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Home My WebLink About642 18TH ST - Building Permitsoi r'Aoplicant to fill in all j ctT, o �eosra MEsa CON�S�T/j� UCnT�ON PERMIT � Project Address �� w`� � Ci ��,r�" N ll' Q Applicant'sMailingAddress �-, << �� 4 � � Oviner'sName� p�� ' hone '��7� Address� flL��=—��.QLN �T �� 9�2% Arch/Eng. �V� ��V�� License No. 1 q.�.� -� Address �iL�p��'g G.�`%� �i�t �-�/-�� /�O��-�.iL Contractor's Name�� Phone 5��1� / Address (mailing) � '�Z� City License No. r • � �—, � " LICENSED CONTRACTOR DECLARATIO ' � ' I hereby a�1i�m that I am licensetl untllr provi5i0�5 of Charter 9(commencing. with 5¢<lion �000) of DiviSiOn 3 0l (he Bu5ine45 antl PlOfQ55I0lIS COAE� dfld my license iz in tull force antl efiecL � '' .� � • _ License Class L'I�ense No. Oale Signature � WORKERS' COMPENSATION DECLARATION �.�• ' ' , 1 heveby aifirm that I have a certl(Icate of consent to snlf-Insure or a•certlficafe� ' Workers' Compensation Insurance, or a cerUfletl copy thereof (Section 00, Lab. C.) � : -olicy No. Company° I ' , •� 8 Certifietl wpy is hereby fumishetl. � �� ' Certifietl copy is (iletl with the <ity Builtlinq.D�y�Sion.�� J Date Appli<ant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION. : � (This section need not be completetl it the permit �s (or one huntlretl (5100) or less). � '� - _ ' I certlty that in the periormance of the work fo which tnis oerm�t is issuetl, I� snall nol employ any person in any manne s�to become subject to.the' Workers' eRsation Laws of Californi ' -^ • - Date Y+� 9nature � � � � � � NOTICE: 1, afier making tnis tleclaration, you snould becoma subject to the Workers' Compensation provisions o! the Labor Cotle, you must forthwith comply with such provisions or tnis permit sha11 be tleemed revoketl. CONSTRUCTION LENOING AGENCV ii '.• I hereby a/iirm that there Is a conslructlon lentlinq agency"for Che"performance of [he work for {� ic this er is 15suetl (SecUon .309] Civ. 'CJ LEnder'S Ndme� '"' �� "'��l` �C.� LentleYs Atltlress� � �"'�'"T��M L� ` "-"' ' - OWNER BUILDER DECLARATION 1 bereby affirm that I am exempt (rom the Contractor's Licanse Law for the tollowing rcason (Secttqn ]031.5 Business antl Pfofe55iOna1 Cotle': Any city or coun[y whlclt requims a permlt lo construct, alteq im0/ove, tlemoli5h or repair any sttuclure, prior to its-issuance, also requiies the applicanl for Such pe�mlt to fil¢ d Siqnetl statemenl Ihdt he/she is licenietl Pursuan[ to Ihe provision5 ot th¢ Contractor's Licens¢ Law (Chapter 9(commencin9 wilb $ection ]000) Ot Division 3 of the Business and'Professions Code) or [hat"he/she is exemp[' � -efrom antl the basis for the alleqetl exemption. Any viola[ion of $ection '..5 by any applicant fo� a permit 5ubjeGtS the applicant Lo a civil Ity ot.not moreShan five huntlrc9,Aollars ($500). �y 1, as owner of the-property o� T9 en��leyP fl A ih � ceA�pmeeliorr, will tlo the work, antl the structure Is not Intentletl or offeretl for sale (Section �044; Businass antl Professional Cotlo: TM1e ConLactor'S License Law tloes.not apply [o an owner of a p�oPerty who builtls or improves thereon, antl who tloes such work'himself/herse�� or through his or her own employee5, provitletl tnat such improvements ar8 no[ Intentletl o� offeretl fOr � 581e. It, however, the bulltling o� Improvement i55oltl within one yea� of com- � pletion, lbe owne� will have tbe burtlen of proviP9 h¢/she tlitl n0t builtl:or im- {�iove tor the pu�po5e of sale). ; �� I as owne� of the 0/operty, am exUusively Eontrattlng with Iiten58tl Wn- ' ' tractors to construct the project (Section 7044, Business antl Professions Cotle: The Contractor's License Law doe5 not apply to an owner of proPerty who bullas or improves thereon, ana who contracts for such orojects with a mn- Crac[or(51 license pursuant to (he Contractor'S L�cense Law). I am aware that p�oof o( SM1eir Worker's Compen5ation in5urance Shoultl be provitlatl to me. ❑ I am exempt untler Section B. & P. 0. �or this �eason �j L O'f'r r�C I hereby certity that I have reatl this application antl state Ihat the above InPormatlon is correct. 1 a9re to compty with all ci[y antl county ortlinances antl Stal! lawz relating to bu tl�i 9 construction, antl hereby autnori e repre- Senta[ives of tnis cit � Ct\upon tne db0`/e-m¢ntionetl p p rty tor inspection purposes. 2 L ti Signature _ Date / `�" Drivers' Licenze or 55 � CMF OB65-46, rev. 10/84 Whlte - Builtlinq; Canary - APPlicani; Pink - � _ ezcept �hose within heavy Dortler lines anE si9n all appropriate tleclarations. �""32 � 0 9 I'i l�a I`�' � � ��, $�. TYPE OF CONSTRUCTION NEW ADD � ALTERATION REPAIR . ❑ CONVERSION ❑ DEMOLISH ❑ OTH�ERpsr� DESCR PTION OF WORK/US OF BLDG. ��v—�CA��r (JN iT [7�E TVPqE OF PERMIT � GRADING FOUNDATION STRVCTURAL /L�PTENANT �ELECTRICAL PLUMBING �ECHANICAL ❑ OTHER _ PROJECT DESCRIPTION 5Q. FT. ��- OCCUPANCv CON�STRUCTION TYPE �_ � VALUATION $ r/7r9�� ZONE GRADINGCU.YDS. ACRES I r� Bar Sink Backflow Preventer Backflow Irrigation rinking Fountains loor Drains loor Sinks . arSeivice' L�, Om rterceptors �� ' icchen Sink avatoiies .�' Roof Drains - ' Reinspection Fee � Showers . Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 ' �Solar Tank Swimming Pool w/Spa Urinal •3 Warer Closet. FEES A.P. # � S Main Building: TFront � B Rear I A C Right � g Left Ping. Ref. # Planninq Notes: Automa[ic Washer Construction Pole Cooking Unit Dishwasher Dryers as ❑ Fan �� F.A.U. C 1 ri Uv �+e�ie� nea .. 