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Home My WebLink About980 17TH ST - Building Permits:JEST 1'ITH STAaET �ao $$j1 - comnleted 31r.:c�`risl'_ +'y 980 A�B�C�D 9466 - 1-15-60 3e::..,/u�s.cp;r.. ._. .. 94uT - 1-19-� 3e::.-.y'�_ci.Cci. . . . g468 - 1-19-� 3e.:r.rie:z.cgc. 9469 - i-i9-6o se:;..i%��z.c�:. 64655 - ll-3a-73 r'�o,;. r;; (�as) E-5553- FS.EC. (Service/100 a�s) - y-}z-x 5 vnit c - N n � 115. 7,�• ; T>908. i 7, 9�. ; 7,908. i i s�� - B23435 _� l�� 5800 - � Unit A �� -. � ��, - B23•=35 � �/ � � 5�00 ' Unit D �� _ B23537 o/a�/� 5800 - t� 6 Unit B �� _ 823536 �/ /��/ 5800 - a-� � ��t � ��o�� —E23691 S /y�� A, B, C, � —� P6109 � I. � "� �) .-,. � _� CITY OF COSTA MESA � o�`°"' , BIIILDING DIVISION > � 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 7%-4856 • �wwi.ci.costa-mesa.ca.us r °. � POR INSPECTIONS CALL: (774) 754-5626 4�� y:` PERMIT NUMBER: B10-00119 PERMIT TYPE B_ROOF2 APN: 42437110 JOB ADDRESS: 980 D W 77TH ST CM Vicinity: CARPORT ROOF Squares: 0 STATUS: DATE ISSUED: ISSUED BY: Suite/Unit: D Valuation: ISSUED 05/O6/2010 RMD $500.00 SCOPE OF WORK: REROOF 10'X20' CARPORT ONLY. TEAR OFF (E) ROOF MATERIALS AND INSTALL ROLLED ASPHALT ROOF MATERIALS. REPAIR AND REPLACE SHEATHING AS NEEDED. . OWNER: SALCIDO, DAVID L PHONE: 949-548-0358 APPLICANT: SALCIDO, DAVID L PHONE: 949-548-0358 CONTRACTOR: OWNER-BUILDER Address: Unit: CitylState/Zip: ARCHITECT: ENGINEER: . � FEE SUMMARY Reroof Plan Check: $0.00 Reroof Permit Fee: $23.50 Reinspection Fee: $0.00 Bldg Sld Admin Fund $1.00 Address: 954 W 17TH ST - City/State/Zip: COSTA MESA, CA Address: 954 W 17TH ST City/State/Zip: COSTA MESA, CA Llcense No. License No. PHONE: License No. 000000 CELL: PHONE: PHONE: Unit: Unit: : TOTAL FEES $24.50 HOURS FOR CONSTRUCTION ACTIVITY; EFFECTIVE 3N812010 - PER CMMC Sec. 13-279 Monday thru Friday - 7:00 am thru 7:00 pm. Saturdays - 9:00 am thru 6:00 pm. Prohibitied all hours - Sundays and the following Federal R NOTICE: The work authorized by this permit shall comply with all applicable handicap access requirements under Califomia staWtes and related regulations. (Ord. No. 92-28, § 1, 12-21-92) 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 inspections and final approval must be obtained. Failure to obtain inspections and final approval will result in the expiration of this permit. COpE /, INSPECTIONME DATE IN7ffiAL CODE/ INSGEC110NTYPE U�TE IN1111AL 1616 Fixed System final Fire Preveniion 208 Final Mechanical 1266 Pool Spa Final �j 208 Final Plumbing 200 FinalRe-Roof 7�L�� 210 FinalElectrical 207 Final Block/Retaining Wall 212 Final Fire Prevenlion 202 Final Factory Fire Place 220 Final Planning Approval 2�3 Fina15ign 222 Final Site 204 Final Demoli�ion 250 Finai Building/Occupancy WOR�BS' COMPENSATION DECLARATION: I hereby aKrm under penalty of perjury one of the tollovnng declaralions: ❑ I have and will mainlain a certificate of consenl lo self-Insure for workers' compensation, as provided for by section 3700 of the Labor Code, for the pertormance of the work for which this permit is issued. ❑ I have antl will maintain workers' compensation insurance, as required by section 3700 0( the Labor Code, (or the peAortnance of the work (or which ihis pertnit is issued. My workers' compensation Insurance carrier antl policy number are: Carrier: (This seIXdn need nof be completetl il fhe pe�mrt is valved a! one bundred tlollars ($100) or IessJ Policy Num6er: � I cetlify that in the per(ormance of ihe work !or which lhis permi[ is issued, I shall not employ any person in any manner so as to become subjecl to the workers' compensation laws of Cali(omia, and agree that if I shoultl become subject [o lhe vrorkers' compensation provisions of Seclion 3700 of the Labor Cotle, I shall lo9hwilh� comply with these provisions. C9-�- //u.l�.r.:.l. S �6� /G �PPfia'_ ' lura i'70abi WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVER4GE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, IMEREST. AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm that I am licensed under provisions of Chapter 9(commencing wi1� Section 7000) of Division 3 ot the Business and Professions Cotle, and my license is in tull force and effect. Lic. # Class # Con�roctor's Signature �a1e CONSTRUCTION LENDING AGENCY: ❑ I hereby aHirm that lhere is a construction lending agency fa lhe peAormance of Ihe woAc fa which this permit is issued. (Sec. 3097. Gvil Code�. Lender's Name: Lender's Address: CO W NERsBIJILDER'DEC�RA�Ib(JS: I hereby affrm that under penalty of perjury lhat I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Pmtessions Code: Any city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement that he or she is licensed pursuant to the provisions of ihe Conirectors License Law (Chapter 9(commencing vnth Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the allegetl exemption. Any violation of Section 7037.5 by any applicaN for a permit subjects the applicant to a civil penalty of nol more than �ve hundred dollars ($500).): O ❑ I, as ovmer of the property, or my employees with wages as their sole compensation, WILL DO THE WORK, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Conlraclors License Law does not apply to an owner ot property who builds or improves ihereon, antl who dces such work himself or �erself or lhrough his or her own employees, providetl that such improvements are not inlentled or ofleretl for sale. If, hovrever, the building or improvement is sold within one year of completion, the owner-builtler vrill have the burden of proving that he or she ///��,y� did not build or improve for purpose of sale.). /� ❑ I, as owner o� the property, am EXCLUSIVELY CONTRACTING WITH ��0 LICENSED CON7RACTORS to construcl the project (Sec. 7044, Business arW Professbns Code: The contractors License Law dces not appy ro an owner of property who builds or improves thereon, and who cont2cts'for such projecl with a contractor(s) license pursuant to Ihe Cont2ctors Ucense Laws.).� ❑ I am exempt untler sec. BuSiness and Professions Code for Ihis reason: Z S 6 r� -s� � ��soeie + 905'l-46(3i0]) Owner ID verified by drivei e license. ❑ Ves ❑ No oriver'r�icen'se: �' EzpireS' /b��jl� �I.Z Verifcalion of Ownership by (rype of document, i.e. - property tax bill or deed): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby cerlAy lhat no excavation frve (5) or more (eet in depth into which a person is required to descen4 will be made in connectbn with work authorizetl by this permit, and that no builtling structure, scaffdding, falsework, ar demolition or dismantling thereof, will be more than thirty-six (36) (eet high. (Chap. 3.2, Grp 2, M 2, Sec. 311, Ttle 8, Cali(omia Administrative Cotle). ❑ As owner-builder, I will not employ anyone lo do vrork which would require a permit from the Division of Industrial Safety, as noled above, unless such person has a permit �o tlo such work from Ihe division. ApplicaN's Signalure Division of IndusVial Safety Permit Number. _ HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant or present or fuNre building occupaN need to fle antl certity a Business Plan for emergency response to release or threatened release of a hazardous matenal? ❑ Yes ❑ No (Section 25505 0( lhe Califomia Heal�h and Sate�y Cotle requires, with some exceptions, that a Business Plan be filed with the Costa Mesa Fire Department by every business which has at any one lime during a reportetl year a quantiry of hazartlous materials equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic feet of compressed gas at standard temperature antl pressure). 2. Does or will the applicant or present or future building occupant nee0 to file a registralion fortn for aculely hazartlous matenals? ❑ Yes � No (Section 25533 of the Cali(omia Heallh antl Safery Code. with some exceptions, requires registration vnth the Cosla Mesa Fire Department by each business which at any one time has on hand a quanlity of acutely hazartlous matenals equal to or greater than a weight of 500 pounds, or a volume of 55 gallons, or 200 cubic (eel of compressed gas at standartl temperature and pressure�. 3. Does or will the applicant or present or tuture building occupant need to prepare an RMPP (Risk Management and Prevention Program lor acutely hazardous materials)? ❑ Ves ❑ No (Section 25534 of the California Heal[h and Safery Code provides that lhe Costa Mesa Pire Department may require ihe preparation, certiflcation and filing with the Pire Department o( an RMPP by businesses which are required to register acutely �azardous materials vrilh the Fire Department. 4. If an RMPP is presently required, has Section 25534 of the Califomia Health and Safery Code been fully complietl with? ❑ Yes ❑ No 5. Does or will the applicant or present or future building occupant require for the work which is the subject of this application a permit (or suc� construction or modifwtion fmm the Soulh Coast Air Quality Managemenl District or from any other air polW[ion control tlislrict or agency? ❑ Ves ❑ No (Section 658502 of the Califomia Govemment Code requires that the requesled infortnation be fumished on applications for noo-residential building pertnits). 6. Will any part of the faciliry to be constructed under this permit be within 7000 feet from the outer boundaries of a school7 ❑ Yes ❑ No Qf'yes", the facility must meet the requirement of Sections 25534 and 42303 o( the Califomia Heallh and Safety Code). 7. If a pertnit from the South Coast Air Quality Management Districl or other air pollution control disMct or agency is requiretl for the work which is the subject ot this application, have all o( the disclosures prescnbed by Califomia Health antl Safety Code Section 42303 been matle? ❑ Ves ❑ No 8. Qf yes", attach certifcate of compliance from the appropriate air pollution control oKcer). CERTIFICATE OF COMPLIANCE: I ceAify Ihat under penalry ot perjury the information given above is correct. I agree ro comply with all state lavrs and ciry oMinances regarding Hazardous Materials and Emissions. SignaWre Oale CERTIFICATE OF COMPLIANCE AND AUTHORIZATION OF ENTRY: I certify under penalry ot perjury that I have read this appliwtion and state that the information given is correct I agree to comply vrilh all state laws and city ordinances relating lo builtling conslruction, and authonze representatives of the City of Costa Mesa ro enter upon the above-described pmpeAy for inspection purposes. I agree not to occupy or allow occupancy of any 6uilding author ze by this e until Mal inspection. h--�/� _ s-,L�//v ��a�awiea.ues�a:.