HomeMy WebLinkAbout685 18TH ST - Building PermitsCity of Costa Meu
Development Services Department
Builqing Safety Division
P. O. Box 7200
Costa Meu, California
CERTIFICATE OF OCCUPANCY No.003��9
The Building located at F,RS '1a�t, cr,-ae�: .n,.4�i.a;..., a ' �
has beeh inspected"and found to comply with the provisions of aIl.City of Costa Mesa Ordinances applicable thereto�
for a Group `�1 Occupancy.
Use of 6uilding F1P3Cttt1eRt3
Legal Description 424-261-03
' (See reverse side for Metes and eounds)
Building Permit No S 36090 Electrical Permit No. E 36790 Plumbing Permit No. P 36100
Mechanical Permit No. M 37429i M37998 Number of apartments 4 and/or guest rooms
ISSUEq T0:
Satra Developman?c
18fb tdewport Center, Dr. Ste. 180
Newporta Beach, CA 92660
Building Official Georae Fdmiston
by
-- /
r i �
Date August 4� 1989
This,Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the CiYy of Costa Mesa under Sec. 307 (e) U.B.C.
CMF 101g-q6 rev. 1/83 ' White - Owner; CanarY - Numerical File; Pink - Bldg. Permit File ' �
Ciry of Costa Mesa
Development Services Department
Building Safety Division
P. O. Box 1200
Costa Meu, California
CERTIFICATE OF OCCUPANCY No.00���4�
The Building located at 685 18th Rtr�nh, R�iilAin3 A
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
, . .,� ,......._. - ..,_ _ - ,.. . ....._ . . ._. _. . . _ _ _._ .. _ _ .. . .. ,. ti
for a Group R3/ml Occu,pancy.
Use of Building Sinale Family
Legal Description 424-261-03
(See reverse side tor Metes and Bounds)
Building Permit NoRif,nRQ.a�f,AS(1 Etectrical Permit No.E 36799 Plumbing Permit No�.�F+�1QQ
Mechanical Permit No. M 3!997 Number of apartments and/or guest rooms
ISSUED T0:
Satra D2velop�¢ent
180 Newp�rt Center, Dr.Ste. 180
ftewport Beach, CA 92660
BuildingOfficial ('�nrno Frfi,�;a��..
bY I ./ • � L � „
Date Auqust 4, 1989
This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the
Building Official of the City of Corta Mesa under Sec. 307 (e) U.B.C.
CMF 1015-46 rev. 1/83 White -Owner; Canary - Numerical File; Pink � Bldg. Permit File
.�
� . CITY OF COSTA MESA �
BIIILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ra.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER: BC07-00081
PERMIT TYPE: B COMBO
Sub Type: RES_ALT
�06 aDDRESS: 685 A W 18TH ST CM
APN; 42426103
Zoning: , ,
Viciniry: BLDG A AND GARAGES
Const Type: V-N SQ. FT: 1534
sraTus: issue�
DATE ISSUED: 0113112008
ISSUED BY: BJK
Suite/Unit: A
Primary Occ:
Valuation: $35,000.00
SCOPE OF WORK: CONVERT 627 SF APT TO CONDO IN BLDG A AND MODIFY 896 SF
5-CAR GARAGE TO MEET CODE. WORK TO INCLUDE REMOVE/REPLACE FINISHES, FIXTURES, WINDOWS, DOORS. ALSO
INCLUDES ELEC/MECH/PLUMBING WORK.
RE�: PA-06-50, T-17112
OWNER: SAYWITZ, BARRY '
Phone:
APPLICANT: JOE PONCINO
Phone: 949-254-5819
CONTRACTOR: BARRY M SAYWITZ
Phone: 949-930-7502
Cell:
ARCHITECT: ROBERT ST�RN ARCHITECT
ENGINEER: �
Address: 4740 VON KARMAN AVE #700
City/Slate/Zip: NEWPORT BEACH, CA
Address:
City/State/zZip:
- - License No. 625416
Address: 4740 VON KARMANUnit:
City/State: NEWPORT BEACH, CA
License No.C16665
License No.
COMBINTATION PERMIT FEE SUMMARY
Building Plan Check: $320.29
Building Fees: $492.75
Electrical Fees: $40:00
Mechanical Fees: $45J5
Plumbing Fees: $101.90
SMIP Residential: $3.50
SMIP Commercial: $0.00
TOTAL FEES: $1,027.69
"Refer to fee receipta tor all fees paitl for proje<t
uotr. _.,.tj���t�1
Unit: :
ZipCode 92660
'PHONE:714-556-2656
PHONE:
>'i ; �'{ •.
NOTICE: The work authorized by this permit shall comply wilh all applicable handicap access requirements under Califomia sfatutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit.
COpE�, INSPELl10NTYPE OATE IN� SQOE� INSPECTIONME �� 11AL
1618 Fixetl System Final Pire Prevention 208 Final Mechaniwl lo-,s��
7268 Pool Spa Final , 208 Final Plumbing ���
Z00 Final Re-Rool 270 Final ElecVical �Q •!J ^�
201 Final BIocWReWining Wall p�p Final Fire Prevention
202 Final Factory Fire Place 22(1 Final Planning Approval
203 Final Sign 222 Final Sita ����
204 Final�ertwli�ion 250 FinalBuilding/Occupancy ���� �0 ��
WORKERS' COMPENSATION DECLARATIOi
I hereby a�rm untler penalty of peryury one of the following tlecla2tions:
❑ I have and will maintain a certificate of consent to selt-Insure for workers'
compensation, as provided for by section 3700 of the Labor Code, for the
performance of Ihe vrork for which t�is permit is issued.
❑ I have and will maintain v.orkers' compensalion insurance, as required by
sectbn 3700 of the Labor CoCe, fa the pedortnance of ihe work ta wfiich Ihis
permit is issuetl. My workers' wmpensation Insurance carner antl policy
number are:
Carrier:
(ihis seVqn neeU rof Oe [anp�etedaNe pemiR 4 rdNeC ai are nuMm00allars fSt001 a ksx.l
Policy Number:
GJ' I certi(y that in the peAormance o( the work tor which this permit is
issued, I shall not employ any person in any manner so as lo become subject
to lhe vrorkers' compensation laws of Califomia, and agree that if I should
become subjecl to the workers' compensation provisions of Section 3700 of
Ihe Labor de, I sha/ll,i/p�thvdth wmply with these provisions.
//`'C 1 "Oti^-[il..�-> � ` 3 � —c�'U'
Appliwnl's Signalure Dote
WARN NG: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SU&IECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLL4RS
($700,000), IN ADDITION TO THE CAST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE IABOR CODE, INlEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirtn that I am licensed under provisions of Chapter 9(commencing
vnth Section 7000) of Division 3 of Ihe Business and Professions Code, and
my license is in full (orce and eflect. /�
Lic. # � 541 � Class # �J
O'Yt�N.w�-� l — 3 / — O °3
Convacmr's 9gnaWre Da�e
CONSTRUCTION LENDING AGENCY:
❑ I hereby affum that there is a conslruclbn lentling agency tor the
perfortnance o1 the v.ork fa wfiich lhis permit is issuetl. (Sec. 3097, Civil Code�.
Lentler's Name:
Lender's Atltlress:
Dale
OWNER-BUILDER DECLARATIONS:
I herehy aKrtn thal under penalry of perjury �hat I am E7(EMPT FROM THE
CONTRACTORS IICENSE LAW for Ihe (ollowing reason (Sec. 7037.5,
Business and Professions Code: Any city or counry which requires a permit to
consWct, alter, improve, demolish, or repair any slrucNre, prior to ils
issuance. also requires me applicant for such permit ro file a signed statement
l�al he or she is licensed pureuanl lo me provisions of the Contractors
License Law (Chapter 9(commencing with Seclion 7000) of Division 3 0( the
Business antl Protessions Code) or that he or she is exempt therefrom and
the basis for the alleged exemption. Any violation of Section 7031.5 by any
applicant for a permit subjects the applicanl to a civil penally ol not more than
five huntlreE tlollars ($500).):
❑ I, as ovmer ol the properry. or my employees with wages as Iheir sole
wmpensation. WILL DO THE WORK, and Ihe struclure is not intended or
offered for sale (Sec. 7044, Business antl Professions Cotle: The Contrectors
License Law dces not apply to an owner of properry who builds or improves
thereon, and who does such work himself or herself or lhrough his or her own
employees. providetl that such improvements are not intended or offered for
sale. I(, however, the buildinq or improvement is sold within one year of
completion, the owner-builder will have Ihe burden of proving that he or she
did not build or improve for purpose of sale.).
❑ I, as owner of the propeny, am EXCLUSIVELY CON7RACTING WITH
LICENSED CONTRACTORS to construcl the prqect (Sec. 7044. Business and
Protessbns Code: The contractors Licensa Law dces not apply to an ovmer of
property who builds or improves thereon, and who contracislor such project with
a cOn12c1a(s) license pursuant to the CAnitactOrS License L2w5.).
❑ I am exempt under sec.
Business and Professions Cotle tor this reason:
9B���ure
305]�A6�3IOi7
Ovmer ID venfetl by Oi lice,._.. ❑ Yes ❑ No
Driver's License No. Expire5:
Verification of Ownership by (type of document, i.e. - property taz bill or deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certi(y that no excavation frve (5) or more feet in tlepth into vfiich a
person is required lo descend, will be made in connection wilh work authorized
by this pertnit, arM that rro building strucNre, scaffdding, false�wrk, a Gemolition
or dismantling the�eof, wiil be more than thiey-sa (36) feet high. (Chap. 32, Grp
2. M 2. Sec. 341, TUe 8. Calitomia Administrative Code�.
❑ As owner-builder, I vrill not employ anyone to tlo work which would
require a pertnil lrom the Division o( Industrial Safety, as noted above, unless
such person has a permit to do such v.ork from the division.
Appliwn[s SignaWre Oate
Division of Industrial Salety Permit Number.
HAZNRDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will Ihe applicant or present or fuWre building occupant need b fle antl
certify a Business Plan (or emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of Ihe Califomia Health an0 Safery Code requires, wiN some
exceptions, that a Business Plan be filed with the Cosla Mesa Fire
Department by every business which has at any one time tluring a reported
year a quantiry of �azartlous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cuhic feet of wmpressetl gas
at standard temperacure and pressure).
2. Does or vnll Ihe applicant or present or fuW re 6vilding occupant need to file
a reqislration form for acucely hazardous materials? ❑ Yes ❑ No
(Section 25533 of Ihe Califomia Health and Salety Cotle, vnlh some
exceptions, requires registration with Ihe Costa Mesa Fire Deparlment by
each business which al any one time has on hand a quantity of acutely
hazardous materials equal to or greater than a weight of 500 pountls. or a
volume of 55 gallons, or 200 cubic (eet ot compressed gas at stantlar0
temperalure and pressure).
3. Dces or will the applicant or preseN or future building occupant need lo
prepare an RMPP (Risk Manaqement and Prevention Program for acutely
hazardous materials)? ❑ Yes � No
(Section 25534 of the Califomia Health and Safery Code provides that the
Costa Mesa Fire Department may require the preparation, certification and
fling vrith the Fire Department o( an RMPP by businesses which are required
to register aculely havardous materials with Ne Fire Department.
4. If an RMPP is presently requiretl, has Section 25534 of the Califomia
Health and Salely Code been fully complied vrith? ❑ Yes ❑ No
5. Does or will Ihe appliwnt or presem or future building occupant require for
the vrork whic� is lhe subject ot [his appliwtion a permit for such conslruction
or modifiration from l�e South Coast Air Qualily ManagemeN DisMct or fmm
any other air pollution control district or agency? � Yes ❑ No
(SeUion 65850.2 of the Califomia GovemmeN Cotla requires �hat the requestetl
inlortnatbn be fumished on applicatbns fa noo-residential building pertnits).
6. Will any paA ot the faciliry to be wnstructed unCer this permit be within
1000 (eel from the outer boundaries of a school7 ❑ Yes ❑ No
Qf yes'. Ihe lacilily must meet lhe requiremen[ 01 Settions 25534 and 42303
of ihe Calilomia Health antl Safety Code).
7. If a permit from the South Coast Air Qualiry Managemenl District or other
air pollution control district or agency is required for Ihe work which is tne
subject of this application, have all of the disclosures prescribed by Califomia
Health and Safety Coae Section 42303 been made? ❑ Yes ❑ No
8. Qf yes", attach certifiwte of compliance from Ihe appmpriate air pollution
control officer).
CERTIFICATE OF COMPLIANCE: I certify that under penalry of perjury the
informalion given above is wrrect. I agree to comply with all state laws and
city ordinances regarding Hazartlous Matenals and Emissions.
Signalure w1e
CERTIFICATE OF COMPIJANCE AND AUTHORIZATION OF ENTRY: I
cenily untler penalry of perjury that I have read Ihis applicaGon and slate lhat
tha infortnation given is cortect. I agree to comply with all state laws and city
ortlinances relating to building construction, antl aulhorize representatives of
the City of Costa Mesa ro enter upon the above-described pmperty for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by Ihis permit until final inspection.
_ SignaWrqc(LegalO+mer(s) Date
� i�� u��"tti.�-�-�,�a /-3/-oS
An0/w Aut�mzCC APdit'anl Da�e
CITY OF COSTA MESA
.
BlIILDIN6 DIVISION
F77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Faz (714) 754-4856 • www.ci.costa-mesa.ca.us
� FOR INSPECTIONS CALL: (714) 754-5626
�� PERMIT NUMBER: BC07-00082
PERMIT TYPE: B COMBO
Sub Type: RES_ALT
JOB ADDRESS: 685 B W 18TH ST CM
APN: 42426103 � - Zoning: , ,
Viciniry: BLDG B
Const Type: V-N SQ. FT: 6612
STATUS: ISSUED
DATE ISSUED: 01131I2008
ISSUED BY: BJK
SuitelUnit: e
Primary Occ:
Valuation: 570,000.00
SCOPE OF WORK: CONVERT 6612 SF 4-UNIT APT TO CONDO IN BLDG B. WORK TO INCLUDE REMOVE/REPLACE FINISHES,
FIXTURES, WINpOWS, DOORS. INSTALL` SOUND INSULATION BETWEEN UNITS. ALSO INCLUDES ELEC/MECH/PLUMBING
WORK.
REF: PA06-50, T•17112 .
OWNER: SAYWITZ, BARRY
Phone:
APPLICANT: JOE pONCINO
Phone: 949�254-5819
CON7w+crOR: BARRY M SAYWITZ
Phone: 949-930-7502 �
CeIL•
ARCHITECT: ROBERT STERN ARCHITECT
ENGINEER:
Address: 4740 VON KARMAN AVE
Ciry/State/Zip: NEWPORT BEACH, CA
Address:
City/State/zZip:
-- -- License No. 625416
- Address: .4740 VON KARMANUnit:
City/State: NEWPORT BEACH, CA
License No.C16865
License No.
COMBINTATION PERMIT FEE SUMMARY
Building Plan Ch@ck: � - $509.44
Building Fees: $783J5 '
Electrical Fees: $76.64
Mechanical Fees; �170:50
Plumbing Fees: - . $539.25 �
SMIP Residential; $7.00
SMIP Commercial: $0.00
TOTAL FEES: $2,110.08
^Rofor to fea receipts for all faes paid for pro�oct
Unit: SUITE 100 f,�
Unit: :
ZipCode 92660
PHONE:714-556-2656
PHONE:
;.
NOTICE: The work authorized by this permit shall comply with all applicable handicap access requiremenLs under California statutes and related
regulatlons. (Ord. Nq, g2•28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorizetl under lhis pertnit to be considered legal, such work must comply with all applicable codes, and all
required inspectiohs and final approval must 6e obtained. Failure to obtain inspectlons and final approvai will result in the expiration of this permit.
COpEt. INSPEG710NTYPE OqTE INiiARLS C�OE� INSPECTIONTYPE D� INIIIIALS
7818 Fixed System Final Fire Prevention ' 208 Pinal Mechanical
1268 Pool Spa Final . 208 Final Plumbing
200 Final Re-Raof 210 Final Electriwl
201 Final Block/Retaining Wall 212 Final Fire Prevention
202 Final Factory Fire Place 220 Final Planning Approval
203 Final Sign 222 Final Siie
2oa Final Demolitipn 250 Final Building�Occupancy
WORKERS' COMPENSATION DECLARATIO�
I hereby affirm untler penally ol perjury one of the lollowing tleclarelions:
❑ I have and will maintain a certificate of consent to sell-Insure (or workers'
compensation, as providetl lor by section 3700 of the Labor Coee, for the
peAormance of the vrork for which this permil is issued.
❑ I have and will maintain worker5' GOmpenSalion insurance, as required by
sectbn 3700 of Ihe Labor Code, for the peRortnance of the work tor which this
pertnil is issued. My worke�s' compensation Insurance carner and policy
number are:
Cartier.
(TRk seUion need rrol6e cnmWetetl LNe permf a vaNM ai ane �uMretl tlallars (Ef 00) a less.)
Policy Number:
I� i certily that in the peAormance of the work lor which this permit is
issuetl, I shall not employ any person in any manner so as lo become subject
to Ihe workers' compensalion laws of Califomia, and agree Ihat if I should
bewme subject to the workers' wmpensation pmvisions of Section 3700 of
Ihe labor Cotle. I shall f h th wmply vnN these provisions.
n..z�� �'3i-oe3
Appliwm§ SignaWre Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE LP,BOR CODE, IMEREST, AND
ATTORNEI"SFEES.
LICENSED CONTRACTORS DECLARATION:
I hereby affirm I�at I am licensetl under provisions of Chapter 9(commencing
wilh Section 7000) ol Division 3 of the Business antl Professions Code, and
my license is in full force and eKecl.
�ic. # � Z. S4l l.o C�ass tt �
BY�"� /� �>/'O°3
Cont2nor's SignaWre Da�e
CONSTRUCTION LENDING AGENCY:
❑ I hereby af(vm that Ihere is a constructbn lentling agency for the
peAormance ol the v.ork ta which this pertnit is issued. (Sec. 3097, Gvil Code).
Lender's Name:
Lender's Address:
OWNER-BUILDER OECLARATIONS:
I hereby aKrtn lhat untler penalty of perjury ihat I am EXEMPT FROM THE
CONTRACTORS LICENSE LAW for the following reason �Sec. 7031.5,
Business antl Professions Code: Any city or county which requires a Dertnil to
wnstruct, alter, improve, demolish, or repair any sWc[ure, pnor ro its
issuance, also requires the applicant for such permit to file a signed statement
that he or she is licensed pursuanl lo Ihe provisions of the Conlractors
License Law (Chapter 9(commencing with Section 7000) of Division 3 of the
Business and Professions Code) or that ha or she is exempt therefrom antl
tha basis for the allegetl exemption. Any violation o( Section 7031.5 by any
appliwnt lor a pertnit subjects the applicant to a civil penalty o! not more than
five hundretl tlollars (5500).):
❑ I, as owner of Ihe property, or my employees wilh waqes as iheir sole
compensaGon. WILL DO 7HE WORK, and the structure is nol intended or
oftered for sale (Sec. 7044, Business and Professions Code: The Cont2ctors
License Law dces not apply lo an ovmer of property who builds or improves
thereon, and who tices such work himsel( or herself or through his or her ovm
employees, provided t�al such improvements are not intended or offered for
sale. If, hov+ever, the building or improvement is sold within one year of
completion, the owner-builder will have tha Durtlen of proving that he or she
did nol build or improve for purpose of sale.).
� I, as owner of ihe property, am EXCLUSIVELY CONTRAC7ING WITH
LICENSED CONTRAC70RS to construct Ihe project (Sec. 7044, Business and
Professbns Code: The contractors License Law tloes not aOPly to an owner of
property who builds or impmves lhereon, and who cont2cts lor such project vrith
a cantracla(s) license pursuant to the Contractors License Laws.).
❑ I am exempt under sec.
Business and Professions Code (or this reason:
005)<6�]q])
Ovmer ID verifietl by di lice.._.. ❑ Yes ❑ No •
Driver's License No. Eapires:
Venfcation of Ovmership by (type of tlocumenl, i.e. - property taa bill or tleetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify that no excavation frve (5) or more feet in depth into which a
person is required to descend, will be made in connection vrith work autMrized
by this pertnit, antl thal no building structure, scaffdding, falsewnrk, or demolition
or dismantling thereof, will be more than thirty-sa (36) feel high. (Chap. 32, Grp
2. M 2, Sec. 341, Title 8, Calrfomia Adminislrative Code).
❑ As owner-builder, I will not employ anyone to do vrork which vrould
require a permit Irom the Division o( Induslrial Sa(ety, as notetl aDove, unless
such person has a pertnit lo do such work from the division.
AOWipm's SignaWre Date
Division of Industrial Safely Pertnit Number:
HAL4RDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to fle and
ceAify a Business Plan for emergency response lo release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the California Health and Safety Code requires, with some
exceptions, ihat a Business Plan be filed with the Costa Mesa Fire
Depanment by every business which has at any one time during a reported
year a quantity o! hazarCous materials equal to or grealer than a weight of
500 pounOs, or a volume o( 55 gallons, or 200 cubic teet o! compressed gas
at standard temperature antl pressure).
2. Does or will the applicant or present or fuWre building occupant need to Gle
a registration form for acutely hazardous materials? ❑ Yes ❑ No
(Section 25533 0l the Califomia Health antl Safety Code, with soma
exceplions, requires regisVation with the Costa Mesa Fire Depanment by
each business which at any one time has on hand a quantiry of acutely
hazarCous materials equal to or greater than a weighl of 500 pounds, or a
volume o( 55 gallons, or 200 cubic feet of compressetl gas at slandar0
temperawre and pressure).
