HomeMy WebLinkAbout279 19TH ST - Building Permits PROJECT•AQDRESS: 279 E 19TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT rtdM NU: N U01 J4o
OWNER'S NAME:ARNOLD FREDERICK W
ADDREss: 279 E 19TH ST PERMIT NO; M 061348 PLAN CHECK NO: N GULJ : N Sure; N
COSTA MESA, CA 9?627
ti CONSTRUCTION TYPE: PERMIT TYPE: MEC PURPOSE: OTH
642-9435
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : CONVERT STORAGE ROOM INTO RECREAT/OFFICE SQ FT: r,
ADDRESS: UNIT:
CLAIM VALUE: CALL—VALUE: GROUP OCC; R-3 /
PERMITTEE: FRED ARNOLD ( 714 ) 642-9435
ADDRESS: 273 E 19TH ST COMMENTS: RE; B61347 PRIMARY BUILDING PERMIT,
>E
COSTA MESA CA 92627 *****#x#X## ##******##>t##t6####** �E#�Ett*##*iE#####x-*###*x##tE#*###########******###
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
7000)of Division 3 of the Business and Professions Code.and my license is in full force and effect. S E T B A C K S
CITY LIC.: STATE LIG.: CLASS:
Date: — Signature:
FRNT: FT MAIN FUILDIRNT:
FT IN FRNT: FTCESSINYREARLDING FT IN
WORKERS'COMPENSATION DECLARATION: I hereby affirm that l have a certificate of consent to serf-insure or a certificate of Workers' LEFT: FT IN RGHT; FT IN LEFT: FT IN RGHT: FT IN
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C).
POLICY NO.: EXP.DATE: PARKING REQ; PROV: PARCEL : 11721416 ZNE: REF NO:
COMPANY: PLANNING NOTES>
0 Certified copy is hereby furnished. 0 Certified copy is filed with the city Building Division. >
late: _ Applicant: DEVELOPMENT SERVICES REQUIREMENTS
;EMPTION FROM WI RICERS'CO 'ENSATION DECLARATION: (This seen... •ed not be completed if the permit is for we hundred(MO)or less).
I certify that in the t rformance ,I the work for which this permit i ' d,I shall note. oy an .erson in a• man 'r so as to become ZONING APPROVED .BY DATE:
subject l2 Wr ers'Com! n (m •ws of Calilorni.
I- • Date: —J? !/ Sign. re: / 'i ', i .r/. as ii
NOTICE.If.alter m. mg this declaration,you sho . • c. e so'o O
the Worke ompens.'rp ions of the Labor BUILDING APPROVED BY DATE:
Code. you musttoGAGcomplyIhersuchfirthattethisaconsshall ine tdeemedrecyto. APPLICATION ISSUED BY: L^` i' �3t I ` DATE: �//
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is aconsbuclion lending agency for the performance of the work for ***********************X-XX ** - *n .****>c •* *-it** -**************+****X-X-- k• li**
which this permit is issued(Section 3097,Civ.C).
LENDER: ##***********#*******##*#**#***#*********** **********##*************###******
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: Ihereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMI P/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of countywhich requires a permit to construct,alter,improve,demolish,or PERMIT 9 00
repair any structure.prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 2 5% SM I P/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by ISSUE FEE 15 . 00
any applicant tor a permit subjects the applicant to a civil penalty of not more than five hundred dollars(5500). BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
I. as owner of the property or my employees with wages as their sole compensation. will do the work, and the TOTALS----> 9 . 00 15 , 00 0 . 00 24 . 00 24 . 00 • 00
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law
does not apply to an owner of a property who builds or improves thereon,and who does such work himsett(herself or through
his or her own employees.provided that such improvements•are not intended or offered for sale.If.however the building or REVENUE DIVISION TOTALS--> COLLECTED• 24 , 00 OVER/SHORT: ,00
improvement is sold within one year of completion.the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMI P/TOT GRADING PLAN—CHECK
for the purpose of sale). ty,4 24 . 00
I,as owner of the property,am exclusively contracting with libr;sed contractors to construct the project(Section 7044,Business
and Professions Code: The Contractors'Stale License Law dtysnol apply to an owner of property who builds or improves thereon *******************************************************************************
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law). I am aware
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
.0 I am exempt under Section$P 70 4 4 B.8 P.C.
for this anon LL WORK BY Ohrie.R — PE QTY DESCRIPTION UNIT COST TOTAL COST
• Date: 3 0 i Ov e MEC 1 INST/RELOC RECESSED WALL HEATER 9 . 00 9 .00
I, I do hereby certify th I am aware of and understand the • ir,• is dl California Health and Safety Cod ections 25505,25517,and END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said state codes and the requirements for a
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions.
