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Home My WebLink About955 18TH ST - Building Permits�Y City of Costa Mesa Development Services Oepartment Building Safety Division P. O. Boz 1200 Costa Mesa, California CERTIFICATE OF OCCUPANCY No.Q��`� The Building located at qSS id 1Rth Ctrx+ah has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable [here[o for a Group B-2 Occupancy. ` Use of Building O££ice and ATaY'2hOU8E Legal Description 429-361-09 (See reverse side far Metes and Bounds) Building Permit No.13�(17.51 Electrical Permit No.E21259 Plumbing Permit No. Pz0540 Mechanical Permit No. [`7?15AR Number of apartments and/or guest rooms Reinsp�ti.on Pezndt No. IB20251, IE21259 E}� Pe��t #a. Pi893`�s ISSUED T0: BuildingOfficial E•'1i2abeth J. Dunn p� 23 Glenaak by �iU •� �.`� �.� I�thertan. CA , ` / 9�� Date % / , yi , t This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa uruler Sec. 307 (e) U.B.C. CMF 1o15-a6 rev. i/B3 White - Owner; Canary - Numerica� File; Pink � Bldg. Permit File ' AOO��ant to fill (n all spatts exceot those within heavy boraer Itnes ana sign all aoC�ooriate eaclantions. ;L�Y•a�.i3OSI~A MESA CONSTRUCTION PERMIT -_ PEti IT�N'02� ( TRACT N LOT NO. � UNIT NO. �Proje/:FAddress �5.5 l� I8 rL ST2rLET � r � Applic�nt's Ma�ling Address � ��5� � G c'rH+Lm`� 1'�. b TVPE OF CONSTRUCTION NEW AD, ,� ALTERATION REPAIR — , ❑ CONVERSION ❑ DEMOLISH ❑ OTHER p� p��y /1 �LI ZI�P�ETN J.I7:ew/^lPhone � ' � Owner'sName DESCRIPTIONOFWORK/USEOFBLDG.�ONSiPi�TJ NEW . Address ?3�!'�Lr./aqe� fltf-/F�v'LTb�v �t� Oi.lE 5Ta�2 ^�� - _I-�� 5 MainBuild .JQ�nsS v�h�sQ:,, e A7ch/Eng._ LicenseNo.�336�J4 7YPEOFPERMIT -. GRADING '-FOUNDATiorv S7RUCTuaA�� ' T Front Address - FR. �SIJD C� � , � � ❑ TENANT '❑ EIECT,RICAL ❑ PLUMBING ❑ MECHANICAL , : B Reaf G Contrdctor'sNamaP%�l�<`EQ 6�-i�C+� SySPhone Z'Z�I �J.. � ❑'OTHEF. . . i � ' �� " ` . � .. A - - PRQIECT DESCRIPTION 5�. FT. �� Z C- - oCCUaANCv' �"� Z C Ri9ht ' Addresslmailing) �GS¢3Z C�cSrFla¢D ��/�T (f . - K � , - � CONSTRUCTIONTYPE r1-N' VALUATIONS'7L�000 g Left G City Cicense No. 35 �J `.%4 � �' N1 C4 ' ' . - � ZONE GRADINGCU.YDS.' , ,ACRES PIng.R¢f.# LICENSED CONTRACTOR DECLARATION ' � �C � � I herebyaHirm that�l.am�lic¢nsetl untler provisions of,Charter;9 (commencin9 � Remarks: � � ' �. 3—�� • �� P,lanning Notes'. wi[n section 7000) ot DiviSion 3 Of th¢ Bu5ine55 antl Pm(es3ion5 Cotle, antl . my,license'is in tu11 torce anQ�eifect. � �' ' � ' . � • � , � , � LJcense�Class %5 - � ' nseN �SO7S � PLUMBING � FEES Date�_�T.�_�_ Si9�ature _ ' ' � � WORKERS'COMPENSATION qE LARATION� • , , � 1 he�eDy affi�m [hat 1 have a ce�{iflcate of consent to sal/-Insure or a WrUficate � Bar Sink ShOwers b( Workers' Compensation Insurance,� or a certifletl coOY thereof (Section S � in9: :ieoo, Lao. C.) ' --� - - � � - , � � �- Backflow Preventer .. . � ernce Smk -. . • � - - - Automatic Washer ' -' . o�._dHs-cx�47f . �i�Rov6 - - - �olicy r�o: �di( Company Backflow Irrigation ''i "Sewer Cap ' Construction Pole Sub. �ny, Certi/ietl copy is �ereby furnishetl. - �- KM .O�Cert' i co y iz tileE with the city B' n9 Divis' . , Bathtubs ' �. � ' Sewer i;��uec.�on Cooking Unit , , Date � Applicant � � , -„ � E%EMP ION�FROM WORKERS' C ENSATION DECIARATION i Clafifief5 f �� .Solar Collecror5,. i ' DiShwasher � � (Thissecliomneetl not b¢ mm0let i( tha Oermit is'for one"huntlretl (E300)'0� - � _, - less). ' ' � � � Dishwasher . ,SolarPiping ,� Dryers ❑Gas� OElectri� I certify that in the performance ot the work tor whlch lh�s permk islssuetl,.l - ' , � snall not employ any person in any manner zo �as lo become subject to the 1 Drinking Fountairis 'Solar Tank .H � � Fan � � Worke�s' Compen5ation,LawS Of CalitOmia. . ' " � �ate Signatwe � ' � Floor Drains; '- , Swimming Pool w/Spa' 1� F.A;U. ' � NOT.ICE: If, after making thfs tleclaration, you sfioultl� become subject to the ' . • Workers' Compensation provisions o( the Labor Cotle, you must forthwith I FloorSinks �.. . _-_ _Urinal -. ._ . . _. - � ..� - Fixtures- - - - camply with� such provisions'or this permlC•shall be.tleemetl revoketl. � CONSTRUCTION L'ENDING AGENCV '� ' , �' " � ' Gas$erviCe 'OUtIC[5�: WatefClout ' �. � I hereby affirm tKat there is a<onstruction�lending aqency for the performanee �� Devite BoH of the wo�k tor whiCh Ihis pe�mit Is issuetl ($ection 3097 Clv. CJ Interceprors ' � - Water Heater . Outlets� Lentler'S� Name - - LenCer'z�AtltlreSs' - � ' � - � KitChen Sink' ' ' • -Water SerViCe -� , '�SWitches � OWNER BVILDER DECLARATION � � ' '� � ' � � _, , � " I hereby aftirm lhat I am exempt f�om lhe Cantracto�'s License Ldw fo� tM1e LdvdtO�i¢s . `AUtO-WdSh � ' following reason (Section 7031.5 Buslnezs antlProfesslonal Cotle: Any tity or •.Garbage Di county wnlch requires a permiLto construct, alter, improve, Oemolish or repair � P-Trap ' Laundr Tra s � ' any sttuctur¢, p�b� to if5 lssuance, also reqWres tne aOP��anLtor SUCh pe�mit Y � Y ��. �'Generator to file a Signetl Statemen� tFla�'he%he I5� �IcenS¢tl,pur5uant to th¢ plovl51on5 of ' ROOf D(dip5 " ' ' � •� .� ......... �... rn rn. nr�mmnn :nn ...111� G�11nn.7(1!1(ll nf I • • �• • • ' ♦• � . �31.5' by any'appl nalty of not more tl J I, as owner o( tt compensalion, will tic tor sale (Section 70� License l.aw tloes not lhereon, antl who tlo employees, provitletl '� sale. If, however, the pletion, lhe owner wi rove for the purpose b�'a pe > huntlr¢i oerty �or ork, antl siness ar to an ow i wo�k h � I, as owner.ot the proper[y, am ex� t�actorsto mnsVuct the projett (Sectio The ConVac[or's License Law tloes n� � builtls or improves thereon, and who�� tractor(51 OcenS¢ pursuant [o Ihe Cont proof of [M1elr Worker's Compensatior ❑ I am exempt un0er Seclion � Date Owner _ I hereby cerlly thaD P have reaG inis inio�matlon Is co�rect. I agree to comp antl state laws relatin9 �a buil0in9 co SCIIId[IV25 Of L1115`CIfy1I� P.[IICf�U I �.....e�n......