3. Does or will the applicant or present or future building occupant neetl to
prepare an RMPP (Risk Management antl Prevention Program !or awtely
harardous materials)? ❑ Yes ❑ No
(Seclion 25534 of ihe Califomia Health and Safery Code pmviAes that the
Cosla Mesa Fire Department may require the preparation, certificalion antl
filing with Ihe Fire Department of an RMPP Dy businesses which are required
to register acutely hazardous materials vrith the Fire Department.
4. II an RMPP is presentty required. has Section 25534 of the Califomia
Health and Salely Code been fuly wmplied vrith7 ❑ Yes ❑ No
5. Does or will the appliwnt or present or future building occupant require (or
Ihe work which is lhe subjecl of �his applicalion a permil for such wnsWction
or modifiwtion fmm Ihe South Coast Air �ualiry Management District or from
any other air polWtion control district or agencyT ❑ ves ❑ No
(Seclbn 65850.2 0l lhe Califania Govemment Cotle requires Iha� Ihe requested
inlormation be (umishetl on applicatbns (a ran-residential builtlinq permits�.
6. Will any pan of Ihe faciliry to be constructed untler this pertnit 6e vnthin
10001eet from Ihe ouler boundaries of a school7 ❑ Ves ❑ No
(II yes", the (acility must meet the requirement of Sections 25534 and 42303
of the Cali(ornia Health and Safety Code).
7. II a permit from the South Coasl Air Quality Management Districl or other
air polWtion control district or agency is required lor lhe vrork which is the
subject of this application, have all of the disclosures prescribed by Califomia
Health and Safety Code Section 42303 been madel ❑ Yes ❑ No
8. Qf yes', attach certificate of wmpliance from the appmpriate air pollution
control oKcer).
CERTIFICATE OF COMPLIANCE: 1 certify Ihat under penalty of perjury the
infortnalion given above is correcl I agree to comply with all state laws and
city ordinances re9arding Hazardous Materials antl Emissions.
Date
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify untler penalry of perjury thal I have read Ihis application and state that
the information given is cortecL I agree lo comply with all state lavrs antl ciry
ordinances relaling to building wnstruction, and authorize represenWtives of
the Ci�y o( Costa Mesa to enter upon lhe aboveCescribed property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authonzed 6y Ihis permit until fnal inspection.
Sigwlurep� galOwna�s) Date
�e U'vh�.�i�r� /-3�-os
And/or Aul�onieE Apprani Dale
CITY OF COSTA MESA •
BAILDING D/VIS10N
F � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www ci.costa-mesa.w.us
� FOR INSPECTIONS CALL: (714) 754-5626 •
!�'°""� ' PERMIT NUMBER: BC07-00082
PERMIT TYPE: B COMBO STATUS: FINALED
Sub Type: RES_ALT DATE ISSUED: 01/31/2008
ISSUED BY: BJK
,los ADDrtesS: 685 B W 18TH ST.CM '. � Suite/Unif:z.,,.6
APN: 42426103 r ,'.:- : ,. Zoning. -.�' �' � �'
Vicinity: BLDG B �. - Primary Occ: •R-1 `�
Const Type: V-N SQ. FT: � 6612 , Valuation: 570,000.00
`, .
SCOPE OF WORK: CONVERT 8612 SF 4-UNIl APT TO CONDO IN BLDG B. WORK TO INCLUDE REMOVE/REPLACE FINISHES,
FIXTURES, WINDOWS, DOORS. INSTALC SOUND INSULATION BETWEEN UNITS. ALSO.INCLUDES ELEC/MECHiPLUMBING
WORK. � . � � �
REF: PA06-50, T-17112 . ' � � � � � . .
� � o . . . . , . .
- ' . '' � � , . ' . , � .
O NER: SAYWITZ, BARRY ��.�� I�, ,, Address: 4740 VON KARMAN AVE '. � .. '.- �. Unit: SUITE 100 �
Phone: , � ' • City/State/Zip: NEWPORTBEACH,CA " ' ' � �
AP�: JOEPONCINO �� - �
Phone: 949-254-5879 -
CONTRACTOR: BARRY M SAYWITZ : '
Phone: 949•930-7502: � .
Cell: , " ' . .
�
ARCHITECT: ROBERT STERN�ARCHITECT
ENGINEER: ' ' .
° Address:
City/State/zZip:
' _ License No. 625416
Address:- 4740 VON KARMANUniF. �
City/State: NEWPORT.BEACH, CA . .
License No.C16865
License No.
COMBINATION PERMIT FEE SUMMARY
Building Plan Check: � . � . $509.44
Building Fees: $783.75
Electrical Fees: � � ' $76.64
Mechanical Fees: ' $170.50`
Plumbing Fees: $539.25
SMIP Residential: $7.00
SMIP Commercial: $0.00
TOTAL FEES: $2,110.08
^Re/er w fee receipts tor all fees palO tor proJect
Unit :
ZipCode � 92660 �
PHONE:714-556-2656
PHONE:
1
r- � `J\
� O
NOTICE: The work aufhortzed by this permif shall comply wilh atl appticable handicap access reqoirements under Califomia.statutes and 2lated
regulations. (Ord. No. 92-28, § 1, 12•21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. �
INSPECTIONS: In order for the work authorized under Ihis permit to be consiqered legal, such work musl cwnply with all appliwble codes, and all
reQuired fnspecHons and flnal approval must be obtained. Failure to obtain inspec6ons and fina! approval will result in the expireGon of this permit.
SR�.l, n�svEcnoxirve
1818 Fiued System Final Fire Prevention
1288 Pool Spa Final
200 Final Re-Rao(
201 Final BbcWRetaining Wall
n12 Final Factory Fire PWce
203 Fina15ign
204 Final Demolitian
Q� L�43 S4BE! msretnoxirve
208 Final Mechanical
208
2t0
212
220
222
250
Final Plumbing
Final Electrical
Final Fire Preventi0n
Final Planning Approval
FinalSite
Final BuildinplOccupanty
� �_ A�n�_
�/
� r1
���' nl
WORKERS' COMPENSATION DECLARATION:
I hereby affirm under penalry of perjury one of lhe following deGarations:
❑ I have antl will maintain a certificate o( consent to self-Insu�e for workers'
compensation, as provided for by section 3700 of the Labor Cotle, for the
peAortnance o( ihe vrork for whlch lhis permit is issued.
❑ I have and v.ill maintain v.orkers' compensation insu2nce, as required by
section 3700 of lhe Labor Code. for the performance of the v.ork fw which this
permit is issued. My workers' wmpensation Insurance cartier and policy
number are:
Cartier:
(Thit seCipn neM nol De mmpetetlONe peimrt a valuee at one hurbretl tlWars f5t00) w less )
Policy Number:
❑ I cenify that in the pertortnance of the vrork for which this permit is
issuetl, I shall nol employ any person in any manner so as lo become subjecl
to the vrorkers' compensation laws of Cali�omia, and agree that it I should
become subject to lhe vrorkers' compensation provisions of Section 3700 of
Ihe Labor Code, I shall forthvrith comply with Ihese provisions.
Apd�m��'s SignaWre Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000�, IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS
PROVIDED FOR IN SECTION 3706 OF THE L480R CODE, II�lTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm that I am licensed under provisions of Chapter 9(commencing
vnth Section 7000) of Division 3 0( the Business and Protessions Code, and
my license is in full torce and eftect.
Lic. # Class #
ConUador's SignaWre Date
CONSTRUCTION LENDING AGENCY:
� I hereby affum that lhere is a constmctbn lending agency tor the
peRormance of the work fd wfiich ihis pertnit is issued. (Sec. 3097. Civil Code).
Lender's Name:
Lender's Address:
Da�e
OWNER-BUILDER DECLARATIONS:
I hereby aKrm that u er penalty of perjury that I am EXEMPT FROM THE
CONTRACTORS LIC E LAW for the following reason (Sec. 7031.5,
Business and Profassi city or county which requires a permit lo
consiruct, alter, impr , tl o or repair any slmcNre, prior to its
issuance, also require e ap (�h permi[ to fle a signed statement
that he or she is lice sed pur to thF��ons of lhe ConVactors
License Law (Chapter 9(comm i wit[rSectio 00) of Division 3 of the
Business and Pro(essions Code) or e s ezempt therefrom and
the basis for the allegetl exemption. Any vio f Section 7031.5 by any
applicant for a permit subjects lhe applicant to a civil penalry of not more man
five hundred tlollars ($500).):
❑ I, as ovmer of the properry, or my employees with waqes as their sole
compensation, WILL DO THE WORK, and the structure is not intended or
oftered for sale (Sec. 7044, Business and Professions Cotle: The Contractors
License Law dces not apply to an owner of property who 6uilds or improves
thereon, antl who dces such work�himself or herself or through his or her ovm
employees, provided Ihat such improvemenis are not intended or oKered !or
sale. If, however, the building or improvement is sold wilhin one year of
wmpletion, the owner-builder will have lhe burden of proving that he or she
did not build or improve for purpose of sale.). . ,
❑ I, as ovmer of the properry, am EXCLUSIVELY CON7RACTING WITH
LICENSED CONTRACTORS to construct the project (Sec. 7044, Business and
Professi0ns Cotle: The contractors License Law dces not apply to an aaner of
property who builds or improves thereon, and wfio contracts for such project with
a cantracta(s) license pursuant to lhe Contraclps License Laws.).
❑ I am exempt under sec.
Business and Professions Code for this reason:
' SgnaWre � Oa�e
305]-d6(3/01)
Owner ID verified by drivei .. ��cense. � Yes ❑ No
Driver s License No. Expires:
Venfication of Ownerehip by (rype of document, i.e. - property tax bill or. deed):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: '�
❑ I hereby cetlHy that no excavation fne (5) or more feet in depth into which a
person is required lo descend, vrill be made in connection with work authorizetl
by lhis pertniC and Ihat no building sWCWre, scaffdtling, falsework, or demolilion
or dismantling thereof, will be more than thirty-siz (36) feet high. (Chap. 32, Grp
2, M 2, Sec. 341, Title 8, Cali(omia Atlminist2live Cotle).
❑ As owner-builder, I vnll not employ anyone to do work which would
require a permit from the Division of Industrial Satery, as noted above, unless
such person has a permit to do such vrork fmm the division.
Appliwnt's Signalure Dale
Division of Intlustnal Safety Pertni[ Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future building occupant need to file and
ceAify a Business Plan for emergency response to release or threatened
release of a hazardous matenal7 ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safery Cotle requires, wilh some
exceptions, that a Business Plan be filed with Ihe Costa Mesa Fire
Department by every business which has at any one time dunng a reportetl
year a quantiry of hazardous matenals equal to or greater than a weighl of
500 pounds. or a volume of 55 gallons, or 200 cubic feet of compressed gas
at slandartl temperature and pressure).
2. Dces or will the applicant or present or future building cecupant need to file
a registration torm for acutety hazardous materials? ❑ Ves ❑ No
(Section 25533 of the Califomia Health and Safery Code, with some
exceptions, requires re9istration with the Costa Mesa Fire Deparimenl by
each business which at any one lime has on hand a quanlity of acutely
hazardous materials equal to or greater lhan a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressed gas a1 stantlard
temperaWre and pressure).
3. Does or will Ihe applicant or present or fuwre building occupant need ro
prepare an RMPP (Risk Management and Prevention Program for acu[ely
hazardous matenals)? ❑ Yes ❑ No
(Section 25534 of the Califomia Health and Safery Code provitles thal ihe
Costa Mesa Fire Department may require lhe preparalion, certifcation and
fling wilh Ihe Fire Departmenl of an RMPP by businesses which are required
to register acutely hazardous materials with the Fire DepaAment.
4. If an RMPP is presently requireG, has Section 25534 0l the Califomia
Health and Safety Code been fully wmplied with? ❑ Yes ❑ No
5. Does or will the applicant or present or future building occupant require for
the v.ark which is the subject of Ihis application a permi[ for such construction
or modification trom the South Coast Air Qualiry Management District or from
any other air polWtiOn COn�fol tli5lriCl or agenCy? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that the requested
information be fumished on applications (a rwrnresidential buiWing pertnits).
6. Will any part of the facilily lo be wnstructed untler this permit be wilhin
1000 (ee[ from the ouler boundaries of a school? ❑ Yes ❑ No
Qf yes", the facility must meet the requirement of Sections 25534 and 42303
of Ihe CaliFomia Health and Safety Code).
7. I( a pertnit from [he South Coast Air Qualiry Management District or other
air pollution control district or agency is required for the vrork which is the
subject of this application, have all of the disclosures prescribed by Califomia
Health and Safety Code Section 42303 been made? ❑ Yes ❑ No
8. (If yes", attach certificate of compliance from the appropriale airpollution
coNrol oKcer). � ' � ' �
"CER7IFICATE OF COMPLIANCE: 1'certify that untler penalty of perjury the
information given above is cortecl I agree to wmply with all stale laws and
city ordinances regarding Hazardous,Materials and Emissions. �_ ,
Dale
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certity under penalty of perjury that I have read this application and�state that
the informalion given is correcl I agree to comply with all stale laws and city
ortlinances relating to building consWction, antl aumorize representatives ot
the City of Costa Mesa to enter upon [he above-described property for
inspection purposes. I agree not to occupy or allow occupanty of any building
au�honzed by lhis permi[ until final inspection. � �.
SignaWre of Legal Owner(s) Date
An4lOrAutbonz¢tlApObcdnl Da�e �
(714) 754-5273 • Fa�c (714) 754-4856 • www.ci.costa-mesa.�y{�DING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 685 W 18TH $T
Suite:
Viciniry:
Primary Occ: MR
Parcel Number: 42426103
Applicant: SAYWITZ, BARRY
Address: 4740 VON KARMAN AVE #100
Type of Construction:
Zoning:
NEWPORT BEACH, CA �
Owner: SAYWITZ, BARRY
Address 4740 VON KARMAN AVE #700
- NEWPORTBEACH,CA� � .
Contredor.�. � OWNER-BUIL'DER-'� ,
Address:' ' � -
,
Zip: �
Phone: 949-930-7502
Zip: 92660.2172
Phone:
Zip: 92660-2172
Phone:
License: 000000
ISSUED BY:
Stalus: ISSUED
Applied: 02/03/2006
Issued: 02/032006
Arch : , Eng:
Address: Address:
� " Phone: � Phone:
Zip: - - License: _ License:
SCOPE OF PERMIT
CONDO CONVERSION INSPECTION OF 2 ONLY UNITS OUT OF 10 UNITS.
Plan Check:
Permit:
SMIP Res:
SMIP Com:
Other:
Inspection:
FEE SUMMARY
S0.00 ,
$0.00
$0.00 , '
$0.00 � � ..,
$0.00 - - . _
$0.00 • . „'
Calc Valuation: 30.00
Claim Valuation: 30.00
Total: $180.00
� � PLANNING 8 ZONING
SETBACKS '
MAIN STRUCTURE Front �0; 0 Rear 0- 0 Left 0- 0� Right 0. 0
ACCESSORY Front �0-0� � Rear 0-0 - Left 0-0 � Right 0.0 �
i� ; ,
. �
PARKING'�'�� � Ezistlnd: ". 0 - � Reauired: 0 Pr000sed: o
�� ,�: , ' � . .
NOTICE: The work aulhorized by this permit shall comply with all applicable handicap access requirements�under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if work is not commenced within 180 days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under Ihis permit to be consldered legal, such work must comply with all applicable codes, and all
requlred Inepectiona end flnel epproval must be obtained. Failure to obtain Inspections and tinel approval will result in the expiration of ihis permit.
FOR INSPECTIONS CALL: (714) 7545828
zaaa+e �e�oo�
WORKERS' COMVENSATION OECLARATION: _ .
I nereby effirm under penalty ot per�ury one of ihe following decleretions:
❑ I heve antl will meintflin e ceRiticate ot consen� to self-Insure tor workers' compensetlon, es provideE tor by section 3700 ot Ne WDor Cotle, lor the peAortnance oi the
work for which this pertnll is Issuetl. .
❑ 1 have arW witl meintain wOrkers' compenSeYon InsurenCe. es requiretl by seclbn 3700 of NB Lebor Code. fw Ihe pBAormence of fhe wWc ta whkh this pertnit is Issued.
My workars' compensaUon Insurence carrler antl policy numDer are:
C4��er. PWky Number.
(yhis sectiar need nat be comp/efed I/ the permit /s valued ef one hundred OWlers (S I00J or less.)
❑ I cenity thal in t�e peAarmance of �he work for which Ihis pertnit Ls issuetl, I shall not employ any person in eny menner eo es to become sub�ect to the workars'
compensat(on laws ol Celllomla, end egrea t�at II I shoultl become sub�ect m the workero' compensetlon praWslons ol Sectlon 3700 ot the Lebor Cotle, I shell fonhwlih
comply with ihese provisions.
App��cant Signature: Date:
WARNINO: FAILURE TO SEWRE WORKER$' COMPENSAiION OpVEMGE IS UNLAWFUL AND SHALL SUBIECT AN EMPLOYER TO CRIMIW�L PENALTIES AND CML FlNES UP TO ONE HUNDRED
T1KIUSMlD DOILAFiE (5100,000�, IN ADpTION TO THE COST OF COMPENSATIpN, DMMGES AS PRONDED FOR IN SECTION 3]OB OF THE IABOR CpDE, IMEREST. AND ATTORNEVS FEES.
LICENSED CONTHACTOHS DECLARATION:
I hereby aNirm that I em Iicense0 under provisions of Chepler 9(commencing with Section 7000) of Division 3 0l the Business and Professions Cqfe, antl my license Is in tull
torce antl ettect. Lic. # Class q
Contrectofs Signature: Dete:
CONSTRUC710N LENDING AGENCY:
❑ I hereby aNirm ihat Ihere i5 e consWction lentling agency lor the pertortnance ot the work for which this permit is issued. (Sec. 3097, Civil Cotle).
Lentlers Name: Lenders Atltlress:
Slgnawre: Date:
OWNER-BUILDER DECLAFATIONS:
I hBreby eMirm that under penelry of per�ury Ihet I em EXEMPT FROM TME CONTRACTORS LICENSE LAW for ihe tollowing reeson (Sec. 7031.5, Business end Protesslans
Codo: Any ciry or wunry which �equires e permit to consimct, elter, improve, demdish, or repair eny sWclure, O�lor lo ite issuance, also �equires Ihe eppliwnt for suc� permit
to �ile a signed statement that he or she is Ilcensetl pursuent ta the provislons of Ihe Conirectors License Lew (Chepter 8(commendng with SecHon 7000) 01 D'Msion 3 of the
BuS��ess end Professions Code) or Ihat he or she is anempl theretrwn antl the hasis tor the alleged exemption. Any Nolation of Section 7031.5 by eny applicant lor a permil
subiects the applicent to e Gvll penalry ol not more Ihen live hundred tldlars (5500)J:
❑ I, es owner of iha property, or my emplayeas with weges es Iheir sole Gompensation, WILL DO TTIE WORK, and the structure is not interMeA or otteretl far ule (Sec.
7044, Busineu antl Pmfessians Code: The Contractors LJcense Lew does nm appty to en owner of property w�o Duilds or improves thereon, arW who does such work
himsetl or herselt or Nrough his or her own employees, provided that such Improvemenis ere not Intended or oflered tor sale. If, however, tha buiiding or improvement is
sdtl vrithin one yrear ot complation, the owneo-0uikfer will Rave the hurden ot proving that he or s�e did rrot builC or improve tor purpose ot safe.). '
❑ I, es owner of the pro0erty, am E%CLUSIVELV CONTRACTING WI7H LICENSED CONTRAC70RS to consiruct the praject (Sac. 7044, Business end Professions
Cotle: 7Te contractore License Law tloes no� apply to an owner ol property who 6ullds or Improves ihereon, end who coniracis for such project with a coniractor(s)
license pursuent to Ihe CONrectors License LewsJ.
❑ I em exempl untler sac. Business antl Professions Code far this reeson:
Signsturet Date:
Ow�er ID veritied by drivefs Ilcense. ❑ Yes ❑ No Drivers LJcense No.
Ved��ce�ian o1 Ownership by (rype ot tlocument, i.e. - property tex Dill or deetl):
DIV�SION OF INDUSTRIAL SAfETY PERMR CER7IFICATION:
Ezpires:
❑ I hereby ceriify ihet no excevation five (5) or more teet In tlepih into which e person Is required to Oescend, wlll be mede in connection with work authonzed by Ihis
pertnit, antl t�at no builtling struCture, scaHoltling, lelsework, or tlemolition or dismanlling �hereof, will be more Ihen ihirry-six (36) teet high. (Chep. 3.2, Grp 2, Art 2, Sec.
341, Title 8, Calitomia Atlminisirative Cotle).
❑ As ownar-builtler, I will not employ enyrone to tlo work which would require e pormit from the Division of Intlustrial Safety, as no�etl ebove, unleu such person has e
pertni� to tlo such work from tha division.
SigpeWre: Date:
Division of Industrial Safery Pertnit Numbar:
CER7�FlCATE OF COMPLIANCE M10 AUTHORVATON OF ENTAY: I certity untler penalry oi perjury that I heve reed this epplication entl slate t�al Ihe informatian given is
Corr�ct. I egree to wmply with ell state laws end city ortlinances releting to DuilAing wnstruction, end euthorize representetives of the Ciry of Costa Mesa to enlar upon the
aboVe-described property for Inspeclion urpo es. I egree not to occupy or allow xcupency ot any building authorized by lfiis permit until tinat iqspociion.
