HomeMy WebLinkAbout675 18TH ST - Building Permits� ADG���ant t0 fill in all ipaees a%Mpt thosa within heavy Eo�Ga� Ilnas anC sign all apo�ooriate Eaclantions.
' CITY Ri COSTA MESA pE MIT NR r TRACT NO. LOT NO. BL . . - ,
�, , CpNBTRUCTION PERMIT. � , ' -� �� d':3.3J �./. 2 / " •
�ApplicanYs Mailing Address ' ' TYPE OF.CONSTRUCTION NEW ADD ALTERATION'' REPAIR ''_ - _ ' ; - _
RfOjeCtAddreR �S�• ��� - ��v� �E"� OCONVERSION ❑DEh10LI5N ❑�OTHER �' � 3B�'2 ij��'J��)"•. ��I�pj�'�] T�
�Owner's Name - pQ�i7A`� ����1 A �hone 7 DESCRIPTION OF ORK . -�„ ' ZONING EGU � 1 �
Address /.7,5 u� ! S�. S� , G�io�-.n /L ��� � O�U �TE. e- � - ' . . - � .
� . •—� : TYPE OF PERMIT �GRADING FOUNDATION STRUCTURAL , A. P.9W - ' ZONE _ ' � �
Arch/Eng:.- ��c«'�f: G�_�JJL"._�P Lic¢n5B Na. _��I�7 ,❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MEGHANICAC' PLNG. REF.S� � � BUILDING� .
Addfeu �Z� dR�`t"AQ' �}Y ! �N�� '� A��C�N��y/ ❑�pTHER .- - ' ' � � � TOBUILDING - ' ,
COntfeCtat'S Nem _� hon�_tQ6iCz(.o.o PRQIECT DESCRIPTION SQ. FT. - � - - OCCVPAN PR PE V INE .�REAR VARD (TO P/U _
P. Z S N I.I C• CONSTRUCTIONTVPF VALUATION$� LEFTSIDEVARD - � � RIGHTSIDEVARD ' �
Address (mailingl . - . .
— � . ZON� � � GfiAOtNG CU.YDS. ACRF� � PKG.SPACE REQ. ; PROVIDED . , .
License No. . � . .
� UCENSED CONTRACTOR DECLARATION Remarks: � . � - STREET WIDTH � ' ' '� PARK FEE $ ' �•
1 hereEy aifirm that 1 am Iicensetl untlar provislons ot Charter.9 (commancing . , . . � , . '
with section 7000� of DIvlSion 3 of the Business an0 Profeiilons COCe, antl � � - - S(�� 7. � � � ' SPECIAL CONDITIONS: ' � �
� my Ilcenie Is In lull !qi�e antl atrect. � . . � � - � 1 . ' � �
en' claI s� 1��ZI �icense No. ��7��� � , - ' . PLUMB�NG ' � . ' ' : , ' .
:e $ L �� Si9natura � � •� , , � � - - � � �
, W00.KER5'COMPENSATION DECLARATION ' ' � BefSink ,� SeMRfCep . . ELECTRICAL
i hereoy.atrirm that i nave a certi}Iwee o/.consent,to zalNnzure or a certHiwte .' � g�kflow Preven[er -- - -- Sewer Connection - - ._ Automatic Wazher • � _ _ Meter ❑over 100 amps
, Ot Workerz' CompensatlOn InsuYanCe, Or a certl/ietl�Copy th0reof (Settlon ' ' ,._ "' ' �,
38oa, Lab. C ' ' � Backflow Irrigation � Solar Collectors� � .. �+ . Construccion Pole Sub Panel
���3 /- Fi �✓i'.r�" �iru� �
Poncy rao. �— � Company , �� ,,,. i, ;,. : ' Cooking Unit ' SubPole � � .
; �Certltietl <opy I5 heraby tuml:petl. � ' ' : � Bathtub4 Solar Piping ! •_.1 ,. r ' . ,
Certl etl�c y9G �5� with th0 ciry � I ing Dlvlsion. ' � � I Di5hwa5h2r �MotofS ❑0-1 HP �iM-8
M Date ���5 � /aDPllcant � ���L�-��n_' Clarifiers • S01arTenk
�S7 � EXEMPTION FROM WORKERS' �OMPENSATION DECLARATION Dlshwa5h2f SWImTing Pool W/Spe - Drye�s ❑Ga5 DElettfiC ' InaSolar 09-15�NP ��16-15+
(Tnis se<tion neeE not be com0letatl i/ the permit Is for one huntlretl (5300) or —
� less) ' Drinkin Fountains . Urinal �. � Fan Microwave .
I certI(y that I� Ine OerfO�minca Of the wo�k f0/ whlGh Ihis p¢�T�t is ISSueE, I 9 - . �
Q� zhall mt employ any person In any manner so,as to Gecome subject ro the - � , ; F.A.U. � ', ' Pole Light .
� Workers'. Compensatlon�Ldws ot Calltornla. ,� ; ; Floor Drains Water Closet' � �
Date� - Sl9nature - ' - �
NOTICE: It, after making [hls tlatlaratlon, you Snoultl ba<ome sub7ect to the �-- � FIOof Si�nks , �- -- -- - ..Nlater Heater - _ . - Fixtures . i i Range ;
Workers` Compensation provi5ions of the Labor Cotle, you must..�orthwitn .'. � � � Device Boxes � � � Si n � �
� comply 'witn su[h .provislons or tnis :permlt , shall be tleemeC revoketl. Gas Service .Outleis . Water Service ' .� t'' 9
, CONSTPUCTION LENDING AGENCV - ' - Outlel5 � StendingSeCtionS ' �
' I hereby aftirm that there Is a constructlom lentling agency tor the pertormdnce, ! Int¢rcepto�s � i. � � �� �
' ot the work for wblch this per Il is I uetl •(Se tlon 3097,. Civ. C':; ` Switches
i � - i• � - ' _ � _� ' � Trash Compacror . �
� Lantle�'s, Name - ' � ' ' Kitchen Sink . _ ��
, Lander's, Atltlress ; ' Ga'vatones- , i � ' � � r' Garbage Dispoul � � ' : � �
'. OWNER'.BUILOER DECLARATION ' � ' ' ' • • � � � �I � " � , �
' I hereby'affirin that I am exemp� from the Con(ractor's.License Law !or Ihe � _ . , GenE�ato� DO-5 KW 05-15 KW � , � '
' followin9 reason (Se<tion 7031.3 Business antl Professlonal�Cotle: Any ciry or ' P-Trep, � - � � -
tounty whi<n requires a permit.to construct, alter ImOrove; tlemolizh or repair , , , . ..� T�ansfOrmer ❑�5-50 KW
any structure; pdor to its issuante,�also reqWres t�e appllcant Tor suc� pavmiE RoOf Dreins • �� . ' . ' ' '
' to tile a signatl stat6ment that ha/sne ii Iltensetl pursuant to the ProviSionz o1 . .- . . ' ❑5U+ KW . �Reinspection Fee $7$
the Contractor's Licensa Law (C4aDtar 9(comrtiencing with Sactloq 7000) of -- - = t - ' ReinSpection Fee � $15 -
DlNsion.3 of Ihe Buslnass antl Pro(es5ions Cotle) or that he/she�is axempt '� Showefs �, ' r - - • Mete! ❑u to 100am s
[herefrom antl the batis tor the allegetl exemptlon: Any violatlonb(,Saction � ' � � - � . � - • . - P P Issue Fe9 ' ' $ 3
7031.5 by any applicant for`e.permit subjects tho�applicant to, a. dvll '�'^ ' ' � � - -- - --
. enalty of not more than five,hurydretl tlollars (5500). � Service Sink . � Issue Fee • � $?.- � •
,.O .. . . ' . • _ . 2onin9�APProvedBY � ,Date . ,
C� I, as ownar of the �property or-my employeas with wages as their sole � MECHANICAL ' �" � �
� compen5ation will. Oo tha work; antl,Me itructure is not intentled or of(ereE .. -' ' Appli�tion Approved 8y _ • ate ----J—+--
!or sale �(Se<fion 7044', Bu5lneSs antl Protesslonal Cotle: � The Contractor's , ' . S
License Law Ooes not aOP�Y ta an owner of a proper[y.who bulitls or Improves gpj�e� � • � - Ref�ige�e[iOn Systcm � , qpP�iotion Issued By � � �at9
thereon„antl who tloes�such work hlmselt/herseH or Ihrou9h his or har own � � ' � �
employees, provitletl that sucn improvements ara not Intentletl or offaretl for Duct-�Under Ground , ❑0.100,000 BTU ❑100,OOOBTU . - . �
sale. If, however, the builtlin9 or improvement Is soltl wltnin one year of com- , ' . - ' ' , SUMMARV OF FEES ,
pletion, the owneriwlll have tha burtlen ot proving he/she tlitl not bulltl or Im- i � O S�
�rovetortne0urposeofsale). ; : � � � Duct-Structural . , , SystemRepeir/Alteration i�'��' -�BUILDINGPERMIT $ /�%So � SMIP . ' $ ,
LJ I, az owner of the property, am axclusively contracting'with-Iicansatl �on- � � I,
tractorsto construct the orolect (SectionJo44, Buslnass antl.Proteszions Cotle: Duct - Ventilating ,. _,_. _ _ �_, _ ��' -' PL"AN�CHECK� . $' . y.� Tz , PERMIT , �
The Contractor's License Law tloas not apply to an owner of pro0erty who � ` ' - � , ISSUANCE $'
Eulltls or improves thereon, antl who contracts tor such Dro7ect5 with a con- Exhaust Syst2m ❑ Mulciple O� � PLUMBING � $ • ,
tractor(s) Iicensa Dursuant to the Contractor•s License Law). ' - � 'PLAN CHECK� g ' ; GRADING , $, ,
❑ I'am exempt untler Section e. & P. C. fbr lhiz reason Firepl/FaCt. BIt. ICBO # '
' ' - , � ��ELECTRICAL $ � � $
Date ' - Ownan Heating System & Ducting ' ' ' ' - MICROFI�M $ �
1 hereby-certify thdt I harB reeA thls appllcatl0n antl State [hat the dbOve--! ❑6100,OOO�BTU �t00,000BT' • .�. �PLAN CHECK $ . �
� � . � i . ' / . : !' . . . I
information is correct. I agree tp comply with all <Ity antl county ortlinances ; • �•MECHANICAL $� TOTA� FEE ;$
antl.siate laws relaling to bulltling <onztruction, antl hereby authoriza repre- HOOd or Type I ❑ LESS
sentatives of this tlty� to ent4r upon the above-mentionetl property for , ReinspeQian Fe0 � $15 ' p�,qN CHECK $ � � � . '
Inspection our s. r , ' ��o T� e II ❑ . ,
9gnature ��i� -- �� ' Date 4' I -H . , f • � , ' ADVANCEDPC $ �7 ��/
� DriverY License or 55 9f, .� $� Registers , .�aue Fee � S 7� , ,, G , T
� FINAL FFE , $
CMF 0865-46 rev. 12/82 WhitO - gUIl0lnq; Canaty - APPlicant; Plnk - Accountin9; GOICen�od - As5e550r � ' ' '
';, ` . - _. •
-- -- -- - - .
-��ONSTRUCTION AND�PLANNIN. POOL & SPA � �
'APPROVALS Permit# `-� �3�`� � Date Inspeaor qppROVALS "Permit.� ' Date Inspector
� 1. Temporary Electrical Service or-Pole ;!• '� - 52: Pool & Equipment Location
��. , .
2. Soil Pipe-Undrgrnd. '_ - � , � ' ' � 53. Steel Reinforcement . '
3: Electrical Conduit Utilitv-Undrgrncl. , 54. Forms � �
.� 4. Electrical Conduit-Undrgrnd� - ' _ . • 55r Electrical Bonding . , - ,
5. Steel �Reinforcement . , . • � � _ ` � � , 56. Rough Plumbing & Pressure Test
6. Electrical UFER Gmd.� ' 57. APPROVAL TO COVER-GUNITEc
7. Footings ;� � - 58.- Electrical Conduit•Undramd. '
8. Foundation ' " � ' _ _ -59. Gas Pipe, O Undrgmd., Test � '
9. Wate'r Pipe-Undrgrnd. -, _ ' 60. Backwash Lines, P-Trap, C� Undrgrnd.
10. St�uctural Ploor System � �� 61. APPROVAL TO DECK '
11. Property Sewer Line &'House Connection' `���l, .62. Backwash & Receptor-Final
12. Sev✓er Cap , � ' - ; ' � 63. Heater & Vent-Final '
13. Roof Drains � - . ' � 64. Plumbing System - Final - . �
14. Rough Plumbing. ` ; � � � � 65. Electrical-Final� �
- 15.'RougN Electrical-Cond"uit-- "- - , - - � '�- � � 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/SPASYSTEMS FINAL
19, Rough Heating & Air Conditioning , , FIRE DEPT. REQUIREMENT •
20. Rough Factory Fireplace ' ' ' APPROVALS Permit #
� �
21. Ducts, in.Strdc[ure: . ' �' �70. Underground Hydro
22. Ducts, Ventilating, �� '��� ' ' 71. Product Piping O Gas ❑ Oil
23. Gas Pipe;Rough & Test : -' , 72. Underground Flush �
24: Roof Framing � ; � � `;,���' ' � �� , �� ' ' . 73. Undergmd. 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
29. Insulation. ' � • � 78. FIRE PREV. FINAL �
30. Drywall Nailing - � ' � Notes: '
31. Plaster�BrownCoat'. � . .��.� -- �
32. Electrical Power Meiar-Final � , � ' �
�
33. Final Electric ' � /
i
34. Final Heating &-Air Conditioning � • ' '
35. Final Gas Pipe-Test _' � . � ' ' �
36. Hood or,CanoPY� , � .. � . � � • -
37. Final Factory Fireplace^ � - , .
38. Final Plumbing: � � � ��j , �
39. Water Seivice-Final � ' � ' � � �
40. Gas Service-Final � �
41. Solar pomestic;Finat ' , � _ , . _ �. - '
42. Backflow Preventer � � � � � ' ` '
�
_i , _ . . . _ .1
43. Backflow Irrigation �- • . � - ' � �
44. Landscape Irrigation System� � i , �" . � � �
45. Sound Attenuation� � � �� i ' ' . . °
46. Handicep Regulations. ' ' �
47. FINAL STRUCTURE�& BUI�LDING� -
48. Special Requirements Completed � ' , � � � .
49. Electric Release to Edison ' .. _ � . _ � �
�50. Gas Release to Southein California Gas Co • � •�
51. CERTIF,ICATE OF OCCUPANCY '. _. � `,
No. � � Date ' � � ' . '
� - - - -
Applleant to �ill in all s0aces eacept t�oze wit�in heary GorEar Iines anG si9n all approoriata tlaelantions.
