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Home My WebLink About419 17TH ST - Building PermitsCity Df Costa Mesa � Dev2lopment Services Department ' Building Satety Division P.O.Box 1200 Costa Meu, California CERTIFICATE OF OCCUPANCY No. GOd.C��l The Building located at a19 �# lith StrP�t has been inspected and found to comply with the provisions of all City of Costa Mesa Ordinances applicable thereto for a Group B-7_ Occupancy. Use of Bu Le9al Description CI25-1t13�-37 (Sea re�rerse side for Metes and Bauntls) B23545 Building Permit No B25A17.828453 Electrical Permit No.p�F+�4ll.t?7A71Splumbing Permit No. n�cic� Mechanical Permit No. �7937 Number of apartments and/or guest rooms iSSUED T0: Building Official Bi11 Howard i�1l�rt L�fmarm - — ' ' �� _',_ ` �' 170 E. 17th Street by _1._ . \ - \ —r . •-1 .� _ Co�ta N1es1. CA Date �1 /..L. /c'� � 1 . This Certificate of Occupancy SHALL BE posted in a conspicuous place on the premises and SHALL N07 BE removed except by the Building Official of the City of Corta Mesa under Sec. 307 (e) U.B.C. CMF 1015-46 r¢v. 1/83 White - Owner; Canary - Numerical File; Pink - Bidg. Permit File �L �O � .^ Applicant to fill in a11 soaees exceot those within neavy ooraer Ilnes ana sign all aooroo��ate aeclarations. CITY OF COSTA MESA CONSTRU{C( TIO PERMIT PERMIT NO_ TRACT NO. LOT NO. .UNIT NO. Project Address ��y � � ��` � ��" L Applicant's Mailin ddr �Q � ��,h ��f'��/'S �'/yy/.t� Owner's Name � ��'eR� �'�'r"��a� Address No. Address ConVactor's Nam�� PhoIne',� � Address Imailing) �u� �dX /�y% / �%��.p � �LL>L7 Ciry License No. �� IICENSED CONTRACTOR �ECIARATION I hereby affirm that I am licensetl untler provisions of Charter 9(commencing with sectlon �000) ot Division 3 of the BuSiness antl Professlons Cotle, antl my license is in tu11 /orce tl eifect. ' y(� LIC2(ISC C�d55 �� Cf152 �`l0, � �� i�v Date 9g�ar .� . . ....*iLds=�r WORKERS' COMPENSATION DECLARATION 1 hereoy aitirm that I nave a certificate o! consent to self-Insure or a certiticate ot Worken' Compensation Insurance, or d certlfietl <Opy (hereo ($ection 3fl00, Lab. C.) /` ':clicy No. �G ��Zd Company �.`�'�./ Certilietl copy is hereby turnisnetl. atee��¢tl copy is tlletl wiFlt PPhCd^?y`Builjling pivision. �'�•--��. tSy � �' �� E%EMPTION ROM WORKERS' COMPENSATION DECLARATION (Thissec[ion neetl no[ be completetl if the permit is for One huntlretl ($100) or less). I certi(y Ihat in the p¢rt0/mance of lbe wo�k (Or which this pe�mit ISlssuetl, I shall not employ any person in any manner so as to become subject [o the Workers' Compensation Laws of Calitornia, Da[e Signature NOTICE: If, aftet makin9 this tlCcla�ation, you Shoultl becOme subj¢ct to the Workers' ComOensation provisions of tne Labor Cotle, you must tortnwith compty with such provlsions or Ihis permit shall be tleemetl revoketl. CONSTRUCTION IENDING AGENCV 1 nereby at(Irm [hat there is a conStruCtion lentling agency fo� the pertormance of the work tor whiGh Ihis permit is issu¢tl (SeCtlOn 3097 Civ. C.) Ltntler's Name Lentler's Atltlress . OWNER BUILDEN �ECLARATION I hereby at(Um Ihat I am exempt 1wm th¢ Con[�acto�'s Litense Law for the tollowing reason (Saction 7031.5 Business antl Protes5ional Cotle: Any city or county wnith requlres a permlt to construct, aller, improve, tlemolish or repair any structure, prio� to its issuance, also requires the applicant tor sucn permit to file a signetl stalement that ho/she is licensetl pu�suant t0 the provi5ions of tne Contractor'S License Law (Chapter 9(commencmg with Section ]000) ot Oivision 3 ot the Busine55 antl Profe55ion5 Cotle) or that he/she i5 exempt tneretrom antl the basis tor tne alle9etl exemptlon. Any violation ot Section I 7031.5 by any applican[ for a Permit subjects tha applicant to, a civil �enalty of m[ more than five huntlretl tlollars (5500). ❑ 1, as owne� ot [he prop¢rty or my emplOye¢5 wltlt wages as [nelr solB Compen5a[ion, wlll tlo the work, antl [hc struc[ure is nof intentletl or ot(eretl for wle (Settion 7044, Business antl Professional Cotle: The Contractor's License Law tloe5 nOt apO�Y to an owne� of a p�ope�ty who builtl5 O/ improvez thereon, antl who tloes such work himselt/herself or through his or her own employees, provitletl that zuch improvements are'not intentletl or offetetl for sale. It,.however, the builtlin9 or improvement is soltl within one year of com- pletion, [he owne� will have tne bu�tlen Of proving he/She tlitl not builtl o� im- 'prove torthe purpose oi sale). ❑ I, as owne� of the prOperty, am exclusively conttacting with IicenSetl Con- tlactor5 tU con5trucl [he Orojecl (SCc[ion ]044, Busine55 antl Professlons Cotle: TM1e ConVactor's License Law does not apply to an owne� of pm0erty who builtls or improves thereon, antl who contracts for such projects with a con- tractor(sl ucense pursuant to the Con[rac[or's Licenze Law). I am aware that proof of tM1eir Worker's Compensatlon insurance shoultl be provitletl lo me. ❑ I am exempt untle� Section B. & P. C. for [his reason Date I hereby certi(y that I if1fOlTdtl00 i5 co1lOCt. I antl state laws relating t 5¢OtdtIV85 OI [hi5 CI(y in5pectlon Ou�yosq5. / � Siqnature _ �� 6�P—i— Orivers' License Or 55 # Owner rve reatl this application antl s[ate tbat tne above �ree to compty wi[h all city antl county ortlinances builtling constructlon, antl hereby authorize repre- e F upon tha above-mentionetl Property for Daia J�� . TVPE OF CONSTRUCTION IJ NEW LJ ADD LJ ALTERATION LJ REPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p, # . DESCRIPTION OF WORK/USE OF BLDG. � S Main Building: E TVPE OF PERMIT GRADING FOUNDATION STRVCTURAL T Front, ❑ TENANT ❑ ELECTRICAL � PLUMBING ❑ MECHANICAL B Rear ❑ OTHER A PROJEGT DESCRIPTION 5�. FT. OCCUPANCv C Right K Left ' CONSTRUCTION TYPE VALUATION $ $ ZONE GRADING CU.YDS. ACRES p�ng. Ref. # Remarks: � Planning Notes: Sink Preventer Irriqation Drinking Fountains Floor Dreins - Floor Sinks Gas Service . Outlets I nterceprors Kitchen Sink � Lavatories • Roof Drains Reinspection Fae Showers Service Sink Sewer Cap Sew n Solar Ilecrors $olar Pi 'ng � $Olar Swimmin ool w/Spa � Urinal Water Closet Water Heater Water Service ' Aum-Wash Laundry Trays ' $15 Isue Fee � $ 3 MECHANICAL ' - FEES Boiler Duct-UnderGround Duct - $trucmrel Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ducting ❑ ai oo,000 eru O i oo.000 Reinspection Fee � $15 —__—....- .__. _ CMF OB65-46, rev. 10/84 White - Builtling; Canary - APPlicant: Pink - Accounting; Goltlenrotl - Assessor Hood or Typel ❑ Canopy Type II ❑ Fefrigeration System Oo�ioo,000eru ❑ioo,000eTu Syst Repair/Alteration ire Dampers Registers � laue Fee � $ 3 Automatic Washer Construction Pole Sub. Cooking Unit Dishwasher • Dryers ❑Gas ❑Electric Fan F.A.U. Fixtures • Device Boxes = � Outlets '�i�. Switches ' Garbage Disposal !;� Generator��0-5KW Q -15 -� ee�2 eii_i�7 ! Zone Accessory Building: Parking Req./Provided i ELECTRICAL �I Transformer ❑ 15-50KW 1.—J I 1 ❑ 50+KW' Meter ❑up to 100 amps . Meter ❑over100amps Sub Panel Moco�: 00�1 N i x- s Inc.Solar -15 HP �16-15+ Range Sigm Standing Sections Trash Compactor ^�:. '� FEES Z O N 1 N G R E Q M T � Reiaspection Fea $15 . Issue Fee � . $ 3 DEVELOPMENTSERVICESREQUIREMENTS: � ,Zoning Approved By - Date Building Approved By Date��.�/L/�p_ 7��`�—��, Appliption laued By Date /� o"� SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT � PLUMBING $ B •O'O �SSUANCE $ PLAN CHECK 25% $�-'_t. � ENERGV P.C. $ ELECTRICA� § GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL 5 TOTALFEE 5 �'2�� PLANCHECK� 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. Steel Reinforcement � � , . 3. Electrical Conduit Utility�Undrgrnd. 54. Forms ' 4. Electrical Conduit-Undrgrnd. 55.-Electrical Bonding , 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test . , 6. Electrical UFER Grnd. . 57. APPROVAL TO COVER-GUNITE 7. Footings � 58. Electrical Conduit-Undrgrnd. � � 8. Foundation • , . 59. Gas Pipe, O Undrgrnd., Test � 9. Water Pipe-Undrgrnd. � -� 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK , � � 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. P00 VSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning . FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace � APPROVALS Permit # 21. Ducts, in Structure 70. U�rclergroundiWydro " 22. Ducts, Ventilating 71. �r`oduct Piping O Gas ❑ Oil . 23. Gas Pipe-Rougfi & Test ��:;, � 72!�Underground Flush a.-:. 24. Roof Framing � �7��. Undergrnd.StorageTank OGas ❑Oil 25. Roof Sheathiny 74.y0veihea�' Hydro 26. T-Bar Ceiling (Struciural� & 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 �at 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 Faaory Fireplace , �'t . 38�. Final Plumbing '� � . . � 39. Water Service-Final � � .. � r 40. Gas Service-Final � � ' : . ; � �91. Solar pomestic-Final � � . , , �.' . .'42. Backflow Preventer � � - � S ,43. Backilow lrrigation . � , .� , , ��, 4'4. Landscape Irriyation System - , ��, `r " • 45. Sound Attenuation . ' � . : �� 46. Handicap Regulations � . -r . . 47. FINALSTRUCTURE&BUILDING . � �, � � � 48: Special Requirements Completed . ' � �' � ' 49� Electric Release to Edison ' ' � 50. Gas Release to $outhern California Gas Cq 51. CERTIFICAT� OF OCCUPANCY • No. _ Date • ✓ 1 _ _ _ AOPlicant to fill in all spatts except ehose within neavy eorOer tines ana sign all appropriate Eeclarations. � GTYOF.COSTAMI/ESA ,CONSTR-7UCTI�O1NPERMIT , PER^^i/_�0.�� TRACTNO. ! LOTNO. �UNITNO. •i �P�CAddress �T� 9 �..' � � / .r(I ST• . �� . . � . , � . O(�� J �"r' TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR - ApplicanYsMailingAddresi' �/� �' -7- ❑CONVERSION ❑DEMOLISH ❑OTHER � � Owner's Name ��-$Lf-'Ry�T7� ��' ��Ml{" phone�3a��/ DESCRIPTION OF WORK/USE OF BLDG. ' � t� '� ' Address � %� E� l � �ri ST� � C69%l} /f1L5S� . . ' , � : ' Arch/Eng: � , License No. TYPE OF PERMIT GRADING ❑ FOUNDATION STRUCTURAL � Addf2S5 ' ❑ TENANT ELECTRICAL ❑ PLUMHING 0 MECHANICAI ConttaCtor'SName' ��£ �Lr �Phone 'G-sU, .0 �THER . . __' _ _ Address (mailing) � 6� ✓� OQf}I?