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Home My WebLink About880 19TH ST - Building Permits, ' . ... _.......�. � i � BEO w. 19Tfi ST, (977) � r: � Completed � - , ' L..: : _,: _:.:.�c::_ , � - t , .-, ., : _ — .. �. ....__.._. . .___ � � FENCE-----------Per. Y� 201$ � ��- completad 11-4-55 ; �i i � -- �� _ Q�43 H773 _ �� r - s166 g/3/�&5� WPIDC)[`' (� 51700. _ � � 1670 Ry�pO 1 g'�7'��SS� .PC SS}84S 1 ��—� _ B1fi912� p'8� L�(7pp $2500. _ A�� B1729Z � FAhIILY Ed7(Y4 5500.00_ . _ i �773 �j�y a jE17271��'uj"� t+¢ ' -• " ' �� E17399 . � hffSC �/� ��-' _ j . . _" • B16708,F1 71 �� Bj.8454 � BIJC FL4LL 54,500. � � ��y//g S / � '� . ' .� 0 n 1 OWNER LF,^� R. E& PET��RSOid�C H �.. ._...—.DATE ll Iy,�KK /� JOBADDRESS 8a0-88l� lN. ].9tY1 S't. BUILDINGPERMITNO. ZU3� ( ERALCONTRACTOR Oumer-Suil3er VAWE $ �'j.nn LOT 392 r�' 393 BLOCK TRACT 1712 �� Bl c�ri� wai l�� h` � l �C1 � INSPECTIONS Trench Grade to Rough Framing Plumbing, Rough to SIa6 Plumbing, Rough Complete �� Temporary Pole I Wiring, Rough Heating, Rough i I Heating, Final ' � Sr�-��r, House Sewer, St. � �' S cTankor Lathina.ln Final, Fix Fin,al Gas Occupancy PERMITS ISSUED DATE SUBCONTRACTOR DATE I NUMBE . ..., .._ _�. _ - _. -.,._. � OWNER I+'F�� RO$ERT E. / DATE I.O—ZO—S7r / JOB ADDRESS HRO �/'1. l9th BUILDING PERMIT NO. I.IS6 f ERALCONTRACTOR O�er-builder VALUE $2��.�0 LOT �qq BLOCK TRACT 1712 Cament block W2�� OWNER Hl�RBOft V_rST9 INC. / DATE 2-23-57 � JOBADDRESS �j�n _� _�qt.h S� BUILDINGPERMITNO. 9I.{S G =RALCONTRACTOR S2CT'85t &. F1SP1 VAWE $ZO�3SII.00 LOT 3°3 BLOCK TRACT 1%12 Res_d@71C0 GROUP I TVPE V ZONE R]. FIREDISTRICT %S7 PERMITS ISSUED !NSPECTIONS DATE SUBCONTRACTOR DATE I NUMBER Foundation Forms and Grade to Rough Framing Plumbinp. Rough to Slab . Heatin Heatin SP' ^r I S� . Plumbing, Fina�l, Fixtures Complete �� '?�/- Plumbing, Final Gas Tes' 30 y-�- £-�i— � Wiring,Final .-!_-�-q Q-1_ Occupancy x�orm 'LIO G-Fi 1�f 1'469 � A ��osta Mesa Building Department PLICATION FOYt PERMIT � 111 EAST 20th STREET 2� ��J S L D i N G � COSTA MESA, CALIFORNIA �� FOR APPLICANT TO �'ILL IN FOR O�'FICE iTSE ONLY Receipt No. Permit No. Butlding Addresa g � � O ,3 'J� CiOSt8� �CS8y Ci8��017113, Received by Date Rec'd. Date Issued Nearest �� ~ 7'—�� r Cross St. V i Building M�•oM�s• .E. �e Addre55 Owner C e Mail Costa Mesa; California Address Nearest Tel. • " � Cross St. City GO � c No. _ 3 Zone / I plans I Type ,/ Group Architect or Lic. �� Engineer No. � Approved b Date Address S a me a s abo Na CORREC'1`IONS City LiC. tractor � h No. Address y Legal I Lot 3Y3 I I ij/ . Description No.:l92 Block �Tract��i� (Attach Metesand Bounda) � / aT' No.ofBldga Size of Lot 6$— /�� I Now on Lot � � p Useof No.of No.ot r� � 70 Existing Bldg.� amilies I Rooms b , � Setback Linefrom i Rear Vard O� Z Center of Street •.S G f Side Vard �� 1v Q r s DESCRIPTION OF WORH � New I Alteration I I Addition I Repair I I Moving I I Demoiish I Building i i No. of Size � Rooms Stories �-'erior all I Roof �ring coveriny APPROVALS _.: of New Building � �� Foundation Lxation Inspecto� Date , „ � Forms, Materials, g � ` — Under-Pinning Q � Frame: Firc 6tops, Bracing, Bolta I hereby acknowledge that I have read this Application and state that the above is correct and agree to rnmply Lath. int. with all Clty Ordinances and State Laws r lating building cons� t�� Ls. �� Lath. Ext. Signatureof Permittee ��y�� (�� / plaster, Int. Authorized Agt. Plaster, Ext. Valuation Permit Fee $ ol •� � Masonry Reiniorced $ �/J ' O O TotalCheck $ Y Bond Beam —�-- ,!� ,. Fee $ a, O O FINAL c.+ "" ��d �1 '1 M 204 3-BP 2T1 8-55 � ri.v1 ri.eilv Show Iocatian and diatances from property Iina and between bulldinga cosrr�Q6i �.�,{,�>2 r�� -�-sSPDnEsa Costa Mesa Building Department APPLICATION FOR PERMIT •� COSTA MESA20CALl OERNIA �� •^�� B U I L D.t N G � FOR OFb'ICE USE ONLY N'� �PLICANT TO FILI� IN . Receipt N��rmit No. Building O S� Address CosYa Mesa, riB��OPII1& Received by I D te ec'd. I Date Issued Nearest Cross St. Owner � L/�cL p{.ct.e.. • Mail Addresa Tel. Gty No. Arohitect Lic. • Enginee �� No. Address City Lic. trector.,�, No. 222 g Address Descrption I No.3431 Bloek I Tract/�%/a (Attach Metesand Bounda) O No. of Bldga Size of Lot � p�� Nowon Lot Uxof I No.oT I No.oT Existing Bldg. Famflies Rooms Setbaok Linefrom - RearVard Centeroi8treet `sj 3ldeVard Q—/0 DESCRIPTION OF WORH New I�/ I Alteration I I Addition I Repair I I Moving I I pemolish I Sizedin9 ��x�� JRooms (p Storfes F-•prlor Wall I RoM �ring �� Covering . , of New . � �.3 -1S Costa Mesa, California / N0.01 � Plans CORRECTIONS _r �l � APPROVALS Foundation Location Inspecto� Forms, Materials, Under-Plnning Frame: Fire Stops. I hereby acknowledge ihat I have read this Applicatton Lath. Int and state that the above is rnrrect and agree to comply Lath. ExL wi[h all City Ordinances and State Laws regulating building cons[ruction. Signature oT �� Plaster, Int. Permittee Plaster, Ext Authorized Agt. Mawnry Reinforced Valuation Permft Fee $ Plan Check $ S Bond Beam $ `� 3(y 7otal Fee $ 3�� FINAL iORM 204 p-q EM 9-Sd Date O a � Z D r � Show Iocation and distaneea from . property Iine and between bulldinga. , " _ T ; ' j ' � _' . " _._ _-_ _.�n'c, rt . _ ' . . � 0 .. .�. - - • .: �;:��. • ...�._. � 0 . - ,.- .. _ ' �. . _ . . � • �, .. . P,.��,— .. . ._`- •, rr.�� . , . . � i� . . �. _ - . ... � �. r '.e.r �. � . : . �. ' . . . .•I' . . , ' _ ... . G _ . . � "_._.- �_._' _...J,.-' - -�� :� J." ___ .' '. ' -. . . � � � . �. . � .� . .I; , ! .'�, . - i .�4' . � ` ` . • -• , . ': • �I�.. , . . . • . .-. _ . ,'�: 11 . � . . � - _ _ � . • _ . � � � - . ' • . . . .�� . � �� --' . . , ,r �, .� . I -- . . ! _ " _�-`. i Costa Mes� Bnilding Department � �.—� 111 EA8T 20th STREET ' COSTA MEBA, CALIFORNIA FOR APPLICANT TO FILL IN Buliding Addresa � CQStB, M03fly CflLfOTllla, St ,l.CLi No.� t � � Lic. ��LXiw>Ne_ � of Lot S�( -// p � Now on Lot of ;, No.of No.of ting Bldg. ,�,,,�Q�_,_„ I Famflles� I Room� ack Line from Rear Vard . o/ 2PLICATION FOR PERMIT ;- BUILDING � FOR OFFICE USE ONLY Recet by Date Reo'tl. Data — �� '�O -S'-I ,/li - Buflding • r, Address Costa Mesa, California Nearest . Cross St. CORRECTIONS New � �� Alteration � � Addition � � � Repair I I Movfng I I Demolish I Building / " No. of �,,. � v.� d. � .e---- �•--�-- � •erior Wall % I Rooi eNng Cove �.,e of New /J__ � Bulldin9 L6CN//2t..G.:� APPROVAI.S � pc.�� , ynucr-rumwy . Frame: Flre 8tope, Bracing, Bolta I hereby acknowledge that I have read thls Applicatlon and state that the abwe is correM and agree to rnmply Lath. I nt with all City Ordinances and State Iaws regulating building constrltction. Lath. Ext. Signatureof Permittee �/�l.N ��t�� P P Plaster, Int �l} AuthoMzed Agt, plaster, Ext Valuation Permlt Fee $ �. �� Masonry Reinforoe � C Plan Check $ �(J (%, Bond Beam $ Total G � Fee $ FINAL FORM 21M S-HP 2M e-SS � . O 9 � " PLOT PI.AN 6how locatlon and dtstancea from property Ilna and between bulldinga .. ., T - , - � .. , _ ^ � _� ' .._, ._ �' �... „ , ' � �� /� _'_ ' �. , ..� ; . � _ �U COSTA ¢ � �_„ J�1 �f1E5A. 749a Aht:t.t�2.1i� .Y ' J- , • 3.�- i`��. ._ . - � ��-� �� U _ _ . `�: � y � . . �� , � � � - -.� . • �i:. � � . � _ . . .. . ' r . - mv) W � � � AOP��ant to IIII in ali soaees exeepl those within neavy eortler Iines antl sign ali aporoD�late aeclarationt. ciTY OF COS7A MESA CONSTRU/CT��'1 PERMIT _ Project Address � ��' �'L� `� ' ' v � APPlicant's Maili�� rnca � �.3(�J ��[ ��- % �J /tir� � Owner's Name �,� �� ( �j b' 1" � � Phone ' Address Arch/Eng.- LicenseNo. _ , Address Contractor's Nam {� • Phone � Addreu (ma'fn�l ,E'! C� " �i �-L��F � City License No. LICENSED CONTl2ACTOR DECIARATION � . I hereby af(irm Ihdl 1 am IicenS¢tl untler provi510n5Of Cnartar 9(commencing with section 7000) of Division J oi lhn Buslness anG Pr01Cs5ions Cotle, antl my license is in full t rt� a(i eHect. . . Licen Class L en5e No..��C �� Date� Signature - - WORKERS' COMPENSATION DECLAR ION � 1 hereby aifi�m that I have a CertHicate oi COnsent �o salNnSure Or a CGrNtica[e � of workers' Compensation Insurance, or a ttrrifieA capy [neraot (SecUon -;380Q Ldb yn�( I 11�, !�� <Y No�� 'v`�`��^-� CompanY �QIP�9�G'h'�� , Certifietl copy IS h¢reDy furni5lt¢tl. EXEM �I ��ROM�ORKERS COMPE� T�11V15'DECLAR TION ' (Thissection neetl not be complatotl if the.permit I5 for one huntlretl (E300) or less). I ce(tify that ln thG perfo�mdnta OI the wOrk (Or �yhlch InIS pe�m�t i5 ITSueG I shall not employ any p¢rzOn In any mdnner so as to b<COme Subjett to t�e Workers"Compensatlon Laws o( Calitomia:� r Date Si9natur8 'NOTICE: It, ait¢r Taking IhiS tlBClarallon, you ShOWU becama Sub�ett t0 the Workers' Compensatlon prOviSions ot Ihe LabOr Gatle, you muSl fOrtnwl[h mmpry �with' sucb provisions or thi5 permlt ittall - bC tleemetl �evokCtl. CONSTRUCTION,LENDING-AGENCV 1 hereby aHirm lhal th¢re I5 a cOnitruGtion Ientling dgGncy tor lne perforTdnGa o( [h0 work ior which thlz permlt is ISSuptl (Sectlon 309] Civ. C.) Lentler's' Name Lentler'S ACtlress OWNER BUILDEH OCCLARATI01i � I hereby affirm that I.am exempt irom [ho Coqtractor'z �Icensc Law for tho followin9 reason (Soclion �031.5 Buslneis and protossional Cotlo: Any ci[y or county whlch rCquires d pe�mit'to Const�uct, altCr ImprOvO, demoliSh or �apair , any strucWre; prior to its Issuance, also require5 t�e applicant for such permit . to fiie a,signotl slatamenLthat ho/she iz Iicenseq pursuant to tho proWsions o( the Contractor'S License law (Chapter 9(cOmmOncin9 with Soctlon ]000) o/ Division 3 of thn Businoss antl PrOla55ion5 Cotle) Or that ha/she i5 e%empt therefrom antl tha basis for the alleqetl