6v ?j'' Outlet5. � Water Service �� ' •,' Auro-Wash ; 2,� j. �' ^� - Laundty Trays /^ ' � (i �. 'J-j :i ` / $15 � Issue Fee $ Duct�UnderGround Dutt - Structural Duct - Ventilating Ezhaust System ❑ Multiple ❑ Firepl/FacL Blt. IC80 # � Heating System & Ducting �,0.100,000 BTU � 100,000 BTi Reinspectian Fee � $15 Hood or Typel ❑ Canopy Typ¢ I I ❑ Refrigeration System ❑0.700,OOOBTU ❑100,000 SVstem Repair/Alteration Fire Dampers Registers . laue Fee 61 f3 3/03/Ci Zone Accessory Building: ELECTRICAL Transformer � 15-50 KW� ❑ 50+KW Meter up ro,100 amps{� Meter ❑over 100 amps Sub Panel Motors 00�1 HP �ih-8 Ina Solar �9-15 HP 016-,15+ Microwave. Pole�Light .. .�. ''Range '� . . . D2(J2-VISp0521 '� ieretoi �0-5 KW05�15 KW �� Fee � $15 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By �. � Compactor � . . i. . i Fee ' �� ,.e r_ � 0^y;.SI 1L FEES E � Z O N I N G R E � M T SUMMARV� FEES SS- BUILDING PERMIT $ 4 �Z� SMIP $ � PLAN CHECK � $ 1 �2'�� PERMIT � , PLUMBING � $ 3Lo � ISSUANCE $ _ PLAN CHECK 25% $ i� z-r ENERG� P.C. $' ELECTRICAL $ _ �<LQ°iO- GRADING $ PLANCHECK 50% $ 7LL� MICHOFILM $ MECHANICAL 5 �_0_s� TOTALFEE $ g2-2'-1 PLAN CHECK 25% $ - � BB � �_ ,CONSTRUCTION AND PLANNING; � � ��' � ,. `' ' POOL & SPA APPROVALS Permit# ' Date Inspector Oate Inspector '�AP.PROVALS' � Permit # � 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location • � ..; 2. Soil Pipe-Undrgrnd. � ' • 3.5�rp (�A 53. Steel R2vnforcement � 3. Electrical Coniiuit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement . 3 q�Q � 56. Rough Plumbing & Pressure Test 6. Electrical UFER GrnU. �� 3 �iJ ^� 57. APPROVAL TO COVER-GUNITE 7. Footings , ' 3 q ('y� 58. Electrical Conduit-Undrgrnd. �•8. .Foundation. �- � , � C� g� �f 59. Gas Pipie, O Undrgrnd., Test � �.9.� Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd. 70. Structural Floor System 61. APPROVAL TO DECK � 11. Property Sewer Line & House Connection /�� !/ 62. Backwash & Receptor-Final _ . fl 12. Sewer Cap - 63. Heater & Vent-Final �,_ "'� 13. Roof Drains ; 64. Plumbing SYstem - Final �'r �� ' - �� 14. Rough Plumbing � f j� 1_ 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 �, t$..Rough Electrical-T Bar Ceiling ,�, 69. P.00L/$PA SY.STEMS FINAL �19.'Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT �"'" 20. Rough FactorY Fireplace APPROVALS Permit# _ . 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating �� 71. Product Piping � Gas ❑ Oil 23. Gas Pipe-Rough & Test � 72. Underground Flush �� . ' 24. Roof Framing ,� � 73. Undergrnd. Storage Tank � Gas ❑ Oil ' 25. Roof Sheathing t Q ��% 74. Overhead Hydro -� 26. T-Bar Ceiling {Structural) & Monocoat 75. Dry Chemiral , 27. Frame and Flashing 6 76. Dry Standpipe � 28. Lathing & Siding 6-(`� 77. FIXED SYSTEM FINAL , - '� 29. Insulation 8' 78. FIRE PREV. FINAL � 30. Drywall Nailing �� HEALTH DEPT. REQUIREMENT .. 31. Plaster Brown Coat � 79. FINAL INSPECTION .. • � 32. Electrical Power MeterFinal �.y3_S 80. FOOD CERTIFICATE �SSUED 33. Final Electric tes:3 J G•�y � s• a�'�T-6, • .t�_ 34. Final. Heating & Air Conditioning �� .__ � e � .,o.--...<....... 35. Final Gas Pipe-Test �� p _ ' �`�S " � ��i �� I v J l � �/1 �/le ' YI� 36. Hood or Canopy �i - r ' �. 37. Final Factory Fireplace , j� �' $ 1Z �(/p �f�,c �j�„ U,��"' � 38. Final Plumbing � � � �GT'� `�� , . ! 39. Water Service-Final 7 // �' ��/ � p/ _ . . �✓ _J,� l�ileDd� aVJ 40. Gas Service-Final ' , �; r : a ^� 41. Solar pomestio-Final - � • 42., Backflow Preventer O� , , 43. Backflow Irrigation � _ 44. Landscape Irrigation System •. ' - 45. Sound Attenuation � ' � 46., Handicap Regulations - - ' 47. FINALSTRUCTURE&BUILDING � � � ' - � . . 48. Special Requirements Completed / � '�, . ' - 49. Electric Release to Edison ' , 50. Gas Release to Southern California Gas Co � :'� 51. CERTIFICATE OF OCCUPANCY . . L. No. - Uate • ,/.% '� .� /�ov��cant to iill in a11 spares exeeot those within neavY Dortler �inas ana siyn an aoorooriate aeciarauo�s. 2�50 �2/$3/8% I 3a4� ' TY OF CosYa MESA. ONSTRUCTIO� PERMIT �R��T�V� � TRACT NO. LOT NO. UNIT NO. �'Z W . I � � ST. 'o� � � P,roject Address _ � ' AppliCanl"5 Mailing AQdreSS � TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ' / �rY /r�b .� / -U 1�7 ❑ CONVERSION ❑ DEMOLISH OTHER q,p, # Zone •Owner's Name (��>�� C�IG r cr,nAnna b �> > DESCRIPTION OF WORK/USE OF BLDG. Address ��CZL(Sf �� Sf • C.tlSTILF 1'VI�SA ��fnZ� S Main Building: Accessory Building: Arch/En9. _ LicenSC No. � � � .TVPE OF PERMIT GRA�ING FOUNDATION ❑ STRUCTURAL T Front � Address � ❑ p HERT �LECTRICAL ❑ PLVMBING ❑ MECHANICAL A Rear N Contractor's Name L � hone C Right � - N .PROdECT OESCRIPTI�N 5c1. FT. • pCCVPANCY Addre55(mailing) .� 'CONSTRUGTIONTVPE VALUATION$ g Left R CityLicenseNo._ •20NE GRADINGCU.VDS. ACRES LICENSED CONTRACTOR DECLARATION - PI�J. R¢f. � Parking Req./Provided E I ttereby a(firm that I an+ licensetl untler provi5ion5 ot Charter 9(commencing Remarks: Planning Notes: M witM1 section 7000) ot Division 3 oi the Husiness antl Professions eoae, ana - � T �� «�- my Iicense is in full force antl eitect. '�. � - ,. /�J��r✓ (� i lf,�,.^ � q, � T License qass ' License No. � 1 � � �'�� . S Date � Sig�ature � � � - PLUMBING � FEES WORKERS' COMPENSATION DECLARATION Bar Si�k � Showers 1 hereby affirm that I have a certifiwte oi consent to zelt-insure or a<ertiflcate (- ELECTRICAL FEE$ �� Workers' Compensati0� Insurance, o� a certlfi¢tl m0Y �hereof (Section _ � o, �ab. C.) • _ Backflow Preventer Service Sink Automatic Washer Trensformer �0 15-50 KW .cy No. � Company Backflow Irrigation Sewer Cap Construction Pole Sub.