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OWNER
JOB AC
GENER
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IN�. ci
�1501L
1�� GAS
W AT ER
PROP. SWR. LINE U HOUSE CON.
SPRINKLING SVSTEM
MISCELLANEOUS�
AIR
UNDERGROUND U POWER U
ROUGH WIRING
TRENCNES � FORMS � STEEL REINF.
FLOOR SYSTEM
BONO BEAM I-I STEEL HEINFORCE I-I
$HEATHING
FRAME /NO FLFSHING
PLAST�R
STF
-NT., REFRIG. AN� A.C., FINAL
FIN4L ANO GAS TEST n
DATt 7_
SUBCONTRACTOR
�
PN0.IECT AOOflE55: 8 S 3 W 1 7 TH $T ' •
OWNEfl'S NAME: BALAIIS FAMZLY TRUST
/ RODNESS: SAME
pflLN/ENGINEEB: 6 7 3— Z 2 8 2
aooeess:
flEG.NO.:
UNIT: A
uxit:
PEPMITTEE: C M ELECTRIC ( 714 ) 548-5831
aooAess: z 18 CRYSTAL AV
LILENSEO CONTflFCTOfl OEBCIAHpTION: 1 her¢Dy allirm ItWt I am Iicen5e0 unOCA o�oGi 6 Zter 9(commencinp wilh Sec�ion
7000� ol �ivision 3 0l I�e Busmess antl Prolessions COAe, anA my lirense is in lul ce and ellecl.
" 58595•, STRTELI ' �9�� cu lII
WOpI(EBS' E/.i 0 IOfT I eOYafiirmt'
CAmOen . n In , or yEeryffetl copy ih eol (�c'
xo.: � E%P.
COMPA
T=� C a' copy is e(e�y �umisned. ❑ Canlile0 co�
WOPKEPS' COMPENSATION OECUflATION:
' petlormance ol ��e work lor w�ich I' p
rtNers' Compe c Laws al C� rnia.
- T � 19nalur
er ing �his ae a mn, you oultl
ENOINC RCE1J�1: I �ereby a1
is issuetl (SyRion 3097. Gv. CI.
oi conseN to
filed wilh Ne ci�y BuilAinp Division.
Wod¢rs
¢0 nOt Ot camvleleA il Ine ce«� is lor one AmMre015100) or 165�.
ISIIdIIlIOItlf y dflY pCl501110 d11y111dfII1Cf50 d5I0 �ECOrtIC
ieca Ie�� �o orA�' Compen tion Dr - ion5 0� I�2 LaEOr
' i permii II 6e Aeemed revak .
I�tR i5 d tmction lentlinp apen �0 B pedOnllaM! 01 Itk wOM1 �0�
� Efl BUILOEB OECLANATION: I �¢reGy allir t 1 am eKempt Iwm ine Caniractars' State Lkense Law for ine IdWvinq reason
$lQiOn 70.31.5 Bu5ine55 antl Proi¢SSiondl COpe' y tily ol tpuniy wNU 2puirGt a p¢rmi� IO COnSIruCi, atier, imprOvp, E¢rtid5�. N
repair any simcWre. prior to its iuuance. al uirts itM aoW�unt for wch permil to lile a sipnetl statement ihat MJSM B I[ensetl
pursuant to ��e pmvisions al the Camracmrs' State License law (Ctwpter 9(commencinq wii� Section 7000) ol Dirisian 3 of t�e Buvness
an0 ProteSsionS Coae) or Ihat he/She is eeempi Iheretmm an0 I�e Ea5i5 �or IA! allep¢C pM¢mpli0n. My Wolatqn o� Seciion 7031.5 Cy
any avd��m tor a Dermi� subi�ts ihe applicant Io a civil penalry of not moa itun live nunErea aolurs (35001.
I, as owner of t�e D�aGeny or my em loyees vnt� waqes az ineir mle comDensa�ron, will ao tAe work, an0 ihe
❑ simcwre a noi intenaea or oilereE Iw sale (�uw 70ta. Business anA Professional COEe: TAe Contractors' State Littnu Law
aoes not apvN �o an owner ol a o�aoeny wro Olriws or imo«s inereon, ana wlq eces sucn work Mmsell/nersetl or tnroupn
�is ar �er awn employees, O�ovi0e0 I�al sUt� improvements art nol intenEeG or ollere0 for Sale. If, IpwNer Ihe DuilGinp or
imptOv2meni i5 SOIU willlin one yGar ol complelipl. Ille OxTltr wi0 IWv! IIIE OurO¢n a� provinp IIUSIIe NO no� Wiltl of imDrO.R
lar t�e OurpOse ol sale�.
/! .�
I, as awner ol Ihe D�oOeny, am exclusivety contractinq vnt� IicemeC wntr�ctars ta consimct t�e prqect (Section 70aa, Business
�❑ an0 Proleuians Coae: TAe Cantractors' State l'cense Law Uces mt �pWY to �n awner ol O�aceny wtq �W4c or unproves ilrereon
an0 wno camracis for sucn projects vntn a contnctarls) Izense purswm to ine Coniraciors' State Lkensa Law�. I am aware
IIWI pmol 01 Iheir Worket'S Compen5a�i0n inwtanm SIrou10 Oe pmviOeE lo me.
� I am exempt unGer Section: B. 8 P. C.
�or Nis rtason:
Wte: Owner:
I ao IreRby cenily Ihat I am aware ol ana unaerstana IM r¢puiRmGnls ol Cdhtomu Healln ana Salely Cotle Salions 25505, 25573, anG
2557d anJ Itat I or any fuWre buileino acupant wilVvnll nol (acle ane) nrea lo fAmpry vnth uiE state wees an0 �he r¢puiremenis iw a
oerrtu� lo� consimc�ion ar modification Imm ine Au OuaOty Manapemenl Usinct. ResiOential Consirucibn aOVlications ire eaempt Imm
��� o�ovisions.
Oaie: Ap0licanl: _
I ne�eDy ce^' ihat I �ave read inis apDlicalion an0 state IIWt t�e
wGinar an slaie laws rNatmg Io GuilGing constmciqn aM �erel
pm y la�inspeciion purposes ,� �
�writy "'
Grean—CoOe
ci. I agree to campty wi�� all
ol tMs tity to enter upOn the a
Goltlenroe—Assesaor
CITY OF COSTA MESA — BUILDING PERMIT
PERMIT NO; E 062580 PLAN CHECK NO; N
ICONSTRUCTION TYPE; PERMIT TYPE; ELE
JOB DESCRIPTION ; UPGRADE METER 6 PANEL
CLAIM VALUE: CALC—VALUE;
PERM NO; E 062580 ' ,�
GOVT: N SUPP; N
PURPOSE: OTH
SQ FT;
GROUP OCC; /
COMMENTS: NO OTHER WORK AUTHORIZED BY THIS PERMIT
k iF it k it iF if iF 1E iE iF if ikif if if if 1k iF iF 1E k iF i! iE 1E i! 1F if k i! iflF ilit if 1t if �F if iF iF iE 1t k 1F iF iF if iF 1Flk 1k if if iE it iEif ik ik iF �f if iE iE 1k ik iF M k 1E iE iE iElF if iF 1!
Z O N I N G R E Q U I R E M E N T S
S E T H A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY BUILDING ---------
FRNT: FT IN REAR: FT IN FANT: FT IN REAR: FT IN
LEFT: FT IN RG}iT: FT IN LEFT: FT IN RGHT: FT IN
PARKING REQ• PROV; PARCEL; 00000000 ZNE; REF NO;
PLANNING NOTES>
�
iE iE iE if !E 1f �F it iE iF �k iF iE 1E if iE iE iF iF iflEiE 1E if iE 1f k IF if iFif iE 1E 1F iF if iF if if iF iF if if it If iF iF if M 1E if iF iF ik if iE iFiF if iF iE iF 1F i! �f if iF ik iE iF 1F iE if iF if if iE if k
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;
�� i
BUILDING APPROVED BY ; .'� DATE;
� � l
APPLICATION ISSUED BY: � DATE: fo
ifkikMlFiEMMifiFlFiFikikiliflEiFifiFlf�E ififiFMiflEiEifiFiE iFif
iFMiEKiEiEkMMikklkikifiEikiEMMiEkikMMiFifikikif3klFikklFififikilikifiFiFiflFk%iEifitifif�fkiEifMiFitififiEifiElEMitiFiFiEik3kKiEiFiFikiEifM
LEGALIZATION;N F E�E S U M M A R Y STRUCTURAL SEGMENT:N
BLDG PMT PLUMBING ELECTRZC MECHANIC FIRE SMIP/RES GRADING
PERMIT 31�Oi SMZP/NON—RES
PLAN
ZSSUE FEE 15.00
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 31,00 15,00 0.00 46,00 46.00 .00
REVENUBLDGVPMT�PLUMB NG ELECTRIC�MECHANI� FIRE6�SMIP�/TOT/SGRADING PLAN—C�HECK
46.00
kiflFMkkikkMMiflkiflfiFififiF3tifitiFiFitiFiFitifkikitkkiEffiF�kihikiFifiliFifilififiF!!*kikkiFilifikikiFkiflkitikihiFiFilkkikkkikikikifiEik
I N D I V I D U A L F E E H 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 2 RECEPT/OUTLET 1 ST 20 EA. .75 1.50
ELE 1 SERVICES BELOW 600 V 6 BELOW 201 AMP 18,50 18.50
ELE 1 SUB—PANEL 11,00 11,00
END OF FEES
UI U014D337-00140387 T C�T 46.00
URTE: O6/14/S3 TI11E: Q8:10
� � •
CONSTRUCTION ANDPLANNING � �
� APPROVALS Permit � Date
1. Temporary Etectrical �rvice oYPole �
z. $pil Pipe•Undrgrnd. - ���
3. �IecViCa! Conduit Ui�lity�Undrgmd.
4. Electricai Contluit-Undrgrr.�i �
5. Steel Reinforcement
6, Electncal UFER Grrd '
7. Pootmgs %
. 8. Foundalion
8. Water Pipe-Undrgmd. '
10. Structural Fbor SYstem �
11, ProRerty Sewer Linc � Ho�se Connect:on
-�>
72. Sewer Cap a �
73. Roof O�ains
14. Rough Plumbi��
15. Fough Electricar-Contlurt
16. Rough Electr.c4Yirin�
17. Rough INinng S�gn
78. Rough Electriwl-T Bar Ce�i�na
19. Rou7h Heating & A r Corurt�on�ng
�
20. �iough Facto,� Pirep!acc ' ` ,'
` iL �
-T
21. OuCts, in Strutture�F � -
a
22. DuGts, Ventit3ting. '. , ..
23. Gas Pipe Rough � Tesc .� +
24. Roofi Framing ' �'
25. flop.F� Sheathing �" , �i -
26. 7•Bar Cedin9 (Svi,cturall & ;�1onocoat �
� p7.� Frame and Ffashi2q � � -
28. Lathing & Siding �� - _ � - _
29. Insulation . �
30. Drywall Naihng
3i. Piastcr Bvo�.p CoaI- � •
32. ElectritaT�Po�7er A�eter•F�ra�
33. Fin21 ElectriC- . �
a4. Final Heating� A�r-Cond.t:anin�-�
35.� Final Gas PiFe-Test - , ,
36. Hood or Canopy �
37. f�nal FaetorV Fveplace ' ,
38. Finti Plumbing J -T
39. 1Vater Service-Firt�l �
40. Gas Service�Flna�
�.1. Solar pomesucF�cu:
42. Backf�ow Preventer
43. Backflow Irrigation .
44. Landscape Iniqaticn SVstem . ' �-
45. Sound Attenaatwr, �
46. Nandicap Re3ula! or.s
47, PINFlL STRUCTURE E BUILDING
48. FINAL PLANNING
49. Electric Release to Edison
50. Gas Release to Southern Caiifomia Gas
51. CERTIFICATEOfOCCl1PANCv
Oate
r
i
J
rQ�� �17
Insp4ctor qppROVALS Permit #
i
m
�
0
52. Pooi & Equipment �ocauon
53. Steel Reinforcement
� 54. Forms
55. Electrical8onding
� 56.' Rough P!umb!ng & Pr¢s�ure Test
--T-
57. APPROVaI_ TO COVER•GU�\i7E
53. Elact-�c.it Conduli�Undrg�nd.
_ ,� -
o"� 59. Gn P�ce, �_1 UndrArnd., Tcst �
� EO. BJr,i:�'.:yh �'^N5, P�TfOP. � �1rd!qrcd _
61. RPPROVAL. TO DECK
62. Batk:..::n & R�captorFinal�
63. He2ter & VenbFinai
64. Piumbing Syscem � Fi�ai
65. E'ect��cal•Ffrtal
66. $alar Sys:em�Finu�
67. rencing & Aceess ApPruval
68. APP70VED FOR PLASTERIYG
69. POOL/SPASYS7E�.4SFINAL
FIRE DF.PT. REQUIREMEIJT I
_ 'r APPRQVALS ,`Pun�it =.....^�,.��;
'_.-..'-. _
- ', 70. l'J�ldergrb�nd H��il�o `�
. � r71. Product.?��iing;-1G�s ❑�Dil
� � - • ' 72. Undergro�nd Flush n •
' ', , � '�3. �lJndergrnd. Storag��ank i 1 Ga> r: Oil � �
-�---_ -�
74.-Overhead Hytlro �
75. Dry Chemical . . � ' .�
, ,----�`
�� 76.� Dry Standp,pe . �. � ' �
'�, , 77. FIXEDSY$7[�14(aNAL;;• .�:
78: FIRF. PREV. FINAL � � �
� HEALTH,�EPT,,RE�UIREMENT
- i-`- _ _
�� { -79. FINA-L-Iiv-SE.ECTIQN: : -
�'2 F� 00� CERTIFIEATE ISSU�D ^
I Notez: _ _ .:
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Date I lnspector
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PROJECT AOOflES$: S S 3 W 17TH ST
OWNEX'S NRME: BALAI IS FA,�IILY TRU5T
aooeess: S,�y�
6'73-2282
AflCHIENGINEEP:
AOUflESS:
�1_ uNiT: A
HEG.NO.:
uxir:
PEXMITTEF:C M ELECTRIC (714)545-5831
nooness: 218 CRYSTAL AV
�V.B. CA 926b2
LICENSEU CONTBqCTOfl OECLANAiION: I hereby al�irm �hat I am licensed under Orovisions of C�apler 9(commencing wi�h Seciion
700o) o� Division 3 0l Ihe Business antl Protessions Cotle, antl my license is in full �prce and elfect.
cirvuc.: srarEuc.:652049 � ..1 �
Oa@: �� S— � T Signalure: _
WQBKEBS' COMPENSATION DECIAflFTION: I �ereb Ifirm e a cQrtiT te of consem f- ure or a ceniticate ol Workers'
Compen5aiion Insurance, or a cerlilietl copy thereoi �Se ' 3 La ).
PO�ICY NO.: .�
CpMPANY:
Q Certilietl copy is herehy lurnis�ed. ❑ Certified coD tl wi�h Ihe ciry Oing Oivision.
Da�e:
E7(�MPTION FHOM WOXKEPS
I cpnity Ihat in tne perlorm2
suh�ect lo Ihe Workers Co
�a�e: y _ 5 �
NOTICE: II, alier maki
COAe. you mus� �orthv
COpSTPUCTION LENOING
which this pennil is issued
LEN�EN:
RDOHE$$:
COMPENSATION 01
ce ol �he work for
�pensaiion Laws <
�is tleclara�ion, you
comply with such {
NCY�� I hereby a�i
��SW7. Crv. C)
sec�ion nee0 not be e
'JSsued.lshallno�
Aecome
s o�
re is
lillhe permitislorone hunaretl�$1001orless�.
any person in any mannpr so as to hecome
:0 5� n D�ovisions o��the LaOor
vo . _
cy for �he pedorman�e o� the work �or
OWNEfl BWL�ER DECLAXRTION: I hereby aftirm fhat I am exempt �mm �he Contracto�s' State License Law tor lhe following rea50n
(Sectian 7031.5 Business antl Prolessional Cotle'. Any cily af county which requires a permi� lo cons�mct, alter, impmve, Uemolish, or
reDair any slmciure. prior ro ils issuance, also requires lhe applicant for such permi� Io lile a 5igne0 s�a�emenl lha� �e/s�e is licens¢4
pu�suanno I�e prOvisions oi �ne ConVacmrs' Sla�e License Law (Chap�er 9 �commenping with Sec�ion 7000) ol Division 3 of �he Business
and Pm�essions Code) or Ihat he/she is exempt �herefmm and the hasis lor �he alleged exemD��on. Any violation ol Sectian 7031.5 6y
any applicant �or a permit sublec�S I�e apPlican� Io a civil penaliy oi not more �han five hunOretl tlolla¢ (5500�.
I. as owner of �he pmpeny or my employees wi�A wages as I�eir sole compensation, will tlo the work, anE the
�� stmcmre is nol intentled or oifered for sale (Seclion 70a4. Business anA Prof¢ssianal Cotle'. The Contracmrs' State License Law
tloes not appry to an awner o� a pmpeny who 6uilas or improves lhereon, antl who Ooes suc� work himselBhersel� or Ihrough
his or her own employees, pmvide0 Ihat such impmvements are not in�entletl ar oiferetl tor sale. Ii, however the building o�
imD�ovem¢nt is SoIU wit�in one year ot completion, the owner will have Ihe buraen of Dmving he/5Ae Oid not huild ar imOmve
lor ��e purpose oi sale).
� 1, as owner ot ihe pmpeny, am exclusively coniracting with Iicense0 WntractaR to con9mct ihe pmie�� (Section 7044, Business
ano Pmiessions Code' The ConVacmrs' Slate License Law tloes nnl apply �o an owner o1 pmperty w�o builUs Or impmves the�ean
and w�o conVaas for such pmlects wi�h a comracmqs� li�ense pursuan� lo Ihe ConVacmrs' S�a�e License Law�. I am aware
Ihal pmoi ot �heir Worker's Compensa�ian insurance shoultl be pmvided �o me.
❑ I am e�emp� under Section: 8. 8 P. C.
for fhis reason:
Date: Owner.
I tla here�y cetlify �hai I am aware oi an0 underslan0 �he requiremenis ol Cali�amia Heal�h an0 Safeiy Code Sec�ions 25505, 25533, antl
�653C antl Ihal I Or any tu�ure �uiltling occupanl wllllwill nol (clrcle one) need to compty w7ih saitl siate coAes antl �he requiremenis �o� e
permrt tor constr�ction or motlilication �mm Ihe Au Oualiry Manag¢ment OiStrkL ReSMential consV�ction apDlications are exempt hOm
Ihese pmvi5i0n5. .
�aie: ApPli�anl:
I hereby cerlily IAat I have rea0 Ihis aDPllcatlon and Slale Iha� Ihe a or �ion i�.e I. I agree �0 COmply wi�h all clry antl counry
o�dinances antl slaielaws relating�o builtling cwsiruclion arW he auU�orirer a� eso�t�is b�y�o ente�uponthe above-menlione0
pmDeny' lo.r inspeclion purposes.
