HomeMy WebLinkAbout353 18TH ST - Building Permits�
�ounEss a ea�m�c 3 5 3 E 18 TH S T
!�ds""YEiFa+°'"": BAIRD, HENRY C 3RD
.00r�ss: 353 E 18TH ST
COSTA MESA,CA 92627
548-8658
�POL.YIJtu10 �DDflE54
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uc no.:
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caxm�crarswu� SENTRY ROOFING CO ( 714 ) 751-7663
�pHfPACTONSMAItWO 3 3 6 4 NEVADA
�oo�ss: COSTA MESA CA uc.ra.: 678801
92626 uxr:
UCENSEO COMfl�CTOflS DECL�F�TION: I heraby Nim under penelly N pxjury Ilm I am liceneetl uMx pa'vbn� d CMpm B
(apmme�a�p with Seetbn TOWI d Olvbbn 3 d Na Bueimae eed Pmimwm Ceda, eeq mY �F^^s^ ie in NII btee vk aMep.
cmuc. o.�:p 60 29 uc.cYss: C�9 uc.No.: 7880 EXP: 10/96
�... 11�4�c._ ��L.� r�J � ��! M �—.�..�,� �7,[fip�
pWNER BIIILDEN OECIAflAT10N: I Miab� etfrm uMm paeWy d prFxy ihd I am axemq kom �M Com'rfm Uwma lew la ihs
Idbwiq neaon (Setlian ]OJt.S Busiiw� uW PMe+eione Cods: AnY ��Y w caunry v.hich ipuirea e perm� to wruWCY. ellx. improva.
�mdeh, m rpei erry eVuclure, pria io n� eeueMs. abo rpuiree iM epd� �ar �uch permn lo fila a upriM e4tement Np M or aM
� IId11Md WA11011� ID ��1! plPMlOfI� G� I�M i�i011�lBIaOl� �ClM! �tW'(�i�H 0(CplllllllM�tl� WII�1 gW1011 )C�) 0� �NY�OII .'1 O� ��IO
'.Wineq W PrMeseiwu Codal a IIW M or ehe is usmq �hereM1om end �hs baau la Ihs NIpeE usmqion. My vblmbn ol Seeqn
/p91.6 by enY aPV��^t lor e psrma wbjW� �he eppliunl lo a d+l psnely d ml mm ilun Ilve hund�eE EOA�n �5500�).
� I, m ormar d iha propeny d my empbyees wth wepee ea tMi ade oompametion, MII do �he xoA, enE �hs eVucturo b nq inteMad
w oll�rad lor va�e (Seclion IOM, Bueirou end Proteeaiona CoEe: The Conlredon Lloenea lew dwe rwl eppy lo en ownerd propeM
who WtlEe or'vnD�„ �hareon. vM who doee �uch wpk himaeH w haneC or IhrouOh hi w her own emplvyees, O��d ihe� wch
impwammn ua nd inteedad a oHarsd M�els. X. Mwmx.IM bulMLq a impmv�moM ie eok xilhin msYw d mmplelion. iM
ow�pr-0uJlrt xitl haw IM buiden d pwi'q M w�he d'q nol buiM a impow ta Ihe WTa� «�1.
� I. m ormer d tM G�OeM. em KdudnN m4reCiq rriN ica�wd canueccon ro oommua the V�9a (Setlon 10u. Busi�ms and
Pmt�uian Code: Tha Gzunam l'emas law dou nat e00N a an ow�wr d D�WNY wM buSi� a'iM�u tM�wn ud w1a
mniraete br axA peqsqs wiN a aomratla(�) Icemed purmuent to IM CaMrem� Liwnss Le�.
� I em eRemq urMer Seclion: B. 8 P.C.. lur INe roeson:
DAs: �
1 bo �enby canAy Mn I mn rnars A erA �ntlxatarA 1M'WuiranMo d Cel3wr,ie /Mehh arA �ety Cals Sapiorw 25•A5.2553�. anE
25`�. �d t�al I or eny fNun EuilEi�p oxupent will / wdl not (tlrcb one) mM to rnmply wilh uid ntla cadw enE iha rpuiremenb far
epe?!�illamnetr�ctionamodifrelionhom�hsAi ue�C—Iityl.renepemantDialrlq.qeeWanlleloonet�udianep011Wbnaeneasmp�iromiheae
poh.wn..
DW: 'bd�:
WORKEN'8 COMGENS�TION DECLAX�TON: I heraby e1Nm undar ponMy d paj�vy ons d ihe lo�owi�p Edwbm:
� I M�a eM Mi1 meinten e nnRcqo W wnwnt Io �sllinwn br xvkxi comp�velM. n prwidW Ia Ey Sapion �140 d �M Lebar
coe.. �« m. o«�omwK. d m..wn� �« w+:�n w w�a e b�.a.
� I hm eM W meinun xaMn' wmpmWion'um�enoe. n nau'vaE M Sadion nao N Ns Lebor CoM. W tM W��ce d tM
wark la whid� Nis 0�� is ivueE. MY wabri canM�u�ion'vuurvic� uniw ud poGry wmber ers:
c.m«:
Polcy Numbx:
�;...�+�o� �.ed �a as �deroe � in. o�u;. ro. o�. nunerod eww.lsiao/ a r.s..�
� I oenM � in Ne perlwmsMs d IM work lor whkh tho pemin b iawW. I Wtl iwl amploy erry px�on in ury menMr ao n Io
Eecana wbjed lo IM waFer�' eompwiWion k�x d CalAanu, end p� Net il �k Eecmie abjaU to IM �wrken'
� Aod�:
a.«un Aren•romv«wuenmrn+wu A.ne.h.l�.un!<ranNna�q..rocnmwa•M�tluw
pN ��nGroO WYNntl tlo/Yn lS10C{ W VF b�Itbn ro IM ro/f al rompMUWM1 Wm�p�� u pvNd�O br In
CON9TqUCT10N LENDINO AOENCY: I henby �rm uMer penMy d Po�N�Y �� �� a e oonelruabn hMiip epam,y br Ns
perlormenca ol lhe �ork /w whid� ihe paimY ie oeusd (SeGbn 309), Civ. C).
LENDEfl'S NAME:
LENDEP'S ADDNE99:
I caniN �� I Aeve rud �hb epplieetlan arM elva �het iM ebova iMamNian h eoned. I epras lo wmpN �h NI tlry vM caunry wdir�enae
�d �itle levn 21e1'vq to Euildn0 �^^m^+a�^^ ��reEy e�lhor¢e npewnletivee Ol lhu dly lo entar upon �hs ebove�menlbnld papsily
fw Inepanbn purpwee.