�Cs� C�FI- PROJECT DESCRIPTION SQ. FT. OCCUPANGV , O� ` � � . . CONSTRUCTIONTVPE � VALUATION$ City,License No. �v ' � � ZONE GRADING CU. VDS. ACRES' LICENSED CONTRACTOR DECLARATION . I hereby affirm Ihat I am Ilcensetl untler provislons oi Charter 9(commencing Remarks: � � • � ' - � with section 7000) o� Division 3 of the Business antl Professions Cotle, antl , , i 'v license is in f W torc,�'an�effecL /(jj�� , ' ' . . � , _ � ense �lass /� �� Licen N J V ' ' � ..ate_[( ��,�c. 519nature ' ' ' ' ' - .PLUMBING ' � .FEES� � WORKERS'COMPENSATION DEC RA N � • - . - - ' ' 1 ne�eby affirm tnat 1 have a certific e ot nsent to selt-insu�e o� a certificate Bd� Sink • ,. � ShOw215 � � of Workers' Compensalion Insurance, or ajcertifietl copytnereof (Section � gackflowPreventer - ServiceSink ' i 3800, Lab. CJ , . - - Policy No. ' � � Comvany ' _ • Backflow Irrigation Sewer Cap � . BCertifietl copy is bereby fumishetl. ' � ' . � . - , _ Certifietl copy is'flle0 with the city Builtling Division. Bathtubi Sewe iOn , Date � � Applicant � � , . . EXEMVTION FROM WORKERS' COMPENSATION OECLARATION � Cidlifief5 � . SOId� I¢CfOrS . (Thissectian need nat be completeE if the permit is for one huntlretl (E300) or . less : � ' ' Dishwasher' ' � - - Solar Pip I certify that in the performance of the work tor which his �per t is Issuetl, I . ' - snall'not employ any person;in any ma er so as to ecom bject to the Drinkin9 Fountains Solar Tank - � Worker Co n n LawS ot Cdlifor ia. � oate ��-��Signature - • Floor Drains ' ' Swimming P /Spa • - NOTICE:9t,atter making this tleclaration ou u tl become subject to the -�' Workers' Compensation provlsions of'th Lab Cotle, you mu5t (orthwith , FIOorSinks ' ' Urindl ' compry with such O�ovisions or titis permi shall be tleemed revoketl. • CONSTRUCTION LENpING AGENCV ' � � � GasService � ' �Ut12t5 - � W3t¢fC105¢t , � I hereby affirm'that there i5 a Construction lentling a9enCy for Ihe p¢r(ormance ' ot the wo�k Por'whlch this pe�mit is issuetl (Section 3097 Civ. C.) Interceptors • � WaterHeater � LenGer's Name Lentler's AtlCress - -- Kitchen Sink - - Water Service - OWNER BUILDER �ECIARATION i � , - I he�eby aftirm that I am exampt drom the Cont�acto�'S LlcenSe Law for the Lavarories AUtO-WaSh foilowing reason (Section ]031.5 Business antl Professional Cotle: Any city or _ county which �equires a pe�mit to construct, alter, improve, tlemolish o� �epair P-T�dp' . � LduOdry T�3y5 - �nv c�n��r�ve. nnnr to its issuance. also reauires the applicant for such permit � a �DiviSion 3 ot�the 6usiness antl Profe55ions�Cotle) o� that be/sh¢ 6 exempt Iherefrom antl the�basis fo� the allegetl exemOtion. Any violation of Secfion �031.5 by anY applicant tor a pe�mlt subjects th2 applicant to' a civil pe�dlty ot notimor¢ than tiv¢ huntlretl tlolla�s ($500). � ❑ I, ad owner ot the property or my employees with wages as tneir sole compensation; will tlo Ihe work, antl the structu�e is not intentletl o� offeretl for.sale (Section 7044, Business'antl Professional Cotle: The Coniractor's License law tloes not apply to an owner of a property who builtls o� improves thereon, antl who tloes such'work himself/fierself or through nis or her own employees, prOvitletl that such improvements are not intentl¢tl or offered for sale. I(,ihowever, the�bulltlin9 or improvement is soltl within one year oi com- • pletion, tne owner will have the bu�tlen of proving he/she tlitl not builtl or im- prove for the purpose oi sale). � � , ❑ I, as owner of the prOperty, am ezclusively tontracting with Ilcensetl con- tractorsto consVuct the Droject_(Section ]044, Business ana Professions Cotle: The Cont�ac[or'S License'Law does not appty to an owner of property wM10 Duiltlsbr imp�oves [he�eon, antl wno mntracts tot such projects wi[h a con- tractor(5) I�cense pursudnt tO�the Cont�acto�'s LicenSe Law). I am aware that proof bf their Worker's Compensalion insurance shoultl be proviGetl to me. ❑ 1'am exertmpt untler Section , B. & P. C. tor this reason . Date� Owner � _ Roof Drains ReinspeMion Fea � $15 Boiler Duct - Under Ground � Duct - Structural Duct - Ventilating ' ' � Exhaust System ❑ Multiple Firepl/Fact. Bit. ICBO # Heating System & Ducting ❑ o-� oo,000 sru O i oo,000 Intormabon is correct i agree to compry wim au ary ana county orainances antl state;laws relating to bui ing c truction, antl hereby autpo�ize repre- . � sentatives ot is city to ' er the above-mentionetl property f ,. ^ inspection pu p es Siqnature Date � . Driver's' Lice or 5 � -- Reinspeetion Fee cMF 0865-46, rev. 10/84 White - Builtlinq; Canary - Applicanh Pink - Accountin9; Goltlenrotl - Assessor $15 lesue Fee ' .Hood or � Type I �❑ � Canopy � Type I I ❑ , Refrigeration System ❑0-100,000 BTU. 0700,000 System Fepair/Alteration FireDampers . Registers _ . Issue Fee A $. 3 _: _ , �za� ll<Lt-E—B(, ' � i � � j � : j . . A.P. # _ S Main Build E T Front ARear C Aight ! g Left ' 'Ing..Ref. # � Planning Notes: 4 t � Automatic Wash j` Construction Po � Cooking Unit � . : . � � � Zone Accessory Building: Parking�Req./Provided . - 'ELECTRICAL , . , Transformer ❑ 15-50 KW ❑ SO+KW Meter ❑up to 100 amps f � Meter ❑over900amps Dryers'LJGas LJElectric � Fan F.A.U. � � � � Fixtures Device Boxes - ' ` � Outlets � Switches �• - - - � Garbage Disposal . Generator 00-5 KW �5-15 KW a.uu 1� 8.00 'TL FEES Sub Panel . , � Motors�0-1 HP�01'/:-8 •. InaSolar �9-75 HP-�16-15+ Microwave' - Pole Light . � � Range ' Sign ' Standing Sections � . Trash Compactor � � ^ I Reinspection Fee � !$15 I I � luue Fee DEVELOPMENT SERVICES REQUIREMENTS: Zonin9 APProved BY ' Building Approved By _� Application Issued By �l /I 1 � � Z O N 1 N G R E Q M T S ' � SUMMARV OF FEES _ � . ' , . � BUILDING PERMIT $ ' �-SMIP� - $. PLANCHECK $ ' ' .PERMIT: , - , PLUMBING ' $ � _ �SSUANCE $ ' PLAN CHECK -'25% $ ' ENERGV P.C. $_ ' ? � ELECTRICAL $ � GRADING ��$ � - . PLANCHECK�;,�50% $ . MICROFILM_ �S � MECHANICAL $ TOTALFEE $ �� $ 3 PLAN CHECK 25% �$�� , ' . � CONSTRUCTION AND PLANNING POOL & SPA . � � APPROVALS Permit # Date Inspector qppROVALS Permit # Date Inspector 1., Temporary Electric8l Service or Pole ��,��6/. �� 52. Pool & Equipment Location W 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement � 3. Electrical Conduit Utility-Undrgrnd. 54. Forms ' 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test � 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. ,., 8. Foundation r. - 59. Gas Pipe, � Undrgmd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, O Undrgrnd. 10. Structural Floor System � 67. 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 FtNAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT � 20. Rough Factory Fireplace APPROVALS Permit # - 27. Ducts, in Structure 70. Underground-li�dro 22. Ducts, Ventilating 71,.jProduct Piping �Gas ❑Oil 23. Gas Pipe-Rough & Test `'�-. ,7,Z, Underground Flush 24. Roof Framing 73��Undergmd.StorageTankOGas ❑Oil � 25. Roof Sheathing 74. Overh°e 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 �/p �Notes: � 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test � 36. Hood or Canopy ' 37..Fina1 Factory Fiieplace ' � - � 38. Final Plumbing � � 39. Water Service-Final . ' " t40. Gas Service-Final � . - 41. Solar pomestic-Final ' , ' 42. Backflow Preventer � � � ' 43. Backflow Irrigation , � � ' � . ' 44. ;Landscape Irrigation SYstem - � • : ". 45:�Sound Attenuation - . � � , � 46. Handicap Regulations ' - � 47. FINALSTRUCTURE&BUILDING • 48. Special Requirements Completed � . . . .. 49: Electrie Release to Edison � . . , • � - " 50. Gas Release to Southern California Gas Co - �+ 51. CERTIFICATE OF OCCUPANCY Np, Date � i Applicant to fill in ali soaces ezceo� inose within heavy Eoraer lines antl sign ali aooropriate tleclarationz. CITV OF,�OSTA M�eG/$A CONSTRUC ION PERMIT PERfy1}�T NO._ ,�„ _ � TRACT NO. LOT NO. UNIT NO. Project Address —/L��/� � �� +1(pplicanYsMailingAddress F ` �L� ��' S � ' �IeA'�%��(-�� (��/� Owner's Name �- � Phone � � ,2..2�CP Address �'� �'�` ST a � Arch/Eng. ��g� ��'S'�D� LicenseNo. Address n^ Contracmr's Name o�`'� ��/�T ��1 �� hone �s?1"��7 Addresslmailing) �� 1V• �L� �=� ST.' dl�RAi%C��" Ciry License No. _ _ ��-� LICENSED CONTRACTOR DECLARATION I nereby atfirm tha[ I am lirensetl untler provislons of Charter 9(mmmencing with section �000) ot oivision 3 oi the Business antl Professions Cotle, antl my license is in (}�I fo antl eije t� � 9///�c /� License �s `-" � G�� er} lo.`� Y( Date Si9nature � `R ER ' COMPENSATION DEC R ION ' ,reby at/irm Ihat I have a certific e oi nsent to seli-insure or a certificate . Worken' Compensation Insurance, or a certifi¢tl copy thereot (Section 3800, Lab. C.) ' Policy No. Company BCerti/ietl copy is hereby turnished. ' Certifietl copy is filetl with the city Builtling Divislon. Date APPiicant EXEMPTION FROM WORKERS' COMPENSATION DECLARATION (Thissec[lon neetl not Ge compleletl i( the permit is tor One huntlr¢tl ($100) or less). I c¢rtify that in [he pe�tormance ot Ihe work for which ris per i5 i55ued, I shall not employ any person in any manr�n� so as to ecom / bject to the Worker b p tion Laws of Californ'6. Dafe Siqnature - NOTIc : If, fter makin9 this declaratio ou s' i tl become,subject to the.. Wo�ker5' C Pensation provi5ion5 of t Lab Cotle, you mus[ torthwith comply witM1 such provisions or [his permi shall be peemetl revoketl. CONSTRVCTION LENDING AGENCV ' 1 herety affirm that there is a mnstruction lentling agency for tne pertormance of tM1e work for which this p¢tmit, is issuetl (Section 309] Civ. C.) Lentler'S Name �entler's Atltlre55 � � OWNER BUILpER �ECLA0.ATION - ' I hereby affirm that I am exempt from the Contractor's License �aw. for the followinq reason (Section 7031.5 Business antl Profe55ional Cotle: Any tity or counTy which requires a permit to construct, alter, improve, demolish or repair any structure, prior to its issuance, also requires the applicant for such permit 10 tile a signetl sta[¢ment that he/she is licensetl pursuant fo the p�ovisions of ;s Contrac(or'S License Law (Chapter 9(commencin9 �+ith Section ]000) of �:�, �ision 3 of the Business�antl Professions Cotle) or Ihat he/she is exempt ��.