�rJ.cn % f 1 , .. s Cotle) or tnat ne/she Is exempt ;mption. Any violation ot Section i �ubjects tha .applicant, to a civil rs (5500�. . - � ' nplOye¢5 with wages as IhGir sole ruciure is not intentletl or otteretl � tessional Cotle: The Contractor's • a property who builas or Improves �herself'or throuqh his o� tter own ts are not intentletl or otteretl for ant is soltl witM1in one yoar of mm- proving h¢/5M1e tlitl not builtl or•im- � pery contracting with licensetl con- 44, Business anC Professlons Cotle: �pry to an owner�ot proparty who racts for Such projects with a con- or'S license Law�. I am aware that u�ance shoultl be prbvitletl to�me. B. & P. C. for thls r¢ason 0 above iances repre- y for - ' • 1 . Reinspactio6.Fee �$15 . � Boiler � � ' . Duct- Under�Giound , Duct - Ventilating � ExhaustSystem ❑ MWtiple Firepl/Fact. Blt. ICBO # Heating,System & Ducting ❑0.100,000 BTU �100,000 � � � ' . I ' I Reins � or 55 � � � pection Fee 30/84 White - Builaing; Canary - Applicant; Pink - Accounting: Goltlenrotl - Assessor 'I $15 Issue Fee Hood or . Type I ❑ � � CanoPY TVPe II; ❑ . ^� Refrigeration System � Oaioo,000aru ❑iao,aooe7 System Repair/Alteratiom � Fire Dampers; � Romem.. 1 t � Issue Fee � FEES � $ 3 ❑0.5 KW �5-15 K � r;_,; � 8206 B/07/B5 h2L,,u TL Zone h Accessory-Building: ' _ , .. Parking Req./Provided �� L ��ItDCMFNTS ' � � . . 1 �. ELECTRICAL, � , —'Trensformer �'15-50:KW"' _ ❑ 50:+ICW y. ( �Meter ❑up to 100�amps !Meter ❑over100amps� Sub Panel � . Morors�al HP�1X-'8'• � � �InaSolanO9-15 HP �i6s15 Pole'Li9ht Range , ; Standing Sections �Trash Compactor Fea �' I$15 I;%' Issue Fee; SERVICESRE� IqEM N7S: , gy d BY -� e 1 ' Z O N b N G A E Q I M � T S -• • � � � ' • SUMMARV OF FEES � Z .".'�. BUILDING PERMIT $� �oI •� SMIP � $ � �' � � PLANCHECK -• $� ��+��bLn pERM1T � + . 'P,LUMBING - ' $ ISSUANCE $ : , � `PLAN'CHECK 25% � $ ENERGV P.C. $ � � •.ELECTRICAL .' . $ : GRADING $ �� MICROFILM $ � � ' ' � PLAN CHECK 50% $ rr Z � . MECHANICAL $ TOTALFEE $T PLAN CHECK 25%'$ � � ��T i , '� � POOL ?A „1 CONSTRUCTION AND PLANNING . ' . � '•�.,y,APPROVALS Permit # - Date Inspector � APpROVACS - Permit # Date �Inspector �9. Temporary Electric2l Service or Pole � 52. Pool�& Equipment Location ' � � 2. �Sotl Pipe-Undrgrnd: �� 53. Steel Reinforcement 3. Electric�l 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-Undrgmd. � � _� � . 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 fi$. 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. Oucts, in�Structure 70. Underground Hydro 22.'Ducts, Ventilatin �. , , g ; 71. Product Piping � Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush . 24. Roof Framing � , 73. Undergrnd. Storage Tank � Gas' O 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 �'-J i^ 78. FIRE PREV. FINAL 30. Drywall Nailing I '�/ u� HEALTH DEPT. REQUIREMENT 31..Plaster Brown Coai, , 79. FINAL INSPECTION 32. Electrical Power Meter-Final 60. FOOD CERTIFICATE ISSUED 33. Final Electric ' Notes: 34. Final Heating & Air Conditioning � u�'�'S 35. Final Gas Pipe-Test ' 9�7 � d6i%✓ �K ,vQ/�(/6 36. Hood or Canopy, �..y �� (, ��i L�//�7,8lN /� � �. �/�, 37. Final Factory Fireplace .: •- �K/,i% iJ �"�� C�c.�(/d/.O -� �O��C 38. FinalPlumbing �. - d" QECQ� �G 39. Water;Service-Fina� � ;'�,�-, �� f ��GGt,p --/�dT 40. Gas Service-F,inal �%O � �LE� Qili�r��iG �/L 41. Solar pomestio-Final --" �? . � 42. Backflow Preventer' ��' . � _ 43. Backflow Irrigation :} • � � - 44. ,Landscape Irrigation System'; - � � 45. Sound Attenuation � , . � 46. Handicap Regulations ' 47. FINAL STRUCTURE & BUILDING /l; �� 48. Special Requirements Completed �6,�i' � � • � 49. Electrie Release to Edison; , - - - � � • 50. Gas Release to Southern California Gas Co ' � 51. CERTIFICATE OF OCCUPANCY e . ' No, /s0�0 Dateo� O� � _ � . . , _, . . � ... . . . . . . . .. . _ _ .J I I Applieant to fill in ail soacef axcao� tnose within neavy eoraer Iines antl sign all aoDroprlate tleelarations. ��' OF COSTq MESA CONSTRUCTION PERMIT �AMIT NO. TRACT NO. LOT NO. UNIT NO. ' Proj�ttAddress �5,�_�q� 1 $TH STRFFT Applicant'sMailingqddress 1fiSR9 (�nTHARD ST_ _H_R_ Owner'srvame �6iZABETH J nUNN Phone Addreu 23 (�LENOAK ATHERTON� CA. Arch/Eng. ��AMFS Wil_SON____Licensenlo. 33694 Address _F-R �(1 ffi ' Contractor'sNam�AL0.1ER BLDfi SY$ Phone R49-74],q Addresslmiiling) �,�5$8 G9THQRD ST 'U��TT—NsH-B• City License No, j„S Q 94 LICENSED CONTqq�TOR DECLHRATION ' I nereby aHirm tpat I am licensetl untltr provlslon5 0l Chart¢� 9(comm¢OCln9 �� with secUon 7000) of Division 3 of lhe Businezs antl Professlonz CoOq antl ', my Iicense Is in tWl /orce antl eftect ' ��. ��/'' �' rrnn License Class R LI nse bo.� Date��_�.fj�� Si9nalure XIl �'�. WORKERS' COMPENSATION DE LAR TION � �, I hCreby affirm Ihat I have a certiti[ate of conSCnt to selLinSure or a certlfiwte i, of Workers' Componsa[ion Insurance,_or a cerUfied copy thereof (Settion �00, Lab.��C�.)!1 t �� O��n!1tI1 . � h IicY No.�v.f._u.1=u_1.52.J_=ut/_4¢Qt�PanY �Certifietl Copy i5 hereby fumiSheE. , Certifi�etl� cop y is til¢tl wiN [he city B4� is Date__11=:1��_ APP��cant % EXEMPTION FROM WORKERS' CO P TION DECLARATION (This section neetl mt De comple[etl if the permit iz for one huntlretl (5100) or Iess). I c¢rtify Ihat in the per(o�mance of the wo�k br whlch tM1is perm�t Is Issuetl I snall no[ employ any person in any manner so as to become subjett to l�e Workers' ComperySatlOn Laws of Calitorrlia. Dale Si9na[ure 'NOTICE: H, aiter makin9 thiz aeclaraUon, you shoule become subject to lhe Workcrs' Compensation provisions of the Labor COUa, you muzt forthwith comply wilh SUch prOVlsion5 or Ihis p¢rmi[ znall b¢ tleemetl revOkeO. CONSTRVLTION LENDING AGENCY ' I herety af/lrm tha[ thlrC Is a conztructlob lending agenty for tne performance of the work �or whlch,this permit iz Issuetl (Section 309�-Civ. C.)' �entler's Name Lentler's AtltlresS , OWNER BUIL�ER dECLARATION - I herCby dHlrm (hat I am axampt irom the COnlractor'S UcenS¢ Law /Or lna to110win9 rea50q ($CCtIOn ]031.5 BuSIn¢55 dntl ProfO551onal COGC: Any clty or county whith reqWrus a Oermlt to conslruct, aller, imorove, tlemolish or repair anv structuru. Ddor to its issuance, alzo reqWres the.applicant (or such