� . � 50+ KW u Certified copY i5 her¢bY fumi5hatl. . , . ❑ Cer[ifietl coOY is filetl �+ith the city Builtlin9 Divislon. ti � Bathtubs Sewe� Connec[ion CoOking Unit I Meter up to 100 amps � Date ApO��an� EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Cldfifi2fi .. � SOldf COIICC[O�5 DishwdShE� M¢t¢/ ❑Ov2� 100 dTpS (This section neetl not be ComplCt¢tl i( the permit IS for one huntl�etl (5100) o� - - less). Dishv�rasher Solar Piping Dryers ❑Gas ❑Electric � Sub Panel S I certify that in the per(Orman<e Of Ih¢ work to whiCh thi5 Oe�m�t Is I55ueQ.1 - - shail not em lo any pe�son in any mann n s az become subje<t to tne. Drinking Fountains Solar Tank Fan Workers' (� t�'p n I�ws of Calitorni . Motors �0-1 HP �1h-8 Date �LZI--5i9nature • � Floor Drains � Swimming Pool w/Spa F.A.U. NOTICE: It, tte� making this tlecla�alion, you shoultl becOme subject [o'th¢ InC.$012/ �9-15 HP �76-1$+ Wo�ke�s' Comp¢n5ation proviSions of the Labor Cotle, y0u must fortbwith FI001$inks U�indl comply with suclt p�oVisions or this permit Shall be tleemeC revOk¢tl. Fixtu�¢5 MiC�Ow2v¢ CONSTRUGTION IEND�NG AGENCV GasService OutIEtS WaterCloset � ' ' I here�y affirm tna[ there is a constructlon lentlin9 a9ency tor the performance .y Device Boxes Pole Light ot roe work for which this permil is issued (Section 3097 Civ. G) ' �ntereeptors �' Water Heater Ovtlets y � I ' Lentler's Name ' . . . . . Ran9e� </ Lenaer's Atlaress Kitchen Sink Water Service Switches Sign _ . OWNER BUILDEN OECLARATION . I hereby affirm that I am exampt irom the Contrac[or's Ucense Law for the LavatOries Auto-Wash ' . ' followinq reason (Sectioq 7031.5 Business antl Professional Cotle: Any tlty or - Garbage Disposal Standing Sections COuniy which requites a Permlt t0 cOnstruct, alte�, improve, tlemollsh o� repai� . P-T�2p ,; ° Laundr T�e 5 any strucfure, prior to itz issuance, also requires the applicant for such permit Y Y Generator �0-5 KW �5�15 KW Trash Compactor lo file a siqnetl Stdt¢ment ttlat he/sh¢ I5 IicenS¢tl pulsuant to the prOvlsions of ROOf Df2in5 � - - the ContractoYz License �w (Chapter 9(comm¢nting wi[h Sectlon 7000) of �� Divizion 3 of tM1e BusinE55 antl�Professions Cotla) Or tha[ he/she-is exempt � -� 1 Iherefrom an0 the ba5i5 �Or Ihe allegetl exemption. Any violation of 5¢ction z1.5 by any applica��t for a permit subjects the aOPlicant to a civil I Qty of not mOre than �ive huntlretl tlollats (y500�. "'. , , � . �, as owner of the property �r plOy 'll 9 """ •"" " ReinSpBc[io0 Fea $15 Iitue Fee $ 3 8wwpawszNee-will tlo the work, antl the structure is mi intendetl or otferetl for sale (Section 7044, Buslness antl Protessional Cotle: The Contracmr's MECHANICAL .FEES Re�nspectian Fee $15 luue Fee $ 3 License Law tloes not app�Y �o an owner of a property who builtls or improves thereon, ana who tloes 5uch work himseli/nerseif or ihrough his or her own DEVELOPMENT SERVICES REQUIREMENTS: employees, prOvitletl lha[ Such Imp�ovemen[s are n0[ intentletl o� orrerea eo. BOiIE� HOOd O� Typ¢ I ❑ , . sale. It, however, the builtling or improvement is soltl within one year ot com- . Canopy Type I I ❑ . Zoning Approved By Date � pletion, the owne� wlll nave th¢ burtlen ot prOving h¢/She ditl not ouiitl or im- Duct - Under Ground ((''�� rove for the purpose of Sale). Building Approved 6y Date LJ I, as owner or tne properry, am axUusiveiy contractinq with Ilcensoa <on- Duct � Strucmral Refrigeration System Appliwtion Issued 8y- ,�Dat� tractorsto construct the prayect (Section 7o44, Husiness anG Professlons Cotle: - The Conttactor'S Licen52 Law tloas not apply [o an owner oPp�operty who Duct - Ventilating' ❑0-100,000 BTU -❑100,000 BTU � - builtls or improves thereon, antl who contractz for such,orojects with a con- SUMMARV OF FEES � ._ tractor(s) ucense'pursuaqt to tne ConVactor's Litense Law). 1 am aware that ' ExhaustSystem ❑ MWtiple ❑ System Repair/Alteration . BUIL�ING PERMIT $, SMIP .$ proof of�their Worker•s CompensaHon insurance shoulC.be provitletl to me. ' P�.AN CHECK $ PERMIT' ❑ I am exempt untler Se«ion B. & P. G. tor Nis reasom FirepUFact.8lt. ICBO # Pire Dampers , p�UMBING ' $ �SSUANCE -$ Date owner Heating System & Ducting Regiscers . . • pLAN CHECK 25% $ �� ENERGV P.C. $ I hereby certify.that I have reatl Ihis appliwtion antl state ihat the above ❑0-100,OOOBTU �100,0008T '/ � GRADING information Is corr¢ct. I'agree to comply with all city antl county Ortlinances _ ELECTRICAL $ � 3• Y� $ antl state laws relatin t builtling construction, antl hereby authorize repre- - MICROFILM $ � sentatives of thi Uf o ent¢r upon the above-mentionetl o Per tor PLAN CHECK 50% $ - inspection purp es MECHANICAL $ Signature �"'e�- Oaiz ��J' �1 $ TOTALFEE § ��•y�- Reinspec[ion Fee $15 laue Fee E 3 PLAN CHECK 25% Drivers"license or 55 � e CMF 0865-46, rev. 30/84 White - Builtlin9: Canary - Appllcant: Pink - Accounting; Goltlenrotl - Assessor CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspect8i 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-Undrgmd. - 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. ,�`.�,� 57. APPROVA� TO COVER-GUNI7E 7. Footings . 58. Electrical Conduit-Undrgrnd. 8. Foundation - 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Struccural Floor System 61. APPROVAL TO DECK 7 7. