sink ' SewerCap Sewer Connection Solar Collecrors , Solar Tank � Swimming Pool w/Spa � Urinal - Water Closet ' Water�Heater Water�Service Auto-Wash - Laundry Trays • Issue Fee IANICAL Hood or Typel ❑ Canopy Typell ❑ � Refrigeration System _ ❑aioo,000eru Oioo,000eT ] System Repair/Aiteration Fire Dampers � Fe9isters ' Reinspection Fee � $16 �� Issue CMF OB65-46, rev. 10/84 Wnite - Bullding; Canary - Applicant: Pink - Accounting: Goltlenrotl - Assessor $ 3 Automatic Washer . Construction Pole Sub. 'Cooking Unit Dishwasher • Dryers ❑Gas' �Elec' Fan 2841 5/ 1.3/85 Accessory Building: �. Parking Req./Providec I ELECTRICAL � Transformer 280050 TL Zone • — Z O N _ ' N G - R � - � E Q M ' T S FEES u ie-so Ku ❑ 50+ KW Meter C�4up to 100 amps ` Meter ❑over 100 amps - (j � ' Sub Panel' - � �Motors 061 HP �1'h - B Ina Solar �9-75 HP 016-15+ � !� �Fiztures ' Device Boxes Outlets Switches Gar6ag¢ Dispoul Generator �0.5 KW OS75 KW Fee Microwave � i Pole Light 'Range � 3J�j(J � Sign ; Standing Sections a Trash Compactor � • i luue' Fee $ 3 DEVELOPMENTSERVICESREQUIREMENTS:� , ' � Zoning Approved By Date Buildin9 Approved By Date Appliration Issued By � Dat .� � ' . SUMMARV OF FEES � ' BUILDING PERMIT ,$ � SMIP, �$ PLAN CHECK . $ PERMIT i PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAI�'�. $r� GRADING $ � PLANCHECK �f'� '"� MICROPILM $ � MECHANICAL $ ' TO7ALFEE $ � PLAN CHECK 25% $ � ' � ,'Zi3l�l_ S71 , 'I� CbNSTRUCTION AND PLANNING � POOL & SPA -" i 'A�PROVALS Permit# Date Inspector APPROVALS Pe�mit# Date Inspecmr a.�TemForary Electrical Service or Pole ��r 52. Pool & Equipment Location 2. �Soil Pipe-Undrgrnd. �, >� 53. Steel Reinforcement � 3. Electrical Conduit UtilitY-Undrgrnd. . 54. Focros 4. E�ectrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Elsctrical UFER Grnd. � � 57. APPROVAL TO COVER-GUNITE 7. Foptings � ' � 58. Electrical Conduit-Undrgmd. - 8.� Foundation �� 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. • � 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Struciural 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 .i 14. Rough Plumbing . 65. Electrical-Final - ' 15. Rough Electriral-Conduit 66. Solar System-final 1,6. ,Rough EleclriaWiring ��3 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. REnUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating . 71. Product Piping �Gas ❑OiV 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-B2r Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe � 28. Latfiing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31,-. Plasier Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final . � 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning ' � 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final � � 40. Gas Service-Final 41. Solar pomesticFi�al � � •. 42. Backflow Preventer r 43. Backflow Irrigation - � 44. .Landscape Irrigation SYstem 45. Sound Attenuation 46. Handicap Regulations � 47. FINALSTRUCTURE & BUILDING 4g. SRec�al Requirements Completed � ; �� 49. Electrie Release to Edison � . 50. Gas Release to Southern California Gas Cv , _ , 51. CERTIFICATE OF OCCUPANCY � No. ' Date � . � AVP�ieant to fill in al1 s0aces except those within heavy eorOer Iines ana si9n all avVropriate Eeclarations. 'OF COSTA MESA � $FRUCTION PE_RMIT Project Addreis �-- i5b/ W 17 �Ltt JLtcC�l _:- - Applicant's Mailing•Address' Zlzl S. '(�F�1ND AVE. ' owner's Name DIVERSIFIED PRQIEGIS Phone 76�3453 nddreu 23201 LA[� CFNrER DRIVE FR TORO " Arch/Eng. LicenseNo. �� Address Contractor's Nam hone 957�991 Address Imailingl --_ S. GRAND AVE. SANCA ANA City.LicPnse No. 1 LICENSED CONTRHCTOR DECLARATI ' I hereby aftirm that i am iicensetl untle ovi5ions of Char[er 9(commencing wlth section 7000) 01 Dlvision 3 of t Bu ness ntl Pro(essions Cotle, antl my Iicense is in full (oYce antl��ct. 5194 . License Class � Date 'S/1 /RS Signature � � WORKERS' COMPENSATION OE RATION i I hereby affirm that I have a certifi te o/ consent to Iftinsure or a certlticate � of Workers' Compen�tion Insuran<e,. o' cerUfled� copy-thereoT {Sectlon 3800, Lab. C . PoIItY No. ��l��l�� Co any F ��.ly -C�¢rtifietl copy is hp�¢by fumishetl. 1�(�eYlif c is fiietl with the city Iltli iv ' • Date ��— APPlicant _ E%EMPTION FROM WORKERS'GO PENSA ION�DE ARAT ON - (This sectlon neetl not be completetl i tne permit Is for o huntlretl (5100) or less): . � . � I certify that in the p¢rtormanca of the work tor,which this perm�t is issuetl I shall. not employ any person in any manner so•as to betome subject [o't�e Workers' Com ensati0n' Laws of Califomia. � . � . ' Date _�� Si9nature ' ' NOTICE: If, after ma4ing this tleclaration, you 5hould become subject to lhe . Workers' Compensa[ion provisions of tne' Labor CoCe, you must forthwi[h cOmply 'wlth� Su<h , p�ovi5ion5_ Or th15 ,perTit' shall be, tleemeA revoketl. CONSTRUCTION; LpfiDING AGENGY 1 nereby afflrm Ihat there is a wnitruction Ientling agency tOr the pertormance of the work for 'Whith. this Dermil �is' Issuetl .(Section .309], Civ, CJ Lentle�'S Namn , Lentler'S Atltlress� ' � OWNER BUILDER �ECLARATION ' - '- ' I hereby afflrm'�that 1 am exempt trom the Contractor's License L.aw for the tollowing reason (Section ]031.5'Business antl Professlonal Cotle: Any city or countv whicb requires a oe�mit to const�uct, alter, ImD�ove. tlemOlish ocrepair 0 b I,.as owner of the� property'or� my employee5.wifh wa9es as their iole cortlp¢nsalion, will tlp tlte wOrk, antl lh¢ zt�uctu�e i5 not in[entletl o� offeretl for sale (Sectlon ]044, gusiness antl Profe55ional Cotle: The Contractor's LlcenSe Law tloez not apply to an owne/ of a Oroperty who builtls or improve5 [hereon, antl who tlUeS such work hiTselt/h¢rs¢If o� lhrough hI5 or he� own � employees, D�ovitl<tl that such improvements a�e pOt In[entletl o� offer¢tl fo� � zale. If, howeveq Ihe bWltlin9 or improvemanf iz sOltl wlthin ane year of cOm- pletion, the owner will have the burtlen o( provin9 he/she tlitl not Euiltl or im- �rove./0/ the purpo50 of sale). I, d5 owner O( thg p�operty, am exclusivaly Contracting with Iicensetl con- tractors lo construct the projecf (Section ]044, Business antl Prof¢ssions Cotla: . The ConVactor's LlCense Law does�not ap01y to an owner ot�property who builtls or improves [hereon, antl who contracts for such proje<ts with a con- tractor(s) Iicense purguant to the Contractor'S Liconse Law). ❑ I am exempt untler Section B. & P. C. for tM1is reason IJate. Owner � , I hereby certit at I have reatl this apv�iwtlon antl state that the above intOtmation is eG{, �agre o Comply wlth all clty-antl counry ortlinan<es ' �antl state laws atin to b c structlon, antl �hereby authorize repre- sentatives of is q to the above-mentionetl property for inspection vur ��y:} , . � V Signature Drivers' Ltc u or 55 � _ CMF-OB65-46rev.7/83 White-Builtlin9:Canary TVPE OF CONSTRUCTIOR .