+ete�efrom antl the basis tor the allegetl exemption. Any violation of Section 703L5 by any applicant foi a permit subjects the applicant [o a civil �� Qenalty of not more than five huntlretl tlollars (§500). ' LJ I, as owner o( the oroperry or my employees with wages as their sole compensation, will tlo'the work, and the structure is not infentletl or otferetl (or sale (Section ]044, Business antl Professional Cotle: The Contracto�'s License Law tloes not apo�Y to an owner of a property wno builds or improves thereon, antl who aoes such work himself/herseit or tnrough his or her own employees, provitletl Ihat such improveinents are noi intentletl or oftaretl for sale. If, howev¢r, the builtling or improvement is So10 witbin one year of com- pletion, the owne� will have the burtlen ot provin9 he/she tlitl not builtl or im- prOve tor the purpo5e of sale). ' ❑ 1, as owner of the property, am ezclusiveiy contracting with licensetl con- traciorsto construct the pro�ect (Section �044, Businessantl Professions Cotle: The Contractor's License Law does not apply to an owner ot propercy who builtls or improves thereon, antl who contracts for such projects with a con- tractor(s) i�cense pursuani to the Contractor's License L.aw). I-am aware thaf proof of their WorkeYs Compensation insu�ance shoultl be provitletl to me. ❑ I am ezempt untler Section B. & P. C. tor this reason Date ' Owner � I hereby certify tnat.l have reatl tnis appli information is correctr I a9ree to compl wi'� antl state laws relatinY to buil 9 co ud sentatives of thS cit to en u the inspection purp6sR;. , _ . � TYPEOFCONSTRUCTION LIGNEW LJ ADD LI ALTERATION LJ REPAIR ❑ CONVERSION ❑ OEMOLISH ❑ OTHER DESCRIPTION OF WOFK/USE OF BLDG. � TVPE OF PERMIT ❑ GRADING FOUNDATIO� STRVCTV RAl ❑ TENANT ❑ ELECTRICAL ❑ Pl.UM81NG MEGHANICAL ❑ OTHER PROJECT DESCRIPTION So..FT. � ' OCCUaANCv �CONSTRUCTION TVPE VAWATION $ i !ZONE GRADINGCU.YDS. ACRES Preventer " lirigation ` Bathtubs Clarifiers � DisFiwasher � Diinking Fountains Floor Drains - Floor Sinks ' ' GasService Outlets Interceptors Kitchen Sink Lavatories � P-Trap Roof Orains , Reinspection Fee $15 0.nJnr . Duct- Under Ground Duct-Strucmral ' Duct - Ventilating . Exhaust System -Multiple FirepVFact BIL-ICBO # H,.,.e,�ati System & Ducting L70-100,000 BTU �100,000 Reinspection Fee ^ CMF 0865-46, re . 30/84 White - Builtlin9; Canary - APPlicant; Pink - Accounting; Goltlenrotl - Assessor $FIOWClS Service Sink Sewer C Sewer Co ecti Solar Colle r; Solar Piping Solar Tank Swimming Pool Water Closet � Water Heater Water Service A uto-W ash Laundry Trays � Issue Fee Hoodor Typel ❑ Canopy Type I I ❑ Refrigeration System , ❑0.100,OOOBTU ❑100,000 System Repair/Alteration Fire Dampers Registers Issue Fee � $ 3 FEES � $ 3 0 A.P. # ' S Main Buildi E T Front B Rear A C Right K Left S Ping..Ref. # Planning Notes: Automatic Washer Consttuction Pole Sub. Cooking Unit ,� Dryers LJGas Fan ' F.A.U. ' Fixtuies Device Boxes � Outlets Swi[ch¢5•� ' Garbage Disposa Generator'DO-5 Y Fee \ 4976 3/30/87 41;75 TL � Zone Accessory Building: Z O N I N G R Parking Req./Provided - E Q ' M S ELECTRICAL � Transformer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps � Meter ❑over100amps . Sub Panel ' Motors 00.1 HP � 1'/: - 8 Inc.Solar �9-15 HP'016-15+ Microwave Pole Light Range KW LJS-15 KW $15 FEES aiyii Stand ing Sections Trash Compactor Issue Fee . ' $ 3 DEVELOPMENTSERVICESREQUIREMENTS: � Zoning Approved By � Building Approved By �, , SUMMARV OF FEES � � BUILDING PERMIT $ SMIP _ $ PLAN CHECK $ PEFMIT - PLUMBING $ �SSUANCE $ PLAN CHECK 25% �$ ENEfiGV P.C. $ ELECTRICAL $ � GRADING �$� P�AN CHECK 50% $ ��/j� MICROFILM $ � MECHANICAL $ ��-`-� TOTALFEE S PLAN CHECK 25% $ ___f_._� � ' CONSTRUCTION AND PLANNING � POOL & SPA APPROVALS Permit# � Date Inspector qppROVALS Permit#� Date Inspector 1: Temporary Electrical Service or Pole � 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. � 53. Steel Reinforcement , • 3. Electrical Conduit Utility-Undrgrnd. 54. Forms - 4. Electrical Conduit-Undrgrnd. � 55. Electrical Bonding 5. Steel Reinforcement � 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. � 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8: Foundation � � ' 59. Gas Pipe, O Undrgrnd., Test . 9. Water Pipe-Undrgrnd. � � 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 72. 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 PIASTERING � 18. Rough,Electrical-T Bar Ceiling . 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning 3��1 �,� FIRE DEPT. REQUIREMENT 20. Rough Facrory Fireplace APPROV�LS Permit #� _ 21. Ducts, in Structure � 70. Uriderground. ydro � , 22. Ducts, Ventilating • � 71. �Broduct Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test 72 Undergrour�d Flush 24. Roof Framing 73. Undergrnd. Storage Tank � Gas ❑ Oil 25. Roof Sheathing - 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical � 27. Frame and Flashing 76. Dry Standpipe . 28. Lathing & Siding . 77. FIXED SYSTEM FINAL � •� 29. Insulation � ' 78. FIRE PREV. FINAL 30. Drywall Nailing ' � HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final , 80. FOOD CERTIFICATE ISSUED 33. Final Electric Notes: �V 34. Final Heating & Air Conditioning L�• �� T-, ' - 35. Final Gas Pipe-Test 36. Hood or Canopy � � 37."Final Factory Fireplace . 38. Final Plumbing � ' � ,� � 39. WaterService-Final !� , � � .. . 40. Gas Service-Final � � � � 41. Solar pomestic-Final . . , � � , 42. Backflow Preventer . . - � 43. Backflow Irrigation � - . . � . � 44. �Landscape Irriqation 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 � . . 51. CERTIFICATE OF OCCUPANCY - � No. Date �� Ap0licant to fill In all spaces ezceD� those within �eavy Gortler Ilnes anE sign all aPProO�iate Aeclarations. CITY OF COSTA MESA CON�TTION �PERMIT PER N /_ TRACT NO. LOT NO. UNIT N6. , -P.rQject Address 5i/9 L-'`. !i 9%N� � tV ' ' 6559 I I/�3/86 45,50 TI Appli�l.�nt's hleiling Addre55 TY� G� CNN�'/�+��%✓ � TYPE OF CONSTRUCTION NEW ADD A�TERATION REPAIR - 1 P�.�Ll2`,../l.t L�� Aip'. / ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q.p, # , i Zone ' vwn0r's Name l.i.; •J "/c/ /�/ �t/ Phone ' � ' ' - � � � - � DESCRIPTION OF WOFK/USE OF BLDG. Address � � S Main Building: Accessory Buildin9: E � Z Arch/Eng. License No. TVPE OF PERMIT GRADING FOUNOATION STRUCTURAL T Front ' O N Addr¢25 ,..� �] "� ❑ TENANT ❑ ELECTRICAL PLUMBING MECHANICAL A. Rear � , � �WMB/�G /�C ��,� �� ❑ �THER Convactor'sName �. n Phone[x.G�+ L1��L ' � �C Fllght' ' - � - � " � ' � N Address (mailing) , y�d �'r ��A�M'B'J D.�iD.��C PROJECT DESCRIPTION� 5�. FT. - oCCUPANCv K , , G CltyLiCenSeNo. � �S ' CONSTRUCTIONTVPE VAWATION$ g Lef[ � � 20NE ADING CU. VDS. ACRES - E LICENSED CONTRACTOR DECLARATION Ping. Ref. � Parking Req./Provided Q I hereby aftirm that I am Ilcensetl unaer provlsions ot Charter 9(commencln9 Remarks: �/� . Planning Notes: . M wi[h sectlon 7000) of DlviSion 3 Of [he Bu5ine55 antl Pmf¢SSions CoOe, antl - T my Ilcensa is in1ull lprpe ana elfecL 3 n,7 .. �� , ' . ' ' S License Class C 3� �IcenSe�A•' o. � • oate I��/�4 %' f/ 579 � �t �/d� �! PLUMBING FEES , WORKERYCOMPENSATIONpECLARATION Ba�Sink � ShOW¢�5 � ' � ELECTRICAL � • -FEES 1 hereby affi�m [ha[ I have a certillcat¢ of conSGOt to 5¢INnSure o� a certificate of Workers' Compansa[lon Insurance, or a tertitietl copy tnareof (Sec[ton Backflow Preventer S i[e ' 3800, lab. c�) . Automatic Washer Transtormer ❑ 15�50 KW Policy No. S D%S� S S� Company��L'�f � Backflow Irri atiOn - � ❑ 50+ KW 9 S Cap ConstructionPoleSub.� �Certlfietl copy Is heteby (urnlShCtl. Ce�tlSi c pvv i❑ICtl with the city BJ� m oivislon,, ' / eathtubs. Se r nection CoOkin UOit Meter• Oup to 100 am 5 Date �/ APplitant l�•/h�---��w� - - .. ,'9 . . P EXEM I-/PT ON FR�yyORKERS' COMPENSATION DECLARATION ClariFi2r5 Solar Coll oi ' Dishwasher . . Meter ❑over 1008mp5 • (This section neetl not be comple[etl i� [he permit is for one nuntlrea (g1o0 or � - � iess). � � Dishwasher - Solar Piping Oryers ❑Gas ❑Electric Sub Panel - 1 certify tnat in the perto�mance ot lhe wOrk fOr which t�Is pe�mit i5 issuetl I . ' , shall not employ any porson in any manner so as to become subject to the Drinkin9 Fountains Solar Tank Fan . � � Momrs �61 HP 01 X- 8 Workers' Compensation L. ws ot Calitornia. Dale Signalure Floor Drains � Swimming Pool w a �' � � F.A:U. Inc.Solar �9-15 HP �16-15+ � NOTICE: If, aRer making this tl¢UdrdtiOn, you Shoultl bemme subject [o [hB . ._ Worke�s' COmpensation p�ovlsions of the LabOr Cotle, you mus[ forthwlth FI00� SinkS �Urinel Fixtures ' . � ' Microwave - comply wi[h su[h prON5ion5 0� thls permit zhall be tleemetl revoketl. � CONSTRUCTION LENDING' AGENCV ' ('idSSCrviCE Outl¢t5 WUt¢� CIOSCt ' ' � � D¢vic¢ BOxES ' POI¢ Liyht • I nereby afflrm that Ih¢re IS a ConStructlon lentling agency for the per(ormanCe of the work for wnich this permit i5 issuetl. (Section 3097 Civ. C.) — ' - Lenaers Name Interceptors Water Heater Outlets Range �:' Lentler's ACtlress '� Kitchen Sink Waler Service � Switches - Sign - OWNER OUILpER pECLARATION - � - I hereby affirm that I am ezempt from the Contractor's Llcense Law tor the y Lavato�ies • Auto-Wash ' � Garbage DiSposal Standing Sections '�� tollowing reason (Sectlon 7031.5 Businoss antl Professlonal Cotle: Any city or '9 county