Date: - _ Applicant:
I hereby certify that I have read this application and state that the above info ation is correct-I agree to com•.with all city and county
ordinances and stale aws relatm o bunging construction and hereby a •. e repr.enla' sof this city •enter pon th• Y'• e.mentioned
property ler insp puree s. /, / /
Date:_.3 /19 Signal • // /If/1
Driver's License or Social Security a:) l }•: -- _ n. . -
1641,46 White—Building:Green—Code Enforcement:Canary—Applicant;Pink—Revenue;Goldenrod—Assessor
CONSTRUCTION AND PLANNING POOL &
APPROVALS Permit# Date Inspector APPROVALS Permit# Date Inspector
,
1. Temporary Electrical Service or Pole `' i' _ 52. Pool & Equipment Location .4
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, 0 Undrgrnd.,Test • r r
9. Water Pipe-Undrgrnd. r' 60. Backwash Lines, P-Trap, D Undrgrryf: -
10. Structural Floor System . f, 61. APPROVAL TO DECK -7
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap
63. Heater & Vent-Final
� i
13. Roof Drains -; 64. Plumbing System - Final
14. Rough Plumbing j 65. Electrical-Final
15. Rough Electrical-Conduit , . 66. Solar System-Finali,
16. Rough Electric Wiring 67. Fencing& Access Approval t •
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 i \,
20. Rough Factory Fireplace APPROVALS Permit#
21. Ducts,in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping D Gas D Oil
23. Gas Pipe-Rough& Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 74. Overhead Hydro
26. T•Ber Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding ) 77. FIXED SYSTEM FINAL
29. Insulation � 78. FIRE PREY. FINAL
I
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 't 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric ) Notes:
34. Final Heating& Air Conditioning 3b�,,u�-
35. Final Gas Pipe-Test ''�� 1 1
36. Hood or Canopy j'
37. Final Factory Fireplace I -
38. Final Plumbing 1 j
39. Water Service-Final
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING ,
48. FINAL PLANNING t
49, Electric Release to Edison • - r
•I
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY •
No. Date
PROJECT ADDRESS: 279 E 19TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: P Ub154`J
OWNER'S NAME: ARNOLD FREDERICK W
ADDRESS: 279 E 19TH ST PERMIT NO: P 061349 PLAN CHECK NO: N GOVT : N SuPP; N
COSTA MESA, CA 92627
CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE; OTH
642-9435
ARCH/ENGINEER: REG.ND.: JOB DESCRIPTION : CONVERT STORAGE ROOM INTO RECREAT/OFFICE SQ FT:
ADDRESS: UNIT:
CLAIM VALUE; CALC—VALUE: GROUP OCC; R-3 /
PERmITTEE: FRED ARNOLD ( 714 ) 642.-9435
ADDRESS: 273 E 19TH ST COMMENTS; RE: 861347 PRIMARY BUILDING PERMIT,
1J COSTA MESA CA 92627 *****************************************kr�E Y **>E*** ******E6*+tlr*x*** x •********
LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section Z ONING REQUIR EMENTS
70o01 of Division 3 of the Business and Professions Code.and my license is in full force and effect. SETBACKS
CITY LIC.: STATE LIC.: CLASS:
Date: signMAIN BUILDING ACCESSORY BUILDING
Signature'
WORKERS'COMPENSATION DECLARATION: I hereby affirm that haveacertificata of consent to self-insure oracenificate of Workers' FRNT; FT IN REAR: FT IN FRNT: FT IN REAR : FT IN
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT; FT IN
POLICY NO.: EXP.DATE:
COMPANY: PARKING RE • PROV: PARCEL : 11721416 ZNE: REF NO;
ElCenified copy is hereby furnished. ElCenified copy is filed with the city Building Division. PLANNING N TES>
>
**********************************************t********************************Dale: Applicant' DEVELOPMENT SERVICES ---:--
REQUIREMENTS
EXEMPTION FROM WORKERS'COMP RATION DECLARATION: (This • '• need not be completed if the permit is for hundred($100)or less).
I cenify that in the erformance of e work for which this p' ' is iss d• : all not mploy an .•rso 'n an a •• •as to become `
subject to se W. kers' snipe .alis La of Californi.. / /LUNING APPROVED BY ,e' DATE:
Date: Sign Air / BUILDING APPROVED BY
� � � DATE:
NOTIC•.If.after mak' g this declaration.you shou d become subject to the Workers'Compens. provisions of the Labor
Code.you must forthwith comply with such provisions or this permit shall be deemed revoked. '
CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for APPLICATION ISSUED BY: 1 — DATE; /
which this permit is issued(Section 3097,Civ.CI. *********BE**************** *'** -m - ** * ,**** ****************** •**
LENDER: ****************************************** ti7 **********************************
ADDRESS: LEGALIZATION:N F E E SUMMARY STRUCTURAL SEGMENT:N
OWNER BUILDER DECLARATION: I hereby affirm that lam exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct,alter,improve.demolish.or PERMIT 2 1 00
repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed 2 5% SM I P/NON—RES
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 of the Business PLAN
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars(S500). ISSUE FEE 20 . 00
I. as owner of the property or my employees with wages as their sole compensation, will do the work, and the BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
❑ structure is not intended or offered for sale(Section 7044.Business and Professional Code: The Contractors'State License Law
TOTALS————> 21 . 00 20 . 00 0, 0 0 41 . 00 41 . 00 . 00
does not apply to an owner of a properly who builds or improves thereon,and who does such work himself/herself or through
his or her awn employees.provided that such improvements are not intended or offered for sale. If.however the building or REVENUE DIVISION TOTALS--> COLLECTED• 41 . 00 OVER/SHORT• 00
orimprovement is ofsolds le)hin one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
for me purpose of sale). 41 . 00
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business
and Professions Code: The Contractors'State License Law does not apply to an owner of properly who builds or improves thereon *******************************.***********_**_**X-******.*..***,**.****_*.*****_***_*****,**
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware
that proof of their Worker's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
q I am exempt nder Section'•P704 4 B.&P.
tor this reas : AL' WO•K BY W "_'" , / : Y E QTY DESCRIPTION UNIT COST TOTAL COST
..c--- Date: // Q % ` L __,K``t -� LU 1 SHOWER 7 , 00 7 , 00
I do hereby c ify that I aware of and understand the requirements of California Health and Safety Code Sections 25505.25533,and PLU 1 SINK KITCHEN 7. 00 7 . 00
• 25534 and that I or any future building occupant win/win not circle one)need to comply with said state codes and the requirements for a LU 1 WATER CLOSET (TOILET) 7. 00 7 , 00
permit for construction or modification from the Air Quality Management District.Residential construction applications are exempt from END OF FEES
these provisions.
' Date: Applicant'.
I hereby certify that I have read this application and state that • e information is c• ed.I agree to comp with all city and county
ordinances and stat aws relati o building construction am •reb .uthor. • •• •se - es oft it aenl. pun tr... e-mentioned
properly Int msp non purp es. / _ / ' -
Date: L � Sig . : f�1/11 ��[�-
Driver's Li rose or Social Security a: 21 u::.: -°' - .
CTE: N. 1.: .. l:
1641,46 White—Building:Green—Code Enlmcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING POOL &
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 -
t , ' �
3. Electrical Conduit Utility-Undrgrnd. 54. Forms ,
. 4. Electrical Conduit-Undrgrnd. -- (. 55. Electrical Bonding / ,
5. Steel Reinforcement I 56. Rough Plumbing & Pressure Test . -
6. Electrical UFER Grnd. 57. APPROVAL TO COVE R-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
.
8. Foundation 59. Gas Pipe, 0 Undrgrnd.,Test '
,
9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK .
i 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final '
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains64. Plumbing System - Final
14. Rough Plumbing / 65. Electrical-Final
15. Rough 9 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 t 69. POOL/SPA SYSTEMS FINAL
-
19, Rough Heating& Air Conditioning FIRE DEPT. REQUIREMENTS•;'-
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 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 I i 77. FIXED SYSTEM FINAL
29. Insulation i I I 78. FIRE PREY. FINAL
30. Drywall Nailing I HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat I I 79. FINAL INSPECTION
32. Electrical Power Meter-Final { 80. FOOD CERTIFICATE ISSUED
33. Final Electric I ;/ i• Notes:
34. Final Heating & Air Conditioning i -l <i
35, Final Gas Pipe-Test
36. Hood or Canopy '
37. Final Factory Fireplace
38. Final Plumbing 3Jt43 Gg/,
39. Water Service-Final ; -J
. ) Il . .