" " '. . . .. _.. . _. . .. . ..__ . . . .. " " . _r . _. _ " '. . .
, GTY OF COSTA MESA� � � ' , . . . P NO. ' ' TRACT NO. LOT NO. - ' 8 . , , � . � . � , � . _
CONSTRUCTIONPERMIT .' - loZ`f'.3 //.32.6." . 'i � . , ,�;/ �.9,: � :,� �
qpplicenYs Mai�ing Addrea P O. 6iOx i697� �0=+7A /L/�i� �%Z: ryPE OF CONSTRUCTION ' NEW � ADD; �ALTERATION _ REPAI R _ . . , . - - . ,
`A I -
Praject Addreu, l'7�' W ��� �� � �n'7A /,LC�d� , ' �� CONVERSION � �DEMOLISM O OTFIER - ' • � ' , . � � ' • � - ,
W) / 163m �FF LOUfS lNG o �SS<S OS.iS -' ��o CRIPTION OF WORK � ' �� ` ' " : . � G E U 1 NS- �
pwner's Name �r � hone _ �� 5 Q U��- ' � � �
qddreu'u3���R��'��-�2p� ���=Qr� .TYPEOFPERMIT � �CiR�FOVNDATION STRUCTURAL , A.P.gW . ' . � ' '20NE � - ' �'
AYCh�En . ��p� C��� LiCCn50 NO. ���d� � O�TENANT �❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL � _ � , BUILDING , . '
9 . , , PWG.REF.rW : �
Addreu SZO �e���A 4VP L' B ' - ' Q�., � �� ' .� �OTHER ' • ' . . . � � � ' TO BUIIDING � . ' ' .
-� ` L ;K7TtlN Phone�2L,2LQG�, PROJECT DESCRIPTION SQ: FT. ' '='OCCUPANCV •' - P PE V INE � �REAR VAqD (TO P/W
Q�pntfBCtOc'SNem ' a �� ��p� � � - , i � . � /��,� - �CEFTSIDE VARD � � � � RIGHTSIDE VARD � '
Addreulmailmg) 29S'9D %[SHLAKDS aYf'��9 � CONSTRUCTIONT;VGE VALUATION$ '�CiCdJ' , -' _':
' ZON� � GRADINGCU.VDS. ACRES PKG.SPACE;REQ. � PROVIDED -
uce�se Nu. : 3S%�G 3 - - . . , , ' . _ .
LICENSED CONTRACTOR DECLARATION t ' ' ; Ramarks: . � ' . ' � • . STREET WIDTH - � , ' 'PARK FEE S , -
�, �,bereby�affirm thdt'.b am IlcensaE untler pro��slons of �Charter 9 (commoncin9 . . . � ' . . � . . • � � ' � _
Mwith dactlon 7000) of Dlvislon 3 of the BUsiness antl Professlons Cotle, anE � : , _+ � !�� � ; • SPECIAL CONDITIONS: i j f '! �-
my �cansa is in full rce anG etfeCt. � :
� . liGenx Class �� I � � ' Ltcense No.' � 7 �' ' , . ' ; PLUMBING . . � ; , : . , 1
Date � 2 - 3 - � 3 5lgnajura - ' � ,
(� WORKERS' COMPENSATION DECLARATION • , ; � � 88i Sink � Sewer Cap � �a i � � , i 1 � , ELECTRICAL _ � f
� •ere0 'affirm.that I have.a Certlflcato oT consent to selt-lnsure or a.certlflcate__'. _ _ � i _ _ _ . ._ Automatit Washer ' � + �Meter ❑over 10a emps_' ,_ ,
Y -� Backflow�Preventer - SawerConnection.� - - S--
Workers' Compensatlon InsurJnce, or a carUfietl: copy thereot (Se<tlon ,
) Jo, Lzb. C.) t - � � _ ' �� Backflo(v Irrigation �� Solar Collectors ; ' : Construction Pole � , Su6 Panel '
aolic rvo. O 3/-C7L ' comaanr ,'SYq7n �cr.�/D � ' . � , � ; - . � � �
Y -�� � � CookingUnit � , SubPole
O �Wi Certitietl copY �5 hereby lurnisned. j � � � • ,!' � Bathtubs ! � � Solar Piping � j � � . ! . {
'� LJ Cntitietl copY I5 flleE with the city Bu' ng Dlvision 1., I, i �• � Di5hwa5hBr ! .MotOro �0-1 HP �1X-8
F Date -^ — �.+ - a� APPllcant � �•�' /� �� 1 ••"�"• �' � �� . Clerifiers � � I � $Otar T3nk , ; 1 . , � , , �
'b" _
EXEMPTION FROM WORKERS' COMVENSATION DECLARATION _ , Diihwd5h¢f • � ( : Swimming POOI W/Sp2 � � ' Dryers �Gas' �ElecbiC'�-� ' ��nC.SOIBI 09�15 HP 016-15+ ;
�(Tp�s sectlon neetl not be completetl if [he permit I5 tor one huntlretl (5300) o�� � � ' , , ,
f iess)�. • • 1 � : ' � ' � � i Fan i � � � � �Mic�owave �
'. I certlly�tnat in t�e Performance ot the work for which thlS permR ii IssueG I.� D�inking Founteins + U�inal - �
sh2�1 not employ any person In any manner so �as to becOme subject ta t�e � - � F.A.U. , � ' �Pole Light � . �
�
Wnrkers• Comcans�t�lo�n Laws of Call/orr�i .. ' ^ � � � � , � ' Floor Drains •' . � Water Closet ' ' ' '
^
Date 1 - �J � jyy _Si9natur8 � '� '.."' . - - • . • - ' - � .
g tleclaratlon, you-shoultl�become suCject [o-tbe-!� ' � � ,' Fixtures � .
r-NtlTICE�df,�aiter.makln this� '-FloorSinks�. . _. .....� _ , WaterHeatef� - - - _ _ Fang2
� .._ . . ,.
. Worke�s'i ComPensatlod provi5ion5 of the Labor Cotle, you must forthwi[h • . ' . , . � ' ' � � . ,
mmpiy 'wim� such crovlslons or tnis permit � shall be tleemed revoketl: �, 1 Gas Service � Outlets � Water,Service - Device Boxes giy� _
� ppNSTRUCY,ION LENDING AGENCV ' ' " ' ' � ' Outlet5 � � �
1 h6reby afiirm that t�ere is a wnstructlon Ientliny agenry for the�per/ormance . Inte�c2ptOrs �- � � � • � � � S[anding Settions • .
, ot th0 wOrk -for whlc�� this. p0rmit -is •Issyptl �SeGtlon � 3097 Civ. C.;� ' � • - • .
; Lentlar'S, Nama• "/'nG'�/'� /��'� J L ' � ' � � � - Kitchen Sinkl -: �� - ' � Switches � � , � Trash CompacYor ' �
l.,entler's Atltlress ' � 7R�1_' ED/IV6L�7E° - LIGN i � .wJA/� /3E'R'H . , � . , , � _ ! i - � .
'—� �. • � � Cavatories. � { '. l � � + ~ Gartiage O�spoul �
OWNER BUILDER DECLARATION - ' ' , , ' , � ' �
1 here�y afflrm lhat I am�exempYtrom the�Cantractoi'S �License Law foi tne' :�_ � ., . Generet0�• �0-5 KW �545 KW � ,
� following reason (Se<tion.7031.5 Business antl Protesslonal Code: Any Uty or , ' P-Tiap. �- � -
' coqnty whicb.reqWreSaPermitto'tonstrucqalter improve;tlembliih�or_repair � . - • � , i .
�.any structure, prlor to its�issuance, also requlres t�e�applicant tor such parmit Roof Drains. . , � � . � ' . � ; 1 Transformer 015-50 KW : ; ' � '
' , '
to f�le a 5i9netl 5tatamant that he/sM1e Is Iicensetl pursuant to the:proWzionS ot' � '' '' ' i � r % ❑5U+ KW,
�tne Contractoi'S.Ucense Law,(CnaD�e� 9 (commencing'with Sectio� �000) of �� ' � ' ' ' r ' : I - q Reins ction Fee � � , 'Reinspection Fea , � $75� �
R�V�sion'3rof che Business antl Prti(essions Cotla)' or,that he/she•li�exempt -• ShOwers � ��� 7a f:� . ..
: efrom antl tha�basii 7m tha alleqeC exemptlon. My, vlolatiun of Se<tbn ' , . �, . '. ' �tet ❑up f0 700amps • ' �5sua-Fae �$ 3
'�"1.5 Gy•any applicdnt toY.a,Permlt:.subJects;ihe�appllcant to a'�civll " • _ , � � ; ' ' �• -. . . _ ,_
fialty o� not mo.e tnan Ova huntlretl aollars (S50o): , 1�,_ � � � Service Sink � _: � Issue Fee'�� ' S 3 , Zo�ing Approdad By ' � ' Date � �
, [] I, as �owner ot� the Iproperty oi.�my emp�oyaes with wages�as thelr sole . _ , � . , • � ! ; ' � ' �
mmPensatlon wi�l•ao the work, a�tl the structure�is not Intentletl or offeretl ' , �: � , ��` MECHANICAL• i ; , � p�pj�qtion Approved By � � ate ' �
, (or salel(Secfion 7044, Bu5lness antl,Protessional COtle:.The Contrattor's � � . . , , ,
: �,j�ense Law Goes not aOP�Y to an owner oi a property.Who buHtls o� Improvas �� '� BOiler, � � j 4 �' RBtrig2rafion Sy5t21i1 � � , � , � �!
' thereon,'antl who tloeslsuth�work hlmself/herself or through his or �er own - �� �� c , Appli�ation Istued By , ' �atB � ' � `+�
� emo�o ees, provitlatl that such�improvements aremot Intentle0 or offeretl for f i i • ❑Q-100,0008TU ❑100.0006TU ' � • � �
r 9 y ` Duct= UndenGround + ; . , I � , � • � � ` SUMMAR�' Of FEES �
• salC. � howaveq the CWltlin o� ITProvemeOt IS SoIA Wlthln one edr of corti- ' f . � • �
' Oletlon, tne owner,wlll have [he burtlen of pYoving he/sha tlIG not bulltl or IM- . y � - , , ' i /� �.� � � .
ro�e/orthepurposeofsa�e): � � � ' ' . , Duct-Structural � � Sy,stemRepair/Alteiati0n � �BUILDINGPERMIT $' _'IrJo' � SMIP � � ; $ SO
�� 1, as ownar of the property, am exdusively coMractfng�wHh�licensatl tbn- ' , i � . ' � � � � �
- tractorsto construct the project (SecUon ]044,.Business antl'Professions Cotle: ° Dutt - Ventileting , _' _. _ __y _ ,_ � �,PLAN CHECK, $; ' - ' PERMIT . ( � !
'The Contractor's Licenfe Law does not�apPly�to an awnerof property who - , , ISSUANCE . �$! � i
Gui�tls or improves. theraon, anA who contracts for such prbjects witn a<on- Exhaust System ❑ Multiple ❑ i ' � � �PLUMBING $ • �� .
tractor(s) Iicense pursuant to the Contmctor's License baw): � � ' - - �PLAN CHECK $� ' � GRADING �$'
❑ 1 am ezempt untler Sectlon , e: 3 P. C. for tnis reason FirepVFaCt. 81t. ICBO *Ik � � � i � , . � . . ' �
. Date � ' owner ' 1 �� Heeting System & Ducting � � � • � � ;ELECTRICAL, i $ � ' ! ; $ ' '
� � � � � � � � � � `PLAN CHECK, $ � MICROFILM , $ � �
.i..ryeieby cert�fY that �I�have reatl•thii appli<atlomand-slate thahtho-a0ova-�� ❑0.100;OOOBTU O100,000BT ---f-• � - _ - i • � �
InfOrmation i5 correct. 1 agree to comply with all clry antl county orGinances -� � � • � � �• � ' � ' i TOTAL FEE� .$.
; and stata laws relatlng to Gulltling construction, antl hereby authorize rapre- ' Hood or T e i ❑' � : ' ' � • ,MECHANICAL . $', . � - .
� sentatWes ot this cttyito artter �upon t�e abova-m4ntlo�ed pwparty tor , �P � Rei�spection Fee S75 � � �ESS t � �
inspectlon ouro s. � . , � Ceno ' T e 11 ❑ 7 � �PLAN CHECK. , $�, ' �
Signature ��-� »-��--a � oa�es�—�— i � ; i ; , . . .4ov,4NcEo eC � S ' /�� ��
orivars� License or 55 qp .;� � � Registers � _ ' � �swe Fee , ' $ 3 � ' � , ' � FINAL FEE ;� ' $ ���31
. __ .. _ - .. . - _ . . _ ' . . - . : .. _ . '.._. . . .
