HomeMy WebLinkAbout785 18TH ST - Building Permits�
Applitant to /ill in all spaces exeeD1 those within �eavy Eo�Eer lines an0 si9n all aOPropriate tleclaralions.
CiTvoF coSTA MESA CON$TRUCTION PERMIT
�� . Pr�ect Address �ti "� 1✓.- � �h .S i
\
ApplKant's Mailing Address � `� ���• `" N, ����
( Owner'sName �.r�-, +'T; � 1�7_F ���P ,� ne `%9d'i i "�d"
� Addreu ' � J.• � V�(�v �c� }c .�
� Arc En . V ��License No.� � �.�� �'
� Address � � �
� Contractor's Name �- �,(� - Phone �� i
Addresslmailingl�s �'� �•u�� Q �'t �� �}���
City License No. -�-�'� J �
LICENSED CONTRACTOR DECLARATION
I hereby aHl�m tha[ I am Ilcensetl unVe� prOvi5lon5 of Charte� 9(commencing
with xction ]000) of Division 3 of the Business anU Professions COCe, antl
my license is in f WI f te antl et/ect. ��p
(� LICCIISC Id55 u�--��--� ^; � LIC2{�SE v
(� Oate—�^<�C+TI c',...�r .e� �Y�}��f,J ���(/�'�
��� WORKERS' COMPENSATION OE LqRAf � 7�pN
I I hereby atiirm that I have a certiflcatQ ot consent to seli-inzure or a certificate
1 ' Workers' Compensation Insurance, or a certlTietl'copy thereot (Sectlon.
]0. Lab. C. . / . .. .'�.�
\ IicY No. ���1"�qb�H�CompanY��/1� ��D
Certitietl <opy is nereby fumishetl. y�
Cer ie cop Is iletl wifh [he city tli Dl� �isio
�Date�_qpplicant_!1� r VII7�ITG �
��EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This sec[ion nGetl not be complet¢tl it �he permit is fOr one huntl�eC (E300) o�
iess). �
1 certify [hat in (he pe�fo�mance of the wo�k for which [his pe�m�t is Issuetl, I
shall not employ any p¢rson in any manne� so'.as to become subje<[ to the
Workers', Compensation Lawz of Califomia. ,
. Date Signature _ '
'NOTICE: If, aiter makin9 this tleciarafion, you shoula become subject to tne
Workers' Compensation provisionz of the Labor Cotle, you must (orthwitn
wmpty witb suc� prOVlSions or this pe�mit shall be aeemetl revok¢tl.
CONSTRUCTION LENDING AGENCV ' ' '
I hereby affi�m tha[ ther¢ i5 a const�uct�on Ientling agency fo� the pe�formant¢
Ot tho work tor which Ihis perrriit is ISsueq (Section 3097 Civ. C.)
Lentler's Name '
Lentler's AtltlreSs
OWNEF BUILpER bECLARATION - � �
I her¢by at(Irm that I am exempt from the ContraCtor'S License Law for the
followin9 reason (Section 7031.5 Business antl Pro(esslonal Cotle: Any ci[y or
. counry wnich �equires a permit to construct, alter, imorove, tlemolisn or repalr
any slructure, prlor to il5 is5uance, al5o �equ7re5lhe applicant f0� such perrttlt
, to Tile a siqnitl statemen[ [ha[ he/She Is Ilcen50tl pursuant to the provisiOns of
tne Contractor's License Law (Chapter 9(�ommencing wilM1 Section 7000) of
Divislon 3 of the Business antl Professions Cotle) or that ne/she is exempt
' t„^refrom antl the basis for the alleg¢tl exem0�ion. Any violation o( Section
l.5 by any applican[ for a permit zubje<tz Ihe apP���ant to a civll
Ity of not mo�e than five huntlred t1011ars (E500).
� I, as owne� of tM1e O�ope�ty o� Ty employees wltn wages as their sole
compensation, will tlo the work, antl the structure is not intentletl or offeretl
tor Shce ($e<tion 7044, Business antl P�otessional Cotle: The ConVacto�'S
LicenSe Law tloes not appty to an owqer Of a property who builtls Or improves
the�eOn, antl� who tloes suc� wo�k nimself/he�selt o� [n�ough his ot �er own
¢mpl0Yee5, p�ovltletl thal Such improy¢ments are not intentletl or offeretl fo�
sale. If, however, Ihe builtlin9 or improvement I5 soltl wlthin one year o( com-
pletion, the owner will have the burtlQn of proving he/she tlltl not builtl or im-
�rove �or the purpose of zale).
I, a5 own¢r o1 the prope�ty, am e%cluslvely cont�acting with Iicensetl con-
vactors to consvuct tne project (Section ]044, Business antl Professions Cotle:
The Contractor's License Law tloes not apply ta an owner ot o�operty who
bulltls or Improves thereon, antl who contracts for such projects witn a con-
tractor(sl license pursuant to tne Contractor's License �aw). I am aware that
proof o� their Wo�ker'S COmpensatlOn in5uranc¢ zhoultl be provitletl to me.
❑ I am exempt untler Section B. & P. Q Por Ihis reason
TVPE OF CONSTRUCYION ,2O NEW U ADD LI ALTERATION tJ REPAIR
❑ CONVERSION ❑ OEMOLISH ❑ OTHER - - A.p..# � [,�
DESCRIPTION OF WORK/USE OF BLDG.
. . � S Main Buildi
E
TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL T F�ont '(
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Reaf
❑ OTHER - ' ' � p'
PRWECTDESCRIPTION Sa FT oCCVv Ncv - - C. Right�7
K
CONSTRUCTIONTVPE Y N VAIUATION§ iOD g Left
ZONE GRADING CU. VDS. ACRES Ping. Ref. # D
Remarks: ,O� V7�'-i(�J - i�i �.. .G�/t/�nA . PlenninyNotes:
Sink
Preventer
Dishwasher .
Drinking Fou
Floor Drains'
Floor Sinks
Gas Service
Interceptars
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspaction Fee
Showers
Service Sink � „
SeweF�CaP _ �..-i •"•:,• -"-'•,' .
Sewer�Connection - ' � � , -� ;,.
Solar Collectors� � +
o_�... o:.....,.. .. r �
' Solar Tank ' �' r' - r�.
Swimming Pool w/Spa
Urinal
DUL�2L5 Water Closet
Water Heater �
Water Service
Auto-Wash �
Laundry Trays.
>
$15 Issue Fee
Duct-UnderGround
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. BIt. ICBO #
Date Owner � HCating SyStem & Ducting .
I nereby certity that I have reatl thls applicatlon antl sfate that Ihe above ❑a700,000 BTU �100,000
information is correcL I aqree to compty with all city antl county ortllnancas
antl statt laws relatin9 [O builtlmg C struction, antl hereby authO�ize repr¢- �
sentatives of this ity tq enter 4 the above-mentionetl property for
inspection purpos � � . o �.
Signature Date�_�_
Drivers' �i�ense or�55 � Reinspee[ion Fee
CMF 0865-46, �ev. 10/84 White - Builtling; Cana�y - Ap011cant; Pink - Accounting; GOltlen�otl - A55¢SSo�
$15
Hood or Typel ❑
Canopy Typell ❑
Refrigeration System
❑o-i oo,000 eTu ❑ i oo,000 er
System Repair/Alteration
Fire Dampers
Registers
Iss�e Fee
FEES
/
7192 6%10/86
-� _O3 2one
Accessory Building:
iD L..
� � � Parking Req./Provided p�
f 7 � � �
Auromatic Washer '�
Construction Pole Sub.
Cooking Unit
Dishwasher
� Dryers ❑Gas �Electric
Fan
F.A.U.
Fixture5 , „ .
J W i tche5
Garbage Disposal
� Generator 00.5 KW �5-15 KW
.-�
_ _' . .
$ 3 ^ I� �
i
� Reinspection,Fee $15
$ 3
�
DEVELOPMENT.SER
Zoning APProved By �
Building Appr ed By
IICAL ,
Transformer ❑ 75�50 KW
. ' ❑ 50+�KW '
. Meter ❑up to 700 amps
Meter ❑over100amPs
Sub Panel . � �
MotOrs �0.1 HP � 1'h�- 8�
Inc.Solar 09�15 HP �76-15+
Microwave .
Pole Light �
Range
Sign
; Standing Sections
Trash Compacmr
Issue Fee
549026 TL '
6
FEES
$ 3
Z
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SUM A O ES � ' ,� f/
+ �BUILDING�PERMIT $ SMIP $ �
• PLAN CHECK $ PERMIT
�' � PLUMBING $ ISSUANCE $
PLAN CFIECK ,25% $ ENERGV P.C. $ •
v'„��ELECTRICAL $ GRADING $
� " •�PLAN CHECK 50% $ MICROFILM $ � �
— - MECHANICAL $ , TOTALFEE ,$
� . '�'PLAN CHECK �25% $ ' �
F�_ ---- �
I' � CONSTRUCTION AND PLANNING
A��ROVALS Permit #
1�. Temporary Electrical Service or Pole
/
��2. Soil Pipe-Undrgrnd.
3. Electrical Conduit Utility-Undrgrnd.
4. Electrical Conduit-Undrgrnd.
5. Steel Reinforcement '
`6. Electrical UPER Grnd.
7. Footing's
8. Foundation
9. Water Pipe-Undrgrnd.
10. Structural Floor System
11. Property Sewer Line & House Connection
12. Sewer Cap
13. Foof Drains ,
14. Rough Plumbing .
15. Rough Electrical-Conduit
16.:Rough Electric Wiring
17. Rough Wiring Sign
18; Rough Electriral-T Bar Ceiling
19. Rough Heating & Air Conditio�ing
20. Rough Factory Fireplace .
21. Ducts, in Structure
22. Ducts, Ventilating •
23. �Gas Pipe-Rough & Test
24. Roof Framing .
25. Roof Sheathing �
26. T-Bar Ceiling (Structural) & Monocoat
27. Frame and Flashing
28. Wthing & Siding '
29. Insulation
30. Drywall Nailing '•<-
�
31. Plaster Brown CoiY 'i
32. Electrical Power Meter-Final �
33. Final Electric
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy �
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final •
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
"43. Backflow Irrigation
v'44. Landscape Irrigation System
�45. Sound Attenuation
�46. Handicap Regulations
��47. FINAL STRUCTURE & BUILpING
48. Special Requirements Completed
49. Eiectric Release to Edison
m
�
e50. Gas Release to Southern California Gas Co
f51. CERTIFICATE OF OCCUPANCY
Date
Poo� - ��a
Inspector AppROVALS Permit #
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER-GUNITE
58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
61. APPROVAL TO DECK �
62. Backwash & Receptor-Final�
63. Heater & Vent-Final
64. Plumbing System � Final
65. Electrical-Final
66. Solar System-Final
67. Fencing & Access Approva7
68. APPROVED FOR PLASTERING
69. POOL/SPA SYSTEMS FINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit#
D�
70. Underground Hydro
71. Product Piping O Gas ❑ Oil
72. Underground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro '
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes: ie.Z / fi i�iw .. /.%f'. n� 1
0
Jo. Date
I I I �
Date - �I�spector
E
0
�
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Appllcant lo /ill in all spaces except t�ose wit�in neyfy ��per Iines anC sign all appro0��ate tleclantions.
CI7v oF COST,4 ME, �CONST ��IOcN PERM�5IT '
Project Address J K �
Applicant's Maiting Addr.es1s ZZ (�� S� �
Owner's.Name �j� /�✓ F ' Phone
Address Zl �CK� ���1/ds
ArchlEng. License No.
Address �����>
Convecror'z Nam � hon .OK�.Z.I�
Address (m '�' � � gi%ZZ �S(�� ���
City License No. 1 J8 97�
LICENSED CONTRACTOR DECLARATION
I hereby affirm lhat 1 am licensetl untler provisions of Charter 9(commencing
with sectlon 7000) o/ DIvlSion 3 Ot th¢ BuSiness an0 Protessions Cotle, antl
my Ilcense is in ful f� ana etfect. r /
Llcense Class d � �
Date��.�-�� Signature
WOHKERS'COMPENSATION D CLARATION � �.
� hereby af8rm thai I hava a certlticate of consent to selfvnsure or a certlficate.
t Workers' Compensation Inzurance, or a cer[ifietl wpY hereof ection/;
�800. Lab. C) �s � �O ,
Policy No. �L�/���� Company �
�Certifietl copy is hereby furnishetl.
Cer ❑er+1 ��a�� il¢tl with [he city �1 ng
�ate�2...� APPlican
EXEMPTION FROM WORKERS' P NSA ION DECLAR ION �.
(Thi55ection neetl not be compleletl if tM1e permit Is tor one hu retl (5300) or �
IC55�. —
I certity thal in [h¢ perfo�mante Ot tn< wOrk to� wnlch thls perm�t i5 issuetl, 1'
shall noi amploy any 0¢rson in any manne� so a5 to b¢cOme subject'JO.the
Workers' Compensation L. ws of CaliPomia.
Date S�9�aturo
NOTICE: If, al[e� mdkinq Ihiz tlucla�alian, y0u ShOUItl be[ome subjeGt t0 tlt0
Wo�kCrs' CompenSdtiOn provlslons ol th¢ Ldbo� Cotle, you mu5t torthwith
comply with suc� O�ovl5ion5 Or lhl: pe�mlt shall be Geematl �evoketl.
CONSTRUCTION IENDING AGENCV
1 hereby aHirm ihat [nere Is a constructlon lentlin9 agency for the pertorman<e
ot tne work for which Ihis perm(t iz Issuetl (Settion 3097 Clv. C.)
L.entler's Name
Lentler's Atltlrois 0 / � �'
OWNER BUILUEH UECLARATION
I nareby aillrm that I am exempt Irom tho Contractor's License Law for tne
/ollowin9 reason (Sectlon 7031.5 Businezs antl Profezzional [otle: Any city or
county which req Wms a permit to construtt, alter, improva, tlemolisn or repair
any sVucture, otlor to its Issuance, a150 reqWres the appllcant tor such permit
to ti�o a slgnetl statement that ne/sho Is Ilcensetl pursuant to the provisions o1
Ihe Con[raclOr's LICen50 Law (Chapter 9(COTmencin9 wllh 5¢ction �000) ot
� 7ivl5ion 3 Of the BusiOOis antl Professions- Coae� o� that he/zhe is GzOmpt
crefrom antl tne basis /or the alle9e0 axemption. Any violation of Sectlon
131.5 by any appllcant for a permit subjacts tne applicant to a civll
enally oi not mOrn ihan IIvO huntlretl tlolldri (5500).
'� I, as ownar of tna pro0erty o� my eTployees with wage5 ds tM1oir sole
compensalion, wlll tlo tne work, anE tna structure 15 not in[ontletl or ofteratl
�or sala (Soclion 7044, BuSiness antl 7rolezsional COAe: The Contrattor's
Llcense Law tloe5 nol apply lo an owner Of a property wtio builtl5 Or Improve5
thureon, antl wno tloes such work himsolt/narself or throu9n his or her own
employees, pwvltlCtl lhal Suth ImprOvemenl5 arG no[ Intentletl or oft¢retl 10�
sdla. If, however, Iho builtling or imp�avomint Is soltl within One yea� of com-
pletlon, tho owner wlll nava tho burtlen of oroving he/sho aitl not builtl or Im-
�rove tor [ha purposo ot salo).
I, as owner Oi llta proPorty, dm axclu5ively conlracting wi[n IlcenSetl con-
tractors to construct the pro)ett (Sectlon 7044, 6usinesi antl Profe55ion5 Code:
Tha- Con[ractOr's Licensa l�w does no[ apply to an owner of property who
builtls or Improves thereon, antl wno conVacts for such projeGts with a con-
tractor�s) ncense pursuant to tho Contractor's License �aw),I am aware that
p�o01 0( thelr Worke�'S Compensalion insurance shoultl be provlCetl to mu.
❑ I am ezempt under Seclion B. & P. C. for tni5 reason
� Date Owner
1 hereby Certil p� at I bave �ea0 Ibls ap0 ��ation antl state that the above
informa[lon iz coC!¢cL I aar@1'D comolv �h all tltv antl county artlinances
Signature�
Orivers' L�ense or SS �
G �� �
TYPE OF C�NSTRUCTION NEW ADD ALTERATION REPAIR'
� ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.p,.�6
, DESCRIPTION OF WORKIUSE OF BLDG.
S Main Building:
E
'TVPEOFPERMIT GRADING FOUNDATION STRVCTURAL T Front
�❑ TENANT � ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Reef
O Ol'HER C Right
. PROJECT DESCRIPTION Sq. FT. oCCVPANCv K
� CONSTRUCTION TVPE VALUATION S S Left
� 20NE GRADING CV. VDS. ACRES ping. ReL'/k
; Remarks: � �f (J�(�Cj Planning Notes:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers .
Dishwasher .
Drinking Fountains
• Floor Orains
Floor Sinks
Gas Service'.� , Outlets
Interceptors
Kitchen Sink
Lavatories
P-Trap '
Roof Drains �
�,�
Roin�paction Feo $15
Boiler
Duct-UnderGround
Duct - Structural
Duct - Ventilnting
ExheustSystem ❑ MWtiple
Firepl/Fact. BIL ICBO �p
Hea[ing System & Ducting
❑ a� oo,000 sru O i oo,000
Reinzpection Fee � S15
CMF 0865-46, rev. 30/84 White - Bullaing; Canary - Appliwnt; Pink - Accounting; Goltlenrotl - Assessor
Showers
Service Sinli
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping �
Solar Tank
Swimming Pool w�Spa
Urinal
Water poset
Water Heacer
Water Service
Auto�Wesh
laue Fee
Hood or Typel ❑
CanoDY Type I I ❑
Refrigeration System
❑0-t00,000BTU ❑100,000
SVs[em Repair/Alteration
Fire Dampers
Registers
Isue Fee
Automatic Washer
Construction Pote Sub. .
Cooking Unit
Dishwasher '
Dryers Gas ❑Elec
Fan
F.A.U.
Fixtures
Dev'
Outlets
' Switches -
' Garbage Disposal �
- Generetor 00�5 K ❑'
S 3
. Roinsaection Fee .
3957 3/13/87
/
_ 2one
Accessory Building:
Parking Req./Provided
ELECTRICAL
Transtormer ❑ 15�50 KW
� ' _ ❑ 50+KW ,
Meter LJup to 700amp��
Meter �over�100amps
Sub Panel
Motors �0.1.HP �1 A'- 8
InaSolar �9�15 HP �1645+
Pole Light
Range —
Standing Sections
Trash Compactor
$15'� � laue
DEVELOPMENT SERVICES REQUIREMENTS: �
Zoninp Approved By Date
Buildinp APP�a'red By � �� � Data
' 37,80 TL
FEES
/
S 3
� SUMMARV OF FEES
BUILDING PERMIT $ SMIP $
PIAN CHECK � $ PERMIT
PLUMBING $ ISSUANCE $
PLANCHECK 25% $ ENERGVP.C. $
ELECTRICAL $ .�.�, •� �J GRADING S
PLAN CHECK 50% $,lI - r F� � MICROFILM S
MECHANICAL § TOTAL FEE $ 3 7-��
PLAN CHECK 25% $
2
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CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector �� qPPROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ,
2. Soil Pipe-Undrgrnd.� 53. Steel R' orcement
3. Electrical Conduit UtilitY-Undrgrnd. 54. Forms �
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test . �
6. Electrical UFER Grnd. 57. APPROVAL TO COVER•GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System ' 61. APPROVAL TO DECK
i i. Property Sewer Line & House Connection � A 62:,"Backwash & Receptor-Final
72. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final �
74. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Cqnduit 66. Solar System-Final
.cRou h Elearic Wicing � Qyp 67. Fencing & Access Approval � �
17. Rough Wiring Sign - � 68. APPROVED FOR PLASTERING
'.18. Rough Elearical-T 9ar 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 77. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & 7est 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil -
25. Roof Shea[hing 74, Overhead Hydro
1�
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 �38�^ Tlc�. 80. FOOD CERTIFICATE ISSUED •
33. Final Electric ,j3�7 � L Notes:� 1,�,�� ���,� � ��� ���
34. Final Heating & Air Conditioning �Q�`�� �G p /v ��,�n 1 �y�io ..
35. Final Gas Pipe�Test �„��r �/��k. � c o c:
36. Hood or Canopy 1, �.
37. Final Factory Fireplace �3^g� �
38..Final Plumbing _ '
39. Water Service-Final t ' �- � �
40. Gas Service-Final ' � •
41. Solar pomesticFinal '
42. Backflow Preventer �� ,
43.�Backflow Irri9ation �
44. Landscape Irrigation System ' -
45. Sound Attenuation �
46. Handicap Regulations ' � r
47. FINALSTRUCTURE & BUILDING - � . ,
48. Special Requirements Completed �
49. Electric Release to Edison •
50. Gas Release to Southem Califomia Gas Co " • f
51. CERTIFICATE OF OCCUPANCY -� I
No. Date
�
�
� '' ADP�icant to fili in all spaces ezceD� those within neavY �orGer lines ana sign all appropriate tleclarations.
CITY OF COSTA MESA CONSTRUCTION PERMIT PERM� ry0'O� � TRACT NO. . LOT NO. UN�IT O. , .
ProjectAddress &�k&& 785 W, lIIth Street C � '
AppliCant'SMaUingAddress Rn?%�C}l2c_teT St/Stanton TVPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR
CI11R'Z F8'Chien � CONVERSION ❑ DEMOLISH ❑ OTHER q,p,#
Owner'sName Phone DESCRIPTIONOFWORK/USEOFBLDG. � apts TeS.
Address 18946 Vicki/Cerritos, CA 90701
Arch/Eng. Licenu No.
Address
co�t�a�cor'srvame Trinitv Electric, Incpno�e826-6979
Addresslmailing) 8022 Chester/Stanton�90680
Ciry License No. 38 �� 1 �
LICENSED CONTRACTOR DECLAR ON^- ^
I hereby aftirm that I am Iicensetl untl rovisio o t (co en in9
witn sec[ion 7000) ot Division 3 f t s n o lo
my Iicenze is in full forte antl eHect. � ���
WORK6'Ei5' C�MPENSATION DECLARA N
I hereby affirm tnat I nave a<ertliiWte of o enl to
�t Workeri' Compensation Insuranc¢, or a certiti<
saoo, �c. �16171023 �
Policy NO.
❑ Certified opy is hereby furnisnetl.
C� Certitie is illetl with [ho cit
Date �— Applicant
EXEF1P7f10 WFROM W00.KER5' COIOIPENSARION DECLARAT
(Thi55ection neetl not bC completetl if the p2rmit is for One buntl� (E300J ar
lezs). '
I certity that in the performance of the work for which this perm�t is issuetl I
shall not amploy any person in any manner so as to betome subject,to t�e
workers' Compensatlon Laws of Californla.
Dafe Si9nature
.NOTICE: If, af[e�.mdking Ihls.Cecla�allon,.you shOultl become sublect to [he
Wo�k¢rs' Compensation provi5ion5-Of tbe Labo� Cotle, you must forthwitn
compty with such provitions o� tbis permit Shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV '
I hereby affirm that there is a` ❑construction lentling agency for the pertormance
Of the wOrk for `�%�umlClsmpergitnls Issuetl ($ection, 3097 Civ. G.)
, Lentler's Name O O a lC
' LentleYSAdtlre55 2107 Atlantic Monterey Park 91754 _
OWNER BUILDER DECLARATION
I hereby af(irm that I am exemp[ from the Contractor'S License Law for the
following reason (Sectlon'� 7031.5 BuSiness antl Professlonal Cotle: Any city or
county which requi�es d pe�mit lo const�uct, dlt¢�, imOrove, tl¢molish or �epai�
any structure, prlor�[o its issuance, also reqWres the applican[ tor such permit
to tile a si9netl sWtement that he/she is Ilcensetl pursuant to the provisions of
the Contractor'S LlcenSe Law (ChaDter 9(Commencing with Section 7000) ot
�- Oivision 3 ot the BusinGss antl P/ofes5ion5 Cotle) or that� he/she is exempt
ierefrom antl the basis for the allegad exemption. Any violation ol Section
031.5 by any applicant for a permit subjects the appllcant to a civil
�+enalty of noi more than five huntlretl tlollars (5500).
LI I, as owner o/ the, oroperty or my employees witn wages az their sole
comDensdHon, will Oo Ih¢ work, antl thG Struc[u�e i5 not intentletl o� otf¢retl
for sale (Section' 7044, Business antl Prote55ional Cotle: The Con[ractor'S
License Law tloes�not apply [o an owner of a properfY who builtls or improves
thereon,.antl who tloes such work himselt/herself or throu9n his or her own
employees, provitletl [hat Suth imOrovCmentS dre not Intentletl or Offeretl for
sale. If, nowever, tne builtling or improvement is soltl wlthin one year o( com-
pletlon, the owner wlll have the burtlen of Orovinq he/s�e tlitl nol builtl or im-
�rove fo� the purPose o( Sale).
I, as owner Of tha prOperty, am ezclu5ively con[racting with IlcansGtl mn-
tractors to mnstruct [he project (Sectiom7044, Business antl Professions Cotle:
The ConVactor'S Li<¢n5e ldw d0¢5 not apply to dn owner o( Prop¢rty who
builds or Improves thereon, antl who contractz for such projects wlth a com
tractor(z) ❑cense puisuant to the Contractor's License Law). I am aware that
' proof of [heir Wo�ker's Compensation insu�an<¢ ihoultl be p/ovltl¢tl to me.
❑ 1 am exemp[ untler Section B. 6 P. C. for this reason
_ �� �
Date
I hereby ce� i
Information s
antl stat s
sentatives
inspection
$i9ndtu�e
Drivers' ' e !
CMF 0865-46, rev.
the.above
ortlinances
TYPE OF PERMIT U GRADING LJ FOUN�ATION LJ STRUCTV RAL
❑ TENANT �ELECTRICAL ❑ PLUMBING ❑ MECHAfJICAL
❑ OTHER '
PROJECTDESCRIPTION Sq. FT. ' ' oCCUVAraCv—
CONSTRUCTION TYPE VALUATION S
ZONE � 'GRADING CU. VOS. ACRES_
�arks: `/
3ar Sink . - ' .
3ackflow Preventer '
3ackfl w Irrigation
3aihtubs' � ; �
Clarifierz . ' .
Dishwasher � ' ' �
Drinking Fountains�
ROor Drains
Floor Sinks - �
Gas Service ,Outlets �
Interceptors
KitchenSink . _ _ ___
Lavatorie3 I �
P—Trep•
Roof Drains '
Reinspaction Fee $75
Boiler
Duct - Under Ground
Duct-Structurel '
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/FacL BIL ICBO #
Heating System &� Ducting
❑ ai oo,000 aTu O i oo,000 eri
Reinspec[ion Fee $15
Bulltling; Canary - Applicant Pink - Accouniing; Goltlenrotl - Assessor
Service Sink -
Sewer Cap '.
Sewer Connection '�
Soler Collectors
Solar Piping � �
Solar Tank
Swimming Pool w/Spa
Water Closet
Water Heater
Water Service
� Auto-Wash
Laundry Trays �
Issue Fee
IANICAL
Hood or Typel O
Canopy Typell ❑
Refrigeration System
❑4100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
laue Fae
/
S Ma�n Building:
E
T Front
A fiear
C Right -
K Left
S
Ping. Ref. #
Planning Notes:
���� 4U•5U
. 2on8 :
Parking
PEES �
� � - � ELECTRICAL � .' �
�
Automatic Washer . Transformer ❑ 15-50 KW
� Construction�PoleSub � 50+KW
Cooking Unit ,
Dishwasher �
Dryers �Gas ❑Electric� ,
Fan l
F.A.U.
Fixtures ' '
Device Boxes �
�UL12[5
Switches-
Garbage Disposal
Generator �0.5 KW 05-75 KW
Meter Llup to 100amps
�Meter ❑over.100 a�mp�s
Sub Panel'"ir. �flJ 5
Motors�0-1;HP�1%-8l ,,
Inc.Solar �9-75 HP 0�6-15+
Microwave
Pole Light ' � �
Range
Sign ''
StandingSections � ��
Trash Compactor
. i./
Z
O
N
I
N
G
R
E
Q
M
• T
S
FEES .
. a�
Reinspection Fee �$15 luue Fee $ 3
FEES
DEVELOPMENTSERVICESHEQUIREMENTS: � - � �
� Zoning Approved By Date
� Building Approved By � /� Date���/�q/�//��
Application laued By- {/�/ � ' DateLY!_2f{.¢3[t.
t--_"'—
SUMMARV OF FEES . -
BUILDING PERMIT $ SMIP $ -
PLAN CHECK $ PERMIT _.
PLUMBING $-� � -�SSUANCE $
PLAN CHECK 25% S� ` ENERGV P.C. $
� ELECTRICAL' � $ � . � GRADING $
' PLAN CHECK 50% $�.�• Sa MICROFILM $ �
, MECHANICAL _�$ TOTAL FEE s �•sa
$ 3 - PLAN CHECK 25% $ � �
CONSTRUCTION AND PLANNING •, POOL & SPA. .,
APPROVALS Permit # Date Inspector qpp,ROVALS Permit # Date Inspector
�.
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ,
2, Soil Pipe-Undrgrnd. 53. Steel Reinforcement '
3. Electrical Conduit Utility-Undrgrnd. �(�-¢"] /�(� 54. Forms .
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding �
5. Steel Reinforcement ' 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVALTO COVER-GUNITE
7. Footings , 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test '�
9. Water Pipe�Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 67. AP.PROVAL 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 Electriral-Conduit 66. Solar System-Final �
16. Rough Electric Wiring 67. Fencing & Access Approval �
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �
20. Rough Factory Fireplace APPROVALS Permit # ' _ .
21. DuCts, in Structure 70. Underground Hydro ;
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe�Rough & Test ' 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
� 25. Roof Sheathing � 74. Overhead �Hydro ,
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical �
27. Frame and Flashing . 76. Dry Standpipe '. �
28. Lathing & Siding 77. FIXED SYSTEM FINAL "
29. Insulation 78. FIRE PREV. FINAL •�'
301 Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION '
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric ��/f:j ��' Notes: V
34. Final Heating & Air Conditioning �
35. Final Gas Pipe-Test - . ,
36. Hood or Canopy - '
37.�Final Factory Fireplace • •
38. Final Plumbing . � � � •
39. Water Service-Final � , � -
40. Gas Service-Final � ��' �
41. Solar pomesticFinal �� �
42.� Backflow Preventer � � •
43. Backflow Irrigation ,' , .
44. Landscape Irrigation System , � . •
45.'Sound Attenuation
46. Handicap Regulations � .
47. FINALSTRUCTURE&BUILDING � _
48.'Special Requirements Completed ' - '
49. Elearie Release to Edison ' . '�
50. Gas Release to Southern California Gas Co ,� .
51. CERTIFICATE OF OCCUPANCY
No. Date .
AVo�icant to till in all spaces exceot ihosa within neavy eoraer Ilnes antl sign all aDD/oprlate tleclantions.
CITY OF COSTA MES O-NyS�TR,�,U�C�TION PERMIT{ PEFMIT NO. TRACT NO. LOT NO. UNI,j NO.
Project Addresz � g� QW"» � • �8�� � '
Applicant's Maising Address
Owner's fVame � Phone
Address
Arch/Eng. License No�� ��A�
Addresslmailingl �/ •`� n �"^
City License No. ( � 7_�
LICENSED CONTRACTOR DECL/�RATION
1 nereby affitm [ha[ I am licensed untlar prOvisions of Chart¢r 9(COmTondng
with section 7000) ot Division 3 of the Busineis antl Profe551ons Cotlo, anC
my Ilcense is in full tarce antl effect. 1 1J
License Class d LI nsa No"�`�� �
Date`�. t i ��IgnaWre �-
WORKERS' COMPEN ATION DECLqRAT10N
1 hereby affirm tnat I have a certiticdte ot consent to 581t-insure or a cartHicate
�t Worker5' Compensation Insuran�e, or a ter[itietl coOY tnereof (Sectlon
1800, Ldb. CJ
Policy No. Company
Certifietl copy is hereby furnishetl.
Certitietl copy Is tiletl with [he city BuilEing DiviSion.
Date • Appliwnt
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This sec[ion neetl not be comDle[etl i� the permit Is for one huntlretl (E300) or
less).
I certity Ihat in the pe�lotmanGe Of the wo�k fOr whlch this pe�m�t i5 iSSu¢d, 1
shall not emplOy any p¢rsOn In any mann 50 as b¢com< Subjecl to lhe
Worker2CompensaUnn�Laws o! Californ /
�ate=��� tiTSi9nature � -•^���
NOTIGE: It, after making this tleclar5tion, you shoul become sub�ect to the
Workers' CompensallOn provi5ion5 Of tne Labor COtla, y0u must forthwi[b
comply with such provisions or this oermlt shall be tleemetl ravoketl.
CONSTRUCTION LENDING AG@NCV
I nureby aHirm�that tnere is a constr�ction lentling agency for the Porformanco
o( [he work for which tnls Oermit is issuatl (Sectlon 3097 Civ. C.)
Lander's Name
L,ontlar'S Atltlress
OWNER BUILOEN UECLARATION
I he�eby afflrm that I dm ¢xempt }rom th0 ConVdttO�'s LlcenSC Law for the
followin9 reason (Sectlon �031.5 �u5iness anG Pro/essional COGe: Any city ar
munty whlcn r<quiras d permil l0 GOnstruct, dlttr, ImprOve, Uemollih or reDdir
anY s[ructure,�prior to its issuan<e, also requires thu applicant tor such permit
to flle a signetl statemont that he/she iz Iicnnsetl pursuan[ lo Ihe provlsions o(
the Contractor's Ucense law (Cnap{er 9(commancing wl(h Section 7000) of
DIVI51on 3 Of the Buslno55 antl Prp�ession5 COCe) or thal he/she i2 axampt
�orofrom antl the basis for tne allegetl exomPtlon. Any violaUon of So<tlon
)31.5 by any applicant tor a permit subjects the applicant lo a clvil
cnalty of not more than hva M1untlr¢tl tlollar5 (5500�.
❑ I, ds own¢� oi tho property or my amD�oY�es wlth wages a5 tbei� 5018
compensation, wlll tlo tnn wo�k, aqtl tha S[ruCtU/e is not intentletl or otferetl
lor sale (Sectlon 7044, Busine5s antl Pr01855iondl COtle: The Contrdctor'S
� License l. w tloei not aOPty to an owner ot a proPerty who bulitls or improves
i'thcroon, antl who tlaes such work himself/norself or throu9h his or ner own
' em01oy ees, provitletl that such improvements aro not Intentletl or ottarotl for
581C. If, howeveq th¢ bUlltli09 ot iry�provamBnl IS soltl wltnl0 One yea� ot COm-
pletlan, the owne� wlll hdva Ihe by�tlen Of P�ovin9 hC/Sh¢ tlitl nOt builtl o� Im-
plova for [h0 purp050 Ot sale).
❑ I, as owner oi the property, am excluslvaly Conlractin9 witn Iicensetl con-
traCtoR f0 mnstrucl lha project ($ectlon 7044, Busin055 antl Profes5ion5 Cotle:
The Contractor's l_icense Law do@s nOt apply lo an own¢r of proporly wh0
bullas or Improves thureon, antl who conlracts for such projects with a con-
tractor(s) Imense pursuant to tna Contratfor'z Litonse Law). I am aware that
proo/ o( thei� Wo�k¢�'s COmpenS;tiOn InSu�anGe Shoultl be provltletl t0 me.
❑ I am exempt unaer Sectlon B. 6 P. 0.�or [his reason
Date —
I hereby
Inbrmati
antl state
sentalive5
insoettlor
Slgnatu�e
Owner
�[hai I have reatl this applica[ton antl state tbal tne abova
orrecL I agree lo comoH with all clty ana countY ortlinances
elating to builtlm9 construction, antl hereby authorize repre-
I q7city lo enter Upon the above-mentionetl p/op¢rty fOr_
/(�"t�—��''`-.'� Dair� �/ �7
or 55 � �.� /� �
I�-( 1 --FF
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.p..�6
DESCRIPTION OF WORK/USE OF BLDG.
S Main Building:
E
TYPE OF PERMIT GRADING FOUNDFTI}O�N STRUCTURAL T Front
� ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING .c_YMECHANICAL A Reaf
❑ OTHER
PROJECT DESCHIPTION ,S4.F7. oCCUPnrvcv C Right
K
CONSTRVCTIONTVPE VALUATIONS S Lef�
ZONE GRADING CU.Y�S. ACRE5 Ping. Ref. dk
Remarkz: %� � Planning Notes:
Sink
Preventer
Irrigation
Claritiers
Dishwasher .
Drinking Fountains
Floor Drains �
Floor Sinks
GasService Outlets
Interceptors
Kitchen Sink -
P-Trap
Roof Drains
Reinspection, Fee $15
Duct�UnderGround
Duct - Structural
Duct - Ventilating
Exheust System ❑ Multiple
Firepl/Fact. Blt. IC80 #
Heating System & Ducling
�00,000 BTU 0100,000
Reinspection Fee � $15
CMF 0865-46, rev. 30/84 White - Buildinq; Canary � APPiiwnt: Pink - Atcounting; Goltlenrotl - AsseSsor
Showers
Service Sink
Sewer Cap - � '
Sewer Connection
Solar Collector5
Solar Piping
Solar Tank
Swimming Pool wlSpa
Urinal
Water Closet
Water Heater '
Water Service
Auto-Wash
Laundry Trays
Isue Fee
IANICAL
Hoad or Typel
Canopy Typell ❑
Refrige ion System
-700,000BTU ❑100,000
System Repair/Alteration
Fire Oampers
Registers
Iszue Fee
FEES '
$ 3
2�%% 2���/8%
Zone
Accessory Building:
Parking Req.IProvided
0
� ELECTRICAL
Automatic Washer Transformer ❑ 15-50 KW
Consvuction Pole Sub. � 50 + KW
Cooking Unit • Meter ❑up to 700 amps
Dishwasher Meter ❑over100amps
Dryers ❑Gas ❑Electric Sub Panel
Fan Motors �47 HP �1'h - B
F.A.U. Inc.Solar �9-15 HP �16-15+
Fixtures Microwave
Device Boxes � Pole Light
Outlets � Fange
Switches Sign
Garbage Disposal Standing Sections
Genera[or DO-5 KW �5�15 KW Trash Compacror
64088
FEES
2
O
N
I
N
G
R
E
Q
M
T
5
I Reinspection Fee �$15 � I Issue Fee � 5 3 I
DEVELOPMENT SERVICES REQUIREMENTS:
Zonine Approved By Date
Buildine APProved By Date
Appliwtion Issued By '� Dat�
SUMMARV OF FEES -
BUILDING PERMIT $ SMIP $ -
PLAN CHECK $ PERMIT
PLUMBING - $ ISSUANCE 5
PLAN CHECK -25% $ ENERGV P.C. S
' ELECTRICAL ' $ GRADING S -
� PLANCHECK 50°,6 $ �— MICROFILM $/
MECHANICRL §]J r�L• b TOTAL FEE $"�'��
PLAN CHECK 25% $ �� c� �
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2, Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms �
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding -
5. Steel Reinforcement . 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. • 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structurel Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final '
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar SYstem-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wirin9 Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS F�INAL
19. Rough Heating & Air Conditioning ��7 FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace �� APPROVALS Permit # _ �
21. Duc[s, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
�
24. Roof Framing 73. Undergrnd. Storege Tank O Gas ❑ Oil ��
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing ' 76. Dry Standpipe
28. Wthing & Siding 77. FIXED SYSTEM FINAL .
29. Insulation 7S. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaste'r 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 � p •
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 � � � ,
i. ' �
49. Electric Release to Edison � • �" �
�.�
50. Gas Release to Southern California Gas Co . •
51. CERTIFICATE OF OCCUPANCY
No. Date �
Applicant t0 fill in all ipaees except
CiTvoFCOS7A ESJ�A �ENSTRUCT�ON�PTRMIT
Project Address ����
Applicant's Mailing Address �
Owner's ame
Address
Arch/Eng. C'�(I �` r� �� License No.
Address
Contractor s Nart� � ne ��
Addresslmailing) /��3
City License No., / �� % ���
LICENSED CONTRACTOR DECLARATION
I hereby aifirm that I am licensetl untler provisions ot Charter 9(commentlng
with section ]000) of Divislon 3 ot the Business antl Profe55ions Cotle, antl
my Iicensa is in ull for<e ana eftect. �
Lic �s I� � � L.icenseNo:_ �
Dai Si9nature� �_
WO KE 5' C MPENSATION DECLAR TIOP �
1 nereby afflrm thabl have a certiticate q� conse t lo self-insure or a certificate
of Workers' Compensa[ion Insurance, o� a certifietl copy fhereof ($ectlon
3000, Lab. C.) '
Policy No. Company
eCertifietl <opy is hereby furnishetl. '
Certifietl copy Is filetl with the city 6Wltling Dlvision.
Date � ApPlicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thiz section neetl not b¢ compleletl if [he permit i5 for one huntlretl (5300) or
lesz).
I C¢rtity that in the perfOrmance ot th¢ H.ork f r which thi5 porm�t I5 issuetl, 1
shall nol D�oy any person in any man a to; ec' ome s ct to the
Worke C e tion Laws of Calito a
Date Signature K'"^
NOTIC : f, aft r ma n9 this tlecla�ati0n, you sh Id become subject to the
Worke�s' COmpensation Provision5 Of the Labo� e, you must forthwith
comply witn juch provisions or �tnls permit zhall be aeemetl revoketl.
CONSTRUCTION LENDING AGENCV
1 hereby afflrm that there is a wnsbuctlpn lentling agency for the performance
of the wark for,which this permit is issuetl (Section 309� Civ. C.)
Lentler's Name
Le�tler'S Atltlress
OWNER BUILDEH DECLARATION
I hereby atiirm that I am exempt lrom the Contractor's Llcenze Law (or tne
fallowing reason (Section ]031.5 Busi�ess antl Protessional Cotle: Any cl[y or
county which �equires a permlt to cons(ruct, alter, improve, Gemolisn or repair
any structure, prior to its issuance, also requires the applicanl for such permil
to fil¢ a slgnGO siatement lhat he/ShC 15 li[en5¢tl pu�suant t0 the provl51on5 Of
tM1e ConVdctor's License law (Chapler g(commentin9 �+�th Section 7000) oi
Division -3 of the Business antl Professions Cotle) or that he/ihe is-exempt
�Iterefrom antl [he basiz for (he alle9etl exemption. Any violatlon ot Sectlon
031.5 bY any applican[ fot a•perrv�i[ subjects the appllcant to a cfvil
=ndlty of not more Ihan five huntlretl tlollars ($500).
L� I, as owner of the property or my employees with wages as thelr sole
Compensation, will tlo the work, antl the structure is not Intentletl o� offeretl
ior sale (Section 7044, Business antl Professlonal Catle: The Contractor's
� License Law tloez not'appy to an own6r of a property who builtls or improves
[her¢on, dntl who tlo¢s such wo�k himselt/h¢rseH or through hi5 0� h¢r own
employees, provitletl that such improv@ments are mt intentletl or offeretl tor
sale. If, however, the bulltling or imprp�emenc is soltl within one year of com-
pletion, the owner will have tne burtleh of proving M1e/she tlitl nOt builtl o� irn-
prOve for the Ourpose of sale).
❑ 1, as owner of tne proper(y, am exclusively contracting with Ilcensetl con-
t�aG[o�5 to cOnstruct the Orojec[ (5¢Clion ]064, Business antl ProlesSions Cotle:
The Conlractor's License Law tloes �ot apply to an owner o! property-who
builas or improves thereon, antl who contracts for such orojects with a con-
VactOf(51 Iltense pursuant to.[Ile Con[rdCto!'s LicenS¢ l.dw�. 1 am aware [ha[
proot of thei� Wo�ker'S CompenSdtioq insuranca Shoultl be provitletl [o m¢.
❑ I am exempt untler-$ection B. & P. C. Po� Ih15 r¢ason
Date Owner
1 hereby cer[ify that I have reatl [his applicati
infOrmation Is m�recL I agree to Comply w�th a
antl sta[e'laws relating'to builtling coqstru<tlon
sentatives oi�y��s city to enter upoh the �b
InspeCtiony[yUU�s. •_ . /% � _ .
tha[ the above
within heavy eoraer Iines ana sign all appropNate tleclarations.
..iACT NO. LOT NO. UNIT NU.
v"z8��� �
TVPE OF CONSTRUCTION rvEW ADD
❑ CONVERSIOM ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG. _
TVPE OF PERMIT �J GRADING
❑ TENANT ❑ ELECTRICAL
❑ OTHER ..
ALTERATION LJ REPAIR
NDATION CJ STRUCTURAL
BING ❑ MECHANICAL
PROJECT DESCRIPTION 5�. Fr. ocCvanNCv
CON STRUCTION TVPE VALUATION $ _
ZONE GRA�INGCU.YDS. ACRES_
Remarks:
Sink �.
cflow Preventer
<flow Irrigation
Drinking Fountains
Floor Drains
Floor Sinks '
Gas Service
Interceptors '
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspaction Fee
a
Duct - Under Ground '
Duct - Strucwral � •
Duct - Ventilating
E.haust Sysrem ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Oucting. �
❑0.100,000 BTU 0100,OOOBT
IDY e s LI se ����%; '�� ��_�__�T I I Aeinspection Fee I $15
CMF 0865�46, rev. 30/84 White - Bulldlqg: Canary - Applicanq Pink - Accountin9; Goltlenrotl - Assessor
Showers
Service Sink
$ewer Cep'
Sewer Cannection ' -
Solar Collecrors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Cbset
Water Heater
Water Service �
Auto-Wash
LaundrY Troys
Issue Fee
Hood or Type I ❑
Canopy Typell ❑
Refrigeration System
❑0.100,000 BTU ❑100,000 BT.0
System Repair/Alteration
Fire Dampers
Registers, ,
laue Fee
$ 3
FEES
$ 3
A.P. #
S Main Buildi
E
T FrOnt
B Rear
A
C Right
K Left
S
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction PoleSub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elec
Fan
F.A,U.
