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Home My WebLink About986 17TH ST - Building Permits; ��.��. � , �86 SV. 17th Street � _ � �` ^ — ! , i ��a F26341 Contruction power pole , _ Gll-l�-8� � ��o�� " B26947 Trash thclosse $1II00 ' PC429-96LS"// 26946 — — —�-- -- ` �� 826946 Auta hlaintenance Bldg. — PC429-86L ��'�5109,523.40 — r/ 8526949 oaro $1,000. PCp429-86L ,-/ B26946 �� b1Y _ &?7167 � /r � B26946 _ �� d �0 F2821G ��39 /'�_ :i2E94o L �z9z�� 4�� ` Backflo igation ''tTs:. . �i " . i• i.r. ' i.5� . ;.-;-; .— Ciry of Costa Mesa Deyelopment Services Department Building Safety Division P. O. Box 1200 Costa Mesa, California "� CERTIFICATE OF OCCUPANCY No. OO�Ei�i,�.�r rf `�he Building located at 986 [V. 77th. Rtra�� has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group B-2/H-9 Occupancy. Use of Building IUltO Maintananra Ch�ilA�nn Legal Description 429-37]-71 (See reverse side for Metes and Boundsl sae9�s,asa6� Building Permit No �6Q46.B26947 Electrical Permit No.EiE34].�E2%ZFi7plumbing Permit No.p�A71li.c9^?ll Mechaniral Permit No. Number of apartments and/or guest rooms ISSUED T0: BuildingOfficial �i�.s . _ _ &�ltslis Corootation ' '471 Via Lido. Suite 213 by � . � �. � ' i , - - � ^ _�gwoa[t 6aach, f:u �7F.F� . , Date._,,.. �, r " �- � � � �.� This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Building Official of the City of Costa Mesa under Sec. 307 (el U.B.C. CMF 1015�46 rev. 1/83 White -Owner; Canary - Numerical File; Pink � Bldg. Permit File City of Costa Mesa Deve�opment Services Department 9uilding Safety Division P. O. Box 1200 Costa Mesa, California CERTIFICATE OF OCCUPANCY No.Q{J��ti��} ;he Building located at 986 West 1%th St[eet has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group R9/HC. Occupancy. Use of Bu;lding Auto t�laintenanCe Legal Description 424-371-11 (See reverse side tor Metes and Bounds) Building Permit No. R iF+9616 Electrical Permit No. E 27167 Plumbing Permit No. Mechanical Permit No. Number of apartments and/or guest rooms ISSUED TO: Building Official �rqe Fdmiston ' p>>>;�. r.,rmrarion • � /�� 471 Via Lido, Ste. 213 bY '``'' '�. � �� `— �'evnnrh Aoal�h. (`A �liFi� ` Date Eebruarv 4. 1987 This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL NOT BE removed except by the Builtling Official of the City of Costa Mesa u�der Sec. 307 (e) U.B.C. CnnF 1015�36 rev. 1/83 White - Owner; Canary - Numerical File; Pink - Bldg. Permit File Aoplicant to fill in all spaces except those within neavy eortler lines ane sign all approv��ate tleclarations. ciTv OF coSTA mESa CONST/RUCTION PERMIT : Proje�Address � �U / � � Rpplicant's Mailin9 Address ✓T��+' ��n SL/r�L��.�3 �/��✓��.,fi O�nraer's Name �/ �A�/s �2 �7 Phone �L Address ✓��7��-� L/�� 'Z�� N'J• � Arch/Eng. License No. Address . Contractor'sName ��-�/et�/3ot/iireh Phone L>i•Zt&Y- Address Imailing) City License No. , ' LICENSED CONTRACTOR DECIARATION I ne�eby affirm Inal I am licensetl untle� provisions of Charte� 9(comm¢nUn9 , with section 7000) ot Dlvislon 3 ot the Business antl Professions Cotle, antl my Ilcense Is in full /orce antl et�ect. � License Class License No. Dale Signature W00.KER5' COMPENSATION OECLARATION ' 'Ifiereby aitirm that I have a certiticate of consent to sel�-insure or a certlficate ( Workers' Compensation Insurance, or a certlfietl copY thereof (Se<tlon �800, Lab. C.) Policy No. Company BCertifietl copy i5 M1ereby fu�nishetl. CertiOee copy is tiletl witn tne city Builainq oivision. Date Applicant E%EMPTION FROM WORKERS' COMPENSATION DECLARATION (Tnissection neea not be completetl if the permit is for one huntlred (5300) or less). I certity lhat in lhe pe�formance Of the wo�k tor which this Oe�m�t i5 i55u¢tl, I snall not employ any Oerzon In any manner zo as to become subject to the Workers' Compensatlon Laws of Cali(ornia. • Date Si9nature NOTICE: It, after making tnis tletlaration, you shoultl become suEject to the Workers' COmpensation provi5ions ot Ihe Labor Cotle, you must forthwith complY �+'��h such prOviziOns o� thi5 p¢rmit shall be tleemetl revoke0. CONSTRUCTION LENDWG AGENCV ' � I hereby aHirm that there Is a construction I¢ntling agency (or the performance '� of [he work tor which this permit is issuetl (Section 3097 Civ. C.) ' l.entler'S Name Lentler's Atltlress , OWNER BUILDEN �ECLARATION 1 he�eby difirm that I am ezempt fmm the Contractor's License Law 10� the followin9 reason (Section 7031.5 Business and Professional Cotle: Any cily or county which requlres a�permit to construcq alter, improve, tlemolish or repalr any struclure, prlor to Its issuance, also requires the aoP��ant tor such permlt t0 tlla a Si9netl 5lateTent t�at he/5M1e IS licensetl pursuan[ [o the provlsions o( the Contractor's License Law (Chapfer 9(commencin9 witM1 Sectlon 7000) of ''�vision 3 01 the BusinG55 antl P�ofe5von5 Cotle) or that he/sh¢-Is exempt uefrom antl [he basis for the alleqetl exemption. Any violation of Section 31.5 by dny applicant fOr a Pe�mit SUbjects the apPlicant to a civil �+E,Odlty of nOt mo�e than five huntlietl tlolla�s ($500). Ll I, as owner of,the property or my emo�oyees with wages as their sole comoensatlon, will tlo the work, antl the slruciure is not intentletl or offeretl tor sale (Sectlon. 7044, Bu5ine55 antl Professional Cotle: Th¢ �ContraGlor'S License Law tloes not apply to an Owne� ot a propertY who builtls or improves tnereon, ana wno tloes sucn work himselt/fierself or throu9h his or her own em0loyee5, provitletl IM1at suCh improvements a�e not intentletl or offeretl fo� 581e. I(, however, the bulltling or improvement is soltl within one year of com- . pletlon, the owner wi11 nave the burtlen oi proving he/she tlitl not bulltl or im- prova torthe purposo otsale). � � I, as owner ot the oroperty, am excluslvely mntracting witM1 licensetl con- tractor5 f0 construct the project (Settion 7044, Business anC Profez5ion5 Cotla: The •Contrac[or's License Law does no[ apply [o an owner of property who builtls or Improves theraon, ana who contracts for such projects with a con- tracto�(5) licent¢ pursuant to [he Contracto�'z License l.aw). I am aware thaf prOoi Of Ihein Wo�ke�'s Compensation insurance shoultl be provltletl to me. ❑ I am exemvt unaer Section � B. &'P. C. tor tnis r¢azon Da[e //-��'� I hereby certify that 1 IO�OITdtiOn IS <OIfBCt. I antl slate laws relat' 9 t sentatives ot tnis ci y InspectlOn purpo5 . Signature . Driveri' License o 5 � Owner lication antl sfate that the above ith all city antl county ortlinances :tion, antl hereby authorize repre- e ab ve-mentionetl property !for Date f� /7'dG - �. PE�T N� O� >�/ I TRACT NO. I LU I rvu. I UNIT NO. �«+ ' TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTIONOFWORK/USEOFBLDG., � TYPEOFPERMIT GRADING FOUNDATION 'O $TRUCTURAL ; �^❑ /TENANT ❑ EL/EC+TR�ICA`L � O [PLVMBfINJG ❑ MECHANICAL � V�OTHER �CIJAJSJ/J/CT/d.(� /�d/uG� � .__ PROJECT DESCRIPTION Sct. FT. oCCUaarvcv GONSTRUCTIONTVPE VALUATION$ � � ZONE �GRA�INGCU.VDS. liCRES Remarks: 0 Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers �rinking Fountains Floor Drains � • Floor Sinks uas Service Outlets Interceptors Kitchen Sink - - Lavatories P—Trap Roof Drains Reinspection Fee $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. BIL ICBO # - Heating System & Ducting � . ❑ b 100,000 BTU � 100,000 6T Reinspection Fee � I �575 CMF 0865�46, rev. ]0/84 White - Bulltling; Canary - Applicant; Plnk � Accounting: Goltlenrotl - Aise55or Showers Service Sink ` $ewer Cap -- . Sewer Connection Solar Collecmrs Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet � Water Heater Water Service�- Auto-Wash Issue Fee Hood or Typel ❑ Canopy Typell ❑ Refrigeration System ❑0-100,OOOBTU ❑100,000 System Repair/Alteretion Fire Dampers Registers e laue Fee n $ 3 $ 3 A.P.SW _ S Main Building: E T Front B Rear A C Right ' ' �S Left � Ping. Ref. # Planning NOtes: 0 Automatic Washer . " Construction Pole Sub. Cooking Unit Dishwasher e Dryers LJGas LJElectric Fan F.A.U. Fixtures Device Boxes � Outlets ' Switches Garbage Disposal Generetor �0.5 KW �5-1 Fea DEVELOPMENT SERVICES Zoning Approved By Building Approved By — 7351 �II/i7/86 Zona Accessory Building: Parking Req./Provided � ELECTRICAI: ' � � Transformer ,❑ 15�50 KW ,� ' ❑50+KW Meter ❑up to 700 amps Meter ❑over 100amps Sub Panel ' Mators'LJO-1, HP � 1'h - 8 Inc. Solar �9-15 HP �16�15+ Microwave Pole Light Bo00 TL FEES Standing Sections ' 5 KW Trash Compactor � $15 . Issua Fee ' - $ 3 IEQUIREMENTS: � Date �� Date� . i � � . SUMMARV OF FEES � BUILDING PERMIT $ ' �SMIP � - PLAN CHECK $ . PERMIT_ � PLUMBING .$ ' ISSUANCE " PLAN CHECK 25% $ ENERGV P.C. ELECTRICAL � $ � GRADING PLANCHECK 50%,�$' MICROFILM MECHANICAL $ TOTALFEE PLAN CHECK 25% �$ � ' f� $ 9 Z O N I N G R E Q M T S CONSTRUCTION AND PLANNING - POOL & SPA . -, APPROVALS Permit # Date Inspector pppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location - 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement � 3. Electrical Conduit Utility-Undrgrrid.� � 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd: 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, O UndrgrncJ., 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 & VenrFinal ' � • � . . � " 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 �Gas ❑-Oil ' 25. Roof Sheathing � 7A. Overhead �Hydro � 26: T-Bar Ceiting (Structural) &�Monacoat � 75. Dry Chemical � 27. Frome 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 Se�vice-Final 41. $olar pomestic-Final 42. Backflow Preventer 43. Backflow Irrigation � 44. Landscape Irrigation System 45. Sound Attenuation � 46. Handicap Regulations , 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electrie Release to Edison � 50. Gas Release to Southern California Gas Co , .� 51. CERTIFICATE OF OCCUPANCY • � No. Date - � � ' n AVO��ant to fill in all spaces exeept tnoze wilhi� h vy Eortler Iines an0 sign all ipproDriale tleclaratlons. � CI7'70F COS7A MpES CONSTR�U�CTIO� 'tate t�at the above tl COUOLy O((illldllCCS ¢by authO�ize �e0�e- lonetl Dropertyc'or oa�a a'�� TYPE OF CDNSTRUCTION NEW LJ ADD LI ALTERATION LI REPAIR ❑ CONVERSION ❑ DE OLISH ❑ OTHER p� p. �y DESCRIP710N OF WORK/USE OF BLDG. 5 Main Bu E TVPEOFPERMIT GRA��rvG FOUNDATION STRUCTURAL T Front '❑ TENANT ��ELECTRICAL ❑ PLUMBING ❑ MECHANICAL B Ree1 ❑ OTHER A C Right PROJECT DESCRIPTION 5c2. �7/�' oCCUCANCv CON STRUCTION TVPE • N VALUATION $ S Left 20NE GRADING CV. VDS. ACRES Ping. Ref. {} Remarkz:�=, � � _ Planning No' nk Prevenrer Irrigation Drinking Fountains Floor Orains Floor $inks Gas Servic¢ Outlets Ki[chen Sink P—Trnp Roof D Reinspection Fea � $15 Boiler Duct - Under Ground Duct - S[ructural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑ ai oo,000 aru � i oo,000 sr� Reinspection Fee � $15 CMF 0865-46, rev. 10/84 White - BUIltling; Canary � ApPlicant; Pink - Accounling: Goltlenrotl - Assessor Showers Service Sink Sewer Cap Sewer Connection $olar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Waeer Closet Water Heater Water Service Auto-Wash laue Fee Hood or Type I ❑ Canopy Typell ❑ Refriqera[ion System ❑aioo,000eTu ❑ioo.000sT System FiepaiAAlteration Fire Dampers laue Fee S 3 FEES S 3 Automatic Washer Construction PoleSub. Cookin9 Unit Dishwasher ' letVic Fan F,A,U. Fiztures Device Boxes Outlets Switches Garbage Oisposal Generaror �0-5 KW Fee �11If86 2/O2/87 Zona Accessory Building: Parking Req,/Provided ELECTRICAL Transformer ❑ 75-50 KW ❑ 50+KW Meter up to 700 amps Meter ❑over100amps Sub Panel Motors 00.1. HP O 1 Y, - 8 , Inc.Solar 09-15 HP �16�15+ Pole Light Renge ' ign Standing Sections 5-75 KW Trash Compactor 515 I I Iszue Fee � 59.10 TL FEES 5 3 Z O N I N G R E Q M T S DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Date Buildin8 APProved By Dat� Applifation Issued By Dat Z SUMMARV OF FEES BUILDING PERMIT $ SMIP § PLAN CHECK $ PERMIT PLUMBING g �SSUANCE $ PLAN CHECK 25% $ ENEfiGV P.C. $ E�ECTRICAL $ � GRADING $. PLANCHECK 50% $ � MICROFILM § MECHANICA� 5 TOTAL FEE $ S4 i� GLAN CHECK ZS% $ � _��' CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit# Date Inspector �AppROVALS Permit# Date Inspector � 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location , 2. Soil Pipe-Undrgrnd. ��53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. ',a�,�-� / 55. Electrical Bonding ' 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test. 6. Electrical UFER Grnd. _ 1 57. APPfiOVAL TO COVER-GUNITE 7. Footings , 58. Electrical Conduit-Undrgrnd. 