HomeMy WebLinkAbout864 18TH ST - Building Permits\\
City of Costa Mesa
Developmgnt Services Department
8uilding Sa(ety Division
P. O. Box 1200
Costa Mesa, California
CERTIFICATE OF OCCUPANCY No. OG����
The Building located at 8� W 18th Street
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group �2 Occupancy.
Use of 8uilding Industri�l.
Legal Description 429-182-31
(See reuerse side for Metes and Boundsl
Building permit No B 27008 Electrical Permit No. Plumbing Permit No. R�7 2767G
Mechanical Permit No. �"� Z�678
ISSUED T0:
John HatiloV
ti�S9 �7. 18L'n Stre2t, �A
Costa f1�sa, CA 9262'7
Number of apartments
Building Official
by K' -. —
— and/or guest rooms
6. �. i�'.?. i.a ! . .... '
� .,
' � Date �vemt�er lr 1988
' This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHAL� NOT BE removed except by the
Building Official of the City of Cona Mesa under Sec. 307 (e) U.B.C.
�� C�vtF 1oi5-a6 rev. 1/83 White -Owner; Canary - Numerical File; Pink - Bldg. Permit File
... . *..
�
Applicant to fill in all sDaces except those wRnin heavy Gorder Ilms antl sign all appropriate Oeclarations.
CI7v OF COSTa/y M�E/S��A CONSTRUCTI N PERM�IT� ��
'Prole�t Addres5 DfY"[ �� W • �� yt• �'IV� � = -
-Applitant's Mailin9 Address �� � 5T. B. cA q2u,�
Owner'sN/a�m�e� �1�NN ��(�'��y Pnone�'�/g�
Address L�q'Q W2iT�,���$ atTBr:i �M•� q�(o21
, Arch/Eng. ��ble� SGIL�' License No. �i--�� 013 �
Address �Sr,. t! r1�-y� • 0• � ��03 �
Contracto�' N /�r�'G�---�. - Phone
Addresslmailingl, � � �
City License No. -
� LICENSED CONTRACTOR DECLARATION . '
I ber¢by a(firm Ihat I am Iicensetl untler prayi5ion5 of CM1arte/ 9(commencing
�with Section ]000) of DIVISion 3 of t�e BUsiness antl Pro(¢Szions Cotle,,antl
�my Iicense Is in tull torce antl eftect.
.License Clazz -' LlcenSe No.
Date Signature -
WORKERS' COMVENSATION DECLARATION -
I hereby aifirm that I have a certificate of consant [o selt-insure or a certificate :
' Workers' Compensation Insuran<e, or d c9rtlfietl copy tnereof�(Section
' J0. Ldb. CJ ' , �
olicy No. ��Campa�y•
�Ceriitlee copy is nereby iurnisnee: ?'
�Certifietl copy is file0 with the ci[y'BuilCjng Dlvision. '
Date APplicant � �
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(This section need not be comPletetl il the pgrmit is (or ono huntlreG (5700) or"
less).
'I cer[ify that in the arformance of th0 w r o� w t Perm� � 5 i55i d, I'
snall not I Y a � pe�son In'any man � o o b� me Su ect t the
VJorkeri' � � ws of Californi,. .
Date Si9nature
. NOTICE: f, aiter akin9 this tleclaration, ihoultl b cbme subjecl t e
Workers' Compensation provislons of.the �abor Cotle,.you must Port wi h.
comply with such provisions or thls oermit shall be tleemetl rev ke .
CONSTRVCTION LENDING AGENCV � ' - '
1 hereby aftirm tnut there is a construction lentling agency tor the pertormance
ot tne work tor 71f�ch�i�x^erm� i_5,ly5ue (SetCon 3097 Civ. C.)
Lentler's Name T�V' r_ YV\•l
Lentler's AtlEress f �y.. � ��
OWNER.BUILDER DECLARATION -
1 M1ereby atflrrti [hat I dm ezEmpt froT the Cont/acto�'s LlcenSe Law, fOr t�e
tollowing reason (Section 7031.5 BuSiness entl Professlonal Cotle: Any city or
county which requirei a permit to construtt, alter, improve, Eemolisn or repair
� any structure, prlor to its issuance, also regWres [he applicant for such permit,
to fll¢ a signetl stdtement that he/ShC is IlcapSetl pu�suant [O the p�ovlsions of
the Contractor's License law (Chapter 9'(tqmmencing with Section 7000) of
' DiviSion 3 of the Business antl'PrOtes51on5 Cotle) o� thdt he/she is ezempt
'herefrom antl the ba5i5 for the allegetl ezpmption. Any violation oi Section'
'31.5 by any applicant tOr a perml[ Subject5 [he aOP���dnt lo a civll
�alty of nol more tnan five nuntlretl tlollars (E500).
J I, as owner of the property or my ernployees witn wages as tneir sole
coTpenSatiOn, will tlo the work, antl the s�ruttu/e I5 nol Intentled or otferetl
(or wle (Section ]044, Business ane Protessional Cotle: The Contractor'S
LicenSe l'dw tloes not appry to an owner oi a properry who bulltls or Improves
thereon, antl wh0 tloe5 such work hl�nselt/h¢rs¢It o� tn�0ugh hi5 0� h¢r own
emO�oYees, prOvitletl [ha[ such improvem¢qts are not intentlea o� offetetl tor
sale.� If, howeveq the builtling or Improvement iz soltl within orie year of com-
pleHon, the owner will have the burtlen ot proving he/she tlitl not builtl or im-
prqve for the purpoze of sale). � �
��I, as own¢r of Ihe O�Operty, am exCluSivaly COO[racting with IicenSea con-
ttac[O�s to construct the projecl (SectiOn 7Q44, Businesi antl PrOtessions Cotla:
The Contracfor's License Law does not apply to an ownet of property who
- builtls or imoroves thereon,-antl who contractsfor svch projects with a con-
t�actor(51 Ilcens¢ pu�suant lo IhG ConVattOr'S License Law). I am dware Ihat
prooi of their Worker'S CompensatlOn InSwanG¢ shoultl be provltletl to me.
� � I am exerpo� untlp,r Sectlon��-� ��& P. C�tor t1�1s reason
Date 1__�('J./ � .-/ Owner �`-'
I he�¢by �certify �lhat.f nave �eatl thi5 app�j�atlOn antl itate that t e bove
intormation is correct. I a9ree to comply with all tlty antl county or ' nces
antl state laws r lating bu' tling co truction, antl bereby authorize repre-
sentativ¢s ot i ci to er upo tne ove-mentlonetl Or erlyyy for
inspeGtion pu 5 ' � , '`�p.�
Signature Oate Gb Q /
Drivers' Li � 55 �
TYPE OF CONSTRUCTION I�Q NEW LJ ADD LJ ALTERATIOfJ LJ REPAIR
❑ CONVERSION ❑ OEMOLISH ❑ OTH' €R��^���'w � .
DESCRIPTION OF WORK/USE OF B�DG. IyC V vs
TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL
O TENANT ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANIGAL
❑ OTHER
PROJECT DESCRIPTION S(yET. ��� oCCUaA v e��
CONSTRUCTIONTVVE' - '�'�•VALUATION$��j. �
ZONE - GRADINGCU.VDS. ACRES
Remarks:
5S/�- �
Bar Sink
Backflow Preventer
Backflow Irrigation
Drinking Fountains
Floor Drains . '
Floor Sinks - �
Gas Service� Outlets
Intercepiors -
Kitchen Sink. '
laJatories
P-Trap
Roof Orains • '
Reinspection Fee I � $15
Boiler
Duct - Under Ground
Duct - Structural .
Duct - Ventilating
Exhaust System O Multiple ❑
Pirepl/Facc Bit. ICBO #
Heating System & Ducting,
❑P700,000 BTU 0100,OOOBTi
Reinspection Fee � $15
CMF OB65-46, rev. ]0/84 White - Builtling; Canary - APPllcanp Pink - Accountin9; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cao _ _ F
Sewer Connection
Solar Collectors
Solar-Piping
SolarTank "�
Swimming Pool w/Spa
Urinal
Water Closet ,
Water Heater
Water Service
Auto-Wash
laue Fee
Hood or Typel �
Canopy Typell 0
Refrigeration System
❑6100,000 BTU� 0100,000 BTU
System'Repaii
Fire Dampers
Registers
' Issue Fee
FEES
A.P. # Z �
S Main Building: �
TFronT� (� �
ARear � -� ",� �
C RighL %C�
� Left i yLT y�
Ping. Ref #� `0 k
Planning otes�--
Automatic Washer -
Construction Pole Sub.
Cooking Unit
Di;hwasher
Dryers �Gas ❑Electric
Fan
F.A.U.
Fixtures ' ' .
'L - 3 zo�d3knSy
� Accessory Building: '
Z
O
^. � N
I
N
i/ � � G
R
�' � ' i�arking Req./Provided 'i.9 2 E
� �
M
. F� ...,..... s
Outlets' '
� Switches . ^ ^
,� Gar6age Disposal '
. Generator �0.5 KW OS-i
.. . i v
( �Y
$ 3 . �
FEES
$ 3
DEVELOPMENTSERVICES
Yning Approved By '
_Builtling Approved'By �
ELECTRICAL .
Transformer � 15-50 KW
, � 50•c KW
Meter ❑up to 100�amps '
Meter ❑overi00amps
Sub Panel ' , �-
MotorsOO-1 HP �iN,-B
Inc. Solar �9�15 HP 0'16�15+
Microwave �
. Pole Light � '
Range
Standing Sections
5 K W - Trash Compactor
$15 I � � luue Fee
—{�
�QU RE�S�
FEES
$ 3
- '~ S,ttl��ppMM/pp wRV F' PEES � -y �
� ,BUILDINGPERMIT�$;� SMIP $ `(7
�ti �PLAN CHECK -, $'• � PERMIT
. PLUMBING S ' �SSUANCE $
� PIAN�CHECK 25% $ ' ENERGV P.C. $ � '
r
.ELECTRICAL � $, GRADING $
� �PLAN�CHECK 50% $ � MICFiOFILM $
— MECHANICAL . ���$'� ' TOTALFEE $ �'-'t'��'�f-
' PLAN CHECK 25% $ .
CONSTRUCTION AND PLANNING � • POOL 'A •
APPROVALS �� Permit # Date Inspector qppROVALS Permit # - Date Inspector
. �
7. Temporary Electrical Service or Pole �- 52. Pool & Equipment Location � �
2. Sal PipecUndrgmd. � 53. Steel Reinforcement � -
3: �Electrical Condu}t Utility-Undrgrnd. - 54. Forms �
4.; Electrical Conduit�Undrgmd. , , 55. Electrical Bonding �
5�;�Steel Reinforcement 56. Rough Plumbing & Pressure Test - .
6�`EI?Ltrical UFER Grnd. 3 57. APPROVAL TO COVER-GUNITE
7.'Eootings � � � 58. Electrical Conduit-Undrgrnd. ' �
8. Foundation ��`��r,A � G 59. Gas Pipe, � Undrgrnd., Test
9., Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O�Undrgrnd. .
10,�S�ructural Flobr System , 61. APPROVALTO DECK
11. Property Sewer Line & House Connection , 62. Backwash & Receptor-Final �
12:�:Sewer Cap':�' 63. Heeter & Vent-Final
13. Root�Drei,ns ' 64. Plumbing System - Final � '
14.��Rough Ptumbing _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/SPASYSTEMS 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. Stoiage Tank O Gas ❑ Oil
25. Roof Sheathing �:. �' - 6 74. Overhead Hydro '
26. T-Baf•Ceiling (Structural) &�Monocoat � 75. Dry Chemical
27.. Freme and Flashing 6 �,).� 76. Dry Standpipe -
28. Lathing & Siding - ,�� 77. FIXED SYSTEM FINAL �
29. Insulation , .,. ! ('y 78. FIRE PREV. FINAL
30. Drywall Nailing -• .. HEALTH DEPT. REQUIREMENT
31. PlasterBrown Coat �, 79.. FINAL INSPECTION �
32.'Electrical Power Met`er-Final ' 80. FOOD CERTIFICATE ISSUED
33. Final Electric ' ' . Notes: �Q� �Qj; $PE�ilil. �i��1j(C�jjLj'(���0
34. Final Heating & Air Conditioning y j-�� 0O z� �� �
35. Final Gas Pipe-Test � ,�Q " "
/Y i'O J
36. Hood or CanopY , � �, q 6 a C s� /
37. Final FactoryFireplace '�3 �7 O/� �p ✓T 3 (��f'�
38. Final Plumbing . , . � �Q.� j �(�� . �
39. Water Service-Final • � . Dy[. � � � �[,l� ��'
�
40. Gas Service-Final . . �-`
41. Solar pomestioFinal . �6� �r « �'�' . q /e R
42. Backflow Preventer ,
43. Backflow Irrigation - � ' .
44. �Landscape Irrigation System`� � �
45. Sound Attenuation �-
46. Handicap Regulations � � '1 �r./ �
47. FINALSTRUCTURE & BUILDING �� �
48. Special Requirements Completed ��
49. Electric Release to Edison �
50. Gas Release to Southem California Gas Co ' � -
51. CERTIFICATEOF�OCCUPANCY . � -
No. Date � � • �
�+volicant to fill in all sDaces exceo� ehose within heavy oortler Iinas anE si9n all aoo�opriate aeclantions.
CIT'9 oF COS7a MESA`[ CONSTQj�j��JC'TIO /P�E'��of M-IT/ ` PERMag s N�s,�T P�Qo � UNIT NOI�
Project Address . -�� T u% ' '�/ � �IJGK ri' /
Applicant'S ATa"ngA dress / TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
Owner'sName� ��Qa(S ��PhoneSp�L1C7_�
Address � �1
Arch/Eng. License o. Ct���
Address � '���
Contractor's Nam � _Phone
Address (mailing)
City License No.
�ICENSED CONTRACTOR DECLARATION
I hereby a(tirm Iha[ I am li<enzetl untler prOvisionz o1 Charte� 9(commencing
with section 7000) of �Ivision 3 af the Businass antl Professions Cotle, ane
my license is in full force antl effect.
License Class Lfcense No.
Da[e Si9na[ute
WORKERS' COMPENSATION OEGLARATION
I M1ereby aifirm tnat I have a cer[ititate of conzent to self-insure or a certl/icate
` Workers' Compensation Insurance, or a certiTietl copy thereof (Section
J00, Lab. C.)
Policy No. Company
BCertitietl copy is hereby fumishetl. .
Certifietl copy is tiletl wifh [he city Builtling �ivision.
Date Applicant
EXEMPTION FROM WOPKERS' C M NSATION DECLARATION
(This section neetl not be complete i e p!r ' f one huntlretl (E300) or
IE55�.
� s
I certify that m t e performance of h m<(o whi h is pe �t is ssuetl, I
shall not e Ploy any e�son in any� n zo a5 t om ubjec to ne
Work¢rs' Laws of Calif r a
Date ' Si9nature
- NOTICE: I(, af[er aking lhis tle[lara - , you s�oultl ome subject the
Workers' Comp¢nsation Provisions ot [he Labor Cotle, you musl to t with
compry with such provisions or this permit sha11 be tleemetl r etl.
CONSTRUCTION LENDING AGENCV
1 hereby at(irm Nat tnere Is a construction lenain9 a9ency for the performance
of tne work far which this permlt is issuetl (Section 309] Civ. C.)
Lentler's Name
.Lentler's Atltlress
OWNER BUILOER �ECLARATION
I hereby alfirm tnat I am exempt trom Nn ConVactor's Llcense l.aw for thc
following reason (Section 7031.5 Business antl Profeisional Cotle: Any city or
county wnlch rGquirei a p¢rmit to const�uGt, dlt¢r, ITProve, tlemOlisb or re0air
any struclure, ptio� to it5 issuance, a120 reqWres the applicant 10/ such permit
to (ile a sign¢tl statflm¢nt tllat he/5hG Is Iiceni¢tl pur5udnt t0 the pfovl5iOn5 Of
the Con[ractor'S Li<¢nse.Law �Chapter 9,(COmmencing with SactiOn 7000) ot
Division 3 of tne Business antl�Professions Cotle) or t�at ne/she is exempt
�erefrom antl thG Dasis for t�e allegetl exemplion. Any vloldtion ol 5actiOn
31.5 Dy any ap0���ant tor a permit subjects the applicant lo a civil
nalty oi not more than tive huntlretl tlollars (g500).
L� I, as ownet of lh¢ ProDer[y or my amploycos with wages a5 Ihnl� 5010
compensation, will tlo lhe work, antl th9 5[Ncture Is not IntentlGC o� afferetl
tor wle (Sectlon 7044, BuSiness antl Professional Cotle: Tno Contractor's
License Law tloes not app�Y to an owner ot a property who builtlz or improves
thereon, antl wno tloes such work himselt/herselt or througn his or ner own
employees, provttletl that such improvements are not Intentlrtd or oHeretl for
sdle. I(, hOwever, the builtling or ImprOvement is Soltl wilhin one year ot COm-
ple[ion, lhe owner will have tne burtlen at provin9 he/s�e tlitl not bulltl or Im-
rove for the purpose o1 sale).
I, as owner of ihe proper(y, am exclusively contracting with Ilcensatl con-
la tOls tU cOnStN[t the prOjeci ($¢ction 7044, BuSin¢ss antl ProtessionT Code:
Tne ContractoYz Llcense Law does n t apply to an owner ot property who
builtls i r improvez lheraon, an0 wtto ont�ac[5 fOr s�proj¢CIs wilh a con-
tractor s) littnse pursuant to the t ctor's Llcens w. I am aware lhat
root of Ihei� Worke�'s Compen tiA Insu�ffi'2 4�du tl be nrovitletl to me.