Fixtures
Device Boxes
Outlets
Switche5
Gar6age Dispoul
Generator DO-5 KW [
9424 6/IC/E7
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL -
Transformer O 15-50 KW '
❑ 50+KW
Meter ❑up to 700 amps
Meter ❑over100amps
Sub Panel � '
Motors � 0-1 HP � 1 h- 8 .
Inc.Solar �g-15 HP �16-15+
Microwave
Pole Light.
Range '
I I Standing Sections
5 KW I I Trash Compactor
A
� Reinspectian Fee �$75 I I luue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved By
Aooliptian Issued Bv
50�]" TL
FEES
$ 3
. SUMMARY OF FEES
BUILDING PERMIT $ SMIP $
P,LAN CHECK $ � PERMIT
PLUMBING $ S• a O ISSUANCE $
PLAN CHECK 25% S ENERGY P.C. $
ELECTRICAL • � GRADING $
PLAN CHECK 50% $ MICROFILM $ '
MECHANICAL $ TOTAL FEE $ S.p p
PLAN CHECK 25% $
2
O
N
I
N
G
R
E
Q
M
T
S
CONSTRUCTION AND PLANNING . POOL & SPA
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical`Service or Pole 52. Pool & Equipment Locaiion
4•
2. Soil Pipe-Undrgrnd. , . � 53. Steel Reinforcement '
3. Electrical Conduit Utility-Undrgrnd. � �54. Forms '
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding '
�
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVALTO COVER-GUNITE _
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test .
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor SYstem � 61. APPROVAL TO DECK �
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final �
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar SYstem-Final '
16. Rough Electric Wiring 67. Fencing & Access Approval �
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning �'FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace ' APPROVALS Permit #� _
21. Ducts, in Structure 70. Underground Hydro -
22. Ducts, Ventilating 71. Product,Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing ' 73. Undergr�d. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro ��
26. T-Bar Ceiling (Structural) & Monocoat ' 75. Dry Chemical '
27. Frame and Flashing 76. Dry Standpipe , � �
28. Lathing & Siding 77. FIXED SYSTEM FINAL -
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat �F 79.� FINAL INSPECTION '
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED -
��
33. Final Electric � ' -.;. Notes:
34. Final Heating & Air Conditioning ' i'
35. Final Gas Pipe-Test � ` - -
.:.
36. Hood or Canopy .. �
, ".
37. Final Factory Fireplace : _ , ,- ,
38. Final Plumbing ' ' ' � � � �
�39. WaterService-Final , . � � �' ' �,-
40. Gas Service-Final � ' - ' .'
. :i::y .
' 41. Solar pomestio-Final � - � � �>. � ' '
.�
iA2. Backflow Preventer � .. '� ..
'43: Backflow Irrigation }� � - . � �
o s7 �/� . '.:.
44. � Landscape �rrigation System / r � - - • •
�45. Sound Attenuation _. " ' � '" �S
, . �
• 46. Handicap Regulations _ �
47.�FINAL STRUCTURE & BUILDING � ' ; ,.
48. Special Requirements Completed '� . ' `t "°
49. Electric Release to Edison � � �
'i
50. Gas Release to Southern California Gas Co , :'
51. CERTIFICATE OF OCCUPANCY � '+*-' �
No. Date
CITY OF COSTA
.
Project AddresS _.
Applicant's Maaing
. 1 (�
CONST
Address
Arch/Eng. /LicenseNo. (�,•� ��fi�0
Address
Convactor's Name ��HN� ��3G' Phone ��ff 337�1
Addresslmailin9l� Z D [ Y/IVE.(/-st. (v�C'iST'(�O✓/.tlR .
City License N0. - � 7
LICENSED CONTRACTOR DECLARATION
I hereby aHbm that I am licensetl untler provi5ion5 of Charter 9(commencin9
with SeCtiOn �000) of Division 3 Ot the Business antl Pro(eszions Cotle, antl
my IicenSe i5 in �ull (o�4P d tl etfe<L • �� ��yf
License Class �' Li<ense ryo. �
oace /O-2z-� Sie t '� ,.Y. A.,,/ .,,,✓ �
WORKERS' COMPENSATION DECLAqAT10N �
1 hereby affirm that I have a certificate of consent to xelf-insure or a terti/icate
rt Workers' Ctlmpen5ation Insurance, or a certidfi"etl copy thereof (Section
3800, Lab. G)n ,? /n` 3, ' comeanv �""""� �����
PolicY No. rC'�
8 CertifieC copY i5 hereby /urnishetl. �
Certifietl coOY �s tiletl with the city 6u}�� � DI IOD '
Date "zZ APPlicant V ([� � � Mn��
EXEMPTION FRpM WpRKERS' COMPENSATION EGIARATION
(Thi55eCtion neetl not be completetl if tnC permit is for one hundred ($300) or
Iess).
I certity thdt in the perto�mance of the �+ork tor whicn [his p¢rT�t is issuetl, 1
Shall noi BmploY any per5on in any mann¢r so a5 to become 5ubjeCt to the
Wo�ke�s' CompC�saUon Ldws of Calitolnia.
Date Si9nature
NOTICE:.If, after makin9 this tleclaratlon,youu shoWtl become subject to tne
Workers' COmpensation provisions ot the Labor Cotle, you must fortnwitn
Compty wi[h Such prOviSions or thi5 PerTlt Shdll be tleeTetl revoketl.
CONSTRVCTION LENDING AGENCY
I hereby at/1rm that there is a constructlon lentling agency tor the performance
of the work for whicn this permit is issuetl (Section 309�` Civ. C.)
Lentler'S Name ,
LentlGr'S Atltlre45 �
OWNER BUILPER bECI.ARATION
I hereby aitirm that I am ezempt from tne Contractor's License Law'for the
followin9 reason (Section 7031.5 Buslness antl Professlonal Cotle: Any city or
county wblch �equir¢5 a Oe�mit to ConS�ruct, alter, improve, tleTollSh o� �epair
any structur¢, priOr to its i55Uance, also requires tlte applicant (or Suth p¢�mi[
co fiie a signetl statement that he/she is licensetl pursuant to the provisions of
the Contractor's License Law (Chapt¢r 9.(wmmenUn9 with Section 7000) ot
7ivision 3 ot the Business antl Profe55�on5 Cotle) or that he/she is exemOt
ierehom�antl the busis for the alleqe0 exemption. Any violation ot Section
031.5 -by any applicant for a permlt subjects [he applicant to a civil
�enalty ot not q�ore tnan five hundretl dollars (5500).
LJ I,' a5 Owner of tM1a property or my employ¢O5 with wag85 as their sole
compensatlon w��l tlo Ihe work, and tbe structure Is not intentletl or offeretl
for sale ($ec{iP� �044, Business antl Professional GoOe: The Contractor's
LicenSe law tlOes not appty to an owner of a property who builtls or improves
thereon, antl Who tloes such wo�k himselt/herself o� through nls o� he� own
employees, pro��tletl tna[ such improvement5 are not intentleG or O/feretl for
sale. If, nowev6�, the builtlinq or Improvement is soltl wlthin one year of com-
pletlon, the oWne� wlll have the burtlen ot proving he/she tlitl not,builtl or im-
prova fo� tne ONrpoSe of Sale). ,
❑ I, as owner of the property, am exclusively contratting wi[n Iicense0 con-
tractors to construct the project (Section 7044, Business ana Pro�essions Cotle:
The ConVactof'S License l.nw dOes nOl apply [o an owner of P/o0e�ty who
builtls or Imoroves tnereon, antl who cantracts tor such projects with a con-
traclo�(51 IicenSe Pu�suant to the ConVactor'S LicenSe �aw). I am aware that
proof of their Ydorker's Compensation insurance sboultl be provitletl to me.
❑ 1 am.exempt untler 5ectlon B. & P. C. tor this reason
,pplicant to fill in all spaces exceD� those within heavy eoider Ilnes an0 sign all aDProo/���e tleclarations.
PE D�C?�/�� TRACT NO. LOT NO. UNIT NO. . �
oS y
� TYPE Of CONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION� ❑ DEMOLISH ❑ OTHER A.p �6 ,
DESCRIPTION OF WORK/USE OF BLDG.
' � ' S Main Buildl
TYPE OF PEHMIT GRAOIrvG� �l1NDA710N STRUCTURAL T Front
❑ TENANT ❑ ELECTRICAL L�J�VMBING ❑ MECHANICAL � B Rear
QS/ � ❑ OTHER � A
PROJECT DESCRIPTION Sa. Fr. � OCCuaArvcY C- Right-�
CONSTRVCTIONTVPE VALUATION§ g LCft
ZONE GRADING CU. VDS. ACRES p��9 qef �
Remarks: � • a (� (,� Q Cy� (i �v / n �� / , � Planning Notes:
Date Owner
I hereby certitY that f have ieatl this application antl state tnat tne above "
Intormation is Gorrect. I agree [o comply with all tlty antl countY ortlinances
antl state laws �eiating to building conSVuction, antl hereby au[horize repre-
sen(d[Ives ot this city to enter upOn the above�mentipnetl P�operty to�
inspectlon pur se , '
Siqnature �ate ���"� 3
�Drivers' Llcense or 55 � � - � "
Bar Sink
Backflow Preventer
Backflow Irrigation
Dishwasher ' '
Drinking Fountains
Floor Drains
Floor Sinks
GasService '�'Y
Interceptors '
Kitchen Sink .
Lavatories '�,d. ^b
P-Trap
Roof Drains
Reinspection �Fee
$15
Boiler
Duct-UnderGround �
Ducl - Strucmral
Duct - Ventilating
Exhaust5ystem ❑ Multiple,❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑P700,000 BTU �100,000BT
Reinspection Fee I $15
CMF 0865-46, rev. }0/80 � White - Builtling: Canary - Applicant; Pi�k - Accounting; Goltlenrotl - AszeSsor
NBING •
Showers '
Service Sink. �
Sewer Cap
Sewer Connection
Solar Collectors _
Solar Piping
Solar Tank
Swimming Popl w/Spa
Urinal
Water Closet � � `��
Water Heater
Warer Service . .
IssUe F¢e
Hood or Typel ❑
Canopy Type II ❑
FEES
e
Auromatic Washer �
- ConstructionPoleSuh.�
- � ' Cooking Unit -
� Oishwasher
Refrigeration System
❑0.700,OOOBTU ❑100,000
System Repair/Alteration
F ire Dampers
Registers
laua Fee
Ury¢!5 LJU85
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
$WitChes -
Generetor
�
5792 10/23/@6
Zone
Accessory Building:
Parking Req./Provided
� ELECTRICAL .
' Transformer ❑ 15-50 KW
JElectric •
I
KW �5-15 KW
.� '�.SO+KW
Meter �up to 100amps
Mecer ❑over 700 amps
Sub Panel ' �
MotorsO0.1 HP�1'/:-8
Inc.Solar �9-15 HP �16-75+
Microwave
Pole Light "i;
Ranae . .
Standing Sections �
Trash Compactor
$ 3
Reinspectiun Fee $15 Iuue Fee
FEES
�DEVELOPMENTSERVICESflE�UIREMENTS: ,
Zoning Appraved By
Buildi�g APProved By '
Aoolication Issued Bv— -_ 1 n
$ 3
' - SUMMARVOF
BUILDING PERMIT $
PLAfV�CHECK � $ _�_
PLUMBING � $
PCAN CHECK 25% 3 �
ELECTRICAL $� -
PLAN CHECK 5096 $
MECHANICAL � $
PLAN CHECK 25% $
138.00 TL
1
FEES
n
$ 3
Z
O
N
I
N
G
R
E
�
M
T
S
SMIP $
PERMIT
ISSUANCE $ -
ENEPGV P.C. $ -
GRADING $
MICROFILM S
TOTAC FEE $ �
CONSTRUCTION AND PLANNING POOL & SPA .
APPROVALS Permit # Date Inspector qppROVALS Permit # � Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location � '
2. Soil Pipe-Undrgrnd.� ���y�s+� E 53. Steel Reinforcement _
3. Electrical Condui[ Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding -
5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test. � �
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings . 58. Electrical Conduit-Undrgrnd. '
8. Foundation .- 59. Gas Pipe, O Undrgrnd., Test �
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System . 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final �
� 13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final .
15. Rough Electrical-Conduit 66. Solar System-Final � ,
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL ,
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #' _ ,
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72, Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing � 74. Overhead Hydro ,
26. T-Bar Ceiling (Structural) & 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
37. 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 �.Jr.�� GEQ i
36. Hood or Canopy
37: Final Faaory Fireplace
38. Final Plumbing 7`���1 �,�'yp
39. Water Service-Final
40. Gas Service-Final �
41. Solar pomestio-Final ' �
42. Backflow Preventer .
•43. Backflow Irrigation ,
44. Landscape Irrigation System ,
45. Sound Attenuation� �
46. Handicap Regulations . � �
47. FINAL STRUCTURE & BUILDING � � � ,
48.'Special Requlrements Completed
49. Electria Release to Edison . �
50. Gas Release to Southern California Gas Co ' .
51. CERTIFICATE OF OCCUPANCY �'
N0. Date �
�
CITY OF COSTA MESA . '
CONSTRUCTION PERMITn
ProjectAddress• � W • 3'
Applicant's Mailiny]`��d,drpss '
Owner's Neme � `�`f�'r � � Phone 6y6 � �-�,
Addreu
Arch/Eng. License No.
Address
Contractor'sNam ac+�F��C [ ej! phones���y��
Addresslm �i' „1 ��� �-�%� G✓rl.ono
City Lic>nsc No. � ���
� LICENSED CONTRACTOH DECLARATION
I hereby af�irm th censetl untlar provisions of Charter 9(commencing ,
with sectlo 0 ' 3, of the Buslness antl Pmfesslons Cotle, anA
my Ilce is�i II force en e � �"�,p9�
uce e Cla�s � ��[�� cense No. ��
Dat 11/� ��. . t. �71a7��G!/�� _ _
'�ORKERS' COMPENSA710N DECLARATION
iereby affirm thal t have a certlfica[e ot consent lo self-inSure or a certificate '
./ Workeri' Compensatlpn insurance,'Or a certlfietl copy thereof (Section
3800, Lab. C. /} ' 7
Policy No. � 3 7�� - Company ��^
Cer[ifietl copy is herehy furnisnetl.
�tlfi¢tl c p filetl �yjth ihe city ItlI Iv' � '
Date f.7��_ APPlicant � � � �
EXEMPTION PROM WORKERS•�COMPENSATION DECLARATION' '
(This section noetl not be mmple[etl if tne permit is for one huntlretl ($100) or
less).
I certlfy tha[ in the perfp�mance of th¢ work fOr whlch th15 perm�t i5 issuetl I'
shall not omploy any person in any mannar so as to become subject to t�e �
Workers' Compensatlon Laws of Califomia. . '
Date 99�ature -
NOTICE: If; atter making Ihis tleclaracion, you shoultl become subject to the
Workers' Compeuwtion provisions of the Labor Cotle, you must forthwith—
comply wltn such provlsionz or this permit shall be tleematl revoketl.: �
CONSTRVCTION LEN4ING AGENCV -
1 hereby"afflrm that there is a constructlon lentling a9en<y /or the pertormance 1
of the work tor whlCh [his permit is Issuetl (SecHOn 3097 Civ. CJ
Lentler's. Namx
Lentler's AtlEress � ' � '
' OWNER BUILDER DECLARATION � �
I hereby a(Brm that 1 aeq exempt ftom the Contractor's License Law for the
following reason. (Saclio� 7031.5 Busina55 antl Pro(essional Cotle: Any city or
county whl<h requires a permit to <onstruct, alter, improva, tlemolish or repair
any scructure, prior to its issuance, also reqWres the appllcanl for sucn permit
,So fil¢ a slgnetl Stal¢ment that he/she i5 licensetl pu�5udnt t0 the p�ovi5ion5 oT -
^ Con[rattor•s Licenu �w (Chapter 9(commenUng with Section ]000) of
rision 3 of the Businpss antl Professions Cotle) or that ne/she is ezempt
:refrom antl� the basis for the alle9etl exemption. Any vlolation ot Sectlon �
031.5 by any"applicaqt for.a Dermlt subjects the applicaM to a civil
� enalty of not more than five huntlretl tlollars (E500).
� 1, as�Owno� of lhe prope[ty or my em0�oyee5 witlt wages a5 th¢i� sole
wmpensatlon, will tlo the work, antl the�structure is nol intentletl or ofteretl '
tor sale (Section 7044, Business and Professional Cotle;' The Contractor's
License Law tloes not app�y to an owner of a properly who builtls or improves
ihereon, antl who tloes such work himseli/hersulf or tn.ougn his or her own
em0�oyees, provitletl that su<h ImOrovements ara not Intentletl or otferetl for
sale. 11, however, the builtling or improvement is soltl within one year of com-
Dletlon, tne owne�� will have the burtlen of p�ovin9 h¢/She tlltl not builtl or Im-
�rove for tne purpose of sale).
1, as owner o� Ihe property, am exclusivaty contractin9 with lirensetl con-
tractors to cons[ruct lhe project (Section 7064, Businezs antl Professions Cotle: �
The Contractor's License Law tloes not apply to an owner ot pro0erty who
builtls or Improves therson, antl who contracts for such pro�ec[s with a con-
tractor(s) IicenSe pursuant to the Contractor�s License Law).
❑ 1 am exempt untler Section . B. 6 V. C. for this reason
Date Owner� �
I M1¢r¢by ce�tl(y Ihat I have reatl tnis appllcation antl State that the above
informatlon Is torrect. I agree to comply wifh all clty anq countY ortlinances '
antl s[ate laws relatlng toy uiltliny construcBon, antl hereby authorlie repre-
sentatives oi� [hlg city� t,E gntaY/upon the above-mentlonetl •property tor
Appllcant 10 till In all spaces except thosa within neavy oortler linas ana si9n all approoriate tleelarations.
PE MIT NO. TRACT NO. LOT NO. ' BL . .
/3 - /OS�S � ._. . .,
TYPEOFCONSTRUCTION � NEw �� noo ALTERATION
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK
TVPEOFPERMIT GRADING- FOUNDATION STRUCTURAL
❑ TENANT ❑ ELECTRICAL O PLUMBING ❑ MECHANICAL
❑ 07HER �
PROJECT DESCRIPTION' S4. FT.• oCCUPANCv_
�CONSTRUCTION TVPE VALU{iTION $
20NE � GRADINGCU.Y�S. ACRES__
Remarks: � ' /
Bar Sink
Backflow Preventer_ '
Backflow Irrigation
Bathtubs
Clarifiers �
Dishwdsher -J
Drinking Fountains
FlOor Orains .
Floor Sinks • '
Gas Service .Outlets
Interceptors .
Kitchen Sink - .
Ld' VdlOfIQS '
P—TraP.
RoofArains . '
Showers �
Service Sink
Sewer Cap
Sewer Connection
Solar Collecmrs
Solar Piping �
Solar Tank
Swimmin9 Pool w/Spa
WB[Ef CIDSEL
Waten Heater
Water Service �
REPAIR
Reinspection Fee. ,I.'.._-$25 I I ' Issue Fee . !- �I� � 3 I
_ ' � , MECHANICAL ' � FEES
_ i .
Duct;�UnderGrOund '
Duct-Structural - - �
Duct - Ventilating '
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO.#
Heating System & Ducting
❑o-i oo.000 eTu � i oo,000
5�9nature / U- �E'i" �� Date
D�� LI ! Reinspection Fee $25
CtrlF 0865-46 rev. ]/83 White - Building; Canary - APDllcan[; Pink - Accounting; Goltlenrotl - Assessor
Hood or Typel �
Canopy Type I I� ��
Refrigeration System
�0.100,OOOBTU ❑t00,0006TU
System Repair/Alteration
� luue Fee � $ 3
A.P. #
S Main Building: �
E -
T Front`
ARear
C Right
g Left�
Ping. Ref. # �
Parking Req./Providi
Use af Building:
Planning Notes:
2349 �I / 1 2/84
. . ..
�
Zone
� Accessory Building: . �
, Park.Fees $ - .
� . .
5.00 TL
Z
O
N
I
N
G
F
E
Q
U
I'
R
E
M
E
N
T
ELECTRICAL ' ; ' FEES �I.
Automatic Washer , Transformer ❑� 15-50 KW
ConstructionPoleSub. ' �50+KW
Cooking Unit � � � � � Meter ❑hp to 100 amps ' ' ,
Dishwasher !Meter ❑over100amps; �
Dryers ❑Gas �DElectric SubPanel � '
Fan � . f' ' Motors�alHP�1h-8 -
F.A.U. � ' InaSolar �9-15 HP �i6-15+
Fixtures ' Microwave .
Device Bozes ' Pole Light
Outlets ' Range '
Switches. Sign '
Garbage Disposal Standing Sections
Generator �P5 KW �5-15 KW . Trash Compactor , �
I Reinspection Fee I$25I Issue Fce ' ' I:$ 3 I
PUBLIC SERVICES REQUIREMENTS:
2oriing Approvetl By ' Date
Appliwtion Approved By ' Date
Applio4ion laued By � � � � ' Data / /�
' � SUMMARV OF FEES
BUILDING PERMIT $ ' SMIP . $ �
PLAN CHECK - $ ,—��— PERMIT
, PLUMBING , $ �ZJ'' ' .ISSUANCE $ .
PLAN CHECK '$ ' ENERGY P.C. ' $
ELECTRICAL � $ GRADING . $ �
PLAN CHECK. $ MICROFILM $ �
MECHANICAL; $ TOTALFEE . $ � �
PLAN CHECK $ � � . .
1
� CONSTRUCTION AND PLANNING � POl SPA �
APPROVALS Permit # Date Inspector pppROVALS Permit # Date Inspector
' 1. Temporary Electrical Service or pole 52. Pool & Equipment Location
•2. Soil Pipe-Undrgrnd. . � , 53. Steel Reinforcement •
3.'Electrical Conduit Utility-Undrgrnd.� 54. Forms
. 4.� Electrical Conduit-Undrgrnd. ' , 55. Electrical Bonding
`5.•Steel Reinforcement ,� 56. Rough Plumbing & Pressure Test
b� Electrical UFER Grnd. � � 57. APPROVAL TO COVER-GUNITE
� .! 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
74. Rough Plumbing • 65. Electrical-Final
15. Rough Electrical�Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval �
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING �
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure � 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
� ��5. 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: 'I�nsulation 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. Fina�ct�ry Fireplace � �
38. �nal Plumb� _�o,�. y( �/ � d � 6
39. W �ice-Final - GJ
40. Gas Service-Final �
41. Solar pomestic-Final ,
42. Backflow Preventer - '
43. Backflow Irrigation .
44. ,landscape Irrigation System
45. Sound Attenuation '
46. Handirap Regulations,
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completetl �
49. Electric'Release to Edison �
50. Gas Release to Southern California Gas Co �
51. CERTIFICATE OF OCCUPANCY . .
No, Date ,
i �
� (
I �'
\
_ ApPlieanT to fill in all spaces
pTY oF COSTn MESa CO SiRI�CT�ION PERMIT P�jM12¢ j'//
e
Projec[ Addres5 � ��
Applicant's Mailing Addreu S V
� - �,r 4 - , 100
Owner's Name �� x�� t r�Phone
Address �g� �_1L1�S.-1] 21Z.�RQ/r�07�'
Arch/Eng. License No.
Address
Contracior's Nam � I1,' � Phon d/A � 2�
Address (ma �'�91 �,LCp'j�t�5 rUwU Q• � {� �A�I�i �i."1 ��0
City License No. 37SS` ( S '
LICENSED CONTRACTOR DECLFRATION •
1 hereby aHirm that I am licensetl untler proy�siont ot Charter 9(tommentlng �
witn setllon 7000) ot Divislon 3 0/ tho Business antl Professions Cotla, antl
my Iicense is in tull force antl lect. � I,I _ O
Licens�/ Class�— C �� � , 't"O
Date ,^'s—��" ��9�aturo �
WORKERS' COMPENSATION DEC ARATION .
hereby affirm that I have a certificate of consenl to self-insure or a cMtifiwte '
r Workers' Compenzation insurante, or a cartiiletl copy thereo( (Settion
3800, Lab. C. .
PoIicY No.�;a'1Q� �Q•� ComPa�Y �X17� �N�
Cer[ifietl copy is �ereby furnisnetl. �
Certif�a c9py is Ietl wilh the city u ng DlQisi n. �
Da e � APPlicant '
EXEMPTION FROM WORKERS' COM ENSATION DECLARATION
(This sectiOn neetl not Oe complet¢tl if the permit i5 for One �und�atl (5100) or
Icss).
I certity Ihat in the performance oi tho work for which this perm�t is issuea, I
Shall nol amploy any pe�son in any manner So a5 to becom¢ Sub)ett [o the �
Wo�kers' Comp¢nsatlon Laws ot California.
pate S�9�ature
''NOTICE: H, after makinq th(s aeclaraUon; you sboultl become sub7ett to the '
Workers' ComoenSaUon provisions of tha L,abor Cotle, you must brNwith
COmO�Y `�'��� suGh provl5ion5 Or thl5 permit S�all be tle¢meC �evoketl.
CONSTRVCTION LENDING AGENCV �
1 hereby altirm thal tltere is a constructlon le4tling agoncy for ihe parformanca ,
ot lhc work for whith Inis Oermil is,issuetl (Section 309] Civ. C.)
Lentler's Name
'Lenaer's A4Ereis ' " �
OWNER BUILOER OECLARATIOfi
1 hereDy atfirm [hat I am exempl irom Iho ContractOr'S Lit¢nzn Law for lha
tollowing reason (Seclion �031.5 Bu5lness antl Professianal Cotle: Any dty or
� counly whicM1 r¢qWreS d pe�mit to cOnstruCt alteq improve, tl<molizh or repair ,
dny zVucture, p�lor to 1[s i55uance, alt0 rCqUI�eS the applitdnt tor SUGh permil
to fil¢ a signe� slallment thdt be/she I5 IlcenSetl pursuant to lhe prOvisionz O/
�he Contmctor's License Law.(Chapter 9(commencing,with Sectlon ]000) ot
`vizion 3 of the Business antl P�ofesSiOns COCe) or [nat he/ine i5 ex¢mpt
:�etrom antl t�e ba5i5 tor Ihe alleg¢tl exemptiOn. Any violalion of Section
J31.5 by any applican[ To� a pe/miI subjects [he appliCant to a Civil
eenalty of not more Nan five huntlretl tlollars (E500�.
e
LJ 1, as owner of tne property or my amployees wi[M1 wages as Iheir sole
mmpensation, will ao Ne work, antl the structura is not intentletl or ofteretl
br. wle (Sectlon ]044, Business antl Professional Cotle: Tbe ConVac[or's ,
LicGnse ldw tloes no[ appty to an owne� Ot 8 properW who builtls Or ImOrOv¢5
thereon, ana wno tloes such work himself/herself or lhrough his or ner own
employees, Orovldetl t�at such impmvemen[5 are not in[entletl or olfaretl for
Shce. 11, nowevGq the•builtlin9 or imOrOvempnt IS SOItl within one yea� ot COm-
o�etion, lhe owner will nave tne burtlen of proving ne/sha tlla not buila or Im-
prove tor tnc purpoze of sale).
❑ I, as owner ot the property, am ezclusirely contractin9 with Ilcensea con-
ItdCtOR t0 COnSfNtl IM1B p�OjCCt (SeGtlon 70d4, Busine55 antl PrOf¢SSionz Cotle:
The ConUactorY License Law dOeS no[ apply to an owner ot pro0erty wh0
builtls or Imo�oves thereon, ana who contrac[s tor such projects witn a con-
traclor(s ticense pursuant�[o the ConVa<[or'i Ucen58 la�v). � am aware tnat
prooi o� their WOrket's CompenSaliOn in5�ranCe zhoultl be provitlea l0 Tn.
❑,1 am exempt unaer Sectlon B. & P. C. for this reason
Date Owner
1 hereby certity that I nave rea�
informatlon' IS Wrrect. I agree lo
antl 5[ate laws relatin9 o builtlir
Sentd[ives Ot [hi5 cit o- ¢nLCr
inspectlon purposes.
Signa[ur¢
Drivers' License or 55 qf �
tale that l�e abOva
C county artlinances
'+by authoriza'r80r8-
lonetl property t r
Date —!��
t�ose wit�in �eavy CorGer Iines antl sign all appro0«ate Ceclaralions.
TRACT NO. LOT NO. ' UNIT NO.
TVPE OF CONSTHUCT9.N UtI NEW U ADD LJ ALTERATION LJ REPAIR
' ❑ CONVERSION �<<i.DEMOLISH ❑ OTHER
' DESCRIP710N OF WORK/USE OF BLDG. � ,
TVPEOFPERMIT GRAOING FOUNDATION STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL
❑ �OTHER . — -
PROJECT DESCRIPTION SQ.FT. oCCUPAN vq�
� CONSTRUCTIONTVPE VALUATION$ �VI%��
ZONE GRADINGCU.VDS. .ACRES
Remarks:T. n.,...�.. �� Z .1nA �lxnnlQ 2�QA09',f.Cl QVL
E
I
Drinking Founlains
Floor Drains �
Floor Sinks
Gas Service � OuUets
Interceptors
Ki�chen Sink '-
Roof Drains
Reinspettion Fee 515
BOiIQf �
Duct- UnderGround '
Exhaust System ❑ Multiple
Firepl/Fact.8lt. ICBO #
Heating System & Ducting .
❑0.100,000 BTU 0100,000
Fee I 515
CMF 0865-46, rev. ]0/84 White - Builtling; Cdnary - APPliwni; Pink - Accounting; Galtlenrotl - Assessor
Showers � �
Service Sink
Sewer Cap - • .
Sewer Connection -
Solar Collectors -
Solar Piping
Solar Tank �
Swimming Pool w/Spe.
Urinal
Werer Clowt.
Wn2er Heaeer
water Service •
Auto-Wash
laue Fea
Hood or Typel ❑
Canopy Typell ❑
Refrigeration System '
Oo-ioo,000eTu ❑�oo,000
SVstem Repair/Alterntion
Fire Dempers
Registers
Issue Fea
5 3
S 3
A.P: •M
S Main Buildi
E
T FrOnt
B Rear
A
C Right
K Left.
S
Ping. Ref. 5Y•
Planninq Notes:
Automatic Wa'sher
Construction Pole Suh.
Cooking Unit
Dishwasher
Dryers .�Gas ❑EI¢ctric-
Fan
F,A.U.
Fixtures
Device Boxes e
Outlecs
Switches -- -
Garbage Disposal
Generator �0.5 KW �5-151C
Y193 6%10%86 _
Zone
Req./Provided
ELECTRICAL •
Transfarmer ❑ 15�50 KW
❑ 50+KW .
� ReinsPection Fee I 315 I
DEVELOPMENT SERVICESREQUIH
2oning APProved BV�
BuildinB AVProvad By
Merer LJup to 100 amps �
Meter �over100amps
Suh Panel
Motors �0.1 HP � 1 Y. - B
Inc.Solar �9-15 HP 016-15+
Microwave
Pole Light
Range
Sign
Standing Settions
Trash Compactor
IssUB Fee
ie:oo T�
FEES
5 3
Z
O
N
I
N
G
R
E
Q
M
T
S
S MARV OF FEES �
BU�L�ING PERMIT $ U `�n% SMIP $ 'S� �
PLAN CHECK $ � PERMIT
PLUMBING g ISSUANCE $�
PLAN CHECK 25% S ENERGV P.C. $
ELECTRICAL • j GflADING � $
PLANCHECK 50% S MICROFILM �$
MECHANICAL $ TOTAL FEE . $ I .OD
PLAN CHECK 25% $ ' .
�
L
ti
CONSTRUCTION AND PLANNING . � POOL & SPA � -
Date Inspector Date , Inspecto
APPROVALS Permit # APPROVALS Permit # m
1. Temporary Electrical Service or Pole _ 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms ' � �(
i
4. Electrical Conduit-Undrgrnd. ' 55. Electrical Bonding �
�
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test =�
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE nt,,,
7. Footings . 58. ElectricalConduit-Undrgrnd. �i'
8. Foundation . 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd.. 60. Backwash Lines, P-Trap; O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap � 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing SYstem - Final
14. Rough Plumbing 65. Electrica6Final � .
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT -
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test � 72. Underground Flush -
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil �
25. Roof Sheathing �74. Overhead Hydro '
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � �
27. Frame and Flashing 76. Dry Standpipe - .
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE RREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION ' � �
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED .
33. FinahElectric 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 '
41. Solar pomestic-Final . . -
42. Backflow Preventer . � � •
43. Backflow Irrigation • � � �
44. Landscape Irrigation System �
45. Sound Attenuation �
46: Handicap Regulations -
47. FINAL STRUCTURE & BUILDING � � •
48. Special Requirements Completed
49. Electric Release to Edison - �
50. Gas Release to Southern California Gas Co -
51. CERTIFICATE OF OCCUPANCY
No. Date
_------
CITY OF COSTA-7MpE�S-A���
. Project Address J��f
Applicant's Mailing Address
� Owner's Name C'u�
_n.r i. .�.
AOP�icant to fill in all spaces except �hose within �eavy Eortler lines antl Si9n all approp/Iate Eecld�ations.
ION PERMIT PE MIT NO. TRACT NO. LOT NO. UN1T NO.
�1D�/ r ati 2�- I
TVPE OFCONSTRUCT�{Q�.I NEW AOD ALTER TION REPAIR
r • �p�� R3ZZ � ❑ CONYERSION r.=�. DEMOLISH ,❑ OTHER� _��' t , A.P. # a
Phow� � DESCRIPTIONOFWORK/USEOFBLDG�. ��"'�''�'� L�
�� Z 1 �, �"I � • r S Main Building:
- E
Cense No. � TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL . T Front
��� �p ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 8 Rear,
CAnVactOr'sNamP/ ��� VU%i ClYI��IKI.UR �C1 ❑'�THER A
Jt1KL.LiJ�_--_1�'1 n��) ! � . . . . _ . o Right
Addresslmailin9lTlt ��T11xl�s�% 1s/�RCA�2I��", llbnb� PROJECTDESCRIPTION Sq.FT. OCCUPA V —
,. CONSTRVCTIONTVPE VALUATION§� g Lef[
Cily License No. _�,�r,1-��� � ZONE GRADING CU.YDS. ACRE
LICENSED CONTRACTOR OECLARATION `� � - � ' � .�� . Ping. Ref. #
I hereby affirm Inat I am Ilcensetl untler provisions o/ Charter'9 (commencing � Remarks: y� \ � �� � ' . Planning Notes:
with section 7000) of Division 3 ot the BuSiness antl�Professions Cotle, antl ,
my license is in lull (orce tl efiect. • �•'�
License Class � Lic se o �� "
Date L+-Z^R� 519nature_��f(}r�f,���b�.
WORKERS' COMPENSATION DECLARATION �� � . ' �
hereby affirm that I nave a certiti<ate of consent to selttinsure or a certi�ficate •
i Workers' Compensation Insurance, or a certl�ietl copY �th'e1reof_(Sectlon �
POI��iC�Y No. �R�1��`�� ComPanY J1Tl,`�-' �VN�
�Certifietl copy is hereby furn{shetl. ^ f ///���
Cert ietl copy�s(}�ilae with the City B �/I,� DIvRi /// ��1� •
Date � -�'� " Applicant � �
EXEMPTION FROM WORKERS' COMPENSATION DECIARATION �
(Thissection neetl not ba complp�etl if the permit I5'for one huntlretl ($1�00) or
less). / � --� �. '
1 certity tM1a[ in the per/OrmanCe ot the wOrk fo� whiclt thi5 perm�t is issuetl I�
shall mt employ any person Iq any manner so as to become s�bject to t�e,
Worker5' Compen5atlon LawS O( Callfornla. ' r , .,.}�
Date Si9ndture � -
'NOTICE: If; atter making this qeclaration, you shoultl�become�subjecbto the` '
Worken'� Compensation provisions oi the Labor Cotle, you must fort�with
mmply with such� provisions pr this pe�mit shall be,tleeme0 revoketl. .
CONSTRUCTION LENDING AGENCV .
I hereby aftlrm that there Is a constructlon lending agency tor tne pertormance
of the work for w i his m t" issuetl (5�qt o 0 � Civ. C.)
Lentler's Name — �1 ��� �A...
Lentler'sAOtlress �� S• ��G
OWNER BUILDER �ECLARATION '
I bereby atfirm thaPl dm exempt irom the Conl�actar's License Law for [he�
following reason ($ection �031,5 Buslnezz antl Professlonal Cotle: Any city or
county which requires.a permlt lo <onsiruct, alteq improve, tlemolisn or repair
any struhture, prlor�to Its issuap�e, also requlres the apD�icant tor such permit
to tile a signetl Statement [hat rye/sha Is licensetl pursuant to tlte p�ovisions of
�he contracror's License Law (Chapter 9(commencing with Section ]000) of
�vision 3 of [he BuSin¢55 antl Profes5ion5 Code) or [ha[ ne/She is exempt
eretrom antl Ihe ba5i5 for the Sllegetl ¢xemplion. Any violation ot Sectlon •
J31.5 by any applicanl for a permlt subjects [na applicant to a civil
penalty of not more tnan tive nuntlr¢a tlollais (E500�. •
❑ 1, as.owner ot the proper(y or my emp�oYees with wages as their sole
comp¢nsation, will tlo Ihe work, antl the structu�¢ is not intentletl o� of}eretl
(Of SdIC ($CCIIOO %�44� BUS�OQ55 dfltl PlOiC55I0OdI Cotle: The COOiIdCIOf�S
Licenu law tloes no[ aOPly [o an own¢r Of a property who builtls o� improves
thereon, antl who tloes such Work himselt/h¢rself or througb M1is or her own
emo�oyees, provitled tnat such �mprovemenb are not intentletl or otferetl (or
sale. If, howeve�, [he bulitling or Vmp�Ovement IS Soltl wilhln one yea� of com-
. pletion, [he owner, will have trye burtl<n ot PrOvinq he/sh¢ tlitl not builtl o� im-
�rove for the purpose of sale).
I, as owne� oi the O�operty, am �eKClusively cont�acting with IlcenS¢tl com
t�acto�5 to conSVuct the project (Sec[ion 7044, BUsiness antl Prote55ions Cotla:
The Contractor's License Law tloes not apply to an owner ot property who
builtls or improves thCreon, a0tl who confracts Po� Such projecls with a con-
tractor(sl license pursuant to tne Contractor's License Law).�I.am aware that
proof o( IM1ei� Work¢YS Comp¢n5ation InsurancB shoultl be. provitletl to me.
❑ I am exempt untlei $ectlon B. & P. C. �or this reason
Date Owqer _
I hereby certify that.l�have ieatl �[his a
informatiom is correcL I aqree to comply
antl state laws relati @ lo builtling const
sen[ativez of lhis ty [o enkr upon
inspeGtion purpoie .
Signature -
Drivers' License or 55 �
i-state thai the above
antl county ortlinance5
iereby autnorize repre-
:ntionetl PLroperty tor
_ Date v' /� �
I
- PLUMBING � ' FEES
Showers . . �
Preventer Service Sink
Irrigation � Sewer Cap '
_ Sewer Connection .
' � Solar Collectors .
Fountains
Floor Sinks ' ' •
Gas Ser'vice Outlets
Interceptors � �
Kitchen Sink - � - - '
Lavatories
P-Trap
Roof Drains�
Reinspection Fee
Boiler
Ducc � Under Ground
Ouct - Structurol
$15
Exhaust System I:J Multiple
FirepUFact. Blt. ICBO #
Heating System & Ducting
❑ o=i oo,000 eTu O i oo,000
Reinspection Fea � $75
MF 0865-46, rev. 30/84 White . guiltling: Canary - APPlicanp Pink - Attpunting; Goltlenrotl - Assessor
Solar Tank
Swimming Pool w/Spa.
Urinal
Water Closet
Water Heater
Water Service
Auio-Wash
laue Fee
Hood or Typel ❑
Canopy Typell ❑
Retrigeration Sys[em
❑0.100,000 BTU ❑100,000 BTU
System Repair/Alteration -
Fire Dampers � '
Registers -
� 'Issue Fee
5 3
S 3
7185 6/I�/.86
� � 2one
' Accessory Building:
.
� • �.
Pa:king Req./Provided
i
ELECTRICAL � � �
Automatic Washer Transformer ❑ 15�50 K1
ConstructionPoleSub. , ❑ SO+KW
Cooking Unit _
Dishwasher ' '
Dryers ❑Gas �Eleciric
Fan
F,A.U.
Fixcures ' '
Device Boxes
Outlecs
Switches• " - ,
Garbage Dispoul
Generator �0-5 KW �5-15 KW
� Reinspection Fee
�
DEVELOPMENTSER
2aning Approved By J
Building Approved By
Application Iszued ey_
$15
Meter LJup�tol00amps
Meter ❑overi00amps
Sub Panel
MotorsOO-7 HP_O1X-8.
Inc.Sola� �9-15 HP �16-15+
A
123.50 TL
FEES
0
•$tanding Sections
Trash Compactor �
laue Fae $ 3
�TS_ /
� Date�
'-���s--� Date �
fG � . _ /__ /-f
BUILDING PERMIT $ �
PLAN CHECK $ ���4�
P�UMBING $ T—
PLAN CHECK 25%; $
E�ECTRICAL, $
PLAN CHECK 50% $ �
MECHANICAL $
PLAN CHECK �25% $
Z
O
N
I
N
G
R
E
Q
M
T
S
SMIP $ / 7 /
PERMIT
ISSUANCE $-
ENERGV P.C. $
GRADING $_ ,
MICROFILM $ �
TOTAL FEE $
ti
CONSTRUCTION AND PLANNING POOL & SPA o
APPROVALS � Permit # Date Inspector p�ppROVALS Peimit # 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 - . m
4. Electrical Conduit�Undrgrnd. , 55. Electrical Bonding �
5. Steel Reinforcement ' 56. Rough Plumbing & Pressure Test �'
6� Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNiTE p
7. Footings .3T6E� ��c�" ,w„y 8/t 58. Electrical Conduit-Undrgmd. ^
' 8. Foundation . - 59. Gas Pipe, O Undrgrnd., Test ;
9� Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection ' 62. Backwash & Receptor-Final
12. Sewer Cap � � 63. Heater & Vent-Final
13. Roof Dreins 64. Plumbing SYstem - Final
14. Rough Plumbirig � 65. Electrica6Fina1 � ,
15. Rough Electrical-Conduit 66. Solar System-Final
,
16. Rough Electric Wiring ' 67. Fencing & Access Approval -
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING �.
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # .
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil .
23. Gas Pipe-Rough & Test 72. Underground Flush _
24. Roof Fra�ming 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. Drywail Naiiing HEALT,H DEPT. REQUIREMENT =�-� �� �
31. Plaster Brown Coat 79. FINAL INSPECTION ,
32. Electrical Power Meter•Final 80. FOOD CERTIFICATE ISSUED
33. Final�Electric Notes: �' L• 6� �L��[�
34. Final Heating & Air Conditioning �� ��� �� �
35. Final Gas Pipe-Test '� � �
36. Hood or Canopy � -'=-_ � �
37. Final Factory Fireplace � - � �
38. Final Plumbing '����
l
39. Water Service-Final � 0 Z•'� 6
. �
40. Gas Service-Final � t 4.�s�C
1 �S�
4i. Solarpomestic-Finaf ��! Q /r ��' _� � ��
42. Backflow Preventer . � .
43. Backflow Irrigazion � �
'44. Landscape Irrigation System � . �
45. $ound Attenuation . �
46. Handicap Regulations • -
47. FINALSTRUCTURE&BUILDING yf / , ..
48. Special Requirements Completed � -
49. Electric Release to Edison � '
50. Gas Release to Southern California Gas Cn
51. CERTIFICATE OF OCCUPANCY
No. Date
��- �Costa Mesa Bnilding Department � APPLICATION FOR PERIVIIT
"� COSTA MEOSA,�CALIFORNIA 2��� B U I, L D 1 N G '
FOR OFFICE USE ONLY
FOR APPLICANT TO FILL IN Receipt No. Permit No.
Building � � � � � � C � � !
Addrese ,r OCni
Costa Mesa, (iB,�OPill& Received by Date Rec'd. Date Iss d
Nearest �L�, " '`��� �/ ' ^ `� �_ / ��
CrossSt. / 'L' �O I qddress � !7 � � � D
Owner SCYCLfn�. / 'F�...�.9.. .
or
1 I Lot
tion No.
Metes and
r
et J.i
� _.
rcepair
Building
te
Costa Mesa, CaLfornia
r�r _ Nearest ,p ,{�
P Cross St. (/ � //
�'J —�JS:3 Zone ✓ I No.oi . � TYP� '
� � Block / d I�
o��dg> I G — — �� �-
� No.ofBldgs
I�� Nowan Lot
a�No.of No.o1
I Famille Roorr
p/ p Rear Yard /
O / SCd Side VaM ! �
Addition
No, ot
Rooms � Stories
1 I Roof _ .�+:��:
N.
APPROVALS
�undation Locatian Inspecto
Forms, Materials,
Under-Pinning
•ame: Fire Stops,
I hereby acknowledge that I have read thls Applicatlon
and state that the above is correct and agree to rnmply Lath. Int.
with all CIty Ordinances and State Laws regulating
building Construction. Lath. Ext
Signatura of �/�p
Permittee Q/S/ti^�l V�- � . Plaster, Ir
Valuation
� � `�°.