8. Foundation ^I ' 59' Gas Pipe, O Undrgmd., Test � 9. Water Pipe-Undrgrnd. � �-- 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 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 ._ � J C, 66. Solar System-Final 16. Rough Electric Wiring 7 J ! 67. Fencing & Access Approval 17. Rough Wirinq Sign � 68. APPROVED FOR PLASTERING 78. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS F INAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIFEMENT ' 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 O Gas ❑ Oil �. . 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Cciling (Structural) & Monocoat � 75. ,Dry Chemical � 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding 77. FIXED SYSTEM FINAL : ' I 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing � < HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat • 79. FINAL INSPECTION .' . 32. Electrical Pqwer Meter-Final J C 80. fOOD CERTIFICATE ISSUED 33. Final Electric 8- ic-87 J,C Notes:. b-y9�7_ p�y(1,Q , JG 34. Final Heating & Air Conditioning � ��_87_ � �� ' � e 35. Final Gas Pipe-Test . 36. Hood or Canopy 37. Final Factory Fireplace ' 38. Final Plum6ing � ' � ' � � 39. Water ServiCe�Final 40. Gas Service-Final . - � " 41. Solar pomestic-Final ' � . 42. Backflow Preventer . - • 43. Backflow Irrigation , , 44. Landscape Irrigation System � . , ' 45. Sound A[tenuation • ! " � 46. Handicap Regulations � 47. FINALSTRUCTURE&BUILDING • _ � 48.� Special Requirements Completed � • - . , 1 49. Electric Relpase to Edison ' � 50. Gas Release to Southern California Gas Co � ' � �� 51. CERTIFICqTE OF OCCUPANCY . � � No. Date �l a City of Cosia Mesa Development Services Department C E R T I F I C A T E O F O C C U P A N C Y No. 0 0� 8� 3 � 8uilding Safety Division P. O. Bax 1200 . Costa Mesa, California The Building located at 986 W. 17th. Street has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto fora Group B-2/H-4 Occupancy. Use of Building AlltO MdlIItenance AvilAing Legal Description 424-371-11 . (See reverse side for Metes and Boundsl B26948,H526944 Building Permit No_B26946,B26947 Electrical Permit No.E26341�E27167 P.lumbing Permit No.P7R976,P79917 Mechanical Permit No. Numher of apartments and/or guest rooms ISSUED T0: BuildingOfficial Bill Howard Bdldlis COCnoT'ati�n � (� � 3471 Via Lido. Suite 213 bY� � , - Newoort Beach. �A 9�FF� � � Date — This Certificate of Ocwpancy SHAIL BE posted in a canspicuous place on the premises and SHA L NOT BE removed exeept by the Building Official of the Citv of Costa Mesa under Sec. 307 (e) U.B.C. . CMF 1o15-a6 rev. 1(e3 White - Owner. CanarY - Numerical File: Pink � Bldg. Permit File j . Applicant to flil in all soaces excev< <�ose within heavy Eortler lines anC sign all approoriate aeclarations. 'J.:ITY OF G7STA-MESA CON�Si,T.�R�UCTION.PERM1`IT �$MIT NO.� ��. TRACT NO. LOT NO. '^ UNIT NO. `� Pr�-I�ci Ac�rss R� V✓' %��{��P'GJ.Tt1��- , �� q.�lnnt'sMxilin�un.�.esc 1� �la-LIrXJ G/rP'i•2�jJ 7r � f�.`i$#� FibLb.L��i �7 Owner i Name � Phone �� Add/�ss � .P' L� 2'� %�Y� Ar�eh/Eng �t' �t�""License No. �lddress � S��f"� _ � ��' Contractor's Name � Phone Addresslmailing) � - � � City License No. � �• �� _ LICENSED CONTRACTOR DECLARATION ' ' � I hereby aifirm that 1 am licensetl untler provislons of Charter 9'(commencing with section ]000) ot Di�ision 3 of lhe Business antl:Protessions Cotle, antl my license is in full force �ntl eftec[. , LJcense Class'� ' _ : License No.- Dale Si9�ature ' ' WORKERS' COMPENSATION DECLARATION � 1 bereby aHirm that5l hav8�a certiti<ate oi <onsent to Self-insure or a car[I(Icate �of Workers' Compeniatitl� ��surante, or a certitietl coOY thereof (Section� 3800, Lab. CJ �' . Policy No. Compdny _ 8 Certified mpy is herebY �umishoil. • ' • � Certifietl copy is tiletl with.the clty Builtling Division.. Date ApplicanC � � ' � - EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection neetl not be Lompletotl'Ifthe permit is �or one huntlretl ($100� or 'less). ' . . • . . I certity that in the pe�fo�mance Of Ih6 wOrk lor which this Pe/m�t Is Issuetl I shall not employ any peYson in any mapner so as t become sub" ct to t{te workers' ompens3f+yp Laws of�Calif 'm - Da[e �`2 Z ��1' / _Si9nature � � NOtICE: If, atte� making this tletlara � , you shoultl become subjecb [o Ihe Workers' COmp¢nsation. provlsions o h< Labor Cotle, you must for[hwith comply with sucn orov�sions or this permk shail be tleemetl revoketl. • CONSTRUCTION LENDING AGENCV 1 ne�eby altirm thatther¢ �5 a Cons(ruction lentling agency fo� the pe�fo�mance - o( the work for - h c I ,e¢sm it�6 j5 5u¢$ ( ction 309] Civ. CJ L.entler'S Name -tG�L�E�` /T "In G:�� Lentler's Atltlress � OWNERBUILDER.DECLARATION - ' I hereby afFlrm thahl arr� exempt from the Contractor's L�cense Law for the followin9 reason (Section 7031.5 Busine5z antl Professional Cotle: Any <ity or County which require5 d permit [o cOnstrucl, alter, improve, tl¢mOlisn or repair any structure, prior;to Its issuance, also requires the applicant for zucn permit lo fiie a si9netl statement that he/she Is Iicensetl oursuant to the provisions of the Contractor's Cicense Law (Chapter 9(commencin9 wi[M1 Section 7000) of 'tivi5ion 3 ot'th¢ Busin655 antl Profes5ion5 COtl¢) or that he/She Is exempt erehom antl the .basis for the alleqetl ezemption. Any violation of Section -;� )31.5 by any applicant, �or a permif subjects the appliwnt to a civil 'e0dlty of not mo�e thdn ��e huntl/etl t1011ars (§500). ❑ I, as owner ot�the property or my employees with wages as tnelr sole cortlOe�Sation, will tlo the work, antl lhe Structur¢ is not intentletl or oftG�¢tl tor sale (Seclion 7044, Bu•iness an0 Gro(essional Cotle: The Contractor's ' �itense Law tloes nol app�Y {o an owner of a property wno builtls or Improves thereon, antl who tloes 5uch work hlmself/nerself or tnrou9h his or her own employees, provitletl that such improvament5 are not intentletl or OHe�etl fo� sale. If, nowever, the bui�tling or improvement is soltl wit�in one year o( com- pletion, lhe owner will hdve Ihe bu�tlen of proving he/she ditl not build o� Im- �� B for [he purpose o( 4ale). I, as owner Of the prOPer[y, am extluzively cont�acting with IlcenSetl COn- tractors to construct the pro�ect (Settion 7044, Business and Pro(es5ions Cotle: The ConVaccorY Licens8 12v+ does not apply to an owner of property who builtls or imDroves thereo�, ana who contracts tor such projects wlth a con- traclor(s ucense pursuant to the Contraclor'S License �aw). I am aware that proof o� their Worker's CompensaHon insurance shoultl be provitletl to me. I] 1 am ex¢mpt untler SeGt�on B. & P. C. for [hIs r¢ason TVPE O�CONSTRUCTION NEW ADD _ALTERATION REPAIR � ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ' AP �y L DESCR PTIO OF ORK/U EOF B DG. �� .wy ��'p �.�� ' : S Main Building TVPEOFPERMIT GRADING FOVNDATION STRUC URAL T F�O�t �S� Q TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANIC L B Reef 8 � ❑�OTHER I CL-L:.� P G � A PROJECT DESCRIPTION 5. FT, oCCUPn .Yp� �C � Right �, � �t 'CONSTRUCTIONTVPE VALUATION$L /•S S �eft �' s � ZONE� GRADINGCU.YDS. � ACRES _ p��y,Ref.# ..� , Remarks: � 4�9'�� L �(' �E� /�g�_¢� p � Planning Notes: � !-�lJl/J Bar Sink Backtlow Preventer Backflow Irrigation . Bathtubs Clarifiers � Oishwasher Drinking Fountains Floor'Drains Floor Sinks � Gas Service Outlets Interceptors Kitchen Sink lavatories P-Trap Roof Dr ' s ReinSpac[ion Fee $15 Boiler Duct - Under Ground Ouct - Struc[ural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact Blt. ICBO # oate �-i<'n i owner �..' � Heatin9 System & Ducting I hereby certify ehat I nave rea Is appliwtion ana state that the above ❑0.100,000 BTU ��.8 ,0006TI Informatlon is correct. I 59ree to comply wi[h all city antl county ortllnances antl state laws relating to buil g�pnstruction, ana hereby authorize repre- sentatives ot t i city to e u on the above-mentio�ea property f r inspec[ion pur os Si9nature �r' Date�2� D e s LI 55 � �� RainspeCtion Fee 1F 0865-46, rev. 10/84 White - Builtling; Canary - Appliwnt; Pink - Accounting; Goltlenrotl - Azsessor $15 Showers Service Sink � Sewer Cap Sewer.Connection Solar Collectors Solar Pipin9 Solar Tan '. Swi ing Pool w/Spa inal Water Closet Water Hearer Water Service Auto-Wash ' ' Laundry Treys Issue Fee iANICAL Hood or Typel ❑ Canopy Typell ❑ Refrigeration System ❑0.100,000 8 100,000 Syst epair/Alteration Fire Dampers Registers laue Fee 0741 I/23/B7 • ��1Fo;:i ,� —5 / _ i Accessc '� � . .Qrn—1 Q ' Parking Automatic Wesher Construction Pole Si Cooking Unit Dishwasher . . Dryers ❑Gas ❑E Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generator ❑ KN $ 3 FEES Reinspection Fee .DEVEI.OPMENTSER 2oning APProved BY _ Building Approvad By APcliration laued By_ $ 3 lectric ' . '__._ u Building: CA{��JRT� � R Z Q i N ! I Q N 33/. c R q./Provided /S � � E � M T _ ___ S ELECTRICAL , Transformer ❑ 75-50 KW OSO+KW . Meter ❑up to 100 amps Meter ❑over.100 am .SubPanel � '- Motors ❑ HP �1'/x-8 _ Inc. ar �9-15 HP �i6-15+ � Pole Light Range ; Sign Standing Sectians 5-15 KW Trash Compactor $15 � � luue Fee FEES $ 3 '�i] SUMMAqV OF FEES � � ? 67 BUILDING PERMIT $ SMIP $ `PLANCHECK � . $ � `�0 PERMIT PLUMBING $ ISSUANCE �- $ PLAN CHECK 25% $ ENERGV P.C. $ ELECTRICAL ' $ ' GRADING � $ PLANCHECK 50% $ MICROFILM- .$ � MECHANICAL $ TOTAL FEE $ � 7�• z PLAN CHECK � 25% $ _ � '7D � � �� CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location � 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement , 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding � , 5. Sieel Reinforcement 56. Rough Plumbing & P.ressure Test � 6. Electrical UFER Grnd. �� 57. APPROVAL TO COVER-GUNITE 7. Footings �` � 58. Electrical Conduit-Undrgrnd. , � 8. Foundation . � 59. Gas Pipe, O Undrgmd., Test �. 9. Water Pipe-Undrgrnd. � 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System. ' 61. APPROVAL TO DECK ' � � 11 . Property Sewer Line & House Connection 62. Backwash & Receptor-Final � � 12. Sewer Cap 63. Heater & Vent-Final 13. Foof 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. POOUSPA SYSTEMS FINAL: ;�� -c 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT ' . .��; i 20. Rough Factory Fireplace APPROVALS Permit# ' .- 21. Ducts, in Structure 70. Underground Hydro � " �- 22. Ducts, Ventilating 71. Product Piping �Gas ❑Oil y�r 23. Gas Pipe-Rough & Test 72. Underground Flush �� 24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil ?�' 25. Roof Sheathing 74. Overhead Hydro , ? ' i 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � -;i �?; 27. Freme and Flashing 76. Dry Standpipe � •�� 28. Lathing & Siding 77. FIXED SYSTEM FINAL r,t , ,. � � 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT .;_ 31. Plaster Brown Coat 79. FINAL INSPECTION ! 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED ' 33. FinalElectric Notes: 8� •�� 34. Final Heating & Air Conditioning �.t g.t - 35. Final Gas Pipe-Test �iC�� 'L� � � 36. Hood or Canopy 1f � �K Z'p ��- yN b(�fT-i �,Ii�i, 01� 37. Final Factory Fireplace � 1 p � �%��' ' 39. Final Plumbing 13 8-� o�< Q„ 6�� S.'� .� �. � 39. WaterService-Final �7 $�O��jd ,�jLp�/�� ' � j�t/pZ�T�� 4b. Gas Service-Final u� i� .� (i�µ,� �( . �r ��•� 41. SolarpomesticFinal � g �� lQ,�,,,, � `� �.rr,� � m. , 42. Backflow Preventer 8� �� - �1• �:rt�ii.. ^` � �cr r� 43. Backflow Irrigation 8� � DC�F� � �- •V��Q, .c�iw 44. Landscape Irripation System �� ' _ ��_ 45. Sound Attenua[ion S� � �� 46. Handicap Regulations �� s �•- 47. FINAL STRUCTURE & BUILDING � ( ; •; ; � �. . ,; ; /9 ��M /� �� , y�� . 48. Special Requirements Completed � �-;4 : 49. Electric Release to Edison � ` � � '�';�.. �+� a 50. Gas Release to Southern California Gas Co '�� i 51.