�a�e: �'�` �J Si/gn�ai
Griqer's License or Sociai Securiiy a:
i6A1-46 �White—Builtlmg; Green—Cotle EntorcemenL Canary phcanC ink—Revenue: Goldenmtl—Assessor
, -�_,-
CITY �F C051'A MESA — BUILDING PEkMIT ,�'ERM NO; E 061615
PEkMIT NO; E Q616I5 PLAN CHECFi NO; N GOVT; N SUPP: N
CONSTFtUCTION TYPE: PERMIT TYPE; ELE PURPOSE: OT$
JOB DESCRIPTIUN : INSTALL NEW METEk 6 PANEL SQ FT;
CLAIM C'ALUE; CALC—VALUE; GROUP OCC; /
CO,NMENTS: NO OTHER WORK AUTHORIZED BY THTS AERMIT
*x*���*�***x�*�*x�r*xz�**��rx***��**�t***��r*****�tx�***x-***x���r*�x��x�r�r�r*#u-*n��t#�r*xx#x��
Z O N I N G 12 E Q[3 I R E M E N T S
S E T B A C K S
------------ MAIN HUILDING ---------- --------- ACCESSOFIY BUTLDING ---------
FftNT: FT Ih1 kEAit; FT IN FRNT: FT IN REAR; FT IN
ZEFT: FT IN RGHT; FT IN LEFT; FT IN RGHT; FT 7N
PAftKING REQ• PROV; PAkCEL; 00000000 ZNE: REF NO;
PL'ANNING N6T'ES>
i
x�rx,rx�*�r**����***�r*x*�*�*�**x-x�x-�r**x****����t#�*x�*#*�***���*#rt�c#***�***�*�c x#cet�a��*��
D E V E L O P M E N T Sf'E,:R V I C E S R E Q U I R E M E N T S
�
20NING APF�ROVfiD HY •:�'" % _ ,DATE;
HUILDING APPROVED BY ; � •-' � DATE;
APPLICATION ISSUED BY• � .'i �1 DATE• �
iEiF�fif'7F#iE'7f#!ElfifiEifX'IE'lflf'M'Ihif'If . . . . . � .x . x. . . .... .*..x. : . ., . .'%'1l'icRi("N'3fiEiE�IE'IFiEiE��n �i.�fFitl(' h%I%iE
iE iE 1f % k i( if 3F �)t jf �1f �lE if iE i4 x� 3F 1F if- if jf� iF # 1k iF 1E lE 3F if iE #l4.1E-k jklE if� iE iF 1F if iFiF 9(� # K�if� ft �lF it 1E i4 if -1E iE-k if -% 3FlE !f �F iE �)F i(� iF �F iFlF�Ih # I!�-)E 1E %� jE?E iE i:
LEGALI2ATION;N r'��E' S U M M A R Y STRUCTURAL SEGMnNT:N
BLDG PMT PLUMBING_ ELECTRIC MECHANIC FIRE SMIP/RES GRAUING
PERMIT 79,50
5�� SMIP/NON—RES
PLAN
ISSUE FEE 15,00
BUILDING—DIV—s PERMIT ISSUE PLAN—CHECK TOTAL PAZP DUE
TOTALS----> 29.50 15.00 0,00 44,50 54,50 ,00
RECrENUE DIVISION TOTALS--> COLLECTED: 44,50 OVER/SHORT• 00
BLDG PMT PLUNBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECiC
44.50
iF tE if % ih �fk ik #�1f ?r 3E it 4 ik 1f iE iF 3E �Yh �iE if 3E i! iE it� iF # it� %� ik iE i6 it 3E �3E iE iE .1(� �lf� if if iF if �E # i(� )Fi6 fF it ik !(� fF if- N� 3F N� if N� # iF�lf �9F ltif� it �1E iFiF !E i'r jf� jFlf� #-M �!F!E?e
I N D I V I D U A � F E E H R E A K D O W N
TYPE QTY D E S C R I P T I O N DNIT COST TOTAL COST
ELE 1 SEkVICE5 BELOW 600 C� 6 BELOW 201 AMP lEi,50 SEi,SU
ELE 1 SUB—PANEL END OF FEES 11.00 11,00
� ,�. �- �
CONSTRUCTION AND PLANNING �- � POOL & SPA t�
APPROVAtS Permit,-'�,_F�.-� �ate Inspector APRflOVAL5 Permit# Date inspectot`
7, Temporary Electrical Service or Pole � 52. Pool & Equipment Location '
Z, Soil Pipe-Undrgrnd. - 53. Steel Reinforcement
3. Electrical Conduit Utility-Uruirgmd. _ 54. Forms �i '�
4. Electrical ConduibUndrgrnd. , 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Pl�mbing & Pressure Test
6. �lectrical UFER Grnd _ 57. APPROVRL TO COVER�GUNITE =�"'
7, Footings '. " 5$�. Electricai Conduit�Undrgrnd. `
.
$. �oundation , • � 59. Gas Pipe, C Undrgrnd., Test .
9. 4Yaier Pipe-Undrgmd. � ` � �. 60. Backwash Lines, P-7rap, O Undrgmd. !' �
10. 5tructural Fioor System ,� . 61. APPROVAL TO DECK -
t1, property Sewer Line & House Connectiwt � � 62. Backwash & ReceVtarFinal � ��
�2. Sewer Cap � � ' � ` 63. Heater & VenFFinal
'�13. Roof prains � � �/�• 64. Piumbing Syscem - Finai
14. Rough Plumbing ,'� 65. Electricai-Final
15. Ro�gh Electrical-Conduit �. 6� Solar System-Final
1
16. Rouc�h Electric Wiring � '. Fencing & Access ApProval
�1�� -
17. Rough Wiring Siyn 68. APPROVED EOR PIASTERING
i
18. Rough Electrical-T 8ar Ceiiing 69. POOL/SPA SYSTEMS FINAL
79, Rough Heating & Air Cn:zditioning FIRE DEPT. REQUIREMENT
20. Rough Factosy Firepiace APPROVALS Permit�` I
21, putts, in Structure 70. Underground Hydro
22. Oucts, Ventilating 77. Product Pipin9 O Gas OOit
23. Gas Pipe-Rough & Tes? 72. Underground Flush
24, Fioof Framing 73. Undergmd. Storage; Ta�k O Gas ❑ Oil
25. Roof Sheathing 74, Overhead Hydro
26. T�Bar Ceiling IStructurat', & Monocoat 75. Dry Chemical
p7, prame and Fiashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINA�
29. fnsulation 78. FIRE PREV. FINAL ��
30. OtYY+all Nailin9 HEALTN DEPT. REQUIREMENT I
37, P�aster Brown Coat 7�. 'INAL INSPECTION ( �
32 Elecirical?owar MeterFinal LL_�_�3 ' �' 'OOD CERTIFICATE ISSUED�- �
T _� _�
33. final Electric ���3 � ' .•� ites:
34. Final Heating & Air CondiCloning
35. Final Gas Pipe•Test ,
36. Hood or Car.opy �
37, Final Pactory Fireplace i i� �
38. F�nal Plumbi�g � � . �
39. Udater Service-Final .�
4Q. Gas Service-Final �
41, Solar pomes2ic-Final i � '
i^
42, gackflow Preventer i '
43. Backflow trrigation � �
44. Landscape Irripation System
A5. Sound Areenuation
46. Handicap Reg:dations ,
47. FINAL STRUCTURE & BUIIDING ``�
� .
48. FINAL PLANNING r ,
49. Electric Release to Edison ��
50. Gas Release io Southern California Gas Co �i
51. GERTIFICATE OF OCCUPANCY
No. Date
�
��
y
PqOJECT ROOflESS: B S 3 Sd 17TH ST
awxexsNaME: HALALISE
aooness: 853 W 17TH ST
CpSTA MESA, CA 92626
RHCN/ENGINEEfl:
ADOflESS:
pEG.NO.:
uxtT:
uxir:
PEftmirTEE PETRONELLA ROOFING i 714 ) 548-1645
ADDNE55: 26'z�`�6 NMEWP,T�ORT 9 201
LICENSEU CONTflFLTOA d�IRfATIOB: ��re6y a�tirm �hai � am licensea undeCr pvison�o�Clfapler 9(commencinp wit� SectiOn
IOUo) o� Oidsion 3 of �he Business and Prolessions Code, an0 my license is in WII lorce antl e��eci.
CITY LIC.: STRTE LIC.: CN55:
,Q32 �1`,� 0046 C 39 EXP; 07/95
Date��' ��� Sipnamre: —
WOBREBS' COMPENSATION OECIAPATION: 1 hereby af�irm lhal I ha enilicat ol consent to seu�insure or a cenilicate o� WOMers'
Comoensation Insurance. o� a cenifie0 copy thereof (Section 7800. Lao.
Poucr xo.: z 15 5 81 15 9 9 5 E%P. ORTE: O I I O 1 I 9(
camrnNv: ARGONI�UT
� Cenified copy is �ereby umrsAed. Q C¢rtilie � tile � t�e ciry BuilAing Division.
—�� Q� »
Oale:�� `'AOWiGant��—
EXEMPTION FPUM WapNEBS' fAMPEN5A710N �ECtANA710N: � ' neeA noi be con etetl i� �h¢ perml is forone �unarM �570�) w less�.
I ceriity Ihai in Ihe Oe�ormance ol Ihe work �ar whic� �his perm�t is issue , ploy any OerSon in any manne� 5o as ro �ecama
su6jea to the Warhers Compensation Laws of Califomia.
Daie: SipnaNre:
NOTICE: II, al�er makinA �his aeciaration, you shoultl eecome su�ject to the Warkers' Compensaiion o�ohsions al tAe Labor
Cotle. yau musl forihwilh comO�Y'A^�h suc� pmvisions or Ihis permit shall be CeemeA revokeA.
C�NSTRUCTI�N lENU1NG AGENCY: I herehy alfitm that Nete is a consUucUon lentling agency lar Ihe pertormance oi t�e wark lor
which �his permit is issuetl (Sec�ian 3097. Civ. C�.
LENDEfl:
AO�NE55:
OWNEH BWLOEH OECLAflATION: I hefeby alfirm I�at I am eeempl irom the CAn�rac�ors' State Lic¢nse Law lor t�e followiOB �ea5on
(Section 7031.5 Business and Pmfessional Cotle'. Any ciry ol counry which requires a Oermit to conslmct, aiter, impmve, OemolisR or
repair any sl�uclure. prior lo ils issuance. also requires ihe applicanl lor sucn oermil to lile a signee statement inal nels�e is IicenseJ
pursuam to I�e pmvisions o� Ine ConVacmrs' State License Law (C�aD�er 9(commencinq with Section 7000) of Oivision 3 0l the Business
an0 Protessiom Co6e) or ihallrelslre is erempt 1Ae�etrom antl Ihe basis b� O�e altep¢d exemD��� Any viotation of Sectbn 7031.5 Gy
any a071icant lor a permit SUGlecis Ihe a001icani to a civil penalry o� �ot more t�an five hunOred OWIarS �ESW).
I, as owner of Ine pmpeny or my employees with waAes as their sole compensation, will tlo the work, antl ine
❑ stmclure is not imentletl or oHered for sale (Section 70a4, Business and Pw�essional Cotle: TAe Contracmrs' Siale License Law
Coes nol aD01y �o an owner o� a D�oDe�y wh0 builtls or im0�a�e5 ihereon, an0 who does Su[h wof� himsell/herself a� �hrougA
�is or �er own employees, O�oviAea ihai such imprwemenis are nol intenUetl or oifered for ule. If, �owever t�e �uildlnA or
, impmvement is sola vnNin One year ol tom01¢�ion, �he owner will have �h¢ Eurden o� Orovinp �e/She Aitl not huilA or imprOVB
br Ihe DurOose ol sale).
I, as owner oi t�e p�openy, am exclusively contractinA wit� licensetl contrac�ors to consimct the prole�� (Seclion 70a4, Businass
❑ antl Professians Code'. The Cantractars' Slate License Law Uoes not apDty to a� ow�er af 0�o4erty who 6altls or imDmves tAereon
and wh0 tanlrad5 �Or Suth prol¢t�s wiUl a Contrac�or(S� liC¢nse pUrSuani lo Ihe CqnVac�afs' Sta�e LiCen50 Law�. I em aware
I�al Orp01 ol�heir WOrkei 5 ComDenSd(ion inSUranc¢ S�Ou10 Ge ProviO¢4 Io me.
� I am exempi unAer Seciion: B. 8 P. C.
lor ��is reason:
CITY OF COSTA MESA — BUILDIP]G PERMIT PERM NO• B 070431
PERMIT NO: B 070931', PLAN CHECK NO; N GOC'T; N SUPP: N
CONSTRUCTION TYPE; PERMIT TYPE: STR PURPOSE: OTH
JOH DESCRIPTION ; T/OF E REROOF W/HUILT—UP SQ FT: 5,000
CLAIM VALUE; 5,00 .00 CALC—C�ALUE; S,OOO.QO GROIIP OCC; H-2 /
COMMENTS; AEROOF 7300SF COMMERCIAL BUILDING W/BUILT—UP
if M if if M if 1E 1E if if if if iE if 1E if 1f if M 1E ik ff aE if iE if if iE if if if aE if if fE �f 1E if if ik i! i� 1f 1f iF 1E 1E iE 1E * M iF i: iF at if it If * iF if iR if � if iE it ii if if if iF if �E if if aR �f jE
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 BUILDZNG ---------- --------- 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 REQ: PROV; PARCEL: Q0000000 ZNE: REF NO:
PLANNING NOTES>
>
if 1E ff M A if iE if if i! if if M 1E it k M 1k it if if if k 4 if 1E iflk iF if iE if if� if iE jf iE if 1f iF if iP if �f iF ff ik �f 1f if iF if if ff if aE if M iF �f iE if 1E if if M it ih if iF iR if iE ff iM1 iR iF iE if
D E V E L O P M E DI T S E R V I C E S R E Q U I R E M E N-T S
ZONING APPROC�ED HY DATE;
HUILDING APPROL.ED BY ; DATE:
��
APPLICATION ISSUED BY; DATE:� �i b
NiEifMiEifiE�E3tdfififilifrifit%ififif�F ifififiEi4lEifififiF . iFiF
aE if ff 1f 1E if iE 4 iE if if iE iE iE if �F it if if M iE 1f if it it iE iE iF r if if if if 3f iE iF if if if jf if if af i4 if if if if iF if iF if if iF iE iF if iE �f at �f it if 1f if if af rt if iG rf af iF 1f iE if iE iE iF
LEGALIZATION:N F E E S U M M A R Y STRUCTURAL SEGMENT;Y
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 72,00 SMIP/NON—RES
PLAN 1.05
ISSUE FEE
BUILDING—DIV—> PERMIT ISSOE PLAN—CFIECK TOTAL PAID DUE
TOTALS----> 73,05 0.00 0.00 73.05 73.Q5 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 73,05 OC�ER/SHORT: ,00
BLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIF/TOT GAADING PLAN—CAECY.
72.00 1,05
1f if if if M if ff iE if if if if if sf �lElf it 1F 1f �f if ft 1f if iF if �F 9f M 1E ik ik 1f �h ff iE ff M ff if if if M 1f if i! if 1f 1f if %if if M iF if iF k ft if fF 1t if if 1f iF iE 4 M if if ��)f iE if ff iE if iE
I N D I V I D U A L F E E B R E A K D O W N
TYPE
Date: Ownec I
I ao nereey cendy thai I am aware ol and uneerslanU Ihe reauiremems of Califomia Healtn antl Salery Cotle Sectbns 25505, 25533, an0 S FC
25534 ana inal I ar any IUNre OuilOing occu0ant wiiVwill not (circle ane) neetl to camO�Y m�� �iG state taUes and tlle repuiremenis for a
permii Im comlmtiion o� moMti¢alion irom �Im Pr �u2���y Manapemeflt Di5Vic4. Resid¢nlial conikUttian appGwliW�s are e+empl lfom
ihese provisions.
Oate. Applicant:
I l�erehy c¢N�y Ihai I tuv¢ reaa IhiS apptita�ion an0 Siate Ihal I�e above informali0n i5 corteci. I ag�ee lo tomply wi�A all tiiy a0d tounry
or4inaMes an0 9ate laws relating lo �uil�ing constmction antl �ereW aulM1orize representatives ot tllis dty Io enter upon ihe above-mentioneA
pmper�y lor inspeclian purpases.
r � �_
Oale: � ��� � Sign ��%
Orive�'s License ar Social Sewriiy � � � _
�6at�46 wmte—Builtling; Green—Code Enlorceme�C Canary—Applicam: Pink—Revenue: GalOanrotl—Assessor
QTY
5000
D E S C R I P T I O N
REROOF HY VALUE COMMERCIAL NOZONE
END OF FEES
UNIT COST TOTAL COST
1,00 5,000,00
01 401757u4—OCi7S7P.S Tr] T i3.05
OpTE: +3S/;iQ/45 TIIiE: 15:10
,b
CONSTRUCTION AND PLANNING PO(. � SPA ,
APPROVALS Permit # -gate inspector ApPAOVRLS Permit # �ate fnspector
1. Temporary Electrical Service or Pole - 52. Pool & Equipment Location
2. Soii Pipe-Undrgrnd. � � _ - 53. Steel fteinforcement
3. Electrica� Conduit Utility-Undrgrnd. .'. 54. Fo�ms
4. Electrical Conduit-Undrgmd. 55. Electrical Bonding
5;:Steel Reinforcemenc . � 56. Rough Pium6ing & Pressure Test
.6. Electrical UFER�Grnd. 57. APPROVAI TO COVER-GUNITE
7. Footings 58. E�ectrical Condutt•Undrgmd.
8. Foundation � 59. Gas Pipe, � Untlrgmd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-.Trap, L� Undrgmd.
10. Structural Fioor SYs[em 67. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. 2ackwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent�Final
73. Roo( Drains 64. Plumbing System - Final
74. Rough Plum6ing 65. Electrical-Final
15. Rough Electrica6Conduit 66. Solar SVstem-Final
16. Rough Electric Wiring 67. Fencing & Access ApP�oval
17. Rough Wiring Sign 68. -APPflOVED FOR PLASTEfltNG
18. Rough Eiectrical-T Bar Celling 69. POOUSPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rovgh Facmry.Firepface ,' • ' - APPROdALS � �- Permit #T�
21. Diicts, in Structure •• - ' - 70. UnderqroUnB Hydra
22. Ducts, Ventilating 7:1. Product P.ipiny C.lGas �Oil
.�
23. Gas Pipe-Rough & Test .�� � � - - 72. Underground Flush �
24. Roof-Framing' • • '� � ._ �3. Undergrnd.Storaye Tenk O Gas ❑ Oil
25. Roof Sheathing --�/. S�- 74. Overhead Nydro .
26. T�6ar Ceiling (StructuraU & Monocoat . � 75. Dr,y Chemi�al _ �
27. Frame and Flashing � . . . � 76. Dry Standpipe '
28. Lathing & Sidfng ' � � ' � • . • • 77, FIXED SY�T�M FINAL `
29. Insulation �. • � ` �� � � � 78. FIRE PREV. FINAL -
30. DrYwall Nailing .. � � - HEqLTH D�PT. REQUIREIVI[NT
31. Pl�ster BroKn Goat . _ , ' 79. PINAL INSPECTION
32. Electrical Pow2r A4eterFina� ' � 80. fOOD CERTIFICATE ISSUED
33. final Electric � - � � Notes: - . -
34, final Heating 8c Air Conditioning . .
