HomeMy WebLinkAbout940 17TH ST - Building Permits�-.- ...
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OWNER PIIVECRAFT SFiUTTERS� I1VC.
10B ADDRESS West 1 th Stre
GENERAL CONTRACTOR Sierra Fire
AP "�. LOT Tf
II. .CTIONS SI
SOIL
c.s
W�TER
ROl1GN GLUMBING
PROP. SWR. LINE Q HOUSE CON.
SPHINKLING SVSTEM
MISCELL�NEOUS
ROUGH HEATING �ND �IR CONOITIONING
TEMPORAqY SEAVICE OR GOLE '
UNOERGROUN� CI POWEF
ROUGN WIRING
TRENCHES FORMS STEEL REINF.
FLOOR SYSTEM
BONO BEAM [] STEEL REINFORCE
SNE�TMING
FRAME AND Fl�SNING
LRTHING - IN I-I OIIT I-I
♦N� A.C.. FINAL
F
DATE 2-15-7$
6UI
SUBCONTRAGTOR
�JUB AUPRESS 940 W.
GENERAL C4NTRACTOR
AP No.11 -230-2 L
.�':;v.i�",e,CT10NS
sE',.:
WS
;waTEa
IRQUGH P4UM91NG
�PaOP. SWR. UrIE HOUBE C
ySPHINNIING SYSTEM
M15CEI.laNEOUS
ROUGH HE0.TING �NO 0.1q CONO
TEMPORAAY SEFVICE OR PO4E
UNOEFGROUN4 [� POWER �
ROUGM wIRiNG
TflENCMES FORMS
FLOOft SYSTEM
BONO BEAM�__,S1EEL FEiI
SNEATHING
FR0.ME ANq Fl.ASHING
LnTM�NG — �N �] OUT [,
PLASTfq, OFOwN COA1
SUBCONTRACTOR
UwNCK JIIL'Sl"G� !(1G�' �• UF 1 C O�LV� �4
s JOB ADDRESS • - BUILDING PERMIT N0.3 2�
:t litNtH
�AP No.
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sc...
W$
WnTEA
� ROUGH F
PROP_ 5
SPFINKLING SVSTEM
MISCELLaNE0U5
ROUGH MEATING ANO Alfl CONDITION
UNDERGROUNO U POWEN
HOUGH WIRING
TRENCHES FOHMS
FLOOR SYSTEM
STEEL
FRqME AND FLASHING
LRTNING — IN rj i
PLASTER. BROwN COaT
A.C.. FINAL
IL'iS�YI
VALUE
SUBCOHTRACTOR
w �.
CITY OF COSTA MESA .
BIIILDING DIVISION
77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.cosla-mesa.ca.us
FOR INSPECTIONS CALL: (714) 754-5626
PERMIT NUMBER 607-00994
PERMIT TYPE B ROOF2 STATUS: ISSUED
DATE ISSUED: ' 10I2412007
. �;x. ISSUEDBY: BJK
JOB ADDRESS: 940 W 17TH ST CM .� Suite%Unit: "l�'
Vicinity: FRONT OFFICE PORTION OF BLDG -• - __ r� : ,
Squares: 1500 " � Valuationr ' .'=' $1,763.91
i., _ � - ' �:.
SCOPE OF WORK: REROOF FRONT OFFICE�PORTION OF AN INDUSTRIAL/COMMERCIAC BLDG: �FLINTLASTIC SA BASE AND SA CAP
WHITE, APOC 133 PROLASTIC CEMENT, 2X2 2 WAY WHITE METAL. ROOF MUST MEET COOL'ROOF.-' +
REQUIREMENTS PER TITLE 24 BLDG ENERGY STDS. 1500 SQ FT �
.L' • - `
OWNER: BELL, THERESA G TR . � � ° Address:. �; 19147 FIRMONA AVE ..�, . Unit:
PHONE: . � '. . ' � . �. �='City/State/Zip:�.TORRANCE,�CA � . '. �
. , � � • �n� , _ .. . .., � . � ,
APPLICANT: BELL, THERESA G TR' "`.� � �� `�" �-�- � � Address: 19147 FIRMONA'AVE `,, �', � . ' - UniL• :
PHONE: 310-528-1344 ; ' - �.. . City/State/Zip: TORRANCE�,CA ',..-J^ ��- -
CONTRACTOR: OWNER-BUILDER, -� � ' ' �� � ' , , ' . � . � �, , �. License No.� � 000000
Address: Unit: �� � i � - , � � . PHONE: „ � � ; . - , �
City/State/Zip: �. � - � � _ . . . � � ` CELL: - . ' -
ARCHITECT: � _ � � License No. '� " - � ' -�PHONE:r, �,
. .�t � , - - , . � ,.. . _ i ,
ENGINEER: � � . � License NO. - , _ , �� -PHONE: `�
FEE SUMMARY
Reroof Plan Check:
Reroof Permit Fee:
Reinspection Fee:
TOTALFEES
'$o`oo,', ., . ,
$63:15 ��. - . • .. , . . . _ .
$0.00 . . ..- - , ,,
�'
�
$63.15 ,. ..
NOTICE: The work authonzed by this permit shall comply with all applicable handicap access requirements under Califomia statutes and related
regulations. (Ord. No. 92-28, § 1, 12•27•92) �
EXPIRATION: PERMIT EXPIRES 180 DAYS FROM DATE OF ISSUE OR DATE OF LAST INSPECTION. �
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicable codes, and all
required inspeetions and final approval musl be obtained_ Failure to obtain inspections and fnal approval will result in the expiration of this permit.
COOE �. INSPEL710N TYPE DRTE IN7ITIAL C0� INSPECTION TYPE ORTE ' IN7171RL5
1616 Fized System Final Fire Prevention p06 Final Mechanical
1266 Pool Spa Final �� 208 Finai Plumbing
200 Final Re-Roof LL /� 7V /�{ 210 Final Electncal
_���
201 Final Block/Retaining Wall 212 Final'Fire Prevention
202 Final Factory Fire Place . 220 Final Planning Approval
203 Final Sign 222 Finaf Site '
204 Final Demolition � 250 Pinal Building/Occupancy
WORKERS' COMPENSATION DECLARATION:�
I hereby aKrm under penalry of perjury one of the following declarations:
❑ t have and will malnlain a certificate of wnsent to sel(-Insure (or workers'
compensation, as providetl for by secUon 3700 of lhe Labor Cotle, tor the
peAormance of lhe work for which Ihis pertnit is issueG.
❑ I have and will maintain Horkers' compensation insurance, as required by
seclion 3700 of Ihe Labor Code, fw the peAortnance of the v.ork fw which this
pertnit is issuetl. My workers' compensation Insurance wrrier and policy
number are: „
Carrier:
(inis sMion neeC mt Ge mnplelep /fM perml q varyppatOne nwqretl Npars (f f001 a leu )
Poli y Number:
� I certify lhat in I�e peAormance o( the work for which Nis permit is
issued, I shall not employ any person in any manner so as to hecome subjecl
b the vrorkers' compensation laws of Califomia. and agree that if I should
hecome subjecl to Ihe vroAcers' compensation provisions of Seclion 3700 of
the Labor Cotle, I shall fortnhwith comply with ihese provisions.
�,pA11 v i.J.t,,...Al ��.L�-� � 10 IZ4 �O�
Ap lipnl'sSignaWre Date
WARNING: FAILURE TO SECURE WORKERS' CAMPENSATION COVERAGE
IS UNLP,WFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL
PENALTIES AND CNIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS
($100,000�, IN ADDITION TO THE CAST OF CAMPENSATION, DAMAGES AS
PROVIDEO FOR IN SEC710N 3706 OF THE LABOR CADE, INTEREST, AND
ATTORNEY'S FEES.
LICENSED CONTRACTORS DECLARATION:
I M1ereby aKrm Ihat I am licensed under provisions of Chapter 9(commencing
wilh Section 7000) of Division 3 of the Business antl Professions Code, antl
my license is in full force and eRecl.
Lic. # Class #
Contrd<tor's SignaWre Date
CONSTRUCTION LENDING AGENCY:
❑ I here6y aHtrm that there is a constnution lending agency for the
peRortnante of the v.ork for �nfiich Uris permil is issued. �Sec. 3097, Civil Code).
Lander's Name:
Lentlers AOtlress:
Da�e
OW NER-BUILDER DECLARATIONS:
I hereby aKrm that under penalry of peryury that I am EJ(EMPT FROM THE
CONTRACTORS LICENSE LAW for Ihe following reason (Sec. 7031.5,
Business antl Professions Code: Any city or county which requires a permit to
conSWc�. alter, improve. demolish, or repair any structure, pnOr to its
issuance, also requires the applicant for such pertnit to file a signed statemenl
that he or she is licensetl pureuant to me provisions of the CanUactors
License Law (Chapter 9(commencinq with Seclion 7000) of Division 3 0( the
Business and Professions Cotle) or thal ha or she is exempt therefrom and
the basis (or the allegeC exemption. Any violation of Seclion 7031.5 by any
applicant lor a permit subjecls the applicanl to a civil penalty ot not more than
five hundred tlollars ($500).):
❑ I, as owner of the property. or my employees with wages as their sole
wmpensation, WILL DO THE WORK, and ihe structure is not intended or
oflered for sale (Sec. 7044, Business and Professions Code: The Contractors
License Law dces not apply to an ovmer of properry who builOs or improves
lhereon, antl who does such work himself or herself or through his or her own
employees, provided that such improvements are not intended or offered for
sale. II, however, the building or improvement is sold within one year of
wmpletioq the owner-builder will have Ne burden af proving that he or she
tl�itl/not build or improve for purpose of sale.).
�j I, as ovmer of the property, am EXCLUSIVELY CONTRAC7ING WITH
LICENSED CONTRACTORS to conslruct the project (Sea 7044, Business and
Professbns Cotle: The contractors License Law tices not apply to an ovmer o/
property wfio builds or improves thereon, and who contracts for such project with
a coniracta(s) license pursuant to the Contractors License laws.).
❑ I am exempt under sec.
Business antl Professions Code for this reason:
� ur �� O,lt�,.� ��P�( e� e�� � 0 7
305]<6 (3/01)
Y
Ovmer ID verified by driv�e. ❑ Yes ❑ No `Z I
Driver s License No. � � Expires: j � bG
Verifiwtion o( Owners�ip by (type af tlocument, i.e. - praperty Ux bill or tleetl):
DIVISION OF INDUSTRIAL SAFEN PERMIT CERTIFICATION:
❑ I hereby ceAify Ihat no excavation frve (5) or more feet m depth into which a
person is required to descentl, will be made in conneclion vrith work autMrized
by this pertnit, and that no builaing structure, sc�tdding, falsev.ork, or demolition
or dismantling thereof, will be more than lhirty-s& �36) teet high. (Chap. 3.2, Grp
2. M 2, Sec. 347, Tille 8, Calitomia Atlministrdtive Code).
� As owner-builder, I will not employ anyone to do work which would
require a permit from the Division of Industrial Safely, as noled above. unless
such person has a permit to tlo such work trom the tlivision.
ApPlitanl'9 SipnaNre Da�e
Oivision of Industrial Safety Permit Number
HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION:
7. Will lhe applicant or present or future building occupant neeA to file and
certify a Business Plan for emergency response to release or lhreateneC
release of a hazartlous material� ❑ Yes ❑ No
(Section 25505 of the Califomia Health and Safery Code requires, with some
exceptions, that a Businass Plan be filed with lhe Costa Mesa Fire
Department by every business which has at any one time tluring a reported
year a quantity o� hazardous materials equat to or greater than a weight of
500 pounds, or a volume ol 55 gallons, or 200 cubic teet of compressetl gas
at standartl temperature antl pressure).
