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Home My WebLink About1041 18TH ST - Building Permits� •r PROJECT ADDRESS: 1041 W 18TH ST . OWNER'S NAME: LINDA JONES AGENCY ADDRESS: SAME(EXCEPT SUITE #203) ARCHIENGINEER: ADDRESS: UNIT: REG.NO.: UNIT: PERMITTEE: DAVIS AIR CONDITIONING (714)634-1695 ADDRESS: 166 N. STATE COLLEGE ORANGE CA 92668 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions at Chapter 9(commencing with Section 7000) of Division 3 at the Business and Professions Code. and my license is in full force and elfect. CITY LICC'.::^0295541gSTATE uc.:438322 /CLASSIC -20 Date: _Lem. —(—( 0 Signature: _/�'� "� WORKERS' COMPENSATION DECLARATION: I hereby affirm that l have a Certilidate of asent to l -insure of a certificate of Workers' Compensation) sy';'d:fC„c gr�r I r copy thereof (Section 3800. Lab. 1.11 / O 1 / 9 1 POLICY ND.t MSIUPERIOR EXP. DATE: U '• COMPANY: ,,55AA ❑ Certified copy is hereby furnished. N Certified Copy is tried with the City 94' sion. Date: �2 L/�( Applicant: / EXEMPTION FROM WORKERS' COMPENSATION DECLARATION: (This section need not be dGened if the perms is for one hundred (SICO) or less). I cenify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date: Signature: NOTICE: It. after making INS declaration, you Should become subject to the Workers' Compensation provisions at the Labor Code, you must lontmith Comply with such provisions or His Permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency tot the performance of the work for which this permit is issued (Section 3097. Civ. Q. LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the CarltraClori State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to Construct, after. improve. demolish, or repair any structure, prior to its issuance. also requires the applicant lot such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) at that he/she is exempl therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit sobject5 the apphunl to a civil penally of not more than live hundred dollars (SSCO). I. a5 owner of the property or. my employees with wages as their sale Compensation, will do the work, and the ❑ structure is not intended or offered for sale (Section 7044. Business antl Professional Code: The Contractors' State License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered lot Sale. It, however the building or improvement m sold within one year of completion, the owner will have Ile burden at proving he/she did not build or improve for the purpose of sale). I. as met of the property. am exclusively contracting will licensed Contractors to Construct the project (Section 7044, Business Eland Professions Code: The Contractors irate License Law does not appy to an met of prime rry who bolds or improves thereon and who contracts tot such projects with a Contractors) license pursuant to the Comractori Btate License Law). I am aware that proof of (heir Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B. 8 P. C. for this reason: Date: Owner: I do hereby cenify that I am aware of and understand the requirements of California Heafth and Safety Cade Sections 25505, 25533, and 25534 and that I or any future building occupant MIVWII not (Circe one) need to comply will said state Codes and the requirements for a permit lot Construction W moddicalion from the Air 5buy Management District. Residential construction applications are exempt from these provisions. Dale: Applicant: I hereby cerllty that Ihave read this application and stale that the above information is correct. l agree to comply with all city and county onknances and slate lava relating to building Construction and hereby authorize representatives at this city to enter upon the above-mentioned property lot inspection purposes. )itis n (/n� (/ ��%(%p ,, ,� Dale: _� 2 � / —(__— Signature: �66& "�`�—"si —" ,s{---�- Driver's License or Social Security ,: � U 1641<6 White—Building; Green—Cope Enforcement: Canarv—Applicant: Pink—Revenue: Goldenrod—Assessor CITY OF COSTA MESA — BUILDING PERMIT PERM NO: M PERMIT NO: M 050174 PLAN CHECK NO: N —LiLJV5 — CONSTRUCTION TYPE: PERMIT TYPE: MEC PURPOSE: OTH JOB DESCRIPTION ; INSTALL ONE "HEAT PUMP" SQ FT: CLAIM VALUE: CALL—VALUE; GROUP OCC: B-2 / COMMENTS: MECHANICAL WORK ONLY/NO 1eB" PERMIT, Z O N I N GS R E Q U I R E M E N T S E T B A C K S ------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RIGHT. FT IN LEFT; FT IN RGHT: FT IN PARKING REQ• PROV: PARCEL: 42442121 ZNE: REF NO; PLANNING N TES> MMkkMMMMkMkMMMMMkkM*MMkMkkkMkkMMkMMMMMkMMMkkkMkMkkkMkkkkM#kkMMkMMkMkkMMMkkkkkMk D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY : —- / _ DATE: APPLICATION ISSUED BY: DATE: ***kMkkkkkkkkkkMkkkkkkkkMMMMkkk MSP MkMkkkkkMMkMkkirkMitkMkkMMMFFkMMkkkkkitkkkMMMMMi MMkMMMMMkk MkkMMkMkkkMkMMMMkMMMMMkik LEGALIZATION:N F E E S U M A R Y STRUCTURAL SEGMENT:N Www PERMIT BLDG PMT PLUMBING ELECTRIC MECH8ANIC 00 FIRE SMIP/RES GRADING PLAN '5% SMIP/NON—RES ISSUE FEE 15.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 18.00 15.00 0.00 33.00 33.00 ,00 REVENUE DIVISION TOTALS--> COLLECTED: 33.00 OVER/SHORT: 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 33.00 ik ik Mik ik ik lk ik iF ik ik MFF ik iF ik iF ik iF iF ik iF kiF IF FFM ik iFkik ik MFF iF iF iF iF aF iF ik sF MiFkkik Mik ik iFkkk MM kMkkkM Mkk MMiFkMkMM Mkk Mkk I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST MEC 1 REPAIR/ALT COOLING UNIT/SYS W/CNTLS 9.00 900 MEC 1 REPAIR/ALT HEATING UNIT/SYS W/CNTLS 9.00 9.,00 END OF FEES 01 O0077':3-GGO75:52 T07 RATE: 12iO4i90 TIKE: 1:.:4:: A CONSTRUCTION AND PLANNING ` POOL & SPA APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service of Pole.,- 52. Pool & Equipment Location , 2. Soil Pipe-Undrgrnd. = 53. Steel Reinforcement r r'3.:ElectricalCond-u`it_tAility-Undrgrnd�"� 54. Forms 4'. Electrical Condui6lfndrgrnd.� 55. Electrical Bonding !i , " 5: -Steel Reinforcement 56. Rough Plumbing & Pressure Test f%=Electrical UFERSGrnd. 57. APPROVAL TO COVER-GUNITE o- 7., Footings S'_ « 58. Electrical Conduit-Undrgrnd. �y �•& Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9: "Water Pipe-UndrgF n d• 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. -Structural Floor System 61. APPROVAL TO DECK , 11. Property Sewer-Llny& House Connection 62. Backwash & Receptor -Final 12. Sewer Cap c 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 _ ' + APPROVALS �CPernit # 20:'Rou h Factor. Fireplace = f g y p :G _ : ,' * 21.' in StrUcturery1 ',... :' ;. 5 - Underground Hydro -Duc't's, f ,70. 22. Ducts, Ventilating•+ •t i, + -71. product Piping 0 -Gas O'Oil •-r - -• -� r-, z .� 23..Gas Pipe�Rough &'Test �. Y �n Underground Flush; S ,; _,72. 24:'Roof Framing � . - - !'> •: �73-'Undergrnb:StorageTank-0 Gas 0Oil- ,� 25. Roof Sheathin9y, ' S^O74verhead Hydro`- y T -Bar Ceiling (Structural) & Montocoat •�_ + -- - 75TDry Chemical26. �� Y - 27. -Frame and Flashing= -mat :, `,. ° * y ,r'. • �= 76. Dry StandPlp-e i_28. Lathing Siding; c: sa x, z. X - 77^ FIXED SYSTEM FINAL t •- >29. Insulation rk L r 78s FIRE PREY. FINAL f ? t•a 30. Drywall Nailing HEALTH_DEPTt REQUIREMENT ` 31. Plaster Brown Coat; x ,•'�', ' FINAL INSPECTION- T I .�. ,..,; 179- X.1 _-32: Electrical Power Miter -Final, > ;u t < v :80.r.FOOD CERTIFICATE IS6UE0 33. Firiil Electric 7 ' '' rl ')Notes: 34. -Final Heatingt& . r'. Condition ng 2l L�jp. u: •y q 35. -Final Gas Pipe -Test, 36. e, or Canopy.:', -�_ I .r •_ ; n t; '.` - F ?] �j .+ . .)(U • '-37.:Final Factory Fireplace j ;��`• ••• '^ -'' r v - .'• 2 No;,. -38. Final Plumbing `'' .'39. Water Service -Finale t„40. Gas Service -Final , _ , >41. Solar Domestic -Final's .^• •• ` •y i1 - .r M. _ ^ 42.'Backflow Preventer 0.3 ` ,D 1, ` `5 U: 7 - 43. Backflow Irr.ioation > tr 044. Landscape Irrigation System"' t� l:: .z. J. T' ` _ T til _ -` ' t; 45. Sound Attenuation 46: Handicap Regulations �_ •r # -� '47,, STRUCTURE & BUI',LDING - i ,> -Y ?) -FINAL , 48.'F1NAL PLANNING >' .; _,• 49vEleetric Release to Edison ' ` ";• >: x l _ I h rf �_50._Gas-Release to Southern California Gas Co '}; S l_ _ �? - •.a 51. CERTIFICATE OF,'OCCUPANCY No Date City of Costa Mesa Development Services Department Building Safety Division v CERTIFICATE OF OCCUPANCY No. rI024"� � ' P. O. Box 1200 Costa Mesa, California The Building located at 1041 Wast 18th Street, Buildino A has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group 32 Occupancy. Use of Buildin Legal Description 424-421-18,19,20 (See reverse side for Metes and Bounds) E38165 Building Permit No B 34584 Electrical Permit NoD1E38042,63471 =Plumbing Permit No P37182,P34628 Mechanical Permit No. ME 38042 Number of apartments and/or guest rooms Fire Prevention Peewit No. F 367119 ISSUED TO: Barto/Richly 809 Via Lido Soud Nawport Beach, CA 92660 Building Official William T. Howard by Date April 25, 1989 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CMF 1015-46 rev. 1/83 White -Owner; Canary - Numerical File; Pink - Bldg. Permit File P, Applicant to fill in all spaces except those within heavy border lines and sign all appropriateOV/Ii nb s. C OFcgsraMESA CONSTRUCTIO�V�PERMSI� i�'I Project Address y/ w. / Applicant's Mailing Address Q-9� A .r. Owndde's Name p 9 - ,Phone • , Aress I 1 , d &I d ^ n - T 52'.4 9166 Arch/Eng.ore MAA es.f License NoC OC 1,.$.�•' `` 07-93 f_p ,aT Address y35.p.5- LS C&A tl/ir r.,n TA."IMS5 -o Z'& i e Contractor's Name i3n rTn a �..' we,'Phone —^—'T'RI '� �T=Q� Address (mailing) �D �yr@�wdp ssr �jlex,nolT �a..L'!1J_� ,f City License No. - ') '- LICENSED CONTRACTOR DE L RATION .. _ 1 hereby affirm that 1 am licen d'under provisions of Charterj9 (commencing with section 7000) of Division 3 of the Business and Professions Code; and my license is in full force and effect. " License Class License. No. - Date Signature v t - Ir 'ORKERS' COMPENSATION DECLARATION - - i ereby affirm that I have a certificate of consent to self -insure or -a certificate PERMIT TRACT NO. 3z-�,z LOT NO. �/ 3 �4PZ A , TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR 1:1 CONVERSION ❑DEMOLISH ❑.OTHER •DESCRIPTION OF WORK/USE OF BLDG. fa d 4 S fit` •' - q,p,# Zone..../ 07 - �oZl _/- /9 �-0 ' r 6 S I Main Building: "Accessory Building: TYOF PERMIT GRADING L-1FOUNDATION El STRUCTURAL PE }❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANI L �¢ ❑ OT. HER , PROJECT.DESCRIPTION SQ. FT. C PANCY 'CON„STRUCTION TYPE Cph CF�TG VALUATION ✓ZONE r%- / GRADING CU.YDS. ACRES D J_ T Front 0I O B Rear 0 N C Righty / N S — OI Left O C' R z� Ping. Ping. Ref. # -8 -7 Parking Req./Provided '}� E Remarks, '/Mp AIR uJ ON ,vd -a A // Planning Notes: _ la,5 /oZT Q M . s'1�`e : f , 0 S 2 Z (� i.9 G-0- r,3. L / - 1 $ PLUMBING FEES y� r - A_ 14/ ; Bar Sink - Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Transformer ❑ 15-50 KW ❑ 50+KW Construction Pole Sub. .t Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C.) - Policy No. .Company - ' � BCertified copy is hereby furnished. Certified copy is filed with the city Building Division. _t - 'Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Date Applicant - `- EXEMPTION FROM WORKERS' COMPENSATION DEC LA RAT I (This section need not be completed if the permit is for one hu ($ 0): or" less). - certify that in the Performance of.th or for which thi it is i ued, I shall not empl0 any erson in -any m r a be o bj oto Life Worker ' n t Laws of Califo - .• ' �� Da Signature -' NOTIC If, fter making this declar t n, you shcold b o object to the Workers' Compensation provisions Of the Labor Code, ust forthwith comply with such provisions or this permit shall deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that -there is a construction lending agency for the performance Of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address - - OWNER BUILDER.DECLARATION I hereby affirm thaCl•am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to -its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of. Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). ❑ I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the -building or improvement Is sold within one year of core- elation, the owner will have the burden of proving he/she tlitl not build or ire- prov for the purpose of sale). ZTI, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code; tractor ' The Contractor's License Law does not apply to an owner of property who builds Or improves thereon, and who contracts for such projects with a con- tractor(s) license pursuant to the Contractor's License Law). 1 am aware that proof of their Worker's Compensation insurance should be rovlded to me. ❑ I am exempt under Section B. P. C. r this reason "� Cla"rif iers $Ola, Collectors Dishwasher Meter Dover 100amps Dilihwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel - - Drinking Fountains Solar Tank Fan Motors ❑0-1 HP ❑1'/h- B Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar ❑9-15 HP 016-15+ Floor Sinks Urinal _ Fixtures Microwave Gas Service .Outlets _ J> , Water Closet Device Boxes POIe Light -' Interceptors _ - Water Heater - Outlets Range g `- Kitchen'Sink - - Water Service _ ,. Switches - Sign s� Lavatories Auto -Wash Garbage Disposal Standing Sections P -Trap : -7'- - - - ,. Laundry Trays _- Generator 00-5 KW 05-15 KIN .Trash COm pactOr ROOF Drains if ,. , Reinspection Fee $16 Issue Fee $ 3 J Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES DEVELOPMENT SERVICES REQUIREMENT / � �Q-wO1 Zoning Approved By Date Building Approved By Date �' c Application Issued By— y Boiler Hood y Type ❑ Canopy Typa II ❑ Duct -Under Ground Duct -Structural Refrigeration System ❑0-100,000 BTU ❑100,000 BTU _ Duct - Ventilating pCp SUMM V OF FEES BUILDING PERMIT $ 4� 9• oo" • �� SMIP $ PLAN CHECK $ �`rT 'V PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING S PLAN CHECK 50% $ MICROFILM S MECHANICAL $ TOTAL FEE $ SZ +3•$ 3 Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBG # Fire Dampers Date .2 - IL owner 1 hereby certify that 1 have rea t is ap ication a ate that the above information is correct. I agree to comply with a cit d county ordinances and state laws relating to building constr c " it rereby authorize repre- sentatives of this y to enter on ab e -mentioned property for Inspection purposes.1• ZS_ ed Oi Heating System & Ducting ❑0100,000 BTU ❑100,o00BT Registers rT Reinspection Fee $15 Is Fee l $ 3 Signature Date Drivers' License or SS Yf PLAN CHECK 25% $ .• v ryY � -/ J TJ�YJ :0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING POOL & SPA . 'APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector 1: Temporary Electrical Service or Pole 52. Pool & Equipment Location. 2. Soil Pipe-Undrgrnd. - 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms ' 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding • -•. 5. Steel Reinforcement $ $ C,, 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. - 8. Foundation- r 59. Gas Pipe, O Undrgrnd., Test i 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, O Undrgrnd. Y7 10. Structural Floor System,. 61. APPROVAL TO DECK. 11. Property Sewer Line & House Connection 62. Backwash & Receptor,;Final, 12. Sewer Ca P •' ` 63. Heater &Vent -Final 7 �•- 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical -Final c'"a (,' ' '• �. ' 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. REQUIREMENTI = 7 x APPROVALS Permit +__!0 % 20. Rough Factory Fireplace 21. Ducts, in Structure - 70. Underground Hydro 22. Ducts, Ventilating -71. Product Piping ❑Gas ❑Oil 23. Gas Pipe -Rough &Test.72. Underground Flush �- .1. +' - 24. Roof Framing 73. Undergrnd. Storage Tank,❑Gas 0Oil,' T 25. Roof Sheathing / 74. Overhead Hydro 26. T -Bar Ceiling (Structural)y& Monocoat 3 /9 0 1, g 75. Dry Chemical 27. Frame and Flashing Z4 ( A 76. Dry Standpipe C-; 28. Lathing & Siding 2,7 g" 77. FIXED SYSTEM FINAL c •• 7 29. Insulation i- 78. FIRE PREV. FINAL •'t :. 30. Drywall Nailing HEALTH DEPT: REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION '' 7. 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes :AQ1.1n R $PC_IAL�TtEQU - •� 34. Final Heating & Air Conditioning -'r i! o � • � SLA6 �. 35. Final Gas Pipe -Test g 5 S 5ZA L Ole - •N" •p^ 36. Hood or Canopy 19 7n 37_ Final Factory Fireplace / S eA e ` ^ ` 38. Final Plumbing /� 3 �I - „• i 39. Water Service -Final • I' !: 1 i% 2 Uy J -%tel •:r a -_ s „ ItJ•� �J ''.40. Gas•Sery&-Final j-�f Qs.ry 1 to �41. Solar.Oomestic-Final 1)L�2 �z ,42�Backflw3 Preven[er '93a ?• b"- art,- rv43/BackflowIrrigation .(_ 27 AI3 -4-Landscape Irrigation System 45 Sound Attenuation 01 i •' 46. Handicap Regulations .:. -� 47.r+FINAL.STRUCTURE & BUILDING /48. Special` -Requirements Completed -' 49. Electric Release to Edison 3 �• ,� - 50. Gas Release to Southern California Gas Co ` •� - 51. CERTIFICATE OF OCCUPANCY \ , No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations CITY OF COSTA MESA GUN - I HUG I IUN Yt IVII I Project Address 1`0 14/ S /�C f'- I r - Applicant's Mailing Ad r¢ [ A 0 }��' K G—s-�� J.� OWnef'S Name s I"O t Phone L112&)7 O nu 0. U, 0 �� Address "" . 9a / I------ --- - u� �1,A4%A.P. g# Zone S Main Building: Accessory Building: TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DE OLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. E T Front Z O A Rear N �Ul Arch/Eng. License No. Address TYPE OF PERMIT GRADING FOUNDATION ❑ STRUCTURAL ❑ TENANT ❑ ELECTRICAL PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CD.YDS. ACRES K Right G S , Left R Contractor's Nam —J ! Ch Phone Address (mailing) ` uMl4 0 If/s '1 f "� City License No. LICENSED CONTRACTOR DECLARATION Ping. Ret. # Parking Req./Provided E Planning Notes: Q M S. Remarks- ' I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in fulLlgrye and effect. ' /OG� SC�(/ } Y I Uy1(li-S 'Z ELECTRICAL FEES License fla s ense Date 7'f Sg at L/LARA ON WORKERS' COMPENSATION ti C I hereby affirm that I helve a certificate of consent to self -insure or a certificate " Workers' Compensation Insurance, or a certified copy thereof (Section ,icy No. Company i PLUMBING FEES Automatic Washer DOnatfUCtlon To e Sub. l Transformer ❑ 15-50 KW 050+KW Bar Sink Showers Backflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps Backflow Irrigation Sewer Cap Dishwasher - Meter Dover 100 amps Certified copy is her y furnishe0. e ti i Y. s filed with the cit iviSIO Bathtubs Sewer Connection Dryers ❑GasGElectric Sub Panel Dale- KERS'ant22= EXE PTI N FROM WORKERS• d if the SATION DECLARATION (This section need not be completed if the permit is for One hundred ($100) or less . I [artily that in the performance of t4wom [his itis issuetl not employ any person anys bec me s bject to the Workers'C R ws of CaliDate Signature Clarifiers Solar Collectors ^' Fan � Motors ❑0-1 HP 01%-8 Dishwasher Solar Piping F.A.U.Inc. Solar 09-15 HP 016-15+ -.. Drinking Fountains Solar Tank FixWresshah 'iMicrowave Floor Drains Swimming Pool w/Spa Device Boxes Pole Light NOTICV If, ai er ma Ming this tleclarhould become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY ks Urinal Outlets Ran 9 e I0Gas Service Outlets Water Closet qq D y Switches Sign I hereby affirm that there is a construction issue agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address Interceptors Water Heater Garba a Disposal 9 P Standing Sections Kitchen Sink Water Service Generator ❑05 KW ❑5-15 KW Trash Compactor OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant t0 the provisions Of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is .exempt ,grefrom and the basis for the alleged exemption. Any violation of Section �'" 1.5 by any applicant for a permit subjects the applicant to a civil of not more than five hundred dollars ($500). • I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or.offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such Improvements are not Intended or offered for Sale. If, however, the building Or Improvement is sold within one year of com- pl¢tio n, the owner will have the burden of proving he/she did not build or im- prove for the purpose of sale). ❑ I, as owner of the properly, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon. and who contracts for such oroiects with a con- tractors) license pursuant to the Contractor's License Law). l am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason • Lavatories Auto -Wash P—Trap Laundry Trays Roof Drains Reinspection Fee $15 Issue Fee $ 3 iiiiiiiiiiiiij DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By 1 n_ Dat Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Boiler Hood Or Type 1 ❑ Canopy Type If ❑ Duct - Under Ground BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL,�� PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT --}}• $�Sd'y `� ISSUANCE $ $ ENERGY P.C. $ $ GRADING $ $ MICROFILM $ $ TOTAL FEE $ $ Duct -Structural Refrigeration System Duct- Ventilating 00100,000BTU D100,000BTU Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Blt. ICBO Fire Dampers Date Owner 1 hereby certify that I have read this application and state that the above Int ormation is correct. I agree to c ply with all city and county ortlinances and state laws rel ti to di c struction, and hereby authorize repre- sentatives of this y e er —the above-mentioned p operty for Inspection Pu / /7 Heating System & Ducting ❑0100,000 BTU 0100,000BT Registers Reinspection Fee $15 Issue Fee $ 3 Slgnat ur Date Drivers' L cense or 55 �. O1Y00D'1447p-C+D024470 TOT nri 1E' 01/17/89 TIME: 15*4 23.0(r 0865-46, rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPF#OVALS Permit # Datei Inspector POOL 'A _ APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. � , V; •' 53. Steel Reinforcement I 3. Electrical Conduit Utilify-Undrgrnd. 54. Forms + 4: Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6• Electrical UFER'Grn& I .57. APPROVAL TO COVER-GUNITE 7. footings 58. Electrical Conduit-Undrgrnd. 8. Foundation i i % 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgr6d. � 60. Backwash Lines, P -Trap, 0 Undrgrnd. , 10. Structural Floor System •� r; 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 y 6. Rough Electric Wiring - -G7`. Fencing & Access Approval r1f7y. Rough Wiring Sign 68 APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning ml FIRE DEPT. REQUIREMENT APPROVALS Permit# 120. Rough Factory Fireplace'. i 21. Ducts, in Structure l4, 70. Underground Hydro 22. Ducts, Ventilating •, 71. Product Piping 0Gas 0Oil 23. Gas Pipe -Baugh & Test .. 72. Underground Flush - 24. Roof Framing 'j• 73. Undergrnd. Storage Tank 0Gas 0Oil 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 30y 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 u 35. Final Gas Pipe -Test 36. Hood or Canopy . 37. Final Factory Fireplace 38. Final Plumbing !((O-4jQ Lim 39. Water Service -Final 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation •n 44. Landscape Irrigation System-• 45. Sound Attenuation 46. Handicap Regulations ' 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF CO$ . MESA CONST UCTION PPERMI,T,� Project Pdd or 4e Applicant's Mailing Addr ss / ✓l"t Owner's Name eC Phone Address Arch/Eng. License No. Address Contractor's Name 'KitePhone S% Address (maili g) n C City License No. e'2,9 7,17 LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in fu f e�en0 effect. License 1 ss (o ns Dat! ` Signature WOR ERS' COMPENSATION DE AR ION I hereby affirm that I have a certificate of consent to self -insure or a certificate ' f Workers' Compensation Insurance, or a certified copy thereof (Section 1800, Lab. �)7 y Policy No. v�-�a O 6 Company , Certified copy is hereby furnished. Cert i c s ed with the city g1WIDrrg G Ion. Oat! Applicant EXE TION FROM WORKERS' C MPEN ATION DECLARATION (Thissectiou need not be Completed if the permit Is for one hundred ($100) or less). I certify that in the performance of the Work for which thisermit is Issued, I shall not employ appy person in any man sow O be subject to the Workers' CD'mpep50I Laws of CalifOryjsl� C/�_ _ Date NOTICY: 1f, offer making this declapHon,y6u should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit Shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there IS a construction lending agency for the peifbrmance of the work for which this permit is Isyped (Section 3097 Civ. C.) Lender's Name _ Lender's Address OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the followingr reason (Section 7031.5 Business and'P,rofessional Code: -Any city or county which requires a permit to construct, atter, improve, demolish or repair any structure, prior to Its issuance, also re quirbs-the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt +"herefrom and the basis for the alleged exemption. Any violation of Section ^.;x'031.5 by any applicant for a permit subjects the applicant to a civil "penalty of not more than five hundred dollars ($500). �� 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work hlmself/herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- 5ove for the purpose of sale). LJ I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: h'ha Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a con- fractor(slicense pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. 0 1 am exempt under Section B. & P. C. for this reason Date Owner that I have read this a Signature �(� Drivers' Li dose or 55 %f TYPE OF CONSTRUCTION .0 -NEW U ADD LJ ALTERATION LJ REPAIR I Issue Fee Backflow Preventer ❑ ❑ ❑ Service Sink Backflow Irrigation CONVERSION DEMOLISH OTHER -Sewer Cap A.P. # Zone DESCRIPTION OF WORK/USE OF BLDG. Clarifiers Fixtures Solar Collectors - - System Repair/Alteration S Main Building: Accessory Building: Fire Dampers Solar Tank E Registers TYPE OF•PERMIT LJ GRAMNG0 FOUNDATION LJ STRUCTURAL T Front ❑ TENANT ElELECTRICALAR PLUMBING ❑ MECHANICAL B Interceptors ❑ OTHER Water Heater A Rear Water Service Lavatories - C Right PROJECT DESCRIPTION SQ. FT. OCCUPANCY KLeft Roof Drains CONSTRUCTION TYPE VALUATION $ $ ZONE GRACING CU.YDS. ' ACRES-1Ping. Ref. dk Parking Req./Provided Remarks: -7 1/ C—a (L Planninq Notes: Bar Sink IShowers I Issue Fee Backflow Preventer Meter ❑up to 100 amps Service Sink Backflow Irrigation Hood or Type I ❑ Canopy Type 11 ❑ -Sewer Cap Bathtubs Motors E10.1 HP 01%-8 Sewer Connection Clarifiers Fixtures Solar Collectors Dishwasher - System Repair/Alteration Solar Piping Drinking Fountains Fire Dampers Solar Tank Floor Drains Registers Swimming Pool w/Spa Floor Sinks Z Urinal Gas Service Outlets S Water Closet Interceptors ' Water Heater Kitchen Sink ' Water Service Lavatories - Auto -Wash P—Trap Laundry Trays Roof Drains Tio i(Jt t -o/ evc Reinspection Fee I $151 I Issue Fee MECHANICAL Meter ❑up to 100 amps Boiler Meter ❑over 100amps Hood or Type I ❑ Canopy Type 11 ❑ Duct - Under Ground Duct -Structural Motors E10.1 HP 01%-8 Refrigeration System ❑0.100,000BTU ❑100,000 Duct -Ventilating Fixtures Exhaust System ❑ Multiple ❑ Device Boxes System Repair/Alteration Firepl/Fact. Bit. ICED # Range Fire Dampers Heating System & Ducting 00.100,000 BTU 1:1100,000 BT Garbage,Disposal Registers Generator 1:10.5 KW 1-15-15 KW Trash Compactor Reinspection Fee 1 $15 1 1 Issue Fee CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor FEES ELECTRICAL FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW , ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter ❑over 100amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors E10.1 HP 01%-8 F.A.U. Inc. Solar 1:19-15 HP 016-15+ Fixtures Microwave Device Boxes Pole Light Outlets Range Switches Sign Garbage,Disposal Standing Sections Generator 1:10.5 KW 1-15-15 KW Trash Compactor $ 3 Reinspection Fee $15 Issue Fee $ 3 FEES H DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date — Z O N I N G R E Q M T S BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% $ S $Ila, $ $ $ $ $ SUMMARY OF FEES SMIP $ PERMIT ISSUANCE $ ENERGY P.C. $ GRADING S MICROFILM $ TOTAL FEE 01 00010325-00010325 TOT 96.00 _ $ 3 CONSTRUCTION AND PLANNING APPROVALS Permit Date Inspector POOL & SPA APPROVALS Permit Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER 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 ;11.11,ef '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 c68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling (, u / tl •; 69. POO USPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning i': t '- FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro - 22. Ducts, Ventilating j 71. Product Piping ❑Gas ❑Oil 23. Gas Pipe-Rough & Test r t' 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank O.Gas ❑Oil 25� Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling {Structurail & Monocoat 75. Dry Chemical 27. Frame and Flashing' .. _ ' _., 1 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 .� t• ` 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED (� 33. Final Electric Notes:e-2T6 e n an - 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test !' ' -j 36. Hood or Canopy 37,:.Final Factory Fireplace •`" 38.Final Plumbing =/6$ 39.'WaterService-Final ytr (�/� - 7 t.i t•` ' t i� is 40. Gas Service-Final r,41. Solar Domestic-Final , ` •� - /• �i % 1,!42. Backflow Preventer /4/�t� (r� `* !