�- -» Z�iZ3`/�F�-I_
\aienacure o �e ei ow�i artsl T�v t— -
�j� INSPECTONTYPE PAIE Ii�L9
1616 Fixed System Final Fire Prevention
1266 Pool Spa Final
200 Final Re-Roof
201 Final Block/Retaining Wall
202 Final Fadory Fire Place
203 FinalSign
20d Final Demdition
GODE� INSPE4DONTYPE
206 Final Mechaniral
20B Final Plumbing
210 Final Elet�rical
212 Final Fire Preventian
220 Finel Planning ApprOval
222 Final Site
250 ci . o.:,
PAg
1d�J—
1�L:
(714) 754-5273 • Fax (714) 754-4856 • www.c�.coste-mesa.�{�LDING PERMIT 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address:
Suite:
Vicinity:
Primary Occ:
Parcel Number.
685 W 18TH ST
R
42426103
Applicant: SAYWITZ, BARRY
Address: 4740 VON KARMAN AVE
UNIT 100
NEWPORT BEACH, CA
Owner: SAYWITZ,
Address 4740 VON KI
i`) �
� �J
:A './l.�i ��� .
V � � �"
�lan-Check:� % $0.00
'✓ Permit:�' . 50.00
�SMIP Res, �i $0.00
SMIP_Com:�;' � $0.00
l _Other'��'�rl $0.00
Inspection 1� �, $0.00
l� 1 �,� �
� � T ( I � �° `�� 270 00
�. o a . \� �A", $ .
Type of Construction: V-N
Zoning:
Phone: 949-930-7502
ISSUED BY:
Status: ISSUED
Applied: 07/25/2006
Issued: 07/252006
i �-1 —�o
� � � i � ��
Rhone:� , �
� ��� Zip:�92660-2172 �
�-- _ —, ,--_� \�
=="=-� ='= ;�� �,��, �
Phone: ' `���\� �O
License: \\
�� Eng: \
�' Address:
r..
Phone: { ��� y �i j�-�"� �
e � r i��
� ��
icense: �-��� �'`" )' �i
��1. �;c •,-c9`�' � ��, � l
: o'� —" � SCOPE OF�PERMIT � ti� -� � /,
3 UNITS �� �- -i- ) �f�
� FEE SUMMARY `� �l �`1'��
- - -� - -- Calc Valuation: �� ��
/`'��� � j�' 'y � °/� CI�mValuation:�'�
'�1� Ir �. ��c' 1 II'11ce �i'.1R��1 � _
r��~�,r--�--�-� �� - - ,� ' /
�,�1-� �, )�� , _ ;'/�
�^ �-- _. _ �� �h- ---� �f,
0 , Rear
NINb i
0 Right � 0-
�1" \> 1 IL��1:J� Q�1�'iG : O, G L'b'U6,I.1• ,.
�Front 0-'0 . Rear.;,;,0-0� 6ek,,, ;0-�0�3?.
V— �• :i.;s'>,-�.s; 0 ° t'r��d�
\\ {`£5 0 n'F'' c��'10 " , p i�'--C,��-v
ExisNn 0�� Required 0� i o� ��-Pr000sed. �0 �
� �� ��
\�l. ��// \\�= � � �. ;��
\1 \ �i l �/\ \ `�� � 0 , „ c __ '�
� . J � C J�\_ �__��=— _=>=`=%
�
� �� � `� `� J ;'�� , � � r-, ��; � r`� �/?
�� ��� , I � '� � �
O_ _ �U�'J � /
i
'�
NOTICE: The work authorized by this partnit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: This permit shall automatically expire and become void if xrork is not commenced within 180 days, or if work Is suspended oi abandoned
for a period of 180 days.
INSPECTIONS: In arder for the rrork authorizetl under this permit to be considered legal, such work must comply with all applicable codes, arrcl all
requlred Inapeetions and Nnal approvel must be obtained. Failure to obtain inspections and final approval wifl result in the expiration of this permit.
FOR INSPECTIONS CALL: (7t4) 7545626
�.....� ",�,,,,
WORKERS'COMPENSAnON OECLARAnON: •
I hereby eNirtn under penalry of perjury one ot the tWlowing tleUarations: •—.. . , �
❑ I have end will maintefn e certifiwte of consem to self-Insure tor workers' campensa6on, as provided for by sectlon 3700 of Ihe Lebor Cotle, for the pedortnanca ot the
work lor whiCh IhiS pertni� i5 i55uetl.
❑ I have en0 will maintain wwkers' cpnpensaUon inwrame, as repu'ved by sectiion 3700 ot Na Labor Code, tor Ihe pertortnar�ce of Ihe wwk ta wh�h tttis pertnit is issuetl.
My workera' compensatlon Insurence cartier anC pdky number ere: ,
Carrier. Pollcy Number.
(Thls sectlar nestl nof be comple(ed ll Ne pertNt Is ve/uetl et me huntlretl tlol/ers (5100) or less.)
❑ I certity Ihal in the pertortnance of Ue work tor which Nls pertnit U issued, I s�all not employ eny person In eny manner so as to become sub�ect to Ne workers'
compensetlon laws of Cellfomia, antl agree that tl I shwld became suDle�� �o Ihe workers' compensetlon pmvislons ol Sectlon 3700 of Ne Lebor Code, I shall forNwiN
compy wit� these P�lons.
Applicent Signetura: Dele:
WFRNINO: FFILURE TO SECURE WORKERS' COf.IPENSATION NVERAOE IS UNUWFUL PND SHALlSU&IEGf PN EMPLOVER TO CRIMINAL PENPLTIES ANU CMl FlNES UP TOONE HUNORED
THOUSMlD DOLLARE (E100,000). IN ADDRION TO THE W5T OF COMPENSATION, DAMAOES r15 PROVIDED FOR IN SECTION 3108OF TME UBOR CODE, INTEREST, AND ATTORNEVS FEES.
LICENSED CONTRACTORS DECLARATON:
i I hareby eMirm thet I em IlcenseC under Orovisions ot Cheprer 9(commendng with Sectlon 7000) ol Divislon 3 oi Ihe Business entl Professions Code, end my license is In full
� forCe end Bttett. LJt. M Class q
� ConireCtOls Signeture: Date:
CONSTRUCTION LENDING AGENCY:
❑ I hereby eHirtn Ihat there is e construction lending agency for ihe peAormence ot Ihe work lor which Ihis permit Is Issued. (Sec. 3097, Civil Code).
Lendefs Name: Lentler's AOdress:
Signeture: Date:
OWNER•BUILDER DECLARATIONS:
I here6y eMlrm thet under penalry of perjury that I am E%EMPT FROM THE CONTRACTORS LICENSE LAW for the tollowing reeson (Sec. 7031.5, Business and Professions
Cotle: Any ciy or caunry which requires e pertnit ro construct, elter, improve, tlemollsh, or repeir any struCWre, pdor to Its issuance, elso reqNres t�e applicaN for such permit
to illa e slgned atetement I�et he or s�e Is licensed pursuant ro the provlslons of �he Contractors License Lew (Chepter 9(commendng wlih SecGon 7000) 01 DMsim 3 oi Ihe
Business entl Prolessions Cotle) or Uat he or she is exempt lherelrom end the hasis tor the alleged e.emptlon. Any violation o1 Section 7031.5 by eny epplicant for a pertnit
sublacts the aOPlicant to a civll penalry of not more than Ilve hundred dollars (5500).):
❑ I, es awner af ihe properry, or my employees with weges es t�eir sole wmpensa�lon, WILL DO TME WORK, antl the siructura Is not intended or oHeretl tor sale (Sec.
7044, Business and Professions Code: The Contractors Ucense Lew tloes not flpply to an owner of property who builds or Improves thereon, and who tloes such work
himsetl or herselt or t�rough his or her own employees, pmvltleG thet such Improvements ere not Intendetl or aHeretl tor sele. If, however, the huilding or improvement is
soltl within one year ot wmpletion, Ne owner-builtler wlll have tha burtlen ot D��ng that he or she did not build or ImDrove lor purpose ot sale.).
❑ I, fls owner of the property, am EXCLUSIVELY CON7RACTNG WRH LICENSED COMRACTORS to construct the Droject (SecJ044, Business flnd Professions
Cotle: The cantractore License Law tloes not eppry to en owner oi pmperty who builds or improves Ihereon, and who contraas lor such pmjea with e contracmqs)
license pursuant to the Caniractors license Laws.).
� � em exempt under sec. Business entl Professions Code for this reason:
S aNre: Date: .1� Ul,�
Owner ID veritied by drivels licen5e. �Yes ❑ No Dr'rvers License No. � Fxpires:
Verlllcation ot Ownership Ey (rype o1 ocument; .e. - property lex blll ar deed):
OIVISION OF INDUSTRIAL SAFETY PERMR CERTIFlCATION:
❑ I hereby certity thet no e:cavation tive (5) or rtrore taet In depth into which e person is requlred to descend, wlll ba mede in connection wit� work authorized by thls
permit, end �hat no building sWdure, swNoltling, talsework, or tlemWitlon or tlismantling Ihereol, wlll be more than thirry•six (38) teet high. (Chep. 3.2, Gry 2, Art 2, Sec.
341, Tltle B, Calilarnla Atlminlsiretiva Cotle).
❑ As owner-bullder, I will not employ enyone to do work which would requlre e permil from the Divislon ol lndustrial Sefery, es noted e6ove, unless such person �es e
pertnit to do such work Irom the division.
Signeture: Date:
Dlvision oi Industdel Sefary Permit Number.
CERTIFlCATE OF COMPLIANCE AND AUTHORQATON OF EHTRY: I certify under penalry of peryury that I have resd this epplicatlon antl state that the intortnetlon given Is
correct. I egree lo comply with all state laws enC Gry orCinences releNnp to bullding wnstructlon, enA euthodze represenlatives ol the Ciy of Coste Mesa to enter upon the
ebova-tlescribed properry tor inspection puryos�. I egree not to occupy or ellow occupancy of eny 6uilding euthorized by this permil until finel ins cUon.
ja(� � �i�r�V
Slanature Of e el Own ate
COOE I. INSPECTION TYPE
1616 Fixed System Final Fire Preventlon
1268 Pool Spe Finel
200 Final Re-Root
207 Finel BIocWRetaining Well
202 Final Fectary Fire Place
203 Finel Sign
204 Finel Demolition
Pdg
Jy]�^ �Qj� INSPEC710NTYVE
206 Flnal MechanlCel
208 Finel Plumbing
270 Finel Eleciricel
212
220
222
Finel Fire Prevention
Final Planning Approvel
Final Site
�nn�.�i.�.�� �-..�.^�.^..7
Date
PAg UII�ELi
la-� -c�? �
�
. �
/
Appliu��fi
CI7Y OF COS7A MEsa, CONSTR,UCTION PERMIT �
Project Address �SS 18th Street 6osta Mesa �$���
Applicant's Mailing Addreu z062 Business Center Dr. ii�7 0�
owner's Namd • SAT A D v 1 opmeht Phone %20-8484
Address �RO Nawonrr Center Itd80 N.B. 92660
qrch/Er.j. License No.
Address
Contractor'sName ATFA Cnnctrurtinn Phone 4��
Addresslmailing) �n�� R� cinPcc ('Pnter �i260� Irvine
City License No. ��G44
LICENSEO CONTRACTOR DECIARATION
I hereby altirm t�at 1 am licensetl untler provislons of Charter 9(commendn9
witn section 7000) 01 Dlvision 3 0( e Business antl Prot ssions Cotle, antl
my license ii in tull tnrce ana ettect. 1030055
license Clasz �S <en N .
oate 11 /__-_, �,__.__/RR Signatur
WORKERS' COMVENSATION DEC R I N
� 1 nereby alfirm tna[ I have a certifi< te of conseM to salLi re or a certifiwte
ol Workers' Compensation Insura e, or a ttrtifiea c y thereof (Sectlon
i800, Lab. G.)
>licy No. Com y
Certifietl copy is hereby turnishetl.
Certifiatl copy Is filea with the cit tli Ivl '
, Date Applican
EXEMVTION FROM WORKERS' COM N E LARAT
(Tnissection neetl not be tompletetl if t e permi[ Is fo o e huntlretl (E 00) or
less). '
I cerUfy lhat In tne performance of the work for wbicn this perm�t iz issuetl I
shall not amploy any person in any manner so as to betome zubject to t�e
Workers' Compeniation Laws ot Galifornia.
Da[e Si9nature
NOTICE: If, atter making this Oeclaration, you shoultl Decome subject to the
Workers' Compensation provisions ol tna Labor Cotla, you must forthwith
como�Y �+«h suth provisions or this permlt shall be aeemetl revoketl.
CONSTRUCTION LEN�ING AGENCV
1 nereby aiflrm that lhere IS a Const�uctlon lentlin9 dgtnty tOr the perlormante
j oi tno work for whlch this permlt is IssueO �Sectlon 3097 Civ. CJ
' Ltntler's Name
Lenticr's Atldresi
OWNER BUIIDEH OECLARATION
1 hereby aifirm lhat I am exampt from the Contractor's Licansa Ldw for the
following reason (Saclion ]031.5 Businezs antl Professlonal Cotle: Any city or
countY whlch repuires a permit lo construct, altor imprave, tlemolish or repair
any 5lrucWre, prl0/ to i[s issuant¢, alm reqWr¢5I{�e appll<dnt fo� Such pe/mil
t0 filo d signotl sla[em¢nt that he/Sne I5 Iicensetl pur5udnt [o tne prOvisions of
t�e Coniractor's Licensc Law (Chapter 9(commencing with Saction 7000) of
DivlSion 3 of [ho Businoss antl Profe55ion5 COUe) o� thdt he/ihe ii ¢xampt
therefrom antl tne basis lor the allegetl ezemption. Any violatian of Section
�W1.5 by dny applicant 10r a parmit 5ubjacl5 [�B applicant to a civil
, �alty ol not more tnan live huntlretl tlollars (E500).
1, as ownor ol tlte proPerty or my employoes wilh wa9es as lheir zole
�mpensatlon, wlll tlo the work, antl the structure Is nol IntonCetl or ofteretl
tor zale (Section 7044, Business antl Professional Cotlo: The Contractor'S
License I.�w tloes not apply to an owner of a property who builtls or irnproves
NereOn, antl who Goes SUCh work Iflmsel(/herselt or thwugh his or h¢r own
empioyms, provitloa tnat such imorovements are not intontlea or offeretl tor
saie. If, however, the bulltlin9 or improvement Is soitl within ono yaar of eom-
pl¢tion, lhe owne� will have lhe bUrden Of ptovl�9 �t/ih0 tli0 not bulltl Or im-
p�Ova 10rthe pu�po5a OI sale�.
❑ I, as owner ol tne property, am ezcluzively contrattin9 with Ilcensetl con-
Vactarzto conrtrucl the project ($ectiOn 7044, BUTIne55 antl Pro1e55iOns Cotl¢:
The Contractor'i License Law daez not apply to an owner ot proPerly who
builtls or improvas lhereon. antl wno contracts for sucn oroie<tz with a con-
tractor(5) hcense pursuan[ to me ConVactar's Llcen50 L.dw). I am aware [IIDt
proof o( tholr WOrke�'S Compensa[lon InSuranca Shoultl be p�ovitletl t0 Te.
❑ I am �xempt untler Section B. 6 P. C. for this reason
e .
Date
antl
Signature _
Drivers' Licei
/ 0865-46,rev.
_ Owner
hav¢ rea�
White - Builtling
the above
>rtlinances
rize �ep�e-
ioertv for
1� 3(o D`5 b_ I N�.u� M�
IRY�1�F CONSTRUCTION r�EW ❑ ADD
u CONVERSION ❑ DEMOLISH ❑ OTHEF
DESCRIPTION OF WORIL/USE OF BLDG...-��
REPAIR
TVPE (fF PERMIT "LJ GRADING LJ FOLNDATION L�l'STRUCTVRAI.
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION
C O N 5T RUCTI ON TY
Remarks:
_7✓ VALUATION $ �`'��F���
GRADiNG CU. VDS. ACRES
PIUMBING
Sink Shawers
<flow Preventer Service Sink
<flow Irrigation Sewer Cap '
itubs Sewer Connectii
ifiers Solar Collectors
iurdsher � Solar Pipin9 _
Drinking Fountains
Floor Drains
Floor Sinks • �
Gas Servic.e Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Dreins
Reinspection Fee
Sal rfank • '
wimming Pool w/Spa
Urinal -r._
Wa[er Clout .
Waier Hea2er
Water Service
Auto�Wesh
Leundry Tra'ys
575 laue Fee
Duct- Untler Ground
Duct • Structural
Duct - Ventilating
Ezhaust System ❑ Multiple ❑
Firepl/Fact. Blt. iC80 #
Heating System & Ducting
❑ 0-100,000 BTU � 100,000 BTi
Reinspection Fee � 515
- Applitant; Pink - Accounting: Goltlenrotl - Assessor
Hood or Typel ❑
Canopy Type 11 ❑
��efrige tion System
� 00,000 BTU ❑ 700,000 BT
iystem Repair/Alteration
fire Dampers
Registers
`\
Isue Fee
A.P. iW —
S Main 8uilding:
E
T Front
A Rear �
C Right
S Left
Ping. Ref. # �
FEES Auromatic Washer
Construction Pole S�
Cooking Unit
oishwasher
Dryers ❑Gas �EI
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �0.5 KW
_ � _ � Reinspection Fee
— Q 2one
Actessory Building:
5 I � o
�I N
N
� G
_,�3 R
Parking Req./Provided E
)R SPECIAL n°�
T
S.
5
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
g 3 DEVELOPMENTSERVICESRE�UIREME
ZoninB APProved By
FEES . Building Approved B�
T nao�iiatfoo �ssued ev
'' BUILDING PERMIT $
�' PLAN CHECK $
PLUMBING $
PLAN CHECK 25% $
� ELECTRICAL $
f�PLAN CHECK 50%� $
-� f) MECHANICAL $
. ',PLAN CHECK 25% $
�J
n
S3 ^
Meter LJup to 100amps
Meter ❑over 700 amps
Sub Panel �
Motors -1 HP O�1�Y, - 8
In olar 09-75 HP �1615+
Miuowave
Pole Light .- �
Range �
FEES
Standing Sections
Trash Compettor
Issue Fee $ 3
1TS� Date �I_ _pC1
' �- `oeta �G 6 B'8
et �
VO F —���`
sa SMIP $ '� 9'
� PERMIT
ISSUANCE $
ENERGV P.C. $
GRADING $
MICROFILM $
— TOTAL FEE $ �j
01 00019��J4-OOD19011 TOT Si:b.Q:
OATE: il/03/&$ TIilc': 1S:4Q
•� ?i , �
�
CONSTRUC710N AND PLANNING POOL F > ,
APPROVALS Permit# Date Inspector qppROVALS Permit# '� Date Inspector -�
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ' �`_"
2. Soil,Pipe�Undrgmd. � 53. Steel Reinforcement - i�,
3. Electrical Conduit Utility-Undrgrnd. 54. Forms �� - �
. �•�
�• 4! Elect�ical Conduit-Undrgrnd. 55. Electrical Bonding � ��'�
5! Steel�� Reinforcement 56. Rough Plumbing & Pressure Test
i , , ,�.
6� ElectricalUFER�G�nd. )/-; � � 57. APPROVALTOCOVER-GUNITE •���,
7�Footings .� i � �� ���f;;j � 58. ElectricalConduit�Undrgrnd. ' �
� B! Founda[ion �� �. '�� �� i 59. Gas Pipe, O Undrgrnd., Test /'� �
. 9� Water Pipe-Undrgmd. � i�;' 60. Backwash Lines, P-Trap, � Undrgrnd. �; � �,
10: Structurel Floor System � J� ,` 9J{i �'f�� � 61. APPROVAL TO DECK � �'
11: Property Sewer Line & House Connection ,�7 � 62. Backwash & Receptor-Final -
,
12. Sewer Cap . i " �1 , 63. Heater & Vent-Final
• � i�
1�i Roof Drains ���. i . i � %. - 64. Plumbing System - Final ' �
i . r
� 1�4.'/Rough Plumbing� � � l �� 65. Electrical-Final
�i&:�Rough Electrical�Conduit - 66. Solar System-Final
�!��. Rough Electric Wiring 67. Fencing & Access Approval �
'•1y. Rough U�living Sign � �, 68. APPROVED FOR PLASTERING
i,.
- 1�8. Rough`Elec[rical-T Bar CeiN�g � 69. POOL/SPA SYSTEMS FINAL
�19. Rough�tieating & Air Cond�oning FIRE DEPT. REQUIREMENT
�20. Rough Factory Fireplace �� APPROVALS Permit#
21�. Ducts„in,Struaure� _� ,. ^ 70. Underground Hydro �
22. Ducts� Ventilating V � 7.7'.� Product Piping � Gas ❑ Oil �
r
. 23lGas Pipe-Rough &�Test A• �� 72. Underground Flush
r':
24. Roof FJaming ('� ! � 73. Undergrnd. Storage Tank O Gas ❑ Oil -
25. Roof' _eathingi � . � B'(� 74. Overhead Hydro 1
26, T-Bar Ceiling (Structural) (&jMonocoat ��, 75. Dry Chemical
n,
27. Fr�me and Ftashing �� ' p 76. Dry Standpipe
� 28. Lathing & Siding �� 8 � 77. FIXED SYSTEM FINAL
29. Insti�ation 7�' 78. FIRE PREV. FINAL
�30. ��wall Nailing � . � $' �jA" HEALTH DEPT. REQUIREMENT -
^31) �latxe'r Brown Codt�/ - � L q � 79. FINAL INSPECTION '
32. Electrical Power'Meier-Final 80. FOOD CERTIFICATE ISSUED
,.