which requires a permit to construct, Slter, improve, demolish or repair P—Trap � Laundry Trays Generator �0-5 KW �5-15 KW J Trash Compactor �. any st�uctu�e, p�lo� to It5 i55uance, also reqWrES [h¢ appliCan[ fo�'such pe�mit j to lile a signetl ztatam¢nt thdt he/Sh¢ Is Ilcensetl pufsuan[ to the plovi5ion5 of ROOf DfainS /O tne COntrdctor's License Law (Chapter 9(commencin9 wilh SeCtioq J000) ot - Division 3 of the� Business antl Professions Cotle� or lhat he/she is ezempt - - ' theretrom antl the basis for the allegetl exemplion. Any violation of SecHon ]031.5 by any appliGan[ fOr a pCrTlt SUEjet[s the applicant [O d civll � �e�dlty of not mor¢ than five huntl�etl tlolla�s (E500). - 1, a5 owne� of the prope�ty o� my employee5 with wages as their sole RBinSpeetlOn Fee $15 ISsue FBB $ 3 compensation, will tlo the work, antl tho structure is not Intentletl or offeretl Reinspection Fee $15 luue Fe9 -$ 3 � tor sale (Section 7044, Business antl Pw(essional Cotle: The Contractor's MECHANICAL FEES Licenze Law tloes not appry [o an owner of a property who builtls or fmproves thereon, antl who tloes sucn work hlmself/herself or tnrough his or ner own DEVELOPMENT SERVICES REQUIREMENTS: , � employees, orovitletl lhat such improvements are not inlentletl or otteretl tor Boiler Hood or Type I ❑ sale. If, however, the Dulltling or improvement Is sola witnin ona year oi com- CanOpy Type 11 ❑ Z�^�^B APP�o�ed By Date �tlon, the owner wlll have [he burtlen of proving hc/sbc tlitl nol build or im- DuGt - Unde� Ground BUilding App�ov2d By _ Dale� rove for tne purpose ot sale). � � I„as owner oi tha property, am exUusively contracting with licensea con- Duct - Struttural Refrigeration System Appliption laued By Dat tractors to construct tho project (Section 7044, Business antl Pro(essions Cotle: The�Contractor's LicenSe Lnw does nol apply to an owner oi property wno Duct - Ventilating ❑0-100,000 BTU ❑100,000 BTU SUMMARV OF FEES builtls or improves thereon, antl who conVacts fo� such projects wlth a con- ' tractor(s) �mense pursuant ro tne Contractor's License Law). I am aware that BUILDING PERMIT $ • ' SMIP $ Exhaust System ❑ Multiple ❑ System Repair/Alteration proof of tneir Worker's Compensation insurance shoultl be provitletl to me. PLAN CHECK $� PERMIT ❑ I am exempt untler Se<tion B. & P. C. for this r¢ason Firepl/Fact. Blt. ICBO # Fire Dampers PLUMBING $ �SSUANCE :$ Date owner ' Heating System & Ducting Registers PLAN CHECK 25% $� ENERGV P.C. $ I hereby certify mat I have reatl this appticatlon and state that the above ❑6.100,0008TU �100,OOOBT ELECTRICAL $ GRADING �$ intormation is correci. I agree to compiy wIN all city antl county ortlinances antl state laws relatin9 �o builUin9 onstructlon, antl hereby autnorize repre- MICROFILM $ sentativas of r'z city to ent r pon the above-mentionetl property for PLAN CHECK 50% $ ��',{ s,�.,� �� inspectionpur o ,,,��%�' MECHANICAL $ TOTALFEE $ � Signature _ �ate�� Reinspection Fee S75 Issua Fee $ 3 PLAN CHECK .25% $ Drivers' License or 55 � CMF 0865-46, r¢v. 30/84 White - Builtling; Canary - Appll<ant: Pink - Accounting; Goldenrotl - ASsessor CONSTRUCTION AND PLANNING POOL & SPA APPROVALS Permit# Date Inspector p�ppROVALS Permit# Date Inspector 1. Temporary Electrical Service or Pole . 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. � sJ D� 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding � . 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test ' 6. Electrical UFER Grnd. 57. APPROVAI TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgmd. 8. Foundation . 59. Gas Pipe, � Undrgrnd., Test � 9. Water Pipe�Undrgrnd. � j.-3-9L 60. Backwash Lines, P�Trap, O Undrgrnd. � 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection � 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains - 64. Plumbing System � Final 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final , 76. Rough Electric Wiring 67. Fencing & Access Approval 77. 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- . APPpOVALS Permit # 21. Ducts, in Structure 70. Underground Hydro '- �... 22. Ducts, Ventilating �� 71. Produ�t Piping � Gas ❑ Oil-.� 23. Gas Pi e-Rou h& Test ` ... P 9 7Y.�Un erground Flus,h 24. Roof Framing 73. Undergrnd. Stor ge Tank 0 Gas ❑ Oil 25. Roof Sheathing 74. Overheacl`H,ydro �� 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical` -• 27. Frame and Flashing 76. Dry Standpipe 28. Lathing & Siding - 77. FIXED SYSTEM FINAL 29. Insulation � 78. FIRE PREV. FINAL � . 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat . • �,� 79. FINAL INSPECTION 32. Electrical Power Meter-Final � 80. FOOD CERTIFICATE ISSUED. 33. Final Electric Notes: 34. Final Heating & Air Conditioning . ' 35. Final Gas Pipe-Test � ` 36. Hood or CanopY 37..Final Fac[ory Fireplace ' 38. Final Plumbing �'J�j��7 (� � , 39. Water Service-Final � 40. Gas Service-Final 1 41. Solar pomestioFinal � �r 42. Backflow Preventer . �,, �• i � 43. Backflow Irrigation ' . . � �44. Landscape I«igation System - , 45. Sound Attenuation , � 46. Handicap Regulations ' . 47. FINAL STRUCTURE & BUILDING . 48. Special Requirements Completed . , ... 49 � Electric Release to Edison ' � � �- � 50. Gas Release to Southem Califomia Gas Co � _t,,, 51. CERTIFICATE OF OCCUPANCY + No. Date � ' . � ' r CITY OF COSTA .Project Address � Address �ONSTRUCTION PERMIT . /7�n-f s'�'. AOP��ant to fill in all spaces exceo� those within neavy boraer lines antl sign all aDCropriate aeclarations. Owner'sName CL L/ NI/YN _Phone Address 'T��/ CA��'L� C�ST11M�(3�d, Arch/Eng. License No. Address Contracror'sName 0 C.� 6ROJ6 /f Gphones33"Gf° Addreu (mailing) �--' �� g - �� City License No. �Q a"�5 LICENSED CONTRACTOR DECLARATION I hereby aHirm lhat I am licensetl untlei p�ovl5ion5 of Charf¢r 9(CommEnting with Section 7000) of Divizion 3 of the Bu51ne55 antl Prote55ions Cotle, antl my license iz in fy�l (orFg an etiefr,t. � r, ,��. ♦/� LICEl15C CId55 �- �J L� � Li se� oate �� g? Si9 � �Q� I WORKERS' COMPENSATION DEC RA N I hereby affirm tnat-I have a certitica e o( consent to selLinsure or a<mtificate ot Workers' Compensation Insurance, or a certifletl copy tnareof (Section 3800, Lab. C.) Policy No. Company eCer[ifietl copy is,�ereby furnishetl. 1 Certit'etl p�j is filetl with the tity B 1 ing D' ' Date �� O� APP�iCanl EXEMPTION FROM WORKERS' COMP SA ON DEC ARATIO (Thissection neetl not be CompleiCtl If t perm Is for one huntlretl ($300) or lezs). 1 certity tha[ in the per(Ormance Of tM1e wo�k 10� wnich I5 pe; R i5 ISSuatl, I snall not emplo any person in any manp so as to ec bject to tne Workers' C� 5 �aws ot Calitorn b Date Si9nature NOTIC : It, after ma Ing tnis tleclaration ou 5 u tl become sub�ect to lhe Worke�s' COmpensation proNzions of t LaD Cotle, you must forthwith comply with such p�ovisions o� tnis Oe�mi Shall b¢ tleemetl tevoketl. CONSTRUCTION LENDING AGENCV '�, 1 hereby atfirm that there is a constructlon lending agency for tne performance '. ot the wOrk for which thi5 permit is I55ueC (Sec[ion 309] Civ. C.) '�. Lentler's Name �� Lentler's Atltlresi OWNER BUILDER bECLARATION I hereby atflrm lhat I am exempt from the ConVactor's License Law for the followin9 reason (Section 7031.5 Business antl Professional Cotle: Any city or county which requires a permit to construct, alteq Imorova, tlemolish or repair any struclure, prlor to its issuance, alzo requlres the applicant tor such permit to file a si9netl statement that he/she Is licensetl pursuant to the provisions ot the Contractor'S License Law (Cnapter 9(mmmencing with Sectlon ]000) ot DiviSion 3 oi the BuSinesS antl Prote55ion5 Cotle) or that h¢/She is exGmp[ therefrom antl the.0asi5 tor Ihe alleqetl exemption. Any viOlatlon of $eclion ]031.5 by any appliCant for a permit SubjeCtS Ihe applican[ to a civil �e�dlty ot not more than tiv¢ huntlretl t1011a�S (E500). I, as owner of the Oroperty or my employees with wages as iheir sole compensation, will tlo the work, antl tne structure I5 not intentletl or oHeretl for Sale (Section 7044, Bu5ine55 antl Profe55iondl Cotle: The Con[ractOr'S Licenu taw tloes not apply to an owner ot a oroperty who builtls or Improves thereon, antl who tloes such work himself/herself or throu9h his or her own employees, Orovitletl Ihat Such imprOv¢menti a�e not intentletl or oit¢red fo� 5aie. It, howeve�, tne builaing o� Improvement is Soltl within One yedr of cOm- oletion, the owner will nave the burtlen oi proving he/sne dia not bulltl or Im- �rove for tbe purpose ot sale). I, as owner of the property, am exclusively contraCting wi[h lic¢nsetl COn- tractors id construct the project (Section ]044, Business antl Protesslons Cotle: The Contractor's License Law tloes not apply to an owner oi property who builtls or improves chereon, ana wno contrat[s for such pmjects with a con- t�actor(s) I¢ense pursuant to ttte Cont�actot's LicenSe Law). I aT aware that proof of tneir Worker'S Compensation insurance shoultl be provitletl to me. ❑ I am exempt untler Section 8. & P. C. for this reason Date Owner I hereby certiry [hat 1 have rea� information is correct. I aqree to Signature _ Drivers' Licens CMF 0865-46, �ev. above TVPE OFCONSTRUCTION LINEW LIADD LIALTERATION LIREPAIR ❑ CONVERSION ❑ DEMOLISH ❑ OTHER p� p�6 DESCRIPTION OF WORK/USE OF BLDG. � S Main Buildi TVPEOFPERMIT GRADING FOVNDATION STRUCTURAL T Front ❑ TENANT ❑ ELECTRICAL ❑ PLUMBING ❑ MECHANICAI B Rear ❑ OTNER A PROJEC7 DESCRIPTION Sp. FT. OCCUPANCV C Right K Left CONSTRUCTION TVPE VALUATION 5 $ ZONE GRADING CU. VOS. ACRES' p�ng. Ref. # Remarks: ��2,'S�`� 8��3� PldnniOfJNOt¢5: Sink Preventer Irrigation Drinking Fountains Floor Drains Floor Sinks Gas Service Outlets Interceptors Kitchen Sink Lavatories P—Trap Roof Drains Rainspec[ian Fee � $15 Boiler Duct- Under Ground Duct-Svucturel Duct - Ventilating Exhaust System ❑ Multiple ❑ Firepl/facL BIL ICBO # Heating System & Ducting ❑0�100,000 BTU 0700,0006T1 Reinspeaion Fee $15 ite - Builtling: Canary - Applicant; Pink - Atcounting; GOItl¢nrotl - ATse55or Showers Service Sink Sewer Cap Sewer Connection Solar Collecto $olar Piping Solar Tank Swimming Pool Urinal Water Closet Water Hearer Water Service - Auto�Wash Laundry Trays laue Fee Hood or Typel � Canopy Typell ❑ Refrigeration System ❑o-ioo,000aru ❑ioo,000eT System Repair/Alteration Fire Dampers Registers Issue Fee Automa[ic Washer Construction PoleSub. Cooking Unit . Dishwasher Fan F.A.U. Fixtures Device Boxes Outlets Switches - Garbage Disposal Generator �65 KW , >� 9a�i E/p4/_7 2one Accessory Building: Parking Req./Provided ELECTRICAI Transformer � � 15-SO KW ❑ 50+ KW ' Meter ❑up ro 100amps Meter ❑over700amps Sub Panel . . Motors O0.1 HP O 1'F� - 8 Inc.Solar �9-15 HP �16-75+ Microwave Pole Light Ran9e . aign . Standing Sections KW Trosh Compactor $ g v v Reinspection Fee $15 luue Fee FEES DEVELOPMENT SERVICES REQUIREMENTS: Zoning Approved By Building Approvad By Appliption lauad By $ 3 !9 1`_ '�Fiof'.. I FEES $ 3 Z O N I N G R E Q M T S • SUMMARV OF FEES BUILDING PERMIT $ SMIP $ PLAN CHECK $ PERMIT PLUMBING � $ ISSUANCE $ PLAN CHECK 25% $ ENERGV P.C. $ � ELECTRICAL $ � GRADING �$� PLANCHECK 50% $. MICROFILM $ ��yJ MECHANICAL $ TOTAL FEE $ � PLAN CHECK 25% $ . �I CONSTRUCTION AND PLANNING . . POOL & SPA APPROVALS Permit # Date Inspector APPROVALS Permit # Date Inspector �'. �Temporary Electrical Service or Pole �j y,�j -- 52. Pool & Equipment Location � J 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. . 54. Forms A. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFEfl Grnd. . 57. APPROVAI TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. &. Foundation ' ' ' 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, O Unclrgrnd. 10. Structural Floor System � 61. APPROVAL TO DECK � 11. Property Sewer Line & House Connection . . 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final , 14. Rough Plumbing 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final .� 16. Rough Electric Wiring � 67. Fencing & Access Approval 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18� Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit # _ 21. Ducts, in Structure �" 70.'iUnderaround Hydro 22. Ducts, Ventilating 4� 7�1� Product Piping O Gas � Oil 23. Gas Pipe-Rough & Test . �2"Und�ground Flush 24. Roof Framing � 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro � 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27, Frame and Flashing 76. Dry Standpipe 28, Lathing & Siding 77. FIXED SYSTEM FINAL 29. Insulation 78. F�RE PREV. FINAL 30. Drywall Nailing HEALTH DEPT. REQUIREMENT 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final SO..FOOD CERTIFICATE ISSUED 33. Final Electric Notes: `.yy-$7 � " y 34. Final Heating & Air Conditioning , .� �� i c,. 35. Final Gas Pipe-Test 36. 'Hood or Canopy � ' 37. Final Factory Fireplace ,' ' ' 38. Final Plumbing �- . 39. Water Service-Final -' � ' , •; r 40. GasService-final '� �ar , � 41. Solar pomestic-Final , - � . 42. Backflow Preventer �� , - � 43;�Backflow Irrigation i r - ` . , � . , � 44.; L'andscape Irrigation System ' ' ' ' . . � 45: �Sound Attenuation ' ' 46. Handicap Regulations • � 47. FINALSTRUCTURE&BUILDING• . � , � • ' -48. Special Requirements Completed • � . � 49. Elec[ric Release to Edison . � , . � 50. Gas Release to Southern California Gas Co � . •� 51. CERTIFICATE OF OCCUPANCY ' •e No. Date • • ._... _�E � . •AVVlicant to (ill in all spacez encept tnoza within heavy bortler Ilnes antl sign all avVrooriate Ceclarations. 1_ 1 PERMIT TRACT NO. LOT NO. UNIT NU. � � t CI7YOF COSTn MF,SyA, CONSTRUCTION PERMIT '� �. a� ; ! � N � E, /7T/�l .ST. �_ . �jeckAddress �� - • • � � �(L.�-N� QL�UL� /_C. TYPEOFCONSTRUCTION NEW ADD AITERATION REPAIR �ApplicanYsMailingAddress i 6KAAl�`�C'A . ]��gtJRTM� LEFMI'�� (p �CONVERSION ❑DEMOLISH ❑OTHER q,p,# ' . �Za�g b oi0 TL � Owner'sMame Phone 9'5-3.3�p(f. • -- f„ . . DESCRIPTIONOFWORKlUSEOFBLDG. ! Address � 7� �' ��TN ST' ''' " � - , S Main Building: Accessory 8uilding: t� ArchlEng. ��gLs �ANSLi�aD�License�No. ! ` TVPEOFPERMIT�y GRADiNG FOUNDATIO�N�/' ST�RVCTURAL T Front . � Addfess /�,,. ,, � '.Q OTHERT lJ ELECTRICAL ❑ PLUMBING LJ MECHANICAL A Reel � � � � . � , N Contractot'sNam< �RA'�� a�✓� nIG Phone S�-�5�� ` ' C Right - '� N /� � D L �� '� ST r PROJECT DESCRIPTION Sq. FL ��'D6 b OCCUPANCv K � � . G Addfess�mailing) �^ �CONSTRUCTIONTVPE VALUATION$ g Left I CityLicenSeNo. `J�� ` ,-ZONE GRADINGCU.VDS. ACRES R LICENSEp CONTRACTOR DECLARATION � �' �` +' ,y � Ping..Ref. # � Parkirig Req./Provided E / Q 1 hereby affirm that I am licensetl unde� provislons,ot Charte� 9(comm¢nclhg Rema�ks: ��t(� ��'` ' Planning NOt¢5: . � ' '� M with section 1000) of DiviSion 3 of [nC Business antl Pro(e55ions;GOGe, anG _ my Iicense is in full�r e ntl eLfe�.� � i/�� /� ' , , . . ' ' S LJCBOS Id55 �� License �YtJS�t� � , � ' �� ' � � �—r�t PLUMBING fEES i ' � � � Date — — Si9nature • � � . WORKERS' C MP NSATION OEC ATIO �� 8a1 Sink'� - . $hOWE�S' "� ELECTRICAL FEES I he�eby affirm tltat I have a certificat f con5 to SelLinsure orp <ertificate � � i of Wotkers' Compensation InSurance, or a certltieG �copy�thereof (SecfiOn ' - � . I . , ., , - . - 3800, Lao. C.) �� Backflow Preventer Service Sink Aummatic Washer � Transformer`0 15-50 KW " I Poliq No. Company �� r Backf�ow Irrigation . Sewer Cap _. , Construction PoleSub. ' �� 50 } KW' ' ❑ Certifietl copy is hereby tumishetl. �:� ' � . - . � ❑ Certifietl coOY i5 filetl witM1 [he city Builtling Divi5iorl � �y � L: �r B2IhtUbS $ 0 � COOkiny Unit M2L¢f up�t0 1�� drt1p5 Date Applicant ' ' ^ ,�- Clarifiers $ol ollectors � ' � Dishwasher .� . . Meter over 100am s EXEMPTION FROM WORKERS' COMPENSATION pECLARATION •� P, (Tbissection neetl not be comple[etl if the Oermit i5 �or one huntlretl (5300) or ' less). , � - - ' Dishu�2sher . Solar ing Dryers ❑Gas ❑Electric � S Sub Panel ' �� O 1 certify that in the per(ormance Of the wo�k tor which�thi5 p¢� �t is i55uetl; I ' � ,,'�� " snall�noc empioy any person in any ma er so Az.to co bject to tn� Drinking Fountains Solar Ta Fan ' Motors OO-1 HP l71 h- ��' , • O Workers' o �sa i l.aw5rot CalifOr a. , �' . . - . qate� ' Signature �� ' Floor Drains Swimmin ool w/Spa F.A.U. � � � Inc.Solar �9-15 HP 076�15+� � NOTICE: I!, af er ma ing this tleclaration ou s become subject to.tfie . ' Wo�ker5' Compensation provi5lon5 of th Labo Cotle, y0u must torthwith FIOO�SinkS Urinal • Fixtures � Microwave comply with such O�ovisions o� thi5 permit shall be tleemetl �evoketl. � /.� CONSTRUCTION LENOING AGENCV (�id5$¢�viC¢ �utl¢t5 WdtE�C105Et Deviceeoxes ' 1 hereby affirm that tnere is a construction Ientling agency for the performantt "- �• , Pole Light y of the woB for � which this petmit is issuetl (SeCtion 3097 Civ. C.) Ineerceptors � ' Water Heater � ' Outlets • • � LenCer's Name Range ��'- �enaer's aaaress Kitchen�Sink Water Service - - 0 Switches � Si n .- OWNER BUILDER DECLARATION . � 9 �u I hereby affllm fhat I artl exempt flom the Contlactol's LicenSe Law foI the LavBtOfiCS - AULO�WaSh . Galb2 2 Di5 OSdI ' ' tollowing� reason (Section �o3L5 Business ana Protessional Cotle: Any tity or �• r , ' 9 P � Standing Sections 'fA�/jFj�° ' b wunty which requirez a permit to,wnstruct, alter, improve, tlemolish or repalr . P-7�aP-' I' - ,� : � ' any sVucture„prior to its izsuance, also requires me apo�icant tor such permit — Laundry Trays Generator O0.5 KW 05-15 KW � to file a signeG statement that he/5M1e i5 licensetl pufsuant t0 the provi5ion5 of Tf25h COmp2cLOI Roof Drains ' the Contractor's License lzw (Chapter 9(commencinq wi[h Section ]000) ot - ^ I, Division 3 of the BuSiness' antl Profezsions Cotle) or tha[ he/she iz exempt � � _ the�¢trom and the basis tor the allegetl exemptiOn. Any violatlon of Section � i� ♦ . ' - 703L5 by any ap0licant fo� a pe�mit subjects the apP��cant lo a civil A �enalty of no[ more than five huntlretl tlollars (E500). ' 1� I, Ss owner ot the property or my employees with wages as tneir sole Reinspection Fee $75 •. � ISue Fee � $ 3 , ' tompensation, will tlo the wo�k, antl the st�ucture is nOt intentletl o� offeretl tor sale (Section 7044, Business antl Professional Cotle: The Contractor's MECHANICAL FEES Reinspection Fee $15 Issue Fee .$ 3 LicenSe ldw tloes mt applY to an owner of a property wbo builtls or improves � thereon, antl who Ooes such work himself/nerself or through his or her own , .� rOEVELOPMENTSERVICESREQUIREMENTS: • employees, provitletl [M1at such improvements are not intentletl or afferetl tor Boilef Hood or Type I ❑ � . ule. It, however, the buimin9 or improvement is soltl within one year oi com- Canopy Type I I ❑ " 2oning Approved By � Date pletlon, the owner will nave Ihe burtlen ot proving he/Sh¢ ditl not builtl o� Im- Dudt - UndEf GfOUOd BuildiOg ApP�aved By D0t0 prova fo� the purpose ot sale). . - - ❑ I, as owner of the praperty, am exUusively contracting with Iicensetl con- Duct - Siruttural Refrigeration System , �. ,Appliration Issued By_ � � Dat tractors to conSV uc[ the project (Settion 7044, Busine55 ana Protessions Cotle: . The Convactor's License Law tloes not apply m an owner of v�operty who ct = Ventilating ❑0-t00,0008TU ❑700,000 BTU _ , SUMMARV OF FEES ' . � builtls o� improves tnereon, antl who coM�actS tOr su[h projects with a cOn- - tractor(s) i�<enze pursuant to the Contractor's Licenze Law�. I am aware tnat ExhaustSystem Multiple ❑ System Repair/Alteration BUILDING PERMIT $ SMIP . $ proot,of their Worwer's Compensation insurance snoultl be pwviaea to me. . t PLAN CHECK $ PERMIT • � . . ❑ I am exempt unCer Section e. & P. C. (or this reason Firepl Pact Blt. ICBO # ' Pire'Dampers ' pLUMBING . $ - '��UANCE :$ . _ Dace ' Owner ' - aJ'ang System & Ducting Regizters . p�qN CHECK . 