�i" NEW U ADD LJ ALTERATION LJ`REPAIR �O CONVERSION ❑ pEMOL:SH ❑ OTHER q,p, # DESCRIPT�ON OF WORK _ - ' � S� Main Building: E TYPEOFPERMIT GRADING FOUNDATION STRUCTURAL T Front � ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING �ECHANICAL , A qeaf ' ❑ �OTHER . C Right PROJECT DESCRIPTION Sa.F7. - oCCUPANCv K CONSTRUCTIONTYPE VAWATION$ ' ,g Left ZONE ' GRA�ING CU. VOS. ACRES p�ng. Ref. # aemarks: gp18037 � ' � Parking Req./Provided . _ - � ' Use of Building: � PLUMBING . ' � FEES Planning Notes: Bar Sink • Showers , . ' � . :ilaw_ rreyenter '.flow Irrigation ' LLIbS ' fiers ' i wasRer � � . - '" � king Fountains i . v Drains . • rt Sinks ' Service _Outlets � �ceptors� . hen Sink itories ' ' ' ran . . _ _ Reinspaction Fee $25 Boiler ' ' �. DucC- Under Ground Duct - Structural ' Duct - Ventilating � Exhaust System ❑ Multiple ❑ Firepl/Fact.'BIt. ICBO # Heating System & Ducting C'�0�100,000 BTU 0100,0006T II Reinsqeetion Fee I =Accountin9;Galtlenrotl-Assessor— - - $25 Sewer Connection Solar Collectors Solar Piping � Solar Tank , Swimming Pool wi Urinal Water Closet� Water Heater �.Water Service - . laue Fee $.3 Hood or Typel ❑ ' ', Canopy Typell ❑ � Refrigeration System - �aioo,000aTu ❑ioo,000ei System Repair/Alteration - Issue Fee 0 t $ 3 Washer Cooking Unit � � Dishwasher � � Fan F.A.U. • Fixtures Device Boxes � Outlets Switches . _ _ 3721 5/29/85 . Zone Accessory Building: Park.Fees $ . •� ELECTRICAL • �� ;Tronsformer ❑ 15-50 KW ' � ❑ 50+KW "` "� Meter'�up ro 100 amps '.' ' Meter ❑over 100 amps , � Sub Panel Motors O0.1 HP � 1 X- 8 � + �InaSolar��9-15 HP �76-15+ � Microwave • � 0 Generator �0.5 KW �5-15 KW Range � Si9n S[anding Section5 Trash Compactor u � � 6�oQu -Tl F 2 O N 1 N G R � E Q . U I R E ' M E N T I Reinspection Fee I$25 �- �ssue Fee • I $ 3 I PUBLIC SERVICES REQUIREMENTS: Zoning Approvod By Date APPlication APProved BY Data �Appliration Issued By �%'� Date .��`7/�.� � SUMMARV OF FEES � BUILDING PERMIT $ SMIP $ � PLAN CHECK $ PFRMIT i . � PLUMBING ,$ 'ISSUANCE $ . P�AN CHECK $ ' ENERGV P.C. $ ' ' ELECTR7CAL $ GRADING $ PLANCHECK $ MICROFILM $ � � MECHANICAL $ • Q� TOTAL FEE $ �K. . PLANCHECK $ /n�•UJ . . � , . . . . . , �� CONSTRUCTION AND PLANNING' � � � ' POOL & SPA , � APPROVALS Permit# _ ' � Date �Inspector -qppROVALS� Permit# Date Inspector ' , _ `i. Temporary Electrical Service:or Pole .� � . 52. Pool & Equipment Location- � � 2. Soil Pipe-Undrgmd. " ' _ . �. - - � 53. Steel' Reinforcement � . ` 3. Electric2UConduit 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, � Undrgmd. � 10. Structural Floor System ty ' 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 Wir�ing Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling , � , . 69. POOL/SPA S,YSTEMS FINAL 19. Rough Heating & Air Conditioning i FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace � , � APPROVALS Permit # . � i 21. bucts, 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. Undergmd.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 &$iding � 77. FIXED SYSTEM FINAL 29. Insulation 78, FIRE PREV. FINAL 30. �rywall Nailing - , . HEALTH DEPT. REQUIREMENT � � 31. Plaster Brown Coat � . � � 79. FINAL INSPECTION 32. Electrical Power�Meter-Final � 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: -r 34. Final Heating & Air Conditioning� 'c�/ �S ' L� ' 35. Final Gas Pipe-Test ' � � � � ' + - 36. Hood or Canopy . � • � 37. Final Factory Fireplace ' � � - 38. Final Plumbing � . 39. Water Service-Final � � � � � 40. Gas Service,Final ' • � ' 41. Solar pomesticFinal ' , _ _ . . 42. Backflow Preventer � . � � 43. Backflow Irrigation ' , � ' � - , � 44. .Landscape irrigation System � � � � 45. Sound-Attenuation . ' 46. Handicap Regulations ' , � 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed , � � � � - 49. Electric Release td Edison -, - - � --- - � � � 50. Gas Release to Southern Califomia Gas Co ' ' . � 51. CERTIFICATE.OF OCCUPANCY • No. Date � � , ' ApPlicant to fill in ail spaces except Ihose within heavY borGer iines antl sign all aDP/opriate Eoela�ations. '� aTA MESA CONSTRUCTION PERMIT PE MIT NO. ; ' �TRACT NO. LOT NO. UNII' N6. . '. �'.:` s�o7 � � � �a�ir, ��- �•- ., . 3� - Nw Gc�i oj ct'Address . r- '� • '��'.�- =�� C�p'�(T(1� �l`, TYPEOFCONSTRUC710N NEW ' ADD ALTERATION REPAIR I . ApplicanCs Mailing Address�p �j� � ' M�A l!\�a� ��" � CONVERSION� O DEMOLISH ❑ OTF�R` � q p# 1,{,n� 1_ Owner's Name Phone 7�y'�� pESCRIPTION OF WORK/USE OF BLDG 15 �� aC;� Address �-� �� ' / A � i S Main Building: Arch/Eng.� '� 2� � ��' � N icense No.� TVPE OF PERMIT� _GRADiNG ❑ oUNDATIOrv STRVCTURA� T Front '� 3 Address c� ❑ ,OTHERT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL � � A Rear �• Contracmr's NamP v�V �^5�� t Phone 76�-3¢S-?. '. - -� . - - C Right j � � Address (mailin 1�� `�` `A�1 CE�'�.� �{�: � S2.a j PROJECT DESCRIPTION SQ. F1T'. OCCUPANCV —� K 9 � � CONSTRVCTIONTVPE y�� VAWATION$�O�IF�iO� g Left I� �. City License No. , � LICENSED CONTRACTOR DECLARATION ' I hereby at(irm that 1 am licensetl untler provi5ion5 0( Charte� 9(mmmencing with section �000) ot Division 3 0( the Business antl P�Of¢ssions Cotle, antl � my license is in ! force antl etfect. ILicense las �—� "`� License No. �-3 � 0 9 I Oate��) Signature YORKERS' COMPENSATION DECLARATI N , hereby affirm that I M1ave a certificate of consent to self-Insure or a certificate of Workers' Compensat(i;on Insurance, o� a certi(iertl_mpy thereof (Section 3800. Lab. ��, I � _I ' '• ,. " K�l.