DAN ILL
"°m` /
O,P om.:(2
SiO�tlum IN Ownerqpen �ApW VConireda
(5151�.WP� W�tls-Build'np 8 Stlery:OnaMFb: Cenery-Appimnl: 7ink-Ra�anue: (3oldenrod-Mwuw
CITY OF COSTA MESA — HUILDING PERMIT
' PERM NO: H 075716
PERMIT NO: B 075716 PLAN CHECK NO: N GOVT: N SUPP; N
CONSTRUCTION TYPE: V—N PERMIT TYPE: STR PURPOSE: OTH
JOH DESCRIPTION ; REROOF COMP OVER 1 LAYER COMP SQ FT: 4,452
CLAIM VALUE: 4,452.00 CALC—VALUE; 4,452.00 GROUP OCC: R-3 /M-1
COMMENTS: SMOKE DETECTORS REQUIRED PER 91UBC
*�*���*� **x�***�r**�� �r�r*+�*�r***��*****��+�**�***�+�� ���**x�***x�****+�***+r+�*�+�*�+��*x *�
Z O N I N G R E Q U I R E M E N T S
5 E T B A C K S
------------ MAIN BUILDING ---------- --------- ACCESSORY HUILDING ---------
FRNT; FT IN REAR: FT IN FRNT: FT IN REAR: FT IN
LEFT: FT IN RGHT: FT IN LEFT: FT ZN RGHT: FT IN
PARRING RE�• PROV; PARCEL: 42502227 ZNE: REF NO: �,
PLANNING N TES>
i _
iE fE 1E 1E iF iElE iE iE 1E 1i 1E ff iE 1E 1E 1E 1E IE 1E'lE iF ik iE iE i! if' ik IF iI� fE iE 1f 1E ff iE if 1f �14 �E iE 1E if 1i �E 3E fF 1Elf!(� 1E 1flF 1E 1E if 1F 1f 1E 1f fk 16 iE if Ik 1f 1(' 1E 1f 1E iE iE IE iE iE 1E fE'lE 1F
D E V E L O P M E N T S E R V I C E S R E Q U I R E M E N,T S
J
ZONING APPROVED BY DATE: �'
BUILDING APPROVED BY : � DATE: �
APPLICATION ISSUED BY:
1f IE iE fE 1E 1E aE iE iE 1E ff 1f 1f if 161E 1E 1E IElf 1E if
LEGALIZATION:N F E E S U A R Y
BLDG PMT PLUMBING ELECTRIC MECHANIC
PERMIT 72.00
PLAN
ISSUE FEE
DATE: �'�
iii�{FiEiEiFiElE�fiElElEif 1fiE
STRUCTURAL SEGMENT:Y
/
FIRfi SMIP/RES GRADING
� .50
, SMIP/NON—RES
HUILDING—DIV—> PERMIT ISSUE PLAN—CHECK TOTAL PAID DUE
TOTALS----> 72.50 0.00 0.00 72.50 . 72.50 ,00
REVENUE DIVISION TOTALS--> COLLECTED: 72.50 OVER/SHORT: .00
HLDG PMT PLUMBING ELECTRIC MECHANIC FIRE SMIP/TOT GRADING PLAN—CHECK
�2,00 ,5�
C,
iE 1E iE iE 1E 1E iFlE 1E 1E 1E 3E 1E 1f 1E 1E iE 1E iE 1E 16 iE iE 1E 1E iE 1E 1E iE iE ik 1k iE 1E iE'lE 1E iE iE 1E 1F 1E iF iE 1E 1E iE 1Ek iE 1E iE iE 1E iE iE iE,iF iE IE iE 1E'IF if iF iE iE i! iE 1E if iE iE 1E iE if i(' k if
I N D I V I D U A L F E E B R E A K D�O W N
TYPE QTY D E S C R I P T I O N UNIT COST TOTAL COST
SFR 4452 REROOF BY VALUE RESIDENTIAL NOZONE 1.00 4,452,00
END OF FEES
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,��CONSTRUCTION AND PLANNING � POOL _'A '
APPROVALS Permit # Date Inspector qPPROVALS Permit # Date In"spector
1. Temporary Electrical Service or Poie 52. Pool & Equipment Location • '
2. Soil Pipe�Undrgrnd. . �{ 53. Steel Reinforcement -_ , _,
�3: Electrical Conduit-Utility-Undrqmd. 54. Forms � < � �
4. Electrical Conduit-Undrgrnd. ` 55. Electrical Bonding
- 5, Steel Reinforcemept � 56. Rough P(umbing & Pressure Test . '
^6..ElectricalUFER<G�nd. 57. APPR�VALTOCOVER-GUNITE
`��,�Footin9s __ � 58. Electrical Conduit�Undrgmd. �
-"g, Foundation . ' 59. Gas Pipe, O Undrgmd., Test
9. Water PIpe�Undrgrnd. 60. Backwash Unes, P-Trap, O Undrgmd.
10. Struaural Fioor Svstem ' 61. APPROVAL TO DECK
11. R'operty Sewer line & House Connection - 62. Backwash & Receptor-Finai %
72, $ewer Cap � 63. Heater & Vent-Final .
13. Roof Drains . � . ' 6A. Plumbing System • final �
14. Rough Plumbing- �r � 65. Electrical-Final �
15. Rough Electricai-Conduit � 66. Solar SYetem-Final '
16. Rou9h Elettric Wiring . � 67. Fencing & Access Approval
77. Rough Wiring Sign � 68. APPROVED FOR PLASTERING �
18. Fiough Electripl�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL
19. Rough Heating & Air Conditioning _ FI.ftE DEPT. �EQUIREMENT .
20. Rough Faetory Ficeglace .- -. - - '�, t ! ._ LL � ;APPFjOVq,'t:S�,-r Permit # � � --
21. Ducts, in Structure' � - ' � ' : ' 70. FUnderg'roiiod Hydro �
22. Ducts,Ventilating-,; � �:, ;� 77, Produczpiping�Gas �Oil
23. Gas Pipe•Rough & Test - �� �, . � �� 7p, Underground Fi�eh • � ' �
24. Aoof Framing" •- ' T' , .. ':73. Undergrnd.Storage,TanlcrOGas��0i1
25. Roof Sheathing - � � - � t � 7q, Overhead Hydrp �°
26. T�Bar Ceiling (Structuraq & Monocoat � ' - � 75 qry Chemical .. � � � �
p7. Frame and Flashing - -.. _o n 76. Dry Starrdpipe -'- _
-�28. Lathing & Si�,ing i �' ' ,' ,'. " 2 ' 7Z; fIXED SYSTEM�FINAL . - `
r,. �
29. Insulatipn � ^ + 78, FIRE PREV. F{NAL �
� 30. Drywal� Nailing ' " ;. .' ` _ �HEALTH�DEPT.�REQUIREMENT
37. Plaster BroWn Coat..� _ � � �- 79. PINAL INSPECTION '•
�' 32. E�ectricaLPower Mecer-Final ` {• 80.7 POOD CERTIFI�ATE ISSUED_. _
��•33. Pinai-Electric^ ��� 4 , � ' � � Notas: i -. -
0
" 34. Final Heatinq & Aii Conditioning `� �`" . ; ; " ` - �
_ t
35. FinalGasPipe-Test , .. . :�-� � ,
. �..
36. Hoad-or CannPv -- - _ ' . � ; � Y . _ �
� .
737. Final Factory Fireplace � r- ' � .
- 38. Fina� Plumbing '• , . ' � � �„ � _ '� ' . -
�
39. Nlater Service-Final ,. ` , - • `x -
�,
40. Gas Service-Final . -'- -
. . , .
41. Solar pomesticFinal � � . . r , -�- � �
42. BackflowPreventer - Z 2z- '�� ��1 i/���� �''�p`
. .