40. Gas Service-Final
41. Solar Domestic-Final
42. Backflow Preventer I
43. Backflow Irrigation
44. Landscape Irrigation System '
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. FINAL PLANNING ,�
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
PRDJKT ADDRESS: 279 E 19TH ST UNIT: CITY OF COSTA MESA — BUILDING PERMIT rtItM NU: b V b 1 jy y
OWNER'SNAME:ARNOLD FREDERICK W
ADDRESS:2279 E 19T11 ST 79TE MESA, ST 92627 PERMIT NO: B 061347 PLAN CHECK NO: 00528-93 S wvl : Al burr: Al
e CONSTRUCTION TYPE: PERMIT TYPE: STR PURPOSE: ALT
642-9435
ARCH/ENGINEER: REG.NO.: JOB DESCRIPTION : CONVERT STORAGE ROOM INTO RECREAT/OFFICE SQ FT: 1 , 000
ADDRESS: UNIT:
CLAIM VALUE: 1 , 000 . 00 CALL—VALUE: • 1 , 000. 00 GROUP OCC: R-3 /
PERMITTEE:CRED ARNOLD ( 714 )642-9435
ADDRESS: 273 E 19TH ST COMMENTS: INSTALL BATH, TOILET & SINK IN 2ND FLOOR, ENLARGE DOOR
COSTA MESA CA 92627 ##*##*******************************###+E####* ETP***4***#*+E##*#*#NSE*##*##***#Oc##*
' LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section ZONING REQUIREMENTS
' ' 7000)of Division 3 of the Business and Professions Code.and my license is in lull force and effect. SETBACKS
CITY LIC.: STATE LIC.: CUSS: .
MAIN
BUILDING
ACCESSORY
LDING
Date: Signature: FRNT: FT IN REAR: FT IN FRNT: FTINREARFT IN
nature:
WORKERS'COMPENSATION DECLARATION: I hereby affirm that I have a certificate of consent to self-insure or a certificate of Workers' LEFT: FT IN RGHT: FT IN LEFT• O HT IN
Compensation Insurance.or a certified copy thereof(Section 3800.Lab.C). HOLD FSR SPEtlA REQUIREMENTS
POLICY NO.: EXP.DATE: PARKING REQQ• PROV: PARCEL : 11721416 ZNE: R1 REF NO•
COMPANY: PLANNING NOTES> INT ALT TO AN EX 2ND FLR OF A DETACHED GARAGF TT•v%'AT T 7 A
❑ Certified copy is hereby furnished. El Certified copy is filed with the city Building Division. > TOILET/SHOWER/HEATER/SINK (NOT IN SEP ROOM) uK REQUIRED
Dale: Applicant: DEVELOPMENT S E R V I C E SR E Q U I R E M E Nr.T S
EXEMPTION FROM WO: ERS'COMPENSATION DECLARATION: (This s '.n need not be completed if the permi s for one hundred(3100)or less). Vitt
�•
certifyI that ine the p: s'formarve of he work for which this p' ued,I sh. of emplo� iso in.; • ner so as to be ome ZONING APPROVED B Y Vit
subject to Me Wor rs'Compeof lion L.. of Californi. / DATE:
Date: ' Sig urs /. BUILDING APPROVED BY : DATE: `
NOTI: .her makim this declaration.you should become subject to the Workers'Comp ion provisions of the Labo
Cade.you usi tontr in comply with such provisions or this permit snag be deemed revoked.
APPLICATION ISSUED B Y: /������ �J( DATE: 3 /—' 9.S
CONSTRUCTION LENOIN AGENCY: thereby affirm that there is a construction lending agency for the performance of the work . *******************.**** Zig)*ir*_._ .**, ****x**xirx****x*16********* .;exxxxxx*#*
which this permit is issued(Section 3097.Civ.C1. ***************************..****B6******** *************************************
ADDRESS: LEGALIZATION:Y F E E SUMMARY STRUCTURAL SEGMENT:Y
1'
OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors'State License Law for the following reason BLDG PMT PLUMBING ELECTR IC•5 MECHANIC FIRE SMIP/RES GRADING
(Section 7031.5 Business and Professional Co* Any city of county which requires a permit to construct,alter,improve,demolish,or PERMIT 50 . 00 ,50
repair any structure,prior to its issuance.also requires the applicant for such permit to file a signed statement that he/she is licensed PLAN 32 . 50
ri SM Z P/NON—RES '
pursuant to the provisions of the Contractors'State License Law(Chapter 9(commencing with Section 7000)of Division 3 0l the Business
and Professions Code)or that he/she is exempt therefrom and the basis for the alleged exemption.Any violation of Section 7031.5 by ISSUE FEE
any applicant for a permit subjects the applicant to a civil penalty of not more than live hundred dollars($500).
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
I, as owner of the property Or my employees with wages as their sole compensation, wit do the work. and the TOTALS----> 50. 50 0 . 00 16 . 25 66. 75 66 , 75 . 00
❑ structure is not intended or offered for Sale(Section 7044.Business and Professional Code: The Contractors'State License Law
does not apply to an owner of a property who builds or improves thereon,and who does such work himself/herself or through
his or her own employees.provided that such improvements are not intended or offered for sale.11.however the building or REVENUE DIVISION TOTALS--> COLLECTED! 50 , 50 OVER/SHORT! ,00
improvement is sold within one year of completion,the owner will have the burden of proving he/she did not build or improve BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SM IP/TOT GRADNG PLAN—CHECK
for the purpose of sale). 50 . 00 . 50
I,as owner of the property,am exclusively contracting with licensed contractors to construct the project(Section 7044,Business
and Professions Code: The Contractors State License Law does not apply to an owner of property who builds or improves thereon ***,***,*,*,*,**************,*,****,****,******,*************************#****,****a(,******
and who contracts for such projects with a contractor(s)license pursuant to the Contractors'State License Law).I am aware
that proof of their Worket's Compensation insurance should be provided to me. INDIVIDUAL F E E BREAKDOWN
I am exempt under SectionBP 7 044 B.AP.C.
for this '
sre..on: ATI. WORK BY OWN�r— •A9TYPE QTY DESCRIPTION UNIT COST TOTAL COST
Date:_ Owner Ay .�� / SFR 1000 ALTER BY VALUE RESIDENTIAL NOZONE 1 . 00 1 , 000 • 00
I do hereby ce ify that I.m aware of and understand the recite.^ . California Health and Safety Code Sections 25505,25533,and END OF FEES
25534 and that I or any future building occupant will/will not(circle one)need to comply with said stale codes and the requirements for a
permit for construction or modification from the Air Duality Management District.Residential construction applications are exempt from
these provisions.