� C^mb� � � PolicY No. �� GomPanY `." � 8 Certifietl mpy is �ereby furnistietl: '` ' �, Certit' c y is filetl with the City�Buila 9 ivi Date APPIi<ant. �' p �� n 1 EXEMPTI N FROM WORKERS' COMPENSATION DE FRATION (This section neetl not be completetl it the permit is for one huntlretl (E100) or Iess). ' � � ' I certily that in the pe�formance of the wo�k for which this p¢rmk is issuetl, I, shall not employ any person in any manner so'as to become subject to the �� Wo�ke�s'. Compensation Laws of California. . - . Date Si9nature ' �NOTICE: It, atter making fhis tleclaiation,-you shoultl become subject to the � Wo�ke�s' Compensation provlsions of Ihe Labor Cotle, you mu5t �orthwith compty with such p�ovisions or 'Ihis Oe�mit , Shall b¢ tleemetl �evoketl. CONSTRUCTION�LENDING AGENCV ' I hereby affirm that tnere is a-ronstruction lentling a9ency for the performance of the work for whith this permit is issuetl (Section 309] Civ. C.) LRnCer's. Name Lentler's Atltlress ' .. . OWNER BUILDER DECIARATION ' 1 her¢by af(irm that I am exemp[ from the Cont�actor's�License Law for the followin9 reason (Section ]031.5 6usiness antl Protessional Cotle: Any city or county wbich requires a pe�mit to const�uct, alter, improve, tlemolisM1 o� repai� any structure, prior to its issuance, also requires the appli<ant for such permit to file a signetl statement that he/she is licensetl-pursuant to the provisions of tne Contractot's License Law (Chapter 9(commencin9 with Section 7000) of � Division 3 of the Business antl Pro(essions Cotle) or tha[ h¢/she is exempt therefrom'antl the basis for the allegetl exemption. AnY violation of Section 7031.5 by any applicant for a permit subjeccs tM1e appllcant to a civil �enalty of'not more Ihan five huntlretl tlollars ($500). - LJ I, as' owner ot the. property �or my emoloyees with wages as their sole � compensation, will tlo the work, antl the structure is no[ intentletl or otferetl for sale• (Section �044, Business anG Professional Cotle: The Contractor'S License Law tloes not apply to an owne� ot a prope/ty who builtls o� improves thereon, antl who tloes such work himselt/herself or throu9h his or her own ' employees, providetl that such'improvements are not intentletl or ofte�etl tor sdle. If, however, the builtlin9 or Improvement is soltl within one year of mm- pleHon, the ownen will have the burtlen of proving he/she tlitl mt buila or im- prove for the purpose of sale). . ❑ I, a5 owner of the p�operty, am exclusively cont�a[ting with licensetl con- traGto�s t0 construct the project (Section ]044, Busine55 antl Professions Cotle: The Contractor'z License Law tloes not appiy to an bwner oi property who bulltls or irnproves Ihereon. antl wM1o.conVacfs for such prolects witM1.a con- tractor(sl license pursuant to tM1e�Contractor's License Law). 1 am aware that � proof of their Wo�ker's Compen5ation insurance shoultl be providetl to me. •� I am exempt untler Section B. & P. C. for this reason Da[e Ownen I have rea I agree to to builtlir � to ent,er inspection puG(Joses./ Signature' L' i" �rivers' License or 55 � {Eqg55-45, rev. 30/B4 � icatiOn antl.state that the above th all city antl county Ortlinances :io�np, yagnd her¢by authorize repre- ,� o -mentionetl property tor // (l Y�� Da[ 3 //9/d1 Remarks: Bar Sink . 8ackflow Preventer . Backflow Irrigation Bathtuhs Clarifiers � � Dishwasher � Drinking Fountains Floor Drains � Floor Sinks � ' Gas Service Outlets Interceotors Lavatories P-Trap Roof Drains Reinspection Fee �— GRADINGCU.VDS. ACRES— �� / id PLUM8ING Showers�" . - . Service Sink SeJaei.Cap .- ' . _ •�,�... Sewer.Connection � � •'' Solar Collectors - ' • - Solar_Pipin9 � ' „ , $15 Boiler - Duct - Under. Ground Duct - Structurel Duct � Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑ 0.100,000 BTU � 100,000 e Bulitling�; Canary - Applicant: Vink - Accounting;�Goltlenrotl - Assessor SolarTank • Swimming Paol Urinal Water Closet Water Heater WaterService � Auto-Wash �Laundrv Trovs laue Fee Hood or - Typel ❑ ' Canopy Typell ❑ , Refrigeration System ❑0-100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers � Registers � laue Fee . ,i-N_`. .1='E- $ 3 Ping. Ref. # 'Z Planning Notes: Automatic Washer Con,struction Pole'Sub. Cookin9 Unit 1. Dishwasher ' Dryers ❑Gas �Elec Fan' . F.A.U. . " Fixtures -�- Device Baxes �/. ' J�,�.y�r7-� :. �r�4.: .7� ��/%j(/� I^� f-.... _ � ~. L:' ' -� '. . � Accessory Buildin9: Parkiog Req./Provided � ' . � ELECTRICAL � ' ,Transformer '0 15-50 KW ❑ 50,+.KW Meter ❑upto100amps��, � Merer ❑over 100 amps > J Sub Panel • _ ,,,� i MotOrs OO-1 HP Oi;f.�- B'� InaSolar.�9-15 HP�016-75+ Switches Garbage Disposal • Generator �0.5 KW �5-15 KW Pole Light Range Sign ; Standing Sections Trash Compactor Reinspection Fea �$15 � � Issue Fee /ELOPMENT SERVICES REQUIREMENTS;. 1 Zoning Approved By_ Building Approved By Aooliption laued Bv_ Z O N I N G R E 0 M T S FEES '� i Y $ 3 . '�- � SUMMARV OF FEES �� c BUILDINGPERMIT $ � Q�� SMIP : $ �-J.�`.2 �(, PLAN CHECK $ ��, ��'� PERMIT . PLUMBING $ � .ISSUANCE � $ ' PLAN CHECK 25% $ l�iO� ENERGV P.C. $� ELECTRICAL ' $ GRADING � $ PLANCHECK 50°� $ MICROFI�M $ MECHANICAL $ ' TOTALFEE $ � PLAN CHECK 25% $ , �?jC�.Q _ Q� . f' 1 , 1.STRUi.TION AND PLANNING �PPROVA�LS � Permit # Date Temporary Electrical Service or Pole 2: ;?oil Pipe�Undrgrnd. '�3. Elec[rical Conduit Utility-Undrgrnd. 4 �Electric8l Conduit-Undrgrnd. �5. Steel�Rsinforcement 6� Electrical UFER Grnd. � � �7. Footings • � 8: Foundation 9. Water Pipe-Undrgrnd. 10. Structural Floor System � i t. Property Sewer Line & House Connection . �7� Sewer Cap 13. Roof Dreins � -y 14. Rough Plumbing 15. Rough Electrical-Conduit 16. Rough Electric Wiring 17. Rough Wiring Sign 18.