35. Pinal Gas P,ipe:Test . .. , . � _ ... - ' . .
36. Hood or Canopy " - � - � � , �� ' , ' ^
37. Finaf F,aciory Firepiace � . -
38. Final Plumbing � ' � � -' � ' J
39. Water Service-Final - � ' .
40. Gas Service-Pinal �. � � "
47, Solar OomesticPinal � ; ' � , . . � � �
42. Backflow Preventer � � � . � �
43. Backflow frrigation ,
44. Landscape irrigation System � * � � '
45. Sound Attenuation , ' . � � , •
46. Handicap Regulations � � �
47. FINAL STRUCTURE & BUILDING � �T� �`� ' '
48. FINAL PLANNING . ' � �
49. Electric Release to Edison � '
50. Gas Release to Southern California Gas Co - � -
51. CEFiTIFICATE OF OCCUPANCY
No. Dace
�
�
�
rxo�cr�ooxess: 853 W 1'7TH ST
� OW11Efl'SNFME: PAUI.� H�+�a1Jr '
aooxess: 1500 W BALHOA '��O1S213
NEWPORT BEAC:i, CA 92663
673-2282
AflCHIENGINEEX:
flEG.NO.:
UNIT:
FOOflE55: UNIT:
PENMITTEE: PAUL BAI�AI�IS ( 714 ) 673-22A2
pDONE55: SSOO W HALBOA Z�1
NB CA 92663
LICENSEO CONTHpCTOfl OECIABATION: I AereOy aflirm Iha1 I am Iiteme0 unUer provisions ol ChaD�er 9(commencinp wii� Seciion
7000) ol Oivigon 7 0� t�e Business antl Prolessions CoOe, anC my license is in lull lorce ana ef�ec�.
CITY LIC.: STpTE LIC.: CLASS:
Date: Sg�aWrt:
WOPNEFS' LOMPENSRTION OECLAXATION: I �ereby aliirm inat I �ave a certilicale ol consent lo selbinsum or a cenificaro ol Worken
Compensation Insuranu. or a cetlilie0 copyoihereof (Sec�qn 3800. La6. C�.
POLICY NO.:�] s Z% 3•L�,• �/� E%P. ORTE: O:�-O ��3
COMP�NY: C�TRT�y F•�7✓ p
❑ Cerli/lieG� COOY �5 IICreGy lumi5�e0. Q��ilieG coOY is fileE wii� t�e city Buildinq OiNsion.
Date: / � � _ / � Appliwnt: �(J,I�� Y W w �
EIfEMPT10N iXOM VlOflNEXS' COMPENSATION OECUINITION: (ih6 SetWn �N ipi be amplelN il Ne pefml6 �a Ore M1MreU (5100) a IRS�.
I CBriily Iliai in I�C pEtlOrmance al Ilm w9d tor wNch �h6 permii is i55ue0, I shall nol ¢mploy any perwn in a(ry mannBr 50 aSIO MWme
5u0itti Io I�e Warkeri fqmp¢n5atron LawS ol CalitOmu.
Date: Sgnawrt:
NOTICE: II, after md4inA INS GCflaration, you sh0uld G¢tOme wGjMi to Ihe Workeri fAmpensation pmvi9on5 al �he LaCor
LoOe. yW musl IaNrxil� comDN ��� w[h O�Ovition5 Or lltis Dermil �M1all De UeemeC r¢vOkeO.
CONSTBUCTION LEN�ING AGENCY: I �e20y allirm t�at l�ere ¢ a con5tmttion IenOinA apency far t�a peAormance ol t�e woM lor
wNtl� tNs oermil is issue0 (Senion 3W7. Gv. C�.
LENOEH:
ROOflESS:
OWNEB BIIILOEN OEClANA710N: I �ereby allirm t�ai I am exemD�fmm Ne Contractors Slate License Law lor t�e following reason
�Section 709L5 9usineu anG Professional CoOe: My uty.Qi caunty w�ic� reQuires a permit to constmct. alter. impmve, Eemolis�, or
reoair any strutture. prior to its issuance. alio requires Ihe aDD�iCant for such permit to hle a sipne0 statement ��al �Pls�e is licentetl
pursuant �o ��e provisions ol �he Coniracmrs' Slaie License Law (Chap�er 9(commencing wi�� Sec�ion 7000) of Oivision 3 0l I�e Business
anG Pmtessions CoOe� or I�al �elshe is exempl t0erelmm antl the basis for IAe alleged exem0�ion. Any violation ol Seclion 7031.5 by
any aD0licant for a permit suoietls Ihe aoPlicant Io a civii Denatty af not more Ihan five nuntlretl eollars (55001.
� I. as awner of Ihe property ar my employee5 with wages as their sole compensation, vnll Eo �he work, and the
stmcwre ¢ not intenaetl or onere0 for sale (Section 7044. Busineu an0 Pmlessional Catle: The Contracrors' State Liunu Law
aoes Irot apO�Y �o an owner al a o�oDeny who Ouilds or impmves ihereon, anA who tloes such wark himsell/hersell or inrouqn
�is or her own employees, pmviUeU ihat such improvemenis are not intende0 or offeretl lor sale. If, �owever t�e builtlinp or
impmvemem is 5010 wit�in one year ol completion, Ihe owner wili have t�e burden ol pmvinA �e�s�e Oitl nol 6ui10 or impmva
, br �he purpOse ol sale).
I, as owner o� t�e O�opetlp. am eetlusively contratlinA m�h Iicense0 contraciors to cons�mct Ihe prolect (Section 70M14, BuSiness
❑ anE PmIe55ian5 Cotle: The Conlraziors' Sia[¢ lkenSe Law tloes not apply lo an owner ot pmpetl9 who LuiIGS ar imprOv05lM1¢r¢On
anE w�o COnlracis tor 5uch prolecis wi�h a[onUacior�s)license pursuan�lo the Coniractors' Siate License Law�.l am aware
I�al proal ol I�eir WOMer'S Campensation insurance s�oulG C¢ pmviGeO �o me.
� I am evemo� unae� Sep1iM: 8. d P. C.
tor INS reason:
� k---1
Daie: � �� ^�� O,mer. G Y W w��
I ao �ereW certdy Inat I am aware al an0 un0erstanU Ine reduirements al Calilomia Healtn ane Salety CoUe $ecii0ns 25505, 25533, aiM
25574 anU IIWI 1 ar a�ry INure EuilGtnp OLCupdni vnllNnll nol (Girtle one� n¢Ed lo COmO�Y ��h SaiE Slai¢ COd¢5 an01�0 �epuir0m8nf510r a
Oermii br talsiruttron or moEilitalion Imm I�e N� ality Manapement Usidct. fleSiGeniul cansiruclion aDDliqtions are exempt Irom
I�a¢ OroW5bn5.
Ddle: Apd�anl:
I �ereW RrtAy t�al I tWv¢ reaOl�is appl¢alion ana stale tlu� ��e above inlormation is [orrect. I agree ta camply wii� all City and counry
otEinaMes an0 statelavrsrelatinqlo GuilCinqConsimction an0 Oe�eEyaullwriierepreuntalives olt�is citylo enleiu0ont�e a0ove�mentiOneE
proDeny (/fo,�r? �insoe�c�ion9ouroMes. JI/1�" ' "
Daie: _�� Siqnalme: J�/JT -_� `
Driver's L¢ense oi Social Seeueiiy .:
�6a1d8 W�ib—BailOino: Groan—CoEe Enb¢emen�: Canarv—AOWkanl: Pink—Revenoa: GOIEenroE—AssesSor
CITY UF CO5TA MESA — SIGN PERMZT PEHM NU: 5B US itl9
PERMIT NO; SB 059184 PLAN CAECK NO; 03680-92 S v i; Sur : N
CONSTRUCTION TYPE; PERMIT TYPE; STR SIG PURPOSE: OTH
JOB DESCRIPTION ; WALL SIGN SQ FT;
CLAIM VALUE; 250,00 CALC—VALUE; 25U,00 GROUP OCC: B-2 /
COMMENTS: WAI.L SIGN
+r�*x--xxxxa�**xx�c*�x*x-*x�r*x*x�r*�x�*a�r�rz�*�x�x�x*�x•x��cx�r�x-�x-rt+t*.x..x.,���c**�r+�xxxx*xxK�*�*
S I G N I N F O R M A T I O N
DISTRIC'T: 2 1'YPE; WALL ILLUMINATION: NON CATEGORY: NEW
DIMENS70NS: 3£T OSIN X 7FT 03IN AREA: 26.605QFT LE'I'TER HT: 12"
STREET FRONTAGH 1: 110,00 S'CREET 1: W 17TH ST
5'TREET FRONTAGE 2; 160.00 STREET 2; BAHCOCK
PARCEL: 42�10115 ZONE: MG I.,OCATION > ERONT: X REAR:
BUSINESS NAME: CORVETTE SERVICE > I.EFT: RIGHT;
O T H E R T O T A L S G R O U N D S I G N
THIS ACTZVITY : 26.60SQFT OVERALL HEIGHT: OFT OIN
THTS SI'CE : 26.60SQFT GROUND CLEARANCE: OET;.OIN
ITEMS OF INFO : 2 PLANTBR AREA: O�OOS�FT
ITEMS FOR ACTIVZ'PY; 2 BLDG SET BACK: 20FT�f
COPY VERHIAVE : CORVETTE SERVICE 853 W 17TH 5T �•
PLANNING NOTES; '�
iFfkiflfltitiFikikiEiE�F1E�FiEiEiFiEiE3hlFiEiFiElE�kikltlE-1f7ElEiElfiEiEkif3fkiElFiEiElEikifiElEiEiFiEiEkji%fF3FiF1EiEMiE�FltiEiEiEif iEiEK-iE�hiFiFffiE
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�� S
ZONING APPROVED BY ;_��i�M —� �— DATE; .,�
BUZLDING APPROVED BY ; DATE: �
APPLICATION ISSUED BY; DATE; ��F����
iFiliEiElEilkiElEiEIFiEiFitffiFiFlh�(�iFfkit . z!¢ r rt frxfriFiEikiEkiElfklkiE tr iE3E
LEGALIZATION;N F E E S U M A R Y STRUCTURAL SEGMENT:Y
BLDG PM1' PLUMBING ELECTRSC MECHANIC SIGN SMIP/RES GRADING
PERMIT 15,00 26,60
SMIP/NON—RES
PLAN 9.75 .SO
ISSUE FEE
BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 92.10 O,UO 9.75 51.85 51,85 ,00
kEV^cNUE DIVISION TOTALS--> COLLECTED: 51,85 OVER/SHORT; 00
BLDG PMT PLUNBING ELECTRIC MECHANIC SIGN SMIP/TOT GRADING PLAN—CHECK
15.00 26,60 .SO 9,75
*�**,��***�***,�����*�**�,�*�*��**�.�,���***.,��**,��**��,�*�*��***�*�-�.�**�*�,�*�**.��**��
I N D Z 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
NO FEES WERE; SELECTED FOR THZS PERMZT
.... :. �l .. _ ' . ' < _c , -•
� CONSTRUCTION ANDPLANNING POOL PA
��. APPROVALS Permit # Date Inspector pppROVALS Permit # Date Inspector �
r "
1. Temporary Electrical $ervice or Pole 52. Pool & Equipment Location `� �i
�
2, Soil Pipe•Undrgrnd. � "� 53. Steel Reinforcement � .;
3. Electrical Conduit Utility-Undrgrnd.` � 54. Forms ' �
�..t
4. Electrical Conduit-Undrgrnd. � �' � 55. Electriwl Bonding �9
' ,-
5. Steel Reinforcement 7: y. 56. Rough Plumbing & Pressure Test
6. Electrital UFER Grnd. �' � 57. APPROVAL TO COVER�GUNITE
,�,
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation ,��1 59. Gas Pipe, O Undrgmd., Test ,\
_/ �
9. Water Pipe-Undrgrnd. �� 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural floor System .. � 61. APPROVAL TO DECK �:_
71. Property Sewer �ine & House Connection 62. Backwash & fleceptor�Final
12. Sewer Cap % 63. Hearer & Vent-final �`t
73. Roof Drains �:, 64. Plumbing System - Final �
i�
14. Rough Plumbing 65. Electrical-Final •,� i
75. Fiough Elecvical-Conduic �.. 66. Solar System-Final � "
16. Rouqh Eledric Wiring 67. Fencing & Access Appro�ai I
17. Rougn Wiring Sign 68. APPROVED FOR PLASTERING :
18. RoughElettrica�-TBarCeiling 69. POOVSPASYSTEMSFINAL
19. fiough Heating & Air Conditionfng FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. Dutts, in Structure 70. U�derground HYdro
22. Ducts. Ventilating 71. Product Piping �Gas ❑Oil
23. Gas Pipe�Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T�Bar Ceilin9 (Structural� & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding � 77. FIXED SYSTEM FINAI
29. Insulation �_�. 78. FIRE PREV. FINAL
30. Drywali Nailing ��! � � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat ��-, J9, FINAL INSPECTION
32. Electriwl Power Meter-Final ' 8�. FOOD CERTIFICATE ISSUED
33. Final Electric l, �Notes:
34. Final Heating & Air Conditioning • �
35. Final Gas Pipe-Test
36. Hood or Canopy , ���
37. Final Factory Fireplace � � ` '
� �
38. Final Plumbing � �� �' '
39. Water Service-Final , �
i
40. Gas Service-Final
i� �
41. Solar pomestic•Final
!T
42. Backfiow Preventer i �•',"
43. Backflow Irrigation
44. Landscape Irripation System
45. Sound 0.ttenuatioa
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING LC�',R ��� ^
48. FINALPLANNING ��
49. Electric Retease to Edison ,
�
50. Gas Release to Southern California Gas Co `
51. CERTIFICATE OF OCCUPANCY
No. Date
0
�
CI�TY'OF COSTA MESA CONSTRUCTION PERMIT ,
. P«�ilt Address � y✓ �7� �`i
NPplicant's Mailina Add 20;• ,,, �� ...,u pL� GSRe�r�z �'`'
Owner's Name `%�f }3,�LAG 5 C�i �y� phaneC-7$ •P2.�i�$
Adtlress�7/�� ��L+�+��"iE 2i'i p�,PtSfAc' ,
Arch/Eng.�'a`�5�!�ARrs71 �icense No.
Address
Contractor'sNamPT^�Ff'.L.Mrf�LL•�i, Phone''i`�+��%�'�
Addresslmailingl��N• %�e�•^�" ��- � ^ � �_!;��
City License No. �I � ( �
LICENSED CONTRACTOR DECLARATION
I be�eby affi�m that I am licens¢tl untler proviSion50� Cha�t¢r 9(mmme0ting
with section ]000) of Divlsion 3 ot t�e Business antl Professionz Coae, antl
my license is in f��� �orce antl effec(. ��,
License Class syq ' ++
Date�`�%�— ZS�$(a Signature �
'YORKERS' COM7ENSATION DEGLARATION
hereby a/firm tha[ I have a cerU(Icate of consent to Selt�insure or a certlfiw[e
.7 Workers' ComPenSation Insurance, or a certitieA copy Ihereof ($eCtion
3800, Lab. C.) w
Policy No��N ��L�/ 4 Compan� '
❑ Ler[ifietl copy is hereby furnishetl. �f
��C rt fie copy iz filetl wi[h Ihe city � g rv p' ,
Date �"" ' Applicant �
E%EMP ION ROM WORKERS• COMPENSAT ON OECLARATION --
(This SCction neetl not be completetl if the pe�mit i5 to� one huntl�etl ($300) or
Iess).
I certify that in tpe perto�mance of the wo�k for which this pe�m�t I5�i55uetl, I
shall not employ any person in any manner so as to become subject [o the
Workers' Compen5atlon LdwS o( California.
Date S9nature
�NOTICE: If, after making [his tleclaration, you Shoultl beGome su0ject t0 the
Workers' Compensation ptovivons of the Labor Cotle, y0u must forthwith
comply with suCh p�Ovisions Or this permit shall be tleemetl �evok¢tl.
CONSTRUCTION IENDING AGENCV �
I hereby affirm th3l tnere is a cons(ruction Ientling a9ency for the oertormance
Ot the work fo� which tnil permit is Issu¢tl ($ectlOn 3097 Civ. C.)
Lentler'z Name
Lender's AOCress
OWNER BUILDER UECIARATION . - �
I hereby'affirm tpat I am exampt fram the Contractor'S License Law for the
followinq reason (Section ]031.5 Business antl Professlonal Cotle: Any ci[y or
county whlch requires a permit to const�uc[, alfer, imp�ovo, tlemolish or repal�
any structure, prior to Itz issuance, also requlres the applicant for such permit
t0 /ile a si9ned slatement that he/ihe Is lic¢n5¢tl Ounuant to th¢ provisions of
the ConVactor's Vtense Law (Chapler 9(commencing with Section 7000) o�
7lvision�3�of"the Business antl Professions'Cotle) o� that M1e/5M1e is exempt
.ber¢from antl th2 basis fo� Ihe allegetl exeTPtlon. Any violation of $ection
�031.5 by any aPPlitant for a- permit subjects tne applicant to a civil
�enalty o( not more than five huntlretl tlollars (E500�.
I, az owner of the property or my em0loyees wiln wa9es as their sole
<omp¢nsalion wil� tl0� the wo�k, antl the sirUcture is not intenCeO or offeretl
tor sale (Section 7044, Business and Protessional Cotlr. The Contractor's �
LicenSe I„aw tloes �ot apply to an owner ot d ProOerty wM10 builtl5 or Impfoves
thereon, antl -who•tloes such work himself/herself or throu9h his or'her own
emDloy ees, provitletl that such Improvements are not intentletl or otferetl Por
sale. H, however, the bWltling or improvement i5 Soltl wilhin One year ot com-
pl¢tloq the ownef will have the burtlen of provin9 hC/sho tlip not builtl o/ im-
�rove for the purpose o� sale).
I, as owne� ot [he p�operty, am �excluSlvely COntracting with licensetl Con-
Vactors lo comtruct the p�ojec[ (Section ]04R, 9uiinesi antl Protessions Gatle:
The Contractor•s License Law tloes not-applY to an owner o( pmperty who
builtls or improvez thereon, antl who contra<ts tor such projects witn a con-
tractor(sl 6cense pursuant�to tne'Contracio}'s License Law�. I am aware tha[
proo/ o( Ineir Wprker's Comp¢nSation insurance sM1oultl be provitl¢tl t0 ma.
❑ I am exempt uPtler 5ection B. 6 G. C. tor [his reason
Avo���ant to fill in a1l spaces except those within heavy Oortler.lines antl sign all appropriate tleclarations.