43. Backf{ow Irrigation � " ,: r T ;, - ' . •
r
44. Landscape Irrigation'System' ''T'��� t � � _' �' " `'' • '
- * ~ n �.. f ' S' <'
. . ' . a _ ` '� '�. -
45. Sound Attenoation ' - r � , � � _ � _ � �, ��
46. Handicap Regulatfons - ' � , - =�� - ��
,�
47, FINAtSTRUCTURE&BUILOING 2 Zf_ �L� . � -' �� �
48. FINAL PLANNING � � ; ' : '
49. Electric Release to Edison ��� . � -
50. Gaz Release to Southem California Gas Co �� �; ' ' • - '
51. CERTIFICATE OF OCCUPANCY �'
No Date
� Applicant to fill in ail soaces except those within heavy bortler Iines ana sign all approDriate tleclantions.
CITY OF COSTA MESA CONSTRUCT�p N �P/ER I PERMIT NO. TRACT NO. LOT NO. UNIT NO.
�, � 3 L/� H n<1Y,l�e�? E� 3 g' � 3
Project Address � �1f �
�%3-� L" � f �/ A 7VPEOFCONSTRUCTION NEW ADD ALTERATION REPAtR
Applicant'SMailingA dress ❑ CONVERSION ❑ DEMOLISH ❑ OTHER p�p ,�
Owner's Name �� e ���j Phone,��� DESCRIPTION OF WORK/USE OEBLDG.
Address .3S 3 C- .%� .j C"D d/'J�7/SN C� C�>�
ArchlEng. License No.
Address
Contractor's Nam Phone
Addrets (mailing)
City Licenu No.
LICENSED CONTRACTOR D CLARATION
I hereby affirm [nat I am Ilcensetl untler provislons of Charter 9(commencing
with 50ction ]000) of Divislon 3 of tM1e 6usiness antl Professions Cotle, antl
my Iic¢nse is in tull force antl effect.
Licensp Clasz License No.
Date 519nature
WORKERS' COMPENSATION OECLARATION
I hereby ai(irm tnat I have a certiftcate of consent to self-insure or a cerUficate
' WOYke�s' Compensation Inzutdnce, Or a C¢rtl�led copy thereot (Se<[iOn
J00, �D. C.)
Policy No. Company
8 Cer(ifietl copy is heraby fumishetl.
Cert�fietl mpy Is filetl wlth the city Bulltling Dlvision.
Date_ Applicant
EXEMpTION FROM WORKERS' COMPENSATION DECLARATION
(Thi55Q�tion neetl nOl De complet¢tl if the permll IS for One huntl�etl (5100) o�
less).
I cerlity fhat in the pe�fotmance of the work f r whith this pN�m�t I5 issuetl, I
shall not employ any person in any manner o as to beco jsc the
Worke�s' Cp mCefsat'o laws of Califor la
Date _..E•��/�S�—� 6'gnature
NOTICE: If, atter making�this tleqarati n, you sb Itl beco e subjecl to the
WOrkeYs' Gompensation provisiops of Ih¢ Ldb Cotle, you must forthwith
comply with Such provisiDns o� this pe� Shall be tleemetl �evoketl.
CONSYRUCTION LENOING AGENCV
I nerehy affirm thal there is a cons�ruc[ion Ientling agency for the performance
o( [hC work ior which thi5 permit is i55uetl (Section 3097 Civ. C.)
LPntler•s Name
Lentlet's Atltlress
OWN�R BUILDEH DECLAHATION
1 hereby aftirm that I am CxempY frOm the Conlracto�'S LiCBnse L.aw tot tpe
follovVing reason (Section 7031.5 guslness antl Protessional Cotle: Any city or
counly which require5a.permit to construcq alte�, improve, tlemOlish or reDair
any Structure, p�ior to It5 issuance, also requ7re5lhe applicant fo� SUGh permit
to til@ a siqnetl Statement tbat he/sM1e is licensetl pu�suant to the provlsions of
[ne Cryntractor's Ucense Law (Chapter 9(commencinq with Section ]000) of
Division 3 of [he Business antl Protessions Cotle) or tM1at he/she is exemot
`erefrom an� the basis for [he afleged exempt7on. Any Wolation of Section
31.5 by any ap0licant for a permi[ subjects lhe applicant to a civil
nalty of not mora than five huntlretl tlollars ($500).
� 4 as owner of the property or my employeas witn wages as their sole
comvensation, wi11 ao the work, ana the ztructure is nol intenCetl or offeretl
i(or sele (Section 7044, Business antl Professional Cotle: The Contrac[oYs
ILiceny¢ �w aoes not appry to an owner ot a oraperty who oviltls or imoroves
lhere0n, antl wbo Ooes sucn work himself/herself or througp hiz or her own
¢mplOyees, provitletl t�at suCn irM1provemen[5 at'e not in[entled o� offared for
sale. If, M1owever, the builtling or improvement Is soltl within one year of com-
pletiOq the ownM wlll have the bu�tlen ot prOvin9 he/she tlitl not builtl o� im-
' prove tOr Ibe pu�po5e of salo).
❑�. as Owne� Oi [he property, am exclu5ively con[�acting witn IiCensetl Con-
tractorsto construct the project (Section 7044, Business antl Professlons Cotle:
The Contractor's license Law does not apply to an owner of pro0erty who
builtl; or improves cnereon, ana who contracts Por such projects with a con-
[ra<tOr(s I¢ense Oursuant to the ContractOr'S Lic¢nse (.aw). I am awate tqat
0/ooi O� tbeir Wo�ke�'s COmpensatiOn in5utaqcC shoultl be provitletl to me.
❑� dm <zempt untler SecUon .� 8. & P. C. �OrjW��eason
�ate v a!7'�tr'/Owner
I nereby certify that I have red
iniorr�a[ion is mrrect I agree [o
antl s�a[e laws relatinq to buiitlir
sentatives of this ' y [o en�r
inspetllon pur os `�
Signa�ure L/ _
Drivers' �icense or 5� —
CMF OBfiS-46, rev.
tion antl state that the above
all Utv antl muntv ortlinances
TVPE OF PERMIT LJ GRAOING U FOUNDATION LJ STRUCTURAL
❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAL
❑ OTHER
PRQIECT DESCRIPTION 5�. FT, oGCUaANCv_
CONSTRUCTIONTYPE ` VALUATION$ 1'1°IC
ZONE GRADINGCU.YOS. ACRES_
Remarks: '��. n�.. .. �i. �� � ...- / J{- �91q
3ar Sink
3ackflow Preventer
3ackflow I rrigation
3athtubs
�larifiers .
�ishwasher
�rinking Fountains
Floor Drains
Roor Sinks
3as Service Outlets
Interceptors
Kitchen Sink
Lavatories
P—Trap�
Roof'Dreins
Rainspaction Fee $15
Boiler
Duct - Under Ground
Duct - Structural
Duct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. ICBO #
Heating System & Ducting
❑aioo,000 aTu �ioo,000
ReinsOection fee � S75
White - Builtling; Canary - Applicant; Pink - Accounting; Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank .
Swimming Pool w/Spa
Urinal �
Water Closet �
Wate� Heater
Water Service
Auto-Wash
Laundry Trays
Issue Fee
FEES
$ 3
S Main Building:
T Front
8 Rear
A
C Ri9ht
K Left
S
Ping. Ref. # —
Planning Notes:
Auromatic Washer
Construction Pole Sub.