pormil therefrom ana tne basis for the alle 41.5 by any ap0liGanl fOr a p �Ity ot not iToro than five huntlrE , as owner of the prOperty o� '. comoensatlon. WIII Oo th0 wo�k, an� not bU1145 or improves �r Iractor(s1 Iicense purs proof o( Inelr Work¢ ❑ I am eaempt untler Date I h¢reby certify tna InformaLon Is correc antl ztate laws ralatii sentatives ot this ci inspection Purposes. Si9nature Drivers' Licen 9! r1F 0865-66, rev. 10/84 a dy t0 an ownel ot a PropOrty who bulltls of Improve5 uch wark himielf/hartOH ot through his or hOr own Such imp�ov¢mant5 are no[ Inteneea or oHuretl for 41ng or Improvemenl Is Soltl wllnin one yeat ot COm- �ve the burEen ol provin9 he/she GIE not builtl or Im- aie). �perty, am exclusivery'contracting with licensetl con- irojact (Sectlon ]044. Business antl Pro�essions Cotle: Law tloes not apply to an owner of oroperry who on, antl wno contracts for suth projects with a con- t�to the COnVactor'S LlcenSe l2w). I dm awdr0 lhat ComOe�sxt�on insuranca Shoultl be provitlee IO me. :tlon B. & P. C. for rois reason Owner ication antl state that the above tlt all clly antl county ortlindnCes :ton, anG hereby authorize repre- ,820251 � � � TYPE OFCONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑�OTHER DESCRIPTIONOFWORK/USEOFBLDG. CONSTRl1CT NEW nNE TVPf OF PERMIT LJ GRADING LJ FOUNOA710N U STFUCTVRAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECTDESCRIPTION Sa.FT. 15jfi OCCUaar�GV_E CONSTRUCTIONTVPE,_�-jiJ' VALUATION$.]1,_p_( ZONE MG GRADING CV. VDS. ACRES_ Remarks: 4ar Sink � Backflow Preventer Backflow Irrigation Bathtubs � Clarifiers Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors � Kitchen Sink " ' Lavatories � . P-Trap � Roof Dreins � ' � Reinspenion Fee- � $15 . , Bailer Duct - Under Ground � Duct-Strucwral � Duct - Ventilating Exhaust System ❑ Multipla ❑ Firepl/Fact.8lt. IC80 # ' Heating System & Ducting � ❑aioo,000eru Oioo,000aT Reinspac[ion Fee $15 White - Builtling; �nary - ApD��^t: P��k - A<counting: Goltlenrotl - Assessor Showers Service Sink ' - Sewer Cap Sewer Connection Solar Colleccors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal' � Water Closet . Water Heater Water Service ' Auto�Wash ' laue Fee 0 Hood or Typel ❑ Canapy Type I I ❑ � Refrigeration System � ❑0.700,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers ' ' Issue Fee A.P. qW S Main Buildi ' E T Front B Rear ! A - C Right - K Lett _ S - Ping. Ref. � Planning Noles: -' Automatic Washer' Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas �Elec Fan F.A.U. � Fixtures Device Boxes Outl¢ts ' Switthes Garbage Disposal Generator �0.5 KW C $ 3 $ 3 3708 II/05/85 � -�Zone Accessory Building: Parking Req.IProvided � ELECTRICAL , �� Tradsformer- ❑ 75-50 KW • � � ❑ 50+KW Meter ❑up to t00�amps , ' Meter ❑over 100 amps Sub Panel - Motors 041� HP O7'f.�- B Inc.Solar �9-15 HP �1G15+ , Microwave � ' Pole Light Range • _ I I; Standing Sections 5 KW � Trash Compacror 1500: TL FEES 2 O N I N G R E Q M T S ,' Reinspection Fee . I$15 ' .�I Issue Fee � I § 3 I DEVELOPMENTSERVICESRE�UIREMENTS: � ' : , Zoning Approvad By - �ate Building Approved By Date�j-�Q� Application laued By � �ate_CL.(P �]_ /n�,.�„��j�� 1 SUMMAR OFfEES � , ��{11LU�NG PERMIT� s SMIP s � PLAN CHECK $ PERMIT � PLUMBING $ � ISSUANCE ; $ PLAN CHECK 25% $. ENERGY P.C. $, ELECTFICAL $ GRADING $ ' PLANCHECK 50% $ MiCROFILM 5 ' MECHANICAL $ TOTALFEE $ �� PIANCHECK 25% $, � , • � � ;�C` POOL & ��A ONSTRUCTION AND PLANNING APPROVALS Permit # Jate Inspector qPPROVALS Pern... # Date Inspector �'1 T.,empOrary Electrical Service or Pole 52. Pool & Equipment Location - 2. Soil Pipe-Undrgrnd. � 53. Steel.Reinforcement 3. E�ectrical Conduit Utility-Undrgrnd. 54. Forms r' � 1 � 4. �Elec[rical 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 � . j�- 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.�RoofDrains ' . � .. 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final '� 15. Rough Electrical-Conduit 66. Solar System-Final � 16� Rough Electric Wirin9 67. Fencing & Access Approval 17. Rough Wiring Sign � 68. APPROVED FOR PLASTERING "18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # , 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing � 73. Undergrnd. Storage Tank 0 Gas � Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat � 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe �28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: - 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. Solarpomestic-Final .� . 42. Backflow Preventer . 43. Backflow Irrigation � 44. .Landscape Irrigation System - 45. Sound Attenuation � � 46. Handicap Regulations � 47. FINAL STRUCTURE & BUILDING �a 8(� �_� 48. Special Requirementt Completed 49. Electric Retease to Edison . " 50. Gas Release to Southern California Gas Co • - 51. CERTIFICATE OF OCCUPANCY No Date u �' Applicant to f711 in all soaces exeept tnose within heavy GorEer Ilnes an0 slgn all approDNate tleelarations. \ CITY OF COSTA MESA ' ' ',CQNSTRUCTION PERMlZ Proje t Address P.pplicant's Mailing Atldren �� y�l��'�' � Owner's NameC7'F�/-%%CcJ��c-99 � ahone Atldreu c� ��-�� +rch/Eng. License No. Address Cbnvacror'S Nam �-- " �� Phon -�'6 Addresslmailing) /�� u �r—=-'= «� � �f City LicPns¢ No. � �%R% � 0 � % LICENSED CONTRACTOR OECLARATION � hereby alfirm that I am Iicensetl untler provi5lons of Charter 9(<ommen<Ing witM1 5¢ction 7000) Ot OIVISion 3 af the BUsiness antl Prote55iOn5 COde, antl my Iicense Is in (ull torce a etfect. ��/ p L 7 Ucense ass cense No. � Dbte Signatura � WORKERS' OMVENSATION DEC RATION 1 hereby aftirm tnat I �ava a certifl te of consen[ to selfinwre or a certificate of Workers' Compen tion Insurance, or a cerNfietl copY thereof (SetNon . 