25% $ ---yyy��.�� ENERG�' P.C. $ I hereby certify'tnat I have reatl this appliwtlon antl state that tne above ,�}100,OOOBTU 0100,0006T $� GRADING $ information is correcL 1 agree to comply wit all city antl counry ortlinantes, _ ' •- ELECTRICAL . antl state laws relating to builtling nsb t n, antl hereby authorize repre-" � - . MICROFI LM $ - sentatives o( t ity ro-enter ove-mentionetl propert .f , PLANCHECK 50% $ , inspection purp zes. ' , MECHANICAL $ ��_ Signature Date � TOTALFEE $ .Drivers' License o 5� � Reinspec[ion Fea $15 Iwue Fee -$ 3 PLAN CHECK 25% $ ' � CMF 0865-46, rev. 10/84 White - Builtlin9: Canary - Applicant: Pink - Accountin9: Goltlenrotl - Asseisor 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. 14, '�,/ 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 Pip� Undrgrnd., Test 9. Water-Pipe-Undrgrnd. 60. Backwash Lines,P-Trap, O Undrgrnd.� 10. Structural Floor System 61. APPROVAL TO DECK 11 . Property Sewer Line & House Connection � 62. Backwash & Receptor-Final �� 72. Sewer Cap � � 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing SYstem - Final � 14: Rough Plumbing '65. Electrical-Final � ' 15. Rough Electrical-Conduit � S 66. Solar System-Final � t. Rou h Elec ic Wiring �1 f 67.. Fencing & Access Approval � 17. Rough Wiring Sign - 68. APPROVEO FOR PLASTERING � 18. flough Electrical�T B /� 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning _ FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace �� APPROVALS Permit # _ 21. Ducts, in Structure 70. Unaierground Hydro „ 22. Ducts, Ventilating 71. Product Pip�ng O Gas ❑ Oil . 23. Gas Pipe-Rough & Test .� ;,e, 72r Underground Flush � �� 24. Roof Framing �.7 ' Undergrr�d. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. OZerhea� 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 6_a2_g7 ,J G, 80. FOOD CERTIFICATE ISSUED . 33. Final Electric , g.j ` Notes:3-.c��,�7 Tw= � in,-,�a� h�� - - a7m � 34. Final Heating & Air Conditioning � ��Rp f�' h1-A.., o� i.,� , i� ha c.../ 35. Final�Gas Pipe-Test 3•J��Yi ��c�� w.r� i..: bLil� � � ,o1R kn 36., Hood or CanoPY �n�� S�p � � ` �� ' `: . �n 37. �Final Fac[ory Fireplace -ay',e'7 Ro� S� �,�. �,o c/cc.�.d S/3f2v;c 38. Final Plumbing . / � d/'7 S c� � .... J , 39. Water Service-Final � � � =a'`+-b7 ca� J � � .t �-�� r �,o!%r..l�,.y , 40. Gas Service-Final � � r. G,Bn . 41. Solar pomestic-Final �� 42. Backflow Preventer � . - �43. Backflow Irrigation ` I � 44. Landscape Irrigation System - , � � 45. Sound Attenuation � • , �46.� Handicap Regulations � � 47. FINAL STRUCTURE & BUILDING ' � � � '48. Special Requirements Completed � . . 49. Electric Release to Edison � ,- � . 50. Gas Release to Southem California Gas Co �- �_ ,�� 51. CERTIFICATE OF OCCUPANCY �� No. Date � � .._+ r _ I_ ADP��ant to fill in all ipaces except those within �eavy nortler Iines anE sign all aoD�oO��ale tlaelarotions. . , .— _ - CITN OF COSTA MESA CON�RUCTION PERMIT PERM N� 2�� TRACT NO. LOT NO. UNIT NU: � , � , ✓ ProlectAddreSs � �' �7 r - . . 3%�0 i4/'2:!/(�io iLr . L'IiJ G• I7 ST. I�O rM TVPE OF CONSTRUCTION NEW ADD ALTERATION REPAIR � AppliCant�S MailingAddt25s ❑ CONVERSION ❑ DEMOLISH ❑ OTHER q,p, # ' � Zone � Owner's Name ^ Phone �s T✓�� DESCRIPTION OF WORK/USE OF BLDG. � Address _`//9 E. /7 S% �_C/�7' � E Main Building: Accessory Building: Z - Arch/Eng. � License No. ' TYPE OF PERMIT GRADING FOUrvDA7lON S7ftUCTURAL T Front _ ' ' p Address - ❑ TENANT ❑ E�ECTRICAL ❑ PLUMBING ❑ MECHANICAL A Rpa� - - N CE6 ��S72ilCiia✓ [. r+ho�ebf'6 �f/33 � ❑ -ornerx Contracror's Nam T�� - - � C Right � ' � - � N Address (mailing) lJO E. /% � 0.3 � �/ • PROJECT DESCRIPTION 54. FT. oCcuPA Cv K Left � � � G .2 ��, p � CONSTRUCTION.TVPE VALUATION 5 %I�� $ - City License No. � 6 � � ZONE GRADING CU. VDS. ' � ACRES - ' R LICENSED CONTRACTOR OECLARATION - Ping. Ref. # Pa�king Req:/Provided � E � 1 hereby attirm that I am licensetl untler provislons at Cnarter 9(commencing ' Remarks: 1 ' Planning Notes: . � ' � M wilh SeCllon 7000) of Division 3 of the Bu5ine55 antl Profe55iOn5 COtla, dntl - my Iicense is in full jyrce antl effect. _, � , � - T� Licen CI « /� Ucense rvo. �%G��S�o13 S Date �"%�! �"�� a� ��'� � ' PLUMBING FEES � WORKERS' COMPENSATION DECLAR ION BarSink Show¢rs I hereby affirm tnat I have a certi�icate ot conzent [o self-Insure or a certlticate • , ELECTRICAL FEES ot Workers' Compensation Insurance, or a certitietl covY thareo/ (Sectlon �"gackflowPreventer � ServiceSink 3800, �ab. C). i Automatic Washer Transformer ❑ 15-50-KW Policy No. /�,'��—�� Company �%7 Backflowlrrigation SewerCap ' . ConstructionPole5u6. � ❑ 50+KW , �] C�ertifieC copy is horeby /umishetl. IId'Cert'tiea So0 s filetl with the city Bui �ivisio . Bathtubs � ' Sewer ConnectiOn � Cooking Unit Meter ❑up to 100 amps � Date� �� APP��cant � E%EMPTtON FROM WORKERS' COMPEN ION DECLARATION- Clafifiefs _ . _ $olar Coll _ . Diihwaihef _� - . _ . Metec ❑over 100ampi - (This seclion neetl no� be com0leletl if the permil is tOr On< huntlroC (5100) o� Iess). Dishwasher Solar Piping Dryers ❑Gas ❑Electric Sub Panel ' I Certity tbal In [h¢ Oerfo�mance of the work tor whith this perm4 is Issuetl, I � � � ' shail not amploy any person in any manner so as to become subject to lhe Drinking Fountains Solar Tank Fan � ' ' Workers' Compensatlon Laws oi California. Moto�s O0.1 HP �1'h�- 8 oate Signature Ploor Dreins Swimming Pool /Spa F.A.U. ' �NOTICE: 1/, afte� mdkinq [his tlecla�ation, you Shoultl beGome sub)ect to the Inc. SOI�� 09-15 HP �16-15+ Workers' Compensatlon provisions of the Labor'Cotle, yau must forthwith ' Floor Sinks Urinal � � .- ' � � comply wi[h such -O�ovi5ion5 or [hi5 permit shall be tleem¢E revoketl. Fi%tu�25 MiCrowdv¢ � CONSTRUCTION IENDiNG AGENCV . ' � Gas S¢NiC2 Outl¢LS Water Closet � Device eoxes � i ' ' � � 1 hereby at9rm that tnere is a construction lentling agency lor the performance . � � � . Pole Light i of the wo�k fOr which tni5 permit is issuetl ($ectlon 3097 Clv. C8 , Interceptors - Water Heater � " _ ' Outlets � - i - � Lentler's Name Range �enaers ntltlress ' Kitchen Sink .. � Water Service �. � Switches Sign OWNER BUILOEN bECLARATIOIV ' � - , . � I hereby afflrm�that I am ¢xemOt trom the ConVactor'S LlcEnse'Law for the � ''LdvdtOfies � AptO�WdSh - G3fba E Di5 0531 ' � foilowing reason (Section 7031.5 eusiness antl Profe55ional CoGe: Any clty o� ' 9 P , Standing Seciions county whlcn requires a permlt to construct, alter, improve, tlemolisn or repair P—Trap ' Laundry Trays � Generamr �0.5 KW �5-15 KW any SVucIU/e, prior lo it5 i55uance, also requires tbe aOP��Cant fOf SUCh pelmi[ 7ld5h C011lpdct0l to file a signetl statement that he/she is licensetl pursuant to tne provisions ot ' Roof Drains � -- ' - . ' � -. the Contractor's License Law (CM1apter 9(commencing wllh Sectlon ]000) o( Division 3 of Me Business antl Professions Cotle) or that he/she is exempt � , the�efrOm antl the basi5 for Ihe allegetl exemplion. Any violalion of $ectlon ' � - 7031.5 by dny appliGant tor a permit subject5 IM10 appllcaOl to a Civil �enalty of no[ more than frve huntlretl tlollars (E500). ' I, as owner of Hte propar[Y or my employees with wages as IM1cir solo � ReinspBCtidn Fee $15 ISSUB Fee . 5 3 compensation, will tlo the work, antl the structure is not IntenOed or ofteretl qeinspection Fee $15 Iszue Fee ' '$ 3 br sale (Settion �044, eusiness anA Protessional Cotle: The Contra<mr's MECHANICAL � . FEES LicenSe Law tloe5 no� applY to an owne� of a properfy who bu(Itls O� imO�OVGs . � thereon, antl who tloes such work nimseif/herselt or tnrou9h his or her own . � - - DEVELOPMENT SERVICES RE�UIREMENTSi . � employees, provitletl that sucn improvements are not intentled or otteretl for ; Boiler . Hood or Type I ❑� Zonin A roved 6 sale. If, howevlr, lhe builUing or improvement IS Soltl wilhin Ono Yeat of cOm- CeOOpy Typ2 I I ❑' . 9 PP Y Date pletlon, tho owner will �ave tha burtlen ot proving he/she tlitl not builtl or im- Duct - Under Ground Building Approved By Date prove for lne purpose oi 5ale). , ' _ � ❑ I, as owner of tne property, am exclusivery contractin9 with Iicensetl con- Duc[ - Structurel . ' Refrigeration Sys[em ' Appliration Issued By pa� :l tractors to consbuct the prolect (Sectlon 7044, Business and Protessions Cotla: The .Contractor's License Law tloes not apply to an owner of property who Duct - Ventilating -- ❑0-100,000 BTU ❑100,000 BTU . , SUM RV�F FEES ' .� bulltls ot improves lhereon, antl who conVaGts fo� such projecl5 wkh a com tractor(s1 licanse pursuant to the Contracror's License Law). I am aware that Exhaust System ❑ Multiple ❑ System Repair/Alteretion ' BUILDING PERMIT S S V �SMIP - $ proot of their Worker's Compensation insurance shoultl be provltletl m me. . PLAN'CHECK �$ PERMIT � � ❑ I am exempt under Section B. & P. C. tor this reason Firepl/Fact: Blt. ICBO # Fire Damperi ' � PLUMBING g ISSUANCE $ � Datc owner Heating System & Ducting Registers . � � ENERGV P.C. $' I horeby certify that I'haJe reatl this application antl slate that �the above ❑0-100,000 BTU 0100,OOOBT PLAN CHECK 25%' $ . Information Is correct. I a9ree to compty with au tity antl munty ortlinancez ' � � ELECTRICAL $ GRADING $' . ana state laws r 9 to builtling construction, antl hereby authorize repre- � , ' g' MICROFII.M $ zentalives o/' s ty, to enter upon the aDove-mentionea prop,�tY_i�r � PLAN CHECK 50°5 �/� inspection Our S. ' , �/ � � � MECHANICAL / [ �p�/ Signature ' �ato �V �7 � $ , TOTAL FEE � $ � � ' Orivers' License r 5 ' Reinspection Fee $15 Issue Fee $ 3 � PLAN CHECK 25% $ CMF 0665-46, �ev. 10/04 Wbtte - 6ulldlnq; Ganary - AppllcanC PInK - HccounLn9; liolaenr00 - A550550i �� CONSTRUCTION AND PLANNING POOL & SPA ' � APPROVALS Permit# Date Inspector qppROVALS Permit# Date Inspector � 1. Temporary Elec[rical Service or Pole 52. Pool & Equipment Location 2. Soil Pipe-Undrgrnd. 