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Eleci
Fan
F.A.U.
Fixtures
Devjce Boxes
Outleu
Switches
Garbage Dispoul
Generator �0-5 KW [
^ 9'L -�Z - Zone
Accessory Building:
01 QGO{TE�O-Q004�28'2 Ti3T 204,0'.
N
I
N
G
R
Q Parking Req./Providetl . E
� Q
M
T
S
ELEC7RICAL
Transformer ❑ 15-50 KW .
❑ 50+KW
Meter ❑up to 100 amps
Meler ❑over700amps
Sub Panel
Motors�0.7 HPO1'f.-8
Inc. Solar 09-15 HP 016-15+
Microwave
Pole Light '
Range
Standing Sections
5�75 KW Trash Compactor
Reinspection Fee �$15 Issue Fee
IANICAL FEES
Hoodor T DEVELOPMENTSERVICESREQUIREMENTS:
YPQ f � Zoning Approved By
Canopy Type I I ❑
Building APProved By
Refrigeration System
❑aioo,000sTu ❑ioo,000
System Repair/Alteration
Fire Dampers
Registers
Izsue Fee � $ 3
FEES
SUMMARV�7 FEES �
BUIIDING PERMIT 3 �9T SMIP $ � Z'�
PLAN CHECK $ PERMIT .
PLUMBING y ISSUANCE $
PLAN CHECK 25% 5 ENEFGY P.C. $
ELECTRICAL S. � q s� GRADING $
PLANCHECK 50% 5 MICROFILM $
MECHANICAL $ TOTALFEE $ Z-0 �s
PLAN CHECK 25% $
� � " POO L & SPA
CONSTRUCTION AND PLANNING '"
�,.-.. i, Date .Inspector Date Inspector
,APPROVALS P,ermit # � � APPROVALS Permit #
1. Temporary Electrical�Service or Pole 52. Pool & Equipment Location
2. �Soil Pipe-Undrgmd. r 53. Steel Reinforcement
3. Elecirical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVALTO COVER�GUNITE
7. Footings '�'' ,� 58. Electrical Conduit-Undrgrnd.
�
8. Foundation ,� F, 59. Gas Pipe, O Undrgrnd., 7est �
9. Water Pipe�Untlrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
70. Structural Floor System 61. APPROVAL TO DECK '_�
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final ��
12. Sewer Cap 63. Heater & Vent-Final - ,
73. Roof Drains 64. Plumbing System - Final �;
14. Rough Plumbing 65. Electrical-Final �
15. Rough Electrical�Conduit 66. Solar System-Final
16. Rough Electric Wiring � 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical�T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL ,
19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �� _
20. Rough Factory Fireplace APPROVALS Permit # �' '
21. Ducts, in Structure 70. Underground Hydro '
22. Ducts, Ventilating 71. Product Piping � Gas ❑ Oil
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof Framing 73. Undergrnd.StorageTank O�Gas ❑Oil
25. Roof Sheathing 74. Overhead Hydro " " ..
�.
26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical �,' _ �
27. Frame and Flashing , - 76. Dry Standpipe _- �� .
28. Lathing & Siding 77. FIXED SYSTEM FINAL��� �
29. Insulation 78. FIRE PREV. FINAL �
30. Drywall Nailing � HEALTH DEPT. REQUIREMENT r�
31. Plaster Brown Coat 79. FINAL INSPECTION � .
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED !�
` '7
33. Final Electric %� �,j Notes: +• '
�
34. Final Heating & Air Conditioning "' �
u�
35. Final Gas Pipe-Test L%.�
36. Hood or,•Canopy . ,
. � •
37: Final Factory Fireplace '� f'. �
,�
38�. Final Plumbing • ,. •' � !
39. Water Service-Final %�^ �" �' .' .,
40. Gas Se�vice-final . "
'.41. Solar pomestic-Final / '
: 42. Backflow Preventer � .% '
� 43. Backflow Irrigation �� � � , '
.
44'. �Landscape Irrigation System '- . �'
i-
` 45. Sound Attenuation (^ . .
� _ �.
46. Handicap RegulaYions f _ � � ._ �
•47. FINALSTRUCTURE & BUILDING � f�. �_ � � � f
,
48.' Special �Requirements Completed `.
i, �
49. Electric Releaseto Edison }�
�, �
50. Gas Release to Southern California Gas Co �
51. CERTIFICATE OF OCCUPANCY
No. Date
� �►._�•--� - - i
l�
AOPlleant to fill In all so��es exeeo� thosa wltMn neavy Dortler Ilnet antl sign all approorlata tleclanUans.
CITV OF COSTp MESA COyN R TJI(��N( PE MIT P RMIT NO. TRACT NO. LOT NO. UNIT N0.
Project Address �� V � [ �, � ��
Applicam'sMailingA dress � �n /�%�SA�
Owner's Name ��� er ��Y Ph ne 3�l
Address - � J /J `%% 1d �� �
Arch/Eng. License No.
Addresz
Contrector'S Nam Phone
Address (ma"1'nal '
City License No.
�ICENSED CON7RALTOR �ECLARATION
1 he�eby alfl�m thdt I am licensetl untl!/ provlslOnS Of Cha�ter 9(�ommencing
with section 7000) ot Dlvision 3 ot the Buslness antl Professions Cotle, antl
my Ilcense is In f W I torce antl eftect.
LICBfISC CId55 LICEf158 NO.
Date Signature
WORKERS' COMPENSATION DECLARATION
� hereby aftirm tpa[ I �ave a certitiwte of consenl to self-Inmre or a certiticata
' Workets' COh�pen5a[ion Insuranc¢, Ot a certl(ie0 copy [hereot (Section
�OQ Ld�. C.)
Policy No. Company
Certifietl copy iz �ereby fumis�eE.
Certi ietl opy i flletl with the city Bu" n9 DIy ision.� �7 /
Da[e��� Applicant CNRIr lSi�//KY
E%EMPTION FpOM WORKEFS' CO GENSATI N DECLA0.ATION
(TM1isseclion neetl not be tompletetl i1 thn permit is for one huntlretl (E300) or
less).
1 certify that In the perfOrmance ot th¢ wo�k for whiGh [his pe�TR i5 i55uetl, I
snall not employ any person in any manner so az to become subjec[ to the
workers' Comoensatlon Laws ot Califomia.
Date Si9nature
NOTICE: It, aitar making this tleclaration, you shoultl become subject to [ho
Wo�keR' Comp@n5ation provizions o� Ih¢ l2bo� Cotle, y0u mUst ro.cnw�m
comply w�th sUch prOvisions or [his pe�mit Shall be tleeT¢tl �evoketl.
CONSTRUCTION LENDING AGENCV
1 n¢reby affirm tnat [here is a construction Ientlin9 agency for (he pertormance
of t�e work tor which this permit h ISsuetl (SettlOn 309] Civ. C.)