PERMIT NO_ _ _ � TRACT NO. LOT NO. UNIT N0.
Da[e — ' - Owner
I hereby certity that I havo reatl tbis a
information is corfect. I a9ree to comply
antl s[ate laws rel3ting to bui�tlip coret
5entative5 o�is o, ent / up
inspettlon p p . �
Signature .
Oriver:' Lice�:e or 5 # -?_$�
TYPE OF CONSTRUCTION LI NEW LI ADD LI ALTERATION LJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ pTHER
� DESCRIPTION OF WOfiK/USE OF BLDG.
TVPE OF PERMIT LI GRAOING L.J FOUNDATION LI STRUCTURAL
❑ TENANT ❑ ELECTRIGAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION 5G1. F7. oCCU�ANCv_
CONSTRUCTION TVPE VALUATION 5
20NE GRADING CU. VDS. ACRES_
Bar Sink ' , Showers - .
Backflow Preventer Service Sink '
Backflow Irrigation . • Sewer Cap� �
Bathtubs - Sewer Connection
Clarifiers ' ' Solar Collectors �
Dishwasher - SolarPiping. �-
Drinking Fountains � Solar Tank �
Floor Drains Swimming Pool w/Spa
Ploor Sinks Urinal '
Gas Service Outlets' Water Closet
Interceptors Water Heater
Kitchen Sink - ' �Water Service � �
Lavatories , Auto�Wash � '
Roof Drains
Reinspection Fee � $15 � I Issue Fee
Hood or Typel ❑
Under Ground ' Canopy Type II ❑
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact.B�t.ICBO# •
Heating System & Ducting
❑6100,000 BTU � 100,000 BTI
lonetl property �or . .
Date2/�� i
peinspection Fee' S75
GMF OB65�46, rev. 10/84 White - Builtling; Canary - App���nt; Pink � AccOunting; Goltlenrotl - Assessor
Refrigeration System
❑0-100,OOOBTU ❑100,000
System Repair/Alteretion
Fire Dampers
Registers � � �
Issue Fee
FEES
i
A.P. qW
S Main Buildi
E
T Front
B Rear •
A
C Right
K Left
S
Ping. Ref. #
Planning Notes:
Automatic Washer
Construction Pole Si
CAoking Unit _
�IShWdShC(
Diyers �Gas ❑E
Fen ,
F.A.U.
Fixtures
Device Boxes
Outlets �
$witCheS
Gar6age Disposal '
Generotor �0.5 KN
lectric
15
1686 3/25/BG'
Zone
Accessory Building: �
Parking'Feq./Provided
ELECTRICAL ' - �
Transformer ❑ 15�50 KW
� 50+KW
Meter ❑up to 100 amps
Meter ❑over t00amps
Sub Panel . . .,
� Momrs O41 HP O 1%- B
Inc. Solar �9-15 HP �16-15+
Microwave ' i
�Pole Light
Range .
', Standing Sections -!,
Trash Compacmr ,
5 3
Reinspection Fee S15 Issue Fee
FEES
� DEVELOPMENTSERVICESREnUIREMENTS:
Zonin9 APProved BY .
8uilding AppiOved By
Applicetion Issuad By
$ 3
. eon . ��.
Z
O
N
1
N
G
R
E
Q
M
T
S
FEES
5
$ 3 ,
�
SUMMARY OF FEES .
BUILDING PERMIT $ SMIP ' 3
PLAN CHECK $ PERMIT �
PLUMBING $ ISSUANCE. $-
PLAN CHECK 25% $ � ENERGV P.C. $
ELECTRICAL � $ � GRADING $
PLAN CHECK 50% $ � MICROFILM $
MECHANICAL $ TOTALFEE $ �
PLAN CHECK 25%' $
CONSTRUGTION AND PLANNING � , POOL & SPA
APPROVALS Permit# ,Date. Inspector AppROVALS Permit# �Date Inspector
1. Temporary Electrical Service or Pole � � 52. Pool & Equipment Location .
2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. ' 54. Forms ' �
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test .
6� Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd.
8. Foundation �- � 59. Gas Pipe, O Undrgrnd.,,Test ,
9. Water Pipe•Undrgrnd. � � 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System , 61. APPROVAL TO DECK
11. Property St'wer 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 Elec2rical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace � APPROVALS Permit #�
21. Ducts, in Structure � 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test , 72. Uniierground 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 & 5iding � 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 15SUED
33. Final Electric � ' Notes: ',�
34. Final Heating & Air Conditioning
35. final Gas Pipe-Test _ _ .
36. Hood or Canopy
37. Final Factory Fireplace ' + . . ' ,
38. Final Plumbing " . � - � " � , �
39. Water Service-Final = � ' � �
40. Gas�Service-Final
41. Solar pomestic-Final . ! �
42. Backflow Preventer � '
43. �Backflow Irrigation � . � _
44.,'Landscape Irrigation System � ` '
�45. Sound Attenuation � • �
46. Handicap Regulations ' ', . � .
47. FINALSTRUCTURE&BUILDING , � � • - ' ,
48: Special Requirements Completed . � , . ��� ' : •
49. Electric Release to Edison � k '
50. Gas Release to Southern California Gas Co ' ' � .
51. CERTIFICATE OF OCCUPANCY � � " �
No. Date . . �� ,.
d
�
�! 3— ZZQ �ppiicant to till in ail soaces ezceDt those within heavy eortler,linas ane slgn all aovropriate tleclaralions.
CiT� coSTn MEsr�a CONSTRUCTION PERMIT
ProjeitAdress SJ-3 w,�7Ty S7/�QEF%
Appliwnt's Mailin9 Address �hI L'�d f0!/� i✓�3
Ow�er's Name 6 C �'ppdtf145 �p o�/�g I Z'
Address -�f1/ �q/ � Q SL!J/ L' i '�/J `^"' _ ' �
Arch/Eng. �p�.�����7Q License No. C �+f `r
Address I>%�!�/n'�-�^��/� C � C'�� -
Contractor's Name- ����� � Phone �
Address (mailingl , �
Ciiy License No.
LICENSED CONTRACTOR DECLARATION '
1 neteby aftirm lhd[ I am licensetl untle� provl5ioni Of Chart¢r 9(<Ommencing
with section 7000) of Division 3 of the Business antl Protessions Cotle, antl
my license is in full torce antl ettect. .
Liconse Class Licenso No.
Dale Si9nature
WORKERS'COMPENSATION DECLARATION
hereby attirm that I nave a certifiwte of consent to self-insure or a certificate
Workers' Compenza[ion Insurance, or a certltietl copy thereot (Section
.d00, Lab. CJ � '
Policy No. Company �
BCercifietl copy is hereby fumisnetl. �
Certifietl coOY I5 filed with the city Builtling Divlsion.
Date Applicant '
EXEMGTION FROM WORKERS' COMPENSATION DECLARATION
(Thi55ection neetl not be completetl.if the permit I51or On¢ huntlretl (§100) o�
less).
I certify thai in tlte pe�fotmanca of the wOrk for whiCh this pGrm�t is Iszuetl, 1
shall not employ any person in any ma er so as to become subjec[ to the '"
Workers' Compens i n taws of Califor i � )� J,
oate _.�—�.'f�signature ��6L��6�-�'-
NOTICE: If, after makin9 this tleclaratl�Ii, you shoultl become subject to the
Work¢rs' Compensation provisions of the Labor Coae, you must forthwith
comply witM1 SUCh . provi5ion5 Or . this permit shall be tleem¢tl revoketl.
CONSTRUCTION'CENDING AGENCV
1 hereby aifirm that there is a canstructlon lentlln9 agenty for the performance
of tne wark for wnicn thls oermit is Issuetl' (Section 3097 Clv. C.)
tentler's Name.
Lentler's Aaaress .
OWNER BUILDEN �ECLARATION
I hereby affirm that I am exempt from the Contractor's Lirensc Law for the
owing reason (Soction 7031.5 Business antl Professlonal Cotle: Any aty or
nty which requires'a permlt to construct, alter„Improve, tlemolish or repair
structu�e, prlo� to`its i55uance, also reqWres the applicant for such pC/mit
'ile a signetl 5Wt¢ment that he/she Is IlcenSatl pursuant [o [he provisions ot
ContractoYs License Law (Chapter 9(commencin9 wi[h Sectlon 7000) of
ISIon 3 Ot the Business antl Profe55ion5' Cotle) Or'that he/sbe iz exempt -
refrom ana the basis for the allegetl �exemptlon. Any violation of Section
I1L5- by any applicant to� a permit SUGjacts the applicant to a civil
alty oi not more than five hundrCtl tlollars (§500).
I, as-owner of the'propeity or my employeoz wlth wages as thelr sole
ipensation, wlll tlo tM1e work, antl the struc[ure Is not intentletl or offeretl
sale (Section 7044, Business antl Protessional Cotle: The Contractor's
en5e Law tlOes n0[ app1Y t0 an own¢r Of a prop¢rty who bUiltls or Improves
r¢on, antl who tloes Su<h work himself/he�self or IhrOugh his or h¢r own
ployees, provitletl that such improvement5 are nOt Intentletl or Otfe�etl tor
:. If, however, the builtlin9 or Improvement is soltl within one Year of com-
fion, the owner will have tha burtlen ot proving he/she tlitl not bulltl or im-
�to� tne pu�pose of sale�. •
I, as owne� of the property, am exCluSively con[�acting with IlcenS¢tl con-
:torst0 cOnStruct the project (Section 7044, Business antl Profe55ions Cotle:
� ConVactor's License Law tloes nol apply to an own¢r ot property wbo
Itls or improvez thereon, antl who contracts for zuch projects with a con-
:to/(5) IlcenSe pursuant to Ine ConVactor's LlCense Law). I am aware that .
�o} of thei� WOrke�'s Compen5ation insurance shoultl be provlE¢tl to me.
1 am.ezempt untler Section B. S G. C. for this reason .
Da(e
Signature
Drivers' Licens SE
^ CMF 0865-46, rev. 30/84
Owner
have iea
��tate tnat tne above
tl county orainances
eby authorize repre-
ionetl Properly f [r
Date �� �'�"
P IT NO. I HAG 1 NV. LV I NV. UNIT NO.
— 2`�� 7 .!Z¢
'TVPEOFCONSTRUCTION NEW ADD ALTERAT.ION REPHIR�
.: �0 CONVERSION ❑ DEMOLISH ❑ OTHER � A.p, #
DESCRIPTION OF WORK/USE OF eLDG. -�L-a-�� -S- Main B
E
TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B R¢a� .
•� ❑ OTHER � ' %�
,PROJECT;DESCRIPTION 5a. FT. � oCCUParvGV C Rigtif t
K
' CONSTRUCTION TVPE VALUATION $ �� n $ L
Remarks: - ,.+�
Bar Sink
-� Backflow Preventer
�� Backflow Irri9ation '
Bathtubs
r Clarifiers :
,,,r Dishwasher ,
king Fauntains
�r Dreins '
ir Sinks
Service
Kitchen Sink-
Lavatories
P-Trap
Foof Drains
Reinspection Fee
GRADINGCU.VDS. ACRES_
�
Showers
Service Sink � �
Sewer Cap
Sewer Connection �
Solar Collectors� -
Solar Piping _
Swimming Pool w/Spa
Urinal
Outleis Water Closet
Water Heater �
- Water Service � - -
Auto�Wash
$15
Boiler
Duct- Under Ground
Duct - Structural
Duct - Ventilating �
ExhaustSystem ❑ Multiple❑
Firepl/Fact: Blt. ICBO #
Heating System & Ductin9 �
❑4100,000 BTU O 100,000 BT
Reinspec[ion Fee ' .�. I $15
White - Builtling; Canary - Applltant; Plnk - Accounling: Goltl¢nrotl - Assezsor
Issue Fee
Hood or Typel ❑
Canopy Typell ❑
Refrigeration System
❑0.100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers _
Issue Fee
s
Ping. Ref. # L
Planning Notes:
0039 7/24/86
� Accessory Building:
A7/ ��
/�
S�
g �
�Q���nl� Parking Feq./Provided
Auromatic Washer
Construction,Pole Sub.
Cooking Unit ,
Dishwasher �
Fan
F.A.U. � �
F,ixtures , :
Device Boxes
Outlets
Switches - -
Garbage Disposal '
Generator O0.5 KW I
��
_i
0
Zone
Transtormer ❑ 15-50 KW '
❑ 50+KW •
Meter' �up to 100 amps
Meter� �over 100 amps
Su6 Panel '
Motors OO-1 HP � 1 X.: 8,
Inc.Solar 09-15 HP �16-15+
Microwave' �
Pole Light
Range
Standing Sections
5-75 KW Trash Compactor
I
$ 3
Reinspection Fee $15
FEES
DEVELOPMENT SERVICES REQI
ZoninB APProved By
Building ApProved By
Aonlication Issued ev
$ 3
Issue Fee
�
�
17.00 .TL
i
FEES
�
�
z
O
N
I
N
G
R
E
Q
M
T
S
- � ' SUMMARV OF FEES
BUILDWGPERMIT $ E ' SMIP , . $ Q•SO
PIAN CHECK $ �� � PERMIT �
PLUMBING _ . $ ��UANCE $. _
� PLAN CHECK 25% $ � ENERGY P.C. $
� E�ECTRICAL $� � � �GRADING $
PLAN CHECK 50% $ - MICROFILM S. •
MECHANICAL $ TOTA�FEE $ @'�
� PLAN CHECK 25% $ � -
CONSTRUCTION AND PLANNING ' , POOL & SPA _
APPROVALS Permi{# Date Inspector qPPROVALS Permit# Date Inspector
i. 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 � i
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test � i
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
_ `
7. Footings �,��[ Z.. � j'6 58. Electrical Conduit�Undrgrnd.
8. Foundation � 59. C3'as Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK '
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final'
12. Sewer Cap 63. Heater & Vent-Final .
13. Roof Drains 64. Plumbing System - Final '
14. Rough Plumbing 65. Electrical-Final ' � �
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ,
20. Rough Factory Fireplace APPROVALS Permit # _ '
21. Ducts, in Structure 70. Underground Hydro �
22. Ducts, Ventilating 77. Product Piping O Gas ❑ Oil ' , %
23. Gas Pipe-Rough & Test � 72. Underground Flush �
24. RoofFraming 73. Undergrnd.StorageTankOGas ❑Oil
25. Roof Sheathing . . 74. Overhead Hydro ' � •
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical , �
27. Frameand Flashing 76. DryStandpipe
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. Electriral Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: ���p ��R $QEC�. �QU � ,
34. Final Heating & Air Conditioning L 5`
Z tS rG e�l�cR 5*�Q /�i�e< w
35. Final Gas Pipe-Test 8!L wiyca- O/� Qa G�Q.O,�`
36. Hood or Canopy � � ��� ��
37. �Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final .
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System .
45. Sound Attenuation .
46. Handicap Regulations ' � .
47. FINALSTRUCTURE&BUILDING (� �(� Q �
48. Special Requirements Completed •� � �
49. Electric Release to Edison .
t
50. Gas Release to Southern California Gas Co •
51. CERTIFICATE OF OCCUPANCY �
No. Date j
,�� � �.'�
� . _ .
0
\� / ' 'L: �i.�
�� /_� ' iJ�: .�Ti
. !�'�i�i. � _
I . �.�'� ��=J � -� �; �:� . ;:� % t-�,t' "' ,�
�
�, ���G_-r �/�''F'; IIfJ � c�:vi =+-'%-
� ��.
fUY O�.J �! � �
HELLMUTH Pro�act Nama 6 Number:
���oaara g / i�_ . � �.- � �. :
KASSABAUM v'�'� %� J (
1999 BunEy Oc Sulte 250 Are�:
Lw Angeiea. CA 90025 I . -�
Ir31 so�-eaoo � ✓ ln �C% - [,�
;� !• .. i i -
'.� /-.,./'j
s
Date:
i -•. �✓'
I'i ' ' -
,,� � r, 7 j Peg� of
G��L�. --%i.� I �
City of Costa Mesa
Developmeni Services Department
Building Sefety Division
P. O. Box 1200
Costa Mesa, California
CERTIFICATE OF OCCUPANCY
No.9�g�'7g
The Building located at R5� W. 77th C4rae.*
has been inspected and found to comply with the provisions of ail City of Costa Mesa Ordinances applicable thereto
for a Group R1 /A7 Occupancy.
Use of euildina I71dUfltZ'131
Legal Description n?4-101-09, 08
(See rever5e side for Me[es and Bounds)
B25499
Building Permit No B229�4 Electrical Permit No. E25313 Plumbing Permit No. QZ324S
MechanicalPermitNo.Ai2559�. M�4F�F Numberofapartments and/orguestrooms
ISSUEDTO: BuildingOfficial�--� �\.\' �+-*—: �,�---c
The Balalis Coruoration �
3471 Via Lido Suite 213 by
Newnort Reach, CA l
Date %1: V E��\��K � � I� i
This Cenificate 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 le) U.B.C.
CMF ]015-46 rev. 1/83 White - Owne�; Canary � Numorical File; Pink � Bldg. P2rmit File
1 ..
36898
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
ForApplicant to Fill in Completety
ADIDRESS ��� W j� �� S�IC�L�. 1
OWNER CC��VI� �VIaUF11Y��C�
MAIL (�"� 1.1 l�iT� Q�j`i'JAf�T
Z ADDRESS
aU CITV�QS `�
Z
CON5fRUCTION
O N LENDEF
am
� � BRANCN
J N
m J ADDPESS
J m ARCHITECT
a OR ENGINEER
U �
Q
w (L ADDFESS
aw
W Z CONTRACTOR
J �
m Z
J � ADDRESS
W W
Z� CITV CD
w � S7ATE
y � UQ NO.
� � SIZE
OF LOT
USE OF
EXISiING BLDG.
PAIO # **.k�
NL —7-73cnsnOO iao 23.0
BUILDING
TEL.p Y/{ilH ACT"'"" 7�
C�Si�� NO.{r 1�a �I /TFt
W D ALTER
OWNER -7
TEL $ �-�� 1
ND.
FIRE
ZONE
APPROVED
tij BV
J t� �� �! e � ZONE NO.OF
M rn..n T.E�Y✓n ni: i.\ AA � PLANS
CITV �'ARDS
LIC. NO. MAIN I
NO.OF BLDGS. (FROM C/L
NOW ON LOT FROM
FOR BUILDING PERMIT
VALUE
i
USE OF NEW �_ J,,;
BUILDING N�d��"
VARDS APPROVED
F' SIZE OF NO. OF O�'Y�
Z NEW BLDG. ROOMS STOfl1ES L. SIDE F
U EXTERIOR WALL , ROOF �
COVERING COVEFING REAR FT.
J USE OF BUILDING AND WORK TO 8E PEFFORMED DSfANCE BET. BET. MAIN &
�' 'MAIN eLOCS. ACCESS. BLO�
O-
1 Q i—O YVi C URP. �{`- APPROVED
y ocJ. jp Yp � APPROVEO �
!r
I z
� O
VI hareby acknowl¢tl8e Met I have reatl this applica[ion and siate
� that tha ab0�a intormation is correct antl agrea to comply with
� all lews regulating builtling consttuction, antl I shall not employ
� eny permn in violation Of the wOrkman'S compenWHOn laws oi
y the Stata at Celifomia.