P
❑ 1 am exempt untler Sec[bn—
oate �Owner
I hereby certity that 1 have rea
inf[]!md[i0¢ IS CO!lCCI. 1 dqlE9 IO
P.
dO� fl¢I¢DV d
�Signature � �^-� oai�
Orivers' Licenze or SS �
CMF 0865-46, rev. 10/84 White - Builtling; Canary - AppliW�{;
❑ CONVERSION ❑ DEMOLISM
DESCRIPTION OF WORK/USE OF
TVPE OF PERMIT LJ GRADING
❑ TENANT ❑ ELECTRICAL
❑ OTHER �'j 1 R � �I
PROJECT DESCRIPTION 5�. FT. '
CON STRUGTION TVPE�
ZONE GRP
Remarks: n _..rc `ei�_ iu ..
�SS 1'15bL'
Sink
'rtlow Preventer
kflow Irrigation .
nubs
ifiers
irvdsher , _
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trap
Rainspection Fae
OTHER
I FOVNDATION LI STRVCTURAL
PLUMBING ❑ MECHANICAL
_ OCCUPANCV
VALUATION 3 s
C U. Y
FEES
Showers
Servite Sink
Sewer Cap
Sewer Connection
Solar Collector
Solar Pipi
imming Pool wlSpa
Urinal
Water Closet
Water Heater
� Water Service
Auto-Wash
Laundry Trays
$15 laue Fee g 3
Boiler
Duct - Under Ground
Duct - SVucwral
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/FacL Blt. ICBO �k
Heating System & Ducci
❑0.100,000 BTU 00,000
� I I Reinspection Fee I $15
Accounting; Goltlenrotl - AssesSor
Hood or Typel ,❑
Canopy Type II ❑
❑aioo,o u ❑ioo.000
S m Repair�Alteretion
Fire Dampers
Registers
Issue Fee � $ 3
A.P. ql� L � � �
S Main Building:
E
T Front
A Rear ' � I�f TE
C Right
K
g Lett
Ping. Ref. q1E �' g'7
Planning Notes: n Lf � I.
Auromatic Washer
Construction Pole Sub.
Cooking Unit
Dishwa5her
Drye�s ❑Gas ❑Elec
Fan
F.A,U.
Fixtures
Device Boxes
Outlets �
Gar6age Disposal
Generator �0-Y
I Rainspection Fee
—
DEVELOPMENTSER
2aning Approved By_
BuildinB APProved By
8253 5/20/n7
. — 3 Zo�a
Accessory Building:
� a � r,TERaTio �
�
—�
�s P ing Req.�Provide� Q
;,, o�' Ec, 9 N o sca .�T. 'Z
n,7oG• TI
2
O
N
1
N
G
R
29 0
� M
T
�w ^y. '/�� S
.tTOA{— Ot iv�( Cy(rt��l/�
I �-�'
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 10 mps
Merer ❑ove OOamps
Sub Pane
Moto 0.1 HP O1 X� 8 -
I .Solar �9-15 HP �16�15+
Microwave
Pole Light
:iange
Sign
Scanding Sec[ions
5 KW Trash Compacmr
$15 luue Fee $ 3
'� QUIREMENTS:
�Mf�—: _ oacas'�-8%
SUMMARV OF FEES ,SO
BUILDING PERMIT $ �� SMIP . 5
PLAN CHECK �" $ �� PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% S ENERGV P.C. S
ELECTRICAL $ GRADING S
PLAN CHECK 50% S MICROFILM 5
MECHANICAL 5 TOTALFEE $ . OO
PLAN CHECK 25% $ _
'i ��1di4'7 �, Q e✓�'�a� ��� < r.� -�l62 I � c~
�,
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. EfecVical Conduit Utility�Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
� 5. S[eel 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, � Undrgrnd.
70. Structural Floor System� 61. APPROVAL TO DECK �
. i t. Property Sewer Line & Fiouse 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 PIASTERING
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 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush '
24. Roof Framing 73. Undergrnd.StorageTank O;Gas OOiI �
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. Fin`al Factory Fireplace , -
38. Final Plumbing ,
39. Water Service-Final . ' . �
'40. Gas SerJice-Final -
41. Solar pomestic-Final _. � •
42. Backflbw Preventer i ' �
43.�Backflo'w Irrigation � � � ,
4A��' Landscape Irrigation System " . �
� 45. Sound Attenuation . � �
46.'Handicap Regulations ' ,
47e. FINAL STRUCTURE & BUILDING ,}� /,N� ' � • �
v
48._Special Requirements Completed �� . , ,
, '�
49. Electric Reiease to Edison � '
50. Gas Release to Southern California Gas Co �
51. CERTIFICATE OF OCCUPANCY
No. � Date _ ' �,
\
Aoo���ant to fill in all spaees except tnose within neavy eorOer Iines ana sign all apv�opriate aeclaratlons.
CITV OF COSTA fSA CONSTRUC ION P�RMIT P MIT NO. TRACT NO. LOT NO. UNIT
Project Address �F' S ^
Applicant's fVV�ilin ddre s� � Z ���� ry�c�
Owner's Name � LPhone _SC�'�L �
Address
. / r�_�1�574.
ArchlEng. 66/C �S��v � �,:o.,� No.
Address �' �
�
Con[ractor's Nem �2 Phon
� � '
Address (ma'I' g) LJ�SL I� � S ` ^r'k
Citv License No. � y�� 93
LICENSEO CONTRACTOR DECLARATION
I Oere�y allirm tnat I am licensea unaer orovisionz ol Cnartor 9(commoncin9
wi[h section 7000) of Divislon 3 0l tho Business antl Profosslons Cotlo, antl
my Iicense is in full (orce3pp eitect.
Licenso Class (�_�t�l�1��a �dnH93 -o k'�
Date.^i- /2-fT7 51 .[i lt:l� ^
---�
WORKERS' COMPENSATION DECLARATION
� hereby atfirm tnat I have a certifiwte ot consent ta selhinsure or a cerBticate
Workers' Compenwlion Insurance, or a certifio� copY �nereol (Soction
,00, Lab. C.)/f . L �
Policy No.�/r�0 bsiq�� Company�M'1Gv��.'Nw/ s'/7L�$
CerNfietl copy is hereDy furnizhetl.
CerHtietl copvy 's�(iletl with tne city il iqg DI i 1
�ate �'��' � Y ( APPlicant � —
E%EMPTION FROM W00.KER5' COMPENSATION DE RATION
(This SOCtiOn neltl not DO complet¢tl if tha pefmlt IS tOr On¢ hunOrntl ( 00) al
tass). '
I certify that in lhe perlormanca of tho work for which this permR Is Issuea, I
shall not emplOy any polSon in any manner 50 as [O become subjGtt t0 lh0
Workets' Compensalion Laws of California.
Date Signature
NOTICE: II, after.making this tleclaration,-you shoultl bacome subjnct to tne
Workers' CompensaUon Provl5ion5 of [he Wbor Cotle, y0u must fo�tnwilh
comO�Y �+'��h such provlsions or this permil shall be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV '
1 boraby afllrm ihat t�are Is a<onstruction lentling agency tor the pertormance
ol th0 work IOr which this permit it ISzued (SecNon 3087 Clv. C.)
Londer's Nama
Leatler's AtltlrCss
OWNER BUILOEN [�ECLARATION
1 hereby 5ffirm that I am exemPi from the Gontracror'S License L.aw for the
following reason (Sectlon ]031.5 Business antl Professional Cotle: Any city or
counly whlcb reqWres a permit to tonstruct, al[¢r, improve, Eemolish or r¢palr
any sVuchre, prior to i[s IsSuan<e, also reqWres the appllcaM far such permlt
to fi1C a 51gnCtl slalemonl thdt he/ih¢ I5 IlcenSCtl pur5udnt to the prOvisions ot
the Coniractor's Ucenso L. w(CnaOter 9(commen<ing wlth Section 7000) ot
- DIWSion 3-oi tno Business antl'Prolesslons Cotla) or tnat ho/s�o Is exempt
�ereirom anC the basis� for the alle9etl exemptbn. Any vlolation o/ Saclion
)31.5 by any appliGant for d pe�mit zubjects thG appllcanl l0 a clvil
enalty of not more lhan five huntlretl tlollars (5500).
❑ 1, a5 owner o( lhC pwp¢rry or my employees wlth wag¢5 as th¢Ir sole
compensation, will Oo the work, antl the structure is not intentletl or oiteretl
for sale (SecUon 7044, Business antl Protessional Cotle: The ConvacloYs
LICenSe l.aw UoeS nOl appty to an Own¢r ot a proPerty who bullCs or Improve5
lhMlon, dnU wh0 daei Such wnrk nlmseR/nersell or through hls or he/ own
tmD�oyOcs, D�oWEatl lbal such ImO�OVGments arB n0[ IntCntlotl or oflare7 for
via. i� nowover, the bulltlin9 or improvemen[ is soltl wl[�in onc year ot com-
pletl00, the owner will navB [h¢ bU/tlen OI Provin9 h¢/She tlitl nol bulltl or IT-
prove �or tne purposa ot sale).
❑ I, as owner oi the property, am ezclusively contractln9 �`/�lh Ilcansetl con-
tractors to construct the project (Sec[lon �044, Business antl Pro�e55ions Cotl¢:
The ConVactor•s License law tloes not apply'to an owner oi property who
buibs or improves tnereon, antl who contracts for zuch orojects with a con-
trd<[Or(5) IICenSe pUfsuanl t0 the Conlrattol's LICenSe Ldw). I am dwar0 lha[
prOol o( thei� WorkG/'S Compen5dtlon inzurance Shoultl ba prOvitlatl [o mC.
❑ I am exempt unaer Sectlon - �: B. & P. C. lor [his reason
Date Owne� '
I hereby certify tnaf I M1ave reatl this apPlication antl sca[e tbat the above
intormation�iz COrtect. 1 a9r¢e t0 comply with all city antl county ortlindnCes
Signatu
Dr�veri'
CMF 0865��
on, antl hereby a�thorize repre-
'abOve-M¢ntlOnPtl plop8rty for
, 9i�/2��%
� DaW
��� � •
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISM ❑ OTHER
DESCRIPTIBN OF.WORK/USE OF BLDG. ^�o �_7 u � iK(
TYPE OF PERMIT LJ GRADING U FOUNDATION LJ STRUCTURAL
❑ TENANT ❑ ELECTRICAL��PIUMBING �LQMECHANICAL
❑ OTHER
PFOJECT DESCRIPTION 5c2. FT. oCCUPANCv
CON STRUCTION TVPE VALUATION 5
ZONE GRADING CU. VDS. ACRES
qemarks: �F ' d .Q�.R .,i
Sink
Preven2er
Irrigation
Drinking Foun�ain5
Floor Drains
Floor Sinks
Gas Service
Interceptors
Kitchen�Sink
Lavatories
P-Trap
Foof Drains
Reinspection Fee
Showers
Service Sink
Sewer Cap
Sewer Connection �-
$olar Cpllectorr
Solar Piping �
Solar Tank
Swimming Pool w/$pa ' '
9
FEES
Outlets �, � Water Closet i �
_ / Water Heater .
Water Service - - � '
� � Auto-Wash �
' Leundry Trays '
$15 Issue Fee g 3
Boiler
Duct- Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Mul[iple
Firepl/Fact. BIL ICBO #
Heating System & Ducting
❑ a i oo,000 sTu � i oo,000
:enm or ss � _� -- -- � � F7einspection Fee � S15
rev. 30/B4 White - Builtlin9: Canary - APpliwnt; Pink - Accounting; Goltlenrotl - Assessor
Hood or Typel ❑
Canopy Type II ❑
Refrigeration System
❑0.700,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers �
' Registers '
laue Fee � S 3
A.P. qW
S Main Bu
E
T Front
B Rear
A
C Ri9ht
K Left
S
Ping. Ref. dF
� _ 3869 3/12/B7
Z8
Accessory Building:
� i
Parking Req,/Provided �
Automatic Washer�
ConStruction Pole:
Cooking-Unit
Dizhwasher -
Dryers ❑Gas ❑I
Fan
F.A.U. .
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal
Generaror DO-5YA
�
� �
. ELECTRICAL � - ,
Transiormer ❑ 15-50 KW
�b. ❑ 50+KW -
- Meter ❑up to l00 amps �
Me[er ❑over100amps '
lectric Sub Panel �
Motors00.1.HP tYh-8
Inc.Solar -15 HP �16-15+
� 61e Lighc � " '
� Range .� '�
Sign ,
Standing5ections - .�.
�5-15 KW , Trash Compactor
. r' �
� Reinspection Fee �$15 � � laue Fee
DEVELOVMENT SERVICES RE�UIREMENTS:
Zoning Approved By
Building Approved By
Aooliption laued Bv �
49o/b TL
Z
O
N
I
N
G
R
E
Q
M
T
5
�
0
. SUMMARVOFFEf5 - . . �
BUILDING PERMIT $ SMIP - $ '
PLAN CHECK $ PERMIT
PIUMBING - $ �SSUANCE � $
PLAN CHECK 25% $ R.Z ENERGY P.C. $
ELECTRICAL $ GRADING . �$
PLANCHECK 50% $ MICROFILM $ � -� `
MECHANICAL S � TOTAL FEE $ �Z�'
PLAN CHECK 25% $ �
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. � 3 � 53. Steel Reinforcement '
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcemen[ , 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVA�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 j/? �� � 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.�StoregeTank OGas ❑Oil
25. Roof Sheathing . 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat .. 75. Dry Chemical
27. Frame and Flashing � � 76. Dry Stantlpipe , �
28. lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation � . 78. FIFiE PREV. FINAL -
30. Drywall Nailing ' HEALTH DEPT. REQUIREMENT .
31. Plaster Brown Coat • 79. FIfVAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED .
33. Final Electric Notes:
34. Final Heating & Air Conditioning 7/r��.J t��
35. Final Gas Pipe-Test %1
36. Hood or Canopy
37. Final Factory Fireplace �
38. Final Plumbing rJl /9� / � ' �,
39. Water Service-Final '
40. Gas Service-Final . �
41. Solar pomestic-Final . .
42. Backflow Preventer •
43. Backflow Irrigation � ,
44. Landscape Irrigation SYstem , • �
45. Sound Attenuation - '
��46. Handicap Regulations �
47. FINALSTRUCTURE&BUILDING .
48. Special Requirements Completed � • � -.
49., Electric Release to Edison
50. Gas Release to Southem California Gas Co '
51. CERTIFICATE OF OCCUPANCY , ,
No. Date •
�
AOD���ant to NII in all spaces except thase wi[nin neavy oartler Ilnes ane sign all approvriate tleclarotlans.
aTY OF COS7a pMESA CONSTRU_C(TION PERMIT
Project Address O� y �% � �� J S��
n,...r...�...•. nn�:c..., naa.e.� / 3 Cn S Z /�. �..n ��.
Owtter i Name /� ��/�'+� hK v vs Phone'o`� �-'o���
Address W � � � � 5 � ' QS�q
Arch/Eng. - s License No.
Address
Caotractor's Name �� C S� v� � "�f Phon �� �Q
Address(mailingl �Z N 'a5 �' � �,
City License No, d�Q �� 3
LICENSED CONTRACTOR OECLARA710N
I hereby aHirm tM1at I am Iicensetl untler OroviSions ot Charter 9(�ommencing
witA sectlon 7000) of Division 3 ot [he Business antl Pmfe551ons Cotla, antl
my �fcense is in fWl farce ntl effect.
Lickns Cle/i� a�s(;�y—� L�eljlb a��
Dute m`—� 5'9 at /�D-�
WORKERS'COMPENSATION DECLARATION
I hereby ailirm tpat I bavo a certiilcato oi consenl lo selt-insure or a c rtlticate
•� Workars' Componsati Insuranco, or�/a cartUiatl <opY theront (Se/5tion
100, Lab.� �C�Jp�i� 0�% Z.%i j 7/� / S%!4-�l �U/�Ld
oli�y No.�LL7� Comoany
n�yCertilletl copy is hereby turnishetl.
y�te([e�t'� copy� filetl wRh the cfty B Itl ng DI si �
5f
rDa d___F qpplicant
EXpMPTION FROM WORKERS' COMPENSATION DEC RATION
(Tbis section neeG not be comple[eE if tho permi[ Is far on¢ huntlratl (bl ) or
less),
I Ce�lify [hat in tne perlorTance of lhC wark tOr wnlch thiz parm�t i5 Iisuetl, I
Shall not emPloy any pe�iOn In any mann¢r so as to become suDjec[ lo tho
Workers' Compen5dtion Laws ol California.
Date Signature
N0710E: H, atter mak(n9 tpis tleclaration, you shoultl become subject to tha
Wmkers' CompensaHon prp�isions of the Labor Cotle, you muzt forthwi[h
COTpIy wilh such p�oWSions or Ihis permit Shall De tl¢¢metl r¢voketl.
CONSTRUCTION IENDING AGENCV
1 hereby atiitm that t�era is a const�uclion lentling agency for [he performance
of Ihe work for whicn tniz permit is issuetl (5¢<tion 309] Civ. C.)
Laqtler's Ndme
Lentler's Atltlreis
OWNER BUILDER �ECLARATION '
1 h¢r¢by afflrT that I am Uxemp[ from Ihe ConlraCto�'s L1COnse Law for tho
' lollowin9 reason (Seellon 7031.5 Busine55 antl Profosslonal CotlB: AnY ���Y or
coUnty whicn r¢quirei a permit to con5truct, dlt¢f, Implove, tlGmaliSh of rCpai!
any sVuc2ure, pflor to its issuance, also requires the apOlicant for such pormit
' to file a Slgn¢d statement that he/She i5licensetl p�isuan[ to t�e Drovisions ot
Ug Contraclor's License Law (Chap[er 9(commencinq with SecUon 7000) ot
DiVision 3 oi Ihe BUSineSi antl Pro(es51on5 Cooe) or that he/she is exempt
�4@�efrom antl the basis 10� the alle9etl ex¢mption, Apy viOlation of Saction
33.5 by any applican[ tor a permit subjects the appllcant to a civll
ialty of not more than fiva �untlretl tlollars (5500).