Date: Applicant:
I hereby unity that I have read this application and state that the a.. :' ',nation is correct.I agree to com y with all city and county
ordinancesand state laws relating to building construction and.- ':y auth•u• •natives of thiscity to sots eon above-mentioned
property for insp bon pure es.
Date:— —j_ gna " / .
Silu
Q/
Driver's Li nseor cial Security# ' - - - -
1641.46 White—Building:Green—Code Enforcement:Canary—Applicant:Pink—Revenue:Goldenrod—Assessor
CONSTRUCTION AND PLANNING POOL& a
AP2ROVALS 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 Reinforcement56. Rough Plumbing & Pressure Test' '
6. Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd. N.-
8. Foundation r 59. Gas Pipe, n Undrgrnd.,Test
, r
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd..'
•
10. Structural Floor System - 61. APPROVAL TO DECK •
11. Property Sewer Line& House Connection • 62. Backwash & Receptor-Final
12. Sewer Cap - 63. Heater & Vent-Final
j'
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 i"
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 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing . . 73. Undergrnd.Storage Tank OGas OOil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical I
27. Frame and Flashing 76. Dry Standpipe
28. Lathing& Siding77. FIXED SYSTEM FINAL
29. Insulation _ 78. FIRE PREY. FINAL
30. Drywall Nailing • HEALTH DEPT. REQUIREMENT
A
31. Plaster Brown Coat 1 . 79. FINAL INSPECTION
32, Electrical Power Meter-Final
- i 80. FOOD CERTIFICATE ISSUED
33. Final Electric i i I Notes:
34. Final Heating& Air Conditioning I 1,
35. Final Gas Pipe-Test 3 I. HOLD FOR SPECIAL REQUIREMENTS
I
36. Hood or Canopy 1
37. Final Factory Fireplace
38. Final Plumbing o
39. Water Service-Final a I i
40. Gas Service-Final +r 1
41. Solar Domestic-Final G; I ,
42. Backflow Preventer I
43. Backflow Irrigation tl
44. Landscape Irrigation System
45. Sound Attenuation w
SY,
1 46. Handicap Regulations a
47. FINAL STRUCTURE & BUILDYNG
yiV3_,PLAI
rri
48. FINAL PLANNING <";:,..,
49. Electric Release to Edison S
50. Gas Release to Southern California Gas Co .
51. CERTIFICATE OF OCCUPANCY
No. Date
Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations.
CITY OF COSTA'7ME_yica ' c STRQUC I'�(_PERMIT PERMIT Nl 96,5-6 TRACT NO. LOT NO. - UNIT NO. ��_Project AddesL•7 ( l / + 1Accessory Building:
c- TYPE OF CONSTRUCTION U NEWip ADD U ALLT RA ON U REPAIRApplicants Mailin Address •U ❑ CONVERSION ❑ DEMOLISH I�g OTHER �L� �� �N6fLni:citir.m1.
ront �-
er'sName ��� �2NQL� Phone U •ESCRITIeN OF1•RDEUSE OF B yrG. - ear N
Sf3 �E 0 . N
Eng. License No. TYPE 0 'ERMIT , GRADING S FOUNOATI•SRUCTURAL Oight G
cessNI TENANT f>I ECTRIC,L yst PLUMBING II MECHANICAL eft R
•ntractor's Name C,-)//3 Phone �� OTHER L ,S/ ''s Y •y GW- 'CNC�ajs.f - -Ing, Ref.# Parking Req./Provided E
PROJECT DESCRIPTION SQ. FT. /J
ddress(mailing) OCCUPANCY Ou Planning Notes:- - , L z? C •
/IMs/N K LT 4/ Sf �< M
CONSTRUCTION TYPE n� VALUATIONS 7D., 1 T
City License No. ZONE GRADING CU.YD5. ACRES l l'f f I Ie f cpkt.ee- Q 4- S.
LICENS. • CONTRACTOR DECLARATION q/. -
I hereby at •• that I am licensed under pr. • s of Charter 9 (commencing Remarks: (A a 11..,# `'v r s
•
with. section 70i• - •!vision 3 • . tusiness and Professions Code, and
ELECTRICAL
my license Is In full torte .. .. • - FEES
License class License No
Date Signature ` . PLUMBING FEES Automatic Washer Transformer 0 15.50:KW
WORKERS' COMPENSATION DECLARATION ` I
Construction Pole Sub. 0 50+.KW ��
I hereby affirm that I have a certificate of consent to self-insure or a certificate Bar Sink , Showers
of.Workers' Compensation Insurance, or a certified copy thereof (Section Backflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps
'0, Lab. C.)
:y No. Company Backflow Irrigation Sewer Cap ■ Dishwasher IIIIDover 100 . ■
{„I Certified copy is hereby furnished. Dryers 7,Gas ❑Electric
LJ.Certified copy is filed with the city Building Division. Bathtubs Sewer Connection El /i
Date Applicant 00-1 ■ I(.`
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers Solar Collectors 1 y��
.(This section need not be completed if the permit Is for one hundred ($100) or ■. ■
Fixtures . Microwave
less). Dishwasher Solar Piping �
I certify that in the performance of the wggq�e�kkc for,wryych this rmn Is issued, I .11
• fi'J
shall not
+ ploy any person In any i S6.fsto b subject t Drinking Fountains Solar Tank
Work waRspp Laws of Cali • //C//'
Date / Signa re � . • . � .
Device Boxes
NOTIC If, ter makingthis dee ion, you should be oma subject t0 e
Workers' Compensation provisions of the Labor Code, you must forthwithI. I. _® I Outlets
• �j
comply with such provisions or this permit shall be tleemetl revoked. IP
CONSTRUCTION LENDING AGENCY tEL
Gas Service Outlets VVater Closet 2Pla Switches DisposalGarbage Sign
I hereby afllrm that they!Is d isn permit s Issue agency for the Performance
of .the work for which this permit is issuetl (Section 3097 CIv, C.) _
Lender's Name
Lender's Address eKitchen Sink Water Lavatories• • , Heatertors Water Auto-WasService Generator ■M ■ Si
OWNER BUILDER DECLARATION
I hereby affirm reaso that I am exempt from the Contractor's License Law for the
following reason (Section 7031.5 Business and Professional Code: Any city or __ �l
County which requires a permit to construct,alter,Improve,demolish or repair _P—Trap ■ Laundry Trays _. - - -
any structure, prior to Its Issuance, also requires the applicant for such permit -
to file a signed statement that he/she IS licensed pursuant to the provisions of . Roof DrainsI. _■ a r
I the Contractor's License Law(Chapter 9 (commencing with Section 7000) of '- r
Division 3 of the Business and Professions Code) or that he/she is exempt Reinspection Fee $15 Issue Fees • '/ /i .