�—c� `"°zt£i AntlIW AWM1Onz¢tl Ap01i�'anl Ddl¢ ♦ y � - � •: . � -_._ .. � CITY OF COSTA MESA suno�N� o►ws�oN 77 FAIR DRIVE, COSTA MESA, CA 92626 •(714) 754-5273 • Fax (714) 754-4856 • www.ci.costa-mesa.ca.us , FOR INSPECTIONS CALL: (7�4) 754-5626 PERMIT NUMBER: BX08-00171 PERMIT TYPE B MISC STATUS: ISSUED APN: 42437110 DATE ISSUED: 06/05/2008 Zoning: , ISSUED BY: CAC JOB ADDRESS: 980 B W 17TH ST CM , ; Suite/Unik B Vicinity: . " "Primary Occ: . _ . Const Type :?? SQ. FT: 0 . Valuation: 58,000.00, � SCOPE OF WORK: ALTERATION TO ROOF. COSNTRUCT NEW�4:12'PITCHED ROOF. 1-30 LB FLET'1/2" PLYWOOD CLASS A 30 COMP. SHINGLES. NEW OVERALL HEIGHT OPF BUILDING IS 13'-7". - � OWNER: SALCIDO, DAVID C q.f r Address: 954 W 17TH ST • , Unit Ciry/State: COSTA MESA, CA Zip Code: 92627-4403 Phone: 949-548-0358 - �_�. � � . APPLICANT: SALCIDO,�DAVID L � � � � ` . � . Address: 954 W 17TH�ST ' � Unit Ciry/State: COSTA MESA, CA . '" �'' ' Zip Code: 92627-4403 Phone: 949-548-0358 ' � " . �. CONTRACTOR: Address: City/State: Zip Code: ARCHITECT: Phone ENGINEER: Phone OWNER•BUILDER �� , � - � - - � � License No. 000000 _ . Phone - License No. . .,. , � .:. . . . . . - _ , _ License No. � . �' � ' �i . . . .. , . , . ,� '%%� �-':'FEE'SUMMARY ' . � Building Plan Checki � •'' �• � �� $99.61 - � � � - Building Permit: ' � $153.25 " Electrical Permit: ' ' � "' `�" � _ _ $0.00 � - - � � � � SMIP Residential � _: _�,� .' � � . $0.00 � � -,� �� , _� SMIP Commercial ' � $0.00 • TOTAL FEES ' � .-� $252.86 � �� . Unik Cell: �, -� : NOTICE: 7he work authorized by this pertnil shall comply wiN all applicable handicap access requirements under Califomia statutes and related regulations. (Oro. No. 92•28, § 1, 12-21-92) . . EXPIRATION: PERMIT EXPIRES 180 DAYS PROM 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 flnal approval must be obtained. Failure to obtain inspections and final aDGroval will result in the expiration of this permit. CODE 1, ixsa�rnoHrrre BAIE �1lIl➢rSi L4BEt n+svetnoHrme p9� � iHnnnis 1818 FixeC System Final Fira Prevention 208 Final Mechanical , 1288 Pool Spa Final ' 208 Final Plumbinq 200 FinalRe-Roof ' 210 FinalEleCtriWl � 20t Final Block/Retaining Wall 272 Final Fire Prevamion � � 202 Final FaIXay Fire Place � � 220 Final Planning Approval 203 FinalSign 222 Fina15ite 4a1 " V 20a Final Demolilion 250 Final Building�Occupancy �/ /1 � � !1 � . .. WORKERS' COMPENSATION DECLARATIONI I hereby aRrm under penalty of perjury one of the��. ,.mg decla2tions: - ❑ I have antl will mainlain a certificate of wnsent to Selbinsure (of workers' compensation, as pmvitletl for by section 3700 of ihe Labor Code, for the pedormance of the v+ork tor which this permit is issuetl. � ❑ I have and will maintain v.orkers' compensation insu2nce, as requiretl by secibn 3700 ot the Labor Code, (a the performance ol the �+ork fw which this permit is issued. My vrorkers' compensation Insurance carrier and policy number are: Carrie[ (�nrs seawr nee0 rot ea cwnpeteOl the pem�a a rehietl a� me nurMioa tloears (5100/ a leu I Policy Number: ❑ I certify lhat in the pertortnance o1 the work for which lhis pertnit is issuetl, I shall not employ any person in any manner so as lo become subject to Ihe workers' wmpensation laws o( Calilomia, and agree that if I should become subject to the workers' wmpensation provisions ol Section 3700 of the Labor Code, I shall forthwith wmply with these provisions. Apd��nfs SignaWre Dale WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000�, IN ADDITION TO THE CAST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. LICENSED CONTRACTORS DECLARATION: I hereby aKrm that I am licensed under provisions of Chapler 9(wmmencing with Seclion 7000) of �ivision 3 of lhe Business and Pro(essions Code, and my license is in full (orce and eHect. Lic. # Class # Convactor's Sipr�aWre CONSTRUCTION LENDING AGENCY: ❑ I hereby affum that there is a construction lending agency fa the per(ortnance of Ne v.ork forwfiich Ws pertnit is issued. (Sec. 3097. Civil Code�. Lentler's Name: Lentler's AOdress: Sig�Wre OWNER-BUILOER DECLARATIONS: I hereby affvm that under panalry of peryury that I am EXEMPT FROM THE CONTRACTORS LICENSE LAW for the following reason (Sec. 7031.5, Business and Professions Code: Any city or wunty which requires a permit to construct, alter, improve, tlemolish, or repair any structure, prior to its issuance, also requires the applicant for such permit to file a signed statement I�at he or she is licensed pursuant to the provisions of the Contractors License law (C�apter 9(commencing with Section 7000) of Division 3 of the Business and Prolessions Code) or that he or she is exempt therefrom and ihe basis for the alleqetl exemption. Any violation of Section 7031.5 by any applicant for a permit subjecis the applicanl to a civil penalty of not more than fve �untlreE dollars ($500).): ❑ I, as owner of Ihe property, or my employees with wages as their sole compensation, WILL DO THE WORK, anC the structure is not intended or otlered for sale (Sec. 7044, Business and Professions Cotle: The Contrectors License Law does not apply to an owner ol property who builds or improves thereon, and who dces such vrork himself or herself or through his or her own employees, provided that such improvements are not intendetl or oReretl for sale. If, however, the building or improvemenl is so10 within one year of completion, the owneo-builder vrill have the burden of proving that he or she did not build or improve for purpose ol sale.�. � �� '�I, as owner of t�e property, am EXCLUSIVELY CONTRAC7ING WITH �CENSED CONTRACTORS to construct ttre project (Sec. 7044. Business and ofessions Code: 7he contractps License law dces not apply to an ovmer of property who builtls or improves ihereon, and wfio contracts tor such projecl with a contrector(s) license pursuant to the Contractors License Laws.). ❑ I am exempt under sec. Business antl Protessions Code for this reason: i� � 6 /U � SgnaWr Date 3057�46�3/0]) � � • •• .. Owner IDyerified 6y �F�coire ta�l6' /ltx.J ��Venfication ofOwnership Dy pype o! documem, i. .- o ertv dl or deeA): DIVISION OF INDUSTRIAL SAFETY PERMIT CERTIFICATION: ❑ I hereby certify that no excavation (ve (5) or more feet in deptFi into which a person is required lo descend, will be made in connectbn with work aulhonzetl by this permit, and Ihat no building stmcWre, scaffdding, falsework, a demolition or dismantling thereof, vrill be more than thirty-six (36) teet �igh. (Chap. 3.2, Grp 2, Art 2, Sec. 341, Title 8. Califomia Administ2tive Code), ❑ As owner-builder, I will not employ anyone to do work which would require a permit (rom the Division of Induslrial Safely, as nOted above, unle55 such person has a permit to tlo such work from lhe division. Appliwnfs SipnaNre Daie Division ol Industrial Sately Permit Number: HAZARDOUS MATERIALS AND EMISSIONS CERTIFICATION: 1. Will the applicant oi present or future builtling occupant need to file and certify a Business Plan for emergency response to release or threatenetl releuse o( a hazardous material? ❑ Yes ❑ No (Section 25505 of the California Health and Salety Cotle requires, with soma eaceplions, ihal a Business Plan be fletl with the Cosla Mesa Fire Department by every business which has at any one time tluring a reported year a quantiry of hazardous matenals equal to or greater Ihan a vreight ol 500 pountls. or a volume of 55 qallons, or 200 cubic teet ol compressed gas at standard tempereture and pressure). 2. Does or will Ihe applicant or present or tuwre building occupant neetl to file a registration lortn for acWely hazartlous materials9 ❑ Yes ❑ No (Section 25533 of Ihe Calitomia Health and Satety Cotle, with some exceptions, requires registration with the Costa Mesa Fire Department by each business which at any one time has on hantl a quantity of acutely hazartlous materials equal ro or greater than a weight o( 500 pounds, or a volume ol 55 gallons, or 200 cubic feet o( compressed gas at stantlartl temperaWre and pressure). 3. Does or will Ihe applicant or present or future building occupant need to prepare an RMPP (Risk Management and Prevention Program (or acutely hazardous matenals)? ❑ Yes ❑ No (Section 25534 of Ihe Califomia Health and Safery Code pmvides ihat Ne Costa Mesa Fire Department may require the preparation, certification and fling with ihe Fire Department of an RMPP by businesses which are required to ragister awtely hazardous matenals vrith tha Fire DepartmeM. 4. If an RMPP is presently required, has Section 25534 of the Califomia Health antl Safety Code been fully complietl wit�? ❑ Yes ❑ No 5. Doas or will �he applicant or present or fulure builtling occupant require (or Ihe work which is the subject of ihis appliwtion a permit lor such conslruction or modifiwlion from Ihe Soulh Coast Air Quality Management District or from any other air polWtion control tlistrict or agency? ❑ Yes ❑ No (Seclqn 658502 of tha Califomia Govemment Code requires that the requestea infwmation be fumished on applications ta ron-resi0ential building permits). 6. Will any part of the lacility to be constructed under lhis pertnit be within 1000 feel from the outer bounCanes o1 a school? ❑ Yes ❑ No pf'yes", the lacility must meet the requirement of Sections 25534 and 42303 of Ihe Califomia Heallh and Safely Code). 7. If a permlt from Ihe South Coast Air Oualiry Management District or other air polNtion control distnct or agency is required tor the work which ts the subject of this application, have all of the disclosures prescribed by Calitomia Health and Safety Code Section 42303 been made? ❑ Ves ❑ No. 8. QI "yes", attach certifcate of compliance from the approD�ate air polWtion control officer). . � CERTIFICATE OF COMPLIANGE: I certify that under penally ot perjury Ihe information given above is corieci I agree to wmply vnth all sWte laws and city ordiriances regarding Hazartlous Matenals antl Emissions. CERTIFICATE OF COMPLIANCE AND AUTMORIZATION OF ENTRY: I certify untler penalty of perjury that I have read this application and state that the inlormation given is cortect I agree to compty with all slate laws antl city ordinances relating to building construclion, and authorize represeNatives of lhe Ciry ol Costa Mesa lo enter upon [he above-tlesuibed property (or inspection purposes. I a ee not to occupy or allow occupancy of any builtling authorized b ihf perm' � until f al inspection. _ �!