exemption. Any'violation of Sectlon 7031.5 by any applicant tor a permlt subfecls tho applicant to a civil �endlty of not more Ihan fivu huntlretl tloliars (E500). , , ❑ I. as owner o1 tha proparty or my omployoes wltb wage5 as tholr solo antl who tloes Suth wOrk himzeli/harSGlt or lhrough his or , If, hOwevoq [he bWltlln9 of ImOrOvemeni �S ToIO wl[nln Ono year o� com- [ion, the owna� will'have lna bu/tlen OI prov��g h¢/Sho Ultl not bui10 0� IT- v0 fo� tho purpOSe ot Sa10). ,- I, as owner of tne property, am ezUusivery �pn[ractlng' wi[h IlcenSetl <on- ;tors to construtt the proj¢ct (Se<tlon 7044, guSinesS antl ProleSSions Code: 3 COfILldCLOf�S LICBlISC LdW doe5 nOt apply to dn owne! of pra0orty who � Itls or Improves thereon, antl who contracts tor such projects with a con- ctor(5} licenie pursuant to the Con[racto�'s L��enia Law). I am aware that �of ol Iheir Wotket's Comp¢nsatlon InSuran�0 ihoultl be provltl¢tl to me. 1 am ezemv� untler Section B. d P. C. tor this reason , Date Owner 1 hereby certify that 1 have �eai information is correct. I agree to antl state laws relating to bullEln Sentatives ot thit C'ty to en r inspection purpose $ignature ' Driverz' License or 55 TVPE OF CONSTRUCTION ❑ CONVERSION ❑ I DESCRIPTION flF WOR �• I NEW LJ ADO LJ ALTERATION LJ REPAIR 15H ❑ OTHER ' n OF.BLDG. (—� �� nc'^�'f� . TYPE OF PERMIT LI GRADING LJ FOVNDATION LJ STRUCTVRAL O TENANT ❑ ELECTRICAL ❑ PIVMBING ❑ MECHANICAL � �OTHER � ' � C �-- . �PROJECT DESCRIPTION �9. F7. �� oCCVanN Y� C O N 5T RUCTION TV PE V A LUATI ON 5�� ZONE GRADINGCU.VDS. �ACRES__ Rem2Ncs: - Backflow Preventer ' Backflow Irrigation Ba[htubs Clarifiers � � � DIShN2ShCf Drinking Fountains Floor Drains . Floor Sinks - Gas Service �Outlets Incerceptors Kitchen Sink " La'varories - P—Trap - � Roof D�ains ' t . . Reinspection.Fee I $15' Boiler Duct-UnAecGround ' Duct - Ventilating Exhaust5ystem ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑aioo,000 eru ��oo,000 Reinspection Fee '� $15 1F 0865-46, r¢v. 10/84 White - Builtling; Canary - qppllwnt; pink - Accountin9: Goltlenrotl - Asse55or Showers Service Sink . Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool wlSpa Urinal . Water Closet Water Heater Water Service Isue Fee Hood or Type I ❑ C2nOpy Typell ❑ Retrigeration System ❑4100,OOOBTU ❑700,000 System flepair/Alteration Fire Dampers ' Registen � , � laue Fee FEES A.P: 9W , � � LI' S Main Building: E � T Front . 8 Rear A C Right �, SLeft �/`, Ping. Ref. # Planning Notes: �nl Automatic Wa3her — Construction Pole Sub. . Cooking Unit Oryers L1Gas' LJElectric Fan F.A.U. Fixtures � Device Boxes Outlets Switches Garbage Disposal Generamr 00�5 KW $ 3 ... � Reinspection Fee FEES DEVELOPMENTSER 2oning Approved By_ BuildinB APProved By . Appliption Issuad BY_ S 3 1172 4/I:�/j_._. � " 2one � � Acceuory Buildin9;. `E� � m \l /• � Parking Req./Provided . ,��nn � .� n.. -, . �1iY 0 15 K $15 ELECTRICAL � ' ' -' Transformer ❑'15-50 KW ' ' � 50+KW Meter ❑up to 100 amps Meter ❑over 100 amps Sub Panel ! Motors �0.1 HP 01 K i 8 Inc. Solar �9-75 HP 016-15+ Microvrdve - ' Pole Light ' � Range � Sign ; Standing Sections � ' . bU Trash Compacror ' Issue Fee � E;.oa.: il ¢ ES $ 3 2 O N 1 N G R E � M T S SUMMARV OF FEES c— BUILDING PERMIT $ �O•S(7 SMIP �$ `-� � PLAN CHECK $ �+�--�� pERMiT • PLUMBING ' $ � ISSUANCE �$ PLAN CHECK 25% $' � ENEFGV P.C. $' ELECTRICAL $ � GRADING -5 PLAN CHECK 50% $� MICROFILM � S MECHANICAL $ TOTALFEE •S 83-'S� PLAN CHECK 25% $ . e .[:ONSTRUCTION AND PLANNING � POOL o. oPA iAPPROVALS � Permit# Date Inspector qPPROVALS Permit# Date Inspector 1. Temporary Electrical $ervice or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgmd. - ' 53. Steel Reinforcement 3. Electcical Conduit Utility-Undrgrnd. � 54. Forms � _ 4. Elecirical Conduit-Undrgmd. 55. Etectrical Bonding . 5. Steel Reinforcement 56. Rough Plum6ing & Pressure Test - 6. Electrical UFER Grntl. - 57. APPROVALTO COVER-GUNITE 7. Footings . . l�l � 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O Undrgrnd., Test '9. Water Pipe-Undrgrnii. 60. Backwash Lines, P•Trap, 0 Undrgrnd. 10. Structural Floor System " 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection � 62. Backwash & Receptor-Fina! 12. Sewer Cap � • . 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing SYstem • Final � . 14. Rough Plumbing 65. Electrical-Final �� 15. Rough Electrical�Conduit 66. Solar System-Final � 16. Rough Electric Wiring 67. Fencing & Access Approval � 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18., Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS F1NAL 19. Rough Heating & Air �nditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas OOiI 23. Gas Pipe-Rough & Test 72. Underground Flush � 24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling IStructural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINA� 30. Drywall Nailing . HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: �� L � �=G Q� 34. Final Heating & Air Conditioning 7-O G v'� � 35. Final Gas Pipe-Test ' 36. Hood or.Canopy 37. Final�Factory Fireplace 38. Final Plumbing � '•� ' • � 39. Water�Service-Final% � 40. GasService-Final�,=•; � - , 41. Solar�DomestiG-Final - r 42. BacRfl'ow Preventer � • � ' � 43. Backflow Irrigation--. 44. Landscape Irripation System: 45. Sound Attenuation 46. Handicap Regulations . ��, � 47. FINAL STRUCTURfi & BUILDING 48. Special Requirements Completed � 49. Electrie iielease to Edison • � 50. Gas� Release to Southern California Gas Co � 51. CEQTIFICATE OF OCCUPANCY - , No. Date � AOV��cant to lill in all spaces except lhose within neavy borOe� lines antl si9� all appropriale tlecla�alions. OFCOSTAMESA CONSTRUCTIONPERMIT ?ERMITNO/�9/,�,' TRACTNO. LOTNO% ,`UNITNU.'�,. �S r1 i 1. `�' � �� Projectnddress � ��n �% /9 �"ln s'�� C�� i�% . Applicant's Mailing Addres -� Owner's Name �[� ' Phone — � Address . �-Z--� Z� �'"� , Arch/Eng. , � License No. ` ,_. Addreu Contractor's Nam W Phone . Address (mailingl - - City Licensc No. ' � ' � � LICENSED CONTRACTOR DECLARATI ' ' . 1 hereby affi�m thdt I am licensetl untl¢r pr isI �$ of Charte� 9�(commencing with section 7000) of Division 3 of the Busi ¢dcl ��tl Professions Cotle, antl my Ilcense is in full torce antl eftect. T� LJcense Class' License No. Date Si9nature W00.KER5'COMPENSATION DECLARATION I hereby altirm that I have a certificata ot consent to salt-insure or a certiflcate ot Workers' Compensation Insurance, or a cerUtietl copy tbereof (Section 3800, LaD. C.) � �olicy No. Company �Certifietl covY �s hereby turnishetl. Certifietl copY i5 Bletl with the'city Builtlinq Division. Data � � Applicant EXEMPTION FROM WORKERS' COMPENSATION DECIARATION (Thissection neetl no[ be completetl if the permlt Is for one huntlretl (y100) or less). ' 1 cerlify.tha[ In the performdnce of tha work fo� which thi5 pe�mh is issuetl, 1' shall no�loy�arn1 y��erson in any manne� ;o=s to b com�ject to the Workers' p satio LawS of Calitomi�� . Date .i.5i9nature 'NOTICE. If, a�ter king this tleclaratioiTyou shou G bew SubjeCt to the • Worke�s' COmpensation prOvisions of the Ldbo� Cotle, you must forthwitn ' compiy wfth such provisions or tnls permil shall be tleemetl-revoketl. CONSTRUCTION LENOING-AGENCV ' ' ' 1 hereby ai/lrm that there is a conztruction Ientling agancy'for the pertormance of the work tor which this permit is Issuetl (Section 309� Civ. CJ Lentler's Name / LenOer'S Adtlr¢55 OWNER BUILDER UECLARATION - I hereby aiflrm Ihat I am exempt from the Contractor's. License Law for the fo�lowin9 rea5on (Section ]031.5' Buslness antl Professional Cotle: Any tlty or county wnlch repuires a permit to construtt, alter, improva, aemolish or reoair, any sVucture, priOr [o its i55udnce, also rCqW/es lh2 aOPlicant fOr sucb Oermit ' to file a si9netl statemenf that he/she is Ilcensetl pursuant to the provisionz of the Contractor's License Law (Chapter 9(commencing with Section ]000) ot '�Division 3 Ot [he BUsiness antl Profe55�on5 Cotle) or tha[ he/she i5 eicemOt � Iherefrom antl the basis for the allegetl exemption. Any violation of Section � 7031.5 by any applicant for a Oermit subjec(5 lne applicant � to a civil venalty ot not more lhan five huntlretl tlollars (E500). � I, as owner of the OroOerty_or my employees wi[M1 wages as thelr sole ,ompensation, will tlo the work, antl the structure I5 not intentletl or offeretl for sale (Section 7044, Business antl Professional Cotle: The Contractor's License law tloes not appty to an owner of a property who builtls or improves thereon, antl who tloes sucn work hlmselt/herself or throu9n his or her own emPl0Yee5, P�ovitletl that such improvements are not Intentletl o� of�eretl tor sdle. If, however, [he builtlinq or improvement I5 zoltl within one year of com- platlon, the owner will'have the burtlen ot proving ne/she tlitl not builtl or im- �tove fot lhe Ourpose ot Sale). I, as,owner oi the property, am exclusivaly contractin9 with Ilcensetl con- tracrors to construct lhe project (Section ]044, Business antl Professions Cotle: The ConVaclor's License ldw does mt apply LO an�owner oi property who builtls �o� ITproves thereon; antl wno con[rac[s to� sUch p�oject5 with a con- tractor(s1 license purzuani ro the ConVactor'S License Law). I am aware that prooi ol tlteir WOrker,s Compens ion ms rance shOultl be providetl to me. r ❑ I.am exem0� untler Section � `/ �� P. G. for this reason � O LU N�EP Oate = � nwner __.. . . . .. _ I nereby certify that I have reatl tnis appliwtlon antl state that the.above information Is correct. I agree to comply with all clty antl county ortlinances antl state laws rela[ing to builtling consVuction, antl hereby authorize repre- 5¢ntativ¢s of this'tlty ¢nter upon the abOve-mentioned property fo� inspection purpozes. _ 51 nature ate � TYPE OF CONSTRUCTION .I..J NEW IJ ADD LI ALTERATION LJ RI ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTIONOFWORK/USEOFBLDG. �� F . ' TVPEOFPERMIT GRA�ING FOUNDATION STRUCTURAL ❑ TENANT ❑ EIECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION 5 F � �oCCUaANcv . CONSTRUCTI NTVPE��VALVATION$ ZONE ' GRAOING CU. VDS. � ACF3E5_ Remarks: ��/729� ' i , Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers ' Dishwasher Drinking Fountains Floor Drains . Floor Sinks • Gas Service � Inrerceptors� Kitchen Sink Lavatories. . P-Trap Roof Drains ; Reinspection Fee Outlets $15 0 Duct � Under Ground � Duct - Structural Duct - Ventilating ExhauSt System � Multiple �� Firepl/Fact. Blt. IC80 # Heating System & Ducting - ❑0.100,000 BTU O100,0006T1 9 Drivers' License or-55 � Reinipeetion Fea � ' . , _ . , . . . .MF 0865-46, rev.