33. Final Electric �� � Notes: ` 1S a` .�� � p�, Q�----
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
,36. Hood or Canopy
37. Final+Factory Fireplace
38. Fnal�Plumliing�
39. Water�ServiCe-Final
40. GasService�Final'
� -
41. Solar. Domestic-Final
( 42. Backflow Preventer
43. Backflow Irrigation
44. .Landscape Irriga[ion System
45. SoundrAttenuation '
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDIMG
48. Special Requirements Completed
49! E�ectric Release to Edison
50. Gas Release to Southern California Gas
�. 51. CERTIFICATEOFOCCUPANCY
No. Date
0
�
'
AGO��eant to flll in all spaces except Ihose within heavy bortler Iines anU sign all aOVropriate tleelan[lons.
CITY OF COSTA MESA �C'qONSTRUCTION PERMIT
Project Address dg 5 �y (g�� /T 23�3 Yk �v�1�G� ?
2o!►' 2 g JS�vN S cT�ti. A C_ � 7-6 c
Appiicant's Ma;iing Atldress
Owner'sName r^AT�A "�-��/• Phone�'(�G—'Z��`,
Addre:s
Arch/Eng. License No.
Address
Contractor's NamA � L*-� G 4aT, phone k-� �;os'
Address (mailin9) -�
City License No. �1 h 33 �
LICErySED CONTRACTOR OECLARATION '
I here4y affirm that I am licensetl untler provi5ions ot Charter 9(commencing
with s¢��lon �000) oi Division 3 ot Ina usiness antl Professlons Cotle, antl
my Iicense is in tull force antl eftect.
License Class 'ce se o. r'✓
Date L/� g Signature
WORKERS' COMPENSATION DECL RATION
I hereby affirm that I have a cerHfitate of consent to self-ins or a certii cate
of Workerz' Compensation Insurance, or a certlfietl copy hereot (Section
900, �b. C.)
olicy No. �o3'a��"� 7 Compa 9--
❑ Cer�ifietl copy is nereby furnishetl.
�Cer��{iatl� pY is Tile�1�with the tlty ! in ivl an
Date \ :- ��/R X qpplitant
E%EMPTION FROM WORKERS' COMP NSATION E LAR ION
(This section neetl no[ be completetl if the permit is for one �u retl (5300) or
less).
I certify tnat in the performance of the work for which this perm�t is issuetl I
shall rlot employ any person in any manner so as to become subject to t{te
Workers' Compensation l.aws of Calitornia.
Date $igndtUfe
NOTItE: If, af[er making this Geclaration, You shoulU becoma subject to tha
Workers' Compensation orovizions of Ihe Labor Coae, you must torthwith
comply wi�h Su[h p�oviSiOns Or [his pe�mit Shall be tleCmetl revoketl.
CONSTRUCTION LENOING AGENCV
I herepy af/lrm that there iz a construction lentlin9 a9ency for Ine performance
of thm �vork for which this permit is issuetl (Section 309� Civ. C.)
Lentler's Name
Lentler's AaGress
OWNpR BUILDER DECLARATION
I hereby alfirm Lhat I am exempt from the ConVactor•s LicenSe Law (or the
folloWing reason (Section ]031.5 Business antl Protessional Cotle: Any city or
County whiclt requires a p¢rmit t0 cOnS[ruct, alt¢/. improve, tl¢moli5h o� �apol�
any struc[ure, prior to tts Issuance, also requires che applicant for such permit
to tilp a signetl statement that he/she Is licensetl pursuant to [he Provisions of
the Contractor'S Litense Law (ChaD�er 9(commencmg witn $ecUon 7000) of
D�vision 3 of lhe Business antl Professions Cotle) or that ne/she is exemot
t�+erefrom antl the ba5is for tne alle9etl ezemption. AnY ��olatlon of Section
l,5 by any applicant to� d Pe�mi[ subjects the applitanl to a clvH
Ity of not more Ihan (ive huntlretl tlollars (g500).
i, as owner of the property or my employees with wages as their sole
comp¢nsation, will tlo the work, and the StruCture is not intentletl or.oi(eretl
ror sale (Section 7044, Business anC Professional Cotle: The Contractor's
Licens¢ l.aw Ooes not apP�Y to an owner of a property who builtlz or improves
thereon, antl who tloes such work himself/herself or through his or her own
emplvyees, provitletl thal such improvements ara not intentlatl or ofteretl for
sale. �f, however, Ihe builtling or improvement is soltl within one year ot com-
pletion, tne owner will have the burCen ot proving he/she tlitl not builtl or Im-
prav4 torthe purpose of sale).
❑�, as owner of the property, am exclusively contractin9 wlth Iicensetl con-
t�aclbr5 t0 const�utt tM1e pro�ect f5ection �064, eusiness antl Protessions Cotle:
The ConVactor's �icense Ldw dces nOt aOP�Y [o dn owner of property who
builtls or improves thereon. antl who convacts tor such oroiects with a wn-
tractvr(s1 I�cense pursuane m[ne ConVactor�s Li<ense L.aw). I am aware that
prooF o( their Wo�ker's Compensatlon Insu�anCe shoultl bu p�ovitletl to me.
❑'I em ozempt untler Section B. & P. C. tor Ihis reason
Date Owner
I ner¢by certlty that I have rea�
IniorMatlon �s co ect. I agree to
antl Ytate laws r ting to buil ir
sentatives O t ci(,/[ e r
Inspe�tion p e
Signdture
Driv@rs' Licen or 55 $ �•.
0865-q6, rev. 5/88
vrvi i rv�. A.P. qW �
B— �C 8 5 � `J�S ,pn'LC�
S Main Build'�
TYPE OF CONS7RUC710N NEW ADD ALTERATION REPAIR E
❑ CONVERSION ❑ DEMOLISH ❑ OTHER T FfOnt
DESCRIPTION OF WORK/USE OF BLDG. A Rear
TYPE OF PERMIT G12ADING FOUNDATION STRUCTURAL Ii C Ri
❑ TENANT O EIECTRICAL ❑ PLVMBING ❑ MECHANICAL g� Left
❑ �OTHER Ping. Ref. #
PROJECT DESCRIPTION 5�. F7. oCCUaANCv Planning Notes:
CONSTRUCTIONTVPE VALUATIONS �
ZONE GRADING CU.1'D5. ACRES
Remarks: � .i1 � �% � � �� ��
Bar Sink
Backflow Preventer
8ackflow Irrigation
8athtubs
Clarifiers
Dishwasher
Drinking Founteins
Flpor Dreins
Floor Sinks
Gas Service Outlets
Inrerceptors
Kitchen Sink
Lavatories
Roof Drains
Reinspection Fee'
Service Sink
Sewer Cap
Sewer Connection
Solar Collecmrs
$olar Piping
Solar Tank
Swimming Pool w/Spa
Urinal •
water Closet
Water Heater
Water Service
Auto-Wash
Laundry Treys
$15 Iwue Fee
Duct - Under Graund
Duct - Structural
Duct - Venfilating
Exhaust System ❑ Multiple ❑
Firepl/Fact Blt. iC80 d`-
Heating System & Ducting
❑o-i oo,000 eru O t oo,000 sr
Reinspection Fee � 515
White - Builtling; Canary - APPllcant; Pink - Accountin9; Goltlenrotl - Assessor
Hood or Typel ❑
Canopy Typell ❑
Refrigeration System
❑o-ioo,000eTu ❑�oo,000
System Repair/qlteration
Fire Dampers
Registers
laue Fee
—aC¢ I — Za^a
Accessory Building:
_ � � �
s��:�
FEES Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Parking Req./Provided ��
ELECTRICAL
Transformer ❑ 15-50 KW
❑ SO+KW
Meter ❑up [0 100 amps
Meter �over 1008Tp5-
Fan
F.A,U.
Fixtures
Device Boxes
Ouclecs
Switches
-' Garbage Disposal
• Generator �a5 KW 05-75 KW
�'� Reinspeaion Fee $15 �i
$ 3 DEVELOPMENTSERVICESREQUI
Zoning Approved By
FEES Building ApOroved 8y �7
Application I�sued By�_`
aa
Sub Panel � . �
Momrs�0.1 HP'�1X-8
Inc, Solar �9-75 HP 016-15+
Microwave ��
Pole Light �
Ra�ge
Sign
Standing Sections
Trash Compactor
Iszue Fae
FEES
$ 3
N
I
N
G
R
E
Q
M
T
$.
SUMMAFiY pF�EES ro
. BUIL�ING PERMIT $ 1•�-� � SMIP g-____��
PLAN CHECK S I� r� `
�'� ISSUANCE $
, PLUMBING $
PLAN CHECK 25% $ ENERGV P.C. $
� ELECTRICAL $ GRADING $
� � PLAN CHECK 50% $ MICROFILM $ �
MECHANICAL $ 70TAL FEE $ ��
PLAN CHECK 25% $ _
oi 000zzass-000zxsa7 r�ir 3;,?s
DAiE: I2114/83 TIflE: lb:i3
CONSTRUCTION AND PLANNING - t' POOL' `A
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 � f'- '�
. 3.�,EIecErical Conduit Utility-Undrgrhd� �'i �i 54. Forms ,;
,,
4'. �Electr,ical Conduit-Undr md. �� � "
g �, 55. Electrical Bonding
5. ;Steel Reinforcement i�� "� 56. Rough Plumbing & Pressure Test .. -`' �� ,�
6� Elect�icalUFERGrnd1' �1j 57. APPROVALTOCOVER-GUNITE ���:
7. F.00tings J S�L �';� (p Z�,� 58. Electrical Conduit-Undrgrnd. '
8. �Fbundation „ � �� ��i 59. Gas Pipe, 0 Undrgrnd., Test
i ' �
9. Water Pipe-Undrgrnd. � � ' 60. Backwash Lines, P-Trap, O Undrgrnd.
,: i
�.
10.;�Structural Floor System -`� � _�r..�. 61. APPROVALTO DECK i
11.�•Property Sewer Line & House Corinection ,.��� , 62. Backwash & Receptor-Final �
i�
12nSewer Cap ^ (, ' ' � � 63. Heater & Vent-Final ' � ,
w , �:
13,iRoof'Prains � � �� ' � 64. Plumbing System - Final - �
1,4.,Rough Plumbing�� /�•-� ' j 65. Electrical-Final .(
15. Roufjh Electrical-'Conduit � 66. Solar System-Final
161 Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
�i
18: RoughElectrical-TBarCeiling 69. POOL/SPASYSTEMSFINAL
19�. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20' Rough Factory Fireplace APPROVALS Permit#
i
27. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil
23. Gas Pipe-Rough & Test ', . 72. Underground Flush
24� Roof Framing ��,� 73. Undergrnd.Storage Tank O Gas ❑ Oil
25. Roof Sheathing . 74. Overhead Hydro
26. T-Bar Ceiling (Structural) &�Monocoat 75. Dry Chemical
�� .
27. Frame and Flashing i� 76. Dry Standpipe ,
28. Lathing & Siding 77. FIXED SYSTEM FINAL �
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailin9 HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat �" ' 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric '' Notes:
34. Final Heating & Air Conditioning 7� Z �� � ��t� ,
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final P{umbing �
39. Water Service-Final '
40. Gas Service-Final
41. Solar pomestic-Final �
42. Backflow Preventer � � •
43. Backflow Irrigation �
44. Landscape Irrigation System ••
45. Sound P,ttenuation
46. Handicap Regulations '
47. FINAL STRUCTURE & BUILDING �
48. Special Requirements ComP�eted
49. Electric Release to Edison i
50. Gas Release to Southern California Gas Co � ,�
51. CERTIFICATE OF OCCUPANCY ' I •
No. Date � �
Applicanl to fili in all svaces exeeot those within heavy bortler Ilnes ana si9n all aporooriate aeelaralions.
.:ITY OF �OSTr�M SA CON R,IjCTION P/EHMI I ' """' ""' "'"'"' "" -- � ---� "'""
Project Address � � �� � _ � ��M � � �� 0 - .
Applicanl's Mailing AddiC3s TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAI R
� • � ❑ CONVERSION ❑ DEMOLISH ❑ OTHER
Owner's Name Phone DESCRIPTION OF WOFK/USE OF BLDG.
Address
� Arch/Eng. LiCenu NO. TVPE OF PERMIT GRADING FOUNDATION STRVCTURAL
Addfe55 ❑ TENANT ❑ ELECTRIGAL PLUMBING ❑ MECHANICAL
COntracto�'SNam �y ��� Ph� n`f��`�� �� �'OTHER
Addreu (mA �'�g! ��� � �'G CS(a %�O.1J7 /( /L/)iCJ PROJECT DESCRIPTION SQ. FT. OCCUaANCv
�/ C O N ST RUCTI ON TV PE V ALUATION $
City LicenSe NO. 'r�� ZONE GRADINCa CU. VDS. ACRES
LICENSED CONTRACTOR DECLARATION
I hereby atfi�m that I am Iicensetl untle� provi5lon5 of Charte� 9(commencing
with secllon 7000) of DIVI51on 3 ot Ihe BuSin¢55 antl Pr0(essions Gotle, antl
my license Is in (ull (orce antl eff �t.
License�� a�s y� License
�Da[e1L^ L'P..� Si9nature
WORI(ERS'COMPENSATION DECLARATION
I hereby af(Ilm thdt I hdve a ceftlficate ot con5ent t0 Sel!-In5u1e Or d C¢rtlflCdt¢
� of Workers' CompensaUon Insurance, or a certi(letl copy thereot (Sectlon
3800, Lab. C.�, y n ' y = L
�Policy N4 �5����` Comoany
8 Cerfifietl copy is hereby fumishea. •
Gert�ttltqpy��led with tne city Bui ' 9 ivislo �
Date 7 APPlicant
EXEMPTION F�ROM WORKERS' COMPENSATION ECL TION
(Tnis section neetl not be completetl it thG permlt Is f, r onG ntlretl (5300) or
less).
I[¢rtify [hat im [he pertormance ot lhe wOrk f0/ which thii p¢rmR is IsSUeU, I
shall not employ. any person in any manner so as.to Decome subject to lhe
Workers' Compensation Laws of California.
Date "�� Si9nature
NOTICE: If, after making this tleclaration, you shoultl become subject to the
Workers' Compensation provisionz ot the Labor Cotle, you mu5t torthwl[h
compty with sucn provisions or thls permlt shall be tleemetl revokeC.
CONSTRUCTION LENDING AGENCV
I hereby altirm tnat lhere ii a conztruction lentling agency for the pertormance
ot the work for whi<h this permit is issuetl (Se<tion 3097 Civ. C.)
lentler's Name
Lentler's Atlaresz
OWNER BUILDER DECLARATION
1 hereby aHirm.lhat I am exemp[ hom the Contractor's Litense L.aw for the
iollowing rcason (Section 7031.5 Business anU ProteSsional COCe: Any city or
county whlcn r¢quires a permit to con5truct, alter, improve, tlemolish or repdir
any sVucture, prior to its issuance, dl5o require5 the applicant fOr such parmit
to file d signetl statem¢nl Ihat he/Sh¢ is IlcenS¢tl pursuant to the provi5iOn5 of
tne Contractor's Licenie Law (Chapter 9(commencin9 with Section 7000) of
Division 3 of the BuSinesS antl Professlonz Cotle) or Ihdt he/she i5 ¢xempt
iherelrom antl tne basis for the allegetl exemption. Any vlolation of Sectlon
'03L5 by any applicant for a parmit subjecls the applican[ [o a civil
ialty ot n0[ more than five huntlretl t1011ars (E500).
. I, as owner oi the properry or my employees with wages as their sole
compensalion, will do the work, antl the StNcture i5 not Intentletl or.offeretl
for wle (Section 7044, Business antl Protessional Cotle: The Contractor's
LicenSe Law tloes nOt apO�Y �o an own¢� of d p/ope�ty who bulltls or imp�ovez
lhereon, an0 who anes such wo�k hlTself/herself o� through his or he� own
employee5, Ptovitletl that SUGh imprOVCmentS ate not int¢ntl¢tl o� offetetl fOt
sale. It, however, the builUing or improvement Is soltl witnin one year o( <om-
pletion, the owner will have the burtlen of provin9 he/she ditl not builtl or Im-
prove forthc Ourpose of sale).
❑ I, as own¢r of Ihe properry, am ¢xcluSlvely mntractlng with II<ensetl COn-
Vactors to cons(ruct the project (Section 7044. Business antl Profezsions COUe:
The Coniractor's License Law does not aPpty to an owner ot property who
�uiltls or imp�oves the�eon. antl who cont�atts fo� Such orOi¢cts witn a ton-
tractor(s1 license pursuant to me Contractor•5 License Law). I am aware tbat
proof of [heir Worker'S COTpensatlon insurance snoultl be provltletl �to me.
❑ I am exempt untler Sectlon B. & P. C. for thls reason
Date
Signature /���!'�
Orivers' License or 55 °
_ Owner
have r tl Ihis applitation antl state that the above
agre o comply with all city antl county ortlinances
o tling constructlon,antl hereby authonze repre-
t en er upon the above-mentionetl property for
. .Qr)
Date
Remark5:
Sink
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks
Gas Servic.e Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fee � $15
Boiler
Duct = Under Ground
Dyct - Structural
1
Duct- Ventilaling
Exhaust System ❑ Multiple ❑
Firepl/FacL BI[. iC60 dk
Heating SyStem & Ducting
❑ O7 00,000 BTU � 100,000 BT�
Reinspection Fee � $15
0865-46, rev. 5/88 White - Builtlin9; Canary - APPlicant; Pink - Accounting; Goltlenrotl - Aszessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecrors
Solar Piping
Solar Tank
Swimmin9 Pool w/Spa
Urinal
Water Closet �
Water Heater
Water Service
Auto-Wash
Isue Fee
Hood or Typel ❑
Canopy Type I I ❑
Fefrigeration Sys[em `
❑a100,0006TU ❑100,OOOE
System Repair/Alteration
Fire Oampers
Registers
laue Fee
A.P. �W
S Main Building:
E
T Front
A Rear .
C Right
K
g Left
Ping. Fief. #
Planninn Notes:
FEES P.utomatic Washer
N ConstructionPoleS
Cooking Unit
Dishurasher
t N Dryers ❑Gas �EI
Fan
� F.A.U.
Fixtures
Device Boxes
Ouclecs
� Swi[ch¢5
Gerbage Disposal
� A , . Generator �0.5 KW
5KW
Accessory
/Provided
2one
ELECTRICAL
Transfarmer ❑ 15-50 KW
❑ 50+KW
Meter Llup to 100 amps
Meter �over 100 amps
Sub Panel
Motors �0.1 HP 01'f. - 8
Inc.Solar �9-75 HP �16-15+
Microwave
Pole Light
Range
Standing Sectiom
Trash Compactor
P'
Reinspection Fee $15 laue Fea
� DEVELOPMENTSEHVICESREQUIREMENTS:
a 3 Zoning Approved By Date
FEES Building Approved By Date
Applintion laued By Data
' SUMMANV OF FEES
.' �BUILDING PERMIT $ SMIP $
`,I jPLAN CHECK $ ��r� PERMI7
� �PLUMBING $ _�Vl�� ISSUANCE $
: PLAN CHECK 25% $ ENERGV P.C. $
�� r � ELECTRICAL $ GRADING $
' • J� MICROFILM $
�" , .PLAN CHECK 50% $
. ..MECHANICAL $ TOTALFEE $
� PLAN CHECK 25% $ __
�j -
_ a a .
01 O�O1S076-OU014076 Y'OT
DATE: 1II09/88 TIME: 10:s3
N
I
N
G
R
E
U
M
T
S.
FEES
$ 3
taa.ao
. . I . .. . . ' . �1.. . " . .. . ♦ r� • „ � , e4.. . • r..�- �. _
- rv.n - . . A. � -
. E�„ _ � - -
.J " �
' CONSTRUCTION AND PLANNWG � POOL ( J � " , -
APPROVALS Permit # Date Inspector p�ppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. �; ,ZF�Z:�(� L� 53. Steel Reinforcement � _ �
3.�Electrical Condui, Utility-Undrgrnd. �, I .� 54. Forms -� ,'
4.; Electrical Conduit-Undrgmd. �' 55. Electrical Bonding � y
5.,Steel Reinforcement r� _ �' � 56. Rough Plumbing & Pressure Test ",�
5. Electrical UFER�G"rnd( ��� � 57. APPROVAL TO COVER-GUNITE �
1 A r �
�n
7.��Footings r' � . 58. Electrical Conduit-Undrgrnd.
i
�8. �Foundation ;' r) - � _� �'� 59. Gas Pipe, O Undrgrnd., Test ' °
9! IWater Pipe-Undrgmd. i '�- a, �y f' 60. Backwash Lines, P-7rap, O Undrgrnd. �;�
/.� / �
10� Structural Floor SVstem ;' �;�;� •��, , ' 61. APPROVAL TO DECK �"
11. Property Sewer Line'& House Corinection �,' '�, �: '
� . , . 62. Backwash & Receptor-Final
12. �Sewer Cap „i' � . �!, ' � 63. Heater & Vent-Final . � '
e
13, Roof Drains ;� ; � � � � 64. Plumbing SYstem - Final .�,
14. Rough Plumbing, , ' , 65..Electrical-Final
75. Rougli Electrical�-Conduit A 66. Solar System-Final �
'•16. Rough Electric Wiring � �67. Fencing & Access Approval ��
'17. Rough Wiring Sign � � � 68. APPROVED FOR PLASTERING �
18. Rough Elearical-T Bar CeiliFn� 69. POOL/SPA SYSTEMS fINAL .
19.� Rougfi Heating & Air Conditioning ' FIRE DEPT. REQUIREMENT �
2D. 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 �S . 77, ,Underground Flush . �
24. Roof Framing 73. Undergrnd.StorageTank �Gas ❑Oil
25. Roof Sheathing , _ .,, ._ , 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical �
27. Frame and� Flashing ' 76. Dry Standpipe
28. Lathing&Siding - � .77. FIXED SYSTEM FINAL �
i
29.'Insulation ' - .. 78. FIRE PREV. FINAL
30. Drywall Nailing ' � HEALTH DEPT. REQUIREMENT �
31; Plaster Brown Coat 79. FINAL INSPECTION '
32. Electrical Power Meter-Final �,.. ��: 80!:F.00D�CERTIFICATE ISSUED
33. Final Electric �' � Notes: � :�� �9 D `
34. Final Heating & Air Conditioning y r a� �
35. Final Gas Pipe-Test �� � O TT
�
. 36. Hood or Canopy .
i ✓�
� 37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final .