$ /
—
R�w �nI 10��15 D. P.
Permit Fee $�° �. C� O Maso
Plan Check $ • � G gond
ToLal
Fee , S � �i 0 � FfNE
_ 1
0
�
a
r
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r
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PI.UT PLAN
Show locatlon and dletancea from
property Ilne and batween bulldinps
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e»_q.S COS�A ¢ �...{.{. I�
sPD�E;Q $la 7�. �
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�
� CITY OF COSTA MESA � y
BIIILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.0
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER. E07-00889
PERMIT TYPE ELEC STATUS: ISSUED
DATE ISSUED: 11/0612007
�.�. : ' -
ISSUED BY: SOK
JOB ADDRESS: 785 A002 W 18TH ST CM; Suite/Unit: A002
vicinity: ' � . _ , - � . ,
SCOPE OF WORK: REPLACE CENTRAL�AIR UNITLOCATED IN-P.ATIO AREA FOR UNIT A002.
` , ,y` ���� •.n; � .. - . •. .
�
OWNER: DZAMAN, DOREEN V�, Address:' 85 8 ST A-2 Unit: '�� �
PHONE: , . '� -� CirylState2� ESA, CA
�
APPLICANT: CECILIA DEtORENZO `� � , . �- ; ��.� ,` - - ''. Address:' 2967 MICHELSO�nitSUITE GNS
PHONE: 949•939-2949 ' � -� - - ,. - ' City/State/zZipi IRVIEN,CA ,
= I �� - �
CONTRACTOR: FIX MY AC INC � License No. 855348
Address: 2967 MICHELSON DRUnit SUITE G118 :. . PHONE: 949-939-2949
City/State: IRVIEN�,CA - ZipCode: 92612 .��-, CEL�: �
ELECTRICAL PERMIT FEES _ ' ,
Electrical Plan Check Fee: $0.00
Electrical Permit Fee: , $78.00 -
Reinspection Fee $0.00
TOTAL FEES � ::, $78:00,
� ��,�,_ ' �
:�.� -
NOTICE: 7he work authorized by this permit shall comply vrith all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authonzed under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and (nal approvai will result in the expiration of this permit.
COOE t. IXSPECTIONTYPE DATE INTRIALS COOEt IN$PECTIONTYPE DATE IN7RIRL5
1818 Fixed System Final Fire Prevention 208 Final Mechanical
1266 Pool Spa Final _ 208 Final Plumbing ,
200 Final Re-Roo( 210 Final Electncal P/� � j��e�jY►fIZ/Y
201 Final Blwk/Retaining Wall 212 Final Fiie Prevention ��
202 Final Factory Fire Place 220 Final Planning Appmval
203 Final Sign 222 Final Site
204 Final Demolition ' p$0 Final Building�Occupancy __
. �
WORKERS' COMPENSATION DECLARATION: �
I hereby affirm under penally o( perjury one ol ihe follOwing declarations:
❑ I have and will maintain a Certiflca�e of CAnSent to sel(-Insure for workers'
compensation, as provided for by section 3700 of ihe Labor Code, for the
performance of lhe work (or whiCh this permit is issued.
;❑ I have and will mainWin wcvlcers' wmpensation insurance, as required by
, section3700 of the Labor Code, for the peRortnance of the v.ork for which this
permit is issued. My workers' compensation Insurance carrier and policy
numberare: n
� am"'—er.�_S�1-rn�i I_�;�._I
�as�4^^�^a� det ONepermlavaAiMefine�umlredclylars(E100)orless)
Pa��pvumber.'r'"`� `g �.�[� � O � 2�,�'
I certify that in [he performance of [he work for which this pertnit is
issued, I shall not employ any person in any manner so as to bewme subject
b the workers' compensation laws of Califomia, and agree that if I should
become subject to the vrorkers' compensation provisions of Section 3700 0(
the Labor Code, I sha forthwith comply with these provisions.
---w,- 1: ' 06_ _ %
, �';iyp. Aoliwnf_�a-Wrer�`,,�r_, Date '"�-:�.
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CNIL 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 LABOR CODE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby aKrm that I am licensetl under provisions of Chapter 9(commencing
with Section 7000) of Division 3 of Ihe Business and Professions Code, and
my license is in full force and eflect.
ua �-�'R553 � �' ciass�u�e�?:o
Sr-i" r�:
� ' . {Date '"'�.,
+£i �k �. - �_-�'�'�.+:_t:: :ir. � ,. �.
CONSTRUCTION LENDING A4ENCY:
❑ I hereby affvm that lher¢ is a constructbn lending agency for the
peAortnance M the xork for wfiich Nis permit is issuetl. (Sec. 3097, Civil Cotle).
Lender's Name:
Lentler's Address:
Date
OWNER-BUILDER DECLARATIONS:
I hereby affirm that unCer penalry ot perjury Nat I am EXEMPT FROM THE
CONTRACTORS IJCENSE LAW fOr Ihe (ollowing reason (Sec. 7031.5,
Business and Professions Code: Any ciry or counry which requires a permit to
conswct, alter, improve, tlemolish, or repair any sirucNre, prior to its
issuance, also requires the appli�ynt for such permit to file a signed statement
that he or she is licensed pursuant to the pmvisions of the Con[rectors
License Law (Chapter 9(commencing vrith Section 7000) of Division 3 ot Ihe
Business antl Prolessions Cod�) or lhat he or she is exempt therefrom and
the basis for the alleged exemption. Any violation of Seclion 7031.5 by any
applicant for a pertnit subjects the applicant to a civil penalry of not more than
five hundred dollars ($500).):
❑ I, as ovmer of lhe property, or my employees wilh wages as their sole
compensation, WILL DO THE WORK, and the slrvcture is not intended or
oftered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law dces not apply to an ovmer of property who builds or improves
thereon, and who dces such vrork himself or herself or through his or her own
employees, provided that such improvements are not intended or oftered for
sale. If, however, the buildinq or improvement is sold within one year of
completion, the ovmer-builtler will have lhe burtlen of proving that he or she
did not builtl or improve for purpose o1 sale.�.
❑ I, as ovmer of the property, am EXCLUSIVELY CONTRACTING WI7H
LICENSED CONTRACTORS to construcl lhe project (Sec. 7044, Business and
Professions Code: The contractors License Law dces not apply to an owner of
property who builds or improves thereon, antl who contracts fa sucb project with
a conlracta(s) license pursuant to the Contractors License laws.).
❑ I am exempt under sec.
Business antl Professions Code for this reason:
�05]d6 (]rt1))
.
Ovmer ID verifietl by drive .❑ Yes ❑ No
Dnver s License No. Expires:
Verification of Ownership by (type of document, i.e. - property tax bill or deed�:
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I hereby certify ihat no excavation frve (5) or more feet in depth into wfiich a
person is required to descend, will be made in connection with xork authonzetl
by this permit, and that no building structure, sc�tdding, (alsewwk, a demolition
or dismantling thereof, will be more than thitly-56c (36) feet high. (Chap. 3.2, Gry
2, M 2, Sec. 341, Title 8, Cali(wnia AdminisbaWe Code).
❑ As owner-builtler, I will not employ anyone to do work which would
require a permit from [he Division of Intlustrial Safety, as noted above, unless
such person has a permit to do such work from the division.
Applicanfs Slgnalure
Division of Industrial Safety Permit Number: _
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will lhe applicant or present or future builtling occupant neetl to file and
certify a Business Plan for emergency response to release or threateneE
release of a hazartlous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Healih antl Safery Cotle requires, with some
exceptions, thal a Business Plan be filed with the Costa Mesa Fire
Department by every business which has at any one time during a reported
year a quanUty of hazardous materials equal to or greater than a weight of
500 pountls, or a volume of 55 gallons. or 200 cubic feet of compressed gas
at standard temperature and pressure).
2. Does or will the applicant or present or fuWre building occupant neetl to file
a registration form for awtely hazardous matenals7 ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Satety Code, with some
exceptions, requires registration vnth the Costa Mesa Fire Department Dy
each business which at any one lime has on hand a quantity of aculely
hazardous materials equal to or greater than a weiqht of 500 pountls, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at standard
temperature and pressure).
3. Does or will the applicant or present or future building occupant neetl to
prepare an RMPP (Risk Management and Prevention Program for aculely
hazardous materials)? ❑ Yes ❑ No
(Seclion 25534 of the Califomia Heallh and Safery Code provides that the
Costa Mesa Fire Department may require the preparation, certification antl
fling with ihe Fire Department of an RMPP by businesses which are required
to register acutely hazardous matenals with the Fire Department.
4. If an RMPP is presently required, has Section 25534 of the California
Heallh and Safery Code been fully complied with? ❑ Ves ❑ No
5. Does or will the applicant or present or future building occupant require for
the vrork which is the subject o( this appliwtion a pertnil for such conslruction
or modification from lhe Soulh Coast Air Quality Managemenf DisMct or from
any other air polWtion wntrol disMct or agencyT ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that ttre requested
infortnation be tumished on appliwtions f« non-resi0ential building pertnits).
6. Will any paA of the Faciliry to De consWcled under lhis permit be within
1000 feet from lhe outer boundaries of a school? ❑ Yes ❑ No
(If'j�es", lhe facility must meet the requirement of Sections 25534 and 42303
of the California Health and Safery Code).
7. If a pertnit from [he Sou[h Coasl Air Quality Management Distric[ or other
air pollution contml district or agency is required for the work which is the
subject of this appliwtion, have all of the tlisclosures prescribed by Califomia
Health and Safety Cotle Section 42303 been made? ❑ Yes ❑ No
8. (If'ves", attach certificate of compliance from the appropriate air pollution
control oKcer).
CERTIFICATE OF COMPLIANCE: I certi(y that under penalty of perjury the
information given above is cortect. I agree to comply wiN all state laws and
city ordinances regardinq Ha�ardous Materials and Emissions.
CERttFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I
certify under penalty ot perjury that I have read this application and state that
the information given is correct I agree to comply with all state laws and city
ordinances relating [o building construction, and authonze representatives of
the Ciry of Costa Mesa to enler upon the above-described pmperty for
inspection purposes. I agree not to occupy or allow occupancy of any building
authorized by this pertnit until final inspeclion.
SignaWr ofLe9alOwner(s) ��e
/��,_ ll `�_
�afiMA iom c� -. ,D- .�
��'
� " CITY OF COSTA MESA
.
BUILDING DIVISION
i � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • vnvw.ci.cosfa-mesa.ca.us
�, ` � FOR INSPECTIONS CALL: (714) 754-5626 1/
�� PERMIT NUMBER` M07-00526
PERMIT TYPE
JOB ADDRESS
vicinity:
SQ. FT:
SCOPE OF WORK:
MECH �
A
STATUS: ISSUED
DATE ISSUED: 11/0612007
ISSUED BY: SOK
: 785 A002 W 18TH ST CM� �Unit: A002
0 .
REPLACE CENTRAL AIR UNIT LOCATED IN PATIO AREA FOR UNIT A002.
OWNER: DZAMAN, DOREEN V -� , � - Address: 785 W 18TH ST A-2 Unit:
PHONE: ' . . � �CitylState2ip: COSTA MESA, CA
APPLICANT: CECILIA DE LORENZO _ � " Address: 2967 MICHELSON DR UNt:SUITE G118
PHONE: 949-939•2949 i, -� ' CirylState/zZip: IRVIEN,CA . '
CONTRACTOR: FIX MY AC INC
Address: 2967 MICHELSON DRUnit SUITE�G118 �, .
Ciry/State: IRVIEN,CA 2ipCode; 92612-� ��
MECHANICAL PERMIT FEE SUMMARY
MECH ITEM FEE: � $50.65
PLAN CHECK FEE: - � , $0.00 . .
INVESTIGATION FEE: $0.00
REINSPECTION FEE: 50.00 '
TOTAL FEES: $50.65
License No. 855348
� PHONE: 949-939-2949
CELL:
0
NO710E: The vrork authorized by this permit shall comply with all applicable handicap access requirements under Califomia statutes and reiated
regulalions. (Ord. No. 92-28, § 7, 12-21-92)
EXPIRATION: PERMIT EXPIRES 180 DAVS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expi�atlon of this pemi
COOE/. �NSPEC710MTYVE U� IN7I71RL �OOE� INSPELl10NTYPE D/L ,y I
1818 Fixed System Final Fire Preventlon 208 Final Mechanical `� �
12fi8 Pool Spa Final
200 FinalRe-RoOf
201 Final BIaWReWining Wall
202 Final Factory Fire Place
203 Final Sign
204 Final Demolition
208 Final Plumbing
210 Final Electriwl
272 Final Fire Prevenlion
220 Final Planning Approval
222 Final Site
250 Final Buildincy0¢upanty
WORKERS' COMPEN$qTION DECLARATION:
I hereby aKrm under penalty of perjury one of the following declarations:
❑ I have antl will maintain a certifiwle O( consenl ro 6elf•InSufe bf workers'
wmpensation, as provided for by section 3700 of the LaDor CoOe, lor ihe
peAprmance of ihe work for which this pertnit is issueC.
��'I�have and will maintain workers' compensation insura�e, as required by
Inn�3700 of lhe Labpr Code, (a the perfortnance M ihe work Iw vfiich this
permit is issued. My w�rkers' compensation Insurance carrier and policy
�mtr�r'3re:'. � � /
��rler:'�.�- �7"Gi..� (1G�
(//us setliu'i nttH n1d Ea mmpefeE dlhe pe�m! a vahreC al me n��gp �pars (5100) a leu )
Policy,�Number.� �!\ � �-{7 � (� _ 2 []�_Cj
❑ I certify thal in the peAormance of lhe work (or which this permit is
issuetl, I shall not employ any person in any manner so as to become subject
to the workers' compensation laws of Califomia, antl agree thal i! I should
become subject lo t�e workers' compensation provisions o( Section 3700 0l
ihe Labor Cod , I shall forihwith comply with these provisions.
� � 06 � �
�+��^`�..'�� �°�- -
WARMI G'N . FAILURE Tq SECURE WORKERS' COMPENSATION'COVER4GE
IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CML 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 LABOR CODE, IMEREST, AND
ATTORNEI^S FEES.
LICENSED CONTRACTORS DECLARATION:
I hereby a�rm lhal I am licensed under provisions ot Chapter 9(commencing
with SecGan 70W) of Division 3 of t�e Business and Professions Code, antl
my I'rcense is in �ull torce artd eflect.
(�' ���. .
L•ic. tt g S 3 ass ��'�'-• ,�
�'a`_"".'-- � • �.�,.
�" Iran nawre .t —
�� _..-:.�.�..+-ti•,... r .:. . �_� �m°�' , ,
CONSTRUCTION LEN4ING AGENCY:
❑ I hereby aH'um lhat Ihere is a construction lending agency for the
peAormance of tha v.ork for which Ihis pertnit is issued. (Sec. 3091, Civil Code).
Lender s Name:
Lender's Address:
Date
OWNER-BUILDER DECLARATIONS:
I hereby aKrtn that under penaly of perjury that I am EXEMP7 FROM TME
CONTRACTORS LICENSE LAW for u�e follovring reason (Sec. 7031.5.
Business and Professions Code: Any ciy or wunty which requires a pertnit to
wnswct. alter, improve, Eemolish, or repair any strucwre, prior to its
issuance, also requires the applicant tor such permit to file a signeC stalemem
that he or she is licensed �pursuaN to the provisions of l�e Contractors
License Law (Chapter 9(commencing with Section 7000) ot Division 3 01 the
Business and Professions Code) or that he or she is exempt therefrom and
ihe basis for the allegeA exemption. Any violation of Section 7031.5 by any
appliwnt for a pertnit subjects lhe appliwnt to a civi� penalry of not more than
five hundred Oollars ($500).):
❑ I, as owner of the property, or my employees with wages as their sole
wmpensation, WILL DO 7HE WORK, and the structure is not intendetl or
offered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law does not apply to an ovmer ot property who builds or improves
thareon, and who does such vrork himself or herself or through his or her ovm
employees, provided that such improvements are not intended or oRered for
sale. If, however, the building or improvement is soltl wilhin one year ot
completion, Ihe owner-builder vnll have the burden of proving that he or she
did not Duild or improve for purpose of sale.).
❑ 1, as owner of the property, am E7(CLUSIVELY CONTRACTING WITH
LJCENSED CONTRACTORS ro construct the project (Sec. 7044, Business and
Professions Code: The contractors License Law dces not apply to an wmer of
pmperty who builds or improves thereon, and v.fio convacts for suc� pmject with
a contractar(s) ticense pursuaN �o �lie Contractas License Laws.).
❑ I am exempt under sec.
Business and Professions Cotle for lhis reason:
]OS]�a6 (YO])
Owner ID verified by driver s I� .e. ❑ Yes ❑ No
Driver's License No. Expires:
Verifiwtion of Ownership by (type of document, i.e. - property tax bill or deetl):
DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION:
❑ I he2by certify that no excavation frve (5) w more feet in depih into vfiich a
persm is required fo descend, wiit Oe made in wnnectbn with �wrk autlronzed
by ihis pertnit, and that no buildirg swcture, scaffdding, falsev.ork, v demolition
or dismantling thereot, will be mo2 than thirty-s& (36) feet �ig�. (Chap. 32, Grp
2, M 2, Sec. 341, Ttle 8, Cali(ania Atlministrative Code).
❑ As owner-builder, I will not employ anyone to do vrork which would
require a permitfrom the Division o(Intlustnal Sa(ety, as noled above, unless
such person has a permit lo tlo such work from Iha tlivision.
Applicam's SignaWre Da�e
Division of Industrial Safery Permit Number:
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
1. Will the applicant or present or future Duilding occupant need to file and
certify a Business Plan for emergency response to release or threatened
release of a hazardous material? ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safety Code requires, with some
exceptions. that a Business Plan be filetl with the Cosla Mesa Fire
Depanmant by every business which has at any one time Curinq a reported
year a quantity of hazardous materials equal to or greater than a weight of
500 pounds, or a volume of 55 gallons, or 200 cubic feel ol compressed gas
at standard temperawre and pressure�.
2. Dces or will the appliwnt or present or future builtling occupant need to file
a registration form for acutely hazardous matenafsY ❑ Yes ❑ No
(Section 25533 of the Califomia Health and Safety Code. with some
exceptions, requires registretion with the Costa Mesa Fire Department by
each business which at any one time has on hand a quantiry ot acutely
hazardous materials equal to or greater than a vreight of 500 pounCs, or a
volume of 55 gallons, or 200 cubic feet of compressed gas at sfandard
temperature and pressure).
3. Does or will the appliwnt or present or future builtling occupant neetl lo
prepare an RMPP (Risk Management ana Prevention Program for acutely
hazartlous materials)7 ❑ Yes � No
(Section 25534 0! the Califomia Health and Safety Code provides that the
Costa Mesa Fiie Department may require the preparation, cenifiwtion antl
filinq with tha Fire �epartment ot an RMPP by businesses which are required
to regisler aculely hazardous materials with lhe Fire Department.
4. If an RMPP is presently required, has Section 25534 of the Califomia
Health and Safety Code been fully wmplied vrith? ❑ Yes ❑ No
5. Dces or will lhe applicant or prese�t or future building occupant require for
the work which is the subject of this applica6on a permit for such wnsWcGon
or modification from the South Coast Air �uality Management DisVict or from
any olher air pollution wntrol tlistricl or agency? ❑ Yes ❑ No
(Seaion 658502 of the Califomia Govemment Cotle requires tnat tne requested
inlormatbn be fumished on applicatbns fa rao-resitlential builCing pertnits).
6. Will any part of Ihe facility lo be wnstruc[ed under this permit be wiihin
1000 feet from the outer poundaries of a school? ❑ Yes ❑ No
Qf'yes', lhe faciliry must meet the requirement o( Seclions 25534 and 42303
of tha Califomia Health and Sa(ety Code).
7. II a pertnit fmm the Sou[h Coasl Air �ualiry Management District or other
air pollution contml district or agency is required for the work whith is the
subject of this applica�ion, have all of the disclosures prescrihed by Califomia
Health antl Safety Code Section 42303 been matle? ❑ Ves ❑ No
8. (If'yes", attach ce�ificate of compliance from the appropnate air polluGon
control officer).
CERTIFICATE OF COMPLIANCE: I certiry that under penalty of perjury Ne
information given above is wrtect 1 a9ree to comply with all sWte laws and
city ordinances regartling Hazardous Matenals and Emissions.
SignaWre
CERTIFICATE OF COMPLIANCE AND AUTMORIZATION OF ENTRY: I
certify under penalty of perjury that I have read this application and Slate that
the information given is wrrecL I agree to comply with all state lavrs and ciry
ordinances relating to buildir�g wnsWction, and authorize representatives o(
the City ot Costa Mesa to enter upon the above-described property for
inspection purposes. I agree not to occupy or allow occupancy of any building
authonzetl by lhis permit until final inspec[ion.
S�gnature o� Lega� Owner(s) Dzm
/_�-_ -L - -
���ror cpipm. �'.�_. ' (�{ ,�ii :Date '�-.
.,�,�..c.�- C_ c_ � . ' Y�s'-�"'^—...a•-•.�...
�. „_ ADP���ant to till in ali spaces exceDt tnose within neavy eoraer Itnes antl si9n all aoProDriate tleclarotions.
��TY CF COSTA MESA CONSTRUCTION PERMIT
Prolect Address 7�� W �� +y S�
ApplicanYs Mailing Address ��'S'� `�� �h' }C�i'�u'r-✓
Owner's Name LTi�-�`1'�
Address Y� D' -�l�. fEs f r
Arcfi%�Eoa License No. C�''
Address
Contractor's Name����-- � 1` � �� Phon�� 4 �
Addresslmailing) �`J ��r�Nks � �A� ��i �f�01
City License No. ]�, �( �
LICENSED CONTRACTOR DECLARATION
� hereby aftirm tM1af �I am'licensetl untler provisions ot Charter 9(commencing
wi[h section �000) of Dlvizion 3 ot the Business antl Profeislons Cotle, antl
my license is in full forLe. and effect. �l� ' Q
Licen CI r� i�a�<o ntr, Z,•
�-�_�� �� r
Date 5'g t �— �
WORKERS' COMPENSATION DECLARATION
.1 hereby affirm tnat I have a certi(icate o( Consent to solf-insure or a certlficate
of Workerz' Compensation Insurance, or a certifietl copy thareof (Settion-
3800, Lab. C.}�^,� _� l 6� p� GomOany � 11/TC �.%N�
PoliCy No. ��� D`O
�CerlifieU capY is her¢by fumisheU. � ,
Certif" tl copy � filetl with the tlty Builtling DlviSiop
Date �'1-�" �`� APPlicant T1��%ll� "�ITO
E%EMPTION FROM WORKERS'�COMPENSATION DECLARATION
(Thiz section ne¢tl not be compleletl it the Permit IS for on¢ huntlratl (E300) or
less). ' '
1 certity that in the pe�fo�mance ot the wO�k tor whi<h thi5 peim�t i5 i55uetl, I
shall mt employ any person in dny TanP¢/ 50 as [o b¢cOme subject to the
Workers' Compensation Laws of California. -
Dale Si9nafure
�NOTICE: It, after makin9 this tleclaration, You shoultl become subject to lhe
Workers' Compensation p�ovision5 of the l.abor Cotle, y0u mu5t (orthwith
comply with such provisions or thh permit shall be tleemetl revoketl.
CONSTRVCTION�LENDING AGENCV -
1 hereby aftirm that Ihere is a mnstructlon lentling agency for the performance
of the work for which this oermit i5 �ssuetl (Section 309] Civ. CJ
tRntler's Name .
Lentler's Atltlress . . �
OWNER BUILUEq OECLARATION �
I hereby aftirm tM1at I am exempt trom tPe ConVactor's LicenSe Law fo� Ihe
following reason (Section' 7031.5 Busines4 and Professional Cotle: Any city or
�..��..�v �.,n'irh rem�nec a oermit to conztruGt. alter, Improve, tlemoll5h or �epaii
[o fiie a siqnetl statement tna[ ne/sne �s n�e��aea Nw.ua��� �� v��.������� ��
��he Contractor'S License Law (Chapter 9(Lommencing with Section 7000) ot
�ivision 3 of [ne Business antl Professionz Cotle) or that he/she is axempt
erefrom antl the basis Tor the allegetl eXemption. Any violation ot Sectlon
, 031.5 by any' applicant for a permit subjects the appllcant .to a civil
,�enalty of not more than five huntlree tlollars (E500).,
LJ I, as owner oi the property.or my'employees with wages as their sole '
Compensafion, will tlo the work, antl tM1e st�ucture Is no[ intentletl or off¢r¢tl
tor sale (Section 7044, Busmess anG Proteszional Cotle: The Contrac[or's
License Ldw tloes mt aoPly to an owner o� a property who bulltls or improves
tnereon, antl who tloes zuch work himself/hersel( or through his or her own '
¢mployees, provitletl [hat such improvomtl��s aro not intentlatl or o(feretl fo�
ule. I(, however, the builtlin9 or improvement Is soltl within one year of com-
pletion,.tne owner will have tne burtlen O� PrOving he/she tlid not builtl o� Im-
p�ove to�lhe purpose ot sale). , �
❑ I, as owner oi the property, am exclu4��e�Y Conlratting with Iicensea mn- '
tractors to construct the project (Section �044, Business antl Professions Cotle:
The Contractor's License Law tloes not 9PP�Y �o an owner oi property who
builas or improves thereon, antl who contracts for sucn projects wlth a com
tractor(Sl llcense pursuant to the Cantrado�'s License Law). 1 am awar¢ that
proof ol their Worker'S Compensation insurance shoultl ba prOvitlea to me.
❑ I am ezempt untler Section B. d P. C. for this reason
owner
certity that I have reatl this app��cation antl state that the above
m is mrrect. t a9ree to comply wi[h all clty antl county orEinancas
laws relating t builtlin9 �onstru n, antl hereby au[horiz¢ repre-
of.this city t enter.upon t abo ntionetl ��operty for
purpose5iii _r
Signature �� � ` , ^`_ Data V �
Drivers' License or 5 �
1�5 Z 4<l �/O I ia Y� � I ' I �' �
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL
❑ TENANT ❑ ELECTRICAI ❑ PLUMBING ❑ MECHANICAL
❑ OT.HEP
PROJECTDESCRIPTION 5[�.FT. OCCVPaNcv ' ^
C O N 57 RUCTION TV PE V ALUATI ON $
ZONE GRADINGCU.VDS. ACRE
Remarks:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Drinking Fountains
Floor Drains�
Floor Sinks •
GasService -(
I nterceprors
Kitchen Sink "
Lavarories ,
Roof Drains
�Rainspec[ion Fae
� 1�� C . ' • V
�
MBING . FEES
$hOW¢f5
ServiceSink �.•
Sewer Cap �- - '
Sewer'Connectioo , -
Solar Collectors . -
Solar Piping � � � '
Solar"Tank � '
Swimming Pool w/Spa '
Urinal }
Water Closet ' �
� Watei Heater � � �
Water Service
A uto-W ash � �
LaundryTrays `
$15 Issue Fea , • � $'3
� MECHANICAL , FEES +
Duct - Under Ground �
Duct - Structural
Duct-Ventilating . . .
Exhaust System ❑ Multiple �
Firepl/Fact.8lt. ICBO #
Heating System & Ducting
❑o-700,000 BTU O100,000BTi
Reinspaction Fee � . $15
CMF 0865-46, �ev. 10/84 White - Builtling; Canary - Applicant; Pink - AGcountin9; Goltlenrotl - Assa55or
Hood or TYPeI ❑
Canopy Typell ❑
Refrigeration System
❑0-100,OOOBTU ❑100,OOOBT
System Repair/Alteration
Fire Dampers �
Issue Fae '
$ 3
i
A.P. # �� �-^
S Main Building:
E �
T Fiont
ARear ' �
C Right ��G
K Left
S
Ping. Ref. # D��j.
Planning Notes: ff ,�
Automatic Washer
Construction Pole
Cooking Unit
Dishwasher
Dryers ❑Gas ❑
Fan
F.A.U.
Fixtures�
Pt 7'194 6Y10/86
['J"!� 2one
Accessory Building:
Parking Req./Provided �
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+�KW
Meter LJup to 100 amps
Meter ❑over 100 amps •
lecvic Sub Panel
Motars �61 HP �1'h � 8
, Inc. Solar 09�15 HP 076-15+
� ' Ou[IetSJ
Switches
' Garbage�Dispoul
Generator O0.5 KW 05-75 KW
. � 1
�' • �
t. �`
� r ��,
� Reinspection Pee $15
DEVELOPMENTSER�
_�
2oning:APy ved By
'8uilding Approved By _
Pole Light
Range
Sign
; Standing Sections
Tf25h COmpaCtOl
luue Fee
50p.8D Tl.
�
FEES
$ 3
Z
O
N
I
N
G
R
E
�
M
T
5
. "� '• ' SU N� OF FEES ' ['� pO
� BUICDING PERMIT $ •�� SMIP $ _71�
_ PLAN`CHECK $ PERMIT
� PLUMBING $ �SSUANCE $
.� PLA�N CHECK �25% $ ENERGY P.C. $ �
• ELECTRICAL $ GRADING $
��• 'PLANCHECK 50% $ MICFOFILM $"Q ,/
�'. �MECHANICAL 5 TOTALFEE � $ �+�'"�'��
� � PLAN CHECK 25% $
r,j�CONSTRUCTION AND PLANNING
� APPROVALS Permit #
L�
1. Temporar�y Electrical Service or Pole
2. Soil Pipe-Undrgrnd. . .
3. Electrical Conduit Utility-Undrgrnd.
4. Electrical Conduit-Undrgrnd. �
�5. Steel Reinforcement �
6. Electrical UFER Grnd.
. 7. Footings� ' -. '
8. Foundation . '
9. Water Pipe-Undrgcnd.
10. StrLctural Floor System
11. Property Sewer Line & House Connection
12. Sewer Cap
13. Roof Drains
74. Rough Plumbing
15. Rough Electrical-Conduit
16. �Rough Electric Wiring
17.�Rough Wiring Sign
18�"Rough Electrica6T Bar Ceiling
19. Rough Heating & Air Contlitioning
20. �Rough Factory Fireplace � �
�
27. Ducts, in Struaure �
22. Ducts, Ventilating �,
23. Gas Pipe-Rough &'Test ' '
24'r Roof Framing' -
25. Roof Sheathing � � �
26. T-Bar Ceiling (Structural) & IVlonocoat
27. Frame and Flashing �
28. Lathing & Siding �
29. Insulation
30. Drywall Nailing ��• , ,
31'. Plaster Brown Coat ��, �
32. Electrical Power Meter.Final '
33. Final Electric ' '
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final.Factory Fireplace '
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
m
T43. Backflow Irrigation
"44. ,Landscape Irrigation System
�45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
5D. Gas Release to Southern California Gas Ca
No. Date
Date
POl SPA
Inspector qppROVALS Permit#
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
56. Rough Pl�mbing & Pressure Test
57. APPROVAL TO COVER-GUNITE
� 58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. 8ackwash Lines, P-Trap, � Undrgrnd.
61. APPROVALTODECK .
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
70. Underground Hydro
77. Product Piping OGas OOiI
72. Underground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
�HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes: mlL- %e �r�'a:.�J�-/s�Lr�.'
0
Date �Inspector
!
l .. . "
AGpI
within heavy porEer Iines anE slgn all appropriate Aeclarations.
CiTY oF cosTA nnEs O ST�,�!�� TION P RMIT ". •'—' "",""' ""' '"�
. u� Y"� � ��'% • _
Prppect F�ddress � � � �
AppliCanYs Mailing Addle55 Z �� S � _'TVPE OF CONSTRUCTION ' NEW ADD ALTERATION REPAIR �
ti ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q p#
Owner'sName � hone -- � /phJ��s '
�s � . DESCRIPTION OF WORK/USE OF BLDG.
Addreu ' ^ S Main Building:
Aroh/Eng. � License No. �'� f-TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front
Address � � � ❑ TENANT �ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear
O OTHER
Contractor's Nam -� �' Phone���� C Right � .
PROJECT DESCRIPTION Sp.FT. OCCVPANCV K
Addreulmailing) �' . � � � Left
.�y��.���/ CONSTRUCTIONTVGE VALUATIONS $
City License N4 �fLL ZONE GRADING CU.YDS. ACRES �
UCENSED CONTRACTOR DECLARATION ' � � Ping. Ref. #-`
I h¢reby afflrm. that I am Iicensed unaer provisionz o( Charter 9(<ommencin9 � yRemarks: . Planning Notes:
with section ]000) oi Divislon 3 ot t �e Business antl Professions Cotle, antl ,
my Iicense is in tulyfo�ce antl ef(ecL _�� �� � ' ' • . ' "
Licenz Clas G c s ,
Date Signatur ,a_ ' ' PLUMBING � FEES ' '
WOR ER GOM ENSATION D C AR N ��� � ' �-
1 hereby alfirm tnat I M1ave a ce�lificate o/ mnsen[ to sel nsu�e o� a ca�tlflcate! � Bar Sink ShOwCIs
oi Workers' Componsation Insurance, or a ceriifietl copy thereof (Section� . gackflOw Preventer ' Service Sink -
3800, Lab. C ) /���� � � / �_ � � -' � - AUtomatic W35her
F�G,Tr-+U �
Policy rvo.' Gompany -� Backflow Irrigation � Sewer Cap ��Construction PoleSub.
n�y. Certi(ietl copy is hereby tumishetl.
1� Certitie o y is tiletl wlth the <Ity l' ' S Bathtuhs Sewer Connection � Cooking Unit '
Date Applica � � �
EXEMP ION F OM WORKERS' C ATION DECLA TION - Cld�i(iEfS - $pla� COIICctOfS Di5hwd5hCf
(Tnis settion neetl not ba compleletl if th¢ permit is Tar one h tlretl (E300) or
less . � "'� O Dishv.asher . Solar Piping Dryers as ❑Electric
1 certity that in lhe performance of the work for which this perm�t is issuetl' I' -
shau not employ any person in any manner so as to become subject to'the � Drinking Fountains Solar Tank Fan
workers' Compensa0on Laws o/ Calitomia. . - +� -
Dale Si9nature t ' F,loor Drains� Swimming Pool w/Spa F.A.U.
NOTICE: It, af[c� makin9 thiS�Oe[Ia�ation, yoaihoultl b¢[ome Subj¢ct�to the '-
Workers' Compensation provisions of the Labor Cotle, you must forthwitn FloorSinks 'Urinal Fixtur25 -
comply with such provislons or thiz permit shalt be tleemetl revokeE.
CONSTRVCTION LENDING AGENCV - Ge55ervice . .Outlet5 WaterClOset '�
� 1 hereby atflrm Ihat there Is a constru[IiOn lentling agency to� lha Oerto�mdnce
3960 3/13/87
' • ' -
Zone
Parking Req./Provided
ELECTRICAL - �
Transformer ❑ �15-50 KW
❑ 50+KW
Meter up to 100'amps
Merer ❑over100amps
Sub Panel
Motors �0-1 HP � 1'h � 8
Inc.Solar 09-15 HP �16-'
Microwave ,
' of the wOrk to� whith [hi5 Oe/mlt is issuetl (Se<Lon 309] Crv. CJ Inierceprors�• _ . • Water Heater �Utl2t5
�I l.entler'S Name
� �enaer's Atleress Kitchen Sinka , � � Water-Service . � - Switches ZZ �
OWNER BUILDE � CIARATION ' � '' ,
I hereby aftirm lhat I am exempt from the ConVactor's License Law �(or tbe Lavatories . Auto-Wash <�, Garbage DiSposal
followin9 reason (Soctlon ]031.5 Buslne55 antl Professional Cotle: Any city or -'; � �
counry wniU reqWres a permit to construcq alter, improve, tlemolizh or repair P-T �ap Laundry Trays � 7 Generator �0-5 KW 05-15 KW
any st�u<fure, ptlo� to its isSuanGe, also �equire5 [he applicanf for such Oe�mit
to file a signetl s[atement that he/she i5 IicenSftl puf5uant t0 the provi5ion5 of ROOf�Of2in5;
•he Contraclor's License law (Chapter 9(commencin9 witM1 Section ]000) of :h
'vision 3 of the Business antl Professions Cotle) or tnat he/she is exempt . - --
^refrom an0 the basis for the alleged ezemption. Any violation of Section }}^ . �
J31.5 by any applicant for a permit subjects the applicant to ;a civil �` l'`
penalty of not more lhan five huntlretl t1011ars ($500). . 3
❑ f t� ro ert or m employeez with wages as their sole Reinspection �Fee $15 luue Fee $
Sign ' r
Standing Sectians
Trash Compactor
I, as owner o e p P Y Y
compensation, will tlo the work, anG the structure is not intentletl or offeretl Reinspectian Fee $15 luue Fee
for sale (Section 7044, eusiness antl Protessional Cotle: The Contracmr's , ' MECHANICAL � � FEES
License. Law tloes'not app�Y to an owner ot a property who builtls or improves
thereon, antl who tloes� such work nimself/hersel� or through his or her own DEVELOPMENT SERVICES RE�UIREMENTS:
employees, providetl that SucM1 improvements are not intentletl or, offe�etl fo� BOiIC! HOOd O� Typ¢ I ❑ �
ule. I(, howeveq the bulltling or improvement Is soltl within one year ot com- , Canopy Type II ❑ Zoning Approved By
pletion, the owner wlll have tne buraen ot proving ne/sne aitl not build or im- Duc[ - Under Ground ' ' Buildin9 Approved By
�rOve for the purpose of salo).
I z owner ot ihe property am extlusively contracting with Iicensetl�con- Duct - StrucNral ' Refrigeration Sys[em Ap0liwtion Issued By -
37080 TL
�
Z
O
N
I
N
G
R
E
Q
M
T
S
ES
. � g a �,
Oate
,a � -
' traGtors to�ConsVuct the project (SeGtlon 7044, Bu5ine55 dntl Pro�es5ion5 Cotle:
: The Contractor'z Llcense Law tloes not apply to an owner oi prooerty who Duct - Ventilating �0.100,000 BTU ❑100,000 BTU ' . ' SUMMARV OF FEES ' '
builtls or Imptoves t�ereon, antl who contratt5 for such p�ojects with a con- ' '
tractor(s1 ucense oursuant to the Contractor's �icense Law). 1 am aware that � Exhaust System � Multiple ❑ System RepaidAlteration • BUILDING PERMIT $ SMIP �. $
proof of tneir Worker's Compensatlon insurance shoula be provlaetl to me. ' P�,4N��CHECK $ PERMIT -
❑ 1 am exempt untler Section B. 6 P. C. for tnis reason Firepl/Fact. BIL ICBO # Fire Dampers ISSUANCE
Date
Signature
Drivers' L
_ Owner _
I nave reatl this a
l aaree �com�
#
Heating System & Oucting
abova . ❑4100,000 BTU 0700,000
iances
rep�e-
v for
Reinspection Fea I S15
0865-46, rev. 30/B4 White - Builtling; Canary - Applicant; pink - Accounting; Goltlenron—^--��_
��
PLUMBING $ $
Registers - � � ' ENERGY P.C. $
, PLAN CHECK �25% $ "
ELECTRICAL � $ . �O� GRADING $
- � � PLAN CHECK 50% $ l• 6 O MICROFILM $���
. MECHANICAL $ TOTAL FEE $"'"� • � l/ �
Ittue Fea � $ 3 PLAN CHECK 25% $ � � �,
CONSTRUCTION AND PLANNING POOL & SPA . ��
APPROVALS Permit # Date Inspector qppROVALS Permit # � Date Inspector
1. Temporary ElectricBl Service or Pole � 52. Pool & Equipment Location ' '
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement• . �
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings � 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. _ _ 60. Backwash Lines, P-Trap, O Undrgmd.
10. Structural Floor System � � 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection � 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final �
13. Roof Drains ' � 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit � 66. Solar System-Final �
�6 Rou h Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTEFING
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.StorageTank OGas ❑Oil "
25. Roof Sheathing � 74. Overhead Hydro �
26. T-Bar Ceiling IStructura!) & Monocoat - 75. Dry Chemical
27. Freme 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 Cpat � 79. FINAL INSPECTION ,
32. Electrical Power Meter-Final l3E` N r��%' 80. FOOD CERTIFICATE ISSUED
i
33. Final Electric ��� �J C Notes: ��5�� UG�,j��r � oi�2c% � l
34. Final Heating & Air Conditioning ' N,pac� G /� .. ra '
35. Final Gas Pipe-7est O... �� �%�ciC. $ c ba
36. Hood or Canopy � ' .
�'� � c -
37. Final Factory Fireplace C
38. Final Plumbing ' � - ` '
j
39. Water Service-Final ' , . .
40. Gas Service-Final � • •� �
41. Solar pomestic,Final . • '
42. Backflow Preventer � • � � : � '
43. Backflow Irrigation ' t - . � '
44. Landscape Irrigation System � ' � '
45. Sound Attenuation
:46. Handicap Regulations �•
47. FINAL STRUCTURE & BUILDING � . '
48 � Special Requirements Completed '� ' � -, •
49. Electrie Release to Edison .
f
50. Gas Release to $outhern California Gas Co
51.'CERTIFICATE OF OCCUPANCY .
No. Date
'�,
ADV���ant to fi11 in all sDaces exeept those wlthin heavy earaer Ilnes an0 sign all aoo�oorlate tleclarations.
GIT;��•OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO., ._, TRACT NO. LOT NO. UNIT NO.
„P bject Address 7�J �`� �f � � r
c
Applicant'sMailingAddress.%d"�� %%� >/�,f"��";_; .�i�,,,��-+—
Owner's Name ��`���A� � ���F�Phone%5-y%��%y
Address ✓`l� 4/ D � �/'. �P `' e'«
Arcl En Q{ License No. �� �8 Z'�
Address
Conirecmr's Nam ',,`` hon a� 7-�
Address (mn�l'nnl (�rvun5 �/�� �
City License Nq .'-a�C(��
LICENSEO CONTRACTOR DECLARATION �
1 hereby attirm that I am licenzetl untler Orovisions oi Char[er 9(commencin9
with section 7000) of Div45ion 3 of the Businesz i tl P afessions COCe, antl
my license is in fuli force antl tect. �
Ucense Class r n O:�
Da�e � Signature
WORKERS' COMPENSATIpN DECLARATION �
I hereGy affirm tnat I have a certificate of mnzent lo selhlnsure or a certificate
0� Workers• Compensalion Insurance, or a certitietl coDY thereoT (Section
3H00, Lab. CJ Q . � �-�(-�
PolicYNo.T����—n� ComPanY .IL�LG �N�
�.Certifi�eetl� CopY Is (Ieftlbwit�rtbehc�tY �YL�P9A4Y�sio�,.�
Da[e h—_._ �._�' �' -. ApPlicant I�F�V l�J
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This sectian neetl not be compieted it the permi[ is !or one nuntlretl (S300j or .
less). •
I cerNty tha[ In th! perto�m�ance of the wo�k fo� wAiCh (hls Oe�T�t i5 issuetl 1
shdll �not employ any perzOn in any mann¢� so a5 [O becoma Subjecl t0 [�e
wOrkers' CortipensaUon Laws ot California.
Da[e $i9nature
�NOTICE: It, aile� making lhis tl¢cla�atlOn, You ThoUltl batOme subj¢ct to th0
W6rke�s' COmpensatlon prpWsions Ot tne Labot Cotla, yaa muzt t0/tnwith
comply with such provisions or tnls permit s�all De Eeemetl revoketl,
�QNSTRUCTION LENOING AGENCV
I h¢reby atflrm that there Is a construction lentling agency for Ihe perPormance
Ot Irye work tor whicM1 IhiS Permit is issuetl (SeCtiOn 309] Civ. C.)
lFntler's Nama�
Lontlar'S Atltltnss
OWNER BUILDEH OECLARATION
I herCby a(filT [hat I am BxeTPt irOT lh< Conlractor'S LlcenSe Ldw fOr th0
' �ollowing reason (Soct{on �031.5 Business antl Profesilonal Cotle: Any titY or
Cqunty wlilth reqWres a petmk t0 conTVutt, alte�, ITProve, Oemolish o� ropdir
aqy structure, prior lo Its ii5uance, alzo requlres Ihe applicant for such permit
t0 file a ziqnetl iWt¢menl tha[ h¢/She IS Iicen52tl pUrsudnt to the P�oWslonS 01
the Conbactor's Licensa Law (Gbapror 9(commendn9 witb SecUon 7000) of
Divislon 3 ot Me Business antl Prolesslons Cotle) or that M1e/she is exompt
vretrom and Iha ba5i5 fOr Ihe a11890tl ezOmption. Any violalion of Soction
31.5 by any applicanf for a Oo/rnit subjlClS th0 aPPllcdnt t0 a Clvil
nalty of not more t�an five huntlroE tlollars (E500). '
�� I, a5 owne� ol the'property or Ty aTP�oYCes with wage5 as thei� solo
IcOmOensation, will Eo tha work, antl the struc[ure is nol Inlentletl or ofleretl
{Or sale (Sectlort ]044, Buslness antl Vrofessional Cotle: The ContractoYs
License Law tloes not aPO�Y lo an owner of a property wM10 builAs or improves
���ereon, antl wha COes suth work bimzeli/hartclf or lhrough his o/ har Own
eryiployacs, prOvbetl [Ilat 4uch improvCm¢nts are Ool IntCntled or oHered for
sdlo, I/, howeveq tbe builCing or Improvement Is soltl within one year of com-
Plotlon, lhe owna� wlll have the bu�tlan o1 P�ovin9 he/she Ultl elot builtl o� im-
Pn�ove tor lhe pu�pOSe of Talej. '
V I, as own¢r ot the property, am exCWsively contracting with Ilcensetl�Gon-
tractors to construct the Droject (Sectlon 7044, Business antl Professions Cotla:
The Contractor'S Llcense l.aw does not apply to an owner oi property who
bulltls or Improves tnereon, antl wno contracts for such projects witn a con-
tractor(51 Ocense pursuant'to the Contractor's License law). I am aware that
�root of [heir WOrker's ComPensation in5urance shoultl bo prOviE¢A to� me.