� 1, as owner o� the o�operly or my employees with wagas as their sole
CA1np¢nsalion, will tl0 Iha work, antl the SfructurC is not IntenCetl or oHeratl
ior gale (Seclion 7094, Businass antl Profasslonal Cotla: The Coniractor's
LiCenSe Law tloes nol apply to an Owne� of a p�operty wh0 DW Itls or impwv¢5
tM1preon, antl wno aoes such work hlmself/herself or through hls or har own
employees, proviaetl that such improvemenls ara not intentletl or otferetl for
Sx�e. It, hOweve�,�the builtling o� Imp/ovement is soltl wit�in one year of com-
D�Ction, ihe oWn¢� will hav¢ Ihe bU/tlen ot proving he/sne tli0 not �uiltl o� Im-
P�ove ror tne purooze ot ule>.
❑ i, as owner ot the prOperly, am extlusively conlractinq wilM1 IicenseE <On-
trdctors to consVuct the project (Sectlon 'loaa, �uslness antl Proiassions Cotla:
The ConVactor's Licensc L.w doe5 nol aPPly to an owner of property Who
builtls or improves theraon, antl who conVacts lor such projocts wltn a con-
tqttor(s) IicenSe pursuanl to the Conl�act0�'s LI<onse Law�. I am�aware that
P�oof 01 tnBi/ Worke�'s COmOenSalion inswanre ihOula bo provitl¢tl lo m!.
❑ I am exempt untlar Section _ B. & P. C, fo� this �ea5on
Date —
I hereby
informalic
antl state
5¢hLdlIV05
��Epecllon
Signature
Drivers' L
— Owner _
I have reatl this
I aoree [o comp
ar SS 4f
tdle thal [he abOve
tl counry ortlinances
:by autnorize repre-
ionetl prOperty (or
Oa�u � �
OFCONSTRUCTION �SI NEW IJ ADD LJ ALTERATION U REPAIR
CONVERS�ON ❑ DEMOLISH ❑ OTHER 1
�SCRIPTIOry� F WOq K/USE OF BLDG. 2^�J! '� �� � �?r'�
oo� Ve�(t�s
TVPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRVGTUqAL
.O TENANT ❑ ELECTRICAL ❑ PLVMBING � MECHANICAL
❑ OTHER _,
PROJECT DESCRIPTION 5a. FT. oCCUPANCV_�,
�CO �ST0.UCTION TVPE VALUATIpN 5 / SO —
'ZONE GRADINGCU.VDS. ACRES
+.
Preventer.
Irrigation
Dishwasher �
Drinking Founteins
Floar Drains
Floor Sinks
Gas Service
�nterceptors
Kitchen Sink
Lnvatories
Roof Drains
G 2 �o o% erc, �'U. 6 T DlG/G GFC'Rir ✓C
' PLUMBING FEES
Showers
Service Sink
Sewer Cap . ..
Sewer Connection
. Solar Coltecrors � .
Solar Piping
Solar Tank �
Outlets
Pool w/Spa
Water Closet
Water Heater
Water Service
Auto-Wesh
Reinspaction Fea � S15 � � laue Fee � S 3
Duct - Under Ground
Duct - Structural
Duct � Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. BIL ICBO #`
Heating System & Ducting
❑0100,000 BTU 0100,000
Reinspection Fea � $15
CMF pB65-46, rev, 30/80 White - Bullding; Canary - APP��cant; Pink - Accounting: Goltlenrotl - AssBssor
�Hood or Typel
Canopy Type 11
Re(rigeration System
❑0.100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers .
laue Fee
A.P. #
S Main Building:
E
T Front
A Rear
C Right
S �eft
Ping. Ref. 51E
Planning Notes:
Auromatic Washer
Construction Pole Sub.
Cooking Unit
DiShwdsher
Dry¢rs ❑Gas ❑EICt1
Fa�
F.A.U. �
Fixtures
Device Boxes
Outl¢IS
$witthes
❑PS KW
943c 6/II/:�
Zone
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15�50 KW
❑ 50+KW
Meter �up to 100 amps
Meter ❑Over 100 amps
Sub Panel / .
Mo�0.1 HPU1Y,-8
�a Sotar �9-15 HP �7615*
Microwave
Pole Ligh[
Range
. I I Standing Sections
15 KW I Trash Compactor
� Reinspactian Fea � 515 ' I Issue Feo
OEVELOPMENT SERVICES REQUIREMENTS:
2oning qpproved By
Buildine aPProved ey
A�P���ation Issuad Bv
� oo . SUMMARV OF FEES '
BUILDING PERMIT $ SMIP
PLAN CHECK S PERMIT
PLUMBING � 5 ISSUANCE
PLAN CHECK � 25% 5- � ENERG� P.C.
ECECTRICAL S GRADING
PLAN CHECK 50% 5 MICROFILM
MECHANICAL $_ 9. O J TOTAL FEE
$ 3 PLAN CHECK 25% $ I•�'J
E
FEES
$ 3
5
3
$
S
S %O'�
Z
O
N
I
N
G
F
E
U
M
7
S
CONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Locatio�
2. Soil Pipe-Undrgrnd. 53. �Steel Reinforcement
3. Electrical Corlduit 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, � Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural FIUor System . 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
i3. Roof Drains 64. Ptumbing System - Final
74. Rough Plumhing � 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
]8. Rough Electri�yl-T Bar Ceiling 69. POOUSPA SYSTEMS F1NAL �
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# ' _
r
21. Oucts, 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. Undergmd.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. F�NAL
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: � �_5.�� � '
34. Final Heating & Air Conditioning � `
T
35. Final Gas Pipe-Test �
36. Hood or Canopy � .
31i
yiFinal Factory Fireplace ' �
38. Final Plumbing ' ' . . �
39. Waier Service-Final �
40. Gas Service-Final � � � •
41. Solar pomestic-Final " �
�
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irriqation System .
45. Sound Attenuation - - '
' 46. Handicap Regulations ' ,
47. FINAL STRUCTURE & BUILDING ' "
48. Special Requirements Completed � � '
49. E�ectric Release to Edison � � . �
50. Gas Release to Southern California Gas Co ��.
51. CERTIFICATE OF OCCUPANCY
No. Date •
Applicant
CITY OF COSTA MESA �CONSTRUCT(�I�N.PERMIT
Project Address �04 � � ��a`..—�.,' ,�___Z
ApplicanYs f�:3iling Address �� �• �'�`--�"W �
Owner'q Name Q� L ��S /+ �� ohone —
Address �� l W� ��� S"r. L.C(y'7��
Arch/Eng. License No. —
Address
Contractor's Nam � 2F i�rLC�T � WC.phone.�
Address (m+'1'nal � d2 :� .'�C7�2ClrYj�.D � S.n�
City License No. �'U 7q �
LIC@NSED CONTRACTOR DECLA O
I hereby atfirm that I am licensetl tler provisl ns of Chart (co
with section 7000) 01 DivlSion 3 of th¢ B' ess �a Prof uns
my Ijcenze iz In full forcc ana efie {�
licoqse Class G-� `\ � Li<e � Wq
Date �- 3- � � SignaWre � �[L�_
WORKERS' GOMPENSATION DECLA ATION �J
1 hereby aitirm that I have a certificafe consent to self-insure or a certificate
`t Workers' Compensation I�njiu�ance, o� a ce/�tlifie�tl �c�opy� ^Ih�ereof (SeCtion
)00, Lab.�SZIO�I' Gl0 -71�� r�7 ^%ri
olicy No. Company
�Gertitietl copy is hereby furnishea. /�
Ber[ijjttl�pY.�cjjletl�withtheCity i ' iv�q{{,��'1��� i
.S^ a `I APOIiCant ���
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(ThiE section need not be completed Ii the permit is for one nuntlretl ($300) or
lezs),
I cer{�(y that in the performanGe o( the work for whiCh this perm�t is issuetl, I
shall not emD�oy any person iit any manner 5o as to become subject to the
Workers' Gompensation Laws ot Califomia.
'Oate 99�ature
NOT�CE: Ii, aiter making this tle<iaratlon, you shoWtl become subject to the
Workers' COmpensation Provi5ion5 of th¢ �ybor Cotla, you must forthwi[h
comply with such provisions or thiz permit shall be tleeme0 revoketl.
CONSTRUCTION LENDING AGENCV
I hereby affl�m thal there i5 a cOnst�uGtion letltling agency for the pertormance
of the work for which tnis permlt is issuetl (Sec[ian 309� Civ. C.)
L.entler's Name
Lentler's AtlCress
OWNER BUILDEH UECIARATION '
I hereby affirm that I am ex¢mpt from the Contrdcto�'S License Law Por the
follpwing reason (Section �031.5 Business antl Professional Cotle: Any ciry or
county which �equires a Pe�mi[ to const�uct, dlteq improve, tlemolish o� �epair
any SVuctu�e, p�Ior to I[s isSuance, also �equi�es the applicant for Su[b permit
to tile a signetl statemenf Ihat he/she i5 licens¢tl pu�sudnt to [M1e P�oviSiOns ot
the ConVactor's License Law (Chapter 9(commencinq with Sectlon ]000) o�
Division 3 of'the Business antl Profess�ons Cotle) or that he/sne is exempt
tnerefrom antl' the basis (or the alle9etl exemption. Any violation ot 5ection
'031.5 by any applican[ for a permit subjects the applicant to a civil
enalty af no[ more lhan Lve Auntlretl tlollars ($500). �
� 1, as owner of tlte property or my employees with wages as thelr sole
Corqp¢nsatiOn, wfll tlo [he wOrk, antl Ihe 5[ructure is not in[endetl o� oftereG
for sale (Section ]044, Business antl Profezsional Cotle: The Contractor's
Licenze Law tloes not app�Y to an owner of a properry who builtls or improves
therCon, antl wpo tloes such Work hlm5elf/herself o� thiouqh his o� h¢r own
employees, provitletl lbat such Improvemenis a�e not intentletl or offCretl fo�
sale. If, however, [he builtlin9 or improvement is soltl wi[hin one year ot com-
Olellon, tha Owner will have Ihe buttlen of prOving h¢/Sne ditl nOt builtl or im-
p�0ye for tn¢ Purposa ot salo).
❑ I, az owner of tna property, am oxclusively contracting witn licensetl con-
Va¢tors to construct the pro�¢Ct (Section 7044, Bu5ine55 dntl Professions COCe:
Th@ Contractor's License Law does not apply to an owner o( property who
buqtls or improves there ntl wno conVa<ts tor such projecls wil0 a con-
tra�to!(s IKen58 ant to [ onVac[OI'S License Law). I am aware that
proof o� their orkeYs Compens tlon insurance shoultl be provitled to me.
❑ I am exe t untler Section B. & P. C. for this reason
Date
Sigha[ure _
Dri�er5' Litnn'
CMF OB65-46, rev.
owner
this li tio a tl state that the above
>mpl I dll it antl COunty ortlinances
con5t C Ion a h¢reby autho/iie r¢pre-
�pon e a netl pro0erty (or
Oatu � ����
in al1 spaces except inoza within neavr boraer Iines antl sign all aporooriate Eeclaratians.
VO. � TRACT NO. LOT NO. � UNIT NO. 9� 4E 6/05/�7
,,,.., � ,� 6300�' TI
TVPE OF CONSTRUCTION LJ NEW LJ AD� LJ ALTERATION lJ REPAIR
❑ CONVERSION ❑�.DEMOLISH ❑ OTHER A p #
DESCFIPTION OF WORK/USE�OF B�DG.
� S Main Builtling:
E
TVPEOFPERMIT GRADING FOUIVDATION STRVGTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL g R¢ar �
❑ OTHER •' . - A
PROJECT DESCRIPTION 5�. FT. OCCUPANCV C Right
CONSTRUCTIONTVPE VALUATION$ �2LbiCd g Left
ZONE GRADING CU. YDS. ACRES Ping. Ref.'/�
Remark:: p � S. L Planning Notes:
� 'Q[D . L
PLUMBING FEES
Sink
<flow Preventer
<flOw Irrigation
rinking Fountains
loor Drains
loor Sinks
as Service , Outlets
Kitchen Sink
Lavarories
Roof Orains
Reinspaction Fea
$15
Boiler
Duct - Under Ground
Duct - Structurei
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating Sysrem & Ducting
❑ ai oo,000 eru O � oo,000
Heinspection Fee
White - Bulltlin9: Canary - Applicant; Pink - Accountin9; Goltlenrotl - Assessor
$15
Showers
Service Sink
Sewer Cap
Sewer Connectfon
Solar Collecrors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
Auto-Wash
Issue Fee
Hood or Type I ❑
Canopy Typell ❑
Retrigeration System
❑0�100,000 BTU ❑100,000 BT
System Repair/Alteration .
Pegisters
luua Fee
Automatic Washer
Construction Pole Sub.
Cooking Unit _
Dishwasher
Dryers -❑Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
Switches
Garbage Disposal
Generator �65 KW
Zone
Accessory Bui�ding:
Req./Provided
ECECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 100 amps
Meter ❑over100amps
Sub Panel
Momrs �P7 HP �1'h-8
Inc.Solar �9-15 HP�[]16-75+
Microwave
Pole Light '
Range
Standing Sections
5 KW Trash Compactor
$ 3 I
� Reinspectian Fee $15 luue Fee
FEES
�DEVELOPMENT SERVICES REQUIREMENTS:
2oning Approved By
Building Appraved By — �
Aoolication fssued Bv
$ 3
FEES
�
$ 3
Z
O
N
I
N
G
R
E
Q
M
T
S
SUMMARV OF FEES
BUILDING PERMIT $ � �Z•�i SMIP $' ��� -
PLAN CHECK 3 PERMIT -
PLUMBING S ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. 5
ELECTRICAL $ GRADING $
PLANCHECK 50% $ MICROFI�M $ �
MECHANICAL $ TOTALFEE $ - ��
PLAN CHECK Z5% $ _ '
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-Uniirgrnd. 55. Electrical Bonding
5. Steel Reinforcement �� 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd, - 57. APPROVA�TO COVER-GUNITE
7. Footings '�' 58. Electrical Conduit-Undrgrnd.
8. Foundation r �� 59. Gas Pipe, O Undrgrnd., Test
9. Water pipe-Undrgrnd. 60. Backwash Lines,-P�Trap, O Undrgrnd.
70. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer �ap 63. Heater & Vent-Final
13. Roof breins 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. ftough Factory Fireplace APPROVALS Permit# � _
27. 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 C]Oil
25. Roof Sheathing � ' 74. Overhead Hydro � �' (p.�j �<(`�
26. T-Bar Ceiling (Structurall.& Monocoat � J5. ��iy Chemical
� 27. Frame and Flashing � � � 76. �Dry'Standpipe �
28. Lathing & Siding 7x.__ FIXED SYSTEM FINAL -LS�- 1.
29. Insulation ' ."78. FIRE PREV. FINAL � �
30. Drywall Nailing .� HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat . 79. FINAL INSPECTION l
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED •'
33. Final Electric Notes: �
34. Final Heating & Air Conditioning „
35. Final Gas Pipe-Test
36. Hood or Canopy �-
37. Final Factory Fireplace � • '
38. Fi I plumbing , � .
39. ater Service-Final . '; ' .
/40. Gas Service-Final �
/ 41. Solar bomesticFinal '� - �
• 42. Backflow Preventer �
43. Backflow Irrigation . . ' ` :
. 44. Landscape Irrigation System ' _�
; 45. Sound Attenuation i -�
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 .
\
0
AOD�kan[ to /ill In all spaces exeeD� lhose wilnin neavy-eortler Ilnes anC slgn all apProDriata tleelantions.
r PFRMIT f�LQ. _ TRACT NO. LOT N,O. UNIT NO_
CiTY OF �OS7,4 MErSA1 CONSTRUCTIO/�N PERM T
Project Address �4+�` � ` ��r\ l� Q� nC� /��
Applicant's Ma' �ng qddress � ��Y �`�� `�7t/';%�'�''/��'
� _—,-� v _lO_`�i�—`''�
Owner's Name � �a hone
Addreu �^-% � /�/
Arch/Eng. t �- $e� LiCense NoL 1��
Address �L� Z_ �,, � %�'Z-�3
Conuacmr'sName �1�"v" c' ' pho 6��
� � ..�75�� ���r..�
Address Imailingl �
Ciry License No.
LICENSED CONTRqCTOR DLCLARATION
1 hereby altirm Ihat I am Iicensetl untlar provl51on5 0l Cbarter 9(commontlnq
with section 7000) bl Oivislon 3 0l tho Business antl Profeisionz Cotle, anC
my lic¢nse i5 in full fbrGa antl eliect.
License Class � LiCense No.
Date 99�ature
WORKERS'COMPENSATION DECLARATION
^reDy atRrm that 1 ryave a certiticatu ol consent to sal/-insure ot a certiiicate
Worke�5' Compepzation InsuranGn, o� a cerUtleU coDY �harmt ($eciion
_.00, Lab. C.�
policy No. Company
eCertifietl cooY �s hereby lurnisnetl.
Certltietl copy is ry�ea with tne city Builtling Division.
Date APplicant
EXEMGTION FROM WORKERS' COMPENSATION DECLARATION
(Tbis se<[ion n¢e0 no{ be compleletl it Ihe permlt IS (or One �untlretl (5300) or
less).