-6ERTIFICATE OF OCCUPANCY : � , % No. � Date ' . . " Applicant to (ill in ali soaces except inose witnin neavy �oreer tlnes ana sign a11 aovra0riate eeclarations. :ITV OF COSTA ME(�SA�f/ CONSTRUCTION PERMIT Project`Address /a ` � � � 7 m S/ Applicnnt's Mailing Address , a�� Ox /U�o' E/nsY-V L, � � 7w�er's Nami ' Phone 4ddress 4rch/Eng. License No. 4ddress /;��q� �ontractor'sNam�C' ��0 • PhoneZ(��L_� 4ddresslmailing) �7r%�O �wr�.:y �OY /06 L.I�'�. City License No. �� / LICENSED CONTRACTOR DECIARATION I hereby atfi�m that I am licensetl untler provisloni OI ChartG/ 9(comm¢ntlng nith se<tion 7000) of DiviSion 3 ot the Business antl Prote55ions Cotle, antl my ncensa �s in twi torce and ettect � 3Gi��. License �Clas� Lic No. Date 7/� fr� St t WORKERS' COMPENSATION DEC�RATION 1 hereDy aiflrm that 1 have a<ertiti<ate of mnsent to Self-insure or a cerNflcate �f Worke�s' Comp(�ensation , Or a ce�tl�,l/etl[ co/OY7 t�ereof (Se<t�lo^n / 3800, Lab. C�i6�OC�b �6 % S/S�£ [_O� /US,/ZTW PolicY NO. [L�.�O ComPdny Certitietl copy is hereby fumishetl. ,/' Certiti¢tl cop i�filetl with the dty Bul in4g Diyjy6�]%/. Date � APPlican� �� EXEMP ION FROM WORKERS' CO PENSATION DECLARATION (This section neetl not be complatetl if the permit is tor one huntlreA (5300) or less). I certify tbal in th¢ perfo�mance of the wOrk fOr which t�is pe�m�t is i55uetl, I :hall no[ employ any person in any manner so as to become subject to t�e Workers' Compensatlon Laws of California. Date Si9natur¢ NOTICE: If, a/ter making this �eclaratlon, you shoultl �ecome su�ject to lha Workcrs' Compen5ation provisions of the Labor Cotle, you must for[hwith romply wilh such O�ovisions or IhiS permit shall be tleemeC revoketl. CONSTRUCTION LENDING AGENCY � 1 hereby aHlrm tnat [here is a conztruclion lentling agency tor the pertormance ot the work br which this permil is Issuetl (SeCUOn 3097 Civ. C.) LtnGor's Name Lontler's Atlare55 OWNER BUILUER DECLARATION I hareby aifirm that I am exempt from'the ConVactor's License Law for tho /ollowing reason (Sectlon ]031.5 Business anA ProfesSional Cotle: Any ctry or county whlch roqulres a pe�mit lo ConStrUct, alter iTprove, tlemolish o� �epdir any strucluro, prbr to ils issuance, also requires l�e applicant for such permit t0 flle a SI9nOtl SldtBmenl thdt he/She Is IICCnSOtl puRudnt t0 the plovlSiOns o1 [he Contractor's License l.aw (Cnapter 9(commencing with Section 7000) of Dlvision 3 ot Ihe Buslna55 antl Pioi¢SsiOns Cotlo) Or that he/ih¢ ii exempl theratrom antl the basis tor [�e alle9atl oxemption. Any vlolation o1 Section 7031.5 by any appli<ant tor a permit SUDjncts Ine apP��cant to a civll penalty of not more than iive huntlretl tlollars (5500). LJ I, as owner of the oroperty or my employaes with wages as their solo comp0nsation, will Ao [he work, antl Ine SlruCturo IS not IntenCetl or 0lferetl lor sab (Setlion 70aa, Businezs antl Profasslonal Cotle: Tha ContractorY Llttnse L. w tlocs not appty to an owner ot a property wl�o oulltls or ImOroves tberoon, antl who tloes such work hlmseii/hersetl or throu9n his or har own employces, provitletl that such improvements are not intentletl or offeretl (or salo. Ii, howoveq the builtlin9 or improvament is soltl within one year ot com• {fletlon, tne ownor will have the bu�tlen Of prOving be/She tlitl not builtl o� Im- p�ova lor tho purpose af Salc). ❑ I, as ownet Of Ihe property, am exclusivety contracting wlttt Iicen58tl cOn- tractor5 to conzt�uct the project (Section 7044, Bu5lness antl Pro/essions Cotlo: The Conlractor's Llcense Law does nOt apply to dn ownCr ot Oroperty who bui105 or Improv¢s thereon, antl who contrd<Is lor Such Orojects wlth a con- tractor(sl licanse pursuant to the ContraC[o�'S Llcen58 Law). I am aware that prooi o( tb01� Wo�ker'S Compensation Inturanca s�oultl be provitletl to ma. ❑ I am exempt untler SecHon B. d P. C. far tbis reason Date Owner I hereby certify that I have reatl tnis appiication antl state that the abovu intormdtiOn IS corrett. I agree to comply witn all city antl County ortlinantes antl-itale laws relati�n2gy �to� b}upiltling cons[ruction, antl hereby authorize repr¢- sentativ¢5 of this C""' t¢r u00n the abovG-mentiOneO ProPertY t r inspe<tion purpo � �f/�' Signature Daia Drivers' Lic o 55 7F .�- 7. p29Z.l1 TYPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER A p �y DESCfiIPTIONOFWORK/USEOFBLDG. Trrl�cl I'�h S Main Buildi E TVPEOFPERMIT GRADING�q/ FOUNDATION STRUCTURAL T Front • ❑ TENANT ❑ ELECTRICAL .YJ` PLVMBING ❑ MECHANICAL A Reaf ❑ OTHER C Right PROJECT DESCRIP710N Sp. FT. OCCUPANCV K CONSTRVCTIONTYPE VALUATIONS g Left ZONE GRAOING CU. VDS. ACRES p�ng. Ref. �k qemarks: Planning Notes: Ber Sink Backflow Preventer Backflow Irrigation Bathwhs '� � Clarifiers ' Dishwasher • - . Drinking Fountains Floor Drains - • Floor Sinks Gas Service Outlets Interceptors ' Kitchen Sink Lavamries P—Trap Roof Drains Reinspection Fee $15 BOiler Duct � Under Ground Duct - Structural Duct � Ventilating Exhaust System ❑ Multiple Firepl/FacL BIL ICBO # Heating System & Ducting ❑0.100,000 BTU ❑ ,000 ^ CMF 0865-46, rev. 30/84 White - BuilUing: Canary - Applicant; Pink - Accounting; Goltlenrotl - As5e55or $15 $IIOWCfi Service Sink Sewer Cap Sewer Connection Solar Collecrors Solar Piping $olar Tank Swimming Pool wlSpa Nat�r Closet Water Hearer Water Service Auto�Wash Leundry Trays Isue Fee iANICAL Hoodor Typel ❑ Canopy Typell ❑ Refrigeration System ❑0�100,000 B 100,000 Syste epair/Alteration ire Dampers Re9isters Issue Fee FEES Auromatic Washer Construction Pole Sub. Cooking Unit � Dishwasher Dryers OGas ❑Electric Fan F.A.U. Fixcures Device Bozes Outlets Switches . Garboge Dispoul i=i� �ii�i Accessory Building: .IPravided ELECTRICAL - �-� Transformer ❑ 15-5 ❑ 50 + Generator ❑ KW 05-15 KW Meter Llup to 100 Meter ❑over 10 Sub Pane� 0.1 HP �1:4-8 ❑9-75 HP �16 Pole Light Range Sign Standing Set[ions Trash Compactor S 3 I � Reinspection Fea 515 Issue Fea FEES �DEVEIOPMENT SERVICES REUUIREMENTS: Zoninp Approvad By Building Approved By 'Appliration Issued By S 3 tl S 3 ' SUMMARV OF FEES . BUILDING PERMIT $ SMIP $ PLAN CHECK $ PEFMIT � PLUMBING $ S, 00 ��UANCE 3 PLAN CHECK 25% $ ENERGV P.C. $ �ELECTRICAL $ GRADING S PLAN CHECK 50% $ MICROFILM S- MECHANICAL -$ TOTAL FEE S S• O O PLAN CHECK 25% $ ' CONSTRUCTION AND PLANNING . FOOL & SPA � APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector 1. �Temporary Electrical Service or Pole 52. Pool & Equipment Location � 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Elec[rical Conduit Utility-Undrgrnd. 54. Forms . 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding � 5. Steel Reinforcement � � 56. Rough Plumbing & Pressure Test � 6. Electrical UFER Grnd. �, 57. APPROVAL TO COVER-GUNITE 7. Footings ` - 58. Electrical Conduit-Undrgrnd. 8. Foundation ' 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection _ 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 73. Roof Drains 64. Plumbing SYstem - Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring 6). Fencing & Access Approval � 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING � � 18. Rough Electrical-T Bar Ceiling � 69. POOL/SPA SYSTEMS FINAL � 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # _ 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72. Underground Flush 24. Roof Framing 73. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathing - 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe � � 28. Wthing & Siding , 77. FIXED SYSTEM FINAL �� 29. Insulation 78. FIRE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT ' 31. Plaster Brown Coat 79. FINAL INSPECTION � . 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED . 33. Final Electric . Notes: 34. Finai Heating & Air Conditioning �� - 35. Final Gas Pipe-Test � � ' i 36. Hood or Canopy , � , -r 37. Final Factory Fireplace ' ., � 38. Final Plumbing �/� ��!%/ . . � 39. Water Service-Final � ' � � -�' 40. Gas Service-Final ' ,. 41. Solar pomesticFinal � � • � ,, - � 42. Backflow Preven[er � � � , 43. Backflow Irrigation � 44. Landscape Irrigation System , . ' � � . 45. Sound Attenuation � � � ' 46.-Handicap Regulations ' . i ". 47. FINALSTRUCTURE&BUILDING • 48. �Special Requirements Completed , 49. Electric Release to Edison ' • - 50. Gas Release to Southern California Gas Co ' �� ' f 51. CERTIFICATE OF OCCUPANCY . _ � , No. Date � - � AVPlicant to /ill in all saaces excePt ihose witnin neavY bortler lines anE sl9n all aPGroVrlate aeclantions. PERMIT NO. TRACT NO. LOT NO. UNIT NO Ci7v oF COSTA ME n CONST/�j UCTION PERMIT Project Address � W / �7' ��' C � �1 , Applicant's Mailing Address Owner'sName• �p1p�� S C16`�p Phone %3-2253'Z Address 2u-�n (%�i� 1 �•C1 �� Arch/Eng. Licenu No. Address 1 �;�� Convactor'sName ` - �_�S �Phones.+=L�� Address (mailing) 2�.�Q, KR \CT\ �u �-. W C•✓✓) � Ciry License No. _ �Q9 y � LICENSED CONTRACTOR DECLARATION I hCreby at�i�m that I am licensetl untlet provisions of Charter 9(commentln9 wlth SeClion 7000) of DIvlSion 3 of the Business antl Professlons Cotle, antl mr u�e�se �: �� i ro��e a�a erre�c. 272- �c 9� Date se �Ipss �� 9 t �� Li�qs o. C.��2 si clr WORKERS' GOMPENSATION DEC RATION I neretiy aifirm that I have a certificate of consent to selNnsure or a certifiwte of Workerf' Compensation Insurance, or a certifietl copY tnereo( (Sectlon 3800, �ab.�C.) PoIiCy No. COmpany 8 Cer[i/i¢tl mpy is hereby tumi5hetl. , Cerliti¢tl copy Is filetl with tne city Builtling Division. Date Applicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissection neetl not be comple[etl if tne Dermlt is for ane huntlretl (E300) or less). I cerNry thal in the performance of the work for which this perm�t is IssueQ I shall not employ any person in any mann so as to become subject lo Ihe Worker �q e ptlp n Laws ot Cali(orni � /1/-� Date ��Z�p 1_Signature d�4• NOTICE: It, atter making Ihis tleclarati n, you shoWtl become subject to tho Worker5' CompensatiOn provi5ion5 of [he Labo� Cotle, you mus[ tOrthwith compry with such provlslons or this permit shall be CeemeG revoketl. CONSTRUGTION LENDING AGENCV ' 1 ha�eby a/flrm [hat there is a const�uctlon lentling agency to� the pe�fb�mance of [h¢ work Por which thi5 permit is issuetl (Section 3097' Civ. C.) Lentler's Name Lentler's AaEre55 OWNER BUILDEN OECLARATION I hereby alfirm that I am exem0� from the Gontractor'S Licenze L'aw for lhe followin9 reason (Section 7031.5 Business antl Profe55ional Cotle: Any ci[y or county which requires a permit to construct, alter, improve, tlemolish or repalr any strutture, prlor to its issuance, also requires the applicant for such permlt to lile d Si9netl Stalement that h¢/she is IicenSCtl pursuant t0 Ihe provi5ion5 ot t0e Contracror'S Llcense Law (Cnapter 9(commencinq with Section9000) of 'DlviSion 3 of [he Business antl Protessions Cotle) or that he/she�is exempt therefrom antl the basiz�for the allegetl exemption. Any violation of Sectlon ]031.5 by any appli<ant fo� a permit subjects tbe apDliCant to a clvll �enal[y of not more than five huntlretl tlollars (5500). I, a5 owner of the property oi my emplOye¢s wi[h wage5 as thair sole compensation, will tlo the work, ana the structure Is not intentletl or of(eretl tor zale (Section �044, Businezs antl Professional Cotle: The Contractor's l.icenze I�w tloes not appty to an owner of a properry who builEs or Improvas thereon, antl who tloes such work himself/herself or through his or her own employees, provitl¢tl that such imOrovements are noI in[entletl or oHeretl to/ sale. It, however, tne builtling or improvement is soltl within one year of com- o�elion, tne owner will have thG bu�tlen of proving �e/she tlitl not builtl or IT- p�Ova (orthe purpose otsale). � I, a5 owne� of the ptoperty, am exclusivety tontrattinq wlth IiCCnsetl mn- tiactors to construct tne project (Section ]044, Business antl Professlons Cotle: The Contractor'z License Ldw does not apply to an owner Ot Property who builtls or improves [hereon, antl who Contratts for sucb p�ojects with a con- trac[or(5) license pursuant to the ConVacto�'s License Law). I am aware [ha[ ptoot o( their WO/ke�'S Compensation insurante shoultl be p�ovitletl to me. ❑ I am axempl untler Section B. & P. Q(or fhi5 r¢a5on Da[e Owner 1 h¢�eby c¢r[ity that I have reatl thi5 application antl sta[e Ihat [he above informabon i5 CorrecL I agree to comply with all city antl COunty ortlinancos antl Sta[e'laws rela[ing to building con5t�uction, antl hereby authorize r¢pre- sentatives. ot this 'ry to enter upon the above-mentionetl property for inspection purpose .l 519nature � Oatn �/1�i/A �rivers' Ucense or 55 � pvs-z16 � ' TVPEOF�CONSTRUCTION NEW ADD ALTERATION REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. TVPE OF PERMIT LJ GRADING �yLJ FOUNDATION LJ STRUCTURAL ❑ TENANT ❑ ELECTRIGAL LiIIPLUM8ING ❑ MECHANICAL ❑ OTHER PROJECT DESCRIPTION Sq.F7. oCCUaANCv CONSTRVCTION TVPE VALUATION $_ ZONE GRA�INGCU.VDS. ACRES_ Remarks: RE F. ,Bz6 Bar Sink Backflow Preventer Backflow Irrigation Dishwasher Drinking Fountains Floor Drains ' Floor Sinks GasService QI1tiCL5 'Z Interceptors Kitchen Sink . Lavatories . P—Trap Roof Drains Reinspection Fae $15 Boiler Duct - Un round Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Duc " ❑aioo,000 sr ioo,000 Fee � $15 CMF 0065-46, rev. 30/B4 White - Builtling; Canary - Appllcant; Pink - Accountln9: Goltlenrotl - A55e55or y.