❑ I am exempt untler Secfion B. & P. C. tor thiz reason
I]ate Owner
I hereby certiry Ihat 1 have reai
�ntormation is mrrect. I aqree to
ahtl s[ate laws relating to builtlir
tion
a11 <
tate that the above
tl county orCinances
�by authorize repte-
iOneC p� perty fo�
oate '�
�02 ii"i. t �
TYPE OP CONSTRUCTION .FJ NEW LJ ADD LJ ALTERATION LI REPAIR
❑ CONVE(3SION ❑ DEMOLISH ❑ OTHER q,p,;� /,��G
DESCRIPTION OF WOflK/USE OF BLDG. g Main Buildi
TVPEOFPERMIT GRADING FOUNDATION STRVCTURAL T Front p�
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear �
❑ OTHER _ �
PROJECT DESCPivnnn� sn c�r � • OCCVPAQ[� Cv K Righ[ ']
CpNSTRUCTIONTVPE VALUATIONSG�� � § Leh a�
ZONE � GRADINGCU.YDS. �ACRES PIng.Ref.#D
Remarks: �( uo �_c-�'i D l_ / Z�- ?n Planning Notes:
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
Dishrvdsher
Orinking Fountains
Floor Orains
Floor Sinks
Gas Service
<itchen Sink .
Lavatories
P—Trep
Roof Dreins
Reinspection Fee
Shawers
Service Sink
Sewer_Cap _
Sewer.Connect
Solar Collecmr
i�
Swimming Pooi w/Spa
Urinel
Outlets Water Closet
Water Heater
Water Service
Aulo-Wesh
' LaundryTrays
Under Ground
515
Duct-Siructural �
Duct - Ventilating
Ezhaust System ❑ Mul�iple ❑
Firepl/Fact Blt. ICBO #
Heating System & Ducting
❑ o-i oo.000 sTu � i oo,000 er
Oriven' License or 55 qF � - � ' Reinspection Fee I
CMF 0865-46, rev, 30/84 White - Builtling; Canary - Appliwnt: Pink - Accountin9: Goltlenrotl - Assessor
$75
laue Fee
Hood or Typel ❑
CanOpy Type II ❑
Re(rigeration System
�0.700,OOOBTU ❑100,000
System Repair/AI[eration
Fire Dampers
Regiscers
Iswa Fee !
�l
S 3
FEES -
i
Automatic Washer
ConShuction Pole
Cooking Unit
Dishwasher
Dryers ❑Gas ❑
Fan
F.A.U.
Fixtures
7'195 6Y'10/86
�— Zone
Accessory Buildin9:
/ � � Parking Req./Provided ��
ELECTRICAL �
Transformer � 75-50 KW
❑ SO+iKW
� Generetor L10.5 KW 05�15 KW
.i ..
( ...e
�
� Reinspeetion Fee $15
DEVELOPMENT SEHV CVE�
Zoning Approved By
Buildin8 APP�o'red By �
Merer �up to 700 amps'
Merer ❑over 10Qamp's .
Suh Panel
Motors OU7 HP O1 A•8 �,
Int.Solar �9-15 HP �1G15+
Microwave
Pole Light
Range
Standing Sections
Trash Compattor
Issue Fee
504.80 TL
FEES
53
Z
O
N
I
N
G
R
E
U
M
T
$
_ ' �+ SU V OF FEES 'y � ,_
� -BUILDING PERMIT $ SMIP � $ _��
PLAN'CHECK $ PERMIT
� PLUMBING $ �SSUANCE $
"'-' PLA�N�CHECK 25% $ ENERGY P.C. $
s,y4ELECTRICAL $ GRADING $
ef �P�NCHECK 50% $ MICROFILM 5 �
/
�MECHANICAL $ � TOTA�FEE S �Q���
$ 3 ,PLAN CHECK 25% $ '
�' CONSTRUCTION AND PLANNING POOI PA �
� ► Date Inspector Date •� Inspector
� APPROVALS Permit # APPROVALS Permit # /
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location /
2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement �
3. Electrical Conduit Utility�Undrgrnd. 54. Forms
4: Electrical,Conduit�Undrgrnd. 55. Electrical Bonding
5. Ste�l Reinforcement 56. Rough Plumb�ng & Pressure Test
6� Electrical UFER Grnd. 57. APPROVAL Y0 COVER-GUNITE
7. Footings . 58. Electrical Conduit-Undrgrnd.
� 8. Foundation . 59. Gas Pipe, O 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. 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
i .
18: Rough Electrical-T Bar Cei�ing 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 � Gas OOiI
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing �� � 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing ' � 3� G 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemiral
27. Frame and Flashing 3 2 76. Dry Standpipe
26. Lathing & Siding • .-� �L, 77. FIXED SYSTEM FINAL
29. Insulation , 3 78. FIRE PREV. FINAL
30: Drywall Nailing � .�Z•7 (j HEALTH DEPT. REQUIREMENT
31: Plaster Brown Coat� � s( Ol a� 79. FINAL INSPECTION
32. Electrical Power Meter-Final ' 80. FOOD CERTIFICATE ISSUED
33. Final Electric �- Notes: � r (rr ��y �
34. Final Heating & Air Conditioning + � " �'
35. Final Gas Pipe-Test �
36. Hood or Canopy
a - z�y,
37. Final Factory Fireplace � � '
38. Final Plumbing
39. Water Service-Final .
40. Gas Service-Final ,
41. Solar pomesticFinal , -
42. Backflow Preventer �
�3. Backflow Irrigation ,
n'44. .Landscape Irrigation System
�15. Sound Attenuation
c46. Handicap Regulations
fD47. FINALSTRUCTURE&BUILDING 2 �./
48. Special Requirements Completed fr
ti49. Electric Release to Edison � . ,
=j�0. Gas Release to Southern California Gas Co ..
c51. CERTIFICATEOFOCCUPANCY . •
� i
No- Date
r-
�
��
�
�
Applicanl to filt in all z0aces e%cepl thosa within heavy Oortle� IIneS an0 si9n all aDD�ovriate tleclarations. �'�--��
CIYY OF COSTA MESA CONST UCTION PERMIT ��IT�10^ ^�. TRACT NO. LOT NO. UN�� • � ' ' _'`_ ^��_
.Project Address ��'� �%. ( O �' t���..,S��.�/�-�� %
Applicant's Maili�g Address ���Z G/Ti4S/O�L S'/�_
Owner's Nameg �/� J'/ J Phone
Adqress .--�iJ�`Lv [��� C���r�
Arch/Eng. Licenu No.
Adqress
Coqtracror's Nam �y hon y-,
Adqress (m++ ���ol ��Z C ��_ .'��O✓ �
City License No. ���
LICENSED CONTRACTOR OECLARATIpN '
I hpreby affirm tha[ I am li[ensetl untlev provislons of Charler 9(commencin9
with section 7000) ot Dlvislon 3 of the Buziness antl Professions Coae, antl
my li<ense-is In full torce antl effect. , �
License Class j, o
Date �'y�J-- Signatur
WOR R•' C MPENSATION O C 10
I nereby altirm t�at I have a certlficate of consenl [o self-in ure or a certiticate
�f Wo�ker5' COTOansation InSurance, or a certi(i¢tl copy [hereo( ($ec[Ion
3800, t2b. C/.)
PoIiCY No. fs�y/�i�?� GomPanY L `e ��
�Certifietl copy is ereby furnishetl.
Ce fie .e p Si etl with the city Dlv"
Da[a � • �� Applican
E% pT10N FROM WORKERS' C MPENSA ION DECLAR
(Thi55eciian neetl not be completetl If the permit IS tOr One huntlr (5300) or
less�,
I c@r[Ify that in lhe perlormanCe ot tM1e work fOr whl<h this perm�t VS ISSUetl, I
shall not employ any person in any manner so as to become subjec[ to the
WOYkerS' Comp¢nsation Laws of CalifOrnia.
Date � Si9nature
NOTICE: It, after makin9'this tletlaration„you snoultl become subject to tM1e
WOYk¢rs' Compensa[iOn provl5ion5 ot the Ldbo� COEe, you must torthwith
corrypry with sUth proNsioriz o� thi5 permit Shall be tleemetl �evok¢tl.
CONSTRUCTION IENDING qGENCV
1 hq�eby aHl�m tha[ tne�e i5 a mnst�uction lentling agenCy tor Me partormance
of the work for which this permit •is Issuetl (Section 309] Civ. C.)
Lentler's Name U,
Leqtler'SAtltlress ���' � �� /�'
OWNER BUILDEN DECLARATION
1 nere�y aftirm that I am exempt from the Contractor's License Law for the
following reason (Secllon 7031.5 Business antl Professional Cotle: Any city or
cOpnty wblch requir¢s a pe�Tit [o const�uct, d�t¢�, improve, Eemolish or te0air
any structure, prior to i[s iss�ance, also iequires the ap0���ant for su�h perml[
to file a 5i9neC Statemenl lndt h¢/She is Iicens¢tl pu�suant to tne Provlsions ot
thp Contracror'S License Law (Cnapter 9(tommencin9 with Sectlon �000) of
Diy�sion 3 ot the� Business �antl Profezsions Cotle) or that he/she is exampt
h@�e(rom-antl the ba5is for the alleqetl exemplion. Aby violation of $ection
'031.5 by any app�icant for a permit subjec[s the applican[ to p civil
�nalty of not more Nan five huntlretl tlollars ($500).
LI �, as owner' of tno �roperry or myemproyees with wages as Ihelr sole
� compensation, will tlo the work, antl the structure is not intentletl or oHeretl
tor sale (Saction �044, Business antl �rofessional Cotle: The Contractor'S
Litense l.aw tloes not apply to an awner of a property who builtls or improves
th¢reon, anG who tlo¢5 suGh work himself/neRClf o� throu9h his or ner own
empioyees, provitlea that such imorovements are not intenaetl or oFtereC for
saie. If, nowever, tne bulltling or improvement ii soltl within one year of com-
0�4tion, the owner will have the burtlen of prOving.he/She tliG nOt bUiltl or im-
�Ova f0/ the purpose of saiej. ,
I, as owner ot the property, am exclusively contracting with Ilcensetl <on-
- t�dctors to mn5truct tlte pro�ect (Section 7044, Businez5 dntl P�ofession5 Cotle:
T�e Contractor's License Ldw does not dpPly to an Owne� of prope�ty who
builds o� Improves tnereon, antl �who contracts for such projects with a con-
tractor(s) ucenze pursuant to the Contractor's Llcense �aw). I am aware ttiat
proof o( their Worker'S Compensation insurance shoultl be provltletl to me.�
❑ I am exempt untler Sett(on B. & P. C. for th(s reason ,
— Owner
I have reatl tnis applicall
I aaree lu comolv with a
above
IdfIClS
repra-
v tor
TVPEOFCONS7RUCTION �'I NEW LJ ADD' L7 ALTERATON LJ REPAIR-
❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p # �
-DESCRIPTIONOF WORK/USE OF BLDG. i
� S Main Building:
E
TVPEOFPERMIT GRADING FOUNpATION 57RVCTURAL T Front
�� TENANT � ELECTRICAL ❑ PLUMBING Q MECHANICAL . B Rear
❑ OTHER - � ' ' %�
PROJECT DESCRIPTION SQ. FT. OCCUaArvcY C Ri9ht
K Left
CONSTRUCTIONTVPE VALUATION$ $
arks: �-7///O/
! 7�
f
ar Sink
�ackflow Preventer� �
sckflow Irrigation �
atht'u6s ��
:larifiers
lishvaasher .
Irinking Fountains
loor Drains
loor Sinks
ias Service � Outlets
nt2fCeptOrs ' �
:itchen Sink�'
.avatories
'—Trap •
ioof Drains� �
Jh. .•.�
Reinspection Fee
GRADING CU. YDS. _ ACRES � p�ng. Ref, #
� _ _ . Planning Notes:
$15
BOiler '
Duct - Under GrOund
Duct - Structural
Duct - Ventilating
Exhaust System � Multiple
Firepl/Fact. Blt. ICBO #
Heating System &�Ducting
❑ 6100,000 BTU � 100,000
�I Signature �//�LI/"/ ��l�'" I Date/%� O / ' �
Dr��¢rs' Ucense or 55 � �
; � Reinzpection Fee
CMF pB65-46, rev. 10/84 White-- Builtlin9: Canary - Applicanp Pink - Accounting; Goltlenrotl - AssesSor
NG
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors .
Solar Pipin9
Solar Tank '
Swimming Pool w/Spa
Urinel
Water Closet
'Water Heater
Water Service
Auto-Wash �
Laundry Trays
lssue Fee
FEES
$ 3
Automatic Washer
Construction Pole Sub. �
Cooking Unit�
D ishwasher
Dryers as ❑Elecn
Fan
F.A.U.
Fixtures
« Ouclets
$witche5
Garbage Disposal
r Generator QP5 KW
3959 3/i3/87 37>80
� Zone
Accessory Building: ' •
� � Z
' O
, N
I
_ _ _ . N
G
R
Parking_Req./Prov(ded . E
� Q
' i M
, � T
S
ELECTRICAL
Transformer ❑ 15�50 KW
❑50+KW ,
Meter up to 100amps '
Meter ❑over 100amps "
Sub Panel
Motors QO-i HP �i h- 8.
�Inc. Solar �9-15 HP 076-75+
Microwave
Pole Light
Range
� ' I Standing Sections
i5 KW I I Trash Compactor
� Reinspection Fee $75� laue Fee
IANICAL fEES
Hoodor Typel ❑ DEVELOPMENTSERVICESREQUIREMENTS:
Canopy Type I I ❑ 2oning APproved By
Building Approved By �%
Refrigeration Systam
❑aioo,000eTu Oioo,000
❑ System Repair/Alteration
Fire Dampers
Registers
$15• �� � Issue Fea � $ 3
. SUMMARV OF F
- � BUILDING PERMIT $
, PLAN CHECK $
> PLUMBING $ ,
' PLqNCHECK '25% $ �J/ ��
� ELECTRICAL $ �'
�. PLAN CHECK 50%- $ � �n 8 ��
'�� MECHANICAL $ �
`��. PLAN CHECK 25% $ ' ��
FEES
�.
3
SMIP $
PERMIT
�ISSUANCE • $ _
ENERGV P.C. $ � �
GRADING $
MICROFILM � $ �
TOTAL FEE $ .�`�i7" a
�
CONSTRUCTION AND PLANNING POOL & SPA , ,
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement ' ,
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. , 55. Electrical Bonding �
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test �
. 6. Electrical UFER Grnd. � 57. APPROV,AL TO COVER-GUNITE �
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, � Undrgrnd., Test �
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
� 13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing � 65. Electrical-Final �
75. Rough Electrical-Conduit � 66. Solar System-Final
16. Rou h Electric Wi�in 67. Fencing & Access Approval
. 17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # _ '
21. Ducts, in Structure 70. Underground Hydro '
22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil .
23. Gas Pipe-Rough & Test 72. Underground Flush
24. RoofFraming 73. Undergrnd.StorageTankOGas OOiI
25. Roof Sheathi'ng 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � t
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 �p� 'ff � �`�`R 80. FOOD CERTIFICATE ISSUED
33. Final Electric � G Notes:-3� „F ) �` „�,��y ti � ���� �' ,
34. Final Heating & Air Conditiqning �
35. Final Gas Pipe-Test
36. Hood or Canopy ,
37. Final Factory Fireplace
38. Final Plumbing . �
39. Water Service-Final �� ' . �
40. Gas Service-Final , ' � � �
41. Solar pomestic-Final ,
,'
42. Backflow Preventer � , � - . �
43. Backflow Irrigation . ' . � , '
44. Landscape Irrigation System '
45. Sound Attenuation � �
46. Handicap Regulations �
47. FINAL STRUCTURE & BUILDING ' - � • .
48.� Special Requirements Completed .
49. Electric Release to Edison �- .
50. Gas Release to Southern California Gas Co .
• � a
51. CERTIFICATE OF OCCUPqNCY � . '
No. Date -
ApP��ednt lo /III in all spaeas ektepl l�osa Within �cavy Gortler Iin@s anG sign all app�opriate Eeelarat(ons.
CITv oF cOSTA rnESA CONSTRUCTION PERMIT
Project Address �d 1 �"� � Y� �
�lpplicant'sMailingAddreu �� 1 � ��'�=��� ���a�"-
Owner'sName �-�"�r�l� �� ���e y��%-����f�
Addreu �? Y ` ' � ���:� ��' �e /
nrc En. � �Y L�7� G LicenseNo.���7'��
Address ��- � p`�
Contractor's Name�!.f9TV�� � J ��-- Phon�$�Z
Addreu (mailingl V �
CirY License No. .� � �
LICENSED CONTRACTOR OECLARATION .
1 tlereby alfirm that I am Iicensetl untler provisioni of Charler 9(commencing
w�th sectlon 7000) ot DIVISion 3 of tha Business antl Pr ss ns Cotla, antl
my IiCensa is in full force an ttect. ' b
Utensy CI s � %/� �i ensa
oate h-i' - ci��ar��.P � i_� n�V
VdbRKERS' COMPENSATION �ECLARATION
' hereby alfirm that I have a certificate oi consent [o self-insure or a tertlflcate
� Worker5' CompensatiOn Insurdnce, or a ce�t((ietl coOY there0f (SC<tlon
.800. Lab. C,L�J �q/ /�/ ' ��C ���
Poliq No. ��2(�- {l^'i� Company
Certitietl coOY �z hereby turnishetl.
Cert) tietl c p filetl With the city 8',i�tling divlJsion
ate_(y � � � APPlicant �K�4 �
EXEMPTION FROM WORKERS' COM ENSATIOf�I OECLARATION
(Thisuctlon neeC not be comple[etl it the permit i51or on¢ hUntlretl (5300) or
IeSsl. ..
i Cer[iry that in the performance of the work for which thii perm�t ii izsuetl, I
shall not employ any pe�50n in any Tann¢r 50 as to become Subjec[ to lhe
WOrkers' COTp<nsation Laws of California.
03(¢ Si9naturo
�NOTICE: 11, dtter making Inis tl¢cla�a[lon, you shoultl becomn sub7ett lo the
M/b�ker5' COTpensaliOn provi5ion5 ot Ihe LabOr Cotle, y0U musl tOrtbwith
comply with Sut� P�oviSiOns or [hls p¢rmit shall be tleemetl r¢vok¢tl.
�bNSTRUCTION LENDING AGENCV
I ryereby atiirm lhal t�ere is a conStr�Cllon InnCing a9oncy for (ha perlormancB
of the work for whicn [ni5 Permit I5 issuatl (5¢<tion 3097 Civ. C.)
Luntler's Name
lCntler's Haeress
OWNER BUILDER OECLARATION
� he�eby affl�m that I am exampt trOm [he Copt�act0�'s LiC¢nse I�w (ar tbo
�011owin9 redion (5¢Ctlop ]031.5 Bu51ne55 antl Profezsional Cotle: AnY city or
c�.��ntv whith reaui�es a oermit to cOnStruct, alt¢r. ImDrove, tlemolish O� �epal
refrom antl the baslz for the allegetl exemp4on. A�Y ��olation ot Section
R.5 by any applicant fOr a p¢rmit Subject5 [he applicant to a civil
alty ot not more t�an five huntlre� tlollars {E500). -
I, as owner of the pmperty or my employees with wages as their zole
ipensation, wi11 tlo tho work, ana tne structure is not intenaee or otteretl
saie (Section 7044, Business antl Profezsional Cotle: The Coniractor's
ense Law tloez not apply [o an owner of a property who bulltls or improves
reon, ana who tloes such work himselt/herseli or lhrough his or her own
ployens, provitl¢tl that Such imprOvem¢nts are not intentletl or otteretl tor
�, Il, howev<�, the bulltlin9 or Imp�Ovament I5 soltl wlthlq onB yea� Ot coT-
:lon, the owner will Aave the buraen o( proving he/she aitl not bulla or Im-
ve �or lne purpose o1 sale).
I, a5 owpC/ ot the Droperty, am o%clusively cont�a<tin9 witn IIWnSetl con-
:tors t0 COnStrucl lhe prqec[ (Sectlon 7044, Busln¢ss antl Prot¢5sion5 COtlo:
> Cont�aCtor'S LlcenSe Ldw do¢5 not dpply to an ownet pf pm0erty who
Itls or Improves thoreon, antl who conVacts /or such pra�ects wlth a con-
:tor(5 Ocense pursuant to Ue ConVac[or's �iconsa Law�. � am awarc that
oi o� lhei� Worker'S COmpensalion Insuranco shoultl b0 p�ovldatl to TO.
I am ex<mpl untler Spction 8. 6 P, C, tOr lnl5 r¢azon
Date Owner �
I hereby certi�y ihat 1 have reatl thit
I4formdtlon i5 conacL 1 agree to comp
antl slate laws relatin9 to builtlin9 con
sencatives ol tnis cit to eCter or
inspectlon Ourposes.
$ignature
Drivers' License ar 55 �
repre-
Y tor
LU' ���tia�.c i /-v
TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ �EMOLISH ❑ OTHER A P #/i Q
DESCRIPTION OF WORK/USE OF BLDG. -�
S Main Building:
TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Ffont �Q �
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL g �
Rear �
❑ OTHER A
PROJECT DESCRIPTION SQ. FT, oCCUPA Cv 'q C Right �v' ���
CONSTRVCTIONTVPE VAWATION$��6 i S LeftA��171'G
ZONE GRADING CV.YDS. ACRES Ping. Ref. 9W ��
Remarks: �J.� ..i4��'L��/ /.. /l��A�l planninqNOtes: I'J_
Bar Sink
Backflow Preventer •
Backflow Irrigation
Bathmbs
Clarifiers
Drinking Foun[ains
Floor Orains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink �
Lavatories
P-Trap
Roof Drains
Reinspection Fee 515
Duct - Under Ground
Duct - StrucNrel
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. IC80 �f`-
Heating System & Ducting '
❑4100,000 BTU �100,000
Reinspectian Fee � $15
CMF OB65-46, rev. 10/84 White - Builtling: Canary - Applicant; Plnk - Accountin9: Goltlenrotl - ASsessor
ABING � FEES
Showers
Service.Sink
Sewer-Cap � '
SeweYConnection. ' �
Solai.Collectors�� '
Solar'P,iping r
SolanTank � � - �
Swimming Pool w/Spa
Urinal �
Water Closet
Water Heater
Water Service
Auto-Wesh
laue Fee
Hood or Typel ❑
Canopy Type 11 O
Refrigeration System
❑o-i oo,000 eru ❑ � oo,000
System Repair/Alteration
Fire Dampers
Registers
laue Fee
$ 3
71,91 6/10%B6
- Q �
Accessory Building:
(
I
.� � � Parkina Ren./Prnvider
Automatic Washer
Cons[ruct ion Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
D'evice Boxes �
Outlets .i
Garbage Dispowl
Generator �0.5 KW
�'
Reinspectian Fee
� DEVELOPMENTSER
� Zoning Approved By�
Building ApProved By
Appliptian Issued By_
��liL*+ �wr
ru
548.26 TL
Zone c� Z
ELECTRICA�
Transformer ❑ 75-50}�KW
❑ 5� K� �;
Meter ❑up to 100 amps
Meter ❑over 100amps --
Suh Panel � (
Motors �0-1 HP 01'h'-.8� �
Inc.Solar �9-15 HP �16d5-
Mitrowave
Pole Light '
Range
Sign
; Standing Settions
5 KW Trash Compac[or
$15 � � Issue Fee
Z
O
N
I
N
G
R
E
Q
M
T
S
$ 3
' ' ��`� SUM/�MALR�'V� �O�F FEES � �-,.��
BUILDING PERMIT $ -�-�fL��Ps.G.Z_ SMIP $ ii_
. PLAN CHECK $ PERMIT �
PLUMBING g ISSUANCE' $
• PLAN CHECK 25% $ ENERGY P.C. $'
,ELECTftICAL $ GRADING �$
�PLqNCHECK 50% $ MICFOFILM $ ��
MECHANICAL $ TOTALFEE $
PLAN CHECK 25% $ - ,
�
' CONSTRUCTION AND PLANNING POO� _ SPA
APPROVALS Permit# Date Inspector p�ppROVALS 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 Condui[-Undrgrnd. 55. Electrical Bonding
5. Steel Reintorcement 56. Rough Plumbing & Pressure Test
6. �Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7: Footings � 58. Electrical Conduit-Undrgrnd. .
S. Foundation � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. . 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System � 61. APPROVAL TO DECK
it. Property Sewer Line & HouseConnection 62. Backwash & Receptor-Final
12. Sewer Cap - 63. Heater & Vent-Final
13. Roof Drains • 64. Plumbing System - Final
14. Rough Plumbing � 65. Electrical�Final
15. Rough Electrical-Conduit 66. Solar System-Final
16.. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electriral-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19.�Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20.1 Rough Factory Fireplace . APPROVALS Permit #�
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Venti�ating 77. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing � 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing ,, ��3 �7 �/� 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical �
27' Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding I Y•'Z•� � 77. FIXED SYSTEM FINAL
29. Insulation � 7�j/- 78. FIRE PREV. FINAL
30. Drywall Nailing y� , j2.7 �/�/ HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat ' Z,� 8� �id 79. FINAL INSPECTION
32. Electricat Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric _ Notes � �' C�� �
34. Final Heating & Air Conditioning G� O
35. Final Gas Pipe-Test �„ �
36. Hood or Canopy �t a �w.` O
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
i
46. Handicap Regulations
47r. FINAL STRUCTURE & BUILDING
r
48. Special Requirements Completed $� g m M �
49. Electric Release to Edison . � '
50� Gas Release to Southern California Gas Co ` '�
5�� CERTIFICATE OF OCCUPANCY . , �
No. Date
_ ,
ADVlicant �o /ill in all spaces exceD� those wilhin �eavy�der �nes anG Tlgn all apPropriale tlaclarations.
CITV OF COSTA MESA CONSTQ{� ��'IONTPoE'RMIT �R^'ui o�. —- TRACT NO. LOT NO. uti�r wo
Project Address -7�� �• �// .�/ FS-C�T
Applicant's Mailing Address «L�%G�eS Si / / QO(
�rbu6 r�? �
Owner's Name Phone
Addreu ��9�G U��[��� ��L.��r� �
Arch/Eng. � License No.
Address y���)��/ �
Contractor's NameQJ^�SLN.L.L/ ��� Pho e
Addresslmailin9l(J{!� �C.I/f�� S/ �� 906P�p
City License No. - �D/ 7�
LICENSED CONTRACTOR DECIARATION
I bereby affirm inat I am licensetl untler provi5loni ot Charter 9(commencin9
witn section 7000) of Divislon 3 of the Business antl Profes ions Cotle, antl
my Iicense is in tyy t rce antl effect. � 7 �
Licen3$ Cl�a�j L- I � n� o. �
Date�_L�.� Signalure
�VO WOHKERS' COMPENSATION � l ATION
� hereby attirm that I have a certiticato ot consent to selhlnsur or a certificate
t Workers' Compensation Insurance, or a certlfietl <opy thereof (Section
J800, Lab. / / //y)
I PolicY No. �/ �{ O�� Com anY ��`^�� ��
� Cer[ifietl copy is hereby (urnishetl.
1 � C Ifi§��j o��} iletl with the city 'I in o. �
� Date�(. ZLL� Applican
EXEMPTION FROM WORKERS' C 1 ATION DECLAR ION
(This section neetl not be completetl if the permit is for one hu retl (5300) or
less).
I certify [hat In the performanGe of the work /or whiCh th15 pe�m�t Is issuetl, I
zhall not employ any person in any manner so as to become subject to the
Workers' Compansa[ion Laws ot CalHornia.
Date Si9na[urc
NOTICE: Ii, alter making this tleclaratlon, you shoultl become subject to the .
Workers' Componsatlon provisions of the Labor Cotle, you muit forthwith
compty with suCh provl5iOn5 or [his permil shall bo tleemetl r¢wketl.
CONSTRUCTION LENDING AGENCV
1 hereby afflrm that there Is a constructlon lentling agency for the performance
of [he work lor which this permit is issuetl (Section 309� Civ. C.)
Lentler's Name
Lenticr's Atltlros�� � � �� r %� �Q.
OWNER BUILDER �ECLARATION
I hereby affirm that I am ezempt from the ConVacior's License Law for the
followinq reason (Sec[lon 7031.5 Busine55 antl Protesslonal Cotle: Any city or
county wnich requlres a permit lo construct, alter, improve, tlemolisn or repair
any sl�ucture, prio� to its i55uanG¢, also �equlre5 the applicant for such pe�mlt
to tile a si9netl statem¢n[ that he/sne is Iicensotl pu�suant to tha provisions o(
the Contractor's LiCense Law (Chapter 9(commencing with Section 7000) of
DivislOn 3 ot the Business antl P�ofC55ions Cotle) or that he/She is exemOt
therefrom antl the Oasis tor lhe allegetl exemptlon. Any vlolation of Section
7031.5 by any applicant for a permlt subjects tM1e applicant to� a civil
penalty o( no[ more [han tive huntlretl tlollars (5500).
❑ I, as owner oi the property or my employees with wages as their sole
compensation, wlll tlo tho work, antl the structure is not intentletl or o�teretl
for Sal¢ ($ection 7044, Bu5ine55 and P�ofe55ional Cotle: The Cont�acto�'S
License Law tloes not apply to an owner Ot a prop¢rty who builtls o� improv¢5
thereon, antl who tloes such work hlmself/herself or tnrou9h nls or her own
employees, provlaea that such improvements are not intentletl or offeretl for
sala. H, however, lne bulltling or improvemen[ is Soltl within one year ot com-
Oletion, the owner wlll nav¢ Ihe burtlen of p�ovin9 he/she dltl not builtl or im-
prOve fo� the purpose ot Salu).
❑ I, ds own¢r o/ tne prOperty, am e%clusively contraCting wi[h IlcenSetl cOn-
tlac[ofs t0 cOnstlucl the project (SecHon ]044, Buslness antl Profe55ion5 COtle:
Tha Contractor's License Law dOes nOt appty to an owner ot property-who
builtls or Improves [he�eon, antl who contrac[5 for such projects with a con-
tractor(51 ucense pursuant lo the Contractor's License Law). I am aware that
proof o1 their Worker's Compensatlon insurance shOultl be providetl to me.
❑ I am exempt untler 5¢ctlon B. & P. C. fOr IhiS rea5on
Date Owner _
I hereby certity tnat I have reaa tnls
InfO�matlon I5 c recL 1 agree cOmp
antl ztate laws lating to b g
sentatives of is c'ty to r
inspectlon
Si9nature
Drivers' L en or 55 � �
TVPE OF CONSTRUCTION �I NEW LJ ADD LI ALTERATION LI REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTIONOFWORK/USEOFB�DG. �
TVPE OF PERMI� GRADING FOUNDATION $TRUCTVRAL
❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT �ESCRIP710N Sq.FT. � oCCUVANCv �
`.CONSTRUCTION TVPE VA�UATION S
�.�ZONE GRADINGCU.VOS. ACRES
Remarks:
, �'.
Preventer
Irrigation
loor Drains '
loor Sinks
Ias�Service Outlets
nterceptors� '
:itchen Sini4 '
.avatories J �
—Trap a
ioof.DrSins� � '
-,r' a:
Reinspactian Fee' $15
Duct - Under Ground :
Duct - Strucmral
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducting -
�6100,000 BTU 0100,OOOBTi
Heinspection Fee ' � $15
CMF 0865-46, tev. ]0/84 WhitG � Builtling; Canary - qpppCdnF Plnk - Accountlng; Goltlenrotl - AsSassor
Showers
Service Sink �
Sewer Cap
Sewer Connection � -
$013f CAIIEC[Of5 �
Solar Piping '
' Solar Tank
. Swimming Pool w/Spa
Urinal
' Water Closet
Water Heater
Water Service
Auto-Wash
i
Issue Fee
Hood or , Type I ❑
Canopy Typell ❑
Retrigeration System
❑0-t00,000BTU ❑t00,000BT
System Repair/Alteration �
Fire Dampers
Registers
Issue Fee
A.P. #
S Main Buildl
E
T Front
B Rear
A
C Right
K Lef2 .
S
Ping. Ref. #
Planninn Notes:
FEES
Aummatic Washer
Construction' Pole Sub.
Cooking Unit
�IShWd5flCf �
Dryers Gas ❑Electric
Fan
F.A.U.
Fixtures
$ 3
$ 3
Outlets
Switches
Garbage Oisposal
Generator �0-5 KW
3952 3/13/97 � �n TL
Zone
Accessory Building:
2
O
N
I
N
G
R
Parking Req./Provided E
� Q
M
S
ELECTRICAL
Transformer ❑ 15-50 KW
❑ SO+KW
�l.'f3�i7
Meter,P�upto100amps !
Meter ❑over700amps
Sub Panel
Motors �0.1 HP �7 h- 8
Inc. Solar �9-15 HP 016-75+
Microwave
Pole Light
Range
Sign
Standing Sections
Trash Compactor
� Hainspection Fee !$15 � � Issua Fee
�DEVELOPMENT SERVICES RE�UIREMENTS:
?0���8 APP�oved By
Building Approved By
Appliratian Issued By
FEES
$ 3
- SUMMARY OF FEES �
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
'�- PLAN CHECK 25% $ ENERGV P.C. $
A ELECTRICAL $t n• oZ0 GRADING $
PLAN CHECK 50% $ /�- � MICROFILM $
'• MECHANICAL $ TOTALFEE $ �
� PLAN CHECK 25% $
CONSTRUCTION AND PLANNING , , ' POOL & SPA �
Date Inspector . Date Inspector
APPROVALS Permit # APPROVALS Permit # .
�
7. Temporary Electrical Service or Pole � 52. Pool & Equipment Location , .
2. Soii Pipe-Undrgrnd. � ' 53. Steel Reinforcement .
3. Electrical Conduit Utility-Undrgrnd. 54. Forms ' - •
4; Electrical Conduit-Undrgrnd. � . 55. Electrical Bonding � � �
5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test . , ., '
6. Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE ,
�•
7. Footings � � 58. Electrical Conduit-Undrgmd. � "�
8. Foundation , � � 59. Gas Pipe, O Undrgrnd., Test .
� 9. Water Pipe-Undrgrnd. 60. Backwash Lines,-P-Trap. O Undrgrnd.
10. Str,uctural Floor System ' '61. �APPROVAL TO DECK '
71. Property Sewer Line & House Connection . 62. Backwash & Receptor-Final � � '
12. Sewer Cap � 63. Heater & Vent-Final .
13. Roof Dralns 64. Plumbing System�- Final �
14. Rough Plumbing 65. Electrical-Final � .
15. Rough Electrical-Conduit � . 66. SolarSystem-Final ' ' '��'
76.0 ou h IectricyJirin'S � � 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 # _ , - jf
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 . '
1
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 !' i
30. Drywall Nailing ' HEALTH DEPT. REQUIREMENT �
31. Plaster Brown Coat � � 79. FINAL INSPECTION ,
32. Electrical Power Meter-Final a' ���R 80. FOOD CERTIFICATE ISSUED�
" �
33. Final Electric � ' Notes:�/r��..�� s��/ �..1�� c�/1%�•�icp,
34. Final Heating & Air Conditioning � . �i �
35. Final Gas�Pipe-Test , ' �
.,
36. Hood or Canopy .
37!•Final Factory Fireplace � � � ' �
�� M1 t
38. Final Plumbing i � ,
39. Water Service-Final � v �` ':l i L` � � � ' �
40. Gas Service-Final `' � ." ' � r � " `
�,41. Solar pomestic-Final � �" � . � , , � J , , ,
42.'SackflowPreventer ' �' � � �� �
. ��
�,43. Backflow Irrigation � � J�� ' � � � '
.44. Landscape Irrigation System • � ' � � • ' �
r..
45. Sound Attenuation , � � '� ' �, � '
'� 46.yHandicap Regulations , � � '�,� � � -; ,;
4�7. FINAL STRUCTURE & BUILDING ' a' r�, ' ` �
48. Special Requirements Completed �. � : j • • '� - � ...
,�
49. �Electric Release to Edison . - ' •. . � � • � .
50. Gas Release to Southern California Gas Co � , �
51. CERTIFICATE OF OCCUPANCY
No. Date '
AOp�icant to fiil in all spaces ezcept thosa within heavy Ga�tler Ilnes anE sign all approp�iale tleclantions.
cl7v oF COS7A MESA CONSTRUCTION PERMIT
. Prolect Address %6=� 1+1. �f t= f7
Applicant's Mailing Address .✓d �/� L� W���*� �"4 � l+� ...
Owner's Name �-� � 1'—�-c.��-�-�h ne 79,f")1 "iS'
Address "/� `� �� � _ '�.�.�
Arc /E .- � License No. LC • �i t'
Address
Convactor's Nam � � � Phon 3
Address (mailing) � �.�i�1A�S � .�✓� �An��y �W�
City License No. ����1
LICENSEU CONTRACTOR DEGLARATION
I her¢by affirm Ihat 1 am Ilcensetl untle� provi5lon5 of Char[Cr 9(commencing
wit� sectlon 7000) of DivizlOn 3 of the Bu5ine55 antl Prote55lon5 COtlC, antl
my Iicense iz in tull force a eHecf. ///����, �/{7q�
LJcens�CI ' ' �I� .�/�yi_�4��
oate (-� ^L 4^ Siynature U.1. /A 1,� �
WORKERS' COMPENSATION OECLARATION
I hereby afiirm tnat I have a certificate of consent ro selt-insure or a certificate
' Workers' Compensation Insurance, or,a <ertltietl copy thereof (Sectlon
J00, Lab. C.) / � �� I\ T
PolicY No. T�j`� �^� � P� ComPdnY C �N ��
Certitie0 coOY �S h¢reby 1umisM1eO.
Cer ifietl co�py� s%�letl with the city iltling OIY ision
a e �— �i - Appli<ant �v � l> �� T� h
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl not be complete0 If the permit Is for one huntlretl ($100) or
Icss). .
1 certi(y thal in th¢ pertormance of the work for whith thi5 p¢rmk is Issuetl, 1
Shall not emplOy any pe�son In dny manner 50 as to become subjecl to th¢
Workers' Compensation Laws of Calitornia.
. Date Si9nalure
'NOTICE: If, atter making this tleclaration, you shoultl bewme subject to the
Workers' Compen5ation provisions ot the Labo� Cotle, you must forthwrth
compry with- sucn provlsions or Ihis permit Shall b¢ tleemetl revoketl.
CONSTRUCTION LENDING AGENCV
1 hereby a�fi�m that there is a const�uction lentling aqency fOr Ihe pe�fo�mance
a/ the work ror which this permi[ is � issuetl (Section 309] Civ. C.)
Lentler's Name '
Lentler'S Atltlress .
OWNER BUILDER �ECLARATION
II herGby aHirT l�at I am ¢xempt from thu Contractor'S Llc¢nse Law for the
following reason (Section 7031.5 Business antl Profesilonal Cotle: Any city or
countv which �equires a pe�mit IO cOnstru<t, alteq improve, tleTOlish o� rapai
'herefrom antl llte ba5i5 (o� Ne allegetl exemption. Any vlolation o( Sectlon
731.5 by any applican[ for a permit subjects [he applicant to,a civil ,
tnalty of not more Nan (ive nuntlretl tlollare (5500). .� ".
�� 1, az own¢� ot the ptoperty o� my�employees with wages as their Sole
compensation, will tlo the w0/k, antl the slruCture is not inten0etl Or offe�etl
tor sale (Section 7044, Business anC Protessional Cotle: The Contracfor's
License Law Coes not aoPty to an owner ot a property who builtls or improves
thereon, antl who tloes such work nimselt/herselt or throu9h his or her own
emplOyees, provitletl that SUGh Improvements are not Intendetl or otteretl� tor
sale. If, however, [he builtling or improvement is soltl withln one year of com-
pletlon, the Owner will have the burtlen of ptoving he/she tlid not bulltl o� im- i
prova to� lhe purpOse ot Sale).
❑ I, as owner of ihe property, am exclusively contracting with licensea con-
tra<tors fd cons[ruct the Oroject (Section 7044, Business antl Professions Cotle:
Tne Contractor'S License Law tloes not appry to an owner ot property who
builtls or improvez thereon, anC who contracts tor such projects witn a tan- �
tractor(si license pursuant ro tbe�Contractor'S License Law). I am aware tha[
p�oof oF thelr Wotker'S Compensation insu�ance shoultl be provitl¢tl to me.�
❑ I am exemo� untler Section B. & P. C. for tni5 reason ,
Date Owner '
I hereby certify that I have reatl thii applicatlon antl state that tne above
in(ormation is correct. I agree to comply wlth all city antl county ortlinancez
antl state laws relatin to builtlin9 consV ction, antl hereby authorize reore-
sentaUveS of, this' ci�t0 ¢nfer upOn�e�ove-mentlonetl oper[y ,fo�
Signature _�
DriverY License or 55
Date�
('� _¢l�3 Ita4a2� / I l'--%�
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
'❑ CONVERSION O DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
_ in� i,�-� . __
TVPE OF PERMIT GRADwG FOUN�oN Sr�L
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ M�ANICAL
❑ OTHER /
PROJECT DESCRIPTION 5�. F7. � oCCU� �rv �
CONSTRVCTION TVPE " VALUATION $ / Oi
ZONE GRADING CU. VOS. ACRES
Remarks: �/' ✓9.( -.��1�/ /� .
Sink
Preventer
Irrigation
Clarifiers '
Dishwasher
Drinking Fountains
Floor Dreins
FloorSinks� �
Gas Service
Interceptore
Kitchen Sink '
Lavatories �
P-Trap
Poof Drains
Reinspection Fee
a
$15
Duct - Under Ground •
Duct-Strucaral ,
Duct - Ventilating
ExhaustSystem ❑ MWtiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting ,
❑ ai oo,000 aTu O i oo,000
. i
Reinspection Fee I $15
CMF 0865-46, rev. 30/84 White - Builtlin9: Canary - Applicant; Pink - Accountlng; Goltlenrotl - Asse55or
Service� Sink
Sewer.Cap �,
Sewer Connectio�.
Solar Collectors�'
Solar Piping
Solar.Tank � �
Urinal _
Water Closet
Water Heater
Water Service
�Auto-Wash
Laundry Trays
Issue Fee
Hood or Typel ❑
Canopy Typell ❑
Refrigeretion System
❑6100,OOOBTU ❑1�,000
System Repair/Alteration
F ire Dampers
Registers .
, Issue Fea
n.r. # 4 v— —c
S Main Building:
E � �
T Front
ARear
C Right Er
g Left —IZ �
Ping. Ref. # ��Q_ g� _ s
Planning Notes:,� �QS' .�
Auromatic Washer .
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas� �Electric
Fan
F,A.U.
Fixtures � '
Deyice�Boxes�
Outlets Z
$witches �
-,
7190 6/ I.0/86 _ 548.26 Tl
, _.�., , ,�.i
io�a /2 3
Accessory Building:
Parking Req.
ELECTRICAL
Trans(ormer ❑ 15-SO:KW -
❑ SO±KW -
Meter ❑up ro 100 amps ,
Meter ❑over100amps, .
�SubPanel !:� �
Motors00-7 HP�1h-8 �
Inc. Solar �9-15 HP �16=15+
Microwave �
Pole Light
. .Garbage�Dispoul ; Standing Sections
Generatpr O65 KW �5-15 KW Trash Compactor
�. r `
� �.
$ 3 '
Reinspec[ion Fee $15 Issue Fee
FEES
$ 3
DEVELOPMENTSERV SR �UIR
Zonin9�APProv�.BY
8uilding Approved By
FEES
' Y
�
$ 3
Z
O
N
I
N
G
R
E
Q
M
T
S
: `� SUM A�RV� (O%F�FEES
' BUILDING•PERMIT $ ---J����.a0 SMIP , $ ���I
'�'PL•AN'�CHECK $ � pERMIT '
. � �PLUMBING S - ISSUANCE $
� PLAN�CHECK 25% S ENERGV P.C. $
,v
', ELECTRICAL . $ GRADING $
� PL•AN CHECK 50% $ MICROFILM $ - �//Q �j/�
MECHANICAL $ � TOTALFEE $ _272fI�V
.�_ , ',PLAN CHECK 25%� $ '
i.
,
sl•, ' CON6TRUCTION AND PLANNING
APPROVALS Permit #
1. "Femporary Electrical Service or Pole
2. Soil Pipe-Undrgrnd. � �
3. Electrical Conduit Utility-Undrgrnd.
4. Electrical Conduit-Undrgrnd.
5. Steel Reinforcement
� 6. Electrical UFER Grnd.
7. Footings �
� � �
8. Foundation
9. Wa"ter PipR-Undrgrnd.
10. Structural Floor System
11. Property Sewer Line & Hause Connection
12. Sewer.Cap
13. Roof Drains . . �
14. Rough Plumbing �
75. Rough Electrical-Conduit
1�6. �Rough Electric Wiring
17. Rough Wiring Sign
18: �Rough Electrical-T Bar Ceiling
19. Rough Heating & Air Conditioning
20.:Rough Factory Fireplace .