I wrlity tlyt in tn pgrtOrmance o( thu �k f hi Inis e�m�t i5 i55uetl, I
shall noj �Q Io�y ny erson in any m ier o beco e sub ct t the
, Worker/��6M(� �1o�w5 of Calilorn . . �
Date ! L�� � Si9nature
NOTIC 11, ail r making this heclaralio , you shoultl become su ja to tne
Workers' Compenfation pravizrons o! the Ldbor CotlO, You mu to thwlih
complY w��h such provisions or tnis permit shall be tleemo r okeE.
CONSTRUCTION LENDING AGENCV
1 bereby atfi�m thal lh¢rf Iz a conitructlon Ientling agnncy fo� lhC pnrto�man<¢
of the wOrk tor j�n� �tpis er It Is1 I{�� tl(S ND. 3 Clv. CJ
I.Pntle�'S Namo i��,Y_W1,�4���1_�V�
Lentler's Atltlres5 �j� � � %� �L d
OWNER BUILOER DECLARA ION
� I h¢reby dllirm that I aT exempl trom th0 Conlydttor's LICGnSe Law tOr lne
(ollowing reason (5¢c(lon 7031.5 Businozs antl Prolesslonal Coae: Any citY or
County wblth requi�es a permil to construc[, altCq Improve, demollzn o� r¢palt
any ztructura, orior'(o�its issuance, also requires tha applicant tor such permit
to fiie a signeE statement tnat he/she is Iicansetl pursuant to the provisions oi
the Contractor's Lit¢ns¢ Law (ChaO�er 9(commencing witM1 $ection 7000) of
"vision 3 of the 6u5ine55 antl Protez5ion5 COtlO) or that he/sh¢ is exBmpt'
�refrom antl the-�asis tor [hc alle9etl exemption. Any violation of Section
31.5 by any appljcant tOr a pe�mlt SubjeCtz Itte applitant lo a civil
enalty of nOt more (han tive huntl�etl tlollan ($500�. �
� I, as owne� of the oroperty or my employees with wages as t�eir sole
compensation, will tlo [he work, anG the s[ructure is not intentletl or oHeretl
for sale (Sec[lon 7044, Business antl Professional Cotle: �The Contractor's
License Law tloes not appty to an owner ot a properry wno builtls or improoez
thereon, antl who tloe5 sucM1 wo�k blm5elf/hers¢If or lhrou9h his or �er own
employeez, oMvitletl that suth imorovemm(z are not Intentletl or ofteretl tor
Sale. If, howev¢r, l4e builtlin9 or improv0ment i5 Soltl wilhin On¢ year of com-
pletbn, the�owner W��I havc Ne burtlon of proving no/she tlltl not builtl or im.
prove iorthe purpoye oisale).
❑ t, as owner o( the property, am ezclusively contra<tlng wlth Iicentotl con-
bactors lo cons[ruc� (hc proleGt (5¢ctlon 7044, Business antl PrOlasslons Cotle:
The Contractor's LicenSe l.aw tloes nol apply to an owner of property who
builtls or Improves�(horeon, antl who mntrac[s for such projects with a con-
trattor(5� bcens8 PUrsudnt t0 [he ConVaClOI's LicOnsa Ldw). I am awara thdt
p�oo1 o tb¢Ir WorkOr'S Compen5atlon inSwanCn shoultl be provltletl to me.
�I am uxempt unq¢r Saction .-n _ rF- 8. 4 P. C. lor this reason
Date _ Owner
I herebvi certl v ttla�
antl stata laws r lmg t
sentatives of thi cit
Inspection purpo e ,
Si9nature
Drivers' Llcense 5 �
CMF 0865-46, rev. 30/8q White - Builtling:
TYPE OF.CONSTRUCTION LKNEW U ADD Ll ALTERATION LJ REPA�R
❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p.� (�'
DESCRIPTION OF�INQR�C/-U,� OF B�y�
�ONC L S Main Buildi
TVPE OF PERMIT GRADING FOUNDATION STRUCTVRAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ' �B peef
O OTHER p'
PROJECT DESCRIP710N 5�. F7. oCCUaArvsj( � � Right
CONSTRUCTION7VPE VALUATIONS �L� g Left
ZONE GRADING CU.'�DS. ACRES Ping. Ref. ��
Ramarks: Planning Notes:
a
Bar Sink
Backflow Preventer
Backflow Irrigation
Bathtubs
king Fountains
rt Oreins
ir Sinks
Service Outleu
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection fee'
S75
Duct - Under Ground
Duct - Structurel
Duct - Venti,lating
Exhaust System ❑ Multiple ❑
Firepl/FacL BIL ICBO #
Heating Sysrem & Ducting
❑0-700,000 BTU 0100,0008T
Peinspection Fee � S75
ApPllcant; Pink - Ac<ounting; Goltlenrotl - Assessor
L
Showers
Service Sink
Sewer Cap
Sewer Connection �
Solar Colle[[ors
Solar Piping
Solar Tank
Swimming Pool�w/Spa
Urinal
Water Closet
Water Neater
Water Service
Auto-Wash
laue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
00.100,OOOBTU ❑100,000
SVztem Repair/AI[eration
Registers
Issue Fae
FE
/1
Autometic Washer
Construction Pole S�
Cooking Unit
Dishwasher
Dryers �Gas ❑EI
Fan
F.A.U.
Fix[ures
Device Boxes
Outlets
Switches
Garbage Disposal
Generator �o-5 KW
— 3 ( Zone
Accessory Building:
. — Z
O
N
1
.r„ N
� j G
R
. Par'king Req.lProvided ' E
� Q
t M
ti� � T
S
ELECTRICAL
7ransformer ❑ 15-50 KW
❑ 50+KW
Meter �up [0 100 amps
Meter �over 100 amps
Su6 Panel
Momrs 00-1 HP Ol Yz - 8
Inc.Solar �9-15 HP �16-15+
Microwave
, Pole Light
5�15 KW
53I
� Reinspection Fee $75
FEES
�DEVELOPMENTSERVICES�
Zoning APPrared By_ L
Building Approved By
Aooliptian Issued Bv
$ 3
Sign
Standing Sections
Trash Compactor
luue Fee
FEES
S 3
SU V OF FEES . O'�
BUILDING PEFMIT $ 'S� SMIP $
PLAN CHECK 5 ZS. OZ . pEFM1T
PLUMBING $ �SSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL- $ ' _ GRADING $
PLAN CHECK 50% S MICROFILM $ ��
MECHANICAL 5 TOTALFEE $ .�(�
PLAN CNECK 25% $ .
ICONSTRUCTION AND PLANNING POOL & SPA
APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector�
1. •Temporary Elec[rical Service or Pole 52. Pooi & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit�Undrgrnd. 55. Electrica� Bonding '
5. Steel Reinforcement ; 56. Rough Plumbing & Pressure.Test
6. Electrical UFER Grnd. 57. APPROVALTO COVER-GUNITE
7. Footings 3 0 g/ G 58. Electrical Conduit-Undrgrnd.
8. Foundation �j G 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 &%�ir Conditioning FIRE DEPT. REQUIREMENT '
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping 0 Gas ❑ 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 76. FIRE PREV. FINAI . .
30. Drywall Nailing HEALTH DEPT. REQUIREMENT �•�
31. Plaster Brown Coat 79. FINAL INSPECTION '
32. Electriral Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: �� OK• 1� '
34. Final Heating & Air Conditioning .
35. Final Gas Pipe-Test �
36. Hood or Canopy
37. Final Factory Fir¢place ' �_
38. Final Plumbing � . �
i ,
39. Water Service-Finel ' '
40. Gas Service-Final ,
41. Solar pomestic-Final ' . '
42. Backflow Preventer � .
43. Backflow Irrigation � _. ' '
� 44. Landscape Irrigation System + , , �
i
45. Sound Attenuati0n �
46. Handicap Regulations '
47. FINAL STRUCTURE & BUILDING � 4� �'G/ ;
48 Special Requiremsnu Completed - • ,
49. Electric Release to Edison � '�
50. Gas Release to Southern California Gas Co + i
57. CERTIFICATE OF OCCUPANCY �
No. Date
%
CITY OI
Projecc�
Applicar
Owner's
Address
Arch/Eni
Address
Convact
Address I
City License No.
LICENSED CONTRACTOR DECLARATION
I hereby a(fi�m that I am licensetl untler provi5ion5 of Charter 9(commencing
with section 7000) of Division 3 of [he Business antl Pro�eSsiont Cotle, antl
my license is in tu11 torce antl eftect. '
License Class License No.
�a[e Si9�ature
WORKERS' COMPENSATION DECLARATION
' ltereby affirm [hat I M1ave a certifiWfe of consent to selT-Insure or a certiticate
Worke�s' Compensation InSurance, or a ce�tifietl copy the�eot (SeGtion
)0, l.ab. CJ
rolicy No. Company
BGer[ifietl copY is hereby /umishetl. '
Certifietl copy is illetl with tne city Bullain9 Dlvision.
Date APplicant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thissection neetl no[ be completetl if the permit is for one huntlretl (5300) or
Iess).
I C¢rtify [hat in the p¢rfo�mance of the w �k or whic his pe m�t i5 i55uetl, I
shall no em�loy any person in any ma B so om Subj ct to the
Worke s �^j alion Laws o� Califomi
Date (J_(_Si9naWre
NOTI[E: It, aiter making thiz declaration, you snoultl become subi � to the �
Workers' Compensatlon provisions of tne Labor Cotle, you must thwifh
com0ly with such O�ovlsions or this p¢rmit Shall be tle¢m¢tl �evoke0.
CONSTRUCTION LENDING AGENCV •
1 nereby attirm [nat tnere is a tonstruction lentlin9 agency for the pertormance
of the work Por h tnis per It if is ued ection ] Civ. C.)
Lentler's Name =�t�1Aa�:l�.`.'{'�� �'�"
Lentler's Atltl�ess K' ��Z
OWNER BUILDER DECLARATION
1 hereby alflrm lhat I am exempt irom ttte Contractor'z License Law tor [he
followin9 reason (Section 7031.5 Business antl Protessional Cotle: Any city or
�nimtv wnich reouires a oermit [o constlu<t: a1tCL ImOrova. tlemoli5F1 of reDail
Applicant to fill in all spaces exceo� those within heavy �arCer lines antl sign all ao0rooriate tleelarations.
a
ir.
�rCfrOm antl Ihe ba5i5 tOr tbe auegeG ¢xempuon. Hny v�oiauon or pecoon
ll.5 by dny applitant for a p¢rmil subjeCtS tbe appllcant to' a civll
�dlry of nOt more lhan tive huntlretl tlollars ($500j.
L� I, a5 owne� o( [he p�OpGrry o� my emPloyees wilh waqGs as their Sole
compenSaUon, will tlo fha work, antl tM1e s[ructuro is no[ intentletl or offeretl
for sale (Sectian 7044; Business antl Professional Cotle: The Contractor's
License Law tloes nOt apply to an ownEr Ot a prop¢rty who bulltls or improoes
thereon, antl who tloes such work hlTself/hers¢If o� tntough his or her own
employees, provltlea that such improvements are not intentletl or otferetl tor
sale. I(, however, the builtlin9 or improvemenf is soltl within ono Year ol com-
pletion, the owner will have the buraen oi proving ne/she tlitl not builtl or im-
p� ve fo� thn purpose of Sale).
I, as owner of tlte property, am ¢xclusivety contractinq wi[h Ilcensetl con-
tracto�5 t0 const�uct the p/oject (Sectlon 7044, Busine55 antl ProtesSions Cotle:
The ConVactor's License Law.tloes mt apply to an owner of properiy who
builtls or Improves lh¢reon, dntl who contracts fo� SUGh projects wilh a con-
tractor(51 Imense pursuant to [he Contra<to�'S LIc9n5e Law). I am aware that
proof of Ihelr WorkeYs Compensati insurance `houltl be pr�itletl [o me.
❑'I arr� exempt untler Sectlon -3� B. & PjjC. f this reason
Date Owner
I hereb cerl y t I have r a
intormalion is c rre L I
antl stale laws t n9 bi
Sentatives of th it e t
Inspectlon purpo e
SignaWre
Drivers' License $
tate thaA h7e above
tl countybr[U�ances
:Dy autho/i20 rep�e-
ionetl p opert for
Date
��.�- L7o/� I���� � V3�iv � �,�„ ,��.
TVPEOFCONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPT�F�VyQ,F31(/USE„QF,BL.QG. _ �
/ Kly J/'-/ ��c�C,1.o . i
TVPEOF'PERMIT GRADING ❑ FOUNDATION STRUCTVRAL
❑ TENANT. ❑ ELECTRICAL ❑ PLVMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SO.PT. ' OCCVPAN v
CONSTRUCTION TVPE VALUATION $ �aoo
ZONE GRADINGCU.YDS. ACRES
Remarks:' � •
� , — L
• ` PLUMBING FEES
Sink _ �
<flow Preventer '
5flow Irrigation �
itu65
�r�e:.: �. � '
Drinking Fountains
Floor Drains �
FlDor Sinks '
Gas Service OuNets
I nterceptors
Kitchen Sink
Lavatories
Roof Drains
Reinspection Fee � S15
Boiler
Duct-UnderGround
Duct - Structural
Duct-Ventilating '
Exhaust System ❑ Multiple
Firepl/FacL Blt. ICBO #
Heating System & Ducting
❑aioo,000 eru Oioo,000
Reinspection Fee � $15
CMF 0865-4fi, rev. 30/84 White - Builtling: Canary - Applicant; Pink - A<counting: Goltlenrotl - AsseSsor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Warer Closet
Water Heater
Water Service —�
Auto-Wash �
laue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0-t00,0008TU ❑700,000
System Repair/Alteration
Fire Dampers
Registers _
Isue Fee
5 3
$ 3
A.P. # �-( �.
S Main Building:
E
T Front
ARear
C Right
K Left
S �,
Ping. Ref. # �
Planning Notes:
Auwmatic Washer
Construction PoleSub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Elec�
Fan
F.A.U.
Fixtures
Device Boxes
Outle[5
Switches
Gar6age Dispoul
Generator DO-5 KW [
� Reinspection Fee
�
DEVELOPMENTSERVI
Zoning Approved By_
Building Approved By ;
Aonlication Issued Bv_
��' __ _ _�_-`_r— ' '
—'� � Zone
Accessory Building:
� • i t � Z
O
. 5 � N
I
I � N
�JV/ � I� �
R
-Ps��ing Req./Provided E
� �� M
s
ELECTRICAL ,
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up to 700amps
Meter ❑over100amps '
Sub Panel
Motors OO-7 HP O1 h� B
Inc.Solar 09-15 HP �)6-15+
Microwave
• Pole Light
Range
Standing Sections
5 KW Trash Compactor
$15 Istue Fee
IEQUIREMENTS:
FEES
$ 3
�^ 26 �%
SU ARV OF FEES ' - �"y
BUILDING PERMIT $ �� SMIP $ O�.�V
PLAN CHECK $ ll, 3% pERMIT
PIUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENEFGV P.C. $ �
ELECTRICAL g _ �- GRADING $
PLAN CHECK 50% $ MICROFILM $ n
MECHANICAL ' $ TOTAL FEE $ G , 3.
PLAN CHECK 25% $ �
CONSTRUCTION ANDPLANNING ' POOL&SPA
APPROVALS ,Permit# Date Inspector qppROVALS Permit# Date Inspector
1'. �Temporary Electrical Service or Pole 52. Pool & Equipment Location �
2. Soil Pipe-Undrgmd. , 53. Steel Reinforcement
3. Elpctrical Conduit Utilily-Undrgrnd. 54. Forms
4. El�ctrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure'�Test
6. Etectrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Fqotings 6 f0 58. Electrical Conduit-Undrgrnd.
$. Fpundation `' 59. Gas Pipe, O Undrgrnd., Test �
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK .�
i l. Property Sewer Line & House Connection 62. Backwash & Receptor•Final � .
12. Sewer Cap 63. Heater & Vent-Final �
13. Rnof Drains 64. Plumbing System - Final
� '
14. Rbugh Plumbing 65. Electrical-Final �' � '� �
75. Rough Electrica6Conduit 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 �
1
20. Rough Factory Fireplace APPROVALS Permit # _
21. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil '
23. Gas Pipe-Rough & Test 72. Underground Flush "
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil -
25. Roof Sheathing 74. Overhead Hydro �,
26. T�Bar Ceiling (Structural) & Monocoat 75. Dry Chemical, �
27. Frame and Flashing 76. Dry Standpipe `� � F
28. Lathing & Siding • 77. FIXED SYST.EM FINAL �
29. Insulation 78. FIRE PREV. FINAL i '
30. Drywall Nailing HEALTH DEPT:I�EQUIREMENT ' �•
31. Plaster Brown Coat 79. FINAL INSPECTION � ' '
,
♦J .
32. Electrical Power Meter-Final . 80. FOOD CERTIFICATE ISSFIED �
33. Final Electric , Notes: t �'6"0 ���
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy �
37. Final Factory Fireplace �
� 38. FinafPlumbing - � ' � ,
t
39. Water Service-Final ` � ' ' ,
40. Gas Service�Final � r, � , ,. ��.
� 41. S�lar pomesticFinal _ - • ' '
'42..Backflow Preventer � � ' . - � •
�
� . � .
43. Backflow Irrigation , �
��
44. Landscape Irrigation SYstem ' � � � " � �
45. Sbund Attenuation � � �
46. Handicap Regulations , „
47. FiNAL STRUCTURE & BUILDING =� „' i •
48. Spe�ciabRequirements Completed rn i '
49. Electrie-Releaseto Edison ' � � �
50. Gas Release to Southem California Gas Co " -
51. CERTIFICATE OF OCCUPANCY
No. Date t
- _.. ��..-
Applicant to fill in all spaces except those wit�in heavy borEe� Iinas anG si9n all appropriate Oecla�ations.
