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Home My WebLink About990 17TH ST - Building Permits;vasT � �m[: sTa�.^r 3&813 - comp. 30473 - 10-i-69 zJ See__cr.cc -$1.0,000. �_1ec. :�C (�_yee� � �eterj � ��.�o _ B15779 - 'NEW �M4 BIi)G 580,000 _ PC34784A a ��o �� _ P-1� � SEvkZ CAP _ � �� _E17279 �q� ,.. _ � 8 /Y B�� a15779 . . �' � _ E17369 pp�� ppig � � 8T B15779 �� - P17430L_/g5 �'�-� P/�•r - ��0 - B179 3 HLK 47AI.L $$2,000 �- -8�J�77�S - M19136 Y�Ja�s � —O � p�28�— S1HIC - ��s _ E-20342 WORIC [PP1N - �/G/Q� r ;=3J ��' - " _. �' . ' 7r" � ... � .� AOP��ant to fill in all spaees axcept tnose w(tnin �eavy CorEer Iinas anC si9n au avoroor�ata aeeiarauo�s. 9'c� I O J� � J� V 5 pl� � � TL CIr�Y OF COSTA MESA CONSTRUCTIO�V PERMIT i— r'ProjectAddress G�!Q {'✓�(-'S�' �71� SC�ee'` Applicanl's Mailin�dress C�O n-S� Q yi i�i�.Co i�M (i��- Owner'sName ��-' Ch�� b�liorte s•2Z2� Address 7 3 g wC:s �' i'� 6i' S L`� i2 eet� Arch/Eng. License No. Address Contractor's Nam Phone Address (mailing) �% � Ciry License No. �ICENSED CONTRACTOH DECLARATION I hereby affirm that I am Ilcensetl untler provislons of Charter 9(commendng with se<tion 7000) of Division 3 of the Buzlness antl Professlons Cotle, antl my licenze is in tull torce antl eftecL�+� License Class h License No. Date Si9nature WORKERS' COMPENSATION DECLARATION '�hereby aftirm that I nave a certilicate ot consent to SelNnsura or a certifiwte t Worke�z' Compensation Inzu�ance, o� a certifietl copY lbe�eof (SecUon a800, Lab. 0. � /� �� Poliry No. ��0 ComDany��f �'^•� 8 Certitietl moY �s hereby fu nishetl. , / Certitied opy i5 �iletl with the city Builtling O� �e(.�.. �� Date�� APPlicant_..�e�•EY�fy! �'�`� EXEMPTI N F OM WORKER�' COMPENSATION DECLARATION (Thiz zection neetl not be cOmpletetl if the permil is for one huntlratl (E100) or less) 1 certity that in Ihe performance of Ne work tor which tnis oerm�t is issuetl I shall not employ any person tn any manner so as to become subject to t{�e � Workers' Compensation Laws ot Calitomia. -Bate Si9nature 'NOTICE: 1f, a1[er making this tleclaration, you shoultl become subject to lha Workers' Comp¢n5alion provi5ion5 of t�e Labo� Cotle, you mu5t forthwith Compry wiN such p�Ovision5 or [his p¢rmlt thall DG tlGGmetl revoketl. . CONSTRUCTION LENDING AGENCV ' I hereby ai(Irm that Ihere is a mnztructlon lentling a9ency for the veriormance � of the work for which this permlt is issuetl (Setlion 3097 Civ. CJ Lentler's Name Lenaer•s Aaaress OWNER BUILDER OECLARATION 1 hereby aHirm that I am exempt trom the Contractor'z Llcense Law !or Ine following reazon (Settion ]031.5 Business antl Professlonal Cotle: Any city or county whith requiras a permlt lo Construct, alteq improvn, Uemolish or repair any sV ucture, prior to Its issuanGe, also requlres the appticant tor such permil to til¢ a slgnetl statem¢nl [hdt he/sh¢ IS IlcenSCtl pur5uant t0 th0 Pfovlsion5 01 the ConVactor's Ucenm Law (Chapter 9(commencin9 wi[h Section �000) ot 'livi5ion 3 01 the Bu5ine55 antl Profes5ioni Cotla) Or [hat he/ihe is axempl ieretrom Sn0 the basls tar the allegetl exemption. Any violation ot Section J31.5 by any applitanl for a permit subjects [he apPlitant to a Civil �enalry ol not more tnan five huntlretl tlallars (E500�. 1, as owner ot th! Prope�ty or my emplOy¢¢5 wil� wages as lholr sole coTD¢nsatio�, will tl0 [he work, antl lh¢ Struttute I5 not IntanGetl O� olleretl fOr sale (Section 7044, Business antl Professlonal Cotle: Thn Contrdc[or's LicenSe Law tloes not apv�Y to an owner ot a pmperty wbo bui�tls or Improves thereon, antl who tloes such work himself/nerself or through �is or her own employ¢es, prOvltl¢tl that such ImprOvemenl5 ara nOt inlentlod or ottcred fo� Sale. If, however, lhe builtlin9 or im0/ovement Is soltl wlthin on0 Yea� of com- pletion, the owner wlll have the burtl¢n o1 provin9 h¢/Sh¢ tliU nol builtl or Im- �av! tot [he pu�pOse of Sale). LI I, az owner ot the property, am axclusively contracting with Ilcensetl con- lractors t0 construcl [he Projecl (SeCtion 7044, Bu5Ine55 antl Prote55ions Cotle: The ConVa<tor's License Law tloes not apply to an owner ol prooerty who builtls or imoroves thereon, antl who contracts for such Vwjects with a con- trattor(s) licenze Pursuant�to tne ConVactor's Licenzt Law). I am aware that o�oor o/ Iheit Wor4er'S ComPensation insurante sttoultl be provitl¢tl to me. ❑ 1 am exemp wtl c ron B. 6 P. C. lor this reason �ate � Owner _ I hereby ce�tlt Ihat I have r¢a0 th iniormation is correct. I agree to con and state laws relating to builtling ca Sentatives ot thi y to {pp u� inspection purpo � Signature Oriverz' License or SS $ above 1dOC25 r¢pr¢- Y . tor TVPE OF CONSTRUCTION D'� NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OT �R OESCRIPTION OF WORK/USE OF BLDG. TVPE OF PERMIT LJ GRA�ING LJ FOUNDATioN LJ STRucTURA� ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER PRWECT DESCRIPTION 5�. F7. Z ocCuvnHcv_ CONSTRVCTION TVPE VALVATION 5 2,()OC ZONE GRADINGCU.YDS. ACRE� Remarks: /•20 � �. � �r •,in _ �is ��.� � L.J � � Preventer Irrigation Drinking Fountains Floor Drains Floor Sinks GasService Outlets Interceptors Kitchen Sink Lavatories Roof Drains Service Sink � � Sewer Cap Sewer Connxtion Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto�Wash Reinspaction Fee I $15 I I laue Fee I S 3 I MECHANICAI FEES Boiler Duct - Under Ground Duct � Structural Duct � Ventilating Exhaust System � Multiple Firepl/FacL BIL IC80 # Heating System & Ducting ❑0.100,000 BTU �100,000 Reinspection Fee I 515 CMF 0865-46, rev. ]0/84 White - Building; Canary - Appliwnt; Pink - Accoun[in9: Goltlenrotl - Azsessor Hood or Typel ❑ Canopy Typell ❑ Re(rigeration System �0.700,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers � Registers Isue Fee I $ 3 A.P. �W S Main Buildi E T Front B Rear A C Right K S Left Ping. Ref. # Planning Notes: Automatic Washer Construction Pole $ub. Caoking Unit Dishwasher Dryers ❑Gas ❑Electric Fan F,A,U. Fixiures Device Boxes Switches Garbage Dispowl Generator �0-5 KW � Reinspection Fea � DEVELOPMEN7SER 2oninB'Approved By � Buiiding Apprawd 8y Aooliwtion Issued Bv_ 515 .BUILDING PERMIT $ PLAN CHECK $ � PLUMBING $ ." PIAN CHECK 25% $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICAL $ PLAN CHECK 25% $ Zone 0 Parking Req./Provided ELECTRICAL Transformer ❑ 15-50 KW ❑ $O+KW Meter ❑up to 100 amps Meter �over100amps Sub Panel Motors O0.1 HP O1 h- 6 Inc. Solar �9-15 HP 016�15+ Microwdve - � Pole Light Range ! Standing Sections Trash Compactor luue Fee FEES $ 3 SUMMARV OF FEES � SU S1 5� SMIP $ � • � � PERMIT ,ISSUANCE $ ENERGV P.C. $ GRADING $ MICROFILM 5 TOTAL FEE S - �' � 3 Z O N I N G H E Q M T S ' CONSTRUCTION AND PLANNING ' POt , SPA - � APPROVALS Permit# Date Inspeetor AppROVALS Permit# Date Inspector ' 1. Temporary Elechical Service or Pole . 52. Pool & Equipment Location 2. SoirPipe-Undrgrnd. 53. Steel Reinforcement . �.3.. Electripl Conduit Utility-Undrgrnd. 54. Forms - -'" � ' 4. Electricat Co�duit-Undrgrnd. - 55. Eleciripl Boixling �� , 5. Steel Reinforcement � ul 56. Rough Plumbing & Pressure Test • `� � . 6�� Electrieal UFER Grnd. 57. APPROVAL TO COVER-GUNITE . , - 7� Footings . ' �y � �/C 58. Electrical Conduit-Undrgrnd. � 8.. Foundation '' . 59. Gas Pipe, O Undrgrnd., Test �, + . 9. Water Pipe-Undrgrnd. �� 60. Backwash Lines, P-Trap, � Undrgrnd. � i /.Y 10. Structural Floor System - � - 61. APPROVAI TO DECK . 11: Property Sewer Line & House Connection , h ', 62. Backwash & ReceptorFinal 12.'Sewer Cap . 63. Heater & Vent-Final �� 93. 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 Elec[rical-T Bar Ceiling .. 69. PQOL/SPASYSTEMS FINAL . 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace � _ APPROVALS Permit # � 21. Ducts, in Structure � 70. Underground Hydro '22. D.ucts, Ventilating �., 71. Product Piping � 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-BarCeiling (Structural) & Monocoat � 75. Dry Chemical � 27,c Frame and Flashing `�• .'� � 76. Dry Standpipe � T8. Lathirg&Siding �� 77. FIXEDSYS7EMFINAL . i .. 29. Insulation �' ,.' 78. FIRE PREV. FINAL 30. Drywall Nailing �. HEALTH DEPT. REQUIREMENT 37. PlastefBrown Coat • - �% � 79. FINAL INSPECTION 32. Elect�i�al Power Meter-Final: : � � 80. FOOD CERTIFICATE ISSUED 33. Final �lectric Notes: 34. Final Heating & Air Conditioning 2` %�„��. O�v . ��y�i 35. Final Gas Pipe-Test . , s ' - _ 36. Hood or Canopy � , 37. Fina� Factory Fireplace � � � 38. Final'Plumbing . � 39. Water.Service-Final . � 40. Gas:Service-Final � 41. Solar pomestic-Final 42. Backflow Preventer . 43. Backflow Irrigation � � 44. -Landscape Irrigation System � ' ' 45. Sound Attenuation :.' . 46. HandicaP tgulationg ' � 47. FINALSTRUCTURE&BUILDING _ � 48. SpeciahFequirements Comple[ed - ' , 49. Electric�Release [o Edison , - . 50. Gas Relaase to Southern California Gas Co � ' 51. CERT,IFdCATE OF OCCUPANCY No� � Date � - , TYPICAL 6" CONCRETE BLOCK FENCE c�� co�,p oP��aw -- Clun�el8bdc With � �� Horuonbl Top of MI � Fencat fo► Hna� 6' a lsu • Vart. Ban 3/6'� �t 4' -0" O.C. For Fanas HigAsr TNn 6' — VeR. B�rt 8/B'�j �t 32" O.C. Fill Celb Solid With GroW — Wharo Steel Ocwn Reinlorcing Stad.SNll Conlonn tp �,A•1639 AS.T.M. AI! Stee! ta be L�pprd 16 " or m Cod� NATURAL(iRADE TYYO 3IC" BARS o � CONTINUOU8TOP 6 BOTTOM -� �� 0 yY�p7 p SEE G �' � BELOW o� N FOOTING REQUIREMENTS ,, GENERAL- NOTES MORTAR: Ora Parf Pleslfe Gmtnt, ond TAn� Pafs Sand GROUT: . pna pat Cement Tlira ond Orw Half �arfa S�and COPIN(i: On� Port Cement, TA�N Porh Sand CONCRETE: Well MiYa� 1: Y� f 3� Moi. ol 7/2 6ollons ot Wat�r Per Sack of Ceme�t (:t10UT MAV BE IOUqED�FROM TME TO► OF TNE FENCE , CELIE AND AREAS OF Npp120NTAl REIN• fORCEMENT SMALL BE CLEAR, CLEAN • iREE OF AL� MDRTAR DEBRIC, ETC. eowos sw�u ee rnowoeo sr ur�No BLOCKSIN6TRE7CMEpCOURSESS(ITMAT VERTICALJDINTSALTERNATE�IN EACN COURSE. �N OF'EARTNTCOTN V� 1ME NEIGTH OF FENCE �ECOW BOTTOY OF FOOTING. SCAIE: I/2"• 1' WALL HEIGHT �� 5' " 4� 3� WIDTH OF FOOT�NG 14 14� 12� 12� THICKNESS GFFOOTING 10� 10� 8� 8� DEPTM OF EARTHTOOTH 24� 20� 16� 12� SPACING OF EARTHTOOTH 12� 14' 16' ' 16� OWNERS NAME: ��LiN.�S_ DGWi D CM a_w1�2R S City of Costa Mesa, Galifornia �� ADDRESY. C/� CZ �e�� 1� �^_StQP,E� ___ Building Department �� 0 � PLANNING DEYT. 6661ER TO BLDG. DEPT. REO. tY.�.:l�.� DATE � DIRECTO! Ot VLANNINO 19° �- � � / �ibu.��-r�N I �'3%`,�'� % � �-1 i �� ,� � � IIit10[MC[ / / � � ueiotrc¢ y W N / � -�) � � .� S � N � I • .• •> 1 � �' I O ' I �1�10[MC{ r� w W F M I —� }a: 5�=-` I �i _.. i��tl'Z�I{t�.6�– (� - l�j'� �C� - ULo�.:� �vPLE.