�-�z 9-d PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collecrors Solar Piping Solar Tank Swimming Pool w/Spa Urinal � Water Closet • ' Water Heater . Water Service Auto-Wash , LaundryTrays Issue Fae Hood or Typel ❑ Canopy Typell ❑ Refrigeration Syste ❑0.700,000 ❑100,000 m Repair/Alteration Fire Dam Fiegisters Issue Fee A.P. � S Main Buildi E T Front B Rear A C Right K Left S Ping. Ref. # Planning Notes: utomatic Washer �xjruction PoleSub. Dishwasher � Dryers ❑Ga Fan F.A.U. Fixtures Device eoxes Outlets Switches Gar6age Disp� Generator ❑ 6742 4/24/87 Zone Accessory Building: Parking Req./Provided . ELECTRICAL � Transformer ❑ 15-50KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over100amps 5KW Sub Panel Motors OO-7 HP 1�- 8 Inc. Solar - 5 HP �16-15+ Micro e �ighi Range Sign Standing Sections Trash Compacror $ 3 � Reinspection Fee $15 Issue Fee FEES DEVELOPMEN7 SERVICES REQUIREMENTS: Zoning Approved By Building Approved By � -�� $ 3 45,50 Tl Z O N 1 N G R E Q M T s FEES $ 3 _Date _Date .. /� n_ l� . . na�n �l�l ` T� SUMMARV OF FEES BUILDING PERMIT $ SMIP � - $ PLAN CHECK $ PERMIT PLUMBING $ Z%• � O ISSUANCE $ , PLAN CHECK 25% $ ff' • S B ENERG� P.C. $ ELECTRICAL $ GRADING $ PLAN CHECK 50% $ MICROFILM 5 MECHANICAL 5 TOTAL FEE $�L S' SO PLAN CHECK 25% $ , . CONSTRUCTION AND PLANNING _, POOL & SPA -. APPROVALS Permit# Date Inspector AppROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location 2. Soi1 Pipe-Undrgrnd. 53. Steel Reinforcement ' 3. Electrical Conduit Utility-Undrgmd. 54. Forms - 4. Electrical Conduit-Undrgrnd. 55. Electrical.Bonding 5. Steel Reinforcement �6. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd.' 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. � ' $. Foundation � 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. • 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Stn�ctural Floor System 67. APPROVAL TO DECK � 11. Property Sewer Line & House Connection ,/f �'7 iLJ = 62. Backwash & Receptor-Final. � lJ 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing �/�f� � 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 Fireplac2 , APPROVALS Permit # _ 21. Du�ts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 77. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test . 72. Underground Flush - � 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing � 74. Overhead Hydro 26. T-@ar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing � �, 76. Dry Standpipe 28. LaYhing & 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: .-+_ �Q _ 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. BackflowPreventer � 43. Backflow Irrigation � ' 44. Landscape Irrigation System � � � 45. Sound Attenuation � 46. Handicap Regulations � � � � 47. FINALSTRUCTURE&BUILDING � � � � . . . 48. Special Requirements Completed ' . , . . , � 49. Electric Release to Edison . 50. Gas Release to Southern California Gas Co ' ' - 51. CERTIFICATE OF OCCUPANCY . No. Date / � . _ �, CER VIFICATE OF y`\,�TE OF i1M�.R _ �o i ^.�� i z � Q A W � � CONFORMANCE /HE UNDERSIGNED MAIVUfACTURER HEREBY CERiIFIES tliat the products identi(ied below and on attached sheets Nos, are marked with the Collective Mark of the AMERICAN INSTITUTE OF TIMBER CONSTRUCTION (AITC) ar�d we�e manufactured ir conformance wi[h appiicable provisions of Hmerican National Standard ANSI/AITC A190.1-1983, Str cturaJ Glued Laminated Timber, and that such manufacture has been at our plant in �wi.sshome� OR , which plant has a quality control system approved by the Inspection Bureau of the AMERICAN INSTITUTE OF TIMBER CONSTRUCTION and inspected periodically by such Bureau. . . . .. . r. The manufacture of these members complies with the manufacturing and fabricating provisions of Chapter 25 of the Uniform Building Code. / ��•`�5;,�, JOB NAME: JOB �OCATIONc CUSTOMER'S OROER NO. _ 2- s% xiz- 6677 ��l �3G1� OATE S- ir,<s� r;j:,.,.;.� .�t__ 4�0�0� MFGR'SOROEH xa�-sz' 24F-V4, idP Glue, Ind. App., Load Wrap. i � `"� � � American Lsminators Inc. SIGNATUflE '�' -� �^r '•�' �'� COMPANV � TITIE _ Vual�ty Wllti�l ADDRE55 POB 99f J4��$$l1lJl�f `"bqTE �"�t!"07 AITC HEREBY CERTIFI_FS that the said company at its said plant is licensed by the AMERICAN INSTITUTE OF TIMBER CONSTRUCTION to use the AITC Collective Mark in respect of productswhichcomply with applicable provisions of said Standard, that the adequacy of the quality control system in effect at said plant is periodically inspected and verified by the Inspection Bureau of the AMERICAN INSTITUTE OF TIMBER CONSTRUCTION, and that, in the judgment of AITC, said company is capable of complying with applicable manufacturing and testing provisions of said Standard in respect of products manufactured at said plant. Conformance with the Standard in respect o:` any specific or particular produci is the sola respunsiui�iry oi tlie manuiacturer; AITCs guarantee hereunder being that the said company is qualified to produce a product meeting the said Standard and that its plant is periodically inspecied and verified by the AITC Inspection Bureau. AITC FORM IBCA AITC Certi/ica(e No. � 3� 11 A AMERICAN iNSTITUTE OF TIMBER CONSTRUCTION � 1983 HMERICAN INSTITUTE OF TIMBER CONSTRUCTION � � � CITY d Projecc . � AOp��ant to fill In all spaces exeept those within heavy �orGer Ilnes antl slgn all a0P/oD/�ate Eeclarations. STRUCTIONPERMIT �?�I N��J� �F�CT�g�,r �o�rvo�, UNITNO. n..�ier's M�^''e� ' � .o„' __' ' .Addres•� �!� �,d /✓c�i S�G �� .0 J3 . iZl+G3 _ � ArcNEng. pU�a3�iJ �%/Ypi.e License No. C' // 32 qJdress '=T O � Y �-Y��..'a� Contractor's Nam Owu��C� /��!//�Q�Qf- __phone stcZ� 2 Address (ma'i'r,gl 3i�%�I/.i.0 K .��s ,U.,�. 9act.� Ciry License No. LICENSED CONTRACTOR DECLARATION ' ' � ` 1 hereby atfirm ehat I am Iicensetl untler provisions of Cnarter 9(commencing with section 7000) 01 Divlifon 3 0/ the Businezs antl Professions Cotle;.antl� fny license is in tull torce antl eitect. . '' License Class � ' License No. fJate $I9nature )RKERS'COMPENSATION DECLARATION � , +� ' erCby atiirm that I have a certificate of consent to selt-inzure or a certifltate ot Workers' CompenSatiOn Insu�ance, or a �certl(Ietl copy,ther¢of (Sectlon 3800, Lab. C.) ' � ' � ' ' Policy No. ' Company BCerlifietl copy is hereby furnishetl. ,, ' Certifietl copy is /IIeE with the <Ity Builtling Division. Date APPlicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (This section neetl not be mmpletetl If the Oermit is tor one huntlratl (5300) or , less). . I c¢rtify [hat In Ihe' peAo�mance of the wo�k for which this perm�t is ISsuatl, I shall not emplOy any pe(son'In any ne� So as t beco zubject to tne' Workers' Comp nsal" L. wz ol Callt n a. � , Date ��Z�"�Si9nature �'�1 NOi10E: It,aHer making.this aeclar n,..you zhoultl become subject�to lhe Workers' Comp¢n5dtion provislons the Labor Cotle, you mu5t (or[hwith tomply wi[h such p�oviSlonS or' (hi5 permlt Shall be tleemed �evoketl. CONSTRUCTION IENDING NGENCV I hereby atflrm that therels a construction Ientling 5gency tor tne performance of t�e work .for � hHhLs�oirmi4 iF�ssy�tl�5ection 309] Civ. C.) Lentler's Name ' �f�+0 te-!TJ C�f LCntl¢�'S Atltlr¢55 !�Q�� - OWNERBUILDER �ECLARATION ' 1 hereby af(Irm tnat.l am ezempt from the Contractor's Llcense L.aw for the following reason (Settlon 7031.5 Business antl Professi6nal Cotle: Any city or county whlch requiros a permit to construct, alter, improve, tlemolish or repalr any structure, pdor lo Its issuance, also requires the apD�icant tor such permit 'o file a signetl statement that ne/sne is licensea pursuant to the provisions ot �e Contractor's LicenSe Law (Chap[er 9(commencing with Section �OQO) of Ivision 3 of the Business antl Professlons Cotle) or that he/sne is exempt - ,nerefrom antl lhe basis for the allegetl exemption. Auy vlolation of Sectlon 7031.5 by any applicant fot a permit subjects the appliCdn[ to a Civil �enalry of not more than,five huntlretl tlollars (E500). LJ 1, as owne'r ot the' property or my employees with wz9es as their sole mm0ensatlon,.wi11 tlo tha work, antl the structure is not intentletl or offeretl for sale (Soction.7044„Business and Protessional Cotle: The Con[ractor's Licens¢ Law tloes not apply to an owne� of a property who builtls or ImprOves thereon, antl wno does sucn work himself/herselt or through his or her own empioyaes, provitletl that such improvements are not intentled or orceretl for 581e.'If, however, Iha builtling or improvem¢nt Is soltl within one year of com- pletion, the owner wi11 have the burtlen of proving he/she tlitl not bulltl or im- �r ve for the purposa of sale)! I, as owner ot the property, am exdusively contracting with licensetl con- VaG[ors [o wn5truct lhe project ISe<Uon 7044, Buziness antl•Profe55ion5 COtle: The Con[ractor's License Law does not appry to an owner of, property who builtls or improves thereon, antl who contracts for such projects wkh a con- tra<tor(5) ucense pursuant to [he Contrattor's License LSw�. I am aware that - ptoof of thair Worktr's Compensatlon Insurance snoultl be provitletl to me. ❑ I am exempt untler Section � 8. & P. C. �or this reason Date ��— Z�—� Owner 1 herebv certifv that I have rea laws [o dppliCation antl state that Ihe above y with all tity antl county oralnances t�uction, antl �ereby authorize �ep�e- e bove-mentionetl property tor � � � � TYPE OF CONSTRUCTION IZ�1 NE� ❑ CONVERSION ❑ OEMOLISH , DESCRIPTIO OF WORK USE OF B . � .�;� �- TVPE OF PERMIT GRADING O TENANT ❑ ELECTRICAL C ❑ OTHER PROJEC7 DESCRIPTION SQ. FT._I_ , C O N ST R V GTI ON TYPE��6R � •ZONE'� GRA�I � Remarks� {J(�,� � ' . �_ Bar $ink � , ' Backtlow Preventer Backflow Irrigation. Drinking Founlains Floor Drains � Floor Sinks ' Gas Service , Outlets I ntercepwrs Kitchen Sink ' Lavatories P—Trap ' Roof Drai Fea LJ ADD t � OTHE�R ) )�G�. _ i�e FOVNDATI ALTERATION IJ REPAIR _ VALUATION $ CU. VDS. A( f ServiceSink • ' Sewef Cep . Sewer Connection � $OIdI COII¢Cf0l5 Solar Pipin9 Solar Tank Swim � 9 Pool w/Spa � Water Close[ . Water Heater , � � Water Service - Auto-Wash ' Laundry Treys $75 � Issue Fee Duct- Under Ground Duct-Structural • Duct - Ventilating ExhaustSysrem ❑ MWtiple Firepl/FacL Blt. ICBO � Heating System & Ductin ❑0.700,OOOBTU 0,000 ISignature �'�'��' / Date� . D' � o SS�t �!,{�^ �� I einspectionFee � I $15 ^ CMF 0865-46, rev. 30/84 White - 8uiltling; Canary - Applicant; Pink - Accountin9: Goltlenrotl - q5ussor Hood or Type I ❑ Canopy � Type I I ❑ Retrigeration System oo.,00,000 ,00,000 Sy Repair/Alteration Fire Dampers ' Registers � lesue Fee A.P. � � S Main Building: E T Front A Pear C Right ' K Left S Ping. Ref. � �Q Planning Notes: � ' 0743 11/23/87 y+ • Zone Accessory Building: �� — Parking Req./Provided � �; �%.lP' �l 1"�'W� �U.'r� iJJ0.�: Q. � 8 CC �V . 6 ��.�. .��' .�.-�'--�i"_ Automatic Washer Cons[ruction.Pole Sub. Cooking Unit ' , Fan F.A.U. Fixtuies Device Boxes � Transformer � 15-50KW . .