,i
21. Ducts, in Structure �
22.- Ducts, Ventilating �;
23. Gas Pipe-Rough & Test
24. Roof Framing "
25. Roof Sheathing ..
26. T-Bar Ceiling (Structural) & Monocoat
27,: Frameand Flashing
28. Lathing & Siding
29. Insulation �:.
30.. Drywall Nailing ' ' I �
31•. Plaster Brown Coat"
32. Electrical Power Meter-Final •
33. Final Electric .�
34. Final Heating & Air Conditioning'
35. Final Gas Pipe-Test
36. Hood or CanopV .
37. Final Factory Fireplace
38. Final Plumbing
39. Water�Service-Final •
40. Gas Service-Final
41. Solar pomestic-Final � �
� 42. Backflow Preventer '.
I,� 43. Backflow Irrigation
-� 44. ,Landscape Irrigation System
� 45. Sound Attenuation
= 46. Handicap Regulations
�
� 47. FINALSTRUCTURE&BUILDING
� 48. Special Requlrements Completed
49. Electric Release to Edison
- 50. Gas Release to Southern California Gas Co
� 51. CERTIPICATE OF OCCUPANCY
Date
Date � Inspector
• 17• � o�C.�
� G�
•12•1 ✓[.
Cr�
r► m
POOL PA
APPROVALS Permit#
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER-GUNITE
58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, � Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
61. APPROVAL TO DECK
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final
66. Solar System-Final '-
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit#
70. Underground Hydro
71. Pruduct Piping OGas ❑Oil
72. Underground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
NoteS:� � /� (.'�-r, k/�C��1
Date I Inspector
0
9
,CI'fY'OF COSTA MESA CONSTRUCcT�N PERMIT
j-Project Address 7.�s w• � 9 s � Q� n�
� ApplicanYs Mailing Address ����.T D allpu n 4. w fs ���;}
Qwner's Name �' � • ti � P' � � C-� �♦! w+v Phone
Address �� 3 (/� Sn TV a- A,s 1�.1 U P.
Arch/Eng. g+E (,` V 1FC1��`� �(� �Z License No. C ECr%Fa�A
Address �000 W � �1 � �^S� H�',fr}
Contiactor's Nam �'p -�/GH�'� ��•'. Phone �S'%� �ii-llt
Addresslmailingl �-S�z' L � CT / �OG'/NA
City License No. � 9 7
UCENSED CONTRACTOR DECIARATION�
I bGr¢by alfirm�t�a[ 1 am licensatl untler provislons of Chartor 9(tommencin9
with section 7000) of Division 3 of tne Business antl Protessions Cotle, antl
my Ilcense is in full torce ndn e/H�ect. ��i
L�CBnS¢ CId55 _• ��! ^T� LIC8n5 NO. ��- ��+ �
Dale /C)'� � �o c'enw� �.n Y �rfiul ��d.� u.nJ
WORKERS' COMPENSATION DECLA0.ATION
I nereby alfirm tnat I hava a certi8cate of consenl to sell-insure or a certificate
of Workers' Comp¢nsallon Insurance, or a certit etl copY thereof (Section
�oo, �o. c.>� 3�G/ 3 ,,,,�T
Iicy No: � Company ���c� '
L� CertifieC copy iz �ereby furnisnetl.
❑ Certifietl co�py i.s.,fJ I¢tl with the city Builtli�+9�p iv Slon
Date_; �� Applicant Y .Prn�..O. �
EXEMPTION FNOM WORKERS' COMPENSATIO DECLARATION
(Thisseclion neeG not be completetl if lhe pe�mlt I5 tor one huntlretl (E100) or
less).'
I cetUry lnat in the per(ormante O( lhe work for whlch thi5 perm�t i5IS5ueU! I
Slld�� OOf BTpIOy dpy pBlSOf1 �fl dOy TdOf18I 50 d1 LO DECOTE SUbjCC2 [O If18
WorkGrs' Comp¢n5alion Laws ot Califomia.
�ate Si9nature
- NOTIGE: I(, att¢r mdking tnis tlaUaration, You shoultl bacome subjoct to tno
Wofker5' COmpenSd[lon provi5ion5 of the L.dbOr COtle; y0u must fOr[tlwlth
compty wit� such �provislons or this p¢rmlt shall be deemetl �evok¢tl.
CONSTRUCTION LENDING AGENCV
1 hereby atfirm that there is a construction Ientling agency ior the performance
o( the work tOr which tn15 permil is Izsuetl (SeGtlon 3097 Civ. C.)
lPntler's Name �
tRnaer's Atltlress _ �
OWNER BUILDER OECLARATION • '
I hereby affirm that I am exemp[ �rom the Contractor's Licenso I�w tor the
following reason (Section 7031.5 Business antl Profesilonal Cotle: Any city or
county wnicn requires a vermit to construct, alter, improve, aemolish or repalr
any Structure, p/b� lo its issudnc¢, also require5 [he ap0licant 1or such pe�mit
to file a zigned statemeni thdt he/she i5 IiCenTEtl pulsudnt (O the pfOvi5ion5 Of
the Contractor's License Law (Cnapter 9'(commencin9 wi[h Sectlon ]000) of
Division 3 of t�e Business and Protessions Cotle) or�that he/she is exempt
theretrom antl the ba5i5 tor the alle9etl exemption. Any violation of Sec[lon
31.5 by any aOV��can[ for a permit subjects the ap0���an[ [o .a tivil
alty ot,noi mor¢ [han fiva huntlretl tlollars (§500).
� I, as owner oi the property or my emo�oYees with wages as Neir sole
�'' comoen5ation, wi11 tlo the work, ana tne structure Is not Intentlea or ofteretl
� for sale (Section �046, Buziness antl Professional Cotle: The Contractor's
� License law tloes not apply [o an owner ot a property wM10 buil�s ar improves
thereon, antl wno tloes such wotk himzelf/ne�self or throu9h nis or her own
¢mploy¢e5, ptavitletl that suth ImprOvement5 ar0 not intenGotl or oiferetl fo�
sale. It; how¢vet, tna bufltlin9 or Improvemen[ Is soltl wLLhin ona yea� of com-
pletlon, tne owner will have the burtlen oi proving he/she tlitl not builtl or im-
�rova for the purpoze of sale�. ' '
1, as owner ot the pro0erty, am exclu5ively contracting wilh IlcenSCtl COn-
` Vactorsto construct tne.prqect (Section 7044, Business antl Prolesslons Cotle:
Tha ConVac[or's l.icensa Law does not apply to an owner of property who
� builtls or Improves thereon, antl who contracts br such Orojects with a con-
tractor(sl uce�u purzuant to tne Contractor's License Law). I am aware that
p�oot a( lhei� WO�ker'S COmpensallon Insurance ihOuld be prOvlUatl to me.
❑ � am exemp[ untler Section . B. & P. C. 1or t�is reason
cr
� Date Owner
I hereby certity that I have reatl tnis aoP���ation ana state that [he above
Information is mrrecc. I agree to comply with all tlry antl county ortlinances
�antl state Iaws relatin9 to builEing construction, antl hereby authoriza repre-
sentatives of this ci[y [o ¢nter upon lhe above-mentionaE property for
in5pettion purp e ��)�?•1
' Si9nature Date V n
DriverY"�icense or 55 $ � �
to flll In all svaces except tnase wltnin heavy Gorder Iinas antl slgn all avoroD��ate tleclaratlons.
�7YPE OF CONSTRUCTION IISNEW U ApD' LJ ALTERATION lJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPE OF PERMIT GRADING^ �FOUNDATION STRUCTURAL
❑ TENANT .❑ ELECTRICAL W�IUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SQ. FT. OCCUPANCV
CONSTRUCTION TVPE VALUATION $
ZONE GRADINGCU.YDS. ACRES
Remarks:
sink
Preventer
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service _1 Outlecs
Interceptors
Kitchen Sink
Lavatories
P—Trap
Fioof Drains
Reinspection Fee � � S15
Boiler
Duct - Under Ground
Duc�-SlrucWral �
Duct - Ventilating
Exhausi System � Multiple ❑
FirepllFacLBIt.ICB05Y .
Heating System & Ducting
❑ 6100,000 BTU O 100,000 BTI
Reinspection Fee � 515
1F 0865-46, rev. 30/84 White - Builtling; Canary - Appliwnt; Pink - Accounting; Goltlenrotl - qssessor
Showers '
Service Sink
Sewer Cap
$ewer Connection
$olar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Wacer Closet
Water Heater
' Water Service
Auto�Wash
laue Fee
Hood or .Typel ❑
CanOpy Typell ❑
Hefrigeration System -
❑a�oo,000 eru 'Oioo,000 sTu
System Repair�Al[eration
Fire Dempers
Registers .
Issue Fee
$ 3
FEES
�
$ 3
A.P. #
S Main Buildi
— E
T Front
B Rear
A
— C Right
— K Left
— S
— Ping. Ref. vlt
, Planning Notes:
Auromatic Washer
Construction PoleSub.
Cooking Unit
u�snwasner _
Dryers ❑Gas ❑EI�
Fan
F,A.U.
Fixtures '
Device Bozes
Outlets
Switches
Garbage Disposal
Generator 00-5 KW
Fee
5793 10/23/86 83.
2one
Accessory Building:;
Parking Req./Provided
ELEC7RICAL � - • � •
Transtormer ❑ 15-50 KW
❑ 50+KW _
Meter ❑up to 100amps -
� Meter ❑over t00�amps•
Sub Panel
Motors OPi HP O 1 X- 8
Int.Solar 09-15 HP 016-15+
Microwave i
Pole Light
Range '
00 TL
FEES
Standing Sectionz
5 KW Trash Compactor
r
$15 Issue Fee ' � 5 3
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning APProved BY
Building Approved By
Z
O
N
1
N
G
R
E
�
M
T
5
SUMMARV OF FEE�' � `
BUILDING PERMIT y SMIP � • $ -
PLAN CHECK $ pERM1T
PLUMBING $ �• �� ISSUANCE $
PLAN CHECK 25% $ �A . ENERGV P.C. $
ELECTRICAL $. GRADING $
PLP.N CHECK 50% $ ' MICROFILM $ �
MECHANICAL $ TOTAL FEE $ (�-3• .
PLAN CHECK 25% $ .
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
1. Temporary �lectrical Service or Pole 52. Pooi & Equipment Location
2. Soil Pipe-Undrgmd. �/p�J,�y� 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test �
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE�
7, Footings 58. Electrical Conduit-Undrgrnd. �
8. Foundation 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. -
10. Structural Floor SYstem 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing - 65. Electrical-Final �
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED fOR PLASTERING
18. Rough Elearical-T Bar Ceiling 69. POOVSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. FEQUIREMENT
20. Rough Fac[Ory 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.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
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 (�-��.y7 �,a/�
36. Hood or Canopy
37. Final Faaory Fireplace .
38. Final Plumbing 7`� y �� �
39. Water Service-Final
40. Gas Service�Final
41. Solar pomestic•Final
42. Backtlow Preventer � �
43. Backflow Irrigation ,
44. Landscape Irrigation System .
45. Sound Attenuation
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release �o Southern California Gas Co �
51. CERTIFICATEOFOCCUPANCY �%
No. Date _ _ ' �,j
Applicant to fill in all spaees except those wltnin heavy borOer Iines antl sign a11 aoo/ovriate tleclarations.
�ITYOFCOSTA�MESA CONSTRUCTI�PPERMIT
P�oject Address � ��_ �'s ' \ g�P S��
Applicant's Mailing P.ddress
Owner's Name Phone
Address . t —
Address (mailingl - ` "`�'^�
Ciry License No. � � �
LICENSED CONTNACTOR DECLARATION
I hereby altirm that I am Iicensetl untle� provlsions Of Charter 9(commenCinq
with se<tion 7000) at Divislon 3 ot the Bu5ine55 antl Protessions Cotle, antl
my license is in ful o e apntl etfeci. / —
License Class � ' ense No: J�S y� S
Date ' S19 1�.� w ^-^ti-'--
WORK RS'COMVENSATIDN DECIARATION . -
hereby atfirm that I nave a certificate ot consent to sel/-inture or a certlficate
�f Worker5' CompC�sxtfan InSurance, or a certitietl copy thereof (Section
3800, Lab. C.)
Policy No. Company
eCertifietl copy is hereby turnizhetl.
Certifietl copy is ���etl with the city Builain9 Division.
Date AGPlicant
EXEMPTION F0.0M N'ORKER$' COMPENSATION �ECLARATION
(This section neetl nOt be ComD�etetl if Me pe�mit i51o� one huntlratl (5300) o�
Iess).
" I cer[iiy tnat in th! Pertormanta of the work (or wnlch [hiz p¢rm�t i5 i55uetl, I
shall not emplOy a�Y person In any man So a5 to become subjeCt t0 the
WorkP,<• Comoens�7�w5 0l ifOr ' .�v�
Date ��� «' Signa4e 7/'�^— /
NOTICE: I(, a/ter rt�akin9 tnis tleclaration, you zh ultl become sub{ect to. the
Workers' ComO¢ns3��on p�ovislons ot tlte Labo� CotlO, you must forthWith
comply wlth Such prOVl5ion5 or thi5 perm�t shall DB tle¢metl r¢voketl.
CONSTRVCTION LENDING AGENCV
I hereby at9rm that there is a construction lentl��9 a9ency for the performance
of tbe wOrk tor whic� Inis permlt Is BsuCG (Settion 3097 Civ. CJ
Lentl¢r'S Name .
Lentler's Atltlrass
OWNER BUILDER �ECLARATION
1 nereby aftlrm t�a� � am oxempt frOm th¢ CO�trattOr'S LICOnSe Law fo� �he
following reason (5e«�a� 7031.5 Businezs antl Prolezslonal CoUe: Any clty or
county whlch requlres a permit to conslruct, allar, ImO�ove, tlemoli5h or r¢pair
any structuro, priof to its issuance, also reqWres lho apD��cant for sucn permit
t0 lile a Slgnotl slatement Ihal he/She is Iicens¢d putsudnt t0 the provision5 of
the Conlractor's Ucanso Law (Cnaoter 9(commenting witb Soctlon 7000) ot
Dlvision 3 Of [na Busine55 antl Professions Catle) or [hat ho/ihe is exempt
nerefrom antl Iha basis for the allegetl exemp��on. Any vlolation ot Sectlon
]031.5 by any apP���ant for a permit suD�ects tho applicant to a civil
�enalty of not'mora lhan hva huntlretl tlollars (5500�.
I, as owner of tno prOperly Or my employees wllh wagas as lhel� Sole
COmpenSaUon, wlll tlo Iha wOrk, antl [he SVuttura I5 nOl Intontl¢tl Or Off¢r8tl
tor sale (Seclion 7044, Busines5 antl Protessional Cotle: The Contractor's
�icense Law tloas qot appty to an owner o( a property wno bulltls or improves
thereon, ana wno tloes zuch work nimzeli/herzoll or thiough his or her own
employees, provitletl that such improvements are not IntentleU or offeretl �or
salo. II, howover, tho �ullCing Or improvemen[ �5 soltl wlthin one year of com-
pletion, the owncr will have the burtlen of proving he/zhe dltl not bulltl or �m-
pfOvO �or the pufpOsa O1 Shco).
❑ I, as owner ol the proparty, am exclusively tantratting with Iicensetl con-
tractors to conslruC< <he Proj¢ct (Section ]064, Buslness antl Professions Cotle:
The COn[ractor's 4�cen5e �aw does noi apply to an owner ot p*operty wh0
builtls or Improvas Iheroon, antl who wntraGts tar Such proj¢<Is witb a Con-
tractor(s7 iicense pursuant ro tne Contracior's Licens¢ l.aw�. I am aware that
proof o( their Wofker's Compensatlon inzurance shoultl be provieea to me.
❑ I am exempt under 5action B. S P. C. for [his reason
Date Owner -
I hereby certiy tnat I �ave reatl tnis applicatlon antl state that the above
iniormation Is corr8«..I agree to comply witn all tlty antl county ortlinances
antl state laws relat�n to builtlinq constructlon, antl hereby authorize repre-
senfatives Of tF115 t0 en r upOn the abova-mentiOnetl O�opefty tOr
inspectlon urpose �
Signature� � �Z _ � � � a�
Drivers' Licen e or 55 � '�� ��
r�i �� �� � nni. � rvv. w i rvv. �JI�j NO.
TYPE OF CONSTRUCTION NEW nDD AL7Ea.aTioN'� EPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p �(, �
DESCRIPTION OF WORK/USE OF BLDG. S Main Buildi
TVPE OF PERMIT GRADING FOUrvDATiOrv STRUCTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear
❑ OTHER A
PROJECT DESCRIPTION 5q. FT. oCCvaANCv C Right
CONSTRUCTION TVPE VALUATION 5 g Left
ZONE � GRA�ING CV. VDS. ACRES Ping. R2L �'
Remarkz: �' . Planning Notes:
Sink
Irrigation
Drinking Fountains
Floor Drains �
Floor Sinks
Gas Service Outletz
Interceptors
Kitchen Sink
Roof Oroins
Roincpaction Fee $15
BOiler
Duct- UnderGround
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact Blt. ICBO #
H�ea �ystem & Ducting
L�4100,000 Bl"U 0100,0006TI
Reinspection Fae � $15
1F 0865-46, rev. 30/94 White - Builtling; Ganary - qpp���nt: Pink - Accounting; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w(Spa
Urinal
Water Claset
Water Heater
Warer Service
Auto-Wash
laundry Trays
Iwue Fee
1ANICAL
Hood or Type I
Canapy Type II ❑
Re(rigera " n System
100.000 BT U❑} pp.ppp 8T
System Fepair/qlteration
Fire Dampers
Registers '
Issue Fee
Automatic Washer
Construction Pole Sub.
Cooking Unit '
Dishwasher
Dryere ❑Ges ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
Outlets ,
Switches
Gaihage Disposal
Generator 00�5 KW �5-75 KW
2178 2/jl/87
Zone
ELECTRICAL
Transformer ❑ 15-50 KW
❑50+KW
Meter �up to 100 amps
Meter ❑over 100 amps
Sub Panel
Motors Da1 HP O1'h- 8
Int.Solar �9-75 HP �16-75+
Microwave �
Pole Light
Range
Sign
Standing Sections
Trash Compactor
5 3
FEES poinspaction Fee $15 luue Fee
�DEVELOPMENTSERVICESREQUIREMENTS:
Zoning Approved By
Building Approved By
Aouliption Issued BV- ` 1 n __
S 3
BUIIDING PERMIT $
PLAN CHECK $
PLUMBING . $
PLAN CHECK �25% $
ELECTRICAL $
P�AN CHECK 50% $
MECHANICAL j
PLAN CHECK 25% $
'64eB8
FEES
$ 3
SUMMARV OF FEES
SM�P 5
PERMIT
ISSUANCE $
ENERGV P.C. $
GRADING S
MICROF�LM �$
QTOTAL FEE 5 % �( . ��
Z
O
N
I
N
G
R
E
Q
M
T
S
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar SYstem-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign. 68. APPROVED FOR PLASTERING
18. Rough Electriral-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning �Z �4 � FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # ,•
21. Ducts, in Structure 70. Underground Hydro
22. DuctS, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation , 78. FIRE PREV. FINAL
30. Drywall Nailing ' HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: �
34. Final Heating & Air Conditioning �� �,
35'. Final Gas Pipe-Test
36. Hood or Canopy �
37. Fina� 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 Irriqation System ' • •
•45. Sound Attenuation '
46. Ha�dicap Regulations '
47. FINAL STRUCTURE & BUILD�NG ;,•
48. Specia� Requirements Completed � ' •. - . .
� . -
49. Electric Release to Edison - �' '
: 1 .
50. Gas Release to Southern California Gas Co . � �
51. CERTIFICATE OF OCCUPANCY
No. Date . '
Applicant to fill in all spaces extept those witltin �eavy bortler linas antl si9n all appraprlate tleelarations.
CiTY UFCOS7A ME A CONSTRU`CT �LO �yPERM
Project Address � �� �� ' ` v �
Applicant's Mailing Address
Owner's Name Phone _
Address
Arch/Eng. �� License No4��'� �7
Address
�
Contractor's Nam 1�_� Phone
Address (mailing) � Y''�� �. �: S � ` �^ �`d' o•�-..
Ciry License No. �, �`7 1Z—�
LICENSED CONTRACTOR OECLARATION
I hereby a(firm that 1 am IlCensetl untler orovislons o( Charter 9(�ommencin9
wlth uc[ion ]OOO) Ot DiviSion 3 ot the Bu5ine55 antl Profession5 Cotle, antl
my license is in full force a tl efiect.
License Class Icense No.��_o�
�ate� - %�� u 7 Si9neture
WORI(ERS'COMPENSATI4N DECLARATION �
� hereby atfirm that I have a certiflcate ot consent to self-insure or a certiticate
4 N/orkers' Compensa[ion Insurance, or a<ertifietl copy thereof (Section
d800, Lab. C.) . .
Policy No. Company
Certifietl copy is hereby turnishetl.
Certifietl copy iz �Iletl with th¢ city Builtlin9 Division.
EXEMPTION FROM WORKERS' COMPENSATION DECLARA'lION
(This section neetl not be mrr�pletetl i( [hc permit is for one huntlretl ($300) or
less).
I certity lhat in tne per(ormance of the work tor which tnis oerm�t iz issueQ I
shall not employ any person in any manner as to betome subject to the
Worke� Compensa[lop_Laws•of Califomia. � —�y�
Date (� P � Signature � _1G(---✓—
NOTICE: 1f, a(ter making 111is tleclaralion, you shoultl become subj¢ct to the
Wo�kers' Compen5ation prp�i5ion5 of the LabOr COtle, you mu5t forthwith
comply with such provisions or tnis oermit shall be tleemetl revoked.
CONSTRUCTION LENDING AGENCV
I hereby affirm Ihal there is a constructlon lentlin9 agency fo� th¢ pe�fo�mdnce
ol the work tor which (his permlt iz issuetl (Section 3097 CiJ..CJ
Lentler•s Name
Lentler's AOtlre55
OWNER BUIL�EH OECLqRAT10N
I hereby affirm that 1 am axempt from the Contractoi's License Law f r tha
tollowin9 reason (Settlon 7031.5 Business antl Professional Cotle: Any city or
county which �equires a p¢rmit to const�u<t, alter, improve, tlemolish or,�epal�
any ztructure, prior to its Issuance, also requires the applicant for such oermlt
to file a si9^etl statement thai he/she is licensetl pursuant to the provisions ot
the Contractor's License Law (Chapter 9(commencinq witb Section ]000) of
'�Ivision 3 of tne Business antl Professions Cotle) or tnat ne/she iz exempt
herefrom antl the basis for the allegetl exemption. Any vlola[lon of Section
!031.5 by any appliwnt for a permit subjects the applican[ to a civil
�endl[y of not more lhan fiye huntlretl tlollar5 (5500).
Ll I, as owner ot the prOperty or my employees with wages as their sole
Comp¢nsation, will tlo the Work, antl the sVUGture Is not int¢ntl¢tl or ofteretl
lor sale (Section 7044, 8usiness ane Protezsional Cotle: The Contractor'S
License Law tloes nol apPlY to an owner of a property who builtls or imOroves
th¢reon, antl who Coes suth work himself/herself or throu9h hi5 or her own
EmD�oYees, prOvitletl that Such improvam¢nts are nOt intentletl o� offeretl for
sale. tl, nowever, tne b W Iaing o� Improv¢ment i5 zoltl within One ylar ot com-
pl¢tiOn, the own¢r will ttav¢ the burtl¢n of prOving he/she tlid not builtl or im-
prove for tne pur0oso of sale). �
❑ I, as owner of the orooerty, am extlusively mntracting with Iicensetl con-
tractors to mnstruct tM1e prpject (Section 7044, Business antl Professions Cotle:
The Cont�act0/'s LicenSe �y�y tloes not apply to an owmt of Oroperty wh0
� builtls or imo�o�es thereon, antl who contracis tor such projects with a con-
Itractor(s) iicense pursuant �o-rne Gontractor's License Law). i am aware,ehat
' p�oof of tbeir WorkCr's Compen5atlon InSurance sboultl be provltletl to me.
�❑ 1 am eaempi untler Secryon 8. & P. C. tor this reason
Date
Owner
certiy that I ha�¢'reatl [nis application and state tnat the above
ion is correct. I agree to tomply witn all city antl <ounty ortlinances
: laws relatin9 to builtlinq consVucUon, antl hereby authorize repre-
s of th' city to enter upon the above-mentioneA property for
n pur 5. G'i
�Odla��b
License or 55 � � �
TYPE OF CONSTRUCTION LJ NEW U ADD LJ AITERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WOFK/USE OF BLDG.
TVPEOFPERMIT GRADING FOUNDATION STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL
❑ OTHER.
PROJECT DESCRIPTION 5a. FT. oCCUaANCv
CONSTRUCTION TVPE VALUATION $
ZONE GRADINGCU.VDS. ACRES
Remarki: �S�_�`�,
Bar Sink
Backflow Preventer �
Backflow Irrigation �
Bathtubs
Clarifiers
Dishwasher . - .
Drinking Fountains •
Floor Orains '
Floor Sinks � � •
Gas Service Outlets '
Inrerceptors �
Kitchen Sink
Lavamries - ,
P—Trap
Roof Drains •
Reinspection Fee $15
Boiler
Duct � Under Ground
Duct - Structural .
Duct - Ventilating
Exhaust System ❑ Multiple
FirepVFact. Blt. ICBO �k��j
Heating System & Ducting �
❑0-100,000 BTU 0100,000
Reinspection Fee � - $15
CMF OB65-46, rev. 30/84 White - Builtling; Canary - ApPiicant; Pink - Ac<ounting: Goltlenrotl - Assessor
$FIOWEfS
Service Sink .
Sewer Cap
Sewec Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Cbset
Water Heater
Water Service
A uto-W ash
Issue Fee
Hoad or Typal ❑
Canopy Typell ❑
Refrigeration System
❑o-ioo,000eTu ❑ioo,000eru
Sysrem Repair/Alteretion
Fire Dampers '
Registers �
15sue Fee � $ 3
A.P. #
S Main Buildi
E
T Front
B Pear
A
C Right
K Left
S
Ping. Ref. #
Planning Notes:
Aumma[ic Washer '
Construction Pole Sub.
Cooking'Unit
Dishwasher .
Dryers ❑Gas ❑Elec
Fan
F.A.U. •
Fixtures
Device Boxes
Outlets
Switches . -
Garbage �ispoul
Generetor 00.5 KW �5-75
2186 2/II/87
Zane
Accessory Building:
Parking Req./Provided
ELECTRICAL
� Transformer ❑ 15�50 KW
❑ 50+KW
Merer ❑up to 100 amps
Meter ❑over 100amps
Sub Panel � .
Motors �0-1 HP � 1 K- B
Inc.Solar 09-15 HP 076-15+
Microwave
Pole Ligh[
Range
c:.... -
Standing Sections
Trash Compactor
18000
FEES
2
O
N
I
N
G
R
E
Q
M
T
S
� Reinspection Fea I$15 I I Issue Fee . � $ 3 I
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning APPraved BY . � Date
BuildinB APProved By ^ Data
Application Issued By- lJ , Dat ��
SUMMARV OF FEES �
' BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT
PLUMBWG $ ISSUANCE .S
. PLAN CHECK 25% $ ENERG�' P.C. $
ELECTRICAL $ GRADING �$
PLANCHECK 50% $ MICROFILM $-�____�
MECHANICAL $ � TOTAL FEE ,$ C �, �--
PLAN CHECK 25% $ 3 d1> �
CONSTRUCTION AND PLANNING POOL & SPA �
APPROVALS Permit # • Date Inspector qPPROVALS Permit # Date Inspector
1. Temporary Electrical'Service or Pole 52. Pool & Equipment Location ' ,
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding �
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. �57. APPROVALTO COVER�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
t4. Rough Piumbing 65. Electrical-Final
15. Fough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiririg Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT r
20. Rough FactorY Fireplace �/s/9rf �' APPROVALS Permit # _
21. Ducts, in Struciure 70. Underground Hydro
22. Ducts, Ventilating . 71. Product Piping O Gas ❑ Oil �
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Freming 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing , , 74. Overhead Hydro �
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe ' '
28. Lathing & Siding 77. FIXED SYSTEM FINAL • �
29. Insulation 78. FIRE PREV. FINAL _
� 30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION � -
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: �
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Pireplace 7�7��� ' �
38. Final Plum6ing , ;
.�
39. Water Service-Final . �
40. Gas Service-Final ' � �
41. Solar pomestic-Final
42. Backflow Preventer '
43. Backflow Irrigation . " •
44. Landscape Irrigation System . �' , , l
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 '
�
AOP���ant to fill in all
CiTVOFCOSTA+M/�ESA��7 CONSTR.s�UC.T�ON ERMIT�7 n,
Project Address �D� u/• �Q�'.J'K¢�.`�11�'�ri�N �W
flpplicant's Mailing Address
Owner's Nam� Phone
AddrGs ,/�' � �/ ���/�
Arch/Engr License No. �
Address
Contractor's Name C Phone
Address�mailigl� Z� �^�5�� � � �(� Q
City License No. ��7�
LICENSED CONTRACTOR DECLARATION
I hereby affitm that I am Ilcensetl untler prOvi5ion5 ot Charte� 9(commencing
with section 7000) oi Division 3 of the Buslnezs and Profeszions Cotle, antl
my iicense is in full orte antl eHect. �QL
License Class Li o 7
Date�e�(/2 Si9natur
WORKERS'COMPENSATION A T N
� 1 nereby atfirm tna[ 1 have a certi(i<a[e of mnsent to ulf-ins e or a certificate
�f Workers' Compensation Insurance, or a cer[ifietl copy thereoAf (Section
3800, �b.��D�� Company[/���'�^�e w
Poli<Y No.
Certifietl copy is hereby fu�nishetl. �
' Ce tifietl co y is tiletl with the city uiltlin i' .
Date ApPlican
EXEMPTION �F OM WORKERS' C N DE ATION
(This section neetl no[ be compietetl if the permi[ is for one undretl ($300) or
less).
1 certity Ihat in the performance ot the work /Or whicn Nis perm�t is issuetl, I
shall,not employ any pe�son in any manner so as to become Subjec[ lo the
Workers' Compensation Laws'o/ Californla.
Oate Signature
NOTICE: It, after makin9 this aeclaration, you shoultl become subject to the
Workerz' Compensation provisions of th< Labo� Cotle, you must torthwlth
�� comply wilh such provisioni or Ihiz pe�mit shall b¢ tle¢metl revokeU.
�.CONSTRUCTION LENDING AGENCV '
�i 1 ne�lby a(flrm that there is a con5truction lentlin9 a9enty for thC pe�formance
of Iho wo�k for which this permit is is5uetl (Sectlon 3097 Civ. CJ
Lentler's Name q
Lentler's.AGtlre55.( � �
OWNER BUILDER �ECLARATION
I he�eby atfl�m tbat I am exemo� irom tne Contracto�'s LlcenSe Law fo� th¢
followin9 reason (Settion 7031.5 Buziness antl Professional Cotle: Any city or
county whiclt requires a Oe�mit to construct, alter, improve, Oemolish or reDai�
any Slructure, prio� to il5 ISsuance, a15o reqWreS the applicant for such permit
to file a sign¢E sta[ement Inal h¢/she I5 IlcenSetl pu�suant t0 [Ite p�ovi5iOn5 of
the Contractor's License Law (Cnapter 9(commencin9 wi[h Secllon 7000) ot
- Dlvision 3'of lbe Busine55 antl Profe55iOns Cotla) or [hat ne/she is exempt
'heretrom antl the basis tor the alle9etl exemplion. Any vlolation of $ecUon
J031.5 by any ap0��cant for a permit subjects [be applicant to a civil
�enalty ot not more Ihan (ive huntlretl tlollar5 (5500).
LJ I, as owner o( iho properry or my employaes with wages as thelr sole
compensation, will Go lhe work, antl the s[ructure iz not intentletl or o(feretl
for sale (Set[ion 7044, Business antl P�ofessional Cotle: The Contractor's
License Law tloe5 not appty to an owner of a proparty wito builtls or imp�ove5
thereon, antl who tloes sucn work himselt/hersell or through his or her own
employoes, prOvitletl lhat such improv¢men[5 a�e not int¢ntletl or offereG (o�
581e. If, however, the bWitlin9 0� improvament is soltl within onf yaa� o/ com-
pletion, the ownnr wlll have tha burtlen of proving he/she tlia not bulltl or im-
�rove tor the pur0ose ot sale).
LJ I, as owner of the property, am exUusively cOntracting wi[h licensatl con-
tia<tors to const�uct the proje[t ($ettion 7044. Bu5ine55 antl Protes5ion5 CotlE:
The Con[ractor's License Law tlOes nol apply to an owner ot property who
builds or fmproves thereon, and who conVacts for zuch projects with a con-
tractor(s) Ilcense pursuant to ihe Contractor's License l.aw). I am aware that
proaf o( thei� Wo�ker's Compensatlon in5umnce shoultl be provitletl to me.
❑' I am exempt untler Section H. & P. C. for th6 reason
Date Owner -
1 hereby certify that I haye eatl tnis appl" ation antl state tnat the above
information Is rect. I'ayye o I w all cc��t antl county orainances
antl state laws elating cy�o�tli sP tr ion. �dtlYhereby aulhorize repre-
sentatives �is�ss,y,Qo t r �e ��7e-menUonecl�yrop�ty for
Drivers' License or 55 �
exceot those witnin heavy Doraer Icnes ana si9n all apDropriate aeclarotions.
�"'���7'� g I ...;�. .._; � . _. .._. � �=�
TVPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR
-� CONVERSION ❑ DEMOLISH ❑ OTHER
DESCR�PTION OF WORK/USE OF BLOG.
TVPE OF PERMIT� / O GRADING ❑ FOUNDATION ❑ STRUCTURAL
� O TENANT �� EIECTRICAL ❑ PLUMBING ❑ MECHANICAL
�O OTHER
PROJECT DESCRIPTION SR.FT. oCCUaANcv_
.GONSTRUCTION TVPE VALUATION 5
"'.ZONE GRADINGCU.YOS. ACRES_
Remarkz:
�� r J
8ar Sink
Preventer
Irri9ation
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collec[ors
Drinking Fountains Solar Tank
Floor Orains Swimming Pool w/Spa
Floor Sinks Urinal
Gas Service Outlets Water Closet
Inrerceptors� Warer Heater
Kitchen Sink` . Water Service �
Lavatories { � Auto-Wash
P—Trap , LaundryTraYs
Roof Dreins
Reinspection Fee � $15.I I Issue Fee I $ 3 I
MECHANICAL FEES
Duct-UnderGround .
Duct - S[ructural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑o-ioo,000 aTu Oioo,000
Reinspection Fee � $15'
CMF 0865-46, rev. 30/84 White - Builtling; Canary - Applicant; Pink - Acrouniing: Goltlenrotl - AsseSsor
Hood or Typel ❑
Canopy Type I I ❑
Retrigeration System
oaioo,000eru ❑ioo,000ar
Sys[em RepaidAlteration
Fire Dampers
Registers
laue Fee � I $ 3
A.P. vf`-
S Main Building:
E
T Front
ARear
C Righ[
5 Left
Ping. Ref. �W
Planning Notes:
Automatic Washer
Constructian PoleSul
Cooking Unit
Dishwasher
Dryers Gas ❑Ele
f an
F.A.U.
Fix�ures
Outlets
Switches -
Garbage Disposal
Generator �0-5 KW
Reinspection Fee
2oning APProVed BY_
-Building Approved By
Appliwtion Issued By_
3956 3/13/87
Zone
Parking Req./Provided
ELECTRICAL � .
Transformer ❑ 75-50 KW
O 50+KW
� Meter up to 100 amps
Meter ❑ove�100amps
75 KW
Sub Panel
Motors�0�i HP �1Yh-8
Inc.Solar �9�15 HP �16-15+
Microwave
Pole Li9ht
Range
Sign
Standing Sections
Trash Compactor
$15 � � luue Fea
�
REQUIREMENTS:
SUMMARV OF FEES
�� BUILDING PERMIT $ SMIP
' PLAN CHECK $ PERMIT
� PLUMBING $. �SSUANCE
.� PLAN CHECK 25% $ ENERGV P.C.
z ELECTRICA� §. � GRADING
�� PLAN CHECK 50% $� I• E, !� MICROR LM
� MECHANICA� $ TOTALFEE
�. PLAN CHECK 25% $ �
$
37oB0 TL
FEES
$ 3
Z
O
N
1
N
G
R
E
Q
M
T
$
CONSTRUCTION AND PLANNING FOOI & SPA
APPROVALS Permit # Date Inspector p�ppROVALS 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. Electricat Conduit-Undrgmd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVALTO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System , . 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
73. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final
i 6. Rou h Electric yVirin S� � � 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, Ven[ilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat � 75. Dry Chemical
27. Freme and Flashing 76. Dry Standpipe
28. Lathing & Sitling 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:3yy�7 �� �,�{��,���R -
34. Final Heating & Air Conditioning .� � J�
35. Final Gas Pipe-Test
36. Hood or Canopy .
37. Final Factory Fireplace , ' ,
38. Final Plumbing ' ,
39. Water Service-Final ' � • - ' �
40. GasService-Final � �� '
41. Solar pomesticFinal � , ,
42. Backflow Preventer �, • ,
'43. Backflow Irrigation �. ,, .- �
�. -
44. Landscape Irrigation SYstem • � . � •
45. Sound Attenuation -
46. Handicap Regulations � ' , �
47. FINAL STRUCTURE & BUILDING ' . ' �
48.�Special Requirements Completed • , ' ' �
49. Electric Release to Edison ,,f �
50. Gas Release tp $puthern California Gas Co �/ '
51. CERTIFICATE OF OCCUPANCY � ,�
NO. Date � ' �
APo���ant to fill in all spaces except tnose within heavy Gortler lines antl si9n alt approptlate tleclarationz.
GiTY oF COSTA IVIESa COfVSTRUCTION PERMIT •
ProjectAddress &� 78�^1: 18th Street .
ApplicanYsMailin9Address ��22 Ghester Street/Stanto�
owner•s Narne Ctting F2 Chien Phone
AOdress 7A946 Vicki/Cerritos, CA 90701
Amh(Eog.• _ License No.
Address - ' �
Contracror'sName T�it;' Electric I[lc phone826-6979
Addresslmailingl ftOZ7 �CI1e5tei St/Stanton
City License No.
LICENSED CON7RACTOR DECLAR ION
1 hereby affirm,fnat 1 am license�l untl rovision h {com e ci 9
with sectlon ]000) of Division 3 0� th i s a si z C
my license is in full lorce antl etfe 4
Licensc CIySs ' .
WORKERS' C�qMPENSATION OECLAR rv ' / .
I hereby atiirm that 1 have a wrtificate of o nt to seli-I s e r a rtiilcate
ot Worken' ComPensa[ion Insurance, or a rtltied p e t o i �
3800, Lab. C.) �
,�v No. W6ll1023 �o ; n
Certifle capy'sherebyfurnisheG.
..Ce (J1i � iletl with th . . .
oat » AOPlicant �
EXEM 10 FROM WOHKERS' COMPENSATI N DECL ATION '
(Tbis sectlon neetl no[ be completetl If the parmit is (or one untlretl (g100) or
�ess).
I C¢rtlty Ihat in tne perfOrmance o( Ihe wo�k fo� whiGh this pe�m�t iz i55ueQ I
5ha11 not employ any person ln any manner so as to become subjecLto the
IWorkers' Compensation Laws ot Californla. . . -
pate Signature '
'-NOTICE: If, a1[er m5king this tleclaration, y0u Should b¢Come 5ubjeCt to the. .
Worker5' COmpensatlOn proNsions of the Labor Code; y0u must forthwith
Gomply with Such ' p�ovision5 0� . tnis, Oaimil ihall be tl¢Emetl �evOketl.
LONSTRUCTION LENOING AGENCV .
I nereby affirm that Ihere ryis a consqtCrur1cntiton lentling agen<y for tne performance
pl tne work tofSLL[R�C01Il0 152tTIK �s (5su¢tl (Section 3097 Clv. C.)
�entler's Name '
Lentler's.AtltlreSs. t antic. on erey ar p�
OWNER BUIL�ER �ECLARATION
I he�eby atflrrn tFat I am Cxempt from the Cont�acto�'S Llcense Law fOr N¢
(ollowing reason (Sec[ion 7031.5 Business antl Protessional Cotle:� Any tltY or
county whicn req Wres a permlt to construct, alter, improve, aemolish or repalr
any structure, prlor to lts lssuance, also requires the appficant tor such permit
t0 fil¢ a signotl statement that he/sne is Ilc¢nsetl pursuant to tne p�ovl51on5 of
the Contractor's L��ense Lzw (Chapter 9(commencing with Sectlon ]000) of
Division 3 of the'Business antl Professions Cotle) or that he/she is exempt
, theref�oT.antl thC basis 10/ the all¢9etl exeTPtion. Any violalion of $Bction
]031.5 bY any aP��icant tor a permit subjects the applicant to a civil
penalty of not more than fiva hundretl tlollars (5500).
as owner of the property ov my amployees with wa9es as tha�r sole
ensation, will Oo the work, antl the structure is not intentletl or offeretl
,ale (Section ]044, Business antl Professlonal Cotle: Tne Contractor's
L-mense law tloes not aDP�Y to an owne� ot a property v+ho bui�tl5 or improves
' thereon, anC wno tloes such work himself/M1erself or throuqh his or har own
employe¢s, provitletl that suth improvements are not Intentled or offeretl for
sale: It, nowever, lM1e builtling or improvement i5 Soltl withln one year O� com-
pletion, the owner wlll have the bu�tlen of proving he/she tlitl not builtl or im-
�rova tor tho purpose of sale�.
I, as O`H�tr Of Ihe properly, am ¢xUUSively contrdcting with Ilcen50tl�con-
' Vactor5to construct theprOlect ($eLtion 7044, Business antl Professions Cotlo:
� The Contra<tor'S License Law tloes not app�Y to an owner of propMty who
builtls or improves thereon, antl wno mnHacts for such projects with a'con-
lracior�s Ucease Oursuant to the Contractor's License Law). 1 am aware that
proof o� Nelr �WOrkeYs Compensatlon InsufanCe ShOultl be 0/ovitletl to me.
� I am exempt utl� Section� B. & P. C. br [hi5 reason .
pate
Signature �
Driver5' License ar 55
TVPE OFCONSTRUCTION RSI NEW U ADD L._I•ALTERATION LI REPAIR
❑ CONVERSION ❑ pEMOLISH ❑ QTHER �
� DESCRIPTION OF WORK/USE OF BLDG. Q�f'T� E'� -
� . i
TVPE OF.PERMIT GRADING FOVNDATION STRUCTURAL
❑ TENANT I�.ELECTRICAL O PLUMBING ❑ MECHANICAL ,
Q OTHER
;OJECTDESCRIPTION 5Q. FL � oCCUPANCv
�CONSTRUCTIONTVPE � VALUATION$_
ZONE GRADINGCU.YDS. ACRES_
low.lrrigation' �
ibs � ' �
ers
asher "
ing Fountains�
Drains �
SinkS �
arvice . OuHets
Kitchen Sink '_ .. _ .
La�atories
'—Tfap �
Roof Drains � '
Reinspectian Fee $15
DUct - Under Ground
DUcI-Structural �
Duc[ - Ventilating
Exhaust SyStem ❑ MuitiplB ❑
Firepl/Fact. BIt. ICBO #
Heating System & Ducting�
00-100,000 BTU 0100,000 BT
Reinspection Fee � � � $15
CMF OB65-46, rev. ]0/84 White - Builtling; Canary - Applicant; Glnk - Accountlng; Goltlenrotl - qssessor
Showers. � ;
�Service Sink
Sewer Cap '
Sewer Connection -
SolarCollectors� �
Solar Pipin9_ •
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet �
Warer Heater
' Water Service -
Auro-Wash
� I _
Isue Fee
1ANICAL •
Hood'or Typel ❑ ,
Canopy Type I I ❑
Refrigeration System
❑o-ioo,000aru ❑i00000eT�
System flepair)Alteration -
fireDampers -
Feq.�isters '
� Issue Fae_ �
� r
A.P. qp
S Main Buildi
E
T Front
B Rear
A
C Right
K Left
S
Ping. Ref. #
Plannina Notes:
fEES { '
" _;.
, 6257 10/29/86
� ,
20ne
Accessory Building: �
. �Parking Rt
" , _ ELECTRICAL
� Automatic Washer .
ConstructionPoleSub'�� '
Cooking Unit _
Dishwasher ' � ,
. Dryers �Gas ❑Elecnic
Fao '
F.A.U. ` �
Fixtures •
Device Boxes ' ,
� Outlets � �
Switches - -� - �
Garbage Disposal � �
Generator DU-5 KW �5-15 KW
Trausformer ❑ 15�50 KW
❑ 50+KW ;
Meter LJup to 100 amps
Meter' �over 100 amps
Motors �Q7 HP �t;h-.8 .
Inc.Solar �9-15 HP �16-15+
Microwave �
Pole Light �
Range •
Sign '" `- - -
Standing Sec[ions
Trash Compactor .