- .. �es� �STREET a _ - _ , Applicant to fill in all SDaees ezcept those within heavy Co�Ger Ilnes antl ilgn all approprlate tleclarationz. •CiTa' OF COSTA ME�SAr GVNJ; I t�iUG I�IVN YCtiMI ) . , � . Projecc Address `,/_q�% L�� 7 � `�, ,� �}�f' � rApplicant's Mailin{g� Address ��a1� -I J^^�•` � Owner's Name ✓�� 1 C� �% L��b2'%L�'�phone �� 2�'' Address �,_3 c,t' �'� L� �k S��' 2 tl+/� ` Arch/Eng. � License No. � Address � Contractor's Nam Phone � Addreu (mailing) ' � �`5 Ciry License No. � � � � LICENSED CONTRACTOR UECLARATION � � Lhereby attirm that I am Ilcensetl untler provislons ot Charter 9�(commencin9 . with section ]000) of �ivizion 3 of tho Business antl Professions Cotle, antl my Iicense is in (ull torce antl eHect. � License Class _�,� �l.lcense No. Date Signature WORKERS' COMPENSATION DECIARFTION. � I here0y aitirm that I have a certi(icate ot tonSGnt to selLinsure or a certiticate of Workers' Compensation Insurance, or a certifietl copy thereot (Sectlon 3800, Lab. C.) - L � - aoiicy r+o.'r� L' 9 GCC� G'ti'G L' Company t�^ t�5 ��^ Cercitietl copy is nereby fumishea. Dateerti�ietl cogY��wAPP ican[Y Builtlin9 Divisi-_ - . U EXEMPTION FROM WORKERS'��COMPENSATIO DECLARATION -�Thissectlon neetl mt be completetl if the permit is (or one huntlretl (y300) or 1255�. I certify lhat In th¢ perlOrmance of the work fOr whlch [his pe�m�t is Issuetl, I shall not employ any person in any manner so as [o become subject to the Workers' ComPensation Laws of Califomia. . Date - � $i9naturC 'NOTICE: If, after making thiz tleclaration, you shoultl become subject to tne Workers' Compensation provislons of lhe Labor Cotle, you must forthwith com0ly'with zuch D�ovlslon5 or thi5 pnrmit shall be�deemetl revoketl. CONSTRUCTION LENOING.AGENCV ' ' � � ' I nereby a(tirm [nat there is a construction lending agencyfor the pei(ormance IN the work for which this parmit is issuetl (Section 3097 Civ. CJ �' LenCer's Name , ILentler's Atltlress • � -� � ' � OWNER BUILDEN DECLARATION . ' � � ' ' I hereby aftirm that I dm axempt irom tho Contractor'S� LlcBnse Law for the �nally LJ i. as the basis for the alleged exemptlon. Any vioiauon or xcvon / applicanl fo� a permit subject5 the applicant "t0 a civil nore than five huntlretl tlollars (E500). ' � of tha property oi my employees with wa9es as their sole wi11 do the work, antl the struclure iz not intentletl or offeretl on 7044, Business antl ProfeSzlonal Cotle: The Contractor's ies not apO�Y to an owner of a proparty who builtl5 or Improves �ho tloes such work himsell/nersali or through his o(her own vitletl that sucn improvements are not intentlatl or ofieretl tor �r, the Guiltlin9 or improvement Is soltl within one year of com- 'ne� wilf have Ine burtlen of prOvin9 he/she dItl nOt Dulltl or iT- �rpose oi sale). � � • ot the prooerty, am ex<lusively tontracUng with licensetl con- t�uct th¢ projec[ (Section ]044, Buziness antl Professions Cotle: "5 License Law tloes nOt apply to an owner of Oroplrty who aves thereon, antl who contracts tor such projects wlth a con- :e pursuant'to the Contractoi's Licanse Law�. 1 am aware that Worker'S COmpensatlon insurance Shoultl be Orovitl¢tl to me. �I�am eaempf untler $eclion ��_ R B. 6 P. C. fo� this rea5on Date Owner I hereby certify that t nave reaa Ihis apPlication antl sta[e that the above information is mrrect. 1 agree to comply with all tlty antl county ortlinances antl.itat¢ laws relating'to Gulltling conStruGtlOn, and hereby authoriie repre- sentatives of this city, to enter up n the above-mentionetl property .(or � inspection purposes. � D �'� Signature _ Date ' G TYPE OF CONSTRUCTION LI NEW LJ ADD L�-ALTERATION LI-REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER ' _ � DESCRIPTION OF WORK/USE OF BLDG. � TYPE OF PERMIT GRADING. FOUNDATION STRVCTUi2AL ❑ TENANT�❑ ELEGTRICHL ❑ PLVMBING ❑ MECHANICAL ' ❑ OTHER PROJECT DESCRIPTION 5(i. F7. ' OCCUPANCv� CONSTRUCTIONTVPE VALUATION $ 20NE GRADING CV. VDS. ACRES Remarks: - � L, � � ,� 7 (`j - Bar Sink Backflow Preventer Backflow Irrigation Bathtubs Clarifiers , . Dishwasher . ' Orinking Fountains Floor Dreins FloocSinks � . . _ . .. Gas Service ' Outlets � � A ' Kitchen Sink ' ' Lavatories �- , P—Trap Roof Drairis � ' - . Reinspectian Fee $15 Boiler Duct � Under Ground Duct-Strucaral � Duct - Ventilating � Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑6100,000-BTU 0100,000 I orivers' �icense or.55 qp ; � Reinspection fee $15 ' CMF 0865-46, rev. 30/84 � Whit¢ - Builtling; Canary -�AOPlicant; Pink - Accoun[Ing; Goltlenrotl - Assessor PLUMBING Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Pipin9 Solar Tank Swimming Pool w, Urinal WdiCf C1052L Water Heater Water Service . Auto�Wash � laue Fee Hood or Type I ❑ - Canopy Type I I ❑ '. Retrigeration Sys[em ❑aioo,000eru ❑ioo,000 System Repair/Alteration Fire Dampers � IRue Fee FEES $ 3 A.P. � S Main Buildi E T Front B Rear A � C Right K left S Pin9. Ref. # Planning Notes: Automatic Washer T- Construction Pole Sub. Cookinq Unit Dishwasher . Dryers ❑Gas� �Electric Fad F.A.U. Fixtures - Device Boxes Outlets Switches � Garbage Disposal Generetor �0.5 KW �5-15 i • � 5205 i,ideie5 ' � 2ona 'Accessory Building: Parking Req./Provided Transformer ❑ 15�50�KW � OSO+KW Meter ❑up to 100 amps Meter ❑over�700amps Sub Panel ' ' Motors OO-1 HP O1'/: � 8 Inc.Solar��9-�15 HP 016-15+ Microwave� � Pole Light . ' � Range i Standing Sectionf Trash Compactor Fee �$15 � � laue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approved By —'�, Aooliption laued Bv LY1N1�' 5.60 �T� Z - O � N I . N G R. - E Q _ M . T ` S � F,EES � � i $ . SUMMARVOFPEES ' , BUILDING PERMIT $ SMIP � ' $ PLAN CHECK , $ PERMIT ', PLUMBING, $ �j -06 � ISSUANCE $ PLANCHECK �25%�$ 'S� ENERGVP.C. $ ELECT(i1CAL . $ GRADING $ � PLAN CHECK 50% $ � MICROFILM ,$ MECHANICAL $ TOTALFEE $ � SS� 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. Soil Pipe-Undrgrnd. ' 53. Steel Reinforcement �- 3. Electrical Conduit Utility-Undrgmd. 54. Forms - � - '. 4. Electrical Conduit-Undrgrnd. ' � 55. Electrical Bonding 5. Steel Reinforcemei�t 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-Undrgmd. 60. Backwash Lines, P-Trap, O Undrgmd. � 10. Structural Floor System 61. APPROVAL TO DECK �1,1. Property Sewer Line & House Connection 62. Backwash & ReceptorFinal .- . 12: Sewer Cap � 63. Heater & Vent-Final � /, -�5� � 13. Roof Drains � 64. Plumbing System - Final 14. Rough Plumbing ' . - 65. Electrical-Final - " • 15. Rough Electrical-Conduit � - , . 66. Solar System-Final • - � 16. Rough Electric Wi'ring - � 67. Fencing & Access Approval -- 17. Rough Wiring Sign � . 68. APPROVED FOR PLASTERING � 78. ,Rough Electrical-T Bar Ceiling 69. POOUSPA 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 & 7est . _, �_, 72. Underground Flush 24. Roof Framing �• 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. �Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Strutturall & Monocoat , 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe � 28. Lathing & Siding � 77. FIXED SYSTEM FINAL 29. Insulation . 78. FIRE PREV. FINAL • 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat � ' 79. FINAL INSPECTION 32. Electrical Power Meter-Final • 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test �, , . _ 36. Hood or Canopy , , � 37. Final Factory Firep�ace ' - . . 38. Final Plumbing , ' ' ' 39. Water Service-Final 40. Gas Service-Final � � 41. Solar pomestic-Final } ,' . 42. Backflow Preveriter� � 43. Backflow Irrigation, � ' � � � 44. �Landscape Irrigation System � - 45. Sound Attenuation � � 46. Handicap Regulations • , ` • ' 47. FINAL STRUCTUFE & BUILDING, � � - � � � . � 48. Special Requirements Completed ' , � ' � - - � 49. Electric Release'to Edison ' � � - . � - - - , - � - �- i 50�. Gas Release 4o Southem California Gas Co ' ' � 51. CERTIFICATE OF,OCCUPANCY � T• 1 _. _ __ . �' No. � �Date - � � ' � i .-�� i � Applicanl to fill in all ipaces exceD� l�ose within �eavy Oortler Ilnas ana si9n all appropriate tleclarations. �-- � -- -� �� ' - � PEFiMIT NO. �� TRACT NO. LOT NO. UNIT N6. \� • Glr �oF coSTA MES��A}/� CON.�S^TRUCTION PERCMyIT U /� /�II 1 • ect Address _L�(� w• �� J 1 � �� I � 1 /� l l��r v� '. � ApplicanYSMailingAddresp rCY�Jt �{11C�e�,�'� MC:�� 7YPEOFCONSTRUCTION NEW %�DD ALTERATION REPAIR � Owner'S Name �v �� .�YNYi�W�g�Z]2`� � CONVERSION ❑ DEMOLISH ❑ OTHER A p # , \ _ l DESCRIPTION OF WORK/USE OF BLDG. 2one Adtlress ��g w' �� S L ' S Main Building: .Accessory Building: ArCh/Eng. LiC2n5eNo, TVPEOFPERMIT GRAOING FOUNDATION STRUCTURAL T Front' . �I � Adtlress o ❑ OTHERT -❑ ELECTRiCAL ❑ PLUMBING d MECHAfJICAL A Rear � N � Contractor's Nam hone pROJECT DESCRIPTION Sq. FT. OCCUVArvCv C Right - N � Adtlre551mailing) , CONSTRVCTIONTYPE VALVATION$ g Left ' G � City License No. � ZONE GRADING CU.vDS. ACRES p�ng. Ret. # Parking Req./Provided -� E LIGENSED CONTRACTOR DECLARATION Q I h@reby affirm tha[ I am IicenseC untler Orovisions of Charter 9(commencin9 Remarks: Planning Notes: W�i�l SfCI1011 %QOQ� O� Divislon.3 1C USI0055 dOtl PIOfQ5510l15 COdO� dlld M my license is in tull force antl eifec . C , v (' 'l.. e ^ . T- License Class License Nq � � �� , 5' Date Signature PLUMBING FEES ' - WORKERS' COMPENSATION DECIARATION Ba�Sink $hOwers � � ' • I hereby atiirm tnat I have a cerpificate oi <onsent to self-insure or a<ertlficate - ELECTRICAL FEES of Workers' Compensation Insurance, or a certlfietl� copy thereof (Sectlon BackflowPtNvente� ServiceSink - 3a0o, Lao. C.IC � �, ,.� � � ❑ 15-50 KW ' Automatic Washer Transtormer Policy No. "��4� Comoany Tr�^'!�-�_lT� Backflow Irrigation �Sewe� Cap � Construction Pole Sub. ❑ 50+ KW eC¢rtifietl copy is hereby tu�ni5h¢0. _ _ .r -- Certit' a copy is tlletl with the Ity.B t�ling Dlvisi ) Bathtubs Sewer Connection . Cooking Uni[ Meter ❑up to 100 amps Oa(e� Applicd� ' � �L - , EXEMPI�ION FROM WORKERS' CO E ATI ECIARATION C12rifier5 � Solar Collectors ' Dishwashef Meter ❑ovef 100 amps � ' (This section neetl nol be completetl if the'�permit Is �or one huntlred (g100) or � I¢ss). . Dishwasher Solar"Piping Dryers ❑Gas ❑Electric Sub Panel - I c@rtity Iha[ In lh¢ Pe�to�mance of Ihe wo�k fo� wh4ch Ihls Oe�m�t i5 issuetl, I � ' Shall not employ any persOn In any manner so as to beCOme subject [o the Drinking Fountains Solar Tank � /,-f � Fan � Motors OO-1 HP OiX- 8 Wo�ke�5' Compensation Laws Of Callto�nia. Date Signature � Floor Dreins Swimming Pool wlSpa ��, F,A.U. � � OTICE: it, atte� mdkinq thi5 tl¢cla�a[ion, you sttoultl b¢Come zubject to the �na Sotar 09-75 HP 016-15+ Wo�kers' COmpenSdtion proviiions Of the l.dbof COtle, you musl fofthwith FIOOf $i0k5 UIi0d1 . - � Fjxtuf¢S � cornpry witn� Such provi5ion5 or [nIs permit shall be tleemetl revoketl. Microw2v¢ ' � CONST0.UCTION LENDING AGENCV - Ga55erviCe OUtlets Wat¢rCloSet DeviceBoxeS � I hpreby affirm that there is a cons[ruction lentling agency for the performance Pale Light " . of the work 'tor whicb this Oermit iz issuetl (Sectlon 3097 Civ. CJ Interce tors Water Heatet ' � � ' LRntler's Name P Outlets - �\� • _ , Range'-' - . �entler'saatlress KitchenSink WaterService ' ' Switches �� $ign'- ' - OWNER BUILUER �ECLARqT10N " . � � ` I heleby at(irm that I am exempt flom Ihe Cantfactor'S LicenSe Ldw �Or Ihe LdvdtOfi25 AutO-WBSh � ' • - - to��owing reason (Sec[ion 7031.5 Business antl Protesslonal Cotle:�Any ci[y or ' Garbag2 Disposal '�` ; Standing Sections �� . county which requires a oermit to construct, aller, imorove, tlemolish or repair P—Trap Laundry Trays ,� ' any structure, orior to its issuan<e, also requires the applicant tor sucn permit Generetor 00.5 KW 05-15 KW Trash Compactor _ - ' to file a signatl statement that he/she is IlcEnsetl pur5uant lo the provislons of ' R001 D�ainS ' � � .