��50+KW � � � Meter ❑up to 100 amp Meter ❑over 700 ps � - Sub Panel _ ".. � Pole Light Renge 1HPOlh-.6; 9-15 HP 01G75+ Switches � Sign "' Garbage Disposal Standing Sections Generator 5KW �5�15KW Tresh�Compactor $ 3 Reinspection Fee $75 Issue Fea FEES j _ DEVELOPMENTSERVICESRE UIREMENT� Zoning Approved By _ _ � Building Approved By � ' Applimtion Ittued By � ' SUMMARV OF FEI $ 3 �, jBUILDING PERMI�$ ,�d._V v '��^LAN CHECK $ Q3 � PLUMBING $ PLAN CHECK 25% S ELECTRICAL 3 � . PLAN CHECK 50% $ MECHANICAL $ • PLANCHECK 25%• $-� E4,03 TI Z O N I N G R E 0 M T S � sa � - rDate � � z'�2 " � _Date �_ � 2 —Dat %Z ^Z'� i SMIP PERMIT ISSUANCE '� ENERGV P.C. GRADING MICROFILM TOTALFEE : ��I i 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. Structurel Floor SYstem . 11. Property Sewer Line & House Connection 12. Sewer Cap 13. Roof Dreins 14. Rough Plumbing 15. Rough Electrical-Conduit 16. Rough Electric Wiring 17. Rough Wiring Sign 18. Rough Electriral-T Bar Ceiling 19. Rough Heating & Air Conditioning 20. Rou9h 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 Meter-Final 33. Final Electric 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy 37.�Final Factory Fireplace 38. Finai 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. Electrie Release to Edison 50. Gas Release to Southern California Gas Co�, Date Inspector POOL SPA APPROVALS Permi 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, O Undrgrnd., Test 60. Backwash Lines, P-Trap, O Undrgrnd. 61. APPROVAL TO DECK 62. Backwash & Receptor-Final . 63. Heater & Vent-Final 64. Plumbing System - Final 65. Electrical-Final 66. Solar System-Final . 67. Fencing & Access Approval ' 68. APPROVED FOR PLASTERING 69. POOL/SPASYSTEMSFINAL � � FIRE DEPT. REQUIREMENT ' • e ' APPROVALS • Permit# ' _ 70. Underground Hydro ' , 71. Product Piping O Gas ❑ Oil 72. Underground Flush 73. Undergrnd. Storage Tank O Gas ❑ Oil �74. Overhead Hydro � 75. Dry Chemical 76. Dry Standpipe � 77. FIXED SYSTEM FINAL 78. FIRE PREV. FINAL HEALTH DEPT. REQUIREMENT 79. FINAL INSPECTION � , 80. FOOD CERTIFICATE ISSUED � Notes:� eJ3 � -�w _.� � _ /� � Date I I . � Date � Inspecror 0 0 i� � ,- (� � � _ ' � Appiicant to fi11 in all so ees;except enose�within neavy Eoraer Iines an.l�sign all appropriate aeelantions. � y _� ' i . . ... .._....,' "".�..�_._.... _ _._... .. . ...�. __'"" _ ""_ _"�. _.�... .�_' _ ' �.__.�-e T .e f 6 /7_ Fbt i� ; .. i� `�' ; '" ,�. CI.��60STA qM�ESA��., CONSTRUCTION-PERMIT,� � MIT N/O._ /{�� :T.R�CT NO. � � LOT�NO. . , UNIT NO. � ' � -._ , � , : ,�yrlf3F°i�dAdd�ess �16� ��..�-�(��I.��.i'i'�� l7 C/'�` .%tP ��" � ;. , , ; .. '; . . .��7�1 �I/2'/d�7� �� : I•.7C��G� �T: �AppliCent'sMeill�oA.�i�7rwce 1I: VI� LIrX% GJT¢i• Zlij-., T�'PEOFCONSTRUCTION NEW ADD ALTERATION REPJi1R , . � �� f. y"- ".' ., - : ��.21f�,..y ❑'�CONV�RSION: ❑:DEMOLISN:D OTHER ' A.P.q� �L/ � �. � / . .. __ . . _ /� Zone . Owner'sNamg� �a � Phone . DESCR1P710fy OF�yJORK/�U$EOFB,LDG:� N��' �� " Adn�.a'.y � v A'�1 -.. �'�� . . �� . �CjFPN f+•1�T0 �M6-INT��.df-r,.� S MainBuilding: '. AccessoryBuildin9� C�'}(c4�iRTs�Z AfCh/Eng.,��' ^ �� Litenv'No_�,._�� p____ TVPEOFPERMIT GRqDING FOVNDATION STRUCTURAL �' T Front 4Sr S�H.0 � ,� �� '� AdqreA ' 8� ' � ' �^�� ,-, ❑.TENANT'O EI.ECTRICf1L, ❑ PLUMBING ❑ MECHANICAI•+�.-,._,..�,. „ B Reef' �%� � ' � � . � �'j � ' N Contracror'S Nam �� i . f �" � - � Phone � "" ' . � OTHER.:, I CLt.�� i C /4 �T� : . �/�.�} A � - . . O � � , __ � . : .. ... ,. . . �- . ✓�•q��/ry Adqrea (mailing) ', �� ' �� ; "' r �"`. � f � "r . 2' � aECT DESCRIP710N 5 . FT. � ` ` OCCUPAflC� �C�mL Righ . . _ , G PR t .: ��. . _ p � / � . _ ' �♦ ,. � � 1�.. ' CON�ST•RIiCYIONTVPF ""'' . . ' �.' VAWATION$�9� j g Left � � '__- 33�. � : R City License No.� " ' � ZONE' '� - GRADING CU. VDS. � ACREs Pln , Ref. #` _ � Parkm Re /Provided /S" E LICENSED CONTRACTOR DECLARAT.ION � � �`�' � �� "- �•' � � �' ' - 9 9 Q' � � I It@rlDy affi�m that I am IicMsed'u�tlet proviSlOns of Chaite�'9 (COmmendn9 Rema�kt: - L'� G FEE � . Planning Notes: . � � � � M with seclion 1000) of �ivistan 3 0! tlre Business antl Prafessions Cotle, anC � ] mY license is in full force anC eHeR `. i�.. � 5. -` � � � . ' � , ' , ' . . ' _ - ' � �- Y .- i :. T _ Lic¢nseClass ` � � ,' LlcenSe�No��I��' � : ' � �.4^. . S � t - - ' t. ..P-. Y !- .t' f . : . �PLUMBING � - a FEES' - ' ' -- HOL ... �. 't ' � � Date" ��` � °" Si9nature �- - . . . " . ' t1 � ' ' ( WORKERS' COMPENSATION DECIARATION 'h '`.j_ � ' �t+ �- _ _ -IhOreDyaffi�m�that'IhavCattrtlfiUteOi�con5en[tos¢It-InSpreofdCartlficatE' '�88�Sipk � � ' � Sbowers . . ,�i -i " ! _ , ['�:' � f . ELECTRICAL ,�y;'� �� :�' - FEES t ��t'Worker5' CompensaLon Insurance, or a certlfleE copy thereoi (Section � - �� ' �. 3800, ub. c.).� - '-�Y �,,;<�''� � � .� �� i'��; -._� t,f: '- BackflowPreenter � ;. Service5m � AutomaticWasher, � - '� Transformer� 15�SOKW.� v � k . F _r '. �( Poiicy rva. ' � � � Company ' � Backflow Irngatwn ;y � �, { ,, . Sewer Cap , r '._ Construction Pole Sub � � - � 50 � KW < - t CertlTietl copy is'hereby turnlSheC'. � �• , r - �l � . .�� ' e Certttietl copy is fiiea wHh tne ctt BWIAing �(v(sfon - �. " - '; Bathtubs r � + r 7 �- � ' Sewer Connectibn:% � � '3 � �t � � � - ' y �_„r � -,"� � E _ -' - i � . f ` Cooking�Unit ' , Meter ❑upto t00amps: � Date .. ' . ' APVliwnt ...� -�, .•. .. ' � -. . . � � " ' ( EXEMPTION FROM WOqKERS' COMPENSATIO DEGLAR qTION . ClarifiCfs u� { p 1 - � -. � �'' •�C: � $013f CollectOlS? � � t � �,t: s � -� .I- ! = Dishwasher � t � i '_ i Meter ❑over�100 am _ � (This section neetl not be'complateG if the permit is f�-one hun�¢ tl(E100) o� � � �iess�: � . , � � � �- � � 1 , .� � \i\�� Dishwasheri �- ..1' - $olar Pipin9 • i Dryerr:�Gas �Electnc Sub'Panel.: ' �� !,� : � 1 certify that in the Pertormance of the work for which this perm�t is I55ueC, I � �� ' . , � � ' ' ' �- ' ' snall not employ any cerson in any ma ner so as becoma s�D" ct to the� Drinking FOuntains'.- i' SolarTan -_! �„� !.. ' � i.- 1 Fan � �'� i, I Motors �HP �1'h,•8'' s- � +j Workers' omPensp�pp Laws oi Calif ...' . �-- . i .- . � ..'. . . . � ti � ' � =.�: _ Date� �Zz�^-/ Si9nature • � - �' �' � FloorDrains i l: �' � � '' Swi ' in Poolw/S a ' ` � - ' y . NOTICE: I(, af[er making this tlaUara ; you ihoultl become�subject to the-' - '' �- � 9 p j� "' ' ' ` F'A U' ' + � _'_ �nC. ar_09-15 HP 016-15+ t .. _ ._..."'_....�_.._,. _ ._ .. �• Workers' Compensation provisions o he Labor Cotle, you must forthwith-- FIOO�SinkS �� h� i:' �� m21� '� � �' ' � t mrnply with such provisions or this permit spall be�tleema0 revokea•.. � �� 7-•- �- �� '� � �� -� �� :- �; Fixtures + �� , icrowave' ' „J , � CON57RUCrION �ENo1NG AGENCV', ('�i '-.}..''-( ,;.- f� 'y ;, �'" GaSServiCC 't' '.�''�Outlet5 i- WaterClosei:-��.G� , I� E�., i.,_�� ! Device8oxes i PoleLight?._;,, ; I hQreby afflrm that there is a constru<tion lentling xgency tor the performance � -- �� of the work for I it su ction 3097 Clv CJ". P '. ;� -E �' �'S Outlets f' � � �`,'�'��', �y, "�1^��ije "�� . Interce tors � , � �- �NJater Heater_t . �� - : ; j � • Ran e I ` LPntler.'s Name �_ - 9 Leqtler's AOGmss�-�� dF"��'J -=-�-"-*- -- -' � ' Kitchen Sink-;--�-a-- - =� Water Sernce --^'—^---`•- ;- � -' Switthes � " - - ' ' '� ' - - ' OWNER BUIIOER UECLARATION: i. . _.. . i � . �. �a .� ' i :, � t S�gn. i'�� ; ; 1 hereby aHirm tnat I am exampt from.tne ConVactoYs Liuensa'law tor tne , Lavatories .. '(' � Rpto-Wash .�! i" '� -�i ' t Garbage Dispoul Standing Sections t J s tollowing reason (Section 7031.5 Busineis antl Profeulonal COGe: Any tlty or � � ' - -' , ` ' � � � countY ��ch requires a cermit to construct, alter, improva, eemolisn or repalr � p-Trap. � Lahndry Trayi " t f. 1 Generator ❑ KW �5-15 KW TraSh Com ctor' -� any structure, prior to its issuance, also requirez the apPlicant for such permit � � . to file a signetl ztatemeTt that he/s�e I5 Iicensed pursuant to tha provizions,of, . � i� .': :� - � � the Contractor's Li<ense Law�{CnaDter 9(commencing with Section 7000) OT ' Roof Dr s. .:^ t"�.:' �' 1 �..� -� � ': '�- �_i, .�^ 3 I �' ' Di��sion' 3 of the--Business an0 Pro}essions Cotle)'or"that he/she I5 exemyt" �� -- '� "-� . .: 'herefrom anq the basiz for th<allegetl exemption. Any violation of Sectfon - f;.j � �- _,i �.- �. -! . -�-' ' �. + � �,'i � � � '�� S 'j_ �.J�� ' t' . :.: .�� ]031.5 bY anY aPPlicant for a .Permll sublecti the aPPtlwnt. to a ci¢71 . � . l . .' , v • �...--r ! � �'�- . ... .... . 1 . . ..i• .. '..�. ' .:.. J-�. _ � �epoltY.ot no[ mo�e than tiva hun�reC tlollars (E500).. j'.:' .�.. ..;. . . .'.;<; . , . '. .. ..`. . ': �:;.. + t i t .a i . _ � . . .! - I, as owner of �the' property or rtiy'employees with.wagez as [hel� zole Rainspec[ion Faey �. - $75 �� .;�-.' ' laue Fe9� � "� $ 3 l � '� ' -' " ' ° � � ' � ' ' ` compenzation,�wilf Eo Ihe work, antl the structure is not IntenOetl or otferetl� ' � � �Reinspection FeB � $15 � Issue Fee '' .-� ��. $ 3 - ' for sale (Settion� �044, eusiness antl Vro(essional Cotle:. The ContractoPs __ _ a.._ �. MECHANICAL'; . �� FEES � LIEen52 Ldw tloe5 nOt apply to an oWnlr Of a pfopCfty Wh0 bUI1tl5 OI iTPIOVCS" ' � _ thereon, an0 who aoes sucn work himselt/herself or throu9h his or her own - .�. � , �.DEVELOPMENT SERVI ES RE� IREMENTS: . �.'�..i �; �' employe¢s, provitletl that such imProvements are not intenaetl or�otfereG for ' Boiler�' � Y � :i ,�� t. �_1';r Hood o� � Type I O j , �-ti-� .� n- '- '� �� 22_=g'7 �- sale. If, however, the bullGin9 or improvement is soltl witnin one year o! com= � - Canopy Type II ❑� f .ty �;�� Zoning Approved By r ate � plepiOn, tne owner will pavG ihe burOen of proVing h¢/She tlitl�nOt bWltl Ot im= �� DUCt- UndCf G�DUOd �I`� i� � ' '" � . Pr e for tbe PurAose oi �Ie)i : - ; . . . ; . ,• ` - _° i : , � . . ��. c �(' ' Buildin8 APProded BY ate' %'-��'�% t ,� . . r. . . �.: - � . ' x t ' �, as owner of the Droverty, am exclusivaly contractlnq witn Iicensee com Duct- Structural' �� [� 5:: RefrigeraLon System (>. � 4 Appliration Isoued By � atu ��-�.�-�%1% tqctof5t0 copSVUCt the prOject (5lCtion 7044, Bu9ne55 antl PrOte55IOn5 Cotle:, '' ' - t- �- 1� _ Tqe Contractor4 Licenu' Law aoea' not appry'io an owner ot prooerry who Dutt- Ventilating�k: �.'e+�. : �4700,000 B 100,000 BTU ��. �- j� s.'. ...i �� __{ �.' C SUMMARY OF FEES -�' ,+ ��' `' b4iltl5 0� improves thereon, anE who COM�actb-�fo� such prOj¢cti with a <on-t - � -� ' • � '� ' ' y�_l I� � ' - i t ..y;;. ` ��❑ �' ;' � tractor(sl ucense pursuant to tne Contracior's License'law . 1 am aware tnat: ' S 1.. r._ �, l' BUILDING PERMIT '$x g�D , SMIP1� -', �;3 $ '! �� proOf ol tneir worker's Compensatlon insurance sboultl be rovltlatl to me:. ' Exheust System' �!: Multlple ��' Syst epair/AlteraLon f'y .� i-. - . . ..� �.pj .. � � ,�- ,,, P . M1" '� i'�.Q��PLANCHECK i:.s.$. � j3.00_PERMITc:ko {�£' i ) �.0:1 am ezempi untler Sectlon'"' '' B: & P .C� tar th�s reason , � - Firepl/Fatt. BIC ICBO.# �.'_-I �"�` Fire Dampers '- �. ti �-:: ��_ . � . g' ?^ ' � ' � �{�� ?1' �: �• ' � a..�d. ' . . -��.tii PLUMBING:� t� �'$�-- � •`.i.=1SSUANCE $ ^: L naro. .. - - .• p�,: Heating SVstem & Ducting' _ Registers ` - Y�� ; �� }:�, !'. � � . ; 4.� - ' n.) .: � � ` ENBRGV P.Ci $= ' �'}'�' ". .�.1 •.. , . : '. � � ., i PLANCHECK' 25% $` ' ' � hereny certify that-I have rea Is aoP�ication 5ntl state that the z0ove�. - ❑6100,OOOBTU � ,OOOBT - ��" ' ' � ELECTRICAL . �$- GFADING� ''$' ' '��L'- information is rorrect. I agree to comply with a11 city antl county oremances; �- ' '� - �< �' MICROFILM.- �y antl �5[ate laws relating to buil 9 conztruction, antl hereo authorize repre-,� -$ M� `� ' oY ProPertY fp�? - -. �:� - : ` '. -!� x' - - �': i G � " �.i PLANCHECK 50%: - . , $;. (�77� 7 serytatives of t city to'e u on the above-menti netl - $ '� ��.. ' inlpection pur os -' c ' � � ' ' - ' signaWre ' �� ••' - ` Date 'ZL'O _ . . . , � .. � ' MECHANICAL� � _TOTALFEE;. �$ � Drivers' Lice or 55 $; ' ��[ �� : . . Reinspection Fee ' � - S75 � -"'. , laue Fee � ,' r � .. S 3 "' � PLAN CHECK 25% �$ � - cMF nAFS-46. rev. 30/84' Whit¢ - BUIltling; Cdnary - ApPllcdnh Plnk - Atcountin9; GOltlenro0 - AssesSor ' � . " � ' . � ' . " ' � ' S Pa�cca.0 � a�2.� � -�� - � � �•y�M Applicant to fill in all zpaces excepl those wilhin �eavy �o�tler Ilnes antl sign all approoriate aeclarations. C.ITV OF COSTA MESAc GUNS 1 HUG 1 IUN YtFSIVII I P��T NO.. __ TRACT„y0. LOT NO, � UNIT NO. Project(addreis �n� �v �� Applicant'sMailin ddress ��7� UA`i�� 5� Z/.3 /iJ� OwneriName ��A�/S �(J/`� Phone �ZZ� ndrneu 3'}��/�v/� L�do Su.