CMF 0865-06 �rev. 12%B2 White - Bulltling; Canary -'Appliwnh Pink - qccountln9: Goltlenrotl - AsSessor " - ' - - ' - '
/. � •
'.' C,ONSTRUCTION AND PLAN - . - ' POOL 'A .. _ � . c �
�/; � .Date �Inspector ' - � ` �'Date Inspector' ,
.� APPROVALS ; Permit #_L�� APPROVALS Permit � �
'•i. Temporary Electric5l Service or Pole � 52. Pool & Equipment Location �' -
� �2�. Soil Pipe-Undrgrnd. � � � . � 53. Steel Reinforcement , - �� � -.. �
� 3. �Electrical Conduit Utilixv-Undrgrnd. � - • � 54: Forms �, �� • - - ,
`� 4. ,Electrical Conduit-Undrgrnd� � 55. �Electrical Bonding "� . . � � �� ' � - �
5�. �Steel Reinforcement� - - � 56. Rough Plumbing & Pressure�Test ..
6. Etecfrical UFER Grnd. ' � ' 57. APPROVAC TO COVER-GUNISE
7. Footings • � � � ,; _ 58. Electrical �pnduit-Undrar.,�: , '
8. �Foundation � � � - � 59. Gas Pipe, � Undrgrnd., Test'' - - .
9. Water Pipe-Undrgrnd. , � . 6p. Backwash Lines, P-Trap, O Undrgrnd. _ '
10. $tructural Floor System 61. APPROVAL TO DECK .
11. Property Sewer Line & House Connection � 62. Backwash & Receptor-Final. � -
12. Sewer Cap '. , ' _�GY.? �� 63. Heater & Vent-Final ' . ' ' . '
13. Roof Drains . - 64. Plumbing System - Final
14. Rough Plumbing . � � 65. Elearical-Final - � ' � ` �
I ; � 15. Rough-Eiectrical-ConduiY- � �' - - 66. Solar System-Final � - �
�
' " �6.' Rough-Elecfric Wiring = � � 67. Fencing & Access Approval � � -� - � - --
`� P,
= fi'r Rough Wiring Sign . • 68. APPROVED FOR PLASTERING
= 18. Rough�Electrica�-T,Bar Ceiling � 69. POOUSPA SYSTEMS FINAL �
19? Rough`Heating & Air Conditioning FIRE DEPT. REQUIREMENT
� �
20.. Rough.FactoryFireplace � APPROVALS Permit# � _
� 21. �Duc[s,�ip,Structure ' � � 70. Underground Hydro �
22. Ducts, Ventilating � -- �, � 71. Produc[ Piping O Gas OOiI �
- 23. GasPipe.Rough & Test �' .. 72. Underground Flush
"24. Roof Framing � . � 73. Undergrnd. Storage Tank O Gas ❑ Oil �
� � 25. Roof Sheathing . _ 74. Overhead Hydro � . �
- � 26. T-Bar Ceiling (Structuralh & Monocoat � � 75. Dry Chemical � � � ' N
_27. Frame and Plashing, . � 76.� Dry Standpipe - - -
i
28. � Lathing & Siding � � � 77. FIXED SYSTEM FINAL. '. .
_ 29. Insulation �� 78. FIRE PREV. FINAL
-30. D�ywall Nailing � � � � : Notes: . - � . '
i. - - - - - - � -
31. Plaster Brown Coat ' • � � � .
. 32. Electrical Power Meter-Final ' - ' ' �� � i - '
33. �Final Electric . .
34. Final Meating &�Air Conditioning . ' , , i . .
, _
� 35. Final Gas Pipe=Test � - - . _ " - -
36. Hood or Canopy . . . . ' . . � .. � .
37. Final Factory Fireplace � � � . . .- � - � -
36. Final Plumbing i i � I � ' ' -
39. Water Service-Final , � '
i
40. Gas Service-Final ��
41. Solar pomestic-Final � � . . . .
� -
42. Backflow Preventer i i � , . _ , ' � � . '�� , ,
43. Backflow Irrigation . '
44. Landscape Irrigation System ' � • �
45. Sound "A. ttenuation � � � ' � . `�
46. Handicap Regulations� � ' . � � � '
47. FINAL STRUCTURE & BUILDING �
48. Special Requirements Completed , � �
i'
49. Elec[ric Release to Edi;on�. . . � . . l� , ' ' i
50. Gas Release to Southem California Gas Co �� � . ' . , •. � ' ' 'b
�.,
51. CERTIFICATE OF OCCUPANCY �
No Date
ADVlleant to flll in all spacea axcept t�osa within
CITY OF COSTA MESA
CONSTRITCTION PERMIT
ApplicenYs Mailing/ Ayddress l' � S �'U ��n`` '�T U.SAf N[ES
Prolett Address ss/ S�-. /��T� s! . �05T4 �:'�G��r6
Owner's Name ul/LULM E� Lt7� �/S� /�ahone - SSl
Addrea �%�� ��DF/PEP �2 � e057A /YiCz5,�4
Arch/Eng. •/O<< �FI GA�PI�NC�.�E' License No. IO /O %
Address S.2a �iC�L��/A L�Y LON6 L.�1�G�
Contractor'sNama E%LTO C.�w/.S772UG7Q/✓ Phone�z-'����
Address (mailing) z95'92 SdNTA f;NA C^-NIYJIJ �D
LicenseNo: �'-3$72/a.`S Ei137'i�/6N1A�++
LICENSED CONTRACTOR DECI,ARpTION �J. � V�. �L��
1 hereby attirm that 1 am Ilcensetl untler O�ovisions o7 Charter 9(commenting
witn saction 7000) of Dlvision 3 of the Business an0 Proteszlons Cotle, antl
my Ilcanse is In full force anG eftect.
LJcense Class j3"� ---r� Lic�nse No- 35�
Dato u —// —•�l� c�a�at .w _ /0.-'. C�e.�.� _ _
WORKERS' GOMPENSATION DpC{J�RATION
`eraDy afflrm that I nava a certitiwta of consent to self�nsure or a certiflCate.
Workarz' Compansatlon Insurance, or a carSifietl copY thareof (Sectlon
J0, Lab: ) o
v�o'7ucy No. � 30 ��—o z' Company STA7E r-UND
W Cert,lJ1letl�copY'S I�otlbwlthrt�ehcltY BY In9 DI �.
. Date u—�� �� - Applicant � ��`"'^+ ��`M �O•
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This sectlon neetl not Da complet¢tl It tha permit Is !or one �unCretl (5100) or
iess) . . � • '
1 certlty that In th! Derforman<e a/ the work for whith this perm�t Is Issuatl I
shall not amploy any perion in any manner so as to becoma sub)ect [o [he
Workeri' Campen5ation'Laws o! �IIlomla.
Date � �19�alUra
NOTICE: If, aflar makirig this Oetlaratlon, you shoulE become subject to the
' Warkers' Gomponsatlon D�ovislohs o! tha labor Cotle, you must farthwitn
, comply -with such 0/oWslons Or tnis permit shatl be tleeme0 rovokatl.
�CON5T0.UCTION.LENDING�AGENCV � �
I horaby affirm that thera IS�a�conEtructlon lentling aqancy lor Ihe performan<o
o/ lhe work for Iwh cIL[hi�Pgr�nly is IssueY (50Lli,on 30B1CIv. C.�
Lentlur's Name M6� ai2 St� /JC tU AN
I.nntler's AdtlraS� � �� Z E[��/.(l E'� ,
� OWNER BUIIDER DECLARATIpN
' I barabY.aftirm lhat I am exemp� /rom tbe Contractor's Ucense Law tor tne
as
owner
� OurG�
er of
1 am axempt untlor
or d permlt sub7ects Ihe appliwnt to a civll
hu�OroO tlollars (E500).
erty ar my amployees with wages.as tnair sole
>rk, antl Ih¢ 5[ructure I5 not IntonOeO or ofipretl
�inass an0 Professlonal Cotle: Tha Contractor'S
o'a� ownor of a property wM10 builAs or Improves
wOYk �imsel//her581t Or [hrough h15 Or her Own '
:h irpprovomonts are nol Intontloa or offareU lor �
g or �mprovement Is solE witnin one year of com-
the burtlon o/ proving he/z�e tlitl nol buiid or Im-
�Y, dm excluiivaly contracting with licensetl ton- '
fct ($ectlon 7046, Business antl Profes5ion5 Cotle:
w does not app1Y to an owner aT D�operty who
antl who contracts for such Oro�ects with a con-
the Contractor's l.icense Law).
� B. 6 P. C. for this reason
oate Owner
I herebycartlfy t�al 1 hare reaC thiz ap0���t�a� antl stata tnat the�above
InformaHon Is correct. I a9ree to comO�Y �+'�th all clty antl county ortlinancet
antl stata laws relatin9 to builtlipg mnstructlon, antl �ereby authorize repre-
�tantativas of th city to enter•upo^ the abave-manUonetl property for
. InsDectlon our s. �7 II
Slgnature B�vv�a.n \ "—_� � �, ' Date Y'll ..��
//3 Z�
TVPE OF CONSTRUCTION YJ NEW U nDD
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESLRIPTION OF WORK
Iinas anO slgn all aoorooriate tleclantloni.
ALTERATION U REPAIR
TVPE OF PERMITJLI GRADING LJ FOUNDATION LJ STRVCTURAI
❑ TENANT L� ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ �OTHER
PROJECT DESCRIPTION 5a. F7. oCCUPANCY
GONSTRUGTION TYPF VAIUATION $ '
ZON� GRADING CU. VDS. ACRES
Remarks:
Preventer
Irrigation
Drinking Fountains �
Floor D'reinz
FloorSinks �
Gas Service • OuUets
Interceptars �
KiMhen Sink
L8V8tafie5 '
Drains
Sink
Duct• Under Ground
Dutt - Slruttural
Duct - Ventilating
Exheust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO 5W
Heeting System & Ducting
❑ai oo;000 eTu O i oo,000 en
Hood or Typel ❑
Orivers' Llcense ar 55 qF � � I ' Registers
CMF 086546 rlv. 12/82 White • BuIItlIn9; Cana�y - AppliWnt: Pink - ACCounting; Golden�Otl - As5e55o�
Sewer Cap
Sewer Connectii
Solef Collectors
Solar Piping
Sotar Tank
Swimmina Pooi
Urinal
WBter�qOaet,
-Water Heater
� Reinspeclion Fee
laue Fee
❑0.100,OOOBTU ❑100,OOOBTU
Syarem RepairlAlteration
$15
§ 3
Reinspection Fee $15
Isue Fee S 3
PLNG. REF. vM�
TO BUILDING
PROPERTV LINE
LEFTSIDE VAqD
PKG.SPACE REQ.
STFEET WIDTH
57ECIAL CONDITIONS:
Automatic Washer
Construction Pole
Cooking Unit
Dryers ❑Gas ❑Electric
Fan �
F.A.U.
Fixtures
Device Boxes
Garbage Disposal
Generator.00•5KW 05-15KW
Trensformer �75�50KW
�5U+ KW
Meter ❑up to 100 empe
2oninp APProvad By
Applitation Approvetl 8�
APPliention Issued By
BUILDING PERMIT
PLANCHECK
PLUMBING
PLAN CHECK �
ELECTRICAL .
PLAN CHECK
MECHANICA�
PLAN CHECK
G9etl 4/ 1 i /d,;
BVILDING
REAR YAPD (TO P,
RIGHTSIDE VARD
PROV�DED
PARK FEE
Je4
Meter LJover 10p emps
Sub Panel
Sub Poie
Motors ❑0-1 HP ❑1'b-8 -
Inc.Solar �9-15HP �16-15+
Microwave . '
Pale Light
Trash
SeCtions
Reinspac[ion Fee
SUMMApV OF FEES
$ SMIP
$ PERMIT
$ ISSUANCE
GRADING
MICROFILM
TOTALFEE
LESS
ADVANCEDPC
FINAL FEE
$
$
$ , Os�
�? ��CONSTRUCTION AND�PLANNING � = ,�'. �� ' POOL A , -- -
�' � - Date, � Inspector� '' ` " � Date Inspector
_- "�APPROVALS Perinit #�'� � APPROVALS - Permit #
; 1. 'femporary Electrical Service or Pole - � � .� �� �� 52." Pool &'Equipment Location _
� � i- . .
�_ 2a �Soil Pipe-Undrgrnd. � . . �53, ,Steel Reinforcement y -
- 3. Electrical Coniiuit UtilitwUndrgrnd. � _ � � 54. -Forms' � - �
'� 4. Electcical Conduit-Undrgrnd. � 55:� Elec[rical Bonding ,
5: Steel Reinforcement : � - -. � '56.� Rough Plumbing & Pressure Test
6: Elect�ical UFER Grnd. '�. _ 57. APPROVAL TO COVEfl•GUNITE
7. ,Footings ' ' - � 58. Electrical �nduit-Undrar��f.
6. Foundation _.. ' y � � � .. 59. Gas Pipe,'O Undrgrnd., Test
."i
9. 1Nater Pipe-Undrgmd. ;� , . �60. Backwash Lines, P•Trap, O Undrgmd. � .