- � � �� the Contractor's License Law (Chapter 9(commencing with Section 7000) of ~ Division 3 of [he Businezs antl Profession5 Cotle) or that he/she is exempt therefrom anU the basis for the alle9etl exemptlon. Any violation of Section . � � ,' ' • . 7031.5 by any applicant ror a Permil su�jects the applican[ to a civil " �enalty of not more than five huntlretl tlollars (E500). � � i I, as owna/ oi llte prope�ty or my eTployees wilh wa9es as thei� sole ReinSpeCtiOn F¢B $15 Issue Fee S 3 " ' - � ComOensation, Will Oo the work, an0 the structure IS nOl intentl¢tl O� O�feretl ii@insp¢CtiOn F@0 $15 155ue F¢e � $ 3 for zaie (Section ]Oab, Business antl Pmfessional Cotle: 1he Contraclor's � MECHANICAL FEES ' License Law tlOes no[ appty t0 an ownEr ot a property wbo builtls or iTproves . .. , � thereon; and who•tloes such work himself/herselt or throu9h nis or her own � DEVELOPMENTSERVICESREQUIREMENTS: '� � - ' erhployees, Provitletl [hat such improvem¢nts are not Intentletl or oHeretl tor Boiler � ' Hood o� Type I ❑ � , , ^ i Shce. Ii, however, the builaing or Imorovement iz soltl within one year of com- Cdnopy Type I I ❑ Y 2oning Approved��8y Date - P�etlon, the owner will have the burtlen ot provin9 �e/sne tlitl not builtl or im- Dut[ � Under Ground guilding Approvetl By - �Date � P�ova'for tho pu�0o5e ot Sale). � . Q I, as owner oi the property, am axclusivety contracNng with licenzetl con- Duct - Strucmral Re(rigeration System Appliption Issued By Data ��( E`�. VactoR [o construct the Oroject (Sectlon ]064, Buziness antl ProfeSsions Cotle: �� The Contracmr's License Law tloes not apply ro an owner of property wno Dut[ � Ventilating ❑0-100,000 BTU ❑100,000 BTU '� SUMM RY OF FEES. ' bUiltls or improves�thereon, 2ntl wM10 contracis b� suclt projects with a con- - - � ' tractor(s} Ocense pursuant fo the Contractor4 Licanse Law). I am awara that BUI�DING PEflM1T .$ � SMIP i' - P�ooi of their Worker's Gompensatlon insurance shoultl be provitletl to me. Exhaust SySt2m ❑ Multiple ❑ Sys[em Repair/q�t2ration � . r $ I'am exempt tler Se�ti n ' B. & P. C. for this reason Firepl/Fact. Blt. ICBO # Fire Oampers ' P�AN CHECK � P�E�R.nMIT�",�,,��— � �7'�� • PLUMBIN � /1-79yA� � -�-/— Heatin S s 7j�j��( ( y�J 1 .� ate owner g y tem & Ducting � Aegisters pLqN CHECK 2� ��Q��,/_� `�F�1E�dG . � hereby certity chat ( have reatl this application antl state tnat the above ❑6100,OOOBTU�iQ0,0006T � ELECTRICAL `l / '' GRADING $ t ��formation I5 correct. I agree to comply wi[n all dty antl munty ortlinances $ - antl state laws relatin9 to builtlin9 conztruclion, antl hereby authorize repre- , - $,' �MICROFILM 5 se�tativeY ol this city m�er upo�� ab ve-menNonetl prooerty for . PLAN CHECK 50% . , � Inspectlan pyrp oses. � - Signature 1/��.L Date �� - MECHANICAL � $ ' / TOTALFEE $ � Oriv¢rs' L��y� v" � � Reinspac[ion Fee� $15 Isue Fee § 3 PLAN CHECK 25% $ . cmr o96s-ne, rev. iu/nn wmce - eumm�g; �.anary - i+apucanx; v�nR - HccounUng: Goltlonroa - Assesso� /\ � � °,�ONSTRWCTION�AND PLANNING - . POOL & SPA ` Date Ins ector PPROVALS - Permit# P APPROVAIS Permit# Date Inspecror ` ;,1. Temporary Electrical Serviceor Pole �� 52. Pool & Equipment Location .. � �2. �-Soil Pipe-Undrgrnd. . � 53. Steel Reinforcement ' � 1 3. �Electrical Conduit Utility-Undrgmd. - 54. Forms . - ' ' � �• �_ 4..Electrical Conduit-Undrgrnd. . ' � 55. Electrical'Bonding� � � _ 5. �Steel Reinforcement (,�,� s p� 56. Rough Plumbing & Pressure Test. , : ' 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE - ' � 7. Footings � �. �� 58. Electrical Cqnduif-Undrgrnd. . _ 8T.Foundation ��' � yr��S DS 59.� Gas Pipe, � Undrgrnd., Test , � , 9. .Water Pipe-Undrgrnd. . . - 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK - � . 11. Property,Sewer Line & House Connectiqn � 62. Backwash & ReceptorFinal - � 12. Sewer Cap ,' " , 63. Heater & Vent-Final � � 93. Roof Dreins � �.� � 64. Plumbing System - Final � 14. Ro'ugh Plumbing � . 65. Electrical-Final 15. Rough-Electrical-Conduit - � 66. SolarSystem-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 � 19. Rough Heating & Air_Conditioning FIRE DEPT. REQUIREMENT . -- 20. Rough Factory Fireplace � • � � APPROVALS. Permit# �� 21. Ducts, in Structure . , , ' 70. Underground Hydro . i ' 22. Ducts, Ventilating � .. 71, Product Piping O Gas ❑ Oil , 23. Gas Pipe-Rough & Test , 72. Underground Flush � � 24. Roof Framing .•� g/� �� « 73. Undergrnd.StorageTank OGas ❑Oil 25..Roof Sheathing i� �� 74. Overhead Hydro ' 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical ' 27. FrameandFlashing � 76. DryStandpipe - � 28.-Lathing&Siding . � �' 77. FIXEDSYSTEMFINAL � 29. Insulation q� ��' � ��j � 6'a� �' � 78. FIRE PREV. FINAL ' 30. Drywall Nailing - � HEALTH DEPT. flEQUIREMENT • 31. Plaster Brown Coat � � �79. FINAL INSPECTION � 32...Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes:� �� 5j ��% _�� i 34. Firial Heating & Air Conditioning ' �/�/L m([ �,[Q � 35. Final Gas Pipe-Test ' '�,-�' i 36. Hood or Canopy . , - 37. Final Factory Fireplace � (9 �/�� ^G� �' � � , 38. Final Plumbing � ' pZ •Z v � �-�' 9S 39. Water Service-Final � 40. Gas Service-Final . l'-. _ 41. Solar pomesticFin81 � �, +-� � � � � 42. Backflow Preventer � , ' `• � �,_,�� o 43. Backflow Irrigation � � a �,� i - 44. .Landscape Irrigation System �-/Z �� .�� i I(gs /p' u � / � 45. Sound Attenuation - � . ' �,,�� C 46. Handicap Regulatio�s . �j g� ,�1�.�(� S 47. FINALSTRUCTURE&BUILDING g�7 � � �j ��11%(d �-�GL 48. Special Requirements Completed �� ;�fy �� C 49. Electric Release to Edison � : ' - ' � a �; � ��5�,` �� , c7--�. 50. Gas Release to Southem California Gas Co � . LG �r-7-c�� 51. CERTIFICATE OF OCCUPANCY _' �� No. � 7 4 z � _ Date �L/' f� . , �vLC�,I' ""'�,y i . ��aj`/'' � h_.f�--- , , 1 �__� - �• . � CITY OF COSTA MESA CONSTRUCTION PERR�IT _. APD��ant to fill in all space5'exce�� pl lhose wit�in �eavy ooraer Iines anA sign a11 aooropriata tleclantians. P�oject Address `" 9NU W�ST / y In �7,�7 �. ,� �. . �Applicant'sMailingAddress 7�� v✓�� .[�f��(�T��j� eOwner's Name �AV!/i .� �/�i/JHR�2'gahona 1¢nL�.z[1sr� �Address� %�i�' �EST �� CT ��9%/i /�i6'�1 �,t �� Arch/Eng.'�t-%��'�? !xhOD f7-�f%SSC� License No. C��S/� Address. N' B � L Contracmr's Nam Phone '�/�9G Addreu (mailingl 7�� -S � ��^� . City License No. LICENSEO CONTRACTOR DECLARATION I nereby affirm that 1 am Iicensetl untler provislon5 of Cha�te� 9(comTencing with section �000) ot Dlvision 3 o� the Business antl Protessions Cotle, antl my license is in full totce antl effect. - M y LIC205C CId55 � IC2f1 NO �.T.y� �7a � Date �/�-�S•-.F�/ Si9nature � WORKERS' COMPENSATION DECLARATIO ' . I hereby atfirm that I have d C¢rtificate of con5ent to self-InSUre or a certificate of Workers' Compensation-Insurance, or.a certlfietl mpy thareof (Section . 3600, Lab. C. e� �f/ ' ' Policy No. 3� g��Z� �Li Company �� r�� /KSU.ERU�r �Certi(ietl copy is hereby fumishetl. . ' � � Certifietl <oR y- I3 flletl with che city wl �ng Ivizl n. �a[e �6 �j'6'� ApPlicant��— � EXEMPTION FROM WORKERS' COMPENSATI N DECLARATION � (This se[tion neetl not bC cOmO�etetl it the parmit I5 for one huntlretl (E100j or Ie55) I certify that in the peAormance ot the work for which this perm�t is issuetl I shall not employ any person in any manner so.az to become subjec[ to t{�e Workers' Compensatlon Laws of Calitomia. . , ' Dafe Si9nature NOiICE: It, after makin9 this tleclaration, you shoultl become sub�ect to Ihe Workers' �Compensatlon �provisions of .ihe� Labor Cotle, you must torthwith � comply with such .provi5ion5 or this permit shall be,tleemetl revoketl. • CONSTRUCTION LENDING AGENCV' ' 1 hereby atfirm lhat there i5 a constructton lentling agency (or the performance of the work for which- this permit is issuetl (Section 3097 Civ. CJ Lentler's Nam¢ - L.entler's Atltlress. � OWNER BUILDER DECLARATION � � I hereby aftirm that 1 am,exampt irom the'ContractorY Litense �aw for the tollowin9 reason (Section 7031.5 Business antl Protessional� Cotle: Any city or <ounty wnich roqWres a pe�mit to Const�uct, alteq improva, tlemolish o� re0ai� any structure, prlor to ils issuance, also requires the applicant for such permit tn tile a sianea statement that Te/she is ilcensetl oursuant to the provisions of theretrom antl the basis for tne allegetl ezemption. Any violation oi Section 7031.5 by any appli<ant for a permit subjects tne applicanl to a civil ienalty of not more Man five huntlretl tlollars (y500J. ' ' � I, as owner of the'oroperty'or my emvloyees with wa9es as their sole compensation, will tlo the work, and the structure is not Intentletl or ofteretl for sale (Section 7044, Husiness antl� Professional Cotle: The Contractor'S License Law tloes not apply to an owner of a property who builtls or improves thereon„ antl�who tloes such work�himself/berself or through his or her own , amployees, provitletl that such improvements are not intentletl or offeretl,for sale. If, howeveq the builtlin9 or improvement is soltl withln one year of mm- pletion, the owner. wlll have the burtlen ot proving ho/sne tlia not builtl or im- �rove tor the purpose o1 sale). I, as owner Of Ihe prOper[y, am ezclu5iv¢ly Contracting wi[h IicenSetl con- tractorsto construct the project (Section �044, Business antl Protesslons Cotle: The Contractor's License 12w does not aOP�Y to an owne� 01 property who builtls or ImprOves th¢�eon, antl who Contrdtt5 to� such p�ojects with a con- � tracim(s) license pursuant to'tne Contractor's License Law). � I am exempt untler Sectlon . B. & P. C. tor this reason TVPEOFCONSTRUCTION �NEW UADO IJALTERATION LJ.REPAIR ❑ CONVERSION ❑ OEMOLISH ❑ OTHER � OESC IPTION OF� WORK � � ' la�� Ll �r�.BA . TVPEOFPERMIT �GRADING FOVNDATION STRUCTURAL ❑ TENANT �'ELEGTRICAL ❑ PLUMBING O"MECHANICAL , ❑'�OTHER ' . " - PROJECTDESCRIPTION S�.FT.37%'3 . OCCUPANCV$� CONSTR,�U/ CTION TYPE �� VALUATION $ RO� oOfi.OZ� ' ZONE /"1 C GRADING CU. VDS. ACRES Remarks: Bar Sink Backflow Preventer Bathtubs • Clarifiers � Dishwasher � Drinking Fountains Floor Orains Floor Sinks Gas Service Outlets Showers Service Sink Sewer Cap ' Sewer Connection Solar Collectors Solar Piping Solar Tank ' Swimming Pool w/Spa Urinal Water Cbset• � Water Heater Water Service Lavatories - ' � � . 