^� � n re oi Legal OwBer a e Mtl/or Aulhonietl Np01iwn1 Dale b �y PR0.IECT pDUHESS: 9 B O W 1 7 TH ST OWNEP'SNpME:CRAlG H. AASE aooeess:g54 W 17TA ST CO5TA MESA CA 92627 RNCH�ENGINEEfl: RODNESS: �- �G D . �N�,: HEG.NO.: UNIT: PENMITTEE: CRAIG H. AASE ( 714 ) 548-035$ aoosess: 954 W 17TH ST COSTA MESA CA 92627 LICENSED CONTBRCTOR OECIABATION: I hereby allirm t�a� I am Iiceq5e0 untler pmvisions 0� C�apier 9(commencing wiih Seciion 7000� ol Drvision 3 ot the Business antl Pmlessmns Code, antl my license is in lull lorce an0 eflect. LITY LIC.: STRTE LIC.: LLASS: Oaie: Signa�ure: WOBKEqS' COMPENSATION UECIABATION: I nereby alfirm ihat i have a ce�ificate ol consent to sell�insure or a cenif¢ate of Warkers' Compen;aiion Insurance, or a ceriifietl copy I�ereol (Seclion 3800, Lab. C�. POLICY NO.: EXP. UATE: COMP4NY: ,❑ Ceqified copy is hereby tumishe0, ❑ Cehified copy is filetl with �he ci�y BuilOing Divisian. L�a�e: ApplicanL E%EMPTION FHOM WOBREBS' COMPENSATION UECLAflATION: (This section nee0 nOt be compl¢�e0 il lhe permii is forone hundred ($100) ar 1e55). I certity �hat in I�e pedormance o� Ihe work lor which Ihis permit is issued, ISAaII noi e�jDloy any person in any manner 5o as Io become subleci lo t�e W� �� P� alion Laws ol Califomia. �� ,A� oa�e: '�j Signamre: /L� NOTICE: II, alter making Ihis 4eclaraiion, you shoul0 Decome sublect �o e Workers' Compensation pmvisionS of lhe Labor CoCe. you must forihwilh comply wii� such provisions or �his permii shall be tleemea revoketl. CONSTflpCTION LEN�ING FGENCY: I �ereby alfirm �ha� there is a constmc�ion lentling age0cy for �Ae pedormance of �he work �or wnich Ihis Dermit is i=sued �Section 3097. Civ. C�. LENDEN: ROUXESS: OWNEX BOILUEP DECIANBTION: I hereby a�lirm �hat I am exemp� irom the Comrac�ors' Sta�e License law �or the �allowing reason (Seclion 703L5 Business an� Pmtessional Code: Any ci�y oi counry which requires a permi� �o consimci, al�eL improve, demolish, or repair any 51mcWre, prior ro i�s issuance, also requires ihe aDPlicant br such permii to file a siAned statement Iha� he/she is licensed pursuan� �o ��e pmvisions o� �he Camracbrs' S�ale License Law (Chap�er 9(commencing wi�� $¢ction 7000) of Oivision 3 0� �he Business antl Pro�essions Catle) or Iha� �e/s�e is exempl therelmm and �he basis for �he allegetl exempiion. Any viola�ion of Sec�ion 7031.5 �y any applican�for a permit subjects �he apDlicantlo a civil penalry o� not more t�an five �unAretl Oollars (8500). I, as owner oi �he pwpehy or my employees wi�h wages as �heir sole compensaiion, will do �he work, ana IAe � 5tmciure is no� intend¢A or o��eretl �or sale (Section 7044. Business anA Prolessional Cotle: T�e Coniratlor5' S�a�e License Law Qaes not apply to an owner o� a pmpeny wlp bviWs o� improves the�eon. an0 wlw dces such work himselt/herse�� or �MouB� his or her own employees, pmvitlea Ihai such impmvemen�s ar¢ no� inlenAed or oll¢re0 lo� sale. If, however the buil0ing or im0�a�ement is sola within one year o� com0lelion, �he owner will have the bur0en o� pmving he/she tlitl not builJ or improve for ihe purpose o� sale�. I. as owner of ihe pmpehy, am exclusively ConVac�ing with licensed conlraciors lo consimc� �he pmlec� (Sec�ion 7044, Business ❑ antl Professions Cotle: T�e Contrac�ors' Slate License law does na� appty to an owner oi pmperty who 6uiIJ5 Or im0�ove5 ��ereon antl who coniracts �or such pmjecls wilh a conirac�oqs�license pursuant�o Ihe Contrac�ors' S�ate License Law�.l am aware . Iha� prool oi �heir Worker'S Compensa�ion insurance shoultl be pmvided �o me. � I am exempt untler Semion'. 8. 8 P. C ,. �or ��is reason: � ///�� Oa�e: � I � � / 9 � Owner �e� •�+��V`+"� I Uo her¢py cenily ihat I am aware ol ana unUerslana ihe requiremenis of Calitomia Healin anA Satety Cotle Sections 25505, 25533, an0 25534 and thal I or any Iuiure building occupanl wilVwill no� (circle one� neetl �a comply wii� 5ai0 slate cotles and �he requiremenls for a . pe�mit tor cansttuction w mo0i�icatios Imm Ihe Air pualiiy Managemenl Distrkt NeSitleniral cOnstrudion applkaibns are ezempt Iram I I�ese Grovisions. Oatel Applican��. hereby cetlilylhat I have rea0 Ihis applicalion an0 sta�e�ha��he abaveiniormaiion is correci. I agree�o comDly with all ciry and county ortlmanc¢5 antl staie laws relating lo buildmg consimclion antl hereby aulharize represeniay'ves ol Ihis ciiy to en�er upon �he above-men�ianeU pmper�y �or mspec�ian puCrp�oses. f �7 ' Date� �� / � Signature: �� .%�C�-'�.M/ � �river's �icense or Socia� secunry a: $ —Ap0licant: Pink—Revenue: Goltlenroa—Asseswr CITY OF COSTA MESA — BUILDING PERMIT PERMIT NO: P 061099 PLAN CHECK NO: N PERM NO; P 061099� GOVT; N SUPP; N CONSTRUCTZOtJ TYPE: 5—N PERNIT TYPE: PLU PURPOSE; OTH JOB DESCRIPTION ; INSTALL FOUR (4) WATER HEATERS SQ FT: CLAIM VALUE: CALC—VALUE; GROUP OCC; R-1 / COMMENTS: ZNST'ALL FOUR (4) WATER HEATERS IN A FOURPLEX, *�*x�****�**��r****�**** ��* *��r**�� ****�**�r**�***��*�±�*� x x�*��r*�r**x ***�r*�r� ***x � �*� Z O N I N GS ERTEBQAUCIxRSE M E N T S ------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING --------- 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; PAftCEL: 42437110 ZNE; REF NO; PLANNING NtSTES> i **�r***�r**�*�r�r�r*�****xx**�*��r�«��r�r**x�*��**�*�r�t*+��r�*��*x***�*�r*�� *�r******��c��*�c* 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; HUILDING APPROVED BY : DATE: APPLICATION ISSUED BY: � '� �.� DA1'E; 2�`j -N-1EiE�lElfiflkiFlF3F�1EiEiEiE1E#EiF7FK�fkiEif . t iFF 3C3f3t"��3Fif;FiF-lE3fiEiEiEiFlE�EiE it%� iEiF ifiEiE�lEiFiE�EiEiEikiFiEififiEiEiF-0FilifaFiElEifiFiEaEiEiFjfiElF3FiEiE3FififiFiE3tiEikilif�) fiEj(�iEillEiE-1F3E�IhiEiEiEiE�lEjfifiEiF�)E#iF9F3FiF3ti(�3EiEiF*�k LEGALIZATION;N F E E S U M M A R Y STRUCTUftAL SEGMENT;N BLDG PMT PLUMBING ELECTRIC MECHANIC FZRE SMIP/RES GRADTNG PERMIT 28,00 25g SMIP/NON—RES PLAN ISSUE FEE 20.00 BUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE TOTALS----> 28,00 20,00 0.00 48,00 48,00 .00 REVENUE DZVISION TOTALS--� COLLECTED; 4$,00 OVER/SHORT; 00 BLDG PMT PLUMBING ELECTRIC MECHANIC FIftE SMIP/TOT GRAllING PLAN—CHEC3C 48.00 if if if iFlE 3E iE iP if ik iE iE if iE 1f !F 1E aE iE iF ik ik iF iF if 1F if if ik iFiE jE it k iE !E iE iF iE iE iE dElF i(� �1(� iF%iE 1E iE iFlE iE iE lE iE iF 1E Ih iP lE �4 iF iE iE iE �F ik iF 9F iF 1E 3E iElf �f iE jf !f Z N D I V I D U A L F E E B R E A K D O W N TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST PLU 4 WATER HEATER AND/OR VENT 7,00 28,U0 END OF FEES �p �� . 2 1993 �.�' � FEB 0 `C�TY OF COSTA MESA t `i CQNSTRUCTION ANDPLANNING � � _ POOL 'A � - qPpROVALS Permii # Date Inspector APPROVALS Permit # Date inspector 7. Temporary Electrical Service or Pole . 52. -Pool & Equipmant Location - �2, Soil Pipe-Undrgrnd. � 53. Sceei Reinforcement - � 3. Electrical Conduix Utiiity-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Booding � � 5. Stsei Reinforcemenc 56. Rough Plumbing & Pressure Test �+ 6. Eleczricai UFER Grnd. 57. APPROVAL TO COVER GUNITE 7. Footings ' 58. Electrical Co�duit�Undrgrnd. 8. Poundation 59. 'Gas Pipe, O Undrgmd., TeSt " ( . 9. Water Pipe-Undrgrnd. . 60. -Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor Syrtem � 61. APPROVAL TO DECK � ' i 11. property Sewer Line & House Connection 62. Backwash & Recepmr�Final . • "12. Sewer Cap �� 63. Heater & Vent-Final � 13. Rooz Ora+ns • 64.- Pfnmbing Systam - Final '- " - � 14. Rough Plumbing 65. Electricai�Final , ' 75. Rough Hectrical-Conduit 66. Soiar SYstem-Pinal �. 16. Ro�gh Electric Wiring 67. Fencing & Access Approval ; 17. Rough Wiring Siyn 68. APPROVED FOR YLASTERING � . � 18. Rough Electrical-T Bar Ceiling 69. POOUSPA SYSTEMS FINAL � � 19. Rough Heating & Air-Conditioning F�RE DEPT. REQUIREMENT i 20. Rough Factory Fireplace � APPROV0.LS Permit # � 21. Ducts,in Structure - 70. Underground Hydro � i 22. Oucts, Ventilating , 77. Product Piping CGas ❑Oil � 23. Gas PiPe�Rough & Test 72, Underground Fiush 24. Roof Framin9 � " 73. Undergrnd. Storaye Tank O Gas ❑ Oil 1 25:`Roof Sheathing � 74. Overhead Hydro � I 26. T-8ar Ceiling (Structurall &�Monocoat 75. Dry Chemical � 27. Frame and Flashing . 76.� Dry Standpipe I i 28, l.athing & Siding • ' � � � 77. FIXED SYSTEP4 FINAL . ( 29. Insu(ation � � i 76. FIRE PREV. FINAL ' � 30. Drywall Nailing � j< � HEAL7H DEPT. REQUIREMENT 37. Plaster Brown Coat j 79. FINAL INSPECT(ON �� 32. EiectrScal Power Meter-Final �-� 80. FOOD CERTtf ICATE ISSUEC� � 33. Finai Electric I,�-• Notes: � I 34. Final Heating & Air Conditioning � I 35. Final Gas Pipe-Test ' "j ! � . 36. Hood or Canopy � �,�,.� �4` , 1 37. Final factory Firepiace � �'�::� j � 38. Final Plumbing � Y�� (iJE(%� ;_ � � 39. Water Service-Final /! 40. Gas Service-Final � � . i 41. Solar pomesticFinat � � i ; 42. Backftow Preventer � ` � r_._ .-, � .�r 43. Backflow Irrigation ° ^�� I ` i� F. 44. Landscape Irripa2ion System � � ' 'T �� t" A5. Sound Attenuation � � : , _ ;' � 46, Handicap Regulations � ? i � �� - �� ; 47. FINAL STRUCTURE & BUILDING � I ��. ! • � ' ',t�. - - � .� 48. FtNAIPIANNtNG � � � � • -- - - 1 i 49. Electric Release to Edson � !- . .. 50. Gas Release to Southem Califomia Gas Co i �� 51. CERTIFICATEOFOCCUPANCY No. Date � _. _, . ADO��ant to fill in all spaces except lhose within heavy �oraer Iines antl sign ali.ap CiTYOFCOSTA Esa CONSTRUC�TIO PERMIT ' ProjecYAddress ' � �� — Applicant'sMaili Address J � /�� - �"� Owner's N/�am/e _- �PhonC7'�,J.o_ �, Address z-/ �L-�. %t! "r.S<.61 w A� - J`� Ul Ii. �� ' Arch/Eng: � , License No. �Address ' - � � Contractor"s Nam � �'� C� ' Npfione � � - �� Addrea (mailingl � • �� /!� �! � . Ciry License No. - � 6� ak � • ' - UCENSED CONTRFCTOR DECLARATION - . 1�he�eby at�i�m thai�.l am litensetl untler provision5 ot CharlCr 9(commencin9 ' with section.]000) of DIvlSion 3 of tM1e BusineSA antl Prote55iOns Code, antl ' my license.is in i1r1uforce antl eHect. ycen's¢ CIa3s�� `_- � ' LiSensa i�yS �' _ Date f� Signature� -V� � .._ WORKERS' COMPENSATION DECIARATION � - I hereby atftrm that 1 nave a certi/icate of consent (o self-insure or a certifica[e o/ Workers' compensation Insurance;�or a certlfgtl <opy thereot�(Section � 3800, Lab./C�J �/ �/ '�O � PoIICY Nq�k S —�jG' �.