10. Structural Floor System 67. APP.ROVAL TO DECK
11. Propertq Sewer Line & HouSe Connection ' 62. Backwash_&��Recepror-Final:
12. Sewer Cap ��� � � 63. Heater & Vent-Final '
�i-
13. �Roof.Drains , � �.64. Plumbing,•System - Final - - �
14. �Rough Plumbing ;� ` - 65. Electrical-Final � �
_ �
_ -15. R6ugh Electrical-Co�duit ��- - -, ' - •" � � �66. SolarSystem-Final ' � �
- t�. �Rough Electric Wiring , � . - � - - :_ 67. Fencing & Access Approval -�-,' - � .
_ `'i7.'Rough Wiring Sign � . _ � � � 68. APPROVED FOR PLASTERING ,;
18. Rougfi_Elec'trical;T.Bai Ceiling. . -� 69. POOUSPA SYSTEMS FINAL -, �
� 19. R�ugh;Heating &-Air Conditioning _ .- � FIRE DEPT. REQUIREMENT _
� 20. Rough Fac[ory Fireplace ' � APPROVALS Permit #
.. � 21. (3ucts.�in Struc[ure , . � � 70. Underground Hydro
� 22. bucts, Ventilating ;` ' , �71. Product Piping O Gas ❑ Oil .
',23. .Gas'Pipe-Rough & Tesf , , ( 72. Underground Flush
_'�24. Roof Framing_ � ' ' •� . , - 73. Undergmd. Storage Tank � Gas ❑ Oil , ,
�I ;� , 25. rRoof Sheathing 2� 74.� Overhead Hydro � _ . � ,
�. 26. T-Bar Cc�iling �Structural) & Monocoat' � ,.' - 75. Dry Chemiwl
27. Frame and Flashing �. ' 76. Dry Standpipe �
, 28. ,Latfiing;& Siding � 77. FIXED SYSTEM FINAL
'. 29. Insulation .• �' i 78. FIRE PREV. FINAL
� `30..Drywall;Nailing �� , Notes: .
31. Plaster BTown Coat ' � � � �
� •. 32. Electrical Power Meter-Final , �� �j � ' ' �
33. Final Eiectric �� � u . .
� 34. Final Heating & Air Conditioning � �
35. Final Gas Pipe-Tesf' � � � � � . '
. -
36. Hood or'Canopy � � - _ � � . • � � �
37. Final Factory Fireplace-' � . ' . "
38. Final Plumbing � -, ' � � �
39. Water Service-Final , � ; . _ �� , '
i
40. Gas Service-Final ' ' .
41. Solar pomesiio-Final � � . � � " � ��
42. Backflow Prever�ter ` ' � - '
43. Backflow Irrigation : n r
44. Landscape Irriga[ion System , � - � � � . -
45. Sound�Attenuation .
46. Handicap�Regulations � - � , i , ' , .
47. FINALSTRUCTURE&BUILDING � � ,
48. Special Requirements Completed, � ; '
49. Electric Release,to Edison � . �.. � � . . � . ' - _ - " .
,,,
50. Gas Release to Southern California Gas Co � . I � , '� ., •
�
51. CERTIFICATE OF OCCUPANCY _ _ _ ' ' �-
, �
No. Date • �
..
CITY OF COSTA MESA
CONSTRUCTION PERMIT
Applicent's Mai
Project Address
Owner's Na/m/e'
Addren �e
N0.
� Applieant 10 flll In all soaeas axeao�
PEflMI 'NO���O
.�
Address "- '"'� � - "
Contrector'nNama �qG�� ���v4�0� Phone�b2'� 6
Addresslmailingll�/•�z �AAlTA i�ff/A C � � '
License No. ��S7��i �i
MLICENSED CONTPACTOR DECIARATION
1 hereby atlirm Ihat 1 am Ilcensetl untler provislons at Chtrter 9(commentlng �
�wlth sectlon 7000) ot Dlvision 3 ot tha BuSiness antl Vrofeislons CoOe, antl
my II<ensa IS in lull tOrte antl aflBCl.
( Ucensa Llass ' � Licen No����
� Date 7�' � Slg at G "'"
' WORKEHS' COMPENSA710N DECLARATION �
O xeby aftirm tha[ 1 nave a Certl/icate of consent-to self-Insura or a Certlficate �
Norkers' Compensatibn Insuranta,. or a certifletl coOY ��cereo�f (Sactlon
�o. Lab. C.��� . ComPanY ��"'4%� zND
� Pollcy No. �
* � Ce�Ufiltl copY �s �<reQy tumisneC.
c\ Certilietl copY �s file0 with the �tltY Builtlin9 Division.
A Dato ADOlicanl _ _
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
�.(This settlon neetl not be �ompleleC If [he permit Is for ona hunOretl (5300) or
less) '
(� , I certify that In tne parfprmance ot the work tor which thls permh is Issuetl I
s�all not amptoy any person in any manner so as to Dacome sub7ect to t�e
^ Workers' Compensatlon' l.yws of Call/ornla. � •
I �Data Slgnature
NOTICE: If,-a/ter making this tlaclaratlan, you shoultl become sub)e<t to [�e
Workers' Compensatlon provlslons o! the Labor Cotla, you must forthwith �
comply �witn sucn proyislons � or thls permlt , snail be �, tleemetl ravokea.
CONSTRUCTION IENq�NG AGENCV '
1 hamby afflrm lhat tharo is a constructlon IenOin9 a9ency for tna performanca
of tnB 'work for����js/pgrMt Iz�Is54e�f$e�11ory.,30�CI�..C.��
Lantler's Nama C � /G Y a1R a�/ .,J XlIr AN
LenCar's Atltlres %��y Z �D%N�� ��/y%�� ��
OWNER BUILDER OECLqRAT10N ,
I hareby a/firm that 1 am oxampl /rom the Cootractor's Licanse Law for the
/ollowinq reazon (Sectio� 7031.5 Buslness anC Profe551onal COEe: Any city or
countv whlch roauires a oermlt to conitruc[, alter, Improve. tlamollsh or rapatr ,
LJ I. d5 OWOBf Oi [fli
comvo��t�on will.tlo
/Of Sd18 ($BC�IOn 704
Uconse Law tloei not
theroon, antl wno Go�
employ ooi, provitled t
sale. I/, �owovar, che I
plptlon, iho owner wll
��ove?or Me purpom �
I, as ownor ot tha
IfdCiOfS SO COf15fIUCL B
The Contrattor's Llce
builtl5 or Improvas tn
tratlo!(5j Ilcense purSL
❑ I am enampt untler
Data
I- hareby -eerti/y� that
Intormation Is carrect
antl stato laws relatin
sentatives of tnis cit
InspecUon ourOPse
SlgnaWre
� Drlvers' lJtensB or 55
i
CMF OB65-46 rev. 12/8
ir.
a
ty or mY amployaes witn
c, an0 t�a structure I5 not
ess antl, Professlonal Cotli
an oWnar at a property w11
d5
mprovements are no[ m[enana or onerea ror
r improvament Is soltl within one Year of com- .
i burtlan o/ proving �e/s�e tlltl nol builtl or Im- �
am axclusively contrac[in9 �+�th Ilconsetl con-
(Sectlon 7044,.Buslness antl Rofasslont Cotle: �
does not aPpIY lo an ownor of pro0erty who
1'who contracts tor such pro�ects wlth a con-
i Contractor's Llcense Law).
8. 6 P. C. !or thls reason .
: Ownei
hava !Gd
to
a�ove
7E OF CONSTRUC
❑ CONVERSION
DESLRIPTION OF
wilhin �aarY borEar Ilnes anC �ign all approo��ala Caelaratlons.
I � NEW L.� ADD LJ ALTERATIpN
DEMOLISH ❑ OTHER
REPAIR
TVPE OF PEflM1T LI ORADING L! FOUNDATION Lyl STRUCTURAL
❑ TENANT ❑ ELECTRICAI.O PLUMBINO ❑ MECHANICAL
❑ qTHER
PRQIECT DESCRIPTION 5�. F7. oCCUPAN—Cvy�
CONSTRUCTIONTVPE VALUATION$ /_f9/�
ZON� GRAOING CU. VDS. ACRF�T—'
Ramarkf: ' �" C'L,(/7 � SL,(22
Sink
cflow Preventer -
cflow Irrigation
Drinkinq Fountains
Floor Drains.
Floor Sinks
G855etJice , C
Intercepmrs � '
Kitchen Sink _
LBvatOfieS . �
F7oof Dreins
c�...:5_... '.
Sink _
Sewer CaP •
• Sewer Connection
• Solar Collectors
Solar PiPing - � .
So1ar Tank •
� Swimming Pool w/Spe �
' Urinal ' ' '
Water Closet' ' �
- Wacer Heater � - - � �
ts �Nater Service .. -.
'
' ' i Reinspection Fee $15
- Issue Fee $ 3
Boiler ' '
Duct • Under Ground
Duct - Structurel
Duct-Ventilating _�
Exhaust System ❑ Multipl
F iiepl/Fact. BI C I CBO 9W
Heating System & Ducting �
❑U700.000 BTU 0100.001
Hood ar Tvpe I ❑
�� � --'�"i—� � : I Registers �
Canary - APPliwnt: Pink - Accountin9� Goltlonrotl - Assessor
❑0.100,OOOBTU ❑100,OOOBTU
Reinspection Fee
laue Fee
a
$15
§ 3
PLNG. REF. qW
LEFTSIDEYARD ��
PKG.SPACE REQ• r`J.'
—�7
STREET WIDTN '
SPECIAL CONDITIONS:
i
Automatic Washer
Cooking Unit
�ryers ❑Gas LJEltttric" ' '
Fan,
F.A.U.
Fixtures � �
Device Boxes
Outlets
Switches .
Garbage Disposal �
Generator DO•5 KW �5-15KW
Transformer ❑75�SOKW
; ❑5U+KW�
Ma[er ❑up �0 100 ompe
2oning APProwd BY
ApPliption ApOroved By ' I
Applimtion Izsued By
46�9 :i/I�i/ = 1... a : �.
BUILDING
CLTpI�I` /`/1 CT
t7EAR YARD (TO P/L)
RIGHTSIDEYARD '
PROVIDED
PARK FEE $
Mater LJover100amps
Sub Penel � �
�Sub Pole ' '
�Motors �0-1 HP ❑17,E -
InaSolar 09-15 HP �16-15+
Microwave ' '
Pole Light � .
Sign
Standing Sectiani ���`�
Trasb Compactor� � �
� ��
,'!
�-
' Reinspeftion Fee $15
�BUIIDINGPERMIT $ �G.S6
PLAN CHECK � $� �
PLUMBING � � $
PLqN CHECK � $ '
ELECTRICAL ; $ �
'PLAN CHECK 5
�MECHANICAL $
PLAN CHECK � $
OFFEES�'
� SMIP $ . O.So
' PERMIT'�} ;� F� .
. ISSUANCE l• S {
GRADING� � S �
. � $
MICROFILM �. S
TOTAL FEE ' $ �
LESS
ADVANCEDPC $�
FINALFEE $,/03 �z
'' ^CONSTRUCTION AND'PL'ANNING .1 � POOL �A
' ` ' � � �. Date - � �Inspector � �� .� � � - �' . Date Inspecto� � �
_APPROVALS ' Permit#� " ,- �APP.ROVALS� Permit# -
.� . :
' 1�. Temporary Elgctrical Seniice or �Pole �, ' � ' ' ! 52: Pool & Equipment Location � ' � . -
i - -
� 2: �Soil Pipe-UPdigmd. . ' _ ' � " . � � ' - . � 53. Steel Reinforcement � � - q :
- 3: Elect�ical Conduit Utiliiv-Undrgrnd. � � �� . � - �54. Forms � �- �'� I
' 4: ElectKical Conduit-Undrgrnd. � ; � '� . � z'j . 55r -Electrlcal Bonding � - ,
5. Steel•Reinforcement � _ ` . - ', � �� - ; �/f, 56, Rough P�umbing & Pressure Test �
6. Elec[rical UFER Grnd � '. � 57: APP.ROVALTO COVER-GUNITE �,;'
7. Footing{ � ' , ' , � � � ' _ ���J 58: Electrical �pnduibUndromd. ' � 1.�
�� 59. Gas�Pipe, O Undrgrnd., Test
8. Foun' ation � • � � . -
i � - �
9. Water Pi e=Undr md. � �. ' . . � , �. ' . 1�. 1
P 9 60. BackwasFi Lines, P-Trap, O Undrgrnd.
10. Structural Floor System � - . - 61. APPROVAL TO DECK -
11. Property Sewer Line &'House�Conn ic�ion' . 62. Backwash & Receptor-Final � .
12. Sewer Cap . .� ' . � � .
i � , � . '63. Heater & Vent-Pinal - ,
13. Roof'Drains � ; � � � ' � .64. Plumbing SYstem - Final '
14. ,Rough Plumbing � � • � � � -65. Electrical-Final ' . '
- '15: �ROugh �Electriral-Conduit � - - ' - ' - � - ". '� 66. Solar System-Final " � ' - �' -
�16.��Rough Electric Wiring . , � �' ' . I �' 67.��Fencing & AccesSAppioval " - ' .. .