Lontler's Name
Lonticr•s AtldreSs
OWNER BUILqEH DECLARATION
I horaby alfirm (hat I am ezempt irom Ihe ConlydGtor's Litensa l.aw iOr tne
followinq reason (Section 7031.5 Buslness antl Protnsslonal Code: Any city or
counly which requiras,a permit to construct, alteq Improve, aemoiish or repalr
any Tt�uGturn, priOr [o-Iti i55uanCe, also reqWres Iho applicanl f0� such pe�mit
lo flle a Si9natl ztalumenl IM1at ho/zne IS licensetl pursUant l0 lhe provi5ion5 oi
[he Conlractor'= License Law (Cnapter 9(commandng with Sectlon 7000) of
D�vision 3 of the BuSiness antl Pro/essions Cotlo) or that he/she is exempt
=rolrom antl tne basis for the allegetl exemption. Any violation ol Seclion
31.5 by any apPllcant for a permit subjects iM1e applicanl to a civil
.�alty ot not more than tive huntlretl tlollars (E500).
L.� I, as owner p{ (he property or my employoes witn wages as their solo
compensation, will tlo the work, antl tne struc[ure is not intentletl or offeretl
ror salu (Snc�ipn 7044, Business and Professional Cotle: The Contrattor's
LIC¢nie Ldw tloes not apply t0 an owner of a proporty who buJtls or Improve5
th¢reon, antl who tloes such work hlmsell/horsolf or throu9h his or her own
employoos, proyltletl tnat such improvements ara nol Intentlotl or 011eretl for
sale. I(, howevar, the builtling or ImD�ovement I5 soltl wltbin one year ot com-
pletloq the owner wlll nave the burtlen ot provin9 ha/shn tli0 not builtl or im-
�rOva forlho pUrpose ot sale).
1, as owne� oi lhe prOPerty, am exclu5ivoly cOntracting wit11 IlcenS¢0 con-
tractors to construct the project (Section 7044, Business antl Prolezsions Cotle:
The Conlra<tor•5 Llcenie Law does not apply lo an owner ot property who
builGs or ImprOves theraon, antl who conVacts lor suth pro7ects with a con-
tra<tor(s) ncenSo pursuant to tne Contractor's Ucense lnw�. I am aware that
prool o( thei� Worke�'S ComPensatlon Insu�anCa zhoultl bo provltletl lo me.
❑ I am ezempt untler Sec(ion , B. b P. C. �or this reason
Date
Signature 7J�/!-1
Drivers' licensg or 55 qf
Owner -�✓K � y-+���cv
ve reatl this ap01' atlon antl itate tpat [he abova
ree to comply w th all cily antl county ortlinanc05
builtlina con5trucllon. antl herebv authorize �eo�e-
v
� 3�28 4
TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR
❑ CONVERSION ❑ DEMOLISH ❑ OTHER
DESCRIPTION,OF WQFiIi/US�QF BLDG.
TVPE OF PERMIT LI Gr2ADING LJ FOVNDATION U STRUCTURAL
❑ TENANT ❑ ELEC7RICAL ❑ PLVMBING ❑ MECHANICAL
❑ OTHER
PROJECT DESCRIPTION Sa. FT. oCCUaANcv_
CONSTRUCTION TYPE VALUATION S z��
ZONE GRADINGCV.YDS. HCRES_
Remarks:
Ber Sink
Backflow Preventer
Backflow Irrigation
6athtubs
Clarifiers
Drinking Fountains
Floor Drains �
Floor Sinks
Gas Service Outlets
Interceptors
Kitchen Sink
lavatories
P—Trap
Foof Drains
Reinspection Fea $15
Boiler
Duct - Under Ground
Ouct - Ventilating
Exhaust System ❑ Multiple
Firepl/Fact. Blt. IC80 #
Heating System & Ducting
❑ o-i oo,000 eTu O i oo,000
Reinspection Fee � $15
CMF 0865-46, rev. 10/84 White - Builtling; �anary - Applicanh Plnk - Accoun[ing: Goltlenrotl - Assessor
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
water Closet
Water Heater
water Service
Auto-Wash
laue Fee
Hood or Typel ❑
Canopy Typell ❑
Refrigeration System
❑4700,OOOBTU ❑100,000
System Repair/Alteration
Fire Dampers
Registers
luue Fee
S 3
$ 3
A.P. qy�
S Main Building:
E
T Front
B Rear
A
C Right
K Left
$
Ping. Ref. �W
Planning Notes:
Automatic Washer
Construction PoleSub.
Cooking Unit
Dishwasher
Dry¢rs ❑Gas ❑ElecVic
Fan
F.A.U.
Fiztures
Device Bazes
Outlets
Switches
Garbage Dispoul
Generator 00�5 KW O5�'
Dt
Zone
Acteuory Building:
883-DOQ4]884 i"GT
Parking Req./Provided
ELEC7RICAL
Transformer ❑ 15-50 KW
❑ 50+KW
Meter ❑up m 100amps
Meter ❑over100amps
Sub Panel
Momrs �47 HP � 1 S- B
Inc.Solar []9.15 HP �16�15+
Microwave
Pole Light
Fange
I I Standing $ections
5 KW I � Trash Compacmr
� Rainspection Fee �$15 � � Issue Fee
DEVELOPMENT SERVICES REQUIREMENTS:
Zoning Approved By
Building Approved By
APPliqtion Issued BV
FEES
$ 3
N
I
N
G
R
E
U
M
T
$
SUMMARV OF FEES �
BUILDING PERMIT $ _4. � SMIP � S
PLAN CHECK $ PEAMIT
PLUMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERGV P.C. $
ELECTRICAL $ GRADING S '
PLAN CHECK 50% $ MICROFILM $ �
MECHANICAL S TOTALFEE $ �
PLAN CHECK 25% $
CONSTRUCTION AND PLANNING ' POOL & SPA
APPROVALS Permit # Date Inspector qppROVALS Permit # Date � Inspector
.. --
1.;Temporary Electrical.Service or Pole 52. Pool & Equipment Location
.�
2. Soil Pipe-Undrgrnd. =- 53. Steet Reinforcement
3. Electrical Conduit Utility-Undrgrnd. 54. Forms
4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding
5. Steel Reinforcement 56. Rough Plumbing & Pressure Test
6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE
7. Footings �:� • 58. Electrical Conduit-Undrgrnd.
8. Foundation l. �� 59. Gas Pipe, O Undrgrnd., Test
9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd.
10. Structur2l Floor System 61. APPROVAL TO DECK . � -
11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final ••�
12. Sewer CaP 63. Heater & Vent-Final
�.: �
13. Roof Drains 64. Plumbing System - Final ,`�
14. Rough Plumbing 65. Electrical-Final �
15. Rough Electrical-Conduit 66. Solar System-Final
16. Rough Electric Wiring 67. Fencing & Access Approval
17. Rough Wiring Sign 68. APPROVED FOR PLASTERING
18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL -
79. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT �"
20. Rough Factory Fireplace APPROVALS Permit # �� �
27. Ducts, in Structure 70. Underground Hydro
22. Ducts, Ventilating 71. Product Piping OGas OOiI
23. Gas Pipe-Rough & Test 72. Underground Flush
24. Roof framing 73. Undergrnd.StorageTank OGes ❑Oil
25. Roof Sheathing 74, Overhead Hydro �
26. T-Bar Ceiling (Strucwraq & Monocoat 75. Dry Chemical _� �.
27. Frame and Flashing 76. Dry Standpipe �
28. lathing & Siding 77. FIXED SYSTEM FINA'L. • ,� .