�Rough.Electrical-T Bar Ceiling 19. Rough Neating & Air Conditioning 20.. fiough Factory Fireplace 21. Ducts, in Structure . 22. Ducts, Ventilating 23. Gas Pipe-Rough & Test .24. Roof Framing . 25. Roof Sheathing s� 3� al� 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 Ga� P�Pe-Test 36. Hood or Canopy 37. Final FaGtory Fireplace 38. Final Plumbing . 39. Water Service-Final 40. Gas Service-Final - 41. Solar pomestic-Final 42. Backflow Preventer �. 43. 8ack51ow Irrigation � 44. .Landscape Irrigation System . 45. Sound Attenuation , r46. Handicap Regulations � �47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed ' 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERT�FICAT OF OCCUPANC,� No. � i Date �� 0 �i� r�r� POOL & SPA Inspector qppROVALS Permit # 52. Pool & Equipment Location (.� " 53. Steel Reinforcement . . � 54. Forms . 55. Electrical Bonding 56. Rough Plumbing & Pressure Test (�tJ�Fi 57. APPROVAL TO COVER-GUNITE (,�jyr. � 58. Electrical Conduif=Undrgrnd. v�/ 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 System - Final �u] 65. Electrical�Final 66. Solar System-Final 67. Fencing & Access Approval , 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # �L v� VC� (�/ C � 70. Underground Hydro 71. Product Piping O Gas ❑ Oil 72. Underground Flush 73. Undergrnd. Storage,Tank O Gas ❑ Oil 74. Overhead Hydro 75. Ory Chemical 76. Dry Standpipe 77. FIXEO SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: . _ w i . �?.( ,6 Ia Date � I �� AVV��ant to llll In al1 soaeas excapt those withln heavy boraer Ilnas ana sign all aDVroOriate tlaclarations. GTV O.f COSTA'MESA CONSTRUCTION PERMIT _ PEPMIT NO. i ; I - -TRACT NO. ' LOT NO. , UNIT N6. ' . � , . T � � , . , . ' ' � ' � �ProlectAddress �.� � ' - . ��' �/G'� � ` ' . . ' �. 0243� 3/2B/pfi ; ' 25:c� �L� APPlitanl'S NUilin Addre55 ZPZ� � 7VPE OF CONS7RUCTIOM 1VEW F10D ALTERATfON •REPAIR � '� 9 ' � "� ❑'CONVERSION ❑ DEM LISH ❑ OTHER' � q,p,.�6 , � - ' _ - � - ' ZonO - � Owner's Namo '� Phone�r�xT DESCRIPTION OF WORK/USE OF'9LDG. � � Addr¢ss 2%7s � L a� �'-��. F' � �'H' 'j,�->> ��^�^�✓d . " ' ' ' ' ' _ S Main Buildin9: ' � Accessory Building: ' � . � - � ' Arch/Eng. �LicenSe NO. � TVPE OF PERMIT GRA�ING� FOUNDATION STRVCTURAI T Front - .�" ' � � ❑ TENANT �Q-EL RICAL ❑�PLV G O MECHANICAL � • 8' , - - , ry Address � y �' � , A Rear . _ � • . �I Contfector'SName' hone�/'�J � �THER _�J'u'�� IE:�Lr� C Right � � � _ � N Address (mailing) 27� � L�2.E (�e-- �- �^ . � �'^� .0 /i'T'7r✓fJ PROJECT DESCRIPTION � 5�. FT. ' nrr��onn�ry K , .. G _ �r' . �CONSTRVCTIONTYPE VALUATIONS g Left _ � " . . . R i City Licen3e No_ ' � � 7.ONE ' GRADING CU. VDS. ACRES � . ' ' . ' LIC�NSED CONTRACTOR DECLA0.ATION •Plny, R¢f. � Parking Req.lProvided � E I hereby'affirm tnat I am Ilcensetl untlar provisions oi Charter 9(commentlng qemarks: � � ' � - Planning Notes: ' ''� � ' M wlth section ]000) oi Division 3 oi tne Businezs antl Professions Cotlo, antl 1 _ T my Iicenze is In futl force ana eife<L Z� - O � � � S � � IJcenze flass Litens¢� o. � v PLUMBING FEES. Date�l �B�'� : c'o ai � 11 /l � I � ' � • � � ' ' � VOqKERS'COMPENSATION,DECLA BarSink � ' Showers ' � , ner¢by aHirm that I ha've a certificate oi consent to selt-Inzure or a urti(Icate i ' ELECTRICAL �FEES of Worker5' Compensation Insurance, or a certifietl coOY thereot (Settlon gaCk(IowPreventei � ServiCeSink - .�.. � ' , . 3800, �Lab. CJ — • - - - Automacic Washer - - --- Transformer �-75-50 KW -- --- — �Poli�yNo. �� Company �� Backflowlrrigation � $¢werCa . ' ❑50+KW � P . Construction Pole Sub, � Certifietl copy is hereby fumis�e0. �1 � ^ � . ' . . � � tif tl c y' tetl with the CitY Buil Ivi on. 11 Batbtubs � Sewer Connection Cooking Unii . Meter �up ro�100amps• ; , Date' � APPlicant ' \ � X. . . . i EXQMPT ON ROM W00.KER5' COMP SH GCRRXTTf7T!' ' Clarifie�5 � SOlar ColleCtOrs � Dishwasher Mete� ❑over 100 amps � (This section noetl not be.completeA if the permit is tor one huntlretl (5300)�or , ' iess), i � ' Dishwasher � , ' Solar Piping � Dryen ❑Gas ❑Electric Sub Panel , I certify tnat In the perfo�ma0ce of the wo�k for whlch thi5lperm�t is ISSueC I , � , � � shalLnot emo�oy any oerson In any manner so as to become subject to the Drinkin9 Fountains . Solar Tank ' Fan � � � Motors �0.1 HP �1'h- 8 Workerz' Compensation Laws of Calitornia. , _ 'Date- Signature � Floor Droins � � Swimming Pool w/Spa F.A.U. ' 'NO710E: Ii, alle� making this tletla�ation, you ihoultl b¢come Subject t0 [he IfIC. $Old� �g-15 HP �16�15+ Worke�s' COTPensdNon D/ovlslons of Ihe l.abOr Code, you muzt forthwlth . FloorSinks � � Urinal_ � Fixtu�¢5 ' �comp�y with Such provi5iona or Ihis permlt snall� b¢ tleemetl rBvoketl. - - Mic�OwdvO -- - -_ i CONSTRUCTION LENDING AGENCV ' - , ' GaSService � OutletS' � WaterCloSet ' - DeviteBOzes � � � � I ner¢by aflfrm [hatrthere is a cons(ructlon lentling agency for the per(ormance' ' � � i Pole Ligh( � ; of the work for, whicM1 tnis permit is issuetl (Section 3097 Clv. C.) ' r, Intercepto�s i Water Heater ' Outlet5 'Ran e � ' l.entler's Name� 9 ' Lentler'S Atltlresi �' ' ' � � , . Kimhen Sink � Wnter Service ' � - Switches ' : OWNER BUILUER OECLARATION � ' � 5�9� I hqreby afflrm that I am exempt irom the'Contractor's License law tor tne � Lavarories - quto-Wash ' ' . ' - tollowing reason (5oction 7037.5 Business ana Professlonal Cotle: Any city oc - ' Garhage Disposal ; Standing $¢ttions county whith raqWres a oermit to construct, alter, improve, tlemolisn or rnpair P-Trap' ' _ Laundry Trays ' Generator 00.5 KW �5-15 KW ' ' � any 5trucWru, Prlor to i[s issuance, also requires ihe applicant for such permi[ Trash Compatior � to iiie a si9nod s[atemen[ that ne/she Is IlcenseA pursuant to the provisions o/ Roof Oralns � the Contractor's Li<ense Law'(Chapter 9.