''17. ,Rough, Wiring Sign _' ' _ � � � gg, APPROVED FOR PLASTERING ' . '
18. Rough Electrical-T Bar Ceiling ' - -, ' 69.� POOL/SPA SYSTEMS FINAL
� 19. Rough Heating & Air Conditioning , � � � � � � � �FIRE DEPT. REQUIREMENT .- .. _
� „ ' '` ' -
20. Rough;Factory Fireplace I , , APP,ROVALS Permit #- .� :
21. ,Ducts, in Svucture '' � '� ' �' � 70. �Jnderground Hydro '
�
; .22. Ducts, Vent�ilating � � � ' � , �7L� Product Piping �� Gas ❑ Oil �
� 23: �Gas Pipe-Rough & Test ' � i, � , 72. Underground Flush
24.'Roof Framing ' -. �_ _ 73. Undergrnd.StorageTank �Gas OOiI
25. Roof Sheathing , ' �74. Oyerhead Hydro
26. T-Bar Ceilirig (Structurall� & Monocoat , � t �'75. Dry Chemical � �
27. Frame and Flashing - � - � , � 76, Dry Standpipe � � � ' .
26.' Lat6ing & Siding , � � 77. FIXED SYSTEM FINAL
29.�Insulation �- � �� � , . , � 78. FIRE PREV. FINAL ' '
30.�DrywallNailing ,,;. ' � � - �Notes o _�,
' 31. Plaster�Brown Coat � � � � � ' .
, � . � .
. 32. Electrical Power MeterFinal � � � �
33.�Final Electric , ,
34. Final Heating & Air Conditioning ' � • �
35. Firial Gas Pipe-Test , � ." ' ' • � - � � � � - - �� � �
36. Hood or,Canopy . � � • � � - .
i,
37. Final Factory Fireplace� � �_ , , � . ' � � � ' -
38. Final Plumbing --i � :� . ' ' - � � , �
39. Water.Service-Final: .' .� ' . � . � . ; , �
40. GasService-Firial , � - �' � ' � � � ' ' � ' ' .
�
41. Solar pomestic-Final �� , __ _ ' . _l _ _ � ' ' '-�
42. Backflow Preventer ' � _ � _' � • � ' - �
43. Backflow Irrigation � � ' � ' �
44. Landscape Irrigation System, , _ , � - � . ' � �
i „ .
45. Sound �Attenua`tion - • ;
46. Handicap Regulation's � , �� �
47. FINAL STRUCTURE & BUILDING - ; �a� �� �� +�
48. Special Requirements Completed � ' � � _ . _ �
49. Electric Release to �Edison � � . _ . _ � . . _ ' " ` .
50. Gas Rele�ase to Southem California Gas Co � , � � i .. � • �
51. CERl11FICATE OF OCCUPANCY � • _ , _ � , , .. . � � �
r �
N0. �� Date � , � � .
a4��p M s9
o, �
, _
r
J
a�� dc�
' CITY OF COSTA MESA '
BUILDING DIVISION
DEVELOPMENT SERVICES DEPARTMENT
PERMIT
(714)754-5273 • Fax(714)754-4856
6��
Job Address: -69JW 18TH ST
Suite No
Vicinity: MEDIA ONE CABLE N BOX
Parcel Nunmber: TPN99087
,4pp�icant: MEDIA ONE
Address:
owner: CITY OF COSTA MESA
Address
ELECTRICAL PERMIT
Phone:
Zip:
Phone:
Zip:
Contracmr. EVANSJE ENETERPRISES DBA: WEST COAST CABLE
Address: 5425 BERRYHILL DR
CA Phone: (714) 985-0411
YORBA LINDA � � Zip: 92886 -
� �License: 734530
ISSUE FEE
Temp service test
Res. alc package
New Res (1-2 units)
New Res (3+units)
Pool / Spa
Lighting Fixts
Recept Outlets
Switches
Non Res Appl
Res Appl
Service to 200a
Service to 1000a
Service over 1000a
Motors to 1hp
Motors to 10hp
Motors to 50hp
Motors to 100hp
Motors over 100hp
Communication drops
Sub panel to 200a
Pole Light Pkg
Sign Circuits
Temp Pwr Pole
Intermed Pole
PERMIT NUMBER
E99-01165
77 FAIR DRIVE, COSTA MESA, CA 92626
Status: ISSUED
Applied: 72l3/7999
Issued: 12/3/1999
ISSUED BY: d� �
SCOPE OF PERMIT
INSTALL EL�CTRICAL METER FOR NEW CABLE T.V. POWER SUPPLY FOR -MEDIA ONE-.
$23.50
$0.00
50.00
$0.00
$0.00
$O.QO
$0.00
$0.00
$0.00
$O.qO
$0.00
530.50
$O.QO
$0.00
$0.00
$o.00
$0.00
$0.00
$O.QO
$0.00
so.00
SO.qO
$0.00
$0.00
$0.00
Quantity
FEESUMMARY
Temp Dist System I Lighting
Busway /100 ft
Standing Section
Misc Electrical Equipment
Transformers up to 1 kva/kw
................up to 10 kva/kw
.................up to 50 kva/kw
.................up to 100 kva/kw
..................over 100 kva/kw
Low Voltage Equipment
Low Volt Wiring System I Ckt
Misc Conduit
Misc. Conductor
Circus ( gen or ride)
Circus (mech ride or lights)
Christmas Tree Stand
Fireworks Stand
Other Electrical Fee
Investigation Fee
Plan Check Fee
Reinspection Fee
Quantity
$0.00 0
$0.00 0
$0.00 0
50.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
$0.00 0
so.00 0
50.00 0
$0.00 0
so.00 0
$0.00 0
$0.00 0
$0.00
$0.00
$0.00
50.00
TOTAL CALCULATED FEES E54.00
COMMENTS / SPECIAL CONDITIONS
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under California statutes and related
regulations. (Ord. No. 9248, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a poriod of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
requlred Inapeetlona end flnal approvel must be obtained. Failure to obtain inspections and final approval will result in the expiretion of ihis permit.
FOR INSPECTIONS CALL: (714) 7545626
WORKERS'COMPENSAnON DECLARAnON:
I hereby aHirm untler penalty af perjury one of the lallowing declarations: ,
❑ I heve end will maintein a cenlficate oi consent to sell-Insure for workers' compensation, es providetl for by sedion 3700 of ihe Lebor Cotle, for the peAormence of the
work lar which this permit is issued.
❑ I have antl will maintain workers' compensation insurance, as raquired by section 3700 ot the Lebor Code, for �he padortnance of the work for which this permit is issued.
My workers' compensation Insurance cartier and polity number are:
Carrier: Policy Number.
(lhis secfion need not be crompleted it t6e permit is va/ued at one hundreU tlollars ($100) or Iess.J
❑ I certity that in Ihe perfortnence of the work for which this permit is issueQ I shell not employ any pereon in any menner so as to becoma suDject to the workers'
compensation laws of Celifornia, end agrea that� I shoulC 6ecome su6ject to the workers' compensation provisions of Section 3700 of tha Labor Cotla, I shall fotlhwith
comply with Ihese provisions. �p � Z���
Applicam Signature: �, �c --v�.—� Date:
WARNING PAILUFE TO SECURE WORKERS' WMPENSATION COVERAGE IS UNLAWFUL AND SHML SU&IECT AN EMPLOYER TO CflIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED
THOUSAND DOLLARE ($100,000). IN ADDITION TO THE COST OF COMPENSATION, �AM4GES AS PROVIDED FOR IN SECTION 3]O60F THE LABOR CODE, IfJrEPEST, AND ATTORNEYS FEES.
LICENSED CON7RACTORS DECLARATION:
I hereby aXirm ihat I am licensetl untler provisions of Chapter 9(commencing with Saction 7000) of Division 3 of Ihe Business and Protessions Cotle, antl my license is in full
force and eHecL Lic. # Class x C-/O
Coniractors Signature: �� _�, .—�� Date: 1 2- S 9 C
�
CONSTFUCTION LENDING AGENLY:
❑ I hereby aftirm that there is a consiruction lentling agency tor the pedormance of the work tor which this pertnit is issued. (Sec. 3097, Civil Cotle).
Lender's Name: Lendefs Address:
Signawre: Date:
OWNER-BUILDER DECLARATIONS:
I hereby attirm ihat under penalry of perjury ihat I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for ihe following reason (Sec. 7031.5, Business and Pmfessions
Code: Any ciry or counry which requires a permit to constmc6 elter, improve, demolish, or repair any stmcture, prior to its issuance, also requires the applicant tor such perml�
to file e signed statement ihat ha or she is licensed pursuant b Ihe provisions of ihe Comractors License Law (Chapter 9(commencing with Seaion 7000) of Division 3 of ihe
Business antl Protessions Code) or thet he or she is exempt iherefrom and the basis tor Ihe elleged exemption. Any violation of Section 7031.5 by any epplicam for a permi�
sub�ects the applicant to e civil penalry of not more than Ilve �undred tlollars (5500).J:
❑ I, as owner of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, anC the structure is not intended or oHered for sale (Sec.
7044, Business and Pwfessions Code: The Contractors License Law does not apply to an owner ot pmperry who builtls or improves thereon, end who dces such work
�imself or herself or ihrough his or her own employees, provitlatl ihat such improvements are noi intended or oNered for sale. If, however, ihe builtling or improvement is
soltl within one year of completion, Ihe owner-builder will have the burden of proving thet he or she did not build or impwve for purpwe of sale.).
❑ I, as owner of the property, am E%CLUSIVELV CONTRACTING WITH LICENSED CONTRACTORS to constmct tha project (Sec. 7044, eusiness and Pmfessions
Code: Tlie contractors License Lew tloes not apply to en owner of property who builds or improves ihereon, and who comracts for such projeci with a contraaoqs)
license pursuant to the Contractors License Laws.).
❑ I em ezempt untler sec.
SignaWre:
Owner ID verified by tlrivefs license. ❑ Yes ❑ No
Business antl Professions Code for this reason:
Verification of Ownership by (rype of document, i.e. - property tax bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
Driver's License No.
Date:
Expiras:
❑ I �ereby certity ihat no eacevation tive (5) or more feet In tlept� into w�ich e person is requiretl to tlescenq will �e matle in connection with work authorized by ihis
permit and Ihat no builtling simcture, scefloltling, falsework, or tlemolition or dismantling thereof, will be more than thirty-six (36) feet high. (Chap. 32, Grp 2, Art 2, Sec.
341, Title e, Californie Adminisirative Cotle).
❑ As ownervhuilder, I will not employ anyone to do work which would require a pertnit from �he Division of Induslrial Safery, as noted above, unless such person has a
permit to do such work from (he division.
Signature: Date:
Division of Industrial Salety Permil Number:
CERTIFICATE OF COMPLIANCE ANO AUTHORIZA710N OF ENiTiY: I cenity under penalry of perjury that I heve read this application end state Ihat Ihe information givan is
correcL I agree to comply with all state laws and ciry ordinances relating to building construction, and au�honze representatives of ihe Ciry of Costa Mesa to enter upon ihe
ebove-tlescriDed propeny for inspection purposes. I egroe not to occupy or allow occupancy ol any buiiding aut�orized by this permit umil final inspection.
y SignaNre Of L gal Ow,ner(s) �(� Date �
,� \ w .._/l il.�`, � 2' .� ._/
d/Or Authorized Applicant Date
CpDE 1, INSPECTIONTYPE �T� INTf�AlS
1616 Pixed System Final Fire Prevention '
1266 Pool Spa Final
200 Final Re�Roof
201 Final BIocWReteining Wall
202 Final Factory Fire Placa
203 Final Sign -
204 Finel Demolition
2aa6-46
CODEt INSPECTIONiYPE
206 Final Mechanical
208 Final PlumDing
210 Final Elecirical
212 Finel Fire Preventlon
220 Final Planning Approval
222 Final Site
250 Final Building/Oaupancy
P�
INTITIALS
�
' ApPlitant to fill in
CI7.Y OF COSTA MESA �PERMIT�
. ; COIVSTRUGTION RERMIT I Cs "
Address
Phone
within
I hereby affirm thct I am Ilcensatl Untler provlsions of Charter 9(cam-
�mencin�-with Stttlon 7000) of DlviSiOn 3 O( tha Bu51n855 entl
Rofeis pns Cotle, an y Iicense Ii In tull torte antl eflett.
Licenzo Clais ' Llcense o.
oace �� 1@-A 3 Signature
WORKQRS'COMPENSATION DECLARATION
I hereby aHirm that I havo a cerUficato of consent to SelLinsura or a
'certlficate of Worker5' CompanSatiOn Insurante, or a CB/tiiletl COpY
thereof(5¢c 380Q, Lab. ).
�-'�tv No. ��O_f:S/-R�Comoanv T�%�_�N.ii
ertlr�¢y �ppy is horeby turnishetl.. _ _ .
:ertl�letl topy is filetl wilh t�e city BUIItlin9 Divizion.
EXEMPYION FROM WORICERS' COMPENSATION DECLARATION
(.This sertlon neetl no( be <ompletetl it Ihe permit.is.for one huntlretl
(5100) or leu).
I certHy that in tne per(o�mante of the work for which thls permit is
(ssuetl, I ihall not employ any person (n any manner so as to become
subject to the WorkeR' CAmpensati0n Laws o( Cdptornia. ._ '-
Date Si9na[ure �
NOTICQ: If atter making thli tleclaratlon, you ShoWU become subject
to the Workers' Componsatlon provisioni ol the 4abor COEo, you muit
forthwith tomply wilh such provisions or thls permit shall be ticemetl
ravoke0. . ' .. _ _ .
GONSTkUCTION LEN�ING AGENCY
1 hereby aHirm Nat tbere I5 a cons[ructlon Ientling agency for [be Der-
tormance of the work lor w�lch tbis permil Is issuetl (Secllon 309]
ci�. c.�. MEQGU�'� S,�L '
'Lentler'g Name
Lentler'g qatlres• �b'�7- EO/ .� Nu,�- gcf,c.