�^--T/yyComPanY . �Certifietl Copy is nereby /urniSheC. ; Certlfletl topy isf� {�etl w�th the city Byy' em� gy� ivis�pn.�j�—� � �Date��.�3-3—APPlicanto�5.'�- ��aL.E��.�"�— � EXEMPTION FROM WORKERS' COMPENSATIQN DECL/:RATION -- �(Thisse<fiOn neetl not be com0�ot¢tl if the pe�mit �s /or on¢ huntlretl ($300) or les,). ' I Certify Ihat in tM1e p¢iformance�of Ihe wo�k for �yhlCh th15 perm�t is'Issuetl, I shall n0[ employ any person in any manne� so� 85 l0 become subject to,(he Workers' Compensation Laws ol Calitornia' . � ' - Dale Si9na[ure ' 'NOTICE: If, after making [bis tlecldration, yOv shoultl become subject to'the . Workers' Compenwtion Provi5ion5'Of the'Labor Cotle, y0u must forthwith , \ comply wilh such p�oviliOnS o� thi5 Oermit Shall be Aeemetl revokeU. CONSTRUCTION LENDING AGENCV - \I hereby af(Irm Nat t�ere is a cons[ruction lentlin9 agency tor Ihe perlormance o/ the wOrk foi,which Ihis pCrmit is Issuetl'(SeCUon 3097 Civ. C.) lRntler's Name ' _ , � Lend2r'S AGtlfe55 - OWNER BUIL�ER DECIARATICfJ ' 1 he�eby aHitm that I am exempt trom Ihe Contracto�'S LiG¢nSe�Law.for the following reason (Section ]031.5 BuSiness antl Professional Code:Any tlry or county which requires a permit to construct, alter� improvo, Cemolish or repalr any 5trucWr¢ prior to its I55Uance, a150 requires the applicant fOr such p¢rmit u to file a si9ne03latement [ha[ he/ShC is-licenietl pu�suanf to-tne provisions of the Con[ractor's License Law (Chapter 9'(commencinq with Section 7000) ot Division 3 oi Ihe Business antl Profe55ions Cotla) or that �e/she, is exempt , thetefrom antl the ba5i5 for the allegetl exemptipn, Any vlolation ot Section '031.5 by any applicant fo� a permit subjec(5 lh¢ appllcant�to'a civil enalty oi not more than five huntlrea tlollars,(g500). � - t� 1;-as owner of ihe pwOe��Y o� my�employQeS wlth wd9e5 a5 their sole compensation, will ao tne work, antl tne sVucture is not Intentlea or otferetl tor sale (Sec[ion 7044, Business an❑ Professiopal Cotle: Tho Contractor's �Icenu Law tloes not apply'to an owner of a property who bullds or improves chereon, antl who aoes such work hiinseli%herzelf' or lhrou9n hiz or her own employees, provitletl that such improvements are not IntenOetl or offeretl tor sale. If, howeveq the builtlln9 or'improvement is 5oltl wlthln one year of <om- plolion, Ihe owner wlll have tM1a bUrtlen of proviqg;he/She tlltl not builtl o� im- �rove for the purpose of saleJ. ' I,'as owne� of ihe property, am exclusively <ontrdctin9 �+'�th licensetl COn- [ractoritd constructlhe prolect (Section 7044, B�siness ana Protessions Cotle: �The Contractor'SJLicense..Law tloes not appry to an owner of'pmperty who builtls or improves thereon, antl who conVacts for such projects with a con- tractor(s1 license pursuant to tne Contractor's Li�ense Law). I zm aware [hal pr007 0( Ihei� Worker's Comp¢nSalion insutanca ShOultl be OrOvitlltl to me. ❑ I am exempt untler Section , — 8. & P. G. tor this reason i Date � - Owner� ' � I herebvi certify that -1 have read tliis applicitipn antl stale fhat the above u a3 s3 � � 'E OF CONSTRUCTION - N[ ❑ CONVERSION ❑ DEMOLISH DESCRIPTION OF WORK/USE OF, ADD LJ ALTERATION Q(1 REPAIR TVP P�,IiM1T � LJ GRADING LI' FOUNDATION LJ STRUCTURAL TENANT O�LECTRICAL 'O PLVMBING � MECHANICAL . �-0THER, '��.tT� - ' PROJECT DESCRIPTION 5�� oCCUPANCV�Q—�J� CONSTRVCTION TYPE . VALVATION 5 �..(LLL ZONE � GRADING CV. VDS. , ACRES_ Remarkz: ' . � � � � � Bar Sink � Backtlow Preventer � Backflow Irrigation � Bathtubs � ' Clarifiers Dishv.2sher � � Drinking Fountains ' Floor Drains � Floor'Sinks{ � • '- �� GasService Outlets Intercepmrs! ' � Kitchen Sink ' Lavatories � �� ' P-Trap � • Roof �rains . � - , � Reinspection Fee $15 Boiler Duct - Under Ground ' Duct � Structural � Duct - Ventilating - - ' Exhaust System ❑ Multiple Firepl/Fact.,81t. ICBO # Heating $ysiem & Ducting ❑ o-� oo,000 eru O i oo;000 � o�v��a. �� Reinspection Fee 15 CMF 0865�46, rev. 30/B4 Wnite - Builtling; Canary - qpplicant: Pink - Accounting: Goltlenrotl - Assessor 0 Showers -Service Sink Sewer Cap ' Sewer ConnectiOn .SolacCollectors Solar Piping � Solar Tank � Swimming Pool w/Spa, Urinal ' � Water Closet � Water Heater - Water Service Isue Fee ' Hoodor Typel ❑ � Canopy � Type I I ❑ ' �� Refrigeration System � • ❑0�100,000 BTU. 0100,000 BTU System Repair/Alteration Fire Dampers Registers � , , , luue Fee � � FEES � $ 3 A.P. ;I`- S Main Buildin9: E . T Front �- �8 Rear A C Right SLeft Ping. Ref. # Planning Notes: � 3753 -4/�S%8c � Accessory Building:' T%.. � _ ' . • Parking Req./Providec Automatic Washer' Construc[ion Pole Su6. Cooking Unit �� Dishwasher- - Dryers ❑Gas ❑Electric Fan ' , F.A.U. Fixtures' Device Boxes Outlets "'�,;>: '. , zone , _ . , ' ELECTRICAL Transformer ❑ 15-50'KW � ❑ 50 �KW � M¢ter ❑up to 700 amps _- _ .Meter .�over-700�amps � - 0 Garbage Disposal ' Generator 00.5 KW �5-15 KW I Reinspeetion Fee 0 DEVELOPMENTSER Zonin9 APProved BV_ Buildin9 APProved By AppliwtiOn IttuBd By_ Motors DO-1 HP 01 h- 8 Inc.Solar �9-15 HP �16-15+ � Microwave • Pole LigFt � Ranqe • Sign � � ; Standing Sections � � Trash Compactor � , ' $15 � � Ixue Fee �� RE�UIREMENTS: a FEES S 3 Z O N I N G R E Q M T S ' ' SUM RVq F FEES � : c-� BUILDING PERMIT $ • �`� SMIP $ • �`-� PLAN CHECK $ PERMIT ' � � � PLUMBWG � ' $ - �SSUANCE ' $ PLAN CHECK �25%� $ � ' ENERGY P.C. $ � ELECTRICAI � ' $ ' GRADING ' $ PLAN CHECK 50% $ 1 MICROFILM ,$ � MECHANICAL ' � $ �_� � TOTALFEE $ PLAN CHECK �25% $ � - • � � CONSTRUCTION ANDPLANNING POOL. A . 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. APPROVALTO COVER�GUNITE � 7. Footings � _ 58. Electrical Conduit-Undrgrnd. � .8. Foundation � . 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Stiuctural Floor System 67. APPROVAL TO DECK 1�1. Property Sewer Line & House Connection 62: Backwash & Receptor-Final ,' 1-2. Sewer Cap ' 63. Heater & Vent-Final � '13. Roof Drains ' 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final ; . 15. Rough�Electrical-Conduit - �- 66. SolarSYstem-Pinal ' ' • 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 Heatin9 & Air Conditioning FIRE DEPT. REQUIREMEf�1T 20. Rough FactorY Fireplace � APPROVALS Permit # 21. Ducts, in Structure ' � ' 70. •Underground Hydro 22. Ducts, Ventilating ' 71. Product Piping O Gas ❑ Oil , 23. Gas Pipe-Rough & Test, ' , 72. Underground Flush � 24. Roof Framing � , 73. Undergrnd. Storage Tank 0 Gas ❑ Oil 25. Roof•Sheathing - - 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat ' 75. Dry Chemical 27. Frame and FlBshing " 76. Dry Standpipe 28. Lathing & Siding )7. 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: 34. Final Heating & Air Conditioning � . 35. Final Gas Pipe-Test - , �� 36. Hood o�'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 �p $'l Q� 48. Special Requirements Completed , . . 49. Electrie Release to Edison - �, � 50. Gas Release to Southem Califomia Gas Co � ' , 51. CERTIFICATE OF OCCUPANCY No. Date , . . , Applicant to /ill In a11 soaces except tnosa wltnin �eavy Oorticr linas an0 si9n all aDV�oDriate oaclamtions. ctT� OF COSTA MESA CONSTRUCTION PERMIT PERMIT NO. TRACT NO.' LOT NO. UNI NO. • 4]3% 5/09/�uS ., ; Project AddreSs �� P� B�� D hl. I'1TM� Y��Dh�F1p ,(,11E5 �'�� 1� . . . Applican(�CCBilingAddre55 P•�• �� (�z�� 10 � ItiH �"�(T�PEOFCONSTRUCTION NEW .°.DD ALTERATION REPAIR � ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A.P. qW Zone - Own�r'sNamqe ��T� %i. QIAl1C�Q�i.. Phone�^+�1^� ��'n� DESCRIPTIONOFWORK/1�f92'Qf'8tB8. Address �l �Iak1N�N-WK =Q��%i(SC 5 MatnBuiidfng: Accessoryeuilding: Arch/Eng. Li[enu No. TVPE OF PERMIT GRA�ING FOUNDATION STRVCTURAL ' T Front � Address ❑ TENANT ❑ ELECTRICAL ❑ VLVMBING ❑ MECHANICAL A Reer - � N ❑ OTHER Convactor's Nam �,Q_/ _Phane pROJECT DESCRIPTION Sq. FT. OGCUCANCV C fiight • � N � ..�`� Addre551m'f �1 CONSTRVCTIpNTVPE VALVATION$ g Left � � G City LiCense NO. 20NE GR NG CU.YDS. ACR 5 ' R � UCENSED CONTRACTOR DECLARATION � � PInJ. R¢L �I' Pa�kinJ R¢q./ProvitlCd E 1 he�eby dlli�m that I am Iicensetl untlar provislons o/ Charter 9(commentin9 Remarks: � . Planning NOtes: � with mction ]000) ot Dlvision 3 0l tha Business antl Protessioni Cotle, antl . . . M my license is In full ta¢e antl etiect. ' • � ' ' - T Llcense Class License No. � • . � S Date Signature ' PLUMBING ' FEES WORKERS' CpMPENSATION DECLP.RATION ' Bar Sink � Showers � � � I hereby aifirm [nat 1 have a certiecate of consenl to sell-insure or a cerlifitate ELECTRICAL FEES ol Workers'- Compensation Insurance, or a�certifietl copy thereof (Section Backflow PrEv¢nter Servit2 Sink - Auromatic Washer Transtormer ❑ 15-50 KW 3800, Lab. C.) I] 50+KW Policy No. Company Backflow Irrigation . Sewer Cap �=i . Construction PDIe Sub. - � eCertifletl cppy is nereby turnishetl. � - � Certitiea copy is flletl wlth the dty Bulltlin9 Divislon. BathNbs Sewer Connection /. Cooking Unit � Meter up ro 100 amps � Date ' APplicant � . EXEMPTION FROM WORKERS' COMGENSATION DECLARATION Clarifiefs $Olar Collector5.. . DiShwasher -� Met2r ❑ovef 1000mp5 - - (This section need not bo completeG it ihe permit is for one huntlretl (S100j or . less). ' Dishwasher • Solar Piping , Dryers ❑Gas ❑Electric Sub Panel I cerlify�in ne perfOrmance ot tney�O�k for whi<h lhls IS i55uetl, I _ snall not � 1 any parson in any RfdMe so 'b s bject to the Orinking Fountains Solar Tank Fan Motors �47 HP 01'h- 8 ' Worke tion Laws of Call( tf . �� Dats i9nature ' Floor DrainS ' Swimmin9 Pool w/Spa F.A.U. Inc. Solar �9-15 HP �16�15+ 'NOTI It a� r making this tlecla at On, you ThOultl betOme sub�eGt [O [he Workers' C m0ensation provisions ot the LaDor Cotla, you' musl forthwitb Floot Sinks Urinal Fixtures � Microwave compty with sucn provlilons or this Oerm(t 5hai1 be tleemetl revoketl. CONSTRVCT�pN LENDING AGENCV GasServiCe Oullets WalerCloSet DeviceBOxCs . � � I hereby alflrrry lltal thero IS a conSt�UCtion Iantlin9 agency for Ih0 pertormance - POIC �i8ht of the wOrk tor wniGh [his permit IS ISSuetl ($eGtlOn 309] Clv. CJ Interceptors� � ' Water Heater - Outlets � . Range ' Lentler'S Narpo . . Lentler's Aatlress Kitcheu Sink - Warer Service Swi[ches g�9� OWNER BUIL�ER OECLARATIOfi I hereby et/lrm thac I am axempt Irom tha Contrattor's Licensa Lnw for lhe Lavatoties� � � AutO•Wesh Garbxge Disposal loilowing raa;on (Section �031.5 Buzlness antl Profossiondi Codo: Any Uty or - , � Standing $ectiOns county which requires a Oermlt to tonstruct, alter imvrove, tlemolisn or repair P—Trap Laundry Trays � . any strucluro, prbr to Its Issuance, also requires t�o apP�kant for such oermit Generamr �0.5 KW �5�15 KW Trash Compactor to �iie a slgnutl ztatement that he/she Is ucenseC pursuant to tna provisions of Roof Drains � ' ' . ' . � � the ContractOr'S U<Cnsa Law (Chdpler 9(commencing wltn SoGtlon ]000) of � Divlsion 3 of the Bu5Ine55 antl Pfota551an5 COGU) o! lhdt h¢/She IS ¢x¢TPt � � � , thCrefrom an0 �h! baz15 b/ the allagetl ex¢mptian. Any violation ot Section . 