• ,/� ,' !", ry %'�43. Backflow Irrigation °,� `l� _ ' • .r �( -� 5' 44., Landscape Irrigation System / t' •' % ' •' X45. Sound Attenuation • 46. Handicap Regulations 47!FINAL STRUCTURE & BUILDING •� -` 4&-Special Requirements Completed r•� v 49. Electric Release to Edison r; 50. Gas Release to Southern California Gas Co All �= r 51. CERTIFICATE OF OCCUPANCY No. =r Date - Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address �� I ��A S�/T� PERMIT NO. � 3 O � TRACT NO. LOT NO. UNIT A.P.# Zona S Main Building: Accessory Building: TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. Applicant's Mallin Address 041 w, lgh S* S(er y/0 P 1� C LC Owner's Name Phone -L /,�)¢1 0%' Bbl S -T Ji..a� C 110 E T Front Z O B A Rear N I Address Arch/Eng. License No. Address TYPE OF PERMIT GRADING FOUNDATIO�N1 ❑STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING 'A' MECHANICAL ❑'OTHER PROJECT DESCRIPTION SO. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YDS. ACRES K Right G $ , Left R / ��,a� Contractor's Name Phone G.34-1t�i5' Address (mailing) �q6 �' S v /+"TF G'c!/e!'Qs City License NO. / �/ �� LICENSED CONTRACTOR DECLARATION Ping. Ref. # Parking Req./Provided E Planning Notes: O M T IS. Remarks: I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in f for and effect. .tom -f Licensf%FFl s `^�_�� cense rjlp. 41JV�GZ Dater S1��=••� ,�'YY WORKERS' COMPENSATION DECLARATION 1 hereby affirm that I have a certificate of consent t0 selftibsure or a certificate Workers' compensation Insurance, or a certified copy thereof (Section )0, Lab. CJ / ! . oucy No. ux�r %0 35 Company er,VU fVAiIVAtA/. CgWied copy is hereby furnished. LLLolfar if of q{) Is flied with the city f tli ng Div n. ELECTRICAL FEES PLUMBING FEES Automatic Washer Transformer ❑ 15-50 KW DOn52(pctlpn Pole Sub. ❑ 50+KW Ba! Sink $hOW¢r5 Backflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps Backflow Irrigation Sewer Cap _ Dishwasher Meter El over 100 amps Bathtubs Sewer Connection ,rj Dryers ❑Gas ❑Electric Sub Panel , Clarifiers Solar Collectors -' Fan (M- Motors 00-1 HP ❑1'h-8 3 n Date C 0 Applicant -M EXEMPTION FROM WORKERS' COMPENSATION OEC R N (This section need not be completed If the permit IS for one hun ed ($100) or less). I certify that in the performance of the work for which this permit Is Issued 1 shall not employ any person In any manner so as to become subject to Sloe DISK Wdsllef Solar Piping F.A.U. �� Inc. Solar ❑8-15 HP ❑16-15+ Drinking Fountains Solar Tank Fixtures Microwave Workers' Compensation haws Of California. Date Signature Floor Drains Floor Sinks Swimming Pool w/Spa Urinal' Device Boxes Outlets Pole Light Range NOTICE: If, after making this declaration, you Should become subject to the Workers' Compensation provisions of the Labor Cotle, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Switches Sign -- I 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. ce Lender's Name Lender's Address Interceptors Water Heater Garbage Disposal Standing Sections 9 Kitchen Sink Water Service - - 7 Generator ❑0-5 KW ❑5-15 KW Trash Compactor �• \ OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Settle" 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior t0 Its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensetl pursuant to the prOvlsions Of the Contractor's License Law (Chapter 9.(co mmnc Ing with Section Is a e of Division 3 of the Business and Professions Co.tle) or that he/she Is exempt erefrom and the basis for the alleged exem pl l on. Any violation of Section �'��"�C31.5 by any applicant for a permit subjects the applicant to a civil :. `,salty of not more than five hundred dollars ($500). :Lj I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner Of a property who builds or Improves thereon, and who does such work himself/herself Or through his Or her own employees, provided that Such improvements are not Intended or offered for Sale. If. however, the building or Improvement is sold within one year of com- pieties, the owner will have the burden Of proving he/She did not build or im- rove for the purpose Of sale). I, a5 owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Cade: The Contractor's License Law does not apply to an owner of property who builds of improves thereon. and who contracts for such oroiects with a con- tractors) license pursuant to the Contractor's License Law). 1 am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Lavatories Auto -Wash P—Trap Laundry Trays - ROOF Drains �- - Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Data Building Approved By _Datery�_ 'Application Issued By Dat '_u`i SEPI' -14 Reinslaeelian Fee $ 3 T $15 Issue Fee ,' MECHANICAL FEES f. Boiler Hood Or Type I ❑ Canopy Type I I ❑ - BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ ISSUANCE $ $ ENERGY P.C. $ $ GRADING $ $ MICROFILM $ —.�'1 1^ $ ---✓ J— TOTAL FEE $ $ Duct - Under Ground Duct.Structural Refrigeration System ❑0.100,000BTU 0100,000BTU r Duct- Ventilating Exhaust System ❑ Multiple ❑ System Repair/Alteration �• Firepl/Fact. Bit. ICBG # Fire Dampers iA Date owner hereby certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this c to enter up0 the above-mentioned pr petty for Inspection Purpose,( /](] t� eating System & Ducting - 140-100,000 BTU El 100,000 BTLMECHANICAL Registers la/•,v Reinspection Fee $15 Issue Fee Signature _� oat. T/7 Drivers' License or SS 9F _ 01 00029757-0.7029753 TC1T DATE: 04/03/39 TII1E:-14:19 31.00 0865-46, rev. 5/89 White -Building; Canary -Applicant; Pink -Accounting: Goldenrod -Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector P POOL PA . APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool &Equipment Location 2. Soil ipe-Undrgrnd. ^ :t :7 I 53. Steel Reinforcement 3. •Electrical Conduit Utility-Undrgrnd. r_ 54. Forms 4. -Electrical Conduit-Undrgrnd. •'j a 55. Electrical Bonding 5. Steel•fieinforcement +'- ', 56. Rough Plumbing & Pressure Test 6. Electrical UFER•Grnd 57. APPROVAL TO COVER-GUNITE 7! Foot ng's "•" (y' 58. Electrical Conduit-Undrgrnd. 8.'•F6undation ,: 59. Gas Pipe, O Undrgrnd., Test "r 9. iWater Pipe-Undrgrnd. �' 60. Backwash Lines, P -Trap, 0 Undrgrnd. -r 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection .. '�- 62. Backwash & Receptor -Final 12: Sewer CapZ.� I,�; � 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating ` 71. Product Piping 0 Gas 0 Oil 23. Gas Pipe -Rough & Test r, 72. Underground Flush , 24. Roof Framing ' • 73. Undergrnd. Storage Tank 0Gas 0Oil 25.'Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27.AFrame 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 -_ - I 33. Final Electric 2 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 Domestic -Final 42. Backflow Preventer ' 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date- Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT Project Address L✓ . Applicant's Mailing Address Owner's Name ( Phone 5441' - Address]() -/I 10 Arch/Eng. License No. Address Contractor's Nam Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Cotle, and my license is in full force and effect. License Class License No. Dale Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -Insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section 00, Lab. C.) /olicy No. Company 8 Certified copy Is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed If the permit Is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so ZO be m subject to Lite Workers' C m e tl n ws of Califor . Date 1/chis declaration, NOTICE: I ,after makin this ionsfthe you sh uld become sub) o to the Workers' Compensation provisions of the labor Code, you mus orthwith comply with such provisions or this permit shall be tleema revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a cis permit issue agency for the performance of the work for which this permit is issued (Section 3007 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's, License Law for the l ollowing reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct, alter, Improve, demolish or repal 031.5 by any applicant for a permit subjects the applicant to a civil anally of not more than five hundred dollars ($500). ❑ 1, as owner of the property or my employees with wages as their Sole compensation, will do the work, and the structure is not Intended or offered for Sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who tloes such work himself/herself or through his or her own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or Improvement is sold within one Year of com- pleli the owner will have the burden of proving he/she did not build or im- p for the purpose of sale). as owner of the property, am exclusively contracting with licensed con- or to construct the or eject(Section 7 04 4, Busi n ass and Pr o fessl o ns Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such wolects with a con- tractor(s) license pursuant to me Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section—_ B.,& P. C. for this reason Date�= 1 (_A Owner information certify that I have read this applicatl on and state that Ina above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city t .nter on the above-mentioned property for Inspection pses. Signature _1-°.� � Fl3g(6IS— I 1 112 TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DE,WDIPTION OF INOM/USE OF9¢DG. TYPE OF PERMIT s777 LJ GRADING LJ FOUNDATION U STRUCTURAL El TENANT K -ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY_ CONSTRUCTION TYPE VALUATIONS— ZONE— ALUATION5ZONE GRADINGCU.YOS. ACRES— Remarks: A.P. 90, S Main Buildi E T Front B Rear A C Right S Left Ping. Ref. #' Planning Notes: Accessory Parking Req./Provided Zone IL N G R E Q M T S. Reinspection Fee Under Ground $15 Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑0-100,000 BTU 0100,000 Reinspection Fee 1 $15, 0865-46, rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee Hood or Type ❑ Canopy Type If ❑ Refrigeration System 130-100,000BTU 13100,000 System Repair/Alteration Fire Dampers Registers Issue Fee Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By ^ FEES Building Approved By, -I 4 4 r, $ 3 ELECTRICAL FEES BUILDING PERMIT PLUMBING FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Bar Sink I Showers PERMIT Backflow Preventer Service Sink /�• �, Cooking Unit Meter ❑up to 100 amps . Backflow Irrigation Sewer Cap ENERGY P.C. $ DishwasherMeter {� ❑over 700 amps Bathtubs Sewer Connection PLAN CHECK Dryers ❑Gas ❑Electric Sub Panel Clarifiers Solar Collectors Fan Motors 110.1 HP El h - 8 Dishwasher Solar Piping ��'• F.A.U. Inc. Solar 09-15 HP 016-15+ " Drinking Fountains Solar Tank Fixtures Microwave Floor Drains Swimming Pool w/Spa Device9 Boxes oxes Pole Li Light Floor Sinks Urinal Outlets Range Gas Service Outlets Water Closet Switches Sign Interceptors Water Heater Garbage Disposal Standing Sections Kitchen Sink Water Service Generator ❑0.5 KW 05-15 KW Trash Compactor Lavatories Auto -Wash P -Trap Laundry Trays Roof Drains Reinspection Fee Under Ground $15 Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑0-100,000 BTU 0100,000 Reinspection Fee 1 $15, 0865-46, rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee Hood or Type ❑ Canopy Type If ❑ Refrigeration System 130-100,000BTU 13100,000 System Repair/Alteration Fire Dampers Registers Issue Fee Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By ^ FEES Building Approved By, -I 4 4 r, $ 3 0100030688-0003068E TOT DATE: 04/17/89 TIKE: 13:26 29.5G SUMMARY OF FEES/ BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ 1!g% GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTALFEE $ PLAN CHECK 25% $ 0100030688-0003068E TOT DATE: 04/17/89 TIKE: 13:26 29.5G CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL ,PA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool &Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding - 5. Steel;Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVALTO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. . 8. Foundation 59. Gas Pipe, D Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, D 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 w 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 APPROVALS Permit # 20'. Rough•F.actor`y Fireplace A- 21. Ducts„irj Structure i 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping D Gas D Oil 23. Gas Pipe -Rough & Test '1. 72. Underground Flush 24. Roof Frafning 73. Undergrnd. Storage Tank D Gas D 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 DrywalVNailing HEALTH DEPT. REQUIREMENT 31'.Plaste,Beown Coat X179. FINAL INSPECTION 33: -_ Electrical Power Meter -Final FOOD CERTIFICATE ISSUED 33. Final Electric rf Z N es: 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 Domestic -Final -- 42. Backflow Preventer 43. Backflow Irrigation - 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations �•� 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed , 49. Electric Release to Edison y% - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No Date <•,� %'1 �•� . l Applicant to fill In all spaces except lh0 se within heavy border lines and sign all appropriate decla CITY OF COSTA MESA 1A) , CONS GTION PERMIT �— project Address S 6J� l l/ Si. 6L � Applicant's Mailing Address S Owner's Named Phone i6 Address A IY2d 1.h0Q -60 Arch/Eng. License No. Address 7��l Contractor's Nama TC/ _ hone / e � r Address (mailing) 'j 7 !.[.�L.t.Ci�/tk'`rMt'�°°y>r Clams City License No 7 mss'// LICENSED CONTRACTOR. DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Cotle, and my license is in full force � fact. /�j License la n e No.(/ Date Signature WORKERS' COMPENSATION DECL ATION I hereby affirm that 1 have a cert)/lute of consent to self -Insure or a certificate if Workers' Compensation Insurance, or a certified copy thereof (Section 1800, Lab. C. ,s/��1 icy No. U//'T/ Company 'J}fDty$L�Certified Copy hereby furnished. / Certified c is filed with the city Si / ate pplicanl-a- EXEMP ION FROMWORKERS'C-MP6s1SATIONDECL ATION� (This section need not be completed if the permit is for one hundred ($100) or less). certian to that in the performance the work for which this permit Is Issued, I shall not employ any person In any manner so as to become subject to the Workers' Compensation Laws California. Date _Signature NOTICE: Compensation alter making this ions f the you r Cod become subject to the Workers' suchprprovisions of she Labor hall you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. CJ Lenders Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit t0 construct, alter, Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) Or that he/she is exempt 'therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for' a permit subjects the applicant to a civil nenalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds Or Improves thereon, and who does such work himself/herself orthrough his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or Improvement is sold within one year of Com - i�on, the owner will have the bOrden of proving he/she did not build or Im- rove for the purpose of sale). , as owner of the property, am exclusively contracting with licensed con- tractors to construct the project Section 7044, Business and Professions Code: The Contractor's License Law Res not apply to an owner of property who builds Or improves thereon, and who contracts for such crojects with a con-' tractor(S) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to, me. ❑ 1 am exempt under Section B. & P. C. for this reason Date I hereby certify th I information isA and state lawsentatives of Inspection pur Signature Drivers' Lice SS 1# Owner have rea this ng cons r upon E 3 14 rl Q Zone S Main Building: Accessory Building: TYPE OF CONSTRUCTION NEW ADD ALTERATION ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. REPAIR T Front 0 A Rear N C Right N TYPE OF PERMIT�-�( GRADING FOUNDATION 0 STRUCTURAL ❑ TENANT NJ ELECTRICAL ❑ PLUMBING 1:1L MECHANICA ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADINGCU.YDS. ACRES S Left d G Ping. Ref. # Parking Req./ProvidedE Planning Notes: Q M Ir T S. I Remarks: t%rr 6:;411�-ACI ELECTRICAL FEES - PLUMBING FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Bar Sink Showers Backflow Preventer Service Sink Cooking Unit Meter Abp to Igo a -31 S Backflow Irrigation Sewer Cap Dishwasher Meter ❑over 100 amps Bathtubs . Sewer Connection Dryers ❑Gas ❑Electric Sub Panel Clarifiers Solar Collectors - - Fan J Motors ❑0-1HP❑1M-8 Dish Washer Solar Piping F.A.U. Inc. Solar 09.15 HP 016-15+ U rr Drinking Fountains Solar Tank Fixtures Microwave i Floor Drains Swimming Pool w/Spa Device Boxes Pole Light Floor Sinks Urinal Outlets RangeLl 7 Gas Service Outlets Water Closet Switches Sign 2 fv Interceptors Water Heater _ Garbage Disposal Standing Sections Kitchen Sink - Water Service Generator 1:10-5 KW E15-15 KW Trash Compactor Lavatories Auto -Wash IP—Trap Laundry Trays Roof Drains ti Reinspection Fee $15 1 Issue Fee gillilig DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By— Dat Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES r~ Boiler Duct - Under Ground Hood or Type 1 ❑ Canopy Type I ❑ BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL - PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ SMIP $ $ PERMIT $ ISSUANCE $ $ ��(`'ENERGY P.C. $ S ==-1—= GRADING $ $ MICROFILM $'gyp $ TOTALFEE s'�R-7 $ Duct -Structural Refrigeration System Duct -Ventilating 00.100,000BTU 0100,000BTU Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBG dk Fire Dampers • Heating System & Ducting Registers 00-100,000 BTU 0100,000BTL Reinspection Fee $15 Issue Fee $ 3 0865-46, rev. 5/88 White - Building; Canary - Applicant: Pink - Accounting; Goldenrod - Assessor 01 00010912-00010912 TOT 387.65 DATE: 08/01/88 TIME: 15:28 CONSTRUCTION AND PLANNING_c 'APPROVALS Permit # Date Inspector POOL a SPA APPROVALS Permit # Datel Inspector 1. tiemporary Electrical Service or Pole, 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. ;. i ; r` • 53. Steel Reinforcement 3.;Electtical Conduit.Utility-Undrgrnd. 54. Forms '4. Electrical Conduit-Undrgrnd. ; 55. Electrical Bonding 5. -Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Ellectrical UFER•Grnd. 57. APPROVAL TO COVER-GUNITE t •7.'Faotings ' 58. Electrical Conduit-Undrgrnd. 8. Foundation ';� I -'^I 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 Linel& House Connection 62. Backwash &Receptor -Final 12.'Sewei Capi1^j 63. Heater & Vent -Final 13. Roof,Drains ! 1 64. Plumbing System - Final 14.'Rough Plumbing" , 65. Electrical -Final 15. Rough Electrical -Conduit Solar System -Final X16. Rough Electric Wiring t 7. Fencing & Access Approval .17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceilin( $ a 69. POOL/SPA SYSTEMS FINAL 119' Rough Heating & Air Conditibning FIRE DEPT. REQUIREMENT APPROVALS Permit # ,20t Rough Factory Fireplace 21. Ducts, in Structure '^ 70. Underground Hydro 22`Duets, Ventilating - 71. Product Piping U Gas ❑ Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas ❑Oil 25. Roof Sheathing1 74. Overhead Hydro 26. T -Bar Ceiling (Structural) &'Monocoat 75. Dry Chemical 27. Frame and Flashing (�.I 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat FI AL INSPECTION 32. Electrical Power Meter -Final ODD CERTIFICATE ISSUED 33. Final Electric tes 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 1� 39. Water Service -Final ' 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 'I ' 44. Landscape Irrigation System ! 45. Sound Attenuation r 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING t 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date . ADplicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA ME);, CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT Project Address -./L CJ w / Aptent's Mailing Address . e'7 -L30 Owner's Name Z- t G AJ'Q' � re, Phone Address OY 0 /,a7e Arch/Eng. License No. Address Contractor's Name f �77-/-- L6 ZL r Phone,92./ 9e47 Address (mailing) City License No. Q)� LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 70001 of Division 3 of the Business and Professions Code, and my license is In full force and a fact. �, 73" License Class L- License No.� T Dated Signature WORKERS' COMPENSATION DECLARATION �reby affirm that 1 have a certificate of consent to self -Insure or a certificate Vorkers' Compensation Insurance, or a certified copy thereof (Section .0, Lab. C.) //�� Q'QD �s Policy No. �D - r1r'2Z)n 'Comps f * %�f A7,,/4i BCertified copy is hereby furnished. Certifieq cops flye� ith the city it 'ng Division. - Date = Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed If the permit is for One hundred ($100) or less). 1 certify that in the performance of the work for which this permit Is Issued I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration. you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit Shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued (Section 3097 Civ. C.) _ Lender's Name L ender•S Address OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed Statement that he/She IS licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of "vision 3 of the Business and Professions Code) or that he/she is exempt refrom and the basis for the alleged exempt ton. Any violation of Section 11.5 by any applicant for a permit subjects the applicant to a civil nalty of not more than five hundred dollars ($500). ti I, as owner of the property or my employees with wages as their sole 'com Densat..n, will do the work, and the structure Is not Intended oroffered for sale (Section 7044, Business antl Professional Code: The Contractor's License Law tloes not apply to an owner of a property who builds or Improves thereon, and who does Such work himself/herself or through his or her own employees, ever. `hethat building orch nimrprovement Its s sola within one YeaIntended or r of comr Sale. it, however, pletlo n, the owner will have the burden of proving he/she tlltl not build or im- rove for the purpose of sale). I, as owner tr the property, am exclusively contracting with licensed ode: con- tractors to construct the project oes no 7044, toBusinesso and Professionsproperty Code: The Contractor's License Law docs not apply to r S owner I, property wn - tbuilds,acto or improves thereon. and who Contracts for such w). I is with a ron- proof rof their pursuant to the ContraInsura License Law). I ov aware that proof o(/ their Worker's Compensation Insurance Should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have read this application and State that the above information is correct. I agree to comply with all city and county ordinances and state laws relating tobuilding constructlon, and hereby authorize repre- sentatives of this city enter upon the above-mentioned property for Inspection purposes. -bits Signature Oa[e --fes_ Drivers' Lice or SS r Showers Backflow Preventer Service Sink Backflow Irrigation A.P. #p S Main Building: Accessory Building: TYPE OF CONSTRUCTION U NEW U ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USEOF BLDG. U ALTERATION U REPAIR E T Front A Rear C iK Right TYPE OF PERMIT GRADING ElFOUNDATION ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ OTHER 11 STRUCTURAL ❑ MECHANICAL $ . Left I Ping. Ref, W, Parking Req./Provided PROJECT DESCRIPTION 50. FT. OCCUPANCY CONSTRUCTION TYPE VALVATIONTION $ ZONE GRADINGCU.YO,S.. ACRES planning Notes: Water Service Lavatories Remarks: P it S� s 11 1 a 6 y FEES Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Water Heater Kitchen Sink Water Service Lavatories Auto -Wash. Roof Drains Reinspection Fee I $15 Issue Fee $ 3 MECHANICAL FEES BUILDING PERMIT Boiler Hood or Type 1 ❑ - Canopy Type 11 ❑ $ 1 PLAN CHECK Duct - Under Ground $ PERMIT Duct - Structural Refrigeration System 04100,000 BTU ❑ 100,000 BTU PLUMBING $ ISSUANCE Duct - Ventilating Exhaust System ❑ Muliiple ❑ System Repair/Alteration - $ ENERGY P.C. $ Firepl/Fact. Bit. ICBG #, Fire Dampers $ GRADING $ Heating System & Ducting ❑4100,000 BTU 0100,000 Registers $ MICROFILM $ MECHANICAL Reinspection Fee I $15 I I Issue Fee 1 $ 3 0865-46, rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor ELECTRICAL Automatic Washer Transformer ❑ 15.50 KW Construction Pole Sub. ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter ❑over 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors 1:10.1 HP❑I%-8 F.A.U. Inc. Solar 09-15 HP ❑i6-15+ Fixtures L -1—M. crowave Device Boxes Pole Light Outlets Range Switches Garbage Disposal Generator 1345 KW 135-15 KW Zone Standing Sections Trash Compactor FEES I N G R E Q M T S. I Reinspection Fee 1 $15 1 1 Issue Fee 1 $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By 0=t 01 00021858-00021887 TOT 548,70 DATE: 12/12/83 TIME: 12:53 SUMMARYfREES BUILDING PERMIT $ �—SMIP $ 1 PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ `O PLAN CHECK 25% $ 01 00021858-00021887 TOT 548,70 DATE: 12/12/83 TIME: 12:53 CONSTRUCTION AND PLANNING APP#OVALS Permit # Date Inspector POO ;PA APPROVALS Permit # Date Inspector 1. L,mporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd, 't 54. Forms 4;.Electrical Conduit=Undrgrnd. f 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd.. 57. APPROVAL TO COVER-GUNITE ' 7^ Footings r ,i 58. Electrical Conduit-Undrgrnd. 8., Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. r 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floolf System 61. APPROVAL TO DECK 11. -Property Sewer' Line,& House Connection 62. Backwash & Receptor -Final _ 12. Sewer Cap i r � 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 APPROVALS Permit# 20_,RoughFactory Fireplace t�. 21. Ducts, in Structure '} 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas OOil 23. Gas Pipe -Rough & Test 72. Underground Flush 4 1(o 6 24. Roof Framing 73. Undergrnd. Storage Tank OGas 0Oil 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. UIREMENT 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 Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation it 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49: Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date , I Applicant to fill in all spaces except those within heavy border lines and sign all appropriate deet rations. Sq –CP CITY OF COSTA MESA CONSTRUCTION PERMIT T aL04 1 t - ie. - I-U 4ppi icantY M�1iin Address cane Name hone (�!Z��76 Address 4A le. PERMIT NO. TRACT NO. OT NO. U IT NO. _2 2 3 �" r1 TYPE OF CONSTRUCTION NEW t ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WOR K/USE OF BLDG. A.P. W — 2 - zone S Main Building: Accessory Building: E T Front Z 0 A Rear N Right N iS Arch/Eng. License No. Address TYPE OF PERMIT GRACING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER r PROJECT DESCRIPTION $G. FT. OCCUPANCY CONSTRUCTION TYPE �JIJ VALUATIONS n� ZONE GRADING CV. YDS. ACRES K K S Left G R Contractor's Nam Phone Address Imailingl–/""�� City License No. Ping. Ref, # Parki Req. /Provided E Planning Notes: M 1 T S. '' LICENSED CONTRACTOR DECLARATION n Remarks: U t Z an 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing ELECTRICAL FEES witn section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. �•g D License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self insure or a certificate of Workers' Compensation insurance, or a certified copy thereof (Section '0 Lab C) .cy No. Company PLUMBING FEES Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ❑ 50 + KW Bar Sink Showers Backflow Service Service Sink - Cooking Unit Meter ❑up to 100 amps - - Backflow Irrigation Sewer Cap Dishwasher Meter El 100 amps I� Certified Copy Is hereby furnished. ❑ Certified copy is filed with the city Building Division. - Bathtubs Sewer Connection Dryers ❑Gas ❑Electric Sub Panel - Clarifiers Solar Collectors Fan Motors ❑01 HP ❑1 h - 6 Date Applicant FROM WORKER$' COMPENSATION DECLARATION (This se<tion neetl not be completed if the permit is for one hundred red (5100) or (Th section less): I certify that in the performance Of the work for which this permit is Issued I shall not employ any parse in any manner so as bac me subject to tlse Workers'' compenssa[I s of Ca lifOr Date-1 Signature—/-.L._.f./ NOTICE- If, alter making this declaration you should becom object to the Workers' Compensation provisions Of the Labor Cotle, you usl forthwith Dish Washer Solar Piping - Drinking Fountains Solar Tank F.A, U. Inc. Solar ❑9-15 HP ❑1fr15+ Fixtures Microwave Floor Drains Swimming Pool w/Spa Device Boxes Pole Light Floor Sinks Urinal Outlets Range comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Gas Service Outlets Water Closet Switches Sign I hereby affirm that there is a construction lending agency for the performance of the work for which this permit IS issued (Section 3097 Civ. C.) Interceptors Water Heater Garbage Disposal Standing Sections Lender's Name Lender's Address Kitchen Sink Water Service Generator 00.5 KW 05.15 KW Trash Compactor Lavatories Auto-Wash OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031,5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant t0 the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business anq Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section t.5 by any applicant for a permit subjects the applicant to a civil Ity of not more than five hundred dollars ($500). as owner of the property or my employees with wages as their sole Co m ponsallon, will do the work, anti the Structure Is not intended or Offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such Improvements are not Intended or offered for sale. I1', however, the building or Improvement Is solo within one year of com- pletlori, the owner will have the burden O1 proving he/she did not build of Im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con- tractors t0 construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thereon, and who contracts for such oroiects with a Con. tractor( Ilcense pursuant to lie Contractor's License Law). I am aware that proof O1/ their Worker's Compensation Insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason P–Trap Laundry Trays Roof Drains Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES R U�EMENTS: Fri �� 3 v –f 2:ORIRg Approved By rt8te Building Approved By Date Application hued By - Date Rainsiaeu'tion Fee $15 Issue Fee S 3 - MECHANICAL FEES goiter Hood Or Type I ❑ Canopy Type 11 ❑ Duct - Under Ground SUMM RY OF FEES T- Z� BUILDING PERMIT $ SMIP $_ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL 1 $ GRADING $ PLAN CHECK 50% $ MICROFILM $ Duct -Structural Refrigeration System Duct- Ventilating ❑0100,000 BTU ❑100,000 BTU Exhaust System C3 Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO al`- Fire Dampers Date Owner I hereby certify that I have read this appltcatloi antl s that -the above information is correct. 