OWNER FlWLOER DFLLARATION , � - -
a
a
is IICe05Ctl puRUant t0 tbe provl5lon5 Of Ino Cont�atlo�'S Litepse L'aw
(Chaptor 9(commencing with Sectlon ]000) oi oivision 3 of the
Bu5ine55 antl ProfCsziOns CotlC) o� tnat h¢ I5 exertlpt th¢rllrom antl Ih¢
basis fo� (hG allegetl exempHon. Any violalion of Sectlon ]031.5 by
� applicant for a permit zubjects che ap011cant to a civll penalty
iot inore [han fiv¢ huntlretl tlo11ar5 (5500).
. I, a5 owner of th¢ property, oP my ¢TPloyees with wages a5 thei�
sole co�hpenzation, will tlo the work, antl ihe sVucture is not intentletl
or ofleretl tor wle. (Sectlon ]044, Busine55 antl Aofessionz Cotle: The
Cont�ac[OCs ucense.l.aw tloes not apply t0 an.owner Ot a property
who bu�ItlS or imp�oVes lh¢reon, antl who tloes such wo�k himself or
lhrough.hls own employees, Provitletl lba[ such Improvements are no[
in[¢ndetl or olteretl for Sale. �f, howeveq the bulltling or Improv¢ment
is Soltl W�(hin on¢ Yedr OI COTPIeIiOn, th¢ own¢r will have the burtlen
of prOving h¢ ditl elOt builtl o� ImprovC to� lhe purposo of sale).
❑ I, aE owner ol-tho property, am� ozcluSivCly conlydGlipq witM1
licensetl conVactars ta consVuct the project (Soc[ion ]044, BuSiness
antl Proiessions Cotle: The Contractor's Ucnnso Law tloes not appty to-
an owner ol prop¢rty wh0 �uiltls Or Impwve5 tp¢reon, antl wlto con-
IraGls Ihom� zuch projects with a Contraclor(5) Ilcesnetl pu�suanl to
the ConirdGlor'S LJceOse Law).
❑ I am exempt unEer Sectlon B. & P. C. for thii
reason -
Date Owner
I her¢by �eriily�nat I have r0atl thi5 appliGation antl state tha[ the above
informa��on is wrrecL I agree to comply with all tltY antl county
o�4lnan�e5 antl ztat¢ laws �elalln9 to conStruCUon, antl h¢reby aUthOriz¢
repre5eqtative5 Of thl5 city lo ent¢r upon Iqe above mentionetl
property fo i pectlon p po�} ( � .T
Signatu.e F�� � `^^- "� Date �`�
Drivers' �icense or 55 3F
bOrtler lines antl sign all apProDrlata tleelaratic
TRACT NO. LOT NO. BLDG. NC
�iBf H?,� U�t!!T
7YPE OF CONSTRUC710N
I�Y% NEW ❑ ADD ❑ ALTERATION
❑REPAIR ❑CONVERSION ❑DEMOLISH
❑ OTHER
DESCRIPTION OF WORK �
TVPE OF PERMIT
❑ GRADING � FOVNDATION �STRU���CyyyT
❑ TENANT � ELECTRICAL �IPLVMBIN�N�
❑ OTHER y���b � 4 5
PROJECT DESCRIPTI ��•D�
SQ.F7. ' /00 /C
V ALU/iTl ON �
GRqDING CV. VOS. _
REMARKS: P� GI �� �
a .i /�l�
p.�: ,�--
PLUMBtNG � . �PL�
:VCTIONTVPE �
ZONE �
_ ACRES _
gS.CvS
/2v �^L�-I'n.vi
N CHECK `
TOILETS 2� URINALS ' '
LAVATORIES �.. DOUBLE LAVS '
KIT. SINKS � DISHWASHERS �'
SERVICESINKS SVMPS �
FLOOR SINKS.'. � FLOOR DRAINS
DRINKING FOUNTAINS -� � � -
INTERCEPTORS CLARIFIERS
SWIMMING�POOL PTRAP ' '
WATERSERVICE ALTERATION - '"
GASSERVICE OUTLETS � J
WATER HEATERS � BTU OUTPUT
SEWERCONNECTIONS /�
/—
SOLARTANK COLLECTORS'
SOLAR PIPING $V5.
ISSUE FEE
MECHANICAL PLAN CHECK
HEATING SYSTEM 0-300,000 BTU
ANDDUCTING 100,000�+BTU
REFRIGERATION 0-100,000 BTU
SYSTEM 100,000 + gTU
BOILERS BTV
SYSTEM REPAIR,A TERATION
EXHAUSTSVSTE /. MULTIPLE
ISSUE FEE
�� CMF 0865-46 White-Builtling; Gnary-APPlicant; Pink-Actounting: Goltlenrotl-Assessor
�
tl
�
�
3
/
3:�48 V� I /'�/
20NING REGULATIONS
A.P. qF !-� ' •-
ZONE �� PLNG. REF. � r� - f
REAR VARD (TO P/L)
PKG. SPACE RE�. a
STREET WIDTFI Jp
, ZONI NG-APPROV ED BV
�SPECIAL CONDITIONS:
ELECTRICAL'
5 ,PROVIOED
�� PARK FEE
hG oan
�L REQUIREMEN
PLAN�CHECK
�GENERATOR' 0-1KVJ_1-lOKW_
TRANSFORMER
qPPLIANCE- 10-SOKW_SO+KW_
MOTORS "- ' "0-1 HP_1-10 HP _
iQNC.50LAR) 30-SOHP_SO+HP_
FI%TURES " OVTLETS SWITCHES
GAS TUBE SIGNS - '
POLE LIGHTS -
C
APPCICATION APPROVED BV'
i AMP
351.2�
SUMMARV OF FEES
BUILDING � �� Q�
PERMIT \ E_i�!_�_ SMIP � E��2.Q_
PLAN CHECK � oERMIT .
' ,�ISSUANCE E
PLUMBING � �
PLANCHECK GRADING E
ELECTRICAL �� 3�•�a S .
PLANCHECK E`"�� MICROFILM E
MECHANICAL 5 _/ � � �_ ��TOTAI FEE 5
LE55 AD- �
PLHNCHECK' S VANCEPC E_
�� � (�[',27� FINFL FEE E�
�� �.�' 3�'l
CONSTRUCTION AND PLANNING ._ ' {. _ . . . . .POOL & SP�3�'�s � - . � •
�5�}Ia Date Inspector � • • ., Date � Inspector
APPROVALS Permit# APPROVALS "• Perrrmit#'� � � .
1. Temporary Electrical Service or Pole ' 43. Pool & Equipment L•ocation- �• � ` � - -
Soil ipe-Undrgrn -� 44. Steel Reinforcement ` � - • • •-�•- • ` � • � • • • - •
. 3. .Electrical Conduit Utility-Undrgm t- .:'�•• � � t ' 45. Forms • • - � � - -� - �
4. Electrical Conduit•Undrgm 46. Electrical Bonding � • � ' ' - � - ' �
. tee e�n orce 47. Rough Plumbin & Pressure Test
6. Electrical UFER Grn y- � 48. 'APPROVALTO COVER•GUNITE -
7. Footings - .49. Electrical Conduit-Undr rn
8. Foundation � � � _ � ' " � . 50. Gas Pipe, ❑ Undr rn,>Test - � - �
9. Water Pipe-Undrgrn ' ' � 51. Backwash ines P-Tra ❑' ndr rn -
10. Structural Floor System ' 52. -APPROVALTO DECK - " ' ' � -- " '
11. Property Sewer Line & House Connection q�� '.53: .,.Backwash & Rece tor-Final � - �
12. Street Sewer Connection ` ' ' 54. �Heater & Vent-Final
13. Rough Plumtiing• � •� � ' S/� y� � - - - -
14. Rough ElectricConduit - - - � ' •�56.�' Electrical-Final • �
15. Rough Electric•Wiring � /1. 57. Solar SYstem-Final �
16. Rough Heating & Air Conditioning /;t -� � encing & Access Approval
17. Ducts, in Structure , APPROVED FOR PLASTERING �
18.. Ducts, Ventilating ' . . . �
19. Gas Pipe-Rough & Test 60. P.00L/SPA SYSTEMS FINAL - �
20. Roof Framing - - - • � � ' �
21. Roof Sheathin - d- �
22. Frameand Flashin NOTES:
23: Insulation (o. ,g'j ' �
24. Lathing & Siding - -� 6- I S-B'S �
25. Drywall Nailing - �
26._ Plaster Brown Coat � � - �
27.� Electrical Power Meter-Final .
28. 'Final Electric -E• '
29. Final Heating & Air Conditioning - � -
30. Final Gas Fpe-Test' - �
31. Final Plumbing
32. Water Service-Final �
33. Gas Service-Final
34. Solar pomestic-Final � �
35. �Landsca e S rinklin S stem - 1 �
36. Sound Attenuation
37. Handicap Regulations �• �\` • • � � . � �
38. FINALSTRUCTURE&BUILDING •
39. Special Requirements Corripleied' �
40. Electric Release to Edison - ' -
41 . Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCY
� � 'No.- Date' , ,
�.,� _ - P4r .
�� � AOV��cant ta lill .n all spaces �SrY'h7n heevy bor0er linas antl sign all appropriate Gecl9ntion5. ��, � _
CIT•Y•OF CbSTA MESA F�R MIT NO. TRACT NO. LOT NO. BLDG. NO. - �
• CON3TRUCTION pERMIT (-*- - S� �7 ��I/3:i� UN/T A n
Addrea
No.
T�V/PE OF CONSTRUCTION
y� NEW ❑ ADD ❑ ALTERAT�ON
�L�JREPAIR ❑CONVERSION ❑DEMOLISH
❑ OTHER
Addr¢5�� ❑Gf2ADING �QFOUNDATION �ST,RUCTURAL
LICENSED CONTRACTOR DECLAkAT10N �q � �yd9 ❑ TENANT � ELEGTRICAL Q�Pl.VMBiNG� MpMECHAI�
9 her<Dy diflrm In:.l I am IICGnSeC untl¢r provislons o1�haLLer 9(COm- u✓'�� '�O�/� ✓�//
montln9 with sectlon ]000) ol Dlviston 3 of the� Buslness antl �❑ OTHER d ZT�
A0105TI0�5 Cotle, anU my IICCOS¢ IS 10 �YII fORG dOtl ¢1flCl. � Z/�
�Lfconse Clazs n a � I � . � +.e�.. N � SQO�CT DESCRIPTIO � /� � "
Date ����-0� 9iqnature_Q R �'�
'WORKERS'�COMPENSATIONDECIqRATION ' OCCVPANCV -
'I hereby atfirm that I have a certificgte of consent to seH-insure or a VALUAT�ON��
C¢rtlfl�te'Ot Worker5' CompensatioM1 InSUranta, Or a certitied <opy
Ihereo( (Se� i,�j n 3800, Lab. G. / [��e �� GRADING CU. YDS.
.PolicY No.r¢d n G" Z/-X �,.mPa�Y �( "/�t.tJ
'ertilietl copy Is'hereby turnisnetl. . _ REMARKSi.-
;ertltietl copy B tiletl with ehe city Builtling DiWsion.
r,..EM7TION FROM WORKERS' COMPENSATION DECLARATION "
(This sectlon neetl not ba completetl it the permlt ii for one huntlretl _ _
'(5100) or leu�. �.
I certify ihat In the per(ormance of the.work for whi<h [his permlt I5
issuetl, I shall not emPloy any person in any manner so as lo become PLUM6ING
subjoct to the Workflrs Componsation. ��ys o1 Califomia. "
Date Si9nature BATHTUBS
NOTICE: Ii af(er making tnis tleclaration, you 5houltl become sub�ect 'TOILETS � /,,
to the Workerz' Compensation provisla�s ot the LaDar Cotle, you must �VATORIES �
lorthwith comply with such pwvlSiOns o� thl5 permit Shall be tleemetl
�evOkcA. . . . . _
CONSTRUCTIONLENOINGAGENCV � KIT.SINKS
I he�eby af�l�m that there Is a co05trUction lentling d9¢nty to� the Oer- SERVICE SINK$
la�mdnCe o� Eh¢ wo�k lor whiGh tbig pgrmit is ISSuetl ($ectlon 309�
Civ. C:I: 2 S' " L ' � `FLOOR SINKS �
,Lantler's Name
�LenGer'S Atltlress �DRINKING FOUNTF
OWNER BUILOER DECLARATION � INTERCEPTORS• �
1 hereby aftirm tha[ I am ozompt /rom tne Contractor's Lltenza l.aw for
tno rollowlna reason f5ection.'�031.5 Business antl Protessions�Cotle: cwinnnn�nir_�onni
improve, tlemolisn-oT repatr any zvuc�ure, Drlor to Its Issuance; aiso re-
qWtas the ap�li�ant to� Suth pC/mil t0 tilC'a Signetl stdt¢T¢Otiha[ ho
Is Ilcense0 oursuan[ to the provlslons pt the Contrattor's Llcense l:aw
Business antl PrWMsions Coao� or tna� ne is exompt tnoretrom ana tne
basls lor the'allegea exemplion. Any �iolation ol Soctlon 7031.5 by
-�y appllwnt lor,a permit sub7ects [�e appliwnt to•a clvll penalty
nol moro than�live'tiuntlretl Aollarz (5500). � . • .
I, as owne� ol lhC P�op¢rty, or r�y emplOyees witn wdgCs as thelr
,ole compensation, will tlo lhe work, �ptl [ne strutture Is noi Intentletl
o� otf¢rCtl tor sal0. (SeCtion 7044, BUSiness antl AO/c551on5 Cotle: The
Conlractor'S License Ldw tloa5 nOl appry to an owne� ot. a property
who builds or imprOveS.tner¢On, antl �yno tloe5 Such wotk bims¢II or
throu9h his own employ2es; provitletl (hat suth�mprovamonts are not
intentled or olleretl foi;zale:•11, howeyer, the builtling O� ImprOvement
I5 soltl wilhin one Year�ot complellon, the owner will have the burtlen'
of p/ovin9 he tlitl not buI10 or improve fOr the pu/poSC o/ sale).