therefrom and the basis for the alleged exemption. Any violation of Section --
1.5 by any applicant for a permit subjects the applicant to a civil w
illy of not more than five hundred dollars($500). DEVELOPMENT SERVICES REQUIREMENTS: t
�, as owner of the property or myemployees with wages as their sole Reinspection Fee $15 r
pI Zoning Approved By Date
compensation, will do the work,and the structure is not Intended or offered -
•
for sale (Section 7044, Business and Professional Code: The Contractor's Building Approved By * a /' Dat
License Law does not apply to an owner of a property who builds or Improves /�/ /
thereon, and who does such work himself/herself or through his or her own ■ Application Issued By AP /•a �.'_ Da
employees, provided that such improvements are not Intended or offered for Boiler Hood or Type I
sale, If, however, the building or Improvement is sold within one year of Com- Canopy Type II ■ SUMMAR OF 'ES
pletion, the owner will have the burden of proving he/she did not build or ImDuct-Under Ground-
Move for the purpose of sale). BUILDING PERMIT $ 3-7 e CD SMIP .07
Li I, as owner of the property, am exclusively contracting with licensed con- • Refrigeration $ ,
tractors to construct the project (Section 7044,Business and Professions Code: PLAN CHECK $ PERMIT !
The Contractor's License Law does not apply to an owner Of property who e 00-100,000 : 0100,000 : 9• - / ( •
builds or Improves thereon, and who contracts for such orolects with a con- • PLUMBING $ PO _ ISSUANCE '$
tractor(s) license pursuant to me Contractor's L cense Law). I am aware thataust ystem ■ ■ PLAN CHECK 25% $ - ENERGY P.C. $ .,i'
prool of their Wor er's Compensationinsurannc should be provided to me. M •• , • 5r
❑ I am exe pt u er Section E/V P.C.for ' re n , :• DampersELECTRICAL $ GRADING �$•
q�' z.5 -.
Q '�y/'µ�i ■ PLAN CHECK 50% $ _ MICROFILM' $' 'Ii\..
Date (/,�/ s�� Ow�.l • MECHANICAL $ ITOTAL FEE ;10.,'a'(• �
I hereby Certify that I d this application and state that the above , 00-100,000 : 0100,000: $
information is correct. I agree to c•mply with all city and county ordinances ■ _. PLAN CHECK 25% $ 'l' s f s` 0 I 1,•.Al
and state laws relatin• b ding con • lion, an.,- on authoriz Meer•- ■ . -. _ _
Inspection
of this ., ' -r e abov�s�f ones prop, ty f.r ■1 { I .�i
Inspection •urpos• Date 7 I■ `\
Signature
0865-46,rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor _ - - _
CON, n AND PLANNING POOL T 'q '
APPRO� „a\ Permit# - Ate Inspector APPROVALS Permit Date Inspector
1. Temporary Electrical Service or Pole �� 52. Pool & Equipment Location ,A�
- r I L.-
2. Soil I?ipe-Undrgrnd. t • cl 53. Steel Reinforcement f,.• 1
3�Elect?ical Conduit Utility-Undrgrnd. 2- 54. Forms --.' ' %
.4. Electrical ConduYUndrgrnd. 1 55 . Efeetrical Bonding �• 1 ✓�
7
54Steel'Reinforce`yent - 56. Rough Plumbing & Pressure Test . "f-1 f
61, Electrical UFER Grnd. ) 57. APPROVAL TO COVER-GUNITE 7 Li
i t
7(F;oot�ngs f` i 58. Electrical Conduit-Undrgrnd. --,.....41 .71/1.1;
ill W. Fou1tdation i , %-a 59. Gas Pipe, 0 Undrgrnd.,Test /
4
9.,Wa[ Pipe-Undrgrnd. ` 60. Backwash Lines, P-Trap, 0 Undrgrnd. - " -7t ,t
10rStructural Floor System ,1 , ) 61. APPROVAL TO DECK •, o % •r I!-
11. Property Sewer Line & House Connection /' 62. Backwash & Receptor-Final
.12. SeVv-Cap •' 63. Heater & Vent-Final 'f ��/jv '
r
13. Roof,Drains is'', 64. Plumbing System - Final Hildi --1/;:".
14. Rough Plumbing o !' 65. Electrical-Final ` ' 7,)
15. Rough Electrical-Conduit '�"
66. Solar System-Final IN
16. Rough-Electric,Wiring 67. Fencing & Access Approval
. 17! Rough Wiring Sign 68. APPROVED FOR PLASTERING
118. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
v
119r Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factoryrireplace APPROVALS Permit#
RI I 21:! Ducts,in Structure 70. Underground Hydro
22. Ducts,-VentilatFJ 71. Product Piping 0G0
Gas Oil
t ing
/
23. Gas Pipe�Rough_& Test / �. Underground Flush /
24. Rdo(tEing� ,� 73. Undergrnd.Storage Tank 0 Gas 0Oil /-
ram
25. Roof Sheathing?"/0 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and)Fla hing 76. Dry Standpipe
28. Lathing'&i$iding 77. FIXED SYSTEM FINAL
29. Insulation to 78. FIRE PREV. FINAL
t n n
30. Dry-,wall'Nailingl - i• HEALTH DEPT. REQUIREMENT
• 31. Plaster Brown Coat AJ 79. FINAL INSPECTION 1
32. Electrical Powert-Meier-Final /.4 t FOOD CERTIFICATE ISSUED
v
33. Final Electric 91 r
,"✓,t iv/4/ � f -.E.7 -s:
34. Final Heating&)Air Conditioning/ ///( -. v +y' ' -.E.7', n 65 .
35. Final Gas Pipe-Test
36. Hood or Canopy .
37. Final Factory Fireplac -
e -
sr .
38. Final Plumbing ",% :.,' .- Y(/Sj43'-t0 - _ -
39. Water Service-Final T`'¢_ eil -
40. Gas Service-Final �, ' :j • 1
,
41. Solarpomestic-Final, J -. . ./ Hi .41�
42. Backflow Preventers r• - . - . / 1_ - Y -
J
43. Backflow Irrigation;• ' r - •//fi ISI (r I n)
44. Landscape�lrrigationniScstem - �/ ti�T r f ^q�j
45. Sound Attenuation" 7
r . k t4 I(pla3 `fp{i� Vs0"--I.�(
46. Handicap Regulatiops" r-- _ ` C)1 -. -
47. FINPL'STRIUCTel RE&By 11/77C01.97/93 1115/- ��`�f a I �_
' ;netnra✓i/1 rt ( r� , .