? I hereby ttrtiSy tfiai 1 am proParly licanxed as e contractor untler SQ. FT.
tha SWte of Calitornia Bus(nass antl Profeuiona Code, DivisiGn 3, THE AMOUNT SHOWN UNDER VAL
Chaptar 9, antl thar such licensas are in tull force entl efteet, or I ?HE PURPOSE OF ESTABLISHING A PEflI
am exempt }ram Uie provisions ot tha State of CalifOrnia Bus(nass �ALUATION
antl Professbns Cnc� Division 3, Cha ter 9. pERMIT FEE $
� Signamre of
Perm(ttae Q�G�a'�Ci . $ �% �� P�,qN CHEGK $
AuthoNzad ABant �
TOTAI F[E $ [
�
�
1 �
0
FOR �
JLY: m
¢
� m
N
�
m
0
� LL
�1
�
Avo��cant lo /ill in ail soaees ezcapt thosa wlehln heavy Dortler Iinas ana slgn a11 apo�oorlate tleelarations.
Ci7Y OF COSTA MESa CONSTRUC{ION PE/RMIT �.J
Prolect4:\ddress �� Z ( A� j 7 k.ST VtJG7/� I I ES7If
' Applicant's Mailing Aqdress W /—/���.�., �
Owner's Name Phonep./.,-CLCZ
Addresz 3�ti7p�� �V��fA/ 'LI��LST� �� A/ i� `�76:��'Z
ArchlEng. q � /_��� �+�e.iS�License Na.
Address � Q' g/�fl�k ��'�fcp �Q�TR HPS�� i����� ��y����r
Contrac[or's Namws4�f�� L lPnC v[ FIYPwlT �[]J�phane Lti�a�uc.a�
Address Imailingl 3 � Q(Z,��, ��W A%� # 1�R Gc7A NE�. �A q26�iC�
City License No. 3�i 79�'
LICENSED CONTRACTOR �ECLARATION
I nereby aHirm [ha[' I am IlcenSatl untler provisions Of CM1artar 9(mmmencing
with section 7000).of Dlvision 3 ot the Buziness antl Profe55ions Cotle, antl �
my Iicense is in ful (or�¢ antl effect. /
Licensa lass License d
Dalc� — $i9nature ,
W00.K RS' OMPENSATION DECLA ION
� hereby alfirm that 1 ryave a certiticate onsen[ to self-insure or a certHlcate
Workers' Compensgtion Inswance, r a certilietl copy thereot (Sectlon
,00. LaD.
P,.o�,}�'�v Nol���s'-'Z;������comaany eFNL�N% INorn.�,�
17 Certitietl covY �z hereby furnishetl. ,
IJ Certi ietl co is ilea with the city Builtlin ivision.
Oate Applicant
EXEM TIO FROM WORKERS' COMPENS ON DE L RATION
(Tnis sectlon neetl not be completetl if the pe it is for one nuntlratl (E300) or
Icss).
1 certily that in lhe p@rformanca ot the wo for which this perm�t is izsuetl 1
shall not employ any po�son in any manner 50 as to become Subject to t�te
Workers' CompensaHon Laws ot Calitornia.
Date Si9nature
'NOTICE: 11, a(ter makjng ihis aeclara[ion, you shoultl become subject to the
Wofke6' COmpenSdtlan provlsion5 Ot the LdbOr COtl¢, you mu5t IOrthwl[h
comply with such p�ovlsion5 or this permit shall be deemetl revoketl.
CONSTRUCTION LENDING AGENCV
I hereby aflbm �hat [hl�e is a ConsVu[tion I¢ntling agency for Ihe pertormdnte
oi lhc work fOr whitn this permit I5 issuetl (SattiOn 309] Civ. CJ
Lentler's Nama
Lentler's Fltltlrcis
OWNER 9UILDEN UECLARATION
I noreby aflirm that 1 am oxomot trom tne Contracror's �icense Law for tha
tollowing rcason (Section 7031.5 Buslne55 antl Profe55ional Cotle: Any cily or
munty wnich requiras a permit to conitruc[, alter, iTP/ove, tlemolish or repalr
any struclura, pdor tp �(s Issuance, alzo requirez the applicant tor sucM1 permlt
(p filo a si9notl itatert�¢nt that h¢/Sha is IICenSatl pUrSudN to the prOvl5ion5 of
the ConlraCtor's UCCqSo Law (Cbapter 9(commencing wlth Sectlon 7000) oi
OiviSion 3 ot tha Bu5lness antl Proles5lons Cotle) or Ihat he/sha ls exempt
erefrom antl lho Dpsis /or th0 allegetl exemption. Any vloldtlon ot Suctlon
31.5 by any appry�ant tor a permit subjects tho applicant to a clvil
malty of not more than Ilvo huntlretl tlollars (E500).
❑ 1, as ownor of t�e prooerty or my employees wlth wa9as as Ihalr solo
CompOn5at100, will tl0 the work, antl the slruGtu/¢ Is nol Inttntl¢tl O/ oHCr¢tl
for sale (Section 70d4, Business antl Professional Cotlo: Tho Contractor's
LiGense 12w tl0¢s not dPp�Y l0 an owne� ot a prOperty who bulltl5 Or ImprOves
thoreon, antl wno tloes such work hlmseli/nerselt or throug h hls or hor nwn
�� emPbye�z, provitlutl that such improvements ar¢ nOt Intentlatl o� olt¢retl for
I sale. H howevcr, tna builtling or improvement is soltl within one yoar o/ com-
plCtloq Ihe Ownor will ttave the burtlen 01 Provin9 h¢/sne tlltl nOl buil� o� Im-
�rova to� tho purposo ot zale).
I, as owner of tne property, am azclusively contratting wilh Ilcensetl con•
t�actors to conzl�uct lhe Orojecl (Sectbn ]044, Business antl PrOte551ons Cotle:
The ConVactor's License Law doez not appty to an owner ot pro0erty who
builtls o/ improves Ihereon, anE who cont�acts�tor such prOjetls with a con-
VactOr(5� Iittnse pur=uant�to the Cont�actor'S License Law). I am aware that
prOof o their Wo�k@r'S Compensation in5urance Shou10 be prOvltletl to me.
❑ 1 am oxempt untlor 5e�tlon B. 8 P. C. tor this reason
Date Owner .
1 he�eby certity that 1 have reatl
Information I5 correct I agree [o c
antl state laws relatlqg lo builEing
seN4llves ol tbis Ul� to enter
1 /Dr:Gers' License
y
CMF 0865-46, tev. 1
_. . _ � �� -_ __
TVPE OF CONSTRUCTI�ON/ NEW ADO ALTERATION REPAIR
❑ CONVERSION L7 DEMOL�SH ❑ OTHER q.p, �4
DESCRIPTION OF WOFK/USE OF BLDG.
S Main Building:
E
TVPEOFPERMIT GRADING FOUNDATION STRUCTURAL T Front
❑ TENANT ❑ ELECTRICAL ❑ PWMBING ❑ MECHANICAL � A Rfer
❑ -OTHER �
PRQIECT DESCRIPTION Sq. FT. oCCUaa.N� 2� C Right
K Left
CONSTRUCTION TVPE VALUATION 3 $
20NE GR DING CU. VDS. ACRES p�ng. Ref. q�
Remar � Planning No[es: �
. • n • _ . .. _ _ n _ i�il�
Sink
Preventer
Irrigation
Drinking FOuntains
Floor Drains
Floor Sinks
Gas Service Outlets
Kitchen Sink
Lavatories
P—Trap
Roof Drains _- .
Rainspection Fee � S15
Duct- Under Ground�
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fact. Blt. ICBO # ,
Heating System & Ducting
00.100,000 BTU 0100,DOOBTi
Reinspeccion Fee � � $15
White - Bulltling; Canary - qpplicanq Pink - AccounUng; Goltlenrotl - Assessor
Showers
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
Laundry Trays
laue Fee
Hood or Typel ❑
Canopy Typell ❑
Retrigeration System
❑aioo,000sTu ❑ioo,000
System Repair/Alteration
Fire Dampers
Registers
� � Issue Fee
Automatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑EleCn
Fan
F.A.U.
Fixtures
Device Boxes
OuUets
Switches
Garbage Dispoul ;
Generator �0-5 KW ❑
7451 I/15/06
ZOne
,/Provided
ELECTRICAL
Trensformer ❑ 15:50 KW
❑ SO+KW
5-15 KW
Meter Uup to 100 amps
Meter ❑over 100amps
Sub Panel
Motors O0.1 HP Oi�Y, - 6
Inc. Solar �9-15 HP �16
Mioowave
Pole Light
Range
$ign
Standing Sections
Trash Compactor
$� �
Roinspection Fee $15 Issue Fno
FEES
DEVELOPMENTSERVICESRE�UIREMENTS:
Zoning Approvod By
Buildine APP�a�ed By
Aooliption luued Bv �1 •
$ 3
��o�:. TL
Z
O
N
1
N
G
R
E
Q
M
T
S
FEES
$ 3
SU A F FEES .
BUILDINGPERMIT $ � SMIP S '��
PLAN CHECK $ PERMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C. $
ELECTFICAL $ GRADIfVG $ '
PLANCHECK 50% $ MICROFILM $��
MECHANICAL' � $ TOTAL FEE $
PLAN CHECK� 25% $' � ��
CO�ISTRUCTION AND PLANNING POO' '�PA -
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector'
1: • emporery Electricgl Service or Pole 52. Pool & Equipment Location
.� 2. Soil Pipe-Undrgrnd. . 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgmd. . 54. Forms
4.' Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
'6^. Electrical UFER Grnd, .. 57. APPROVAL TO COVER-GUNITE <
7. Footings , •' 58. Electrical Conduit-Undrgrnd.
8.,Foundation . � 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, O Undrgrnd. -
10:-Structural Floor System - � 61. APPROVAL TO DECK
11.• Property Sewer Line & House Connection � 62. Backwash & Receptor-Final
12. Sewer Cap _ . " 63. Heater & Vent-Final .
• 13. -Roof.Drains ' � � .- � 64. Plumbing System - Final � .
14. Rough Plumbing 65. Electrical-Final .
75. Rough. Electrical-Conduit 66. Solar System-Final .
i 6.. Rough Electric Wiring 67. Fencing & Access Approval
-17.,Rough Wiring Sign 68. APPROVED FOR PLASTERING
78. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit #
21. -Ducts, in Struaure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil '
23. Gas Pipe-Rough & Test 72. Underground Flush �
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
• 27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation ' 78. FIRE PREV. FINAL
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION -
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: ' �
34. Final Heating & Air Conditioning � �
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final � .
40. Gas Service-Final � ,
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. .Landscape Irrigation System :
45. Sound Attenuation
46. Handicap Regulations
47. F�NAL STRUCTURE & BUILDING /B S�o ��"
48. Special Requirements Completed
49. Electric Fielease to Edison ,
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
No. Date
�':
♦
11
' `
AOplicant to fill in all spaces excepl those witnin heavy
`�TX OF COSTA ESA CON TRUCTION PERMI I
`Proje A"ddr�s ��s�. u e � 7Y� �
�Appli�a��'s Mailing AddressGP%N. SL/n7il..• Y P2. (5.7�,A�X'F. �;'ZG
Owner's Name��= �-���-�� �-^�aRA'�Ye�,.fphone
Arch/Eng.��L,a�'.. �f-,�.-7:A Licenu No. .
Address
Cantractor's Nama�� �L M!Y[.'.iFL Cz�i Phone'{�R• 7dl%�
Address Imailing) � � ` nR �
City License No. � ��� V '
LICENSED CONTRACTOR DECLARATION '
I hereby affirm that I am licensetl untler provisions of Charter 9�(commencing
�+'��h sectlon 7000) of Divislon 3 ot the Business antl ProfeSsions COCe, and
my Ilcense is ir� force antl effect. � , S'
Llce�se Class Jcen/ N � `
Date`�/7tii�/.� Si9nature �
WOqKERS' COMPENSATION DECLARATION •
h¢�eby aftirm that I have a certiticat¢ Of Consent to self-insure O/ a certiticate
' Workers' Compensation Insurance, or a certi(ietl copy thereot (Section
.800. Lab. c.) .. -n ,�
P�Icy No, MliAf O f i Zrl n' Cortipznyl '� ,
�t¢riifietl copy i5 he�eby fu�nishetl.
���Certifietl cop 15 filetl with the city But �5 rlc
Dat¢� % APplicdnt ��.,����
EX@M TIO��RO�RKERS' COMPENSHTION DECLARATIO
(Th{g section neetl no[ be completetl if the permit iz for one huntlretl (5100) or
lezs�, � ,� .
I certiry Mat in Me per(ormance of tha work (or wM1ich tbis perm�t is issuetl, 1
shall not employ any pe�iOn in any manner 50 as to beGOme subjeGt [o ihe
Workers' eompensatlon Laws oi California! • .
Da[e Si9nature
�NO710E: If, afte� makinq this tleclatation, you shoultl become subJect to the
Workers' Compeasatlon provisions of the I,.abor Code, you must torthwith
comply witn such provisions' or' tnis permlt shall ba tleemetl revokea.
CONSiRUCT10N LENDIMG AGHNCV
1 nereby atflrm that [here is a construc[lon lentling agency lor the pertormance
o/ the work for whicn this permit � is issuetl (Section 3097 Civ. CJ
Lentler's Name ,
Lontler'S NaCress
OWNER BUIIDER UECLARATION � ' �
I be�¢by affirm thal I am Cxempt i�om lho Con[ractor's Ucenso Law for tne '
following reason (Seclion 7031.5 Buslness antl Professional Cotle:-Any ciry or
coUnty whicM1 r¢quires a p¢rmit to const�uct, alter, improv¢, tlemoli5h o�;r¢pai�
any structure, p�iOr to its issuance, al5o requires Ihe applicant tOr Such pe�mit
l0 lile a� si9netl statement that he/5hE Is Iic¢nsetl pur54ant to Ihe p�ovisions Ot
the fnntractor4 Licens¢ Law fChdOter 9(commencing with Section 7000J of
or v
Any
Itnes ana sign all aoP�ovriate Eeclarations. ���� ""'��
DT NO UNIT NO.
.� ��9oy r�,�� � 9c�
TYPE OF CONSTRUCTION NEW ADD ALTERATION REPHIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
' DESCRIPTION'OF WOFK/USE OF BLDG.
TYPE OF PERMIT GRADING FOUNDATION STRUCTVRAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION SQ.FT. oCCUPANCv
CONSTRUCTIONTVPE VALUATION$��P'-�.7 �
ZONE ' GRADINGCU.YDS. ACRES
Remarks:
Bar Sink
Backflow Preventer
Backtlow I�rigation
Bathtubs
Clarifiers
Dishwasher
Drinking Fountain5
Floor Drains '
Floor Sinks ' � �
Gas Service Outlets
Inrercentors '� -
Kitchen Sink
Roof Drains. . -
��',si.�y�� 5 by any appliCan[ tor a p¢�mit Subje[ts tbe aAP���m [O a c�vu
�+ �alty of not more lhan five huntlretl tlolla(s (g500). �
LJ 1, as owner of the property or my employees with wages as theii zole Reinspeclion Fee
compensation, will tlo the work, antl the slructure is not intentletl or offeretl '
for sale (Section 7044, Business antl ProfessionaP Cotle: The Contractor's �' �
LiCense ldw tloes not app1Y to an.owner oi a property wM10 builtls or imOroves
tb@teOn, antl who tloe5 such wo�k hirtisel//M1e�seH o� N�ough his or ner own '
employees, provltletl [hat Such-improvements are not�intentletl o/ ott¢reQfO/ BOil2!
salr �f however the builtling or imorovement Is soltl witnln one Year ot com- �
Showers
Service Sink
SewerCap �
Sewer Connection
Solar Collectors
Solar�Piping
Solar Tank
Swimming Pool w/Spa
Urinal
' Water Closet
� Water Heater
Water Service �
. Auto-Wash
" l.aundry Trays
$15 . Issue Fee
Piatlon, tne owne� wlll hav¢ the burtlen Of p�ovin9 ne/she Oitl noI builtl ar im- , DuCt - Wnd¢� GroUnd -
�Ove for the purpbse of zale).
LJ i, as owner ol the prooerty, am exciusivety contractin9 with Ilcensea com Duct-StrucWfal
tra�tors to construct the projecf (Section 7044, Busineis antl Protessions Cotle:
The ConVactor'z License Ldw does nobapPly to an owne� of property who ' DUCL - VEntildNOy
builtls o� im0/Oves lhereon, antl who cobtracts fOr sUch projCc[5 wittt a con- '
tractor(sj Iicense pursuant to the ContraCtor's License Law). 1 am aware that Exhaust Sy51em ❑ MWtiple �'
proof of [heir Wo�ker'S CompensatiOn Insurance shoultl be provitletl to me. __
❑ I am exempl untler Sectidn , H. & P. C. lor this reason � Firepl/FacL BIL ICBO�#
Date � Owner Heating System & Ducting '
I hereby certify tnat I have reatl this application ana stale that Ihe above ❑0100,000 BTU �100,OOOBTI
in/ormation is mrrect. 1 agree lo compty wit� II dty antl county ortlinancez �
antl state iaws reiatin to builtli ' construFt , antl hereby autnorize reore-
seqtativ¢5 ot thi �C to ¢n u��� t bove-mentlonetl property for '
inspection pC�ir . � �
Signature �� ( Date F�% ReinsPeciion Fee
Drivers' License or SS � �'�
CMF OBfi5�46, rev. 10/04 White - Bulltling: Canary - Applicant: Pink - Accounting; Goltlenrotl - Assessor
$15
•A1
Hood or Typel ❑ '
Canopy . Type I I� ❑ �
Pefrigeration System
❑aioo,000sru ❑ioo,000e�
SVstem Repair/Alteration
Fire Dampers � �
Registers �
Istue
A.P. #� a
S Main Building:
E
T Front /
AFear (. �
C Flight � -
S Left / �
Ping. Ref. # �
Planning Notes: �..
Automatic Washer
Cons[ruc[ion Pole Sub.
Cooking Unit '
Dishwasher - ��
Dryers ❑Gas ❑Elec
Fan
F.A.U. ,
Fixtures ' -
Device Boxes � -'
OuUe[s {J � ,d
� Garbage Dii�oul
Generator OOl5�K
�
I t
. �
g 3 _ .�
FEES ' RoinspectiamFee �
T DEVELOPMENT;SER
L ZoninB APProved By_
Building Approved By
$ 3 ! ,
0173 2/�6/ i "/1=�% �-
f Zone �
Accessory Building: ,
2
O
N
1
N
G
R
Parking Req./Provided �� � E
. . M
T
S
ELECTRICAL
. � Transformer
LJ;50+KW� -
. .�
Meter ❑up ro�100 amPs
Meter ❑over100amps
Sub Panel
Motors O0.1 NP,'O1 % - 6 �
Inc. Solar �9-15 HP �16�15+
. Pole Light
Renge
Sign
� Sianding Sectiom.