1 P-Trap Roof Drains - Reinspection Fee . $25 I�sue Fee . Boiler Duct- Under Ground Duct - Structural Duct - Ventilating Exhaust System O Multiple ❑ Firepl/FacL BIC ICBO # Date Owner Heating System & �ucting I he�eby ce�ti/y that I hdve �eatl IhiS application antl stdte that the above ❑a100,��0 BTU �10�,�OOBT intormation K�correct. 1 agree to comply with all tlty antl county ortlinances ancl state laws relating to builtlinq construction, antl heraby authorize repre- sentatives ot thls city to entert upon the above-mentlonetl property for in5peciion pu oses . Si9nature __��' . DatelO /3`�/ Drivers'�i % ReinspectionFee CMF.08fi5-46 rev. 7/83 Whi[e - Building; Canary -Applitant; Pink _Accounting; Goltlenrotl -Assessor _ $25 Hoodor Typel ❑ Canopy Typell ❑ Refrigeration Sys[em ❑aioo,000sTu ❑�ao,000 System Repair/Alteration luue Fea A.P. �h S Main Bu E T Front B Rear A C flight K Left S Ping. Ref. # Use of Building: FEES Planning Notes: a �Automatic Washer Construction Pole - - �Cooking Unit Dishwasher Dryers ❑Gas ❑ . Fan $ 3 L F.A.U,.- Fiztures Device Boxes Outlets 0230 10/15/84 � � 2one Accessory Building: �U 1 ' �� . ' � �� Park. Fees $ . - ELECTRICA 4"09•�� Ti. 2 O N I N G R E Q U 1 R E E . � reea �, � Transformer ❑ 15-50 KW � '• • � ❑ 50+KW : - . Mater ❑up to 100amps-- Meter ❑over 100 amps Sub Panel . Morors �0.1 HP O1 %- 8 Inc.Solar��9-15 HP �16-15+ Microwave � � ' .Pole Light � � ' Garbage Dispoul Genere[or �0-5 KW 05-15 KW � Reinspection Fee — PUBLIC SERVICES F�Ed Zoning Approved By� Application�Appraved By BUI�DING PERMIT PLAN CHECK PLUMBING PLAN CHECK ELECTRICAL PLAN CHECK MECHANICAL PLAN CHECK Standing Sections Trash Compactor luue Fee $ 3 SUMMARV OF FEES ��^� 5 '37,�3.�,'�1 SMIP ' $ ��) $ � PERMIT $ ISSUANCE $ $ ENERGV P.C. $ � g GRADING • $ $ MICROFILM $ $ TOTAL FEE $ 4�' 2' $ o��- . '_ �vi-r�Q� �{'.f� . Z �. 1 �� CONSTHUCTIONANDPLqNNING ' POOL&....� � 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-Undrgq�d. , � 54. Forms � . CL' Electrical Conduit-Undrgrnq, � � 55. Electrical Bonding � 5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test � 6. Electrical UFER Grnd. _ 57. APPROVAL TO COVER-GUNITE ' � , 1 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. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection . ' 62. Backwash Si Receptor-Final 12. $ewer Cap � � 63. Heater & VenbFinal 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 OGas ❑Oil . 23. Gas Pipe-Rough & Test ��. 72. Underground Flush ,�-�,4. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil 25. Roof Sheathing `'�� 74. Overhead Hydro ,26. T-Bar Ceiling (Structuraq &�Monocoat , 75. Dry Chemical 27. Frame and Flashing '� �„ 76. Dry Standpipe �f2S. Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation �� 78, fIRE PREV. FINAL 30. Drywall Nailing ` HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat '-�-.'{ 79. FINAL INSPECTION 32. Electrical Power Meter-Final � 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes:� �� 34. Final Heating & Air Conditioning � � [j �,�.4p,SZ .Sp� 35. Final Gas Pipe-Test - :7] I 36. Hood or Canopy. � Z �� 37. Fii�al Fac4Qry Fireplace . �� 38. Fi�al Plumbing�� ', � 39. Water Service�Final i , , - �, . . 40. Gas,Service-Fina1 ' S Cs . 41. Solar pomestic-Final 42. Bsckflow Preventer . �, 43. Backflow Irrigation � � 44. .Landscape Irrigation System 45. Sound Attenuation " � � - 46. Handicap Regulations � ��'• F: 47. FINALSTRUCTURE&BUILDING 48. Special Requirements Completed � �l. 49. Electric Release to Edison � ��,� - �50. Gas Release to Southem Califomia Gas Co " ' � � 51. CERTIFICATE OF OCCUPANCY � � No. Date � — ��_� `, . , �_,___ � , i-= — Ci[y ot Costa Mesa Development Services Department Building Safety Division P. O. Box i200 Costa Meu, Cali(ornia CERTIFICATE OF OCCUPANCY No.u�Llt�L3�{� The Building located at 99l1 WF:c'1' 17'r'[7 CTRF'Fm has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group B-4 Occupancy. Use of Building SAEE'i' MEl'AI. BUSINESii Legal Description $24-373.-12 (See re�erse side for Metes and Bounds) Building Permit No R1.5779 Electrical Permit No. R17279 Plumbing Permit No. P7743(1.P197.A0 Mechanical Permit No. M—� Q� �� Number of apartments iSSUED T0: BuildingOfficial llAVID D. C'tR1P�F.F�t �J � by �P� 990 4J. 17TH ST.. C7c1STA MFSA. CA. (/�/�/ - Date � This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premia Building Official of the City of Costa Mesa under Sec. 307 (e) U.B.C. CMF 3015•46 rev, 1/83 White -Owner; Canary - Numerical File; Pink � Bldg. Permit File and/or guest rooms ti�,�.G and SHALL NOT BE removed except by tha Applieant to fill in all spaces exceo< tnoze wit�in neavy Oortler Iines ana sign a11 avP�ovriate Oeclarations. CITYOFCOSTAIVIESA1;.SONSTRUCTION_ PERMJ7� Project Address ~ "vf �=a�' . Applicant'sfNai�ingAddress y ��'�� 1 Owner's Name v C p '� hone Address Arch/Eng. � LicenseNo.3CO�Q7 Address Contracror's Nam �% E-' �one yz 4 P Address Imailing) S�i ��' �'G' of 4:'��¢S� . Ciry License Na. � 7 � y�,? � LICENSED CONTRACTOR DECLARATION . � I hereby affirrt� that I am licensetl untler provisions of Charter 9(commencing � with section 7000) ot Division 3 of tM1e Business antl, Professionz Cotle, antl my Ilcense is iP tull t ce a efiect. Licenx Class � L��ense No. Date '� —Z �Si9nature WORKERS'CPMPENSATION DECLARATION I hereDy aifi�ni tM1at.l hav¢ a certi(icale of consent to Sel(-insu�e or a ce�tl ' e oi Workers' Gompensalion Insurance, or a certitietl copy thereo( (Sectlon 3800, Lab. C.) _ - ' ' ` ' " . Policy No. Company � 8 Certifietl ctlPY �s hereby fvrnishetl. Cartifietl cOPY IS,filetl with th¢ tity Builtling DivlSion. Date P.oP��ant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Th75 section n¢e0 not be campletetl if the Permit.is for one huna�etl ($100) or less). - I certify that in the periormance of tha work for whith this pe�m�t is Issuatl, I shall not employ any person in any Tanne� so as IO b¢come subject [o the Workers' ComOensation Laws of Califomia. � � Date Si9na[ure �NOTICE:Jt, at�er making this tlecla�atlOn, y0u shoultl become subject t0 th¢ Work¢r5' ComPenSation Orovisions of the Ldbor Cotle, you rt�ust (orthwith comply with such provisions' or� thi5 permit sball be tleemetl-revok¢tl.-' CONSTRVCTION LENDING AGENC�' - I hereby af}i�m that l�e�e I5 a conSVuctlon lentling agenCy to� tne Pe�formanC¢� �oi tb0 work� for which thi5 permit Is issuetl (Secfion 309] Civ. C.) l,entl¢r's Name Lentler's ACtlress . OWNER BUILDER DECIARATION ' ❑ ` ' I hereby af(irT lhat I am exempt t�orn the Conl�acto�'s License Law to� the followin9 r¢asOn (Secl�on 7031:5 Busine5s antl Pro(e557onal Cotle: Any <ity or County wnich requires a permit to ConStru<t, alt¢r, Improve, tlemolish or repalr , any structure, prior to its issuance, also requires the applicant /or such parmit to fi�e a signed statement that'he/she is Iicensetl pursuant to tM1e provlsions of the Contractot's License Law (Chapter 9(commencing with Section ]000) oi DiviiiOn 3 ot Ihe Business antl Profe55ion5'COGe) o� tha['he/she�is exempt th¢ref�om and �he ba5is t0� the alleqetl exemption..Any, violat�on of Se<tion 7031.5 by aAY applicant tor'a perT�l Subjects'tne applican[ to a clvil �enalty of not more lhan five hunCretl dullars (5500). �; �J I, as owne� oi•the property'or mY employees with wages as their sole comp¢nsationJ,�+'ill tlo Ihe work,�antl th¢ s[ructwe i5 not fn[e�tletl or Olf¢retl fOr sala (SecUon 7044, Business antl ProfesSional Cotle: The Contrac[or's' License Iaw does not apply to an owner of a property who builtls or improves thereon, antl '�'ho tlOes'such.wo�k himselt/herself o� throuqh his o� ne� own employ ees, p�ovide0 that such�im0/ovements are not Intentletl or offeretl for sale. If, howeVer, lhe builtlin9 or imprOVBment Is Soltl wit�in one�year of com- oletion, the owner w111 have the burtlen of oroving he/she tlIG not bulltl or im- �rove for tbe purpo5e of sale). I, as ownef o1 [he property, am exUuSively cont�acting wi[h licensetl con- Hacto6 to mnstruct the project (Section 7044, Buziness antl Professions Cotle: The ConVacto�'s License Law tloes not appry to an owner of proDerty who builtls or improves tnereon, antl who contracts for suc� projects with a con- tractor(511icee�se PurTuant�to the�ConVactor's l.icense Law). I am aware that proof o� Iheif Wo�ke�'S CompensatioP �nsu�ance shoultl be provltled to me. ❑ 1 am exemQt un0er Section _ B: 6 P; C. tor [his reason . Date � � Owner � I hereby ttrti�Y that 1 have reatl'thls application antl state that tne above information is correct. I agree to comply with all city antl county ortlinances antl state laws relating to builtlingj-0 nslrucfion, antl hereby aathorize repre- Sentatives of IbiT)City to ente�on the�above-mentione0 p�oper�y (or ISignature — Drivers' Licen4e or 55 �, � F 0865-46, rev. 30/84 Whit¢ - Builtling; Canary TVPE OF CONSTRUCTION L�S.rvEW LJ qoo LI ALTERATION L ❑ CONVERSION ❑ DEM<LISH ❑ OTHER DESCfiIPTION�OF WORK/USE OF BLDG. � TYPEOFPERMIT GRADING FOVNDATION STRVCTURAL ❑ TENANT ❑ ELECTRIGAL LVMBING ❑ MECHANICAL ❑ OTHER � PROJECT DESCRIPTION 5Q. Fr. ' oCCUPnNcv_ CONSTRUCTIONTVPE ' VALUATIONS 20NE GRADING CU. VOS.� ACRES— Remarki: ' I REPAIR Bar Sink eackflow Preventer Backflow Irrigacion � Bathtubs Clarifiers � � ' Dishwasher Drinking Fountains Floor Drains � ' Floor Sinks Ges Service Outlets Interceptors Kitchen Sink • Lavatories � ' . —irap • Root Drains �Reinspection Fee $75 Boiler Duct - Under Ground � Duct - Structural Duct-Ventilating � ' Exhaust System ❑ Mu�tipl2 Flrepl/Fact. Blt. ICBO # Heating System & Ducting ; ❑aioo,000eTuOioo,000 I, I Reinspec[ion Fee Pink - Atcounting_ Goltlenrotl _ Assessor_ Showers � Service.Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping ' Solar Tank Swimming Pool w/Spa ' Urinal � Water Closet � Water Heater Water Service Auto-Wash � ' a laue Fee - Hoodor Typel .❑ � �Canopy , Typell ❑ ' Refrigeration System ^ ❑aioo,000sTu ❑ioo,000eTu ] SystemRepair/Alteration' Fire Dampers � ' Registers $15 I I � Issue Fee A.P. qM S Main Buildi E T Fiont B Rear A C Ri9ht K g Left i Ping. flef. # Planning Notes: FEES Automatic Washer � Construction PoleSub. ' ZC9� � CookingUni[ > Dishwasher � � Fan F,A.U. ' Fixtures • 0 O� ,Device eoxes Z ' �Outlets ,� .. . ' CA � -Switches� 1 ! .Ga�tiage Disposal �Generatoi��0.5 6 . i_ �. ' . ' � 3 I "� � FEES Reinspectian Gee $ 3 • 6977 2/04/B5 � 2one • Accessory Building: - . ' � . _ Parking Req./Provided ' , r' ELECTRICAL Merer ier ❑� 15-50 KW i ❑50+KW � ip to 100 amps • >ver 100 amps . , lectric � Su6 Panel � ' � Motars DO-1 HP 01'f, - 8 Int.Solar �9-15 HP �16-15+ - - Microwave _. . Pole Liaht ' . Zoninp APPro,vad By - � Building,Appraved By , i Sign ; Standing Sections �15 KW Trash Compactor � , ' , $15 Issue Fee '� REQUIREMENTS � � i c`�ri.G; TL� I �I �. � Z O N I N G �R. ' : E ,� � M i T S � I �FEES $ 3 � �� ' SUMMICRV OF,fEES � � � BUILDING'P,ERMIT '$ � SMIP. '$ � PLAN�GHECK �� $ FERMIT ' � ;' PLUMBING� � �$ _Zq ��i� �SSUANCE $ PLAN CHECK 25% $ Co-S� ENERGY P.C. $ � �, ECECTRICAL ' $ ' GRADING' �$ "i PLAN,CHECK�.50% $ MICROFILM $ _MECHANICAL ' $ 70TAL FEE �$ � s� � . PIAN�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. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement ' . Electrical Conduit Utility-Undrgrnd. 54. Forms - - • y. Electrical Conduit�Undrgmd. �55. Electrical Bonding , ia. 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-Undrgrnii. 60. Backwash Lines, P-Trap, O Undrgrnd. � '10. Structural Floor System � 61. APPROVAL TO DECK � �-71. Property Sewer Line & House Connection �.J./�� e 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 76. Rough Electric Wiring 67. Fencing & Access Approval 17. Rougfi Wiiing 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. RoofFraming . 73. Undergrnd.StorageTankOGas OOiI 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:� �f 34. Final Heating'& Air Conditioning '� f- � 35. Final Gas Pipe-Test - - � 36. Hood or Canopy � �- � 37. Final Factory Fireplace - / � i 38. Final Plumbing j•�2q�o4" �A ` � 39. Water,Service-Final ' y% � � . 40. Gas Service-Final . � ' , � � 41 . Solar pomestic-Final � ' � - - - � - 42. Backflow Preventer ' - ' . . . " � 43. Backflow Irrigation , . � ' � � 44. ,Landscape Irrigation System; � . � ' � ' 45. Sound Attenuation , i , � • , � ' �' • . ' � =, 46. Handicap Regulations, � . � � � � 47. FINALSTRUCTURE&BUILDING ` � � ' ' � . � � 48. Special Requirements Completed � � � � 49. Electric Release to�Edison, `� , . - � p � � �, � . T.��. . Ya�. . � 50. Gas Release to Southein California Gas Co '' � '"' � � •� 51. CERTIFICATE OF OCCUPANCY �, - - � -- ' . No �Date � � _ � , , . _ -- . _ � - � - ti � AOP��ant to till in all spaces except tnose wlinin heavY bortler Iines anC zl9n a1l aoo�opriate tleelarations. CITY OF cosrA MESA CONSTRUCTIO PERMIT Project Address r�' 9ar/� , �� Appiicant's Mailing Address - � Owner's Name Phone Address Arch/Eng. License No. Address Contracror's Nam Phone ��(/ Addresslm='�'^^_� �3 �/t'-�kr� -�l'L.��_ City License No. ,L.� r u` LICENSE� CONTRACTOR DECLARATION 1 hereby affirm [hat 1 am licensetl untlGr provislons of Charter 9(commencing ' wifh section ]000) oi DiviSion 3 ot the Business antl Profe55ions Cotle, antl my license is in (u11 tor antl etiect. License Class �'� Lic¢ ze No. Date� Z�S_T Signature WORKERS' COMPENSATION DECLARATION 1 hereby aRirm that I nave a certiticate of ronsent to self-insure or a cer [e ot Wo�ke�s' Co pensatiop Insurance, or a certitietl cOPy the�eof (Section 3800, l.ab. CJ �'�� - � ir.n�c,�It Poli[y No. Company , 8 Certifietl copy is hereby furnishetl. Certitietl copy is tiletl w��h the �,�Y a��,��,� P( 6� Date APplicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATIOIV� (This sectlon neetl not be comple[etl if the Oermlt is fo� one huntl�etl ($300) or less). I ce�tify tha[ in the perfo�mance ot Ihe work Tor which tltis pe�m�t is issuetl, 1 snall no[ employ any perzon in any manne� so as to become Subjett to the workers' Compensatlon Laws of California. Date Si9nature 'NOTICE: If, atfer making [his tlecla�atlon, y0u shoultl become sub�ect to the Wotke�s' COmpensation Orovision5 Ot [he Ldbo� Cotle, you must torthwith comply with such provisions or tnis Oe�mit shall be tleemetl �evokeE. CONSTRUCTION LENDING AGENCV I M1ereby affl�m that there is a const�uction lentling agency for [he pa�formance ot the work for which tbis permi[ i5 i55uetl (Section 309] Civ. CJ Lentler's Name Lentler•s Atldress _ OWNER BUILDER bECLARATIOfJ 1 hereby affirm that I am exempt from [he Con[ractor's License Law for tha tollowing reason (Section ]031.5 Business antl Protessional Cotle: Any city or county whith reqW�es a permlt to conzt�uct, alter, improve, tlemolish or repai� any sl�ucture, p�lor to Its issuance, also require5 the applicanl lor such pe�mit to file a signe0 SWtement tnat he/sM1e I5 liceni¢tl pu�suanl to Ihe provi5ion5 of tM1e Contracror'S License Law (Cnapter 9(commenan9 with Sec[ion �000) ot DiviSion 3 of [he Busine55 ana Profe55ions Code) or that he/sne is ex¢mpt Iherfirom antl the ba5i5 IOr tne alleg¢tl exemptiOn. Any violatiOn o/ Sectlon ]031.5 by any applicant for a pe�mit subjects the applicant to a civil 0¢ndlty of not more than tive huntlretl tlollars (E500). ❑ I, as owner of the property or my employees witn wagez as ihelr sole compensation, will tlo the wo�k, antl the Structu�e i5 not intentleC o� ofl¢retl br sale (Sectlon 7044, Business antl Professional Cotle: The Con[racror'S License Law tloes nol applY to an owner of a property who builtls or improves thereon, antl who tloes such work hlm5elt/berself or through his u� h¢r own employeas, provitlea that sucn Improvements are not Intentlea or otferetl for sale. If, however, the builtlin9 or improvement is soltl witnin one year oi com- plotion, the owner will nave tha burtlen oi proving he/she Oitl not bulltl or Im- prove tor [he purpOse ol Sal¢). �❑ I, as owner ot the o�operty, am exUusively conlracting with licensetl con- I lmcto�s to construct thC p�ojecl (Sec[ion 7044, Business and Profe55ions Gotle: The Contractor'S License Law doe5 not apply to an owner ot property who builtls or improves thereon, antl who confracts for such project5 wilh a mn- trattor(sl Ilcense pursuant�[o the Contractoi'i Licenze Law). I am awa�a tha[ proof o( their Worker'S Compensation insurance shoultl be provitletl to me. ❑ I am exempt untler Section 8. & P. C. tor this reason Date Owner — I hereby ce�tlfy tbat I nave rea0 this information is mrrect. I a9ree to comp antl state laws relati to builtling con Sen[atives of i�is to enter upoi inspectlon purpos . c- Siqnature Drivers' License or 55 � �n antl state [hat the above city and county ortlinances an0 hereby autho�iie �ep�e- ve-mentionetl O�operty for r � Oate �3�� TYPE OF CONSTRUCTION LJ NEW IJ ADD LJ ALTERATION LJ REGAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BIDG. TVPEOFPERMIT LIGRADING{-IyJ FOUNDATION LJSTRUCTURAL ❑ TENANT ❑ ELECTRICAL �1PLUMBING ❑ MECHANICAL ❑ OTHER � PROJECT DESCRIPTION 5a. FT. oCCUParvCv_ CONSTRVCTION TVPE VALUATION $ ZONE GRA�INGCU.YDS. ACRES— Remarks: Sink Preventer Irrigation Drinking Fountains Floor Drains Floor Sinks GasService OuUets Interceptors Kitchen Sink Lavatories P-Trep Roof Drains Reinspection Fea � $15 Boiler Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple � Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑o-ioo,000 eru Oiao,00asr ReinspeMion Fee � $15 CMF 0865-46, �ev. 10/84 WhiteV Builtling; Canary - Appliwnt; Pink - AccounUn9; Goltlenrotl - Aszessor Showers Service Sink Sewer Cap Sewer Connection Solar Collectors Solar Piping Solar Tank Swimming Pool w/Spa Urinal Water Closet Water Heater Water Service Auto�Wash laue Fae Hoodor Typel ❑ Canopy Type II ❑ Refrigeration System ❑0-100,000 8TU ❑100,000 BTU System Repair/Alteretion Fire Dampers Registers Issue Fee ES $ 3 FEES $ 3 A.P. #� $ Main Buildi E T Front 6 Rear A C Right K Left S Ping. Ref. # Planning Notes: Automatic Washen Construction Pole S� Cooking Unit ' Dishwasher Dryers ❑Gas ❑EI Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Disposal Generetor �0.5 KW Fee 4189 6/D5/85 2one Accessory Building: Parking Req./Provided ELECTRICAI Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter ❑over100amps Sub Panel Motors �0-1 HP �1 %- 8 Inc. Solar 09-15 HP �16-15+ Microwave Pole Li9ht Range ; Standing.Sections 5 KW Trash Compactor $15 Issue Fee DEVELOPMENT SERVICES REQUIFEMENTS: Zoning Approved By Building Approved By 5,�0 T� FEES $ 3 SUMMARV OF FEES BUILDING PERMIT $ SMIP , $ PLAN CHECK $ PERMIT PLUMBING $ 5 • �T1 ��UANCE 3 PLAN CHECK 25% $ . lS� ENERGV P.C. $ ELECTRICAL $ GRADING S PLANCHECK 50% $ MICROFILM � $ MECHANICAL $ TOTAL FEE $• S• S� PLAN CHECK ZS% $ Z O N I N G R E Q M T S �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-UndrgFnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE � t 7:, Footings � . . 58. Electrical Conduit-Undrgrnd. � 8. Foundation �• � 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. .' 60. Backwash Lines, P-Trap, 0 Undrgrnd. ' - i 10. Structurol Floor System I 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final I 73.'doof Drains ' ,� 64. Plumbing System - Final 14. Rough Plumbing � dj (� p 65. Electrical-Final 75. Rough Electrira!-Conduit 66. Solar System-Final 16. Rough Electric Wiring 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 1S.-RoughElectrical-7BarCeiling 69. POOVSPASYSTEMSFINAL . � 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # 21. DuCis, in Struciure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping OGas ❑Oil 23. Gas Pipe-Rough & Test � 72. Underground Flush 24. Roof Freming 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Struc[ural) & Monocoat 75. Dry Chemical 27. Frameand 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 ��jCp�si' � 39. WaYer Service-Final 40. Gas Service-Final 41. Solar pomestic-Final 42. Backflow Preventer � 43. Backflow Irrigation . 44. Landscape Irrigation System 45. Sound Attenuation • 46. Handicap Regulations 47. FINAL STRUCTURE & BUILDING 48. Special Requirements Completed 49. Electric Reiease to Edison . 50. Gas Release to Sputhern California Gas Co 51. CERTIFICATE OF OCCUPANCY . No. Date ' .4Dv��cant lo /ill in all spacas axeeo� tnose w(tnin neavY �orEei Ilnas antl sign all aDv�ovriata tleclantions. CITY•OF COSTA MESq - ;; CONSTRUCTION P�RMIT Projec[ Address � y!) L� �% '7 Tr1 Appliwnt's Maiting Addreu �Z/'1 L4< ' fQ�C(�A/AS �/ Owner's Name �C% A'L✓� �F�S Phon,e �'z�ii Addreu g'�"�� Arch/Eng. Licenu No. Addreu �/�� V, Contractor's Nam � hone �'L�—/ Addrew (maiting� z/ ��S ` Q • � ' Ciiy Licenie No. �� u L7 IICENSED CONTRACTOR DECLARATION ' ' I hereby atfirm lhzt I am Iicansatl unOer provisions of Charter 9(commencing with section 7000) of Dlvialon 3 of tha Buziness antl Professions Cotle, antl . my Iicense is in full f rce and effect. , License CI 5t � Z{2 License No. �� % �� Date Sl9natura (bZG�Pn•�� aBt"' WORK RS' COMPENSATION DECLARATION I hereby,attlrm that I �ave a certi te of onsent to zelt-insure or a certifiwte of Workers' -Compansatlon Ins ra te, " 'a certitietl topy thereof (Settton 3800, Lab. C_) • ' . � . Policy No. C p � � Certifietl copy Is hereby tu is tl. CerUfietl copy i5 filetl wiph t cit Buil i DI islon. '' -+ � Date AOPlican 'EXEMPTION FROM WORKERS' COMPENSATION OECLARATION ' - (This seCtiOn need nOt bo complet¢tl if the permit IS fot,'One huntlretl (E300) or lesz)-. . . . ' I certi�y.that in lhe performan<e oi the work tor.which this permR is issuea I, snall not employ any par50n in any man er so as to become subject lo t{�e Worker '� mpa s tloa Laws of Calitp r i /�j � n ,/J� • Date_i�i� Y.