2. Does or will the applicant or presenl or future building occupant need to fle
a registration form for aculely hazartlous matenals? ❑ Yes ❑ No
(Section 25533 of the Calilornia Health and Safery Code, with some
exceptions, requires registration with the Cos[a Mesa Fire Department by
each business which at any one time has on hand a quantity of acutely
hazardous matenals equal to or greater than a weight of 500 pounds, or a
volume of 55 gallons, or 200 cubic feet of compressetl gas at standartl
temperature and pressure).
3. Does or will the appliwnt or present or future building occupant need to
prepare an RMPP (Risk Manaqement and Prevention Program for acutey
hazardous materials�7 ❑ Yes ❑ No
(Section 25534 of the Califomia Health antl Safety Code provitles [hat the
Costa Mesa Fire Depariment may require the preparation, ceeification and
fling vrith the Fire Department of an RMPP by businesses which are required
to register acutely hazardous malenals with t�e Fire Department.
4. If an RMPP is presenlly requiretl, has Section 25534 of the Califomia
Health antl Safety Cotle been fully complietl with? ❑ Yes � No
5. Does or will the applicant or presenl or luNre builtling occupant require !or
Ihe work which is the subjeCt 0� lhis applicatlon a pefmlt IOr SUCh cOnStru[ti0n
or motlification trom the South Coast Air Qualily Managemenl Distncl or from
any other air pollution control district or agency? ❑ Yes ❑ No
(Section 658502 of the Califomia Govemment Code requires that Ihe repuested
informatbn be (umished on appliwtions lor non-residential buildirg permits).
6. Will any part of the lacili�y �o be constructetl untler this pertnit De wit�in
1000 feet from the outer boundaries of a school7 ❑ Ves ❑ No
Qf 'yes", the faciliry must meel lhe requirement of Seclions 25534 and 42303
ol the Calitomia Health and Salely Code).
7. If a permit trom the South Coasl Air Quality Manaqement District or other
air pollution control district or agency is required for the work which is the
subjecl of this application, have all ot the disclosures prescnbeC by Califomia
Health antl Safety COCe Seclion 42303 been made7 ❑ Yes ❑ No
8. Qf'yes", attach certi(cate of compliance �mm the apDropriate air polluGon
control oKcer).
CERTIFICATE OF COMPLIANCE: I certify that untler penaly of perjury the
information given above is correct. I agree to comply with all state laws and
city ordinances regarding Hazardous Materials and Emissions.
SignaWre Da�e
CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF. ENTRY: I
certity under penalty of perjury t�at I have reatl this appliwtion and state that
the information given is correct. I agree to comply with all sWte laws and city
ordinances relating to building construction, and authorize represeniatives of
the City of Costa Mesa to enter upon Ihe above-0escrihed property for
inspection purposes. I agree not to occupy or allow occupancy of any building
orized by this permit until (nnal inspe•c,t�io.n. ✓1
QANA I /I.M-W�'� �`�'� � d�i
Signamreo eealOwner(s) �e
MClor Aut�onxeE Applibnl Qate
�' CITY OF COSTA MESA ,
� BUILDING DIYISION
� . � DEVELOPMENT SERVICES DEPARTMENT
� PERMIT PERMIT NUMBER
'`�'� 698-01397
(714) 754-5273 • Fax (714) 754-4856 77 FAIR DRIVE, COSTA MESA, CA 92626
Job Address: 94U VV 17TH ST
Suite:
Vicinity:
Parcel Nunmber: 42437105
Appliwnt: GERARDO, GREGORY
Address:
Owner: BELL,
Address 19147,1
� � </'�/�
ih / Eng�:��%
Address
t / i,l,�I %/
BUILDING PERMIT
Status: ISSUED
Applied: OB/0611998
Issued: 08/O6/1998
Zoning:
-- - Phone:,, 714-960-2752-_
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\ � Phone: � 310-274,0715 � _ � -�v � �� � � �
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�. � ��' �� `�,.%�> SCOPE OF PERMIT �� A �
f T/OFF B.U.R & REROOF WITHGLASS CAPSHEET. - - _ � - - '
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'i � ` jl ' -- — " FEE SUMMARY �:< '
� 'Plan Check:•' ' $0.00 � r'^ F; � Caic Valuation: .
�'�� ' �✓ �l/ ;A,h�A'� T —_�' �'9[�. ���� ' �
i ! Permit: � �� $112.25 �1 � ��� �'�� � � �:,': �-Claim Valuation: �
�,�SMIPRes � ,� �$0.60 � -= - � � � ,
�\SMIPCom: ,,��$0.00 �f
� Other. �'$0.00 j,
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SETBACKS`-� , � ! ,!' `�- `
MAIN STRUCTURE�Front . 0�0 � -Rear � �0. 0
1"11YIYIIYV Ol LVIVIIYV\ ` j j' \
4 � /
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-���-Lefl - 0-0' � - ' �Right - �'0.0- ",�
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ACCESSORY Front - 0-0� �, i��=Rear,-__0-0 left 0-0_,� -� Right 0-�0���"�
_. , . . _ . ,'r: ''
PARKING Existinq �� ,0 � . Reauired:`' 0 , � Pr000sed: . 0 ; � ; �
,. � � �. . .
NOTES:
_ - � . ... . . . , � �- , '
, 5s,000.00
ss 000.00
,,
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,
, / 1
EXPIRATION: This permit shall automatically expire and become void it work is not commenced within 1 BO days, or if work is suspended or abandoned
for a period of 180 days.
INSPECTIONS: In order for the work authorized under this permit to be considered legal, such work must comply with all applicab�e codes, and all
requlretl Inspeetions end final epproval must be obtained. Failure to obtain inspections and finel approval will resutt in the explration ot this permit.
FOR INSPECTIONS CALL: (714) 7545828
WORKERS' COMPENSATON DECLARATION:
I heraby affirtn under penalry o1 perjury ona ot the tollowing declaretlons:
❑ I have en0 will melntein a cert�cate of consent to self-Insure tor workero' compensetion, as provitletl tor by sedion 3700 of the Lebor Cotle, for the pertortnance ot ihe
work for which this permit is iuued.
❑ I heve and will malntein workers' compensetion insurence, as required by section 3700 of Ihe Lebor Code, for ihe perfortnence of the work for which this partnit is issued.
My workers' compensation Insurence cartler entl policy number ere:
Cartler: Policy Number.
(Th/s section need not be complefetl il the perm/t /s ve/ued et one hundreC dollars ($100) or less.)
❑ I cartity thet In Iha pertortnence of the work tor which ihis permit is Issued, I shall not employ eny person in any menner so es to become subJect to ihe workers'
compensation laws o1 Califomia, and egree ihat tl I should became sub�ed to the workers' compensation proNslons of Sectlon 3700 of Ue Lebor Cotle, I shall tonhwlth
compty wiN the5e OroviSions.
Applicant Signature: ' Date:
WARNINO: FNLUFE TO SECURE WORNERS' COMPENSATION COVERAGE IS UNLAWFUL M1D SHALL SUBIECT AN EMPLOYER TO CRIMINAL PENALTIES AND GVIL FINES UP TOONE HUNDREO
T/KKISAND DOLLARE (5100,OW), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECiION 3%O60F THE LABOR CODE, IMEREST, AND ATTORNEI"S FEES.
�i LICENSED CONTRACTORS DECLARATION:
I I hereby eKrtn that I em Ilcensetl under pmNsions of Chflpter 9(commencing wlth Seclion 7000) ot Divislon 3 of Ihe Business entl Pmfessions Catle, end my licensa is in tull
'�. force end eftecl. Lic. # qau k
Contrectofs Signeture: Data:
CONSTRUGTION LENDING AGENCY:
❑ I hereby attirtn Ihet there is a constructian lending egency for the perfortnance ot the work for which ihis permit is issued. (Sec. 3097, Civil Code).
LenCefs Name: Lendels Atldress:
Signature: Date:
OWNER-BUILDER UECLARATIONS:
I hereby etfrtn thet under penelry af perjury thet I em E7(EMPT FHOM 7HE CONTRACTORS LICENSE LAW for �he tollowing reeson (Sec. 7031.5, Business end Professlans
Coda: Any city or county which reQuires a pertnit to construct, alter, improve, tlemolish, or repelr any structure, pnor to its Issuence, also requlres Ihe applicant for such permit
to Hle e signetl stetement ihet he a she is Ilcensed Dursuent to Ihe prwislons of Ihe Contrectors License Law (Chapter 9(commencinq wflh Sectlon 7000) of Divlsion 3 of ihe
Business and Profassions Cotle) or that he or she Is exempt �hereirom end ihe besis for the elleged exemption. Any vialetion oi Section 7031.5 by any epplicant tor e parmit
subJecLs Ne applicant to a civil penalty ot not more Nen flve huntlreA tlollaro ($500).):
❑ I, es owner of �he property, or my employees wllh wages as iheir wle compensation, WILL 00 THE WORK, entl tha swcNre is not intendetl or offered for sale (Sec.
7044, Buslneu end Professions Code: The Conirectors License Lew does not appy to an owner ot property who builds or improves Ihereon, end w�o tloes such work
�Imself or herselt or t�roug� his or �er own employees, provldetl Ihat such Impmvements ere not IntendeA or otteretl tor sale. Ii. however, Ihe building or impmvemem Is
soltl within one year at completion, the awner-bulltler will �ave the burtlen o1 proving that he or she did nm build or improva for purpose ai sale.).
❑ I, as owner of the property, em EXCLUSIVELY CONTFiACTNG WITH LICENSED CONTRACTORS to consiruct the prqact (Sec. 7044, Business and Professions
Code: The contrec�ors license Law tloes noI epply to an owner of properry who Guilds or Improves thereon, end who conirects lor such pro�ect with a contractor(s)
�license pursuant to the Contr tors License LawsJ.
I a /aempt under sec. � �- Business and Professions CoOe tor this reason:
na . I� 1 I�. o w_� �� D "
ner ID veritied by ddvers license. ves ❑ No D ers ucen . ves S,/�/—S�
Vedticatlon of Ownerehip 6y (rype ot dwument, I.e. - properry tax bill ar deed):
DIVISION OF INOUSTRIAL SAFETV PERMR CERTIFICATION:
❑ I hereby certNy that no excevation five (5) or more feet in depth Inta which a person Is requlred to descenq will be metle In connection with work euthorizetl by Ihis
permit, end Ihe� no bulltling siructure, scaHolAing, telsawork, or demolitlon or tlismantling �hereof, will be more ihen thirty-six (36) feel �Ig�. (C�ep. 32, Grp 2, Atl 2, Sec.
341, Title 8, Celifomia AtlmInI5lreMe Cotle).
❑ As owner-builtler, I vnll not employ anyone to do work which would require e pertnit trom the Division ot Industrlal Satery, as noted above, unless such person has a
pertnit ro do such work trom the tlivislon.
Signature: Date:
Division of Industrlal Sefery Permit Number:
CADE �. INSPECTIONTYPE
1616 Fixed System Final Fire Preventlon
1288 Pool Spe Finel
200 Final Re-Root
201 Final BIocWRetaining Well
202
203
204
24i8-68
Final Factory Flre Plece
Final Sign
Fnal Demolitlon
�eg ��
COUE� IMSVECTIONTVVE
206 Flnel Mechanicel
20B Final PlumDing
210 Final Elecldcal
212 Flnal Fire Prevention
220 Final Planning Approval
222 FInalSite
250 Finel Building/Occupanq
QA7E II�EIS
P P PC 0 ��,004'J D/�//C� (io�lF �.,
ApPlicant to /III in all s aces exce t those within heavy ba�Ee� lines antl si9n all a ro riate declarations.