3800, Lab. C.) "': � , y....ff �' P IicY No. w � 37is ComPanY ,��`"'�-r�'�� - �Certiiietl copy is her¢by tumhhetl. _� �'" � Certif tl co is flletl wiM t�e city Bui i Div' ' n. � Da[e � APPIiGant • . E%EM 10 FPOMW00.KER5'COMP NSATIONDECLARATION� (7hissection naetl not be completetl if Oermit is for one huntlretl (5300) or Iess). I certify that in the pertormance ot the work tor which this paim�t is issuetl I shalt not employ� any person in any mannar so as to becomB.subject to t�e Workers' CompensaUon Laws of Califomia. �;A Dato b Si9naturo NOTICE: If, after makin9 tnis tleclaration, you shoultl becoma subject to the Workers' Compensation Provislons of tne Labor Code, you must fortOwith comply with such provlsions or this pormit shall ba tleemetl revoknU. CONSTRVCTION IENDING AGENCV � hereby affirm that there Is a<onztruction lentlln9 agency tor tha pertormance of the wOrk fOr Which IhiS perTit IS Issuetl (SecHon 3097 Civ. C.) Lnntler's Nam« I.antler's Atlaress � OWNEF BUILDER OECLARATION i horeby afBrm that I am ezempt from lha Cantrac[or's LJcenso L.aw for tho �ollowing reason (Seclion 7031.5 Businass antl Professlonal Cotle: Any city or �ounty which requires a permlt to construtt, alter, improve, tlemolisn or repair any structuro, prior to Its issuanco, also requires the applicant tor such pnrmit to iile a Slgnetl statemant lnat ho/she is Iiconsetl pursuant to the provislont of �he ContractorY UCan50 Law (Chapter 9.(commencing witb Sectlon 7000) of qlvision 3 of the Businoss antl Protessions Cotle) or that he/she is exompt �herotrom and the basis tor the alla9etl exomp0on. Any violation o( Sectlon � �031.5 by any apP�icant tor a permit sub)ects the applicant to a<Iv11 enalty of not more than live huntlretl tlollars (E500J. I� 1, a5 owner of tho ��operty or my OmPloYeeT wilh wa9es as thMr sol0 Componsation, will tlo tho work, antl the structure is not intentletl or oiferetl �or ule (Sectlon 7044, BuSinnss antl Vro/esslonal Cotle: Thn Contractor'S Ucense Law tloes mt appry to an owner o� a properW who builtls or Improvas �he�eon. antl who tlOes such w0/k himself/horscli or Ihrougp b15 or her own saie. �q noweveq tne owimng or improvamenc is soio wimm ona year o. com- pletlon, tho owner wlll have tn0 burtl¢n ol proving h¢/sh¢ tlitl n0l bulltl Or Im- �rova (or tne purpose ot sale). I, as owner ot tha Oroperty, am ¢zclutively contracting with Iicensetl <on- t�aGtors to conSt�uCt the pro�ect ($ection 7044, Business antl ProtO55ion5 Cotle: 7he Contractor's License Law doez not apPIY [o an Owner 01 prop¢rty who builAs or impioves thareon, antl wno <onva<cs to. zucn o�oiacts wim a con- traclor(s) Iicense Oursuant to t�e Contractor's License Law). ❑ I am exempt untlor Sectlon B. 6 P. 0. for [his reason Date Owner Signature Drivers' License r 55 � CMF 0865-46 �av. 7/83 � 7VPE OFCONSTRUCTION 151NEW lJ ADD LJ ALTERATION IJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER (�.p. q�6 DESCRIPTION OF WORK S Main Buildi E TVPE OF PERMIT GRADING FOVNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL �PLVMBING ❑ MECHANICAL A Rear ❑ �OTHEfi PRQIECT DESCRIPTION 5p. FT. OCCUPANGv C Right K Leit CONSTRUCTIONTVPE VALVATION$ $ ZONE GRADING CV.YDS. ACRES p�ng, Ref. #5 Ramarks: , Parking Req./Prt . , . Use of Building: PLLIMBING FEES P�anning Notes: Bar Sink � Backflow Preventer Backflow Irrigation ' Bathtubs Clarifiers Dishwasher � ' Drinking Fountains Floor Drains Floor Sinks GasService / Outlets In[erceptors Kitchen Sink Lavatories � . P—Trap Roof Drains Reinspection Fee $25 doiler ' Duct - Under Ground Duct - Strucmral Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blc ICBO # Heating System & Ducting ❑6100,000 BTU 0700,0006TI Reinspection Fea Builtlinq; Canary - Applicant; Plnk - AccounHn9; Goltlenrotl - Assessor $25 Showers Service Sink Sewer Cap Sewer Connection Solar Collecmrs Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Claset Water Heater Water Service laue Fee Hood or Typel ❑ CanoPV TVPe 11 ❑ Refrigeration System �0.100,OOOBTU ❑100,000 System Repair/Alteration Iswe Fee $ 3 S 3 Caoking Unit Dryers LJGas L1E1 Fan � F.A.U. Fixtures Device Boxes OuUets Switches Gerbage Disposal Generator d0.5 KW 9802 9/ I �/(�!� Zone � Accessory 9uilding: Park. Fees $ ELECTRICAL � TransFormer ❑ 15�50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over100amps Sub Panel Momrs 00.1 HP �i'h-8 Inc.Solar �315 HP �1615+ Microwave Pole Light Fiange Slanding Sections 5 KW Trash Compactor 2�, �� - -0 ..� � Z O N I N G R E � U R E M E N T S FEES � Reinspaetion Fee � � gy5l Issue Fee I $ 3 I PUBIIC SERVICES REQUIREMENTS: Zoninp Approved By Data Application Approved By Date Appliqtion Issued By Date 9�0 � SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ � ��UANCE , $ PLAN CHECK $ a ENERGV P.C. $ ELECTRICAL $ GRADING S PLAN CHECK $ MICROFILM § � MECHANICAL $ TOTALFEE $ �?'�L PLAN CHECK $ � �� CONSTRUCTION AND PLANNING � POOL & SPA ' "' - Date ' Inspector Date Inspector _ l�PPROVALS Permit # � , APPROVALS Permit # �� 1.' Temporary Electrical Service or Pole � 52.. Pool & Equipment Location 2: Soil Pipe-Undrgrnd. _ .C� �6 �f 53. Steel Reinforcement 3: Electrical Conduit Utility-Undrgmd. �� 54. Forms •4. Electrical Conduit-Undrgrnd. �. 55. Electrical Bonding . � '5. Steel Reinforcement � - 56. Rough Plumbing & Pressure Test �� Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE 7: Foo[ings � _ 58. Electrical Conduit•Undrgrnd. 8. Foundation - � 59. Gas Pipe, O Undrqrnd., 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. flough Plumbing '" - �p��d /5 L.�� 65. Electrical-Final . 15. Rough Electrical-Conduit� �� 66. SolarSystem�Final '.16.` Rough Electric Wiring • ' 67. Fencirig & Access Approval 17: Rough Wiring Sign � - 6S. 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. Wthing & 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 MeterFinal 80: FOOD CERTIFICATE ISSUED 33. Final Electric Notes: . 34. Final Heating & Air Conditioning � . 35. Final Gas Pipe-Test �U//� �l (�/J 36. Hood or Canopy . _ 37. Final Factory Fireplace � 38. Final Plumbing /�jpJ%� L� 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'Releaseto Edison ' - 50. Gas Release to.Southern California Gas Co � 51. CERTIF.ICATE OF OCCUPANCY . No. Date �r Applicant to f7ll In all spaces axcept enosa witnin neavy bortler lines ane sign all approD��ale aeclaratlons. CITY OF COSTA ESA CO ST "IO ERMI PEA-�41,7 NO. _. , TRACT NO. LOT NO. UNIT NO. - ��5 . u� . ��-h �ee+ Projecl Atltlress Applicant's Mailing Ad�d�r\ess a3 Owner's Name �� w� ��j�� Phone Address �-�.