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final � 13. Roof Drains � ' 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit , 66. Solar System-Final 16. Rough Electric Wiring ' 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # _ 21. Duccs, in Structure 70. Underground Hydro 22. Ducts, Ventilating � 71. Product Piping � Gas � Oil 23. Gas Pipe-Rough & Test 72. Underground Fluth 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing 74. Overhead Hydro ' . 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ' • 27. Frame and Flashing 76. Dry Standpipe � ' 28. Wthing & Siding . � 77. FIXED SYSTEM FINAL . 29. Insulation 78. FIRE PREV. FINAL 30. Orywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat i�, � f'y j 79. FINAL INSPECTION � � i 32. Electrical Power Meter-Final �80. FOOD CERTIFICATE ISSUED .•33. Final Electric ,,r.., Notes: ' � /6�j' St;i� vicr' C:,/`. �.c- RVinnJ/� 34. Final Heating & Air Conditioning ' �,�Z ,; � �e„ c Gc_s�n �c ��. 35. Final Gas Pipe-Test .. �.> G� I N.:JR `/..., I.�fI T1, r d 36. Hood or Canopy j . /v S G�/`'• � n• i��ac� 37. Final Factory Fire�lace . . . 38. Final Plumbing ' , • 39. Water Service-Fina1 � � 40. Gas Service-Final� � . 41. Solar pomestioFinal - � - 42. Backflow Preventer � " � • - , 43. Backflow Irrigation � . � ' 44. Landscape Irrigation System � ' � �45. Sound Attenuation � � � 46. Handicap Regulations 47. FINAL STRUCTUR.E & BUILDING 48. Special Requirements�Completed � 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co .� - 51. CERTIFICATE OF OCCUPANCY � No. Date • i, / � 3/25/87 � noo��=a�t to tm in au svaces exceot tnose witnin neavy eoraer u�es aoa siyn au arcrooriate aeciantio�s. GBBB 620�0 �,� c�OSTA rE�S�A/ CONSGT.�ihUCcTION PERMIT ct 'ie�� lXl'` f�J �U /T. Ys Mailing A dress � Owner's Namqe�Q� ��/��T �` N� Phone _�i1 Address �Ll! �_��- � Arch/Eng. License No. Address Contrector's Name — Phone Address Imaifngl - ��«"'✓L �V ll.(�./L- Ciry License.No. LICENSED CONTRACTOR DECLARATION 1 hereby af(i�m that I am Iicensetl untler provi5ion5 of Cha�ter 9(commenCing with Sectlon ]000) of Division 3 of roe Business antl Professions Code, antl my license is in full force antl eftect. Licenze Class - License No. Oate Signature WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I nave a certificate of consent to self-insure or a<ertiticate ' Workers' Compensation InSu�ante, or a certifi¢tl COpY the�eo( (Section ]0, Lab. C.) � �� olicy No. Company �- 8 Certifietl copy is hereby fumishetl. ;' Certifietl copy,is tiletl with the city Builtling Division. �I.� Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION � (This section neetl not be completetl if the permit is tor one huntlretl ($100) or less). . , �. I te�tl(y that in [he per(ormance o( the work fOr which this p¢rm�t is issuetl, Ir shall not employ any person in any manne� o o become subject to Ihe Workers' j' n Laws of Califor � Date �� Signature — S-��"�—�� NOTICE: If, atter'making this tleUaration, you shoultl become subject to the Wotke�s' Comp¢nsation prOvizion5 of the Labor Cotle, you muzt forthwi[h comply with 5uch O�ovisions or this pe�mlt shall Oe tleemetl �evoketl. CONSTRUCTION LENDING AGENCV 1 hereby SfBrm that there is a construction IenOing agency for the pertormance of th¢ work ,for .which thi5 permit is issuetl (Section 309] Civ. CJ L.entler's Name Lentler's Aatlress OWNER BUILOER OECLARATION � ' I M1ereby affirm that I am ezempt from Ihe Cantractor's Llcense Law /or the following reason (Section 7031.5 Business antl Professional Cotle: Any city or county which requires a permil �o const�uct, alter, improve, Gemolish o� �epair any sVucture, prior to its issuance, also requires tne appllcant lor suM permit '.to file a signetl statement lhat he/She Is licenzetl pur5udnt t0 [he provisions of the Contractor's License Law (Cnapter 9(commencin9 witn Seclion �000) oi � Division 3 af the Business antl Profes5ion5 Cotl¢) or tha[ M1e/she is exempt' ,� S,�erefrom antl the basis for the.allegetl exemptlon. Any violation of Section `��;;k,31 5 by any applicant for a permit -subjects the appli<ant to a civll. �* `talty of not more than five huntlretl tlollars ($500). � €/� I, as owner oi the property o �_. an owner oi a property who builtls or mrk hlmself/herselt or throu9h his or improvements are mt IntenCetl or oi sale. If, however, the bWltlin9 or Improvement is soia w�[mn one yea� ot mm- pletion, tM1e owne� will have the burtlen of proving he/she tlitl nol builtl or im- ��ove for the purpo5e of sale). I, as owner of the property, am exclusivelY contraCting with licensetl con- tractors [O mnstru[t the project /5ection 7044, Bu5ine55 antl Protessions Cotle: The ConVactot's License Ldw does not appty [o an owne� ot property who builtls or improves thereon, antl who contracts for such projects with a con- tractor(sl license'pursuant to the Contractor's License �aw). I am aware that proof of their Worker's Compensation insura ce shoultl be provltletl to me ❑'I am exempt untler Section�T� �� :B. & P. C. for thi5 reason Date �(<-��v Owner I have reatl thiz application antl state that the �agree to comply with all city antl county ortli up bultlin9 �onstruction, antl hereby authorize Signature V'�` Driver5' Litense or 55 � TVPEOFCONSTRUCTION IJ NEW IJ ADD U ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH �OTHER A P #, DESCRIPTION OF WORK/USE OF BLDG. S Main Buildi TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T FrOnt ❑ TENANT � ELECTRICAL � PLUMBING �MECHANICAL g Rear ❑ OTHER A PROJECT DESCRIPTION Sq. F7. � oCCUPArvcv C Right CONSTRVCTION TVPE VALUATION $ S Left 20NE GRADING CV. VDS. ACRES Ping. ReL # Remarks: �PCJJ�-Ill�h �%ISTIN�. �i�S�� PlanningNotes: Bar Sink Backflow Preventer - Backflow Irrigation Bathtubs Clarifiers - Dishwdsher .