CiTv OF COSTA MESA G STRUCT,ION PERMIT
ProjectAddress �r�j.sr. c�3�J�a �Md3
Applicant's Mailing Address � �� 7
Owner's Name � t � L C�, f}(C � Li�.� n
Address ���~ ' 4A1r �1�A�L2.�Q-
_
Arch/Eng. License No.
Address
ConVactor'sNam ��'�� �� �
Addresslmailing) /f�S9�L8X%!i+'fl�6''��� �fV�1bS�
CiryLicenseNo. �,1�-'�Z—�- '
LICENSED CONTRACTOR DECLARATION �
1 hereby at(irm that I am licensetl untler provlslons ot Charter 9(commencing
with zection �000) of Division 3 ot the Bu5ine55 antl Pro(¢ssions Cooe, antl
my iicense is in tu11 (orce antl effect.
License Cya55 — L' se No '
Date��+//'��'�/ � Si9nature �✓�,yw�_(/
WORKERS' OMPENSATION DECLARATION
hereby at(irm that I have a certiBcate of consent to self-insvre or a certi/icate
1 Workers' Compensation Insuranc¢, Or a cer[ifietl copy thereof (Section
3800, Lab. C.)
Policy No. Company
8 Certifietl ropy is hereby fumishetl.
Certifletl copy is flletl with the city Builtlin9 Division.
Da[e ADPlicant
EXEMPTION FROM WORKERS' COMPENSATION OECLARFTION
(TM1issaction neetl not be completetl if Iho permlt i5 tor one huntlretl ($300) or
less).
�I certily Ihat in [hE Pe�fo�manca oT th0 wo�k fo� whiCh this perm�t is issuetl, I
rnall not emolov anv oerson in anv manner so as�o become subject ta the
Worker ' mpe tion l.aws ol Calif i �
Date Signature
NOTICb. 1f, a er� aking this tleclar iOn, y0u Oultl become �.
wnrkers' [omo¢nsation orovision5 ot Ihe 12bo1 Cotle. YOu m
comply wilh such plovi5ions Or tF1i5 pelmlt SM1all be tleemeO revoK¢0.
CONSTRUCTION LENDING AGENCV
I hereby a(lirm that lnere is a construction lentlin9 a9ency for the pertormance
Of the work � tor whi<h this permit i5 ISsuetl (Section 3097 Civ. CJ
I..entler's Namc
Lantler's AOtlress
OWNER BUILOER UECLARATION
I he�eby affl�m thai 1 am ezempt troT ttte Con(racto�'s LicenSe Law tor the
followin9 reason (Section 7031.5 Business antl Professional Code: Any ciry or
county whith �equires a Oe/mit to construct, alteq improve, Oemoli5h or reOalr
any structuro, prior to its issuance, also requires the aPplicant for such permit
lo lile a signetl 5tatement that ne/she is Iicensetl pursuant to the provisions of
tne Contraclor'S License law (Chapter 9(commencing with Section ]000) ot
'Jivi510n 3 of the Business antl Professions Cotle) or that ne/she i5 exempt
heretrom antl [ne basis for the allegetl exemptlon. Any violation of Section
/031.5 by any applicant for a permit subjects the applicant to. a civil
�enalty of not more than tive huntlretl tlollars (5500).
LJ I, as owner ot tne property or my employees witn wages as their sola
tompensation, wiil tlo tM1c work, antl tM1e siructuro is not In[en0etl or olteretl
for sale (Section 7044, Business antl Profe55ional Cotle: The Contractor's
Licenza Law tloes not applY to an owner of a property who builtls or imOroves
thereon, antl wno tloes sucn work himself/herself or through his or her own
employees, provitletl that Such improvement5 are nol intentle0 or ofte�etl fo�
sale. It, nowever, tne builtling or imp�oveTen[ IS So10 wlthin one yea� 01 com-
. pletion, the owner wlll have Ihe burtl¢n ot proving M1e/she tlItl not builtl or im-
prove forthe purpose oisale). �
❑ I, as owner of the oroperty, am ezUusively mntractin9 with Ifcensetl mn-
tractors IO construct the project (SectlOn 7044, Buslne55 antl Professions Cotle:
The ConVactor'S License Law tloes not apply [o an owner of property who
builtls or improves thereon, antl who contra<ts tor such projects with a con-
lraCtor(5) Ilcense pUlsuant'to the Contra<fOf's LiCBnSe Ldw). I am awar¢ that
prOot of Uteir Work2r'S Compen5ation insurdnGe shoultl be P�ovitletl [o me.
� I am exempt untler Section B. & P. C. for this reason
Date ' �Owner _
I hereby certlry that I bave�reatl this
inlormation is correct. I a9ree to comp
antl state laws relating to builtlin9pon
sentatives of tnyt� Uty to ent4r ,t/poi
� er Licens or 55 �
CMF 0865-46, rev. 10/84 1
above
TVPE OF CONSTRUCTION LJ NEW I.J ADD U ALTERATION LJ REPAIR
❑ CONVERSION ❑ OEMOLISH ❑ OTHER
DESCAIPTION OF WORK/USE OF BI.DG.
TVPE OF PERMIT__ %J GRADING LJ FOUNDATION IJ STftVCTURAL
' O TENANT LJ��ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
� ❑ OTHER
PROJECT DESCRIPTION 5�. FT. ' oCCUPANCv_
CONSTRUCTION TVPE VALUATION $
ZONE GRADINGCU.VDS. ACRES_
Remarks:
Sink
Preventer
Dishvrdsher
Drinking Fountains
Floor Drains
Floor Sinks
Gas Service Outlets
Kitchen Sink
Lavatories
P—Trap
Roof Drains
Reinspection Fee � $15
Duc[ - Under Ground
Duct - Structural
Duct � Ventilating
Exhaust System ❑ Multiple ❑
�Firepl/Fact. BIL ICBO #
Heating System & Ducting � .
❑0-100,000 BTU �100,OOOBTI
Reinspaction Fee
- Applicant; Pink - Accounting; Goltlenrotl - Assessor
$15
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Piping .
Solar Tank
Swimming Pool w/Spa
Urinal
Water Clout
Water Heater
Water Service
Auto-Wash
laue Fee
Hood or Typel ❑
Canopy Type I I ❑
Refrigeration System
❑o-ioo,000eTu ❑ioo,000eTu
System Repair/Alteration
, Fire Dampers
laue Fee
FEES
A.P. #
S Main Building:
— E
T Front
B Rear
A
— C Right
— K Left
— S
— Ping. Ref. #
- Planning Notes:
Accessory Buildin9:
ELECTRICAL
Automatic Washer - Transformer ❑ 15-50 KW
ConstructionPoleSub. � 50+KW
Cooking Unit -
Dishwasher -
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches
Garbage Disposal ' �
Generator �0�5 KW 05-15 KW
Zane
Meter LJuU to 700 amps
Meter ❑over100amps
Sub Panel
Motors �0�1 HP �1'h � 8 Z
Inc.Solar 09-15 HP �76-15+
Microwave �
Pole Light
Range
Standing Sections
TraSh CompaCtor
FEES
Z
O
N
I
N
G
R
E
O
M
T
S
$ 3 '
Reinspection Fee $15 luue Fee $ 3
FEES
DEVELOPMENTSERVICESREQUIREMENTS: ,
2aning Approved By %Date
Building Approvad By ' Date�
Appliption Issued By— Data��
� • SUMMARY OF FEES �
BUILDING PERMIT $ SMIP $
PLAN CHECK $ PERMIT � .
PLUMBING § ISSUANCE �$
PLAN CHECK 25% $ ENERGV P.C. $: � '
E�ECTRICAL $ _� GRADING $ � '
PLANCHECK 50% $ MICROFILM �S —,_
MECHANICAL $ �— ��
TOTALFEE $ Jl�
$ 3 PLAN CHECK 25% $
' � ` �' POOL & SPA � .
CONSTRUCTION AND PLANNING � - -'
APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector
1. Temporary Elearical.Service or Pole 52'-Pool & Equipment Locatiom , � '
� -
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. Strucwral 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
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT
20. Rough Factory Fireplace APPROVALS Permit# _
21. Ducts, in Structure 70. Underground Hydro ' "
22. Ducts, Ventilating 71: Product Piping OGas ❑Oil
23. Gas Pipe-Rough & Test 72. Underground Flush -
24: Roof Framing 73. Undergrnd.StorageTank �Gas ❑Oil
25. Roof Sheathing � 74. Overhead Hydro
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical
27. Frame and Flashing 76. Dry Standpipe
28. Lathing & Siding 77. FIXED SYSTEM FINAL
29. Insulation 78. FIRE PREV. FINAL
30. Drywall Nailing HEALTH DEPT. REQUIREMENT
31. Plaster Brown Coat 79. FINAL INSPECTION - -
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED
33. Final Electric Notes: �
34. Final Heating & Air Conditioning
35. Final Gas Pipe�Test
36. Hood or Canopy � � �
37. Final Factory Fireplace ' ' -
38. Final Plumbing ' • � • , �
�
39. Water Service-Final , � . , '
40. Gas Service-Final . e • „ � ' • ,,
41. Solar pomestioFinal , , � ' .�
42. Backflow Preventer ��_ ' � �` I
�,43. Backflow Irrigation !� �, : '. , �
44. Landscape Irrigation System �✓� . .
�
45. Sound Attenuation
46. Handicap Regulations � . � �• ' '
47. FINALSTRUCTURE&BUILDING � �- ,
•% �
48. Special Requirements Completed �' -
�� � 1
49' Electric Release to Edison - � � �
.�
50. Gas Release to Southem California Gas Co �3- ��'
;�
' 51: CERTIFICATE OF OCCUPANCY
No. Date
PflOJECT pDUPESS: 9 4 O W 1 7TH ST
OWNEH'S NAME: GERARDO MARY C TR
aooaess:19147 FfRMONA AVE
TORRANCE,CA 90503
RFCNIENGINEEfl:
HEG.NO.:
UNIT:
AOUHFSS: IINIT:
PEHMITTEE: TI'IE HAKER COMPANY ( 714 ) 835-8572
aoosess: 1202 HUNTEA
SANTA ANA CA 92705
❑CENSED CONTBACTOfl DECIANATION: I hereby allirm Ihai I am licensetl under pmvisions oi Chapter 9(commencinq with Seciion
/7p00) o� �i isi gi Business an0 Prol n qCo ntl my iicense is in lult torce�' n�tl{ eilect.
LITY LIC.: ��� `�� f STATE LIC .��� J�!/�r� C1A55: C 1�"I
Date:��� �.i} .. Signatur��"%��" �i�L�
WOBRENS' COMPENSATION OECLANATION: I �er¢by attir hat I have a cehi�icate o� consen� �o self-insure or a cerlilicate oI WOBers'
Comoensa�io�emnc,.pr� �1i�f�myznp�em 1Sectibn 3floo. �ab�t] � O S/ 9 3
roucr No.:CNA INS C� EXP. DATE:
COMPPNY: }�
� Cenitiea copY is hereby Wmishe0. L Ceniliea co ' ie wilh ihe city BuilGpg Division.