(commenUng with Section 7000) of - . � . � . � 1 � Division 3 oi the Business ana Prolesiions Cotla) or that he/she iz exemPt � . � �he�efrom antl the basis f0/ the dIIC9etl exEmptiOn. AnY violation oi Snction � , '' ' _ . . . ' 70�1.5 by any ap0��cdnt for a permil Sub�ects lh0 applicanl l0 a dvll � eqalty ot not Tore lhan live huntlrCO tlollars (5500). �� - as ownEr o1 th0 Pwpprty O/ my employe¢s with wage5 az Ihelr zole "� RBinSpeMiOn FOe $15 IQUB Fea 5 3 �mpenSaUon, will tlo the work, antl the �structure Is not inlentletl or o/tereB Reinspection Fee $15 Issue Fee $ 3 lor sale (Saction 7044', Business ana�Professional Cotle: The Contractor's ,,. � MECHANICAL � FEES� License Ldw tlocs not apply to an owner of a proparty who builtls or Improvez . � - , thcreon, �antl who tloes sucn work nimsell/horselt or tnrough his or har own ' • , • - DEVELOPMENT SERVICES RE�UIREMENTS: � � '� employea5, Provitletl lhat such ImOrOvemC�ts are not Intentletl or o�feretl for � BOIICY �'�. HoOd of TyP¢ I ❑ � � - , � SalB. H, howevo�, thc builtling or Improvement is soltl witbin one Yaar uf com-� - . C2nOpy TypC I I'❑ . ZOning ApprovBd By DatB , pie�lon, tne ownor will have tha Durtlen of proving ho/zhe tlitl not bulltl or Im; • Duct+Under�Ground� . - Buildine �+Pvrovad By Oate P�Qva fo�the Ourpose olsale), •� . � � 1, az ownm of tbe o�operty, am exclusively contracting with Iicansatl ton- � Duct - StrucNral , � qe(rigeration System Application luued By -�� Dat ? �� Ira�tots to con5trucl thC O�oj¢ct (Seclion 7044, Bu5ine55 antl Pro1e55ions Cotle: � � Tne Convactor'S License Law does not aoplY to an owner oi praperty who Duct- Ventilating �0.100,OOOBTU ❑t00,000.BTU 1 SUMMARV OF FEES f builtls or imOroves th¢reon, dntl who conl�a<IS toc SUG� p�oje[ts wi[h a Con_�• • , tractor(s) licansp pu/suant to the ConVat[or'S Llcense �.aw). i am awarn tnat Exheust System ❑ MWtiple � System Repair/Alteration BUILDING PERMIT $ SMIP � $ - P�Uot of their Worker's Comp¢nSaHon iniuran<e shoultl be prOvltlOtl to me. � � i . i i , PLAN CHECK $ PERMIT ❑ fam ezempt untler Section B. d P. C. tor lhis reason � Firepl/Fact. Blt. ICBO # ; Fire Dampers PLUMBING $ ISSUANCE $ �i Date , ' Owner • - ' ' Heating System & Oucting � Registers ' � PLAN CHECK 25% $ ENERGY P.0. �$ ; i horeby�certlry ttiat i have read thiz applicatlon ana stare ehat the above ❑6100,OOOBTU �100,0006 - ELECTRICAL � GRADING' $ ' information is corract.`I'agree o complY w��M1 all dty an� county ortlinances ' ' � S� � and state laws relating to Oull ing constr ctlon, antl hereby authorize reore- PLAN CHECK 50% $ %. SO MICROFICM $ ' sen�atives of this tlty en , pon e above-mantionetl roparty tor � � � inspectlon ourposes. � . ' � � � � ' �j . � L � 1� � . , MECHANICAL '$ TOTALFEE '$ -� � � Si9�ature ' Date � Reinspettiori Fee $15 laue Fee $ 3 ' PLAN CHECK 25% ;$ � ' 1 r Dri�¢rs' Lfcense or 55 � r � . . - ""' - " ' __' . . _ '" ' '"_ � __ "' _ ' . CMF 0865-46, rev. ]0/84 White - Builtling;'Canary - Appliwnt; Pink - Accountinq; Goltlenrotl - Assessor - - '- ' --' -" '- - - - - ;� CONSTRUCTION AND PLANNING _ POOL & SPA 'i�� APPROVALS Permit# Oate . Inspector �pppROVALS Permit# Date Inspector � 1. Temporary Electrical Service or Pole �a/ar� � ,eCt 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-GUN�TE 7. Footings 58. Electrical Conduit-Undrgrnd. _ 8. Foundation , 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. , � 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor SYStem �, 61. APPROVAL 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 , 74. Rough Plumbing � 65. Electrical-Final �' ' b 75. Rough Elect�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. POO.L/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 & 7est � 72. Underground Flush � , 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat � 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe, 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Elearic 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 ' ' f� � 42. Backflow Preventer v _ � 43. Backflow Irrigation � 44. ,Landscape Irrigation System ' 45. Sound Attenua[ion 46. Handicap Regulations . 47. FINALSTRUCTUFE&BUILDING , , � . 48. Special Requirements Completed , � ' 49. Electric Release to Edison ' � � • ' � � 50. Gas Release to Southern California Gas Co � � 51. CERTIFICATE OF OCCUPANCY - � • � - - � No. Date � � .- ApO��cant to fill in all spaees except those within �eavY �mCer lines anQsign all apvrooriate eeclarotions. ,_l CITY oF COSTA MEsa CONSTRUCTION PERMIT P�ojectAddress E67-877 W. 19th St Costa Mesa APplicant'sMailingAddress2�2O1 Lake C'tY. �2�� +.7.'. Owner'sName :lesa Breez�e A�"t. pry � 7683453 Adqress z3201 Lake Ctr E1 Toro 9�1��— Ai�h/Eng. 7nY(]dri P,YCYl. LicenseNo.C-129�Z3 Adqress � nl Ma �n 4 Trv;ne �1t.2 2�1 contracror'srvam DivE+rcifiad ProT Pho�e �683453 Adqresslmailingl ��201 T.akP Ctr_ �201� �L TOrO City Licenre Mo. � LICENSED CONTRACT00. pECLARATIpN I hQreby a(firm that I am licanzetl untle� provi5ions of Charter 9(commencin9 with section 1000) oT �ivision 3 of the gusinezs antl Professions Cotle, antl my �icense is In full (orc antl ettect. Licpnse,Clasf� ,p � • - ` Llcenpg [�o. 4 2 � � d9 / oa<e�� .. �a�ar /' r/ I W00.KER5' C-' �OMPENSATION DE lAR - l0 ' hereby affirm that I have a certificate olt nsent to selt-insure or a certitiwte � Workers' Compansa[lon Insurance, or a certifietl copy thereof (Sectlon 3600, Lab. C.) R 44379 Pairmont Ins. C� Policy No. Company G] Certi(ietl copy is heraby turnishetl. �6erti letl c py is iiletl with the city Bu i i idsion. Ddte APPlicant EXEM TION OM WORKERS' COM EN DECLARATION (Thisxction neetl not be completetl if the perm I5 for one huntlretl ($100) or Iess). I[E�tify that'in the pe�fo/mdnce 07 the wo�k /o� which thls Oe�m�t is issuetl 1 sha�� not employ any person in any manner so as to become subject to [�a Workers' Compensa[ion Laws of California. . Date � 99nature 'NOTICE: If, a(ter making [his tleclaraHon, you shoultl become subject to the Workers' ComOensation provisions of the Labor Cotle, you mus[ forthwith corliply with such p�ovi5ion5 0� tnis Oe�mit shall be deemetl revoketl. CONSTRUCTION LENDING AGENCV I h@�eby dffl�m [hat