29. Insulation 78. FIRE PREV. FINAL ��� �
HEALTHDEPT,�REQUIREMENT �
30. Drywall f"lailing �
31. Plaster Brown Coat 79. FINAL INSPECTION :. �
'..
32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED �
-..
33. Final Elec4ric � Notes: •-
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test r
36. Hood or Canopy .
37. Final Factory Fireplace ' _
38: Final Plumbing , '
.
39. Water Service-Final ' . �
40. Gas SecviCe�Final . , - �
. 41. Solar pomestic-Final - . `
, 42. Backflow Preventer - � - ,
� 43. Backflow Irriga[ion ' , - � �
. ;��
� 44. Landscape Irrigation System : � � ,
��45. Sound Attenuation
46. Handicap Regulations .. '.�
47. FINALS7RUCTURE&BUILDING .S , ,
48rSpecial�RequirementsCompleted �' � ' '�
49. Electric Retease to Edison "� '
5Q. Gas Release to Southern Califomia Gas Co
57. CERTIFICATE OF OCCUPANCY . .
No. ' Date
N
�
l
M
N'
Y
�
0
3
/
CqSTA MESA. _Ci1NS �({/�JCT/IO�N. wP�ERMI/T,�p
roject.�,adress ��.3 � ���"' • ��°�"/K/, CH _`l��%
Applicant's Mailing Address �`3G_ � � m. �_,��
Owner's Name � rW"� C�'���? 1 Phone ��
Address -�5-3 L �! -i���� ���' ,q.�-��
Arch/Eng. License No: _
v �
Address .
Contrector's Nam �Phone
�..
Address (mailing� �
City License No.
LICENSE� CONTRACTOR D C�-ARPTION • � .� _
I he�eby affi�m tha[ I am licensetl unde� ptovisions of Cha�te� 9(commencing
with section 7000) of Divlsion 3 of the Business antl Protessions Cotle, an0
�i licenso is in full (orce antl eftOCL ' '�r
enre Class license�No. � � ,
.ete Si9naWre �
WORKERS' COMPENSATION pECLARATION '
1 nereby affirm ihat I M1ave a certificate of consenl to ielf-insure or a certlticace
�f Workers' Compensation InsWance, or a certlfietl <opy thereof (Soction
100, Lab. CJ + � � 1 '
rolicy No. Company - � � �� .
8 Certifietl Copy is hereby furnl4hetl. - �
Cerlifietl copy is tilea with the city Builtling Dlvision.��
Oate APpliGant
EXEMPTION FROM WORKERS' ��MPENSATION DEC'LARATION '
(TM1is seGtion neetl not be completetl if the permit is tor One huntlr¢tl ($300) or
less).
1 certify roat in the performante of the work for wnicn this perm�t is Issuetl, I �
shall not em0loy any person bl,.any man r so as to become ect to the�_
Workers'f o e sa wn Laws o( Ca�lTotin' - '
oate �+'�,�-�a' $i9nature �
NOTICE: If, afler making [his tleclara[ion, you �Oultl become Subjett to the
Worker5' COmpensation provislo�s of the la ot Cotle, y0u mu5t torthwith
compty with such �Orovisions or this per it snall pe tleemetl revoketl.
CONSTRVCTION LENDING PGENCV
��� 1 hereby atfl�m Ihat there IS a construction lentling a9ency to� the pe�fo�mance
' ot [he work far which this permi[ is issuetl (Se<tion 309] Clv. CJ
lRntler's Name "
�i Lentle�'s Atltlress
IOWNER BUILDER DECLARAY�ON
� hereby afflrm that 1 am exempt irom the Contractor's License Law for the
9owing reason (Section 7031.5 Buslness antl Protessional Cotle: Any cltY or
mtv wnicn reouires a oermlt fo Construct, alter, imOrove, tlemolish or repair
Oivision 3 of the Bu5ine55 antl Prote55ion5 Cotle) o� that he/she ii exemp[
•�erefrom antl the tlasis tor Ihe alle9etl exemption. Any violatiOn of Section
;31.5 by any appliwnt fo� a pe�mit 5ubject5 [he applitant to a civil
-"�,'^�,�ytty of not more tnan five huntlred tlollars (E500).
�3'I, as owner ot the propertV Or my employees with wages as [heir sole
compensa[ion, will tlo the work. antl tne s[ructure is not intenOeC or offeretl
for sale (Section 7044, Business antl PrOtezsional Cotle: The Contrdctor'S
License 12w tloes not apply to an owner ot a property who builtls or improves
[hereon, antl who tloes such wOrk himzelt/hersClf o� tM1rough h15 or h¢r own
¢mD�oy¢es, 0/ovitletl thal such Improvem¢nfz ar¢ no[ IntenOeC or oHercE for
sale. If..eR,vever, the builtlin9 or improvement is soltl within one year ol com-
pleiiop,'lne owner will have tne burtlen ot provin9 ne/she tlitl not builtl or im-
.�Ove for the purpose of Sale).
U I, a5 owner of the properry, am exclusively contracting with IlcenSetl con-
Vac[orsto construct the project (Section ]044, Business antl Professions Cotle:
The Con[ractor's License l.aw does not apply lo an owne� of property who
buiitls or Improves thereon, and who contracts tor such prajects witn a com
t�actor(S) ❑cense pu�suant to the Cont�acto�'S License Law). I am aware that
'proof o( their Worker's Compensstion insurance shoultl be provitletl to me.
�] I am exempt untler 5¢ction�� B. & P. 0. for this jedsqn
I hereby certi/y that
intormation Is correct
:ntl state laws relatim
sentatives of this cit
in5pection purp .
SignaWre s
Driver5' License or 55
CMF 0865-46, rev. 30/BN
_ Owner _
I have rcatl t
I agr¢e t0 Co
to builtling �
to enter u
t
II in all zoaces exeept tnose withln neavy baraer lines antl sign al1 appropriate tleelarations.
,$��3"i Z� ( I,,,,,.., ,..,. I �.,, ,..,. I,,,�„ ���.
,,,TYP^EOFCONSTRUCTION NEW ADD ALTERATION REGAIR
•LICONVERSION ❑ DEMOLISH ❑ OTHER
flESCRIPTION OF WORK/USE OF BLDG.
- �K(,WSL'D '�Oc"ft0
���TVPE OF PERMIT GRADING FOUNDATION STRUCTURAL
� ❑ TENANT ❑ ELECTRICAI ❑ PLUMBING ❑ MECHANICAL
�, ❑ OTLIER
PROJEC7'DESCRIPTION 5Q Fr oCCUPaNCv �
._ CONSTRUCTIONTVOF � \f VAl11GTIQN4 ���n�
20NE GRADINGCU.VDS. ACRES
_ .. . . /� _ r. .. . . U n . . r _
-�� •�. Ysi. �t 432-
Bar Sink;
� Backflow Preventer .
�� Backflow Irrigation
Drinking Fountains
Floor �rains
Floor Sinks
Gas Service Outlets
Interceptors �
KitcYien Sink .
Lavamries
P—Trap
Roof Drains .