G " ✓ /� �
Oa�e: ��� ' � NPPlicanL , .1,;! n�„I �! ��c
EXEMPTIONFHOMWONREFS'COMPENSATIONOECNPATION:i hi55ectionneedno�Decomple�e0i11Ae0ermi�isloranehundreA�$100��r1e55�.
I certify Iha� in Ihe pedormance ol �he work lor which ihis permil is issued. I s�all not employ any person in any manner so as lo became
subject Io Ihe Workers' Compensation Laws ol Califomia.
Dale SignaNre:
NOTICE: II, after making ihis Oeclaration, you should hecome suDject m Ihe Workers' Compensatian provisions oi ihe Labor
Code. you must forl�wilh com0ly with such pmvisians or �his permit shall �e Aeemed �evoketl.
CONSTflUCTION 1EN01NC AGENCY: I hereby atiirm Iha� �here i5 a cons�mc�ion lending agency �ar �he pedormance of �he work �or
which Ihis Oermit is i=suea (Section 3097. Crv. C).
LENDEfl:
ADDNE55:
OWNEfl BWLUEfl OECIABATION: I here6y afiirm Ihai I am exempt imm the Coniractors' Sta�e License Law �or Ihe �ollowing reason
ISection 7Q31.5 Business and Pmfessional Cotle: Any city ol county whiGh requires a Dermit to cansiNct, atler. improve, tlemolish, or
repair any stmclure, prior lo its issuance, also reQuiresihe aOPlicant lor such pe�mit �o file a signetl statement �hat he/she is iicensetl
pursuant lo ihe pmvisions oi Ihe Contradors' S�ate License Law (Chapter 9(commencing wiih Seclion 7000) of Oivision 3 0� Ihe Business
antl Pmlessions Code) or Ihat helshe is exempt ��ere�mm anA the basis for lhe allegetl exemp�ion. Any viola�ion ol Sec�ion 7031.5 �y
any applicant Im a permii subjeqs Ihe apPlican� to a civil penalry ol no� more Nan �ive hunared doilars (E500).
I, as owner oi ��e pmpehy or my employee5 with wages as iheir sole compensa�ion, will do �he work, antl �he
❑ simcture is not imende0 or offeree for sale (Section 70aa. Busineu and Professional Code: The Contractors' State License Law
aoes nol apPry to an owner oi a D�oDehY who builtls or impmves iherean, antl who tloes such work himsell/Aerself onhmugh
his or her own employees, pmvide0 Ihat such impwvements are not intentlea or offere0 tor sale. I�, however �he huilding or
impmvemeni is soltl wilhin one year o� complelion, Ihe owner will have �he hurden of pmving he/s�e tlitl no� builtl or impmve
��f [II¢ POfpOSC 01 Shc¢�.
I, as owner o� the pmpetly. am exclusively conirac�ing wi�h Iicen5e0 con�rac�ars �o cons�mct ��e pmlect (Section 7044, Business
❑ an� Pmlessi0n5 COCe: The CqnUati0r5' S�a�e License Law AoeS nol aDDly �o an owner af pmp¢tly who butlAs ur impmves Ihereon
antl who contrac�s lar suclt pmlecls wi�� a conlractor(s�license pursuan� to the Conirac�oK Slate Licens¢ Law�. I am aware
Ihat pmol ot I�eir Worker's ComDensalion insurance shoWd 6e pmvidetl �o me,
� 1 am exemp� under Sec�ion: B. 8 P. C.
lor ihis reason:
�ate: Ownec
I do here�y ceni�y Iha� I am aware oi antl untlersiantl ��e reQuiremems ol Calilomia Heallh antl Sa�ery Cotle Sec�ions 25505, 25533, antl
25534 and lha� I or any �ulure building occupan� willlwill nol (circle one) neetl �o comply wiih saitl s�a�e cotles and �he requirements lor a
permil for con9mclion or motlilicalion imm Ihe Air Ouahry Managemenl DiSVicL RevAen�ial consiructian applicalions are exemp� �mm
Nese pmvisians.
Dale- FpplicanL
I h rebY ceriity �hal I have reatl Ihis application and slate tha� �he above in�ormalion is mrrecL I agree �o comply wiN all ciiy antl counry
o manresantl5latelaw5relatmglobuAdingconstmctionantl horiterepre5e��a�ive50��hi5tilyiDen�eruponlheabove�mentionea
mperly for inspeclian pur0oses. '��/
� / .. �/��
Da�e: � �� � Y� SignaWre. ��/%y' �
onvef s License or 5ocial Security n:
�bat�a6 Wbite—Builtling: Green—Coae En�orcemem: Canary—ApO�icanC Pink—Revenue: Goldenrod—Assessor
CITY OF COSTA MESA — BUILDING PERMIT ,
PERMIT NO; F 062456 PLAN CHECK NO; 01856-93 S , ,
CONSTRUCTION TYPE; PERMIT TYPE; FIR PURPOSE; OTH
JOB DESCRIPTION : HACKFLOW RETROFIT SQ FT;
CLAIM VALUE: 3,400,00 CALC—VALUE; GROUP OCC; B-2 /
COMMENTS: THE "PINECRAFT CUSTOM CO"
*x *�r**�r�rx**�r�r*�r** �r*x***�r*� x�***x��e******x��e*�**�r***+r*�e*�r�***+�**x��*x�********x �*****
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 BUILDZNG ---------
FRNT; FT IN REAR: FT IN FRNT; FT IN REAR; FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT IN RGHT: FT IN
PARRING REQ• PROV; PARCEL; 92437105 ZNE; REF NO;
PLANNING N01'ES>
i
�x�****+r«*******�**********�********«**«***�*+�***��r****���r*+r******�****+�*****�r�r*
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N T S
ZONING APPROVED BY DATE;
BUILDING APPROVED BY ; DATE:
APPLICATION ISSUED BY• DATE; D 6��
if1Flflfifltit�t�Eklklflfif�tlt3FiFk�ltlf�t �lf�Flflk�fiF�fikiFifiF'iFiF {F�f
M�t�fkifftkitlfiEMiFifMfFiFiFiFkififiFikifMifiFifkklFMMlFafifl 1EMiFiFifiFiFiFik�l3Flf�Fif kifdflfikiFkkiE�FiFititklfiEiFif iFitikiFifif if ifiFif
LEGALIZATION;N F E E S U M M A R Y STRUCTURAL SEGMENT;N
BLDG PMT PLUMHING ELEC RIC MECHANIC FIRE SMIP/RES GRADING
PERMIT 63�Si SMIP/NON—RES
PLAN 40.95
ISSUE FEE
BUIiDING—DIV—> PERMIT ISSDE PLAN—CHECIt TOTAL PAID DUE
TOTALS----> 63,00 0,00 40,95 103,95 103,95 ,00
REVENUE DIVISION TOTALS--> COLLECTED; 63.00 OVER/SHORT: 00
HLDG�PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
63,00
itif if 1f �IEiF if ikiEif If iF�1FlkiEiE�1E if itif fEiFft ikiF�IkiE iElFlkiF ik%lkitiFiE�kif IEil�i(�iEiEiEif iEif iF �1FiE iflElklt if �IEih 1F iE�14fFlf iklk�lE7Eif ikJF ik IE iE kiFik iF1EiF
i N D I V I D U A L F E E B R E A K D O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
FIR 63
E'
�...
FIRE EQUIP FEE (FROM BLDG VAL TABLE)
END OF FEES
�
j
1,00
01 0014p3�4—p014Q35S TG T
DATE: 06/03/93 TIHE: 10:36
63.00
63.OD
v
CONSTRUCTION AND PIANNiNG POOL & SPA
APPROVALS Permif ,�'-r Date Inspector pppROVALS Permit � Date Inspector
1. TemporarY Electrical Sernicu or Pq�G - ' 52. Pool & Equipment Location -
- 2, Soil Pipe�Uncirgrnd. ' �1 �� 53. Steel Reinforcement '
�3. electrical Cond;;it�Itifity-Undrgrnd� 54. Forms
' C4' �^ectrcal Conduit�lndrgrnd, y�� 55. Electricai Bonding
� 5. Steei Reinforcement -�'� 56. Rough Plumbing & Pressure Test
+ - '
: ;L�'EtectricafUfC.R,Gr�d. � ` 57. APPROVALTOCOVER�GUNITE -�
>X, FooUngs i�� .. � 58. Electrical Conduit�Undrgrntl. �
`j ��� Foundauon ',- ,� : 59. Gas Pipe, � Undrgrnd., Test "
I,�9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrod.
I 10. Structural Floor System � • 67. APPROVAL TO DECK
, 11.'Properry Sewer Lipe & House Cor{ISection 62. Backwash & Receptor-Final .
12. Sewer Cap ti--c . o. . 63. Heater & Vent-Final
�- t
13. Roof �rains .� .� 64. Piumbing System - Final
• 14. Rough G�umbmg � 65. Electrical-Final
15 Rough Electri�a6Conduit 66. Solar SVstem�Final
� 16. Rough Electriq Wiring � 67. Fencing & Access Approval �
17. Rough t'1�iring&ign 68. APPROVED FOR PLASTERING
lII. Rough ElBctripl-T Bar Ceding 69. POOUSPA SYSTEP.iS FINA�
79, Rqugh Nsating �i Air Conditioning . P�p En pT..REQUiREMENT
. , . .. C'G .. .: x t'- 7 CTI-S� . r (�
2t� Ri�ugh4act�?rY�iiePlace i� Ca, � S T+�..� x��APP�iSV,�I',�C P�mit '' �
>". C� i�A-+= � � � �r--
' . _ ` .� _,y_:' e -.' r 'v� --�� a .� «. �� �.''---��•--- �
2' D'a,cts.•in Sirucjort '•. • �� � � �, R t.{ 70. �Jnder�iJ�j{.� f�dro x
2 0" 5_Ye�4+'I3ticir, � � • �•. x 3 ', �i x
1� pct � .r i < r ,� � r c,� .� 71. Prod�att�'.:fDing ,�as �] Oil
� -,.:-i: ' - -
23r Gzf Pipe'Rough.BYTest � rr rS �� '�' C+�� 72. Undergr�t�d���h � 2
i :
'- F - o � � � S,. , 6_2z.43 w,�
2Q. Rbbf Framing `_, ��� ''r x' >»� �y %�t 73; Undergrnd. StocDSie Tan(c � Gas ❑ Uil
25. Rtrof �'`„�eathin �.� ��✓����*� �
Y ff'. �t v`� .- ��:� K� 7 W Overhead Hydr$ r y
28; T'�'�ar Ce�l�ng �Sii�ctural! &t�*.c�iocoat t� j; '�� � 7"��-. Dry Chan�icat z-� ',`� " "._
27_� FrameAnp.F�ashin9 -��.,r, Y'* F 76. Dry Stafrypipe�s x' � T
� v � . - n•
• 28. Lathi4,� & Sidin� �",. � `xs r x� 7.�j FIXED�S�TFt'n�INP.�.�� , �
� 29. Insularion ' _ S •' � x 7 FIRE PREV. F�t�L `� S - �.�,J4S (��
30. Orywa�t Nail�ngy �,..., i i�.,, k x - �ALT�� DEP�':"�tECFUIl�Eft;EiUT
i � - � --,•-`•?-"�`-:r
31. Plaste rrn9n CDa� S ���:� x�. 79v FINAL CX'v"PECT!DN * .
-r � � �1:z- �' !-- -
32 EiettrEcsl Powec,f�? pr��inal � ��' �;,. � 8(�' FOOD CERTIt��J.�TE �S46JED_
� � r � `_ Yr_ T_�:i'-r-'_�_ _ .