� Drinking Fouri[ains Floor Drains f'� Floor Sinks � GasService Outlets Interceptors . � ' Kitchen Sink ' Lavarories P—Trap Roof Drains Reinspection Fea $15 Boiler' .. . Duct- Under Ground Duct - Structural � Duct - Ventilating , Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # �Heating System & Ducting �Q-100,000 BTU 0100,OOOBT Reinspection Fee � $15 CMF 0865�46, rev. 10/04 White - Builtling; Canary - Applicant: Pink - Accountlng; Goltlenrotl - AsSessor Showers Servite Sink Sewer Cap Sewer Connection Solar Collecrors Solar Piping Solar Tank ' � Swimming Pool w/Spa Urinal Water Closet - � � Water Heater � Water Service AULO-WeSh . Issue Fae Hood or Typel ❑ Canopy Typell ❑ Refrigeration'System � ❑0�100,OOOBTU ❑100,OOOBT Sys[em Repair/Alteration � Fire Dampers Registers Issue Fae FEES �! $ 3 FEES $ 3 Automatic Washer - Construction Pole Sub. Cooking Unit .. Dishwasher F?A.U. 1 Fixture5 ' Device Boxes Outlets Switches Garbage Disposal Generator 00.5 KW Fee � � Zone Accessory Buildin9: Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ' ❑ 50+KW Meter ❑up to 100amps . Merer ❑over 100 amps ' Sub Panel Motors 00.1 HP � 1 h� B Inc.Solar �9-15 HP �76-15+ Microwave ' - ' Pole Light - Range Standing Sections 5 KW Trash Compactor $15 luue Fee �DEVELOPMENTSERVICESREQUIREMENTS: Zoning Approved By Building Approved By Applieotion Imued Bv �'� � FEES $ 3 Z O N I N G R E � M T $ _' • SUMMARV OF FEES BUILDING PE(iMIT $ SMIP $ '� PLANCHECK $ PERMIT ' PLUMBING $ � ISSUANCE $ � PLAN CHECK 25% $' ENERG� P.C. $ ELECTRICAL $ � GRADING $ PLAN CHECK . 50% $ MICROFILM $ MECHANICAL $ � � TOTALFEE $ � PLAN CHECK 25% $ fRUCTION AND PLANNING POOL 'P, OVALS Permit # Date Inspector _ AppROVALS Permit # Date Inspector I. �mporary Electrical Service or Pole - 52. Pool & Equipment Location � �-' � i� 2.!�$oil Pipe-Undrgrnd. . 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgmd. 54. Forms � � 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, � Undrgrnd., Test . ' 9. Water Pipe-Undrgrnd. � 60. Backwash Lines,P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK . 11. Property Sewer Line & House Connection � 62. Backwash & Receptor-Final � 12. Sewer Cap 63. Heater & Vent-Final ' ' 13. Roof Drains � 64. Plumbing System - Final , 14. Rough Plumbing /� 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring S„�T 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Elearical-T 8ar Ceiling 69. POOL/SPA SYSTEMS FINAL � 19. Rough Heating & Air Conditioning �0 �� FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # _ . 21. Ducts, in Structure 70. Underground Hydro � 22. Ducts, Ventilating 77. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test 72. Underground Flush , 24. Roof Framing 73. Undergrnd.StorageTankOGas ❑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 �76. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION � 32. Electrical Power Meter-Final 30-�Z „),G 80.. FOOD CERTIFICATE ISSUED 33. Final Electric � 30..& C, �Notes:/�_/y_�7 F/OT l�10�/�� .•� 34. Final Heating & Air Conditioning /�/f? L, _� � 35. Final Gas Pipe-Test y� .f8.g'l � �/0 0�� .�l •�,` 36. Hood or Canopy � 37. Final Fac[ory Fireplace � 38. Final Plumbing . 'f��/"% � 39. Water Service-Final ' . 40. Gas Service-Final � 47. Solar pomestic-Final 42. Backflow Preventer � 43. Backflow Irrigation � � • 44. Landscape Irriqation SYstem 45. Sound Attenuation - 46. Handicap Regulations . . 47. FINALSTRUCTURE&BUILDING , 48. Special Requirements Completed � , � 49. Electric Release to Edison � ' � , • 50. Gas Release to Southern California Gas Co 57. CERTIFICATE OF OCCUPANCY � No. Date � . . '� ADP��ant to fi11 in a11 svaces except thosa within neavY bortler lines ana si9n all avoroD��ale tleclarations. CITY OF COSTA M�S�(a- CON��s[Ty RUCTION PERtMIT "'�"'T �.� . � T��T �� T �� . �.�.` .... ProjectAddress oT�'. � �� 5r � �NI'f Ft� 1 _� Appli�t's Mailing dress Owner's Name �� Phone �13 Address ��`� Arch/Eng. �� t�n License No. ' Address �VT'/ � L � p" Contracmr'sName w � V�L��' _Phone Address (mailing) �� Ciry License No. LIGENSED CONTRACTOR DECLARATION I hereby afiirm thal I am IlCensetl untle� provizions ot Charter 9(commendn9 with sectlon 7000) of Divig�on 3 of tM1e Business antl Professlons Cotle, an0 my Iicense is in tull force antl etlect. ' License Class License No. Date Si9neture WORKERS'COMPENSATIbN DECLARATION 1 hereby afiirm that I have a certificate of conzent to seli-insure or a certliicate ' Wo�kers' CompensaliOn InSurance, or a certlfietl copy thereo( ($actlon .00, Lab. C.) � rolicy No. Company BCertifi¢tl copy IS h¢reby /urnizhetl. Certifie c Y IS (iletl with the city Buil in vision. oate AOPlicant�� EXEMGTI N FROM WORKERS' COMPENSATION DECLARATION (TniS sectiOn neetl no[ De coTO�eletl if the Oermit IS tOr one huntlretl (EI00) or lessl. I certlty [hat In th¢ pGrfo�mante ot the wo�k f which tn� IS p�suetl I shall no[ emplOy any per5an in any mann¢r to b0<Om0 SUDject [o t�e workers' Cofu ensation Ldws ot Ca11(omia/� , Date 7� 5 Signature ��a NOTICE: Ii, af[e� mdking lqis tleGlaration, you shoultl becoma Subj¢Ct to Ihe Workers' Compen5dtion OrOvisionz of tne Labor Cotle, you must fortnwl(h comply wilh such provisions or this permit snall be tleemed revoketl. CONSTRVCTION LENDING AGENCV ' 1 hereby aitlrm that there is a construction Ientling agency for the performance of the work for �v�n this 1�rOmii�i; iyspetl (Section 3097 Civ. GJ Lentler'S Nam¢ S- �"�K - Lentler's Atltlress ��CL� ��w� �:a' 2- O OWNER BUILDEH DECLqRAT10N I hereby affitm tha[ I,am exempt irom the Contracror'S LlcenSo Law for thE foliowin9 reason (Section 7031.5 Business antl ProfeSsianal Cotle: Any dty oi county wltiGh �equires�a pe�mit [o construct, alter, iTProve, tl¢molish Or repai any stru<ture, pri0� to Its iszuance, also �equires the applicant for Such perTi' en tiia a uanetl statement tnat heKM1e is IicPnseE oursuant to lhe orovl5ionz o' "�erefrom ana the basis for tne alle9eC exemp[lon. Any violation o( Section '31.5 by any appliCant for a permit sUbjects Ihe applicdnt to a<Ivil �alty of no[ more than fiy¢ hun pollars (§SOOj. I, as owne� o! the OrOp¢rty �E 5"WIN OOa92fa5 t1911 SOt ��p��•�� will Go the Work, antl the structure Is not intentletl or otferetl for sale (Section 7044, Business antl Professional Cotle: The Contractor's License Law tloez not apply to an owner o( a property who builtls or improves thereon, antl who tlo¢s zu�h wOrk him5elf/he�s¢If o� Intough his o� h¢r own emD�oYees, p�ovitl¢tl [hat Such improv¢ments are not int¢ntlatl or offe�etl for sale. Ii, nowever, the builtling or improvement is soltl within one year of com- pletion, tne owner wi11 hav¢ {he burtlen of p�ovin9 he/she ai0 not builtl or lm- �rova for the purpOse ot Sale). I, a5 owner o1 tne OrOperty, am exclusively contracting with IlcenS¢tl con- tractors [o consGuct lhe prO�ect (Settion )044, Business antl PrOfession5 Cotle: The Contractor's License I�w tloez mt appty to an owner of pro0erty who builtls or imp�oves [hereoq, antl who contracts for such projeCts with a con- tractor(s1 ucense pursuant ro the Contractor's License Law). 1 am aware that proot of� lnair Wo�ke�'s CpmPensatlon inzurance shoultl be prOvltletl to me. L� I am exempt untler Sect�on . B. 6 P. C. for this reason � ,�'L n,.,�> T" e-� — ❑t 'I hereby certi(y Ihat I ha�¢ reatl this application antl state that the above �nformation is mrract. I a ee to comply with all clty antl county ortlinances antl state laws relating to ulltling construclion, antl hereby authorize repre- sentatives ot this cit G`Cter upon the above-mentionetl o op rt' for In50ection putposes.�� / �� Signahra L \ .L� ' D t Drivers' License or 55 �. 832410' I I1� TYPE OF CONSTRUCTION NE ❑ CONVERSION ❑ DEMOLISH DESCRIPTION OF�WORK/USE OF R ALTERATION TVPEOFPERMIT UGRADING LJFOUNDATION �25LSTRUCTUI ❑ TENAN7 ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL ❑ OTHEft PRQIECT DESCRIPTION SO. FT. ��7 OCCVPANCv CONSTRUCTfON TVPE V N VALUATION $_ ZONE GRADINGCU.VDS. ACRES- Remarki: SqI1 � (� � ��—�E PL Bar Sink Backflow Preventer Backflow Irrigation Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink � Lavatories P-Trap Roof Drains Reinspection Fee � $15 Boiler Duct- UnderGround Duct - Svuctural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact.8lt. ICBO # Heating System & Ducting ❑aioo,00a aru �ioo,00aari Reinspection Fee � ��5 CMF 0865-46, rev. ]0/84 Wh�te - Builtling; Canary - Applican4 Plnk - Accounting; Goltlemotl - Azze55ot Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto-Wash Laundry Trays Issue Fee Hoodor� Typel ❑ Cznopy Typell ❑ Refrigera[ion System Oaioo,000eru ❑ioo,000 System Repair/Alteration Fire Dampers Registers laua Fee (3 EPA I R — A.P. � S Main Building: — E T Front ARear � C Right _ S Left — Ping. Ref. # Planning Notes: FEES 6114 3/03/88 Zone ELECTRICAL Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ❑ 50 + KW Cookin9 Unit Meter ❑up to 100amps Dishwasher' Meter ❑over100amps � Dryers OGas ❑Electric Sub Panel Fan � Motors �0-1 HP � 1%- 8 F.A.U. . Inc.Solar �9-15 HP �)6-15+ Fixtures Microwave Device Bozes Pole Light Outlets Range Switches ' Sign � Garbage Disposal Standing Sections Generaror �65 KW �5-15 KW Trash Compactor $ 3 I �- Reinspeetion Fee $15 luue Fee FEES �DEVELOPMENT SERVICES RE�UIREMENTS: ZoninB APProved BY � Building Approved By Appliption luuad By � $ 3 52081 TL Z O N I N G R E � M T S FEES $ 3 � � SUMMARV OF FEES BUILDINGPERMIT $ � �� SMIP $ �� PLAN CHECK $ �3I pERM1T PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL $ GRADING $ - PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ S � PLAN CHECK 25% $ CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector 1'. -.Temporary Electrical�Service or Pole 52. Pool & Equipment Location �._ 2. Soil Pipe-Undrgrnd. , 53. Steel Reinforcement 3. Electrical Conduit Utility-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 �•- .T, 58. ElectricalConduit-Undrgrnd. � i 8. Foundation. �- ' � 59. Gas Pipe, � Undrgmd., Test � 9. Water Pipe-Undrgrnd. � 60. Backwash Liries, P�Trap, � Undrgrnd: � 10. Structural Floor System 61. APPROVAL TO DECK � 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing SYstem - Final � 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar SYstem-Final 16. Rough Electric Wiring 67. Fencing &' Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING ,. � 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL � � i� 19. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT �� '� 20. Aough 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 Framin �� 9 73. Undergrnd. Storage Tank � Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro - 26. T-Bar Ceiling (Structuraq & Monocoat 75. Dry Chemical - ' • 27. Frame and Flashing 76. Dry Standpipe � - "' 28. Lathing & Siding 77. FIXED SYSTEM FINAL " ^ . i 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT � 31. Plaster Brown Coat 79. FINAL INSPECTION . 