�10/84 White - Builtling; Canary - qpplican[; Plnk - Accountinq; Goltlenrotl - Asse55or $15 Showers Service Sink Sewer Cap Sewer Connection . Solar Collecmrs Solar Piping Solar Tank , ' Swimming Pool w/Spa Water Closet ' � - Water Heater � •WaterService � Auto-Wash ' � ' 'Laundry Trays . ' - Issue Fee H A Hoodor Typel� ❑ Canopy � Type 11 ❑ Refrigeretion System ❑0.100,OOOBTU ❑100,000 System Repair/Alteretion Fire Dampers Registers � laue Fee . i':v:91° � � S Main Buil� E_ u v �A Rear .,._ c a�sntUS;, g Left Ping. Ref. # � Planning Notes � Automatic Washer ' Construction Pole Sub. Cooking Unit Dishwasher Dryers �Gas' ❑Elec Fan F.A.U. Fixtures - � Device Boxes Outlets Swi[ches. � ' _ I . .. _ _ . Accessory Buil � � - � Z ` O _� N I ' _ N _ G Parking Req./Provided `{ i .,� E Q M T 5 ELECTRICAL FEES Transformer O'15-50.KW ' " "' � O SO+KW � � Meter ❑up to 100 amps Meter �over 100 amps Sub Panel � ' Morors 067 HP 07'/: -�6 Inc.Solar �9-15 HP 016-15+ Microwave • -' - - Pole Light � . Ran9e , � Generetor U65 KW LJS-15 KW � � � Standing Section Trash Compacror $ 3 � / Fainspection Fee � $15 Issue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: ' Zoning APProved By Building Approved 9y � �� G $ 3 $ 3 SUMMARV �ES '� BUILDING PERMIT 5 � SMIP ' $ � PLAN CHECK , § PERNIIT . ' ' PLUMBING � $ � �SSUANCE ' $ �� PLAN CHECK 25% $ � ENEBGV P.C. $ • ELECTRICAL $ � GRADING $ � PLAN CHECK 50%, $ MICROFILM $ . ; MECHANICAL $ � TOTAL FEE • $ ' �SSO PLAN CHECK 25% $ t .. . � CONSTRUCTION AND PLANNIN� � POOL & . � APPROVALS Fermit;y Date InsPector pppRO,VALS Permit� Date Inspector . . 1. Temporery Electrical Service or Pole �� 52. Poot & Equipment Location , � '2.',Soil Pipe-Undrgrnd. � ' ' 53. Steel-Reinforcement - '-3. Electrical Conduit Utility-Undrgrnd. �{ 54. Forms . . � . - � � �4. Electrical Conduit-Undrgmd. � � 55.' Electrirzl'Bonding � � _ � � � 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test -�6. Electrical UFER Grnd. 57. APPROVALTO COVER-GUNITE �� 7. Footings � . 58. Electrical Conduit-Undrgrnd. . � 8. Foundation - 59. Gas Pipe, � Undrgrnd., Test _ � ; 9. Water Pipe-Undrgrnd. � � - 60. Backwash Li�nes, P-Trap, O Undrgrnd. -10.� Structural Floor System � - �� 61. APPROVAL TO DECK �1�1: 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 � 16: Rough.Electric Wiring 67. Fencing & Access Approval � .�17. Rough Wiring Sign 68. APPROVED FOR PLASTERING - 18. Rough Elec[rical-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.Ventilatin9 .' 71. ProductPipi�❑Gas �Oil. �� 23. Gas Pipe•Rough & Test 72. Underground Flush 24. Roof Praming ' 73. Undergrnd. Storege Tank O Ges ❑ Oil 25. Roof Sheathing . 74. Overhead Hydro 26. T•Bar Ceiling (Structural) & Monocoat � 75. Dry Chemiwi -, 27. Frame ard FWshing 78. Dry Smndpipe ��. 28. Lathing & Sidirg 77. FIXED SYSTEM FINAL. 29. Insuiation 78. FIRE PREV. FINAL 30. Orywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster'erown Coat, 79. fINAL INSPECTION 32. Electrical Power MeterFinal 80. FOOD CERTIFICA�EISSUED 33. Final Electric ' ' Notes: . � 34. Final Heating & Air Conditioning �-p-g'S� � L�SS /� �� /�Oo i,r:ti �,pKiH� 35. Final Gas,Pipe�Test C��e j�� X /6�it �'�/�.CS - � 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. FINALSTRUCTURE&BUILDING �-�� (J� 48. Special R'equirements Completed ' • , � . � ' � 49. Elearic Release to Edison ,- - 50. Gas Release to Southern California Gas Co • � � , 51. CERTIFICATE OF OCCUPANCY. . _ _ _ - . , -� No. � ' _Date � � � � � _ _ _ .,� ApD��anl lo till In all iDaces exeept t�ose wlt�in �eavy Eortle� Iinas antl si9n all aDPropriate tleelarations. Y OF COSTA�MESA CONSTRUCTION PIERMIT PF_RMIT NO. TRACT NO. LOT NO. 11NIT Nh. PrOject Ac�ress .;� L�l � f-rh -5T . C. %% � Applicnnt's�MailingAddress, �-��y_i�/L�'� ��'�'L � M � -`� �( ,�2 �n� ca�a Phone.� Owner'�aame (�2/ [ Addres� �.��. �`�n��' �� Arch/Eng. License No. AAdress Contracror's Name- �� Phone Address (mailing) City license No. LICENSEO CONTRACTOR DECLARATION 1 hereby af/i�m Ihat I am licensetl unUe� pr viSlOni o/ Cna�te� 9(comm¢ncing with section 7000) of Oivlston 3 of t{(o\ ss antl Proten(ons Cotle, antl my license is in full force antl eHecL U LJcanse Class icense No. Oa[e Si9naWre WORKERS'COMPENSATION DECLARATION I M1ereby atfirm that I have a certificata o/ consent to Selltinsure or a certllicate ot Work¢r5' Compensation Inzurance, or d Certifletl copy lher¢ot (Sectlon 3800, Lab. C.) Pollcy No. Company ❑ Certifietl copy is hereby fumishea. ❑ Certifietl copy is filetl with the city Builtling Division. Date Applicant E%EMVTION FROM WORKERS' COMPENSATION DECLARATION (This seclion neetl mt be cOmO�etetl if lhe permit Is fo� ona huntlr¢tl (§300) or less). I cerUfy Ihal in lhe perlormance of the work fo� wttl lhi5 p¢rTh 15 IsSUeQ I shall not employ any person tn any manner so as o becom subject to the Workers' ompinsa on w5 Ot Cal fomid. . Date ��-.�-�LSi9natu� �.. .,,7.. .....�. n ......,e .n.�� comply with such p�ovlsion5 or [�I5 pe�mit Snau o0 aeemea �evoK¢o. CONSTRUCTION LENDING AGENCV I hereby aifirm that tnere I5 a Cons[ructlon Ientling agnncy ior the pertormanGe of the work for whith thls permit is issued (Sectlon 3097 Civ. CJ Lentler's Name LontleYs AOtlress OWNER BUILOEH OECLARATION I hereby alflrm that I am exumpt trOm Ih0 ConlraGtor's Llcen50 Law tor th¢ followin9 reason (Sectlon 7031.5 Business antl Professional Cotlo: Any cl[y or county whiGh require5 a pe�mit IO cOnsl�utt, altGr, Improvq demolish Or repai� any structure, prior to Its Izsuance, also requiros the applicant for such'oermil to file a signetl s[alement lhat no/sho is Iicansotl pursuanl to Iho provisions ot t�e Contractor's License Law (Chapter 9(commencing wllh Sactlon '/000) oi Division 3 of lhe Businezs antl Professions Cotlo) or that he�sha is oxompt therafrom antl lhe basis lor the allegetl ezamplion. Any viola lon of Seclion 7031.5 by any apDlicanl for a permit sub�octz tne ap011tant to a civil �enally of not more than tivn huntlretl tlollari (E500). ❑ I, a5 owner o1 tho proparty or my nTPloyeo5 wilh wages a5 lhal� sole compensation, will Oo the work, antl Ihe strutturo is not Inlentle0 or offeretl /or sale (Saction 7044, Business antl Prolezslonal Cotle: Tna Con[ractor's LI[eni¢ I.aw tloes not apply to an owner of a proporty wbo bulltls Or Impfove5 Ihereon, antl who does such work hlmsell/hors¢II or tntough hiz or nor own em0loyces, provitletl that such ImprOvements are not Int¢ntlotl or ottoretl fo� sale. Ii, howevoq lhe builtlin9 or Improvement is zoltl wltnin ono Yaar ol com- pletlon, the owne� wlll have lhn burtlan oi proving ha/sh0 tlitl not bulltl O� Im• ,, pr va for tho purpose o1 sale). , I, as owner of the Droperty, am exclusiv¢ty contracting wi[h Ilcen50tl <on- ractors to constru<t the Projec[ ($¢ction 7049, Business antl Profe55ions COtla: The ConVactor's Liconso law does not aPply [o an ownm o/ p�operty who builtls or improves tnereon, antl who contracts lor such projects with a con- , tractor�s1 licenze pursuant�to tne ConVattor's Liconie Law). I am aware tnat � proo( oi [heir WorkeYs CompenNHon ^utanca ShoW� bo provitletl to me. � I am exempt untlerrt5eption ��. 6 P. C. Por lhis r¢ason Date � -7- � � ��wner �' I hereby certify that I hav¢ reatl tfii5 iniormation Is correct. 1 agree to comv� antl state laws r¢latin�y to builtling cons sentatives of �tnis c' y to ent¢r upon inspectiOn purpose _ �{ /J TVPE OF CONSTRUCTION �tiJ NEW IJ ADD U ALTERATION U REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ^�, p,p,yy, �L.S - DESCRIPTION OF WORK/USE OF BLDG. ��Q-(�F-L�� S Main Building: E TVPEOFPERMIT GRADING FOVNDATION STRVCTVRAL T FrOnt ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear ❑ OTHER /' C Right PROJECT DESCFIPTION SQ. FT. �'Se�i� � S'c�'FTOCCUPANC K GONSTRUCTION TVGE � " VALUATION $ I��% $ t ZONE Q�� GRADING CU. VDS. ACRES p�ng. Ref. qW Remarks: Planning Notes: i y?� 2_ � � ..Jm h ...� <i, Bar Sink Backflow Preventer Backflow Irrigation Ba[hmbs Clerifiers � Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Kitchen Sink Lavatories P-Trap Roof Drains Reinspaction Fee $15 Boiler Duct - Under Ground Duct - Structurel Duct-Ventilating , Ezheust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑ ai oo,000 sru O i oa,000 sT �. Signature � 2 � M�� ^� uate � I Drivers' Licerise or 55 � _ � I I AeinSpeRion Fee ^� CMF 0865-46, rev. 10/86 Whit¢ - Builtling; Canary - Appliwnt; Pink - ACcountin9: GOltlenrotl - A55855or Service Sink Sewer Cap .