1 agree to comply with all city an county ordinances and state laws relating to buil ing constr fiction, and hereby authorize repre- sentatives of this, to en up n the above-mentioned property for Inspection purpo s IA Signature �� Data Drivers' License or 55 � Heating System & Ducting Registers ❑0100,000 BTU 0100,0008 Z� MECHANICAL $ TOTAL FEE $ ' PLAN CHECK 25% $ ' - Q1 OR028t15/P,9]2_11RE T1�T it'0.2G cad/CEJ %p ST ril(E 1fi 14.1 - - Reinspection Fee $15 Issue Fee t $ 3 0865-46, rev. 5/88 White Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor O RUCTION AND PLANNING P VA LS Permit # Oate Inspector POOL P �A APPROVALS Perm.. # } Date Inspector 11 . mporary Electrical Service or Pole 52. Pool &Equipment Location 2. lil 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 LIFER 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 ' 95. Rough Electrical -Conduit 66. Solar System -Final 16: Rough Electric Wiring 67. Fencing & Access Approval 17! Rough Wiring Sign 68. APPROVED FOR PLASTERING 18:1 Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit# 20. Rough Factory Fireplace -� 21. Ducts, in Structure 70. Underground Hydro 22:;Ducts, Ventilating 1 71. Product Piping D Gas D Oil 23: Gas Pipe -Rough & Test 72. Underground Flush 24! Roof Framing - _ '• 73. Undergrnd. Storage Tank D Gas ❑ Oil 25. Roof Sheathing , 1 74. Overhead Hydro 26 -T-Bar Ceiling (Structural) & Monocoat j s� 75. Dry Chemical 27: Frame and Flashing 76. Dry Standpipe 28.' Lathing & Siding - 77. FIXED SYSTEM FINAL 29'- Insulation -. 78. FIRE PREV. FINAL J 30. Drywall Nailing 3 HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat -j - 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 o 37. Final Factory Fireplace i 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final ; 41. Solar Domestic -Final• 42. Backflow Preventer 43. Backflow Irrigation- . 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison - - y 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations CITY OF COSTA MESA TNSTR TION PERMIT Project Address _1041 �%. /,9� 57' AL 1 1141 jAn Applicant's Mailing Address 6 157 Owner'f Namet T /• ho� e' L Address OCCQ Lu. /6 S csLt/ PER T O. %� 391 S TRACT NO. LOT NO. UNIT NO A P 4% Zone $ I MainBuilding: Accessory Building: TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH OTHER DESCRIPTION OF WORK/USE OF BLDG. E T Front Z O A Rear N Arch/Eng. License No. Address TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU. YDS. ACRES � C Right N K $ Left G R Contractor's Name—��!U7� � � Phone 3 � Address (mailing) I�''� �'' STti� �dl � t. _ -Z�S / , City License No. b �-/ LICENSED CONTRACTOR DECLARATION Ping. Ref. 9F` Parking Req./Provided E Planning Notes: M T S. Remarks: I hereby affirm that I am licensed under provisions Of Charter 9 (commencing with section 7000) of Division 3 Of the Business and Professions Code, and my license is in ft for a and effect. ELECTRICAL FEES License ss (cans NO.434 ', 22 Date ��/G Sig t U v WORK RS' OMPENSATION DECLARATION - I hereby affirm that I have a certificate of consent to salt -Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section o, Lab. �U) e, G l e 2 3 S ��cn0r for I' .cy No. Company NgTi-ONL PLUMBING FEES Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. 050+KW Bar Sink $hdW¢r$ Backflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps Backflow Irrigation Sewer Cap p - ,' Dishwasher Meter ❑over 100 amps Certified copy is hereby furnished. / Cer "f' d led with the City Bdi�°y,�nw n Ddte�Applicant �„`s--'�- E%EMP 10 FROM WORKERS' COMPENSATION DEC RA ON 4 (This section need not be completed if the permit Is for one hundred ($100) or less). 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Bathtubs Sewer Connection Dryers ❑Gas ❑Electric Sub Panel - Clarifiers Solar Collectors t� Fan Motors 00-1 HP ❑1'h-8 - Dishwasher Solar Piping F.A.U. Inc. Solar 9-15 He 1316-15+ Drinking Fountains Solar Tank Fixtures i Microwave Workers' Compensation laws of California.Device Date Signature Floor Drains Swimming Pool w/Spa Boxes •-� Pole Light NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions Or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Under's Name Lender's Address Floor Sinks Urinal Outlets Ran 9 e Gas Service Outlets Water Closet Switches Sign Interceptors Water Heater Garbage Disposal 9 P Standing Sections Kitchen Sink Water Service Generator 00-5 KW E35-15 KW Trash Compactor OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its Issuance, also requires the applicant for Such permit to file a signed statement that he/She IS licensed pursuant to the provisions of 1,h4 Contractor's License law (Chapter 9 (commenting with Section 7000) Of -Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the bails for the alleged exemption. Any violation of a ion 5-1.5 by any applicant for a permit subjects the applicant to a civil Ay of not more than five hundred dollars ($500). �'' as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered Contractor's for sale (Section 7044, Business and Professional Code: builds License Law does not apply to an owner of a property who builtls or improvos thereon, and who does such work himself/herself or through his or her own employees, provided that such Improvements are not Intended or offered for sale. 11, however, the building or improvement Is sold within one year of com- pletlon, the Owner will have the burden of proving he/she did not build or im. prove for the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractorsto construct the project' Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such oroiects with a con- tractors) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensatlon Insurance should be provided to me. C1 am exempt under Section B. & P. C. for this reason Lavatories Auto -Wash P—Trap Laundry Trays Roof Drains Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Dat: Application Issued By Dat Reinspection Fee $15 Issue Fee $ $ MECHANICAL FEES Boiler Hood Or Type 1 ❑ Canopy Type II El Duct - Under Ground SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ S� PLAN CHECK 25% $ Duct -Structural Refrigeration System Duct - Ventilating ❑0.100,000 BTU 0100,000BTU Exhaust System El Multiple El System Repair/Alteration Firepl/Fact. Bit. ICBG dk Fire Dampers 7� V Date Owner 1 hereby certify that I have read this application and state that the above information Is correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize repre- sentatives OI this city to ter uD0 the above-mentioned pr pert for inspectlan pur s, Signalu re Date Drivers' License or 55 :r Heating System & Ducting Registers E10-1 00,000 BTU ❑100,0008 QI 00030$77-CG030$77 y'CI T ;7•=L DATE: 04/19/99 TIrnE: 09:r' Reins coon Fee pe $15 Issue Fee $ �J 0865-46, rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor 1 n` \: \ \\ 1 CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL P 'A APPROVALS Perm, # Date Inspector 1. Temporary Electrical Service or Pole _ - 52. Pool & Equipment Location 2. wil 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 OF ER Grnd. i 57. APPROVAL TO COVER-GUNITE 7. Footings - 58. Electrical Conduit-Undrgrnd. , B. Foundation 59. Gas Pipe, O Undrgrnd., Test 1 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. Rdof 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 APPROVALS Permit # •q0 . Rough Factory Fireplace 21. Ducts, in Structure 1 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe -Rough & Test (' 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -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 lz 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 Domestic -Final tJ 42. Backflow Preventer �• L. 43. Backflow Irrigation i 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co " 51. CERTIFICATE OF OCCUPANCY No. Date r� _. 1 - O Applicant to fill in all Spaces except those within heavy border lines and Sign all appropriate declarations. clry OF cosTq NiEU!> CONST UCTION PER4-110 MIT /` .Project Adiigess—SL71�1� 5�,,s• 7'7 ��V - Applicant's "aili Add /7(/t/C Owneri Name/ � %�� G7t/—Phone Address Arch/Eng. License No. — Address Contractor's Name Phone Address (mailing) ZZ �E�.�• City License No. LICENSED CONTRACTOR DECLARATION Thereby affirm that I am licensed antler provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class Gib License No. �TOZk_9 Dated S'anature vi{..., WORKERS' COMPENSATION D ATIO I hereby affirm that I have a certificate of consent to self -Insure or a certificate M Workers' Compensation Insurance, or a certified copy thereof (Section )0, Lab. C.) (9� icy No. _h %(�-heAcn I Certified copy izhereby turni5heDivision.I N DECLARATION (This section neetl not be Com pletetl if the permit s for one hundretl (5300) or less). certify that in the performancethe work fwhich this permit i5 issued I shall not employ any persononinin any manner so so as to become subject to fife Workers' Compensation Laws Of—Signature California. Datehs NOTICE: C after making this ions declaration, you r Co become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions Or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCV- I hereby affirm that there is a construction lendingagency for the performance of the work for which this permit ississued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I -am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section '1.5 by any applicant for a permit subjects the applicant to a civil Illy of not more than five h,rt red dollars ($500). i, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). ❑ I, as owner of the property, am exclusively contracting with licensed con. tractors to Construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds Or improves thereon. antl Who contracts for such croiects with a con- tractors) license pursuant to me Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section— B. & P. C. for this reason Date wner I hereby certify t at have reaq this application and state that the above Information is Corr c , agree to comply with all city and county ordinances and state la r uildmg construct) on, and hereby authorize repre- sentatives thi [ e er upon the above-mentioned u^�aKt yr�er Inspection urpos �Hlil� Signature Date Drivers' License or SS -P A.P. # S Main Building: Accessory Building: TYPE OF CONSTRUCTION LJ NEW LJ ADD LJ ALTERATION 11 REPAIR E ❑ CONVERSION ❑ DEMOLISH ❑ OTHER T Front DESCRIPTION OF WORK/USE OF BLDG. - A Rear TYPE OF PERMI[ GRADING El FOUNDATION K TENANT STRUCTURAL C Right "lyp}I''I _ ❑ ELECTRICAL ❑ PLVMBING ❑MECHANICAL $ Left ❑ BOTHER Ping. Ref. # Parking Req./Provided PROJECT DESCRIPTION SO. FT. OCCUPANCY Planning Notes: CONSTRUCTION TYPE VALUATION $ ZONE GRAOING CU.YDS. ACRES Remarks: Qj,'.{"7FSL/1L Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers.—' Dishwasher? Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories Roof Reinspection Fee $15 Boiler Duct - Under Ground. Duct - Structural Duct - Ventilating _ Exhaust System ❑ Multiple El Firepl/Fact. Bit. ICBG # Heating System & Ducting ❑ 0-100,000 BTU ❑ t 00,000 BT Reinspection Fee �1 $15 0865-46, rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor dBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w Urinal Water Closet Water Heater Water Service Auto -Wash Issue Fee AANICAL Hood or Type ❑ Canopy Type it ❑ Refrigeration System 00-100,0006TU 1:1100,000 System Repair/Alteration Fire Dampers Registers Issue Fee FEES Zone 0 N G R E Q M T S. ELECTRICAL FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+ KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter Dover 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors 00-1 HP Ell %-8 F:A.U. Inc. Solar 09-15 HP 016-15+ IYC Fixtures Microwave rA4Do Device Boxes Pale Light Outlets - Range I 45 I. Switches Sign g f Garbage Disposal Standing Sections Generator 065 KW 05-15 KW Trash Compactor $ 3 0100029215-00029215 TOT DATE: 03/27/89 TIME: 11:25 67.24 Reinspection Fee $15 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By -- -� • nate Date Date 3�7 ea $ 3 FEES - BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL / PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF $ $ $ $ENERGY $ CG—GRADING $ $ $ FEES SMIP PERMIT ISSUANCE P.C. MICROFILM TOTALFEE $ $ $ $ $. $ cca . $ 3 0100029215-00029215 TOT DATE: 03/27/89 TIME: 11:25 67.24 A 0 CONSTRUCTION AND PLANNING APPROVALS Permit # Date l > Inspector POOL' `A APPROVALS Permit # Date Inspector .1.einporary Electrical Service or Poie y 52. Pool & Equipment Location 2. Siiil Pip'a-Undrgrnd. _ :.• -ice t� 53. Steel Reinforcement - 3r Electrical Conduit; Utility-Undrgrnd. 54. Forms 4..Electrjcal Conduit-Undrgrnd. +1 - 55. Electrical Bonding .. 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test i 6.' Electrical UFER-Grad. 57. APPROVAL TO COVER-GUNITE `•' 7. Footings 58. Electrical Conduit-Undrgrnd.-� 8. Foundation 'I •� �� - 59. Gas Pipe, O Undrgrnd., Test •'j 9. Water Pi a-Undr rnd. P 9 60. Backwash Lines, P -Trap, O Undrgrnd. f•' 10.'St�ructural 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, ,�, i• 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 117 Rough Wiring Sign 8. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 1'19. Rough Heating & Air Conditioning - FIRE DEPT. REQUIREMENT APPROVALS Permit# 20. Rough Factory Fireplace :T 21. Ducts, in Structure "J, 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas ❑Oil 23. Gas Pipe -Rough & Test: 72. Underground Flush 24. Roof Framing . 73. Undergrnd. Storage Tank O Gas []Oil 25. Roof Sheathing ,' 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30:'Drywall Nailing HEALTH DEPT. REQUIREMENT 31: Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter -Final FOOD CE TIFICATE ISSUED 33. Final Electric �Notes: 34. Final Heating & Air Conditioning �'.. _ h n 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 Domestic -Final, 42. Backflow Preventer - -. 43. Backflow Irrigation 44. Landscape Irrigation System ' 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co / 51. CERTIFICATE OF OCCUPANCY No. Date PROJECT UDRESS: 1041 W' 1'8 in ST UN17: A110 OWNER•SNAME: BARTO/,RICHLEY ADDRESSi.809 VIA LIDO SOUD� _ �`•' NEWPORT BEACH CA -92663 �.ARCMIENGINEEfl: (71A) - 673-2837- REO.NO.: ADDRESS: UNIT: PERMITTEE: BAR'TO/RICHLEY (714)673-2837 ADDRESS: 809 VIA LIDO SOUD '. NEWPORT BEACH CA 92663 LICENSED CONTRACTOR DECLARATION: 1 hereby affirm that I am licensed under provisions of Chapter 9 (Commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. CITY LIC.: STATE UC.: CLASS: Date: Signature: WORKERS' COMPENSA710N DECLARATION: I hereby affirm that I have a ceNficate of consent to self -insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C). POLICY NO.: ENP. DATE: .COMPANY: '-� CeffifieE Copy is hereby furnished. ❑ Certified copy Is filed with the City Building Division. Date: Applicant: EXEMPTION FROM WORKERS' COMPENSATMN OECIAMTION: (this section need not be Completed if the Pectin is for one hundred ($1110) or less). I certify that in the performance of the work for which this permit is issued. I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date: Signature: NOTICE: If, atter making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Comply with such provisions or this permit shall be deemed revoked. - CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097, Civ. C). LENDER: ADDRESS: OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following mason (Section 7031.5 Business antl Professional Code: Any city of County which requires a permit to Construct. atter, improve, demolish, or repair any structure, poor to its Issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that hushe is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). I, as owner of the property or my emyloyees with, wages as their sole compensalion, will do the work, and the El structure is not intended or offered for sale (Section 7044,. Business and Professional Code: The Contractors' State License Law does not appN.to an owner of a propend who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. It, however the building or improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). ,. • I, as owner of the property, am exclusively contracting with licensed contractors to Construct the project (Section 7044, Business ❑ and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon and who Contracts for such projects with a contractorjs) license pursuant to the Contactors' State License Law). I am aware that proof of their Worker's Compensation insurance Should be,pruwded to me. - I am exempt under Section: B P 7 0 4 4 0'A P. C. forihismason: NO EMPLOYEES Date: Owner:. I do hereby certify that Ihat I am and understand the requirements of California Health and Safety Code Sections 2 , 25533, and 25534 and that I or any future building occupant will/will not (circle one) need to comply with said state codes and the requirements for a permit for construction or modification from the Air Duality Management District. Rest ntie construction applications are exempt from these provisions. Date: 3-1A —� Applicant: I hereby calmly that I have read this application and sate that the above information Is Correct. I agree to Comp 1a all city and county ordinances and sate lays relating to building construction and hereby autlwnze apresenat the dry to the abovo-mention rd property for inspection purposes. f�"�� C Date: '� _ p� Signature: J�� Driver's License or Social Security x: CITY OF COSTA MESA — BUILDING PERMIT PERM NO: -P: '046489 PERMIT NO: P 046489 PLAN!CHECK-NO.: N GOVT: N SUPP: N CONSTRUCTION TYPE: 5-•N PERMIT TYPE: PLU PURPOSE: OTH JOB DESCRIPTION :'GAS SERVICE SQ FT: CLAIM VALUE: CALL—VALUE: GROUP UCC: B'-2 / COMMENTS: NO "B" PERMIT FOR REFERENCE. `3;7SWy) iE*at*#aEN )E1E*MiE aF aE)F aE 1E aE of aE iE JetE*rtie eE ae ee eE ♦E*aF*4F aH 4E iF iFM ie 3e*iE♦E*MIe**iE*iE iE ae aF 9L 9H 4F aE*aE of aE iF ie**aE iK*iE*if 4L aE if iE Z O N I N G R EQ U I•R E M E N T S S E T B A C K S ------ ---'— MAIN BUILDING —'=-------- -------•--- ACCESSORY BUILDING"--------- FRNT: FT IN REAR: F'T' IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 00000000 ZNE: REF NO:, PLANNING NOTES> { > .. _ . . aF ie ie aF ie aE if aE at***iE if iE lE if iE lE ie iE iE ielE lE eE iFrtlE3E aE ifkkiE ee iE iF*ee ie eE lE of iE eH yE 4H If iE ee ee*iE 4E Se 3E***it ie lE,kiE eF ie iF iF ie 9d**#ifkiE kiE ' D E V E L O P M E N T' S E R V I.0 E S R E Q U I R EM E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY :- ' DATE: APPLICATION .ISSUED BY: G�� DATE: 3%O iE ae le K�fF 1E 4F ie ie lE eE eH *-0E 4H iH ie iF ee ee eE ee7FiFi '�iFiFiZ � - 3i: iF3F akde ae �ekaE*1e iE le�FiF�iF � JFa( Ie aE BE ih*dE*3r it et 4e*it iE iE♦F 3e iH*if iH iFM ie*ie eE aF ie iF ie.N.lE ee*keH ae ie Jt iE aE ie ie ie* 3k ie K4E*aE eE 4f aE JE*iF if lE ie it ie iH 3e iE aF iE*iE iF ;Hai iFiE*ie LEGALIZATION:N F E E S'U M M A R Y STRUCTURAL SEGMENT:N BLDG PMT •PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 2 .00 ' . 01000`5909-00055909 TOT DATE: 03/12/90 TIME: 16:15 5.00 9 25% SMIP/NON—RES PLAN ISSUE FEE 3.00 BUILDING—DIV—> PERMIT ISSUE. PLAN—CHECK, TOTAL PAID 'DUE -TOTALS-----> 2.00, 3.00. 0.00 ;5',00 5.00 .0,0 REVENUE DIVISION TOTALS--> 'COLLECTED: 5.00. OVER/SHORT: '.00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK 5.00 ; IE aL * * if ae * iE iE IE iE of iF iE eF ae ae iE IE * 7H iF * * iF Jt 1E aE aE * aE LF 4F ee ek k ee * * JE iE eE # aE eE aE iE * M aE ee * * * iE aE * i(-�f iE iE iE iE iE iE if iF if it ie iE iE ifK 7f if 1fIf iE I N D I V I D U A L. F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST PLU 1 GAS SERVICE 2.00 2.00 END OF FEES 01000`5909-00055909 TOT DATE: 03/12/90 TIME: 16:15 5.00 9 CONSTRUCTION AND PLANNING' " ' POOL PA .. Date Permit # [InspectorAPP�iOVALS APPROVALS Permit # Date . Inspector + •1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd_ 53. Steel Reinforcement ;.( - ,3: Electrical Cond-uit-Utility-Undrgrnd. 54. Forms 4.:Electrical Conduit-Undrgrnd. 55. Electrical Bonding- ' .5. Steel Reinforcement - 56. Rough Plumbing & Pressure Test' c6.7E1ectrical UFER.Grnd. 57. APPROVAL TO COVER-GUNITE `7. -Footings �;r, • 58. _Electrical Conduit-Undrgrnd.- B:uFoundation 59. Gas Pipe, ❑ Undrgrnd., Test A 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, ❑Undrgrnd. n 10. Structural Floor System 61. APPROVAL TO DECK r i 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final - i 12. Sewer Cap 63. Heater & Vent;Fi al J rn 13. Roof Drains .. ,.• - 64. Plumbing System - Final 14. Rough Plumbing 65. -Electrical -Final a 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 DEPT. REOUIREMENT ». .FIRE APPROVALS~Permit # - 20. •Rough Factory Fireplace _ - - y" _-•;. i 21! -Ducts, in Structure, - - ` ° -•70. Underground Hydro ¢. 22. Ducts, Ventilating Product Qiping ClGas ❑-Oil 23.•GarPipe-Rough & Test .72. Underground Flush - 24 Roof Framing :73. Undergrnd.Storage_Tank OGas ❑Oil 25. Roof Sheathing -- r 74, Overhead Hydro. 26.. T -Bar Ceiling (Structural) & Mohocoat -- 75: Dry Chemical - - 27.. Frame and Flashing - _ >• w , 76. Dry Standpipe 28. Lathing & Siding . - ;: 77.E FIXED SYSTEM p W AL _ 29. Insulation -' 787; FIRE PREY. FINAL - - 30. Drywall Nailing HEALTH DEPT;. REQUIREMENT =.31. Plaster Brown Coat = - ' -r i > "79. FINgL INSPECTION -321.'Electrical Pcvver'.Mew-Final x v ; -•'80 _FOOD CERTIFICATE ISSUED. _33 _Final Electric _ �. +- .'N 3/$1,4-0 .��c�i�- LEFr-4ew.G�v'� otes: ! 34; Heating & Aii itio ing Cond » r __ _Final 35r Final Gas Pipe -70F 36 Hood or Canopy, 37. Final Factory Fireplace - tai fir: '38. Final Plumbing''39. Water Service -Final, •^ - ,_ ;'. -. "40. Gas Service -Final - _ _ C `-41. Solar Domestic -Final` - 42. Backflow Preventer• -:C 43. Backflow Irrigation -• •-.�;�.: + -44. Landscape Irrigation Systema_ �. _ - r 4 '7, r 45: Sound Attenuation 46. Handicap Regulations - r 47. FINAL STRUCTURE & BUILDING �; _ • 1.; j r - _ 48.:FINALPLANNING.- _ 49. Electric Release to Edison •Gas y + ;,`, •; r " 50. Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No Date City of Costa Mesa Development Services Department CERTIFICATE OF OCCUPANCY No. (y Building Safety Division 0 0 3 0 7 3 P. O. Box 1200 Costa Mesa, California The Building located at 1041 WeRf, 18th S rpt•, Units Al04. A9()4, A;PQA. A9nr. has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group B7 Occupancy. Use of Building Offica/Wacwhoma , Legal Description 424-,421-18 ISee reverse side for Metes and Bounds) BE 38864 Building Permit NoF�RE,d Electrical Permit No EM44557 Plumbing Permit NoP 39138 Mechanical Permit No. M 39010, EM 44557 Number of apartments and/or guest rooms Fire Prevention Permit No. E 38910 ISSUED TO: Barto/Rich&ev 1041 W. 18th Street,, Ste. 110 Costa Mesa, CA 92626 Building Official George. Pc4michon by /�. _ p•�.r/., Date November 9,, 1989 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. . CMF 1015-46 rev. 1/93 white - Owner; Canary - Numerical File; Pink - Bldg. Permit File ,I Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT ia3i Project Address 104 W MAST: Lb , 1_ ` ' w r`",3 S � 4 " � S aAWAIicant't's Maili Ad r s '_ , e 11th Owner's I�ame�- KO"es -7i 1... address ! 13 , CU A -7 — % -T ( _ _,h I �� k TYPE OF CONSTRUCTION NE ❑CONVERSION 1:1 DEMOLISH DESCRIP NOF WORK/USE OF ly . TYPE OF RMIT GRADING ❑ TENANT ❑/ELECTRICAL I [3 OTHER �n(M yyPW PROJECT DESCRIPTION CO N ST RUCTI ON TYPE ZONE— ONE Arch/Epg. 061"PI121 S ST LC_ License No. C• —6-7-4 &nl my ah, PZ.w &Ft�q zk Andress '121 1-0w�11)1� ,4 Contractor 's�"am II��'�^� 1 sy honei,46 r t. /. City License No. - CONTRACTOR DECLARATION CONTRACTOR I he �� dor with section 7000) f DIS ...� my license Is In IUIV.,i 55d effect. t 9 ( mencing tle antl Right Remarks; L $ Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self4riswe or a certificate Workers' Compensation Insurance, of a certified copy thereof (Section 00, Lab. C.) olicy No. Company Certified copy is hereby furnished. Certilieo copy is filed with the city Building Division. ,is Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed if the permit Is for one hundred ($�Suel less). I certify that in the performance of the work for which this rmR is i shall not employ any person in any manner so as to O e subjec Workers a Laws Of Calif Date Signature NOTICE:nf, after mak ng this declardhermit ou should be orie subjec to the Workers' Compensation provislons Labor Code, you must fp thwith comply with such provislons or shall be deemed voked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 30971 Clv. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Buslne4s and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the Provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt `erefrom and the basis for the alleged exam often. Any violation of Section 31.5 by any applicant for a permit subjects the applicant to a civil rally of not more than five hundred dollars (5500). LJ I, as owner of the property or my employees with wages as their sole compepsdt iod, will do the work, and the structure IS not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work himself/herself or through his or her Ovrn employees, provided that such Improvements are not Intended or offered for Sale. If, however, the building or Improvement is Sold within one year of com. pletion, the owner will have the burden Of proving he/she did not build or Im. �rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con. tractors to construct the project (Section 7044, Business and Profelssions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for Such oroleCts with a con. tractor(S) Ilcense pursuant to me Contractor's License law). I am'a are that Boot of their Worker's Compensation Insurance should be provid to me jib 1 am exempt under Section R. j)P. C. fort s reason Date ct'!= I hereby car Infer matter i antl state lav sentatives of inspection Slgnat ure Drivers' Lice 0865-46, rev. 15 f Owner that I have read rect. I agree to c latin9 Io buildinc ; city to enter j It # � . White - Building; above Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher; Drinking Fountains Floor Drains Floor Sinks' Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Reinspection Fast $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBG * Heating System & Ducting C30.1 00,000 BTU ❑ 100,000 Reinspection Fee 1 $15 Applicant; Pink - Accounting; Goldenrod . Assessor f. Lo4,,Z� % A.P. M 'J�L S Main Building: ADD ALTERATION LJ REPAIR D OTHEERR1_� IT E T A Front Rear r�G. C Right FOUNDATION LJ STRUCTURAL 'LUM;!?j MECHANIC •�� J $ Left ' Ping. Ref. dp LaIt UA e R,_ OCCUPANCY' r • VALUWN $ 3 CU. YDS. ��{ AHiE Planning Notes: . rPLAN 'MECHANICAL 26q, 93, Fit (d PLAN CHECK 25% ABING FEES Automatic Washer • howers Construction Pole Sub. Service Sink Cooking Unit Sewer Cap - Dishwasher Sewer Connection - Dryers ❑Gas ❑Electr Solar Collectors Fan Solar Piping ,-, F.A.U. Solar Tank '• -- Fixtures Swimming Pool w/Spa Device Boxes Urinal Outlets Water Closet Switches Water Heater Garbage Disposal Water Service Generator 00-5 KW Cl! Auto -Wash Issue Fee Hood or Type ❑ Canopy Type II ❑ Refrigeration System 110.100,Oo0BTU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee Reinspection Fees 1i I 31 DEVELOPMENT SERVICES Zoning Approved By FEES Building Approved By�..1 Application Issued By` $ 3 _S Zone Accessory Building: JIz N N G R Parking Req./Provided E 0 M T S. ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+ KW Meter LJup to 100 amps Meter ❑over 100amps Sub Panel Motors❑0-1 HP Ell h-8 Inc. Solar 09-15 HP 016-15+ Microwave Pole Light t. Range Standing Sections KW Trash Compactor $15 1 I IOUs Fee FEES SMIP $ 7•44 SUMMARY OF BUILDING PERMIT ISSUANCE $ _4L4_- so PLAN CHECK $ $ PLUMBING •. MICROFILM $ _ PLAN CHECK 25% $ ELECTRICAL $ 2 37 CHECK 50% $ rPLAN 'MECHANICAL $ PLAN CHECK 25% $ FEES SMIP $ 7•44 PERMIT ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTAL FEE $ til' JCiJ "?'-1 R:515F7 COT „2 CONSTRUCTION AND eLANNING Date APPROVALS -Permit #, Inspector � p POOL ?A APPROVALS Permit # ••_ r ` Date Inspector I.