53. Steel Reinforcemen[ 3. Electrical Conduit Utility-Undrgrnd. 54. forms � I4. Electrical Conduit-Undrgrnd. 55: Electrical Bonding 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE 7. Footings 58. Electrical Conduit-Undrgrnd. 8. Foundation 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trap, � Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK �� 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap - 63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final . 14. Rough Plumbing ' 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar SYstem-Final 16. Rough Electric Wiring 67. Fencing & Access Approval � 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electriral-T Bar Ceiling 69. POO VSPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT � 20. Rough Factory Fireplace APPROVALS Permit # � 21 � Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test ' ' 72. Underground Flush - 24. Roof Framing 73. Undergrnd. Storage Tank O Gas ❑ Oil 25. Roof Sheathing 74. Overhead Hydro 26. T-Bar Ceiling (Structural) & Monocoat 75. Dry Chemical 27. Frame and Flashing ��..� 76. Dry Standpipe 28. Lathing & Siding i� ��7•7.��FIXED SVSTEM FINAL 29. Insulation f. r'j 78. FIRE PREV. FINAL 30. Drywall Nailing � HEALTH DEPT. REQUIREMENT . 31. Plaster Brown Coat 79. FINAL INSPECTION 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE ISSUED 33. Final Electric ' Notes: 34. Final Heating & Air Conditioning 35. Final Gas Pipe-Test 36. Hood or Canopy � 37. Final Factory Fireplace 38. Final Plumbing 39. Water Service-Final 40. Gas Service-Final 47. Solar pomestic-Final 42. Backflow Preventer ' � 43. Backflow Irrigation � 44. Landscape Irrigation System 45. Sound At[enuation 46. Handicap Regulations 47. FINALSTRUCTURE&BUILDING � � � Q�, 48. Special Requirements Completed . 49. Electric Release to Edison ' 50. Gas Release to Southern California Gas Co : � 51. CERTIFICATE OF OCCUPANCY NO. Date Aop��cant to fill in all spacez exceo< lhoze witnin neavy eortler Iines antl sign a11 aooro0��ate Ceclantions. CiTY QF COS7A Iy�SA CONSTRU�TION PERMIT Address Address ,• �62-.�.��L�S( �L«' Arch/Eng. �-%�� License No. Address /�� ,�� Contractor's Name Phone ��L�� .Address Imailingl Ciry License r1o. IICENSED CONTRACTOR DECLARATION I hereby affiYm tha[ I am IicenSeU untlGr provi5iOn5 ot Cha�te� 9(tommencin9 with section �000) of Divizion 3 ot the Business antl Professions Cotle, antl my license is in tull force antl eitect. License Class license No. Date Signature WORNERS' GOMPENSATION DECLARATION 1 nereby atiirm that 1 have a certiticate of consenl to selt-insure or a<crti(icate ot Wo�ke�s' Compensation Insu�2nce, Or a certitietl Gopy there0( (Sec[io0 3800, Lab. CJ Policy No. Company eCertifietl Lopy is hereby tumishCtl. Certifietl Gopy i5 (iletl with the city � Itl' 9 IviSion Date Applica�t - . EXEMPTION FROM WORKERS' CDM E SA ION A ATION (Tnis section Peetl not be completC if e er t I5 fo o h ntlretl (5300) or less). I ce�tify LM1at �n the pe�(o�manc O� � � to� wh � perm�t is Issuetl I shall not emPloy any per5on i any d r So � ecome subj¢Ct to the NOYICE: If, Bfter mdking this tleUa�a(lon; ybu sM1qUl come subject to thB WOrkers' COR�Pensation proNsionS di the Labor C e, you must forthwi[n comply with suc� p�ovisions o! tttis permit sh 1 be tleem¢tl r¢voketl. CONSTRUCY��N LENDING AGENCV I nereby at(inn that Inere is a consVuctlon lentling agency for the periormance ot tne worK for which thiz permit is issuetl (5¢cLon 3097 Civ. CJ Lenaer's Na�ne Lentler's Atltlress OWNER BUILDER DECLARATION I hereby afii(m lhat-I am exempt from the Contractor's License Law for the tollowing reason (Section J031.5 Businass antl Professio�al Cotle: Any clty or <ounty whicl� /equi�e5 a pe�mlt t0 cons[ruct, alt¢r, improve, demo115h or r¢pair any 5[ructuB, P�b� to'its issuanc¢, also �eqW�es the applicant to� such pe�mit to file a signCtl Statement thal he/she IS licensetl pu�suant to Ne p�ovisions of t�e ContractJr'S License Law (Chapter 9.(Comm¢nCin9 with SeCtion ]000) of Olvision 3 ot the Bu5ine55 dntl P�o(e55ion5 Cotle) or [hat he/she ii exempt therefrom antl [he Casis tor the alle9etl exemption. Any violation of Sectio� ]031.5 by any applicant tor a Permit subjects tne applicant to a civil �enalty of not'more than twe bunOretl tlollars (§500�. ' I, as owqer ot the property or my employees with wages as their sole compensatior�. �+ill'tlo the work, dntl the st�uctu�e is nOt intentletl ot offeretl tor Sale (5¢G�ion 7044, Bu5ine55 antl PrOfG55ional Cotle: The Contractor'S License Law tloes not apply to an owner ot a oroperty who builtls or Improves thereon, antl who tloes zuch work nimseif/nersetl or rougn nis or her own employees, provitlea that such improvements are n i entlea or otferetl for sale. I(, howCVGr, th¢ builtlin9 or imp�ovement 15 5 wi hin one yea� 05 Com- pletion, the owner will have tha burtlen ot provin e n tlia not buiitl or Im- r vB fo� tlte Purpose of sale). I, as owne� of the Oroperty, am ex sively n[ra ng with licensetl ton- rac or5fo construc[ the project 1 ctl 046, sines ntl Profe55ions Cotle: Tne ContradoYz License Ldw d 5 Of pply an ne� of p�operty who builtlz or imP�oves thereon, an h co tracts or su projects with a con- tractor(s) �ice�ze purzuant to t t tor's cen LawJ. 1 am aware that proot of the�r Worker's Comp nsura ultl �e provitletl to me. ❑� I am exert�Pi u�tle� Section B. R P. C. for [hi5 reaso0 Date _aZ�• I M1ereby cer<if� Information is antl state Iaws sentatives oi � Inspectlan pu< < Signature D�ivets' LiceqSe CMF 0865-46, reV. 1 i5 applic on antl State that the abov¢ mply with 11 tlty a�tl county ortlinances construction, and hareby authorize repre= upon Ihe abova-mentionetl yroperty fo� � 2� 4s� I�'�p'�Yrt� P�- 87 I V..� �..., TYPE OFCONSTRUCTION LJ NEW AOD ALTE ATION REPAIR ' ❑ CONVERSION ❑ DEMOLISH ❑ OTHER DESCRIPTjQfyO� WORK OF BLDG. 't.�'t-L��'T--�ri—�-1...�. TVPE OF PERMIT RADING LJ FOVNDATION �❑ STRUCTURAL TENANT � LECTRICA PLUMBING ❑ MECHANICAL OTHER P OJECT DESCRIPTION Sq. FT. oCCUCAN2G V CONSTRUCTION TVPE VAIUATION $ �'DU.O'� ZONE � GRADING CV.YOS. ACRES Remarks: .r�0 l. K' _ R'f �� i�'16 N-' R1.iC_ Id/I?/(/ Sink Preventer Irrigation Bathtubs Drinking Fountains ' Floor Dreins � Floar S"inks Gas Service Outlets Kitchen Sink �- Lavatories . P-Trap Roof DreinS Feinspection Fee $15 8oiler Duct - Under Ground DuC[ - StfuGtufdl �uct - Ventilating Exhaust System ❑ Multiple Firepl/Fact. Blt. ICBO # Heating System & Ductiog ❑0-100,000 BTU 0100,000 -- uaia�� +c _ Reinspection Fee $15 WM1ite - Bu�ltling; Canary - qpplicanh Pink - Accounfin9; Goltlenrotl - Assessor Showers Service Sink Sewer Cap Sewer Connection Solar C011ectors Solar 'pi Solar T k Swimmin Pool w Urinal Water Clo � Water Heate Water Service � Auto-Wash luue Fee Hood or Typel ❑ Canopy Type I I ❑ Refrigeration System ❑0-100,OOOBTU ❑700,000 System Repair/Alteration Fire Dampers Regiscers Issue Fee FEES A.P. �W p1 — S Main Building: E T Front B Rear A C Right S eft Ping. Ref. # Planning Notes: Aummatic Washer COnscruction PoleSub.. Cookin9 Unit Dishwasher � Dryers ❑Gas ❑Elect� Fan F.A.U. Fixtures Device Boxes Outlets Switches Garbage Dispoul Generator �65 KW �! 7791 �/I3/97 Zone Accessory Parking Req./Provided '0� .Y 1 1/Y 1 A — ELECTRICAL � Transtormer ❑ 15-50 KW ❑ 50+KW Meter ❑up to 100 amps Meter �over 100 amps Sub Panel Motors � 0.1 HP � 1%- 8 � IncSolar �9-15 HP �16-15+ Mittowave Pole Light Range 5KW Trash Compactor 36oB0 T� I FEES Z O N I N G R E � M T S $ 3 I �- Reinspection Fee $15 Issue Fee $ 3 FEES �DEVELOPMENTSERVICESREQUIREMEN7:9y) {�, ^ t� / 2 � 2onin9 APProved 6y �L.Xi% ��C�X' ti• Date�'!. / ��J Buildin9 APProved BY � � Date_ `}�.�yt� Annl:nnfinn leu�ad Rv � �� $ 3 SUMMARV OF FEES BUILDING PERMIT $ 22.0 h SMIP q • 5 0 PLAN CHECK $ _!� �.,p PERMIT � PLUMBING $ ISSUANCE S PLAN CHECK 25% $ ENERGY P.C. $ ELECTRICAL $ - GRADING $ PLAN CHECK 50% $ MICROFILM $ MECHANICAL $ TOTALFEE 5 ��,�D PIAN 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. Steel Reinforcement 3. Electrical Conduit Utility-Undrgrnd. 54. Forms 4. Electrical Conduit-Undrgrnd. 55. Electrical Bonding 5. Steel Reinforcement , � 56. Rough Plumbing & Pressure.Test � 6. Electrical UFER Grnd. 57. APPROVAL TO COVER-GUNITE _ � 7. Footings gT��(, j.� g ��' 58. Electrical Conduit-Undrgrnd. - 8. Foundation 59. Gas Pipe, � Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P-Trep, � Undrgrnd. � 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62.. Backwash & Receptor-Final 12. Sewer Cap �63. Heater & Vent-Final 13. Roof Drains 64. Plumbing System - Final ' � 14. Rough Plumbing � 65. Electrical-Final 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough Electric Wiring - 67. Fencing & Access Approval � � 17. Rough Wiring Sign 68. APPROVED FOR PLASTERING 18. Rough Electrical-T Bar Ceiling 69. POOL/SPA SYSTEMS FINAL 19. Rough Heating & Air Conditioning FIRE DEPT. REQUIREMENT 20. Rough Factory Fireplace APPROVALS Permit# _ 21. Ducts, in Structure 70. Underground Hydro n 22. Ducts, Ventilating 71. Prod�ict Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test r' 72. Underground Flush 24. Roof Framing �;' -�� .73. Undergrnd.StorageTank �Gas ❑Oil - u 25. Roof Sheathing 74.bverhead 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 ' - i 32. Electriral Power Meter�Final 80. FOOD CERTIFICATE ISSUED � 33. Final Electric Notes: , 34. Final Heating & Air Conditioning ,L7 ��,u�'� � 35. Final Gas Pipe-Test - 36, Hood or Canopy . �� 37. Final Factory Fireplace � 36. Final Plumbing ;� 39.' Water Service-Final , � 40. Gas Service-Final " � 41. Solar pomesticFinal � � • � 42. Backflow Preventer � .` . 43. Backflow Irrigation _ � � 44. Landscape.lrrigation System ' ' 45. Sound Attenuation ' � . �. � 46. �I-landicap Regulations ,� �I r, , � 47. FINAL STRUCTURE & BUIIDING � .