ReinspeMion Fee.., $15
Boiler
Duct - Under Ground
Duct - Structural '
Duct-Ventilating -
Exhaust System ❑ Multiple
FirepVFact Blt. ICBO #
Heating System & Ducting
❑aioo,000 sru Oioo,00a
Reinspec[ion Fee
White - Builtlin9; Cana�y - ApO�icant; Plnk - AccOuntin9: Goltlenrotl - ASseS50r
$15
PLUMBING
Showers
Service Sink
Sewer Cap
Sewer Connection
Solar Collectors
Solar Pipin9
Solar Tank
Swimming Pool w/Spa
Urinal
Waeer Closet
Water Heater
Water Service
Isue Fee
Hood or Typel ❑
Canopy Type I I ❑
Re(rigeration System
❑0-100,000 BTU ❑100,000 BT
Sysrem Repair/Alteration
F ire Da mpers
Registers
Issue Fea
FEES
$ 3
FEES
$ 3
���\ ` �\1l
�\
A.P. �p �
5 Main Building:
E
T Front
A flear ��
C Right
g Left � R �
Ping. Ref, dh �
Plannin9 Notes:
�
�� SI ,��
�- 2 ' Zone � .
Accessory Building:
Z
O
N
I
N
G
R
Parking Req.(Provided E
. M
T
S
ELECTRICAL _
AutOmatic Washer Transformer ❑ 15-50 KW
Construction PoleSub. .0 50+KW
Cooking Unit
Dishwasher
Dryers ❑Gas ❑Electric
Fan
F.A.U.
Fixtures
Device Boxes
Outlets
Switches . �
Garbage Disposal �
Generemr �65 KW �5-15 KW
FEES
Meter LJup ro 100 amps
Meter ❑over 100amps
Sub Panel - �
Motors DO-1 HP � 1 f. � 8
InaSolar d9-15 HP �76-75+
Microwave
Pole Light
Range
Standing Sections
Trash Compacror
Fee �$15 � � Issue Fee
DEVELOPMENT SERVICES REQUIREMENTS: Q�
2oning Approved By �� Date / ��_<+'
Building Approved By Date���[('�
Appliwtion Issued By � Date�'�'�� 't T j
SUMMAp V � FEES ,r�
BUILDINGPERMIT $ � SMIP �$ ��
PLAN CHECK $ PERMIT
P�UMBING $ ISSUANCE $
PLAN CHECK 25% $ ENERG�' P.C. $
ELECTRICAL $ �i�I — GRADING $
PLANCHECK 50% $ MICROFILM $ �
MECHANICAL $ TOTALFEE $ �u�6 -
PLAN CHECK 25% $
.:7�, __"- �
CONSTRUCTION AND PLANNING
APPROVALS Permit # �
1. Temporary Electrical Service or Pole
2. �Soil Pipe-Undrgrnd. '
3. Electrical Conduit Utility-Undrgrnd.
4. Electrical Conduit-Undrgrnd.
5. Steel ReinforCement .
6. Electrical UFER Grnd.
7. Footings ,
8. Foundation �
9. Water,Pipe-Undrgrnd.
10. Structural Floor System ,
11. Property Sewer Line & House Connection
12. Sewer Cap
13. Roof Drains
14. Rough Plumbing
75. Rough Electrical-Conduit
16. Rough Electric Wiring
17. Rough Wiring Sign
18. Rough Electrical-T Bar Ceiling
19. Rough Heati�g & Air Conditioning
20. Rough Factory Fireplace
21. Ducts, in Structure
22. Ducts, Ventilating
23. Gas Pipe-Rough & Test
24. Roof Framing
25. Roof Sheathinq
26. T-Bar Ceiling (Structural) & Monocoat '
27. frame and Flashing
28. Lathing & Sitling
29. Insulation
30. Drywall Nailing �S 0-1�
31. Plaster Brown Coat
32. Electrical Power Meter-Final
33. Final Electric (
34. Final Heating & Air Conditioning
35. Final Gas Pipe-Test
36. Hood or Canopy
37. Final Factory Fireplace
38�. Final P�umbing
� 39. Wa[er Service-Final
.,,40. Gas Service-Final
i 41. Solar pomesticFinal -
� 42. Backflow Preventer
i
�
1 43 �Backflow, Irrigation
� 44. Landscape Irrigatron System
� 45. Sound Attenuation
46. Handicap Regulations
47. FINALSTRUCTURE&BUILDING �
48. Special �Requirements Completed
49. Electric Release to Edis n
50. Gas Release to Southern" California Gas Co
�
Date
' � POOL & SPA ;
Inspector qppROVALS Pe�mit# ,
52. Pool & Equipment Location '
53. Steel Reinforcement
54. Forms
55. Electrical Bonding .
56. Rough Plumbing & Pressure Test
57. APPROVALTOCOVER-GUNITE
58. Electrical Conduit-Undrgrnd.
59. Gas Pipe, O Undrgrnd., Test (-
60. Backwash Lines, P-Trap, O;Und`rgrnd.
61. APPROVAL TO DECK '� 1
62. Backwash & Receptor-Final' '
63. Heater & Vent-Final ' .
64. Plumbing System - Fina! � • ,
65. Electrical-Final � '
66. Solar Sys[em-Final
67. Fencing & Access Approval -
� 68. APPROVED FOR PLASTERING
r ,
69. POOL/SPASYSTEMSFINAL .. ,
FIRE DEPT. REQUIREMENT � .
�:.
APPROVALS Permit #
3 I G�
q y.
70. Underground Hydro ) �
71. Product Piping � Gas ❑ Oil
72. Underground Flush � �
73. Undergrnd.StorageTank OGas� OOiI
74. Overhead Hydro
75. Dry Chemical --
76. Dry Standpipe �'� '" •
77. FIXED SYSTEM FINAL� �
78. FIRE PREV. FINAL � ' -
HEAITH DEPT: REQUIREMENT
79. FINAL INSPECTION , �-
80. FOOD CERTIFICATE ISSUED�
U�
' / /` �vi � �Z
l
�
Date � Inspector
./
�� '�4
- . - . �i� �-- .- -� .� _ ._ -. �
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� COSTA MESA BUILDING-SAFETY DEPARTMENT
P.O. BOX 1200 COSTA MESA. CALIFORNIA 92626
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For Applicant to Fill in Completely
ADIDFESS J �� �✓ �V � " , C� ['�%7,
OWNER Nr NKY C
MAI�
AODRESS 3S 3 .�-.
CITV �pf d MfJ�
CONSTRUCTION . /
BRANCH
ADDFiESS
ARCHITECT
CONTRACTOR iO(�
A�DRESS 3.Sy� ,C.r,
CITv �US q /V/t,_{�7
STATE
LIC. NO. �(Jfj
OF LOT �a O,X 3O� �
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NO.
L.
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No.S'F8-P�
CITV
LIC. NO. �IJIJ
INO.O LBF�DG,.
NOW ON LOT
512E OF NO. OF
NEW BLDG. ROOMS 5T01
E%TERIOR WALL ROOF
COVERING COVERING
USE OF BUIL�ING AND WOfiK TO BE PERFORMED
I he�eby acknowletl8e thet I have �eatl this application antl stete
that [he above intormation is correct and aBree ro comply wl[h
all lawc regulating builtling co�istructlon, antl 1 shall not amploy
any person in violation ot the workman's compensation laws of
the Ste[e of Calitornie.