5��KW ;'� � Trash Compacror
•.�
� $15 + : Issue Fee
VICE EQU RE EN75:
— n . . -.
. � r g�
^r'� �BUYLDING�PEflMIT $
dJ PLAN CHECK' � , $�
` � PLUMBING•� � $
PLAN CHECK 25% $
, �� ELECTRIM1CAL $—
PLAN CHECK �50Y6 $,_
' , MECHAN CAL � ' $
�• �PLANCHECK z5% $ '
FEES
$ 3
V I
• . : ♦ _�
SMIP ' $ �� _9�
PERMIT
ISSUANCE � $
ENERGV P.C. $ ' '
GRADING S
MICROFILM $ ^� /�
TOTAL FEE ' $ �� jL/�
i
;_� :,�,.�RUCTION AND PLANNING
� '�FiPPRQVALS Permit#
1. i emporary Electrical Service or Pole
2. 'oil Pipe�Undrgrnd.
3: Electrical Conduit Gtility-Undrgrnd.
4. Electrical Conduit-Undrgrnd.
5. Steel Reinforcement
6: Electrical UFER Grnd.
7. Footings
8. Foundation �
9. Water Pipe,Undrgrnd.
10. Structural Floor System .
11. Property Sewer Line & House Connection
12. Sewer Cap
13. Roof Drains
14. Rough Plumbing
15. Rough Electrical-Conduit
i6. RoughElectricWiring
17. Rough Wiring Sign
78. Rough EleCtrical-T Bar Ceiling •
19. Rough Heating & Air Conditioning
20. Rougfi Factory Fireplace
i
21. Ducts, in Structure �
22. Ducts, Ventilating
23. Gas Pipe-Rough & Test '
I 24. Roof Framing
�. 25. Roof Sheathing �
26.,T-Bar Ceiling �Structural) & Monocoat
' 27. �Frameand Flashing
' ?.8." Lathing & Siding
I29 1 Insulation
I 30. Drywall Nailing
I 31. Plaster Brown Coat
� 32. Electrical Power Meter-Final
I33. Final Electric
�34. Final Heating & Air Conditioning ; '�,
I35. Final Gas Pipe-Test '�.
� 36. Hood or G7nopy •
� 37. Final Factory Fireplace
138. Finai Plumbing ,
�i �
39. Water Serv�ce-Final
40. Gas ServicC-Final i
41. Solar pomesticFinal .' �
42. Backflow Preventer ��
43. Backflow Irrigation
4?. Landscape Irrigation System
45. Sound Attenuation I
46. Handicap Regulations ''
47. FINAL STRUCTURE & BUILDING
48. Special Requirements Completed
,
49. Electric Release to Edison �
50. Gas Fielease to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY
Date
Date
POOI 'PA
Inspector APpROVALS Permit #
- I 52. Pool & Equipment Location I
53. Ster.l Reinforcement
54. Forms
55. Electrical Bonding
56. Rough Plumbing & Pressure Test
57. APPROVALTOCOVER-GUNITE
58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test
60. Backwash Lines, P-Trap, O Undrgrnd.
� 61. APPROVAL TO DECK
62. Backwash & Receptor-Final
63. Heater & Vent-Final
64. Plumbing System - Final
65. Electrical-Final
66. Solar System-Final
67. Fencing & Access Approval
68. APPROVED FOR PLASTERING
69. POOL/SPASYSTEMSFINA�
FIRE DEPT. REQUIREMENT
APPROVALS Permit# _
70. Underground Hydro
71. Product Piping O Gas ❑ Oil
72. Underground Flush
73. Undergrnd. Storage Tank O Gas ❑ Oil
� 74. Overhead Hydro
75. Dry Chemical
76. Dry Standpipe
77. FIXED SYSTEM FINA� �
p� 78. FIRE PREV. FINAL �
I HEALTH DEPT. REQUIREMENT
I 79. FINALINSPECTION
, 80. FOOD CERTIFICATE ISSUED
--r
mrn
Date �Inspector
Notes: �%fj L(�f (J�(d' �i'C�'L �ltj
3 P,� c �6f �Rx' S�►'�rc. ,o�c dj
��'l��IIL'ifl
�
1
'i�, ,:
BACA ._�SSOCIATES � � y ,
GEOTECHNICAL ENGWEERING CONSULTANTSa _
Soils - Foundations - Geology . -
1145 N. LEMON STREET, AfVAi-tEiM, CALIFORNiA 92801 (774) 778-0702
INSPECTION NOTICE
Oate= ��d-�" ���
Project No.� i7 � �d-7c� '��
Project Name: v�r � //f —�������'� G'/
Project Address�
�OJTi� /�/e✓fI ��I
REMARKS To serve notice that the following has been inspected:
U�i� �Al ii y3 �� a' � %� `� v� �E�r� /�s/��G.��� � -� -���'s
r-�,-; o.�
c t��C �iT�er'� � �
U
: ���Z� �� 5�'�
p�,-� �(' Ziidvrr
�%Y/ �iY) Ci[ Q -!'iC G`�i ) �
�
�IA-O�
���'�L> eGE' 7c
bu� ��ns' r
NOTE� A written report wili be submitied upon
completion of the project.
aJ�i� c h
GU�_ �
0
i%
BAC SOCIAT
B Y� �'` LG �� CCt-c�,G�vc�/� .
Applicant to fill in all spaces except t�ose within heavY bortler lines anE si9n all apvropriate tleclaratians.
CI7Y OF COSTn MESA CONSTRUCTION PERMIT
project ,4ddress gs� W I ��
� FpplicanYs Mailing Address 3J�-�zL �!'�i f id�A S//iF l�
J , !ar��,�
Owher's Name honea,c.L�Z-
�j�1 i��[� �j
Address sS � 0 CT�" ��; '4,• -
Arch/Eng. �' ��� License No. �`-� ��
qddress � �L� �-�����t
Contractor's Nam � " Phona ttL.a�S�Z
qddres5lmailing) � ,
�iry License No. � �
� LICENSED CONTRACTOR DECLARATION
I hereby affirm thac I am licensed untler Orovislons ot Charter 9(commencin9
(y(th sectlon 7000)�ot Dlvision 3 of tna Business and Professlo05 Cotle, antl
,inY license is in full force antl efiect.
�i�enze Class License No.
D9�e S19nature ,
WORKERS' COMPENSATION DECLARATION .
1 pereby aifilm that I bave a certificate of consent to ielf-insura or a certiflcate �
o( Workers' Compensatlon Insurance, or. a certltietl copy thereof.(Sectlon
3800, Lab. CJ . �
�licy No. CompanY
Cerfi/ietl copy is hereby furnisnetl. ' ' � '
Certifletl copy,is fileC with fhe city Builtlinq Divislan. � .
D9te APPIiGdnt � ,
EXEMPTION FROM WORKERS' GOMPENSATION DECLARATION
(Yhis sectlon neetl no[ be completstl if the permit is tor one huntlretl ($300) or .
Iess). • 1
� �¢rtify Ihat in Ihe per(ormance ot the wOrk to� wlticb thi5 pe�m�t IS ISSuatl, I
� shdll no[ emPloy any'.perzOn In dnY ma ner�as ip bec G� s ject to tne
Workers/'� omoen on Laws ot Califo /J �f .
x. p,te 71�j^�Si9nature !(�L
NOTICE: If, after making this tlnclar i n, you shoultl become subjett lo tbe
..Workerz' Compensa[ion provisions Ihe Labor Cutle, you must /orthwith
comply witn such provi5ion5 or tnis pe�mlt snall b2 tleemetl �evoked.
CONSTRUCTION LENDING AGENCV . '
I nereby aHlrm that th¢fC is a con5truction lentling agencY for th< performanGe
of tho work, f this erm�i} isr issuep (Section 30��i �!v. C.)
� �gntler's Nam ���'�� � �'r" �L'�1�"� CA! i
1 La�der's Atldress -� 5' �7fA2 n' il.r„ J'ww�a 'd UA CA
pWNER BUILOER OECLARATION � � �
� hareby dffirm that 1 dm examp[ trom the Gont�actot's Lic¢nse Ldw tor tbe
. ...un,.,;nn .on<nn rcncrton �03] _5 Buziness antl Professional Cotle: Any city o�
rom antl the basis tor the aliegetl exempuon. Any vioiauo� o> >ecuon
5 by any applicant for a permit subjects the applicant to,a,civtl
;y of not more than five huntlreE tlollars (5500).
as owner of the p�operty or my'emPloy¢¢5 with wage5 d5�[heir sole
ensation, wlll tlo the work, antl the structure is not intenaetl or oHeretl
�I¢ (Section 7044, Business antl Professional Cotle: The Contraccor's
se Law tloe5 nol aPP�Y t0 an owner of a prop¢rty who builtl5 or improves'
m, and who tloes such work hlmselfjhorself or throuqh his oi her own
ryees, provitletl tna[ such ImProvements are not Intentletl o� olferetl for
f, Itowever, the bulltling or imOrovement is soltl wi[hin one Year ot com-
n, the owner will hdve th¢ burtlen of ptoving he/She tlIG not bulltl or IT-�
for Ihe Purpose of sale). ' '
a5 owner Of the p/operty, am excWsively cont�aCting wltn IIc0n5etl con-
RS to cOnstfuct th8 Project 15ecYiOn 7044, Busine52 aOtl PrOfB5510n5 COCe:
..ontraccor's License Law does not applY to an owner ot property wno
t 1 h' ts wlth a con-
d�`LJ 7
TVPE OFCONSTRUC
❑ CONVERSION
DESCRSpTION OF
� I'�c'vk I F'e/t 90`7 I
I � NEW ADD ALTERATION REPA�R
DEMOLISH ❑ OTHER
TVPE C� PERMIT LJ GRADING LJ FOUNDAT�ON CJ STRUCTU
LI'�TENANT ❑ ELECTRICAL O PLUMBING ❑ MECHANICAL
❑ OTHER �
PROJECT DESCRIPTION S�.FT " pCCUPANC�
CON STRUCTION TVPE VALUATION $ y�
ZONE GRADINGCl1.YD5. ACftES_
Remarks: f7C 7j's S]� � s(/� �
Bar Sink
Backflow Prevenrer
Backflow Irrigation
Bathtubs '
Clarifiers �
Dishwasher' - !
Orinktng Fountains �
FlOor Drains '
noor mnns - -
3as Service Outlets -
I nterceprors
Kitchen Sink ' .
Lavatories
P-Trap
Roof Drains � - �
Reinspection�Fae $15
Boiler ' �
Dutt-UnderGround �
Duct - Structural
Dutt-Ventilating _ . .
DY��as o� ImProves the�eon, antl `Nho cont�dc s or Tuc prolet �
��ac[or(s) ucense pursuant to [he Contra<tor's Llcense Law). I am aware that Exhaust Syst2m ❑ Multiple
pyoof O( Iheir Worke�'s Comp¢n5ation Insurance ShoUltl be proWtletl to the.
❑ 1 am exemPt untler Sec[ion B. d. P. C. �or thls reason FirepVFaGt. BIt, ICBO #
Date owner Heating System & Ducting
� i hereby certi(y that I have'read is applicatlon anA state tnai the above ❑0�100;000 BTU �100,000
in�ormation is correcL I agrea to c mo�Y witn all city antl county orainances
antl state lawz r ating to buil n9 construction, ana hereby autnorize repre- �
se�tatives of is ci[y [o ¢ �yon [he o�e-mantionetl property t$ r
inSPection pu s. //�j s y/ '
$i9nahre -� /"-'�� Date 9-� —`�
D/��er5' Lic or 55 �.;, , Reinspection Fee
CMF 0065-46, tev. 10/04 Whit¢ - Buildinq; Canary - Applitant; Pink - Atmuniing; Goltlenrotl - AssessOr
$75
$hOWCfS
ServiceSink '
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping
Solar Tank .
Swimming Pool w/Spa
Urinal -
Water Closet
Wacer Heater
Water Service
Auto-Wash .
tl
Fee'
Hood or Typel ❑
Canopy Typell ❑
Refrigeration System
00-100,0008TU ❑700,000
System Repair/Alteration
Fire Dampers
Registers
Issua
$ 3
A.P. #
5 Main Buildi
E
T Front
B Rear �
A
C Right
K Left
S
Ping. Ref. #
Planning Notes:
3905' 9f261B6
'� � Q /. � Q Zane
Accessory Building:
, Parking Req./Providetl '
�
Automatic Washer
Construc[ion Pole Sub.
Cooking Unit '
Dishwasher
Dryers OGas ❑Electric
Fan
F,A,U.
Fixtures
Device Boxes
Outlets
Garbage Disposal
Generator �0-5 KW
� Rainspection Fee
��
DEV EIOPMENT SER
�Zoning Approvad By _
,Building Approved By
Aoolicetion Iuued Bv_
�H070 .(��G�oP. /�,N�
. N- O �"a-Ft ew-r'
PE 2M,�'(TE�%
ELECTRICAL
Transformer ❑-15-50Xi
_� 50+K1M1
- v
Meter ❑up to 100amps
, Meter ❑overi00amps
KW
Su6 Panel
Motors �0.7 HP•�
Inc:Solar �&151
Microwave " �
Pole Light
Range
S�9n
Standing Sections
Trash Compactor
$15 � � luue Fee
—
REQUlREMEfVTS:
f3
5+
\
489.06 TL
�
Z
O
� N
I
_ N
G
R
E
�
� M
� T
S
FEES
0
5 3
•�s•
S MMARV OF FEES 2,/�
���.BUILDING PERMIT $ SMIP � $
B�L•PLANCHECK $ _�_�BeP �pERM1T�
, PLUMBING �. $ ISSUANCE $
PLAN CHECK 25% $ ENERGY P.C.' $'
ELECTRICAL $ � ' GRADING $ � '
PIANCHECK 5096 $. MICROFILM $
MECHANICAL .$ _ �TOTALFEE $ 4�89.ao
PLAN CHECK 25% $ � ' ,
CONSTRUCTION AND PLANNING POI.� & SPA
� Date Inspector Date Inspector
. APPROVALS Permit # APPROVALS Permit #
•• 1� Temporary Electrical Service or Pole ' 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement � ' . .
3. Electrical•Conduit Utility�Undrgrnd. � 54. F.orms .
� 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
,_5. Steel Reinforcement 56. Rough Plumbing & Pressure Test .
��6. Electrical UFER Grnd. 57. APPROVAL TO COVER�GUNITE
7. Footings ,' 58. Electrical Conduit-Undrgrnd. -�
8. Foundation 59. Gas'Pipe, � Undrgrnd., Test �
9. Water Pipe�Undrgmd. ,, 60. 8ackwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
17. Property Sewer Line & HouSe Connection 62. Backwash & Receptor-Final
12. Sewer�Cap " , 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing SYstem - Final
14. Rough Plumbing' - 65. Electrical-Final
15. Rougli Electrical-Conduit . 66. Soiar System-Pinal � - -
1.6. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling � � 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air CondiYioning � FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace _� APPROVALS Permit #
21. DuCts, in Structure •- 70. Underground Hydro
22. Ducts, Ventilating . 71. Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test � 72. Underground Flush
24. Roof Framing , 73. Undergrnd. Storage Tank O Gas ❑ Oil �
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling (Structurall & 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 � �j0 � p'�' 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 f�' �Q. �( � j�
35. Final Gas Pipe-Test � , '
36. Hood or Canopy
37. Final Factory Fireplace :
38. Final Plumbing . , �
39. Water Service-Final � � "
40. Gas Service-Final ,
41. Solarpomestic-F.inal -�
42. Backflow Preventer. . '�
r'
43. Backflow Irrigation- � '
44: Landscape Irrigation System � ' .
45. Sound Attenuation � �
46. Handirap Regulations . p 6 �
47. FINALSTRUCTURE&BUILDING l ��(j ,
48. Special Requirements Completed
49. Electric Release to�Edison . .
5Q. Gas Release to Southern California Gas Co , � '� �
51 ° CERTIFICATE OF OCCUPANCY �
No. - Date . . �
Aoo�icant to fill in all sDaces eacept those.within heavy Cortler lines antl sign all approprlate Geclarations.
CI7v oF coSTA SA �6pNSTRUCTION PERMIT ', PE$f��T NQ TR/{6`;�{.10. LOT NO: UNIT NO. ,
Projec[ Address '�S� � �:% • ,1��'� , ST ' �
Applicant's Mailing Address � � �G���'��1�.lZ 1'S-S'�� 7 }V � L" YJ
Oivner's Name �i�/1I'� S �� f��.� Phone�}7�•��92
Address � j� �% L.�. F7 � �]0..�—Rl' ' i[i `
Arch/Eng. �icense No.
Address "
Contractor's Name L C G f�'S'� 5 �'�F �C.�',. Phone _`� 7
Addresslmailing) � ' %� �
� � . '
City License No. .
LICENSED CONTRACTON DE LARATION '
1 M1ereby attirm ihat I am licensery untler provisions ot Charter, 9(commencing
with zection ]000) ot Division � ot the Business antl Professions Cotle, antl
my license is in�full � rce antl efi ct. t�
License CI � Li e se No ;A x�.' � T Y
Date Signature
`NORKERS'COMPENSATION DECLARATION �
hereby atiirm that 1 nave a certificate oi consent fo self-Insure or a certificate
.f�WorkerY Compen5ation� Inswance, o� a certitietl coOY thereof ($ection
3800, Lab. C.) � . , � i � �
Policy No. ' Company '
8 Certifietl copy is hereby furnished: �
Cer�tiji tl {op i filetl with the city Builtling Division.
Date �/�[l' � �^ APPIiSant
EXEMPTION FROM WORKERS' COMPENSATION DECLARATION -
(Thissection neetl not be completetl if the permit is for one huntlretl ($300) ory �
less). ' , . . .
I certify'that in the performance of the work tor which this permit Is issuetl I
shall not eppp��+Ploy any person in dny manp� � so as [o become Subject to t{�e
Workery'/�m�ey5ayion Laws ot Californ. i3(��, !7 �T - �
Oate T J �S W Si9nature _yJ lJiv�.c
'NOTICE: It, after making this tleclarati�you shOultl become sub�ect to �Ihe .
Workers' Compensation provisions of-th¢ Labor Cotle, yOvmust forthwith
comply with such.provisions, Or,this.�0e�mit shall be tleeritetl revoketl; �
CONSTRUCTION�LEN�ING AGENCV . �' � ' �
I hereby atfirm that there is a construction lentling a9ency tor the performance �
of the �work Por �which thi5 permit is i55uetl,. ($ection 3097 Civ. C.) '
Lentler's Name -
Lentler's Atlaress - � �
OWNER BUIL�ER DECLARAT�pN � �- ' ' -
I hereby aftirm that I am exemGt from [he Contractor's License'Caw for tlie
tollowing reason (Section 7031.$ gusiness antl Protessional Cotle: Any tlty or
county wN[h �equires a perrnit lo Const�uct, alter, improve, Oemolistt o� �¢pai�
'�any st�ucture, prior to its issuance, also requi�es the applicant fOr such pe�mit i
' to file a Si9netl ztatement that he/she is licensetl pu�suant fo the provisiorl5 of
the COntractor'S Litense Law (Chapter 9(cOmmenang.wi[h Section 7000)_of.