40. Gas Service-Final ' "��'
41. Solar pomestic-Final
42. Backflow Preventer � - � � �
43. Backflow Irrigation ' '��
44. ,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 ' f- • i
51. CERTIFICATE OF OCCUPANCY � ' � � � r
No. Date ' �^, . -'
� I
Applieanl to Iill in all spaees except thora wit�in heavy borExr Iines a�C slgn all 3pp�00/�dta Eetlara�ions.
CiTY OF COSTA ryiE�� COT�S ST CTIOpI.P�RMI� ��
Proje�_ddre�,s -b85 � $ K /61d�s ,b
Appiicant'< MAiling Address �7 �� ��:�1.101J%0: ��
Owner's Name 5'A7�A ����P �'%1'CoR�- phone
Address ���p�e'��2 DO�IJE �/ 80 ,,(iGN.��
Arch/Eng. License No.
Address
Contractor's Name �G �IC /3JR D� �GIJ Phone ���
Addresslmailin9l 176�E�Q)!/��jEJQ �Q-j,� �i �%2705
City License No. ���- �o /� � s_
LICENSED CONTRACTOR DECLARATION
1 ttereby affi�m that I am licensetl untle� p�ovi5ion5 of Cha�t¢/ 9(ComminCing
with sectlon �000) of DivlSion 3 of the BuSiness antl Professions Cotle, antl
my license is in t II torce ettecL Sy � 79�
Licenie Class ��� License No.
Date'LT�-R� Si9�ature
WORKERS' COMPENSATION DECLARATION
I hereby at(irm that I have a certi(icate of consent to self-insure or a certlflcate
�f Workers' CompensatiOn Insurance, or a certlti¢tl cOpy ther¢Of ($ection
I800, Lab. C ^
aou�y No. S�Ckoo6�57cpn comaaov AEn`��
Certifiea mpy Is hereby furnishetl.
Certifietl ca Xis filetl with the <iry Builtli g D-lvis�i� n-.
Date �`�-�( AOP���dnt ��
EXEMGTION FFOM WORKERS' COMPENSATION DECLARATION
(This seclion neetl not be completetl if tne permit is for ona huntlratl (5300) or
Iess)
I certify thaf in the pe�fo�mance ot th0 wo�k f0/ which thl5 pe�mit IS IsSu¢tl I
shall not employ any person in any manner so as to become subject to t�a
Workers' Compensation Laws of Calilornia.
Da[e S�9�ature
NOTICE: If, after making thiz tleclaratlon, you 5hou10 Decome su�ject to the
Workers' Compensation provisions oi [he Labor Cotle, you must forthwith
comply with such p�OvisiOns o� [hi5 permit shall be Aeemetl revokEtl.
CONSTRUCTION LENDING AGENCV '
1 hereby affirm tnat there is a constructlon lentlin9 agency for tne per(ormance
Of the wo�k to� which this pe�mit is i55uetl ($ection 309] Civ. C.)
Lentler's Name
Lentler's AtlOre55 �
OWNER BUILDER DECLARATION
I he�eby d(fi�m lha[ I am ¢zempt troT Ihe Cont/a[to�'s LI<Cnie l.aw fOr the
followin9 reason (Section 7031.5 BuSiness antl Professlonal Cotle: Any city or
county which �equl�es a pe�mit to COnSt�uCt, alt¢�, imprOvO, Cemoli5h o� �epdir
any sVucture, pdor to ifs issuance, also requires the applicant tor zucb parmit
, to file a zignetl statement that he/she is licensetl pursuant to lhe provisions of
��� the Contractor's Lit¢nse l.aw (CnaO�er 9.(commencing with Sec[ion 7000) of
I'Division 3 ot t�e Business an0 Pro(ess�ons Cotle) or that he/she is enempt
aretrom anE tne basis (or the allagetl exemption. Any violation of Section
31.5 by any applican[ for a permit subjects the applicant [o a civil
,�alty of not mOrG than five huntlre0 tlollars (E500).
L, I, ds owne� of tne prOpe�ty O/ my employea5 wiltt wage5 as �hel� sole
compen5ation, will tlo Ihf work, antl lhe st�uctu/e Is not Intentletl O/ offe�etl
for wle (Section 7044. Business antl Professional Cotle: The Contractor's
License Law tloes not aOP�Y ta an owner of a property who builtls or Improves
[hereon, an0 who tloes such work himselt/hersolf or through his or her own
employees, ProvitleA that sucn improvements are not intentlatl or offeretl tor
sale. It, however, <he buiitlin9 o(imorovement is soltl within one year ot <om•
pletlon, the owner will have the burtlen of proving ne/she tlitl not builtl or Im-
�rove forthe pur0ose ot saleJ.
1, as own¢r oi lhe property, am excluzively ContraCfing with Iicensetl COn-
Vactors to construct the pro�ect (Section 7044, 8usiness antl Professions Cotle:
The ContracrorY License Law tloes not apply [o an owner of property who
builtlz or improve5 thereon. antl who conttact5 �or Such oroieCts with a r.on-
tractor(sl Lcense pursuane to me ConVactor's Lic¢nse Law). I am aware that'
proof o( thei� Worker'S Compensalion in5uranc¢ should Ge P�ovitlatl to m¢.
L7 1 am exempt untler Section B. & P. C. for Nis reason
Date
I hereby certify lhat
in(ormation is correct
antl state laws relatin
sentatives ot tnis c1't
InSp¢Cfion purp se�p
Signature �•�:
�rWers' Litense or 55
0865-46, rev. 5/88
_ Owner
I have reatl [his application antl state lhat tne above
I agree to comply with all city antl county ortlinances
to D�ilA�ng conztruction, anC hereby authorize repre-
� to en[er upon the above-mentionetl property tor
Date o�'��B
.�
_ '3 74 2�
TVPE OF CONSTRUCTION LI NEW I.J ADD LI ALT RATION LI REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG. ��STfL� /p�/a,p�y,/rA� ,pl.Jp«S
TVPE OF PERMIT LJ GRADING IJ FOUNDATI N LJ STRUCTURAL
❑ TENANT ❑ ELE TRICAL ❑ PLUMBING MECHANICAL
❑�OTHER �E • ��i P''��
PROJECT DESCRIPTION St�. FT. oCCUPANCv
CONSTRUCTION TVPE VALUATION $
ZONE GRADINGCU.VDS. ACRES
Remarks: �+3 bO 4 O �C •/`�'�' 22.Ja+ P�. 2��
P. c. S 72 - 88 �.t�a�i�zs P�' .sie��rr�
Sink
Preventer
Irrigation
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks .
Gas Service
Interceptors
Kitchen Sink
Roof Drains
Reinspection Fee $15
Boiler
Duct- Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact Blt. iC60 �I`-
Heating System & Ducting
�P7 00,000 BTU � 100,000 BTi
Reinspection Fee � $15
White - Buileing; Canary - APPlitant; Pink - A<countin9: Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimmjng Pool w/Spa
Water pOu[
Water Heater
Water Service
Auto�Wesh
laue Fee
Hood or Typel ❑
Canopy Typell ❑
A.P. �
S Main Buildi
E
T Front
B Rear
A
C Right
g Left
Ping. Ref. #
Planning Notes:
Aummatic Washer
Canstruction PoleSub.
Cooking Unit
�ishwasher
Dryers ❑Ges ❑Electric
?� Fan
a � F.A.U.
'' ' Fixtures
%'.
� Device Boxes
f �Ui�C[5
$WitCh¢5
Garbage Dispoul
Generetor �0.5 KW C
Refrigeration System �
00-100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
laue Fee
Zona
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter �up to 700 amps �
Meter ❑over 100 amps
Sub Panel
Motors �0.1 HP OtY,-8
Inc. Solar �9-15 HP �16-15+
Microwave
Pole Light
Standing Settions
5-15 KW Trash Compactor
Rainspeaion Fae $15 Issue Fee
$ 3 DEVELOPMENTSERVICESRE�UIREMENTS:
2oning APOroved By
FEES BuildinB APProved By -(�—{
APolication Issued Bv_�.�J �
SUMMAqV OF �
BUILDING PERMIT $
PLAN CHECK '$
PLUMBING $
PLAN CHECK 25% $
ELECTRICAL 5
PLAN CHECK 50% $
MECHANICAL $ IOS 00
PLAN CHECK 25% $ .
O
N
I
N
G
R
E
Q
M
T
S.
FEES
$ 3
SMIP $
PERMIT
ISSUANCE $ ,
ENERGV P.C. $
GRADING $
MICROFILM $
TOTALFEE $. /�S a%
D1 �1t�42bOfiS-G00260E9 TOi 105.�G
D�1TE: 02/G4/39 TTIYE: l3;51
CONSTRUCTION AN� PLANNING `-� POOL 'A
�PROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole . 52. Pool & Equipment Location
�
2. �� il Pipe-Undrgrnd. ' i � 53. Steel ReinforcemeM �,
3�Electrical Conduit Utility-Undrgmd. 54. Forms ', ,
4� Electrical Conduit-Undfgrnd. -• 55. Electrical Bonding
5.�•Steel �Re �nforcement��i� _ 56. Rough Plumbing & Pressure Test
' ;6. Elgctrical UFER'Grrid,-'� .� : 57. APPROVALTOCOVER-GUNITE
'f 7. Footings� j-� �- --� � 58. Electrical ConduirUndrgmd. �
8. Foundation ;,� '� 59. Gas Pipe, O Undrgrnd., Test
9i. Water Pipe-Undrgmd. !' . 60. Backwash Lines, P-Trap, O Undrgrnd.
10:,Str�uctural Floor SysSerii, - 61. APPROVAL TO DECK
11 � Prqperty'Sewer Line�&;House Connection 62. Backwash & Receptor-Final
r
1�.,�Sewer Cap �� ���� 63. Heater & Vent-Final
1�3='Roof Dr2in5 • �� 64. Plumbing SYstem - Final
14!�Rough Pfumbing • 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
i6; Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling;j 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Condition`ng FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace -��� . APPROVALS Permit #
2,7. Ducts, iniStructure ' �
_ � 70. Underground Hydro
22. Ducts, Ventilafing :� 71. .Product Piping � Gas ❑ Oil
' 23. Gas Pipe:Rough & Test ,.-�. 72. �Underground Flush
�^ 24. Roof Framing � � %� ,�, 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof �heathing _i �r �;y 74. Overhead Hydro
<i
� 26. T-Bar Ceiling (Structural) &�Monocoat 75. Dry Chemical
:.
� 27. Frame;arid Ft�ashing �' �� 76. Dry Standpipe
28. Lathing �& Siding} t/; ��? 77. FIXED SYSTEM FINAL
i
29. Insulation �� n; 78. FIRE PREV. FINAL
30! Drywall Nailing i), � HEALTH DEPT. REQUIREMENT
�% l�
31� Plaster Brown Coat . 79. FINAL INSPECTION
+�312� Electrical Power Meter-Fina�'' � 80. FOOD CERTIFICATE ISSUED i� �: �
33. Final Electric �;', �j Notes: w G
34. Final Heating & Air Conditioning _2 �i9
-r /
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace -
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final '� °
�
41. Solar pomestic-Final � j
42. Backflow Preventer �.� . ;J
. ��
43. Backflow Irrigation � ' �
44. �Landscape Irrigation System .J�7 ��
. ; 'v
45. Sound Attenuation � . -' j;�j
46. Handicap Regulations �
:�
47. FINALSTRUCTURE&BUILDING �
48. Special Requirements Completed
49. Electric Release to Ediso� '^�
. 50. Gas Release to Southern California Gas Co i' �
i
57. CERTIFICATE OF OCCUPANCY � � '
-�
No. Date %'� '1
ADO���ant to fill in all spaees excapt t�ose wtihin heavY �ortler Iines anC sign all appropriate Geclaratians.
CITV OF COSTA M€�i`� yQNS�y�yyT�yN P�gf1M�T[ ocannir n�n TRGf`T N(1 LnT N(] iiniir nin
Project Address �n�L�l��i4Wj Sr%/e1 �L/�S% ( nc�•r� _
Applicant's Meiling Addrefs
Owner's Name Phone
Address
Arch/Eng. License No.
Address
Contracto 's Name � � �� P oLn'e '
Addresslma'I'ng1�7��� ��'/!�!/,� %i�M7Q �%Q5
Ciry License No. � � � �' d�S�
LICENSED CONTRACTOR DECLARATION
I h¢r¢Dy aftirm Ihdt 1 am Ilcensetl untlar provl510n5 Ot Chartar 9(commencin9
with 5¢ctiOn 7000) of �IvislOn 3 OI the Bu Ine52 antl PrOtlSSIOf15 COtlB, dntl
my Ilcense is in tull lorc antl el(e Z�/� 7�
� v � �
license7[ s� � QFans
Datell Cianafivw /�/X U� —_
WOR RS' COMPENSATION DE RAy ON
1 hereby affirm tnat I nave a certiti ate o/ c6nsent to salHnsura or a terti(Itate
' of Workers' Compensa[ion Insuranca, or a certit eG copy the eo/ (Sectlon
3800, Lab. C ` /�L
Policy No. '�«��%� ����� Company " ✓
�Certilietl copy is hereDy furnishetl. �
CerY �e -letl wrth the city B Iitlin ion �
Date APplicant
EXEMP ION FROM WORKERS' CO PENS TION DECLARATION
(Thi55¢c[Ion neetl nOl ba <Ompletetl lhe p mit IS /Or OnG huntlred (E300) o�
less�.
1 certify that in the performance oi t�e work for whith this perm�t Is issuatl 1
shall not employ any person In any manner so as to become subject to t�e
Workerz' ComOansatiOn Laws of Cali(ornia.
Date Si9nature
NOTICE: If, after makin9 this tleclaratlon, you shoula �ecome subjatt to the
Workers' Compensation provisions ot the Labor Cotle, you must (orlhwith
compty with such provisions or this permit snall ba tleemetl revoke0.
CONSTRUCTION LENDING AGENCV
I hereby alfirm inal Ihero is a construttlon IenEing agency !or the Oerformance
ot thG wolk fOI wllich It115 OGrmit IS Isiuetl ($BCtIOn 3097 Clv. C.)
l.entler's Name
�entler's AtlEress
OWNER BUILDER DECLARATION
1 hereby aftirm Ihat I am exempl lrom the Contractor's Licensn I..aw for the
following reason (Seclion 7031.5 Buslness antl Prolessional Cotle: Any cily or
tounlv whlch rOqUi�eS a pefmit t0 cOnsllutt, all0f, ImprOve, Eemoll5h Of fepolr
nally of not more [han five'huntlratl tlollars (E500).
.� I, as owner.o/ the property or my omployees with wa9es as thelr sole
compensation, will tlo t�e.work, antl the ztruttura is nol Intentlotl or otleratl
1or sale (Settion 7044, Business antl Profe55ional Cotla: Tha Contra<tor's
License Law tloes not apply to an owner of a property who builtls or improvos
th¢reon, antl who tloes sucn work nimsalf/lienelt or [hrOugn his or her own
employecs, O�ovitletl that such improvements are not Intentletl or otlaretl for
sdle. I1, howevor, the bulltling or Improvoment is soltl withln one yaar oi com•
pletion, tne owner will nave the burtlen of Proving ho/sno tlitl not builtl or Im-
�rove Por lM1e purpose o1 salo).
I, az_owner..oL.the.property, am excluslvoly contracUng with Ilcensatl ton-
tractors to constru<t the pro7ect'(5¢ction 7044, Businass antl Professions Cotle:
The Contractor's License law does nOt apply to dn owner of proparty who
builtls or improves thereon, antl who contracts �or such orolects wltn a con-
tractor(s) Lcense purtuant to [ne Con[ractor•s License Law),I am aware that
proo/ 01 thelr WOrker'z COTPenSaliOn InSurance zhoultl be provltletl lo me.
❑ I am exempt untler Section B. S P. C. for Ihls reason
Date ' Owner
1 hereby certify [hat I have reatl tnls applicatlon antl state that the above
information is correcL I agree to comO�Y N'��h all <tty antl county ortlinances
an0 s[a[e laws rel ting to b Itling <onztruc[ion, antl.hereby au[hoNze repre-
sentatives of in' city LC� nter po lh�e bove-ml entione0 �pJroperty for
inspection pu �r ��[�� "A�,.. � Date ✓�
'Signature � �`��v
Drivers' LiceMe or
0865-46, rev. 5/88
3 7 2
� OFCONSTRUCTION NEW ADD ALTERATION REPAIR
� CONVERSION ❑ DE LISH ❑ OTHER
DESCFIPTION OF,WORK/USE OP BLDG. �
TYPE OF PERMIT LJ GaAD�NG LJ FOUNDATIQN- U STRUCTUI
❑ TENANT �O ELECTRICAL ❑ PLUMBING 4i MECFIANICAL
❑ OTHER /
PROJECT DESCRIPTION So. F7. OCCVPArvCV
CONSTRUCTION TVPE VALUATION S _
ZONE GRADINGCU.YDS. ACREi
Remarki: �
P
3ar Sink
38ckflow Preventer
Sackflow Irriga`ion
9athtubs
Clarifier5 r'
Dishwesher �.
Drinking Fountains
Floor Drains�,n �
Floor Sinks
Gas Service Outlets
Imerceptors
Kitchen Sink
�.BVBtofie5
P—Trap
Roof Drains �
Reinspection Fee � $15
Boiler
Dutt - Under Ground
Duct - Structural
Duct � Ventileting
Exheust System ❑ Multiple
Firepl/Fact. Blt. IC60 #
�ting System & Ducting
0�100,000 BTU 0100,000
Reinspection Fee � $15
White - Bulltling; Canary - ApPlicant; Pink - Accounting; Goltlenrotl - ASsestor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecmrs
�61ar Tank
Swimming Pool w/Spa
Urinal
Wa[er Closet
Water Heater
Water Service
Auto-Wash
laue Fee
Hood or Typel ❑
Canopy Typell ❑
Refrigeretion System
❑o-ioo,000eru ❑ioo,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
N.r. �
S Main Buildi
E
T Front
B Rear
A
C Pi9ht
K Lett
s
Ping. Ref. sW
Planning Notes:
FEES P.utomatic Washer
Canstruction Pole Sub.
Cooking Unit
Dishwasher
` Dryers �Gas ❑Elec�
Fan
F.A.U.
Fixtures '
,`"< Device Boxes
�
Outlets
Switches
Garbage DiSposal
Generator �0.5 KW [
Fea
2one
ELECTRICAL
Transformer � 15-50KW
O 50+ KW
Meter �u o 100amps
Met over 100 amps
ub Panel
Motors ❑0�1 HP O1 h- 6
Int.Solar �9�15 HP 016-15+
Microwave
Pole Light
Stendinq
5 KW Trash Co
$15 luue Feo
$ 3 DEVELOPMENTSERVICESREQUIREMENTS:
Zoninp Approved By
FEES Building Approved By
� Application Issuad Bv '
SUMMARV O�
BUILDING PEFiMIT $
PLAN CHECK $
PLUMBING $
PLAN CHECK 25% $
ELECTRICAL $
PLAN CHECK 50% $ ��—
MECHANICAL $ �_ •�
PLAN CHECK 25% $ __ _ .
N
I
N
G
R
E
d
M
T
S.
FEES
$ 3
SMIP $
PERMIT
ISSUANCE $
ENERGV P.C. $
GRADING $
MICROFILM $
TOTALFEE $ �s��
ez aao29a?s-nnaz9a?s �e�-e =t.n�
DATE: Oa'!29/S9 TIfiE: 15:57
. •.. \\ '�\ , _ , . •
CONSTRUCTION AND PLANNING � . ��� 'A
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-Undigrnd. • 55. Electrical Bonding '
5. Steel Reinforcement t.� . 56. Rough Plumbing & Pressure Test �
6. ElectricalUFER�Grnd�:� 57. APPROVALTOCOVER-GUNITE '
7:,Footings � � 58. Electrical Conduit-Undrgrnd. '
� 8. 'Foundation . � � , 59. Gas Pipe, O Undrgrnd., Test ,,
9. Water Pipe-Undrgrnd.. , 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System � 61. APPROVAL TO DECK
11. Property Sewer Line�& House Connection 62. Backwash & Receptor-Final
12.. Sewer Cap ; . . 63. Heater & Vent-Final
13. Roof Drains ,� �' 64. Plumbing System - Final
14. RoughPlumbing, 65. Electrical-Final �,
15. Rough Electrical-Conduit 66. Solar System-Final
•1;6� Rough Electric Wiring , 67. Fencing & Access Approval '
� 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
�.•
�19. Rough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT
�.:
20, Rough Factory Fireplace ' APPROVALS Permit#
21�. Ducts, in Structure 70.� Underground Hydro
22. Ducts, Ventilating 7•1. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test . � 72. Underground Flush
24. Roof Framing � 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
3Z. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED t` � "A
fJi
33. Final Electric Notes: � � �
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final �
i /J
40. GasService-Final / `� �
41. Solar pomestic-Final �
/ l'" . �
/ /J .\
42. Backflow Preventer � •� � .
43. Backflow Irriga[ion / '� ��
44. Landscape Irrigation System ' � ' �'
45. Sound Attenuation � j�
46. Handicap Regulations ;
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison ''
r.