32. Electriral 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 . ' f 39. Water Service-final � ' ' � 40. Gas Service-Final � ��'� � 41. $olar pomestic-Final - .t � 0 - 42. Backflow Preventer , F . „1- ' `,' i- 43. Backflow Irrigation ' � ' ' � ' 4 • 44. .Landscape Irrigation System ' � - ' . � '+ • 45. Sound Attenuation � � � - 46. Handicap Regulations � , �. � 47. FINAL STRUCTURE & BUILDING ��-� - • , � 48. Special �Requirements Completed ' , . '9 r. 49. Electric Release to Edison , .` 50. Gas Release to Southern California Gas Co f . 51. CERTIFICATE OF OCCUPANCY� ... No. � Date _ _ . ApD��cant to /ill in all spaees axceD< <hose within haavY �ortler Ilnas anE sign all apP�oOriate Geclarations. Clrv oF cOSTA MES �y �CONSTRU/'C�,�ON PERMIT ProjectAddress" � �"R' �� • •�7i� �� _ Applicant'sMailif�GAd-d�ress ��'+'V,� �� y.�� -�� Owner's ffame -'�' `'T �'��Nr'�' PhoneL�� Address �� Arch/Eng. , License Na. Address Contractor'sNama��'�y�—rJ�i��ti�-�'d Phone , Address (mailing) � City License No. � IICENSED GONTRACTOR OECLARATION I herebyaffi�m that 1 am licensetl untle� p�ovi5lons of Charta� 9(commenCin9 with seclion ]000) ot Divislon 3 ot the Business antl Professlons Cotle, antl my license is in (ull force antl et(ect. License Class License No. Date Si9nature WORKERS'COMPENSATION DECLARATION 1 M1ereby affirm that I �ave a certi(icate of wnsen[ to self-Insure or a certificate �f Workers' Compensation Insurance, or a certifietl copy thereof (Sectlon 00, Ldb. CJ - ' �licy No. Company L� Certitiecl mpy is nereby furnishetl. ❑ Certifietl wpy iz tiletl with the city Builtling Division. , Date Applicanl EXEMPTION FROM WORKERS' COMPENSATION DECIARATION (This section neetl no[ be completetl if the 0¢rmit i5 (o� on¢ huntlr¢G ($300) o� less). . ` I certify'that in the pertormance of the wo�k to�W hich th15 pe�m�t IS issuetl I snall not emo�oy any person in any manner sg a5 f pecome subject to the Worke�z'L oTBE�Sdtin�y laws of Cali(ornia F G � Date `+^�� /--�Y• S�9�ature L+ n NOTICE: If, atter makin9 this tleclaration, you shoultl become zubject to the Workers' ComOensation provisions of the Labor Cotle, you must (orthwith comply wiU such provisions or tnis permlt_ shall be tleemetl revoketl. CONSTRUCTION LENDING AGENCV � I hereby affirm lhat there is a construc8on lentling agency for tne oeriormance of the work for whicn this permlt is issuetl (Section 3097 Civ. CJ Lentler'r IVame Lender's Atltlreis OWNER BUILDER DECLARATION � I hereby attirm ihat I am exempt from the Contractor's Licenze taw tor the followin9 �eason (Section �031.5 Business antl Protessional Cotle: Any city or ' county which rtquires a pe�mit to cOnst�uct, alt¢q imp�ove, tllmolish or repair any'straciure, prlor to its issuance, also requires tne appliwnt for such permit to file a signetl SWlement lhaf he/sh¢ is licensetl pur5uant to the provlsion5 of .[he Contractor•5 License Law (Chapter 9(commencing with SecSion 7000) ot Division 3 of the Business antl Professions Cotle) or that be/she Ii exempt '�,�erefrom antl the basis for [�e alleqetl ezemption. Any violation of Section e?31 5 by any applicant for a Permit subjects the applicant ro a civil ; 7ialty ot not mo�e than five huntlretl tlollars (E500). , . --�, as' owner of the property or my employees with wages as their sole �¢�omp¢n5ation, wlll tlo the work, antl the sbucture Is not Intentletl OLofferetl 'or sale (Section 7044, Bu5ine55 antl PrOfe55ional Cotl¢: The COntractor'S � license Law tloez not appry to an owner of a property who Ouiltls or lmproves '�, (hereon, anC who tloes such work himselt/herself or througn his or her own Iemployees, prOvitled that such imOrOvements are not intenGetl or offereE for rnle. H, howeveq the builtlin9 or improvement is soltl witnin one year of com- pletion, the owner will have the burtlen oi provin9 he/she tlitl not bulltl or im- �/ova tor the purpoze ot sale). U I, as owner of tne property, am exclusively contracting with Ilcensetl con- tractors to construcl the project (SeC[ion ]044, Bu5ine55 antl ProteSsions Cotle: The Contracto�'s License l.aw tlOes nOt apply to an owne� ot Oroperty who builtls or imOroves thereon. antl who contracts fo� Such oroi<cts with a mn- t�actor(51 Lcense pursuan� to me ConVa<f0/'S License Ldw). I am aware tha[ proof O( their Wo�ker'S COmpensation insu�anc< shoultl be o�oviaea to me. ❑ 1'am ezempt un0er Section ' B. 6 P. C. tor t�is reason . � � Date ' - `'�-�'�-� Owner �'�� 1 hereby certifY that I have reatl tnis aoP��atlon antl state that the above intormation is correcL 1 a9ree to compty with all city antl county ortlinances antl state laws relatin9 to builtlmg con5trucLon, dn0 hereDy duthorize repr¢- 5entative5 ot IhiS city to"2nter upOn tM1e dbOve-meptionetl Propefty to! inspection Purposes:" `� . ,�,� �`r �� $ignature 7'� " L� Date„ — Drivers' License or 55 � TYPE OFCONSTRUCTION �`I`NEW I.J ADD LI ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OP BLDG. �iE^�� '�F_Tk.