�'; Sewer Connection � Solar Collectors Solar Piping _ - Solar Tank : ' +' Swimming Poo�w/Spa'- Urinal Water Clout Water Heater Water Service Auto-Wash Laundry Trays Isue Fae Hood or Typel 0 Canopy . Typell ❑ Refrigeration Sys[em ❑aioo.000aru ❑iao,000 System Repair/Alreration Fire Dampers Registers � laue Fee FEES Aummatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets 4473 12/�I/34 zone Accessory Building: Z'4 � Parkin9 Req./Provided n 1 I n f'7 i n n . � ELECTRICAL • Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over 100 amps Su6 Panel ' Motors�0�1 HPO1X-8 Inc.Solar 09-15 HP �16-15+ Microwave Garbage Disposal Generaror �0-5 KW 05�15 KW �-�� Range Siqn ; Standing Sections Trash Compactor � �-'b = -' � � . Z O N I N G R E � M T 5 FEES . , � Reinspection Fee $15 luue Fee $ 3 FEES � DEVELOPMENTSERVICESRE�UIREMENY1TS: YJ, � 2oninp Approved By p`i��/Wv Date-�5� Building ApProvad B� � �- ^� Data � !` n " ff Aoolintian luued Bv � � Date $ 3 SUMMARV OF FEES -�'� BUILDING PERMIT $� ��. FfO SMIP 3_� ' $LAN CHECK � $,� 5�n..2'Z- pERM1T �� ISSUANCE $ PLUMBING $ � - PLAN CHECK 25% $. • ENEFiGV P.C. $ ' •ELECTRICAL $.� � GRADING S _ PLANCHECK 50% $ � - MICROFILM $ }" MECHANICAL $ �' TOTALFEE $ Iq3..�1 . PLAN CHECK 25% $ � ' . . �ONSTRUCTION AND PLANNING �� APPROVALS Permit # �� 1.fTem orary Electrical Service or Po�e "2, Soil Pipe�Undrgrnd. .3. Electrical Conduit Utility-Undrgrnd. ��4. Electrical Conduit-Undrgrnd. . 5. Steel Reinforcement �6. Electrical UFER Grnd. �•7. Footings 8: Foundation �- - 9. Water Pipe�Undrgrnd. 10. $tructural Floor System �11, Property Sewer Line & House Connection 12. 5ewer Cap 13. Fioof Drains 14. flough Plumbing 15. Rough Electrical-Co�duit 76. Rough Electric Wiring 17. Fough Wiring Sign �i8. Rough Electrical-T Bar Ceiling 79. Rough Heating & Air Conditioning 20. Ftough Factory Fireplace 21. Ducts, in Structure 22. •Oucts, Ventilating 23.' Gas PIpe�Rough & Test 24. Roof Framing � 25. Roof Sheathing 26. T-Bar Ceiling (Structural) & Monocoat 27. Frame and Flashing 28. Lathing & Siding ' i 29. Insulation 30. Drywall Nailing �' 31. Plaster Brown Coat �ti �' 32..Electrical Power Meter-Final 33. Final Electric 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy j 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final . '' 40. Gas Service-Final . 41. Solar pomestic-Final 42. Backflow Preventer . 43. Backflow Irrigation - . � 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southerri California Gas Co 51. CERTIFICATE OF OCCUPANCY Date � ss POOLo��PA� 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. Elr.ctrical Conduit-Undrgmd. 59. Gas Pipe, O Undrgrnd., Test � 60. Backwash Lines, P-Trap, O Undrgrnd. 61. APPROVALTODECK 62. Backwash & Receptor-Final 63. Heater & Vent-Final 64. Plumbing SYstem - Final 65. Electrical-Final 66. Solar System-Final - 67. Fericing & Access :4pproval 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # 70. Underground Hydro 71. Product Piping O Gas ❑ Oil 72. Underground Flush 73. Undergrnd. Storage Tank O Gas ❑ Oil � 74. Overhzad Hydro 75. Dry Chemical � 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT � � �9 FINALINSPECTION �80. FOOD CERTIFICATE ISSUED Date I � 1 Notes: l- 9- dS' iUE�� L �rT4',c P� /1 Q / l�frC� �/ud / /�DfJ Date �Insp?c:or :J AOVllcant to fill in all spaces exea0t t�osa wit�in �eavy bo�tler IineS antl sign ail aoaropriate Eeclantions. CITV OF COS�A MESA CONSTRUCTION PERMIT Project Address � ��' G ('w % / �y"f�/ -S't � C : %� ' Ap�licant's Mailing Add�re/u �1� _ �( 'L/�'r d� % � �'% � Owner'sName �NG�/ ��('%1�,�{c.1! /.. Phone C�r�L/� Address �� `�f��/�'✓` Arch/Eng. ' LicenSe No. Address Contractor's Nam l'�'�% NMFr � � Phone Addreu (mailingl Ciry License No. LICENSED CONTRACTOR DECLARATION I nereby affirm that I am Ilcansetl untler provislons ot Gbartar 9(commancing with section ]000) ot �Ivision 3 0l th usiness antl Professionz Cotlu, antl my license Is In tull torce antl eifect. LicenSe Class nse No. Date - 9gnature WORKERS' COMPENSATION DECLARATION • I nereby aftirm tnat I �ave a certificata of consent lo salf-insure or a corUfiwte f Wo�ke�s' Compensation Insurance, or a ce�tlfietl copy tnereot (Section 300, Ldb. CJ " • Company 8 CertifieG copy is �ereby ur . Certifietl copy is filed with the city Builtling Division. Date Applicant E%EMPTION FROM WORKERS' COMPENSATION DECLARATION (Thiszection neetl not be completetl it Ine pa�mit i5 tor One huntlratl (EI00) or � less). I certify that in tbe performance o1 lbe wo�k r whith thi5 D¢rm�t ii i55uCG, I shall not emplo�n in anY mann¢r 5=as to ecome sublect to t�e Worker ' ompinsaH w5 ot CdlifOrnl . . Date i9nalure 'NOTI :If,a(ter a ing this tleclarat on, u sho itl bec e subject to the Wofker5' Compen5dtion PrOvisions o� lhe Ldbor Cotle, y0u mu5t IOrlhwith comply wltM1 Such p�ovlsion5 or thi5 Permit shall be tleemetl �evoketl. CONSTRUCTION LENDING AGEfJCV. I hereby altlrm that tnere is a construction lentling a9ancy tor t�e�0erformance Of [he wOrk tor whiCh [hiz permil is issuetl (SeCtion 3097 Civ. C.) L¢ntler's Name � Lentler's Atlaress - � OWNER BUILDER DECIARATION � I hereby affirm that t am exempt trom lha Contractor's LI<ensc law for the followin9 rea5on (Saction 7031.5 Business antl Frofesstonal COUe: Any city or county wnich requires a permit to construct, alter, improva, Cemolish or repair any st�uGture, priOr IO its I55uanCe, also req Wres tM1e applicant fOr such pormit t0 /ile d zignetl statement thdt he/she i5 licensetl pur5udnt [O lhe pfoviSiOns OI the Contractor's Ucense Lsw (Ghapter 9(commencin9 with Secllon 7000) ot Division 3 of lne Business antl Professions Cotl¢) o� that tte/sha i5 exempt tnere(rom an0 the basis tor th¢ allegetl exemption. Any violdtiOn ot $ection '031.5 by any ap0�icant tor a permit subjecls the dpplicant to d civil ieOdlty of not more than five buntlretl tlolla�s (5500). ' �� ❑ 1,'as� owner ot Ihe 0/o0erty o� my emplOyees wlth wag¢s as theb So18 ' com0ensation, will tlo Ihe work, antl the st�ucture Is nol intentletl Or Otteretl ' tor sale (Section 7044, Bvsiness antl Protessional Gotle:, The Contractor's License -Law tloez mt apO�Y �o an owner ot a property who builtls or impmves thereon, antl who tloes Such work himself/herselt or [hrou9h his or her own employee5, Provitletl [hat such improvement5 ar2 nOt intentletl Or offefetl tor sale. If, howevGr, [he builtlinq or imOrOvemen� Is soltl within One y¢ar ot cOm- � ple80n, tbe owner will have lhe burtlen of provin9 h¢/she tlitl not builtl o� Im- �rOve fori�e purpose Of sale). ' I, az owner of the vroperty, am exclusively mMracting wltn licensutl con- tractors to wnstruct the project (Sectlon 70a4, Businass antl Prolossions Cotle: Tne Contractor's License Ldw does not apply to an owner of proPerty wM10 builtls o� im0�o�e5 the�eon, antl who wntracts lo� 5uch pw�ec�s wll� a con- traclor(51 license pursuanl to tno Contrac[or'S Licans¢ Law). I am awar0 that proof o( lhelr Worker'S Comp�G satlon nsurancn shoultl be P�ovitleC to m0. ❑ 1 am exem0� untler Se<lion '/m�� _ _.,B. d P. C. lor thit reason � A Date �� Owner I bere�ertity t at I have reatl hi IntOrmation is correct. I agree lo compl antl stace laws relatin9 to IIUin9 conf �Sentativ¢s of thiz City ¢nter upon abovo iancas reDre- v.for -.L . � . .. TVPE OF CONSTRUCTION NEW �� ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q p � �/ � � � DESCFIP ION OF WORK/USE OF BLOG. �l'=%� �Zr /�'Y F .�,-�� S MainBuilding: E TVPE OF PERMIT GRA�IN FOUNDATION STRUCTURAL T Front ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Reaf � I ❑ OTHER A PROJECT DESCRIPTION 5�. FT. � oCCUaANCv _-_�i � Righc � � CONSTRUCTIONTVPE�-�-/V � VALVATION$ 5��_ g Left � ZONE GRADING CV.YDS. ACRES P��g. Ref. # Remarks: , � � — � Planning Notes: ' �. . . _ r . _ � �. �. .. l �, Sink Preventer Irrigation Clari(iers Dishwasher Drinking Founcains Floor Drains � Floor Sinks Gas Service Out�ets Sink Roof Orains Reinspection Fee � $15 Boiler Duct - Under Ground Duct-$LfuCtUral ' Duct - Ventilating Exheust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO 5W Hceting System & Ducting flo� i oo,000 eru O i oo.000 en m purposes. e �..�^ v�.�'/1.W��• DateLL� . L'c se 5� ��'� % Reinspeetion Fee 4ev. 10/84 White - Builtlin9: Cana�y - Appliwnt; Plnk - ACCOunting; GOltlenrotl - Hssesso� $15 Shower: Service Sink Sewer Cap Sewer Connection Solar Yipin9 Solar Tank Swimming Pool w/Spa Urinal . Water Closet Water Heater Water Service Auto�Wazh Issue Fee Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,000 BTU ❑ 100,000 BTU System Repair/Alteretion Fire Dampers Registers � ' Iwue Fee FEES Automatic Washer Construction Pole Cooking Unit Dishwasher ' 644I I/25/85 • � � i 2one Accessory Building: Par ELECTRICAL 7ransiormer ❑ 15-50 KW ❑ S0+ KW Meter ❑up [0 100 amps Meter �over 100 amps Sub Panel Fan F.A.U. Fixtures Device Boxes � Outlets � � 'Switches ' .+ ' Garba9e Dispoul Generator 00.5 KVJ.�&75 KW - 5 3 _ . S 3 � Reinspection Fee'� — DEVELOPMENTSERV Zoning Approved By— Building Approved 6y� $15 lie;. T. � 2 O N 1 N G R E � M T S FEES Motors " ' _ Inc.Solar 09-15 HP �16�15+ Microwave ' - Pole Light , Range • � � ^"�� Sign � �7 ; Standing'Sections , � Trash Compactor ' �^ r�� ' r Issue Fee �'�� $ 3 ��MEN � - ��Q.�' Date -' _� . . • � � � - SU MARV OF F�ES ' ry� BUILDING'PERMIT $ ��' � ' �SMIP ' $� • �v PLAN CHECK , $� �� '� �'pERMIT •)� ! ' PLUMBING � $ ' ISSUANCE :� '$ � PLANCHECK 25%�$ � ��.ENERGVP.C. $ , � ELECTRICAL �.; $' � �GRADING $ . PLAN'CHECK 50% $ r � MICROFILM $ MECHANICAL . � $" " � �TOTALFEE $ �7•� PLAN CHECK 25% $ � • r- � � � CONSTRUCTION AND PLANNING qP'PROVALS � Permit # ' 1. Temporary Electrical Service or Pole �2, .$oil Pipe-Undrgrnd. - � 3. Electrical Conduit Utility�Undrgrnd. '!4. Electrical Conduit-Undrgmd. 5. Steel Reinforcement � 6. �lectrical UFER Grnd. . • 7. Footings � 8:' Fouadation 9. Water.Pipe-Undrgrnd. 