�. �^ Arch/Eng. License No. Address Q�; Contracto 's Name� ,^ /� Pho,ny¢ �ty Addresslm�'�'n�10��('�V�\l..l �Q�A" � � City License No. �L1� LICENSED CONTRACTOR DECLARATION 1 hereby aHirm t�at I am licensetl untler provi51on50t Charte� 9(commentln9 wi[h 5ection ]000) of Dlvislon 3 of the Bu5ine55 antl Prolessions Cooe, antl my license is in t I ntl etfect. ,�` _� �� License SI zs � �re� e ��«-1 Date 1 �� ' �51g t WORKERS' COMPENSATION DECLARFTION I hereby aftirm that 1 nave a certiticate ot consent to selt-insure or a tertiticate �i Workers' Compensation Insurance, or a certitietl mpy thereof (Sectlon 800. lab. n _ , , —� n /olicy No. �� Company ,�C� 6 �7� �Certifietl copy is hereby furnishetl. Certif�tl (�py��tl with [he Gty pplldipg Djai{i�ff_ date 1_I�) APPlicant 1s��—q � Y 1J2'� EXEMPTION FROM WORKERS' COMPENSATION OECLARATION (Thissection neetl not be completetl if the permi[ is for one huntlretl ($100) or less). I certi(y [hat in lhe perfOrmance of the wOrk f0/ wM1ich Ihis pe�m�t is is h I shall not employ any person in any manner so as to become 5 bje e Workers' C p s i ws of Calif i Date �Signature � 'NOTICE: It, afte� maki Ihis tlacla�ation, you Shoul betOme subj o the Workers' Comp¢nsati pwvisions o/ the Labor Catle, you must rtnwith wmply wilh such provision5 or tM1is permit shall be tleemetl revok¢tl. CONSTRUCTION IENOING AGENCV I he�eby afflrm Ihat the�e i5 a Construction lentling agency /or th¢ pertormanc¢ ot the wo�k for whiGh Ihis petmit is issuetl (Sectlon 309] Civ. C.) Lender's Name LentleCs Atlaress OWNER BUILOEN OECLARHTION I he�eby altltm tha[ I am ex¢mpt /wm the Cont�actor's LICCnse Law for the followin9 reason (Sectlon ]031.5 Business antl Professional Cotle: Any city or counry which �equires a pe�mit t0 const�uct, dlt¢r, improve, tlemoliSh o� re0a1� any structure, prior ta iK issuance, also requires the applicant (or such permit to file a Slgnetl statemen[ tha[ he/she i5 licensetl pur5uanl to tha provisions of tne Conira<tar's License Law (Chapter 9(commencin9 with SecUon ]000) ot Division 3 of [ne Business antl Profezslons Cotle) or that he/she is exempt therefrom an0 Ihe bazis for the allegetl exemptlon. Any vlolation of Section 031.5 by any applicant 1or a permi[ subjects the applicant to a�civll :nalty of no[ more than tive nuntlretl tlollars (550o). J I, as owne� ot the p/operty o� my employees with wag¢5 as thei� so18 tompenSatiDn, will tlo the work, antl the Structure i5 nof intentletl o� oft¢retl for sale (Settion 7044, Buslness and Professional Cotle: The Contractor'S License Law tloes mt aov�Y to an owner ot a property who bulltls or improves thereon, antl who tloes such work himself/herself or tnrough his or her own employee5, provitletl that such Improvement5 ar¢ not intentlatl Or ottere0 for sale. If, M1owever, the builtlin9 Or imOrov¢Tent Is soltl wl[hin one year of com- pletion, the owner will have the burtlen of proving he/sne tlltl not builtl or Im- �rove torthe purpose otsale). I, as owner of [he property, am exClu5lvery contracting with Iicensetl cOn- tractors to construct tne proiect (Section 7044, Business antl Protessions Cotle: Th¢ ConVacto�'s Lic¢nse Law tloes not apply to an owner of property wh0 Duiltls or Improves.thereon, antl who contratts for such orojetts wltn a con- tractor(zl license punuant to Ihe Contractor's License Law). I am aware that proot of [heir Worker'S COmpensation insu�ance shoultl ba provl0etl to me. ❑ I am exempt untler Section B. & P. C. tor this reason Date Owner certiry that I have reatl this m is correct. I agr¢e to compl law5 relatinq to builtling cons of Uis citv to ent4r upon TVPE OF CONSTRUCTION LJ NEW U ADD LJ ALTERATION LJ REGAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TVPE OF PERMIT GRADING FOVrvoATION S7RVC7URAL ❑ TENANT ❑ EI.ECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ -OTHER PROJECT DESCRIPTION 5�. FT. OCCUPANCY � CONSTRUCTION TYPE VALUATION $ ZONE GRA�INGCU.YDS. ACRES Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers " Dishwasher Drinking Fountains Floor Dreins Floar Sinks Gas Service Outlets Interceptors Kitchen Sink . Lavatories � . P—Trap Roof Drains Reinspeetion Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating . � Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting �i0.100,000 BTU O 100,000 BT — I I Reinspection Fee I 515 �"8\ Whlte - Builtling; Canary - APO��ant: Pink - qCcounting; GOltlenrOtl - A558550� Showers Service Sink Sewer Cap Sewer Connection Solar Collecrors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water�Heater Wa[er Service Auto-Wash laue Fae Hood or Typel ❑ Canopy Typell ❑ A.P. # S Main Building: E T Front A Rear C Right SLeft 'Ping. Ref. #' Planning Notes: Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric � Fan f.A.U. ' - Fixtures' Device Boxes Outlets Switches Garbage Disposal Generator �0.5 KW C 4efrigeration System �0.100,000 BTU ❑100,000 BTU System Repair/Alteration Fire Dampers Registers �, m �'j Issue Fee --. -•._ --'� 3788 II/07/85 \ � Zone Accessory Parking ELECTRICAL � Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up ro 100 amps Meter ❑over 100 amps Sub Panel Momrs DO-1 HP 01'h - 8 Inc.Solar �9-15 HP �16-15+ � Microwave -" Pole Li9ht . Sign ', Standing Sections 5-15 KW Trash Compactor $ 3 ' � Reinspection Fee $15 luue Fee FEES' DEVELOPMENT SER VICES REQUIREMENTS: Zoning Approved By Building Approved By , ApplieatiOn laUed By n � S 3 SUMMARV OF FEES ' BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ � ISSUANCE $ PLAN CHECK 25% $ ' ENERGV P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ , MICROFILM $ MECHANICAL $ � TOTAL FEE $ � PU1N CHECK 25% $ � � FEES $ 3 Z O N I N G R E Q M T S CONSTRUCTION ANDPLANNING � i AP�'ROVALS Permit # 1: -Temporary Electrical Service or Pole -! 2. Soil Pipe=Undrgrnd. - - .3. Electrical Conduit Utility-Undrgrnd. 4. Electrical Conduitlllndrgrnd. 