3$ Fir�ai E�eCtric c !'; • � � x N'otes: - '-�*I ... - .� '�LT
,.__.e��y �'"
3� F�ial Heating & R�r,�6tiditiom�ig �r } r� � S n:-' S _
3{"r, Pinal Gas Pipe�Tesi �S .. � z- so i: a a -_
_ ,_t' - - - -
� 3F. H86d or CanoPY "- r- a < Cl x. S_ .^.cj 'r �-
� S�� U rz .n c'J ss.^ 7"
� .: � � , y . - ' _-
. 3.. Firial Factory Firapla�. . F!� � * z x �:ti
_ z � j i x= N -------
: 3� FiFal Plumbin -- • " ` '' * ! s -. ` _ -
9 , rY' r, i4C 7} t-! r_C�. n �
` 39: \Vafler Service•Fin� � j .;r x y.Tr� T� a`�_�' �----
40. Gas Serv�ce-Final' � •t r . : . x ev �< ^ --
o. � `- r � <+: _ �• �>_ <4
; 4f. Solar pomesticFicat� :: �� "�- x � * •. � � _ x: .-c _ . •
� .3 ,-
42. Backflow Preventer cu I t x .- •�o^ ='' ': •� -
- , .n u �o vc. .n.? '
A3. Backflow Irrigation rS � z y*� � `.`� �`- r�` � ' -.
. � �-a
44. LandscapelrngatibnSvste�-'"� t= � r = �'.x'c � '? ^^ " _ o
c �'�' �r r d<x. f 7 ',�a .<5
4rs�,,' Sound.,ACtenuation -�'` �. r y " .r r � +: � " � yu � �
46. Handicap Re9ulations � � * "� x� � r� � = '
- � ,. .c . .n (:. (� k
4� F;P'1JAL S7f?UCTt�RE & BUIIDING ` �' y � �' � `. ��
a . I 'T F
i. -
4� FINAlP4ANNING .. :` t I ,`,;. �� �.�i�'. � b 1 .
� 49, El�ctric Refease tq` Edison ,` I ♦, (r ; : s ,- ; ' .
•- 5(3, GN3 Release to Sowthern Califomia Gas Cn' I I �' y�� V ''�%,� '
t r :% ' �n YJ �'
51. CERTIFICATE OF OCCUPANCY f ' �• `� � 'y -
No. Date =.
Aoulicant to (iil in all soaces ezceot those witnin heavv Eortler lines ana sign all aoorooriata aetlantions.
CITY OF COSTA Q�rjESA ONS UCT N PERMIT PERlM/�IT NO. AT' wTPNQ LOT NO. UNIT NO. �
ProjectAddress • ��• l'�p�S� B/'1 2�Z 2�� - 1"� OK po'= 1008 6781 4/27/87 57066 TL
AppliCant's Mail'�� A�ddra�cO<� �IO O P �/(j[ ly/�((�O� TVPE OF CONSTRUCTION NEW D/ ALTERATION REP
OWnef'S NaGmte' �%�"'^" � • "'r•"��S y � �7 � CONVERSION ❑ DEMOLISH ���If ' ,p q p # — � � ' Zone �
Php�n/e�, E$ RIPTIONOFWOFK/USEOFBLDGh i�%�����/��-��`%
Adtlress Z�r� �� �� S�y �S�/� �i/�' �P�d-db�irrnT7� L�f7[Q �lJ�-l�-f�'-S S MainBuilding: AccessoryBuilding:
Arch/Eng. ��� Licen52 No. TVPE OF P RMIT ' GRADING FOUNDATION STRVCTURAL T Front 0
Add�¢55 ` - pppp'/ ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rear � T'E (D LT �/ N
CoMfector'SNam��rr-,�.� � s, / (���� � OTHER . _
���� Phone C 'Right N
Address (ma I'ng) IO�S(oS DGC(./C.Y /n!1-y�CT L,�,/��,(J�%C✓� PRQIECT DESCRIPTION SQ. FT. oCCUaAf.�Cv
—`,-7 � '—C"� CONSTRUCTION TVPE VALUATION $ fl�, �OD �� g Lef[ G
CilyLicenseNo. O"IObSL ZONE � GRADINGCU.VDS. ACRES ' R
LICENSED CONTRACTOR•DECLARATION �^ Ping. Ref. # Parking Req./Provided E
1 he�eby affi�m that I am IiCenS¢tl untler provi5iOn5 ot Charte� 9(commencing Remarks: ��'• E� J'�r Z �. z 8 Planning Notes: 5 n
wi[h� settion ]000) of'Divlsion 3 ot the Busine55 antl Professions Gotle, antl � -�� M
my Iicense is in f II fo e an'tl etfect. .�` `% - S ' T
License Class �� ice rvo ' �� � PLUMBING FEES ' S
Dalc z'�_�—o _��7'" Signa[ure _
WORKERS' COMPENSATION DECLARATION Bd� Sink � ShOWE�S � � � �
I hereby afiirm that 1 have a certiti<ate ot consent to seli-Insure or a certiflcate � ELECTRICAL FEE$
ol Wo�kers' Compen5ation Insurance, or a certHietl copy [he�eot (Se<tlOn Bd ilOwPf¢v¢pt¢� ServiceSink
3800, lab. C.) r Aummatic Washer Transformer ❑ 15-50 KW
POIicyNo.�6yy��� Company �� � Backfl Irrigation SewerCap nsVuctionPoleSub. . .�50+KW�
[] �r,rifietl copy is he�eby tumi5hetl.
LTCerti letl £opy i fi�iYyd wim tne city vlsi \ Bathtubs - Sewer Connection � Cooki Unit . ' Meter ❑up to 100 amps
Date �-S' �% `APPlicant�'�� � . , '
EXEMPTIONFROM�WORKERS'COMPENSATIONDECLARATION Clafifiers SolarColleCrors - � - DiShwasher Meter ❑over100a
(This section neetl noLbe cam0�etetl i! the permit Is for one huntlretl ($300) or
less). -'.i � Dishwasher � Solar Piping ' Dryers ❑Gas Elec[ric Sub Panel '
I certlty tha[ in the pe�fo�man<¢ ot Ihe work fo� whlcb th(5 perm�t iz issuetl, I
shall not employ any� person in any manner so as to become subject to lhe Drinking Fountains Solar Tank Fan
Workers' Compensahon'Laws ot Calitornia. ' . Motors 1 HP �1'h-6
Date ��' Si9nature Floor Drains Swimm' Pool w/Spa F.A.U. � '
NOTICE: If, atter�making this tleclara[ion, you shoultl become zubject to tne Inc la� �9-15 HP 016-75+
WOlkers' Com0en5ation plovlsions of the Ldbor COtlG, you musi fofthwlth FIOOf $iOkS U� dl Fiztuf25 icfOwdvQ
comply with such provi5ions o� thi5 permi[ shall �e tleemeE �evoketl.
CONSTRUGTION LENDING AGENCY GasService �Utl¢t5 Wd CI052L D¢VIC¢BOx25 '
I hereby affirm that there is a tonstruction lentling agancy (or the perPormance ole Light
oi tho work far which this permit is issuetl (Sactlon 309] Civ. C.) - Intercepto�s Water ter Outlets �
Lentler's Name Ran
�entlor's Atltlress Kitchen Sink Water Servic - Switches Sign
OWNER BVILOER bECLARATION ' _
I hereby affirm that I am exempt from the GonlydttOr's Llcense Law fot the L3vdtO�i¢5 AU�O-W2ih Garbage Disposal
followin9 reason (Section 7031.5 Buziness antl Professional Cotle: Any clty or Standing Section
cOunlY which requires a p<rmit [o const�uct, dlt¢q Improve, tlemolish o� r¢pair . P-T�dp Leu�d� T�a 5
any sVuc[ure, Orior to i[s issuance, also requires tha applicant tor such permlt � Y Generator ❑ KW �5-15 KW Trash Compactor
to file a signetl statement that he/she is licensetl purzuant to the provisions oi Roof Dr � s
[he ContraC[Or's Lic¢nse Law (ChaOter 9.(mmmencing with Sec[ion ]000) o/
Divislon 3 oT roe Buslness antl Professions Cotle) or lhat he/she is exemp[
Iherefrom ana tne basis tor Ihe alleged exemplion. Any vlolation of Sectlon
7031.5 by any applican[ t0� a permit subjecl5 lhe appliCant to a civll
�enalty ot not more Ihan five huntlretl dollars (5500).
IJ 1, as owner of the property or my employees with wa9es �as their 5ole Reinspection Fee $15 Issue Fee
compensation, wili Oo the work, antl tne structure is not intentled or offeretl Reinipeetion Fee $15 luue Fee �
tor sale (Sectfon ]044, Businnss antl Professional Cotla: The Contractor's MECHANICAL FEES $ 3
License Law tloes not appry lo an owner ot a property wh0 builtls or improves
thereon, ana who tloes such work himself/herself or throu9h nis or her'own DEVELOPMENT SERVICES REQUIREMENTS:
employ¢es, prOvitletl that SUCh Improvements ar¢ nOt Intentletl or offeretl for BOiI¢� HOOd O� Typ2 I ❑ ^�
sale. It, however, the Duiltling or improvement is soltl within one year of com- . Canopy Type I I ❑ 2oning Approved By �r�G/ M1N� Data 2 �
o�etion, the.owner will have lhe burtlen of proving he/she tlla not builtl or im- Duct - Under Ground B�ilding Approved By ��Dat�
�rOva fo� the purpose.of Sale).
1, as owner of ihe property, am exclusively contracting witn licensetl <on- Duct - Structural Refrigeration System AppliWtion ISSued By Dat
trac(ors to mnsiruc[ tbe proj¢ct 15ection �044, BuSiness anU Pro�essions Cotle:
Tne Con[ractor's LiGenze law does not apply to an owner oYProperty who Duct - Ventilating ❑0-100,000 BTU ❑100,000 BTU
builtls or improves thereon, antl wno contracts for sucn proje�ts with a con- SU RV OF FEES
tractor(sl iicense pursuanl to Ihe Contractor•s �Icense Law). I am aware that / Exhaust System Multiple ❑ System Repair/AlteratiOn 4 BUILDING PERMIT $�v�� SMIP $ Q�.SQ
prool of their Worker's Compensation insurance shoultl be p�ovitletl to me. PLAN CHECK $ ?`9 � PERMIT '
❑ 1 am exempt untler Sectlon B. & P. C.for this reason Firepl/Fact. Blt. ICBO # Fire Dampers PLUMBING $ ISSUANCE $_
Date Owner Heating System & Ducting � � Registers • pLqN CHECK 25% $ ENERGY P.C. $
I hereby cer[ify that I have read this applicatlon antl state Nai the above ❑0700,OOOBTU �100,OOOBT GRADING $
intormation is mrrect. I a9ree to como�Y with all dty antl county ortlinances EI.ECTRICAL $
antl state Iaws relati Duiltlm9 c nstruction, antl hereDy a�thorize repre- . MICROFILM $
sentatives ot this y o enter n th above-menNonetl prop¢rty for . PLAN CHECK 50% $ �
inspectionp . Z 3�G� MECHANICAL $ �,�D TOTALFEE $
Signa[ure . -
Datz _
Drivers' License or 55 # � ' Reinspeetion Fee $75 Issue Fee $ 3 PLAN CHECK 25% $
CMF 0865-46, rev. 10/eo Wnite - 6wiaing; canary - Fappucan[; r�nH - qccounung; �oiaenroa - qssassor
.CONSTRUCTION AND PLANNING ,. POC SPA • �
APPROVALS �Permit,# � Date Inspector qppROVALS Permit# Date Inspector
1!T�mporary Electrical Service or Pole 52. Pool & Equipment Location
2. Soil Pipe-Undrgrnd. ' 53. Steel Reinforcement ' �
3. �ectrical Conduit Utility-Undrgrnd. 54. Forms
�
4.'Electrical Conduit-Undrgrnd. 55. Electrical Bonding
�
5:�Steel Reintprce�rient 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-Und�grnd. � 60. Backwash Lines, P-Trap, 0 Undrgrnd.