50. Gas Release to Southern California Gas Co � -�
51. CERTIFICATE OF OCCUPANCY � - �
�
No. Date � �
1
_... .. . APPlicanl to fill In ali ipaees except t�osa wil�in �eavy Uo�Eer lines anG sign all apo�ovriate Oeclantioas.
CiTY oF cOS7n'MESA CONSTRUCTION PERMIT
ProjcctAddress Ess i8L-h sL. #s
Applicant's Mailing Address
Ow�er'sName SATR�� DEVELOPMENT ahone
Address
Arch/Eng. License No.
Address
Contractor'sNamB�"i¢ O F.1 .- i. Phone549-597�
Addreulmailing) 4� S. fail �� W� R�1] a Ana
City License No. � 271 9$
LICENSED CONTRACTOR DECLARATION
I bereby allirm Uat I am Iicensetl untler provizlons al Charter 9(commenUng
with section 7000) of DivisiOn 3 ot the B Pr tes5ion5 Coae, antl
my qc¢nze is in lull force an eH cl �
Licens'e Ctass — 33�39 �3 �+cn9tg iv C-7 0
Datd —1� Si9nature /'���M
WORKERS' COMGENSATION DECLARATION
1 hereby affirm lhat I have a cerHllcate o( consent t selLinsure or a tertiticate
ol Wotkers' ComOensalion Insurdnce, ot a certlfl<tl cOPY thareof (S¢ctiOn
3800, Lab�+.
PoIIGy NOr�� �71�- �-088 Company a7 i f 9C ]a1{'V
�Certitietl coOY �S h¢reby fumishetl. �
Cert"�(i cQpy iia i tl with the city H 1 g D z i
Date 1 �-1 `}' V � APPlicant
�EXEMPTION FROM WORKERS' COMPENSATION ECIARATION
(Thib section neetl not be compleletl if Ine p¢�mlt I5 f r one huntlratl (5100) or
less),
I cer(7(y tnal in thG pe�formdnce O( the wo�k tOr whlch thls pe�m�i Iz lssuetl I
sltall not employ any person in any manner so as to become subJect to t�fe
Workers' Componsation Laws ot Calltornia.
Datq Si9nature
NOTi�E: 11, alter making thls tlaclaratlon, you 5houltl becomo sub�ect to tne
Workeri' ComPnnSalion provlslons of the Labor Cotle, you must forthwilh
comply wit� SUch proWifOns or IM1is permit sbalf b¢ deemOtl �evoked.
CONSTRUCTION LENDINC AGENCV
I ner¢by a(Iirm that tbere is a conslruction Icntling agency for the performance
o( [he work lor whicn thii Permit is issuctl (Section 309] Clv. C.)
L.entler's Name
'. Lontler's AtlEresi �
OWNER BUILDEN bECLARATION
I hgreby atfirm inat I am ezempt lrom tho Contraclor's Litanze Law tor the
followin9 �eason (Sectlon 7031.5 Bu5lness antl ProfesSlonal Cotle: Any city or
COunry wbich requires a permit lo construcl, alter, improve, demolish or repalr
any St�ucture, prb� to iti i55uante, alio �eqWreSlhe applicant t0/ suth pe�mit
lo f�ie a Si9netl statGment [hal he/sbe i5 IicPnsatl Ou�SUant [o lhe provl5ion5 Of
the Contractor's License Law (Cnapter 9(commenNng with Sectlon 7000) ot
Div{sion 3 Of tM1C Business an0 Protesvons Cotle) o� tbat he/she is eaempt
theYetrom antl the basis for the allegetl ExemOtion. Any violatlon o1 SecUon
'7031.5 by any applicant fo� a pe�mit subjects th¢ applitant to a Civil
�enalty ot no[ more tnan five huntlretl tlollars (5500).
LJ I, as owner of tne property or my empioyees with wa9es as their sole
cort�0ensatiOn, Will Oo the w0/k, antl lhe SVUCtu�e i5 not inten0etl O/ otfer¢tl
lor ule (Settion ]044, Busine55 antl Professional Cotle: Tne Con[ractor's
LJ[ppSE ldW COlS f10: dpplY IO dfl OWOe� Of 2 prOPerty WM1O bWltlS O� ITplOVGS
thcreon, antl who tloes such work h(m5¢If/h¢rzal( or througn his or �er own
employees, o�ovlEetl that sucn Improvements are not Intentletl or piferea tor
581@, It, howevar, lhe builtlipg or ImproveTent i5 soltl wl[hin one year of com-
plo�ion, [be ownor will have tba burtlen Of proving h¢/she tlltl ml bulltl or im-
Prove for Ibe pur0ose of sale),
❑ I, as owne/ oi tlta proPerty, am ezc1u51voly Cont�acting wlth Iicenzetl con-
tractors to construct the pro7ect'Se<tlon ]044, Businlsz antl Protesilons Cotle:
Tne Contractor's License Law does not apply to an owner of Vroperty who
builds or ImOroves therean, antl who contracts tor Suth Dro�etts witn a con-
trartor(s) i�cente pursuanl to tne Caniractor's �Icans¢ �yw), I am aware tnat
prqp� of thalr Worker's ComoenSaHon insuranca snoultl De provltletl to me.
❑ 1 am exempt unCer Section B. G P. C. lor lhis reason
Data
I ber¢by certify Ibat 1 ha
���Ormation is torrect. 1 ag
anq stace laws mlatin9 to
5¢ntativ¢5 of thiz city IO
Insp¢�tiOn Pur/�ps�/��� ��
Signature �L(�
Dr{�ers' Licenso or 55 � �
Ownei
upon
in antl
clry a
dn0 h�
hae tne above
ity ortlinances
rt�orize repra-
property tor
12-14-88
t.3��qo :.
TVPE OF CONSTRUCTION
❑ CONVERSION ❑ I
DESCRIPTIONOF WOR
�NEW U ADD LJ qLTERATIpN LJ REPAIR
�LISH ❑ OTHER A p #
�E OF BLDG.
ment S Main Building:
TVPE OF PERMIT LI GRAOING FOUNOATION STRUCTUIiAI � T Front
❑ TENANT �I EIECTRICAL ❑ PWMBING ❑ MECHANICAL A Rear
❑ OTHER - C Right �
PROJECT DESCRIPTION Sa. FT. OCCUaArvGv K
COIVSTRVCTIONTYVE VALVATION$ g LCft
ZONE GRAOING CV. VDS. ACRES PItIg. Rei. #
pemarks: # R'j (� (� 9 n Planning Notes:
Sink
kflow Preventer
<tlow Irrigation
Drinking Fountains
Floor Drains �
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trap
Roof Orains
Reinspection Fee � S15
Boiler
Duct-UnderGround
Duct - Structural
Duct - Ventilating
Exhaust System 0 Multiple ❑
Firepl/Fact. Bit. ICBO dk
Heating'System & Ducting
❑ a 100,000 BTU O t 00,000 8Ti
2einspec[ion Fee � $75
CMF OB65-46, rev. 30/84 Wnite - Builtling; Canary - Applican4 Plnk - Accountlbg; Goltlenrotl - Asse55or
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
$olar Piping
Solar Tank
Swimming Pool wlSpn
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Isua Foe
Hood or Typel ❑
Canopy Type I I ❑
Refrigeretion System
C]aioo.000eru ❑iooRoo
System Repair/Alteration
Fire Dampers
Registers -
Issue Fee
FEES
5 3
$ 3
Automatic Washer
Construction PoleSub.
Cooking Unit
Dishwasher
Dryers �Gas ❑Elec
Fan . '
F,A,U.
Fixtures
Device Boxes
Outlets
Switches
Garbage DiSnosal
Generator DO-5 KW �
zone
Actessory Buildin9:
ELECTRICAL .
Transformer ❑ 15-50 KW.
❑ 50+KW
Meter �lup io 100 amps
Meter ❑over 100amps
Sub Panel
Motars [10�1 HP O1 h� B
Inc.Solar 09-15 HP �16�15+
Microwave
Pole Li9ht �
Range
Standing Settion,
Trash Compactor
Q
FEES
Z
O
N
I
N
G
R
E
Q
M
T
S
' Reinspection Fae I$15 ' I Issue Fee I $�? ��
DEVELOPMENT SERVICES RE�UIREMENTS:
ZoninB APVroved By Date
Building Approved By Date
Applicatian Issued BY �� Dat�
SUMMARV OF FEES ,
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% S ENERGY P.C. $
ELECTRICAL 5 --Ls� GFADING $ '
PLANCHECK 50% S I• MICROFILM $
MECHANICAL $ TOTALFEE $ �'3
PLAN CHECK 25% $ _
: 19
CONSTRUCTION AND PLANNING � POOL & SPA
APPROVALS Permit # ''� , Date Inspector pppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Poo� & Equipment Location
2.� Soil Pipe�Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. I 54. Forms �
4. Electrical Conduit-Undrgmd. �, 55. Electrical Bonding �
5. Steel Reinforcement 56. Rough,Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVALTO COVER•GUNITE
7. Footings , r 58. Electrical ConduibUndrgrnd.
8. Foundation 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Strucwral Floor System �� 61. APPROVAL TO DECK �- � �-
11. Property Sewer Line & House Connection �' 62. Backwash & Receptor-Final
12. Sewer Cap � 63. Heater & Vent-Final
13. Roof Dreins 64. Plumbing System - Final •
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring -� � 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS�FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT •
20. Rough Factory Fireplace APPROVALS Permit # �
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24.. Roof Framing 73. Undergrnd. Storage Tank O Gas �� Oil � �
25. Roof Sheathing- . 74. Overhead Hydro �-
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry S[andpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL �'
4.�
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT •
31. Plaster Brown Coat 79. FINAL INSPECTION ` >- .
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric - � Notes: �
34. Final Heating & Air Conditioning �
35. Final Gas Pipe-Test
36. Hood or Canopy ,
37. Final Factory Fireplace � .
38. Final Plumbing . �� ' •
39. Water Service-Final � '
40. Gas Service-Final (� ; ^ , ; _
i ��
41. Solar pomestioFinal • � - - � �
. i . .
� ,
42. Backflow Preventer `U -j �
,
43. Backflow Irrigation �" ' �
/' .
44. �andscape Irrigation System �� "
4�.�Sound Attenuation
� 46. Iiandicap Regulations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Compieted �
r
49. Electric Release to Edison �
. �
50. Gas Release to Southern California Gas Co �
51. CERTIFICATE OF OCCUPANCY k
No. Date � , �
0
Applicant to fill in all spaces excepl tnose within �eavy GorEer Ilnes an0 sign all apP�oDriate tleclarations.
Ci7v OF COSTA MESA CONSTRUCTION PERMIT �
ProjectAddress �R�XR�X 685 1$t�l Street �Q�
Apo��c-, �s:1�WilingAddress 2062 Business Center Dr ll2 0�
SATRA Development " 720- n
O � s Name Phone
n�es: 180 Hewport Center Dr11180. N.B. 92660
ArcYYEng. License No.
Address
Contractor's Nama �FA Cons hone 476-3005
Address (mailing) z Z �r Dr It260. IRvine
City License No.
LICENSED CONTRACTOR DECIARATIO
I hereby altirm lhal I am licln5atl unGlr rOv IonS of Chd/ter 9(commencing
with section 7000) ot Dlvlslon 3 ot t Busl eu an �tesslons Cotle, a
my Ilcense is in (u11 torce antl etfect.
License C�l�as���� o.
Dale +�SLYLSZSl_ Signatura
WORKERS'COMPENSATION DEC R I N
. 1 hereDy atiirm Nat I nave a certHica e o1 <onSGnt to sel ure ar a certi(Itdte
of Workers' Compenvtion Insurance, or a cartifie OY thereof (Sectlon
l0. Lab. C.) " 1. �
;�r No. 1030055 com „Y State n
� �.( Certifiea copy is nereby furNshea. _.
l�i Cercitietl co yis (iletl with the cit IOin �' is
. Date 1 7 �RA APPlicant
EXEMPTION FROM WORKERS' COM TI N E LA 10
'(Tnis section neetl not be completetl ii a Oermit 6 tor one Gretl (5300) or
less).
I c¢rlily that in Ihe Oe�lormanco ot Ine work fOr whicn IhIS pe�m�t i5 (ssuetl I
shall not employ any person in any manner so as to betome sub7ect to t�a
Workers' Compansation Laws of Californla.
Da[e 5�9�ature
NOTICE: It, atter makin9 this tleclaration, you shoultl become sub7ect to the
WOrke�s' CompensdtiOn provlslon5 Oi thG Labo� Co}fe, y0u must torthwlth
comply witn such provisions or this oermit shall Do tloemetl revokotl.
CONSTRUCTION LENDING AGENCV
I hereby aflirm [hat [here is a consVuctlon lentlln9 a9ency tor the Oar(ormance
ot tbe work (or whlc� t�ii permit is Iisuetl (Section 3097 Civ. CJ
Lentler's Namo
Lentl¢r's AtltlreSs
OWNER BUILDER DECLARATION
I hereby.affirm lhat I am oxompt irom tha Contrattor's Licenso Law for tnn
following reason (Sectlon 7031.5 Business antl Professional Cotlo: Any city or
county whicn r¢qWroS a permit t0 conSbuct, alter, ImD�ove, tlemolish or repalr
any siruchro, prlor to� i[s Issuanco, also req Wrei [he apPlicant for sucb pormlt
to filo a signetl statement that he/she Is Iicenwtl pursuant to the Orovisiont ot
[he Cantractor's Ucensa Law (Cnapter 9(commencln9 witn Sectlon 7000) of
Division 3 of tbe Business antl Pro/essions Cotle) or lhat ho/sho is exemp[
[herefrom antl the basis for tno allogod exemptlon. Any violaUon of Soctlon
p;;131.5 by any applicant for a pormlt SUDjacts tna applicant lo a clvil
+..;,. �alty ot not more than live huntlratl tlollars (§500).
*��� I, as owner of [ne proparty or my amployeos wilh wages as tnelr sole
�`tompensatlon, will tlo the work, antl tna structura is not in[entletl or oHoretl
fOr sale (SecliOn 7044. Bu5lness antl ProtOsslonal COtlO: Th0 Contractor's
Litense Law tloe5 not apD�Y �o an ownor of a v�opnrry wno bultCs or Imp�oves
tnereon, antl wno �oes Sucn wOrk nimselt/nersoll or through hls or har own
employcez, proNdotl that such ImProvamenls are not InlentleC or ofteretl for
salC. It, howev¢r, th¢ bUlltling or ImProvOTent IS SOIG wlthin on0 year 01 com-
pletlon, tne owner wlll havC tno bu�tlan O� proving ne/iha UIC not builtl or im-
p/Ove forthe purposa olzala).
❑ I, as owner o1 the O�operry, am exclu5ivoty contractlng wit� Ilcensetl con-
tractors to construc[ the Oroject (SecNon 7044, Buslnoss antl Profesiloni COGa:
The Contractor's License Law does not apply to an owner of property who
builtli or Imowves lhereon. antl wbo contracts lor such oroiacts with a r.on-
tractor(s) Imense pursuan[ m me ContractoYs Lltenu Law). I am awam that
prooi o( Iheir WO�ker's Cort�pensaUon MSurance ShoWG be provltle0 to m!.
❑ I am exempt untlor SecUon B. & P. C�r this reason
Oate
I nereby certify t
iniormation is cori
dlld SLd�C IdWS lC�i
Sentativ¢5 ot [hiz
inzpection purpos4
Si9nature =
Orivers' License or
0865-46, rev. 5/88
Owner
ve rea0 this ap plication antl
rea to com^IY W� all tlry a
n�.unina m I4 uE(ion. antl h�
96y authorlie �e0r0-
ianeG Droperty (or
oace 11/7/S8
TVPE OF CONSTRUCTION L]srv[
❑ CONVERSION ❑ DEMOLISH
DESCRIPTION OF WORK/USE QF
J AOD LJ ALTERATION LJ REPAIR
OTHER
�r�.i -F'�—
TVPE OF PERMIT LJ GRADING LJ FOU DATION STRUCTURAL
❑ TENANT ❑ LECTRICAL ❑ PL MBING
❑ �OTHER �IR� tS ��
PRQIEC7 DESCRIPTION �F7.
CONSTRUCTIONTYPE � �
ZONE GRADING CU.YDS.
Remarks: �J(� J lL,�
k
Bar Sink
Backflow Preventer
Backflow Irrigation
rinking Fountains
loor Drains
loor Sinks �
as Servic.e Outlets
Kitchen Sink
Lavatories
P—Trap
Rooi Drains
Reinzpection Fee � $15
Boiler
Duct-UnderGround
Duct - Structural
Duct - Ven[ilating
Exhaust System ❑ Multiple
Firepl/Fact Blt. ICBO #
Heating System & Ducting
❑0�100,000 BTU 0100,000
Reinspection Fee � $15
Whit¢ � Bu�ry - Applicant; Plnk - Atcounting; Goltlenrotl - Assessor
PLUMBING
Showen
Service Sink
Sewer Cap
Sewer Connection� � •
Solar Collec[ors '
Solar Piping _
Solar Tank
Swimming Pool w�Spa
Urinal. •
ater Closet
Water Heater
Water Service
Auto-Wazh
laue Fee
Hood or Type I O
Canopy Type II ❑
I $ -� i�j-���'j •
AC R ES
ief ' eretion System
0.700,OOOBTU ❑100,000
System Repair/AI[eration
Fire Dampers
Registers
Isue Fee
FEES
A.P.SW �a�-
S Main Building:
T�Front 2(j
A Rear � .5
C Right i
g Lett `1
Plnq. Ref. 5W —
Planning Notes:
Auromatic Washer
Construc[ion Pole
Cooking Unit
Dishwasher
Dryers �Gas ❑
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
2one
Attessory Building:
Parkin9 Req.IProvided
ELECTRICAL
Transformer ❑ 15-50KW
- ❑ SO+KW
Dispoul
ir �0�5 KW �5-15 KW
tion Fee $15
Meter �up to 100amps
Meter �over100amps .
Sub Panel - '
Motors � 0. 7 HP � 1'h - 8
Inc. Solar �9-15 HP � 16-15+
Mitrowave '
Pole Light ��
Range
Standing Sections
Trash Compactor
luue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
S 3• Zoning�APProvedBy
FEES Building Approvad By
Application Issued By
� -.
$ 3
�• SUMMARV O� FEES�
�tiBUILDING PERMIT $ 4'r�s� SMIP $
-�PLAN CHECK $ ��� PERMIT
'-PIUMBING $ ISSUANCE $
� ENERGV P.C. $
PLAN CHECK 25% $
��ELECTRICAL $ GRADING $
. ,_PLANCHECK 50'/�$ MICROFILM $
�• MECHANICAL $� TOTAL FEE 5
PLAN CHECK 25% $ \
Ol Ofl019D18-ODQ14p?0 Te�T
ORiE: 1?/C3fEE TIfiE: 1:�:4�
O
N
I
N
G
R
E
a
M
T
S.
$ 3
527.:5
�
�`../ { �\ ,�, :.
� i �
CONSTRUC710N A�JD PLANNING : POOL A
APP,P~✓ALJ Permit # Date Inspector APPROVALS Permit # - Date Inspector
1. emporary 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 i�'�
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test '
6. Electrical UFER Grnd. /, . , � 57. APPROVALTO COVER�GUNITE '
7. Footings - � :, .-I;� 58. ElectricalConduit-Undrgrnd. �����,•''
8. Foundation �' �.' �� � 59. Gas Pipe, O Undrgrnd., Test • • -- �: •
9. Water Pi e-Undr rnd. - � �� �-
P 9 ',; 60. Backwash Lines, P-Trap, O Undrgrnd. ��
10. Structural Floor System "� '� '� ,r�p 0'�_ 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection " '' / 62. Backwash & Receptor-Final
,
18. Sewer Cap � :� �� 63. Heater & Vent-Final �
:�
13�.�Roof Drains ' ��� . ;
,,�' , 64. Plumbing System - Final
14: Rough Plumbing �. • ' 65. Electrical-Final
1. Rough Electrical-Conduit - 66. Solar System-Final
i
(,1�6t Rough E�lectric Wiring 67. Fencing & Access Approval
G17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
` 78. Rough Electricai-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
v .,
;79. Rough fieatinq_$� Air Condltioning FIRE DEPT. REQUIREMENT
�20, Rough�Fyctoryl�Fireplace � •APPROVALS Permit#
21. Ducts, in Structure V 70. Underground Hydro
22. Ducts,.Ventila�ng `� � 71. Product Piping O Gas ❑ Oil
23:�Gas Pip�-Rough &?est �., � 72, l�nderground Flush
�
24. Roof Fr�ming��.,.j . 73. Undergrnd.StorageTank OGas ❑Oil'�
25. Roo��Slieathin�l i �� (� � p'�- 74. Overhead Hydro
26. T-Bar�Ceiling (StPuctural��&'Monocoat 75. Dry Chemical
i•27. Frame and Flashing ' � 76. Dry Standpipe
�28. Lathi g& Siding- ' � �(1-� 77. FIXED SYSTEM FINAL
� r. i
29. InsUlation ;�� � � 78. FIRE PREV. FINAL
�9�. Drywall Nailirjg' y�, gf (�� HEALTH DEPT. REQUIREMENT
.39. Plast"ei Brown!'Coaz;{� 79. FINAL INSPECTION
32. Elect ical Pow2�iMeter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric�"' =�� � Notes: Gq 8y �, s�� .oK �y,�-
34. Final Heating & Air Conditioning �Q� __� P�jAj� �� ,
35. Final Gas Pipe-Test
- 36. Hood or Canopy .