❑ I, as owner of IhG propCrty, dm exclu5ively Wnt�actiog wilh
liGensetl coOtractors lo capSlruCtthe projeCt (SeCtIoO 7044, Business
dntl Prot¢ssioos �Cotle: The ConlractOYs LicenSC'law tloe5 no[ aOPN to
an owncr ol Property wh0 builtls o� improves therCan, dnd who COn-
tratts trom'such projects with a contractor(5) Ilcebn0tl pursuant to
the Convactor's License Law).
� I am ¢xempt untle� Section B. 6 P. C. for this
f¢d50�
Date Owner
�hat I have rcatl IhiS a0pli[ation antl state tnat thG dbOvc
correct. t agree to comply with all ct[y antl county
5[ate IawS rolatlng to tOnslruttion, antl hereby au[ho�iie
of [his city to$@�enlern upon Ihe above men[ioen¢tl
Pq,s ect�on PJ(rCo4�...QV.� ^ C-QJ
.Yww.� K
'TR VCTION TVPE ��/_�
LZONE _
AC R ES
i99.sS --
. �
PLAN CHECK'
SFIOWERS �j
URINAL$
DOVBI"ELAVS 'Y_
SUMPS ' '
FLOOR DRAINS
NS � ,_
. �CLARIFIERS .
WATE�RSERVICE ALTE0.ATION
GAS.SERVICE OVTLETS J •�
WATER HEATERS BTU OUTPUT '
SEWER CONNECTIONS , . , „ „
SOLAR PIPING $V5.
ISSVE FEE
MECHANICAC . S � ' PLAN CHECK
HEATING SVSTEM 0-]00,000 BTU�
AND DUCTING, � 000.+ BTU _
� �• 300;
REFRIGERATION 0-100,000 BTU_
SVSTEM- ' 100,000,+BTV_
BOILERS BTV �
SVSTEM REPAIR,ALTERATION
E%HAUSTSVSTEM /. VLTIPLE
Slqna[ure � Dale �
Drivers' License or 55 9f ' " �SSUE FEE
CMF 0865-46 WhitG-Builtling; Candry-APPlitant; Pink-Ac[ountin9; GOltlen�otl-A55¢sso�
0
-1
A.P. q� '
ZONE 2
SETBACK T.
Ip VHRO �
' E
IC 5IpE VA - 1
RIGHT
REAR VA(3D (TO P/L)
iPKG.SPACE REQ.
STREET WIDTH -
- ZONING APPROVED B\
SPECIAL CONDITIONS:
HOLD FOR
" ELECTRICAL '
REGULATIONS
- D.5
PLNTGp. RgUEF�. p$ 7 F �
i�� PROPE�RTYNLINE c
��
^� n�
) Pi20ViDED �
� � PARK FEE E q
�J./. 'DATE
IIV
RF.nrrtx�ru�y�
PLAN CHECK I
TRANSFORMER 0-1 KW_ 1-30 KW _
APPLIANCE 10-SOKW_50+KW_
MOTORS ' 0-1 HP�1-10 HP _
(IN0. SOLAR) 30-50 HP 50+ HP _
FI%l'URES w 'OUTLETS SWITCHES
GAS TUBE SIGNS
POLE L'IGHTS "' '
PANELS - MAIN SUB'
ISSUE FEE
APPGCATION HPPROVED
SUMMARV OF FEES �
BUILDING " -'- �
PERMIT §�7i_ SMIP; b �•�
PLAN CHECK S PERMIT
� ISSUANCE b�
PIUMBING $� �• �
P�ANGHECK E _ GRADING S
ELECTRICAL b�� S
PCANCHECK 5 M�CROFILM 5
MECHANICAL E��-TOTALFEEE
PLANCHECK § - - LESSAD- _
VANCEPC S_
FINAL FEE E vQS� �"� •�
, �. AOPlicant to llll in all s0aces witbin
CITY OF WSTA MESA PEg� IT NO. -' /
CONSTRU�TION PERMIT •—C'Y— ST l G
Address
LICENSED CONTRFGTOR DECLARATION . "
I herOby affi�m thut I dm IlcenS¢tl �ntl¢� p�oNtlons o7 Chart¢r 9(Com-
mancing with section -7000) oi Division 3 0l the Business � antl
Profosslons Cotle, •�tl �my Iicenze is In full forcy4 �n� 2�3t.
Licenso Class � � � �-�•��< ni.. S
Date � ' �U ^� 3 Signature _s,j �--�- R ���
WORKERS' COMPENSATION DECIARATION
1 here0y at(irm that 1 hav! a certiticate of tonsent to selftinsure or a
cerU(iwterof Workers' CoMpenutlon Insurance, or a certi/1eA capY
thereof ( t ton 3800 Lab. �.).
� o-�cy rac� � �� Z r--P7 Company ST4TE f7JND
� ertifletl copy is hereby turnishetl._ . _
.¢rtlfletl cOpy is filetl with the city Builtlln9 Olvislon.
EXEMPTION FROM WORKER$' COMPENSATION DECLARATION
� (ThiS SettlOn neetl not be Completee if tha permit is for one huntlred,
csioo� o, iess;. �
F 1 certity tha[ n the perfortnance ot the work for which this permit is
O Issuatl, I shall not emptoy any person in any'manner so'as to become'
� Subject t0 the Work¢rs' CorqpenSation laws of_CaIltOmia._ '
Date $�9�dturG
NOTICE: If after rtlaking lhi5 tleClaration, you shOultl becoTe SubjO<t
to the Workers' CompenSatlon provisions of the labor Cotle, you must
f0/thwith ComplY '�'�th suc� p�ovi5ions ot thl5 p¢rTit shall be tleemOtl
ieVokCU. . - . � . . ,
CONSTRUCTION LENDING AGENCV
I nereby affirm that there 15 a constructlon lentling a9ency for the per�
formdnGt o1 Ih¢ work for which thi5 permit I5 Issuetl (SectiOn 3097
ci�. c.�.- - ME�2CUK�' - S� L- •. .
:LentleYs Name
�enCer•s AEtlras !8�Z �'O/AJC�� i l/J�T. BCN.
OWNER BVICDER DECLARATIOM '
I Itereby a11IrT that I am Gxempt i�om th¢ Conl�aclor'S LicenSe Law tor
the following reason (Sactlon 7031.5 BuSiness antl Profe55ions Coda:
Any tlty or county wni¢h requires a permlt to construcq attor,
Improve, tlemolish�or repair any structure, prior to its issuance, also re-
qW�eS the ap4����� fo� sutb pe�mit to tile a Slgnetl Statement that h0
Is'IICCnsetl pufsuanl't0 th¢ p�ovi51on5 ot the Contrdttof'S LiCenSG Law
�Chapter 9(commencing �y��h Section 7000) ol Divislon 3 of lM1e
uzlne55 antl P�'MGssions CqtlO) or that he ii GxOmpt IherefrOm antl lhe
bn515 for the allegetl exemption. Any violation ol Sncllon 7031.5 by
appllWnl Por a pVmlt SubjeGts-Ihe appliWnt lo a civil pCnalty
ot more Nan iive huntlretl tlollars (5500).
i, az owner ol the property, or my employeci with wages as lheir
SOIe COTpenidlion, wi11 tlo tn0 wOrk, antl the ilruGture i5 n0t In[Cntled
or otleretl for wle. (Seclion ]04A. Busineis antl Rolessions �oAc: The
Cohl/aClor'S Llcen58 Law �Oes not apply lo an owner of a praperty
wh0 bu11tl5 0� ImprOves t11Cr0on, antl who CoeS SucM1 work himsali or
thrO�9h hIs owqemployCeg� provltletl that su<h ImprOvemenis ar0 not
Intentlatl or offeretl ior salo, �/, howeveq the builtling or improvamenl
I5 SOItl W�lhin one yCa� oi COmpletion, the owner will have the burtlOn
o/ p�ovin9 M1e tlitl not b���ltl or improv¢ 1or lh¢ Purpos¢ Ot sala).
❑ 1, as owner oi [ba property, am exUusively mntracting wlth
licensetl <onVactors to coqsUuct the Orojo<t ($action 1044, Business
dntl PrOfesSions Gotle: Tha Contracror'S License Law tl0¢s�not apply t0
an owncr ol O�oOerly who builtl5 or imp�Ov¢s [heraOn, antl who Con-
tract5 irom Such pro�ec�s q�(h d conVdGtOr�s) Ilcesnatl pursuant lo
tne Contractor's License LaW�.
❑ I am exemp[ unAer Seclion B. 6 P. C. for tnis
ieason
Da[a Own¢r
I hereby cerlity that 1 have reatl lhis ap0�����on antl stdte that ihe abov¢
information is correct. I dgree to comply with all "city antl county
ortlinance5 antl state laws r¢latlng Io Wni[�uc80n, dn0 hereby authOriie
mpresentaHveS of this cify l0 enter �yppn Iha abOve mentionee
property for �ias ection PurRose �
Signatur¢ �) �� �� Date 1 -2G-��
Drivors' Licen
CM F 0865-46
bortler Ilncs antl slgn all aDProp�latc tlaclarations.
TRACT NO. LOT NO. BIDG. NO-
f�i, 1 //3� U.VIT C
TVPE OF CONSTRUCTION
�NEW ❑ ADD ❑ ALTERAT�ON'
❑REPAIR OCONVERSION ❑DEMOlISH
❑ OTHER
DESCRIPTION OF WORK
O GRADING � FOVNDATION �STR
❑ TENANT 6Q ELECTRICAL �PLU+BIfxGa
❑ OTHER � � � L/V/Alfi y�L6
PROJECT�DESCRIPTIONG�Q L�� T.�
SQ. FT.�'� ' �.I�
OCCVPANC`/- CONSTRUCTION TYPE .
VALVATION ZONE �� �
GRADING CU..VDS. ACRES _
� :. .. v-.e: �f�5s27v
PLUMBING - PCAN CHECK �
BATHTVBS � SHOWERS
TOILETS � •�URINALS
LAVATORIES� DOUBLELHVS
KIT.SINKS � DISFiWASHERS'
SERVICESINKS " . SVMPS '
FLOOR SINKS •, FLOOR DRAINS
DRINKING FOUNTAINS • '
INTERCEPTORS CLARIFIERS
SWIMMINGPOOL PTRAP
WATER SERVICE ALTERATION
GASSERVICE OUTLETS
WATER HEATERS BTV OVTPUT
SEWER CONNECTIONS
SOLAR TANK COILECTOfiS '
SOLAR PIPING SVS. � �
ISSUE FEE � � -
MECHANICAL PLAN CHECK
HEATING SVSTEM 0-100,000 BTU
AND DVGTING 100,000 � BTU _
REFRIGERATION 0-300,000 BTU_
SVSTEM �100,000+BTU_
BOILERS BTV
SVSTEM 0.EPAIR,AITERATION
EXHAVSTSYSTE I. ULTIPLE
or 55 � ' ISSUE FEE
White-Builtlin9; Canary-APPlicant; Pink-Accounting; Goltlenrotl-Assessor
3'�49 I /��1 /i'"r;
I�ING REGULA�TIONS
_�I (JJ
PLNTGp. Rg�E/F. p�'
PROPE�RTVr
REAR YARD (TO P/L) �
PKG. SPACE REQ. �
STREET WIDTH �
ZONI NG APPRO V ED BY
SPECIAL GONDITIONS:
ELECTRICAL
PROVIDED
PARK FEE S
PLAN CHECK
- �� -utrvtKiaiun 0=1KW_1-30-KW_
,TRANSFORMER .