10. Structural Floor System 61. APPROVAL TO DECK
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final
12. Sewer Cap 63. Heater & Vent-Final �
13. Roof Drains 64. Plumbing System - Final
14. Rough Plumbing 65. Electrical-Final
15. Rough Electrical-Conduit 66. Solar System-Final �
16. Rough Electric Wiring 67. Fencing & Access Approval ,
17. Rough Wiring,Sign . 68. �APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling ' 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �
20. Rough Factory Fireplace APPROVALS Permit # �' _
21. Ducts, in Structure . 70. Underground Hydro
22. Ducts, Ventilating - 71. Product Piping � Gas ❑ OiL
23. Gas Pipe-Rough & Test 72. Underground Flush . �
24. Roof Framing _ 73. Undergrnd.StorageTank OGas ❑Oil
25. Roof Sheathing � 74. Overhead Hydro • '' "
26. T-Bar Ceiling (Structural) & Monocoat . 75. Dry Chemical �
27. Frame and Flashing , 76. Ory Standpipe ' {-��' •
28. Lathing & Siding 77. FIXED SYSTEM FINAL�,.
29. Insulation 78. FI�RE 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 � �
. , t.
40. Gas Service-Final • . '
41. Solar pomestic-Final � . �
42. Backflow Preventer � -
. 43. Backflow Irrigation � -� " ' . ,
i.
� 44. Landscape Irrigation System � � , �
-45. Sound Attenuation ' , .
"46. Handicap Regulations . � ? � ' �
47. FINAL STRUCTURE & BUILDING _� �e .•ga � Q y�. v8C p�A •
( 0 oQ'
48.,Special Requirements Completed � ` • �
49. Electric Release to Edison � � -
50. Gas Release to Southern California Gas Co � ,
51. CERTIFICATE OF OCCUPANCY
No. Date �
0
C..(L. _..-- AC?liA I'c_I V 5 �; � V t,�-1-! Cti.1 - LAY-C.�
- - � ,� : ,��,
5 3Al.LAST £ p2Y ��
�a. BOND B��LAST c(�2Y � TG� w�
7, 1_11ST.ALL �q]TE0.i p•.t F �fLY
,S. SAND, �JT�y� �Pn�N� � £ OiLy Y
.4, Lus-rn.�-�_. cTrZ3�.£ Htv�� HDW. �-- - -
�
./U. .Dt.CtL .kDW. '� � p � j j
I�I`I{n
.II.,....DE� K_,BOAT ' � I I 1'� �
/ l 1 l
(Z. �if,,1iE,2:�6R, Pl�it�-r �QrEP. I
(3 'Ii.iTE2�02 r`�A1�T��TG. � E.
14: ��..!?C2�prt F7tJ! S�-k � ,
�5,. 1f-iTE_21C2lEXTE2lp2 FtrJ. . �Z�
(/o,_.'fOVf.N-V(�,�C�EAti�i E PACK � �
A...SMn�� F�AZTS L�.Y-uP �� I
P. SMAL�.. f?A��T.s. 62i�.�D, c.TC, � -
C. �Ck G2iti�p I
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PLANNING DEPT.
SU8IECT TnO BLDG. DEPi. RECi.
fGQl�[1_._r DATE.If- �-z �
DIRECT A OP PLANNINO
ii � ;� �; � �
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MOI��, P�U� ��!.ASS S.� U? A.�>c
P�`,+_...si.Cf�AV� - - -
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p���_�,uv �;o�s�-
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�City �f �C�os� Mesa
1'HESE PUNS MU3T BE ON .lOB�AT ALL TIMES
MAKE NO CHANGES WlTHOUT PRIOR APPIiOVAI
OP DEP1.
iHf ISSURNCE OR GRANtING 6F A PERMIT OR APFflOVAI
Of PtANS AND SPECIFIC0.TIONS SHALI NOT 8E CONSiRUED
TO BE A PERMiT FOF, OR AN APPROYA4 Oi, ANY VIOLATION
OF ANY Of THE PROYISIOttS OF THIS GODE, NO PERMI7 PRE�
SUMING TO GIVE AUTHORfiY TO YIOLA7E OR CANCE! THE
PROVi510NS OF 7NIo CODE SHALL BE YALIC, E%CEPT IN SO
iAR AS THE WOflH QR USE WMtCH IT AUTNORI2ES IS LAWNt.
THE ISSUANCE DF A PFRMIT BASED IIPON PLANS ANd
SPECIFlCAiIONS SHALL NOT PRE4ENT THf BUILDING OiFiCIAt
fROM TNEflEAF1'ER REQUIRING THE CORRECTION OF ERRORS
IN SAip PIJtNS ANO SPECIFICATIONS OR Fl20M PREVENTI{1G
BWLDIN6 OPERATIONS BEING CARRIED ON THERfUNDER IVNEH
IN YIOIAAON DF iHIS fADE OR 4P ANY OTHfR ORDIHANCE
OF TNE CITY.
S�� �U�L p4P �R� ����tt��0.
RERM�tS ,Uc�e��ac,
SEpPAP�����-�RiGM1j,, n��N�, ANO
�EOR ��CaG, FAP�t�ii W09K
tiEAR�FR`G"� _-.il��
��� � , � ��`��s�s � ,
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��� a�'� ti;,s� �tii�'��� � �. �
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4DZ �'?l ; �V. •`+r t�,,l P,p g�li� FpR
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. .
�/fI.DIRG SAFETY DEPABTMENT \�
O.'SD��No.317 N° 146� �
Costa Mesa, California
nateL�]A.e - 24 19/. /
CITY OF COSTA MESA
CERTIPICATE OF OCCUPANCY
Building Permit No.�.��� Electrical Permit No Plumbing Permit No
use oe suaa�g 57'� k. I� -f i L•-r n F'F'. hG. D�J .
Ttie building located at y L�n 1.� i l"7 / N �i7"�
Legal DeScilpWion
(See reverse side for Metes and Bounds)
•has been inspected and found to comply with the provisions of all City of Costa Mesa Ordin•
ances applicable thereto for a Group FZ�+ �� Occupancy.
ISSUED TO:
City Bailding Official
Ra,�;� r_- a��F� � x� -�' 1. � ��
(Owner of Building) By �
CC: ❑ Ori mal—Owner � � 'n � �
g� ❑ lst copy—Gas Co. ❑ 2nd copy—Edison Co. p�rd�py—File
Form 208 SB P IM I-W .
. . • .
Appiicant to lill in ali spaces witnln �eavY �orOer lines anG s14n all aPVroONate Geclaratlonf.
CITY OF COSTA MESA PERMIT NO. � TRACT NO. ' LOT NO. BLDG. NO. - ' ' ' - '
CONSTRUCTION PERMIT / �p � • ''
. 8277 7/07/81 8a00
Project Address TYPE OF CONSTRUCTION • � � � � � � ''
OWnef ��EW ❑ ADD ��ALTERATION • � ' - � , �
AdAress � • ❑ REPAIR ❑ CONVERSION ❑DEMOLISH ZONING REGULATIONS
Arch/En9. - LicenSe No, - ❑ OTHER .
Addr25s DESCRIPTION OF WORK A'P' � -
ZONE PLNG. REF. �
. Contractor -� Phone yp� OP PERMIT. TpBUi LpING
SETBAC C 5T. PROPERTV LIN�
AddfE55 � / G/ � ❑ GRADING ❑ FOUNDATION ❑ STRUCTURAL SID VqRD - ' -
LICENS D O TRACTOR DEClARA710N , �EDE
I nereby aifirm that I am IltenSeG untler ptoviilons of Cnarter 9(com- � TENANT�ELECTHIGqL ❑PLVMBING ❑MECHANICA �IGHTA
m¢ncing wlth Settlon" 7000) ot DlviSion 3 ot tbe Bu51ne5S antl ❑ OTHER .
Rofesilons Cotle, and my Iicense Is In full forCe ana etfec[: REAR VARO (TO P/L)
PROJECT �ESCRIPTION
LlconSe Clasz -� 4 licen N , � PKG. SPACE REQ. , PROV IDED
OatB Z 7 y� Si4nature 5�. FT. . .
� f' STREET WIDTH PARK FEE 5
WORKERS' COMVENSATION DECLARATIpN - OCCUPANCV_CONSTRUCTION TYPE
I bereby affirm tnat 1 have a certiticate of tonsent to ulHnsure or a VAlVAT10N ZONE ' ZOfJING APPROVED BV � DATE
�ertifi�ate of Workers' Compensation Insurance, or a certitietl coPy ' � SPECIAL CONDITIONS:
thereoi (Setlion 3800, lab. C.). ' GRAOING CU. VDS. P.CRES
� "�.y No. Company � � ' .
:rtHietl copy is �ereby fur�isbetl. - - qEMARKS: � - • � .
�ertl�letl copy Is filetl wilh ihe city Huiltling Division. �
2XEMPTION FROM WORKERS' COMPENSATION DECLARATION � � -
(7h15 secllon neetl Oot be COmplet¢tl If the pe�miLli f0/ one hunOr¢tl , . _ _ ' '
yE300) or less). - . .
ceriiry that In the pertormance of the work for which Shi permlDiz
�ssuatl, I shall not employ any pe n in any manne so as betome PLUMBING -PLAN CHECK ' ELECTRICAL -- PLAN CHECK .
5ubjeCt to tM1! WO�kG�s' CompCnsd On w5 0! Califo la. __ _ _
Date ��!��� Si9nature BATHTUBS SHOWERS� -�
NOTICE: If atter making thii tleclaratlon, you shoul becomc subject TOILETS URINAl.S 'GENE0.ATOR 0-1 KW_1-30 KW � �
to thC WOrkers' Compenutlon pravislonz ot the lnbor Cotl¢, you mus[ � TRANSFORMER - '
forthwlth comply with such provizions or this permit sball be tleemetl �VATORIES DOUBLE LAVS APP�IANCE " 30-50 KW=50+KW -
�¢yok¢tl. - - -
GONSTRUCTION LENDING AGENCV KIT. SINKS DISHWASHERS MOTORS 0-1 HP_1-10 HP - �
� hereby afffrm that tnere is a constru<Uon lentling a9ency for the per SERVICE SINKS SUMPS �(�NC. SOIAR� l0-50 HP SO i HP
�ormance of t�e wO�k for whlCh [tili parmit is ISSuetl ($tctiop 309]
Civ. C.). Fl_OOR SINKS FLOOR DRAINS FIXTURES - OUTLETS SWITCHES
Lentler's Nama
Lentler'SAtltlrMs ORINKINGFOUNTAINS - GASTUBESIGNS `
OWNERBUILDERDEGLARATION INTERCEPTORS CLARIFIERS POLELIGHTS '
I hereby atlirm thal 1 am exempt lrom Iha Contrat[or'S Llc¢nse l2w IOr
the lollowing reason (Section ]031.5 6us(ness antl Profe551ons COtle: SW�MMING POOL � P TRAP -
Any cily or county which requiros a permit to construct, alter, POLES METE0.ED SUB
Improve, tlemolish Or repair any ztructure, prior lo its iszuance, also re- yyATER SERV ICE AITERATION PANElS MAIN SVB
pWres lhe applicant tor such permit to file a signetl statement that he
Is Iicensotl pursuant [o lhe provislons of the ContraclorY Uttnse Law GASSERVICE OVTLETS SERVICE ' AMP ' '
(Chapter 9(commencing with Seclion 7000) ot Division 3 of the
Busines5 antl RdessiDnS Cotl¢) or tbat he is exOTpl tOerGhofO dntl [bB yyqTER HEATERS BTU OVTPUT 'Z (f V Q
bs�'� for tM1e allegetl axemptlon. Hny violation of Section 7031.5 by �
a ppli�ant tor a permit sub7etts Ihe applicant lo"a--Civil penalty' SEWER COfJNECTIONS � � � '
< t more iban live �untlretl tlollars �y500).