� � • -. ; � 48. Speci9l Requirements Completed � � � � ' " 49. Electrie Release to Edison . � '> =- 50. Gas Release to Southern California Gas Co r. � 51. CERTIFICATE OF OCCUPANCY ,�t • /`� ' No. Date y � CITY O F COSTA Project Address _ .-� Addreu CTION PERMIT i Applicant�iil'in all soaees except tnose within heavy boraer Iines ana si9n all aooropriate eeclarations. PriG �lN�l� I i% I�ni7Yb'lfflGls .M2T tii R7 UNITNO�. Qwner'sName UCIUCf"6'LY_IIIIaIill '�Phone VY`�—JAVu Address �m1ne � . ' � ArchlEng. �c��likHh%i LicenseNo. � � Addreu ��" ��✓�,� . ' Canvactor's Name N�N � �' ' •Phone Addreulmailing) ��' ' Ciry Licenu No. LICENSED CONTRACTOR DECLARATION '. � . ' 1 nereby aftirm that I am II<anietl untlar provl5ion5 of Charter 9(commencing with soction 7000) o/ Divislon 3 0l Ihp Bu57ness anU Profesiions Cotlo,�antl my Iicansa is in tull force antl eflect. ,. , Llcenm Class License No. Date Signafuro WORKERS' COMPENSATION DECIARATION ' � hcreby atfirm that 1 havp a CerOficate ot COnsent l0 SelNniura or a car[itiwte �1 WOrk¢ri' CompensaliOn Iniu�anto, O� e certHlotl CODY tnereof.(Section � 3800, Lab. C.� . Policy No. '- � Company � ' BC¢rti(letl copy is �erebyJurnlShetl. - � . , Certlfietl copy I5 Iiletl with tho city Builtlin9 Divlslon. ' Dala Applitant � EXEMPTION FROM WORKERS' COMVENSATION DECLARATION " (Tblz zuc[ion neetl not Ce�<ompletec�il the pe�mit Is tOr one bUntl�aC (5100) Or'. less). . I cortify that in the pertormanco of tha wark for whi<h tnis oermitii issuetl, I Sllall nOt Bmploy any pertOn In any mdnn¢r So,-as t0 bBtomB subject to Ih0 . Workers' CompensaUon Laws oNCalifomia. , . Date Si9naturn NOTICE: If, after making this tletlaration, you shoultl becomo sub�ect to the Workers' CompensstlOn DrovlsionT Of the Labar COGe, you must tOrlhwlth Comply wlth Sutn proviSiOnS ar Ihis Oarmil s�all ba deamotl revokeG. CONSTRUCTION LENDING AGENCV 1 hereby at(irm lhat there is a tonstruct(on Iantling agency for the parformanco of tne work for .Which this permit is issuetl (Sectlon 3097 pv. CJ Lentler's Name Lentler's Aaaress OWNER BUILDER OECLARATION � Ihe ContrdttOf'S LIC¢n5¢ Ldw fOr th8 rss antl Professional Cotle: Any city or ruct. alter. Imorove. tlemalish or reoah also ia.a oy any appucan� �or a permit su alty of not more Iban iivn huntlreG tlollars 1, az OwnCr ot Ih¢ prope�ty o� my Cml ipensatlon, will Oo t�0 wOrk, antl the stn Sale (Sectlon ]044, BusVness antl Prole en50 Law tloes not apply to an owner oi a reon, dn0 who tloes Suctt wotk him5¢If/h or tnat he/she is exempt Any vlolation of 5ection (h9 apD��cant (O� a Clvil 1. witn wages as their sole 5 not Intendatl or ottereC e� �oloy ees, provlaea that such improvements ara noi �mm�aea or orrerea ror sdte. If, howeve�, [be Dulltling or improvemont is so10 wlthln one year o1 Com- D�etion, lb0 OwnCr wlll have [ha bUrtlen Of p�oving he/zM1e Gitl nat builtl Or im- �rove for tne purpose of sale). I, as owner oi the property, am excluslvely contracting wit� Iicensetl ton- tractor5l0 ConStruct ttle project (SeGllOn ]044, Bu5Ine55 and Profe55Io05 COtlB: T�o Contractar's Liconse Law does not apply to an ownor of property who builGs or improvas lhereon, antl who contractz for su<h pro7ects with a con- tractor�sl Ilcense pyrsudnl t0 th0 Cont�actOr's Licnnso Law). I am awaro tnat prOOt O( tnelr Workar's Compu��,{Ipn Insurance shoultl Ue provlUotl to mo. ❑ 1 am exempt untler Settion ��`f B. & P. C. for thls rcason� Date �-1�—Fjb Owner I hereby ttrtity tnat I have rcatl Ihls aoolicatlon antl state tnat thn abovo t I ano siace wws r i un sen[atives of tn II ' InSpCction purp Signatute Drivers' License or 55 CMF OB65�46, rev. ]0/84 Whito - aTYVEOPCONSTRUCTION VStINEW LI ADD LI ALTERATION LI REPAIR ❑ COfJVER510N ❑ DEMOLISH ❑ OT ER �OESCRIPTION OF WORK/USE OF BLDG. �etai 1Ce l\T _ �i \/ TVPE OF PERMIT GRADING . ❑ TENANT ❑ ELECTRICAL O OTHER PR0.IECT DESCRIPTIO� '� CONSTRVCTION TVPE �L N VALUATION S GRADINGCV.VDS. A< FOUN�ATION Ad STRUCTURAI LVMBING ❑ MECHANICAL Ramarks: �/ � � "C,O � 4�L • P.C'__-t-r� 4- PI Bar Sink Backflow Preventer Backflow Irriqatian rinking Founteins loor Drains loor Sinks asService Outlets �terceptors � itchen Sink -- . Rooi Drains ' ' , Reinspection Fee $15 Uuct � Untler Ground Duct -SlrucWral Duct - Ventilating Exhaust System ❑ Multiple Firepl/Fac[. Blt. ICBO 51E Heating System & Ducting 00�100,000 BTU 0100,000 Reinspection Fee � S15 Applitant; Plnk - A<COuntlng; Goltlenrotl - Asseisor Show¢rs • Service Sink Sewer Cap Sewer Connection Solar Solar Solar T Urinal Wacer ' Water Isue Fee iANICAL Hoad or Typel ❑ Canopy Type I I ❑ Retrigeration System ❑aioo,000aru ❑ioo,000 System Repair/Alteretian Fire Dampers Registers laue Fee FEES A.P. # �'p25 ' S Main Building: E T Front� A Rear ` C Right C K g Left � Ping. Ref. 5f`- Planninp Notes: Auromatic Washer Construction Pole Sub. � CAoking Uni[ � Dishwasher � � Dryen OGas ❑Electric Fen F.A.U. 3493 9/19J86 Zone Acteswry Building: P ing Req.IProvided ELECTRICAL Transformer ❑ 15-50 KW ❑50+KW Meter �up to 100 amps Meter �over 100 amps Device Boxes Outlets Switches � - Garbage Dispoul Generator �65 KW �St5 KW $� Reinspection Fee $15 FEES DEV ELOPMENT SERVICES REQI Zonine APDroved By� Building Approved By APoliotion lauad Bv $ 3 Sub Panel MororsQO1 HPO1Y,-B Inc. Solar 09-75 HP 01G15+ Mitrowave � Pole Li9ht . . Range,' , � Standing Sections.�� T�ash Compactor � . Issue Fee 856.40. TL FEES $ 3 Z O N I N G R E Q M T S S�FEES • / BUILDING PERMIT $ � SMIP $ 1 b.�� p ,P�AN CHECK $ � • � -PERMIT . PLUMBING $ �SSUANCE $ PLAN CHECK 25% $ ENERG� P.C. 5 \ELECTRICAL § GRADING $ P LA P1 C �K MECHANICIYI PLAN CHECK 5� g MICROFILM $, -� $ TOTAL FEE �$ 25% �CONSTRUCTION AND PLANNING POOL $ SPA . � ` Date Ins ector APPROVALS Permit # P 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-Undr9rnd. 54. Forms 4. Electrical Conduit-Undrgrnd. �$6 p 55. Electrical Bonding . 5. Steel Reinforcement 56. Rough Plumbing & Pressure Test 6. Electrical UFER Grnd. (. '� � Q 57. APPROVALTO COVER-GUNITE ' 7. Footings '`S�� L��(� �ki 58. ElectricalConduit-Undrgrnd. 8. Foundation � . 59. Gas Pipe, O Undrgrnd., Test 9. Water Pipe-Undrgrnd. 60. Backwash Lines, P�Trep, O Undrgrnd. 10. Structural Floor System 61. APPROVAL TO DECK 11. Property Sewer Line & House Connection 62. Backwash & Receptor-Final 12. Sewer Cap 63. Heater & Vent-Final . 13. Roof Drains 64. Plumbing System - Final 14. Rough Plumbing 65. Electrical-Final ' 15. Rough Electrical-Conduit 66. Solar System-Final 16. Rough 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 Conditionin9 FIRE DEPT. REQUIREMENT � 20. Rough Factory Fireplace APPROVALS� Permit # _ 21. Ducts, in Structure 70. Underground Hydro 22. Ducts, Ventilating ' 71. Product Piping O Gas ❑ Oil 23. Gas Pipe-Rough & Test . 72. Underground Flush �.. 24. Roof Framing � 73. Undergrnd�. Storage 7ank 0 Gas ❑ Oil �'�+aa > 25. Roof Sheathing � O�- 74. Over ad Hydro 26. T-Bar Ceiling (Structural) & Monocoat (� I p�� 75. Dry Chemical 27. Frame and Flashing 7 p� 76. Dry Standpipe � . 28. Lathing & Siding (,� g Q(� 77. FIXED SYSTEM FINAL 29. Insulation �Q 82 �' 78. FiRE PREV. FINAL ' 30. Drywall Nailing � HEALTH DEPT. REQUIREMENT 37. Plaster Brown Coat � Q^'t Q�- 79. FINAL INSPECTION - 32. Electrical Power Meter-Final 80. FOOD CERTIFICATE �SSUED 33. Final Electric Notes: %� /� � (,�,�� .,,) f�2 �K � 34. Final Heating & Air Conditioning � s p �� ,� w D 35. Final Gas Pipe-Test �` 36. Hood or Canopy 37. Final Factory Fireplace � OF /� �i(,Qy� t_p<.0 ��y�ii ��i'�� 38. Final Plumbing � � 06� � Za� �:�� 39. WaterService-Final , /L Q�L'�C .��k � 40. Gas Service�Final �` dK � �� (�i a 41. Solar pomestic-Final �2 �. p� � ,j�� 42. Backflow Preventer � eq �f,..OL� a(�- 43. Backflow Irrigation yj ?�` �d WX.�/�� . 44. Landscape Irrigation System 45. Sound Attenuation � - 46. Handicap Reguiations 1 47. FINALSTRUCTURE & BUILDING �_ � 48. Special Requirements Completed Z& : 49. Electric Release to Edison � ' i' 50. Gas Release to Southern California Gas Co '`: 51. CERTIFICATE OF OCCUPANCY ' . • No. ' Date . � . ,� ^ �' �. ta 1liesa Baildirig Dep� ent , P. O. Box 317 1 4 �� COSTA MESA, CALIFORNIA fUR APPLICANT TO FILL IN Build(ng Addrcsa . 17th St. Costa Mesa, California Nearest Crass St Tu.at{ n Av. Don Huddleston 191 E. 17th St. Costa Mesa No�' LI OI' I_ir._ � APP)LIC��.'ION FOR PL+`�LMIT ' BUILDING � � t FOIi OFFICE USE ONLY f� Receipt No. /P/ermlt No. T 7� � Received by � Date Redd. � Dah leaued Costa Mesa, California Nearest Crass SL Zone„ r � No.oT � Type � Date New or Dike & Cole Pove y'Lr "G 4615 � No. 419 E. 17th St. Costa Mesa tion I No. ls � I Block � Tr �' Metes and Bounds) / / % "' ��(� ^ /.. � 0. of Bldgs � 50 x 330 I Nowon Lot 2 No.oi No.of Bldg. OffSC9 Famillea Roor,�n Line Trom Rear Vard ta�...� �7CfJltl e�aev�.a a3� Addition I E Demolish I . �% d a .. lii OST.a ti!ES4 nG DEf-1'. Slze��7��3��7C��—OnRooms 3 Stories 1 Exterior Wail Roof •ering Stucco Covering Comp. i� AppROVALS ,e oi New Offiee � Foundation Location Inspecto� Building Forms, Materlals, 5 Q /�%S $� (J= undervPlnning Frame: Fire Stops, Bracfng, Bolts I hemby acknowledge that I have read this Applicatlon and state that the abwe Is rnrreM and agree to comply �ath. Int wlth all CIty Onlinances and State Laws regulating bullding rnnstructlon. Lath. Ext S�anatureof DIKE AND OOLEGROVE Permittee Plaster,lnt AuthoAzed Aai Plaster. Ext Valuatlon Permit Fee $ /p � Plan Check $ s — $ •`�j � � y' Totai /�S _ . _ _ _ . _ _ _ _ ' ' ' Fee 0 � � Z D A r 7 ! � L �1 � u C • u � _ d J o a a` � a Eui riuq qR 4E P�a:P SED � �AAD�` io►l � �XiSriN . OFF��E �� Street � - PLOT PLAN 8how location and dislances irom w property Ilne and between buildinpa � e. ; � � c: �: 1 �S � r� a � 4 � 64 -; . . ' , r� 6; ° : 1"_;`' -� ... �-'.'