�'-S_$I9naWro [- (.rEQIG6�GL-�'�da� �� ' NOTIC : If, aflnr mdkinq Ihis tleclardt�on, you ihoultl becOTe subjeCt t0 lh0 ' Wo�k¢r5' CompensdUOn P�Ovlslon5 Of the Labo� COtle, you rtlust forthwiln� � comply wilh zuc� provl5ions or this parmit shall be tleemed revoketl. ' CONSTRUCTION CENDIryG AGENCV ' � I heroby affirm t�al them is a construction lentling agency Tor t�e performance � of lhe work �or which tnls permit is issuetl (Sechon 309] Civ. C.) Lentler'z Namn , l.entler's Atltlress OWNER BUILDER DECLARATION � I hereby atfirm that I am exampt 7rom lhe ContractorY License Liaw for tha following reason (Sattlon �031.5 Business antl Professlonal Cotle: Any city or county whicn reQuiros a permit lo construct, alter, improve, tlemolish or reDalr 'any itructure, prlor to i[s 16suance, alm requires Ihe applicant tor suth permi[ to (iln a signetl s[atament tnat hn/zhe Is Ilcansetl pursuant to tne provisions ot the ConbattOr's Lltanso LaW (Chapter 9(commencing wi[h SecUon 7000) o( DIvlSion 3 Of ttlo Bu5InO5S and Pfote55lons Cotle) of t11dt hG/slle Is exampl lherefrom antl t�e basis for the allo9etl exemptlon. Any violation of Soctlon . 7031.5 by�any appllcant tor a permit sub�ects lhe aovncant to a civll �enalty o! not moro Ihan fiyp puntlratl tlollars (5500). - I, as owner ot the prqperty or my emP�oYees with wages as [heir sole compensation, wlll tlo lho Work, antl tha siructure is not IntenEetl or oiteretl for saie (Sectlon ]044, Businass antl Pro(ez5ional Cotle: Th¢ Conlractor'S Licnnse Law Eoos not apP�Y to an owner of a property who builtl5 or improves [he�oOn, dntl �who tloes SUCn work himselt/�¢r5C1f or through hIs o� he� own amployaes, provltletl tnat such Improvementi are not Intentle0 or oftaretl for sale. If, howovnr, [be bulltl��g or Improvemnnt is soltl within one year of com- oietto�, cna owne� will nava tho burCen o� proving he/S�e Altl not build or Im- �rove for tho purpose ot sala), ' I, as owner ot tne property, am exclu5ively tontracting with licensetl con- tractors to conSV uct tho prpject (SecUon 7044, Business antl Rofessions CoCe: Tha Contractor's Llcense I�w does not apP�Y �o an owner of Oroperty who bulltls or improves theroon, antl who contracts for such projects wlth a wn- trac[or(5)Iicansa Dursuantto t�a Contractor's �icense Law). . ❑ 1 dT ex¢mpt unCel $O<tjOn B. & P. C. (oI thi5 r¢aiOn Date 5 -1%% 1 hereby certify information is ca antl state laws re sent5tives of hl insoection o o ' Signature Drivers' en � CMF 0865-46 rev. - Owner have r¢ai entar TYPE OF CONSTRUCTION .%]J NEW L.J ADO LJ ALTERAT�ON LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER � DESCRIPTION OF WORK . TYPEOFPERMIT GaADING FOUNDATIO�qN STRUCTURAL ❑ TENAN7 ❑ ELECTRICAL ❑ PLUMBING �ty MECHANICAL . O�OTHER PRQIECT DESCRIPTION Sa. FT. OCCUPANGv - CONSTRUCTIONTVPF VALUATIONS ' ZONE GRADINGCU.Y�S. ACRES Rema�ks: Bar Sink Backflow Preventer Backflow I�rigation Bethtuhs Clarifiers Floor Drains� Floor Sinks Gas Service Interceptors, Kitchen Sink Lavatories ' Roof Reinspecti0n Fee FEES Showers - _ Service Sink� Sewer Cap Sewer Connection Solar Collectors • � Solar Pipin9 ' - ... . Solar Tank Swimming Pool w/Spa Urinal � Water Closet - Watec Heater Water Service - $25 � � Isue Fee g 3 Boiler ' Duct - Under Ground Duct - Structural Duct - Ventilating Exhaust System ❑ Multiple ❑ FirepNFact. BIL ICBO � Heating System & Ducting SIO-100,000 BTU 0700,OOOBT Rainspection Fee � $25 W�ite - Bulltling; Candry - Appliwnt; Pink - Accounting; GOIG¢nrOtl - Ass¢Ssor A.P. dp S Main Building: E i T Front A Rear C Right K g Left Ping. Ref. # ' Parking Req./Provid Use of Building: Planning'NoteS: 0 3671 5/28/35 I�oG� T�� Zone Accessory Park. Fees $ � � ELECTRICAI . ' � Automatic Washer Transformer ❑ 75-50 KW ❑ 50'+KW � Construction Pole Su6. ' � i Cooking Unit �� Meter� �up to 700 amps " �'" Dishwasher Meter ❑over100amps Dryers �Gas ❑Electric � , �SubPanel ' Fan F.A.U. Fiztures:• Device Boxes OIILIBfS Switches� Garbage Disposal � Generator �0.5 KW 15 KW Motors LJOI HP L11 X- 8 Inc.Solar 09-15 HP �1615+ Mittowave . Pole Light � Sign Standing Sections ' Trash Compactor Reinspection Fee $y5 Issue Fee IANICAL FEES PUBL'IC SERVICES REUUIREMENTS: Hood or Type I ❑ Zoning Approved By Canopy Type I I ❑ , Appliceti0� App�OVBd By iefrigeration System �4100,OOOBTU 0100,000 Sysrem Repair/Alteration Iswe Fee � $ 3 ' ;�BUILDING PERMIT � PLAN CHECK � PWMBING � PLANrCHECK �ELECTRICAL J F PLAN CHECK , , ��MECHANICAL PLAN CHECK O N I N G R E U U I R E E N FEES $ 3 SUMMARV OF FEES � $ SMIP $ $ PERMIT ' $ ISSUANCE $ $ ENERGV P.C. $ S GRADING $ $ MICROFILM $ �r.,��)' . � $ ��'Dil TOTALFEE $ _L�— �/ $ / / � CONSTRUCTION AND pLANNING � ' ,- � POOL & SPA • � � .'�APPROVALS . Permit # • � Date - Inspector _p�ppROVALS Permit # " Date � Inspector ' L�Temporary Electrical Service or Pole' � _ 52. Pool & Equipment Location � 2. Soil Pipe-Undrgrnd. '� - ' - 53. Steel Reinforcement .3. Electrical Conduit�Utility-Undrgmd. ' � . . 54. Forms � . 4.�Electrical Conduit-Undrgmd. ` , 55. Electrical Bonding 5. Steel Reinforcement �. .• " _ � � � � � 56. Rough'Plumbing & Pressure Test '�6.' Electrical UFER Grnd.� ; "� _ � ' 57. APPROVAL TO COVER-GUNITE 7.�Footirigs � _ , � � . 58. ElectricalConduit-Undrgrnd. 8. Foundation '. � _ -. 59. Ga; Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd�.; ' . 60. Backwash Lines, P-Trap, � Undrgrnd. 10.�StructuralFloorSystem ,- ,61. APPROVALTODECK 11., Property Sewer Line & House Connection � , 62. Backwash & Receptor�Final 12. Sewer Cap ' � . 63. Heater & Vent-Final 13. Roof Drains ''. - � 64. Plumbing Systein - 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 19. Rough Heating & Air.Cqniiitioning '' FIRE DEPT. REQUIREMEIVT 20 ° Rough Faciory 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. Storage 7ank O Gas ❑ Oil' � 25. Roof Sheathing -. � � 74. Overhead Hydro . � 26. T�Bar Ceiling (Structural) & Monocoat . - 75. Dry Chemical . . 27. FrameandFlashing . : 76. DryStandpipe 28. Lathing & Siding � � 77. FIXED SYSTEM FINAL 29: Insulation � ' , 78. FIRE PREV. FINAL 30. Drywall Nailing � � HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final , 80. FOOD CERTIFICA7E ISSUED � 33: Final Electric � • � Notes:G/b �5" NOf IZEdI�n'( CE� 34. Final Heating & Air Conditioning f�yf�p�' �j' �. � �s-- �Ti t ri � 7 c 35. Final Gas Pipe-Test � ' ' , ' � . ' ct- � c . i f 36. Hood or Canopy • , , • � ' - _ . r 37. Final Faaory Fireplace � � • i " 38. Final Plumbing . � � � . 39. Water Service-Final � ' � 40. Gas Service-Final � � � ' ' 41. Solar pomesticFinal ; . ' _ � , _ � 42. Backflow Preventer ' - 43. Backflow Irrigation . , � � - � • 44. landscape Irrigation System - 45. Sound Attenuation � � ' � 46. Handicap Regulations � - ' � i � 47. FINALSTRUCTURE&BUILDING - ' , . 48. Special Requirements Completed i 49. Electric Release to Edison � � , - � 50. Gas Release to Southem Califomia Gas Co , � . 57. CERTIFICATE OF OCCUP,ANCY . . ' - . • No. � Date � . � . ,r• Appllcant to till In all spaces excep� those wit�in heavY �ortlerJines anG si9n all apprapriala tleclarations. Ci7Y of COSTA�Grj JEQSQ CONSTRUCTION PERMIT ProjECTAddress / /�� %� /?�S� - Applitant's Mailing Address� 7. ��p� ��A�'1_ron . n M. � Owner's Name �� Q-�'A^'��-'y e Phone �%' D. L✓r !7'�- r Addiess Arch/Eng. -License No. ' Address ?• .�p Contractor's Nam<�' �/��/i�rya��X(� ��T��hon ��+ �1'�'�"i'�S Addresslmailing) �-_�ae� ��'�'�"�% Y"-� C��• City License No. � ��%� � � ' � LICENSED CONTRACTOR �ECLARATION ' I hereby a�firm tha[ I am IicenSetl untllr provislons of Charter 9(commencing with section 7000) of Dlvislon 3 0( tha Buziness antl Professions Cotle, antl my licenze Is in full force anC effect. Licen � Class �'�� 0 Lice �� +� � Date Si9nature W00. ERS' OMPENSATION DECLARATION 1 hereby afflrm that I have a certiticate oi consent to selhinsure or a certificate oi workers' Compensation Insurance, or a certlfletl copy thereot (Section 38oa, �b. �,SQ µ�b r 5 y ComPanY �rI�i7G FI.0 tJ V oliGy No. titietl copy is herBby fu�ni5hatl. � Certiti¢U copy 75111¢d wi[h the cily Bulltlln9 DlvislOn. Dat � AOP�icantT � EXE MION FROM WORKERS' COMPENSATION DECLARATION (Thizsection neetl not be como�etetl i/ thn permit is (or one huntlree (E300) or less). I certify t�at in lhe performance of the work for whlch this perm�t Iz issuetl, I shall not employ any parson in any manner so as to become sub7ect to Ihe Workers' ComOensatiom Laws o( California., Date Si9nature 'NOTICE: 1f, atter making this tletlaration, you snoultl become subject to tne Workers' ComOenzation provisions of tne Labor Cotla, you must torthwith compty with such Drovisions or lhis permit sha11 be tleemetl ravoketl. CONSTRUCTION LENDING AGENCV 1 hereby altirm that there is a con5tructlon.lenUing agency tor the performance o( lhn work (or. whicb this permit is issuetl (Secfion 309] Civ. CJ Lentler's Name Lender'S AtlGress � _ OWNER BUILDER OECLARATION I hereby atflrm,tnat I am exempt from lhe Contractor's license Law for the following reazon (Section 7031.S.Busina55 anU ProfaSsional Cotle: Any tlty or tounty whicn requires a permit to construct, alter, improve, tlemolish or repair any structure, prbr lo its issuante,-also reqWres tne applicant for such permit to file a signetl statGmenl thal he/ihe IS Ilcensetl pur5uan[ to Ihe provisions of Ihe Contractor's Licensa Law (Chapter 9(commencMg with Sectlon ]000) of Division. 3 of the Businesi antl Prolcision5 Cotle) or that he/she is ezempt • therefrom antl Ihe basis tor the allegetl exemption. Any violaHon of Section 7031.5 Dy any applicant for a permit subjec(5 Ihe� apP��anl'to a civil /�enalty of not more than iive huntlretl t1011arS (5500). LJ I. as owner of tha propeity or my employees wlth wages as tnalr sole ana tne structure Is not intentletl or o(teretl s antl Protessional Cotle: Tha Contractor'z Owne� ot a p�opa�ty who builtls O� Imp�ove5 � �k himself/he�selt or [hrough h15 0� her own iprovem¢n[s ara mt intentlatl o/ olteretl'for Improvement is soltl within one year of com- burden Of proving h¢/sne tlitl not builtl or im- antl wno aoes sucn �5, provitletl tha[ suct iowever, the bulltlln9 �.he owne� will have t the purp05! Oi sale). �wne! ot th! OroOerh builtls or Improves tnermn, antl who contracts for such projects wttO a con- -tractor(s1 licenie puisuant to the Con[ractor's License Law). I am aware that o�oor o( thelr Worker's Compensatlon insurance snoultl be provltled to me. ❑ 1 am exempl under Section B. & P. C. for thi5 reaion Date Owner' � ' I hereby certity that I have reatl thiz application antl state that the above Information is corrGct. I agree to comply with all City antl coun[y ortlinant¢5 antl,state laws re ting to bullCin construction, antl heraby authorize repr¢- sentativas of t tlry to e . pon the above-mentlonetl pro0erty for insvectlon � � � � Dater�� S`z � /��7y I� , � I ' � I -' �°� TYPE OF CONSTRUCTION - NEW ' ADO ALTERATION: REPAI R '❑ CONVERSION ❑ DEMOLISH � OTHER �j � DESCRIPTIONOFWORK/USEOFBLDG. �:�..r C�Q45� TVPEOFPERMIT�.