%Temdorary 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. Steeen l Reinforcemt _ � r. � 56. Rough Plumbing & Pressure Test 6J Electrical UFE_ R Grnd. 57. APPROVAL TO COVER-GUNITE Footings `` '� 58. Electrical Conduit-Undrgrnd. _ 8:, Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. ' 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12: Sewer Cap 63. Heater & Vent -Final ' '•;13�`.Aoof Drains i 64. Plumbing System - Final 14TRough Plumbing .. ` 65. Electrical -Final ' 15. Rough Electrical -Conduit 66. Solar System -Final if! Rough Electric Wiring j 3 Fencing & Access Approval 17: Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceiling 77 --e9. POOL/SPA SYSTEMS FINAL 19. Rough Heating &Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit# 410, Rough Factory Fireplace `i 21. Ducts, in'Structure 70. Underground Hydro 22. Ducts, V.entilatiq'g 71. Product Piping 0Gas ❑Oil 23. Gas Pipe-Rough;&'Tess 72. Underground Flush 24. Roof Framing i^ r 73. Undergrnd. Storage Tank C1 Gas 0Oil 25. Roof Sheathing .` �, * - 74. Overhead Hydro 26. T -Bar Ceiling JStructural) &'Monocoat 75. Dry Chemical 27. Frame and Flashing _r .� ,(� �� Y%'� 76. Dry Standpipe 28. Lathing & Siding *V 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 20. Drywall Nailing` '`r iS HEALTH DEPT. REQUIREMENT �1. Plaster Brown Coat �'l yl 79. FINAL INSPECTION 321'Electrical P4 Meter�Final 0. FOOD CERTIFICATE ISSUED 33: Final Electric'No ti v 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test �• ,S/ �/ 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final -1 41. Solar Domestic -Final '•=� �'� ,,1 42. Backflow Preventer I 43. Backflow Irrigation 44. Landscape Irrigation System f J 45. Sound Attenuation } 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING - 48. Special Requirements Completed 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ' R YL � �" , -- .S` " Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA.. MESA CONSTRUCT T PERMIM p3 PERMIT NO TRACT NO LOT NO. WIT &0 IMM 'A �/' IQ� A� Project Address W� va SfiC- Applicant's Mailing Address Owner'- Name Phone Address Arch/Eng. License:No. Address Contractor's Na r r�27�—gT�jr�( Address (mailing) _I L1 S1 ny—iC b`n its �i �dC�+IIG/`27r'1 7a City License No. 4t5CJg LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) Of Division 3 of the Busing and Professions Code, and my license is in full o ce and effect. �Z,v �je� License Class leans¢ No, LO Dale — Signature WORKERS' COMPENSATION DAT ION I hereby affirm that I have a certibca a of consent to self -Insure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 1800, Lab. C.) Policy No. Company eCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Dale Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION This section need not be completed if the permit is for one hundred ($100) or ass). I Certify that in the performance of the work for whi this ermit Is Issued I shall not employ any person in any maero b me subject to the Workers'/CorgPpd Laws of Californ Date (p G7= Signature NOTICE: If, after making in is tleclara Iuld become subject to the Workers' Compensation provisions ootle, you must forthwith comply with such Provisions or ( is permit shall be deemed revoked., CONSTRUCTION LENDING AGENCY 1! I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 CIV. C.) Land Or'e Name Landers Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or rnunte which ranuires a permit to construct. alter. Improve. demolish or repah to file a skined statement that he/she Is licensed Pursuant to Division 3 of the Business and rroresslons code, or mas nepo a :s exvriwr therefrom and the basis for the alleged exemption. Any violation of Section '031.$ by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). ❑ 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work himself/herself or through his or her own em DlOyea$, provided that such improvements are not intended or offered for sale. If, however, the building or Improvement Is Sold within one year of com- plelloh, the owner will have the burden of proving he/she did not build Or Inn prove for the purpose of Salo). ❑ I, as owner of the property, am exclusively contracting with Ilcensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner Of property who builds or Improves thereon. and who contracts for such orolects with a can. tractor(s) license pursuant to me Contractor's License Law). I am aware that proof of their Worker's Compensation Insurance Should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Ownei I hereby cert icy that I have re Information is correct. I a ree and State laws relating t bui ii sontatives of [his c' toi inspection purpos Signature 1 this application and state that the above comply with all city and county ordinances g conStr uctiom, and hereby authorize repre- upon the above-mentioned Property for Date TYPE OF CONSTRUCTION LJ NEW L ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. `4'01A=,0 TYPE OF PERMIT LJ GRADING FOUNDATION LJ STRUCTURAL ❑ TENANT 1:1 ELECTRICAL PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SO. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE—�s rG�RAOINGCU.YDS. ACRES Remarks: ;S1,t2f _ III— FE Bar Sink Showers Backflow Preventer Service Sink SUMMARY OF FEES Backflow Irrigation Sewer Cap BUILDING PERMIT Bathtubs Sewer Connection $ Clarifiers Solar Collectors $ Dishwasher • Solar Piping Drinking Fountains Solar Tank PERMIT Floor Drains Swimming Pool w/Spa PLUMBING Floor Sinks Urinal $ Gas Service Outlets Water Closet 1"1r Interceptors Water Heater 25% Kitchen Sink Water Service ENERGY P.C. Lavatories Auto -Wash ELECTRICAL P—Trap Laundry Trays $ Roof Drains t, Izs..- Reinspection Fee 1 $15 Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG dk Heating System & Ducting 00.100,000 BTU ❑100,000BT' Reinspection Fee Drivers' Licen SS 1 1 0865-46, rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $15 Issue Fee Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System 00.100,000BTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee rs.r. •a= S Main Building: E T Front ARear C Right K Left Ping. Ref. # Planning Notes: Automatic Washer Construction Pole Cooking Unit Dishwasher - Dryers ❑Gas .❑ Fan F,A'.U, Zone Accessory Bui Par ELECTRICAL Transformer ❑ 15-50 KW IA ❑ 50+KW Device Boxes - Outlets Switches Garbage Disposal Generator 00-5 KW 05-15 KW Meter LJup to 100 amps Meter El over 100 amps Sub Panel Motors ❑0.1 HP 01'A-8 Inc. Solar 09-15 HP 016-15+ Microwave Pole Light Range Standing Sections Trash Compactor Reinspection Fee I $15 I I Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By FEES Building Approved By Application Issued By S 3 T N G R E Q M T S. FEES $ 3 TILE- jc,. •Y', SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK - $ PERMIT PLUMBING $ _ y ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ _- MECHANICAL $ TOTALFEE $ PLAN CHECK 25% $ TILE- jc,. •Y', CONSTRUCTION AND PLANNINGI ,APPROVALS Permit # Date Inspector POOL . 'A APPROVALS Permit# Date Inspector. 1. Temporary Electrical Service or Pdle 52. Pool & Equipment Location '2. Soil Pipe-Undrgrnd. F1"• 53. Steel Reinforcement ' ., 3�Electrical Conduit Utility-Undrgrnd! 54. Forms H 4' Electrical Conduit-Undrgrnd. 55. Electrical Bonding : s 5%Steel Reinforcement - ;• 56. Rough Plumbing & Pressure Test 6q Electrical UFERvG ncl 57. APPROVAL TO COVER-GUNITE 7.'Footings F . 58. Electrical Conduit-Undrgrnd. 8!Foundation t•.. - 59. Gas Pipe, 0 Undrgrnd., Test r, 9"Water Pipe-Undrgrnd'. j-` 60. Backwash Lines, P-Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property SeweG.Line &House Connection i v e 62. Backwash & Receptor-Final 12.'Sewer Cap - • =; 63. Heater & Vent-Final 0�3r•Roof Drains r� t 64. Plumbing System - Final 4!- Rough Plumbing' , _- 65. Electrical-Final 2 15. Rough Electrical-Conduit t66. Solar System-Final v 16. Rough Electric Wiring X67. Fencing & Access Approval 1.7' Rough Wiring Sign 68. APPROVED FOR PLASTERING 18- Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19'. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace ' 21. Ducts, in Structure J r, 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil 23. Gas Pipe-Rough &Test ,'{�' 7,7r.. Underground.F lush 24. Roof Framing r 73. Undergrnd. Storage Tank OGas 0Oil 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: I 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing %3 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irriqation System •c- 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co- - 51. CERTIFICATE OF OCCUPANCY No. Date -" P�ECT ADDRESS: • 1041 W-. 1 aXH ST ` OWNEWS NAME: BUD RICHLEY ' - ADORESS: SAME' AS ABOVE UNIT: 2 0 3 ARCHIENGINEER: REGIME).: ' ADDRESS: 0 UNIT: 00000 PERMITTEE: TODD KAUSEN (714)548-7791 ADDRESS: 1041 W. 18Th COSTA MESA CA 92646 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (Commencing with Section 70D01 ofpivision 3 of the Business and Professions Code, and my license Is in full force and effect. CITY LIC.: STATE LIC.: CLASS: Date: Signature: WORMERS' COMPENSATION DECLARATION: I hereby affirm that I have a certificate Of conunt to self -insure or a certificate of Workers Compensation Insurance, or a certified copy thereof (Section 3000. Lab. C). POLICY NO.: EXP. DATE: COMPANY: ❑ Certified copy is hereby furnished. ❑ Certified copy is filed with the city Building Division. Date: Applicant: EXEMPTION FROM WORMERS' COMPENSATION DECLARATIO 1 cenify that in the performance of the work for which this subject to the Workers Cfimpensafion Laws of Califomi it the permit is for one hundred ($101) or less). my person In any manner an as to become Data: 10-14- Signature: C U IJ ii - NOTICE: If; after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a Construction lending agency for the performance of the work for which this permit Is issued (Section 3097, Civ. C). LENDER: ADDRESS: - - OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from,the Contractors State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of County which requires'a permit to Construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such'permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). 1, as owner of the pmperty, or my employees with wages as their sole Compensation, will do the work, and the ❑ structure's not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractors' State Liam Law does not apply to an owner of a property who builds or Improves thereon, and who does such work himselUherseff or through his at her own employees, provided that such improvements are not intended or offered for sale. If, however the building or Improvement is sold within one year of Completion, the owner will have the burden of proving he/she did not build or improve for the purpose of sale). - I, as owner of the property. am exclusively contracting with licensed contractors to construct the project (Section 7044, Business 23 and Profeuions Cade: The Comractors' Sate license Law does not apply to an owner of property who builds or improves thereon and who contracts for such projects with a contractor(s) license pursuant to the Contractors' State License Law). I am aware that profit of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section: B., & P. C. for this reaun: Date: -' �' ` . Owner: do hereby certity that I am aware of and understand the requirements of Cali rnia Health and Safety Code Sections 25505, 25533, and 25534 and that 1 or any future budding Occupant MIVMll not (circle one) need to comply with said state codes and the requirements for a permit for convection or modification from the Airualiry Management District. Residential construction applications are exempt from these provisions. Date: Applicard:. I hereby certify that 1 have read this application and state ordinances and stale laws relating to building construction; propertyforinspection purposes. Date: to ` Signature: Driver's License or Social Security x: information is conect. Iagree to comply with all city and county Driagyepfesgptatives(o hk city to enter upon the above-mentioned Canary—'Applicant; Pink=Revenue: Goldenrod—Assessor CITY OF COSTA'MESA -. BUILDING PERMIT PERMIT NO: EM 044557 PLAN CHECK NO: N GOVT: N SUPP:!N i CONSTRUCTION TYPE: 'PERMIT -TYPE: ELE.MEC PURPOSE: NEW JOB DESCRIPTION � SQ FT:, CLAIM.VALUE: GALC-VALUE: GROUP OCC: / COMMENTS: ��-�L>E�s�r�rx�-�e**�s�sx-*�rxx+��Ltsas�+r�H+�**�*x-��x��x-�E*>E�+E+H*x�s�L*�*�k*�s�x•��E**aH�x�Exyr�H�L**if*�**�* Z O N.I N G S E T B A C K SR E Q AU I R E M E N T S --------=--- MAIN BUILDING ---------- ------- ACCESSORY BUILDING--------- FRNT: FT IN REAR: 'FT IN. FRNT: FT IN REAR: :FT IN. LEFT: FT IN.RGHT: FT IN LEFT: FT IN RGHT:. FT 'IN PARKING REQUIRED: PARKING PROVIDED: REHIRED: PARCEL: 42442120 ZONE: ' PLANNING N k 9H 1E if if Be iE et ik at iE iE 9F aE k iE iH iE * 9E aE 9H * ie 3e 4H et iE if iE iE iF it * Oce ie Oce iH aE 3E 9E'iF at 9E iE 9e yF ie 9f 9F Bt iE itiH BE iE ie at Oce BE BH iF iF * iH it 3E iE 4F aE aE lE * 9e iE itef jD,rE V E L O P M E N T S E R V I C E S R E Q U I R E M E N T:S I ZONING APPROVED BY' DATE: BUILDING'APPROVED BY ; DATE- ATE: _ ':1J1 APPLICATION ISSUED BY:: (/IJ/ DATE: if iH 3e9f*iE ik*ie It iEit9ea(-3E if 0e iE BE ie fE9E3F3FiFiF�FiF 3FiF3Fl��iE3F3-F7�iF3F3F3F3F�f�3FTF3F3F3F�F7F 1E iE if iE iF iF if kiE i(- iF 1E Oce ie 1E ie ie iE iH Oce * * if 9e ie ie * eE iE iF iE 9E aH 9e iH 3e * 9t ie iF * 1E 9E iE �! iF * iE 9e iE aH 4H 9e iE iF it -9k Oce iH 9E is aH i4 Bt it 9e eE Be 9E 9E ee 9E BF eH 9E Oce 9f 4F1E ie k ie iE 9E iE * eH ie iH 9t 9E LEGALIZATION:N F E E S U'M M A R Y- STRUCTURAL SEGMENT:N'- BLDG PMT PLUMBING ELECTRIC 'MECHANIC FIRE SMIP/RES GRADING PERMIT 3.00 6.50 = 503 25t SMIP/NON—RES PLAN ISSUE FEE 15.00 15.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS ---- > 9.50 30.00• 0.00 39.50 39.50 .00 REVENUE DIVISION TOTALS--> COLLECTED: 39.50 OVER/SHORT: 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING'PL'AN—CHECK 18.00 21.50. k i4.9e * 9E Be * 1E i( -I( -ie iE if if if 3k if 1E iF iE iE if 9(- iF ik iF 3(-iE k aE iE iF iE iE 1E i(- iE iE IE Ik #F iE if if- k if iE i4 ikiE iE1f it iE k 1E if iE 1E if iE iF iF iE iE iE iE of if 3E iE iE iE if iE 1E if x- iE I N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST ELE 1 MOTOR/POWR APPARATUS 0.0 = 1.0 I4P 3.00 3.00 MEC 1 VENTILATION SYS.NOT UNDER PERMIT,EA. 6.50 6.50 END OF FEES • 01 D494.`OS i—°'ID43b52 p-t:y i" ZS'. `ll t DATE: 10/17it,9 TfiTcp _2:3, CONSTRUCTION AND PLANNING APPROVALS Permit# Date - Inspector POOL _- dPA APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or' -Pole 52. Pool & Equipment Location ' 2.:.Soil Pipe-Undrgrnd. 53. Steel Reinforcement _ . 3.7bectrical ConduiHiiility-Undrgrnd. 54. Forms y 4.s Electrical Conduit-Undrgrnd. 55. Electrical Bonding . .',15. Steel Reinforcement 56. Rough Plumbing & Pressure Test I6.-'ElectricalUFER.Grnd. 57. APPROVAL TO COVER-GUNITE 7.400tings -• _ 58. Electrical Conduit-Undrgrnd. ' 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test r 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. , 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line,& House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 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. - - -APPROVALS: - Permit # - 20':'Rough Factory Fireplace ._ 'r. _ - :� 21 -.Duds, i,Structurer.'70. Underg'rtiund HYilro 22. -Ducts, Ventilating. L �/' -71. Product:Piping ❑Gas 0Oil 23. Gas:Pipe.Rough & Test _ C ,�. �. ''72, Underground Flush - 24..RoofFraming -73.'.Undergrnd.StorageTank0Gas OOil ,74, 25. Rodf Sheathing-%' _ s Overhead Hydro -•- 26.4T -Bar Ceiling (Structural) & Monocoat t - 75.: Dry Chemical ; 27.' Frame and Flashing r 76. Dry Standpipe - _28. Lathing & Sidings _ -,- 77t" FIXED SYSTEM FINAL= - 29. Insulation 7B FIRE PREY. FINAL ='30. Drywall Nailing HEALTH DEPT: REQUIREMENT 31. Plaster Brown Coat FINAL INSPECTION; ' ',32?.Etectrical Power Meter -Final �. 80i FOOD CERTIFICATE ISSUED- _ ,_33=Final Electric Notes: 7 J-' - - _ ('34' ,FirSal Heating & Air Conditioning' 35. Final Gas Pipe -Test: 36.-Ho6d or Canopy r _._ ,37.`Final Factory Fireplace- ,38. FinTal Plumbing r r- ,; +, � __ ••, v x - .,39. Water Service-Final- ervice-Final.40. .40.Gas'Service-Final , - , : i •, - ", - ._ ,. <, X41. Solar Domestic -Final '•42^ Backflow Prepenter_ _ _ 43. Backflowlrrlgatiom i 44. Landscape Irrigation System,..'-"� r -r - , - c -' •2 _ 45.`•Sound Attenuation - x 7 -• r F'`--' 46. Handicap Regulations S c S ; - =, 47: FINAL STRUCTURE & BUILDING^ .%•- < r ,. - 48:;FINALPLANNING I 49 ..Electric Release to'Edison I •'�•- -t 50 -Gas` -Release to Southern Calif67nia Gas Co ' 51. CERTIFICATE OF OCCUPANCY No Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. Vier, �yA CITY OF COSTA ME CONSTRUCTION CONSTRR1U�CITION PERMIT � PERMIT NO. TRACT NO. LOT NO. UNIT NO. Project Address �64 W- isel1 ST -r Applicant's Mailing Address �,(npiA Owner's Name 1�+ /rS!C%i pnnne673-i7 AddressRes 7� 8333 Arch/Eng. License No. Address Contractor's Nam, �Phone X/34 -1695 Address (mailing) " N• ro ftp City License No. oa 95,4 1 LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full rce and effect. '43 F? �� Licens Chats—E—_= � dense Data q %1 Signature �.[�X.Hi.t% WORKERS' OMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -Insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section 0, Lab. �C�.)) 1 I ,,icy No. JD44G /6-135 Company Gs Xw _-1Qe /UAiIUNA� ❑ Certifietl copy is hereby furnished. Cc tifie copy is filed with the city din Di y' ion. Date Applicanl EXEMPT ON FROM O RKERS' COMPENSATION ApLAR N - (This section need not be completed if the permit is foK.9sus hu ed ($100) or lescs). I ertify that in the performance the work for which this permit is issued I an Shall not employ any person in any manner so as to become subject to the WOfk¢ri' Compensation Laws of California. Data Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit t0 construct, alter, improve, demolish Or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt "9refrom and the basis for the alleged exe in ptlon. Any violation of Section t1.5 by any applicant for a permit subjects the applicant to a civil alty of not more than five hundred dollars ($500). I, as owner of the property Or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Buti ne ss and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such Improvements are not intended or offered for Sale. If, however, the building or Improvement is sold within one year Of COm- elation, the owner will have the burden of proving he/She did not build or Im- prove for the purpose of sale). ❑ I'as owner of the property, am exclusively contracting with licensed con- tractors t0 construct the project Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such oro leets with a con- tractor(s) license pursuant tO the Contractor's License Law). I am aware that proof o// their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have teat information is correct. I agree to and slate laws relating to bUildin sentatives of this city to enter Signature PJ.)e " Drivers' License or SS # and state that the above ty and county ordinances o hereby authorize repro- -mentioned nrooertv for 39d[y I L_ PE OF CONSTRUCTION NEW ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. — ALTERATION LJ REPAIR TYPE OF PERMIT L GRADING LJ FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING 4 MECHANICAL ❑ OTHER PROJECT DESCRIPTION SO. FT. OCCUPANCY_ CONSTRUCTION TYPE VALUATIONS ZONE GRADING CU.YDS. ACRES_ Remarks: A.P. 0 S Main Buildi E T Front B Rear A C Right S Left Ping. Ref. # Planning Notes: Accessory Building: Parking Req./Provided Zone 17 N G R E Q M T S. Reinspection Fee 1 $15 0865-46, rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee $ 01 00035949-00035999 TOT 37r17U UFTE: 04/22/69 TIRE: 10:23 ELECTRICAL FEES PLUMBING FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50+KW Bar Sink Showers Backflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps Backflow Irrigation Sewer Cap Dishwasher Meter Dover 100 amps Bathtubs Sewer Connection Dryers ❑Gas ❑Electric Sub Panel Clarifiers Solar Collectors Fan Motors 1:10-1 HP ❑1%-8 Dishwasher Solar Piping F.A.U. c.Solar 119-15 HP 016.15+ Drinking Fountains Solar Tank Fixtures Microwave Floor Drains Sw' ming Pool w/Spa Xt Device Boxes Pole Light Floor Sinks rinal I Outlets Range Gas Service Outlets Water Closet Switches Sign Interceptors Water Heater Garbage Disposal Standing Sections Kitchen Sink - Water Service Generator ❑05 KW ❑5-15 KW Trash Compactor Lavatories -. Auto -Wash P -Trap Laundry Trays - Roof Drains Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Application Issued By A s Dat Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Boiler Duct - Under Ground Hood or Type I ❑ Canopy Type 11 ❑r BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEE $ SMIP $ $ PERMIT $ ISSUANCE $ $ ENERGY P.C, $ $ GRADING $ $ MICROFILM $ 00 $ �7r TOTAL FEE Q . 0 Duct -Structural Refrigeration System Duct-Ventilating3 M0-100,000BTU 0100,000BTU OV Exhaust System El Multiple El System Repair/Alteration firepl/Fact Bit. ICBO=A 4+ Fire Dampers 3 Heating System &Ducting -.Registers XO- 100,000 BTU 1:1100,000 BT �% Op Reinspection Fee 1 $15 0865-46, rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee $ 01 00035949-00035999 TOT 37r17U UFTE: 04/22/69 TIRE: 10:23 .p CONSTRUCTION AND PLANNING ; APPROVALS Permit # Date Inspector POOL 'A APPROVALS Permit # Date Inspector J. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3! Electrical Conduit Utility-Undrgrnd: r 54. Forms 4 -Electrical Conduit-UndFgrnd. t a r 55. Electrical Bonding 5. Steel Reinforcement; 'l 56. Rough Plumbing & Pressure Test 6• Electfical LIFER Grnd.- r - 57. APPROVAL TO COVER-GUNITE 7,> Footings 58. Electrical Conduit-Undrgrnd. ; 8. 'Founiiation 59. Gas Pipe, 0 Undrgrnd., Test % 9.. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. �t 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 ,1= Rough Electric Wiring 67. Fencing & Access Approval - 17 . Rough Wiring Sign 68. APPROVED FOR PLASTERING 18.7 Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20., Rough Factory Fireplace 21. Ducts, in Structure "• 70. Underground Hydro 22. Ducts, Ventilating '`� 71/Product Piping 0Gas 00il , 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas 0 Oil 25. -Roof Sheathing r, 74. Overhead Hydro 26. T -Bar Ceiling (Structural) &,Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 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 �� 1 41. Solar Domestic -Final 42. BackflowPreventeri' 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation r 46. Handicap Regulations f 1 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 ! v. - Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. A -P -qts Zone ,1 Project Address IQ4-(Ws is-rysi C'M Lf� Aio3- P=313 S Main Build ing: Accessory B uilding: - ` �. /n�� Applicant's Mailing Address ((mss E J /-•"'� eOnYR Ca /IY ('A/L�'O < �v �< �,, m_n ¢ Owner's Name s � FF 10¢1 W fBTL/5Y. Cf». (`R_ TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR I CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. D '�( �£ E T Front Z O A Rear , N Address Arch/En . i I f e fw// r �� 00 Arch/Eng. � �P` F � � License No. ,.^ Address If 3e-- ��n IVA-u 11Y4 Lfolf— n�i �l TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL r -I q`TENANT ❑ ELECTRICAL 0 PLUMBING ❑ MECHANICAL LI .OTHER %(%G,E A6� ,r_( (� i �HL Q L. 'P'O DESCRIPTION SD. FT. OCCUPANCY � CONSTRUCTION TYPE VALUATION $ li.P ZONE GRADING CU.VOS.' ACRES ZONE— C Right N K $ Left Cs R Contractor's Name �•S`A • 0. PIEC r✓'/' Phone 213-3-�•AI Address (mailing) �A'6,9V F City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions Of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force an effe t// ^ p O O License Class I b _Llcenn No. 4 / � Date __s is- Signature WORKERS' COMPENSATION DECLARATIONConstruction I hereby affirm that I have a certificate of consent to self -Insure or a certificate " Workers' Compensation Insurance, or a certified copy thereof (SectionCooking 0, Lab. C.) .icy No. 7 f? 215- Company SI /T�£ IF(i/`�%7 {'SOiQ./rLS/5 8 Certified copy I% hereby furnished. �' N'��/s'S/i"�(/O Cettitied co fi ed wrth the city ��gqUtlirt Division. pin Ref. # Parkin Re /Providetl g g Req./Provided E Planning Notes: M T Remarks: 2 _ ELECTRICAL F EES PLUMBING FEES Automatic Washer Transformer ❑ 15.50 KW Pole Sub. ❑ 50+KIN Bar Sink Showers Backflow Preventer Service Sink Unit Meter ❑up to 100 amps Backflow Irrigation Sewer Cap Dishwasher Meter ❑over 00 amps Bathtubs Sewer Connects Dryers ❑Gas ❑Electric Sub Pa Clarifiers Solar COII ors Fan ors❑0.1 HP❑1%-8 Date.. Applicant�A/`- EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be completed if the permit is for One hundred ($100) or less). 1 certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner so as to become subject to the Dishwasher Sola (ping F.A.U. Inc. Solar 09-15 HP 016-15+ Drinking Fountains lar Tank Fixtures Microwave Worker C e sa ion Laws of California, Date-"�� Signature Floor Drains Swimming Pool w/Spa Device Boxes Pole Light ` NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit Shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby work that there is a construction lending agency for the performance of the work for which this permit Is Issued (Section 3097 Civ. CJ Lender's Name Lender's Address Floor Sinks Urinal outlets Range Gas Service Outlet Water Closet , Switches Sign 9 Interceptors Water Heater Garbage Disposal Standing Sections Kitchen Sink Water Service Generator E10-5 KW 115-15 KW Trash Compactor OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish Or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/She is exempt '"vrefrom and the basis for the alleged exemption. Any violation of Section 1.5 by any applicant for a permit subjects the applicant to a civil ally of not more than five hundred dollars ($500). o I, n owner of the property n my employees with wages as their sole compensation, will do the work, and the structure is not intended n actortl for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that Such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year Of com- plellon, the Owner will have the burden Of proving he/she did not build or im- Me for the purpose of sale). I, as owner of the property. am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License law does not apply to an owner of property who builds or improves thereon. and who coot'acts 10, such orolecls with a con- tractor(s) license pursuant to the Contractor's License law). I am aware that to Lavatories Auto -Wash P -Trap Laundry Tra Ys Roof Drains Reinspection Fee $15 Issue Fee $ 3 iiiiiiiiin DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date -7-/1 Building Approved By Data Application Issued By - Dat Reinspection Fee $ $ Pe $15 Issue Fee MECHANICAL FEES Boiler Hood O Type I ❑ Can y Type II Cl Duct - Under Ground)� SUMMARY OF FEES BUILDING PERMIT $ 7, W $MIP $ — PLAN CHECK $ PERMIT PLUMBINGISSUANCE $ $ PLAN CHECK 25% $ ENERGY P.C. $ Duct -Structural efrigeration System Duct - Ventilating 130.100,000 BTU 0100,00OBTU Exhaust System ❑ Multiple System Repair/Alteration proof of their Worker's Compensation insurance should be provided me. ❑ 1 am exempt under Section E. & P. C. for this reason ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ Firepl/Fact. Bit. ICBO dk• Fire Dampers Date Owner I hereby certify that I have read this application and state that the above Information is correct. I agree to comply with an city and county ordinances and State laws relating to building construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned property for Inspection p nos s, . _ Signature 1 Date Drivers' License or SS $ Heating System & D g Registers ❑0700,000 BTU 100,00087 MECHANICAL $ TOTAL FEE $ LAN CHECK 25% $ - 91 00035451-0003545? T".3 _1' ", { CI(Tis obi i5i J7 TIPE 12:02 Reinspection Fee $15 Issue Fee $ 3 0865-46, rev. 5/88 White - Building: Canary - APDlicant; Pink - Accounting; Goldenrod - Assessor P?. i CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL 'A APPROVALS Permit # Date Inspector j. Temporary Electrical Service or Pole 52. Pool & Equipment Location j .,'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 UFERGrnd. 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, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 13- Roof Drains 64. Plumbing System - Final 14J Rough Plumbing 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Fina( r16. Rough Electric Wiring 67. Fencing & Access Approval 177. Rough Wiring Sign 68. APPROVED FOR PLASTERING 48, Rough Electrical -T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 1.0. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure -" 70. Underground Hydro - 22. Ducts, Ventilating X71. Product Piping O Gas 0 Oil 23. Gas Pipe -Rough & Test - % 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas 0,0111' 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) 811 Monocoat 75. Dry Chemical 27. 'Frame and Flashing - i 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation - ". 