I hereby certity that I am prOperly licansetl as a convactor untler
the State of California Businass antl Professions Coda, Divisicn 3,
Chaptar 9, and thet such licenxs ere in full forca antl eftact, or I
em eaompt irom the provisions of the Stete of Califomia Business
antl Professions Cotle Divislon 3, Chapter 9.
♦
SIB�aNra ot / /� /�
Permittee ' L�LL.[-i/ ` • �� k�
Au[horizetl Agent
APPL�CATION FOR BUILDING PERMIT
��� �%^�E�%/�� DA�TEISnSJI
BUILDING �
AODRESS
TRA
W AD A P
OWNER
USE
FIRE
ZONE TVPE
BVPROVED ���
ZON NO.OF
V, PLAN$
VAqOSAPPFOVED
MAIN BUILDING
(FROM GL STREfjT)
FROfYi• ���Q,-
R. SIDE � FT.
�. . .�. .
DISTANCE BET
MAIN BLDGS.
VAR. #
C.U.P. $
APPROVED /.
LOT' BLOCK
� �
VALUE
$
GFOUP T �
�ATE rQ - �
USE OF N W ' "
BUILDIN • �� \y�
VARDSAPPROVED `""
ACCESSORV BUILDING
/
FT. �FT
� FT.
FT. �
BET. MAIN &
ACCESS. BLDGS.
DATE
APPROVED
... _. 4_� 7/J
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/ e
/ Q SQ. FT. o
THE AMOUNTSHOWN UNDER VALUATION IS FOR �
THE PURPOSE OF ESTABLISHING A PERMIT FEE ONLV: m
¢
VALUATION { p m
PERMIT FEE S {O O � o-t% �
)
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$ // � �Q � PLAN CHECK $ `� � o-� E
/ `o
/ TOTAL FEE $ ! ���dr% LL
" ��- 43894
COSTA MESA BUILDING-SAFETV DEPARTMENT
P.O. BOX 1200 C�STA MESA, CALIFORNIA 92626
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BUILDING /1 /� � / fj� /'
ADDRESS iJ O J
OWNER �1
MAIL
ADDRESS v
CITV COJ
CON5TRUCTION
LENDEF
BRANCH
ADDRESS
ARCHITECT
Ofi ENGINEER
ADDFESS
CONTRACTOR
ADDRESS
CITV
STATE
LI0. NO.
SIZE
OF LOT
USE OF
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APPLICATION FOR STRUCTURAL PERMIT
R/'�%/ Bv �l'N./�/ /D D�TE�I�EC
A.P. NO.
yZ,s`-ozz-`z,�l''E'
BUILOING e Y�+
ADDRESS �'s3 �• � o V /T
.>'f* .—J / z 6
OWNER
TEL. S D
NO.
FIRE
20NE
/ ._ APPROVED
TEL.
NO.
CITV
LIC. NO.
NO. OF BL�GS.
NOW ON LOT
Separate permits are required for
electric, plumbing and heating work.
UIIDING ANP �^10RK TO BE PERFOFMED
.1 hereby ecknowled8a tnat I hava read this appllcatian and sxete
that the above information I% cortect and agrea to camply with
all Iaws repulatlnp bulldin8 �onshuction, antl I shall not employ
any person in vlolatlon of the workman's compensetion lews o4
the Siaie of Calitornle.
I hereby cartify that I aT Properly Ilcensetl as e contractor untler
tha State of California Business end Professions Cotle, Divislon 3,
Chapier 9, antl that such licenses era in full force and effect, or I
am exempt from tha pro�isions of the Stete of Celifornla Buslnass
and Professlons Cotle, Oivi ion 3, Chapter 9.
Signet�ra o�
Parmlttee � �
Authorizeq Agent
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ZO�_Z PLANS Z I BUILDING E��q.�� (J//�
^ e�r�a
VARDSAPPROVED VARDSAPPROVED
MAIN BUILDING ACCESSORV BUILDING
//
DISTANCE BET. BET. MAIN &
MAIN BLDGS. ACCE55. BLDi
VAR. # DATE
c� -
SQ. FT.
THE AMOUNT SHOWN UNDER VAIUATION IS FOR
THE PURPOSE OF ESTABLISMING �+ PERMIT FEE ONLV:
VALUATION PERMIT FEE $
� PLAN CHECK E � �,�
$�-�
� '�' TAX E � G
TOTALPAID $ �
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COSTA MESA BUILDING•SAFETY DEPARTMENT .
P.O. BOX 1200 COSTA MESA, CALIFORNIA 92626
For AppGcant to Fill in,Comple[ely — Use Ink Only
BUILDING � (�'
AODRESS � ( .j i
OWNER ,�— A�K,
MAIL .� , p, 1J (�1
CITV l OS�A /�pyq/�� NpL.
BRANCH
ARCHITECT TEL.
ADORESS
CONTRACTOR ��ut/(, �[,�II L'IL
ADDRESS
TEL.
CITV NO.
STATE CITV
LIC. NO. LIC. NO.
SIZE NO.OF BLDGS.
OF LOT NOW ON LOT
Separate permits are required for
electric, plumbing and heating work.
VSE OF BUILD�NG AND WOFK TO BE PERFORMED
A/1P0/L�
I hereby acknowledBa thet I heve reatl this eppllcetion entl state
thet tho above ��formation Ia correct ond apree to camply with
ell lews repulnting builtlinp conctrucNon, entl I chell not amplov
any pe�aon in violeNon o1 tho wo�kmen'e componastion laws of
the Steca ai Ca�ifornie.
I hareby cerNfy Thot I am properly Ilcanfetl es e contrector untler
tho Smta of Californio Bueinese end Profeeslons CoEe, Dlvislon 3,
Chepmr 9, and thet such Iicenaez ere in tult force and affect, or 1
em ¢zempt frory� ihe praviclane of tho Stete of Cniifornie Bus(nau
antl Professione Gode Ivlcion 3, Cheptor 9. /�
S(pnatursot /D ,/{_ i/ )
Parmlttee �� � )v�'�h/
Authorizatl Apont
R
Pato # ****
AUG —5-77C1t5AOO 949 42.50
FORSTRUCTURALPERM[T
DATE RECEIVED D E I�j$V
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_'^ n PEHMIT NO.
A.P. NO. 7.CU 1 %lL�
BUILDING +� � ..
ADDRESS J�I � L' .
OWNER Lr�K,
s C�%� O�
FIRE
20NE T
APPROVED
BV
ZO —� NO.OF �
PLANS
YAROS APPqOV ED
MAIN BUILDING
(FROMC'/�' •SJTREET) `
FROfYT / �C F'�
R. SID / `�$ G
L.SIDE ,y/ FT.
REAR�( /�I1
DISTANCE BET.
MAIN BLDGS.
VAR. sW 7 ^J�
C. V.P. qWLE'//��
APPROV �
�
VALUE
VARDSAPPRpVED
BET. MAIN &
ACCESS. BLDG:
DATE
APPROVE u
THE AMOUNT SHOWN UNDER VALU
THE PURPO6E OF ESTABLISHING A PER!
VALUATION PERMIT FEE S
DO 7LAN CHECK E
$ �DOO � TAX S
TOTALPAID E
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