t�era 15 a c n5tructlon lentling a9enc fo� the pGrTo�mance , ot the work for hic t 5 errqit I ssuep (Se tion 3097 Civ. C.) Lxntler•s Name �^<-^ .L( - Leqtler's Atltlress •y �i`� � OWNER BUILDER OEC ARA�1 � 4e�eby a(flrm that I am ¢xempt irom the Conl�ac[or'S LlcenS< Ldw for tne following.reazon (Section 7031.5 Business antl Profe55ional Cotle: Any city or county whlch �equira5 a permit to const�Uct, alte�, irtlp�ove, tlemoli5h o� �apai� any structure, prior to its issuance, also requires the applicant Tor such permit tn nin a clanetl ctatement that M1ehhe Is Ilcensetl our5uant to the Dlovisions of L1 I, a5 owne� ot th comoensation, will tlo fot sale (Section 70� LICCf15C ldM� dOQS f10I thereon, antl who Co� eet�ployees, provitled t sdle. It, hOwevEr, t�e P�Etlon, the Owne� wi ��pya fo� Ihe pUrpase I, ds owne� of the trettors to consfruct tl The Contractor's Lin bUi105 or improves tM1 vector(s1 Ilcense purs P�oot ol their Wo�ke ❑ I am ezempt untler Ddte � hereby c¢rti(y that ��tormabon is correct dl1� SId�! IdWS rela !li sentatives o( this '� Inapectlon purpos Signature Driverz' License or 55� CMF 0865-46, rev. 30/B4 ' the allegetl exemption. Any violalion of Sectlon For a pe/mit Subject5 Ihe applicanl to a civil e nuntlretl Aollars (§500). pe�ty o� my em0loyee5 With wages as their zole �ork, antl the structu�e IS not int¢ntletl o� offeretl ainess antl Protessional Cotle: Tha Contrattor's' to an owner of a property who builtls or improves h work himselt/herseli or through nis or her own mh improvements are not intentletl or otferetl for . ng or improvement is soltl within one year o� com- : the burtlen oT proving �e/she aitl not builtl or im- the Owner have rea iuch projects with a con- se Law). 1 am aware tbat ou10 be provitletl to me. 8. & P. C. for this reason TVPE OF CONSTRUCTIO�I LJ rveb ❑ CONVERSION P9 DEMOLISH DESCFIPTION OF WORK/USE OF B 7YPE OF PERMIT U GRADIN� ❑ TENANT ❑ ELECTRICAL ❑ OTHER PROJECT DESCRIPTION 5(2. FT._ CON STRUCTION TVPE ZONE GR Remarks: NG Ptl Bar Sink Backflow Preventer Backflow Irrigation ' ' Bathtubs 7rinking Fountains Floor Drains Floor Sinks GasService OuUets Intercepiors Kitchen Sink _ Lavatories P—Trap Roof Drains Reinspeetion Fee � $15 Boiler Duct - Under Ground . Duct - Structurel Duct - Ventilating Exhaust System ❑ Muitipte Firepl/Fact. Blt. ICBO �k Heating System & Ducting ❑ ai oo,000 sTu O i oo,000 Reinspection Fee .� 515 Whi[e - BWttling; Canary - ApplicanQ Pink - AccounNng; Goltlenrotl - Assessor ]� AL ERATION LJ REPAIR A.P. #E S Main Building: E N STRUCTURAL T Ffont ❑ ECHANICAL B Reef A OCCUPANCY C Right - ALUATION $ _JDOO S Left ACtiES PIng.Ref.# i Planning Notes: Showers Servite Sink Sewer Cap Sewer Connection Solar Collecrors Solar Pipin9 Solar Tank Swimmin9 Pool w/Spa Urinal warer Closet Water Heater Water Service Auto-Wash Issue Fee Hood or Typel ❑ Canopy Type 11 ❑ Refrigeration System ❑aioo,000eru ❑ioo,000 Sysrem Repair/Alteration F ire Dampers Registers laue Fee Automatic Washer Consiruc[ion Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Elec Fan F.q.U. Fixtures Device Boxes Outlets � 6607 I/29/85, zune Accessory Building: Parking Req./Provided I 23,Ou ELECTRICAL Transformer � 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel Motors�0-1 HP �1'/:-8 Inc.Solar [�9-15 HP �1E75+ Microwave Pole Light Range Garbage Dispoul Generator �45 KW �5-15 KW $ 3 Reinspeaion Fee $75 FEES DEVELOPMENT SEHVICES REQU Zoning Approved By Builtli�g Approved By $ 3 !Standing Sections Trash Compactor Issue Fee FEES $ 3 Z O N I N G R E Q M T s SUM ARV OF FEES . � ,.\ BUILDlNG FERM17 $ • �U SM1P $ • SV PLAN CHECK : $ • PERMIT PLUMBING $ S'OO �SSUANCE $ PLAN CHECK 25% $ ENERG�' P.C. $ ELECTRICAL $ GRADING .$ PLANCHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ � PLAN CHECK 25% $ 7�,(�'� CONSTRUCTtON AND PLANNING' � ` " � . : - ^ � i �L- °` SPA . � ' .'_ ` - - • - =�Dafe � Inspeetoc � • `, _ . c Date' In�ector. � APPROVALS - Permit # - � - . . �; `APPROVALS . Permit #� % - _ °` ' - "� 1'.zTemporary Electrical Service or Pole" ' ' �/ ; � � • � 152._ Pool`&' ' - � . ' � - Equipment Coption ;' 2. Soil PiPe-Undrgrral: ' .. - - -'� - � 53. $teet Reinforcement � > � _ '_ ,� : i : 3. Electrical Conduit Utility-Undrgrnd. �' � ', . � - 54: Forms` . : • ". ' � _ � � ` •--�, ' ' 4. Electrirai Conduit-Undrgrnd. <'� ' ' . 55. Electripl Bonding4 ': - -; � � � • y5. Steel Reinforcement - • - - - . 56: ,RougFi Plumbing:& Pressure Test � • ' :' . y �_ 6. Electrical UFER Grnd.. ,, ' f� :' - � -, 57. APPROVAI`TO COVERrGUNITE .� �-i:�` '� = �7.'Footings - . ' , � . "^ `- . � � 58. Eleccrical Coriduii•Undcgrnd.; -' - � ': .t� -�-- � g. �Foundation � , � � . " � ' � _ � - ; 59r. Gas Pipe, O ��Undrgrnd., TesM1 ` � - . _ _ ` �9. �Water; Pipe�Undrgrnd. � ,f � ' . � � ' ' 60. �Backwash Lines, P-Trap,�O Undrgrnd' � ' �i�' � ; �i10. �Structural Floor System - . � ' � %.' � '. � 61c APPROYAL�TO�DECK. c � _ . ' . � 1 � : �11 . Property Sewer Line & House Connection � � �i � � ' , ' . � , _ ,,,s �, � 62�. Backwash &� ReceptorFinal :: _ �-72. Sewer Cap � , . ` ... . . - " - . . - ` - -' , - _ I^ 63.'Heater&Vent-Firial �o �' . i � 93. Roof Drains � , � � � �.64..Plumbing'System -:Firial � = - '- - � i4, Ro'ugh Plumbing .., � - - - 65. Electrical-Final = : _ ,.� ' .' , : . ' i = � 1:.15..Rough �Electrical-Conduit - ,, , .- ; � � ,-- - � � - � - 66.'Solar System-F.inal'" -' ' - """' i ' `�-�- ` "- '� ""'� �� .'16.�Rough Electric Wiring � � �. � . - - '. -�L � - ' 67�. Fencin &'Access Approval- -�" -' - '� �- �Y` �-i - i � 9 � �: � 17.; Rough,WiringM1Sign: '� i � " _ � ' 68. APPROVED FOR PLASTERING � '�� '18. Rough Electncal-T?Bar Ceiling i - , , ` ' 69. POOUSPA SYSTEMS FIN71L � . ! ' 19.��Rough Heating & Air Conditioning � � _ � � ` i • FIRE DEPT. REQUIREMENT ; � ` � � - � � � V � � i 20.�'Rbugti Factory Fireplace � � � ' qPPROVALS ' Permit# � ` , � � .. � i � � I � 21„Ducts;.in Structure ' � � � i � i � � ' 70. Underground Hydro � : � _ � � � , 22.!'pucts;Ventilating- � �� ' � � '71. Prod'uctPiping(�Gas:OOil � � � � I � �' . . ' '�... i i ,� _ _ _ y _ __ _ _ ��23.;Gas��Pipe-Rough&�Tes(.