37. Final. Factpry Fireplace
38. �Final Plumbing 'i''
39. Water Service-Final �,T�-
40. Gas Service-Final���c _ j
� 41. Solar pomestio-Final _ � � �y�
"�42. Backflow Prevente� � �" I,�� ,Uy•
:�
43. Backflow Irrigation � ,� ; •
44. .Landscap@ Irrigation System �� ,�i,•^ �. '�
45. Sound Attenuation . �
�
4�'�
46. Handicap Regulations •�
47. FINALSTRUCTURE&BUILDING � �i�j` `•• �
i
48.-&pecial Requirements Completed �� �(,g.(/
49. IElectric Release�to Edison � :, %
(.
.-�� V '.
� 50. Gas Release to Southern California Gas Co ' ,•j
51. CERTIFICATE OF OCCUPANCY ,' i�' � `•
No. Date " .1. �,/ • � �
�.,
ADGlicant to flll In all spaees eacept t�ose wlt�in neavy bortler linas anE sign all approprlate Geclarations.
cirY oF COS7A MESA CONST UCTION PERMIT
Praject Address �� � Vi � g���T2A511 �N«�:`' 1
` i aL Z 6K�i7trS S G^2 �.2. fs L6.s
A;Vlicam's Mailing Address
Owner'sName SAT�C1� J-�J. phone416-30�-
Addreu ��M�
Arch/Eng. License No.
Address - - --
Contracmr'sNam ALrf� GeYVS� Phoney�6-too•
Address Imailing) _
City License No. �{( 3 2} •
LICENSEU CONTRACTOR DECIARATION
1 hereby alti�m lhat I aM �j�anietl untle� prOviSlons o( Charte� 9(commencing
wlin sectlon 7000) of bivlsion 3 oi the Business antl ProteSsions Cotle, antl
my Iicense is in full /orc0 antl affact.
�.icense Giass a ce N.— 4
DateT�� ��gp$Ignalure
WORKENS' COMPENSqTION DECL RATION
I boreDy aHirm that I ha�e a tertiflcate o/ tonsenl lo sel/-1 sure or a tertifiwte
' Worke�s' Compensation Insurante, o� a cBrtlfietl coOY thereof (SOCUOn
90. Lab. C.) � (l
�IICY No. S - Z°%^4+� ComPan 10 3od �i 7—$ a
eCertified copy is nereby furnishea. �
Certifietl copy is file w�(h Ihe city � ng D IO .
�ate Applicant �
EXEMPTION FR M WbRKERS' COMFE SATION O AR ION
(This section neetl not be completetl it the ermlt I5 for one hu retl (5300) or
less�.
� 1 c¢rtlty Ihat In th¢ peryo�mdOte Ot tne wOrk f0/ whlCh thls pe�m�t IS IssUetl I
I shall not amploy any porson in any manner so as to become SuDject to t�e
Worke 5' Co e a n ws o/ California.
— Date 519naturc
NOTIGE: It, aiter aki�g this Eoclaration, you shoultl become suo7ect to lhe
I Wofket5' COmpenSdtiOn provl510n5 0/ th! LdbO! COtle, y0u Tust foltllwith
<omply with such provisions ar this permit sha11 be tleemetl r¢voketl.
CONSTRUCTION LENDING AGENCV
1 hereby aillrm thal th¢te IS d Conit�uclion lentling dgency tor the pertormdnce
of lhe work for wh��h Ihis permit is ISSUBtl ($eGtiOn 309] Civ. CJ
' Lcntler's Name
Lentler's Atltlrezz
OWNER BUILDER DECLARATION
I nereDy aHirm lhat I am exempt trom the Contractor's License Law for the
following reason (Sectlon 7031.5 Business antl Professlonal Cotle: Any <lty or
county whlch require5 a parmit t0 cOnstruct, alter, Improve, tlemolish or repalr
any structure, prior to i(s issuance, alzo requires Na aOP�icant for such permi[
lo lile d zignatl itat¢ment Ihal he/sh¢ is Ilcensetl purSUanl lo the prOvislon5 ot
the Contra<tor's License Law (Chapter 9(commenting with SecUon 7000) o!
Division 3 0/ tne Busi�oss antl Pro(ession5 COUe) or Ihal ne/5he is exempt
'herelrom ane the basis tor the alle9etl exemptlon. Any violation ot Sectlon
�31.5 by any appliCan( br a permit subjatts the applicanl to a civil
halty oi nOt mOre lhdn 11v0 nuntlr¢tl tlollars (5500).
.� I, as owner of lho proporty or my em0loyaei with wa9es as [heir solo
Compensation, will tlo (ha wo�k, antl the structure ii not I�tentleG o� oHarotl
for wlo (Section ]04y, Businoss ana Profossionai Cotle: The Contraclor'S
LlcenS¢ Law tloes nol Apply [O an Own¢r Of a OrOpefty wh0 bulltl5 Of ImprOves
t�e�eon, antl who tloe5 Tuch work him5elt/herself or thrOugh hI5 O/ her Own
am0�oyeez, pwvidetl lqat such Improvements ara not Intentletl or ottaretl for
sale. 11, however, the bulltling or Improvement is soltl within one year of com-
pleUon, tne owner wlll have the burtlen of provin9 he/she tlitl not bulltl or Im-
prove tor the purpose oi sale).
❑ 1, as owner oi tne proPerty, am exclusively contracting with Ilcensatl con-
tractors to construct the Project (Sec[lon 7044. Businesi antl Professions CoCe:
- Tne Contractor's License L.aw does nOt apply to dn Owne� of prOPerty wh0
builtls or imoroves tn@reon. antl who contracts �or such oroiec[s wlth a<on-
[rac(m�sl Lcense pursuan[ [o [ne ConVactor•s License I..aw). I am awara t�at
prOof Ol their Wotker�5 Compensatlon in5urance Shoultl ba v�ovmea io me.
❑ 1 am ezempl untler Sectlon B. d P. 0.(or this roason
Dale
I nareby certity tnat
informatlon is correcl
antl stale laws relatl
SBflldtlVlS Ot t i5 �
Inspection purp
Slgnatura N
Drivers' Llcense 55
0865-46,rev.5/80
_ Owner
I have reai
I agree to
lo bulltlir
r
tM1oriza repre•
property tor
�e�-�� 8 5 0 1�1..._. tl^I �NS CI�i�..,. A.P. �W L.I'�],L,
S Main Buildi
TVPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR E
❑ CONVERSION ❑ DEMOLISH ❑ OTHER 7 Ffonl
DESCRIPTION OF WORK/USE OF BLDG. A Rear
TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL I C Aighl
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL . g� Left
❑ �oTHER Ping. Ref. # �
PROJECT DESCRIPTION 5q. F7. OCCUPArvCV�/�G'��' planning Notes:
CON STRUCTION TYPE VALUATION $ �_ZL�
20NE GRADINGCU.YDS. ACRES
Remarku � �rc/.� � �
Bar Sink
Backflow Preventer
Backflow Irrigation
Clarifiers
Dishwasher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Roof Drains
Rainspeetion Fee � S15
Boiler
Duct-UnderGround
Duct - Structural
Duct - Ventilating �
Exhaust System ❑ Multiple �`
Firepl/Fuct BIL ICBO #
Heating System & Ducting
O ai oo,000 eTu O i oo,000 er�
Reinspection Fee � $15
White - Bulltling: Canary - qpplicant; Pink - Accounting: Goltlenrotl - Assessor
Shawers
Service.Sink
Sewer Cap
Sewer Connection
Solar Collecrors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auio-Wazh
laue Foe
Hood or Type 1 ❑
CanOpy Type I I ❑
Refrigeration System
�0-100,OOOBTU ❑100,000
System Repair/Alteration
F ire Dampers
Registers
Iswa Fee
Au[ometic Wesher
Construction Pole Sub.
Cooking Unit
Dishwa5her
Dryers ❑Gas ❑Elecl
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
_ zone 3
Atcessory Building:
0?5 � o
SS � i I "
a5� � �
i R
Parking Req./Provided E
�
M
T
S.
ELECTRICAL FEES
Transformer ❑ 15�50 KW
❑ SO+KW
_ Garbage Disposal
-' Generator �65 KW 05-15 KW
Meter Uup to 100 am�
Meter ❑over 100 amp.
Sub Panel �
Motors �0�1 HP �1 h'
InaSolar �9�15 HP.�
Microwave �„
Pale Light
Range
$i(Jfl
Standing Sections
Trash Compactor
8
6-15+
Reinspeetion Fee $15 IssuB Fee $ 3
$ 3 DEVELOPMENTSERVICESRE�UIREME Tg/ �y� �
ZoninB APProved BY �^^""— Date I� - ' �
FEES Building APP�o"ed By -_c� / Date
$ 3
� BUILDING PERMIT $
PLAN CHECK $
�, PLUMBING $
. PLAN CHECK 25% $
ELECTRICAL $
PLAN CHECK 50% $
MECHANICA� $
PLAN CHECK 25% $
EES �SMIP $
PERMIT
ISSUANCE S
ENERGV P.C. $
GRADING 5
MICROFILM $ �
TOTALFEE $ � , —
^ 1 000223E8-0���
DATE: Y2i�=�
� CONS�RUCTION AND PLANNING POOL, q � �
� Date Inspector Date Inspector
APPROVALS Permit # � APPROVALS Permit #
1. Tp�mporar.y'Electrical Service or Pols • ' 52. Pool & Equipment Location
. 1` ' �
2. Soil.Pipe'Undrgrnd. �• �% 53. Steel Reinforcement �
3.iElectficalConduit�Utility�Un'----'a ' � '
4�. Electr,ical Condu�t:Undrgrnd.
a ��
5iSteel Reinforcement t�
6._Electcical UFER Grnd ��
8jFoundation ,
' 9 �Water Pipe-Undrgrnd.
�
10.� St�uctural Floor System
11.�Property Sewer Line & House
�r �
--1
_�
. �i �
i .
.'1•� � .
.��� . �� .
73. Jioof Drains ,; 'Q`/
�.
14.',RoOgh PlOmbing j w
15. Roughv Electrical�Conduit
�16.1 Rough Electric Wiring
i
17! Rough Wiring Sign
18.��Rough Electrical-T Bar Ceiling
79! Rough Heating & Air Conditioning
i
20 � Rough Factory Fireplace
21. Ducts, in Structure �
22-Ducts, Ventilating
��
23�,Gas Pipe-Rough & Test ��
24�.� Roof Framing v�
25. Roof Sheathing
26, T-Bar Ceiling (Structural) &�Monocoat
27. Frame and Flashing -
26. Lathing & Siding
29. Insulation
30.� Drywall Nailing � ^ - •
31.-Plaster Brown Coat ��' ' -
1
32. Electrical Power Meter-Final
33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe•Test
36. Hood or Canopy
37•. Final Faciory Fireplace
. •
38. Final Plumbing � ,
39. Water�Service-Final �
40. Gas Service-Final
41. So�ar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation '
44. .Landscape Irrigation System
45. Sound 'Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to So�uthern California G8s
51. CERTIFICATE OF OCCUPANCY
lo. Date
��
�
�. � 54. Forms
� 55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER-GUNITE
¢ 58. Electrical Conduit-Undrgrnd.
' 59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
61. APPROVALTODECK , .
� � 62. Backwash & Receptor-Final
63. Heater & Vent-Final '
64. Plumbing System - Final
65. Electrical-Final.
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL(SPASYSTEMSFINAI
FIRE DEPT. REQUIREMENT
APPROVALS Permit#
70. Underground Hydro
71. Product Piping O Gas ❑ Oil
72. Underground Flush
73. Undergrnd. Storage Tank O Gas O Oil
74.' Overhead Hydro ' ,y _. .,. _ _
' 75! Dry�Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes:
1 � Sr5' (�/c vo �.¢� �` �
�
._•
i
� � a � AOolicant to flll In all soaces exeept thosa wltnin heavy eoraer Iines antl sign all aoCropriala eeclarations.
CITY OF COSTA MESA CONST�UCTION PERMIT P�MIT iO.Q TRACT NO. LOT NO. UNIT O. .
Project Address _ ,���
AppliCani'i Mailing AddfE55 , � / TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISM ❑ OTHER
Owner's Name �hone DESCRIPTION OF WORK/USE OF BLDG.
Aldress
Ai�h/Eng. LiCenu No. TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL
/�ddress ❑ TENANT ❑ ELECTRICAL � PLUMBING� ❑ MECHANICAL
COnlractor'S Nem � � � � Phon — S.� � �OTHER
Address (mailing) ��• �d�' i��l Yi+>w:ao �n�dO PROJECT DESCRIPTION 5�. FT. OCCUPANCV
City LiCense NO. ���� Z�NE TRUCTION TVPE GRADING CU. VDSVALUATION CRES
LICENSED CONTRACTOR DECLARATION
I ner¢by altirm that 1 am ticensatl unUer provisions of Charter 9(commencing
with sectian ]000) of Division 3 ot tha Business antl ofessions COGe, anG
my li<ense is In full i te n ettect.
License Ia li ��
Date ' ' Signature
WORKERS' COMPENSATION DECLARATION
1 hereby aftirm that I have a certiticate of consent to self-in re or a certitiwte
ot WOrke/s' Compen5ation InSurdnce, Or d Certltietl copy thereof ($ection
"°00, �ab. C. t,� �'
ICY No. ��� ,U Z ComPanY n �
Certl(letl copy is hereby turnishea. • -
❑ Certi�e/�py�s�letl w�iAth the city B tl ivision.
�ate f j� PPiicant
EXEMPTION FROM WORKERS' COMPENSATION D CIAR ON
(This section neetl nat ba completetl if the permit is tor e hu red (E100) or
less). 'S'
I Certlry [nat in-th¢ Performance oi the wOrk 10r whlch [hls perm�t is IsSUetl, I
snall not emDloy any person in any manner zo as to become subject to the
Workers' CompBnsation Laws ot Califomia. , .�
Date Si9nature � "�
NOTICE: It, atter making this tleclaration, you shoultl becoma subject to the
Wofkefs' COmponShcion provi5ioni O/ the Ld�of Catle, you mu5[ fOrthwith
comply wil� such Orovi5ion5 Or [hIs pe�mil Snall be tlG<metl �evaketl.
CONSTRUCTION LENDING AGENCV
1 hereby afllrm that there is a conzlruction lentling agenty lor the performance
of the work for whicn Ihiz permit 71 Issuetl (Se[[IOn 309] Clv. C.)
LenCcr's Name
Le�tler's AtlOre55
OWNER BUILDER DECLARATION
I hereby alfirm lhat I am exempt irom the Cantraclor'S License l.aw for the
lollowing rCason (Sectlon 7031.5 Bu51n055 antl ProtG55iOna1 Cotle: Any city or
County whicn reqWres a p<rmlt ro ConSVuct, alter, improve, tlemOlish or rBpolr
any SGuctu�a, pri0� �o IIS Issuance, dlso �equlroSlha applicdnt fo� such pOrTlt
to tile a signetl statement that ha/iha Is Iltansotl pursuant to the provisions of
the Conlraclor's Litense Law (Chapter 9(commencing with Seclion ]000) of
Division 3 01 the Business antl Pr01e55ion5 COGO) o� lhat he/she IS exemo�
tM1eralrom anE tne ba5is for the allegetl axemption. Any vlolation oi Section
�031.5 by any apD���ant tor a pe�mlt subfacl5 the appllcant to a CIvII
�ally ot not mora tban tive huntlretl tlollars (E500).
�, ds owne/ o/ thG O�operty or my empl0yC05 with wages a5 thel� sol9
�mpensation, will tlo the work, antl tne structure ii not Intentle0 or oifere0
lor zala (Saction 7044, Businezs antl Prolezsional Cotle: The Contractor'z
LlcenSe ldw tloes not apply to an owner of a prOperty who bulltls ar imp�oves
theraon, antl wno tloes such work himseli/horself or tnrough his or her own
employeos, provitletl that such improvements ara not intentlea or offaretl for
sale. If, hOwevGr, tne building or ImprOvement IS Soltl within onG year of coT-
plotloq the owner will have the buraen of proving he/she tlItl not builtl or im•
prove tor the purpose of sale).
❑ I, az owner of the property, am exclusivety tontracting witn licensetl con-
Vactors to tonstrucl Ihe prqect ISectlon 7044, Buslnoss antl Professions Cotle:
Tne Contractor•s Ucense Law does not apO�Y �o an owner of property who
�ui1tl5 or Improve5 thereon, antl who cont�act5 �or suGh oroiect5 wlth a mn-
(�ractor(s1 hcanso pursuant m me Convac[or•s Llcense Lnw). I am aware that
ril oi [beir Worker'S Compen5ation InSuranca Shoultl be provltletl to ma.
❑�am exempt untler Section B. 3 P. C. �or thls reason
Date�p Owner
1 her�Dy certl(y tha[ I have read this applicatlon antl siate that the above
Informatlon Is correct I agree to comp y with all ci[y antl county ortlinancas
antl Stale laws �ela i to builtling c it�uCtlon, antl �ereby autho�ize rGprO-
sentatives of tnis <i y[o enter tha above-mentionetl Property for
InSpaCtiOn Pulpo /, i%�r
Signature �a�e � �
Drivari' License ar SS �
Rem9rks:
Sink
Preventer
Irrigation
Drinking Fountains
Floor Orains
Floor Sinks
Ges Service Outlets
Interceptors
Kitchen Sink -
�avatories -
Roof Drains
Reinspection Fee � $15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating -
Exheust System ❑ Multiple ❑
FirepUFact. Blt. iC80 #
Heating System & Ducting
❑aioo,000 aru oioo,000er
Reinspection Fee � $15
0865-46, rev. 5/88 Wnite - Builtlin9: Canary - Applicant; Pink - Accounting; Goltlenrotl - Asussor
PLUMBING
Showers
Service Sink
Sewer Cap
Sewer Connection
So�ar Collectors
Solar Pipin9
Solar Tank
Swimming POoI w/Spe
Urinal
Water Clout
Water Heater
Water Service
/ Auto-Wash
Isue Fee
Hood or Typel �
Canopy Type I I ❑
Refrigeration System
❑6700,OOOBTU ❑100,000
System Repair/Alt¢ration
Fire Dampers
Registers
Issue Fee
A.P. qW
S Main Buildi
E
T Front
B Rear
A
C Right
S . Left
Ping. Ref. dp
Planning Notes:
FEES Au[omatic Washer
Construction Pole Sub.
Cooking Unit
,Dishwasher /,y
� -0ryers ❑Gas DEleci
Fan �
i
y F.A.U. 1.
Device Boxes �A
Outlets
$witCheS
Garbage Disposal
Generator �0-5 KW
Zana
Accessory
Req./Pravided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter Llup to 100 amps -
Meter ❑over 100amps
Sub Panel
Motors �0.1 HP � t'h - 6
Inc. Solar 09-75 HP �1615+
Microwave
Pole Lighi '
Renge
_��tanding Sections
15 KW � Trash Compactor
FEES
N
6
N
G
R
E
0
M
T
S.
Rainspeaion Fee $75 Iuue Fea $ 3
S 3 DEVELOPMENTSERVICESREUUIREMENTS:
2oning Approved By nate
FEES Building Approved By Date
avvr�t�o� ittued ev naca 1�
SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
r
PLUMBING $ _�� -- ISSUANCE $
PIAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING $
PLANCHECK 50% $ MICROFILM $
�/ /� l'b
MECHANICAL $ TOT,AL FEE $ �— ^
PLAN CHECK 25% $ .
$ 3
di 00919077-00019077 T�]T 2b.00
�ATE: ?!/09/S8 TI11F: ±0=34
� . .
; :, :_, ,
, CON$TRj,ICTIE�I AND PLANNING POOL & '
Uate Inspector �late Inspector
.. .APPROVALS Permit # APPROVALS Permit #
' 1. Te�nporary Electrical Service or Po�e �.: 52. Pool & Equipment Location
., .
' 2. Soil Pipe-Undrgmd. �(Z� /Z;xb' L�9 53. Steel Reinforcement
3., lectrical ConduiUUtility-Undrgrnd! �•� � 54. Forms __ /�
� 4. Electrical Conduit-Undrgrnd. ''� . 55. Electrical Bonding -
p 5. Steel Reinforcemenf� - , � 56. Rough Plumbing & Pressure Test �
<<
6.��Ele�ctrical.UFER Grn`d•.� . 57. APPROVAL TO COVER-GUNITE '�,�
u
7: Foptings ��,y ; � 1� 56. Electrical Conduit•Undrgrnd. ��'7
6� Foundation ''� `i '� -'� 59. Gas Pipe, O Undrgmd., Test ��^;
,. ' �
9;• Water Pipe-Undrgrnd: :,: ,�� � 60. Backwash Lines, P-Trap, O Undrgmd.