7031.5 by, dny appll<anl for a permit subjects tna applicant lo a Uvil '� enalty oi n0[ more lhan five huntlretl tlo11ar5 (E500). I, as owq¢r of [he ptopa/ry'Or my <mployae5 wllh wdgez a5 thCi� so1B f2Bin5pactiOn Fao ' $15 ' Issue Fee . � g 3 , ' compensation, wiil tlo Wn work, ana tho structuro is not Intnntletl or offerotl Reinspection Fee $15 luue Foa ' '$ 3 ior sale (SaCtion 7044, Buslnezs antl Gmtessional Cotle: Tno Contractor's � MECHANICAL FE@S Litense L. w Ooes not app�Y �O an Owno� 01 a p�operty wno builtls or Imp�ove5 , lhoreon, antl wno aoes sucn work nimselt/nersell or througn his or her own DEVELOPMENT SERVICES REQUIREMENTS: ' emplOyeei, P�Ovidetl that such Imp�ovCmonlS are not IntenCotl or o(fcrea lor BOiI¢/ ,- HOOd O� Typf I ❑ ulo. 11, how0veq tne bulltlin9 or improvoment fs tola wlthin one yoar oi com- Canopy Type II ❑ - ZoninB APProved By Date ple �on, Ibo Owner will hav¢ tha CY/tlBn O! P�oving he/she tliA nOt builtl Or im- Duct - Under Ground _- BuildinB Approved By Daie a for IM1a purposa ol zale). U_ �y� 1, as owner of ,the pro0erty, am excWsively coMractlng wlth Iicensetl ton- Duct - StrucWral Refrigerati0n Syi[em Application Issued By Date S� e fi t Ctofs t0 conslruct the ploj¢Ct (SeCtiOn 7044, BUSlness antl Pr01e55Ion5 COtla: , Tne ConVac�or4 License law tloes not apply to an owner of D�aPerty who Duct - Ventilating ❑0.100,000 BTU� �100,000 BTU - SUMMARV OF FEES builtls o/ Improves the�eon, and who cont�act5 fOr such pro�¢c�s with a con- • tractor(s Ilcense pursuant�to the Contractor's Llcense Law). I am aware that Exhaust SyStem ❑ Multiple ❑ System Repair/Altera�ion BUILDING.PERMIT $ SMIP $ prool o� t11@ir WOrk¢r'S Compen5dlion insUrance ShOultl bG prOvltl¢tl to me. ❑ I am e � t unCer Soctlon P. C. for this reason FirepVFact.6lt. IC80'# Fire Dampers ; P�+N CHECK $ PERMIT PLUMBING $ ISSUANCE $ Date � owne Heating System & Ducting Registers ' ENERG� P.C. S PLAN CHECK 25% $ --,�-�--p� I hereb at I have reatl this application antl state that the above ❑0.100,000 BTU �100,0006T ELECTRlCAL $ �a •� GRADING 3 iniorma on is mrre L I agree to comoly II cfty antl counry ordinances . antl slate IaWs rela ng to builtlinq con <ti n, anC he�eby authorixe re0re- � MICfl�FILM $ sentatives o/ [ni ty t r t bove-menGonetl G�oPert for P�N CHECK 'S0% $ � InspecUo MECHANICAL $ TOTAL FEE $ ' �" Si9naturo Da � . , Orivers' nse or 55 $ Reinspeetion Fee S15 ' Isue Fee S 3 PLAN CHECK 25% $ . �MF OB65-46, �e�, 30/84 Whli¢ - Builtlin9: Cana�y - ApP��dn[; Pink - Accounting; Goltlen�Otl - ASSessor . _a l CONSTFUCTION AND PLANNING POOL & SPA .lAPPRO�{ALS Permit# Date Inspector APPROVALS Permit# Date In:pector 7. Te porary Electrical Service or Pole . 52. Pool & Equipment Location ; 2. Soil Pipe-Undrgrnd. • 53. Steel Reinforcement 3. Electrical Conduit Utili[y-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Raugh Plumbing & Pressure Test � 6. Electriral UFER Grnd. � 57. APPROVAL TO COVER-GUNITE � 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation • 59. Gas Pipe, O Undrgrnd., Test '' 9. Wa[er Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgmd. 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 Drai�s 64. Plumbing SYstem - Final ' 14. Rough P�umbing 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 8ar 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. f?oof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil 25. F?oof Sheathing 74. Overhead Hydro 26. 7-Bar Ceiling (Structural) & Monocoat 75. pry Chemical Q7, Frame and Flashing 76. Ory Standpipe 28. 4athing & Siding 77. FIXED SYSTEM FINAL 29. Insulation ' 78. FIRE PREV. FINAL 30. �rywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION � 32. Electrical Power Meter-Final � 80. FOOD CERTIFICATE ISSUED 33. Final Electric � Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer • 43. Backflow Irrigation 44. Landscape Irrigation System 45. Sound Attenuation 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. SOecial Requirements Completed 49. Electric Release to Edison 50. Gas Release to Southern California Gas Co � 51. CERTIFICATE OF OCCUPANCY � No. Date i� . . ApPlicant to till in all spaces excepl lhose within heavY �• CITY OF COSTA/, E CONSTRq U`E�T O PERMI PE M��S� S _ TRACT NO. . Project Address ' ,7� ��%� 7� �.�✓/ �� '� � s' �� ' � ' ' TVPE OF CONSTRUCTION ' NEW - Applicant's Mailin ddress /J� �/ `uJ�, ' Owner's Name �-��-�! -�C�A- PhOne��, � CONVERSION.' ❑ DEMOLISH ❑ O" " y � DESCRIPj'I�O�J OF WORKfb1SEAF BCDGG A'ddress ��I �-^.•�✓ �.�L� . . Arch/Eng. license No. Address ��p � Con[racmr's Nam n - Phonet�LLLr Addieu (ma'i'nnl ' ' / � � . Ciry Licenu No. �1�� G LICENSED CONTRACTOR DECLARATION � 1 ber¢by a�fi�m Ihat I am licenzetl untler provisions o( Chart�C� 9(commencing witn section 7000) of Divlsion 3 ot the Business antl Protezslonz Cotle, antl my license is i uIl fo ana effect. ' ` Lice/nz�e Class � Lj enye �%`s/ 6 y Datp ^-�3 —rl'� �Signat� -'�• , WORKERS' GOMPENSATION DECLARATION I he�eby alfirm that I have a certificate ot con5ent to selt-Insure ov a CertiflCate " ' Workers' Compensa[ion Insurance,•o� a� certifietl-cOpy Iher¢Ot (Section 00, Lab. C � ✓olicy No. ��'— �,4T_ Company� �- �y y� y � ❑ Certitietl copy i5 hereby (umishetl. � + � � 6#�Cer ifie�tl �opy i� �" jtl with the <it B diny ivis n. ate(�Y`-�=' • APplica ,!-� {�� EXEMPTION FR04�I WORKERS' C�'6MPENSATION D CL ATION (This seclion neetl not be cOmO�e[etl if the permit i5 fo� one huntl�etl (5100) or less). 1 CeftHy thdl in Ih¢ P¢rfOrmdnCe Of th¢ wOfk fOf WhICh thi5 pefmi[ IS i55u¢tl, I shall not employ any person In any manner so as to become subject to the Workers' Compensation LawS o( Califomia. � , � , � . Date Signature 'NOTICE: H, after'makinq this tleclaration, you shoultl become subje<t to'the � Workers' Compensation-provisions-ot tne l.abor Cotle, you must torthwi[h'� como�Y � with such owvisions or this..permlt shall ,be' tleemetl revoketl. CONSTRUCTION LENDING AGENCV: � ' I hereby aifirm tnat there is a construction lentling a9ency for lhe performance ol the'work tor which this permit is issuetl (Se<tlon •309� Civ. CJ �, Lentler's Name LCnEer'S AatlreSz OWNER BUILDEH DECLARATION � I he�¢bv aHi�m that I am CXEfOpI (�OT LI12 COI121dCIOf�S LICBIISC LdW t0/, tne IT '=refrom antl the basis tor the al 1.S,by� any appliCant for a .elty otno[ more Ihan frve huntl 'tJ I, as owner o( the property i 'comp¢nsatlon, will tlo Ihe wo�k, a �or salo (Section 7044, Business LicenSe 12w tloez'not apply'to an i thereon, ana who tloes such worL emD�oy¢es, prOviOetl tha[ such,iml sdle. If, boweveq Ihe builtling ar i pletion, the owner will have the b p�ova to� th¢ PurpOse ot sale). ❑ I as owner oi the orooercv. ar tractors lo con5[rucl tl The Contractor's Lia bullds or Improves lh tractor(s1 Ilcense purs proof o( Ihel� Work¢ ❑ I am exempt untler Date [he owner' ig wl[h SecUon 7000),of � or tha[ he/Sho is exempt Any vlolaHon of Sectian � the appllcant fo�a civil - J = with wages as their sole s not Intontled or otieretl Cotle: The ContratlOr's' N who bulltls or Imoroves uemerits are nol intentlea or ofterea tor rovement is zoltl withln one year ot com- . Ilnas an0 si9n all app�opriate Eeelarations. liDD LJ ALTERATION �REPAIR' -HE R' TVP PFi�M1T '� LI GRADING LI FOUNDfCTION LI STRUCT.URAL �TENANT ❑ E CTRICAL ❑ PLVMBING � MECHANICAL� � � OTHER PROJECT DESCRIPTION Scp. F._ � CONSTRUCTIONTVPE • ZONE GRADING Remarkz: - � 1 Bar Sink Backflow Preventer ' Backflow Irrigation 8athtubs Clarifiers ' Dishwasher - ' • Drinking Fountains Floor Drains Floor Sinks ' — ' ' Gas Service Outlets Interceptors � - Kitchen Sink ' � " Lavatories � P—Trap 'Roof Drains � i � - Reinspectiun.Fee . $15 Boiler , en of provin9 he/she tlitl not builtl or im- . Dutt - Undei Ground � zclusively contracUng with II<en5etl mn- Duct-Sttuctural , OO J044� BUSII1B55 dfltl PfOf855�0lIS COtlE: not apply [o an owner o/ prOperty who ' DuCt - V¢ntilati�y - � contracts fo� SUGh pwlecl5 with a con- rtractor's License Law). 1 am aware that Exhaust System ❑ Multiple ❑ >n insurance shoultl be provitletl to me. ' e. & P. C. tor this reason Firepl/FacL Blt. IC80 # ' Heating System & Ducting is aooiication antl ztate"that the above- - �a700,000 BTU �100,OOOBT' ioly with all city anC county ortlinances ins�ctlon, an0 hereby au[norize repre- , , �� r. o an��a.mentinnee orooertv tnr � I7�gnaiur�y �v Drivers' Llcense or 55 � � � Reinspection Fee $15 F 0865-46, rev. 10/B4 Wbite - Builtlinq; Canary - APPlicanh Pink - Accounting; Goltlenrotl - AsseSsor _'VALUATIONS � �/V-•� YDS. ACRES - ' ' � � � FEES Showers ' Service Sink Sewer Cap Sewer Connection Solar Collecrors .. Solar Piping�, � Solar Tank Swimming Pool w/Spa Urinal � � " Water Goset � Water Heater � Water Service � Aum-Wash , ' Issue Fee ; Hoodor Typel ❑ Canopy Type 11 ❑ � 3efrigeration System ❑aioo,000eTu ❑ioo,000 Sys[em Repair/Alteration Fire Dampers � • Registers Issue F a 0 A.P: �p S Main Building: - E - T Front'. 8 Rear 1 A C Right g Lef[ ' Ping. Ref. # Automatic Washer Construction Pole Su6. Cookin9 Unit; ' Dishwasher . � Dryers OGas ❑Electric Fan F.A.U. Fixtures� ' � Device Boxes � Outlets Garbage Dispoul Generamr �0-5 KW �5-15 K $ 3 Reinspection Fea FEES ... DEVELOPMENTSER 2aning Approved By_ Building Approved By Appliption laued By_ $ 3 3751_ !t/23190. 