10. Structural Floor System 11. Property Sewer Line & House Connection 12. ,Sewer Cap 13. Roof Drains 14. Rough Plumbing 15. Rough Eiectriral-Conduit fk�aa�`b 16.' Rough Electric Wiring � � 17. Rough Wiring Sign � 18. Rough ElectriCal-T Bar Ceiling � 19, Rough Heating & Air Conditioning 20. Rough Factory Fireplace 21. Ducts, in Structure � 22. Ducts, Ventilating , 23. Gas Pipe-Rough & Test � 24. ROof Framing • 25. Roof Sheathing , � 26.,T-Bar Ceiling (Structural) & Monocoat 27.� Frame and Flashing . � 28. Lzthing & Siding ' 29. Insulation � 30. DrYwall Nailing . 31. Plaster Brown Coat 32: Electrical Power Meter-Final 33. Final Electric ' 34. Fi�al 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. Special Requirements Completed 49. Electric Release to Edison .50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY • Date Date 0 POOL _ SPA I�spector AppROVALS Permit # 52. Pool�& Equipment Location 53. Steel Reinforcement 54. Forms 55: Electriral6onding 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVER-GUNITE � 58. Electricel Conduif-Undrgrnd. � 59. Gas Pipe, � Undrgrnd., Test 60. Backwash Lines, P-Trap, O Undrgrnd. � 61. APPROVALTODECK 62. Backwash & Receptor-Final 63. Heater & Vent-Final 64. Plumbing System - Final 65. Electrical-Final 66. Solar System-Final 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # 70. Underground Hydro 71. Product Piping OGas ❑Oil 72. Underground Flush 73. Under9rnd.StorageTank OGas ❑Oil 74. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL i78. FIRE PREV. F�NAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: x Date �ISS' �j��yL Ac►�-r,v,��%o,:� �J�/ �.�v/iL ��L�� i�2.o �%i,�� Tm � C.'��7r�-� s vcTv�- - . a , � • f.�� O.� iCC-��2��'�.l%�r� ' �Cf/ec�C' (/l�l� % o �e (fPT �s V C%��i�Y � �-Y� �+a�.� Sh,a,�! 6.. �QT�� ,:�s -o�:,r�oa� � sr�,)`v e�c- -.� _ . r.- _ / � a PHOJECTAOUPESS: � �(}j VIC�TORIA ST owNExsName: COPLEY/COLONY CATV nooRess: SAME , ReQ i �� BSo v i�to ��"a APCH/ENGINEEfl: . REG.NO.: � aooness: UNIT: O uwT: PEHMITTEE: DEKORTE ELECTRIC ( 714 ) 361-8406 AOOflE55: 2'1ZS VIA CASA LOMA SAN CLEMENTE CA 92672 LICENSED CONTBACTOB OECIAXATION: I �ereby a�hrm I�at I am licensetl un0er pmvisions ol Chapter 9(commencing wiU Seclion 7000) ol Orvision 3 of Ihe BVsiness antl Prolessions Code. and my license is in tull lorce antl elfecl. cirruc.: Sif�p2 sTnreuc.:559304� cuss: 1� �aie: � S � Signature: — _ � �� y� WOflKEflS' COMPENSPTIUN OEC BATION: I �ereby aBirm �hat I have a ceni�icaie of co�em m sel4insure or a cetlilica�e o� Workers' Compensa�ion Insurance. or a certtlie0 copy �hereo� (Section 3800. Lab. C�. POLICY NO.: E%P. OATE: COMPANY: � Ce�ifietl copY i5 hereby fumishetl. ❑ Certifie0 caDY is �ileU wilh �he city Builtling Divisian. Oaie' ApPlicani: E%EMPtION FROM WOHNEHS' COMPENSA710N OECLi1BATI0N: (This section neeU nol �e campleteA il t�e permit is tar one �unarea ($100) or less�. I certi�y thai in Ihe pedormance o� �he work for w�ich �his permi� is issuetl. I shall no� employ any person in any mann¢f so as to 6ecome subled to Ihe Workers' COMPensation laws o� Cah�omia. /l �` a. �� Daie: �� ^ SignaNre: � — NOTICE: II, al�er making ihis etlaraii0n, yoU ShoUltl �etome SUble�� o lhe Workers' Compensation pmvisions of Ihe Labor Code. yau mu5i fo�hwiN comply wilh such pwvisians or t�is permrt shail be tleemetl revoke0. C�NS7811CTION LENDING PGENCY: I hereDy aHirm t�at there is a constmction IentlinA agency for ihe peAormance ot ihe work for w�ich Nis Oermi� is issued (Section 3037, Civ. C�. LENDEX: aooeess: OWNER BUILDEB DECIABpT10N: I hereby affirm ihat I am exempl imm ihe Conirac�ors' Sla�e License Law for tne lollowing reason (Settion 7031.5 Busine5s anJ P�ofe55ional Cotle: Any tiry ol wunry wAich repuires a permii lo tonstmct, alier, impmv¢, tlemolish, or repair any slmcture. orior lo hs issuance. also repuires the apolicam for sucn permii to tile a signed statemem thai �elshe is liceinetl pursuant to tAe pmvisions of the Convamors' Staie License Law (Chapter 9(commencing with Section 7000) oi Division 3 oi the Business an0 Pmfessions Cotle) or th2� he/s�e is exempl Iherefmm and ��e basis br ihe allegetl exemplion. Any viola�ion oi Sec�ion 7031.5 by any applicani lor a permi� s�blecis ��e applicant �o a civil penally o� not more than �ive hundretl tlollars ($500). . � I. as owner o� �hf. Pmperty or my employees with waAes as their sole compensa�ion, will Oo Ihe work, and �he ❑ simclureis nolintendetl oroflere0larsale (Sec�ion 7044, Business antl Pm�e55ionalCotle: T�e Con��actors' Siate License Law tloes nol apply to an owner ol a pmpe�y who builtls ar impmves �hereon, antl who tloes suth work himsel�/herself or thmugh his or Aer own employees, DroviOeU t�at such impmvements are not intenUeO or affere0 lor sale. II, however the builtling or improvemenl is sold within one year of complelion. ihe owner vnll have Ihe burAen ol pmving he/she Jid not Guiltl or improve for I�e purpose ol sale). _ I, as owner ol the proPeny. am exclusively conVacting wit� licens¢tl contrac�ars to conslmc� the prolec� (Section 704d, Business ❑ anA Pmlessions Cotle: The Coniradors' State License I.aw does no� appty m an owner of property who bwltls or imDmves �hereon antl who conirads fo� such pmjecis wiih a coniractoqsllicense pursuant to ihe Contractors' Stale License Law�. I am aware thal pmof oi �heir Worker's Compen5aiion insurance shoultl be pmvide0 to me. . � I am exempi unAer Section: B. 8 P. C. �or this reazon: � IOate: Ownec . I tlo hereby cenily Ihat I am Bware of and underslantl ��e requiremems ol California Heatlh antl Sa�e�y Cotle Sections 255U5, 25533, antl 25534 antl ihal I or any INurz building occupant will/will not (circle one) n9ed ta comply wllh 6ald 6late cotles ana �he requirements for a permit lor constmction or mo4ificaiion hom Ihe Air �uali�y Management DistricL Resitlen�ial constmc�ion applicaiions are exempt hom IheSe Orovisions. ` � Oa�e: Applicanl: `I here�y cerlilylAat I haveread ihis application antl sta�e Ihal ihe a0ove inlorma�ion is correct. I agree to comply wi�A ailcily an0 coun�y , ar0inance5 ana 5talelaws rela�i�9ta builaing con5imc�ion antl hereDyaut�orizerepresen�a�ives ollhis ciryto enter uDon�he above�mentionetl pmperty Iar mspeciion purpJses. , /J G / /p, .�_ Oa1e'. O '�J� Signa�ure. �—I �'�� oriver's L¢ense or Social security d: i6ai�a6 W�ite—Builtlinq: Green—Code En�orcemen�; anary—Applicanl; Pink—Revenue�GolaenraC—Assessor �'� C,ITY OF COSTA MESA - BUILDING PERMIT PERM NO; S 053650 PERMIT NO: &- 053650 PLAN CHECK NO; N GOVT; Y SUPP: N CONSTRUCTION TYPE; PERMIT TYPE; ELE PURPOSE; OTH JOB DESCRIPTION : PONER PEDESTOL , SQ FT: CLAIM VALUE: CALC-VALUE: GROUP OCC: B-2 / COMMENTS• NO STRUCTURAL WORK HEING DONE lFiF1E 3E �)E1E 1ElElEif dF�FiF�E iFlE�f 1E 1E IE iF iFiflElE�F 1F1EIE iElflf �EfElkif 1Elf if iE iFlFiE if 9E iEiFiFiE iEfFN �f if 3E1E iFiFiEif 1Eif if if iE iE1EiEiElE 1E�ElE1EiF1F 1E1E iE Z O N I N GS ERTEH�AUCIKRSE M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ------=-- FRNT: FT IN REAR: FT IN, FRNT: FT IN REAR; FT IN LEFT: FT IN RGHT: FT IN LEFT; FT IN RGHT: FT IN PARKING REQ• PROV; PARCEL: 00000000 2NE; REF NO; PLANNING NZSTES> , � �i�r�• . . � iF iF 1t 1f �F �kiF k it IF M iE 3f if fFif if �k it iF �F iF it if �FiE it ikif iF�F if 3F�f'ik iF 1f i!!f iE it �FiF �k 1f 1t �f 3FiE iF IF k�F iF iE �f 1F ff if if 3F k 1f if iFi! 1F iF if 3f ff if 1f iF�t k iFiF �f D E V E L O P M E N T-'" 5:&,: R V Z C E S R E Q U I R E M E N T S ,. "t.r 20NING APPROVED BY _ � -� �'-- DATE• BUILDING APPROVED BY ;� APPLICATION ISSUED BY: � 1f k�lf itit 3f �1t 1k k iE iF iF 1t if �f if �f �t 3Ffk 1F iE�iF 1k M itiE iF if iklf 1F �f �f ik iF iE iF if if �F �f if k iE iFlf LEGALIZATION:N BLDG PMT PLUMBING �it �flf iE �f �F ff iFiE E E S U DATE: DATE • -�i�� 1fiFiFkif�f�fifiFif fFiF ifik�l.+i f�F�FlffFlFik�F3F1F�fif�Fik�fiFiflf�FlFiElfiF�f�Fifikif�lkifiFifiF�f yYM A R Y STRUCTURAL SEGMENT;N MECHANIC FIRE SMIP/RES GRADING PERMIT SO SOY SMIP/NON-RES ' PLAN ISSUE FEE 15,00 ' BUILDING-DIV-> PERMIT IS E PLAN-CHECK TOTAL PAID DUE� TOTALS----> 0.00 0.00 0,00 0.00 ,00 ,00 REVENUE DIVISION TOTALS--> COLLECTED• ,00 OVER/SHORT• 00 BLDG PHT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN-CHECK iF it �f if iF if �f iE if �k iF it iF if if if iF k ik ik iF iF if iFiFik �t ik 1F if aF ik if 1k 1f 3t if 1f if if iFfFit iF iF 3t �t 3f iF iFiF if �F iF iFiF�t atiFiFi! if 3kif iliE if �l! iF iE 3t ikiF iF!! iF 3F 3k ik I N D I V I D U A L F E E B R E A K D O W N . TYPfi (?TY D E S C R I P T I O'N UNIT COST TOTAL COST ELE 1 SERVICES BELOW 600 V 6 BELOW 201 At9P 18,50 18.50 END OF FEES � ' � � 4�� 1 GC�]4d10:-L1l09o.t17 Zr�B ;' . „ L'a7E: 0°/�U:9?. Ti:1c: iQ::9 : � - --- �(/ CONSTRUCTION AND PLANNING . PO01 ,PA APPROVALS Permit # Date� Inspector pppROVALS Permit # Date Inspector � 1._Temporary Electrical Serv7�2 or Pole 52. Pool & Equipment Location ti. 2. Soil Pipe-Undrgrnd. �� 53. Steel Reinforcement ' . a��lecir�ical Cond�t�'t�'U�lity-Cindrgrnd. 54. Forms • } �+��4;�Elect7ical Condin,t_l�ridrgrnd. � 55. Electrical Bonding . ?� Steef Reinforceii'i�� _ � 56. Rough Plumbing & Pressure Test �'`. �i� � Electrical UfE�t' rgd. ,N 57. APPROVAL TO COVEP�GUNITE � r sS Foqtings t%�M h� . 58. Electrical Conduit�Undrgrnd. c� �- �+ S8� Foundation �y� j- 59. Gas Pipe, O Undrgrnd., Test �' H� W�at��r Pipe-Undrgt�d. 60. -Backwash Lines, RTrap, 0 Undrgrnd. i�� ,✓ 10. Str�`ctural Floor �stem . ' 61. APPROVAL TO DECK - 11. Property Sewer Ling�� Hoose;Connection 62. Backwash & Receptor-Final 12. Sewer Cap z "" � . 63. Heater & Vent-Final . 13. Roof Drains rc 64. Plumbing System - Final . 