5. Steel Reinforcement � 6. Electrical UFER Grnd. � � 7. Footingf_ � ' 8. Foundation � - 9. Water Pipe-Undrgrnd. 10. Structural Floor System � 11: Property Sewer Line & House Connection 12. Sewer Cap 13. Roof Drains 14. Rough Plumbing. � 15. Rough Electrical-Conduit . 16. Rough Electric Wiring 17. •Rough Wiring Sign 18. Rough Electrical-T Bar Ceiling 19. Rough Heating & Air Conditioning 20. Rough Factory Fireplace 21. Ducts, in Structure 22. Ducts, Ventilating 23. Gas Pipe-Rough & Test � 24. Roof Freming 25. Roof Sheathing 26. T-Bar Ceiling (Structural) & Monocoat 27. Frame and Flashing 26. Lathing & Siding 29. 'Insulation . 30. Drywall Nailing 31. Plaster Brown Coat 32. Electrical Power Meter-Final 33. Final Electric 34. Final Heating.& Air Conditioning 35. Final Gas,Pipe-Test 36. Hood or Canopy, 37. Final Factory Fireplace 38. Final Flumbing 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. Electrie Release to Edison 50. Gas Release to Southern California Gas Co ,51. CERTIFICATE OF OCCUPANCY - Date Date r ii POO L 'A Inspector AppROVALS Permit# 52. Pool & Equipment Location 53. Steel Reinforcement � � 54. Forms - � 55. Electrical Bonding 56. Rough Plumbing & Pressure Test - 57. APPROVALTOCOVER-GUNITE 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, O Undrgrnd., Test 60. Backwash Lines, P-Trap, O Undrgrnd. _ 61. APPROVAL TO DECK � 62. Backwash & Receptor-Final . 63. Heater & Vent-Final ' , 64. Plumbing System � Final 65. Electrical-Final 66. Solar System-Final . . 67. Fencing & Access Approval 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL FIRE DEPT. REQUIREMENT APPROVALS Permit # � 70. Underground Hydro ' 71. Product Piping OGas ❑Oil 72. Underground Flush 73. Undergrnd. Storage Tank O Gas ❑ Oil 74.� Overhead Hydro ' 75. Dry Chemical 76. Dry Standpipe � 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: i i � �s ��.. _ .� � ..., . __ !7. , Date �Inspector � Appllcant to fill In all ipaces except thosa within heavy bo�Ee� Iinas anC si9n all aovroo��ate aeclantions. .CIj�F COSTA MESA CONSTRUCTION PERMIT � PERMIT NO_ _ � TRACT NO. LOT NO. � UNIT NO. �7'roject Address 47:ti'� (�.J I (F � �f � Applicani's�Mailing Addreu �y� 'S ��'N V« �%�'JC /a'- Owner's Name �� { �*J �� '''' �K'� Phone Address ��J' (� • /`f � ✓'T Arch/Eng. License No. Address Contractor'sNam�� ' � �°r�one��'`�F� Addreulmailing) ��.w -� T �•- Ciry License No. LICENSED CONTRACTOF DECLARATION I hGreby atflrm tbat I am Iicansetl untler provi510n501 Charta� 9(commtntlng wlth section ]000) of Divislon 3 oi the Businass antl Protesslons Cotle, antl my Iltenza Is tn Iu11 ce a a eltoct. Ucense Class -�� Llcense No. H/1 / S7J Oate� '� ` $I9nature �-C`��^� WORKERS'COMPENSATION DECLARATION 1 hereby aftirm that I have a certlfiwte ol consent to selNnsure or a certifiwte ot Workers' Compenzation Insuranca, or a ccrtlfietl copY tnereOf (5!<llon 3800, Lab. C.) Policy No. Gompany _ BCertifietl capy is nereby fumisnetl. ' Certitietl ropy is 1lletl with the city Builtling Division. Date Appticant EXEMPTION FROM WORKERS' COMPENSATION OECLARATION (Tnis sec[ion neetl not be COmpleletl i1 [hc parmi[ is lor one huntlretl (E300) Or less). 1 cartify thal In the performance of the work for whic� lhls pe�m�l ISISSuetl I snall no[ employ any person in any mannnr so as to become SUCject [o t�te Workers' CortW e satlan Laws of Callfo. rpy� �j J / Date �/� �l�"�n S�9nature oS-� ��'�� 'NOTICE: 11, altet making this tlecla�aUon, y0u ShOultl become subjGct t0 th0 Wo�ke�s' Compensation provlsioni of Ihe L�bo� Cotla, you musl tOr[hwith comply wilh Such p�ovlslon5 Or lltls po�mlt inall ba tlGemetl �evoked. � CONSTRUCTION LENDING AGENCV 'i I nereby aftirm that tnero Is a Wnstructlon Iontling agency for the pertormance of Ihe work tor whith thls pormlt i5 ISSuetl (Sectlon 3091 Civ. C.) L.entler's Name LenOer'S Adtlre55 OWNER BUILDEN OECLARATION I her¢by affirm thal I am exampt trom the ConVattor's License Law br ttte following reason (Section ]031.5 BUSiness antl Professlonal Cotlo: Any city or county whlch requires a De�mit lo cOnSl�uCt, al[eq ImOrove, tlemOlisb or ropai� any ztruclur¢, prbr to its issuance, also reqWres the applicant tor such permit to file a Signetl Statemenl [hat he/Sh¢ Is Ilcen58tl purSUanl to the prOvlsion5 of [he Contractor'S License Law (Chapter 9(commencing wlth 5ectlon 7000) of Division 3 of lhe Business antl Professlons Cotle) or tha[ he/she is axempt - the�efrom antl [he baSis �or the allegetl ez¢mplion. Any viOlalion o1 Section 7031.5 by any applicant ror a permit 5ubject5 the applicant to a civil �enalty of not more [nan five nuntlretl tlollars (E500�. I, as owner o1 [he pro0erty or my employeas with waqes as [heir sole comvensation, will tlo the work, antl the structure is not Mtentletl or o1(eretl for wle (Section 7044, Business and Protezslonal Cotle: Tne Contractor's License l.aw does nOt apply [o an Owne� of a proparry who bulltl5 O� Improv¢5 thereon, ana who aoes such work hlmseH/herself or throuqh M1is or her own emO�oYeeS, OrOvitletl thal such improvemonls a�e not IntCntlad or olferetl fo� sale. If, howeve�, lhc bulltlin9 0� ImO�ovomenl I5 Soltl wlthin ono year of com- o�etlon, the owner wlli have tha burtlon oi proving he/she tlitl not builtl or im- prove for the purpose oi sale). . ❑ I, as owner ol the property, am oxcluslvely contracting wilh Ilcensetl con- tlactors tU cOnsV utl tho OrOject �SecHon 7044, Busines5 antl PrOt0551on5 COtlO: Tha Con[ractor's Liconsn Law oaz not apply [o an owner of property who Guiltlz or improves tnereon, antl who contrac[s for 5uch pro7act5 wlth a con- tractor(sl license pursuant�to tno Contractor's Litonse Law). I am awara tM1at prooi o( tneir WorkeYs Componsatlon Insuranco shoultl be provltlaU to mo. ❑ I am nzempt Undet Section B. & P. C. /or thi5 reason Date Signacure Drivers' L Owner -tnat I have reatl tM1is applicatlon antl stato that Ihe above �rrect. I a9ree to comply with dll City antl county ortllnance5 elatlng to builtlin9 constructlon, antl horeby authoriza repre• �) ciry to entar upon the abovo-mentlonatl property tor es. /j .s ._ i� �b' L7.