�e.214 w/_/3_ �'RLL`3 Arch/Eng. vu� r I, License No. `+`/1 p 3 Z Address p/`�'��/�-' e.4 ��i N • �_ Convactor'sName :x �LL� V�°/" nU//d.0f Phone�7� Address Imailing) �T�� +� �� 3 u �`' ��+� City'License No. LICENSED CONTRACTOR DECLARATION I hereby affi�m that I am licensetl untler provislon5 of Charter 9(commencing with section �000) of DiviSion 3 ot the Business antl Protesslons Cotle, antl my license is in tull torce antl etiect. . • License CIa55 LlcenSe No. `ate � Si9nature ' � �RKERS' COMVENSATION OECLARATION . . n¢reoy afOrm that,l have a certificate of consent to 5e1t-insure or a certificate ot workers' Compensation Inzurance, or a certifletl cooY thereof (Section 3800, Lab. C.) ' ' . � Policy No. Company BCertifietl topy is hereby furni5hetl. � ' Gertifletl copy Is filee witn the city Builtling Division. Date Applicant EXEMiTION FROM WORKERS' COMPENSATION DECIARATION (This section neetl not be completetl if the permiYis for one huntlretl (5100) or less). � I certity that in the perfOrmance of the wo�k.fo� whlch this pe�m�t IS i55uetl' I shall.not emplOy any pe�son in any nner so [o ecome ubfect to t�e Wo�ke�s' � ensaj� LawS of Caf o�i . � Datc � �L�D� Si9nature � NOTICE: II, after making this tleclar ' n, you3houltl become subjectlo She. Workers' Compensdtion provisions the Ldba� Cotle, you mu5t forthwith comply wilh such. provlsions or� ihis Oermit ihall be tleemetl revoketl. CONSTRUGTION LENDING AGENCV I M1erety atflrm ihat there is a construction lentlin9 a9eney for tne perPormance ot the work .for I thi p !� is ( io9� 309] Civ. CJ Lentler's Name �� ^'�p��4i'J l.ender•s naeress b�lZd ��- C'� � ' OWNER BUILOER OECIARATION � I here�y afflrrti Ihat I am exempt trom�the Conbacto�'s License L.aw fOr the o.u....,...� .e.mn ie.e��inn �n3� s wucineaa antl Prolesslonal Gotle: Anv eitv or therefrom' ana the basis for the alleqetl.exemption. Any vlolatlon ot Sectlon 7031.5 by any applicant for a permit subjects the applicant to.a civil �enalty of not more Iham(ive huntlretl tlollar5 (E500). � � LJ I, as owner ot �the property or my employees with wagas as their sole . compensaUon,'will tlo tM1e work, antl the st�ucture i5 not in[entletl o� offeretl for sale ($ection 7044,'Business anE Profeisional COtl¢: The Con[ractor's �icense Law tloes nol app�Y to an owner of a Oroperty who bulltls or improves thereon, antl who tloes 5uch work himself/herself or through his or her own employees, provitletl that such improvements are not intentletl or offer¢tl for sale. If, however, the builtlin9 or improvement is soltl within one year of com- ' o�et�on. cne owne. will have the burtlen of provin9 he/sne Ultl no[ builtl or im- �r.Qve for the purpose of sale)., .E4,1, as owner of the pro0erty, arti exclusively contractlng with licenred wn- tractors to construct tne Oro�ec[ (Sec[ion ]044, Businesz antl Pro(essions Cotle: ; The Contrac[or's ,Licens¢ Law tloes m[ apply lo an owner of Oroperty who builtls or improves lhereon, antl who mnira<[s tor such proiects witn a con- traclor(5) I¢ense pursuant to tne Conttactor's License Lawj. I am awar¢ that proof of (neir Worker•s Compensation,insuranca shoultl be provitletl to me. ❑ I�am exempt untler SectlOn , B. & P. C. fo� thi5 red5on naro l�Z�� ri,.. �.i 1� TYPE OF CONSTRUCT�ON LJ r�Ew LJ qoo � ❑ CONVERSION �L�DEMOLISH ❑ OTHER .DESCRIPTION OF WOAK/USE OF BLDG. E•', IYPE OF PERMIT LJ GRADiNG LI FOVNDA' ❑ TENANT ❑ ELECTRICAL, O PLVMBING ON LJ REPAIR L.1 STftUCTURAL MECHANICAL ❑ OTHER VROJECT DESCRIPTION 54. F7. oCCUPI CONSTRUCTION TVPE VALUATION $ ZONE ' GRA�ING CU. VDS. � AC Remarks: � � "') q ,' /� ' n n ` n.. _ _ . _. . � Sink kflow Preventer � � kflow Irrigation vuhs . . Dishwasher . Drinking�Fountains FloorDrains � � � Floor Sinks Gas Service Outlets Interceprors Kitchen Sink . _ Lavatories ' P—Trap Roof Drains � 0 Reinspection� Fee. E $15 Duct-UnderGround Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ FirepVFacL Blt. ICBO �I`- Heating System & Ductin _ ❑0-100,OOOBTU O,OOOBTi sentaUves o�, m� � m,enter t e menuonea oro ert .or inspection pur0 es - ��, � l7 � Signature `f.� �` Rainspection Fee 'S1 �MF 0865-46, rev. 30/04� White - Builtling; Canary - Applitant; Pink - Accounting; Goltlenrotl - Assessor ShOwers Service Sink � Sewer Cap Sewer Connection Solar Collecrors Solar Piping Solar Tank ; Swimming Pool w/Spa i Urinal Water Closet . Water Heacer '- Water Service- Auro-Wash Issue Fae e FEES $ 3 A.P. � S Main Buildi E T Front B fiear A C Right K Left S Ping. Ref. # , � ` `_ Ir_ 0740 I/23/87 L2. —� '7 � _ � � Accessory Building: Auromatic Washer Construction Pole, Cooking Unit Dishwasher . . Dryers ❑Gas ❑ Fan F.A.U. Fixtures Device Boxes Outlets Switches - Garbage Disposa Parking Req./Provided � �600�� TL Zone /�(� �j" ELECTRICAL Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amp . Meter ❑over 100 ps , Sub Panel Motor p7.HPO1'f.-6 I .Solai �9-15 HP �16-15+ Microwave , Pole Light Generator 5 KW 05-75 KW Sign Standing Sections Trash Compactor Reinspection Fee '' $15 luue Fee IANICAL ' 'FEES Hoodor ,Typel ❑ ' DEVELOPMENTSERVICESREQUIREMENTS: CanoPY ' TYPe 11 ❑ . 2oning APProved By — Buiiding Approved By � Refriqerati0n System ' Appliotion Issued By ❑o-ioo,000 �Oioo,000eTu ' Sy Repair/Alteration Pire Dampers - Registers � � � � Issue Fee � $ 3 Z O N I N G R E � M T $ ' SUMMARV OF FEES" � - � ,� BUILDWG PERMIT $- .�? �% SMIP - $ . � PLAN CHECK $ PERMIT �� _ I PLUMBING $ Yi� � �SSUANCE $ {�PLAN CHECK 25% $ ENERGV P.C. $ _ ` ELECTRICAI S GRADING $ PLAN CHECK 50% $ � MICROFILM $ � MECHANICAL $ � TOTAL FEE _ $ � PLAN CHECK -25% $ - ' CONSTRUCTION AND PLANNING POOI & SPA � APPROVALS Permit # Date Inspector qPPROVALS Permit �h Date Inspector 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location � 2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement � 3. Electrical Conduit Utility-Undrgrnd. 54. Forms � 4. Electrical Conduit�Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement • 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd.' 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. ' . � 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Str�ctural Floor SYstem 61. APPROVA�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 Elearical-7 Bar Ceiling � 69. POOUSPA SYSTEMS FINAL 19. Rough Heating &%��r Conditioning FIRE DEPT. REQUIREMENT 20. Rough FactorY Fireplace APPROVALS Permit # _ 21. Ducts, in Struaure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil �. 23, Gas Pipe-Rough & Test ' 72, Underground Flush j 24. Roof Framing 73. Undergrnd. Storage Tank O Gas .O Oil "� 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe � . , 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation .- 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: Q ��3 � 7 34: F�inal Heating & Air Conditioning . , 35. Final Gas Pipe-Test � 36. Hood or Gnopy 37: Final Fac[ory 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 Regulatipns 47. FINALSTRUCTURE&BUILDING 8 48. Special Requirements Completed � 49. Elec[ric Release to Edison � 50. Gas Release to Southern California Gas Co � 51. CEfiTIFICATE qF OCCUPANCY � No. Dat� • � Aoo��ant to flll in al1 soaces exeeo� those witnin heavy Cortler lines ana si9n all appro0riate aeclarations. ciTY oF COSTn MESA CONSTRU��ON�PERMIT , ' � kti �.1 !� � ' . ProjecUAddress n�pilicant's Mailing'Address �'i7/ G,/A uiO�v S�f.`1�/3 �N.Id_ Owner'sName`��Alll��A � ' Phone��3�2ZS'7 •Address' '� 7 7/ �%A �llo Stit f4 213 A/.l3_ 9�t�G�L, �3 -�.rch/Eng. rDU�Ai.�i��A�l�ie �icens/e�No. � I%n � ` Address � ` � � Contractor'sNam uer i �dg�"/ Phone �'Y�y Address (mailing� �' 7/!/ia L.do SuiTL%.�� /U..�3 iZ:�.3 i City License No. LICENSED CONTRACTOR �EGLARATION I hereby affirm that I am licensetl untler provizlons o/ Charter 9(commencing wVth section 7000) oi Division 3 of the Business antl Professions Cotle, antl my license is in full force antl nflect. ' Li<ense Class Licensa No. Date Si9nature ORKERS' COMPENSATION DECIARATION nereDy aftirm tnat I have a certificate of consent to self-insure or a certlfiwte of Workers' Compensation Insuran<e, or a certifietl copy thereof (Section 3800, Lab. C.) ' . , Policy No. Company eCertltietl copy is'hereby furnisnetl. ' • Certltietl copy is tiletl with the city Builtling Dlvlsion. Oate APOlicant EXEMPTION FROM WORKERS' COMGENSATION �ECLARATION (Th155¢ction neetl no[ be completetl if Ihe permi[ Is for One �untlretl (E100) or Iess�. I certity Nat in the performance of the work for wnlch thls perm�t is Issuetl, I Shall no[ employ any person In any qner So a5 to be o Subjett to the workers• oTpens�(�pn Laws oi Calif m a Da[e � ZL �� / Si9nature NOTICE: If, after, making this Ceclara n, you snoultl become subject to the _ Worker5' Compensation p�ovi5iOn5 the Labo� Cotle, you mu5t (orthwilh comply wiN such. prOviiiOns o� this pe�mit Shall .be tl¢¢metl revoked. CONSTRUCTION�LENDING AGENCV � I hcreby aifirm that there'is a construction lentlin9 a9ancy for the performance of the work for I$� [nis errtyt s is�syetl (Se on 309] Civ. C.) Lentler's Name -��`S��OT�tl1ri1/�A I� �entler's AtlOress ��A2.( � Y_ G� .Gl. ' OWNER BUILDER OECLARATION � ' I hereby affirm-that I am exampt ftom Ihe Conlydctor's License Ldw for tne follOwing reasOn (Section 7031.5 BuSiness antl PrOfesslonal COtle: Any city or county whicn requires a permit to construct, alter, Improve, tlemolish or repalr any sVucture, prior to its issuance, also requlres the applicant tor such permit 'o filC a signetl siaiement that he/She Is Iicens¢tl pUrsuant to th< P�ovision5 oi e Conlydctor4.l'it¢n5¢ Law (Cnapter 9(toTmencing with Section ]000) Of �vision 3 ot tbe 6usine55 anU �Protessions CoOe) or�that he/sne is exempt herefrom antl the ba5is 10r the alle9etl exemptlon. Any viOlation of Se[tion � 7031.5 by any applicant for a permit 5ubject5 tM1e applicant to' a civil i�enalty of not more than tive huntlretl tlollars (E500). � LJ I; as� owner of the• property or my employees with wa9es as their solo ' CompenSatiOn,�wil1 tlo the work, antl the Structur0 I5 n0[ Intentletl o� offeretl for .sale (Section 7044, Business antl Professional Cotle: 'The Contractor's �� License Law tloes not apply to an owner of a property who bWltls or improves '� thereon, antl who tloes such work hims¢If/herseli or tnrou9h his or her own employees, provitletl that such improvemenfs ara not Intentlatl or offoretl for sale. If, nowever, the builtling a� Imp�ovement IS Soltl wlthin one y¢ar o1 mm- 'pl¢Hon; the owner will bave ihe burtl¢n Ot proving ne/sno tlIC not builtl or im- �� ve fOr the purpose of Sale). I, a5 owner of the prOPerty, am exclusively ConlraCtinq wi[h IlcenSeE con- • tractorsto construct the project (Section �044, Business antl Protesslons Cotle: The -ContractoYs'Llcense Law does-not apply to dn owner of Oroperty wbo builtls or improves the�eon, and who contraC[5 for such projects with a Con- tractor(sl imense pursuant to the Contractor's �icense Law). I am aware that proof of their Worke�'s Compensation in5uranca shoultl_be p�ovldetl t0 me. ❑ I am,exemp[ untler Section B. & P. C. fo� this reason Date � Owner I hereby certify tnat I have reatl is application antl state that tna above iniormation is correct. I agree to mply wiih all city antl co�niy ortlinances antl s[ate laws relating to buildin9 constructlon, antl hereby authorize repre- • sentatives of ci[y [o ¢nt upq� tne bove-mentloned property fOr inspection vu o es ,/ 7 Signature � N�' Date � �� Drivers' Lit 55 � � " / �, CMF 0865-46, rev. 10/84 A�D LJ ALTERATION DEMOLISH IK/SLSE OF REPAIR TVPE OF PERMIT QS'�GRADING VJ FOUNDATION 'l`J STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING O MECHANICAL � OTHER %r/�S� ��l/�OSUI`C � PROJECT DESCRIPTION SQ. FT. 9� OCCUPANCV_' CONSTRUCTIONTVPE � L VALUATION$�' ZONE- GRA�INGCV.VDS. ACRE$_ Remarks: ��^ L � �Q. � ��i I T� 1 PLUMBING ' - . Showers. Preventer Service Sink Irrigation " - Sewer Cap � - Sewer Connectii � Solar Collectors �r � '. - . Solar PiD��9 . Drinking Fountains Floor Drains � ' Floor Sinks Gas Service � Outlets Interceptors Kitchen Sink - Lavarories P—Trap ' Root Drei Fee Under Ground A.P.