��'Ni�.Ki �}}� TYPE OF PEflM1T ' LJ GRADING LJ FOUNDATION U STRVCTVRAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANIGAL ❑ OTHER PROJECT DESCRIPTION SQ.FT, CONSTRUCTION TVPE VALVATION $ GRADING CU. VDS. AC Remarks: Bar Sink Backflow Preventer Backtlow Irrigation CBtI1tUD5 . Clarifiers . , ' Dishwasher Drinking Fauntains Floor Drains Floor Sinks Gas Service . Outlets <itchen Sink Lavatories Roof Drains Reinspection �Fee $15 Boiler , Duct - Under Giuund Duct-Structural , Duct - Ventilating Exhaust System ❑ Multiple Firepl/FacL Blc ICBO # Heating System & Ducting 06100,000 BTU 0100,000 Reinspection Fee I $15 0865-46, rev. 5/88 W�ite - Builtling: Canary - Applicant; Pink - Accounting; Go�Oenrotl - Assesior $hoWefS Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank ' Swimming Pool w/Spa Urinal Water Closet � Water Heater Water Service � Auto-Wash laue Fee Hood or Typel ❑ Canopy Typell ❑� RetrigeraGon System � , ❑4100,000 BTU � ❑100,000 BTU System Repair/Alteration Fire Dampers � Registers � laue Fee FEES A.P. dp Z S Main Building: E T Front ARear. � C Right � • g. Left � Ping. Ref. # Plunning N� W �Par�king R�eq./P�rovided �YP�i��.Nl'M � ELECTRICAL Automatic Washer Transformer ❑ 75-50 KW Construction Pole Sub. ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter ❑over 100amps Oryers ❑Gas ❑Electric Sub Panel � Fan Motors �0.1 HP �1'h - 8 F,A.U. - Ina Solai �9-15 HP-016 Fixtures � Microwave ' . Device Boxes . . Po1e Light • � Outlets � Range • Switches Sign Garbage Disposal Standing Sections � Generator �0.5 KW 05-15 KW Trash Compactor 2ona Reinspection Fee � $15 luue Fea $ 3 DEVELOPMENTSERVICESREQUIREMENTS: Zoninp Appraved By FEES Building APProwd BY � - Aoolicetion laued Bv S 3 O N I N G R E Q M T S. FEES $ 3 , SUMMARV OF FEES BUILDING PERMIT $ 5¢ - SMIP $ �� PLAN CHECK $ �«,� PERMIT PLUMBING . $ ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL� $ GRADING $ PLANCHECK 50% $ � MICROFILM $ ,Q� MECHANICAL $ TOTAL FEE $ �_ PLAN CHECK 25% $ ' ' . 01 00011876-�OO11E78 TQT 89.60 OATE: O8/12/8E TIHE� iD�46 CONSTRUCTIONANDPLANNING POOL �$i�.. „ A. APPROVALS Permit # Date � Inspector qppROVALS Permit # Date Inspector 1. Terr!porary Electrical Service or Pole '�� 52. Pool & Equipment Location � i ' 2. Soil Pipe-Undrgrnd. '? 53. Steel Reinforcement ��• 3. Electrical Conduit Utility-Undrgmd. �.;i 54. Forms �� ,' '4. Electrical Conduit-Undrgmd. � �� 55. Electrical Bonding � 5. Steel Reinforcem�nt 56. Rough Plumbing & Pressure Test ,,� , . 57. APPROVAL TO COVER-GUNITE � � 6:, Elecirical UFER�Grnd. 7. Footings = � - "' S8. Electrical Conduit-Undrgmd. .�� 8.�Foundation ' f 59. GasPipe,OUndrgmd.,Test ""�; '� � 9. Water Pipe-Undrgrnd. '�` j_ 60. Backwash Lines, P-Trap, O Undrgrnd. �i � 10. Structural Floor System '�' 61. APPROVAL TO DECK ' 11. Property Sewer Line & House Connection � 62. Backwash & Receptor-Final i 12. Sewer Cap , �I 63. Heater & Vent-Final _ 13. Roof Drains � . 64. Plumbing Sys[em - Final � i 14. Rough Plumbing 65. Electrical-Final �, 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring - 67. Fencing & Access Approval • 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING '18. Rough Electrical-T Bar Ceiling , 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning ' FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace �� !. APPROVALS Permit # � 21. Ducts, in Structure 70. Underground Hydro � 22.rDucts,Ventilating ,:� 71. ProductPipingOGas ❑Oil � 23.' Gas Pipe-Rough & Test � 72. Underground Flush • 24. Roof Framing � � 73. Undergrnd.StorageTank OGas �Oil _ �25. Roof Sheatfiing ' � � : , 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 Mefer-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 �, 3$.'Final�Plumbing ' ' � 39.- Water Service-Final . - 40. �Gas Service-Final ��, . ' 41. �Solar pomesticFinal � 42.�`Backflow Preventer i ' � , 43. 8ackflow Irrigation ' � � � 44. Landscape Irrigation System � ' � - 45. Sound Attenuation � 46. Handicap Regulations ' , � 47. FINALSTRUCTURE&BUILDING ,(6-(�j 48. Saecial Requirements Completed _ �, 49. Electric Release to Edison ' ��, • � 50. Gas Release to Southern California Gas Co . , . ,' . � 51. CERTIFICATE OF OCCUPANCY . � ' .. � No. - Date � � ' Z . a cwj FZ ZF O m J7 J N 00 J J m Q UN Za W � aW WZ J Q m Z J � W w �_ 2 F- O W � � r z Q U J a a Q � F N Z � H U � � r H z 37954 COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626 For Applicant to Fill in Com letely BUILDING �� j�� / ADDRESS ` � OWNEF W � � �C��I�CS ADDRESS ��7(�. /-G(Q ��S D %�' CITV PWP /p��FJ tRc.l� N�'/.{ �S7 CONSTRUCTION � LENDER BRANCH �,�. ADDRESS ARCHITECT �`I �n i TEL. A�ORESS ^ CONTRACTOR LU IIS(/N �/ 7SC��f T�' ADDRESS/ �QOV df y�iY�//" �.(i1{ �S / S�(� �� IaWWJ NOL Db6G CITV p 'i LIC. NO. / Sj��G LICYNO. S I Z E � NO.OF BLDGS. OF lOT I NOW ON l0T SIZE OF !i X l.Y NO. OF NEW BLDG. a ROOMS STOf EXTERIOR WALL ROOF COVERING COVERING USE� BUILDING AND WORK TO BE PERFOFiMED GJ i kd YNIU fE011-74cMs,00 48or.• ;:,r�::�5.50 APPLICATION FOR BUILDING PERMIT RECE TE EIV �J DATEI I � —/ �%— BUILDING ADDRE55 � TRACT FIRE ZONE APPROVED �'L IP�nr�s;( YARDS APPflOV ED V AR. � C.U.P. #' APPflOVED USE OF NEW'��c�AiF' BUILDING��p �� YAROS APPROVED ACCESSORV BUILDING DATE APPROVED FT & ' "� I hereby ecknowledge that I have reatl this application antl ztate) � \ [het ffie above iMarmation is correct antl ngree io comply wi[h� � all laws repuletinB b�iltling construction, und I shall not employ` , eny person in violatfon of tha workman's compensation laws of _, the Stata ot Calitornie. � T� I hereby certify that I am properly lic¢nsed as e contractor untler SQ. PT. � Me State of Celifornia Business antl Professions Cotle, Divisicn 3,- THE P.MOUNT SHOWN UNDER VALUATION IS FC Chapter 9, antl th s h licenses are in full force antl etfect, or 1� THE PURP06E OF ESfA8LI5HING A PERMR FEE ONL` am ezempt fro tt e ovisions ot the Sta of California Businazs _ VALUATION � and Protessio Cn � ivisio er - •� � PERMIT FEE $ Signatura �� Permittee $ � 7 � PLAN CHECK $ O Authoriz Agenc TOTAL FEE $ � � � � 0 a � Q m N ] m E `o LL