��. � .,;� � � �� 72. UndergroundFlush �� -� I 24.�Roof Framing �. _ �,�; � � � 73. Undergmd.StorageTankrOGas:OOil � ' I � � � � 25..,Roof'Sheathing � � ; � � � � �' � _ - 74. Overhead Hydro � . � � � � +; . , ' � �. 26. �T-Bar Ceiling_�(Structural)'& Monocoat �. , �75. Dry�Chamical � _ �� , • '! I � ' i � "27. �Frameand.Flashing ' , � � . ' ` �76. Dry Standpipe� . � - � � ' � � - - 28. �Cathing&S�id+ng , , � i� � � � � � :o � ;77. FIXED�SYSTEM FINA�L ' ' � - i � � � 29. ti�sulation . � .. � � � � 78. FIRE PREV. FINA�L ''' ' ^ I � I 30.`prywallNailing ; �� ' � ' � � ' � HEALTHDEPT.REQUIREMENT� i ' � � � i I , 3L� Plaster Brown Coat . � " ' i � ' � �. 79: FINAL INSPECTION' ; - -'- - - � • �_ �' 32. Electrical Power Meter-Finai � � � � ��80: FOOD CERTIFICATE ISSUED ; . � � . � 33. Final Electric � 1 �' , � Notes � , , ' � 34. Final Heatin9 &.Air Conditioning �� i � � I ' r� '" ' ' : :i 35. Final Gas Pipe-Test � � ! � � _ - � ' . " � � ' � - - . . . I � , .. . � i .. � � • . p., . - 36. Hood or Canopy - ' . . . `� '� " ` , � , : �. 37. Final FactorY Fireplace � � ' . � � . � t ; ' � �; - - ' �� i : '_ ' - � 38. Final Plumbing � � . . � , ' ' . ' -- '". ; ' ' ' . � . 39. Water''Ser�vice-Finatj ; � ' � r ` ' �� , ; ��; , ' " �� ! �� ` 40. Gas Service-Final � � i � , � ` . � � , . ,i - . " ti � , . ( � : i . . � _ � Y - •�:a 41. 5olar pomesticFinal � � , , �_ .� t � ; _..,_ _ 42. Backflow Preventer, � . ' '� - ' i � � L ' _a... �. ' � �� " ' ' . ; �. i . ,, - -. '_P . i : _ �I' 43. Backflow Irrigationi ri , � _ . r _ ; - � , � 44. ,Lahdscape Irrigation System , � ' � . � .� � , � � � , , � I r �� : r J ' 45. Sound Atterivatiori � T- � � , - ' • , � . � . . � � � � " �� ...,, � . - � �', i �� i-� ,' t i 46. Handicap Regulations � - � � : ' � . . � = � � ' � ' ' � � , � � 47. FINAL STRUCTURE &,BUILDING, j � � ' ' - ; j ; ' , ; ' ' _ � ; , • 48. Special Requirements Completed � � � . _ � I � � � � � � i � ��( � ° .I{ .' , � , � .. � � � , �49. ElectrieReleasetoEdi;on) � -, --� �� -� - �- i 'i-�-� •�--,-'d".'"'-�"'_`'; . � ' 50. Gas Release to Southern California GasCn � '� � � ' f �' � � � . � `^ � � � �' I; , � t � i � 51. CERT�FICATEOF:OCCUPANCY., '� 1 i. � � .� � ) � .�; i " � No � � . � o n Date'' - �. •� -; : }. t ,. . .�_. - -. - -�{ - : �' � - , t_._:� � :.-r.._ .._ sCTM .�._; .._... _ .L ._�_ -.._I_ ._. . �... _��_..�s �_.. : .. _�. -:=�,r-��.,.._�:s.rr...- AO011eant to fill in all spaces except t�osa wlt�in neavy EorOet Ilnes anE slgn all approprtale tleelanUons. CITY oF COS7A nQnE,SA C�O�[J� ST, U�TION PERMIT Project Address �+ '^' � �� 5/��2�'� Applicant'SMailin/of�AAdrPsi •�� OI�fO �/ Owner'sName �•�� , � PhOne%� � 5' Address Arch/Eng. License No. Address ' Contracror's Nam �� hone � Addresslmailing) •�`� -3 City License No. �� LICENSED CONTRACTOR DECLARATION ' I hereby aHirm thal I am licensetl untler provisions of Char r 9(commancing witn saclion �000) ot Dlvision 3 of the Business antl Pr f ssions Cotla, ana my Ilcense is in tull /orce antl eftecY e � License Cla �Z • ` �� Lirensa ��0 / Oate��_r._ � � 'NORKERS' COMPENSATION DECLARATION � � \ereby affirm that I have a certificate ot consent to zelftinsure or a cnrtifi<a[e i Worke�s' Compensation Insurance, Or a ce�tifietl cOpY Ine�eof (Section 3800, Lab. C.��'_ n��3 " �.A�r� ��'� PolicY No. �t LVLV ComPan; �Cer[itietl copy is �ereby fumishetl. - � Certitie c 0�5 filetl with t�e CitY ng Divis' Dale Applicant EXEMiTI N ROM WORKERS' COMPENSATION DECLAR TION (This sectlon neetl not be completetl it tbe permit is for one huntlrntl (5300) or less). � . I certily Ihal in Ihe Oerformance of lne work for wnlch thiz perm�t Is Issuetl, 1 shall not employ any person In any manner so as to become sub�ect to the Workers' Compansatlon LawS O( Califomia. � .,Date SignaWre �NOTICE: If, atter making thi5 tlecia�a[ion, y0u shOuld becom¢ Subject to th¢ Workers' CompenSallon provisions of the Labor Cotle, you must forthwith complY �+'��h such provl5ioni or thls permit Shall b0 Ueematl revokotl. �CONSTRUCTION LENDING AGENCV 1 hereby affirm tnat lhere is a construction lenein9 a9ency tor the pertormance 01 tha work tor wnlch thls permit is issuetl (Sectlon 30B] CW. CJ LenEer's Name Lenaers naaress . ' OWNER BUILDER OECLARATION. ' � I hereby alfirm thal 1 dm oxempt frOm the Contraclor's LicOnse Law iOr [ne tollowing roason (Section 7031.5 Business antl Professional CaCe: Any cily or county whlch reqWres a permit t0 construGt, alter, improve, tlemOlish or ropalr any structura, prior to its Issuance, alzo requlres the applicant for such oarmlt to lilo a Signotl stat¢mant that he/She is IlcenSetl pur5udnt to lhe prOvlsion5 ot the ContraCtor's �icense Law (Chap[er 9(commencing with Secllon ]000) oi DIVISiOn 3 ohth¢ Bu51nCs5 antl Proles5ion5 Cotle) or,that he/she is oxemOt �heref�om antl lhe ba5is fo� the allegetl exemplion. Any viOlatlon oi Socllon ]031.5 by any applicant 10/ a P¢/mil SUDjects thn appllCanl lo� a Clvil �enalty o! not moro tnan livo nuntlrca tlouars (E500). �J I, as ownar ot�tho prooarty or my umployces wilh wa9es as tholr sole compansation, will tlo t�e work, antl the structure is nol intentletl or oiferetl llor salo (Sc<tion 7044, Busine55 antl �Protessional Cotle: Tha Contractor's LICCnse I.dw tlo¢s not apply to an owne� ot d prope�ty wno builtli Or Imp�ov05 thereon, antl wno tloes tucn work nimself/herselt or through hls or her own ' employc05, OrovlOetl [hal such Improvements are no[ intentlo0 or oHored for sale. I I, nowaveq the builtling or imOrovement Is soltl within one yaar o1 com- pletlon, Ihe ownm wlll have the burtlan of proving he/shc tlld not builtl o� Im- , prOve tor lba purposo oLSale). ❑ I, a5 ownM o1 the Oroperty, am excluzively contracting with IlcanSntl con- tractors to mnsV uc[ the project 15ection 7044, Businezs antl ProfeSzions Catla: The ConVattor's Li<enx Law does not apply to an own¢r Ot Property who builtls or ImOroves lhOreon, anG who coniraG[5 fo� suth pro)act5 wit� a cOn- tractor(51 Iicense pursuant to the Con[ra2tor's Ucense Law). I am aware [hat prool o( tneir Worker'S Compenvtion insurance shoultl ba provitlatl lo me. ❑ I am exempt untlar Section B. & P. C. for this reason Date Owner �I hereby certify hat I have'rea� ,Information is m ct. 1 agree [o antl ztate laws rel ny to builtlir ,zentatives o1 tni c to enter in50e�LiOn OUrp05 Signature ; Drivers' License or 55 9f � m antl sta[e tltat the abOve 'Clfy dOtl COUlliy Oltl�lIdOC85 antl h¢rebY authorixe.repre-. i TVPE OF CONSTRUCT� LJ NEW L-� ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION DEMOLISH ❑ OTHER � q p.