I
S 3 I
� � Reinspection Fee $15, 15sw
FEES '
DEVELOPMENT SERVICES REQUIREMENTS:
Zonin9 ApProvad 8Y
Building Appraved By
- Appliption luued BV � �
$ 3
18e00 7l
. . Z
. O
N
. �
N
G
F
E
Q
M
7
5
FEES
,
u
$ 3
' . SUMMARV OF FEES � � .
eU�IDING PERMIT � $ -SMIP _ $ �
PLAN CHECK $ PERMI,T„ � •
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ' ENERGY P.C. •$- -
ELECTRICAL $ -� d.���— GRADING 5 �
PLAN CHECK 50% $; �." � MICROFILM $ —/�p � �� -
MECHANICAL $ TOTAL FEE , $ ' ` '
PLAN CHECK 25%- $ � � �
CONSTRUCTION AND PLANNING ,,/: POOL & SPA , -
APPROVALS Permit # Date Inspector qp�PROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrg�nd. 53. Steel Reinforcement �
3. Electrical Conduit Utility-Undrgrnd. �.G-fr'� �� 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. Water Pipe-Untlrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structurel Floor System 67. APPROVAL TO DECK
11 . Property Sewer �Line & House Connection 62. Backwath & Receptor-Final '
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing , 65. Electrical-Final
15. Fough Electrical-Conduit 66. Solar SyStem-Final
16. Rough Electric Wiring 67. Fencing & Access Approval '
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19: Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # _ �
21. Ducts, in Structure 70. Underground Hydro - �
22. 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 C�eiling (Structural) & Monocoat 75. Dry Chemical - � �
27. Frame and Flashing � 76. Dry Standpipe �
r,
i.
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 � j: G Notes: G�
34. Final Heating & Air Conditioning •
35. Final Gas Pipe•Test .
a
36. Hood or Canopy , ' '
1 ., f
37. Final Factory Fireplace � . - .
38. Final Plumbing � . ' � -' �
39. Water Service-Final ' ' �" � • • �
40. Gas�Service-Final ,t, , .� ,
41. Solar pomestic-Final . � � � ..
42.�Backflow Prev�nter ��. - � "" '
t � .
43. Backflow Irrigation . -
44. Landscape Irriqation System • �, '
45. Sound Attenuation �
46. Haridicap Regulations �
47.-FINALSTRUCTURE & BUILDING
48. Special Requirpments Completed � . • �
�
49. �Elec[ric Release to Edison . � . / �
50. Gas Release to $outhern Califomia Gas Co , , I
51. CERTIFICAT� OF OCCUPAN� '� I
No. Date �
� - f
"''� CITY O� COSTA MESA
Project Address )�J
Applicant's Mailing Address
Owner's Name �}'�
Address �'r v� v�
CONSTRUCTION PER
'. /�1` �' JT
_nu,`.�. ._„ i r
No.
Applicant to till in all Spaces excepl those wit�ln �eavy Gartlet
Address
ContractoCs Name C Phone �
Addresslma�l"ng1��T ��_�l ai1-S Q �� ��iDl%# � ��
Ciry License No. ���
LICENSED CONTRACTOR DECIARATION
I �ereby atfirm that I am Ilcensetl untler provislons ot Charter 9(commencing
wilh section 7000) of Division 3 oi the Business antl Protessions Cotle, antl
my licenze is in f�ll f rce antl effe ^
IJcense ss ' � � ic;nsg r����� � �
Date�2�� 5'9 t r C.%wn.�F' !/�8
WOHKEf25' COMPENSATION DECLARATION �
. hereby atfirm that I have a certlficate ot consent [o selLinsure or a certificate
of Workers' Compensation Insurance,-or a certl(ietl copy thereof (Section
3800, L.ab. C. ("�' C, T
� Pollcy No. �$-14'�_ Compeny ✓�� 1� N�% �
Certilietl c py is hereby fumi5hetl. ��
Cer(�fietl co�j i$ filetl wlth the city Builtling DIu� ion./
ale (n'i— C-,• (�_ AP�licant �'V �1� - J��L �
EXEMPTION FROM WORKERS' GOMPENSATION DECLARATION
(This section neetl not be completetl If the permit IS tor one huntlr¢e (5100) or
less). ,
1 certify that in [he Oe�formance of the wo�k to� which this pe�mit Is issuetl, I
snall not employ any person in any manner so as ta become subject to the
Workerz' Compen5a[IOn Laws of Cali(Omia'.
. Date Si9na[ure
�NOTICE: If, after making this tleUaratlon, you shoultl become subject to the
Workers' Compensatlon provisions of the Labor Cotla, you must forthwith
comply with suctt prOvisions o� thi5,permit Shall be tleemetl revOketl.
CONSTRUCTION LENOING AGENCV . . '
1 nereby afilrm that there Is a construction lenain9 agency for the per(ormance
of [he work for whlch Ni5 plrmit is issuetl (SeGtiOn 3097 Civ. CJ
Lentler's' Name _
Lentler's Htltlress
OWNEF BUILDER bECLARATION
1 hereby affirm t�at I am exempt from the Contractor's License I..aw tor the
following reason (Section �031.5 Businezs antl Profes5ional Cotle: Any clty or
<ounty which requires a permit to construcq alter, improve, tlemolish or mpair
any ztructure, prior to its issuance, also repuires tne applicant for such permit
to tile a signetl statement lhat he/sne Iz licensetl pursuant to tne provislons of
the Contraccor'S License Law (Chapter 9(commencin9 with Section 7000) of
Jivision 3 ot Ihe Bu5ine55 antl Professmns Cotle) or that h¢/She is exempt
'her¢from antl the ba5i5 10� the allegetl exemption. Any violation o� Section
�031.5 by any applicant Tor a permit sub�ects the applicant to a civil
�endlty of not more than tive huntlretl tlollars (E500�.
I, a5 owner oi lhe prope�ly or my employees' with wages a5 [h¢ir sole
� compensation, will tlo the work, antl the structure is not intentletl or offeretl
for sale (Sectlon 7044, Business antl Professional Cotle: The ContraCtor'S
License ldw tloes not apply to an owner ot a property who builtls or Improves
thereon, antl who tloes such work himseli/nerselt or throu9h his or her own
employees, prOvitletl that such imp�ovement5 are not intentl¢0 or of(ere0 fo�
sale. It, nowever, the bulltling or imorovement is so�tl within one year of com-
pletlon, the owne� will have tne burtlen of prOving he/She Oitl not bulltl or im-
prove for the purpose of sale). .
❑ I, as.owner oi the property, am exclusively contracting with licensetl ton-
tractor5lo construct th¢ Project (Section 7044, Business antl Protession5 COtle:
Th¢ ConVactor'S License law does mt apply (o an owner of property who
Culltlz or improves thereon, antl who contracts for such Drojects with a con-
Iraclor(i1 license pursuan[ to th¢ Contractor's Llcense Law). I dm aware tha[
proof of thei� Worke�'S Compensatlon insuranc¢ shoultl be provltletl to me.
❑ I am exemp[ untler Sectlon , B. & P. C. tor [his reason
Date � Owner
'I he�eby certHy [hat I M1av¢ reai
intO�mation is correcL I agree to
antl state laws relating�to builtlin
sen[ativez of thi5 city t nte�
inSpGttiOn puf005e5. ' �
$i9ndture
Drivers' License or 55 �
above
nances
an0 sign all aDVropriate tleclarations.
�• UNIT NO.
/
TYPE OF CONSTRUCTION � NEW LJ ADD LI ALTERATION LJ REPAIR
.O CONVERSION ❑ DEMOLISH � OTHER
DESCRIPTION OF WORK/USE OF BLDG. .
TVPEOFPERMIT GRADING FOUNDATION STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL
� OTHER
PROJECT DESCRIPTION SR.FT. OCCUPA ' ' d �
CONSTRUCTIONTVPE - VALUATION$,�,,?,��ZCJ�C
ZONE GRADING CU. VDS. AC0.E5
Remarks: �
Bar Sink �
Backflow Preventer
Backflow Irrigation
Bathtubs
;loor Drains
Roor Sinks
3as Serviie
Interceptors
Kitchen Sink
lavatories .
P—Trap
Roof Drains �
Reinspectian Fee
���-J'� !_ � ��, �
PLUMBING . .
Showers
Service Sink
SewerCzp ' . -
' Sewer�Connection � a - '
Solai Collecmrsf' '•'
Solar.P,iping ' �
Solar Tank � � •
. - Swimming Pool�w/Spa
Outlets
$15
Boiler
Duc[ - Under Ground .
Dutt - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact.elt.ICBO# �
Heating System & Ducting
❑0.100,000 BTU �100,000
8
Reinspection Fee .� $15
CMF OB65-46, rev. 10/84 White - Builtlin9: Canary - Appllcant: Pink - Accouniing; Goltlenrotl - Assessor
0
Urinal
Water Clout
Water Heater
Water Service
Auto-Wash
Laundry Tray
laue Fea
Hood or Typel ❑
Canopy Typell ❑
Refrigeration System
�0.700,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
laue Fae
rJ
A.P. # p(
S Main Building:
E
T Front
ARear �
C Right �
g Left �
Ping. Ref. # Da
Planning Notes: 6
-gs-�2
-8'S -d�o
'} Crz&^:hi r-^�
� Automatic Washer
Construction Pole Sub.
Cooking Unit �
Dishwasher
Dryers ❑Ges ❑Electric
Fan
F.A.U.
- Outlets �:
Switch¢5 '
�.
Garbage Dispo':
Generator �O
' {i
• •� ' �
g 3 ' �
Reinspection F
FEES
7196- 6%10%86
Parking Req./Provided
•�or.vn
ELECTRICAL
Transformer �� 15-50 KW
❑ 50+'KW
r
Meter ❑up w 100 amps .
Meter ❑over 100 amps -
Sub Panel �;
MotorsOal HP�1Y:-s- .
Inc. Solar �9-15 HP 016-15+
Microwave - -
Pole Light
Range
� ; Standing Sections
KW �5-15 KW Trash Compactor
DEVELOPMENTSER
ZoninB'Approved By_
Building Approv¢d By
Issue Fee
504.
��
FEES
$ 3
Z
O
N
I
N
G
R
E
Q
M
T
5
�v" `� `' ;! SUMMARV OF FEES �
_ �
� �•BUILDING PERMIT $ ��' �� SMIP $ 0
:.'PLAN CHECK $ ��T D pERMIT , -
' '_P,LUMBING g ��SSUANCE $ ,
'`'�PLAN CH�CK 25% 5 ENERGV P.C. $�
"� ELECTRICAL $ GRADING $
� �� PLANCHECK 50% $ � MICROPILM $
' � 'MECHANICAL $ � TOTA'L FEE $ _50.�.�
$ 3 .+ PLAN CHECK 25% $ i 1 ' ' ,
.` CONSTRUCTION AND PLANNING F0�_ & SPA
' APPROVALS Permit# _Date Inspector pppROVALS Permit# Date Inspector
1. Temporary Electrical $ervice or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement
� 3. Electrical Conduit Utility-Undrgrnd:� 54. Forms �
4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test '
6. � Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE •
7. Footings , j v 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, � Undrgrnd., Test
9. Water Pipe-Undrgmd. � 60. Backwash Lines, P-Trap, O Undrgrnd. � •,
10. Structural Floor System � 61. APPROVAL TO DECK -
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap , ' • 63. Heater & Vent-Final '
13. Roof Drains , • 64. Plumbing System - Final .
14. RoughPlumbing� � 65. Electrical-Fina�
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 71. Produci Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing �� � r� 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27' Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding � �- )L•7 ✓L 77. FIXED SYSTEM FINAL
29. Insulation � �� 78. FIRE PREV. FINAL
30. Drywall Nailing .• � tf.f2,� �L HEALTH DEPT. REQUIREMENT
31: Plaster Brown Coat' �' � 21 � Q�. 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 � �t-p� O �b 6
36. Hood or Gnopy , �� � � � 1 G'
37. Final Factory�Fireplace � r� _��' 8
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 L3
48. Special Requirements Completed $� M
n
49. Electric Release to Edison �
z 50. Gas Release to Southern California Gas Co � , - _
� 51. CERTIFICATE OF OCCUPANCY _ �. � ' , �-
No Date '
' . (�
� , Applicant to fiil In all spaees exceot those within heavy bortler Ilnez ana sign all aov�ooriate aeclarations.
PF Rnnl NO. TRACT NO. ' � LOT NO. U T
�GTV OF.COSTA MESA COI�,S7pR�UCTiO PERMIT �}-� �-77 u r- .
P�oj2ct Address 7�S ([%. ��Z�n1[�c . � %/)� `:� �./ " / � � '�
ApplicanYs Mailing Address [��/- ���B.s�� � TVPF f1F CONSTRLICTION New A�D ALTERATION REPAI R
� /
Owner's Name � .�y Phone
Addren G�� r V S
Arch/Eng. Licenu No.
Address �
Contractor's Namp r � _Phone
Addresslmailingld!).�LZ L�NJ�STEQ Si� � q0(aFiO
City License No. 3�,�� �
LICENSED CONTRACTOR DECLARqTION � '
I M1ereby affitm that I am licensetl untl@r provisions ot Chart¢� 9(commencin9
witn section ]000) of �ivision 3 oi the Buziness antl Protessions Cotle, antl
my Ilcense iz in t II force antl effecL � /J �/
LicenzeCla �/D �e e iqp._L 73fL
Date�_�'� Signature � �
� WORKERS'COMPENSATION D ATION
iereby atiirm that I have a certiticate of consent to selt-i sure or a certificate
� Workers' Compensation Insurance, or a certifletl copY �hereof (Sectlon
Ia800, Lab. /�iD� COm any
Po���Y No. 3� N�S c.�o Ga
\ Certifietl copy is hereby (umishetl.
` � C ��e op�� IS fil¢tl wi[h the cit i in 5� .
`Date APPlicdn
EXE T N R M WORKERS' DEC ION
(This section neetl not be completetl if the permit is tor one ntlretl (5300) or
IQ55).
I certity that in [h¢ Pertormanre of [n0 work fOr which [his pe�m�t i5 issuetl, I
shall not employ any person in any manner so as to become subject to the
Workers' Compensatlon Laws of California.
Date Signa[ure
NOTIGE: If, afier makin9.this tleclaraUon, you shoultl become subject.to the
Wo�ker5' CompensdtiOn p�ovi5ion5 of [he Labor Cotle, you mu5t forthwitn
comply with su<h provisions or tbis pCrmit shall be tleemetl revoketl.
CONSTRVCTION LENDING AGENCV
1 ner¢by affi�m that Ihe�e i5 a Const�uct�on lentling agency tor tM1e pe�formante
ot [he work for whiGh this permi( i5 issuetl (SetfiOn 309] Civ. G.)
Lentler•s Name
Lender•s Atldresy�Di � O /'ilN'��l' _
OWNER BUILDEH UECLARATION
I hereby afiirm that I am exempt fro�n the Contractor's Llcense Law for the
tollowing reason (Section �031.5 Business antl Professional Cotle: Any city or
County which r¢quires d pe�mit [o conStruGt, alteq improva, tlemolisM1 o� r¢pai�
any 5[ructure, prior to its issuance, also requires Ihe applicant br such permit
to fiie a signetl scatement that he/she is Iicenzetl pursuant to the provisionz of
the Contractor's License Law (Chapter 9(commencing wi[h Section 7000) of
'Ivision 3 of th¢ Busfness antl Protes5ion5 CoOe) or tbat he/She is exempt
ereirom antl the basis for lhe allegatl exemption. Any violation o( Section
J31.5 by any appliCan[ tor a permit subjec[s the applicant [o a civil
pEnalty ot not more Ihan five nuntlretl tlollars ($500).
❑ 1, as owner ot [he property or rhy ernployees with wages as their sole
compen5ation, will tlo thC work, antl �he st�ucture is not Mtentletl o� offeretl
tor sale (Section ]044, Business anq professional Cotle: The Contractor's
License Law tloes nol appty to an owner of a property who builtls or imp�ove5
thereon, antl who aoes such work himself/herseli or tnrou9h his or her own
employees, prOvitletl thal Such improvement5 ate not Intentled ot otteretl fo/
581e. If, howeveq the buil0ing or imp�ovament i5 Soltl wi[hin one year of mm-
pletioq the owner will M1ave the burtlQn ot provin9 he/she tlltl not buiitl or Im-
p�ove fo� the pu�po5e of sale). �
❑ I, as owner of the property, am exelusively contractlng wlth Iicensetl con-
traclors to construct the pro�ect (Sectiry� 7p44, Business ana Professions Coae:
The Conira<tor's License Law tloes �ot apply to an owner of property who
builtls or improves tl�ereon, antl who conVacts.for such projects with a mn-
tractor(s1 ucense pursuant to the Gon�ractor's �icense Law�. I am aware that
proof o( their Wo�ker'S CompensatiOn Insu�ance zhoultl be p/ovitletl to me.
❑ I am exempt untler Sec[ion B. & P. C. for this reason
Date
Drivers' License or 55 �
. owner
have rea�
ortl
./
U CONVERSION LJ DEMOLISH LJ OTHEH p p �6
DESCRIPTION OF WORK/USE OF BLDG.
r S Main Buildi
E
TVPEOF'PERMIT � GRADING FOurvDATION STRUCTVRAL T Front
❑ TENANT �ELECTRICAL ❑ PLUMBING ❑ MECHANICAL � A qear
:�Q OTHER C Right
PROJEC�T DESCRIPTION 5R. FT. oCCUanrvcv K
-CONSTRUCTION TYPE VALUATION $ g Left
�ZONE GRADINGCU.VDS. ACRES Ping.'Ref.#
Remarksi. 'f [I//i Plannino Notes:
i'
<•
Bar Sink
Backflow Pieventer
Backflow Irngation
rinking Fountains
loor Drains
loor Sinks �
Outlets
r— aM .
Roof'Drains
�� F?l
Reinspection Fee
$15
Boiler
Duct-UnderGround
Duct - Sfructural
Duct- Ventilating
Exhaust System � Multiple �
Firepl/Fact. BIL ICBO #
Heating System & Ducting
❑ ai oo,oao eTu � i oo,000 er�
Reinspection Fee � $15
CMF OB65-46, rev. ]0/84 White - Builtling; Canary - AOPlicant; Pink - Accountinq; Goltlenrotl - Assessor
ShoWers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecrors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Cbset
Water Heater
Water Service
Auto-Wash
Laundry Trays
Issue Fee
Hood or Type I ❑
Canopy Type I I ❑
Refrigeration SVstem
06100,000 BTU ❑ 100,000 BT
System Repair/Alteration
Fire Dampers
Regisrers
Issue Fee
FEES
$ 3
$ 3
n
Automatic Washer
Construction PoleSub.
Cooking Unit
Dishwasher
Dryers Gas ❑Blectric
Fan .
F.A.U.
OStlets
Switches -
Garbage Disposal
Generator �0.5 KW
3955 3/13/B7
Accessory Building:
Parking Req./Provided
37.80 TL
Zone '
ELECTRICAL
Transformer ❑ 15�50 KW
❑ 50+KW.
Meter up to 100 amps
Meter ❑over100amps .
Sub Panel
Motors �0.1 HP 01'f, - 8
Inc. Solar 09-15 HP.016�15+
Microwave
, Pole Light
• Sign
� Standing Sections
KW Trash Compactor
� � Reinspection Fee '$15 � � Issue Fee
,DEVELOPMENT SERVICES REQUIREMENTS:
,Zoning APProved By
Building Approved By
'Application Issued Bv
FEES
$ 3
Z
O
N
I
N
G
R
E
Q
M
T
S
� SUMMARV OF FEES -
BUILDING PERMIT $ ' SMIP $ ' �
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE 5
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ . �ZJ GR/IDING S ,
PLAN CHECK 50% $ �, -� MICROFILM $ ���q-[�)
MECHANICAL $ TOTALFEE $ �=
7LAN CHECK� 25% $ .
,`
CONS7RUCTION AND PLANNING � • ' , POOL & SPA
APPROVALS Permit # Date � Inspector AppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundaiion 59. Gas P'ipe, O Undrgrnd., Test
9. Water pipe-Undrgrnd. , 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System � 61.' APPROVAL TO DECK
: ,
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final �
13. Roof Drains 64. Plumbing SYstem - Final
14. Rough Plumbing ' 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System�Final �
16. Rough lectric 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 Conditionfng 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 � Gas ❑ Oil
25. Roof Sheathing 74. Overhead HYdro � �
26. T-8ar 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 L, Notes: �� ..
! 3 J 3/5��7 S� n o��o� n i�
34. Final Heating & Air Conditioning � �
35: Final Gas Pipe-Test � I
36. Hooq or Canopy
37. Final Factory Fireplace ' ,
38. Final Plumbing -
39.'Water Service-Final � . � ' - .
40. Gas Service-Final _ � . � - ' ' .
��
41. Solar pomestic-Final • .
42. BackflowPreventer �,,: � . � � . �
�'
'�43. Backflow Irrigation ; .
44: Landscape Irrigation System • � , • ' �
45. Sound Attenuation � � �� / �
�46: Handicap Regulations . .� ' ,
47. FINAL STRUCTURE & BUILDING , ' �
48..Special Requirements Completed - , • � � '.
�i
49. Electric Release to Edison .. �� � ,
50. Gas Release to Southern California Gas Co � .
51. CER7IFICATE OF OCCUPANCY , �
No. Date ,
Applleant �o fill In all ipaees exceDt l�ose wit�in hedvy bOrtlGr Iinas antl sign all approprlate tleclanlions.
�CI�Y�JF COSTA MESA CONSTRUCTION PERMIT
F
. Project Address �+�-�~ %•' � � =� = '
Applicant's Mailing Address ��� �--
Owner's rvame '�� C�}�A ✓ h ne p5'dSl7P
Address y� `�� �`•�u a�
Arc En Licenu No.�� �2� ( D
AdAress
Contractor's Nam [— ' ���,( � A hone�gitlf�.rii'i�
Addresslmailin9) (a��Tv�cy � �N F#�i�ld �' A �;/�Q�
Ciry License No. _���"��
LICENSED CONTRACTOR DECLARATION
I �e�eby alfirm [hat 1 am Ilcensed untl<r prOvi5ion5 of C�a�te� 9(commencing
wi[h uction 7000) o( Division 3 ot tha Business antl Proteszions Cotle, ana
my Iicense is in tull force and �.jfect.
Ucens Class �� sice s o.
Date --f" Si9�ature
WONKERS' COMVENSATION DECIARATION ' '
' hereoy aHirm that I have a certiticate of conseM to self-insure or a certificate
' Workers' Compenulion Insurance, or a certifietl copy t�ereof (Sectian
800, Lab. CJ�p r $2,� •'= �2
Policy No. �?XJ _ ��`�`^' Company ��� ` ����
�Certifietl topy is hereby tumizhed.
Cer ifietl copy i tiletl with the city Bu' n DlviSion.
Oate� Applicant � m S1� ,
E%EM ION F.ROM WORKERS• COMPENSATION DECLARATION
(This se<tion neetl not be com0le[etl if tbe permit is for one huntlretl (5100) or
Icss). .
I certify that In the pertormance oi the work for which this perm�t is issuetl, I
shall not employ any perzon in any manner so as to become subject to the
Workers' Compensation Laws of California.
. Date Si9nature
.'NOTICE: It, atter makin9 tnis Aeclaration, you zhoultl become zubje<t to the'
�'� Work¢rs' Comp¢nsation proviSionS O1 the LdDo� Cotle, you must fOrthwiln
I cOmply wllh Such p�ovisiOni or I�IS Oe�mit shall be tleemetl revoketl.
' CONSTRVCTION LEN�ING AGENCV
1 hereby altirm Ihat t�eie Is a const�uction lentling a9enCy fo� Ihe performance
oi tne work for whicn tnis permit iz izsued (Section 3097 Civ. C.)
lAntler's. Name
Lontler's Atltlress � -
OWNER BUILOEH bECLARAT10fJ "
I hereby affirm that I am azempl Irom tho Contrac[or'S License l.aw tor the
following reason (Sectlon 7031.5 Buziness antl Profeisional Cotla: Any cl[y or
county wbicn requires a permit to construct, alter, improve, tlemolizn or repair
any strucWra, prlor to its issuance, also reqWres tha applicanl for such permit
t0 /ile a Sign04 stalomen[ lhat he/sh¢ Is Iicensetl pur5uant to the p�oviSiOns O/
the Contractor's l.icense Law (Chapter 9.(<ommencing wilh Section 7000) of
Division 3 ot thc Business antl Prolessioni Cotle) or tnat ne/ihe is exempt
�erefrom antl the ba5ii for Ihe allegetl exemOtion. Any violdtiOn of $eclion �
)31.5 by any ap0��<ant for a permi[ subjetts [he appli<ant to a civil
enalty of not more than 71ve huntl�etl tlolla�s (E500).
� 1, as owncr oi tha proporty or my employacs with wages as thetr soln
CompenSalion, will Oo the wOrk, aOtl the st�ucWre Is nat Intentletl o� o�tEr¢tl
lor sale (Section 7044, Business antl Professional Cotle: The Contractor's
Llcansa lAw tloe5 not apO�Y �o an ow0lr O� a p�operty who bu11Gs o� ImprOves
thereon, antl who tloes such work himzelf/herzelf.or through his or her own
employees, provitletl t�at such improvements are not Intentletl or offeretl (or
sale. If, howaver, the builtlin9 or ImprOvement is Soltl wlthin on¢ year ot com-
pletlon, the owner wI11 have tha burtlen o1 proving he/she aitl not bulitl or im-
prov0 tor the purpose o1 sale).
❑ I, as ownt/ of the pro0erty, am ezclu5ively cont�aGting with IicenSetl con-
[�actoR to con5t�uct the project ($ection 7044. Busin¢55 antl PrOtesSions COtle:
The Conlractor'S License Law does not appry to an owner of property who
builas or ImGroves lhereon, anG who tontracts for sucn projects wlm a con-
traclor(s1 Iicenso pursuant ro tbe ConVactor•5 License Law�. I am aware that
proof of tnelr Worker'S Compen5atlon inw�anca Shoultl be prOvitletl to ma.
❑ I am exemp[ untler Section B. & P. C. for this reason
Date '
I nereby certlty tna
intormation is correc
antl state laws r¢latii
sentatives of tnis,ci
Inspection purposes.�
Signature __.r
Drivers' License or'S'
9f 0865-46, rev. 30/84
Owner _
have r¢atl th
agree fo cort
o builtling cc
te enfeF, up
N
0
the abova
ortlinances
irize repre-
TYPE OF CONSTRUCTION Jd NEW LJ ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPEOFPERMIT GRADING FOUNDATION STRVCTVRAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIFTION 5q FT � oCCVPnpp�Cv � '
CONSTRUCTIONTVPE VAIUATION§ `�yD -Q�C
20NE GRADING CU. VOS. ACRES
Remarks: � / _
Bar Sink
Backflow�Prevencer �
BackflOw Irrigation
Bathtubs
Clarifiers
Dishwa5her
Drinking Fountains
Floor Orains
Floor Sinks -
Gas Service Outlets
Kitchen Sink
Lavatories .
P—Trap ,
Roof Drainr - . '
Reinspeetion Fee $15
Duct- Under Ground
Duct - SVuctural
Duct - Ventilating
Exheust System ❑ Multiple �
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑ai oo,000 eru O � oo,000 er�
Reinspection Fee � $15
White - Builtling; Canary - Appllcant; Pink - Ac<ounting; Goltlenrotl - ASSe55or
Showers
Service Sink '
Sewer Cap . ,
$CW2f C0002Ct1011 '
SoladGollxtors •
SOlar Pipin9 � . •
SolawTank
Swimming.Pool w/Spa
Urinal
Wetef Closet
Water Heater
Water Service
Auw-Wash
laue Fae
Hood or Typel ❑
Canopy Typell' ❑
Retrigeration System
❑0.700,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
laue Fee
FEES
S 3
$ 3 � ,
A.P. qW
S Main Bi
E
T Front
B Rear
A
C Aigh[
g Left A
Ping. Ref. #
Aummatic Washer
Construction Pole S
Cooking Unit
Dlshwasher
Dryers ❑Gas ❑E
Fan
F.A.U.
Fixtures •
Davice Boxeiv �
OOtICL$ ' .s�
Switches - ..
r .na�e m...,,�,i r
DEVELOPMENTSER
2aning•Approved ByJ
Building Approved.By
Applieation IuUBd BY:
7189 6%10/B6
548.26 -TL
. r_.. .. ....
— p zo�a R 3
Accessory Building:
2
O
N
I
N
G
R
� Parking Req./Provided 'a,3 E
Q
M
� T
. ..._lU ;:..__':.tl s
E�ECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 e
Meter ❑over100a�
lectric Sub Panel
Motors �41 HP ❑
Inc. Solar 09-15 HP
Microwave -
Pole Light
Si9n
; Standing Sections
5�75 KW Trash Compactor
$15 � � Ittue Fee
6�15+
FEES
S 3
�1�
+� �� — • � � ' SU AH O FEES / �+,
+� BUIIDINGPERMIT $ --1j�1.�f�1 SMIP $ �
' ., .PLAN CHECKS $ � 2(o.7:S' PERMIT �
' '" .PLUMBING.� $ � ��UANCE 5 �
. PLAN CHECK�25% 5 ENERGV P.C. $
ELECTRICAL�f $ ' GRADING 5
PLAN CHECK 50% 5 MICROFILM S
y� •�MECHANICAL $ TOTAL FEE $ � � �
�.�t PLANCHECK 25% $ '
�
' CONSTRUCTION AND PLANNING POOI ;PA
!: APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
1. Temporary Electricel Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd, � 53. Steel Reinforcement
3r Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings� _ �L 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test .
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor SV�tem 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-Fina�
15. Rough Electrical-Conduit 66. Solar System-Final
i6. Rough Electric Wiring 67. Fencing & Access Approval
i
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 ii 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 � Gas ❑ Oil
25. Roof Sheathing •� .� 3 � 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27� Frame and Flashing j 7� 76. Dry Standpipe
28. �athing & Siding �s � �/v 77. FIXED SYSTEM FINAL
29. Insulation ' S, 78. FIRE PREV. FINAL
30. Drywall Nailing � �Z vL HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat � � 7��. 79. FINAL INSPECTION
32. Electrical Power Meter-Final . 80. FOOD CERTIFICATE ISSUED
33. Final Electric _ � Notes: �
34. Final Heating & Air Conditioning '� --
/ O
35. Final Gas Pipe-Test � �
36. Hood or Canopy � . -1
lL_ �e.�r✓� . (O Z ��r
37. Final Factory Fireplace . �% r= ( 0/� �
38. Final Plumbing ' '' O - Z g
39. Water Service-Final
40. Gas Service-Final •
41. Solar pomestic-Fina1 . '
42. Backflow Preventer . �
4�3�..Backflow Irrigation
4r4: .Landscape Irrigation System � '
45: Sound Attenuation .
46. Handiwp Regulations
47. FINALSTRUCTURE&BUILDING 7l ('y-
48. Special Requirements Completed g� s
4�9� Electric Release to Edison .
5Fj; Gas Release to Southem California Gas Co �
5ai CERTIFICATE OF OCCUPANCY � • .
No Date �
�
n �
AO ca t t�1 I In
cirv OF COS7n ,M.pESA CONQSTT�U�C !TION PERMIT
� Project Address 7D�W�p��-�Z.��/�J/ ����
Applicant's Mailing Address y15���� ���
/'
Owner's Name C /G���� /� Phone
Addreu ��� ` "' R / G / �
ArchlEng. Licenu No.
Address /�
Contrector's NameC7,q��A�!%%� KIS�� Cq7f
Addreu (mailing) �flz2 � i�� ST � � ���i
Ciry License No. ��/7� ,
LICENSED CONTRACTOR OECLARATIOf�I
I hereby affirm that I am IlcenSeG unUet provlsions o� Cnarter 9(commencing
with section 7000) of DlviSion 3 ot the Business antl Professions Cotle, antl
my Iicense is in ❑ Porce antl eftect. l
Licenze>C�ia�ss� ��0 [ir nse
Date_� R Si9natur
WORKE 5'COMPENSATION � A
' hereby affirm that I havc a certilicate ot consent to Self-Insur or a ceriificate
Workers' Compensa[ion Insurance, or a certifietl coOY areof (Section
J0, �ab. q��i�Z3 ComPanY "'
Pnolicy No.� /J �J �/� /J
11A� Celtlfiell�opyJS (Iletlbwith lhehcrty�ilgjng �ypsJ�I/. // � �[/
___.... ..__ _ .._._ _ _...__. _ _ . _ .
(This 5ection neetl not be COmpletetl if the permit is for one hu r¢tl (E100) or
lass).
I certity lhat in tne OerfOrmance o1 [he work for whith thi5 perm�t is iiSuetl, I
shall not empioy any person in any manner so as to become subject to the
WOrkers' Comp¢nsation l.aw5 of CalilOrnia.
Date Signature
NOTICE: It, after making lhis tleclaration, you shoultl become subje<t to the
Workers' Gompensation provisions of t�e Labor Cotle, you must fortbwtt�
comply wi[n such Orovisions or this permit shall be tleemea revoketl.
CONSTRUCTION LENDING AGENCV
I hereby altirm that there is a construction lentling a9ency fo� tne performance
01 lhe work fOr whicn tnii parmit IS Issuetl (Section 309] Civ. C.)
Lentler's Name
Lenaer'i Atltlre � �
OWNE0. BUILDEH �ECLARATION
I herCby alflrm [hat 1 am BXempl irOT th0 CanlractOr's lJcense Law tOr the
following reason (Soction 7031.5 Business antl Prolessional Cotle: Any clty or
<ounty whlch ropWrez a pe�mit t0 conit�utt, dltlr, ImO�ove, tl¢molish o� r¢palr
any sVucturo, prbr to Ili issuance, atio requires [he applicant for suth p¢rmlt
to 1i�e a signed statement that na/she I5 Ilconsetl Dursuant to the provisions ot
the ConUactor's Li<anse Law (Chapter 9(commancin9 wi[b Sect(on 7000) of
DlviSion 3 of lne 9usinoss antl PrOles5lon5 COCt) o� Ihat hG/She Is�exempl
`^mfrom and the basis for thc allegetl exemptlon. Any violation o( Sectlon
31.5 by any appllcant br a permit subjact5 t�a applican[ to a clvil
.ialty oi not morn than fivo buntlro0 tlallars (E500�.
L� I, as owner of ine proparty or my employees witn wages as their sole
coTp¢nsation, will tl0 tllo work, antl the SlfUctufe IS llot inl¢ntletl Or OIf¢!Ctl
lor sala (Soction 7044, Buslnosi anC Profassional Code: Tha Contractor'S
License Law tloes nol apply to an owner ot a proper[y who builtls or improves
th¢reon, an0 who tloes such work hlmsolt/nerselt or [hrOu9h nis or hCr own
emD�oyCes, provitletl that such improvemen[5 ara not in[enG¢tl Or oiferetl br
sala. If, howovar, tho bulltlin9 or improvnmont Is soltl wltM1ln on¢ yea� ol cOm-
pletlon, tne owner will havo tho burtlen ot pwving he/she tlia not bulltl or Im-
provG for (h0 purpOse ol Saln�.
❑-'I, as owner of the property, am ozclusivaly contracting wilh licensetl con-
IractorSld con5tru<t tha pro�ect (Secdon 7044, Busine55 antl PrOtesslon5 COtle:
The ConVaC[or's Litunse Law doez not appry to an owner of pro0erty who
builtls or improves thereon, antl wno contracts lor zu<h projects wilh a con-
tractor�zl ucan5e pursuant to the Contracror's License Law). I am aware that
pvoof o( their Worker'S COmpanwllon inw�anca should be prOvitletl lo m¢.
❑ I am exempl untlor Section B. d P. C. for [his reason
Date Owner
I hereby certiy [hat J have rea�
informaliOn is c rec[. I agr e
antl siate laws elatin9 to r
sentativez ot is �
insoection
$i9natu�e
Drivers' License or 55 �
CMf 0865-46, rev. 30/84
i state tnat the aCove
ana county orainances
ier¢by authorize repre-
:ntionea oroaertv tor
those w(4ifHTCJ�YborGer Iines anE si9n all appro0��ate Geclantions.
TRACT NO. LOT NO. U� N�
TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
�O CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE O,F BLDG.
TVPEOFPERMIT GRADING FOUNDATION STRUCTURAL
O TENANT � ELECTRICAL ❑ PWMBING ❑ MECHANICAL
�O OTHER
PROJECT DESCRIPTION 5�. FT. oCCUaarvCv—
CONSTRUCTION TVPE VALVATION 5
GRADINGCU.VDS. ACRES_
Remarks: K % (y
!/ b
!r
n
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs '
Dishwdsher �
Drinking Fountains
Floor Drains
Floor Sinks
GasService Outlets
Ipt¢fC¢ptOfS '
7ZS1
Reinspection Foe � $15
Duct-UnderGround
Duct - Strucmrel
Duct - Ventilating
Exheust System ❑ Multiple
Firepl/Fact. Blt. IC80 #
Healin9 System & Ducting
❑ ai oo,000 sru O i oo,000
Reinspection Fae � $15
White - 8ulltling; Canary - Applicant; Pink - A<counting; Goltlenrotl - Assessor
$FIOWCfS
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors-
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash �
laue Fee
Haod or Typel ❑
�Canopy Type II ❑
Ref�igeration Sys[em
Oaioo,000eru Oioo,aoo
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
FEES
$ 3
$ 3
A.P. qY+
S Main Bi
E
T Frant
B Rear
A
C Right
K Left
S
Ping. Ref. #
Automatic Washer
Consjruction Pole Si
Cooking Unit �
Dishwasher
3954 3/13/B7
Zona
Parking Req./Provided
ELECTRICAL
� Transtormer ❑ 15�50 KW
❑ 50+KW
Meter p to 100 amps
,� Meter ❑over100amps
Dryers Gas ❑Electric
Fan '�
F.A.U.
Fiztures
Device Boxes �
Outlets �
Switches �3
Garbage Dispoul /
Generator O65 KW 05�15 Kw
Sub Panel
Motors O0.1 HP O1 h� 8
Inc.Solar �9-15 HP �16-15+
Microwave
Pole Light
Range
Sign
Standing $eciions
Trash Compactor
� 1Reinspaction Fee � 515 � � luue Fee
DEVELOPMENT SERVICES REQUIREMENTS: •
2onin8 APOrovad By
,Building Approved By
Aaolication Issued Bv -
37,80 , TL
FEES
$ 3
2
O
N
I
N
G
R
E
Q
M
T
S
� � SUMMARV OF FEES
- BUILDING PERMIT $ SMIP g
i PLAN CHECK $ PERMIT
� PLUMBING $ �SSUANCE $
PLAN CHECK 25% $ ENERGV P.C. S
r:
ELECTRICAL §_�J��-b GRADING S
PLANCHECK 50% $ lr, 6O MICROFILM $ '� �7 ��
� MECHANICAL $ t TOTAL FEE $.�L ��1
. , PLAN CHECK ZS% $ �
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
7. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. � 54. Forms
4. Electrical Conduit-Undrgrnd. . ' 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test �
9. Water Pipe-Undrgrnd'. 60. Backwash Lines, P-Trap, � Undrgmd.
10. Structural Floor System � 61. APPROVAL TO DECK
1 i. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap � 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final �
I
14. Rough Plumbing 65. Electrical-Final '-
15. Rough Electrical-Conduit , 66. Solar System-Final
16. Rough Electric Wiring �& 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING �
18. Rough Electrical-T Bar Ceiling 69. POOL/$PA 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 OGas ❑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 g
27. Frame and Flashing 76. Dry Standpipe ��
28. Lathing & Siding 77. FIXED SYSTEM FINA� � v
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT �
31. Plaster Brown Coat 79. FINAL INSPECTION �.
32. E�ectrical Power Meter-Final R'�'` "E 80. FOOD CERTIFICATE ISSUED
i
33. Final Electric ^�'� L+ Notes3 j9�:7.�c/Y� �iv:. Sac�ti�i�c�r �
34. Final Heating & Air Conditioning . �
35. Final Gas Pipe-Test
36. Hood or Canopy .
37. Final Factory Fireplace � ' � � ,
38. Final Plumbing � '
.
39. Water Service-Final . . '
40. Gas Service-Final � ' � .
41. Solar pomesticFinal � � � � "
, 42. Backflow Preventer , . . • �
"43. Backflow Irrigation � � . ' .
�
�'44. LandscapelrrigationSystem . . ,
45. Sound Attenuation • � • �
46. Handicap Regulations ' ' . .
47: FINALSTRUCTURE&BUILDING ; �
48. Special Requirements Completed , ' . • � '
�
49. ;Electric Release to Edison � • .
50. Gas Release [o Southern California Gas Co - . 1
57. CERTIFICATE OF OCCUPANCY
No. Date � , �
ADG�icant to fill in ali soaces exceot those within neavy borGer lines ana sign ail appropriate tleclarotions.
CITv oF cOST,4 MESA CONS�RUCTION PERMIT , �`�"2 4 �� ..�aG, a�.`�' �" .' "C, "/
Project Address 7�� �'`�� �d � -� � �
ApplicanYS Mailing FCddress ��'�Y� ` w17�'f�rJ( G.� .�+•'+w.. TVPE OF CONSTRUCTION_ _ NEW �A�D ALTERATION REPAIR
OWner'S Name ��t �` � � ��'�_`A Ph ne %if"11 �lf � CONVERSION ❑ �EMOLISH ❑ OTHER
� . DESCRIPTION OF WORK/USE OF BLDG.
Address "//� \ �I�/�i,}e.,�G.r .i.l.«.. _^ ' . .
Arc n � LicenSeNo.���-Z�Z-'�� TVPEOFPERMIT GRADING_ FOUNDATION STRUCTURAL .
Addr� ❑ TENANT ❑ ELECTRICAL �❑ PLUMBING ❑ MECHANICAL
ContractOr'SName � 11,� CB Phone �Z ' �'OTHER '
Address (mailing) ��7 C+ bp� PROJECT DESCR�PTInN cn cr i% OCCUPAQNCV
��� � CONSTRUCTIONTYPE � � VAIUATION$Q_�
Ciry LiCenie NO_ - ZONE ' GRADING CU. VDS. ACRES
LICENSED CONTRACTOR DECLARATION � - �
1 hereby aTfirm that 1 am licensetl untle� provision5 of Charter.9 �(mmm¢nCing Remarks: �=� YS�.I �.!�i f � - /��. �/% \
with section ]000) of DiviSion 3 of Ihe Business antl Profeision5 Cotle, antl , �
my Iicense is in full forte an effect. O
Licens Class Lice se
Date �<�� S'9 t n Ve.�� �i ,�f .
WORKERS' COMPENSATION DECLARATION ' '
I hereby attirm that I have a certiticate ot consent to self-insure or a certificate
ot workers' Compensation _Insurance, or a certitietl� covY thereot (Section .
3800, Lab. C. -'Y� / �(y ! k � � /
Policy No. �3�� /�'b �_(,!� Comp ny `��T� ��� —
�^Certifietl copy is hereby tumishetl. %.�
y'� Cert{it-ie-ticc-o�p�f.is iletl with [he city Builtling Div slon.
Date �a___j r� APPlicant •��\I 1 � ���t� � ,
EXEMPTION FROM WORKERS'�COMPENSATION DECLARATION '
(Thissection neetl not be completed if the p¢rmit i5 for one huntlretl (§300) o� �
less). � .' � '
I certify.that in the performance ot tne work for.which thi5 permk isJssuetl, I
snall not employ any person in any manner so as to become subject to the ,
Workers' Compen5ation� LawS of Califomia.
Date Signature '
'NOTICE: If, after making this tleclaration, you shoultl become subject to the
Wo�ke�s'-Comp¢nsation provisions ot the LabOr Cotle, you must torthwltit
comply �with� such p�ovisions or this permit shall be tleemetl �evoketl.
CONSTRUCTION LENDING.AGENCY. ' - � - �
1 M1ereby affirm that the�e is a con5tructionientling agency fo� the pe�formance�
of the work tor which this ,permit is issuetl- (Section 309] Civ. CJ
t,entler'S Name - -
Lentler's Adtlress . �
OWNER BUILOER DECLARATION ' ' '
I heieby afilrm�that I am exempt trom the Contractor's license �Law tor the
11 Y wi���.� �c4u��ca o V
any Structure, prlon to it5 issuance,'alw requires the applicint f0� such permit
to tile a signetl statement that he/she Is licensetl pursuant to the provisions o(
�tne ConVactor's License Law (Chapter 9(commencing witM1 Section 7000) of
Jivision 3 of the Business antl Prafe55�on5 CotlE) ot tnal he/She is exempt
.heretrom antl tne basis for Ih¢ allegetl exemption. Any violation of Section
�]031.5 by any appliCant fo� a permit subjects the applicant-t0 a civil
��enalty of not more Ihan five huntlretl tlollars (y500). �
I, as owner ot the property o��my�employees with wages as their sole
compensation, will do the work, antl the structure is not intentletl or otferetl
for sale (Section ]044, Busine55 antl Professional Cotle: The ContraCto�'s'
l.icense Law tloes not apO�Y �o an owner of a property who builtls o� imp�oves
thereon, antl who tloes such work hlmselt/herselt or throu9h his or her own
employees, provitletl that such imProvements are not intentletl or offered for.
sale. It, however, the builCin9 or improvement IS Soltl within one year of com-
O�etioq the owner will have ihe bu�tlen O( provinq he/she tlitl not bulltl or im-
prOve tor[he purpose o� 5ale).
❑ I,'as owner of the property, am exclusively contracting with licensed con-
tractorsto construct the project (Section �044, Business antl Professions Cotle:
TM1e Con[ractor's License Law does not apply to an owner o( prope�ty who
builtls or improves thereon;�antl who conttacts tor such projects with a con-
tracior(5S �icense pursuant to the Cont�actor's License Law). 1 am aware that
prooi of tneir Worker's Compensation insurance shoultl be provitletl to me.
❑ Pam exempt untle� $ection B. & P. C. for this reason
Date ' Owner�—
I hereby certify thab I have reaa this
information is correct. I agree to comp
antl state laws relatin,g to builtlin9 mn
sentativez oi this cKy� to eqier,�upoi
1 state that tne�a0ove
and county ortlinance5
ereby authorize reore-
ntionetl property .for
Date "l�— ?