�p Lf � S Main Building: � E . T Front A Rear C Right ' g Left Ping. Ref. qk a' f�( Planning Notes: 'j"r.� FEES' � ' Automatic Washer r � Construction PoleSub.. • Cooking Unit Swimmi Pool w/Spa - Ur' I ' � � r Water Closet � Water Heater � ' Water-Seivice - ' ' Auto�Wash � LaundryTreys . '� $15 , � ' Issue Fee . , $ 3 � MECHANICAL� � FEE �. Hoad or . Type I � � � Canopy Type I I ❑ Duct-Ventilating ' Exhaust System ❑ Multiple ❑ Firepl/Fact.,BIt.ICBO# �� Heating System & Ducting ❑aioo,000eTu�ioop i Fee I $15 White - Bulltling; Canary - Appllcant Pink - Accountlng; Goltlenrotl - Asse55or Refrigeration Sys2em ❑0-100,OOOBTU ❑1 System Repair erat laue Fee Dishwasher . Dryers .�Gas L Fan F.A.U. ' Fixtures Device Boxes � Outlets Switches - � Garbage Dispoul Generator ❑ 1 Reinspection Fea � — DEVELOPMENTSERVI 2oning Approved By� Buildin8 APProved BY r. Aoolication luued BvJ :,0742 I/23/87 � Zone Accessory Building: Z.(D ♦_J � — �� Z / �/ ^ �g Parking Req./Provided �I � q9oIB Tt 2 O N I N G R E Q M T S ELECTRICAL � - _ FEES � Transformer ❑ 15-50 KW ❑ 90+KW. � Meter �up to 100 a s - . Meter ❑over 1 amps � Sub Panel � � Motor 0.1HPO1X-8 I .Solar �9-75 HP �76-15+ Pole Light � Range . Sign ._ Standing Sections ❑5-15 KW � Trash Compactor ' $15 . Issue Fea � :SREAUIREMENTS: � � $ 3 � ` i Z _ �' � � SUMN1A V OF'FE�S � � BUILDI�NG PERMIT $ �t SMIP $ � ��5� PLAN CHECK ' $ , ' � c PERMIT ' , PLUMBING $ ISSUANCE $ i PLAN CHECK _25% 3 ENERGY P.C. $ ELECTRICAL $ ' GRADING $ - PLAN CHECK 50% $' MICROFILM $ �� Q �� MECHANICAL S TOTAL FEE $ J�sL� $�3 , , PLAN CHECK 25% $ � CONSTRUCTION AND PLANNING FOOL & SPA APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector , 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location � � 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement � 3. Electrical Conduit Utility-Undrgrnd. � , 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding _ 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings . . 58. Electrical Conduit-Undrgrnd. 8. Foundation ' 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 71. 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 Elec[ric Wiring - 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 78. Rough Elearical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil � 23. Gas Pipe-Rough & Test 72. Underground Flush ,_' � 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Freme and Flashing 76. Dry Standpipe ' 28. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. FIRE�PREV. FINAL 30. Drywalf Nailing � HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Finat _ 80. FOO CERTIFICATE ISSUED 33. Final Electric �- Notes• O � 34. Final Heating & Air Conditioning - ' � 35. Final Gas Pipe-Test . 36. Hood or Canopy 37. Firial Factory Fireplace 38. Final Plumbing � . 39. Water Service-Final ' � 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer 43. Backflow �rrigation � 44. Landscape Irrigation System • 45. Sound Attenuation �. 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING � . 48. Special Requirements Completed ,a 49. Electric Release to Edison � 50. Gas Release to Southern California Gas Co ' 51. CERTIFICATE OF OCCUPANCY No. Date • +� ., , � _ , �.� � - � , . .. . . r ' '' ' -� n00��anc lo tl�l In a:! �naces�a:eapt thoai wltnin �ury �orAv Ili,et enC fiqn all �pV�oprlab Caetantlon�. • � ' � � � 1 CP oj O�F,� CO�TA+MESA � CONS 1 R� CTIiONi PERM17 j-.. I'_ I P!� IT`�J f� ' IT�� N��` j LO'I' NO. "�'-` UNIT Np, i _�_"' '__�_,.. "''."""�'--'r"'�`.-r._-�� 7'3fi.'.y(I I�I 7/�.!l. 1..! .•-j'�.`� I TL I', � � { � 9s � �ir Sr � � ` � � . ' I� "� t. ""/,/ � ' � � � � I �•iE�L� �D❑ESCRIPTIONOFW❑ON(iKEljSEO BOG 7HER _i ALIF_R,TION A_Ivaiq_. A.P..fi�'.�.'_.I"'...-._.1 -J--.1-.:1__ �-J-. -�._--� l..zbrre.,�_J.,.�. I �uai�� s nna�r Add ess /.{.G,�r. IJoi!%?/3 X� � /� Owner'sNai�e � hone � --� - � --�— —1---f — -- -; Addleu '�`17/T,� L� -3 �f! �/�3 if/ �i 1 � j_ 4 � : ' ; �. + I � i i � i '. I �S Main Building: : � I � � Acceuory Building: ( ' � I ArCH/Eng! � � � I I � � LI6en5C�N0. � � � ! I T�PE OF PERMIT � !GRADINO � FOUNDATION � 5'I�RUCTURAL i + �T Front � � � I � ' I � ( � , O ! Addreu � � � � � � f ' � � 1 � I ❑��jT-ENANT; ��ELEGTRICA ❑ PLUMBING Q MECHANICAL � � i'—�' � i Contrecror s Nema ��• ��/'fPi-' � ' ZLtc L�� • . I ' j �B Rear i . �..._ � 1 i_ � � � � i � � I\ N i t. � ��. I �. i laiOTHER.�-'1 :td!/�Y/C�/L�.fI. P��.:St` i I. I I A I Phone.t.a.� i I 1 I -�� I � I ; I � .. � I PRQIECT DESCRIPTION � 50.'F7. � � �� OCCIIIPANCv Cy Ai ht; - "`i' t"' '�' � \ i i I t a � f � � i_� ..T �- � i 1 i, -N � Addreu (meiling) � I -T— ' ; I i � ' i� . � K Left ; � a I � � � g I I � ( �. � � � � � ; , ' I CONSTRUCTIONTYVE � VALUATION§ � �g , ' i ' I , ` � � � � � � , Ciry,licenae No. . � i { : � � R IZONE • ° - 'GRADINGCU.VDS._� � ACREd � I I =� � i LICENSEO CONTRACTOR bECIARATION I �: i I f : . l 1 � :_. , I . . � r� �� v Ping.�RBf.� I I � ' > � Perking H@q./PfOvi�led : ( I I E I nereby jHirm that I am IltanseO,unOe( proviilons o/ Chartar 9(commenclnq Remarkn �'� �� I'' o � 4 with; uctlon 7000)� of DIVISIOn 3'1of ttle Buslnezi antl� Pra}ezslons COEe, anG I , , � y� ,�U � � I j i�, ;_, � , ;u I �_ � ,Pianninp No[ez: � � � ' �, ��; ,� I f ' � � M mv �Icense Is In full torce!ana efiect. i � i � 1 SU ( � ' i � I� � � � "�`. ;�= � ti � : ' . `u� l: ,mi i T t:! �_ ! t . . � . �.: � �_ � ��' i � i i I. C I I i I �. I .I � i. i i i� i, �I I�'; � Llcense Class � Llcenze,No.� ' -' S, , �Date � � 9neture � _� ! ; i u �. � isi i i:- ; PLUMBING �: i � � � o- 7:F.EES' a' �� i. � o � � i,i, �:1 �. � j_ -�U�.� m;, � i�{ ��i �:. WORNERS' COMVENSATION DECLA ATI N , j � � I I � � BarjSink- �: ' Sh<iwera �— �- i�' �r )s � �� o. � Ill � V I Q' u � I . � I hereby aHlrrtl Uat I haJe a chrtlfltate of consent o uiunsura or a cernriuee . _% �.�� • � a � U,-_ I_ ��: �.. ; � i;. � ��. ':� I�. �,� � ELeCTRICAL �� `�A { m , j� �,� FEES • uf Workeis' Compensation Ihsurauce, ;or a� certitletl 'toDY therao( (Sactlon - • � � � : ,�i i . � �� ' " ' ' ' ' ' 3800, LnD. C.1' �' i i � � i i I ' ! � Backflow Pieventer �_, �' : � Ser'vice Sirik i��, j .p. �•o . L �� • i p, Automatio Weshe�� i n��= ��u' � PoIICY No. � ComDanY -� . . i . . _ . .. . _.. i = trdnlfOFmer�O 16 $0 K1jV � � �'� i � 4 � ' Backflow Ir�igetion i I 9evrer Ca ' f : + „� � � i -', � � ' ' � � � � . : i . w . . P � .. _� i '�. 1 � ` C 1 ,., Cons�ruction PoleSub:O � �- i . i r � . � �. �� 50+KW; � I a, � '-�✓ � e Certitletl coPr li nereDY f Nsh�G. J I I I j I ( , �` � . . - I i � I � � Certlfletl capy Is filetl wlth the C�tY dulltllnq Dl�lslorl. � 1 Bathtubs �, _� ��; �,•. � $By�Cr-ConneCiion n� � � �" �. � � Date � � : I AdD�I<apt � � ' �' � � i � . . . I1 �, �-�; I., � Cookiflg'UnR t� � � I[. �t MBtet up(O�t00amps� :� W+ I' � ��' EXEMVTION RROM WURKERS' COMVENSqT10N OECLARATION� I i . Cletifi2r3 C � y � � 4,) t..� � �$pllf�Collett0�f i I i� T. �: ;'• � S i; DiShWeshe� �� i� � �:p �� ', MBt@i 'OdvOi 100'e pf �� f'_ � L � �(Thif sectlon MeE not be completeE I/ the permit Is far one huntlm0 (5700)'or � . '' ' - �� ^ � �- IBSSI: � I 1 �. 1 I � i ' ' I : 1 � DishNeShet.S I�'. � :' '-` 6 e I . I ". i . ! $pler-PiP��!B � ;: � � 1 5 j ��; � i '�, I d� i = Dryere ;OGas jG�Eleciric 1' I . �� . �, Su Parm"I - ° � � ' y � . I<errt Ity Mat ip th! perf rmance of thelwork lor whlcli thls�pe:mh Is IssueA I . 9 _ - _ • ^- � • � S � . �]�. �u � i, !`� � T i shall not em0�by aoy parwn In LII mlanner so �s to'become sub)ect to the ; Drinkin Fountaini �„�. j Soiar Tank._ �.�., � T �. _ f�.. � Fan �� ' ' D � Workers' ComOensation Laws of G�Itomia. i i � i I � � � . • . . , - ' ' ' ^ _ . „ � n I c � %o � ^ � .=. � I r � Mq?as O�Y1.HP��1 Xy 8 N, � .�,� � ; , , Date� � � �T51 atuie -=1 t Flobr Dreins � ! " I " ^ Swimmin Popl w/Spa" ° � • ..NOTICEv'I1�a/tec.njaklnp.th tlsclautlpn,.ybu.shoWtl.Oecome.aubinct.to.th�:_. I ' � � � I .0 I � I `� F.A.V_,� _� . .Inc sois.O9;t5 Nr Oi�is+l ' I f, - : , I _l_.l.�l.._. __1 _ L " 1.... _. .. ' r Workers' Compensatlon �pro slon! of the Lmbor �Coee, you must forthwltn � Flobr Sinka � � � ` I Urinel � � . � . p � ` . I Fixtures � comply v/ith �such! prodslotls or tblf Oermit shall be tleemeE rsvoketl. I - � 1 � �--� � f I� �NittMM1avC, I � I I � j � � CONSTRUCTION LENDINQ A6ENCV I, i I I I � � GBsSBrvICa � � OU �IetS � � WeM� CI058t �� (, I � Device Bakn � I hereby afOrm�Mat'tnere Is a ConstiuctlOn IenCinq agenty fo� lhe erfo}mance I_ � PaIB �ighti I � ' � � ro ; ol the �Arork � tor � which tnls permit Is Izsued (S�ctlon 30�7 Civ. CJ �� . .� I � . � � � : i t � . 1 IntercePtors � � � � � Water Heater � . { + � � (. . Outlets ( . � � -' � qe�ge 3� � � ( � � . � � � LenEar'S !Name _undar:: MCaess._ i :. - !. I . f i � 1 � ! _' Kitchen Sink l_._ Water ServiceG -. ' +�-. ' {-- 1 --+. -" -�- . - I T'_ � - . � �..�' _.' �'. . _ . �. . �.-. �.._ �..., 7-' Switche!' " _ J. . . � "' '! , OWNER UIL�CER�ECLAf�ATION I � 1 �� I { • � � 'I"" I.1�._- � �Q��.J'�� '"F_"�- � i I he�eby �tOrrp tnat I aip ex�mOt I��om tne Cont actol's Cicense Law for t�e I i LBVBtorils , , I � Auto-Wesh � � 4. . � I ( I GerbB e Df S91 : � ', f A ` , ' 1 - ' foilowin9' masOn (�ttioh 7091.5 Buslness aotl Proteszlonal Cotle: Any clty; or ' � ,8 ,$o , Standin $ectiOnS � �� i county whlch rrequ ms aiDerrt)It to;constructJ alter Improve, tlembli>n or revalr i ; p_Trep � � I � � � �. �,yundry,Trnyt � � � I � I Geneietor ❑ '�p�p� I � � I � i � any sVUCture,� rbr to Its bSYente� als0 reqUVes t�e apP�ltanl /oY such parmlt ,� � i 65 KVd� O5•�75 KNl Trasli Com � to }tie a dl9neE statpmeM t�[t he/c�e U IlceAsetl Dursuant lo lhe�p�ovlsloni of � q001 D�ein3 !, � � I.'�� lha Contractor's LlCenselLaw (ChaOlery (commeqcin9 wltn Sectlor 7000) of 1 � . � � , . . . � ' � 1 .. { ' 1 �_4___,_,v _ -� . �� .. . ' . �. ._i,l,_i`_I I"�_ ` ! � blWSlon-3�'of{tM•Bmhnsr�tl�Rohstlonf+,COEqI'or;thatlhelipeN'emmpY� -; . i- . -� � 1 1 '-- t"'.l -I � I herlirorr� anO the1basis'/or lha elleqed exemptlon. Any vinlatlon o! Sectlon � � � , ' I � ,�� .�' �' � I !, �` � I � � f i • �_ � � � .. � � � µ.��]31.5', �1Y any apDlicant tOr a iperml� sub�ects th4 apPllcant to� a dvll . .� � I T� y:"enaltY ot natlmori tnarl fivethundretl Aollarf (5500). i 1 � I � I f � i � ''� I t 1 1 � � I � J � . ❑ I� af owner o1ltKe�p ro�rty or my embloyees Wlth wagas�as tryelr sole � I AainfpaQiOn FN� S15 �;j ,� IstUBF� � �, S'3 � �. � �. ��. .,.':f '..) '� '. .�� . � ,� �.. �(„ � 1 � � ( CompMsatlOn wlll�d t e rk, �G the strYcture IS Oot IqlanGetl o�offereE ' ' ' ' ' � " �' ' Rlin � � 4' � � � �R � '. . �.. . �ctun.FN�f'.l.7 �518. -j .IowjFae.'� � +... I � �.?? 9,'' p ror,sa�e I�c oR- 0 eu ness�antllPropssioqal'Cotlm�TMlContractor's� i i �� ( MECHANI AL; � � J � 2FEES C � Llunse lilw EOM �otapply lo an pwneh of a propery Wfio bu11At br ImproVes � F � theroon, 2n0 whC {1o�s such worN Illrtualf/MerseN or `hrouy b nU or �er own � , � � Y ��y � DEVELOPMENT SERVIC�S REUUIREMENTS: b �' ' � emDloyaas, Dr4vpf_ W tlfa( su ImDroyemantF arajnot (ntentletl or o/fera0 for ��oflar ,� _( � ! IHoi�d or : Type I j� .� _ � � �w�i ,ry.�. � r � � ` � !�, I^� �,� � S� � W 4�a1e. I/'.nowewf�tpa,`Qu11E1n or Improveme t Is soitl wlMln on�yoar o/ com- � � Ce�}apy i Typa II ❑ t� �Za�i�B A rov�d f• � � � pletlan; lbe;od'ner �wNY Nava, he burden Of p�ovin9 he/iha 010 noI bulltl or im• I Du4�l - UOd�f i�irou{td ;, f � �:_ I t '' �' � r '� �. rove tor�trro qur�anf sale)� I 1 f 1 � i �"�� I ' �e ! . • . � � =� � �� I i Y A y Buiklin9 MProvetl� •�J ' t=7 - �. {� �` � •net� {�7 �' � I i �•1; di awrar, qf, the prowrfy, arh�ikclusiv�ly� contra�tlnp:withjlb:eniao con• I � Duct - Structural I Refi iperation Syrtem � �''"-' :� � lipplifation IouW By t 1��+�`"� :_'.'� � �� ' �'.nen� �17� � vacton tc t6nstrud th0 prolx�, S�ctlan 7040, BusinasS an� ROPostlons Cotla: "• ' ' � { � �.�r - x � . � � ^v ' � - �� Tna7ConhatidrY,LiNnse�L`aW�,�oes:aotaoDly:toanownermwopertywho Duct-VBnti1Mi �0700,0008TU,�1�OOO�TU'�ri ' f i ' ' - g u y bullos,or Improwz; tner�or�, Yntl who Coritractc for suth D�ojectt •hil� a.con- ' " � � �' � � - � � -! = � �' ?' � � : � � L �u SUMMARY OF FEE6 0 ... y � � tracfor(t ncanu pwzti�nt'to�llW CaitraCtor.'s LlCenseiLew�. I am awarl�tha� -i I �� ro' S it mfle /Ake �' �� BUI�bING PERMIT $a �'� � � -� �SMIP �' Sa I' � -� "Y , .