2one . (. � Parking Req ELECTRICAL • � � . ' Trensformer ❑ 15-50 KW : ❑ 50+KW Meter ❑up to 700amps - -Meter ❑over 100 amps - - Sub Panel `. f" � Momrs�0-1 HP�1% �8 � Inc.Solar �9;15 HP 016-15- ' Microwave � . Pole Light � � Range $ign ; Standing Sections � W Trash Compactor $15 luue ��EOUIREMENTS: :�, �� ; FEES 0 � $ 3 Z O N I' N G R E Q M T S ' SUM RV F FEES � S� BUILDING PERMIT $ % �� SMIP $ PLAN CHECK � $ PERMIT PLUMBING $ ISSUANCE $ ', . PLAN CHECK 25%. $ ENERGV P.C. $� ELECTRICAL , , $ GFiADING S PLAN CHECK 50% $ � MICROFILM S� MECHANICAL � $ � TOTAL FEE � $ � y PLAN CHECK 25% $ • . � CONSTRUCTION AND PLANNING APPROVALS Permit# 1. Temporary Electrical �Service or Pole 2. Soil Pipe-Undrgrnd. . 3. Electrical Conduit Utility-Undrgrnd. 4. Electrical Conduit-Undrgrnd. 5. Steel Reinforcement 6. Electrical UFER Grnd. _ 7. Footings � �8. Foundation � � 9. Water Pipe-Undrgrnd. 10. Structural Floor System 1-1. Property Sewer Line & House Connection 72. Sewer Cap � � 13. Roof Drains 14. Rough Plumbing 15. RougFi Electrical-Conduit - i6. Rough ElectricWiring 17. Rough Wiring Sign � . . 18. Rough Electriral-T Bar Ceiling ' 19. Rough Heating & Air Conditioning 20. Rough Factory Fireplace 21. Ducts, in Structure - , 22. Ducts, Ventilating � 23. Gas Pipe-Rough & Test 24. Roof Framing ' 25. Roof Sheathing 26. T-Bar Ceiling (Structural) & MonocOat 27. Frameand Flashing , 28. Lathing & Siding - � 29. Insulation � ' ' , 30. Drywall Nailing � - 31. Plaster Brown Coat � 32. Electriral Power Meter-Final � 33. Final Electric � � 34 Final Heating & Air Conditioning 35. Final Ges 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 o. Date , POOL 'A Date � Inspector qppROVALS Permit# 52. Pool & Equipment Location 53. Steel Reinforcement 54. Forms 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVAL TO COVER-GUNITE 58. Electrical Conduit-Undrgrnd. , '59. Gas Pipe, � Undrgrnd.; Test. 60. Backwash Lines, P-Trap, � 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/SPASYSTEMS'FINAL � FIRE DEPT. REQUIREMENT APPROVALS Permit # � 70. Underground Hydro 71. Product Piping � Gas .�❑ Oil ' � 72. Underground Flush � �� . � 73. Undergrnd..Storage Tank O Gas ❑ Oil ' 74. Overhead Hydro ' � 75. Dry Chemical - 76. Dry Standpipe , � 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT , � � 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED � Notes: ' . ' e Date � Inspector �' � . _ _ .Apo��ant to /III in all sDaces exceot �hose within tiITY OF COSTA MESA CONS�RU � ION PEyR M/IT' . � P RMIT NO� TRACT I - Prolect Address ��:�_�'vq �'—. ..�✓7 l� /� 23 S3 �� . �Applicant's Mailin Address Y' n �-.T�G .S 7/ n�-�-7��=�-�/� Owner's Name � ' �Phone7l.L.uC � Address � � -� ^'�� ) Arc1i/Eng. ' License No. • Address Contracmr's Na�� - Phon��'� Address (mailingl r=n�i � 7� _ City•LicenseNo.�'�U-�� ` LICENSED CONTRACTOR DECLARATION 1 hereby a(firm that I am licensetl untler provtsions ot� Charter 9(commencin9 witn section ]000) o� Division 3 of the Bu5ine55 antl Profe55ions Gotle, antl my Iicense is i�tytll fo ��?ntl effecL , '�� . �. License Clas �cen Dat � � Signature � WORKERS' COMPENSATION DECLARATION; ' I ncreby affirm tha[ I have a certifica[e-of consent to self-insure or a certificate f Workers' �Compen5a�ion Insurance, or a-certitie copy ttter of (Sectlon 300, Lab. ) - PoIiLY No��J'� ��YCOmPanY. __ ❑,Ccrti/ietl copy is h¢reby tumish¢tl. ' ' � � y� Ccr} if,ietl <opy Is /il tl with the tity Bu' Eing rolslg n. DataT ' a �'�� Applicant��/ EXEMPT.ION FROM M�ORKERS' COMVENSATION DECLA ATION� � - ��This section neetl not be comple[Etl if the p¢rmit is for one hUntlretl ($100) or less). ' ' ' ' I CCrtity [ha[ in the performance Of the work to� wM1ich this p¢rinit i5 iSSuetl I shall not em0�oy any Oe�son in any mann¢r So a5 t0 become subject [o I�G ' Workers' CompensatiOn Laws o( Califomia. � . . �ate Si9nature � � �NOTICE: I(, aftet maKinq this tl¢Claration, you shoWtl become subject to the -Workets; CompenSatlDn ptovisions ot'the Labo�'Cotle, you must'forthwith . mmply wiN zuth.provisions or this p�rmit_ Snall be' tleemetl revoketl. CONSTRUCTION IENDING AGENCV � � - � " 1 hereby affirm that thGre i5 a construction lentling a9ency fo� [he per(ormanGe of �he work , tor Which [his permit is issuetl .(Section 3097 Civ. �CJ Lender's Name Lenticr's Atltlress OWNER BUILDER tlECLARATION . I hereby aftirm that I am exemOt trom tha Cantractor's License Law lor the following reason (Settion ]031.5 Businezs antl Protesslonal Cotle: Any city or county whlch requiros a permit to construct, alteq �mprove, tlemolish or reoalr any structure, p�lo� to Its issuance, also require5 the applicant for such permit to file a si9neG:statement that he/she is Iicensetl pursuant to the provisions of tne Contraclor's LicePse Law (Chapter 9(commenUn9 wi[h Section 7000) of Diviiion 3 of the BUSlness,antl Protessions Cotle) Or Ihat ha/she is exempt g�� }�Cre(rom an0 �the b95is tor the dllegetl ex¢mp[ion. Any violatiOncot Section �'.;;;31.5 by anY�appl�Wn[ for a pe�mit subjectsthe,applicant to a civil '- �alty ot not more lhan tive huntlretl tlollars ($500). � '�i, I,.az owne� of tne property o� my employee5 with wagef as thei� sole Compensation will tl0 the work, antl the Structur¢ iz�nOt Intentletl or otferetl bo�Ge� lines antl si9n all appropriate tle[larations. LOT NO. UNIT NO. . � . TYPE OFCONSTRUCTION' LJ NEW LJ AOD IJ:ALTERATION L�REPAIR ❑ CONVERSION 0 DEMOLISH ❑ OT ER ' DESCRIPTIO F WORKN E OF BLDG � � _�� /� e�(.� �—IS� -��,� �r- E. �9 TVP � PE IT GRADING ❑ FOUNDATION ' STRUCTURAL TENANT ��$/�LECTRI jAL ❑ PLUMBING ❑ MECHANICAL ��OTHE0. ([/ ./y � PROJECT DESCRIPTION 5a. T._ oCCUPArvCv (�}� �_� CONSTRUCTIONTYPE VALUATION$ q�' ZONE � GRADINGCU.VDS. ACRES n Sink cflow Preventer � -' kflow Irrigation itubs � itiers iwasher � � • iking Fountains . x Drains � � � xSinks, - "� -' -- • Service � , OuUetr Kitchen Sink : ' Lavatories P-Tiap Roof Drains Reinspection Fee , ; � '. $15 for wle (Seclion 7044. Business antl Protessional Cotle: The Contractor's __ _ License Law tloes noC apply to an owner of a property who builtls or improves Ihmebn, antl who tltles such-work himSCit/herself o� tn�ough Itis or her bwn gpjle - employ¢es, provitletl �hat such improvements are not intentlotl or offeretl fo� � sdl0. If, however, the bulltling o� improvamen[ is Soltl wlthin one year of com- � pletlon,'tne owner w�ll have the burtlen ot proving he/she tlitl not builtl or Im- Ducl - Under Ground prove torthe purpose ol sale). ❑ I, a5 owne� of �th0 P�operty, am exclu5iv¢ly contracting wi[h li<en5etl con- DuCt -$I�uCtU�dl (IdC101S'SO COOSIIUC[ IhC plOj2Cl ($ECt1011 %044� B1I510055 dOE P(01ESSIOOS COCB: The Contractor's License Law tloes not aDP�Y lo an owner of Property who Duct - Ventilating. � builtls or imoroves Nereon, antl�who contracts for such orojects with a con- tractor(s) llcense pur5uant to tne Contracior's License Law). I am aware that Exhaust System ❑ MW[iple ❑ proof of their WOrkCr'S Compen5ation InSuranc¢ Shoultl be ptovitletl to me. _ ❑'I am�exempt untler Section B. & �. C. for this reason Firepl/Fact. BIG IC80,# Date owner Heating System & Ducting - 1' horeby certitv that i have reatl U�is appiication 5ntl state ttiat the above � � ❑D100,000 BTU'�100,OOOBT inlormation is correcC. I agree to�wmply with all clty antl�county ortllnances , antl state laws relatip9 to buil0inq wnslruction, d�tl,h¢reby authorize repre- sentatives ot tni tlty t ter uDy � the above-mentionetl.properly for � . inspec[iOn Pu e / Signatur �/� -�-�.�"� ��— Rainspection Fee �$15 , MF 0865-46, rev. 30/04 White - BuilGing; Canary - Applicant: Plnk - Accounting; Goltlenrotl - Assessor t FEES Showers Service'Sink' � � Sewer Cap Sewer Connection Solar.Col lectors_ Solar Piping Solar Tank - ' Swimming Pool w/Spa' Urinal . � � - " ' Wet¢( ClOset . -Water Heater � WaterService- � Auto-Wash oy� _ i . . laue Fee ' - $ 3 Hood or Type I ❑ , ' Cariopy' Typell ❑ Refrigeration System � � � ❑o•i ao,000 sT u'O i oo,oao aru System Repair/Alteration � Fire Dampers � Registen n Issue Fee !� $ 3 A.P. # � S Main Buildl E 7 Front B Rear A C Right •K Left S Ping. Ret. # Planning Notes: Construction PoleSub. Cooking Unit , Dryers LJGas Fan F.A.U. Fixtures Device Boxes Outlets 3752 _ 4/23/96 � ' Zone� ` Actessory Building: Parking Req:/Provided� r u ELECTRICAL • � � � Transformer � 15-SO�KW ❑ 50 `KW Meter ❑up to 100 amps Meter �over.�t00ainps _. . Sub Panel ' , Motors �41 HP �1�X - 8 Inc. Solar �9-15 HP �16-15+ Garbage DiSposal ' Generator DO-5 KW �5-15 KW Pole Light ' Range Sign ; Standing Sections Trash Compector 0 tl � Reinspectian Fae � S75 � � Issue Fee DEVELOPMENT SERVICES REQUIREMENTS: 2oning Approved By � � Bui�dinB APProved By �, Appliration laued Bv y� •t� j'�� ES $ 3 2 O N I N G R E � M T 5 � SUMMARVJOF FEES �) BUILDING PERMIT $ �, O SMIP $ ' J � PLAN CHECK , $ � � 'PERMIT � PLUMBING � ' $ ' ISSUANCE � $ PLAN CHECK 25% $ ENERGY P.C. � S' ELECTRICAL $ � � GRADING $ � MICROFILM �. $ � PLAN�CHECK ,50% 5 _ MECHANICAL S ' TOTAL FEE . $ �� PLAN CHECK 25% $ � . � _ � / CONSTRUCTION AND PLANNING j� � APPROVALS� Permit # � 1. Temporary Electrical Service or Pole 2. Soil Pipe-Undrgrnd. 3. Electrical Conduit Utility-Undrgrnd.� 4. Electrical Conduit-Und�grnd. 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 Electriral-CondU�t - 16. Rough Electric Wiring , 17. Rough Wiring Sign , 18. Rough Electrical-T Bar Ceiling 19. Rough Heating & Air Conditioning ' 20. Rough Factory Fireplace . . 21. DuCts, in Structure 22. Ducts, Ventilating 23. Gas Pipe�Rough & Test 24. Roof Framing 25. Roof Sheathing 26. T-Bar Ceiling (Structural) & Monocoat 27. Frame and Flashing 28. Lathing & Siding 29. Insulation 30. Drywall Nailing � 31. Plaster Brown Coat 32. Electrical Power MeterFinal . 33. Final Electric � 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 Ediso� 50. Gas Release to Southern Califomia Gas Co 51. CERTIFICATE OF OCCUPANCY � No. Date Date POOL `A Inspector qppROVALS Permit# 52. Pool & Equipment Location� 53. Steel Reinforcement - 54. Forms 55. Electrical Bonding 56. Rough Plumbing & Pressure Test 57. APPROVALTOCOVER�GUNITE 58. Electrical Conduit-Undrgrnd. 59. Gas Pipe, � Undrgrnd., Test 60. Backwash Lines, P-Trap, � 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/SPA SYSTEMS FINAL FIRE DEPT. REQUIREMENT APPROVALS Permit# 70. Underground Hydro 71. Product Piping �Gas ❑Oil 72. Underground Flush 73. Undergrnd. Storage Tank O Gas ❑ Oil 74. Overhead Hydro 75. Dry Chemical 76. Dry Standpipe 77. FIXED SYSTEM FINAL 78. FIRE PREV: FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION 80. FOOD CERTIFICATE ISSUED Notes: Date �Inspector Applicant to fill in all spaces excapt t�ose within heavy bortler lines anE sign all aDProOriata Gaclarations. 