)IviSion-3' of [ne' Bu5ine55 antl Professions Cotl¢) or that M1e/she is exempt �
herefrom antl the basis for the alleqetl exemption. Any violation of Sectlon
]031.5 by any applitant for a pe�mit 5ubject5 tne applicant to a civil
_ eenalty of not more than five huntlretl tloliars ($500). ,� -
LJ I, as owner ot the property or my employees with wage5 as their Sole �
compensation, wi11 tlo the work� antl the structure is not intentled or oiferetl
for sale (Section 7044, Business antl Protessional Cotle: The Contractor's'
LicenSe l_aw tloe5 not apply [o an owner.of a property wM10 builtls or improves
thereon, antl who DoeS such wGtk himself/hers¢If o� tnrough his or. he� own
employees, provlCetl that such iMprovemenls ate not intentle0 or o(feretl fo�
sale. It, however, the building or Improvement is soltl within one year of com- �
pletion; the owne� will have the burtlen of provin9 he/she tlitl not builtl or Im-'
pwve 1or the Purpose ot sale). i � !
❑ I, as'owner of the property, am exclusibely contracting with licensetl con- �
tractors td construct the project (Section 7044, 6usiness antl Professions Cotle:
The Confractor.'s License_Law_does. noLapply to an owner_of property who
builtls or improves thereon; anp who'contracts tor such projects wrth a con- �
tractor(51 license pursuant�lo the ConVactor'S Licenze Law). I am aware,that
proof o( [heir Worker'S Compensation insurance SM1oultl be provitletl to me.'
❑.I, am exempt untler Section— � B. & P. C. for this reason
Date � Ownar
I-hereby c¢rtify that I have�reatl tliii applica[ion antl� state that ihe a4ove
information is mrrect.'I aqree �0 <omply wi[n all tlty antl county ortlinances
antl state laws relating to builtling consttucliOn; antl hereby authorize repr¢-
sentatives oL this city to ent4ri upon the above-mentionetl property for
inspection pu�p e p /
Si9na[ure :��' Da[e �I b
Drivers'�licenseor55� �" �'%� � -
�do� �V�� ' ' _
TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR —
�.O CONVERSION ❑ DEMOLISH ❑ OTHE p� p#
: DESCRIPTIONOfiWOFK/USEOF.BLDG.���«-�- � � �
i.
� � ' S Main Buildi
7YPE OF PERMIT 'GanDirvG FOUNDATION � STRUCTURAL . T Front
❑ TENANT ❑ ELEGTRICAL PLUMBING �'MECHANICAL _ A Rear
❑ �OTHER, ' � � � -
PROJECTDESCRIPTION SQ.FT. (,LtU.'�C�—OCCUvaNCV � C Right
K Left
CONSTRUGTIONTVPE � VALUATION$ $
20NE GRADING CV. VDS. ACRES ' Ping. fief. #
Rema'rks: � '7 (�"j� . � ' _ , . ' � Planning Notes:
Bar $ink �
Backflow Preventer
Backflow Irri9ation
Bathtubs
Clarifiers
Dishwasher � .
Drinkin9 Fountains � �
Floor Dreins
Floor Sinks � - �
Gas Seivice ' ��Outlets'
Interceptors �
Kitchen Sink - �
Lavatories ' � ..
�Reinspection-.Fee
- �
Showers ,
Service Sink ' - � '
Sewer Cap .
Sewer Connectiori
Solar Collectors
Solar Pipin9� �
Solar Tank �
Swimming Pool w/Spa
Urinal ' " � - '
Water Closet • � i
Water Heater
Water Service
Auto-Wash - -�
Laundry Trays
$15 '
,MECHA
8011¢f
Duct - Under Ground '
Duct - Structural �
DucR- Ventilating
Ezhaust System ❑ Multiple ❑
Firepl/Pact.,BIL IC80 # •
Heating System & Ducting
Oo=i oo,000 eru O i oo,000 eT
Fee � $15
CMF OB65-46, rev. 30/84 White - guiltling; Canary - APPII<ant; Pink - Accounting; Goltlenrotl - Assessor
Issue Fee
FEES
$' 3 .
_ 1 PEES
Hood or Type 1 ❑ -�
Canopy � Type I I ❑ ' �
1
Refrigeration Sys[em
❑0-100,OOOBTU ❑100,0008"
System ftepaidAlteration '
FireDampers '
Registers �
�
, Issue Fee
t
53
n
Automatic Washer �
ConstructionPoleSuti. �
Cooking Unit ' �
Dishwasher '
Dryers ❑Gasl �Elecvlc �
Fan ' �
P.A.U.
fixtures " - -
Device Boxes
OULIeLS ' - �
Switches
Garbage Disposal � �
Generator �0.5 KW �5-15 KW
/.
" Reinspection Fee �
DEVELOPMENTSERV
2anin9 APP�oved BY _
Building Approved 6y,
Appliration luued 8y_
,; 2108 9/�I/c�6; ., .. �: o:� Tl
" 2one .
Accessory Building:
Parking�Req./Pro��h¢� . �
�
iCTRICAL .
Transformer ❑ 15-50 KW
' � ❑50+KW
'Meter ❑upto100amps
Meter ❑over100amps
Sub Panel � �
Motors �0-1 HP O1'/:,6 '
Inc.Solar �9-15 HP 016-15+
Microwave � '
Pole Light � �
Ranae �
Sign
Standing Sections �
Trash Compacror
$15 � �, Issue Fee .
REQUIREMENTS: �
�
FEES
"�'
t
$ 3
Z
O
N
I
N
G
R
E
Q
M
T
S
� � . SUMMARV OF FEES � ' ' .
BUILDING PERMIT $ SMIP � ' $
— ' PLAN CHECK $ � PERMIT �
PLUMBING � $ � ;�SSUANCE $ ; ,
PLAN CHECK 25% 3� � � O•S� ENERGY,P.C. S�
:. '� ELECTRICAL . $ � GRADING ; $
; tir' PIANCHECK .50% g � MICROFILM � $ � �
— MECHANICAL � $ � � TOTAL FEE $��
' PLAN CHECK 25% $ ' � , .
CONSTRUCTION AND PLANNING - POC . SPA
APPROVALS Permit # Date Inspector AppROVALS Permit # Date Inspector
1. TemporarY Electrical Service or Pole � 52. Pool & Equipment Location
2. Soi1 Pipe-Undrgrnd. � , 53. Steel Reinforcement -
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding
5. Steel Reinforcement'. 56. Rough Plumbing & Pressure Test
6•� Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings �, . 58. Electrical Conduit-Undrgrnd.
8. Foundation 59. Gas Pipe, � Undrgrnd., Test
i
� 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK -
11. Property 5ewer Line & House Connection 62. Backwash & Receptor-Final �
12. Sewer Cap 63. Heater & Vent-Final �
13. Roof Drains 64. Plumbing System - Final •
14. Rough Plumbing 7_Zy_� L(e/) 65. Electrical-Final
15. Rough Electrical�Conduit ,� 66. Solar System-Final -
16.• Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL "
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �
20. Rough Factory Fireplace APPROVALS Permit # ,
21. DuCts, in Siructure - 70. Underground Hydro
22. Ducts, Ventilating . � 77. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test .. 72. Underground Flush �
24. Roof Framing - 73. Undergrnd. Storage Tank 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
i
29. Insulation ' 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster BroWn Coat 79. FINAL INSPECTION �
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Elect�ic Notes: /�` �' �•%��J� � f v
34. Final Heating & Air Conditioning -- �
Q.� s C.+✓e %'
35. Final Gas Pipe-Test .
36. Hood or Canopy � ' �
37. Final Faaory Fireplace .
38. Final Plumping ����;iG G � �
39. Water Service-Final 7-2Y_�� �,�,(�
40. Gas Service-Final ' ,
47. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation �
�
44. Landscape Irrigation System �
45. Sound Attenuation ' �
46. Handicap Regulations ' �
47. FINALSTRUCTURE&BUILDING '
48. Special Requirements Completed � . ,
49. Electric Release to Edison � � , � - � � .
50. Gas Release to Southem Calitornia Gas Co �
51. CERTIFICATE OF OCCUPANCY
No. Date " � '
Aoo���ant to filt ln all spaces exeeo� inose witnin neavy bortler Iines antl sign all approo/���a declaratlons.
CITY oF COSTa, iwESA CONSTRUCTIONrP�jRMIT
Project Address �� 3 w • / � � 'S,Ir
Applicant'sMailingAddress 735� r!�%� �l� �/������jv
Owner'sName ��LALIS ' phoneCl�1�.2=��u�
Addreu
Arch/Eng. Licenu No.
Address
Con[racmr's Nam ��s ��� � Phone z u �
Addresslmaiiingl 7 5/ Na� '/C
City LicenseNo. 2 q75(�
LICENSED CONTRACTOR DECLARATION
I M1eraby a/firm thal I am licenz¢tl untle� provi5ion5 ot Chdrte� 9(commencing
wi[h section 7000) of Division 3 Of [h! BUSinesz antl Pr feszions Cotlo, antl
my license is in tun for antl ¢fiecL 2Q� � 3 �
License CI ' l�� O ..%iYi
Oate ��' � c��a+ .
WORKERS'COMPENSATION DECLARATION
' hereDy attirm that I nave a certificate oi consent to 5¢Ittinsure or a certiflcate
f Worke�s' Compensation Insurance, o� a ce�tifietl coOY thereof (Section
�800, Lab. C.j '
Policy No. Company
� BCertifietl copy is hereby furnishe�.
Certifietl copy is tiletl with the city Builtling Division.
Oate Appliwnt
E%EMPTION FROM W00.KER5' COMPENSATION DECIARATION
(ThiSsection neetl nat be tompletetl if tne permit Is (or one nuntlreC (5100) or
Iess).
I certl(y that In tne pertormance of the work tor wnlch this permR is Issuetl, I
shall not em0�oy any pe�son in any manner so as lo b¢come ubjett [o [he
� Workers' Cq�m,pe tl n Laws ot California. n �
Da[e _JL�Si9nature - � ��� -�—
NOTICE: Ii, atter making'this�tleUaration, you snoul�t�i e subj/n ect to the
Workers' Compensation provisions of tne ldbar Cotle, you must forthwith
comply with such provisions or this. permit shall be deemetl revoketl.
CON5T0.VCTION LENDING AGENCV '
I ner¢by a/firm thdt there is a construc[ion lentling a9ency fOr the perfOrmanco
of the work for whith tnis permit is iszuea (Section 3097 Civ. CJ
Lender'S Name
LenOer's Atltlress
OWNER BUILOER OECLARATION �
I hertby a(flrm [haI I am exempt trOT Ine ConVactols LIC¢nse law for th!
tollowing reason (Soction �031.5 Business antl Professlonal Cotle: Any citY or
munty which rlquiies a D¢rmit to const�uct, alt¢�, Improve, tlemOlish o� repdir
any structure, prlor.to its issuance, alio reqWres the appilcant for such.permit
to f0e a si9netl statemen[ that he/she is Iicenutl pursuant to the provisions of
the Contraclor's License Law (C�apter 9(commancing with Section 7000) of
OlJision� 3 of the Business antl'ProtesSions Coae) or that he/5he Is ezempt
ierefrom antl the basis br the allegetl exemptlon. Any violation of Section
031.5 by any applicant tor a pnrm{t suDjectS th0 appliGant lo d Civil
I�enalty of not more than iive huntlretl tlollars (5500).
I, as owner o1 �he prOp¢rty o� my ¢mployees wilh wage5 LS [Itei� sole
an
wno
tls or
�is or
or o1
sale. I1, nowever, tna builtling o� ImprovOment i5 SoIO w�inin One Year o� com-
o�etlon, the owner will have the ouraen oi proving hc/she tlltl not builtl or im-
�rov< fo� th¢ Ourpose of salc).
I, as own¢� of [ne property, am exclu5ivnly mM�acting wlth IlcenS¢tl Con-
tractor5.t0 constrUct the project ($¢ction 7044, 8usinezs dntl Profe55ions Cotle:
� ThrConVac[orR License law does not apply to an owner of property who
Duiltls or Improves thereon, antl who contracts ior such projects witn a'con-
tractor(s) ucanse pursuant co tne Coniraccor's Llcenze Law). I am awara lhat
proof of thai� Worker's Compenzation Insuranta Shoultl be OrOvltlOtl t0 me..
❑ I am exempt untler Section B. 6 P. C. for this rea5on �
� Date Owner '
I nereby certity tnat 1 have reatl this applicatlon antl state that lhe above
into�mation i5 correGt. -I agree to comply with all city antl county ortlinance5
antl state taws relatin9'to Guiltling �onstrucUon, antl hereby authorize repre-
s¢ntatives ot this aty jo'en r pon th! above-mentionetl P�operty tOr
Inspection purooses w / /
Signature �Y�` Date 11J-3 Rf0
Drivers' License or 55 � —� .
TVPE OF CONSTRUCTION }!�`-NEW' LJ ADD LI ALTERATION IJ REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.p,.�(6
DESCFIPTION OF WORK/USE OF BLDG. S Main Building:
E
TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL T Front
'� TENANT ❑ ELECTRICAI. ❑ PLVMBING � MECHANICAL B Reaf
❑ OTHER %� .
PROJECT DESCRIPTION 5�. FT. oCCUPANCY C Right
K Left
CONSTRVCTION TVPE VALUATION $ � $
ZONE GRADING CU. VDS. ACRES Ping, Ref. dh
Remarks: �� (� (Q 2(,� ' � vq� Planning Notes:
Backflow Preventer
Backflow Irrigation
Bathtubs
Clari(iers
Dishwdsher'
Drinking Fountains
Floor Drains
Floor Sinks '
GasService Outlets
Iriterceptors
Kitchen Sink -
Lavatories
P—Trap
Roof Drains
Reinspection Fee
$75
Duct- Under Ground
Duct - Strucwral
Duct - Ventilating
Exhaust System ❑ Multiple ❑
Firepl/Fect.8lt. ICBO �
Heating System & Ducting
�0.100,000 BTU � 100,000 BT'�
Reinspectian Fee � S75
CMF 0865-46, rev. 30/84 White - Builtling; Canary - APP�icant; Pink - Accounting: Goltlenrotl - Assessor
Showers
Service Sink �
Sewer Cap
'Sewer Connection
Solar Collectors �
Solar Piping
Solar Tank .
Swimming Pool wlSpa
Urinal
Water Closet
Water Heater
Warer Service
Auto-Wash
Laundry Trays
laue Fee
Hood or -Typel ❑
CanaPV TVPe I I ❑
Refrigeration System
❑0.100,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers .
laue Fee
$ 3
S 3
Automatic Washer
Construction P.ole Sub.
Cooking Unit
Dishwasher
Dryen ❑Gas ❑Elec
Fan
F.A.U.
Fixtures
Device Bozes �
Outlets
Switthe5 '
Garbage Dispoul
Generator O0.5 KW C
Fee
a
4429� 10/03/B6
c�'
Building:
Parking Req./Provided
EIECTRICAL
. Transformer .� 15-50 KW
❑ 50+KW
-. ' Merer ❑up to 100 amps .
Meter ❑over 100 amps
Sub Panel' i '
Motors �0.1 HB �1'h � 8r
InaSolar �9-75 HP �16�15+
Microwave '
Pole Light
Fange
Standing $et[ioos
5 KW Trash Compacror
$15 Issue Fee
DEVELOPMENTSERVICESREUUIREMENTS:
Zoninp Approvad By
Buildin8 APP�a�ed By ' �
APPliptian Issued BY
qa00 TL
FEES
3
r
Z
O
N
1
N
G
R
E
�
M
T
S
SUMMARV OF FEES �
BUILDING PERMIT $ SMIP 5
PLAN CHECK S ' PERMIT ' � -
PLUMBING � � �$- :.ISSUANCE � $ .
PLAN CHECK 25% $_ � ENERGV P.C. S .
ELECTRICAL $ � ' GPADING , 3 _ �
PLANCHECK 50% $ MICROFILM $ Q�
MECHANICAL $ .TOTAL FEE $ VSj,L�!
PLAN CHECK 25% $ �,
CONSTRUCTION AND PLANNING POOL & SPA -
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement
3. Electrical Conduit Utility-Undrgrnd. � 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test +
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd. "
8. Foundation 59. Gas Pipe, a Undrgrnd., Test
9. Water Pipe-Undrgrnd. . 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final �
12. Sewer Cap 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
75. Rough Electrical-Conduit 66. Solar Sysiem-Final
76. Rough Electric Wiring 67. Fencing & Access Approval �
� 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning . FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # _
21. Ducts, in Structure . 70. Underground Hydro
22. Ducts, Ventila[ing 71. Product Piping O Gas ❑ Oil .
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil
25. ftoof 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
r
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION �
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED �
33. Final Electric Notes:
34. Final Heating & Air Conditioning �, � •
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation SYstem
45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING
48. Special Requirements Completed
49. Electric Release to Edison
50. Gas Release to Southern California Gas Co
51. CERTIFICATE OF OCCUPANCY '
No. Date
AOP��cant to fill in a11 spacez except those within heavy DorCer Iines anC sign all aoProoriate tleclarations.
�. I • �~ PER IT N � � � TRACT NO. LOT NO.' UNIT NU.
Ci7Y oF COSTa MESA CONSTRUCTION PE�T �' � y/ a6
Prolect Address � 3 � • �� /� 1p
Applicant'S Mailing AddresS ���I ��L �I� H/J TVPE OF CONSTRUCTION ' NEW ADD ALTERATION REPAIR
p ❑ CONVERSION ❑ DEMOlISH ❑ OTHER q,p, #
Owner's Name L'�G � L%S Phone / � DESCRIPTION OF WORK/USE OF BLDG.
Address iD73 zZ Z S Main Buildi
E
Arch/Eng. � License No. TVPE OF PERMIT GRADING' FOUNDATI� STRUCTURAL � T Front
Addr¢Ss , / /1� ( ❑ TENANT ❑ EIECTRICAL ❑ PLUMBING MECHANICAL B Reaf
W �/T G Phone�l.L�Z_GL/ ❑ OTHER � : C Ri
Contractor's Name 9ht
Addresslmailinl �-�� y�L �V� ��G' PROJECTDESCRIPTION SQ.FT, oCCVPaNCV K
9 , CONSTRUCTIONTYPE VALUATION$ S Left
Ciry License No. 7�%75�+ ZONE GRADING CU. VDS. ACRES �
LICENSED CONTRACTOR DECLARATION Ping. R¢L #
I he�eby afnrm tnat I am iicensetl untler orovisions oi Charter 9(commencing Remarks: �'� [� . ' - Planning Notes:
with section 7000) of Divi5lon 3 01 the Business antl Prot¢ssions Coae, antl
my Iicense is in (ull 1Crc,¢�anOtl etfect: S J�7 i/ ''
�icens�Clpss h, < < Lice�Np. � 7 .