14. Rough Plumbiri,yg �'• 65. Electrical-Final 15. Rough Electric3`]:-Conduit 66. Solar System-Final 16. Rough Electric�Wiring 67. Fencing & Access ApProval "17. Raugh Wiring SJgn 68. APPROVED FOR PLASTERING 18. Rough ElectricBFT Bar Ceiling . 69. POOL/SPA SYSTEMS F INAL 19. Rough Heating & Air Conditioning � ' FIRE DEPT. REQUIREMENT C 20.t�fiiough . tory FReplace i a�r; �^� � C'.� u��: . PPR�VRtr6Hi�CPermit #+ x� �c ✓ � � tr � . �+' , ".� -n rr 21.�u�,inLStr�Ltu��' tFF xS .� �'' "� �-'�"` 0. �yde7S�pmaH�{�ro � •!� x i•• •�-+5 S C�-+x x� 9.� � v.� :r. � 22.�DucIs, Urhti�ating<x � ^S �r � S �x W� 1. ProductTP.F�ing �7c9}is Q+OiI � ' t u: x o' r;� M rn a, r) . �23.,�'jasEPipe�'�ioµ�h8i`f�est '�72. Underro�c�F1' � � .-a � h7S T!r7 7' 4 Od� r 9 �� : t- 24.r�§ioq�Fr�ming• pr: i FF •�F ' 7 O o' *� J 3�+UndergrnthStora<aTank€7Gas ❑C3'rl H Ii 25. Roo`P'Sheething NW r ;� *'•'� � v (�* x G ~�E"' M � r' ,� i-� �C v k• D> N:i x: 74n�verhead��iydro� .� �� _ 26. , -Ban Ceilin (Stn ural) & ocoat .� � � '� r 9 � �i�+l T G [*7m'.4' 75!7Dry Chemical �'-7 Y� � O oJ L. � 27.RFrame and Flashin �> � ^ �� • 76�'"Dry Stan��tF3e N� t; s � �� / �i/ �J' �Ju:47C r: O' J" U.7� �k Y28 �"Lathing�'¢� Siding`� c� �dx tK �: E .. ••� .•w x 77u FIXED 5145'TEfW�NALx � Ct , v a: q :1 ..'.. ;> a. >29. Insulatio`�4i �"- � � 78` FIRE PREV. FI(��IA �� '`� � 3x: S Yc d:.r. �'6 '1' I.}- :K'� rr, I • * r�0. Drywall� ailing tr;:}� `� :k `� �hc x �-+ HEAL�F{AEPT.t.REQUIREMENT .. 1. Plaster w Co,� �� i r � .�` * 79i�FINAL I, gECTI�JV .� b a O i� F rL ^`* � FF k ^ � ' p.32.�lectricarjPoa;er h4�e;tq�Final� � � �:$OF,fOOD CERi�IFI;F�F,t�7'E IS D rc r n 3. in Electri �� a *"' (,� x' N�s_,. ,ti� 7Z 'F' � '7t*1 +� "7 � D: {-� � .• x � r-ir-a a � i: x N J m. Cu34,-�in� Heatin �r o itio�w� ^ x .�; r� •,z; •� n� * S d 35 t�finatGas Pip�-T€ik�� 'y �x � ^oqt cc^ b7S � t^ ^O x ( . H :!: '*'O ON v. �D[T' . .. t " k: lq . ••Cl a. [�: t�i ,D36'Hoo�'d or CanoPY � p`t �[ry c r n x � no r �7t*. 7.�ina'�Factory FirepYece � 5tr O 'i [Tl . * " �t� 3[T! O v a' :L K N �8. Fin�Plumbin y � �� * � } �s 9 c+5 � o � X S �- +�r o t�9. WaCer Service�Final* � � o �x � !� !'Tf �ti �: :r. x K �r40. Gas Service-Final �' N '*' 'T � " tn .�.?; <Lri"tT� S :�c�l � W Oc oN ±. G' �,41. Solar pomestirFinaJ S C1� ^ w O% � `'t� �-' �'� .� � -r O tT � 7' Ct7 -.K ',7 {+ '1. �-+ O.: a'. F'732.�ackflow Prevente � `" ;J x. � lii * 'x ✓E� :t� fl � � Y' � 43. Backflow Ir �Jation'� xSS � * � x`-" �� `� '� v: %: V i i: tl � tT: VC * :t. ti _ P x, r. �._ ��14. Landsca� IRiqatio� Systerr��n r,y . p+ C7 v b?� x: �L t� F!'J � N o t✓ �. .r ' ^ ' ' �45.��ound AtterlLatiort• � F tr r Z F F F.K *'l � H '" ti:�5 X - - x x:� � tt F G Q 6.';;iandica`-R'tilati s d S � � " " "* � r : :-+o ••:� +� P e9. �c �- O y: * r cC S c+. S �: 47.�FIN�L STR1ilCTURE & BU OING x� �'! iv S � * i� + r �{�:k f U' '6 F 48.�INAL PLAIQ�NINC;, ' tr� '� I I f' � V � � . I F(-' :1. CJ n=k � l� H; K H �v49.tEleEiric Release to fdison i x ( •� � X � � "' ' c n � � ``,�,50.�Gaz�Aelease to Sou em Calitor ia Gas Co �' � �' »' `� o'� * � p T,�, t. �-, :r I � �: .: � r, r. or•f :r G :,51. CER7IFICATE OF70CCUP NCY � y::r -;� [�a ;; • E-. o N0. Date � . Applicanl lo /III ln all spaces ezcapt thosa wllhin heavy Ga�Ee� Ilnas an0 si9� all approprlate tlecia�ations. �IrY OF COS7A MEsn CIO�'NSTR � ON PERMIT . Project Address a �/✓ • Applicant's Mailing Address ' ' Owner's Name � Phone S v Address ` � Arch/Eng. � License No. Address c��q�� Contracmr's Nar� v � R^D Q/� 6 hona�—Z2L/�.��S Address (moiliny) ��' � ^ �^C Sf• C • i / � City License No, �9 �" � LICENSEO CONTRqCTOR DECLARATIOfY ' 1 hcreby allirm inat I am Ilc¢nsetl untler provi51on5 ot Chdrte� 9(commencing with section 1000) of Division 3 of the Business antl Professions Cotle, antl my license�is in tvll fo ewntl e ecL ' ��o�se� �1 ��e�, No233/��' � Date . Si9�ature b/ WOR ERS'C MPENSATION DECLARATION - I hCreby affltm Ihat I have a cerlilicate oi con5¢nl to s¢IftiOsur¢ o� a ce�8ilCdtG f Worker5' CompensatiOn Insurance, Or a carUfietl copY thereOt (Sectlon 500, Lab. C ✓ 0. - �^ PolicY No. �1��'✓��I ComPanY=�� `^' S ' Q�Certifiea copy is hereby fumishetl. ' , . � �4 Certi ' co 'iJp,tl with the city B' i D n Datc_ p�� s Applicant EXEM ION ROM WOiiKERS' COMPENSATION DECLARATION . (Thisx<tion ne¢tl not be completetl iT the permil Is /or one huntlretl (5300) or lest). I certHy that in the Oerformance of the wo�k tOr whlc� Ihis permk I5 issuetl I sball'not employ any person in any manner so as [o become zubject to t�e Workers' Comppnsstion Laws of Calitornia. . . Date. Si9na[ure �NOTICE: If, after making this tleclaration, you shoultl become sub�nct to the Workers' Compensatlon provisions of the Labor COCo, you must forlhwilh comply with Such provlsion5 Or this Oermlt •snall b¢ deemetl ravOkotl. CONSTRUCTION LENDING AGENCV ' I horeby dffl�m �hat there IS a cOnst�uclion I¢ntling agOnGy for tne,pertormance ot Ihe work for which thls p¢rmit is Issuetl (Sectlon 3097 Clv. CJ l.entler's Nama � LontlC/'s AOtlrebs OWNER BUILbEH �ECLARATION ' � � I neroby altirm that I am axampt from the Contractor's License L.aw for the following reason (Section 7031.5 Business antl Prolosslonal Cotlo: Any city or countY whicn �equires a permit to construct, alter, improve, aemolish or repalr uny sVucluru, pNOr lo Its tssuance, also requiros the apP��anl tor such permit to t110 a Slgnetl nalCment thdt h¢/She IS IICln50tl pursUant (O the plovlSlonS ot the Con(ractor�s Liconse law (Chapter 9(commencing with Sectlon 7000) ot DiviSion'3 of [ho,Bu5ino55 antl Profes5iOn5 COtla) of thdt he/5h8 IS axemp[ therelrom antl the ba5i5 Por th¢ a11e9e0 exemptiOn. AnY ��olaHOn ot SocUOn '031.5 by any applicant tor a permit subjects thn aooncan� to a civil enalty ol not more than five nuntlre0 tloltars (E500). 6 I, as owner of Iho proporty or my employoos with wa9es'as their solo compensatlon, �yill.tlo the work, antl t0e sVucture I5 nol Intentled or olteratl /o� Shce (Seclion 7044', BUs{ne55 antl Pm/es5iondl Cotle: The Contractor'S LicenSe Lavu tloes not apply lo an owne� of d p�op¢rty who builas or Improve5 thareon, antl Who OoeS Su<h work himselt/he�5elf O� tbrough hls or ha� own em0�oynes, prOvitletl thal Such fmprov¢menl5 ar0 not Intentlatl Or oHeretl fot sale. 11, howev¢r, tho builtling or improvement Is Soltl wllhin one yoar ol com- O�otlon. tne ownm will hava lhe burtlen ol provin9 he/sh¢ tlitl not builtl or IT- �Ove f0� lhe Pu�Dos¢ of sa10). LI I, as owner o/ tne Droperty, am exclusivaly conlractin9 with Ilcensoa con- tractors to construct llte prolect (Section 7064, Business antl Profesiions Cotle: Tho ConVat[or's Llcensa Law doe5 n0[ apply [O an owner of property who builtls or Improves tltereon, antl who contracts lor such projects with a con- tractor(s licanse pursuant�to thc Contractor's License Law). I am aware tna[ proof o� lheir Worke�'S COmpBnsation in5urance ShOuld be prOvltletl to me. ❑ I dm azempt untler $ectiOn B. 6 P. C. tOr thls rea50n Oal¢ Owner _ I hereby certity that I-have reatl this a informatlon is �p��ect. I agr¢B to comply an0 state laws relating to b tlinq conf sentatives ot this i[y to er upo Inspectlon purpose � Signature Drivers' Ucense or 55 � CMF 0865-46, rev. 30/84 White - Builtling; in anA slate Nat the abovc dty antl county ortlinancas antl hereby authorize repre- �ve•mentionea orooerty� tor _E 1 �%2,� � � _ _ _ _ —� TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVE0.5�ON ❑ DEMOLISH OTHER DESCRIPTION OF WORK/USE OF. BLDG. TYPE OF PERMI LJ GRADING LJ FOUNDATION LJ STRUCTURAI' .O 7ENANT �ELECTRICAL �� PLUMBING O MECHANICAL ❑ OTHER PR0.IECT DESCRIPTION Sq. F7. oCCUaAraCv_ CONSTRUCTIONTYPE VALUATIONS � ZONE GRADINGCV.YDS. ACRES_ Remarks. � Bar Sink Backflow Preventer — - Backflow Irriga[ion Bathmbs � Clari(iers Diahwasher Drinking Fountains Floor Drains ' Floor Sinks � Gas Service Outlets . � Interceptors . Kitchen Sink � � � Lavatories � • P—Trep - Roof Drains � . -. �Reinspection Fee $15 8oiler � Duct - Under Ground DuCt � Sttuctural ' Duct - Ventilating � ExhausCSystem ❑ MWtiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑aioo,000 eTu Oioo,000eT Reinspaction Fee � $15 AppliGant; Pink - ACCOunting; GoltlenfOtl - A55¢550/ Showers Service Sink - Sewer C2p . Sewer Connection. Solar Collectors Solar Piping Salar Tank Swimming Pool wlSpa Urinal Water Closet Water Service � Auro�Wash Laundry Trays laue Fee Hoodor 7ypel ❑ Canopy Type I I O� Re(rigeration System ❑aioo,000eTu Oioo.000 System Repair/Alteretion Fire Dampers Registers laue Fee F A.P. 5p S Main Buildi E T Fmnt B Rear A C Right K Left S Ping. Ref, � Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Eleci Fan . l� Fixtures , ' Device Boxes � �Q �UlIQtS Switches Garbage Disposal � Genera�or �0.5 KW �5-15 6375 I/2tj/li„ ^:,�u �t. Zone Accessory Building: �� . Z O N 1 - N , G R Parking Req,/Provided � � Q M � � T ' S EIECTRICAL �Transformer ❑ 15-50 KW ❑ SO+ KW Met u t 1 amps Meter over 100 amps � Sub Panel -. Motors061 HP�Ih-8 Inc.Solar �9-15 HP �16-15+ Miciowave � � � 'Pole Light . Range Sign ; Standing Settions � Trash Compactor $ 3 Reinspection Fee $15 laue Fee FEES . DEVELOPMENTSERVICESREDUIREMENTS: � 2oning Apprayed By Building APProved By , Application luued By � $ 3 FEES $ 3 , � SUMMARV OF FEES . BUILDING PERMIT $ SMIP � $ PLAN CHECK $ PERMIT � PL'UMBING $ ISSUANCE $ PLAN CHECK 25% $ ��OOO ---��,,,�� ENERGY P.C. $ --"' ELECTRICAL •S � GRADING �S PL•AN CHECK 50% �$ MICROFILM .$ MECHANICAL $ TOTALPEE $ Z�� PLAN CHECK 25% $ . ��CONSTRUCTION AND PLANNING �� POOL � S?A APPROVALS Permit�p Date Inspector qppROVALS Permit# Date Insp?ct�r � i 1. Tempofary Electrical Service or Pole � 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit UtilityUndrqrnd. 