�` � oroP1 �o�(tbelc Wor�k9r9' Co pmsallon' Insurance snoulo be drov'eeE to mr, �; Exheust Syst ; ❑'�Multipli � p: y 9 pair �-�atipo c .c r�. � f: � � u� �-� , �'.� ^, I_� � � ' ta� � �� q'' � �, � ❑ti am exemPt unaen5ectio� � � ;;BJ d,P. C.�for thq reas r, Fire 1/Fect Blt: IC80 � '" �� FiielDampen % f . S' -. I P�N CHECK I �5�� • �PEf�M1T� p� w�' ':.t � tN t '� i... i I��- P iy � i� i P _ _ I i � , i c'' I �`,a I PLUMBING i �d I t� S.y I�r .I -7 I I r' ISSUAINC��SC'� N,;Ca u �., I Ddti " - � `�� • .O neV _ =. I .� I 6 Heating SYatem�8 Ducting'. � '� ,. Regist�t „ I .� � < ! : � `ii =, t Ui � :. � u� � � ' ^+ � � �i � D I � � � �`' � � r. ; �'�' -� PLAN GHECK �Jj5y, IS�. �%I I" � m�.I T, ENERGV P.C. I$�"'. � tioeti� 'cuury';inatrl hdde�reaE�t aDo��atlon ana stata tndt "tne a'tiove' ❑6100,000 B7U �100,0008 - � i ; � � � �� i • t-- . � ' ' ^ ' ' � u • � (� ° I rt� :'7 y � � � 1'� ^� � � .R2 i': i :- � ``rs' ELECfRICAIui� _ �S��yGRAOING IS y'- � Inlorma lon.ls colrect•.I ayroe tp Iy with all�dty antl counl ortllMntas. -: � m - t ..� � c � 1;.` � �'t �. i ana,suta�lawYrpla �to bu Iding nslructlon, antl henny wthnrize repre-; � . _ � � � ,n - - . f � „ I ' � C ' `p y; � " � � � � � � $ � I -� . � + � i _ " � ' ; � ' � � } I o u MICROFILM� S •� . Sedtallws� ot� ��b I y; to �e�lo pon' ttle� aD m-mantlonaO Oroperty: Porj, �• �.�' i^ . � :.1 f ,� y_r 3 i PLAN�CHECK ��F'+OA'r� fN ��) �� f ��, t�f � A . :� c� ::0 1• 3 � -7 i) � - s n �. � I ,,� � w �n c InsDxtlon olirpos I I' i i � � 1 I .., : I � -{ '' i � '_ , � , �`� - ! �i g% � � Siqniture' . ,. Oate��/%',�li. I i � o+ � �- j , rt� 'x •�+ • o�: �.•o t -. . �-.� �:�'�+ � � �, MECHANItCAL'� IS� _y � N � p�TOFA,L�EE;,; �5�. �',± U � : � Drivers'�Llcens6 0� •5 � � y ��" � r �'^. ��.' RNmpsetlon Fea �� : iS16o '. I ✓� �. In�a�FN i? ': o i'� S�3- �- j � i PL'AN�CHECK �-;59f� S- I . I I � 1 , . � � � _ , � . . ,. � _ __ ._,_. ._...__..._.�....._ _'.' _.. ._.. . _ . . .. _'_' ' "_ ' "' . ' _ '_ .' __.. .._..__... -.�.. _...-_.._ . .- CMF 0865-46, rev. 70/B4 Wnite - Bulltling; Canary - Applicanl; Plnk - qccaunting; Go�tlanrotl - Assessor ' . .. . . / __ ___ _ .� __ . :�.�.-- .,-�:-:a:.._ - - ��-.�::...--- _ ---__.._ ..�_ _--�--__..__._.�.......�, � . ..� . . _... � • POOL& PA�:�i�•W�a :t��S.O�A �6� CONSTRUCTION AND PLANNING...- ` �, -,--.{- ,- -;--.=-- � -�-• � � --�- � N .aq. ' APPROVALS ' Permit q�T � �Date � �Inspector` ; APPROVACS rmh �� ., i Qate 1�paetor �°•y 1. Temporery Electric8l Service orPole + � { 1 i_� � 5Y. �ool_& Equipment Lpwtion �� .j� �� k � 2, Soil Pipe-Undrgr�d!�� . p� ' I�. i i � 1 � �`�53. 5teel Reinforcement� �� j-� i � �^ i 3. Electrirel Conduit lhAit'-E1ndr�nd. � � �-• 'S4: Foimsl � � Y� 1 . I ' I � j Y iIf# I, - _ _. ,1�l.�(l'.iI ' � - i `� �5. �Ele� ricai Boi�diri ` � 1 � � �� F� 4:• Elec[ripl Conduit•Undr rnd. � ' : � - ra, � ,iI_3� �, r�._ ,9 l{:i,� -1� R 5 � SteelJReinforcement � � � , 4 � �'. � i � .) „i =C�6 ;Raugh#Plumtiirig & P}essure Test; � � i � s� �� - " 6. Electrical UFER �md. 5� f{�: ��.I �'m j�( Q57- �AP�RDV�L Tp�CO E-GUNITE � � � �;; i - I�,� -�; 7. Footings � �i � a, r j � >; i= �:� ��, � 4 t C. i_ 56. �Elec(r �cal ronduft�l"drgrnd. • �=..i � � i'�� '� , ,, Y - , , : ... �-. � � -, ms � .� � }- �-� » 8. Foundation' v II� � � 3 n 1 i� � i��8.'Ptde: O"tlA'drgrrM...Test .i. !. i � I , �, 9. Water Pipe-Untlrgind. l ; s � 1 � r � � � � � � � ; u p ; � g ' ! . --�-�---+ � �-H0:-8eckwashfLirier;P� ❑�U„rdr_ . d i-- I � i � - : � ` ' � ,u 'i � �, 'i =�1 � i � � � ,�i lwoeo�.�e� �Tvvc K ,.T;'.y'-rti i..,i'. i i i � A . � 10. Structurel Floor Svitem � �. ; � �, � � � _ • �� , �, � � � } � j � ,� ` 7!. P:�,.^e�:y Sewa��Line Fi Ho �� ,na� ;�n' `;`• � i i l �� Ci�t .a:zxash'.'Si Receptor Firial' ��- i j Et - c� a ' ! �i -1 i i � � � w i �:�s'v�- . , ! } � � �.. ��= 12. Sewer CaP '_ �.: '<�^ j j j I %' i j. � j G3. f1e'ater. ' � � k'� {',.'S"_ �' i`` i � I � yt ' - i ` i, i � i& Ve'rtt•F�nal �Y ,,.,jK, . U , , . , : 13:�Roof Drains. r.� I�' `� �".�'' t I; r�=.' !.: j .i 64. Plumbirre Sjstem - F nal 1 I! j; �_ � < S;� t. i i � � � ��4.� n� h"P��irtlbl❑ ��- ',-.', J. F� i - i { y'. , 4 � � "� " t •- � [ • i3 i: � •1 ��c �i."Elec[iical-Finel' i i �"� � u9 . 9 : � ' 3�;� I � � .�:J.�� :.I . (<- : i 9 ��is� 1= k � 15'Rough.Elect�ical-Conduit ` ' ' ; ' i � ; � � - � - . ' - " - � ; , ( � _ � _ � 1 : . _ - : �= 66i Solar,System-Final � -. , � :. .,Yta i � .;i ! �=�t�. �. �:.( ..?: `- 16. Rough Electric WirinB � - '?�� -��' 67. Fe'ncing &'Access �ro'va�! � i= �-1 ` `� , _o� - r-�_ �:: � �.. . � °-77.'Rough'Wi�ing Sign."-"""".-E' ; -� - -' �."'._"""� """" `�'.'`(""` gg'. APPROV'E�FrOR F�,4STERIIfG �� !�� ' 78. Rou h Electripl-T B'ar�Ceilin � - - r - -?-r� -- -- -- ' -'�--� - �� '�- � �� ; ; • _ : � � 9 , 9 �j�,-� i 69. POOUSPASYSTEMSFINAL ; ,�6 ?" 19i Rough Heating & Air Conditiqning � �; j I� � � j FIRE DEPT. REQUI EMENT i e_ i� '' � s`% � : , � ._�_ _i_�.;._� . �; i � ; � '�. -? 20. Rough Factory Fireplace � i' i � � !'' I APPROVAL6 -T ?ermh qW '.� �; i �.� T� ` 21 f DuCts., in Structure � �. 1 i � � ! '.70. Undergiound Hydro�� I' �.- t u'�; � 5� �,y_._�� - S 22: Ducts, Ventilating' i_. �� ' i �' I �71. Vroiluct Piping O Gas Q Oil j o:+ �� ` j :, � �` � L Vf r 23. Gai Pipe•Rough & Test = - l . _ � i �1 + `72. Undergtnun�+ FI�� h i; ' �. -} � � �. D ��. S - - � ' �,'� .� :. : i _ , � � . � � .- � . -. , � - _ , _! c.�; �= 24. Roof Framing . _ _ . _ _, � . �73. Undergirid.StorageTank OGas ❑Oil , :_� _ 25. Roof Sheathing - _ - � - � _ .7e p;ror!:a±d }+y3.� i ` �' "'�i i - ~ f" � - 26� T•Bar Ceiling'(StructuraQ'& Monocoat �` • i � c �75..Dry Chemicel c.:I � � �,. ' � � ' ` - -j �,j : _. _ _._. . � � _ : __ � . �..� _.__�� _�. -- -• --,t , �, .. F ,o > � 27: Frome and Flashing "---� r ,::; . -- - �-- ._ �'� �. -76. Dry Standpipe• k �;' � " ; j - ;.:i - 28. Lathing & Siding i � ' 77. �FIXED SYSTEM FINAL a ' C �k,.'� ' " �y ; '. 4 �', : , 29. Insulation : � . " p . i ; 78. FIRE PREV. FINA�! ;; ' ; ; i: _ S� � y� ". � 30, Drywell Nailing � ; . ' , , , � � � � ! i � ; HEALTH DEPT. REDUIREMENT �_� s; '-= `. � � � 31. Plaster Brown Coat < ' ' � ; ' � � 79., FINAL INSPECTION �' � " ' :, - � � � . � � J' ��: a ; .. .. • .' ' , i . � 1 ' �: (:. l.• .� (� i / � 32. Electripl�Power Meter-Final '_�� 80. FOOD CERTIFICATE ISSUED : v= _ , 33. Fiq21 EIBC[fiC . - �� i � ^ i ' �NOteE: ? ;' ' o ( ' I � � i ' n- - f -� � � V � ! i - {'' ' ' 'i:.J. I�ji: '.a ;j�n� �'7. _ � 34. Final Heating & Air Conditioning � - � � ' = `' � - - _ ,. ' �' ^=,��_y � `: � t � ' , ^ /_„-` ` � ! _ � ..yf -" "c - - - - - - � '"'_ "' _'_ _' _' _-__" '=. . 't .�p.. » ." ' '_ '_ "' ' .' - _ � _ 35. Final Gas Pipe-Test � � � _ � ' . � � . . + L.....� - -� --- -- - -- - �.. _ .�__ .. �_.__. - -- -- -------- -- - ----- - - ---- 36. Hood or WnoPY . --- - ;' - �, k %, ..� . _ �: � >c j -_ � � 5 37. Final Fac[ory:Fireplace " �- _ _ � _ . _ _ � = �- __ ' � , �' l : � r � " � • � � _ , _I .38. Final Plumbing � . - . _ -_ _ _ -- � - . ; ,-_ " . . � � . .� ' 39. Water Service-Final - ' ;; _ = _,_ : - _ _ _ - _ ='- - � � . - � _ - _ �. � � 40. Gas Se[vice-Final . - _ _ c 7-.. � ` - . z _ - _ _ _ _ _ � �:=;< - . . : . _ y � ' _ C S '� . � ,�41. Solarpomestio-Final. ' _ - - °'-. - -- ^`= _ �`• s3x"'' , - . ' • , ='; . D � _ - _ � � i - _. o i � "t � ' - � i 4.. i . �'42. Backflow Preventer � � � � � � _ - -_ s '.' � ; - : � _ - � , , _ , r ,. . � .. t . - ' . �i�' ' ' , i' _ i .4�g � . �.:.- r , .- . io. . _ i . . :.' � j';43. Badcflow Irrigation - - ' - - - ' 1 - ° ` - - __ � s ; _ � ' -' ; � _ _ � � � �; � � :�. �- s, Z :� - - - - ; x ` D � _ != . �.� i � i ;44. ,Landscape Irripation System - - -_° _ 's: - _ - < � x � � - - ` h' `: �' 1 r : `-" ? - - - =�::' - - � -_>[ i i a" r�i,.,__ ` � - _" ' - - - - - • _ ,, Q1 45. Sound Attenuation : '.�e�- -" - ` -.._ _ _ • . �.: v>`' ;>-- -- e�ov� -�,..L i ` �Y� .;.;� "`- - - - r -- - 'zr- -� rc' L t � " Vti = - :r-' - -- - _ - - :-. ... - � � - -� i ! c i � = 46.HandinpReguletions'€._ -�i�--- '";,>'r i:- - F;_ - -"�p _-_Y i • 1 k. �'!: f. f . - - �_: ' _ :, `. � . ' . 9�;�7. FINALSTRUCTURE&BUILDING ' _ � ,i zr . a> >`S � � _�i :" � I r��.R ��',: N � � `46. �Special Requirements�Cqmpleted `• ' ° - � = E„ � -' � � = -+ - � _ . ' _ -' `� � �� yf� `J N� q - �ii � �49.-ElactrieReleaseto'Edisonz --°"___ _ = -_ - -�? 'e' .= - ' , c� -"- __ ' ' , ,? ; ` ". - _ ;4'� _- " 3c,' - �c'�a ` ) : -." '. " � `50. Gas.Release to Soirthem California Gas Co _ " . - � ` > � '� _ � - 'w - �'. R k a` v e u-��: 51. CERTIFICATE OF OCCUPANCY = : � - • _ - � e � f - =, _ _ _ _ = �• - - ; ' _, F . �No � +Date. _ ... . -. � ----=- - ` -- - -- _ � _ . � � .. - �, �. - -'- - --- -'----- -_ ------ ----- COUNTI� OF OAANGB BUILDING DEPT. , 636 No. Broadway Sdnta Ana� California Phone: KI 2-6211 1. OWNER'S NAMf MAILIIVG ADDR Name..--------------" Address .____._.__._._ City .... .. $[ate Lic. No- ----------------- PROPOSED USE: 2. JOB LOCATION. 3 4. 5. Application for. Building Permit AND FOR A Certif�cate of Use and Occupancy Pecmic No._�--Y�S__� -- Date.______�-��. �-----________________ 7- or Engineer) Phone ___._ Name------- ---- -----------------------------'--`---------------- (Contracror) Address------- -- ---------------------'-------'---------------- City-------- ------�-----'-------------------- State . Lic. lVo. -----------------"'--------- - Phone.------...------------------ (Ho�sc iYo.) (Name of Streec) (Town or School Dis�ria) LEGAL DESCRIPTTON: Lot .------__ ------_Block ---__-________-------------__-- - Trac[ -___-- -.'------ (Meres and Bounda Description—Use resene side of form) _ M. CORNER LOT ( ) INTERIOR LOT ( ) THROUGH LOT ( ) SLOPE OF LOT ( SIZE OF BLDG.:....... AREA:._.�/_CL_D_____.._.__.SIZE OF LOT:_SL�.3D�REA: _.__._._. 6. HEIGHT OF BLDG.:..____..__________._._......_._...CEILING HEIGHT:.________________________ _____ NO. OF STORIES________________ 7. NO. FAMILIES ..__._, _...._.....Size of Smallest Bedroom: __._._______________._. Size oE Kitchen: 8: EXTHRIOR WALL CONSTRUCTION:__�!l^��__�:.INTERIOR WALL COVERING ___ (Frame� Stucto, Etc.) , (Plaster-Drywall, Ea.) 9. SETBACKS: Front Yard from Center Line of StreeC---�_(,.L'_-'-------_-----_---'-_--__---_-_--___--__-_---_------_---- ('�� ^/ Nearest Side Yard___.�J....._____....Rear Yard.___��__.Distante in Fcet Between Bldgs. on Same Lot.%r ..._�-�___._.__ i 1G. A COMPLETE PLOT PLAN IS REQUIRED, SHOWING ALL STRUCTURES AND USE OF EACH. 1l. For Accessory Bldgs._and Similar � Structums: (a) Footing: Width Depth in Ground (b) Sizc of Studs: --"'--'-------'---------Spacing----_"----"------------��CC (c) Size of Floor Joiscs:. (d) Size of Ra£ters: Spacing $pacing ____Width of Wall Material of Floor .._.... -- -- "cc. ..____' CC 12. VALUATION OF PROVO,i�D WORK: Includi� all labor, plumbing, electrical wiring, hea[ing, fire sprinklers, paino- /r� , . ing and sewage disposal �.__./___.. a S�..C.-O y___ _. '_____ 1;. I HEREBY CERTIFY THAT TO THE BEST OF'MY KNOWLEDGE AND BELIEF THE I[VFORMATION IN THIS APPLICATIO[�I IS CORRECT AND THAT THE CONSTRUCTIO[V � WORK WILL CONFORM TO ALL LA�K�S OF THE CpUIVTY OF ORANGE AND THE STA OF CALIFORNIA PPLICABLE THERETO. � � / � � J - --Signed: �l_-""--- a'� --------------`------------- ---��- --------- --- �L . .• • _ PlansFiled:."--'- --'�---------------------"-------- '-/� - By. J �� GC� pPR7 0.. FEES: �j Bldg. Pennit - $.-y_--�qi-`-�'--�-- Plan Chet: - �--n. 1'"_ll_/_�Q____ Total - - - �-l.�r�3 -Q y----- Receip[ No. - - -'---'-_--_ _ ---- Paid to - - ---��------ Date ...................."------------'�_��-��^�! !� / /'� L DATE.-/�----- L - /._�`�--�J -- - --------- SM-9-SO // / // �- FOR DEPARTMENTAL USE ONLY GROUP.__.__.� � TYPE.---------- � ---- ----- DIST. �b � �// MAP.---�-- C..=-----f--'-- -J`"-- SHEET NO._____�___.._.____ (Authorized CHECKING BY APPLICATIOI�ic� f-up HEALTH.------------------- FIRE ZONI[VG_---�-------�R- - MARSHAL-------------------- PLANS A[VD SPEC'S. --- ------- ------ STATE -- - CORRECTIONS ENGINEER VERIFIED ------------------ CAL.---------... � ��