78. FIRE PREY. FINAL 30. Drywall Nailing %HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat -.y 79. FINAL INSPECTION 32. Electrical Powe -r 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 Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations - 47. FINAL STRUCTURE & BUILDING • 48. Special Requirements Completed ,49. Electric Release to Edison -- ) 50. Gas Reiease to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date City of Costa Mesa Development Services Department Building Safety Division CERTIFICATE OF OCCUPANCY No. O O 2 A 90 P. O. Box 1200 • Costa Mesa, California The Building located at 1041 West 18th Street, unit R has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group B2 Occupancy. Use of Building Industrial - Legal Description 424-421-18,19,20 (See reverse side for Metes and Bounds) E38043,ME38843 Building Permit No R 34585 Electrical Permit No. E38166.P.3471dPlumbing Permit No.p-A4F29•p371A3 Mechanical Permit No. MR 38043 Number of apartments r and/or guest rooms Fira Prev. Permit No. F 36719 ISSUED TO: Barto/Richly 809 Via Lido Soud _Nzwport Beach, cA 92660 Building Official William T. Howard by Date April 18,1989 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307,(e) U.B.C. CMF 1015-46 rev. 1/93 white -Owner; Canary - Numerical File; Pink - Bldg. Permit File Applicant to fill in all'spaces C1TY..rDF-COsTA MESA CONSTRUCTION PERMIT Project Address lU'♦ I In/ )k FT o �l Apptant's Mailing Address ✓I0.//�� Owner's Name M"A17 aux( Levi. Ll %Ze•_.'&Phone 4-71-7767 Address G , L Sod 1. Y SA'rch/Eng. S.'�D�-S' - I- S C0.�1 � eu. License No. •�q ' 'Address 5 4B '� - Contractor's Nam OlteAj_ -" Phone 5'0 Address (mailing) S oci Vlcv City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions. Code, and my license is In full force and effect. , License Class License No. ` t Date Signature WORKERS' COMPENSATION DECLARATION / hereby affirm that I have a certificate of consent to self -Insure or a certificate Workers' Compensation Insurance, or a certified copy-.thereof'(Section ,00, Lab. C.) Policy No. Company 8 Certified copy is hereby furnished. •, Certified copy Is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION''- (This section need not be completed if the permit is for One hun ) or. less). - 'i '• 1 certify that in the performance of the work for which this it is ISI shall not empla any person in any r so as- ecoWs lifeCY o the - '"a k�4 i, C. to n laws of C.h or Cate%f� r_ Signature - s-.•' .. NOT IC f If. "a ler making this dec la ra t' sT,6 u br bee a rALWeCt to the comply with such provisions or this permit shall be �Ieem¢fl revokea. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name. ' Lender's Address OWNER BUILDERDECLARATION I hereby affirm that 'I am exempt from the Contractor's License 'Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior,to Its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's -License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt 'herefrom and the basis for the alleged exemption. Any violation of Section 031.5 by any applicant for a permit Subjects the applicant to a civil enalty Of not more than live hundred dollars ($500). ❑ 1, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for Sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered for Sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or on - prove for the purpose of sale). as owner of the property, am exclusively contracting with licensed con- tractors to construct the project(Section 7044. Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for Such projects with a con- tractor(y license pursuant to the Contractor's License Law). I am aware that proof off their Worker's Compensation insurance should be ded.to me. ❑ 1 am exempt under Section --yam B.AC. for his reason Date 4- ] A - r Jr Owner 1 hereby certify that I have real information is correct. I agree to and state laws relating to buildir sentatives of is cit ent Inspection p Signature Drivers' Li ense or 5 :�, liner and sign all appropriate declarations. OT NO. UNIT NO. 0 8 3 5- S 1 PN3.2- 1 MaP 94& 5! TYPE OF CONSTRUCTION NEW LJ ADD LJ ALTERATION LYREPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION Or WORK/USE OF BLDG. ie •-,1� TYPE OF PERMIT LJ GRADING LJ FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MEC H A,ryyI CAL ElJ77 [� p/_ OTHER s�3R& PROJECT DESCRIPTION SO. FT. y4.fst 1216 y2- OC I,fPANCY' CONSTRUCTION TYPE Cdl"41d.Fe 411+ Sill VALUATION))$ _211*1922^ z 'ZONE W'1-1 OR CU. YDS. ACRES Z.US Remarks: AID /a0i A);WL PC, :1A9, 9016, , 9-7 I -z �-�r l'c,� l03- ti c PLUMBING FEES Bar Sink I Showers Preventer Irrigation Drinking Fountains Floor Drains Transformer ❑ 15-50 KW ❑ 50 + KW Floor Sinks Meter ❑up to 100 amps - Gas Service . Outlets Interceptors Sub Panel Kitchen Sink Motors ❑0-1 HP 01 'A - 8 Lavatories I Inc.Solar ❑9-15 HP ❑16-15+ P -Trap Microwave Roof Drains Pole Light Reinspection Fee 1 $15 Boiler Duct - Under Ground Duct - Structural Duct- Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICED # Heating System & Ducting ❑ 0.100.000 BTU ❑ 100,000 BT' Date 2-L S^QQ Reinspection Fee $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto Wash I Issue Fee Hood or Type ❑ Canopy Type I I ❑ Refrigeration System -00-100,000 BTU ❑ 100,000 System Repair/Alteration Fire Dampers Registers Issue Fee A.P. # 44-f L%_- -4D1I - I S Main Building: - TFront/ -7N ARear 37 C Right . 8 / SLeft a5 i Ping. Ref. # �� -�-/ `+r'a Planning Notes:gOLD F'OR SPECUI ,)_0I Zone `L Accessory Building: Parking Req./Provided ). is Ui$F116'[ NTS 1.tAi1. ELECTRICAL Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps - Dishwasher Meter Clover 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors ❑0-1 HP 01 'A - 8 F.A.U. I Inc.Solar ❑9-15 HP ❑16-15+ Fixtures Microwave Device Boxes Pole Light Outlets Range I Switches ' Sign Garbage Disposal Standing Sections Generator 1:10-5 KW 05.15 KW Trash Compactor FEES Z O N 1 N G R E O M T S $ 3 Reinspection Fee $15 Issue Fee $ 3 FEES DEVELOPMENT SERVICES% Zoning Approved B Building !approved By Application Issued By LJ/•• / Q� Date & CJ Date a- �-8R Dat BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY OF FEES $ 1687,36 $ i;190• .2S $ $ $ $ $ $ SMIP PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM TOTALFEE �.p $ 'y ?` cri $•.� $ $ $ $ $ 3 0100009983-00009985 TGT 2037,.51 'CONSTRUCTION AND PLANNING APPROVALS ' Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1:jTemporary 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 & Pres-sure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings ; .., I, 58. Electrical Conduit-Undrgrnd ' 8. Foundation 59. Gas Pipe, ❑ Undrgrnd., Testl. 9. Water Pipe-Undprnd. 1 r'_ 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 . j. 12. Sewer Cap 63. Heater & Vent-Final - 13. Roof Drains 64. Plumbing System - Final-- inal-14. 14.Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final r 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 c: 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # n. • n '• v' 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro r. ~�I 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test X72. Underground Flush,,. 24. Roof Framing 3. Undergrnd.Storage Tank0Gas 00i 25. Roof Sheathing ! 74. Overhead Hydro i 26. T-Bar Ceiling (Structural( & Monocoat 75. Dry Chemical -' ,• I�' 27. Frame and Flashing �I 76. Dry Standpipe = 28. Lathing & Siding 77. FIXED SYSTEM FINAL ' 29. Insulation 2 78. FIRE PREV. FINAL 30. Drywall Nailing 9 HEALTH DEPT! REQUIREMENT i r♦ 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: TOLD FOR SPECIAL MUM-M-M-S 34. Final Heating & Air Conditioning 1 a . /V ` 35. Final Gas Pipe-Test 36: Hood or Canopy OUB- ,✓ 37. Final Factory Fireplace ro 8g �-C. 38. Final Plumbing 39. Water Service-Final��l �•• W �. 2S%�� X40. GaslService-Final �7 01Z ± ii/. v41. Solar Domestic-Final- - 42. Backflow Preventer i43. Backflow Irrigation 44. Landscape Irrigation System r 45� Sound Attenuation ' 46: Handicap Regulations , 47. FINAL STRUCTURE & BUILDING- 48�,Special•Requirements Completed r 49. Electric Release to Edison jM 50. Gas Release to Southern California Gas Co t 51. CERTIFICATE OF OCCUPANCY No. Date J�- —' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. P MIT NO. TRACT NO. LOT NO. UNIT NO. CITYOFCOSTADME � GCOl U-mulm rERMIT Project Address ' `�« Applicant's Mailing dr ss �PSN� Owner's Name Phone 7 Address / y O pt.c Arch/Eng. License No. Address "7 Contractor's Name L' Phon-4ym „/ Address (mailing) ,--e' C City License No LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 Of the Business and Professions Code/ na my license is in fu{(,jryce and effect. License Date.%/1C Signature _ — WORj(ERSVClYhrPENSATION DFOLAWrION I hereby affirm that I have a certificate of consent to self -insure or a certificate r Workers' Compensation Insurance, or a certified copy thereof (Section lOQLallo. (�b- Polley 4. -t 7 � Company ��•�+� eCertified copy is hereby furnlshed- Cer fi c s ' etl with the cit ng v Ion. Date Applicant..�/rL EXEM TION ROM WORKERS' COMPEPISATION DECLARATION (This section need not be completed if the permit is for One hundred ($100) or less). 1 certify that in the performance of the work for which this perm) is issued, I shall hbt employ any person in any manner ecome s t to the Worker ' Laws of Calif or Date _Signature NOTI : If, er making this declar ion, y hould become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance Of the work for which this permit is issued (Section 3097 :Civ. C.) Under's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Lawfor the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter improve, demolish or repair any structure, prior to Its issuance, also requires tke applicant for such permit to file a signed Statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 031.5 by any applicant for a permit subjects the applicant to a civil entity of not more than five hundred dollars ($500). ❑ 1, as owner Of the property or my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves lher¢on, and who tloes such work hlmsel(/herself or through his or her own ¢m p IOyecs, pro Vitled that S4ei1 impr OVemenLS are nOl Intentletl Or 0lf erect for I If, however, the bu i ltl l he Or, r Improvement is sold _It hfn one year of com- pletion, the owner will have the burden Of proving h¢/she tlid not b4iltl or im- prove for the or of sale). ❑ I, as owner of the property, am ¢xclusiveIy contracting with licensetl con- tractorstd construct the project (Section 7044, Business antl Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, antl who contracts for such Dr OfecIS with a con - "act or(sl ❑cense pursuant In the Contractor's License Law). I am aware that proof off their Worker's Co mpen sat ton Ins oran c¢ shou Id be provided to me. ❑ 1 am exempt Under Section B. & P. C. for this reason Date Ownei I hereby certify that I have ret information is correct. I agree t9y and state laws relati to buyl,Eli sentatives of lhi y to . tei Signot ure rh Oriyers' License or 55 CMF 0665-46, rev. 10/64 r a Pi 3 4 vz 11 PLUMBING FEES TYPE OF CONSTRUCTION EW LJ ADD LJ ALTERATION 0 REPAIR ❑ CONVERSION ❑ DE OLISH ❑ OTHER A.P.# Zone DESCRIPTION OF WORK/USE OF BLDG. S Main Building: Accessory Building: TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL LUMBING ❑ MECHANICAL ❑ OTHER T Front ZO B A Rear N I C Right N PROJECT DESCRIPTION SO. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION$ ZONE GRADING CU. VDS. ACRES g Left G R ping, Ref. # Parking Req./Provided E Remarks: Planning Notes: O M Clarifiers - Solar Collectors T Dishwasher S White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor PLUMBING FEES Bar Sink Showers ELECTRICAL FEES Backflow Preventer Service Sink Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW ❑ 50+ KW Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Cooking Unit Meter ❑up to 100 amps Clarifiers - Solar Collectors Dishwasher Meter Dover 100 amps Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank I Fan Motors ❑0-1HP❑1X-8 Floor Drains Swimming Pool w/Spa F.A,U. Inc. Solar 09-15 HP 016-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets 5 Water Closet Qv Device Boxes ' Pole Light Interceptors Water Heater Outlets` Range Kitchen Sink i Water Service Switches Sign ' j Lavatories Auto -Wash Garbage -Disposal Standing Sections .P—Trap Laundry Trays Generator-❑0-5KIN ❑5-15 KW Trash Compactor ` Hoof Drains • Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ 3 ' MECHANICAL FEES SERVICES REQUIREMENTS: Zoning Approved By Date Building Building Approved By Da Application Issued By Dat Boiler Hood or Typel El Canopy Type II El Duct - Under Ground Duct - Structural Refrigeration System ❑0-100,000 BTU 11100,o0O BTU Duct - Ventilating BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SUMMARY $ $ $ _ �Z:52 $ $ $ $ $ OF FEES SMIP $ PERMIT. ISSUANCE $ ENERGY P.C. $ GRADING $ MICROFILM $ TOTALFEE $ Exhaust System ❑ Multiple ❑ System Repair/Alteration - Firepl/Fact. Bit. ICED # Fire Dampers Heating System & Ducting ❑0-100,000 BTU 0100,00013TI, Registers Reinspection Fee $15 Issue Fee $ 3 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1, -.Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. -1 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 i , I 58. Electrical Conduit-Undrgrnd. 8. Foundation`• 59. Gas Pipe, ❑ Undrgrnd., Test 9. Water PipetUndrgrnd. 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 r ... t. L, 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating 81 Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit# 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas ❑Oil - 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank ❑Gas []Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing I 76. Dry Standpipe k 28. Lathing &Siding 77. FIXED SYSTEM FINAL. i t 29. Insulation 78. FIRE PREY. 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 y /' 37. Final Factory Fireplace ✓ i 38-. Final Plumbing 39. Water Service -Final 40. Gas Service -Final. k f-41. Solar Domestic -Final / r x142. Backflow Preventer %�� 43. Backflow Irrigation t' e 44.x' andscape Irrigation.System i Y ✓ r`-- "� �'" "P 1 'L- ' 45. Sound Attenuation ir'' L � _) ! •},/ " 46. Handicap Regulations 47. FINAL STRUCTURE &BUILDING v 1. n r 48./Special Requirements Completed n •_, ` 1 �1 49. Electric Release to Edison' 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date _ Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA IVIS/A CO U� ION PERMIT Project Address o �e e (— Applicant's Mailing Address z241/h 7 Owner's'Name Phone 3/ Address D //(,-L G u Arch/Eng. License No. Address c[� Contractor's Nam,LSC P-5 e r Phone T Address (mailing) 7 e. .Gfl G /✓InQ City License No. 3 Z S7 LICENSED CONTRACTOR DECLARATION I hereby affirm that 1 am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license s �Iuancl ��License Class Lic oDale L_WORKERS' ATION ' hereby affirm that I have a certificate of consent to self -insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section JOO, Lab. C.) (7� Policy No - Company ertifieed copy Is hereby furnished. p 11€d with the elft' B ild4rfi'tslOn- 1_ Date_j_� APPlicant�— -• EXEMPTION FROM WORKERS' CO PFA ENSATION DECLARATION (This section need not be completed if the permit Is for one hundred ($100) or less). certify that in the performance of the work }yr h this mit iS Issued I shall not em I y ayy person In any man s to be subject to tfle Workers' Ktbn Laws of Calif Dale // Signatur _ NOTICE. If, after making this tlecl Ion, , should become subject to the Workers' Compensation provisions of the Labor Code, You must forthwith comply with such provisions Or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/She is licensed pursuant to the provisions Of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt lerefrom and the basis for the alleged exemption. Any violation of Section 031.5 by any applicant for a permit subjects the applicant to a civil oenalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole Compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a properly who builds or improves' thereon, and who does Such work himself/herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. If, however, the building or Improvement Is Sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- rove for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such oroiacls with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that proof oftheir Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date 1 he info, Drivers' License or SS 1 0865-46, rev. 5/88 Owner a above F37/93 1 . 1 TYPE OF CONSTRUCTION INNEw LJ ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. — ALTERATION L)REPAI TYPE OF PERMIT LJ GRADINGjj��J L/ FOUNDATION L.J STRUCTURAL ❑TENANT ❑ELECTRICAL rL^I.PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SO. FT. OCCUPANCY_ CONSTRUCTION TYPE VALUATION $ ZONE GRADINGCU.YDS. ACRES Remarks: Z Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Water Heater Kitchen Sink Water Service Lavatories Auto -Wash P—Trap Laundry Trays Roof Drains $• A.P. 5W S Main Bu E T Front B Rear A C Right 8 , Left Ping. Ref. # FEES Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas w Electric Fan F.A.U. Fixtures Device Boxes- >^/ Outlets O Switches Garbage Disposal Generator ❑0-5 KW 125-15 Reinspection Fee I $151 I Issue Fee I $ 3 I_, I Reinspection Fee 1 $15 1 1 Issue Fee White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $ 3 Zone Bui ELECTRICAL - Transformer ❑ 15-50 KW ❑ 50+ KIN Meter LJup to 100 amps Meter ❑over 100 amps Sub Panel Motors 130.1 HP ❑1 %- 8 Inc. Solar ❑9-15 HP ❑16-15+ Microwave Pole Light Range Standing Sections Trash Compactor FEES I N G R E Q M T S. Reinspection Fee 1 $15 1 1 Issue Fee 1 $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Boiler Hood or Type 1 ❑ Duct - Under Ground Canopy Type I1 ❑ SUMMARY OF FEES BUILDING PERMIT Duct -Structural Refrigeration System Duct - Ventilating 00.100,000 BTU 0100,000 BTU $ SMIP $ PLAN CHECK Exhaust System ❑ Multiple ❑ System Repair/Alteration $ PERMIT Firepl/Fact. Bit. ICBG 4h Fire Dampers $ 1 J , OU ISSUANCE Heating System & Ducting Registers X0-100,000 BTU 0100,000 BT PLAN CHECK 25% $ ENERGY P.C. Reinspection Fee 1 $15 1 1 Issue Fee White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor $ 3 Zone Bui ELECTRICAL - Transformer ❑ 15-50 KW ❑ 50+ KIN Meter LJup to 100 amps Meter ❑over 100 amps Sub Panel Motors 130.1 HP ❑1 %- 8 Inc. Solar ❑9-15 HP ❑16-15+ Microwave Pole Light Range Standing Sections Trash Compactor FEES I N G R E Q M T S. Reinspection Fee 1 $15 1 1 Issue Fee 1 $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By 0100024471-00024471. T 1�.a0 DATE. 01/17/99 TIME:P' 15:3; SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ 1 J , OU ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $• PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTALFEE $ 13-00 PLAN CHECK 25% $ , 0100024471-00024471. T 1�.a0 DATE. 01/17/99 TIME:P' 15:3; CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POO, SPA 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-Undrgrrid. ? _ 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. Fqotings 58. Electrical Conduit-Undrgrnd. ,8. ,Foundation • .�% 59. Gas Pipe, 0 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 - 1�6- Rough Electric Wiring 4- . .67.• Fencing & Access Approval 1Rough Wiring Sign 68. APPROVED FOR PLASTERING 18 Rough Electrical -T Bar Ceiling' 69. POOL/SPA SYSTEMS FINAL t19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace v. 21. Ducts, in Structure 70. Underground Hydro 22,Ducts, Ventilating 71. Product Piping ❑Gas ❑Oil 23.1 Gas Pipe -Rough & Test 1 72. Underground Flush 24. Roof Framing , Xi `.. i 73. Undergrnd. Storage Tank ❑Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T -Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29_ Insulation 78. FIRE PREV. FINAL ,36 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: _ �9 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing /pl�Q Lief 39. Water Service -Final ' 40. Gas Service -Final 41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation =' 44. Landscape Irrigation System 45. Sound Atkenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison _ - 50. Gas Release to Southern California Gas Co Aj 51. CERTIFICATE OF OCCUPANCY No Date �•'^ Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CIT'OF_cosTAMESA NST PER IT Project Address 1,5-11 Y" Applicant's Mailing Address Owner's Name L � 71 Phone---r!h'S��' Address tf7 K/ t../ 1 4--6 -S.-,Le 101 Arch/Eng. License No. Address Contractor's Nam f`�� ✓ 1 Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 Icommencing with section 7000) Of Division 3 of the Business and Professions Code, and my license is In full force and effect. License Class License No. Date Signature w6RKERS' COMPENSATION DECLARATION 1 hereby affirm that 1 have a Certificate of consent to self -insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section W. Lab. C.) licy No. Company e Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Date— Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed If the permit is for one hundred ($100) or less). I Certify that in the performance of the work for which this ermit is Issued I shall not employ any person m any manner so as eco e s bject to the Workerg C !n t n Laws of Calif . Dale l Signature NOTICE: it, after mak 9 this declaration, you should become subject the Workers' Compensation provisions of the labor Code, you must f with Comply with Such provisions or this Permit shall be deemed ked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section -3097 Civ. C.) Lender's Name Lander's Address OWNER BUILDER DECLARATION Uereby affirm that I am exempt from the Contractor's License Law for the lowing reason (Section .7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the Provisions Of the Contractor's License Law (Chapter 9 (commencing with Section 7000) Of Division 3 of the Business and Professions Code) Or that he/she is exempt -aerefrom and the basis for the alleged exemption. Any violation of Section 31.5 by any applicant for a permit subjects the applicant to a civil salty of not more than five hundred dollars ($500). .J I, as owner of the property Or my employees with wages as their sole compensation, will do the work, and the Structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for Sale. I however, the building or Improvement is sold within one year Of Com- pletiothe owner will have the burden of proving he/she did not build or Im- foWn, r the purpose of sale). as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and who contracts for such oroiects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date - Owner information certify that 1 have read this applicatlon and state th the above information is Correct. I agree to comply with all city and county ordinances and state laws relating to buil "ng Construction, and hereby authorize repre- sentatives of t city t e r up a above-mentioned property for Inspection pur Signature Date Drivers' License or SS „ �' � 3$ 16 , I I TYPE OF CONSTRUCTION NEw ADo ❑ CONVERSION ❑ DEMOLISH ❑ OTHER _DESCR IP510N OF WORK/USE OF -13 LDG. — ALTERATION TYPE OF PERMIT LJ GRADING LI FOUNDATION LJ STRUCTUI ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SQ. FT, OCCUPANCY CONSTRUCTION TYPE VALUATIONS— ZONE— ALUATION$_ZONE GRADINGCU.YDS. ACRES_ Remarks: 72 T 4L,< ---Q C7— Sink Preventer Irrigation king Fountains Ir Drains u Sinks Service Kitchen Sink Lavatories P -Trap Roof Drains Reinspection Fee Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool W/Spa Urinal Outlets Water Closet Water Heater Water Service Auto -Wash Laundry Trays $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO * Heating System & Ducting C3 0-100,000 BTU 0 100,000 Reinspection Fee I $15 0865-46, rev. 5/88 White - Building; Canary - APPlicant; Pink - Accounting; Goldenrod - Assessor Issue Fee Hood or 7ype1 ❑ Cangoy Type 11 ❑ 3efrigeration System 110-100,00OBTU 1-1100,000 System Repair/Alteration Fire Dampers Registers Issue Fee FEES A.P. sW S Main Building: E T Front B Rear A C Right K Left Ping. Ref. 'Ik Planning Notes: Automatic Washer Construction Pole Cooking Unit Dishwasher Dryers ❑Gas ❑ Fan F.A.U. Fixtures Device Boxes Outlets Zone Accessory Building: ELECTRICAL Transformer ❑ 15-50 KW ub. ❑ 50+ KIN �— Meter ❑up to 100 amps -Meter Elmer 100 amps lectric Sub Panel Motors ❑O-1 HP 01 %- 8 Inc. Solar 119.15 HP ❑16-15+ Microwave Pale Light Range —1 1 1 Sign Garbage Disposal I I Standing Sections Generator 00.5 KW 05-15 KW I I Trash Compactor Reinspection be 1 $15 1 1 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By FEES Building Approved By Application Issued By $ 3 T N G R E O M T S. FEES 01 00030639-00030689 TOT 97.0 DATE: 04./17/89 TIrE: 13:26 SUMMARY OF FEES v BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ . ENERGY P.C. $ ELECTRICAL $ Oa GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTALFEE $ . 7- 9 PLAN CHECK 25% $ 01 00030639-00030689 TOT 97.0 DATE: 04./17/89 TIrE: 13:26 CONSTRUCTION AND PLANNING _- Date 'APPROVALS Permit;* Ins POOL 'A APPROVALS APPROVALS Permit# Date Inspector •1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3, Electrical Conduit Utility-Undrgrnd. 54. Forms 4: Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5.' Steel, Reinforcement 56. Rough Plumbing & Pressure Test -' 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 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. SevJer Cap 63. Heater & Vent-Final 13. Roof Drains j 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 1,7 Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough.Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20: Rough'Factory Fireplace 21. Ducts, in Structure ! 70. Underground Hydro 22. Ducts, Ventilating 7 711. Product Piping 0Gas []Oil ' 23. Gas Pipe'-Rough & Test 72. Underground Flush 24. Roof Framing �•� 73. Undergrnd. Storage Tank ❑Gas ❑Oil 25. Roof Sheathing" 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27.,,Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE PREV. FINAL 30:-Drywall Nailing HEALTH DEPT. REQUIREMENT 3.1. Plaster Brown Coat . FINAL INSPECTION 32. Electrical Power Meter-Final FOOD CERTIFICATE ISSUED '33. Final Electric Not 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 Domestic-Final 42. Backf low Preventer 43. Backflow Irrigation -- 44. Landscape Irrigation System 45. Sound Attenuation -� 46. Handicap Regulations ' 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date �v• h ,v _ ' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA COST UUcTIMPERMIT Project Address '� / ��Y. X vas r.�7N at hl s - Applicant's Mailing ddress 0 Owner's Name hone Address UffY um 56VI/ Arch/Eng. License No. Address' Contractor's Namhone _ Address (mailing) q kQ& City License No. 6 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force nq effect. Licen Class icense No.qU✓--1 !; 9 Dalc&(51g 4 ®7 WORKERS' COMPENSATION DE ATION I hereby affirm that I have a certificate of consent to self -Insure ora certificate ,f Workers' Compensation Insurance, or a certified copy thereof (Section 600, Lab. C.) �„ s �"� icy No. 7/-`(P)'itlrryt/"Af/_ Company �A'� certified copy is hereby furnished. `Car co s filed with the city Buil vi i Date Applicant V% EX EM ION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed If the permit Is for one hundred ($100) or ass). I certify that in the performance of the work for which this permit is Issued I shall not employ any person in any manner so as to become subject to tke Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration. you should become subject to the Workers' Compensation provisions Of the Labor Code, you must forthwith comply with such provisions Or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance o1 the work for which this permit is. issued (Section 3097 Civ. C.) Lender's Name Lender's Address - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit t0 construct, alter, improve, demolish or repair ..,., .e........a n Jnr to Its leuunce- msn reouires the applicant for such Permit Division 3 of the Business and Professions copal or mat ne/sne i- exullivi. therefrom and the basis for the alleged exemption. Any violation of Section '031.5 by any applicant for a permit subjects the applicant to a civil ienalty of not more than five hundred dollars ($500). ❑ I,'as owner of the property or my employees with wages -as their sole compensation, will do the work, and the structure is not intentletl' or otferetl for sale, (Section 7044, Business and Professional Code: The Contractor's License Law does not apply t0 an owner of a property who bullds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im- prove for the purpose of sale). .I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the pr Oject (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of .property who builds or improves thereon, and who contracts fOr-shCti oroleCts with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date Ownel I hereby certify that a oa Int OrmdII00 is correct. ag a t0 and state laws re 9 ui Id i, sentatives Of t a y' t Inspection our os Signature Drivers' Licen # 1 this application and state that the above complywith all city and county ordinances g construction, and hereby authorize fre- upon the above-mentioned . rop or -- Date_ L— h�73 11 TYPE OF CONSTRUCTION 16NEw LJ ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. — ALTERATION LJ REPAIR TYPE Or OF PERMIT GRADING ❑ FOUNDATION ❑ STRUCTURAL ❑ TENANT](_J ELECTRICAL ❑ PLUMBING ID MECHANICAL C3 -OTHER '\ PROJECT DESCRIPTION SO. FT. OCCUPANCY- -.51 RUCTION TYPE VALUATION $ ZONE GRADING CU.YDS. ACRES_ Remarks: t f7 Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW ❑50+KW Cooking Unit Meter Qup to 10 Dishwasher id Meter 1$over 100 amps PLUMBING FEES Bar Sink Showers F.A.U. Backflow Preventer Service Sink Microwave Backflow Irrigation Sewer Cap ' Bathtubs Sewer Connection - . Clarifiers Solar Collectors ' Dishwasher: Solar Piping $ Drinking Fountains Solar Tank ' floor Drains Sw imming Pool w/Spa r Floor Sinks Urinal Gas Service Outlets Water Closet Interceptors Water Heater Kitchen Sink - - Water Service . 