-�'.` �1 LCi�-`�e� Date __ TYPE OF CONSTRUCTION L_ NEW LJ A�D LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TVPE OF PERMIT�y LJ GRADING LJ FOUNDATION Ll STRUCTV RAL ❑ TENANT LJ ELECTRICAI ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PR0.IECT DESCRIPTION Sp. FT. OCCUPANCV_ CONSTRVCTION TVPE VAWATION $ ZONE GRADWGCU.YDS. ACRES_ Remarks: Sink <flow Preventer kflow Irrigation Drinking Fountains Floor Drains Floor Sinks GasService Outlets Interceptors Kitchen Sink Lavatories P-Trap . Roof Drains Reinspeetion Fee . I $15 Duct - Under Ground Duct - Structurel Duct - Ventilating Exhaust System ❑ MWtiple ❑ Firepl/Fact.8lt. IC805W ' Heating System & Ducting ❑ a� oo,oao eru O i oo.000 sr Reinspection Fee � $15 CMF 0865-46, rGv. ]0/84 WM1ite - Builtling; Canary - Applicant; Plnk - AccounUn9; Goltlenrotl - ASsessor Showers Service Sink Sewer Cap Sewer Connection Solar Collxtors Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service ' Auto-Wash Isue Fee EES $� A.P. # � S Main Buildi E T Front B Rear A C Right K g Left Ping. Ref. qW Planning Notes: Automatic Washer Constructian Pole Sub. Cooking Unit Dishwasher Dryers �Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator DO-5 KW �5�1 2756 10/23/05 Zone Parking Req./Provided ELECTRICAL Transtormer ❑ 15-50 KW ❑ 50+KW r Meter lip to 100 amps Meter ❑over100amps ! Sub Panel Motors � 0.1 HP � 1 X- 8 Inc.Solar �9-15 HP �16-15+ Microwave � Pole Light , � Sign ; Standing Sections KW Trash Compactor IANICAL FEES a Reinspection Fae $15 luue Fee Hoodor Typel O DEVELOPMENTSERVICESREQUIREMENTS: CanoPY TVPe II ❑ ' Zonin9 APProved By ' _ � _ . Building Appmved 9y ,n Refrigeration System ❑aioo,aooaru ❑ioo,000 System Repair/Alteration Fire Dampe�s ' Regiscers Issua Fee �4ou0 ?L 2 O N I N G R E Q M T S FEES 0 $ 3 � � SUMMARV OF FEES � c BUILDING PERMIT $ SMIP ' $ - PLAN CHECK $ �� PERMIT � • PLUMBING $ ' ISSUANCE $ PLAN CHECK 25% $ . ENERGV P.C. $ ' EIECTRICAL $ GRADING . $ PLANCHECK 50% $ � MICROFILM $'� ' • MECHANICAL $, TOTALFEE $ -'�""- $ 3 PLAN CHECK 25% $ � I -��•' ��ONSTRUCT.lON AND PLANNING POOL & 5PA � APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location ' 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement . 3. Electrical Conduit Utility-Undrgrnd. 54. Forms � �4. Elec[rical 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. Structurai Floor System . 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap - 63. Heater & VenrFinal 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 . 77. Rough Wiring Sign . 68. APPROVED FOR PLASTERING � 18. Rough Electrical-T Bar Ceiling /�� 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 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. Storage Tank O Gas ❑ Oil .� 25. Roof Shea[hing . � 74. Overhead Hydro 26. T-Bar Ceiling (Structurap & Monocoat � 75. Dry Chemical ^ 27. Frame and Flashing 76. Dry Standpipe _28. Lathing & Siding � 77. FIXED SYSTEM FINAL � 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final / 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: /O /O U 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-Finai 41. Solar pomestic-Final 42. Backflow Preventer - . . - 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation � ' 46. Handicap Regula[ions 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electrie Release to Edison . • . 50. Gas Release to Southern California Gas Co � 51. CERTIFICATE OF OCCUPANCY ' � No. Date ' � ' � ' =� /' AODlicant to fill in all soaees encepl those within heavy bortler Ilnes anG slgn a11 appropriate tleelaratlonz. : CiT.TOF coSTA MESA CONSTRUCTION PERMIT ' '�Proj�t Address q�$ W_ 1 R T H S T R T Applicant'sMailingAddress 16�$Q �OTHARn ST-�H_R_ Ow�er': tvame ��p��TH J RUNN vho�e Qddress � ��+ (�I FNOAK� ATHERTON CA: � Arch/Eng. JL�MFS WTI SON - LicenseNo. 33�9�+ , Address � � FRFSNni � CA. � � Contracror'sNama PALMER B-LI�..Ln SVS _ phone R47-747�{ �Address (mailingl� ] � � $'� G9TH/•1RD—S T � "H" � H EL � � Ciry License No. � 3 S J J 4� LICENSED CONTRACTOR DECIARATION 1 hereby affirm that I,am licensetl untle� p�ovi5lon5 of CM1arter 9(commencinq wiih section ]000) Of DiviSion 3 of [he Business antl P�otes5ions Cotle; antl S my license is in fWl forte and efiect. � � License Clazs icen No. � 1 Date—j�--�{��—{}�� Signature ' � WORKE�RS' COMPENSATION D CLARATION . � I hereby aftirm that I have a certificate of consent to selLinsure or a certificate � of Worke�s' Compensation Insu�ance, o� a ce�titietl coOY thereot (SeGtion i800, Lab. �C'�Jrr� � n� o 1_ t�� , 'olicY No. �yyy�}y.p_�_ B-Qy,dnVa�Y � • }1,�{,'Certifietl�mpy is he�eby fumishetl. HNcertitietl mpy is filetl with the city B i vi5 n. Date 1 �1 —F,—R 5 Applicant EXEMPTION FROM WORKERS' COM ENS TION DECLARATI N (This section neetl not be completetl If the permit is tor one huntlred (E100)br less). I cer[ify tha[ in the pe�formance of tM1e wo�k fo� whlch this pe�m�t Is ISSuetl I shall not employ any person in any mann s to becoq�e subject t t�e Worket o pe a(Lon Laws of Calitor ��/�. �//�A � a Date � Signature �� 'NOTICE: I, after making this tleclarati o snoultl become subject to the Workers' Compensation .provisions.of the labor Cotle, you must forthwith comply with such prOvisions o� this permit Shall be deemetl revoketl. CONSTRUCTION LENDING AGENCV , I bereby affirm'that�ihere is a construction lentling a9enty (or the per/ormance of �the work for whicn tnis�permit Is issuetl (Sectlon, 3097 Civ. CJ� I..entler's Name . Lenaer's Ftltlress � _ OWNER BUILDER'bECLARATION I hereby affirm that 1 am exempt (rom the Contractor's �License Law for tne' ' followin9 reason (Section �031.5 Businessantl Professlonal Cotle: Any.city-oi county which requires a permit to construct, alter, improve, tlemolizh or repair any sVucture, prior fo its issuance, also requlres the applicant for such.permit to fi�e a siqnetl statement that he/she Is IicenS¢tl pu�suant to the provisions of, - the Contractor's License Law (Chapter 9(commencing with 5ection 7000) oT - Division 3 of the Businesz antl� Profes5ions Code) or that'he/she is exempt 'ther¢trom antl the ba5i5 10r the all¢getl exemption. Any viDlation of 5¢ction �031.5 by any applicant tor a permit'subjects the applicant lo a civll rtdlty of not more than tive huntl�etl tlollar5 (E500). I, as owner of the p�operty o� �my em0�oyee5,with� wa9e5 as,their Sole -..om0ensation, will Oo the wo�k, antl the stru[lure i5 not intentletl or offeretl tor sale (Section �Oa4, Businezs antl Professional Cotle: The Contractor's License Law tloes not apply to an owner of a property wno.builtls or improves thereon, antl who tloes such work� himself/herselt or through his or ner own emolovees, provitlea tnat such Improvements are not Intentletl or of(eretl tor, sale. It, however, the builtlin9 or Improvement is saltl within ona year o( com- pletiOn, the Owner will have the bur0en of proving he/she tlitl no[ bWltl or im- �rove for the purpose of sale). - I, a5 owne� of the property, am exclusively mn[ractinq with licensetl Con- tractors to construct Ihe pro�ect (Section 7044, Business antl Professions Cotle: The Contractor'S License Law does not apply to an owner of property who 'builtls or improves thereon, antl who contracts for such projects with a con- tractor(si license pursuant to the Contractor's Llcense Law). I am aware that proot of thei� Worker's Compen5ation in5uranc¢ Shoultl be provitletl to me. ❑ I am exempt untler 5ection B. & P. C. for [h15 reason Date Owner I herebY cer[ity tna[ I have rea upon Signature _L�{//L Drivers' license�or 55 � Date//�—/ —� e TVPE OF CONSTRUCTION �I NEW LJ ADD LI ALTERATION LI REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. GONSTR� L�T �I.EN� �NE TVPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑OTHER-• � - PROJECTDESCRIPTION S�.FT.-�S3Fi pCCUPANCV R—% CONSTRUCTIONTYPE TT—N � VALUATION$]iI.00O zorve MG GRADING CU. VDS. ACRES Remarks: � ' � � � ' Sink � <flow Preventer �- <flow Irrigation � Drinking Fountains � � Floor Dreins ' � � Floor Sinks - - - Gas Service Outlets Interceptors - Kitchen Sink - - Lavatories � . P—Trap Roof Drains i - � Reinspenion Fee , � $15 Boiler Duct - Under Ground ' Duct-Struttural � Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Hea[ing System & Ducting � O P7 00,000 BTU O 7 00,000 BTi Reinspection Fee � $15 CMF 0865-4fi, rev. 30/84 White - Builtling; Canary - Appliwnt; Plnk - q�counting; Goltlenrotl - Assessor ES Showers Service Sink — Sewer Cap' Sewer Connection Solar Collectors' Solar Pipin9 Solar Tank Swimming Pool w/Spa Urinal Water Closet � Water Heater � Water.Service Auto-Wash _ . � � . , Issue Fae $ 3 iANICAL � FEE Hood or Type I ❑ � � Canopy Type I I ❑ � ` RefrigerationSys[em ,� ❑P100,OOOBTU ❑100,OOOBTU System Repair/Alteration Fire Dampers � Registers . • laua Fee $ 3 A.P. � S Main I E T Front B � Rear A C Right K Ping. Ref. # Planning Notes: Automatic Washer ' Construct ion' Pole Sub. Cooking Unit Dishwasher . Dryers ❑Gas ❑Electric Fan F,A.U. Fixtures-' • Device Boxes Outlets Switches • . Garbage Disposal Generator DO-5 KW C Reinspection Fee 3709 fi/06/85 ing Req./Provided i�oa� Zone Z • N i N G � � ELECTRICAL • Transforme� ❑ 15-50 KW ❑ 50+ KW � ' Meter ❑up to 100 amps Meter ❑ovei100amps ' � Sub Panel ' � � Morors �0-1' HP �1'/, - 8' Inc.Solar �9-15 HP �16-15+ . Pole Light � Fange � Si9n � ; Standing Sections � 15 KW Tresh Compactor ' � �DEVELOPMENTSERVICESR ZoninB Approved By ' Building ApP�oved By PLAN CHECK PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK MECHANICAL PLAN CHECK luue Fee EMENTS: I �E Q M T S FEES 0 $ 3 SUM EES � ' � ' AIT �� SMIP . $� $ PERMIT � $ � ISSUANCE $ 25% $ � ENERGY P.C. $ $ GRADING $� 5096 $ MICROFiLM $, - J� $ TOTALFEE • $, � � ' V 25% $ , ' �C'ONSTRUCTIPN AND PLANNING POOL F 1 �" APPROVALS Permit# Date Inspector p�ppROVALS Permit# Date Inspector ' f , � 1. Temporary ElBctrical Serviceor Pole �i 52. Pool & Equipment Loca[ion 2. Soil Pipe-Undrgrnd. . 53. Steel Reinforcement � '_ 3. Electrical Conduit Utility-Undrgrnd. �� 54. Forms � '�, •. "_4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding • �" . �5. Steel Reinforcement 56. Rough Plumbing & Pressure Test �� ,� � 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE '. �: 7. Footings � j f� 58. ElectricalConduit-Undrgrnd. .r�', � 8. Foundation � ,�� j_��. . i. � 59. Gas Pipe, � Undrgrnd., Test :' 9. Water Pipe-Undrgrnd. • ' �' . � '., 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System . � i' �' 67. APPROVAL TO DECK � 11. Property Sewer Line & House Connection ' ! � 62. Backwash & Receptor-Final � � 12. Sewer Cap y ,% �� 63. Heater & Vent-Final � �j � 13. Roof Drains � • .�„� 64. Plumbing System - Final 74. Rough Plumbing 65. Electrical-Final ' 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring . 67. Fencing & Access Approval � 1�. Rough Wiring Sign 68. APPROVED FOR PLASTERING ..t8. Rough Electrical-T Bar Ceiling 69. POO VSPA SYSTEMS FINAL � �19. Rough Heating & Air Conditioning FIRE DEPT. REnU1REMENT �20. Rough Factory Fireplace APPROVALS Permit# 21. Ducts, in Structure � 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test � 72. Underground Flush 24. RoofFraming � � 73. Undergrnd.StorageTankOGas ❑Oil � 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe ' 28. �Lathing & Siding , 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION -- 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. FinalElectric �� 3 Notes: - 34.-Final Neating & Air Conditioning - � 35. Final Gas Pipe-Yest . � .- , � 36. Hood or Canopy � ' . , , 37. Final Factory Fireplace - � 38. Final Plumbing � 39. Water Service-Final � 40. Gas Service-Final - - � i 41. Solar pomestic-Final � � 42. Backflow Preventer � , 43. Backflow Irrigation � � _ 44. ,Landscape Irrigation System � 45. Sound Attenuation' , ` . - 46. Handicap Regulations . . ' � � 47. FINAL STRUC7URE & BUILDING -• 48. Speci'al Requirements Completed ' ' � . 49. Electric Release to Edison - � � � 50. Gas Release to Southern California Gas Co , ' � - � 51. CERTIFICATE OF OCCUPANCY NO. � � - Date ' - '