-�f GRAOING ' FOUNDATION STRVCTURAL � '0 TENANT LrIELECTRICAL ❑ PLVMBING ❑ MECHANICAL ❑ �OTHER � � - ' PROJECT DESCRIP710N 5�. F7. � � oCCUPnNCv CONSTRUCTIONTVPE VALUATION$ � � ZONE � GRADING CU. VDS. ACRES Remarks: , � .' �`�� Sink Irrigation D�inking Fountains Floor Drains . � Floor Sinks Gas Service -OuHets Interceptors Kitchen Sink � LdVdtOlICS � � - , , P—Trap Roof Drains• Reinzpeetion �Fae $75 Boiler . - - - Duct- Under Ground Duct - S[ructural Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/Fact. Blt. ICBO # Heating $ystem & Ducting ❑6100,000 BTU �100,0008T LSlqnaWre I I Drivers' License or 55 � � ` Reinspaction Fee , CMF 0065-46, r¢v. 10/84 -White - Builtling; Canary - APPlicant; Pink - Atcountin9: Goltlenrotl - Assessor ' t a�s ShoWers Service Sink ' Sewer Cap Sewer Connection ' Solar Collectors $olar Pipin9. - Solar Tank Swimming Pool w/Spa Urinal Water Closet Wacer Heater Auto-Wash ' ' . Laundry Trays ' - Isue Fee � $ 3 �NICAL FEES Hood or Typel ❑ Canopy Type I I ❑ Refrigeretion System �0.100,OOOBTU ❑100,000 System Repair/Alteration � Fire Dampers Registers Issua Fee , $ 3 -r��-��- s�.� � - r�� ; {�a y- sa3o e�aµ T. � A.P. #' ! ; S Main Building: TFrorit A Fea� C Riglit K S Left� 71ng. Ref. q� Planning�,Notes: Automatic Washer Construc[ion Pole Sub. Cooking Unit Dishwasher ' Dryers �Gas ❑Elec Fan F.A.U. Switches; Garbage Disposal Generator �0.5 KW �5�15 l � Parki ELECTRICAL ��Tm..� � I 1/2�+�/85 3�a53 � i�L �..�- j) -' � '� Zone; I � � _. � �,ry Building; ' � 1 ., i -- 2 � I a. O li C, i ... � N i � � . N � r j �. , � i R � �Req./Provided � � E � � , - M I S . i � FEES I o , s-so Kw - ❑ SO+KW � � Meter LJup to 100amps � Meter L90 er 100amps' �j � Sub Panel ' ' �Motors 61HPO1X-8 � InaSolar�O9-15 HP �1615+ ' - Microwave - � . - Pole Light Range ; Standing Sections Trash Compactor .� Reinspection Fee I$15 I I laue Fee' DEVELOPMENT SERVICES REQUIREMENTS: Zonin9 APProved By Building Approved By BUILDING PERMIT $ PLAN CHECK $ PLUMBING $ PLAN CHECK 25% � $ ELECTRICAL $ PLAN CHECK 50% $ MECHANICP.L ' $ PLAN CHECK 25% $ SUMMARV OF FEES SMIP f $ PERMIT � ISSUANCE ($ ENERGV P.C. � $ ��GRADING ( $ S MIC(iOFILM $ � TOTALFEE $ $ 3 i � �. � CONSTRUCTION AND PLANNING �� - - - � POOL & SPA � APPROVALS -'Permit # _ Date . Inspector qppROVALS � Permit # Date Inspecror 1. Temporary Electr(cal Service or Pole - . 52. Pool & Equipment Location ` � - �. - 2. -Soil Pipe-Undrgrnd. • , ., , � �53. Steel Reinforcement , _ , ' , ' ' 3. Electrical Conduit,Utility-Undrgrnd._ �l,�j � 54. Forms • ; 4. Electrical Conduit�Undr9rnd. � .55. Electricaf Bonding � - 5. Steel Reinforcement � 56. Rough Plumbing�&�Pressure Test � , 6. Electrical UFER:Gmd. � 57. APPROVAL TO COVER-GUNITE - 7: Footings � � � �- � �58. Electrical Conduif-Undrgrnd. ^ 8: Foundation _' . . 59. Gas Pipe, O Undrgrnd., Test . 9. Wate� Pipe-Undrgrnd. ' 60. Backwash Lines, P-Trap, O Undrgrnd. 10. Structural Eloor SYstem 61. APPROVAL TO OECK , ' 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-Gonduit � � 66. Solar SYstem-Final � . -� " � � 1.6. Rough Electric ' i � ' ' ' , - '�ll 67. Fencing & Access Approval - 17. Rough Wi ing Sign � . 68. APPROVED FOR PLASTERING � 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL ' . _ 19. Rough Heating & Aii Conditioning FIRE DEPT. REQUIREMENT. . � , �� 20. Rough Factory Fireplace �APPROVALS Permit # � � i 21. Ducts, iqStructure - 70. Underground Hydro 22. Ducts, Ventilating '� � 71. Product Piping O Gas ❑ Oil - '. _ . .._ � .. . _ . .- ---_------..._._.._._._ ...__ ... ... .._ ..................._.._.. _. ,... ._. ...... _. �._.... 23� Gas Pipe-Rough & Test � . � � � 72. Underground Flush � 24. Roof framing , � -i . � 73. Undergrnd.Storage Tank O Gas ❑ Oil ,. � 25. Roof Sheathing . , � ' � � 7q. Overhead Hydro � ' - � �. 26. T-Bar Ceiling (Structural) & Monocoat ' 75. Dry Chemical ' 27. Frame.arxl Flashing • � 76. Dry Standpipe . _ ' 28. Lathing &$iding . � . , ' 77. FIXED SYSTEM FINAL 29. lnsulation � .. . 78. FIRE PREV. FINAL ' i 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: s�8 34. Final Heating &.Air Coriditioning , � � 35. Final Gas Pipe=Test � cb .6 - , �� 36. Hood or Canopy � � � , C, c' 37. Final Factory Fireplace - ' . 38. Final Plumbing � � ' 39. Water Service-Final � � � • 40. Gas Service-Final . i , ' 41 . $olar pomestic-Final ; �_ � . . _ _ . 42. Backflow Preventet , ' � �,�` � . � ' 43. Backflow Irrigation � � � � � . 44. .Landscape Irrigation System � . � 45. Sound Attenuation � ' � ' � � 46. Handicap Regulations � , , ' ` ' . . 47. FINAL STRUCTURE'& BUILDING � ! 48. Special Requirements Completed ' '� � �' , . � �� ' ' � 49. Electric Release to Edison � � - - ; -- �- -' - � " ' ' � ' 50. Gas Release to Southern California Gas Co � � ' I �, � 51. CERTI F.ICATE OF OCCUPANCY ' � � '. . _ • _ � ; _ � No. ' ` - � Date � � i � - - - - 1• , �_ AoO��ant to fill in all spaces except ihose within neavy borOer lines ana sign ali aooropriata aeclarations. CITY OF COSTA Project Address - Owner's Name �/ �-✓ < </ v 4�'^i'�`�/zF4lone �*{Z�y Address � ` Arch/Eng. � ' � d�� LicenuNo. Address ' - ' T ' � �' �y Comracror'sNama ��n (�"'�� Phone Address (mailing) City License No. LICENSED CONTRACTOR DECLHRATION I hereby aflirm that 1 am�licensetl untle� provisions o/ Charter 9(commencing wiih section,7000) 01 Division 3 of th Bu Iness antl Protessions Cotle, and my II<ense is in full torce antl e/iect. License Class e 5e No. Oa[e Si9nature WORKERS' COMPENSATION DECLARATI N � 1 hereby aifirm that I have a'certificate of consent to selt-insur¢ or a certititate of Workers' ComOensalion Inzuranca, o� a certlfietl cooY ��ereof (Section 3000, Lab. G.).�, b ....a� / `. ^ !' �.��5�� [L�1� PoIICY No: {.V SL'c � d��llOComPSny Certitietl:mpy is nereby fumishetl. .Certifie mp 6 C tl yt}Lh the city Builtlinq Divisi _' Date ' Applicant .} - EXEM 10 FR M WORKERS' COMPENSATION DECIARATION (This sec[ion neetl not be comple[etl It the permit is for one huntlretl (5300) or IC55). I certify [ha[_in ttie pertormance of the work for wnich this permH is issuetl, I shall no[ employ any perzOn In any manner So a5 to become 5ubjeCt to the WarkersCCompensation Laws oi Calitornia. . > Da[e � � Signature � ' �NOTICE: H, after making this tleUaration, you shoultl Eecome suD�ect to the Workers' CompensatiOn provisions of Ihe Labo� Cotle, you must forthwith � comply • wilh such � p�ovisions or IhiS permit Shall be tleemetl revoketl. CONSTRUGTION LENDING AGENCV 1 hereby alfirm tita[ lhere i5 a constructlon Ientling agency fo� Ihe pe�lo�mance oi lh¢ work tor which this pe�mit is issuetl (SeCtion 3097 Clv. CJ ' lPntl¢r's Name _ Lentler's Atltlress � __ OWNER BUILDER OECLARATIOfJ I nereby atfirm thal I am exempt from the ContractorY Ucense Law for the following reason (Section 7031.5 Business antl Professional Cotle: Any city or wunty'which rGquires a pGrmlt to conStruCt, alt¢r, ImprOve, tlemolish or repair any-structure, prlor to its issuance, also requires Ihe applicant for such permit •to fiie a si9netl 5tatement lhat he/she is litensetl pursuant to the provisions of � the Contractor's License Law (Chapter 9(mmmencing with Section 7000) oi DiviSion 3' ot the Busin¢55 antl Profe55ions Cotle) or that he/zhe is exempt �therefrom-antl tM1e ba5is tor ihe alle9e0 exempliOn. Any violation of Section ]031.5 by any applicant tor a Oermit subjects lhe aoo��ant. to a civll �enalty of mt more than five nuntlretl tlollars (E500). 1, a5 owner o( tne D�operty or my employeez with �wages as tM1eir sole � compensation, will tlo the work, antl the'struciure is not intentletl or offeretl for sale (Section 7044, Business�antl Pwfessional Cotle: The Contractor's' Licenu Law tloez not apO�Y �o an owner oYa p�operty who Cuiltls or improves [hereon, antl wbo tloes Such wo�k him5etl/he�self or [brough his o� he� own employ¢es, p�oviGetl that such improv¢ments are not IntentleA o� offerGtl fo� sale. If, �oweveq the builtling br improvement Is soltl within one year of com- pletlon, lhe owne� wlll have the burtlen of p�ovin9 he/she tlitl not builtl or Im- prove for the purpose of sale). , ❑ I, as owner o� ihe prOpe�ty, am axclusively contracting with IlcenseC con- Vatto�sto consVuct the proje<[ (Seclion 7044, Bu5ine55 antl A0lession5 Cotle: The ConVactor's'License Law tloez not apply ro anlowner of pmperty who builtls or improves [hereon, antl who contractsYor such projects.with a con- l�acto�(51 Ntense pu�suant�to the�Contractoi's License Law�. 1 am dware tha[ proof o( thei� Worker's Compensatlon insurance shoultl be prOvitletl to me. ❑' 1 am exempt uqper Section 8. & P. C. ior [his reason �Lr Date � Ownec • ' I hereby certity that I have raatl this application antl state that the above Intormatlon'Is correct. I aqree to comply with all ti[y antl county ortlinances antl state laws relating to builtliri9 construcHon, antl'hereby authorize repre- 5entativa5 0/, [his ci�y, [o enter pon the above-menHOnetl P/operty for inspection purposez. • �n Si9nature . ate l � O.r Orivers' License or 55 � - - TYPE OF CONSTRUCTION LJ NEW LI ADD L� ALTERATION ❑ CONVERSION: ❑ DEMOLISH � OTHER - DESCRIPTION OF WORK/USE OF BLDG. � TVPE OF PERMIT ' GRADING "FOUNDATION STRUCTURAL ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL ❑ OTHER ' PROJECT�.DESCRIPTION So. F7. oCwParvCV— CONSTRUCTIONTVPE ' -VP.LVATION$ ZONE � GRADING CU. VDS. . ACRES_ REP� ` - Remarks: � ear Sink Backflow Preventer Backflow Irriqation Ba[htubs � � � Clarifiers i Diihwasher ' Drinking Fountains Floor Drains Floor Sinks ' Gas Service ' Interceptors' Kitchen Sink , Lavatories P-Trap 'Roof Orains � , Reinspection Fee Showers ' Service Sink Sewer Cap- ' Sewer Connection Solar Collecmrs Solar Piping � Solar Tank Swimming Pool w/Spa -Water Closet Water Heater Water Service Auto-Wash Laundry Trays $15 � laue Fee Boiler . Duct - Under Ground Duct - Strucaral Duct-Ventilating ' � Exhaust System ❑ Multiple Firepl/Fact. Blt. IC80 �k Heating System & Ducting � ❑0-100,000 BTU 0100,000 Reinspection Fee CMF 0865-46, rev. 30/84 White - Builtling; Canary - Applicanp Pink - Accounting: Goltlenrotl'= Assezsor Hood or Type I � ❑ Canopy Type I I ❑ , Fefrigeration Sys[em � ❑0.100,OOOBTU ❑100,000 ❑ System Fepair/Alteration Fire Dampers , , � � $-3 A.P. # - S Main Building: E T Front. ARear h C Right SLett Ping. Fef. # � Planning Notes: a � � 6741 . 1'/31'/ � . I ' � - Accessory Buildin �.