54. Forms 4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough PVumbing & Pressure Test 6. Electrieal UFER Gmd. 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-Trep, O Undrgrnd. 10. Structural Floor System . 61. APPROVAL TO DECK 1 i. 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 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, i� 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) & Monocoa[ - 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 Nntes: 34. Final Heeting & Air Conditioning 35. Final Ga5 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. .LandscaDe Irrigation System 45. Sound Attenuation • 46. Handicap F±e9ulations � 47. FINALSTRUCTURE&BUILDING 48. $peciai Requirements Completed ' 49. Electrie Release to Edison �50. Gas Release to Southern California Gas Co � ' � 51. CERTIFICATEOFOCCUPANCY- " - No. Date � - ' ► m Aop��ant to fill in all spaces except those witnin neavy Dortler Iines antl sign ail aoo�ov��ate tlectaretions. CITYOFCOSTAMESAB�CON/�STRUC9T IC�jN�PERryIIT , 'II Project Address' �(!;L—� / J�W t �yy� J ' Applicant'sMailingAddress ��S• x��' � �y�'- . Owne'r's Name b �� ' Phon��7�' Address � � ��t- � � i9/N�<. % d/�i (•�' /N, Arch/Eng. � , Licenu No. � � Address ' � � � ' Convacror's tvam�Q R 6r, ') O/.J /hQ'�M b'i 2D3 Address (mailing) � � S' � "'� 'S • L —�� /' Ciry License No. � -? 9 � � LICENSED CONTRACTOR DECLARATION I he�eby aifirm thal 1 am licensetl untle� O�ovi5ion5 ot Charter 9(commentlng with section 7000) of DlvisiOn 3 of the Business antl� Pro1¢Szions COUe, aotl , . my license Is in full �ce antlR(fect. n��/✓ y`� License CI s -� �� licens No.� Date Si9nature � � � ' WORK RS' COMVENSATION DECLARATION - � � � hereby af/irm that 1 hav¢ a ce�tilicate ot Consent to self-insu�e o� a C¢rtlfl<ate i Workers' Compensatio>nq In/surance, or a certitietl copy hereof Settlo 300. Lab�)`� �D/ b��/ _ . . , Policy No. / K Company • �Certitietl copy is hereby (u�nishetl. . '.�^ O C¢rtlff/IIC %O�% �5 �fl tl WIIh the City Bunuy�y DIV ��A� Date__Pt�yy�'1 APPIiCant Y—'� /l�Fi� . . EXEM 10 FROM WORKERS' COMPENSATION DECLARATION (This sectlon neea not be <ompletetl If the permit is for one huntlretl (E300) or less). I certity that in the pertormance of the wOrk tor which tnis perm�t i5 ISsu¢tl I 'Shall�nol employ any persOn In any manne� so as to'b¢Come Subject to t�e Workers' Comoensation Laws oi Callfornia. ' . Date- Si9nature ' 'NOTICE: If, after making this tleclata�ion, you ShOUItl become subject t0 the Workers' •Compensalion provislons of the Labot Cotle, you must forthwi[h wmply with mch provisions or this permlt shall be tleemetl revoketl. CONSTRUCTION LENDING FGENCV I hereby aiflrm Ihat there Is'a constructlon lentling agancy for tne pertormance ot the work for whiGh this _Oermit i5 Issuetl ($ectlon 309] Civ. C.) � l.entler's Name _ � i Lender'sAtltlress- - , -� � I OWNER BUILDEH DECLARATION 1 hereby affirm,that I am exempt M1om the Contractor)i License Law for the following reason (Section 7031.5 Business antl Professional Cotle: Any city or ' county which�requlres a perTit to Construct; altCr, ITProvo; tl¢molish or repair any structure, prlor [o Its�isSuanCe, also requlres th0'applicant for Sucb permit to tile a Si9uetl Statement that he/she IS Iicensetl pu�suant t0 the provisions of the Contractor•5 License Law (Chapter 9(commencing with Section �000) ot � Division 3 of the Businetz antl Professions CotlC) o� that he/ihe-i5 exemp[ tnerefrom antl the basis for the allegetl exemptlon. Any vlolation of Section '031.5 by any applicant for a permi[ subjects tM1e applicant to a<ivil ienalty ot not more than five nuntlretl tlollars (5500). . ❑ I, as own¢r oi the property Or my employees with wage5 as Ihel� sole ; compensation, will tlo the work, antl the structure is not intentletl or oiferetl for sale (Section 7044, Busine55 antl Profezslonal Cotle: The Contractor'S License law tloes nol epply [o an owner of a proporty wM10 builtls or Improves thereon, and who tloes such wo�k himzelf/har5¢II o� LhrOu9M1 his or h¢r Own employee5, provitletl that such improvements are not in[entletl or offe�ed tor sdle. If, however, the Gulltlin9 or imo�o�ement Is sold wllhin one year of com- pletion, tne owner wlll have tne burtlen ot proving he/she tlltl not builtl or im- piove tor [he Ourpose o1'saleJ. ' � I, as owner oi the property, am exclusivety contractin9.with Iicensetl con- . tractorsto construct the project (Sectlon 7044, Business ana�Professions Cotle: The Con[ractor's license law doe5 n0[ aOP�Y �O an owner ot prope�ry wbo builtls or improves thereon, antl who contracts for such projects with a con- tractor(sl Ilcense puisuant�to�th¢�Contractoi'i LlCense Law�. I am aware Iha["- proof ol their Worker'S Compensatlon insuranGe snoultl ba provitletl to me. ❑ I,-am ezempt untle� $ection . B. & P. C. �ar IhiS reason , Date Owner 1 herebv�certiH lha[ I nave�rea tion antl state that the above aII.Nty antl <ounty ortlinances i, and hereby au[ho�ize re0�e- bove-mentionetl prooerty for TVPE OFCONSTRUCTION IJ NEW U ADD.IJ ALTERATION 'IJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OT R �DESCRIPTION OF WORK/USE OF BLDG. �, �� TVPE OF PERMIT.�•j' LI GRADING �I.J FOUNDATION iLJ STRUCTURAL ❑ TENANT f/�ELECTRIGAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER � � ' � PRWECTDESCRIPTION Sa.Fr. ' � oCCUanrvCV— CONSTRUCTION TYPE VALUATION $ ZONE GRADINGCU.VDS. ACRES_ Remarks: Bar Sink' ' Backflow Preventer Backtlow Irrigation Bathtubs Jrinking Foun[ains Floor Drains � Floor Sinks �asService Outlets Interceptors � Kitchen Sink - i .,.,�.�.�o. . Showers . Service Sink � Sewer Cap + Sewer Connec[ion Solar Collectors Solar Piping - Solar Tank ' Swimming Pool w/Spa Urinal � Water Closet , Water Heater Water Service Auto-Wash P-Trap ' ' LaundryT�ays . Roof Drains � ' - ' ' Reinspection Fee $15 � � laue Fee - '�$ 3 Boiler � Duct - Under Ground Duci- Structural Duct - Ventilating ' Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting . ❑ a i oo,000 eru a i oo.000 I Signature L / !/Y'q ua�e �' . � � : Heinspection:Fee Drivers' License or 55 � ��— i J CMF 0865-46, r¢v. 10/84� White - Bulltling; Canary - Applicanh Pink - Accounting; Goltlenrotl - Assessor -- 0 $15 Hood or Typel ❑ Canopy Typell ❑ ' Refrigeration System � �� Oaioo,000sru ❑ioo,000eru System Repair�Alteration Fire Dampers Registers • A.P. #- , ' S� Main Buildi E T Front B Rear A C Right K Left S Ping. Ref. # Planning Notes: Automatic Washer _: Construction Pole Sub. Cooking Unit Dishwasher Fan F.A. Device Bones Outlets Switches Garbage Dispoul Generator �0-5 KW Fee 6872 2/01/y5 - Zone Accessory Building: Parking Req./Provided ELECTRICAL _Transtormer ❑ 75-50 KW ' OSO+KW � Meter ❑up to 100 amps 5-15 KW I Meter �over100amp Sub Panel � / Motors �0.1 HP �i% Inc. Solar �9-15 HP [ Microwave Pole Light ' ' Range I Sign � ! Standing Sections � Trash Compactor � $15 Issue Fee � FEES �DEVELOPMENT SERVICES REQUIREMENTS: _ Zoning APProved By � Building Approved By ��'��,{' Aoolintion luued Bv �/� " �" laue Fee � � $ 3 8 6-15+. I�a_:. i,. FEES _ � I $ 3 � . SUMMARY OF FEES BUILDINGPERMIT �$ SMIP $ PLAN CHECK $ PERMIT � � PLUMBING . $ ISSUANCE $ . PLAN CHECK 25% �$ ENERGV P.C. $ ELECTRICAL $ � �- SO GRADING $ PLAN CHECK 50% $ �J � 7 S MICROFILM ,$ MECHANICAL $ ' TOTALFEE $ I'{.ZS PIAN CHECK 25% $ � , ' �. Z O N I N G R E � M T $ L CONSTRUC710N AND PLANNING - • POOc a SPA . Date Inspector � � � Date Inspector APPROVALS Pe�mit# . APPROVALS Permit# 1. Temporary Electrical Service or Poie 52. Pool & Equipment Location ' � 2. Soil,Pipe-Undrgrnd� �� '. , 53. Steel Rei�forcement � 3. Electrical Conduit Utility-Undrgrnd.. .� 54. Forms � �4. Electrical Conduit-Undrgrnd. . 55. Electrical Bonding . �' -� 5. Sfeel Reinforcement ' 56. Rough Plumbing & Pressure Test _ , .� 6.� Electr,ical UFER Grnd. . 57S APPROVAL TO COVER�GUNITE � � 7. Footings � ' -. 58. Electrical Conduit-Undrgrnd. � �, 8. Foundation � • � 59. Gas Pipe, � Undrgmd., Test � 9. Water Pipe-Undrgrnd. , � . 60. Backwash Lines; P-Trap, � Undrgrnd. . 10. Sfructural Floor System .- 61. APPROVAL TO DECK ' 7�1,: Property Sewer Line & House Connection ' -� ' 62. Backwash & Receptor-Final 12. Sewec"Cap � � ' . � 63. Heater & VenbFinal . 13. Roof Drains 64. Plumbing System - Final _ 14. Rough Plumbing � - ' 65" Electrical-Final ' 15.�Rough Electrical-Conduit 66. $olar System-Final 16. �Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign ,; 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling � 69. POOUSPA SYSTEMS FINAL - 79. Rough Hea`ing & Air Conditioning . FIRE DEPT. REQUIREMENT, �� 20. Rough Facto�Y Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground HYdro � � 22. Ducts; Ventilating ' 71. Product Piping O Gas ❑ Oil �� 23. Gas Pipe-Rough & Test. ' ' 72. Underground Flush 24. Roof Framing � 73. Undergrnd, Storage Tank O Gas ❑ Oil 25. Roof Sheathing � ' 74. Overhead Hydro , . � 26. T-Bar Ceiling (Structural) & Monocoat � 75. Dry Chemical 27. Frame and Flashing , 76. Dry Standpipe 28. Lathing & Siding _ 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30: Drywall Nailing � HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat ' � 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric � Notes: _ _ _ 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test � � 36. Hood or CanoPY 37. Final'Factory Fireplace . ' 38. Final Plumbing . 39. Water Service-Final � ' . 