CITY OF COSTA ME�A CONSTRUCTION�P�RMIT
Project Address ¢i r
ApplicanYs Mailing ddres L J Z�• � 6' e /.- 's/-�^i/� ,
Owner's Name �j � Phone ��:
Address O � � s � Q Sp •
Arch/Eng. � License No.
Address
r
Con[ratlor's Nam on �
Address (m� �'��I � 3%.S 2. /�y !b 3.G�Qi • SiA�..%xiiivi! �J2
c��Y �i�e�se No. O �lbl0 `Z_S �
LICENSED CONTRACTOR DECLARATION
1 hereby attirm tbat I am Iicensetl untler provisions oi Charter 9(commencing
with sec[ion 7000) ot Divislon 3 of the Business antl Pro(essfons Cotle, and
�my license is in full forc tl effect. O
LicenSe Class �C�%ise
` Date?��o�i(i Si9nature
WORKERS' COMPENSATION DECLARATION
� hereby afiirm that I have a certificate oi wnsent to selt-insure or a tertificate
Worke�s' COmp¢nsation Insutance, o� a certifietl copy tne�eof (SeCtion
00, Lab. �C.,JIn,�,�'_ /���
1 ✓olicy No.C[LCCSL� S �� Company�I �E� S �
I� Certifiea coDY is nereby (urnishetl.
,/� Certitie coPvp �s iletl with the city B iltl 9 Div' lo
�,/ Date � -� � " � APPlicdnt
EXEMPTION FROM WORKERS' COMPENSATION DECL ATION
(Thissec[ion neetl not be completetl i� the permit is for one huntlretl ($SO or
less).
I C¢rtity tnat in the performanG¢ of th¢ work f0� whic� this pe�mR ISlssuetl, I
shall not employ any perzon'tn any manner so as to become subject to the
Workers' Compensatlon Laws oi California.
Date � Si9nature
� NOTICE:If,alte� making IhiS da<IdratiOn, y0u shOu10 becOme Subject�to the
Workers' Compensation provi5ions of the Ldbo� CoOe, y0u must forthwitn
comply with such provislons or this permit shall be tleeme0 revoketl.
CONSTRUCTION LENDING AGENCV
I hereby a(firm that there is a constructlon lentling agency for the oer(ormance
of tne work tor which this permit is Issuetl (Section 3097 Civ. C.)
Lentler's Name ^
Lentler's AtlOress �
OWNER BUILOEH GECLARATION
1 hereby affirm that I'am exempt from [he Contractor's Licenso Law for tha
following reason (Seciian 7031.5 Buslness antl ProfeSzional Cotle: Any city or
county which requlres a permit to construct, alter, improva, tlemolish or repalr
any structure, orior,to its issuance, also requires tne avolicant tor sucn permit
to file a si9netl ztatement that he/zhe Is Ilcensetl oursuant to the provisions ot
the Contractor's Ucense Law (ChaO�er 9(commencing witn Seclion ]000) o(
Division 3 of the Business antl Professions Cotle) or that he/she is ezempt
=retrom antl tM1e basis for the allegetl exemption. Any violation o� Section
A.5 by any applicanl for a permit subjects Ihe appliwnt to a civll
�alty ot not more [ban tive huntlrea tlolla�5 (5500).
L� I, as owner o( tne property or my employees witn wages as their sole
corppensatio0, will'tlo the wo�k, antl the strUcture i5 not Intentletl o� offeretl
for sale (Section 7044, Business ane Profe55ional Cotle: The Contrac[or's
LicenSe Law tloes not apply to an owner ot a property who builtls or improves
thereon, and wM10 tloes SucM1 work himself/horsolf o� Ihrou9h his or her own
employee5, provitled that such improvement5 are not intentletl or ofteretl for
sale. If, howev¢r, [he builtlin9 or ImO�ovement i5 Soltl within On¢ year of com-
pletioq tne owner will have the burtlen of provin9 he/she tlitl not build or im-
� ��Ove for fhe purpoSC o( sale).
1, as owner of the property, am extluzively wn[racting with Iicensed con-
tractors to construct the project ISection 7044, Business antl Protesslons Cotle:
The Contractor's License Law does not apply to an owner of properry who
builtls or impraves tnereon, antl who contracts for such projects with a can-
tractoi(s) ucense pursuant to the Contracfor's �icense Law). 1 am aware that
proot of thei� Wo�ker'S Compen5ation insu�anc¢ Shoultl be provitletl to m0.
❑ I am ezempt untler Sectlon B. & P. C. for this reason
Date Owner _
I M1ereby certify that I have read this
Infolmation IS COIf¢Ct. I dqfE¢ f0 COTp
Signature �,j�
Drivers' Licensc or SS
above
nances
repre-
b tor
�SL ���� - I -- - I ...... ,.�.
TYPE OFCONSTRUCTI� NEW ADD ALTERATION REPAIR
❑ CONVERSION DEMOLISH ❑ OTH R
DESCRIPTI N OF WORK/ SE OF B DG �C.Lsin� �b<as .�rRS
Tv�s� � /- �a�L� �A-�-.aoc ou f- ��
TYPEOFPERMI GRADING FOUNDATION STRUCTURAL
❑ TENANT � ELEf�7RICAl ❑ PLVMBING ❑ MECHANICAL
❑ OTHER aS�
PROJECT DESCRIPTION Sa. FT. oCCVaANGv„�,}_
CONSTRUCTIONTVPE VALVATION$ � ��
ZONE GRADINGCU.VDS. ACRES
Remarks:
Bar Sink
Backflow Prevencer
Backflow Irrigation
Bathtubs
Clarifiers
Dishwasher
Drinkin9 Fountains
Floor Drains
Floor Sinks
Gas Service� Outlets
Intercepro�s
Kitchen Sink ' .
Lavarories�
P-Trep ;
Roaf Drains
Reinspection Fee
Showers
Se�vice Sink
Sewer Cap
Sewer Connection
$olar Collecrors
Solar Piping �
Solar Tank
Swimming Pool w,
Urinal
Weter CIOut
Water Heater
Water Service
Auto-Wash
Laundrv Travs
$15 � � ' Iuue Fee
Boiler
Duct-UnderGround
Duct - SlrucWral
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Facc Blt. ICBO #
Heating System & Ducting
❑ 0-100,000 BTU � 100,000
Reinspection Fee � $15
CMF 0865-46, rev. 30/84 White - Builtlin9; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor
FEES
A.P. #
S Main Buildin9:
E
T Frant
6 Rear
A
C Right
SLeft
Ping. Ref. # '
Planning Notes:
Automatic Washer
Construction PoleSub.
�' Caoking Unit •
Dishwasher
Dryers OGas ❑Elec
Fan
F.A.U.
Fixtures
' Device Boxes
Outlets
Switches� -
Garbage Dispoul
� Generaror �0-5 KW C
$ 3
1924 2/05/87
Zone
Accessory Building:
Parking Req./Provided
ELECTRICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter �up to 100 amps
Meter �over 100 amps �
Sub Panel
Motors �0.1 HP D�iX-8
Inc.Solar �9-15 HP �16-75+
Microwave
Pole Light
Range
Standing Sections
5 KW Trash Compactor
Reinspection Fee $15 luue Fee
IANICAL FEES
Hoodor Typel ❑ DEVELOPMENTSERVICESREQUIREMENTS:
CanoPY TYPe I I ❑ ' ZoninB APProved BY _
Building Approved B� � �
Refrigeration System
❑0�700,OOOBTU ❑100,000
System Aepair/Alteration
Fire Dampers
Registers
Issue Fea � $ 3
!
37.50 � TL�
Z
O
N
I
N
G
R
E
Q
M
T
S
FEES
$ 3
SUMMARV OF FEES
BUILDING PERMIT $ �g•0� SMIP $ 'J��
PLAN CHECK $� PERMIT
PLUMBING $ •00 ISSUANCE � $�
�JOV�2.PLAN CHECK 25% $ • ENERGV P.C. $
ELECTRICA� $ ' �•� GRADING $
PLANCHECK 50% $ ' MICROFILM $
� MECHANICA� $ TOTAL FEE $
PLAN CHECK 25%� $ ;��
/i�
' 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-Undrgmd. � 53. Steel Reinforcement
3. Elecvical Conduit Utility-Undrgrnd. 54. Forms �
4. Electrical Conduit�Undrgmd. ' 55. Electrical Bonding
5. Steel Reinforcement ' 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings • 58. Electrical Conduit-Undrgrnd.
8. Foundation � � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pip,e-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System 61. APPROVAL 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-Finel �
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 �• �
79. 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 IStructurel) & 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. Electrical Power Meter-Final .3_�� 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: - '� ,
34. Final Heating & Air Conditioning . .��
r
35. Final Gas Pipe-Test `
36. Hood or Canopy � . , �
r
37�.�Final Factory Fireplace ' . � � �. y !` 9 � .
38. Final Plumbing � ' . -�� �
.� .
39-. Water Service-Final � �` �' � � � - '
Y� � , .
40. Gas Service-Final � . � '
41. Solar pomestioFinal . ' � ��� - �� '•
_ • . '�
�42. Backflow Preventer , �� ! ' , �
43.�Backflowlrrigation - .� ,� - , ;'�. �i,-�
44.'Landscape Irrigation System � � , . . ` r� '• � '
�
d5-. Sound Attenuation � � � � �
�46. Handicap Regulations ' � -- ' � . ' - "
47: �FINAL STRUCTURE & BUILDING -I . ' � , ; . .-�
� , .
48.�_Special Requirements Completed - . . ' ' - � . � "
49: �Electric Release to Edison i �- ,
50. Gas Release to Southern California Gas Co ;��� .�
51. CERTIFICATE OF OCCUPANCY
No. Date -� r �
�- _
��
�— \V�V
ADP���ant to fil`in all spaeas except t�ose wit�in heavy Oo�Ee� linas an0 si9n all aDOroOriata Oeclaralions.
ciTv oF �oSTn QnnE/S�A� CONST UC ION PERMIT
I�roject Address —4�� ` �, � T� �� � /�
Applicant's Mal7liyn �.Address �4�?Z���:�.�/�� �G
Owner'sNa/m�e �`��3�`.�'L'-�Qd�s� �����Ph�oyn�e�=2 �
Address 2`CS_►JN ` l� L���-�1��"�'
Arch/Eng. � Licenu No.
Address -�. .1� �.��^� 6
Contracror's Nam�T�W` {�( • Phone�
Address (mailin9) ���Zc� '�u�'� �/ ll]`l�_� Q
City License No. ���� •�3
LICENSED CONTRACTOR DECLARATION
1 hereby aHi�m thdt I am licensetl untle� provision5 of Charter 9(commencing
with section 7000) ot Oivision 3 of tna Buslness antl Profe55ion5 Gotle, antl
my Ilcense is in f W I force antl eRect. ,
LJCBIISC CId55 �/_ � L 5 N ��
�ate�?Si9natu � .9 —
WORKERS' COM ENSATION DECLARATION
I hereoy aHirm Ihat I have a certiticate oi consent to self-insure or a certiilcate
ot Workers' Compenzafion Insu�ance, or d certifietl WpY thereof (Sectlon
7800,- Lab. ) � � �
coii�v No.�_�Q� � �� comoa�r �t ♦l'X,� �
❑ Certifietl <opy is hereby turnishe0.
fx2`erti ' cop i filetl with the ci u g Division.�
Date Applicant ����'�
EXEMPTION FR M WORKERS' COMPENSATION DECLARATION
(Thisseclion.neetl not be completetl if the permit islor one�huntlretl (E100) or .
less). •
I certity tha[ in the performance of lne wo�k tor which this perm�t is Issuetl I
shall not employ any person in any mann¢r so'az to become subject to t�¢
Workers' Compensatiom Laws of Califomia.
. Date Si9nature
�NOTICE: II, af[er making this tleclaratlon, you shoultl become subject to the
Workers' Compensation provisions of the Labor Cotle, you must forthwith
mmply with such provislons or this permlt shall' be tleemetl r¢voketl.
CONSTRUCTION�LENOING.AGENCV �
I hereby atfi�m tha[ there iz a[on5truction lentling a9enty tor the pe��o�mance
of [he 'work ror wM1ich this permil i1 i55uetl (Section 309] Civ. C.)
Lentler's Name � _
Lentler's Atltl/ess
OWNER BUILDER bECLARATION �
I hereby affirm that I am exemp[ trom lhe Contractor'S litense Law for Ihe
tollowin9 reason (Section 7031.5 Business antl�Protessional Cotle: Any tlty or
county wnlcb r¢qui�as a perml[ to conz[ruct, alter, improve, tlemoliSM1 o� repair
any st�ucture, prio� to its i55uanc¢, also �equlr¢5 the appli<an[ to� Such pe�mil
to fi�e a.5ignetl statement that he/she is licensetl pursuant to the provisions of
the Contractor'S License Law (Chapler 9_(commencing with Sectlon 7000) bf
Division 3 of the Business antl Protessions Catle) or that he/she Is exempt
Nerefrom antl the basis for tne allegetl exemptlon. Any violation oi SecUon
�031.5 by any applican[ for" a permit zubjects [he applicant lo a Civil
enalty of nol more than tive huntlretl tlollars (5500).
L� 1, as owner ot Ihe proper[y or TY emplOyees with wa9es as Ih¢ir sole ,
Compen5ation, will tlo the work, anC Ue structure i5 not in[entletl o� o(feretl
, tor sale (Seccion 7044, Business antl Professional Cotle: The Contractor's
� License law tloes not apply to an.owner of a property who builtls or improves
' thereon, antl who aoes such work himself/herselt or tnrough his or her own
employees, proviDetl Ihat such improvements are not intentletl or OffereQfor
sale. If, hOwever, [he builtling o� Improvement is Soltl within one year of <om-
pletion, the owner will have the bur�en ot proving he/she tlitl not builtl or�lm-
�ove tor the vurpose ot sale). ,
LI I, as owner oi the properry, am exclusively contractin9 with licensetl con-
tractors to construct the proie�t (Section 7044, Business antl Protessions Cotle:
The ContraCtov's License Law tloes not apply to an owner of property who I
builtls or Improves thereon, antl. who contracts ior such projects with a con- '
tractor(s1 Ocense pursuant to tM1e Conlractor's Li<ense Law). I am aware that
proof o� thei� Worket'S Compensatlon insurance shoultl be provltletl to!me.
❑'I am exempt untler Section B. & P. G lur this r¢ason '
IDate - Owner .
I hereby certity that I have �eatl thi3 applicatlOn antl state lttat Ihe above
in/ormatlon is corrett. I agree to comply with all clty antl counly ortlinances
antl s[a[e laws relating to builtlm9 constructlon,.antl hereby autnorize repre-
sentatives of this city to enter �{on�t(ie above-mentionetl property for
Orivers'
TYPE OF CONSTRUCTION LI NEW LJ ADD LJ ALTERATION LJ REPAI R
❑ GONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION OF WORK/USE OF BLDG.
TVPE OF PERMIT LJ GRADING LJ FOUNDAT� LJ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SQ.Fr. oCGuanrvCV—
CONSTRUCTION TVPE VALUATION $
ZONE GRADING CU. VDS. ACRES_
Remarks: O_._.� �
S.{_t�i
Bar Sink
Backflow Preventer
Backflow IrrigatiOn
Bathtubs -
Clarifiers �
Dishwasher '
Drinking Fountains
Floor Drains
Floor Sinks. • .
Gas Service Outlets
Interceprors �
Kitchen Sink
'Lavamries -.
P—Trap
Roof Drains •
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collecmrs
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Water Heater
Water Service
.AutO-Wash _
Reinspection Fee I $75 I � Issue Fae I $ 3
Boiler
Duct - Under'Ground
Duct - Struc[ural
Duct-Ventilating •
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑ ai oo,aoo eru O i oo,aoo eT
cc >t ( -�— —r� -. I I Rainspection Fee
CMF 0865-46, rev. 10/84 White - Bulltling; Canary - Applicant; Pink - Accountln9: Goltlenrotl - Assessor
$15
Hoodor Typel ❑
Canopy Type I I ❑
3,,e/frigeration System
d�0�700,0008TU ❑100,000
System Repair/Alreration
Fire Dampers �
Registers '
Issue Fee
A.P. #
S Main Building:
E
T Front
B Rear
A
C fli9ht
g Left
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction Pole Sub.
Cooking Unit .
Dishwasher
Dryers ❑Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Boxes
OuUets
Switches
Garbage Disposal
Generetor �0-5 KW [
f'I �69B 5/28/P_7
�
Zone
Accessory Buildin9: �
Parking Req./Provided
ELECTRICAL .
Transformer ❑� 75-50 KN
❑ 50+KW
Merer ❑up to 100 amps
Meter ❑over100amps.
Sub Panel
.Motors�0-1 HP �1'/:-8
Inc. Solar �9�15 HP �16
Microwave ' -
Pole Li9ht
Range
5KW
Reinspection Fee $15
FEES
�DEVELOPMENTSERVICESREQI
Zoning Approved By
Building Approved By
�,
$ 3
; Standing Sections
Trash Compacror
�
Issue Fee
7n0" TI
FEES
$ 3
Z
O
N
I
N
G
R
E
�
M
T
5
SUMMAHV OF fEES �
BUILDING PERMIT $ ' SMIP � �, $ �
PLAN CHECK $ PERMIT �
PLUMBING� $ ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $�
ELECTRICAL '$ GRADING $
PLAN CHECK 50% 3 �JM�ICROFILM $_
MECHANICAL $ �iVI�OTAL FEE $ '�
PLAN CHECK 25% $
/ --
=CONSTRUCTION AND PLANNING � POOL ,PA
% APPROVALS - Permit# Date Inspector AppROVALS Permit# Date Inspec*or
!
i 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location .