`� .60OU ; - Zone Parking Req./Provided 0 ELECTRICAI . Automa[ic Washer- . . - Trensformer-� 15-50 KW Construction PoleSub. � 50+KW Cooking Unit Dishwasher Dryers �Gas ❑Electric Fan F.A.U. Fixtures i Device Boxes Outlets Swi[ches Garbage Disposal , Generator �0�5 KW �5-15 KW Meter LJup to 100 amps Meter ❑over 100 amps Sub Panel ' • Motors O0.1 HP O1 h� 8 InuSolar �g-15 HP 076- Mivowave . ' _'.. Pole Light Range : Sign ; Standing Sections Trash Compactor � Rainspection Fee $15 laue Fee . FEES . DEVELOPMENTSERVICESREQUIREMENTSi � � Zoning APProved BY D: Building Approved By � p; APPlintion luued BY- D: r�i , � � . ,E75' Issue Fee $ 3 _ Z � ' O N I N G _ q • � E � M � T. S FEES 0 $ � SUMMARV OF FEES � - ' • BUILDINGPERMIT $ - �SMIP � $ PLAN CHECK , $ � PERMIT - � PLUMBING � � $ �SSUANCE $ � PLAN CHECK 25% $ . � ENERGV•P.C. $ ELECTRICAL $ � g�� GRADING ' $ PLANCHECK 50% $ MICROFILM � $ � MECHANICAL � $ � � TOTA� FEE $ l�.00 PLANCHECK ,25%' $ ' ,+ CONSTRUCTION AND PLANNING " POOL & SPA APPROVALS Pe�mit # Date Inspector p�ppROVALS Permit # Date Inspector � 1. Temporary EleGtrical Service or Pole' ��, 52. Pool & Equipment Location , � 2. oil Pipe-Undrgrnd. � 53. Steel Reinforcement ' 3. Electricai Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical 8onding ' 5. Steel,Reinforcement � 56. Rough Plumbing & Pressure Test � �6. Electrical'UFERGrnd. 57. APPROVALTOCOVER-GUNITE " 7. Footings � 58. Electrical Conduit-Undrgrnd. 8. Foundation � 59. Gas Pipe, � Undrgrnd., Test , 9. Water Pipe-U�drgrnd. 60. Backwasfi Lines, P-Trap, � Undrgrnd. 10. Structural�Floor System ' � 61. APPROVAL TO DECK � i i. 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 Elettrical-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 O Oil 23. Gas Pipe-Rough & Test � � 72. Underground Flush � 24: RoofFraming , 73. Undergrnd.StorageTank�Gas ❑Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling �Srructural) & Monocoat 75. Dry Chemical 27. Frame and Flashing 76. Dry Standpipe � 28. Lathing & Siding 77. FIXED SYSTEM FINAL � 29. Insula[ion� . 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 E�ectric Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Tes4 . 36. Hood or Canopy � � . 37. Final Factory Fireplace - . � 38. Final Plumbing 39. Waier Service-Final 40. Gas Service-Final . � 41. Solar pomestic-Final . 42. Backflow Preventer 43. Backflow Irrigation - � ' ' 44. .Landscape Irrigation System � ' - 45. Sound Attenuation • ' . 46. Handicap Regulations , : � ' • . �, 47. FINAL STRUC7URE & BUILDING � . � 48. Special Requirements Completed . � � • 49. Electric Release to�Edison � � � - � - , 50. Gas Release to Southern California Gas Co � . 51. CERTIFICATEOFOCCUPANCY � � _ , _, __ . � . � No. Date ` ' � � Applicant to /ill in all spaces exceD< <hose within heavy EorCer Iinas antl sign all aDOropriate Eaclarations. CITY OF COSTA M SA CONSTRUCT N PERMIT /� �,. Project Address �� /,�.��. �� S ��l .��/ Applicant's Mail"nyg�A�dd ess � Z ��✓ �!�• Owner's Name .s,�{, �� a f1'� t Phon� �'�� Address Arch/Eng. License No. Address Contractor's Name � Phone Address (mailingl City License No. _ LICENSED CONTRACTOR DECLARATION I hereby affl�m tha{ I am licensetl untler provi5ions o( Charte� 9(commenCin9 with section 7000) 01 Divfsion 3 of the Business antl Protessions Cotle, antl my Iicense is in (ull torce antl eHect. License Class License No. -Date Signature WORKERS' COMPENSATION DECLARATION I hereby aHlrm that � pave a certificate oi consent ro 5elf-Insure or a tertifi�ate • Workers' Compensation Insurance, or a tertlfletl coDY thereof (Section 100, Lab. G.) ' .'olicY No. Company eCertifi¢tl coOY �S hereby furni5h¢tl. Certitietl copy �S filetl wittt the city Builtling DlviSion. Date _ Applicant EXEMGTION FROM WORKERS' COMPENSATION DECLARATION (This settion neetl �ot be completetl if the permlt I5 tor on¢ huntlretl ($300) or less). I cerlify thal in th¢ pe�formance of the work to� which this pe�m�t is i55u¢tl 1 shall nOt emplOy dny person in any manne� so a5 [o become subjeGt to t�e Workers' Compensdtion Laws of Californla. �ate Signature 'NOTI[E: H, at[er makin9 tnis tleclaratlon, you shoultl become subject to the Workers' Compensation provisions ot lhe Labor Cotle, you must forthwith Comply with Such p�ovisiOns o� this pe�Tlt shall be tleemetl revoketl. CONSTRVCTION LENDING AGENCV ' 1 hereby afllrm lhat tnere is a construction Ienqing a9ency tor lhe performance ot lhe work for �yhich this permit is ISSuetl (SeGtlon 3097 Civ. C.) Lenaer's Name _ LQnde!'S Adtlle55 OWf�ER BUILOEq UECLARHTION ' I hareby aHlrm Ihat I am exemp[ from IM1e Cont�aclor'S LicenSe l_aw for the tollowing reazon (5e<tion 7031.5 Businesz antl Professlonal Cotle: Any ci[y or countY which reqUires a permit to construct, alter, Improve, tlemolish or rapair any sVucW�e, prl0t to its issuance, also r¢qWreS [he applican[ tor sucb p¢rmit to file a sianetl stdtement that he/she is Ilcensea pursuan[ to the provi5ions ot IDivision 3 of lne-Business ana Professions Cotle) or that he/she is ezempt 'he�etrom antl [h@ basis (o� the alle9etl exeTp[ion. Any violation o( Section 931.5 by any dpplicant tor a permit subjects the appllcant to a civil � enalty of no[ mohe [han five nuntlretl Oollars (�500). ' L� I, as owner ot tlie property or my employees with wages as their sole comoensatlon, wiq Go the work, antl the structure Is not intentled or ofteretl for sale (Sec[ion ]044, Business antl Prolessional Cotle: The Contrattor's License Law tloes not apply to an owner of a property who builtls or improves thereOn, antl wlto tloes su<h work himself/h¢rself or th�ough his o� he� own employ¢es, provitletl that such imp/ovemenls a�e n0[ Intentletl or ottered to� sale. It, nowever, tne Guiltlin9 or improvement Is soltl within one year ot com- pletion, the owner wlll have tne burtlen of proving he/she tlitl not builtl or im- p�od! �or the purpose Ot sale). ❑ I, as owner ot the property, am ezclusively contracting with licenzed con- lractor5 to cons[ry�� Ihe Oro�ect (Section ]044, Business antl Professions Cotle: TM1e ConVa<ror'S License Law tloes not apPly to an owner of Property who builas or Improvas thereon, antl who tontracts tor suth projects with a con- tractor(s1 Ocense pursuant�to the Contractor'i License Law). I am awara that proof o1 their WOrke�'s CompenSation insurdnce Shoultl be provitletl to ma. ❑ I am exempt uqder Section B. L P. C. for this reason Date � Owner _ I hereby rerti/y'tha[ I have reatl thiz IptOYffldtlo0 IS COlf¢Ct. I d9f¢¢ t0 COTP antl state laws relatin9 [o builtling con sentatives oi J.qiz citv to efl(er uqp� privers' Ll�se o{55 tlon zntl state that Ihe above' all Uty antl county orainances• n, antl her¢by authoriie repr¢-' �bove en[lonetl property for Date �— 6 ` � TVPE OF CONSTRUCTION LJ NEW LJ ADD ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTION OF WORK/USE OF BLDG. — ALTERATION LJ RE?AIR TVPE OF PERMIT DING U FOVNDATION LJ STRVCTURAL . ❑ TENANT. LECTRICAL �❑� P�LV.�M/g ING � MEGHANICqL �� -y� I/ ❑ATHER - (/,YyL�41J,r.v�r.y I/}�i2,(( L/%//? PROJECT DESCRIPTION 5(�. F7. oCCUaANGV CONSTRUCTION TVPE VALUATION $ 20NE GRADINGCU.YDS. ACRES Remarks: ' low Irrigation Clarifiers Dishwasher Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors - Kitchen Sink Roof Drains Reinspection Fea � $15 Boiler Ducl - Under Ground Dutt - Structural Duct - Ventilating � Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting 00�100,000 BTU 0100,000 Reinspaction Fee � � $15 CMF 0865-46, rev. 30/84 Wnite - Builtling: Canary - Applicant: Pink - Accountin9: Goltlenrotl - Assessor Shawers Service Sink " Sewer Connection Solar Collectors . Solar Piping Solar Tank Swimming Pool w/Spa Urinal � Water Closet , Water Heater Water Service Auto-Wesh wunOty i rayi � . Issue Fee $ 3 iANICAI FEE Hood or Typel ❑ ' Canopy Typell ❑ Reirigeration System ❑aioo,000sru ❑�oo,000eTu Fire Dampers Registers laue Fee t I 53 A.P. # S Main Buildi E T Front. B Fear' ' A C, Right K �ett S Ping. Ref. # �Plannina Notes: Automatic Washer Construction Pole Sub. COoking Unit Dishwasher Dryers ❑Gas ❑Eleceric Fan F,A, U. Fixtures Device Boxes OuUets ' 8723 8/16/85 � Zone Accessory euilding: . Parking Req./Provided ELECTRICAL . Transformer � 75-50 KW � ❑ 50+KW Meter ❑up to 100 amps Meter �over 100amps Sub Panel Motors DO-7 HP � 1 h- 8 Inc.Solar �9-75 NP �16-15+ Microwave Pole Light ' awiicnes Sign Garbage Disposal ! Standing Sections Generator �0.5 KW 05-15 KW Trash Compactor ecoG- 1'l. 2 O N i N G ` R E U � M T $ � FEES 0 � Reinspection Fee �$15 � � Issue Fee ' � $ 3 � DEVELOPMENT SERVICES REQUIREMEN7S: Zoning Approved By Date 8uilding Approved By — Date� Appliotion Issued By Date ' SUMMARV OF PEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ � PEFMIT � . , PLUMBING $ ISSUANCE $ , i PLAN CHECK ' 25% $' ENERGV P.C. $ ELECTRICAL $. �.2gi0O � GRADING $ � ' PLAN CHECK ' 50% $ MICROFILM $' � MECHANICAL � $ . TOTA� FEE $ � � � PLAN CHECK 25% $ �� CONSTRUCTION AND PLANNING P�� 'A . APPROVALS � Permit # Date Inspector AppROVALS Permit # Date Inspector '� 1. Temporary Electrical Service or Pole 52. Pool & Equipment Location �-2. Soil Pipe-Undrgrnd.- ,. 53. Steel Reinforcement � _3. Electrical Conduit Utility=Undrgmd. 54. Forms '� 4. Electrical Conduit=Undrgrnd. 55. Electrical Bonding � � 5. Steel Reinforcement , _ 56. Rough Plumbing & Pressure Test ' 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. � 8. Foundation 59. Gas Pipe, O Undrgrnd., Test .9. Water �Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd. � 10. Structural �loor System � 61. APPROVAL TO DECK ,� 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final - .12. $ewer Cap 63. Heater & Vent-Fi�al 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�Electriral-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL � 19:�Aough Heating & Air Conditioning � FIRE DEPT. REQUIREMENT � 20.;,Rough Factor,-y;Fireplace APPROVALS Permit # 21. DuCts, in Sttucture 70. Underground Hydro � ` 22. Ducts, Veniilating - 71. Product Piping � Gas ❑ Oil � , _ 23. Gas Pipe�RougFi & 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 �lashing � 76. Dry Standpipe 28. Lathing & Siding- 77. FIXED SYSTEM FINAL 29. �Insula[ion 78. FIRE PREV. FINAL - 30. Drywall Nailing , HEALTH DEPT. REQUIREMENT � 31. Plaster Brown Coat ' 79. FINAL INSPECTION - 32. IElectrical Power�MeterFinal 80. FOOD CERTIFICATE ISSUED , 33. Final Electric : ' Notes: - � � . 34. Final Heating & Air Conditioning � � � 35. Final Gas Pipe-Test � ' � - � i� 36. Hood or CanoPY 37. Final Factory Flreplace� � � • 38. Final Plumbing ' ' • • 39. Water Service�Final. � , , � 40. Gas Service-Final ' ' , , 41. Solar pomestic-Final � � , A2. Backflow Preventer, ' � - 43. Backflow Irrigation -- . � � I� 44. Landscape Irrigation System � , , 45. Sound Attenuation - � � � !x' . � 46. Handicap Regulations . ' ' • 47. FINALSTRUCTURE&BUICDING � • , 48. Special Requirements Completed� . , . 49. Electric Release to Edison � � _ _ �' 50. Gas Release to Southern California Gas�Cv - � r' 51. CERTIFICATE OF OCCUPANCY ' � ' .� No. Date� - � ' � ��