48. Special-RequiretsCompleted . - . v '--- - ,QO, +
49. Electric Release to Ellison 1.';- �, -\
50. Gas Release to Southern California Gas Co •
/ri�y=�-GJ v ceC
51. CERTIFICATE OF OCCUPANCY ! 1.J e'' .2 !1 yI�.rf.� •.� t��6 et
No. .. • . .Date t • !. i 's r- dine '
I
Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declaations. - s,• P MIT NO. TRACT NO. LOT NO. UNIT NO.COSTA MESA _CONS RUCTION PERMIT 2403 4/0 /85 -flirF
roject Address 2 79 G r 1 7 H S r. - /55 a3 qq 71 i9 l,!�' . -. . ..• ! �,S,4,-?e) TYPE.OF CONSTRUCTION NEW U ADD U ALTERATION U REPAIR
(Il$pts N's Marlin• AddrCst //�tpp.. rr ❑CONVERSION ❑ DEMOLISH ❑ OTHERJ��� - / ',"wns Na e 0- /Cie -A e. t'hone/02•/49 A.P,# 11 -] -ao/-]' /69 I Zone ej _C : DESCRIPTION OF WORK/USE OF BLDG. Nem+ Z 'STfSIZ-'/' 1[{iddcess •
/ ` tC Ar 3 ' �•r- E Main Bul mg:/f �'(,� essory Building: ZrcA/Eng. License No. TYPE OF PERMIT GRADING U FOUNDATION ❑ STRUCTURAL - T Front & / J O
ddress ....//,�..-�'�LLpp ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL - A Rear `/•`(' Nontractor's Namef.[.c-��L•F/�✓J�-D•�••e Phone ❑ -OTHER .!.? - C Right N
PROJECT DESCRIPTION SG- FT. /ci/ Z DCCUPAry yrJ K G
ddress(mailing) ><
CONSTRUCTION TYPE l/ N VALUATION$ jL/ 00 U $ Le Bf -
ityLicenseNo. ZONE GRADING CU.YDS. ACRES R
ICENSED CONTRACTOR DECLARATION Q� Ping. Ref.>hh pier -840- la tr.� Parking Req./Provided - E chereby affirm that I am licensed under provisions of Charter 9 (COmmendng Remarks: ' �� j� Planning Notes: HOLD EOR SPECIAL REQUIHEd4R:4 iJ CIM
ith section 7000) of Division 3 of the Business and Professions Code, and t..1 .y license is in full force and effect. / 4 / , / T
•icense Class License No- ` "� "`' _ - O. -I / 1 0 0-1 r .1 -L O. ,I 4...-Lyy�1'_-��/"" '' �y11-._ / S
ate Signature PLU :ING I FEES 14 .0 •1 r� �� Garai a".1 hrnAlORKERS' COMPENSATION DECLARATION Bar$ink , Showersrhereby affirm that I have a certificate of consent to self-insure or a certificate ELECTRICAL FEES
f Workers' Compensation Insurance, ora certified copy thereof (Section Backflow Preventer Service Sink - -
900, Lab. C.) - Automatic Washer Transformer 0 15-50 kW
Policy No. Company Backf low Irrigation $ew&'Ca t,' - 0 50}KW
• Cap Construction Pole Sub.
,r n Certified copy is hereby thehed. - - _ .
❑ Certified copy Is filed with the city Building Division. Bathtubs Sewer Connection • 49 Cooking Unit' • Meter Duo to 100 amps
Date Applicant
1 EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers. - Solar Collectors ._ Dishwasher • - Meter Dover 100 amps-- -
(Thissection need not be completed if the permit is for one hundred ($100)or - • `
less). Dishwasher Solar Piping - -xDryers ❑Gas ❑Electric Sub.Panel
I Certify that in the performance of the work for • ich this permit is' s • I -
shall not e ploy ny person in any ma t. •ecome sum the Drinking Fountains Solar Tank Fan
work yi t' Laws of Cali . f. Motors 00-1 HP 01%-8
Datexio#j�(i/�[� Signatu : /������ Floor Drains SwimrRing Pool w/Spa ^ F.A'.U.
NOTICE If,atter making this declar •n, you •u • •e ome subject to the ` Inc.Solar ❑9-15 HP 016-15+
Workers' Compensation provisions of the Labor Code, you must forthwith Floor Sinks Ur. al
Fixtures Microwave
-
comply with such provisions or this permit shall be deemed revoked-
CONSTRUCTION LENDING AGENCY - Gas Service Outlets Water Closet - - it
I hereby affirm that there is a construction lending agency for the performance • Device Boxes Pole Light _ • I
of the work for whic this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater -' OutI¢Ls' •
'Lender's Name _ Range - IRO
Lender's Address
_-/ Kitchen Sink Water Service r Switches Sign .-T�
OWNER BUILDER D CLARATION .
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash • . . Garbage Disposal i • ••
following reason (Section 7031.5 Business and Professional Code: Any city or ,Standing Sections
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays • Generator ❑0-5 KW❑5-15 KW Trash Compactor - - -
any structure, prior to its Issuance, also requires the applicant for such permit
to file a signed statement that he/the is licensed pursuant to-the provisions of Roof Drains - - -
the Contractor's License Law(Chapter 9(commencing with Section 7000) of - •
Division 3 of the Business and Professions Code) Or that he/she is exempt -
therefrom and the basis for the alleged exemption. Any violation of Section -
7031.5 by any applicant for a permit subjects the applicant to a civil ' •
g ty of not more than five hundred dollars($500). •
-
oInonn. ..a,h��. to mv.-Wo Reinspection Fee $15 Issue For $ 3 I •
_
I, as owner of the property fir the structuret _
/ uU�I will do the work, and the is not : The Otl ntracered - Reinspection Fee $15 Issue Foe 1 / -r $ 3 -
for sale (Section 7044, Business and Professional Code: ThesContractor's) MECHANICAL - FEES
-//tr License Law does not apply to an owner of a property who builds or improves "
thereon, and who does such work himself/herself or intended
his or.her own •
DEVELOPMENT SERVICES REOUIREM TS: '-:
employees, provided that such Improvements are not Intended or offered for Boiler Hood or Type I 0 • //�
sale. It, however,the building or improvement is sold within one year of com- Canopy Type II ❑ - Zoning Approved By - �i D.� ���,� Ifs
plellon, the owner will have the burden of proving he/she did not build or im- Duct-Under Ground Building Approved By i.nag. I •.t.y.e���i;:�
prove for the purpose of Sale)-
0 I,as owner Of the property,am exclusively contracting with licensed con- Duct-Structural Refrigeration System .Application Issued By tb. •at- fF7:
tractors to construct the project (Section 7044, Business pod Professions Code: -
Tlie Contractor's License Law does not apply to an owner of property who Duct-Ventilating 00.100,000 BTU ❑100,000 BTU t .�.