2. -Soil Pipe-Undrgrnd. _ � 53. Steel Reinforcement
3. Electrical Conduit Utility-Urldrgrnd. - 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 .
� 77 Footings 58. Electrical Conduif-Undrgrnd. .
8- Foundation 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P-Trap, O Undrgrnd.
� 10. •Structural Floor Sysfem 61. APPROVAL TO DECK
11. Property Sewer Line & House Connectiqn 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
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
, 33. Final Electric Notes:
34. Final Heating & Air Conditioning � /� ��� -
35. Final Gas Pipe-Test �
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing .
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final , .
42. Backflow Preventer i7� '
43. Backflow Irrigation 'j' - � , �
�
44. Landscape Irrigation System i'I'! '
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�ieant to fill in all soaces exceot those witnin heavy EorCer Iinas an0 sign all approvriate aeclarations.
CITV OF COSTA MESA CO STRUCTIONQ PF�II IT /`-s
Project Address ��� �� � L�
' 3Yy 5: la2E�..�G�e ae.�
' Applicant's Mailing Address
/�1liL /y�4 G �
. Owner's Name (� � Z�`,� Phone
�Address W �U-� �S�- ���
Arch/Eng. Licenu No.
Address � SSy g7
Contrector's Nam 7 G��C Phone
Addresslmailingl �y S• U/[G�it.K�2�t� u�Ge
City License No. 2-a �& L�
LICENSED CONTRACTOR DECLARATION
1 h¢reby affirm that I am lic¢nsetl untle� provislOns of Charter 9(comm¢ncinq
with sectlon �000) of Division 3 of the Business antl P�ofesslons Cotle, antl
my license is in tull forca antl /esitec .,. ,.,
License CIa55 "'�� � i se No. Y��Z •�
Date 519nature ^ �
'ORKERS'COMPENSATION DECIARATION
iereby aHirm that I havo a certilicate o( mnsent to selt-inzure or a certlticate
�f Workers' Compensation Insurance, or a certitietl copy thereot (Section
3800, Lab. C.) .
Policy No. Company
8 Certifietl mpy is hereby furnl5he0.
Certitietl copy Is filetl witn the city Builtling Division.
Date Applicant
EXEMPTION FfiOM WORKERS' COMPENSATION OECLARATION
(Tbis settlon neetl not be completetl if the permit is tor one huntlretl (E100) or
less).
I ce�tify that in [h¢ Pertormanco of the work fOr which this Oe�m�t i5155u¢tl, I
snall mt employ any person in any manner so az to wm subj t to the
Workers' � nsati n Laws of Cdlifornia. C
Date Si9nature
'� NOTICE: If, atte� �mdking tttis tletlaratlon, you Shoultl become ec lo thB
� Worke�s' COmp¢nsdtion provi5ion5 ot the LabOr Code, you mus torthwith
comply witn Such prOviiiOns o� IhiS permit shall be tle¢metl �evoketl.
CONSTRUCTION IENDING AGENCV
1 nereby allirm that tnero iz a construction lentling agency tor the performance
oi [he work for wMcn this permit is issuetl (Section 3097 Civ. CJ
Lentle�'S Name
Lentler's Aaaress �
OWNER BUILOEN OECLARATION
I hereby afti�m lha[ I am exempt from the Cont�actor'S License L.aw 10� [he
followin9 reason (Section 7031.5 Businass antl Protessional Cotle: Any city or
county which requires a perml[ to construct, alter, improve, tlemolish or repalr
any 5[�ucture, prio/ to Il5 Issuance, alm require5 the applicant to� suCh pe�mit
to fiie a si9netl statement tnat he/she Is licenzetl oursuant to the provisions ot
`he ConVactor's License Law (Chapter 9(commencinq with Settion 7000) of
livision 3 0( [he Bu57ness antl Profe55ions Coae) or Ihat-he/she is exempt
.he�etrOm antl the ba5i5 for the aIIEg¢tl exemption. Any violation of SeGtlon
7031.5 by any applican[ for a Permit subjects ihe applicant lo a clvil
p¢nalty of not more than five huntlretl tlollars (5500).
❑ I, as owner of the o�operty or my employees with wa9es as their sole
comoensation, wi11 tlo the work, antl the struciure iz not intenCetl or otferetl
fo� sale (Section �044, Businass antl Professional Cotle: The ContraCtOr's
License ldw tloes not apply to an owner of a property who builtls or improves
t�ereon, antl who tloe5 suctt work hlmselt/he�self or through his or h¢� own
employees, p�ovitletl that such improvements are not Intendetl or offeretl br
sale. If, �owever, the bulltlin9 or improvemen[ is soltl within One year ot com-
pletion, the owner will have tha burtlen of p�ovin9 he/she tlid not builtl or IT-
prove for the ourpose of sale).
❑ I, a5 owner Ot the property, am excluSively contracting wi[h IlcenSetl con-
tractorz to construct the vroject ISection 7044, Business antl Profeszions Cotle:
The Con(racroYs Licenze Law doez not appry to an owner ot property wbo
builtls or Improves thereon, antl who contracts for such projects with a con-
tractor�zl ucense Dursuant to the Contractor's License Law). 1 am aware that
proof of their Worker's CompnnsaHon insu�ance shOultl be provitl¢tl [o me.
❑ I am exempt untler Seccion B. & P. C. for tnis reason
`rl
Da[e � Owner
I h¢reby certify thal 1 hava rea�
information is correct. I agree to
antl state laws relatlng to builtlir
sentatives of thi5 city ro enter
inspection purposes.
Signature �
Drivers' License or SS 9f
this appliwtion antl state that the abovo
�mON �+'ith all city antl county OrtlinanCos
construction, antl hereby authorize repre-
3pon t C d}1 ve-mentionetl prOperty fol '
L Date �� ���
E2.?89E�
�YPE OF CONSTRUCTION NEW ADD AITERATION REPAIR
-� CONVE0.510N ❑ DEMOLISH ❑ OTHER �+� q p#
DESCRIPTION OF WORK/USE OF BLDG. M T—Y!—�
' S Main Building:
E
TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Flont
❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear
❑ OTHER C Righf
PROJECT DESCRIPTION SQn. -FT. �OB� OCCUPaNCV K
CONSTftUCT10N TVPE �y��1L BLI=- VALUATION $ g Left
ZONE GRADING CU. VDS. ACRES p�ng. Ref.9�
Remarks: . , Planning Notes:
Sink
Preventer
Irrigation
Drinking Fountains �
Floor Drains
Floor Sinks
Gas Seryice Outlets
Int¢rceptars
Kitchen Sink
Lavatories
P—Trap
Fioof Dr � s �
Reinspenion Fee
FEES
3ervice Sink
SewerCap
Sewer Connection
Solar Collectors
Solar Piping
Solar T
Sw' ming Pool w/Spa
rinal
Wat Closet
Water He er '
Water Service
Auto-Wash
laundry Trays
$15 laue Fee $
MECHANICAL FE
� I Hood Or Type I ❑
Canopy Typell ❑
Duct - Ventilating �,
Exhaust System ❑ Multiple
FirepUFact. BIL ICBO #
Heating System & Ducting�
❑0700,000 BTU Ot , 00
fee � $15
AF 0065-46, �ev. 30/B4 Whit¢ - BUIltling; Canary - ApplicanC Pink - Accountin9: GolOenrotl - Assessor
Refrigeration
❑0.100,000.
luua Fea
100,000
$ 3
.. �
�� � �'_
�
, { Zone
'Accessory Buildin .
Z
_ ' O
L�� . , �.ii/i �:;GJ N
I
N
G
R
Parking Req./Provided E
M
T
S
ELECTRICAL
Automatic Washer Transformer ❑ 15-50 KW
Construction Pole Sub. � 50 + KW
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fix[ures
Device Boxes
�Utl¢t5
$witCh¢5
Garbage Disposal
Generator �0-5 KW 05-75 KW
Meter ❑up to 100 amps
Meter QSvert00amps
� Sub Panel
f Mom�s�0.1 HP �1X-8
Inc.Solar �9-75 HP �16-75+
Microwave
Pole Light V ,
Range •
Sign
Standing Sections
Trash Compactor
Fee �$15 � � luue Fee
�DEVELOPMENT SEflVICES REQUIREMENTS:
Zoning Approved By
, Building Approved By �d
Aooliwtion luued ev ���1
FEES
ZO
C
$ 3
SUMMARY OF FEES
BUILDING PERM17 $ SMIP $
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $
ELECTRICAI $ 6.S •OD GRADING $
PLAN CHECK 50% $ � I.O'C MICROFILM $
MECHANICAL $ TOTALFEE� $ 9E .04
PLAN CHECK 25% $
CONSTRUCTION AND PLANNING - � � POOL & SPA
Date Inspector �ApPROVALS Permit # Date Inspector
APPROVALS Permit# ,
1. �Temporary El2ctrical 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 Wirin . � 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. Rou9h 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. Frameand Flashing �� � Z6. 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 � _':g' J C, Notes: 3� -
34. Final Heating & Air Conditioning �
� e �v.-r�. 'l: / -s
� 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 e'
�42. Backflow Preventer •
43. Backflow Irrigation - . �
'44. Landscape Irrigation System � -
45. Sound Attenuation • "
48. Handicap Regulations � . � � �
47. FINALSTRUCTURE&BUILDING '
48. Special Requiremen[s Completed "
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
57. CERTIFICATE OF OCCUPANCY -
No. Date - _,��
COUNTY OF ORANGE' � , �
BUILDING DEPT. ' permit No.
636 No. Broadway �.��".� ..."""'�' '"
. s�,t,,,,,,,�,�;{o,,,;, _ Application for Building Permit
Phone: KI 2fi211 AND FOR A
Certificate of Use and Occupancy
Da�e.... .T..c�,�E......6..�. -- ........1..4�'s----��--
1. OWNER'S NAME.....�AL.'1.�G`...R...- ..R.�._.1j�11.IQ...N..S'./.1TE ......................................... PHONE:..��--�ZG.Q�._W
p Ttr �.'y—
MAILING ADDRESS.........0..6.!riF..._.......Ce%.�.... /� ........................................................ CITY...... �Q.ST.�...../.�I FS�.......
Name._...._..�..4.!J'�....-�--� �— ............. •----........- ........
(Architcct or Enginecr)
Address........................................................................................
City ._.
State
Lic. N
Name ..�Q�Glt�......�......l.d..�l.l� .X.I[Qf...-- ...................
(Contractor)
Address.----�--•'--'- ..............................'-------..........._....-----.......-'-----
City
State
Lic. i
PROI'OSED USE: - ..C�J.ARAi�j.4�.., ... . .......................................................................................................................................... .
p TMp
JOBLOCATION.._Oi.4k.......-- � � .W'.....I..� -.....a.T...........-- ... ..........._�S.G4. .Mi.s.4---........--............. --
(House No.) (Name of 5[ree[) ("Iown or School Diserict)
LEGAL DESCRIPTION: Lat----� ..-.------_----.....Block ....�--_ ................ Tract.-_____ _'�.'. . ----_.......-.--.-.-
(Me.es and Bounds Dcscription se reverse :ide o( f
CORNER LOT ( ) INTERIOR LOT ( x) THROUGH LOT ( ) SLOPE OF LOT ( > F�.Ar
^_ L q/ t�,
SIZE OF BLDG.:.�+ X� AREA:.....T� ...............SIZE OF LOT:.16� ..i�.....6.�t.....AREA:-----17'��..----�-- -
HEIGHT OF BLDG.:._...L�_,..__ .....................CEILING HEIGHT:......._�,..�.�....__..NO. OF STORIES......._L......._...........
7. NO. FAMILIES......�±.�tw?fi.........___.Sizc of Smallest Bedroom:.......N'b. ..�1,.. � .............. Size of Kitchen......./�Q.�l�r........
8. EXTERIOR WALL CONSTRUCTION:.._�rV�G�..,... ..INTERIOR WALL COVERING ............................................
� (Frame, Stucco, E[c.) � (Plaster�Dr uall, Etc.
9. SETBACKS: Front Yard From Center Line of St .�sa�..���.�.. ,........fl%.Q ......................._Y...._......._)_.
-------•--... --•-.........
/ �
. ti , : .
Nearesc Side Yard/..� ...............Rcar 1'ard....,�:� �......Distance in Feet Betwcen Hldgs. on Same Lot........�.0............................
10. A COMPLETE PLOT PLAN IS REQUIR�, SHOWING ALL STRUCTUR�S AND USE OF EACH.
p�I
] l. For (a) Footing: Width.....1�%.' ............................Depth in Ground......._e.........---...---.Width of Wall---...._.......-.----.........
Accessory
Sldgs. and b Size of Studs:..IIt.� .... ..........5 acin �� e..:'CC Material of F1oor.....CQ1�G.�6sT..�........
$imilar � ) � P �.... . ...� �.
Structures:
�c) Sizc of Floor Joists:--.../:TC.2.N.� ...............Spacing........---........................---...:'CC
(d) Size of Raf2ers:......Y.-..X . 4' �
.. ... ............--..........Spacing....---.....�..�...........,---..."CQ
]2. VALUATION OF PROPOSED WC�R�,: Including all labor, pfumbing, electrical wiring, heating, fire sprinklers, painting and
sewage disposal 5---}..0..4.)..�0�% ............... —
13. , I HEREIIY CERTIFY THAT. TO THE BEST OF 2v1Y KNOWLEDGE AND BELIEF THE INFORMATION IN THIS
APPLICATION IS CORRECT AND THAT THE CONSTRUCTION WORK WILL CONFORM TO ALL LAWS OF
THE COUNTY OF ORANGE AND THE STATE OF CALIFORNIA APPLICABLE THERETO.
D ""-- Signcd:--..:4±7Ri..:�el.-._'-�S.--z.--`��7.rfyl�n�+lr.!�:e4.'-<_'-----"....'-'_..-'—`--_'-
plans Filed:-_--�4..- -�� - �, ��' (O.�,ner)
..-- -------- ...__- .
By:..-. _" ....... ..........."--"_"'-"---'...--_....'_.__._."'....__-""--""----""_.......-'-"--•-'-
Dldg. Permit
Plan Check
Tonl - -
Receipc No.
I':tid to •
Date -------....
OM-P.SI
FEES: �
0
S"'y'p r """""'...""_'""'
• 5.../...8.�.......---�— -
• s_y .......................�- -
DATE....V�...."'�.L....-. �.. .�.�.........
FOR DEPARTMENTAL USE ONLY
GROUP.. _�..
TYPE_..... � ....................
DIST. C � l4
MAP........'.. • - .......Y...... -...
SHEET IQO...s..------ ........
(Auehorized Agent)
CG'�' "� ]NG BY
APPLICATION.d., �....... HEALTH......__ ...................
ZONING...----- .............._. FIRE
PLANS AND MARSHAL......._ ................
SPEC'S.-------� ............:_... STATE............. ----..........
CORRECTIONS ENGINEER
Ciry of Costa Mesa
Development Services Department
Building Safety Division
P.O.eox 1200
Costa Mesa, Califomia
CERTIFICATE OF OCCUPANCY No. �OZ%19
The Building located at RS<R M17- 1RRF CFraa+t
has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto
for a Group S—� Occupancy.
Use of Building I(1dU8tF.l.d1
Legal Description 424-182-31
(See reverse side for Metes and Bounds)
Building Permit No R 97009 Electrical Permit No. E 2�g97 Plumbing Permit No. � 2�679
Mechanical Permit No. � 27679 Number of apartments and/or guest rooms
Eire Prev. j�armit [�o. F 28736
ISSUED TO:
John Ha�le
&i� 47. 18th Street. 4A
Costa t�sa, CA 92627
Building Official William T. Hocaard
by �.�. _ :� / /.a,- -
Date Novemfi'�ir 1. 1988
This C�ertificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE
Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C.
CMF 1015-46 rev. 1/83 White - Owner, Can^—� - Numerical File; Pink - Bldg. Permit File
removed except by the
Aop�icant to fill in all spaces ezeept ihose within heavy eortler lines ana zign all aDoropriate tleclarations.
c!TY OF COS7A MESA_ '_CONS'fR�I,�TION PERMIT
*Project Address ,���A1 rJi �`b C�s,-ia f•1 zsa
:Applicant'Sil4ailingAddress 3��5 C2FE�L�Qci+�'� D�%.0
�Owner's Name �'— ���i�� ,A Phone
Address +� 57 ��STA rt�$(�
ArchlEng. License No.
Address N'
Convactor's Name S����I r���LEL Phone 33 �$Jt5
Addresslmailin9) 37p-17=�1 L���N�"'Q��
City License No. —y7 SD �
LICENSED CONTRACTOR DECLARATION �
1 hereby at(irm that I am licensetl untle� ProviSions af Charte� 9(commenCing
with section �000) of Division 3 of the Business antl Professions Cotle, antl
my license is in f W I force�tl et ct. _`
License Class � icens NP. ' CZ9
Date� Signah�e
WOftKERS'COMPENSATION DECLARATION
iereby affirm <hat I have a certiticafe ot consent to self-inzure or a cerHficate
Wo�ke�s' COmpensation InSurance, o� a certifietl copy th¢/eof (SeCtion
..800. Lab. CJ .
Policy No. Company
eGertifietl coQY �5 he�eby /urnishetl. .
Certitietl copY is (iletl with the city Builtling �Ivision.
Date APPllcant .
EXEMPTION FROM WORKERS' COMPENSATION DECLARAT{ON
(Thissection neetl not be mmpletetl if tne permit is �or one hundretl (g100) ar
less)
I certify that in the pertormance of tne work !or which this permk is issuetl, I
shall not emploY any person in any manner so as t9.betome subje to Ihe
Workers' Com.H,¢nsdtion�ws of California. /// � M •
Date `�-5ignature %.`3lsa �rlP _ �
NOTICE: If, after making this tleclaration, you shoultl become su ect to the
Workers' Compen5ation pmvisions of the Labor Code, you must (orthwitn
comply with 4uch provisions or thi5 D¢�mlt shall be tleetnetl �evoketl.