Sink
Preventer ' -
Irrigation �
Drinking Fountains
Floor Drains�
Floor Sinks � -
Gas Service Outlecs
Interceptors' '
KitcFien Sink - '
Lavatories '
P—Trep
Roof�Drains •
Reinspection Fee �
Showers
' Service Sink�
I
SeweroCap� �':i
Sewei�Connection •
. Solar Collectors-+� ' �
Water Closet
Water. Heater
Water Service
_Aum-Wash -
'Laundry Trays �
' $15 _ Issue Fee
Boiler '
Duct - Under Ground
Duct � Structurel �
Duct-.Ventilating �
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑ 0.100,000 BTU � 100,000
Ioi9namre . � � .
Drivers' License or 55 � Reinspection Fee $15
CMF 0865-46, rev. 10/84 White - Builtling; Canary - Applicanq Pink - Accounting; Goltlenrotl - Assassor -
�
A
A.P.#E �L�l -
S Main Building:
TFiont ,�g �
ARear ' �
C Right - "Tf�
�g Left I 3 '- I�
Ping. Ref. # QQ�'
Planning Notes: Q �
)197 6%I.0%66
504.80 TL
Zone
2
O
N
I
G
� 'Z� � Paiking Req./Provided p'Z
ELECTRICAL
Aummatic Washer - ' -
" ' Construction Poie Sub.
' Cooking Unit ; ' , •
Dishwasher � •
' Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures ,� '
F . . ��U
Device Boxes�� �
_ ' ; Outlets �� '�� �
o � � Switches .') -
• `' Garbage Disposal•�� '
, Generator 00.5�KW �5-15 KW
Hood or� Type 1 ❑
Canopy Type I I' ❑ �
Refrigeration System � _
oo-,00,000eru o,00,000eTu
System Repair/Alteration -�
Fire Dampers ' .
i
laue
\ , `�
�.
$ ,3 _ `. /
Reinspection•Fee�f
FEES �
DEVELOPMENT-SER��Vr
Zoning /lpproved'By �c
' Building Approved By�
��
$ 3
Meter LJup
Meter ❑ov
Su6 Panel
Morors OO-
� Inc Solar'.❑
Microwave '
Pole Light
Range
� � ' i
i , i
-O 15-50,KW : � �
❑ SO.+;KW
to 100 amps . ;
er 100 amps J
1 HP O 1�X - 8•",.�
9-15 HP �16-15+
QI
M
T i
S
Standing Sections
Trash Compactor
luue Fee ' $ 3
�'S:� , 5 - � S�10 '
� _ n.... .
.; • ' ' ' �- SUl�yvlg{iV OF FEES
• 'BUILDING�PERMIT $ �� SMIP $ 5,&�
.+, PLAN'CHECK� $ � PERMIT � �
.!i PLUMBING $ � ISSUANCE $
` ' .PLAN'CHECK� �25% $ ENERGV P.C. $
`•~ •�ELECTRICAL" $ � GRADING $
� MICROFILM � $
��; '�PLAN CHECK 50% $ � . 5d4,�
�,:,�.�� MECHANICAL $ , TOTALFEE � $
� PLAN CHECK ,25%' $ . . �
�
.
�' CONSTRUCTION AND PLANNING PO� h SPA
'� , APPROVALS Permit # Date Inspector p�ppROVALS Permit # Date Inspector
1. Terriporary ElectricBl Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. � � 53. Steel Reinforcement
3. Electri�caLConduit Utility-Undrgrnd. - 54. Forms �
4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding •
5. Steel Reinforcement . _ ' 56. Rough Plumbing & Pressure Test
6.'Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
�7. Footings� � 58. Electrical Conduit-Undrgrnd.
� 8. Foundation � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System . . 61. APPROVAL TO DECK
11. Pro,perty Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewei�Cap � . 63. Heater & Vent-Final
13. Roof' Drains , 64. Plumbing System - Final ,
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit . 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
t
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING �
18: Rough ElectricabT 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 OGas ❑Oil
23. Gas Pipe-Rough & Test 72, Underground Flush
24. Roof Framing ' 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing .� . „. -� G 74. Overhead Hydro '
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing G,. 76. Dry Standpipe ,
28. Lathing & Siding . •�'Z.'r ✓� 77. FIXED SYSTEM FINAL
29. Insulation ' �r G/ 78. FIRE PREV. FINAL
30. Drywall Nailing ,"' y �.L .� �v HEALTH DEPT. REQUIREMENT
31. Plaster Brown CoaY,: ' � -y,( ��� 79. FINAL INSPECTION
32. Electrical Power MeterFinal ' 80. FOOD CERTIFICATE ISSUED
33. Final Electric .. � Notes: Q��L � r/' Lr :%�
34. Final Heating & Air Conditioning ^ � 0
35. Final Gas Pipe-Test '�
36. Hood or Canopy -1 ¢ 0
37. Final Factory Fireplace . ��_ d�(� �
38. Final Plumbing � � . ' � �- _ z _ " �
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 �
4� Handicap Regulations ,
47� FINAL STRUCTURE & BUILDING -1 %3
48. Special Requirements Completed, g ZS 8 M �
4�� Electiic Release to Edison. . ._.
50y Gas Release to Southern California Gas Co � .. ,
51� CERTIFICATE OF OCCUPANCY . -, '
No. Date • �
AOP�icant to fill In all spacei except Ihose wit�in heavy EorGer Ilnes antl f�9� all aoo�ooriate aeclantions.
Ci7Y OF COSTA MESpA CONS7R�TION PER'M`�' 'IT
Prolect Address 7 p;� �f �' '� `
Applicant'sMailingAddress ��d� D6� J'u�u (�J ihl/i
Owner's Nome � �^� � ' H i�— C- �` � � +�-� Phone
Address y �.AS_ p r�u � � (�
Arfh/Eng. _/.¢{/�7.,License No. C'��/�� / L)
Address �
Contracror'sNam -�PIG��^� �H �^�S�one%�f"33�'��
Address (mailing) ��- �� �� e ✓��'`�
/� CitY License No. � 7 '
�� � LICENSED CONTRACTOR OECLARATION
� 1 hareby affirm that 1 am licensetl untler provislons of Charter 9(commencin9
�, wi�h 5ection 7000) of Division 3 of the Business antl Pro(essions Cotle, an0
my license IS In (ull (orce a�0 e1f Ct. ��0���
U�BnS�CDlats�s� A� � Lic ns4 0.
1 Dale ^.+��_ Si9neture �
WORKERS' COMPENSATION DECLARATION
I h6reby aftirm that I have a certlficate of cOnSent to selPinsur¢ o� a ce�tlflCat2
of Worker5' Compen5ation �nzu�anG¢, Or a certifi¢tl Copy thereof (Settloh
aaoo, �o. c.>'�38l0� 3 comoa�'r—�-�//Y��°"/L�i
Polity No.
BCerfifi¢tl copY iz he�eby furni5hetl. '
Certifietl c%py is t letl with ihe city Buipla in Div s�on�J��� �_-- I
Date �/��'"^���i' APPIiCdnt��/�-,��i��-`*iT�Z
EXEM�TION FROM WORKE0.5' COMPENSATION D CLARATION
(Th�s section neetl not be comPleteO if the parmit is for one hunOreU �5100) o!
Iessl.
��ertity that In the performance o( Ihe work for whlch this permR is issuetl I
shal� not amPloy any p¢rso� In any mannar,so as to become subject to t�te
Wofkers' Compen5ation Ldwz O/ Cali(o��ia.
Da[e Si9nature
NOTICE: If, allc� making [hiz tlatla�alion, YOu ihou�tl become subj¢Ct to tn!
Wofker5' Comp¢�salion pwvf5bn5 of [he tabor COtle, you must forthwlt0
cOrt�p�Y �dth such provisiOns or thiz pOrmil sball C¢ tl¢eTetl revokatl.
CONSTRUCTION LENDING AGENCV ' �
I horeby aHirm [ha[ tltera is a ConStruction Ientlin9 age�cY for Ihu pe�}ormance
ol lha work tor whlcb this p¢rmit �5 IssueO (SeClion 3097, �Civ. Q)
Lentler's Name .
LAntler'z Atltlress
OWNER BUILDEH OECLARATION -
I nereby afflrm that I am exempt from tha Con[rac[or's Licenso Law tor the
following reason (Snctlon 7031.5 Bu5in055 antl Pro(essional COUo: Any city or
��pnty whi<h requires a permit to consVuct, alter, imProve, tlemolish or repalr
any structure, prlor to Its issuanca, also requlres the applltant for suth permil
j0 ��le a Signatl S(dt¢mCnt tM1dt h0/ShC is IICOnietl puYSuanl to th0 P�Ovlslon5 01
tha Contracior's License Law (Chaple� 9(commen<In9 with $actlon'7�00) at
� Oiv�sion� 3 01 the Business�antl Protessions Cotle) or thaD he/she Is exemp[
ierefrom antl tne basis for the allegetl exemption. Any violation ot So<tion
031.5 by any applltanl tor a permit subjocts tne applicant to a clvil
e�dlty of not mOre than fiv¢ huntlretl t1011ars (E500).
� I, as owner of ina•property or my employees wl(h wages as thelr sole
cort�Pensalion, will tlo lhe work, antl Ihe structure is not intandetl or oftored
5or sale �Soction 7044, Busioess ana Proleisioaal Cotle: Thn Contractor's
�i�ense l.aw tloes not apply to an owner ot a property who builds or improvot
tbo�eon, antl wno Ooez sucn work him5¢It/hersel/ ar t�rOuqh hiS or he� ow0
emP�Oyeos, prov�tlatl thdt SUCh ImproveTMts dre not Inlentletl Or otteretl tor
sa10. i�, however, the bulltli�9 0� ImproVement is Sottl within on0 YOdr of com-
plo��on, lhe owner wlll have the burtlen of proving he/she tliE no� builtl or Im-
nro�a tor tho purposo at sale).
❑{, as own¢r O�� the proce«Y� am exclu:lvely cnntractlng witn Ilcensea con-
tractors lo construct the oroject ISection �044, Businoss ana Professlons Cotla:
Tha ConVattor'S License Law dOes uot apply f0 an owner of Orope�ty wh0
builtls o� ImOroves Ihe�eon: an0 who COntrdtti to� Such projecls with a Con-
tra�tor(z) ucenu pursuant to t�e Contractor'S Licqnse L.aw). I am aware thal
prtlof of their Worke�'S Compen5atian in5utance snoultl be p�ovltle0 to me.
❑ 1 am axempt untler Sec[ion B. 6 P. C, tor tbis reason
Date
sentailves ol this
fnspe�tlon p pose
Sigpature �
Dri�ers' Ucense or
_ Owner
I have reatl t�is application antl stata that the above
I agree to comply wlth all city antl countY ortlinances
ta builGing consVuction, and hereby autboNze repre�
to enter upon tne above-mentionatl property for
oate � �'� "
Ei���� .
TVPE OF CONSTRUCTION �ISNEW LJ ADD LIALTERATION lJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPE OF PERMIT LJ GRAOING IJ�UNDATION LJ STRUCTURAL
❑ TENANT ❑ ELEC7RICAL L�i�UMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCflIPT10N Sa.FT. pCCUPArvCV^
CONSTRUCT,ION TYPE VALUATION $
20NE GRADINGCV.YD$. ACRES__
Remarks: - � ' �� / /\ ` -
Sink
Irrigation
rinking Founta
oor Orains•
ioor Sinks
as Service �/
Kitchen Sink : - '
Lavatories )y, W
P—Trap
Roof Drains i
Reinspection .Fee
Showers
- Service Sink
Sewer Cap
Sewer Connection
Solar Collectors'" '
Solar Piping '
� Solar Tank
Swimming Popl w/Spa
Urindl '
�s Water Closet �. a�
Water Heater
- . Water Service
$15
Boiler
Dutt - Under Ground
Duct - Structural
Duc� - Ventila[ing
Exhaust System O Mul[iple ❑
Firepl/Fact BIL ICBO #
Heating System & Ducting "
❑4100,000 BTU 0100,0008T�
Rainspection Fee � $75
CMF OB65-4fi, rev. 30/84 White - Builtlin9: Canary - APplitant Pink - AccounUn9; Goltlenrotl - AssasSor
A.P. qW
S Main Bui
E
T Front
B Rear
A
C Right
K Left
S
Ping. ReL #
FEES
�
Automatic Washer
, Canslruction�PoleS
6. . - Cooking Unit '
Dishwasher
Dryers ❑Gus ❑f
Fan
F.A'.U. �� . . . .
Fixtures
Device Boxes
Outlets
5791-10/23/86
65v50 TL
I Zone
Accessory Building: �
' � I Parking I
�
�
Garbage DisUosal
Generator �0-5 KW �5-15 KW
—i�� �
-�� �
��■��
Hood or Typel ❑
CanoPY Type I I ❑
Hetrigeration SYstem.
❑0.100,OOOBTU 0100,000
System Repair/AI[eration
Fire Dampers
Registers
laue Fee
$ 3
� Reinspection Fee �I
DEVELOPMENT SERVICES
Zoning Approved By
BuildinB APP�oved By ' —
Auolicatian luued Hv_
$15
Transformer ��O 75-50 KW -
� 50+KW _
Merer ❑up m 100 amps - �
Sub Panel ' •
Motors �0.1 HP 01 h- 8
Inc. Solar �9-15 HP �7g-15+
Microwave
Pole Light -r�
Range
Sign
Standing Sections • .
Trash Compactor _
litue Fee
- SUMMARV OF �.
BUILDINGPERMIT -$
PLAN_CHECK $ �
PLUMBIN6 � $ �S'?' �
PLAN CHECK 25% $ ��• �s�
ELECTRICA� $
PLAN CHECK 50% $
MECHANICAL � $
PLAN CHECK 25%� $
SMIP
PERMIT
ISSUANCE
ENEFiGY P.C.
GRADING
MICROFILM
TOTAL FEE
$ 3
$
Z
O
N
1
' N
G
R
E
�
M
� T
$
S
S
$ '.
5 �SSC
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit # Date Inspector qppROVALS Permit # ' Date Irispector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location .
2. Soil Pipe-Undrgrnd. �p/,��ys f 53. Steel Reinforcement �
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding •
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd. �
8. Foundation �• 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
17. 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. 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 O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical . '
27. Freme 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. Electricai Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric ' Notes: �
34. Final Heating & Air Conditioning � '
35. Final Gas Pipe-Test . (�-tl-Y7 (.�J
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing 7��z L�
39. Water Service-Final
40. Gas Service-Final I
41. Solar pomestic-Final
42. Backflow Preventer '
43. Backflow Irrigation
44. Landscape Irriga[ion System � ,
45. Sound Attenuation ,
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING
48. Speciai Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
" AVGlicant lo fill In all spaees exccot these witnin �eavy bortler Ilnes ane sign all aoCrooriate tleclaratlons.
CiTY oF COS7a MESA CONSTRUCTION PERMIT P�%� �• 'C TRACT NO. LOT NO. UNIT o.
785 �4�1 1Rrh SYreet " �O�V
Project Address W
•AppliCant'SMailingAddrESs ��ZZ Chester St/Stanton TYPEOFCONSTRUCTION ' NEW ADD ALTERATION REPAIR
ChinQ Fa Chien � CONVERSION ❑ DEMOLISH ❑ OTHER A P #
Owner's Name Phone DESCRIPTION OF WORK/USE OF BLDG. �� �E��
Address 18946 Vicki/Cerritos, CA 907m1 - s MainBuilding:
E
Arch/Eng. Licenie No. TVPE OF PERMI� GRADING FOUNDATION STRUCTURAL ' T Front •
Address ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear
co�vac�o�•srvame Trinitv Electric, Inc.Pho�egZ6-6979 � OTHER
PROJECT DESCRIPTION SQ. FT. oCCUvnrvCV C Right
Addresslmailing) 8022 Chester St/Stanton 90680 � K Left
City License No. 3H%% 1 CONSTRUCTION TVPE VALUATION S $
ZONE , GRADING CU. V�S. ACRES p��y, Ref. #
LICENSED CONTRACTOR OECLH A .ION —
I nereby at(irm that I am Iicense un r vis n ar c e ing Remarks: s NQ���" Planning Notes:
with sectlon ]000) 01 plvlsion 3 i P tl
my Iicense is in full force antl etfecL �� �,� � M . �= �� ��Q Qnn,��
Oate � y� Si9nature�tid —
VORK RS' C MPENSATION D CLARATION
hereby aHirm that 1 have a certlficate o onsent to -in e cert ate
oi workers' Compensation Insurance, r a car(ife oreof ( e on
3800, Lab. C.) ,
Policy No. �1�.17 �(�� 3 m a
Ccrti/i co i5 hereby fur0i5h¢tl.
C tif � filetl wilh the City '
oat G . qppiica
EXE TIO FROM WORKERS' COMPENSATION D CLARAT
(Thissection neetl not be completetl if the permit is tor one huntlr (E100) or
less).
I certity that in the performance oi the work fo� which this perm�t is issuetl I
snall not employ any person in any manner so as to becomn subject to [�e
Workers' Compensafion Laws of California. ' ,
Date - Si9nature
NOTICE: If, after making this tleclara[lon, you.shoultl becoma subject to the
Wo�k¢rs' Compenzation provisions of th¢ l.dbor Cotle; you must (orthwith
comply with such,provislons or'this permit snall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV '
I hereby dffi/m that th¢re is a conStruCtlon lentling a9ency fOr the Oertormance
of tne work for ��rl�i��e�[ll(s issuetl. (Sectlon 3097 Civ. C.)
Lentler's Name
�x�aer:naa�ez: 9107 Atlantic Bl Monterev Par 5�
OWNEH BVILpER dECLARATION �
I heraby affirm that I am exempt trom the Contractor's License Law for tM1e
following reason (Section 7031.5 Businezs antl Professional Cotla: AnY city or
munty which �equire5 a Oermlt to Conztruct, alter,.improve, tlemoll5h ot �epair
anY SVuc�u�e, prio� to it5 issuant¢, also reqWreg {he dpplicant for such p¢rmit
to file a signetl statemen[ that he/she I5 Iicens¢tl pu�suant t0 [he p�ovisions ot
`he ConVactor's License Law (Chap[er 9(commencing witb Section 7000) of
�ivision- 3 of tbe Bu5ine55 antl Profe551on5 CoOep o� that he/she is exempt
[herefrom antl Ihe basis for the allegetl exemption. Any violation of Section
7031-.5 �by any applican[ for d Permlt subja�ts the appllCant to a civil
��enalty oi not more than five huntlretl t1011ars (5500). � � �
LJ I, as owner ot the property or my employees with wa9es as their sole
' compensation, will Oo Ihe work, antl the structure is mt intentletl or ofteretl
' for ule (Section 7044, Busin¢ss antl Professional Cotle: Tne Contractor'S
License Law tloeinot appty to an owner of a prpperty who builtls or improves
thareon, antl who tloez such work himself/nerzeli or through his or her own
employee5, prOvitletl that such Improvemen[5 are not intentletl Ot o�(er¢tl fo�
sale. If, however„the builtling or improvement is soltl witnin one year of com-
pletlon; the owner wi11 have tha burtlen of prov{pq he/she tlitl not bulltl or im-
�rova tor Ihe purpose of saic).
1, as owner of the prooerty, am exclusively �ontractin9 with Ilcensetl con-
tfactOts to cOnslruct the pro�ect ($eCtlon 7044, gusiness antl PrOfe55ions Cotle:
The ConVactor's License Law do¢5 not apply to an own¢r ot property who
builCs or Imp�oves tnereon, antl who•contraCts.for such p�oj¢ct5 wi[h a con-
traclor(s1 bcense oursuant to the Contractor's L��¢nse Law). I am aware that'-
prool of their Worker'S Compen5ation InSuran�¢ shoultl be provitletl to me.
� �] 1 am exempt untler Section—i----��-�p,�— B. $� P, C. tor this reason �
Date
Signature Q�/FG'�'�
.Orivers' Litense or �5 �
above
nances
repre-
b !or
Sink
Preventer
'inking Fountains
oor Drains , '
oor Sinks '
Interceptors
Kitchen Sink
P—Trap
Roof Drains
Reinspection Fea
Showers
Service Sink
Sewer Cap
Sewer Connecti�
Solar Collectors
Solar Piping
' Swimming Pool w/Spa
Urinal ,
�U[IC[5 Water CIOSCt
Water Heater
Water Service
Auto-Wash
Laundry Trays
$15
Boiler
Duct - Under Ground
Duct - Structural
Duct � Ventilating �
Exhaust System � 'Multiple ❑
Firepl/Fact. Blt. ICBO # �
Heating System & Oucting
❑6100,000 BTU � 100,000 BTI
Rainspection Fee � $15
CMF OB65-46, rev. ]0/84 White - Builtlin9: Canary . qppllcant; Pink - Accounting: Goltlenrotl - A55essor
Issue Fee
Hood ar 'Typel ❑
Canopy Typell ❑
Refrigeretion System
❑aioo,000eTu O�oo,000aT
System Repair/Alteration �
Fire Dampers
Registers
Isue Fee
Automatic Washer
Construction Pole Sub.
Coaking Unit
. ' Dishwasher �
' Dryers ❑Gas ❑Elec'
Fan
F.A: U.
5 3
$ 3
Device Boxes
Outlets
Switches
Garbage Dispoul
Generator �0.5'KW
Fee
6255 10/29/86
zone
Accessary Building: �
Parking Req./Provided
ELECTRICAL " ,.
Transformer ❑ 15-50KW �
. ❑ 50+�KW , -
Meter� Dup to 100'amps �
Meter ❑over 100�amos
Momrs00.1 NP�1X-6 I ��_
Inc.Solar'�9-15 FIP �16-15+
Microwave
Pole Li9ht ; �
i Range � �
Sign ' '
Standing Sections
Tresh Compactor
Issue Fee
DEVELOPMENT SERVICES RE�UIREMENTS:
2onin9 APProved BY .
Building APPraved BY .
, �.I' .
25;50 �TL
Z
O
N
i
N
G
R
E
U
M
T
S
FEES
SUMMARV OF FEES � � -' �
B�UILDING PERMIT $ SMIP $
IIfLAN CHECK $ PERMIT
PLUMBING $ �ISSUANCE $
iPLAN CHECK 25% $ �� "�� ENEflGV P.C. $ �
. 'ELECTRICAL $ J�.= �GRADING $
PLAN CHECK 50% $ 7•�fO MICROFILM $ �
MECHANICAL S TOTALFEE $� �
PLAN CHECK 25% $ _ _ �
CONSTRUCTION AND PLANNING
APPROVALS Permit #
7. Temporary Electrical Service or Pole
2. Soil Pipe-Undrgrnd.
3. Electrical Conduit Utility-Undrgrnd.
4. Electrical Conduit-Undrgrnd.
5. Steel Reinforcement
6. Electrical UFER Grnd.
7. Footings
8. Foundation
9. Water Pipe-Undrgrnd. �
10. Structural Floor System
11. Property Sewer Line & House Connection
12. Sewer Cap ,
13. Roof Drains ' -
14. Rough Plumbing
15. Rough Electrical-Conduit
16. Rough Electric Wiring -
17. Rough Wiring Sign - � � • . �
18. Rough Electrical-T Bar Ceiling
19. Rough Heating & Air Conditioning
20. Rough Factory Fireplace
21. Ducts, in Structure
22. Ducts, Ventilating
23. Gas Pipe-Rough & Test
24. Roof Framing � �
25. Roof Sheathing
26. T-Bar Ceiling (Structural) & Monocoat
27. Frame and Flashing .
28. Lathing & Siding
29. Insulation
30. Drywall Nailing
31. Plaster Brown Coat
32. Electrical Power Meter-Final
33. Final Electric .
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38.�Final Plumbing
39. Water Service-Final
40. Gas�Service-Final
41. Solai Domestic-Final
42: �Backilow Preventer .
43. Backflow Irrigation
44. -Landscape Irrigation System
45. Sound Attenuation
46. Handicap�Regulations
47: FINAL STRUCTURE & BUILDING
48..Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATEOFOCCUPANCY
o. Date
Date
�' G �
f POOL & SPA
Inspector qppROVALS Permit#
, 52. Pool & Equipment Location
53. Steel Reinforcement
��(� 54. Foims -
55. Electrical Bonding
56. Rough Plumbing & Pressure?est
57. APPROVAL TO COVER-GUNITE
58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P�Trap, O Undrgrnd.
61. APPROVAL TO DECK
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/SPASYSTEMSFIIVAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit # ' _
G
70. Underground Hydro "
71. Product Piping OGas ❑Oil'
72. Underground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro �
75. Dry Chemical' -
76. Dry Standpipe '� �
r .
77. FIXED SYSTEM FINAL �
78. FIRE PREV. FINAL ��,�
HEALTH DEPT. REQUIREP
79. FINAL INSPECTION � ��
80. FOOD CERTIFICATE ISSUED
Notes: d. i�. �e��/_ ii�w i.. �
0
5
NT
Date Ilnspector
0
\I
Applicant to flll in all spatts axce0t those within heavy Eortler Iines antl si9n atl apvroDrtate Oeclarations.
CITYUF COSTA M SA CONSTRUCTION��_RrM1T
Project Address� �� `�"� ( �-` �
P,pplicant's Mailing Address
Owner's Name Phone
Address
Arch/Eng. • S� _ Licens Na 44 ��� �
Address � � � � _ ��-s--.� Q ��• S"—�—_'� N
Contrector's NamA��k �� Lkd Ph � �S2 �
Addresslmailingl ���'� �—• �• 5���--�e.�o--c-
Cily LicenSe Na. �� Z�
LICENSED CONTRACTOR OECLARATION
I hereby aftirm that I am Iicensetl untler provizlons ot C�arler 9(commen<ing
with section 7000) of Oivision 3 of the Bu51nas5 antl Professions Cotle, anA
my Iicense is in i n torce ana et�ect L�/S�/D�
Llcense Class licensa No.
Oate � �T7 Signature
ORKERS'COMPENSATION DECLARATION
nereby aftirm tbat 1 have a certilitdte of consen[ to salNnsure or a certifiwte
of Workers' Compensation Insurance, or a certifieE copy thereof (Section
3800, �ab. C.)
Policy No. - Compdny
BCertifietl copy iz her¢by furnisnetl.
Certifietl cooY is filetl with the city Builtling Division.
Date APplicant
E%EMPTION FROM WORKERS' COMPENSATION DECLA0.ATION
(ThiS section neetl not OC completetl It lha plrmit IS tOr On0 hunEretl (§100) or
less).
I certify that in th¢ p¢rbrmance of tha wO�k fOr which lhiz plrmit is ISzuetl I
shall not employ any pe�son in any man s0 az to become subject lo t�B
Worke�5�' COm nsali ws of CalifOm �'y�
Date 'J%Si9nature /�"�/ ���'-^--��'
NOTI : If, atter making thiz aeclaratlon. You shoultl becoma subject to tha
Workers' Comp¢nsation provisions ot [ne LabOr COtle, y0u must (ortnwilh
tomply with such O�ovisions or thl5 p¢rTlt shall be tleemetl rOVOkeG.
CONSTRUCTION LENDING AGENCV ✓'-
1 hemby affirm t�at t�ere is a tonstructlon lentling agency tor the per/ormance
ot the work for which thi5 Permlt ii is5u0tl (SettlOn 3097 Giv.•CJ
�entler's Name
LentleYs Atltlress
OWNER BUILDEH OECLARATION
1 hereby alfirm that I am exempt trom tho GonVac[oPs Licensa Law tor tne
tollowing reason (Sectlon 7031.5 Business antl Professional Gotle: Any Uty or
county whlch r¢qWms a p¢rTil to con5truct, alter, Improv0, �tmoli5h O� /epair
any structur0, prlor to i[s issuante, also reaWreS thn applicant lor Such pormil
'O file a Sign¢tl itat¢ment that ho/she IS IICCnSCtl putiudnt t0 th0 Pfovi510lIS ol
ie ContractoYs LJcense L.aw (Cnapter 9(commancin9 wllh Se<tlon 7000) of
JWsion 3 of the Bu5Ine55 dnd' %ofe55iOn5 Cotle) or that h@/SM1e IS Cxampt
�herefrOT antl th! ba5i5 fOr lhe allegatl exOmptlOn. AnY ��olatlan of Saction
7031.5 by any applicant for a pe�mlt Subjet[5 Ihe appllcant t0 a clvil
�enalty 01 nol more Man iivo huntlratl tlollars (5500).
LJ I, as ownar ot the proporty or my employeos with wa9os as thoir solo
compensation, will tlo the work, anC lhe 5[rutturo is not IntenCetl or oHerotl
for sale (Section 7044, Buslnest antl Protessional CoEo: Tha Contraclor's
I..icenm Law tloes nol app1Y �o an owner ot a proporry wtto bulltls or improv¢t
iM1ereon, ana who tloes su<h work himielf/harzolf or tnrough his or her own
employees, proWUetl that suth ImprovCmenls a�e nol IntentlOtl o� oflu�etl for
sale. H, howaver, (he bulltling or improvement is soltl wl[hin one yoar of com-
- pletlon, tho owner will have the burtlan of proving he/she tlltl not bulltl or Im-
�ova 1or the pu�pOSn of sa10).
I, as owner of the property, am exclusively tontracting with Iicensetl con-
� tractors t6 construct tna project (Sectlon �044, Businoss antl Professions Cotle:
Tbe Con[ractor's LiCenSe l2w dae5-nOt apP�Y to an own¢r ol prope�ty who
builtls or imoroves thereon, antl who contra<ts lor such prqecls with a con-
bactor(s) Imense pursuant to the Contractor's Licanse Law�. I am awaro that
proof of thlir WO/ker'S Compensalion InSurance ShoWe be provitletl l0 mo.
❑ I am ezempl untler Section 8. 6 P. C. tor this reasOn
Date
1 hereDy ceriit
ipfOlmdti00 i5 �
antl state laws
sentatives o( t
inspection purp
Signature�
Drivers' Licensi
ing
city
or SS
Owner
have reatl [bis application antl 5tate th5t the above
a9�ee to como�Y w��n all city antl county ortlinances
o builtlin9 �on5t�tlGtlOn, antl he�eby autho/ize �ep�e-
to!�s nter upon tM1e above-mentione� Droperty pfor
/ C�� �..�✓` Dal � O
� _ __
TYPE OF CONSTRUCTION LJ NEW U ADD LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p �!,
OESCRIPTION OF WORK/USE OF BLDG.
. S Main Building:
E
TVPEOFPERMIT GRAOING FOUNDATION STRUCTVRAL T FrOnt
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 8 Reaf
❑ OTHER A
PROJECT DESCRIPTION Sq. FT. OCCuaAtvcv C Right
CONSTRUCTIONTVPE VALUATIONS g Left
ZONE � GRADING CV.YDS. ACRES p�ng. Ref. #
Remarks: � � (l/�/ � Planning Noles:
Preventer
Irrigation
rinking Fountains
loor Drains -
loor Sinks
asService Outlets
Kitchen Sink
Lavatories
Hoof Dreins
Roinspeetion Fee
$15
Boiler
Duct � Under Ground
DUct - StruCtUral
Duct - Ventilating
Exhaust System ❑ MWtiple ❑
Firepl/Fact. Blt. ICBO dhZ51(
Heating System & Ducting
❑ ai oo,000 eTu O i oo,000 sT
Reinspection Fae ' � 315
CMF 0865-46, rev. 30/84 White - Builtlin9; Canary - ApPllcanq Plnk - Accounting; Goltlenrotl - Asse55or
PLUMBING
Showers
Service Sink
Sewer Cap� .
Sewer Connection
Solar Collectors
Solar Piping
Solar 7ank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service -_ .
Auto�Wash
Laundry Trays
laue Fee
Hood ar Typel ❑
Canopy Type II ❑
Refrigeration System
❑0.100,OOOBTU ❑100,000
System Fiepair/Alteration
Fire Dampers .
Fiegisters
Issue Fee
FEES
2�85 2����8% �Bo�O TL
2ona
Accessory
ELECTRICAL
Automatic Washer Transformer ❑ 15�50 KW
Construction Pole Sub. � 50 + KW
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �0.5 KW 05-15 KW
Meter LJup to 100 amps
Meter �over 100 amps
Sub Panel
Motors�61 HP�1'/,-8
Inc.Solar 09-15 HP �16-75+
Microwave
Pole Light
Range
Sign -
Standing Sections
Trash Compactor _
S 3
Reinspection Fea $15 luue Fee
FEES
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
BUilding APProVed By �
$ 3
BUILDING PERMIT $
PLAN CHECK $
PLUMBING � $
PLAN CHECK 25% S
ELECTPICAL S
PLAN CHECK 50% $
MECHANICAI S
PLAN CHECK 25% $
SUMMARV OF F
Z
O
N
I
N
G
H
E
�
M
T
S
FEES
S 3
SMIP $
PERMIT
ISSUANCE $
ENERGY P.C. $
GRADING 5
MICROFILM 5 r�
TOTAL FEE $ _( �_`-'v
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector qpPROVALS Permit# Date Inspector
1. Temporory Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Feinforcement
3. Elec[rical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
75. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
77. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough ElectricabT Bar Ceiling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace 3�f/d-•J � APPROVALS Permit # _ "
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. FrameandFlashing 76. DryStandpipe �
28. Lathing & Sitling 77. FIXED SYSTEM FINAL
29. �nsulation 78. FiRE PREV. FINAL
30. Drywail Nailing HEALTH DEPT. REQUIREMENT �
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. f00D CERTIFICATE ISSUED
�
33. Final Electric Notes:
34. Final Heating & Air Conditioning
35. Final Gas Pipp-Test
36. Hood or Canopy � , ,
37. Fina� 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 ' i -
47. FINAL STRUCTURE & BUILDING , .
48. Special Requirements Completed ' '
49. Electric Release to Edison '� i
50. Gas Release to Southern California Gas Co ' l
51. CERTIFICATE OF OCCUPANCY
No. Date '
Applicant to fill in aIl soaces except those within heavy eoraer Iines ana sign all aDPropriate Oeclarations.
CiTV o,F Co37A MESA ONSTRUCT�ON PERMIT
Project Address �-�1 • �� �= S��•
'Applicant'sMailingAddress �
Owner's Name Phone
Addreu
Arch/Eng.� � � ��_d License NO� � �Ca
� �. T..._.�..� Q . T ' �.ti:
ont ac�tor s � nn �w�- i.��:.._cr_�: �Pho�� �I.S�Z�(o(E
Address (mailingl 4 � �"�� �^"
City License No. � �9
LICENSED CONTRACTOR DECLARATION
I hereby afti�m thal I dm licensetl untle� provislons of ChartEr 9(Commencln9
wlth Section 7000) of Division 3 Of [he Bu5ine55 antl Profeszion5 Cotla, antl
my Ilcenze is in i W Porc ntl efiect. ����S
License Class � ' License No.
Date_� � � �'� Si9nature
'ORKERS'COMPENSATION DECLARATION
nereby aflirm that I have a certi/icate of consent lo selt-insure or a<erHfica[e
o/ Worker5' Compensation Insurance, or a certifietl coOY thereo( (Settion
3800, Lab. C.) ' �
Policy No. Company
eCertifietl topy is hereby fumishetl. '
Certifietl copy I5 flletl with the city Builtling Dlvlsion.
Date AOPlicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section neetl no[ be completetl if the permit is !or one �untlretl (5300) or
less).
I cer[ify that in th¢ perlo�manca of lh¢ work tOr which this pe�mit is ISSuetl, I
Shall not emplOy any pe�son in dny manne� o as to become subjett to the
Wor s' C mpensation ws of Calitomia
Dat 9� �" �Si9nature -- - —
NOTICE: I(, aftar making this tleclar�on, you shoultl beWme subjoct to the
Workers' Compensation provlsions of the Labor Cotle, you muzt forthwith
comply with such provisions or thiz permit shall be tleemetl revoketl.
CONSTRVCTION LENDING AGENCV
I hereby aftl�m that tM1ere i5 a construc[ion lentling agency to� the perfOrmance
Ot lna work for whith thiz permit is issuetl (Section 3097 Clv. CJ
I LentlGr's Name
�' LBlld¢I�5 /iddl�55
I OWNER BUILDEN �ECLARATION
I bereby affirm that I am exempt from the Contrac[or's �Icense Law for the
following reason (Sectlon 7031.5 Business antl Professional Cotle: Any city or
county whlch requlres a permit to construct, alter, improve, tlemollsh or repair
any structure, prior to its issuance, also requires the applicant for such permit
b file a sign¢tl slalement that he/sne is licensetl pu�suant to the prOvlsions of
ie Con[racror's License Law (Chapter 9(commencing with Set[ion ]000) of
iivision 3 of Ihe Bu5ine55 antl Protessions Cotle) or fhat he/She i5 exempt
�herefrom anE the basis for the alleqetl exemption. Any violatlon of Section
703L5 by any applicant tor a Permit subjec[s the appliwnt [o, a Uvil
�enalty ot no[ more Ihan five M1untlretl tlollare ($500).
1, as owner ot the pvoperty or my employee5 with wage5 ds their sole
compensation, will tlo the work, antl [he structure is not intentleA or otferetl
for sale (SecUon 7044, Business antl Protessional Cotle: The Contra<tor'z
�icense Law tloe5 nOt apply to an Owner of a prop¢rty who builtls or Improve5
tpereon, antl who tloes such work himselt/hersel( or th�ou9h nls or nar own
employeez, provltletl that such Improvements are not intenGetl or otteretl (or
zale. If, however, the builtling or imProvemeni is soltl within one year ot com-
pletion, the Owne� will have Ihe burtlen of proving he/s�e tlia not builtl o� Im-
�rOve tor tha purpose of sale).
I, a5 Owne� ol the prop¢r[y, am exclusively contraCting with IiCenSetl COn-
trattorsto constructthe project (Section ]044, Business antl Protesslons Cotle:
TM1e Con[ractor's LicenSe Law does mt apply to an owner oi property who
builtls or improves lhereon, antl who contracis for such projects wlth a con-
tractor(s) Imense pursuant to the Contractor's License Law). I am aware that
proof of their Worklr'S Compensatlon insu�ance Shoultl be provitletl to me.
❑ 1 am exempt under Section 8. & P. C. fo� this rea5on
Oate
I hereby certify that
information IS corr¢ct
antl state laws relatin
sen[atives of tnl5 i1
in5pectlon purpos
Siqnature
Orivers' LicenSe or SS
iF OB65-46,rev.30/84
Owner
have reatl tnis application and state that [M1a above
agree to comO�Y �"/iih all clty antl county ordlnances
o builtling construction, antl hereby authorize repre- �
to en[er u on the above-mentlonetl property rfor
Dat'-� // d �
�.� �
����� � I I
TYPE OF CONS7RUCTION New aoo
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
' DESCRIPTION OF WORK/USE OF BLDG. —
ALTERATI ON
TVPE OF PERMIT GRADING FOVNDATION
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑
❑ OTHER
PROJECT DESCRIPTION SQ.FT.�
REPAIR
STRUCTURAL
CONSTRUCTION TVPE VALUATION 5
ZONE GRADING CU. VOS. AC
Remarlcn� ��� / /'� ��
{� L
Bar Sink
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service
Interceptors
Kitchen Sink -
Outlets
P-Trep
Roof Drains
Reinspection Fee $75
Boiler
Duct- Under Ground
�Uct - $tfuCtuf2�
Duct - Ventilating
Exhaust System � Multiple ❑
Firepl/Fact. Blc ICBO #
Hea " ystem & Ducting
0-100,000 BTU O 100,000 BT
Reinspection Fea � $15
White - Bulltlin9: Canary � APPlicanh Pink - Accounting; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap �
Sewer Connection ,
Solar Collecrors
Solar Piping '
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service -
Auto-Wash �
Laundry Trays
Issue Fee
Hood ar Type I L�S
Canopy Typell ❑
3�ef�ri e ation System
W-100,OOOBTU ❑700,000
System Repair/Alteration
Fire Dampers
Registers .
Issue Fee
FEES
C
A.P. #
$ Main Building:
E
T Front
ARear
C Right
g Left
Ping. Ref. 5�k
Planning Notes:
Automatic Washer� .
Construction Pole Sub..
Cooking Unit
Dishwasher
Dryers.�Gas �Elect
Fan '
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator DO-5 KW ❑
Fee
2179 2/II/87
I Zone
Accessory Building: �
ELECTRICAL • �
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps -
Meter ❑over 100 amps
Sub Panel
Motors DO-7 HP � i X- 8
Inc.Solar 09-15 HP �16�75+
Microwave '
Pole Light '
Range
i
5-15 KW
$75
Standing Section
Trash Compactor
Issue Fee '
i
64,86 TL
Z
O
N
I
N
G
R
E
Q
M
T
S
FEES .
$ 3
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By Date �
Building Approved By Date
Applitation Issued By � 1� - Date z � �%
SUMMARV OF FEES
BUI�DING PERMIT $ SMIP $
PLAN CHECK $ PERMIT -
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C, $
ELECTRICAL $ GRADING $ --
PLAN CHECK 50% $ ' - MICROFILM $� �'
MECHANICAL � $ sS�- S � TOTAL FEE $(� Y-��'
PLAN CHECK 25% $ L_�3 �
�
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement . '
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding
5. Steel Reinforcement . 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE .
7. Footing5 58. Electrical Condui[-Undrgrnd.
6. Foundation 59. Gas Pipe, O Undrgrnd., Test '
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
i t. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
72. Sewer Cap 63. Heater & Vent�Final �
13. Roof DrainS 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical�Final �
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring ' 67�..Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning � � FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # _ '
21. Ducts, in Structure 70. Underground Hydro
�
22. Ducts. Ventilating ,' 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. RoofFraming 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 �
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 ���7 Re� - .\
35. Final Gas Pipe-Test •
36. Hood or Canopy '�' �
37. Final Factory Fireplace . • ' �„
t
38. Final Plumbing , ' �
�
39. Water Service-Final . � �
40. Gas Service-Final ` - � ; ,�
41. Solar pomesticFinal
c
42. Backflow Preventer , � �
. �'
43. Backflow Irrigation � � .
44. Landscape Irrigation SYstem ' ,
45. Sound Attenuation '�
. 'i
46. Handicap Regulations • . , � l';
', .
47. FINALSTRUCTURE&BUILDING � '
48.•Special Requirements Completed � - , �
:
49. Electric Release to Edison 1�' '
r �_�
50. Gas Release to Southern California Gas Co ,_ •
51. CERTIFICATE OF OCCUPANCY
No. Date •
ADPlicant t0 /ill {n all spaees axcept tnose wit�in heavy Do�Aer Ilnes anC si9n all appro0/Iate tleclaralions.
CITY�COSTA �M7ESA CONSTRUCTION PERMIT
Project Address - / �S � �� �� Sf
Applicant's Mailing Address
Owner's Name Phone
Address
Arch/Eng. T' to Liceyn�se No. �
Address �i��� li°S� / -^'�'ES� /�� ���- �
Contractor's Nam� ��/�',� ��yp��� Ph�4� ac r= ffL
Addresslmailingl lb ��Ll� �S G�t/ ���,'nfl,L)
City License No. �.
LICENSED CONTRACTOR DECLARATION
I hareby alfirm tha� I am licensetl untler provi5ions of Chart¢r 9(CommenCing
witM1 section 7000) oi Olvlsion 3 of [he Business antl Protesslons Co/tle', antl
my Iicense Is in tuu f%o ce�j a effecL y�S Y�S
Licanse CI ss ` j � � ,41 �lse No.
Date �//��� Si9 t � �/�
�R RS'�GOMPENSATION DECLARATION
ere y aftirm tnat I have a certi(itate ot consent to selM1insure or a<ertHicate
„r Worke�s' CompinSa[ion Inw�ance, o� a certitiltl cOpy.Ihe�eof (5¢ction
3800, lab. C.)
Poli<y No. � Company
Certifietl copy is �ereby fumishetl.
Certifietl copy is filetl with.the city Builtlin9 Divlsion.
Oate Applicant
EXEMPTION FROM WORKERS• COMPENSATION DECLARATION
(Thissection neetl not be comple[etl it the permit I5 for one huntlrotl (§100) or
less).
1 certi(y that In Ihe performdnGe Of the work tor whith thii pGrmR is issuetl, I
shall no[ omolov anv oerson in anv mannPliso as [o become subject to the
Date � 99nature ^-- �-
NOTIGE• 1, alte making tM1is tleclar tlon, you sboultl become subjoGt to the
Workers' COmpCnSatlon provi5ion5 ot [hC Ldbo� Cotle, you muSt brthwi[b
comply wi[h sucn prOvisions or [nls pe�mit Shall bB tlBnmetl �evoketl.
CONSTRUCTION LENDING AGENCV ° '
I nureby a1/1rm Mat there is a constructlon lentling agency for ine performance
of thu work for which tN5 permi[ iz Issuetl (Sectlon 309� Civ. CJ
Lentler's Name
LB�1f18f'S Atldf055
OWNER BUILOER �ECLARATION '
I he�eby a1fl�m lhat I am 9xempt from th¢ ConVattor'S Llcensa Law fo�.[ne
tollowing reason (Soction 7031.5 8u5inezs antl Proteszlonal Cotle: Any,clty or
county which reqWr¢5 a permit to cons[rucq alter, improve, tlemolish or repair
any structuro, prlor to iti issuance, also requirez the apD���ant tor suth permit
t0 1i10 d sl9nOtl Stdt�ment that he/sM1¢ i5 Ilcen58tl OURudn[ lo lbe pfOVI5iOn5 of
•e Contractor'S Ucense Law (ChaO[er 9(commenUng wi[n Soctlon 7000) of
viSiOn 3 0l t11C Busin¢55 antl Professiani COG¢) Of Ihal ho/Sh¢ Is exampt
�eretrom antl lhe ba5is for the allegetl exemption. Any violation of Snc[lon
"l031.5 by any applicant for a permit subjects tho applicant to a dvll
�enalty ol not more lhan Bve huntlretl tlollars (E500).