btsilds or improves thereon,and who contracts,for such projects with a con- __ S[(�MMAg,'LOF FEES
tract orfs license pursuanl'lo the Contractor's License Law). I am aware that Exhaust System ❑ Multiple j System Repair/Alteration - BUILDING PERMIT $ I2•��J SMIP $
proof of their Worker's Compensation insurance• ould be provided o me. PLAN CHECK $ PERMIT
•
❑ 1 am exempt u der Section P.C.for reason Firepl/Fact BIL ICBG# I Fire Dampers ISSUANCE $
/r•//d „sr — PLUMBING $
Date 1Fi Z - Owner . eS�0f����E%e Heating System& Ducting Registers -
I hereby cerci y that I have rea• s p� - and state that the above ❑D-100,000 BTU ❑100,000 BTL •
PLAN CHECK 25% $ • ENERGY P.C. -•$
information is correct. I agree to comply with all city and county ordinances ELECTRICAL $ GRADING , S
and state laws relati • b ild• g construction,and ereby authorize repre- MICROFILM $
sentatives of tn.'_dig!'" en-r •on the ab• -- -ntioned pro-•rty f.r PLAN CHECK 50% $ r •
•
insPectIOn p $ 98 7�
Signature .• / //.�/' -a Oat-_ .•••••
MECHANICAL TOTAL FEE $
Drivers' Lice -- 0 "... !ei �� Reinspection Fee $15 /n{-Is-su_e-Fee $ 3 PLAN CHECK 25% $
J- / ,s
CMF 0865-46,rev.10/84 White - Building; Canary.-Applicant; Pink - Accounting; Goldenrod - Assessor /id" (�i.(Q' �.�`�A J�
t
'OJASTRUCTIOIV AND PLANNING POOL&SrA'
AP!' LS' Permit# Date Inspector APPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole , 52. Pool & Equipment Location
2. Soil Pipe,Undrgrnd. • 53. Steel Reinforcement •
•3. Electrical,Conduit-Utility-Undrgrnd. - 54. Forms ,
4: Electrical Conduit-Undrgrnd. - 55. Electrical Bonding .
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
• 6.•.Electrical UF ER Grnd. 57. APPROVAL TO COVER-GUNITE r
7. Footings '(t ."r/g& vc • 58. Electrical Conduit-Undrgrnd. -
' 8. Foundation 59. Gas Pipe, 0 Undrgrnd.,;Test -
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd. -
•
10. Structural Floor System - 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final '
12. Sewer,Cap 63. Heater & Vent-Final
13. Roof Drains • , 64. Plumbing System - Final
14. RougRPlumbing 65. Electrical-Final
15. Rough Electrical-Conduit - 66. Solar System-Final -
16. Rough Electric Wiring 7-_ s-.gs--get. I(4 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 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank 0 Gas 0 Oil
25. Roof Sheathing 7/cl,Y/0 Vr /y , 74, Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat � 75. Dry Chemical
27. Frame and Flashing • r/0 /,P VL 76. Dry Standpipe
28. Lathing & Siding . Fj��p/$�`7 JL, 77. FIXED SYSTEM FINAL
29. Insulation 61/41$7 ✓L, 78. FIRE PREV. FINAL
30. Drywall Nailing A//(alt? VC._ HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric 4,-j -4y e,,,,v Notes: 6/30/g,J _ ivQ APP47f0
34. Final Heating & Air Conditioning HOLD,FSPAL REQUIRESILII a n8 pQ Xelli
/
35. Final Gas Pipe-Test 67f�- F tete 1W, L NJ'- A tea
36. Hood or Canopy - CCc�'M �'I 3 r fa,
37. Final Factory Fireplace -
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. SolarDomestic-Final . �
•
42. Backflow Preventer
43. Backflow Irrigation -
44. Landscape Irrigation System
•
45. Sound Attenuation
46. Handicap Regulations (�
47. FINAL STRUCTURE & BUILDING /- ,9efVlb I / I ' / 0308
48. Special Requirements Completed / (( �" ; r' , ' .12: 1 • -
49. Electric Release to Edison &k.- r'fr ./C-4-t 'I
50. Gas Release to Southern California Gas Copalwi- mo r. tste " .P„• ,• 7-51. CERTIFICATE OF OCCUPANCY , / t4r4tNo. Date V
I.
.
4.
- Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. _00'70' 7/24/86 . (s•30 T_L{ 1
•
CITY' r COSTA MESA PERMIT PERMIT NO- l ��� TRACT NO. LOT NO. UNIT NO. 1 •
-
Pr0)ec• !_-Pyddress 2 / ( L-• / ♦ _ c LC GG/-L �-,// • ' '
Ap;i1`ant's Mailing Ad/d�ress i TYPE OF CONSTRUCTION , 'U' NEW ❑ADD Li!ALTERATION U REPAIR• ' ;i
EPA-0 477?��O/ /f _ } El CONVERSION ❑ DEMOLISH ❑ OTHER _ • A.P.# • Zone
'y pwner's Name q /moi _ �J/ Phone�J DESCRIPTION OF WORK/USE OF BLDG.
s Address � � - • S Main Building: . Accessory Building: i
---. lI��'II Z
Arch/Eng. -/� l • es icense No. TYPE OF PERMIT GRADING ❑ FOUNDATION 0 STRUCTURAL T Front . 0
Address • - p q ,IE TENANT ELECTRICAL ❑ PLUMBING MECHANICAL i Rear I N
1'Contractor's Name,0&14✓•��/!707Carl '❑ OTHER- - A Right - - - - - N
Phone •
. PROJECT DESCRIPTION. SG. FT. • • OCCUPANCY K G
Address(mailing) Left
CONSTRUCTION TYPE ,VALUATION S S R
City License No. - •
'ZONE GRADING CU.YDS. ACRES•• ,
LICENSED CONTRACTOR DECLARATION Ping. Ret.# Parking Req./Provided ) E
i •
a
I 1 hereby affirm'that'I am licensed of th provisne s of Charter 9(commencing Remarks: i Planning Notes: M
with section 7000) of Division 3 of the Business and Professions Code, and - T
my license is In full force and effect. ' ^���,-23247'9 - S
License Class License No. /J -
Date Signature • . . PLUMBING FEES - -
WORKERS' COMPENSATION DECLARATION • Bar Sink • Showers ' , I - ELECTRICAL. - FEES M:
I hereby affirm that I have a certificate of consent to self-insure or a certificate
of Workers' Compensation Insurance, or a certified copy thereof (SectionBackflow Prevenier Service Sink
3800, Lab. C.) ` Automatic Washer • 'Transformer 0 15.50 KW . ..