40. Gas Service-Fi�al � - 41. Solar pomesticFinal ' � -- � , 42. Backflow Preventer � _ � _ _ . . _ 43. Backflow Irrigation � . ' 44. ,fandscape Irrigation System � � 45. Sound Attenuation i . . ' ' -. ' � 46. Handicap Regulations , � � 47. FINALSTRUCTURE&BUILDING i . • . , � ' � � �- ' � 48. Special Requirements Completed , • . � . ' 49. Electric Release to Edison � - • ' 50. Gas Release to Southern California Gas Co , � 51. CERTIFICATE OF OCCUPANCY � � - � ', . - � - - - - No. � Date - . . _ . � - - � � � ♦ �. ADOlicant to fill in all soaces eacepl those witnin heavy bortler lines antl sign all appropriate deciarations. C�TY OF COSTA MESA-� CON�TRU�TION��RMIT ; -P�R IT N/O./ �-!_- (� � TRACT NO. - LOT NO. �� UNIT N6. � . . '� ' _�'�IOiG/rl0 .t. ' , i.. . i � �Vroject Address �� !�. �S' f � s • � , � A;�plicant's Mailing Address K� ,� �LZR%i�%�D�Y1 � + � �a�a p$ -b�l—L6�S� Owner's.Name O i tl tA�GfA Phone Address " ' ��i!/��" �n . Arch/Eng. License No. Address '� � . Contractor's Nam � _Phone - , Address (mailing) � � ' I Ciry License No. � ' LICENSED CONTRACTOR UECLARATION I hereby aflirm that I, am.licensetl untler prOvislons Of CM1arte� 9(commencing with section 9000) oT DiJision 3 of <1 B isiness antl Professions Cotle, anJ ' my license is in tull torce antl eftect. ' , ' License Class � ' L1 ense No. � � Date Signature � ' ' . WORKERS' GOMPENSATION DECLARATION � � - I herebyaffirm that I have a certificate of consent to self-insure or a certificate � Workers' Compensation Insurance, or a certifietl copy thereot (Secilon l00. Lab. CJ _. .. _ . _ t . . . . . . - ' Policy No. • Company � eCertifietl copy is hereby fumishetl. � � :Certlfied copy is filetl with the city Builtlinq DlviSion. � ' Date ' Appliwnt ' ' � • E%EMPTION FROM WORKERS' COMPENSATION DECLARATION � (Tbissection neetl not be com0�ete0 if the permit is tor one huntlretl ($100) or ' �Iezs). - " ' _ ' ' . ' _ ' " I certity that in the pe�to�mance of the wo�k fyyy� which this pe�m�t is issuetl, I shall' not employ any person in any manner/So15 to become subject to the Workers�ComoensationlLws of CalifO��q./ �/ i� . � TYPE OF CONSTRUCTION LJ NE ❑ CONVERSION ❑ DEMOLISH � DESCRIPTION OF WORK/USE OF ADD ALTERATION 'REPAIR- TVPEOF PERMIT U GRADING LJ FOUNDATION LJ STRUCTVRAL ❑ TENANT ❑ ELECTRICAL p�❑ PIUMBING ❑ MECHA ICAL . ❑ �OTHER '.G/f�OLJ q �_�f.'Q,r. . ��fCCC PROJECT DESCRIPTION SQ.F7. OCCVaarv� cv � CONSTRVCTIONTYPE � VALUATION$� ZONE �� GRAOINGCU.YDS. ACR 5— Ramarks: ' - : I J� '. x, � :—. � � � Sink Preventer i Irrigation ing Founta � Drains 'NOTI�E: It, after makidg this tleclarat�nCYou shoQla becortf£Subject to the • Workers'. Compensation provisions ot the Labor Cotle, you must forthwitn FloorSinks , . � comply with. such p�ovisions oi th�s p¢rmit Shall be tleemetl _ rewketl. _ CONSTRUCTION;LENDING P.GENCV ' ' " ' GaSServiCe . Outlet I hereby affirm that there is a,ronstruct�on lendin9 a9ency (or the pertormance - � � Ot the work tor which'this permit'is issuetl (Section 3097 Civ'. CJ InterC¢ptOrS� � Lentler's' Name ' Lentler•s AtlOress � . , ' Kitchen Sink '' � OWNER BUILDER dECLARATION � - ' � � I hereby affirm,that.l am exempt trom the Contractor's License Law,forlthe LavatOfieS . . following reason (Section 0031.5 Bus�ness antl Professlonal Cotle: Any city or � ' county which requires a pe�mit to coPst�uct, alter, improve, tlemolisM1 o� repai� P-T�dp any structure, prior to its issuance,.also iequires the applicant for such permi[ . to file a signetl statement'that he/she 1s licensetl pursuant to the provisions ot � Roof Orains the Contractor'S License Law (Chapter 9.(commencing with Section 7000) ot ' �Division 3� of the Business antl Professions Cotle) or that he/she is ekempt � ,,- th¢refroin antl the basis tor the x1legCtl exemptiOn. Any violation ot Se[tion ' - ," �31.5 by, any_ applicant to� a, peYmit subjects tne applicant to a civil � � ialty of nol more than five huntlretl tlollars (E500). � 1,-as owner ot tbe propertyp� �ny,emplOyees with wages as their Sole R¢in5pettion Fee compensa[ion, will tlo the work, and the structure is not intentletl or otfereG tor sale �Section •�044, Business antl Professional Cotle: The Contractor•s . . License Law tloes not appry [o an owqer of a p�opertY who builtls or improves If h It tn h hi or her own $15 ther¢on, antl.who tloes such work himse / e�se o�, rou9 5 B��ef employee5, provitletl that such imOroVemenl5 are not intentletl o� otferetl (or � - sdle. It, howeveq Ihe builtling or impYOvement is soltl within one year oi com- pletion, the owner will� M1ave'the burtlen of proving he/she tlitl not builtl or im- Duct - Under Ground pr ve for[he.purpose ot sale). . : I, �as owner of the property, am°e%clusively contraccin9 �'�th �icensetl con- Duct -Structural r ctors to construcc ihe project (Section 7044, Business antl Protessions Cotle: , The Contractor'S LicenSe Law tloes Pot apply to an owner ot property who DUCt - V¢ntilating , builtls or improves thereon, antl who contracts for sucn projects with a con- • tractor(s} license pursuant to the Con«actor'S License Law). I am aware that EXh3Uit SySt¢m ❑ MWtipl2 ❑ proot of their Worker's Compensatitl� ��suran<e shoultl be provitlea to me. _ ❑ I am exempt untler Section—' B. & P. C. tor thi5 reason . Fir¢pl/FdCt. BIt. ICBO # r, Date , "� Owner � � Heating System & Ducting ' 1 her by cerfify at I have reaC his appiication an state that ttie above ❑0.100,OOOBTU �100,0006T Showers Service Sink Sewer Cap Sewer Connection ' Solar Collecmrs Solar Pipin9 - Solar Tank ' Swimming Pool w/Spa . Urinal Water Closet' Water Heater 0 u �� ! FEES � h ` '�� -reys ' i laue Fae ' $ 3 FEES Hood or Typel ❑ � - Canopy , Typell ❑ ' Refrigeration System �6700,OOOBTU ❑100,OOOBTU System Repair/Alterotion Fire Dampers • Registers � Intormatioais m rect. I.agree to.comPly with all clfy antl county ortlinances . antlstat¢ laws relating to bulltling const�uction, antl hereby authoriie repre- � , sentatives of this'•cit to enter�up0� the above-mentionetl property tor ' inipection purposes. � q�.s�9P Signature Date�/��p _ % "', . Reinspeetion Fee $15 Drivers' Licenze oY55 � CMF OB65-46, rev..30/84_ .Whit¢ - Builtl7�9� Canary - qppllcant; Pink - Acmuntinq; Goltlenrotl - �Assessor - - - - -- Issue Fea ' ' � $ 3 - AlP. # S Main Building: � ' — E T Ffont �/ A Rear C RigFit . _ S Left — Ping. F1ef. # Planning Notes: . - Automatic Washer � ' Canstruction Pole Sub. ' Cooking Unit � � Dishwasher � Dryers ❑Gas ❑Electii� Fan F.A.U. � Fixtures Device Boxes . � i Outlets � �- 4246—�4cl-�tr�• � . . .. � i. I . . �,- . ' �. .. - � Zone � Accessory Buildin ' ar in9•Req./Provitled' . J � ELECTRICAL ' � �Transformer ❑ 15-50 KW ❑ 50+KW i Meter Qup to 100 amps -Meter ❑over100amps Sub Panel � � Motors �0.1 HP �1 Inc. Solar �9-15 HP Microwave Pole Light Range , • 2 O N ' I N G R E Q M T �- S F.EES Sign „ j : ; Standing Sections , �5-75KW .- TrachCmmnacinr � � � ' .. _. . � . � ' � � � -� ^ . � ' ' � - . = Reinspection Fee $15 Issue Fee_ � � $ 3 — . DEVELOPMENT.SERVICES REQUIREMENTS: � ' Zoning Approve8 By ' � ate �� Building Approved B�-' ti= nate 2� . Appliotion laued 6y �r /�1.��i Date (Z� I TI%�i r` ,�i '� '. •�SUMMAqVOFFEES' : � ' BUILDING PERMI7 $ i' z�J �Si_� SMIP $� � 5 � —'. PLAN.CHECK $ s� � S� z-7 PERMIT � � , — � PLUMBING ' $ � ISSUANCE ;$ � �PLAN'CHECK � 25%• $ - ENERGV P.C. $ � �� - ELECTRICAL ` "$ �` ' GRADING ' $ , PLAN CHECK 50% $� � MICROFILM � $ � ' _ �MECHANICAL � $;�� TOTALFEE $ 3 • Z • . PLAN CHECK 25% $,'" � � � � I ., , ,�CC�NSTRUCTION AND PLANNING - �+ �APPROVALS - Permit#- Date Inspector i 1.��Temporarv Electrical Service or Pole ` ,� 2. �Soil Pipe-Undrgrnd. � `3�. Electrical Conduit Utility-Undrgmd. 4. Electrical Conduit-Undrgrnd. 5. Steel Reinforcement UFER Grnd. 7. Fooiir�gs �'8: Fou`ndation . � � 9.'Water Pipe-Undrgrnd. 10. Structural Floor System � �11:'Property Sewer Line & House Connection 12. Sewer Cap � 13. Roof Drains �. : 14. Rough Plumbing 15: Rough Electrical-Conduit 16. Rough Electric Wiring 17. Rough Wiring Sign � � 18. Rough Electrical-T Bar Ceiling . . 19�. Rough Heating & Aii�Conditioning 20. Rough Factory'Fireplace 21�. DuCts, in Structure ' 22. Ducts, Ventilating � 23. Gas Pipe-Rough & Test �� 24. Roof Framing : � 25. Roof Sheathing ' 26. T�Bar Ceiling (Structural) & Monocoat 27. Frame and Flashing 28. Lath;ng & Siding 29. Insulation � 30.. Drywall Nailing� , v 31."Plaster Brown'Coat ' � 32: Electrical Powei Meter-Final � 33. Final Electric ? 34. Final Heating & Air Conditioning - 35. Final Gas Pipe-Test ' 36. Hood or Canopy �' 37. Final Factory Fireplace -�. 38. Final Plumbing , 39. Water Service-Final ' ' . • 40. Gas Service-Final � 41. Solar pomestic-Final ' 42. Backflow Preventer � 43. Backflow Irrigation . 44. .Landscape Irrigation System 45. Sound Attenuation - 46. Handicap Regulations 47. FINALSTRUCTURE�&BUILDING 48. Special Requirements Completed ' � 49. Electrie Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATEOF.00CUPANCY . o. ' Date . a POO iPA � � 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, O Undrgrnd. 61. APPROVALTODECK 62. Backwash & Receptor-Final 63. Heater & Vent-Final � 64. Plumbing System - Final 65. Electrical-Final 66. Solar System-Final . 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOL/SPA SYSTEMS FINAL FIRE DEPT. REQUIREMENT . APPROVALS Permit # 70. Underground Hydro 71. Product Piping � Gas ❑ Oil 72. Underground Flush � . 73. Undergrnd. Storage Tank O Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe �77. FIXED SYSTEM FINAL �78. FIRE PREV. FINAL � HEALTH DEPT�. REQUIREMENT � �79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes:f 1-�S`��l4/d/!/CNpTf[�� /_ .o_ ol .,,,,.,�J e__.� c %-��Ecf ��fC�P/C' t c -Date Inspector �. � . 1 . _ ' I' l