LJ i, as ownor of tha oroperly or my employees with wagez as their sole
Liten50 ldw tloe5 nOl apply to an Owner OI a pfopaf[y wno Dullas or Improves
tna�eon, antl who tloes such wo�k nlm5clt/tterialf or thrOugh hls o� he� own
employ eaz, provltletl that such Improvementt are not Intenaetl or olleretl for
salo. If, hOwovar, lne bullCing Or imD�ovOmnnt I5 sotd wlthin One yed� ot com-
pletion, the ownar will have tne burC¢n of oroving he/she tl10 nol builtl or im-
provB fo� tha purposo oi sala).
❑ I, as owner ol tne proporty, am excluzively contracting wlth Ilcenzetl con-
tractor5 to construct th0 PlojeGt (Sectlon 7044, Bu51ne55 dntl PrOtoSzlonS Cotle:
The Contractor's license Isw tloes not apply to an owner oi property who
bulltls or Improvos tnereon, antl who mnVacts for such vrojects witn a con-
tractor(s) 1¢anse pursuant to the Contractor's Llcen50 Law�. I am aware tnat
proof of [holr Worker's ComPensatlon insurance sboultl bo provltlod to ma.
❑ I am exeTpt untlec$ectlon B. 6 P. C. �Or thi5 reason
Date Owner
I hereby certify t�at I have reai
. informalion is correct. I agree to
, antl state laws relatin9 to builtlin
, 5¢OtdlIV85 Of 1h15 � ty t0 ¢Ol¢!
inspe<tion pwp0
Signature � /
Drivers' License ar 55 /�
thiz application antl scate that the above
�mply witn all cily antl counry OrGinances
construction,antl heraDy author@e repre-
�pon the abova-menHonetl property for-
+�++-� Daie 1 � // .�
/�
r-r ✓�"7 3 I S�I I I-}�a��
TVPEOFCONSTRUCTION NEW ADD ALTERATION IJ REPAIR
❑ CONVERS�ON ❑ DEMOLiSH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRVCTVRAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SO.FT. OCCVPANCV—
CON STRUCTION TVPE VALUATION $
ZONE GRADING CV. VDS. ACRES_
Remarks:
Sink
Preventer
Irrigation
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceprors
Kitchen Sink
Lavatories
P-Trap
Roof Drnins '
Reinspection Foe � 515
Boiler
Duct - Under Ground .
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact BI[. ICBO #`ZS
Heating System & Ducting
❑P700,000 Bi'U 0100,000
Reinspection Fee � $15
CMP 0865-46, rev. ]0/84 Whi[e - Builtlin9; Canary - Applicant; Pink - Accounting: Goltlenrotl • Assessor
Showers
Servite Sink �
Sewer Cap
Sewer Cannection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool'w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
laue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑o-�oo,000eTu ❑ioo,000
System Repair/Alteration
Fire Dampers ��
Registers
laua Fee
�
�
5 3
$ 3
A.P. qW
S Main Buildi
E
T Front
B Rear
A
C Right
K Left
5
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher �
Fan
F.A.U.
Fixtures
Device Boxes �
Outlets
$witches ,
Garbage Disposal
Generator �0�5 KW
clu/ C/II/tl/
Zone
AcceSsory Building:
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
, ❑50+KW
Meter Oup ro 100 amps
Meter �over 100amps
Sub Panel
' Motors �Pl HP � 1'/, � 8
Inc Solar �9�15 HP 016�15+
Microwave
Pole Light
Range
Standing Sections
5�15 KW Trash Compactor
� Reinspaciion Fee
DEVELOPMENTSERVICES
ZoninB APOroved BY_
Building Approved By —
Application Issued By_
$15 I I Issue Fee
SUMMARV OF FEES
BUILDING PERMIT $ SMIP S
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING 5
PLAN CHECK ,� f MICFOFILM S
MECHANICAL �S TOTALFEE S
PLAN CHECK 2�6• � - �
� 8000 �
FEES
$ 3
2
O
N
1
N
G
R
E
U
M
T
5
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility�Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, O Undrgrnd., Test
. 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVA'L TO DECK
i t. 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 Elec[ric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
78. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
i
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT .
♦
20. Rough Factory Fireplace t�f, £ APPROVALS Permit # _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Produc[ Piping O Gas OOiI
23. Gas Pipe-Rough & Test 72. 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
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 a� ,
38. Final Plumbing , '
39. Water Service-Final •
40. Gas Service•Final
41. Solar pomestic-Final •
42. Backflow Preventer �
43. Backflow Irriga[ion .
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 Southem California Gas Co " � �+
57. CERTIFICATE OF OCCUPANCY '
No. Date
ADDlicant to fill in all spatts except those witnin heavy boraer Ilnes antl slgn all apo�opriale tleelarations.
I
CITY OF COSTA ME�$,.({� C`O`N�S R�UCTION PERMIT PE� i 2°�,4�5 TRACT NO. LOT NO. U�,CNq� 2.��4 '�/_t / y., I;_r
Project Address �`� �' �'�1 •�� C OST L�-1.� E,�
/ S � TVPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR
Applicant'j Ma�ilin`g Address(� '�y�j'� �
��1����-FACtj�n1�C�{{ieNU �� _ 3 -7T-'CONVERSION ❑OEMOLISH THER q,p,# . Zone
Orner's Name �� � DESCRIPTION OF WORK/USE OF BLDG. ,
Address S Main Building: Accessory Building:
� 1'�) , LL- 1�r�D TYPEOFPERMIT ❑GRADING FOUNDATION ❑STRUCTURA� E Front Z
Arch/En„ ��-',^T��,-��tU «B� PLVS �.N� L' e e No �,-/ T O
Atltlres���s� S `� � O ' ❑ TENANT/ y����� ECTRICAL.O PLUMBING ❑ MECHANICAL 6 Rear N
CAntraClor'S Nam �T � p �e 9 ❑ �THER/ %� _ �
PROJECT DESCRIPTION Sa.FT, oCCUParvCv
9
C Ri ht N
Address (m ��� „� 80Z2. IESTE'PS� ST�A�ou C�A r���o K • . G
CONSTRUCTION TYPE VALUATION § S L¢ft
City LicE�Sf NO. ZONE GRADING CU. DS. ACRE$ R
LICENSED CONTRACTOR DECLARATION L�1'� 5��, _ Ping.�Ref. # Pefkiny R¢q./P�Ovid¢d Q
I nereby affirm that I am licensea untler o�ovizions ot Cnart 9 � Remarks: ��� Planning Notes:
witn 5¢Clion 7000) of DlviSion 3 ot Ihe Bus' e5 antl Pro M
m license is in full forte a tl f(e +� � l p O . 5
License ass �� i O--b nse N. `
Date Si9nature PLUMBING . FEES
WOfEK RS' OMPENSATIONDECLARATI N BefSink ShOw¢r5 � �
I hereby aHlrm that I have a certificate ot wnsent to seli-insure or a c ti�icate ELECTRICAL FEES
� of Workers' Gompenwtion Insurance, or a certifietl mpy thareof (Section _ gackflowPreventer ServireSink .
3800, �ab C.). —7 �qA�d Automatic Washer 7ransformer ❑ 15-50 KW
1 Poiicy No��" I�1 � D�'3 Company � �- U Backflowlrrigation SewerCa ❑ 50+KW
P Construc[ion Pole Sub.
\ Certifietl copy is nereby turnishetl.
Certitie copy is filetl with the city Bui �ivisi �\ Bathtu6s Sewe� Connection Cooking Unit Meter�p to 100 amps
` Date �9� APO���a�t Clarifiers Solar Collectors Dishwasher Meter
EXEM ON F OM WORKERS' COMPENSATION DECLARA O ❑Ov¢r 100 dmp5
(This section neetl not be completetl ii the Oermit IS for One huntl�etl 300) or
iess). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel
I certify lha[ in the Verto�mante Of the wo�k (or whith this p¢rm�t is i55uetl, 1
shall not employ any person in any manner zo az to become subject to the Drinking Fountains Solar T k - Fan
Workers' Compensation laws oi Cantomia. Motors �0-1 HP 01 %� 8-
Date Si9nature Floor Drains . S' ming Pool w/Spa F.A.U. Inc.Solar 09-15 HP �76-15+
NOTICE: If, after making tnis tleclaratlon, you should become subject to the
Workers' COmpenSdtion plovision5 of [he LdbOr Cotle, you must folthwlth FIOOI SinkS J U�indl FixtUf¢5 MiCfOwdvC
compry with such provi5ions o� 1h15 permit shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV GasService�� Outlets W3L2fC1052t
1 hereby aifirm that there is a construction lentling agency for the performance Devite Boxes Pole Light
ot the work for which this permlt is issuetl (Sectloo 309� Civ. C.) Intercepto�s � Water Heate� Outl2t5
Lentler's Name Range
�entler's Atltlress - Kitchen'Sink Water Service Switches � - ' Sign
OWNER BUILDEft �ECLARATION
I he�eby alflrm that I am exempt lrom the Cont/actor'S Lic¢nse Law fOr [he Lavarories AutO-WeSh ('iefbey¢ Di5pO5dl g
followin9 �eason (Section 7031.5 Buslness antl Pwtessional Cotle: Any dry or _ . , Standin Sections
counry which requires a permit to construct, alter, improve, tlemolisn or repair P-Trep;, Laundry Trays Generator DO-5 KW:�5-15 KW
dny SVuc�ure, prmt to ils issuant¢, also requir¢5 [he-applicant fo� such pe�mit T�BSh COmpdCtOf
to file a signetl statement that he/sha is licensetl pursuant to [he provisions of Roof Drains � �
the Contractor's License Law (ChaD�er 9(commencin9 witn Sectlon 7000) of
Division 3 of the Business antl Professions Cotle) or that he/she is exempt _ - - .
th¢retrom antl the basis tor the alleg¢tl exemption. Any viOlation of Sectlon '
]031.5 by any applicant for a permit subjects the applicant [o a civil
penalty ot not mare tnan five nuntlred tlonars (gsoo). � � $ 3 ' .
LJ I, as owner of the property or my employees with wages as their sole Reinspection fee $15 Issue Fee
compensation, will do the work, antl the sVucture is not in[entletl or,offeretl Reinspection Fee $15 Issue Fee $ 3
for sale (Section 704a, Business antl Pwieszional Cotle: The ConVactor's - MECHANICAL' ' FEES-
License Law tloe5 not apply [o an Owner Of a properiy who builtls or imp�oves
thereon, antl who tloes sucn work himself/herself or throu9h his or her own Boiler Hood or Type I.❑ DEVELOPMENT SERVICES REQUIREMENT •
employees, p�Ovitletl thal SUCh imp�ovements a�e not intentl¢tl o� offeretl fo/
sale. Ii, however, the builtlin9 or improvement iz zoltl within one year ot com- Cano q Type II ❑ 2oning Approved By Date�
pletion, the owner will nave the burtlen ot proving he/she tlltl not builtl or im- Duct - Under Ground - Building Approved By �-Oata
�rova for lhe purpose of sale).
I, as own¢r of ihe property, am ezclusivety mnt�acting with lic¢nsetl con- Duct -St�uCtu/el efrigeretion Syitem AppliCdtiOn IRu9d By- � Dete'9�� V a�i
ttaG[or5 t0 mnsiruct the projec[ (S8CII011 JOQA. BU510255 dllC PIO�e55I0O5 COEB: ❑aj OO, '
The Convactor's License Law tloes not apply to an owner ot proPerty who Duct - Ventilating 000 BTU ❑100,000 BTU SUMMARY OF FEES
builtls or improves tnereon, antl who con[racts for such projecls with a con-
tractor�sl iicense pursuant to tne Contractor's License �aw). i am aware tnat Exhaust System ❑ M ple ❑ System Repair/Alte�ation BUI LDING PERMIT $ SMIP , $
proof o( their Worker's Compensatlon insurance shaum be proviaea to me. PLAN CHECK $ PERMIT
❑ I am exempt untler Section B. & P. C. for tnis reason Firepl/Fact. Blt. 1 # Fire Dampers PLUMBING � $ � • ISSUANCE $-
Heatin S stem & Ductin Re isters - PLqN CHECK 25% $ ENERGV P.C. $
Date Owner 9 Y 9 9
I hereDy certity that I have reatl is ppli ation antl state tnat the above ❑4100,000 BTU 0100,0006T � � •g. p� GRADING $
intormation is co a9ree to co pl wi aty antl county ortlinances ' ELECTFICAL $
antl state �laws elating b iltling c ns ru on, antl hereby authorize repre- ' PLAN CHECK 50% $ 2• Sy MICROFILM $
sentatives is city o nlBr up he bove-mentionetl pr erty f r �
inspectlon po �� � 7 MECHANICAL $ ��•�
Signatur Datu TOTAL FEE $
Orivers' License or 55 � Reinspeaion Fee S15 Issue Fee S 3 PLAN CHECK 25% $
CMF OB65�46, rev. 10/84 White - Builtling; Canary,- Applicant; Pink - Accountin9: Goltl¢nrOtl - As50550r
CONSTRUCTION AND PLANNING •' POOL & SPA
'''' Date Inspector � ' Date Inspector
APPROVALS Permit #' APPROVALS Pe�mit #
1.'Temporary Electrical�Service or Pole 52. Pool & Equipment Location �
2. Soil Pipe-Undrgrnd.� " 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgmd. 55. Electrical Bonding �
5. Steel ReinforcemenC` ' � 56. Rough Plumbing & Pressure Test
� " 57. APPROVAL TO COVER-GUNITE
6. Electrical UFER Grnd. � ,
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. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit • 66. Solar System-Final
i 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
tJ
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 Freming 73. Undergrnd. Storage Tank � Gas ❑ Oil
25. Roof Sheathing 74. Overhead Hydro :�
26. T-Bar Ceiling (Structural) & Monowat 75. Dry Chemical -��
27. Frame and Flashing 76. Dry Standpipe � �
28. Lathing & Siding 77. FIXED SYSTEM FINAL �:. .
r:
29. �nsulation 78. FIRE PREV. FINAL ��
30..Drywall Nailing , HEALTH DEPT: REQUIREMENT
31. Plaster Brown Coat • 79. FINAL INSPECTION '' �('
32. Electrical Power Meter-Final 7 80. FOOD CERTIfICATE IS$�UED "
33. Final Electric , Notes: ' ' � �
34. Final Heating & Air Conditioning ;,
35. Final Gas Pipe-Test � . - .
36. Hood or Canopy �- `. �.
37,: Final Factory Fireplace .. . � -�' • ��� � � . .� '
�_ ..,
38.-Final Plumbing � •'^ ' ��� �' �" '. '. �
/' N t.
� 39. Water Service-Final . ' :-� � , i• � r � _ - _ -
40. Gas Service-Final : � � - � ,
�'
41. Solar pomesticFinal � ' '' '� . • - ��, � �
'+
42. Backflow Preventer t .� • • :� ' '
� -. . .
. 43:� Backflow Irrigation . ,' . � � .. - . . �
, 44. Landscape Irrigation System �_ � �
� 45. Sound Attenuation .. � � - � ',
-.i -
46. Handicap Regulations ' ' ' '� � � �� •i:'` --
47.. FINALSTRUCTURE&BUILDING �' � � �.
-' ..
48:'Special Requirements Completed - � ' - �
49. Electric Release to Edison ' � � '
. • �
50. Gas Release to Southern California Gas Co ' .. , � y��
51. CERTIFICATE OF OCCUPANCY � �I
No. Date
Applitant to fill in all spaces except tnose wit�in heavy Gortler lines antl sign all appropriate tlecla�ations.
CiTk dF COSTA MQESA CON TRUCTIOnN PERMIT
�Project Address �T%�%' WQi^ ����?�n i�%K � T
Applicant's Mailing Address O� a�Li�a�
Owner's Name ���G �� - ��'��� Phone -
Address
Arch/Eng. License,No. _
Address '�j� /�y�
Contractor's Name � C Phone �S'�
Address Imailing) �%ZZ �°f��$�'�.� SY �
Ciq Licensc No. 3g 7 7/
LICENSED CONTRACTOR DECLARATION
I hereby attirm that I am licensetl untler provisions o( Charter 9(mmmencln9
with sec[ion 7000) of �ivizion 3 oi tna Business antl Professions Cotle, antl
my license is in f W fo,ce antl eftect. � ��L '
License Class � icY,� N
Oate �i� Signature �
DRKERS' COMPENSATION DECLARATION
iereby atfirm that I have a certificate o� consent to self- sure or a certificate
of Workers' Compensation Insurance, or a certifietl c�eof (Section
3800, Lab. C��/��� ,%_._ / .
Policy No.� Company%��1� V
'I �Certifietl copy is hereby tumishetl.
C rtitietl op is filetl�with the city iltlin9 i
ii Oate • APPlicdnt .
EXEMPTIO�RKERS' C ATION DEC AR ION
(Thissection neetl not be completetl if the permit is �or one hu tlretl ($300) ar
less). ,
I certify that in the per�ormance of the work for which this permk is issuetl, I
shall,not employ any person in any manner so as to become subject to the
Workers' Compen5ation l.aws of California. � �
Date Signature �
NOTICE: If,.after making this declaration, you shoultl become subject to the —
Workers' Compen5ation provl5ion5 ot the Lzbor Cotle, you must forthwith
comply with sucn provi5ion5 or this Oe�mit shall be tleemed revoketl.
CONSTRUGTION LENDING AGENCV '
I hereby aftirm that there i5 a conSVuction lentling a9enty for the perfo�mance
of the work tar which tnis permit is i55uetl (Section 309] Civ. C.)
Lentler's ,Name
Lentler's AtlOress . �
OWNER BUILOEH DECLARATION '
1 hereby affirm that I am ezemo�-��om the ConVactor'z License Law forthe
(oilowin9 �eason (Section 7031.5 Business antl Protessional Cotle: Any city or
county wni<h requires a pe�mit f0 const�uct, alt¢q improve, tlemolish o� repair
any sVuc[ure, prior to it5 i55uance, also requi�es the applicant fo� such permit
b tile a siqnetl 5[atement [hat ite/she is licensetl pur5udnt to tbe p�ovisions of
e Contractor's Li<ense law (Chapter 9(commencin9 witn Section ]000) of
vision 3 of the Bu5ine55 antl Professwns Cotle) o�.tnat be/she is exempt
.�erefrom antl tne basis for the allegetl exemption. Any violation of Section
]031.5 by any applicant for a permit subjects the applicant to a civil
penalty of not more than tive buntlretl tlollars (E500).
❑ I, as owner ot lhe property or my employees with wages as their sole
compensation, will tlo the work, antl the st�ucture i5 not intentletl or oftere�
for sale (Sectlon'�044, Business antl Professional Cotle:-The Contractor•s
LicenSe law tloes not apD�Y to an owner ot a property who builtls or improves
thereon, antl wno tloes such work hlmseli/herself or through his or her own
employees, provitletl that such imDrovements are no[ IntenOetl or offeretl Tor
sale. If, howev¢r, [he builtlin9 or improvement i5 Soltl within one yea� ot com-
pletion, tne owner will nave the burtlen oi provin9 he/she aitl not builtl ar im-
. p�ov¢ tor the purpose o( sale). '
❑ 1, as owne� of the property, am ezclusively cont�acting �with licensed mn-
tractors to construct the project (Sec[ion ]064, Business antl Professions Cotle:
The Contractor's l.icense Law does m[ apply to an owner of prope�ty who
builtls or improves [he�eon, antl who con[�ac[5 for such projects with a con-
t�actor(5) bcense pursuan[ to the Con[�acto�'s License Law). I am aware thab
proaf of tM1eir Worker's Compensatlon insurance shoultl be proviGetl to me.
❑ I am exempt untler Section B. & P. Gtor this reason
Date Owner _
I hereby certify that 1 have reatl t
information is correc[. a ree to co
antl state law relatin b' inq �
sentatives o this c' nt r
inspection .
Signatur �
Drivers' L¢ense or 55 �
GMF OB65-46, rev. 30/84 Wnite - Buil
pro
TYPE OFCONSTRUCTION I�iINEW IJ aoo LJ ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER p� p#
DESCFiIPTION OF WORK/USE OF BLDG.
- ' S Main Buildi
TVPE OF PERMI� GRADING ❑ FOUNDATION O STRUCTURAL � T FrOnt
�❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Reaf �
�O OTHER ' %�
PROJECT DESCRIPTION � SCZ. F7. oCCUPANcv C Aight
K Left
`.CON.STRUCTION TVPE VALUATION $ $
�ZONE � GRADINGCU.VDS. ACRE$ PI� Ref.#
y. 9.
Remarks: /D� - . Planning Notes:
�. .
Bar Sink
Back�flow Preventer
Backflow Irrigation
Bathfubs ' ' �
Clarifiers �
Dishwasher ,
Drinking Fountains '
F.loor Drains " -
Floor Sinks � �
Gas Service � Outlets
Interceptors�'
Kitchen Sink(, -
Lavatoiies •
P—Trap � •
Roaf:Drains:
ReinspeMion Fee � $15
Boiler
Duct-UnderGround
Duct - Strucmral
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. BIL IC80 #
Heating System & Ducting
❑0-100;000 BTU 0100,OOOBT
painspection Fea ' � $15
Canary - qpp���ant; Pink - Accountin9: Goltlenrotl - Assessor
PLUMBING
Showers
Service Sink
Sewer Cap '
Sewer Connection
Solar Collectors
Solar'Piping
� Solar Tank
Swimming Pool w,
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Laundry Trays
laue Fee
Hood or Typel ,❑
Canopy Type I I ❑
Refrigeration System
❑o-ioo,000eru ❑ioo,000
System Repair/Alteration
Fire Dampers
luue Fee
Automatic Washer
Construction Pole Sub.
Cooking Unit � '
D ishwashe�
Dryers as OElec
Fan
F.A.U.
Fixtures
'_._. \�
3958' 3/13/87 37.80 TL
Zone
Accessory Buildin9:
Z
• O
N
I
- ' - N
G
R
Parking Req./Provided E
M
. � { � . : ' S
ELECTRICAL
Transfo�mer ❑ 15-50 KW �
❑ 50+KW' �
Meter up to 100 amps •
Metei ❑over100amps '
Outlets �y
Switches - �3
Garbage Disposal �
Generator �0-5 KW,�S-15 KW
Motors�0-1 HP�1'f.-8
Inc.Solar �9-15 HP �76-15+
Microwave
Pole Light,
Range
Standing Sections
Trash Compacmr
$ 3
j Reinspection Fee $15 Issue Fee
FEES
�DEVELOPMENTSERVICESREQUIREMENTS:
Zoning Approved By
-;Building Approved By � �
FEES
$ 3
SUMMARV OF FEES � �
BUILDING PERMIT $ � SMIP� ' $�
PLAN CHECK $ � � PERMIT.
PLUMBING . $ � • ISSUANCE $
PLAN CHECK . 25% $ ENERGV P.C. $ �
ELECTRICAI $ ��o--� O � GRADING' $ . �
PLANCHECK � 50% $. �(- � MICROFILM $ - '
MECHANICAL $ TOTALFEE '$ 3�
PLAN CHECK 25% $ ,
�
CONSTRUCTION AND PLANNING ` _ _ POO� & SPA
APPROVALS Permit# Date Inspector' �pppROVALS Permit# Date� Inspector
1. Temporary Electrical Service or Pole � 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement-'. � '
i
3. Electrical Conduit Utility-Undrgrnd. 54. Forms �� '
4. Electrical Conduit-Undrgrnd. . � 55. Electrical Bonding '
5. Steel Reinforcement . 56. Rough Plumbing & Pressure Test ; �
6. Electrical UFER Grnd. � 57. APPROVALTO COVER-GUNITE •
7. Footings � 58. Eiectrical Conduit-Undrgrnd. � '
8. Foundation ' 59. Gas Pipe, O 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
72. 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 ,
�i6. Rou h Elect�c Wir'n � 67. Fencing & Access Approval �
3- �
1�7. 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 � Gas ❑ Oil
23. Gas PiPe-Rough & Test 72. Underground Flush
24. Roof Framing , 73. Undergrnd�.StorageTank OGas OOiI �
25. Roof Sheathing ' � 74. Overhead Hydro -
26. 7-8ar Ceiling (Structurai) & 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 P` N 80. FOOD CERTIFICATE ISSUED
�•
33. Final Electric +� 1 G Notes:`7��.�7 �t�2��y c�j�a�/�.c-��c,P
34. Final Heating & Air Conditioniny �� 3� 8. G
35. Final Gas Pipe-Test •
36.'Hood or Canopy . _ ,
37. Final Facto}y Fireplace , . . � �
38. Final Plumbing ' • • �'
39.•Water Service-Final �
. ,. .
40. Gas Service-Final � ' ' . � � � �
41. Solar pomestic-Final � � ' ' ` `�'
r:
' 42. Backflow Preventer � � �. �' �
.�
� ' !� r - ,
43.'Backflow Irrigation - � , -
. 1 �.
'; 44. Landscape Irripation System , ; � �
,45.,Sound Attenuation ' �
. 46. Handicap Regulations �
42. FINALSTRUCTURE&BUILDING � . � ' � '
i'
48..;Special Requirements Completed � � ' • � ' � .
49.;Electric Release to Edison � .
50. Gas Release to Southern California Gas Co . �
51. CERTIFICATE OF OCCUPANCY
� �
No. Date ' �
1
• ���F COS7n MESA CONSTRUCTION PERMIT
. Prolect'Address %+�5 t•J. /� _'� r -
� ,'/
ApplicanYSMailin Address ��y/ �� yvh�i+:1�.- �s�u1
Owner's�Name ^ ' ��' r_,^+r� � �Phone�7 9F91�
Address a E' Y / D � ✓F � �iC �^ '�-.,�
Arc� �- License No. � ���--�'�
Address
Contractor's Nam To �Phone �-
Addreulma'I'n91 �� �A��T. `�� �'�I%�,f�qf00�
City License No: �i���r �
LICENSED CONTRACTOR OECtqRATION '
1 hereby aHirm [ba[ 1 am lirensetl untler provislons oi Charter 9(commenNng
with section ]000) of DlviSion 3 oi the BusineSs antl Gro(e55ion5 Cotle, antl
my license is in tull torce antl ef <t. I OG
Licenie C�ass � Lic se e'
Date �� Signature � .
WORKERS' COMPENSATION OECLP.pAT10N � �
I hereby aftirm tnat I have a certifl�ate oi consant to sel!-insure or a<ertificate �
ot Workers' Compensation Insurdnce, or a certifietl <opY thereof (Section
3800, Lab. C.) {� :" , }�
Pollcy No. ��._79��= ` COTpany�� ��L�
�Certi/ietl copy is hereDy furnishetl. '. - � .
Cer% ilietl cop,�Y I tiletl with tne �it Iltling N-1TV ISionL. '
a[e!�- ��.. -^�,r�� APPlic;ntY �L `1 � - L��
EXEMVTION FROM WORKERS' �OMPENSATION OECLARATION
(This sec[iOn neetl not be completea i( the permit is for ona huntlr¢tl (y100) or
lesz). . *
1 Certify�tha[ in the performance Ot the work fOr which thi5 p¢rmR is�issuetl, I
Snall nOt emplOy any pBrson in dny manne� so as to b<come subject f0 Ihe •
Workers' Compensation Laws ot Californla.
, Dale � � SignatUre '
'NOTICE: If,after making this tlec�aration, you shoultl become sub�ect lo the
Wo�ker5' Comp¢n5alion p�oviziorls of-the Labot Cotle, y0u must fo�thwith
[omply with. zuch prOviSiOns o� Mis pe�mit shall b¢ tleemetl revoketl. ;
CONSTRVCTION LENDING A6ENCV '
I he�eby aHirm that there Is a con5truttiOn lentling ag¢ncy �o� tna perfo�mance
ot the wOrk for which this p¢rmit ii IsSu¢tl (Sectlon 3097 Civ. C.)
LenAer'S Name � ,
Lwitler'S Atltl�e55 �
OWNER BUILQER DECLARATION '
I hereby aftirm that I am exemp� trom tha ConVactor's Lioense Law for tne •
tollowing reason (Section 7031.5 Busin¢ss antl Professional Cotle: AnY dty or
rounty wM1ich requires a permit [O construct, alter, Improve, tlemolish or repalr
any structure, prior to its IsSuanCe, also reqWres tho applicant for SUCh permit
to fiie a signetl statement that he/she is Ilcensetl pursuanf to tne provisions of
the Contractor's License Law (Chgpter 9(commentlng with Section 7000) of
Division 3 of the Businesz antl professions Code) or Ihat he/she is exempt �
therefrom anU the basis to/the 811egetl exemption. Any violation of Sectlon
'031.5 by any applicant for a permit subjects. the applicant to a civil
enalty of not more than (ive huntlretl tlollars (E500). '
.� I, ai owner of [he prOperty o� my ¢Tploye¢5 witb wages as their sole
compensation, will ao the work, antl the structure is not IntenGetl or ofieretl
for sale (Section 7044, Business antl Professlonal Cotle: The Contractor's
License L.aw Goes not apply to�an owner ot a oroperty who builtls or improves
thereon, antl who tloe5 such work himself/herSBtl or thrOu9n his o� her own
employees, provitletl tM1at such improvements are not intendea or oHerea for
sale. If, Itoweve�, the bull0in9�or improvement Is SOIG wlthin one yCa� of com-
plation, tlie owner will have the burtlen of provin9 he/sho Oitl not builtl or Im- .
prov! for the�pu�DoSe of sale). '
❑ I, ai Owner ot tM1e property, dm exclusively cmt�acting with litensetl Co0-
tractors to construc[ tne pro�ect (Section 7044, Businesz antl Profazsions CoOe:
The Contractor's License Law does not apply to an owner of Prope/ty who
builtls or improves tnereon, antl �vho contracts for such projec[s wi[b a con-
[racior(s1 Ilcense pursuant [o the ContractoPs Llcanse Law). I am aware tnat
prooi o( [heir WO/ker'S ComPeqsytion insuranc¢ should be provitletl to me,
❑ i am exempt untler Section B. & P. C. for this reason
Date Owner
1 nereby certify that P have read tnis applicatlon
infnrmatinn is correct. I aoree [o comolv with all f
Inspectlon purposes.
Signature �
Drivers' Licenso or
65-46, rev. 30/84
to flll in all spaces exceot tnose witnin neavY eorOer Iines anE sign all aDD�ooriate tleelaralions.
� t�4�2_ / �-�
TVPE OF CONSTRUCTION NEW ADD ALTERATION ' REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER ` p�p # �/
DESCRIPTION OF WORK/USE OF BLDG. �
• S Main Buildi
TVPE OF PERMIT GRADING FOUNDATION STRUCTV RAL T Fron[ J
❑ TENHNT ❑ ELECTRICAL ❑ PLVMBING ❑ MEGHANICAL A Reaf �
❑ OTHER
PROJECT DESCRIPTION Sq. FT. OCCUa v - ' � ��
CONSTRUCTION TVPE VALVATION $ � � g L¢ft JO
ZONE ' GRADING CU. V�S. ACRES Ping. Ref. # L'
Remarks:�/' ✓9r'-�'..r/ /�7n� PlanningNO[es:
Sink
<flow Preventer
<flow Irrigation
Showers � � .
ServiceSink �
• Sewer CaP " ' -" - � - - •
SerJeTConnection -'' ' �'
Solar Collectors` � ,
Drinking Fountains �
Floor Drains
Floor Sinks� - �
GasService _Outlets�
Interceprors '
Kitchen Sink -
Lavatories �
P-Trap
floof Drains �
Reinspection Fee $15
Duct - Under Ground
Duct-Structural
Duct - Ventilating
Exhaust System ❑ Multiple ��
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑6100,000 BTU � 100,000 BTI
� i I I Rainspection Fee I $15
White -�uiltling; Candry - APPlicant; Plnk - ACCounting; Goltlenrotl - As5B55or
Solar Tank
Swimming Pool
Urinal-
Water Closet
Water Heater -
Water Service
Auto-Wash
Laundry Trays
Isue Fee
Hood or Type I ❑
Canopy Type I I ❑
�
�
Refrigeration System ' '
Oa�oo,000eru ❑ioo,000eru
System Repair/Alteration '
Fire Dampers , .
Issue Fee
$ 3
FEES
Automa[ic Washer
Construction Pole Sub, '
Cookin9 Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
uevice noxes• •
� �Utl¢t5 � � �✓f
•i Switches. '�
�
Garbage Disposal ,
? Generator �0�5,K4
� /
_ �'' . �.
. � Reinspection Fee,�
� DEVELOPMENTSER)
Zonin9�APProved.BY �
�
�'Building Approved By�'
7188 6%10/86
.�Q Q� Zone
� �Accessory Building:
Parking Req./Provided
ELECTRICAL �
� Transtormer ❑ 15-50 KW
' ❑ 50+'KW
.�
Meter ❑up ro 100aMps
Meter ❑over100amps
Sub Panel •",`
Momrs OO-1 HP O1'/, � 8 �
Inc.Solar �9-15 HP �i6-15+
�- Microwave '
Pole Light
Range �
4
548.26 TL
FEES
; Standing Sections
5 KW Trash Compactor �
$15 luue Fee $ 3
�nu�n�yTs: c �_
Z
O
N
I
N
G
R
E
Q
M
T
S
^ ` •. Applitation IssuBtl 6Y �/ � - Date (I �LV -TJI�
� t` +� SUM OF FEES �
. , '. �BUILDING PE� IT $ �Od SMIP $ ���/
. . P,LAN.CHECK � $ _ l 2 . IS pERM1T '
� 'PLUMBING �y+ $ � ��UANCE $
��PLAN CHECK,r 25% $ ' ENERGY P.C. $
ELECTRICAL $ GRADING $
•�PLANCHECK 50% $ � MICROFILM $ � ,�{���(�(//��
�MECHANICAL $ - � TOTALFEE $ _e�lL�
$ 3 ��PLAN CHECK 25% $
, CONSTRUCTION AND PLANNING
� APPROVALS �, Permit # �
i. �-empora'ry Eiectrical Service or Pole
2. Soil Pipe-Undrgrnd. �
3. �,Electrical Conduit•Utility�Undrgrnd.
4. Electrical Conduit-Undrgrnd.
5. Steel-Reinforcement ,
6. Electrical UFER Grnd.
7. Footings �
8. Foundetion '
9. Water Pipe-Undrgrnd. �� ,
10. Structural Floor System
11. Property�Sewer Line & House Connection .
12. Sewer'CaP . .
13. Roof Qreins , .
14. Rough plumbing
15. Rough Electrical-Conduit
16.'Rough Electric Wiring
17. Rough �lyiring Sign
18:�Rough Electrical-T Bar Ceiling
19.,Rough Heating & Air Conditioning
20..Rough Factory Fireplace ,
21. Ducts, in Structure
22. Ducts, Ventilating ' .
23. Gas Pipe-Rough &";� est
24. Roof Framing �
25. Roof Sheathing�:.• �
26. T-Bar C,eiling (Structural) & Monocoat
27� Frame and Flashing
28. Lathing & Siding
29. Insulation �
30. Drywall Nailing .� ,
•� �
31. Plaster Brown Coat` .�
32. Electriral Power Meter-Final �
33. Final �lectric • ��
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test �
36. Hood or Canopy �
37. Final Factory Fireplace .
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43!Backflow Irrigation
44V Landscape Irrigation System
45(�nSound Attenuation
46�Handicap Regulations
47!OFINALSTRUCTURE&BUILDING ,
48. Special Requirements Completed g
49. Electric Release to Edison � �
n:
50zGas Release to Southern California Gas Co
�51:�CERTIFICATE OF OCCUI
No. Date
Date
POOL � A
Inspector qppROVALS Permit#
52. Pool & Equipment Location
53. Steel Reinforcement
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVAL TO COVER-GUNITE
58. Electrical 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/SPASYSTEMSFINAL
FIRE DEPT. REQUIREMENT
APPROVALS Permit #
r/v
Date
70. UndeFground Hydro
71. Pruduct Piping O Gas ❑ Oil
72. Underground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINAL
78. FIRE PREV. FINAL
HEALTH DEPT. REQUIREMENT
79. FINAL INSPECTION
80. FOOD CERTIFICATE ISSUED
Notes: / "`'� r /'�,._a� 0 7 a,!
n
7
i
• , t Aoolicant to flli in all spaces except those within neavY Dortler Iines ana sign all apo�oo�iale Geelaratlons.
CITY OF QOCTA ME a CONSTRUCTION PERMIT PE8fW/T� O TRACT NO. LOT NO. • UN T N .
f � �'�� I '- - c�'-L
Prtoc� Add�ess / �
Z � //�(J� D TYPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR�
Applicant's Mailing Address � �
Owner's Name Phone
Addreu
Arch/Eng. License No.
Address 't� O-�i
Contracmr'sNamp �i+�.,��C Phnnr�� �7/7
Address Imn �'��I dql12QZ ��i%�i� .S%�AJ%t%^' /��e�
Ciry License No. ���
LICENSED CONTRACTOR OECLARATION
I hereby a(/irm thal I am IicenSetl untl¢r prOviSions ot Chartar 9(commenNn9
with sectlon 7000� of Divislon 3 of the Business antl Profezsions Cotle, antl
my license is in f 1�, i� rqe antl eftecL �
License Class Q i e
Dale�� Si9natur
WOR ERS'C ENSATION T
heteby aftirm Ihat 1 have a certifitat¢ of consent to Selt-I Sure or d C¢rtHiGate
( workers' Compensatlon Insurance, or a certlflea copy thereo( (Saction
3800, Lab. �f
Policy No��/ /�T�2� Company
aCertitietl copy is �ereby fumisne0.
y4 Certifie cop is Illed with the ciry 'I in 1
�ate Applica
E%EMP I N M WORKERS' C D CLA ON
(Tnis section neatl not be COm0letetl it the permit is for One h retl (5300) or
less).
I certity Iha� in the perlOrmance of the wo�k tOr which lhis pe�m�t Is ISSuetl, I
shall not employ any person in any manner so as to becoma subject to tha
Workers' CompensaHan Laws ol Calitornia.
Date Si9na[ure
� NOTICE: 11, alte� making thi5 tlCcla�ation, you Shoultl beCOTn zubject to tha
Workers' Compensatlon provisions af the Labor,Cotle, you must forthwith
comply wlllt tuGh ptovl5ions or thi5 p<rmit shall be tleemetl rnvoketl.
CONSTRVCTION LENDING AGENCV
I nereby aflirm that thare Is a construction IenCin9 agency for tha pertormance
of tne work tor wbich Ihis permit is issuatl (5¢ction 3097 Clv. CJ
Lentler's Name N / /� e �
Lontler's AEtlrrts
OWNER BUILDEN UECLARATION
I heroby afflrm tnat I am exempt irom the Contractor's Li<enze Law for tho
/ollowing reason (Saction 7031.5 Business antl Profezslonal Cotle: Any cltY or
county whicb roqWres a Permil [o <onztruct, all¢r, ITprova, tlemollih or rCpalr
any s[rucWre, prbr to Its issuance, also reqWres the apP��cani tor such pormit
t0 lile a Signetl StalCment Ihdt he/ibe i5 litensetl pur5udnt t0llte p�ovl5ion5 0!
[he Contractor's License Law (Chapter 9(commen<in9 �+Ith Seclion 7000) ot
Dlvlsion 3 of lh0 Buslne55 antl ProfCssions Cotla) or that no/sho is exemo�
iharo(rom antl the ba5i5 10/ Ihe allegetl exemptlon. Any violdUOn ot $octlOn
'7031.5 by uny applitanl fOr d permil Subjects th0 appliwnl to d civil
�endlty ot not more than fiva huntlretl tlollars (E500).
I, as ownor ot tne o�oparty or my employeos with wag¢s as thelr sola
compen5ation, will tlo lhe work, antl the structure is not Inientletl or olleretl
tor salo (Soctlon ]044, Businezs antl Professional CoEe: The ConVatlor'S
License I.aw tlous not apply to an owner of a proparty who builtls or improves
tboreon, antl who tloes such work nlmsetl/nersalf or throuph nis or nar own
emplOyeeS, pfOvltlOtl [na[ such imProvements ara nOt Int¢ntletl or OHofatl fOr
saie. Iq nowaveq tho Dulltlln9 or Improvoment is soltl withln ono Year of com-
pletion, tho ownnr wlll havo tna burtlen oi proving he/she tlitl not builtl or im-
prove lor tho purposa of salo).
❑ I, as owner ot lhe Oroperty, am axclusively contracting with Iicensea con-
[ractors lti consV uct the Oroj¢ct (Sectlon 7044, Business antl Pro�aizions Cotla:
The Contractor'z Lltanie Law aoes not aoPly to an owner ot property who
builtls or Improvas thereon, antl who contracts for such projacts wltn a con-
Vattor(sl bcenSB puRudn[ [O Ihe ContraGtot's LiCenS¢ Ldw). I dm awdre that
proof of lhCir WOrke�'s Compen5dtlon Insu�ance shoultl be provitletl to ma.
❑ 1 am exempt untler Section 8. 4 G. C. Por this reason
Date
a
owner
thls application antl state tnat the above
ply th dll ity and counly o�tllnanCCs
nstr ctlon ntl hereby au[horize repre-
i o ve-mentlonetl Ptoperty or
�� CONVERSION ❑ DEMOLISH ❑ OTHER q.p..�6
DESCRIPTION OF WORK/USE OF BLDG.
� ' S Main Buildi
E
TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL T FrOnl
'O TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear
❑ OTHER
PRWECT DESCRIPTION 5�. FT, ocCuaANCv C Right
K Left
�CONSTRUCTIONTVPE VALVATION$ $
!ZONE GRADING CV. VDS. ACRES Ping. Rei. #
Remarki: � �0 7 Planning Notes:
3ar Sink
9ackflow Preventer
Backflow Irrigation
Bathtubs
Clarifiers
Dishuvasher'
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
I ncerceptors�
Kitchen Sink��
Lavato�ies .
P—TraP :.�
Roof+Draingl
�.��
Reinspection Fee $15
Boiler
Duct-UnderGround
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating SYstem & Ducting
❑o-i oo,000 aru O i oo,000
Signaturr�[�,(� � Da� � :
Drivers' License or 55 � I I peinspection Fee I $15
CMF 0865-46, rev. 10/84 White - Buildin9; Canary - Appliwnt; Pink - Accountlng; Goltlenrotl - Assessor
$IlOW2l5
Service Sink
Sewer Cap
Sewer Cannxtion
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool wl5pa
Urinal
Water Cioset
Water Heater
Water Service
Auto�Wash
laue Fea
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0-100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
laue Fee
S 3
$ 3
Automatic Washer
Canstruction Pole Sub.
Cooking Unit .
Dishwasher
Dryers � as ❑Eleo
Fan
F.A,U.
Fixture5 '
Outlets
Switches
Garbage Disposal
Generator 00�5 KW
Fee
�d:,. �
3953 ''�� 37oBa�� L
2one
Parking Req./Provided
ELECTRICAL� .
Transformer ❑ 15-50 KW
❑ SO+KW
� Meter p to t00amps
Meter ❑over t00�amps
Sub Panel
Motors �Ol HP � 1 Y. - 8
Inc.Solar 09�75 HP �16-15+
Microwave
Pole Light
Standing Sections
5-15 KW Tmsh Compactor
$15 Issue Fee
FEES
S 3
Z
O
N
1
N
G
R
E
�
M
T
S
�DEVELOPMENT SERVICES REQUIREMENTS:
2oning Appraved By Data
- Building Appraved By Date
�Appliation Issued By- Data i Q�
SUMMARV OF FEES
BUILDING PERMIT § SMIP $
' PLAN CHECK $ PERMIT
� PLUMBING $ ISSUANCE 3 �
PLAN CHECK 25% $ � ENERG� P.C. $ �
. ELECTRICAL $ J� GRADING $ �
PLANCHECK 50% y MICROFILM $ � y-�
MECHANICAL .$ TOTAL FEE $ �7� v�
,�. PLAN CHECK 25% $
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electriral Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical CondUit Utility�Undr9md. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Eleccrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings ' 58. Elec[rical Condui[-Undrgrnd.
8. Foundation , 59. Gas Pipe, O 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
72. 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. Rou h Electric WiGing � 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 77. Product Piping O Gas ❑ Oil
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil �
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL �
29. Insulation 78. FIRE PREV. FINAL .
30. Drywall Nailing HEALTH DEPT. REQUIREMENT .
31. Plaster Brown Coat 79. FINAL INSPECTION �
32. Electrical Power Meter-Final 3~'` �� 80. FOOD CERTIFICA7E ISSUED
33. Final Electric � C Notes: �..�.� 7 S '
f3,3 /1 ii � � c
34. Final Heating & Air Conditioning _�3'S7 L,
35. Final Gas Pipe-7est �
36. Hood or Canopy
37. �Final Factory Fireplace . , ' �
38. Final Plumbing �, '
39. Water Service-Final ' � -
40. Gas Service-Final � ,, . ' ' -
41. Solar pomestic�Final � �
42. Backflow Preventer � � •
43. Backflow Irrigation , . , " '
44. Landscape Irripation System � � � ' ' .
45. Sound Attenuation � � .
46. Handicap Regulations ' '
47. FINALSTRUCTURE&BUILDING ' �
48/Special Requirements Completed . ' , ,
49. Electric Release to Edison � � •-I
50. Gas Release to $outhern California Gas Co ' '
57. CERTIFICATE OF OCCUPANCY • � 1
No. _ Date