t . . 050+KW
;Ce No. Company - Backflow Irrigation Sewer Cap Construction Pole Sub., • -
Certified copy is hereby the
J Certified copy is filed with the city Building Division. • Bathtubs - Sewer Connection , Cooking Unit Meter Pup to 100amps -
•
Date Applicant -
EXEMPTION FROM WORKERS'COMPENSATION DECLARATION Clarifiers - Solar Collecjors - Dishwasher - Meter Pover'-100 amps - ,1
(This section need not be completed if the permit is for one hundred($100) or -
less Dishwasher • •
). Solar Piping Dryers ❑Gas ❑Electric Sub Panel
I no fe in the rior mance of[he f•r w c ,,,���sssyyyddd111' permit ed'I - - '
• shall not e ploy a erson in any j.• `•me�••'evtto the Drinking Fountains Solar Tank •
Fan - Motors 00-1 HF 01,h-8
Workp�a7 p s JC�ws of C.•• / �. -
• Date / �n Signature Floor Drains • Swimming Pool w/Spa F.A.U. Inc.Solar 09-15 HP 016-15+
NOTIG` f,a t mak ng this dec . ion,you ou d •eco subset • he rxf
Worker Comp nsation provisions of the Labor Code, you must forthwith Floor Sinks •Urinal 0 Fixtures Microwave
comply with such provisions or this,permit shall be deemed revoked. • 0 e.0
CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Device Boxes • Pole Light '
I hereby affirm that there is a construction lending agency for the performance
of the work for which this permit is issued (Section 3097 Civ. C.) Interceptors Water Heater Outlets Range /'zQ
Lender's Name % OA)C .,
Lender's Address - ll/C/ Kitchen Sink Water Service • - .7_,_ Switches • Sign 0 545
OWNER BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the Lavatories Auto-Wash Garbage Disposal Standing Sections
following reason (Section 7031.5 Business and Professional Code: Any city or
county which requires a permit to construct,alter,improve,demolish or repair P-Trap Laundry Trays Generator 00-5 KW 05-15 KW Trash Compactor '
any structure, prior to Its issuance, also requires the applicant for such permit ,
to file a signed statement that he/she is licensed pursuant to the provisions of Roof Drains '
the Contractor's License Law (Chapter 9(commencing with Section 7000) of _ -
Division 3 of the-Business'and Professions Code) or that ne/she is exempt - -
therefrom and the basis for the alleged exemption. Any violation of Section .
7031.5 by any applicant for a permit subjects the applicant to a civil • - )
'Penalty of not more than five hundred dollars($500).
-) I,'asI owner of the'property or my employees with wages as their sole Reinspection Fee I $15 Issue Fee: $ 3 '
:
>mpensatlon will do the work, and the structure is not Intended or offered — 1 - ' Reinspection Fee -f $15 Issue Fee $ 3 ..
or sale (Section 7044, Business and Professional Code: The Contractor's MECHANICAL . FEES '
License Law does not apply to an owner.of a property who builds or improves __ _ '
thereon, and who does such work himself/herself or through his or her own DEVELOPMENT SERVICES REQUIREMENTS: .' '
employees, provided that such Improvements are not Intended or offered for .
sale. If, however, the building or improvement is sold within one year of com- ■ Zoning Approved By Date
' pletion, the owner will have the burden of proving he/she did not build or Im- Duct- Under Ground
prove for the purpose of sale). Building Approved By Date *--7/z'
/ ,
• IJ I, as owner of the property,am exclusively contracting with licensed con- • '- • . Application Issued By Date �S � "'_'
tractors to construct the project (Section 7044,Business and Professions Code: .
The Contractor's-License Law does not apply to an owner of property who • 00-1•It I r f e ■ f s r s r SUMMARY OF FEES . -
builds or Improves thereon,and-who contracts for such projects with a con- .
tractor(s) license pursuant to the Contractor's Li -nse Law). I am aware;thathaust •stem ■ ■ BUILDING PERMIT $ -SMIP $
•proof of their Worker's Compensation i• uran . should be provided to me. PLAN CHECK $ PERMIT
'0 lam e4mmatt tAdder Section �/1/ •�& P.C.fo ,is r.son B• •. • ISSUANCE $ • -
Date/ �/ Z�� ••vner /� .�� PLUMBING $ - -
r4 • -ENERGY P.C. $
PLAN CHECK 25% $ •
i hereby Ce Ify that I have •.• this app.: l.n and state t at t e above ■I I1 111 0100,000 .57•2_,S _ 'GRADING - $ -
information is correct. I a• ee tort• ply with all city and county ordinances ELECTRICAL• $ -
and state laws relating u' • n9 0• ctlon,and hire•. author ee recce- PLAN CHECK 50% $ /o • MICROFILM $ •
sentatives of this o .�er a above- •:n •neo pr••erly or ‘. So
• inspection purp di `�/A f MECHANICAL $ / - TOTAL FEE $
• Signature /' / I/ �� •ate - • - - J -
s -Drivers' Llcen . • SS# - .
��/
CMF 0865-46,rev. 10/84 White - Building; Canary - Applicant; Pink-Accounting; Goldenrod - Assessor /
CONSTRUCTION AND.PLANNING • 3 POOL &SPA
APPROVALS Permit# Date Inspector APPROVALS Permit # Date Inspector .7.2
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 COVE R-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, ❑ Undrgrnd.,lest
9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap,.0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14: Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring _/5-87 "7.Ajaw 67. Fencing & Access Approval
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 0 Gas 0 Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.Storage Tank O Gas 0 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
..-...,..39r-F'rnaf Efectrre-.: <,...-.-:.; ::a _-.`;.T ;rf N� -Notes:.,.- -.... ..M:. . .........,_,.::.- -�._.-"-�....',_.._ _._..�....;. .....
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test •
36. Hood or Canopy •
37..Final Factory Fireplace .
•39. Final Plumbing •
39..Water Service-Final
40. Gas Service-Final _41. Solar Domestic-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
srr
50. Gas Release to Southern California Gas Co -
51. CERTIFICATE OF OCCUPANCY - `r
No. Date _ . -