CONSTRVCTION LENDING AGENCV
I hereby affirm that there is a construction lentling agency !or the Performance
of the work �or which tnis permit is issuetl (Section 3a9� Civ. C.)
Lentler's Name
Lentler's AtltlreSs
OWNER BUIIPER OECLARATION
I hereby atfirm [ha[ I am exempt from the Contractor's Litense Law for the
following reason (Section 7031.5 Business antl Protessional Cotle: Any cl[y or
counry wM1ich requires a permit to const�uct, alte�, improve, DeTolish o� �epal�
any Structur¢, Prlor [o its isSUanCe, also reqWres the applicant for such permit
to fiie a signetl statement tbat M1e/she is Iicensetl pursuant to the provisions of
the Contractor'S License Law (Chapter 9.(commencmg witM1 Sec[ion 7000) o(
� '�ivision 3 of the Business antl Professions Cotle) or tM1at he/she is exempt
herefrom antl the basis,tor the alleged exemption. Any violabon of.5ection
/031.5 by any applicant for a permit subjects tM1e applican[ to a civil
�enalty ot not �nore than tive huntlretl dollars (E500).
LI I, as owner of ine O�oOeitY or mY employees with wages'as their sole
compensation, will tlo the work, antl tne sVucture is not intentletl or offerea
for sale (Section 7044, Busine55 antl �rofessional Cotle: The Contractor's
License Law tloes nof apply to an owner ot a properry who builtls or improves
thereon, antl Who does such wo�k himselt/M1e�self o� through bis or her own
employees, pro�itletl that suCh improvements are not intentletl or offe�etl fo�
sale. If, howevR/, [he builtling o� imp�ovement Is soltl withln one year of com-
pletion, the ow�ar will have Ihe burtlen of proving he/she tlitl not builtl or im-
prove tor the pUrpose ot sale).
❑ I, as owner of [he property, am exclusivery contractinq witb licensetl con-
trattorsto construct the project (Section 7044, Business antl Pwfessions Cotle:
The Contracto/'s License Law tloes not apply to an owner of Property who
builtls or imprPves thereon, antl who contracts tor such p�oleCts with a con-
tractor(s) Ilcen4e Pu�suant to the ContYactor'S LiCenze LawJ. I am aware that
proo( of their worker's Compensation insurance shoultl be provitletl to me.
❑ I am exempt under Section B. & P. C. for inis reason
�ate Owner
I hereby certi/y that 1 have reatl tM1is appliCation antl state tnat the above
information is Gorrect. I agree to complY with all city antl countY ortlinances
antl stdte laws rClating to builtling wn5tructi , antl hereby autM1orize repre-
sentatives of tp�s city to ent _--tip n th¢ bove-mentionetl P�ope�ty fo�
inspectlon purposez. O �
Signature � Date �' �J' 7
Drivers'�License or 55 � / _ _
F 27 8 g� I I I- _
TYPEOFCONSTRUCTION EW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHE
DESCRI�IONOFWORK/USEOPBLDG. �N� L✓ G�JC
G/
TVPE OF PERMIT� �LJ GRADING LJ FOUNDATION LJ STRUCTURAL
❑ TENANT Lld'ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SQ. FT. ��%�� oCCUParvC�'—
� CON¢TRUCTION TVPE��'�� R�� VA; UATION $
. ZONE GRADINGCU.V�S. ACRES—
Remarkt: � .
�PEr- s5l - &6L — si7o,o
Sink
Preventer
Irrigation
Bathtu6s
�rinking Fountains
Floor Orains '
Floor Sinks '
Gas Service
Interceptors
Kitchen Sink '
Lavatories
Roof.Drains
Reinspection Fee
Showers
Service Sink
Sewer Cap
Sewer Connection ,
Solar Collectors •
Solar Piping '
Solar Tank
Swimming Pool w/Spa
Urinal
OutIeLS Wdief CIOSei
Water Heater
� � Water Service .
Auto-Wash
$15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Mu�tiple ❑
Firepl/Fact. Blt. IC80 #
Heatin9 System & Ducting
❑0-100,000 BTU Ot00.0006T
Reinspection Fee � $15
CMF 0865-46, rev. 10/84 White - Builtling: Canary - AppOcant; Pink - Acmunting; Goltlenrotl - Assessor
Isue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑0-700,OOOBTU ❑100,
System Repair/Alteration
Fite Dampers
Registers .
laua Fee
FEES
A.P. #
5 Main Building:
E
T Front
ARear
C Ri9ht
g Left
Ping. Fef. #
Planning Notes:
Automatic Washer
Canstruction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U. .
i
Device Boxes
'jZ Outlets � .
3 Switches '
' Garbage Disposal
Generator �0.5 KW
$ 3
FEES Reinspection Fee
$ 3
� � .
,.. _ _
7 z e
�� Accessory Building:
'— 2
�� ",�;-r9�Tn nnFta o
N
I
,. .. .......' . - N
G
R
Parking Req./Provided � E
. Q
M
T
S
ELECTRICAI �
Transformer ❑ 15-50 KW
❑ 50+KW
Meter G�vp to 100 amps�'
Meter ❑over 100 amps �
Sub Pane� .5/
Motors �0-1 HP 01'F. - 8
Ina Solar �9-15 HP �16-15+
Microwave
Pole Light_
Standing Sections
15 KW Trash Compactor
$15 luue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Buildi�g Approved By � -
. SUMMARY OF FEES -
BUILDING PERMIT $ SMIP
PLAN CHECK $ PERMIT
PLUMBING $ �SSUANCE
PLAN CHECK 25% $ ENERGV P.C.
ELECTRICAL $� � �• S� GRADING
PLAN CHECK 50% $- Z E. 7 S MICROFILM
MECHANICAL $ YOTAL FEE
PLAN CHECK 25% $
$
FEES
a
$ 3
CONSTRUCTION AND FLANNING ' POOL & SPA
APPROVALS Permit # Date Inspector. pppRO,VALS 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, � Undrgrnd., Test ' �
9. Water Pipe-Undrgrnd. � - 60. Backwash Lines, P-Trap, O Undrgrnd. �, ,
70. Structural Floor System - 61. APPROVAL TO DECK � � ��
11. Property Sewer Line & House Connection . . 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical�Conduit 66. Solar System-Final �
16. Rough Electric Wiring ' 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 �Gas ❑Oil
25. Roof Sheathing � .74. Overhead Hyiiro •
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 'l..'7�87 J, �,� No'tes: �
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 pomestioFinal . - .
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 �
50. Gas Release to Southem California Gas Co • , � -
51. CERTIFICATE OF OCCUPANCY �
No. Date - , �^`
0
Applicant to fill in all spaces exceD1 tnosa wit�in heavY �orCer lines antl sign all apD�oDriate tleclarations.
CiTv OF COSTA MESA. CONSTRUCTION PERMIT ��
ProjectAddress ��1,,.,�. ZAIi• QJTI� STLE"E�
Applicant's Ma�� a Add e F`�. G• ������'SI�YN�1 i�
Owner';,[Vetne ,,RJ Q
�_g��l '� Pho e
Addreu � � • �� S '. �� Y'{�`� _I��
-Arch/En9. License No.
Address - �� ��'�
Convactor's NameM�zir F� ac 27'(f£G110 _ a�,��e�y��s
Address (mailing) �� G ' �H��' Q.' `��
City �icense No: �Q���� '
-LICENSED CONTRACTOR DECLqRAT10N
1 he�eby atfirm Iha[ I am licensetl �r�tl prov IonS o( Charte� (commGncing
witn'section �OOO��of Division 3.rf (ness antl r es ns Code, antl
my Iicense is in tull force antl e(fe`t,
LIC¢n5¢ CId55 G'� ICCn e G
Date '��� �$, Signature
WORKERS' COMPENSATION DEC RATION
I hereby affirm Ihat I have a certiticate ot consent to salttinsure or a certlficate
ol Wo�ker5' Comp¢nsation Insurance, or a cer�tltiCtl Acopy t.n�e'f�eof (SeCtion
400. Lab. C.��L IU9 ��XJ �WI� 7UNYi
�licy No. �x�' Company
ertifietl copy is hereby furnish@tl.
Certifi c y I £�-1e/tl with the City u'I DI lo an [
Oate �_��� • APPlicant ��r�� �I�c.�
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Tl�issection neetl not be complete[f if the permit is tor one huntlretl ($300) or
less).
I certify lha[ in the perfo�mance of Ihe wo�k for whlch [hIs pe�m�t is iisuetl, I
shall not employ any person in aryy manner so as to become subject to the
Workers' Compensation Laws of Calitornia.
Date Si9nature �
'NOTICE: If, afler making this tleclaratiOn, you shoultl become subject to th¢
Workers' ComPensation provision4 Of [he LabOr Cotle, you must tor[hwrtn
comply with suGh p�ovisions Or thiz Oermit shall be tleemetl /evoketl.
CONSTRUCTION LENDING AGENCV
I hereby a(tirm that there is a const�uction I¢ntling agency for the p¢rformance
of tne work for which this Permit i5 Issuetl (Section 3097 Civ. C.)
Lentler's Name
Lentler'S Atltlress
OWNER BUIL�ER �ECLARATIQN
I nereby atflrm that I am exempt trom tne Contractor's License Law for the
following reason (Section �031.5 Business antl ProfeSsional Cotle: Any city or
county which requir¢5 a pe�mit [o const�uct, alte�, ITP�ove, tlemolish or tepai�
any structure, prbr to its issuancg, also reqWres the applicant tor such permit
to tile�a signetl Statement that ne/She I5'licensetl pur5uant to the provisionsof
the Contractor's License Law (Chap�¢r 9(commenUn9 with Section 7000) of
Division 3 of the Business antl Professions Cotle) or [hat'he/she is exempt
lheretrom antl lne basis for the a�legetl exempliOn. Any viOla[ion ot Section
,f,?Q31.5 by any applicant tor a p¢rmit subjacts lhe applicant to, a civil
s.":: nalty of not more than live huntlretl tlollars ($500�.
x'y� I ds owne� Ot the prope�ty or my employees with wag¢5 as their sole
�" uompensation, will tlo the work, antl the structure is not intentletl or otteretl
lor sal¢ ($ection 7044, Businesi antl PrOfessiOnal Cotle: The Contracto�'S
Litense Law tlols no[ apply to an p�vnet ot a proplrty who builtls or improves
thereon, antl w�o tloes such work himself/herself or tnrou9h his or her own
employees, Orovitletl that sucb improvements are not intentletl or offeretl tor,
sale. If, however, Ine buil�ing or imp�ov¢ment Is soltl within one year of com-
pletion, the owner will nave the burtlen of provin9 he/she tlitl not bulltl or im-
�iove for the purpose of sale). • .
U 1, as ownm oi the,property, am exclusively contrattln9 with licensetl con-
ttatto�s to cons[rucl the Orole« (5ection 7044, BuSiness antl ProtesSions COtle:
The ConVa<[or's License Law d0es not aOPty to an owner of property who
builtls or Improves thereon, antl who contracts /or such projects witn a con-
tracfor(51 Ocense pursuant�to the Con[ractor's License Law). I am aware that
proot o( thei� W 5 mpen��lon in5u/anc¢ Shoultl be provltletl to me,
❑ I am exe untler Secti n B. & P. C. tor thi5 reason
Date
SlgnaWre y�.
' DriverY �icens
CMF 0865-46, rev.
Owner
i have reaq t�i a pfiCa�n and state that the above
I agree to co ly witlj III tlty antl county ortlinances
to �uiltling � n u<t bn Sntl hereby authorize repre-
to nter u h db e-mentionetl properry �f/or
Date � � r
�'2��3�, I ' I I
TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERS�ON ❑�DEMOLISH ❑ OTHER �
DESCRIPTIONOF WORK/USE OF BLDG.
TVPE OF PERMIT U GRADING LJ FOUNDATION Ll STRUCTURAL
❑ •TENHNT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANIC �//'�� UG
❑ �OTHER ��� �✓�~
PROJECT DESCRIPTION Sq. FT. �/ nr_'ri innr.icv �y
1 CONSTRUCTION TVPE � VALUATION $ �r�/MRjZ
20NE GRADINGCU.YOS. ACRES
Remarks: �:.�I.c C`/N��\✓I lil9 �...iCi�^1AA %�.�f2�C ��
Sink
Preventer -
Irrigation '
Clarifiers �
Dishwasher
�rinking Fountains
Floor Drains
Floor Sinks �
Gas Service Outfets
Interceptors '
Kirehen Sink . �
Lavatories � �
P—Trap
Roof Drains
Reinspection Fee ' � $15
Duct-UnderGround
Duct - Sttuclural
Duct - Ventilating .
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Du'cting
❑ o-i oo,000 aru 0 i oo;000
i
55 � I ' Reinipection Fee
34 White - BVIIUing; Canary - Applicant; Pink - Accoun[ing; Goldenrotl - Assessor
i
$15
Showers
Servite Sink -
Sewer Cap- •
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank
Swimming Pool w/Spa
Urinal
Water Closet
Wa2er Hea[er
Water Service
� A uto-W ash
Issue Fae $ 3
1ANICAL FEE
Hood or Typel ❑
Canopy Type 11 ❑ ,
Refrigeration System
❑0-100,000 BTU ❑100,000 BTU
Fire Dampers � • �� I
Registers .
..
� laue Fee' , $ 3
A.P. #
S Main Bu
E
T Front
8 Rear
A
C Right
K Left
S
Ping. Ref. #
Auromatic Washer �
Consvuction Pole Sub.
Cooking Unit
Dishwasher �
Dryers ❑Gas ❑Electric
Fan
F,A,U. ,
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal'
Generator �0-5 KW C
Fee
9145 b/05787 63e�1 "'L
I
. �
2one
Accessory Building:
Z
O
N
I
. N
G
R
Parking Req./Provided E
Q
M
, T
$
ELECTRICAL
Transtormer ❑ 15�50 KW �
❑ 50+ KW
Meter ❑up [0 100 amps
Meter ❑over100amps
Sub Panel
Motors�0.1 HP�1N,-8
Inc.Solar �9-15 HP �16-15+
Microwave -
Pole Light
', Standing Sections
5�15 KW Trash Compactor
$15 ��luue Fee
DEVELOPMENTSERVICESREQUI
Zoning Approved By
Building Approvad By
FEES
$ 3
SUMMARVOFFEES
BUILDING PERMIT $ �02� S� SMIP $ ''i'd
PLAN CHECK $ � PERMIT ,
PLUMBING $ '� ISSUANCE $�
PLAN CHECK 25% $ I ENERGV P.C: $�
ELECTRICAL $ � GRADING $
PLAN CHECK 50% $. �I , MICROFILM $�
MECHANICAL . $ ;TOTALFEE $ � .od
PVaNCHECK 25% $ _
�� 1
CONSTRUCTION AND PLANNING POOL! A
, APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspecto��
7. Tempsrary 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, � 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 Wiri�g 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 # �
� 0 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 FINAI �� 3
29. 'Insulation ' � 78. FIRE PREV. FINAL
30. Dcywall Nailing � �, - - HEALTH DEPT. REQUIREMENT
, 31. Plaster Brown Coat 79. FINAL INSPECTION
'32. Electrical Power Meter-Final�- 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes:
34. Final�Heating & Air Conditioning • -
35. Final Gas Pipe-Test
36. Hood or Canopy - � � .
37. Final Factory Fireplace •
38. Final Plumbing � � . '
39. Water Service-Final
40. Gas Service-Final
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 Fielease to Edison . -
50. Gas Release to Southern California Gas Co •.- i�
51. CERTIFICATE OF OCCUPANCY • . .
No. � Date � � , �
ICITY OF' COSTA
Project Address _
Applicant's Mailjn�
ONSTR
� � .
'T
Applicant to fill in all spaces except thosa
Address ' w �
Arch/Eng. sc � �' License No.
�^ S W O
Address •
Contractor's Na � � �✓C ✓ ' ��Php �� '�
Address (m=_i!in;1 / � �(o/ S� C� . Ya�f _SiFiY �+ �c
Ciry License No. � 7 `% � 7 3
LICENSED CONTRACTOR DECLARATIpN
� I hereby aHi�m that I am licensetl untler provi5ion5 of Char[er 9(commancing
� with section ]000) Of Division 3 Of the Qu5ine5i antl Prote55ion5 Cotle, antl
my Iicense is in full tarc a effect.
� License Class i�e N � g
J oate /� �L�7 S�s t � —
^� WORKERS' COMPENSATION DECLARA710N � �
� I hereby affirm Nat� I have a certifitate of conzent lo selhinsure or a certificate
� M Worker5' Gompen5ation Insuran[e, or a certitietl <opy [her�eof/ (Se tlon
i00, Lab. nC..�) �/��^' ���( ComPanY��CY/Ol9N Yl'�
olicY No.U{.� �f�
Certlfietl copy is hereby (urnishetl.
e StifiC copy' file0 with the ci[y i �yy i5' . �
�ate."�'�y' APPlicant �
EXEMPTION FROM WORKERS' COMPEry5AT10N DE LARATION
(This soction n¢etl not ba comple[etl it the permit IT for one huntlr¢tl ($300) or
less).
I'certity that in tne periormance of the work !or whlch this perm�t is Issuetl, I
shall not omploy any person in any manrier so as to become subject to the
Workers' Compensation Lawsb( Califomia. , �
Date Signature
NOTICE: If, after �making this tleclaration, you�shoultl become subject to the
Workers' Compensation Orovlsionz ot the �bor Cotle, you must forthwitn
comply with such OroviSiOns o� thi5 Permit Snall be tleemetl �evoketl.