[� �, as owner of the proporty, or my amPloyces witn wages as tneir SO�AR TANK COLLECTORS � �
5o1C compensation, will tlo l�e work, anG lha itruclur¢ IS not intentletl
or offeratl (or wle. (Section 7044, Business antl Rofesstons Cotle: The SOLAR PIPING SVS. �SSUE FEE
Contractor's �Llcen4e law tloes no[ apply to dn owner ol a proParty
who bulltli or ImprovCs ihereon, anE who tloos sucn wo�k himzall or �SSUE FEE AFFLIGATION APPROVEO BV DATE
throu9h his own employeas, provitlotl that suc� fmprovnmentz are not
intentletl or oifcretl for sala. H, howeveq tne buil01n9 or Improvement - MECHANICAL PLAN CHECK
Is soltl wilhln ono year ot completion, tha owner wlll have tho burtlen SUMMARV OF FEES .
ot Proving he Oitl nol builtl or improve (or the ourpose o( zale). BUILOING ' - -
❑ I, as owner 'of lhe property, am exclusively contracting wi[n HEATING SVSTEM 0-300,000 BTU PERMIT E SMIP E
IlcenseO conl�actors to consbucl tbe O�oiect (Sectlon 7044, Buslness AND DUCTING 100,000+gTU
PLRN CHECK 5 PERMIT
anE Prolessions Cotle: The Con[rac(or'z License Law tloes not appry to ISSUANCE S
an owner o( property who builtls or improves Ihereon, anC who con- REFRIGERATION 0-100,000 BTU � PLUMBING S
Vacts �rom sucb pro�octs with a contractor(s) 11<esnetl pursuant to SVSTEM " GRAOI/YG S
the Contractor's License Law). 300,000 + BTV PLAN CMECK E—�y_����r
❑ 1 am exampt un0er Section B. & �. C. for lhis gO1lER5 BTU ELECTRICAI S�= s
reason - MICROFIIIN E
Date Owner - SVSTEM REPAI R, AITERATION PLAN CHECK E TOTAL FEE E
1 bereby certify that I nave reatl tnis applica[ion antl state lhat the above , EXHAUST SVSTEM MULTIP�E MECHANICFL S
Information is correct. I a9ree to compty with all ci[y antl county PLAN CHECK S �E55 AD-
ortlinances and State Idws reldting lo cOnStructiOn, an0 nereby dUtnorize VANCE PC E_
repr¢5entative5 of [hI5 clty t0 ent¢r upOn the dbOv¢ m¢ntiopetl d0'
property for in5pectlon purposes. . - ' � /�
Sl9natur¢ Date FINAL FEE 5
Drivers' License or 55 3� ISSVE FEE ' � ..
CMYUtlbJ-'�O WNI¢-CWIO109:�nafY'HPP���nqrina-McwVnun9:�+uiVenroovavoa��
TL
CONS7RUCTION AND PLANNING � POOL & SPA . � .
APPROVALS Permit # �//G Date Inspector qppROVALS� Permit #� '�« ' t Date Inspector
`»=
7. Temporary Electrical Service or Pole 43. Pool & Equipment Location -- - �- � �
2. Soil ipe-Undrgm 44. Steel Reinforcement �� ' �" �,
3. Electrical Conduit Utility-Undrgrn_ 45. Forms -
4. Electrical Conduit-Und�grn 46. Electrical Bonding � �
. tee e�n orce 47. Rough Plumbin & Pressure Test �
6. Etectrical UFER Grn 48. APFROVALTO COVER-GUNITE
7. ootings 49. Electrical Conduit-Undr m �
$, Fpundation � 50. Gas Pi
pe, Undr rn, Test
9. Water Pipe-Undrgrn 51. Backwash Lines P•Tr 0' ndr rn
10. Structural Floor System 52. APPROVALTO DECK- �' ' -
11. Property Sewer Line & House Connection 53. Backwash & Rece tor-Final
12. . Street Sewer Connection ' 54. Heater & Vent-Final
13. Rough Plumbing -
14. Rough Electric-Conduit �56. � Electrical-Final �
15. Rou h Electric-Wiring - 57. Solar System-Final
i6. Rou h Heating & Air Conditioning � encing & Access Approval
17. Ducts in Structure '' APPROVED FOR PLASTERING `
18. Ducts, Ventilatin9 �
19. Gas Pipe-Rough & Test 60. POOL/SPA SYSTEMS FINAL
20. Roof Framing � � ` �
21. Roof Sheathi� ' •
22. Frame and Flashin NOTES:
23. Insulation ' '
24. Lathing & Siding
25. Drywall Nailing
26. Plaster Brown Coat - �
27. . Electrical Power Meter-Finai � G
28. .Final Electric -/..i �i '
29. �Final Heating & Air Conditioning . '
30. Final Gas Pipe-Test
37. Finai Plumbing
32. �� Water Service-Final �
' �33:• 'Gas Service-Final'�
� 34. Solar pomestic-Final
35. Landsca e S rinklin S stem
36. Sound Attenuation
37. Handicap Regulations
38. FINAL STRUCTURE & BUILDING
39. Special Requirements Compleied
40. Electric Release to Edison ' �
41 . Gas Release to Southern California Gas Co.
42. CERTIFICATE OF OCCUPANCV .
No Dare
fi-�' „1L32�iF�
COSFA MESA� BUILD�NG•SAFETY DEPARTMENT F E E� E C E I V E D
P. O. BOX 9f7 COB'TA MHBA. CALIFORNIA �.p2" _/ �. � Q 6 0 OKtV�
For Applieanf fo Fill In Completely APPLICp 7FINµA�NFCE �DEpPuT.
TYPE OR PRINT � �lif�P'UI'��.YIA�191�A
///��� BUILDING
BUILDING /i/� ���'� � � _C-L
ADDREBS /�T o'� v /
COSTA MESA. CALIFORNIA For Office Use Only
�� � S�O �-. ���} �� �%Z l�.pf� aece�vr ruo. � r.Lr J+o�
OWNER �(p
MAIL J RECEIVEO pY I OAi qEC61VED �ATE IB6lI8U
ADORESS / Y O 3 /� A '��Z O AI T. U � 6 � �� �"�
CITY L WO fC � No`: L I�6�� � pDOREb6 ��� L
ORCENGEINEEft L �E�L 'lI i+o. COSTA MESA. GALIFORNIA
o�
ADDRE6S FIRE ' ' ' ' �3
/� ZONE � TYPE - GROUP
CONTRACTOR I�I . N� �9OS � BYPROVED ATE�/_�}��d
^(� (J
ADDRES6 r� O r � O K. � V u� NING �
CITY `� W � IC � �l`. A G�. [1 , �ONE � I PLANe �/ I BUIL�INO e�
/ t, TEL. � (/ p �pAL
LIC.TNO. I�' 3 I r7 � NO. I� I S O,/� 3 I DeeGa�nrioN
81ZE ,� y � I No. oF eLDoB. O l �]'h
OF LOT {� �J O O Now oN wT A. P. NO. I b � 3 L-' �
U6E OP V�' � YARDS ' EVES
E%18TING BLDG. APPROVED ALLOWED
B8T911CK LINB PROM /Y�, (�NT6P LIN[ 6T � J� -- �
CeNTeP oF 6TR66T / REAR YARD PRONT "'
/ �/�j,
SIOE YARO LEF? O RIGH7 �la�/O R.81DE
DESCRIPTION OF WORK
L.SIDE
NEW ALTERA7�ON I II ADDITION I REA �Y
REPAIR I IIMOVING I IIDHMOLISH I BYPROVH�
BBZIeLDINGAO J �� RO�MS � STORIES �
/ )�
EXTBRIOR WAL�D�N C� I G�VQRING l50 M b,
COVHRING
USE OR BUILDING AND WORK O BE PER QR�1 D
�PA�� � i3T,�f,s� o6F� „ ,
�
7
� XEREBY ACKNOWLBDOB TXAT � HAV6 pGD TMIB APPLIWTION n{6 AMOUM BHOWN UNDeR VAWATION IB POR TXE'
AND BTATE TXAT TH6 ABOVE IID CORRECT AND A6RC8 TO COM- pURP08H OP 68TABLIBHING A PERMIT FEE ONLY.
PLY WITH ALL CITY O NCEB AND 8TAT8 lAW6 pHODUTNO
Bu1tDINo CONBTIi o VALUATION �yq j
SIGNATURE OF PERM17 FEE $ {JKJ�
PERMITfE � �/ I e
� �� 3j PLAN CHECK $
AUTHORIZED AGENT / �' ¢
TOTAL FEE � � �
�
�" .;.: ' � . � 3 I I 60
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COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA, CALiFORNIA 92626
DEC -4-6�00 417* *�**2�.0�
[p5A
For Applicant to Fill in Completely %�PPLICATION FOR BUILDING PERMIT
ADDRESS � y C �J � -=�y REC I V D B DZTE RECEIVED �p�E IS$UED
BUILDING �� i/ / G
OC �T/O /
'OASTAL r�3+�on � / PERMIT NO,
OWNEF - '�. . � � A.P.NO. � �b ^� b iJ
MAIL .j� 1�Y1/1 �I�nr BUILOING �J _
ADDRE55 �'t � Y �� ADDRESS pI
pTY 5 NOL L. �{� IO TRACT -�Q(,( �LOT BLOCK
�.CONSTRUGT�ON W D A
LENDER
�'BpANCH
OwNEfi
�'ADDFE55
A UE
ARCHITECT TEL. 5
�OR ENGINEER N
FIfiE � `=-
'�ADOFESS 20NE TVPE GROUP �
APPROVEO
CONTRACTOR BV ' D.4TE
ADDfiESS
TEL. Z E NO.OF .VSE OF NE
CITY NO.
PL4N5 BUILDING
STATE CITY YA OSAPPROVED VARDSAPPROVED
LIC. NO. LIC. NO. MAIN BVILDING ACCESSORV BUILDING
SIZE NO.OF BLOGS. (FROM C/L STREET)
OF LOT NOW ON LOT FROM FT. FT.
USE OF
EXIS7ING BLDG. FT
SI2E OF NO. OF �
NEW BLDG. ROOMS STORIES L. SIDE FT. FT.
EXTERIOF W�1�L ROOF
COVERING COVEpING REAR FT. FT.
USE OF BUI�DING AND WORK TO BE PERFORMED OLSTANCE BET. BET. MAIN &
� MAIN BLDGS. AOCES.S. BLOGS.
VAR.#` � DATE
QV.P.� APPROVED
J' L ��1 l � �ROVED � q
Y
1 ^:1 1 ti: � I S-i1MD �'a1�-�fc-.