1 Lavatories - Auto -Wash P—Trap Laundry Trays Roof Drains r. Reinspection -Fee $15 1 Issue Fee $ 3 MECHANICAL - FEES Boiler Duct - Under Ground Duct - Structural Duct . Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBG # Heating System & Ducting 00-100,000 BTU 0100,000 Reinspection Fee 1 $15 0865-46, rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type ❑ Canopy Type II ❑ Refrigeration System 00.100,000BTu ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee 1 $ 3 A.P. # Zone S Main Building: Accessory Building: E T Front ARear C Right SLeft Ping. Ref. # Parking Req./Provided Planning Notes: ELECTRICAL Automatic Washer Construction Pole Sub. Transformer ❑ 15.50 KW ❑50+KW Cooking Unit Meter Qup to 10 Dishwasher id Meter 1$over 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan Motors 1:10-1 HP 01 h - 8 F.A.U. Inc. Solar 09-15 HP 016-15+ Fixtures Microwave Device Boxes Pole Light ' Outlets Range Switches Sign Garbage Disposal Standing Sections Generator 00-5 KW 05.15 KW Trash Compactor Reinspection Fee 1 $15 1 1 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By O N I N G R E Q M T S. FEES 01 00010913-00010913 . TO T 235.15 DATE: 08/01/88 TIME: 15:29 SUMMARY OF FEES BUILDING PERMIT' $ ;SMIP PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE PLAN CHECK 25% $ ENERGY P.C. ELECTRICAL $ GRADING PLAN CHECK 50% $ MICROFILM MECHANICAL $ TOTAL FEE PLAN CHECK 25% $ O N I N G R E Q M T S. FEES 01 00010913-00010913 . TO T 235.15 DATE: 08/01/88 TIME: 15:29 f CONSTRUCTION AND PLANNING .Cl ' APPROVALS Permit # Date -o' Inspector POOL,. ,,PA APPROVALS Permit # - Date Inspector 1 -Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pip�-Undrgrnd. I �} •,r 53. Steel Reinforcement 3:;Elect1r'i6l Coniluit,Utility-Undrgrnd. 54. Forms , 4..Electriical Conduit-,Undrgrnd. ' •' 55. Electrical Bonding 5. Steel Reinforcernent, ; 56. Rough Plumbing &Pressure Test ' . 6..Electri,3lLIFER &d. 57. APPROVAL TO COVER-GUNITE :7.1Footings r 58. Electrical Conduit-Undrgrnd. :8. Foundation 4; .' 59. Gas Pipe, 0 Undrgrnd., Test ' ,9. Water Pipe-Undrgrnd. /' � 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor $Yslem t • 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection' '-' 62. Backwash &Receptor -Final 12. ISewe� Cap l 63. Heater & Vent -Final 13. •Roof;Drains ;,' ,r 64. Plumbing System - Final 14: Rdugh Plumbipg 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final - - 16 i . Rough Electric Wiring 67. Fencing & Access Approval 1,7. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical -T Bar Ceilin6 69. POOL/SPA SYSTEMS FINAL 19'. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # -20: Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22 Ducts, Ventilating 71. Product Piping 0Gas ElOil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas OOil 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 PREY. 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 3 Notes:4 89 ��/./- 34. Final Heating & Air Conditioning %I �;' '•� 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 Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date F.• •• __ r_t ;,-� t Applicant to fill in a111spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTAE Ik,EM-COIma 1 CTION PERMIT PERMIT NO. TRACT NO. LOT NO. UNIT NO. Project Address (L / 5'r Applicant's Mailing Address • 11//0 d Owner's Name Pho "f' ?3; Address Arch/Eng. License No. Address �^1',�/�' Contractor's Nam C�—�—�— Phone &_34-1110,95 Address (mailing City License No. 6;Z C;541 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Cotle, and my license is in I fospe and effect. Z+ Licen4l) F -/.CJ P ,a .43832 Date {� /� c gnat r WORKS S COMPENSATION DEC LARATION `" V 1 hereby affirm that I have a certificate of Consent to self -Insure or a certificate Workers' Compensation Insurance, or a certified copy thereof (Section )0, Lab..) �s licy No. �r IQ23 ; Company Wy,.sdVfi d copy is hereby furnished. tS—c "f etl filed with the city B�- in Dlviyipn, ii Date Applicant.; EXEMPTION FROM WORKERS' COMPENSATION DEC ARA N (This section need not be completed if the permit Is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Signature NOTICE: If, after making this declaration, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Comply with such provisions or this permit- shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt '�erefrom and the basis for the alleged exemption. Any violation of Section 31.5 by any applicant for a permit subjects the applicant to a civil salty of not more than five hundred dollars ($500). L) I, as owner of the property or my employees with wages as their sole .Compensation, will do the work, and the structure Is not Intended or offered for sale (Section 7044, Business and Professional Code; The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who tloes such work himself/herself or through his or her own employees, provided that such Improvements are not Intended or offered for sale. If, however, the building or Improvement Is sold within one year of Com- pletion, the owner will have the burden of proving he/she did not build or im- prove efor the purpose of sale). ❑ I, as. owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who build$ or improves thereon. and who.contracts for such projects with a Con- tractor(sl license pursuant to the Contractor's License Law). I am aware that proof o their Worker's Compensation Insurance should be provided to me. ❑ I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have rea information is correct. I agree to and state laws relating to buildir sentatives of this �7ly tc e�r inspection purpos$�(_ �_ /y, Signature (/�jeiC� Drivers' License or SS # ] this application and state that the above comply with all city and county ordinances ig construction, and hereby authorize repfe- upo the above-mentioned p p rty for Date 9 E'3g0�3 TYPE OF CONSTRUCTION LJ NEW ADD LJ ALTERATION LJ REPAIR 1:1 CONVERSION 1:1DEMOLISH OTHER DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Date DESCRIPTION OF WORK/USE OF BLDG. FEES Bathtubs Sewer Connection TYPE OF PERMIT ❑ GRADING El FOUNDATIQIy STRUCTURAL El TENANT 1:1 ELECTRICAL El PLUMBING fcA-y MECHANICAL ❑ OTHER Drinking Fountains Solar Tank PROJECT DESCRIPTION SQ. FT. OCCUPANCY CONSTRUCTION TYPE VALUATION $ ZONE GRADING CU.YDS. ACRES nn Remarks: 1� - F7 Bar Sink Showers Reinspection Fee Backflow Preventer Service Sink DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Date Backflow Irrigation Sewer Cap FEES Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Solar Piping Drinking Fountains Solar Tank _ Floor Drains Swimming Pool w/Spa Floor Sinks Urinal Gas Service Outlets Water Closet - Interceptors Water Heater Kitchen Sink Water Service ' Lavatories Auto -Wash P -Trap Laundry Trays - Roof Drains Reinspection Fee I $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting [1&100,000 BTU ❑ 100,000 Reinspection Fee 1 $15 0865-46, rev. 5/68 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System 00-100,000BTU 0100,000 System Repair/Alteration Fire Dampers Issue Fee A.P. # S Main Building: E T Front ARear C Right 8 Left Ping. Ref. # Planning Notes: Accessory Building: Parking Req./Provided ELECTRICAL Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ❑ 50 + KW Cooking Unit Meter ❑up to 100 amps Dishwasher Meter ❑over 100 amps Dryers ❑Gas ❑Electric Sub Panel Fan W Motors E10-1 HP ❑1X-8 F.A.U. ^h7 Inc. Solar 09-15 HP 016-15+ Fixtures Microwave Device Boxes Pole Light Outlets Range ' Switches Sign Garbage Disposal Standing Sections Generator ❑0-5 KW 1:15-15 KW Trash Compactor Zone FEES .T N G R E Q M T S. $ 3 01 00029759-00029759 TOT 30.00 DATE: 04/03/39 TIME: 14:20 Reinspection Fee $15 Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Date $ 3 FEES SUMMARY OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ PLAN CHECK 25% $ _ $ 3 01 00029759-00029759 TOT 30.00 DATE: 04/03/39 TIME: 14:20 - CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL `A APPROVALS Permit # Date Inspector 1.r Temporary Electrical Service or Pole, 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. ;'� ' �'Y'i 53. Steel Reinforcement . 37EIectrical Conduii Utility-Undrgrnd` ' r� 54. Forms !' 4 -.Electrical Conduit-Undrgrnd. ^ 55. Electrical Bonding l C'Steel Reinforcement �': 56. Rough Plumbing & Pressure Test 6. Electrical UFER;Grrid r 57. APPROVAL TO COVER-GUNITE 'I 7•.� Footings 1 • ' ,• 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 t -i62: Backwash &Receptor -Final 12. SeWTr Cap ' ' • • r' 63. Heater & Vent -Final ' 13. Roof Drains - =i 64. Plumbing System - Final •t 14. Rou -h Plumbin t .9 9t 'i ;1f 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure ., 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas OOil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas OOil _. 25.'R6of 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 FOOD CERTIFICATE ISSUED 33. Final Electric 34. Final Heating & Air Conditioning :U 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 Domestic -Final 42. Backflow Preventer i 43. Backflow Irrigation 44. Landscape Irrigation System �� r 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison - 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date EI CITY OF COSTA A CRgUHICNPERMIT - Project Address Applicant's Mailing Address '7 3 V .5 0 J a-W,5ii-IJ A s/t' Owner's Name PZ I G A4 L T -b Phone Address O Y / �' 0 7-A1 ArchlEng. License No. Address op I(-�— Contractor's Name F—A L Lo rt� �Phone9� WZE T OJIf.n ✓ t- Address lmailing) 22, City License No. S 10 5 LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Cotle, and my license is in full force and a fect. License Class License No -Sr--/ 73Y Date_jZ--`*— Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent t0 wif4nsure or a certificate of Workers' Compensation Insurance, or a certified copy thereof (Section 3800, Lab. C) Policy NO. /D 2'a omaany %19 7z'' r✓� Certified copy is hereby furnished. t 'ng Dlvi Sion. B Certified cp 5 tilesypsith the city i Date / C Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection need not be Completed if the permit Is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws Of California. Date Signature NOTICE: If, after making this declaration, You should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the Performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any Structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/She Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil enalty of not more than five hundred dollars ($500). I, as owner of the property or my employees with wages as their sole compensation,, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/tuoSeil Or through his or her own employees, provided that such improvements are not intended or offered for mle.flf, however, the building or Improvement is sold within One Year o1 com- pletion, the owner will have the burden Of Proving he/she did not build or im- rove for the purpose of sale). 1, as owner of the property, am exclusively Contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code; The Contractor's License Law does not apply to an owner of properly who builds or improves thereon. and who contracts for such oroiects with a Con- lractor(s) bceose pursuant to the Contractor's License Law). I am aware that proof of theif Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. _ TRACT NO. LOT NO. UNIT W. Date Owner I hereby certify that I have read this application and state that the above Information is correct. I agree to comply with all city and county ordinances and slate laws relating tobuilding construction, and hereby authorize repre- sentatives of this city to enter upon the above-mentioned Property for Inspection purposes..' oC Signature Date Drivers' License or SS TYPE OF CONSTRUCTION U NEW LJ ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. ALTERATION Lj REPAIR TYPE OF PERMIT LI GRADING LJ FOUNDATION L1 STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SO. FT. OCCUPAN CONSTRUCTION TYPE VALUATION $ ZONE GRADINGCU.YDS. ACRE5_ Remarks: P -AQm • S II 111figy Bar Sink Showers Backflow Preventer Backflow Irrigation Service Sink Sewer Cap Bathtubs Sewer Connection Clarifiers Solar Collectors Dishwasher Drinking Fountains Floor Drains Soler Piping Solar Tank Swimming Pool w/Spa Floor Sinks Gas Service Outlets Urinal Water Closet Interceptors Water Heater Kitchen Sink Water Service Lavatories Auto -Wash Roof Drains Reinspection Fee 1 $15 1 1 Issue Fee 1 $ 3 1 1 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact Bit. ICBO 4, Heating System & Ducting 110-100,000 BTU 11100,000 Rainspection Fee I $15 Hood or Type ❑ Canopy Type 11 ❑ Refrigeration System ❑0-100,000BTU 0100,000 System Repair/Alteration Fire Dampers Registers Issue Fee 1 $ 3 A.P. + S FFn Build, E T t B A Ct Accessory S I Left Ping. Ref. # Parking Req./Provided Plannino Notes: Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Garbage Disposal Generator 005 KW 05-15 Zone ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+ KW Meter ❑up to 100 amps Meter Clover 100 amps Sub Panel Motors 00-1 HP Ell h-8 Inc. Solar 09-15 HP 1116-15+ Microwave Pole Light Range Standing Sections Trash Compactor FEES 71 N G R E Q M T S. Reinspection Fee 1 $15 1 1 Issue Fee 1 $ 3 1 1 DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By — �-• SUMMARY EES � BUILDING PERMIT $ — SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE .$ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ to PLAN CHECK 25% $ CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit =f- Date Inspector 1. Temporary Electrical Service or Pole 1 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 LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. B. Fo4rldation - 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Flo& 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 APPROVALS Permit # 20...Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil •23. Gas Pipe -Rough & Test 72. Underground Flush (p (� 24. Roof Framing 73. Undergrnd. Storage Tank OGas 00il 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. REQ I 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 Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas GD , 51. CERTIFICATE OF OCCUPANCY Jo. Date CITY OF CO: MESA BUILDING SAFE -1 i DIVISION POST IN CONSPICUOUS PLACE ON THE JOB NOTICE You must furnish PERMIT NUMBER and the JOB ADDRESS FOR EACH RESPECTIVE INSPECTION. CALL 754-5627. APPROVED PLANS SHALL BE ON JOB AT ALL TIMES. _ 3 32. ElectricL .ver Meter -Final 33. Final Electric 34. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy ' 37. Final Factory Fireplace 38. Final Plumbing A. P. NO.q ¢Z¢^ �f-ZJ-�� /// 2-67'�- DATE ISSUED .0.1?39. Water Service -Final / TYPEGROUP 'V A. L PERMIT N g 3 �51� S 40. Gas Service•Final 41. Solar Domestic -Final BUILDING ADDRESS 104-1 / u y 42. Backflow Preventer �/ Q TRACT FAI 32 -Z0.1 LOT / Zr 3 BLOCK 43. Backflow Irrigation l��r NEW ADD ALTER REPAIR MOVING DEMOLISH 44 Landscape Irrigation System 45. Sound Attenuation OWNER Af fi, 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING USE /'0 DUS r%L/-t-C /' W14,9/A % 48. Special Requirements Completed _?C IJ� 3L� POOL &SPA APPROVALS Permit 46 - f - 37 / � 3 G.S SETBACKS Front Yd. Side Yd. L R Rear Front Side Yd. L R Rear 49. Pool & Equipment Location 50. Steel Reinforcement CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector 51. Forms 52. Electrical Bonding 1. Temporary Electrical Service or Pole 53. Rough Plumbing & Pressure Test 2. SoilPipe-Undrgrnd. 54. APPROVAL TO COVER-GUNITE 3. Electrical Conduit Utility-Undrgrnd, 55. Electrical Conduit-Undrgrnd. 4. Electrical Conduit-Undrgrnd. 56. Gas Pipe, ❑ Undrgrnd., Test 5. Steel Reinforcement .-,....__-._...- .p 57. Backwash Lines, P -Trap, O Undrgrnd. 6. Electrical UFER Grhdf•''j 2 58. APPROVAL TO DECK 7. Footings •'- g r/ 59. Backwash & Receptor -Final 8. Foundation I G/`/ 60. Heater &Vent -Final 9. Water Pipe-Undrgri(Id.'C-'J I 61. Plumbing System - Final 10. Structural Floor SystefW.,, <1 : :. j! A,- 62. Electrical -Final 11. Property Sewer Lini &-Nouse C6nnection1/ / �f 63. Solar System -Final 12. Sewer Cap I 64. Fencing & Access Approval 13. Roof Drains 65. APPROVED FOR PLASTERING 14. Rough Plumbing j2 W 4-j2 66. POOL/SPA SYSTEMS FINAL 15. Rough Electrical -Conduit FIRE DEPT. REQUIREMENT APPROVALS Permit +a -7Z':2___ 16. Rough Electric Wiring 3 17. Rough Wiring Sign 67. Underground Hydro _ 18. Rough Electrical -T Bar Ceiling 68. Product Piping ❑ Gas ❑ Oil 19. Rough Heating & Air Conditioning 69. Underground Flush 20. Rough Factory Fireplace 70. Undergrnd. Storage Tank O Gas C Oil 21. Ducts, in Structure 71. Overhead Hydro 22. Ducts, Ventilating 72. Dry Chemical 23. Gas Pipe -Rough & Test 73. Dry Standpipe 24. Roof Framing /p GN 74. FIXED SYSTEM FINAL 25. Roof Sheathing o GAJ• 75. FIRE PREV. FINAL l 26. T -Bar Ceiling(Structur Mono at Y oL--...7 3 zo d% Notes, Q I I' ) di (. in77- :22 i 27. Frame and Flashing SL C+ 28. Lathing & Siding �S r 29. Insulation /L �J Ta <JR ut. 30. Drywall Nailing ':�OL f)0q-r_ 31. Plaster Brown Coat fsee reverse for additional notes) CMF 0559-46, rev. 12/82 Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations CITY OF -COSTA MESA CONSTRUCTION PERMIT PEQq1y1 ITN — 720 TRACT NO. 19t- TyNO. l/ Zf3 UNIT - A P 0 ItaL-4 - ai - 9 Zone Project Address b' -f 1 Irl/ I frf-A -- -- Applicant's Mailin Address TOLD �� i 4f �S�L ~ yZ Owner's Name t✓�--�-�trr Phone �Sr'tii2 Address tG�(f L� kTOL&s G..��"i- rJ ! "-' S Main Building: Accessory Building: TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER p CR IPTIOff��..QqF��WORK/US OF2g��DG. Lal �`E /U N6' !aJ G T Fran[ U B A Rear N Arch/Eng. License No. Address TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ ,OTHER PROJECT DESCRIPTION W. FT. OCCUPANCYs/O CONSTRUCTION TYPE VALUATION$ / ZONE GRAOINGCU.YOS. ACRES C Right N K $ Left G R Contractor's Nam Phone Address (mailing) 9 City License No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing With section 70001 of Division 3 Of the Business and Professions Code, and MY license is in full force and effect.�7 License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -Insure or a certificate r' 'Yorkers' Compensation Insurance, or a certified copy thereof (Section Lab. C.) -..:y No. Company eCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Ping. Ref. # Parking Req./Provided E Plannin Notes: aK 1 g M �nsv LJ1v T S. Remarks:�-+ L. ELECTRICAL FEES PLUMBING FEES AutorPatic Washer Transformer El 15-50 KW Construction Pole Sub. El 50 + KW Bar Sink Showers Backflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps Backflow Irrigation Sewer Cap Dishwasher Meter Dover 100 amps Bathtubs Sewer Connection Dryers ❑Gas ❑Electric Sub Panel - Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers Solar Collectors FanMotors❑61 HIS ❑1'h -8 Dishwasher Solar Piping F.A.U. Inc. Solar ❑9-75 HP ❑ 1 15+ 6- (This Section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this permit is Issued i shall not employ any person in any manner so as to beco a subject to the WorkCr C pe tion Laws, CalifOr�fy , Date . - Signature ` Drinking Fountains Solar Tank Fixtures Microwave Floor Drains Swimming Pool w/Spa Device Boxes Pole Light NOTICE: 11, after making this declaration, you should becorrig subject to the Workers' Compensation provisions of the labor Cotle, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance Lf the of the work for wnlL t1ys_ ermil I I�s��p ($p�tlgn 7 Civ. C.) Name L/�E� i T ��+1 n Lender's Address 7777 - — ✓�'.. f.3. Floor Sinks Urinal Outlets Range Gas Service Outlets Water Closet ^ Switches Sign Interteptor5 Water Heater - Garbage Disposal Standing Sections Kitchen Sink Water Service Generator ❑0.5 KW ❑5-15 KW Trash Compactor OWNER BUILDER DECLARATION I- I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any Structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of Ina Contractor's License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt l^r^,from and the basis for the alleged exemption. Any vi Olation Of Section '•� 5 by any applicant for a permit subjects the applicant to a civil ^,_Sty of not more than five hundred dollars ($500). •l'�i"i, as owner of the property or. my employees with wages as their sole compensation, will do the work, and the structure is not Intended or offered for Sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property "a builds or Improves thereon, and who does such work himself/herself or through his or her own employees, provided that such Improvements are not Intended or offeretl for sale. If, however, the building or Improvement IS Sold within one year of com- pie n, the owner will have the burden of proving he/she did not build or im- r ve for the purpose of sale). 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the protect (Section 7044, Business and Professions Code:PERMIT The Contractor's License Law does not apply to an owner of.p,.perty wno builds or Improves thereon. ane who contracts for such protects With a con- tractor(S license pursuant to the Contractor's License Law). I am aware that proof o their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Lavatories Auto -Wash P—Trap Laundry Trays Roof Drains - - - Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: � , LM�� I Zoning Approved By Oat= Building Approved By Dat= Application Issued By Dat $9 7 Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Boller Hood O! Type I ❑ yP Canopy Type I I ❑ Duct - Under Ground rs BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL r, PLAN CHECK 50% MECHANICALTOTAL PLAN CHECK 25% SU7, Y OF FEES $ 0 O SMTP $ / gy $ -40 $ ISSUANCE $ $ ENERGY P.C. $ S GRADING $ $ MICROFILM $ FEE $ 2r39.LIz no $ Duct - Structural Refrigeration System Duct- Ventilating ❑0.f00,0008TU ❑100,000 BTU Exhaust System ❑ Multiple ❑ System Repair/Alteration Firepl/Fact. Bit. ICBO */k Fire Dampers Date - — _ Owner certify that I have read this application and stale that the above information Is correct. 1 agree to comply with all city and county ordinances :.formation and state laws relating to building constru ion and hereby authorize repre- sentatives of this city to enter on t ove-mentioned property for Inspection purp _ Signature Date Drivers' License or SS 3° Heating System & Ducting 110-100,00000,000 BTU ❑100,0008 Registers 01 00027785-00027787 TOT DATE! 03/07/89 TETE: 13:07, 239.45 Reinspection Fee $15 Issue Fee $ 3 0865-46, rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor t. CONSTRUCTION AND PLANNING ' APPROVALS Permit # Date i Ins pector POOL " nPA ; APPROVALS Pen.,,t# Date ' Inspector 411. Temporary Electrical Service or Pole L 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 �R 59. Gas Pipe, 0 Undrgrnd., Test ' 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection , 62. Backwash &Receptor -Final 12. Sewer Cap - 63. Heater & Vent -Final 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 i 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 Conditioding FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough -Factory Fireplace ; 21. Ducts, in Structures r 70. Underground Hydro 22. ,Ducts, a/entilating 71. Product Piping 0 Gas 0 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. DrywalbNailing - 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 Domestic -Final , 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound- Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 04 48. Special Requirements Completed 49. Electric Release to Edison ' 1 50. Gas Release to Southern California Gas Co - 51. CERTIFICATE OF OCCUPANCY No Date• Applicant to fill In all spaces except those within heavy border lines and sign all appropriate declarations. CITYOF COSTA MESA CONSTRUChTION PERMIT PERMIT NO. _ TRACT NO. LOT NO. UNIT NO. Project Address GG Applicant'sAAailina Addres OU9 Vlo� �. 6jp SOv Owpe'r's Name '-�'�" d /x Ic, leS(Phone C71-"7747 Address VtL Lr�( Sb..ri Arch/Eng. License No. Address Contractor'sName U Phone Address (mailing) r City License No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -Insure or a certificate Workers' Compensation Insurance, or a Certified copy thereof (Section 00, Lab. C.) rolicy No. Company ' ® Certified copy is hereby furnished. Certified copy is filed with the City Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be Completed if the permit is for one hundred ($100) or less). certify that in the performance of the work for which thisyyerm it is issued, 1 shall not employ any person in any anner so s t ecbn s ject to the Work¢ pe anon Laws of Cal' Dat�his decl NO ICE: If, atter making this tleclara[ion, you should become su c to the Workers' Compensation provisions of the Labor Code, you mus forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit 10 file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she isexempt ",erefrom and the basis for the alleged exemption. Any violation of Section 31.5 by any applicant for a permit subjects the applicant to a civll Cof not more than five hundred dollars ($500). 1, as owner of the property or my employees with wages as their sole pensation, will do the work, and the structure is not Intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work himself/herself or through his or her own employees, provided that such Improvements are not intended or offered for sale. It, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im. Fva for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con. tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who Contracts for such projects with a can. traclor(s1 license pursuant to the Contractor's License Law). I am aware that proof off their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section S. & P. C. for this reason Date Owner 13 I hereby certify that I have read this applicatlor information is Correct. I agree to comply with all and state laws relating to building construction, a sentatives of 3134 city tp e)rt)r upgp.tjie abov 8459 4/1 1/80 E �52 l03 TYPE OF CONSTRUCTION LJNEw ADD LJ ALTERATION 7REIAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P-.A6 Zone DESCR I PT ION OF WORK/USE OF BLDG.WjI!4-b Ott (,&/�/. $ Main Building: Accessory Building:' E TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front ❑ TENANT ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJECT DESCRIPTION. SQ.FT. OCCUPANCY— C Right K CONSTRUCTION TYPE VALUATIONS S Left ZONE GRADING CU.YDS. ACRE$ Ping. Ref. # Parking Req./Provided Remarks: 1 Planning Notes: 30oOF TL Z O N I N G R E Q M T S Bar Sink Showers ELECTRICAL FEES ' Backflow Preventer Service Sink - Automatic Washer Transformer ❑ 15-50 KW ❑ 50+KW Construction Pole Sub. Backflow Irrigation Sewer Cap SUMMARY OF FEES BUILDING PERMIT $ -SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ 30.00 GRADING $ PLAN CHECK 50% $ MICROFILM S MECHANICAL $ TOTAL FEE $ 30.e -.:Ig._ PLAN CHECK 25% $ Bathtubs Sewer Connection Cooking Unit Pb Wig Meter L1 up to 100 amps Clarifiers Solar Collectors Dishwasher Meter ❑over 100 amps Dishwasher Solar Piping Dryers ❑Gas []Electric Sub Panel Drinking Fountains Solar Tank $ 3 Fan Motors 1:10-1 HP❑1'h-8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar ❑9-15 He 016-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash Garbage Disposal Standing Sections - P -Trap Laundry Trays Generator ❑0-5 KW 05-15 KW Trash Compactor Roof Drains Reinspection Fee $15 Issue Fee $ 3 Reinspection Fee $15 Issue Fee $ Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑0100,000 BTU ❑100,000BT Signature Date Drivers' License or SS Reinspection Fee $15 CMF 0865-46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Hood or Type ❑ Canopy Type II ❑ Refrigeration System DO-100,000BTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By Date Application Issued By Date;. T I j�pJ SUMMARY OF FEES BUILDING PERMIT $ -SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ 30.00 GRADING $ PLAN CHECK 50% $ MICROFILM S MECHANICAL $ TOTAL FEE $ 30.e -.:Ig._ PLAN CHECK 25% $ $ 3 W .CONSTRUCTION AND PLANNING p PPROVALS Permit # i Date Inspector POOL & SPA APPROVALS Permit 46- Date Inspector It 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-U.gdrgrnd. 55. Electrical Bonding 5. Steel Reinforcement.!_ 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water'Pipe-Undrgrnd. 