1'��TYbFCOSTA SA CONSTRU�CA+TIO� ",PrOject Address � � U��/�.e[ /1/ %�• . �Applicant_s Maili/p�p/�, ddress d /�+/�X-S 7 � Owner's Name ��! �G3LrR%� �� `t P�aL-- �Phone�lq3Sb7/ ' liddress '�NT �Ia+u,{' T�iJI/�U� � Arch/En9. , Licenu No. Address e� �� Convactor's NamrJ�� L S Phone'.iL—� '� Address Imailing) �: �_�+ �� - //� ' ' City License No. /1'�� n'L � -� LICENSED CONTRACTOR OECLARATION � 1 M1ereby affirm Inat I am lic¢nsee untler provisions of Cnartar 9,(commancing with 5ection,l000) ot Division 3 of the Bu5ine5z antl Professions Cotle, antl my license is in j�il torce tl eifect. i ' v Cicense Class `�-� �' �-�� Ice�' Nd:� S�� ozte 4�-/h- 5�9 � C2' G¢scr/ �`'r�"oD",`� WORKERS' COMPENSATION DECLARATION � � 1 hereby aftirm that 1 have a certificate of consent ro self-insure or a certiticate N- Workers' Gompensa[ion�lnsurance, or a certifietl coOY thereof (Section '' 1800, 12b. C ry/� /` � PolitY No. ��'-��"Co�anY �%/�!� /'Cd�n.O� . ' Certifietl copy i5 h¢reby futnishetl. . , Ce ie op � tiletl with the ci[ iltl� isi � ; � Date �- APPIic ' � EXEMGT�ON FROM WORKER OMPENSHTION DE ARATION - (This sectiOn neetl not be completetl if the permit is fo� one huntltetl (5300) or Ie55). I ' I certify [hat in the Perto�mance ot the work fo� which this pe�m�t is i55uetl, I shall mt employ any Derson in any manner so as to become subje<t to'the � Workers' Compensation Laws of California. � Date ' Signature ' � ' 'NOTICE: If, after making [his tleclara[lon, you shoulU become subject to the �Workers' Compensation provisions ot•the lzbor Cotle,-you must for[bwl[n comply , with such .provisions or . tnis Oermit snall be tleemetl revoketl. ' CONST0.UCTION LENDING AGENCV•� •� .� � � I M1ereby aftirm fhat theie is a mnstruc8on lentling ag¢ncy tor the pe�formanc� � of the work 'fo� which [his pe�mit, i5� i55uetl ($ectlon 309] Civ. C.) �enGer'z Name- Lentler's Atltlress _ OWNER BUILOEH OECLARFTIOfJ . I heiaby attltm.that I am ¢xempt f�om thG�ConVa[lor's l.icense Law (o� th0 /ollowin9 reAson (Section 7031.5 Business antl Professional Cotle: Any clty or county whiGh �aquirCs a p¢�mit to ConSt�uCt, alte�, improv¢, Cemolish Or �epair any sl�ucturo, piiOr lo It5 i55uance, al5o requires the applicant for Such pe�mil t0 file a Si9netl Statement [ha� Ile/she is Ilceni¢tl pWsuant to lhe provl5ion5 of the Contraclor's LlcenSC law (Chapter 9(cOmmencing with SocUon 7000) of Division 3 ot Ihe Bu5ine55 antl Prolessions Cotla) or that ne/she i5 oxumpt 'herefrom antl \ne bazis for the allegetl exemplion. Any violation Of $ection )31.S,by, any applidant ror a permil subjettz tne applicant to'a civil analty of not more than five nuntlretl aollars,(S5o0). ' �� I, ai Owner o� tha ptoperty O/ my employee5 wi[h wagei ai thCi� sole -compensation, will tlo the work, antl the structuro.is'not Intentletl or oftere0 for salo (Section 7044, Business antl Professional Cotle: Tne Contrac[or's' License Law tloes not apply to an owner ot a properry wno builtls or improves thereon, antl. who tloes suth work himseli/herself or cnrough hls o� her own emO�oYeeS, provitle0 tttal such improvemenls are no[ In[entled or affereC for � sale. It, noweveq tho bui�tlin9 or Imorovement is soltl wlthln ono year ot com- plelion, Ihe Owner will nav¢ Ihe burtlen of Proving M1e/shc dIC not builtl o� IT- p�ov0 fo� the purpOse oi Shce). , : ❑ I, as owne� of the property, am excWsively toM�ac[ing wi[h Iicensetl ron- tractoR [O con5iruct the ptole« (Section 7044, Businez5 antl Professions Code: -The.ConVac[oCs.License I�w does nol dPPIY to an,-owne� of p�o0erty who builtls Or Improves Ihereon, antl who contracts for zuch projecls wlth a con- � tracto��s) licenz¢ pursuant to the ConVaGto�'S License Law). 1 am aware�fhat proof o1 [heir Worker's Compensalion insurance shoultl be provltled to me. ❑ 1 amrexempt untler 5ection B. & P. C. for this reason Date • Owner ' �' ' I'hereby certify thzf I-have reatl ihis application antl itale �that the above information is correct. I agr¢e lo comply wi[h all city antl county ortlinances antl�state laws relacing to builtling consVuction, antl hereby auNorize repre- sentatives of th's city o ter upon the above-mentionetl property for inspectlon p se L� �6 � TVPE OF CONSTRUCTION LJ r�Ew �-1 ADD LI ALTERATIOfJ JLi REPAIR ❑ CONVERSION ❑ DEMOLISH' � OT R_ -• DE�S/CRI TIONO�IjJQJi�/US�n.BLDG.��_7��,,�y�.Q� ��` �7y]� S� `/d�_�d7.y_5�' '� TVP�/0 `RMIT GRADING FOUNDATION STRVCTURAL� - ❑ TENANT �ELECTRIGAL '� PLUMBING ❑ MECHANICAL ' ' ❑ �OTHER e�,rt�,�i. [ . PROJECT DESCRIPTION �. F. oCCUPAN y�T�_ , CONSTRUCTION TVPE '-VALUATION $ ' ' �� ZONE GRADING CU. VDS. ACRES 0.emarks: • . , � Bar Sink Backflow Preventer � Backflow Irrigation + � Bathtubs � • � . _ Clarifiers _ . ._._ .. .� Dishwasher , . � Orinkin9 Fountains , Floor Orains � � � � Floa� Sinks . ' "' � � - � � • Gas Ser,vice �TOutlets " ' Interceptors . ' Kitchen Sink - , � Lavatories � '� . � P-Trap ' ' .,'_`..____ - r . Reinspection�Fae � i $15 � . loiler � . �, 1uc�- UnderGrountl ' Duct - Ventilating • Exhaust System � Multiple Firepl/Fact: Blt. IC80 # Heating System & Ducting � ❑aioo,000sru Oioo,000 Siqnatur Date - ' � �rivers'�License or 55 � I I Reinspec[ion Fee I $15 �'F 0865-46, rev. 30/84 White - Builaing: Canary - APPlitant: Pink - Accounting; Goltlenrotl - Assessor ABING � � � � FEES Showers ' Sewer Cap , Sewer Connection SolacCol leCtOrS .. . Solar Piping, Solar Tank � Swimming Pool w/Sp Urinal - `Water Closet ' - Water Heater - Water Service . Auto-Wash , " ' ' I "' � laue Fee � . S 3 JICAL . . FEES Hoad or Typel ❑ Canopy Type I I ❑ Refrigeration System ❑aioo,000eru ❑ioo,000 System Repair/Alteration Fire Dampers Registers � Isue Fee 0 $ 3 ` ' • 3236 4/ I 6l�3 I i�� =�: TI. A.P. dk S Main Buildi E T Front B Rear � A C Right K Left S Ping. Ref. # Planning Notes: � t Zone ' � ' -Accessory Building: _ • � , Z • O � _ N - 1 - . N , G . ' . R. Parking Req./Pro'vided� - E _ Q M I � , T ' S 'Automatic Washer ' � Construction Pole Sub. � Cooking Unit � � Dishwasher - - - -- - Dryers ❑Gas ❑Electric Fan � F.A.U. Fixtures Device Boxes Outlets Switches• . ' Garbage Disposal Generator �0-5 KW �5-15 K ELECTRICAL ' ' Transformer ❑ 15-50 KN • � ❑ 50+'KW� , , �� Meter �up to 100 amps Meter-�over 700�amps; � Sub�Panel U Motors �0.1 HP O�1 Y, �,8 Inc.Solar �9-15 HP �16� Microwave � Pole Light � Range ' Sign � ; Standing Sections , W Trash Compactor ' I Reinspection Fee $15 Issue Fee DEVELOPMENTSERVICESREQUIREMENTS: � . ZoninB APProved By ' Building Approvad By � � � Aooliwtion luued Bv � � 0 0 �$3 • � SU�%� R�j� F FEES ' BUILDINGIPEFiM1T $ '� SMIP $ . � �� PLAN CHECK �� $ ' ,PERMIT 1 _ PLUMBING � $ �ISSUANCE � S , PLAN CHECK 25%' $' ENERGV P.C. ��$ ELECTRICAL , � $ GRADING • S � PLANCHECK 50%. $ �MICROFILM � $ � MECHANICAL $ TOTAL FEE $ � � •.�� PLAN CHECK ,25%� $ ' . , . , . , �CONSTRUCTION AND PLANNING , POOL 'A 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. Elecvical 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 l'0 COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation � 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Undrgrnd. � 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains � . 64. Plumbing SYstem - Final - 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Elearic 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 ' � 7p, Underground Hydro . 22. Ducts,Ventilating 71. ProductPipingOGas ❑Oil 23. Gas Pipe-Rough & Test � 72. Underground Flush � 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Root 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 Conditi�oning 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 g'� ��" ' 48. Special Reguirements Completed _ , 49. Electric Release to Edison � 50. Gas Release to Southern California Gas Co , . 51. CERTIFICATEOFOCCUPANCY _ _ � - . N0. Date ' Applicanl to fill in all spaees wilhin �1TY QF COSTA�INESA�' PERMIT�NO. � CONSTRUCTION PERMIT F SSS 3 EorGer Ilnes anC slgn all appropriate tleclaratlons. TRACT NO. LOT NO. �BIp�.NQ� -rro ect naaress rn I , l . . TVPE OF CONSTRUCTION ` w �, Ownel ' 'Q� - Phone �j(J- v ❑ NEW _� ADD ❑ ALTERATION -yy�[ / N AddfEa .a.� �'� � �REPAIR ❑CONVERSION ❑DEMOLISH Arch/Eng. License No. ❑ O7HER Addfess . OESCii1PTION OF WORK. Contractor � Pho e� - _ TVPE OF PERMIT -� -� Addre55 -❑ GRADING ❑ FOUNDATION _Q STRUCTV RAL LICENSED CONTR CTOR DECLA ATION � ❑SENANT �LECTRICAL,OPLUMBING ❑MECHAN I hereDy atfirm Ihat 1 am Ilcensetl untler provisions of Charter 9(com- , , mencing .wil� section ]000) o(. Dlvision 3 of the Business antl � OTHER; Professlons ,Cotle, antl my Ilcense is In full force antl effect. PROJECT DESCRIP.TION� • ' . License Class Licensa'No.' - , - � - - �- � - •- - Date Si9nature � . SQ. FT. WORKE(35' COMPENSATION DECLARATION � � OCCUPANCV_CONSTRUCTION TYPE I�hereby a(firm thaY 1 have a certlflcate of consent to selt-insure or a VALUATION - ZONE I cartlilrate of Workers' Compensatlon Insurance,.or,.a certifletl copy _ thereof (Section 3800, ISC. C.). � GRADING CU. VDS. ACRES � P^'icy No. ' -Company 'ertifietl copy Is hereby tumishetl. . _ , __ , REMARKS: � ' - Jertifietl topy is flletl with the Uty Bulltlin9 DlWslon. _- - E%EMPTION FROM WORKERS'-COMPENSATION DECLARATION � (ThisSettlon naetl not be complatetl i( tha permit is (or one huntlratl �� ., .- . . SE100 orleu ' - ' ' - ' -- cert�ty�that•�n the performance ot the work for whlch this permit is �� IssueO; I shall not emPloy any p¢rson IM any manner so'as to Decome PLUMBING � �-.PLAN CHECK �- subjBct tOlha WOrkers Compenzat�{.yyas o California. � - " _ Date Slgnature�� E� BATHTUBS - 'SHOWERS � �- NOTICE: If after making this tleciaration, you shoultl become subject TOILETS URINAlS� -� - ' to the Workers' �Compensation provlzions of Ihe Labor Cotle, you must - , � forthwith comply with such provisions or tnis permit snall ba tleemeC LAVATORIES � DOUBLE LAVS - �- �BVOk¢C. � . CONSTRUCTION LENDING AGENCV � ' -'" ' KIT: SINKS � �-----OISHWASHERS -- - I hereby aHirm [�at thera Is a construction lentling agency for the per- SERVICE SINKS .