� APPLIANCE " 10-50 KW_50+-KW _
� �MOTORS 0-1 HP_1-10 HP _
. � . (IN0. SOLAR) - �0-50 HP 50 + HP _
FIXTURES' 'OVTLETS SWITCHES
GAS TUBE SIGNS - - -
. POLE LIGHTS ' -- ' ' -
PANEL$ MAIN 'SUB
. J -- � �� "SERVICE � � �� AMP
ISSVEFEE ' -
� �, � APPLICATION APPROVED BV /�/ (
SUMMARV OF FEES �
BUILDING � p Q �
PERMIT E� SMIP . b_�2QSL �
� PLqN CHECK f }P5ERMIT - �
PLUMBING E� {/ $UANCE S
. GRADING b
PLAN CHECK E ,
ELECTRICAL E�� ✓ s �
PLAN CHECK $ �CftOFILM g y
��/� TOTAL FEE E � �
MECHANICAL §___ ��(• -
PLAN CHECK �E LE55 AD� •
VANCEPC S_
J�
� FINAL FEE S -����—� /
J /O. GO �
CONSTRUCTION AND PLANNING ^- - . -_- . � POOL & SPA -- ._ _ . "
APPROVALS Permit# US�'�'�� Date Inspector qppROVALS � Permit#` " ' Date_ Inspector
1. Temporary Electrical Service or Pole . 43. Pool & Equipment Cocation � - = ' • - ` � • �
Soil ipe-Un rgrn � 44. SteelReinforcement •• -� • • - � • •• • �-
3. Electrical Conduit Utility-Undrgm � ' • -�' 45. Forms �-• ' - �� � ' '
4. Electrical Conduit-Undrgm 46. Electrical Bondin � � � � ' -- - ' ' ' � `" ' '
. tee ein orce 47. Rough Plumbin & Pressure Test•- •� �''• �
6. Electrical UFER Grn �f � " 48. ;4PPROVAL TO COVER-GUNITE -
7. ootings_ _ ' - 49. Electrical Conduit-Undr m
8. Foundation � � 50. Gas Pipe, ❑ Undr in, Test ,
9. Water Pipe-Undrgrn ' 51. Backwash Lines P-Tra `❑ ndr m - '
10. Structural Floor System 52. 7�PPROVAI TO DECK -� "' ' " '
91. .Property Sewer Line & House Connection. �? �_ 53. .Backwash & Rece tor-Final
12. Street Sewer Connection � ' � 54. Heater & Vent-Final�
13. ' Rough P�umbing - '� � "
14. Rough ElectricConduit - �56. Electrical-Final �
15. Rou h Electric-Wiring - .g 57. Solar System-Final �
16. Rough Heating & Air Conditioning -� f • encing�& Access Approval -
17. Ducts, in Structure APPROVED FOR PLASTERING
18. Ducts, Ventilating � - . = :" � � _ . .
19. Gas Pipe-Rough &Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing � � • •
21. Roof Sheathin - �
22. Frameand Flashin S •3-1-) NOTES:
23. Insulation �n-' .,4- -
24. Lathing & Siding • 6- !i- � - �
25. Drywall Nailing � -
26. Plaster Brown Coat - � �
27. ��•-Electrical Power Meter-Final ' �
28. Final Electric -
29. Final Heating & Air Conditioning � �
30. Final Gas Pipe-Test �
� 31. Final Plumbing
32. Water Service-Final
33. � � Gas Service-Final
34. Solar pomestic=Final '
35. Landsca e S rinklin S�stem • �
36. Sound Attenuation '
37. Handicap Regulations ' ' ' � • �
38. FINAL STRUCTURE & B LDING � f
39. Special Requirements Com{31e ed G
40. Electric Release to Edison
41 . Gas Release to Southern California Gas Co. ��
42. CERTIFICATE OF OCCUPANCY
' No � Date . _ , ,
ApPlieanl to fill in all
CIT,V OF COSTA MESA r�i=
COIVSTRUCTION'PERMIT
within heavy ooraer lines ana sign all apv�opriate aeelaratio
TRACT NO. LOT NO. BLDG. Nq
?D �U3X �? 1
• Proiect Atldres 7p TYPE OF CONSTRUCTION
OwnEf �CV' Phon �NEW ❑ ADD ❑ ALTERATION
Addfe55 �p ❑ REPAIR ❑ CONVERSION ❑DEMOLISH
ArCh�Eng. Q LicenSe No. � � ❑ OTHER �
Addre55 =� DESCRIPTIONOF'WORK
Contracto c� (, 0 Phone �(�2 TVPE OF PERMIT
AddrEss � �yy�- � � JA/I%'ARNA �R1 N �O GRADING �FOUNDATION �STR
LICENSED CONTRACTOR DEC6ARATION �,N/6�/,ft�HD� CA ❑ TENANT �ELECTRICAL LUMBING
I hemby af/irm th:.t 1 am Il�ensetl untler Orovis onz oT ChartOr (cam- ' �u� �(�
mencing wIN 5ection ]Ob0) of Divislon 3�of -the Buslnass antl ❑ OTHER �ry�/�.�/��
Vrofosslans Cotle, an my Iicnnse is In fuu for tl ajt tt. pROJECT DESCRIPTIOM _ ����rTµ'�Y'
Liconco Cless � License o. � . ,
Date 1'��` g� - Slgnatum � 54� ��
WORKERS' COMPENSATION DECLARATION - • OCCUPANCY CONSTRUCTION TVPE _
MI hereby aftlrm that I havg a tertlficate of consent to selhinmm or a VALUATION • ZONE
tertlflca[e o1 Workers' Compensatlon Inwrance, or a certlflea copy
� tberco( ( tlon 800,^Lab. ,), �^, GRADING CU. VDS. ACRES —
� POI�cY No� � ComPanY � J �'�- ��D "'
(-''-�,i'+rtlfletl copy is h¢reby iumishetl. - - • REMARKS:
� ���P"�trc�rtiflOU copy is filed wi�h th0 ci[Y Builtling Division.
� Ea��PT10N FROM WORKERS' COMPENSATION DECLARATION _
� (Thiz section neetl not be CompleteG It the permif is tor one huntlretl _ _,� �)
IEcer��fY ��atsin.the perforry�ance of the work (or which this permit is , G
ISsuOtl, I shall not emploY b�y pCrion In any manne� so a5 t0 bGcome PLUMBING � PLAN CHECK
subjacl to Ihe Workers' CaTpenzallon Laws oi Ulifornia. - .
Date Si9nature BATHTUBS SHOWERS
NOTICE: It af[er making this tleclaratlon, you shoultl be<ome sub�ect 'TOILETS �, URINALS -
to the Workers' Compensat�on provisions ot the �abor Cotla, you must �VATORIES DOUBLE LAVS
fOrthwith coTply witn suth provI510�s ot tbl5 pe�mit shall be tleomatl �
rovakotl. .. -
CONSTRUGTION LENDING AGENCV KIT.SINKS DISHWASHERS �
I heroby aHirm that there I5 a construcHon lentling agency for tha per- SERVICE SINKS ' SUMPS �
f0/mante Ot the wOrk tor H.hlt� tnis permit Is issu tl($attlOn 3097
Clv. C.). ���CU�� 'S� � ,FLOOR SINKS' ' ,FLOOR DRAINS
LCntle!'S Ndme '
Lentler's AtlOres• 7R/� /i 1�-f�P ��]'' SGi{. DRINKING FOUNTAINS �� � r,�,-
OWNEH BUILDER DECLARATION INTERCEPTORS CLARIFIERS
I heroby a/firm that I am exempt Irom the Contracmts LicenSe Law tor
the tollowing reason (Section ]031.5 Business antl Prafeistoni Cotle: SWIMMING POOL � P TRAP � �
Any c(ty or county wM1iCh reqWres a permit to conStruct, alter,
im�wve, tlemolisn or repalr any ztrucWre, Orior to I[s issuan<e, also re- y.�qTER SERV ICE � ALTERATION
qu rCs Ine ap�.11cant /0r such permit to file a signetl sWtemOnt tha[ h�
Is Iicensetl pursuanl to (he'provlsionz of the Contractor's License L'aw GAS SERV ICE OUT�ETS � -� �
(Chapt¢r 9(cOmmencing wlth SeCtion ]000) oi Dlvislon 3 of the
B
�
A.P._�
ZONE
�SET ACK C 5T.
RAL � .I YARD l�
CHANICA ��IG T
✓22 REAR YARD (TO
�, PKG. SPACE RE�.
� ��
STREET WIDTH
,•�,. �` ,ZONINGAPPROVI
� - �SPECIALGONDITI
_ , - OLD F
3 :�0 I/21/�;"! 3c'o�.;
NG REGULATIONS � � -
PLNTGp.gRUEF.�' �
VROPE�RTVNLINE �
/� � .
% 5 PROVIDED ,� �
�1'/1�� PARK FEE S� RRI Pl I
�� ��ELECTRICAC " " PLAN CHECK - "
� ' 'GENERATOR 0=1�KW_1-30 KW
TRANSFORMER .
`�APPLIANCE' 30�50KW_50�+KW
MOTORS - - 0-1 HP_1�30 HP'
" (IN0. SOLAR) .. 30-50 HP 50 + HP � �
- FI%TURES -' OUTLETS 'SWITCHES '
' '�GAS TUBE SIGNS ' - -
� � 'POLELIGHTS ' ' �
usiness antl Rofessions Cqtle) or that he is exempt theretrom antl [he yyqTER HEATERS BTU OUTPUT �
basis for the allegetl exempHon. Any violation of Se<llon 7031.5 by
a��� apP���nt for a permit sub�ect5 [ne applican[ [o-a tivil penalty SEWERCONNECTIONS - `�. �
�t more than five huntlretl dollars (E500). -
.as owner oi the property, or my amployees witb wages as their SOLA0. TANK "�COLLECTORS ` ' '
so.,.-compensation, will tlo the work, antl the.sbucture is nat Intentlea . _.
or offeretl for sale. �Section ]044, Business antl Rofesslons Coee: The SOLAR PIPING SVS.
Cont�ac[Or's License_Law qo¢S.nol apply to an.owner Of a prope�ty _.
who builtl5 or Improves thereon, antl who tloes such wo�k himsel� or ISSUE FEE
th�ou9h h15 Own employeeg, provitletl tna[ Suclt improvem¢Ots dfe nOt
initntletl or Otteretl �or Sale, Ii, however, Ihe bwltling or Improv¢mtnl MECHANICAL PLAN CHECK
is soltl witnin one year ot CompletlOn, tM1e owneLwill nave the buraen
oi prOving he tlitl not bUiltl or ImprovC for tne purpose p1 sale). HEATING SVSTEM 0-300,000 BTU
❑ i, as owner-oP the proper[y, am exclusivary contractin9 with qND DUCTING ' '
II<ensetl COnVac[ors to CoqilruGt the projCct (Section ]044, Busin055 300,000'+BTV L
antl Pt01ls51o�5 Cotle: The Cont�actor's LlcensC I.dw tloes not apply to
an owner ol property who builtls or Improves thereon, antl who con- REFRIGERATION 0-100,000 BTU
tracts Irom such pro)ects with a contractor(s) licesnetl pursuant to � SVSTEM - -
the Conlractor'S License LaW), 100,000+BTU �
❑ 1 am exompt untler Section � B. & P. C. tm Nis BOILERS BTV
reasOn '
Dato ��+ner SVSTEMREPAIR,ALTERATION
I hereby certily lhat I.nave roatl this appli<ation antl stale lhat the above EXHAUST SVSTE /, MULTtPLE
Iniormation is correcL I dgree to comply witn all tity antl county ��
ortlinanCes antl stdte IawS rclating to consVuction, antl hereby authOrizB
fepreS¢ntdtivCs of Ihis tl�y t0 Cn[Cr u on Ihe above menUonetl
prOperty lorf,jns ¢<tion Pu Ose . � �� �7
Slgnature Date J-l�!l.=O.L •
Drivers' License or 55 � ISSUE FEE -� • -- -
ICMF 0865-46 White-Builtlin9; Canary-APPlicanh Pink-Accounting; Goltlenrotl-Assessor
FANELS '"� -' -MAIN SVB -
SERVICE - DO P'MP S
' ISSUE FEE ' --
� APVLICHTION APPROVED BV � ATE � � �
SUMMARV OF F.EES
.BUILOING [�
PERMIT E `�n7_ SMIP �S�_J_
^� �P�AN CHECK E PERMIT . ,
�� � ✓i55UANCE $ �
PLVMBING 5 .GRADING b � �
� PLANCHECK E /. < .
ELECTRICAL 5� �� s
PLANCHECK 5' /JN �CROFILM E
✓ TOTAL'FEE S
� MECHHNICAI."E� .
PLAN CHECK -E LESS AD-
VANCEPC E_
� . ,
� FINALFEE S`��v•
✓
��
CONSTRUCTION AND PLANNING � � . . POOL & SPA � � . . - . "
APPROVALS Permit # �"��`f y0 Date Inspector qppROVALS � Permit.#' Date . ,Inspector
•.
1. Temporary Electrical Service or Pole 43. Pool & Equipment L'ocation - '" � ' -
2. Soil ipe-Un rgrn 44. Steel Reinforcement �- •• -• � -•
3. lectrical Conduit Utility-Undrg[n ' � � , 45. Forms , • • � �� � �
4. Electrical Conduit-Undrgrn 46. Electrical Bonding '•�� "'� �• ' �-�� �
tee ein orce . 47. Rough Plumbin & Pressure Test
6. Electrical UFER Grn y 48. 'APPROVALTO COVER-GUNITE
7. Footings _ ' � ' 49. Electrical Conduit-Undr rn'
8. _ Foundation 50. Gas Pipe, ❑ Undr rn, Test
9. Water Pipe-Undrgm 51. Backwash Lines P-Tra ❑ ndr m. •
10. Structural Floor SYstem 52. PROVALTO DECK � � '� �-
11.. Property Sewer Line & House Connection •8J 53 :�.Backwash�& Rece tor-Final � �
12._ Street Sewer Connection ' 54. Heater & Vent-Final
13. Rough Plumbing� • �- •• � X7 3'l �' - - ' '
14. Rough Electric-Conduit - • • � �56. Elecirical-Final
15. Rough Electric-Wiring -.'d�- -� � 57. Solar System-Final � � �
16. Rough Heating & Air Conditioning ' �z7 �j � encing & Access Approval
17. Ducts, i� Structure APPROVED�FOR PLASTERING
18. Ducts, Ventilating-. � � • .
19. Gas Pipe-Rough & Test � � 60. POOL/SPA SYSTEMS FINAL � '
20. Roof Framing �
21. Roof Sheathin �
22. FrameandFlashin -3_ NOTES:
23. Insulation - ��-3 ! �% '
24. Lathing & Siding- '
25. Drywall Nailing ' Y(, . - " �
26. Plaster 8rown Coat •
27. Electrical Power Meter-Final
28. Final Electric - � � -
29. Final Heating�& Air Conditioning �
30. Final Gas Pipe-Test � '
31. Final Plumbing ' - '
32. Water Service-Final
33. Gas Service-Final �
34. Solar pomestic-Final '
35. Landsca e S rinklin S stem � � ' '� �
36. Sound Attenuation � �
37. Handicap Regulations - • �
38. FINALSTRUCTURE&BUILDING • ��„ �
39. Special Requirements Completed -
40. Electric Release to Ediso.n � �
. 41. Gas Release to Southern California Gas Co. -
42. CERTIFICATE OF OCCUPANCY �
^ ' 'No " Date . , ,