Date �� �as� 5.9 I � / .
WORKE 5' OMPENSATIONDECLARATION ' BafSink
1 hereby affirm thal I have a certificate of consent to seltd sure or a certificate
f Workers' Compensation Inswanca, o� a certifletl COpy thereof (Section Backflow�Preventer, .
800, Lab. C.)� '
Policy No. Company Backflow I��igation
BCer[ifietl copy is hereby furnishetl. � .
Certifietl copy is tiletl witn the city Builtlin9 Divizlon. Bathtubs 1
Oa[e AP011canl
E%EMVTION FtiOM WORKERS' COMPENSATION DECLARATION Clarifiefs
(Thi55ection neetl nat be compiat¢tl if the permil i5 (or Ona huntlretl ($100) or
less). � Dishwasher �
I certlfy that in the performance ofthe work for whicM1 this perm�t is issuetl, I . -
shall not emPloy a y per50n In any manner 50 as to becoma Subjec[ [o the Dfinking FOUOtdipS
WOrkerS' Co ens o laws ot Calitomia� ,
Date Signature ��k� FIOOr Drains' .� �.
NOSICE: , afte making tnis tleclaration, you shoultl me subject.to the .
Work�rs' Compensation p�ovi5ion5 of tlte Labor COtl¢, you must forthwith FI00� $inks '
comply with sucn provi5iOn5 0� [hi5' permif shall be tleem0tl �evoketl.
CONSTRUCTION LENDING AGENCV ' Ga55CrviC2 i OUL12t5 �
I hereby atfirm that tbere is a construclion lentling agency for the performance �•
of lM1e work •for whicn tnls Oermit is issuetl (Se<tion 3097 Civ. C:) InterceptOrs
l.entler'z Name �
.Lenaers.t+mres� -
OWNER BUILpER �ECLFRATION �
' I hereby affirm that I am exampt irom the Contractor's Licensa Law for tne
followinW reason (Settion 7031.5 Business antl ProTessional Cotle:.Any city or
...��.,r� mm reauires a oermit to con5truct, alter, imProve, tlemolish or repair
a
'efrom antl the Dasls for t�e al�egea exempuon. qny vro�auon i�e �wi
1.5 by any apD�icant for a permit subjects [he applicant to a civil
alty of no[ more than tiva huntlretl tlollars ($500).
I, as'owner of Ihe p�operty o� my employee5 witn wag0s as thair sole
�pensation, will tlo the work, antl tne structure Is not intentletl or offeretl
sale• ($ection 7044, Busine55 antl Protessional Cotle: Tha Contractor's
anse Law tloes nOt apply to an owne� of a property wbo bulltl5 0� im0�ovez
'eon, anA who'aoes such work �hlmself/herselt or through his or her own
o�0yee5, provi0etl that such imp�ov¢ments are not Intentletl o� otferetl for
: It, however„the builtlin9 or improvement is soltl within ona year ot com-
.lon, tM1e owner will havu tho burtlun of proving he/s�e ditl not builtl or im-
va (or tne purposa of sale). .
I, az owner of the properly, am,exclusively mn[racUn9 with Iicensetl con-
:to�sto const�u[t the project lSectlon ]044, Busine55 antl Profe55ion5 Cotle:
� ContractoYs License Law does not apply to an owner o1 property who
Itls or Imp�oves thereon, antl who mn[racts fo� Such project5 w�th a con-
:tor�s) imense pursuant m the Contractor's License Law): I am aware that
of of tneir Worker's Compensation insurance shoultl be provitletl to me.
1 am exempt untl¢r Section _ B. & P. C. for this reason
Date Owner _
I hereby cer[i(y that I have reatl this
informatlon Is mrrect. I a9ree to comp
antl state laws relatin9 to buildmg co0
Signawre / v/
Drivers' License or 55 � /
;chen Sink . _ .
vatories
T,rap •
�of Dreins - . �
.' -. ' r
. � �
Service Sink�
Sewer Cap . �
Sewer Connection
Solar Collectors
Solar Pipin9 .
'Solar Tank
,Swimming Pool w/Spa
Urinal �
,Water poset
Water Heater
Water Service -
Auto-Wash
. Laundry Trays
ReinspeMion .Fee �, $15 �, � � , laue Fee �
eoiier
Duct- Under Grountl �
Duci - Structural
Duct - Ventilating
ExhaustSystem ❑ MWtiple,❑
Firepl/Fact Blt. ICBO #
Heating System & Ducting
� ai o0 00o eru O i oo.aoo sr
Reinzpection Fee �, $15
CMF 0865-46, rev. 30/84 White - Builtling: Canary - APP��canh Plnk - Accounting; Goltlenrod - Assessor
fEES
e
' � � Automatic Washer
� ' Construction PoleSu
� Cooking Uni[ .
� Dishwasher, '
' Dryers ❑Gas, ❑Eli
Fan
F.A.U.
Fixtures �
' DCVICC BO%CS
Outlets
- - - Swi[ches
Garbage Dispoul
Generator �65 KW
Hood or �Typel ❑ .
Canopy ,Type II ❑ .
iefrigeration System � ,
70.100,000 BTU ❑ 100,000 B
System Repair/Alteration
Fire Dampers � �
Fiegisten � - �
� � � Issue Fee ' �
- 9780 7/2t/86
Zone
Parking Req./Provided
ELECTRICAL. .. •
TransfOrmer ❑ �15-50 KW
, ❑ 50+KW
� Meter ❑up to 700 amps
Meter �over 100 amp5
15 KW
20.50 TL
FEES
Sub Panel� �
Momrs�0-1 HP�1'h-8 �
� InaSolai �9-15 HP �1645+ �
Microwave
Pole Light � �
Fiange
-Sign " - ' �' .
Standing Sections •
r.���, r,.,..,.��.,.. ' r
$� Reinspeccion Fea �$75 Issue Fea
FEES
DEVELOPMENTSERVICESREQUIREMENTS:
� � Zoning APProved BV . �
� Building Approved By �
. ApPliptiOn laued By -
$ 3
C
3
Z
O
N
I
N
G
R
E
Q
M
T
S
�
_ � ' SUMMARV OF FEES � � ' � . _'
' BUILDING PERMI7 $ • � SMIP . " $
PLAN CHECK $ PERMIT - � ,.
PLUM8ING $ � ISSUANCE $
PLAN CHECK 25% S ENERGV P.C. $
� ELECTRICAL $ - � GRADING - $ _
PLAN CHECK 509G $ .MICROFILM $ �,� �/� _
MECHANICAL $ � TOTAL FEE � $ �' 'LL
PLAN CHECK 25% $ - ��S � • '
\ y
POO L & Sr �
CONSTRUCTION AND PLANNING ci
APPROVALS Permit# Date Inspector pppROVALS Permit#_. Date Inspector
1. Temporary Electrical Service or Pole , 52. Pool & Equipment Location ' ' V
2. Soil Pipe-Undrgrnd. • 53. Steel Reinforcement l
3. Electrical Conduit Utility-Undrgrnd. 54. Forms '
4. Electrical Conduit-Undrgmd. 55. Electrical Bonding ."- - �
� ' Y �� '
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test '
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings 58. Electrical Conduit-Undrgrnd. - ^
i,
� 8. Foundation 59. Gas Pipe, � Undrgrnd., Test �
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap - 63. Heater & Vent-Final
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit � 66. Solar System-Final �
16. Rough Electric Wiring 67. Fencing & Access Approval - '
17. Rough Wiring Sign 68. APPROVED fOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # _
21. Ducts, in Structure, � , 70. Underground Hydro
22. Ducts, Ventilating � 71. Product Piping O Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing 74. Overhead Hydro
26. T-Bar Ceiling��Structural) & Monocoat . 75. Dry Chemical
27. Frame and Flashing . 76. Dry Standpipe . �
28. Lathing & Siding 77. FIXED SYSTEM FINAL �
29. Insulation 78. FIRE PREV. FINAL �
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION
32. Electrical Power Meter-Final �� 80. FOOD CERTIFICATE ISSUED
33. Final Electric � Notes:
34. Final Heating & Air Conditioning �J �
iq
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38. Final Plumbing
39. Water Service-Final
40. Gas Service-Final "
41. Solar pomestic-Final
42. Backflow Preventer
43. Backflow Irrigation
44. Landscape Irrigation System
45. Sound Attenuation �
46. Handicap Regulations
47. FINAL STRUCTURE & BUILDING ' •
48. Special Requirements Completed �
49. Electric Release to Edison -
50. Gas Release to Southern California Gas Co �
51. CERTIFICATE OF OCCUF ""� '
No. Date � � �
,
\ � ,
11 I
�� Y •• . - � ' �� � ^ AVV���ant to fill in all spaces exceo� ihose witnin neavY Dortler
CI7V OF COSTA MES����STRUC/TION E�;M� ' �}�-n
� Project Address y /l'l��+ . �� J + UyN�G/a;
Applicant's Mailina7�AclrlrPcs /�/ � J �% 6 G�'.i/ ST i%. -.�l�
/]N.�i4Li} -'ORQ ��' / "
Qwner's Name �Phone
�r • r •� ,
Address -
Arch/Eng. Licenu No. ' T '
L' . - :- i
Address ' �
Contractor's Nam ' �% - : Phone�7
i G�F�% OG.s S'TS'� fY. n
Addreu (maiiing)
Ciry License No. • �� �� - 4 ' �
LICENSED CONTRACTOR DECLARATION � �� ,
1 hereby atfirm tha[ 1 am Iicensetl untler provi5ion5 0/ Charle�4 (comm¢ncln9�
with sectlon 7000) oi Divlsion 3 of the Business antl�Professioris Cotle, and
' my Iicense i5 in full orce�ana ef(ecL ,�� .�. . y'
Licens la5s � Licensa No
Date ' � 5iqnature �" ,
W00.KER5' COMPENSATION DECLARATION . � � J
. y
I hereby affirm that I have a certlflcate of consent to self-insure or:a certlficate •
of Workers' Compensation Insurance, or a ceiHff'etl copy'thereof (Section '
'800, Lab. Cy�/ /� � j /— ••""
1llcY No. /�.�Ury����`�T�PanY -ST /%� / Uil/h�
iy Certifietl mpy is hereby furnlSheC. �1 : ✓ r : �
LJ Certtii tl co is (II with the Uty B il ing Divisionq � /
Date�� ��'�� APPlicant
EXEMGTION FROM WORKERS' COMPENSATION DECLAq ION
(Tnitsection neetl not be completeC if the permit is'tor one fyT retl ($300) or
lezs). �` .
1 cerUfy Ihat In the perfO�mance of the work Tor whlch t1ii5 pe�m�Yis IsSuetl"I
snall not employ any person in any manner zo as-to betome zubjecY to t�e
Workers' Compensatlon Laws of California. . �� - .�
Date Si9nature —
� NOTICE:If,aiter Takinq.this EeclaratiOn, you snoultl become subj¢Ct to the
Wo�k¢r5' ComO¢nsatlOn provlsion5 of the tabo� Cotle, you must ro�mwim
Icomply with such provisions or this permit shall�be tleemetl revoketl.
CONSTRUCTION LENDING AGENCV �
� I hereby affirm that there IS a const�uction lentlin9 a9ency fOr tM1e per}o�mdnGe
of lhe work Por whlcM1 [nis permit is i55uetl (Sectlon 309] Civ. C.)
Lentler's Name �
Lentler's A�dress _
OWNER BUILOER DECLARATION
I hereby affirm that I am exemo� from tne ConVactor's License Law tor tha
following reason (Settion 7031.5 Business antl Professional Cotle: Any city or
county which �equirez a pe�mit to construct, alteq impwva, tl¢molish or repai�
any sVucture, prior to its issuance, also tequires the applicant for zu<h permit
to file a signetl statem¢n[ that he/She is licensetl pur5uant to lhe provi5ion5 Of
the Contractor'S License Law (Cbapter 9(commencing with Sectlon ]000) ot
Divislon 3�of the Business antl Professions Cotle) or tha[ he/she is exempt �
the�efrom antl the basis for Ihe allegetl ezemption. Any violatlon of $ectlon
�031.5 by any appliCant for a permit subjecls tne applicant to: a civll
ialty ot not more than tive.huntlretl tlollars ($500). .
;I; as owner o( tho orooerry or my emploYees with wages as chelr sole
�mpensation, will tlo'the work, antl [he structure is not intentletl or offeretl
tor sale (Section ]044, Business antl•Professional Cotle:'The Contractor's
LicenSe Ldw tloes nol apply to an owne� ot a property who builtl5 O� Imp�ove5
thereOn, antl who tloe5 Sucn wOrk himself/herself or th�ough hiz o� ner own
CmO�oyee5, prOvitletl that such ImOrovements are not intentletl o� ott¢retl fo�
sale. It, howeveq the builtlln9 or Improvement is soltl within one year of com-
pletion, the owner will have the burtlen of provin9 he/she tlltl not builtl or im-
prove for the purpose of sale�.
❑ I, as owner oi the property, am exclusively contracting with licensetl Con-
tractors to construct tha O�o�oct (Sec[lon �044, Business antl Professions Cotle:
The Contractor's License Law does not apply to an owner of Oroperty,who
bWltls'or improves thereon, antl who conVaccs for such projects with a con-
tractor(s) b<ense oursuant to the Contractor's License Law). I am aware that
proof of'their Worker's Compensatlon insurance shoultl be provitlee to mo.
❑ 1 am ¢xempt untl¢r Secllon B. & P. C. for thi5 reason
Date Owner
I hereby certiry that l have rea
Information is correc[. I agree to
antl state laws relating to builtlu
5entatives of fi3� tlty to ent��
�insp¢Ction pur O s. � �
Signa[ure
� . _ . _ ._—
anE sign all approoriate tleclarations.
._...... .._. _..._..-- -- ---- ..,..., ,....
,-E� �� 3
TYPE OF CONSTRUCTION NEW ADD ALTERATIOfJ REPAI R
� �❑ CONVERSION ❑ DEMOLISH ❑ OTHER _ q,p, q�b �
jDESCRIPTION OF WORK/USE OF BIDG. $ Main Bu
'TVPE OF PERMI7 GRADIrvG FOUrvDATION ❑ STaUCTVRAL T Front
❑ TENANT � ELECTRIGAL ❑ PLUMBING ❑ MECHANICAL A Reaf
r. �❑ O� HER
PROJECT DESCRIP710N Sa. F7. OCCVCArvcv C Right
K Left
. �.CONSTRUCTIONTVPE VALUATION$ $
' 'ZONE GRADINGCU.YDS. ACRES PIng.REf.#
Bar Sink'
' Backflow Preventer .
�� Backflow Irri9ation
Bathtubs
Clarifiers �
' Dishwasher � �
' Drinking Fountains
� �loor Orains
Floor Sinks
Gas Service Outlets
Intercepmrs
Kitchen Sink
Lavatories
P—Trap ;
Roof Drains
Reinspection Fee $15
Duct- Under Ground
Duct - Structural
Duct - Ventilating
ExhaustSystem ❑ Multiple
Firepl/Fact. BIt. ICBO �
Heating System & Ductin9
❑ai oo,000 eru � i oo,000
• I Reinspection Fee I $15
Canary - Appllcant; Pink - Accounting; Goltlenrotl - Assessor
Showers
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
Laundrv Travs
Issue Fee
Hood or Typel ❑
Canopy Type II ❑
Refrigeration System
Oaioo,000eTu ❑ioo,000
System Repair/Alteration
FireDampers '
Re9isters
Iwue Fea
FEES
!� ' Automatic Washer
'�� � ConstructionPoleSub.
� Cooking Unit
Dishwasher
. Dryers ❑Gas ❑Electric
$ 3
$ 3
Fan
F.A,U.
Fixtures
Device Boxes
Outlets
Switches- •
Garbage Disposal �
Generator.�0.5 KW C
3100 - gil5/86
Zane
Accessory Building:
Parking Req./Provided �
ELECTRICAL � �
�,
Transformer ❑ 75�50 KW..
. ❑ $O+KW
Meter ❑up to 100 amps � '
� MeterJelover100amps
� Sub Panel �
Motors �1 HP � 7 X- 6
Inc. Solar �9-15 HP �16-15+
Microwave
� Pole Light
Range
Standing Sections
5�15 KW Trash Compactor
I Reinspection Fee I$15 I. I luue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
ZoninB APProved By
Building Approved By
Aualiration Issued By
75.G5 , TL
Z
O
N
I
N
G
R
E
Q
M
T
S
FEES
SUMMARV OF FEES
BUILDING PERMIT $ � SMIP � $ , "
PLAN CHECK $ PERMIT
PLUMBING $ � ' ISSUANCE $'
PLANCHECK 25% $ �� ENERGVP.C. $. ' �
ELECTFICAL $ ��.�,��7U GRADING $ '
PLANCHECK 50% $ �, MICROFILM $ �
MECHANICAL $ . TpTALFEE $ iS •yS
PLAN CHECK 25% $ � �
CONSTRUCTION AND PLANNING � POOL & SPA
APPROVALS Permit# Date Inspector p�ppROVALS Permit# Date Inspector-
�
1. Temporary Electrical Service or Pole 52. Pool & Equipment Location-
2. Soil Pipe-Undrgrnd. � 53. •Steel Reinforcement �'
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical 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-Undrg�nd. �
8. Foundaiion 59. Gas Pipe, O Undrgrnd., Test � -
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trzp, 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 . �- ,.� f� � 67. Fencing & Access Apprpval ��
t�. Rough Wiring Sign . ' ' 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling ��, y.`(y /� 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT: REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit # _
21. Ducts, in Structure � 70. Underground Hydro
22. Ducts, Ventilating �� 71. Prod'u"ct Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing � 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical '
27. Frame and Flashing � 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL �
29. Insulation 78. FIRE PREV. FINAL .
30. Drywall Nailing ; HEALTH DEPT. REQUIREMENT �
31. Plaster Brown Coat 79. FINAL INSPECTION '
32. Electrical Power Meter-Final /� 80. FOOD CERTIFICATE ISSUED
� 93. Final Electric 6 Notes: T
L ASoiv '� �
34. Final Heating & Air Conditioning ` � r
G" .c c i c'R
35. Final Gas Pipe-Test (� '� �� ' hF
36. Hood or Canopy �
c rt o c, n.
37. Final Factory Fireplace � � � � /J2 /� /�
�
38. Final Plumbing �
� C Sri
39. Water Service-Final � �
i- I�u GF �
40. Gas Service-Final
Ci fi ti M �
41. Solar pomestic-Final �+ �_&
42. Backflow Preventer .
43. Backflow Irrigation
�44. Landscape Irrigation System �
45. Sound Attenuation
46. Handicap Regulations '
47. FINALSTRUCTURE&BUILDING , �
48. Special RequirementsCompleted , .�
49.� Electric Release to Edison
50. Gas Release to Southem California Gas Co • ' ��
51. CERTIFICATE OF OCCUPANCY '�
No. Date � �
- - - •
. ,
_ "