�SVMPS- --� -•- � �- formance of the work fOr whith thi5 p¢rmit is Issuetl (Setlion 309] Clv. C.). - - - � - � � -- �--• � - .. . . FCOOR SINKS - -FLOOR'DRAINS'� -- - Lentler's Name Lentler'z AtltlraS � ' � ' -DRINKING FOUNTAINS - ^-^ �� OWNER BUILDER�DECLARATION � INTERCEPTORS " • CLARIFIERS - " 1 he�eby aftirT Ihdt 1 am ezempt ��om the Cont�actot's License Law fo� [ha tollowing-reaSon.(SeCtion 7031.S.BUSin¢ss antl_PrOfesSions Co0¢:. �SWIMMING POOL � - -PTRAP - - Any city Or COunty w�ich requires a permit to construct, alter, improve, tlemolish�or•repair any structure,.prior.to its issuance, also re- yyqTER SERVICE- �- � ALTERATION �� - quir¢5_Ihe apO�IWnt for SUCh p2rTl[ to flle a signetl statement that he Is� Iicensetl-pursuant to tho provisions of the ContractorY License.Law GAS SERVICE' ' OUTLETS' � �� ^ (C�apter 9(commencing with Section ]000) of Division 3 of [he Business antl RofeSsionS�Cotla) oothat he is exempt therefrom antl the -yyqTER HEATERS� -� - BTU'OUTPUT -� � �. -. ba�� for tho alle9etl exemption. Any violation o( Se<tion �031.5 by ��`'�"`r�,""*PPmore�than five h nitlred tlo lars ($500� �cant.So..a.civil.-penalty SEWERtONNECTIONS - •• - .� - � - - J�"6'a5owne�bf'tbe'property;w�tRl�-Cf1}Agyi�s�viEp-wa�e�-ef�bel� -SOLAR�TANK - ^ �COLLECTORS - • ❑IactoYi LlcenSe Ldw tloe5 not a � bWltls or imprOves [hereon, antl �u9h his Own ¢mployees, provitletl �.ntled ofof(eletl tof Shc¢. It, hOwe� �Itl within One yea� 01 completion proving ba tlitl not"bulltl'or' im 1, as. Owne� of,.the. prop¢rty, a an owner ot property I�actS.(�om sucn pro; the Contractor's Licen ❑ t am ¢xempt untlEr reasan Date' IS Of a cc to an owner o* a property � tloe5'suth wo�k hlmself or such improvemenls are not he builtling'or'improvement owner will have the�burtlen �. fo� the purpoz¢'of'zdle). , ana wno con- :tl pursuant to & P.�C. for Ihis I lnis application antl State that lo �Comply with dll City-ar , q to cons[ruction, antl hereby o enter upon - the - abovR-�/ V oses. /a,r} L]�/ SOLAR PIPING SVS. " .i ""' ' ' -' ISSVEFEE ""-' "'-- '- MECHANICAL � ` - vLAN CHEC1c '- � "" HEATING SVSTEM .0-100,000 BTU AND DVCTING ^ 100,000'+�BTU REFRIGERATION 0-100,000 BTU ' � SVSTEM. ' 100,000+gTU - BOILERS � �� BTU SVSTEM REPAIR,ALTERATION � � - EXHAUSTSYSTEM MULTIPLE Signature � - Da[ - � - - -' DHvers"LitenSe or'S5 # ' ' - - " � - ISSUE FEE. __. . __ __ . _ _ _ CMF 0865-46 White-Builtling; Canary-Applicant; Pink-Accounting; GolGenrotl-Aszessor - �5e5., i � i i �i�je ' - ZONING REGULATIONS A.P.4f � - ' � - 20NE PLNG. REF. � � Ti1�f1T..__ .. REAR VARD'(TO PKG. SPACE RE�. •• ZONINGAPPROVED�B` ' SPECIALCONDITIONS: e>Uu TL � , - PROVIDED'� - • PARK FEE § � • - - . DATE - - ' . _ ' ' � ' _ ' . . . . ELECTRICAL --• p�.araCHECK � � 50. FT. .' . •� ' ' " GENERATOR. Od KW_1-lO�KW - � TRANSFORMER APPLIANCE - 30-50 KW�50 +"KW ` . ' MOTORS .""" "_' 0-1�HP=1-lO.HP -.. ' ' ' QNC.SOLHR). ,30-SOHP_50�,HF - _}_ l: FI%TURES -OVTLETS�•�SWITCHES�- . GAS TUBE SIGNS _ - � .._. _ . . . � POLE LIGH75� . �- � - .- - - � POLES""' - MFTFRFII 'SIIR ' • . . � ELS � - . .. MAIN -- -� SUB � - � . ... . . _ . _ - ., ' � ' 1. d55VEFEE-- � - --- -. . - � NPVLICATION APPROVED BY .. . ' . DATE � � � SUMMARY OF FEES - , BUILDING.- - _ . . ' . � � PERMIT E SMIP E � PLAN CHECK S � PERMIT - . PLVMBING §' � ' • �SSUANCE S GRADING E - PCANCHECK E- - �� ' - ' ' '-�' -' ELECTRICAL S� - � - -- a � - - - �PIANCHECK •E` 'MICROFILME - MECHANICAL� E � - � TOTAL FEE E . PLAN CHECK S � . LESS�AD-. ' - - :VANCE�PC E T- - . _ a ' , - . . V — �. _ _ FINAL FEE S r .. . ♦ , i ' � . . 4. . '1 � •. t I . �l ' . i � �! -� .. Y .t' �8�`J_ COSTA MESA BUILDING DEPARTMENT P. O. BOX 31� COSTA MESA. CALIFORNIA FOR APPLICANT TO FILL IN a� 'AD MAIL nooRess IARCHITECT OR ENGINEER COSTA MESA. CALIFORNIA TEI. NO. LIC. NO. QTY LIC. w/.� NO. �[ca� LOT /�� DESCRIPTION NO. I✓ BLOCK TR T A.P. NO. I/ �_/- C/ ^ O% $IZE �f/ y / �j ^ NO.OF BL�GS. (]F I.(]T /\ / C/ NOW ON LOT 115E OF EXISTING BLDG. SET9/.CN LINE FROM � � ./ c[rvlev ov sinee� REAR YARD � a� Q !. SIDE VARO RIGHT IEFT DESCRIPTION, OF WORK NEW � � ALTEFATION AODITION REPAIR MOVING DEMOLISH BUILDING NO.OF SIZE AOOMS STORIES EXTERIOR WALL ROOF . t.'��AI�LIiP�i��A�in�a atr,rQa2.0� .a Fif�ANCE OEPT. ' Ci n oF r,nSTn e�tsn APPLICATION FOR PERMIT BUILDING� FOR OFFICE USE ONLY RECEIPT NO, �A pqp� � V QIJ� ECEIVED BV D�TE RECEIVED O�TE ISSUEO �P/ ✓��/J—.C—� _�—/7-� % COSTA MESA. CALIFORNIA DATE CORRECTION SUBlECT TO UEPT. USE OF ISE � I BUILDING L .—�Q� r _ .- ? �/ •'� Y� �� / The Amount shown uader valuation i 1 HEFEBY �CRNOWLEOGE TH�T 1 N1VE NE�U THI$ APPLICATION 1N0 { ST�TE TH�T iHE �BOVE IS CORflEQ nND AGREE TO COMPLY WITM �Ll purpose o es:ablishmg a permit fe CITY ONDINM1NCES AND STATE L�WS REGULATING BUILOING CONSTFUC� T�oN. VALUATION � SIGNATURE OF PERMIT FEE $ PERMITTEE // �/" nLl $ S �r�� PLAN CHECK $ AUTHORIZED AGENT TOTAL FEE S � ��6� C05TA MESA BUILDING-SAFETY DEPARTMENT P. O. BOX 31'/ COSfA MESA, CALIFORNIA FOR APPL/CANT TO f/LL /M COMPLfTELY TYPE OR PRINT BUILDIN �O / 1 ADDRESS COSTA MESA, CALIFORNIA OWNE ��'. � o c To 2 ADDRES �% ]� /�,y � O � NC' ciTrl:%!�%7'%T/E� : �%S7� AODRE55 q�er rlo O s ' ADDRES � D � �y1 LEGRL I LOT /�O y UESCHIPTION NO, f O •// ar<• F'IY�y Nj STATE�.7�22� f/CLIC. Nq / rm . .r a T�/c ��/�0�� f �_�� cE�� (c . e�i. ' � `i � APPLICAj�'j ON.�FO�PPE RM IT CI BUILDING�ESA �oR offic� usF aNcy REC8IPT NO. I @�CO.� 1 RE�CE�IVED� BYr/ D/ATE RECEIV('E�D%q DATE 195UED �//"�� f��V-�/ I �^—��_� BUILDING COSTA MESA. CALIFORNIA ZONING NO. OF I U9E OF NEW PLANS �� BUILDING U � BY / '"` � �\ �OO' ��' oF e�oce. a ypRDS �[- I How on �oi REpUIRED ` �C.: � (CENTEH LINE 6TJ LDG. FRONT E FHOM � .J •nEE* � O REAR YARD �� R.SIpE , , 6. LEFT S RIGHT /� L. SIOE DESCRIPTION OF WORK REPAIR , I II M( BVIcDINGROU � OF BUILDI %� C S I HER6BY ACKy�W4y qND BTNT�iTFM1T THE PLY WITH'ALL QTY BUILDINO CO $TR SIGNATUR PERMITTE AUTHORIZED AGENT � NO.OF � ROOMS � STORIES ROOF T pY (y�J �� COVERINC/ �l. /` �C WORK TO BE PERFOjiMED �� %� �Ii / � f� S FT. IN. FT. 1 N. �� ' T T A a �c_ .- � �(' d -�J — ' I H/�VE REAO THIS APPLICATION 7HE AMOIINT 6HOWN fIN VALUATION 18 FOR THE 18 CONNECT AN AGREE TO COM- pUflPOSE OF ESTABLISH NG • PEflMIT FEE ONLY. �S�.TE AWS RE6lILATING � VALUATION � O� LC/L� PERMIT FEE $ � $ � �O� PLAN CHECK $ �O � TOTAL FEE $ � V � 9�6'� COSTA MESA BUILDING-SAFETY DEPARTMENT P. O. BO% 31] COSTA MESA, CAL�FORNIA fOR APPUCANT TO f/LL /N COMPLE7ELY - TYPE OR PRINT BUILDING l /� ��/ � � ADDRE55 ' V N v COSTA MES�+. CALIFORNIA ow�ER = e /�oC Ta � �-�E ��c�i��.� 6 - � � a-�e( v u FINANCE DEPT. CITY OF COSTA MESA APPLICATION FOR PERMIT BUILDING f0'R OFF/CE USE ONLY � HECEIM NO. I PEpMIT N Y `� . MAIL S�� ^J �, � RECEIVED BY I DqTE RECEIVED OATE 188U ADDRE55 /� � � �� /�- CIT �� I^T�L CY"NO�J <3 pDD EISS �RCFN�EN�Fa � N�o COSTA MESA, CALIFORNIA 7 LEGAL LOT Q / T `�� n DESCRIPTION NO BLOCK � WA�Cr A.P.NO. /(� ��-3D-47 $I$E�' � � � Q / � NO.OF BLD('.6. 2 OF L NOW ON LOT USE OF � � EXISTING BL�G. SETBr1CK LINE FPOM � 3 D ,2�, CENTER OF STREET �� REAR YARD / � / �/ SIDEVARD ILEFT � IRIGHT��-� DESCRIPTION OF WORK BUILDING �Q� GY� NO�OF SIZE RO�ME EnTE e�OR WAL�/ ��OOF _ J %ilC�:, nvcw OF BUIL� G AND WORK i� nc rcntonmtu [v LT F /� I`}i'Y7 i�.i/ � S �� MEFEBT � •ND STATE PLY WITH . BWLDING ( AUTHORIZED AGENT NO.OF PLANS ICENTEH LINE ST.) � FRONT 7/0 L.SIDE USE O N BUILDING — v ._ � � c� Q a v —�-1� � 9 � � HAVE READ THIS APPLICATION I COliRECT NU AGPEE TO COM� THE �MOUNT SHOWN UND VALUATION IS FOR THE 31�NO STAT LAW6 FEGULATING PURPO6E OF ESTABLISH • PERM�T FEE ONLT. � /�. C VALUATION ��J{ /�/� �% I PERMIT FEE $ OG�<� $ � HDo '� PLAN CHECK S �� / 3D — TOTAL FEE S � �� r� R�CEi� E� L_Z-��v� CdSTA MESA BUILDING-SAFETY DEPARTMENT E DEPT• P.O. BOX 31] COSTA MESA, CALIFORNIA �I�A�Cj r,�TV OF COSTA MESA fOR APPL/CANT TO F/[C /N COMPLETELY APPLICATION FOR PERMIT TYPE OR PRINT /-� C .� BUILDING BUILDINGC' `% e ��j � � / ' / A�ORESS � �Ap COSTA MESA. CALIFORNIA ryn OFFICE USE O/ILJ � � U� / �� I RECEIPT NO. I CJ MIT OWNER �- �L /[G� MAIL ( [/� /�/�^ �/ RECEIVED BY OATE HECEIVED OATE 9: 4OORFS4 /V^�I�� /T � //�/ I � �., ��OI �- % C��'J I � �� ADDR�56 �"�-�L (/"' (.1 / �e / / NS ��' LEGAL ILO/IO � I�`'� � OESCRIPTION NO LOCK �y A A.P. NO. /�/�. � � J O � �� / / SIZE �� Y��1/�� I NO. OF BLOGS. T OF LO �� '�V NOW ON LOT L� USE OF ��'J a E%ISTING BLDG. SEfBRCK LINE FROM /J CENTEIi OF STREET �/ REAR YAR � � f�! N SIDE YARD I LEFf � RIGHT /� � DESCRIPTION OF WORK c�� REPAIR I IIMOVING BUILDING�/I� TJ� NO.O SIZE G� ROOM EXTERIOR W 41� � ROOF COVERIN(✓/ �«�� COVE Uy�F,SJi�L�N��ND WO�K � J 7 i� II HEPEOY Aj'.R AN� STATE TF PLY WITH ALL BUILDING COt�I � AUTHOftIZED AGENT � II OEMOLISH I � STORIES / �if � • 5 =RFORMED �� : � l/ FIRE COSTA MESA, CALIFORNIA ZONING� NO. OP - I fISE OF NEW PLANB '/ �I aui�owc /'� f./ � N • _ 1'1ATF G YARDS REpUIRED f<ENTER LINE ST.1 FRONT R.sioe �Jd r 0 -!�il/G� L�R�a%� r— � pL�v v TH�T 1 HAVE READ THIS APPLICATION J}�E IS COPRECT D PGREE TO COM� THE AMOUNT 9NOWN DEP VALUATION 19 FOH THE �!lGCS NO AT LAWS FEGIILATINC PURPOBE OF EBTABLIBHINO A PEPMIT FEE ONLY. � VALUATION 7 � PERMIT FEE $ Q(�,O ` $ �90�/ PLAN CHECK $ / O l � TOTAL FEE 8 �D ` �' 9�s�. COSTA MESA BUILDING-SAFETY DEPARTMENT P.O. BO% 31] COSTA MESA. CALIFORNIA FOR APPL/CANT TO• F/LL /N COMPLET TYPE OR PRINT BUILDIN �6 �f � `�ST ADDRES COSTA MESA, CALIFORNIA � OWNER ,� /C'o c^a� MAIL /r�«� �i .� , .� � _.,� i j /'/� � LEGRL - I L�T � OESCRIPTION NO��O i/L _ 7 � ��E RECEiU�� _a—s� V� FINANCE DEPT. riTv Of COSTA MESA APPLICATION FOR PERMIT BUILDING FOR OFf/CE USE ON[Y COSTA MESA. CALIFORNIA 'vna �f �rrnro K ZONING ZONE NO. OR - I�USE OF NEw PLANB v i BVILDING oe',�19� � - - ,,,r� /. SIZE ��Y s�Q r .I rvow on �oie O YARDS OF LO �� REpU1RED USE OF � � /T (CENTEF LINE ST.1 EXISTING BLDG. L� FRONT 6ETBRCN LINE FROM � -/// � T CENTER OF BTREfiT Z REAR YAR✓ • r R. SIDE �" ` }' �+ � �� SIDE YARD LEFT ` I RIGHT �J �� L. SIDE DESCRIPTION OF WORK � � — REAR IREPAIR 1 BUILDING�D� SIZE EXTERIOR WLtR COVERING v II HERE�V ACK OWl •NO 6TATE T AT TI PLY WITH P CITY 9VILO�NG NSTRUJ AGENT � .[e' � "r� 7' L. /� /�' d .0 i TNAT 1 HAVE NEAq TH18 APPLICATION ��VE 5 CORfiECT AN AGREE TO COM- 9TpTE L WS REGULATING d'cTT� ` .,2 d-tJ � � THE AMOUNT 9HOW PUflPOBE OF E8TA1 .unrioN // �O�J VALUATION IS FOR THE A PERMIT FEE ONLY, T FEE S (x�O � CHECK S �Q � L FEE S � D — ,