I hereby dcknawlatlBa [hat I heva•reud [hia application antl smte
thet the abave intormotion Is correct antl agrae to eomply with
ell laws �ae��a���e builtlinp consvuction, antl I shall not employ
any perso� in viola[lon ot Me workman's compensallon lews oi
Ma Stata Qt Calitomle.
I hereby certity xhat I am properlV licensetl as e contractor under SQ. FT.
the Stata ot California Business entl Protassions Cotle, Oiv(sicn 3, THE AMOUNT SHOWN UNDEti VALUATION IS FOR
Chepttr 9� antl [hat such licanses ara In full forca entl aftect, or 1 TNE PURPOSE OF ESTABLSNING A PERM�T FEE ONLV:
em exempt frOm the provisians ot the Stete of Colifornia Business VALUATION
entl Profe4sion otle, Divisian 3, Chapter 9. � GO
O� PERMR FEE 5
SiB�ature ot r1 ,� ` � �
Permittee ,= - � v�"' �+7+! i 5//�Q � P�p,N CHECK $ • 0 0
Authorizatl ABent �I /' O 0
TOTAL FEE S f^
•'' " . 31 191
^ � COSTA MESA BUILDING-SAFETY DEPARTMENT
p.b. BOX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely
BUILD�NG��A � .. ♦ 1"9..L\L / f
OWNEP �'
MAIL r1
ADDRE55 J
CITY A�
CONSTRUCTION
IENDEA
6RANCH
ADDRESS
ARCHITECT
ADDRES��-�
CONTFACTOR
dTV
STATE
lIQ NOGI(�
SIZE
OF �OT
USE OF
EXISTING BLDG.
TE
L, N�
TE
TE L.
NO. ��
CITV �
LIC. NO.���
INO.OF BL�GS.
NOW ON lOT �
DEC 78-64��h00 853 �****32.00
APPLICATION FOR BUILOING PERMIT
RECEIVEDBV DATERECEIVED �..r�����i
BUILDING
ADDRESS
OWNER
VALUE
DATE
ZONE NO.OF USE OF
PLANS � BUILDITyI
VARDSAPPROVED VAF
MAIN BUILDING ACCE:
(FROM GL R ETI
� S12E OF NO.OF
Z NEWBL�. ROOMS STORIES L.SIDE FT.
U EXTERIOR WALL ROOF
COVEFING COVERING FEAR FT.
J USE OF BUILDING AND WORK TO BE PE(iFORMED DISTANCE BET
a MAIN BLDGS
a
O ^���C+ CUflP.#
� APPROVED
VJ �..� �
z
�
~ I herebY acknowletlge that 1 have reatl this application antl state
�� that th9 above information is correct end agree to comply with
� all laws raBulatinB building construction, antl I shall not employ
F any person in violatlon of xM1e workman's compensation laws of
y the State of California.
zI hereby certity thei I am ploperly licensetl as a contrector untler SQ. FT.
the StaTe ot Celifornia Business antl Protessions Code, Divisicn 3, THE AMOUNT SH
Chapter 9, antl that such lice are in full farca antl effect, or I THE PURPC6E OF
am eaernpi from the provisi �s t theState of California Business VAI�UAT �
antl Pro�essi Cotl , ivisia Chapter 9. �/
Signatura of � �
PermlttBe $
BET. MAIN &
w
0
VALUATION IS FOF '
A PERMIT FEE ON�V: �
¢
� r% m
E $ =r �
K $ � E
`a
�^/ LL
$ N'�
Z .
ww
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- • 375I6
COSTA MESA BUILDING-SAFETY DEPARTMENT
P.Q. BOX 1200 COSTA MESA. CALIFORNIA 92626
vnio
`:OV-7-73c�is•�� 237� +�***+�5.50
A PL C ION FOR BUILDING PERMIT
For Applican[ to Fill in Completely qECE B DATE RECEIVED
D TEISSUED
BUILDING /� _
ADDRESS '14D W. 11t� ST.
GORPOM1AT�ON - PERMIT NO.
OWNER DOU M/�LR22 p� (7CD8M I�C FL=�KC A.P.NO.� -
MAI L n BUILDING
ADDRESS -I¢� W• I%t� 'r, ADDRESS �(J, ' 1�C
TE l. �'�
CITY OSTA ELA GA . NO. S`f�. Q TRACT �,5 LO BLOCK
CONSiRUCTION W ADD A P
LENDEF
BRANCH /
OWNER �
ADORESS
VALUE ��i�� �
ARCHITECT TEL 5 O G " JC $,�x�
OR ENGINEER N
' FIRE �
ADDRE55 ZONE TVPE GRO P
APPROVED
CONTRACTOR � BV DATE �
ADDRESS
TEL. ZONE NO.OF USE OF NEW
CITV NO. P�� BUILDING Q /
I\.
STATE CITV �'�+RDSAPPROVED VARDSAPPROVED
LIC. NO. LIC. NO. MAIN BUILDING ACCESSORV BUILDING
SIZE � � . NO.OF BLDGS. (FROM GlSTREET)
OF LOT 1 I 3 % I le 4'� NOW ON LOT �' ROfYT F.
USE OF /�
EXISTING BLDG. 5� f/ T
SIZE OF NO.OF �
NEW BLOG. ROOMS STORIES L. SIDE - FT. FT.
EXTERIOR WALL ROOF 'u'N
COVERING COVERING REAR '• FT.
USE OF BUILDING AND WORK TO BE PERFORMEO DISTANCE BET. BET. MAIN &
L J I O R O Awl E A K MAIN BLDGS. ACCE�. BLDGS.
VAR.# DATE
� 1�7 2- CrA L• r� E V S E FO j'1. C.U.P. � - APPROVED
pR-ILLIGT FvEllwl �'ROV6D � _ �
!/
I hereby acknowletlp0 that I have reatl ihis application entl stete STAT
thai the ebove informetion is correct antl agree to comply wlth
all laws ragulaHng builtlinp conscruc[ion, antl I shall mt employ /
any person in violation of the workman's compenseNon laws of ��J
the State af Celitornla. m
b
I hereby cartify Nat 1 am proDerly IicenseA as a conttactor untler SQ. FT. p
the Stare ot California Business entl Protessions Cotle, Divisicn 3, THE AMOUNT SHOWN UNDER ATION IS FOR �
Chapter 9, antl that such licenses are in full force antl atiect, or I THE PURPOSE OF ESfABLISHING A�PERMR FEE ONLY: m
am exempt trom tha provisions of the State of Celifornie Busineu �
antl Prof¢ssiDns Cnc�e, Division 3, Chapter 9. VA WATION •�� N
PEFMIT FEE $ � ]
SiBnature oi m
Permlttee � ��(n. �A.� i� � �� �- $ �� � P�.qN CHECK $ E
a`
Authorizetl Agent LL
TOTAL FEE $
r.
- - . ;;86cW
COSTA MESA BUILDING-SAFETV DEPARTMENT
� �.0. BOX 1200 COSTA MESA, CALIFORNIA 92626
� For Applicant to Fill in Completely
CITY `�'i
CONSTRUCTION
LENDER
BRANCH
ADDRE55
CONTFACTOR
ADDRESS
CITV
STATE
LIC. NO.
USE OF
EXISTING BLDG.
SIZE Of 1
NEW BLDG.I�
EXTERIOR WALL
USE �F
�li No. ,
TEL.
NO.
-S2'�c'�i��
TEL.
NO.
CITV
LIC. NO.
NO. OF BLDGS.
NOW ON LOT
' N�.OF
ROOMS STOFIE:
ROOF
COVERING
WORK TO BE PEfiFORMED
A.P. NO.
BVILDING
ADDFiESS
FiRE
20NE
APPROVED
�i��J %Q-7�=P—.���:��C�� ..::ir�; �n
n • � �.J6'
N FOR BUILDING PERMIT
DATE RECEIVED ❑A7E I�S_fl �
� S(
VARDSAPPROVED
MAIN BUILDING
ROM GL STREETI
DISTANCE BET.
MAIN BLDGS.
VAR. #
USE OF NEW
BUILDING �
VAROS AI
DATE
APPROVED
I �ereby acknowletlpe that I �avo reatl this applicaUon entl sten V
that the ebove Informallon le e0rract ontl aprae to eomply with �
ell lews reguletinp builtlinB consSruction, antl I ehe�l not amploy
any Parson In violation oi the workman'a eompanesNon laws al
the Stero of Calitomla.
I haraby carNfy that I am proparly Ilcanaetl az o<ontractor untlar S�. FT.
the State ot Callfornle euztneas e�tl Profosslona Cotle, Dlvielcn 3, THE AMOUNT SHOWN UNDER V
Chapter 9, antl Nat sueh ticenses ere 1n tull forea antl aftec<, or I TNE PURPOSE OF ESTqBIISHtNG A
am exemDt trom the provisions o� the Stato of Collfornln Buciness �qLUATION
antl ProfasSions Cotle, D���don 3, Cheptar 9.
PERMfT FEE
SI natu f L/�, �\��,(��
Permttt��'��� -p'��/'�-/y ���— 4 ��.� PLAN CNECK
Auffiorizetl Apant v
TOTAL FEE
L
0
U �
d
a
¢
7
m
0
LL
E"�
�
W
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. ,• 45518
J �COSTA MESA BUILDING-SAFETY DEPARTMENT
p.p'81DX 1200 COSTA MESA, CALIFORNIA 92626
For Applicant to Fill in Completely — Use Ink Only
BUILDING ' � W , 171� sr.
nnnwcSS
OWNEF7
QTY (�Jy
�pryyTqUCTION
BR
ARCHITECT
OR ENGINEEF
ADDRESS
w 1'1 � sT.
%l,l%Sr� � . '
r
Sii�2n TIYiL
TE L.
ADDRESS �]�)�� C/� FIIL � L� •
CITV W,�'� `' yL��� V�L. NOL �p'
STATE CITY
LIC. NO. � 0� LIC. NO.
SIZE NO.OF BIDGS.
OF LOY NOW ON LOT
EXISTNG BLDG. �/� r� .
Separate permits are required for
electric, plumbing and heating work.
USE OF BUILDING AND WORK TO BE PERFORMED
c�rv �� ��s�� a��SA
APPLICAT N FOR STRUCTURAL PERMI'
BUILDING
ADDRESS
IRE
ZONE NO.�b
PIAf�
YARDS APPROV
MAIN BVILDIN
(FROM C/L STREE'I
VAR. qW
C.V.P.ye
APPROVED'
VALUE
VARDS AVPROVED
FT
I haraby acknowlatlBa thet I have read thtf epplication anE state �^
n
Mat the abova informetlon Is corract and apree to comply wiM
m
ell lawa raBulatlnB �ulltlinB conctruction, and 1 ahell noi employ
eny perwn �� v�uleLon af ihe workman's compensation laws of m
the Sta<a of Calitornie. -
I herebY certify that I am properly Iieenzetl as a contractor untler 54. FT. w
tha Steie of Calitornia Business and Professtons Cotla, Dlvision 3, THE AMOUNT SHOWN UNDER VALVATION IS FOF m
Chapter 9, and that sueh Iice sas ere i� full ore arttl effect, or 1 TFIE PURPOSE OF ESTABLSHING A 7ERMR FEE ONLY: �
am axampi fram M provial of th State C Iifornie Business y
VAIVATION PERMIT FEE E ♦ DO
anE Profeuio a Co Divisl n ha ier 9. OO . . m
� � PLAN CHECK E �� o
SlpnaTUYa of
ParmlttBa $ O TAX $ � $'v u
Autholl2ad BB t TOTALPAID y � 5