10^S[ructural Floor Sysfem . �� ���• 61. APPROVAL TO DECK <'
�! 11.rProperty Sewer Line & House Connection ! G, 62. Backwash & Receptor-Final ��
.�
f 72. Sewer Cap •;.� � �' � 63. Heater & Vent-Final �
r 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
171 Rough Wiring Sign 68. APPROVED FOR PLASTERING
18� Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
r�
19. Rough Heating & Air Conditi ning FIRE DEPT. REQUIREMENT
20:••Rough Factory Fireplace .;� APPROVALS Permit #
21. Ducts, in Structure �
„• 70. Underground Hydro
22. Ducts, Ventilating �'✓' 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test � 72.. Underground Flush •
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing , 74. Overhead Hydro � � � -
� 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
26. 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 y, ,� 80; FOOD CERTIFICATE ISSUED
33. Final Electric �� Notes: ; 1
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test 7 �
36. Hood or Canopy
37. Final Factory Fireplace �
38. Final Plumbing 7�,�y�
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer � �� -�
43. Backflow Irrigation '• �
44. Landscape Irrigation System
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison - _�
50. Gas Release to Southern California Gas Co -�� '
51. CERTIFICATE OF OCCUPANCY , , '�
No Date � '
� � AppllCant to fill In ali fpaeas excep� thofe wlthin heavy Oo/Ear Iines anC slgn all appropridte Oeclaratlons.
CITY C}F COSTA MESA CON�T�t UCTION P��M IT P� :MIT„NZO.� TRACT NO. LOT NO. UNIT Np, A P�y Ze�e
10�5 !c% /Si°"" �e�f L[�if.' /�'l.S� � .�
Project Address e _ /, S Main Building: Accessory Building:
Ap Ii�,ant'SMailingAddress 7VPEOFCONSTRUCTION NEw ADD ALTERATIorv REPAIR E Z
� ❑ CONVERSION ❑ DE USH ❑ OTHER T Fron[ 0
Owner's Name Phone DESCRIPTION OF WORK/USE OF BLDG. I A Pear N
Address
ArchlEng, LicanseNo. TVPEOFPERMIT GRAotNG FOUrvDATlqfy STqUCTVRA� I, K Right G
Address / ❑ TENAN7 ❑ ELECTftICAL Q PLVM9ING r MECHANICAL g Le1t
Contrar,tor's Nam �� S� Phonf - Q ��OTHEn / Pln9. Ref. 5W Parking peq./Providetl E
PNOJECT DESCRIPTION Scl. FT. oCCVPANCv n
R O D Planning Notes:
Address Ima'I'ng11.% � � �_ � ry�
�p�b� CONSTRVCTIONTYPE VALVATION$ T
City Licen� No_ o ZONE GRADING CU. VDS. ACRE�
UCENSED CONT0.ACTOR DECLARATION S"
I hCreby a/firm �hat 1 am licensetf untler proviSions o( C�arter 9(commGnCing Re�na�kt:
witn section 7000) of Divislon 3 ot the Businezs antl Professions Cotle, antl ELECTRICAL FEES
my Iicense is in full lo e a fect. A �
Licens Clazs � �ipens) � v
Dam ��%� 5'9 t �/J [� /Y1s� PLUMBING FEES
Automatic Washe� Transformer ❑ 75-50 KW
WORKERS' COMPENSATION DEC RA ON Baf Sink ShOwMs ConstrUctfon PolESub. ❑ 50+ KW
I hereby attirm lhdt I Ilave d Certiflc te O( OnSCnt t0 581fin5ufe Or d Cef[I(ICdt¢
oi Workers' Compen5ation Insurance, or a certifietl copy tnereo( (Section Backflow Preventer ServiceSink CAoking Unit Meter ❑up to 100amps
0, Lab. �J -
cy No. ����7y7�!� Compa _ �/iJkLS(71Y122Q� �qt. Backflow Irrigation Sewer Cap ,r Dishwasher Meter ❑over 100amps
,y�'Cer�i(ietl copy is hereby furniihetl. � -� � - Dry¢rs ❑Gas ❑Electric Sub Pan21
f�l CeRitjeAfqpy I�jJetl wttn tna city Bui i � s7on Batbiubs Sewer Connection
Da[e r4 d`> r7 qpplicant ' Fan Motors �41 HP �i'r4-8
EXEMpTION FROM WORKERS' COM NS ION DEClA0.AT10N Clarifi¢�5 $olat C0112[tors
'(ThisSQ�tiOn neetl not be Completetl If t e p¢r it islo� on¢ huntlred ($300) o� piSh�MdShCf ' F�A�U� Inc oiar 09-75 HP 016-15+
Icss). �I Soler Pipin9
I certify (hat in the perfo�man<e ot Ihe wo�k for whlch thi5 p¢rT�t is IsSUetl, I � r Fi%Iu�¢5
sltdll not employ dny pe�Son in any manner 50 as to b¢COmG Sub)ect f0 the Drinking Fountains $012� Tettk iC�OWavf
Workers' Compansatlon Laws of California. ' �
Date Signature Floor Drains �/ Swimming Pool w/Spa .� Device Boxes Pole Light
NOTICE: If, atter making this tlaclaration, you shoultl become sub7ect [o [he
Workers' Comoenutlon provisions of tne Labor Gotla, you musl fort�with Floor Sinks � Urin OuUets Range
tomply witn such provisions or tnis Dermit shall ba tleemetl revoketl. Switches
GONS7RUCTION LENDING AGENCV GasService Outlets atCfCloset 5�9�
1 hereby altirm lhat there is a constructlon lentling agency fOr lhe perbrmance
ot tne work for wnicn tnis permlt is issuetl (Sectlon 3097 CIv, C.) Interceptors Water Heater Garbage Dispo501 Standing Sections
1_entler5 NamE
�enae.•s Atlaress Kitchen Sink Water Service Generator DO-5 KW �5�15 KW Trash Compactor
OWNE0. BUILDER DEGLARATION
I haleby alflrm lhdt I dm exampt IrOm the Conlractor'S Llceni0 Ldw 7of Ih8 LBvatOfiCS AUfO-W85h
lollowing reason (Saction ]031.5 Business antl Prole55ional Cotlo: Any city or
counly which req Wr<5 a OGrTit [O cOnStruct, dlt0/, imp/ave, tltmo115h o� r¢Pal� p_7�ep �UOdry TfeYS
any struclure, prbr to its Issuance, also reqWres tho applicant for such pormil
to /ila a signetl statement thal �e/she is Iicensatl pursuant to the PravtstOns of ROOf Drains
the Cpntractor's License Law (ChaD�er 9,(commencln9 wit� Sectlon 7000) of
Divisipn 3 of tne Business anC Professions Cotle) or lhat ne/She Is OXempl Reinspeetion Fee $15 Issue Fee
tncrelrom anO ihe ba5i5 for the alle9etl exemptlon. AnY �lolatlon of Saction $ 3
.,?5?r�?,1.5 by any applicant tor a permi[ subjec[s tho applicanl to a civil
,y,,;?a�lty ot not mora than tive huntlratl tlonars (E500). DEVELOPMENT SERVICES REOUIREMENTS:
Reins ction fee $ 3
`�� a-5:'�. �s owner ot (ho Proporly or my employeas with wages as tneir sole Pa $15 Issue Fea Zp�ing App�oved By
lomp¢nsatiOn, wlll tl0 the wo�k, antl Ihe Struc[w0 IS not intentl¢tl o� OHe�etl �et0
Ior sale (Seclion 7044, Business antl Professional Cotle: Tho Coniractor's MECHANICAL FEES Building APP�oved By
�iceny¢ �w does not apP�Y to an owner of a property who builtls or improves Data
therepn, antl who tloes suc� '�+ork himself/herseli or throu9n his or her own AppliCd�ian ISSued 8y �
empl6yeeT, prOvlCetl Ihat such ImprOvemints ar0 not IntenEatl OI ottel8tl tOf BOiI¢f HOOd Of TyP¢ I ❑ � t
salo. If, however, the bulltlin9 or improvement is soltl wit�in ona yoar ot com- �nopy Type I I ❑ SUMMARY OF F S
ploUon, tne ownar will have tna burtlen o( pr ving na/sho tli0 nat buila or im- Duc[ - Under Ground
prove for tno purpose of sale). � BUILDING PERMIT $ SMIP $
❑ �, as owner o� the Droverry, am exclusively tontraci�ng witn Ilcentetl con- Duct -SvuCfural Refi'rgeretion Sys[em PLAN CHECK $ PEFMIT
lractOrs to conslruct the Droject (Sactlon 1044, Businais antl Protesslons Cotle:
buetl%or�improres�tnereon, ntlwhOcontPattitoasuthO�ol�cl5�wlthtacohn Duct-Ventilating �4100,OOOBTU ❑100,OOOBTU PLUMBING $ I$$UANCE $
tractor�sl Lcenza pursuan[ �o cne ConVactor's Licensa Lnw�. I am aware that Exhaust Sys[em � Multiple ❑ System Repair/Alteration PLAN CHECK 25% $ ENERGV P.4 $
prooi of tnelr Worker's Compensation Insuranca shoula be provitleC to me. � ELECTRICAL $ GRADING j
❑�I dm exempt unUer Sectian B. 6 P,. C. ior this reason FirepUFact. BIG �CBO dk Fire Demper5
: PLANCHECK 50',6 $ MICROFILM $
Date owner �� e ting System & Ducting Aegisters � MECHANICAL $� ��.(��
I h¢t¢by certity thdt I have /eatl lhli aO���Cation dn0 Stat¢�that th0 above / �Q100,000BTU ��00,�00BT TOTAL FEE .$_�_
PLAN CHECK 25% —�
information is wne t. I ag�ee t0 ComD�Y �'/��h all Clty antl countY ortlinances $
antl state laws rela ng to �uiltling construction, antl hereby autharize repra-
5¢nta�ives Ot ttli city ent8r p the dbOve-m0ntionetl Pf0 erty Of ,
Inipettionpur � � Q Ol 9�P194a�-QDA294&0 YOT =�eGa
Signature �e
Ior�vers' �icens or 55 Reinspection Fee $15 Isue Fee - S QiiTE: 03/2?!89 jIFiF: �S:j$
OB65.q6, rev. 5/88 White - Builtling; Canary - Ap0licanL Pink - Accounting; Goltlenrotl - Assessor
�.` ` :� . .
COI�STRUCTION AND PLANNING
� POOL f A
APPROVALS Permit# Jate Inspector AppROVALS Permit# � Date Inspector
1. 7'e�mporary Electrical Service or Pole 52. Pool & Equipment Location � -�
•2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement -
3. Electrical Conduit Utility-Undrg�nd. � 54. Forms �
4. �Electrical Conduit-Undrgrnd. 55. Electrical Bonding �
5. Steel Reinforcement . � i 56. Rough Plumbing & Pressure Test �;
6. Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE
7: Footings .�' � 58. Electrical Condui[-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
i •
12. Sewer Cap �, •� . 63. Heater & Vent-Final
13. Roof Drains �:" � 64. Plumbing SYstem - Final
14. Rou h Plumbin � � •
9 9 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
'16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
i ,:
19. Rough Heating & Air Conditioning �� FIRE DEPT. REQUIREMENT
�..
20. Rough Factory Fireplace APPROVALS Permit #
�21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping � Gas ❑ 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 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final ' 80. FOOD CERTIfICATE ISSUED �;� ��
33. Final Electric Notes: ? � �
34. Final Heating & Air Conditioning V
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing �
39. Water Service-Final r
�
40. Gas Service-Final �
� 1
41. Solar pomestic-Final � � �
i
42. Backflow Preventer / �' � :
43. Backflow Irrigation �� •�/� "
44. Landscape Irrigation System �"�
'd',
45. Sound Attenuation � .,�
46. Handicap Regulations '�
47. FINAL STRUCTURE & BUILDING �
48. Special Requirement5 Completed
49. Electric Release to Edison ��-
� '
50. Gas Release to Southern California Gas Co ,�/ ��
51. CERTIFICATE OF OCCUPANCY "
No. Date ' I� '
-� - - ._ AGO���an( to fill in ail spacei excepl
C�7Y oF COSTti n�ESA CONSTRUCTION PERMIT
PrOjectAddreSs ufi 7 "�] #j�
Dp�lica�ft's Mailing Address
Owner•s Name SATRA DEVELOPMENT phone
Adtlress
ArGh/Eng. Lic¢nse No.
Adtlress
Contractor'sName Bl"1SCOC.' EZL�CtilC phone 549-5970
Adtlress(meiling)- ZS46 S. Fairvzeti•�. Santa .�11d
City License No. � 2 71 9$
LIGENSED CONTRACTOR DECLARqT10N
I hereby afllrm that I am Ilconsea una¢r provislons oi Chartar 9 �commenpinq
w��n settion ]000) of Divislon 3 of the Busine55 antl Prolesslons Cotle, antl
my ficense is in full lorce ana eflect. ���—^1y`
V�ense 1 ss L_ �Cen —
Date �� �— g9�ature �
WORKEHS' COMPENSATION DECLARATION � �
� hp�¢by aflirm that 1 havo a ttrUficat¢ 01 consent to self-Insure or a certifi�ate
Worken' C7o,mpensation Insurance, or a<artl/iea copy t�ereof (Sectlon
Q0, Lab. �.J � �% 1. 1 1 0 3�
V�otljcy No, ompany Calif . Cu$11t11tj�
� C¢rti(ietl Copy is hereby tumished. �
Dalgerti( P� Cppx is Qlq�tl wAPPhcantY 8' tl Dlvi n.
1L 14 i52f
EXEMPTION FROM WORKERS' COMPENSATION CIARATION
(Th{szection neea not be comoletetl if tha oermit is f one huntlretl ($100) or
less).
�I certity that in the performance of tne work (or vehich this pormk Is Issuotl, I
zhall not employ any person In any manner so as to become subject to tha
Workers' Compansation LawT O1 Ca17fOmia.
1 Data S9nature
NOTICE: N, at�er making Uii tleclaration, you shoultl become subject to the
Workers' Compensation Provlsions of tne Labor Cotla, you must fortnwith
comply witn sucn provisions or this permit shall be tleemetl revoketl.
� CONSTRUCTION'LENDING AGENCV
0 1 hereCy aHlrm ihat there is a consiruction lentlin9 a9ency for ihe performance
Ot the work for whiCh [hi5 permit is Issuetl (Sectian 309] Civ. C.)
��tler't Name
LR�tler's Atltlress
OWNER BUILDEH bECLARATION
I hg�eby aftirT ihat I am exampt irom the ContraCtor'S LlcenSe Law fo� th¢
following r¢asOn (Section ]031.5 Business antl Profe55ional COtle: Any cily or
co4nty whic� tequire5 a permit to conStruCt, altet, ImO�ova, tl¢molish or repair
any structure, prior to its issuance, also requlres the applicant for such permit
to file a si9n¢tl statement thdt he/she is IicanSetl pursuant to lhe provlsioni Of
the Contractor's License Law (Cnaoter 9.(commencing with SecHon ]0o0) of
Dirizion 3 at the Business antl Protezsons Cotle) or that he/she is exCmpt
eretrom antl the basis for the allegetl exemption. Any vlolation ot Section
31.5 by any applicant for a permit subjetts tha a0011can[ to a civil
.lalty af not more tnan liva huntlretl tloliars (5500�.
� I, a5 owne� of �he Prope�ry o� tY�y ¢m01oy¢es wilh wages ai th¢ir sole
tompensatlon, will tlo the work, antl tho structure Is not Intentletl or o7feretl
tor sale (Section 7044, Buslness antl Professlonal Cotle: The ConVactor's
LicenSe Law tloes not apply to an owner ot a property who bulltls or Imv�oves
. thereon, antl who Uoes such work nimself/herself or throu9h his or her pwn
emp�oy ees, orovitlea that such fmorovements are not intenaea or oHoretl for
s2�E. If, hOwevor, Ihe Dullding Or imptovem¢nt IS sola wllbin On¢ yea� ot COm-
plttiOn, th0 Owner will have [he burtlen Of praving he/Sh¢ tlitl not builtl or Im-
P�Ova fo� tho purpose of sale).
❑ 1, as owner ot the Oroperty, am exclusNely coniracHng wlth Ilcensotl con-
lractorsto Cons[tuct [he projact ($ection 7044, BUsiness and Protession5 COtla:
The Con[ractor's License t�w does not apply to an ownor ol proper[y who
bulltls or Improve5 [hereon, antl who conVdtts tor such projacl5 with a Con-
l�actOr(SI bcepse pursuant to Ibe COntra<tOr's License Law�. I am awara [nat
PrOot o/ lnGi� WOrker'S Compansatlon InSU/ancC ShOultl �a Orovitletl t0 mB.
❑ I am exempt untler 5¢ction B. 3 P. C. lor lhis reason
Dato Owner
� hereby certi/y that 1 nave rea
���ormation iz �orrect. I aqreo to
antl s[ate laws relatin9 to bulltlir
sen[alive5 0l IhiS city lo enter
Inippttion p y0
5�9nature
���vers' Licenso or 55 � _�
�n antl state tnaf iho abova
Uty antl county artllnances
anC hereby authoriza repre-
ve-m0nlionea pro0erty fOr
_ Data 1z-1'�-8a
wit�in heavy EorOer lines anE si9n all dOVroDriate tleclarations,
RACT NO. LOT NO. UNIT�U. '
. ;
TVPE OF,CONSTRUCTION L�SI NEW L1 ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPEOFPERMIT�7 GRAOING FOUN�ATION STRUCTVRAL
❑'TENHNT y� ELECTRICAL ❑ PLVMBING ❑ MECHANICAL ,
❑ OTHER
PROJECT DESCRIPTION 5a. F7. oCCUa.aNCv
CONSTRUCTION TYPE VAIUATION $ __
20NE GRADINGCU.YDS. ACRES—
Ramarki: #$36�89
Ber Sink
dackflow Preventer
Backf�ow Irrigation
Bethtubs
Clarifiers
Dishwasher
Drinking Fountains
Floor Orains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavarories
P—Trap
Roof Drains
Reinspection Fae $15
Duct- Untler Ground
Duct - Strucwral
Duct - Ventilating
Exhaust System ❑ Multiple �
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
06100.000 BTU O 100,000 BT'
Rainspaction Fee � $15
CMF 0865-46, rev. ]0/84 Whito - Bulltling; Canary - qppllcant; Plnk - Accountinq; Goltlenrotl - Assessor
PLUMBING
Showers
Service Sink
Sewer Cap
Sewer Connettion
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Laundry Trays
Isue Fee
Hood or Typel ❑
Canopy Type II ❑
Refrigeration Sys[em
❑o-ioo,000eTu Oioo,000
System Repair/Alteration
Fire Dampers
Registers
Issua Fae
FEES
A.P. #
S Main Builtli
E
T Front
B Fear
A
C Right
K Left
$
.Ping. ReL 91�
Planning Notes:
Automatic Washer
Consvuction Pole Su
Cooking Unit
Dishwa5her
Dryers ❑Gas ❑EI�
Fan
F,A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Dispoul
Generamr �P5 KW
y.�
5
Zona ,
Accessory
ELECTRICAL
Transformer 0 15�50 KW
❑ 50+KW
Meter ffiup to 100 amps
Meter �over 100 amps
Sub Panel
Motors �0.1 HP � 1 Y, - 8
Inc.Solar 09-15 HP Oi6-15+
Microwave �
Pole Light
Range
Standing Settions
Trash Compactor
���
FEES
Z
O
N
I
N
c
R
E
Q
M
T
S
$� Rainspection Fee $15 luue Fee $�3
FEES
DEVELOPMENT SERVICES REQUIREMENTS: '
Zoning Approved By Date _
Building Approved By Data' �.� � �pp
Appliwtion Issued 8y Datfl1L^i�_O�
. SUMMARV OF FEES
� BUIIDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ ��YD.6 GRAOING $
PLANCHECK 50% $ ��•� MICiiOFI�M $
MECHANICAL $ TOTAL FEE $ �
$ 3 PLAN CHECK 25% $ 5lOp
002�311-a0U2'L212 T'�:T .`'i.Ji
: 1?/14/E8 7If�E: n9:pg
CONSTRUCTION AND PLANNING' "' • FOOL & SPA �
i�'�� • t' ` Date ' Inspectoi � Date Inspector
, APPROVALS Permit # APPROVALS Permit #
'_ 7U.
(;�1 t(Temporary Electrical Service or Pole . 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. � . • 53. Steel Reinforcement
3. Electrical Condui[ Utility�Undrgrnd. ��r 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE
7. Footings '. 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
�
9. Watei Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
70. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
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 .� SQ , 67. Fencing & Access Approval
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ��
27. Frame and Flashing 76. Dry Standpipe �
28. Lathing & Siding 77. FIXED SYSTEM FINAL '
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION �� '
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: �_ _ � .� o� O//d�Vi f�
34. Final Heating & Air Condi[ioning Q�
35. Final Gas Pipe-Test � "
36. Hood or Canopy
37. Final Factory Fireplace � C
v
38. Final Plumbing �� _
39. Water Service-Final
40. Gas Service-Final ' j �
41. Solar pomesticFinal ' • �
�.
42., Backflow Preventer ' � .
i.
43: Backflow Irrigation ' '
44'. Landscape Irrigation System
46: Sound Attenuation
46. I�andicap Regulations
47', FINAL STRUCTURE & BUILDING ' �
48. Special Requirements Completed
49. Electric Release to Edison �
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY ,
No Date