CONSTRUCTION LENDING AGENCV �
I hereby aftirm that tnere iz a cons[ruttion lentling agency for the per(ormanca
ot the work tor which tbis permi[ ii Issuetl (Section 309� Civ. CJ
Lentler's Name
Lentler's Atltlress - ' �
OWNER BUILDER DECLARATION � '
I hereby a/firm that I am ezempt irom the Con[ractor'S License Law for the
followinq reason (Section 7031.5 Business antl Professional Cotle: Any city or
county which requires a perm7l to <onstruc[, alter, improve, tlemolisn or repair
any structure, prior to itz izsuance, also requires the apP�icant for such pormi[
to tiie a si9notl statement that ha/she I5 Ilrensetl pursuant to the provisions ot
[he Contraclor's License Law (Chap[er 9(commencing wi[n Section 7000) ot
Division 3 o('the Business antl' Profezsions'COCe) or [ha[ he/sne is ezempt
the�efrOm antl the basis for th¢ allegetl ekemption. Any violation ot Sectlon
931.5 by any applicant for a permit subjects the applicant to a Nvll
nalty ot not more than tive huntlretl tlollars ($500).
J 1, as owner of tne property or my employeez with wages as their sole
mmpensatlon, will tlo'tne work, antl the Etructure Is not intentletl or otferetl
fo� SaIC (Sectlom �044, Business antl Professional Cotle: The Contracto�'s
License Ldw tlo¢s not ap01y [o an owner ot a proper[y who builtls o� imp/ove5
[bereon, antl who tloes such work M1imsel{�n¢rself or through his or he� own
employee5, provltletl Ihat such imp�ov¢men[5 a�e �nOt In[entletl or offeretl fo�
sale. If, however„the builtling or Improvement I5 soltl within one year ot com-
pletlon, the owner will have the burtlen oi proving he/she tlitl not builtl or im-
prova for the purpose oi sale�.
❑ I, as owner ot the property, am exclusivery contracting with Iicensetl con-
trattof5 f0 conStNct the projec[ (Setlion ]044, Busine55 antl PrOfesslons Cotle:
The Contractor's License Law tloes not apply to an owner ot praperty who
builtls or Improves ihereon, antl who contracts for such projects with a con-
tractor(sl ucenze pursuant to tne Cmtractor'zyiwnse �aw). I am aware that
proof,o/ tneir Worker's Compen5ation iqsuranCe shoultl be provitletl to me.
❑ I am exemp[ un0e� Section B. & P. G(o� this r¢a5on
Date � � �� Owner ' � '
1 hereby certl(y thaY I have reatl Miz a0plicalion antl state thal the above
inPormation is correct:l a9�ee to compty Wittt all tlty antl county ortlinanCes
antl state laws relaling. to builtlin9 construc(ion, antl hereby au[horize repre-
Si9nature
or
ntlone0 property for
Oate� -2—� 7
TYPE OF CONSTRU(
❑ CONVERSION
DESCRIPTION OF
DEM
TYPE OF PERMIT LJ GRAOING
❑ TENANT ❑ ELECTRICAL
❑ OTHER
heavy bortler lines antl sign all appro0riate tleclarations.
ADD LJ ALTERATION LJ REPAIR
J FOUNDATI LJ STRVCTURAL
PLVMBING �MECHANICAL
PROJEC7 DESCRIPTION SQ. FT. OCCUPANCV
COIV STRUCTION TYPE VALUATION $ _
ZONE GRADINGCU.YDS. ACRES_
Remarks: �((! F�' �- ' /•
y�{ 1� {�
Bar Sink
/ Backflow Preventer
BackfloW Irri9ation -
king Fountains �
? �Yd105
�r Sinks
Service Outlets
Kitthen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fee � $15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
ExhaustSystem ❑ MWtiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
�0.100,000 BTU �100,000
i'
II Reinspection Fee
licant; Pink - Accounting; Goltlenrotl - Assassor
$15
$hoWers
Service Sink -
Sewer Cap � �
Sewer Connection ' .
$OIdI C0112CL0l5 . � �
Solar Piping '
Solar Tank � �
Swimming Poofw/Spa , .
Urinal
Water Closet �
Water Heater
Water Service � • - - - �
Auto�Wash .
laue Fee
Hood ar Typel ❑
Canopy Typell ❑
Fefrigeration System
oaioo,000sru ❑ioo,000
System Repair/Alteration
Fire Dampers
Registers
Issue Fee
A.P. # . �
S Main Building: i �
E
T Front
6 Rear
A
C A�9ht - '
•g Left
Ping. Ref. #
Plannina Notes:
Automatic Washer
Construction Pole Sub. .
Cooking Unit
Dishwasher .
Dryers ❑Gas �QElectr
Fan
F.A.U. , � � ' �
3870 3/12/87
�
Accessory euilding:
;
Parking Req./Providec
32025 TL
Zone
2
O
N
I
• N
G
. 1 � R
� � E
, n
� M
T
� S
ELECTRICAL - �
Transfo�mer =� 15�50 KW - �
' � 50+KW
. Meter ❑upto700amps'
— Meter ❑over100amps . -
Sub Panel � '
Motors�0. P�1'F,-8,,,
'� Device Bozes � �
Outlets
]. Switches � - - +
Garbage Disposal . w ,� �
Generator 00.5 �5-15 KW
$ 3
FEES
$ 3
I Reinspection Fee
—
DEVELOPMENTSER
Zoning Approved By_
Buildin9 Approved By
Inc.So LJ9-15 HP 016-75+
rowave
Pole Light, ✓ ;
Range ;"
Sign '
StandingSections �yy
Trash Compactor � ''
. �. •i
S75 � ' luue Fee
—
REQUIREMENTS:
$ 3
SUMMARVOKFE�S. �
BUILDINGPEFMIT $ SMIP � $ �
PI.AN CHECK $ ��—��� PERMIT
PLUMBING $ -----/--L'L ISSUANCE $ - , .
PLAN CHECK 25% $ ENERGV P.C, $
ELECTRICAL $ - GRADING 5-
PLANCHECK 50% $ —� ��� MICROFILM� $
MECHANICAL $ `� '� TOTALFEE $ �.�
PLAN CHECK 25% $ � �
CONSTRUCTION AN,D 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. � ? f?�', 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electriral Bonding '
5. Steel Reinforcement' 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd:. 57. APPROVAL TO COVER-GUNITE
7. Footings �. 58. ElectricalConduit-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 /�� �7 62. Backwash & Fleceptor-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. POOUSPA SYSTEMS FINAL
19. Rough Heating &�Air Conditioning , FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Ducts, in Structure 70. Underground Hydro �
22. Ducts, Ventilating 71. Product Piping �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 �
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 �71J�Y7 /���
35. Final Gas Pipe-Test �
36. Hood or Canopy .
37. Final Factory Fireplace , . � �
38. Final Plumbing , �/�/3'rf C f .
l
,•
�
�•
�� ,�, . i �n,
Applicant to fill in all soaces exceDt those within heavy Coraer Ilnes ana si9n all approoriata aaelarations.
CITY9F COSTA MESA CONSTRUC�ION PERMIT
Project Address �-� W• �$ i'r!t$ G(y.,_l.A
Applicant'sMailipg1�A,ddress� y4�23 31sr Ng, CA ���J12�W�ic3
Owner's Na�m�ep �vH�`% C�i+J�S l�� Phone�2�s�
Address _L+'[_1'_A/ '��26'-t �� 'Stf'��T � � q2�i2'7
Arch/Eng. Q�� S���License No. GIr9O1�J
Address �
Contractor's Nam � hone
Addreu (mailing) � �
�Ciry License No. ' �
LICENSED CONTRACTOR DECLARATION
�I M1ereby aftirm tnal I am litensetl untle� provlslon5 oi Charte� 9(commenCin9
with zection ]000) of Dlvision 3 0/ [hu Business antl Professions Cotle, antl
my 1lcense B tn tull /orce antl eHect.
'License Class LiCende No.�
Date � Signature - -
WORKERS' COMPENSATION DECLARATION �
I hereoy atiirm that I have a certHicata ol mnSCnt to SelNnsura or a certiiicate '
�f Workers'. Compensation Insurance, or.a certifiatl coDY thereof (Sectlon
' :00. Lab. C.) ' �. � .
�licy No. Company
eCertitietl capY �5 her¢by fu�ni5hetl, j�
�Ce�Iified copy i5 tiletl with the city, Builtling DiviSiOn. •
Date � A�Plita`nt'
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION
(Thii section naetl not Ce comD�etetl i/ tno permit is for one huntlretl (E100) or
less). '
I clrtity thal in th¢ performanCa OT' ork ni iT p¢r t is lssuetl, I
shall not e loy an person in an • ne so 5 t ome s bjecl o tho
Workers' ws of Callt r
Data 519nature
NOTICE: i, after aking Ihis tleclaration, you ihoultl b cama-sub7ect t the
Workers' Compensation provisioni of the Labor Cotle, you must fort tn .
comply wllh sucn vrovisions or thls permit snall be Oeemetl revo tl.
CONSTRUCTION LENDING AGENCV '
1 nereby ailirm thal Ihere is a constructlon lentling agency tor the pertormanca
of the work for�(�°� ic�h t I per i i��I,S�(�e�tl ( ion 3097 CIvJ CJ
Lenaer's Namo —+��+f T��tT��n"��"'�
� �e�aer: aaa.es: �� p^ L�3L`C• Q'�i—� �
OWNER BUII.DEH DECLARATION '
I he�eby aftl�m [hat I am exOmpt f�om tho ConVdttOr's LlcenS¢ Ldw to� ln0
r following reason (Section �031.5 Bu5lness antl Protesslonal Cotle: Any dty or
coun[y whlch requires a�Permlt to construct, alter, ImOrovo, tlemolish or rePalr
. any sVucture, orior to Its issuance, also requires tha apD��cant lor such parmit
-.to fi�e a 519natl slatement that ho/shc is litansetl pursuant to the provlslons of
the Contractor's License Law (Chapter 9(commoncln9 wlth Snction 7000) of
' Division 3 of [ne Businuss antl Protas5ion5 Cotle) or tnat ho 5ne is exompl
theretrom antl tfie baSVs for the allegetl exomptlon. Any viola�lon oi Sactlon
�31.5 by any applicanl ror a permlt sub�ac[i tho applicant to a civil
' ialty oi not mOre lhan five huntlrBtl tlolldri (5500�.
� I, as owner Ot tha property O/ my ¢mployees wlln wag05 as IhOir sole
compensation, wlll tlo tho work, antl Iha z[ructure is not IntonCetl or oiferetl
for sale (S�ction �044, Business antl Prolesslonal Cotle: Tha Contractor's
license Ldw tloei not apply to an owner ot a proparry wM1u bulltls or imo�o�os
� ther¢on, antl wno tlo<5 such wOrk nim5811/her5ell Or thrOugh his or her own
em0�oyees, provitic0 [bal SUGh Imp�ovOmentS aro not Intentletl Or ofPoretl f0/
sale. If, �owevur, the builtling or Improvemant Is soltl wllhin one year of com-
pletlon, the ownOr wlll have [he bU�tlen Of Proving he/Shn tlId not builtl or IT-
prove for tne purposa ol sale). �
I, as owuer of the property, am excluslvery contracling with Iicensetl con-
raCtolS tU Constfuct the projact ISCclion ]044, Bu51nes5 antl Plof855Ion5 COtlO:
The ConVactor's Liconse Law does not apPly to an owner of PropertY wno
bulltls or' Improves thar00n, anG who cont�acts fo� such prOj0ct5 wlth a con-
tracto�(s) Imense pursuant t0 th0 Cont�acior's Llcense Law�. I am awarn [nat
proot of [heir Worker's COmpensaHon InsU/ance shoultl'be provitlntl [O m0.
❑'I am exe�nOt uptler Section �— _—� B. d� P. C�tor thi5 reason
Date ' Owner �
I hereb certif that I have reatl is application ana-state th the above
Informatlon is <qrrect. I agreo comt�y wilh all city antl coun[y orGinances
antl state laws rLM1ating�b ii ng corlGtruCtiop, �nC h¢ra�y authONEe repre-
sentative: nr Nilil cit b uoo8 tne aee4e-mentionetl oroDertY for
Signature �
Driver5' License 5'
CMF 0865-46, rev. 10/84
�f
Whit¢ - Builtling;
TVPE OF CONSTRUCTION 125I NEW LJ ADD U ALTERATIOfJ LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
OESCRIPTIONOFWORK/USEOFBLDG. NEW IN�T��L
TVPE OF PERMIT LJ GRAD�NG LJ FOUNDATION LJ STRVCTVRAI
❑ TENHNT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION 5�. oCCVPANCv
i
COIVSTRUCTIONTVPE_ •VALUATION�S
ZONE GRAPIN CU.YDS. ACRES_
Remarks: � ��� '�.�y � �
Bar Sink
Backflow Preventer
Backflow Irrigation
�rinking Fountains
Floor Drains ,
Floor Sinks -
Gas Service
Interceprors -
Ki�chen Sink
Lavatories
P-Trap
Roof Orains �
Reinspection Fee
PD. d/zr/87
A IN�
Showers
Servire Sink � . -
Sewer Cap �
Sewer Connection
Solar Collectors "
Solar Piping
Snlar TanL � . • � •
- Swimming Pool w/Spa
Urinal
Outlets . Water Closet �
Wacer Heater
Water Service
Auto-Wash '
$15 laue Fee
Boiler
Duct - Under Ground
Duct � Structural �
Duct-�Ventilating '
Exheust System ❑ Multiple
Firepl/Fact.Blt.IC80# •
Heating System & Ducting
❑6100,000 BTU 0100,000
ReinspeRion Fee � $15.
ApPlitant; Pink - Accounting; Goltlenrotl - Assessor
Hood or Typel ❑
Canopy Typell ❑
Refrigeration System •
❑ai oo,000 sru p i oo,000.sru
Sys[em Repair/Aiteration �
Fire Dampers �
Registers '
laue Fee
$ 3
0
.. _i
A.P. � �%c-R' -�'h
S Ma' ;Builtling:/.� �
T F� S�I .
e Re L1 N �
A
C Fig � �
g Le t —
Ping. Ref. #V �� �
Plannir�;NOtes: "� r
Automatic Washer'
Construction Pole Sub.
Cooking Unit ,
Di:hwasher
Dryers ❑Ges ❑Elec
Fan
F.A.U. '
Fixwres
Device Boxes
Outle�s '
Switches
Garbage Disposal �
Generaror 00�5 KW C
Fee
-I DEVBLOPMENTSERVICES
Zoning Approved By .�j
Building Approved By g�
5 a � `
�, • zo�a /'� G
� �� � AccessoryBuitding:
Z
O
N
;;..{.Db! N
G
1 CC R
- Z,Q Parking Req./Provided .24 �,�% E
T'� . � � M
T
_ . $
ELECTRICAL '
Transformer ❑ 15-50 KW" -
❑ SO+KW .
Meter ❑up to 700 amps •
Meter ❑over 700 amps -
Sub Panel
Momrs �0.1 HP � 1 h- 8..
Inc.Solar �9�15 HP �1fr15+
' Microwave ' � '
Pole Light
Range
Standing Sections
5 KW Trash Compactor
$15 Issue Fee
FEES
5 3
.�-,6 �P
BUILDINGPERMIT $ 'TIDO.SO SMIP $ %.%�
PLAN CHECK $ PERMIT ,
� PLUMBING $ ISSUANCE S
� PLAN CHECK 25% $ 'ENERGV P.C. $
.� ELECTRICAL � $ GFiADING $ �
PLANCHECK 50% $ � MICROFILM $ p
� MECHANICAL $ � - -TOTAL FEE $ �• 2
' PLAN CHECK 25% $
�-
CONSTRUCTION AND PLANNING POOL A
Date Inspector Date Inspector
APPROVALS Permit# APPROVALS Permit#
1. Temparary Electrical Service or Pole �� 52. Pool & Equipment Location
�?. Soil Pipe=Undr�qrnd. 53. Steel Reinforcement
3.•�Electrical Cbnduit Utility-Undrgrnd. 54. Forms
4. ,Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5.',Steel:Rginforcement 56. Rough Plumbing & Pressure Test
6: ��Electfical U�ER Grnd. ; 3 ��' 57. APPROVAL TO COVER-GUNITE
7.' Fnotings 58. Electrical Cqnduit-Undrgrnd. � �
8r.Foundation � T� 3I�4 � 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 P�umbing 65. Electrical•Final � �
15. Rough Electrical-Conduit 66. Solar SYstem-Final
76. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18� Rough Electrical-T Bar Ceiling 69. POOL/SBA 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 ,�T- ` GIt� 74. Overhead Hydro
26. T-Bar'�Ceiling (St�uctural) & Monocoat 75. Dry Chemical �
27. Frame and Flashing , t i� 76. Dry Standpipe
28. Lathing & Siding - 77. FIXED SYSTEM FINAL
29. Insulation . 78. FIRE PREV. FINAL
30. Drywa(I Nailing � 6� �/✓ HEALTH DEPT. REQUIREMENT
� _
31. Plaster Brown Coat • 79. FINAL INSPECTION
_�
32. Electrical Power Mete�-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric �� ' Notes: � Q
34. Final Heating & Air Conditioning ?' a K K M ry
3 . Final Gas Pipe-Test �
3G, Hood or Canopy
'Jr. Fin�liFactory Fireplace .
38. Final�Plumbing
39. Water Service-Fiaal
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 Z y� ��J
48. Special Requirements Completed � 1
49. Electric Release to Edison �
50. Gas Release to Southem California Gas Co � , �
51. CERTIFICATE OF OCCUPANCY -
No. Date