60. BackwasK Lines, P -Trap, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash 8i 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 APPROVALS Permit # I 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0Gas 0Oil , 23. Gas Pipe -Rough & Test 72. Underground Flush ' I- 24. Roof Framing 73. Undergrnd. Storage Tank OGas 0Oil tl 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 z 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning l,r 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service -Final 40. Gas Service -Final .41. Solar Domestic -Final i .42. Backflow Preventer i 43. Backflow Irrigation ' 44. Landscaye Irrigation System -• , 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING I ..:Specials Requirements Completed ' 49. Electric Release to Edison , r 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY. No. Date �-, Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO. l.AT NQ. UNIT NO. �' D B..i �o . /7aA 'R7 -i17 w. / 3 c Project Address A y1 owIf p Applicant's Mailing Address / D e V/al 4 Owner's Name -A- e- .�C.Cw-/(Ahr-7o Phone -7" '% D Address �lZ% to L n Cod d Arch/Eng.k4,M0e Sr Q.1'ef-r 7d Cpm'' License No. G /)O ✓1P,� Address C d r / Contractor's Nam Ta t a. Phone �'» L 7 Address (mailing)—g.o SIA l .d. S. v, a City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License No. Date - Signature WORKERS' COMPENSATION DECLARATION 1 hereby affirm that 1 have a certificate of consent to self -Insure or a certificate of Workers' Compensation Insurance, Or a certified copy thereof (Section '900, Lab.- C.) icy No. Company Certified copy is hereby furnished. Li Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this p mit s issued I shall not employ any person In any marl SO a t bet su ed t0 the Worker;' ��—T- sa —tion Laws a California Dale _is.� Signature Py NOTICE: If, after making this declaratiorf y u sho Id becolWsubject to the Workers' Compensation provisions Of the labor Code, yo must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name: Lender'S•Address OWNER BUILDER DECLARATION I hereby atfile-A bat I am exempt from the Contractor's License Law for the folmwinJ'.reasOVP($ection-7031.5 Business and Professional Code: Any city or cgynty- which requires a permit to construct, alter, improve, demolish or repair arwgdlructure, prior to Its issuance, also requires the applicant for such permit '.to file a signed statement that he/She Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9(commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis forthe alleged exemption. Any violation of Section .7031:5 by any applicant for a permit subjects the applicant to a civil alty of not more than five hundred dollars ($500). ' as owner of the property or my employees with wages as their sole .npen5dtion, will do the work, and the structure isnot intended or offered for sale (Section •7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or Improves thereon, and who does such work himself/herselfsor hrough his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is Sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or, Im- prove far the purpose of sale). ❑ I, 'as owner of the property, am exclusively contracting with licensed con tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who builds or improves thereon. and who contracts for such oroiects with a cnn- tractor(5) license pursuant to the Contractor's License Law). 1 am aware that proof of their Worker's Compensation Insurance should be provided to me, ❑ I am exempt under Section` n B. APP. T31`this reason Date-6Af/LI7 f owner' I hereby certify--that-1 have reae ;n fnrmatinn is correct. I agree to Drivers' License or SS 9F 0865-46, rev. 5/88 TYPE OF CONSTRUCTION r(il NEW LJ ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. — ALTERATION LJ REPAIR TYPE OF PERMIT LI GRADING •s -L FOUNDATION OGSTRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION SO. FT.�—OCCUPAN Y_ CON STRUCTION TYPE 7/ALUATION$ �0• ZONE > GRAOINGCU.YDS. ACRES_ Remarks: 67V. --��Vts�� . AL -k WALL '522- L.1= Sink Preventer Irrigation Drinking Fountains Floor Drains Floor Sinks Gas Service - Outlets Interceptors Kitchen Sink Lavatories P -Trap. Roof Drains - Reinspection'Fee . I - $15 Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBG d6 Heating System & Ducting I ❑ 0.1 ob,000 BTU ❑ 100,000 BT Reinspection Fee . I $15 White - Building: Canary - Applicant; Pink - Accounting; Goldenrod - Assessor S Main Building: Accessory Building: TFronto A Rear C Right K 74 Left Ping. Ref. Parking Req./Provided Planning Notes: Mi 0, 1 a 1-d 0 Zone - 7 N G R E D M T S. - ELECTRICAL FEES , LUM13ING- FEES Automatic Washer Transformer .❑ 15.50 KW Construction Pole Sub. ❑ 50 + KW Showers Service Sink Cooking Unit Meter ❑up to 100 amps_ Sewer Cap Dishwasher Meter Dover 100 amps Sewer Connection Dryers ❑Gas ❑Electric Sub Panel Solar Collectors ' Fan Motors DO -1 HP Dil/. - a Solar Piping F.A.U. Inc.Stilar ❑9.15 HP ❑16-15+ Solar Tank Fixtures Microwave Swimming Pool w/Spa Device Boxes Pole Light Urinal - _ Water Closet Outlets _ Range _ Switches Sign Water Heater Garbage Disposal Standing Sections Water Service Generator ❑0.5 KW ❑5-15 KW Trash Compactor Auto -Wash - Laundry Traysl ' -- Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES-NTS: Zoning Approved By Date 9t • 2. _t09 Building Approved By Date �Application Issued By Date Issue Fee � $ 3 CHANICAL FEES Hood or Type I 1-1 Canopy Type II ❑ - 'a SUMMARY OF FEES _ BUILDING PERMIT $ 2ro v SMIP $ /..57 PLAN CHECK $ YL 90 PERMIT PLUMBING $ ISSUANCE $ ENERGY P.C. $ PLAN CHECK 25% $ . ELECTRICAL $ GRADING $ •�+ PLAN CHECK 50% $ MICROFILM . $ MECHANICAL $ TOTAL FEE $ 209.47 PLAN CHECK 25% $ Refrigeration System -. 00.100,000BTU ❑100,000BTU System Repair/Alteration Fire Dampers Registers 0100009980-00009982 TOT 209.47 J ' Issue Fee '$ 3' CONSTRUCTION AND PLANNING APPROVALS Permit # i Date Inspector POOL 8 \ APPROVALS Permit # Date Inspector . 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undigrnd. 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 '• I �' 7. Footings d rCl 58. Electrical Conduit-Undrgrnd. 1 8. Foundation - 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Und'rgrnd. ;� 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System ,, 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash &Receptor -Final 12. Sewer Cap _ 63. Heater & Vent -Final , 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing, 65. Electrical -Final 15. Rough Electrical -Conduit 66. Solar System -Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18: Rough Electrical -T Bar Ceiling,, 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22.• Ducts, Ventilating 71. Product Piping ❑ Gas 0Oil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 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 Factdry�Fireplace• 38. Final Plumbing I.' '39. Wafer`Service;Final fi% 7 `40. Gas Service -Final 41. Solar Domestic -Final L ii n. .42. Backflow P.reventer•� 43, Back lbw Irrigation's n 44. Landscape Irrigation System 45. Sound'l Attenuation 1 46. Hand icap• Regulations - 47. FINAL, STRUCT € :BUILDING Zl 48. Special Recjuirements Completed 49. Electric Release to Edison •� -50. Gas Release to Southern California Gas Co - 5f. CERTIFICATE OF OCCUPANCY No. Date ' Applicant to fill in all spaces except those within heavy border linea and sign all appropriate declarations. CIT=SOF COSTA MESA CONSTRUCTION PERMIT Project Address g y / Lu lB r^ - Applicant's Mailing Address J-0 S r Owner's Name Pf Ia Phone Z-2 2-!)2d :> Address AAq 1,/A Llt/u t Arch/Eng.'NI » &_ I� P r" --F 07 M Ofp h License Nock n '%J -Ir Address 3 r 0-'( LS C'r A I)) A c Contractor's Nam�_Phone(1 I ?- 3) s b Address (mailing) h IA L A., .S" d City License No. LICENSED CONTRACTOR DECLARATION 1 hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and MY license is in full force and effect. License Class License No. Date - Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -Insure or a Certificate Of Workers' Compensation Insurance, or a certified copy thereof (Section 00, Lab. C.) licy No. Company L� Certified copy is hereby furnished. ❑ Certified copy Is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION -(This section need not be completed if the permit is for one hundred ($100) or - less). I certify that in the performance of the work for which thi mit is issued I shall• riot employ any person in any r so to me subject to tke Workers- C pe is on Laws of Calif Date // rr Signature NOTICE: If, after making this declar I n, yod should be a subject to the Workers' Compensation provisions of the Labor Code, ou must forthwith comply with' such provisions Or this permit shall a deemed revoked. CONSTRUCTION'LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance Of the work for which this permit is Issued .(Section 3097 Civ. C.) Lender's Name Lender's Address OWNER BUILDER DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of :the Contractor's- License Law (Chapter 9(Commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt merefrom_and the basis for the alleged exemption. Any violation of Section '31.5 by any applicant for a permit subjects the applicant to a civil ally of not more than five hundred dollars ($500). 1, as owner of the' property or my employees with wages as their sole .compensation, will do the work, and the structure is not Intended or.offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law tloesnot apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or Im-' prove for the purpose Of sale). ❑ I, as owner of the property, am exclusively contracting With licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon. and ,who contracts for such oroiects with a con- tractor($) license pursuant to me Contractor's License Law), I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Settlon— B, &y: -C) for this reason Date Signature ZA Drivers' License or 0865-46, rev. 5/88 have DateK1/(1r1_ :ieinspection Fee •$15 Issue Fee $ 3 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor NATIO 240- A.P.tW - 0I Zone S Main Building: Accessory Building: TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR 1:1 CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG./ T Front Zr a • V ZO A Rear 'f- �� - N TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑MECHANICAL ❑ OTHER C Right 2 S - N $ Left �' - G R Ping. Ref. # Parking Req./Provided E PROJECT DESCRIPTION SQ. FT. OCCUPAN Y CONSTRUCTION TYPE VALUATION$ WOO— ZONE GRADING CU.YDS. ACRES Planning Notes:O M s \s n _ T S. Remarks: ` ELECTRICAL FEES • PLUMBING FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW - a ❑ 50 + KW Bar Sink Showers Backflow Preventer Service Sink - Cooking Unit Meter ❑up to 100 amps Backflow Irrigation`/ Sewer Cap Dishwasher Meter Clover 100 amps Bathtubs - Sewer Connection - Dryers ❑Gas ❑Electric Sub Panel ' ' Clarifiers • Solar Collectors Fan Motors E10-1 HP ❑1'h - 8 Dishwasher Solar Piping F.A.U. Inc. Solar 119-15 HP 016-15+ •- Drinking Fountains Solar Tank Fixtures, Microwave Floor Drains Swimming Pool w/Spa Device Boxes Pole Light Floor Sinks Urinal Outlets Range Gas Service Outlets Water Closet _ Switches Sign Interceptors Water Heater -,,' Garbage Disposal Standing Sections Kitchen SinkWater Service 1 Generator C10-5 KW C3 5-15 KW Trash Compactor - I Lavatories - Auto -Wash P -Trap Laundry Trays Roof Drains - L$3 Reinspection Fee $15 Issue Fee DEV ELOPMENT SER V-IC,ESI.q Zoning Approved By I,(/S�f Building Approved By Application issued By E¢UIREMENTS: ` Q• �� Date (0 Date.--��p+- Datff Reinspection Fee $15 Issue Fee $ 9 MECHANICAL FEES Boiler Duct - Under Ground Hood or Type I ❑ Canopy Type I I ❑ - _ BUILDING PERMIT PLANCHECK ' PLUMBING / PLAN CHECK 25% ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% SU MARYOF FEES $ "77.0. SMIP $:�_ $ r! L PERMIT $ ISSUANCE $ $ ENERGY P.C. $ $ GRADING $ $ MICROFILM $ $M4 L FeF'Oi' �rCZ $—rt`i'-G3 Duct -Structural Refrigeration System -. Duct -Ventilating 00-100,000C-1100,000.00 BTU 100,000 BTU Exhaust System ❑ Multiple 0 System Repair/Alteration � Firepl/Fact. Bit, ICBG# Fire Dampers Heating System & Ducting Registers I ❑0-700,000 BTU❑100,00087 - _ DateK1/(1r1_ :ieinspection Fee •$15 Issue Fee $ 3 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor NATIO 240- 'CONSTRUCTION AND PLANNING r APPROVALS Permit# Date Inspector POOL A APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location _ 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement .r I Electrical Conduit Utility-Undrgrnd. 54. Forms 4� Electrical Conduit-Undrgrnd. 55. Electrical Bonding d 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical LIFER Grnd. 57. APPROVALTO COVER-GUNITE 7. Footings " `= 58. Electrical Conduit-Undrgrnd. - 8. Foundation 59. Gas Pipe, D Undrgrnd., Test 9. Water Pipe-Undrginil. 60. Backwash Lines, P -Trap, O Undrgrnd. 10. Structural Floor System r i 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. Rqugh 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping El Gas DOil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank D Gas D Oil 25. Roof Sheathing U: 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 ) q_ vim. 35. Final Gas Pipe -Test 36. Hood or Canopy ,, •t 37. Finah�actory.Fireplace� 38. Final'Plumbing 39. Water Service -Final. Ty 40. Gas -Service -Final 41. Solar DomestiiG-Final 42. Backflow Preventer'= 43. Backflow Irrigation A 4'4. Landscape Irrigation System 45. Sound Attenuations 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING Z� 4R. Snecial Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations.. CITY OF COSTA MESA CONSTRUCTION PERMIT / Project Address 16111 ��5t /R'7V St -CM J262% Applicant's Mailing Addr@ss A^ Owner's Name /=-/'//' %�yy.1i� Phone �{3Z'a lid Address we Arch/Eng. License No. Address Contractor's Nam Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing withsection 7000) 01 Division 3 of the Business and Professions Code, and my Il cense is In full force end effect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -Insure or a certificate •f Workers' Compensation Insurance, or a certified copy thereof (Section ;800, Lab. C.) Policy No. Company Certified copy is hereby furnished. Certified copy Is filed With the city Building Division. its Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). 1 Certify that In the performance of the work for which this permit is issued, I shall not employ any person in any mann o as o becommm the Workers' on ,Ly evf Ca lifor .�� Date thisna[ure `( NOTICE: I1, aft r making this declaration, you should—became subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is Issued (Section 3097 Civ. C.) Lender's Name Lender's Address- - OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the' Contractor's License Law (Chapter 9_(commencing with Section 7000) of ;a:,herefrom and the basis for the alleged exemption. Any violation pt Section aq 31.5 by any applicant for a permit subjects the applicant to a civil �'stl•alty of not more than five hundred dollars ($500). 'K I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not Intended or offered for sale. If, however', the building or improvement Is sold within one year of cpm. pletlon, the owner will have the burden of proving he/she did not build or im- rve for the purpose of sale). bI, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or Improves thergon, and who contracts for such projects with a con- tractor(s) Incense pursuant to the Contractor's License Law). I am aware that proof of their Worker's Compensation Insurance should be provided to me. ❑ 1 am exempt under Section B. & P. C. for this reason Date owner I hereby certify that have read in to enter Signature - Drivers' License or SS :it tion and State that the above all city and county ordinances t, and hereby authorize repre- bov - ntioned pr erty for Date /� 83253-1 TYPE OF CONSTRUCTIOj11 LJ NEW " ADD LJ ALTERATION L -J REPAIR ❑ CONVERSION gI DEMOLISH ❑ OTHER A,P,+ DESCRIPTION OF WORK/USE OF BLDG. $ Main Bt E TYPE OF PER MIT GRADING 0 FOUNDATION LJ STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL 13 A Rear E) OTHER :O �Al7Q��C?/l PROJECT DESCRIPTION SQ. FT. OCCUPANCY C Right CONSTRUCTION TYPE VALUATION $ ,.(y— S Left ZONE GRADING CU.YDS. ACRES Ping. Ref. # Remarks: / I¢1 11c1.I !T A- \AAic-I.L_ flktsll Nal Planning No 6502 3/10%68 Zone _ Accessory Building: Parking Req./Provided 25,50 TI Z O N 1 N G R E Q M T_ S �. Reinspection Fee 1 $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO * Heating System & Ducting ❑ 0100,000 BTU ❑ 100,000 BT Fee 1 $15 CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 PLUMBING - FEES Bar Sink Showers $15 Issue Fee ELECTRICAL FEES Backflow Preventer Service Sink iANICAL FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW El 50+KW Backflow Irrigation Sewer Cap ' Bathtubs Sewer Connection Cooking Unit Meter El up to 100 amps Clarifiers Solar Collectors SMIP PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM TOTALFEE Dishwasher - Meter ❑over 100 amps Dish Washer Solar Piping F ire Dampers Dryers ❑Gas ❑Electric Sub Panel Drinking Fountains Solar Tank Fan Motors C10-11 HP Ell %-8 Floor Drains Swimming Pool w/Spa F.A.U. Inc. Solar ❑9-15 HP 016-15+ Floor Sinks Urinal Fixtures Microwave Gas Service Outlets Water Closet Device Boxes Pole Light Interceptors Water Heater Outlets Range Kitchen Sink Water Service Switches Sign Lavatories Auto -Wash I Garbage Disposal Standing Sections ' P -Trap Laundry Trays Generator ❑0-5 KW ❑5-15 KW Trash Compactor Roof Drains Reinspection Fee 1 $15 Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO * Heating System & Ducting ❑ 0100,000 BTU ❑ 100,000 BT Fee 1 $15 CMF 0865.46, rev. 10/84 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Issue Fee $ 3 Reinspection Fee $15 Issue Fee _ $ 3 iANICAL FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By Application Issued By Date Date Date -3 — Hood or Type I ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,000 BTU 0100,000BTU BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL 1 - PLAN CHECK 50% MECHANICAL PLAN CHECK 25%' SUMMARY OF FEES $ Z��^^ $ $ $ $ $ $ $ SMIP PERMIT ISSUANCE ENERGY P.C. GRADING MICROFILM TOTALFEE $ $ $ $ $ $ O•� System Repair/Alteration F ire Dampers Registers Issue Fee $ 3 -CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL & SPA APPROVALS Permit # Date Inspector 1. ,Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding ' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings _ 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, 0 Undrgrnd., Test 9. Water Pipe-Undrgrnd. - 60. Backwash Lines, P -Trap; 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor -Final 12. Sewer Cap 63. Heater & Vent -Final 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro` 22. Ducts, Ventilating 71. Product Piping 0 Gas OOil 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank OGas OOil 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 - r 32. Electrical Power Meter -Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: ' 4. Final Heating & Air Conditioning 35. Final Gas Pipe -Test 36. Hood or Canopy ' I 37: Final Factory Fireplace �< 3B.'Final Plumbing f�1 39. Water Service -Final 40. Gas Service -Final ' 41-. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation , 4,4: Landscape Irrigation System i' 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING / Sl1d1? (;�A� • ' 48Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY.,- CCUPANCY.-No. Date No. ADDRESS: 1041 'W lW ll ST ,WNER•SNAME: ERIC BARTO • ADDRESS: SAME AS ABOVE 714/631--8066 ARCH/ENGINEER: REO.NO.: ADDRESS: UNIT: A101 UNIT: PERMITTEE: ERIC BARTO (714)631-8066 ADDRESS: 1041 (4 18TH ST A101 COSTA MESA CA 92627 LICENSED CONTRACTOR DECLARATION: I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. CITY LIC.: STATE LIC.: CLASS: Date: Signature: WORKERS' COMPENSATION DECLARATION: there affirm that I have a certificate of consent to self -insure or a certificate of Workers' Compensation Insurance, dr a certified copy Ihercol (Section 3800, Lab. C). POLICY NO.: EXP. DATE: COMPANY: ❑ Certified copy is hereby fumLstced. ❑ Certified copy Is filed with we city Bidding DMsion. I ' .ate: Applicant: EXEMPTION FROM WORKERS' COMPENSATION DOCI (NATION: (This section need not be completed it die pejilrd is for one hundred (SI00) or less). I certify that in tie performance of the work for which this permit is i5,giel I shall r10 toy aag an In m,�_;a as to become subject to Ill Workers/' CCoompensatlon Laws of California. ` C Gate: jf `!/--x-90 Signature: ROTI E: IL aftel' cols ply with s you should become subject to the Workers' Compensation provisions at the Labor Coda, you must forthwith comply with such previsions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY: I hereby affirm that there is a construction lending agency for the performance of the work for which Ihh permit is issued (Section 3097, Civ. C). LENDER: ADDRESS: - OWNER BUILDER DECLARATION: I hereby affirm that I am exempt from the Contractors' State License Law for the following reason (Section 7031.5 Business and Professional Code: Any city of county which requires a permit to construct. alter, improve, demolish, or repair any structure, DApr to its Issuance, also requires the applicant for well permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt therefrom and the basis far the alleged exemption, Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more lVJ1ve hundred dollars (3500). 4 as owner of the property 0 SAW-a�mupp of sou will do the work, and the 91 structure t.5 not intended or offeredfor ale(Sectipn 7044, Business nd' P3 rofessional Code: The Contractors' State License Law does not apply to an owner of a property.who bullds or Improves thereon, and who does such work himself/herself of through his or her own employees, provided that such improvements are not intended or offered for sale. If, however the building or Improvement is sold within one year of completion, the owner will have the burden of proving he/she did not build or improve, for the purpose of sale). I - 1, as owner of the property am exclusively contracting with licensed contractors to construct the project (Section 7044, Business ❑ and Professions Code: The Contrnuirs' Sate License Law does not apply to an owner of property who builds or improves thereon and who contracts ton well projects with a contractor(s) license pursuant to the Contractors' SSare License Law). I am aware that proof of their Worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Section: B. 8 P. C. for this re son(,:,/ Date: / Owner: �e(� I do hereby certify, that tam aware of and understand the requirements at California Health and Safety Code Sections 25505, 25533, and 25534 and that I or any future building occupant will/will nor (circle one) need to amply with said state codes and the requirements for a permit for construction or modification from the Auualiry Management District. Residential construction applications are exempt from these provisions. Date: Applicant: I hereby certify that I have read this application and state that the above information I5 correct. I agree to comply with all city and county Ordinances and sate ams relating t0 building construction and hereby authorize representative; of the CM ro aWpOo the above-mentioned property for foelns eton purposes. k Date: Signature: Driver's Licence or Social Security if: White—Building: Green—Code Enforcement; Canary—ApplicenC Pink—Revenue; Goldenrod—Aseessor CITY OF COSTA MESA - BUILDING PERMIT_ PERM NO: P, 046512 PERMIT NO: P 046512 PLAN CHECK NO: N GOVT: N SUPP: N CONSTRUCTION TYPE: PERMIT TYPE: PLU PURPOSE:'OTH JOB DESCRIPTION GAS LINE_ FOR CLOTHES DRYER SQ FT: CLAIM VALUE: CALC-VALUE: GROUP OCC: / COMMENTS: ##########iEMN-##SERA##########)e#############k####kNN####.#eE###############1(•######## Z O N I N G R E Q U I R E M E N T S S E T B A C K S ------------ MAIN BUILDING ----------- ----------- ACCESSORY BUILDING---------- FRNT: FT • IN REAR: FT IN FRNT: FT IN REAR: FT IN LEFT: FT IN RGI1T: FT IN LEFT: FT IN RGHT: FT IN PARKING REQ: PROV: PARCEL: 00000000 ZNE: REF NO: PLANNING NOTES> > ###################sE############iF############at###########x#Ic########### D E V E- L O P M E N T S E R V I C E S R E Q U I R.E M E N T S ZONING APPROVED BY DATE: BUILDING APPROVED BY _ I • _ 'DATE: APPLICATION ISSUED BY: DATE:/ ##ae##############3e##N•#iE�iFii".iFiF�F-iF'�ii'R'iF'iF'iFiFiFii�'�"RiFIF'iF#####>t###NiF �E��fe LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT':N BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING PERMIT 2.00' PLAN 258- SMIP/NON-RES ISSUE FEE 3.00 BUILDING -DIV-> PERMIT ISSUE PLAN -CHECK TOTAL PAID DUE TOTALS-----> 2.00 3.00 0.00 5.00 5.00 .00 REVENUE DIVISION TOTALS--> COLLECTED: 5,00. OVER/SHORT: .00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE. SMIP/TOT GRADING PLAN -CHECK 5.00 5.00 I N D I V I D U A L' F E E B R E A K D O W N TYPE QTY D E S C-R I P T I O N UNIT COST TOTAL COST PLU 11 GAS PIPING SYS OFEND 10TOF4 OUTLETS 2.00 2.00 If 01 00056047-00056047 TOT 5.00 DATE: 033/14/90 TIME: 11:36 - CONSTRUCTION AND 'PLANNING- APPROVALS Permit # Date )'Inspector - POOL 'A APPROVALS, Permit # Date Inspector r• 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location - 2: so!'Pipe-Undrgrnd. 53. Steel Reinforcement - -3._-Electrical Conduit Utility-Undrgrnd. - i 54. Forms ,4. Electrical Conduit-Undrgrnd. 55.. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test r - 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. % , f 60. Backwash tines, P -Trap, 0 Undrgrnd. °• 10. Structural Floor System 61. APPROVAL TO DECK ( 1"K 11. Property Sewer Line & House Connection 'r 62. Backwashl Receptor-Finalill -v.,i 12. Sewer Cap 63. Heater & Vent -Final 13. Roof Drains , -1 64. Plumbing System • Final 14. Rough Plumbing - 65. Electrical -Final 't�• t 15. Rough Electrical•Conduit 66. Solar System -Final t 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 _ APPROVALS ;.-Permit # - 20..Rough Factory Fireplace 21Ducts, in Structure` -- " - 70. Underground Hydro 22 -Ducts, Ventilating . , :71. Product Piping [Gas [Oil 23. Gas Pipe -Rough & Test - " ' 72. Underground Flush ' 24. Roof FFaming •- • • -73-Undergrnd.Stora ge.-Tank 0Gas ❑Oil •74: 25. Roof Sheathing - -'Overhead Hydra _. 26`T -Bar Ceiling (Structural) & Moriocoat - 75. Dry Chemical •_ _ 27: -Frame and Flashing 7+ ' 76. Dry Standpipe ` 28. Lathing'& Siding 77.; FIXED SYSTEM FINAL 29. Insulation i 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 - 31 -Final Electric Notes: t - ' 34. .Final Heating & Air Conditioning •_ y. , _ _ - _ 35: Final Gas Pipe -Test- • - -"36. Hood or Canopy7. - 37. Final Factory Fireplace- _38. Final Plumbing - -39. Water Service -Final- - - -• ' 40. Gas Service -Final - i - °41. Solar Domestic -Final 42. Backflow Preventer 43. Backflow Irrigation ' :44. Landscape Irrigation System 45. Sound Attanuation r 46.••Handicap Regulations _ •' _ ,- .- ; •47. FINAL STRUCTURE & BUILDING E• 48. -FINAL PLANNING �- 49 Electric Release to Edison =50. - Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date ' Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations CITY OF COSTA MESA�J CONSTRUCTION PERMIT Project Address ` can' _. P RMIT NO. � 3-1 -� '83 TRACT NO. 3Z -ZZ T NO UNIT NO. �/ .2( A.P. qW � - J- / /�j ,2Q zone (� S Main Building: Accessory Building: TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCR IO OF WO U E OF BLDG. A.) Q l ,ts / `1 Applicant's Mailing Address �D�t 17so' 0 s?s n' ins 'RFV'W rW S2 -5_aL Owner's Name L�an/'iD Phone Address IoK( �(� E T Front Z O B A Rear N I Arch/Eng. License No. Address TYPE OF PERMIT GRADING FOUNDATION STRUCTURAL ❑ TENANT, El ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER / PROJECT DESCRIPTION �$l.7. FT. OCC UPAN;Y CONSTRUCTION TYPE VALUATION$ ZONE GRADING CU.YDS. ACRES K Right G S Left R Contractor's Nam Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (Commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect.C` License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent t0 self -insure or a certificate ' Workers' Compensation Insurance, or a certified copy thereof (Section 0, Lab. C.) ,Icy No. Company BCertified copy is hereby furnished. Certified copy is filed with the city Building Division. Ping. Ref. # Parking Req./Provided - E �, _ I _ PlanningNotes: f M I LF' T S. _ 2 Remarks: 9 C. O �, .,7 ' _ �8 (� CgLCs' 0/.aL�' ELECTRICAL FEES PLUMBING FEES Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. 11 50 + KW Bar Sink Showers Backflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps Backflow Irrigation Sewer Cap Dishwasher Meter Dover 100 amps Bathtubs Sewer Connection Dryers ❑Gas ❑Electric Sub Panel - Clarifiers Solar Collectors Fan MdtOr$ ❑Ql HP ❑1'rS-8 Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed If the'permlt Is for one hundred ($100) or less). 