�6 � DESCRIPTION OF WORK/USE OF BLDG. �n^�'� S Main Buildi E TVPE OF PERMIT GRADING FOVNDATION STRVCTI'1RAL ' T Front ❑ TENANT ❑ EIECTRICAL I� PLVMBING ❑ MECHANICAL � A Reaf � ❑ �OTHER C Plght PROJECT DESCRIPTION�Sa.F7. OCCuaArvCv QO�— K CONSTRUCTIONTVPE VALUATIONS � g Left ZONE GRADING CU. VDS. ACRES Ping. Ref. qW aemarts: � � � Planning Notes: 3ar Sink 3ackflow Preventer 3acktlow Irrigation 3athtubs Clorifie�s ' Dishovasher ' Drinking Fountains Floor Dreins Floor Sinks Gas Service Outlets � Interceptors Kitch"en Sink - Lavatories ' - P—Trap Roof Drains Rainspection Fae � $15 Boiler � DuCi - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact Blc ICBO �I`- Healin9 System & Ducting ❑ ai oo,000 aTu � i oo,000 � i Reinspection Fee CMF 0865-46, rev. 30/84 White - Builtlin9: Canary -�Applicant; Pink - Accountin9: Goltlenrotl - Assessor Showers Service Sink Sewer Cap Sewer Connection . Solar Callectors Solar Pipin9 Solar Tank Swimming Pool wlSpa Urinal Warer Closet Water Heater Weter Service Auto-Wash laue Fea Hood or Typel ❑ Canopy � Typell ❑ Refrigeration Sys[em ❑4100,OOOBTU ❑100,000 ❑ System Repair/Alteretion Fire Dampers Registers $15 laue Fee FEES $ 3. $ 3 Automatic Washer Construction Pole S� Cooking Unit Dishwasher Dryers �Gas ❑EI Fan F.A.U. Fixwres Oevice Bozes Outlets Switches Garbage Disposal Generator DO-5 KW Fae � 689 a al,l�1�. Zona ' Atcessory Buiiding: Parking Req./Provided ELECTRICAL _ ' Transformer ❑ 75-50 KW ❑ 50+KW Meter ❑up to 700 amps Meter �over 100amps ic 5KW S15 Sub Panel Motors �0.1 HP � 1:5 - 8 Inc. Solar 09-15 HP 016�15+ Microwave Pole Light Range Si9n ' Standing Sections Trash Compacror Issue Fee DEVELOPMENT SERVICES RE�UIREMENTS: ZoninB APP�oved By Building Approved By �3.av� FEES $ 3 SUMMARV OF FEES BUILDINGPERMIT $ ��5� SMIP $ '-5� PLAN CHECK $ PERMIT PLUMBING $ S�UG ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING $ � PLAN CHECK 50% $ MICROFILM �$ � MECHANICAL $ TOTAL FEE $ a.� 6d PLAN CHECK 25%� $ , ' � , ! Z O N I N G R E a M T 5 CONSTRUCTION AND PLANNING �� - POOL & SPA I� APPROVALS Permit# Date Inspector qppROVALS Pe�mit# Date Inspecior �' 1. Temporary ElectriCal Service or Pole ,� -� , 52. Pool_& Equipment Location _ 2. Soil.�Pipe-Undrgmd. � ' � . 53. Steel Reinforcement ,�._� f3. Electrical Conduit Utility-Undrgrnd. �' 54. Forms `• �� ' 4. Elec[rical Conduit Undrgrnd. L, , � ' �55. Electrical Bonding . �+ _ 5; Steel Reinforcement i -� ' . � 56. Rough Plumbing & Pressure Test �� - 6. Electrical UFER Grnd: 57. APPROVAL TO COVER�GUNITE . 7. Foo[ings •� - . 58. ElectricalConduirUndrgrnd. _�, '8. Founda[ion , . � � � , 59. Gas Pipe, O Undrgrnd., Test � - �9. Water Pipe-Undigrnd. _ 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 1�2. Sewei Cap '•.� � /�3�r-- 0 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 & 7est 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O Gas O,OiI 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 �SSUED 33. Final Electric ' Notes: 34. Final'Heating & Air Conditioning , 35. Final Gas Pipe-Test � 36. Hood or Canopy � 37. Final Factory Fireplace . � 38. Final Plumbing � 39. Water Service-Final � 40. Gas Service-Final 41. Solar pomestic-Final -- - - � � 42. Backflow Preventer , ' • _ . 43. Backflow Irrigation . ' � � ' 44. Landscape Irrigation System � � 45. Sound Attenuation � � , � " 46. Handicap Regulations , � � � 47. FINAL STRUCTURE & BUILOING � � , 48. Special Requirements Completed � � ' � 49. Electric Release to Edison � �� i � . 50. Gas Release to Southem California Gas Co � � � 51. CERTIFICATE OF OCCUPANCY ' - - - No. �Date .. _ _ . � . _ - � . October 4, 1985 � � �. CITY OF COSTA MESA CALIFORNIA 92626 P.O. BOX 1200 FROM THE OFFICE OF THE DEVELOPMENT SERVICES DEPARTMENT/ PLANNING DIVISION Buildirig Safety Division � Business License Division Ccmnunications County Ac�ninistration Office County Clerk/Hoard of Supervisors County I�gistrar of Voters County Tax Assessor Engineerirg Division (2) Finance, Revenue Division Fire Prevention Manager, MID Nhsa Consolidated t,�ter District Newport-Mesa Unified School District (2) Pacific Telephone C�ar.y ;2) R�lice Departrnent - Ping. & Research Santa Ana Heights Water Company Sanitary District Engineer Southern California Edison Co. Southern California Gas Co. State Hoard of Equalization Street Division United States Fbst Office, Pdams Avenue United States R�st Office, Santa Ana Zip 4 - Santa Ana File (2) The City of CAsta Mesa wishes to advise you that in revising street addresses, the follqwing addresses have been changed: OLD ADDRESS 867 S 877 W. 19th St NEW ADDRESS 867 W. 19th A-101-104 201-204 B-101-105 201-205 C-101-106 201-2QE D-101-106 201-206 E-101-106 201-206 F-101-104 201-204 G (carports) H (carports) J (carports) A.P. N0. 424-191-04 424-191-04 424-191-04 424-191-04 424-191-04 424-191-0� 424-191-04 424-191-04 424-191-04 424-191-04 424-191-04 424-191-04 424-191-04 424-191-04 424-191-04 For your convenience we are listing the agencies above that we have notified of the change. In addition to those listed, you are advised to notify your correspondents of the change in order to avoid any possible interruption of mail service. 77 FAIR DRIVE (714) 7545245 Lp F � � � � ��s �r.l6i � M �°,� � ZOZ ZOt �� , Zo'L zor � IoZ �lo► r-.�'L 50l � iAZ £o� , �, t �, -:� ►