1 certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner so as to becomt s bject to the workers' �pmq�Isatsoyyy.aws of Calif .J Date -<' /— OY Signature -�- R-+- Dishwasher Solar Piping F.A.U. Inc. Solar 09-15 HP 016-15+ lDrinking Fountains Solar Tank Fixtures' Microwave Floor Drains Swimming Pool w/Spa Device Boxes v Pole Light NOTICE: If, after making this declaration, you should become SLAIJOct t0 the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the performance of the work fqr y+hic ilii er I 510, (SeUton 3097 Civ. C.) /-te hi O -s... Floor Sinks Urinal Outlets Range - Gas Service Outlets Water Closet Switches Sign Interceptors Water Heater Garbage Disposal Standing Sections Lender's Name Lender's Address "t �� CA, QI r W42- t'1'• Kitchen Sink Water Service Generator ❑0-5 KW 05-15 KW Trash Compactor OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt •—refrom and the basis for the alleged exemption. Any violation of Section 5 by any applicant for a permit subjects the applicant to a civil Ry of not more than five hundred dollars ($500). v I, as owner of the property or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law. does not apply to an owner of a property who builds or improves thereon, and who does such work himself/herself or through his Or her own employees, provided that such improvements are not intended or offered for sale. If, however, the building Or improvement Is sold within one year of com- pletion, the owner will have the burden of proving he/she did not build or im- pe for the purpose of sale). I, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License law does not apply to an owner of property who builds or improves thereon, and who contracts for such protects with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that _ Lavatories Auto -Wash P—Trap Laundry Trays Roof Drains - Reinspection Fee $16 Issue Fee $ $ DEVELOPMENT SERVICES REOUIREMEf�1TSy Qq/ ``�� ' /U U Zoning Approved By Date Building Approved By Date .Application Issued ByDat- Reinspection Fee $15 Issue Fee $ 3 MECHANICAL FEES Boiler Hood or Type I El Canopy Type II ❑ Duct - Under Ground SUMMARY OF FEES �� 3 - BUILDING PERMIT $ 72.0o SMIP $ PLAN CHECK $ PERMIT PLUMBING $ ISSUANCE $ PLAN CHECK 25% $ ENERGY P.C. $ Duct -Structural Refrigeration System Duct- Ventilating ❑0-100,000BTU ❑100,000 BTU Exhaust System ❑ Multiple El System Repair/Alteration proof o their worker's Compensation insurance should be provided to me. ❑ 1 am exempt under Sect' n e. & P. C. for this reason ELECTRICAL PLAN CHECK 50% MECHANICAL PLAN CHECK 25% $ GRADING $ $ MICROFILM $ $ TOTAL FEE $ $ Firepl/Fact. Blt. IC80 dk Fire Dampers Date �b - owner I hereby certify that I have read this application and stw that -the above information is Correct. 1 agree to comply with all city and county Ordinances and state laws relating to building construction, and hereby authorize repre- sentatives of this city to ter pan the above-mentioned property for Inspection puny Ses. Heating System & Ducting ❑0-100,000 BTU 0100,00067 Registers - Reinspection Fee $15 Issue Fee $ 3 ��--I,�dq Signature Date r O 1 Drivers' License or SS 9° 01 00028116-00028117 T r_, T DATF: 03/10/89 TIME: 1537 i2. fi3 0865-46, rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting: Goldenrod - Assessor CONSTRUCTION AND PLANNING APPROVALS Permit # Date Inspector POOL " 'A APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 1n. 52. Pool &Equipment Location 2. Soi! Pipe-Undrgrnd. 53. Steel Reinforcement 3. Elecvical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5" 9teehReinforcement 56. Rodgh Plumbing & Pressure Test 6i Electrical LIFER Grnd. 57. APPROVAL TO COVER-GUNITE e- h 7, Foof ngs .f • 3 (,4, ,,; 58. Electrical Conduit-Undrgrnd. t 4 8'i Foundation A 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. h 10. Structural Floor System j 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection _ 62. Backwash & Receptor-Final 12. Sgvaer Cap '1 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. Rougl• Electrical-T Bar Ceiling riF^ 69. POOL/SPA SYSTEMS FINAL 1.9!. Rough Pleating &Air Condli oning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20 Rough-Factory Fireplace 21. Ducts;q Structure r) i_. 70. Underground Hydro 22. Ducts,�Ventilating �';t 71. Product Piping EJ Gas EJ Oil 23, Gas Pipe•Rough & Test 72. Underground Flush 24. Roof Framing ``� / .�� 73. Undergrnd. Storage Tank OGas ❑Oil 25. Roof Sheathing.'/�' 74. Overhead Hydro 26. T-Bar Ceiling (Structural) &�.M ocoat 75. Dry Chemical 27. Frame and Flashing ,r 76. Dry Standpipe 28. Lathing;& Siding �? "� 77. FIXED SYSTEM FINAL 29. Insulation .'/ 78. FIRE PREV. FINAL 1� 30. Drywall:Nailing �;� / HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat.%I /• 79. FINAL INSPECTION 32. Electrical Power Meter-Final' 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes:�1yR-p-aJtT- 34. Final Heating & Air Conditioning I 'Su b 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace X38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar Domestic-Final •�� 42. Backflow Preventer 43. Backflow Irrigation 44. Landscape Irrigation System 1 - 45. Sound Attenuation i. 46. Handicap Regulations 47. FINAL STRUCTURE"&BUILDING Zf 48. Special Requirements Completed ' 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co , 51. CERTIFICATE OF OCCUPANCY No. Date f �� • ,v Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. CITY QF COSTA MESACONSTR y TION PERMIT a I Address �0T/ �� ('Applicant's Mailing Address fpr yiG L . r rs' � � r` L!t (j51 Owner's Name •62>�YI n.1 �• PE R"MIT No. -2k x.1 TRA -92022 9 SGT NO. 4 3 �,� UNIT N0. A P 91" S E T A Main B TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑CONVERSION ❑ DEMOLISH ❑ OTHER DESCRI PTION OF WORK/USE OF BLDG. J Front Rear Address Arch/Eng. I cense No..Sc�(lS�y, Address 3+ O/f�x L ,S' G 4 r 1 JAr Contractor's NameP /Ja�' 14 hone 40.1 •1147 Address (mailing) 8�0 el r/in L, a1L_,nr a. �f 1LG) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license Is in full force and effect. License Class License No. Date ' Signature WORKERS' COMPENSATION DECLARATION I hereby affirm that 1 have a certificate of consent to self -Insure or a certificate 'f Workers' Compensation insurance, of a certified COPY thereof (Section �00, Lab. C.) - alicy No. Company 8 Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section need not be completed if the permit is for one hundred ($100) or less). I certify that in the performance of the work for which this mut s issued I shall not employ any person in any manner so as bac u ect to the Workers' Compensation Laws of Califo Date Signature NOTICE: If, atter making this tleclarat ou thou tl be a ubject to the Workers' Compensation provisions of the Labor Code, y u must forthwith comply with such provisions or this permit shall ad deemed revoked. CONSTRUCTION LENDING AGENCY 1 hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Section 3097 Civ. C.) Lender's Name - Lender's Address OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to Its issuance, also requires the applicant for such permit to file a signed statement that he/she Is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she Is exempt '+erefrom and the basis for the alleged exemption. Any violation of Section 31.5 by any applicant for a permit subjects the applicant to a civil salty of not more than five hundred dollars ($500). -J 1, as owner of the property or my employees with wages as their sole a s or s or employees, provided that such improvements are not wren... or ...area wr sale. If, however, the building or Improvement is sold within one year of com- pletion, the owner will have the burden of proving he/she old not build or im. Sfor the purpose of sale). ❑ 1, as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of properly who builds or Improves thereon. and who contracts for such projects with a con. tractor(:) license pursuant to the Contractor's License law) I am aware that proof o/ their Worker's Compensation Insurance should ba-Wpvided to me. ❑ 1 am exempt under Section B. VP. C. foli this reason Date f_f_51_C. f I <C I hereby certify I information is cor. and state laws rely sentatives of t Inspection p Signature Drivers' L nse or Owner TYPE OF PERMIT LJ GRADING ❑ FOUNDATION ❑ STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑MECHANICAL ❑ OTHER PROJECT DESCRIPTION SO. FT. OCCUPA7CY CONSTRUCTION TYPE VALUATION.. 0 doh ZONE GRAOINGCU.VDS. ACRES Remarks: Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories. P—Trap Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Bit. ICBO dk Heating System & Ducting ❑ 0100,000 BTU [1100,000 BT Reinspection Fee ,$15 0865-46, rev. 5/88 Whitt/ Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor l Zone C Right �" 3 •� SI Left -h- I 1101i(-' Z Ping. NOT. # Parking Req./Provided Planning Notes:'ir A . ,O , a w. r,i . r F.J. L rl A n T N G R E O M T S. ELECTRICAL FEES IMBING FEES Automatic Washer Transformer ❑ 15-50 KW Construction Pole Sub. ❑ 50 + KW Showers Service Sink Cooking Unit Meter ❑up to 100 amps Sewer Cap Dishwasher Meter ❑over 100 amps - - Sewer Connection Dryers ❑Gas ❑Electric Sub Panel ' Solar Collectors Fan Motors E10 -l' HP Ill 'h - 8 Solar Piping - - - F.A.U. - Ina Solar 09-15 HP 1116-15+ Solar Solar Tank Fixtures Miaowave Swimming Pool w/Spa Device Boxes Pole Light Urinal Outlets Range Water Closet Switches Sign ' Water Heater Garbage Disposal Standing Sections Water Service Generator 1:105 KW 05-15 KW Trash Compactor Auto -Wash Laundry Trays ' Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVIC�$$��UIfjE�jTS: (0-9 Zoning Approved By ((,,((JJ,,�� /f Date 8� �'—) . Building Approved By Date—._fl-,i_ Application Issued By Date1_ Issue Fee $ 3 iANICAL FEES Hood or Type I ❑ Canopy Type II ❑ SU M.QRV OF FEES BUILDING PERMIT $ �l'-0 Dom- SMIP $ "ra PLAN CHECK $ f t ' J ' PERMIT r PLUMBING $ ISSUANCE S PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTAL FEE $ OS PLAN CHECK 25% $ Refrigeration System ❑0100,000 BTU ❑100,000 BTU System Repair/Alteration Fire Dampers Registers 01 00009992-00009995 TOT 45.05 Issue Fee $ 3 /ONSTRUC710N AND PLANNING 'APPROVALS Permit Date .r Inspector POOL ?A 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.,Electrlcal 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, 0 Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash &Receptor -Final 12. Sewer•Cap- 63. Heater & Vent -Final - 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 APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 70. Underground Hydro 22" Ducts, Ventilating 71. Product Piping 0Gas 0Oil 23, Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd. Storage Tank 0 Gas 00il 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. F ina l'Factory''. F i replace 38. Final -Plumbing 1 r- '39. Water Service -Final •o 40. Gas Service,Pinal •" 41. Solar''Domestic-Final, r i l '42. Backflow �Pre`venter,' 1 � _ .43. Backflow Irrigation t44• Landscapellrrigation System (45. Sound Attenuation j " 46. Handicap RePU' lati V 5, 47. FINAL STRUCTURE & BUILDING 74 O I 0 48. Special Requirements Completed 49. Electric Release to Edison'.' ,50. Gas Release to Southern California Gas Co 51. CERTIFICATE OF OCCUPANCY No. Date �• Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations CITY OF COSTA MES�A/ (((j��O�NSTRUCTION PERMIT PERMIT NO. "3 2.•3� TRACT NO. LOT NO. UNIT NO. Qs / A.P.+ zone Project Address /0T� �I Applicant's Mailing Address BVD/E-HL.L c/ ��g �e' 9wner's Name Phone 55,8 I IBOQ l✓/A /nn `JOuta A/<wiizynr (�c'isaiJ S Main Building: Accessory Building: TYPE OF CONSTRUCTION LJ NEW 29 ADD LJ ALTERATION U REPAIR ❑ CONVERSION ❑DEMOLISH ❑ OTHER DESCRIPTI C'A B14 c1_ .4N OF BLDG. C>DIR� E E T Front Z 0 B A Rear - N (Address Arch/Eng. License No. Address -OF_ALrORK/USE TYPPEE1 OF PERMIT GRADING LJ FOUNDATION ❑ STRUCTURAL ueJ TENANT ® ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑` OTHER' PFrOUECT DESCRIPTION SQ. FT. OCCUPANCY CON STRUCTION TYPE VALUATION$ ZONE GRADING CU.YDS. ACRES K Right G $ Left - R Contractor's Nam Phone I Address (mailing) !. City License NO. LICENSED CONTRACTOR DECLARATION Pin Ref. + 9 Parkin g Req./Provided E Notes: PlanningN Q M TS Remarks: �1/•W b i•Q 1 he affirm that I am licensed under provisions of ommencing with sectl0 Of Division 3 Of t�h�e t++cu� nnl5 d Professions Code, and _ ELECTRICAL FEES my license is in full fo O CI J Lice se N rte— �� s WORKERS' COMfiENSATI ON DECLARATION I hereby'affirm that 1 have a certificatete of consent to self -insure or a certificate Workers' Compensation Insurance, or a certified copy thereof '(Section 0, Lab. C.) licy NO. Company 8 Certified copy is hereby furnished. Certified copy is filed with the city Building Division. PLUMBING FEES Automatic Washer Construction Pole Sub. Transformer ❑ 15-50 KW Ll50+KW Bar Sink Showers Backflow Preventer Service Sink Cooking Unit Meter ❑up to 100 amps - Backflow Irrigation Sewer Cap Bathtubs Sewer. Connection _ Dishwasher Meter ❑over 100 amps Dryers ❑Gas ❑Electric Sub Panel Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION Clarifiers Solar Collectors Fan Motors ❑0-1 HP ❑1 h-8 Dishwasher Solar Piping F.A.U. - Inc. Solar ❑9-15 HP ❑16-15+ (This section need not be completed if the permit Is for one hundred ($100) or less). I certify that in the performance of the work for which this permit Is issued I shall not employ any person in any manner so as t0 become subject to t6 Drinking Fountains Solar Tank : FIX1U!¢$ Microwave Workers' Compensation Laws of California. Date �/ — Z rj/ Signature � _ to 04 Floor Drains Swimming Pool w/Spa Device Boxes Pole Light NOTICE: If, atter making this declaration, you shout lett to the Workers' Compensation provisions of the ode, u must forthwith comply with such provisions or this permit Shall be deemed revoked. CONSTRUCTION LENDING AGENCY hereby affirm that there Is a construction lending agency for the performance of the work for which this gpsmit is issued (Section 3097 Civ. C.) Lender's Name 40 t/G Lender's Address _ Floor Sinks .. _ Urinal Outlets Range Gas Service Outlets Water Closet Switches Sign 9 Interceptors Water Heater Garbage Disposal 9 P Standing Sections' Kitchen Sink Water Service Generator 1:105 KW 05-15 KW Trash Compactor OWNER BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5 Business and Professional Code: Any city or county which requires a permit to construct, alter, Improve, demolish or repair any structure, prior to its issuance, -also requires the applicant for such permit to file a signed statement that he/she is licensed pursuant to the provisions of the Contractor's License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he/she is exempt •efrom and the basis for. the alleged exemption. Any violation of Section 1.5 by any applicant for a permit subjects the applicant to a civil alty of not more than five hundred dollars ($500). 99 1, as ossue wner of the property or. my employees with wages as their sole Compensation, will do the work, and the structure is not intended or -offered for sale (Section 7044, Business and Professional Code: The Contractor's License Law does not apply to an owner Of a property who builds or improves - thereon, and who does such work himself/herself or through his or her own employees, provided that such improvements are not intended or off for sale. If, however, the building or improvement is sold within one year of com- n,.the owner will have the burden of proving he/she did not build or im- prove for the purpose Of sale). ❑ I, 'as owner of the property, am exclusively contracting with licensed con- tractors to construct the project (Section 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for Such oreacts with a con- tractor(s) license pursuant to the Contractor's License Law). I am aware that proof o their Worker's Compensation insurance should be provided to me. I am exempt under Section B. & P. C. for this reason Lavatories, Auto -Wash - P—Trap Laundry Trays Roof Drains :N 1V• Reinspection Fee $15 Issue Fe $ DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Building Approved By /7 + A Date Application Issued By ` L4 v Dete__3� • } Reinspection Fee $15 I Fee $ 3 MECHANICAL FEES Boiler Duct - Under Ground Hood O! T Type I ❑ Canopy Type II Elplebo BUILDING PERMIT PLAN CHECK PLUMBING PLAN CHECK 25% ELECTRICAL PLAN CHECK 50°,6 MECHANICAL PLAN CHECK , 25% $U RV OF FEES . $ SMIP $ $ PERMIT $ ISSUANCE $ $ ENERGY P.C. $ $Z �o • 00 GRADING $ $ MICROFILM $ $ TOTAL FEE $ �O $ , Duct -Structural Duct- Ventilating Refrigeration System 00100,0006TU 1:1100,000,BTU Exhaust System El Multiple EJ System Repair/Alteration Firepl/Fact. Bit. ICBG # Fire Dampers Date Owner I hereby certify the I have read this applicatio na state that the above information is correct. I agree to comply with all ty and county Ord finances and. state laws relating to building construction, nd hereby authorize repre- sentatives of this city to enter. upon the above-mentioned property - Heating System & Ducting ❑0100,000 BTU❑100,0006T Registers - pfoqr Inspection pure s. Date � Signature Drivers' -License or S 01 P003311?3-0003:193 TOT ii O DATE' '04/24-89 TIME: 08:58 r Reinspection Fee $15 Issue Fee $ 3 0865-46, rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor CONSTRUCTION AND PLANNING POOI PA APPROVALS' Permit 4A. { Date Inspector APPROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement i ,Z 3.�jElectrical Conduit Utility-Undrgrnd. 54. Forms 4a,",Electrical Conduit-Undrgrnd. Ir 55. Electrical Bonding' 5" Steel Re0orcement ,i 56. Rough Plumbing & Pressure Test r. 6. -Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7�rFootings I 58. Electrical Conduit-Undrgrnd. 8MFoundation 1 59. Gas Pipe, 0 Undrgrnd., Test i 9!ater Pipe-Undrgrnd. '1 60. Backwash Lines, P -Trap, 0 Undrgrnd. 10aStructural Floor System 1 '"c5 1 61. APPROVAL TO DECK - 111. Property Sewer Line & House Connection - 62. Backwash & Receptor -Final r 12. Sewer Cap 63. Heater & Vent -Final i 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing . --------------- 65. Electrical -Final / 15. Rough Electrical -Conduit 66. Solar System -Final f6. Rough Electric Waling 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18i Rough Electrical -T Bar CeilT9 69. POOL/SPA SYSTEMS FINAL 19: Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT APPROVALS Permit # 20. Rough Factory Fireplace 21. Ducts, in Structure 'i 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping 0 Gas 00il 23. Gas Pipe -Rough & Test 72. Underground Flush 24. Roof Framing - 73. Undergrnd. Storage Tank 0Gas 0Oil 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.' FOOD CERTIFICATE ISSUED .33. Final Electric l Notes: 34. Final Heating & Air Conditioning f,� , 35. Final Gas Pipe -Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing r-rc ; - 39. Water Service -Final -- .0 , 40. Gas Service -Final .r 41. Solar Domestic -Final 42. Backflow Preventer -' 43. Backflow Irrigation .' 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations i 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co _ 51. CERTIFICATE OF OCCUPANCY No. Date /� t •, iu CITY OF COSTA MLLE''SA''''``(C�ONSTRUC�T�jI.ON PERMIT f Prniect Address 1Q'71 WeS*1bnn14.�y Applicant to fill in all spaces except those within heavy border lines and sign all appropriate declarations. PERMIT NO. I TRACT NO. ,LOT NO,I UNIT NO. f plicant's Mailing Address ]Q$ Z SriS � ,Sg 'dprner's Name �� yC o t� Phone.�1. Address ror ¢ /age Pir Arch/Eng. License No. Address Contractor's Name Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensetl under provisions of Charter 9 (commencing with section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. License Class License No. Date Signature WORKERS' COMPENSATION DECLARATION hereby affirm that I have a certificate of consent to self -insure or a certificate Workers' Compensation Insurance,or a certified copy thereof (Section ,800, Lab. C.) Policy No. Company B Certified copy is hereby furnished. Certified copy is filed with the city Building Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissedtion need not be completed if the permit is for one hundred ($100) or less). I (-certify that in the performance of the work for which this permit is issued, I shall riot employ any person in any manner so as to become subject to the Workers, Compensation Laws of California. Date w Signature NOTICE: If, after making this declaration, you sh Caltl subject to the Workers' Compensation provisions of the .Labor Cc must Crow comply with such provisions lir this permit sh deemed re CONSTRUCTION LENDING AGENCY I I hereby affirm that there is a construction lendin cy f erfor of the work for which this permit is issue c 097 ) Lender's Name Lender's Address — OWNER BUILDER DECLARATION t I hereby affirm that I am exempt from the Contrac IYy se Law for the following reason (Section 7031.5 Business and Profes ode: Any city or county which requires a permit to construct, alter, im , demolish or repair any structure, prior to Its issuance, also requires the a (cant for such permit to file a signed statement that he/she is licensed pursuant to the provisi ops of rom and the basis for the alleged exemption. Any violation C i by any applicant for a permit subjects the applicant t y of not more than five hundred dollars ($500). as owner of the property or my employees with wages as nsation, will do the work, and the structure is not intended le (Section 7044, Business and Professional Code: The Cc ,e Law does not apply to an owner of a property who builds or n, and, who does such work himself/herself or through his of 11- ......neon mr..nrn teat aiIveme is are not intended or o ion, the owner will have the burden of proving he/she did not build or imill! v for the purpose of Sale). I, as owner of the property, am exclusively contracting with licensed Con - :tors to construct the project (Section 7044, Business and Professions Code: Contractor's License Law does not apply to an owner of property who Ids or improves thereon. antl who contracts for such oroiects with a Con. aor(s) license pursuant to the Contractor's License Law). I am aware that of of their Worker's Compensation insurance should be provided to me. I am exempt under Section B. & P. C. for this reason Date Owner I hereby certify that I have re, Information Is correct. I agree to and state laws relating to buildii sentatives of thisy ty sto enter inspection Purr.92 a .. _--IV f Drivers' License or SS # - ] this application and state that the above comply with all city and county ordinances g construction, and hereby authorize repre- upo the above-mentioned property, for / Date Jy TYPE OF CONSTRUCTION - U NE% ❑ CONVERSION ❑ DEMOLISH DESCRIPTION OF WORK/USE OF 8 TYPE OF PERMIT LJ GRADIN ❑ TENANT ❑ ELECTRICAL ❑'OTHER PROJECT DESCRIPTION SQ. FT.- CONSTRUCTION TYPE ZONE GR ADD W ALTERATION LJ REPAIR 1 FOUNDATION LJ STRUCTU PLUMBING ❑ MECHANICAL W1 0.--� VALUATIONS "/r / /O NG CU.YDS. ACRES A.P. # A�l S Main Build, E T Front ARcar C Right K Left Accessory Building: Zone II Ping. Ref. # I Parking Req./Provided ' Planning Notes: Tcp nim A— .7 O,4ur. .� I Remarks: 'L/C 7F G b S - -A -'Am / T C _-gill /Z/. • L- � Y FEES Bar Sink Showers Backflow Preventer Service Sink Backflow Irrigation I I Sewer Outlets InterceptoW, Kitchen Sink Lavatories P -Trap Roof Drains Boiler Duct - Under Duct - sic Duct- I g Exhaust Sys m Firepl/Fact. Heating System ❑0-100,000 BTU $15 Fee 1 _$15 0865-46, rev. 5/88 White - Building; Canary - Applicant; Pink - Accounting; Goldenrod - Assessor Solar Tank Swimming Pool w/Spa Urinal Water Closets Water Hea d Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures Device Boxes Outlets Switches ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter 13 over 100 amps Sub Panel Motors 00-1 HP ❑l'/,-8 Inc. Solar 119-15 HP 1116.15+ Microwave Pole Light Range Standing Sections 5-15 KW Trash Compactor FEES Ji N G R E Q M T S. Issue Fee I $ 3 Reinspection Fee $15 Issue Fee $ 3 DEVELOPMENT SERVICES REQUIREMENTS: j�J�i $ 3 has Zoning Approved By Building Approved By Application Issued By a Date Date Date IANI L ( FEES ❑ Ype Pe 11 ❑ SUMMARY OF FEES -, BUILDING PERMIT PLAN CHECK aw. so $ SMIP PERMIT $ ion System 100,000BTU ❑t00,000BTU PLUMBING PLAN CHECK 25% ELECTRICAL $ $ $ ISSUANCE $ ENERGY P.C. $ GRADING $ System Repair/Alteration Fire Dampers PLAN CHECK 50% MECHANICAL $ $ MICROFILM TOTAL FEE : $ $ Registers PLAN CHECK 25% $ Issue Fee I $ 3 . " CONSTRUCTION AND PLANNING POG. _SPA ` Date r APPROVALS Permit # Inspector APPROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole .52. Pool & Equipment Location 2. Soil PipCUndrgrnd. 53. Steel Reinforcement . r. 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 f • 59. Gas Pipe, ❑ Undrgrnd., Test "I 9.- Water Pipe-Undrgrnd.Backwash Lines, P -Trap, O Undrgrnd. 10; Stauctural Floor System Al. APPROV;4L TO DECK a: v 11.�Property Sewer Line & House Connection 62.,yBackwa h & Receptor -Final 12;Sewe,'Cap 63. Heater & Vent -Final 13. Roof Drains i 5 64.' Plumbing System - FinLa r 14. Rough Plumbing t X65. Electrical -Final i� 15. Rough Electrical -Conduit -+'"r -?'y 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 72 69.,POOL/SPA SYSTEMS fJNAL _ 19. Rough Heating &Air Conditioning FIRE DEPT. REQUIREMENT emit "� 20. Rough Factory Fireplace APPROVALS P 21. Ducts, in Structure i l'11 rs 70. Underground Hydro r 22. Ducts, Ventilating �1 `1 :•, '„ 71. Product Pipng[Gas ElOil ' 23. Gas Pipe -Rough & T �� n i' 72. Underground Flush `• ..�*. 24. Roof Framing 1 Y {ih 73. U n d a rgrnd. Storage Tank []Gas" ❑ Oil 25. Roof Sheathing 74. Overhead Hydros ryr, -26.-T-Bairpeiling (Structural)'&�Mopocoat 75. Dry{Chemical 271 'Frame and Flashing 76. Dry Standpipe i 28. Lathii;9,& Siding s- 77. FIXED SYSTEM FI�AL n 29. Insulation 78. FIRE PREV. FINAL •'�`+ 30; DrywalMai ling L. r -r _ s' HEALTH,DEPT. REQUIREMENT 31 Plaste rBrown Coat y p 79. FINAL INSPECTION 32 Electrical Power Meter-FiriaQ 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: ^••. --� 34. Final Heating & Air Conditioning-'�"� ^• 35. Final Gas Pipe -Test 1 -36. Hood or Canopy _37,. Final Factory Fireplace 38. Final Plumbing - '39. Water Service -Final . 40. Gas Service -Final 41�'Sola Domestic -Final- Backflow Preventer ;• l/ i• 43. Backflow Irrigation •� 44. Landscapeilrrigatiori System 45. Sound Attenuation_ r' 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 s y o oTsu COSTA MESA BUILDING -SAFETY DEPARTMENT P. O. BOX 917 COSTA MESA. CALIFORNIA For Applicant to Fill In Completely /'-/� / TYPE OR PRINT _ (/ 9nn.../%% /// /P JP COSTA MESA. CALIFORNIA FEE RECEIVED Y FAME PT. " CITY OF COSTA MESA y OAPPLICATION FOR PERMIT BUILDING \' For Office Use Only 1'' RECEIPT NO. SRM NO. OWNER S 4Y MAILR[ % 1 BY OAT[ RECEIVED TE I ■ ADORE65 A (� Q . � TEL- CITY NO. BUILDING ADDRESS U ARCH TEL. COSTA MESA. CALIFORNIA OR ENGINEER NO. FIRE ADDRESS ZONE TYPE GROU ma CONTRACTOR P V L/6,70,APPROVED APPROVED BY ATE / y ^ / VP ZING ADDRESS / O. iD Y �I CITY Olrh 17 /4 i ^ IIT Z . NO.OP I PUNK UB[ OP NSW I BUILDING STATE TEL. s 0 LEGAL I /� I� .L� LIG.NO. NO. a DEBCRIPTIOIT�AIp.' 1" EII.�P(1 SIZyVT ^^.� S O I }1E.S _r I L I Po/y, SI OF LOT ..G !1` NOW ON LOTH A. P. NO. / USE OF/ �.- YARDS EVES EXIST[G BLDG 2 APPROVED ALLOWED SETBACK LINE PROM 2 O O <CEM[R {JHS GT./ CENTER OF STREET REAR YARD` PRONT FT. IN. I I SIDE YARD LEFT RIGHT R. SIDE/qvdw FT. IN. DESCRIPTION OF WORK L. SIDE FT. IN. NEW I ALTERATION I II ADDITION I REAR addIT. II I I APPROVED REPAIR MOVING DEMOLISH REPAIRDATE V BUILDING NO. OF SIZE 2 ROOMS STORIES EXTERIOR WALL ROOF Co COVERING L��V Cl COVERING 1' USE OF BUILDING AND WORK TO BE PERFORMED ai 4 a � �54v 1 HEREBY AMNOWL G8 THAT 1 HAVE READ THIG APPLIGTION THE AMOUNT GROWN LANDER VALUATION 18 FOR TH. AND STATE THAT THE ABOVE IB CORRECT ANO AGREE TO COM. PURPOGE OF ESTABLISHING A PERMIT FEE ONLY. PLY WITH ALL CITY ORDINANCBB AND BTATE LAWS REGULATING VALUATION ` BUILDING CONSTRUCTION. ^}' SIGNATURE OF %S / �J y 6 y/ SPERMIT FEE S e= PLAN CHECK S PERMITTER�} ?G s I Syl . , o` AUTHORIZED AGENT' �• / ,� TOTAL FEE 18101 COSTA MESA BUILDING -SAFETY DEPARTMENT P. O. BOX 917 COSTA MESA. CALIFORNIA For Applicant to Fill In Completely TYPE OR PRINT BUILDING ry / ADDRESS /D - /V COSTA MESA. CALIFORNIA FEE RECEIVED NOV 1 1962 , ll_ FINANCE DEPT. r. APNTiCATION 76R'0PERMIT BUILDING For Office Use Only LIL RECEIPT NO. PERMIT NO. / /?,e)/ Al RECEIVED BY DATE RECEIVED I D I/-/ S� �O �' IP- FARCPHTECT - z.> - TEL. TEL. - CSO S j F{ /% 6 NO. BUILD NG '/ y�� ADDRESS 1041 C/!/ '� /,FYI TEt.COSTA MESA. CALIFORNIA EER NO. FIREZONE DDRESS TYPE GROUP APPROVED/ BY CONTRACTOR �)w/Y r v / TONING ADDRESS ONENO. OF USE OF NEW CITY PLANS �/ BUILDING I STATE r- TEL. LEGAL LIC. NO. NO. DEBCRIMON dL /. A. P. NO. SIZE [d / �, P� 30-bI NO. OF EIDGIL OF LOT /� d NOw ON LGT USE OFa7� r C f� YARDS EVES S EXISTING BLD /� �- APPROVED ALLOWED SETBACK LINK FROM REAR YARD O CENTER OF STREET S6 J ICBNTER LINE ST.). / FRONT '�U FT. ? IN. SIDE YARD I L@FT j9 I RIGHT 169 R. SIDE IN. DESCRIPTION OF WORK ,t�FT. ss��1�O L. SIDE 9'M< I FT. ,,r. IN. NEW I ALTERATION I II ADDITION I REAR 2 QD t_FT. IN. REPAIR I MOVING I DEMOLISH APPROVED. //) BY NJ�J SY DATE / L. �BU#t9tNC— NO. OF SIZE ROOM " DRIES T O /? EXTERIOR WALL—_ ROOF COVERING COVERING - / 1> / U USE OF BUILDING ANOfWORK TO BE PERFORMED / s , e 1 H8R8BY AC O LEDGE THAT I HAVE READ THIS APPLICATION THE AMOUNT SHOWN UNDER VALUATION IS FOR THE AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COM- PURPOSE OF ESTABLISHING A PERMIT PEE ONLY. PLY WITH ALL CITY ORDINANCES AND STATE LAWS N80ULATING VALUATION BUILDING CONSTRUCTION.. SIGNATURE OF O, {{'' PERMIT FEE S 5,eo PLAN CHECK $ PERMITTEP r 00 S /�a� �j AUTHORIZED AGENT OOV TOTAL. FEE OO LIL